Healing process of torn human anterior cruciate ligament (ACL) was studied histologically. Torn anterior cruciate ligaments were obtained from 21 patients at primary ACL reconstruction and stained with hematoxylin and eosin. Patients age was from 16 to 40 years. The interval between initial injury and operation ranged from 2 to 30 days. At 2 days after ACL injury, fibroblasts were not seen in the torn ligament and lymphocytes appeared in the injured ligament. Although vascular endothelial capillary buds and fibroblasts appeared around the torn ligament at 11 days, few fibroblasts were seen in it. At 30 days, torn ligament shrank macroscopically and resembled scar tissue with irregular alignment of fibroblast and collagen fiber. In conclusion, torn ligament is not healed probably due to few fibroblasts proliferation.
Thirty-seven patients who were treated by anterior cruciate ligament reconstruction with Leeds-Keio artificial ligament, were available for analysis. The average age was 28.9 years and the follow-up period ranged from one to five years with an average of three years. Seven patients were operated on by open method and thirty by arthroscopic. Post-operative infection occurred in two cases and in one patient, the ligament had to be removed. The post-operative arthroscopy showed scar formation around the ligament in ten out of eighteen cases. The rupture of the ligament was observed in two cases. Clinical evaluation revealed excellent in 54.8%, good in 12.9%, fair in 3.2% and poor in 29.0% by J. O. A. score system for ligament injury. These results suggest that the indication of this ligament should be made more carefully because the long-term durability is not confirmed.
The usefulness of the artificial ligament for ACL reconstruction is not still definite because of various reasons such as its strength, stress shielding, wear particles. We tried the ACL reconstruction using Dacron artificial ligament augmented by iliotibial band and retinaculum in 17 patients. But in 4 cases we had to remove artificial ligament because of tears (3 cases) and hydrarthrosis (1 case). The average period from the time of operation to the remofal was 20 months. We examined removed artificial ligaments histologically, in these 4 cases and got the results that there was no formati on of the new ligament but there was a remarkable foreign body response. Since we had to remove 4 artificial ligaments from 17 cases, Dacron artificial ligament may have a problem in affinity to the tissue for a longer period. It is necessary to think more about the patient's activity, and we must be careful in using artificial ligament for ACL reconstruction.
Fifty-five knee arthroplasties wiht Miller/Galante porous knee prosthersis were evaluated clinically. The mean age was 66.4 years (range, 36-81 years). The mean follow-up was 2.8 years (0.5-4.1 years). Osteoarthritis was a diagnosis in 28 knees, rheumatoid arthritis in 27. The knee score based on Hospital for Special Surgery knee arthroplasty rating system was 83.2 in osteoarthritis and 66.8 in rheumatoid arthritis postoperatively. Complications occurred in 7 cases. Of these, 3 cases were loosening, 2 cases were wear, 2 cases were patella dislocation. Reoperation was necessary for both 1 cases of patella dislocation.
Sixty-seven patients had double-stay reconstruction using iliotibial tract for anterior cruciate ligament (ACL) injury. Thirty patients were evaluated at least 2 years postoperatively to assess the results and ability to return to sports. Follow-up study consisted of an interview, clinical and radiological examinations. In 28 patients the complaint of giving way completely disappeared and in 2 patients they had experienced it several times during sports. N-test was negative in 26 patients and trace or apprehension in 4 patients. To evaluate the instability in flexion, anterior drawer rate (ADR) was measured radiologically by a mid-point measurement method. The difference in ADR between the reconstructed and healthy knee was less than 5% in 20 patients. The range of motion was full or nearly full in all of patients. Fifteen patients showed wasting of the thigh more than 1cm measured at 10cm above the proximal pole of the patella. Sports activity improved significantly and 90% of the patients returned to the sports. In conclusion, the results of double-stay reconstruction using iliotibial tract for ACL injury was satisfactory.
The weakness of the thigh muscle is one of the most troublesome procblem after reconstrution of the anterior cruciate ligament (ACL). To reveal the progressive change of circumference of thigh and strengh of thigh muscles after the reconstruction of ACL, 40 patients with a minimal interval after the operation of one year were examined in this study. The cicumference of thigh at the point located 10cm above the upper pole of the patella and peak torque of the quaduiceps and hamstring on the Cybex II isokinetic dynamometer were measured and non-operated leg were calculated. The difference in circumference of thigh was maximal at the time of 12 weeks after the operetion, and gradually became smaller after then. At the time of one year after the operation, the difference in circumference of thigh was greater and strength ratios of both quadricps and hamstring were lower than those seen preoperatively. Although they became equal to preoperative value at the time of two years after the operation, the circumference of thigh and srength of quadriceps and hamstribg in the operated leg were still smaller than those in non-operated leg.
We experienced a case of a synovial osteochodromatosis which completely occupied the knee joint cavity. The patient was 28 years old woman. The synovial osteochondromatosis was composed of hundreds of brilliant white loose bodies. The synovia included cartilage foci. The loose bodies were removed and the synovia was partially excised. At present, recurrence is not recognised and the function of the knee is good.
A case of the idiopathic osteonecrosis of the medial tibial plateau was reported. A 61-year-old male had sudden onset of severe knee pain with typical findings of Stage 3 necrosis according to the Koshio's classification on radiographs The patient obtained good results from curettage, bone graft and high tibial osteotomy. The etiology, diagnosis and treatment of this case were discussed with some references.
A 19 year-old male who had avascular necrosis in lateral condyle of the right femur with multiple epiphyseal dysplasia as well as flattening of the fourth lumbar vertebra was presented. Although the height was normal, the limbs were short. Three of his five siblings were also atypical epiphyseal dysplasia. Fairbank (1947) described 20 cases of multiple epiphyseal dysplasia (MED) with the triad of dwarfism, stubby digits, dysplasia of epiphysis inherited by autosomal dominant trait. However, Ribbing (1955) reported arypical type of MED characterized by avascular necrosis of middle phalanx, osteochondritis dissecans, multiple flattening of spine, flattening of femoral heads, normal stature inherited by autosomal recessive trait. Our case representing avascular necrosis of lateral femoral condyle, flattening of femoral and humeral heads, flattening of lumbal spine was diagnosed as Ribbing type MED. There are a few reports describing MED with avascular necrosis of femoral head or osteochondritis dissecans of knee joint. However, no case of avascular necrosis of femoral chondyle has been reported. Histologically, osseous avascular necrosis with empyt lacunae was demonstrated by the specimen biopsied at the time of surgery. So, our case is supposedly a rare type of MED with avascular necrosis in femoral condyle described by Ribbing.
Rosenberg et al. reported that the 45-degree flexion weight-bearing radiograph (Rosenberg view) was useful in gonoarthritic patients. The purpose of this study is to determine whether Rosenberg view will be useful for diagnosis of meniscal injury. 27 patients who had torn menisci without severe cartilage damage were used for this study (lateral: 16, medial: 12). Six patients without any abnormality in the knee joint were used for control. We measured width of each joint space and calculated as affective/non-affective ratio at both extension and Rosenberg views. On extension weight-bearing radiographs, the ratio was not significantly different compared with control (p>0.1). In Rosenberg view, however, it was significantly lowere than control (p<0.05). In Rosenberg view, decrease in meniscal thickness resulted in joint space narrowing. This view was considered to be useful for patients wiht torn menisci.
To assess the effect of non-patellar resurfacing in M/G TKA, 14 knees were evaluated in 13 patients (OA, 9 knees; RA, 5 knees). The average of follow-up periods was 11.5 months ranging from 2 months to 44 months. All patients had no complaints around the patella postoperatively. Postoperative skyline view roentgenograms showed lateral protrusion of the patella in all patients. It was considered that these protrusions were resulted from small femoral components compared to the patella. Partial destruction of the patella may occur in the case of severe lateral protrusion. In the case of non-patellar resurfacing, it is important to examine not only the soft tissue balance around the patella but the congruity of shape and size between patellar and femoral component. If good conguruity is not obtained, the patella should be resurfaced.
129 knees treated between 1982 and 1989 had several cementless total knee arthroplasties (TKR) with or without patellar resurfacing. 110 knees in 84 osteoarthritis (OA) patients and 19 knees in 14 rheumatoid arthritis (RA) patients had 14 Ceramic (KOM-1), 6 Whiteside OrthoLoc, 43 PCA (porous-coated anatomical), and 66M/G (Miller/Garante) knees. They were followed for a period more than a year (average; 35.4 months) and assessed using The Hospital for Special Surgery scoring system (Insall 1976). Almost all patients had a satisfactory result. But, three tibial component loosenings, three tibial component subsidences, a fracture of patellar component, a severe instability of the joint and a late infection were included in this series, and four of these patients had a revisional surgery. Cementless TKR needs a good quality of bone and a precise osteotomy. If these conditions are satisfied, this type of TKR will yield a long-term satisfactory result.
We evaluated clinically the results of 7 patients (14 joints) operated on for bilateral ostedo-arthritic knee joints. All patients underwent total knee replacement (TKR) on one side and high tibial osteotomy (HTO) on the other. The results were as follows; there was no difference between the two in terms of the degree of pain and the capacity of going up and down stair based on the criteria of osteo-arthritic knee joint. Bilateral knee joints respectively decreased the range of motion after these operations, in particular, the TKR decreased excessively, (mean, 28 degress). On the overall score, mean post-operative one was increased in comparison with the pre-operative one, namely 50 to 80 for the TKR side and 52 to 88.6 for the other side. These data suggest that dissatisfaction of the patients on the post-operative function of the knee is not at the joint with HTO but at the other.
We have operated on patients complaining of severe knee joint dysfunction (52 joints) from osteo-arthritic changes using Okayama University type (Mark II) or over 5 years. And Post-operative knee function is evaluated clinically and roentgenologically in 12 patients (13 joints). Results are as follows: femoro-tibial angle (170°-177°), medial tibial angle (85°-90°), posterior tibial angle (82°-90°), and clinical evalution is good. In spite of clinically good function, sinking of the tibial component is shown roentgenologically in only one patient (1 joint).
Kumamoto University Knee Brace is used postoperatively to stabilize the anterior cruciate ligament (ACL) reconstructed knee. This brace is consisted of a shell brace, pads and aderotation strap. To evaluate the stabillizing effect of Kumamoto University Knee Brace to control the anterior tibial displacement, 10 knees of chronic ACL injury were examined by using Knee Laxity Tester at 20° of flexion and 20 pounds of force. The mean value of anterior laxity of the injured knees which fitted in the shell brace with pads was smaller than that of normal knees. The stabilizing effect of Kumamoto University Knee Brace was equally good in comparison with the braces of which efficacy had been reported.
Post-traumatic false aneurysms of the foot are not seen frequently. Recently we experienced one case of an 8 years old boy, who was injured in his left foot sole by a sharp piece of glass, and the skin was sutured as an initial treatment. Twelve days and 22 days after the accident, bleeding from the wound was observed, and then a pulsating mass was present on that region. Suspecting the false aneurysm, he was advised to visit our hospital. In the lateral side of the foot sole, there was a wound of which shape was like a character “V” of its one side about 2.5cm and the laceration edge was slightly opened. On physical examination a pulsating mass was noted in the proximal side of the wound. At the time of operation, between the tear edges of the plantar aponeurosis, an aneurysm of the lateral plantar artery was found and was resected without vascular reconstruction. Recovery was uneventful. The histological examination showed a false aneurysm because the wall of the aneurysm was not stained purple black with the Elastica Van-Gieson's stain. If there is sufficient space in the foot to form hematoma, which results from disruption of an arterial wall, especially a longitudinal tear of the artery, and from recurrence of bleeding, the development of a false aneurysm will often occur. So we concluded that it is important to ascertain the injured artery and to do an appropriate treatment for it initially.
A case of successful transfers of the medial plantar F-C sensory flap was reported. A 31-year-old male sustained multiple digit injuries after electric burn to his both hands. We employed medial plantar F-C sensory flaps for coverage of the skin defect of the left big toe after a wrap around flap transfer to the left thumb and for replacement of a scarred pulp and volar skin of the right long finger. A big toe is a very useful donor site for a flap reconstruction of a thumb or finger pulp. However, the donor site morbidity is not negligible. A medial plantar F-C sensory flap may solve this problem.
Spontaneus ruptures of quadriceps tendons have recently been reported in patients with chronic renal failure maintained on hemodialysis. We reported such three cases. Operative findings and histological examination of these three cases showed that the area of tendon rupture was located in the fibrocartilaginous junction between tendon and bone. We suppose the cause of this rupture may be the fragility of the enthesis, derived from the disturbance of calcium metabolism.
Idiopathic humerus varus is a rare disease, and little is known about the etiology. We had a case of humerus varus with excess of external rotation of shoulder joint, and underwent internal rotational osteotomy of humerus. The result of the surgical procedure was satisfactory in obtaining functional improvement.
We present two cases of bilateral simultaneous rupture of the quadricps tendon associated with chronic haemodialysis. In both cases, rupture was complete and a small flake of bone was found to be avulsed from the upper pole of the patella.
Twelve patients wiht surgically proved lumbar disc herniation over 70 years of age were studied clinically, and compared with younger patients (20-39y. o.). Pain of the low back region and lower limbs was more severe, and gait was disturbed worse than in younger patients. The surgical recovery rates of low back pain score and gait score wete good, but those of sensory disturbance score and M. M. T. score were bad.
Three hundred cases of lumbar disc herniation treated by Love's operation without fusion were reviewed. Clinical evalution above 50% was obtained in 253 cases (84.1%). Low back pain, leg pain and gait disturbance were well improved. Recovery of SLR test and muscle weakess was good, but sensory disturbance and low back pain remained. Relation between type of disc herniation and clinical result was not significantly found. Reoperation was done in 18 cases (6%). Long-term clinical results were good.
Eighty-two patients underwent discectomy for herniated nucleus pulposus between 1985 and 1989. Of these, 49 patients were diagnosed having a ruptured disc herniation. All ruptured disc herniations were removed from the posterior approach without fusion. The average improvement rate by the Japanese Orthopedic Association Score was 79.7%. We consider the surgical treatment should be done as early as possible after clinical and imaging assessment of ruptured disc herniation. This attributes a good result.
Twenty-four patients operated for lumber disc herniation and five patients treated with chymopapain injection were studied to evaluate the effectiveness of magnetic resonance (MR) imaging in investigating postoperative disc degeneration and disc herniation. After operation in 9 patients compressed dura was present, after chymopapain injection in one patient. After operation in 6 patients the progress of disc degenerati on waspresent. In patients with chemonucleolysis changes of MR findings correlated histological reports, which may show the reconstruction of disc, while postoperative MR findings and clinical findings did not correlate.
Percutaneous discectomy is a new method for lumbar disc herniation that replaces traditional surgical treatment. This procedure is simple, safe and only slightly invasive since it causes no direct damage to the dura or nerve roots. For this technique, we develope a nucleotome probe with a rotating electric shaver (3mm in diameter) and applied it to 119 patients with disc herniation who had not been relieved of sciatica in spite of conservative treatment. The result is evaluated as effective in 95 patients (79.8%) with excellent results in patients with protrusion or prolapse type herniation and slight disc degeneration. We presume from the findings of MRI that the pain relief is achieved by the reduction of the herniated disc resulting in decompression of the nerve root.
The purpose of this paper was to describe the therapeutic effect of nerve root infiltration for lumbar disc herniation. 108 patients diagnosed as lumbar disc herniation, who underwent nerve root infiltration, were divided into two groups, conservative and operative groups. The results were as follows. 1) We can expect the good therapeutic effect of nerve root infiltration for older patients who are slightly possitive in SLR test. 2) We can predict the therapeutic effect at the time of 24 hours after the 1st nerve root infiltratioln.
The results of surgical treatment of lumbar disc herniation performed from Dec, 1986 to July, 1990 were evaluated in 37 patients. (1) The improvenent of JOA score, (2) the return to work and (3) the contents of patients were used for the evaluation. The results were as follows; 1: In the postoperative results and the safety, the microscopic operation was better than other operative methods for lumbar disc herniaton. 2: The methods of our exercise was effective for lumbago after microscopic surgery.
Recently, various operative procedures for lumbar disc herniation have been developed. The purpose of this paper is to evaluate operative results in various procedures for the condition and to show to chose the operative procedure. One hundred patients were studied. Male cases were 73 and femal, 27. Age ranged from 15 to 74 years with an average of 41 years. Duration of follow-up time averaged 2.8 years. We used 4 kinds of operative procedure; partial laminectomy, osteoplastic laminectomy, microdiscectomy and Caspar procedure. We evaluated the clinical results using the Japanese Orthopedic Association scores. Each procedure had good results. The important factor which indicates the choice of procedure is deciding which method will remove the disc herniation safely and completely. Provided that this is the objective, any procedure can be utilized. The other important factor in deciding the operative procedure is the keeping of the operative invasion as small as possible. Bearing these factors in mind, we found that the Casper procedure for ordinary disc herniation was the most suitable. For extraferminal disc herniation we chose the osteoplastic laminectomy.
78 cases of lumbar disc herniation treated by Love's operation and Love's operation with postern-lateral fusion were reviewed. The age range was from 17 to 70 years old (average 37.1 years old). The follow-up term ranged from 3.2 years to 12.5 years with an average of 7.3 years. 47% of the patients had herniation of the disc between the 4th and 5th lumbar vertebrae, whereas 44% had between the 5th lumbar vertebrae and the 1st sacrum. The average improvement rate by the JOA score was 80%. Sciatica and Lasegue sign were more improvable than other symptoms.
From January, 1984 to June, 1990, surgical treatment of the lumbar herniated disk by disk excision and posterior lumbar interbody fusion was performed in 33 consecutive patients by us at the Department of Orthopedic Surgery, Fukuoka City Hospital. Posterior lumbar interbody fusion has been used in conjunction with segmental spine plates (developed by Arthur. D. Steffee) by using transpedicular screw fixation to enhance the osteosynthesis and success rate of interbody fusion. Indicatons for this procedure are spinal instability in a laborer, alignment disorder of the lumbar spine, and recurrent herniated disk of the lumbar spine. The present study indicates that this method of treatment is recommended to improve overall results for properly selected patients.
Lumbar disc herniation in aged patients is relatively rare. Eighteen cases of lumbar disc herniation over 60 years of age treated by Love's operation were evaluated. Pre-operative clinical findings were relatively severe. All patients complained of lumbago and pain of the lower extremity. The average improvement rate by the Japanese Orthopaedic Association Score was 62 percent.
Surgically treated lumbar disc herniations are 1747 cases for the past 13 years. Of these 161 cases (anterior approach; 100, posterior approach; 61) passed over 10 years after surgery were clinically investigated. The results are as follows; According to the postoperative evaluation using the JOA score, the results were, in anterior approah, Excellent: 69%, Good: 24%, Fair: 6%, Poor: 1%, and in posterior approach, E: 63.9% G: 23%, F: 13.1%, P: O. From these dresults, anterior approach was better than posterior approach. On the other hand, the degree of self-satisfaction was better in posterior approach. It seems to be a cause that in anterior approach, lots of cases were heavy wokers.
We reperted long-term result of ten patients diagnosed atlant-axial rotator fixation (AARF), who were treated conser atively or operatively. This report included seven males and three females, three to ten years-old (avarage age 7.4 years). This petiod of follow up was 2 months to 9 years (average 2.6 years). All patioents had torticollis, painful neck and limit of motion. They were diagnosed by clinical, the plain roentgenography and computed tomography in neural position. Gulison or skull traction were done in all patients. In six patients conservative therapy had performed, and in four had operated. Six performed conservatively were asymptomatic and had normal reange of motion. Only one in them remained slightly rotatory deformity on CT. Four done operatively remained mildtorticollis and small limit of motion, and rotatory deformity, but disturbanceof ADL were none.
Two cases of cervical intervertebral disc calcification in children are presented. Case 1: A 13-year-old boy landed on the back of his head and complained of neck pain from the next day. Physical examination revealed only tenderness around spinal process of C7. There were no abnormal neurological signs. Cervical spine radiographs identified calcification at the C4-C5 interspace. Symptom resolved spontaneously in a few days and the calcification disappeared 22 months later. Case 2: A 10-year-old boy visited our clinic complaining of a stiff neck and neck pain without trauma. Positive physical findings were limitation of neck motion and radiating pain toward left scapula region. Cervical spine radiograps identified calcification at the C6-C7 interspace. Three weeks later he was completely free of symptoms with antiinflammatory drug and calcification showed partial resolution.
Since 1984 operative treatment was performed in 80 patients of cervical myelopathy Kurokawa's method of cervical canal enlargement. There were cervical spondylotic myelopathy in 45 patients and OPLL in 35 patients. Clinical evaluation above 50% was obtained in 50 cases (63%). There was no significant difference in the recovery rate between segmental fusion and long fusion. Roentgenologically, 21 patients (34%) showed postoperative decrease in lordosis.
Four cases of anterior decompression and fusion for the OPLL in cervical spine and reported here. The indication of anterior approach is the ossification in two spinal bodies or disc herniation between the ossifications. One of the problems of this method is its difficulties in the technique, and the other is the necessity of modification for fixation of grafted bone. Although these cases had some troubles in grafted bone, each patient obtained good results with no neurlogical deficit.
In order to investigate the participation of cevical disc degeneration in the ossification of the posterior longitudinal ligament [OPLL], we studied cervical disc degeneration of 40 patients of OPLL (33 males, 7 females; average age, 54 years). By disc index in plain roentgenogram, cervical disc degeneration of OPLL patients was examined comparatively with the patients of cervical spondylotic myelopathy [CSM] (30 malesa, 10 females; average age, 56 years) and controls (40 males, 40 females; average age, 26 years). Furthermore by magnetic resonance imaging, the degree of disc degeneration and the shape of extruded disc of OPLL patients was studied in comparison with CSM patients. Cervical disc degeneration of OPLL patients occurs frequently in association wiht location of ossification. The degree of the disc degeneration of OPLL patients is moderate, and much different from the degree of osteoathritis with severly narrow disc space, or typical disc herniation extruded throughout posterior longitudinal ligament.
In this report, we proposed an amended evaluation system of cervical spondylotic myelopathy, to discuss (consider) problems of the score system of the Japanese Orthopaedic Association. The main Points are as follows. 1) The total score is 100 points: 30 points for the function of up-per limbs, 30 for the function of lower limbs, 20 for sensory, and 20 for the function of the bladdar. 2) Sensory and mortor functions of extremities and estimated on either side. 3) The ability of the gait is estimated to be divided into 11 classes, from impossibility of the gait to normal gait. 4) The function of the upper limb is estimated to be diveded into 3 parts; shoulder, elbow and finger.
Cervical angina, resembling true angina pectoris, but resulting from cervical spondylosis and nerve root compression, is also known as pseudoangina. 8 patients with cervical angina were evaluated from 1986 to 1990. Patients included 2 men and 6 women, ranged from 35 to 68 years of age, averaging 50.6 years of age. Of these 4 were treated surgically, and resulted in complete relief of complaints and the other 4 patients were treated conservatively, 2 were relieved complaints and 2 were treated continuously. It may be concluded that the pathophysiologic mechanism of cervical angina is related with C7 root and sympathetic nerve system.
An evaluation system for finger function in cervical myelopathy is presented. The system was achieved through the technique of multivariate analysis of 115 tests data of a total of 103 cervical myelopathy cases, which were obtained from 64 cervical myelopathy cases pre-operatively and/or post-operatively. Finger function can be evaluated simply and quantitatively by the system.
The cervical radiographs of 70 patients on hemodialysis were studied wiht reference to DSA. There were 40 males and 30 females, with a mean age and duration of hemodialysis of 56 and 9.2 years respectively. DSA of cervical spine was found in 7 patients. The occurrence of DSA was not correlated with the mean age and the duration of hemodialysis. The value of β2-microglobulin of all patients was significantly high. We speculated that DSA is a subtype of systemic amylod osteoarthropathy.
The Coerel-Dubousset instrumentation is reported to give a correction of vertebral rotation and reduction in the cosmetic rib hump deformity. The Patients with idiopathic scoliosis were analyzed to evaluate the extent of correction of the vertebral rotation by this instrumentation. Each patients was assessed by standard radiographs and CT slice was made through the apical vertebra. The frontal plane upper curve correction averaged 63%, and thoracic kyphosis changed from an average of 15.2° to 23°. The mean preoperative apical vertebral rotation was 19.9° and postoperatively it was 15.7°. The average rotational change was 4.5°, or 21.1%.
Magnetic resonance imaging (MRI) was performed on 18 patients with acute cervical cord injury using T2-weighted images of a 1.0-T magnet. Three different types of MRI signal patterns were detected in association with these cervical cord injuries. A classification was developed using these three patterns. Type I, seen in six patients, demonstrated a low signal intensity consistent with acute intraspinal hemorrhage. Type II, seen in seven patients, demonstrated a high signal intensity consistent with acute cord edema. Thpe III, seen in five patients, demonstrated no abnormal signal intensity. Type I patterns showed complete quadriplegia except for one and no improvement in their Frankel classification. In comparison, Type II and III patterns improved at least one Frankel classification. MR at 1.0T in extremely useful in the diagnosis of acute cord injury and also demonstrates potential in predicting neurologic recovery.
Magnetic resonance imaging of 66 cervical OPLL patients (50 males, 16 females) were reviewed. It has been reported that MRI of OPLL was low signal epidural lesion on T1- and T2-weighted images, but we identified almost 30% of our cases to have high signal intensity area. In addition, hypertrophy of posterior longitudinal ligament were recognized in 12 cases (18%), which compressed dural sac or spinal cord.
Operated herniated nucleus pulposus in lumbar spine was compared to preoperative findings of magnetic resonance imaging. Thirty-five cases were studied. Types of hernia were classified in T2 weigted sagittal images. Ruptures of the posterior longitudinal ligament were indicated in T1 weighted images, its accuracy being 91%, T1 weighed transverse images showed th dorsal root ganglion clearly. MRI was useful not only for detecting the mass of hernia but also for considering the roots in lumbar disc hernia.
The diagnostic value of MRI for lumbar disk herniation was investigated retrospectively. The midline sagittal T1-weighted images were classified into four grades according to the morphology of the intervertebral disks and the condition of the dural tube. Grade 3 and 4 were subdivided according to the presence of the continguous epidural fat and compression of the dural tube (Takagi's classification). MRI findings of 92 patients with lumbar disk herniatin were compared with operative findings. On the results of intraoperative findings of the 92 patients, the incidence of consistency was 91.7%. In the grade 4, showing segmentation in the posterior disk, the consistency rate was high at 100%. In the patients with sciatica, myelography and the other images become unnecessary when the midline sagittal image demonstrates grade 3-B or 4 in the single level, and such findings were consistent with the affected side on the parasagittal or axial images.
We studied the correlation between MRI findings of the patients with low back pain and the assesment score after Japanese Orthopaedic Association. There were significant correlation among number of degenerated disc, herniated disc and displacement of epidural fat on MRI and the score.
In twenty-one patients with lumbar disc herniation, myelography, CTM and magnetic resonance imaging (MRI) were examined to determine the positional relation between the herniated disc and the nerve root. The location of the herniated disc was classifed into five types according to classification described by Tsuji. At present, we conclude that the combination of myelography and CTM is more useful than MRI to determine the positional relation between the herniated disc and the nerve root.
Ganglion cysts are common lesions about the hand and wrist, but can also be found in other locations on rare occasions. We recently had a case of an intraspinal ganglion cyst that was successfully removed. We reviewed a total of 26 cases from the world literature and discussed the clinical presentations, findings, etiology, and the findings of X-ray, Myelogram, CT, and MRI of these cases.
A case of Schwannoma of the left L4 root was reported. The patient was a 60-year-old male. Hemilaminectomy, excision of the tumor and posterolateral fusion were performed with excellent results. CT and MRI were useful for diagnosis of this disorder.