Six cases of acute isolated posterior cruciated ligament (PCL) injuries were treated nonoperatively. They were mobilized with a functional knee brace at 3 weeks after immobilization in full extension. Magnetic resonance imaging and posterior stress radiography were performed at the time of injury and 6 months later. On the posterior stress radiographs at follow-up, all patients showed increasing stability compared to the time of injury (rangel-7mm). In all patients, the MR images of PCL had demonstrated a high intensity area on midsubstance at the time of injury, and this had decreased in intensity over the following 6 months. One case decreased in intensity to become like intact PCL, three cases decreased moderately and two cases only slightly decreased in intensity. This study suggested that the acute isolated PCL injury may acquire static stability without surgery.
We treated one case of parellar ligament rupture with STATAK soft tissue attachment device. The patient, a 50-year-old man fell from a height of 4 to 5m and injured his left knee joint. A rupture of the patellar ligament was diagnosed and five days later we operated on him, suturing the patellar ligament using STATAK. Three months after surgery, the patient had a good range of motion and is now able to work well without any complaint. The operation using STATAK was a good method because it enabled us to easily suture soft tissue such as a ligamentand tend on at the bone in a narrow operating field in a short time.
Traumatic dislocation of the knee joint is rare, but we report our experience with eight cases. Six of the patients were assessed by questionnaire on their subjective symptoms. Four patients were treated surgically, the other two received conservative management. The average age of the patients was sixty years. We evaluated their walking ability, pain, swelling, straight sitting, knee instability, walking up and down stairs, giving way, and activity of daily living. One patient was evaluated as achieving an “excellent” outcome, and all the others were ranked as “good”. There were no clear differences fourd between the results of the surgical treatment group and the conservative treatment group.
Numerous surgical methods have been described for correction of dislocation of the patella. We have treated ten patients with patellar dislocation and evaluated various operative methods used. Dislocation of the patella is classified as congenital, permanent or recurrent type. In all either the etiology is thought to be due to a lateral shift of the quadriceps muscle. It is possible to treat the congenital type with both closed manipulation and casting. In the recurrent type, the quadriceps muscle slightly shifts to the lateral side therefore making transposition of the tibial tubercle taking the patellar ligament medially necessary for recovery. The permanent type is residual to the congenital type, associated with a severe lateral shift of the quadriceps muscle. It is necessary to treat this type with not only transposition of the tibial tubercle moving the patellar ligament medially but also reefing of the fascia of the Vastus Medialis and Rectus Femoris muscles. Treatment of patellar dislocation aims at correcting the lateral shift of the quadriceps muscle. We suggest that surgical procedures which sacrifice muscles are not recommended.
The results of treatment of patellar fractures with the Herbert Screw were reviewed retrospectively to clarify the usefulness of this screw. Three patients had open reduction and internal fixation with the screw. The other two patients were established non-unions of the patella, so they had bone-grafting with internal fixation. None of the patients required external fixation after surgery and knee exercises were encouraged as soon as possible. Three fractures healed primarily and all of these three achieved a painless knee which had a full range-of-motion. Both cases of non-union achieved a solid union clinically as well as radiologically. By using guide wires and X-ray images, this screw could be driven safely and accurately, and bone fragments could be fixed solidly. In addition, as they were buried in the bones, no irritable symptoms caused by screw heads developed after surgery and therefore removal of the screw was not required in any cases. However this screw could not be used for comminuted fractures of the patella.
We reviewed the use of two kinds of suture applied in the treatment of 25 patellar fractures, Polyesterbraided (15 cases) and Tekmiron (10 cases). Results were assessed as good or excellent in 80% of cases. All cases except those with complications of isolateral extremities were judged as achievirg good or excellent results. Patients ranged in age from 15 to 81 years (mean; 47.2 years). The length of follow-up ranged from 6 to 38 months with a mean period of 16 months. Osteosynthesis using polyesterbraided sutures were effective for fractures of the distal end of the patella. Tekmiron, which has no effect on X-ray nor MRI, is strong enough to replace stainless wire and is expected to be a useful material for osteosynthesis. The advantage of this method is that there is no need to extract the suture.
We report three cases of osteochondral patellar fractures in children. In all cases a medial parapatella incision was used and no ruptures of the medial extensor apparatus were found. Osteochondral fractures were located in the lower half of the medial facet of the patella and the size of these fragments was nearly the same, measuring 2.0×1.5×0.5cm. Osteochondral fragments were reduced and fixed with cross wire tightening over the patellar dorsal surface. The medial capsular tissues were implicated when the wound was closed. Primary fracture union was achieved and two of the cases have returned to sporting activities. We concluded that these fractures were caused by lateral displacement and rapid spontaneous reduction of the patella associated with hypermobility with no rupture on the medial extensor apparatus.
We reviewed the post-operative course of 48 cases of hip fractures treated by Ti-CHS fixation. Follow-up period ranged from 1.5 months to 53 months (mean; 27 months). Seven cases developed complications related to the operation: two nonunlons, one osteonecrosis, one plate separation from the femoral shaft, one penetration of the lag screw, one fracture around the hole of the lag screw and one case of excessive telescoping. Among the patients who had been able to walk before fracture, 70% improved enough to be able to walk independently after discharge. One-year mortality was 18.8%.
Triangular crossed pinning is a method of biomechanical internal fixation for pertrochanteric fractures of the femur using M. K. pins, which are inserted along the compression and tensile trabeculae of the femoral neck. The operative procedure is simple and surgical intervention is small so that even elderly and risky patients can be treated by this method. The method of operation and clinical course are presented in detail.
We report nine elderly cases with delayed union and non-union of fractures of the femoral neck, whom we treated at out hospital during the period, April 1990 to August 1992. The main factor related to the delayed union and non-union and the functional prognosis of this disorder were most related to general complications. Prognoses were satisfactory as close watch was kept against complications. Elderly cases with non-union can preserve activity of daily living to a certain extent.
We report a case with a rare complication of intertrochantric fracture. A 74-year-old woman sustained an injury by slipping on the road. Conservative treatment was carried out for two months, but bone union was not obtained. She then presented to our hospital with continuous left hip pain. Osteosynthesis was performed for the intertrochanteric fracture of the femur using a Captured Hip Screw. Three months postoperatively, bone-union was obtained and the patient returned home pain-free. However one month later, she developed pain in her left hip. Roentgenographs showed a subcapital femoral fracture on the same side. Prosthetic replacement was performed after removement of C. H. S. and she was discharged two months after surgery. We report on the roentgenographic changes.
A 35-year-old healthy female patient sustained an ipsilateral intracapsular fracture of the femoral neck and fracture of the femoral shaft in a car accident. This was successfully treated by DHS fixation. Four and a half years after the operation, DHS was removed, and a new subcapital fracture of the femoral neck was found by X-ray one week after surgery. This was treated by bone grafting to the bone cavity by removal of the lag screw, followed by triangular crossed MK. multiple pinning for the subcapital fracture. Favorable clinical results were achieved.
We treated 52 elderly patients with femoral neck fractures from 1988 to 1992, with closed reduction and multiple pinning performed in 27 of these patients. A new pool system, which we developed 4 years ago, was used in the postoperative management after multiple pinning. The system consists of a treadmill on the bottom of the small pool and a flow water circulating system. About two weeks after Surgery, patients started walking in the pool without the risk of full-weight-bearing, and there-fore avoided disuse muscle atrophy and complications associated with bed rest. Patients were willing to walk on the treadmill, because the pain was reduced in the heated pool and walking on it required less energy. There were no major complications after the early pool training.
Subtrochanteric fractures of the femur are sometimes difficult to immobilize because of the extraordinary stress on this area. Between 1986 and 1991, we experienced 58 fractures in 57 patients ranging from 17 to 94 years of age (mean; 58.1 years). The fractures were classified according to Seinsheiner as Type II A in 3 fractures and Type II B, Type II C, Type III A, Type III B, Type IV and Type V in 13 fractures, 11 fractures, 14 fractures, 2 fractures, 6 fractures and 9 fractures, respectively. All cases were treated by osteosynthesis, Ender nailing being carried out for 39 fractures (67%), and all fractures except one united successfully. Fractures in young patients with open reduction and anatomical fixation of the fragments obtained a good anatomical and functional result rather than blind intramedullary naling, while Ender nailing was considered to be more favorable in elderly patients and for comminuted fractures.
From 1987 to 1991, 43 fractures of the femoral shaft in 42 patients ranging in age from 17-74 years (mean; 25 years) were treated. All fractures were caused by high energy accidents. The fractures were classified according to Aoyagi as Type 1 (13 cases), Type 2 (14 cases), Type 3 (11 cases), Type 4 (2 cases) and Type 5 (3 cases). Bone healing was obtained in all cases except one (97.2%), despite a deep infection which occurred in one case. In 2 cases with floating knees and one case with a fracture near the knee slight limitation of knee motion remained. Shortening less than 1.5cm was detected in 3 cases and more than 2.5cm in 1 case. Breakage of the transverse screw occurred in 2 cases.
Eight cases with femoral non-union followed up for more than six months are reported. In four cases of non-union without infection, a plate or intramedullary rod was used to stabilize the femur and iliac bone grafting averaging 2.7cm was used to bridge the femoral defect after resecting sclerotic bone. In four infectious cases of non-union, segmental bone resection was done as a first stage surgery under external fixation of the femur in order to eliminate chronic femoral osteomyelitis. After four to six months following the first stage surgery, and after confirming the absence of infection, vascularized fibula graft (VFG) averaging 7cm was used to bridge the bone defect. In all cases without infection, primary femoral union was achieved within three months. Two cases of non-union treated with dual plating which enabled early knee joint motion by CPM achieved a satisfactory range of motion (0/125, 0/110 respectively). In the cases with infections non-union, recurrence of osteomyelitis was not seen. Three cases achieved primary bone union and the remaining case achieved union after additional bone grafting. In two cases treated with folded VFG earlier bone union and slightly better knee motion was achieved in comparison to those treated with single VFG.
Eighteen supracondylar fractures of the femur in sixteen patients have been treated at out hospital since 1982. These fractures were divided into the following groups according to Sunami's classification IIA (1 fracture), IIB (1 fracture), III (4 fractures), IVA (2 fractures) and IVB(10 fractures). The average follow-up period was four years and two months. Clinical results were evaluated using Neer's criteria with excellent and satisfactory results obtained in 83.3%. Male patients were younger than females and the results were good irrespective of the fracture type. Ender's intramedullary nailing was indicated for supracondylar fractures because it keeps the surrounding soft tissue intact. Factors which were associated with unsatisfactory results were elderly osteoporotic conditions (particularly female patients), severe complications, and delay in ROM exercises.
We treated 4 distal femoral shaft fractures, and 6 distal tibial shaft fractures with May plates in 6 men and 4 women. The average age was 58 years. According to our results, nine cases achieved excellent results. However there was one case of nonunion in which the desired compression of the fracture was not achieved. May plates are useful for obtaining anatomical alignment, and they provide stable fixation thereby allowing early mobilization. However compression of the fracture in not always achieved as the May plate is not a self compression type of plate and it has round holes. If theses disadvantages could be solved, the May plate would be more useful.
Four supracondylar and intercondylar fractures of the femur in eighteen patients were reduced and stabilized with extensive surgical approach techniques. The results were rated as excellent in two cases, satisfactory in one, and unsatisfactory in one. An extensive surgical exposure, accomaplished by elevation of the tibial tuberosity with the attached extensor mechanism, can facilitate the reduction and fixation of severely comminuted intra-articular fractures of the distal end of the femur.
We reported a case of a coronal fracture of the lateral femoral condyle. The patient, a 42-year-old male, injured his left knee in a motor cycle accident. Radiographic examination revaled a posterior dislocation of the knee with an osteochondral fragment of the lateral femoral condyle. We performed an open reduction and internal fixation with two cannulated Herbert bone screws which gave excellent fixation. Nine months after surgery, the patient had an excellent range of knee movement with a unied fracture. Cannulated Herbert bone screws seem to be a useful fixation device in treatment of this fracture.
Tibial condylar fractures were surgically treated in 28 patients. The cases consisted of 14 males and 14 females. Patients were classified according to Hohl as divided central depression in 2 cases, split depression in 10, total depression in 1, split in 4 and comminuted in 11. Injuries to the following soft tissues were also present, 4 lateral meniscus, 5 medial collateral ligament, 4 anterior cruciate ligament and 1 posterior cruciate ligament. Anatomic results were excellent in 12 cases, good in 14 and fair in 2. Functional results were excellent in 14 cases, good in 13 cases and fair in 1. Almost all results were judged as good or better, and were not related to the fracture, type, but were influenced by the accompanying soft tissue injuries.
Recently, the idea of minimal invasive surgery (MIS) has spread among surgeons, with attention focusing on Ender's nailing developed for treatment of tibial fractures. We developed the technique of driving the nail from the fractured side of the tibia, and reduction is achieved by intermedullalry packing pins which are driven from the opposite direction. If the fracture line involved the ankle or knee joint, we additionally used percutaneous fixation with screw or K-wire. In the case of open fractures we used Ender nailing after skin damage and infection had healed. We treated 43 tibial fractures from 1987 through 1992 all of which healed without infection or non-union.
Between 1986 and 1992 we surgically treated 64 patients (67 legs) with 114 tibial shaft fractures including tibial condyle fractures. Patients comprised 49 males and 15 females ranging in age from 16 to 79 years (mean; 45.1 years). The main instruments used for osteosynthesis were plates (K-U plate, Dupuis plate, May plate and T-buttress plate) and intramedullary nails (Küntscher type nail and Ender nail). Only plates were used in the upper third of the tibial shaft while in the middle and lower third, plates and intramedullary nails were used. In the upper third, the shortest period of weight bearing was observed in cases treated with anatomical plates (Dupuis and May plates). In the middle third, the longest period of bone union was in those who received K-U plates. In the lower third, the longest period of bone union was in those treated with Ender nails. In the upper third, anatomical bone plates and in the middle third, intramedullary nails provided good results. In the lower third, the use of Ender nailing depended on consideration being given to personal features.
Lateral subtalar dislocation is a rare injury resulting from forceful eversion of the foot. The frequency of an associated fracture is related to the type of dislocation, with lateral dislocations more often associated with fracture, and these tend more often to be open fractures. A case of lateral subtalar dislocation with open fractures was reported. The patient was an 83-year-old male who fell from a height of approximately two meters. Open reduction was performed and the foot immobilized in plaster for 4 weeks. Partial weight bearing started 6 weeks after the injury. Eight months after the injury, there were no severe complications and avascular necrosis of the talus.
Quantitative Computed Tomography (QCT) is popularly used for the diagnosis of vertebral osteoporosis. This study investigated the relationship between the diagnosis of fresh compression fractures in elderly patients with thoracolumbar spinal osteoporosis and bone mineral density (BMD) at QCT. We measured the QCT number in the vertebral bodies of 20 patients suspected as having fresh compression fractures of the thoracolumbar spine using CaCO3 phantom. In all vertebrae with fresh fractures, the QCT number was high in comparison with neighbouring vertebrae. The QCT number then was noted to decrease later on in the fractured decrepit vertebrae. QCT was a useful examination for judging whether vertebral fractures were new or old.
Spinal fractures in patients with osteoporosis frequently occur in the thoracolumbar region. Malunion or delayed union of the fracture causes continuous back pain or delayed paralysis. Proper treatment appeared to be beneficial for patients with osteoporosis, after assessing the state of the fracture by computed tomography. Spinal fractures can cause local kyphosis, and this can be corrected by spine corrective radiography. We studied the radiographs obtained by this method in 47 patients with thoracolumbar fractures. Contiguous vertebral deformity after an injury was able to distinguish between new and old fractures. During the healing process, corrective radiography showed the state of bony union. Patients satisfactorily corrected by our regimen of treatment gained good aligned body union. There were several advantages of this method, including ease of performing without requiring further equipment, easy diagnosis of new fractures, assessment of bony healing and instability of the fractured body.
It is suspected that an abnormality of gravity sway is involved in the etiology of idiopathic scoliosis. We evaluated 20 patients with idiopathic scoliosis using a gravicorder to assess their gravity sway. Gravity sways were recorded in the anteroposterior and lateral direction and assessed by autoregressive and component-wave analysis. Gravity sways were influenced by past sways for 250-270msec. The sway of idiopathic Scoliosis revealed significant differences in the anteroposterior direction.
3-D analysis has gained increasing interest in the study of scoliosis. The shape of the spinal column can be computed from AP and lateral radiographs with the top view providing specific information about the dimensions of the scoliotic spines. A vertical view of the thoraco-lumbar spine is symbolized by a graph of the vertical projection of the centers of the vertebral bodies on to the horizontal plane. An oblique top view is also obtained using the S1-T1 axis for projections instead of the vertical axis in order to avoid any distortion secondary to a S1-T1 imbalance. The spines are homogenized after surgery, with a better balance achieved between the shapes of the thoracic and the lumbar segments. The C-D. procedure results in sagittalization of the instrumented and non-instrumented segments of the spine.
Twenty-three patients were treated with spinal instrumentation from January 1983 to July 1992. Patients comprised 15 males and 8 females with a mean age of 37 years (range; 12 to 79 years). Subjects had 12 spinal injuries, 4 spinal deformities, 3 spinal tumors, 3 degenerative disorders, and 1 ossification of the yellow ligament. The following four types of instruments were used: Harrington instrumentations in 13 cases (Distraction system: 10, Compression system: 3), CD systems in 7 cases, 1 Luque system, 2 ISOLA systems. Instrumentation failure occured in four cases two of which were reoperafed upon.
We investigated the clinical results and progress in ossification in 52 patients with cervical OPLL who underwent expansive laminoplasty using sagittal splitting of the spinous process (Kurokawa's method) since 1984. There were 47 patients with cervical myelopathy, and 5 patients with spinal cord injuries with a mean age of 61 years. The operative results were evaluated according to the Japanese Orthopaedic Association (JOA) score, after a mean follow-up period of 2 years and 11 months. The overall mean recovery rate by JOA score was 48.8%. A recovery rate of 50% and over was achieved in 26 patients(51.1%) of 47 myelopathy patients. The recovery rate was significantly higher in patients of less than 2 years disease duration than patients with a disease duration of 2 years and over. Progressive OPLL was seen in 21 patients(40.4%). In 9 patients with over 5 years follow-up, progressive OPLL was seen in 5 patients (55.6%). There was no significant difference in recovery rate between progressive OPLL patients and non-pogressive patients.
Severe cervical myelopathy cases sometimes require combined anterior and posterior approaches to achieve circumferential decompression of the spinal cord. When complete decompression was desired, we used a one-stage procedure comprising bilateral open laminoplasty and anterior decompression with body fusion. This procedure was used in two patients who suffered from cervical canal stenosis associated with disc herniation. In both cases, there were no blood transfusions or complications. The one-stage procedure offers several advantages over the staged procedure, including the requirement of only one operation and anesthetization, leading to fewer days spent in the hospital. Furthermore, neurological improvement may be ameliorated, because complete decompression of the spinal cord is performed at once in the one-stage operation.
Radiographic changes after anterior body fusion of the cervical spine were analyzed in 51 cases with a mean follow-up period of 2.4 years. Thirty-five males and sixteen females were included. Lordosis was not related to the period of follow-up. Kyphosis tended to be reduced after cervical anterior body fusion. In the upper adjacent disc of the cervical spine, the disc height and range of motion tended to be greater than in the lower adjacent disc. In this study radiographic changes were not related to clinical findings.
We report on a 51-year-old man complaining of dysphagia that was caused by ossification of the anterior longitudinal ligament of the upper cervical spine. The ossification was extirpated using the transoral approach which was an easy and safe method. The patient's symptoms were completely relieved after the removal of the bony mass and surrounding fibrous soft tissue.
we report a case of a 67-year-old woman with kyphotic deformity of the lumbar spine due to tuberculous spondylitis, which she had suffered from twenty seven years previously. The patient complained of back pain and weakness of both legs. Thoracic myelopathy due to tuberculous spondylitis associated with ossification of the ligamentum flavum was diagnosed radiographically. She had a laminectomy from T11 to T12 and posterior fusion with Luque rod from T9 to L2. After surgery, symptoms improved and a good clinical result was achieved. Posterior decompression and fusion is a valid operative procedure for this pathology.
Calcification of the intervertebral disc in adults is not uncommon, and is usually asymptomatic. We reported a symptomatic case of thoracic intervertebral disc calcification in a 40-year-old man who complained of back pain. Calcification of the intervertebral disc was found roentgenographically between the ninth and tenth thoracic vertebrae. He was treated conservatively, and was symptom-free three months later, but the calcification still remains.
In order to evaluate spinal spasticity quantitively, we recorded the T waves of the patella tendon reflex following the Jendrassik manoeuvre and at rest, and measured the ratio of the amplitude of T wave (J/R ratio). The J/R ratio of 8 normal subjects ranged from 1.89 to 10.3 (mean: 4.60), and in 12 patients with spinal spasticity ranged from 1.0 to 1.88 (mean: 1.28). The more the spasticity increased, the closer to 1.0 the J/R ratio tended to be.
The function of sural nerve in 6 cases of myelopathy and in 15 cases of spinal cord injury was assessed by recording the amplitudes of sensory nerve action potentials (SNAPs) and conduction velocities. In 6 cases of myelopathy and in 12 cases of spinal cord injury SNAPS were obtained. In all cases of myelopathy and in g cases of spinal cord injury the amplitude of sural SNAPS remained within the normal range. Sensory conduction velocities were generally normal when obtainable. If the amplitude of SNAPs are below the normal range in the cases of myelopathy or spinal cord injury, we have to consider the complication of the peripheral nerve damage.
We studied the EMG findings of 6 cases with severe motor disturbance due to cervical or lumbar radiculopathy. All cases were surgically treated. In two cases, preoperative manual muscle test revealed a level of zero. In one of those two cases, preoperative EMG showed muscle contraction. In the case whose preoperative EMG was silent, there was no change in the postoperative EMG. In the other 5 cases motor disturbance improved. EMG changes were recognized 2 days after the operation. It was concluded that EMG is a useful test in qualifying abnormalities when we treat patients with motor disturbances.
Calcified material taken from a seventy-year-old female patient with calcification in the ligamenta flava of the cervical spine was analyzed crystallographically and ultrastructurally by electron probe microanalyzer (EPMA). Rod-shaped crystals of 0.5-3μm in diameter were recognized on the upper side, and round shaped crystals of 1-7μm in diameter were found on the lower side of the ligament flava at the same intervertebral level. These crystals were identified as calcium pyrophosphate dihydrate and hydroxyapatite, respectively. At the transitional zone, each crystal coexisted individually in a mosaic pattern. No intermediate form of the crystal was noted. There is a possibility that both crystals coexist primarily, instead of a structural alteration of the crystals.
We evaluated the effects of etretinate therapy on the spinal ligaments of patients. Nine patients who were treated with etretinate for disorders of keratinization received radiographic evaluations. Five patients showed ossification of the cervical spinal ligament. We observed the patients who developed ossification within therapy. We suspect that ossification of the spinal ligament was etretinate induced.
We experienced 4 cases of spinal canal stenosis associated with achondroplasia. All were treated operatively. A 48-year-old woman who complained of quadriparesis had C1 laminectomy and C2-7 enlargement. After the opration, the patient's upper limb symptoms improved, but there was no change in her lower limb complaints. Therefore a Th10-12 laminectomy was carried out, but her symptoms still remained unchanged. Three other cases complained of lower leg numbness and intermittent claudication due to lumber canal stenosis. Two patients had L3-5 laminectomy and demonstrated some improvement. The other case had an L5 laminectomy and fenestration (L1/2, L2/3, L3/4) and improved immediately after operation. Since stenotic changes in achondroplasia were recognized in multilevels of hte spinal canal, the decision as to the decompressive site is critical.
A case of a 50-year-old man with a lumbar spinal epidural abscess is reported. MRI, myelography, and computed tomography myelography were useful in the diagnosis. Antimicrobial therapy was given and decompressive laminectomy of L1 to L4 performed with as much as possible of the pus and granulation tissue removed during the operation. Satisfactory neurological results were achieved. Spinal epidural abscess is an uncommon disease and the importance of a rapid diagnostic procedure and rapid surgical intervention is emphasized.
Magnetic resonance imaging (MRI) was used to evaluate the time course of a patient with anterior spinal artery syndrome. A 66-year-old woman presented with sudden onset of left scapular pain. Within a few hours, she developed paralysis of both upper extremities as well as loss of pain and temperature sensation below the T10 dermatome. A diagnosis of anterior spinal artery syndrome was made clinically. After 6 months of physical therapy, she regained a small amount of upper extremity strength but neurological deficits were otherwise unchanged. MRI obtained 1 and 7 days after onset showed a low intensity area on T1-weighted view and high intensity area on T2-weighted view in the cord at the level of C3-C6 and the images showed cord enlargement. One month after onset, the cord enlargement was decreased. MRI obtained 6 months after onset showed cord atrophy and a low intensity area on T1-weighted images and high intensity area at the same level on T2-weighted images at C4-C5 levels.
Since 1986, we have treated five cases of spinal epidural hematoma, all of which were examined with magnetic resonance imaging (MRI). Up till 4 days from onset, the hematoma was visualized as iso-intense on the T1-weighted view, although on the T2-weighted view various patterns were seen. Thirteen days after onset the lesion was iso-intense on the T1-weighted view, and of high intensity on the T2-weighted view. Eighty days after onset, the lesion was visualized as highintensity on T1 and T2-weighted views. The signal intensity of spinal epidural hematoma on MRI changes with time according to the metabolism of hemoglobin. We confirm that MRI is a useful examination for spinal epidural hematoma.
We report three cases of young patients with malignant tumors in the cervical spine who underwent decompression surgery. Case 1. A 16-year-old male was admitted to our hospital with progressive tetra-paresis and neck pain. Plain radiographs at C5 showed sclerosis. He underwent subtotal resection of the C5 body with fusion and radiotherapy. The histological diagnosis was Ewing's sarcoma. Case 2. A 19-year-old female was admitted with bilateral numbness in her upper extremities after a traffic accident. CT findings showed destruction at the C6 body and lamina. She underwent subtotal resection of C6 with anterior and posterior spinal fusion, radiotherapy and chemotherapy. The tentative histological diagnosis at surgery was chordoma. However, the autopsy results showed metastatic thyroid cancer. Case 3. A 25-year-old male was admitted with severe neck pain and progressive tetraparesis. Plain radiographs and CT findings showed destruction at the C3 body. The spinal cord at C3/4 was compressed by an anterior mass, on MRI. The treatment was similar to that for Case 2. The histological diagnosis was malignant meningioma. Both Cases 2 and 3 who underwent anterior and posterior spinal fusion, had a postoperative recovery period of 3 to 4 months without ADL disturbance. However all three cases died of multiple lung metastases within 1 year and 7 months after surgery.
We report a 17-year-old female who presented complaining of back pain. A mass, the size of 5cm×6cm was seen on the right laminae of Th5. The tumor had a radio-lucent area on X-P and a cystic lesion was seen on CT scanning. T1-weighted images showed high intensity and T2-weighted images were of high intensity in a low intensity area on MRI. On angiography, the mass was shown to be hypervascular. A pathological diagnosis of ‘Benign osteoblastoma’ was made.
Two cases of sacrococcygeal chordoma, were surgically treated in our hospital. One case was discovered after investigation of an episode of bruising on the hip, and the other case was diagnosed two years after the excision of rectal cancer that had no specific histological features. Both cases had partial destruction of sacral bone in the lateral plain X-ray film of the pelvis and a defined mass anterior to the lower sacrum was seen on MRI. We performed complete excision of tumor using the posterior approach and retained the unilateral S3 nerve. Postoperatively there was no neurological disturbance except the symptom of slight residual urine.
The growth patterns of sacral chordomas were studied in 4 cases by MRI before surgery. The size of the tumor in each patient was 6×6×6cm, 6×9×7cm, 9×7×6cm and 11×16×14cm, respectively. As the tumors increased in size, the structure of the sacrum was destroyed aggressively, and muscles such as gluteus maximus, piriformis and coccygeus were involved irregularly. However, only slight tumor invasion into the sacral spinal canal was seen in all cases. The rectal wall or the sacro-iliac joints were never involved. These results indicated that the growth patterns of sacral chordomas differed dependent upon the specific tissue surrounding the tumors.
A case of benign hemangioendothelioma which occurred in the thoracic spinal intradural-extramedullary region, and which caused a myelopathy is reported. Benign hemangioendothelioma rarely involves the spinal cord. MRI was very useful in making the diagnosis of the spinal cord tumor. We recommend early diagnosis and surgery in such cases due to the possibility of spinal cord obstruction developing due to compression and ischemia of the spinal cord. A good post-operative result was achieved.