We describe the results of conservative treatment using a Kyuro knee brace in 12 cases (6 males and 6 females, ranging in age from 6 to 64 years) who had fresh tears of their cruciate ligament. The treatment consisted of eary continuous passive knee motion with protective bracing for three months. The mean follow-up period after injury was 5 months. M R imaging at follow-up revealed two different modes of conjoining. Seven cases with ACL tears had successful results at 6 months. However one case with on ACL tear and plateau fracture did not achieve such successful results. Two cases with avulsion fractures of the PCL had successful results at 3 months. We believe that conservative treatment is effective for treating fresh tears of the cruciate ligament.
Functional knee-braces are widely used to protect injured or reconstructed anterior cruciate ligaments, despite the fact that few scientific data support their efficacy. We studied the effect of the tibial strap of the Don-Joy brace used for 17 knees with cruciate ligament insufficiency. Injuries included the following: 12 knees, PCL 5 knees. The F-scan force distribution measuring system was used for the evaluation, and involved inserting a sensor-sheet between the strap and the tibia. We then testod for the transition of forces in the gait cycle compared with normal gait. The strap forces increased in the stance phase during normal gait, although the transitional forces were small. We found that the functional knee-brace acted as a braking device for anterior posterior laxity of the tibia, but it did not go far enough. There is a current trend toward early postoperative mobilization and intensive rehabilitation after reconstruction of the cruciate ligament with a bone-patellar tendon-bone graft. In this situation the usefulness of braces must not be over inflated.
Seven cases (thirteen legs) of infantile severe bowleg were treated using foot appliances and shoe alterations with medial heightened wedge soles. Averge age of patients was 1.5 years (range, 1.3-1.8 years) at the begining of treatment. The patients used the orthosis for an average of 16 months (range, 10-23 months). Average follow-up period was 4.3 years. We used the femoro-tibial angle (FTA) and metaphyseal-diaphyseal angle (MDA) for radiographic evaluation. During the assessment no patients were found to have radiographic evidence of Blount disease. At the time of follow-up, no deformities or malalignment of the lower extremities were found and all patients obtained normal FTA and MDA. We consider this foot appliance to be useful and easy to use for patients in treating infantile severe bowlegs.
In 19 knees of 16 patients with Osgood-Schlatter disease, a separate ossicle was noted at the proximal aspect of the tibial tubercle. Between January 1984 and July 1996, we treated Osgood-Schlatter disease in 13 males and 3 females ranging in age from 12 to 17 years. The preoperative observation period ranged from 3 months to 3 years. Postoperative clinical findings were evaluated by Wray's method. Fifteen knees did not show symptoms (Excellent), while 4 knees occasionally showed mild pain (Good). Surgical excision is necessary to relieve the symptoms of Osgood-Schlatter disease involving a separate ossicle.
Forty three knees in thirty six patients over forty years of age that had arthroscopic meniscectomy were reviewed and their articular cartilage degeneration assessed according to the classification by Fujisawa. Sixteen knees of grade 0, 1 and 2 improved from a mean JOA score of 68.4±12.6 to 96.9±4.43, and all were satisfied with the results. Four of six grade 3 knees, and only seven of twenty one grade 4 and 5 knees were satisfied with the results. The factors affecting the results of meniscectomy in cases with grade 3, 4 and 5 cartilage degeneration need to be clarified.
Stress fractures of the lower limbs are a well-known entity to the orthopaedic surgeon. The most frequent locations are the tibia, fibula and metatarsals. However stress fractures of the patella are a rare injury. We describe a case of stress fracture of the patella in a 21-year-old hand-ball player who had been followed up for three years with a diagnosis of jumper's knee. Our case revealed a non displaced fracture of the distal portion of the patella. We operated on the patient due to his desire for an early return to playing sports. Five months after surgery, the patient had no problems with his knee function and had recovered his previous level as a hand-ball player.
We report a thirty year-old man who presented with a locked knee caused by both type D medial plica and partial tear of the anterior cruciate ligament. He experienced pain in the left lateral side of his femoro-tibial joint and his range of motion was limited from -10 degree to 130 degree. Preoperative diagnosis was a lateral meniscus tear. Arthroscopic examination revealed that the torn type D plica had impinged on the medial femoral condyle and the knee was flexed by the partial tear of the ACL which had impinged on the intercondylar space there by blocking full extension. After arthroscopic resection of both lesions, the patient's symptoms diminished. The diagnostic difficulty of such a patient with a locked knee not caused by a meniscal injury are discussed.
We report the clinical study of 9 Judo players who had painful finger joints and complaints of difficulty in performing. There were 18 joints in all 16 of which (88.9%) had a history of trauma (ex. sprain and collateral ligament injury), but no history of fractures or dislocations. Instability of the joints was not found on clinical examination. Almost all players complained of a limitation in ROM and pain when they gripped a rival's sleeve with finger full flexion. X-ray examination of the finger joints revealed osteoarthritic changes in 15 joints (83.3%) and fragments in 7 joints (38.9%). No statistical differences were found in the techniques and experience between the 9 players and the other 11 players who had no finger complaints. The 2 joints with fragments had no history of trauma, therefore suggesting that they developed due to the distinctive overuse reaction in Judo.
Fifty patients with stress fractures occurring during sports activities were treated between 1989 and 1996. We assessed the sites of injury, sports specificity, relationship between sites and sports, the month of injury and the interval between the cessation of sports activities and the disappearance of symptoms. The predominant sites were tibia (48%), metatarsal bone (18%) and ribs (14%). Running was the major associated sport. 48% of patients were injured between April and June. The mean period until disappearance of symptoms was 9.1 weeks in the tibia, 6.7 weeks in the metatarsal bone and 6.4 weeks in ribs.
We carried out a questionnaire survery of running injuries occurring in the 8th Saiki Banjou Kenkou marathon competition. There were 201 runners, 173 men and 28 women with a mean age of 47 years. 67 runners had sustained running injuries, 48% of which were knee disorders. Training distance showed a strong association with knee disorders in this study. However there were numerous slight knee injuries occurring in subjects many times until recovery, compared with other non-knee injuries.
We examined the postoperative sports ability of patients with lumbar disc herniation who had been treated surgically. One hundred and forty three patients were treated by percutaneous discectomy (Group PD); 64 patients underwent laminotomy with discectomy (Group Love); and 15 had laminotomy and discetomy combined with posterolateral fusion (Group PLF). Forty five per cent of the Group Love patients and 56% of Group PLF returned to sports, although 39% of Group PD patients played sports at the final observation. However, 72% of the Group PD patients recovered their preoperative level of activity while 53% in Group Love and 40% in Group PLF resumed their original sports activity.
We studied 415 cases of ACL and 226 cases of ATF injuries in order to analyze the relationship between the causative incident and the patient's physical characteristics. We classified each case into two groups: contact or non-contact conditions. To study the physical characteristics we measured the tibial plateau angle and notch width index (NWI) of the knee and A-P mortice angle of the ankle on X-ray films and also the patient's joint laxity score. In the non-contact group of ACL injuries, the tibial plateau angle was greater (p<0.05 in male, p<0.01 in female), NWI was smaller (p<0.01 in male and female) and the joint laxity score was higher (p<0.05 in male, p<0.01 in female) than the control group. In the non-contact group of ATF injuries, the A-P mortice angle was smaller (p<0.01 in male, p<0.05 in female) and the joint laxity score was higher (p<0.05 in female) than the control group. In this study, it was suggested that knee and ankle shape and joint laxity were important factors in ACL and ATF injuries. To prevent ACL and ATF injuries, we recommend physical examination to help athletes understand the importance of these physical characteristics.
A 26 year-old right-handed, female golf player complained of pain in the right wrist during play and triggering at the wrist, when the fingers were extended. Surgery revealed the cause to be flexor tenosynovitis after overuse of the wrist and fingers. After division of the transverse carpal ligament and tenosynovectomy. She had no symptoms and returned to Golf.
We report a rare case of a suspected stress fracture of the sternum. A 14 year-old male, baseball player had acute anterior chest pain after performing trunk stretching exercises. For several days he was not able to play baseball, so consulted a private orthopaedic hospital. Pathologic findings were noted on the X-p film and the doctor advised him to visit our department. X-p images and Tomogram showed a transverse fracture in the sternum, and 3-D CT showed an irregular fracture line. We also suspected a bone, cyst and planned a biopsy. However the X-p, CT, and 3-D CT findings did'nt show typical signs of a bone cyst, and there were no reports of bone cyst in the previous literature, so we diagnosed it as a stress fracture and advised him to decrease his daily activity and stop playing baseball. He progressively improved over 3 to 4 months on our conservative management and then was able to return to playing baseball. Cases with these fractures are very rare with only a few reported in the literature.
The external variety of snapping hip is well known, but the internal variety is rare and poorly understood. We experienced a case of an internal variety of snapping hip in a young KARATE athlete. Iliopsoas bursography demonstrated that an iliopsoas tendon jerk on the iliopectineal eminence or the anterior capsule of the femoral head. It was effectively treated by partial release of the iliopsoas tendon.
Many authors have reported the usefulness of the drain clamp method when performing a cementless total knee arthroplasty. Clamped time (clamp-release-interval) is usually one hour, however the optimum clamped time is unclear. We compared a one hour clamped time group (30 cases, 37 knees) with 4 hours clamped time group (12 cases, 12 knees). Total blood loss was significantly less in the 4 hours clamped time group. (one hour clamped group; 720.2±261.7ml, 4 hours clamped group; 424.2±117.5ml: p<0.01) Postoperative decrease in hemoglobin and hematocrit levels was significantly less in the 4 hours clamped group than in the one hour clamped group. There were no complications associated with the drain clamp method in both groups.
In total knee arthroplasty, a posterior condylar line and so-called anterior-posterior axis are available to decide the rotational alignment of the femoral component. In this study, the reliability of these two axes was evaluated. We evaluated 84 knees (42 osteoarthritic knees in 40 patients and 40 normal knees in 40 volunteers). A computed tomography (CT) scan was taken at the level of the femoral epicondyle. On the CT image, the two axes and the epicondylar line were constructed on each image, and the relationship of the three axes was evaluated. The angle between the epicondylar and posterior axes was 5.8°±2.7° in the normal knees and 6.3°±2.1° in the osteoarthritic knees. The angle between the epicondylar axis and the perpendicular to the anteroposterior axis was 2.3°±3.1° in the normal knees and 0.6°±3.3° in the osteoarthritic knees. The posterior condylar axis was more reliable compared to the anteroposterior axis in the osteoarthritic knees.
The purpose of this study was to evaluate outcome of bilateral total knee arthroplasties (TKA's) in two groups of patients: Group A had simultaneous arthroplasty of both knees, and Group B had staged bilateral arthroplasty. Bilateral (TKA's) were performed in fifteen patients with severe rheumatoid arthritis (4 cases) and osteoarthritis (11 cases). Group A (8 patients) had both knees replaced simultaneously in one operation. Group B (7 patients) had two operation in a staged procedure. The postoperative mobility was analyzed in the two groups of patients who were similar with respect to age, type of arthritis, preoperative range of motion, and postoperative management. In this small series of cases there was a significantly shorter hospitalization period, and cheaper costs in Group A.
We clinically evaluated the result of 41 knees in 28 OA patients treated by MG I with MG II total knee systems. MG I were used in 11 knees (MG I group) and MG II were used in 30 knees (MG II group). The mean post-operative JOA score was 80.9 points for MG I and 80.8 points for MG II. There were two cases with patella component failure in MG I group. We found tibial component subsidence in 9.0% of MG I group and in 3.3% of MG II group. Femoral and tibial component placement in the two groups was good. Patella component placement of MG II group was good but that of MG I group was not good according to measurement of the tilting angle and lateral shift. Patella ligament-tibial shaft angle (a) of MG I group was significantly greater than that of the MG II group. It was supposed that PF joint pressure of MG I group was higher than that of MG II group by calculating sin 1/2(a+knee flexion angle). The reasons of patella component malalignment and PF joint high pressure were due to designs of femoral and patella components.
Thirty six knees in 30 patients treated by TKA with patellar resurfacing and 24 knees in 21 patients with patellar retention were clinically reviewed. 25 knees in 22 patients were rheumatoid arthritis, and 35 knees in 29 patients were osteoarthritis. The follow up period averaged 3 years. All patients were evaluated using the JOA score and Patellar score (Feller, 1996). In patients with osteoarthritis, there was no difference between the patellar resurfacing and retention group in clinical outcome. In patients with reumatoid arthritis, patellar resurfacing group had slightly better results than the retention group, but there was no difference between the two groups in activities of daily living. Radiographs showed no differences in prosthetic alignment and FTA. We did not find any significant benefit from resurfacing the patella during TKA in the medium term.
Eight knees with patellofemoral disorders following total knee arthroplasty had patellar revision surgery including proximal realignment of the extensor mechanism using the Insall procedure. The primary prosthesis was the Miller-Galante 1 (MG1) in seven knees and the Press Fit Condylar in one. Patellar dislocation occurred in three knees, patellar subluxation in two, patellar lateralization in two and patellar fractures in one. The MG1 prosthesis in four knees (2 subluxation and 2 lateralization), the metal-backed patellar implants failed because polyethylene wear or fracture exposed the metal backing. Revision of a failed patellar prosthesis is difficult. Complications occurred in three of the eight patients. There was a patellar fracture in two patients and patellar subluxation in one. With the current use of total condylar prosthesis that have improved design and instrumentation, patellofemoral complications following total knee arthroplasty can be best avoided by meticulous operative technique.
Twenty-nine cases with osteoarthritis of the knee joint were treated by high tibial osteotomy using the Giebel blade plate. All cases achieved bone union. Good clinical and radiological results were obtained. The average JOA score improved from 62.1 to 81.3, and the average femorotibial angle (FTA) was corrected from 181.7° to 166.2°. Giebel blade plate provided stable fixation which allowed early joint motion with relatively small invasion.
We reviewed 28 knees with osteoarthritis (femoro-tibial joint) who had undergone high tibial osteotomy (interlocking osteotomy). They were evaluated by arthroscopy before and after surgery. We graded the arthroscopic cartilage and meniscal findings according to Fujisawa's classification. We observed fibrous tissue growing over the ulcer of the medial cartilage. Several knees had fibrillation at the lateral cartilage, but had no symptoms. One medial and lateral meniscus had fibrillation.
We reviewed twenty-six patients who were operated on using a high tibial osteotomy due to medial osteoarthrosis of the knee. Seven cases were male and 19 female. At the time of operation, mean age was 63 years (range, 52 to 72 years), mean follow up period was 2 years and 9 months (range, 6 months to 9 years). Evaluation was carried according to the JOA score and single standing roentgenogram of the knee. Results were as followed; 1. 22 cases (77%) were good results. 2. Post operative FTA which was 169±3.4 degree. 3. Osteotomy degree was decided by Mikulicz line passed through mid portion of lateral joint line.
We review four cases who developed infection following insertion of continuous epidural anaesthesia for pain control. These infections included subcutaneous abscess, meningitis, epidural abscess, and pyogenic spond ylitis. High fever and pain were common symptoms at the onset of these infections. Two of these cases (epidural abscess and pyogenic spondylitis) necessitated surgical intervention. Neurological deficits with dural compression needs early surgical decompression.
Spinal epidural abscess is uncommon but it is important that it be recognized as it must be diagnosed immediately and managed appropriately to rescue patients from severe residual neurological disabilities. We report 2 cases of spinal epidural abscess with serial MRI images of the lesions and the postoperative complications. Case 1: A 65 year-old man was admitted with lumbago and pain over the left lower extremity. MRI revealed an epidural space occupying lesion (SQL) from L5 through to the sacrum with sacral osteomyelitis. An epidural abscess was confirmed at surgery, and a retroperitoneal abscess was a complication 2 months after the operation. Case 2: A 51 year-old woman was admitted complaining of severe lumbago, fever, paraparesis and acute urinary retention. MRI showed ventral epidural SOL from L3-L5, which was diagnosed as an epidural abscess at surgery. Suppurative spondylitis was reported a month after the operation, which was diagnosed through serial MRI scans. This lesion, again, completely disappeared clinically. We stress the importance of serial MRI examinations which enable the evaluation of inflammatory complications in the surrounding tissues following spinal epidural abscess.
A female aged 72 years, presented with a history of backache and weakness of the lower leg for 2 months. Sagittal MRI showed posterior extradural mass at Th4 level and CT showed destruction of the lamina at Th4. Gradually paralysis of the lower leg increased, so laminectomy of Th3-5 was performed 12 days after admission. A hard mass-like tumor with adhesion to the dura, and white pus was found at surgery. Pathology was tuberculosis, and acid-fastended bacteria were detected in the pus. Five months after the operation, the patient made a good neurological recovery and could walk with the aid of a cane.
A case of pyogenis spondylitis with respiratory quadriplesia is reported. MRI was helpful for diagnosis of C5/6 discitis and an epidural abscess that was disseminated from the C5/6 to C2/3 epidural spaces. 24 hours later, we operated on the patient with anterior decompression and an iliac bone graft. However respiratory quadriplesia was not recovered. The present case appeared to be caused by cord necrosis and myelomalacia with compression of the spinal cord (by an epidural abscess) and ischemic change to the cord.
A 64 year-old man was admitted to the Komonji Hospital with neck pain and vertigo following a fall from a motor bicycle. On admission he complained of continuous neck pain and then 3 days later, he suddenly complained of vertigo and left hemimotor disturbance. He then slowly developed dysphagia while the his consciousness level tended downward. CT scans repeated 4 days after admission, revealed hydrocephalus induced by left cerebellar infarcts. Anteroposterior and lateral angiograms revealed bilateral vertebral arteries to be occluded at the 5th cervical vertebral level. The patient underwent surgical exploration of the left vertebral artery which was shown to have a subintimal dissection of its cervical portion extending from the transverse foramen of C-6 to c-4. The arterial lumen was occluded with organized thrombus. A common carotid to vertebral artery bypass procedure was performed using a reversed saphena vein graft. The patient's dysphagia cleared and his motor disturbance improved. Postoperative angiogram 2 weeks after surgery revealed good patency of the intracranial basilar artery and the oppo site vertebral artery. Successful therapy of vertebral artery dissections has been severely limited by failure to recognize the problem. We believe that agressive surgical management of vertebral artery lesions, especially when flow in the contralateral vessel is reduced by hypoplasia, occlusion or stenosis should be performed.
Magnetic resonance (MR) imaging has been found useful, not only for the diagnosis, but also the healing of thoraco-lumbar vertebral fractures. Seven patients with nine vertebral fractures participated in the present study. MRI was conducted using a 1.5-T system (TOSHIBA MRT 200, Japan). T1-and T2-weighted images in the sagittal plane were obtained by spin echo (SE). Patient follow up data was entered on a chart for overall assessment (immediately, 1M, 3M, and 6M after trauma). The Marrow-contrast images proposed by Baker were used for retrospective evaluation and expressed as (signal intensity of the abnormal marrow)-(signal intensity of the normal marrow)/(signal intensity of the normal marrow). This parameter was useful for examining the T1-weighted images. However for healing, T2-weighted images are more important than T1-weighted images. Factors influencing the prognosis of thoraco-lumbar vertebral fractures were the particular region of the vertebral fracture, absence or presence of damage to the middle colomn, age and the bone mineral density.
We investigated the clinical results of surgical treatment for metastatic spinal tumors in 14 patients. The tumor involved the cervical spine in 3 cases, thoracic spine in 8, the lower thoracic and upper lumber spine in 3 and the lower lumber spine in 2 cases. There were 10 males and 4 famales. The average age at surgery was 59.2 years (37-78yrs.). Pre-operatively, the primary focus was unknown in 6 cases, thyroid in 2, prostate in 2, epipharynx in 2 and one each in breast and liver. In the cervical spine cases, curettage of the metastasis and anterior stabilization was performed in 2 cases and posterior stabilization in one case. Total en bloc spondylectomy of the 10th thoracic vertebra was performed in one case whose primary focus was the thyroid gland. Posterior stabilization in addition to decompressive laminectomy was performed in 9 cases of thoraco-lumber spine. Laminectomy alone was performed in 3 metastasis cases of the thoracic spine. Two cases of thyroid cancer and one case of breast cancer survived over 2 years. In 75% of patients, pain was relieved to a considerable extent, palsy was improved in 43% and increase in locomotion activity was seen in 42%.
We report two cases of aneurysmal bone cyst in the spine. Case 1: A 12 year-old female suffered from low back pain. CT and MRI scans demonstrated a balloon-like lesion in the 4th lumber spinal body and left lamina. Case 2: A 25 year-old female complained of neck pain and numbness of the left ring and little finger. Plain radiographs of the cervical spine revealed a compression fracture of the 7th cervical body and cystic lesion of 6th cervical body. CT and MRI scans demonstrated a balloon-like lesion in the body and right lamina of the 6th and 7th cervical spine. Under the microscope the tumor was resected and the spinal column reconstructed using instrumentation by the posterior approach. The tumor of the spinal body was then resected using the anterior approach surgically in both cases. A microscope was found to be useful for minimizing invasion of the nervous tissue and the vertebral artery.
Benign tumors of the spine are relatively infrequent. Five cases of primary benign tumors of the spine were operated on between 1984 and 1996. The ages of patients ranged from 11 to 17 years with an average of 13.4 years. The diagnosis was confirmed by radiography, computed tomography, and magnetic resonance imaging. Two patients had bladder dysfunction and required urgent surgery. The histological diagnoses were a giant-cell tumor, an osteoblastoma, an aneurysmal bone cyst and osteochondromas. Careful examination of the plain radiogram is the most important for finding primary spinal tumors.
We report two cases diagnosed as malignant vertebral tumor which were treafed by Total en bloc spondylectomy (TES). Patients complained of lumbago only and no abnormal neurological findings were reported. In the first case, the patient was a 36 year-old male. CT scan findings revealed a small space occupying lesion in the left side of the vertebral body. Percutaneous transpedicular biopsy confirmed a chondrosarcoma. TES was done using the posterior approach with a thread wire saw. Reconstruction was done with pedicle screwing and bone grafting. In the second case, the patient was a 49-year old female. MRI scanning reuealed a focal lesion developing over the bone edge on the right side of the vertebral body. According to the results of investigations, the patient was diagnosed as having breast cancer and metastatic vertebral tumor. Three weeks after total mastectomy, TES was done using the anterior and posterior approaches. Six months after surgery, both patients were symptom-free with no pain and the cage was not displaced radiographically. TES is now the best method for local radical resection but care needs to be taken when indicating this method for malignant vertebral tumors.
We reviewed 7 cases who underwent surgical intervention for dumb-bell tumors of the cervical spine. According to Eden's classification was one case there of type 2, five type 3, and one type 4. The type 2 case was operated on by both the posterior and anterior approach. All of the type 3 cases were operated on by the posterior approach alone. The type 4 case was operated on by the anterior approach. Pathological diagnoseis were all neurinoma except one case of malignant Schwannoma. To make an appropriate decision for the best surgical approach, it is very important to elucidate the localization of the tumor preoperatively using MRI, myelography, CTM, and angiography, etc. In this study, clinical results were gererally good, with only one case having a kyphotic deformity in the cervical spine postoperatively. In order to avoid postoperative kyphotic deformity, some kind of fusion technique should be added to the posterior approach.
Malignant Rhabdoid Tumor (MRT) is a rare neoplasm which usually arises from the kidney of infants. Extrarenal MRT is also known to occur in other organs or soft tissue. We report a case of retroperitoneal MRT which developed in the paravertebral region and invaded into the intrathecal sac through the intervertebral foramen. A twenty seven year old female who had developed severe sciatica ten months earlier was referred to our hospital. MR imaging disclosed no evidence of spinal tumor. Three months later, a mass in intrathecal sac at the level of L4/5 vertebra was seen. Postmyelogram CT scan revealed an intradural mass at the same level. Surgical treatment was performed to the intrathecal region. Histological and immunohistochemical examinations revealed is as MRT.
We experienced a relatively rare case of metastatic cauda equina tumor. The patient is a 76 year old man who presented with sphincter disturbance, pain and numbness from the gluteal region to the right thigh back, and digits of the right foot. On myelography, an intradural tumor, especially a neurinoma of the cauda equina was suspected. At surgery, the tumor was derived from the right S1 nerve root and adhered to the nerve root, so was not easily removed. The histopathological diagnosis of the tumor was adenocarcinoma. Chest CT and TBLB was performed and primary lung cancer was confirmed. We report on metastatic cauda equina tumors with a review of the literature.
Anterior interbody fusion, combined with cervical laminoplasty can be performed to treat cervical myelopathy in which severe anterior cord compression is caused by multiple stenotic lesions. This study demonstrated the new laminoplasty in which posterior spinal fusion was performed simultaneously, using our original hydroxyapatite spacer. Fourteen patients (mean age, 66.5 years) were operated on by the above-mentioned procedure; cases included nine cervical spondylotic myelopathy, four OPLL and one spinal cord injury. Two spacers were broken, two spacers loosened and two patients complained of transient upper extremity pain, but no neurological signs had deteriorated. Bone fusion was solid in 12 patients, except for two cases with broken spacers. CT demonstrated a better outcome of laminar fusion and spacer fusion between spina processes in the levels of posterior fusion, compared with those of laminoplasty only, in all fourteen patients. Although the value of the anterior procedure or problems associated with multiple fusion should be discussed, this new procedure will offer the spinal surgeon many advantages in laminoplasty of elderly patients.
Since 1982, we have operated on 130 cases of cervical spondylotic myelopathy using laminoplasty and report our post-operative results. The results were almost all satisfactory, but recently we experimented on two cases requiring reoperation. We report on the analysis of these cases.
To investigate the location and extent of intraspinal cord lesions, evoked spinal cord potentials (ESCPs) following transcranial electrical stimulation (TE-ESCPs) and median nerve stimulation (MN-ESCPs) were recorded in 9 patients with cervical myelopathy. Comparison of the abnormal lesion in ESCPs and high signal intensity area of the spinal cord on T2-weighted MRI was also investigated. High signal intensity areas on T2W MRI were observed in 6 of 9 patients. In 4 of 6 patients, this area corresponded to the area showing abnormal findings in both TE-ESCPs and MN-ESCPs. In 2 of 6 patients, the lesion confirmed by ESCPs is more extensive than the area revealed by MRI. In these 2 cases, the lesion confirmed by ESCPs was from C4/5 to C5/6 disc level but the high signal intensity area was observed at only C5/6. We concluded that high signal intensity on T2-weighted MRI exactly matched the abnormal disc level confirmed by MN-ESCPs, although this lesion can also include spinal tract lesions (corticospinal tract) observed in TE-ESCPs.
We analyzed the relationship between the level of Jacoby's line (Intercrestal line, Tuffier's line), which is an imaginary line between the uppermost iliac crest, and the grade of disc degeneration as evaluated by magnetic resonance imaging. The subjects of this study were 147 patients with low back pain and/or sciatica, with ages ranging from 20 to 59 years, with elderly patents excluded. The distance between the upper posterior margin of the sacral vertebra and the level of the uppermost iliac crest was divided by the height of L4 vertebra measured on lateral roentgenogram. We named this numerical value the Jacoby height index (JHI) and suggested it as a parameter which shows the level of Jacoby's line. JHI, lumbar lordotic angle (LLA) and lumbosacral angle (LSA) were compared with the grade of disc degeneration. The grade of disc degeneration increased significantly less with JHI at the L4-5 (p<0.05) and L5-S (p<0.01). However at the L3-4 level, there was no relationship between JHI and the grade of disc degeneration. LLA and LSA did not correlate with the grade of disc degeneration. We concluded that the lower the level of the uppermost iliac crest, the higher the grade of disc degeneration at L4-5 and L5-S.
A pathophysiological study of low back pain or lumbago was carried out by assessing thermography together with patients's subjective and objective symptoms. Active and dummy magnets were randomly assigned to patients (29 male and 34 females) in a double blind study. All patients wore 35-49 magnets for three weeks and after that the magnets were removed. Temperatures were monitored weekly for 4 weeks to investigate the response to magneto-therapy. Significant pain relief was observed 1 weeks after application of the active magnets.
We reviewed a case of anterior release for idiopathic scoliosis using video-assisted thoracoscopy. The patient was a fifteen year-old female with a double thorathic curve pattern (King type V) in which the upper curve was so rigid that it could not correct for side bending. We planned a two stage operation. First, we performed anterior discectomy of T4/5, T5/6 using video-assisted thoracoscopy. 1 week later, posterior instrumentation (Isola system) was performed. Postoperative pain was mild, and she was able to start walking 7 days later with no brace. We concluded that VATS (Video-Assisted Thoracoscopic Surgery) allows less blood loss, shorter operative time and hospital stay compared with open series, and offers new minimal invasive surgery for the treatment of most thoracic spine disorders.
The purpose of this paper is to introduce a new operative method for spondylolysis and spondylolisthesis. This consists of screw fixation (the modified Buck's method) and bone grafting with thread (tekmiron) fixation. The key point is to make good use of the screw head in thread (tekmiron) fixation.
Ceramic interspinous block (CISB) was used following anterior lumbar interbody fusion (ALIF) in 210 patients with lumbar disk lesions from 1988. A comparative study was performed assessing differences in outcome between the CISB group and non-CISB group. Although this method allowed patients early ambulation, there was no difference between the two groups in regard to changes in JOA score and radiographic outcome. CISB is useful for achieving good results following ALIF.
From 1976 to 1995, 288 primary and 33 reoperations for lumbar spinal disorders were performed in our department. The average age of the patients was 45 years (range, 13-81 years). Anterior procedure was used in 41 operations, and posterior in 280. Arthrodesis was performed at the same time in all operations using the anterior procedure and in 89 of those using the posterior procedure. We evaluated the postoperative complications of these operations. The overall complication rate was 34.9%. However, the complication rate, excluding minor problems such as wound problems, pressure sores, and stomachache, which were well controlled with medication and disappeared within one day, was 17.1%. The rates of gastrointestinal, genitourinary, cardiovascular, pancreato-hepatocystic, and psychotic complications, and DIC were 5.0%, 4.7%, 3.4%, 1.6%, 0.9%, 0.9%, respectively. The average age of patients with gastrointestinal, genitourinary, cardiovascular, pancreato-hepatocystic, and psychotic complications, and DIC were 46.8, 56.3, 48.0, 51.6, 66.7, 49.8, 57.0 years, respectively. Patients with genitourinary or psychotic complications were significantly older than those without postoperative complications. Gastrointestinal, genitourinary, cardiovascular, pancreato-hepatocystic, and psychotic complications, and DIC occurred at an average of 5.4, 25.8, 24.7, 26.6, 8.7, 5.3 days after surgery, respectively. Therefore, gastrointestinal, and psychotic complications, and DIC occurred about one week after surgery, compared to genitourinary, cardiovascular, and pancreato-hepatocystic complications which occurred about one month after surgery.
We evaluated the location of 748 pedicle screws in a random sampling of 160 patients, and assessed the incidence of neurological complication in 685 consective patients who underwent lumbar and sacral spinal fusion using the Zielke transpedicular fixation system. 93% of 748 screws were right in the pedicle, while 6.2% penetrated the cortex of the pedicle, and 0.8% were completely misplaced from the pedicle. Neural injury relating to screw displacement occured in 11 of 685 cases, giving a neurological complication rate of 1.6%, all of which were nerve root injuries. This figure is consistant with other reports. 8 of these 11 cases had revision surgery with retrieval of the misplaced screw. 6 of 8 cases achieved satisfactory recovery and the remaining two cases resulted in some neurological deficits. 3 cases who did not require revision surgery because of minimum neurological deficits showed complete recovery.
Mallet fracture is a common injury, with the Ishiguro procedure a useful and effective therapeutic technique. We report on our treatment of 16 patients 13 of whom were followed up. Fractures were classified and evaluated by radiographs according to Wehbé's method. Clinical results were assessed according to Kanie's criterion (composed of extension lag and arc of DIPj). We also measured “Dorsal Gap”. Clinical results were excellent in 4, good in 5, fair in 1, and poor in 3. According to the separate criterion of DIPj arc, results were exellent in 9, good in 2, fair in 0, and poor in 2. According to extension lag, results were excellent in 4, good in 6, fair in 2, and poor in 1. From the above it can be seen that overall clinical results depend more on swayed extension lag than the DIPj arc. Since extension lag is correlated with the size of bone fragments and “Dorsal Gap” it is important to reduce the “Dorsal Gap” as much as possible when reducing a Mallet fracture.
Collateral ligament injuries of the proximal interphalangeal (PIP) joint and metacarpophalangeal (MP) joint of the thumb are relatively common. However only a small series has been reported regarding ruptures of collateral ligaments of a non-thumb MP joint. We present two interesting cases of ruptures of the collateral ligament of the index and ring finger, which needed surgical treatment. One was accompanied by volar dislocation of the MP joint. In both cases, the metacarpal bone head was entraped between the extensor and dorsal joint capsule. This entrapment may be most important pathologic feature militating against successful closed reduction.
Dislocation and fracture-dislocation of Carpometacarpal (CM) joints except for the thumb are relatively rare. In particular, volar dislocation of CM joints are very rare. We experienced one case of volar fracture-dislocation of the 2nd CM joint, and dislocation of the 3rd, 4th, 5th CM joints. A 25 year-old woman was involved in a motorcycle accident, sustaining an injury to her right hand. On examination she had a swollen left hand, and she complained of pain in her left hand. The XP findings showed volar fracture-dislocation of the 2nd CM joint, and volar dislocation of the 3rd, 4th, 5th CM joints. Closed reduction was performed, but instability of the 2nd CM joint remained. We therefore performed percutanous fixation, which was removed 8 weeks after the operation. Twenty weeks post-operatively the patient has no problems with her left hand.