Spontaneous hematomyelia is a disease whose origin is unknown. The disease causes an abrupt onset of pain and rapidly developes myelopathy in asymptomatic patients. We present two cases with paraplegia due to spontaneous hematomyelia. MRI is considered a valuable examination for the early diagnosis of spontaneous hematomyelia.
From July 1996 to August 1999, 109 patients had decompression of the spine, of which, 6 (5.5 percent) sustained dural tear during the operation. We retraced the 6 cases, and examined the method of the prevention and management against dural tears. The cause of dural tear was sevare adhesion to the dura in 3 cases, unskilled drilling of the airtorm in 2 cases, and careless operation during releae of the dura. One patient who had posterior-operation of the cervical spine had postoperative cerebrospinal fluid fistula, but he did not need reoperation for treatment of the dural tear, the outcome was satisfactory. Careful attention is requined to preven the occurrence of dural tear, and if it actually occurs appropriate measures must be taken.
We examined the complication of 94 patients who had undergone autogenous iliac bone grafting in spine surgery. Donar site pain, nerve injury, delayed wound healing, infection, hematoma and fracture were observed in 31.9%, 3.2%, 2.1%, 0%, 1.1%, 1.1%, respectively, but there were no serious complications. There was no significant difference between the complications of harvesting anterior iliac bone graft and that of posterior iliac bone graft. Strict observation of relevant anatomic considerations should help avoid these complications.
We experienced two cases of scoliosis thought to be caused by spinal disorders. [Case 1] A 5-year and 11-month old boy was diagnosed as scoliosis with thoracic curve in August, 1997. In the following month, motor paralysis of the right foot occurred and syringomyelia with type I Arnold-Chiali malformation was found at MRI. Posterior fossa decompression and insertion of a cystsubarachnoid shunt were performed in March, 1998. A thoracic curve at T6-T10 of 14 degrees and another at T10-L2 of 27 degrees were seen on the anteroposterior radiograph in May, 1998. One year after operation, the curve had improved at T6-T10 of 9 degrees and at T10-L2 of 3 degrees. [Case 2] A8-year and 2-month-old girl she had right thoracic curve at T8-T2 of 17 degrees on the anteroposterior radiograph in February, 1997. She had no neurological symptoms then. But gait dysfunction appeared in March, 1998. MRI of the spinal cord revealed an intradural mass lesion in the cervical spinal cord and tumorectomy was performed. The Cobb angle improved by 8 degrees one year after operation. There are some spinal disorder patients who show no neurological symptoms and only scoliosis. We recommend MRI screening for scoliosis patients less than 11 years old showing asymmetry of the abdominal reflex, and atypical curve pattern.
Spinal·medullary diseases may be complicated with neurogenic bladder. At our hospital we measure pressure of bladder and study its diagnostic and thorapeutio usefulness in the cases of spinal-medullary diseases complicated with dysuria. In this paper we report three cases, in which neurological information of the bone marrow not obtainable with orthopedic imaging and clinical findings could be obtained by cystometry. Cystometry is an auxilliary diagnostic method that can easily be done. We intend to use it positively in the future.
Preservation of lordosis has been reported to be a factor critically affecting long-term results of spinal fusion, but there has been no detailed report on sagittal spinal alignment and balance in the elderly. We performed a radiological study of lumbosacral and pelvic alignment in 40 elderly volunteers, and compared the results with those of adult volunteers for the parameters of thoracic kyphosis, lumbar lordosis, hip axis to the C7 plumb line, sacropelvic angle, and sacral inclination. We also compared the lumbar lordosis subgroup to the lumbar kyphosis subgroup for the elderly group. The elderly individuals stood up with a flat back and vertical sacrum, and their trunks bent forward compared with the young adult control to compensate for their imbalance. The lumbar kyphosis group tended to exhibit loss of thoracic kyphosis, bending more forward than the lumbar lordosis group on standing.
We performed laminectomy on patients with lumbar canal stenosis for the decompression of the lumbar spine. Instability of the lumbar spine is a serions postoperative complication. In this paper, 88 patients with lumbar canal stenosis without degenerative spondylolisthesis were reviewed in clinical and radiographical investigation. 28 patients were famale and 60 were male. The mean age was 64.1 years (range, 33-84). The average follow-up time was 30.2 months (range, 11-73). 23 patients were treated with total laminectomy and 65 were treated with partial laminectomy. The postoperative results were evaluated with the JOA score. The mean preoperative JOA score was 14.4 points and the mean postoperative JOA score was 23.1 points. The recovery rate was 59.8%. Postoperative instability of the lumbar spine was found in 9 patients (10.2%), but postoperative instability did not always correlate with the clinical symptoms. Thus, laminectomy is a safe and useful procedure for lumbar canal stenosis without degenerative spondylolisthesis.
We operated on cases of degenerative lumbosacral kyphosis by use of the Isola-galveston method. However, correction of pelvic posterior rotation was unsatisfactory and instrumentation failure occurred. Two years ago, we introduced posterior wedge vertebral osteotomy in which shortening and fixture by the intrasacral fixation (ISF) method are performed. We operated on 6 cases by this method. At follow-up (mean: 11 months), the cases showed remarkabe improvement of the clinical symptoms and good correction of the lumbosacral alignment. This method was found to reasonably correct flat backs and maintain correction during follow-up.
We reviewed 14 patients with cervical dumbbell tumor who underwent surgical treatment. They consisted of 7 males and 7 females, and the mean age at surgery was 44.4 years old. They revealed 12 schwannomas and 2 meningiomas. In 8 patients, the dumbbell tumor was extirpated. In 5 out of the remaining 6 patients, the intra-spinal lesion of the tumor was removed, but anterior extra-spinal lesion, which could not be removed by posterior approach, was left alone. In only 1 patient, the intraspinal lesion located in front of the spinal cord was left alone. Neurological symptoms improved in 12 out of 14 patients, and clinical recovery rate averaged 57.8%. None showed neurological deficit, but 3 cases developed meningitis after surgery. In the 8 cases with complete extirpation of the tumor, none showed recurrence. However in 3 out of 6 cases, enlargement of the remaining tumor was evidently observed. In cases of dumbbell tumors where the intra-spinal portion extends to the anterior paravertebral area, both the anterior and posterior approaches should be performed to extirpate the dumbbell tumor.
We report a case with dumbbell tumor of the lumbar spine who recived recapping laminoplasty by the T-saw pediculotomy method. The patient was a 52-year-old woman who complained of slight lumbago and abdorminal pain. MRI showed a dumbbell tumor at the L3 level. She was threrfore admitted to our hospital for examination and treatment. We planned recapping laminoplasty by T-saw pedinoplasty by T-saw pediculotomy, but the tumor by only posterior approach was considered diffecult. However, as this operative method yields a wide view of the intervertebral foramen, then we were able to perform total resection of the tumor by the posterior approach. Recapping laminoplasty by T-saw pediculotomy not only yields an excellent and wide surgical field, but also achieves physiologecal and anatomical elements after excision of the tumor.
In MR imaging, T2-weighted images are useful in the diagnosis of intramedullary spinal cord diseases. But edema, inflammation, demyelination, and tumor are nonspecifically seen in the high in tensity area. It is therefore difficult to distinguish between tumor and multiple sclerosis. In this study, the manipulation of the window level and width on T1-weighted images, which should be superior in appearance, showed new findings and were effective in the diagnosis of intramedullary spinal cord diseases.
We examined the clinical features of 9 patients with cauda equina tumors. These tumors were definitively diagnosed by magnetic resonance, imaging (MRI) or myelography. Postoperative histological diagnosis indicated neurinoma in 5 patients, neurofibroma in 1 patient, epidermoid cyst in patient, myxopapillary ependymoma in 1 patient, and meningioma in 1 patient. In 5 patients, pain was relieved in specific postures. Initial symptoms consisted of pain such as lumbago, pain involving the gluteal region and lower limbs, and lower limb pain in 8 patients as well as numbness of the lower limbs in 1 patient However, it was difficult to hold other postures for prolonged periods. It is important to monitor the features of pain and clinical course carefully. In patients with movement or night pain in addition to lumbago and lower limb pain as well as relief of pain in specific postures who resist conservative treatment, diagnostic imaging procedures such as MRI and myelography should be performed, considering cauda equina tumor.
Two cases of intraspinal dermoid cysts were reported. Intraspinal dermoid cyst is a congenital tumor whose genesis is related to the anomalous implantation of ectodermal cells during closure of the neural tube between the 3rd and 5th weeks of embryonic life. Repeated lumbar punctures are sometimes responsible for this tumor. At operation, dermoid cysts are often found embedded in the conus medullaris or firmly adherent to the cauda equina, thus pre- cluding complete removal. However evacuation of the cystic contents gives lasting relief of low back pain and does not cause any deterioration in neurological function. In two cases, the tumor capsule adhered so tightly to the nervous tissue that part of it was left in situ. In the followup study, ranging from 5 to 10 years after operation, neurological symptoms were not recognized.
We report a case of intraspinal enterogenous cyst complaining of chest pain and gait disturbance. A 43-year-old male experienced chest pain 7 years ago when driving over bumps and swallowing something. I schemic heart disease was initially suspected, but no abnormality was detected by detailed examination. These symptoms subsided with antidepressant drugs. He experienced chest pain again which did not subside with the antidepressant drugs, and gait disturbance started. Magnetic resonance imaging (MRI) and myelogram showed a cystic lesion located in front of the cervicothoracic spinal canal, and which oppressed the cord severely to the posterior. Neither turbulence in the cyst nor communication flow between the cyst and subarachnoid space was seen in cine MRI. Tumor was resected by the posterior approach. After resection, pathological study revealed the mass to be an enterogenous cyst. The symptoms disappeared after surgery, and no tumor recurrence was seen by MRI for 6 months after surgery.
Among the elderly, hip fracture is the most common outcome of osteoporosis. The main aim of this study was to investigate the clinical characteristics, treatment, complications, long-term outcome and mortality of elderly hip fracture patients, aged 90 years and over. MATERIAL AND METHODS: We retrospectively analyzed 44 patients admitted between 1994 and 1998 with femoral neck or trochanteric fracture. The age of the patients ranged between 90 and 99 years and all 44 patients were surgically managed with one exception who died during the preoperative hospitalization. Hemiarthroplasty was most often used for medial (subcapital and transcervical) fractures. Internal fixation with either Ender nails or a compression hip-screw with a plate was used for lateral (per-, inter- and sub- trochanteric) fractures. RESULTS AND CONCLUSIONS: Most fractures (98%) were due to low energy trauma. Overall, mortality was 29.6% during the first year, being higher in patients with greater severity of pre-existing medical illness and in patients with difficulty in walking before the operation. In addition, if hemiarthroplasty was performed, the rate of death was higher. Rehabilitation was difficult if the patient had severe dementia or had difficulty in walking before the operation.
To clarify the significance of surgical treatment for intertrochanteric fractures in the very old, we investigated the clinical outcome of intertrochanteric fractures in the very old. We treated 40 patients surgically, except for one patient over 85 years old with intertrochanteric fracture at the injury. Patient outcome was assessed by clinical judgement for the change of ADL between at the injury and at the follow-up, the relationship between the grade of dementia and the change of ADL, and the grade of satisfaction of patients and/or their families. Twenty seven patients were alive and 13 patients were dead (4 patients died within 1 year after the injury) at the follow-up. While the ADL of the patients without dementia was relatively maintained at the follow-up, that of patients with dementia worsened at that time. Sixty five percent of the patients and/or their family were satisfied with the clinical outcome. We concluded that surgical treatment of intertrochanteric fracture is significant for the very old.
953 patients over the age of 65 with femoral neck fractures from April, 1989 to March, 1999 were studied by clinical recordings to investigate the tendency at our hospital. The items investigated were age, sex, type of fracture, location of injury, gait performance before injury, complications, etc. The results were as follows; 1. The number of patients and the average age have gradually increased year after year. 2. In all patients with femoral neck fracture, the ratio of medial to lateral was 1:1.7 and in patients over the age of 90, the percentaye of lateral was higher. 3. For medial, the percentage of indication of osteosynthesis was higher. 4. The number of bilateral femoral neck fractures increased, and in female cases lateral fracture and gait disturbance were high.
We studied the results of various surgical treatments for femoral neck fractures. 21 patients were studied in the period between January, 1992 and December, 1998. The patients were 4 males and 17 females with a mean age of 75 years. All patients had a history of cerebrovascular disorder. Bipolar arthroplasty was performed on 8 patients with medial type fractures and osteosynthesis on 13 patients (1 case of Ender pin, 2 cases of CHS, 10 cases of γ nail) with intertrochanteric fractures. Affected side fractures were observed in 20 patients with hemiplegia. Suggestine that pretrauma walking ability is correlated with lower extremity function of hemiplegia patients (Brunnstrom stage), 7 patients (58%) regained their pretrauma walking ability. Hemiparesis did not influence the results for patients with affected side fractures. Early operation (osteosynthesis or bipolar arthroplasty) and early rehabilitation prevent loss after femoral neck fractures.
We studied the clinical results of the internal fixation for femoral neck fractures. Between 1983 and 1998, we treated 160 cases. Osseous union was evaluated in 93 cases followed-up for more than 6 months with x-rays. Aseptic necrosis and late segmental collapse (LSC) were evaluated in 45 cases using MRI and 81 cases followed-up for more than 1 year with x-rays. The osseous union rate was 100% in Garden I fractures, 94.4% in Garden II fractures, 96.8% in Garden III fractures, and 88.9% in Garden IV fractures. The aseptic necrosis rate was 16.7% in Garden I fractures, 21.1% in Garden II fractures, 43.8% in Garden III fractures, and 57, 1% in Garden IV fractures. The LSC rate was 0% in Garden I fractures, 7.1% in Garden II fractures, 25.0% in Garden III fractures, and 41.2% in Garden IV fractures. Internal fixation for femoral neck fractures showed good results for the osseous union.
Contusion is common in contact sports but it is a rare cause of anterior compartment syndrome of the thigh. A 17-year-old man was kneeled in the thigh during a basketball game and suffered anterior compartment syndrome. He lost his gait ability immediately after injury, but normal pulsation of his popliteal artery and no neurological deficit were seen. Intracompartmental pressure increased over 100mmHg 24 hours after injury. At fasciotomy, considerable hematoma was observed in the ruptured vastus intermedius. Eight weeks after fasciotomy he was able to return to his sports activity completely. Contusion may cause muscle rupture, resulting in anterior compartment syndrome of the thigh more frequently than previously reported.
The congruity of the patellofemoral joint, clinical characteristics, and surgical technique in patients who had undergone revision surgery due to patellar component failure (revision group) following Miller-Galante I total knee arthroplasty were compared with those of patients who had not undergone revision surgery (non-revision group). The mean age at primary surgery in the revision group was significantly younger than that in the non-revision group. In the early stage following primary surgery, the mean patellar tilt in the revision group was significantly larger than that in the non-revision group. In addition, the mean pattellar prosthesis-bone angle in the revision group was significantly larger than that in the non-revision group. It is thought that younger age and larger patellar prosthesis-bone angle might be related to patellar component failure.
Standing radiographs are useful for evaluating joint space in knees with osteoarthritis (OA). However, ordinary methods such as hemi-foot standing ar the so-called Rosenberg method have several problems. We therefore developed a new method, in which an anteroposterior radiograph is taken with both knees at about twenty-six-degree flexion. In this study, the joint space angle (JSA) and femorotibial angle (FTA) which were measured by means of the new method were compared with those by ordinary methods. Values of JSA and FTA were more or less the same between the hemi-foot and bilateral feet. Bilateral feet achieved stable lower extremities position compared with the hemi-feet. Radiographs with the knee flexion were more sensitive for evaluating JSA than those in full extension. We concluded that this method is reliable and sensitive in assessing the degree of OA.
This study was performed to assess the accuracy of the operative correction angle in high tibial osteotomy and consider the possible causes for inconsistency between the preoperative and post operative correction the angles. We studied 40 knees in 31 cases (9 males and 22 females) treated by high tibial osteotomy between 1996 and 1998. The mean age was 66.2 years (45 to 81). We used five kirschner wires (∅ 1.8mm as the osteotomy guide, inserted them roentgenographically and performed interlocking wedge osteotomy. Preoperative and postoperative correction angles were measured and the postoperative correction angle was subtracted preoperatively. The inconsistency between the preoperative and postoperative correction angles was within ±2° in 31 knees (77.5%), +3° in 5 knees (12.5%), +4° in 2 knees (5.0%), +5° in 1 knee (2.5%), and -4° in 1 knee (2.5%). Satisfactory results were obtained in a majority of the patients. High tibial osteotomy requires operative technique taking into consideration inconsistency between the preoperative and postoperative correction angles.
We evaluated the use of manipulation under anesthesia in 5 knees as part of a retrospective study on 72 total knee arthroplasty cases (TKA) with osteoarthritis between September 1995 and May 1999. Manipulation was considered when intensive physiotherapy failed to increase flexion to more than 90° of ter 3 weekspostoperatiuly. The mean active flexion before manipulation was 67°. The mean final flexion achieved 104°. The mean gain was 37°. Between the manipulated patients and pativents requiring no manipwlatiow, the following parameters were assessed and compared; age, flexion, JOA, FTA, lateral release, and polyethylene? The manipulated patients in showed significant changes in FTA and used thick polyethylene. None of the patients showed supracondylar fracture, avulsion of the patellar tendon, myositis ossificans, and wound breakdown.
Patellar tendon is a very useful autogenous material for anterior cruciate ligament reconstruction, but this surgery is not easy. Double-skin incision and a bone plug cutter are used to examine the problems in the use of the patellar tendon for endoscopic anterior cruciate ligament reconstruction. The double-skin incision presented little saphenous nerve injury in front of the knee and satisfied the patients in cosmetic appearance. The use of the bone plug cutter facilitated achievement of the bone-tendon-bone from the patellar tendon and made it easy to insent the bone-tendonbone into the drilled holes of the femur and tibia for the endoscopic anterior cruciate ligament reconstruction.
Rosenberg devised a method to use Endobuttons (Acufex Microsurgical Inc. Mansfield, MA) for femoral fixation in ACL reconstruction. 80 cases underwent arthroscopic anterior cruciate ligament (ACL) reconstruction using the Endobuttons from April 1997. There were 41 males and 39 females, whose ages ranged from 15 to 50 years (average 24.6 years). Our substitute was bone-patellar tendon-bone autogenous. Artificial ligament was anchored at the tibial side with a post screw. Based on these experiences, we reviewed the demerits of this procedure. The clinical results showed that the Endobutton, used for ACL endoscopic fixation, flips outside the extensor mechanism or vastus lateralis rather than flipping directly outside the lateral femoral cortex. We also found out one case in which the Endobutton dragged into the femoral tunnel during X-rays after operation. The purpose of this study was to estimate the cause of the demerits and improve the method.
We report a case of a 39-year-old man whose magnetic resonance imaging (MRI) revealed an atypical occult bony lesion associated with anterior cruciate ligament (ACL) injury. During gardening, he slipped down a small ditch and injured his right knee in the slight flexion and valgus positions. Plain radiographs on his knee did not show any abnormalities, but MRI revealed a large geographic high signal intensity area from the subchondral portion in the lateral femoral condyle to the diaphysis and from the posterior part of the lateral tibial plateau to its metaphysis, in addition to ACL complete tear and MCL injury. At 4 months after injury, these abnormal signals on MRI returned to normal completely.
We report three cases of ossified Achilles tendon. In two cases, the insulin resistance assessed by homeostasis model assessment was high. Another case was impaired glucose tolerance. We assume that tendon ossification is relted to insulin resistance.
We experienced 2 cases of ossification of the Achilles tendon, reportedly a rare condition in literature. Case 1 was 50-year-old man who had ruptured ossifying Achilles tendons bilaterally, and underwent surgical procedure. Osseous masses were seen at the end of the ruptured proximal tendon and the peripheral tendon tissue had degeneratively changed. After excision of the osseous masses and resection of the degenerated tendon tissue, the tendons were repaired by the Kirshmeyer method for the left side and pull-out method for the right side. Histological appearances demonstrated osteogenic potential and degenerated tendon tissue. The paticnt is now asymptomatic and no reccurence of ossification is seen. Case 2 was a 56-year-old woman who had no trauma and operation history. Roentgenograms showed ossous mass at the Achilles tendon. The condition was treated with anti-inflammatory agents and two steroid, injections. The patient is now free of symptons. But the osseous mass seen in the roentgenograms remains the same.
In this past, we treated cases of dislocation-fracture by anterior cervical fusion without the cervical spine plate or with posterior wiring. But since 1996, we have been using the ORION anterior cervical plate for such fractures. The purpose of this study is to estimate the usefulness of the anterior cervical plate. We compared the results of the treatments among 3 different operative procedures concernig the alignment of the cervical spine. Although the local alignment of all the cases treated by the anterior cervical plate was well-maintained one case showed slight kyphotic changes of the total cervical spinal alignment.
Patients with spinal injuries require meticulous check for general status and neurological damages. Imaging studies are important for determing the treatment. In this paper, we discuss the diagnosis and choice of treatment for flexion-distraction fracture-dislocation from the retrospective study of three cases of this injury. On diagnosis, posterior element disruption which was palpated in back served as a useful factor in the diagnosis of this injury. These posterior element damages could be seen cleary in sagittal images on MRI. As for structural problems, the spinal column was injured from posterior to anterior, and all three columns were damaged, which means that this type of injury is considered unstable injury. Conservative treatment may be suggested, but rigid external support should be used to stabilize the spine. Usually surgical treatment may be indicated for reconstruction and stabilization of the spine. In early cases, only posterior surgery is performed to reconstruct the spine. However, for misdiagnosed old cases, anterior and posterior approaches are needed to correct angular kyphotic deformity and provide good anterior support.
We studied MR imaging to evaluate the prognosis in vertebral body fractures (54 vertebral bodies in 48 patients). In all cases, T1WI showed a low intensity, thoughout progress, and their progress could not be estimated. T2WI showed mixed low and high intensity areas in 47 vertebral bodies. The low intensity area showed low and very low zones. We assumed the very low intensity area tobe a fracture line, and the high intensity area surrounding the low intensity area to be edematous lesion caused by trauma. In many cases, there were no changes in between the T1WI and T2 fat suppression imagings, after the patients were cleared of their symptoms. But 5 out of 12 patients followed 6M, showed decreased intensity in T2WI in proportion to decrease in their symproms. The cases showed remaining vacuum cleft in the vertebral body, especially across the vertebral body, assumed instability, and vertebral collapse.
The prognosis of osteoporotic vertebral fracture was studied by MRI and X-ray findings. There were 7 males and 39 females with ages ranging from 58 years to 97 years. Both prominent type (mid-anterior margin of the vertebra is protruded) and retraction type (mid-anterior margin of the vertebra is retracted) who had severely compressed vertebral fracture in lateral roentgenogram on admission showed poor prognosis. In these two types, compressed vertebral fracture with change in intensity over the entire vertebra in MRI caused severe wedge deformity.
Surgical results of 13 females with osteoporotic vertebral fracture resulting in non-ambulatory paraparesis were studied. Their mean age was 72 year-old at the time of operation. In 6 patients with spinal canal encroachment by displaced fragments in only 1 segment, anterior decompression with A-W glass ceramic (AWGC) and Kanede anterior device was performed. In 5 patients with spinal canal encroachment in more than 2 segments, posterior instrumentation and secondary anterior decompression with AWGC were performed. In 2 patients with spinal canal stenosis combined with kyphosis, posterior instrumentation and laminectomy wereperformed. The mean follow-up was 25 months. Twelve patients regained gait with support. Preoperative low back pain in 13 patients disappeared in 2 and improved in 9. Urinary disturbance in 7 patients disappeared in 5 and improved in 2. Instrumentation failure occurred in 3 patients and needed additional operation. Four patients lost more than 20° of correction; 3 occurred by the instrumentation failure and one by fracture of the upper segment. By excluding these 4 patients, preoperative kyphosis (mean 25.2°) improved at follow-up (mean 16.7°). In the case with multi-segment fracture, correction of kyphosis may not be maintained even by posterior and anterior combined surgery.
Osteomyelitis of the spine caused by Salmonella is rare. The authors describe a case in which the patient had fusion of the L1 to L3 vertebrae, which wereaffected by spondylitis of the Salmonella group O9. A man, sixty-eight years old, had a two-month history of low back pain and gait disturbance without any injury. He was already observed with incomplete paraplegia and bladder disturbance on admission. Laboratory findings suggested mild inflammation. Radiographs of the lumbar spine showed the burst fracture of the L3 vertebra and instability between the L2 and L3 vertebrae. MRI showed the rim enhancment of the abscess in the psoas. We performed anterior intervertebral fusion with iliac bone graft and found Salmonella group O9 from the culture of thegranulation tissue. Six months after, he was able to walk with Lofstrand crutches. Salmonella spondylitis may mimic tuberculous spondylitis both clinically and radiologically. Therefore it is important to discriminate Salmonella spondylitis from other pyogenic or tuberculous spondylitis.
Eleven patients with thoracic and lumbar tuberculosis were treated by anterior débridement and fusion combined posterior instrumentation. A one-stage surgery was done on seven patients and a two-stage surgery on four patients. Posterior instruments included seven ISOLA, three Luque rods with sublaminar wiring, and one Spine system. The average range of anterior fusion was 2.4 segments and that of the posterior fixation was 3.8 segments. Seven patients presented paraparesis before surgery and all improved after surgery. None showed persistent or recurrent tuberoculosis. Sagittal alignment, corrected after surgery, was not lost by more than 10 degrees in 10 patients but by 30 degrees in one patient treated with Luque rods. Solid bone union was obtained in all patients. Our study showed that anterior débridement and fusion combined with posterior instrumentation are useful for spinal tuberculosis.
Temporal and spatial immunolocalization of TGF-βs and their receptors in the intervertebral disk of senescence-accelerated mouse (SAM) were examined to determine the biological roles played by TGF-βs and its receptors in the process of degeneration in intervertebral disks. Ten male SAM and to male ICR mice aged 8, 24 or 50 weeks after birth were used for this experiment. Histological and immunohistochemical studies using specific antibodies for TGF-β1, -β2, -β3, TβR-I, and TβR-II were performed. Intervertebral disks of the SAM showed earlier degenerative changes compared with the ICR mice. TGF-β s and TβRs expressed abundantly in the disk of the SAM and ICR mice at 8 weeks of age, and became weaker with aging. Our result suggests TGF-β s may play a role in the growth and maintenance of the intervertebal disk.
In order to examine the effectiveness of Static Magnetic Fields (SMF) for pain, we measured the tail skin temperature and behaviours of chronic Adjuvant-Induced Arthrits (C. A. A.) in rats. After continuous exposure of SMF in C. A. A rats, the tail skin temperature as well as the movement could increase significantlycompared with control group. These results suggest that SMF plays an important role in C. A. A rats as an inhibitor of inflammation.
The purpose of this paper is to evaluate the biomechanical and radiological changes in the cervical spine after laminectomy. This study is a control study on the change in the cervical spine after the Hattori's method. Eighteen mature Japanese white rabbits were laminectomized from C3 to C7 without damage to the facets under general anesthesia. They were evaluated prepostoperatively 2, 4, 8 and 12 weeks after the procedure. Of the 12 rabbits observed for more than 2 weeks after the procedure, 6 rabbits (50%) developed postoperative kyphotic curvature and 8 rabbits (67%) developed anterior displacement of the vertebral body. We considered the causes of the anterior displacement of the vertebral body to be disruption of the lamina and yellow ligaments, and the cause of the kyphotic deformity to be weakness of the cervical posterior muscles.
We report a case of Madelung's Deformity in a 23-year-old female. When she was 11 years old, she was aware of the deformity of her bilateral wrist and forearm. Wrist pain started when she was 13 and the symptoms worsened. We performed wedge osteotomy of radius with the Sauvé-Kapandji Method at the bilateral sides when she was 22 and 23. After the operation, wrist pain and range of motion improved.
We performed bilateral lower limbs lengthening in a 17-year-old boy with spondyloepiphyseal dysplasia tarda (SED tarda). The method of lengthening was callus distraction (callotasis) using Orthofix external fixators. His height was 139cm (-5.4 SD) and his arm span was 145cm before the operation. The lengthening in the tibias was 7.5cm after about 10 months. His height after treatment achieved 146.5cm. There were no major complications, such as pin tract infection or irreversible joint contracture. The disadvantages of lengthening with SED tarda, compared with achondroplasia, were tight soft tissue, poor callus formation, and degenerative changes of the joints. To solve these problems, we changed the speed of lengthening and exercised stretching of the knee and ankle joints. Lengthening with SED tarda is not contra-indication if these problems are solved. Observation of the degenerative changes of the joints is considered most important in future investigations.
Septic arthritis of the hip in infancy and early childhood can result in severe sequelae in the form of dislocation of the hip, and growth disturbance with limb-length discrepancy. This is a report of 4 cases with sequelae of the septic arthritis. They were treated at other medical centers, and referred to our hospital because of limp and limb-length discrepancy. There were 3 boys and 1 girl. All underwent femoral distraction lengthening with the Orthofix system after acetabuloplasty or femoral osteotomy in order to acquire adequate coverage of the femoral head. The age at limb-lengthening ranged from 9 to 15 years, with an average follow-up of 4 years. The overall lengthening achieved ranged from 2.3 to 4cm, with the healing index from 35.8 to 46.5 days/cm. All hips remained stable, but considerable precautions against articular cartilage damage on the hip joint during limb-lengthening seemed to be important.
The authors dissected 72 paired arm to study the anatomy of Gantzer's muscle. The dissection explored course of the median nerve from the elbow to the distal end of the forearm. The following anatomical structures and variations were noted; (1) The presence of a Gantzer's muscle, as well as its relationship to the median and anteriorinterosseous nerves. (2) The origin and insertion of Gantzer's muscle. Results: Gantzer's muscle arose from the medial epicondyle of the humerus in 45 arms (90%), from the coronoid process of the ulna in 3 arms (6%), from the intermuscular fascia in 1 arm (2%), and from a double origin- the medial epicondyle and the coronoid presess-in 1 arm (2%). Insertion was to the proximal part of the tendon of the flexor pollicis longus muscle in all arms. Gantzer's muscle always lies posterior to the median nerve. In 12 out of 50 arms, the muscle passed posterior to the anterior interosseous nerve, and in the remaining 38 arms, the anterior interosseous nerve ran proximal to the muscle along its proximal border and never cross Gantzer's muscle and its tendon. Based on these findings, the authors concluded that Gentzer's muscle rarely contributes to anterior interosseous nerve compression in the proximal forearm.
This is a report of a case of the pronator syndrome which relapsed three times and was operated on four times. Case: A 70 year old female with a complaint of paresthesia in the median nerve region and muscle weakness in the right index finger. A positive Tinel's sign at both proximal forearm and wrist were elicited and a nerve conduction test revealed the slowing of conduction velocity in the forearm and prolongation of distal motor latency across the carpal tunnel. The patient was diagnosed as having both the pronator syndrome and the carpal tunnel syndrome. A release operation for the median nerve was performed June 1996, and symptoms remitted, but, recurred two months later, the nerve having been compressed by the exostosis of the radius. This tumor was resected February 1997 and again symptoms remitted, recurred four months later. July 1997, the operation to release the nerve compressed by the pronator teres muscle was performed and symptons disappeared, but recurred 21 months later, the nerve having been compressed by the osteochondroma of the ulna which was resected April 1999. To date, the patient has been free from symptoms for more than 7 months.
Fracture of the medial tubercle of the posterior prosess of the talus is rare. We report one case, a 17-year-old man, who was injured in a motorcycle accident in May, 1998. He had pain behaind the medical malleolus, limitation of the plantar flexion of the toes, and numbness over the sensory disribution of the medial planter nerve. A diagnosis of the fracture of the medial tubercle of the posterior process of the talus with the plantar nerve palsy was conducted. We performed open reduction and internal fixation, and kept him non-weight-bearing for 7 weeks after surgery. Twelve months after operation hypesthesia disappeared and there was no limitation of activity.
The purpose of this paper is to bring attention to a major complication which may follow a minor procedure in the posterior cervical triangle of the neck. Two patients who had a accessory nerve palsy following lymph node biopsy are presented. The ipsilateral accessory nerve was injured in the posterior cervical triangle in both cases. External neurolysis was performed in both cases. The symptom was completely resolved in both patients within 9 months.
We report an extremely rare case of large spinal pseudomeningocele caused by cervical root avulsion. The patient was a 17 year-old male, injured by a motorcycle accident which caused polytrauma. Right brachial plexus palsy and right cervical mass were observed. MRI showed a large spinal pseudomeningocele. 110ml of cerebrospinal fluid was taken from the pseudomeningocele by needle puncture, but on the next day the pseudomeningocele returned to the same size as before the puncture. At our hospital, MRI revealed a large pseudomeningocele measuring 10×5×6.5cm. On myelogram the cerebrospinal fluid leaked out from the intervertebral foramen of the C8 root. We closed the liqurrhoea with a fatty tissue. But on the day following the operation, the pseudomeningocele relapsed. We therefore performed spinal drainage and closed with a tendon ball by the tie-over method. No relapse of the pseudomeningocele hasbeen seen since then.
The finger tips of children are not only important for the function of the hand, but also important cosmetically. In our department, 10 digits have been treated since 1982. This included 8 males and 2 females, with mean age of 2.9. In these cases, 8 digits were complete and 2 digits were uncomplete amputation. The cases were classfied into 4 types according to the Ishikawa method (subzone I-3, II-2, III-3, IV-2). Replantation were performed on 4 digits, and composite graft on 4 digits. The other 2 digits were treated by skin graft and ointment. The survival rate in replantation cases were 100%. The complete survival rate in the composite graft cases were 25%. In these cases except replantation cases, many had nail defomities. We think that the indication of replantation in children is subzones III and IV and the indication of composite graft in children is subzonse I and II.
Three patients (4 hands) had recurrence of symptomes after receiving endoscopic carpal tunnel release. Physical examination at our hospital indicated that all patients had ipsilateral pronator syndrome. Operations for carpal tunnel and pronator syndrome were performed at the same time. In the findings of the carpal tunnel, sever adhesion around the median nerve and insufficiently incised transverse carpal ligament were seen in all hands but one hand, which had received a second open method operation prior to visiting our complicated pronator syndrome one discussed. Pronator syndrome shows similar symptons to the clinical features of the carpal tunnel syndrome, and It is therefore easily misdiagnosed as carpal tunnel syndrome. It is stressed that pronator syndrrome must be considered in the differential diagnosis of carpal tunnel syndrome.