We investigated and compared surgical outcomes and postoperative complications in 106 patients who underwent spinous process-splitting laminoplasty and en-bloc open door laminoplasty. Seventy-nine patients were male and 27 were female. Their age ranged from 32 to 84 years. Fifty-eight patients underwent spinous process-splitting laminoplasty [cervical spondylotic myelopathy (CSM) in 41 patients, ossifiction of posterior longitudinal ligament (OPLL) in 9, and cervical hernia in 8] and 48 patients underwent en-bloc open door laminoplasty (CSM in 36 patients, OPLL in 7, and cervical hernia in 5). Preoperative and postoperative JOA (Japanese Orthopaedic Association) scores, improvement ratio in JOA scores, surgery time, amount of hemorrhage, and postoperative complications were investigated. For patients who underwent spinous process-splitting laminoplasty and en-bloc open door laminoplasty, the average preoperative JOA score was 10 and 11 points, the average postoperative JOA score was 14 and 14 points, and improvement ratio was 50 and 52%, respectively. The average surgery time and average hemorrhage did not differ signifficantly between groups. However, the incidence of liquorrhea tended to be higher in the spinous process-splitting laminoplasty group.
Anterior fusion is widely perfomed for cervical spondylotic radiculopathy, and good results are reported for posterior foraminotomy. We treated seven cases suffering from cervical spondylotic radiculopathy with this method from May 2000 to July 2003. They consisted of five men and two women with a mean age of 58 (44 to 48) years. The average period to the operation was 13 (3 to 48) months, and the follow-up period was 20 (3 to 41) months. Numbness decreased in five cases, pain decreased in four cases, and muscular power recovered in five cases. Though we were concerned about the developing instability of the cervical spine after foraminotomy because of partial facetectomy, but this did not occur. Posterior foraminotomy is a good operative method for cervical spondylotic radiculopathy.
We present a case of fracture-dislocation of the lower cervical spine with slight neurologic complications. The case was a 66-year-old male who fell from a high place. Radiographic examination revealed fracture-dislocation of C7, fracture of the lamina of C6, and fracture of the body of Th1. Due to bilateral pedicle fracture of C7, the spinal canal was maintained and there were slight neurologic complications. The patient was operatively treated with posterior spinal fusion and showed good course at follow-up one year later.
We evaluated the operative results of 5 cases of thoraco-lumbar burst fractures. Canvas traction and posterior fusion were performed with instrumentation. The subjects were five males with a mean age of 39.8 years (range: 18-66 years). The mean follow-up period was one year 11 months (range: one to three years). Clinical evaluation was then carried out according to the improved Frankel grading. During an average of one year 11 months, neurological improvement was seen in all cases. All cases were evaluated based on radiology findings. The kyphotic angle improved from 12.8 degrees before the operation to 2.3 degrees at the latest follow-up. There were no patients with low back pain. Posterior fusion with instrumentation is considered useful for thoraco-lumbar burst fractures.
The prognosis for vertebral fracture is discussed in this study. The patients were divided into two groups: early treatment group and late treatment group. It was found that early treatment prevents kyphotic deformity and low back pain. It was difficult to asses prognosis only by fracture type. We found clear correlation between the number of NTx and onset of multiple vertebral compression fracture. Patients complaining of back pain despite being under appropriate recumbency indicated aggravation of kyphotic deformity. Steroids adversely enhanced the deformity of compressed vertebral compression fracture. Moreover kyphotic deformity and incomplete fusion appeared when T1 weighted MRI showed clear low band.
Spinal cord stimulation delivers low-voltage electrical stimulation to the spinal cord to inhibit or block the sensation of pain, and it has proven to be useful for pain induced by spinal disorders. We report 10 cases of chronic neuropathic pain treated with spinal cord stimulation. The patients consisted of eight males and two females with a mean age of 58 years (range: 37 to 81 years). We assessed the degree of pain with use of a visual analog scale. Pain was relieved in eight cases. We concluded that spinal cord stimulation is useful for patients without effective treatment such as surgery, drug therapy, physical therapy, etc.
Spasticity is a common complication after spinal cord injury, for which treatment has been difficult. Physical therapy, oral baclofen and another treatments are not so effective, but spasticity can be treated relatively easily by ITB (intrathecal baclofen) therapy. We attempted one shot intrathecal injection of 50μg baclofen for six cases. In all cases, spasticity was dramatically reduced and the quality of life improved, resulting in high patient satisfaction. For three out of six cases, we performed implantation of the pump system (ITB therapy). Effects continued in three cases and they were followed up over a long term.
We report a case of a 76-year-old man with cervical spondylotic myelopathy acconpanied by calcification of the ligamentum flavum. The patient complained of numbness with bilateral fingers and precise motion disturbance a year and a half ago, and expressed conspicuous spastic gaits three months ago. MRI scanning showed spinal canal stenosis and CTM revealed calcification of the ligamentum flavum especially at C3/4. We performed spinous process-splitting laminoplasty, which decreased their symptoms. Under a scanning electron microscope, we examined the surgical specimen extracted from the ligamentum flavum. It included shaped crystalline structures extensively. Results of chemical composition analysis suggested crystal as calcium pyrophosphate dihydrate (CPPD), but did not confirm the existence of hydroxyapatites (HAP).
Calcific tendinitis of the longus colli should be recognized as one of the causes of acute neck pain. It is induced by inflammation of the longus colli muscle following deposition of calcified particles. Although the clinical presentation may mimic more serious disorders such as retropharyngeal abcess, diagnosis can be easily established by image analysis including plain X ray, CT, and MRI. The case was a 22-year-old woman who complained of cervical stiffness due to acute nuchal pain. Plain X-ray and CT showed amorphous calcification localized in the caudal portion of the anterior arch of C1. MRI revealed diffuse swelling of the longus colli muscle as the signal intensity changes, especially in T2 weighted image. She was treated by medication with NSAIDs and local rest using neck collar application. After nine days, neck pain gradually decreased and the X-ray on day 30 showed disappearance of calcification.
We present a rare case of a cervical ganglion cyst. An 81-year-old woman with a 10-month history of neck pain was admitted with deterioration of left hand function, numbness in the legs and gait disturbance. Physical examination showed hyperreflexia with scapulohumeral reflex and muscle weakness especially in her left side. Magnetic resonance imaging revealed an intraspinal extradural mass at C1 level with extension of cystic lesion to C2 level compressing the spinal cord. C1-level mass showed low intensity on T1 and T2-weighted images. C2-level cystic mass showed low intensity on T1-weighted images, high intensity on T2-weighted images and rim enhancement on Gd-enhanced T1-weighted images. The cyst had a yellowish gelatinous content. C1-level mass was pathologically degenerative fibrocartilagenous tissue with chondrometaplasia. This case was diagnosed as an intraspinal ganglion cyst accompanied by pseudotumor.
We report three cases of lumbar intraspinal cyst surgically treated. The three cases included two men and a woman, whose ages were 85, 64 and 69 years respectively. MRI, facet arthrograns and pathological findings were reviewed. All cases had nerve root disturbance. MRI revealed existence of two cysts existed at the level of L4-5, and one cyst at L5. Cysts were isointense on T1-weighted image and hyper or isointense on T2-weighted image. Facet arthrography was performed on two cases, and it demonstrated that these cysts communicated with facet joint. Laminoplasty or fenestration was performed, and cysts were resected. Preoperative symptoms improved by resection in all cases. Pathologically, one case was ganglion cyst, and two cases were synovial cyst. Pathological diagnosis of ganglion and synovial cyst were based on the existence of the lining cell, mucoid degeneration, detritus or communication with facet joint. There is no criteria for diagnosis of cyst without lining cell and mucoid degeneration.
Solitary bone cysts involving the axial skeleton are very unusual. Only seven cases of histologically proven solitary bone cyst involving the lumbar vertebra were found in literature. We report a case of solitary bone cyst in an 18-year-old female patient with a 4-year history of persistent low back pain. Magnetic resonance imaging and computed tomography scan showed a well defined osteolytic lesion in the vertebral body extending into the left laminae of the first lumbar vertebra. The patient underwent curettage of the tumor by the transpedicular approach. Intraoperative findings were suggestive of solitary bone cyst, because of the existence of cyst fluid. The diagnosis was confirmed histologically. The lesion was curetted, and the cavity was packed with ß-tricalcium phosphate. Postoperatively the patients backache was relieved and she returned to normal daily life. When a spinal cystic lesion is encountered, although uncommon, solitary bone cyst should be considered.
Surgical results of 15 patients suffering from vertebral metastases of breast cancer were investigated. The patients were all female whose age ranged from 29 to 72 years. Four had visceral metastases (lung in two, brain and liver in one each). Preoperatively all but one patient showed paralysis or palsy (Frankel grade B : 5, C : 5, D : 4). Preoperative pain was severe in four, moderate in nine and mild in two. The average survival period for those without metastases and followed up to more than one year (none died within one year) was 63 months and they could walk for 86% of their remaining life. The average survival period for those with visceral metastasis was 4.3 months and they could walk for only 32%. Ten patients with Frankel grade B and C preoperatively showed improvement of at least one grade, whereas, nine patients with grade D and E remained the same as before. Surgical treatments for vertebral metastases of breast cancer are effective especially for patients without visceral metastasis.
We studied 12 patients (four men and eight women) with spinal cord tumor at the upper cervical spine. Eleven schwannomas and one meningioma were included. They were observed for nine months to 20 years (average 9.1 years) after surgery. Posterior approach was performed on all patients. In eight patients, tumor was resected totally, and in four patient partially. There was no recurrence in all the cases of total resection. Even cases of partial resection revealed no recurrence of symptoms, and no re-operation was needed. The mean JOA score of all patients has improved from 7.8 points to 12.9 points. In conclusion, careful observation is possible in cases of partial resection.
Intraosseous lipoma is a benign bone tumor. We report a case of intraosseous lipoma of the proximal humerus. A 51-year-old man presented with a history of gradually increasing right shoulder pain on motion. Plain radiographs revealed a 2 × 3 cm osteolytic lesion in the right proximal humerus. CT showed a low-density area in the bone, identical to the findings in the normal adipose tissues. On MRI, the lesion had high signal intensities on both T1-weighted and T2-weighted images. On MRI with fat suppression, the lesion was suppressed. Curettage of the lesion and artificial bone grafting were performed. Histological examination revealed mature fat cells, and intraosseous lipoma was diagnosed. Since then, the patient had been free from symptoms, and there was no recurrence identified on plain radiographs six months following the surgery.
This article reports a case of osteoid osteoma of the proximal humerus. A 22-year-old man had pain in the right shoulder for 18 months after a traffic accident. We found a small sclerotic change in the proximal humerus on X-ray images and typical nidus on CT in his first visit to our hospital. The tumor was removed and the pain in the shoulder disappeared completely after operation. He underwent arthroscopic surgery for the pain at another hospital one year ago, but the cause of the pain was not identified. We reviewed X-ray images which were taken 18 months ago at that hospital. The images did not show any marked changes. Osteoid osteoma of the proximal humerus is rare but we should consider the diagnosis of osteoid osteoma for patients with severe and long-term pain in the shoulder.
Pigmented villonodular synovitis (PVS) is a benign but aggressive lesion of the synovium, most commonly involving the knee joint. Knee joint is the most commonly involved site. The extraarticular form of PVS is extremely rare. We report a very rare case of extraarticular PVS of the proximal lower leg. A 35-year-old woman was referred to our hospital complaining of pain and swelling of the right lower leg. Synovial sarcoma was suspected as its diagnosis with MRI and Sono-CT. However since this tumor was histologically diagnosed as PVS, marginal resection of the tumor was performed. No recurrence of the tumor was seen for 12 months after the operation. We reviewed differential diagnoses comparing characteristic imaging features between extra-articular PVS and synovial sarcoma.
We report two cases of intramuscular myxoma occurring in the thigh. Case 1 was a 71-year-old man who presented a painless lump in the anterior aspect of the left thigh, which he noticed four months earlier. Physical examination revealed a painless and movable, 1.5×1 cm well demarcated mass in the region of the rectus femoris muscle. MRI showed an oval mass lesion in the muscle. Case 2 was a 63-year-old woman who noticed a painless lump in the lateral aspect of the left thigh. One month earlier. Physical examination revealed a painless and movable, 4×2 cm well demarcated mass in the rectus femoris muscle. MRI showed the mass to be in the vastus lateralis muscle. Final diagnoses were made by histological examination. These cases had a tendency of muscle invasion on MRI and histological examination, which is thought to be a hallmark of diagnosis.
Subcutaneous rupture of the extensor pollicis longus [EPL] tendon after nondisplaced fracture of the distal radius is a well known complication, which however can also be seen in displaced fractures or as a late complication after open reduction and internal fixation [ORIF] of the distal radius. We describe seven EPL tendon ruptures occurring with distal radius fractures in this article. The age of the patients ranged from 18 years to 77 years [mean: 53 years]. Rupture occurred at 202 days and 150 days from the operation for distal radius fracture in the ORIF group. In the non-operated group, rupture occurred at a median of 30 days [range: 25 days to 32 days] from the time of the fracture. Of these, one case had displaced fracture, and the other cases had nondisplaced fractures. Several possible mechanisms are discussed in literature, such as anatomical characteristics of EPL tendon, mechanical irritation of the tendon caused by a sharp edge of the fracture bone or a metal edge of the screw or K-wire, and direct or indirect microvascuular compromise of the poorly vascularised tendon. Not only simple causes but also many complicated causes are involved in these cases. Tendon transfer or free palmaris longus graft yields excellent results after EPL tendon rupture.
Four symptomatic scapholunate advanced collapse wrists treated with Watsons method were reviewed. The ages of the cases at surgery ranged from 43 to 59 years, with a mean of 50.3 years. One wrist was stage two and three wrists were stage three. Clinical examination was performed at an average of 3.25 years after the operation. Evaluation was done by X-ray and Cooney method. At follow-up, all patients were able to return to their original jobs. Wrist motion averaged 60% and grip strength averaged 86% of the opposite nomal wrist. Satisfactory pain relief was observed in all patients, indicating that Watson's method is effective for SLAC wrists.
Hamate body fracture is so rare that it is sometimes difficult to diagnose. We treated a patient who punched a pillar with his clenched fist and sustained a fourth carpometacarpal joint fracture-dislocation with hamate body fracture. Plain lateral x-ray and plain CT films were useful for the diagnosis. Treatment with open reduction and internal fixation with compression screw achieved excellent clinical results.
Pressure measurement in the carpal canal is often reported. However because the carpal canal is not a closed cavity, compression pressure measurement is more suited than internal pressure measurement to investigate the effects on the median nerve. We measured the compression pressure between the median nerve and transverse carpal ligament in patients with carpal tunnel syndrome using an air packed type pressure measurement device. A sensor for pressure measurement was inserted between the median nerve and transverse carpal ligament and used to register pressure at varying degrees of wrist and MP-joint flexion, before release of the carpal tunnel. At the neutral position, the mean pressure was 33.8 mmHg, at the modified Phallens position 37.9 mmHg, and in MP-joint flexion 50.6 mmHg. We believe the mechanism of the increase in pressure is as follows: as the wrist and MP-joint are flexed, the median nerve in the carpal tunnel bends around the transverse carpal ligament. At the same time the nerve is subjected to compression against this ligament by tensed overlying flexor tendons that also bend around the ligament.
Pediatric both bone fractures are usually caused by indirect forces, such as falling on the out stretched hand. Fractures are commonly treated conservatively, but this process requires caution in order to prevent displacement of fracture, rotation deformities, compartment syndrome, and other complications. In this paper, we report our experience of a case of flexion contracture of the right middle, ring, and little fingers after reduction of pediatric both bone fractures of the forearm. Immidiately after extension limitation of the digits on the hand of the involved limb with both bone fractures is found, the possibility of compartment syndrome must of course be considered, as well as the possibility of muscle fibers entrapment in ulnar shaft fractures.
We reported the treatment for radial head fractures (Morrey classification; type 2) by reduction and fixation using intramedullary pinning from the distal of the radius (Métaizeau method). From May 2003, we treated three cases (one female and two males) by the Métaizeau method. Their mean age was 42.3 (range: 33 to 54) years. According to Morrey classification, all fractures were type 2. After operation, triangle bandage fixation was performed for three or four weeks. Soon flexural extension exercise was carried for pain self-control, and the Kirschner wire extracted early when bone union was achieved. Bone union was achieved in all patients, and the average range of motion was flex/ 131.6°: , extension/-6.6°: , pronation/ 80.0°: , spination/ 78.3°: . The average JOA score was 93 points. The Métaizeau method is originally carried out for radius neck fractures, but it is considered a simple and minimally invasive good method for type 2 patients who are generally adaptive to operations.
We treated two fractures of the proximal radius.One was fracture of the radial head and the other was fracture of the radial neck. These two cases were satisfied with the results. The canulated screw was useful for rigid internal fixation and early rehabilitation. To obtain good results for these fractures, we recommend surgical procedure for rigid fixation.
We report a study comparing the use of the screw with ONI transcondylar plate in the treatment of distal humeral fracture at our hospital. Use of the ONI transcondylar plate tends to be better than the screw on fixation. Use of the ONI transcondylar plate is considered to be a useful fixation material for distal humeral fracture.
We reviewed eight patients with humeral shaft fractures treated by Ender nailing from 1998 to 2002. The average follow-up period was 16 months (range; eight to 26). There were four males and four females. The age of the patients ranged from 16 to 56 years (average; 31 years). The patients were placed in the supine position under general anesthesia and retrograde technique was used. Except for one patient, functional brace was applied two weeks after operation to inadequate fixation. Union was obtained in all eight patients, five were transverse (type A3) and functional results in the shoulder and elbow were good in daily life. Fastening the eyelet of the nails to the bone with 0.8-millimeter wire eliminates complications caused by nails backing out. Ender nailing for humeral shaft fractures is useful especially in transverse fractures.
We reported an extremely rare case of Monteggia's fracture with fracture of the medial epicondylar apophysis. A five-year-old girl was admitted after a fall. Plain radiographs of the elbow and forearm revealed acute plastic bowing of the ulna, anterior dislocation of the radial head, and fracture of the medial epicondylar apophysis. Six days after injury, closed reduction and osteosynthesis were performed. During the follow-up at eight months, the patient achieved bony union and well range of motion of the elbow and forearm.
Surgical neck fracture of the humerus is a common injury in elderly people and usually successfully unites following adequate conservative or surgical treatments. Thus, the nonunion of the proximal humerus is not very common, but is difficult to treat once it develops. We present a case of surgical neck nonunion of the left humerus for which prosthetic replasement was performed. Although she was unable to hold anything in her left arm or elevate left shoulder due to a severe pain before prosthetic replacement, she could hold a one kg dumbbell five months after the operation without pain.
In the present study, changing in pelvic inclination before total hip arthroplasty (THA) were investigated using 59 patients with osteoarthritis of the hip. The subjects were divided into following four groups by their age: Group A consisted of 21 patients between 45 and 54 years, Group B 10 patients between 55 and 64, Group C 18 patients between 65 and 74, and Group D 10 patients at 75 years or older. Pelvic inclination became retroverted with age, further retroverting at the standing position especially in elderly people. When performing THA on patients with severe pelvic retroversion, alignments of the lumber spine, pelvis, and hip should be carefully considered. Insertion of acetabular socket should be considered in some cases taking into account standing position or pelvic inclination in future. In elderly people with lumbar degenerative kyphosis and severe pelvic retroversion, it was important to insert the acetabular socket in prospect of future changes of the pelvis inclination since the pelvis retroverts according to posture and age.
We performed arthroscopic manipulation on frozen shoulders for which no improvement by conservative treatment was seen. Sixteen shoulders of 16 patients, undergoing arthroscopic manipulation from July 1995 to August 2001 at our hospital, were investigated in this study. There were eight males and eight females with a mean age of 56.5 years (45 to 68 years), and mean follow-up period of 7.2 months (3 to 19 months). The improvement of preoperative and postoperative ranges of motion (flexion, abduction, external rotation, internal rotation) and sharp pain (JOA score) were compared. The mean improvement of the range of motion was 55 degrees in flexion, 63 degrees in abduction, 28 degrees in external rotation and three vertebras in internal rotation, respectively. Moreover, for sharp pain (JOA score), the mean postoperative score improved to 22.2 points, compared to the preoperative 11.3 points. Arthroscopic manipulation for frozen shoulders was therefore effective for improving range of motion and sharp pain.
Clinical results of greater tuberosity fractures of the humerus were studied. Displacement of the greater tuberosity reguiring no reduction was determined. Twenty-two patients (14 men, eight women) were acute injuries (average age 52.5). Seven out of 22 patients underwent conservative treatment. Internal fixation was performed on the remaining 15 cases. Seven chronic patient (six men, one woman) with malunion of greater tuberosity underwent conservative treatment at other clinics. Both acute and chronic cases indicating a more than 4mm-displaced fragment of greater tuberosity fracture complained of disability due to impingement. We concluded that internal fixation should be performed on these more than 4mm-displaced fragment of the greater tuberosity fracture.
We treated three patients suffering from lower thoracic disc herniation. They consisted of one male aged 49 years and two females aged 79 years each. All patients presented with muscle weakness and gait inability due to compression of spinal cord and nerve roots. MRI and CTM revealed the location of disc herniation at T12/L1, T11/12 and T10/11 respectively. Removal of herniated disc was performed by posterior approach with fenestration of roots in two patients and with laminectomy in one. All three patients showed satisfactory recovery of motor function. Two returned to independent gait and one required a T-cane. Posterior approach for lower thoracic disc herniation may be beneficial in patients with lateral disc because it is less invasive and has little postoperative complications.
With reference to secondary hip-spine syndrome, pelvic inclination before total hip arthroplasty (THA) was investigated in 50 patients with osteoarthritis of the hip. The degree of pelvic inclination was estimated according to two methods, one the Doiguchi method using antero-posterior radiographs of the hip joint and pelvis (pelvic inclination index), and the other the method of Jackson using lateral radiographs of the hip joint to lumbar spine (pelvic angle). Pelvic inclination index decreased and pelvic angle increased with advancing age, or equivalently, the pelvis retroverted with age. There was a close correlation between pelvic inclination index and pelvic angle (R² =0.6264), suggesting that the pelvic inclination index measured based on antero-posterior radiographs of the hip joint may help estimate sagittal spinopelvic alignments. When performing THA on patients with severe pelvic retroversion, it may be necessary to place an acetabular socket in prospect of standing position or pelvic inclination in the future.
Alcaptonuria is rare metabolic disorder caused by deficiency of homogentisic acid enzyme. Ochronotic arthropathy is one of its late complications accompanied by pain and motion restriction of the spine, hips, knees, and shoulders. We report a case of a 61-year-old man with ochronotic hip arthropathy. The patient's radiograph showed rapid collapse of the femoral head. Total hip arthroplasty was carried out and short-term results were good.
We examined cases of adapted clinical pathway for herniated lumbar disk. A total of 43 patients underwent programmed partial laminectomy or osteoplastic hemi laminectomy. For partial laminectomy, patients were programmed to start walking three days after operation, and leave hospital at 14 days postoperatively. For osteoplastic hemi laminectomy, patients were programmed to start walking at five days, and leave hospital at 21 days postoperatively. Satisfaction index for the operation was generally high. Most of the patients wanted to start walking earlier than we programmed, and when slight variances happened after the patients started walking, we could change the clinical pathway. However, since satisfaction index was low for the length of hospital stay, we must consider how to use clinical pathways appropriately by collecting EBM.
Assimilation of the atlas is a rare disease, and this condition is characterized by a partial or complete congenital union between the atlas and the base of the occiput. We report two cases of assimilation of the atlas. A 32-year-old male had been suffering from neck stiffness, progressive numbness of the extremities and walking disturbance since he was 13 years old. Assimilation of the atlas associated with atlantoaxial instability was seen and spinal cord was compressed at the atlanto-occiput junction severely on MRI. Removal of the posterior arch of the atlas and occipito-cervical fusion was pertormed using instruments and the symptoms improved. A 51-year-old female lost consciousness which driving and collided into a concrete fence. She regained consciousness after a few minutes but experienced walking disturbance and right hand numbness. No intracranial lesion was found but MRI indicated a high signal area in the spinal cord at the occpitocervical junction. In addition to spinal cord injury, computed tomography revealed assimilation of the atlas, atlantoaxial subluxation, and os odontoideum. Loss of consciousness was considered resulting from vertebral artery insufficiency. After more or less the same surgery as the previous case, she could leave the hospital by walking and lead daily life without difficulties.
(Objective) Anterior spinal fusion was performed on patients who developed myelopathy as a result of mild cervical instability, and the results of treatment and degree of instability were investigated. (Subjects and Methods) Subjects were seven patients (four male, three female; ages 42 to 78 years; mean age 61.7) who developed myelopathy due to cervical instability after November 2001. JOA scores were compared before and after surgery, and cervical instability was assessed using plain X-ray (dynamic imaging). (Results) The degree of slippage of the cervical spine as assessed on plain X-rays ranged from 2 to 5 mm (mean: 3.3mm). The direction of slippage was forward in three patients and backward in four patients. Slippage was confirmed in one intervertebral space in six patients (C4/5 in three patients, C3/4 in two patients, and C5/6 in one patient) and in two intervertebral spaces in one patient (C3/4 and C4/5). In all patients, MRI confirmed a change in the spinal luminance in these areas. Preoperatively, the JOA score (maximum score of 17 points) ranged from 7 to 15 points (mean: 11.3 points), and postoperatively, it ranged from 11 to 17 points (mean: 14.2 points), thus confirming improvement. Although the patients were followed up for only a short period of time, the clinical courses for these patients were favorable.
Although anterior spinal decompression and fusion (ASF) is established for cervical myelopathy, some cases undergo re-operation because of disorders in the adjacent segment for a long-term. In our institution, twenty-five cases underwent laminoplasty for disorders in the adjacent segment after ASF. We evaluated risk factors by comparing re-operation cases with a control well natching in terns of age, sex, and postoperative terms. We examined diameter of spinal canal, stenosis of the adjacent segment to fusion performed in the first operation, pre-operative Japanese Orthopaedic Association score for cervical myelopathy, and preoperative cervical spine sagital alignment. Only stenosis of the adjacent segment to fusion performed in the first operation showed significant differences between the two groups. There were no significant differences for the other itens. Although ASF poses a high risk of re-operation compared with posterior surgery in the first time operation, ASF has some merits. Posterior surgery is not always considered superior to anterior surgery, however, only in terms of lower rate of re-operation.
Recently, there have been some reports that total hip arthroplasty in rapidly destructive coxarthrosis results in more perioperative blood loss and loosening of the acetabular component in early postoperative phase than regular coxarthrosis. We studied the clinical perioperative outcome in 26 total hip arthroplasties performed for rapidly destructive coxarthropathy and compared it with the outcome of 104 regular coxarthroses. Blood loss and loosening of acetabular components showed no difference between these two groups. The rate of dislocation after total hip arthroplasty in rapidly destructive coxarthrosis was greater than regular coxarthrosis.
We performed brachial plexus block under color doppler echo-guided using a nerve stimurator (axillary approach) on five patients. We used ultrasound (10 MHz transducers) and nerve stimurator, avoiding nerve injury and intravascular injection. General anesthesia was required in one patient for radial nerve pain. We recommend color doppler echo-guided brachial plexus block using a nerve stimurator for hand surgeries.
The prevalence of idiopathic carpal tunnel syndrome among housewives at or near the time of menopause supports the hypothesis that some physiological changes may render the nerve susceptible to compression at this particular period of life. The syndrome may occur even in the elderly. We investigated the preoperative status and outcome in elderly to compare with the so-called normal aged carpal tunnel syndrome (control group). The outcome of carpal tunnel release was evaluated retrospectively in 17 hands of 13 patients followed up over three months. Ages ranged from 66 to 93 years, with a median of 75 years. Three (five hands) were males and ten (12 hands) were females. Prevalence among the elderly was 35.4% out of all idiopathic carpal tunnel syndrome. Preoperative status was worse than the control group. Although postoperative motor nerve conduction recovered, velocity was insufficient because age was a risk factor for slowing of nerve conduction, and carpal tunnel release was effective in many cases. In three severe cases with marked atrophy of the thenar muscle, simultaneous opponens plasty was selected with carpal tunnel release. Pathological findings including tenosynovitis, edema, fibrosis, and hyalinization of synovium were more orless the same between the groups.
Six hemodialized patients suffering from fractures of the proximal humerus were treated surgically with intramedullary curved Kirschner wires. The average of patient age was 78 years (range: 68 to 90). One case was group 2 according to Neer's classification, and five cases were group 3. The method of anesthesia was brachial plexus block in five cases, and local anesthesia in one case with dementia. All patients achieved union of fractures and satisfactory results. This operative procedure, which has less surgical stress and provides sufficient stability for fractures of the proximal humerus, is considered to be very useful for patients with high risks of hemodialysis etc.
Four cases of subtalar dislocation were treated. All cases were men whose average age was 23 years (range from 16 to 32). These injuries occurred either from sports activities or traffic accidents. There were three lateral and one medial dislocations. One case involved in a traffic accident suffered calcaneal open fracture, and another case talar body fracture. Closed reductions under intravenous anesthesia was performed for closed dislocation in the emergency department and these were successful. Open reduction, debridement, and osteosynthesis under general anesthesia were performed on one case of calcaneal open fracture. Short leg cast or splint was applied for all cases after reduction. The mean period of immobilization was 40.5 days (range from 21 to 60). The mean period of partial weight bearing was 43 days (range from 29 to 60) after reduction. All patients complained of pain during sports activity or work, however arthritic change of the subtalar joint and avascular necrosis of the talus were not recognized.
We retrospectively reviewed and functionally assessed 13 patients with rheumatoid arthritis (RA) who had undergone ankle arthrodesis with an intramedullary nail. They were all female and followed for an average of 15 months (six to 39 months). The mean duration of RA was 19 years. We used the intramedullary nail with fins for 10 ankles, the ReVision nail (Smith & Nephew) for two ankles, and the Biomet Ankle Arthrodesis Nail for one ankle. Solid fusion was achieved in 11 out of 13 patients. Mean time to union was 4.2 months. The patients were able to bear weight fully in an average of four weeks after surgery. We believe that the intramedullary nail with fins can increase stability, allowing early weight bearing. To treat rheumatoid severe ankle deformities, partial or all resection of the talus was necessary for the correction of ankle alignment. The ReVision nail or the Ankle Arthrodesis Nail was useful for tibiocalcaneal fusion in such cases.