巻号一覧
52 巻, 9 号
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Original Article
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Yoshitaka HIRANO, Junichi MIZUNO, Masaaki TAKEDA, Yasunobu ITOH, Hiden ...2012 年 52 巻 9 号 p. 625-630
発行日: 2012年
公開日: 2012/09/25
ジャーナル オープンアクセスWe report our early clinical experience with percutaneous endoscopic lumbar discectomy (PELD) for herniated nucleus pulposus (HNP) in the lumbar spine. We introduced PELD to our clinical practice in June 2009. A total of 311 patients with degenerative lumbar spine disease were treated in our hospital up to August 2011. Thirty-seven patients with lumbar HNP were treated by PELD. PELD was carried out under local anesthesia, and the endoscope was continuously irrigated with saline. Twenty-eight patients were treated through the transforaminal approach, 5 were treated through the interlaminar approach, and 4 were treated through the extraforaminal approach. Surgery was discontinued due to uncontrollable intraoperative pain or anatomical inaccessibility in one case of the interlaminar approach and 2 cases of the extraforaminal approach. In the other 34 patients, the elapsed time of surgery was 34 to 103 minutes (mean 62.4 minutes). Extracorporeal blood loss was insignificant. Immediate symptom relief was achieved in all patients, and postoperative magnetic resonance imaging revealed sufficient removal of the HNP. The length of the postoperative hospital stay was 1 or 2 days in all patients. The surgical method of PELD is completely different from percutaneous nucleotomy, and the aim is to directly remove the HNP with minimum damage to the musculoskeletal structure. Although this study is based on our early clinical outcomes, PELD seemed to be a promising minimally invasive surgery for HNP in the lumbar spine.
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Case Reports
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—Case Report—Yukihiro WAKABAYASHI, Yuzo HORI, Yayoi KONDOH, Tomoshige ASANO, Akira ...2012 年 52 巻 9 号 p. 631-633
発行日: 2012年
公開日: 2012/09/25
ジャーナル オープンアクセスA 74-year-old woman was admitted to our hospital due to severe nuchal pain and occipitalgia. Neurological examination found neck stiffness but no throat pain or dysphagia. Blood examination showed slight elevation of white blood cell count, but C-reactive protein level was normal. Cerebrospinal fluid examination found no abnormalities. Computed tomography (CT) and magnetic resonance (MR) imaging demonstrated no abnormalities in the brain. Cervical CT showed a small calcification in front of the C1 body. Cervical T2-weighted MR imaging showed a high intensity area in front of the upper cervical vertebral body from C1 to C4, suggesting inflammation of the longus colli muscles. We diagnosed acute calcific prevertebral tendonitis. She was administered nonsteroidal anti-inflammatory drugs. Her symptoms gradually improved and she was discharged without neurological deficit 8 days after admission. It is important to be aware of the possibility of this rare disease in a patient with severe occipitalgia but no sign of intracerebral lesion.
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—Case Report—Min-Soo KANG, Yong-Hwan SHIN, Choon-Dae LEE, Sang-Ho LEE2012 年 52 巻 9 号 p. 633-636
発行日: 2012年
公開日: 2012/09/25
ジャーナル オープンアクセスA 79-year-old woman developed neurological deficits 6 weeks after the onset of a thoracic osteoporotic compression fracture. Magnetic resonance (MR) imaging of the thoracic spine revealed an epidural hematoma at the T10-L2 levels. Acute decompressive laminectomy and percutaneous vertebroplasty were performed. Following the surgery, the patient's neurologic deficits improved and follow-up MR imaging showed complete resolution of the hematoma. Spinal epidural hematomas are rare and associated delayed neurological deficits are extremely rare. Conservative treatment may be effective for epidural hematomas in neurologically intact patients, but epidural hematomas can be a cause of neural compression and symptomatic deterioration resulting in delayed neurological deficits during the follow-up period
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—Case Report—Daisuke WAJIMA, Hiroshi YOKOTA, Yuki IDA, Hiroyuki NAKASE2012 年 52 巻 9 号 p. 636-639
発行日: 2012年
公開日: 2012/09/25
ジャーナル オープンアクセスA 78-year-old female fell and hit the back of her head on the floor. Head computed tomography (CT) showed right acute interhemispheric subdural hematoma (ISDH). Her left hemiparesis worsened, so partial removal of ISDH was performed. The hemiparesis was improved, but leg monoparesis persisted. Lumbar magnetic resonance imaging showed spinal subdural hematoma (SSDH) at the S1-2 level. Nerve conduction velocity measurements at the knee joint to lower limb showed disappearance of the left peroneal nerve conduction wave, indicating that one of the causes of drop foot was common peroneal nerve palsy. With conservative therapy, her drop foot was gradually improved, then she recovered to walk with a stick and moved to a rehabilitation hospital. Lumbar MR imaging should be performed to rule out SSDH in a patient with posterior fossa subdural hematoma on initial head CT who develops leg palsy.
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—Case Report—Tae YAMASHITA, Hisaya HIRAMATSU, Naoto SAKAI, Hiroki NAMBA2012 年 52 巻 9 号 p. 640-643
発行日: 2012年
公開日: 2012/09/25
ジャーナル オープンアクセスA 37-year-old man with C4-5 spinal cord injury (SCI) presented with abnormally high blood pressure after vesicocutaneous catheter exchange and was treated with antihypertensive agents. Two weeks later, he developed headache and visual disturbance, and presented with fluctuating blood pressure. Multiple subcortical hemorrhages in the left occipital and right frontal lobes occurred on the next day, and he died of increased intracranial pressure 3 weeks later. Based on the symptoms and computed tomography findings, the retrospective diagnosis was posterior reversible encephalopathy syndrome (PRES) due to autonomic dysreflexia (AD). AD occurs frequently in patients with quadriplegia and high paraplegia by distention of the bladder and bowel. PRES secondary to AD is very rare, but we must always be aware of this life-threatening complication in SCI patients.
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—Case Report—Yuichi TAKAHASHI, Kenki NISHIDA, Koichi OGAWA, Takao YASUHARA, Shinji ...2012 年 52 巻 9 号 p. 643-645
発行日: 2012年
公開日: 2012/09/25
ジャーナル オープンアクセスA 69-year-old woman presented with a rare case of multiple supra- and infratentorial intracranial hemorrhages after cervical laminoplasty for cervical spondylotic myelopathy without intraoperative liquorrhea. A wound drainage tube under negative pressure was placed with subsequent 380 ml of drainage in the first 12 hours. She had no complaint of headache and nausea at that time. Computed tomography of the brain obtained at 15 hours after surgery demonstrated cerebellar hemorrhage, acute subdural hemorrhage, subarachnoid hemorrhage, supratentorial intraparenchymal hemorrhage, and pneumocephalus. She was treated medically without consequent neurological deficits other than right hemianopsia. Overdrainage of cerebrospinal fluid through an occult dural tear might cause severely low intracranial pressure with subsequent multiple intracranial hemorrhages. Wound drainage should be controlled thoroughly even in patients without intraoperative liquorrhea.
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—Case Report—Zhao-Jian LI, Peng SUN, Yi-He DOU, Xiao-Lei LAN, Jian XU, Chun-Yong ZH ...2012 年 52 巻 9 号 p. 646-648
発行日: 2012年
公開日: 2012/09/25
ジャーナル オープンアクセスA 14-year-old girl presented with a rare case of spontaneous bilateral supratentorial epidural hematomas which developed rapidly following cervical surgery. The hematomas presumably resulted from dural dynamics changes secondary to cerebrospinal fluid loss and intracranial hypotension. Intracranial epidural hemorrhage after spinal surgery is extremely uncommon with only one previous case report. Spontaneous intracranial epidural hematoma is an extremely rare complication, but should be considered as a possible complication of spine surgery, especially in adolescents complicated by delayed consciousness and breathing restoration from anesthesia. This case report expands the presently known clinical spectrum of this uncommon complication.
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—Case Report—Kyeong-Sik RYU, Nitesh Kumar RATHI, Myung-Hoon SHIN, Chun-Kun PARK2012 年 52 巻 9 号 p. 649-651
発行日: 2012年
公開日: 2012/09/25
ジャーナル オープンアクセスA 72-year-old man presented with gas-containing disc herniations resulting in dual nerve root (exiting and traversing root) compression at the single level manifesting as lower back pain with the right anterolateral thigh and medial calf pain and no response to 4 weeks of conservative treatment. Physical examination revealed positive Lasegue's sign at 40°, but the patient had no evidence of neurological deficit. Magnetic resonance imaging showed two separate disc herniations, a posterocentral herniated disc that had migrated inferiorly at the L3-4 level and compressed the L4 traversing root, and another that had compressed the L3 exiting root in the extraforaminal area at the same level. Coronal computed tomography demonstrated the presence of gas in the spinal canal and extraforaminal area at the L3-4 level, and the vacuum phenomenon was also noted at the L3-4 intervertebral disc. Microscopic discectomy was performed using midline and paramedian approaches, and the presence of gas was confirmed by bubbles after pouring saline into the area intraoperatively. Histological examination revealed fibrous tissue. The patient was discharged with complete relief of pain. This is a rare case of symptomatic gas-containing disc herniations causing dual compression of exiting and traversing roots at a single disc level.
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—Case Report—Hiroyuki IKEDA, Junya HANAKITA, Toshiyuki TAKAHASHI, Keita KURAISHI, M ...2012 年 52 巻 9 号 p. 652-656
発行日: 2012年
公開日: 2012/09/25
ジャーナル オープンアクセスA 21-year-old woman presented with cervical myelopathy due to nontraumatic cervical disc herniation associated with cervical canal stenosis. The patient underwent removal of the herniated disc and anterior fusion with an autogenous iliac crest bone graft. After surgery, the patient showed satisfactory improvement. Cases of cervical disc herniation in our center and reported cases without cervical trauma in either young adults or in childhood were reviewed retrospectively. We discuss the pathogenesis of cervical disc herniation in our young patient in the context of these other cases. Cervical disc herniation rarely occurs before the age of 30 years. A history of cervical trauma and preexisting fusion of the cervical spine are risk factors for cervical disc herniation. The present case is the youngest known of nontraumatic disc herniation without other underlying disease. Hypermobility due to neck cracking and a relatively narrow spinal canal might have been important in causing cervical myelopathy by disc herniation.
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—Case Report—George DIMOGERONTAS, Nikolaos A. PAIDAKAKOS, Epaminondas KONSTANTINIDI ...2012 年 52 巻 9 号 p. 656-658
発行日: 2012年
公開日: 2012/09/25
ジャーナル オープンアクセスA 56-year-old man presented with a rare case of a voluminous herniated disc fragment mimicking an intraspinal extradural tumor on magnetic resonance (MR) imaging. He had experienced low back pain and sciatica in his right leg for 12 months, which exacerbated suddenly 4 days before admission accompanied by right quadriceps muscle weakness. MR imaging with gadolinium demonstrated a tumor-like longitudinal lesion, extending from the L1-2 to the L3-4 intervertebral disc spaces and occupying most of the right half of the vertebral canal. L2 and L3 laminectomy, as well as L2-3 right foraminotomy, were performed. We were prepared for an oncological operation, but instead, a huge disc fragment was removed en bloc from the right epidural space. The patient's postoperative course was uneventful and he demonstrated full neurological recovery within 2 months. Sequestrated lumbar disc fragments must be considered in the differential diagnosis of longitudinal extradural mass lesions in the spinal canal independently of their size. MR imaging with contrast medium can differentiate herniated disc from tumors and other epidural lesions. Nevertheless, nontypical sequestrated disc herniations are extremely rare and can be misinterpreted.
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—Case Report—Yusuke NISHIMURA, Masahito HARA, Atsushi NATSUME, Masaya TAKEMOTO, Ryu ...2012 年 52 巻 9 号 p. 659-665
発行日: 2012年
公開日: 2012/09/25
ジャーナル オープンアクセスA 56-year-old man presented with a rare intra-extradural dumbbell-shaped hemangioblastoma in the lumbar spine associated with von Hippel-Lindau (VHL) disease manifesting as subarachnoid hemorrhage. The tumor, which was exiting at the right L2-3 intervertebral foramen, was removed successfully by total facetectomy and posterior spinal fusion at the L2-3 segment. Nine years later, a recurrent tumor due to VHL was also totally removed with minimal neurological complications. Accurate diagnosis of this vascular-rich lesion is essential for developing an adequate surgical strategy. The dumbbell-shaped tumor requires total facetectomy and spinal reconstruction, and care should be taken to preserve the entire nerve root origin by only identifying the affected nerve fascicles at the origin, if possible. Postoperative adhesion must be minimized for second surgery in patients with genetic disease such as VHL, who are likely to suffer recurrence.
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—Case Report—Yoichi KANEKO, Kazutoshi YAMABE, Masamitsu ABE2012 年 52 巻 9 号 p. 665-669
発行日: 2012年
公開日: 2012/09/25
ジャーナル オープンアクセスA 48-year-old man presented with a 2-week history of progressive gait disturbance. Neurological examinations showed mild weakness in his lower extremities and depreciation of deep sensation. Magnetic resonance (MR) imaging showed an intradural extramedullary enhanced lesion at the levels of the T10 and T11 vertebrae. Laminectomy of the T10 and T11 vertebrae was performed, and the vascular tumor on the spinal cord surface was completely resected. Histological analysis indicated that the lesion was a capillary hemangioma with an elevated proliferative index. Postoperatively, the patient showed rapid motor and sensory improvement. However, 6 months after the operation, MR imaging showed regrowth of the tumor although the clinical symptoms of the patient had not deteriorated. The patient has shown no tumor regrowth 9 years after the second operation. Capillary hemangiomas in the skin and soft tissues are often associated with high proliferative activity, and recurrence/regrowth is not infrequent. On the other hand, recurrence/regrowth of capillary hemangioma in the neuraxis after tumor resection has rarely been observed, even in cases of incomplete resection. The present case illustrates the treatment of recurrent capillary hemangioma of the spinal cord.
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—Case Report—Toru SASAMORI, Kazutoshi HIDA, Shunsuke YANO, Takeshi AOYAMA, Takeshi ...2012 年 52 巻 9 号 p. 670-674
発行日: 2012年
公開日: 2012/09/25
ジャーナル オープンアクセスA 25-year-old man presented with malignant transformation to malignant peripheral nerve sheath tumor (MPNST) in the cervical spine associated with neurofibromatosis type 1. He presented with a 3-week history of rapidly increasing weakness and numbness in all four extremities. Magnetic resonance (MR) imaging of the cervical spine demonstrated a dumbbell-shaped tumor, which compressed the spinal cord at the C2-3 level. The tumor was excised, mainly within the spinal canal to decompress the spinal cord. The histological diagnosis was benign neurofibroma. Three months after surgery, he rapidly developed progressive tetraparesis and MR imaging revealed marked regrowth of an extradural mass into the spinal canal. At reoperation, the regrown mass in the spinal canal was totally excised. The histological diagnosis revealed MPNST. He underwent radiation therapy, with a total dose of 32 Gy, for approximately 3 weeks after the second surgery, but MR imaging showed tumor regrowth within the spinal canal, and his condition deteriorated. The decision was made to remove the tumor radically, including the involved facet and extradural lesion. Posterior fusion using a pedicle screw was performed one month later. He manifested no additional neurological deficits. He has been free of relapse for 46 months. Radical resection remains the most effective treatment for MPNST, although complete removal with a clear tumor margin is often impossible in practice.
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—Case Report—Yoshifumi KAWANABE, Masahiro SAWADA, Hiroyuki YUKAWA, Shigeo UEDA, Nob ...2012 年 52 巻 9 号 p. 675-678
発行日: 2012年
公開日: 2012/09/25
ジャーナル オープンアクセスA 54-year-old man presented with a very rare case of radiation-induced intramedullary spinal cord anaplastic astrocytoma, which developed 37 years after radiotherapy for testicular seminoma. The patient presented with weakness and numbness of the left lower extremity that had gradually aggravated for 3 months. Magnetic resonance imaging demonstrated an intramedullary mass lesion with syringomyelia at the T9 to T12 levels. Subtotal removal of the tumor was performed using standard microsurgical technique. Histological examination revealed anaplastic astrocytoma. Although radiotherapy was seriously considered, chemotherapy was employed as adjuvant therapy considering the previous treatment. Although his neurological status improved transiently after surgery, relentless neurological decline occurred and resulted in death 9 months following surgery. Considering that subtotal removal of the tumor and chemotherapy had little influence on the quality of life and the length of survival in our case, cordectomy may be the optimum treatment for patients with radiation-induced spinal intramedullary malignant astrocytoma.
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—Case Report—Motoyuki IWASAKI, Kazutoshi HIDA, Shunsuke YANO, Takeshi AOYAMA, Sadah ...2012 年 52 巻 9 号 p. 679-683
発行日: 2012年
公開日: 2012/09/25
ジャーナル オープンアクセスA 69-year-old man presented with a very rare case of primary central nervous system lymphoma originating in the cauda equina manifesting as progressive paraparesis. The patient underwent a biopsy, and was treated with intravenous high-dose (3.5 g/m2) methotrexate chemotherapy and local irradiation. Histological study revealed large B cell type lymphoma. Follow-up magnetic resonance imaging showed complete remission of the lesion, but the patient died of pneumonia at 18 months after the initial onset without tumor recurrence, so the efficacy of this strategy remains unknown.
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—Case Report—Yuiko KIMURA, Atsushi SEICHI, Akira GOMI, Masahiro KOJIMA, Hirokazu IN ...2012 年 52 巻 9 号 p. 683-686
発行日: 2012年
公開日: 2012/09/25
ジャーナル オープンアクセスA 65-year-old woman with a history of rheumatoid arthritis presented with a rare case of acquired Chiari malformation secondary to atlantoaxial vertical subluxation, associated with congenital atlanto-occipital assimilation. Syringomyelia and tetraparesis improved immediately after posterior fossa decompression and simultaneous occipito-cervical junction fusion. The progression of acquired Chiari malformation is not well known. We concluded that coexisting assimilation accelerated crowded foramen magnum following atlantoaxial vertical subluxation and induced acquired Chiari malformation over the course of a few years.
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—Case Report—Shunsuke ISHIZAKA, Kentaro HAYASHI, Munehiro OTSUKA, Shuji FUKUDA, Kei ...2012 年 52 巻 9 号 p. 686-690
発行日: 2012年
公開日: 2012/09/25
ジャーナル オープンアクセスA 66-year-old woman with primary Sjogren syndrome developed syringomyelia following two episodes of subarachnoid hemorrhage (SAH) due to the rupture of basilar artery aneurysms. Gait disturbance and abnormal sensation with pain over the foot and abdomen appeared 3 years after the last SAH. Magnetic resonance (MR) imaging revealed a syringomyelia throughout the thoracic cord, from the T2 to T11 levels. In addition, the thoracic cord was compressed by multiple arachnoid cysts in the ventral side of spinal cord. Computed tomography myelography revealed complete block of cerebrospinal fluid (CSF) flow at the T7 level. Surgery for microlysis of the adhesions and restoration of the CSF flow pathway was performed. Postoperatively, leg motor function slowly improved and she could walk unaided. However, abdominal paresthesia was persisted. Postoperative MR imaging revealed diminished size of the syrinxes. We should recognize syringomyelia and arachnoid cysts due to adhesive arachnoiditis as a late complication of SAH. Microlysis of the adhesions focusing on the lesion thought to be the cause of the symptoms is one of the choices to treat massive syringomyelia and arachnoid cysts associated with arachnoiditis following SAH.
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Technical Note
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—Technical Note—Tomosato YAMAZAKI, Susumu YASUDA, Kazuya UEMURA, Akira MATSUMURA2012 年 52 巻 9 号 p. 691-694
発行日: 2012年
公開日: 2012/09/25
ジャーナル オープンアクセスSufficient bone decompression of osteophytes is important for positive functional outcomes in anterior cervical spine surgery. Achieving good alignment and bone fusion in anterior cervical decompression and fusion requires a bone graft bed of the optimum size and shape. We have developed a stainless steel instrument named the anterior fusion spinal fork, which is designed to aid in accurately drilling the bone cavity, thus enabling selection of the correct size of bone graft or bone graft substitutes. The device has an open design with 4 prongs, and resembles a three-dimensional fork. This instrument assists in guiding the direction of drilling, and marking the drilling point of the graft cavity with pyoctanin markers. We have used this instrument in 40 cases of anterior cervical spine surgery using the modified Smith-Robinson procedure since March 2000. This simple instrument allowed us to design and construct a bone graft cavity of the correct size and shape for iliac bone graft or bone graft substitutes for anterior cervical spine surgery.
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Editorial Committee
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2012 年 52 巻 9 号 p. EC17-EC18
発行日: 2012年
公開日: 2013/02/16
ジャーナル オープンアクセスPDF形式でダウンロード (52K)
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