Neurologia medico-chirurgica
Online ISSN : 1349-8029
Print ISSN : 0470-8105
ISSN-L : 0470-8105
Volume 55, Issue 7
Displaying 1-12 of 12 articles from this issue
Review Articles
  • Ryu KUROKAWA, Phyo KIM
    2015 Volume 55 Issue 7 Pages 529-539
    Published: 2015
    Released on J-STAGE: July 15, 2015
    Advance online publication: June 29, 2015
    JOURNAL OPEN ACCESS
    Cervical laminoplasty was developed as an alternative to cervical laminectomy for treatment of cervical myelopathy, in which hinges are created to lift the lamina. Various techniques of laminoplasty have since been developed after two prototype techniques: Hirabayashi’s open-door laminoplasty and Kurokawa’s spinous process splitting (double-door) laminoplasty. Several in vitro studies report superior biomechanical stability of the cervical spine after laminoplasty compared with laminectomy. In clinical situation, randomized control studies are scarce and superiority of one procedure over another is not uniformly shown. Lack of hard evidence supporting the purported advantages of laminoplasty over laminectomy, that is, reduced rate of postoperative instability and kyphosis development, while preserving range of motion (ROM), has been a weak selling point. Currently, laminoplasty is performed by majority of spine surgeons in Japan, but is rarely performed in the United States and Europe. Recent development in laminoplasty is preservation of muscle attachment, which enabled dynamic stabilization of the cervical spine by neck extensor muscles. After treatment with new laminoplasty techniques with active postoperative neck ROM exercises, postoperative instability, kyphosis, axial neck pain, and loss of ROM seems minimal. Well-designed clinical trials to show the effectiveness and long-term outcome of this surgical procedure are warranted.
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  • Taku SUGAWARA
    2015 Volume 55 Issue 7 Pages 540-546
    Published: 2015
    Released on J-STAGE: July 15, 2015
    Advance online publication: June 29, 2015
    JOURNAL OPEN ACCESS
    Anterior cervical spine surgery is an established surgical intervention for cervical degenerative disease and high success rate with excellent long-term outcomes have been reported. However, indications of surgical procedures for certain conditions are still controversial and severe complications to cause neurological dysfunction or deaths may occur. This review is focused mainly on five widely performed procedures by anterior approach for cervical degenerative disease; anterior cervical discectomy, anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, anterior cervical foraminotomy, and arthroplasty. Indications, procedures, outcomes, and complications of these surgeries are discussed.
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Original Article
  • Masahito HARA, Yusuke NISHIMURA, Yasuhiro NAKAJIMA, Daisuke UMEBAYASHI ...
    2015 Volume 55 Issue 7 Pages 547-556
    Published: 2015
    Released on J-STAGE: July 15, 2015
    Advance online publication: June 29, 2015
    JOURNAL OPEN ACCESS
    Minimally invasive transforaminal lumbar interbody fusion (TLIF) as a short fusion is widely accepted among the spine surgeons. However in the long fusion for degenerative kyphoscoliosis, corrective spinal fixation by an open method is thought to be frequently selected. Our objective is to study whether the mini-open TLIF and corrective TLIF contribute to the improvement of the spinal segmental and global alignment. We divided the patients who performed lumbar fixation surgery into three groups. Group 1 (G1) consisted of mini-open TLIF procedures without complication. Group 2 (G2) consisted of corrective TLIF without complication. Group 3 (G3) consisted of corrective TLIF with instrumentation-related complication postoperatively. In all groups, the lumbar lordosis (LL) highly correlated with developing surgical complications. LL significantly changed postoperatively in all groups, but was not corrected in the normal range in G3. There were statistically significant differences in preoperative and postoperative LL and mean difference between the pelvic incidence (PI) and LL between G3 and other groups. The most important thing not to cause the instrumentation-related failure is proper correction of the sagittal balance. In the cases with minimal sagittal imbalance with or without coronal imbalance, short fusion by mini-open TLIF or long fusion by corrective TLIF contributes to good clinical results if the lesion is short or easily correctable. However, if the patients have apparent sagittal imbalance with or without coronal imbalance, we should perform proper correction of the sagittal spinal alignment introducing various technologies.
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Review Article
  • Kiyoshi ITO, Tatsuro AOYAMA, Yoshinari MIYAOKA, Tetsuyoshi HORIUCHI, K ...
    2015 Volume 55 Issue 7 Pages 557-563
    Published: 2015
    Released on J-STAGE: July 15, 2015
    Advance online publication: June 29, 2015
    JOURNAL OPEN ACCESS
    Cervical spinal neurinomas are benign tumors that arise from nerve roots. Based on their location, these tumors can also take the form of a dumbbell-shaped mass. Treatment strategies for these tumors have raised several controversial issues such as appropriate surgical indications and selection of surgical approaches for cervical dumbbell-shaped spinal neurinomas. In this report, we review previous literature and retrospectively analyze cervical spinal neurinoma cases that have been treated at our hospital. Surgical indications and approaches based on tumor location and severity are discussed in detail. Thus, with advances in neuroimaging and neurophysiological monitoring, we conclude that appropriate surgical approaches and intraoperative surgical manipulations should be chosen on a case-by-case basis.
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Original Articles
  • Murat YILMAZ, Ahmet KARAKASLI, Orhan KALEMCI, Ceren KIZMAZOGLU, Zafer ...
    2015 Volume 55 Issue 7 Pages 564-569
    Published: 2015
    Released on J-STAGE: July 15, 2015
    Advance online publication: March 23, 2015
    JOURNAL OPEN ACCESS
    The present study aimed to evaluate the clinical outcomes of patients who underwent asymmetrical posterior screw fixation for the treatment of unilateral posterior vertebral pathological entities. The study included 21 patients with a spinal tumor who underwent asymmetrical posterior spinal fusion surgery between April 2009 and March 2012. The American Spinal Injury Association (ASIA) motor score visual analog scale (VAS) score were used as the outcome measure at admission and follow-up. Among the 21 patients, 12 were male and 9 were female, and mean age was 50.71 (range, 24–78) years. Mean follow-up was 16.04 (range, 4–47) months. Postoperatively, neurological findings did not deteriorate in any of the patients. Among the ASIA grade C and D patients, eight (38%) of them exhibited clinical stability or recovery to ASIA E, whereas none of the ASIA B patients scores changed postoperatively. Perioperative complications were noted in six patients (28%). Spinal stability and fusion were achieved in 18 (85%) patients. The surgical asymmetrical fixation technique described reduced the duration of surgery, and the patients required less dissection of paraspinal muscles than bilateral symmetrical fixation. Asymmetrical fixation provides good stabilization for unilateral thoracolumbar vertebral pathological entities, and facilitates rapid rehabilitation of such patients, who are often elderly with comorbidities.
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  • Myung-Hoon SHIN, Jin-Sung KIM, Kyeong-Sik RYU, Jung-Woo HUR
    2015 Volume 55 Issue 7 Pages 570-577
    Published: 2015
    Released on J-STAGE: July 15, 2015
    Advance online publication: June 29, 2015
    JOURNAL OPEN ACCESS
    The purpose of this study was to determine the feasibility and efficacy of bilateral decompression procedure via microscopic tubular crossing laminotomy (MTCL) for treating lumbar spinal stenosis (LSS). Seventeen patients with LSS underwent bilateral decompression via an MTCL procedure in which tubular retractor was placed. The mean age was 72 (range 59–84) years and there were 10 men and 7 women. All patients underwent pre- and postoperative dynamic lumbar x-ray, magnetic resonance (MR) image, and computed tomography. To verify the efficacy of this technique, pre- and postoperative cross-sectional area (CSA) of thecal sac, facet resection, and fatty infiltration (FI) of multifidus were measured. Clinical results were evaluated using Oswestry Disability Index (ODI), back and leg visual analog scale (VAS). The mean follow-up period was 17.5 months (range 12.1–21.2). 70.5% of MTCL was performed at the level of L4–5 and one case of dural violation (5.8%) was noted at the level of L5–S1. The mean preoperative CSA was 70.5 mm2 (range 25.1–87.6) and it increased to 198.8 mm2 (range 177.3–219.2) postoperatively (p = 0.00). The mean facet resection rate was 18.4% (range 9.9–26.9) and no radiological instability was noted postoperatively. MR image showed no increase in FI of the multifidus after 12 months of follow-up (p = 0.53). Preoperative clinical symptoms improved significantly at postoperative 6 months and 12 months of follow-up. These results indicate that an MTCL with use of tubular retractor system can be an effective procedure to achieve neural decompression for the treatment of LSS and it may be beneficial in preserving both facet joint and multifidus muscle.
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  • Tao YANG, Liang WU, Huiliang WANG, Jingyi FANG, Ning YAO, Yulun XU
    2015 Volume 55 Issue 7 Pages 578-586
    Published: 2015
    Released on J-STAGE: July 15, 2015
    Advance online publication: June 29, 2015
    JOURNAL OPEN ACCESS
    Delayed neurological deterioration in the absence of direct spinal cord insult following surgical decompression is a severe postoperative complication in patients with chronic severe spinal cord compression (SCC). The spinal cord ischemia-reperfusion injury (IRI) has been verified as a potential etiology of the complication. However, the exact pathophysiologic mechanisms of the decompression-related IRI remain to be defined. In this study, we developed a practical rat model of chronic severe SCC. To explore the underlying role of inflammation in decompression-related IRI, immunoreactivity of pro-inflammatory cytokines including tumor necrosis factor-alpha (TNF-α) and interleukin-1β (IL-1β) before and after decompression were measured. In addition, expression level of TNF-α and IL-1β was examined with Western blot. Immunohistochemical staining showed negative result in gray matters in the sham group and sham-decompression group. In the severe compression group, strong positive staining of TNF-α and IL-1β were found, suggesting a dramatic infiltration of inflammatory cells in gray matters. Furthermore, the severe compression group showed a significant increase in expression level of TNF-α and IL-1β as compared with the sham group (p < 0.05). In the severe compression-decompression group, both immunostaining and Western blot showed significant increase of TNF-α and IL-1β levels in the spinal cord compared with the severe compression group (p < 0.05). The results demonstrated that surgical decompression plays a stimulative role in inflammation through increasing the expression of inflammatory cytokines in the rat model of chronic severe SCC injury. Inflammation may be one of the important pathological mechanisms of decompression-related IRI of chronic ischemia.
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  • Takashi ASAHI, Michi SATO, Hiroyuki KAJIMOTO, Masaki KOH, Daina KASHIW ...
    2015 Volume 55 Issue 7 Pages 587-591
    Published: 2015
    Released on J-STAGE: July 15, 2015
    Advance online publication: June 29, 2015
    JOURNAL OPEN ACCESS
    When the head is encircled with a wire clothes hanger and the unilateral fronto-temporal region is compressed, the head rotates unexpectedly. As the mechanism is unclear, however, we have temporarily named this phenomenon as the “hanger reflex.” We previously reported a case wherein this phenomenon was applied to treat cervical dystonia. Because little is known about this phenomenon, we determined how often this phenomenon is observed in healthy subjects. Study participants were 120 healthy Japanese adults (60 men and 60 women) aged 19–65 years. A wire clothes hanger was applied to each subject’s head. The longer side of the hanger was attached over the volunteer’s fronto-temporal regions on both sides of the head in succession (i.e., two applications per volunteer). We evaluated whether the subjects felt the sensation of head rotation by using a questionnaire. The sensation of head rotation was observed in 95.8% of subjects. There were five non-responders (4.2%). In 85.4% of the trials, head rotation was observed in the direction that coincided with the side compressed by the hanger. There were no differences in responses between genders. The incident rate of the hanger reflex was remarkably high and most likely represents a prevalent phenomenon in humans. The mechanism underlying the reflex remains unknown. Further research should be performed to elucidate the underlying causes of the hanger reflex, which represents a potential treatment for cervical dystonia.
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  • Kosuke KONDO, Masaaki NEMOTO, Hiroyuki MASUDA, Shinichi OKONOGI, Jun N ...
    2015 Volume 55 Issue 7 Pages 592-598
    Published: 2015
    Released on J-STAGE: July 15, 2015
    Advance online publication: June 29, 2015
    JOURNAL OPEN ACCESS
    We prepared rapid prototyping models of heads with unruptured cerebral aneurysm based on image data of computed tomography angiography (CTA) using a three-dimensional (3D) printer. The objective of this study was to evaluate the anatomical reproducibility and accuracy of these models by comparison with the CTA images on a monitor. The subjects were 22 patients with unruptured cerebral aneurysm who underwent preoperative CTA. Reproducibility of the microsurgical anatomy of skull bone and arteries, the length and thickness of the main arteries, and the size of cerebral aneurysm were compared between the CTA image and rapid prototyping model. The microsurgical anatomy and arteries were favorably reproduced, apart from a few minute regions, in the rapid prototyping models. No significant difference was noted in the measured lengths of the main arteries between the CTA image and rapid prototyping model, but errors were noted in their thickness (p < 0.001). A significant difference was also noted in the longitudinal diameter of the cerebral aneurysm (p < 0.01). Regarding the CTA image as the gold standard, reproducibility of the microsurgical anatomy of skull bone and main arteries was favorable in the rapid prototyping models prepared using a 3D printer. It was concluded that these models are useful tools for neurosurgical simulation. The thickness of the main arteries and size of cerebral aneurysm should be comprehensively judged including other neuroimaging in consideration of errors.
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Case Report
  • Satoshi OGIHARA, Junichi KUNOGI
    2015 Volume 55 Issue 7 Pages 599-604
    Published: 2015
    Released on J-STAGE: July 15, 2015
    Advance online publication: June 29, 2015
    JOURNAL OPEN ACCESS
    The surgical treatment of cervical kyphotic deformity remains challenging. As a surgical method that is safer and avoids major complications, the authors present a procedure of single-stage anterior and posterior fusion to correct cervical kyphosis using anterior interbody fusion cages without plating, as illustrated by three consecutive cases. Case 1 was a 78-year-old woman who presented with a dropped head caused by degeneration of her cervical spine. Case 2 was a 54-year-old woman with athetoid cerebral palsy. She presented with cervical myelopathy and cervical kyphosis. Case 3 was a 71-year-old woman with cervical kyphotic deformity following a laminectomy. All three patients underwent anterior release and interbody fusion with cages and posterior fusion with cervical lateral mass screw (LMS) fixation. Postoperative radiographs showed that correction of kyphosis was 39° in case 1, 43° in case 2, and 39° in case 3. In all three cases, improvement of symptoms was established without major perioperative complications, solid fusion was achieved, and no loss of correction was observed at a minimum follow-up of 61 months. We also report that preoperative total spine sagittal malalignment was improved after corrective surgery for cervical kyphosis and was maintained at the latest follow-up in all three cases. The combination of anterior fusion cages and LMS is considered a safe and effective procedure in cases of severe cervical kyphotic deformity. Preoperative total spine sagittal malalignment improved, accompanied by correction of cervical kyphosis, and was maintained at last follow-up in all three cases.
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Technical Note
  • Nobutaka HORIE, Kentaro HAYASHI, Minoru MORIKAWA, Tsuyoshi IZUMO, Izum ...
    2015 Volume 55 Issue 7 Pages 605-609
    Published: 2015
    Released on J-STAGE: July 15, 2015
    Advance online publication: March 27, 2014
    JOURNAL OPEN ACCESS
    Endovascular coil embolization for intracranial aneurysms, arteriovenous malformations (AVMs), dural arteriovenous fistulas (AVFs), and hypervascular tumors are recognized as an effective adjunctive or curative treatment. In this setting, it is sometimes difficult to navigate a coil delivery microcatheter to the target point of a tiny, tortuous vessel. We herein present a case series of a novel method that enabled super-selective coil embolization using an extremely soft bare, electrodetachable coil (ED extrasoft® coil) through a liquid embolic delivery microcatheter (Marathon®). The Marathon® catheter was successfully placed at the target point of the tiny, tortuous vessel, and coil embolization was achieved in all 16 patients with 9 AVMs, 2 distal aneurysms, 2 AVFs, and 3 meningiomas. The primary ED extrasoft® coil and delivery wire have a very small radius, and the coil is rapidly detachable with an alarm notice from the generator even under Marathon® with one marker. We believe that this technique can provide safe and efficient embolization for selected patients.
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