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2002 年 16 巻 3 号 p.
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2002 年 16 巻 3 号 p.
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原稿種別: 付録等
2002 年 16 巻 3 号 p.
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原稿種別: 目次
2002 年 16 巻 3 号 p.
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2002 年 16 巻 3 号 p.
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飯塚 秀明
原稿種別: Article
2002 年 16 巻 3 号 p.
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Nancy E. Epstein, Rob D. Dickerman
原稿種別: Article
2002 年 16 巻 3 号 p.
197-206
発行日: 2002/11/30
公開日: 2016/09/16
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Introduction : Seven of 67 patients undergoing plated single level anterior corpectomy and fusion (ACF) utilizing iliac crest autograft were evaluated with plain/dynamic X-ray and 2D-CT studies to assess the etiology of recurrent postoperative pain. Methods : Fixed (10 patients) and more recent dynamic ABC (Aesculap, Tuttlingen, Germany) plates (57 patients) were applied in patients undergoing single level ACF using non-reversed iliac crest autografts. Patients averaged 46 years of age and exhibited moderate preoperative myeloradiculopathy. Plain/dynamic X-rays and 2D-CT-studies performed 3, 6, and selectively up to 15 months postoperatively were utilized to document fusion progression. Cervico-thoracic orthoses (CTO) were worn until fusion was confirmed. Patients were followed an average of 3.0 years. Results : At 3 postoperative months, X-rays documented a 83% and 2D-CT studies confirmed a 50% fusion rate. At 6 postoperative months, X-rays documented 98% while 2D-CT confirmed only 70% fusion. By the 15th postoperative month, X-rays documented fusion in 96% of patients, while only 90% demonstrated 2D-CT evidence of fusion. Seven (10%) of 67 patients who had fused developed delayed autograft fractures between 6 months to 2 years postoperatively. Four sustained X-ray and 2D-CT documented mid-graft fractures, while 3 cephalad/caudad end plate fractures were identified only on 2D-CT examinations. After 6 months of additional CTO bracing, 3 patients with end plate fractures fused spontaneously, while 4 patients with mid-graft fractures required secondary posterior arthrodesis with ultimate fusion. Discussion : Few series report on recurrent pain associated with delayed strut fractures following single level ACF, as they are typically reliant on X-ray studies alone. Conclusions : Recurrent cervical pain signaled delayed autograft strut fractures in 7 (10.4%) of 67 patients undergoing plated single level ACF. Two-dimensional CT and X-ray studies identified 4 mid-strut fractures, while only 2D-CT studies identified 3 fractures occurring at the extreme cephalad or caudad end plates.
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Praveen V. Mummaneni, Jahnavi K. Srinivasan, W. Haid Jr. Regis, Junich ...
原稿種別: Article
2002 年 16 巻 3 号 p.
207-216
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Anterior cervical discectomy and fusion has progressed over the last century from the use of no bone graft, to the use of autograft, to the use of allograft, and finally to supplementation with anterior cervical plate fixation. Anterior cervical plate fixation has been shown to enhance anterior cervical arthrodesis following anterior cervical discectomy and anterior cervical corpectomy. We present an overview of anterior cervical plating, summarize its historical evolution, describe the Cervical Spine Study Group classification of anterior cervical plates, review clinical outcome studies following plate fixation, and report on continued advances in anterior cervical arthrodesis.
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Koang Hum Bak, Hyeong Joong Yi, Jae Min Kim, Choong Hyun Kim, Seong Ho ...
原稿種別: Article
2002 年 16 巻 3 号 p.
217-224
発行日: 2002/11/30
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Endoscope assisted microsurgery (EAM) was performed on thirteen patients with single level unilateral compressive cervical radiculopathy to reduce the skin incision and evaluate the efficacy of using a minimally invasive technique for the anterior decompression of cervical diseases and their clinical results. Using the (MED)^<TM> system, anterior cervical foraminotomy has been applied to thirteen patients with unilateral radiculopathy due to posterolateral osteophyte or soft disc herniation. Nerve roots were decompressed successfully under endoscopic control as in conventional microsurgical foraminotomy. Postoperatively, all patients showed improvement in their radicular symptoms and satisfactory anatomical decompression in corresponding CT scans. There was no postoperative instability, and all patients showed a fibrous union of the disc on long-term follow-up examination. Foraminotomy using EAM for cervical spine disease has resulted in good clinical outcome with fast recovery.
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西浦 司, 丸尾 智子, 河田 幸波, 荻原 浩太郎, 後藤 正樹, 津野 和幸
原稿種別: 本文
2002 年 16 巻 3 号 p.
225-232
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高齢者に対する脊椎instrumentation手術の問題点とその対策について述べた.高齢者の脊椎は脆弱であることを常に念頭に置き, 個々の病態を十分検討した上で綿密な手術計画を立て, 脊椎instrumentを適切に選択使用すれば脊椎instrumentation手術は高齢者に対しても安全かつ有用な治療手段となると確信する.
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寳子丸 稔, 小山 素麿
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2002 年 16 巻 3 号 p.
233-240
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Purpose : It is important to make a correct diagnosis of spinal dural arteriovenous fistulae (SDAVF) because the possibility of neurological improvements after correct treatment of this disease is strong. We studied the clinical characteristics of SDAVF. Materials & Methods : Between 1983 and 2001, 15 patients with SDAVF were surgically treated at our hospital. The 2 women and 13 men had a mean age of 59.8 years (range, 41-74 yr). At the time of their admission, five patients had a provisional diagnosis of intramedullary tumor, multiple sclerosis, or ossification of yellow ligament. The average duration of symptoms before the correct diagnosis was 24 months. All patients had motor weakness and sensory disturbance of lower extremities, which occurred insidiously in 11 patients or abruptly in 4 patients. Results : MRI scans were performed in 13 patients. T2-weighted MRI scans showed a diffuse high intensity area within the spinal cord in all patients examined. Swelling of the spinal cord was demonstrated in 85%, and gadolinium-enhanced areas were observed in 91%. The fistulae were located at the craniovertebral junction (1 case), thoracolumbar region (13 cases) and sacral portion (1 case). Three patients had multiple fistulae. Fistulae were coagulated and removed at the intradural and/or extradural areas. Symptoms improved in 9, remained unchanged in 5 and worsened in 1 patient after the treatment. Discussion and Conclusion : There may be several pitfalls in the diagnosis and treatment of this disease. Accurate knowledge of the clinical characteristics of this disease is essential for the correct diagnosis and treatment. In addition, a thorough angiographic study is also required because fistula may be located outside the thoracolumbar region and may be multiple.
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井上 洋, 西 秀夫, 永関 慶重, 小林 聡, 栗原 秀行
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2002 年 16 巻 3 号 p.
241-246
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Cranio-cervical fixation with instrumentation and cranial bone graft was performed for patients with atlantoaxial vertical subluxation (AAVS) due to bone anomalies of cranio-cervical junction. The five patients treated were all female with ages ranging from 49 to 73 years (mean : 60.2 yr). Symptoms were tetraparesis, weakness of the bilateral upper extremities, sensory disturbances, paresthesia, and neck pain. Accompanying bone anomalies were atlanto-occipital assimilation, hypoplasia of the atlas, os odontoideum, and block vertebrae. After correction of AAVS by traction using a halo-vest, symptoms were improved in all patients. Cranio-cervical fixation using an Olerud cervical fixation system with bone graft taken from some portion of occipital bone with or without foramen magnum decompression was performed under the halo-vest traction. No complications occurred during or after operation. All patients have been able to resume the daily activities of housewives in follow-up periods up to 5 years 4 months. Occipito-cervical (C2) bony fusion was completed and no recurrence of symptoms has been observed to date. The Olerud cervical fixation system with a cranial bone graft is safe and effective for the treatment of AAVS due to bone anomalies, although limitation of rotation neck movement is occurred by occipital and trans-articular screw fixation.
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雄山 博文, 池田 公, 天野 泉, 森田 弘之, 井上 繁雄, 佐藤 元美, 依馬 弘忠, 勝又 瞬, 渋谷 正人
原稿種別: 本文
2002 年 16 巻 3 号 p.
247-254
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The experience of cervical destructive spondyloarthropathy in 9 hemodialysis patients is reported and a favorable operative method is discussed from the viewpoint of analysis of the x-ray findings. Cervical destructive spondyloarthropathy was mainly found in the C3-4, C4-5 level in 5 cases and in the C4-5, C5-6 level in 3 cases. Kyphotic deformity frequently existed around the C4 and C5 level. Overall, anterior displacement of the 3rd vertebra over the 4th vertebra and posterior displacement of the 5th vertebra over the 6th vertebra were observed most frequently. The vertebral body was deformed at the 4th and 5th vertebral level. During the surgical procedure, the compressed vertebral body should be decompressed anteriorly as much as possible and bone transplantation should be performed between the normal vertebral bodies. Internal fixation should be done with an anterior cervical plate system and/or a pedicle screw system when intervertebral fusion is performed at more than two levels. In addition, external fixation with a Halo vest might be necessary in some cases.
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渡辺 敦史, 本郷 一博, 高澤 尚能, 多田 剛, 小林 茂昭
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2002 年 16 巻 3 号 p.
255-260
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We report a surgical case of a huge C1 neurinoma causing sudden onset of tetraplegia. A 45-year-old man, who had suffered from occipitalgia, numbness and mild motor weakness of the four extremities, became tetraplegic just after a cervical hyperextension injury. An MRI revealed a huge intradural mass severely compressing the medulla oblongata and upper cervical spinal cord. Suboccipital craniectomy, laminectomy from C1 to C3 and tumor biopsy were urgently performed. The histological examination confirmed a neurinoma. Although the tetraplegia slightly improved after decompression surgery, the symptoms worsened again. Ten days after the first surgery, the tumor was totally removed. The symptoms improved remarkably following the second surgery and the patient was discharged ambulatory. He returned to his previous job 6 months after surgery. Diagnosis of neurinomas in this region is difficult simply from the clinical states in the early stage. The possibility of this lesion must be considered when seeing a patient with occipitalgia, numbness and mild motor weakness of the four extremities even if those symptoms are subtle. Even when symptoms are severe, marked improvement can be expected following surgery.
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川口 務, 河野 輝昭, 金子 好郎, 大浅 貴朗, 小笠原 貞信, 魚住 洋一, 横山 博明, 福田 清輔
原稿種別: 本文
2002 年 16 巻 3 号 p.
261-268
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We studied three patients with craniocervical junction dural arteriovenous fistulae (CCJ-DAVF). Although more than thirty cases with CCJ-DAVF had been reported, the clinical features, diagnosis and treatment of CCJ-DAVF remain unclear. We reported on our three patients with CCJ-DAVF. Two cases involved an intracranial hemorrhage and the third was found incidentally. In all cases, direct surgery was performed and the draining vein was interrupted. Complete cure in the three cases was confirmed on postoperative angiography. It was difficult to distinguish CCJ-DAVF from craniocervical junction perimedullary arteriovenous fistula (CCJ-PAVF). Intraoperative digital subtraction angiography was useful in confirming the diagnosis of CCJ-DAVF. We reviewed the reported cases with CCJ-DAVF and studied the clinical features, neuroladiological findings, and surgical management of CCJ-DAVF.
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岩崎 喜信
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2002 年 16 巻 3 号 p.
269-
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2002 年 16 巻 3 号 p.
270-
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原稿種別: 付録等
2002 年 16 巻 3 号 p.
271-
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原稿種別: 付録等
2002 年 16 巻 3 号 p.
272-
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2002 年 16 巻 3 号 p.
273-
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諏訪 英行
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2002 年 16 巻 3 号 p.
274-
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内門 久明
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2002 年 16 巻 3 号 p.
275-
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2002 年 16 巻 3 号 p.
276-277
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原稿種別: 付録等
2002 年 16 巻 3 号 p.
278-
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2002 年 16 巻 3 号 p.
279-
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2002 年 16 巻 3 号 p.
280-
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2002 年 16 巻 3 号 p.
281-283
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2002 年 16 巻 3 号 p.
284-
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2002 年 16 巻 3 号 p.
285-
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原稿種別: 付録等
2002 年 16 巻 3 号 p.
286-288
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原稿種別: 付録等
2002 年 16 巻 3 号 p.
289-
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原稿種別: 付録等
2002 年 16 巻 3 号 p.
290-
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原稿種別: 付録等
2002 年 16 巻 3 号 p.
291-
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原稿種別: 付録等
2002 年 16 巻 3 号 p.
292-
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2002 年 16 巻 3 号 p.
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2002 年 16 巻 3 号 p.
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原稿種別: 表紙
2002 年 16 巻 3 号 p.
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