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2003 年 17 巻 2 号 p.
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2003 年 17 巻 2 号 p.
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2003 年 17 巻 2 号 p.
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2003 年 17 巻 2 号 p.
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2003 年 17 巻 2 号 p.
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角家 暁
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2003 年 17 巻 2 号 p.
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原田 範夫
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2003 年 17 巻 2 号 p.
81-88
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Object : For anterior cervical fusion, hydroxyapatite (HA) grafts have been used extensively among Japanese neurosurgeons. Many different types of HA grafts have been devised and are being marketed in Japan. However, there are still no ideal grafts. New graft : The author devised a new type of compound HA column graft which is composed of the anterior portion (40% porosity) and the posterior portion (50%). This graft is 12mm in diameter (10 and 14mm are also available), while the anterior portion is 5mm in length and the posterior portion is 15mm. The compound structure was designed to replicate the autograft's cortical bone and the cancelleus bone. The hard anterior portion is strong enough to bear stress to the intervertebral space, and the soft posterior portion is more easily unified vertebral bone. Method and results : With this new HA graft, 146 patients were operated on by following the modified Cloward's surgical method between 1994 and 2001. Post-operative follow-up observations were made by plain X-ray and CT films. Thirty patients were followed-up for more than 3 years. All of the grafts were fused firmly without pseudo-arthrosis. No destruction nor separation of the two portions of the graft were found, except for a few cracks which caused no problems. Conclusion : This operative procedure is simple and the operative results were satisfactory. The new HA graft has superior quality in strength and bone union ability. Furthermore, it can be shaped to fit the host site by cutting the posterior end. The 40%-porous HA grafts can be used safely for anterior cervical fusion.
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西川 節, 大畑 建治, 西尾 明正, 高見 俊宏, 後藤 剛夫, 原 充弘
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2003 年 17 巻 2 号 p.
89-98
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Ependymoma, Hemagioblastoma, Cavernous angiomaでは, いずれも生命予後は良好であった.腫瘍の病理学的分類, 腫瘍の存在部位, 手術摘出度は長期経過に影響しない.手術部位の脊髄の硬膜への癒着が, 機能評価を悪化させる因子であると推定される.Astrocytic tumorでは, 腫瘍の病理学的分類が予後に関係しており, grade IIIとIVでは特に生命予後は悪かった.Grade IとIIの例には, 機能温存を考慮した手術を考えるべきであると思われた.
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田中 雅人, 中原 進之介, 竹内 一裕, 原田 良昭, 川井 章
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2003 年 17 巻 2 号 p.
99-106
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We report the surgical results of posterior and/or anterior decompression with spinal stabilization in 100 patients with spinal metastasis. Between January 1990 and December 2002, 100 patients (60 males, 40 females, ages raging from 16 to 83 yrs with an average of 60 yrs) were identified as having spinal metastasis from a variety of tumors. The average follow up period was 14 months. The treatment results were assessed in relation to the improvement of pain, neural deficit, and activities of daily living. The pain was evaluated on a scale of 1 to 5, and neurologic symptoms were divided into 5 groups according to Frankel's grade. The assessments were performed usually one month after the operation. Cumulative survival was calculated by the Kaplan-Meier method. The average operation time was 185 min : 178 min for posterior surgery, 245 min for anterior surgery, 465 min combined surgery and 475 min for total en-bloc spondylectomy. The average blood loss during operation was 1630ml for posterior surgery, 1760ml for anterior surgery, 1930ml combined surgery and 3640ml for total en-bloc spondylectomy. Preoperative pain and paralysis improved by 88.0% and 53%, respectively, and the quality of life score improved by 53.0%. The results of this study indicated that, if properly indicated, posterior and/or anterior decompression with spinal stabilization is a safe and effective treatment for patients with spinal metastases to improve the quality of life for their remaining years.
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森本 哲也, 越前 直樹, 永田 清, 小櫃 久仁彦, 乾 多久夫, 鳥海 勇人, 乾 登史孝
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2003 年 17 巻 2 号 p.
107-112
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We have modified the original mini-ALIF by using a cage technique to eliminate posterior fusion in patients presenting with lumbago. Twenty-eight individuals have been treated with this technique. All but 2 individuals were evaluated with discography for the responsible level suitable for discectomy and fusion. Twenty-one of the 26 patients presented with discogenic pain concomitant with the usual home pain. A retroperitoneal approach employing a minimal opening technique was applied for all patients, after which discectomy was followed by Mayer's original technique and cage fixation. Patients were allowed to walk on the postoperative first day, fitted with a soft corset. The average follow-up period has been 14 months. Pain relief achieved excellent results in 11, good in 14, fair in 2 and poor in 1. The mean improvement rate was 60.5% evaluated using the Japanese Orthopaedic Association score. In conclusion, the present technique for the treatment of lumbar spinal disorders has proved to be safe and useful in terms of minimally invasive surgery.
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中西 欣弥, 花北 順哉, 川原 功祐, 佐藤 宰, 織田 雅, 梶原 基弘, 駒谷 英基
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2003 年 17 巻 2 号 p.
113-118
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高位腰椎椎間板ヘルニアの外科的治療は, ヘルニアの突出方向に対応してlateral typeに対してはUPH, mediolateral typeにおいても基本的にはUPH, ただしhuge discの場合はBPHあるいはTLが必要と考えられた.far-lateral typeにおいてはLA, medial typeに対してはTLあるいはTDAによりヘルニア摘出が可能と考えられた.
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冨士 武史
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2003 年 17 巻 2 号 p.
119-124
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Although posterior lumbar interbody fusion (PLIF) using threaded cages alone is a useful procedure, the rate of union for this operation is, in my experience, not so high. The Lumbar Alligator Spinal System (LA) has been developed to serve as a supporting instrumentation for this procedure. The LA is a kind of a clamping plate for the spinous processes. The aim of this paper is to clarify the results of PLIF using threaded cages and the LA. Between 2000 and 2001, single level posterior lumbar interbody fusion using LA and BAK Proximity Cages was performed in 24 patients with degenerative spondylolisthesis. One patient who suffered burst fracture of the fusion site at one month after surgery and another patient who had moved to an area very far from our hospital were excluded in this study. Therefore, we assessed 22 out of 24 patients. The study group consisted of 10 males and 12 females. The mean age at the operation was 64.9 years and the mean follow up period was 17 months. The intervertebral level of the operation was L4/5 in 20 patients, L3/4 in one and L5/6 in one. Diskectomy was done as much as possible, and the graft bone was placed not only in the cages but also in the spaces around the cages. Union was assessed radiologically. Solid union was defined as the point where bony bridging was detected between two vertebral bodies. Solid union of the operative intervertebral level was achieved in all cases. The LA is a useful instrument for PLIF using threaded cages.
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岩月 幸一, 吉峰 俊樹, 加藤 天美, 佐々木 学, 安田 恵多良
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2003 年 17 巻 2 号 p.
125-130
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Purpose : Commonly used techniques of lumbar decompression that include bilateral takedown of paraspinal musculature and aggressive bony resection can result in significant iatrogenic sequelae. Bilateral fenestration through a unilateral approach for lumbar spinal canal stenosis has been reported as a minimally invasive procedure. In addition to this method, we have performed contralateral facetectomy and foraminotomy. In this study, we describe and analyze this technique that affords excellent decompression while minimizing damage to surrounding tissues. Materials and Methods : Between 2000 and 2002, 30 patients with lumbar spinal canal stenosis were surgically treated at our hospital. The 12 women and 18 men had a mean age of 60.4 years (range, 29-75yr). Mean duration of symptoms prior to surgery was 28.6 months (range, 3-120 months). Spinal canal stenosis was shown at a single interlaminar space in all patients who were suffering from cauda equina syndrome with bilateral root pain at the stenosis level. We performed bilateral fenestration, facetectomy and foraminotomy using unilateral approach. Results : The technique affords excellent decompression while minimizing destruction to tissues not directly involved in the pathologic process. Functional outcome scores increased remarkably and 93.3% of patients reported high satisfaction rates. Conclusions : This method is a minimally invasive technique that appears to provide excellent functional outcomes. In particular, the contralateral facet joint is preserved very well since only lower part of the superior articular process is resected.
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井上 洋, 西 秀夫, 清水 常正, 柿沢 敏之, 小林 聡
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2003 年 17 巻 2 号 p.
131-138
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A microsurgical bilateral ligamentectomy via a unilateral approach was performed in patients with intermittent claudication due to central lumbar stenosis. Twenty-eight patients (23 males and 5 females) between the ages of 45 and 79 years have been treated. The cauda equina was compressed by a thickened ligamentum flavum at L4-5 in most patients and at L3-4 and/or L5-S1 in 14 patients. Seven patients had spondylolisthesis at L4-5. A unilateral approach from the left side was selected in most patients. After partial drilling of the spinous process and lamina with a dome laminectomy, the thickened ligamentum flavum was removed bilaterally. An ultrasonic bone scalpel (bone-removal bar) was used to perform the dome laminectomy and partial facetectomy; this instrument is safe to use because it produces vibration without rotational movements. The dural sac was decompressed, and cauda equina decompression was confirmed though the dura. Most patients were able to walk one day after their operation. Intermittent claudication improved postoperatively in all patients. No recurrence or spondylolisthetic deterioration has been observed in a 7 years follow-up. This approach is a safe and effective treatment for central lumbar stenosis, although long-term follow-up studies are required.
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西田 憲記, 井上 崇文, 平澤 元浩, 永廣 信治
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2003 年 17 巻 2 号 p.
139-146
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The primary operation for lumbar canal stenosis, including herniation of lumbar vertebral discs, is a comparatively easy procedure. However, when reoperation is required the procedure is very much complicated by granulation tissue round the circumference of the operated site causing adhesion with the lumbar dural sac and root. The author analyzes cases of lumbar canal stenosis and disc herniation requiring reoperation and the methods employed. From April 1996 to December 2002, reopration for restenosis was required in 67 cases out of a total of 817 operations for lumbar canal stenosis and disc herniation. Patients comprised 35 males and 32 females, with an average age at reoperation of 64.3 yr. In 39 cases, the site of reoperation was the same as for the primary operation, but in the other 28 patients involvement of the adjacent lumbar levels had occurred. The reoperative approach was basically the same as for the primary procedure. In cases with instability of the lumbar vertebrae, the author used mechanical lumbar vertebral fixation was necessary with decompression and, in cases without instability, performed only a trumpet-shaped vertebrae laminoplasty. The improvement rate was 72.8%. For restenosis between lumbar vertebrae at a level similar to the primary procedure, in 7 patients spinal column expansion alone was performed, and in 32 patients vertebral fixation using a device was employed. Concerning the causes of restenosis at the same level, there were many case of recurrent lumbar disk herniation with an average age at reoperation of 54.2 yr. The overall improvement rate was 81.4%, however there was a significant difference between improvement in the group in whom a fixation device was used (88.1%) and those in whom a device was not used (50.8%). In conclusion, the author strongly advises the lumbar fixation is necessary when reoperation is required for restenosis at the same level of the primary procedure.
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藤本 俊一郎, 柚木 正敏, 中川 実, 寺井 義徳, 吉野 公博, 時岡 孝光, 佐々原 渉
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2003 年 17 巻 2 号 p.
147-154
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When surgically removing a spinal neurinoma, preservation of the involved root may be feasible. However, in many cases, sacrifice of the relevant root is required to achieve total tumor removal. Sacrifice of the posterior root has been reported as having a low risk of causing any disabling neurological deficit. However there is the possibility of severe neurological deficit after sacrificing the anterior root in the cervical or lumbosacral region is pointed out. Intraoperative bipolar stimulation (1Hz, 1-2mA, 200μsec, square wave) was applied to three patients with neurinoma of cauda equina to confirm whether relevant root is anterior or posterior. Stimulation of anterior root showed movement of the lower extremities, and that of posterior root did not show any movement. The neurinomas of all three patients arose from the posterior roots, and were totally removed by sacrificing the involved roots. Postoperatively no new neurological deficit was observed, and the preoperative neurological deficit improved within several months after operation. Intraoperative electiric stimulation may prove useful to determine the nerve roots involved by neurinomas, and to test whether they are motor or sensory roots. However, we should bear in mind that this method can be applied when the level of the involved root is S1. For roots below the levelof S2, monotoring of electromyography should be used.
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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
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2003 年 17 巻 2 号 p.
155-160
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A bilateral pedicular fracture of the axis (hangman's fracture) is regarded as stable and can be treated with a collar or a halo vest. Surgical stabilization is only rarely needed in patients with significant displacement of the axis or chronic instability. We report on a patient with unstable hangman's fracture, for whom posterior and anterior fixation were performed in one stage. To the best of our knowledge, this is the first such reported case in the literature. A 74-year-old female was hit by a car on Jun. 12, 1999 and admitted to our hospital due to fractures of her lower limbs. The patient was neurologically normal. When she sat on a bed after treatment of her leg fractures, she complained of severe neck pain. Radiograph of the cervical spine showed fracture of the neural arch of the axis with dislocation of C2 on C3 due to locked facet (Levine type III) and a compression fracture of the C3 vertebral body. CT showed a bilateral interarticular fracture involving the body of the axis and facet dislocation. Reduction was not achieved by the use of 6 kg of skeletal traction, so the patient underwent surgery. She was placed prone and 3kg of skeletal traction was maintained during surgery. Following reduction of the dislocation by drilling of the superior facet of C3, posterior transpedicular fixation at the level of C2 was performed with pedicle screws combined with C2-C3 inter-spinous process wiring. Following posterior fixation, anterior discectomy of C2-C3 and bone grafting was performed in one stage. After surgery the patient's neck pain had disappeared, and was allowed to walk with neck collar day following her surgery. Our experience indicates that anterior fixation added to posterior fixation is a suitable treatment for aged patients with a complex hangman's fracture who are not successfully managed non-operatively.
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飛騨 一利
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2003 年 17 巻 2 号 p.
161-
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原稿種別: 付録等
2003 年 17 巻 2 号 p.
162-163
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阿部 弘
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2003 年 17 巻 2 号 p.
164-
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2003 年 17 巻 2 号 p.
165-
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2003 年 17 巻 2 号 p.
166-
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2003 年 17 巻 2 号 p.
167-
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2003 年 17 巻 2 号 p.
168-169
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2003 年 17 巻 2 号 p.
170-
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2003 年 17 巻 2 号 p.
171-173
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2003 年 17 巻 2 号 p.
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2003 年 17 巻 2 号 p.
175-
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2003 年 17 巻 2 号 p.
176-178
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2003 年 17 巻 2 号 p.
179-
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2003 年 17 巻 2 号 p.
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2003 年 17 巻 2 号 p.
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2003 年 17 巻 2 号 p.
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2003 年 17 巻 2 号 p.
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2003 年 17 巻 2 号 p.
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2003 年 17 巻 2 号 p.
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