Spinal Surgery
Online ISSN : 1880-9359
Print ISSN : 0914-6024
ISSN-L : 0914-6024
Volume 32, Issue 3
Displaying 1-15 of 15 articles from this issue
Vistas
Special Contribution
Masters in Spinal Surgery
Reviews and Opinions
Review-Essentials
Forum-Strategies & Indication
Original Articles
  • Yasuyoshi Miyao, Manabu Sasaki, Masao Umegaki, Kazuyoshi Tamura, Nobum ...
    2018 Volume 32 Issue 3 Pages 300-305
    Published: 2018
    Released on J-STAGE: January 24, 2019
    JOURNAL FREE ACCESS

      Introduction : The rate of surgical site infections (SSI) after spinal surgery is thought to be low. However, once this complication occurs, especially in instrumentation surgery, we require prolonged antibiotic therapy and repeated operations, such as wound debridement or removal of the instruments. In this paper, we investigate SSI occurring at Suita Municipal Hospital and Iseikai Hospital between January 2012 and December 2015 as well as the risk factors in each hospital using the Japan Nosocomial Infections Surveillance (JANIS) data.

      Materials and methods : We experienced 753 cases of spinal surgery, including 482 cases of decompression with laminectomy (abbreviated as LAM in JANIS [Group L]) and 271 cases of spinal fusion with instrumentation (abbreviated as FUSN in JANIS [Group F]) for 4 years from 2012 to 2015. For baseline data, we compared the JANIS data released in the period containing 19,162 cases in Group L and 17,440 cases in Group F.

      Results : Among the 753 cases, SSI occurred in 11 (1.4%) ; 3 cases (0.6%) in Group L and 8 cases (3.0%) in Group F. Compared to the JANIS data, the rate of SSI was identical in Group L (1.3%) but higher in Group F (1.9%). In our SSI cases, there were several factors affecting infection ; diabetes mellitus in 3 cases, immunosuppressive states in 5, severe atopic dermatitis in 2, and re-operation in 2. The risk index (RI) used in JANIS was RI : 0 in 2 cases and RI : 1 in 1 case in the 3 SSI cases of Group L, while it was RI : 1 in 6 cases and RI : 2 in 2 cases in the 8 SSI cases of Group F. The most important factor was found to be the long operation time ; 6 cases of 8 SSI cases in Group F exceeded 260 minutes, which is the time 75% of operations that registered in JANIS required to complete. As a result of the comparative analysis, we implemented a new protocols when we had to operate for long time period, which resulted in the suppression of postoperative infection.

      Conclusion : We investigated the risk factors of SSI cases in spine surgery by using JANIS data. We made effective measures to longer operation time which was thought to be the most affected factors in our hospitals.

    Download PDF (1100K)
  • Naoto Nakamura, Yoshiyuki Takaishi, Atsushi Arai, Atsushi Uyama, Takes ...
    2018 Volume 32 Issue 3 Pages 306-310
    Published: 2018
    Released on J-STAGE: January 24, 2019
    JOURNAL FREE ACCESS

      Background : Although spontaneous spinal epidural hematoma (SSEH) is a rare disease, its differentiation from stroke is difficult because of their similar clinical symptoms. This study aimed to clarify the clinical features and treatment of SSEH.

      Methods : Seven patients (age : range, 47-79 years ; median, 76 years) with SSEH, including 5 women and 2 men, who were admitted in Shinsuma General Hospital between September 2009 and May 2017 were reviewed retrospectively.

      Results : All the patients first experienced sudden onset of neck or back pain. Six patients subsequently had motor disorder with or without sensory impairment, and 1 patient had neck pain alone (Frankel classification A : 1 case ; B : 2 cases ; C : 3 cases ; and E : 1 case). All the patients were definitely diagnosed using magnetic resonance imaging (MRI) and computed tomography (CT) examinations, which were performed at the same time in 5 patients who also had hematomas in the spinal canals. The hematoma was located in the cervical spine in 6 patients and in the thoracolumbar spine in 1 patient. The patient who had neck pain alone was treated conservatively. Surgical treatment was performed in the other 6 patients with neurological symptoms (performed within 6 hours of onset in 3 patients and within 15 hours in the other 3 patients), resulting in clinical improvement in all the cases.

      Conclusions : The sudden onset of neck or back pain followed by motor disorder seems to be an important clinical sign in differentiating SSEH from stroke, and spinal canal CT is also useful in diagnosing SSEH. As no criterion has been established for the operative indications for SSEH, the therapeutic options might be decided depending on the neurological severity in each case.

    Download PDF (1785K)
  • Yoshiyuki Takaishi, Hirofumi Iwahashi, Naoto Nakamura, Takeshi Kondoh, ...
    2018 Volume 32 Issue 3 Pages 311-315
    Published: 2018
    Released on J-STAGE: January 24, 2019
    JOURNAL FREE ACCESS

      Finding Juxta facet cyst is not rare in the era of magnetic resonance imaging (MRI) but little is known regarding cyst formation following lumbar laminectomy. Between 2010 and 2017, we performed lumbar laminectomy on 264 patients. Lumbar laminectomy was performed for either lumbar canal stenosis (n=221) or degenerative spondylolisthesis (n=43). Postoperative MR images were obtained from patients who developed recurrent lumbar pain or leg pain. Juxta facet cysts were diagnosed by MR images. The images demonstrated cyst formation adjacent to the facet joint with low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. Nine patients (3.3%) were found to have developed juxta facet cysts after lumbar laminectomy. The incidence of cyst formation was higher in the patients with degenerative spondylolisthesis (n=4, 9.3%) than in patients with lumbar canal stenosis (n=5, 2.3%). All patients were managed conservatively by medication and/or nerve root block and eight out of nine patients showed resolution of recurrent pain in a few months. The cysts disappeared in four patients as seen in MR images. Juxta facet cyst development following lumbar laminectomy is likely due to facet joint degeneration. The facet joint is covered with ligamentum flavum and injury to the ligamentum during the surgical procedure may accelerate joint degeneration postoperatively.

    Download PDF (647K)
Case Reports
  • Nobuhiro Sasaki, Hiroaki Manabe, Miyuki Fukuda, Tomoaki Fujita, Minoru ...
    2018 Volume 32 Issue 3 Pages 316-321
    Published: 2018
    Released on J-STAGE: January 24, 2019
    JOURNAL FREE ACCESS

      Introduction : Intradural disc herniation (IDH) is relatively uncommon and is considered difficult to diagnose because of the radiographically wide range of properties of the herniated disc itself, with no IDH-specific symptoms. Extruded herniated tissues are frequently found at surgery, and the diagnosis of IDH is often made intraoperatively. Here, we report our experience with a case in which IDH was difficult to differentiate from a schwannoma on the basis of intraoperative findings and analysis of postoperative pathological results took a long time.

      Case report : A 64-year-old man who was diagnosed as having a herniated disc 2 years before at another hospital had a sudden intense pain in the posterolateral aspect of his left lower extremity for the past 2 weeks, which made walking difficult. When he presented to our hospital, an intradural neoplastic lesion measuring 10 mm in diameter was found at his lumbar spine (L3/L4 level). A suspicious cystic lesion with low signal intensity on T1-weighted images, along with its lesion inside with high signal intensity on T2-weighted images, was detected with simple magnetic resonance imaging (MRI). A ring-enhancing lesion presenting uniformly on contrast-enhanced MRI examination seemed connected to the cauda equina. This lesion was most likely to be a schwannoma of the cauda equina, but due to the ring-shaped contrast enhancement, IDH was also considered in the differential diagnosis. Intraoperative findings showed loss of mobility of the dura mater, but no visible escape of the nucleus pulposus was observed in the dura mater. A lesion, which appears to be a schwannoma arising from the cauda equina, was detected from the intraoperative findings. After removal of the lesion, the diagnosis of ancient schwannoma was initially made on the basis of the pathological results, but the final diagnosis of IDH was confirmed by S-100 immunostaining.

      Conclusion : When intradural tumoral lesions are found, cyst formation must be suspected on simple MRI. In case of ring-enhancing lesions observed on contrast-enhanced MRI examination, extradural adhesion occurs even if these lesions are morphologically similar to schwannomas. If solid lesions are detected, considering degenerative conditions such as IDH or others seems necessary. If schwannomas are the most unlikely intraoperative diagnosis (though difficult to diagnose) and if IDH is strongly suspected, it seems necessary to consider only performing decompression achieved by reduction surgery such as internal decompression, without cutting off the cauda equina when complete removal of lesion is difficult to achieve due to adhesion.

    Download PDF (2101K)
  • Shinji Yamamoto, Kenkichi Takahashi, Yoshihiro Kuga, Hideyuki Ohnishi
    2018 Volume 32 Issue 3 Pages 322-328
    Published: 2018
    Released on J-STAGE: January 24, 2019
    JOURNAL FREE ACCESS

      Intracranial hypotension is a well-recognized disorder of cerebrospinal fluid (CSF) hypovolemia caused by iatrogenic or spontaneous spinal CSF leakage. The most common manifestation of intracranial hypotension is orthostatic headache, frequently accompanying general fatigue, appetite loss, tinnitus, hearing disturbance, blurred vision, and/or limbs dysesthesia. Persistent low-intracranial pressure status can lead to several complications, such as cranial nerve palsies, subdural effusion/hematoma, cerebellar tonsil descent, superficial siderosis, and brainstem dysfunction, including coma. The occurrence of cerebral venous thrombosis has been reported in some patients with intracranial hypotension, but the mechanism has not been fully elucidated. When these two pathologies occur together, it raises practical problems about the treatment.

      We present two cases of spontaneous CSF hypovolemia complicated by intracranial hypotension and cerebral venous thrombosis. In one case, extensive venous thrombosis involved many cerebral cortical veins, the superior sagittal sinus, and the right transverse-sigmoid sinus, which caused symptomatic diffuse cerebral blood flow disturbance. Treatment with epidural blood patch caused complete resolution of the CSF hypovolemia ; however, the non-orthostatic headache recurred and persisted. Additional anticoagulation was needed for progressive venous thrombosis. In the other case, many cerebral cortical veins, the superior sagittal sinus, and the right transverse-sigmoid sinus were involved asymptomatically. Epidural blood patch resolved both the CSF hypovolemia and cerebral venous thrombosis.

      Cerebral venous thrombosis is a rare but serious complication of CSF hypovolemia. A change in headache pattern has been reported as a possible predictor of the development of cerebral venous thrombosis in patients with intracranial hypotension. We discuss the importance of early detection of cerebral venous thrombosis in patients with CSF hypovolemia along with its management and potential complication.

    Download PDF (4047K)
  • Naoto Nakamura, Yoshiyuki Takaishi, Atsushi Arai, Atsushi Uyama, Takes ...
    2018 Volume 32 Issue 3 Pages 329-333
    Published: 2018
    Released on J-STAGE: January 24, 2019
    JOURNAL FREE ACCESS

      A 49-year-old man with lumbar spinal lipoma was surgically treated because of intractable pain. The lipoma was originally asymptomatic and found incidentally 10 years before. He began to have occasional dysesthesia in the right lower limb 8 years before. The symptom became severe 1 year before he visited our hospital for the first time. The dysesthesia was in the L5 region of his right lower limb. Muscle weakness and urinary incontinence were not found. The magnetic resonance imaging demonstrated low-set conus (L3/L4) associated with spinal lipoma, which extended from the extradural part (from L4/L5 to L5/S1) to the intradural part (from L2/L3 to L3/L4). Computed tomography revealed hypoplasia in the laminae of L4, L5, and S1. We observed him for a year, and the dysesthesia became intolerable while the lipoma size was unchanged. Untethering was performed with L2-L5 laminectomy. The extradural part of the lipoma was completely removed with the adhered dural membrane. The intradural part was detached from dural membrane and partially removed. A GORE-TEX patch was used for dural membrane closure. The mechanism of adult-onset spinal lipoma is considered tethered cord syndrome or spinal cord compression. As spinal lipoma is usually adhered with the spinal cord, the appropriate surgical strategy seems to be untethering and partial resection of the lipoma.

    Download PDF (4370K)
Extended Abstracts
feedback
Top