Spine Surgery and Related Research
Online ISSN : 2432-261X
ISSN-L : 2432-261X
Volume 2 , Issue 4
Showing 1-15 articles out of 15 articles from the selected issue
ORIGINAL ARTICLE
  • Gaurav Raj Dhakal, Santosh Paudel, Siddharth Dhungana, Ganesh Gurung, ...
    2018 Volume 2 Issue 4 Pages 249-252
    Published: October 26, 2018
    Released: October 27, 2018
    [Advance publication] Released: April 27, 2018
    JOURNALS OPEN ACCESS

    Introduction: Outcome of spine injury treated in resource constrained regions may not be the same as in developed nations. The aim of the present study was to study the epidemiological characteristics, delay, complications, and outcome of surgically treated dorsal and lumbar trauma.

    Methods: Retrospective study of dorsal and lumbar spine injury patients treated between December 2015 and August 2017. Patients were segregated into four groups based on the timing of surgery: 0-2 days, 3-7 days, 8-30 days, and more than 31 days. Only one operating room twice a week was allotted to spine surgery, and spine had to compete with orthopedic and surgical trauma for admission and surgery.

    Results: Ninety-one patients (male 61) with mean age 33 years were operated for dorsal and lumbar spine injuries. 84% of the total patients sustained a fall, and 86.8% were from the periphery. Though 69.2% presented within 2 days, only 4.4% were operated within 2 days. Majority of the delay was due to unavailability of the operating room followed by financial constraints. Twenty-seven patients had complete deficit, 32 incomplete deficit, and 32 normal neurology. Four patients operated within 2 days improved their neurology, 7 incomplete deficit patients in 3-7 days group improved, 6 in 8-30 days group improved, whereas no patient in more than 31 days group improved. Overall 53.1% of neurologically incomplete deficit patients improved if operated within 30 days. No neurological improvement was seen in the 27 complete deficit patients. Wound infection, pulmonary contusion, and deep vein thrombosis were seen in 3 patients.

    Conclusions: As expected 95.6% of our patients were treated more than 3 days after injury and 60% more than a week later, which may not be acceptable in advanced countries. Despite the delay, 53.1% had an improvement in neurology when operated within 30 days. Hence, surgery still holds the hope of neurological recovery and quicker rehabilitation.

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  • Kazunari Takeuchi, Toru Yokoyama, Takuya Numasawa, Kan-ichiro Wada, Ta ...
    2018 Volume 2 Issue 4 Pages 253-262
    Published: October 26, 2018
    Released: October 27, 2018
    [Advance publication] Released: April 27, 2018
    JOURNALS OPEN ACCESS

    Introduction: Difficulties with neck mobility often interfere with patients' activities of daily living (ADL) after cervical posterior spine surgery. The range of motion of the cervical spine decreases markedly after multilevel cervical posterior decompression and fusion (PDF). However, details regarding the limitations of cervical spine function due to postoperative reduced neck mobility after multilevel PDF are as yet unclarified. The present study aimed to clarify the quality of life and its related factors after PDF, and the optimal fixed neck position in multilevel PDF that minimizes the limitations of ADL accompanying markedly reduced postoperative neck mobility.

    Methods: Limitations of ADL involving neck extension, rotation, and flexion were investigated in 32 consecutive patients who underwent C2-T1 PDF using the responses to the cervical spine function domain of the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). The EuroQol 5 Dimension, Japanese Orthopedic Association score, and five domains of the JOACMEQ were also investigated. We investigated the risk factors regarding the fixed neck position in PDF for the impossibility to perform ADL involving each of three movements using cut-off values obtained from receiver-operating characteristic curves.

    Results: Postoperative comprehensive quality of life was significantly related to neurological improvements and to poor outcomes of cervical spine function after PDF. The significant risk factors for impossibility to perform ADL involving neck rotation were a C2-C7 lordotic angle ≥ 6° (P = 0.0057) or a proportion coefficient of C2-T1 tilt angle/C2-C7 lordotic angle ≤ 1.8 (P = 0.0024). There were no significant risk factors for impossibility to perform ADL involving neck extension or flexion.

    Conclusions: The optimal fixed neck position in C2-T1 PDF to reduce postoperative limitations of ADL involving neck mobility is a C2-C7 lordotic angle of less than 6°, or a C2-T1 tilt angle (°) of greater than 1.8 × the C2-C7 lordotic angle (°).

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  • Hiroyuki Takashima, Tsuneo Takebayashi, Mitsunori Yoshimoto, Maki Onod ...
    2018 Volume 2 Issue 4 Pages 263-269
    Published: October 26, 2018
    Released: October 27, 2018
    [Advance publication] Released: April 07, 2018
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    Introduction: Gender differences may play a role in the pathogenesis of lumbar spinal stenosis. However, few reports that discuss the effects of gender differences in ligamentum flavum (LF) hypertrophy have been published, and no study has investigated the relationship between LF thickness and the quantitative value of intervertebral disc (IVD) degeneration. This study aimed to investigate the impact of gender on the pathomechanisms underlying LF hypertrophy, focusing on the relationship among LF thickness, IVD degeneration, and age.

    Methods: The subjects include 100 patients with low back pain and leg numbness, tingling, or pain. We measured LF thickness and the T2 values of IVDs using MR imaging and analyzed the relationship among LF thickness, T2 values of IVDs, and age. The interclass correlation coefficient (ICC) was calculated as the inter-rater reliability between the LF thickness values measured by two investigators.

    Results: ICC was calculated for the two measurements of LF thickness (r = 0.923, 95% CI: 0.907-0.936). No statistically significant difference in the T2 values of IVDs was observed between females and males from L2/3 to L5/S. There were significantly negative linear correlations between LF thickness and the T2 values of IVDs at all levels, but this correlation was not observed in females at L4/5. There were significantly negative linear correlations between age and the T2 values of IVDs from L2/3 to L5/S for all patients, females, and males (r = 0.422-0.756). In addition, there were significantly positive linear correlations between age and LF thickness from L2/3 to L4/5 for all patients (r = 0.329-0.361) and females (r = 0.411-0.481). Correlations were not observed for males at all levels or for all patients at L5/S.

    Conclusions: The relationships identified among LF thickness, age, and IVD degeneration suggest that gender differences play a role in the pathogenesis of LF hypertrophy.

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  • Kotaro Satake, Tokumi Kanemura, Hiroaki Nakashima, Yoshimoto Ishikawa, ...
    2018 Volume 2 Issue 4 Pages 270-277
    Published: October 26, 2018
    Released: October 27, 2018
    [Advance publication] Released: April 07, 2018
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    Introduction: This retrospective study was performed to evaluate the clinical influence of - and to identify the risk factors for nonunion of transpsoas lateral lumbar interbody fusion (LLIF) with use of allograft.

    Methods: Sixty-three patients who underwent transpsoas LLIF (69.8 ± 8.9 years, 21 males and 42 females, 125 segments) were followed for a minimum 2 years postoperatively. For all LLIF segments, polyetheretherketone (PEEK) cages packed with allogenic bone were applied with supplemental bilateral pedicle screws (PSs). Bone bridge formation was evaluated by computed tomography (CT) 2 years postoperative, and a segment without any bridge formation was determined to be a nonunion. Sixty-one participants (96.8%) were classified into two groups for clinical evacuation: Group N that contained one or more nonunion segments and Group F that contained no nonunion segment. Visual analogue scales (VAS) scores and the effective rates of the five domains of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were compared between Groups N and F. The risk factors for nonunion were determined by univariate and multivariate analyses.

    Results: Twenty segments (16%) were diagnosed as nonunion. There were no significant differences in all VAS scores, and the ratio of effective cases in all domains of JOABPEQ between Group N (n = 14) and F (n = 47). Multivariate analysis identified percutaneous PS (PPS) usage (odds ratio [OR]: 3.14, 95% confidence interval: 1.13-8.68, p = 0.028) as a positive risk factor for nonunion.

    Conclusions: We should be aware of the higher nonunion rate in the LLIF segments supplemented with PPS, though nonunion does not affect significantly clinical outcomes at 2 years postoperative.

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  • Mitsuyoshi Matsumoto, Masayuki Miyagi, Wataru Saito, Takayuki Imura, G ...
    2018 Volume 2 Issue 4 Pages 278-282
    Published: October 26, 2018
    Released: October 27, 2018
    [Advance publication] Released: April 07, 2018
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    Introduction: Patients with neuromuscular disorders sometimes show progressive spinal scoliosis. The surgery for neuromuscular scoliosis (NMS) has high rates of complications. In this study, we elucidated the perioperative complications in patients with NMS.

    Methods: We included 83 patients with NMS (58 boys and 25 girls; 61 with muscular dystrophy, 18 with spinal muscular atrophy, and 4 others) who had undergone posterior fusion surgery for scoliosis. We evaluated the perioperative complications (within 3 months), age at time of surgery, operative time, blood loss, preoperative %VC and FEV1.0 (%) for pulmonary function, and preoperative ejection fraction (EF) for cardiac function.

    Results: There were 5 (6%) major complications, including pneumonia and a cardiovascular complication requiring intensive care unit (ICU) care, and 15 (18%) minor complications including viral enteritis and a urinary tract infection. Overall, there were 20 (24%) complications. Three of the 5 major complications were pulmonary. The mean age at the time of surgery was 13.7 y, operative time was 304 min, and blood loss was 1530 ml. The mean preoperative %VC was 41%, FEV1.0 was 91%, and EF was 60%. When we separated the patients into a group with major complications (n = 5) and a group without major complications (n = 78), the preoperative %VC in the group with major complications (23%) was significantly lower than that in the group without (42%) (p < 0.05). However, operative time, blood loss, preoperative FEV1.0 (%) and EF between the two groups were not significantly different (p > 0.05).

    Conclusions: Compared with the previous findings of the perioperative complication rate (45%-74%) for NMS, the complication rate was remarkably low in this case series. Because of advances in medical skills, including anesthesia and surgical instruments, surgery for NMS appears to be safe. However, patients with NMS with complications demonstrated severe restrictive ventilatory impairment preoperatively. Therefore, we should be vigilant for perioperative pulmonary complications especially in patients with NMS and preoperative severe restrictive ventilatory impairment.

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  • Tatsuya Yasuda, Tomohiko Hasegawa, Yu Yamato, Daisuke Togawa, Sho Koba ...
    2018 Volume 2 Issue 4 Pages 283-289
    Published: October 26, 2018
    Released: October 27, 2018
    [Advance publication] Released: April 07, 2018
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    Introduction: Correction of lumbar lordosis is the primary goal of surgical treatment of adult spinal deformity. However, only limited research has evaluated the effects of this correction on the adaptive curvature of the thoracic spine. The purpose of this study is to evaluate the change in thoracic curvature after corrective surgery to restore lumbar lordosis in patients with adult spinal deformity.

    Methods: We completed a retrospective analysis of the radiological data of 65 patients, ≥50 years old, who underwent corrective surgery of lumbar spine lordosis from any level below T8 to the ilium. Patients with insufficient correction, defined by a pelvic incidence minus lumbar lordosis angle (PI-LL) > 10°, were excluded, with the data of 43 patients included in the analysis. The following radiological measures of spinal alignment were measured at three time points, preoperatively, on the first day of standing postoperatively and at 2 years post-surgery: sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), and PI-LL.

    Results: Postoperative change in TK was correlated to preoperative TK and age. The increase in TK was larger for patients <75 years of age, increasing from 23.1° to 38.0° after surgery and to 46.7° at 2-years postoperatively. In contrast, for patients >75 years, TK remained largely unchanged at 37.8° just after surgery but increased substantively to 50.1° at the 2-year follow-up. The postoperative change in TK immediately after surgery was determined using equation "predict change in TK = −0.21 × age − 0.6 × preoperative TK + 41.8" by multiple regression analysis.

    Conclusions: Reciprocal change in TK after lumbar spine correction is correlated to preoperative TK and age.

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  • Hidekazu Suzuki, Kenji Endo, Yasunobu Sawaji, Yuji Matsuoka, Hirosuke ...
    2018 Volume 2 Issue 4 Pages 290-293
    Published: October 26, 2018
    Released: October 27, 2018
    [Advance publication] Released: March 15, 2018
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    Introduction: Most people in modern societies spend the majority of their time sitting. However, sagittal spinal alignment is usually analyzed in the standing position. For understanding the symptoms associated with postural changes, this alignment is better to be analyzed in various positions. The purpose of this study was to investigate lumbo-pelvic relationships between standing up and sitting (sit-to-stand) motion.

    Methods: The study subjects were 25 healthy young adult volunteers without any spinal symptoms. The following parameters were measured, namely, intervertebral range of motion (IV ROM), lumbar lordotic angle (L1L5), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI), on lateral whole-spine radiographs while sitting upright, sitting anterior flexed (anteflexed), standing anteflexed, and standing upright.

    Results: The measurements of spinopelvic parameters during sit-to-stand motion (sitting upright, sitting anteflexed, standing anteflexed, standing upright, respectively) were as follows: L1L5 (7.9, −4.4, 3.1, 31.9) and PT (31.5, 26.5, 11.9, 7.7). Regarding IV ROM, the lumbar segmental ROM after seat-off was wider than before seat-off (sitting anteflexed). In particular, the L4-L5 segments had a wide ROM from standing anteflexed to standing upright.

    Conclusions: The pelvis was retroverted in the sitting upright position and gradually anteverted during sit-to-stand motion. Lumbar lordosis decreased in the sitting upright position, temporarily decreased further (sitting anteflexed), and then increased in the standing position (standing anteflexed and standing upright). The mechanical loads on lumbosacral segments were greater after seat-off due to the reverse movement between upper lumbar and pelvic segments.

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  • Shoichiro Takei, Masayuki Miyagi, Wataru Saito, Takayuki Imura, Gen In ...
    2018 Volume 2 Issue 4 Pages 294-298
    Published: October 26, 2018
    Released: October 27, 2018
    [Advance publication] Released: April 27, 2018
    JOURNALS OPEN ACCESS

    Introduction: Patients with spinal muscular atrophy (SMA) usually have progressive scoliosis. Although fusion of the sacrum or pelvis has been recommended for correcting pelvic obliquity (PO), the procedure is invasive. This study determined as to whether performing instrumentation to the fifth lumbar vertebra (L5) is safe and effective for scoliosis in patients with SMA.

    Methods: Twelve patients with SMA underwent posterior spinal fusion and stopping instrumentation at the L5 level. We evaluated age at surgery, the duration of surgery, blood loss, complications, preoperative and postoperative Cobb angles, and PO.

    Results: The mean age at surgery was 11.4 years; the mean duration of surgery was 319 minutes, and the mean blood loss was 1170 mL. The Cobb angle improved from 97.3° to 39.1° at 1 month postoperatively (correction rate, 60.9%) and to 42.3° at the final follow-up. PO was corrected from 27.8° to 13.1° at 1 month postoperatively (correction rate, 51.7%) and to 19.8° at the final follow-up. No complications were reported. All patients showed improvement in low back pain, with reduced difficulty while sitting. However, >10% correction loss of PO was observed in 6 patients with high preoperative PO.

    Conclusions: The correction rate of scoliosis in SMA patients with posterior spinal fusion and instrumentation to the L5 level was acceptable, and no complications occurred. Scoliosis associated with SMA was more rigid and severer than scoliosis associated with Duchenne muscular dystrophy. Correction rates of the Cobb angle and PO in SMA patients with instrumentation to L5 were similar to those in SMA patients with instrumentation to the sacrum or pelvis. Correction loss of PO was greater in patients with high preoperative PO than in those with low preoperative PO. Instrumentation and fusion to L5 for scoliosis in patients with SMA seems safe and effective, except in cases of high preoperative PO.

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  • Makoto Takeuchi, Akihiro Nagamachi, Keisuke Adachi, Kazumasa Inoue, Ya ...
    2018 Volume 2 Issue 4 Pages 299-303
    Published: October 26, 2018
    Released: October 27, 2018
    [Advance publication] Released: May 29, 2018
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    Introduction: A high-intensity zone (HIZ) in an intervertebral disc of the lumbar spine is a high-intensity signal located in the posterior annulus fibrosus on T2-weighted magnetic resonance imaging (MRI). There is limited information on the prevalence of HIZ in the lumbar spine according to age. The aim of this cross-sectional study was to investigate the prevalence of HIZ in the lumbar spine by age and the correlation between HIZ and other degenerative findings, such as disc degeneration, disc bulging and herniation, and changes in adjacent vertebral endplates on lumbar MRI.

    Methods: We retrospectively reviewed MRI studies of 305 patients (1525 discs) with low back pain, leg pain, or numbness. The prevalence of HIZ was calculated in 5 age groups (<20, 20-39, 40-59, 60-79, 80-91 years).

    Results: The number of patients in the 5 age groups was 19, 38, 69, 145, and 36, respectively. The prevalence of HIZ in the 5 age groups was 11.8%, 47.3%, 52.2%, 42.8%, and 50.0%, respectively. Disc degeneration was observed in 58.1% and 39.2% of discs with and without HIZ, respectively; disc bulging and herniation was observed in 63.9% and 41.1% and intensity changes at adjacent end plates in 11.6% and 10.0%, respectively.

    Conclusions: Prevalence of HIZ from the third decade of life onward was around 50%, with no significant change in prevalence beyond the age of 20 years. HIZ was correlated with disc degeneration, disc bulging, and disc herniation in patients with LBP, leg pain, or numbness.

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  • Norito Hayashi, Hideaki Iba, Kazuhiro Ohnaru, Kazuo Nakanishi, Toru Ha ...
    2018 Volume 2 Issue 4 Pages 304-308
    Published: October 26, 2018
    Released: October 27, 2018
    [Advance publication] Released: April 27, 2018
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    Introduction: There are patients with lumbar disc herniation (LDH) having contralateral sciatic symptoms although the mechanisms of this clinical feature are still not well understood. The purpose of this study was to investigate these mechanisms by microendoscopic findings.

    Methods: Patients were performed microendoscopic surgery using over-the-top approach (ME-OTT), with laminoplasty, extirpation of herniation, and observation of the contralateral nerve root. The over-the-top approach was applied through the same incision from the herniation side. Clinical results were assessed according to the clinical scoring system established by the Japanese Orthopedic Association (JOA) score.

    Results: This study consisted of five patients, with the average age of 55.6 years old. The mean preoperative JOA score was 13 points. Three cases were Grade II and two were Grade III degrees of disc herniation. Levels of herniation were one at L3-4 and four at L4-5. Remission of sciatic symptoms was obtained in all cases after surgery. The average and percent improvements (%IP) of JOA scores at 2 months after surgery were 27.8 points and 92%, respectively. By the approach from the herniation side using ME-OTT, image around the contralateral nerve root was obtained without radical intervention. By ME-OTT, redness of the nerve root and fibrosis around the symptomatic nerve root were identified, whereas inflammatory changes were not apparent on the ipsilateral nerve root.

    Conclusions: Operative treatment of LDH with contralateral symptoms by ME-OTT was a useful procedure for decompression and observation of the affected nerve root. Asymptomatic disc herniation, "silent disc herniation," was considered at the herniation side since there were less inflammatory changes around the ipsilateral nerve root. In contrast, compression of dura toward the opposite side by disc herniation could have led to mechanical stress against the contralateral nerve root and triggered inflammation at lateral recess, resulting in radicular pain.

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  • Ivan Sekiguchi, Naoki Takeda, Naoki Ishida
    2018 Volume 2 Issue 4 Pages 309-316
    Published: October 26, 2018
    Released: October 27, 2018
    [Advance publication] Released: April 27, 2018
    JOURNALS OPEN ACCESS

    Introduction: In an attempt to increase anchoring strength of posterior instrumentation in spine with compromised bone quality, we introduced diagonal trajectory pedicle screwing (hooking screws) that do not rely on screw thread purchase in bone but rather hook onto the strong posterior elements of vertebrae from inside the bone.

    Methods: Between November 2016 and July 2017 we treated eight patients, mean age 80 years old (75-86 years old) with compromised bone quality for spinal instability. The diagnosis was osteoporotic fracture nonunion in three, ankylosed spine fracture in three, pyogenic spondylitis in two cases. All spines were percutaneously instrumented. Groove-entry technique was used for down-going thoracic screws. No additional hooks, cables, or any other augmentation was used. All patients were mobilized on post-operative day 1.

    Results: 84 screws were inserted overall. Groove-entry technique was used for 42 screws insertion. On average, 5.3 spinal segments were fixed per case. Mean operation time was 252 min (46 min per one spinal segment). Mean intraoperative bleeding was 112 ml per case (21 ml per one fixed spinal segment). All cases achieved bony union of the fracture site or across the destroyed intervertebral disk. Mean time to union was 4 months postop (3-7 months). All patients were ambulatory at the time of discharge. No nerve injury, no skin irritation caused by implants, no screw loosening, no screw pullout, no loss of correction, and no junctional kyphosis were noted in this series.

    Conclusions: Diagonal screw instrumentation (our hooking screws and groove-entry technique) appears to provide sufficient anchoring strength while being minimally invasive and possibly helpful in prevention of junctional kyphosis.

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  • Yoshihiro Matsumoto, Kenichi Kawaguchi, Jun-ichi Fukushi, Makoto Endo, ...
    2018 Volume 2 Issue 4 Pages 317-323
    Published: October 26, 2018
    Released: October 27, 2018
    [Advance publication] Released: April 27, 2018
    JOURNALS OPEN ACCESS

    Introduction: To investigate the clinical outcome and prognostic factors of malignant spinal dumbbell tumors (m-SDTs).

    Methods: We retrospectively reviewed the clinical outcome of 22 consecutive cases of m-SDTs and analyzed the prognostic factors associated with worse outcome.

    Results: Nineteen of the 22 cases were managed with surgery (86%), and gross total resection (GTR) was achieved in four cases (21%). The duration of overall survival (OS) ranged from 3 to 140 months, with a median survival time of 15.3 months. The 5 year OS rate was 55.6%. In multivariate analysis, histological subtype (high-grade malignant peripheral nerve sheath tumor) (hazard ratio [HR] 14.9, p = 0.0191), GTR (HR 0.07, p = 0.0343), and presence of local recurrences (HR 11.2, p = 0.0479) were significant and independent predictors of OS.

    Conclusions: On the basis of clinical data, we propose that GTR and prevention of local recurrence may improve the clinical outcome of m-SDTs.

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  • Koki Abe, Kazuhide Inage, Sumihisa Orita, Yoshihiro Sakuma, Hirohito K ...
    2018 Volume 2 Issue 4 Pages 324-330
    Published: October 26, 2018
    Released: October 27, 2018
    [Advance publication] Released: May 29, 2018
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    Introduction: Thus far, few reports have described the time series histological variations in injured paravertebral muscle tissues for long durations, considering the type of pain. The purpose of this study is to evaluate histological changes in injured paravertebral muscles and dominant nerves considering the type of pain.

    Methods: We used 59 eight-week-old male Sprague-Dawley rats. A 115-g weight was dropped from a height of 1 m on the right paravertebral muscle. Fluoro-Gold (FG), a sensory nerve tracer, was injected into this muscle. Hematoxylin and eosin (HE) staining and nerve growth factor (NGF) immunostaining of the muscle were performed for histological evaluation. L2 dorsal root ganglia (DRG) on both sides were resected, and immunohistochemical staining was performed for calcitonin gene-related peptide (CGRP, a pain-related neuropeptide) and for activating transcription factor 3 (ATF3, a neuron injury marker). Each examination was performed at 3 days, 1-3 weeks, and 6 weeks after injury.

    Results: HE staining of the paravertebral muscle indicated infiltration of inflammatory cells and the presence of granulation tissue in the injured part on the ipsilateral side at 3 days and 1 week after the injury. Fibroblasts and adipocytes were present at 2-3 weeks. At 6 weeks, the injured tissue was almost completely repaired. NGF was detected at 2-3 weeks post injury and appeared to colocalize with fibroblasts, but was not observed at 6 weeks post injury. The percentage of cells double-labeled with FG and CGRP in FG-positive cells of the primary muscle was significantly higher in the injured side at 3 days and 1-3 weeks post injury (P < 0.05). However, at 6 weeks, no significant difference was observed. No significant expression of ATF3 was observed.

    Conclusions: These results suggest that sensitization of the dominant nerve in the DRG, in which NGF may play an important role, can protract pain in injured muscles.

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CASE REPORT
  • Narihito Nagoshi, Ken Ishii, Kaori Kameyama, Osahiko Tsuji, Eijiro Oka ...
    2018 Volume 2 Issue 4 Pages 331-334
    Published: October 26, 2018
    Released: October 27, 2018
    [Advance publication] Released: April 27, 2018
    JOURNALS OPEN ACCESS
    Supplementary material

    Introduction: Intramedullary lesions and tumors are generally accessed by a posterior approach. However, if the lesion is located on the ventral side of the spinal cord, a posterior resection with myelotomy poses technical difficulties. We report two cases of complete resection of a cervical ventral intramedullary cavernous hemangioma using an anterior approach.

    Case Report: Two cases of intramedullary cavernous hemangioma located on the ventral side of the spinal cord were successfully treated by total resection with anterior cervical corpectomy followed by anterior spinal fusion with an autologous bone strut from the iliac crest. In both cases, the postoperative course was uneventful, and there was no neurological deficit. Bony fusion was achieved, and there was no recurrence or complication during a follow-up period of at least two years.

    Conclusions: Here, we describe an anterior approach for total resection of cavernous hemangiomas on the ventral side of the cervical spinal cord. Outcomes were stable two years after the operations. Although the method should be assessed with more patients and a longer follow-up time, this anterior approach may be useful for the radical resection of a vascular malformation or tumor.

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  • Manabu Mukai, Masayuki Miyagi, Tomohisa Koyama, Takayuki Imura, Kuniak ...
    2018 Volume 2 Issue 4 Pages 335-339
    Published: October 26, 2018
    Released: October 27, 2018
    [Advance publication] Released: April 07, 2018
    JOURNALS OPEN ACCESS

    Introduction: Spontaneous spinal epidural hematomas (SSEHs) are rare in childhood, especially in infants.

    Case Report: We present the case of a 17-month-old-boy with trisomy 21 and a large SSEH. He was hospitalized for acute onset paraplegia after 6 days of irritability. Nine days after symptom onset, magnetic resonance imaging (MRI) of the spine revealed an extensive epidural hematoma between C7 and T5 causing severe spinal cord compression. After a coagulation disorder was ruled out (12 days after onset), he underwent emergency hemilaminectomy with evacuation of the hematoma. His neurologic impairment gradually improved, and 4 months after surgery he was back to his neurologic baseline. At 18 months after surgery, he was walking independently, although he had some developmental disabilities due to trisomy 21.

    Conclusions: Only 20 cases of SSEH in infancy have been previously reported, and this is the first report of SSEH in an infant with developmental disabilities. Because of the non-specific symptoms and difficulty obtaining MRIs in infants, particularly in those with developmental disabilities, the diagnosis and treatment of SSEH may be delayed. However, early diagnosis with MRI and early evacuation of SSEH in patients with severe neurological impairments is important for good outcomes. Attention must be paid to postoperative spinal deformity in infants.

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