Cervical intradural disc herniation.

STUDY DESIGN: A case report of anterior en bloc resected cervical intradural disc herniation and a review of the literature. OBJECTIVE: To discuss the pathogenesis of cervical intradural disc herniation. SUMMARY OF BACKGROUND DATA: Including this study case, only 17 cases of cervical intradural disc herniation have been reported. There have been few detailed reports concerning the pathogenesis of cervical intradural disc herniation. METHODS: A cervical intradural disc herniation at C6-C7, with localized hypertrophy and segmentally ossified posterior longitudinal ligament, is reported in a 45-year-old man who had Brown-Sequard syndrome diagnosed on neurologic examination. Neuroradiologic, operative, and histologic findings, particularly the pathology of the anterior en bloc resected posterior vertebral portion of C6 and C7, were evaluated for discussion of the pathogenesis. RESULTS: Adhesion of dura mater and hypertrophic posterior longitudinal ligament was observed around a perforated portion of the herniated disc, and histologic study showed irregularity in fiber alignment accompanied by scattered inflammatory cell infiltration and hypertrophy in the posterior longitudinal ligament. The cervical intradural disc herniation was removed successfully and followed by C5-Th1 anterior interbody fusion with fibular strut graft. Neurologic recovery was complete except for minor residual sensory disturbance in the leg 7 years after the surgery. CONCLUSIONS: Cervical intradural disc herniation is an extremely rare condition. The pathogenesis remains obscure. Only 16 cases have been reported in the literature, and there has been little discussion concerning the local pathology of the herniated portion. The pathogenesis of the disease in the patient reported here was considered to be the adhesion and fragility of dura mater and posterior longitudinal ligament. This was caused by hypertrophy, with chronic inflammation and ossification of the posterior longitudinal ligament sustaining chronic mechanical irritation to the dura mater, leading to perforation of the herniated disc by an accidental force.

Tetraplegic wheelchair basketball.

Tetraplegic wheelchair basketball was started in the Kanagawa Rehabilitation Center (KRC) as a recreational sport for tetraplegics in 1980. In this game, there are two goals on each side, thus we call it 'twin basketball'. One goal is of ordinary height and the other is low. Three ways of shooting and two ways of dribbling are allowed according to the player's level of tetraplegia and technical skill. The first official game was held in 1983. Since then, the game has been taken up in several areas of Japan. The first All Japan championship game was held in 1987, ten teams including 98 tetraplegics attending. Five years later, in the sixth championship game, 18 teams including 171 tetraplegics attended. As official physicians, we have examined the physical condition and technical skills of all players since 1987. All players are classified, and assigned points from 1 to 4.5. The total number of points of five players in one team are limited to 11.