Recurrence of fibrous hamartoma of infancy excised 14 years after the primary surgery.

Fibrous hamartoma of infancy is a rare, benign, superficial soft-tissue mass. It usually occurs within the first 2 years of life at the axial regions, upper arms, and external genital areas. There have been some recurrences within the 1st year of the surgery, although no cases have been reported to recur after 1 year. The authors present a recurrent case of fibrous hamartoma of infancy 14 years after the primary surgery, and they show the clinical and histopathological findings.

Clinical usefulness of assessing lumbar somatosensory evoked potentials in lumbar spinal stenosis. Clinical article.

OBJECT: The aim of this retrospective study was to evaluate the clinical usefulness of assessing lumbar somatosensory evoked potentials (SSEPs) in central lumbar spinal stenosis (LSS). METHODS: The latencies of lumbar SSEPs were recorded in 40 patients with central LSS, including 16 men and 24 women. The mean age of the patients was 67.3 +/- 7.4 years. The diagnosis was LSS in 23 cases and LSS associated with degenerative spondylolisthesis in 17 cases. The average duration of symptoms was 43.8 +/- 51.2 months. Twenty-two cases had bilateral and 18 cases had unilateral leg symptoms. Thirty-seven cases were associated with neurogenic intermittent claudication and the mean walking distance of patients with this condition was 246.8 +/- 232.7 m. The mean Japanese Orthopedic Association scale score, as well as the visual analog scale (VAS) scores of low-back pain, leg pain, and numbness, were 16.5 +/- 3.5, 6.0 +/- 2.5, 6.9 +/- 2.1, and 7.8 +/- 2.2, respectively. The minimal cross-sectional area of the dural sac on MR imaging was 0.44 +/- 0.21 cm(2). Thirty-nine cases of cervical spondylotic myelopathy without lumbar and peripheral neuropathy were chosen as the control group. RESULTS: The latencies of lumbar SSEPs in patients with LSS and in the control group were 23.0 +/- 2.0 ms and 21.6 +/- 1.9 ms, respectively. There was a statistically significant difference between the LSS and control groups (p < 0.05). The latency of lumbar SSEPs was significant correlated with the VAS score of leg numbness (p < 0.05). The latency of lumbar SSEPs in LSS was clearly delayed when the VAS score of leg numbness was > or = 8 (p < 0.05). CONCLUSIONS: Lumbar SSEPs are able to detect neurological deficit in the lumbar area effectively, and they can reflect part of the subjective severity of sensory disturbance (numbness) in LSS. Both lumbar SSEPs and VAS scores of leg numbness may be useful for clinical evaluation in patients with LSS.

Clinical value of motor evoked potentials with transcranial magnetic stimulation in the assessment of lumbar spinal stenosis.

The objective of this study was to evaluate the clinical usefulness of assessing motor evoked potentials (MEP) in lumbar spinal stenosis (LSS). Twenty-three LSS patients were enrolled. The preoperative data of MEP latency (MEPLT), clinical symptoms, Japanese Orthopaedic Association (JOA) scores for low back pain, visual analogue scale (VAS) for back pain, leg pain and numbness, walking distance and the minimal cross-sectional area (mCSA) of the dural sac were evaluated. The mean MEPLT was 42.1 +/- 2.8 ms. Fourteen patients had bilateral leg symptoms. The mean walking distance and mCSA were 302.1 +/- 302.8 m and 0.4 +/- 0.2 cm(2), respectively. The mean JOA score and VAS scores for back pain, leg pain and numbness were 15.9 +/- 4.8, 6.0 +/- 2.9, 7.7 +/- 1.9 and 7.3 +/- 3.0, respectively. MEPLT was related to the walking distance, limb symptoms and the VAS for numbness. MEPLT was significantly delayed in patients who showed a walking distance less than 500 m. MEP is useful in LSS assessment. It can reflect the subjective severity of motor disturbance and predict the neurological deficit prior to appearance.

Epidemiological study of low back pain and occupational risk factors among taxi drivers.

A survey of taxi drivers was conducted to determine the actual situation of drivers' low back pain (LBP). The survey was carried out in October 2002, the target drivers were asked to complete a questionnaire which contains questions regarding physique of drivers, demographic features, working conditions, office environment, health conditions, the presence of low back pain, the level of low back pain based on Visual Analogue Scale and Roland-Morris Disability Questionnaire score. As a result, the total number of valid responses was 1,334 and the response rate was 71 percent, and the 1-wk prevalence of LBP was 20.5 percent of respondents. Regarding 275 subjects with LBP, Visual Analogue Scale (VAS) averaged 4.3. There was a positive weak correlation between VAS and Roland-Morris Disability Questionnaire score (R=0.41). And Logistic regression analysis was performed to examine the relationship between LBP and occupational factors, the results suggested following items as risk factors; such as history of LBP, suffering from fatigue, diseases other than LBP and smoking habit.

A case report of rapidly progressing cauda equina symptoms due to rheumatoid arthritis.

Although rheumatoid involvement of the lumbar spine is relatively rare, we report a patient with rapidly progressing cauda equina symptoms due to rheumatoid diskitis. A 72-year-old woman was admitted to our hospital because of motor weakness below the iliopsoas muscle and sensory disturbance beneath the level of L2. Plain X-ray films, computed tomography, and magnetic resonance imaging demonstrated destruction of the L2/3 intervertebral disc and endplates with subluxation of the facet joints. The dural sac was compressed. Based on a diagnosis of spinal canal stenosis due to rheumatoid diskitis, we performed partial laminectomy and posterolateral fusion with pedicle screws. The neurological deficits improved immediately. The mechanism of intervertebral disc destruction in this case is thought to be rheumatoid nodes or enthesitis. Destruction of the facet joints and the intervertebral disc might have led to severe instability and spinal canal stenosis.