Osteoporotic Thoracolumbar Vertebral Fractures With Neurological Deficit Treated by Balloon Kyphoplasty Augmented with Newly Developed Minimally Invasive Posterior Hook Stabilization.

Most osteoporotic vertebral fractures (OVFs) are treated conservatively, but surgery is often indicated for residual pain, neuropathy, or severe deformity. OVFs tend to develop in elderly patients, so less invasive surgery is desirable. Surgery is mainly performed to stabilize the fractured vertebral body. Percutaneous cement augmentation, such as via balloon kyphoplasty (BKP), has produced satisfactory results as a surgical method for managing OVFs. Posterior fixation with implants is often performed with or without cement augmentation when stronger fixation is considered necessary for OVFs with local kyphosis and angular instability. Pedicle screws (PSs) are widely used as an implant for posterior fixation, but given the risk of backing out in bones with severe osteoporosis, several measures have been taken to increase the strength such as by adding hooks. In cases of osteoporosis, hooks that can use cortical bone as an anchor are considered more useful than PS but are rarely used in minimally invasive surgery. We developed a minimally invasive posterior hook stabilization approach to directly stabilize the posterior spinal components as a new augmentation method for BKP and applied it to four cases of thoracolumbar OVF with neurological symptoms. The operation time was about 60 minutes, including BKP, and the estimated blood loss was about 10 ml. No postoperative implant problems occurred, and in all cases, neurological symptoms, such as buttocks and leg pain, were alleviated at an early stage after surgery. One patient had a postoperative adjacent vertebral body fracture that was conservatively treatable. Minimally invasive posterior hook stabilization, which we developed as a way of augmenting BKP, was considered useful for managing vertebral body fractures of the thoracolumbar spine with local kyphosis and angular instability.

The Efficacy of Imatinib Mesylate in the Treatment of a Rare Lytic Bone Lesion Caused by Hypereosinophilic Syndrome/Chronic Eosinophilic Leukemia: A Case Report.

CASE: We report a patient with hypereosinophilia-associated massive osteolytic lesion of the sacrum who was admitted to our hospital. Genetic analysis revealed that atypical eosinophilic cells were positive for FIP1-like-1-platelet-derived growth factor receptor-alpha (FIP1L1-PDGFRA) fusion gene. Treatment was initiated with oral administration of imatinib mesylate. The patient responded rapidly to this medication with a marked reduction in eosinophilia both from the peripheral blood and FIP1L1-PDGFRA fusion gene in the bone marrow within 2 weeks, followed by gradual osteosclerotic repair of the sacrum. CONCLUSIONS: This case study found that the drug imatinib proved very effective in the treatment of this rare condition.

Diffuse Idiopathic Skeletal Hyperostosis: A Case with Dysphonia, Dysphagia and Myelopathy.

BACKGROUND Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by the ossification of soft tissues, primarily the ligaments and enthesis. Exuberant osteophyte formation of the anterior longitudinal ligament of the spine is usually found. Among the reported complications of cervical osteophyte, dysphagia is the most frequent symptom, and dysphonia is rare. CASE REPORT A 66-year old male was suffering from progressive dysphonia, dysphagia, and myelopathy. Anterior cervical osteophytes and ossification of the posterior longitudinal ligament (OPLL) was shown on x-ray and computed tomography (CT). He was diagnosed with DISH and the osteophytes were resected. The patient's symptoms gradually improved. CONCLUSIONS DISH may induce varying symptoms and surgical intervention is a good way to relieve these symptoms. We rarely see the symptoms of dysphonia, but we should consult with other professionals, such as otolaryngologist and dietician, when treating DISH patients.

Clinical outcome of microscopic lumbar spinous process-splitting laminectomy: clinical article.

OBJECT: The authors sought to quantify the clinical outcome of microscopic lumbar spinous process-splitting laminectomy in patients with lumbar spinal stenosis (LSS). They performed a microscopic laminectomy in which the spinous process is split longitudinally into 2 halves. For single-level decompression, they inserted a tubular retractor between the split process. METHODS: Data obtained in a total of 124 patients were retrospectively analyzed. Patients were divided into 2 groups: the "slip" group, comprising patients with spondylolisthesis-type LSS with vertebral body slippage (Group 1), and the "nonslip" group, comprising patients with spondylosis-type LSS without vertebral body slippage or with LSS due to central protrusion of lumbar disc herniation. Clinical outcome in all patients was evaluated by using the Japanese Orthopaedic Association score. In the slip group, slippage and instability rates were evaluated by using pre- and postoperative dynamic radiographs in the sagittal plane. Postoperative CT images were used to evaluate bony union at 2 sites: a region between the left and right portions of the halved spinous process and a region between the base of the halved process and vertebral arch. Signal intensity of the multifidus muscle at individual decompression levels was evaluated on pre- and postoperative T1- and T2-weighted MR images. RESULTS: Preoperative clinical symptoms improved significantly after surgery in all patients. Slippage and instability rates in the slip group showed no significant differences when pre- and postoperative conditions were compared. Union rates at the region between the left and right portions of the halved process and the region between the base of the halved process and vertebral arch were 97.1% and 82.5%, respectively. Magnetic resonance imaging showed only a small amount of fat infiltration in the multifidus muscle after surgery in 12.2% of cases. CONCLUSIONS: The authors recommend microscopic lumbar spinous process-splitting laminectomy as a promising minimally invasive surgery for the treatment of LSS.

Evaluation of postoperative spinal epidural hematoma after microendoscopic posterior decompression for lumbar spinal stenosis: a clinical and magnetic resonance imaging study.

OBJECT: The incidence of postoperative spinal epidural hematoma (SEH) is low, and to the best of the authors' knowledge, no researchers have evaluated its actual incidence and clinical features. The purpose of this study was to investigate the clinical consequences of SEH after microendoscopic posterior decompression (MEPD) in patients with lumbar spinal stenosis. METHODS: Data obtained in 30 patients undergoing MEPD for lumbar spinal stenosis were reviewed. At 1 week after surgery, magnetic resonance (MR) imaging documented SEHs in 10 patients (33% [Group 1]) and no evidence of SEHs in 20 patients (67% [Group 2]). The authors compared MR imaging findings, postoperative morbidities, and clinical outcomes between the groups. Three Group 1 patients had symptomatic SEHs. All symptoms were mild without associated neurological deterioration and spontaneously subsided within 3 weeks of surgery. Magnetic resonance imaging demonstrated spontaneous regression of the SEH in all patients at 3 months after surgery. In Group 1 patients, however, the authors observed less expansion of the dural sac after 1 year despite sufficient widening of the osseous spinal canal. Low-back pain within 1 week of surgery was moderate in Group 1 and mild in Group 2. Improvements at the final follow up were greater in Group 2 patients. CONCLUSIONS: The incidence of postoperative SEHs may be greater than reported. Postoperative SEHs caused poor expansion of the dural sac despite its spontaneous regression. In addition, postoperative SEHs caused a delay in the patient's recovery and led to a poor clinical improvement. The prevention of postoperative SEHs might be required to prevent not only neurological deterioration but also a delay in the patient's recovery.

Short-term results of microendoscopic posterior decompression for lumbar spinal stenosis. Technical note.

OBJECT: The authors applied the technique of microendoscopic discectomy to posterior decompression procedures for lumbar spinal stenosis. The purpose of this study was to determine the feasibility of using an endoscopic technique to treat lumbar spinal stenosis and to evaluate the clinical and radiographic results of microendoscopic posterior decompression (MEPD). METHODS: Microendoscopic posterior decompression, which involves a unilateral endoscopic approach for bilateral decompression, was performed in 47 patients. Clinical and radiographic/neuroimaging results were evaluated during the follow-up period (minimum duration 1 year). The clinical results were compared with those of the conventional laminotomy. Radiographic instability and the degree of surgical invasion of the facet joints were evaluated. In a control a group of 29 patients open laminotomy was performed. The clinical outcome was evaluated in 44 patients. The mean follow-up duration was 22 months. The mean rate of improvement was 72% based on the Japanese Orthopaedic Association score, and good results were obtained in 38 patients. Although the rate of morbidity decreased in the MEPD group, the incidence of complication was slightly higher. Effective decompression was demonstrated in the majority of the patients by using magnetic resonance imaging. Radiographic instability appeared in one patient postoperatively, and based on computerized tomography scanning, a tendency toward invasion of the facet joint on the approach side was noted. CONCLUSIONS: Microendoscopic posterior decompression is a minimally invasive procedure and is as useful as other conventional procedures in treating lumbar spinal stenosis; however, a few technical problems remain to be solved.