18F-sodium fluoride positron emission tomography may help determine better treatment for thigh pain after hip arthroplasty-A case report.

Thigh pain after hip arthroplasty is multifactorial; uncovering its etiology is paramount for optimal treatment. This is the first case where 18F-sodium fluoride positron emission tomography substantially helped in diagnosing the post-hip arthroplasty persistent thigh pain and appropriate treatment selection. This imaging modality warrants further study and more widespread application.

NaF PET assessment of bone metabolic changes around the femoral canal by intramedullary femoral alignment technique in total knee arthroplasty.

We used the NaF PET scan to assess osteometabolic changes around the distal half of the femoral canal by intramedullary (IM) drill for femoral IM guiding rod insertion in total knee arthroplasty. Gentle IM rod insertion and focused attention can minimize surgical stress-induced biological reaction of the femoral IM canal.

The efficacy of prostaglandin E1 derivative in patients with lumbar spinal stenosis.

STUDY DESIGN: Randomized controlled trial. OBJECTIVE: To examine the effect of limaprost, an oral prostaglandin (PG) E1 derivative, on health-related quality of life (HRQOL) in patients with symptomatic lumbar spinal stenosis (LSS), compared to etodolac, a NSAID. SUMMARY OF BACKGROUND DATA: Limaprost, an oral PGE1 derivative, was developed in Japan to treat numerous ischemic symptoms of thromboangiitis obliterans (TAO) and LSS. Previous studies have demonstrated the effectiveness of limaprost in the symptoms in patients with LSS. However, the evidence for effect on patient-reported outcomes, such as patient's HRQOL or satisfaction, is limited. METHODS: This study was conducted at 4 study sites in Japan. Briefly, inclusion criteria were: age between 50 and 85 years; presence of both neurogenic intermittent claudication (NIC) and cauda equina symptoms (at least presence of bilateral numbness in the lower limbs); and MRI-confirmed central stenosis with acquired degenerative LSS. Limaprost (15 microg/d) or etodolac (400 mg/d) was administered for 8 weeks. The primary outcome was Short Form (SF)-36, and the secondary outcomes were the verbal rating scale of low back pain and leg numbness, walking distance, subjective improvement, and satisfaction. RESULTS: A total of 79 participants were randomized (limaprost:etodolac = 39:40). Thirteen participants withdrew from the study (limaprost:etodolac = 5:8) and 66 completed the study (limaprost:etodolac = 34:32). Comparisons showed that limaprost resulted in significantly greater improvements in the SF-36 subscales of physical functioning, role physical, bodily pain, vitality, and mental health. Limaprost was also significantly better than etodolac for leg numbness, NIC distance, and subjective improvement and satisfaction. In the subgroup analysis stratified by symptom severity, limaprost seemed more effective for milder symptoms. No serious adverse effects were reported in either treatment group. CONCLUSION: In this study, limaprost was found to be efficacious on most outcome measures, such as HRQOL, symptoms and subjective satisfaction, in LSS patents with cauda equina symptoms.

Novel method to evaluate femoral head penetration in the polyethylene liner after total hip arthroplasty: three-dimensional evaluation on standing radiographs.

BACKGROUND: After total hip arthroplasty, the femoral head penetrates the liner because of polyethylene wear and the so-called bedding-in phenomenon. The head moves three-dimensionally, but few reports have evaluated such movement radiographically. Moreover, even fewer reports have evaluated it in a standing position, although the load stress influences the movement. The purpose of the present study was to evaluate the head movement in the liner three-dimensionally using standing images. METHOD: The distance between the centers of the metal shells and femoral heads were measured in 29 unilateral hips implanted with porous-coated acetabular components. Standing anteroposterior and lateral radiographs obtained approximately 2 years after operation were photographed by a digital camera, and the data were used. The measured distances divided by the time after operation and enlargement ratio of the radiographs gave linear penetration rates in the frontal and sagittal planes, and three-dimensional linear penetration rates were calculated from the penetration vectors. Frontally evaluated and three-dimensionally calculated penetration rates were compared, and the correlation of age and other factors with the penetration rate was evaluated. RESULTS: Linear penetration rates were 0.14 +/- 0.11 mm/year frontally, 0.18 +/- 0.08 mm/year sagittally, and 0.21 +/- 0.10 mm/year three-dimensionally. The mean three-dimensional penetration rate was 42% greater than the frontal rate. An inverse correlation was observed between age and the sagittal penetration rate (r = -0.621), and between age and the three-dimensional penetration rate (r = -0.388). The sagittal and three-dimensional penetration rates were significantly higher (P = 0.0008 and 0.0010, respectively) in patients aged <75 years compared to those aged > or = 75 years. CONCLUSIONS: The average three-dimensional penetration rate during the first 2 years after operation was markedly greater than the frontal two-dimensional penetration rate that was conventionally applied for postoperative evaluation. Three-dimensional evaluation using both frontal and sagittal radiographs is necessary to avoid undervaluation of the head movement after total hip arthroplasty.

Age-related changes in histogram pattern of anterior horn cells in human cervical spinal cord.

The purpose of the present study was to clarify age-related changes in histograms of spinal anterior horn cells. The study examined Rexed lamina IX of the C7 spinal cord segment in 22 men who had died of non-spinal disease (age range, 0-85 years). First, we confirmed that the size of nucleoli exhibited a linear relationship to the diameter of spinal anterior horn cells by preparing histograms of nucleoli. Second, this formula was used to create histograms of cervical anterior horn cells. Results were as follows: (i) diameter of nucleoli ranged from 2.0 microm to 6.0 microm; (ii) in each subject, no changes were seen in histogram patterns among ventral, intermediate, dorsal and overall sections; (iii) at < or =20 years of age, histograms displayed a single peak for the diameter of nucleoli at about 4.0-4.5 microm; (iv) at 21-60 years of age, histograms displayed two peaks, at about 3.5-4.0 microm and 5.0-5.5 microm; and (v) at 61-85 years of age, histograms displayed a single peak at about 5.0-5.5 microm.

Ossification of the posterior atlantoaxial membrane and the transverse atlantal ligament.

STUDY DESIGN: Case report. OBJECTIVE: To report a case of ossification of the posterior atlantoaxial membrane (PAAM) and ossification of the transverse ligament of the atlas (TAL). SUMMARY OF BACKGROUND DATA: Ossification of the PAAM and TAL are both very rare clinical entities. This is the first case involving ossification of both the PAAM and TAL with the development of cervical myelopathy. METHODS: Patient's history, physical examination, radiographic evaluation, surgical treatment, and outcome are examined. Relevant literature is also reviewed. RESULTS: The patient's neurological symptoms significantly improved after posterior decompressive surgery. CONCLUSION: Ossification of various parts of the spinal ligament have been reported previously. Among them, ossification of both the PAAM and TAL has never been reported previously and is thus extremely rare. Surgical intervention improved the neurological impairment.

Klotho insufficiency causes decrease of ribosomal RNA gene transcription activity, cytoplasmic RNA and rough ER in the spinal anterior horn cells.

The klotho gene was identified in 1997 as the gene whose severe insufficiency (kl/kl) causes a syndrome resembling human aging, such as osteoporosis, arteriosclerosis, gonadal atrophy, emphysema, and short life span in a mouse strain. Regarding the gait disturbance reported in kl/kl mice, the present study examined the spinal cord of kl/kl mice, and revealed decreases in the number of large anterior horn cells (AHCs), the amount of cytoplasmic RNA, the number of ribosomes and rough endoplasmic reticulum (rER), and the activity of ribosomal (r) RNA gene transcription without significant loss of the total number of neurons in the ventral gray matter. Increased immunostaining of phosphorylated neurofilament in the AHCs and of glial fibrillary acidic protein in reactive astrocytes in the anterior horn of kl/kl mice were also observed. On the other hand, the posterior horn was quite well preserved. The results suggest that the kl/kl insufficiency causes atrophy and dysfunction of the spinal AHCs through decreased activity of rRNA gene transcription, which may reduce the amount of cytoplasmic RNA and the number of ribosomes and rER. These findings resemble those found in the spinal cord of patients with classic amyotrophic lateral sclerosis (ALS). The results show that klotho gene insufficiency causes dysfunction of the protein synthesizing system in the AHCs, and might indicate the klotho gene is involved in the pathological mechanism of classic ALS. The kl/kl is a new animal model of AHC degeneration, and may provide clues to understanding the etiology of classic ALS.

Measurement of occipitocervical angle.

STUDY DESIGN: This study compared the reliability of 3 techniques used to measure alignment between the occiput and cervical spine. OBJECTIVES: Intraobserver and interobserver intraclass correlation coefficient were computed to determine the most reliable method to measure occipitocervical angle. SUMMARY OF BACKGROUND DATA: No studies have been performed comparing occipitocervical angle measurement techniques. METHODS: The angles between the inferior endplate of second cervical vertebrae and the occiput line using the Chamberlain line, McRae line, and McGregor line were measured from lateral cervical radiographs of 30 healthy volunteers. Five spine surgeons made measurements. RESULTS: Mean intraobserver variances of the angles using Chamberlain line, McRae line, and McGregor line were 2.0 degrees (ranging from 0 degrees-15 degrees), 4.7 degrees (from 0 degrees-28 degrees), and 1.5 degrees (from 0 degrees-9 degrees), respectively; intraobserver intraclass correlation coefficients of the angles were 0.956, 0.835, and 0.975. Mean interobserver variances of the angles using Chamberlain line, McRae line, and McGregor line were 2.3 degrees (from 0.4 degrees-6.4 degrees), 5.0 degrees (from 1.8 degrees-11.9 degrees), and 1.4 degrees (from 0 degrees-4.5 degrees), respectively; interobserver intraclass correlation coefficients were 0.939, 0.802, and 0.972. The highest reliability indexes were obtained for McGregor line. CONCLUSIONS: The McGregor line is the most reproducible and reliable method for measurement of the occipitocervical angle.

Case of idiopathic thoracic spinal cord herniation with a chronic history: a case report and review of the literature.

Idiopathic spinal cord herniation is a rare disease that presents with slowly progressive myelopathy. This article describes the clinical findings of a patient with a chronic history. A 68-year-old woman initially presented at the age of 32 years with left leg weakness. After slowly progressive neurological deterioration over 34 years, she became completely paraplegic. At the age of 66 years, magnetic resonance imaging resulted in a diagnosis of idiopathic spinal cord herniation at the T6/7 level. Surgery was performed to reduce aching of the lower extremities. The spinal cord was released from the dural defect through a T5-T8 laminectomy. The dural defect was enlarged by resecting its periphery to prevent reherniation of the spinal cord. After the surgery, pain in the lower extremities resolved and her motor function slightly improved. Although operative treatment is naturally recommended at the early stage of this disease, our case suggests that some symptoms can be resolved by surgical treatment despite prolonged, severe preoperative symptoms.