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1.
Clin Spine Surg ; 2020 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-32282403

RESUMO

STUDY DESIGN: A prospective multicenter study. OBJECTIVE: The purpose of this study was to determine whether laminoplasty (LP) is comparable for myelopathy caused by cervical disk herniation (CDH). SUMMARY OF BACKGROUND DATA: Anterior decompression and fusion (ADF) has conventionally been used for myelopathy caused by CDH with stable outcomes. However, recurrence of myelopathy due to adjacent segment degeneration are its drawbacks. The efficacy of LP without discectomy has been sporadically reported, but no long-term prospective study has been conducted to verify it. MATERIALS AND METHODS: Patients with cervical myelopathy caused by CDH were studied. The first 30 patients and the next 30 patients were treated with ADF and LP, respectively. The outcomes were compared between the 22 ADF patients and the 20 LP patients who had completed the follow-up examination scheduled 10 years after surgery. RESULTS: There was no statistically significant difference in the postoperative severity or recovery rate of myelopathy between the 2 groups 10 years after surgery. One patient in the ADF group underwent LP for secondary myelopathy due to adjacent segment degeneration 2 years after the surgery. Reoperation was not required for patients in the LP group. Postoperative neck pain was significantly more severe in the LP group than in the ADF group. CONCLUSIONS: ADF and LP for cervical myelopathy caused by CDH achieve similarly favorable outcomes. Recurrence of myelopathy caused by adjacent segment degeneration is a disadvantage of ADF while residual neck pain is a disadvantage of LP.

2.
Spine Surg Relat Res ; 3(4): 304-311, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31768449

RESUMO

Introduction: Laminoplasty is a common surgery for cervical myelopathy. Previous studies have analyzed the reoperation rates in posterior decompression surgeries of the cervical spine. However, few studies have solely focused on midline-splitting laminoplasty (MSL) using a large number of patients. This aims to analyze the reoperation rates after MSL using the survival function method. Methods: Between 1988 and 2013, 4,208 MSLs were performed as a primary operation for cervical myelopathy and enrolled in our spinal surgery registration system. The Kaplan-Meier survival function method was used to analyze the rates of reoperation. Results: Of 4,208 patients with primary MSL, 40 underwent reoperation for neurological complications. The overall reoperation rate was 0.26%, 0.64%, 0.83%, 0.93%, and 0.95% at 1, 5, 10, 20, and >20 years, respectively. The causes of reoperation were postoperative cervical radiculopathy in 10 patients, stenosis at an adjacent level in 8, stenosis due to failed "open-door" lamina in 6, instability of the cervical spine in 4, cervical disc herniation in 3, elongation of ossification of the posterior longitudinal ligament in 3, spinal cord injury in 1, fracture of the cervical spine in 1, postoperative scar formation in 1, ossification of anterior longitudinal ligament in 1, and unknown in 2. The number of patients with surgical site infection (SSI) who needed surgical debridement was 34 (0.81%). Conclusions: Excluding reoperations for SSI, the reoperation rate of MSL was approximately 1.0% at the maximum of 26 years after surgery. MSL was determined to be a reliable surgical procedure regarding postoperative complications requiring additional surgeries.

3.
Tohoku J Exp Med ; 238(2): 153-63, 2016 02.
Artigo em Inglês | MEDLINE | ID: mdl-26876801

RESUMO

Spinal disorders affect mainly older people and cause pain, paralysis and/or deformities of the trunk and/or extremities, which could eventually disturb locomotive functions. For ensuring safe and high-quality treatment of spinal disorders, in 1987, the Tohoku University Spine Society (TUSS) was established by orthopedic departments in Tohoku University School of Medicine and its affiliated hospitals in and around Miyagi Prefecture. All spine surgeries have been enrolled in the TUSS Spine Registry since 1988. Using the data from this registration system between 1988 and 2012, we demonstrate here the longitudinal changes in surgical trends for spinal disorders in Japan that has rushed into the most advanced "aging society" in the world. In total, data on 56,744 surgeries were retrieved. The number of spinal surgeries has annually increased approximately 4-fold. There was a particular increase among patients aged ≥ 70 years and those aged ≥ 80 years, with a 20- to 90-fold increase. Nearly 90% of the spinal operations were performed for degenerative disorders, with their number increasing approximately 5-fold from 705 to 3,448. The most common disease for surgery was lumbar spinal stenosis (LSS) (35.9%), followed by lumbar disc herniation (27.7%) and cervical myelopathy (19.8%). In 2012, approximately half of the patients with LSS and cervical myelopathy were ≥ 70 years of age. In conclusion, the number of spinal operations markedly increased during the 25-year period, particularly among older patients. As Japan has a notably aged population, the present study could provide a near-future model for countries with aging population.


Assuntos
Sistema de Registros , Sociedades Médicas , Doenças da Coluna Vertebral/epidemiologia , Doenças da Coluna Vertebral/cirurgia , Universidades , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
4.
J Orthop Sci ; 15(1): 71-8, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20151254

RESUMO

BACKGROUND: Anterior decompression and fusion (ADF) has conventionally been used, with stable outcomes, for cervical myelopathy caused by soft disc herniation. However, complications related to bone grafting and recurrence of myelopathy due to adjacent segment degeneration are its drawbacks. The efficacy of laminoplasty as an alternative has been sporadically reported, but no prospective study has been conducted to verify it. The purpose of this study was to determine whether laminoplasty is comparable for this condition. METHODS: Patients with cervical myelopathy caused by soft disc herniation whose preoperative disease period was less than 1 year were studied. The first 30 patients and the next 30 patients were treated by ADF and laminoplasty, respectively. All patients were given the same postoperative management. The outcomes were compared between the ADF and the laminoplasty groups consisting of 25 patients each who completed a follow-up examination 1 year after surgery. RESULTS: The two groups were found statistically matched regarding age at surgery, sex, disc level of herniation, anteroposterior diameter of the spinal canal, preoperative severity of myelopathy, cervical lordosis angle, and cervical range of motion (ROM). There was no statistically significant difference in the postoperative severity or recovery rate of myelopathy between the two groups. The amount of blood loss during surgery was significantly less in the laminoplasty group. Donor site pain and neck pain was minimal in all patients. Cervical lordosis angle and ROM were diminished postoperatively without a significant difference between the two groups. CONCLUSIONS: There was no critical difference between the ADF and laminoplasty groups with regard to neurological recovery and other surgery-related factors 1 year after surgery. Laminoplasty can be employed for cervical myelopathy caused by soft disc herniation in particular combined with multilevel spinal canal stenosis to avoid secondary myelopathy.


Assuntos
Artroplastia , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica , Deslocamento do Disco Intervertebral/cirurgia , Fusão Vertebral , Adulto , Idoso , Feminino , Seguimentos , Humanos , Deslocamento do Disco Intervertebral/diagnóstico , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Recuperação de Função Fisiológica
5.
Ups J Med Sci ; 113(1): 95-102, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18521803

RESUMO

BACKGROUND: Post-traumatic contracture is a common complication after elbow trauma. If conservative therapy fails to restore adequate elbow motion, arthrolysis is indicated. The purposes of this study were to evaluate the clinical outcome of open arthrolysis for post-traumatic elbow contracture and to determine factors influencing the outcome. METHODS: Twenty-seven patients with post-traumatic elbow contracture were followed-up after open arthrolysis for at least 12 months. Before surgery, the mean limitation in extension was 30 and the mean maximum flexion was 83 degrees. A posterior surgical approach was used in 18 patients, and a lateral approach was employed in nine patients. Using the posterior approach, the fibrotic posterior capsule was excised and the ulnar collateral ligament was split. Both the anterior and posterior capsules were released with a lateral approach. RESULTS: The mean flexion increased from 83 degrees to 121 degrees, but the mean extension improved little from -30 degrees to -26 degrees. The mean flexion-extension arc increased from 53 degrees to 95 degrees. According to the elbow evaluation score by the Japanese Orthopaedic Association, both pain and function scales improved significantly. By Hertel's subjective evaluation, the results were good in 13 patients, fair in ten patients, and poor in four patients. Twenty-three patients (85 percent) were satisfied with the results, but four were not satisfied because of residual contracture. These poor results were related to severe soft tissue trauma, residual displacement of intra-articular fragments, and recurrence of heterotopic bone formation. CONCLUSIONS: Tendon lengthening of stiff triceps, accurate reduction of intra-articular fragments, and sharp epiperiosteal resection around the heterotopic bones are essential procedures of open arthrolysis to restore adequate motion in post-traumatic elbow contracture.


Assuntos
Contratura/cirurgia , Cotovelo/cirurgia , Ferimentos e Lesões/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Contratura/fisiopatologia , Cotovelo/lesões , Cotovelo/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular
6.
Nihon Hoshasen Gijutsu Gakkai Zasshi ; 63(5): 603-8, 2007 May 20.
Artigo em Japonês | MEDLINE | ID: mdl-17538227

RESUMO

In conventional 3D-CT image processing, the images are influenced by subjective threshold settings. The purpose of this study was to evaluate an objective threshold setting technique based on the discriminant analysis method. The concentration of contrast medium in a joint of a simulated upper cervical spine phantom was changed, and its threshold was measured from scanned data by using the discriminant analysis method, and mean CT attenuation was measured. On the other hand, an accurate image of the corresponding joint in the phantom was made, and its minimum threshold was measured. Regression analysis between the adjusted minimum threshold and mean CT attenuation of the region of contrast medium was performed. The obtained linear regression formula was applied to the threshold settings in five cases for atlanto-axial 3D-CT facet arthrogram(3D-CTF), and the accuracy of the images was examined. There was a strong correlation between the adjusted threshold and mean CT attenuation, and the obtained linear regression formula was y=0.625x-141(r2=0.991, p<0.01). This equation could be used clinically for correction of the threshold settings. We propose the following method for threshold setting of 3D-CTF: the threshold of the region of contrast medium is measured using the discriminant analysis method, then the adjusted minimum threshold for the threshold settings of 3D-CTF is calculated from mean CT attenuation. The method described herein is an objective, general-purpose methodology that is applicable to various types of 3D-CT.


Assuntos
Articulação Atlantoaxial/diagnóstico por imagem , Imageamento Tridimensional , Tomografia Computadorizada por Raios X , Articulação Atlantoaxial/anatomia & histologia , Humanos , Imagens de Fantasmas
7.
J Neurosurg Spine ; 5(5): 398-403, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17120888

RESUMO

OBJECT: The authors define facet cyst as a cyst located beside the facet joint and exhibiting a communication with the joint, as demonstrated on arthrography and subsequent computed tomography (CT) of the joint space. The purpose of this study was to determine the pathogenesis of facet cysts based on their radiological and histological features. METHODS: Forty-six juxtafacet cysts in 45 patients (26 men and 19 women, age range 41-82 years) were surgically treated after evaluation by arthrography and subsequent CT scanning. A communication channel between the cyst and the joint was confirmed in all cases and thus the lesions were designated facet cysts. In almost all patients the involved facet joint showed moderate to severe degeneration. After a thorough preoperative radiological evaluation, these cysts were excised en bloc by medial facetectomy with the entire ligamentum flavum. The specimens were cut axially at the maximum diameter and were histologically investigated. Morphologically, the cysts exhibited three shapes, appearing as: 1) a small protrusion, 2) a semicircular cyst, or 3) a round cyst. The cyst walls consisted of elastic and collagen fibers undergoing fibrinoid degeneration, but no synovial lining cells were detected. The cystic cavities were regularly filled with fibrinoids, and myxoid degeneration was found particularly in the larger cysts. CONCLUSIONS: Facet cysts are closely related to the degeneration of the neighboring facet joint. Analysis of the findings in this histological study suggests that there are several shapes of facet cysts. The authors propose that the shape could depend on the stage of the cyst's development.


Assuntos
Cistos/diagnóstico por imagem , Cistos/patologia , Vértebras Lombares , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/patologia , Articulação Zigapofisária , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrografia , Cistos/etiologia , Feminino , Humanos , Ligamento Amarelo/patologia , Masculino , Pessoa de Meia-Idade , Doenças da Coluna Vertebral/etiologia , Tomografia Computadorizada por Raios X
8.
Tohoku J Exp Med ; 210(3): 199-208, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17077596

RESUMO

Thoracic myelopathy is defined as spinal cord compression in the thoracic region, leading to sensory and motor dysfunctions in the trunk and lower extremities, and can be caused by various degenerative processes of the spine. Thoracic myelopathy is rare, and there are many unsolved problems including its epidemiological and clinical features. We have established a registration system of spinal surgeries, which covered almost all surgeries in Miyagi Prefecture, and enrolled the data of 265 patients with thoracic myelopathy from 1988 to 2002. The annual rate of surgery gradually increased and averaged 0.9 per 100,000 inhabitants, which was less than 1/10 of that for cervical myelopathy. About 20 patients with thoracic myelopathy are operated on in Miyagi Prefecture each year. It frequently develops in middle-aged males. About half of the cases were caused by ossification of the ligamentum flavum, followed by ossification of the posterior longitudinal ligament, intervertebral disc herniation and posterior spur. Patients usually noticed numbness or pain in the legs and the preoperative duration was long, averaging 2 years. Its symptomatic similarities to lumbar disorders might cause difficulty in making a correct diagnosis. Since thoracic myelopathy can markedly restrict the activities of daily life, even general physicians should recognize this entity.


Assuntos
Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/epidemiologia , Doenças Torácicas/diagnóstico , Doenças Torácicas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Japão , Ligamento Amarelo/patologia , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/patologia , Ossificação do Ligamento Longitudinal Posterior/patologia , Estudos Retrospectivos , Compressão da Medula Espinal/patologia , Doenças da Medula Espinal/cirurgia , Doenças Torácicas/cirurgia , Resultado do Tratamento
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