Akiko Misawa

Clinical application of peroneal nerve stimulator system using percutaneous intramuscular electrodes for correction of foot drop in hemiplegic patients.

Objective.  To assess the orthotic effect of a functional electrical stimulation device (Akita Heel Sensor System; AHSS) in the treatment of hemiplegic gait with foot drop.

Bilateral and symmetric C1-C2 dumbbell ganglioneuromas associated with neurofibromatosis type 1 causing severe spinal cord compression.

BACKGROUND CONTEXT Ganglioneuromas are rarely located in the cervical region compressing the spinal cord. Only two cases of bilateral and symmetric dumbbell tumor have been reported previously. PURPOSE The purpose of the study was to present an additional case with bilateral and symmetric dumbbell ganglioneuromas of the cervical spine as part of multiple ganglioneuromas of the spine in a patient with neurofibromatosis type 1 (NF-1). STUDY DESIGN The study design was a case report. METHODS A 15-year-old boy with NF-1 presented with a 6-month history of progressive tetraparesis. Magnetic resonance imaging showed voluminous bilateral and symmetric dumbbell masses at the C1-C2 level severely compressing the spinal cord. The spinal cord was also indented by a dumbbell mass at the left C3-C4 level. A systemic imaging survey of the patient showed numerous asymptomatic foraminal and extraforaminal tumors at all neuroforamina of the spine. RESULTS The result was found to be surgical decompression of the spinal cord by subtotal resections of bilateral tumors at the C1-C2 level and unilateral tumor at the left C3-C4 level alleviated patient symptoms. Histopathological diagnosis was ganglioneuroma for all resected tumors. CONCLUSION Multiple ganglioneuromas, particularly bilateral and symmetric dumbbell tumors, are extremely rare but could be associated with NF-1.

Electrical Stimulation Using Implantable Radiofrequency Microstimulators to Relieve Pain Associated With Shoulder Subluxation in Chronic Hemiplegic Stroke

Objective.  To evaluate the ability to relieve shoulder pain by implanting ceramic‐case versions of radiofrequency microstimulators (RFM) in paralyzed shoulder muscles.

Chronic expanding hematoma after spinal surgery

BACKGROUND CONTEXT Chronic expanding hematoma after spinal surgery is extremely rare, with no case previously reported in the literature. PURPOSE To report a rare case of a chronic expanding hematoma of the spine that occurred 24 years after thoracic laminectomy and spinal cord tumor resection. STUDY DESIGN Case report. METHODS A 71-year-old man presented with a spinal mass located approximately at the level of the sixth thoracic vertebral body. The patient had undergone thoracic laminectomy with tumor resection 24 years previously. The mass had appeared 5 years after this and had gradually enlarged over 19 years. RESULTS The tumor was resected en bloc. The lamina and spinous processes had been partially eroded by the tumor at the fifth and sixth thoracic vertebrae, but the dura was intact. Histopathologic examination confirmed the diagnosis of chronic expanding hematoma. The hematoma had not recurred at the 1-year follow-up. CONCLUSION We report herein an extremely rare case of chronic expanding hematoma after spinal surgery. This entity may be considered a late complication after surgery regardless of the number of years that have passed since the index surgery.

Surgical Treatment for Severe Scoliosis in Patients with Reduced Cardiorespiratory Function after Surgery for Congenital Heart Disease: A Report of Two Cases

Purpose Congenital heart disease (CHD) is associated with an increased risk of scoliosis. The prognosis of scoliosis patients with CHD has improved because of advances in cardiac care. As a result, the frequency of surgery for scoliosis in this population has increased, although the risk of perioperative complications remains high. We treated two patients with CHD who underwent surgery for severe scoliosis. To avoid perioperative complications, we evaluated the preoperative cardiac status and anesthetic risks before posterior correction and fixation in both patients. Methods An expert anesthesiologist evaluated the anesthetic risk in each case, and an adequate reservoir of autologous blood was collected preoperatively. The patient in case 1 was at risk of significant blood loss and required extremely careful operative technique. The patient in case 2 had low cardiac output preoperatively. We therefore performed a thorough preoperative cardiac evaluation. Both patients were admitted to the intensive care unit postoperatively. Results Neither patient suffered serious complications, and both achieved favorable outcomes. Conclusions Appropriate surgical technique and teamwork among experts are the keys to success in patients with severe scoliosis and CHD.

Nerve Growth Factor and Estrogen Receptor mRNA Expression in Paravertebral Muscles of Patients With Adolescent Idiopathic Scoliosis: A Preliminary Study

STUDY DESIGN Comparison of nerve growth factor (NGF) and estrogen receptor (ER)α messenger ribonucleic acid (mRNA) expression in bilateral paravertebral muscles in adolescent idiopathic scoliosis (AIS). This expression in AIS was compared with that of normal control subjects. OBJECTIVES To investigate NGF and ERα mRNA expression in bilateral paravertebral muscles in AIS and control subjects to clarify its association with the development and progression of spinal curvature. SUMMARY OF BACKGROUND DATA Paravertebral muscle abnormalities in AIS patients have been investigated through various methods. Despite the roles of NGF and ER in human skeletal muscles, the association with idiopathic scoliosis is still unclear. METHODS A total of 14 AIS patients (average age, 15.9 ± 2.2 years; average Cobb angle, 48.2° ± 8.9°) and 8 controls (average age, 27.3 ± 9.3 years) were included. Muscle samples were harvested from bilateral paravertebral muscles at the apical vertebral level. Nerve growth factor and ERα mRNA expression was evaluated by the real-time polymerase chain reaction. The researchers compared expression levels in bilateral paravertebral muscles in each group. The expression ratio, the expression at the convex side relative to the concave side, was compared between groups and the correlation between Cobb angle and expression ratio was analyzed. RESULTS Nerve growth factor and ERα mRNA expression on the convex side was higher than on the concave side in the AIS group (p = .024 and .007, respectively) and the expression ratio of NGF and ERα in the AIS group was higher than that of control subjects (p = .004 and .017, respectively). The expression ratio of NGF and the Cobb angle were significantly correlated (r = -0.5728; p = .0323). CONCLUSIONS In the AIS group, both NGF and ERα mRNA expression was asymmetric. The AIS group had higher expression ratios than control group and the NGF expression ratio was positively correlated to the Cobb angle.

Evaluation of scoliosis screening using Moire topography in school children

Objective Screening of school children for scoliosis is an orthopedic examination that has a direct effect on the health of these children. Screening can be performed using various methods. Since 1983, in our prefecture, we have used Moire topography for screening. The purpose of this study was to evaluate the prevalence rate of scoliosis diagnosed by screening school children using Moire topography.

Surgical treatment and intraoperative spinal cord monitoring in scoliosis associated with chronic inflammatory demyelinating polyneuropathy: a case report.

Abstract There has been only one reported case of neuromuscular scoliosis following chronic inflammatory demyelinating polyneuropathy (CIDP). However, no cases of scoliosis that were treated with surgery secondary to CIDP have been previously described. A 16-year-old boy with CIDP was consultant due to the progression of scoliosis with the coronal curve of 86° from T8 to T12. Posterior correction and fusion with segmental pedicle screws were performed under intraoperative spinal cord monitoring with transcranial electric motor-evoked potentials. Although the latency period was prolonged and amplitude was low, the potential remained stable. Coronal curve was corrected from 86° to 34° without neurological complications. We here describe scoliosis associated with CIDP, which was successfully treated with surgery under intraoperative spinal cord monitoring.