Fumio Kasama

Long-term observations of vertebral fractures in spinal osteoporotics

SummaryThe changes in the number and distributions of vertebral fractures were studied from the long-term observations (average 7 years) of 21 spinal osteoporotic patients. Distribution of wedge fractures was biphasic with peak frequencies at the midthoracic and thoracolumbar spine. Biconcave fractures occurred predominantly in the lumbar spine. These patterns of distribution did not change during the period of observation. The rate of biconcave fracture increased, the rate of wedge fracture decreased, and that of collapse remained the constant in follow-up. The changes in the number of fractures were divided into three types; increasing, plateau, and unchanged type. With the advance of osteoporosis, the increasing type was considered to change into the plateau type, which is probably the terminal stage of spinal osteoporosis. The unchanged type, in contrast, was distinct from the other two types because of increased spinal bone mineral density and decreased urinary calcium, which suggests that spinal osteoporosis is heterogeneous with regard to calcium metabolism.

Open Elbow Arthrolysis for Post-traumatic Elbow Contracture

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 °. 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 ° to 121 °, but the mean extension improved little from –30 ° to –26 °. The mean flexion-extension arc increased from 53 ° to 95 °. According to the elbow evaluation score by the Japanese Orthopaedic Association, both pain and function scales improved significantly. By Hertels 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 fragmens, and sharp epiperiosteal resection around the heterotopic bones are essential procedures of open arthrolysis to restore adequate motion in post-traumatic elbow contracture.

Anterior decompression and fusion versus laminoplasty for cervical myelopathy caused by soft disc herniation: a prospective multicenter study

BackgroundAnterior 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.MethodsPatients 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.ResultsThe 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.ConclusionsThere 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.

Bone mineral density and back muscle strength in spinal osteoporotics

In the 63 patients with spinal osteoporosis who had been treated with vitamin D3 and calcium supplement, back muscle strength was compared with the following parameters; bone mineral density (BMD) of the distal 1/6 and 1/3 of radius by single photon absorptiometry, BMD of lumbar spine and femoral neck by dual photon absorptiometry, body height, body weight and age. Back muscle strength correlated significantly with BMD of lumbar spine and BMD of radius (1/3), and less with BMD of femoral neck. The strength of back muscle also showed a significant negative correlation with age. Back muscle strength and the body weight were the significant predictors of the bone mineral density of the lumbar spine. These data suggest that back muscle strength has a possibility of affecting bone mineral density of the spine.

LONG-TERM TREATMENT WITH 1αHYDROXYVITAMIN D3 WITH CALCIUM SUPPLEMENT IN SPINAL OSTEOPOROTIC PATIENTS

The long-term effect of 1 alpha-hydroxyvitamin D3 and calcium lactate in osteoporotic patients was evaluated by the bone mineral density (BMD) measured at the distal one third and one sixth of the radius and by the vertebral fracture rate. Forty-five osteoporotic patients medicated for 1 to 13 years (treated group) and 11 osteoporotic patients with no medication for 1 to 3 years (control group) were compared. The BMD of the treated group remained unchanged for the first 4 (one-third site) and 6 years (one-sixth site), followed by significant decreases, whereas that of the control group decreased significantly at the second and third year. The effect on BMD was more prominent in the patients with lower initial BMD. The vertebral fracture rate of the treated group was significantly less than that in the control group at the third year. No serious side effects were recognized. Overall, we believe 1 alpha-hydroxyvitamin D3 with calcium supplement can be considered a safe and effective agent for long-term use in osteoporotic patients.

Serum bone gla-protein in osteoporosis treated with 1α-hydroxyvitamin D3 for more than five years

It has been reported that 1,25-dihydroxyvitamin D3 increases serum bone Gla-protein (BGP) in a short period in osteoporotic patients as well as in normal subjects. There have been, however, no reports on serum BGP in osteoporotic patients under long term treatment with 1α-hydroxyvitamin D3. We measured serum BGP in 11 osteoporotic women treated with 1α-hydroxyvitamin D3 and calcium for 5–12 years, 8.4 years on average. Bone mineral density of distal radius was assessed by single photon absorptiometry. Other biochemical parameters such as serum alkaline phosphatase, fasting urinary hydroxyproline/creatinine and calcium/creatinine were also measured.Serum BGP levels were 6.25±0.36ng/ml (mean±S.E.), being all within the normal range (6.2±3.86ng/ml). We found no significant correlation between serum BGP and other biochemical parameters. Significant correlation was found neither between serum BGP and period of treatment nor between serum BGP and bone mineral density.Our result that serum BGP is within the normal range in osteoporotic patients whose bone mineral density has been maintained by long-term treatment suggests the normal bone turnover in these patients.