H. Kida

Surgical results of dynamic nonfusion stabilization with the Segmental Spinal Correction System for degenerative lumbar spinal diseases with instability: Minimum 2-year follow-up

Background When spinal fusion is applied to degenerative lumbar spinal disease with instability, adjacent segment disorder will be an issue in the future. However, decompression alone could cause recurrence of spinal canal stenosis because of increased instability on operated segments and lead to revision surgery. Covering the disadvantages of both procedures, we applied nonfusion stabilization with the Segmental Spinal Correction System (Ulrich Medical, Ulm, Germany) and decompression. Methods The surgical results of 52 patients (35 men and 17 women) with a minimum 2-year follow-up were analyzed: 10 patients with lumbar spinal canal stenosis, 15 with lumbar canal stenosis with disc herniation, 20 with degenerative spondylolisthesis, 6 with disc herniation, and 1 with lumbar discopathy. Results The Japanese Orthopaedic Association score was improved, from 14.4 ± 5.3 to 25.5 ± 2.8. The improvement rate was 76%. Range of motion of the operated segments was significantly decreased, from 9.6° ± 4.2° to 2.0° ± 1.8°. Only 1 patient had adjacent segment disease that required revision surgery. There was only 1 screw breakage, but the patient was asymptomatic. Conclusions Over a minimum 2-year follow-up, the results of nonfusion stabilization with the Segmental Spinal Correction System for unstable degenerative lumbar disease were good. It is necessary to follow up the cases with a focus on adjacent segment disorders in the future.

Salvaged Surgery of Non-fusion Stabilization for the Adjacent Segmental Diseases after Posterior Spinal Fusion

Posterior lumbar fusion with instrumentation provides immediate stability on spine and is an effective surgical technique in deformity correction, whereas ASD remains as a mid/long term issue. In this study, we applied posterior decompression and non-fusion stabilization with SSCS to total of 21 patients (13 males and 8 females), who had undergone posterior lumbar fusion in the previous five years and then suffered ASD. The mean age was 69.4 years (range: 49 to 85) and the mean period between the primary surgery and the revision surgery was 5 years and 9 months (range: 11 months to 18 years). Site of ASD occurrence was at; upper level on 16 patients, lower level on 4 patients and upper/lower level on 1 patient. Preoperative JOA score 14.6 improved to postoperative 23.8 at the follow-up (improvement rate: 63%). ROM of the operated segments was significantly decreased from mean 8.2 to 1.7 degrees. We applied non-fusion stabilization with SSCS to salvage ASD occurred after posterior lumbar fusion with instrumentation. In case that further spinal fusion is applied to ASD, it could cause another ASD. Therefore non-fusion stabilization seems to be meaningful.

Transforaminal Lumbar Interbody Fusion (TLIF) Using Pedicle Screws with Mobility

We believed that the delivery of a moderate compression force to bone grafts in transforaminal lumbar interbody fusion (TLIF) was better for bony union and performed the TLIF using a pedicle screw with mobility. Using the Segmental Spinal Correction System for TLIF, we investigated 13 patients with a minimum postoperative follow-up of 1 year. A good bony union was observed and clinical results included an improvement rate of 76.8%. Recent spinal instruments are made from more rigid and break-resistant materials. Bony union is less likely to be achieved in TLIF unless segmental subsidence is tolerated to some extent. The use of pedicle screws with mobility may enhance bony union. Background: TLIF using a rigid pedicle screw has become the gold standard in spinal fusion. However, do stronger instruments have advantages for bony union? Bone grafts in TLIF once undergo necrosis and the volume decreases over time. If the disc height does not decrease accordingly, it will create some space between the grafted bone and both upper and lower vertebral bodies, which is disadvantageous for bony union. Thus, we considered that a pedicle screw with mobility would provide moderate compression force to the bone grafts in TLIF and would be better for bony union. The Segmental Spinal Correction System (SSCS) was used for TLIF in this study. Results: We investigated the clinical results of this method in 13 patients (6 male and 7 female, 56 to 79 y/o) with a minimum 1-year follow-up. The mean JOA score improved from 13.5 pre-OP to 25.4 post-OP. The mean improvement rate was 76.8%. Bony union was observed for all patients. Conclusion: TLIF using a pedicle screw with mobility provides moderate compression force to the bone grafts in TLIF and bony union may be enhanced. This could be a new method in spinal fusion surgery.

Bilateral bipartite carpal scaphoid: a case report and literature review.

Congenital bipartite carpal scaphoid has been reported as an extremely rare congenital anomaly. We report a case of a 47-year-old man who was found with bilateral bipartite carpal scaphoids with no history of injury. Radiographs demonstrated symmetric findings of the distinct bipartition of the scaphoid without obvious degenerative change in both wrists. The patient complained of no other symptoms. The diagnostic differentiation of scaphoid bipartition from the pseudarthrosis of the scaphoid could be important in avoiding unnecessary surgery and inappropriate assessment in compensation cases.

Use of HUCKSTEP HIP Prosthesis

In this paper, we report the results of using HUCKSTEP HIP prosthesis for the revision surgery of total hip arthroplasty or the salvage operation for failed hip surgery.Between 1994 to 1997, 9 patients were operated on using this method and 6 patients were followed up. The follow-up periods ranged from 6 to 35 months. With the exception of 1 fracture, these patients were permitted early weight-bearing and all 6 patients had relief of pain with early ambulation. Although the period of postoperative follow-up was short, HUCKSTEP HIP proved useful for these cases.

Treatment Using the Ultrasonic Surgical System for Hard Tissue

The advantages and limitations of the ultrasonic surgical system in spinal surgery are disccused in this report.We used SUMISONIC ME-24000, which transmits ultrasonic vibrations (maximum vibration 2400times/sec, maximum amplitude 200μm) to the horn tip. Since the horn tip is very thin, accurate, precise cutting and resection of hard tissue is possible using a light touch.Cool water is discharged by the horn tip, minimizing heat gererated from cutting, and also washs away dissolved tissue.It was very useful in spinal surgery, especially in surgical decompression of spinal cord of OPLL and OYL.The risk of damage to soft tissue appears to be very low, in comparison with surgiairtome.