Hideaki Hamanaka

Significance of hanging total spine x-ray to estimate the indicative correction angle by brace wearing in idiopathic scoliosis patients

BackgroundAlthough most idiopathic scoliosis patients subject to conservative treatment in daily clinical practice, there have been no ideal methods to evaluate the spinal flexibility for the patients who are scheduled the brace treatment. The purpose of this study was to investigate the value of hanging total spine x-ray to estimate the indicative correction angle by brace wearing in idiopathic scoliosis patients.MethodsOne hundred seventy-six consecutive patients with idiopathic scoliosis who were newly prescribed the Osaka Medical College (OMC) brace were studied. The study included 14 boys and 162 girls with a mean age of 13 years and 1 month. The type of curves consisted of 62 thoracic, 23 thoracolumbar, 22 lumbar, 42 double major, 14 double thoracic, and 13 triple curve pattern. We compared the Cobb angles on initial brace wearing (BA) and in hanging position (HA). Of those, 108 patients who had main thoracic curves were selected and evaluated the corrective ability of OMC brace. These subjects were divided into three groups according to the relation between BA and HA (BA < HA group, BA = HA group, and BA > HA group), and then, maturity was compared among them.ResultsThe average Cobb angle in upright position (UA) of all cases was 31.0 ± 7.8°. The average BA and HA of all cases were 20.3 ± 9.5° and 21.1 ± 8.4°, respectively. The average chronological age was lowest in BA < HA group. And also, maturity in BA < HA group was the lowest among each of them. The rate of BA < HA cases were decreased as the Risser stage of the patients were progressed.ConclusionsThe use of hanging total spine x-ray served as a useful tool to estimate the degree of correction possible curve within the OMC brace for main thoracic curve in idiopathic scoliosis. Maturity had some influence on the correlation between HA and BA. Namely, in immature patients, HA tended to be larger than BA. In contrast, in mature patients, HA had a tendency to be smaller than BA. With consideration for spinal flexibility based on maturity, in mature patients, larger BA than HA may be allowed. However, in immature patients, smaller BA than HA should be aimed.

Long Thoracic and Lumbar Spinal Stabilization with a Minimally Invasive Spine Surgery Technique

Objectives: The purpose of the current case presentation was to indicate the usefulness of long thoracic and lumbar (TL) spinal stabilization by percutaneous minimally invasive instrumentation. Materials and methods: From August 2012 to May 2013, we performed long TL spinal stabilization with VIPER 2 system (Depuy Spine, Inc., MA, US) by using a minimally invasive surgery (MIS) posterior approach in 4 patients. The first case was a 54 year old male who suffered from burst fracture of T12 (Frankel A) with brain contusion by a fall. The second case was a 68 year old male who developed incomplete paraplegia by metastatic renal cell carcinoma of T11 (Frankel C). The third case was a 79 year old male who affected Chance fracture of T12 (Frankel E) with an ankylosing spinal hyperostosis. And the fourth case was a 75 year old male who sustained pathological fracture of T8 (Frankel A) due to metastasis of prostatic carcinoma accompanied by an ankylosing spinal hyperostosis. The assessment included the clinical outcome of the patients and implant imaging evaluation. Results: Physical function was improved in all cases with quick pain relief. Mean operative time was 204 minutes. Mean estimated blood loss was 62.5 ml. In radiographic evaluation, spinal alignment was successfully maintained. One pedicle screw in case 3 cut out laterally in a pedicle-rib unit, but other pedicle screws in all cases were correctly inserted. No implant related complication was observed. And there were no conversions to open surgery. Discussion: In comparison with conventional open surgery, intraoperative blood loss, operative time, and postoperative pain were remarkably decreased in a MIS technique. Long TL spinal stabilization with a MIS technique is useful method for the patients who are desirable to avoid major surgical procedure.

Posterior occipito-axial fixation applied C2 laminar screws for pediatric atlantoaxial instability caused by Down syndrome: Report of 2 cases

Background Upper cervical spine instability is one of the most critical orthopedic problems in patients with Down syndrome. However, arthrodesis of the upper cervical spine in these patients can be very difficult to achieve and has a high complication rate because of mental retardation and accompanying various medical conditions of the vital organs. Even now, surgeries in such patients, especially pediatric cases, are challenging and the optimal operative procedure remains unsettled. The purpose of this study was to report 2 cases of pediatric atlantoaxial instability due to Down syndrome in which posterior occipito-axial fixation with C2 laminar screws was performed. Methods Case 1 was a girl aged 6 years 10 months who had atlantoaxial rotatory fixation with os odontoideum. Atlantoaxial rotatory fixation was incompletely reduced by halo traction, and it was not maintained without halo-ring and -vest fixation. Posterior occipito-axial fixation with bilateral C2 laminar screws was then performed. Case 2 was a boy aged 10 years 7 months who had atlantoaxial subluxation with os odontoideum. He also had incomplete quadriplegia, so he could neither walk nor have a meal by himself. Posterior occipito-axial fixation with right C2 pedicle and left C2 laminar screws was then carried out. Results In case 1 bone union was obtained at 3 months after surgery and the patients symptoms were resolved. In case 2 bone union was obtained at 3 months after surgery and the paralysis was improved. Conclusions/level of evidence In cases of atlantoaxial instability due to Down syndrome, symptomatic patients often present between ages 5 and 15 years and mental retardation interferes with postoperative cervical immobilization. C2 laminar screws can be safely applied for the pediatric axis and biomechanically accomplished rigid fixation. The C2 laminar screw is one of the most useful options to achieve stability of the pediatric atlantoaxial complex without the risk of vertebral artery injuries (level IV case series).

Two siblings with neuropathic scoliosis caused by Chiari malformation type I with syringomyelia

Chiari malformation type I (CMI) has been considered a sporadic condition without a heritable etiology; however, there have been a number of case reports identifying familial aggregation and clustering of CMI, suggesting a genetic basis [1]. We report two siblings with neuropathic scoliosis (NS) caused by CMI with syringomyelia. The patients and their families were informed that data from the cases would be submitted for publication and gave their consent.