I. Kimura

Long-term follow-up of cervical spondylotic myelopathy treated by canal-expansive laminoplasty

We have studied 29 patients for at least five years after canal-expansive laminoplasty for cervical spondylotic myelopathy. The short- and long-term clinical results were compared, and successive radiographs assessed. The long-term clinical outcome was excellent in five patients, good in 12, fair in 11 and poor in one. The mean short- and long-term improvements were 54.4% and 48.5% but patients with focal kyphotic, kyphotic and S-shaped cervical spines did less well, as did those who had a decrease in the index of curvature of the cervical spine of more than 10 at follow-up. Canal-expansive laminoplasty with reconstitution of the posterior soft tissues may help to prevent postoperative malalignment and late neurological deterioration.

Lumbar posterolateral fusion alone or with transpedicular instrumentation in L4--L5 degenerative spondylolisthesis.

We retrospectively reviewed 57 patients with L4--L5 degenerative spondylolisthesis (L4--L5 DS) who underwent posterior decompression and posterolateral fusion of L4--L5 without (Group A) or with (Group B) transpedicular screw instrumentation at least 2 years earlier. The clinical results and fusion rate were similar between Groups A and B, that is, a 72.4% satisfactory outcome with a fusion rate of 82.8% in Group A versus 82.1% satisfactory outcome with a 92.8% fusion rate in Group B. Screw instrumentation reduced postoperative low back pain and resulted in a lordotic slip angle of L4--L5. However, in patients with radiologically excessive segmental motion showing a translational motion of 3 mm or more, flexion angulation of -5 degrees or less, and a slip angle of -5 degrees or less at the site of spondylolisthesis (L4--L5), the kyphotic slip angle (L4--L5) tended to increase after surgery. In the future, in patients with radiologically excessive segmental motion, this point should be considered, and surgical techniques should be evaluated. Our results suggest that the validity of the general addition of screw instrumentation to L4--L5 fusion for L4--L5 degenerative spondylolisthesis is low.

Clinical Studies of Lumbar Canal Stenosis Associated with Heavy Work

Clinical, radiological and surgical studies have been made of 57 farmers who were operated upon for degenerative lumbar canal stenosis (Group A) and degenerative spondylolisthesis (Group B). The improvement rate was excellent in both groups.(Group A: 75.6%, Group B: 71.7%). The improvement rate in abdominal and back muscle strength was lower in cases with postoperative kyphosis than in those with postoperative lordosis. Cases with a slip angle of less than 0 degrees postoperatively showed less improvement and a lower abdomminal and back muscle strength than those with an angle of 0 degrees or more. Disappearance of lumbar lordosis, local kyphotic alignment, low strength of abdominal and back muscles are unfavourable factors influencing return to farm work.

A Long-term Influence of Cervical Interbody Fusion on the Neighbouring Disks

A review of 17 patients who had undergone anterior cervical disectomy and fusion was performed to analyze the change of the neighbouring disks. Their ages renged from 43 to 65 years old (average; 49 yeras old) at the time of operation. The follow-up period ranged from more than 8 years to 27 years (average; 14 years). The number of fused inter-vertebrae were 1 in 5 cases, 2 in 6 cases, 3 in 4 cases, and 4 in 2 cases.Of 17 cases, 14 cases have radiographic changes on the neibouring disks of fused vertebrae. There were narrowing in 8 cases, olisthesis in 8 cases, and fusion in 2 cases.2 cases had non-union in the previously fused vertebrae.These changes were influened by the factors including the number, portion, and alignment of the fused vertebrae.

Reconstruction of the Anterior Crutiate Ligament by the Kenneth-Jones Method

Since 1975, we carried out reconstruction to 4 cases of the injured anterior crutiate ligament by the Kenneth-Jones method which utilizes 1/3 of the patellar ligament. Cases were 4 males aged from 27 to 47 years, all physical laborers. The period before operation ranged from 3 months to 2 years. Three cases showed associated injury such as of the collateral ligament. Reconstruction of the anterior crutiate ligament was performed in these cases. Postoperative results were examined based on the estimation criteria by Solonen and comparatively favorable results were obtained except muscle atrophy of the thigh.

Spinal cord neurinoma; report of 5 cases

During these 5 years we have experienced 5 cases of spinal cord neurinoma (2 men, 3 women). One was multiple and 4 were single. When classified by injured sites of the vertebrae, 2 were in the thoracic vertebrae, 2 in the lumbar ones and the rest (multiple case) was distributed in the changing part from the thoracic to lumbar vertebrae. Patients complained of lumbago, pain and numbness in the limb, and were diagnosed at the first medical examination as radicular ischias and spondylosis deformans. The period from the onset of symptoms to surgical treatment extended from 3 months to 12 years, though 4 cases were within 2 years. The other was of the multiple type, and as it was encountered by a traffic accident, its symptoms were complicated and to diagnose was very difficult. These may be the causes of spending a long time until surgical treatment.All the cases were treated by surgical total extirpation, and histologically diagnosed as neurinoma. Postoperative courses were uneventful.

Observations on the Results of Intertrochanteric Osteotomies for Osteoarthritis of the Hip

The nineteen patients treated for osteoarthritis of the hip ranged in age from sixteen to fifty-one years. The severity of their arthritis was classified as incipient type in five, progressive type in ten, and severe type in two.The patients were followed one to eleven years.In incipient type osteotomies gave satisfactory results in all cases. In progressive type osteotomies gave satisfactory results in eight cases and roentgenogram showed improvement in the joint space and dissappearance of the subchondral cyst in four cases. In severe type pain in the hip joint was alleviated in two cases.

Results of the treatment in anterior lumbar fusion

The 41 cases treated with anterior interbody disc excision and bone-grafting were analysed based on clinical symptoms and functional radiograms.A good clinical result was achieved by 85% of the patients with a roentgenographic evidence of fusion occurred in 58%.Nevertheless the cases who indicated roentgenographically the incomplete union, were clinically good in 80%.In only anterior lumbar fusion, the cases with pain lower extremity had the poor result.In 20 cases operatively treated, the cause of sciatica were identified.It is suspected that the operation has some influences in degenerating the lower or upper disc.

Radiological Changes of Bone and Joint in the Upper Extremities of Chain-saw Workers

Changes of the elbow and the wrist joint were studied by analysing the indirect roentgenograms of 100 fellers using chain saws. The incidence of changes was significantly higher (p<0.01) in the wrist joint (16.3%) than in the elbow (10.9%). The occurrence rate of changes in the elbow was not correlated with the period of chain-saw-use, but rather with age of the individual, while, in the wrist joint no correlation with the both.The following changes were seen with comparatively high frequency: In the elbow, osteophyte formation (25.0%), spur formation at the olecranon (21.0%) and bone atrophy (13.5%). In the wrist joint, displacement of radial and ulnar articular surfaces (46.0%), bone atrophy with bone cysts (11.5%) and osteophyte formation (9.0%).The right elbow showed significantly higher incidence of subchondral sclerosis and bone cysts (p<0.05), and joint space narrowing and joint mice (p<0.01) than the left side. As to the wrist joint, no predominant difference of the changes between left and right was found.

Experiences of Early Management in Patients with Cervical Spinal Cord Injury

A follow-up study of nineteen patients early treated for traumatic lesions of the cervical spine with associated neural deficits is presented.Mannitol, predonin, cytochrome C, neurotropic vitamins, etc. were administrated.Operation was performed in thirteen patients on one day to fourty days after injury. The objectives of these procedures were to reduce the dislocation by Rogers technique and wiring of the spinous processes or to stabilize the cervical spine by interbody fusion.Two of the nineteen patients died after acute complete transverse cord lesions. Three died in five months to one year after injury.Five cases of postmortem examination on spinal cord are reported. Four cases were studied the patterns of the spinal vasculature by mean of injection of micropaque solution through the vertebral arteries.In all cord injuries there were combinations of both of vascular and direct damage. Four cases showed a longer segment of the cord involved than was expected by vascular disturbances or by compression and crushing alone. In one case with the syndrome of acute anterior spinal cord injury the damage which involved the posterior, lateral and central portion of the cord was observed.