Keiichiro Okajima

Immunohistochemical distribution of s-100 protein in tumors and tumor-like lesions of bone and cartilage

Various tumors and tumor‐like lesions of bone and cartilage were examined for S‐100 protein using the avidine‐biotin‐peroxidase complex (ABC) immunostaining method. The most intense reactivity for S‐100 protein was found in well‐differentiated chondrocytes of enchondromas, osteochondromas and chondrosarcomas, and in normal epiphyseal cartilage. S‐100 protein was positive in both polygonal stromal cells and chondrocytes of chondroblastomas and in chondrocytes of mesenchymal chondrosarcoma. In osteosarcomas not only chondroblastic areas but also osteoblastic areas showed positive cells. Reticulum histiocytic cells of eosinophilic granulomas and chordoma cells were positive for S‐100 protein. The study yielded three main conclusions: (1) S‐100 protein could be the marker for tumors of cartilaginous origin and differentiation, notochord origin, and T‐zone histiocyte origin; (2) chondroblastoma can be distinguished from other histologically confusing giant cell lesions by using ABC to detect S‐100 protein; and (3) S‐100 protein has some relationship with tumoral calcification not only in cartilaginous tumors but also in osteosarcoma.

Anterior Plate for Anterior Fixation in Cervical Spine

Since October 1999, we have been using anterior plate for anterior fixation in the cervical spine. The clinical results of a group using a plate for anterior fixation for degenerative disorders (50 cases) and a group that did not (50 cases) were compared.No significant differences were seen between the two groups in terms of operation time, a quantity of operative hemorrhage, and clinical results.There was a tendency for delay in fusion time by shortening the postoperative time in bed. The group using a plate showed correlation between delay in fusion time and postoperative time in bed and the group that did not use the plate indicated good fusion.In addition, better alignment of the whole cervical vertebrae and fixed vertebral body could be maintained more easily with the use of the plate.

Rescurable Pulmonary Embolism after Spinal Surgery -A Case Report-

We experienced one case of pulmonary embolism in a patient after spinal surgery over the past two years. The patient was a 51-years-old man who had experienced deep vein thrombosis in the past. He under went anterior spinal fusion for C6/7 disc hernia.5 days after the operation, he suddenly experienced respiratory difficulty. Though his consciousness was clear, and his vital signs were stable, even after 3L pure oxygen supplied, his arterial saturation rate was low at 74%. We supplied 10L oxygen, used an Ambu bag, kept his venous line, and injected lactolingel, His chest pain was relieved and his arterial saturation rate improved to 95%. To investigate the cause, we examined his arterial blood gas, ECG, and chest X-p, and suspecting pulmonary embolism, we consulted cardiologists. In the UCG, the right ventricle hed apparently enlarged, and angiography showed that his right pulmonary artery the patient restricted by 80% due to thrombosis. We diagnosed as having pulmonary embolism, attempted cardiac cathetelization, and injected urokinase, the thrombosis was reduced by 1/3, and the patient survived.

Study of Surgical Treatment for Vertebral Osteomyelitis

In the 12 years from 1989 to 2000, we operated on 27 patients with vertebral osteomyelitis. The patients included 17 males and 10 females with a mean ago of 62.4 years (range: 42 to 83 years). Generally, anterior fusion is performed on patients with vertebral osteomyelitis. However we treated 9 patients out of 27 by posterior fusion using Luque rods, because of their poor general condition. Our study showed that this low invasive poeration is useful for patients with poor general conditions (elderey patients, hemodialysis patients, etc.).

A Case of L2/3 Disc Hernia and L4 Dumbbell Tumor

We experienced a 70-year-old male case suffering L3 and L4 roots impairment due to L2/3 disc hernia, and L4 root impairment due to dumbbell tumor. He complained of severe low back pain, right femoral neuralgia, weakness, and urinary infection. MRI revealed two lesions; one was a tumor in the psoas muscle at the L3-L5 level originating from the L4 root ans the other was a downward sequestrated mass from the L3/4 disc. We operated two-stages from the anterior to posterior. The anterior tumor was histologically neurinoma and the sequestarted hernia mass impinged both the L3 and L4 roots.

Operative Results for Ligamentous Ossification in the Thoracic Spine

We surgically treated 20 cases of thoracic myelopathy caused by ossification of the yellow ligament (OYL) and combined OPLL. Subjects included 10 males and 10 females. The duration between the occurrence of symptoms and time of surgery ranged from 1 month to 2 years (average 8.3 months).The average age at surgery was 58 years. All patients had had laminectomy. We found difficulty in some cases in performing decompression of the ossified spinal lesions.

Surgical Treatment for Paraparesis after Vertebral Fracture with Osteoporosis using Luque Instrumentation

The number of high aged patients with osteoporosis are increasing. We treated surgically two patients with paraparesis after fracture of vertebral body with osteoporosis using Luque instrumentation. These cases showed good neurological recovery after operation. Up to now, surgical treatment for osteoporosis was aboided, but we proved that surgical treatment was useful for improvement of neurological deficit.

Therapy and Problems to C. S. M. Patients over 65 Years Old

Since 1979 we have operated 53 patients over 65 years old. They were evaluated as to postoperative results. Satisfactory results were achieved in 27 (55%).Patients under 64 years of age appeared to do better. Postoperative complications were found considerably among them.To avoid postoperative complications, we make efforts to improve technical devices for anterior and posterior decompression surgery.

Posterolateral Decompression for OPLL with OYL in Thoracic Spine

Recently we have experimented witn the treatment of three cases associated with OPLL and OYL in the thoracic spine. For three cases with myelopathy we carried out resection of the OPLL and OYL using the posterior and lateral approach. Results of them were good, but one case needed Halo-pelvic apparatus for post-operative instability.

Luque Instrumentation after Posterior Decompression for Lumbar Degeneration of High Aged Patients

Eighteen cases of Luque instrumentation with spinous process wiring after posterior decompression for lumbar degeneration of high aged patients were discussed.The operative time and intraoperative bleeding of them were not so different from those of the cases without Luque instrumentation. The mean duration until ambulation was 10 days. The improvement rate of JOA score was 72%.Comfortable stabilization for decompressed segment was obtained. The decrease in total lumbar motion was about 10 degree, and it did not disturb the ADL so much.This method is easy, and has good application when high aged patients need early ambulation, and when the instability of multiple segments exists or will occur by decompression.