Kenzo Shirasawa

Subchondral insufficiency fracture of the femoral head and acetabulum : a case report.

Subchondral insufficiency fracture of the femoral head generally occurs in elderly patients, who tend to have osteopenic bone and/or to be overweight. It characteristically presents as acute pain in the hip without obvious antecedent trauma1. Some subchondral insufficiency fractures of the femoral head resolve spontaneously2,3, but several have shown progressive collapse requiring surgical intervention1. Findings on magnetic resonance imaging are characterized by a subchondral linear or serpiginous pattern of very low signal intensity on T1-weighted images with an associated bone-marrow edema pattern. This subchondral low-intensity band has been shown histologically to be a fracture line4. In a recent study, eleven subchondral insufficiency fractures of the femoral head were associated with rapid destruction of the hip joint similar to that seen in rapidly destructive arthrosis of the hip joint5. The prognosis for subchondral insufficiency fractures of the femoral head thus remains unclear. Previous investigators have examined histological specimens obtained from the femoral head1-5. We describe a case of an early-stage subchondral insufficiency fracture in which histological sections were obtained from both the femoral head and the acetabulum. We found a subchondral fracture on the acetabular side as well as in the femoral head. A sixty-four-year-old woman had a sudden onset of severe pain in the right hip when she bent to pick up something from the floor. The pain persisted, even at night, and a limp developed. There was no history of steroid therapy or alcoholism. The patients height was 157 cm, she weighed 82 kg, and the body mass index (33.3) indicated obesity. On examination, the range of motion of the right hip was slightly limited (115° of flexion, 40° of abduction, 20° of adduction, 15° of external rotation, and 20° of internal rotation). …

Validation study of a clinical diagnosis support tool for lumbar spinal stenosis

BackgroundA clinical diagnosis support tool for lumbar spinal stenosis was developed by the Japanese Society for Spine Surgery and Related Research. However, the use of this tool has not yet been validated.MethodsPatients with symptoms in the lower extremities and who visited the Department of Orthopedics initially were recruited to the study. Orthopedic physicians who were not spine specialists completed the support tools. Spine specialists examined the patients, made a diagnosis, and completed the lumbar spine examination sheet made for the study. The support tool and lumbar spine examination sheet were sent to a central panel comprising four panelists who then decided on a final diagnosis.ResultsIn total, 118 patients were evaluated, including 62 males and 56 females. Lumbar spinal stenosis was diagnosed in 58 and nonlumbar spinal stenosis in 60 patients. The mean score in the lumbar spinal stenosis group was 12.2 points (median 13 points). In the nonlumbar spinal stenosis group, the mean score was 7.5 points (median 7 points). Sensitivity was 0.948, and specificity was 0.40.ConclusionsPatients with lumbar spinal stenosis with a very low score were diagnosed with mild lumbar spinal stenosis, whereas nonlumbar spinal stenosis patients with a very high score were diagnosed as suffering from spine disease and needing special treatment by spine surgeons. Our results validate the use of the support tool for the diagnosis of lumbar spinal stenosis. Although the specificity observed in the present study was lower than that reported at development, we conclude that this support tool is useful for screening patients with lumbar spinal stenosis.

Solitary epidural amyloidoma of C2–4 without osteolysis of the spine in a multiple myeloma patient

Abstract Spinal cord compression sometimes occurs in patients with multiple myeloma (MM), and it usually involves bone infiltration from proliferative plasma cells leading to vertebral collapse, with the occasional extradural extension of a plasmacytoma [1]. However, a localized amyloid tumor, also known as an amyloidoma in the spine, is rare, and a few patients [2, 3] had underlying multiple myeloma (MM). The present case was unique in the form without osteolysis or vertebral collapse, which did not originate from adjacent spinal vertebrae, in a patient with a known diagnosis of MM.

Clinical and imaging features of a subchondral insufficiency fracture of the femoral head after internal fixation of a femoral neck fracture: A comparison with those of post-traumatic osteonecrosis of the femoral head

OBJECTIVE Recent articles have demonstrated that subchondral insufficiency fractures (SIFs) of the femoral head can occur following internal fixation of femoral neck fractures (FNFs), in addition to post-traumatic osteonecrosis (ON) of the femoral head. The purpose of this study was to determine the clinical and imaging features of SIF after internal fixation of FNFs compared with those of post-traumatic ON. METHODS We reviewed five hips in five patients, who received internal fixation for the treatment of FNF and were diagnosed as having SIF according to the shape of the low-intensity band on the T1 weighted MR image. Four hips of four patients with post-traumatic ON were compared with the SIF cases. Both the clinical and imaging findings were investigated. RESULTS There were no significant differences in the age, sex, body mass index, stage of FNF or duration from injury to surgery between SIF and post-traumatic ON. Regarding the prognosis, one of the five cases (20%) with SIF underwent prosthetic replacement owing to a progressive collapse of the femoral head. Two of the four cases (50%) with post-traumatic ON underwent prosthetic replacement. CONCLUSION The results of this study suggest that SIF should be considered a possible condition following the internal fixation of FNFs, and it is important to differentiate SIF from post-traumatic ON. ADVANCES IN KNOWLEDGE SIF should be considered a possible condition following the internal fixation of FNFs.

Surgical Results of Spinous Process Splitting Laminoplasty for Cervical Myelopathy

Spinous process splitting laminoplasty was performed on 52 patients with cervical myelopathy. We evaluated the surgical results of laminoplasty on operating time, blood lose, JOA score, alignment of the cervical spine, and postoperative complications. Clinical evaluation based on the JOA score indicated improvement from 8.5 points preoperatively to 12.1 points postoperatively. Postoperative complications were axial symptoms (4 cases), epidural hematoma (1 case), and liquorrhea (4 cases). Spinous process splitting laminoplasty is an effective procedure for cervical myelopathy.

Vertebral Body Fracture after Spinal Instrumentation Surgery

Seven cases of vertebral body fractures adjacent to the instrumented vertebral were observed after posterior spinal instrumentation surgery. All patients were females and their ages ranged from 51 to 68 years (mean, 69 years). The interval between surgery and fracture recognized radiographically ranged from two months (mean, 3.5 years). This case report presents the possibility of biomechanical stress on the porotic spine adjacent to the instrumented rigid spinal segments.

Three Dimensional Imaging of the Spine with Helical Volume CT

Helical volume computed tomography (CT) involves continuous patient translation during x-ray source rotation and scan data acquisition. As a result, high-quality three-dimensional images can be produced from the continuous volume data sets in a relatively short period of time. Helical CT scanning and three-dimensional surface reconstruction of the spinal lesions were performed. In fracture and dislocation of the spine, three-dimensional CT provides excellent images of posterior aspects of the lesion and demonstrates sharp sagittal images of vertebral fractures compared with magnetic resonance imaging. In degenerative spinal disorders, three-dimensional CT is helpful in evaluating patients with ossification or calcification of ligaments. Three-dimensional images with helical volume scanning may be useful for the diagnosis of spinal disorders.

Rediographical Features of Acute Injuries of the Upper and Middle Thoracic Spine

We reviewed 32 cases of acute injuries of the upper and middle thoracic spines associated with paraplegia.Spinal injuries were distributed with peaks at T3/4 and T7/8 In 27 cases a fracture-dislocation was present: were twenty were anteriorly dislocated: six were lateraly dislocated; and one was posteriorly dislocated. On CAT scan, a separation of pedicle adjacent to the vertebral body was seen characteristically. All fracture-dislocations with incomplete spinal cord injury were accompanied with the charactaristic pedicle separation.

Operative Results of Aged Patients with Cervical Myelopathy

The operative results of cervical myelopathy were evaluated in twenty-eight patients who were more than sixty-five years old. The mean age of the patients was seventy-one years (range, sixty-six to seventy-nine) at the time of operation (older patients group). Cervical disorders included CSM in 16 cases, CDH in 4 cases, OPLL in 6 cases, and OYL in 2 cases. We compared older patients group with non-older patients group (less than fifty-four years old) in the operative results, as well as a good-result group (more than 50% recovary ratio) with a poor-result group (less than 49% recovary ratio) in the older patients. The results were as follows; 1) the older patients group were greater than the non-older patients group in the severity of symptoms and duration of symptoms before surgery, worse than in the recovery of symptoms after surgery; and 2) the severity of symptoms before surgery of the poor-result group was greater than that of the good-result group.