Kuniyoshi Ohtsuka

Clinical outcome and survival after palliative surgery for spinal metastases: palliative surgery in spinal metastases.

The authors sought to identify treatment‐related factors that influenced survival after surgical treatment for metastatic spinal tumors and to evaluate the relationship between survival and postoperative ambulation time as a factor related to quality of life.

Urinary Tract Dysfunctions in Tethered Spinal Cord Syndrome: Improvement After Surgical Untethering

We reviewed 55 patients with urinary tract dysfunction owing to the tethered spinal cord syndrome, a form of spina bifida occulta with or without mild myelodysplasia, to evaluate the effects of neurosurgical treatment. Of the patients 24 underwent laminectomy with release of a tethered spinal cord and 31 were followed without the operation. Median followup was approximately 5 years. Urological findings at the most recent examination were compared between the 2 groups. In the operated group 5 patients, including 2 with myelodysplasia, apparently were cured of urinary tract dysfunction and 6, including 2 with myelodysplasia, had somewhat satisfactory results, whereas in the unoperated group only 4 patients had satisfactory results and the remainder were unaffected. Urinary tract dysfunction in some patients with spina bifida occulta may be relieved by surgical release of a tethered spinal cord.

Percutaneous transpedicular biopsy of thoracic and lumbar vertebrae—method and diagnostic validity

BACKGROUND Percutaneous transpedicular needle biopsy was performed on thoracic and lumbar vertebral bodies with a thin trocar (2.0 mm outer diameter) under observation with a conventional X-ray image intensifier in order to establish a correct histopathological diagnosis. We also evaluated the clinical validity of this less invasive diagnostic method in terms of the accuracy of the pathological diagnosis. METHODS Twenty-eight thoracic or lumbar vertebrae of 26 patients with abnormalities observed on routine X-ray, CT, or MRI images underwent percutaneous transpedicular needle biopsy under local anesthesia. A threaded trocar with an outer diameter of 2.0 mm was screwed into the intra-vertebral lesion through the pedicle from the posterior side under control of X-P imaging, and a small amount of tissue or fluid was collected. RESULTS For all patients but two, where inadequate specimens were obtained, correct diagnoses were made, which were confirmed by pathological diagnoses of massive tissue obtained during subsequent reconstructive surgery. CONCLUSIONS The accuracy rate of diagnosis with this biopsy method was 92% without significant intra- or postoperative complications. Therefore, it can be concluded that this less invasive biopsy method used in conjunction with conventional X-ray apparatus has good potential to result in correct preoperative diagnosis of thoracic and lumbar lesions so that more effective treatment can be determined.

Embryological study of the spinal ligaments in human fetuses

We studied embryological development of the human spinal ligaments by dissecting 25 fetuses that ranged from 6 to 24 weeks of gestational age. At 6 and 7 weeks, the spine consisted of light zones and dark zones. The light zones were hypocellular and corresponded to vertebral bodies. The dark zones were hypercellular and corresponded to intervertebral disks. The anterior longitudinal ligament was identified at the gestational age of 8 weeks. At 10 weeks, the posterior longitudinal ligament was detected. At 12 weeks, laminae, the ligamentum flavum, and an ossification center were identified. At 15 weeks, fibers of the ligamentum flavum became clearer, but they were not as well as stained as the adult ligamentum flavum. The enthesis of the ligaments in the human fetuses was not completely identical to that in adults.

Multilevel subtotal corpectomy and interbody fusion using a fibular bone graft for cervical myelopathy due to ossification of the posterior longitudinal ligament

A retrospective study of the outcomes of multilevel anterior decompression and interbody fusion for cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL) was performed to both investigate the long-term results and assess the cause of late deterioration. Twenty-seven patients (mean age, 58.1 years) underwent this procedure and were followed for at least 5 years. The severity of the clinical symptoms was described using the scoring system for cervical myelopathy proposed by the Japanese Orthopaedic Association (JOA score). The average preoperative JOA score was 7.7, and the score at final follow-up was 13.4 with a recovery rate of 62.0%. A delayed deterioration was attributed to a thoracolumbar lesion other than a compromising alteration of the cervical spine. Consequently, this method of treatment for OPLL could stop the progress of ossification and keep a physiological cervical alignment and thus provide good long-term results.

Anterior surgery with short fusion using the Zielke procedure for thoracic scoliosis : focus on the correction of compensatory curves

Anterior instrumentation is recommended to correct idiopathic thoracolumbar or lumbar scoliosis through short fusion within the major curve. Only a few reports exist of anterior surgical correction for thoracic scoliosis. This study assessed the results of Zielke instrumentation for thoracic curve and analyzed the three-dimensional correction of deformity, especially correction of the uninstrumented compensatory curve. Seventeen patients, who had undergone selective thoracic correction and fusion using the Zielke procedure to treat thoracic scoliosis, had been followed for at least 3 years. Three-dimensional correction was evaluated radiographically. Furthermore, three-dimensional back deformities were evaluated using a topographic body scanner. Twelve patients with a single thoracic curve and five with a double curve were all female, with a mean age of 14.6 years. The preoperative main thoracic curve was 54.8 degrees +/- 10.5 degrees (range, 40-78 degrees), and it was 23.8 degrees +/- 10.5 degrees (range, 7-40 degrees) at the final follow-up examination (p < 0.0001). The average correction rate of the main curves was 56.6%. By correcting the thoracic curve, the upper and lower compensatory curves were corrected spontaneously without surgical instrumentation, with average correction rates of 45.1% and 50.2%, respectively. The average correction loss of the main curve was 2.3 degrees. The hump angle measured using a topographic body scanner decreased from 12.8 degrees +/- 4.5 degrees to 8.4 degrees +/- 4.3 degrees after surgery (p = 0.0001). Of the three patients in whom the rod broke up, only one showed a correction loss of 10 degrees; however, bony fusion was obtained. Anterior short fusion for thoracic scoliosis appears to offer significant correction, stabilization, and spontaneous correction of the compensatory lumbar curve without limiting lumbar motion.

Percutaneous lumbar nucleotomy.

We performed 66 percutaneous lumbar nucleotomies (PLN) in 63 patients from October 1984 to March 1990. The patients (42 male patients, 21 female patients) ranged in age from 13 to 73 years (average, 36.8 years). Postoperative observation ranged from 6 months to 5 years and 11 months (average, 2.0 years). Pre- and postoperative discograms were reviewed. Fifty-one patients (79.7%) were judged to have successful results: They were able to return to gainful employment and to their preinjury level of activity. Six patients (9.4%) were judged to have unsuccessful results, and they required more radical surgical procedures. PLN was not effective for the patients with extremely severe positive SLR or agonizing leg pain.