Masakazu Morita

Cervical myelopathy in elderly patients: clinical results and MRI findings before and after decompression surgery

We examined 173 patients with cervical myelopathy of various casuses. Seventy-seven patients underwent anterior decompression and fusion at not more than two levels, while 96 underwent posterior decompression by an expansive laminoplasty. Patients were followed up for between one and 4½ years and the outcome was assessed both from a functional and a radiological point of view. The functional assessment used was according to the Japanese Orthopaedic Association (JOA) score (the higher the better), and the imaging outcome was assessed by a midline sagittal MRI assigned to three categories either for restoration of cord morphology, improvement or unchanged. Patients were divided into two groups: those 65 years old and older (50 patients), and those younger than 65 years old (123 patients). The data allowed the following conclusions to be reached: Older patients were likely to have more levels, and higher levels affected and as a result were more likely to require a posterior operation. The recovery rate after an anterior operation was the same as that after a posterior operation. The pre- and post-operative JOA scores were higher in younger patients who tended to have milder disease with fewer levels affected. Younger patients had better morphological restoration. The recovery was likely to be better if the postoperative morphology was better. The morphology postoperatively was likely to be better if there had been less compression preoperatively. If the morphology was restored the disease duration was likely to have been less. The patients did better if the cord morphology was restored to normal, and this was easier to achieve in younger patients who had fewer levels involved and had less cord distortion preoperatively

Examination of Emergency Orthopaedic Patients at a Major Regional Hospital

We report the realities of our emergency medical treatment, and define problems associated with being a regional hospital. The method of presentation, cause of injury, and the principal complaint were collected and examined. Targeted patients included 5, 992 in total examined mainly by the orthopaedics department. They accounted for 11.9% of 50, 273 patients cases who were sent to our hospital for emergencies.According to our data, 12% of 5, 992 patients required admission to hospital. This number comprises 65% of the total yearly orthopaedics inpatients. We also found 33% of the patients come from the suburbs of Kurume city, reflecting the role of the hospital works well as the major regional hospital.However these are times when the second or the third emergency patients are not treated adequately. This implies, the first (the most urgent) patients are treated urgently white less urgent patients are not treated as well. We suggest adjustment to our medical systems. In the near future we have to examine our hospitals function as well as the needs of the community.After doing this, we may have to adjust our medical care systems.