Masashi Sagara

Clinical value of magnetic resonance imaging for cervical myelopathy.

The magnetic resonance imaging (MRI) findings in 115 cases of cervical myelopathy, 121 cases of cervical radiculopathy, and 64 cases of neck pain with no neurologic deficit were prospectively studied to investigate the clinical value of MRI for cervical myelopathy. The MRI findings in the T1-weighted sagittal projection were classified into four groups according to the degree of the compressed deformities of the cervical cord. The degree of compression of the cervical cord on MRI findings showed a significant correlation with the severity of myelopathy, the anteroposterior diameter of the spinal column, and the degree of compression of the dural tube in the myelograms (P<0.01). Fifty-one patients of cervical myelopathy had undergone both preoperative and postoperative MRI. Of these, the spinal canal of 47 patients that was well decompressed was recognized according to plain computed tomography (CT). However, 24 (51%) of these 47 patients showed on MRI a deformity in the spinal cord amounting to cord atrophy. The correlation between the clinical function of the spinal cord and the recovery of the cord deformity on MRI at the operative levels was accurately investigated in 34 patients who had no cord deformities in the adjacent intervertebral levels. Twenty patients with cord atrophy had sligtly poor clinical results, although no significant difference was found between these 20 and 14 patients with recovery in the cord deformities. From these results, it was evident that T1- weighted MRI is useful in the accurate diagnosis of compression myelopathy, in accurately deciding the level of the disease focus, and in the accurate assessment of the surgical results.

Social Prognosis of Patients with Whiplash Injury

We investigated by questionnaire the social prognosis of 55 patients (29 male and 26 female) with whiplash injuries caused by traffic accidents. Twenty-two patients who were treated for less than one month had no sequellae, however, 23 out of 33 patients treated for more than one month did have sequellae. Seventeen of 23 patients with sequellae were not payed compensation. Eleven patients with sequellae did not continue treatment after private settlement. 86% of the 55 patients were able to return to their former job. These results suggest that the usual sequellae caused by whiplash injury are not severe. However, 20% of patients had some social problems and difficulties remained after out of court settlement.

Reference Standard of Thermographic Analysis for Lumbar Root Compression Syndrome

Skin temperature measurements were carried out in 70 healthy subjects, and in 35 patients with lumbar disc herniation. In healty subjects, the degree of thermal asymmetry varied in different between each homologous regions of the body. The most of symptomatic patients had the manifestation of thermographic cold area coinciding with the pain distribution. When asymmetries exceeded 1 standard deviation from the mean temperature of homologous regions measured in healty subjects, the positive finding was 94% of the patients with lumbar disc herniation.From these results, we consider that the temperature differences obtained in healthy subjects should be used as the reference standard for clinical diagnosis.