Nobuaki Tsunoda

Lumbo-sacral Transitional Vertebrae and Thier Relationship with Slipping of the Upper Lumbar Spine

To study the several changes of the disc just above the lumbo-sacral transitional vertebrae, the features of slipping at this level were examined in 216 patients who had lumbo-sacral transitional vertebrae in both anterior and posterior sides.Type II and type III of modified Custivellis classification for the posterior element and the modified Wighs Classification for anterior element were employed for this purpose. The results were compared with 597 patients with low back pain who visited our clinic.Isthmus spondylolisthesis (8 cases, 3.7%) was almost same as the frequency in our low back pain patients. The slight increase was shown in degenerative spondylolisthesis (30 cases, 14%). The greater incidence was proved in posterior slip (115 cases, 52.3%) in this series compared to the our low back pain group (19%). The almost same incidence was shown in young group and in old group. The slight increase was found in type I and type II in the anterior classication and in type IIb and type IIIb in the posterior classification. In conclusion, posterior slip at the spine just above the lumbo-sacral transitional vertebrae was one of the special features.

CT Myelography on Cervical Disc Herniation

It is difficult to diagnose a main lesion of cervical spondylosis in consideration of neurological findings when there are several abnormal findings in cervical myelography. We could diagnose 12 cervical disc herniations correctly by CT myelography after cervical myelography and treated them by anterior spinal decompression and fusion. They recovered remarkably. Therefore, we reported 12 cases of cervical disc herniations and utility of CT myelography.

A Case of Incomplete Myelopathy by Ossification of Yellow

A case of incomplete myelopathy at proxmal thoraco-lumbar spine kyphosis caused by ossifcation of yellow ligament is reported.A 60-year-old male was addmiteed to our hospital complaining of bilateral lower extremity pain and gait disturbance of 5 months duration. Motor-sensory palsy below L1, and complete block on myelogram caused by OYL on T11/12 was seen and the compression was found by CTM.We performed wide laminectomy on T11, T12, and the palsy was gradually reduced as a result of the operation. 14 weeks after operation, he was discharged on his foot.

Cervical Alignment in the Sagittal Plane Following Laminectomy

From June in 1979 to Septemenber in 1984 thirty-five patients underwent cervical laminectomy.We usually used the modified Kiritas method, and used with posterolateral fusion. Our routine technique of posterolateral fusion was a chip bone graft or the Robinsons method. These procedures were performed on thirty-four patients after laminectomy. Lateral view of these patients X-ray films were examined. Almost all patients had maintained good aligment in the sagittal plane. There was no case of the Swan neck deformity.

Operative Findings of Acute Cervical Spine Injuries

We think that injured spine with neurological involvement is unstable in acute phase. From June in 1979 to June in 1982, we treated 75 patients with injured spine by several operative methods within 1 month after trauma. We compared their operative findings with radiographic appearances. The results indicated that (1) Simultaneous anterior and posterior decompression and fusion was necessary in all cases of fracture-dislocations and some of flexion teardrop fractures. (2) Anterior decompression and fusion was indicated for cases of no significant radiographic appearance of injury because of their usual disc damage.

The Value of Computed Tomography in Spinal Injuries

We studied 71 consecutive patients with spinal injuries by multiplane computed tomography (CT). In fracture-dislocation of 10 patients, displaced vertebrae indicated double marginal sign in transaxial image. In fractures of 20 patients, CT was effective method for demonstrating bony encroachment into the canal and severity of fractures. We divided burst fractures in thoracolumbar region mainly into two types by CT scan in transaxial plane image. In one of them, free body fragments projected into full area of the body posteriorly and plane radigraphy demonstrated that the bilateral adjacent discs were damaged. In the other type, free fragments projecting into the canal were limited in upper half of the body and distally fracture line of the lamina and body was in the same direction. In later plain radiography indicated that the damaged disc was limited in one side. In 10 patients with no significant radiographic evidence of injury, CT scan demonstrated swelling of the cord after gas myelography. CT scan was useful in cases with spinal instrumentation. CT scan was a safe method for evaluating patients with spinal injuries in acute phase.

Shoulder Pain of Quadriplegic Patient

Fourty two patients with cervical spinal cord injury were studied about their shoulder pain and contracture.It the patient had shoulder pain, further study was done about characteristic of pain, its duration, and reference between pain or contracture and injured level of spinal cord.Twenty four cases out of 42 cases (57%) had shoulder pain.Most of them were suffered from severe joint contracture, and there was tendency that the patient with higher level injury of the spinal cord had more problems of shoulder.We recommened the early passive mobilization of the shoulder and the proper positioning of arm on the bed (neutral rotation, the shoulder in 90 degree abduction) to prevent the shoulder problem in cervical spinal cord injured patient.