Noburo Hashimoto

Degeneration and ossification of the yellow ligament in unstable spine.

Lumbar yellow ligaments were obtained from 20 cases of lumbar spinal canal stenosis and 20 cases of degenerative olisthesis with slippage of more than 3 mm. The ligaments were stained with safranin-O, von Kossa, and immunohistochemical staining methods (S-100 protein). In the unstable group the safranin-O staining was more intense, microscopic ossification and chondroblasts were noted more frequently, and S-100 protein was more abundant. These findings show that instability of the lumbar spine accelerates degeneration and chondrometaplasia of the yellow ligament, which may lead to the enchondral ossification of the ligament.

Cervical spinal epidural hematoma with spontaneous remission

Spinal epidural hematoma (SEH) is comparatively rare. In most cases, urgent surgical decompression is necessary. Several reports have described spontaneous remission of SEH. The authors present a rare case of spontaneous resolution of cervical SEH.

Arthrotomy followed by Open Wound and Early Motion Exercise in Septic Arthritis of the Shoulder.

We report a case of septic arthritis of the shoulder joint treated by arthrotomy followed by open wound and early motion exercie. The patient was a 55-year-old male taxi driver. The infecting organism was methicillin-resistant staphylococcus aureus. At first he was treated by arthroscopic debridment which had no effect. Then we performed arthrotomy followed by open wound and early motion exercise. This open wound method was successful for infection. Concomitant antibiotics were administrated. We think arthrotomy followed by open wound and early motion exercise is a useful method for treating arthritis of the shoulder.

Critical Path in Rotator Cuff Tear

We applied critical path to rotator cuff tears. At the introduction of the path, we decided the criteria for discharge. The criteria were the removal of shoulder abduction brace and the activity level of patients for face-washing and eating. At the programming of the critical path, we improved the process in our hospital. After anesthesia, patients remained asleep for 6 hours, and antibiotics administration stopped 2 days after surgery. The surgical wounds were fixed with tape so that the thread did not need to be removed.We examined the patients who were 8 before and 9 after introduction of critical path. We examined the duration of brace use, average number of days of hospital stay, and JOA score.After the introduction of the critical path, the duration of wearing brace use and average number of days in the hospital became shorter. Doctors, nurses, and patients were all satisfied with the critical path.

Non-collar Fixation and Early Ambulation after Cervical Laminoplasty

We have been trying non-collar fixation and early ambulation after cervical laminoplasty since July 1998.The aim of this report is to evaluate this postoperative physical treatment.In the radiological evaluation, the range of motion of the neck after operation was more or less the same as before operation.This group did not complain of post operative neck pain and showed no complications.The course of postoperative rehabilitation without collar fixation was shorter than traditional rehabilitation.

Inconsistency between Preoperative and Postoperative Correction Angles in High Tibial Osteotomy

This study was performed to assess the accuracy of the operative correction angle in high tibial osteotomy and consider the possible causes for inconsistency between the preoperative and post operative correction the angles.We studied 40 knees in 31 cases (9 males and 22 females) treated by high tibial osteotomy between 1996 and 1998. The mean age was 66.2 years (45 to 81). We used five kirschner wires (∅ 1.8mm as the osteotomy guide, inserted them roentgenographically and performed interlocking wedge osteotomy. Preoperative and postoperative correction angles were measured and the postoperative correction angle was subtracted preoperatively. The inconsistency between the preoperative and postoperative correction angles was within ±2° in 31 knees (77.5%), +3° in 5 knees (12.5%), +4° in 2 knees (5.0%), +5° in 1 knee (2.5%), and -4° in 1 knee (2.5%). Satisfactory results were obtained in a majority of the patients.High tibial osteotomy requires operative technique taking into consideration inconsistency between the preoperative and postoperative correction angles.

Effects of Argatroban on Patients with Lumbar Canal Stenosis

The purpose of this study is to estimate the effects of the drip infusion therapy with argatroban and its sustenance.14 patients who had failed conservative treatment were administered argatroban (20mg/day) for 2 weeks. 12 patients showed some improvements in their symptoms following this treatment. No patients worsened. The mean JOA score significantly improved from 12.9 points to 19.4 points. Most subjective symptoms showed significant improvement, but not objective symptoms. 5 patients had continuous improvements for more than a mean of 17.8 months, but 4 patients showed recurrence after a mean follow-up of 3.7 months.These results suggest that drip infusion therapy with argatroban is recommended for lumbar spinal canal stenosis.

Non-Surgical Treatment of Full Thickness Tears of the Rotator Cuff

We report on the results of non-surgical management of 7 patients with full-thickness tears of the rotator cuff proven by arthrographic examination. Average age at first examination was 62.4 years. Patients were evaluated twice; average follow up year at first examination was 2.1 years and at second examination was 6.2 years. All patients were reviewed by direct examination at the time of final follow-up. Patients were evaluated-according to their JOA score. Pain, ADL, Angle of elevation and internal rotation scores were all improved and the mean JOA total score improved with time. At the first follow-up, muscle strength had worsened but at the last evaluation the average muscle strength score was higher than on first examination. This result is almost the same as the result found in the previous questionnaire study. Direct examination revealed that conservative treatment produces satisfactory results when given to patients who have a reasonable JOA score when first examined.