Ryoichi Kobayashi

DISTAL PHALANGEAL RECONSTRUCTION FOR RECURRENT INTRAOSSEOUS EPIDERMOID CYST OF THE FINGER — A CASE REPORT

Intraosseous epidermoid cyst of the finger phalanx is rare. We report a case of postoperative recurrent intraosseous epidermoid cyst of the distal phalanx of the ring finger. To prevent further recurrence while maintaining morphology and function, the distal half of the distal phalanx that included the epidermoid cyst was resected to completely remove the lesion. The distal phalanx was then reconstructed by grafting corticocancellous bone from the ilium and shaped into a distal phalanx. The operation was performed using a through-the-nail approach, temporarily removing the nail and placing a longitudinal incision in the nail bed to approach the phalanx. Postoperatively, bone fusion was achieved without recurrence and the shape of the distal phalanx was normal. Distal phalangeal hypertrophy and nail plate deformity also normalized and excellent results were obtained.

Complications Associated With Spine Surgery in Patients Aged 80 Years or Older: Japan Association of Spine Surgeons with Ambition (JASA) Multicenter Study:

Study Design: Retrospective study of registry data. Objectives: Aging of society and recent advances in surgical techniques and general anesthesia have increased the demand for spinal surgery in elderly patients. Many complications have been described in elderly patients, but a multicenter study of perioperative complications in spinal surgery in patients aged 80 years or older has not been reported. Therefore, the goal of the study was to analyze complications associated with spine surgery in patients aged 80 years or older with cervical, thoracic, or lumbar lesions. Methods: A multicenter study was performed in patients aged 80 years or older who underwent 262 spinal surgeries at 35 facilities. The frequency and severity of complications were examined for perioperative complications, including intraoperative and postoperative complications, and for major postoperative complications that were potentially life threatening, required reoperation in the perioperative period, or left a permanent injury. Results: Perioperative complications occurred in 75 of the 262 surgeries (29%) and 33 were major complications (13%). In multivariate logistic regression, age over 85 years (hazard ratio [HR] = 1.007, P = 0.025) and estimated blood loss ≥500 g (HR = 3.076, P = .004) were significantly associated with perioperative complications, and an operative time ≥180 min (HR = 2.78, P = .007) was significantly associated with major complications. Conclusions: Elderly patients aged 80 years or older with comorbidities are at higher risk for complications. Increased surgical invasion, and particularly a long operative time, can cause serious complications that may be life threatening. Therefore, careful decisions are required with regard to the surgical indication and procedure in elderly patients.

Risk Factors for Delirium After Spine Surgery in Extremely Elderly Patients Aged 80 Years or Older and Review of the Literature: Japan Association of Spine Surgeons with Ambition Multicenter Study

Study Design: Retrospective database analysis. Objective: Spine surgeries in elderly patients have increased in recent years due to aging of society and recent advances in surgical techniques, and postoperative complications have become more of a concern. Postoperative delirium is a common complication in elderly patients that impairs recovery and increases morbidity and mortality. The objective of the study was to analyze postoperative delirium associated with spine surgery in patients aged 80 years or older with cervical, thoracic, and lumbar lesions. Methods: A retrospective multicenter study was performed in 262 patients 80 years of age or older who underwent spine surgeries at 35 facilities. Postoperative complications, incidence of postoperative delirium, and hazard ratios of patient-specific and surgical risk factors were examined. Results: Postoperative complications occurred in 59 of the 262 spine surgeries (23%). Postoperative delirium was the most frequent complication, occurring in 15 of 262 patients (5.7%), and was significantly associated with hypertension, cerebrovascular disease, cervical lesion surgery, and greater estimated blood loss (P < .05). In multivariate logistic regression using perioperative factors, cervical lesion surgery (odds ratio = 4.27, P < .05) and estimated blood loss ≥300 mL (odds ratio = 4.52, P < .05) were significantly associated with postoperative delirium. Conclusions: Cervical lesion surgery and greater blood loss were perioperative risk factors for delirium in extremely elderly patients after spine surgery. Hypertension and cerebrovascular disease were significant risk factors for postoperative delirium, and careful management is required for patients with such risk factors.

Gorham disease of the lumbar spine with an abdominal aortic aneurysm: a case report

BACKGROUND CONTEXT Reports of Gorham disease of the lumbar spine complicated by abdominal aortic aneurysms are rare. PURPOSE We herein report the case of a patient with Gorham disease of the lumber spine involving an abdominal aortic aneurysm (AAA). STUDY DESIGN Case report. METHODS A 49-year-old man had a 1-month history of right leg pain and severe low back pain. Plain lumbar radiography revealed an osteolytic lesion in the L4 vertebral body. Computed tomography images demonstrated the presence of an extensive osteolytic lesion in the L4 vertebral body and an AAA in front of the L4 vertebral body. RESULTS The patient underwent mass resection, spinal reconstruction, and blood vessel prosthesis implantation. During surgery, it was found that the wall of the aorta had completely disappeared and was shielded by the tumor mass; therefore, we speculated that the mass in the lumbar spine had directly invaded the aorta. CONCLUSIONS The patient was able to walk without right leg or low back pain 1 year after undergoing surgery. No recurrence was demonstrated in the magnetic resonance images taken 1 year and 10 months after surgery.

A Retrospective Analysis of Subaxial Subluxation Following Atlanto-axial Arthrodesis in Patients with Rheumatoid Arthritis Based on Annual Radiographs Obtained for Five Years.

Study Design: Retrospective study. Objective: The purpose of this study was to investigate the incidence of subaxial subluxation (SAS) after atlanto-axial arthrodesis in rheumatoid arthritis (RA) patients using annual radiographs obtained for 5 years and clarify the characteristics of SAS after surgery. Summary of Background Data: Rheumatoid SAS has been reported to occur after atlanto-axial arthrodesis. Many authors have noted that excessive correction of the atlanto-axial angle (AAA) results in a decrease in subaxial lordosis, thereby inducing SAS; therefore, we paid special attention to acquiring a suitable AAA in patients with atlanto-axial arthrodesis. Methods: Twenty-five patients with AAS treated with surgery were reviewed. In all patients, lateral cervical radiographs were obtained in neutral, maximal flexion, and maximal extension positions every year for 5 years after surgery. We investigated the occurrence and progression of SAS using these annual radiographs. Results: There were no significant differences between preoperative and postoperative value in AAA and subaxial angle (SAA), respectively. Before surgery, SAS was found in 10 patients. The occurrence and progression of SAS after surgery was found in 12 cases (SAS P+ group). There were no significant differences in age, sex, or the duration of RA between the SAS P+ group and the remaining 13 cases. We also found no differences in the preoperative and postoperative AAA and SAA between the 2 groups. Conclusions: Although SAA was maintained after atlanto-axial arthrodesis in RA-AAS patients, 12 of 25 patients (48%) with AAS developed SAS after atlanto-axial fusion. Further surgery was not needed for SAS up to 5 years after the initial surgery. We did not find any relationship between the occurrence of SAS and the AAA and SAA before and after surgery. Therefore, our findings suggest that proper reduction of AAA in patients with atlanto-axial arthrodesis does not affect the occurrence of SAS at 5 years after surgery.

Giant schwannoma with extensive scalloping of the lumbar vertebral body treated with one-stage posterior surgery: a case report

IntroductionSchwannoma is a relatively common benign spinal cord and/or cauda equina tumor; however, giant cauda equina schwannoma with extensive scalloping of the lumbar vertebral body is a rare pathology, and the treatment strategy, including the use of surgical procedures, is controversial. In this report, we present a rare case of a giant lumbar schwannoma of the cauda equina with extremely large scalloping of the vertebral body, and we discuss the surgical strategy we used to treat this pathology.Case presentationA 42-year-old Japanese man presented to our department with complaints of a gait disturbance and muscle weakness in the left lower limb. His muscle strength in the proximal part of the left lower limb was grade 2 or 3/5, and he exhibited a mild urinary disturbance on the first visit. X-ray and computed tomography myelography of the lumbar spine showed an extremely large erosive lesion at the L3 vertebral body. Magnetic resonance imaging of the lumbar spine showed a large soft-tissue mass in the spinal canal at L2-L3 and the vertebral body at L3. A one-stage complete tumor resection and instrumented circumferential fusion were performed via a posterior approach, and a good outcome was achieved after the surgery.ConclusionsWe performed one-stage posterior surgery in a patient with a giant cauda equina schwannoma with extensive scalloping of the vertebral body, and a good post-operative outcome was achieved.