Satoshi Isogai

Débridement Arthroplasty for Primary Osteoarthritis of the Elbow

BACKGROUND Formal and more aggressive débridement procedures have been described for the treatment of advanced primary osteoarthritis of the elbow. However, the literature contains little information on the results of long-term follow-up. The purpose of this study was to evaluate outcomes at an average of ten years after débridement arthroplasties performed through a posteromedial approach. METHODS Thirty-three elbows with primary osteoarthritis in thirty-two patients treated with débridement arthroplasty were available for clinical follow-up evaluation. Through a posteromedial approach, the flexor-pronator muscle origin was reflected from the medial epicondyle and the joint was opened, preserving the anterior oblique bundle of the medial collateral ligament. The ulnar nerve was decompressed in all patients. Osteophytes were removed from the anterior, medial, and posterior sides of the elbow joint. In nine elbows, osteophytes from the lateral compartment were removed through an additional lateral approach. The mean age at the time of the operation was fifty years. The mean duration of follow-up was 121 months, and nineteen elbows were followed for more than ten years. RESULTS The mean preoperative limitation of extension of 31 degrees was reduced to 24 degrees, and the mean preoperative flexion of 101 degrees improved to 118 degrees (p < 0.001). The mean arc of movement improved by 24 degrees. The mean Japanese Orthopaedic Association elbow score was 83 points at the latest follow-up evaluation compared with 60 points preoperatively (p < 0.001). Of twenty-five patients who had performed heavy manual work, nineteen (76%) returned to their previous job or an equivalent job. At the latest examination of the nineteen elbows followed for more than ten years, the limitation of extension was found to have increased by 7 degrees compared with the limitation noted at one year (p < 0.009); the mean arc of flexion had remained the same. Three elbows required a reoperation. Overall, 85% of the elbows were satisfactory to the patients. CONCLUSIONS Débridement arthroplasty through a posteromedial approach can provide stable and reliable long-term results with regard to relief of pain, gains in range of motion, and the patients ability to return to his or her previous occupation. In our series, a modest loss of extension was observed at ten years, whereas the arc of flexion remained consistent.

Piriformis Syndrome Resulting From a Rare Anatomic Variation

Study Design. Case report. Objectives. We report a rare case of piriformis syndrome accompanying anatomic variation in the piriformis muscle and sciatic nerve. Summary of Background Data. Beaton classified anatomic variation in the piriformis muscle and sciatic nerve into 6 types based on cadaver studies. There has been no report in the English literature of surgical treatment for a case of piriformis syndrome accompanying Beaton type d anatomic variation. Methods. A patient with sciatica showing no nerve root compression in lumbar MRI underwent pelvic MRI and perineurography of the sciatic nerve followed by CT. The findings in these images suggested piriformis syndrome accompanying anatomic variation of the piriformis muscle and sciatic nerve. Surgical treatment was performed. Results. Surgical exploration of the piriformis muscle revealed Beaton type d anatomic variation. Both anterior and posterior lobes of the piriformis muscle were resected. The pain in the leg had completely disappeared after surgery. Conclusions. This is a very rare case of surgically treated piriformis syndrome resulting from type d anatomic variation in Beaton’s classification. Pelvic MRI and perineurography of the sciatic nerve were useful for diagnosis in this case.

Diagnostic features of sciatica without lumbar nerve root compression.

Study Design Retrospective case series review of patients showing sciatica without radiographic evidence of nerve root compression. Objective To elucidate clinical features of sciatica caused by extralumbar spinal lesions. Summary of Background Data Sciatica caused by extralumbar spinal lesions has been reported sporadically. Given the paucity of case series studies, however, the pathology and clinical features of such sciatica remain not fully understood. Methods Sixty-one patients who presented with persistent sciatica were examined with lumbar magnetic resonance (MR) imaging. Of these, the records of patients showing no detectable nerve root compression in MR images were reviewed with respect to demographics, neurologic status, further diagnostic procedures, treatments, and treatment outcomes. Results Of 61 patients, 10 (16.4%) showed sciatica and a lack of nerve root compression in the lumbar MR imaging. In demographics, there was female sex dominance (9 patients) and right side preference (9 patients). Eight patients exhibited sensory disturbance beyond a single dermatome. Piriformis syndrome was diagnosed in 3 patients and 5 patients were considered to have sacral plexus pathologies associated with gynecologic conditions such as ectopic endometriosis, ovarian cyst, and pregnancy. A review of the literature also supported the right side preference in sciatica associated with gynecologic conditions. Conclusions Piriformis syndrome and gynecologic conditions account for most cases of extralumbar spinal sciatica. Female sex, right side involvement, and overlapping sensory disturbance are suggestive of extralumbar spinal sciatica associated with gynecologic conditions.

Morphological changes of the dorsal root ganglion in a patient with herpes zoster seen by magnetic resonance imaging

To the best of our knowledge, there has been only one previous report on morphological changes of the dorsal root gan glion (DRG) seen on magnetic resonance imaging (MRI) in patients with herpes zoster. We present this case report of a rare case of swollen lumbar DRG caused by herpes zoster, with complete restoration in the size of the DRG after curing cutaneous lesions. The patient was informed that data from the case would be submitted for publication and gave his consent.