Shinichi Fukumoto

Release of flexors and intrinsic muscles for finger spasticity in cerebral palsy.

Between April 1987 and March 1996, 32 deformed hands of 31 patients with cerebral palsy were treated with combined release of the flexor digitorum profundus, flexor digitorum superficialis, and intrinsic muscles. Of these 31 patients, 26 patients (27 hands) were followed up after treatment. Improvements were evaluated by the modified classification of Zancolli et al, the classification of House et al, the object handling score, and the activity of daily living score. Improvements of more than one level on an average were observed in the modified classification of Zancolli et al and the classification of House et al. The ability to grasp, pinch, and release increased with improvement of 2.5 points in the object handling score, and activities of daily living were enhanced with improvement of 2.4 points. The fine motor skills could be facilitated, and dexterity was restored in most patients.

Degenerative Change in the Adjacent Segments to the Fusion Site after Posterolateral Lumbar Fusion with Pedicle Screw Instrumentation : A Minimum 4-Year Follow-up

BACKGROUND Controversy remains regarding the subsequent degeneration of adjacent segments, and little reliable information could be found in the literature regarding long-term clinical results and adjacent segment degeneration. The objective of this study is to investigate the degenerative change of adjacent segments to the fusion site and clinical outcome after posterolateral lumbar fusion with pedicle screw instrumentation and identify the risk factors in degenerative change at adjacent segments. METHODS Thirty-two patients who underwent posterolateral lumbar fusion and were able to be followed over four years were evaluated in this study. The intervertebral disc height, percent of slip, lumbosacral joint angle, lumbar lordosis and disc angle were all examined. The postoperative progression of degeneration at adjacent segments were defined as more than a 50 % narrowing in the adjacent disc height or more than a 5 % slip in adjacent segments in comparison to the preoperative neutral lateral radiographs. The clinical results were assessed using an evaluation scores for lumbar lesions proposed by the Japanese Orthopedic Association. RESULTS Fifteen (46.8%) of the 32 patients had adjacent segment degeneration including slip or narrowing. No significant correlation was found between the adjacent segment degeneration and the recovery rate at the final follow-up. In addition, no significant correlation was observed between the adjacent segment degeneration at the lastest follow-up and postoperative radiographic measurements. CONCLUSIONS The rate of radiographic degeneration at the adjacent segments was 46.8%. No significant correlation was found between degenerative change in the adjacent segments and the clinical results. We could not identify any preoperative radiographic factors which might have influenced the segments adjacent to the fusion.

Quantification of bone volume on radiographs using NIH Image

Abstract We attempted to quantify periarticular bone atrophy from radiographs of the proximal phalanx in patients with rheumatoid arthritis (RA) by means of the National Institutes of Health (NIH) Image computer program. The degree of brightness or darkness in four squares, each 20 × 20 pixels, in the right third proximal phalanx was measured using NIH Image, and the mean value of the 400 pixels was defined as the brightness/darkness index (BDI). The BDI was used to express bone volume. The BDI value was set at zero for an area of complete darkness and at 255 for an area of maximum brightness. The mean coefficient of variation in our hospital was 2.28%. The BDI was measured in 54 RA patients and 146 normal volunteers. The mean BDI at the midpoint of the diaphysis was 100 in RA patients and 176 in normal volunteers, while at the medial side of the proximal end it was 75 and 145, respectively. The difference between normal volunteers and RA patients was greatest in younger people. In some young RA patients, the BDI was significantly low at the medial side of the proximal end, clearly demonstrating periarticular bone atrophy. Periarticular bone atrophy can be quantified using the NIH Image computer program.