Tadashi Egawa

Results of Surgical Treatment for Ossification of the Yellow Ligament of the Thoracic Spine

Some patients with ossification of the yellow ligament of the thoracic spine (OYL) have been reported as achieving poor results following surgery. We investigated the factors affecting postoperative prognosis of OYL in our cases.Since 1984, ten patients with OYL have been operated in our hospital. Nine were available for follow-up. Four were male and five were female. The age at operation ranged from 34 to 77 years (mean age 58.4 years). Average symptomatic period prior to surgery was 22 months. The JOA score improved from a mean of 4.6 pre-operatively to 7.6 after surgery. Patients who were either elderly or had a long period of symptoms tended to achieve poorer results after surgery. Severe stenosis on CT (or CTM) and combined OPLL of cervical or thoracic spine seemed to influence their prognosis to some degree.

Internal Fixation for High Tibial Osteotomy

From 1988 to 1992, 91 cases of high tibial osteotomy were performed using four types of internal fixation methods. Group A, consisted of 14 cases fixed by stapling. Group B, consisted of 24 cases fixed by plating located on the lateral side of the tibia. Group C, consisted of 17 cases fixed by lateral side plating in combination with medial side stapling. Group D, consisted of 36 cases, fixed by medial side plating in combination with lateral side stapling.Postoperative changes in the tibial-plateau-tibial-shaft-angle (TPTS) were measured. Decrease in TPTS of more than 2 degrees, was 28% in group A, 46% in group B, 47% in group C, and 0% in group D. This result indicates that medial side plating in combination with lateral side stapling should be recommended for internal fixation of high tibial osteotomy.

A Study of Meniscus Injury to Knees in the Elderly

Injuries to meniscus were studied in 31 knees of 30 patients, of which 11 knees were male and 21 were Female Their ages ranged from 65 to 78 years old with an average being 68.9. The following observation were noted:1) Of the 31 knees, 27 were surgically treated under arthroscopy only, and the remaining 4 were with additional intraarticular incision.2) Medial meniscus injury was seen in 24 knees, lateral in 4 knees, and both in 3 knees. Total meniscectomy was carried out in 3 knees, extensive in 13 and partial in 18.3) No obvious correlation between the meniscus injury and the degeneration of articular cartilage was shown.4) Certain correlation between the X-ray findings of Injured Meniscus and the degeneration was noted.5) No correlation between the injury and the difference in body weight or the medial deformity of knee joints was noted.

The Post-Operative Evaluation of Spondylolysis, Degenerative Spondylolisthesis and Spondylolytic Spondylolisthesis in Adults -A Long-Term Follow-up-

Thirty-two patients (24 male, 8 female) had clinical and radiographic evaluation with an average follow-up of ten years and one month. (range 6-15 years)The material consisted of 12 cases of spondylolysis, 10 cases of degenerative spondylolisthesis and 10 cases of spondylolytic spondylolisthesis. Ten cases of spondylolysis were treated with P. L. F. J 2 cases with P. L. F. and laminectomy, and all cases of deg. spondylolisthesis with P. L. F. and laminectomy. Seven cases of lytic-listhesis were treated with P. L. F. or P. L. F. and laminectomy, 2 cases with A. F. and laminectomy, and one case with laminectomy. An increase in the slip was recorded in 5/7 cases in deg. spondylolisthesis and 4/9 cases in liytic-listhesis.Clinically, 28 cases (87.5%) were evaluated as excellent or good, one case as fair, and 3 cases as poor. The spondylolytic group was evaluated as worse than the other two groups.

Postoperatice Evaluation of Cervical Myelopathy due to Ossification of Posterior Longitudinal Ligament

Postoperative clinical results were evaluated in 42 patients (33 males and 9 females) with O. P. L. L. in cervical spine. The mean follow-up period was 5 years and 5 months. The mean age of the patients at operation was 56 (36-73) years. Twenty-six (61.9%) patients were treated by the method of enlargement of spinal canal (reported by Hirabayashi and Miyazaki), 9 patients by extirpation of ossification area by anterior approach, and 7 patients by laminectomy. Thus, 34 (92.8%) of the 42 patients obtained good and excellent results. This clinical outcome correlated with trauma and severity of the preoperative symptoms.