Tomoya Muta

Low-intensity pulsed ultrasound (LIPUS) increases the articular cartilage type II collagen in a rat osteoarthritis model

In this study, the effect of low‐intensity pulsed ultrasound (LIPUS) on cartilage was evaluated in a rat osteoarthritis (OA) model using serum biomarkers such as CTX‐II (type II collagen degradation) and CPII (type II collagen synthesis) as well as histological criteria (Mankin score and immunohistochemical type II collagen staining). OA was surgically induced in the knee joint of rats by anterior cruciate/medial collateral ligament transection and medial meniscus resection (ACLT + MMx). Animals were divided into three groups: sham‐operated group (Sham), ACLT + MMx group without LIPUS (−LIPUS), and ACLT + MMx group with LIPUS (+LIPUS; 30 mW/cm2, 20 min/day for 28 days). CTX‐II levels were elevated in both −LIPUS and +LIPUS groups compared to that in the Sham group after the operation, but there was no significant difference between +LIPUS and −LIPUS groups, suggesting that LIPUS does not affect the degradation of type II collagen in this model. In contrast, CPII was significantly increased in +LIPUS group compared to −LIPUS and Sham. Moreover, histological damage on the cartilage (Mankin score) was ameliorated by LIPUS, and type II collagen was immunohistochemically increased by LIPUS in the cartilage of an OA model. Of interest, mRNA expression of type II collagen was enhanced by LIPUS in chondrocytes. Together these observations suggest that LIPUS is likely to increase the type II collagen synthesis in articular cartilage, possibly via the activation of chondrocytes and induction of type II collagen mRNA expression, thereby exhibiting chondroprotective action in a rat OA model.

Vertical dislocation of the talus without malleolar fractures

We report an unusual case of open vertical dislocation of the talus without malleolar fracture following motor vehicle accident.Most previously reported cases are medial, lateral, posteromedial and posterior dislocations. The anterolateral, posterolateral, and purely superior dislocations of the talus make up smaller a percentage. The mechanism of this injury appears to be forced eversion of the foot when it is maximally plantar flexed and axially loaded.Our case has treated by open reduction of the talus and anatomical repair of the disrupted deltoid ligament at the time of initial incision and open reduction with internal fixation of the calcaneus also achieved good long-term functional and radiographic results.

Acute posterior neck pain in adult: a case series

Calcification around the cervical spine is thought to be relatively rare case, among these conditions the calcification at the longus colli muscle is called retropharyngeal tendinitis and only several cases were reported in the literature. In this disease, the three characteristic clinical features are acute severe posterior neck pain without any trigger, severely restricted range of motion, and odynophagia. The radiographic findings include swelling of the retropharyngeal space and amorphous calcification anterior to C1-C2 in lateral view of the cervical spine. Diagnosis is established by sound history taking coupled with computed tomography (CT) scan of the affected area, treatment is the administration of oral non-steroidal anti-inflammatory drugs (NSAID), for a few weeks and/or oral steroid. We present a new 3 cases (27, 35, and 24 years old, male) and review of literature.

Novel diagnosis and subsequent management of a very large Giant Cell Tumour of bone arising as a rarity in the thoracic spine

A 34-year-old male, who presented with mild upper back pain of recent onset was discovered to have a large intrathoracic mass, which was in continuity with tumour which had extensively destroyed the T5 and T6 vertebrae. Microscopy of an aspirated pleural effusion unexpectedly revealed many large multinucleated giant cells and the subsequent needle biopsy confirmed the diagnosis of a Giant Cell Tumour (GCT) of bone. In addition to being the first reported occasion when a GCT has been provisionally diagnosed by cytological examination of a pleural effusion, this case report also considers the unusual features and unpredictable behaviour of a tumour, which very rarely originates in the thoracic spine. The complex and prolonged surgical procedure adopted to extirpate tumour, which had permeated important mediastinal structures and to restore stability to the spinal column is outlined.

Tubular surgery with the assistance of endoscopic surgery via a paramedian or midline approach for lumbar spinal canal stenosis at the L4/5 level

Background: Lumbar spinal canal stenosis surgery has recently improved with the use of minimally invasive techniques. Less invasive procedures have emerged, and microendoscopic decompression through smaller incisions is frequently performed. Tubular surgery with the assistance of endoscopic surgery procedures has led to particularly remarkable changes in surgery, with reduced tissue trauma and morbidity. Purpose: The purpose of this study was to compare the clinical outcomes of two different minimally invasive decompressive surgical techniques (microendoscopic bilateral decompression surgery using the unilateral approach [microendoscopic laminectomy (MEL)] and microendoscopy-assisted muscle-preserving interlaminar decompression (MILD; ME-MILD)) using spinal endoscopy for lumbar spinal canal stenosis measured using a visual analog scale (VAS), the Japanese Orthopedic Association (JOA) score, and the JOA Back Pain Evaluation Questionnaire (JOABPEQ), which is based on a patient-oriented scoring system. Study design: This study was a retrospective review of prospectively collected surgical data. Methods: The study included 81 patients (MEL 39 patients, 20 men and 19 women, mean age 68.9 years; and ME-MILD 42 patients, 22 men and 20 women, mean age 73.1 years) with lumbar spinal stenosis (LSS). The indications for surgery were moderate-to-severe stenosis, persistent neurological symptoms, and failure of conservative treatment over 3 months, with a JOA score under 15 points or intermittent claudication at 100 m. This study included patients having LSS at a single vertebral level (L4/5). Results: Low back pain, buttock-leg pain, and numbness were significantly improved in terms of the VAS score from 3 months with both MEL and ME-MILD. In all periods, JOA scores over 3 years of follow-up were significantly higher than those obtained before surgery with both MEL and ME-MILD, and there were improvements of low back pain and walking function. Conclusions: These observations demonstrate that ME-MILD is a safe and very effective minimally invasive technique for degenerative LSS, similar to MEL.

Cervical fracture of the anterior and posterior elements without evidence of neurological deficit

Abstract We present three cases of cervical spinal fracture, involving two columns without an obvious neurological deficit. Usually if two of three columns are fractured, the injury is considered unstable structurally and clinically. Fortunately our cases did not involve sensory or motor impairment because of an enlargement of the spinal canal.