Y. Takemitsu

Surgical results of dynamic nonfusion stabilization with the Segmental Spinal Correction System for degenerative lumbar spinal diseases with instability: Minimum 2-year follow-up

Background When spinal fusion is applied to degenerative lumbar spinal disease with instability, adjacent segment disorder will be an issue in the future. However, decompression alone could cause recurrence of spinal canal stenosis because of increased instability on operated segments and lead to revision surgery. Covering the disadvantages of both procedures, we applied nonfusion stabilization with the Segmental Spinal Correction System (Ulrich Medical, Ulm, Germany) and decompression. Methods The surgical results of 52 patients (35 men and 17 women) with a minimum 2-year follow-up were analyzed: 10 patients with lumbar spinal canal stenosis, 15 with lumbar canal stenosis with disc herniation, 20 with degenerative spondylolisthesis, 6 with disc herniation, and 1 with lumbar discopathy. Results The Japanese Orthopaedic Association score was improved, from 14.4 ± 5.3 to 25.5 ± 2.8. The improvement rate was 76%. Range of motion of the operated segments was significantly decreased, from 9.6° ± 4.2° to 2.0° ± 1.8°. Only 1 patient had adjacent segment disease that required revision surgery. There was only 1 screw breakage, but the patient was asymptomatic. Conclusions Over a minimum 2-year follow-up, the results of nonfusion stabilization with the Segmental Spinal Correction System for unstable degenerative lumbar disease were good. It is necessary to follow up the cases with a focus on adjacent segment disorders in the future.

Salvaged Surgery of Non-fusion Stabilization for the Adjacent Segmental Diseases after Posterior Spinal Fusion

Posterior lumbar fusion with instrumentation provides immediate stability on spine and is an effective surgical technique in deformity correction, whereas ASD remains as a mid/long term issue. In this study, we applied posterior decompression and non-fusion stabilization with SSCS to total of 21 patients (13 males and 8 females), who had undergone posterior lumbar fusion in the previous five years and then suffered ASD. The mean age was 69.4 years (range: 49 to 85) and the mean period between the primary surgery and the revision surgery was 5 years and 9 months (range: 11 months to 18 years). Site of ASD occurrence was at; upper level on 16 patients, lower level on 4 patients and upper/lower level on 1 patient. Preoperative JOA score 14.6 improved to postoperative 23.8 at the follow-up (improvement rate: 63%). ROM of the operated segments was significantly decreased from mean 8.2 to 1.7 degrees. We applied non-fusion stabilization with SSCS to salvage ASD occurred after posterior lumbar fusion with instrumentation. In case that further spinal fusion is applied to ASD, it could cause another ASD. Therefore non-fusion stabilization seems to be meaningful.

Transforaminal Lumbar Interbody Fusion (TLIF) Using Pedicle Screws with Mobility

We believed that the delivery of a moderate compression force to bone grafts in transforaminal lumbar interbody fusion (TLIF) was better for bony union and performed the TLIF using a pedicle screw with mobility. Using the Segmental Spinal Correction System for TLIF, we investigated 13 patients with a minimum postoperative follow-up of 1 year. A good bony union was observed and clinical results included an improvement rate of 76.8%. Recent spinal instruments are made from more rigid and break-resistant materials. Bony union is less likely to be achieved in TLIF unless segmental subsidence is tolerated to some extent. The use of pedicle screws with mobility may enhance bony union. Background: TLIF using a rigid pedicle screw has become the gold standard in spinal fusion. However, do stronger instruments have advantages for bony union? Bone grafts in TLIF once undergo necrosis and the volume decreases over time. If the disc height does not decrease accordingly, it will create some space between the grafted bone and both upper and lower vertebral bodies, which is disadvantageous for bony union. Thus, we considered that a pedicle screw with mobility would provide moderate compression force to the bone grafts in TLIF and would be better for bony union. The Segmental Spinal Correction System (SSCS) was used for TLIF in this study. Results: We investigated the clinical results of this method in 13 patients (6 male and 7 female, 56 to 79 y/o) with a minimum 1-year follow-up. The mean JOA score improved from 13.5 pre-OP to 25.4 post-OP. The mean improvement rate was 76.8%. Bony union was observed for all patients. Conclusion: TLIF using a pedicle screw with mobility provides moderate compression force to the bone grafts in TLIF and bony union may be enhanced. This could be a new method in spinal fusion surgery.

Bilateral bipartite carpal scaphoid: a case report and literature review.

Congenital bipartite carpal scaphoid has been reported as an extremely rare congenital anomaly. We report a case of a 47-year-old man who was found with bilateral bipartite carpal scaphoids with no history of injury. Radiographs demonstrated symmetric findings of the distinct bipartition of the scaphoid without obvious degenerative change in both wrists. The patient complained of no other symptoms. The diagnostic differentiation of scaphoid bipartition from the pseudarthrosis of the scaphoid could be important in avoiding unnecessary surgery and inappropriate assessment in compensation cases.

Spinal Surgery for Misdiagnosed Amyotrophic Lateral Sclerosis in Spinal Diseases

Spinal operations were performed on 4 cases with Amyotrophic Lateral Sclerosis (ALS), in which 3 cases were wrongly diagnosed with cervical spondylotic myelopathy, 1 with L4 degenarative spodylolisthsis, and 1 with L1/2 disc herniation. (In 1 case, operation was performed two times for cervical lesion and lumbar lesion.) The chief complaint of all cases with obvious sensory disturbance, were muscle weakness, dullness, and numbness of the extremity. Sensory disturbance and MRI/CTM showed spinal compression slightly presenting spondylotic degenerative change were misdiagnosed. We must be careful in the evaluation of cases who have simultaneously spondylotic degenerative lesion and ALS. In all cases, post-operational symptoms were worse than pre operational itself. We believe that the operation deteriorated the neurological states progressively and gave no benefit. In conclusion, spinal disease, with ALS or those for which ALS cannot be ruled out should not be operated.

Vertebral Body Fracture after Spinal Instrumentation Surgery

Seven cases of vertebral body fractures adjacent to the instrumented vertebral were observed after posterior spinal instrumentation surgery. All patients were females and their ages ranged from 51 to 68 years (mean, 69 years). The interval between surgery and fracture recognized radiographically ranged from two months (mean, 3.5 years). This case report presents the possibility of biomechanical stress on the porotic spine adjacent to the instrumented rigid spinal segments.