Yasuyuki Fukui

Open-door laminoplasty for cervical myelopathy resulting from adjacent-segment disease in patients with previous anterior cervical decompression and fusion.

Study Design. This is a retrospective study of patients with cervical myelopathy resulting from adjacent-segment disease who were treated by open-door expansive laminoplasty. Objectives. The purpose of this study was to evaluate the effectiveness of laminoplasty for cervical myelopathy resulting from adjacent-segment disease. Summary of Background Data. Adjacent-segment disease is one of the problems associated with anterior cervical decompression and fusion. However, the optimal surgical management strategy is still controversial. Methods. Thirty-one patients who underwent open-door expansive laminoplasty for cervical myelopathy resulting from adjacent-segment disease and age- and sex-matched 31 patients with myelopathy who underwent laminoplasty as the initial surgery were enrolled in the study. The pre- and postoperative Japanese Orthopedic Association scores (JOA scores) and the recovery rate were compared between the two groups. Results. The average JOA scores in the patients with adjacent-segment disease and the controls were 9.2 ± 2.6 and 9.4 ± 2.3 before the expansive laminoplasty and 11.9 ± 2.8 and 13.3 ± 1.7 at the follow-up examination, respectively; the average recovery rates in the two groups were 37.1 ± 22.4% and 50.0 ± 21.3%, respectively (P = 0.04). The mean number of segments covered by the high-intensity lesions on the T2-weighted magnetic resonance images was 1.87 and 0.9, respectively (P = 0.001). Conclusions. Moderate neurologic recovery was obtained after open-door laminoplasty in patients with cervical myelopathy resulting from adjacent-segment disc disease, although the results were not as satisfactory as those in the control group. This may be attributed to the irreversible damage of the spinal cord caused by persistent compression at the adjacent segments.

Spinal chronic subdural hematoma in association with anticoagulant therapy: a case report and literature review.

Study Design. A case of spinal chronic subdural hematoma (SCSDH) in association with anticoagulant therapy was treated surgically. Objective. To clarify the etiopathogenesis, clinical presentation, and surgical outcomes of SCSDH. Summary of Background Data. Intracranial chronic subdural hematoma is a well-recognized complication of anticoagulant therapy. However, SCSDH is very rare and its etiopathogenesis is uncertain. Methods. A 72-year-old man with SCSDH who had received anticoagulant therapy for atrial fibrillation complained of bilateral lower extremity pain, cramps, and gait disturbance. The patient underwent an operation for evacuation of the hematoma. Results. Lower-extremity pain, cramps, and gait disturbance improved, and the patient was discharged 10 days after surgery. Conclusion. SCSDH should be included in the differential diagnosis of progressive spinal cord and nerve root compression in patients receiving anticoagulant therapy. Prompt diagnosis and early surgical decompression lead to a good outcome.

Halovest Dynamic Loads : Full Crossover Comparison of Three Vest Types

Study Design. Ten cervical spine trauma subjects were studied during halovest treatment. Each subject wore each of three different vests. Objectives. To compare the effect of vest design on loads between halo and vest during various activities. Summary of Background Data. Complications during halovest use may be related to vest design, a variety of which are available. Loads between halo and vest have been shown to vary with activity type, but no comparison between vest types has been reported previously. Methods. Loads between the halo and the vest were measured during performance of activities of daily living and during load application to the halo, using custom-built four-channel transducers and a PC-based data acquisition system. Results. Substantial variations between subjects exist in loads between the halo and the vest. At rest, neck distraction loads were significantly greater for the supine posture than for either the sitting or standing postures. Loads applied to the halo by the investigators are carried by the neck and not by the structure connecting the halo to the vest. During activities of daily living all four measured load components are generally nonzero. During activities of daily living substantial differences in loads occurred between vest types. For all activities of daily living combined, the relative neck distraction load values were as follows: 4PAD 100%, Bremer 159%, and PMT 180%. Conclusions. Previous evidence supports a connection between certain complications of halovest wear (such as pin loosening) and loads on the pins. This study shows that different halovests are associated with quite different loads between the vest and the halo (and thus loads on the pins and the neck). This is encouraging for prospective, clinical comparison of different halovests and for improvements in clinical performance through halovest design improvements.

Idiopathic spinal epidural fat accumulation is associated with hyperlipidemia

Study Design. Single-center retrospective analysis of consecutively collected data. Objective. To determine the clinical characteristics of idiopathic spinal epidural lipomatosis (SEL). Summary of Background Data. SEL is associated with the overt accumulation of nonencapsulated adipose tissue in the epidural space, leading to spinal cord or nerve root compression. The etiology of this condition is currently not completely understood. Methods. Data of 166 male patients who underwent primary surgery for lumbar spinal canal stenosis (LSS) from May 2013 to February 2016 were retrospectively reviewed. Participants were divided into three groups based on the degree of epidural lipomatous lesion. Patient data of age at surgery, body mass index, prevalence of common noncommunicable diseases, blood tests, arteriosclerotic index, and preoperative clinical scores (assessed using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire) were evaluated. Multivariate analysis was performed to assess the potential associated factors for idiopathic SEL. Results. Patients with LSS with severe SEL had a significantly higher body mass index and elevated serum levels of total cholesterol and triglyceride compared with those without SEL. Analysis of preoperative clinical scores revealed that patients with SEL experienced pain more frequently and showed less walking ability than did those without SEL. Multivariate analysis revealed that hyperlipidemia was significantly associated with idiopathic SEL (odds ratio = 3.74, 95% confidence interval = 1.31–10.64). Conclusion. Our data suggest that aberrant lipid metabolism is related to the pathogenesis of idiopathic SEL and that patients with LSS with idiopathic SEL have more severe pain than do those without SEL. Level of Evidence: 3

Traumatic subluxation of the axis after hyperflexion injury of the cervical spine in children.

Six cases of children (four boys and two girls, mean age 11 years) who had traumatic subluxation of the axis (C2) were reviewed retrospectively. Initial radiographs demonstrated no detectable vertebral fracture in any of the children. However, a slight anterior subluxation of C2 was observed in three of the patients. Radiographs, taken at 1 month after injury in all but one patient, revealed a progression of the subluxation and a local kyphosis in all of the patients. Four of the children were treated conservatively with a cervical brace, and an improvement of both the kyphosis and the anterior slippage of C2 was obtained accompanied by an anteroposterior growth of the C3 vertebral body. The kyphosis of two of the patients became severe and, ultimately, these patients underwent fusion surgery. At the follow-up, none of the patients presented with any significant symptom. For the correct diagnosis of traumatic subluxation of C2, sequential radiographs to confirm the progression of subluxation and local kyphosis are mandatory. Conservative treatment rather than early surgical treatment may be chosen for this injury, because mild and moderate kyphosis can be corrected spontaneously by remodeling of the cervical spine.

Modified Goel’s Methods for Basilar Impression: A Case Report with Literature

We report the case of a 57-year-old woman who had basilar impression manifesting as severe myelopathy and occipital neuralgia and was treated by distraction and fixation performed using a modification of Goel’s method. Magnetic resonance imaging (MRI) and computed tomography (CT) scans showed severe myelocompression by the dens of the axis from the ventral side and occipitalization of the atlas. After traction using a Halo vest, C1–2 facet distraction and fixation was performed in one stage using a modified Goel’s method. Although Goel et al. used a custom-made spacer to distract the facet joints, we used a threaded titanium cylindrical cage that was inserted into the joint to fix the C1–2 facet joint with posterior fixation from occipital bone to C5. Postoperatively, gradual symptomatic and neurological amelioration were observed. The atlantoaxial joints were bone-fused at 3 years post-operation. Distraction and fixation performed using this modified version of Goel’s method was effective for treating basilar invagination. The threaded titanium cylindrical cage provided adequate C1–2 space and strong initial fixation.