Yoshihisa Kawauchi

The effect of Lipo prostaglandin E1 on cauda equina blood flow in patients with lumbar spinal canal stenosis: myeloscopic observation.

Study Design: Myeloscopic examination was performed to observe the cauda equina in patients with lumbar spinal canal stenosis before and after treatment with Lipo prostaglandin E1, a strong peripheral vasodilator. Objectives: The purpose of this study was to clarify the effects of Lipo prostaglandin E1 on blood flow in the cauda equina in patients with lumbar spinal canal stenosis. Setting: Japan, Kagoshima Methods: We performed myeloscopic observations of morphological changes in blood vessels running along the cauda equina in 11 patients with lumbar spinal canal stenosis before and after treatment with Lipo prostaglandin E1. Results: In six of these patients, dilation of the running blood vessels was observed immediately after administration. In all of the patients who exhibited a dilation of vessels on the surface of the cauda equina, intermittent claudication and lower extremity pain and/or numbness lessened immediately after examination. However, none of the patients who exhibited no morphological changes in the vessels along the cauda equina after administration of Lipo prostaglandin E1 experienced any improvement of symptoms at the time of examination. Conclusion: Results of this study suggest that Lipo prostaglandin E1 may enhance blood flow in the cauda equina and improve clinical symptoms in some patients with lumbar spinal stenosis. Sponsorship: None

Myeloscopic observation of adhesive arachnoiditis in patients with lumbar spinal canal stenosis

In this study a myeloscope was used to assess the influence of adhesive arachnoiditis on the surgical outcome of patients with lumbar spinal canal stenosis (LSS). The presence or absence and the degree of the complication of adhesive arachnoiditis were preoperatively determined by myeloscopy in 36 patients with LSS, and these findings were compared with the postoperative results. Various degrees of adhesive changes in the cauda equina were observed in all 36 patients. Patients with marked adhesions, which may indicate a blocked cauda equina, had distinctly worse operative results than did patients with slight or moderate adhesions. Adhesive arachnoiditis was considered to be one of the causes for the poor operative results for LSS. Myeloscopy is useful in diagnosing the morbid condition of the cauda equina in LSS, and for predicting the operative results.

Surgical Results of Lumber Fusion in Hemodialysis Patients

今回，透析患者に対する腰椎固定手術についてその手術成績と問題点について検討した．対象は，2002～2008年に手術を行った30例（男性15例，女性15例）であった．手術時年齢は52～72歳（平均61.8歳），透析歴は6ヶ月～31年（平均13年6ヶ月）であった．術前診断は，破壊性脊椎関節症（DSA）12例，腰椎変性すべり症10例，腰部脊柱管狭窄症4例，腰椎椎間板ヘルニア3例，分離すべり症1例であった．手術方法はPLF 24例，PLF+PLIF 4例，前方固定術2例であった．結果，JOAスコアの改善率50％以上が22例（73.3％）であったが，合併症による死亡が2例（6.7％）あった．透析患者に対する腰椎固定手術は合併症が多く，透析医，麻酔医との連携と十分なインフォームドコンセントが重要である．

Two Cases of Cervical Disc Hernia after Anterior Fusion

We successfully treated two patients with cervical disc hernia after anterior fusion. Case 1 was a 50-year-old woman. In 1991 she underwent anterior cervical fusion after being diagnosed with cervical disc hernia (CDH) at another hospital and postoperative course was good. Ten years later, due to numbness of both hands and finger elaborate movement disorder developed, and she visited our hospital for checkup. Cervical disc herinia was noted at the proximal adjacent level of the previous fusion level in magnetic resonance imaging (MRI), for which we performed anterior cervical fusion again. Postoperatively, numbness of the arms and elaborate movement disorder improved. Her Japan Orthopedic Association(JOA) score improved 16 points from 12 points.Case 2 was a 60-year-old man. In 1993 he underwent anterior cervical fusion after being diagnosed with CDH and ossification of the posterior longitudinal ligament. Eight years later, he visited our hospital again for checkup due to numbness of both arms and urine leak. We recognized CDH at the proximal adjacent level of the previous fusion level in MRI for which we performed front fusion again. Postoperatively, spastic paralysis improved. JOA score also improved 12 points from 10 points and he was able to return to work.

Postoperative Results of Spinal Metastases

We evaluated postoperative results in fifteen patients with metastatic spinal tumor who underwent surgical treatment between 1989 and 2000. There were eleven males and four females with a mean age of sixty-four years (range: forty-eight to seventy-seven). The primary tumor was prostate cancer in five, lung cancer in four patients, etc. The level of spinal metastases was cervical in three and thoracic spine in eleven. We treated the patients surgically with anterior procedure in three and posterior procedure in twelve. For fixation, spinal instrumentation was employed in five patients.As a result, five of the fifteen patients recovered from their paralysis and twelve of fifteen patients attained pain relief. The rate of survivl was 42.9 percent at three months, 30.8 percent at six months, and 23.1 percent at one year.Surgical treatment for spinal metastases is effecticve for improving the quality of life in patients with severe pain of progressive paralysis. However, the indication of surgical treatment for spinal metastases must be determined carefully, taking into consideration their general condition, variety of primary cancer, and prognosis of each patient.

A Case Report of Candida Vertebral Osteomyelitis

We report a rare case of candida vertebral osteomyelitis at the multi level lesion. A-58-year old man had complained of low back pain and fever elevation, one month later after abdominal surgery. The findings on plain radiographs and tomograms showed narrowing of the disc space at the Th12/L1, L4/5 and L5/6 levels. MRI showed abnormal signal intensity in the region of the Th12-L1 and L4-6 vertebral bodies. The needle biopsy of the spine grew candida tropicalis. He was managed conservatively with antifungal agents and bed rest. The symptoms reduced gradually. The treatment was successful with no recurrence after follow-up of 10 months.

A Case of Blunt Traumatic Arteriovenous Malformation of the Forearm

Arteriovenous malformation (AVM) is classified as either congenital or traumatic (acquired) in origin. Most cases are congenital, with traumatic AVM relatively rare in Japan. About 30 traumatic AVM cases have been reported in the literature, only 5 (16.7%) of these cases were caused by blunt trauma. We surgically treated a blunttraumatic AVM of the forearm which existed in the flexor pollicis longus muscle and obtained a satisfactory surgical result.

Three Cases of Burn Scar Cancer

Three cases of carcinoma developing in the burn scans are reported. Two cases are male and another is female. The ages at onset of cancer ranged from 44-years-old to 73-years-old (average: 58-years-old), and the time interval between burn and onset of cancer ranged from 15 years to 41 years (average: 31 years). The causes of the burn were as follows: the first case by boiling water, the second by bonfire and the the third unknown. All cases had ulcer formation with a large quantity of discharge and bad smell, and pathological diagnosis was squamous cell carcinoma. In all cases, amputation above the site of the lesions followed by chemothrapy was performed and satisfactory results were obtained at the short-time follow-up.