A seasonal variation in the incidence of congenital talipes equinovarus in England was reported previously. A review of 218 neonates who presented to Kyushu University Hospital and Fukuoka Children's Hospital with congenital talipes equinovarus over a ten-years period revealed an increase in the condition amongst babies born during winter.This finding was particularly apparent among cases with more severe club foot. Possible reasons for this seasonal variation are discussed.
Thirty-seven patients (32 men and 16 women) who received decompressive surgery extending to the foraminal region between December 1989 and December 1993 were studied. The average age at the time of operation was 63 years, and the average postoperative follow-up period was 20 months, with 22 patients (60%) being followed for over one year. On preoperative investigation, latefal displacement and nerve block as determined by selective radiculograhy (SRG) as well as a marked reduction or absence of perineural fat tissue in the intervertebral foraminal region on MRI, were considered abnormal. In general en block laminectomy (laminoplasty) was performed for nevrve root canal decompression.Fifty nerve root canal decompressive procedures were performed, since nine patients required surgery at two or more sites. The operative findings included 37 cases of osteophyte and or disc protrusion and six cases of ala-transverse impingement. Postoperatively, 35 patients (94%) were either pain-free or had slight residual pain in the lower extremities. In patients with lower extremity pain due to degenerative lumbar disease, it is important to detect abnormalities of the interforamina on MRI and SRG. En block laminectomy (laminoplasty) is an effective procedure because it does not result in structural failure and it allows adequate observation of the nerve root pathway.
We operatively treated 8 cases of discopathy, which did not respond to long-term conservative therapy. The mean term of conservative therapy was 4.08 years. Because of low back pain, all patients experience disability in their daily life. The clinical results were evaluated by the JOA score, and the recovery rate was determined by Hirabayashi's method. The preoperative mean JOA score was 9.8 points, which changed to 24.5 points, and mean recovery rate was 73.8%. All patients had undergone magnetic resonance imaging (MRI) and discography. Discography is an indispensable examination to check the symptomatic level(s). We think that careful review of medical history is the most important factor in determining indication for operation.
Infectious disease of the spine needs early diagnosis and definite treatment. Development of magnetic resonance (MR) imaging has made it possible to depict the infectious lesions. MRI seems to be superior to other morphological diagnostic methods for showing the lesions.We studied 19 consecutive cases diagnosed by MR imaging. Early changes of the spine and soft tissue were diagnosed by MRI correctly in cases of acute onset. Degenerative disc disease made diagnosis difficult in some cases. High signal intensity of the disc on T2 weighted images, and serial axial images showed the lesions. Ga-enhanced MR imaging was also helpful to distinguish infectious from degenerative disc lesions. MR imaging is useful for the diagnosis of infectious spinal disease. In regard to treatment, MR imaging was helpful in deciding on the effectiveness of antibiotics but was not useful for deciding on the duration of antibiotics.
Degenerative lumbosacral kyphosis occurs due to lower lumbar disc degeneration. Patients with this deformity indicate marked loss of lumbosacral balance. This disalignment disturbs walking and standing ability markedly. Conservative treatment including brace treatment for this deformity is difficult due to the loss of lumbosacral balance.Surgical treatment had been performed by use of the Isola-Galveston method from only a posterior approach. This procedure was performed to obtain correction and fusion at degenerated discs. Patients operated on by this procedure gained relative relief of symptoms, but loss of correction occurred in the fused area. No correction of the lumbopelvic alignment, measured by the pelvic angle offered by Jackson, seemed to be a major factor of this results.We changed the operative procedure to gain correction of the pelvic angle and more lumbar lordosis. Posterior transverse wedge osteotomy in the L4 region by the modified eggshell procedure and posterior shortening with spinal instrumentation started from 1997. Three patients were operated on by this method. The Isola-Galveston method was used in one case and the Jackson lumbopelvic fixation method with the Liberty system in another two cases. The fusion area was from L1 to sacrum. After the operation, the pelvic angle was corrected to under 30 degrees and lumbar lordosis over 30 degrees and maintained during follow up. There was no loss of correction and instrumentation failure. Symptoms related to malposture improved markedly in all patients.
A 66-year-old man with pseudoarthrosis of the tibia in von Recklinghausen's disease was treated with an intramedullary Huckstep nail. Adult onset pseudoarthrosis in this disease has been reported only rarely. This skeletal lesion is considered to be the result of mesodermal dysplasia and osteomalacia.
On surgical treatment for degenerative spondylolisthesis of the lumbar spine, we performed the operation according to pathological conditions in each patient. Decompression and fusion was done in all patients. Indications of reduction with spinal instrumentation were as follow; kyphotic alignment, increasing slip rate over 5% in motion picture.We operated on 33 cases, from April 1988 to October 1977. 12 cases, mean age at the operation was 59 years old, were operated on by reduction and fusion. 21 cases, mean age at the operation was 68 years old, were operated on by decompression and fusion in situ. Bony union was obtained in all cases except without reduction. Improvement from preoperative symptoms was marked in cases with reduction. Cases without reduction showed decreased disc height in slipped level within 3 months after the operation.Our indication for reduction and fusion seemed to have justfication. Further indications for reduction and fusion may be needed in surgical treatment for spondylolisthesis.
107 patients suffering from various disturbances following a whiplash injury were studieds retrospectively. Patients were divided into four groups based on clinical, radiological and MRI findings; 55 cases had soft tissue injury only of the neck, 25 cases had traumatic thoracic outlet syndrome, 18 cases had cervical radicular syndrome and nine cases had a combination of traumatic thoracic outlet syndrome and cervical radicular syndrome.Patients with whiplash injuries were treated using a soft neck collar for sprain injuries, a thoracic outlet syndrome pillow that we developed to relax neck muscles and decompress brachial neuro-vascular plexus in traumatic thoracic outlet syndrome and a firm cervicothoracic orthosis was used to treat cervical radicular syndrome. Furthermore, according to the situation, chronic cases were also treated by non-steroidal antiinflammatory agents, muscle relaxants, stellate ganglion block, epidural block and isometric muscle exercises of the neck and pectoral muscles.
Most proximal humeral fractures could be treated by conservative treatment, and only a few patients were treated by operation. In this study, we discuss 20 patients, 14 with 2-part and 6 with 3-part fracture. The JOA score was 82.0 point, and major complications were seen in one patient.
It is very important that occurate diagnosis of the level and location of lumbar disc herniation is made, before surgery is carried out. Recently, the diagnosis of lumbar disc herniation has been made easier with magnetic resonance imaging.We performed a nucleotomy in 22 cases of lumbar disc herniation, which were only diagnosed by magnetic resonance imaging. All cases achieved a good results post-operatively.We concluded that we could operate upon herniated nucleus pulposus diagnosed only by MRI without myelography or CTM. But care must be taken when there is neurological disagreement, spondylosis deformens, central type herniation, old age, or cases requiring re-operation.It is more important to have static rather than dynamic information from MRI, therefore we should perform nucleotomy, rather than instrument surgery.
