摘要:

The relation between improvement of myelopathy achieved by surgery and postoperative spinal cord morphologic changes was investigated by magnetic resonance imaging in 51 patients with cervical myslopathy, in 22 patients, the cord indentation disappeared completely (Type I), in 23 it pertially disappeared (Type II), and in 3 it remained unchanged (Type III). In three patients the cord enlarged after surgery (Type IV). With the exception of Type IV, Increased resloration of cord morphology paralleled improvement in the myelopathy, suggesting that morphologic changes closely reflect neurologic recovery. In Type IV, notwithstanding the peculiar postoperative reaction, improvement was relatively good, and shrinkage of the cord enlargement was seen after 1 year. This kind of postoperative change has not been demonstrated previously by other conventional imaging methods.

ISSN:0362-2436    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

A comparative study of surgical results was used to determine the tratment of choice for multisegmental cervical spondylotic myelopathy, forty-one patients who received subtotal corpectomy and strut grafting (SCS) and forty-tow undergoing laminoplasty were followed up for at least 2 years after surgery. Regarding factos known to affect surgical prognosis (age at surgery, duration of symptoms, severity of neurologic deficit, anteroposterior canal diameter, transverse area of the cord at the site of maximum compression, number of levels invoived), the two groups were statistically comparable with each other. The sevenity of neurologic deficits was assessed by the Japaneses Orthopaedic Association scale. Results were evaluated in terms of postoperative score and recovery rate, The difference between the recovery rate and final score between the two groups was not statistically significant. Surgical complications were more frequent in the subtotal corpectomy and strut grafting group than in the laminoplasty group. The most frequent complications encountered in the subtotal corpectomy and strut grafting group were related to bone grafting. Spinal aligment worsened in six patients of the laminoplasty group, but none of them suffered from neurologic deterioration, Another disadvantage of subtotal corpectomy and strut grafting was the longer postoperative period of bed rest needed to secure graft stability. We conclude that laminoplasty should be the treatment of choice for multisegmental cervical spondylotic myelopathy when neurologic results, incidence of complications, and postoperstive treatment are taken into consideration.

ISSN:0362-2436    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Spinal cord evoked potentials were recorded preoperatively from the thoracic spidural space after spinal cord stimulation in 20 patients with thoracic myelopathy with multisegmental vertebral involvement. Waveform abnormelities in spinal cord evoked potentials, namely, positive-going wave or decrease in amplitude, were observed in all cases. Abnormalities, especially in the first negative component of spinal cord evoked potentials, were recorded at the most compressed site in each case, Decrease in amplitude of more than 50% was noted frequently in moderately involved cases, whereas positive-going wave was elicited predominantly in cases of severe myelopathy. Spinal cord evoked potantials should provide information for determining the range of decompression in multisogmental vertebral involvement.

ISSN:0362-2436    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Rotation vector for three-dimensional deformity, a new concept in scollosis, Is presented. This vector quantifies three-dimensional deformity in scollosis,Rotation vectors are calculated between pairs of end plates. Any three-dimensional malalignments (scoliosis, lordosls for kyphosls) and rotational existing between a pair of end plates should be cancelled perfectly by rotating one and plate against the other about an axis represented by the rotation vector.A rotation vector suggests how the deformity in scoliosis should be corrected three-dimensionally.

ISSN:0362-2436    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Somatosensory evoked potentials were after double stimuli on the posterior tibial nerve for the intraoperative monitoring In 58 thoracolumbar or lumbar surgeries, The first cortical positive potential P38 and P'38 after the second stimulus was recorded after double stimuli.Transient decreased amplitude more than 50% or missing potential of P'38 was found in 11 cases. These P'38 changes occurred in five procedures of retracting the nerve roots or dural sacs, three cases of reducing of thoracolumbar fractures, and tow procedures of traspdicular screwing, No causative procedure was found in one case. In those 11 cases, 5 showed no abnormality in P38 potentials and 6 cases showed less decreased amplitude in P38 than in P'38 Consequently, P'38, which was evoked by the second stimulus, can be used for the intraoperative monitoring in the thoracolumbar and lower lumbar surgery.

ISSN:0362-2436    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Pain provocation was analyzed in 1477 intervertebral discs in 523 patients subjected tolumbar computed tomography/discography. The relation between pain provocation and the degree of general degeneratin and anular disruption assessed according to the Dallas Discogram Description as indices of intradiscal deterioration was investigated. Pain provocation was also evaluated after categorizing the discs by the clinical diagnosis. Pain provocation showed little relation to intradiscal deterioration, whereas a strong relation was found between it and herniated nucleus pulposus. In herniated nucleus pulposus, discs with extrallgamentous extrusion or sequestration, large protrusions, maximum protrusion site at the nerve root portion, and herniation routes passing throughthe central portion of the disc showed a high pain provocation ratio. Pain provocation ratios of discs associated with spinal canal stenosis were extremely low.

ISSN:0362-2436    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Computed tomography/discography was performed in 378 patients (403 discs) with lumbar disc hemiation receiving intradiscal therapy. The garde of disc degeneration defined by the Dallas discogram description correlated closely with age. The most common herniation routes ran thourgh the central portion of the posterior aspect of the disc (48.9%), through the paracentral portion (18.6%) and through the entire central portion (9.7%), with these directions parallel to the sagittal plane. However, the intraforaminal and extraforaminal routes (4.2%) passed obliquely to the sagittal plane. The development of these herniation routes has been well explained by the findings of earlier histopathologic and biomechanical studies. Computed tomography/discography was very useful in observing the detailed features of HNP such as the range, site of maximum protrusion and protrusion size.

ISSN:0362-2436    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The siblings and parents of 40 patients (cases) with lumbar disc herniation (aged 18 years or younger) who underwent surgery at the Department of Orthopaedics at Toyama Medical and Pharmaceutical University Hospital between 1976 and 1990 were examined for incidence of lumbar disc hermiation. A total of 120 randomly sampled, age and sex-matched patients (controls) who were hospitalized during the same period due to extraspinal diseases also were studied in the same manner. A survey of the occurrence of definite lumbar disc herniation was carried out that included 75,237 students in elementary, junior high, and senior high schools in Toyama Prefecture, Japan, covering a mean period of 3 years and 4 months. The incidence of surgically treated lumbar disc hermiation among people aged 18 years or younger was calculated, and the expected value of disc hemiation was obtained in an age-specific manner, on the basis of the age distrbution of encumbrances in the above cse-control study. The encumbrances of 18-year-old or younger patients with lumbar disc herniation showed familial predisposition, with an odds ratio of 5.61 in comparison to the controls. It was suggested that there is familial clustering of lumbar disc hemiatio among the encumbrances of 18-year-old or younger patients with lumbar disc herniation.

ISSN:0362-2436    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Surgical treatment of degenerative spondylolisthesis in 27 patients by means of anterior lumbar interbody fusion and in 14 patients by means of posterior decompression yielded average degrees of recovery of 77% and 56%, respectively. Preoperative analysis of myelograms, and computed tomographies after myelography indicated taht anterior shifting of the inferlor articular process of the slipping vertebra was the main factor responsible for compresion of the nervous tissue in the early stages of degenerative spondylolisthesis. Patients in these stages should be treated by anterior lumbar interbody fusion. In the later stages of degenerative spondylolisthesis, osteophytes on the superior articular processes of the lower vertebra were an additional factor in compression, and patients should be treated by posterior decompression. Computed tomographies after myelography provided the key images for identifying pathologic proceses in degenerative spondylolisthesis and selecting appropriate surgical procedures.

ISSN:0362-2436    

出版商:OVID    

年代:1992

数据来源: OVID