Spinal Surgery最新文献

{"title":"Polyaxial screw and rod systemを用いて治療したhangman骨折少年例","authors":"尚規 浅見, 充人 岩永","doi":"10.2531/SPINALSURG.21.159","DOIUrl":"https://doi.org/10.2531/SPINALSURG.21.159","url":null,"abstract":"","PeriodicalId":283326,"journal":{"name":"Spinal Surgery","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126004015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Review Article on CyberKnife Stereotactic Radiosurgery for Spinal Lesions","authors":"N. Epstein","doi":"10.2531/SPINALSURG.21.83","DOIUrl":"https://doi.org/10.2531/SPINALSURG.21.83","url":null,"abstract":"The efficacy of the CyberKnife [Accuracy, Inc., Sunnyvale CA], a new stereotactic radiosurgery device utilized in the treatment of benign and malignant spinal tumors, is reviewed. The study assesses the number and type of spinal tumors safely and effectively treated with CyberKnife radiosurgery. Most reports concerning the utilization of CyberKnife stereotactic radiosurgery [CSR] for the treatment of malignant [primary, metastatic] or benign spinal lesions have been published within the last 5 years. CSR may be administered alone or in conjunction with surgery and external beam radiation therapy. A major benefit of CSR is that it can be completed within 1 week [1-5 fractions] as compared with the several weeks required for external beam radiotherapy, with limited toxicity. A frameless device, the CSR’s accuracy is +/- 1 mm. Additionally, the Xsight program now allows the cervical and lumbar spine to be treated without fiducial marker placement; however, this is still required to accurately target thoracic lesions. CyberKnife radiosurgery is effective in treating both benign and malignant lesions. For benign tumors, the CSR successfully arrests tumor progression and minimizes pain. It is unique for the management/palliation of malignant metastatic disease where it functions as an adjunct or alternative to invasive surgery and/or routine external beam radiotherapy. In summary, CyberKnife stereotactic radiosurgery, approved by the Federal Drug Administration [USA 2001], may be safely and effectively administered within 1 week’s time to treat both benign and malignant spinal lesions with limited toxicity.","PeriodicalId":283326,"journal":{"name":"Spinal Surgery","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131500744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal Intramedullary Arteriovenous Malformation Draining into the Petrosal and Straight Sinuses resulting in Intraventricular Hemorrhage","authors":"Masanori Ito, Y. Nonaka, Hidenori Ohishi, H. Arai","doi":"10.2531/SPINALSURG.21.35","DOIUrl":"https://doi.org/10.2531/SPINALSURG.21.35","url":null,"abstract":"We report here on a 33-year-old man who presented with intraventricular hemorrhaging (IVH) into the fourth and third ventricles that was caused by a cervical intramedullary arteriovenous malformation. The patient suddenly suffered from occipitalgia, frequently vomited and had a deteriorating headache. Computed tomography (CT) revealed intracranial hemorrhaging in the fourth and third ventricles, and magnetic resonance (MR) angiography and CT angiography showed a vessel coursing ventral to the brainstem connecting to the superior petrosal sinus. We subsequently diagnosed dural arteriovenous fistula of the superior petrosal sinus and performed cerebral angiography. A six-vessel-study showed no dural AVF, but we found a venous structure draining into the petrosal sinus. Vertebral angiography was thus focused on the cervical region with the spinal arteriovenous malformation at the cervical levels 6 and 7. Selective angiography of the muscle branches of the right vertebral artery revealed an AVM nidus and draining veins of the anterior spinal, anterior medullary, lateral pontine, petrosal veins, as well as the superior petrosal sinus, lateral mesencephalic vein, posterior mesencephalic vein, and straight sinus. Although it was difficult to assume the exact position of the rupture, it is conceivable that the rupture occurred form the intracranial draining vein, and anterior medullary vein, which coursed closest to the orifices of the fourth ventricle. The unique clinical features of the present case were (1) fourth intraventricular hemorrhage which is usually caused by an aneurysm or vascular malformation in the posterior fossa, (2) the intracranial draining veins being connected to the petrosal sinus visualized by MRA and CT angiography, leading us to diagnose him with dural AVF, and (3) intraventricular hemorrhaging caused by the rupture from a draining vein in the posterior fossa of the cervical intramedullary AVM without accompanying intramedullary hemorrhaging.","PeriodicalId":283326,"journal":{"name":"Spinal Surgery","volume":"271 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2007-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123018538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal Cord Subependymoma","authors":"Y. Fukuzumi, S. Tani, Akira Isoshima, H. Nagashima, T. Abe, Junko Fujigasaki","doi":"10.2531/SPINALSURG.20.245","DOIUrl":"https://doi.org/10.2531/SPINALSURG.20.245","url":null,"abstract":"Subependymoma is considered a relatively slow growing benign tumor that is usually found at autopsy. It is difficult to differentiate from astrocytoma or ependymoma on the basis of morphologic or radiographic findings. 33-year-old female patient presented with a 16-year history of left lower extremity pain followed by numbness of the same area as well as both upper extremities. Spinal MRI revealed an enhanced abnormal intra-medullary mass extending from Th3 to Th7 and accompanied by a cystic mass lesion. No specific findings were apparent todifferentiate this tumor from astrocytoma or ependymoma. The patient underwent total resection, resulting in good neurologic recovery. Histopathologic analysis demonstrated findings typical of subependymoma. Clinical course, pathological features, treatment and prognosis of 41 published cases are reviewed in the discussion","PeriodicalId":283326,"journal":{"name":"Spinal Surgery","volume":"6 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131785647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-instrumented Posterolateral Lumbar Fusions Utilizing Combined Lamina Autograft and Beta Tricalcium Phosphate in a Predominantly Geriatric Population : An Outcome Assessment","authors":"N. Epstein","doi":"10.2531/SPINALSURG.20.219","DOIUrl":"https://doi.org/10.2531/SPINALSURG.20.219","url":null,"abstract":"The morbidity associated with allograft or demineralized bone matrix utilized to supplement autograft in spinal fusions has prompted the search for the ideal artificial bone volume expander. One artificial supplement, Beta Tricalcium Phosphate [Vitoss, Orthovita, Malvem. PA, USA], was prospectively utilized to supplement lamina autograft [50:50 mix] in 30 consecutive patients undergoing multilevel laminectomies [average 5.1 Ievels] and I [16 patients] or 2 [ 1 4 patients] level non-instrumented posterolateral fusions. These older patients averaged 7 1 .4 years of age, with 28 of 30 patients over 65 years old. The series included 21 females and 9 males. Major comorbidities included osteoporosis [24 patients], hypertension [20 patients], obesity [20 patients] , elevated cholesterol [12 patients], coronary artery disease [9 patients], diabetes [7 patients], and smoking [8 patients]. Seven of 30 patients had prior surgery including far lateral disc excision in 4 patients, and laminectomy for stenosis in 3 patients. Preoperatively, dynamic X-rays documented degenerative spondylolisthesis [25 patients], spondylolysis [1 patient], and instability secondary to prior surgery [4 patients]. Preoperative MR and CT studies predominantly demonstrated multilevel stenosis [30 patients] and hypertrophy/ossification of the yellow ligament [OYL] [24 patients]. Multilevel laminectomies and non-instrumented fusions resulted in both dynamic X-ray and 2D-CT documented fusion in 27 patients [average 6.5 months]. Two patients exhibited fusion on dynamic X-rays [no motion] but not on the 2D-CT studies obtained up to 1 8 months postoperatively; neither was symptomatic and no second operations were required. Only one patient exhibited symptomatic dynamic X-ray and 2D-CT documented pseudarthrosis I year following surgery, and required a second operation. Patients were followed a minimum of I postoperative year [average 20 months] , Utilizing Odom's criteria, recovery assessed I year postoperatively revealed 26 excellent, 3 good, and I fair outcome(s). SF-36 questionnaire data obtained preoperatively and 6 weeks, 3 months, 6 months, and I year postoperatively demonstrated maximal improvement by the 6th postoperative month at which time patients demonstrated moderate improvement on 2 Health Scales EGeneral Health, Social Function], and marked improvement on the remaining 6 Health Scales [Physical Function, Role Physical, Bodily Pain, Vitality, Role Emotional, Mental Health].","PeriodicalId":283326,"journal":{"name":"Spinal Surgery","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131116643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Management of Secondary Syringomyelia associated with Spinal Surgery","authors":"S. Fukao, J. Hanakita, Y. Kitahama, M. Minami, N. Ando","doi":"10.2531/SPINALSURG.20.257","DOIUrl":"https://doi.org/10.2531/SPINALSURG.20.257","url":null,"abstract":"A case of delayed onset of secondary syringomyelia associated with spinal surgery is presented and the mechanism of syrinx formation and surgical treatment are discussed. This 59 year old woman had an intradural thoracic Schwannoma and developed a thoracic syrinx 25 years after surgery on the thoracic Schwannoma. She complained of paresthesiae below the lower thoracic level. There was mild weakness in both legs. Hypalgesia was presented below T9. MRI showed a syrinx with adhesive arachnoiditis in the thoracic levels at the operated site. We performed a syrinx-subarachnoid shunt after microsugical lysis between the dura and the adhesive arachnoid membrane. An expanded polytetrafluoroethylene sheet (Gore-Tex® sheet) was inserted to maintain CSF flow. Postoperative neurological deterioration did not occur for 1 year postoperatively, but postoperative MRI showed a recurrence of the syrinx. These results suggest that postoperative adhesive spinal cord arachnoiditis can cause syrinx formation, and this procedure may be inappropriate surgical treatment for patient with longitudinally extensive arachnoiditis.","PeriodicalId":283326,"journal":{"name":"Spinal Surgery","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125455093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuroradiological Assessment of the Thickness of the Yellow Ligament in Degenerative Lumbar Canal Stenosis","authors":"M. Minami, J. Hanakita, S. Fukao, Y. Kitahama, N. Ando, K. Hashizume, S. Maeda, T. Hirai","doi":"10.2531/SPINALSURG.20.143","DOIUrl":"https://doi.org/10.2531/SPINALSURG.20.143","url":null,"abstract":"","PeriodicalId":283326,"journal":{"name":"Spinal Surgery","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127904566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CERVICAL SPINAL KYPHOTIC DEFORMITY","authors":"P. Matz, T. Moore, C. L. Wolff, M. Hadley","doi":"10.2531/SPINALSURG.20.77","DOIUrl":"https://doi.org/10.2531/SPINALSURG.20.77","url":null,"abstract":"Cervical spine kyphotic deformities are common sequelae of degenerative disease. Patients may present with a combination of symptoms including myelopathy and radiculopathy. We retrospectively studied a cohort of 78 patients who underwent decompression and reconstruction of the cervical spine for such deformities. Decompression and reconstruction were done by vertebrectomy (51%), multilevel interbody arthrodesis (40%), posterior decompression and reconstruction (4%), and circumferential surgery (5%). In those patients whose pretreatment kyphotic deformity was more severe than -15 degrees, 10 of 27 required revision compared with only 4 of 51 patients whose initial deformities were less than -15 degrees (p<0.005, Fisher exact test). For patients requiring revision surgery, the average degree of pretreatment kyphosis was -25.1 ± 16.6 degrees compared with -12.4 ± 10.0 degrees preoperative angulation for those patients who were effectively treated via their primary procedure (p<0.001, unpaired t-test). The mean preoperative kyphosis was -14.6 degrees, which was improved to a mean postoperative lordosis of +5.3 degrees. For patients with symptomatic cervical kyphotic deformity, consideration should be given to decompression and stabilization. In patients whose pretreatment deformity is -15 degrees or greater, strong consideration should be given to circumferential decompression and reconstruction with internal fixation and arthrodesis.","PeriodicalId":283326,"journal":{"name":"Spinal Surgery","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131227138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nucleoplasty: Reliable Intradiscal Therapy in selected Lumbar Disc Herniations","authors":"K. Bak, Jae Min Kim, Cheong Jin Hwan, C. Kim","doi":"10.2531/SPINALSURG.20.87","DOIUrl":"https://doi.org/10.2531/SPINALSURG.20.87","url":null,"abstract":"This study was designed to determine the mid-term follow-up outcome of herniated intervertebral discs treated with NucleoplastyTM (Arthrocare spine, Sunnyvale, California, U.S.A.) which utilizes coblation technology for ablating and coagulating the nucleus for partial disc removal. Sixty-five patients underwent Nucleoplasty from August 2000 through February 2002. Sixty-one patients who had been followed-up more than 12 months were included in this study. Male was outnumbered female by 37 to 24 and their mean age was 32.3 years (21-46). Fifty-three patients underwent one level procedure and 8 patients underwent two level procedure. The L4-5 level was the most commonly involved. All patients had axial pain and 49 patients had accompanying radiating pain in the leg. Intraoperative discogram was performed to determine the symptomatic level. Most patients underwent the procedure under the local anesthesia and discharged same day or next day. Ruptured or migrated disc herniations, spinal stenosis, previous major spinal surgery and definite radiological spinal instability were contraindications. Mean follow-up period was 15.6 (12-27) months. Average operation time was 46 minutes. The surgical result according to the MacNab classification showed Excellent and Good in 51 cases, Fair in 7 cases and Poor in 3 cases. Most patients showed symptom improvement one or two days after surgery. There was no heat related nerve injury. Difficulties were found in targeting into L5-S level. Three patients underwent an open discectomy and three patients had an epidural steroid injection during the follow-up period. There was one discitis that treated with intravenous antibiotics as a surgery related complication. These results indicate that the Nucleoplasty is a safe and reliable armamentarium in minimally invasive disc surgery for the contained herniated intervertebral discs. Patient selection is the most important key for the successful surgical result","PeriodicalId":283326,"journal":{"name":"Spinal Surgery","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129372483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Fuses When Dynamic X-rays Document Stability Following Posterior Cervical Fusion?","authors":"N. Epstein, R. Silvergleid","doi":"10.2531/SPINALSURG.20.1","DOIUrl":"https://doi.org/10.2531/SPINALSURG.20.1","url":null,"abstract":"How would CT-based criteria correlate with dynamic X-rays in documenting posterior cervical fusion? To study this, CT and dynamic radiographic studies were prospectively evaluated 3, 6, and up to 12 months postoperatively in 14 patients with severe myeloradiculopathy (Nurick Grade IV) undergoing dorsal decompression with fusion). “Focal” 1-2 level laminectomies with undercutting of adjacent levels were accompanied by average 6.5 level posterior fusions utilizing a rod/eyelet/braided cable system in conjunction with iliac crest autograft and demineralized bone matrix. Fusion on dynamic X-rays was defined by less than 1 mm of motion between adjacent spinous processes with less than 3 mm of translation between the vertebral bodies. Four CT-based indicators for fusion were evaluated: facet fusion, graft fusion [bone continuity overlying facet joints/ lamina], new anterior vertebral fusion, and >50% of total graft mass remaining. CT-based facet fusion most closely correlated with dynamic X-ray confirmation of fusion. At 3 months, 10 patients showed facet fusion while 8 demonstrated stability on dynamic films; all 14 patients met both fusion criteria by 6 months and continued to demonstrate these findings at one year postoperatively. At 3 and 6 months, graft fusion increased from 5 to 9 while anterior vertebral body fusion increased from 3 to 5; by 1 year, 12 demonstrated graft fusion and 7 anterior fusion. However, CT-based graft mass regressed rather than progressed over time; 7 showed graft mass of over 50% 3 months postoperatively which further diminished to 7 at 6 months and 6 by 1 year postoperatively. Together, dynamic X-rays and 4 CT-based criteria of fusion provided a more complete picture of the evolution of posterior cervical fusion.","PeriodicalId":283326,"journal":{"name":"Spinal Surgery","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2006-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132411994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}