Katsumi Harimaya

Kyushu University, Hukuoka, Fukuoka, Japan

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Publications (52)104.82 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Marked neurological deterioration within a few days of traumatic spinal cord injury, known as subacute posttraumatic ascending myelopathy, is rare. Although several hypotheses regarding the pathogenesis of this condition have been proposed, the details remain elusive.
    The spine journal: official journal of the North American Spine Society 09/2014; · 2.90 Impact Factor
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    ABSTRACT: To investigate the clinical outcomes and imaging features of malignant peripheral nerve sheath tumors (MPNSTs) presenting as spinal dumbbell tumors.
    07/2014;
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    ABSTRACT: Study Design Retrospective cohort study. Objectives The mechanism underlying the pain relief observed following balloon kyphoplasty (BKP) to vertebral compression fractures is reported to involve stabilization of the fractured vertebrae. However, whether fixation of the vertebrae was achieved immediately after BKP has not been investigated. The purpose of this study was to assess fixation of the vertebrae immediately after BKP and whether the instability was related to visual analog scale (VAS) scores. Methods Thirty-eight patients with vertebrae that were evaluated on lateral roentgenkymography within 1 week after BKP were recruited. Instability was defined as a cleft observed between the cement and end plate of the vertebra in the supine position that disappeared in the sitting position, and the posterior wall height of the vertebra was reduced in the sitting position. Results Instability of the vertebrae immediately after BKP was observed in 17 cases. VAS scores improved in all cases, and no significant differences were observed with or without instability. Conclusions The mechanism of rapid pain relief following BKP was not strong fixation but some degree of stabilization or other factors. We suggest that more research is needed about the mechanism of pain relief following BKP in the future.
    Global spine journal. 06/2014; 4(2):89-92.
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    ABSTRACT: Although a substantial percentage of patients with rheumatoid arthritis (RA) experience low back pain, the characteristics of lumbar spine pathology in RA patients has been poorly investigated. In our institutions, lumbar spine radiographs indicated scoliosis in 26 patients. The present study aimed to clarify the characteristics of lumbar scoliosis in RA patients. This is a retrospective study of 26 RA patients with lumbar scoliosis. Patient characteristics such as disease duration, disease stage and class according to Steinbrocker's classification, and medication for RA and osteoporosis were reviewed. Radiologic evaluation of scoliosis was performed at two different time points by measuring Cobb angles. The progression of scoliosis per year was calculated by dividing the change in Cobb angles by the number of years. Apical vertebral rotation, lateral listhesis, and the level of the intercrestal line at the first observation were also measured. The correlation between different factors and changes in the Cobb angles per year was analyzed. Majority of the patients had a long disease duration and were classified as stage 3 or 4 according to Steinbrocker's classification. During the observation period, most patients were treated with glucocorticoids. Unlike the previous studies on degenerative scoliosis, apical vertebral rotation, lateral listhesis, and the level of the intercrestal line at initial observation were not significantly related to the progression of scoliosis. Initial Cobb angles were inversely related to the progression of scoliosis. Patients who were treated with bisphosphonates showed slower progression of scoliosis. Our results indicate that the characteristics of lumbar scoliosis in RA patients differ from those of degenerative lumbar scoliosis. Bone fragility due to the long disease duration, poor control of disease activity, and osteoporosis is possibly related to its progression.
    Journal of Orthopaedic Surgery and Research 04/2014; 9(1):30. · 1.01 Impact Factor
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    ABSTRACT: Right thoracic curvature, rib cage deformities and aortic left shift are features of adolescent idiopathic scoliosis that are correlated with each other. We recently reported that disturbance of ribcage development results in progressive thoracic scoliosis in mice. Recently, it has been confirmed that the normal spine exhibits right thoracic curvature and rib cage deformities and that these deformities worsen during the adolescent period. The purpose of this study was to examine whether rib cage deformities correlate with thoracic side curvature in the normal spine, as observed in scoliosis, which is important basic knowledge needed to elucidate the causative factors of adolescent idiopathic scoliosis.
    Scoliosis 01/2014; 9:14. · 1.31 Impact Factor
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    ABSTRACT: The pathomechanism underlying idiopathic scoliosis remains unclear, and, to our knowledge, a consistent and relevant animal model has not been established previously. The goal of this study was to examine whether a disturbance of rib cage development is a causative factor for scoliosis and to establish a nonsurgical mouse model of progressive scoliosis. To examine the relationship between rib cage development and the pathogenesis of progressive scoliosis, a plastic restraint limiting anteroposterior rib cage development was placed on the chest of four-week-old mice. All mice were evaluated with whole-spine radiographs, and the severity of scoliosis was consecutively measured. The rib cage rotation angle and the anteroposterior chest dimension were measured with use of micro-computed tomography scanning. To examine whether the imbalanced load transmission through the ribs to the vertebral body was involved in our model, we performed a rib-neck osteotomy in a subgroup of the mice. The thoracic restraint did not provoke spinal curvature immediately after it was applied, but nine of ten mice that wore the restraint but did not have rib osteotomy gradually developed progressive scoliosis. Radiographs and computed tomography images showed a right thoracic curvature, vertebral rotation, and narrow chest in the mice that had worn the restraint for eleven weeks but did not have rib osteotomy even after the restraint was removed. The anteroposterior chest dimension was significantly correlated with both the curve magnitude and the rib cage rotation angle. The progression of spinal deformity was observed only during the adolescent growth spurt, and it plateaued thereafter. The left-side rib osteotomy led to the development of progressive left-thoracic curvature, whereas the bilateral rib osteotomy did not cause scoliosis, even with restraint wear. We established a nonsurgical experimental model of progressive scoliosis and also demonstrated that a rib cage deformity with an imbalanced load to the vertebral body resulted in progressive structural scoliosis.
    The Journal of Bone and Joint Surgery 09/2013; 95(18):e1301-7. · 3.23 Impact Factor
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    ABSTRACT: Malignant peripheral nerve sheath tumor is a malignant tumor showing nerve sheath differentiation. Approximately one-half of malignant peripheral nerve sheath tumors arise from a benign peripheral nerve sheath tumor, which is commonly a neurofibroma in patients with neurofibromatosis type 1. Malignant peripheral nerve sheath tumor arising in a sporadic schwannoma of soft tissue is extremely rare. In this condition, malignant cells usually show epithelioid morphology, meeting the diagnostic criteria for epithelioid malignant peripheral nerve sheath tumor. Here, we present an extraordinary case of spindle cell-type malignant peripheral nerve sheath tumor arising in a schwannoma on the back of a 58-year-old woman without neurofibromatosis. The malignant component showed hypercellular spindle cell proliferation with high mitotic activities; in contrast, the benign component showed hypocellular spindle cell proliferation in a palisading pattern and with Verocay bodies. Immunohistochemical S-100 protein staining showed a clear contrast between the malignant (negative) and benign (positive) components, which was useful for differentiating cellular schwannoma. Recognizing this rare condition is helpful in the pathologic diagnosis of schwannoma showing cellular proliferation in part.
    Human pathology 09/2013; · 3.03 Impact Factor
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    ABSTRACT: Intraosseous hemangioma (IH) is commonly seen in the vertebral column and skull: however, IH occurring in the appendicular skeleton, including the clavicle, is uncommon. We herein report the case of a 69-year-old female presenting with IH of the left clavicle. The findings of preoperative imaging studies, including radiographs, computed tomography (CT), magnetic resonance imaging, fluorine-18-fludeoxyglucose ((18)F-FDG) positron emission tomography (PET)/CT and ultrasonography, are described. In particular, (18)F-FDG PET/CT showed an ill-defined osteolytic lesion with abnormally high FDG uptake. Surgical en bloc resection with preoperative embolization was carried out and a histopathological examination confirmed the presence of an intraosseous cavernous hemangioma in the clavicle.
    Skeletal Radiology 08/2013; · 1.74 Impact Factor
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    ABSTRACT: Dedifferentiated chondrosarcoma (DDCS) is a rare and aggressive bone tumor with poor prognosis. Primary DDCS of the mobile spine is extremely rare, particularly in the cervical spine. We herein describe a first case of cervical DDCS in an 81-year-old male presenting with a slowly growing mass. Radiographs showed an expansion of the cortical contour of the C2 lamina and a soft tissue mass with punctate calcification. Magnetic resonance imaging demonstrated a lobulated lesion expanding over the entire lamina and pedicles of C2 with the tumor protuberant to the adjacent soft tissue. A complete tumor resection was performed. Histologically, the majority of the tumor was a low-grade chondrosarcoma component. However, atypical spindle cells that had proliferated in a fascicular pattern with a collagenous stroma, mimicking fibrosarcoma, were focally observed without a transitional zone, and these features confirmed that the tumor was DDCS.
    World Journal of Surgical Oncology 02/2013; 11(1):32. · 1.09 Impact Factor
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    ABSTRACT: BACKGROUND: Dedifferentiated chondrosarcomas consist of two distinguishable components: low-grade chondrosarcoma components and high-grade dedifferentiated components.Materials and methods: Nine cases (4 males, 5 females) of dedifferentiated chondrosarcoma were treated in our institute. The average age was 58.6 (range, 37--86) years. The tumor location was the long bone in 7 cases (femur, n=5; humerus, n=1; tibia, n=1) and the pelvic bone in 2 cases. The average time from appearance of symptoms to treatment was 9.4 (range, 1--40) months. RESULTS AND DISCUSSION: On plain radiographs, matrix mineralization was seen in all 9 cases (100%). Bone destruction was observed in 5 of 9 cases (56%), while pathological fracture was seen in one femur case (11%). Lung metastasis was observed in all cases (initially in 5 cases; during the treatment course in 4 cases). Surgery was performed in 8 cases, with local recurrence occurring in 2 of those cases (time to recurrence, 2 and 10 months). Chemotherapy was administered in 4 cases, but did not result in significant improvement. All 9 cases died of lung metastases, with a median survival time of 10 (range, 3.4-18.8) months. The presence of initial metastasis at diagnosis was a significant unfavorable prognostic factor. CONCLUSION: The prognosis of dedifferentiated chondrosarcoma is dismal. With the lack of convincing evidence of the benefit of chemotherapy, complete surgical excision is the initial recommended treatment.
    Journal of Orthopaedic Surgery and Research 12/2012; 7(1):38. · 1.01 Impact Factor
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    ABSTRACT: BACKGROUND: Myxoid liposarcoma occurs in middle age, and is characterized by extrapulmonary metastasis, including bone metastasis. Bone scans and [18F]-2-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) are widely used for assessment of tumor extension, including vertebral metastasis. However, both methods have a low positive rate with regard to vertebral metastasis arising from myxoid liposarcoma. This is particularly true for bone scans for intramedullary lesions that have no cortical involvement. CASE PRESENTATION: We present the case of a 53-year-old male with myxoid liposarcoma in the leg. He had been treated for multiple metastases over a ten-year period, and was experiencing back pain due to a pathological fracture in the second lumbar vertebra (L2). Magnetic resonance imaging of all the vertebrae showed abnormal signal intensity suggestive of metastasis in eight vertebrae, and revealed extraskeletal extension in three vertebrae. Bone scans and FDG-PET were negative except for the L2 fracture which was indicated on a bone scan. CONCLUSIONS: Both bone scans and FDG-PET can be negative in cases of vertebral metastasis that arise from myxoid liposarcoma, even when extraskeletal extensions are present. . Similarly, even a fractured vertebra may not always be visible on FDG-PET.
    World Journal of Surgical Oncology 10/2012; 10(1):214. · 1.09 Impact Factor
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    ABSTRACT: An in vivo animal study to examine the influence of pre-existing or concurrent spinal canal stenosis (SCS) on the functional recovery after spinal cord injury (SCI). To clarify whether spinal cord compression before or after SCI results in less favorable neurological recovery. The influence of spinal cord compression on the neurological recovery after SCI remains unclear. We created mice with SCS using an extradural spacer before or after producing SCI and statistically analyzed the correlation between the extent of SCS and neurological outcomes. The extent of SCS was calculated by micro-computed tomography, and the spinal cord blood flow (SCBF) was measured serially with laser Doppler flowmetry. Molecular and immunohistochemical examinations were performed to evaluate the neovascularization at the site of cord compression. Spacer placement (<300 μm) alone in the control mouse resulted in no neurological deficits. Even with spacer placement that caused asymptomatic SCS, the functional recovery after SCI was progressively impaired as spacer sizes increased in the mice with SCS co-occurring with SCI, whereas no significant impact was observed in the mice with pre-existing SCS, irrespective of the spacer sizes. The SCBF progressively decreased immediately after SCS was produced, but it fully recovered at the later time points. Angiogenesis-related genes were upregulated, and neovascular vessels were observed after producing the SCS. We found that concurrent SCS resulted in a significant reduction and impaired the subsequent recovery of the SCBF, whereas pre-existing SCS did not affect the hemodynamics of the spinal cord after SCI. The dynamic reduction of the SCBF occurring immediately after spinal cord compression is a significant factor that impairs the neurological recovery after SCI, whereas pre-existing SCS is not always an impediment due to the potentially restructured SCBF.
    Spine 03/2012; 37(17):1448-55. · 2.16 Impact Factor
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    ABSTRACT: The purpose of current study was to evaluate recurrence of diffuse pigmented villonodular synovitis (DPVNS), functional outcome, and osteoarthritic change of the knee. Seventeen cases in 17 patients who had DPVNS of the knee that had not been previously treated were reviewed to determine the outcomes of surgical treatment. There were 10 males and 7 females, and their average age was 33.2 years (SD 17.2) at the time of first operation. Magnetic resonance imaging (MRI) was performed preoperatively to estimate the extent of the lesion. All patients were operated with open synovectomy. The mean postoperative follow-up period was 65.4 months (range 10.2 to 145.8; SD 48.3). Two of 17 patients had posterior extra-articular lesions and recurrence. Two knees slightly reduced range of motion (from 145 to 130, from 145 to 125) and four knees progressed osteoarthritic changes, but overall postoperative results were satisfactory. Because DPVNS sometimes exists out of knee joint, we should adequately check the location of the lesions using preoperative MRI, and synovectomy should be performed throughout knee joint including extra-articular lesion, especially around ligaments, meniscus, and suprapatellar was completely resected.
    The Knee 01/2012; 19(5):684-7. · 2.01 Impact Factor
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    ABSTRACT: Leukocytosis associated with secretion of granulocyte colony-stimulating factor (G-CSF) has been reported in various tumors, primarily poorly differentiated epithelial tumors, but is extremely rare in bone tumors. An 84-year-old woman experienced swelling and pain in the shoulder for 1 month. Leukocytosis and elevated serum G-CSF were observed, but resolved following tumor resection. A diagnosis of leiomyosarcoma of the bone with expression of G-CSF was confirmed immunohistochemically. Histological diagnosis of leiomyosarcoma showed it to be differentiated, which is unusual for G-CSF-secreting tumors.
    Skeletal Radiology 12/2011; 41(6):719-23. · 1.74 Impact Factor
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    ABSTRACT: Retrospective study. To identify the clinical significance of coexistence of lumbar spinal stenosis (LSS) with thoracic ossification of ligamentum flavum (OLF), and to study the surgical outcome of the thoracic OLF patients with or without LSS. The OLF at the thoracic level (thoracic OLF) is a rare disease that causes acquired thoracic spinal canal stenosis. Thoracic OLF is frequently combined with other spinal disorders, such as LSS, and it is not uncommon for thoracic OLF to be misdiagnosed as LSS, resulting in delayed diagnosis. However, clinical impacts of the coexistence of LSS with thoracic OLF remain unknown. In the present study, 36 patients who underwent posterior decompression for OLF-induced thoracic myelopathy were retrospectively reviewed, and the adverse influence of the copresence of LSS with thoracic OLF was studied with regard to clinical features such as clinical symptoms and surgical outcome. Out of 36 patients, 18 patients had LSS (combined group: C-group), and the remaining 18 patients had thoracic OLF only (thoracic group: T-group). No significant inter-group differences were found in terms of gender, age, follow-up period, and preoperative duration of symptoms. Regarding the etiology of LSS in the C-group, 12 cases had degenerative LSS, two cases had lumbar OLF, one case had degenerative LSS with lumbar OLF, one case had had degenerative LSS with lumbar OPLL, and two cases had traumatic LSS due to lumbar kyphosis after vertebral fracture. Clinical examination revealed that the T-group was significantly more likely to demonstrate Achilles hyper-reflexia, while the C-group was significantly more likely to demonstrate Achilles hypo-reflexia. The mean preoperative and postoperative JOA scores were not statistically different between the two groups. However, the mean recovery rate of the JOA score was 17.3% in the C-group, and 30.4% in the T-group. Statistical analysis revealed that the recovery rate of the C-group was significantly lower than that of the T-group. Thoracic OLF with LSS will show a more severe clinical manifestation than that without LSS. In this study, we clearly indicated that the coexisting LSS in thoracic OLF will have adverse effects on the surgical results in thoracic OLF.
    Archives of Orthopaedic and Trauma Surgery 12/2011; 132(4):465-70. · 1.36 Impact Factor
  • Journal of Orthopaedic Science 08/2011; · 0.96 Impact Factor
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    ABSTRACT: STUDY DESIGN.: Retrospective multi-institutional study. OBJECTIVE.: To investigate the incidence of neurological deficits after cervical laminoplasty for ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA.: According to analysis of long-term results, laminoplasty for cervical OPLL has been reported as a safe and effective alternative procedure with few complications. However, perioperative neurological complication rates of laminoplasty for cervical OPLL have not been well described. METHODS.: Subjects comprised 581 patients (458 men and 123 women; mean age: 62 ± 10 years; range: 30-86 years) who had undergone laminoplasty for cervical OPLL at 27 institutions between 2005 and 2008. Continuous-type OPLL was seen in 114, segmental-type in 146, mixed-type in 265, local-type in 24, and not judged in 32 patients. Postoperative neurological complications within 2 weeks after laminoplasty were analyzed in detail. Cobb angle between C2 and C7 (C2/C7 angle), maximal thickness, and occupying rate of OPLL were investigated. Pre- and postoperative magnetic resonance imaging was performed on patients with postoperative neurological complications. RESULTS.: Open-door laminoplasty was conducted in 237, double-door laminoplasty in 311, and other types of laminoplasty in 33 patients. Deterioration of lower-extremity function occurred after laminoplasty in 18 patients (3.1%). Causes of deterioration were epidural hematoma in 3, spinal cord herniation through injured dura mater in 1, incomplete laminoplasty due to vertebral artery injury while making a trough in 1, and unidentified in 13 patients. Prevalence of unsatisfactory recovery not reaching preoperative level by 6-month follow-up was 7/581 (1.2%). Mean occupying rate of OPLL for patients with deteriorated lower-extremity function was 51.2 ± 13.6% (range, 21.0%-73.3%), significantly higher than the 42.3 ± 13.0% for patients without deterioration. OPLL thickness was also higher in patients with deterioration (mean, 6.6 ± 2.2 mm) than in those without deterioration (mean, 5.7 ± 2.0 mm). No significant difference in C2/C7 lordotic angle was seen between groups. CONCLUSION.: Although most neurological deterioration can be expected to recover to some extent, the frequency of short-term neurological complications was higher than the authors expected.
    Spine 07/2011; 36(15):E998-E1003. · 2.16 Impact Factor
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    ABSTRACT: Retrospective review. To determine the safety of pedicle screws placed in infantile and juvenile patients younger than 10 years of age, and to evaluate the accuracy and the incidence of short and long-term (>2-year follow-up) complications for the screws and construct utilized. Although much has been written regarding the use of pedicle screws for the treatment of adult and adolescent spinal deformities, few studies have examined complication rates with regard to pedicle screws placed for pediatric spinal deformities in patients younger than 10 years of age. Eighty-eight patients treated with 948 pedicle screws placed for a variety of pediatric spinal deformities were performed at a single institution. We evaluated the accuracy of pedicle screw placement via radiographic review by two spinal surgeons not involved in the surgical treatment. The average age at surgery was 6.8 year (range, 1 + 11 to 9 + 11 year). Five hundred ninety-four pedicle screws were placed in the thoracic spine and 354 screws in the lumbar spine. Three screws (0.32%) violated the lateral wall of the pedicle, two screws (0.21%) violated the inferior wall, and three screws (0.32%) were suspected of medial wall violation for a total of eight screws (0.84%) malpositioned. Although short-term complications occurred in nine patients (10.2%) (four-wound infection, two-foot drop, two-respiratory problems, first-sixth cranial nerve palsy), there were no insertion or short-term complications specifically related to the use of pedicle screws. Long-term complications occurred in nine patients (10.2%) (three-deformity progression, four-growing rod breakage), whereas two patients required revision surgery because of pullout and prominence of proximal thoracic pedicle screws (n = 4) placed in growing rod constructs (2.3% of patients, 0.4% of screws). There were no intraoperative or short-term pedicle screw insertion-related complications and a very low long-term complication rate (2.3% of patients, 0.4% of screws) specifically related to the use of pedicle screws in infantile and juvenile spinal deformity patients. More than 99% of screws were accurately placed.
    Spine 06/2011; 36(20):1645-51. · 2.16 Impact Factor
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    ABSTRACT: Retrospective case analysis. The purpose of this study was to evaluate the etiology and salvage strategies of failed lumbosacral fixation in adult spinal deformity patients. When extending a long spinal deformity fusion to the sacrum, the lumbosacral junction is a common site for implant problems and pseudarthrosis. Clinical and radiographic results of 33 patients (26 women/seven men; average age, 53.5 years; range, 21-73) diagnosed and treated for lumbosacral fixation failure between 1995 and 2007 were reviewed. Twenty-one of the 33 patients underwent revision surgery at one institution for these failures and were followed postoperatively for more than 2 years (average, 50.7 months). Twenty-nine of these 33 patients had two sacral screws, two patients one sacral screw, and two patients none. Bicortical sacral screws were placed in 18 patients, only 12 had distal fixation to the sacral screws (bilateral iliac screws, n = 9; others, n = 3). Seventeen of 19 patients without distal fixation to the sacral screws had screw loosening/pullout at L5 or S1. Anteriorly at L5-S1: 4/6 bone grafts collapsed, 5 of 15 intervertebral discs without anterior column support collapsed, and two of 12 titanium cages subsided into the endplates. Rod breakage between L5 and S1 (n = 9) was seen only in patients with distal fixation to the sacral screws. Nineteen of 21 revision patients received two bicortical sacral screws, whereas 20 received distal fixation to the sacral screws consisting of bilateral iliac screws in 16. Nineteen patients received anterior column support at L5-S1. Fifteen of 21 revision patients achieved solid fusion at ultimate follow-up; however, six had additional rod breakage or dislodgement at the lumbosacral junction. With long fusions to the sacrum in the treatment of spinal deformity, the use of bilateral S1 screws alone may allow for screw loosening/pullout and/or L5-S1 cage/graft collapse/subsidence. Adding bilateral iliac screws and an anterior structural cage/graft at L5-S1 will protect the S1 screws, but may still allow L5-S1 rod breakage/dislodgement because of lumbosacral pseudarthrosis. Revision surgery in these patients remains a challenge.
    Spine 06/2011; 36(20):1701-10. · 2.16 Impact Factor
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    ABSTRACT: Case report. To describe a patient with nodular fasciitis arising in the lumbar extradural space. Nodular fasciitis is a benign proliferation of fibroblasts and myofibroblasts. It commonly occurs in the subcutaneous tissue of an upper extremity, trunk, head, and neck, but rarely arises in the spinal canal. A 7-year-old boy experienced gradually increasing intense radiating pain from the bilateral buttocks to the lower extremities after a bruise on his lower back. Computed tomography and magnetic resonance imaging demonstrated a relatively circumscribed mass in the dorsal epidural space from the first lumbar vertebra (L1) to L2. The presumptive diagnosis based on the radiologic findings included aggressive neoplasm such as extraskeletal Ewing sarcoma/primitive neuroectodermal tumor or malignant lymphoma. The patient underwent L1-L2 laminectomy and resection of the tumor. Histologically, the tumor was mainly composed of a proliferation of spindle cells without atypia, positive for vimentin and smooth muscle actin, and myxoid areas with a loosely textured feathery pattern. These findings are the typical features of nodular fasciitis. Surgery relieved the patient's pain, with no evidence of recurrence at a recent 4-year follow-up. This report presents a very rare case of extradural nodular fasciitis arising in the lumbar spinal canal, which could have been misinterpreted as a malignant tumor such as extraskeletal Ewing sarcoma/primitive neuroectodermal tumor because of its rapid growth and absence of distinguishing radiologic features. A detailed histopathologic examination including immunohistochemistry is important for the correct diagnosis.
    Spine 06/2011; 37(2):E133-7. · 2.16 Impact Factor

Publication Stats

401 Citations
104.82 Total Impact Points

Institutions

  • 1997–2014
    • Kyushu University
      • • Department of Orthopaedic Surgery
      • • Faculty of Medical Sciences
      Hukuoka, Fukuoka, Japan
  • 2011
    • St.Mary's Hospital (Fukuoka - Japan)
      Hukuoka, Fukuoka, Japan
  • 2009
    • Washington University in St. Louis
      • Department of Orthopaedic Surgery
      Saint Louis, MO, United States