[Show abstract][Hide abstract] ABSTRACT: Object : The authors report a retrospective analysis of treating 18 patients with symptomatic lumbar intraspinal extradural cysts from April 2003 to January 2008. Methods : Patient characteristics including age, sex, symptoms, and neuroimaging studies were reviewed. Surgical procedures, results, and pathological findings were then correlated with preoperative assessment. Results : Patients consisted of 14 men and 4 women with an average age of 68 years (range 41-90 years). The most common symptoms were painful radiculopathy (100%), back pain (83%), and neurogenic claudication (100%). The most commonly affected level was L4-5 (56%). Fourteen patients were surgically treated for symptomatic lumbosacral intraspinal extradural cyst. Four patients were treated with conservative therapy and experienced spontaneous resolution of their cyst. Conclusions : Lumbar intraspinal cysts can be a cause of lumbar radicular pain and intermittent claudication. Surgical removal of the cyst is a safe and effective treatment for symptomatic patients. However, spontaneous resolution of the cystic lesion can occur in some patients, so meticulous follow-up may play an important role in some cases.
No preview · Article · Mar 2009 · Japanese Journal of Neurosurgery
[Show abstract][Hide abstract] ABSTRACT: Cervical angina is defined as anterior chest pain that resembles true cardiac angina but originates from cervical spondylosis. This symptom commonly results from compression of a nerve root. We present a case of cervical angina caused by unstable cervical spondylotic myelopathy. A 72-year-old woman presented with a complaint of anterior chest pain. After excluding coronary artery disease, C3-7 expansive open-door laminoplasty with C3-4 transarticular screw fixation was performed. After surgery the chest pain improved. Therefore we diagnosed this case as cervical angina caused by spinal cord compression at C3-7 level. We presumed that the main mechanism of this symptom was as follows: 1. deactivation of the descending pain inhibitory pathway in the posterior horn of the C3-7 spinal cord 2. referred pain caused by unstable facet joint and anterior or posterior longitudinal ligament of the cervical spine. Cervical angina caused by cervical myelopathy should be included in the differential diagnosis of anterior chest pain. We mention the etiology and clinical characteristics of cervical angina.
No preview · Article · Feb 2009 · Japanese Journal of Neurosurgery
[Show abstract][Hide abstract] ABSTRACT: Hemorrhage that results from spinal dural arteriovenous fistula (Type I arteriovenous malformation [AVM]) is uncommon. There are some reports of subarachnoid hemorrhage and subdural hematoma caused by Type I spinal AVM, but there are few reported cases of hematomyelia caused by spinal dural arteriovenous fistula.
To describe an interesting patient who had hematomyelia caused by a dural arteriovenous fistula (Type I spinal AVM).
A case report.
We present a case of a 51-year-old man who presented acute onset epigastric pain, paraplegia, and sensory loss below his nipples. Magnetic resonance imaging and selective spinal angiogram demonstrated hematomyelia, subarachnoid hemorrhage, and spinal arteriovenous fistula fed by the right Th7 intercostal artery. By laminotomy of Th6-8, the varix-like draining vein and intramedurally hematoma were partially removed and the arterial supply was interrupted by coagulation of the right Th7 segmental artery.
One month after surgery, he regained movement against gravity at the left ankle and toe but no functionally significant improvement.
It must be kept in mind that spinal dural arteriovenous fistulas (Type I spinal AVM) has possibility of hematomyelia origin, despite the fact that it is extremely rare.
No preview · Article · Sep 2008 · The spine journal: official journal of the North American Spine Society
[Show abstract][Hide abstract] ABSTRACT: Lumbosacral nerve root anomalies are occasionally encountered during treatment for degenerative lumbar diseases. In the literature, anatomical studies showed a higher incidence (8.5-30%) of anomalous nerve root than that found in clinical investigations (2.2-4.0%). A 69-year-old female was admitted complaining of low back pain and left sciatica. While her neurological symptoms suggested radiculopathy at the L5 nerve root area, L5/S1 mediolateral disc herniation was noted by radiological examinations. Myelography and the coronal section of her magnetic resonance imaging (MRI) demonstrated an anomalous L5 nerve root (caudal origin) compressed by the L5/S1 herniated disc. With the preoperative knowledge of this nerve root anomaly, microscopic discectomy with adequate exposure achieved effective decompression and satisfactory resolution of clinical symptoms. Attention must be paid to nerve root anomalies, especially when neurological findings are atypical. Preoperative diagnosis of nerve root anomalies is essential for both safe and effective procedures for lumbar spine surgery.
No preview · Article · Sep 2008 · Japanese Journal of Neurosurgery
[Show abstract][Hide abstract] ABSTRACT: Object: The authors investigated patients' self assessments of cervical surgery and evaluated the short-term results. Materials and Methods: Our center had 114 cervical surgeries from July, 2005 to September, 2006 and we investigated all cases. Patients assessed Visual Analog Scale (VAS), Neurological Cervical Spine Scale (NCSS), Neck Disability Questionnaire Index (NDI) and Short-Form 36 (SF-36) v2 at admission, 2 weeks, 3 months, 6 months and 12 months of post operation. Data was analyzed by one-way ANOVA, and then differences among means were analyzed using the Scheffe method (p < 0.05). Results: 105 patients (73 men and 32 women) responded to the scales at admission and returned 528 answers for 24 months. The mean age was 58.6 years (16-86). The mean follow-up period was 17.1 months (range, 10-24). We observed that VAS, NDI, SF-36-BP and MH improved significantly (p < 0.01) from 3 to 6 months after the operations. NCSS, SF-36-PF, RP, SF, GH, VT and RE didn't improve significantly. Conclusions: VAS, NDI and SF-36-BP and MH had significantly improved from after 3 to 6 months with the cervical operations.
[Show abstract][Hide abstract] ABSTRACT: We have retrospectively investigated surgically treated lumbar disc herniation (LDH) in our hospital and examined the clinical features of eighteen cases which presented with radiculopathy one level higher than normal. These eighteen cases are categorized into three types ; i. e. upward type, foraminal type and extra-foraminal type. Symptoms of the upward type tended to be more severe than those of the other two types. Patients who presented with radiculopathy one level above were older than other patients with ordinary type LDH. It's very important in planning the operation to thoroughly understand the anatomy and relative location of the herniated disc, apophyseal joint and nerve root. In the upward type cases, an interlaminar approach was expanded in an upward and lateral direction and then the herniated disc could be removed. Many of the foraminal type cases required facet joint resection so as to visualize the lesion and for additional stabilization. In the extra-foraminal type cases, resection of the herniated disc was achieved via a lateral approach combined with a medial approach preserving the facet joint.
No preview · Article · Mar 2008 · Japanese Journal of Neurosurgery