Kunihiko Uehara’s scientific contributions

Panner's disease is defined as avascular necrosis of the humeral capitellum and was first reported by Panner in 1927. It usually occurs in boys younger than 10 years of age. Residual deformity and loose bodies are not usually seen.Osteochondritis dissecans, which sometimes results in residual deformity and loose bodies, need to be distinguished from Panner's disease.We experienced an eight-year-old boy with Panner's disease who was successfully treated by immobilization for 20 weeks. Radiograph and MRI showed satisfactory revascularization of epiphysis of the humeral capitellum. Prolonged immobilization may enhance the rapid revascularization of the humeral capital epiphysis.

Two surgical cases of os odontoideum in spondyloepiphyseal dysplasia (SED) tarda were reported. The first case was a 34-year-old male suffering from intractable neck pain with bilateral numbness in his hands due to myelopathy. The radiogram demonstrated atlantoaxial subluxation and invagination of the posterior arch of C1 into the foramen magnum.CT-myelogram showed the spinal cord to be compressed between the posterior arch of C1 and the base of the odontoid process. The second case was a 28-year-old male who developed tetraplesia after falling down. His radiogram demonstrated posterolateral atlantoaxial subluxation.In both cases, the posterior arch of C1 was located close to the foramen magnum and was unable to be reduced downward. Both cases required occipitocervical fusion using a fan-like rod. We experienced two cases of SED congenita with similar radiological findings to SED tarda. Narrowing of the atlanto-occipital interval and loss of motion were also seen in SED congenita experienced previously. Their finding may be characteristic of case with os odontoideum in SED.The first case achieved a good recovery after surgery, however, the second case remained tetraplegic.

We reviewed clinical and radiological results of five patients with lower lumbar burst fractures treated by pedicle screws. All patients achieved successful union of the fracture with good alignment and improved their neurological deficits as well as reducing their low back pain. Posterior decompression with reduction of the prolapsed fracture fragment in the spinal canal was useful for treating patients who underwent surgery within four weeks from the time of injury. It may be possible to preserve the lower disc segment in Dennis type B fractures by using posterolateral fusion of the upper disc segment only. To achieve earlier mobility, and reduce the period of bed-rest required, anterior strut grafting may be needed in patients with a burst fracture whose spinal bodies and upper and lower discs are severely destroyed including those with Dennis type D fractures.

We experienced three cases of spinal vascular disorders showing negative angiographic findings.Case 1: A 15-year-old female had two paraplegic attacks with spontaneous remission after the first attack. Intraspinal hemorrhage was speculated because of a chronological change in her MR imaging. Two selective angiographies did not reveal any pathological findings. Surgery was done after the second attack which had resulted in severe paraplegia. Intraspinal hemorrhage without any abnormal vessels was found and was evacuated. Paraplegia improved markedly.Case 2: A 28-year-old female showed staggering gait due to a deep sensation disturbance. Case 3: A 34-year-old female developed numbness in her left lower extremity. In both cases, a spinal vascular disorder was strongly suspected by MR imaging, but selective angiography did not reveal any positive findings.Possible reasons why selective angiography failed to show any pathological findings include the failure to hit feeder arteries, no arterial component in the vascular disorder and a vascular disorder that was too small to detect.Spinal vascular disorders may show a similar clinical course to multiple sclerosis. Using sequential MR imaging and MR imaging enhanced with Gd-DTPA, intraspinal hemorrhage can be distinguished from multiple sclerosis.