Radiographic and Clinical Results of C1 Laminoplasty for the Treatment of Compressive Myelopathy

Tarukado Kiyoshi,Ikuta Ko,Iida Keiichiro,Tono Osamu,Doi Toshio,Harimaya Katsumi 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.4

Study Design: Case series.Purpose: To evaluate the radiographic and clinical results of C1 laminoplasty without fusion.Overview of Literature: C1 laminectomy has been the standard procedure for decompression at the C1 level. However, there have been some reports of trouble cases after C1 laminectomy. C1 laminoplasty might be superior to C1 laminectomy with regard to maintaining the original C1 anatomical shape, preventing compression from the posterior soft tissue, and ensuring an adequate bonegrafting site around the C1 posterior part if additional salvage fusion surgery is necessary afterward.Methods: Seven patients with spinal cord compression without obvious segmental instability at the C1/2 level treated by C1 laminoplasty were included. The indication of C1 laminoplasty was same as that of C1 laminectomy. C1 laminoplasty was performed in the same way as subaxial double-door laminoplasty. The imaging findings were evaluated using X-ray, computed tomography, and magnetic resonance imaging. The clinical results were evaluated using the Japanese Orthopaedic Association (JOA) Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) and JOA score. Peri- and postoperative complications were also investigated.Results: No patient showed increased C1/2 segmental instability after the surgery. The mean pre- and postoperative JOA scores were 8.6 and 11.7, respectively. The mean recovery rate was 40.2%. The effective rate in the JOACMEQ was 50% for the cervical spine function, 33% for the upper extremity function, 50% for the lower extremity function, 17% for the bladder function, and 17% for the quality of life. No major complication that seemed to be unique to C1 laminoplasty was observed over a period of about 4 years follow-up.Conclusions: C1 laminoplasty for patients without obvious segmental instability might be a viable alternative procedure to C1 laminectomy.

A Retained Epidural Catheter Fragment Treated by Surgery

Kiyoshi Tarukado,Takaaki Oda,Osamu Tono,Hiroyuki Suetsugu,Toshio Doi 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.3

The breakage of an epidural catheter is an extremely rare complication. We describe a unique case where a retained epidural catheter fragment after epidural anesthesia was treated by surgery. The epidural catheter broke during its removal, requiring surgery to remove the retained catheter. Intraoperatively, the removal of the catheter was attempted by simple traction, but was impossible because of the adhesion. The adhesion of the dura mater surface was carefully exfoliated and the successful removal of the catheter was accomplished. Conventionally, it was said that this follow-up was enough for the retained catheter. However, if a catheter is retained within the spinal canal, surgical removal should thus be considered before the adhesion advances.

Ordinary Disc Herniation Changing into Posterior Epidural Migration of Lumbar Disc Fragments Confirmed by Magnetic Resonance Imaging: A Case Report of a Successful Endoscopic Treatment

Kiyoshi Tarukado,Osamu Tono,Toshio Doi 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.1

The posterior epidural migration of lumbar disc fragments is an extremely rare event with an unknown pathogenesis. To the best of our knowledge, there are no previously reported cases of a change of ordinary disc herniation into the posterior epidural migration of lumbar disc fragments as confirmed by magnetic resonance imaging (MRI). A 26-year-old male presented to our department complaining of left buttock and lateral leg pain. An ordinary herniation was shown in the first MRI. The patient’s unilateral symptoms changed into bilateral symptoms while awaiting admission to the hospital. Posterior migrated lumbar disc fragments were shown in the second MRI taken at the time of admission. Microendoscopic surgery providing a detailed observation of the region was performed. Our case indicates that an ordinary lumbar disc herniation may lead to the posterior migration of lumbar disc fragments, and that microendoscopic surgery may provide a treatment.

Simultaneous Use of Both Bilateral Intralaminar and Pedicle Screws for C2 Stabilization

Kiyoshi Tarukado,Osamu Tono,Toshio Doi 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.5

Four patients underwent stabilization surgery using both bilateral C2 pedicle screw (PS) and intralaminar screw (LS). Neural and vascular injury resulting from incorrect screw placement was assessed using computed tomography (CT). The evaluation of bone union was assessed by lateral flexion-extension X-ray films and CT. The symptoms were improved in all patients. There were no intraoperative complications. Furthermore, there were no cases of neurological worsening or vascular injury from incorrect screw placement. Failure of instrumentation or screw loosening during the follow-up period did not occur in any of the patients. All cases had accomplished bone union at the final follow-up. Theoretically, the stabilization technique using both bilateral C2 PS and LS at the same time can provide more stability than any other single technique. Simultaneous use of both bilateral C2 PS and LS is potentially a good choice for surgical repair.

Cervical Myelopathy Caused by Disc Herniation at the Segment of Existing Osteochondroma in a Patient with Hereditary Multiple Exostoses

Ko Ikuta,Kiyoshi Tarukado,Hideyuki Senba,Takahiro Kitamura,Norihiro Komiya,Satoshi Shidahara 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.6

Hereditary multiple exostoses (HME) is a benign hereditary disorder characterized by multiple osteochondromas. Osteochondroma appears occasionally in the spinal column as a part of HME. A 37-year-old man presented with a history of HME and cervical compressive myelopathy caused by intraspinal osteochondroma arising from the lamina of the C5 and disc herniation at the C5–6. He was treated by open-door laminoplasty at the C5 and C6 with excision of the tumor. The neurological symptoms were immediately relieved after surgery. Magnetic resonance images demonstrated a sufficient decompression of the spinal cord with a spontaneous regression of the herniated disc at one year after surgery. There was no recurrence of the tumor and no appearance of kyphosis and segmental instability of the cervical spine on postoperative imaging studies for three years after surgery. The patient could be successfully treated by laminoplasty with excision of the tumor and without removal of the herniated disc.

Kyphosis Progression after Balloon Kyphoplasty Compared with Conservative Treatment

Keiichiro Iida,Katsumi Harimaya,Kiyoshi Tarukado,Osamu Tono,Yoshihiro Matsumoto,Yasuharu Nakashima 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.6

Study Design: Retrospective cohort study (level of evidence: 4). Purpose: To demonstrate the effects of balloon kyphoplasty (BKP) on prevention of kyphosis progression. Overview of Literature: Kyphoplasty can correct local kyphosis (fractured vertebra), but its efficacy is attenuated by adjacent fracture and/or disc height reduction with endplate damage. With these attenuating factors incorporated, a comparison between BKP and conservative treatment is necessary to verify the effect of BKP on kyphosis correction. Methods: This study retrospectively analyzed 129 patients treated conservatively and 95 treated with BKP in our institution. The rate of new adjacent fracture occurrence was determined using Kaplan–Meier analysis. We examined the progression of local kyphosis in patients who underwent lateral X-ray after 1 year. Local kyphosis was measured as an angle between higher end plate of the vertebra above and lower end plate of the vertebra below the fractured vertebra. The comparison included 45 patients treated conservatively and 58 treated with BKP. Results: The incidence of new adjacent fracture at 1 year was 7.3% in the conservative treatment group and 23.2% in the BKP group (p<0.001), while the progression of local kyphosis at 1 year was 5.7°±4.7° and 3.2°±4.6°, respectively (p=0.01). Relative to conservative treatment, local kyphosis did not progress after BKP, despite the higher incidence of adjacent fracture. Local kyphosis progressed in cases with adjacent fracture compared with those without adjacent fracture (6.0°±4.3° vs. 2.1°±4.3°, p=0.003), and fractured vertebral instability was found to be a risk factor for adjacent fracture in BKP. Conclusions: Compared with the conservative treatment, BKP suppressed the progression of local kyphosis. However, an adjacent fracture attenuated the BKP correction and was more frequently seen in patients with unstable vertebral fractures.