Comparison of Spinous Process-Splitting Laminectomy versus Conventional Laminectomy for Lumbar Spinal Stenosis

Masashi Uehara,Jun Takahashi,Hiroyuki Hashidate,Keijiro Mukaiyama,Shugo Kuraishi,Masayuki Shimizu,Shota Ikegami,Toshimasa Futatsugi,Nobuhide Ogihara,Hiroki Hirabayashi,Hiroyuki Kato 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.6

Study Design: Seventy-five patients who had been treated for lumbar spinal stenosis (LSS) were reviewed retrospectively. Purpose: Invasion into the paravertebral muscle can cause major problems after laminectomy for LSS. To address these problems, we performed spinous process-splitting laminectomy. We present a comparative study of decompression of LSS using 2 approaches. Overview of Literature: There are no other study has investigated the lumbar spinal instability after spinous process-splitting laminectomy. Methods: This study included 75 patients who underwent laminectomy for the treatment of LSS and who were observed through follow-ups for more than 2 years. Fifty-five patients underwent spinous process-splitting laminectomy (splitting group) and 20 patients underwent conventional laminectomy (conventional group). We evaluated the clinical and radiographic results of each surgical procedure. Results: Japanese Orthopaedic Association score improved significantly in both groups two years postoperatively. The following values were all significantly lower, as shown with p -values, in the splitting group compared to the conventional group: average operating time (p =0.002), postoperative C-reactive protein level (p =0.006), the mean postoperative number of days until returning to normal body temperature (p =0.047), and the mean change in angulation 2 years postoperatively (p =0.007). The adjacent segment degeneration occurred in 6 patients (10.9%) in the splitting group and 11 patients (55.0%) in the conventional group. Conclusions: In this study, the spinous process-splitting laminectomy was shown to be less invasive and more stable for patients with LSS, compared to the conventional laminectomy.

Challenges of Transarticular Screw Fixation in Young Children: Report of Surgical Treatment of a 5-Year-Old Patient’s Unstable Os-Odontoideum

Jun Takahashi,Hiroki Hirabayashi,Hiroyuki Hashidate,Nobuhide Ogihara,Keijiro Mukaiyama,Masatoshi Komatsu,Yuji Inaba,Tomoki Kosho,Hiroyuki Kato 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.5

Surgical procedures for atlantoaxial (C1–C2) fusion in young children are relatively uncommon. The purpose of this study was to report on a surgical treatment for a case of atlantoaxial instability caused by os-odontoideum in association with quadriparesis and respiratory paralysis in a 5-year-old girl. We present the patient’s history, physical examination, and radiographic findings, describe the surgical treatment and a five year follow-up, and provide a literature review. The instability was treated by halo immobilization, followed by C1–C2 transarticular screw fixation using a computed tomography-based navigation system. At the five year follow-up, the patient had made a complete recovery with solid union. The authors conclude that C1–2 transarticular screw fixation is technically possible as in a case of atlantoaxial instability in a five-year-old child.

Mini Open Foraminotomy for Cervical Radiculopathy: A Comparison of Large Tubular and TrimLine Retractors

Masashi Uehara,Jun Takahashi,Shugo Kuraishi,Masayuki Shimizu,Shota Ikegami,Toshimasa Futatsugi,Kaoru Aoki,Keijiro Mukaiyama,Nobuhide Ogihara,Hiroyuki Hashidate,Hiroki Hirabayashi,Hiroyuki Kato 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.4

Study Design: Retrospective chart review. Purpose: A comparison of mini open foraminotomy (MOF) for cervical radiculopathy using either large tubular (LT) or TrimLine (TL) retractors. Overview of Literature: Posterior foraminotomy relieves compression of the cervical nerve root in radiculopathy patients. However, invasion of the paravertebral muscle may cause major problems in these patients. To address these problems, we performed MOF. Methods: Twenty cervical radiculopathy patients (16 male and 4 female) who underwent MOF between May 2004 and August 2011 were assigned to LT and TL groups. Each group contained 10 subjects. Surgical and clinical outcomes were compared. Results: The average operating time in the TL group was significantly shorter than that in the LT group. The final follow-up mean neck disability indices significantly improved compared to the preoperative values (LT group, 12.0±7.8 vs. 28.0±9.4; TL group, 6.0±5.9 vs. 21.9±10). The final follow-up neck pain visual analog scale (VAS) scores also decreased significantly from the preoperative of 8.0±1.5 and 2.5±2.5 to the final follow-up values of 2.2±2.2 and 1.0±2.5 in the LT and TL groups, respectively. The recovery rate for the neck pain VAS score was 70.0±31.9 in the LT group and 87.0±32.0 in the TL group, thus suggesting no significant difference between the two groups. Conclusions: MOF with the TL retractor is an easy and safe procedure. Furthermore, the use of the TL retractor allows for a minimally invasive and effective surgical treatment of cervical radiculopathy patients.

Mid-Term Results of Computer-Assisted Cervical Pedicle Screw Fixation

Masashi Uehara,Jun Takahashi,Keijiro Mukaiyama,Shugo Kuraishi,Masayuki Shimizu,Shota Ikegami,Toshimasa Futatsugi,Nobuhide Ogihara,Hiroyuki Hashidate,Hiroki Hirabayashi,Hiroyuki Kato 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.6

Study Design: A retrospective study. Purpose: The present study aimed to evaluate mid-term results of cervical pedicle screw (CPS) fixation for cervical instability. Overview of Literature: CPS fixation has widely used in the treatment of cervical spinal instability from various causes; however, there are few reports on mid-term surgical results of CPS fixation. Methods: Record of 19 patients who underwent cervical and/or upper thoracic (C2–T1) pedicle screw fixation for cervical instability was reviewed. The mean observation period was 90.2 months. Evaluated items included Japanese Orthopaedic Association (JOA) score and C2–7 lordotic angle before surgery and at 5 years after surgery. Postoperative computerized tomography was used to determine the accuracy of screw placement. Visual analog scale (VAS) for neck pain and radiological evidence of adjacent segment degeneration (ASD) at the 5-year follow-up were also evaluated. Results: Mean JOA score was significantly improved from 9.0 points before surgery to 12.8 at 5 years after surgery (p =0.001). The C2–7 lordotic angle of the neutral position improved from 6.4° to 7.8° at 5 years after surgery, but this was not significant. The major perforation rate was 5.0%. There were no clinically significant complications such as vertebral artery injury, spinal cord injury, or nerve root injury caused by any screw perforation. Mean VAS for neck pain was 49.4 at 5 years after surgery. The rate of ASD was 21.1%. Conclusions: Our mid-term results showed that CPS fixation was useful for treating cervical instability. Severe complications were prevented with the assistance of a computed tomography-based navigation system.

Comparison of Clinical and Radiological Results of Posterolateral Fusion and Posterior Lumbar Interbody Fusion in the Treatment of L4 Degenerative Lumbar Spondylolisthesis

Shugo Kuraishi,Jun Takahashi,Keijiro Mukaiyama,Masayuki Shimizu,Shota Ikegami,Toshimasa Futatsugi,Hiroki Hirabayashi,Nobuhide Ogihara,Hiroyuki Hashidate,Yutaka Tateiwa,Hisatoshi Kinoshita,Hiroyuki Kat 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.1

Study Design: Multicenter analysis of two groups of patients surgically treated for degenerative L4 unstable spondylolisthesis. Purpose: To compare the clinical and radiographic outcomes of posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) for degenerative L4 unstable spondylolisthesis. Overview of Literature: Surgery for lumbar degenerative spondylolisthesis is widely performed. However, few reports have compared the outcome of PLF to that of PLIF for degenerative L4 unstable spondylolisthesis. Methods: Patients with L4 unstable spondylolisthesis with Meyerding grade II or more, slip of >10° or >4 mm upon maximum flexion and extension bending, and posterior opening of >5 degree upon flexion bending were studied. Patients were treated from January 2008 to January 2010. Patients who underwent PLF (n=12) and PLIF (n=19) were followed-up for >2 years. Radiographic findings and clinical outcomes evaluated by the Japanese Orthopaedic Association (JOA) score were compared between the two groups. Radiographic evaluation included slip angle, translation, slip angle and translation during maximum flexion and extension bending, intervertebral disc height, lumbar lordotic angle, and fusion rate. Results: JOA scores of the PLF group before surgery and at final follow-up were 12.3±4.8 and 24.1±3.7, respectively; those of the PLIF group were 14.7±4.8 and 24.2±7.8, respectively, with no significant difference between the two groups. Correction of slip estimated from postoperative slip angle, translation, and maintenance of intervertebral disc height in the PLIF group was significantly (p <0.05) better than those in the PLF group. However, there was no significant difference in lumbar lordotic angle, slip angle and translation angle upon maximum flexion, or extension bending. Fusion rates of the PLIF and PLF groups had no significant difference. Conclusions: The L4–L5 level posterior instrumented fusion for unstable spondylolisthesis using both PLF and PLIF could ameliorate clinical symptoms when local stability is achieved.