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RISS 인기검색어
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- 저자 : Jiro Hirayama (검색결과 3 건)
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Masao Koda,Chikato Mannoji,Masazumi Murakami,Tomoaki Kinoshita,Jiro Hirayama,Tomohiro Miyashita,Yawara Eguchi,Masashi Yamazaki,Takane Suzuki,Masaaki Aramomi,Mitsutoshi Ota,Satoshi Maki,Kazuhisa Takaha 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.6
Study Design: Retrospective case-control study. Purpose: To determine whether kissing spine is a risk factor for recurrence of sciatica after lumbar posterior decompression using a spinous process floating approach. Overview of Literature: Kissing spine is defined by apposition and sclerotic change of the facing spinous processes as shown in X-ray images, and is often accompanied by marked disc degeneration and decrement of disc height. If kissing spine significantly contributes to weight bearing and the stability of the lumbar spine, trauma to the spinous process might induce a breakdown of lumbar spine stability after posterior decompression surgery in cases of kissing spine. Methods: The present study included 161 patients who had undergone posterior decompression surgery for lumbar canal stenosis using a spinous process floating approaches. We defined recurrence of sciatica as that resolved after initial surgery and then recurred. Kissing spine was defined as sclerotic change and the apposition of the spinous process in a plain radiogram. Preoperative foraminal stenosis was determined by the decrease of perineural fat intensity detected by parasagittal T1-weighted magnetic resonance imaging. Preoperative percentage slip, segmental range of motion, and segmental scoliosis were analyzed in preoperative radiographs. Univariate analysis followed by stepwise logistic regression analysis determined factors independently associated with recurrence of sciatica. Results: Stepwise logistic regression revealed kissing spine (p =0.024; odds ratio, 3.80) and foraminal stenosis (p <0.01; odds ratio, 17.89) as independent risk factors for the recurrence of sciatica after posterior lumbar spinal decompression with spinous process floating procedures for lumbar spinal canal stenosis. Conclusions: When a patient shows kissing spine and concomitant subclinical foraminal stenosis at the affected level, we should sufficiently discuss the selection of an appropriate surgical procedure.
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Seiji Ohtori,Masaomi Yamashita,Yasuaki Murata,Yawara Eguchi,Yasuchika Aoki,Hiromi Ataka,Jiro Hirayama,Tomoyuki Ozawa,Tatsuo Morinaga,Hajime Arai,Masaya Mimura,Hiroto Kamoda,Sumihisa Orita,Masayuki Miy 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.4
Purpose: The pathological mechanism of lumbar spinal stenosis is reduced blood flow in nerve roots and degeneration of nerve roots. Exercise and prostaglandin E1 is used for patients with peripheral arterial disease to increase capillary flow around the main artery and improve symptoms; however, the ankle-brachial index (ABI), an estimation of blood flow in the main artery in the leg, does not change after treatment. Lumbar spinal nerve roots contain somatosensory, somatomotor, and unmyelinated autonomic nerves. Improved blood flow by medication with prostaglandin E1 and decompression surgery in these spinal nerve roots may improve the function of nerve fibers innervating muscle, capillary, and main vessels in the lower leg, resulting in an increased ABI. The purpose of the study was to examine whether these treatments can improve ABI. Materials and Methods: One hundred and seven patients who received conservative treatment such as exercise and medication (n=56) or surgical treatment (n=51) were included. Low back pain and leg pain scores, walking distance, and ABI were measured before treatment and after 3 months of conservative treatment alone or surgical treatment followed by conservative treatment. Results: Low back pain, leg pain, and walking distance significantly improved after both treatments (p<0.05). ABI significantly increased in each group (p<0.05). Conclusion: This is the first investigation of changes in ABI after treatment in patients with lumbar spinal stenosis. Improvement of the spinal nerve roots by medication and decompression surgery may improve the supply of blood flow to the lower leg in patients with lumbar spinal stenosis.
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Seiji Ohtori,Masaomi Yamashita,Yasuaki Murata,Yawara Eguchi,Yasuchika Aoki,Hiromi Ataka,Jiro Hirayama,Tomoyuki Ozawa,Tatsuo Morinaga,Hajime Arai,Masaya Mimura,Hiroto Kamoda,Sumihisa Orita,Masayuki Miy 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.3
Purpose: To examine the effects of conservative and surgical treatments for nocturnalleg cramps in patients with lumbar spinal stenosis (LSS). Nocturnal leg cramps is frequently observed in patients with peripheral neuropathy. However, there have been few reports on the relationship between nocturnal leg cramps and LSS, and it remains unknown whether conservative or surgical intervention has an impact on leg cramps in patients with LSS. Materials and Methods: The subjects were 130 LSS patients with low back and leg pain. Conservative treatment such as exercise, medication, and epidural block was used in 66 patients and surgical treatmentsuch as decompression or decompression and fusion was performed in 64 patients. Pain scores and frequency of nocturnal leg cramps were evaluated based on self-reported questionnaires completed before and 3 months after treatment. Results: The severity of low back and leg pain was higher and the incidence of nocturnal leg cramps was significantly higher before treatment in the surgically treated group compared with the conservatively treated group. Pain scores improvedin both groups after the intervention. The incidence of nocturnal leg cramps was significantly improved by surgical treatment (p=0.027), but not by conservative treatment (p=0.122). Conclusion: The findings of this prospective study indicate that the prevalence of nocturnal leg cramps is associated with LSS and severity of symptoms. Pain symptoms were improved by conservative or surgicaltreatment, but only surgery improved nocturnal leg cramps in patients with LSS. Thus, these results indicate that the prevalence of nocturnal leg cramps is associatedwith spinal nerve compression by LSS.
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