Diastematomyelia: A Surgical Case with Long-Term Follow-Up

Hirofumi Bekki,Yuichiro Morishita,Osamu Kawano,Keiichiro Shiba,Yukihide Iwamoto 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.1

Few reports have described the involvement of syringomyelia associated with diastematomyelia in the etiology of neurological deficits. We reported a case with syringomyelia associated with diastematomyelia. A female patient with diastematomyelia was followed up clinically over 14 years. At the age of 8, she developed clubfoot deformity with neurological deterioration. Motor function of the right peroneus demonstrated grade 2 in manual muscle tests. Continuous intracanial bony septum and double cords with independent double dura were observed at upper thoracic spine. Magnetic resonance imaging revealed a tethering of the spinal cord and syringomyelia distal to the level of diastematomyelia. Extirpation of the osseum septum and duralplasty were performed surgically. She grew without neurological deterioration during 7 years postoperatively. A long-term followed up case with syringomyelia that was possibly secondary to the tethering of the spinal cord associated with diastematomyelia, and effective treatment with extirpation of the osseum septum and duralplasty was described.

Clinical Relationship of Degenerative Changes between the Cervical and Lumbar Spine

Yuichiro Morishita,Zorica Buser,Anthony D’Oro,Keiichiro Shiba,Jeffrey C. Wang 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.2

Study Design: Retrospective, observational, case series. Purpose: To elucidate the prevalence of degenerative changes in the cervical and lumbar spine and estimate the degenerative changes in the cervical spine based on the degeneration of lumbar disc through a retrospective review of magnetic resonance (MR) images. Overview of Literature: Over 50% of middle-aged adults show evidence of spinal degeneration. However, the relationship between degenerative changes in the cervical and lumbar spine has yet to be elucidated. Methods: A retrospective review of positional MR images of 152 patients with symptoms related to cervical and lumbar spondylosis with or without a neurogenic component was conducted. The degree of intervertebral disc degeneration (IDD) was assessed on a grade of 1–5 for each segment of the cervical and lumbar spine using MR T2-weighted sagittal images. The grades across all segments were summed to produce the degenerative disc score (DDS) for the cervical and lumbar spine. The patients were divided into two groups based on the IDD grade for each lumbar segment: normal (grades 1 and 2) and degenerative (grades 3–5). Results: DDSs for the cervical and lumbar spine were positively correlated. Significant differences in cervical DDSs between the groups were observed in all lumbar segments. Although there were no significant differences in cervical DDSs among the degenerative lumbar segment, cervical DDSs at the L1–2 and L2–3 segments tended to be higher than those at the L3–4, L4–5, and L5–S degenerative segments. Conclusions: Our study shows that participants with degenerative changes in the upper lumbar segments are more likely to have a certain amount of cervical spondylosis. This information could be used to lower the incidence of a missed diagnosis of cervical spine disorders in patients presenting with lumbar spine symptomology.

Radiological Outcome of Short Segment Posterior Instrumentation and Fusion for Thoracolumbar Burst Fractures

Truc Tam Vu,Yuichiro Morishita,Itaru Yugue,Tetsuo Hayashi,Takeshi Maeda,Keiichiro Shiba 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.3

Study Design: Retrospective study. Purpose: To evaluate the radiological outcome of the surgical treatment of thoracolumbar burst fractures by using short segment posterior instrumentation (SSPI) and fusion. Overview of Literature: The optimal surgical treatment of thoracolumbar burst fractures remains a matter of debate. SSPI is one of a number of possible choices, yet some studies have revealed high rates of poor radiological outcome for this SSPI. Methods: Patients treated using the short segment instrumentation and fusion technique at the Spinal Injuries Center (Iizuka, Fukuoka, Japan) from January 1, 2006 to July 31, 2012 were selected for this study. Radiographic parameters such as local sagittal angle, regional sagittal angle, disc angle, anterior or posterior height of the vertebral body at admission, postoperation and final observation were collected for radiological outcome evaluation. Results: There were 31 patients who met the inclusion criteria with a mean follow-up duration of 22.7 months (range, 12–48 months). The mean age of this group was 47.9 years (range, 15–77 years). The mean local sagittal angles at the time of admission, post-operation and final observation were 13.1°, 7.8° and 14.8°, respectively. There were 71% good cases and 29% poor cases based on our criteria for the radiological outcome evaluation. The correction loss has a strong correlation with the load sharing classification score (Spearman rho=0.64, p <0.001). Conclusions: The loss of kyphotic correction following the surgical treatment of thoracolumbar burst fracture by short segment instrumentation is common and has a close correlation with the degree of comminution of the vertebral body. Patients with high load sharing scores are more susceptible to correction loss and postoperative kyphotic deformity than those with low scores.

A Safe Surgical Procedure for Old Distractive Flexion Injuries of the Subaxial Cervical Spine

Osamu Kawano,Takeshi Maeda,Eiji Mori,Itaru Yugue,Takayoshi Ueta,Keiichiro Shiba 대한척추외과학회 2017 Asian Spine Journal Vol.11 No.6

Study Design: Retrospective review. Purpose: To describe a safe and effective surgical procedure for old distractive flexion (DF) injuries of the subaxial cervical spine. Overview of Literature: Surgical treatment is required in old cases when a progression of the kyphotic deformity and/or persistent neck pain and/or the appearance of new neurological symptoms are observed. Since surgical treatment is more complicated and dangerous in old cases than in acute distractive-flexion cases, the indications for surgery and the selection of the surgical procedure must be carefully conducted. Methods: To identify a safe and effective surgical procedure, the procedure selected, reason(s) for its selection, and associated neurological complications were investigated in 13 patients with old cervical DF injuries. Results: No neurological complications were observed in nine patients (DF stage 2 or 3) who underwent the anterior-posterior-anterior (A-P-A) method and two patients (DF stage 1) who underwent the posterior method. It was initially planned that two patients (DF stage 2) who underwent the P-A method would be treated using the Posterior method alone; however, anterior discectomy was added to the procedure after the development of a severe spinal cord disorder. Conclusions: The A-P-A method (anterior discectomy, posterior release and/or partial facetectomy, reduction and instrumentation, anterior bone grafting) is considered to be a suitable surgical procedure for old cervical DF injuries.

Clinical Influence of Cervical Spinal Canal Stenosis on Neurological Outcome after Traumatic Cervical Spinal Cord Injury without Major Fracture or Dislocation

Tsuneaki Takao,Seiji Okada,Yuichiro Morishita,Takeshi Maeda,Kensuke Kubota,Ryosuke Ideta,Eiji Mori,Itaru Yugue,Osamu Kawano,Hiroaki Sakai,Takayoshi Ueta,Keiichiro Shiba 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.3

Study Design: Retrospective case series. Purpose: To clarify the influence of cervical spinal canal stenosis (CSCS) on neurological functional recovery after traumatic cervical spinal cord injury (CSCI) without major fracture or dislocation Overview of Literature: The biomechanical etiology of traumatic CSCI remains under discussion and its relationship with CSCS is one of the most controversial issues in the clinical management of traumatic CSCI. Methods: To obtain a relatively uniform background, patients non-surgically treated for an acute C3–4 level CSCI without major fracture or dislocation were selected. We analyzed 58 subjects with traumatic CSCI using T2-weighted mid-sagittal magnetic resonance imaging. The sagittal diameter of the cerebrospinal fluid (CSF) column, degree of canal stenosis, and neurologic outcomes in motor function, including improvement rate, were assessed. Results: There were no significant relationships between sagittal diameter of the CSF column at the C3–4 segment and their American Spinal Injury Association motor scores at both admission and discharge. Moreover, no significant relationships were observed between the sagittal diameter of the CSF column at the C3-4 segment and their neurological recovery during the following period. Conclusions: No relationships between pre-existing CSCS and neurological outcomes were evident after traumatic CSCI. These results suggest that decompression surgery might not be recommended for traumatic CSCI without major fracture or dislocation despite pre-existing CSCS.