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- 저자 : Taigo Kawaoka (검색결과 2 건)
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Analysis of Revision Surgery of Microsurgical Lumbar Discectomy
Taku Inada,Sei Nishida,Taigo Kawaoka,Toshiyuki Takahashi,Junya Hanakita 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.1
Study Design: A retrospective study. Purpose: Our objectives were to determine the association between the pathological changes of disc herniation and the interval between primary and revision surgeries and to investigate the frequency and site of the dural laceration in the primary and revision surgeries. Overview of Literature: Among 382 patients who underwent microsurgical lumbar discectomy, we investigated 29 who underwent revision surgery to analyze recurrent herniation pathologies and complications to determine the manner in which lumbar disc herniation can be more efficiently managed. Methods: Of 29 patients, 22 had recurrent disc herniation at the same level and site. The pathological changes associated with compression factors were classified into the following two types depending on intraoperative findings: (1) true recurrence and (2) minor recurrence with peridural fibrosis (>4 mm thickness). The sites of dural laceration were examined using video footage and operative records. Results: The pathological findings and days between the primary and revision surgeries showed no statistical difference (p =0.14). Analysis of multiple factors, revealed no significant difference between the primary and revision surgery groups with regard to hospital days (p =0.23), blood loss (p =0.99), and operative time (p =0.67). Dural lacerations obviously increased in the revision surgery group (1.3% vs. 16.7%, p <0.01) and were mainly located near the herniated disc in the primary surgery group and near the root shoulder in the revision surgery group, where severe fibrosis and adhesion were confirmed. To avoid dural laceration during revision surgery, meticulous decompressive manipulation must be performed around the root sleeve. Conclusions: We recommend that meticulous epidural dissection around the scar formation must be performed during revision surgery to avoid complications.
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Yuki Oichi,Junya Hanakita,Toshiyuki Takahashi,Manabu Minami,Taigo Kawaoka,Yusuke Funakoshi,Takeshi Kawauchi,Yasufumi Ohtake 대한척추신경외과학회 2018 Neurospine Vol.15 No.4
Objective: Computed tomography following myelography (CTM) revealed an unusual flow of contrast dye into the anterior median fissure (AMF) in a patient with cervical spondylotic myelopathy. Since then, several AMF configurations have been observed on CTM. Therefore, we evaluated morphological patterns of the AMF on CTM and investigated the significance and mechanisms of contrast dye flow into the AMF. Methods: Morphological patterns of the AMF on CTM were examined in 79 patients. Group A (24 patients) underwent surgery because of symptomatic cervical myelopathy. Group B (43 patients) had no clinical symptoms but showed spinal cord compression on CTM. Group C (12 patients), who showed neither clinical symptoms nor cord changes, underwent CTM for lumbar lesion evaluation. AMF patterns were classified into 4 types according to their configurations on CTM (reversed T, Y, V, and O types). Results: In group B, the reversed T type and Y type appeared significantly more often near the compressed portion (p<0.001). A similar tendency was seen in group A. The V and O types were most frequently observed in group C (p<0.001). Conclusion: On CTM, contrast dye tends to flow into the AMF of the cervical cord when the spinal cord is compressed. We speculate that there may be 3 possible mechanisms for this phenomenon: deformation of the epipial layer of the AMF due to cervical cord compression, AMF dilatation due to atrophy of the anterior funiculus or anterior horn, and temporary AMF dilatation when it becomes an alternative route for cerebrospinal fluid circulation.
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