Full-endoscopic lumbar discectomy (FED) is one of the least invasive procedures for lumbar disc h... more Full-endoscopic lumbar discectomy (FED) is one of the least invasive procedures for lumbar disc herniation. Patients who receive FED for lumbar disc herniation may develop recurrent herniation at a frequency similar to conventional procedures. Reoperation and risk factors of recurrent lumbar disc herniation were investigated among 909 patients who received FED using an interlaminar approach (FED-IL). Sixty-five of the 909 patients received reoperation for recurrent herniation. Disc height, smoking, diabetes mellitus (DM), subligamentous extrusion (SE) type, and Modic change were identified as the risk factors for recurrence. Other indicators such as LL, Cobb angle, disc migration, age, sex, and body mass index (BMI) did not reach significance. Among 65 patients, reoperation was performed within 14 days following FED-IL (very early) in 7 patients, from 15 days to 3 months (early) in 14 patients, from 3 months to 1 year (midterm) in 17 patients, and after more than 1 year (late) in 27...
Despite the accumulated knowledge of spinal alignment and clinical outcomes the full corrective s... more Despite the accumulated knowledge of spinal alignment and clinical outcomes the full corrective surgery cannot be applied to all the deformity patients as it requires considerable surgical burden to the patients. The aim of this study was to investigate the clinical and radiological outcomes of the patients who have received short and long fusion for ASD. A total of 21 patients who received surgical reconstructive spinal fusion procedures and were followed up for at least one year were retrospectively reviewed. Sixteen cases have received spinal corrective surgery that upper instrumented vertebrate (UIV) was thoracic level (group T), or 5 cases were with UIV in lumbar level (group L). Group L had shorter operation time, smaller intraoperative estimated blood loss, and shorter postoperative hospitalization days. Group T tends to improve more in the magnitude of VAS of lumbar pain compared to group L. Improvement of spinal alignment revealed the advantage of long fusion compared to sh...
Mini-invasive Surgery www.misjournal.net Aim: Full-endoscopic posterior cervical foraminotomy (FP... more Mini-invasive Surgery www.misjournal.net Aim: Full-endoscopic posterior cervical foraminotomy (FPCF) has been utilized to treat cervical lateral disc herniation and provided good surgical outcomes. The authors examined the superiority of FPCF in patients with spondylotic foraminal stenosis. Methods: Fifty-nine cases of FPCF were evaluated. Of the 59 patients, 34 had lateral disc herniation (group H) and 25 had spondylotic foraminal stenosis (group S). Operative time, complications, length of hospital stay, visual analog pain scale scores of neck and arm pain, and the amount of facet joint resection were compared between the groups. Results: The mean operative times were 96 min (group H) and 100 min (group S). The lengths of hospital stay were 3.0 days and 3.9 days, respectively. No significant differences were observed in pre-operative neck and arm pain between the groups. Average neck pain at the final follow-up was significantly less severe in group H (2.9) than in group S (12). However, postoperative arm pain was the same after surgery in both groups (14). In both groups, 52% of the facet joint was resected. Conclusion: The surgical outcome of FPCF in patients with spondylotic foraminal stenosis is equivalent to that in patients with lateral disc herniation.
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 2002
We report a rare case of undifferentiated leiomyosarcoma (LMS) with incidental B-cell lymphoma in... more We report a rare case of undifferentiated leiomyosarcoma (LMS) with incidental B-cell lymphoma in a 70-year-old woman. T2-weighted magnetic resonance images revealed a high signal intensity mass measuring 9 x 8 cm in the gluteus muscle. The pathological diagnosis of repeated surgery was undifferentiated LMS that included various sarcomatous components, such as fibrosarcomatous, rhabdomyosarcomatous, and malignant fibrous histiocytoma-like elements. A specimen from a supraclavicular lymph node showed the characteristics of malignant B-cell lymphoma (follicle type). Adjuvant chemotherapy or radiation therapy was not performed because of the patient's advanced age. The patient died from liver metastasis and dysfunction 5 years 8 months after the initial therapy. This is a rare case of LMS with malignant lymphoma. Considerable debate remains whether the B-cell lymphoma developed incidentally.
The Journal of bone and joint surgery. American volume, 2002
Although the etiology of lumbar disc disease is unknown, it has been suggested that a genetic fac... more Although the etiology of lumbar disc disease is unknown, it has been suggested that a genetic factor contributes to its development. Recently, some genetic polymorphisms have been found to be related to clinical disorders. We investigated the association between vitamin-D receptor gene and estrogen receptor gene polymorphisms and lumbar disc disease in young adults. The participants included 205 young adults (166 women and thirty-nine men) with or without low-back problems. A magnetic resonance imaging scan of the lumbar spine was performed for all subjects, and the grade of disc degeneration was determined, according to the four-grade classification system of Schneiderman et al. The presence or absence of disc herniation was also evaluated. Genomic DNA was extracted from peripheral blood samples. The polymorphisms of the vitamin-D receptor and estrogen receptor genes were detected with use of a polymerase-chain-reaction assay. The restriction fragment length polymorphisms (RFLPs) f...
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 2001
The effectiveness of hyperbaric oxygen therapy (HBO) in predicting neurological recovery in patie... more The effectiveness of hyperbaric oxygen therapy (HBO) in predicting neurological recovery in patients with spinal cord injury was evaluated. HBO has been used to treat spinal cord injury, but HBO does not appear to greatly alter the neurological outcome. This is the first report of the use of HBO as a diagnostic tool to evaluate neurological recovery after spinal cord injury. The study group consisted of 22 patients, aged 21-73 years, with spinal cord injuries. The effect of HBO was evaluated on admission and categorized as one of four grades (excellent, good, fair, or poor). The neurological status was evaluated on admission and at the time of follow-up, according to Frankel grade and the American Spinal Injury Association (ASIA) motor score. Correlations between the HBO effect and Frankel grade recovery and correlations between the HBO effect and recovery rate of the ASIA motor score were evaluated. The recovery in Frankel grade from admission to the final follow-up became better a...
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 2002
We report two patients with rheumatoid arthritis in whom posterior atlantoaxial fixation was carr... more We report two patients with rheumatoid arthritis in whom posterior atlantoaxial fixation was carried out using transarticular screws with computer assistance. Two bilateral transarticular screws were inserted in one patient; however, in the other patient, only a unilateral screw was used, because computerized images showed that the vertebral artery at the other side was placed too medially to allow insertion of the screw. Neither of these patients had any neurovascular complications after surgery. Computer-assisted surgery is useful for avoiding neurovascular complications with transarticular screw fixation of C1-2.
We evaluated the clinical and radiologic features of patients with lumbar spinal stenosis with ne... more We evaluated the clinical and radiologic features of patients with lumbar spinal stenosis with neuropathic bladder. Based on cystometrogram analysis, the patients were divided into two groups--the neuropathic bladder (NB) group: the NB+ group (23 patients), and the nonneuropathic bladder group: the NB- group (14 patients). The symptom of incontinence was characteristic in patients in the NB+ group. Patients in the NB+ group had a more severe neurologic disturbance, compared with those in the NB- group. The more severe neurologic disturbance was caused by the more striking finding of degenerative spinal stenosis associated with developmental narrowing of the spinal canal. Decompressive surgery had a beneficial effect on the recovery of the neurologic symptoms in both groups. Residual urine volume was reduced after surgery. Postoperative cystometrogram was carried out in nine patients in the NB+ group. It showed a normal pattern in six patients; however, three patients remained in an ...
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 2001
We report a patient with a large intra-abdominal metastasis of myxoid liposarcoma. The patient fi... more We report a patient with a large intra-abdominal metastasis of myxoid liposarcoma. The patient first noticed an asymptomatic mass in her left leg in 1985, when she was 20 years old. The mass was left untouched until she realized its rapid growth and consulted a local doctor in 1994. After needle biopsy, she was histologically diagnosed as having a myxoid liposarcoma. She disagreed with the recommendation for an amputation below the knee, made at another hospital. A marginal resection was performed as an alternative treatment. She subsequently underwent three more marginal resections and four intra-lesional resections for repeated local recurrences. In 1997, an abdominal computed tomography scan revealed the presence of multiple intra-abdominal metastases, and the lesions were judged to be inoperable. Ileus and respiratory distress, caused by compression by the abdominal mass, gradually worsened, and she died in 1999, at the age of 34. The girth of her abdomen was 135 cm at the time ...
This study evaluated postoperative enteroparesis influenced by patient-controlled analgesia combi... more This study evaluated postoperative enteroparesis influenced by patient-controlled analgesia combined with continuous epidural block in patients who underwent posterior lumbar surgery. One hundred nine patients were divided into three groups at random (group 1, controls (18 patients); group 2, postoperative patient-controlled analgesia and continuous epidural block (45 patients); group 3, one-shot epidural analgesia, postoperative patient-controlled analgesia, and continuous epidural block (46 patients). The patients in groups 2 and 3 had more satisfactory pain relief and needed analgesics less frequently. However, their clinical abdominal findings the morning after surgery were worse than those in control patients. The times when patients could take any nourishment and eat solid food (rice) were delayed by patient-controlled analgesia with continuous epidural block.
Tumour biology : the journal of the International Society for Oncodevelopmental Biology and Medicine, 1996
We investigated the invasiveness through the extracellular matrix and pulmonary metastatic potent... more We investigated the invasiveness through the extracellular matrix and pulmonary metastatic potential in high laminin-adherent [LN(+)] and low laminin-adherent [LN(-)] Dunn oseosarcoma cells selected for adhesiveness to laminin. In the invasion assay using a reconstituted basement membrane (matrigel) in a Boyden chamber, LN(+) cells proved to be more invasive than LN(-) and the parental Dunn cells. Pulmonary metastatic potential was correlated with invasiveness through the matrigel in three cell types. The ability of LN(+) cells to attach to laminin and the matrigel was significantly higher than that of LN(-) or the parental Dunn cells. LN(-) cells showed much lower attachment ability compared to the other cells. There were no significant differences in type IV collagenolysis and cell migration among the three cell types. In LN(+) and the parental Dunn cells, laminin significantly stimulated type IV collagenolytic and migration activities. LN(-) cells showed no significant difference...
A 70-year-old woman presented with a painful buttock tumor that became progressively larger over ... more A 70-year-old woman presented with a painful buttock tumor that became progressively larger over a period of 1 month. She was otherwise in good health. Upon physical examination, the elastic-hard tumor measuring 9 ϫ 8 cm was tender to palpation. No neurological deficit was present. Computed tomography (CT) showed a large low-density mass, with calcifications, involving the right gluteus muscle. Magnetic resonance imaging (MRI) demonstrated an ill-defined gluteal soft tissue tumor showing isointensity on the T1-weighted image and heterogeneous high signal characteristics on the T2-weighted image compared with surrounding muscle. Gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA)-enhanced MRI showed a high-signal-intensity mass except for a central round area (Fig. 1). Chest radiographs and CT scans were obtained and interpreted as normal. Available laboratory data were red blood cell count 389 ϫ 10 4 /µl, white blood cell count 8330/µl, C-reactive protein 19.4 mg/dl, erythrocyte sedimentation rate 91 mm/h. The initial pathological diagnosis with needle biopsy was fibrosarcoma. The tumor was composed of pleomorphic cells with an ovoid or irregularly shaped nucleus containing dense chromatin. Few mitoses were seen. It was diagnosed as a low-grade fibrosarcoma after by staining with hematoxylin and eosin (H&E). The patient underwent en bloc tumor resection with a wide margin under general anesthesia. The tumor was an oval mass occupying the entire extent in the right gluteus muscle. The surgical specimen was confirmed to be fibrosarcoma with a herring bone pattern (Fig. 2A). The symptoms decreased after operation, and the patient was discharged from the hospital 1 month later. Adjuvant chemotherapy or radiation therapy was not given because of the patient's advanced age. At 2 years 3 months after operation the tumor was detected again in the subcutaneous region along the Abstract We report a rare case of undifferentiated leiomyosarcoma (LMS) with incidental B-cell lymphoma in a 70year-old woman. T2-weighted magnetic resonance images revealed a high signal intensity mass measuring 9 ϫ 8 cm in the gluteus muscle. The pathological diagnosis of repeated surgery was undifferentiated LMS that included various sarcomatous components, such as fibrosarcomatous, rhabdomyosarcomatous, and malignant fibrous histiocytomalike elements. A specimen from a supraclavicular lymph node showed the characteristics of malignant B-cell lymphoma (follicle type). Adjuvant chemotherapy or radiation therapy was not performed because of the patient's advanced age. The patient died from liver metastasis and dysfunction 5 years 8 months after the initial therapy. This is a rare case of LMS with malignant lymphoma. Considerable debate remains whether the B-cell lymphoma developed incidentally.
Fig. 1 A: Gallium systemic bone scintigrams revealing multiple regions of hyperaccumulation in th... more Fig. 1 A: Gallium systemic bone scintigrams revealing multiple regions of hyperaccumulation in the skeleton including the skull. B: Computed tomography scan showing a skull tumor in the right occipital bone and intracerebral hemorrhage in the right occipital lobe.
Regulation of gelatinase production, invasiveness and migration activity by organ-specific fibrob... more Regulation of gelatinase production, invasiveness and migration activity by organ-specific fibroblasts from embryo, subcutaneous and lung tissues of mice were investigated in high-metastatic RCT+ and low-metastatic RCT- clones established from a poorly differentiated murine sarcoma. In the conditioned media of RCT+ cells, mouse skin fibroblasts (MSF) obtained from the tissue of tumor origin (orthotopic) stimulated the production of the 105-kD gelatinase more than C3H/ 10T1/2 clone 8 (C3H/10 T1/2 CL8) or mouse lung fibroblasts (MLF). In the conditioned media of RCT- cells, however, cocultivation with fibroblasts showed only slight stimulatory effects on the production of the 105-kD gelatinase. In the invasion assay, using a reconstituted basement membrane (matrigel), RCT+ cells cocultivated with MSF showed significantly higher invasiveness than those cocultivated with C3H/10T1/2 CL8 or MLF. However, no significant differences were shown in the invasiveness of RCT- cells in cocultivation with three types of fibroblasts and in cultivation without fibroblasts. There was no significant difference in migration activity between RCT+ and RCT- cells cultivated alone. But in the cocultivation of both clones with MSF, the migration activity of RCT+ cells was significantly higher than that of RCT- cells. These findings suggest that MSF might delineate the difference in characteristics related to the metastatic potential of RCT+ and RCT- cells through regulation by organ-specific factors.
In degenerative lumbar spinal stenosis with scoliosis (DLS), many authors stated that nerve root ... more In degenerative lumbar spinal stenosis with scoliosis (DLS), many authors stated that nerve root compression is almost always seen on the concave side of the scoliosis, and L4 and L5 nerve roots are the most often involved. However, there are few reports on the relationship between nerve root compression and the pattern of scoliosis. To investigate the factors that may contribute to radiculopathy in DLS and their association with the pattern of the scoliosis. Retrospective analysis. Twenty-two consecutive patients with DLS with radiculopathy were examined. The symptomatic nerve roots were determined by pain distribution, neurological findings and nerve root infiltration using lidocaine. The compressive factors were diagnosed by magnetic resonance imaging or myelography, discography, computed tomography after myelography or discography and radiculography. The pattern of scoliosis was determined in plain radiographs. We evaluated the correlation between the affected nerve root and the compressive factors or the pattern of the scoliosis. The L3 root was affected in 23% of patients; L4 root in 68%, L5 root in 55% and S1 root in 18%. L3 and L4 roots were more compressed by foraminal or extraforaminal stenosis on the concave side of the curve, whereas L5 and S1 roots were commonly affected by lateral recess stenosis on the convex side. The Cobb angle and the lateral slip of the cases in which L3 or L4 root was affected were significantly larger than in cases in which L5 or S1 root was compressed. In the treatment of radiculopathy caused by DLS, it is important to bear in mind that L3 or L4 roots were more strongly compressed by foraminal or extraforaminal stenosis at the concave side of the curve, whereas L5 or S1 nerve roots were affected more by lateral recess stenosis at the convex side of the curve.
Clinical and radiologic analyses in elderly patients with cervical myelopathy. To investigate the... more Clinical and radiologic analyses in elderly patients with cervical myelopathy. To investigate the pathomechanism of cervical myelopathy and the surgical results of laminoplasty in elderly patients older than 70 years old. To date, there have been no reports on the pathomechanism of cervical myelopathy in elderly patients. Further, the surgical results and postoperative complications of laminoplasty have not been fully evaluated in elderly patients. Eighty-nine patients who underwent cervical laminoplasty were reviewed. The patients were divided into 2 groups according to the age at the time of operation (the elderly patient group: 20 patients who were older than 70 years old, and the control group: 69 patients who were younger than 69 years old). Pre- and postoperative neurologic status (the Japanese Orthopedic Association score) and postoperative complications were compared between the two groups. Radiologic features were also examined. There was no statistical difference in the recovery rate of Japanese Orthopedic Association score between the elderly patient group and the control group. Activities of daily living improved in the elderly patients. Several complications, such as delirium and worsening hypertension, were found in the elderly patient group. In the preoperative radiographs, the incidence of either retrolisthesis or anterolisthesis in the elderly patient group was significantly higher than that in the control group. Retrolisthesis and anterolisthesis are often the cause of myelopathy in elderly patients. Surgical decompression for cervical myelopathy was beneficial even in elderly patients older than 70 years old. Laminoplasty achieves stability of the cervical spine, and this procedure is reasonable for the treatment.
A report of three cases of thoracolumbar vertebral collapse treated with image-guided anterior co... more A report of three cases of thoracolumbar vertebral collapse treated with image-guided anterior corpectomy. To document the surgical technique and the usefulness of image-guided anterior corpectomy for thoracolumbar vertebral collapse. Computer-assisted navigation systems can provide accurate three-dimensional surgical information intraoperatively. However, there is no clinical report regarding the application and usefulness of the computer-assisted navigation system for anterior thoracolumbar corpectomy. After exposure of anterior and lateral aspects of the vertebral bodies through the transpleural approach, a reference frame was fixed to the thoracolumbar spinous process. Then thoracolumbar corpectomy and decompression were carried out under computer assistance. The tip of the standard probe and the angled rongeur could be monitored on three-dimensional images during surgery, and the retropulsed fragments within the spinal canal could be safely and completely removed under computer assistance. This image-guided procedure would aid surgeons in the complete and safe decompression of thoracolumbar injury.
Full-endoscopic lumbar discectomy (FED) is one of the least invasive procedures for lumbar disc h... more Full-endoscopic lumbar discectomy (FED) is one of the least invasive procedures for lumbar disc herniation. Patients who receive FED for lumbar disc herniation may develop recurrent herniation at a frequency similar to conventional procedures. Reoperation and risk factors of recurrent lumbar disc herniation were investigated among 909 patients who received FED using an interlaminar approach (FED-IL). Sixty-five of the 909 patients received reoperation for recurrent herniation. Disc height, smoking, diabetes mellitus (DM), subligamentous extrusion (SE) type, and Modic change were identified as the risk factors for recurrence. Other indicators such as LL, Cobb angle, disc migration, age, sex, and body mass index (BMI) did not reach significance. Among 65 patients, reoperation was performed within 14 days following FED-IL (very early) in 7 patients, from 15 days to 3 months (early) in 14 patients, from 3 months to 1 year (midterm) in 17 patients, and after more than 1 year (late) in 27...
Despite the accumulated knowledge of spinal alignment and clinical outcomes the full corrective s... more Despite the accumulated knowledge of spinal alignment and clinical outcomes the full corrective surgery cannot be applied to all the deformity patients as it requires considerable surgical burden to the patients. The aim of this study was to investigate the clinical and radiological outcomes of the patients who have received short and long fusion for ASD. A total of 21 patients who received surgical reconstructive spinal fusion procedures and were followed up for at least one year were retrospectively reviewed. Sixteen cases have received spinal corrective surgery that upper instrumented vertebrate (UIV) was thoracic level (group T), or 5 cases were with UIV in lumbar level (group L). Group L had shorter operation time, smaller intraoperative estimated blood loss, and shorter postoperative hospitalization days. Group T tends to improve more in the magnitude of VAS of lumbar pain compared to group L. Improvement of spinal alignment revealed the advantage of long fusion compared to sh...
Mini-invasive Surgery www.misjournal.net Aim: Full-endoscopic posterior cervical foraminotomy (FP... more Mini-invasive Surgery www.misjournal.net Aim: Full-endoscopic posterior cervical foraminotomy (FPCF) has been utilized to treat cervical lateral disc herniation and provided good surgical outcomes. The authors examined the superiority of FPCF in patients with spondylotic foraminal stenosis. Methods: Fifty-nine cases of FPCF were evaluated. Of the 59 patients, 34 had lateral disc herniation (group H) and 25 had spondylotic foraminal stenosis (group S). Operative time, complications, length of hospital stay, visual analog pain scale scores of neck and arm pain, and the amount of facet joint resection were compared between the groups. Results: The mean operative times were 96 min (group H) and 100 min (group S). The lengths of hospital stay were 3.0 days and 3.9 days, respectively. No significant differences were observed in pre-operative neck and arm pain between the groups. Average neck pain at the final follow-up was significantly less severe in group H (2.9) than in group S (12). However, postoperative arm pain was the same after surgery in both groups (14). In both groups, 52% of the facet joint was resected. Conclusion: The surgical outcome of FPCF in patients with spondylotic foraminal stenosis is equivalent to that in patients with lateral disc herniation.
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 2002
We report a rare case of undifferentiated leiomyosarcoma (LMS) with incidental B-cell lymphoma in... more We report a rare case of undifferentiated leiomyosarcoma (LMS) with incidental B-cell lymphoma in a 70-year-old woman. T2-weighted magnetic resonance images revealed a high signal intensity mass measuring 9 x 8 cm in the gluteus muscle. The pathological diagnosis of repeated surgery was undifferentiated LMS that included various sarcomatous components, such as fibrosarcomatous, rhabdomyosarcomatous, and malignant fibrous histiocytoma-like elements. A specimen from a supraclavicular lymph node showed the characteristics of malignant B-cell lymphoma (follicle type). Adjuvant chemotherapy or radiation therapy was not performed because of the patient's advanced age. The patient died from liver metastasis and dysfunction 5 years 8 months after the initial therapy. This is a rare case of LMS with malignant lymphoma. Considerable debate remains whether the B-cell lymphoma developed incidentally.
The Journal of bone and joint surgery. American volume, 2002
Although the etiology of lumbar disc disease is unknown, it has been suggested that a genetic fac... more Although the etiology of lumbar disc disease is unknown, it has been suggested that a genetic factor contributes to its development. Recently, some genetic polymorphisms have been found to be related to clinical disorders. We investigated the association between vitamin-D receptor gene and estrogen receptor gene polymorphisms and lumbar disc disease in young adults. The participants included 205 young adults (166 women and thirty-nine men) with or without low-back problems. A magnetic resonance imaging scan of the lumbar spine was performed for all subjects, and the grade of disc degeneration was determined, according to the four-grade classification system of Schneiderman et al. The presence or absence of disc herniation was also evaluated. Genomic DNA was extracted from peripheral blood samples. The polymorphisms of the vitamin-D receptor and estrogen receptor genes were detected with use of a polymerase-chain-reaction assay. The restriction fragment length polymorphisms (RFLPs) f...
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 2001
The effectiveness of hyperbaric oxygen therapy (HBO) in predicting neurological recovery in patie... more The effectiveness of hyperbaric oxygen therapy (HBO) in predicting neurological recovery in patients with spinal cord injury was evaluated. HBO has been used to treat spinal cord injury, but HBO does not appear to greatly alter the neurological outcome. This is the first report of the use of HBO as a diagnostic tool to evaluate neurological recovery after spinal cord injury. The study group consisted of 22 patients, aged 21-73 years, with spinal cord injuries. The effect of HBO was evaluated on admission and categorized as one of four grades (excellent, good, fair, or poor). The neurological status was evaluated on admission and at the time of follow-up, according to Frankel grade and the American Spinal Injury Association (ASIA) motor score. Correlations between the HBO effect and Frankel grade recovery and correlations between the HBO effect and recovery rate of the ASIA motor score were evaluated. The recovery in Frankel grade from admission to the final follow-up became better a...
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 2002
We report two patients with rheumatoid arthritis in whom posterior atlantoaxial fixation was carr... more We report two patients with rheumatoid arthritis in whom posterior atlantoaxial fixation was carried out using transarticular screws with computer assistance. Two bilateral transarticular screws were inserted in one patient; however, in the other patient, only a unilateral screw was used, because computerized images showed that the vertebral artery at the other side was placed too medially to allow insertion of the screw. Neither of these patients had any neurovascular complications after surgery. Computer-assisted surgery is useful for avoiding neurovascular complications with transarticular screw fixation of C1-2.
We evaluated the clinical and radiologic features of patients with lumbar spinal stenosis with ne... more We evaluated the clinical and radiologic features of patients with lumbar spinal stenosis with neuropathic bladder. Based on cystometrogram analysis, the patients were divided into two groups--the neuropathic bladder (NB) group: the NB+ group (23 patients), and the nonneuropathic bladder group: the NB- group (14 patients). The symptom of incontinence was characteristic in patients in the NB+ group. Patients in the NB+ group had a more severe neurologic disturbance, compared with those in the NB- group. The more severe neurologic disturbance was caused by the more striking finding of degenerative spinal stenosis associated with developmental narrowing of the spinal canal. Decompressive surgery had a beneficial effect on the recovery of the neurologic symptoms in both groups. Residual urine volume was reduced after surgery. Postoperative cystometrogram was carried out in nine patients in the NB+ group. It showed a normal pattern in six patients; however, three patients remained in an ...
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 2001
We report a patient with a large intra-abdominal metastasis of myxoid liposarcoma. The patient fi... more We report a patient with a large intra-abdominal metastasis of myxoid liposarcoma. The patient first noticed an asymptomatic mass in her left leg in 1985, when she was 20 years old. The mass was left untouched until she realized its rapid growth and consulted a local doctor in 1994. After needle biopsy, she was histologically diagnosed as having a myxoid liposarcoma. She disagreed with the recommendation for an amputation below the knee, made at another hospital. A marginal resection was performed as an alternative treatment. She subsequently underwent three more marginal resections and four intra-lesional resections for repeated local recurrences. In 1997, an abdominal computed tomography scan revealed the presence of multiple intra-abdominal metastases, and the lesions were judged to be inoperable. Ileus and respiratory distress, caused by compression by the abdominal mass, gradually worsened, and she died in 1999, at the age of 34. The girth of her abdomen was 135 cm at the time ...
This study evaluated postoperative enteroparesis influenced by patient-controlled analgesia combi... more This study evaluated postoperative enteroparesis influenced by patient-controlled analgesia combined with continuous epidural block in patients who underwent posterior lumbar surgery. One hundred nine patients were divided into three groups at random (group 1, controls (18 patients); group 2, postoperative patient-controlled analgesia and continuous epidural block (45 patients); group 3, one-shot epidural analgesia, postoperative patient-controlled analgesia, and continuous epidural block (46 patients). The patients in groups 2 and 3 had more satisfactory pain relief and needed analgesics less frequently. However, their clinical abdominal findings the morning after surgery were worse than those in control patients. The times when patients could take any nourishment and eat solid food (rice) were delayed by patient-controlled analgesia with continuous epidural block.
Tumour biology : the journal of the International Society for Oncodevelopmental Biology and Medicine, 1996
We investigated the invasiveness through the extracellular matrix and pulmonary metastatic potent... more We investigated the invasiveness through the extracellular matrix and pulmonary metastatic potential in high laminin-adherent [LN(+)] and low laminin-adherent [LN(-)] Dunn oseosarcoma cells selected for adhesiveness to laminin. In the invasion assay using a reconstituted basement membrane (matrigel) in a Boyden chamber, LN(+) cells proved to be more invasive than LN(-) and the parental Dunn cells. Pulmonary metastatic potential was correlated with invasiveness through the matrigel in three cell types. The ability of LN(+) cells to attach to laminin and the matrigel was significantly higher than that of LN(-) or the parental Dunn cells. LN(-) cells showed much lower attachment ability compared to the other cells. There were no significant differences in type IV collagenolysis and cell migration among the three cell types. In LN(+) and the parental Dunn cells, laminin significantly stimulated type IV collagenolytic and migration activities. LN(-) cells showed no significant difference...
A 70-year-old woman presented with a painful buttock tumor that became progressively larger over ... more A 70-year-old woman presented with a painful buttock tumor that became progressively larger over a period of 1 month. She was otherwise in good health. Upon physical examination, the elastic-hard tumor measuring 9 ϫ 8 cm was tender to palpation. No neurological deficit was present. Computed tomography (CT) showed a large low-density mass, with calcifications, involving the right gluteus muscle. Magnetic resonance imaging (MRI) demonstrated an ill-defined gluteal soft tissue tumor showing isointensity on the T1-weighted image and heterogeneous high signal characteristics on the T2-weighted image compared with surrounding muscle. Gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA)-enhanced MRI showed a high-signal-intensity mass except for a central round area (Fig. 1). Chest radiographs and CT scans were obtained and interpreted as normal. Available laboratory data were red blood cell count 389 ϫ 10 4 /µl, white blood cell count 8330/µl, C-reactive protein 19.4 mg/dl, erythrocyte sedimentation rate 91 mm/h. The initial pathological diagnosis with needle biopsy was fibrosarcoma. The tumor was composed of pleomorphic cells with an ovoid or irregularly shaped nucleus containing dense chromatin. Few mitoses were seen. It was diagnosed as a low-grade fibrosarcoma after by staining with hematoxylin and eosin (H&E). The patient underwent en bloc tumor resection with a wide margin under general anesthesia. The tumor was an oval mass occupying the entire extent in the right gluteus muscle. The surgical specimen was confirmed to be fibrosarcoma with a herring bone pattern (Fig. 2A). The symptoms decreased after operation, and the patient was discharged from the hospital 1 month later. Adjuvant chemotherapy or radiation therapy was not given because of the patient's advanced age. At 2 years 3 months after operation the tumor was detected again in the subcutaneous region along the Abstract We report a rare case of undifferentiated leiomyosarcoma (LMS) with incidental B-cell lymphoma in a 70year-old woman. T2-weighted magnetic resonance images revealed a high signal intensity mass measuring 9 ϫ 8 cm in the gluteus muscle. The pathological diagnosis of repeated surgery was undifferentiated LMS that included various sarcomatous components, such as fibrosarcomatous, rhabdomyosarcomatous, and malignant fibrous histiocytomalike elements. A specimen from a supraclavicular lymph node showed the characteristics of malignant B-cell lymphoma (follicle type). Adjuvant chemotherapy or radiation therapy was not performed because of the patient's advanced age. The patient died from liver metastasis and dysfunction 5 years 8 months after the initial therapy. This is a rare case of LMS with malignant lymphoma. Considerable debate remains whether the B-cell lymphoma developed incidentally.
Fig. 1 A: Gallium systemic bone scintigrams revealing multiple regions of hyperaccumulation in th... more Fig. 1 A: Gallium systemic bone scintigrams revealing multiple regions of hyperaccumulation in the skeleton including the skull. B: Computed tomography scan showing a skull tumor in the right occipital bone and intracerebral hemorrhage in the right occipital lobe.
Regulation of gelatinase production, invasiveness and migration activity by organ-specific fibrob... more Regulation of gelatinase production, invasiveness and migration activity by organ-specific fibroblasts from embryo, subcutaneous and lung tissues of mice were investigated in high-metastatic RCT+ and low-metastatic RCT- clones established from a poorly differentiated murine sarcoma. In the conditioned media of RCT+ cells, mouse skin fibroblasts (MSF) obtained from the tissue of tumor origin (orthotopic) stimulated the production of the 105-kD gelatinase more than C3H/ 10T1/2 clone 8 (C3H/10 T1/2 CL8) or mouse lung fibroblasts (MLF). In the conditioned media of RCT- cells, however, cocultivation with fibroblasts showed only slight stimulatory effects on the production of the 105-kD gelatinase. In the invasion assay, using a reconstituted basement membrane (matrigel), RCT+ cells cocultivated with MSF showed significantly higher invasiveness than those cocultivated with C3H/10T1/2 CL8 or MLF. However, no significant differences were shown in the invasiveness of RCT- cells in cocultivation with three types of fibroblasts and in cultivation without fibroblasts. There was no significant difference in migration activity between RCT+ and RCT- cells cultivated alone. But in the cocultivation of both clones with MSF, the migration activity of RCT+ cells was significantly higher than that of RCT- cells. These findings suggest that MSF might delineate the difference in characteristics related to the metastatic potential of RCT+ and RCT- cells through regulation by organ-specific factors.
In degenerative lumbar spinal stenosis with scoliosis (DLS), many authors stated that nerve root ... more In degenerative lumbar spinal stenosis with scoliosis (DLS), many authors stated that nerve root compression is almost always seen on the concave side of the scoliosis, and L4 and L5 nerve roots are the most often involved. However, there are few reports on the relationship between nerve root compression and the pattern of scoliosis. To investigate the factors that may contribute to radiculopathy in DLS and their association with the pattern of the scoliosis. Retrospective analysis. Twenty-two consecutive patients with DLS with radiculopathy were examined. The symptomatic nerve roots were determined by pain distribution, neurological findings and nerve root infiltration using lidocaine. The compressive factors were diagnosed by magnetic resonance imaging or myelography, discography, computed tomography after myelography or discography and radiculography. The pattern of scoliosis was determined in plain radiographs. We evaluated the correlation between the affected nerve root and the compressive factors or the pattern of the scoliosis. The L3 root was affected in 23% of patients; L4 root in 68%, L5 root in 55% and S1 root in 18%. L3 and L4 roots were more compressed by foraminal or extraforaminal stenosis on the concave side of the curve, whereas L5 and S1 roots were commonly affected by lateral recess stenosis on the convex side. The Cobb angle and the lateral slip of the cases in which L3 or L4 root was affected were significantly larger than in cases in which L5 or S1 root was compressed. In the treatment of radiculopathy caused by DLS, it is important to bear in mind that L3 or L4 roots were more strongly compressed by foraminal or extraforaminal stenosis at the concave side of the curve, whereas L5 or S1 nerve roots were affected more by lateral recess stenosis at the convex side of the curve.
Clinical and radiologic analyses in elderly patients with cervical myelopathy. To investigate the... more Clinical and radiologic analyses in elderly patients with cervical myelopathy. To investigate the pathomechanism of cervical myelopathy and the surgical results of laminoplasty in elderly patients older than 70 years old. To date, there have been no reports on the pathomechanism of cervical myelopathy in elderly patients. Further, the surgical results and postoperative complications of laminoplasty have not been fully evaluated in elderly patients. Eighty-nine patients who underwent cervical laminoplasty were reviewed. The patients were divided into 2 groups according to the age at the time of operation (the elderly patient group: 20 patients who were older than 70 years old, and the control group: 69 patients who were younger than 69 years old). Pre- and postoperative neurologic status (the Japanese Orthopedic Association score) and postoperative complications were compared between the two groups. Radiologic features were also examined. There was no statistical difference in the recovery rate of Japanese Orthopedic Association score between the elderly patient group and the control group. Activities of daily living improved in the elderly patients. Several complications, such as delirium and worsening hypertension, were found in the elderly patient group. In the preoperative radiographs, the incidence of either retrolisthesis or anterolisthesis in the elderly patient group was significantly higher than that in the control group. Retrolisthesis and anterolisthesis are often the cause of myelopathy in elderly patients. Surgical decompression for cervical myelopathy was beneficial even in elderly patients older than 70 years old. Laminoplasty achieves stability of the cervical spine, and this procedure is reasonable for the treatment.
A report of three cases of thoracolumbar vertebral collapse treated with image-guided anterior co... more A report of three cases of thoracolumbar vertebral collapse treated with image-guided anterior corpectomy. To document the surgical technique and the usefulness of image-guided anterior corpectomy for thoracolumbar vertebral collapse. Computer-assisted navigation systems can provide accurate three-dimensional surgical information intraoperatively. However, there is no clinical report regarding the application and usefulness of the computer-assisted navigation system for anterior thoracolumbar corpectomy. After exposure of anterior and lateral aspects of the vertebral bodies through the transpleural approach, a reference frame was fixed to the thoracolumbar spinous process. Then thoracolumbar corpectomy and decompression were carried out under computer assistance. The tip of the standard probe and the angled rongeur could be monitored on three-dimensional images during surgery, and the retropulsed fragments within the spinal canal could be safely and completely removed under computer assistance. This image-guided procedure would aid surgeons in the complete and safe decompression of thoracolumbar injury.
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Papers by Kazuo Ohmori