spine @ ウィキ

02272008

2008-02-27T21:44:36+09:00

** 02272008 * #1 [tumor] 31M conus tumor, myxopapillary ependymoma - 画像所見　くりっと丸い-neurinoma, 辺縁不整-myxopapillary ependymoma - 術中一塊として切除できない場合播種のリスクあり - 10年?生存率は70%　播種によりpoor prognosisもある - したがってpiece by pieceの場合は術後照射を加える　evidenceなし -　良性なのに照射を加えることについて意見がわかれる * #2 [tumor] 74F recurrent thoracic cord tumor, tanycytic ependymoma - S36 C6-Th2 meningiomaで手術 S39 Th1-3 spongioblastoma (glioma?)で手術。長い期間をおいての再発 - tanycyticはependymomaの珍しいvariant - 病理　紡錘形の細胞が流れるようにある。髄内腫瘍で紡錘形腫瘍があったらこれを疑う * #3 [tumor] 59F recurrent cervical spinal cord tumor - 21年前頸椎memingiomaで手術　後方アプローチ - 病理　砂粒体 - 腫瘍はcordの腹側。後方は前回手術で癒着。今回は側方アプローチ。MSの後縁から - ３回手術　それでも神経根の周りに残存あり * #4 [tumor] 51F recurrnet cervical spinal cord tumor, granular cell tumor - 1.5年前頸椎の砂時計種で手術　診断neurinoma - MRIはT1 iso, T2 low, Gd+ - 3ヶ月前再発、頚部の腫瘤もあり　連続性あり - T2 lowはneurinomaの所見としては矛盾 - T2 low 線維組織が多い　granuloma (Tbc,真菌) solitary fibrous tumor - 病理　顆粒状の胞体をもつ細胞

12102007

2007-12-10T20:12:27+09:00

** 12102007 * #1 [trauma] 18M Th8/9脱臼骨折 - H19/7 肺炎で入院　転落受傷（詳細不明）、脳挫傷合併　 - Frankel A+左上肢麻痺リハは右上肢で電動車いす、全介助 - Th8/9 機能写で可動性有り - plan #1 in situ posterior fusion --- 前方支柱がないのでinstrumentation failure危惧 - 　　 #2 椎体を一つ切除し短縮。後方固定。Frankel Aであるので脊髄は結紮

11122007

2007-11-13T12:34:34+09:00

** 11122007 * #1 [tumor] ? 頸胸椎移行部脊髄腫瘍再発 - 長い経過　３回目の手術 - 手術　硬膜切開-脊髄切開　髄内腫瘍摘出 - frozen sectionは subependymoma - 古いカルテ、病理結果参照中 * #2 [] 変性側弯 - 腰椎固定上位隣接の骨折と偽関節 - 手術　Th8まで固定を伸ばし、前方からL1/2にcage - L5のdiscographyのあとL5/sの固定追加　 * #3 []　71F -　15年来の腰痛、立位30分、腰痛のためあるけず、L3側弯 -　手術予定 L3/4-5/SのPLF * #4 []　10292007の#1 -　3椎間PLIFのあとのinfection 培養は陰性 -　手術予定 L3/4-5/SのPLF * #5 [CSM] 58M - 造園業　３月から両上肢しびれ、右下肢しびれ　走れず、高いところでの作業できず - JOA 10/17 - MRI C3/4, 5/6 discの突出　disc表面石灰化 - Tx plan 1) ASF C3/4 2) 拡大 * #6 [] 84M L1-5 固定術術後の5/S hernia - porosis+ - 除圧に固定を追加すべきか否か * #7 [infection] 82 F - 7月に入ってから両下肢脱力、歩行不可 - 7/13 他院受診　CT/MRI Th9-11 椎体圧潰 meta 疑い - 7/14 　紹介入院　CRP 1.47 ALP 193 CEA,CA19,9 WNL - 原発検索骨シンチ　胸椎のみ集積　胸腹CT 原発なし - CTガイドか胸椎生検　診断はカリエス - CT sagで病変の中にところどころ正常な骨組織が残っているのはspondylitisの所見 - 西病院へ転院　リファンピシン、アイナー、エタンブトールの三者療法 - 麻痺の進行なく10月末退院

10292007

2007-10-30T15:14:57+09:00

** 10292007 * #1 [infection] 78M DISH - 腰痛 spondylosis LCSx3 foraminal stenosisx2 - 7月 PLIF 2/3,3/4,4/5 術後創部癒合不全　D/Cで閉じた - 短期間でL4/5 PSのclear zone, cage 緩み - 8月末　revision pusなし granulationのみ　生食10lで洗浄 - L5のPS抜去、4/5 cage抜去　自家腸骨移植　S1まで固定をのばす - 今後の方針 #1 4/5のみならASF , 3/4も怪しい場合はどうするか？ * #2 []　53F LBP+obesity - L1/2,2/3,3/4,4/5 PLIF - その後L1 fx - L5のdiscographyのあとL5/sの固定追加　 - L1 fxでkyphosis, imbalance - 今後の方針　#1 L1 PSO, #2 前方で伸ばす - 伸展位でのレ線で可動性がないとき、矯正は可能か * #3 []　81M -　H18 5/S PLF, 2/3 4/5 laminectomy -　10月転倒歩行障害　MRIでL2/3ヘルニア -　L2/3 はfacetが立っているので、除圧にはfacetおとすー固定を準備して除圧が必要。

業績

2007-08-31T13:25:20+09:00

[1]Nakamura T, Sofue M, and Homma T: "Spina Bifida Occulta associated with a low-placed conus medullaris," J Spinal Disord, 1, 194-201 (1988).
[2] Uchiyama S, Yashiro K, Takahashi H, and Homma T: "An experimental study of spinal cord evoked potentials and histologic changes following spinal cord heating," Spine, 14, 1215-1219 (1989).
[3] Katsumi Y, Honma T and Nakamura T: "Analysis of cervical instability resulting from laminectomies for removal of spinal cord tumor," Spine, 14, 1171-1176 (1989).
[4] Yashiro K, Homma T, Hokari Y, Tatsumi Y, Okumura H, and Hirano A: "The Stefee variable screw placement system using different methods of bone grafting," Spine, 16, 1329-34 (1991).
[5] Yamazaki A, Homma T, Ishikawa S, and Okumura H: "Magnetic resonance imaging and histologic study of hypertrophic cervical posterior longitudinal ligament A case report," Spine, 16, 1262-1266 (1991).
[6] Takano Y, Homma T, Okumura H, and Takahashi HE: "Ganglion cyst occuring in the ligamentum flavum of the cervical spine. A case report.," Spine, 17, 1531-1533 (1992).
[7] Hasegawa K, Takahashi HE, Koga Y, Kawashima T, Hara T, Tanabe Y and Tanaka S: "Mechanical properties of osteopenic vertebral bodies monitored by acoustic emisson," Bone, 14, 737-743 (1993).
[8] Hasegawa K, Takahashi H, Koga Y, Kawashima T, Hara T, Tanabe Y, and Tanaka S: "Failure characteristics of osteoporotic vertebral bodies monitored by acoustic emission," Spine, 18, 2314-2320 (1993).
[9] Okumura H, and Homma T: "Juvenile compression myelopathy in the cervical spine," Spine, 19, 72-76 (1994).
[10] Ito T, Takahashi H, Ikuta F, and Sato H: "Case Report Metastatic pineocytoma of the spinal cord after long-term dormancy," Pathology Int, 44, 860-864 (1994).
[11] Ishikawa S, Kumar SJ, and Torres BC: "Surgical treatment of dysplastic spondylolisthesis," Spine, 19, 1691-1696 (1994).
[12] Hasegawa K, Turner CH, and Burr DB: "Contribution of collagen and mineral to the elastic anisotropy of bone," Calcif Tissue Int, 55, 381-386 (1994).
[13] Kimura S, Homma T, Uchiyama T, Yamazaki A, and Imura K: "Posterior migration of cervical spinal cord between split laminae as a complication of laminoplasty," Spine, 20, 1284-1288 (1995).
[14] Hasegawa K, Turner CH, Recker RR, Wu E, and Burr DB: "Elastic properties of osteoporotic bone measured by scanning acoustic microscopy," Bone, 16, 85-90 (1995).
[15] Hasegawa K, Turner CH, Chen J and Burr DB: "Effect of disc lesion on microdamage accumulation in lumbar vertebrae under cyclic compression loading," Clin Orthop Rel Res, 311, 190-198 (1995).
[16] Takano Y, Tanizawa T, Mashiba T, Endo N, Nishida S, and Takahashi HE: "Maintaining bone mass by bisphosphonate incadronate disodium (YM175) sequential treatment after discontinuation of intermittent human parathyroid hormone (1-34) administration in ovariectomized rats," J Bone Miner Res, 11, 169-177 (1996).
[17] Ito T, Yamada M, Ikuta F, Fukuda T, Hoshi S, Kawaji Y, Uchiyama S, Homma T, and Takahashi HE: "Histologic evidence of absorption of sequestration-type herniated disc," Spine, 21, 230-234 (1996).
[18] Ito T, Oyanagi K, Takahashi H, Takahashi HE, and Ikuta F: "Cervical spondylotic myelopathy clinicopathologic study on the progression pattern and thin myelinated fibers of the lesions of seven patients examined during complete autopsy," Spine, 21, 827-833 (1996).
[19] Ishikawa S, Kumar SJ, Takahashi HE, and Homma M: "Vertebral body shape as a predictor of spinal deformity in osteogenesis imperfecta," J Bone Joint Surg, 78A, 212-219 (1996).
[20] Carreon LY, Ito T, Yamada M, Uchiyama S, Takahashi H, and Ikuta F: "Histologic changes in the disc after cervical spine trauma: evidence of disc absorption," J Spinal Disord, 9, 313-316 (1996).
[21] Yajiri Y, Yoshimura M, Okamoto M, Takahashi H, and Higashi H: "A novel slow excitatory postsynaptic current in substantia gelatinosa neurons of the rat spinal cord in vitro," Neuroscience, 76, 673-688 (1997).
[22] Uchiyama T, Tanizawa T, Muramatsu, Endo N, Takahashi HE, and Hara T: "A morphometric comparison of trabecular structure of human ilium between microcomputed tomography and conventional histomorphometry," Calcif Tissue Int, 61, 493-498 (1997).
[23] Kinto N, Iwamoto M, Enomoto-Iwamoto M, Noji S, Ohuchi H, Yoshioka H, Kataoka H, Wada Y, Yuhao G, Takahashi HE, Yoshiki S , and Yamaguchi A: "Fibroblast expression sonic hedgehog induce osteoblast differentiation and ectopic bone formation," FEBS Letters, 404, 319-323 (1997).
[24] Hirano T, Tanizawa T, Endo N, Takahashi HE, and Morita T: "Oncogenic osteomalacia: pre- and postoperative histomorphometric studies," J Bone Miner Metab, 15, 227-231 (1997).
[25] Hirano T, Hasegawa K, Takahashi HE, Uchiyama S, Hara T, Washio T, Sugiura T, Yokaichiya M, and Ikeda M: "Structural characteristics fo the pedicle and its role in screw stability," Spine, 22, 2504-2510 (1997).
[26] Hasegawa K, Takahashi HE, Uchiyama S, Hirano T, Hara T, Washio T, Sugiura T, Youkaichiya M, and Ikeda M: "An experimental study of a combination method using a pedicle screw and laminar hook for the osteoporotic spine," Spine, 22, 958-962 (1997).
[27] Hasegawa K, Hommna T: "Morphologic evaluation and surgical simulation of ossification of the posterior longitudinal ligament using helical computed tomography with three-dimensional and multiplanar reconstruction," Spine, 22, 537-543 (1997).
[28] Hasegawa K, Homma T, Uchiyama S, and Takahashi H: "Osteosynthesis without instrumentation for vertebral pseudoarthrosis in the osteoporotic spine," J Bone Joint Surg, 79B, 452-456 (1997).
[29] Carreon LY, Ito T, Yamada M, Uchiyama S, and Takahashi HE: "Neocascularization induced by anulus and its inhibition by cartilage endplate," Spine, 22, 1429-1434 (1997).
[30] Uchiyama S, Hasegawa K, Homma T, Takahashi HE, and Shimoji K: "Ultrafine filexible spinal endoscope (myeloscope) and discovery of an unreported subarachnoid lesion," Spine, 23, 2358-2362 (1998).
[31] Kimura S, Uchiyama S, Takahashi HE, and Shibuki K: "cAMP-dependent long-term potentiation of nitric oxide release from cerebellar parallel fibers in rats," J Neurosci, 18, 8551-8558 (1998).
[32] Kimura S, Gomibuchi F, Ikezawa Y, Kaneko F, Uchiyama S, and Homma T: "Ossification of posterior atlantoaxial membrane," J Neurosurg , 89, 491 (1998).
[33] Hirano T, Hasegawa K, Washio T, Hara T, and Takahashi H: "Fracture risk during pedicle screw insertion in osteoporotic spine," J Spinal Disord, 11, 493-497 (1998).
[34] Hasegawa K, Homma T, Uchiyama S, and Takahashi H: "Vertebral pseudoarthrosis in the osteoporotic spine," Spine, 23, 2201-2206 (1998).
[35] Yamazaki A, Homma T, Uchiyama S, Katsumi Y, adn Okumura H: "Morphologic limitaions of posterior decompression by midsagittal splitting method for myelopathy caused by ossification of the posterior longitudinal ligament in the cervical spine," Spine, 24, 32-34 (1999).
[36] Uchiyama T, Tanizawa T, Muramatsu H, Endo N, Takahashi HE, and Hara T: "Three-dimensional microstructural analysis of human trabecular bone in relation to its mechanical properties," Bone, 25, 487-491 (1999).
[37] Uchiyama T, Tanizawa T, Ito A, Endo N, and Takahashi HE: "Microstructure of the trabecula and cortex of iliac bone in primary hyperparathyroidism patients with determined using histomorphometry and node-strut analysis," J Bone Miner Metab, 17, 283-288 (1999).
[38] Takano Y, Turner CH, Owan I, Martin RB, Lau ST, Forwood MR, and Burr DB: "Elastic anisotropy and collagen orientation of osteonal bone are dependent on the mechanical strain distribution," J Orthop Res, 17, 59-66 (1999).
[39] Kimura S, Watanabe K, Yajiri Y, Motegi T, Masuya Y, Shibuki K, Uchiyama S, Homma T, and Takahashi HE: "Cerebrospinal fluid nitric oxide metabolites in painful diseases," NeuroReport, 10, 275-279 (1999).
[40] Ito T, Honma T, and Uchiyama S: "Sciatica caused by cervial and thracic spinal cord compression," Spine, 24, 1265-1267 (1999).
[41] Hirano T, Burr DB, Turner CH, Sato M, Cain RL, and Hock JM: "Anabolic effects of human biosynthetic parathyroid hormone fragment (1-34), LY333334, on remodeling and mechanical properties of cortical bone in rabbits," J Bone Miner Res, 14, 536-545 (1999).
[42] Hasegawa K, Yamamoto N: "Nerve root herniation secondary to lumbar puncture in the patient with lumbar canal stenosis," Spine, 24, 915-917 (1999).
[43] Hasegawa K, Ogose A, Kobayashi H, Morita T, and Hirata Y: "Simultaneous anterior-posterior approach for excision of malignant paraspinal tumor and subsequent reconstruction technical note," J Neurosurg (Spine 2), 91, 236-240 (1999).
[44] Yajiri Y, Hunag LY: "Actions of endomorphins on synaptic transmission of Aσ-fibers in spinal cord dorsal horn neurons," J Biomed Sci, 7, 226-231 (2000).
[45] Kimura S, Gomibuchi F, Shimoda H, Ikezawa Y, Segawa H, Kaneko F, Uchiyama S, and Homma T: "Boomerang deformity of cervical spinal cord migrating between split laminae after laminoplasty," Eur Spine J, 9, 144-151 (2000).
[46] Imura K, Ishii Y, Yagisawa K and Matsueda M: "Postoperative ambulatory level after hip fracture in the elderly predicts survival rate," Arch Orthop Trauma Surg, 120, 369-371 (2000).
[47] Hirano T, Turner CH, Forwood MR, Johnston CC, adn Burr DB: "Does suppression of bone turnover impair mechanical properties by allowing microdamage accumulation ?," Bone, 27, 13-20 (2000).
[48] Hirano T, Burr DB, Cain RL, and Hock JM: "Chnages in geometry and cortical porosity in adult, ovary-intact rabbits after 5 months treatment with LY333334 (hPTH 1-34)," Calcif Tissue Int, 66, 456-460 (2000).
[49] Hasegawa K, Ikeda M, Washio T, and Hara T: "An experimental study of porcine lumbar segmental stiffness by the distraction-compression principle using a threaded interbody cage," J Spinal Disord, 13, 247-252 (2000).
[50] Watanabe K, Hasegawa K, and Takano K: "Anomalous vertebral artery-induced cervical cord compression causing severe nape pain," J Neurosurg Spine, 95, 146-149 (2001).
[51] Kimura S, Watanabe K, Yajiri Y, Uchiyama S, Hasegawa K, Shibuki K, and Endo N: "Cerebrospinal fluid nitric oxide metabolites are novel predictors of pain relief in degenerative lumbar diseases," Pain, 92, 363-371 (2001).
[52] Kimura S, Steinback GC, Watenpaugh DE and Gargens AR: "Lumbar spine disc height and curvature responses to an axial looad generated by a compression device compatible with pagnetic resonsnce imaging," Spine, 26, 2596-2600 (2001).
[53] Kawaji Y, Uchiyama S, and Yagi E: "Three-dimensional evaluation of lumbar disc hernia and prediction of absorption by enhanced MRI," J Orthop Sci, 6, 498-502 (2001).
[54] Ito T, Takano Y, and Yuasa N: "Type of lumbar herniated disc and clinical course," Spine, 26, 648-651 (2001).
[55] Hasegawa K, Abe M, Washio T, and Hara T: "An experimental study on the interface strength between titanium mesh cage and vertebra in reference to vertebral bone mineral density," Spine, 26, 957-963 (2001).
[56] Hasegawa K, Homma T, Chiba Y, Hirano T, Watanabe K, and Yamazaki A: "Effects of surgical treatment for cervical spondylotic myelopathy in patients >= years of age: a retrospective comparative study," J Spinal Disord Tech, 15, 458-460 (2002).
[57] Hasegawa K , Homma T: "One-stage three-dimensional correction and fusion: a multilevel posterior lumbar interbody fusion procedure for degenerative lumbar kyphoscoliosis," J Neurosurg Spine, 99, 125-131 (2003).
[58] Hasegawa K, Ogose A, Morita T, and Hirata Y: "Painful Schmorl's node treated by lumbar interbody fusion," Spinal Cord, 42, 124-128 (2004).
[59] Watanabe K, Hasegawa K, Uchiyama S, and Endo N: "Use of the scoliosis research society outcomes instrument to evaluate patient outcome in untreated idiopathic scoliosis patients in Japan Part I : conparison with nonscolisosis group: preliminary/limited review in a Japanese population," Spine, 30, 1197-1201 (2005).
[60] Watanabe K, Hasegawa K, Hirano T, Uchiyama S, and Endo N: "Use of the scoliosis research society outcomes instrument to evaluate patient outcome in untreated idiopathic scoliosis patients in Japan. Part II : relation between spinal deformity and patient outcomes," Spine, 30, 1202-1205 (2005).
[61] Watanabe K, Hasegawa K, Hirano T, Endo N, Yamazaki A, and Homma T: "Anterior spinal decompression and fusion for cervical flexion myelopathy in young patients," J Neurosurg Spine, 3, 86-91 (2005).
[62] Kimura S, Hesselink JR, Garfin SR, Kawaji Y, Hasegawa K, and Hargens AR: "Axial load-dependent cervical spinal alterations during simulated upright posture: a comparison of healthy controls and patients with cervical degenerative disease," J Neurosurg Spine, 2, 137-144 (2005).
[63] Uchiyama T, Kawaji Y, Moriya K, Kohda H, and Denda H: "Two cases of odontoid fracture in preschool children," J Spinal Disord Tech, 19, 204-207 (2006).
[64] Sawakami K, Robling AG, Ai M, Pitner ND, Liu D, Warden SJ, Li J, Maye P, Rowe DW, Duncan RL, Warman ML, and Turner CH: "The Wnt co-receptor LRP5 is essential for skeletal mechanotransduction but not for the anabolic bone response to parathyroid hormone treatment," J Biol Chem, 281, 23698-23711 (2006).
[65] Watanabe K, Hasegawa K, Hirano T, Uchiyama S, and Endo N: "Evaluation of postoperative residual spional deformity and patient outcome in idiopathic scoliosis patients in Japan using the scoliosis research society outcomes instruments," Spine, 32, 550-554 (2007).
[66] Hasegawa K, Homma T, and Chiba Y: "Upper extremity palsy following cervical decompression surgery results from a transient spinal cord lesion," Spine, 32, E197-E202 (2007).
[67] Hasegawa K, Homma T, Hirano T, Ogose A, Hotta T, Yajiri Y, Nagano J, adn Inoue Y: "Margin-free spondylectomy for extended malignant spine tumors. Surgical technique and outcome of 13 cases," Spine, 32, 142-148 (2007).
[68] Hosaka N, Kimura S, Yamazaki A, Wang X, Denda S, Ito T, Hirano T, and Endo N: "Significant correlation between cerebrospinal fluid nitric oxide concentrations and neurologic prognosis in incomplete cervical cord injury" Euro Spine J published online (2007)

07232007

2007-07-24T20:54:30+09:00

** 07232007 * #1 [CP myelopathy] 50代F - S50 hipの手術の後歩いてない、電動車いす　アテトーゼは強くない - 昨年両上肢しびれ、現在食事スプーン上肢MMT 2 - MRI C2/3, 3/4 狭窄 - op plan 除圧固定 - C2から最低C4まで固定。骨が固いのでlateral mass screwも選択肢 * #2 [trauma]　87M - サイドボードが倒れて頚部にあたる。右上肢びりびり - plain X-9 C6/7の開大 facet fx - MRI C7 fx PVMの血腫　discの突出なし - 後方固定術 PS C5-7　 - ASFも選択肢 * #3 [anomaly]　 -　93年　胸椎くも膜嚢腫の診断でくも膜嚢腫摘出 -　最近　右TA以下の麻痺がすすむ -　診断　脊髄ヘルニア　初回もこれか？ - 　手術　後方は癒着必発、側方のpedicleを切除して側方から硬膜にアプローチ - 　liquorrhea必発　はじめからspinal drainageする * #4 [頸椎] [[07092007]]の#8 - OPLL C3-6 ASF C2/3のOPLLの残存あり - C3除圧 C2-4 lateral mass screw C2はlamina screw * #5 [trauma] 65M - traffic accident 両肩の挙上できず - x-p C4/5 flex C4前すべり、extでもどる　DFS - 手術計画 #1 後方固定 lateral mass or PS, VAの障害は? - #2 ASF * #6 [porosis] - 去年秋受傷　コルセット　L１偽関節　症状足のしびれ - X-p extでL1 cleft Denis type B - 手術後方短縮固定　Th11,12 L2 PS 正中にhook - 短縮すると硬膜がたごまる * #7 [変性] - L4すべり、4/5外側ヘルニア L4症状 - 右のpedicleが低形成 - 手術　低形成部はlamina hookを用いてPLIF * #8 [trauma] 17M - ラグビーのスクラム、四肢に電気はしる、示指中指しびれ - X-p C5/6ヘルニアあり。 DFS - 手術　ASF+plate * #9 [変性] 62 - ６年前 C4-6 ASF+plate ２年して抜釘 - 7/19から体幹の痛みのあと左上肢痛、左GP 0kg - MRI C5/6 non union, C6/7, 7/1 foraminal stenosis C3 T2 high - 骨間筋のatrophy+ 以前から潜在的に症状でていたか？ - foraminotomy, C3 拡大 * #10 [変性] 79 M - 過去に２回腰椎椎弓切除 - IMC 20m 右大腿前面の痛み、下腿外側の痛み - X-p 5/s , L2-上の可動性がない - op L2/3,3/4,4/5 PLIF - 可動部位がなくなる

07092007

2007-07-10T09:30:43+09:00

** 07092007 * #1 [後弯] 18 achondroplasia - 1st op 胸腰椎移行部の前後合併手術(ASF) - 固定の頭側で後弯(147度)の進行、麻痺の出現 - 後弯の手術の問題点（小児の後弯は進行しやすい） -- 後弯の頂点では、軟部組織の余裕がない後方固定難　対策形成 tissue expander -- その他の方法　後方はいじらず、前方のimplantを抜釘して,前方除圧strut bone graft * #2 [tumor] 90 F - 10年前胸椎部のmeningiomaのop F/Uあまりされておらず - 再発した。手術適応は？年齢 * #3 [CSM] 56F -　初発症状は胸部のびりびり、循内はn.p. 数日の経過であるけず -　MRI C5/6 stenosis 胸椎 n.p. -　頸椎拡大術にて症状改善 - 　上肢症状の全くないCSM * #4 [CSM] 69 F CSM - C4/5 stenosis - APで変性側弯あり * #5 [] 76 M 右上肢痛 - 後弯　& foraminal stenosis - 手術　foraminotomy して改善なければASF * #6 [] 63F - 半年前から右上肢筋力低下ADL障害なし - 右deltoid biceps 5- 感覚障害なし。GP 28/35kg 10sectest 30 以上　下肢の反射更新なし -　MRI 4/5 5/6 stenosis - 病因　右のC5髄節motorのみ　C4/5で前角or 前根のみの障害か - op 適応?　手術なら後方拡大、foraminotomy * #7 [] ? - L5分離部の後方所圧 - conjoined nerve rootあり * #8 [OPLL] - 頸椎OPLLで3椎間前方除圧固定済 - C2/3のOPLLが発育　MRI 2/3 stenosis 足がつっぱって歩きにくい - 手術 C2/3 ASF 術中所見　硬膜骨化あり　骨化巣をとるとくも膜がみえる - 術後画像で頸髄の腫大あり。　後方拡大固定するか？ * #9 [] 63 F - 半年続く後ろ頚部痛　左回旋しにくい　CTでlt C1/2 facet OA - 側方からfacet block - 手術 C1/2 C1-2 後方固定 * #10 [] - L3/4 ,4/5 PLIF手術後 L1,2 fx 1/2 disc deg - 手術 L2 PSO - 術後麻痺あり　後方のscarがPSOでたごまる - 手術　硬膜形成術 - PSOの20%にSEPで波の乱れあり, wake upしていた。 * #11 [] 先天性後側弯症 - - - * #12　[infection] 73M - 昨年　L5分離すべりに椎弓切除　感染(菌不明) open Txで改善 - 今年両下肢痛 AAAがあり5/29 胸部外科で手術　その後腰痛　MRIで腰部の感染 - DM angina あり - 方針　PNして、菌の同定が先決 * #13 [] DSA - DSAでO-Th固定し歩行不能が歩行できるようになった - その後Oのscrewのゆるみ。CTでOのrodがOの中へ -　抜釘予定

06112007

2007-06-12T12:23:44+09:00

** 06112007 * #1 [infection] 57M - 昨年秋交通事故他院で下肢骨折骨接合その後リハビリの病院へ転院。 -11月頃39℃の発熱。L3/4 discitis 穿刺や血液培養未ファーストシンのdivで解熱 - ４月中旬初診。腰痛、両下肢萎縮。抗生剤を中止しても発熱、CRP上昇なし - MRIではL3/4 rim enhancement, 馬尾の圧迫なし - 手術後方固定 PS L1,2,5,S1 前方固定 L3/4 後日抜釘予定 * #2 [porosis]　57M - H17転倒後Th12圧迫骨折　H19/4 右下肢麻痺、痛み、尿漏れ - Th12 偽関節 epiconusの障害か - 手術 Th12 後方骨切り（椎弓根切除), Th10,11,L1,L2固定 * #3 []　78 M L4/5 PLIFの既往あり -　H18末転倒 L1Fx ハードコルセット -　MRI L1 burst fx, cleftなし。10分歩くと腰痛 -　手術　まず前方固定L1 cage、それからTh12-L2後方固定 - 固定の間L3は今後どうなるか * #4 [CP] 42 F CP myelopathy - H7 C3 laminoplasty - 独歩 ADL自立頚部痛 - MRI C3 cord T2 high, C6/7 stenosis C1の後弓が小さい - VAは右が優位 - 手術 O-Th1 固定, C6,7 laminectomy　骨移植の場所少ない - Halo 2Mの予定 * #5 [] 81 F - H18/8 転倒 Tibia fx - ORIF - 3月から左以遠のしびれ、反射亢進 - 多発性脊椎骨折, CYLあり - 手術 CYLの部分のみ除圧 * #6 [] 63F - L3/4,4/5 PLIF、頸椎前方固定既手術 - L1圧迫骨折 - 手術 L2 PSO * #7 [] 68F - [[05282007]] の　#1と同じ症例 - 現在神経内科にて化療。ステロイドパルス、エンドキサン * #8 [NF] 24 NF , dystrophic, 後弯 - 後方固定後 rod 折損 - salvage 手術　PS 入れ替え後方固定　前方には脛骨から採骨し、骨移植

05282007

2007-06-08T10:22:52+09:00

** 05282007 * #1 [] 68F - ３週前から歩行障害、立てない - 胸椎MRI　Th2/3 disc level , cordの腹側にT1/T2 lowのmassあり　一見ヘルニア - 造影MRIでmassは造影、cordの背側も一部造影される - ヘルニアは否定的 - myelo-CT/MRIでもmassが硬膜外か内か不明 - 造影CTで大動脈弓の壁に不整あり multifocal fibrosis? - L/D CRP 3代、P-ANCA陽性 - 手術所見 Th1-3 laminectomy, Th1levelの正常な硬膜を切開していくとTh2levelは硬膜の肥厚あり - frozen sectionにだすと、硬膜に炎症細胞浸潤あり　硬膜は縫合できずfascia patch 　病理診断は非特異的炎症でWegenerではないとのこと。P-ANCA関連肥厚性硬膜炎？ - tentative diagnosis : ANCA 関連 Wegener 肉芽腫症 - 今後　膠原病科で免疫療法 or ステロイド療法 - - MR imaging findings of spinal dural involvement with Wegener granulomatosis. - AJNR Am J Neuroradiol. 2002 Oct;23(9):1603-6. [[pubmed>http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=12372756&query_hl=6&itool=pubmed_docsum]] * #2 [tumor] 31F - 頚部痛、左腋窩から肘のいたみ -MRIでC6-Th3 背側硬膜外腫瘍 T1low T2 ややhigh Gd + 一部傍椎体にmassあり -Th2 hemilaminectomyで生検　病理はHodgkin病 - 血液内科で化学療法6コース - 化学療法後のMRI 脊柱管内の腫瘍消失。傍椎体のmass一部残存 - 現在残存腫瘍に対して照射中