Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
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We reviewed the results of 35 operations performed on 29 patients with osteonecrosis of the femoral head in which a pedicle iliac bone was utilized. The average age was 35 years (17-62). There were 28 patients of stage 2 and 7 of stage 3; there were 17 type C-1 hips and 18 type C-2 hips. ⋯ Thirteen of 17 hips did not show collapse in patients with type C-1 necrosis, whereas 15 of 18 hips developed collapse in patients with type C-2 necrosis. When the bone graft was inserted in the anterolateral direction of the femoral head, incidence of collapse was reduced. These results indicate that deep circumflex iliac pedicle bone graft may be indicated for stage 2 type C-1 necrosis, and that the penetration of the graft into the anterolateral aspect of the lesion is essential for the procedure to succeed.
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To investigate the nerve root distribution of deltoid and biceps brachii muscle, compound muscle action potentials (CMAPs) were recorded intraoperatively following nerve root stimulation in cervical spondylotic myelopathy. A total of 19 upper limbs in 12 patients aged 55-72 years (mean, 65.5 years) with cervical spondylotic myelopathy were examined. CMAPs were recorded from deltoid and biceps brachii muscle following C5 and C6 root stimulation. ⋯ The C5 root predominantly innervated both deltoid and biceps brachii in patients with symptomatic cord lesions at the C4-C5 intervertebral level compared to patients with symptomatic cord lesions at the C5-C6 intervertebral level. Although no patients sustained postoperative radiculopathy in our study, severe weakness and unfavorable recovery are expected when the C5 root in patients with C4-C5 myelopathy is damaged. From the electrophysiological aspect, C4-C5 cord lesions are likely to be a potential risk factor for postoperative shoulder muscle weakness in patients with compressive cervical myelopathy.
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Review Case Reports
Transient talipes equinus deformity of bilateral lower limbs following malignant hyperthermia: a case report and review of literature.
Malignant hyperthermia (MH) is a potentially fatal disease triggered by general anaesthesia. Four cases of compartment syndrome complicating MH have been reported. ⋯ MRI revealed high intensity in the bilateral soleus muscles but not in the gastrocnemius muscles. We discuss the possible mechanisms of the deformity of the lower limbs after the MH crisis.
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Multicenter Study
Nationwide survey on complications of spine surgery in Japan.
The Japan Spine Research Society carried out a nationwide survey on complications of the spine, enrolling a total of 16 157 patients who had undergone spine surgery in 196 institutes in the 1-year period from January to December 2001. Diseases, surgical procedures, and complications were surveyed in detail. Forty-nine percent of patients were aged 60 years or older, which was remarkably increased in comparison with the percentage reported by the 1994 survey (37.3%). ⋯ Posterior lumbar interbody fusion has been increasingly used in cases of lumbar degenerative disease. Complications of spinal surgery were reported in 1383 patients (8.6%). The incidence of complications associated with instrumentation surgery was 12.1%, being twice as much as that associated with noninstrumentation surgery (6.8%).
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The variation in symptoms of spinal nerve root damage may be caused by the difference of the size of damaged nerve fiber or difference between the mechanical influence and some chemical factors. We studied the relative vulnerability of small versus large myelinated fibers to a focal compression and/or an application of nucleus pulposus. We prepared the mechanical compression model by clipping the nerve root and the nucleus pulposus model by applying autologous nucleus pulposus on the nerve root in a rabbit and evaluated nerve root damage with respect to its fiber diameter. ⋯ Histologic study showed the number of damaged small fibers increased significantly in the compression group compared with sham after 7 days. However, in the NP group the number of damaged fibers did not increase compared with sham. In conclusion, large myelinated nerve fiber was damaged earlier than small myelinated nerve fiber by compression, while nerve fiber damage caused by only the nucleus pulposus had no relation to nerve fiber size.