Biomedical subjects

Hisashi Yoshimoto

Publications and source records attributed to Hisashi Yoshimoto.

7 recordsLinked to original sources

PubMed2007

Discal cysts of the lumbar spine. Report of five cases.

Discal cysts are rare lesions that can result in refractory sciatica. Because they are so rare, their exact origin and details of the clinical manifestations are still unknown. The authors report on five men treated for discal cysts. The mean age of the patients at the time of the surgery was 32 years (range 25-38 years). All patients suffered from lower-extremity pain and the results of the straight leg-raising test were positive in all cases. Three patients reported motor weakness and four had sensory disturbance-symptoms similar to those found in patients with lumbar disc herniation. Magnetic resonance imaging demonstrated spherically shaped extradural lesions of various sizes with low and high signal intensities on T1- and T2-weighted images, respectively. Discography revealed obvious communication between the cyst and the intervertebral disc with reproducible leg pain in all patients. All patients underwent posterior decompression and excision of the cysts either with or without additional discectomy. The radicular symptoms were remarkably improved in all patients immediately after surgery, and no recurrent lesions were noted during follow up.

Adult↗

PubMed2007

Deep vein thrombosis due to migrated graft bone after posterior lumbosacral interbody fusion. Case report.

The authors report the case of an 83-year-old woman with refractory sciatica attributable to isthmic spondylolisthesis at L-5. Her symptoms were successfully improved after posterior lumbar interbody fusion (PLIF) at L5-S1; however, notable swelling in her left leg suddenly developed 2 days postoperatively. Anterior migration of a fragment of bone graft was demonstrated on computed tomography scanning, and there was obvious occlusion of the left common iliac vein (CIV) on magnetic resonance venography. Ultrasonography revealed a thrombus in the left CIV at the site of compression. To prevent a pulmonary embolism during manipulation of the affected vein, an inferior vena cava filter was placed just before excision of the migrated bone fragment. The swelling in the patient's leg subsided quickly after the surgery, and she was treated with heparin and warfarin to prevent recurrent deep vein thrombosis (DVT). Six months after the second surgery, complete restoration of blood flow to the left CIV and no recurrence of DVT were demonstrated on magnetic resonance venography. Especially in elderly patients with degenerative disc disease, excessive curettage and impaction of disc materials during the PLIF procedure may cause migration of bone graft fragments. Surgeons should be aware of the possible vascular complications of PLIF.

Aged, 80 and over↗

PubMed2005

Spinopelvic alignment in patients with osteoarthrosis of the hip: a radiographic comparison to patients with low back pain.

STUDY DESIGN: A retrospective, age- and sex-matched radiographic study. OBJECTIVES: To investigate the spinopelvic alignment in patients with osteoarthosis of the hip (HOA) and those with low back pain (LBP) and to determine the characteristics and differences in both groups. SUMMARY OF BACKGROUND DATA: Hip-spine syndrome, first described by Offierski and MacNab, is quite an important pathology when treating patients with pain in their low back and lower extremities. However, despite it being a well-known entity, few papers have adequately investigated and assessed the spinopelvic alignment in patients with hip-spine syndrome. METHODS: Sagittal and coronal spinopelvic alignments were investigated in 150 patients with HOA and 150 with LBP using radiographs of the whole spine in both anteroposterior and lateral views. Parameters measured in this study were lumbar lordosis (LL), sacral slope (SS), the shift of the sagittal C7 plumb line, pelvic incidence (PI), and pelvic tilt (PT) on the lateral radiographs. On the anteroposterior (AP) films, lumbar scoliosis, pelvic obliquity, leg length discrepancy, the shift of the coronal C7 plumb line, and Sharp angle were measured. These parameters were compared between the two groups. In patients with HOA, the relationships between Sharp angle and other parameters were also analyzed to clarify the possible influence of sagittal and coronal spinopelvic alignments on HOA without acetabular dysplasia. RESULTS: LL, SS, PI, and PO were found to be less in patients with LBP compared with those with HOA, and there was no significant difference in LS between the two groups. PI was significantly greater in HOA patients and strongly correlated to PT, SS, and LL (i.e., as the PI increased so did the PT, SS, and LL). Sharp angles were also significantly greater in HOA patients and strongly correlated to age, LL and SS (i.e., as Sharp angles increased so did LL and SS); however, age decreased in the hip patients. CONCLUSIONS: These findings suggest that higher PI in the younger individual may contribute to the development of HOA in later life without both lumbar kyphosis and acetabular dysplasia because of the anterior uncovering of the acetabulum. More investigation will be expected to analyze the spinopelvic alignment in patients with hip spine syndrome.

Acetabulum↗

PubMed2005

A prospective evaluation of anesthesia for posterior lumbar spine fusion: the effectiveness of preoperative epidural anesthesia with morphine.

STUDY DESIGN: A prospective, randomized, single-blinded study. OBJECTIVES: To prospectively compare the anesthesia for posterior lumbar spinal fusion between the age- and gender-matched groups with and without preoperative epidural anesthesia with morphine. SUMMARY OF BACKGROUND DATA: To reduce the blood loss, hypotensive anesthesia is frequently used in the spinal fusion. However, in spite of administration of the hypotensive agents, inadequate analgesia during operation often causes unfavorable and unexpected elevation of blood pressure resulting in excessive bleeding. As well, intractable wound pain sometimes occurs after spinal fusion due to inadequate analgesia during surgery. METHODS: Forty cases of posterior lumbar spinal fusion were investigated prospectively. Twenty patients underwent preoperative epidural anesthesia with morphine and sedation by continuous intravenous administration of propofol but without administration of any kind of anesthetics, including intraoperative and/or postoperative epidural anesthesia (Group E). Another 20 patients underwent inhalation general anesthesia with sevoflurane and intermittent intravenous administration of fentanyl without any regional block (Group F). In these groups, dynamics and average mean blood pressure during surgery, blood loss during surgery, postoperative requirement of analgesics, the visual analogue scale, and accuracy of neurologic evaluation immediately after surgery were analyzed. RESULTS: The average mean blood pressure during surgery was significantly lower in Group E than Group F: 57.1 mm Hg and 72.8 mm Hg, respectively. In addition, the dynamics of blood pressure were more stable in Group E than Group F. The blood loss during surgery was significantly less in Group E than in Group F: 546 g and 631 g, respectively. The patients of Group E required analgesics after surgery less frequently, and the rating on the visual analogue scale was significantly lower in Group F on the first, second, and third days after surgery. It was difficult to evaluate the neurologic status accurately in 5 patients of Group F because of the inadequate emergence immediately after surgery. There were no patients in Group E whose neurologic status was unclear because of the paralysis caused by epidural anesthesia. CONCLUSIONS: To combine preoperative epidural anesthesia with other anesthetic procedure for spinal fusion contributes to maintain more stable hypotension during surgery. As a result, it will be possible to lessen the bleeding during surgery. In addition, the postoperative pain was easily controlled with administration of fewer analgesic agents in patients who underwent the epidural anesthesia. The effectiveness of pre-emptive analgesia should be emphasized to diminish the postoperative pain.

Adult↗

PubMed2005

Spinal reconstruction using a cervical pedicle screw system.

Although the cervical pedicle screw system is considered the most effective instrumentation for posterior cervical spine surgery, reports on clinical application are limited because of the unresolved and inherent risk of neurovascular complications. The purpose of this study is to retrospectively evaluate the accuracy of placement and clinical effectiveness of the cervical pedicle screw. The cases of 26 patients were investigated. The average followup was 20 months. All but one patient had simultaneous decompression and fusion of various extent. In these cases, screw placement, alignment of the fused segment, fusion rate, neurologic improvement, and complications were assessed. Using an image intensifier, 134 screws were inserted. Five screws (3.7%) completely perforated and 10 (7.4%) partially perforated. The complete perforations occurred in the first 10 patients. Except for two patients with metastasis, bony union was obtained in all patients without loss of correction. Neurologic impairment also was improved in all patients, and no complications associated with the cervical pedicle screw were seen. Clinical results of the cervical pedicle screw system were excellent with few complications. However, there is the possibility of screw perforation, which could cause neurovascular complications. Increased accuracy of screw insertion is needed to make this instrumentation safer.

Adult↗

PubMed2005

Pyogenic spondylitis in the cervicothoracic junction with high-positioned aortic arch. Case report and review of the literature.

The authors report the case of an 87-year-old woman who suffered from T1-2 pyogenic spondylitis resulting in progressive and severe paraplegia. Debridement and anterior manubrium-splitting fusion were difficult because a high-positioned aortic arch was very close to the infectious lesion. Because adequate intravenous antibiotic agents had nearly resolved the inflammation, the authors undertook anterior debridement and posterior fusion that involved costotransversectomy and the placement of a posterior cervical pedicle screw fixation system. At 1.5 years postoperatively, there were no signs of recurrent infection. Solid osseous union was documented, and the patient's paraplegia had improved. A high-positioned aortic arch will likely interfere with an anterior approach to the cervicothoracic junction. If adequate antibiotic therapy has successfully controlled the spinal infection, anterior debridement and posterior fusion can be conducted in cases involving such anatomical limitations.

Aged↗

PubMed2004

A retrospective radiographic analysis of subaxial sagittal alignment after posterior C1-C2 fusion.

STUDY DESIGN: Subaxial sagittal alignment following atlantoaxial (A-A) posterior fusion was investigated retrospectively in patients with A-A subluxation. OBJECTIVES: To evaluate the association between A-A fusion angle and postoperative subaxial sagittal alignment and to determine the optimal fusion angle for preservation of physiologic subaxial alignment. SUMMARY OF BACKGROUND DATA: A-A posterior fusion has been used for patients with A-A instability and provided satisfactory clinical results. However, there are patients showing unexpected development of subaxial kyphosis after surgery. The reasons for subaxial kyphosis after A-A fusion remain unclear. METHODS: Seventy-six patients with A-A subluxation who underwent several types of posterior A-A fusion were involved. There were 46 women and 30 men. The causes of A-A subluxation were rheumatoid arthritis in 47, trauma in 16, os odontoideum in 8, and unknown in 5. The methods of posterior fusion consisted of Magerl procedure with posterior wiring in 51, Brooks wiring in 18, and Halifax clamp in 7. Angles at C1-C2, C2-C7, and C1-C7 in the neural position were measured before surgery and at the final follow-up to find out any association between postoperative C2-C7 angle and the other radiologic parameters. The association between O-C1 range of motion and C2-C7 angle was also investigated. RESULTS: The mean angles of C1-C2, C2-C7, and C1-C7 before surgery were 18.4 degrees, 14.5 degrees, and 32.9 degrees, respectively. Those at the final follow-up were 26.0 degrees, 5.5 degrees, and 31.5 degrees, respectively. These results indicated that C1-C2 fixation in a hyperlordotic position led to a subaxial kyphosis after surgery. Statistics showed that there was a linear association between the C1-C2 lordotic fixation angle and the C2-C7 kyphotic angle. CONCLUSIONS: Surgical fixation of A-A joint in a hyperlordotic position will lead the lower cervical spine to a kyphotic sagittal alignment after surgery. To maintain the physiologic sagittal alignment of the subaxial cervical spine, C1-C2 should not be fixed in a hyperlordotic position.

Atlanto-Axial Joint↗