記述言語：日本語   出版者・発行元：(株)メディカ出版  

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

症例は48歳女性で、前日からの頭痛を主訴とした。頭部CTでくも膜下出血を脳底槽からシルビウス裂に認め、やや左優位であった。脳血管撮影では右内頸動脈・左内頸動脈・左中大脳動脈・左前大脳動脈に多発脳動脈瘤を認めた。造影MRIによるvessel wall imagingで破裂瘤は右内頸動脈前壁動脈瘤の可能性が高いと判断し、同日開頭クリッピング術を行ったが、術中破裂所見は認めず動脈瘤を切除した。翌日に左側開頭クリッピング術を行い、左前大脳動脈瘤を破裂瘤と判断し、中内脳動脈瘤と左内頸動脈瘤もクリッピングした。初回手術7日後に脳血管撮影にて各動脈瘤の消失を確認し、遺残した高次脳機能障害のリハビリテーション目的に第76病日に転院した。切除した右内頸動脈瘤の病理所見では脳動脈瘤壁に炎症細胞の浸潤および毛細血管の増生を認め、造影された原因と考えられた。

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記述言語：日本語   出版者・発行元：(一社)日本脊髄外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Internal carotid artery (ICA) ligation for placing a high-flow extracranial-intracranial (EC-IC) bypass is used in patients with aneurysms on the cavernous portion of the ICA. Recanalization and rupture after proximal ICA ligation can occur. We present four patients who underwent endovascular distal ICA occlusion and report our surgical technique and treatment results. We ligated the ICA to place an EC-IC bypass using a radial artery (RA) graft. Failure to obtain spontaneous occlusion in the distal region required endovascular treatment an average of 219 days later. A guide catheter was placed in the common carotid artery, a guide or distal access catheter was introduced in the RA graft from the external carotid artery, and a microcatheter was navigated into the cavernous aneurysm through the RA graft. Using detachable coils, endovascular ICA occlusion was from just distal to the aneurysmal neck to a site proximal to the origin of the ophthalmic artery. Aneurysmal occlusion was completed by endovascular occlusion of the distal ICA. Complications were RA graft stenosis and transient consciousness disturbance due to local subarachnoid hemorrhage. Outpatient follow-up for a mean of 109.5 months revealed no recurrences. Distal occlusion of the ICA through the implanted RA graft is simple and presents a low risk for cerebral infarction due to thrombus formation during the procedure. To treat cavernous carotid aneurysms that do not disappear after placing the EC-IC bypass after ICA ligation at the aneurysmal neck, we offer our procedure as a treatment option.

DOI： 10.2176/jns-nmc.2022-0303

PubMed

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Transarticular screw fixation is a method for posterior cervical fixation. It is ergonomic because neither connectors nor rods are needed. Biomechanical studies have shown that its fixation force is not inferior to that of lateral mass screws. More information is needed on the surgical outcome of procedures using bioabsorptive screws. We investigated the long-term surgical and radiological outcomes of posterior cervical decompression and fusion using bioabsorptive screws for transarticular fixation.Of 10 patients who underwent cervical spine transarticular fixation using bioabsorptive screws, nine presented with cervical degenerative spondylosis and one with a traumatic cervical spine injury. The mean postoperative follow-up period was 57.1 months. Transarticular screw fixation was successful in all 10 patients; no intraoperative complications were encountered. Bilateral screw breakage was discovered in a patient with cervical spine instability and associated dystonia due to cerebral palsy; there was no symptom deterioration, facet joint breakage, or instability exacerbation. Facet fusion was obtained in the nine other patients. At the patients' last visit, their clinical symptoms were significantly improved. Whole cervical spine alignment (-4.21 ± 7.2 to -5.2 ± 8.7) and the fused segment angle (mean, -0.1 ± 9.9 to -1.2 ± 13.7) did not significantly worsen postoperatively (mean: -0.1 ± 9.9 to -1.2 ± 13.7). Transarticular fixation using bioabsorptive screws is safe and associated with good long-term outcomes. In patients with exacerbation of local instability after posterior decompression, additional transarticular fixation using bioabsorbable screws is a treatment option.

DOI： 10.2176/jns-nmc.2022-0215

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Posterior inferior cerebellar artery (PICA) infarction can lead to ischemic stroke at the lateral part of the medullary oblongata. PICA dissection can also elicit an ischemic event in this region but its detection on radiological images is difficult due to the small diameter of the vessel. We report a 48-year-old male with Wallenberg syndrome due to PICA dissection, which was difficult to diagnose on first admission. He reported sudden-onset sensory disturbance on the right side of his face, ataxic gait, and headache. Brain magnetic resonance imaging (MRI) revealed a fresh cerebral infarct in the right lateral medulla oblongata. Serial MRI and magnetic resonance angiography (MRA) performed at the time of his admission failed to demonstrate cerebral vessel abnormalities. MRI study performed 18 months after the attack revealed a fusiform aneurysm on the lateral medullary segment of the PICA; its site was extremely close to the cerebral infarct. We concluded that the infarct was due to PICA dissection because it was sudden onset of the symptom at the event and the lesion enlarged dissecting aneurysm located to be coincident with symptoms of Wallenberg syndrome. The aneurysm was trapped, and an occipital artery-PICA bypass was placed. At the latest follow-up, one year after the operation, he manifested no neurological symptoms.Imaging findings at the time of his first admission indicated that the PICA was intact in this patient with Wallenberg syndrome attributable to PICA dissection, which obscured on imaging studies performed at symptom onset and was diagnosed later. However,18 months later, MRI revealed enlargement of an aneurysm at the site of the dissection. A cerebral infarct in the PICA territory in patients with headache may be indicative of PICA dissection.

DOI： 10.1272/jnms.JNMS.2024_91-101

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We compared the treatment satisfaction of patients who had undergone surgery for tarsal tunnel syndrome (TTS) and carpal tunnel syndrome (CTS). We enrolled 44 patients in this study; 23 were operated for CTS and 21 for TTS. All patients had received surgery under a microscope and under local anesthesia. Using the numerical rating scale (NRS) for numbness/pain (range 0-10) we compared their preoperative outcome expectations with their satisfaction with our treatment 6 months after the operation. We also recorded their pre- and postoperative EuroQol 5-dimension 5-level (EQ-5D-5L) scale for their health-related quality of life (QOL). The subjective assessment of their QOL showed that it was significantly lower in TTS- than CTS patients both pre- and postoperatively. Six months after the operation, the NRS for symptoms and the (EQ-5D-5L) scale for the QOL were significantly improved in TTS- and CTS patients; however, these scores were significantly better after CTS- than TTS surgery. Also, the postoperative NRS was significantly lower in the CTS- than the TTS patients. Our comparison of the patients' expected- and actual surgical outcome showed that the result was better than expected after CTS- and TTS surgery; in CTS patients the difference was significant. Overall, CTS- were more satisfied than TTS patients with the treatment outcome. Satisfaction with the treatment was greater after CTS- than TTS surgery. TTS- experienced less symptom relief than CTS patients although the actual- exceeded the expected outcome in patients operated for TTS.

DOI： 10.2176/jns-nmc.2022-0245

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Pleomorphic adenomas tend to arise in the salivary glands. They are rare and histologically benign but can result in distant metastasis, and their characteristics need further investigation. We report a case of locally recurring benign primary palatal pleomorphic adenoma that resulted in spinal metastases and review the relevant literature. CASE REPORT: A 58-year-old woman had undergone surgery for a palatal pleomorphic adenoma 22 years earlier and 6 subsequent operations for local recurrences. During follow-up, metastases to multiple organs, including the spine, were diagnosed and 4 CyberKnife treatments were performed. She suffered right flank pain and slight paralysis of the right leg; radiological findings showed a growing metastatic spinal tumor. She underwent removal of a thoracic vertebral tumor and posterolateral fusion. Postoperatively, her symptoms improved. Histopathological analysis indicated a pleomorphic adenoma and no evidence of malignancy. Although there was no local recurrence, 23 months after surgery, a fifth CyberKnife procedure was performed for a growing salivary gland tumor and she is currently being followed up. CONCLUSION: We described a rare case of benign pleomorphic adenoma that metastasized to the spine. Long-term follow-up for recurrence and metastasis is required for patients with benign pleomorphic adenoma.

DOI： 10.1272/jnms.JNMS.2023_90-101

PubMed

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The morphology of vertebral artery (VA) dissections can change in the clinical course. A 58-year-old female with a 2-week headache was diagnosed with left VA dissection. Hemodynamic stress on the right VA detected on 4D flow MRI scans resulted in increased wall shear stress but the vessel was morphologically unchanged. Subsequent MRA revealed right VA dissection. Her bilateral dissections were treated conservatively and no neurological abnormality developed. Serial 4D flow MRI may be useful for observing morphological changes in VA dissections and help to clarify the mechanism(s) underlying VA dissections.

DOI： 10.1007/s00701-022-05333-4

PubMed

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Low back pain (LBP) from superior or middle cluneal nerve entrapment has been addressed surgically. We recorded patient satisfaction with this treatment. METHODS: We included 22 consecutive patients who had undergone surgery for unilateral cluneal nerve entrapment (superior: n = 17, middle: n = 5). The numerical rating scale (NRS) for LBP, the Oswestry Disability Index (ODI) score, and the EuroQOL 5-dimension, 5-level (EQ-5D-5L) scale before and 6 months after the operation were compared. Using these scores, the treatment outcome was compared with the patients' preoperative expectations. RESULTS: LBP was ameliorated in all 22 patients; their NRS, ODI, and EQ-5D-5L were significantly improved after surgery. Surgical satisfaction based on the postoperative NRS scores was recorded as 8.8 ± 1.1 (range 7-10). While the postoperative was significantly better than the expected NRS, the postoperative ODI was significantly higher than expected by the patients (both: p < 0.05). There was a moderate correlation between the postoperative NRS and ODI and postoperative patient satisfaction. CONCLUSION: Patient satisfaction with the surgical result was rated as acceptable.

DOI： 10.1007/s00701-022-05344-1

PubMed

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記述言語：日本語   出版者・発行元：(株)中外医学社  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Tarsal tunnel syndrome (TTS) is a common entrapment syndrome whose diagnosis can be difficult. We compared preoperative magnetic resonance imaging (MRI) and operative findings in 23 consecutive TTS patients (28 sides) whose mean age was 74.5 years. The 1.5T MRI sequence was 3D T2* fat suppression. We compared the MRI findings with surgical records and intraoperative videos to evaluate them. MRI- and surgical findings revealed that a ganglion was involved on one side (3.6%), and the other 27 sides were diagnosed with idiopathic TTS. MRI visualized the nerve compression point on 23 sides (82.1%) but failed to reveal details required for surgical planning. During surgery of the other five sides (17.9%), three involved varices, and on one side each, there was connective tissue entrapment or nerve compression due to small vascular branch strangulation. MRI studies were useful for nerve compression due to a mass lesion or idiopathic factors. Although MRI revealed the compression site, it failed to identify the specific involvement of varices and small vessel branches and the presence of connective tissue entrapment.

DOI： 10.2176/jns-nmc.2022-0118

PubMed

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記述言語：日本語   出版者・発行元：(株)三輪書店  

＜文献概要＞はじめに くも膜下出血後の後期合併症として正常圧水頭症が知られているが,その機序は,くも膜下出血による軟膜とくも膜の癒着によりくも膜顆粒の永続的な障害が生じるためと考えられている.脊髄くも膜炎は,外傷や脊髄手術,脊椎麻酔,腫瘍,感染などに関連して起こり得るが,まれにくも膜下出血に関連して発生することがある.しかしその頻度は低く,その病態や発生に関する詳細な検討はなされていないのが実情である.本稿では,くも膜下出血に続発する脊髄癒着性くも膜炎について解説する.

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J02317&link_issn=&doc_id=20220704090004&doc_link_id=10.11477%2Fmf.5002201796&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.5002201796&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Placing an extracranial-intracranial (EC-IC) high-flow bypass using a radial artery (RA) graft plus internal carotid artery (ICA) trapping or ligation is an option for treating patients expected to be at high risk for complications by direct surgical treatment of the ICA. We focused on the anastomosis between the external carotid artery (ECA) and the RA graft in the cervical region and present adverse events and salvage procedures. METHODS: EC-IC high-flow bypass procedures using an RA graft were performed to treat 87 consecutive patients. The ECA diameter at the midpoint of the planned ECA-RA anastomosis and the non-branched length of the ECA were measured on preoperative angiograms. To study adverse events related to ECA-RA anastomoses, we reviewed the patients' surgical records and intraoperative videos. RESULTS: In 11 patients (12.6%) we encountered adverse events during anastomosis between the ECA and RA. The rate of ECA dissection was significantly higher in male patients (4 of 17; 23.5%) than female patients (3 of 70; 4.3%) (P = 0.012). Logistic regression analysis revealed that male sex, individuals with diabetes mellitus, and patients whose non-branching length of the ECA was short (16.1 ± 6.7 mm) were at high risk of ECA problems. We set the cutoff point at 17.5 mm (the area under the receiver operator characteristic curve was 0.72). CONCLUSIONS: Our findings indicate that patients, especially male patients, treated by EC-IC high-flow bypass using an RA graft are at increased risk for adverse events when the ECA length at the site of the planned anastomosis is shorter than 17.5 mm.

DOI： 10.1016/j.wneu.2022.04.061

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

本学では腰椎穿刺シミュレーターをクリニカルクラークシップ(CC)に導入し、積極的に活用している。腰椎穿刺の講義は、まず穿刺の方法や必要性などを30分ほどで講義した後、「腰椎・硬膜外穿刺シミュレータルンバールくんII」を用いて直接腰椎穿刺を行いながら、様々な場面で起こりうる事柄について学んでいく形式で実施している。今回、シミュレーターを用いた講義が医学教育に与える影響を明らかにするため、CCに参加した4・5年生のべ53名にアンケートを行った。その結果、腰椎穿刺シミュレーターは学生の理解度や技能の向上に役立ち、学生の満足度も高いことが確認された。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Peripheral nerve diseases are common. Para-lumbar spine diseases (PLSDs) include peripheral neuropathy around the lumbar spine, e.g., cluneal nerve entrapment and gluteus medius muscle pain. While these diseases can be treated by less invasive surgery, postoperative complications have not been sufficiently investigated. We document complications after surgery for peripheral nerve diseases and PLSDs. Between July 2014 and December 2020, 678 consecutive patients with peripheral nerve diseases and PLSDs underwent 1068 surgical procedures (upper limb 200 sites, lower limb 447 sites, para-lumbar spine 394 sites, and tumor 27 sites). After excluding 27 procedures to address tumors, we examined the remaining 1,041 procedures undergone by 672 patients (average age 68.2 years) and recorded the complication rate observed within 30 days after the procedures. The overall surgical complication rate was 3.9% (41/1041 procedures); 6 procedures required surgical salvage and 35 were treated conservatively. There were no long-term sequelae from complications. The complication rate was high after surgery for lateral femoral cutaneous-, saphenous-, and common peroneal nerve entrapment and tarsal tunnel syndrome; all sites involved the lower limbs. As a result, intergroup comparison showed that the complication rate was significantly higher for the upper limb (3.0%) procedures than the lower limb (6.7%) and PLSD (1.3%) procedures. It was significantly lower for PLSD operations than lower and upper limb operations. The patient age and diabetes mellitus were significant risk factors for postoperative complications. Their rate was low in patients treated for peripheral nerve diseases and PLSDs; 34 of the 41 complications (82.9%) were related to the surgical wound.

DOI： 10.2176/nmc.oa.2021-0131

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記述言語：日本語   出版者・発行元：(株)三輪書店  

＜文献概要＞はじめに Failed back surgery syndrome(FBSS)の原因にはさまざまなものが報告されているが,われわれはその中に腰椎周辺疾患や下肢の絞扼性末梢神経障害が少なからず含まれていることを報告してきた.これらは腰椎疾患と似た症状を呈するため,見過ごされてしまうことがあり,その結果遺残症状によって患者のみならずわれわれ脊椎外科医もつらい日々を送ることになる.一方,これら疾患は思いのほか簡便に,低侵襲に治療できる特徴をもっており,何はともあれ気にかけておくことが診療における最大のポイントである.今回,腰椎周辺疾患および下肢の絞扼性末梢神経障害のFBSSへの関与について,われわれの取り組みを紹介する.

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J02317&link_issn=&doc_id=20220228110008&doc_link_id=10.11477%2Fmf.5002201677&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.5002201677&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Common peroneal nerve (C-PN) entrapment neuropathy is the most common peripheral nerve neuropathy of the legs. C-PN decompression surgery can be performed less invasively, but it may result in neurological complications. We report a rare case of nerve paralysis immediately after C-PN decompression surgery. CASE REPORT: This 85-year-old male suffered from leg numbness and pain. Electrophysical study revealed C-PN entrapment in the affected area and he underwent surgical decompression. Immediately thereafter he complained of slight paralysis without pain (manual muscle test: 3/5). It gradually worsened and 60 min after surgery his paralysis was complete. We re-opened the skin incision 3 hours after the first operation and found that a subcutaneous suture had been applied to the connective tissue near the C-PN, resulting in strong squeezing of the nerve. Upon release of the suture his paralysis improved immediately. We confirmed that there was no other nerve compression and finished the operation. His paralysis disappeared completely. CONCLUSION: Peripheral nerve surgery, including C-PN decompression surgery, is less invasive and the risk for complications is low. As the C-PN is located in the shallow layer under the skin, a stitch too deep in the subcutaneous layer may squeeze the nerve and elicit nerve palsy. Therefore, careful postoperative follow-up is necessary because early decompression leads to good surgical results.

DOI： 10.1272/jnms.JNMS.2023_90-201

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Carpal tunnel syndrome(CTS)is a common entrapment neuropathy caused by compression of the median nerve around the wrist. The risk factors of CTS include female sex, diabetes mellitus, hypothyroidism, obesity, arthritis, hemodialysis, acromegaly, and pregnancy. CTS is characterized by paresthesia in the distribution of the median nerve. Patients are often unaware of ring-finger splitting and the combination of Tinel's sign and Phalen's test improves diagnostic accuracy. In addition, electrophysiological assessments can help to confirm a CTS diagnosis; their sensitivity ranges from 57-94% and their specificity from 51-97%. CTS negatively affects the quality of life but improvement by surgery can be expected. For conservative treatment, a neutral wrist splint worn at night or oral medication such as nonsteroidal anti-inflammatory drugs, vitamin B12, and pregabalin have been shown to be effective against CTS. CTS surgery may be indicated in patients with thenar muscle atrophy and when conservative treatment is ineffective. The surgery involves a small skin incision under a microscope and local anesthesia. Long-term outcomes with respect to pain, numbness, function, symptomatology relapse, and frequency of re-surgery do not significantly differ between patients subjected to open or endoscopic surgery.

DOI： 10.11477/mf.1436204516

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記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞Point ・手根管症候群の症状は,第1〜4指橈側のしびれ,夜間〜早朝にかけての増悪,ring finger splittingが特徴的である.・診断は,臨床症状とPhalenテストやTinel様徴候などの身体所見,電気生理検査を組み合わせて行う.・手術療法は有用であり,局所麻酔下に顕微鏡を用いて低侵襲に行える.

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J01228&link_issn=&doc_id=20211209270021&doc_link_id=10.11477%2Fmf.1436204516&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436204516&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Lymphomatoid granulomatosis (LYG) is a rare Epstein-Barr virus-associated systemic angiocentric and angiodestructive lymphoproliferative disorder. It commonly involves the lungs and can also affect the skin, liver, kidney, and central nervous system. It can rarely occur in the spine, however, the details are unclear. We performed a systematic review of published cases (including our 1 case) of spinal LYG. We performed a systematic search of studies in English on spinal LYG, focusing on its clinical features, imaging, and treatments, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on the PubMed database. We identified 14 patients from the literature. We also found 1 case of isolated cervical LYG (grade 3) who was treated with steroid and radiation therapy for the spinal lesion after pathologic diagnosis. We performed a pooled analysis of these 15 cases. The mean age was 43.4 years, and 13 of the 15 patients were male. Brain lesions were present in 11 of 12 intramedullary spinal lesions, and only 1 was an isolated spinal LYG case. Regarding the diagnostic methods, 1 case was not described. Of the 14 cases described, 12 patients underwent biopsies (7 brain, 4 lung, and 1 spinal cord lesion) and 2 underwent surgical removal for an extramedullary lesion. In the overall prognosis from a mean follow-up period of 21.6 months, 4 patients died despite several treatments. Spinal LYG, particularly isolated spinal LYG, is rare. Thus further accumulation of cases may be necessary to better understand its characteristics.

DOI： 10.1016/j.wnsx.2021.100106

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

STUDY DESIGN: Retrospective study. PURPOSE: This study aims to evaluate the effectiveness of mirogabalin in treatment of peripheral neuropathic pain due to lumbar spine disease. OVERVIEW OF LITERATURE: Mirogabalin is a novel selective ligand for the α2δ subunit of voltage-gated Ca channels. METHODS: Between April and December 2019, we used mirogabalin to treat 60 consecutive patients (mean age, 67.6 years) with leg symptoms due to lumbar disease. The treatment outcome after 8 weeks of mirogabalin therapy was evaluated by comparing the preand post-administration Numerical Rating Scale (NRS) for leg symptoms and sleep disturbance, the NRS and Roland-Morris Disability Questionnaire for low back pain (LBP), and the quality of life (QOL) score (based on EuroQol five-dimension five-level scale). RESULTS: Mirogabalin treatment was stopped at less than eight weeks in eight patients. The remaining 52 patients for evaluation were divided as group 1 (17 patients who presented with leg symptoms that lasted for less than 3 months) and group 2 (35 patients with leg symptoms that lasted longer than 3 months). The leg symptoms and LBP in both groups significantly improved at 4 and 8 weeks of treatment, and sleep disturbance and QOL were improved at 8 weeks as well. Compared to group 2, the pretreatment leg symptoms and QOL were significantly worse in group 1, and their improvement after 8 weeks of mirogabalin treatment was significantly better (p<0.05). Of the 60 original patients, 17 suffered adverse effects, which were mild in 16 patients and required treatment cessation due to excessive weight gain in one patient. CONCLUSIONS: We have validated the effect of mirogabalin on neuropathic pain due to lumbar spine disease, which has effectively addressed the associated leg symptoms, LBP, and sleep disturbance.

DOI： 10.31616/asj.2020.0136

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

As superficial peroneal nerve (S-PN) entrapment neuropathy is relatively rare, it may be an elusive clinical entity. For decompression surgery addressing idiopathic S-PN entrapment, narrow-area decompression may be insufficient and long-area decompression along the S-PN from the peroneus longus muscle (PLM) to the peroneal nerve exit site may be required. To render it is less invasive, we performed S-PN neurolysis in a combined microscope/endoscope procedure. We report our surgical procedure and clinical outcomes. We microsurgically decompressed the affected S-PN under local anesthesia without a proximal tourniquet. We made a small linear skin incision at the distal portion of the S-PN, performed distal decompression of the S-PN where it penetrated the deep fascia, and then performed proximal decompression under an endoscope. At the site where the S-PN exited the PLM, we placed additional small incisions and proceeded to microscopic decompression. We surgically treated three patients with S-PN entrapment. They were two men and one woman ranging in age from 66 to 85 years. The mean postoperative follow-up was 22 months. Their symptoms before treatment and at the latest follow-up visit were recorded on the numerical rating scale (NRS). The mean incision length was 5.5 cm and 17.3 cm of the S-PN was decompressed. All three patients reported postoperative symptom improvement. There were no complications. In patients with idiopathic S-PN entrapment, long-site neurolysis under local anesthesia using a microscope/endoscope combination is useful.

DOI： 10.2176/nmc.oa.2020-0200

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Meralgia paresthetica (MP) is an entrapment neuropathy of the lateral femoral cutaneous nerve (LFCN). We report a rare MP complication after microvascular decompression (MVD) surgery in the park-bench position in a patient with hemi-facial spasm. CASE: The patient was a 46-year-old female (height: 155 cm, weight: 42 kg). She was neither diabetic nor a regular alcohol user. After the first MVD for right hemifacial spasm, her symptom recurred and she underwent a second MVD procedure in the park-bench position that led to the disappearance of her hemifacial spasm. However, she complained of right antero-lateral thigh pain and dysesthesia without motor weakness. The symptom was limited to the LFCN area; pelvic compression test elicited a positive Tinel-like sign. Our preliminary diagnosis was MP. As conservative therapy was ineffective she underwent LFCN block 9 months after the second MVD procedure. Her symptom improved dramatically and we made a definitive diagnosis of MP. There has been no recurrence in the course of 30 months although she reported persistent mild dysesthesia in the LFCN area. CONCLUSION: MP is a rare complication after MVD surgery in the park-bench position. Symptom abatement and a definitive early diagnosis can be obtained by LFCN blocks.

DOI： 10.1272/jnms.JNMS.2022_89-112

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Entrapment of the middle cluneal nerve (MCN), a peripheral nerve in the buttock, can elicit low back pain (LBP). We examined the epidemiology, clinical course, and treatment of MCN entrapment (MCN-EN). METHODS: Among 383 LBP patients who visited our institute, 105 were admitted for intractable LBP. They were 42 men and 63 women; their average age was 64 years. Based on clinical symptoms, palpation, and the effects of MCN block, we suspected MCN-EN in these 105 patients, 50 of whom are our study subjects. Their treatment outcomes were assessed at the time of discharge and at follow-up visits. RESULTS: MCN-EN was diagnosed in 50 of the 383 patients (13.1%) and they were hospitalized. In 43 (11.2%), MCN-EN was associated with other diseases (superior cluneal nerve entrapment, n = 21, sacroiliac joint pain, n = 9, other, n = 13). At the time of discharge, the symptoms of patients with LBP due to MCN-EN were significantly improved by repeat MCN blocks. In 7 of the 383 patients (1.8%), LBP was improved by only MCN blocks; 5 of them had reported leg symptoms in the dorsal part of the thigh. After discharge, 22 of the 50 hospitalized patients required no additional treatments after 2-5 blocks; 19 required only conservative treatment, and 9 underwent microsurgical release of the MCN. CONCLUSIONS: We confirmed MCN-EN in 50 of 105 patients admitted for intractable LBP. Repeat MCN blocks were effective in 22 patients; 19 required additional conservative treatment, and 9 underwent surgery. Buttock pain radiating to the posterior thigh was an MCN-EN symptom that has been diagnosed as pseudo-sciatica. Before subjecting patients with intractable LBP to surgery, the presence of MCN-EN must be ruled out.

DOI： 10.1007/s00701-020-04676-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Middle cluneal nerve entrapment (MCN-E) around the sacroiliac joint can elicit low back pain (LBP). Pain control can be obtained with anesthetic nerve blocks; however, when their effectiveness is transient, surgical release may be necessary. We investigated the efficacy of radiofrequency thermocoagulation (RFTC) in patients with MCN-E. METHODS: Between December 2018 and August 2019, 11 consecutive patients (4 men, 7 women; mean age 76.4 years) with intractable medial buttock pain due to MCN-E underwent MCN RFTC. The mean symptom duration was 49.5 months; pre-RFTC local MCN blocks provided pain relief for a mean of 7.7 days. The severity of pain in the medial buttock due to MCN-E was recorded before and 2, 6, 12, and 24 weeks after RFTC on the numerical rating scale (NRS) and the Roland-Morris Disability Questionnaire (RDQ). RESULTS: All patients reported pain alleviation; there were no complications. While there was a significant difference in the pre- and post-RFTC treatment NRS (p < 0.05), the RDQ scores were significantly lower only after 12 weeks. The duration of pain relief was significantly prolonged by RFTC (p < 0.05). Two patients suffered pain relapse 10 weeks post-RFTC; pain alleviation was obtained by re-RFTC performed 2 weeks after pain recurrence. Two other patients relapsed 20 and 21 weeks post-RFTC; their symptoms also disappeared by MCN block administered 24 weeks after they had undergone RFTC. CONCLUSION: RFTC may safely control intractable LBP due to MCN-E.

DOI： 10.1007/s00701-020-04404-8

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記述言語：英語  

Background: Middle cluneal nerve entrapment neuropathy (MCN-EN) is a known cause of low back pain (LBP). Here, we succeeded in treating a patient with a lumbar disc herniation who actually had MCN-EN with a nerve block and neurolysis. Case Description: A 52-year-old female presented with severe left lower back and lateral thigh pain making it difficult to walk. The lumbar MRI revealed a disc herniation on the left at the L5/S1 level. On palpation, we identified a trigger point on the buttock where the MCN penetrates the long posterior sacroiliac ligament between the posterior superior and inferior iliac spine. Two left-sided MCN blocks, followed by the left MCN neurolysis procedure, were performed under local anesthesia. At the last follow-up, 10 months after surgery, the LBP has not recurred, and she requires no medications for pain control. Conclusion: Here, a patient with a left-sided L5S1 disc herniation and low back/leg pain was successfully treated for MCN-EN with nerve block followed by neurolysis.

DOI： 10.25259/SNI_167_2021

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記述言語：英語  

Background: Extracranial carotid artery aneurysms are rare. Surgery may be difficult when vessels are tortuous and on a high cervical level. We report two patients whose tortuous extracranial internal carotid artery (ICA) aneurysm located on a high cervical level was successfully treated by ICA ligation and a high-flow bypass using a radial artery (RA) graft between the external carotid- and the middle cerebral artery. Case Description: (Case 1) A 47-year-old man suffered a recurrent cerebral infarct despite medical treatment. His right extracranial ICA aneurysm measured 33 mm; it was tortuous and located at a high cervical level. We ligated the ICA after placing a high-flow bypass using an RA graft. The aneurysm was not repaired. (Case 2) A 59-year-old woman noticed pulsatile swelling on her left neck. It was due to an extracranial ICA aneurysm that was large (36 mm), tortuous, and located at a high cervical level. We performed ICA ligation after placing a high-flow bypass using an RA graft without direct aneurysmal repair. Six months after the operation she noted a pulsatile bulge on the left oropharynx. We confirmed recurrence of an aneurysm from retrograde blood flow and performed internal trapping by occluding the distal portion of the ICA aneurysm using an intravascular procedure. Conclusion: ICA ligation after placing a high-flow bypass with an RA-graft is a technically demanding, but safe procedure to address extracranial ICA aneurysms that are tortuous and located at a high cervical level.

DOI： 10.25259/SNI_408_2021

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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記述言語：日本語   出版者・発行元：(株)医学書院  

症例は51歳男性で、右上肢のしびれと脱力が出現し、当院を受診した。しびれは右前腕尺側、右手第4指尺側と第5指全体にあり、右手の骨間筋および小指球筋の筋萎縮、右手の手指外転の筋力低下を認めた。精査の結果より肘部管症候群とギオン管症候群の合併例と診断し、運動障害を呈していたことから外科的治療の適応ありと判断した。電気生理学的検査の結果からはギオン管症候群の関与が示唆されたが、しびれが前腕部および手指背側にもあること、肘部管部にTinel様徴候があることから、まず肘部管症候群に対し神経移行術を施行した。肘部管症候群術後に症状が残存したことから、肘部管症候群手術1ヵ月後にギオン管症候群に対し外科的治療を行った。手術に際し何ら合併症はみられなかった。術後は、外固定はせず日常生活の範囲内で手指使用を許可した。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01228&link_issn=&doc_id=20200917110013&doc_link_id=10.11477%2Fmf.1436204282&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436204282&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：英語  

Spinal epidural hematoma (SEDH) is an uncommon pathology. Here, we report a case of SEDH with recurrences, along with a literature review of relevant cases to identify characteristics of SEDH recurrence. A 13-year-old girl experienced sudden-onset of back pain and bilateral leg weakness. She was diagnosed with a cervical idiopathic epidural hematoma, and the symptoms subsided with conservative management. Four months after the event, she again experienced back pain due to recurrence of the cervical epidural hematoma, but she was observed because no neurological deficits could be detected. Fifteen months after the initial SEDH, she experienced severe back pain and tetra-paresis due to recurrence. The SEDH was located in the left ventral and dorsal aspect at the C6-T1 level, with severe spinal cord compression. The hematoma was removed through left hemilaminectomy. Bleeding was noted from the epidural venous plexus along the left C6 spinal root, which had coagulated. After hematoma resection, her symptoms gradually improved, and she was discharged 3 weeks after surgery without any neurological deficits. No hematoma recurrence has since been experienced. Recurrent SEDH is relatively rare, with only 11 cases previously reported. Recurrent hematoma cases are more common in young, female patients, while SEDH, in general, is more common in males in their late forties. The recurrence interval is shorter in non-surgical cases than those requiring surgery. Knowledge of these characteristics may be useful in the future management of SEDH.

DOI： 10.2176/nmccrj.cr.2019-0253

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Surgery for idiopathic tarsal tunnel syndrome (TTS) is of limited effectiveness or ineffective. Using indocyanine green video angiography (ICG-VA), we treated idiopathic TTS by posterior tibial artery (PTA) decompression from the posterior tibial nerve (PTN) and evaluated postoperative patency of the PTA. METHODS: We treated 12 patients (12 feet) with idiopathic TTS by PTA decompression from the PTN and transposed its location. Age range of patients was 70-87 years (mean 77.9 years); all patients were operated on under local anesthesia. After a 2-cm skin incision, the flexor retinaculum was resected, and the PTA was decompressed from the PTN. It was then sutured to the flexor retinaculum for decompression and to prevent compression recurrence. ICG-VA was used to confirm the absence of PTA flow disturbance and to inspect the vasa nervorum of the PTN. RESULTS: We encountered no intraoperative or postoperative complications. Postoperatively, ICG-VA confirmed blood flow in the PTA and intactness of the vasa nervorum in all cases. One patient required adjustment of PTA position. All patients reported symptom improvement. CONCLUSIONS: Our surgical method of treating idiopathic TTS under ICG-VA monitoring is simple, safe, and effective.

DOI： 10.1016/j.wneu.2020.06.042

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記述言語：日本語   出版者・発行元：(株)医学書院  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 51-year-old man had a 1-year history of numbness on the ulnar side of the 4th finger, the 5th finger, and the ulnar side of the forearm, and weakness of the right hand. The Spurling sign was negative, and cervical radiography and magnetic resonance imaging revealed no abnormality. The Tinel-like signs at the Guyon's canal and cubital tunnel were positive. The diagnosis upon electrophysiological examination was cubital tunnel syndrome and Guyon's canal syndrome, but the possibility of Guyon's canal syndrome was high. Based on the presence of numbness in the forearm, the Tinel-like sign at the cubital tunnel, and the high incidence rate of cubital tunnel syndrome, an operation for cubital tunnel syndrome was performed. After the first operation, the numbness in the forearm was improved, but numbness in the 4th and 5th fingers, and weakness of the right hand remained, and the Tinel-like sign at the Guyon's canal also remained positive. The second operation for Guyon's canal syndrome was performed a month after the first operation for cubital tunnel syndrome. After the second operation, the residual symptoms improved gradually. Guyon's canal syndrome is a rare condition, but it may be considered a causative factor in patients with ulnar neuropathy.

DOI： 10.11477/mf.1436204282

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Lumbar disc herniation (LDH) elicits low back pain (LBP) and lower-limb symptoms. Paralumbar spine disease (PLSD), for example, superior cluneal nerve/middle cluneal nerve entrapment (SCN-EN, MCN-EN) and sacroiliac joint pain (SIJ), may be attributable to LDH whose treatment may not ameliorate their symptoms. We treated LDH patients and addressed their coexisting PLSDs. We retrospectively analyzed the effects of targeted block therapy for PLSD in 47 patients with LDH. They were 23 men and 24 women ranging in age from 21 to 79 years. They were seen between August 2014 and October 2018, within 3 weeks of LDH onset. PLSD was diagnosed based on the symptoms of patients whose pain was not controlled by oral medications. The treatment outcome was assessed by comparing the numerical rating scale (NRS) and the Roland-Morris Disability Questionnaire (RDQ) score recorded before and 2 weeks after last block treatment. Of the 47 patients with LDH, 2 suffered no LBP and 30 reported tenderness in the low back. We performed block therapy in 13 patients; 9 (19.1%) had concurrent PLSD and experienced pain relief. Their NRS improved from 8.1 ± 1.8 before- to 1.3 ± 0.9 after treatment; their RDQ score fell from 11.2 ± 6.0 to 0.9 ± 1.2 (both, p < 0.01). In an LDH patient with MCN-EN alone, MCN neurolysis was performed 2 weeks after a single MCN block proved to be only transiently effective. Paralumbar diseases may coexist in patients with LDH; treatment of the former may alleviate their LBP.

DOI： 10.2176/nmc.oa.2020-0013

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Carotid artery stenosis is elicited by atherosclerosis and is the main cause of cerebral thrombosis. Flow-mediated endothelial vasodilation (FMD) can be measured noninvasively to assess vascular endothelial function related to atherosclerosis. The pulse wave velocity (PWV) is used to evaluate the vascular media involved in atherosclerosis. We investigated the relationship between these measurements in 75 consecutive patients with atherosclerotic cerebral thrombosis. They were assigned to three equal groups based on the severity of carotid artery stenosis on ultrasonograms. Group 1 had no stenosis, group 2 manifested moderate stenosis (<60%), and group 3 presented with severe stenosis (≥60%). We compared the FMD and PWV among the three groups. The PWV was significantly lower in group 1 than the other two groups. The FMD was significantly lower in group 3; it was significantly lower in group 2 than group 1. There was an inverse correlation between the FMD and the severity of carotid artery stenosis. Our findings show that for assessing the severity of carotid artery stenosis, the FMD is more useful than the PWV.

DOI： 10.2176/nmc.oa.2019-0193

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: We compared the preoperative quality of life (QOL) of patients with carpal tunnel syndrome, lower extremity-, and para-lumbar entrapment syndrome, and the effect of surgery on their QOL. PATIENTS AND METHODS: We prospectively enrolled 66 consecutive patients who underwent surgery for carpal tunnel syndrome (group 1, n = 23), lower extremity entrapment syndrome (group 2, n = 22), and para-lumbar entrapment syndrome (group 3, n = 21). Their pre- and postoperative overall health status was assessed on the Medical Outcomes Study Short-Form 36 Health Survey, v2 (SF-36). RESULTS: Except for the mental component summary, the preoperative score for items rated on the SF-36 was significantly lower in group 3 than in groups 1 and 2 (p < 0.05). In all 66 patients, the scores for bodily pain (BP) and the physical component summary (PCS) were significantly lower (p < 0.05) than the national standard, as was the score for physical functioning (PF) in groups 2 and 3. After surgery, PF of group 2 and PF, BP, and PCS of group 3 improved significantly (p < 0.05). CONCLUSION: The detrimental QOL effects are stronger in patients with para-lumbar- or lower extremity entrapment syndrome than in patients with carpal tunnel syndrome.

DOI： 10.1007/s00701-020-04226-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

At posterior cervical fixation, iatrogenic injury of the vertebral artery (VA) must be avoided. As the VA is usually located in front of the posterior line of the vertebral body, intraoperative lateral fluoroscopy is used to identify the line. We investigated in how many of 105 patients (210 VAs) this line is a safe marker. We also inspected the original cervical magnetic resonance angiograms (MRA) of 105 consecutive patients who had been treated for other than cervical spine diseases to study some anatomical characteristics of the VA in the cervical spine. The distance from the posterior line of the vertebral body to the posterior VA surface was classified as safe, as requiring attention, and as unsafe. Among the 210 VAs, four hypoplastic vessels were excluded from this study; consequently, 206 VAs were available for assessment. The average distance exceeded 6 mm, it was shorter at the upper cervical level. Although in at least 200 VAs (97.1%) the distance between C4 and C7 was safe, in only 170 VAs (82.5%) was it safe at C3. We observed a total of 31 tortuous loops in 17 VAs; their presence had a significant negative effect on the usefulness of the safety line. Although the posterior line of the vertebral body may be useful for safe screw insertion at the C4-C7 level, it may be less useful at C3. In the presence of tortuous VA loops, close attention must be paid to the reliability of the safety line during cervical spine surgery.

DOI： 10.2176/nmc.oa.2019-0244

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記述言語：英語  

BACKGROUND: Aplastic or twiglike middle cerebral artery (MCA), a congenital anomaly related to the abnormal development of the MCA, is rare. It is usually unilateral; bilateral lesions are extremely rare. An aplastic or twiglike MCA may lead to cerebral ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage (SAH). In patients with ischemic stroke due to hemodynamic stress, extracranial-intracranial (EC-IC) bypass surgery is indicated. As hemodynamic stress may also elicit SAH, it is important to select the appropriate treatment. EC-IC bypass surgery was successful in a patient with bilateral aplastic or twiglike MCA who suffered SAH due to hemodynamic stress. CASE DESCRIPTION: A 64-year-old female with a history of surgery for tetralogy of Fallot experienced SAH in the left sylvian fissure. As angiography showed a bilateral aplastic or twiglike MCA and single photon emission computed tomography revealed a decrease in the cerebral blood flow in the left MCA territory, we attributed her SAH to hemodynamic stress due to the decreased blood flow in the MCA territory and to the vulnerability of abnormal vessels as are seen in moyamoya disease. We performed EC-IC bypass surgery to reduce hemodynamic stress. A cerebral angiogram obtained 2 weeks postoperatively revealed sufficient blood flow in the MCA territory from the superficial temporal artery used for bypass. In the course of 2-year follow-up she remained stroke free. CONCLUSIONS: The presence of aplastic or twiglike MCA may lead to stroke due to hemodynamic stress. EC-IC bypass surgery may help to prevent stroke recurrence and SAH.

DOI： 10.1016/j.wneu.2019.10.054

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Study Design: Retrospective analysis. Purpose: The present study aimed to investigate the features of low back pain (LBP) due to superior cluneal nerve (SCN) entrapment neuropathy (SCN-EN) using the Roland Morris Disability Questionnaire (RMDQ), and to analyze the differences between LBP due to SCN-EN and lumbar spinal canal stenosis (LSS). Overview of Literature: The SCN is derived from the cutaneous branches of the dorsal rami of T11-L5 and passes through the thoracolumbar fascia. LBP due to SCN-EN is exacerbated by various types of lumbar movement, and its features remain to be fully elucidated, often resulting in the misdiagnosis of lumbar spine disorder. Methods: The present study included 35 consecutive patients with SCN-EN treated via nerve blocks or surgical release between April 2016 and August 2017 (SCN-EN group; 16 men, 19 women; mean age, 65.5±17.0 years; age range, 19-89 years). During the same period, 33 patients were surgically treated with LSS (LSS group; 19 men, 14 women; mean age, 65.3±12.0 years; age range, 35-84 years). The characteristics of LBP were then compared between patients with SCN-EN and those with LSS using the RMDQ. Results: The duration of disease was significantly longer in the SCN-EN group than in the LSS group (26.0 vs. 16.0 months, p =0.012). Median RMDQ scores were significantly higher in the SCN-EN group (13 points; interquartile range, 8-15 points) than in the LSS group (7 points; interquartile range, 4-9 points; p <0.001). For seven items (question number 1, 8, 11, and 20-23), the ratio of positive responses was higher in the SCN-EN group than in the LSS group. Conclusions: Patients with SCN-EN exhibit significantly higher RMDQ scores and greater levels of disability due to LBP than patients with LSS. The findings further demonstrate that SCN-EN may affect physical and psychological function.

DOI： 10.31616/asj.2018.0324

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The causes of low back and buttock pain are variable. Elsewhere, we presented a surgical technical note addressing the gluteus medius muscle (GMeM) pain that elicited buttock pain treatable by surgical decompression. Here, we report minimum 2-year surgical outcomes of GMeM decompression for intractable buttock pain. METHODS: Between January 2014 and December 2015, we surgically treated 55 consecutive patients with a GMeM pain. Of these, 39 were followed for at least 2 years; they were included in this study. Their average age was 69.2 years; 17 were men and 22 were women. The affected side was unilateral in 24 patients and bilateral in the other 15 (total 54 sites). The mean follow-up period was 40.0 months (range 25-50 months). The severity of pre- and post-treatment pain was recorded on the numerical rating scale (NRS) and the Roland-Morris Disability Questionnaire (RDQ). RESULTS: Of the 39 patients, 35 also presented with leg symptoms. They were exacerbated by walking in all 39 patients and by prolonged sitting in 33 patients; 19 had a past history of lumbar surgery and 4 manifested failed back surgery syndrome. Repeat surgery for wider decompression was performed in 5 patients due to pain recurrence 15.8 months after the first operation. At the last follow-up, the symptoms were significantly improved; the average NRS fell from 7.4 to 2.1 and the RDQ score from 10.5 to 3.3 (p < 0.05). CONCLUSIONS: When diagnostic criteria are met, GMeM decompression under local anesthesia is a useful treatment for intractable buttock pain.

DOI： 10.1007/s00701-019-03923-3

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Sacroiliac joint (SIJ)-related pain is associated with low back- and buttock pain and the SIJ score is diagnostically useful because it helps to differentiate between SIJ-related pain and pain due to other factors such as lumbar disc herniation and lumbar spinal canal stenosis. Middle cluneal nerve (MCN) entrapment (MCN-E) can produce pain involving the lower back and buttocks. Therefore, the origin of the pain must be identified. We successfully treated patients with a high SIJ score whose pain was attributable to MCN-E. METHODS: Between August 2016 and June 2017, we treated 40 patients with non-specific low back pain. Among them, 18 (45%) presented with a positive SIJ score. Although SIJ treatment was unsuccessful in 4 of these patients, they responded to MCN-E treatment. RESULTS: All 4 patients reported tenderness at the site of the sacrotuberous ligament (STL); 3 were positive for the one-finger test and experienced pain while sitting in a chair. The effect of SIJ block was inadequate in the 4 patients. As they reported severe pain at the trigger point in the area of the MCN, we performed MCN blockage. It resulted in pain control. However, in 1 patient, the effect of MCN block was transient and required MCN neurolysis. At the last visit, our patients' symptoms were significantly improved; their average numerical rating scale score fell from 8.3 to 1.0, their Roland-Morris Disability Questionnaire score fell from 12.8 to 0.3, and their average Japanese Orthopaedic Association score rose from 12.5 to 19.5. CONCLUSIONS: In patients with suspected SIJ-related pain, the presence of MCN-E must be considered when the effect of SIJ block is unsatisfactory.

DOI： 10.1007/s00701-019-03861-0

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記述言語：英語  

In rare cases, pedicle fracture is associated with spine surgery, spondylolysis, or stress fracture. We report a patient without trauma whose bilateral lumbar pedicle fracture was detected incidentally. A 67-year-old woman reported leg numbness and pain. Lumbar MRI showed spinal canal stenosis at the L4/L5 level. Drug treatment was only partially effective. A lumbar computed tomography (CT) scan performed 3 months later revealed bilateral pedicle fracture at L4. A second lumbar MRI showed fresh bilateral L4 pedicle fracture that was not observed on the first scan. Due to the presence of osteoporosis we prescribed daily teriparatide and the wearing of a lumbo-sacral corset. Her subsequent clinical course was uneventful and the fractures fused under conservative treatment. During this period, she had no low back pain (LBP). Only 12 earlier patients with spontaneous bilateral pedicle fracture without trauma, spinal surgery, or bone abnormality have been reported. In 8 patients, including ours, the fracture level was at L4. In all except our patient, LBP was the most common symptom. Pedicle fracture as detected incidentally in our patient. Of the 13 patients, 4 were physically active adolescents; of the 9 others, 5 were women with osteoporosis. Our case is the first report of incidental spontaneous bilateral pedicle fracture.

DOI： 10.2176/nmccrj.cr.2018-0185

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Meralgia paresthetica is a mononeuropathy of the lateral femoral cutaneous nerve (LFCN) caused by compression around the inguinal ligament. We report a surgical alternative for the treatment of meralgia paresthetica under local anesthesia and its outcomes. METHODS: We operated on 12 patients with unilateral meralgia paresthetica whose age at surgery ranged from 62 to 75 years. The mean postoperative follow-up period was 19 months. Microsurgical deep decompression of LFCN was performed with the patient under local anesthesia. Clinical outcomes of surgical treatment were assessed based on the patient's most recent follow-up visit and were classified into 3 categories: complete, partial, or no relief of symptoms. Symptoms of pain or numbness in the anterolateral part of the thigh were evaluated, using a visual analog scale, before surgery and after surgery, i.e., at the most recent follow-up visit. RESULTS: All patients reported symptom improvement: complete relief in 9 patients (75%) and partial relief in 3 patients (25%). In the 3 patients with partial relief, the remaining symptoms did not affect their daily living. Overall, the visual analog scale scores were significantly improved in all patients (P < 0.05), and no patient experienced postoperative recurrence of their symptoms at the time of the last follow-up visit. CONCLUSIONS: Symptoms of meralgia paresthetica can resemble those of a lumbosacral disorder. Microsurgical deep decompression under local anesthesia produces good surgical outcomes. The use of local anesthesia contributes not only to reduction of pain during surgery but also eliminates excessive surgical procedures and reduces the duration of hospital stay.

DOI： 10.1016/j.wneu.2018.06.252

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE The etiology of low-back pain (LBP) is heterogeneous and is unknown in some patients with chronic pain. Superior cluneal nerve entrapment has been proposed as a causative factor, and some patients suffer severe symptoms. The middle cluneal nerve (MCN) is also implicated in the elicitation of LBP, and its clinical course and etiology remain unclear. The authors report the preliminary outcomes of a less invasive microsurgical release procedure to address MCN entrapment (MCN-E). METHODS The authors enrolled 11 patients (13 sites) with intractable LBP judged to be due to MCN-E. The group included 3 men and 8 women ranging in age from 52 to 86 years. Microscopic MCN neurolysis was performed under local anesthesia with the patient in the prone position. Postoperatively, all patients were allowed to walk freely with no restrictions. The mean follow-up period was 10.5 months. LBP severity was evaluated on the numerical rating scale (NRS) and by the Japanese Orthopaedic Association (JOA) and the Roland-Morris Disability Questionnaire (RDQ) scores. RESULTS All patients suffered buttock pain, and 9 also had leg symptoms. The symptoms were aggravated by standing, lumbar flexion, rolling over, prolonged sitting, and especially by walking. The numbers of nerve branches addressed during MCN neurolysis were 1 in 9 patients, 2 in 1 patient, and 3 in 1 patient. One patient required reoperation due to insufficient decompression originally. There were no local or systemic complications during or after surgery. Postoperatively, the symptoms of all patients improved statistically significantly; the mean NRS score fell from 7.0 to 1.4, the mean RDQ from 10.8 to 1.4, and the mean JOA score rose from 13.7 to 23.6. CONCLUSIONS Less invasive MCN neurolysis performed under local anesthesia is useful for LBP caused by MCN-E. In patients with intractable LBP, MCN-E should be considered.

DOI： 10.3171/2017.12.SPINE17991

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

STUDY DESIGN: Retrospective study (level of evidence=3). PURPOSE: We examine the relationship between residual symptoms after discectomy for lumbar disc herniation and peripheral nerve (PN) neuropathy. OVERVIEW OF LITERATURE: Patients may report persistent or recurrent symptoms after lumbar disc herniation surgery; others fail to respond to a variety of treatments. Some PN neuropathies elicit symptoms similar to those of lumbar spine disease. METHODS: We retrospectively analyzed data for 13 patients treated for persistent (n=2) or recurrent (n=11) low back pain (LBP) and/or leg pain after primary lumbar discectomy. RESULTS: Lumbar re-operation was required for four patients (three with recurrent lumbar disc herniation and one with lumbar canal stenosis). Superior cluneal nerve (SCN) entrapment neuropathy (EN) was noted in 12 patients; SCN block improved the symptoms for eight of these patients. In total, nine patients underwent PN surgery (SCN-EN, n=4; peroneal nerve EN, n=3; tarsal tunnel syndrome, n=1). Their symptoms improved significantly. CONCLUSIONS: Concomitant PN disease should be considered for patients with failed back surgery syndrome manifesting as persistent or recurrent LBP.

DOI： 10.31616/asj.2018.12.4.720

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Superficial peroneal nerve (S-PN) entrapment neuropathy (S-PNEN) is comparatively rare and may be an elusive clinical entity. There is yet no established surgical procedure to treat idiopathic S-PNEN. We report our surgical treatment and clinical outcomes. We surgically treated 5 patients (6 sites) with S-PNEN. The 2 men and 3 women ranged in age from 67 to 91 years; one patient presented with bilateral leg involvement. Mean post-operative follow-up was 25.3 months. We recorded their symptoms before- and at the latest follow-up visit after surgery using a Numerical Rating Scale and the Japan Orthopedic Association score to evaluate the affected area. We microsurgically decompressed the affected S-PN under local anesthesia without a proximal tourniquet. We made a linear skin incision along the S-PN and performed wide S-PN decompression from its insertion point at the peroneal tunnel to the peroneus longus muscle (PLM) to the point where the S-PN penetrated the deep fascia. One patient who had undergone decompression in the area of a Tinel-like sign at the initial surgery suffered symptom recurrence and required re-operation 4 months later. We performed additional extensive decompression to address several sites with a Tinel-like sign. All 5 operated patients reported symptom improvement. In patients with idiopathic S-PNEN, neurolysis under local anesthesia may be curative. Decompression involving only the Tinel area may not be sufficient and it may be necessary to include the area from the PLM to the peroneal nerve exit point along the S-PN.

DOI： 10.2176/nmc.oa.2018-0039

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We report a surgical case of entrapment neuropathy of lateral femoral cutaneous nerve (LFCN) with anatomical variation. CASE DESCRIPTION: This 53-year-old man had a 10-year history of paresthesia and pain in the right anterolateral thigh exacerbated by prolonged standing and walking. His symptoms improved completely but transiently by LFCN block. The diagnosis was LFCN entrapment. Because additional treatment with drugs and repeat LFCN block was ineffective, we performed surgical decompression under local anesthesia. A nerve stimulator located the LFCN 4.5 cm medial to the anterior superior iliac spine. It formed a sharp curve and was embedded in connective tissue. Proximal dissection showed it to run parallel to the femoral nerve at the level of the inguinal ligament. The inguinal ligament was partially released to complete dissection/release. Postoperatively, his symptoms improved and the numeric rating scale fell from 8 to 1. CONCLUSION: We report a rare anatomical variation in the course of the LFCN.

DOI： 10.1016/j.wneu.2018.04.159

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Here we report our treatment results of low back and leg pain(LBLP)considering para-lumbar spine disease(PLSD)and peripheral nerve neuropathy(PNN). MATERIALS AND METHODS: We enrolled 103 patients who were admitted to our institute for LBLP treatment between January and December in 2014. For the treatment, we preferentially performed intensive block therapy for PLSD. RESULT: Among 103 patients, 89 patients had PLSD. In 85 patients, we performed intensive block therapy and 82 patients experienced short-term improvement of symptoms. In 35 of these 82 patients, lumbar spine and/or PNN surgical treatment was required as the effect of block therapy was transient. Intensive block therapy was effective in 47 of 103 patients(45.6%), and the remaining patients required surgical treatment(PLSD and/or PNN:31 cases, lumbar spine:13 cases, both:8 cases). CONCLUSION: Among 103 patients with LBLP, intensive block therapy for PLSD and PNN was useful for short-term symptom improvement in 82 patients(79.6%), and for long-term symptom improvement in 47 patients(45.6%)as evaluated at the final follow-up. Surgical treatment of PLSD and/or PNN was required in 39 patients(37.9%). These results suggested that treatment of PLSD and PNN might yield good results for patients with LBLP.

DOI： 10.11477/mf.1436203756

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：John Wiley and Sons Inc.  

Introduction: We studied the clinical and nerve pathologic features in 6 patients whose low back pain (LBP) was relieved by superior cluneal nerve (SCN) neurectomy to determine whether nerve compression was the mechanism underlying this type of LBP. Methods: All 6 patients (7 nerves) underwent SCN neurectomy for intractable LBP. Their clinical outcomes and the pathologic features of 7 nerves were reviewed. Results: All patients reported LBP relief immediately after SCN neurectomy. Pathologic study of the 7 resected nerves showed marked enlargement, decreased myelinated fiber density, an increase in thinly myelinated fibers (n = 2), perineurial thickening (n = 5), subperineurial edema (n = 4), and Renaut bodies (n = 4). At the distal end of 1 enlarged nerve, we observed a moderate reduction in the density and marked reduction in the number of large myelinated fibers. Discussion: The pathologic findings and effectiveness of neurectomy suggest that, in our patients, SCN neuropathy likely elicited LBP via nerve compression. Muscle Nerve 57: 777–783, 2018.

DOI： 10.1002/mus.26007

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier Inc.  

Objective: Some patients experience failed back surgery syndrome after lumbar spine surgery. We report the effect of additional treatments for paralumbar spine and peripheral nerve diseases addressing residual symptoms after surgery. Methods: We enrolled 74 patients (59 men and 15 women
mean age 62.9 years) who had undergone lumbar posterior decompression surgery. Mean follow-up after initial surgery was 26.2 months (range, 13–48 months). We subsequently diagnosed paralumbar spine diseases, including superior cluneal nerve entrapment neuropathy with (n = 3) or without gluteus medius muscle pain (n = 4) and gluteus medius muscle pain alone (n = 5), and peripheral nerve diseases, including peroneal nerve entrapment neuropathy (n = 4) and tarsal tunnel syndrome (n = 1), based on persistent or recurring clinical symptoms and nerve block effects. Treatment outcomes were analyzed by comparing Roland-Morris Disability Questionnaire and Japanese Orthopaedic Association scores. Results: Of 74 patients, 54 (73.0%) improved after initial lumbar surgery (group A), and 20 (27.0%) continued to experience symptoms or experienced symptom recurrence during follow-up (group B). In group B, 4 patients improved with conservative therapy, 11 underwent 1 additional surgical procedure, and 5 underwent &gt
1 additional surgical procedures. After these additional treatments, clinical outcomes were recorded as good. At the last follow-up visit, there was no difference between group A and group B. Conclusions: Of 74 patients who underwent lumbar spine surgery, 16 (21.6%) required additional surgery. To reduce the incidence of failed back surgery syndrome, concurrent diseases that may be masked by symptoms resulting from severe lumbar spine disease must be ruled out, as these diseases may become apparent after initial lumbar spine surgery.

DOI： 10.1016/j.wneu.2018.01.154

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

The clinical features and etiology of low back pain(LBP)and buttock pain(BuP)has been poorly understood. We report a case of long-term BuP that was successfully treated with gluteus medius muscle(GMeM)decompression under local anesthesia. A 71-year-old man was referred to our hospital because of long-term BuP and claudication. Left BuP that radiated to the left thigh was observed. The pain was mostly triggered by palpation at the middle of the iliac crest and greater trochanter. Lumbar and pelvic radiograms showed no significant lesions. Lumbar magnetic resonance imaging revealed a mild lumbar spinal canal stenosis at the L4/L5 segment. Based on the evidence of a trigger point and pain relieved after GMeM block injection, we made a diagnosis of GMeM pain. Although several GMeM block injections relieved his pain, the analgesic effect was transient and the claudication remained. Then, we decided to perform GMeM decompression. We made a 5-cm-long skin incision across the trigger point on the buttock. After confirming a wide exposure of the gluteal aponeurosis over the GMeM, we cut and opened it for sufficient GMeM decompression, and the GMeM expansion was confirmed. After surgery, his symptoms immediately improved. No evidence of recurrence was observed 6 months after his treatment. For the treatment of LBP and BuP, GMeM pain would be considered a causative factor. We report that it can be treated with a less invasive surgical technique, which would contribute to good clinical outcome.

DOI： 10.11477/mf.1436203724

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Low back pain (LBP) is encountered frequently in clinical practice. The superior and the middle cluneal nerves (SCN and MCN) are cutaneous nerves that are purely sensory. They dominate sensation in the lumbar area and the buttocks, and their entrapment around the iliac crest can elicit LBP. The reported incidence of SCN entrapment (SCN-E) in patients with LBP is 1.6%-14%. SCN-E and MCN entrapment (MCN-E) produce leg symptoms in 47%-84% and 82% of LBP patients, respectively. In such patients, pain is exacerbated by lumbar movements, and the symptoms mimic radiculopathy due to lumbar disorder. As patients with failed back surgery or Parkinson disease also report LBP, the differential diagnosis must include those possibilities. The identification of the trigger point at the entrapment site and the disappearance of symptoms after nerve block are diagnostically important. LBP due to SCN-E or MCN-E can be treated less invasively by nerve block and neurolysis. Spinal surgeons treating patients with LBP should consider SCN-E or MCN-E.

DOI： 10.14245/ns.1836024.012

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：W.B. Saunders  

Background: We investigated the role of acute-phase stroke lesions and patient characteristics in poststroke depression (PSD) and its effect on the clinical outcome. Patients and Methods: Five and 30 days after admission, 175 patients self-reported their depressive symptoms on the Patient Health Questionnaire-9. We compared the clinical characteristics and outcomes in patients with (n = 41) and without PSD (n = 134). Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS)
the modified Rankin Scale (mRS) was used to determine the functional outcome. Results: There was no significant difference between patients with and without PSD in the age, gender ratio, lesion side, and the history of hypertension, diabetes mellitus, alcohol and tobacco use, and previous stroke. Thalamic lesions were significantly associated with PSD (P =.03), although there was no significant difference in both the NIHSS score and the final mRS score of patients with thalamic lesions. Backward stepwise logistic regression analysis showed that a higher NIHSS score and thalamic lesions were independent predictors of PSD. Total hospitalization was significantly longer in patients with PSD. At the time of admission, the NIHSS score was significantly higher in patients who developed moderate to severe PSD than in those with mild PSD or without PSD. Conclusions: PSD in the acute phase was associated with thalamic lesions and severe stroke. Hospitalization was significantly longer in patients with PSD and their functional disability was more severe, suggesting that PSD played a role in the unsatisfactory results of poststroke rehabilitation.

DOI： 10.1016/j.jstrokecerebrovasdis.2017.09.028

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier Inc.  

Background Klippel-Trenaunay-Weber syndrome (KTWS) is a rare congenital vascular disorder characterized by the classic triad of cutaneous nevi, venous varicosities, and osseous and soft tissue hypertrophy of the affected limb. Various vascular anomalies of the central nervous system have also been described in patients with KTWS. The English language literature to date contains 6 reports of associations between KTWS and spinal cord cavernous angioma (CA), but management of these patients has not been well described. Case Description A 23-year-old woman was admitted to our institution with acute onset of leg weakness accompanied by upper back pain. Thoracic magnetic resonance imaging of the spinal cord showed a heterogeneous mass with a slit component at the T1-2 level. The patient underwent left hemilaminectomy followed by removal of the tumor, and her neurologic symptoms improved postoperatively. Pathologic examination showed the spinal lesion was characterized by hemosiderin deposition and thin-walled vascular channels surrounded by fibrous tissue. Conclusions This is the first report to provide a detailed pathologic description of the features of spinal CA in a patient with KTWS. Assessment of the clinical features and management of CA associated with KTWS are discussed. This syndrome is rare, and further experience in the treatment of these patients is needed. However, considering that the pathologic findings of spinal CA in patients with KTWS include the typical features of CA, the management of CA in patients with KTWS may be identical to management of isolated CA.

DOI： 10.1016/j.wneu.2017.10.040

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Igaku-Shoin Ltd  

BACKGROUND: Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve within the tarsal tunnel below the medial malleolus. An accurate diagnosis is difficult, and TTS is usually diagnosed from clinical symptoms due to the lack of accurate diagnostic tools. We aimed to standardize the diagnosis of TTS using MRI, and report the MRI conditions for clear visualization of the tarsal tunnel. METHODS: We investigated which sequences and MRI conditions would be appropriate for the imaging of the tarsal tunnel in a healthy volunteer. As in routine brain MRI, the imaging time was within 15 minutes. We also performed an MRI study of the tarsal tunnel in two patients with TTS. RESULTS: Axial images obtained by fat-suppression 3-dimensional T2·-weighted imaging (3D-T2·WI) are the most useful for visualization of the tarsal tunnel. The axial images obtained by T2-weighted imaging (T2WI) and T1 - weighted imaging (T1WI) were also useful for visualization of the area around the flexor retinaculum. The appropriate slice thickness was determined to be 1.5 mm, based on the resolution and photographic time. The flip angle, necessary for tissue resolution, was set at 15° because it provided the clearest image and highest contrast between different tissues. The total photographic time was within 14 minutes, and it Is acceptable for routine MRI studies of TTS. In the two cases of TTS included in this study, the tarsal tunnel was clearly visible. CONCLUSIONS: For diagnosis of TTS using MRI, axial images obtained by fat-suppression 3D-T2·WI, 2-dimensional (2D)-T2WI, and 2D-T1WI are recommended. A coronal image obtained by reconstruction of fatsuppression 3D-T2·WI might be useful for anatomical understanding. In future studies, we plan to evaluate patients with TTS using the above protocol.

DOI： 10.11477/mf.1436203667

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER WIEN  

Common peroneal nerve (CPN) entrapment neuropathy (CPNEN) is the most common peripheral neuropathy of the lower extremities. The pathological mechanisms underlying CPNEN remain unclear. We sought to identify dynamic factors involved in CPNEN by directly measuring the CPN pressure during stepwise CPNEN surgery.
We enrolled seven patients whose CPNEN improved significantly after CPN neurolysis. All suffered intermittent claudication, and the repetitive plantar flexion test, used as a CPNEN provocation test, was positive. During decompression surgery we directly measured the CPN pressure during several decompression steps.
Before CPN decompression, plantar flexion elicited a statistically significant increase in the CPN pressure (from 1.8 to 37.3, p &lt; 0.05), as did plantar extension (from 1.8 to 23.1, p &lt; 0.05). The CPN pressure gradually decreased during step-by-step surgery; it was lowest after resection of the peroneus longus muscle (PLM) fascia.
Dynamic factors affect idiopathic CPNEN. The CPN pressure decreased at each surgical decompression step, and removal of the PLM fascia resulted in adequate decompression of the CPN. Our findings shed light on the etiology of idiopathic CPNEN and recommend adequate CPNEN decompression procedures.

DOI： 10.1007/s00701-017-3265-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Verlag  

Purpose: The etiology of low back pain (LBP) is complicated and the diagnosis can be difficult. Superior cluneal nerve entrapment neuropathy (SCN-EN) is a known cause of LBP, although the middle cluneal nerve (MCN) can be implicated in the elicitation of LBP. Methods: A 76-year-old woman with a 4-year history of severe LBP was admitted to our department in a wheelchair. She complained of bilateral LBP that was exacerbated by lumbar movement. Her pain was severe on the right side and she also suffered right leg pain and numbness. Based on palpation and nerve blocking findings we diagnosed SCN-EN and MCN entrapment neuropathy (MCN-EN). Results: Her symptoms improved with repeated SCN and MCN blocking
the MCN block was the more effective and her symptoms improved. As her right-side pain around the MCN -EN with severe trigger pain recurred we performed microscopic right MCN neurolysis under local anesthesia. This led to dramatic improvement of her LBP and leg pain and the numbness improved. At the last follow-up, 7 months after surgery, she did not require pain medication. Conclusions: The MCN consists of sensory branches from the dorsal rami of S1–S4. It sandwiches the sacral ligament between the posterior superior and inferior iliac spine as it courses over the iliac crest. Its entrapment at this hard orifice can lead to severe LBP with leg symptoms. An MCN block effect is diagnostically useful. Less invasive MCN neurolysis under local anesthesia is effective in patients who fail to respond to observation therapy.

DOI： 10.1007/s00586-017-5208-2

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Igaku-Shoin Ltd  

A 60-year-old woman presented with a 1-year history of pain and numbness in the left anterolateral thigh. The symptoms aggravated on walking and standing. Her visual analogue scale (VAS) score was 7.1/10. Tinel's like sign was positive over the lateral femoral cutaneous nerve (LFCN), in the inguinal ligament region. LFCN block at the trigger point, in the inguinal ligament, resulted in relief of the symptoms and we diagnosed meralgia paresthetica (MP), which is the entrapment neuropathy of the LFCN. Initially, we performed observation therapy with oral medication and LFCN blocks. However, these treatments failed to relieve the symptoms. Therefore, we performed neurolysis with a microscope under local anesthesia. The symptoms improved immediately after surgery and her VAS score of thigh symptom improved from 7.1 to 1.9 after 3 months. Conservative and surgical treatment for MP generally yield good outcome and we should pay attention to the MP as a differential diagnosis for thigh numbness and pain.

DOI： 10.11477/mf.1436203528

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Study Design. Prospective observational cohort study.
Objective. The objective of this study was to present the longterm surgical outcomes of operative treatment for superior cluneal nerve (SCN) entrapment neuropathy (SCNEN) and to analyze the causes of poor results and further treatment required.
Summary of Background Data. There are a few reports of the outcomes of surgical treatment for SCNEN, and most studies describe results for operations conducted under general anesthesia with short follow-up periods.
Methods. Surgery was performed for SCNEN in 52 consecutive patients on 79 sides, excluding patients who had undergone previous surgery on the lumbar spine. Entrapment was unilateral in 25 patients and bilateral in 27. The mean postoperative follow-up period was 41.3 months (range, 29-58 months). All patients had received conservative treatment without improvements, and operations were performed under local anesthesia.
Results. Twenty-three cases (44%) involved only low-back pain (LBP), and 31 cases (60%) involved LBP associated with leg numbness or pain. The mean number of SCN branches decompressed in the operative field at the first operation was 1.4 (range, 1- 4 branches). There were no local or systemic complications during or after the operation. All patients reported symptom improvement, but LBP caused by SCNEN recurrence was reported for 10 sides (13%) in seven patients who subsequently underwent repeat surgery. In the second surgery, the number of additionally treated SCN branches was 2.0 (range, 1- 5). Additional surgeries were performed in two cases for lumbar disorders. All patients showed significant improvement at the last follow-up visit (P&lt; 0.05), including those who developed recurrence.
Conclusion. Long-term outcomes of surgical treatment for SCNEN were satisfactory. For prevention of recurrence, as many SCN branches as possible should be decompressed in the operation field during the first operation.

DOI： 10.1097/BRS.0000000000001913

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

OBJECTIVE: In the very elderly, their general condition and poor compliance with drug regimens can render the treatment of low back pain (LBP) difficult. We report the effectiveness of a less-invasive treatment for intractable LBP from superior cluneal nerve entrapment neuropathy (SCN-EN) and gluteus medius muscle (GMeM) pain.
PATIENTS AND METHODS: Between April 2013 and March 2015, we treated 17 consecutive elders with LBP, buttock pain, and leg pain. They were 4 men and 13 women ranging in age from 85 to 91 years (mean 86.6 years). We carefully ascertained that their symptoms were attributable to SCN-EN and GMeM pain. The median follow-up period was 21.5 +/- 12.2 months (range 2e35 months).
RESULTS: SCN-EN was diagnosed in 15 patients (28 sites) and GMeM pain in 14 (27 sites). In 5 patients, we obtained symptom control by local block (Numerical Rating Scale for LBP: declined from 7.8 to 0.8 [P &lt; 0.05], RolandMorris Disability Questionnaire score: declined from 16.5 to 5.2). The other 12 were operated under local anesthesia (SCN neurolysis, GMeM decompression). As 3 patients reported the persistence of leg pain postoperatively, they subsequently underwent peroneal nerve neurolysis and surgery for tarsal tunnel syndrome. These treatments resulted in significantly symptom abatement (Numerical Rating Scale: from 8.2 to 1.7, Roland-Morris Disability Questionnaire score: from 12.8 to 8.6; P &lt; 0.05).
CONCLUSIONS: Even very old patients with intractable LBP, buttock pain, and leg pain due to SCN-EN or GMeM pain can be treated successfully by peripheral block and less-invasive surgery under local anesthesia.

DOI： 10.1016/j.wneu.2016.10.096

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.22603/ssrr.1.2016-0027

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

絞扼性総腓骨神経障害に対し局所麻酔下総腓骨神経剥離術を行った11例について検討した。対象は男8例・女3例で、平均年齢は59歳であった。平均罹病期間は21ヵ月、術後平均観察期間は13ヵ月であった。1例のみが両側性病変で、その他10例は全て片側性病変であった。全例で下腿外側部から足背部の痛み・しびれ、間欠性跛行を認めた。足関節の連続底屈運動では、全例で患肢の下腿外側部から足背部である総腓骨神経領域に痛み、しびれが平均47.3秒で誘発され、陽性と判定した。全例で周術期に合併症は認めず、下肢痛のNRSは術前平均7.7から術後平均1.0へ改善した。また、平均170m程度の間欠性跛行も術後4例で消失し、残りの7例は平均1400m歩行可能なレベルまで改善した。

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記述言語：日本語   出版者・発行元：(株)三輪書店  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

OBJECTIVE: Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve in the tarsal tunnel. It is not known whether vascular or neuropathic factors are implicated in the cause of a cold sensation experienced by patients. Therefore, we studied the cold sensation in the pedal extremities of patients who did or did not undergo TTS surgery.
METHODS: Our study population comprised 20 patients with TTS (38 feet); 1 foot was affected in 2 patients and both feet in 18 patients. We acquired the toe-brachial pressure index to evaluate perfusion of the sole and toe perfusion under 4 conditions: the at-rest position (condition 1); the at-rest position with compression of the foot dorsal artery (condition 2); the Kinoshita foot position (condition 3); and the Kinoshita foot position with foot dorsal artery compression (condition 4). Patients who reported abatement in the cold sensation during surgery underwent intraoperative reocclusion of the tibial artery to check for the return of the cold sensation.
RESULTS: The toe-brachial pressure index for conditions 1 and 3 averaged 0.82 +/- 0.09 and 0.81 +/- 0.11, respectively; for conditions 2 and 4, it averaged 0.70 +/- 0.11 and 0.71 +/- 0.09, respectively. Among the 16 operated patients, the cold sensation in 7 feet improved intraoperatively; transient reocclusion of the tibial artery did not result in the reappearance of the cold sensation.
CONCLUSIONS: Our findings suggest that the cold sensation in the feet of our patients with TTS was associated with neuropathic rather than vascular factors.

DOI： 10.1016/j.wneu.2016.04.095

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記述言語：英語   出版者・発行元：SPRINGER  

Purpose Symptoms of cauda equina syndrome due to ependymoma in the conus medullaris or filum terminale develop slowly. However, hemorrhagic change inside spinal tumors can induce acute neurologic decline. Here, we report a case of posttraumatic hemorrhage inside a filum terminale myxopapillary ependymoma presenting as acute neurologic decline, which had a positive prognosis after surgical resection.
Methods A 28-year-old man presented with buttock pain, sensory disturbance, and motor weakness of bilateral lower extremities after falling on ice during smelt fishing. Magnetic resonance imaging demonstrated a mixed-intensity hemorrhagic intradural mass extending from L1 to L2.
Results The patient underwent emergent surgical decompression and resection. Pathologic examination revealed a myxopapillary ependymoma with intratumoral hemorrhage. After surgery, the patient demonstrated gradual improvement in neurologic deficits and no tumor recurrence.
Conclusions This is the first case of a filum terminale myxopapillary ependymoma with an acute neurologic decline after injury. Early diagnosis and treatment are associated with favorable outcomes.

DOI： 10.1007/s00586-016-4521-5

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記述言語：英語   出版者・発行元：SPRINGER WIEN  

DOI： 10.1007/s00701-016-2770-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

The clinical features and etiology of low back pain and buttock pain remain poorly understood. We report ten patients with buttock pain who underwent gluteus medius muscle (GMeM) decompression under local anesthesia.
Between December 2012 and November 2013 we surgically treated ten patients (four men, six women; mean age 65.1 years) for buttock pain. The affected side was unilateral in seven and bilateral in three patients (total sites, n = 13). The interval from symptom onset to treatment averaged 174 months; the mean postoperative follow-up period was 24 months. Decompression of the tight gluteal aponeurosis over the GMeM was performed under local anesthesia. Assessment of the clinical outcomes was on the numeric rating scale (NRS) for low back pain (LBP), the Japanese Orthopedic Association (JOA) score, and the Roland-Morris Disability Questionnaire (RDQ) score before and at the latest follow-up after treatment.
There were no intraoperative surgery-related complications. The buttock pain of all patients was improved after surgery; their NRS decreased from 7.0 to 0.8 and JOA and RMDQ scores indicated significant improvement (p &lt; 0.05).
In patients with buttock pain, pain around the GMeM should be considered as a causative factor. Less invasive surgery with cutting and opening of the tight gluteal aponeurosis over the GMeM under local anesthesia yielded excellent clinical outcomes.

DOI： 10.1007/s00586-016-4440-5

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

DOI： 10.11477/mf.1436203277

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

DOI： 10.1016/j.wneu.2015.11.043

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Igaku-Shoin Ltd  

A 43-year-old man with a 10-year history of low back pain (LBP) had been conservatively treated elsewhere with medications for non-specific back pain. He presented to our institute with LBP and difficulty in standing up, sitting down, and sitting for prolonged periods. His Numerical Rating Scale score, due to LBP, was 8 out of 10. He had numbness on the lateral aspect of his left thigh. A lumbar radiography and magnetic resonance imaging studies revealed mild degenerative changes and mild canal stenosis in the lumbar spine. Palpation over the left posterior superior iliac crest, 8 cm from the midline over the iliac crest, revealed severe tenderness. A superior cluneal nerve (SCN) block performed at the trigger point in both the buttocks resulted in complete pain abatement and disappearance of the radiating pain. Therefore, we diagnosed SCN entrapment neuropathy (SCNE). However, the pain reappeared a few days later and subsequent treatments failed to relieve it therefore, we decided to perform surgery. The SCN penetrates the thoracolumbar fascia through an orifice just before crossing over the iliac crest. We opened the orifice with microscissors in a distal to rostral direction along the SCN and released the entrapped nerve. After surgery, the symptoms were relieved and the patient experienced no recurrence in the last 4 years after the treatment. SCNE should be considered as a causative factor of LBP, and its treatment using minimally invasive surgery yields excellent clinical outcome.

DOI： 10.11477/mf.1436203248

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AMER ASSOC NEUROLOGICAL SURGEONS  

OBJECTIVE Superior cluneal nerve (SCN) entrapment neuropathy (SCNEN) is a cause of low-back pain (LBP) that can be misdiagnosed as a lumbar spine disorder. The clinical features and etiology of LBP remain poorly understood. In this study, 5 patients with intermittent LBP due to SCNEN who had previously received conservative treatment underwent surgery. The findings are reported and the etiology of LBP is discussed to determine whether it is attributable to SCNEN.
METHODS Intermittent LBP is defined as a clinical condition in which pain is induced by standing or walking but is absent at rest. Between April 2012 and March 2013, 5 patients in this study who had intermittent LBP due to SCNEN underwent surgery. The patients included 3 men and 2 women, with a mean age of 66 years. The affected side was unilateral in 2 patients and bilateral in 3 (total sites, 8). The interval from symptom onset to treatment averaged 51.4 months; the mean postoperative follow-up period was 17.6 months. The clinical outcomes were assessed using the numerical rating scale (NRS) for LBP, the Japanese Orthopaedic Association (JOA) scale, and the Roland-Morris Disability Questionnaire (RDQ) preoperatively and at the last follow-up; these data were analyzed statistically.
RESULTS None of the 5 patients reported LBP at rest. Intermittent LBP involving the iliac crest and buttocks was induced by standing or walking an average of 136 m. In 2 patients with unilateral involvement, LBP was improved only by SCN block. Surgeries were performed on 6 sites in 5 patients because the SCN block was only transiently effective. Patients' SCNs penetrated the orifice of the thoracolumbar fascia. SCN kinking at the orifice was exacerbated at the lumbar-extension provocation posture, and radiating pain increased upon manual intraoperative compression of the SCN in this posture. After releasing the SCN surgically, disappearance of the pain was intraoperatively confirmed by manual compression of the SCN with the patients in the lumbar-extension posture. Surgery was effective in all 5 patients, and all clinical outcome scores indicated significant improvement (p &lt; 0.05).
CONCLUSIONS To the authors' knowledge, this is the first report of patients with intermittent LBP due to SCNEN. Clinical and surgical evidence presented suggests that their LBP was exacerbated by lumbar extension and that symptom relief was obtained by SCN block or surgical release of the SCN entrapment. These results suggest that SCNEN should be considered as a causal factor in patients for whom walking elicits LBP.

DOI： 10.3171/2015.1.SPINE14173

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

OBJECTIVE: The diagnosis of common peroneal nerve entrapment neuropathy (CPNEN) is based on clinical symptoms and nerve conduction studies. However, nerve conduction studies may not detect abnormalities. Under the hypothesis that repetitive plantar flexion that loads the peroneal nerve (PN) at the entrapment point without lumbar loading would be a useful CPNEN provocation test, we evaluated the repetitive plantar flexion (RPF) test as an adjunct diagnostic tool for CPNEN. The study design was a retrospective analysis of prospectively collected data.
METHODS: Our study population consisted of 18 consecutive patients whose ipsilateral CPNEN improved significantly after PN neurolysis. Using repetitive ankle plantar flexion as a CPNEN provocation test, results were recorded as positive when it elicited numbness and/or pain in the affected area of the PN.
RESULTS: The RPF test induced symptoms on all affected sides in the course of 57.4 seconds (range, 14-120 seconds). In 3 patients it induced numbness in the affected area of the PN in the normal leg. Receiver operating characteristic analysis showed that the diagnostic sensitivity and accuracy of the test were 94.4% each. The suggested cutoff point was 110 seconds and the area under the receiver operating characteristic curve was 0.97 (95% confidence interval 0.93-1.02). The positive and the negative predictive values were 89.5% and 94.1%, respectively.
CONCLUSIONS: Our simple RPF test elicited the symptoms of CPNEN and our provocation test helped to identify dynamic PN entrapment neuropathy as the origin of intermittent claudication.

DOI： 10.1016/J.WNEU.2015.09.080

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記述言語：日本語   出版者・発行元：(株)医学書院  

43歳男。10年来、年に1〜2度の頻度で急性腰痛を繰り返しており、その都度、他院を受診していたが、原因不明で非特異的腰痛として扱われていた。今回、椅子を持ち上げた際に腰痛が出現し、痛みが改善しないため発症5日目に当科を受診した。画像上、腰椎に原因となるような異常所見は認められなかったが、腰痛がある左側腸骨稜上には正中から約8cm外側に圧痛点があり、同部位の圧迫で臀部の外尾側から左側大腿外側部に痺れと痛みが放散した。以上より、上臀皮神経(SCN)の絞扼性障害と診断し、SCNブロックにて鎮痛効果が得られなかったため、左側SCNの神経剥離術を施行した。術後、腰痛は消失し、JOAスコアは術前6点から術後1ヵ月で27点へ改善し、術後46ヵ月の最終観察時も27点とその効果が維持していた。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J01228&link_issn=&doc_id=20160219080014&doc_link_id=10.11477%2Fmf.1436203248&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436203248&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(株)医学書院  

糖尿病患者488名のうち、四肢の強いしびれを訴えて当科を受診した23例(男10例、女13例、平均年齢63歳)のしびれの原因を前向きに検討した。受診率は糖尿病患者の4.7%であり、神経学的な診察、画像検査や電気生理学的検査を行った結果、しびれの部位は上肢7例、下肢11例、上下肢5例で、アキレス腱反射の消失は22例、下肢の振動覚の低下は20例にみられた。また、21例に絞扼性神経障害などの合併を認めたが、薬物療法や理学療法、外科療法により症状が改善した症例もみられた。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J01228&link_issn=&doc_id=20160419070008&doc_link_id=10.11477%2Fmf.1436203277&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436203277&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：日本脊髄外科学会  

&emsp;ここに示す脊椎脊髄疾患の神経症状の評価方法は, 症状のスコア化であり, 臨床研究に使用されるものである. 種々の疾患を対象として多くの評価方法が使用されている. 実際の臨床の場での個々の患者の評価は, 厳密な神経学的診察と臨床所見によって行われるべきである. しかし, 治療成績の分析・評価を行う臨床研究としては, 複数の症例の症状をスコア化する必要がある. 本指針では, 脊椎脊髄疾患の各種評価方法 (スコアリング法) について, 現在どの疾患にどのような評価方法が行われているかを文献のレビューから提示した. 文献のエビデンスレベルの評価や, 推奨レベルの決定は行っていない. 本指針の目的は, 脊椎脊髄疾患の臨床研究の計画と評価方法の決定に役立てることである. <br>&emsp;本指針では, これまでの文献で多く採用されてきた各種評価方法を解説し, 臨床研究間の比較に有用な共通言語として紹介した. しかし, そのことは, 新たな評価方法の導入・開発の妨げになってはならないものである. 評価方法 (スコア化) は, 患者が示す症状の一部を, 臨床研究において統計学的解析を可能とする変数の1つに置き換えることであり, すべての症状・臨床経過をスコア化することは不可能である. 研究目的に応じたスコア化が必要といえる. 本指針は, 臨床研究の方法を示すガイドラインではない. 今後の脊椎脊髄疾患の臨床研究計画や, より有用な評価方法の構築の参考にするために, 現時点での知見を示したものである.

DOI： 10.2531/spinalsurg.30.41

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：北海道整形災害外科学会  

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記述言語：日本語   出版者・発行元：北海道整形災害外科学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

We report an extremely rare case of proximal entrapment neuropathy of the median nerve above the elbow in a 44-year-old man who presented with paresthesia with median nerve distribution. Tinel's sign was located in the upper arm medial to the biceps and 5 cm proximal to the elbow. The patient underwent microsurgery under local anesthesia. The fascia covering the brachial- and the biceps brachii muscle entrapped median nerve. After operation, he reported symptom improvement. Lesions above the elbow should be considered as possible causative factors of entrapment neuropathy of the median nerve.

DOI： 10.1272/jnms.82.287

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Medknow Publications  

Background: Superior cluneal nerve entrapment neuropathy (SCN-EN) may contribute to low back pain (LBP). However, it is often misdiagnosed as lumbar spine disorder and poorly understood. Methods: Between April 2012 and September 2013, we treated 27 patients (3 men, 24 women
mean age 75.0 years) with LBP due to SCN-EN elicited by vertebral compression fractures. Symptoms were unilateral in 4 patients and bilateral in 23 patients. The interval between symptom onset and treatment averaged 10.8 months
the mean postoperative follow-up period was 19.0 months. The clinical outcomes were assessed utilizing the numeric rating scale (NRS) for LBP, the Japanese Orthopedic Association (JOA) score, and the Roland-Morris Disability Questionnaire (RDQ) before and after treatment (e.g., until the latest follow-up). Results: LBP in 17 patients was immediately improved by SCN block only. The remaining 10 patients required surgery (involving 18 sites) as SCN blocks were only transiently effective. Operative intervention resulted in the immediate and continued improvement of their LBP. Notably, their NRS decreased from 7.4 to 1.5, their RDQ scores from 19.6 to 7.0, and their JOA scores increased from 10.7 to 20.3. Conclusions: In this series, 27 patients with LBP due to SCN-EN responded either to SCN blocks (17 patients) or surgical release of SCN entrapment (10 patients at 18 sites).

DOI： 10.4103/2152-7806.170455

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記述言語：英語  

DOI： 10.2176/nmccrj.2014-0430

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN NEUROSURGICAL SOC  

Peroneal nerve entrapment neuropathy (PNEN) is one cause of numbness and pain in the lateral lower thigh and instep, and of motor weakness of the extensors of the toes and ankle. We report a less invasive surgical procedure performed under local anesthesia to treat PNEN and our preliminary outcomes. We treated 22 patients (33 legs), 7 men and 15 women, whose average age was 66 years. The mean postoperative follow-up period was 40 months. All patients complained of pain or paresthesia of the lateral aspect of affected lower thigh and instep; all manifested a Tinel-like sign at the entrapment point. As all had undergone unsuccessful conservative treatment, we performed microsurgical decompression under local anesthesia. Of 19 patients who had undergone lumbar spinal surgery (LSS), 9 suffered residual symptoms attributable to PNEN. While complete symptom abatement was obtained in the other 10 they later developed PNEN-induced new symptoms. Motor weakness of the extensors of the toes and ankle [manual muscle testing (MMT) 4/5] was observed preoperatively in 8 patients; it was relieved by microsurgical decompression. Based on self-assessments, all 22 patients were satisfied with the results of surgery. PNEN should be considered as a possible differential diagnosis in patients with L5 neuropathy due to lumbar degenerative disease, and as a causative factor of residual symptoms after LSS. PNEN can be successfully addressed by less-invasive surgery performed under local anesthesia.

DOI： 10.2176/nmc.oa.2014-0454

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記述言語：日本語   出版者・発行元：(一社)日本救急医学会  

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記述言語：日本語   出版者・発行元：Igaku-Shoin Ltd  

DOI： 10.11477/mf.1436203035

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Igaku-Shoin Ltd  

OBJECTIVE: Peroneal nerve entrapment neuropathy (PEN) is generally known as a drop foot with sensory disturbance. However, some patients experience numbness and pain in the affected area without severe paresis due to PEN. We report the clinical features and our surgical results of PEN cases. METHODS: We encountered 17 cases of PEN. The patients were 7 females and 10 males and their ages ranged from 30 to 78 years (average 56.1 years). In these cases, conservative therapy was unsuccessful
therefore, we performed surgical treatment for PEN. RESULTS: Among the 17 cases, 4 were of bilateral and 13 were of unilateral PEN. There was no severe paresis, as in drop foot
however, mild paresis (4/5, manual muscle test, MMT) was noted in 15 cases. In all cases, intermittent claudication presented, which ranged from 10 to 800 m (average 150 m). In 13 cases, radiological abnormality of the lumbar region was noted and 8 cases had a history of lumbar surgery (they had failed back surgery syndrome). In all the cases, we performed neurolysis of the peroneal nerve under local anesthesia
there was no surgical complication. After the surgery, symptoms improved, and the numerical rating of the lower limb improved from 8.6/10 to 0.8/10. Intermittent claudication also improved in all of the cases. CONCLUSIONS: We successfully treated 17 cases of PEN, which had lower limb pain without severe paresis, as in drop foot. Our results indicate that PEN should be recognized as a cause of intermittent claudication. Neurolysis for PEN under local anesthesia is less invasive and is useful for the treatment of lower limb pain.

DOI： 10.11477/mf.1436203012

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記述言語：日本語   出版者・発行元：(株)医学書院  

2013年4月〜2014年4月迄に外科治療を行った絞扼性腓骨神経障害17例を対象に、その臨床像に着目し、特に間欠性跛行との関連について検討した。検討した症例は13例が片側性病変、4例が両側性病変であった。全例で下腿外側〜足背部の痛みやしびれを呈し、立位や歩行負荷により症状が増悪し、座位や患側肢への非荷重下での安静により症状は緩和した。同部の感覚低下は12例に認めたが、運動障害として下垂足を呈したものはなく、足関節の背屈や足趾の背屈がMMT4/5程度と軽度の麻痺を呈したものは15例であった。間欠的跛行は17例全例で認め、歩行距離は平均150mであった。17例中5例では安静時に痛みはなく、13例では下腿外側部の重苦しさを自覚し、11例では同部位の痛みやしびれにより夜間に覚醒することもあった。外科治療に伴う合併症はなく、全例で手術直後から症状の改善を得た。下肢痛の平均数値評価スケール(NRS)は8.6/10から0.8/10へ改善した。間欠的跛行も全例改善し、17例中10例では間欠的跛行は消失、7例は平均3700m(300〜7000m)となった。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J01228&link_issn=&doc_id=20150415170005&doc_link_id=10.11477%2Fmf.1436203012&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436203012&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

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記述言語：日本語   出版者・発行元：日本脊髄障害医学会  

上臀皮神経障害の外科治療において、自験例をもとにその絞扼部位に注目して検討した。対象は外科治療を行った上臀皮神経障害患者12症例(16側:平均69.5歳)で、片側例8例、両側例4例であった。手術中に全例で上臀皮神経を同定でき、10側では胸筋膜貫通部で絞扼されていたが、他の6側では筋膜下での障害が疑われ、剥離や除圧を行った。腰痛は術直後から軽減したが、経過観察期間中に2名で腰痛が再発し、再手術によって腰痛が軽減した。

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Anterior cervical fixation with autologous bone transplantation without the need for harvesting bone from other sites, such as the ilium was developed by Williams and modified by Isu et al. In recent intervertebral fusion procedures, after harvesting the cuboid bone from vertebral bodies, a hydroxyapatite block is placed between two harvested vertebral bones in the same way as in the sandwich method for intervertebral fixation. According to previous studies, this procedure has the following disadvantages: (i) as the corrective force for cervical kyphosis is insufficient, it could not be adapted for patients with preoperative kyphosis; (ii) special devices, including a microsurgical saw, are required for harvesting vertebral bones. In our modified method, we used a conventional high-speed drill instead of a microsurgical saw. Nevertheless, the results show that the operated spine can be stabilized to a greater extent by decreasing the height of the grafted bone, and this might help in reducing postoperative kyphosis.

DOI： 10.1272/jnms.82.50

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DOI： 10.4103/2152-7806.170455

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記述言語：日本語   出版者・発行元：The Japanese Society of Spinal Surgery  

DOI： 10.2531/spinalsurg.29.18

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その他リンク： http://search.jamas.or.jp/link/ui/2015237851

記述言語：日本語  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：HINDAWI PUBLISHING CORPORATION  

Gremlin is an antagonist of bone morphogenetic protein (BMP) and a major driving force in skeletal modeling in the fetal stage. Several recent reports have shown that Gremlin is also involved in angiogenesis of lung cancer and diabetic retinopathy. The purpose of this study was to investigate the role of Gremlin in tumor angiogenesis in pituitary adenoma. Double fluorescence immunohistochemistry of Gremlin and CD34 was performed in pituitary adenoma tissues obtained during transsphenoidal surgery in 45 cases (7 PRLoma, 17 GHoma, 2 ACTHoma, and 2 TSHoma). Gremlin and microvascular density (MVD) were detected by double-immunofluorescence microscopy in CD34-positive vessels from tissue microarray analysis of 60 cases of pituitary adenomas (6 PRLoma, 23 GHoma, 22 NFoma, 5 ACTHoma, and 4 TSHoma). In tissue microarray analysis, MVD was significantly correlated with an increased Gremlin level (linear regression: P &lt; 0.005, r(2) = 0.4958). In contrast, Gremlin expression showed no correlation with tumor subtype or Knosp score. The high level of expression of Gremlin in pituitary adenoma tissue with many CD34-positive vessels and the strong coherence of these regions indicate that Gremlin is associated with angiogenesis in pituitary adenoma cells.

DOI： 10.1155/2015/834137

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN NEUROSURGICAL SOC  

Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve and its branches in the tarsal tunnel. We present our less invasive surgical treatment of TTS in 69 patients (116 feet) and their clinical outcomes. The mean follow-up period was 64.6 months. With the patient under local anesthesia we use a microscope to perform sharp dissection of the flexor retinaculum and remove the connective tissues surrounding the posterior tibial nerve and vessels. To prevent postoperative adhesion and delayed neuropathy, decompression is performed to achieve symptom improvement without excessive dissection. Decompression is considered complete when the patient reports intraoperative symptom abatement and arterial pulsation is sufficient. The sensation of numbness and/or pain and of foreign substance adhesion was reduced in 92% and 95% of our patients, respectively. In self-assessments, 47 patients (68%) reported the treatment outcome as satisfactory, 15 (22%) as acceptable, and 7 (10%) were dissatisfied. Of 116 feet, 4 (3%) required re-operation, initial decompression was insufficient in 2 feet and further decompression was performed; in the other 2 feet improvement was achieved by decompression of the distal tarsal tunnel. Our surgical method involves neurovascular bundle decompression to obtain sufficient arterial pulsation. As we use local anesthesia, we can confirm symptom improvement intraoperatively, thereby avoiding unnecessary excessive dissection. Our method is simple, safe, and without detailed nerve dissection and it prevents postoperative adhesion.

DOI： 10.2176/nmc.oa.2014-0090

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記述言語：日本語   出版者・発行元：(一社)日本臨床スポーツ医学会  

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

症候性脊椎脊髄病変に合併した足根管症候群(TTS)の治療成績について検討した。症候性脊椎脊髄病変に合併したTTS患者11例16足を対象とした。TTSに対する手術治療を優先するA群、脊椎脊髄疾患に対する手術を優先するB群に分けた。A群は9例、B群は2例であった。糖尿病の合併は2例で、A群1例、B群1例で、ともに糖尿病に対する薬物療法を開始し、コントロールは良好であった。治療成績は、excellent 6例、good 3例、fair 2例であった。fairは、A群のCMS 1例、LSS1例で、ともに脊椎脊髄疾患に伴う足底の痺れが残存した。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J03120&link_issn=&doc_id=20140903260010&doc_link_id=issn%3D0917-1495%26volume%3D24%26issue%3D9%26spage%3D1016&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0917-1495%26volume%3D24%26issue%3D9%26spage%3D1016&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

OBJECTIVE: Cervical anterior fusion with autologous bone grafts (Williams-Isu method) is a modified, accepted method to treat spinal degenerative disease. Here we report minimum 10-year outcomes.
METHODS: Of 101 patients we treated by cervical anterior fusion using the Williams-Isu method, 50 patients were followed up for a mean of 177 months. Among the 51 patients lost to long-term follow-up 12 were contacted by telephone; they reported their condition as good and none required reoperation. We evaluated their clinical outcomes on the Japan Orthopedic Association (JOA) score and assessed radiologic findings.
RESULTS: The average JOA score was 12.5 preoperatively, 15.9 at 2 years after surgery (recovery rate 74.9%), and 15.5 at final follow-up (recovery rate 67.0%). All 5 reoperated patients were treated on the level adjacent to the original lesion. Radiographically, cervical alignment changed from 12.5 degrees to 9.0 degrees, the fused segment angle changed from 5.4 degrees to -0.6 degrees. Although worsening of the fused segment angle did not affect the clinical results, it did affect postoperative cervical sagittal alignment. Cervical alignment and range of motion (ROM) were not different between reoperated (group I) and nonreoperated patients (group II). Fused segment angle worsening was milder than expected in group I.
CONCLUSIONS: The long-term results after the Williams-Isu method were good. The fused segment angle loss of approximately 6 degrees did not affect long-term outcomes although it did affect sagittal cervical alignment. Postoperative worsening of the fused segment angle and hyper ROM changes in the adjacent level were not related to the need for reoperation in our study. SPINE

DOI： 10.1016/j.wneu.2012.11.072

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記述言語：日本語   出版者・発行元：(株)三輪書店  

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記述言語：英語   出版者・発行元：ELSEVIER SCIENCE INC  

OBJECTIVE: Patients with cervical instability and intramedullary signal intensity changes on preoperative magnetic resonance imaging scans may benefit from not only cervical decompression but also from fusion surgery. Transarticular screw (TAS) fixation is a useful technique for posterior fixation. We first report treating a patient with cervical spondylosis and instability by cervical laminoplasty with TAS fixation using a bioabsorptive screw.
METHODS: A 66-year-old woman who had undergone surgery for carcinoma of the tongue via the anterior approach experienced cervical myelopathy. Radiologic findings showed severe cervical canal stenosis with myelomalacia and spondylolisthesis at C4/C5 with instability.
RESULTS: We performed laminoplasty of C3 to C7 and TAS fixation of C4/C5 using a bioabsorptive poly-L-lactide screw that contained hydroxyapatite. Her postoperative course was uneventful, and at 1 year after treatment we confirmed C4/C5 fusion.
CONCLUSIONS: Our method has advantages over metal instrumentation. The treated area can be evaluated with the use of magnetic resonance imaging, and the space left after screw absorption is filled by newly formed bone. Because our screw contains hydroxyapatite, it is osteoconductive. This may increase the fusion rate and induce substitution with new bone. To our knowledge this is the first patient treated by cervical posterior TAS fixation via the use of a bioabsorptive screw. Our method is safe and economical and free of the complications elicited by the use of metal parts. TAS fixation with a bioabsorptive screw may be appropriate for one fixation in patients without severe instability.

DOI： 10.1016/j.wneu.2013.01.024

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記述言語：日本語   出版者・発行元：日本脊髄障害医学会  

腰部脊柱管狭窄症に対して手術を行った35例を対象に検討した。術後に末梢神経障害への積極的加療を要したものが10例あった。これら10例の術後JOAスコアを他の25例と群間比較すると、末梢神経治療前は有意に低かったが、治療後には平均3.8点改善し、他の25例との有意差は消失した。代表例2例を提示した。

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記述言語：日本語   出版者・発行元：(一社)日本脊髄外科学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J02943&link_issn=&doc_id=20140508210017&doc_link_id=10.2531%2Fspinalsurg.28.86&url=https%3A%2F%2Fdoi.org%2F10.2531%2Fspinalsurg.28.86&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本脊椎脊髄病学会  

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記述言語：英語   出版者・発行元：SPRINGER WIEN  

DOI： 10.1007/s00701-013-1987-3

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記述言語：日本語   出版者・発行元：(一社)日本脊椎脊髄病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AMER ASSOC NEUROLOGICAL SURGEONS  

Object. Spinal subdural hematomas (SDHs) are rare and some are concomitant with intracranial SDH. Their pathogenesis and etiology remain to be elucidated although their migration from the intracranial space has been suggested. The authors postulated that if migration plays a major role, patients with intracranial SDH may harbor asymptomatic lumbar SDH. The authors performed a prospective study on the incidence of spinal SDH in patients with intracranial SDH to determine whether migration is a key factor in their concomitance.
Methods. The authors evaluated lumbar MR images obtained in 168 patients (125 males, 43 females, mean age 75.6 years) with intracranial chronic SDH to identify cases of concomitant lumbar SDH. In all cases, the lumbar MRI studies were performed within the 1st week after surgical irrigation of the intracranial SDH.
Results. Of the 168 patients, 2 (1.2%) harbored a concomitant lumbar SDH; both had a history of trauma to both the head and the hip and/or lumbar area. One was an 83-year-old man with prostate cancer and myelodysplastic syndrome who suffered trauma to his head and lumbar area in a fall from his bed. The other was a 70-year-old man who had hit his head and lumbar area in a fall. Neither patient manifested neurological deficits and their hematomas disappeared under observation. None of the patients with concomitant lumbar SDH had sustained head trauma only, indicating that trauma to the hip or lumbar region is significantly related to the concomitance of SDH (p &lt; 0.05).
Conclusions. As the incidence of concomitant lumbar and intracranial chronic SDH is rare and both patients in this study had sustained a direct impact to the head and hips, the authors suggest that the major mechanism underlying their concomitant SDH was double trauma. Another possible explanation is hemorrhagic diathesis and low CSF syndrome.

DOI： 10.3171/2013.10.SPINE13346

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

上臀皮神経(以下SCN)障害は腰痛の原因の1つである。今回我々は、SCNの神経剥離術によって難治性腰痛を改善し得たので報告する。対象は当科で外科治療を行った7例11側である。平均年齢は66.3歳、両側性4例、片側性3例、術後平均観察期間は6.4ヵ月であった。SCNの診断は(1)SCN領域の痛み、(2)SCNの胸腰筋膜貫通部でのTinel様徴候、(3)SCNブロックで痛みが75%以上軽減することによって行い、保存療法無効例に外科治療を行った。手術は局所麻酔下に手術用顕微鏡を用いて行った。SCNは術中全例で同定され、神経の絞扼を解除、除圧した。手術症例全例で術直後から腰痛の軽減を得た。(著者抄録)

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記述言語：日本語   出版者・発行元：日本脳神経外科コングレス  

腰部脊柱管狭窄症は罹病率の高い疾患であり、時に外科治療が優れた治療効果を発揮することから、安易に外科治療が行われてしまうこともあるが、自然経過を十分理解したうえで保存療法を基本とし、手術は低侵襲に行うべきである。外科治療は後方支持組織を可能なかぎり温存し、適切に神経根を除圧することを目的とすべきで、決して脊柱管の除圧のみで満足すべきではない。一方固定術は、明確なエビデンスのない状況下ではその適応は慎重にすべきである。手術後は、術後残存症状を後遺症と安易に決めつけるのではなく、末梢神経障害などの合併に注意し、長期の経過観察のもと適切に対応する能力をつけるべきである。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Congress of Neurological Surgeons  

The primary therapy for lumbar spinal canal stenosis (LSS) is conservative treatment. Although severe symptoms of LSS are dramatically improved by surgery some results are unsatisfactory (failed back surgery syndrome). Surgical indications and procedures and the response to postoperative residual symptoms are three issues that must be considered to obtain good results after LSS treatment. According to earlier studies the long-term surgical results were unexpectedly unsatisfactory and contrary to expectations, conservative treatment could prevent symptom exacerbation. The decision to perform surgery must not be based on radiological findings alone because there is no correlation between the radiologically defined stenosis- and the symptoms grade. The main goal of the surgical treatment of LSS is decompression of neural structures. Not only the spinal canal but also the nerve roots should be decompressed appropriately. At surgery, posterior elements such as the paraspinal muscles and facet joints should be preserved as much as possible. As a less invasive surgical option we recommend bilateral decompression using the spinous-process splitting approach and bilateral decompression via hemilaminectomy Fusion surgery may be an alternative approach although its efficacy remains to be determined. Postoperative residual symptoms should not be readily accepted as a sequel of surgery, rather, a merger of peripheral neuropathy should be considered. Superior cluneal nerve neuropathy produces low back pain and tarsal tunnel syndrome results in numbness and pain of the soles of the feet. In some patients it is difficult to distinguish between S1 symptom due to lumbar disease and piriformis syndrome. It is also difficult to distinguish between L5 symptoms due to lumbar disease and peroneal nerve neuropathy. These diseases can be addressed by observation therapy and surgery without lumbar re-operation. We found that these peripheral nerve neuropathies affected lumbar surgery outcomes and that in patients subsequently treated by observation therapy and surgery the JOA scores improved by 3.8 points. Spinal surgeons must respond appropriately to different situations encountered in the course of long-term postoperative observation.

DOI： 10.7887/jcns.23.468

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AMER ASSOC NEUROLOGICAL SURGEONS  

Superior cluneal nerve (SCN) entrapment neuropathy is a known cause of low back pain. Although surgical release at the entrapment point of the osteofibrous orifice is effective, intraoperative identification of the thin SCN in thick fat tissue and confirmation of sufficient decompression are difficult. Intraoperative indocyanine green video angiography (ICG-VA) is simple, clearly demonstrates the vascular flow dynamics, and provides real-time information on vascular patency and flow. The peripheral nerve is supplied from epineurial vessels around the nerve (vasa nervorum), and the authors now present the first ICG-VA documentation of the technique and usefulness of peripheral nerve neurolysis surgery to treat SCN entrapment neuropathy in 16 locally anesthetized patients. Clinical outcomes were assessed with the Roland-Morris Disability Questionnaire before surgery and at the latest follow-up after surgery.
Indocyanine green video angiography was useful for identifying the SCN in fat tissue. It showed that the SCN penetrated and was entrapped by the thoracolumbar fascia through the orifice just before crossing over the iliac crest in all patients. The SCN was decompressed by dissection of the fascia from the orifice. Indocyanine green video angiography visualized the SCN and its termination at the entrapment point. After sufficient decompression, the SCN was clearly visualized on ICG-VA images. Low back pain improved significantly, from a preoperative Roland-Morris Questionnaire score of 13.8 to a postoperative score of 1.3 at the last follow-up visit (p&lt;0.05). The authors suggest that ICG-VA is useful for the inspection of peripheral nerves such as the SCN and helps to identify the SCN and to confirm sufficient decompression at surgery for SCN entrapment.

DOI： 10.3171/2013.7.SPINE1374

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Object. Superior cluneal nerve (SCN) entrapment neuropathy is a poorly understood clinical entity that can produce low-back pain. The authors report a less-invasive surgical treatment for SCN entrapment neuropathy that can be performed with local anesthesia. Methods. From November 2010 through November 2011, the authors performed surgery in 34 patients (age range 18-83 years
mean 64 years) with SCN entrapment neuropathy. The entrapment was unilateral in 13 patients and bilateral in 21. The mean postoperative follow-up period was 10 months (range 6-18 months). After the site was blocked with local anesthesia, the thoracolumbar fascia of the orifice was dissected with microscissors in a distal-torostral direction along the SCN to release the entrapped nerve. Results were evaluated according to Japanese Orthopaedic Association (JOA) and Roland-Morris Disability Questionnaire (RMDQ) scores. Results. In all 34 patients, the SCN penetrated the orifice of the thoracolumbar fascia and could be released by dissection of the fascia. There were no intraoperative surgery-related complications. For all patients, surgery was effective
JOA and RMDQ scores indicated significant improvement (p &lt
0.05). Conclusions. For patients with low-back pain, SCN entrapment neuropathy must be considered as a causative factor. Treatment by less-invasive surgery, with local anesthesia, yielded excellent clinical outcomes. © AANS, 2013.

DOI： 10.3171/2013.3.SPINE12420

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCI LTD  

Ketamine, an N-methyl-D-aspartic acid (NMDA) receptor antagonist, maybe useful for treating neuropathic pain, which is often difficult to control. We report a prospective study of 13 patients with acute neuropathic pain due to spinal cord injury (SCI) treated with ketamine. All underwent a test challenge with 5 mg ketamine. Patients with satisfactory responses were then treated intravenously and subsequently perorally with ketamine. Pre- and post-treatment pain was recorded on a visual analogue scale. All 13 patients responded positively to the ketamine test challenge and underwent continued ketamine administration. At the cessation of treatment and alter at final follow up, pain was decreased by 74.7% and 96.8%, respectively. The average administration period was 17.2 days; it was longer (59 days) in one patient treated in the subacute phase. All patients suffered allodynia-type pain and experienced 30% or less of their original pain intensity upon test challenge. Side effects were noted in five patients, although their severity did not require treatment cessation. In patients with SCI, ketamine reduced allodynia. Particularly good results were obtained in patients treated in the acute phase and these patients did not experience post-treatment symptom recurrence. Our results suggest that in patients with SCI, ketamine is useful for treating neuropathic pain in the acute phase. (c) 2012 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jocn.2012.07.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER JAPAN KK  

The aim of the present study was to develop a novel transfection method for short interfering RNA (siRNA). A nanotube with surfactant activity, A6K, consisting of six alanine residues and a hydrophilic head, lysine, was compared to the conventional cationic transfectant reagents siFECTOR and Lipofectamine 2000. Cytotoxicity for the human glioblastoma cell lines U87MG, A172, and T98G was examined with the MTS assay. Transfection efficiency was analyzed with FITC-labeled siRNA targeting matrix metalloproteinase (MMP)-2 mRNA by fluorescent activity on microscopy. The ultrastructure of A6K was evaluated by electron microscopy. The level of cytotoxicity associated with A6K in the U87MG cells was significantly lower than with siFECTOR and Lipofectamine 2000. Transfection efficiency for siRNA was increased in a dose- and time-dependent fashion. The relative expression of MMP-2 mRNA to beta-actin was reduced in a dose-dependent manner by real-time RT-PCR analysis. The ultrastructure of the A6K was transformed to micelle formation when mixed with the siRNA. The lipid-like self-assembling peptide, A6K, has genes in the micelle associated with the hydrophilic tail. This transfection method is a novel and stable technique with lower cytotoxicity than the current standard methods.

DOI： 10.1007/s00795-013-0011-6

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記述言語：日本語   出版者・発行元：日本脊髄障害医学会  

上臀皮神経障害の診断で神経剥離術を行った腰痛患者4例について、放射線学的検討を行った。手術成績が良好な症例では上臀皮神経障害の画像上の特徴をより反映しているものと考え、術後Roland-Morris Disability Questionnarie(RDQ)が5点以下になった24例と手術によりRDQが14点以上改善した12例について、術前後の腰椎X線より上臀皮神経障害と矢状面配列、側彎Cobb角、骨盤傾斜角との関連を検討した。その結果、上臀皮神経障害の罹患に男女差はなく、矢状面配列は良好で一部に変性側彎が含まれるものの変性側彎の側と上臀皮神経障害の痛み側は一致しなかった。一方、冠状断骨盤傾斜角が比較的強く、頭側へ変位している側と痛み側が一致する傾向にあり、冠状断骨盤傾斜角が上臀皮神経障害と関連している可能性が示唆された。

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記述言語：日本語   出版者・発行元：(一社)日本脊椎脊髄病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Objective The Japanese have higher levels of n-3 polyunsaturated fatty acids (PUFAs) such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in their diets. These facts may contribute to the lower rates of atherosclerosis in Japanese. The purposes of this study were to assess the PUFA levels in patients with subtypes of acute ischemic stroke and to assess the relationship between severity and PUFA levels. Material and Methods We studied 75 patients with lacunar infarction (LI; n=25), atherothrombotic infarction (AT; n=32), and cardiogenic embolism (CE; n=18). The patients underwent blood examinations in a fasting state next morning of hospitalization, including examination of low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), triglyceride (TG), blood glucose, hemoglobin A1c (HbA1c), uric acid, and fatty acid fractions of EPA, DHA, dihomo--linolenic acid (DGLA), and arachidonic acid (AA). We used the modified Rankin Scale (mRS) to assess clinical severity at discharge. Results There was no significant difference in the EPA/AA and DHA/AA ratio among the three stroke subgroups, although the DGLA/AA ratio was significantly higher in patients with LI than in patients with CE. Considering the confounding factors, the mRS was negatively correlated with EPA/AA and positively correlated with age, DHA/AA, and blood glucose. Conclusions High EPA/AA ratio was associated with good outcome in ischemic stroke. Our paper suggests that prestroke dietary habits affect the severity in patients with ischemic stroke.

DOI： 10.1111/j.1600-0404.2012.01695.x

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記述言語：日本語   出版者・発行元：(一社)日本脊椎脊髄病学会  

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記述言語：日本語   出版者・発行元：(一社)日本脊椎脊髄病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN NEUROSURGICAL SOC  

The incidental detection of thyroid lesions in patients undergoing magnetic resonance (MR) imaging of the cervical spine was prospectively evaluated on 389 MR images. Sagittal images extended from the cranio-cervical junction to the upper thoracic level, and axial images from C3-4 to C7-T1 intervertebral levels. Twenty patients (5.1%) had a total of 26 thyroid nodules. Eighteen patients presented with a single dominant nodule, of whom 2 had a multinodular gland with a single dominant nodule (one had 3 and the other had 5 nodules). Two patients had diffusely enlarged gland without a dominant nodule. The mean size of the nodules was 11.6 mm. One thyroid nodule was detected at the C5-6 intervertebral level, 14 at the C6-7, and 11 at the C7-T1. T-2-weighted imaging was more useful than T-1-weighted imaging for the detection of thyroid nodules because of the hyperintense versus isointense appearance of the lesions. Thyroid carcinoma was identified at surgery in one patient. The detection rate was low compared with computed tomography with contrast medium and ultrasonography. Our results suggest that MR imaging has limited value for the detection of thyroid lesions and that the presence of such lesions cannot be denied based only on MR imaging of the cervical spine. However, asymptomatic thyroid lesions, including thyroid cancer, can be identified on MR images of the cervical spine, so we recommend that evaluation of these images should consider such lesions.

DOI： 10.2176/nmc.53.77

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記述言語：日本語   出版者・発行元：(株)三輪書店  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Background: Misdiagnosis and inadequate treatment of lumbar foraminal stenosis (LFS) are the most common causes of failed back surgery. Although several surgical procedures have been reported, the optimal surgical treatment remains controversial.
Aim: We describe our method of microsurgical medial fenestration using an ultrasonic bone curette (Sonopet, Stryker Corp., Kalamazoo, MI, USA) to treat patients with LFS and report our early results.
Patients and Methods: We followed up 26 patients who had undergone microsurgical medial fenestration at least 1 year earlier. The patients were 15 men and 11 women with a mean age at surgery of 59.5 years: the mean follow-up period was 30.6 months. The affected nerve root was at L4 in 1 patient and at L5 in 25. Evaluation of our clinical results was based on the Japanese Orthopedic Association score.
Results: There were no intraoperative surgery-related complications. After surgery, 1 patient had recurrence of L5 radiculopathy associated with iatrogenic spondylolysis. He was successfully treated with resection of the inferior articular process without fusion surgery: there was loss of disc height without obvious instability at the corresponding level. The Japanese Orthopedic Association scores showed significant improvement at 1 month after surgery and at final follow-up (p&lt;0.001). No patient had spinal instability or malalignment postoperatively.
Conclusions: Microsurgical medial fenestration using Sonopet, a less-invasive surgical technique that does not result in spinal instability or malalignment, yielded excellent clinical outcomes. (J Nippon Med Sch 2012: 79: 327-334)

DOI： 10.1272/jnms.79.327

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記述言語：日本語   出版者・発行元：(一社)日本脊椎脊髄病学会  

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記述言語：英語   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Anterior decompression and fusion of the cervical spine is a widely accepted treatment for cervical canal disease. The Williams-Isu method involves cervical anterior fusion with autologous bone grafts from cervical vertebral bodies. Its advantages are a wide operative field, excellent graft fusion, the absence of problems related to the iliac donor site, and direct visualization of the nerve root. For detailed decompression of the cervical root, an ultrasonic bone curette (SONOPET, Stryker Japan K.K., Tokyo) may be useful. To prevent graft extrusion, bioabsorbable screws featuring a head are placed in 4 corners of the bone graft and are fixed with a tap on a part of the graft. The screws are visualized on postoperative X-ray, computed tomography, and magnetic resonance imaging studies. In 69 patients reported elsewhere there were no complications attributable to screw insertion, screw or graft extrusion, or surgery-related infections. When adequate bone cannot be harvested, a piece of ceramic hydroxyapatite is placed between the bone grafts. This sandwich method reinforces the graft, and radiological evidence suggests that it yields better results with respect to the angle and height of the fused segment. For the surgical treatment of cervical ossification of the posterior longitudinal ligament, a large vertebral bone window and a large bone graft are needed: this may result in postoperative radiological worsening. Radiological studies have shown that cervical ossification of the posterior longitudinal ligament can, as can cervical spondylosis, be addressed with the Williams-Isu method. Detailed radiological studies in patients treated with the Williams-Isu method have demonstrated that the range of motion and the disc height of the fused segment must be considered to prevent worsening in that segment after anterior fusion. The Williams-Isu method cannot completely correct cervical alignment., and great caution must be exercised in patients with preoperative malalignment. To reduce the levels to be fused in patients with multilevel lesions due to cervical disease, the Williams-Isu method can be combined with the transvertebral approach. The transvertebral approach facilitated by the wide Williams-Isu window allows the root bifurcation area to be confirmed during the early stage of surgery and possible decompression along the root. Radiological examination has shown that the combination of the Williams-Isu method and transvertebral approach does not affect the fusion level compared with the Williams-Isu method alone and produces better results than does the transvertebral approach alone. (J Nippon Med Sch 2012; 79: 37-45)

DOI： 10.1272/jnms.79.37

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Objective : Spontaneous spinal epidural hematoma (SSEH) is rare. There was not enough information about diagnosis and treatment of SSEH, although they require emergency surgery and some surgeons may hesitate to use alternative treatments. We report our six cases SSEH and discuss treatment of SSEH from the literature. Materials and Methods : We encountered six cases of SSEH. They were 4 female and 2 male cases and age ranged from 61 to 75 years (averaging 67.3 years). The SSEH were located in the cervical (n=3), cervicothoracic (n=3) regions. In 4 cases, there were hematomas at the right side of the spinal epidural space, and 2 cases were at the left side. Results : All cases experienced severe neck or shoulder pain. In five cases, hemiparesis was noted. Cervical MRI showed that epidural hematoma had compressed the spinal cord posterolateraly. In all cases, cervical CT scans also revealed epidural hematoma, too. Five cases were operated on by removal of the hematoma with hemilaminectomy and one case was operated on with laminectomy because of severe paresis. The mean time since the start of the operation was 11 hours (ranging from 7 to 20 hours). Only one case who had only severe pain without paresis was treated conservatively. All except two patients completely recovered neurologically. The two cases continued to have sensory disturbance. Conclusions : We successfully treated 6 cases of SSEH. MRI is useful for diagnosis of SSEH, and CT scan can also diagnose it as in our cases. Cases with severe neurological deficit would be considered as needing surgical treatment at an appropriate time and the cases without neurological deficit should be kept under observation until surgery becomes necessary.

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記述言語：日本語   出版者・発行元：(株)医学書院  

治療を行った脊髄硬膜外血腫6例(男2例・女4例・平均67.3歳)について検討した。全例発症に痛みを伴っており、2例では症状側に一致した頸部から肩に、他の4例では両側に痛みを認めた。発症は突然で、誘因は洗髪2例、大笑いに伴った頸椎の前後屈1例、誘因なし3例であった。6例中5例で麻痺を認め、うち3例は上肢に強い片麻痺を生じていた。頸椎CTでは全例血腫を高吸収域として認め、MRIではT1強調画像で低〜等信号、T2強調画像で高信号の境界明瞭な脊髄を圧迫する硬膜外病変として描出された。血腫は平均5椎体に広がり、全例硬膜後側方に存在していた。強い麻痺の5例には手術を行い、軽度上肢脱力の1例は保存的治療で回復した。手術は発症から平均11時間で行い、4例は片側椎弓切除による血腫除去術、1例は椎弓切除術とし、術直後より症状の著明な改善を認めた。経過観察期間1〜136ヵ月で、2例に軽度の温痛覚障害が残存したが、他の4例では症状の残存や再発はない。

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

A 25-year-old woman and a 31-year-old man presented with chronic lower back pain and unexplained lower abdominal pain. Both patients had groin tenderness at the medial border of the anterior superior iliac spine. The results of radiographical and physical examinations suggested sacroiliac joint dysfunction. Sacroiliac joint injection relieved their symptoms, including groin tenderness. in our experience, groin tenderness is highly specific for sacroiliac joint dysfunction. We speculate that spasm of the iliac muscle can cause groin pain and tenderness. Groin pain and a history of unexplained abdominal pain, with lower back pain, are symptoms that suggest sacroiliac joint dysfunction. Additionally, compression of the iliac muscle is a simple and useful maneuver; therefore, it can be used as a screening test for sacroiliac joint dysfunction, alongside other provocation tests. (J Nippon Med Sch 2011: 78: 257-260)

DOI： 10.1272/jnms.78.257

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCI LTD  

In anterior fusion, we use autologous bone grafts from cervical vertebral bodies (Williams-Isu method; WI-method). To reduce the fusion level, we combine the WI-method and the transvertebral approach (TVA). The wide window yielded by the removal of the bone graft from vertebral bodies at the fusion level provides for the safe decompression of neural structures. Further decompression with TVA is performed from the wide window to the adjacent level. After a two-level decompression, anterior fusion at one level is performed by autologous bone grafting. We subjected 20 patients with cervical disease to this approach. All recovered from their symptoms without surgical complications and in all patients we confirmed fusion and the retention of mobility at the TVA level. The wide operative field yielded by the WI-method is an advantage when the procedure is combined with TVA, and this technique is less invasive in patients with multilevel cervical disease. (C) 2010 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jocn.2010.04.052

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN NEUROSURGICAL SOC  

Detailed changes involved in the worsening of the fused segment angle were assessed after application of the Williams-Isu method using autologous bone grafts from cervical vertebral bodies in 30 patients with cervical disease treated by single-level anterior fusion. The mean follow-up duration was 25.4 months. The fused segment angle was measured on serial radiographs. Whole cervical spine alignment changed from 12.8 degrees to 9.9 degrees. The alignment of the fused segment worsened by mean 3.3 degrees. To elucidate the characteristics of worsening of the fused segment, the 30 patients were divided into 2 groups: Group I (n = 20) without and Group II (n = 10) with postoperative worsening of the fused segment. The loss in the fused segment angle was significantly greater in Group II (8.0 degrees) than Group I (0.9 degrees). Preoperative range of motion and disc height were significantly greater in Group II than Group I. Worsening of the fused segment angle occurred within 1 month in Group I, whereas stabilization was observed after 3 months in Group II. Graft subsidence was primarily posterior and inferior. Our results indicate that the preoperative range of motion and disc height of the fused segment must be considered to prevent worsening in that segment after anterior fusion. Such detailed information is useful for the selection and postoperative monitoring of patients eligible for treatment by the Williams-Isu method.

DOI： 10.2176/nmc.51.208

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN NEUROSURGICAL SOC  

Two patients presented with post-traumatic carotid-cavernous sinus fistulae (CCFs) that were successfully treated by high-flow bypass using a radial artery graft after initial unsuccessful attempts at obliteration by intravascular embolization. Case 1 was a 20-year-old man with a CCF detected by magnetic resonance imaging and angiography following an accident. Although the CCF appeared partially occluded by intravascular embolization, serial angiography revealed CCF recurrence. The CCF was trapped by placing a high-flow bypass. Case 2 was a 21-year-old man who presented with bilateral CCFs after sustaining face trauma. The bilateral CCFs were directly treated because of recurrence after balloon occlusion. At present, intravascular surgery is the first treatment choice, but placing a high-flow bypass with trapping of the CCF gained time to treat the CCF and may be useful for treating post-traumatic CCF that cannot be effectively eliminated by intravascular techniques.

DOI： 10.2176/nmc.51.113

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN NEUROSURGICAL SOC  

Posterior decompression of the cervical spine is an accepted treatment for patients with cervical canal disease, but some patients experience postoperative axial pain and C5 or C6 palsy that affect their quality of life. Here we describe selective posterior decompression using a spinous process-splitting approach to prevent these complications performed in 17 patients with myelopathy treated at median 2.4 levels by selective posterior decompression via the transspinous approach. Clinical symptoms, axial pain, and C5 or C6 palsy were compared before and after treatment. The range of motion of the cervical spine and shift of the cervical cord were studied at the C5 level. All patients experienced symptom improvement and none suffered deterioration or required reoperation. The Japanese Orthopaedic Association score improved from 10.9 to 14.4 points and none of the patients reported C5 or C6 palsy or axial pain at the last follow-up visit. There was no statistically significant change in pre- and postoperative cervical alignment and range of motion. The posterior shift of the spinal cord at the C5 level was 1.7 mm. None of our 17 patients experienced significant postoperative axial pain after selective posterior decompression via the transspinous approach. Minimal spinal cord shift at the C5 level may have contributed to the reduced incidence of postoperative C5 or C6 palsy in our series. Selective posterior decompression is less invasive and effective in some patients with cervical canal disease.

DOI： 10.2176/nmc.51.108

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Schwannoma can occur wherever peripheral nerve Schwann cells are found. However, retroperitoneal schwannoma is extremely rare in that only 16 cases have been reported, including that of the present patient. A 51-year-old male complained of chronic lower back pain and paresthesia in the lower left region. Lower back pain increased with leftward bending. Magnetic resonance imaging (MRI) revealed a neoplastic lesion about 6 cm in diameter in the left psoas major muscle, and the lesion was in contact with the L4 and L5 vertebral bodies The tumor did not continue to the lumbar foramen. The symptom had become disabling, therefore tumor removal was performed using Wiltse's approach. From intraoperative findings, the origin of the tumor was suspected to be the L4 nerve root. The ventral surface of the tumor could not be observed with this posterior approach. Lumbar plexus might adhere closely to the ventral surface of the tumor, therefore the capsule of the tumor was left to avoid neurological deterioration. Schwannoma was diagnosed by pathological analysis, and no malignancy was evident. After the operation, symptoms were completely relieved, and the residual capsule of the tumor diminished in size on MRI after 12 months. The posterior Wiltse's approach can be useful to treat mass lesions in the psoas major muscle. The 16 reported cases of retroperitoneal schwannoma, including that of the present patient, are reviewed.

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記述言語：日本語   出版者・発行元：(株)医学書院  

51歳男。ゴルフでスイングをした後に腰痛が出現した。腰痛は自制範囲内であったために様子をみていた。左側下肢外側のしびれを伴うようになり、左側傍脊柱筋内腫瘍を認めた。保存的治療を行っていたが症状の改善なく、紹介となった。画像所見から神経鞘腫が最も疑った。腰椎椎間孔内に明らかな腫瘍の進展を認めないことから、傍脊柱筋間経由の後方アプローチにより腫瘍に到達し、腫瘍摘出を行う方針とした。術後、腰痛および左下肢外側部のしびれは消失し、術後15日目に独歩で自宅退院した。術後1ヵ月後のMRIでは残存した腫瘍被膜と腫瘍周囲の大腰筋の手術侵襲に伴い炎症に陥っている部分が造影されていたが、術後1年後のMRIでは、大腰筋の炎症は消失し、残存腫瘍被膜は左側腸腰筋の背側に小さな病変として造影される程度にまで縮小した。現在、症状の再燃なく、良好な臨床経過を辿っている。病理所見は、神経鞘腫として矛盾しない結果であった。

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記述言語：日本語   出版者・発行元：(株)医学書院  

60歳男。両手のしびれ、疼痛、脱力が出現した。近医で頸椎症と診断され、前方固定術(C5/C6)、後方除圧(C3-5)を施行された。術後、症状が増悪し、四肢体幹のしびれ、熱感、疼痛、さらに四肢運動麻痺が出現したため紹介となった。両下肢脱力と痙性歩行でADLはサークル歩行、四肢腱反射は亢進し、バビンスキー反射は両側陽性であった。頸椎ミエロCTでC4-7の脊髄圧迫を認め、頸椎症性脊髄症と診断して頸椎後方除圧(C4-7)を行うが硬膜嚢への癒着が強く、十分な除圧は得られず四肢麻痺は進行した。術後約1年の頸椎前方除圧固定術を施行した。両上肢運動麻痺はMMT 4+/5程度に改善したが、四肢体幹のしびれ、疼痛、熱感に関しては、明らかな改善を認めなかった。保存的療法として、5日間ケタミン50mgを1日2回点滴静注し、その後、経口投与(30mg×3/日)へ変更し60日間投与した。しびれはVAS10点が5点、熱感は10点が7点に改善し疼痛は消失した。内服中止で症状が再増悪し継続としたが、ケタミンは連日の通院が必要なため同様の効果を得られるリン酸コデインへ変更し、疼痛としびれはVAS 3、熱感VAS 5は自制範囲内で副作用も認めていない。

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記述言語：日本語   出版者・発行元：(株)医学書院  

症例は75歳男性で、20年前から腰痛があり経過をみていたが、腰痛の増悪に伴い両側下腿外側のしびれと間欠性跛行が出現し外来受診した。精査の結果より腰椎分離すべり症(L5)と診断した。保存的治療を行ったが症状が改善しないため、後方除圧術を施行し、術後ダーメンコルセットを装着した。軽度の腰痛は残存したが、両下腿外側のしびれおよび間欠性跛行は消失し、独歩退院となった。JOAスコア(29点満点)は手術前8点から退院時22点に改善した。しかし、術後4週間時に腰痛増悪と右鼠径部疼痛が出現し再入院となった。腰痛は右側仙腸関節部を中心に差し込む感じが強く、同部位の用手的圧迫で疼痛の増強を認めた。腰痛、右鼠径部痛はビジュアルアナログスケール(VAS)で共に10/10であった。Gaenslenテスト、straight leg raisingテスト、femoral nerve stretchingテスト、Kemp徴候は陰性であった。右側側臥位、寝返り、起き上がりなどの動作、座位・立位の持続で増悪を認めた。歩行も困難なためADLは車椅子であった。腰痛分離すべり症術前の腰椎単純X線の前後像で軽度の左側側凸の側彎を、側面像でL4前方すべりを認めたが明らかな不安定性は認めなかった。腰椎CTでL5両側峡部の分離所見があり、腰椎MRIでL3/4、L4/5レベルにおける硬膜嚢の圧排を認めた。臨床症状、画像所見より仙腸関節障害を疑い右側仙腸関節ブロックを施行した。ブロック直後から右側鼠径部痛、圧痛が改善したことから右側仙腸関節障害と診断した。退院後8ヵ月経過したが腰部の軽度のだるさはあるが右側仙腸関節部疼痛や右側鼠径部痛は再燃を認めていない。

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 75-year-old male presented with groin pain after an operation to treat lumbar spondylolisthesis (L5). Groin tenderness was localized to the medial border of the anterior superior iliac spine (ASIS). Radiographical and physical examination raised the suspicion of sacroiliac joint (SIJ) dysfunction. Injection of a painkiller into the SIJ relieved symptoms, including groin tenderness. Symptoms improved gradually, and finally disappeared after five SIJ injections. Groin pain has been reported as a referred symptom of SIJ dysfunction in 9.3∼ 23% of patients. Prior to the patient undergoing surgery to treat lumbar spondylolisthesis, SIJ dysfunction had not been noted on physical examination. Long penods spent in the abnormal posture due to lumbar spondylolisthesis induced SIJ stress. After the operation, an improvement in daily activity actually increased stress on the SIJ, resulting in SIJ dysfunction. Certain pathologies, including SIJ dysfunction, should be considered as residual symptoms after operations for lumbar spinal diseases.

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記述言語：日本語   出版者・発行元：(株)医学書院  

症例1は38歳男性のバス運転手で、運転中に強い腰痛と左側大腿後面痛が出現した。症例2は24歳男性のガソリンスタンド店員、仕事中に強い腰痛と右側大腿後面の痺れが出現した。症例3は32歳の専業主婦で、乳児を抱きかかえた際に強い腰痛が出現した。3例とも腰椎単純X線や骨盤MRIでは明らかな異常所見は認められず、仙腸関節ブロックにより症状改善がみられたことから仙腸関節障害と診断した。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2010&ichushi_jid=J01228&link_issn=&doc_id=20100712070009&doc_link_id=10.11477%2Fmf.1436101214&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436101214&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Sacroiliac joint (SIJ) can cause low back pain when its joint capsule and ligamentous tissue are damaged. We report our experience in treating three SIJ dysfunction patients presenting with acute low back pain (a 38 year-old male, a 24 year-old male, and a 32 year-old female). SIJ dysfunction was diagnosed using the one-finger test, the modified Newton test, and SIJ injection. In all three patients, lumbar MRI demonstrated slightly degenerated lumbar lesions (lumbar canal stenosis, lumbar disc hernia). Two patients had paresthesia or pain in the leg and all three patients showed iliac muscle tenderness in the groin, which was thought to be a referred symptom because of improvement after SIJ injection. The two male patients returned to work and the problems have not recurred. Although our female patient resumed daily life as a housewife, her condition recurred at intervals of 2-3 months and she required regular SIJ injections. The prevalence of SIJ dysfunction of low back pain is about 10% , so it should be considered as a differential diagnosis when treating low back pain and designing treatment for lumbar spinal disorders.

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記述言語：日本語   出版者・発行元：日本脊髄障害医学会  

自家椎体を用いた頸椎前方固定術(Williams-Isu法;以下WI法)への自家椎体グラフトにセラミックをはさみ移植骨の補強を行うSandwich法(以下S法)併用が術後の頸椎アライメント等に与える影響ついて放射線学的に検討した。方法は、頸椎症に対しS法を併用してWI法を行った群(20例)と、頸椎症に対しS法を併用せずにWI法を行った群(20例)、およびOPLLに対しS法を併用してWI法を行った群(17例)の3群間で「頸椎アライメント」「固定椎角」「固定椎間高」の術後変化を比較した。結果、「頸椎アライメント」の術後変化に有意な群間差は認められなかった。「固定椎角」と「固定椎間高」は3群とも術後やや悪化したが、その程度はS法を併用した2群が併用しなかった群に比べて有意に小さかった。これらの結果から、S法はWI法におけるグラフト作製に有用であるのみならず、固定椎角と固定椎間高の維持に貢献し、その効果は頸椎症だけでなくOPLLにおいても同様であることが示唆された。

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN NEUROSURGICAL SOC  

A 24-year-old woman presented with concomitant spinal and bilateral intracranial subdural hematomas (SDHs) after hitting her head and lower back in a fall while snowboarding. She developed lower back pain and posture headache. Magnetic resonance imaging revealed bilateral intracranial SDHs and spinal SDH. Her symptoms improved and all hematomas resolved gradually without treatment, and completely disappeared by 5 months after the accident. Simultaneous intracranial SDH and spinal SDH have been reported in only 18 patients, including ours, of whom 6 had suffered trauma. The mechanism of concomitant SDHs has not been clarified, but migration of the hematoma from the intracranial to spinal sites may be an important mechanism. In our patient, low cerebrospinal fluid pressure syndrome and double trauma may also have been involved.

DOI： 10.2176/nmc.50.402

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCI LTD  

Autologous bone grafts from cervical vertebral bodies (Williams-Isu method) are used for anterior fusion of the cervical spine. When adequate amounts of bone cannot be harvested from the vertebral body, hydroxyapatite (a ceramic) is placed between the bone grafts (the sandwich method). We conducted a radiological study to examine the efficacy cif the sandwich method by comparing the alignment of the whole spine and the fused segment between patients who had received a sandwich graft (n = 20) and a control group (n = 20). Although there was no difference between the two groups with respect to the alignment of the whole spine, the alignment and height of the fused segment was significantly better in the patients in the sandwich graft group. In both groups the position of the anterior edge of the graft and the loss in the angle of the fused segment were significantly correlated (p &lt; 0.05). We found that the sandwich method not only reinforced the graft, but also yielded better results with respect to the angle and height of the fused segment. (C) 2009 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jocn.2009.07.118

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 31-year-old woman presented with worsening numbness and pain in the arms and chest. Neurological findings at admission were decreased pain sensation and temperature sensation in the arms and chest. Magnetic resonance demonstrated a large cervical syrinx from the level of C4 to Th4 associated with Chiari I malformation. Occipital craniectomy and C1 laminectomy were performed for foramen magnum decompression. Intraoperative ultrasonography, performed after removal of the outer membrane of the dura mater at the level of the foramen magnum, revealed insufficient decompression. Therefore, the dura mater was completely opened and duraplasty was performed with a polyglycolic acid patch and fibrin glue. Sufficient decompression was thus achieved. The neurological symptoms and signs improved within the first postoperative month, and magnetic resonance showed a decrease in the size of the syrinx and no cerebrospinal fluid leakage. In patients undergoing foramen magnum decompression with duraplasty, the use of a polyglycolic acid patch and fibrin glue renders suturing unnecessary and avoids the common complications associated with suture duraplasty.

DOI： 10.1272/jnms.77.221

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN NEUROSURGICAL SOC  

Three men aged 40 to 60 years presented with rare lumbar spinal intradural lipomas without spina bifida manifesting as worsening numbness, pain of the lower extremities, and bladder dysfunction. All 3 patients underwent decompressive laminectomy. The lipoma and cauda equina nerves were dissected from the dura mater under the operating microscope, untethering the spinal cord and returning the cauda equina nerves to the original position. Duralplasty was performed using an expanded polytetrafluoroethylene sheet. Postoperatively, all patients experienced improvement of their neurological deficits. In the surgical treatment of spinal lipomas, the primary purpose is untethering and decompression, which can be achieved by untethering the spinal cord, returning the cauda equina nerves to the normal position, laminectomy, and duralplasty, without removal of the lipoma.

DOI： 10.2176/nmc.49.616

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER WIEN  

In anterior fusion, we use autologous bone grafts from cervical vertebral bodies and bioabsorptive screws to prevent graft extrusion (Williams-Isu method). We report the application of and indication for the Williams-Isu method for OPLL and present our clinical and radiological results.
Using the Williams-Isu method, we treated 17 patients with cervical OPLL; 15 had segmental- and 2 had continuous-type OPLL. The median follow-up term was 24 months. The patients underwent anterior decompression and fusion at a single level (n = 8) or at two levels (n = 9). As a control, 17 patients with cervical spondylosis underwent anterior single-level decompression and fusion using the Williams-Isu method. Pre- and postoperative radiographs of the cervical spine were obtained in all patients, and the alignment of the whole cervical and fused segment and the height of the fused segment were compared.
All but one patient experienced alleviation of clinical symptoms without deterioration during the follow-up period. The recovery rate on the JOA score was 71.7%. The patient with continuous-type OPLL suffered postoperative neurological deterioration because of a remnant of the upper-level OPLL. Radiological studies confirmed the absence of bone graft dislocation and fracture, and of satisfactory bone fusion in all patients. There was no significant difference between the two patient groups with respect to whole spine alignment and the alignment and height of the fused segment.
The Williams-Isu method is useful for treating not only cervical spondylosis but also cervical segmental OPLL at one or two levels.

DOI： 10.1007/s00701-009-0478-z

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：IGAKU-SHOIN LTD  

OBJECTIVE: Sacroiliac joint (SIJ) dysfunction, piriformis syndrome (PFS) and tarsal tunnel syndrome (TTS) produce symptoms similar to lumbar degenerative disease (LDD). Patients who have these diseases plus LDD sometimes experience residual symptoms after surgery for LDD. We therefore assessed the results of treatment of SIJ dysfunction, PFS and TTS associated with LDD.
PATIENTS AND METHODS: We assessed 25 patients who underwent surgery for LDD and were affected with SIJ dysfunction (12 patients), PFS (7 patients) or TTS (6 patients). SIJ dysfunction was treated with rest, drugs, pelvic band and sacroiliac joint block. PFS was treated with rest, drugs, physical exercise, injection of local anesthetic into the piriformis muscle, and surgical resection of the piriformis muscle. TTS was treated with drugs and tarsal tunnel opening. We analyzed the improvement score and recovery rate (JOA score) for both LDD surgery and the treatment of SIJ dysfunction, PFS and TTS.
RESULTS: Symptom improvement was observed in all patients with SIJ dysfunction and PFS and in 4 patients with TTS. The improvement score and recovery rate of treatments for SIJ dysfunction, PFS and TTS were lower than those of surgery for LDD.
CONCLUSION: The improvement score and recovery rate of treatment for SIJ dysfunction, PFS and TTS were not as high as those for LDD. To enhance patient satisfaction, it is important to consider these complicating diseases when designing treatments for LDD. (Received : March 2, 2009, Accepted : May 26, 2009)

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記述言語：日本語   出版者・発行元：(株)医学書院  

仙腸関節障害、梨状筋症候群、足根管症候群を合併した腰椎変性疾患の治療経験について検討した。腰椎変性疾患術後に合併した仙腸関節障害、梨状筋症候群、足根管症候群に対して治療を行った25例を対象とし、仙腸関節障害合併は12例、梨状筋症候群合併は7例、足根管症候群合併は6例であった。治療効果は、腰椎変性疾患治療前と合併疾患治療前後の日本整形外科学会腰痛疾患治療成績判定基準の改善値と改善率を用いて検討した。3疾患ともに問診と触診による特徴的な臨床症状を把握することにより診断は可能で、適切な治療を施行することにより良好な臨床成績が得られた。腰椎術後のfailed back surgery症例の中には、3疾患の合併が潜んでいる可能性もあると考えられた。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2009&ichushi_jid=J01228&link_issn=&doc_id=20090828180007&doc_link_id=10.11477%2Fmf.1436101012&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436101012&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語  

Lumbar canal stenosis (LCS) is a degenerative disease involving the lumbar vertebrae, discs, and ligamentum flavum that result in neurological deficit to some extent. The natural history of symptoms of LCS is highly important because they do not necessarily worsen with progressive degeneration. Therefore, a observation therapy is adopted for the treatment of this condition. Although invasive treatment is required for some patients, surgery cannot be performed solely on the basis of radiological findings and careful evaluation of neurological symptoms is necessary. In the event that spinal surgery is required, it is important to minimize degree of invasiveness
various devices and operative approaches and methods have been developed to this end. Our strategy for the surgical treatment of LCS involves microscopic decompression via a posterior approach. In our method, modified bilateral decompression via the splitting of the spinous process using an ultrasonic bone curette (SONOPET), and the results of this approach have been excellent. Our method is less invasive, facilitates the preservation of the paraspinal muscle, and represents a useful approach to posterior spinal elements. Our findings indicate that this method involves less muscle damage as compared to other methods. LCS should be differentiated from conditions other than those involving the spinal canal such as foraminal stenosis and far-out syndrome, piriformis syndrome, and tarsal tunnel syndrome. The incidence of these conditions is higher than appreciated and they present with neurological deficits similar to observed in LCS. Here, we report our criteria of operative indications for surger and the procedures that we developed for the treatment of LCS, based on a review of the available literature.

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記述言語：日本語   出版者・発行元：日本脊髄障害医学会  

脊髄障害によると思われる四肢の強い神経性疼痛を認める6例にケタミンを用いた治療を行った。原因疾患は頸髄中心性脊髄損傷4例、頸椎OPLL術後1例、胸椎OPLL後遺症1例であり、ケタミン5mg静注によるチャレンジテストで症状が改善した5例に対し、ケタミン50mg(1日2〜3回)を数日間静脈内投与した後、150mg分3で経口投与を行い、投与期間は2週間〜3ヵ月とした。その結果、重篤な副作用を認めることなく、2例では著明な改善、2例では改善が得られた。なお、有効症例4例は全てアロディニア様疼痛で、投与終了後も症状の再燃は認めなかった。ケタミンはアロディニア様脊髄障害性疼痛に対して投与を考慮する価値のある薬剤と考えられ、罹病期間が短く、チャレンジテストで鎮痛効果が高いもの、投与期間や経過観察期間を長くできるもので高い効果が期待できる可能性が示唆された。

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記述言語：日本語   出版者・発行元：(一社)日本脊椎脊髄病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN NEUROSURGICAL SOC  

Growth hormone-releasing hormone (GHRH) stimulates not only the synthesis and secretion of GH but also the proliferation of normal somatotrophs. The expression of GHRH receptor (GHRHR) is regulated by GHRH, both of which are known to be expressed in human GH-secreting pituitary adenoma cells. Somatic mutations in the subunit of Gs alpha protein (gsp), lead to the constitutive activation of adenylyl cyclase in pituitary adenomas that secrete GH. It has not been examined how gsp mutations influence GHRHR expression in GH-secreting adenomas. We therefore analyzed the expression levels of GHRHR messenger ribonucleic acid (mRNA) in GH-secreting pituitary adenomas focusing on a gsp mutation. Furthermore, we investigated the effect of GHRH on the expression of GHRHR mRNA in primary cultures of GH-secreting pituitary adenoma cells. GHRHR mRNA expression levels were significantly elevated in gsp mutation-positive GH-secreting adenomas compared with those in gsp mutation-negative ones. In primary-cultured GH-secreting adenoma cells, the increase of GH secretion in response to GHRH was shown in both gsp mutation-positive and -negative adenoma cells with a significantly higher response in the latter adenoma cells. GHRH increased GHRHR mRNA expression level in gsp mutation-negative adenoma cells while it was not influenced by GHRH in gsp mutation-positive adenoma cells. These results suggest that gsp mutations up-regulate GHRHR mRNA expression in GH-secreting pituitary adenoma cells, and that gsp mutations desensitize the adenoma cells to GHRH

DOI： 10.2176/nmc.48.481

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外科学会  

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記述言語：日本語   出版者・発行元：日本脊髄障害医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN NEUROSURGICAL SOC  

Cervical anterior fusion is useful for the treatment of patients with cervical disease, but carries the risk of postoperative worsening of the cervical spine alignment and kyphosis. Preoperative prediction of the risk for kyphosis could help to avoid such postoperative complications. We attempted to predict the postoperative development of kyphosis in 59 patients scheduled for cervical anterior fusion using antologous vertebral bone grafting. Of these, 36 underwent single and 23 two level fusion with median follow up of 58.2 months. Whole spine alignment, fused segment alignment, and mobility of the intervertebral disc were compared using pre- and postoperative radiographs. Alignment of the whole spine changed from 13.7 degrees to 11.1 degrees, and the angle of the fused segment changed from 3.6 degrees to - 3.2 degrees. Postoperative alignment was not worse than the preoperative flexion posture in any of the 59 patients. Forty-nine patients with preoperative lordotic alignment did not develop postoperative kyphosis. Nine patients with preoperative straight alignment had several types of postoperative alignment, including kyphosis. Two patients with postoperative kyphosis showed marked loss in the angle of the fused segment, which affected mobility to flexion of the fused segment. One patient with preoperative kyphotic alignment manifested postoperative kyphosis. The postoperative alignment was influenced by the preoperative alignment. Kyphosis may develop in patients with preoperative straight alignment and large mobility to flexion of the fused segment. This information is useful for surgical planning of anterior cervical fusion using autologous vertebral bone grafting.

DOI： 10.2176/nmc.48.201

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN NEUROSURGICAL SOC  

A 58-year-old woman (Case 1) presented with disturbance of fine movement and gait. Magnetic resonance (MR) imaging and computed tomography (CT) demonstrated bilateral ossified ligamentum flava at the C34 and C4-5 levels and severe cervical canal stenosis. She underwent posterior decompression and despite strong adhesion to the dura mater, the ossified ligamenturn flavurn was removed without inducing liquorrhea. Her neurological symptoms improved postoperatively. A 63-year-old man (Case 2) was admitted with disturbance of fine movement and gait that had developed gradually. MR imaging and postmyelography CT demonstrated cervical canal stenosis via the ossified posterior longitudinal ligament at the C4-6 levels and ossified ligamentum flavurn on the right at the C4-5 levels. He underwent right posterior decompression of C4-5. After right hemilaminectomy of C4-5, the ligamentum flavurn was exposed. Neither the ligamenturn flavurn nor the ossification had adhered to the dura mater, so complete removal was successful and he recovered completely from his neurological symptoms. Diffuse-type ossified ligamentum flavum had adhesion to the dura mater, as in our Case 1, whereas focal-type ossified ligamentum flavurn did not, as in our Case 2. This information is useful for treatment planning.

DOI： 10.2176/nmc.48.183

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

Background: To assess the effect of 3 different surgical approaches on paraspinal muscle atrophy in patients undergoing lumbar back surgery, we compared their pre- and postoperative CT scans and their serum Hb, CRP, and CPK levels.
Methods: The study population consisted of 71 patients who had undergone lumbar back surgery with microscopic posterior decompression without fusion. We examined the effect on paraspinal muscle atrophy of 3 different approaches to the spinal canal. Group 1 (n = 19) underwent unilateral paraspinal dissection from the spinous process with cutting of the spinous process. In group 2 (n = 24), we used modified bilateral decompression via hemilaminectomy, and group 3 (n = 28) was treated by modified bilateral decompression via spinous process splitting. We measured the levels of CPK, Hb, and CRP preoperatively and on the first postoperative day, and compared the preoperative volume of the paraspinal muscle with the volume measured I year after the operation.
Results: Age, sex, operative time, and CRP and Hb levels were not statistically different among the 3 groups. The postoperative elevation of CPK was significantly lower in groups 2 and 3 than in group 1. Group 3 manifested a significantly lower degree of atrophic changes of the paraspinal muscle than groups 1 and 2.
Conclusions: We found that among the 3 approaches evaluated, modified bilateral decompression via spinous process splitting is less invasive, facilitates preservation of the paraspinal muscle, and is a useful approach to posterior spinal elements resulting in decreased muscle damage. (C) 2008 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.surneu.2007.04.021

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：IGAKU-SHOIN LTD  

Objective: To treat lumbar foraminal tumors, the chosen operative approach depends on the tumor location and size. Although total facetectomy and the combined intra- and extraspinal canal approach provide a wide operative field, facet fusion is required and the procedure is invasive. We report the successful removal of Eden type IV tumors using only the paraspinal approach without complete facetectomy.
Patients and Methods: We treated 4 patients with lumbar foraminal tumors. All were Eden type IV (neurofibroma, n=3; schwannoma, n=1) and all were removed via the paraspinal approach without total facetectomy and the intraspinal canal approach. Although total facetectomy was not needed to remove the intraforaminal component, phased foraminal expansion with a SONOPET (m&m Co., Ltd., Tokyo, Japan) device was required in all cases. Intratumoral decompression was performed with probe for tumor and PAL-I and EMG recordings were obtained with direct stimulation of the nerve root.
Results: All tumors were completely removed via only the paraspinal approach; neither total facetectomy and fusion, nor the addional intraspinal approach was required. There was no tumor recurrence or lumbar instability during the follow-up period.
Conclusions: To remove the intraforaminal component of Eden type IV tumors, phased expansion of the foramen with a SONOPET and intratumoral decompression with CUSA and PAL-I are required and effective. Using these devices, this less invasive approach is useful for the treatment of patients with lumbar foraminal tumors of Eden type IV.

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記述言語：日本語   出版者・発行元：(株)医学書院  

Eden IV型の腰部椎間孔部腫瘍に対して傍脊柱筋アプローチを用いた。Eden IV型に分類された腰部神経鞘腫1例および腰部神経線維腫3例を対象とした。主訴は全例下肢痛で、4例中3例では痛みのため歩行障害を伴った。傍脊柱筋アプローチにて腫瘍摘出術を行った。4例全例で、椎間孔内部腫瘍を含めて全摘出がなされた。腫瘍摘出に際して、椎間関節の全切除や、脊柱管内操作が必要となったものはなかった。全例で術前に認めていた下肢痛は消失し、腫瘍摘出により新たな感覚障害や麻痺が出現した症例はなかった。術後経過観察期間に腫瘍が再発したものや、腰椎の不安定性が出現したものはなかった。

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記述言語：日本語   出版者・発行元：(株)医学書院  

47歳男。臀部痛、右下肢外側の痺れ・疼痛が出現し、症状が増悪し徐々に歩行困難となった。精査・加療で入院となった。放射線学的所見より、L5/S1レベルの右椎間孔狭窄症と診断した。約2週間、腰部コルセットを装着し安静にしたが、症状は改善しなかったため、手術を施行した。術野が狭いうえ、骨棘が神経根に喰い込んでおりスペースがなかったので、超音波骨メスを使用して神経根に喰い込んでいる骨棘を骨削し、神経根を除圧した。除圧後、神経根周囲の静脈還流は改善した。術直後より下肢の痛みは軽減し、歩行可能となった。術後5ヵ月半経過しているが、下肢痛は消失している.術後CTでは骨棘の切除により関節突起間部の十分な減圧と関節の温存を認めた。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2007&ichushi_jid=J01228&link_issn=&doc_id=20071205040005&doc_link_id=10.11477%2Fmf.1436100658&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436100658&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：IGAKU-SHOIN LTD  

Lumbar foramimal stenosis is one of the important disorders underlying radicular symptoms and unrecognized or recurrent foraminal stenosis may result in failed back surgery. We report a 47-year old man with foraminal stenosis of the lumbar spine associated with a bone spur at the pars interarticularis. He suddenly experienced severe right leg pain, lumbago and gait disturbance. Radiographic studies revealed foraminal stenosis on the right L5/S1 associated with a bone spur at the pars interarticularis. There was no dural sac compression by spondylolysis. As his symptoms failed to respond to conservative treatment, he underwent decompression without fusion with an ultrasonic bone curette.
We performed lateral fenestration and foraminotomy at the right L5/S1 using the extraforaminal approach. After partial foraminotomy, the right L5 nerve root was compressed by the bone spur at the pars interarticularis. For satisfactory decompression we removed the bone spur using an ultrasonic bone curette. His symptoms disappeared immediately after surgery.
Although long-term follow-up is necessary, we suggest that microdecompression with an ultrasonic bone curette is a useful method to treat patients with foraminal stenosis of the pars interarticularis.

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

吸収性スクリューを用いたWilliams-Isu法による頸椎前方除圧固定術を施行した57症例(男39例、女18例、年齢33〜75歳、平均年齢57.2歳)を対象に検討した。対象疾患は頸椎症47例、OPLL9例、外傷1例で手術を行った椎間は1椎間48例、2椎間8例、3椎間1例であった。手術材料の吸収性スクリューとして結晶性のPLLAスクリューを用いて頸椎前方固定術に必要なグラフトを自家骨から採取するWilliams-Isu法を用いて充分に脊髄および神経を減圧後、グラフトである移植骨を減圧部へ挿入した。その結果、椎間固定率は96.1%で、術前後のアライメントに統計学的な有意差はなく、また経過観察期間中の本手術に伴うグラフトおよびスクリューの脱転や感染もなかった。手術患者は麻酔覚醒後、数時間で歩行が可能で頸椎カラーも数日の装着で済んだ。本法の手術適応は1〜2椎間レベルのOPLLや頸椎症症例に効果的で広い視野が得られることから、比較的経験の浅い術者にとって良い手術法であると考えられた。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2007&ichushi_jid=J03120&link_issn=&doc_id=20071203270012&doc_link_id=issn%3D0917-1495%26volume%3D17%26issue%3D12%26spage%3D1458&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0917-1495%26volume%3D17%26issue%3D12%26spage%3D1458&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：日本語   出版者・発行元：(一社)日本脳神経外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

Background: The aim of this study is to report our use of new bioabsorbable screws in cervical anterior fusion. These screws need not be removed because they are completely absorbed by resolution in vivo. We describe our method and the new bioabsorbable screws.
Methods: We used PLLA screws until September 2004 and uncalcined uHA-PLLA screws thereafter. They are completely absorbed by resolution to water and carbon dioxide upon in vivo hydrolysis. The uHA-PLLA screws are x-ray impenetrable, and their uHA content renders them osteoconductive. In cervical anterior fusion, the graft is inserted in the area of deletion resulting from decompression. The screws are inserted in the 4 comers of the vertebral body and graft. In long fusion, they are introduced in the 2 lateral wings of the bone graft on each vertebral body and in the 4 comers. Our method eliminates the need for plates or mesh.
Results: We have used this method in 62 patients and encountered no complications. There were no screw or graft extrusions and no surgery-related infections. The patients were able to walk a few hours after the operation and wore a simple neck collar for a few days.
Conclusions: This safe and easy method shortens the hospital stay and reduces the risk of graft extrusion and complications associated with the use of nonabsorbable devices. (0 2007 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.surneu.2006.11.061

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記述言語：日本語   出版者・発行元：(株)三輪書店  

過去5年間に手術が施行された70歳以上の高齢者手術例17例を検討し、高齢者頸椎症に対する頸椎前方除圧固定術の手術適応について検討した。手術を行った70歳以上の高齢者頸椎症は45例中、過去5年間に経験した17例を検討した。重篤な全身合併症がなく、発症前まで自立した生活を送っていた場合は、高齢者頸椎症の手術治療は可能であった。歩行が困難になるほど重篤な症状を呈すると、術後の症状改善は良好でなく自立した生活を送ることができなくなるため、治療時期を遅らせない配慮が必要であった。手術治療は低侵襲手術を心がけるべきである。生体内分解吸収性スクリューを用いた自家椎体使用の前方固定術は手術超早期(数時間後)に離床可能であり、高齢者には最適な手術法であった。1椎間レベルの神経根症例や後方要素が軽度である脊髄症例に手術適応があった。

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記述言語：日本語   出版者・発行元：日本脊髄障害医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

Background: The transvertebral approach is useful for decompression in patients with cervical radiculopathy; because the intervertebral disk is preserved, moveability is retained. We performed wide deletion of the vertebral body to increase the patient population eligible for treatment with this approach and include patients with compression of the cervical spinal cord.
Methods: In patients undergoing anterior decompression, we performed vertebrotomy (13 x 8 mm) at the midline of the cervical vertebral body at the upper level using a surgical saw. The resulting hole facilitates decompression of the cervical cord and nerve root; a ceramic insert is introduced in the area of deletion. To prevent graft extrusion, the bilateral wings of the bone graft are fastened with bioabsorbable screws.
Results: We used this approach in 163 patients with several cervical diseases. Collapse of the vertebral body and fusion of the operated intervertebral disk were encountered in only 1 patient (0.61%). There was no significant difference between pre- and postoperative alignment. Reoperation was required in 7 patients whose symptoms did not improve, in 1 with disk hernia, in 5 with severe spondylosis, and in 1 with combined-type OPLL.
Conclusions: Although this approach is appropriate in patients undergoing cervical anterior decompression, the narrowness of the visual field may result in insufficient decompression, and its indication is restricted to patients with cervical disk hernia, mild cervical spondylosis, and segmental OPLL. In patients with segmental instability, continuous or combined OPLL, severe cervical spondylosis, and kyphosis, this approach should not be used. (c) 2007 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.surneu.2006.06.059

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

OBJECTIVE: We report our experience with the SONOPET ultrasonic bone curette.
METHODS: Between September 2001 and July 2005 546 patients underwent micro-scopic spinal surgeries using a high-speed drill and the SONOPET instrument.
RESULTS: We encountered operative complications thought to be attributable to the use of the SONOPET in six patients (1.1 %). There were five instances of dural puncture and one spinal cord injury. All dural tears occurred when the dura mater was aspirated into the tip of the SONOPET. None of the affected patients developed postoperative clinical complications because cerebrospinal fluid leakage was avoided by appopriate closure. We think that the transient spinal cord injury occurred, because the vibration emanating from the SONOPET was, transmitted directly to the spinal cord. Some patients experienced damage to the epidural venous plexus for reasons similar to those described above.
CONCLUSION: SONOPET facilitates the removal of bone in a narrow field, such as that encountered during keyhole surgery. It aids in the removal of the lateral edge of bone and is especially useful for expanding the foramen intervertebrale or opening the lateral recess. However, its use is not without risk. To prevent dural tears and venous Plexus injury, we recommend that cotton be placed between the SONOPET and important structures. To avoid spinal cord injury, we suggest that the SONOPET be inserted horizontal with the dura mater to avoid the direct transmission of vibrations emanating from the instrument to the spinal cord. SONOPET is suitable for decompression on the lateral side, but not for decompression above the spinal cord.

DOI： 10.1227/01.NEU.0000222655.69368.19

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1227/01.NEU.0000232659.56174.28

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Hypoxia-inducible factor-1 (HIF-1) alpha is the major transcription factor involved in the adaptive response to hypoxia. The purpose of this study was to investigate whether HIF 1-alpha protects HP75 cells, pituitary adenoma cell line from hypoxia induced apoptosis. HP75 was transfected with siRNA targeting HIF 1-alpha mRNA sequences or scrambled RNA duplexes, followed by subjected to hypoxia (1% oxygen) for 24 h, compared with normoxia (21%). The efficacy of RNAi was assessed via real-time RT-PCR and immunohistochemistry. Apoptosis was determined by Tdt-mediated dUTP nick end-labeling (TUNEL) assay and agarose gel electrophoresis. Membrane cDNA microarray was examined to detect gene profiling among the cell in normoxia, hypoxia, or hypoxia following the RNAi. A significantly greater proportion of HP75 cells transfected with specific siRNA duplexes and subsequently exposed to hypoxia demonstrated apoptosis to a large extent when compared with non-transfected cells. Transfection with specific siRNA duplexes knocked down HIF 1-alpha mRNA and protein expression in hypoxia-exposed cells by approximately 80%, whereas transfection with scrambled siRNA duplexes had no noticeable effect on HIF 1-alpha expression. Microarray analysis indicated that HIF1-alpha down-regulated caspase-10. These findings strongly suggest that HIF 1-alpha exerts an antiapoptotic role in HP75 in hypoxia.

DOI： 10.1007/s11060-005-9017-9

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：IGAKU-SHOIN LTD  

Far-out syndrome (FOS) is a rare disease in which the L5 nerve root is compressed by a transverse process, the sacral ala, and a bony spur at the extraforaminal zone. We report the case of patient with FOS due to a bulging disc and review the literature. This 34-year-old male experienced severe left leg pain and slight motor weakness of the left, extensor digitorum. Radiographic studies revealed no abnormality in the spinal canal. The intervertebral disk bulged to the left. Because of fat it was difficult to discern the left L5 nerve root from the sacral ala in the extraforaminal zone, His symptoms failed to respond to conservative treatment, and lie underwent decompression of the L5 nerve root without fusion, During the operation, the left L5 nerve root was exposed by drilling the sacral ala via the left paraspinal approach. The sacral ala was removed along with the left L5 nerve root to obtain sufficient pulsation and movement of the left L5 nerve root. Neither the intervertebral joint nor the intervertebral disk was removed. The patient's symptoms disappeared immediately after surgery. Due to anatomical factors, the L5 nerve root is easily compressed and the presence of this syndrome should be considered in a differential diagnosis. Careful and appropriate decompression without fusion yielded an excellent outcome.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Hypoxia inducible factors (HIF) are transcription factors regulating expression of several genes related to oxygen homeostasis in response to hypoxic stress. Although HIF1-alpha and platelet derived growth factor-B (PDGF-B) are expressed in glioma tissue and closely related to tumor angiogenesis mediating vascular endothelial growth factor (VEGF) activity, their direct relationship has not yet been clarified. The aim of this study is to investigate whether HIF1-alpha regulates PDGF-B expression. The human glioblastoma cell lines, U87MG, U251MG, and A172, were exposed to 1-21% oxygen for 24 h. PDGF-B mRNA expression were quantitatively analyzed by real time RT-PCR, their intracellular protein levels were determined by computerized image analysis supported by flow cytometry to detect intracellular PDGF-B, and the concentration of secreted PDGF-B protein was assayed by ELIA. We also assayed following transfection of the cells with short interference RNA (siRNA) targeting HIF1-alpha mRNA. Relative PDGF-B mRNA and secretion of PDGF-B protein were significantly elevated at 1% oxygen. Following transfection of HIF1-alpha siRNA at 1% oxygen, PDGF-B expression was significantly suppressed at mRNA level. Our findings indicated that HIF1-alpha up-regulated expression of PDGF-B in human glioblastoma cells and showed the feasibility of siRNA technology in glioblastoma cell lines.

DOI： 10.1007/s11060-005-3279-0

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記述言語：英語  

DOI： 10.1007/s00701-005-0685-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：TAYLOR & FRANCIS LTD  

DOI： 10.1080/02688690500495380

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記述言語：日本語   出版者・発行元：IGAKU-SHOIN LTD  

Unilateral spondylolysis and midline defects in the posterior spinal elements attributable to spina bifida occulta (SBO) result in the unilateral floating of the vertebral arch. We report a patient with unilateral spondylolysis associated with SBO in the lumbar spine and review the literature. This 71-year-old male experienced severe left leg pain and lumbago that worsened upon walking. Radiographic studies revealed SBO and unilateral spondylolysis of L5. The dural sac and left L5 nerve root were compressed by the organization of tissues around the spondylolysis. As his symptoms failed to respond to conservative treatment, he underwent unilateral laminectomy without fusion. At operation, the left lamina of L5 was floating and unstable, the right lamina was stable. Medial facetectomy at L4/5 and excision of the left floating lamina of L5 were performed. For satisfactory decompression of the dural sac and left L5 nerve root, the cartilaginous fibrous tissue around the lysis was removed. His symptoms disappeared immediately after surgery. Although long-term follow-up is necessary, we suggest that unilateral microdecompression without fusion is a useful method to treat patients with unilateral spondylolysis with SBO.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We document the co-localization of honeycomb golgi and ACTH-immunopositive granules in giant ACTH-producing pituitary adenoma cells. A 42-yr-old woman presented with Cushing's disease and a giant adenoma that invaded the sphenoid and cavernous sinus. She underwent transsphenoidal surgery followed by radiation therapy. Some of the adenoma cells were ACTH-positive and upon electron-microscopic (EM) study most were found to contain sparse granules and no type-l filaments. In many cells the golgi complex had undergone partial or total vacuolar transformation that resulted in the appearance of honeycomb golgi. Immunohistochemical study of mirror sections of portions containing cells with honeycomb golgi revealed that the cells with honeycomb golgi showed ACTH-immunopositivity. Honeycomb golgi, which was formerly considered a morphological marker of gonadotroph adenomas in females, has previously been identified in large ACTH-producing pituitary adenomas but there has been no direct evidence that individual cells with honeycomb golgi are cells that produce ACTH. Our immunohistochemical documentation of ACTH-immunoreactivity in individual adenoma cells containing honeycomb golgi clearly confirms that honeycomb golgi is not confined only to gonadotroph adenomas in females. Rather, the existence of honeycomb golgi in cells of other adenoma types may be due to their low hormone production and/or to disturbances in the regulation of the exocytotic pathway. © Copyright 2005 by Humana Press Inc. All rights of any nature whatsoever reserved.

DOI： 10.1385/EP:16:3:239

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

Background: Measurement of dural sinus or drainage vein pressure is useful for determining the appropriate treatment for some patients. We report a novel measurement procedure that reduces bleeding from the needle puncture site as well as further tearing of the wall.
Methods: The vessel is punctured through the patch by gelatin sponge with fibrin sealant and a siliconized elastic needle is introduced. After obtaining the desired measurements, the needle is withdrawn through the fibrin sealant-bearing patch whose presence facilitates sealing of the puncture site. To further decrease the incidence of complications due to incomplete hemostasis, an additional identically prepared path is placed over the site.
Results: We have used this method in several operations and have encountered no complications. Our method also makes it possible to safely approach the drainers of pial arteriovenous malformations.
Conclusions: Our method is easy and convenient and prevents the leakage of blood from the puncture site and further tearing of the venous wall. (c) 2005 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.surneu.2004.07.046

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Hypoxia-inducible factor (HIF)-1α is a transcription factor in hypoxia adaptation mechanisms. In malignant tumors, HIF-1α upregulates vascular endothelial growth factor (VEGF) expression to induce tumor angiogenesis. Although VEGF and HIF-1α are expressed in pituitary adenomas, the relationships of these factors remain unclear. Therefore, we examined the expression of HIF-1α and VEGF using real-time RT-PCR and immunohistochemistry to clarify the relationship of these factors in pituitary adenomas. HIF-1α mRNA and VEGF mRNA levels in pituitary adenoma tissues from 25 operated patients were quantified using real-time RT-PCR. Some tissues were also studied by double fluorescent immunohistochemical methods. HIF-1α mRNA and protein were expressed in all pituitary adenomas examined. Their expression tended to be higher in GH-producing and lower in ACTH-producing tumors. VEGF mRNA and protein were also expressed in all pituitary adenomas. There was no significant correlation in the expression levels of HIF-1α and VEGF mRNA. The mutual expression of HIF-1α and VEGF was of no significance
in only a few cells were HIF-1α and VEGF co-localized. Our results suggest that in pituitary adenomas VEGF expression may not depend strongly on HIF-1α expression. © Copyright 2005 by Humana Press Inc. All rights of any nature whatsoever reserved.

DOI： 10.1385/EP:16:2:115

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Hypoxia-inducible factor (HIF)-1α is a crucial transcription factor involved in the adaptive response to hypoxia, whereas cathepsin D, which regulates angiostatin in several cancer cell lines, has been reported to be upregulated by HIF-1α. In order to determine the involvement of angiogenesis in pituitary adenomas, we studied the expression of both HIF-1α and cathepsin D in tissues from 58 patients (39 women, 19 men, ranging in age from 20 to 78 yr), sorted by histological group, and assayed by double immunohistochemistry. HIF-1α immunoreactivity, confined to the nucleoplasm, was present in both tumor and vascular endothelial cells. There was no difference in microvascular density (p = 0.7761) by histotype. ACTH-producing adenomas showed the lowest level of HIF-1α, whereas prolactin (PRL)-producing adenomas and HIF-1α-positive microvessels showed the high-est (p &lt
0.001). In contrast, the lowest expression of cathepsin D was observed in PRL-producing adenomas, whereas the highest expression was detected in ACTH-producing adenomas (p &lt
0.0001). Imaging analysis with fluorescence double immunohistochemistry showed that HIF-1α-negative tumor cells did not express significantly higher levels of cathepsin D. In these poorly vascularized tumors, the hypoxic marker HIF-1α may not downregulate cathepsin D. The mechanisms of tumor angiogenesis and cell invasion in pituitary adenomas may differ from those in other tumor cells. © Copyright 2005 by Humana Press Inc. All rights of any nature whatsoever reserved.

DOI： 10.1385/EP:16:2:123

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記述言語：日本語   出版者・発行元：日本脳腫瘍病理学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING LTD  

OBJECTIVE Double pituitary adenomas are extremely rare. They can be divided into contiguous and clearly separated types. Most contiguous tumours are surgically removed as one tumour and the co-existence of different adenoma types can be confirmed by histological methods. In contrast, detailed preoperative neuroimaging studies can suggest the co-existence of separated multiple adenomas. In patients with multiple adenomas, surgical failure may result when one adenoma is missed during surgery. Among 600 surgical cases we encountered four patients with clearly separated double pituitary adenomas; all were highly suspect on preoperative MRI studies.
PATIENTS AND RESULTS All four patients manifested acromegalic symptoms; one patient also exhibited hyperprolactinemia and two had familial pituitary adenomas unrelated to multiple endocrine neoplasia type I (MEN-1). All underwent transsphenoidal surgery and histology confirmed the diagnosis of GH-producing plus gonadotroph adenoma in two cases and of two GH-producing adenomas each in the other two patients.
CONCLUSION Although the pathogenesis of our double adenomas remains unknown, genetic abnormalities may be involved because two patients had familial pituitary adenomas unrelated to MEN-1. When preoperative MRI is suggestive of double adenomas, careful surgical exploration is necessary to avoid missing the other adenoma because the risk of surgical failure is high, especially in patients with functioning adenomas.

DOI： 10.1111/j.1365-2265.2004.02055.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING LTD  

OBJECTIVE Ghrelin and its receptor, growth hormone secretagogue (GHS) receptor (GHSR), are expressed in the normal pituitary gland and various types of pituitary adenoma. Somatic mutations in the subunit of Gs alpha protein (gsp), which led to a constitutive activation of adenylyl cyclase, are reported in GH-producing pituitary adenomas. We analysed the relationship between ghrelin mRNA and GHSR mRNA expression levels in gsp mutation-positive and -negative GH-producing pituitary adenomas.
PATIENTS Pituitary adenoma tissue was obtained at surgery from 20 patients with acromegaly.
METHODS The expression levels of human ghrelin mRNA and GHSR mRNA were quantified using a competitive RT-PCR method. To detect the gsp mutations, amplified Gs alpha subunit cDNA fragments were sequenced directly using RT-PCR method.
RESULTS There was no significant difference in the expression of ghrelin mRNA between mutation-positive and -negative adenomas. The expression of GHSR mRNA was significantly lower in gsp mutation-positive than -negative adenomas. There was a significant negative correlation between the levels of ghrelin mRNA and GHSR mRNA expression in mutation-negative adenomas; no such correlation was found in mutation-positive adenomas.
CONCLUSION These results suggest that GHSR mRNA expression is downregulated by ghrelin in gsp mutation-negative GH-producing pituitary adenomas, and that changes in intracellular signalling pathways in gsp mutation-positive GH-producing pituitary adenomas affect the expression of G protein-coupled receptors such as GHSR. The absence of negative correlation between ghrelin and GHSR expression might be induced by lowered GHSR expression in gsp mutation-positive GH-producing adenomas.

DOI： 10.1046/j.1365-2265.2003.01898.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

OBJECTIVE AND IMPORTANCE: We describe a very rare case involving a ruptured intracranial aneurysm at the distal posteroinferior cerebellar artery (PICA) branching from the extracranial vertebral artery.
CLINICAL PRESENTATION: A 53-year-old woman experienced the sudden onset of a severe occipital headache and vomiting. Computed tomographic scanning revealed subarachnoid and intraventricular hemorrhage. Cerebral angiography of the left vertebral artery demonstrated the left PICA branching from the extracranial segment of the extracranial vertebral artery at the level of C2; a saccular aneurysm arose from the intracranial portion of the distal PICA.
INTERVENTION: Via the transcondylar approach, we were able to obtain adequate visualization without retracting important structures. To avoid injury to the anomalous PICA, the aneurysm was clipped.
CONCLUSION: Only four other cases of a distal aneurysm of the PICA branching from the extracranial vertebral artery have been reported in the literature. In all cases, the aneurysm originated at the intradural extracranial portion of the PICA. To our knowledge, the case presented here is the first report of a ruptured aneurysm at the level of the intracranial portion of the PICA branching from the extracranial segment of the vertebral artery.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL SCIENCE LTD  

OBJECTIVE The level of growth hormone (GH), growth hormone secretogogue (GHS) and GHS receptor (GHSR) messenger ribonucleic acid (mRNA) expression has been reported as being higher in GH-producing pituitary adenomas than in other types of pituitary adenomas. Recently, ghrelin, an endogenous ligand specific for GHSR, was isolated. Therefore, we attempted to clarify whether ghrelin mRNA is expressed in various types of human pituitary adenoma by competitive reverse transcription-polymerase chain reaction (RT-PCR). We also examined the relationship between the levels of ghrelin or GHSR mRNA and hormonal and tumour characteristics in patients with pituitary adenomas.
PATIENTS Pituitary adenoma tissue was obtained at surgery from 13 patients with acromegaly, 4 with prolactinomas, 5 with gonadotrophin (Gn)-producing adenomas, 4 with non-functioning adenomas, 2 with ACTH-producing adenomas and 2 with TSH-producing adenomas.
METHODS The expression levels of human ghrelin mRNA and GHSR mRNA were quantified using a competitive RT-PCR method.
RESULTS Ghrelin mRNA was detected in all pituitary adenoma tissues examined, with the highest mean level detected in non-functioning adenomas, a moderate level in OH-producing adenomas and Gn-producing adenomas, and the lowest level in prolactinomas, The level of ghrelin mRNA expression in GH-producing adenomas correlated negatively with the size of the adenoma (n = 13) (r = - 0.756, P = 0.0028). Furthermore, the mean level of ghrelin mRNA expression in high-grade (III and IV of Hardy classification) GH-producing adenomas was significantly lower than that in low-grade (I and II) OH-producing adenomas (P = 0.0016). GHSR mRNA was also detected in all pituitary adenomas with the highest mean level in GH-producing adenomas, a moderate level in nonfunctioning adenoma, and the lowest level in prolactinoma and On-producing adenomas.
CONCLUSIONS Ghrelin mRNA, in addition to GHSR mRNA, is expressed in various types of pituitary adenoma with different levels of expression in each type. Our findings suggest that ghrelin produced in pituitary adenoma may play some role in the mechanism underlying the development of adenoma cells through autocrine and/or paracrine pathways.

DOI： 10.1046/j.1365-2265.2001.01286.x

Web of Science

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AMER PHYSIOLOGICAL SOC  

We attempted to clarify whether leptin and uncoupling protein 1 (UCP1) are involved in the action of nicotine on the energy balance. Male Wistar rats were infused subcutaneously with nicotine (12 mg.kg(-1).day(-1)) for 4 or 14 days. At the end of the 4-day period, the plasma concentrations of leptin of the nicotine-treated and pair-fed rats were lower than those of the freely fed rats, although the levels of leptin mRNA expression in various white adipose tissues did not differ among the three groups. At the end of the 14-day nicotine infusion period, plasma concentrations of leptin were higher, and leptin mRNA expression in the omentum and epididymal and retroperitoneal adipose tissues was stronger in the nicotine-treated rats than in the pair-fed and freely fed rats. UCP1 mRNA expression in the brown adipose tissue of nicotine-treated was stronger than that of the pair-fed rats. These results suggest that continuous nicotine infusion differentially affects the synthesis and secretion of leptin according to the duration of infusion and stimulates UCP1 mRNA expression, probably in a manner independent of leptin.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL SCIENCE LTD  

OBJECTIVE Thyrotrophin-releasing hormone (TRH) paradoxically induces the release of growth hormone (GH) when injected intravenously into acromegalic patients, although the mechanism of this action is unknown at present. Several research groups have reported that the level of TRH receptor-1 (TRHR-1) mRNA expression is variable in pituitary adenomas, and does not correlate with the degree of paradoxical GH response to TRH administration in a limited number of acromegalic patients. We aimed to compare the expression levels of TRHR-1 mRNA among various types of pituitary adenoma and to clarify whether these levels correlate with the degree of pituitary hormone response to TRH.
PATIENTS Pituitary adenoma tissue was obtained by surgery from 14 patients with acromegaly, four with prolactinomas, nine with nonfunctioning adenomas and one with a TSH-producing adenoma.
METHODS The level of human TRHR-1 mRNA expression in each adenoma was quantified using the competitive reverse transcription polymerase chain reaction (RT-PCR) method. For amplification of a TRHR-1 cDNA fragment, a sense primer was designed according to the sequence in exon 2 and an antisense primer designed according to the sequence located at the region in exon 3 that does not encode for the alternative splicing-generated short form of TRHR-1 mRNA.
RESULTS TRHR-1 mRNA was detected in all pituitary adenomas examined and did not correlate with their size. The mean level of TRHR-1 mRNA expression was significantly lower in GH-producing adenomas than in prolactinomas and nonfunctioning adenomas (1.4 +/- 0.4 x 10(2) attomol/mug total RNA, 10.7 3.4 x 10(-2) attomol/mug total RNA, and 7.2 +/- 3.3 x 10(-2) attomol/g total RNA, respectively). The ratio of plasma peak: GH induced by TRH administration to the basal level of plasma GH in the patients with acromegaly correlated positively with the level of TRHR-1 mRNA expression in their GH-producing adenomas (r = 0.620, P = 0.0179). The responsiveness of plasma PRL and gonadotrophin to TRH in the patients with prolactinoma and nonfunctioning pituitary adenoma did not significantly correlate with the levels of TRHR-1 mRNA expression in their pituitary adenomas, respectively.
CONCLUSIONS The findings of the present study suggest that the level of TRHR-1 mRNA expression varies among different types of pituitary adenoma. Furthermore, in acromegaly, the responsiveness of plasma GH to TRH administration appears to at least partially depend on the level of TRHR-1 mRNA expression in the GH-producing pituitary adenoma.

DOI： 10.1046/j.1365-2265.2001.01237.x

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総ページ数：167p   記述言語：日本語  

CiNii Books

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記述言語：日本語   出版者・発行元：(一社)日本脊椎脊髄病学会  

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J-GLOBAL

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

近年、脳神経外科でも脊椎疾患の診療機会は増えている。頸椎X線画像は、脊椎疾患の診断において多くの情報を提供してくれるものの、われわれ脳神経外科医にとってはCTやMRIと比べると臨床の場で有効に活用できていないことも目にする。本稿では、X線画像の読影のポイントを実例を提示しながら解説する。(著者抄録)

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記述言語：日本語   出版者・発行元：日本脊髄障害医学会  

胸腰椎手術後の残存腰痛に関連した腰椎周辺疾患に対し手術施行した15例の健康関連QOLを測定し、治療効果を検討した。症状は腰痛15例、臀部痛7例、下肢痛1例で、手術した腰椎周辺疾患は上臀皮神経障害8例11側、中臀筋障害8例8側、中臀皮神経障害3例3側であった。80歳未満の13例について術前にSF-36v2を測定し、得られた8つの下位尺度得点と2つのサマリースコアを国民標準値と比較したところ、Mental Component Summary以外の全ての下位尺度が国民標準より有意に低値を示した。また、対象15例において術前後のNumerical Rating Scaleを測定したところ、術前後で有意な改善を認めた。以上、腰椎周辺疾患を治療することで患者QOLが改善する可能性が示唆された。

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記述言語：日本語   出版者・発行元：(一社)日本脊髄外科学会  

足根管症候群(TTS)に対するMRI撮影の標準化を目的として、足根管および後脛骨神経を明瞭に描出するための適正な撮影条件について検討した。その結果、3D脂肪抑制T2*WI、2D-T2WI、2D-T1WIのaxialは解剖学的把握に有用で、特にガングリオンなどの腫瘤が存在した場合、T2WIとT1WIを比較することで、その成分の判断材料に役立つ可能性が示唆された。

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記述言語：日本語   出版者・発行元：(株)三輪書店  

＜文献概要＞はじめに 腰痛診療ガイドライン2012によると,腰痛の85%は原因が特定できない非特異的腰痛に分類されている.われわれはこのような原因が特定できない腰痛に関して,仙腸関節障害や上・中臀皮神経障害,中臀筋障害,梨状筋症候群などの腰椎周辺疾患に着目して治療を行ってきた.上臀皮神経障害をはじめ,これらの腰椎周辺疾患についてさまざまな報告がされてきているが,中臀皮神経障害に関する報告はいまだ少ない.1957年にStrongらは30例,39側の腰臀部痛を起こした上・中臀皮神経の遮断術を報告しているが,57%の症例で鼠径部痛もしくは下肢痛を認め,手術により80%の症例で症状が改善した.30例中5例にあったS1-2領域の下肢症状に関しては,中臀皮神経遮断術で改善したと記載されている.その後長い間,渉猟し得る範囲では文献的な報告はみられず,近年になって2016年にAotaらが中臀皮神経の剥離術により腰臀部痛が改善した症例を報告し,2018年にわれわれもParkinson病に合併した中臀皮神経障害の症例報告,および11例13側の中臀皮神経障害例に対する中臀皮神経剥離術の詳細な外科手技と,その治療成績を報告した.本稿では,われわれの経験をもとに,中臀皮神経障害の臨床的な特徴や診断,治療について解説する.

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記述言語：日本語   出版者・発行元：(株)三輪書店  

＜文献概要＞はじめに 腰椎周辺には傍脊柱筋などの筋肉や末梢神経,骨盤などさまざまな組織や臓器があり,これらが原因となる腰椎周辺疾患により腰痛や臀部痛をきたすことがある.腰椎周辺疾患は的確な診断と治療により改善が得られるものの,画像での診断が困難であることから,往々にして非特異的腰痛として扱われている場合がある.近年われわれは,これら腰椎周辺疾患に注目し,積極的に介入することで良好な治療成績を収め報告してきた.本稿では,腰椎周辺疾患の1つである中臀筋障害に対する診断および治療について概説し,中臀筋障害に関する最新の文献をレビューする.

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

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記述言語：日本語   出版者・発行元：(株)三輪書店  

＜文献概要＞はじめに 「腰痛診療ガイドライン2012」によれば,腰痛の85%は原因が特定できない腰痛に分類されており,腰痛の日常診療では原因が特定できない腰痛をどのように治療していくかが重要なことである.古くから,仙腸関節障害や上臀皮神経障害による腰臀部痛は知られていたが,MRI,CTなどの画像診断の進歩により,これら画像診断ができない疾患については忘れられた腰痛となっていた.近年,村上らが仙腸関節障害,井須らのグループや青田らのグループが臀皮神経障害(上臀皮神経障害,中臀皮神経障害)による腰臀部痛を報告し,再び注目されるようになってきた.本稿では,非腰椎性腰臀部痛を呈する臀皮神経障害(上臀皮神経障害,中臀皮神経障害)や仙腸関節障害などの腰臀部疾患の診断,治療を概説的に述べ,現時点での問題点についても言及する.

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記述言語：日本語   出版者・発行元：(株)メディカ出版  

＜POINT1＞中下位頸椎損傷・側面透視は正確に。・外側塊スクリューは椎体後縁を越えないように。・固定はスクリューだけに頼らず、状況に応じてフックやワイヤリングも併用。＜POINT2＞胸腰椎損傷・手術適応はDenisの3 column theoryを参考に。・スクリュー挿入点と角度は、解剖、術前CT、透視で確認。・スクリュー挿入は、海綿骨を感じながら、皮質骨を穿破しないように。(著者抄録)

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：(一社)日本臨床神経生理学会  

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記述言語：日本語   出版者・発行元：(一社)日本脊髄外科学会  

総論として絞扼性末梢神経障害の頻度、臨床症状と診断、保存療法と手術治療について概説し、各論として以下の下肢絞扼性末梢神経障害の臨床症状、診断、治療について述べた。1)外側大腿皮神経障害、2)総腓骨神経障害、3)浅腓骨神経障害、4)足根管症候群。下肢のしびれ痛みを呈する下肢絞扼性末梢神経疾患の診療に際して最も重要なことは、まず最初に下肢絞扼性末梢神経疾患を疑って検索を進めることであると考えられた。

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記述言語：日本語   出版者・発行元：(株)三輪書店  

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記述言語：日本語   出版者・発行元：(株)三輪書店  

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記述言語：日本語   出版者・発行元：(株)医学書院  

著者等は腰痛・腰下肢痛患者に対し、初診時から腰椎周辺疾患と末梢神経障害に十分留意する方針のもと治療を行っている。今回、2014年1月〜12月に腰椎もしくは腰下肢痛を主訴に受診した新規患者のうち、入院加療を要し、かつ6ヵ月以上経過を追えた103例の治療成績について検討した。治療方法は先ずプロック治療を行い、効果が一時的な症例や疼痛が残存した症例には外科治療を行った。治療成績の評価にはNRSやJOAスコアを用いた。成績は、ブロック治療のみで改善したものが47例(45.6%)、外科治療を要したものが52例(50.5%)、ブロック治療の効果がなく、画像上原因を特定できず経過観察しているものが3例(2.9%)であった。NRSは治療前平均7/10が最終観察時2/10と有意に改善し、JOAスコアも治療前平均12/29が最終観察時21/29と有意に改善していた。

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記述言語：日本語   出版者・発行元：(株)医学書院  

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記述言語：日本語   出版者・発行元：(株)医学書院  

症例は71歳男性で、左臀部を中心とした腰臀部痛が出現した。症状は左側臀部から大腿外側部の痛みで、左側臀部の腸骨稜と大転子からほぼ等距離のところに強い圧痛点を認めた。立位および歩行で症状は増悪し、間歇性跛行は500mと連続歩行は制限されていた。骨盤X線では軽度の変性変化、腰椎MRIではL4/5レベルに軽度の脊柱管狭窄を認めた。臨床症状および理学所見より左側中殿筋障害を疑い、左側中殿筋ブロックを行ったところ、NRS 2点まで痛みは改善した。ブロックによる鎮痛効果から左側中殿筋障害と診断した。その後痛みは再燃し、合計5回のブロックを施行したが、鎮痛効果は一時的であった。日常生活に支障があることから、左側中殿筋除圧術を施行した。術直後より座位や歩行は許可し、ADLの制限や外固定などは行わなかった。手術に伴う合併症は生じなかった。皮下ドレーンを術翌日に抜去し自宅退院した。退院後は長距離歩行や駆け足も可能となった。疼痛の再燃はみられていない。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01228&link_issn=&doc_id=20180427180010&doc_link_id=10.11477%2Fmf.1436203724&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436203724&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(株)メディカ出版  

末梢神経障害は、頻度は少なくないものの接する機会が少ないためか、脳神経外科医が一般的に治療しているとは言い難い。特に、腰下肢の末梢神経障害はあまり知られていないのが現状であろう。本稿では、手根管症候群、上臀皮神経障害、総腓骨神経障害、足根管症候群の代表的な4つの末梢神経疾患についてポイントを絞って解説した。これらは、日常臨床で遭遇する機会が多く、疾患の特徴を理解することで疑い病名をつけることは思いのほか難しくない。また手術も局所麻酔下に低侵襲に行えるため、高齢者にも積極的に適応できる利点がある。本稿に触れたことを機にぜひ興味をもち、脳神経外科診療の一つのツールとして取り入れていただきたい。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

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記述言語：日本語   出版者・発行元：(株)医学書院  

MRI装置のコイルは小さな対象物の感度を上げるため、3インチのサーフェスコイルを使用した。健常人3名(30〜45歳)を対象とした。足根管症候群(TTS)で手術を行った2例でMRIを撮影し、描出と術中所見と比較検討した。2D撮像結果から、後脛骨神経を判別しやすいシーケンスは、T2強調画像(T2WI)、T1強調画像(T1WI)、脂肪抑制T2*強調画像(T2*WI)であった。足根管部のコントラスト差が最も明瞭であったものは脂肪抑制T2*WIであったため、シーケンスは3D-GREの脂肪抑制T2*WIを採用した。撮像時間を考慮してスライス厚は1.5mmを採用した。フリップ角度は15度を採用した。撮像時間は、脂肪抑制3D-T2*WIに7分57秒、T2WIに3分11秒、TIWIに2分49秒を要し、合計13分57秒であった。足根管症候群での検討では、足根管部の神経や血管の描出は良好であった。腫瘤性病変はなく、特発性のものと診断した。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01228&link_issn=&doc_id=20180131040004&doc_link_id=10.11477%2Fmf.1436203667&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436203667&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：日本脳神経外科コングレス  

末梢神経障害は、頻度は少なくないものの接する機会が少ないためか、脳神経外科診療で一般的に治療されているとはいいがたい。手根管症候群や肘部尺骨神経障害は、比較的多くの施設で治療されつつあるが、上臀皮神経障害や総腓骨神経障害、足根管症候群などはあまり普及していないのが現状であろう。本稿では、これら代表的な5つの末梢神経障害の手術について解説した。これらは、局所麻酔下に低侵襲に行えるため、高齢者にも積極的に適応できる。ときに劇的な症状の改善をもたらし、患者、医師ともに高い満足度が得られる。手術の難度はそれほど高いものではないため、ぜひ興味をもち、脳神経外科診療の1つのツールとして取り入れていただきたい。(著者抄録)

DOI： 10.7887/jcns.27.307

Scopus

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語  

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本末梢神経学会  

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記述言語：日本語   出版者・発行元：日本脊髄障害医学会  

吸収性スクリューを用いた頸椎後方固定術について生体力学的な検討を行った。生体力学的研究にはMechanical Finder ver8.0EE(計算力学センター)を使用した。健常なヒト頸椎CT情報を元にC3-6の頸椎モデルを作成し、その後、前縦靱帯等を追加して更に頸椎可動性モデルを作成した。前後屈、左右側屈、左右回旋の計6方向の荷重実験を行った。次に、C4/5椎間関節へのtransarticular screw(TAS)固定術を行い、頸椎固定術モデルを作成した。挿入したスクリューを吸収性スクリュー、チタン製スクリューと定義し、同様に6方向の荷重実験を行った。その結果、頸椎可動性モデルに対し6方向の荷重実験を行い、可動域を算出したところ、過去の報告と差がなく、受容できるものと判断した。更に、スクリュー挿入後、同様に荷重実験を行ったところ、吸収性スクリュー、チタン製スクリューともに生理的な可動域では破損はなく、固定力も両者に差はなかった。以上、吸収性スクリューを用いたTASによる頸椎後方固定術は、生理的な可動域では受容できると考えられた。

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記述言語：日本語   出版者・発行元：(株)医学書院  

60歳女。左側大腿外側前面の痺れ、腰痛を主訴とした。数年来の腰痛と1年前より出現した左側大腿外側前面に限局する痺れがあり、症状は立位および歩行で悪化した。左側鼠径部のTinel様徴候が陽性であることから、左側外側大腿皮神経(LFCN)障害が疑われ、診断を兼ねた左側鼠径部圧痛点へのLFCNブロックが奏功したことよりLFCN障害と診断した。鎮痛薬服用やLFCNブロックによる保存的治療に抵抗性であり、日常生活に支障をきたしていることから外科的治療の適応と判断して左側LFCN神経剥離術を行ったところ、術後3ヵ月には左側大腿外側前面の痺れは消失し、術後1年経過現在、症状の再燃なく良好に経過している。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J01228&link_issn=&doc_id=20170525170013&doc_link_id=10.11477%2Fmf.1436203528&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436203528&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：医学書院  

DOI： 10.11477/mf.1408200791

CiNii Books

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

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記述言語：日本語   出版者・発行元：羊土社  

CiNii Books

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記述言語：日本語   出版者・発行元：(一社)日本脊髄外科学会  

腰椎椎間孔狭窄症で外科的手術を行った28例(男性17例、女性11例、平均62.3歳)を対象に、その治療成績を報告した。術式は外側開窓術9例。内側開窓術19例、術後の追跡期間は平均45.5ヵ月であった。術前CT、MRIでは椎間孔部での神経根圧迫部位は上関節突起、関節突起間骨棘、椎間板ヘルニア各2例、椎体後方骨棘6例、上関節突起と後方骨棘12例、術中所見と合わせて黄色靱帯肥厚4例であり、Kunogiらの分類では前後型、上下型各6例、全周型16例であった。X線画像では、冠状面配列で平均Cobb角は6.3度→6.2度と有意な側彎は認めず、Cobb角10度以上の変性側彎は6例で、神経根との関係は凸型5例、凹型1例であった。全例で術前より椎間不安定性はなく術後も新規発生はなかった。腹側/背側の平均椎間板高は13.7/7.4mm→13.3/7.2mmと有意な減少はなかった。臨床成績は平均JOAスコアが7.0→12.5と有意に改善し、平均JOA改善率は64.2%であった。

DOI： 10.2531/spinalsurg.27.145

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記述言語：日本語  

DOI： 10.2531/spinalsurg.27.130

CiNii Books

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記述言語：日本語  

CiNii Books

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記述言語：日本語   出版者・発行元：(一社)日本脊髄外科学会  

腰椎すべり症を伴う脊柱管狭窄症に対し初回手術を後方除圧術を単独で行った112例(男性41例、女性71例、平均66.0歳)を対象に、術後症状再燃例について検討した。術後経過観察期間は平均46.3ヵ月であった。術後滑り進行が5例、術前不安定性を26例に認め、術後不安定性消失2例、新たに出現11例で、調査時の不安定性は34例であった。術後症状再燃は32例(28.6%)で、うち再手術を15例(13.4%)に行った。初回手術の治療成績(JOAスコア)は術前7.6点→12.9点、症状改善率は79.41%であった。再手術の原因は上位の隣接椎間障害7例、椎間孔狭窄5例、外側陥凹での圧迫、手術椎間再狭窄、far-out症候群各1例であり、すべりの悪化や不安定性が原因の再手術はなかった。再手術の治療成績は再手術前8.8点→12.9点、症状改善率は69.2%であった。症状悪化の原因は仙腸関節障害21例、梨状筋症候群、下肢閉塞性動脈硬化症各1例で、保存的加療を行った。

DOI： 10.2531/spinalsurg.26.205

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記述言語：日本語   出版者・発行元：(公社)日本医学放射線学会  

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記述言語：日本語   出版者・発行元：日本脳神経外科コングレス  

腰椎変性すべり症を伴う腰部脊柱管狭窄症に対して,後方除圧術のみで初回手術を行うことを治療方針としてきた.今回,このような治療方針に基づいた後方除圧術単独の手術成績を報告する.術後3年以上の経過観察を行った腰椎変性すべり症を伴う腰部脊柱管狭窄症患者31例を対象とした,脊椎不安定性の有無にかかわらず,初回手術として椎間関節を可能なかぎり温存する後方除圧術にて良好な手術結果が得られた.再手術の原因はすべり椎体の頭側レベルが多かった.再手術を回避するためには,時にすべり椎体の1頭側も減圧範囲に含めることも考慮すべきと考えられた.術後または再手術後も症状が持続し,患者の満足度が低い場合には腰椎疾患以外の病変も考慮する必要がある.今後,後方除圧術後成績不良例や再手術例を検討することにより,腰椎変性すべり症に対して,固定術の併用が必要かどうかを検討していくことが重要と思われる.

DOI： 10.7887/jcns.21.111

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記述言語：日本語   出版者・発行元：(一社)日本脊髄外科学会  

DOI： 10.2531/spinalsurg.25.307

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記述言語：日本語   出版者・発行元：(一社)日本脊髄外科学会  

DOI： 10.2531/spinalsurg.25.325

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語  

CiNii Books

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記述言語：日本語  

This 60-year-old man with cervical spondylosis experienced bilateral arm pain and weakness. After anterior cervical fusion and posterior decompression at a local hospital his symptoms worsened and he was admitted to our hospital. On admission he manifested bilateral motor weakness, neuropathic pain, and numbness below the C5 level. Radiological findings showed spinal cord compression at the C4 to C7 level. He again underwent postenor decompression and anterior fusion. Although his paresis was improved, his severe neuropathic pain and numbness persisted. Because treatment with NSAIDs, clonazepam, and gabapentin failed to control his symptoms we administered ketamine (NMDA receptor antagonist) because his symptoms were alleviated upon ketamine test challenge. His severe symptoms improved and there were no complications. However, upon cessation of ketamine treatment they reappeared. Therefore, we continued daily ketamine treatment for 6 months, after which we changed to codeine phosphate. His symptoms were controlled without any complications. Ketamine is useful for the control of severe neuropathic pain, however, as long-term ketamine administration is inadvisable, we suggest that treatment be tailored to each patient's particular clinical status.

Scopus

PubMed

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記述言語：日本語   出版者・発行元：(NPO)日本脳神経血管内治療学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本頭痛学会  

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記述言語：日本語   出版者・発行元：(一社)日本脊髄外科学会  

仙腸関節障害の診断・治療方針を紹介し、患者20例(男5例・女15例・平均67.6歳)の治療成績を報告した。腰椎変性疾患に対する外科治療後に仙腸関節障害の治療を行ったのが16例(A群)、仙腸関節障害に対する治療単独が4例(B群)であった。A群は両側性6例、片側性10例、B群は各2例であった。腰椎変性疾患に対しては椎弓形成術あるいは内側開窓術を、仙腸関節障害には仙腸関節ブロックを中心とした保存的治療を行った。追跡期間平均4.1ヵ月で、A群の腰椎変性疾患は術前JOAスコアが平均12.0点、術後改善値7.1点、改善率(平林法)45.6%であった。仙腸関節障害は治療前JOAスコアが平均13.9点、治療後改善値6.2点、改善率44.0%であった。16例中12例が、治療により改善した大腿外側部のしびれなどの関連症状を有していた。B群は治療前JOAスコアが平均12.8点、改善値5.3点、改善率34.7%であった。4例中2例が治療により改善した関連症状を伴っていた。

DOI： 10.2531/spinalsurg.24.6

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記述言語：日本語   出版者・発行元：(一社)日本脊髄外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本脊髄外科学会  

DOI： 10.2531/spinalsurg.24.80

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記述言語：日本語   出版者・発行元：(一社)日本脊髄外科学会  

DOI： 10.2531/spinalsurg.24.111

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

DOI： 10.1272/manms.6.152

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記述言語：日本語   出版者・発行元：(一社)日本脊髄外科学会  

2001〜2005年に後方除圧術単独で初回手術を行い、3年以上経過観察した腰椎変性すべり症を伴う腰部脊柱管狭窄症34例中、調査時に直接診察可能であった31例(男19例、女12例、41〜71歳・平均65.7±9.7歳)を対象に、治療方針に基づいた中期的な臨床成績について検討し、、放射線学的検討をを行った。JOAスコアの自覚症状と他覚所見は有意に改善していた。腰椎変性すべり症を伴う腰部脊柱管狭窄症に対しては、脊椎不安定性の有無に拘わらず、初回手術としては、椎間関節を可能な限り温存する後方除圧術で良好な手術結果が得られた。除圧術単独に伴うすべり症の増悪・不安定性の出現と、術後症状悪化との間に関連性は見いだせなかった。再手術回避のためには、初回手術時にすべり椎体頭側レベルも除圧範囲に含めることを時に考慮すべきと思われた。

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記述言語：日本語   掲載種別：書評論文，書評，文献紹介等   出版者・発行元：医学書院  

Scopus

PubMed

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記述言語：日本語   出版者・発行元：メディカ出版  

CiNii Books

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外傷学会  

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記述言語：英語  

A 61-year-old man presented with an extremely rare neoplastic cerebral aneurysm caused by brain metastasis from pleomorphic lung carcinoma manifesting as intracerebral hematoma and sudden onset of semicoma. Computed tomography demonstrated huge intracerebral hemorrhage in the left cerebral hemisphere, which had collapsed into the lateral ventricle. Cerebral angiography disclosed a fusiform aneurysm in the periphery of the left middle cerebral artery (approximately 2 mm diameter). Resection of the aneurysm and removal of the hematoma were performed. Histological examination revealed that the aneurysm walls were invaded by pleomorphic carcinoma. The present case indicates that neoplastic cerebral aneurysm may be the cause of intracerebral hemorrhage in patients with pleomorphic lung carcinoma.

DOI： 10.2176/nmc.49.33

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PubMed

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記述言語：日本語   出版者・発行元：日本脳神経外科コングレス  

術後5年以上経過観察が可能であった症例を分析,検討した.脊椎不安定性の有無にかかわらず,後方支持組織ならびに椎間関節を可能なかぎり温存する後方除圧術にて,下肢痛,しびれのみでなく腰痛に対しても良好な手術成績が得られた.再手術を回避するためには,初回手術時,すべり椎体頭側レベルも除圧範囲に含めることが重要であると思われた.今後,腰椎変性すべり症に対する後方除圧術成績不良例や再手術例を分析検討することにより,どのような症例に固定術が必要かどうかを検討したい.

DOI： 10.7887/jcns.18.90

Scopus

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本脳神経外科学会  

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記述言語：日本語   出版者・発行元：日本脳神経外科コングレス  

CiNii Books

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記述言語：日本語   出版者・発行元：(一社)日本脊椎脊髄病学会  

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記述言語：日本語   出版者・発行元：日本脊髄外科学会  

objective : We report on the utility and necessity of myelography and CT myelography in diagnosing spinal disease. methods : The study population consisted of 150 patients who had undergone spinal surgery in our institution within the past one year ; cervical disease was involved in 42 cases, thoracic in 4 cases and lumbar in 104 cases. The utility of these procedures was evaluated according to 3 stages : 1.) necessity, 2.) usefulness and 3.) non-necessity. Moreover, to enable evaluation according to disease distribution, the disease was further classified into four (4) types based on location : lateral disease (group A), medial- (group B), stenotic- (group C) and others (group D). results : The myelography and CTM necessity cases comprised 18 (42.9%) cases of cervical disease and 30 (28.8%) cases of lumbar disease. The: non-necessity cases 14 (33.3%) cases of cervical disease, all thoracic and 65 (62.5%) cases of lumbar disease, and the other cases were categorized by their usefulness. In lateral disease (group A), the necessity cases were mede up of 15 (75.0%) cases of cervical disease and 13 (56.5%) cases of lumbar disease. In medial cases and stenotic cases, the non-necessity cases accounted for 3 (25.0%) and none 0% of cervical disease, and 1 (16.7%) and 16 (25.8%) of lumbar cases. At any rate, all reoperation cases were classified as CTM necessity and usefulness cases. conclusions : Myelography and CTM are necessary in those cases where MRI is unusable and post operation. They are useful procedures in cases which have instability and/or lateral disease, and which are not definable from the responsibility point of view from several neurological studies. On the other hand, these procedures lack the necessity in cases involving thoracic region, clear disc herniation and cases with severe stenosis.

DOI： 10.2531/spinalsurg.22.10

CiNii Books

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記述言語：日本語   出版者・発行元：日本脊髄外科学会  

DOI： 10.2531/spinalsurg.22.131

CiNii Books

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記述言語：日本語   出版者・発行元：日本脊髄外科学会  

DOI： 10.2531/spinalsurg.22.139

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記述言語：日本語   出版者・発行元：日本脊髄外科学会  

DOI： 10.2531/spinalsurg.22.150

CiNii Books

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記述言語：日本語   出版者・発行元：日本脊髄外科学会  

OBJECTIVE: As for the operation of lumbar spondylolysis and spondylolysic spondylolthesis combination of decompression and fixation is generic. However, we will report our results in a series of 26 patients who underwent decompression without fusion treated for spondylolysis and spondylolysic spondylolisthesis. PATIENTS AND METHOD: In 26 patients (mean age 54.2 years) who underwent decompression without fusion treated for spondylolysis and spondylolysic spondylolisthesis, the postoperative follow-up time was 16.8 months. We divided them into A group and B group. The A group performed subtotal resection of floating lamina, the B group performed total resection of floating lamina. The following were clinical outcome(the recovery rate of JOA score), lower back pain (JOA score) and use of anti-inflammatory agents. RESULTS: The symptom recovery rate of Group A, assessed on the JOA score was 66.8%, and 84.3% for the B group. We performed re-operation in 2 patients of the A group. It was thought that the remaining floating lamina was caused by the recompression of the nerve root. We performed re-operation that removed the remaining floating lamina and the right amount of ambient fibrous tissue. As for the lower back pain, both groups had improvement tendency. Use of postoperative anti-inflammatory agents disappeared in 18 patients, and all patients had improvement tendency. CONCLUSION: In the short-term, we obtained good operation results of decompression without fusion treated for spondylolysis and spondylolysic spondylolisthesis. On the occasion of an operation, it is important to perform enough decompression by resection of floating lamina.

DOI： 10.2531/spinalsurg.21.137

CiNii Books

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記述言語：日本語   出版者・発行元：日本脊髄外科学会  

OBJECTIVE; The results in patients with lumbar spinal canal stenosis (LCS) who undergo re-operation for failed back surgery syndrome are usually unsatisfactory. We will report our results in a series of 54 patients with recurrent LCS who were re-operated. PATIENTS AND METHOD; We reviewed 54 patients who underwent posterior re-decompression without fusion to treat recurrent LCS. All were operated at our institution during the last 5 years. At the initial operation, all patients underwent posterior decompression and 8 of them were also subjected to posterior fusion. RESULT; The most common reason for the re-operation was stenosis of the lateral recess. Further treatment after the initial operation was required in 3 patients with iatrogenic spondylolisthesis. The symptom recovery rate, assessed on the JOA score, was 68.6%. The surgical outcome was better in patients whose symptoms were present for less than 1 year before re-operation. Instability of the lumbar spine before the 2nd operation was not significantly correlated with poor outcomes. CONCLUSION; Re-operation consisting of posterior re-decompression without fusion did not worsen the clinical condition of our 54 patients. There was no significant correlation between instability of the lumbar spine before reoperation and poor outcomes. Our findings stress the importance of carefully considering the indication for fusion in patients undergoing re-operation for LCS. As we found a significant correlation between poor results and the duration of symptoms in re-operated patients, the observation period after the first operation must be limited to avoid poor outcomes.

DOI： 10.2531/spinalsurg.20.105

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

DOI： 10.1272/manms.1.110

CiNii Books

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

Hypoxia, the disruption of oxygen homeostasis induced by low oxygen supply, is critical in the development and progression of a large number of tumors. Various solid tumors are basically in a hypoxic condition, when growth exceeds vascular supply. Under such conditions, cellular oxygen concentration redirects cellular biosynthetic pathways to promote adaptation and enable survival. Recently, a transcriptional factor called hypoxia-inducible factor (HIF)-1&amp;alpha; has been shown to play a crucial role in the regulation of many genes involved in the hypoxia adaptive pathway, especially vascular endothelial growth factor (VEGF). Under hypoxic conditions, many tumor cells promote angiogenesis via HIF-1&amp;alpha;. Meanwhile pituitary tumors are solid tumors in which the regional oxygen saturation is lower than that of normal pituitary gland and the vasculature is usually poor. Despite expression of HIF-1&amp;alpha; was confined in pituitary adenomas, its function driving to angiogenesis, apoptotic induction, and cell invasion, even though these issues have been extended in the other malignant tumors in recent years, has not yet been discussed. We have investigated the expression of microvascular density, HIF-1&amp;alpha;, and VEGF in primary human pituitary adenomas focusing on the co-localization, and subsequently in vitro study, elucidated gene profiling regulated by HIF-1&amp;alpha;. Our previous studies indicated that HIF-1&amp;alpha; immunoreactivity was confined to the nucleoplasm, but was present in both tumor cells and vascular endothelial cells. There was no difference in microvascular density by histotype. ACTH-producing adenomas showed the lowest level of HIF-1&amp;alpha;, whereas PRL-producing adenomas and HIF-1&amp;alpha;-positive microvessels showed the highest (p&lt;0.001). There was no significant correlation in the expression levels of HIF-1&amp;alpha; mRNA and VEGF mRNA in pituitary adenomas. Both of HIF-1&amp;alpha; and VEGF proteins expressed in pituitary adenoma and they were, in part, co-localized. Transfection with specific siRNA duplexes knocked down HIF1-&amp;alpha; mRNA and protein expression in hypoxia-exposed cells by approximately 80%. Microarray analysis indicated that HIF1-&amp;alpha; down-regulated caspase-10, but up-regulated of laminin &amp;beta;2 (4.26 folds), SAP90 (3.34 folds), and BNIP3 (3.24 folds). Conclusively in these poorly vascularized tumors, HIF-1&amp;alpha; may not mainly regulate the VEGF expression in pituitary adenoma. In vitro studies strongly suggest that HIF 1-&amp;alpha; exerts an antiapoptotic role in HP-75 in hypoxia mediated by down-regulation of caspase-10 and that hypoxia can potentially enhance the cell invasion properties of a pituitary adenoma cell line through elevated expression of laminin &amp;beta;-2. The mechanism of tumor angiogenesis and cell invasion in pituitary adenomas may differ from that in the other cancer cells.&lt;br&gt;

DOI： 10.1272/manms.1.110

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記述言語：日本語