Language：Japanese   Publisher：(一社)日本脊髄外科学会  

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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

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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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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

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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

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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

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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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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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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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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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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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Asian Spine Journal (ASJ)  

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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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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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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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

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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Other Link： http://link.springer.com/article/10.1007/s00701-020-04404-8/fulltext.html

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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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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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Other Link： http://link.springer.com/article/10.1007/s00701-020-04226-8/fulltext.html

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japan Neurosurgical Society  

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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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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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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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier Inc.  

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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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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Language：Japanese   Publishing type：Research paper (scientific journal)  

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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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：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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Language：English   Publishing type：Research paper (scientific journal)   Publisher：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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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：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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Language：English   Publishing type：Research paper (scientific journal)   Publisher：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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Language：English   Publishing type：Research paper (scientific journal)   Publisher：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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Language：Japanese   Publishing type：Research paper (scientific journal)  

PURPOSE: Many patients with diabetes mellitus (DM) experience numbness in the extremities. This DM neuropathy may be complicated by peripheral entrapment neuropathy. We prospectively investigated the cause(s) of limb numbness in DM patients. MATERIALS AND METHODS: We enrolled 23 patients with uni- or bilateral limb numbness who were treated in our DM clinic. They were 10 men and 13 women; their average age was 63 years. The average duration of their neurological symptoms was 28.3 months. RESULTS: Numbness was located in the upper limb in 7 patients, the lower limb in 11, and both the upper and lower limbs in 5. Among the 12 patients with upper-limb numbness, 9 manifested carpal tunnel syndrome and one each cervical OPLL or cervical spondylosis. Of the 16 cases of lower limb numbness, 10 were attributable to tarsal tunnel syndrome, 7 to lumbar spinal disease, 3 to restless leg syndrome, 2 to piriformis syndrome, and 1 to peroneal nerve entrapment neuropathy. CONCLUSIONS: In 21 of the 23 patients with uni- or bilateral limb numbness, the cause was attributable to several kinds of etiology such as entrapment neuropathy. Consequently, other treatable peripheral nerve disorders, e.g. tarsal tunnel syndrome, must be considered when diagnosing DM patients with limb numbness. Our findings suggest that therapeutic intervention to address such diseases will affect the quality of life of DM patients with limb numbness.

DOI： 10.11477/mf.1436203277

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE INC  

DOI： 10.1016/j.wneu.2015.11.043

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The diagnosis of peroneal nerve (PN) entrapment neuropathy (PNEN) is based on clinical symptoms and nerve conduction studies. However, these studies do not always detect PNEN. Our 64-year-old patient suffered persistent left L5 numbness after two lumbar surgeries. Two years before admission to our institute his left leg pain gradually reappeared. When walking, his numbness in the left lower thigh to the dorsum of the foot increased. Electrophysiological testing revealed no conduction block on the PN. To identify the origin of his intermittent symptoms we performed loading of repetitive ankle plantar flexion in the at-rest posture to avoid the lumbar factor. We used this provocation test to check for PNEN because it occurs at a site where the PN passes the soleus- and the peroneus longus muscle (SM, PLM). The symptoms appeared reproducibly within 10 s of loading. PN neurolysis under local anesthesia showed that the PN was strongly compressed by the SM and PLM. This procedure eased his symptoms and he was able to walk without elicitation of numbness and pain upon repetitive ankle plantar flexion. In our case, repetitive plantar flexion elicited the symptoms and this provocation test may be useful to identify PN dynamic entrapment neuropathy as the origin of intermittent claudication.

DOI： 10.2176/nmccrj.2014-0430

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：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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Language：English   Publishing type：Research paper (scientific journal)   Publisher：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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Language：Japanese   Publishing type：Research paper (scientific journal)  

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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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：(株)中外医学社  

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Language：Japanese   Publisher：(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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Other Link： 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

Language：Japanese   Publisher：(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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Language：Japanese   Publisher：(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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Other Link： 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

Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：(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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Other Link： 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

Language：Japanese   Publisher：(株)メディカ出版  

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Language：Japanese   Publisher：日本脳神経外科コングレス  

絞扼性末梢神経疾患は思いのほか罹患率が高く、脳や脊髄疾患と鑑別を要する。手術はmicrosurgical techniqueを駆使して比較的短時間で、低侵襲に行え、医師への負荷も軽いため、脳神経外科医がこれらの治療に取り組むことを提案したい。外来で診察するには、上肢は手根管症候群の鑑別をまず行い、下肢は大腿前外側(外側大腿皮神経)、下腿外側から足の甲(総腓骨神経)、足底(足根管症候群)の3つに分け、腰椎周辺疾患は腸骨稜周辺(上臀皮神経)、臀部内側(中臀皮神経)、臀部外側(中臀筋と梨状筋)の3つに分けて診察すると簡便である。これら疾患の治療が脳神経外科の1つの領域として確立することが期待される。(著者抄録)

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Language：Japanese   Publisher：(株)メディカ出版  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：(一社)日本臨床神経生理学会  

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Language：Japanese   Publisher：(一社)日本臨床神経生理学会  

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Language：Japanese   Publisher：(株)メディカ出版  

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Language：Japanese   Publisher：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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Language：Japanese   Publisher：(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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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：(一社)日本臨床神経生理学会  

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Language：Japanese   Publisher：Japanese Congress of Neurological Surgeons  

Although worldwide, peripheral nerve entrapment neuropathy is not uncommon, it is rarely encountered by Japanese neurosurgeons. Carpal tunnel syndrome and ulnar neuropathy at the elbow are treated at relatively many Japanese neurosurgical institutions
their incidence is lower than of superior cluneal nerve neuropathy, common peroneal nerve neuropathy, and tarsal tunnel syndrome. We describe our surgical approach to treat carpal tunnel syndrome, ulnar neuropathy, superior cluneal nerve neuropathy, common peroneal nerve neuropathy, and tarsal tunnel syndrome. Since surgery for these typical peripheral entrapment neuropathies can be performed less invasively under local anesthesia, it can be used to treat elderly patients. It requires sufficient decompression under a microscope using microsurgical techniques. If dynamic neuropathy is involved, dynamic factors must be considered. After this type of surgery, neither external fixation nor restriction of the activities of daily living is needed. We obtained drastic symptom improvement that satisfied both patients and surgeons. We suggest that our method of addressing typical peripheral entrapment neuropathies be added to existing neurosurgical treatments.

DOI： 10.7887/jcns.27.307

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Language：Japanese   Publisher：(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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Language：Japanese   Publisher：(一社)日本脳神経外傷学会  

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Language：Japanese   Publisher：(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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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：(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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Language：Japanese   Publisher：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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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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Language：Japanese   Publisher：(一社)日本救急医学会  

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Language：Japanese   Publisher：(一社)日本脳神経外傷学会  

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Language：Japanese   Publisher：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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Language：Japanese   Publisher：日本末梢神経学会  

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Language：Japanese   Publisher：(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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Language：Japanese   Publisher：(株)三輪書店  

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Language：Japanese   Publisher：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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Language：Japanese   Publisher：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

Scopus

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Language：Japanese   Publisher：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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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(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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CiNii Books

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Language：Japanese   Publisher：(一社)日本頭痛学会  

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DOI： 10.2531/spinalsurg.24.80

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Language：Japanese   Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Poster presentation  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Poster presentation  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Poster presentation  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Poster presentation  

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Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Presentation type：Poster presentation  

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Presentation type：Oral presentation (general)  

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Language：English   Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Presentation type：Poster presentation  

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Presentation type：Poster presentation  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Presentation type：Poster presentation  

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Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Symposium, workshop panel (public)  

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Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Poster presentation  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Language：English   Presentation type：Oral presentation (general)  

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Presentation type：Poster presentation  

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Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Oral presentation (general)  

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Presentation type：Poster presentation  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Poster presentation  

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Presentation type：Poster presentation  

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Presentation type：Oral presentation (invited, special)  

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Presentation type：Oral presentation (general)  

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Presentation type：Poster presentation  

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Presentation type：Oral presentation (general)  

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Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Poster presentation  

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Presentation type：Oral presentation (general)  

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Language：Japanese   Presentation type：Poster presentation  

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Presentation type：Oral presentation (general)  

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