著者

村井 智 荻原 浩太郎 西 和彦 伊丹 尚多 大塚 真司 日下 昇 西浦 司

出版者

日本脊髄外科学会

雑誌

脊髄外科 (ISSN:09146024)

巻号頁・発行日

vol.31, no.3, pp.270-275, 2017 (Released:2018-01-06)

参考文献数

21

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Objective : Odontoid fractures are the most common cervical injuries among the elderly population. We evaluated treatment outcome in 14 patients with odontoid fractures who were treated at our institute between 2003 and 2016. Additionally, in this report, we discuss the optimal treatment option for odontoid fractures in the elderly population and provide a literature review.  Results : Patient age ranged 19-90 (average, 60.6) years, and the patients included five (36%) octogenarians. According to Anderson’s classification, four cases (29%) were type II and 10 cases (71%) were type III odontoid fractures. Surgical intervention was performed in 12 cases, including anterior odontoid screw fixation in nine, posterior cervical instrumented fusion in four (including reoperation after anterior screw fixation in one), and conservative treatment with halo vest fixation in two. Moreover, 13 patients received radiographic follow-up, and 11 (85%) attained bone fusion. In octogenarians, three (60%) of five cases attained bone fusion through anterior screw fixation.  Conclusion : In the elderly population, tailor-made treatment is necessary according to systemic diseases, activities of daily living, and radiographic assessment of odontoid fractures in addition to Anderson’s classification.

著者

長尾 省吾 角南 典生 筒井 巧 本間 温 門間 文行 西浦 司 西本 詮

出版者

社団法人 日本脳神経外科学会

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.24, no.6, pp.396-400, 1984 (Released:2006-09-21)

参考文献数

15

被引用文献数

3 7

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Correlations between changes in wave V of the auditory brain-stem response, intracranial pressure, and neurological signs of uncal herniation as graded by Plum and Posner were investigated in 12 patients with supratentorial mass lesion. In three of the five patients who later showed signs of uncal herniation, the latency of wave V, which presumably originated in the inferior colliculus, was already significantly prolonged. In 6 cases which progressed to the early third nerve stage of uncal herniation, the latency of wave V was prolonged in 5 cases. In 7 cases which progressed to the late third nerve stage or worse, the latency was prolonged in 6 cases and suppressed in one. In four of six attempts (three cases), lowering of the intracranial pressure by 10% glycerol solution resulted in normalization of the latency of wave V without clinical improvement. These results strongly indicate that measurement of wave V can predict the beginning of uncal herniation and can assess the effectiveness of medical or surgical decompression on brain-stem function.