1 0 0 0 気象変化と痛み
- 著者
- 佐藤 純
- 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.29, no.2, pp.153-156, 2015
- 被引用文献数
- 4
 慢性痛が天気の崩れで悪化することは以前より知られており, 疼痛治療の臨床において重要な問題である. 筆者は, 気象要素 (気圧, 気温) による慢性痛悪化のメカニズム研究により, 日常体験する程度の軽微な気圧変化あるいは低温への曝露が慢性痛モデル動物の痛み行動を増強し, 慢性痛有訴者の症状を再現することを実証してきた. また, 気圧変化による痛みの増強には内耳の気圧感受メカニズムが関与することを明らかにし, 温度変化による痛みの増強には皮膚の温度受容線維の反応性の変化が原因である可能性を示した. また, 慢性痛有訴者の一部では気圧や気温の変化に対して自律神経系が過剰に反応することがあり, それが症状悪化のもう1つの原因であることを示唆した.
1 0 0 0 低髄液圧症候群診断の混乱について
- 著者
- 土居 浩 中村 精紀 望月 由武人 徳永 仁 吉田 陽一 大橋 元一郎 井田 正博
- 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.23, no.2, pp.211-217, 2009
<p> Spontaneous spinal cerebrospinal fluid (CSF) leaks are an increasingly recognized cause of intracranial hypotension. Comprehensive diagnostic criteria encompassing the varied clinical and radiographic manifestations of spontaneous intracranial hypotension are not available. In this report the authors review the diagnosis of the point of cerebrospinal fluid leak. The major presenting symptoms include postural headaches, nausea, vomiting, and diplopia. Often, there is no history of traumatic injury. The most common cranial magnetic resonance (MR) imaging features include pachymeningeal gadolinium enhancement. MR myelography is a non invasive method to detect CSF leakage, however, extradural hyperintensity on MR myelography is non-specific for CSF. Fat-saturated T2-weighted imaging and post contrast T1-weighted imaging should be added to confirm CSF leakage. On spinal MR images, meningeal cysts and extradural venous plexus are frequently misdiagnosed as CSF leakage. In cases in which symptoms are severe and refractory to less invasive measures, surgical intervention is indicated. Recently, some authors reported the identification of upper cervical epidural fluid collections as a false localizing sign in patients with spontaneous intracranial hypotension (SIH) and this has provided significant insight into the selection of management options. However, herein we report on true C1-2 CSF leakage. We examined a group of consecutive patients with 25 SIH and 13 posttraumatic CSF hypovolemia and investigated clinical, MRI, CT myelography, and radioisotope findings and therapeutic outcomes of this syndrome.</p>
1 0 0 0 OA 頭蓋頚椎移行部の解剖と不安定性—非リウマチ性歯突起後方偽腫瘍の成因も踏まえて—
- 著者
- 吉藤 和久 今泉 俊雄 宮田 圭 外山 賢太郎 野村 達史
- 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.18, no.3, pp.203-208, 2004 (Released:2006-10-30)
- 参考文献数
- 18
Superficial siderosis (SS) of the central nervous system (CNS) is characterized by the deposition of hemosiderin on the surface of the CNS due to chronic and recurrent subarachnoid hemorrhage. This results in irreversible neurological deficits. We present a case of SS associated with an idiopathic meningeal cyst, dural ectasia, and scalloping of the vertebral bodies. A 51-year-old male presented with drowsiness and bloody cerebrospinal fluid. His medical records revealed perceptive hearing impairment that had developed in his early teens; generalized motor weakness, hypesthesia, and ataxia which had progressed over 10 years; and frequent episodes of transient disturbance of consciousness (drowsiness) since the age of 46. MRI revealed atrophy of the cerebellum, the brain stem, and the spinal cord with low signal intensity on their surfaces. This low signal intensity, indicating the deposition of hemosiderin, was more detectable by gradient echo T2*-weighted MRI than by other MRI conditions. A meningeal cyst at the level of Th1-2 and dural ectasia with scalloping of the C2-Th3 vertebral bodies were also revealed. It was considered that either of these two conditions could have led to the bleeding, because no other lesions were exposed. We did not continue with follow-up treatment, because he was bedridden and it was considered that no treatment would be effective in reversing his condition.
- 著者
- 西川 節 金 安明 正村 清弥 井上 剛 中西 愛彦 生野 弘道
- 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.26, no.2, pp.221-226, 2012 (Released:2017-05-11)
- 参考文献数
- 31
- 被引用文献数
- 1 1
Object : To study long-term outcomes of anterior decompression and fusion (ADF) and expansive laminoplasty (ELP). Materials and Methods : Our study included 120 patients who underwent iliac bone grafting via the modified trans-unco-discal approach (TUD) or ELP with spinous process or ceramic spacers over 5 years ; the neurological symptoms and Japanese Orthopedics Association (JOA) scores of these patients were reviewed. Results : Neurological symptoms and JOA scores improved in 111 out of the 120 patients (93%), and worsened in 9 patients (8%). There was no significant difference in the rate of improvement of neurological symptoms, and JOA scores in all groups. There was no significant difference in the improvement rates of neurological symptoms and JOA scores between all groups. Conclusions : ADF and ELP showed comparable rates of improvement in neurological symptoms and JOA scores. It is important to choose the appropriate methods according to the pathophysiological conditions. ADF should be performed only for the appropriate lesions, since the problems pertinent to the adjacent lesions may ensue.
1 0 0 0 OA 脊髄神経再生の現状
- 著者
- 岩月 幸一
- 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.29, no.1, pp.26-31, 2015 (Released:2016-01-20)
- 参考文献数
- 32
1 0 0 0 OA 血管炎性ニューロパチーの診断と治療
1 0 0 0 OA 成人期発症の二分脊椎を伴った脊髄脂肪腫の1手術例
- 著者
- 中村 直人 高石 吉將 荒井 篤 鵜山 淳 近藤 威 岩橋 洋文
- 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.32, no.3, pp.329-333, 2018 (Released:2019-01-24)
- 参考文献数
- 16
A 49-year-old man with lumbar spinal lipoma was surgically treated because of intractable pain. The lipoma was originally asymptomatic and found incidentally 10 years before. He began to have occasional dysesthesia in the right lower limb 8 years before. The symptom became severe 1 year before he visited our hospital for the first time. The dysesthesia was in the L5 region of his right lower limb. Muscle weakness and urinary incontinence were not found. The magnetic resonance imaging demonstrated low-set conus (L3/L4) associated with spinal lipoma, which extended from the extradural part (from L4/L5 to L5/S1) to the intradural part (from L2/L3 to L3/L4). Computed tomography revealed hypoplasia in the laminae of L4, L5, and S1. We observed him for a year, and the dysesthesia became intolerable while the lipoma size was unchanged. Untethering was performed with L2-L5 laminectomy. The extradural part of the lipoma was completely removed with the adhered dural membrane. The intradural part was detached from dural membrane and partially removed. A GORE-TEX patch was used for dural membrane closure. The mechanism of adult-onset spinal lipoma is considered tethered cord syndrome or spinal cord compression. As spinal lipoma is usually adhered with the spinal cord, the appropriate surgical strategy seems to be untethering and partial resection of the lipoma.
1 0 0 0 OA 妊娠・授乳関連骨粗鬆症の1例
1 0 0 0 OA 成人発症の髄内頸髄脂肪腫の1例
- 著者
- 中井 啓 丸島 愛樹 松村 明
- 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.23, no.1, pp.80-84, 2009 (Released:2017-05-11)
- 参考文献数
- 14
Intramedullary lipomas of the cervical spinal cord without dysraphism are rare lesions, accounting for only 1% of spinal cord tumors. We experienced a 60-year-old male with cervicothoracic (C6 to T2) lipoma who complained of dysesthesia in his lower extremities. Magnetic resonance imaging identified a tumor which was dorsolateral to the cord in the intramedullary legion. In these cases, a fat suppression sequence is useful for diagnosis. He underwent surgery for partial removal of the tumor and expansive laminoplasty. Postoperative course of the patient was uneventful and follow-up showed an improvement in sensory disturbance.
1 0 0 0 OA 症候性Tarlov囊胞に対する自家脂肪片を用いたball valve閉鎖術の手術成績
- 著者
- 宮尾 泰慶 佐々木 学 青木 正典 梅垣 昌士 嶋田 延光
- 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.32, no.1, pp.56-60, 2018 (Released:2018-06-20)
- 参考文献数
- 23
Introduction : Lumbosacral perineural (Tarlov) cysts (TCs) are rare and usually asymptomatic. However, these cysts occasionally cause neuralgia or bowel/bladder dysfunction. We surgically treated symptomatic TCs with occlusion of the cyst orifice using autologous fat tissue. This report presents the long-term surgical outcomes using this method. Materials and Methods : Six consecutive cases with symptomatic TCs were included in this study. Patients were initially examined with magnetic resonance imaging (MRI) and treated conservatively for at least 1 month. Preoperative CT myelograms in all patients showed pooling of contrast medium in the cyst. Surgery was performed as follows : after laminectomy at the S1-S2 level, the cyst wall was dissected and penetrated. The orifice of the cyst operated as a ball valve for cerebrospinal fluid and was occluded with autologous fat tissue that was sutured to the cyst wall. The visual analogue scale (VAS) score for pain in the buttock and/or posterior thigh was recorded before and after surgery. Results : All patients were female, and the mean age was 63.3 years. Preoperative symptoms were sacrococcygeal pain in 5 cases, sciatic pain in 2, and bladder dysfunction in 1. The mean duration between onset and definitive diagnosis was 23.7 months. All cysts were located at the sacral level including S2. Three cases had solitary lesions and the other 3 had multiple lesions. Cyst sizes ranged from 7 to 30 mm. The average postoperative follow-up period was 37.8 months. The mean preoperative VAS score was 91.7, and gradually decreased to 33.3 at 6 months. The score was stable from the 6-month examination to the final follow-up. Postoperative MRI showed that the cysts decreased in size. A complication of surgery was mild bowel/bladder dysfunction in 1 case. During follow-up, no recurrence of symptoms or cyst regrowth was observed. Conclusion : For symptomatic TCs, closing the orifice with fat tissue provides good surgical outcomes.
1 0 0 0 OA 初回痙攣発作後に発症した非外傷性腰椎椎体骨折の1例
- 著者
- 土方 保和 高橋 雄一 安原 隆雄 先成 崇 久壽米木 亮 井上 崇文 李 秦辰 隈元 真志 田之上 崇 小川 浩一 西田 憲記
- 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.27, no.1, pp.57-60, 2013 (Released:2017-05-11)
- 参考文献数
- 21
- 被引用文献数
- 1 2
A 40-year-old woman presented with unbearable low back pain that followed a witnessed epileptic seizure without any external injuries. This epileptic seizure was her first episode. Magnetic resonance imaging (MRI) and computed tomography (CT) revealed a compressed vertebral fracture at L3. She had no riskfactors for fractures such as osteoporosis, except for chronic alcoholism. Non-traumatic compressed fracture of the lumbar vertebral body is a rare entity. This type of injury may be due to the compressive force exerted on the vertebral column by the contraction of the trunk muscles during an epileptic seizure. Balloon kyphoplasty was performed, and she did not experience any symptoms postoperatively. This case emphasizes the importance of thorough examinations of patients after generalized convulsions.
1 0 0 0 中脳赤核と運動機能:—系統発生的観点から—
<p>1) 霊長類の赤核には, 局在する位置, 細胞構築, 連絡する回路構造など, その解剖学的特徴から明瞭な区分 (おもに大細胞性と小細胞性) が存在し, それぞれの機能には大きな差異がある. </p><p>2) 赤核の各区分における細胞群の発達の程度は, 哺乳類の中で大きなバリエーションがあり, 四足歩行動物では赤核脊髄路が, 高等霊長類では赤核オリーブ路が発達している. ヒトにおいてこの差異は極端であり, 前者の赤核脊髄路はほぼ退化し痕跡的となっている. このため, 齧歯類, ネコ, さらにはサルにおける実験結果から得られた知見を直接ヒトに外挿するには慎重を要する. </p><p>3) ヒトにおいて特異的に発達した小細胞性赤核の具体的, 詳細な機能についてはほとんどわかっていないが, その臨床病態の像や破壊損傷によって作出された実験動物の機能異常から, 小細胞性赤核は振戦への関わりがある.</p>
1 0 0 0 OA 脊髄は脊椎の中でどう動くだろう?
- 著者
- 野地 雅人 稲垣 浩 遠藤 聡 常松 尚志
- 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.1, pp.80-86, 2017 (Released:2017-07-08)
- 参考文献数
- 25
- 被引用文献数
- 1
Cervical angina is a pathological condition characterized by angina-like paroxysmal precordial pain caused by a lesion in the proximity of the cervical spine without cardiovascular abnormality. The symptom cannot be alleviated even with nitroglycerin administration. Although various reports have suggested possible causes, no report has identified the definite etiology of the disease. We report a rare case with frequent chest pain attacks, which completely disappeared after anterior cervical decompression and fusion and cervical calcified disc herniation. In addition, we compared the present case with previously reported cases. The patient was a 78-year-old woman who complained of pain in the left chest and back area. Her symptoms worsened in August 2007. She was then hospitalized after undergoing medical examination in the emergency department, with the following results: ST segment depression (+), horizontal down-sloping V4-V6 on electrocardiography, and troponin (−). On the basis of these results, she was diagnosed as having unstable angina. Later, we conducted a cardiac catheter test and found 99-100% stenosis for #6 and 99% stenosis for #13 periphery. Percutaneous coronary intervention (PCI) for #6 was performed with a favorable collateral circulation. The patient did not have any symptoms during treadmill exercise and was discharged from the hospital. Although she repeatedly visited the emergency department every 2 or 3 months because of the pain in her left chest and back area, ischemia findings at the time of electrocardiography and blood test results were always negative. In March 2012, the symptom persisted even with PCI for #13. In June 2014, an acetylcholine prorocation test was conducted for suspected vasospastic angina, but the result was negative. As the patient occasionally had numbness and pain in both upper extremities, which worsened, she underwent a medical examination in our clinic in February 2015. Midline calcified hernia at C3/C4 and spur at C4/C5 were found on magnetic resonance imaging and computed tomographic myelography. Anterior decompression and fusion (C3/C4 and C4/C5) were conducted with a cylindrical cage in June 2015, and the postsurgical pain in the chest and back area completely resolved. A philological study showed that the affected segment often indicated symptoms associated with radiculopathy at the C6 or C7 myotome areas, but our case was considered a spinal segment disorder or sympathetic involvement.
1 0 0 0 OA 病態に合わせたPLIFとTLIFの術式選択についての検討
1 0 0 0 OA 脊髄・脊椎疾患における手の症候学 : 筋萎縮性側索硬化症におけるSplit Hand
- 著者
- 桑原 聡
- 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.25, no.3, pp.248-251, 2011 (Released:2017-05-11)
- 参考文献数
- 13
