著者
村上 正人
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.30, no.3, pp.260-265, 2016 (Released:2017-01-31)
参考文献数
24
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 (Released:2016-01-20)
参考文献数
18

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.
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 (Released:2017-05-11)
参考文献数
14

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.
著者
飯島 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.30, no.3, pp.239-247, 2016 (Released:2017-01-31)
参考文献数
24
被引用文献数
1 1
著者
小山 なつ 等 誠司
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.29, no.3, pp.287-292, 2015 (Released:2016-04-01)
参考文献数
12
著者
梶原 基弘 花北 順哉 諏訪 英行 塩川 和彦 佐藤 宰 織田 雅
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.17, no.1, pp.53-58, 2003

正中型の大きな腰椎椎間板ヘルニアに対するtransdural approachにつき, 経験した4症例を呈示しながら, その利点, 欠点につき論じた.高位腰椎の大きな正中型ヘルニアの症例に対してはtransdural approachは有用な手術オプションになると思われた.
著者
中尾 弥起
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.30, no.1, pp.83-87, 2016 (Released:2016-07-06)
参考文献数
39

Most patients with significant spinal cord damage have permanent symptoms and may be wheelchair-bound, depending on their residual motor function below the spinal cord lesion. Spinal cord damage, whether caused by injury or disease, is currently not repaired by any therapy. The sensory, motor, and autonomic functions of each segment depend crucially on connections with supraspinal sites for all conscious or voluntary actions. Damage to these connections leaves spinal segments caudal to the lesion site partially or totally isolated from the brain, resulting in debilitating consequences. Studies in humans have demonstrated, however, that the lumbosacral spinal circuitry retains an intrinsic capability to oscillate and generate coordinated rhythmic motor activity even when isolated from brain control. Although the anatomical architecture of locomotor central pattern generators remains poorly understood in mammals, the functional phenomenon of central pattern generation has been documented extensively. Techniques to stimulate spinal networks lend themselves as potent tools to facilitate locomotor recovery after severe spinal cord injury. Among several experimental strategies tested for activation of locomotor circuits in mammals after complete spinal cord transection, electrical stimulation has been investigated in human spinal cord injury. A recent clinical study demonstrated that some patients with complete paralysis were able to perform voluntarily controlled movements with epidural stimulation. In combination with epidural electrical stimulation of lumbosacral segments, activity-based rehabilitation can restore supraspinally mediated movements. Electrical neuromodulation therapies that activate spinal cord central pattern generators open up new avenues for treatment of spinal cord injury in human subjects.
著者
高橋 敏行 冨永 悌二 横堀 寿光 吉本 高志
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.15, no.1, pp.1-6, 2001
被引用文献数
1 1

Cervical interbody fusion cages (CIFC) are currently used for anterior cervical fusion. There are few reports documenting their biomechanical property in the cervical spine. The purpose of the present study is to investigate biomechanical stability of the caprine cervical spine implanted with a CIFC device. Thirty-two spinal units (C3-4 and C5-6) were harvested from 16 fresh-frozen caprine cervical spines. Each spinal unit underwent discectomy and transection of the posterior longitudinal ligament, and then was implanted with single CIFCs, double CIFCs, autograft, or autograft and anterior cervical plate. An iliac crest tricortical bone was used as an autograft. The degrees of displacement of the cervical spine specimens by multidirectional moments in flexion, extension, lateral bending and axial rotation were evaluated using a video-recording. The stiffness against the multidirectional loads was calculated from load-displacement curves. There were no statistical differences in stiffness between the single-cage and autograft groups in flexion, extension and axial rotation. The autograft group showed significantly increased stiffness compared with that of the single-cage group in lateral bending. The stiffness values were far larger in both the double-cage and autogtraft with plating groups than in the other groups in all directions. There were no statistical differences in stiffness between the double-cage and autogtraft with plating groups in flexion, lateral bending and axial rotation. The double-cage group showed significantly decreased stiffness compared with that of the autograft with plating group only in extension. The stiffness values of the single- or double-cage groups would represent the characteristic biomechanical properties derived from the structure and shape of the implants.
著者
末綱 太
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.246-256, 2017 (Released:2018-01-06)
参考文献数
67

I reviewed the epidemiology and occurrence of traumatic cervical spine injuries of athletes in Japan and other countries, and noted the importance of initial assessment at the sports site, imaging diagnosis, and treatment of cervical spine injuries. From the global epidemiology of sports-related spinal cord injury, the frequency and cause of spinal cord injuries are different among countries, along with their respective characteristics. Taking prompt measures at the sports site is necessary to ensure safe patient handling and transport. However, as many people other than doctors are involved in sports events, the staff involved in these events should be prepared and practice emergency response measures. No major difference was found between athletes and non-athletes in regard to the treatment of cervical spine injury. However, athletes strongly hope for early return to active participation in their sport. Thus, surgical methods that are less invasive to soft tissues and involve strong fixation should be selected. However, further knowledge about evaluation and judgment for these athletes to return to their sport is needed. Many sports-related spinal cord injuries are preventable, and we must strive toward achieving zero incidence of spinal cord injuries. Thus, physicians attending to sports-related spinal cord injuries should both communicate more actively and supervise players of the team.
著者
望月 秀紀 柿木 隆介
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.30, no.1, pp.53-57, 2016 (Released:2016-07-06)
参考文献数
32

かゆみはかきむしりたくなる不快な体性感覚であり, アトピー性皮膚炎など皮膚疾患において多く認められる症状である. また, 末梢や中枢における神経疾患においてもかゆみが症状としてあらわれることがある. かゆみの治療では抗ヒスタミン薬が一般的に用いられているが, 疾患に伴うかゆみ (慢性掻痒) には十分な効果を示さないことが多い. そのため, より効果的なかゆみの治療法開発が強く望まれている. そのためにも, かゆみや慢性掻痒のメカニズムを理解することが重要である. 1994年, はじめてかゆみの脳機能イメージング研究が報告された. その後, さまざまな研究者によって健常者や慢性掻痒患者を対象にかゆみの脳研究が行われた. さらには, 非侵襲的脳刺激法を用いたかゆみの抑制に関する研究も行われた. 本稿ではこれまでに報告されたかゆみの脳研究について概説する.
著者
遠藤 秀紀
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.28, no.2, pp.122-127, 2014 (Released:2017-05-11)
参考文献数
4
著者
坂本 真一 三木 幸雄
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.3, pp.279-286, 2015 (Released:2016-04-01)
参考文献数
56

水分子の拡散現象を画像化した拡散画像の中でも, 拡散の方向や速さの描出に特化した拡散テンソル画像は, 一方向性が強いという特徴的な構造を有する脊髄の質的評価に対して, きわめて親和性の高い画像診断法である. 拡散テンソル画像の解析から得られる各種のパラメータは, 従来の画像からは得ることのできない脊髄の微細な変化を鋭敏に反映すると考えられており, 3次元表示した拡散テンソルトラクトグラフィは, その視覚的効果から術前術中の治療計画作成にも利用されている. 現在, 拡散テンソル画像の臨床応用は急速に広がっているが, 今後はより詳細な脊髄状態の評価を可能にする非ガウス分布拡散画像に移行していくことが予想される.
著者
犬塚 則久
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.28, no.3, pp.239-245, 2014 (Released:2017-05-11)
参考文献数
8

The spinal column of a human body must support the weight of the upper half of the body including the head and the upper limbs, befitting to the bipedal upright posture. Vertebral bodies of the lower lumbar are larger than the upper one for this support. Since the ventral side of the spinal column has a thorax, cervical and lumbar lordoses are indispensable to bring the center of gravity close to a centroidal line. Therefore, the thickness of the inferior lumbar vertebrae are greater ventrally, and an intervertebral disk is thick, and wedge-shaped. Since the weight shifts forward and backward as to the standing and the sitting position, the angle of a pelvis must be changed, and a sacrum and lumbar vertebrae cannot be unified. The lumbar vertebrae at the time of a walk should take the rotational shear, between an upper-limb-thorax block and a lower-limb-pelvis block, since they can hardly rotate due to the dissociation of the center of the rotary axis and the actual center of the vertebral bodies. The situation results in propensity for disk herniation or compressive fractures.