2 0 0 0 OA 脊髄刺激を用いた重度脊髄損傷者における歩行機能再構築の試み
- 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 2
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.
1 0 0 0 OA 胸椎黄色靭帯骨化症に対する内視鏡下除圧術の経験
1 0 0 0 OA 一側上肢のみの自覚症状、神経症状を呈した頸椎椎間板障害例の放射線学的検討
1 0 0 0 OA 慢性期に環軸椎亜脱臼が遅延性に進行した頚椎外傷の1症例
- 著者
- 朝日 稔 金 秀浩 藤本 基秋 岡田 崇志 平田 英周
- 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.20, no.1, pp.55-61, 2006 (Released:2006-08-29)
- 参考文献数
- 14
Traumatic atlanto-axial subluxation (AAS) is a rare injury which can be diagnosed by flexion-extension dynamic radiograph on the cervical spine. Here we report on a case of delayed progression of AAS in the chronic phase after a cervical spinal injury. The described case is a 58-year-old man who sustained a closed occipital head injury with subsequent severe tetraparesis and was admitted to our hospital. Although, no obvious bony injuries of the cervical spine were revealed on plain radiograph and CT scan, Magnetic resonance imaging demonstrated intramedullary spinal cord injury at the level of C1-2. In the acute phase, the patient was treated conservatively and the motor dysfunction was well ameliorated. However, the patient gradually suffered again from motor deterioration eight months later and the radiological examinations revealed delayed progression of AAS. After the unsuccessful trial of external reduction for AAS, the patient underwent atlas laminectomy and occipito-cervical internal fixation with compact Cotrel-Dubousset instrumentation. The motor disability improved again after the operation. Sufficient decompression of spinal cord and stable fixation of craniovertebral junction have been obtained for over two years post-operatively. The unique clinical course of the present case is discussed.
1 0 0 0 OA 脊椎疾患と鑑別を要する筋骨格系運動器疾患について考える
1 0 0 0 OA 仙腸関節障害の今,そしてこれから
- 著者
- 伊藤 圭介
- 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.37, no.1, pp.12-16, 2023 (Released:2023-05-12)
- 参考文献数
- 28
1 0 0 0 OA 自然退縮を認めた頚椎黄色靭帯石灰化再発例―プレガバリン内服効果の可能性―
- 著者
- 田中 聡 山本 一徹 権藤 学司 渡辺 剛史 堀田 和子 田中 貴大 田中 雅彦
- 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.35, no.3, pp.312-315, 2021 (Released:2021-12-28)
- 参考文献数
- 13
Calcification of ligamentum flavum (CLF) is a degenerative spinal disease in which calcium crystals deposit in the ligamentum flavum. The CLF may cause spinal cord compression, and the patient may need decompressive surgery. However, CLF can spontaneously regress with some medications as well as no treatment. Here, the authors reported a case in which small CLF remaining after cervical decompression surgery markedly enlarged during the follow-up period and spontaneously regressed after pregabalin administration. Therefore, pregabalin might be involved in the spontaneous regression of CLF. A 66-year-old female complaining of right upper limb pain and numbness was diagnosed with CLF at C5/6 and C6/7 by computed tomography (CT) and magnetic resonance imaging (MRI). The symptoms improved after removal of the CLF at C5/6 with C5 laminectomy and C4, C6 laminoplasty. Postoperative CT showed small residual CLF at C6/7. Six years after surgery, she suffered pain and numbness in her right arm. Her cervical MRI showed a marked increase of CLF at C6/7. The pain disappeared after the administration of pregabalin. Six months later, a marked reduction of CLF was observed on MRI. It has been reported that the administration of cimetidine or etidronate resulted in the regression of CLF. Cimetidine affects calcium metabolism via parathyroid hormone (PTH), and etidronate has an inhibitory effect on calcification. It was reported that the serum PTH was markedly reduced in a uremic patient after the administration of pregabalin. The efficacy of pregabalin was also reported for a case with refractory paroxysmal kinesigenic choreoathetosis whose parathyroid glands were removed. It is presumed that pregabalin was involved in calcification regression via PTH metabolism in this case.
1 0 0 0 OA 多発性骨髄腫患者の脊椎MRI所見
- 著者
- 渡辺 剛史 権藤 学司 田中 雅彦 山本 一徹 堀田 和子 玉井 洋太郎 田中 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.33, no.2, pp.170-174, 2019 (Released:2019-09-10)
- 参考文献数
- 12
The purpose of this article is to analyze the characteristics of spinal magnetic resonance images (MRI) in multiple myeloma patients. Two hundred and eighteen patients were diagnosed with multiple myelomas at the Shonan Kamakura General Hospital from January 2009 to April 2018. Spinal MRIs were evaluated in 66 cases. Initial symptoms, spinal MRI findings, and blood sample test findings at the time of diagnosis were investigated. There were 37 males and 29 females analyzed. Mean age at the time of diagnosis was 70.1 years (42 to 87 years). Main initial symptoms were low back pain (n=23), back pain (n=15), neck pain (n=1), lower limb weakness (n=6), lower limb pain/paresthesia (n=4), cranial nerve palsy (n=2), respiratory symptoms (n=6), renal failure (n=4), anemia (n=3) and asymptomatic (n=6). Spinal MRI revealed vertebral fracture (n=42), intravertebral tumor (n=35), epidural tumor (n=9), diffuse spotty signal (n=13), and diffuse low signal (n=4). There were only five cases where no abnormality was observed beyond the vertebral body fracture. Dural sac compression was observed in 16 cases, of which 12 cases were co-localized with the tumor and 4 cases were by a fractured bony fragment. The results of the blood sampling were confirmed in 65 patients. Anemia, decreased albumin/globulin ratio, hyperproteinemia, hypercalcemia, and increased alkaline phosphatase were observed in 57, 44, 29, 13, and 12 patients, respectively. Only 9 cases showed normal blood test results. The most common symptom of multiple myeloma was lower back pain. As such, half of the patients had visited an orthopedic or spinal surgery clinic. Spinal MRI findings were classified as intervertebral focal lesion, epidural mass, diffuse spotty signal, or diffuse low signal. The presence of an abnormal finding was observed in 92% of patients by spinal MRI and in 86% by blood sampling. Spinal MRI and blood sampling examination should be considered in cases of vertebral fracture in order to prevent the misdiagnosis of multiple myeloma as an osteoporotic vertebral fracture.
1 0 0 0 OA 頚椎術後遅発性C5麻痺の発生メカニズムの検討—前方手術法を用いた画像解析—
1 0 0 0 OA 脊髄癒着性くも膜炎に対する治療経験
1 0 0 0 OA 神経学的診断のピットフォール
- 著者
- 亀山 隆
- 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.33, no.1, pp.15-22, 2019 (Released:2019-05-24)
- 参考文献数
- 43
1 0 0 0 OA 腰椎後方固定術後のMRSAによる手術創部感染に対する抗菌剤療法
- 著者
- 佐々木 学 梅垣 昌士 鶴薗 浩一郎 松本 勝美 芝野 克彦 呉村 有紀 米延 策雄
- 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.30, no.2, pp.170-175, 2016 (Released:2016-09-03)
- 参考文献数
- 14
- 被引用文献数
- 2
Objective : Surgical site infection (SSI) caused by methicillin-resistant Staphylococcus aureus (MRSA) after spinal instrumentation surgery is often intractable, and removal of the implants is frequently necessary for infection control. Although vancomycin (VCM) has been most frequently used against SSI caused by MRSA, recent literatures questioned its efficacy because of its low tissue penetration. Some experts recommend combination therapy with anti-MRSA agents possessing higher tissue penetration or an anti-biofilm effect. The present report shows outcomes of antibiotic therapy for SSI caused by MRSA after spinal instrumentation surgery. Materials and methods : From January 2011 to December 2013, four patients developed SSI caused by MRSA after spinal instrumentation surgery. Posterior lumbar interbody fusion was used in all patients. As initial therapy, VCM was given to one patient, and combined teicoplanin (TEIC) and rifampicin (RFP) were administered to the other three. These patients subsequently received therapy with TEIC, linezolid, or daptomycin combined with RFP, sulfamethoxazole-trimethoprim, or clindamycin. These agents were stopped sequentially if C-reactive protein remained negative for more than a week. Results : Infection was uncontrolled in one patient initially treated with VCM, and removal of the posterior instrumentation and interbody cages was required for infection control. Combined therapy was given postoperatively, with complete cure by 13 weeks after removal of the implants. Infection was controlled and the implants could be retained in the other three patients who were initially treated with TEIC and RFP ; cure was achieved with subsequent combined therapy for 3-15 weeks. Conclusion : The present study suggests that SSI caused by MRSA is treatable with retention of the implant by using combined therapy with anti-MRSA agents possessing higher tissue penetration than VCM or those with an anti-biofilm effect.
1 0 0 0 OA 超音波頚部神経根ブロックのテクニック
1 0 0 0 OA 排尿障害の新しい薬剤治療と電気・磁気治療法
- 著者
- 山西 友典 布施 美樹 内山 智之 柴田 千晴
- 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.1, pp.11-16, 2014 (Released:2017-05-11)
- 参考文献数
- 14
排尿障害 (下部尿路機能障害) には, 蓄尿障害と排尿 (排出) 障害があり, それぞれ膀胱 (排尿筋) 機能障害と尿道 (括約筋) 機能障害に分けられる. 蓄尿障害に対する治療の目的は, 膀胱機能に対しては排尿筋収縮を減弱する (膀胱知覚を抑制する) ことであり, 尿道機能に対しては, 尿道平滑筋, あるいは横紋筋の収縮性を増強することである. 保存療法の行動療法には, 生活指導, 膀胱訓練, 理学療法がある. この理学療法の新しい治療法として, 磁気刺激療法がある. これは尿道括約筋 (骨盤底筋) の収縮性を増強することにより腹圧性尿失禁に, 膀胱の収縮を抑制することにより排尿筋過活動に有効である. 薬物療法としては, 過活動膀胱に対しては, これまで抗コリン薬が主流であった. 新しい抗コリン薬としてフェソテロジンが発売され, また副作用軽減を目的にオキシブチニン経皮吸収型製剤 (ネオキシテープ) が発売された. また新しい機序の薬物療法として2011年にβ3-アドレナリン受容体刺激薬 (ミラベグロン) が発売された. その他の新しい薬物として, ボツリヌス毒素膀胱壁内注入療法などが開発されているが, いまだ日本での適応は認められていない.
1 0 0 0 OA 脊髄損傷後の内在性幹細胞への神経転写因子導入による神経再生治療の試み
1 0 0 0 OA MRIによる末梢神経疾患の診断—できることとまだできないこと—
1 0 0 0 脊髄外科手術 随想—平成世代から令和世代へ—
- 著者
- 水野 正喜
- 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.34, no.2, pp.123-128, 2020
1 0 0 0 OA 上肢の症状を呈する虚血性心疾患
1 0 0 0 OA Currarino triadの手術治療について
- 著者
- 尾原 裕康 野中 康臣 宮嶋 雅一 新井 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.24, no.2, pp.217-222, 2010 (Released:2017-05-11)
- 参考文献数
- 24
The Currarino triad was first described by Currarino et al as a combination of presacral mass, bony sacral defect, and anorectal malformation. Neuroanatomic malformations associated with this hereditary syndrome are anterior sacral meningocele, teratoma, tethered cord syndrome and Chiari malformation. In this paper the authors report four surgically treated cases of Currarino triad. The patients' age at first admission was between 1 month and 8 months, 3 patients were female and one was male. Initial symptoms were meningitis, periproctal abscess, constipation and abdominal mass. The indication for surgery was different in each case. The combination of the pathological findings of the presacral mass and the tethered cord in our cases were different in all patients. All patients showed tethered cord in our cases, although tethered cord was reported in only approximately 18% of the patients with the Currarino triad reported in the literature. The Currarino triad is categorized as a of hereditary abnormality but each case shows various combination of anomaly. It is therefore necessary to understand the condition of each individual case and to determine the proper strategy for treatment accordingly.