Average Preoperative Japanese Orthopedic Association Research Articles

Value of Evoked Potential Changes Associated with Neck Extension Prior to Cervical Spine Surgery.

Multimodal intraoperative monitoring (MIOM) is a useful tool to warn surgeons to intervene for intraoperative spinal cord injury in cervical spine surgery. However, the value of MIOM remains controversial before cervical spine surgery. To explore the value of MIOM in early detecting spinal cord injury associated with neck extension before cervical spine surgery. Data of 191 patients receiving cervical spine surgery with the MIOM were enrolled from June 2014 to June 2020. The subjects were divided into a group of evoked potentials (EP) changes and a group of no EP changes for analysis according to the monitoring alerts or not. Five (2.62%) patients showed EP changes associated with neck extension during intubation or positioning. After early different interventions, such as repositioning and timely surgical decompression, none or transient postoperative neurological deficits were observed in four cases, and only one case was with permanent neurological deficits. The average preoperative Japanese Orthopaedic Association (JOA) scores of the group with EP changes were lower than those of the group with no EP changes (P = 0.037 < 0.05). There was no statistical significance in gender, average age, mean Pavlov ratio, and the minimum Palov ratio between the two groups (P > 0.05). The MIOM could identify spinal cord injury associated with neck extension before cervical spine surgery. Active and effective interventions could prevent or reduce permanent postoperative neurological deficits. Severe spinal cord compression might be a risk factor for EP changes.

Foraminal Stenosis at L5-S1 as an Overlooked Pathology of Bilateral Radiculopathy: A Case Series.

The classical symptom of foraminal stenosis is unilateral radiculopathy. Bilateral radiculopathy caused purely by foraminal stenosis is rare. Here, we report five cases of bilateral L5 radiculopathy caused purely by L5-S1 foraminal stenosis and describe the clinical and radiological features of these patients in detail. Among the five patients, two were men and three were women with an average age of 69 years. Four patients had undergone surgeries at L4-5 level, previously. All the patients showed an improvement in symptoms in the post-operative period. After a certain period, the patients complained of bilateral leg pain and numbness. An additional surgery was performed in two patients; however, there was no improvement in symptoms. One patient, who did not undergo surgery, was treated conservatively for 3 years. All the patients had been suffering from bilateral leg symptoms before their first visit to our hospital. The neurological findings in these patients were consistent with bilateral L5 radiculopathy. The average pre-operative Japanese Orthopedic Association (JOA) score was 13 out of 29 points. Bilateral foraminal stenosis at L5-S1 level was confirmed using a three-dimensional magnetic resonance imaging or computed tomography. Posterior lumbar interbody fusion was performed in one patient and bilateral lateral fenestration using Wiltse's approach was performed in four patients. The neurological symptoms recovered immediately after surgery. The average JOA score at 2-year follow-up was 25 points. Spine surgeons may overlook the pathology of foraminal stenosis, particularly in patients with bilateral radiculopathy. Familiarity with the clinical and radiological features of symptomatic lumbar foraminal stenosis is necessary to properly diagnose bilateral foraminal stenosis at L5-S1 level.

Role of Intraoperative Disc Contrast Injection in Determining the Segment Responsible for Cervical Spinal Cord Injury without Radiographic Abnormalities.

To determine the features of discs in spinal cord injury without radiographic abnormality (SCIWORA) by intraoperative disc contrast injection (IODCI) and to subsequently treat the responsible discs operatively. From January 2007 to December 2011, 16 adult cases of cervical SCIWORA were enrolled in this study. The average preoperative Japanese Orthopaedic Association (JOA) score was 9.1 ± 1.8. Although preoperative imaging showed no obvious fracture or dislocation, spinal cord compression was evident in all cases. High spinal cord signals on MRI T2WI and cervical disc degeneration were present in all cases and swollen soft tissue anterior to the cervical spine in nine cases. All patients underwent anterior cervical surgeries for spinal cord compression, IODCI being performed after exposure of suspicious discs. Patients with only one ruptured disc underwent anterior cervical discectomy and fusion; those with more complex injuries underwent anterior cervical corpectomy and fusion with fixation of the ruptured segment. JOA scores, X-rays and CT scans were checked at specified intervals over an average of 24.4 months. Of 32 discs suspected preoperatively of being injured, 19 were identified as ruptured by IODCI. Anterior annulus fibrosus rupture was proved in 11 patients whereas the anterior longitudinal ligament was intact in all. JOA scores at 2 weeks, 3 months and last follow-up postoperatively were 13.3 ± 1.5, 14.5 ± 1.6 and 15.1 ± 1.5 respectively. The recovery rates were 53.2%, 68.3% and 75.9%, respectively. IODCI helps to determine the segment responsible for cervical SCIWORA.

Interlaminar Bony Fusion After Cervical Laminoplasty: Its Characteristics and Relationship With Clinical Results

A radiographic study in 32 patients with cervical myelopathy. To investigate postoperative interlaminar bony fusion, and its characteristics and relationship to clinical results in patients undergoing laminoplasty. Laminoplasty is being increasingly performed for multi-segmental cervical myelopathy, and its superior long-term results have been reported in some articles. We often see cases that develop postoperative interlaminar bony fusion after laminoplasty. In 32 patients, lateral cervical radiographs were obtained every year after surgery, and postoperative interlaminar bony fusion was evaluated. Range of motion (ROM) of the cervical spine at last follow-up was compared with the respective preoperative values. Furthermore, the neurologic recovery rates at last follow-up were compared to preoperative values. Postoperative interlaminar bony fusion was shown in 17 patients (53%, group 1), and in most, fusion appeared within 3 years after surgery. Average age at surgery in group 1 and the remaining 15 patients (group 2) was 64.6 years and 57.0 years, respectively (P < 0.04). Preoperative and postoperative ranges of motion in group 1 were 45.6 degrees and 28.1 degrees on average, respectively. However, those of group 2 were 50.3 degrees and 39.8 degrees on average, respectively. Postoperative ROM in group 2 was significantly better maintained than that in group 1(P < 0.04). In group 1, the average preoperative Japanese Orthopedic Association score was 9.56 points, which improved to 13.6 points at the final follow-up, providing a 55.6% average recovery. In group 2, it was 10.9 points, which improved to 14.1 points at the final follow-up, providing a 56.5% average recovery. There was no significant difference in the average percentage of recovery between the 2 groups (P > 0.93). Postoperative interlaminar bony fusion occurred in 53% of patients, with marked frequency at C2/3 after laminoplasty. It did not influence neurologic recovery, but it did reduce the postoperative sagittal ROM of the cervical spine.

Expansive Laminoplasty for Multilevel Cervical OPLL

Expansive laminoplasty is a new technique for the management of cervical ossification of the posterior longitudinal ligament (OPLL). Twenty patients were followed up for an average 3-year period. Follow-up examinations were performed every 3 months and at 1-year intervals. On lateral radiographs, the average increase in the anteroposterior (AP) diameter of the canal was 42%. Bone fusion was documented on computed tomography (CT) studies 3 months after surgery in 96% of patients. An average 83% of normal range of motion was preserved on long-term follow-up (3 years on average). Postoperative improvement over the same interval increased from an average preoperative Japanese Orthopaedic Association score of 7.9 to 14.1 Expansive laminoplasty as described is safe and has a high fusion rate, while better preserving the normal range of motion.