Mean JOA Score Research Articles

頚椎変性疾患における前方固定術の中期成績

This study reviewed an over 5-year follow-up results of 21 patients who underwent anterior spinal fusion for cervical degenerative spondylosis between 1989 and 1996. The average patients age was 50.7 years. The mean JOA score improved to 16.0 on the last follow-up from the preoperative score of 13.2. Clinical success was defined according to Hirabayashi’s scale. The average was 73.7%. The latest X-p showed increase of the range of motion (19 out of 21 cases) and degeneration (12 out of 21 cases) in intervertebral disc adjacent to the fused disc. We recommend long term follow-up, because of the risk of cervical disc herniation and the progress of degenerative spondylosis in intervertebral disc adjacent to the fused disk.

Significance of Space-Occupying Ratio According to MRI Finding in Lumbar Disc Herniation

Study design : Clinical significance of space-occupying ratio according to MRI finding in lumbar disc herniation. Objectives : To estimate relationship between patient’s symptoms and space-occupying ratio in herniated lumbar vertebral disc in MRI according to JOA scoring system. Summary of literature review : Using MRI, herniated intervertebral disc may be estimated with the extent of derangement of the constituents of the disc. Symptoms and signs did not correlate with the degree of reduction of the herniation in MRI. Material and Method : A retrospective analysis was performed upon 99 patients that underwent lumbar spine MRI. The degree of the occupied spinal canal was measured by ‘Space-occupying ratio’, which was the ratio of the longitudinal diameter at the spinal canal to the longitudinal diameter at the herniated nucleus purposus. Each ‘30% Space-occupying ratio’ to ‘50% Spaceoccupying ratio’ was classified to analysis I, analysis II. Under the percent was group A, above the percent was group B. We estimate the patient’s condition related with lower back pain according to JOA scoring system. Results : The herniation type of the nucleus purposus was classified to 5 protruded type, 62 subligamentous extruded type, 22 transligamentous extruded type, 10 sequestral type. The patients who have above 30% were 62 cases, under 30% were 26 cases in analysis I, have above 50% were 19 cases, under 50% were 69 cases in analysis II. So, there was not distinguished from analysis I to analysis II according to the degree of the herniation. Mean JOA score was 9.307 in group A, mean JOA score was 9.370 in group B in analysis I. Mean JOA score was 9.391 in group A, mean JOA score was 9.315 in group B in analysisII. There was not correlate statistically with analysisI(p value=0.5669) and analysis II(p value=0.5390) using the Wilcoxon score test. Conclusion : There was not correlate statistically with the degree of the herniation in lumbar spine MRI according to JOA scoring system.

腰椎変性疾患に対するＰＬＩＦ ｃａｇｅ単独使用の経験

This study, evaluated the clinical outcome of posterior lumbar interbody fusion (PLIF) with threaded cages only (AESCULAP H.M.A. system). We performed the operation on 13 patients (5 males and 8 females) with lumbar spinal canal stenosis, disk hernia with instability and degenerative listhesis. The mean age at surgery was 67.4 years (range : 54 to 75) and the period of follow-up was 6 to 57 months, (average : 23.7). Fusion success was judged by absence of motion on flexion-extension radiographs and absence of bone halo around the implants. The mean JOA score improved from the preoperative score of 12.4 to 23.5 at the last follow-up (average improvement rate 60.1%). Leg pain was reduced in all cases. Intervertebral angle improved to less than 2 degrees in 8 cases which we judged as bone union occurred. No halo around cage, migration, or displacement of implant was observed in any case. We believe that PLIF with interbody cage is useful for elderly patients who have lumbar spinal canal stenosis with spinal instability.

腰神経根外側障害に対する片側還納式椎弓形成術

The clinical results and radiologic findings in 15 cases diagnosed as lumbar radiculopathy and treated with osteoplastic hemilaminectomy were studied. Follow-up period was from 7 months to 4 years, (average 2.3 years. Clinical results were evaluated by JOA score, and the recovery rate was determined by Hirabayashi’s method. Bone union of spinous processes and vertebral arch, which had been dissected with a surgical thread wire saw, was judged by radiographs and computed tomographs (CT). Osteoarthritic deterioration of the facet replaced was judged by CT. The preoperative mean JOA score was 5.2 points, which improved to 12.1 points at the final evaluation. Clinical evaluation improved with statistically significant differences. The mean recovery rate was 70.7%. The bone union rate of spinous processes and vertebral arch was 100% and 56%, respectively. However, the bone union rate showed little correlation with the improvement of clinical symptoms. Osteoarthritic deterioration of the facet progressed in 2 cases and appeared in 1 case. Re-operation was necessary for 1 case due to recurrence of severe leg and lower back pain. These results suggest that osteoplastic hemilaminectomy is effective for short term treatment, and longer follow-up is necessary.

腰部脊柱管狭窄症における後方除圧の成績

This study reviewed follow-up results of more than 2 years in 29 cases who underwent lumbar decompression without fusion for acquired lumbar spinal canal stenosis between 1994 and 1998. The average patient age was 68.8 years. The mean JOA score improved to 12.2 in the last follow-up from the preoperative score of 7.8 (total score was 15). Clinical success was defined according to the Hirabayashi scale. The average score was 61.1%. Twenty-four cases were categorized as excellent, good or ; fair only 1 cases was poor. Four cases required re-operation due to worsening of symptoms. The cases required re-operation due to excessive medial facetectomy.

外側型腰椎椎間板ヘルニアに対する内外側アプローチの成績

We treated 8 cases (5 males and 3 females) with lateral lumbar disc herniation surgically since 1995, and the intralateral approach, in which intralamina fenestration was performed in addition to a paraspinal approach, was conducted in 5 cases. We operated on the cases that had not been efective for conservative treatments, and chose the intralateral approach for the cases that was thought difficult for only medial fenestration. The purpose of this study is evaluate postoperative clinical improvement the in JOA score with procedure.The average age at the time of surgery was 63.4 years (range; 56 to 76 years). The follow-up period averaged 1 year 9 months. The level was L2/3 in 1 case, L3/4 in 1, L4/5 in 3, L5/S1 in 3. Depending on the case intralateral approach, Love's method, or partial laminectomy was conducted without facetectomy.The results were as follows: the mean JOA scores before treatment were 11.8/29 for the intralateral approach (5 cases), 17/29 in Love's method (1 case), 12.5/29 in partial laminectomy (2 cases), and 14/29 for the conservative group. The mean JOA scores after treatments were 24.2/29 for the intralateral approach, 26/29 for the Love's method, 26.0/29 for the partial laminectomy, and 25.4/29 for the conservative group. The mean percentage of clinical improvement was 71.9%, 75%, 82.2%, and 75.6% respectively. All patients evaluated their degree of satisfaction were excellent or good.

Ｏｓ ｏｄｏｎｔｏｉｄｅｕｍに伴う環軸椎亜脱臼の病態と手術法の検討

Atlantoaxial subluxation (AAS) with os odontoideum is more unstable than AAS without it. We investigated the surgical results of symptomatic AAS with os odontoideum. Eleven males and 16 females (mean age: 38 years) underwent surgery. Fifteen patients showed myelopathy (mean JOA score: 9.4), and 12 had only local symptoms without myelopathy. Three parameters on the lateral radiographs (minimum diameter in flexion, maximum diameter in extension and atlanto-axial angle in flexion and extension) were measured preoperatively, and the instability index was calculated. Manipulation (18) or anterior release (3) reduced AAS in 21 patients. Posterior atlanto-axial fusion and bone graft were performed with wiring (9), transarticular screw fixation with wiring (9), and Olerud Cervical fixation (3). In 6 patients, AAS was not reduced and occipito-cervical fusion was performed. Correction loss and union rate were investigated on the postoperative lateral radiograph. The mean follow-up was 5 years and 4 months. There was no significant difference between preoperative radiological values and clinical symptoms. The mean JOA score improved to 13.0 after surgery, and the improvement rate was 52.3%. Four patients treated with wiring showed correction loss. Three of them developed non-union and required re-operation. Bone union was achieved with other fixations.

腰椎片側固定術の術後成績

The merits of fixation on lumbar surgery are widely known. Tight fixations may cause disorder of the adjoining disc after along interval. Solutions such as the Graf system were developed to cossect such problems: as its purpose is to stabilize intervertabral fixed joints. We performed unilateral posterolateral fusion on the lumbar spine for stabilization. In this paper, we report the clinical and radiographical results of postoperative surgery.36 patients (10 men, 26 women) with an average age of 45 years (range: 24 to 70) underwent unilateral postlateral fusion from June 1996 to April 2000. The average follow-up time was 15 months. We evaluated clinical symptoms using the JOA score, and determined the recovery rate by Hirabayashi's method. We also evaluated bone union, and range of motion of fixed intervertebral joint.The mean JOA score was 12.7 before operation, and 26 postoperatively. The mean recovery rate was 84.9%. The rate of bone union was 83.6%. The instability of the intevetebral fixed joint undergoing surgery improved from 6.5 degrees preoperatively to 4.5 degrees postoperatively.We started to obtain good results from the middle term. Unilateral lumbar posterolateral fusion is effective for stabilization. We consider unilateral posterolateral fusion to be an effective option when other cossective produses are doubtful.

８０歳以上の腰部脊柱管狭窄症の術後成績

We reviewed 14 patients over 80 years of age after surgical decompression for lumbar canal stenosis. The average age at the time of surgery was 83.6 years. The average duration of follow-up was a year and eleven months. Another group of 45 patients aged 70 was compared as the control group. The clinical result was evaluated on the basis of the JOA score. The mean JOA scores of the group of over 80 was 12.9 points before surgery and 18.7 points after surgery. The JOA score improvement rate was 36.8%. These dates were low compared to the other group. But 93% of over showed excellent or good results.

Bombelli's valgus-extension osteotomy for osteoarthritis due to acetabular dysplasia: results at 10 to 14 years

Severe osteoarthritis due to acetabular dysplasia ( n = 17) was treated with valgus-extension osteotomy, and the patients’ clinical outcomes 10–14 years after operation were evaluated according to clinical factors (Japanese Orthopaedic Association hip score; JOA score) and by roentgenography. The mean JOA score 10 years or later had improved by 22 points compared with the preoperative score. On roentgenography, joints which had preoperative roof osteophyte had better postoperative formation of roof osteophyte. The JOA score was higher in the 12 joints which had osteophyte 5mm or longer than in those joints with osteophyte that was 5mm or shorter. Postoperative joint space widening occurred in 15 joints (88.2%) 3–6 months postoperatively, and it reached the maximum at 3–5 years. In patients who had a large bone cyst in the femoral head preoperatively, the cyst collapsed, and deformation of femoral head occurred after operation, but remodeling of the joint surface occurred naturally and the congruity improved. In the 6 joints in which the preoperative acetabular head index was less than 60% and the acetabular angle was larger than 30°, the JOA score at 10 years or later was lower than that of the other joints. Based on these findings, valgus-extension osteotomy was evaluated as a useful surgical method for advanced or terminal osteoarthritis in young or middle-aged patients. Predictive factors for longterm prognosis would be the preoperative length of roof osteophyte, joint space widening, and the degree of femoral head covering.

Bombelli’s valgus-extension osteotomy for osteoarthritis due to acetabular dysplasia: results at 10 to 14 years

Severe osteoarthritis due to acetabular dysplasia (n = 17) was treated with valgus-extension osteotomy, and the patients’ clinical outcomes 10–14 years after operation were evaluated according to clinical factors (Japanese Orthopaedic Association hip score; JOA score) and by roentgenography. The mean JOA score 10 years or later had improved by 22 points compared with the preoperative score. On roentgenography, joints which had preoperative roof osteophyte had better postoperative formation of roof osteophyte. The JOA score was higher in the 12 joints which had osteophyte 5mm or longer than in those joints with osteophyte that was 5mm or shorter. Postoperative joint space widening occurred in 15 joints (88.2%) 3–6 months postoperatively, and it reached the maximum at 3–5 years. In patients who had a large bone cyst in the femoral head preoperatively, the cyst collapsed, and deformation of femoral head occurred after operation, but remodeling of the joint surface occurred naturally and the congruity improved. In the 6 joints in which the preoperative acetabular head index was less than 60% and the acetabular angle was larger than 30°, the JOA score at 10 years or later was lower than that of the other joints. Based on these findings, valgus-extension osteotomy was evaluated as a useful surgical method for advanced or terminal osteoarthritis in young or middle-aged patients. Predictive factors for longterm prognosis would be the preoperative length of roof osteophyte, joint space widening, and the degree of femoral head covering.

上腕骨近位端骨折の観血的治療例の検討

Among the patients with Humerus proximal fumeral fracture who were treated at our department during the past 5 years, 31 with fractures which were unstable or associated with marked dislocation were treated by surgery. Among the 31 patients, 9 underwent hemiarthroplasty, and 22 underwent open reduction fixation (hook plate percutaneous pinning and tension band wiring). The patients were all followed-up postoperatively. The results of treatment were assessed according to the JOA score in 29 cases. JOA scores assessed at thefinal visit were 79.9 in patients receiving hemiarthroplasty, 85 in those with hook plate, and 73.3 in those with tension band wiring. With respect to the adverse effects of treatment, 1 patient with tension band wiring had aseptic necrosis, 1 with hook plate had pseudoarthrosis, and 2 with hemiarthroplasty had a wire broken at the terminal-point of the major knot. The patients receiving hemiarthroplasty had relatively favorable outcomes when the terminal points of the major and minor knots were well handled and fixed (the mean JOA score was 88). Patients with hook treatment, even with 3-part or 4-part fractures, had relatively well fixed major knots, leading to favorable outcomes (the mean JOA core was 88.6).

Ｃａｇｅ単独で行ったＬ５／Ｓ１後方進入腰椎椎体間固定術（ＰＬＩＦ）の治療経験

The purpose of this study was to evaluate the clinical outcome of posterior lumber interbody fusion (PLIF) with the interbody fusion cage for L5/S1. PLIF was performed on 18 patients consisting of 12 males and 6 females. 8 were diagnosed as disc degeneration, 7 as spondylolisthesis, 3 as spondylolytic spondylolisthesis. The average patients age was 38.2 years. The mean JOA score improved to 25.3 on the last follow-up from the preoperative score of 14.2. Posterior elements were preserved as much as possible, and two cages were then inserted into both sides.Low back pain and leg pain recurred in all patients. No breakage, displacement, backout of cage, progress of slipping, nor sinking was observed. In all cases, the interbody height was enlarged. Four cases showed clear zones less than 1mm around the cages. No motion was seen at the fusion level in all cases on dynamic radiographs.We believe that PLIF with interbody fusion cage for L5/S1 is useful for cases with diminished disc space.

Ｄｕｒａｃｏｎ型人工膝関節全置換術の中期成績（４年〜６年経過例）

We evaluated the clinical and radiographic results of total knee arthroplasty in 17 patients using the Duracon System. 13 knees of 10 patients had osteoarthrosis and 8 knees of 7 patients had rheumatoid arthritis. The mean age at the time of operation was 68.3 years. The mean follow-up period was 5.0 years. The mean JOA score improved from 42 to 77 points in the OA group and from 41 to 76 points in the RA group. The mean extension changed from -17° to -4° in the OA group and from -6° to -1° in the RA group. Obvious loosening was not confirmed on the radiographs.

Outcomes of surgical treatment for cervical myelopathy in patients more than 75 years of age.

Retrospective study on the results of surgical treatment of compressive cervical myelopathy in patients more than 75 years of age. To investigate clinical features and surgical outcomes of compressive cervical myelopathy in aged patients and to discuss the role of surgical treatment. There are few data focused on the outcomes of surgery in patients with cervical myelopathy who are more than 75 years of age. Seventeen patients with compressive cervical myelopathy who underwent surgery were reviewed. The average age at the time of surgery was 77.2 years. Posterior decompression in 15 patients and anterior decompression in 2 patients were performed. Neurologic deficits before and after surgery were assessed using a scoring system proposed by the Japanese Orthopaedic Association (JOA score). Independence of daily living was evaluated. Radiologic features were examined with radiographs and magnetic resonance imaging. Clinical results were compared with those of patients less than 65 years old as a control. The preoperative mean JOA score was 6.1, the postoperative maximum JOA scores averaged 11.4, and the recovery rate was 48.4%. These were significantly inferior to scores in those less than 65 years of age. All seven of the patients who could not walk even with aids before surgery became independent in daily activities after surgery. At the final follow-up, the mean JOA score had decreased to 10.7 and the recovery rate to 39.1%. Five of nine patients whose follow-up periods were more than 5 years showed decreases in JOA score, although all patients were still ambulatory. Surgical decompression for cervical myelopathy appears to be beneficial, even in patients more than 75 years of age, in improving neurologic function and ability to engage in activities of daily living.

広範囲肩けん板断裂の治療経験

Six patients underwent operative repair of massive rotator cuff tear and were followed up after an average of 8.2 months (range 6 to 12 months). The mean age of the patients was 63.2 years; there were 5 male and 1 female patients. All patients experienced significant pain and 5 patients recall a traumatic event. Magnetic resonance imaging (MRI) permits evaluation of the size of the rotator cuff tears. Preoperatively, average JOA shoulder score was 55.0 points.All patients had anterolateral acromioplasty and repair with interpositional graft with fascial lata. Early passive flexion exercises were performed on all cases. All patients showed satisfactory results, with 4 rated as excellent, and 2 rated as good. Five patients had satisfactory pain relief. The mean JOA score was 92.5 points.

腰部脊柱管狭窄症に対するアルガトロバン（ノバスタン注）の効果 効果の持続性について

The purpose of this study is to estimate the effects of the drip infusion therapy with argatroban and its sustenance.14 patients who had failed conservative treatment were administered argatroban (20mg/day) for 2 weeks. 12 patients showed some improvements in their symptoms following this treatment. No patients worsened. The mean JOA score significantly improved from 12.9 points to 19.4 points. Most subjective symptoms showed significant improvement, but not objective symptoms. 5 patients had continuous improvements for more than a mean of 17.8 months, but 4 patients showed recurrence after a mean follow-up of 3.7 months.These results suggest that drip infusion therapy with argatroban is recommended for lumbar spinal canal stenosis.

Results of surgical treatment for ossification of the posterior longitudinal ligament of the thoracic spine.

Conservative treatment is ineffective for ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine, and surgical treatment is indicated for most cases, while such cases are not often experienced. In the present study, the results of surgical management involving mainly posterior decompression for this disease were evaluated clinically. The study included 9 patients (1 man and 8 women) who underwent surgical treatment for OPLL of the thoracic spine between 1984 and 1993. Laminectomy was performed in 5 patients, and laminectomy plus anterior decompression of the OPLL via the posterior approach based on Otsuka's method was performed in 2 patients. In 1 patient, laminoplasty for OPLL of the cervical spine was combined with laminectomy of the symptomatic lesion in the thoracic spine. One patient underwent anterior decompression and fusion. The results were evaluated using the Japanese Orthopaedic Association score (JOA score) and recovery rate. The postoperative follow-up period ranged from 1 year to 10 years and 3 months (mean, 4 years and 6 months). The mean JOA score was 4.8 before surgery and improved to 7.6 at the final examination. This was a mean recovery rate of 50.1%. Symptoms caused by OPLL in the thoracic spine can be alleviated by posterior decompression where OPLL extends from the upper to the middle thoracic spine or extends from the middle to the lower thoracic spine. It seems, however, that OPLL localized to the middle thoracic spine requires anterior decompression.

腰部脊柱管狭窄症の神経根症状に対する手術的治療の検討

This study investigated the operative results of the lumbosacral radiculopathy of lumbar canal stenosis. 24 cases were treated by surgery 9 cases received fenestration, 8 cases also received wide laminectomy, and in addition 7 cases received lumbar segmental fusion by instrumentation. The mean age at the time of surgery was 69.8 years (ragne; 56 to 81 years). The mean duration of follow-up was 23 months (range; 12 to 31 months).The clinical results were evaluated by the JOA score, and the recovery rate was determined by Hirabayashi's method, and by the recovery ratio of radiculopathy symptoms, pain and dysesthesia of the lower extremities. The preoperative mean JOA score was 14.5 points, which changed to 20.5 points at the final check, and the mean recovery rate was 42.7%. The recovery ratio of radiculopathy pain shows a tendency to decrease as the number of decompressed intervertebral segments increase.

中高年者の膝半月板断裂の治療成績の検討

Forty three knees in thirty six patients over forty years of age that had arthroscopic meniscectomy were reviewed and their articular cartilage degeneration assessed according to the classification by Fujisawa. Sixteen knees of grade 0, 1 and 2 improved from a mean JOA score of 68.4±12.6 to 96.9±4.43, and all were satisfied with the results. Four of six grade 3 knees, and only seven of twenty one grade 4 and 5 knees were satisfied with the results. The factors affecting the results of meniscectomy in cases with grade 3, 4 and 5 cartilage degeneration need to be clarified.