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  • Author or Editor: Futoshi Suetsuna x
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Futoshi Suetsuna, Hozumi Narita, Atsushi Ono and Hirotaka Ohishi

✓The authors report a new technique for C-1 laminoplasty without fusion in the treatment of cervical myelopathy associated with a retroodontoid pseudotumor (also known as a phantom tumor).

The authors review the cases of three patients who underwent C-1 laminoplasty in which hydroxyapatite was used and fusion was not performed. All patients suffered from severe progressive myelopathy before surgery. Magnetic resonance imaging revealed a retroodontoid pseudotumor compressing the spinal cord at the C-1 level in all cases. Computed tomography was performed to examine the extent of bone erosion at the atlantoaxial joint and dens. Clinical parameters included neurological function, measured using the Japanese Orthopaedic Association score, and neck pain. Imaging parameters included pre- and postoperative atlas–dens intervals; the space available for the spinal cord; instability of the atlantoaxial joints; osteoarthritic changes of the atlantoaxial joint; postoperative changes in T2 high-intensity signal; and postoperative alteration in the size of the pseudotumor.

Magnetic resonance imaging demonstrated complete disappearance of the pseudotumor in two cases and partial reduction in one case. In all three cases sufficient neurological recovery was observed. The mean recovery rate was 87.0%.

This new technique is less invasive than standard procedures, preserves the cervical range of motion, and avoids the morbidity of obtaining a bone graft and placing instrumentation. The authors conclude that C-1 laminoplasty without fusion is an option in the surgical management of cervical myelopathy associated with a retroodontoid pseudotumor, either without C1–2 instability or with slight, but reducible, C1–2 instability.

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Atsushi Ono, Futoshi Suetsuna, Kazumasa Ueyama, Toru Yokoyama, Shuichi Aburakawa, Takuya Numasawa, Kanichiro Wada and Satoshi Toh

Object

The clinical characteristics of pediatric scoliosis associated with syringomyelia have been reported in previous studies, but scoliosis associated with syringomyelia in adults is rarely treated, and there is a paucity of detailed studies. In the present study of adult syringomyelia associated with Chiari malformation Type I, the authors investigated the relationships among the syrinx, scoliosis, and neurological data.

Methods

The population was composed of 27 patients (≥ 20 years of age) who underwent foramen magnum decompression for the treatment of syringomyelia. The patients were divided into two groups: those with scoliosis of 10° or more (Group A) and those without scoliosis (Group B). The authors assessed the length of the syrinx, duration of morbidity, and clinical status before and after surgery based on the Japanese Orthopaedic Association (JOA) Scale.

There were 15 cases in Group A and 12 in Group B. The mean length of the syrinx was 12.8 vertebral bodies (VBs) in Group A and 7.2 VBs in Group B. The mean duration of morbidity was 14.2 years in Group A and 6.8 years in Group B. The mean preoperative JOA score was 10.1 in Group A and 14.4 in Group B, whereas the mean postoperative JOA scores were 11.9 and 15.8, respectively. There were significant differences between Groups A and B in length of the syrinx, duration of morbidity, and pre- and postoperative JOA scores.

Conclusions

In patients with syringomyelia and scoliosis the syringes spanned a greater number of VBs, the duration of morbidity was greater, neurological dysfunction was more severe, and surgical results were poorer. Scoliosis could be a predicting factor of the prognosis in patients with syringomyelia and Chiari malformation Type I.

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Atsushi Ono, Futoshi Suetsuna, Tomoyuki Irie, Toru Yokoyama, Takuya Numasawa, Kanichiro Wada and Satoshi Toh

Object

Previous reports of redundant nerve roots (RNRs) of the cauda equina have been limited to evaluations based on myelography. Neither the imaging nor the clinical features of RNRs in relation to magnetic resonance (MR) imaging have been elaborated. The MR imaging characteristics of RNRs were evaluated using the Japanese Orthopaedic Association score before and after the surgery.

Methods

There were 44 patients with L4–5 spondylolisthesis in which a complete blockage was demonstrated on myelography. All patients underwent posterior L4–5 interbody fusion. Based the myelographic and MR imaging findings, the patients were stratified into the following three groups: RNRs recognized on both myelographic and MR imaging (Group A); RNRs recognized on myelography but not very evident on MR imaging (Group B); and RNRs not recognized on either myelographic or MR imaging (Group C). Among these three groups, pre- and postoperative clinical symptoms were compared.

Results

There were 16 patients in Group A, 14 in Group B, and 14 in Group C. In terms of preoperative clinical symptoms, there was a significant difference between Groups A and C in the incidence of leg pain and tingling sensation. Significant differences were also noted between Groups A and C and between Groups B and C in ambulatory ability. Evaluation of postoperative clinical symptoms showed a significant difference between Groups A and C in ambulatory ability.

Conclusions

Patients with MR imaging evidence of RNRs presented with more severe clinical symptoms. It is believed that the RNR features derived from MR images represent important findings.

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Atsushi Ono, Futoshi Suetsuna, Kazumasa Ueyama, Toru Yokoyama, Shuichi Aburakawa, Kazunari Takeuchi, Takuya Numasawa, Kanichiro Wada and Satoshi Toh

Object

There have been few reports about the cervical spinal motion in patients with Chiari malformation Type I (CM-I) associated with syringomyelia. To investigate this phenomenon, the relationship between the preoperative cervical range of motion (ROM) and the stage of cerebellar tonsillar descent as well as the cervical ROM before and after foramen magnum decompression (FMD) were evaluated.

Methods

Thirty patients who had CM-I associated with syringomyelia and who underwent FMD participated in the study. The ROM and lordosis angle of the cervical spine were measured on x-ray films. In addition, the relationship between preoperative degree of cerebellar tonsillar descent and the ROM between the levels of the occiput (Oc) and C2 was investigated.

Results

The mean flexion–extension ROM at Oc–C2 was 15.5° before and 14.1° after surgery, and the mean flexion–extension ROM of C2–7 was 55.1° before and 52.8° after surgery. The mean pre- and postoperative lordosis angles at C2–7 were 16.8 and 19.1°, respectively. There was no significant difference between the values measured before and after surgery. There was no correlation between the degree of cerebellar tonsillar descent and the ROM at Oc–C2.

Conclusions

Foramen magnum decompression is an excellent surgical technique that has no effect on the postoperative cervical ROM and cervical alignment.