脊椎ジャーナル

Donor to donor variation has long been a concern of the allograft industry. DBM and stem cell products have been particularly susceptible to intervariability between donors, regardless of the process used to manufacture these products. Manufacturers of allograft based products have often utilized in vitro or small animal models to help predict reliability, yet little data is available correlating preclinical outcomes with clinical efficacy.

OsteoAMP is a commercially available allograft-derived growth factor rich in osteoinductive, angiogenic, and mitogenic proteins. An analysis of radiographic results comparing fusion outcomes was conducted for 285 consecutive cervical and lumbar spinal fusion patients utilizing OsteoAMP bone grafts from 114 donors of varying ages. A blinded radiological fusion assessment, performed by an independent radiologist, showed all patients, except one, fused within 18 months (average time to fusion was 189.9 days). This evidentiary analysis shows that OsteoAMP fusion success did not show donor intervariability and that fusion rate/time is not dependent on donor age. In addition, the implant retained bioactivity over time and terminal sterilization via low-dose gamma irradiation did not impair the bioactivity of the grafts.

Objective: Establishment of brucellosis spondylitis of imaging classification; provision reference for clinical treatment methods.

Methods: Form January 2008 to July 2012, 89 cases imaging data confirmed by clinical examination and laboratory of brucellosis spondylitis patients were analyzed retrospectively, based on X-ray, CT and MRI imaging of their clinical manifestations- Vertebral inflammatory infiltration and extent of the damage, the extent of damage to the intervertebral space, periostitis inflammatory changes, paraspinal abscess, spinal cord, cauda equina and nerve root compression. All this imaging indicators above were the evaluation criteria. Acquisition and analysis of the imaging data was implemented by the blinded reading group which was composed of Imaging Center physicians and orthopedic surgeons. According to these imaging performances, develop the imaging classification.

Results: Brucellosis spondylitis image was made up of I-VI type: type I: vertebral inflammation; type II: Discitis; type III: periostitis; type IV: abscess; type V: spinal nerve and type VI: compound. The group of 54 cases accounted for 60.67% of the compound, in which the incidence of type I Image companied by type II was maximum: 22 cases accounted for 40.74% (22/54) and second type II Image and companied by V type was 20 cases: accounted for 37.03% (20/54). In the group, 35 cases of simple type accounted for 39.33%: type I: 4 cases; type II: 12 cases; type III: 3 cases; type IV: 2 cases; type: 4 cases. Simple and complex type of type II imaging accounted for 59.55% (53/89) the highest occurrence rate, in which the type I was 47 cases: accounted for 52.81% (47/89). Based on imaging classification, 67 cases was treated by surgery, in which 59 cases was treated by debridement and 8 cases was treated by percutaneous minimally invasive surgery, 22 cases was not treated by surgery. The group of 89 cases had been followed for 1 year: 83 cases had been cured without prognosis, and 6 cases had been improved.

Conclusion: Brucellosis spondylitis images classification has a reference value and guiding significance for the strategies of clinical treatment. According to this classification, simply type I, type II, type III, and IV type can be used in clinical conservative treatment, and when the evolution of the disease has surgical indications, or type V and VI type the patients should be treated actively by surgery.

Ependymomas are primary CNS tumors representing 3%-6% of all CNS tumors, and 34.5% of ependymomas occur in the spine. Spinal ependymomas occur most frequently in the cervical spine. Rarely, tumor-associated syringomyelia and hematomyelia may complicate cervical spinal ependymomas. Here, the authors present a case of a 37 year-old gentleman with cervical intramedullary WHO Grade II ependymoma with hematomyelia extending cephalad to the brainstem. The authors also detail their operative procedure using the OmniGuide CO2 laser and review current literature on the management of cervical intramedullary ependymoma with tumor-associated syringomyelia and/or hematomyelia.

Objective: Accurate measurement of the Thoracic Kyphosis Angle (TKA) has great value for both evaluating patients and monitoring treatment progress. Dual Digital Inclinometer (DDI) has introduced as a non-invasive device that can measure the kyphosis angle. Because of lack of sufficient data, this study was aimed to determine the validity and the reliability of the DDI in measuring TKA in a group of women.

Materials and Methods: In this study, TKA was measured by DDI three times in 20 women aged 45-70 years. The first two measurements were taken with an hour apart in the same day, to assess the within -day and the third measurement was taken a day later to assess the between-day reliability. Finally, the validity of obtaining values of the TK with DDI compared with Cobb's angle as a gold standard.

Results: The ICC between the measurements from the Cobb’s angle and DDI method was 0.86. TKA measurements using DDI were shown to be reliable with high Inttraclass Correlation Coefficient (ICC) values, 0.92 and 0.87 for within- day and between- day respectively.

Conclusion: According to the present study, the DDI is a valid and reliable device for non-invasive and clinical measurement of TKA in women over 45 years.

Background: Previous reports have described patients with groin pain induced by lumbar radiculopathy below the L3 spinal level, but this type of groin pain has not been studied in detail. This retrospective clinical study investigated the possibility of groin pain caused by lumbar radiculopathy below the L3 spinal level.

Methods: We reviewed the clinical records of 210 consecutive patients who were surgically treated for singlelevel lumbar radiculopathy between June 2005 and September 2012. We examined the spinal level of the affected nerve root, clinical symptoms, and surgical outcomes based on the Japanese Orthopedic Association (JOA) score for lumbar diseases and a visual analog scale (VAS) for leg pain.

Results: The 210 patients underwent surgery for single-level lumbar radiculopathy due to L3 radiculopathy (7 patients), L4 radiculopathy (20), L5 radiculopathy (127), or S1 radiculopathy (56). Groin pain was experienced by 8 patients (3 patients with L3 and 5 with L4 radiculopathy). Most of these 8 patients also experienced pain in the anterior thigh (6 patients) or knee (5 patients) regions. The pain experienced by these patients was relieved by surgical decompression of the affected nerve roots. The JOA and VAS scores showed significant improvement postoperatively. The mean postoperative follow-up period was 19.6 months (range, 6–40 months), during which time none of the patients required additional treatment for groin pain.

Conclusions: L3 or L4 radiculopathy should be considered during the examination of patients with groin pain and radicular leg pain.

Background Context: Thoracic involvements of meningiomas are rarely seen and only a couple of dumbbellshaped meningiomas are reported in the literature. Spinal meningiomas (SM) consist of 25% of all spinal masses. Most of the SMs are intradural. Less than 10% have extradural extension.

Purpose: Pure spinal extradural meningiomas (SEM) are seen so rare. We are reporting the 7th case of meningioma with dumbbell-appearance located in the cervicothoracal region.

Methods: 48 years old female patient who has no known disease before she has referred to our clinic with complaints of pain, feeling of numbness at the right arm, shoulder and the back that she has been suffering for 6 months. In the neurological examination of the patient, hypoesthesia has seen under the level of Th1. Deep tendon reflexes of the lower extremities (DTR) were observed to be suspicious bilaterally in respect to hyperactivity. In the spinal magnetic resonance imaging (MRI) of the patient), after Gadolinium infusion of the mass involving the epidural area in the spinal channel of the bone between C7 vertebra and T2 vertebrae, resulting in dumbbell appearance, a lesion with homogenous contrast enhancement was observed.

Results: T1 total laminectomy was applied to the patient. The mass found in the extradural region and extending to the apex of the right lung was totally removed with micro chirurgical method. Pathology of the mass was reported as psammomatous meningioma. The patient was discharged at the post-operative 3rd day without an additional neurologic deficit.

Conclusion: Though extradural spinal meningiomas are rarely seen, since they imitate spinal metastatic masses, should be kept in mind in the differential diagnosis. Surgery should be the first treatment of choice.

Objective: The effect of rifampisin was examined using a spinal cord ischemia/reperfusion (I/R) injury model in rats.

Materials and Methods: 25 Wistar Albino rats weighing 200-250 g were used for the study. Rats were divided in 5 groups. After laparatomy, aorta was clamped 45 minutes below the left renal artery in all groups except shamoperated group. 1 cc saline was injected to vehicle group and rifampicin (20 mg/kg) was administered to treatment group intraperitoneally. In group 5, 20 mg/kg of rifampicin applied intraperitoneally before laparotomy. 2 hours after application of rifampicin, the animals underwent clip compression for 45 minutes after exposure of the abdominal aorta. At 1 h and 24 h, all groups were examined for neurologic outcome according to Tarlov scale. At 24 h, rats were sacrificed. The spinal cord was excised by laminectomy between the T8-12 levels and tissue MDA levels were studied.

Results: At 1 h, difference between motor scores of sham-operated group and other groups was statistically significant (P=0.008). At 24 h, difference between trauma and treatment or p-treatment group was statistically significant (P<0.05). When MDA levels of the groups were compared by using Kruskal Wallis variance analysis, the result was statistically significant (P=0.001). When trauma and vehicle group were compared with treatment group by Mann Whitney U test, the results were statistically significant (P=0.008).

Conclusions: To our knowledge, this is the first study that shows the effects of rifampicin on spinal cord ischemia/reperfusion injury. Rifampicin was found to be effective on spinal cord ischemia/reperfusion injury, but further investigations are mandatory.