Seiji Yamaya, Fumitake Tezuka, Kosuke Sugiura, Makoto Takeuchi, Hiroaki Manabe, Masatoshi Morimoto, Kazuta Yamashita, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Risk Factor for Additional Intravenous Medication during Transforaminal Full-endoscopic Lumbar Discectomy under Local Anesthesia., Neurologia Medico-Chirurgica, 2021.
(要約)
Transforaminal full-endoscopic lumbar discectomy (TELD) can be performed under local anesthesia. However, there have been no reports on risk factors for a change in vital signs or the need for additional medications to maintain adequate analgesia during this procedure. The purpose of this study was to identify risk factors for additional intravenous medication during TELD under local anesthesia. The following factors were retrospectively evaluated in 113 consecutive patients who underwent TELD under local anesthesia at our institution: demographic characteristics, radiological features at the intervertebral disc level, distance between the superior articular process and the exiting nerve root, height of the intervertebral disc, height of the bulging disc, height of the intervertebral foramen, and distance from the insertion site to the spinous process on magnetic resonance imaging (MRI) and computed tomography (CT) scans of the lumbar spine. Logistic regression analysis was performed to determine factors associated with the need for additional drugs. In all, 23 cases (20.4%) required additional intraoperative medications because of hypertension, hypotension, bradycardia, or pain. Logistic regression analysis revealed that age (partial regression coefficient 0.05, p = 0.02) and bulging disc height (partial regression coefficient -0.7, p = 0.003) influenced the need for additional drugs. There were significant associations of need for additional intravenous medication with older age (>62 years) and a smaller bulging disc height (<8.2 mm). Patients with these factors require close monitoring for changes in vital signs or increasing pain when performing TELD under local anesthesia and may need additional intravenous medication.
Mitsuhiro Kamada, Hiroaki Manabe, Kazuta Yamashita, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Full-endoscopic Decompression of Foraminal Stenosis Caused by Facet Hypertrophy Contralateral to the Dominant Hand in a Baseball Pitcher: A Case Report., NMC Case Report Journal, Vol.7, No.4, 173-177, 2020.
(要約)
Back pain and lower extremity pain have various causes and occasionally occur simultaneously, creating diagnostic difficulties. In addition, athletes require special consideration in terms of treatment. Here, we report a case of foraminal stenosis as a result of lumbar disc prolapse combined with facet hypertrophy contralateral to the dominant hand in a baseball pitcher that was successfully treated by minimally invasive full-endoscopic surgery. A 31-year-old left-handed male baseball pitcher presented with complaints of low back pain and right buttock pain while pitching. A diagnosis of foraminal stenosis caused by a disc bulge combined with facet hypertrophy contralateral to the dominant hand was made on the basis of physical and radiological findings. His symptoms improved immediately after transforaminal full-endoscopic lumbar discectomy and foraminoplasty under local anesthesia. He returned to play 3 months after surgery. Foraminal stenosis due to facet hypertrophy may occur in the side contralateral to the throwing arm in pitchers. Minimally invasive decompression using a full-endoscopic procedure is required for high-level athletes at this position.
Hiroaki Manabe, Toshinori Sakai, Kosuke Sugiura, Yoshihiro Ishihama, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Toru Maeda and Koichi Sairyo : Spontaneous Laminar Fracture during Successful Conservative Treatment of Lumbar Spondylolysis at the Adjacent Spinal Level: A Case Report., NMC Case Report Journal, Vol.7, No.4, 179-182, 2020.
(要約)
Although lumbar spondylolysis (LS) is regarded as a stress fracture, the underlying pathomechanism has yet to be fully elucidated. Here, we present a case that casts doubt on the notion that LS is truly a stress fracture. An 11-year-old female basketball player was brought to our clinic with a 2-week history of persistent low back pain. Magnetic resonance imaging with short TI inversion recovery (STIR-MRI) showed high signal intensity changes at the L4 pedicles bilaterally. Computed tomography (CT) revealed a faint fracture line at the left pars interarticularis. We made a diagnosis of stress fracture and recommended conservative treatment, including cessation of sports activities and wearing of a hard brace. Compliance with treatment was excellent. As expected, the STIR-MRI findings at L4 gradually resolved and bone healing was achieved. However, a follow-up STIR-MRI scan 10 weeks later revealed high signal intensity at the left L5 pedicle. Conservative treatment was continued for the findings at L5, which were considered to indicate a stress fracture (spondylolysis). Five weeks later, CT revealed a bony defect in the lamina at L5 on the left and bone union at L4. Although LS is generally considered to be a stress fracture, there have been several reports of familial occurrence and genetic predisposition. This patient's mother had also been treated for spondylolysis at L5. These observations suggest an underlying genetic etiology in this case.
Makoto Takeuchi, Takashi Chikawa, Naohito Hibino, Yoshinori Takahashi, Yuhei Yamasaki, Kaori Momota, Tatsuhiko Henmi, Toru Maeda and Koichi Sairyo : An Elite Triathlete with High-grade Isthmic Spondylolisthesis Treated by Lumbar Decompression Surgery without Fusion., NMC Case Report Journal, Vol.7, No.4, 167-171, 2020.
(要約)
The patient was a 48-year-old female recreational triathlete who had been experiencing mild low back pain since high school. She had recently developed right leg pain and had gradually worsening difficulty in running. She preferred to undergo spinal surgery without fusion so that she could return to triathlons as soon as possible, and she was referred to our hospital. Plain radiographs showed Meyerding grade 3 isthmic spondylolisthesis at L5 and a slipped L5 vertebral body. Selective nerve root block at L5 relieved the right leg pain temporarily. The final diagnosis was right L5 radiculopathy due to compression by the ragged edge of the L5 pars defect from the posterior side and by the upside-down foraminal stenosis at L5-S1. An L4-L5 partial laminectomy was performed with resection of the ragged edge and one-third of the caudal pedicle at L5. Adequate decompression was achieved by exposing the L5 spinal nerve root from the branch portion to the outside of the L5 pedicle. The right leg pain disappeared postoperatively and she returned to participating in triathlons. One year after surgery, there was slight radiographic progression of the slip in 5 mm; however, there had been no recurrence of the right leg pain. Several studies have reported excellent outcomes after decompression surgery in patients with isthmic spondylolisthesis. To our knowledge, this is the first report of successful lumbar decompression surgery without fusion for high-grade isthmic spondylolisthesis in a triathlete, although in short-term results.
Toru Maeda, Kousaku Higashino, Satoshi Hattori and Koichi Sairyo : A Rare Case of Delayed Onset Tunneling Disc Herniation in the Lumbar Spine., Spine Surgery and Related Research, Vol.4, No.3, 280-283, 2020.
Hiroaki Manabe, Fumitake Tezuka, Kazuta Yamashita, Kosuke Sugiura, Yoshihiro Ishihama, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Operating Costs of Full-endoscopic Lumbar Spine Surgery in Japan., Neurologia Medico-Chirurgica, Vol.60, No.1, 26-29, 2020.
(要約)
For full-endoscopic lumbar discectomy, operating costs are also important because expensive equipment are necessary. We surveyed the operating costs of surgical equipment necessary for full-endoscopic surgery together with surgical procedure reimbursement fees. A total of 295 cases of full-endoscopic surgery via a transforaminal approach were retrospectively analyzed. We calculated the frequency of damage and the unit purchase price of devices such as endoscopes, and surgical instruments such as grasping forceps for nucleotomy, high-speed drill bar, and bipolar forceps, and examined the operating costs in Japanese yen against the procedure fee per case. Endoscope breakage occurred seven times, and a payment of ¥760,000 was necessary for trade-in and purchase of a new endoscope. The total breakage number of grasping forceps was 58, and the purchase price per unit was ¥116,000. Therefore, a total of ¥12,020,000 was required for the 295 cases, and the calculated operating cost that accompanies equipment breakage was ¥40,000 per case. In addition, about ¥118,000 was required for disposable bipolar forceps and high-speed drill bar to be used intraoperatively for each case. Thus, for one case it is calculated that total ¥158,000 is utilized for equipment from the surgical reimbursement fee per case specified by the Japanese Ministry of Health being ¥303,900. Minimally invasive procedures provide great benefit to patients; however, the eventual contribution to hospital profits is small and may not be sufficient. To resolve this issue, the cost of surgical equipment should be lowered and/or the surgical reimbursement fee of the full-endoscopic surgery should be raised.
Yugen Fujii, Kazuta Yamashita, Kosuke Sugiura, Yoshihiro Ishihama, Hiroaki Manabe, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Early return to activity after minimally invasive full endoscopic decompression surgery in medical doctors., Journal of spine surgery (Hong Kong), Vol.6, No.Suppl 1, S294-S299, 2020.
(要約)
Full endoscopic surgery including discectomy (FED) and ventral facetectomy (FEVF) is a minimally invasive lumbar decompression surgery that only requires an 8 mm skin incision and can be done under the local anesthesia and sedation. Six male medical doctors underwent the endoscopic decompression (FED/FEVF) for common degenerative lumbar spine problems. Their age ranged from 27 to 63 years of age with a mean of 40 years. Five doctors underwent FED surgery for herniated nucleus pulposus (HNP), and the remaining one physician had FEVF for lumbar lateral recess stenosis. There were no surgery related complications. Postoperatively, 5 out of the 6 physician patients returned the original job within a week because they had clinical duties. The shortest duration to return to work was reported by a 63-year-old orthopedic surgeon resumed working in his clinic 2 days after the FEVF surgery. The longest duration to return to work occurred in general medicine resident who took almost 2 weeks for the sick leave because he did not have clinical duties. The mean duration for the returning to work was 5.8 days after the surgery. At final follow-up ranging from 6 to 30 months, all physician patients were working without any residual pain. In the hands of the authors, the full endoscopic transforaminal decompression surgery is the preferred surgical option and allowed early return to work-an observation that is not the norm in Japan.
Koichi Sairyo and Toru Maeda : Safety of Interlaminar Full-Endoscopic Lumbar Decompression, EC Orthopaedics, Vol.11, No.10, 18-22, 2020.
9.
Yusaku Nakayama, Kazuta Yamashita, Kosuke Sugiura, Makoto Takeuchi, Masatoshi Morimoto, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Surgical management of stress fracture of the contralateral pedicle in a baseball player with unilateral lumbar spondylolysis : A case report., The Journal of Medical Investigation : JMI, Vol.67, No.3.4, 382-385, 2020.
(要約)
We describe successful surgical treatment in a case of L5 unilateral spondylolysis with contralateral pedicle stress fracture that was not resolved by conservative treatment in a high-performing college baseball player. The 20-year-old man presented with left low back pain that stopped his sports activities. Over the previous year, he had experienced a couple of episodes of pain that subsided with cessation of sports but reappeared after a return to sports. Computed tomography and magnetic resonance imaging revealed a right terminal stage pars fracture and a left pedicle stress fracture at L5. The pain originated from the left pedicle fracture, with no pain from the right unilateral spondylolysis. Given that conservative treatment for 1 year had not been effective, we decided on surgical treatment. Bilateral pedicle screws and the smiley face rod method were applied, and both fractures subsequently healed. In the 2 years since the surgery, the patient has returned to sports and has the potential to become a professional player. J. Med. Invest. 67 : 382-385, August, 2020.
Yoshihiro Ishihama, Toshinori Sakai, Hiroaki Manabe, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Toru Maeda and Koichi Sairyo : Debridement for Infectious Spondylodiscitis in a 9-year-old Girl Using Full-Endoscopic Discectomy System : a Case Report and literature review., The Journal of Medical Investigation : JMI, Vol.67, No.3.4, 351-344, 2020.
(要約)
Objective : Infectious spondylodiscitis (IS) is rarely seen in healthy elementary school age children. Conservative treatment with antibiotics is usually preferable but sometimes fails because of the low identification rate of the pathogen by percutaneous needle biopsy. When surgical treatment is indicated, selecting the appropriate procedure is crucial in terms of invasiveness for such young children. Case report : We present the case of a 9-year-old otherwise healthy girl with IS who successfully underwent debridement and identification of the causative pathogen using full endoscopic discectomy (FED) system. Methicillin-susceptible Staphylococcus aureus was identified on several cultures of samples. Immediately after the surgery, the LBP was significantly decreased and the remittent fever resolved dramatically. At the 1-year follow-up, she had no symptoms and plain radiographs showed bony fusion. Conclusion : This is the first report on IS in elementary school-age children treated with the FED system. Debridement using this system could provide minimally invasive and effective curettage of the infected disc space and can be helpful in identifying the pathogen even for small children. J. Med. Invest. 67 : 351-354, August, 2020.
Daiki Nakajima, Kazuta Yamashita, Fumitake Tezuka, Kosuke Sugiura, Yoshihiro Ishihama, Hiroaki Manabe, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Successful full-endoscopic decompression surgery under local anesthesia for L5 radiculopathy caused by L5-Sforaminal stenosis and L4-5 lateral recess stenosis : A case report., The Journal of Medical Investigation : JMI, Vol.67, No.1.2, 192-196, 2020.
(要約)
In this report, we presented a 65 year-old male case having right leg pain due to L5 radiculopathy. Based on the radiological examination including CT, MRI and radiculography, double crash impingement of L5 nerve root due to L4-5 lateral recess and L5-S foraminal stenosis was diagnosed. Because of the strong pain, he could not work anymore. His job was a general manager of big hospital, he needed to return to job as soon as possible. We decided to conduct the full-endoscopic decompression surgery of ventral facetectomy (FEVF) for L4-5 lateral recess stenosis and foraminoplasty (FELF) for L5-S foraminal stenosis. The technique can be done under the local anesthesia with only 8 mm skin incision; thus, it must be the least invasive spine surgery. Soon after the surgery, he could return to the original job as a general manager. In conclusion, the full-endoscopic decompression surgery for the spinal canal stenosis such as FELF and FEVF would be minimally invasive procedure and it enable patients the quick return to the original activity. J. Med. Invest. 67 : 192-196, February, 2020.
Makoto Takeuchi, Fumitake Tezuka, Takashi Chikawa, Naohito Hibino, Yoshinori Takahashi, Yuhei Yamasaki, Kaori Momota, Tatsuhiko Henmi, Toru Maeda and Koichi Sairyo : Consecutive double-level lumbar spondylolysis successfully treated with the double "smiley face" rod method., The Journal of Medical Investigation : JMI, Vol.67, No.1.2, 202-206, 2020.
(要約)
We report a case of double-level lumbar spondylolysis at L4 and L5 that was successfully treated with the double "smiley face" rod method. A healthy 29-year-old man who presented with a 6-year history of chronic low back pain was referred to us for surgical treatment. Plain radiographs and computed tomography of the lumbar spine revealed bilateral pars defects at L4 and L5 without slip or scoliosis. The patient underwent direct repair of the pars defects using the double smiley face rod method at L4 and L5. There were no intraoperative or postoperative complications, and the patient had improved clinically by 1 year after surgery. The low back pain was completely disappeared and visual analog scale was 0. He restarted tennis again as the recreational level. While several techniques for direct repair of lumbar spondylolysis have been described, this is the first report of the double smiley face rod method being used to repair the consecutive double-level lumbar spondylolysis. J. Med. Invest. 67 : 202-206, February, 2020.
Fumitake Tezuka, Toshinori Sakai, Toshihiko Nishisho, Kosuke Sugiura, Yoshihiro Ishihama, Hiroaki Manabe, Kazuta Yamashita, Yoichiro Takata, Toru Maeda and Koichi Sairyo : Distribution of the Spinal Arteries in Adult Patients with Lumbar Spondylolysis., The Journal of Medical Investigation : JMI, Vol.67, No.1.2, 62-66, 2020.
(要約)
INTRODUCTION : The pathology of lumbar spondylolysis is generally thought to begin with a stress fracture in adolescence. Stress fractures of the lower extremities occur in watershed areas with a poor vascular supply because of an inability to respond to stress and heal. This pathology has not been well researched in the lumbar spine. The aim of this study was to evaluate the distribution of the spinal arteries in patients with lumbar spondylolysis. METHODS : The extraosseous distribution of the arteries around the pars interarticularis was retrospectively investigated in 14 patients with colon cancer who underwent abdominal contrast-enhanced computed tomography (CE-CT) as part of a preoperative assessment at our hospital and were found to have spondylolysis at L5. RESULTS : All patients were found to have terminal-stage spondylolysis at L5 (1 unilateral, 13 bilateral). L5 segmental artery was absent in all cases. However, separate spinal arteries supplying the pars interarticularis at L5 were found above and below the transverse process at this level. CONCLUSION : All the patients had two separate arteries originating from the cranial and caudal sides that distributed to the superior and inferior articular processes, suggesting that the pars interarticularis is a posterior element containing a vascular watershed area. J. Med. Invest. 67 : 62-66, February, 2020.
Shota Shigekiyo, Toshihiko Nishisho, Yoichiro Takata, Shun-ichi Toki, Kosuke Sugiura, Yoshihiro Ishihama, Hiroaki Manabe, Fumitake Tezuka, Kazuta Yamashita, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Intracanalicular Osteochondroma in the Lumbar Spine., NMC Case Report Journal, Vol.7, No.1, 11-15, 2019.
(要約)
resection of the osteochondroma with the ligamentum flavum relieved the symptoms. Spinal osteochondroma occurs relatively frequently in elderly individuals compared with peripheral lesions and mimics a degenerative spinal disorder. Careful physical examination and imaging evaluation can reveal this tumor and surgery is effective for relieving the symptoms.
Hiroaki Manabe, Kosuke Sugiura, Yoshihiro Ishihama, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Imaging Features of Non-Isthmic Spondylolysis: A Case Report., Spine Surgery and Related Research, Vol.4, No.2, 187-189, 2019.
Koichi Sairyo and Toru Maeda : Fullendo-KLIF for the Anatomical Nomenclature of the Full-Endoscope Guided Lumbar Interbody Fusion through the Kambin Triangle: PELIF, PETLIF, FELIF, FE-TLIF or KLIF?, EC Orthopaedics, Vol.10, No.9, 743-745, 2019.
17.
Haruhiko Yoshinari, Fumitake Tezuka, Kazuta Yamashita, Hiroaki Manabe, Fumio Hayashi, Yoshihiro Ishihama, Kosuke Sugiura, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Transforaminal full-endoscopic lumbar discectomy under local anesthesia in awake and aware conditions: the inside-out and outside-in techniques., Current Reviews in Musculoskeletal Medicine, Vol.12, No.3, 311-317, 2019.
(要約)
Initially, TELD was performed as the "inside-out" technique but was associated with reports of postoperative dysesthesia due to exiting nerve injury. Recently, the "outside-in" technique after foraminoplasty was proposed for safer insertion of the cannula into the disc. Foraminoplasty can widen the narrow foramen, thereby allowing the 8-mm cannula to pass through easily and safely, and thus injury to the exiting nerve root can be theoretically avoided. We described two types of the TELD in this review. Surgeons should be familiar with the inside-out and outside-in techniques for TELD; therefore, we can select appropriate technique for each case.
Yuhei Yamasaki, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Multiple Loose Bodies in the Lumbar Facet Joint: Case Report., NMC Case Report Journal, Vol.6, No.3, 79-81, 2019.
(要約)
We describe here a patient diagnosed with multiple loose bodies in the lumbar facet joint. The patient was a 52-year-old woman who presented with left sciatic pain. Neurological findings indicated L5 radiculopathy. Radiological findings revealed lateral recess stenosis at the L4-L5 level, and loose bodies in the left L4-L5 facet joint were noted that compressed the left L5 nerve root. We performed laminotomy at the left L4-L5 level, and removed five loose bodies located on the dorsal side of the ligamentum flavum. Following removal of the loose bodies and flavectomy, the L5 nerve root was decompressed. Postoperatively, the patient's symptoms improved markedly. Symptomatic multiple loose bodies in the lumbar facet joint are very rare, and can cause lumbar radiculopathy. It is important for spine surgeons to recognize this pathology.
Kaori Momota, Toshihiko Nishisho, Ryo Miyagi, Shun-ichi Toki, Kazuta Yamashita, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Akihiro Nagamachi, Toru Maeda and Koichi Sairyo : A Rare Case of Acute-Onset Spastic Quadriparesis Caused by a Chondroma of the Cervical Spine., Case Reports in Orthopedics, Vol.2019, 2019.
(要約)
Chondromas are benign cartilaginous tumors that occur very rarely in the spine. Moreover, chondromas of the extraskeletal origin are also very rare. In this case report, we describe an extremely rare case of chondroma arising from the ligamentum flavum in the cervical spine. A 67-year-old man presented to our clinic with acute-onset spastic quadriparesis. We performed emergent magnetic resonance imaging and found an epidural mass in the right ligamentum flavum at C4-C5. The acute-onset presentation was suspicious for intraligamentous hematoma in the ligamentum flavum at this level. We performed emergency decompression surgery and en bloc removal of the epidural mass with the right C4 and C5 lamina. The lesion had the appearance of cartilaginous tissue rather than hematoma. Based on the histological investigation, the final diagnosis was intraligamentous chondroma of the cervical spine. The quadriparesis improved postoperatively, as did the results of manual muscle testing in the affected area, and he was able to resume walking independently with a cane. At the one-year follow-up, the manual muscle testing results were almost normal. Surgeons should keep in mind the possibility of benign tumors including chondroma of the cervical spine when a patient presents with acute-onset quadriparesis.
Hiroaki Manabe, Kazuta Yamashita, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Thermal Annuloplasty Using Percutaneous Endoscopic Discectomy for Elite Athletes with Discogenic Low Back Pain., Neurologia Medico-Chirurgica, Vol.59, No.2, 48-53, 2019.
(要約)
The purpose of this study was to assess the usefulness of radiofrequency thermal annuloplasty (TA) using percutaneous endoscopic discectomy/TA (PED/TA) in elite athletes with discogenic low back pain. Twelve patients (11 men, 1 woman; mean age 27.9 years) underwent PED/TA under local anesthesia. Clinical data for these patients (17 affected intervertebral discs), including type of sport played, average duration of low back pain, disc level affected, presence or absence of a high signal intensity zone on magnetic resonance imaging, and whether the patient returned to playing competitive sport, were retrospectively reviewed. The most common sport played by the patient was baseball (n = 8), followed by cycling (n = 2), tennis (n = 1), and hammer throw (n = 1). The average duration of low back pain was 24.3 months. The intervertebral disc levels affected were L4/5 (n = 11) and L5/S1 (n = 6). A high signal intensity zone was detected in nine discs. Although two patients required additional surgery, all patients were able to return to their original competitive level of play. Duration for the return to play was 2.8 months after surgery except the two revision cases. PED/TA for discogenic pain enables an early return to competitive sports, and so is particularly useful for elite athletes.
Yuto Sugimine, Kentaro Sakaeda, Kazuta Yamashita, Hiroaki Manabe, Kosuke Sugiura, Fumio Hayashi, Yoshihiro Ishihama, Yoichiro Takata, Toshinori Sakai, Toru Maeda, Tomohiko Tateishi and Koichi Sairyo : Surgical Treatment of Lumbar Herniated Nucleus Pulposus Combined with Residual Bony Fragment of Apophyseal Ring Fracture in High-Level Athletes : A Report of Two Cases., The Journal of Medical Investigation : JMI, Vol.66, No.3.4, 358-361, 2019.
(要約)
In this paper, we present 2 cases of herniated nucleus pulposus (HNP) combined with the residual bony fragment of apophyseal ring fracture. HNP typically exists at the narrow lateral recess formed by the bony fragment, and so it has been reported that symptoms may persist. Case 1 was a 22-year-old man, a high-level javelin thrower and Paralympic athlete. He had a history of persistent pain for 4 years due to HNP, and so we performed surgical removal. Case 2 was a 23-year-old male professional baseball player. He was referred to us only 17 days after the onset of pain and presented with muscle weakness, a feature which may prolong the clinical course in addition other features such as pain. Thus, we performed a comparatively quick intervention of surgical removal. In both cases, we had excellent clinical outcomes and better function and performance. In conclusion, in cases with HNP and apophyseal ring separation, surgical intervention in the comparatively early phase can be recommended, particularly if the patients desire quick return to their original level of activity. J. Med. Invest. 66 : 358-361, August, 2019.
Kazuta Yamashita, Kosuke Sugiura, Hiroaki Manabe, Yoshihiro Ishihama, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Accurate diagnosis of low back pain in adult elite athletes., The Journal of Medical Investigation : JMI, Vol.66, No.3.4, 252-257, 2019.
(要約)
Background : There is few reports evaluated accurately the pain generator of low back pain in elite athletes. The purpose of this report was to show case series and to investigate the cause of unidentified low back pain of elite athletes. Methods : Twenty-three adult elite athletes consulted our sports spine clinic to seek a second opinion for low back pain between April 2013 and March 2016. Their cause of low back pain had not been identified by nearby doctor. Spine surgeons had diagnosed using diagnostic injection and STIR-MRI and the final diagnosis made by the spine surgeon were collected. Results : The mean age of 23 patients (16 male, 7 female) was 30.4 years. The most common sport played was baseball. The final diagnosis made by a spine surgeon was as follows : disc related low back pain (n = 12), facet joint arthritis (n = 5), vertebral endplate injury (n = 4), early-stage lumbar spondylolysis (n = 1), supraspinous ligament injury (n = 1). Conclusions : A thorough medical interview, careful physical examination, appropriate diagnostic imaging, and injection block examination can effectively identify the cause of low back pain. J. Med. Invest. 66 : 252-257, August, 2019.
Koichi Sairyo, Kazuta Yamashita, Hiroaki Manabe, Yoshihiro Ishihama, Kosuke Sugiura, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Yasuyuki Omichi, Nobutoshi Takamatsu, Ayaka Hashimoto and Toru Maeda : A novel surgical concept of transforaminal full-endoscopic lumbar undercutting laminectomy (TE-LUL) for central canal stenosis of the lumbar spine with local anesthesia : A case report and literature review., The Journal of Medical Investigation : JMI, Vol.66, No.3.4, 224-229, 2019.
(要約)
Full-endoscopic spinal surgery was first developed for the lumbar herniated nucleus pulposus. Mainly, there are two types in the full-endoscopic lumbar surgery : i.e., transforaminal (TF) and interlaminar approach. The surgery can be done under the local anesthesia for the TF approach ; therefore, we need to further develop the TF approach to variety of the spinal disorders. Recently, the TF full-endoscopic surgery has been applied for the spinal canal stenosis. First, transforaminal full-endoscopic lumbar foraminoplasty for the foraminal stenosis ; then, transforaminal lumbar lateral recess decompression for the lateral recess stenosis has been developed. Finally, we have developed the surgical technique to decompress the central stenosis via TF approach under the local anesthesia. Prior to initiate the clinical case, we have attempted the lumbar undercutting laminectomy using a fresh cadaveric spine. After we technically confirmed that the transforaminal full-endoscopic lumbar undercutting laminectomy (TE-LUL) is possible, we applied the technique to the patient whose lung capacity did not allow general anesthesia. The 72 years old female patient with central canal stenosis could be improved her left leg pain and muscle weakness after TE-LUL under the local anesthesia. In this paper, we introduce the surgical technique of the TE-LUL and discuss of the efficacy of the TE-LUL. J. Med. Invest. 66 : 224-229, August, 2019.