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In an attempt to formulate a standardised approach to the diagnosis and management of patients with the double-crush syndrome, we reviewed 65 surgical cases (39 men and 26 women) with cervical myeloradiculopathy associated with entrapment neuropathy in the arm by examining the clinical features, results of nerve conduction velocity studies and distribution of the vertebral levels of compression. Fifty-three patients (average age, 43 years) presented with a carpal tunnel syndrome at the wrist and cervical lesions (41 with spondylosis and 12 with ossi®ed posterior longitudinal ligament), while 12 had a cubital tunnel syndrome at the elbow with cervical lesions (eight with spondylosis and four with ossi®cation of the posterior longitudinal ligament). In the former group, the lesions were found mostly at C5 ± 6 and C6 ± 7 levels, while in the latter group involvement of C6 ± 7 was frequently observed. Two patients in each group required additional cervical decompression after carpal or cubital tunnel release. A retrospective review of our patients suggested that it is reasonable to pursue an accurate diagnosis followed by treatment based on individual neurological and electrophysiological ®ndings, but taking into consideration the signi®cant level of physical impairment associated with cord compromise, we believe that it may be reasonable to perform a cervical decompression rather than peripheral nerve release in such cases. Our ®ndings suggest that one should be aware of a double-crush during examination of patients complaining of neck and hand problems.

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JapanThis report reviews our experience with spinal decompression for posterior limbus vertebral lesions or osteocartilaginous vertebral corner defects in the lumbar spine in 29 children and young adults. There were 19 male and 10 female patients with a mean age of 16.5 years (range, 9 to 24 years). Twenty-four patients were involved with various athletic activities.Clinical presentation included low back pain with a variable degree of radiculopathy in 25 patients and a cauda equina syndrome in four. The level of the affected spinal area was LJ-2 in one patient, L2-3 in one, L3-4 in seven, L4-5 in 17, and L5-S I in three. The preoperative imaging workup showed lateralised 'non-calcified' or 'calcified' limbus vertebral defects in 13 patients and centrally displaced lesions in 16 patients. All patients underwent posterior spinal decompression with a slightly extended laminotomy, except for three patients who had a subsequent posterolateral fusion. All of the patients consequently returned to practice their favourite preoperative sport and lifestyle, but five discontinued their previous sports. We suggest that patients with posterior limbus vertebral lesions require careful diagnosis and therapy that are different from those with an ordinary lumbar disc herniation.

Ring-shaped vasoconstrictions of arterioles at their branching sites have often been reported in vascular corrosion casts of the brain and spinal cord in rats and cats. It is surmised that smooth muscle cells in arteriolar walls could regulate the blood¯ow by changing the diameter of the lumen (ie vasomotion). However, few reports have described vasomotion at the capillary (capillaries have no smooth muscle cells). Also, there have been no reports on endothelin-1 in the arterioles and capillaries of the spinal cord. This study was designed to determine (1) the electron microscopic architecture of vasomotion; (2) the immunohistochemical identi®cation of a actin and endothelin-1 in the arterioles and capillaries of the spinal cord. Twenty-seven adult mongrel cats were used to study vascular corrosion casts at the lumbosacral spinal cord segments immunohistologically and through scanning electron microscopic observations. Sections of the spinal cord were stained with monoclonal anti-a actin and endothelin-1 antibodies.Vascular corrosion casts demonstrated two types of vasomotion: a sausage-like peristalsis and a ring-shaped vasoconstriction at the arteriole and capillary levels. In the immunohistological study, a actin and endothelin-1 were identi®able in the vascular wall at the bifurcation, and pericytes were found to contain micro®laments of a actin. The ringshaped vasoconstriction might be regulated by smooth muscle cells in arterioles and by pericytes in capillaries by releasing endothelin-1.

We report two cases of superficial siderosis (SS) of the central nervous system (CNS), which is caused by chronic haemorrhaging into the subarachnoid space with haemosiderin deposition in the superficial portion of the CNS. Patient 1 had fluid collection in the spinal canal, which was reported as the source of the chronic bleeding. Patient 2 was bleeding from thickened dura at the level of the sacral vertebrae. Both of the patients had xanthochromic cerebrospinal fluid. We surgically repaired the sources of bleeding. Subsequently the cerebrospinal fluid (CSF) cleared and their symptoms were not aggravated for about one year. We measured several CSF markers of SS before and after surgery. Total tau protein (CSF-t-tau), phosphorylated tau protein (CSF-p-tau), iron (CSF-iron) and ferritin (CSF-ferritin) in the CSF were highly elevated at diagnosis. After surgery, the levels of CSF-t-tau and CSF-p-tau were markedly reduced while CSF-iron and CSF-ferritin had not decreased. It is suggested that CSF-t-tau and CSF-p-tau reflected the neural damage in SS and were useful to evaluate the effectiveness of SS therapies.-2 -CSF tau protein in superficial siderosis

We describe a consecutive series of 26 patients with simple bone cysts who were treated by curettage, multiple drilling and continuous decompression by the insertion of either a cannulated screw or a pin. In the first 15 patients we used titanium cannulated screws (group 1) and in the next 11 a cannulated hydroxyapatite pin (group 2). Satisfactory healing was achieved in 12 patients in group 1 (80%) and in all in group 2. This technique seems to be a promising option for the treatment of simple bone cysts. The cannulated hydroxyapatite pin is recommended because of its higher success rate and the fact that it does not need to be removed.

Summary. Spinal lesions were reviewed in 9 pa