No abstract

BackgroundDiffuse idiopathic skeletal hyperostosis has long been regarded as a benign asymptomatic clinical entity with an innocuous clinical course. Neurological complications are rare in diffuse idiopathic skeletal hyperostosis. However, if they do occur, the consequences are often significant enough to warrant major neurosurgical intervention. Neurological complications occur when the pathological process of ossification in diffuse idiopathic skeletal hyperostosis extends to other vertebral ligaments, causing ossification of the posterior longitudinal ligaments and/or ossification of the ligamentum flavum. Thoracic spondylolisthesis with spinal cord compression in diffuse idiopathic skeletal hyperostosis has not previously been reported in the literature.Case presentationA 78-year-old Japanese man presented with a 6-month history of gait disturbance. A magnetic resonance imaging scan of his cervical and thoracic spine revealed anterior spondylolisthesis and severe cord compression at T3 to T4 and T10 to T11, as well as high signal intensity in a T2-weighted image at T10/11. Computed tomography revealed diffuse idiopathic skeletal hyperostosis at T4 to T10. He underwent partial laminectomy of T10 and posterior fusion of T9 to T12. The postoperative magnetic resonance imaging revealed resolution of the spinal cord compression and an improvement in the high signal intensity on the T2-weighted image.ConclusionsWe report the first case of thoracic spondylolisthesis and spinal cord compression in diffuse idiopathic skeletal hyperostosis. Neurosurgical intervention resulted in a significant improvement of our patient’s neurological symptoms.

Purpose] To evaluate the severity of symptoms before and after cervical myelopathy surgery using the Simple Test for Evaluating hand Function. Because a test ceiling effect was observed in patients with less severe forms of myelopathy, we investigated the correlation between and accuracy of several different tests in order to clarify the usefulness of the Purdue Pegboard Test for evaluation of one or both hands. [Participants and Methods] Thirty-four patients (6 females and 28 males; mean age, 64.5 years) were examined, and scores were determined for each of the following tests: Purdue Pegboard Test; Simple Test for Evaluating hand Function; Japanese Orthopedic Association assessment; and Disabilities of the Arm, Shoulder, and Hand assessment. Correlations between scores of different tests were then determined. The cut-off values used for the Purdue Pegboard Test and the Simple Test for Evaluating hand Function were determined using the area under the receiver operating characteristic curve to assess the use of chopsticks.[Results] The Purdue Pegboard Test assembly task correlated moderately with the Japanese Orthopedic Association and Disabilities of the Arm, Shoulder, and Hand scores. In the receiver operating characteristic curve analyses, the Purdue Pegboard Test cut-off value was 11 and the Simple Test for Evaluating hand Function cut-off value was 90.[Conclusion] The Purdue Pegboard Test is useful for evaluating manual dexterity and coordination in both hands in patients with cervical myelopathy.

Background Aspergillus terreus , a saprophytic fungus, is recognized as an emerging pathogen in various infections in humans. However, bone and joint involvement is uncommon. To the best of our knowledge, only seven cases of spondylodiscitis caused by Aspergillus terreus have been reported previously in humans. We report a case of a patient with Aspergillus terreus spondylodiscitis following an abdominal stab wound. Case presentation A 74-year-old Japanese man with no particular medical history fell from a ladder and sustained a left abdominal stab wound from an L-shaped metal peg. Computed tomography showed the trace of the L-shaped metal peg from the left abdomen to the left rib and left kidney. The scan also showed an anterolateral bone avulsion of the left side of the T12 vertebral body, as well as fractures of the L1 left transverse process and the left 10th–12th ribs. He was hospitalized and treated with conservative therapy for 6 weeks. He was readmitted to the hospital with complaints of sudden back pain, numbness of both legs, and inability to walk 13 weeks after the fall. Magnetic resonance imaging findings were typical of spondylodiscitis. Gadolinium-enhanced T1-weighted magnetic resonance imaging indicated increased signal intensity at T11–T12 vertebral bodies and severe cord compression and epidural abscess at T11–T12 associated with infiltration of soft paravertebral tissues. On the seventh day after admission, he underwent partial laminectomy at T11 and posterior fusion at T9 to L2. The result of his blood culture was negative, but Aspergillus terreus was isolated from the material of T11–T12 intervertebral disc and vertebral bodies. His Aspergillus antigen was positive in a blood examination. Histological examination showed chronic suppurative osteomyelitis. On the 35th day after admission, he underwent anterior fusion at T11 and T12 with a rib bone graft. For 5 months, voriconazole was administered, and he wore a rigid corset. Posterior partial laminectomy at T11 and anterior fusion at T11 and T12 resulted in a good clinical course. The patient’s neurological dysfunction was completely recovered, and his back pain disappeared. Two years after the operation, computed tomography was performed and showed bone fusion at T11 and T12. Magnetic resonance imaging revealed no evidence of increased signal intensity at T11–T12 vertebral bodies and severe cord compression and epidural abscess at T11–T12. Conclusions To our knowledge, this is the first report of spondylodiscitis caused by Aspergillus terreus after an abdominal penetrating injury. The histological finding of chronic suppurative osteomyelitis and the radiological findings strongly suggested direct inoculation of Aspergillus terreus .

The modified STEF is a reliable measurement tool, with a moderate positive correlation with the PPT and a greater responsiveness than the STEF and PPT.