✓ Retroodontoid or periodontoid pseudotumor unassociated with rheumatoid arthritis or hemodialysis is clinically rare. The authors report three cases of retroodontoid pseudotumor that they treated surgically. All patients exhibited myelopathy of the upper cervical spinal cord. Plain radiography depicted atlantoaxial instability in two of the three patients. Spinal cord compression caused by a mass lesion in all patients was clearly demonstrated on magnetic resonance images. In two patients, the mass lesion was not limited to the retroodontoid region and expanded continuously to the cranial base. Posterior laminectomy of the atlas and occipitocervical fusion were performed. After surgery, the pseudotumor disappeared in two cases and was clearly reduced in one case, and neurological symptoms also improved. Retroodontoid pseudotumor is a lesion for which symptomatic improvement can be expected with posterior decompression and fusion, even without direct tumor excision.
Objective: This study aimed to obtain guidelines for choosing between subtotal corpectomy (SC) and laminoplasty (LP) by analysing the surgical outcomes, radiological changes and problems associated with each surgical modality. Study Design: A retrospective analysis of two interventional case series. Setting: Department of Orthopaedic Surgery, Kagawa University, Japan. Methods: Subjects comprised 34 patients who underwent SC and 49 patients who underwent LP. SC was performed by high-speed drilling to remove vertebral bodies. Autologous strut bone grafting was used. LP was performed as an expansive open-door LP. The level of decompression was from C3 to C7. Clinical evaluations included recovery rate (RR), frequency of C5 root palsy after surgery, re-operation and axial pain. Radiographic assessments included sagittal cervical alignment and bone union. Results: Comparisons between the two groups showed no significant differences in age at surgery, preoperative factors, RR and frequency of C5 palsy. Progression of kyphotic changes, operation time and volumes of blood loss and blood transfusion were significantly greater in the SC (two-or threelevel) group. Six patients in the SC group required additional surgery because of pseudoarthrosis, and four patients underwent re-operation because of adjacent level disc degeneration. In the LP group, the problem of elimination of postoperative axial symptoms remains to be solved. Conclusions: The merit of SC is the low frequency of axial symptoms. One-level SC can be considered to have similar degree of invasiveness as LP. Compared with SC, LP is more suitable for elderly patients with multilevel stenosis.
✓Tumoral calcinosis commonly occurs in the articular soft tissues of the extremities but rarely in the spine. The authors performed surgery to treat lumbar tumoral calcinosis in a patient with scleroderma, in whom symptoms of neurological dysfunction had manifested.This 49-year-old woman presented with low-back pain and gait disturbance. Seven years before presentation, scleroderma had been diagnosed, and the patient had received medical treatment ever since. Imaging revealed tumoral calcinosis centered at the bilateral facet joints between L-3 and L-4, marked stenosis of the spinal canal, L-3 spondylolisthesis, and intervertebral instability. Surgery was performed to excise the lesion en bloc. After neural decompression, posterolateral fusion and pedicle screw fixation were undertaken. Symptoms improved after surgery.In this case, the underlying scleroderma that predisposes to calcinosis and facet joint degeneration due to lumbar spondylolisthesis were probably factors leading to the development of tumoral calcinosis in the lumbar spine.
A case of lipofibromatous hamartoma in the foot is described. This tumor-like lesion commonly occurs in the hands, wrists and forearms of young persons. The median nerve is affected in the great majority of cases. Only very rarely, however, is it found in the nerves of the foot. It is believed that the present study is the seventh reported case of lipofibromatous hamartoma in the foot, and is the first case reported in Japan. A review shall be made of the six reported cases in the foot.
Sarcopenia during HSCT was affected by oral caloric intake during the preparation regimen and after transplantation. Physical therapy in conjunction with nutritional therapy may help prevent weakness in HSCT recipients.
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