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Abstract Background  A new technique involving screw fixation of the atlas via the posterior arch and lateral mass has recently been reported for atlantoaxial instability. Because the posterior arch is thin, lateral mass screws risk penetrating the upper part of the posterior arch and damaging the vertebral artery running along the upper part of the posterior arch. Methods  A total of 50 dry bone samples of the atlas from Japanese cadavers were used. We manually measured the shortest distance from the vertebral canal to the transverse foramen and the thickness at the thinnest part of the groove using calipers and investigated the frequency of dorsal ponticuli at the posterior arch. Results  The area from the vertebral canal to the transverse foramen was thick enough to allow screw insertion, but the thickness of the posterior arch at the thinnest part of the groove was less than the screw diameter (3.5 mm) in 22% of vertebrae and Conclusions  The size and shape of the posterior arch must be evaluated using radiography and computed tomography before inserting a lateral mass screw of the atlas via the posterior arch. [ABSTRACT FROM AUTHOR]

Abstract Background  Lumbar facet joint tissue has inflammatory cytokines. However, no reports have shown whether inflammatory cytokines in the facet joint leads to pain. This study was designed to characterize the correlation between inflammatory cytokines released from facet joint tissue and symptoms in degenerative lumbar spinal disorders. The purpose of this study was to seek involvement of inflammatory facet joint for radiculopathy in lumbar spinal canal stenosis with clinical and anatomical studies. Methods  Lumbar facet joint cartilage and synovial tissues in 40 cases of posterior lumbar surgery were harvested to measure tumor necrotizing factor-α (TNFα), interleukin-1β (IL-1β), and interleukin-6 (IL-6) during operation. The visual analogue scale (VAS) and Roland-Morris disability questionnaire (RDQ) were used to examine the correlation between cytokine concentration and symptoms. Coloring agent was injected into facet joints of fresh cadavers to find leakage of pigment from the facet joint into the spinal canal. Results  Inflammatory cytokines were detected in the joint tissues in the lumbar spinal canal stenosis (LSCS) and lumbar disc herniation (LDH) groups. A positive reaction rate of IL-1β was significantly higher in the LSCS group than in the LDH group. IL-1β-positive cases in the LSCS group showed higher VAS scores for leg pain and higher RDQ scores. Intraspinal canal tissues including lumbar nerve root were stained by injection of methylene blue into the facet joints. Conclusions  IL-1β in facet joint cartilage in LSCS was associated with leg pain and a decline of quality of life. Inflammatory cytokines produced in degenerated facet joint may leak into the intraspinal space through the lateral part of the ventral facet joint capsule. These results suggest the involvement of inflammatory cytokines in degenerated lumbar facet joints regarding the genesis of pain production. [ABSTRACT FROM AUTHOR]

Abstract Background  The Japanese Orthopaedic Association decided to revise the JOA score for low back pain and to develop a new outcome measure. In February 2002, the first survey was performed with a preliminary questionnaire consisting of 60 evaluation items. Based on findings of that survey, 25 items were selected for a draft of the JOA Back Pain Evaluation Questionnaire (JOABPEQ). The second survey was performed to confirm the reliability of the draft questionnaire. This article further evaluates the validity of this questionnaire and establishes a measurement scale. Methods  The subjects of this study consisted of 355 patients with low back disorders of any type (201 men, 154 women; mean age 50.7 years). Each patient was asked to fill in a self-administered questionnaire. Superficial validity was checked in terms of the completion rate for filling out the entire questionnaire. Factor analysis was then performed to evaluate the validity of the questionnaire and establish a measurement scale. Results  As a result of the factor analysis, 25 items were categorized into five factors. The factors were named based on the commonality of the items: social function, mental health, lumbar function, walking ability, and low back pain. To establish a measurement scale for each factor, we determined the coefficient for each item so the difference between the maximum factor scores and minimum factor scores was approximately 100. We adjusted the formula so the maximum for each factor score was 100 and the minimum was 0. Conclusions  We confirmed the validity of the JOA Back Pain Evaluation Questionnaire and est ablished a measurement scale. [ABSTRACT FROM AUTHOR]

Abstract Background  A new self-administered questionnaire as an outcome measure for patients with cervical myelopathy was drawn up in Part 1 (Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, JOACMEQ). Because a question with regard to driving a car (C-41) was not suitable for this patient group, the authors composed an alternative question related to neck motion (C-41-2). The purposes of the present study were to perform a secondary survey on patients with cervical myelopathy and to statistically analyze the responses to validate the JOACMEQ, and also to determine if it was possible to convert item C-41 to the alternative question. Methods  A member of the Subcommittee on Low Back Pain and Cervical Myelopathy Evaluation from each hospital administered the questionnaire to more than 50 patients with cervical myelopathy in each hospital. The questionnaire consisted of 25 questions, 24 of which were extracted in the primary survey. The authors statistically examined whether it was possible to convert question C-41 to C-41-2. Results  Three hundred and sixty-eight patients with cervical myelopathy were enrolled in the present study. No questions elicited no answer or “I am not sure” in more than 5% of patients except question C-41. There were no questions that the patients answered with difficulty. There was no tendency that was concentrated on one option as an answer to questions. There was a high correlation between questions C-41 and C-41-2. Spearman''s correlation coefficient and κ value showed that there was high coincidence between the two questions C-41 and C-41-2. It is possible to convert the question C-41 to the alternative question C41-2. Conclusion  The questionnaire has sufficient reliability for clinical use. It is possible that the JOACMEQ will prevail and become a global standard to evaluate outcomes in patients with cervical myelopathy. [ABSTRACT FROM AUTHOR]

Abstract Background  An outcome measure to evaluate the neurological function of cervical myelopathy was proposed by the Japanese Orthopaedic Association in 1975 (JOA score), and has been widely used in Japan. However, the JOA score does not include patients'' satisfaction, disability, handicaps, or general health, which can be affected by cervical myelopathy. The purpose of this study was to develop a new outcome measure for patients with cervical myelopathy. Methods  This study was conducted in eight university hospitals and their affiliated hospitals from February to May 2002. The questionnaire included 77 items. Forty-one questions, which were originally listed by the authors, were for evaluation of the physical function of the cervical spine and spinal cord. The Medical Outcome Study Short-Form 36-Item Health Survey (SF-36) was used to examine health-related quality of life (QOL). Patients with cervical myelopathy and healthy volunteers were recruited at each institution. After analysis of the answers from patients and volunteers, irrelevant questions using the following criteria were excluded: (1) a question 80% of answers for which were concentrated on one choice, (2) a question whose answer was highly correlated with that of other questions, (3) a question that could be explained by other questions, and (4) a question for which the distribution of the answers obtained from the patients was not different from that obtained from the normal volunteers. Results  The patients comprised 164 men and 86 women, and the healthy volunteers 96 men and 120 women. Thirteen items from the questions about the physical functions of the cervical spine and the spinal cord and 11 items from SF-36 remained as candidates that should be included in the final outcome measure questionnaire. Conclusion  Twenty-four questions remained as candidates for the final questionnaire. This new self-administered questionnaire might be used to evaluate the outcomes in patients with cervical myelopathy more efficiently. [ABSTRACT FROM AUTHOR]

Abstract Background  Since 1996, we have applied endoscopic techniques to the treatment of various spinal disorders. The purpose of this study was to clarify the complications of endoscopic spinal surgery using thoracoscopy and retroperitoneoscopy. Methods  Fifty-two patients (26 male patients, 26 female patients, mean age: 49.7 years) underwent endoscopic surgery for various spinal disorders including burst fracture (20 cases), pyogenic spondylitis (10 cases), tumor (8 cases), scoliosis (4 cases), thoracic disc herniation (3 cases), and others. Thoracoscopy was performed in 20 patients, retroperitoneoscopy in 20 patients, and a combination of thoracoscopy and retroperitoneoscopy in 12 patients. Intraoperative and postoperative complications were retrospectively examined for these cases. Results  The intraoperative complications for thoracoscopic surgery were two cases of extensive bleeding (more than 2500â??ml); for retroperitoneoscopic surgery, there were three cases of extensive bleeding and one case of penetration of the peritoneum; and for the combination of thoracoscopy and retroperitoneoscopy, there were two cases of extensive bleeding. The postoperative complications for thoracoscopic surgery were three cases of atelectasis and other respiratory complications; for retroperitoneoscopic surgery, the most common complication was transient neurological dysfunction (five cases); and for the combination of thoracoscopy and retroperitoneoscopy, three cases of atelectasis were observed. The overall incidence of complications in endoscopic spinal surgery was 42.3% (20/52 cases). Of the intraoperative complications, extensive bleeding was most frequent, and of postoperative complications, respiratory problems and transient neural damage were most frequent. The incidences of extensive bleeding and respiratory problems during the past 4 years were significantly fewer than during the first 4 years of surgical experience. Intraoperative bleeding and the operative time were significantly decreased after the first five cases of burst fracture. Conclusions  Complications of endoscopic spinal procedures occurred in 42.3% of our cases, but decreased with increase in surgical experience. [ABSTRACT FROM AUTHOR]