Cantilever Transforaminal Lumbar Interbody Fusion for Upper Lumbar Degenerative Diseases (Minimum 2 Years Follow Up)

PURPOSE: To evaluate the clinical outcomes of cantilever transforaminal lumbar interbody fusion (c-TLIF) for upper lumbar diseases. MATERIALS AND METHODS: Seventeen patients (11 males, 6 females; mean +/- SD age: 62 +/- 14 years) who underwent c-TLIF using kidney type spacers between 2002 and 2008 were retrospectively evaluated, at a mean follow-up of 44.1 +/- 12.3 months (2 year minimum). The primary diseases studied were disc herniation, ossification of posterior longitudinal ligament (OPLL), degenerative scoliosis, lumbar spinal canal stenosis, spondylolisthesis, and degeneration of adjacent disc after operation. Fusion areas were L1-L2 (5 patients), L2-L3 (9 patients), L1-L3 (1 patient), and L2-L4 (2 patients). Operation time, blood loss, complications, Japanese Orthopaedic Association (JOA) score for back pain, bone union, sagittal alignment change of fusion level, and degeneration of adjacent disc were evaluated. RESULTS: JOA score improved significantly after surgery, from 12 +/- 2 to 23 +/- 3 points (p < 0.01). We also observed significant improvement in sagittal alignment of the fusion levels, from - 1.0 +/- 7.4 to 5.2 +/- 6.1 degrees (p < 0.01). Bony fusion was obtained in all cases. One patient experienced a subcutaneous infection, which was cured by irrigation. At the final follow-up, three patients showed degenerative changes in adjacent discs, and one showed corrective loss of fusion level. CONCLUSION: c-TLIF is a safe procedure, providing satisfactory results for patients with upper lumbar degenerative diseases.

Actual Condition and Difficulty in Using the Objective Structured Clinical Examination (OSCE) in the Education of Acupuncture Students / 全日本鍼灸学会雑誌

Acupuncturists should have clinical competency, including knowledge, skill and humanity, such as attitude.<BR>In acupuncture and moxibustion educational institutions, educational objectives and strategies have been established to develop competency as a therapist. Therefore, an evaluation was performed in order to confirm the achievement of the learners, and whether the established initial objectives and strategies were appropriate or not.<BR>As a matter of course, the National Examination for Acupuncture and Moxibustion Therapists is an evaluation standard which assesses the social competency oftherapists completing the educational course, namely they must have significance.<BR>However, the current National Examination can only estimate the aspect of knowledge. Each educational in-stitution should, therefore, responsibly evaluate other acupuncturists' competency including skills and attitudes toward their competency insociety.<BR>In the Objective Structured Clinical Examination (OSCE), an adequate method to evaluate clinicians has widely been introduced for medical education.<BR>The OSCE was introduced to educational circles of acupuncture in Japan because OSCE can evaluate competency; i.e. the psychomotor and affective domain, that is difficult to measure using a paper test.<BR>Various difficulties still remain using OSCE for the education of acupuncture students in the view of both its adequacy and objectivity.<BR>In the present paper, the actual condition and difficulty in using OSCE in education of acupuncture students are reviewed based on the reports presented atthe educational session of the conference.

The Effect of Eppi-Ka-Jutsu-To on Osteoarthritis of the Knee / 日本東洋医学雑誌

In order to study the effects of Eppi-ka-jutsu-to on osteoarthritis of the knee, the author administered it to thirty subjects (nine males; twenty-one females) with osteoarthritis for eight weeks. Synovial fluid was obtained from all subjects before and after formula administration. All subjects had chronic swelling, tenderness and slight heat in the knee joints before therapy. Viewed from the change in score evaluation for knee osteoarthritis set by the Japanese orthopedic association, there was a significant improvement in pain on walking and joint effusion. In synovial fluid analysis, both the white blood cell count (especially the polymorphonuclear leukocyte count) and catalase activity were decreased significantly. This finding suggests that the sedation of inflammatory synovitis with Eppi-ka-jutsu-to might relieve the symptoms of knee osteoarthritis.