ABSTRACT
PURPOSE: The diagnosis of spinal dural arteriovenous fistula (SDAVF) is difficult and often delayed because clinical features are often nonspecific. We assessed the motor function electrophysiologically in patients with SDAVF. METHODS: Motor-evoked potentials after transcranial magnetic stimulation and compound muscle action potentials and F-waves after electrical stimulation in the ulnar and tibial nerves were measured from the abductor hallucis (AH) muscles in 14 patients with SDAVF (SDAVF group), 12 patients with compressive thoracic myelopathy (CTM group), and 16 normal subjects (control group). The peripheral conduction time determined from abductor hallucis muscles (PCT-AH) and the central motor conduction time determined from abductor hallucis muscles (CMCT-AH) were calculated. According to the neurological findings, patients in the SDAVF group were classified to upper motor neuron (UMN) sign and lower motor neuron (LMN) sign categories. RESULTS: CMCT-AH in the SDAVF and CMT groups were significantly longer than those in the control group. PCT-AH in the SDAVF group was significantly longer than that in the control and CMT groups. Twelve patients in the SDAVF group showed abnormal CMCT-AH and/or PCT-AH. Abnormal CMCT-AH and PCT-AH were detected in five cases that exhibited UMN sign and/or LMN sign. Three cases with abnormal CMCT-AH and normal PCT-AH exhibited UMN sign. LMN sign without UMN sign was observed in four cases with abnormal PCT-AH and normal CMCT-AH. CONCLUSIONS: Our study revealed abnormalities in the corticospinal tract and/or lower motor neurons, and classified the patients with SDAVF into three types: the UMN type, LMN type, and mixed type.
Subject(s)
Central Nervous System Vascular Malformations/diagnosis , Central Nervous System Vascular Malformations/physiopathology , Electrodiagnosis , Action Potentials , Adult , Aged , Central Nervous System Vascular Malformations/classification , Electric Stimulation , Electrodiagnosis/methods , Evoked Potentials, Motor , Female , Humans , Male , Middle Aged , Motor Neuron Disease/classification , Motor Neuron Disease/diagnosis , Motor Neuron Disease/etiology , Motor Neuron Disease/physiopathology , Muscle, Skeletal/innervation , Muscle, Skeletal/physiopathology , Neural Conduction , Pyramidal Tracts/physiopathology , Spinal Cord , Spinal Cord Compression/classification , Spinal Cord Compression/diagnosis , Spinal Cord Compression/physiopathology , Thoracic Vertebrae , Tibial Nerve/physiopathology , Transcranial Magnetic Stimulation , Ulnar Nerve/physiopathologyABSTRACT
In cruciate-retaining (CR) type TKA, the increase in posterior condylar offset (PCO) is considered to be correlated to flexion angle acquired postoperatively according to the article reported by Bellemans (J Bone Joint Surg Br 84:50-53, 2002). However, the significance of PCO seems to differ according to the size of joints. We therefore have defined a new parameter of posterior condylar offset ratio (PCOR) on the lateral view of plain X-ray photographs and studied the relationship between PCOR and postoperative flexion status in posterior-stabilized (PS) type TKA. Flexion status includes two parameters, such as postoperative flexion angle (FA) and flexion achievement rate (AR). The subjects of this study were 160 knees (16 males and 144 females, average 75 years.) with PS type TKA for osteoarthritic knees between 1999 and 2003 at our institution, more than at least 1 year postoperative follow-up. In the study of FA, patients with FA of less than 100 degrees were divided into Group L (n = 28), patients with FA of 130 degrees and greater were divided into Group H (n = 58). In the study of AR, patients with AR of less than 100% were divided into Group P (n = 46), patients with AR of 120% and greater were divided into Group G (n = 22). PCOR was statistically compared in each group, respectively. In FA, PCOR in Group L (0.385) was significantly lower (P = 0.027) than that in Group H (0.428). In AR, PCOR in Group P (0.376) was significantly lower (P = 0.0018) than that in Group G (0.456). We have concluded, though there are many factors influencing the range of movement after TKA, our newly defined PCOR could possibly serve as a parameter of postoperative flexion status of PS type TKA on plain X-ray photographs.
Subject(s)
Arthroplasty, Replacement, Knee/methods , Knee Joint/diagnostic imaging , Knee Joint/surgery , Range of Motion, Articular , Aged , Aged, 80 and over , Biomechanical Phenomena , Female , Humans , Male , Middle Aged , Radiography , Statistics, Nonparametric , Treatment OutcomeABSTRACT
STUDY DESIGN: A case report of a 55-year-old patient with extensive cervicothoracic ossification of the posterior longitudinal ligament (OPLL) that was treated with posterior decompression and fusion. OBJECTIVE: To report the preventive effect of posterior instrumentation on postoperative paralysis in extensive cervicothoracic OPLL. SUMMARY OF BACKGROUND DATA: Thoracic myelopathy caused by OPLL in the thoracic spine was treated with operative decompression of the spinal cord via an anterior, posterior, or posterolateral approach. However, the lack of availability for some approaches in specific cases, as well as reports of some problems for each approach, indicates that a lack of consensus still remains regarding the choice of operative procedure. METHODS: A 55-year-old female with extensive cervicothoracic OPLL presented with progressive numbness in the both hands and a gate disturbance. Cervical laminoplasty, thoracic laminectomy, and posterior fusion were performed with electrophysiologic monitoring of the spinal cord evoked potential. RESULTS: After thoracic laminectomy, the amplitude of spinal cord evoked potential waveforms decreased but recovered after a posterior fusion by instrumentation. CONCLUSION: Prevention of postoperative paralysis from increasing by posterior instrumentation was shown using neurophysiologic monitoring.
