Spontaneous migration of a redundant nerve root accompanied by absorption of lumbar disk herniation. A case report.

A redundant nerve root is defined as a large, elongated and tortuous nerve root commonly associated with severe lumbar spinal canal stenosis. Elongation of nerve roots as a result of mechanical trapping at stenotic level is assumed to be a possible mechanism. Here we present a case in a patient who showed a redundant nerve root above the level of a lumbar canal stenosis caused by disk herniation and redundancy spontaneously migrating to a lower lumbar stenosis level accompanied by absorption of the herniated disk as shown by magnetic resonance imaging (MRI). A 67-year-old Japanese woman presented with bilateral thigh/leg pain and intermittent claudication. A midsagittal T2-weighted MR image of the lumbar spine revealed severe spinal canal stenosis at the L3-4 and L4-5 levels. At the L3-4 level, central disk herniation compressed the dural tube. An MR image revealed redundant nerve roots just cranial to the severely compressed L3-4 level. A follow-up MRI study revealed regression of disk herniation at the L3-4 level. In contrast, there was no significant change of the stenosis at the L4-5 level. Sagittal T2-weighted MR imaging at follow-up revealed redundant nerve roots just cranial to the L4-5 level, whereas the redundant nerve roots cranial to the L3-4 level had disappeared. The MRI findings of the present case support the "squeeze" hypothesis as causative of redundant nerve roots.

Dupuytren's disease following acute injury in Japanese patients: Dupuytren's disease or not?

This paper reports the development of Dupuytren's disease following acute injury in 16 hands in 14 Japanese patients. The patients included six women and eight men. Five patients developed disease following trauma, one following infection and eight following elective surgery. In the present series, the patient age and sex are irrelevant. The disease was unilateral, confined to a single digital ray, and without ectopic lesions in most cases. Disease presented predominantly in the ring or middle finger rays. There were only three patients who underwent surgery for definite flexion contracture. Diabetes mellitus was the most frequently associated risk factor. Our results suggest that Dupuytren's disease following acute injury could be considered a separate entity from typical Dupuytren's disease. At present, we believe that this condition should be considered a subtype of Dupuytren's disease.

Clinical results of dermofasciectomy for Dupuytren's disease in Japanese patients.

The surgical outcomes of dermofasciectomy for Dupuytren's disease were evaluated in nine hands of eight patients in a Japanese population. The patients were examined for postoperative complications, problems associated with the skin graft, evidence of recurrent disease, sensation over the graft and pre- and postoperative range of motion at the metacarpophalangeal and the proximal interphalangeal joints. The mean two-point discrimination over the skin graft was 14 mm. The mean remaining flexion contracture at the metacarpophalangeal joint was 5 degrees and that at the proximal interphalangeal joint was 34 degrees . Recurrence occurred in two patients: one had a minor nodule and the other a natatory cord, which did not result in the redevelopment of a contracture. This study supports the use of dermofasciectomy for the treatment of recurrent Dupuytren's disease, as well as for the treatment of primary disease in those patients with a strong Dupuytren's diathesis in this population.

An objective method to evaluate the risk of recurrence and extension of Dupuytren's disease.

This study was undertaken to assess the influence of the factors related to Dupuytren's diathesis on the rates of recurrence and extension of Dupuytren's disease after surgery. The records of 65 patients who underwent surgery for Dupuytren's disease were retrospectively studied and the presence of factors related to diathesis were recorded. The sensitivity and specificity of each factor for predicting recurrence and extension were calculated. Odds ratios and 95% confidence intervals were also calculated and a discriminant analysis was performed to explore correlations between recurrence and extension and the significant variables. Our results confirmed the prognostic value of diathesis. The results have been used to develop a new scoring system for evaluating the risk of recurrence and extension.

Dupuytren's disease on the radial aspect of the hand: report on 135 hands in Japanese patients.

We studied 135 hands in 77 Japanese patients to assess the frequency of radial involvement and its association with recurrence and the Dupuytren's diathesis. The radial aspect of the hand was affected in 22% of the hands. Diseased cords were observed in ten patients who underwent surgery on the radial aspect of the hand. Longitudinal cords on the radial side of thenar eminence and distal transverse interdigital cords were common. The radial aspect of the hand was the most common site of disease extension, though recurrence never occurred after excision of a radial lesion. Ectopic lesions, bilateral hand involvement, and recurrence were significantly more frequent in patients with the radial side involvement. Thus the results of this study suggest that radial side disease is associated with the Dupuytren's diathesis and is a risk factor of recurrence.

Surgery for Dupuytren's disease in Japanese patients and a new preoperative classification.

The surgical outcome of Dupuytren's disease was evaluated in 73 hands of 57 patients in a Japanese population. Subtotal fasciectomy was performed in all cases. Surgical results were evaluated using the percentage improvement of extension in each finger joint. Statistical analyses were performed on the risk factors associated with recurrence and extension. The surgical outcome depended on the degree of contracture of the proximal interphalangeal joint. Recurrence of disease occurred in eight patients (14%) and extension occurred in nine (16%). Recurrence and extension frequently occurred in those who had ectopic lesions or involvement of the radial side of the hand. The present results suggested that the Dupuytren's diathesis had an influence on recurrence and extension. We proposed a new classification of Dupuytren's disease that might help to predict the surgical outcome and facilitate surgical planning.

Pressure distribution in the humeroradial joint and force transmission to the capitellum during rotation of the forearm: effects of the Sauvé-Kapandji procedure and incision of the interosseous membrane.

A biomechanical study was undertaken, using four fresh cadaveric arms, to evaluate the changes in pressure distribution in the humeroradial joint (H-R joint) during rotation of the forearm before and after the Sauvé-Kapandji procedure (S-K procedure) and also after incision of the interosseous membrane (IOM) following the S-K procedure. The pressure distribution was measured with a pressure-sensitive conductive rubber sensor while the forearm was rotated. Force transmitted to the capitellum was calculated from the measured pressure. In the intact specimens, pressure was concentrated on the medial side of the capitellum in pronation and on the posterolateral side in supination. The pattern of change after the S-K procedure and that after incision of the IOM following the S-K procedure were almost the same as that in the intact forearm. Although the force transmitted to the capitellum increased after the S-K procedure, there were no significant differences between the forces before and after the S-K procedure. However, the force increased significantly after incision of the IOM following the S-K procedure when the forearm was supinated more than 35 degrees, and it was concentrated on the posterior side of the capitellum. The IOM seemed to have an important axial load-bearing function in the forearm position supinated more than 35 degrees. The S-K procedure in patients suffering from distal radioulnar joint disorders with IOM injury is likely to induce H-R joint osteoarthritis, so it should be avoided in these patients.