Retro-Odontoid Mass in High Elderly Patients : Genesis, Therapeutic Strategies and Post-Operative Care
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概要
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It has been controversial whether surgical treatment for retro-odontoid mass including disc hernia is indicated. We surgically treated 8 patients with retro-odontoid mass. We discuss clinical characteristics, therapeutic strategies, the genesis based on histological findings, and problems of post-operative care in this lesion. Age distribution of the patients was from 77 to 86 years old (mean : 81.0 years). Male/female ratio was 6/2. All patients showed neurological deficits due to myelopathy. Pre-operative magnetic resonance (MR) imaging showed an isointensity mass at the retro-odontoid space. Only marginal enhancement was seen in 2, and heterogenous enhancement in 6 patients. All patients underwent surgery via postero-lateral transdural approach for removal of the extradural retro-odontoid mass. All patients showed neurological improvement, however, severe neurological deficits still remained in 2 patients who had been in bed-ridden pre-operatively. The surgical specimens consisted of degenerative cartilaginous tissue and reactive fiborvascular tissue. As the retro-odontoid mass contains various pathological lesions, histological confirmation is necessary. Among reported surgical approaches, the postero-lateral transdural approach is less invasive, especially for high elderly patients. A source of cartilaginous tissue is probably derived from the herniated disc penetrated posterior longitudinal ligament at C2/3, which has migrated upward to the retro-odontoid space. Not only such migration, but also some proliferative change might come to form the retro-odontoid mass. Retro-odontoid mass is characteristic in very elderly patients. Elderly patient-specific problems such as disuse atrophy due to less movement and painful arthrosis deformans in the lower extremities prevent successful rehabilitation. Earlier planning to advance rehabilitation in cooperation with neurosurgeons, orthopedists, and rehabilitation physicians is necessary for very elderly patients' quality of life.
- 日本脊髄外科学会の論文
- 2005-03-31
著者
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Nishizawa Shigeru
浜松医科大学脳神経外科
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Yamaguchi Mitsuo
浜松医科大学脳神経外科
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Kitahama Yoshihiro
浜松医科大学脳神経外科
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Nishizawa Shigeru
浜松医科大学 脳神経外科学