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1.  Fracture and contralateral dislocation of the twin facet joints of the lower cervical spine 
European Spine Journal  2011;21(2):282-288.
Purpose
The combination of a facet fracture and a contralateral facet dislocation at the same intervertebral level of the cervical spine (a fracture and contralateral dislocation of the twin facet joints) has not been described in detail. The aims of this study are to report a series of 11 patients with this injury, to clarify the clinical features and to discuss its pathomechanism.
Methods
Among 251 patients with lower cervical spine fractures and/or dislocations surgically treated, 11 (9 males and 2 females, averaged age, 52 years) had this kind of injury. Medical charts and medical images were reviewed retrospectively.
Results
Injury levels were C4-5, C5-6 and C6-7 in 1, 4 and 6 patients, respectively. A fracture was found at the superior facet in 6, and at the inferior facet in 5. The anterior displacement of the vertebral body ranged from 7 to 19 mm. The unilateral horizontal facet appearance on an anteroposterior radiograph and the triple image on a CT composed of a separated fracture fragment, the base of the fractured facet, and the neighboring non-fractured facet were characteristic. All patients had neurological deficits from Frankel A to D, and were surgically treated by posterior fusion using wire or cable, or combined anterior and posterior spinal fusion.
Conclusions
The fracture and contralateral dislocation of the twin facet joints can cause severe neurological deficits because of its gross anterior displacement. Its plausible pathomechanism is extension force exerted to the cervical spine when it is maximally bent laterally.
doi:10.1007/s00586-011-1956-6
PMCID: PMC3265599  PMID: 21830078
Cervical spine; Facet fracture; Facet dislocation; Distractive flexion injury; Compressive extension injury; Neurological deficits
2.  Bilateral spondylolysis of inferior articular processes of the fourth lumbar vertebra: a case report 
Lumbar spondylolysis, a well known cause of low back pain, usually affects the pars interarticularis of a lower lumbar vertebra and rarely involves the articular processes. We report a rare case of bilateral spondylolysis of inferior articular processes of L4 vertebra that caused spinal canal stenosis with a significant segmental instability at L4/5 and scoliosis. A 31-year-old male who had suffered from low back pain since he was a teenager presented with numbness of the right lower leg and scoliosis. Plain X-rays revealed bilateral spondylolysis of inferior articular processes of L4, anterolisthesis of the L4 vertebral body, and right lateral wedging of the L4/5 disc with compensatory scoliosis in the cephalad portion of the spine. MR images revealed spinal canal stenosis at the L4/5 disc level. Posterior lumbar interbody fusion of the L4/5 was performed, and his symptoms were relieved.
doi:10.3109/03009734.2011.629750
PMCID: PMC3282246  PMID: 22111522
Articular process; scoliosis; spondylolysis; surgery
3.  Cervical myelopathy due to degenerative spondylolisthesis 
Upsala Journal of Medical Sciences  2011;116(2):129-132.
Objective
To investigate clinical-radiological features of cervical myelopathy due to degenerative spondylolisthesis (DSL).
Methods
A total of 448 patients were operated for cervical myelopathy at Nishitaga National Hospital between 2000 and 2003. Of these patients, DSL at the symptomatic disc level was observed in 22 (4.9%) patients. Clinical features were investigated by medical records, and radiological features were investigated by radiographs.
Results
Disc levels of DSL were C3/4 in 6 cases and C4/5 in 16 cases. Distance of anterior slippage was 2 to 5 mm (average 2.9 mm) in flexion position. Space available for the spinal cord (SAC) was 11 to 15 mm (average 12.8 mm) in flexion position and 11 to 18 mm (average14.6 mm) in extension position; 11 cases were reducible and 11 cases were irreducible in extension position. Myelograms demonstrated compression of spinal cord by the ligamentum flavum in extension position. Compression of spinal cord was not demonstrated in flexion position. C5-7 lordosis angle was lower than control. C5-7 range of motion (ROM) was reduced compared to controls. These alterations were statistically significant.
Conclusions
DSL occurs in the mid-cervical spine. Lower cervical spine demonstrated restricted ROM and lower lordosis angle. Pathogenesis of cervical myelopathy due to DSL is compression of spinal cord by the ligamentum flavum in extension position and not by reduced SAC in flexion position.
doi:10.3109/03009734.2011.551932
PMCID: PMC3078542  PMID: 21329487
Cervical spine; degenerative spondylolisthesis; myelopathy
4.  Lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis 
Upsala Journal of Medical Sciences  2011;116(2):133-137.
Study design
Case-series study.
Objective
To describe the clinical presentation, characteristic findings of imaging studies, and treatment of lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis.
Background
Lumbar lesions in rheumatoid arthritis are relatively rare, with a limited number of systemic reports.
Methods
Six patients with lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis were treated. The patients were all women with a mean age of 69 years and mean rheumatoid arthritis duration of 15 years. The medical records and imaging studies of all patients were reviewed.
Results
The affected nerve roots were L4 in four patients and L3 in two patients. Foraminal stenosis was not demonstrated in magnetic resonance images in four of the six patients. Selective radiculography with nerve root block reproduced pain, manifested blocking effect, and demonstrated compression of the nerve root by the superior articular process of the lower vertebra in all patients. Conservative treatment was performed on one patient, and surgery was conducted for the rest of the five patients; radiculopathy was improved in all patients.
Conclusions
Lumbar foraminal stenosis is a characteristic pathology of rheumatoid arthritis, and should be kept in mind in the diagnosis of lumbar radiculopathy. Selective radiculography is useful in the diagnosis of affected nerve roots.
doi:10.3109/03009734.2010.526722
PMCID: PMC3078543  PMID: 21091389
Diagnosis; foraminal stenosis; lumbar spine; radiculopathy; rheumatoid arthritis; surgery

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