Since 1982, 21 patients were operated at our hospital including 12 males and 9 females. The average age were 59.4 years, the average duration of HD was 15.5 years, and DSA was in the cervical spine in 14 cases, and the lumbar spine in 7. Symptoms were pain in 21 patients (100%) and neurological deficits in 19 (90%). Histological examination of respected specimen revealed amyloid deposits in all cases. We classified the X-rays changes from DSA in stage 0 (no change) to stage 3 (end stage), and as type A (kyphosics), B (subluxation), C (amyloid deposits in soft tissues), and D (spontaneous fusion). All 21 cases were classified as stage 3. The 14 cervical spine cases belonged to type A or B, but all 7 lumbar spine cases belonged to type C or were combined types. In the 14 cervical spine cases, spinal fusion was done to stabilize the spine (AO plate in 3, Axis plate in 2, Olerud system in 2, and others in 7). In contrast, posterior decompression (laminoplasty with or without spinal fusion) was done in all 7 lumbar spine cases. The results were evaluated from the JOA scores. The score improved from 6.1 to 10.1 points (full score:17) in cervical patients and it improved from 12.2 to 20.2 points (full score:29) in lumbar patients. One patient died 2 days after surgery because of massive blood loss. Twenty-one operations for DSA were investigated. Surgical strategies were decompression, stabilization, or combination. In addition, minimum invasive procedure should be considered for the patients with high-risk and the poor bone quality.
Between 1974 and 1998, 34 patients with primary bone tumors and 28 with soft tissue tumors, all located in the foot, were surgically treated at our institutions. Of the 34 patients with a bone tumor, 27 (79%) had chondrogenic tumors: exostoses, 17; enchondromas, 7; benign chondroblastomas, 2 and chondrosarcoma, 1. This chondrosarcoma was misdiagnosed as a benign chondroblastoma at the initial biopsy. Five months after the initial curettage and bone grrafting, the tumor was recurred as a chondrosarcoma. This patient died with pulmonary metastasis another five months after the below the knee (BK) amputation. The differential diagnosis between benign chondrogenic tumors and low grade chondrosarcoma is very difficult as proposed by Mirra. Whereas the malignant tumor is very rare in the foot, the diagnosis of chondrogenic tumor should be made carefully. Of the 28 soft tissue tumors, diagnoses were giant cell tumor of tendon sheath or pigmented villonodular synovitis, 8; angioleiomyoma, 4; ganglion, 4; hemangioma, 2; miscellaneous benign tumors, 7 and soft tissue sarcomas (STS), 3. All patients with a STS were treated by a BK amputation, a partial foot amputation or a marginal resection, and died with pulmonary metastasis. However the function of the operated limb and the emotional acceptance were better in a patient with the less abrasion surgery.
