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In the last 8 years, 1407 patients were diagnosed as cervico-omo-brachial syndrome in our out-patient clinic. We could classify the various disorders considered as a cause of the cervico-omo-brachial syndrome on the basis of the clinical findings, plain and functional radiograms.In these disorders, there are cervical osteochondrosis (subdivided into radicular syndrome and spinal cord compression groups), scalenus anticus syndrome, cervical rib, costo-clavicular syndrome, hyperabduction syndrome, Pancoast tumor and tumors in the cervical spine etc. But in the cases of undetermined cause we classified them as other.342 of 435 patients of cervico-omo-brachial syndrome were of radicular syndrome (79%) and 93 of them of spinal cord compression groups (31%). Others were 922 cases (67%). We discussed each group according to age, sex, occupation, cause, sign and symptoms with their localization, radiological findings and end results.

In order to examine the spinal canal after enlargement of the cervical canal, eighteen cases were studied on computed tomograpy. In all cases, configuration of the cervical canal was normal or further enlarged after surgery. Thinned laminae became thicker by bone formation at the dorsal side as time passed. Cervical canal were enlarged by 3.3mm in sagittal diameter and by 47% in the area.

Since 1970, thirty-one “osteoplastic enlargement of the spinnal canal” have performed in our clinic on the patients with disorder of cervical cord who had had the indication of posterior decompression.The advantages of this operation are 1) decompression of the cord at both posterior and lateral sides, 2) to prevent increasing instability of the cervical spine, and 3) to reduce delayed compression of the cord caused by adhesion and scar.There were 16 cases of cervical spondylotic myelopathy, 11 of ossification of posterior longitudinal ligament, 2 of spinal cord tumor and 2 of cord injury.The follow-up studies, from one month to 5 years and 6 months, showed enlargement of the canal, improvement of symptoms and also thickenning of remained laminae (average 3.6mm).The proportion of the enlargement of the canal, measured by X-ray films, ranges from 16.7% to 53.8% (average 37.0%).

Forty patients with cervico-omo-brachial syndrome, twenty with cervical spondylotic myelopathy, twenty cervical spondylotic radicuolpathy and 20 normal controls were selected for this study.After catheter for cevrical epidural anesthesia had been placed in the cervlcai epidural space of these cases, circulation of the epidural space by R. I. and cervical peridurography were examined.From the results of our study, we suggest that one of the causes of cervico-omo-brachial syndrome is the lesion of the root area or unstable circulatory dynamics of the cervical epidural space.

Perdurography is considered to be the best way for the measurement of the thickening of the ligamentum flavum in the cervical region. 119 cases of peridurography were observed for this purpose. The more the disc space is narrow and or posterior spur is large in plain X-ray of cervical spine, the thicker the ligamentum flavum is in peridurography. At the extension position of cervical spine, the inward bulgings of ligamentum flavum are strikingly observed, at the neutral position they are mild but they are significantly reduced at the flexion position.

The operational error in the heat flux measurements is theoretically investigated when the heat flux from a furnace wall to the environment is measured by a heat flux transducer. Change of the original heat flux, which is caused by placing a transducer on the furnace wall, is clarified by solving a three‐dimensional heat transfer problem. The operational error is explicitly given by a simple equation taking into account the thermal properties of the furnace wall and the transducer. Numerical results are also provided for a typical application to industrial furnaces.

Seventy-three patients with cervical myelopathy were able to be followed directly more than 3 years up to 16 years and 9 months (mean 6 years and 8 months). There were 57 patients with cervical spondylotic myelopathy (CSM) and 16 with myelopathy due to ossified posterior longitudinal ligament (OPLL).Better results were, generally, obtained at the time of follow-up (excellent+good: 77% in CSM, 69% in OPLL), compared with discharge time (69% in CSM, 62% in OPLL).However, 13 patients had worse results at the time of follow-up. Sensory disturbance increased or appeared in the upper limbs (10 cases) and in the lower limbs (9 cases). Gait disturbance increased or appeared (4 cases).The patients who had late regression showed a tendency of old age, previous history of trauma, appearance or increase of degenerative changes adjacent to the operated level and increased ossification of the posterior longitudinal ligament.

A recent study concluded that lateral bending, rotation and flexion-extension at the upper cervical level were not well controlled by any of the conventional orthoses (occipito-mandibular orthoses). Our orthoses (occipito-zygomatic orthoses) is designed to controll movements of the upper cervical spine. A subzygomatic pad is changed for mandibular support in the orthoses and subzygomatic pad is widened to nose. Occipital pad is also widened to bilateral and parietal. There is no complication by pressuse on the sub-zygomatic soft tissues in our experience.

The myelopathy in cervical osteochondrosis was classified into the three types, that is the central type (type I), the posterolateral type (tye II) and the posteroanterolateral type (type III), due to the range and the severity of the cord damage.It was discussed the relation between these types and clinical findings.The posteroanterolateral type shows most sevese type in the subjective and objective symptom.Generally, the first subjective and objective symptom appears on the upper extremities.The type is transitive (type I→type II→type III).Compared the disturbed region of the spinal cord by the clinical view with by myelogram, the former extend to some upper cord.

Since 1959, cervical osteochondrosis and idiopatic cervico-omo-brachialgia have been examined in our clinic. Those invlod 256 cases of idiopatic cervico-omo-brachialgia, 116 cases of cervial osteochondrosis. In the previous paper, upon the cervical osteochondrosis, the myelopathy and radiculopathy were comparatively studied. In this paper the author wishes to make a comparison with the radiculopathy, the myelopathy and idipatic cervico-omo-brachialgia. Both of the radiculopathy and the idiopatic cervico-omo-brachialgia, manifest the nuchal and shoulder pains.The symptome of the myelopathy are specialized as sensory disturbance and numbness sensetion with various manifestation in cervical X-ray finding. On the other hand, idiopatic cervico-omo-brachialgia has only pain and tenderness localized in cervical and shoulder region and there are some changes in X-ray.The follow-up studies were upon the idiopatic cervico-omo-brachialgia, the radiculopathy and the myelopathy. The symptome became better in 58% of the idiopatic cervico-omo-brachialgia, and 68% of the radiculopathy, but it was unchanged or became worse in 60% of the myelopathy.

A new method for reconstruction of an amputated thumb with a free neurovascular flap and an iliac bone graft in one stage is described. The method consists of fbur operative steps: (1) preparation of the recipient hand, (2) elevation of a free dorsalis pedis flap, (3) iliac bone graft, and (4) transfer of the flap with microvascular anastornoses. Four successful results with this operation are presented. The method, which reconstructs the thumb in a single operation, is suitable for patients who refuse other reconstructive methods which sacrifice uninjured digits or toes.

In order to evaluate the cervical cord function and diagnose the level and severity of cervical cord lesions, both segmental and conductive spinal evoked potentials (SEP) were measured in 73 patients with cervical spondylotic myelopathy and/or radiculopathy. In normal subjects, segmental SEPs consisted of two waves (R and N waves). Ascending conductive SEPs consisted of two waves (first and second waves). Abnormal waves are discussed according to classification of myelopathy. Abnormal waves in cervical spondylotic radiculopathy are also discussed. The function of the cervical cord including roots, grey matter and white matter could be measured by the combined method with segmental and conductive SEPs.

A new surgical technique, enlargement of the spinal canal, was carried out on eight patients with lumbar canal stenosis. The conditions of all the patients have improved, and there have been no complications so far. A laminectomy is performed in which both sides of the pars interarticularis are cut out with an osteotome to eliminate the cause of the stenosis. The ventral side of the removed lamina is then ground with a surgical air drill to enlarge the posterior area of the lumbar canal. The lamina is subsequently replaced and fixed with screws. This method makes it possible to remove the cause of the stenosis. By replacing the removed lamina, the additional advantage of avoiding weakening vertebral stability is afforded.