OBJECTIVE: The purpose of this study was to evaluate radiological and clinical results in patients with lumbar spinal canal stenosis due to degenerative spondylolisthesis who had undergone posterior decompressive surgery without fusion. We report our findings in 30 patients who were followed for at least 5 years after surgery. PATIENTS AND METHODS: We evaluated 30 consecutive patients who underwent posterior decompressive surgery without fusion between 1997 and 2003. The mean follow-up was 80 months. Clinical results were evaluated using the Japanese Orthopaedic Association (JOA) score and the recovery rate. The radiographic parameters we assessed were the change in % slip and the slip angle on lateral neutral, flexion and extension films obtained before and after surgery. RESULTS: The symptom recovery rate assessed with the JOA scoring system was 85%. The postoperative % slip was statistically larger than the preoperative value (p<0.05) although the progression of slippage and instability after surgery did not affect the clinical results. We performed reoperation in 2 patients (6.6%); they underwent posterior decompression. None of the 30 patients required secondary fusion. CONCLUSION: In the mid-term we obtained good operative results in patients who had undergone decompression without fusion to treat lumbar spinal canal stenosis due to degenerative spondylolisthesis. Our findings suggest that posterior decompression wide enough to reach the lateral recesses while preventing damage to the articular processes does not routinely require spinal fusion and provides satisfactory clinical results.

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Introduction: Problems of lumbar spondylolisthesis treatment are 1. Many surgical tactics, 2. Elderly patient, 3. Osteoporosis, 4. Complications and 5. Recurrence of the symptoms. PLIF (posterior lumbar interbody fusion) and PS (pedicle screw) fixation technique for lumbar spondylolisthesis provide good patient satisfaction. Good outcome has been reported by only laminectomy alone, but patient satisfaction becomes worse year after year. The role of instrumentation for lumbar spondylolisthesis is decompression of the nerve root, correction of lumbar pathologies, bony fusion and early mobilization. We show our surgical technique and long term outcome of PLIF with PS for lumbar spondylolisthesis. Material and Methods: 350 cases of lumbar spondylolisthesis were operated on in Department of Neurosurgery, Fujita Health University during the period of from December 1992 to August 2008. Patient background: age 16-84 years old (mean 62.5), Gender: male 153, female 197. Follow-up period 1-180 months (mean 61.2). Degenerative: 255, Isthmic: 63, Dysplastic: 10, Fracture: 5 and scoliosis 16 cases. Surgical procedure was PS with interbody fusion cage: 331, Hybrid cage (titanium cage with hydroxyapatite) 314, PS with Cerabone: 2 and PS with autograft: 17. CT was done to evaluate bony fusion postoperatively. Results: Post operative improvements by JOA (Japan Orthopedic Association) score is 11.4 before surgery, 24.1 (post op. within 2years), 25.4 (post op. 2-5years), 25.0 (post op. 5-10years) and 22.4 (post op. 10-15years). Significant improvements were observed in %Slip and Slip angle but no remarkable change was observed in lumbar lordotic angle by postoperative X-ray evaluation. Complications: No root injury, and systemic complication except 4 cases of CSF leakage during surgery. Two cases were reoperated in whom cage with autograft migration due to pseudoarthrosis. Two cases had to undergo screw and cage system removal due to infection. Two cases of adjacent level stenosis had to undergo operation 10 tears after surgery in this study. Conclusions: Rigid fixation (PLIF+PS) technique for lumbar spondylolisthesis provide good surgical result for over 15years. Minimum invasive surgery is popular but this technique achieved good satisfaction for patient and prevent malpractice.

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Percutaneous Vertebroplasty (PVP) is an elegant less-invasive therapy for patients suffering from painful vertebral compression fracture. Good patient selection warrants successful PVP. Painful osteoporotic vertebral compression fracture refractory medical therapy is a primary indication for PVP. Patients improving on conservative medical therapy should not be treated by PVP. We present a typical case with osteoporotic vertebral compression fracture treated by PVP and discuss this case's indications. The main discussion is about the indications for PVP and the complications, including adjacent vertebral fracture after PVP and extravertebral cement leakage during PVP. Intravertebral cleft, which means pseudoarthrosis clinically, is a prime candidate for PVP, because it is thought to be imaging evidence of conservative therapy failure. Actually, in all PVP cases in our hospital, the ratio of the cases with intravertebral cleft was 80% in 2006 and 84% in 2007. Excellent image guidance and good indication are essential for selecting PVP.

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Percutaneous vertebroplasty (PVP) is a new therapeutic procedure that involves injection of polymethyl-methacrylate (PMMA) into the vertebral body. The procedure is a minimally invasive procedure for compression vertebral fractures. This procedure can be performed with excellent clinical results and a very low complication rate. Over the past 3 years, we have treated more than 400 cases with PVP for thracic and lumber osteoporotic veretebral fractures. We describe our approach, technique, and clinical results using PVP. In our experience, PVP is a safe, less invasive and effecive medical treatment for achiving pain relief. PVP will improve the outcome of osteoprotic vertebral compression fractures.

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Vertebroplasty is widely used for the treatment of compression fractures secondary to osteoporosis and metastatic spine tumors. The technique is safe and effective in reversing the course of decline in general activities including mentation, often caused by conservative treatment consisting primarily of immobilization for osteoporotic fractures. Conditions such as unstable fractures, metastatic tumors to the cervical spine, and fractures of the posterior wall of the vertebral bodies, have been excluded from indications for the procedure. However, we have been expanding the use of the technique to such applications in conjunction with open surgery, and the techniques can be used effectively for unstable fractures, as well as multi-level metastasis involving the cervical spine. Vertebroplasty can be effectively employed in combination with advanced technologies in radiotherapy, such as spinal radiosurgery (SRS) and/or intensity modulated radiation therapy (IMRT) for metastatic spine diseases. It is useful in restoring and maintaining the walking capability in the cancer patients, whose prospects for survival and activities in daily life can be limited due to the primary disease and systemic metastasis. The immediate efficacy in pain relief, recovery in locomotion, little invasiveness and short hospital stay makes the combined procedure an attractive and promising alternative to conventional surgery such as vertebrectomy and fixation/instrumentation, which can be extensive and excessively invasive for those patients suffering from cancer and the side effects of treatments.

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Cervical angina is defined as anterior chest pain that resembles true cardiac angina but originates from cervical spondylosis. This symptom commonly results from compression of a nerve root. We present a case of cervical angina caused by unstable cervical spondylotic myelopathy. A 72-year-old woman presented with a complaint of anterior chest pain. After excluding coronary artery disease, C3-7 expansive open-door laminoplasty with C3-4 transarticular screw fixation was performed. After surgery the chest pain improved. Therefore we diagnosed this case as cervical angina caused by spinal cord compression at C3-7 level. We presumed that the main mechanism of this symptom was as follows: 1. deactivation of the descending pain inhibitory pathway in the posterior horn of the C3-7 spinal cord 2. referred pain caused by unstable facet joint and anterior or posterior longitudinal ligament of the cervical spine. Cervical angina caused by cervical myelopathy should be included in the differential diagnosis of anterior chest pain. We mention the etiology and clinical characteristics of cervical angina.

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The authors describe a case of ruptured right vertebral artery dissecting aneurysm accompanied with left subclavian artery occlusion. Right vertebral angiogram showed the steal phenomenon from left to right. An aortogram revealed that the left subclavian artery was occluded at its origin. First of all we decided to reconstruct the occluded left subclavian artery. A balloon expandable stent was deployed under the temporary balloon occlusion of the left vertebral artery. Regular blood flow from the left subclavian to the vertebral artery was restored after the procedure. Finally, the endovascular trapping of the right vertebral artery including the aneurysm was performed safely with detachable coils.

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Glioblastoma multiforme (GBM) is the most aggressive brain tumor in adults. The median survival period of patients with GBM is approximately twelve months. Radiation therapy plus temozolomide, the current standard therapy, has generally failed to prevent recurrence of GBM. The efficacy of chemotherapy for the recurrent GBM is limited. The phase II trial of bevacizumab, an anti-vascular endothelial growth factor antibody, and irinotecan reports the efficacy for the recurrent GBM. We report a patient with recurrent GBM who responded very well to the chemotherapy consisting of bevacizumab and irintoecan. Bevacizumab and irinotecan may improve the treatment outcome of patients with recurrent GBM.

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