Osteoporotic compression fracture patients often cite lumbago as their main complaint. These patients typically develop shortened vertebral bodies, which can be relieved naturally. If there is difficulty with body movement or the patient is hospitalized, relief for the compression lumbar fracture is often afforded by NSAIDs and wearing a corset. However, when such conservative treatment fails or when protracted sharp pain or other neurologic symptoms develop, surgical treatment is necessary. For prolonged low back pain, the vertebral body formation can be augmented using artificial bone or bone cement via a low invasive surgical procedure. BKP (Balloon Kyphoplasty), which became an insurance covered procedure in Japan in 2011, is one of the useful methods employed in the art of vertebral body formation recently.

  Since the severity of osteoporotic compression fractures can change at any moment, it is necessary to treat them while carefully weighing the pros and cons of each therapeutic method according to each patient’s needs.

  Anterior decompression and expansive laminoplasty are widely utilized surgical procedures for the treatment of symptomatic cervical ossified posterior longitudinal ligament (OPLL). However, surgical intervention must be cautiously prepared to avoid postoperative neurological deterioration and surgical complications. In this article, the natural history of OPLL progression, the indications for anterior and posterior surgery, the preoperative assessment of dural ossification for anterior surgery and the necessity of fusion for posterior surgery are all reviewed and the optimal surgical strategy criteria are discussed.

  Since the craniovertebral junction (CVJ) has complicated anatomical and functional properties allowing greater mobility, there are a wide variety of surgical approaches available and each of these approaches is complicated. Decompression at the CVJ is typically achieved via posterolateral approaches and transoral surgery, whereas fixation is usually achieved via atlanto-axial fixation, occipito-cervical fixation and anterior odontoid screw fixation. The best approach should be selected for each patient accordingly and it should be performed properly. In this paper, a selection of surgical method is described along with tips for safely performing and mastering the required surgical techniques.

  Chronic subdural hematoma (CSDH) is one of the most common neurosurgical pathologies and it is often surgically treated by burr-hole drainage. However, the reported rate of post-surgical recurrence is around 10%, and some factors have been investigated. We describe recurrence risk factors for chronic subdural hematoma retrospectively determined from experience at our institution.

  The clinical characteristics and CT findings were analyzed in a series of 187 patients who underwent burr-hole surgery at our hospital (222 surgeries) between January 1, 2014 and July 31, 2015.

  Recurrence was identified in 26 (13.9%) of 187 patients and clinically significant risk factors were age, hypertension and anticoagulants. Other significant risk factors comprised preoperative CT findings of hematoma volume, midline shift and niveau, as well as post-operative CT findings of hematoma reduction rates between days 1 and 7. The rate of hematoma reduction decreased, indicating an increase in hematoma between post-operative days 1 and 7 in patients with recurrence. We consider that a post-operative increase in the size of a hematoma can predict recurrence in the early stages.

  We examined the outcomes of anterior cervical decompression and fusion (ACDF) for cervical spondylotic myelo-radiculopathy, including the improvement rate of neurological symptoms and signs, and the time period of stabilization and lordosis, and then compared them among each groups of fixation methods and number of fusions.

  We prospectively examined the cases of 330 patients, who underwent a modified trans-unco-discal approach (TUD) with iliac bone graft or cage, and followed their neurological symptoms, neuroradilogical findings and complications. We used the Japanese Orthopaedics Association (JOA) score, radiological stabilization (cervical spine plain dynamic x-ray), C2-7 Cobb angle (CA), and C2-7 sagittal vertical axis (SVA) as examinations of lordosis and inter-vertebral space (IVS) were utilized.

  The cases in which the cage was used as a fixation method had a higher rate of recovery of the JOA score and a shorter stabilization time than those in whom the iliac bone graft was used, and those with two or three levels of fusion. The patients who underwent iliac bone grafts as a fixation method had lower C2-7 CA, longer C2-7 SVA, and higher IVS than those in whom the cage was used. Patients who underwent iliac bone grafts experienced significant increases in complications and re-operations than those in the cases which the cage was used.

  We confirmed that ACDF had good results as a fundamental treatment for cervical spondylotic myelo-radiculopathy by removal of the compressive lesion for the cervical cord and let to improve alignment of the cervical spine. The comparison of cages and iliac bone grafts as fixation methods demonstarated that the cage, and fewer fusions resulted in better outcomes. However, in the long term, newly adjacent lesions remain a problem.

  Subdural hematomas (SDHs) are common radiographic findings in patients with intracranial hypotension (IH). The pathophysiological features of this condition are complicated, and are quite different in each case. In some cases, only treatment for an underlying cerebrospinal fluid leak is needed. However, some SDHs have an obvious mass effect, and hematoma evacuation is required before or after treatment for the underlying IH. Thus, the optimal management technique for this condition remains challenging. We hypothesize that by measuring the intra-SDH cavity pressure we can discern the pathophysiological features of this condition, which is the key to optimal management of these SDHs. We herein report a novel management technique for a case of bilateral SDHs associated with IH in which an intracranial pressure sensor and drainage tube were simultaneously inserted into the hematoma cavity. As a result, the intra-SDH cavity pressure accurately revealed the pathophysiological condition of this case and therefore an appropriate treatment could be performed. We postulate that the management technique described in this report can be applied in cases of bilateral SDHs associated with IH when conservative therapies have failed.

  Spinal cord stimulation (SCS) is effective for various types of peripheral neuropathic pain. However, SCS has not been applied for patients with pain due to nerve tumor because this would prevent magnetic resonance imaging (MRI). We report the case of a patient with lower extremity pain due to multiple nerve root tumor associated with neurofibromatosis type 1 who underwent SCS using a new MRI-compatible device. The 35-year-old man had received several types of medication, including morphine and repeated nerve blocks, but all failed to relieve the pain. He could not stand or walk due to this pain, and underwent SCS using a new MRI-compatible device in our department. Lower extremity pain was relieved during stimulation. He could stand and started rehabilitation for walking. This case indicates that SCS may be effective for pain associated with peripheral nerve tumors.