Introduction: The incidence of vertebral osteomyelitis has been increasing with the aging society in Japan. The treatment of vertebral osteomyelitis is often difficult because the number of compromised hosts is increasing. We have been providing multidisciplinary treatment for vertebral osteomyelitis since 2007 by cooperating with other departments. We consult with the infection control department for identification of the causative organism and selection of antimicrobial agents and ask the radiology department for computed tomography-guided biopsy and drainage. In this study, we investigated the clinical background, treatment course, and trends of this disease.

Methods: For 11 years, from April 2007 to August 2018, we treated 117 patients with pyogenic spondylitis who had been hospitalized in our department. Treatment methods and antimicrobials used were investigated, and their effects on the number of treatment days were examined.

Results: The average number of treatment days was 60 days. The treatment period did not correlate with the hospitalization history, affected vertebrae, and Kulowski classification. The compromised host rate was 59%, and the treatment period was significantly prolonged. The detection rate of the causative organism was 63%. There were 52 gram-positive cocci, of which 29% were methicillin-resistant Staphylococcus aureus (MRSA). The treatment period of MRSA was significantly longer than that of the top three causative organisms (methicillin-susceptible S. aureus, streptococcus, and Escherichia coli). The treatment period was shorter in the group using the first-generation cephem system, and the treatment period was longer in the group using anti-MRSA drugs. Even though the causative organism was unknown, it did not affect the treatment period. Of the 12 patients whose treatment period was prolonged for > 100 days, all were compromised hosts, and 92% of the causative organisms were MRSA.

Conclusions: In the treatment of vertebral osteomyelitis, the importance of collaboration with other departments, intervention of the infection control department, proper use of antibacterial drugs, and early treatment has been reported. We believe that appropriate and prompt treatment was possible using a multidisciplinary approach at our hospital. In this study, the treatment period was not affected even in the group with unknown causative bacteria, suggesting that the causative bacteria were similar to the bacteria-detecting group. These results suggest that the use of first-generation cephem antibiotics as a first-line drug for patients with unknown causative organisms is appropriate. However, there is a need for improvement in MRSA cases, such as selection of antibiotics and early response to minimally invasive surgery.

Introduction: The purpose of this study was to evaluate postoperative spinal canal stenosis at an adjacent level after microendoscopic laminoplasty (MEL) for lumbar spinal stenosis.

Methods: Overall, 95 patients who underwent MEL for one vertebra were enrolled.

Results: The results suggest that new spinal canal stenosis can occur at a superior adjacent level in patients with a dural canal area of < 85 mm² and an asymmetric facet joint of more than12° in the superior intervertebral space at the decompressed level.

Conclusions: These findings will be useful to determine the decompression range for the prevention of spinal canal stenosis at an adjacent level.

Spinal fusion is necessary for patients with an unstable cervical spine. The lateral mass screw is widely used; however, it is unstable in elderly patients with osteoporosis. Although pedicle screws have better fixed force and stability than lateral mass screws, the violation spinal canal or vertebral artery can be a concern. In recent years, various angle screws with longer allows and more oblique screw placement in the lateral mass have been developed. Here, we report techniques using the long lateral mass screw.

Introduction: Open surgery, microscopy, micro-endoscopic laminotomy (MEL), and percutaneous stenosis lumbar decompression (PSLD) methods have been performed for spinal decompression. We aimed to verify the advantages and disadvantages of the novel technique unilateral biportal endoscopy (UBE). UBE includes the application of an arthroscope to the spine, and the surgery is performed while holding the triangle with both hands.

Methods: UBE was used as a posterior decompression method for a total of 64 cases: 56 cases of spinal canal stenosis, 3 cases of foraminal stenosis, and 5 cases of disc herniations. The surgeons stood on the left side of the patient, created a scopic portal for a 4-mm arthroscope at 1 cm above the disc level along the paraspinous process. From an 8-mm working portal to 2 cm of the caudal side, arthrocare was used for ablation and hemostasis of soft tissue, 4 mm diamond bar, curved Kerrison of various angles, dissectors, forceps, and other appropriate instruments.

Results: The operation time was initially approximately 2 hours, however, it later decreased to within 1 hour. There was no postoperative hematoma. VAS (Visual Analogue Scale) symptoms of the lower limb and low back pain significantly decreased. The satisfaction rate was 83% according to Macnab's evaluation. Two cases of dural rupture were repaired using the fibrin patch technique without significant neural damage.

Conclusions: The UBE method can be used to freely operate the target tissue without restriction by the outer-tube. The amount of bone resection is small because there is no limit to the range of use of the device. Various types of instruments can be used. The tip of the endoscope is close to the tissue, the capillaries are enlarged by approximately 70 times, and hemostasis can be carefully performed, so that the postoperative hematoma rate is low. Performing UBE with a clean view just under the lens with continuous water irrigation will be among the future decompression techniques.

Introduction: Development of Dural Arteriovenous Fistula (AVF) in the craniocervical junction (CCJ) is rare. CCJ dural AVF often presents as an intracranial lesion, and spinal cord symptoms are relatively rare.

Case Report: An 81-year-old man was diagnosed with ossification of the posterior longitudinal ligament and was referred to our hospital with the chief complaints of lower limb muscle weakness and dyspnea. Because he had received an implantable cardioverter defibrillator for hypertrophic cardiomyopathy, magnetic resonance imaging was contraindicated. His deep tendon reflexes had decreased in the upper extremities and increased in the lower extremities. His manual muscle testing score for the upper and lower extremities was decreased to 1-3, and the left face, trunk, and upper lower limbs showed impaired thermal nociception. Computed tomography (CT) myelography revealed slight compression of the spinal cord by ossification of the posterior longitudinal ligament of the spine at C2-C7 level. Contrast-enhanced CT revealed an abnormally enlarged vein at the craniovertebral junction. He was diagnosed with CCJ dural AVF and underwent surgical treatment.

Conclusions: We report a case of CCJ dural AVF with spinal cord symptoms and dyspnea. A vascular lesion, including dural AVF, should be considered if a patient presents spinal cord symptoms without compressive spinal disease.

Background: Recently, lateral lumbar interbody fusion (LIF) including eXtreme lateral lnterbody fusion (XLIF), direct lateral interbody fusion (DLIF), and oblique lateral interbody fusion (OLIF), has been introduced in Japan. Despite the effectiveness of this procedure, several complications have been reported. Since 2015, to identify the overall complication rate and type, the Japanese Society for Spine Surgery and Related Research (JSSR) has started a nationwide survey on the incidence and the type of complications related to LIF among all JSSR members.

Purpose: To report the results of a nationwide survey performed by JSSR on complications in LIF performed in Japan in 2018

Methods: A web-based survey on the complications following LIF was performed by JSSR for all JSSR members. Any complications meeting the criteria listed below have been included: (1) major vessel injury, (2) urinary tract injury, (3) renal injury, (4) visceral organ injury, (5) lung injury, (6) weakness of psoas, (7) motor deficit, (8) sensory deficit, (9) vertebral injury, (10) nerve injury, (11) anterior longitudinal ligament injury, (12) surgical site infection (SSI), and (13) other complications. Incidence and type of complications were analyzed in all LIF cases, and the difference in incidence and the type of complications between XLIF and OLIF were also compared.

Results: Among the 2,354 LIF cases (XLIF: 1,130 cases [48%], DLIF: 21 cases [0.9%], and OLIF: 1,230 cases [51%]), complications occurred in 54 (2.3%) cases. The most common complications were motor deficit (0.34%) and SSI (0.34%), followed by sensory deficit (0.25%) and major vessel injury (0.17%). Eighteen (30% of all complications and 0.8% of all cases) cases required revision surgery during the survey period. There were three (0.1%) cases of mortality cases due to complications of this surgery. There was no statistically significant difference in the frequency of complications between XLIF and OLIF (2.7% vs.1.7%, p = 0.10).

Conclusion: We conducted a nationwide survey on complications following LIF surgery. The overall complication rate was 2.3%, and 0.8% of cases required revision surgery related to complications. Three mortality cases occurred due to complications. Future detailed studies are recommended to evaluate severe complications to mitigate the risk of mortality in this procedure.