There have been reports of implants for three-level Anterior Cervical Discectomy and Fusion (ACDF) for treating multilevel Cervical Spondylotic Myelopathy (CSM), such as the cylinder-type, plate, screw fixation type, and hybrid with cervical disc replacement (CDR). However, there have been no reports using stand-alone titanium coated PEEK cage (ROI-C^®). This report investigates the effectiveness and postoperative alignment changes of a three-level ACDF using the ROI-C^® and presents findings based on literature review. The study involved seven patients who underwent the three-level ACDF surgery at our institution from April 2021 to January 2022. Evaluation criteria included JOA scores, various X-ray parameters, and the presence of cage subsidence. As a result, JOA scores for upper limb movement and sensation significantly improved; and postoperatively, C7 slope significantly increased in X-ray parameters. Cage subsidence was observed, but no implant damage was found. Postoperative outcomes of this surgical procedure were favorable. The results also suggest that the C7 slope may be a useful parameter for predicting therapeutic effects in anterior cervical spine surgery.

Introduction: We conducted an investigation on cerebrospinal fluid leakage after planned dural incision in our department and compared the results.

Subjects and Methods: The study included 75 cases (37 males, 38 females) with a mean age of 56.2 years and a mean follow-up period of 37.1 months. We examined the disease, laminectomy method (bilateral or unilateral), dural treatment method, and postoperative MRI.

Results: The diseases comprised 72 cases of spinal cord tumors and 3 other spinal conditions. Laminectomy methods consisted of bilateral in 46 cases and unilateral in 29 cases. Dural treatment methods included suturing in 54 cases and the Vascular Closure System clips (VCS) in 21 cases. Cerebrospinal fluid leakage was observed in 20 cases (26.6%) overall on the first MRI at an average of 3 months postoperatively. With regard to laminectomy, no significant differences were found between bilateral (34.7%) and unilateral (13.7%) cases (NS). For dural treatment, suturing was observed in 29.6% and VCS in 19.0% (NS). In particular, leakage was significantly less (6.2%) in cases of unilateral laminectomy using VCS compared to three cases of bilateral laminectomy with VCS (60%) (P=0.03).

Conclusions: Reducing dead space is crucial in the prevention of cerebrospinal fluid leakage. The combination of the less invasive unilateral laminectomy and VCS could help reduce postoperative cerebrospinal fluid leakage compared to bilateral laminectomy.

We report a case of a 57-year-old woman who previously underwent occipitocervical fusion (O-C4) at the age of 37 for subluxation of the atlantoaxial subluxation due to rheumatoid arthritis. She was found to have a loss of fine motion skills in the hand and gait disturbance due to myelopathy caused by adjacent segment disease, and was referred for surgery. The patient was transferred to our hospital due to tracheal intubation difficulties at the previous hospital. The operation was postponed again because the epiglottis could not be confirmed by endoscopic intubation. One month later, we could finally complete the operation by conscious nasal intubation. The initial surgery was performed in the flexed position. Airway narrowing due to pharyngeal edema was thought to be the cause of the intubation difficulty.