Introduction: Spinal cord edema is rarely seen in patients with cervical spondylotic myelopathy. Still, some cases demonstrate spinal cord edema, also known as cervical spondylotic intramedullary edema.

Methods: Nine male patients (mean age: 53±13.9 years) with cervical spondylotic intramedullary edema (8 surgeries, 1 preserved) were examined from March 2017 to October 2023. We examined the range of motion of the cervical spine, changes in the spinal cord area during cervical anteroposterior flexion (narrowest part, cranial intervertebral area, caudal intervertebral area), an indicator of edema severity, Japanese Orthopedic Association (JOA) scores, and the recovery rate of JOA score at 1 year postoperatively.

Results: There were no significant differences in the range of motion of the cervical spine and the area of the spinal cord. However, edema severity was significantly reduced at 1 year postoperatively, and the recovery rate of JOA score improved by 42.9%±11.0% at 1 year postoperatively.

Conclusion: There were no significant differences in the range of motion of the cervical spine and the area of the spinal cord between the narrowest part and the cranial/caudal intervertebral areas.

Introduction: In our aging society, the majority of people requiring treatment are elderly. Osteoporosis is common, and some people require spinal surgery with strong fixation. Recently, the cement-augmented pedicle screw (CAPS) has become available for osteoporosis-related surgery in elderly patients. Although CAPS is being increasingly used, intra- or postoperative cement leakage is sometimes a serious problem. This study aimed to describe an effective method for minimizing cement leakage that we use in our hospital and determine if it reduces cement leakage-related complications.

Methods: Twelve patients (four males, eight females; mean age: 77.1 years) with osteoporotic vertebral fractures or diffuse idiopathic skeletal hyperostosis treated between April 2022 and November 2023 were included. This cementing method was designed to inject 0.3 ml of cement into the same CAPS several times, alternating from left to right, for a total of 1.0-1.2 ml, instead of injecting all at once. Cement leakage was assessed by postoperative computed tomography, and each patient's postoperative clinical record was reviewed to determine the cement-related complications.

Results: The vertebral levels that received CAPS ranged between T9 and L4. The rate of cement leakage was 33.3% (4/12 cases) or 15.2% (7/46 screws). In the cement-leakage case, the cement-leakage involved embolization of the anterior external vertebral venous plexus, and no intraspinal leaks or postoperative complications were observed.

Conclusions: This method allows the use of high viscosity cements, slow injection, and low-pressure injection. Our results indicate that the method can potentially reduce the cement leakage rate in osteoporosis-related surgery.

Cervical epidural abscesses are relatively rare; cervical pain, fever, and neuropraxia are considered classic triads; however the series of symptoms is uncommon. When paralysis occurs, surgical treatment is required. Herein, we report two cases of cervical epidural abscesses that required surgical treatment. A 50-year-old man (Case 1) complained of cervical pain for 7 days. Magnetic resonance imaging (MRI) revealed a retropharyngeal abscess and an epidural abscess centered on C4/5. The patient was treated with cervical laminoplasty and drainage. Preoperative manual muscle testing (MMT) included 2/3 of upper limb proximal muscles, 1/1 of wrist dorsiflexion, and 2/3 of lower limb proximal muscles. Eventually, he was able to walk independently. Furthermore, a 53-year-old man (Case 2) complained of cervical pain for 7 days. He was hospitalized because of worsening neck pain and difficulty during movement. The day after admission, he complained of tetraplegia, and an MRI revealed discitis and epidural abscess centered on C5/6 and retropharyngeal abscess. He was referred to our hospital; on that same day, he was treated with cervical laminoplasty and drainage. Preoperative MMT was 2/3 in the proximal muscles of the upper extremity and 0/0 in the lower extremity beyond the iliopsoas muscle. Numbness in his upper limb remained, and his muscular strength was fully improved eventually. Posterior decompression was effective in both cases, and early surgical intervention resulted in an improvement in paralysis and infection control.

Introduction: Dropped head syndrome is a disease caused by cervical kyphosis that results in head drooping.

There are various causes for dropped head syndrome, including neuromuscular diseases and Parkinson's disease.

Recently, the treatment of malignant tumors has made significant progress, and the number of patients with long-term survival has been increasing. However, reports of dropped head syndrome as a late complication after radiotherapy are becoming more common.

We report a case of dropped head syndrome as a long-term complication after radiotherapy for hypopharyngeal carcinoma.

Case: This report included a 65-year-old male with a history of anticancer drug treatment for hypopharyngeal cancer at age 53 who underwent left neck dissection and radiation as an intensification therapy.

He had neck pain at age 61 and experienced symptoms of head drooping at age 63.

Because the patient was neurologically asymptomatic, a close examination of the underlying disease was conducted first, but no diagnosis was made.

After surgery, the patient's primary disease remained unknown, and it was determined that radiation was the cause.

Conclusions: The number of cancer survivors is expected to increase with the development of medical treatment in the future, and the incidence of dropped head syndrome due to radiation injury may increase, which should be noted as one of the causes of dropped head syndrome.

Introduction: When considering a surgical approach to treat pyogenic spondylitis, lesions located in the anterior part of the spinal canal are generally more effectively addressed through an anterior approach. It, however, may be challenging to apply an anterior approach to the upper thoracic spine. We performed anterior curettage and fusion of the thoracic spine using the sternum splitting approach.

Case Report: A 55-year-old man presented with upper thoracic pyogenic spondylitis at the Th3-4 level, experiencing back pain and right lower limb muscle weakness. Magnetic resonance imaging (MRI) revealed a vertebral body collapse and an epidural abscess anteriorly compressing the spinal cord at the Th3-4 vertebral level. A biopsy from the same site detected MSSA. Due to progressive worsening of paralysis, we initially performed thoracic posterior fusion (Th1-6) and thoracic laminectomy (Th2-4), followed by a two-stage thoracic anterior curettage and fusion (Th2-4) using the sternum splitting approach. His paralysis improved with relieved pain, and no recurrence of pyogenic spondylitis was observed during follow-up.

Conclusions: Despite the challenges of performing an anterior approach for upper thoracic lesions, the sternum splitting approach proves to be a useful technique for treating localized lesions in the anterior part of the spinal canal at the upper thoracic level.

Introduction: At surgical treatment of adult spinal deformity, some cases are difficult to release bony fused facet joint and vertebral discs by using only LIF technique. Cage insertion in such rigid cases sometimes resulted in vertebra fractures and endplate damages.

Therefore, in such cases, after the release of the facet joint and gain the movement between the vertebras, we performed LIF technique and correct the deformity. But this method takes long operation time and is highly invasive. So at most cases two-stage surgery is planned.

Case Report: At two-stage surgery for rigid facet fusion cases, we perform pedicle screw insertion and facet joint release in the first stage, then install the rods while the deformity remains. At second stage, remove the rods in the lateral position, perform LIF, and perform the correction of the deformity again from the posterior side. By doing so, even during the waiting period for the second stage surgery, the patient can move freely without wearing a corset. However, if the rod is installed while the deformation remains, it takes long time and is difficult to insert the rod. So, we report usefulness of Bendini use for making rod curve even if the deformation remained in the first stage.

Conclusion: We reported the usefulness of Bendini use for rod formation in the first stage of two-stage adult spinal deformity correction surgery while the deformation remains.