The authors report our clinical experience and surgical results with soft Graf stabilization system in a series of 47 cases with lumbar degenerative disc disease. The aim is to determine the usefulness of a soft stabilization system associated to clinical and radiological results of this patient series. At a mean period of postoperative observation of 32.5 months, excellent, good, fair and poor results were obtained in 9 (19%), 25 (53%), 9 (19%) and 4 (9%) of the patients, respectively. The height of disc space at that level increased from 8.2mm to 9.0mm in L3-4, 8.8mm to 9.9mm on L4-5 and 9.3mm to 10.4mm on L5-S1. Regional as well as global lumbar lordosis were maintained. Angulation instability was changed from-4.5' to 4' on L3-4, -6.2' to 4.8' on L4-5 and -2.2' to 9.8' on L5-S1. Translational instability was corrected from 14.5% to 12.3% on L3-4, 17.5% to 13.1% on L4-5 and 20.8% to 18.6% on L5-S1. These results suggest that soft Graf stabilization system in lumbar degenerative disc disease would be effective and useful alternative treatment method.

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Transvertebral anterior decompression (TVAD), primary aim of which is to treat multi-level anterior spinal cord disorders directly, provides anterior decompression at a greater width to expose the nerve root and the vertebral artery. In this series, we have achieved good results using a modified method of the transvertebral anterior decompression (TVAD), i.e., by exposing the dura mater of the spinal cord at a shorter width without approaching laterally. We report the details of our surgical experience with modified TVAD for anterior spinal cord disorders presenting with myelopathy. This procedure was performed on 28 patients with cervical myelopathy (with average age 65.0 years). These cases included cervical spondylosis, disc herniation and OPLL. The range of anterior decompression included 1 to 4 intervertebral spaces with an average of 2.3. The width of anterior decompression was 6 to 15mm with an average of 10.5mm. Surgical results were evaluated in accordance with the Neurosurgical Cervical Spine Scale (NCSS). The average of preoperative score was 9.1, with the score being 12.1, the score remained at the same level one month later and one year after the surgery. The surgery was found to be efficiently reduce the symptoms, especially regarding the improvement of lower limb weakness. No instability was observed. Modified TVAD has high potential for anterior decompression because this technique can be performed not only on the disc level, but also continuously on the vertebral body level. Furthermore, it may be unnecessary to extend the width of vertebrectomy to the lateral side for patients suffering from myelopathy.

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We present our experience using a 40%-porous hydroxyapatite (HAP) spacer in 17 patients undergoing anterior cervical fusion. Of the 20 total HAP spacers inserted, linear fractures were observed in eight spacers and three spacers collapsed. Spacer fracture was most frequently observed at a mean of two months following insertion with a range from two weeks to 12 months after implantation. In three cases showing collapse of the spacer, two were reoperated on using an iliac bone graft. Histological studies revealed that new bone formation was not observed within the pores of the broken spacers. These findings suggest that 40%-porous HAP spacer, because of its fragility, would appear to be unsuitable for use as a graft material in anterior cervical fusion procedures.

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The diagnosis of intramedullary spinal cord lesions is occasionally difficult. It is important to distinguish tumors from nonneoplastic intramedullary lesions. The purpose of this study was to elucidate characteristics that would aid in preoperative differential diagnosis. We report on nine patients with intramedullary spinal cord lesions which were diagnosed with difficulty. Six patients were diagnosed based on clinical presentation, radiographic findings and laboratory examinations. The diagnoses were multiple sclerosis in two patients, neurosarcoidosis in two patients and spinal cord infarction in two patients. In three patients, differential diagnoses were difficult to achieve preoperatively, and biopsies were performed. In one patient, T2-weighted magnetic resonance images (MRI) showed multiple high intensity areas in the brain and the conus medullaris. Although there were few clinical features that distinguish gliomatosis cerebri from multiple sclerosis in the early stages, the signs of increased intracranial pressure such as headache and papilledema appeared afterwards. Histology of the surgical specimen from the brain lesion showed anaplastic astrocytoma. The patient showed tumor progression and died during the follow-up. Pathological examinations of the other surgical specimens from the spinal cords revealed hamartomatous dysplasia (secondary changes in vascular malformation) and glial tissue (contusion due to narrowing of the canal). Analysis of angiotensin converting enzyme (ACE) in cerebrospinal fluid was useful in the diagnosis of neurosarcoidosis. The sequential changes on MRI were of value in diagnosing ischemic cord infarction. Nevertheless we stress the importance of close follow-up evaluations of clinical symptoms. Indication of biopsy or surgical treatment should be carefully determined to avoid unnecessary cord exploration and biopsy.

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The authors examined the clinical features, neuroradiological findings, surgical results, and performed molecular analysis of the von Hippel-Lindau (VHL) tumor suppressor gene in 10 patients with 17 spinal hemangioblastomas. Change from pre-to postoperative functional status was graded according McCormick's classification. Germline or somatic mutations of the VHL gene were examined with single-strand conformation polymorphism (SSCP) analysis, direct sequencing. Assessment with McCormick's classification resulted in improvement in all cases except for no change in one case. Germline mutations of the VHL gene were detected in 3 out of 4 VHL cases, and somatic mutations were detected in 1 out of 4 sporadic hemangioblastomas. In conclusion, surgical treatment of spinal hemangioblastoma can be achieved at low levels of surgical morbidity. DNA analysis of the VHL gene is useful for genetic screening and decision making of treatment of spinal hemangioblastomas.

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Percutaneous vertebroplasty (PVP) is a therapeutic procedure that consists of a percutanous injection of surgical cement into a vertebral osteoporotic compression fracture. We report the first 8 patients treated with PVP at our hospital. We conclude that PVP for compression fractures may be a minimally invasive procedure that provides pain relief immediately.

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Objectives : Spinal surgeons generally use an air drill system for operations. We report our results using ultrasonic osteotome in recent years for spinal surgery. Subjects and Methods : The period of this study was from September 1997 to December, 1998. The subjects numbered 42 patients (18 cervical disc disease, 6 cervical OPLL, 15 lumbar canal stenosis, 2 lumber disc hernia and 1 spinal tumor). Ages ranged from 25 to 78 with 54.2 as the mean age. We performd anterior decompression in a total of 17 cases (11 cases at level one, 6 cases at level two), in 4 cases of laminectomy, in 16 cases of laminectomy and medial facetectomy, and in one case of hemilaminectomy and herniotomy. We used ultrasonic osteotome (Sumisonic ME-2400 made by SUMITOMO BAKELITE CO., LTD) in all these cases. Conclusion : We were able to perform spinal surgery more safely with this method as compared with the air drill system, especially when dealing with soft tissue. This ultrasonic osteotome did not roll into the surrounding tissues, because the material as it did not have rotative movement. Risks of damege for the dura matter and compression of the spinal cord were reduced, because we were able to break bone tissue using only a light touch.

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The national diet has proposed and is taking care of a new law in terms of dealing with private data for the adaptation of rapid changes in computer technology and the society. Patients in a research study should give their consent to the use of data that preferably should not identify them directly. By these restrictions, the long-standing common law delineating the duty of doctors to observe strictly the confidentiality of their patients, intrinsic in the Japanese constitution as well as the Helsinki Declaration, may be supplemented by restrictions on processing electronic and paper based records. The Seventh Division of the Science Council of Japan asked that this preliminary law should be modified along with the existing common laws so that authors working in the field of spine and spinal cord research activities observe ethical rules in dealing with patient-identifiable data, similar to the other surgical fields. The three main Japanese societies whose scope includes spine and spinal cord diseases did not have any rules as far as contributions to their official journals, nor presentations at their meetings, nor in their regulations. Sixteen domestic journals out of 50 and 32 overseas journals out of 50, respectively, in the surgical field provide ethical regulations in terms of contributions to these journals. The current study concludes by proposing that Japanese physicians should take into account the protection of privacy in dealing with patient-identifiable data while the new law is under modification.

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A case of infant cervicothoracic lipoma with intracranial extension is reported. The lipoma was located from the fourth ventricle to the level of the fourth thoracic vertebra. Partial resection of the lipoma and dural plasty combined with osteoplastic craniotomy and laminectomy were done. Postoperative examination revealed slight improvement in motor activity.

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Lateral thoracic meningocele is rare and usually associated with neurofibromatosis. Their etiology is still controversial. Also spontaneous leakage of the spinal cerebrospinal fluid (CSF) is rare, but it is increasingly recognized as a cause of intracranial hypotension. The authors report a case of traumatic subarachnoid-pleural fistula mimicking lateral thoracic meningocele. A 52-year-old woman presented the symptom of intracranial hypotension secondary to a leakage of CSF originating from traumatic thoracic pseudo-meningocele. Most cases of intracranial hypotension resolve spontaneously, but in cases with protracted symptoms we suggest that surgical treatment can be accomplished with satisfactory results. We postulate the role of trauma in development of lateral thoracic meningocele in some patients without neurofibromatosis.

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There are many problems in the treatment of metastatic spinal tumors, particularly when we must take into consideration of the patient's : life expectancy, his or her medical conditions, and the severity of neurologic symptoms. A 61-year-old male patient with C6 metastatic gastric cancer underwent surgery due to the rapid progress of tetraparesis and intractable neck pain, making the supine position impossible. Pyramesh^<TM> and Orion plate^<TM> were used for reconstruction of the cervical spine, due to metastases to the ilium. Postoperative improvement was satisfactory and the patient was able to have a fruitful and pain free life for four months, in so much that he could even play golf. A surgical approach may be effective for the establishment of ADL, even in cancer patients under systemically aggravated conditions.

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