Background and Context: The efficacy of iliac crest strut autograft and dynamic plating (ABC: Aesculap, Tuttlingen, Germany) for one level anterior cervical corpectomy/fusion with two level diskectomy (1 level ACF ) needs to be established.
Purpose: To document fusion (2D-CT and dynamic X-rays) and outcomes (SF-36) following 1 level ACF.
Study Design/Setting: Graft and plate-related complications and outcomes were prospectively evaluated in 86 consecutive patients undergoing 1 level ACF.
Patient Sample: Preoperative MR/CT studies documented contiguous two-level disc disease, spondylosis, stenosis and/or ossification of the posterior longitudinal ligament (OPLL).
Outcome Measures: Fusion was documented on 2D-CT/dynamic X-rays. Outcomes (Odom's Criteria, Nurick Grades and SF-36 ) were assessed 3, 6, 12, and 24 months postoperatively.
Methods: Patients averaged 48 years of age and exhibited moderate/severe preoperative myelopathy (average Nurick Grade 3.0). All underwent 1 level ACF, and were followed an average of 3.5 years (minimum 2 years).
Results: Two pseudarthroses, 2 delayed strut fractures, and 1 plate/graft extrusion (5.8% total) developed postoperatively; all required secondary posterior fusion. Outcomes 2 years postoperatively revealed mild residual radiculopathy (average Nurick Grades 0.24), 82 good/excellent outcomes (Odom's Criteria), and marked improvement on 6 SF-36 Health Scales. The average time to fusion was 4.7 months.
Conclusions: Successful 2D-CT/dynamic X-ray documented fusion occurred in 94.2% of patients undergoing 1 level ACF performed with iliac crest autograft and dynamic ABC plates. Results were comparable to those cited for fixed-plates in other series.

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Subpial spinal lipoma (SPL) is a rare tumor with an incidence of 1% of primary spinal cord tumors. The few scattered reports of SPL have described its generally poor prognosis and lack of improvement following surgery. We report 5 cases of SPL and discuss the difficulties associated with its treatment (7 surgeries).
Among 66 cases of spinal cord tumors encountered at Jikei University School of Medicine, Japan, between 1998 and 2003, 5 cases were diagnosed as SPL and 7 surgeries were performed (including 2 reoperation cases due to deterioration). Postoperative outcome was unchanged following 3 surgeries, including 1 reoperation case and deteriorated following 3 cases, 4 surgeries.
Deterioration in the 3 cases (including both reoperation cases) was caused by extensive removal of the SPL (n=1), postoperative kyphotic deformity (n=1) and was probably caused by adhesive arachnoiditis due to the re-operation (n=1).
These treatment results were unsatisfactory. SPL has a different pathogenesis from the lipomas associated with dysraphism. However, compressive factors appear to play an important role in the etiology of spinal damage, as malformative or hamartomatous lipoma cause neurological deficit at some ages. Therefore, biopsy or insufficient removal of the SPL might not prevent the progression of symptoms. On the other hand, extensive removal sometimes results in spinal injury. In addition, deformity of the vertebra should be considered. Decompression of the spinal cord due to partial removal of SPL, and reconstructive laminoplasty for alignment might be the best surgical option.

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341 operated cases of lumbar disc hernia were analyzed. Cases of pure hernia were 87%, those with lumbar canal stenoses were 13%. The average age was 50.3 years-old and the male to female ratio was almost 2 to 1.
The indication of surgery should be analyzed first, according to the patient's neurological status, complaints and the duration of leg pain. It also can be determined by examining the evidence of the findings of radiological images of neural compression. However, it may be also indicated, in consideration of the psychiatric aspects, excluding neurological degenerative diseases.
In deciding the surgical plan, (whether it is limited to minimum surgery, or extended to the wide laminectomy), the surgeon should consider the following points; whether the patient is of working age or not, and whether his labor is physical work or not, for example.
One of the other important points of surgical strategy is to make a change as promptly as possible from minimum laminotomy to the wide laminectomy, when the case of a large size hernia is accompanied with a severely narrow canal. This is in order to protect the nerve root, at the same time, as aiming for the maximum removal of the herniated tissue. Nevertheless, the rate of recurrence could not be decreased more than 2∼3%.
The investigation of preoperative risk factors brings a decrease in the percentage of complications, such as, brain or heart vascular disorders, Exceptions would be postoperative infections or hematomas.

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Purpose: Some elderly people, suffering from numbness or pain in their lower limbs, gait disturbance and so on, are restricted in their daily life. We undertook operations for these elderly patients over eighty years old with degenerative lumbar spine disease and acquired excellent results. Operative methods and outcomes are reported.
Materials and methods: 623 patients of degenerative lumbar spine disease were surgically treated in Inazawa City Hospital. 36 (5%) out of those 623 were performed on patients aged over eighty years. There were twenty-eight lumbar canal stenoses, six lumbar disc herniations, and two superior facet syndromes. Symptoms were; numbness or pain in the lower extremities in twenty-nine, and intermittent claudication in sixteen. Unilateral lumbar fenestration was considered at first as the operative approach for degenerative lumbar disease and bilateral lumbar fenestration was carried out for the patients with bilateral radiculopathy. Central lumbar fenestration was also selected for patients with severe lumbar degeneration. Moreover, if necessary, lumbar fixation was added to lumbar fenestration.
Result: Operative approach was chosen as central lumbar fenestration in seventeen, unilateral lumbar fenestration in seventeen, and bilateral lumbar fenestration in two. In six cases instrumentation was used for lumbar fixation. Intermittent claudication improved in all cases. However numbness or pain in the lower extremities was not improved in three patients, so a second operation was performed for them. After the second operation, their symptoms improved.
Conclusion: The purpose of the operations for elderly patients with degenerative lumbar spine disease was to improve the restrictive symptoms in their daily life. Operation was limited, only to the levels presenting symptoms, and can not be decided only with radiographic findings. In operative approach, central lumbar fenestration had advantages in the safety of the procedure and appropriate operative decompression for degenerative lumbar spine. Even if lumbar fixation was needed, a less invasive method had to be chosen.

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Objective and Importance
Minimally invasive techniques for spinal surgery are rapidly evolving. We present a rare case of a symptomatic spinal epidural cavernous hemangioma that was treated using minimally invasive surgical techniques. The pathophysiology, radiology, and histology of epidural cavernous hemangiomas are reviewed. The advantages and pitfalls of minimally invasive spinal surgery techniques are discussed.
Clinical Presentation
A 45 year-old woman presented with a four-year history of right leg weakness and difficulty with ambulation. MRI examination of the lumbar spine revealed an epidural mass.
Intervention
The patient elected to undergo a minimally invasive, microendoscopic resection of the lesion. The MetRx^TM (Medtronic, Memphis, TN) dilator system was employed to gain access to the L2 lamina. A hemilaminectomy and resection of the lesion was accomplished without complication.
Conclusion
Spinal epidural masses, in this case a cavernous hemangioma, can be safely and effectively treated with minimally invasive techniques. With decreased soft tissue injury, minimal blood loss, and shortened operative time, minimally invasive techniques should be considered when resecting epidural masses.

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A 64-year-old woman with a 3-month history of gait disturbance and left leg numbness followed by headache, dementia and urinary incontinence. Head computed tomography (CT) revealed marked ventriculomegaly and magnetic resonance imaging with gadolinium contrast showed an enhanced mass at C2-3. Excision of neurinoma resulted in improvement of both gait and memory disturbance with no urinary incontinence. Follow up head CT demonstrated ventricular size became smaller without periventricular lucency. In this case, mechanical obstruction of the cerebrospinal fluid (CSF) pathway resulted in alteration of the spinal subarachnoid space function as a ‘buffer reservoir’ to cranial CSF circulation, and this can play a critical role, particularly in patients with normal CSF protein concentrations.

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Objective: A case of spondylolytic spondylolisthesis at L4/5 and L5/S1 was treated by performing 360 degree fusion using combined unilateral transforaminal lumbar interbody fusion (TLIF) and contralateral pedicle screw fixation (PSF).
Case report: A 78-year-old man presented with 8-year history of low back pain and left leg pain. Neurological examination showed positive straight leg raising test on the right and hypesthesia in the left L4 region. Computerized tomography and magnetic resonance imaging demonstrated spondylolysis at L4 and L5 with slip at L4/5. The patient was treated with a single cage by performing TLIF from the left L4-5 foramen obliquely to the ventral cortex (45 degree to vertical plane), and then PSF at L4, L5 and S1 under an intraoperative fluoroscopy.
Result: Postoperatively, the patient showed a marked recovery. His left leg pain and low back pain subsided, and he was back to work shortly after the operation.
Conclusion: Spondylolytic spondylolisthesis is one of the targets of spinal instrumentation. Although a broad combination of implants can be selected for this pathological condition, combined TLIF after discectomy and contralateral PSF was useful in a case like this.

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A 42-year-old man suffering from not only meralgia paresthetica-like symptom at bilateral thigh for 8 months but paraparesis after lumbar surgery for L5/S disc hernaition was admitted to our hospital. MRI and CT scan revealed an anterior cervical spinal cord compression at C5/6 level by a horn-like osteophyte in addition to the disc herniation at the same level. The patient was successfully treated by an anterior decompression for the cervical disease to be free of both meralgia-like paresthesia and paraparesis.

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Juxtafacet cysts can be formed in the spinal canal, most often near an articular facet or in a yellow ligament, and possibly causing neurologic symptoms mimicing disc herniation. These cysts are diagnosed by characteristic findings on magnetic resonance imaging (MRI) or computed tomography (CT) scan. Pathologists divide these cysts into synovial and ganglion types but they do not have any prognostic significance. In this article, we report three surgical cases which presented with radiculopathy, proven to have originated as juxtafacet cysts. All the patients underwent surgical excision of the lesion and had good recovery from their symptoms. A follow-up at 6 months has not revealed any recurrence or new neurologic conditions. Recurrence after surgery is extremely rare and has only been reported in the lumbar spine cases. Reported clinical outcomes of surgical treatment have been considered to be satisfactory.

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A case of two non-contiguous burst fractures of the thoracolumbar spine is presented. The patient was a 54-year-old female, who had a traffic accident, fell off the bus and landed on her back. She had been suffering from severe pain in her back and paresis of the lower extremities. X-ray showed burst fractures of both Th12 and L3. CT scan and MRI showed severer anterior compression of the spinal cord at L3. We performed anterior decompression and stabilization for L3 and conservative treatment for T12. Postoperatively she was free from backache but scoliosis developed gradually. We will discuss the treatment for this case with non-contiguous burst fractures.

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