Recently, spinal surgery by neurosurgeons has been gradually increasing in Japan. It may not take a long time until spinal surgery will become a main business for neurosurgeons in our country, similar to other countries. How frequent is spinal surgery currently performed by neurosurgeons? To understand this, it is necessary and important for neurosurgeons to activate and develop the department of neurosurgery. In this report, we demonstrate the results of survey questionnaires to all of the neurosurgical institutes in our country in 2004 to evaluate the present situation of spinal surgery for neurosurgeons.
In the results, 8.65% of all surgical cases by neurosurgeons was spinal surgery. This rate increased compared to the results of 1996 and 2000. However in about 40% of all neurosurgical institutes, spinal surgery was not performed at all. In this report, regional analysis, which separated our country into 9 areas, was also performed. In the results, spinal surgery was found to be performed actively in the areas of Chubu, Kansai, Hokkaido, and Hokuriku. However, the Tohoku, Shikoku, and Chugoku areas were not vigorous in spinal surgery.

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Spinal hemangioblastomas may occur sporadically or in association with von Hippel-Lindau(VHL) syndrome. The purpose of this study is to elucidate the clinical differences between sporadic and VHL groups retrospectively.
Eighteen patients presented with spinal hemangioblastomas. Eleven patients harbored sporadic ones and 7 had VHL syndrome. Although patients in VHL group tend to be presented with clinical symptoms at a younger age than do patients in sporadic group, no differences were found in initial symptoms, duration of symptoms and the location of the tumor. MRI findings depended on the size of tumors, however, there was no difference between two patient groups, except for the multiplicity and higher percentage of small tumors in VHL group. Surgical outcomes are favorable in both groups.
Surgical outcomes for spinal hemangioblastomas are generally favorable. However, management of lesions is more difficult for patients with VHL syndrome. Therefore, in patients with spinal hemangioblastoma, clinical and neuroradiological screenings are important to differentiate between sporadic hemangioblastoma or in association with VHL syndrome.

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Generation of free radical plays an important role in development of secondary spinal cord injury (SCI). Edaravone is a free radical scavenger, and has been used for protection against ischemia in patients with cerebral infarction. We investigated the effect of edaravone on severe experimental SCI. Treatment with edaravone (3mg/kg of body weight administered intravenously and subcutaneously (s.c.) immediately after injury, plus 3mg/kg s.c. on day 1 and day 2) was compared with saline treatment in rats subjected to severe 50 g · cm weight drop thoracic SCI. Neurological recovery was evaluated periodically over 3 weeks by BBB locomotor rating scale and inclined plane method (IPM). To investigate protective effect of edaravone on axons, we evaluated the preservation of rubrospinal tract by counting red nucleus (RN) cells labeled retrogradely from lumbar spinal cord with fluorescent tracer. Edaravone significantly improved recovery in early phase in both BBB scale and IPM. The number of labeled RN neurons of edaravone-treated group had a tendency to be larger than of control group. These results indicate that edaravone has therapeutic potential for protecting the injured spinal cord.

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Dysfunction of the C5 nerve root, called C5 palsy, has been known as one of the complications after cervical spinal surgeries. Adding foraminotomy or not, to prevent this mechanical hidden complication remains controversial.
In our institute, from 1996 to 2001, spinous process-splitting laminoplasty without foraminotomy was performed in the treatment of a total of 126 patients with cervical spinal cord compression. 94 cases were diagnosed as cervical spondylosis, 33 cases as narrow canal and 41 cases as ossification of the longitudinal ligament. Most of the stenotic lesions were shown from C4 to C6. In 97 patients, numbness of the upper extremities was recognized preoperatively. In 20 patients, pain was recognized and in 51 paresis. After the cervical surgery without foraminotomy, only 7 cases developed complications of the upper extremities and particularly paresis in one(0.8%). These complications disappeared within at least one month.
These results seem to suggest that foraminotomy is not necessary to prevent dysfunction of the cervical nerve root.

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Drop foot occurs commonly by peroneal nerve palsy, however it is generated to any portion from a brain to a peripheral nerve. We investigated 8 patients (Male 7, female 1) with drop foot from April, 2003 to December, 2003. The cause was brain tumor in 2 patients (superior frontal gyrus astrocytoma: 1, parasagittal meningioma: 1), ossification of yellow ligament (OYL) of thoracic level in 2 patients (Th11/12: 2), lumbar disc herniation in 3 patients (L4/5: 3) and lumbar canal stenosis in 1 patient (L4/5). The period from initial symptoms to a definite diagnosis were 2.5 and 3 years in brain tumor, 4 and 5 years in thoracic OYL, several days or during follow-up in lumbar disorders. In brain and spinal epiconus disorders, there was a tendency for delayed diagnosis. Although the cause of drop foot are dominantly peroneal nerve palsy and lumbar disorders, it was considered that rare causes such as brain and spinal epiconus disorders should be included in the differential diagnosis of drop foot.

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In the fall of 2000 Dr. S. Hinohara, Tsukiji, Tokyo, launched a campaign of “New Elder Citizen's movements” where people more than 74 years of age are encouraged to lead a more motivated active life. The New Elder Citizen's movement particularly emphasizes physical and mental independence from younger age generations and positive contributions to the contemporary society. During the past three years the authors treated 20 such consecutive elderly patients with lumbar spinal stenosis (LSS) surgically. In this age group of patients the clinical study was conducted to learn how well they can tolerate the operations under general anesthesia, and the various risks existing before the resumption of their previous daily active social life. Causative components of LSS were only one or combination of the two or three or four out of compressive lesions such as intervertebral disc prolapse, hypertrophic lig. flavum, and hypertrophic facets and laminae. Surgical results were evaluated by The Japanese Orthopedic Association (JOA) scores with calculation of recovery rate(%). In 75% of the patients studied, neurogenic intermittent claudication and radicular pain were in complete resolution post operatively, irrelevant to the duration of symptoms, level and number of compressing lesions. None of the 20 patients required spinal fusion because of the absence of spinal instability. During the same span of three years, three patients were considered not to be good candidates for decompressive surgery because of poor physical status for general anesthesia such as severe ischemic coronary heart disease, dementia with hearing loss and pulmonary emphysema with atrial fibrillation and recent stroke.
To expect favorable surgical outcomes with full recovery in the age group of patients such as “new elder citizens” with LSS, shorter preoperative duration of symptoms and evaluation of the strong desire to recover and to resume the patient's previous social life without dementia-in-progress seems to be of absolute necessity.

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The detection rate of spinal intramedullary cavernous angioma (IMCA) has increased with the increasing use of magnetic resonance imaging (MRI) techniques. The risk of progressive deterioration after serial hemorrhagic events is well recognized, but the indications for surgical resection of spinal IMCA are controversial. We present three consecutive cases of surgically treated cervical IMCA. Two patients had obvious signs of sensorimotor deficit corresponding to the level of the lesion. The other patient presented with frequent episodes of dizziness and neck pain. T2-weighted MRI showed characteristic hemosiderin deposits in all 3 cases. The cervical IMCAs in this series were located on the dorsal surface of the spinal cord.
Areas of discoloration (hemosiderin deposits) were easily identified on the surface of the spinal cord in all three cases, glial planes were identified between the lesions and spinal cord. Total resection of the IMCAs was achieved by careful microsurgical dissection under intra-operative monitoring. The Valsalva maneuver was used to check for residual vascular lesions.
When dorsal cervical IMCAs are identified by MRI, surgical treatment should be considered to prevent catastrophic deterioration due to recurrent hemorrhage.

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A 65-year-old man presented thoracic paraplegia following lumbar spinal surgery because of a missied thoracic compressive lesion. A Magnetic resonance image showed an extradural mass causing spinal cord compression at T6 level. Emergent decompression allows patient to walk unassisted 3 months after surgery. We should be aware of the possibility of double lesions in patients who require lumbar surgery.

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