Cervical spine kyphotic deformities are common sequelae of degenerative disease. Patients may present with a combination of symptoms including myelopathy and radiculopathy. We retrospectively studied a cohort of 78 patients who underwent decompression and reconstruction of the cervical spine for such deformities. Decompression and reconstruction were done by vertebrectomy (51%), multilevel interbody arthrodesis (40%), posterior decompression and reconstruction (4%), and circumferential surgery (5%). In those patients whose pretreatment kyphotic deformity was more severe than -15 degrees, 10 of 27 required revision compared with only 4 of 51 patients whose initial deformities were less than -15 degrees (p<0.005, Fisher exact test). For patients requiring revision surgery, the average degree of pretreatment kyphosis was -25.1 ± 16.6 degrees compared with -12.4 ± 10.0 degrees preoperative angulation for those patients who were effectively treated via their primary procedure (p<0.001, unpaired t-test). The mean preoperative kyphosis was -14.6 degrees, which was improved to a mean postoperative lordosis of +5.3 degrees. For patients with symptomatic cervical kyphotic deformity, consideration should be given to decompression and stabilization. In patients whose pretreatment deformity is -15 degrees or greater, strong consideration should be given to circumferential decompression and reconstruction with internal fixation and arthrodesis.

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This study was designed to determine the mid-term follow-up outcome of herniated intervertebral discs treated with Nucleoplasty^TM (Arthrocare spine, Sunnyvale, California, U.S.A.) which utilizes coblation technology for ablating and coagulating the nucleus for partial disc removal. Sixty-five patients underwent Nucleoplasty from August 2000 through February 2002. Sixty-one patients who had been followed-up more than 12 months were included in this study. Male was outnumbered female by 37 to 24 and their mean age was 32.3 years (21-46). Fifty-three patients underwent one level procedure and 8 patients underwent two level procedure. The L4-5 level was the most commonly involved. All patients had axial pain and 49 patients had accompanying radiating pain in the leg. Intraoperative discogram was performed to determine the symptomatic level. Most patients underwent the procedure under the local anesthesia and discharged same day or next day. Ruptured or migrated disc herniations, spinal stenosis, previous major spinal surgery and definite radiological spinal instability were contraindications. Mean follow-up period was 15.6 (12-27) months. Average operation time was 46 minutes. The surgical result according to the MacNab classification showed Excellent and Good in 51 cases, Fair in 7 cases and Poor in 3 cases. Most patients showed symptom improvement one or two days after surgery. There was no heat related nerve injury. Difficulties were found in targeting into L5-S level. Three patients underwent an open discectomy and three patients had an epidural steroid injection during the follow-up period. There was one discitis that treated with intravenous antibiotics as a surgery related complication. These results indicate that the Nucleoplasty is a safe and reliable armamentarium in minimally invasive disc surgery for the contained herniated intervertebral discs. Patient selection is the most important key for the successful surgical result

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The author presents the C1-C2 fusion technique using individual fixation of the C1 lateral mass and the C2 pars interarticularis with polyaxial screws and rods. Materials and Methods: Four patients with ages ranging from 19-41 had C2 fractures and one 81 year -old female had granuloma at the level of C1. Results: All patients showed improvement of atlanto-axial instability without complications and mean blood loss was 50cc. Careful subperiosteal stripping was useful for C1-2 exploration. Conclusions; This “Harms methods” C1-2 posterior fixation using polyaxial screws and rods is a useful and safe technique without intraoperative navigation systems and postoperative C1-2 articulation.

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Recently spinal degeneration disease and spinal surgery for elderly patients is increasing. It may increase the incidence of postoperative dementia and delirium in elderly patients compared to that of younger ones. The present study was designed to examine the risk factors for dementia and delirium after spinal surgery in elderly patients. We studied 39 patients who had spinal surgery aged greater than 70 years. We retrospectively studied about age, duration of anesthesia, duration of bed rest, and past history. The incidence of postoperative dementia was 9 (23.1%) and delirium was 2 (5.1%). Delirium was improved after leaving the bed, but 8 patients however had dementia which lasted until time of discharge, many of which developed a tendency to improve after that time. Patients who had postoperative dementia or delirium tended to have a diabetes mellitus and significantly longer length of stay in bed at the preoperative stage due to paresis from spinal cord injury. These results suggested that age, diabetes mellitus, bedridden to be important factors in postoperative dementia and delirium.

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OBJECTIVE; The results in patients with lumbar spinal canal stenosis (LCS) who undergo re-operation for failed back surgery syndrome are usually unsatisfactory. We will report our results in a series of 54 patients with recurrent LCS who were re-operated. PATIENTS AND METHOD; We reviewed 54 patients who underwent posterior re-decompression without fusion to treat recurrent LCS. All were operated at our institution during the last 5 years. At the initial operation, all patients underwent posterior decompression and 8 of them were also subjected to posterior fusion. RESULT; The most common reason for the re-operation was stenosis of the lateral recess. Further treatment after the initial operation was required in 3 patients with iatrogenic spondylolisthesis. The symptom recovery rate, assessed on the JOA score, was 68.6%. The surgical outcome was better in patients whose symptoms were present for less than 1 year before re-operation. Instability of the lumbar spine before the 2nd operation was not significantly correlated with poor outcomes. CONCLUSION; Re-operation consisting of posterior re-decompression without fusion did not worsen the clinical condition of our 54 patients. There was no significant correlation between instability of the lumbar spine before re-operation and poor outcomes. Our findings stress the importance of carefully considering the indication for fusion in patients undergoing re-operation for LCS. As we found a significant correlation between poor results and the duration of symptoms in re-operated patients, the observation period after the first operation must be limited to avoid poor outcomes.

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A case of ossification of anterior longitudinal ligament at C2/3 level with dysphagia is presented. The patient was a 70-year-old man. He had been suffering from dysphagia for five years. He was admitted to our hospital with increasing dysphagia and muscle weakness of the right arm. X-ray and three-dimensional CT showed a small anterior osteophyte at C2/3 level. MRI demonstrated a spondylotic hard disc compressing the spinal cord at C3/4 level. We performed anterior decompression with fusion using titanium cage and autogenous graft bone for C3/4. In addition, surgical decompression of the anterior osteophyte at C2/3 was achieved. The right arm weakness and dysphagia improved postoperatively.

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Spondyloptosis is defined as the most severe form of L5 spondylolisthesis, one that causes vertical descent of the entire vertebral body of L5 below the end plate of S1. The treatment of this complicated deformity still remains controversial. We will report about a case of spondyloptosis for whom two staged surgeries, transperitoneral L5 resection and reduction of L4 onto S1 by intrasacral fixation, were performed. A 25-year-old female, who had been diagnosed with grade 3 spondylolisthesis since she was 7 years old. The lumbosacral fixation had been recommended but she refused. At the time of admission, she complainted of lower back pain, gait disturbance, pain and numbness in her both legs, incontinence of bladder and abnormal body appearance due to the slipping of the L5. Plain radiograph showed spondyloptosis. MR imaging revealed marked canal stenosis at the S1 level. Surgery was performed in two stages. At first, the L5 vertebral body was totally resected through transperitoneal approach. During the second procedure, posterior segments of the L5 were resected through posterior approach to facilitate reduction of the L4 to the sacrum. The lumbosacral spine was stabilized using two mesh cages and was fixed by intrasacral fixation technique. After the operation, improvements in pain, neurological symptoms and cosmetic appearance were achieved. Alignment in the sagittal plain was restored. At the time of 18 months follow up, redisplacement did not occur and bony fusion was obtained.

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