Objective: A retrospective study was done on a series of patients in whom authors performed a pedicle subtraction wedge osteotomy within a single vertebral body for deformity correction and decompression. Methods: The authors performed 16 pedicle subtraction osteotomy procedures in patients with thoracolumbar kyphosis after osteoporotic vertebral fracture (OVF). Fourteen cases were available for follow-up 24 months after operation, averaging 33 months (range 27-51 months), are included. Patient examination and interviews, subjective questionnaire, chart reviews, and radiographic measurements were performed. All patients had severe pain and/or deformity; 12 (86%) cases had a preoperative neurologic deficit including two patients with cauda equina syndrome. 6(42%) patients were unable to stand. Their mean age was 66.1 years (range 52-76 years). The mean local kyphotic deformity before surgery was -34.1 degrees (range -58 to -19 degrees). Results: At 24-month follow-up, the mean local kyphotic deformity measured -10.7 degrees (range - 24 to 12 degrees), indicating that the mean surgical correction was 23.5 degrees (range 10 to 36 degrees); All the 12 preoperative neurologic deficit cases improved postoperatively. All patients reported decreased back pain at follow up without narcotic analgesic medication. Complications included two temporary minor neurological injuries and three associated medical complications. There was one case of a neural compression by the dural wrinkling treated conservatively. There were no deaths and prolonged intensive care stay. Conclusion: Pedicle subtraction osteotomy provides both sagittal correction of kyphotic deformity and decompression of spinal cord in the thoracolumbar region. Complications, risks were affordable if patients were carefully selected.

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OBJECTIVE: The craniocervical junction(CCJ) diseases often require posterior fixation surgery. For the treatment of the CCJ diseases, C1-2 transarticular screw (Magerl technique) which was used as an anchor screw in combination with other cervical instrumentation or for atlantoaxial fixation provides immediate stability and rigid fixation. However, the technique remains technically demanding and has hazardous complications. Recently, C1 lateral mass screw(C1LMS) and C2 pedicle screw(C2PS) have been used for the posterior instrumentation. We reviewed 13 cases of the CCJ diseases treated by using C1LMS and/or C2PS. MATERIAL AND METHODS: Between June 2003 and July 2006, 13 patients (6 male, 7 female) who ranged in age from 21 to 77 years-old underwent posterior fixation using C1LMS and/or C2PS. Five patients had atlantoaxial subluxation due to rheumatoid arthritis, four had congenital abnormalities including Chiari I and os odontoideum, two had degenerative articular cyst due to CCJ instability and two had traumatic lesions. All cases used navigation systems preoperatively to confirm the feasibility of implanting screws. All screws were placed under lateral fluoroscopic guidance. RESULT: Both C1LMS and C2PS were used to achieve atlantoaxial or occipitocervical fixation in nine patients. Combining either C1LMS or C2PS with other cervical instrumentation were used to achieve atlantocervical or occipitocervical fixation in four. There were no permanent complications. In all cases rigid fixation was confirmed on postoperative radiographs and maintained on follow-up radiographs. CONCLUSION: We suggest that C1LMS and C2PS are efficacious in posterior fixation for CCJ diseases. Particularly, in cases precluding to achieve posterior instrumentation including C1-2 transarticular screw, this procedure provides rigid fixation and the feasibility of short fusion in safety.

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The simple decompression procedure for degenerative spondylolisthesis is noninvasive and ample for the cases which complain only of lower extremities symptoms. However some patients have intolerable lower back pain, for which the lumbar fixation technique should be performed. The posterior lumbar interbody fusion (PLIF) and the pedicle screw fixation (PSF) are generally performed. Also, the less invasive procedures such as the unilateral approach, the transforaminal approach and the percutaneous pedicle screw insertion have been reported. The selection of these procedures depends on the experience of the surgeons and remains controversial. We report a new technical procedure. This one is the combination of the unilateral PLIF and the interspinous process fixation by the hemilateral approach. A total of 16 patients underwent this procedure from 2004 to 2006. The characteristics of this technique are the almost bloodless procedure, the bilateral facet joints preservation and the whole microscopic maneuver. The outcomes of all patients are good and so far no minor or major complications have been observed.

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The authors conducted a retrospective analysis of patients with thoracolumbar fractures who underwent instrumentation surgery via anterior or posterior approach. The study group was composed of 25 men and 7 women with the mean age being 40.5 (range 15-69 years). The affected level was midthoracic in 5 patients, thoracolumbar in 23, and lumbar in four. The type of injury was classified as burst fracture in 22 patients, compression-distraction in two, and fracture dislocation in eight. The instrumentation was placed posteriorly in 21 patients and anteriorly in 11. Most of the patients with burst fracture were treated by anterior approach; however compression-distraction and fracture dislocation patients were treated by posterior approach. Solid bony fusion was achieved in all patients. Good neurological outcome was obtained in 26 of 32 patients independently of whether the fixation was by anterior or posterior instrumentation. The five patients who had sustained complete spinal cord injury didn't recover neurologically. The initial and at follow-up kyphotic angle averaged 17.7 and 13.1 degrees in the anterior instrumentation group. They averaged 18.3 and 12.8 degrees in the posterior group.

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We report here on a 33-year-old man who presented with intraventricular hemorrhaging (IVH) into the fourth and third ventricles that was caused by a cervical intramedullary arteriovenous malformation. The patient suddenly suffered from occipitalgia, frequently vomited and had a deteriorating headache. Computed tomography (CT) revealed intracranial hemorrhaging in the fourth and third ventricles, and magnetic resonance (MR) angiography and CT angiography showed a vessel coursing ventral to the brainstem connecting to the superior petrosal sinus. We subsequently diagnosed dural arteriovenous fistula of the superior petrosal sinus and performed cerebral angiography. A six-vessel-study showed no dural AVF, but we found a venous structure draining into the petrosal sinus. Vertebral angiography was thus focused on the cervical region with the spinal arteriovenous malformation at the cervical levels 6 and 7. Selective angiography of the muscle branches of the right vertebral artery revealed an AVM nidus and draining veins of the anterior spinal, anterior medullary, lateral pontine, petrosal veins, as well as the superior petrosal sinus, lateral mesencephalic vein, posterior mesencephalic vein, and straight sinus. Although it was difficult to assume the exact position of the rupture, it is conceivable that the rupture occurred form the intracranial draining vein, and anterior medullary vein, which coursed closest to the orifices of the fourth ventricle. The unique clinical features of the present case were (1) fourth intraventricular hemorrhage which is usually caused by an aneurysm or vascular malformation in the posterior fossa, (2) the intracranial draining veins being connected to the petrosal sinus visualized by MRA and CT angiography, leading us to diagnose him with dural AVF, and (3) intraventricular hemorrhaging caused by the rupture from a draining vein in the posterior fossa of the cervical intramedullary AVM without accompanying intramedullary hemorrhaging.

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We report a unique case of postoperative CSF leakage secondary to expansive laminoplasty for cervical ossification of posterior longitudinal ligament (OPLL) treated by insertion of ventricular drainage and dural repair. 34 years old, male was admitted our hospital introduced, because of his paraparesis. He had hereditary congenital rickets, therefore he took Calcium medicine for a long term. Neuroimages revealed massive OPLL at C3-7. Expansive open door laminoplasty was performed. At the operation, we found CSF leakage from the thinning dura and we repaired dural defect with muscle and fibrin glue. 10 days after operation fluid collection and CSF leakage from the operative wound was observed. The ventricle drainage and dural repair were performed, because lumber drainage could not be inserted. After second surgery CSF leak was improved. Generally speaking the ventricular drainage is not the first choise procedure for the postoperative CSF leakage. But the ventricular drainage is the basic procedure for our neurosurgeons and the complication rate of the ventricular drainage was reported about 1%. If necessary the ventricular drainage is thought to be the choice for continuous CSF drainage.

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Solitary or multiple osteochondromas are rarely found in the vertebral column. We reported two cases of solitary lumbar spinal canal osteochondroma arising from the articular process that contributed to radiculopathy: in the cases of a 57-year-old man and a 63-year-old woman with no history of hereditary multiple exostoses. Osteochondroma compressing the spinal nerve root was seen at the articular process of the lumbar vertebrae by computed tomography (CT), three-demensional reconstruction of CT scans, myelography, and magnetic resonance imaging. The symptoms disappeared after surgical removal of the lesions. Histopathological examination confirmed the diagnosis of benign osteochondroma.

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