Juxta-facet cysts (JFC) normally occur in the lumbar vertebrae and are sldom encountered in the cervical vertebrae. We report one case of cervical JFC with C5 radiculopathy.

  A 68-year-old male developed left M. deltoideus and M. biceps weakness. Radiography showed instability at C4/5 and a cystic lesion in the left C4/5 on MRI. Consequently, cervical anterior fusion at C4/5 and cyst extraction from the posterior approach was performed. The pathologic diagnosis was a juxta-facet cyst. After surgery, the left upper extremity muscular strength improved, and there has been no recurrence.

  To date, 45 cases of cervical JFC have been reported. As to the neurological manifestations, myelopathy is much more frequently found in these cases than radiculopathy. The most prevalent sites are at the C1-2 and C7-T1 levels. Good postoperative courses have been obtained by removing the cyst by posterior approach.

  When treating cervical JFC, we strongly suggest a thorough evaluation of vertebral instability as fixation in the case of remarkable spinal instability must also be considered.

  We report rare case of dumbbell C1 schwannoma, which was grossly removed. A 33-year-old female suffered from intermittent headache and neck pain when rotating head to the left during the past 33 months, and the symptom was progressively. Cervical spine-radiogram showed erosion of the left C1 lamina. Cervical magnetic resonance imaging (MRI) demonstrated a dumbbell shaped tumor at the C1 level, which compressed the spinal cord to the right and extended into the intracranial space beyond the foramen magnum. Extra- and intra-dural tumor was resected via a posterolateral approach with occipital craniotomy and left C1 recapping hemilaminotomy. Operative findings indicated that the tumor arose from the C1 posterior nerve root and then extended ventrally until the brainstem. Postoperatively, she had transient accessory nerve palsy especially in the left trapezius muscle, but this gradually improved. Less invasive approach for resection of cervical schwannoma should be selected in order to maintain cervical spine stability for a long time, and pertinent techniques are discussed.

  Objective : A case of a sinking laminar flap after thoracic laminoplasty is reported and the causative factors and preventive measures are discussed.

  Clinical presentation : A 44-year-old man of strong physique had an 18 months history of sensory disturbance in both legs and 6 months of progressive weakness, bladder and rectal disturbance. Magnetic resonance imaging showed an intradural extramedullary tumor at the T2 level with significant spinal cord compression.

  Intervention : The patient underwent an osteoplastic laminotomy of T1-3 for resection of the tumor under SEP and MEP monitoring. After the intradural procedure, the laminar flap was reinserted and secured with titanium miniplates to the residual laminae and the spinous processes, appearing to be correctly in the original site.

  Postoperative course : Immediately after the surgery, the patient demonstrated paraplegia. A CT scan revealed that the laminar flap was sinking into the spinal canal and compressing the cord, so the flap and spinous processes were removed emergently under local anesthesia. After the removal of the laminar flap, the patient showed improvement of his symptoms but no change of the preoperative sensory disturbance. After 2 weeks of physical therapies and rehabilitation, he was discharged on his foot.

  Consideration : Causative factors were assessed as follows : preparation of miniplates, cutting bony loss of laminae, direction of drilling and patient physique and position. Preventive measures were thought as follows : monitoring until the end of surgery, intraoperative fluoroscopy, attention to vital signs and checking the neurologic manifestation and CT scan immediately after surgery.

  Conclusion : Laminar flap sinking can occur in thoracic laminoplasty although such a complication is very rare. It is important for spine surgeons to be well informed about causative factors and to take preventive measures against laminar flap sinking.

  Medulloblastoma often comes to lead to cerebrospinal fluid dissemination and spinal metastasis, although, presentation of rapid deterioration of ambulation is rare. Generally, operative results for spinal tumors presenting lasting paraplegia are poor. We experienced a case with medulloblastoma who recovered markedly from paraplegia after treatment of operation, chemotherapy and irradiation. A 16-year-old male developed paraplegia 6 to 7 days printo operation. DTR's were not absent but no voluntary movement is abserved. He had an anesthesia below the 10th thoracic level and urinary disturbances. Magnetic resonance imaging (MRI) showed multiple metastatic tumors in the posterior fossa and the spinal subarachnoid space. The spinal cord was compressed at the 9th to 10th thoracic level.

  The thoracic cord tumor was resected, after total removal of the brain tumor. A vascular, soft tumor was found in the subarachnoid space. As the tumor adhered to the thoracic spinal cord markedly, total resection was impossible. Consequently, surgery was followed by chemotherapy with etoposide and carboplatin at 2, 6, 10, and 24 weeks after the operation. Conventional irradiation was also initiated 12 weeks after surgery. The dosage was 40 Gy in the whole brain, an additional 20 Gy in the posterior fossa and 30 Gy in the whole spine were given.

  Although the lower limbs became flaccid soon after the operation and the weakness continued for 2 weeks after the operation, he was able to stand and walk in 12 and 24 weeks, respectively. The tumor completely disappeared. A follow-up MRI showed no evidences for recurrence of brain and spinal tumors 10 months after the operation. Eventual recovery can be expected even if the paraplegia had lasted for a long time, a decompression operation in conjuction with chemo-radiotherapy should be considered.