Introduction : Disease-specific scales for myelopathy, such as the Japanese Orthopedic Association (JOA) score, have been used to describe the treatment outcomes of spine surgery. However, these scales are not sufficiently adequate for measuring quality of life (QOL), the improvement of which is essential for patients suffering from symptoms caused by cervical spondylosis, an aging-related non-life threatening disorder.

  Methods : Patients with cervical spondylosis were prospectively evaluated using the Medical Outcome Scale 36-Item Short-Form Health Survey (SF-36) as well as the JOA score, both before and after decompression surgery.

  Results : In 102 patients with cervical spondylosis, both mental health and physical health subscales of the SF-36 were significantly lower compared with the normal population, although both modalities improved after surgery. Patients who underwent anterior fusion surgery tended to have more radiculopathy, but showed significant improvements in bodily pain and other SF-36 subscales related to mental health. In contrast, patients who underwent laminoplasty had more severe physical dysfunction, and postoperative improvement was more prominent in the SF-36 subscales related to physical health. Further, patients with better preoperative vitality showed better outcome in subscales of bodily pain, social functioning, general health, and mental health.

  Conclusion : The SF-36 is a useful tool for assessing QOL in patients with cervical spondylosis, and can be used for the evaluation of treatment effectiveness.

  Introduction : In this study, cases of cervical compression myelopathy showing enlargement of the spinal cord and hyperintensity within the spinal cord on magnetic resonance imaging (MRI) were studied to clarify clinical characteristics and provide adequate surgical treatment.

  Patients and Methods : Between 2003 and 2009, 8 patients were surgically treated at our hospital. Six of these patients had been referred to our hospital because of the tentative diagnosis of such an intramedullary lesion as myelitis. Lateral cervical spine radiographs showed mild or moderate developmental cervical canal stenosis in all patients. MRI showed enlargement of the spinal cord and hyperintensity within the spinal cord at the level of the canal stenosis in all patients. The patients underwent cervical laminoplasty without intradural exploration.

  Results : The average Japanese Orthopaedic Association score of the patients increased from 9.4 to 13.1, and none of the patients showed neurological deterioration caused by surgery. The enlargement of the spinal cord improved after surgery in all patients. However, 3 years after surgery, the symptoms recurred and radiological abnormalities were observed in 1 patient because of unknown reasons.

  Discussion and Conclusion : Compression myelopathy should be suspected if the site of spinal cord enlargement and hyperintensity corresponds to the level of the disc. If the diagnosis of compression myelopathy is highly probable, cervical laminoplasty should be the primary treatment. However, long-term follow-up is mandatory after surgery.

  We report cases of 2 patients who underwent posterior fusion (spinous process wiring and iliac bone grafting) for cervical instability. Two women aged 35 years and 43 years without a history of trauma had unilateral occipitalgia and neck pain refractory to physical or pharmacological therapy for several years. The women were unable to work because of the pain and were referred to our hospital. Neurological examinations revealed no motor or sensory impairment. In both cases, headache originated in the cervical region and was intensified by head movement. Routine radiography performed during flexion and extension of the cervical spine showed angulation of the spine at the C4/5 level in both cases. The source of the headache could not be identified on magnetic resonance imaging. Injection of 3 ml of 1% lidocaine and 4 mg of dexamethasone into the C4-5 interspinous space afforded temporary relief. On the basis of the assumption that the pain was associated with cervical instability, we performed posterior fusion at the C4/5 level by using spinous process wiring combined with iliac bone grafting. After the procedure, the pain was relieved, and both women have been free from pain for about 6 or more years. Although the pathophysiology of cervicogenic headache remains unclear, our findings suggest that cervical instability could be one of the causes. Hence, surgery should be considered for the treatment of cervical instability, particularly in patients with long-lasting headache refractory to conservative treatments.

  We report a surgical case of a dumbbell-shaped non-Hodgkin lymphoma in the thoracic spine. The patient was a 70-year-old male, who had noticed a swelling in the right thoracodorsal area approximately 6 weeks before seeking medical consultation. The swelling rapidly enlarged, and approximately 2 weeks prior to presentation, grew to the size of a fist. Both legs became paralyzed and he became aware of a loss of sensation below the waist 12 hours before presentation. Subsequently, the symptoms developed rapidly and he was brought to our department. On MRI obtained at admission, a lesion was observed in the spinal canal at the Th1-2 levels. The lesion was also observed paraspinally, and was connected with the intraspinal lesion between Th1 and 2, demonstrating a so-called dumbbell-shape. After admission, emergency surgery was performed with the aim of alleviating the pressure and obtaining a pathological diagnosis. During surgery, the tumor was observed to be not only epidural but also intradural. The pathological diagnosis showed diffuse large cell B cell lymphoma. After surgery, the symptoms improved immediately and chemotherapy was commenced. Three months after surgery, both the intraspinal and paraspinal lesions disappeared on an MRI. A pseudomeningocele was observed 3 months after surgery, but because there were no symptoms, a wait-and-see approach was adopted. At present, 7 months after surgery, the tumor has not recurred, and the pseudomeningocele appears to be receding. To our knowledge, this is only the fourth reported case of dumbbell-shaped spinal lymphoma. In patients with malignant lymphoma, when symptoms such as pain in the extremities are observed and spinal cord metastasis is suspected, then a spinal MRI should be performed immediately. During surgery for dumbbell-shaped spinal lymphoma, the surgeon should carefully determine whether or not an intradural tumor is present. Moreover, when postoperative chemotherapy is performed in such cases, careful follow-up, including checking for the formation of pseudomeningocele, is necessary.