Primary spinal and paraspinal bone tumors are rare, with most lesions arising because of metastasis. According to the bone tumor registry of the Japanese Orthopaedic Association, the most frequent origin of bone metastases is lung carcinoma. The most frequent primary bone tumor is chordoma, followed by hemangioma and giant cell tumor of bone. For diagnosis of bone tumors, a range of clinical data are to be considered, including age, gender, clinical course, and history, together with the results of imaging, cytogenetic, and histological studies. Imaging studies are particularly important as the tumors have shown particular imaging characteristics. With regard to treatment, most of the many benign tumors do not require surgical intervention. For those with severe, uncontrollable pain, or disability, treatment usually involves curettage, resection, or arterial embolization. Malignant tumors such as those of the Ewing sarcoma/primitive neuroectodermal family, rhabdomyosarcoma, and malignant lymphoma should be treated with chemotherapy. Wide or curative resection of the tumor is often impossible because of adjacent major visceral organs or the risk of severe disability after surgery. Recent advances in radiotherapy, including proton beam or carbon ion techniques, have also shown efficacy. Other recent advances worth noting include a newly recognized disease, such as benign notochordal cell tumor, and new treatments such as molecular targeted therapy utilizing anti-receptor activator of nuclear factor-κB ligand antibody against giant cell tumor of bone.

  In this review, we describe details of truncal signs in Parkinson's disease (PD). All four main motor signs in PD (loss of postural reflexes, akinesia, rigidity and resting tremor) contribute to the truncal signs to some extent in PD. The reduced postural righting reflex appears first, and it is lost in an advanced stage. Loss of postural reflexes coupled with a flexed posture may lead to festination and falling. Postural deformities (antecollis, camptocormia, Pisa syndrome and scoliosis) are frequent and disabling complications. They are produced by several mechanisms, such as body scheme defects due to centrally impaired proprioception ; axial dystonia ; muscular rigidity ; weakness caused by myopathy ; and structural changes in the spine. The above-mentioned signs contribute to the Parkinson gait ; stooped posture, small shuffling steps, festination, pulsion phenomenon and frozen gait.

  Object : We experienced 12 patients who underwent additional surgery after anterior decompression and fusion (ADF) or expansive laminoplasty (ELP). We examined the clinical course and the causes of occurring cervical myelo-radiculopathy in the cases.

  Materials and Methods : 278 patients who underwent modified trans-unco-discal approach (TUD) with iliac bone graft, or ELP using spinous process or ceramic spacers were reviewed for the neurological symptoms, Japanese Orthopaedic Association (JOA) score. Twelve patients who needed additional operation were examined regarding its clinical course and the causes for myelo-radiculopathy.

  Results : The pathogenesis in which those cases needed re-operation were 1) inadequate decompression, 2) instability, and 3) adjacent inter-vertebral lesions. Improvement of neurological symptoms after second operation is less than that after the first operation.

  Conclusions : Thorough decompresson of the cord including its lateral aspect is crucial for good results of ELP in cases with OPLL (ossification of posterior longitudinal ligament). If the cases have the instability, complete stabilization should be obtained. Adjacent lesions after ADF persist to be one of the causes for the revision.

  We report a case of spontaneous spinal subdural hematoma that was not associated with a coagulation abnormality. A 72-year-old woman was admitted to our department because of sudden back pain and motor weakness in both legs. There was no history of trauma, iatrogenic factor, or use of anticoagulant agents, and no laboratory evidence of a bleeding diathesis. Magnetic resonance imaging (MRI) showed a longitudinal, space-occupying lesion extending from C7 to T3 in the left posterolateral spinal canal. Based on the clinical and MRI findings, a cervicothoracic spinal epidural hematoma was diagnosed. The patient underwent a left hemilaminectomy from C6 through T4. A subdural hematoma was identified and evacuated. Angiography revealed no vascular malformations. Postoperatively, the patient had significant neurological recovery, and was discharged on foot 6 weeks after the surgery.

  It is important to consider the possibility of this clinical entity in patients who present with acute signs of cord compression, as a prompt diagnosis is essential for the successful treatment of spinal subdural hematoma. Differentiation of spontaneous spinal subdural hematoma from spinal epidural hematoma may be difficult and warrants close inspection of the MR images.