The purpose of this article is to analyze the characteristics of spinal magnetic resonance images (MRI) in multiple myeloma patients.

　　Two hundred and eighteen patients were diagnosed with multiple myelomas at the Shonan Kamakura General Hospital from January 2009 to April 2018. Spinal MRIs were evaluated in 66 cases. Initial symptoms, spinal MRI findings, and blood sample test findings at the time of diagnosis were investigated.

　　There were 37 males and 29 females analyzed. Mean age at the time of diagnosis was 70.1 years (42 to 87 years). Main initial symptoms were low back pain (n＝23), back pain (n＝15), neck pain (n＝1), lower limb weakness (n＝6), lower limb pain/paresthesia (n＝4), cranial nerve palsy (n＝2), respiratory symptoms (n＝6), renal failure (n＝4), anemia (n＝3) and asymptomatic (n＝6). Spinal MRI revealed vertebral fracture (n＝42), intravertebral tumor (n＝35), epidural tumor (n＝9), diffuse spotty signal (n＝13), and diffuse low signal (n＝4). There were only five cases where no abnormality was observed beyond the vertebral body fracture. Dural sac compression was observed in 16 cases, of which 12 cases were co-localized with the tumor and 4 cases were by a fractured bony fragment. The results of the blood sampling were confirmed in 65 patients. Anemia, decreased albumin/globulin ratio, hyperproteinemia, hypercalcemia, and increased alkaline phosphatase were observed in 57, 44, 29, 13, and 12 patients, respectively. Only 9 cases showed normal blood test results.

　　The most common symptom of multiple myeloma was lower back pain. As such, half of the patients had visited an orthopedic or spinal surgery clinic. Spinal MRI findings were classified as intervertebral focal lesion, epidural mass, diffuse spotty signal, or diffuse low signal. The presence of an abnormal finding was observed in 92% of patients by spinal MRI and in 86% by blood sampling. Spinal MRI and blood sampling examination should be considered in cases of vertebral fracture in order to prevent the misdiagnosis of multiple myeloma as an osteoporotic vertebral fracture.

　　While rare, ossification of the anterior longitudinal ligament (OALL) of the cervical spine can cause dysphagia, dyspnea, and dysphonia. There are no case reports of sleep apnea syndrome (SAS) caused by OALL of C1-2 in the cervical spine. Here, we report a case of surgical treatment for massive C1-2 OALL leading to severe sleep apnea. A 46-year-old man presented with gradually progressing SAS secondary to OALL. Flexible laryngoscopy revealed a protruding posterior wall in the middle pharynx. Overall apnea-hypopnea index was 50.5 events/hour. Lateral cervical X-ray and computed tomography (CT) showed massive OALL from C1 to C2 and stenosis of the nasopharynx. A microscopic transoral approach was utilized to remove the OALL with a bone rongeur and a high-speed drill. Postoperatively, SAS was significantly reduced, and the quality of life improved. In conclusion, we suggest that surgical management of symptomatic upper cervical OALL will prevent secondary complications of SAS, and improve the quality of life.

　　Various complications are found in ventriculo-peritoneal shunts (V-P shunts) used in hydrocephalus. Overdrainage can be the source of some of these complications and is the primary cause of orthostatic headache, nausea, and vomiting. Here, we report a case of overshunting-associated myelopathy with progressive tetraparesis.

　　A 56 year-old female had undergone placement of a V-P shunt four years prior to presentation in our clinic. She presented with progressive spastic tetraparesis and dysarthria but had no headache. In a brain magnetic resonance image (MRI), enlargement of the bilateral subdural space was noted. Gadolinium enhanced MRI showed dural enhancement. The presence of intracranial hypotension was suspected. Engorgement of the epidural vein at the C2 level in the cervical epidural space was also observed in the gadolinium enhanced cervical MRI.

　　Since overdrainage of the V-P shunt was obviously present, a programmable valve was placed, and the flow of cerebrospinal fluid was controlled. The symptoms improved, and the epidural enhanced lesion diminished in subsequent MRIs.

　　Here, we report a case of overshunting-associated myelopathy after placement of a V-P shunt and a review of the currently available literature.

　　Spontaneous spinal epidural hematomas (SSEH) rarely reoccur, and repeated bleeding events are extremely rare. Here we report a case of SSEH, which caused hemorrhages four times at the same site during a 17 month period.

　　A 54 year-old man presented with sudden onset neck pain and right hemiparesis and was transferred to our emergency department. Magnetic resonance imaging (MRI) of his cervical spine showed a dorsal epidural hematoma from C5 to C6. Contrast-enhanced MRI and computed tomography did not reveal abnormal vessels, and he was diagnosed with SSEH. He was treated conservatively due to his symptoms improving rapidly. He had identical episodes eight and nine months subsequent to the primary occurrence. He underwent spinal digital subtraction angiography during the second episode, but abnormal vessels were not detected. Following the third episode, he was also treated conservatively but SSEH recurred at the same site three days later. During the fourth episode, his symptoms were identical to the previous occurrences. Surgery was conducted due to the short interval of recurrence, and the spinal epidural hematoma and the epidural venous plexus were resected. He was discharged without neurological deficits and has not had any reoccurrence for two years.

　　To the best of our knowledge, this is the first report of a patient with four relapses of recurrent SSEH. Only three cases of recurrent SSEH with three bleeding episodes have been reported previously. While it remains unclear when and if surgery is necessary in patients with recurrent SSEH with mild clinical symptoms, we believe that surgical treatment should be implemented for these patients as the relapsing time interval tends to decrease. Here, we have shown here that surgery can prevent recurrence for at least two years.