Background : Although a thoracolumbar burst fracture (TLBF) is a common disease in spinal trauma, a definitive treatment strategy has not been established. Percutaneous posterior reduction and fixation (PPRF) using a sagittal adjusting screw (SAS) is a less invasive spine surgery option for TLBF patients. This study investigated the clinical outcomes of TLBF in patients, with and without neurological deficits, who underwent PPRF.

  Methods : Six patients with TLBF who underwent PPRF between April 2018 and May 2020 were retrospectively analyzed. Percutaneous pedicle screw fixations (two levels above and two levels below the fractured vertebra) were performed by inserting SAS at one level above and one level below the fractured vertebra. The patients’backgrounds were collected, and the thoracolumbar AO spine injury classification system (TL AOSIS) and lord sharing classification were assessed. As radiographic variables, the local kyphotic angle, fractured vertebral height of the anterior and posterior edge, collapse rate of the fractured vertebra, and stenotic area of the spinal canal at the affected level were analyzed at three time points : pre-operation, post-operation, and at last follow-up [L/F].

  Results : The patients comprised five men and one woman. The affected levels were T6 in one, L1 in three, and L2 in two. Two patients had neurological deficits. The kyphotic angle was significantly corrected postoperatively and at L/F (p<0.05) without significant loss of correction between postoperative and L/F. The fractured vertebral height of the anterior and posterior edges and the collapse rate of the fractured vertebra were significantly improved postoperatively (p<0.05), but these parameters showed significant correction loss at the L/F (p<0.05). The stenotic area tended to expand over time, and patients who underwent PPRF within 48 hours exhibited greater expansions of the stenotic area than the patients who underwent PPRF for over 48 hours.

  Conclusion : We have reported on the short-term clinical outcomes of patients with thoracolumbar burst fractures who underwent PPRF in our hospital. PPRF in the acute stage might be effective for some patients with thoracolumbar burst fractures, even in the presence of neurological deficits ; therefore, further study will be needed.

  An 11-year-old boy presented to our hospital with neck pain. There were no abnormal findings during the neurological examination or on the cervical radiograph. Therefore, conservative treatment was administered. One month later, the neck pain did not improve, and a hyper-intense lesion was shown at the left side of the C4 vertebral body on T2-weighted magnetic resonance imaging (MRI). An osteolytic lesion was revealed at the same area on computed tomography (CT) scans. There were no abnormalities regarding the laboratory blood tests. The whole-body bone scintigraphy did not reveal other lesions except for the C4 lesion. Clinically, single-organ type, single bone Langerhans cell histiocytosis (LCH) was suspected. An incisional biopsy was performed to rule out the possibility of malignant tumors under CT-guided navigation (O-arm). Because rapid pathological diagnosis during surgery excluded the possibility of osteomyelitis, local steroid injection was administered at the same site. The final pathological diagnosis was LCH. The osteolytic lesion disappeared postoperatively. There are several reports on local steroid injections after a definitive diagnosis of LCH. We performed the biopsy and local steroid injection simultaneously to lessen the burden on the patient and increase the accuracy of steroid injection after excluding the possibility of inflammatory diseases, and had excellent results.

  Background : Coffin-Lowry syndrome (CLS) is a rare, X-linked disease characterized by mental retardation, facial dysmorphism, musculoskeletal abnormalities, cardiac abnormalities, and stimulus-induced drop episodes. Various vertebral diseases, such as scoliosis, develop as a consequence of this disease, and there are reports on the calcification of the cervical ligamentum flavum. The risk of falls is reported to be high as a result of developmental disability and stimulus-induced drop episodes, often leading to traumatic cervical spinal cord injury (SCI). We present the case of a patient with CLS who had calcification of the cervical ligamentum flavum and atlantoaxial subluxation. This patient also experienced cervical SCI due to a fall.

  Case Description : The patient was a 12-year-old male who had typical facial dysmorphism, tapered fingers, developmental delay, and stimulus-induced drop episodes, which occurred approximately once a month. One day, he experienced a stimulus-induced drop episode and bruised his head. Computed tomography of the cervical spine showed calcification and thickening of the yellow ligament at C2-3. Magnetic resonance imaging displayed compression of the cervical cord. Cervical spine dynamics revealed atlantoaxial subluxation. We diagnosed the patient with quadriplegia secondary to cervical SCI and performed C1-4 posterior fixation and C2-4 laminectomy. During the C2-4 laminectomy, ligamentum flavum calcification was observed at C2-3. No new neurological abnormalities appeared after the operation, and the patient’s paralysis gradually improved. In pathological diagnosis, the extracted tissue was a yellow ligament thickened with calcification.

  Conclusion : CLS is characterized by multi-system affectation. Appropriate and timely surgical treatment is required with the cooperation of other departments, such as pediatrics, anesthesiology, and endocrinology. In the present case, yellow ligament calcification and atlantoaxial subluxation were observed. C1-4 fixation and C2-4 laminectomy were performed in collaboration with other departments at a children’s hospital.

  Adhesive arachnoiditis is caused by disturbances in cerebrospinal fluid (CSF) flow due to trauma, hemorrhage, meningitis, spinal surgery, and others. This condition may potentially cause spinal edema and syringomyelia. The effectiveness of syringo-subarachnoid or syringo-peritoneal shunts for syringomyelia treatment has already been reported. Furthermore, adhesiolysis can also be performed for reconstruction of the subarachnoid space; however, dissection is often difficult, and neurological symptoms may deteriorate due to the surgical procedures. Adhesive arachnoiditis remains a difficult condition to treat, and there have been many cases of postoperative recurrence. We present a case of adhesive arachnoiditis treated with subarachnoid space reconstruction, duraplasty, and lift-up laminoplasty using Laminoplasty Baskets.

  A 54-year-old male patient sustained a C7 spinal cord injury (Frankel B) at the age of 17 due to a traffic accident and thereafter became wheelchair-dependent. At the age of 43 years, the patient experienced sensory disturbance and deterioration of fine motor skills on both his upper limbs. Upon undergoing magnetic resonance imaging (MRI), he was diagnosed with adhesive arachnoiditis. After referral to our hospital, the patient underwent C4-C6 anterior cervical discectomy and fusion. The symptoms temporarily improved, but later worsened. Compared to his previous MRI, taken 11 years ago, his new scans showed increased spinal edema from C1 to C7 that was concentrated at the C4/5 level. We decided that there were severe adhesions at this level and subsequently performed subarachnoid reconstruction. En block laminotomies from C3 to C6 were performed, and the dura mater was exposed. After dural incision, we cut the arachnoid membrane and detached it carefully from the spinal cord. We divided the dentate ligaments and dissected the arachnoid membrane around the nerve roots as much as possible, restoring CSF flow from the cranial to caudal side. At closure, we expanded the dural sac with Gore-tex duraplasty, and the laminoplastic laminotomy from C4 to C6 was fixed with laminoplasty baskets. A tenting suture lifting the Gore-tex patch towards the laminoplasty baskets was used to maintain the expansion of the subarachnoid space. We observed improvement in the spinal cord edema on postoperative MRI.

  In cases of local subarachnoid adhesions, CSF can be restored by adhesiolysis and subarachnoid reconstruction. We also believe that fixation of the dural sac to the laminoplasty baskets can provide efficient expansion of the subarachnoid space and maintain CSF flow.

  Lumbar spondylolysis is a relatively common disease that affects approximately 5% of the general population. However, cervical spondylolysis is a rare condition, with only approximately 100 cases reported to date. Herein, we report the case of a patient with cervical spondylolysis who developed myelopathy, for whom posterior decompression and circumferential fixation was performed, resulting in a good outcome.

  The patient was a 56-year-old male who had a history of fall after consuming alcohol and numbness in his right hand. His skilled upper limb movement disorder and gait disturbance had recently progressed ; therefore, he was referred to our hospital. On neurological examination, quadriparesis, hyperreflexia of bilateral triceps, positive pathological reflexes (Hoffman, Trömner, and Babinski’s signs), and gait disturbance were observed.

  Neuroradiological findings included spondylolisthesis at C6-7, C6 spina bifida, and spondylolysis of C6 between the superior and inferior joint processes. Magnetic resonance imaging (MRI) revealed ligamentum flavum thickening at C5-6. The patient’s spinal cord was highly compressed, and intramedullary high signal intensity was observed on T2-weighted imaging. Accordingly, we performed posterior decompression and circumferential fixation using C5 lateral mass and C7 pedicle screws and anterior cervical discectomy and fusion at C5-6 and C6-7. The patient’s skilled upper limb movement disorder and gait disturbance improved immediately postoperatively, and his rehabilitation is ongoing.

  A dural arteriovenous fistula (dAVF) is an abnormal anastomosis in the dural tissue. Its symptoms vary, depending on the site of the arteriovenous shunt and venous reflux pattern. The Cognard classification categorizes intracranial dAVFs into five types. Cognard type V dAVFs are rare, accounting for only 0.06% of intracranial dAVFs, and are defined as intracranial dAVFs with reflux into the spinal vein.

  We report two cases of Cognard type V sigmoid sinus (SS-) dAVFs with myelopathy. SS-dAVFs generally present with headache and pulsating tinnitus, whereas Cognard type V SS-dAVFs mainly present with myelopathy and hemorrhage. Cerebral angiography performed in our patients revealed occluded SSs with associated drainage into the spinal veins. A possible pathophysiological mechanism of myelopathy was the reflux into the spinal veins, causing spinal cord congestion secondary to venous hypertension. The drainage root into the spinal vein and fistulas was completely occluded with transvenous embolization, resulting in the disappearance of the fistulas.

  These types of SS-dAVFs are diagnostically challenging owing to their rarity. Once paraplegia or bladder and rectal disorders are observed, the prognosis becomes poor. Therefore, early completion of treatment after diagnosis is mandatory.

  Furthermore, visible flow voids on the surface of the upper cervical spinal cord on T2-weighted magnetic resonance images are useful diagnostic findings. We emphasize that clinicians should consider this type of SS-dAVF as a differential diagnosis when imaging reveals flow voids between the upper cervical spinal cord and brainstem.

  The life expectancy of patients with progressive breast cancer has recently increased, thanks to advancements in chemotherapy, hormone treatment, and molecular target drugs. As the number of advanced breast cancer survivors increase, these initial treatments are typically required prior to spinal surgery. This is because asymptomatic breast cancer may initially be diagnosed as a pathological vertebral fracture. The decision for comprehensive treatment of the malignancy later on could benefit from improved performance status by spinal surgeries.

  A 68 year-old female was admitted to our hospital because of sudden neck pain without neurological deficits. Brain magnetic resonance image (MRI) demonstrated multiple metastatic lesions in the skull. Cervical computed tomography (CT) showed a burst fracture in the C2 vertebral body, and spinal MRI showed multiple metastatic lesions in the cervical spine, including in the C2 vertebral body. Furthermore, chest CT showed a mass lesion in the right breast. With a diagnosis of pathological fracture, the primary lesion was found to be progressive breast cancer. The patient’s life expectancy was estimated at more than 6 months according to the Tokuhashi score. Her cervical spine was considered unstable based on the spine instability neoplastic score (SINS). We performed posterior cervical fixation, hormone therapy, and chemotherapy. The treatment was planned according to the results of the breast and skull biopsies. The diagnosis was progressive breast cancer (Luminal A-like), and there was no discordance between the two results. Her postoperative course was good ; however, the patient died 21 months after surgery.

 Patients with pathological vertebral fracture from progressive breast cancer are often expected to live more than 6 months. Surgical treatment for vertebral fractures and subsequent treatment according to pathological findings lead to a good prognosis.