Purpose : We evaluated the results of surgical treatments for lumbar spinal canal stenosis (LSCS), listhesis, and instability in 75-90 year old elderly patients (EP) and 65-74 year old pre-elderly patients (PEP).

  Materials and Methods : We examined the Japanese Orthopaedic Association (JOA) score preoperatively, immediately postoperatively, at 6 months and 1 year after surgery, and recently, as well as the recovery rate of the JOA score (JOAS RR) in EP (45 cases) and PEP (25 cases). Operative procedures included 50 cases of laminectomy with foraminotomy [posterior decompression (PD)] and 20 cases of posterior decompression and posterolateral fixation (PD+PLF). Stabilization of joints and bony fusion were examined by lumbar dynamic X-ray and computed tomography (CT). Between the EP and PEP groups, and each operative method, JOAS RR joint stabilization, bony fusion, and the complications were investigated.

  Results : In both EP and PEP groups, the JOAS RR was high and there was no significant difference between PD and PD+PLF. A high JOAS RR was maintained for a long time after surgery in both groups. In the EP group, there was no significant difference in the RR 6 months after surgery between PD with and without instability, and severe osteopolosis. However, JOAS RR 1 year after surgery and recently was significantly lower in PD with instability than in PD without instability. Although PD+PLF achieved bony fusion in the EP group, the rate was lower than that in the PEP group, and the stabilization rate of the joints was high in both groups. In PD+PLF, the JOAS RR of patients undergoing joint stabilization was not significantly different from that of patients undergoing bony fusion 6 months and 1 year after surgery.

  Postoperative complications included transient delirium, urinary tract infection, and pneumonia in eight (15.4%), three (5.8%), and one case (1.9%), respectively. Delirium occurred more frequently in the EP than in the PEP group.

  Discussion : Both the EP and PEP groups had good surgical outcomes despite the operative procedures. Early ambulation should be promoted to avoid postoperative delirium and urinary tract infections. In EP, PD in patients with mild instability and without severe neurological symptoms due to instability achieved good outcomes. In both the EP and PEP groups, PD+PLF achieved a high JOAS RR and a high rate of joint stabilization. For cases with mild listhesis and instability, PD+PLF surgery should be justified for EP due to joint stabilization.

  Introduction : The most common symptoms of lumbar disc herniation are low back and lower limb pain, but emergency surgery is generally only required in cases with severe lower limb muscle weakness and bladder and rectal disorder. A herniated disc that penetrates the dura mater can trigger an intradural herniation (IDH). Although there are no specific symptoms of IDH, it often causes acute and severe neuropathy. Here, we report a case with residual postoperative dysuria due to IDH.

  Case report : A 39-year-old man complaining of lower limb muscle weakness and bladder and rectal disorders was referred to our hospital. Radiological imaging revealed lumbar disc herniations with remarkable osteophytes at the L4/5 and L5/S1 levels, and emergency surgery was performed. Leakage of a small amount of cerebral spinal fluid was observed after resection of the ligamentum flavum. A small perforation was confirmed in the dorsal dura mater, from which a part of the white mass was exposed. A disc-like mass was found in the dura mater and dural sac following the dural incision. The mass penetrated the ventral dura mater and extended to the area around the osteophytes. No adhesion to the cauda equina was observed, and the mass could be easily removed. Both the ventral and dorsal dura maters were repaired with an artificial dura mater after removal of the mass. Pathological examination revealed disc cartilage tissue. Lower limb muscle weakness was improved by postoperative rehabilitation, but dysuria remained.

  Conclusion : It is sometimes difficult to diagnose IDH preoperatively, but this condition it should be considered as a differential diagnosis in cases suspected of osteophyte formation or chronic lumbar degeneration with epidural adhesions. It is important to educate the general public about IDH as patients with bladder and rectal disorders should present to a medical institution as soon as possible.

  We report a case of sufficient improvement of postural and gait abnormalities by surgery and additional postoperative meticulous rehabilitation in the patient with juvenile lumbar disc herniation. The patient was a 17-year-old boy with lumbar disc herniation at L4/5 level. In spite of conservative treatment for nine months, he began to show remarkable postural and gait abnormalities, such as forward bending posture with shortening of the iliopsoas muscle and knee joint flexion contracture.

  Microsurgical lumbar discectomy partially improved his symptoms, the residual symptoms were sufficiently improved by additional postoperative rehabilitation.

  To identify the causative muscles for the knee joint contracture and iliopsoas muscles shortening, trigger muscle identification test was performed. After the identification, muscles stretching was meticulously performed with satisfactory results. The significance of postoperative rehabilitation for patients with residual symptoms was confirmed in the present case. Herein, the clinical manifestation and postoperative rehabilitation are described in detail.

  Introduction : Spinal hemangioblastoma is commonly associated with syrinx. However, hemangioblastoma with isolated syrinx from a tumor is rare. Here we report a case of C1-2 level spinal hemangioblastoma with T1-3 level isolated syrinx.

  Case report : A 34-year-old man noted numbness in the left finger when he rotated his neck to the left 1 year prior. He presented to a nearby orthopedic hospital and was treated conservatively. Despite treatment, his symptoms gradually worsened, with progressive weakness of the left upper limb. He subsequently visited the hospital neurological department and was diagnosed with a cervical lesion with isolated thoracic syrinx. He was subsequently referred to our hospital for surgical treatment.

  Sagittal T2-weighted images (WI) revealed multiple cysts with edema at the C1-2 level and isolated syrinx at the T1-3 level. Sagittal gadolinium-enhanced T1-WI revealed an enhanced tumor at the dorsal surface of the cervical spine.

  Tumor resection was successfully performed with C1-2 laminectomy. The tumor was completely removed without symptom progression. His left hand grip strength recovered immediately after surgery. At 2 years after surgery, he experienced slight numbness in the radial side of his left hand. Magnetic resonance imaging (MRI) revealed complete tumor removal and resolution of the syrinx and cyst.

  Conclusion : Spinal hemangioblastoma with isolated syrinx is rare. The syrinx was resolved after tumor removal. In the present case, the syrinx formation may have a similar etiology to Chiari malformation. In such a situation, normalization of the cerebrospinal flow at the craniocervical junction is a reasonable solution for the syrinx, even though the syrinx is far from the original lesion.

  Advances in both critical care medicine and diagnostic imaging have allowed increased recognition of traumatic atlanto-occipital dislocation (AOD). AOD is often overlooked due to severe coexistent complications, and even in cases with mild concomitant complications, AOD may be overlooked because of its anatomical specificity. Here we report a case of traumatic AOD in a 38-year-old woman. She had fallen from the 4th floor of a building and was unconscious on arrival at the hospital, with a Glasgow Coma Scale score of E1V1M1. In the emergency ward, a chest drain was inserted for left traumatic hemopneumothorax. After her vital signs had stabilized, clinical and radiological workups revealed traumatic AOD with subarachnoid hemorrhage at the craniocervical junction. Furthermore, multiple rib fractures, traumatic aortic dissection, T10 burst fracture, and dislocation of the temporomandibular joint were diagnosed. After intensive care treatment, the patient regained consciousness and could move her limbs fully except for the left deltoid muscle (manual muscle test, 4/5). Fixation was performed for the ribs and thoracic burst fracture before occipital-C2 fusion. She was able to walk and manage all activities of daily living after 2 months of clinical treatment and rehabilitation. As emergency medicine and care continue to develop, survival after AOD will increase, meaning that immediate and appropriate diagnosis and treatment will be increasingly important. Traumatic subarachnoid hemorrhage at the craniocervical junction is often complicated by AOD. This is important to keep in mind for doctors who do not specialize in pathologies of the spinal cord.

  The clinical applications of three-dimensional (3D) printing in the field of spine surgery and education have recently begun to progress. Technological advances have made it relatively inexpensive and easy to create 3D models. Herein, we explain how to construct a full-scale model using a 3D printer, and review articles on the current clinical applications and limitations. Creation of a 3D model based on the patient’s radiographic image data facilitates understanding of the complicated anatomy. This model enables improvements in visual understanding, preoperative surgical planning, and gives the surgeon a training opportunity. Furthermore, 3D printer technology can also be useful during surgery, and 3D printed surgical guidance systems have previously been successfully used for spine surgery. 3D printing patient-specific guides and templates are highly useful to facilitate safe screw insertion. In addition, 3D printers can be used to create patient-specific implants.