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Backgrounds: For the surgical treatment of lumbar canal stenosis (LCS) due to spinal epidural lipomatosis (SEL), several studies have reported direct decompression, including fat debulking. However, none of these studies have mentioned indirect decompression for SEL. Here we report two cases in which indirect decompression with lateral interbody fusion (LIF) was effective in treating LCS due to SEL. Case description: Case 1 involves a 71-year-old male with LCS due to SEL at the L3/4 and L4/5 levels without a history of steroid usage. Case 2 involves a 60-year-old male with LCS due to SEL at the L2/3, L3/4, and L4/5 levels, who had been medicated with prednisolone (2.5 mg/day) and methotrexate (6 mg/week) for the treatment of remitting seronegative symmetrical synovitis with pitting edema syndrome. After oblique lateral interbody fusion and posterior fusion with percutaneous pedicle screw, the patients’ symptoms disappeared immediately. Postoperative magnetic resonance imaging showed that the epidural fat had been successfully stretched, and the dura was decompressed. Conclusions: Indirect decompression with LIF could be a new surgical option for treating LCS due to SEL.

The authors reported a 58-year-old male who suffered from severe low back pain due to kyphoscoliosis associated with congenital contractural arachnodactyly (CCA), a subset of Marfan syndrome. Posterior spinal corrective fusion surgery from T8 to the pelvis with pedicle subtraction osteotomy at L4 was conducted. Because of long upper extremities due to CCA, we had no choice but to keep his shoulders abducted 90°, horizontal flexed 30°, and elbow flexed 120° with the conventional arm table during the surgery. Immediately after the surgery, he complained of numbness on the lateral aspect of his right forearm, difficulty of elbow flexion, and supination. Postoperative upper arm magnetic resonance imaging revealed evidence of coracobrachialis, brachialis, and biceps brachii myositis resulted from denervation by musculocutaneous nerve. We diagnosed his symptoms as postoperative isolated musculocutaneous neuropathy (MCNP) based on physical and radiological findings. Weakness and numbness began to be resolved 1.5 months after the surgery. Active motion of the elbow started to recover two months after the surgery and completely recovered six months postoperatively. The potential cause of our patient’s pathology was regarded to be intraoperative malposition of the abnormal long arms. In conclusion, we reported a case of isolated MCNP after thoracolumbar spine surgery under prone position, which is extremely rare and not well known among surgeons. Therefore, spine surgeons should take care of arm position and joint angle even though prone surgery to prevent MCNP, particularly in the patient with long arm span because of Marfanoid.

Background: Although many complications of the spinal implant have been reported previously, to the best of our knowledge, this is the first report on a delayed implant complication of the ilium, leading to buttock pain and aggravated scoliosis. Case description: A 78-year-old woman underwent transforaminal lumbar interbody fusion with pedicle screws at the L4–L5 level at another institution. Preoperative symptoms, left leg pain, disappeared soon after surgery. However, 6 months post surgery, she experienced severe pain in her left buttock and sacroiliac joint area, which was treated only at our pain clinic. Based on our initial consultation 5 years after the operation, her plain radiography findings showed a 29° convex left-sided scoliosis spanning from the L1–L5. Computed tomography scan revealed apparent iliac bone erosion at the point of contact with the left-side screw head and rod at L5. The patient had painful scoliosis owing to implant irritation. Soon after the removal of the left implant, the pain was relieved and the degree of scoliosis decreased to 17°. Conclusion: This study reports the presence of an unexpected complication caused by pedicle screw fixation at the L4–L5 level. Although the implant was far from the iliac bone, at the L4–L5 fusion, it could cause erosion of the bone after the progression of L3–L4 and L5–S1 disk degeneration and aggravate scoliosis. Neurosurgeons should be aware that patients may present with buttock pain and unprecedented scoliosis by hardware irritation.

Aim: Spinal cord injury in elderly populations has increased in recent years. This study aimed to investigate the pathology, severity, efficacy of the surgery, and complications of cervical spinal cord injury in extremely elderly patients aged >80 years. Methods: Sixty-three patients who underwent surgical treatment for cervical spinal cord injury were enrolled in this retrospective multicenter study. Forty patients were aged