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Abstract The aim of this study was to compare in-hospital mortality of three procedures –halo-vest immobilization, anterior spinal fixation (ASF), and posterior spinal fixation (PSF)– in the treatment of elderly patients with isolated C2 odontoid fracture. We extracted data for elderly patients who were admitted with C2 odontoid fracture and treated with at least one of the three procedures (halo-vest immobilization, ASF, or PSF) during hospitalization. We conducted a generalized propensity score-based matching weight analysis to compare in-hospital mortality among the three procedures. We further investigated independent risk factors for in-hospital death. The study involved 891 patients (halo-vest, n = 463; ASF, n = 74; and PSF, n = 354) with a mean age of 78 years. In-hospital death occurred in 45 (5.1%) patients. Treatment type was not significantly associated with in-hospital mortality. Male sex (odds ratio 2.98; 95% confidence interval 1.32–6.73; p = 0.009) and a Charlson comorbidity index of ≥ 3 (odds ratio 9.18; 95% confidence interval 3.25–25.92; p

Introduction: Primary epidural extra-osseous Ewing sarcoma/peripheral primitive neuroectodermal tumor (ES/pPNET) is a rare entity included in the Ewing sarcoma family of tumors (ESFTs) that is associated with an unfavorable prognosis. Methods: We described the case of a patient with primary epidural extra-osseous ES/pPNET of the cervical spine, and reviewed the relevant literature for reports on this rare malignant tumor. Our research yielded 24 articles describing 40 patients. We analyzed these reports to identify factors associated with long-term survival. Results: A 30-year-old woman presented with pain and numbness in the right scapula and right upper limb. Cervical MRI showed an epidural mass extending into the right C6-7 foramina. We performed gross total resection of the mass; the histological diagnosis was ES/pPNET. We also performed adjuvant chemoradiotherapy after the operation. No recurrence has been observed for 10 years. Based on the review of the literature, we conducted a Kaplan-Meier analysis of 36 patients who underwent surgery. The analysis showed that the median survival time in patients treated with adjuvant chemotherapy was significantly longer than that in patients treated without adjuvant chemotherapy (25 months vs. 18 months, p = 0.002, log-rank test), whereas neither the mode of resection nor the performance of adjuvant radiotherapy significantly influenced survival. Conclusions: Long-term survival (>10 years) was obtained by gross total resection and adjuvant chemoradiotherapy. Adjuvant chemotherapy was associated with a long median survival time in a patient with epidural extra-osseous ES/pPNET of the cervical spine.

Introduction. Spinal angiomatous meningioma arising in the craniocervical junction has not been reported. Case Presentation. A 68-year-old man presented to our hospital with pain in the back and left leg. He showed slight motor weakness in his upper extremities. Magnetic resonance imaging revealed a mass with marked enhancement in the craniocervical junction. Computed tomography angiography showed feeding vessels arising from the right vertebral artery. Preoperative embolization of the feeding vessels was performed to reduce intraoperative bleeding. Gross total resection of the tumor was achieved by debulking and piecemeal resection. The tumor attachment to the dura mater was also resected (Simpson grade 1 resection). A histopathological examination confirmed the diagnosis of an angiomatous meningioma. The patient’s symptoms improved shortly after surgery. Conclusions. We achieved gross total resection of spinal angiomatous meningioma arising in the craniocervical junction. A preoperative evaluation and embolization of the feeding arteries may help prevent massive intraoperative bleeding.

Background: Vertebral compression fractures (VCFs) in older adults cause considerable health and socioeconomic burdens due to worsening ability to perform activities of daily living. The long-term effects of VCFs on patient outcomes, particularly prolonged analgesic use and functional decline, remain unknown. The aims of this study were to examine longterm clinical outcomes and to determine the risk factors for persistent pain and functional disability after VCFs. Methods: This retrospective cohort study evaluated mortality, duration of analgesic use, and changes in care requirements in older adults with VCFs using claims data from a suburban prefecture in the Greater Tokyo Area. Patients were included if they were ≥65 years of age and had been diagnosed with a VCF between June 2014 and February 2019, as determined on the basis of International Classification of Diseases, Tenth Revision (ICD-10) codes; we also used claims data that could determine whether the patients underwent imaging examinations. Patients who discontinued outpatient visits within 1 month after the VCF diagnosis were excluded. Results: We included 18,392 patients with VCFs and a mean age of 80 years. Seventy-six percent of patients were women, and the median follow-up period was 670 days. At the index VCF diagnosis, 3,631 patients (19.7%) were caredependent. Overall, 968 patients (5.3%) died within 1 year. Among the 8,375 patients who received analgesics, 22% required analgesics for >4 months. Factors associated with prolonged analgesic use for >1 year were female sex (odds ratio [OR], 1.39 [95% confidence interval (CI), 1.16 to 1.65]) and VCFs in the thoracolumbar region (OR, 1.95 [95% CI, 1.50 to 2.55]) or lumbar region (OR, 1.59 [95% CI, 1.23 to 2.04]) (the reference was the thoracic region). The care needs of 1,510 patients (8.2%) increased within 1 year. Patients with a preexisting care dependency had a 10 times higher risk of increased care need (30.2% [1,060 of 3,509]) than those who had been independent at the time of the index diagnosis (3.0% [450 of 14,761]) (p < 0.001). Conclusions: Individuals with preexisting care dependency were more likely to experience functional decline following VCFs than those who were independent, which underscores the need for intensive and appropriate allocation of healthcare resources to care-dependent patients. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]