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Background In several previous studies, Charlson comorbidity index (CCI) score was associated with postoperative complications, mortality, and re-admission. There are few reports about the influence of CCI score on postoperative clinical outcome. The purpose of this study was to investigate the influence of comorbidities as calculated with CCI on postoperative clinical outcomes after PLIF. Methods Three hundred sixty-six patients who underwent an elective primary single-level PLIF were included. Postoperative clinical outcome was evaluated with the Japanese Orthopaedic Association lumbar score (JOA score). The correlation coefficient between the CCI score and postoperative improvement in JOA score was investigated. Patients were divided into three groups according to their CCI score (0, 1, and 2+). JOA improvement rate, length of stay (LOS), and direct cost were compared between each group. Postoperative complications were also investigated. Results There was a weak negative relationship between CCI score and JOA improvement rate (r = − 0.20). LOS and direct cost had almost no correlation with CCI score. The JOA improvement rate of group 0 and group 1 was significantly higher than group 2+. LOS and direct cost were also significantly different between group 0 and group 2+. There were 14 postoperative complications. Adverse postoperative complications were equivalently distributed in each group, and not associated with the number of comorbidities. Conclusions A higher CCI score leads to a poor postoperative outcome. The recovery rate of patients with two or more comorbidities was significantly higher than in patients without comorbidities. However, the CCI score did not influence LOS and increased direct costs. The surgeon must take into consideration the patient’s comorbidities when planning a surgical intervention in order to achieve a good clinical outcome.

Anterior decompression with fusion (ADF) for patients with cervical ossification of the posterior longitudinal ligament (OPLL) is reportedly associated with a higher incidence of complications than is laminoplasty. However, the frequency of perioperative complications associated with ADF for cervical OPLL has not been fully established. The purpose of this study was to investigate the incidence of perioperative complications, especially neurological complications, following ADF performed to relieve compressive cervical myelopathy due to cervical OPLL.Study participants comprised 150 patients who had undergone ADF for cervical OPLL at 27 institutions between 2005 and 2008. Perioperative--especially neurological--complications occurring within 2 weeks after ADF were analyzed. Preoperative imaging findings, including Cobb angle, between C2 and C7 and occupying ratio of OPLL were investigated. Multivariate analysis with logistic regression was performed to identify independent risk factors for neurological complications.Three patients (2.0 %) showed deterioration of lower-extremity function after ADF. One of the three patients had not regained their preoperative level of function 6 months after surgery. Upper-extremity paresis occurred in 20 patients (13.3 %), five of whom had not returned to preoperative levels 6 months after surgery. Patients with upper-extremity paresis showed significantly higher occupying ratios of OPLL, greater blood loss, longer operation times, fusion of more segments, and higher rates of cerebrospinal fluid leakage than those without paresis. Independent risk factors for upper-extremity paresis were a high occupying ratio of OPLL and large blood loss during surgery.The incidences of deterioration in upper- and lower-extremity functions were 13.3 % and 2.0 %, respectively. Patients with a high occupying ratio of OPLL are at higher risk of developing neurological deterioration.

Study Design. Retrospective cohort study. Objective. To evaluate diagnostic validity of space available for the spinal cord (SAC) at C1 level for myelopathy in patients with rheumatoid arthritis (RA). Summary of Background Data. The relationship of SAC at C1 level with myelopathy has been evaluated by relatively small number of the patients, and 2 criteria have been proposed. Methods. Two cohorts of the patients with RA were established. Group A consisted of 140 patients with myeopathy due to upper cervical involvement selected from the database. Group B consisted of 99 patients with upper cervical subluxation, but not associated with myelopathy selected from the consecutive series of the hospitalized patients. Distributions of SAC at C1 level in both groups were evaluated. Efficacy indexes for screening (sensitivity, specificity, etc.) were calculated for these patients' population by previously demonstrated 2 criteria. In addition, analysis according to receiver operating characteristic (ROC) curve was performed. Results. The average values of SAC were 11.1 mm in Group A and 16.5 mm in Group B. When cut-off point for myelopathy was defined as 13 mm or less, sensitivity and specificity were 82% and 85%, respectively. When it was defined as 14 mm or less, sensitivity increased (88%) while specificity decreased (74%). Accuracies by these 2 criteria were almost the same (83%, 82%). The left upper corner point of ROC curve was located between these 2 cut-off points. Conclusion. Distributions of SAC showed that SAC was a reliable parameter for relating myelopathy in patients with upper cervical subluxation in RA. The plots according to ROC curve showed adequacy of previously demonstrated 2 cut-off points. For the purpose to screen the patients with high risk for myelopathy, 14 mm or less was recommended as a cut-off point of SAC.

Study design Retrospective multi-institutional study Objective To describe the surgical outcomes in patients with ossification of the posterior longitudinal ligament in the thoracic spine (T-OPLL) and to clarify factors related to the surgical outcomes. Summary of background data Detailed analyses of surgical outcomes of T-OPLL have been difficult because of the rarity of this disease. Methods The subjects were 154 patients with T-OPLL who were surgically treated at 34 institutions between 1998 and 2002. The surgical procedures were laminectomy in 36, laminoplasty in 51, anterior decompression via anterior approach in 25 and via posterior approach in 29, combined anterior and posterior fusion in 8, and sternum splitting approach in 5 patients. Instrumentation was conducted in 52 patients. Assessments were made on (1) The Japanese Orthopedic Association (JOA) scores (full score, 11 points), its recovery rates, (2) factors related to surgical results, and (3) complications and their consequences. Results (1) The mean JOA score before surgery was 4.6 +/- 2.0 and, 7.1 +/- 2.5 after surgery. The mean recovery rate was 36.8% +/- 47.4%. (2) The recovery rate was 50% or higher in 72 patients (46.8%). Factors significantly related to this were location of the maximum ossification (T1-T4) (odds ratio, 2.43-4.17) and the use of instrumentation (odds ratio, 3.37). (3) The frequent complications were deterioration of myelopathy immediately after surgery in 18 (11.7%) and dural injury in 34 (22.1%) patients. Conclusion The factors significantly associated with favorable surgical results were maximum ossification located at the upper thoracic spine and use of instrumentation. T-OPLL at the nonkyphotic upper thoracic spine can be treated by laminoplasty that is relatively a safe surgical procedure for neural elements. The use of instrumentation allows correction of kyphosis or prevention of progression of kyphosis, thereby, enhancing and maintaining decompression effect, and its use should be considered with posterior decompression.

The Japan Spine Research Society carried out a nationwide survey on complications of the spine, enrolling a total of 16 157 patients who had undergone spine surgery in 196 institutes in the 1-year period from January to December 2001. Diseases, surgical procedures, and complications were surveyed in detail. Forty-nine percent of patients were aged 60 years or older, which was remarkably increased in comparison with the percentage reported by the 1994 survey (37.3%). The number of cases with degenerative spinal diseases comprised 78.2% of the total number of spine surgery cases. The percentage of patients with stenosis was the greatest (38.5%), reflecting the increase in the elderly population undergoing spine surgery. Spinal instrumentation was used with 5497 patients (34.0%). The frequency of its use was much greater than that reported in 1994 (27.0%). The pedicle screw was the most frequently used instrument (54.6%). The use of spinal instrumentation greatly increased for spinal deformity, trauma, and tumors. Posterior lumbar interbody fusion has been increasingly used in cases of lumbar degenerative disease. Complications of spinal surgery were reported in 1383 patients (8.6%). The incidence of complications associated with instrumentation surgery was 12.1%, being twice as much as that associated with noninstrumentation surgery (6.8%).

We describe a case of Down's syndrome associated with progressive extradural neuroblastoma. Postmortem aspiration of the bone marrow revealed diffuse infiltration by tumor cells, in which trisomy 21 was found by fluorescence in hybridization in situ.