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Introduction. Spinal mobile tumors are very rare. We herein report a case of paraplegia caused by migration and incarceration of thoracic mobile schwannoma after myelography. Case Presentation. A 25-year-old man who had weakness and numbness in both his legs also had pain radiating to the back that was induced by back flexion or extension and jumping. Magnetic resonance imaging (MRI) showed an intradural extramedullary lesion at the T10 and T11 levels. Myelography was performed but discontinued due to his back and lower limb pain. Computed tomography after myelography revealed a rostrally migrated intradural mass with a discrepancy in the exact location in comparison to the MRI findings. He underwent a second lumbar puncture and drained the cerebrospinal fluid (CSF) to aid the spinal cord, because the symptoms gradually worsened and led to paraplegia. After the drainage of the CSF, his symptoms were immediately resolved. The day after myelography, he underwent complete resection of the tumor with the diagnosis of schwannoma. One year after the surgery, he had been working despite having hyperreflexia in his lower limbs with no weakness or sensory disturbance. Conclusion. Severe neurological deficits associated with spinal cord damage can occur due to migration of mobile tumors.

Congenital scoliosis is defined by the presence of structural anatomical malformations that arise from failures of vertebral formation or segmentation before and after birth. The understanding of genetic background and key genes for congenital scoliosis is still poor. We herein report that the excess expression of plasminogen activator inhibitor-1 (Pai-1) induced by the upregulation of miR-224-5p is involved in the pathogenesis of congenital kyphoscoliosis through impaired osteoblast differentiation. We first investigated the variety and progression of abnormalities of the lumbar spines in Ishibashi (IS) rats, a rat model of congenital kyphoscoliosis. The rats had already shown fusion and division of the primary ossification center at postnatal day 4. Over time, the rats showed various abnormalities of the lumbar spine, including the fusion of the annular epiphyseal nucleus. At postnatal day 42, spinal curvature was clearly observed due to the fusion of the vertebral bodies. Using a microRNA array, we found that the expression of miR-224-5p was increased in the lumbar spine of the rats at postnatal day 4. The expression of Pai-1, which is involved in osteoblast differentiation regulated by miR-224-5p, was also increased, while the levels of type I collagen, a marker of osteoblast differentiation, were decreased in the lumbar spine. These results indicate that the aberrant expression of miRNA-224-5p and its target genes is involved in the impaired osteoblast differentiation and may provide a partial molecular explanation for the pathogenesis of congenital scoliosis.

Introduction Spinal malignant peripheral nerve sheath tumors (MPNSTs) are extremely rare. Because of vital surroundings, en bloc resection can be difficult in MPNSTs of the cervical spine. Herein, we report three cases of MPNST followed by radiotherapy or carbon ion radiotherapy (CIRT) after surgery. Technical note In case 1, the patient underwent subtotal resection from both a posterior and anterior approach following by adjuvant X-ray radiotherapy. The patient died 13 years after surgery due to liver cancer unrelated to MPNST. In case 2, recurrence spread to the spinal canal in 10 months after primary CIRT. The patient underwent resection of the spinal canal lesion with the residual lesion treated by additional CIRT. Recurrence could be controlled for at least 1 year. In case 3, the patient underwent partial resection for the spinal canal lesion with the residual lesion treated by CIRT. Intradural and extradural recurrences from outside of the CIRT field were observed at 3 years after surgery. Conclusions Complete resection and adjuvant X-ray radiotherapy would be an effective treatment for MPNST of the cervical spine, even if en bloc resection with a wide margin is impossible. CIRT for the residual tumor after incomplete resection may have the potential to be an additional treatment option; however, further investigation is warranted.

EQUULEUS (EQUilibriUm Lunar-Earth point 6U Spacecraft) will be the world's smallest spacecraft to explore the Earth-Moon Lagrange point. It is being jointly developed by JAXA (Japan Aerospace Exploration Agency) and the University of Tokyo, and will be launched by NASA's Space Launch System Exploration Mission-1. The spacecraft will fly to a libration orbit around the Earth-Moon L2 point (EML2) and will demonstrate low-energy trajectory-control techniques within the Sun-Earth-Moon region for the first time by a nano-class spacecraft. EQUULEUS also carries three scientific observation missions: imaging of Earth's plasmasphere by extreme ultraviolet wavelength, lunar impact flash observation on the far side of the moon, and micrometeoroid flux measurements in the cis-lunar region. While all these missions have their own scientific objectives, they will also contribute to future human activity and/or infrastructure development in the cis-lunar region. Most parts of the spacecraft system use commercial off-the-shelf components, or are designed based on the experiences of various past space missions, with the exception of the newly developed water resistojet propulsion system. EQUULEUS uses X-band frequency for deep space telecommunication. Japanese deep space antennas (64-m and 34-m) will be nominally used for spacecraft operation, and support from the deep space network of JPL (Jet Propulsion Laboratory) is also being planned, especially for the initial phase of operation. The spacecraft will fly to EML2 in less than one year, and will remain there for scientific observations until shortly before the depletion of the onboard propellant, when the spacecraft will leave the orbit for space-debris compliance.

Purpose To compare in-hospital mortality of three procedures in the treatment of elderly patients with isolated C2 odontoid fracture: halo-vest immobilization, anterior spinal fixation (ASF), and posterior spinal fixation (PSF). Methods 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. Results 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

Background Although incidental dural tears are relatively common during spine surgery, transdural nerve root herniation without the identification of dural tear is a rare complication during spine surgery. Case presentation An 80-year-old woman was diagnosed with L4-5 degenerative spondylolisthesis with spinal stenosis. The patient underwent L4-5 posterior decompression surgery and without any obvious incidental dural tear during surgery. On postoperative day (POD) 2, she complained of left leg pain. Magnetic resonance imaging (MRI) on POD 3 did not show any clearly causative lesion. Her left leg pain remained, but she was ambulatory. MRI findings on POD 15 were suggestive of transdural nerve root herniation contained in a pseudomeningocele. Reoperation was performed on the same day. Herniated cauda equina fibers were observed through a dural tear and dural closure was performed with continuous suturing after reduction of the herniated cauda equina fibers. Her left leg pain resolved immediately after surgery. At 12 months after surgery she reported that she had been doing housework without pain or bladder problems. Conclusion Reoperation was performed for transdural nerve root herniation after lumbar decompression surgery, and resulted in a favorable outcome. Clinicians should be aware that transdural nerve root herniation can occur, even if no dural tear is identified intraoperatively.

Intradural-extramedullary solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is a rare entity. SFT/HPCs can recur after surgery, even if a benign histology of the tumor is observed. We herein report a 68-year-old woman with intradural-extramedullary SFT/HPC. On magnetic resonance imaging (MRI), the intradural-extramedullary mass was isointense on T1-weighted images and hypointense on T2-weighted images with heterogeneous gadolinium enhancement. Whole-body fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) was also performed, showing no accumulation. We performed surgery for the intradural-extramedullary mass, and the pathological findings of the resected specimen were a benign histology consistent with World Health Organization (WHO) grade I SFT/HPC. She had no evidence of tumor recurrence three years after the surgery for intradural-extramedullary SFT/HPC. 18F-FDG-PET/CT before surgery may be useful for predicting the postoperative behavior of spinal SFT/HPCs.

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.

Study Design: Case series study. Objective: We aimed to clarify the prevalence of rotator cuff tear (RCT), and the association between RCT and the severity and prognosis in patients with proximal type cervical spondylotic amyotrophy (CSA). Methods: We retrospectively analyzed 35 proximal type CSA patients who were treated conservatively. The following data was collected: age, rotator cuff status on MRI, manual muscle test (MMT) score of shoulder abductor and biceps brachii muscles both at the first visit and final follow-up. We investigated the prevalence of RCT and the association between the rotator cuff status, and the severity and recovery of upper extremity weakness in patients with proximal type CSA. Results: Of the 35 patients, 21 had an RCT on MRI, indicating that the prevalence of RCT in patients with proximal type CSA was 60%. An age-adjusted analysis showed that the presence of RCT was significantly associated with the MMT score of the shoulder abductor muscles both at the first visit and at the final follow-up. The presence of RCT was significantly associated with the recovery of the shoulder abductor muscles. The size of the RCT was negatively correlated with the MMT score of the shoulder abductor muscles at the final follow-up. The size of the RCT was independently correlated with the change of the MMT score of the shoulder abductor muscles. Conclusion: RCT was detected in >50% in patients with proximal type CSA, and the presence and severity of RCT can be used as prognostic factors for proximal type CSA patients who are treated conservatively.

Background Although osteoblastoma is an uncommon benign bone tumor, it sometimes behaves in a locally aggressive fashion. We herein report a case of recurrent lumbar spine osteoblastoma that was treated by repeated surgery and carbon ion radiotherapy. Case presentation A 13-year-old Japanese girl presented with left side lumbar pain. Computed tomography and magnetic resonance imaging of the lumbar spine demonstrated a tumorous lesion in the left side pedicle of L4. Although gross total resection of the mass, including the nidus, was performed in the initial surgery, recurrence was observed repeatedly in the short term and the pathological diagnosis of all of the resected tumors was conventional osteoblastoma. We finally performed carbon ion radiotherapy after the patient’s 3rd palliative operation, and achieved a good outcome. No further recurrence has been observed in 10 years of follow-up. Conclusion We performed carbon ion radiotherapy for a case of recurrent spinal osteoblastoma and achieved a good outcome without recurrence at 10 years after carbon ion radiotherapy treatment. To the best of our knowledge, this is the first case of osteoblastoma that was treated with carbon ion radiotherapy after multiple surgeries.

Developments in radiation therapy modalities offer alternative treatments for unresectable malignant tumors in the pelvis and trunk. However, poor vascularity as a result of radiation therapy makes the treated lesion susceptible to infection, and there are no established treatments for pelvic osteomyelitis with a large dead space after radiation therapy. The authors report 2 cases of sacral osteomyelitis after radiation therapy that were treated successfully with a gluteus maximus turnover flap. To create the flap, the distal portion of the lower third of the muscle was detached from the trochanter. The distal edge of the flap was turned toward the sacral defect and sewn to the remnant of the sacrum, which filled the dead space with the muscle bulk. A 68-year-old man with a recurrent sacral chordoma was treated with carbon ion radiation therapy; however, a sacral infection developed 5 months later. Debridement and a course of antibiotics could not control the infection and did not induce sufficient formation of granulation tissue in the large and deep dead space. The turnover flap with both gluteus maximus muscles cured the deep-seated infection and closed the wound. A 58-year-old woman had sacral osteoradionecrosis with infection. A turnover flap created with the left gluteus maximus muscle controlled the infection and closed the wound after the first operation, a V-Y flap, failed. This study showed that a gluteus maximus muscle turnover flap effectively controlled infectious lesions with large and deep dead space around the sacrum. [ Orthopedics. 2015; 38(7):e651–e654.]