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Background: Ectopic gas in the graft is occasionally encountered upon follow-up computed tomography (CT) after anterior cervical corpectomy and fusion (ACCF). However, most cases lack inflammatory responses and manifestations of infection. Although the clinical significance of ectopic gas in the graft has not yet been established, to the best of our knowledge, no previous studies have described ectopic gas in the graft after ACCF. This study evaluated ectopic gas in the fibular graft upon follow-up CT after ACCF., Methods: We reviewed 112 patients who underwent ACCF and follow-up CT, with a minimum follow-up period of 3 years. CT images were retrospectively reviewed to confirm the presence of ectopic gas in the graft and bone fusion. Bone fusion was defined as follows: mobility less than 2 mm between spinous processes on the flection-extension radiograph or a bone bridge on CT images., Results: Of the 112 patients, 30 (27%) patients had ectopic gas in the fibular grafts. Among them, ectopic gas was initially observed 3 months after surgery (early onset) in 23 (77%) patients and 6 months after surgery (late-onset) in the remaining seven (23%) patients. Upon the latest follow-up CT, ectopic gas more frequently remained in late-onset (4/7, 57%) rather than in early-onset (3/23, 13%) cases (p = 0.033). Bone fusion was not observed when CT images exhibited ectopic gas in the graft, whereas ectopic gas was not observed when CT images exhibited bone fusion., Conclusion: Ectopic gas in the fibular graft was observed at both early and late-onset after ACCF; late-onset gas remained significantly. The remaining gas was strongly associated with pseudoarthrosis; therefore, pseudoarthrosis should be considered when ectopic gas in the graft is observed on CT images., (© 2021. The Author(s).)

Purpose: Alterations of three-dimensional cervical curvature in conventional anterior cervical approach position are not well understood. The purpose of this study was to evaluate alignment changes of the cervical spine in the position. In addition, simulated corpectomy was evaluated with regard to sufficiency of decompression and perforation of the vertebral artery canal., Methods: Fifty patients with cervical spinal disorders participated. Cervical CT scanning was performed in the neutral and supine position (N-position) and in extension and right rotation simulating the conventional anterior approach position (ER-position). Rotation at each vertebral level was measured. With simulation of anterior corpectomy in a vertical direction with a width of 17 mm, decompression width at the posterior wall of the vertebrae and the distance from each foramen of the vertebral artery (VA) were measured., Results: In the ER-position, the cervical spine was rotated rightward by 37.2° ± 6.2° between the occipital bone and C7. While the cervical spine was mainly rotated at C1/2, the subaxial vertebrae were also rotated by several degrees. Due to the subaxial rotation, the simulated corpectomy resulted in smaller decompression width on the left side and came closer to the VA canal on the right side., Conclusions: In the ER-position, the degrees of right rotation of subaxial vertebrae were small but significant. Therefore, preoperative understanding of this alteration of cervical alignment is essential for performing safe and sufficient anterior corpectomy of the cervical spine.

Background: 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., Methods: 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., Result: 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., Conclusions: 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 analysis of adjacent disc degeneration (ADD) after anterior cervical decompression and fusion (ADF)., Objectives: To elucidate the influence of the number of levels fused in ADF on the incidence of ADD., Summary of Background Data: ADD is known as a complication associated with ADF. However, how the number of levels fused affects the incidence of ADD is not well understood., Methods: One hundred and two patients with cervical degenerative disease, who underwent ADF and were followed for more than 24 months, were retrospectively analyzed. They were classified into 2 groups, a long group (L group) consisting of 50 cases with ADF of 4 or more disc levels, and a short group (S group) consisting of 52 cases with ADF of 3 or fewer disc levels. Furthermore, the patients were also divided into 2 groups according to inclusion or exclusion of C5-6 and C6-7 (C group: including both, NC group: not including both). The incidence of ADD, and that of symptomatic ADD (sADD), was compared between the 2 classifications., Results: In the L group, there were 13 cases of ADD (26.0%), including 1 case of sADD (2.0%), whereas in the S group, there were 22 cases of ADD (42.3%), including 11 cases of sADD (21.2%). The incidence of sADD was significantly lesser in the L group (P=0.024). Three cases with sADD in the S group required revision surgery, whereas no additional surgery related to ADD was performed on patients in the L group. In addition, in the C group, ADD occurred in 20 of 71 cases (28.2%) and sADD occurred in 4 of 71 cases (5.6%), whereas in the NC group, ADD occurred in 15 of 31 cases (48.4%) and sADD occurred in 8 of 31 cases (25.8%). The incidence of ADD and sADD were significantly lesser in the C group (P=0.048)., Conclusions: ADD occurs less frequently among patients in whom C5-6 and C6-7 are fused than among those in whom C5-6 or C6-7 is left at an adjacent level, irrespective of the length of the fusion.

Study Design: Retrospective analyses of six cases., Objective: To describe six patients with previous failed laminoplasty who were subsequently managed by anterior cervical decompression and fusion (ACDF) using fibular strut as revision surgeries., Summary of Background Data: While several complications and unsatisfactory results of cervical laminoplasty have been reported, there is no general consensus on how to best surgically treat these pathological conditions., Methods: Six patients, who had been treated by laminoplasty for cervical spondylotic myelopathy (n = 2) or ossification of posterior longitudinal ligament (OPLL, n = 4) and had unfavorable outcomes, underwent ACDF using autogenous fibular strut grafts. The pathological factors associated with the poor outcomes were intraforaminal spur, slip, spondylotic change, disc herniation, and increase of OPLL in size. Clinical outcomes were assessed by evaluating the modified Japanese Orthopedic Association score (JOA score) of cervical myelopathy, severity of radicular pains, axial pains, and perioperative complications. In addition, C2-7 angle and the presence of bony union were analyzed., Results: The revision ACDF significantly increased the mean ± SD. JOA score, from 10.3 ± 3.9 to 13.5 ± 2.7 points (p = 0.028), with a recovery rate of 47.1 ± 26.7%. Radicular pain and axial pain also improved. C2-7 angle was not changed significantly. Solid fusion was achieved in all patients at 12.2 ± 4.2 months after revision surgery., Conclusion: ACDF with fibular strut graft was effective as a revision procedure for failed laminoplasty.

Study Design: Comparison of magnetic resonance imaging (MRI) and computed tomography-myelography (CTM) for cervical intracanalar dimensions., Objective: To compare the capability and reproducibility of MRI and CTM in measuring the cross-sectional morphology of intracanalar lesions of the cervical spine., Summary of Background Data: The relative advantages and disadvantages of MRI and CTM in measuring cervical intracanalar dimensions are poorly understood., Methods: MRI and CTM were used to measure cervical disc levels in 45 subjects with various cervical spinal diseases. Measurements included dural area, dural anteroposterior (A-P) diameter, dural right-left (RL) diameter, cord area, cord anteroposterior (A-P) diameter, cord right-left (RL) diameter and cerebrospinal fluid (CSF) space (anterior and posterior). Each section was graded by 2 orthopedic surgeons for degree of stenosis (Grades, 0-3), and the intra- and interobserver reproducibility of these measurements (intraclass correlation coefficients: ICC) was assessed., Results: In both CTM and MRI, intra- and interobserver reproducibility (ICC) ranged from 0.702 to 0.989, suggesting that both imaging methods are reproducible. Importantly, CTM measurements of dural area, dural A-P diameter, dural RL diameter, and CSF space (anterior and posterior) were slightly, but significantly (P < 0.001), larger than MRI measurements. In contrast, MRI measurements of cord area, cord A-P diameter, and cord RL diameter were slightly, but significantly (P < 0.001), larger than CTM measurements. Degree of stenosis was significantly more severe in MRI than in CTM., Conclusion: Both CTM and MRI provided reproducible measurements of cervical intracanalar dimensions. Measurements of dura were slightly larger in CTM, whereas measurements of spinal cord were slightly larger in MRI, making stenosis more severe in MRI than in CTM. The clinical relevance of these slight differences requires further examination.

Study Design: Retrospective study of clinical outcomes of 1-staged combined cervical and lumbar decompression for patients with tandem spinal stenosis (TSS)., Objective: To describe middle-term clinical outcomes of this procedure., Summary and Background Data: Little is known with regard to the clinical outcomes of 1-staged combined cervical and lumbar decompression for TSS., Method: Surgical intervention, perioperative complications, and clinical outcomes were reviewed in 17 TSS patients who underwent 1-staged combined cervical and lumbar decompression and were followed-up for more than 3 years. Clinical symptoms were evaluated using the Japan Orthopaedic Association Score for back pain (JOA-B) and cervical myelopathy (JOA-C) and activity of daily life, before surgery, at 6 months postoperatively, and at final follow-up. Patient satisfaction was determined at final follow-up., Results: The JOA-B, JOA-C scores, and activities of daily life improved significantly 6 months after surgery, but ultimately deteriorated. At 6 months, the improvement ratios in JOA-B and JOA-C scores were positively correlated. Complications involving other parts of the body significantly influenced clinical deterioration. Twelve patients (71%) were satisfied., Conclusions: One-staged combined cervical and lumbar decompression for TSS provided fair results, even for elderly patients. Although reasons other than spinal pathology affected symptom deterioration at final follow-up, most patients expressed satisfaction at middle-term follow-up periods.

Introduction: Recently, solitary fibrous tumors occurring in spine-related lesions have been reported. However, the destruction of vertebral bodies by this type of tumor has not been reported., Materials and Methods: A 71-year-old female presented with pain from a mass on the right side of her neck. Plain radiographs of the cervical spine showed collapse of the C5 vertebral body and dislocation of the C4 vertebral body. The MRI image showed a large mass surrounding C4 and C5, which had low signal intensity in the T1W image and high signal intensity in the T2W image. At first, resection of the tumor and spinal fusion was performed by anterior approach., Results: Histology revealed a solitary fibrous tumor with proliferating spindle cells. Immunohistochemistry showed positive stains for vimentin and CD34. One year postoperatively, a local recurrence manifested extensive destruction of the C4 and C5 vertebral bodies. Then, palliative surgery with posterior cervical instrumentation and radiation therapy were performed. Because the destruction proceeded and the rods were broken 2 years after, she underwent additional occipito-cervical instrumentation., Conclusions: This is the first report of a solitary fibrous tumor that involves the destruction of the spinal structure. An extensive destruction of the vertebral body by the solitary fibrous tumor needs to be aware in treating this tumor with spinal involvement.

Study Design: The reliabilities of and correlations among 5 standard methods of assessing cervical sagittal alignment were evaluated., Objective: To investigate the reliabilities of and correlations among 5 standard methods of assessing cervical sagittal alignment., Summary of Background Data: Although various cervical sagittal alignment assessment methods are widely used, their relative reliability and intercorrelation have not been reported., Methods: From 442 lateral cervical radiographs, 40 with lordotic, 40 with straight or sigmoid, and 40 with kyphotic alignment were selected. Two orthopedic surgeons independently evaluated the sagittal alignment in each group twice using CCL, C1-C7 Cobb, C2-C7 Cobb, sagittal tangent, and the Ishihara methods. Intraobserver and interobserver reliabilities were confirmed and the correlations among the 5 methods were measured., Results: Intraobserver and interobserver reliabilities for all 5 methods were good. In the lordotic group, the correlations among all 5 methods were consistently strong (r = 0.731 to 0.922). In the straight or sigmoid group, the correlations were weak to moderate among the CCL, C2-C7 Cobb, sagittal tangent, and Ishihara methods but tended to be weak between these 4 methods and the C1-C7 Cobb method (r = -0.245 to 0.777). In the kyphotic group, the correlations were also weak to moderate among the same 4 methods, and were statistically insignificant between them and the C1-C7 Cobb., Conclusions: The correlations among the CCL, C1-C7 Cobb, C2-C7 Cobb, sagittal tangent, and Ishihara methods are strong when lordosis is retained; otherwise, they are moderate to poor. In the kyphotic group, C1-C7 Cobb has no significant correlation with the other 4 methods.

Cervical vertebral involvement of clear cell meningioma is very rare. We report a case of clear cell meningioma in the cervical vertebral body in a 72-year old male. Seven years prior to this presentation, the patient underwent palliative surgery and posterior instrumentation for a cervical vertebral tumor at C5, which had been diagnosed as a metastatic renal cell carcinoma. On this admission, the patient presented with severe neck pain. Examination revealed hypesthesia on the left in a C6 nerve root distribution. Plain X-rays and MRI revealed an enlarging tumor in the C5 and C6 vertebral bodies. The tumor was resected via an anterior approach followed by fusion using a strut bone graft. Histological examination of the surgical specimen diagnosed a clear cell meningioma. Postoperatively, the patient achieved pain relief and resolution of the neurological deficit. At follow-up two years postoperatively, he remains asymptomatic. We emphasize that cervical clear cell meningioma with involvement of the vertebral bodies may mimic metastatic renal cell carcinoma.

Study Design: The effects of a halo vest on the gait were studied. The motions of the head, shoulder girdle, trunk, and hip were analyzed with the vest and tong either connected by bars or unconnected., Objective: To analyze effects of wearing a halo vest using three-dimensional motion analysis., Summary of Background Data: We have little information on the effects of halo vests on gait., Methods: Twenty-eight healthy male volunteers participated (age, 32 +/- 7.2; average +/- SD). The halo tong and vest were applied in a noninvasive way. Gait patterns and three-dimensional motions of the head, shoulder girdle, trunk, pelvis, and hip in control and halo vest gaits were analyzed using rectangular force plates and a VICON system (Vicon Motion System Ltd., Oxford, UK)., Results: The halo vest decreased the gait speed; it increased the duration of strides and decreased the length of strides. It also decreased the motions between the shoulder girdle and the trunk, the trunk and the pelvis, and decreased the motion of the hip in 3 planes., Conclusion: Our study provides preliminary evidence that halo vests increase stride time and decrease stride length and reduce motions between the shoulder girdle and the trunk, the trunk and the pelvis, and decreases the motion of the hip.

Study Design: Case report of a solitary fibrous tumor in the occipitocervical region., Objective: To describe a rare clinical entity and successful management in a patient with solitary fibrous tumor in the occipitocervical region., Summary of Background Data: Solitary fibrous tumor is a rare spindle cell neoplasm of adults that arises most commonly in the pleura. Recently, this tumor has been reported in a number of other sites. However, its occurrence in the occipitocervical region is rare., Methods: The patient presented with a painless mass in the left posterior neck. Resection of the tumor was performed., Results: Histopathological study revealed features of a solitary fibrous tumor. Clinical follow-up review for 2.5 years shows no evidence of recurrence or metastasis., Conclusion: A case of extrapleural solitary fibrous tumor in the occipitocervical region was reported. Solitary fibrous tumor should be considered in the differential diagnosis in a tumoral mass of this region.

We report a case of an 80-year-old woman with dropped head syndrome associated with cervical spondylotic myelopathy. She could not keep her cervical spine in a neutral position for >1 minute. She had a disturbed gait and severe kyphotic deformity in her thoracic spine. Magnetic resonance imaging revealed severe compression of the spinal cord due to cervical spondylotic change. Laminoplasty from C2 through C6 levels was performed. One year after operation, she could keep her cervical spine in a neutral position easily. Her gait was also improved. The symptoms did not recur during 4 years of follow-up. We surmise that to maintain daily activities, she had to extend her cervical spine owing to the thoracic kyphotic deformity, resulting in compression of the spinal cord. The compression led to weakening of the cervical extensor muscles. Cervical laminoplasty was effective.

We report an extremely rare case with bilateral and symmetric dumbbell ganglioneuromas of the cervical spine in an elderly patient. A 72-year-old man came by ambulance to our hospital due to progressive incomplete paraplegia. Magnetic resonance imaging demonstrated bilateral symmetric dumbbell tumors at the C1/2 level. We performed total resection of the intracanalar tumor, aiming at complete decompression of the spinal cord, and partial and subtotal resection of foraminal outside portions. Histopathological examination of the surgical specimen indicated the tumor cells to be spindle cells with the presence of ganglion cells and no cellular pleomorphism, suggesting a diagnosis of ganglioneuroma. Although the surgery was not curative, the postoperative course was uneventful and provided a satisfactory outcome. This is the fourth known case of cervical ganglioneuromas of the bilateral symmetric dumbbell type. [ABSTRACT FROM AUTHOR]

Presents a case of atlantoaxial subluxation of the cervical spine accompanied by mixed connective tissue disease treated by surgery. Reason behind the surgical treatment; Complication of the operation; Information on mixed connective tissue disease.

The article presents a case study of a rare combination of Charcot joint in the elbow and syringomyelia in a patient treated by foramen magnum decompression. It reveals the results of a physical examination on a 57-year-old woman presented with painless instability and swelling of the left elbow. The etiology of Charcot joint includes diabetes mellitus, leprosy, yaws, congenital insensitivity to pain or syringomyelia. It is suspected that syringomyelia is a result of Chiari malformation type I and was the most probable cause of the Charcot joint.