Atlantoaxial Stabilization Using C1 Lateral Mass and C2 Pedicle/Translaminar Screw Fixation by Intraoperative C1- and C2-Direct-Captured Navigation with Preoperative Computed Tomography Images.

In C1-C2 posterior fixation, the C1 lateral mass and C2 pedicle/translaminar screw insertion under spine navigation have been used frequently. To avoid the risk of neurovascular damage in atlantoaxial stabilization, we assessed the safety and effectiveness of a preoperative computed tomography (CT) image-based navigation system with intraoperative independent C1 and C2 vertebral registration. It is ideal when a reference frame can be linked directly to the C1 posterior arch for C1-direct-captured navigation, but there is a mechanical challenge.

[A Case of Bilateral Trigeminal Neuralgia and the Possible Onset Mechanisms Based on the Operative Findings].

Several cases of bilateral trigeminal neuralgia(TN)have been reported;however, the possible onset mechanism has rarely been discussed. We encountered a case of bilateral TN occurring in two stages. A 64-year-old woman presented with left TN.

History and Evolution of Laminoplasty.

Techniques of expansive laminoplasty for degenerative cervical myelopathy and ossified posterior longitudinal ligament are described, focusing on the history of the surgical procedure. Laminectomy was the only approach for posterior decompression before Japanese orthopedic surgeons introduced laminoplasty from the 1970s to the 1980s to overcome the poor outcomes of laminectomy. Recent laminoplasty techniques offer less invasive maneuvers to the posterior cervical muscle structures to reduce axial neck pain and to obtain better functional outcome, but every operation is carried out based on the unchanged initial concept.

Clinical study of C3-C4 level surgical cases of cervical spondylosis.

Objective: The purpose of this study was to elucidate the pathological characteristics of C3-C4 cervical spondylotic myelopathy (CSM).

Methods: Single-level anterior cervical discectomy and fusion (ACDF) was performed at C3-C4 in 53 patients (38 men, 15 women). The mean duration of preoperative symptoms was 6.

Surgical consideration of cervical dumbbell tumors.

Background: Nineteen patients with cervical dumbbell tumors treated surgically were analyzed retrospectively.

Methods: Surgical strategies for dumbbell tumor were discussed from the perspective of safe, less-invasive surgery.

Results: Patients included 6 men and 13 women, with a mean age at the time of surgery of 48.

Thoracolumbar extradural arachnoid cyst--three surgical case reports.

Three cases of symptomatic extradural arachnoid cyst were treated by surgery. Total excision of the cyst followed by tight closure of the fistula by suture was achieved in all 3 cases. Surgery improved the neurological deficits but urinary incontinence persisted in all three patients.

Percutaneous endoscopic lumbar discectomy - early clinical experience.

We report our early clinical experience with percutaneous endoscopic lumbar discectomy (PELD) for herniated nucleus pulposus (HNP) in the lumbar spine. We introduced PELD to our clinical practice in June 2009. A total of 311 patients with degenerative lumbar spine disease were treated in our hospital up to August 2011.

Recapping hemilaminoplasty for spinal surgical disorders using ultrasonic bone curette.

Objective: The authors present a novel method of the recapping hemilaminoplasty in a retrospective study of patients with spinal surgical disorders. This report describes the surgical technique and the results of hemilaminoplasty using an ultrasonic bone curette. The aim of this study was to examine the safety and effectiveness of the hemilaminoplasty technique with ultrasonic bone curette.

β-Tricalcium phosphate promotes bony fusion after anterior cervical discectomy and fusion using titanium cages.

Study Design: Retrospective consecutive cohort study.

Objective: To study the effectiveness of β-tricalcium phosphate (β-TCP) granules as a packing material in the titanium cages for anterior cervical discectomy and fusion (ACDF), compared with the conventional hydroxyapatite (HA) granules.

Summary Of Background Data: ACDF using titanium cages is a standard procedure for the treatment of cervical spinal degenerative diseases.

Minimally invasive central corpectomy for ossified posterior longitudinal ligament in the cervical spine.

Minimally invasive central corpectomy (MICC) for cervical segmental ossified posterior longitudinal ligament (OPLL) is described. The procedure of MICC includes upper- or lower-half central corpectomy of the involved cervical spine, transdiscal decompression of the adjacent disc level, dissection and partial removal of the OPLL, removal of the OPLL behind the vertebral body via these windows, and fusion with cylindrical titanium cages. Anterior plate fixation is not necessary.

Long term outcome and adjacent disc degeneration after anterior cervical discectomy and fusion with titanium cylindrical cages.

Background: Anterior cervical discectomy and fusion (ACDF) is widely performed for the treatment of cervical spinal degenerative disease. Autogenic or allogenic bone grafts are used for interbody fusion with satisfactory long term outcomes. However, harvest of the autograft causes donor site complications and allograft is associated with low fusion rate.

Angiographically occult spinal dural arteriovenous fistula located using selective computed tomography angiography. Case report.

Spinal dural arteriovenous fistula (DAVF) is the most common type of spinal arteriovenous malformation and may cause progressive myelopathy but is usually treatable in the early stages by direct surgery or intravascular embolization. Selective spinal angiography has been the gold standard for diagnosis, but angiographically occult DAVF is not uncommon. A 67-year-old man presented with a 2-year history of progressive paraparesis.

Pathophysiology of cerebral circulatory disorders in idiopathic normal pressure hydrocephalus.

This study was conducted to elucidate the pathologic conditions of cerebral circulatory disorders in idiopathic normal pressure hydrocephalus (iNPH). Among 44 possible iNPH patients, 40 patients underwent shunt surgery based on diagnostic flow charts plotted by the Southern Tohoku method and were evaluated to be shunt-effective at the end of the first post-surgical month. The cerebral blood flow (CBF) was measured by N-isopropyl-((123)I)-P-iodo-amphetamine single photon emission computed tomography (mean, mCBF; cortical region, cCBF; thalamus-basal ganglia region, tbCBF on autoradiography [ARG] method) and the perfusion patterns of the cerebral cortex were measured based on three-dimensional stereotactic surface projection (3D-SSP) Z-score images, before and 1 month after the surgery in all 40 subjects.

Novel dural closure technique using polyglactin acid sheet prevents cerebrospinal fluid leakage after spinal surgery.

Objective: Extradural or subcutaneous cerebrospinal fluid (CSF) leakage is a common complication after spinal surgery and is associated with the risks of poor wound healing, meningitis, and pseudomeningocele. Numerous methods to prevent postoperative CSF leakage are available, but pressure-tight dural closure remains difficult, especially with synthetic surgical membranes. The efficacy of a novel dural closure technique was assessed by detecting extradural or subcutaneous CSF leakage on magnetic resonance imaging.

[Four cases of spontaneous spinal epidural hematoma].

Spontaneous spinal epidural hematoma (SSEH) is a rare clinical entity. Although approximately 500 cases have been reported, controversy exists concerning timing of the treatment and the validity of decompression surgery. We recently encountered four cases of SSEH.

Evaluation of anorectal function in patients with tethered cord syndrome: saline enema test and fecoflowmetry.

Object: Disturbance in anorectal function is a major factor restricting the activities of daily living in patients with spinal cord disorders. To detect changes in anorectal motilities due to a tethered spinal cord, anorectal functions were evaluated using a saline enema test and fecoflowmetry before and after patients underwent untethering surgery.

Methods: The bowel functions in five patients with a tethered cord syndrome (TCS) were evaluated by performing a saline enema test and fecoflowmetry.

Spinal cord edema preceding syringomyelia associated with Chiari I malformation--case report.

A 38-year-old woman with Chiari I malformation presented with spinal cord edema preceding syringomyelia manifesting as a 5-month history of nuchal pain and numbness of the upper extremities. Magnetic resonance imaging showed spinal cord edema, a poorly defined syrinx at the C-2 to T-2 levels, and distorted cerebellar tonsils. Computed tomography revealed cerebrospinal fluid (CSF) density in the center of spinal cord edema, and positron emission tomography revealed no uptake of L-[methyl-11C]methionine, indicating a non-neoplastic lesion.