Sensory profile of picky eaters among college female students.

Picky eaters are at risk of an unbalanced diet, which is critical for women of reproductive age. A sensory profile, which is a potential factor in picky eating, has not been well researched. This study assessed the differences in sensory profile and dietary intake according to the picky eating status among female Japanese undergraduate college students. Cross-sectional data were obtained from the Ochanomizu Health Study conducted in 2018. The questionnaire included items regarding demographic characteristics, picky eating status, sensory profile, and dietary intake. Sensory profile was assessed using the Adult/Adolescent Sensory Profile questionnaire, and dietary intakes were calculated using a brief-type self-administered diet history questionnaire. Among the 111 participants, 23% were picky eaters and 77% were non-picky eaters. The age, body mass index and household status did not differ between the picky eaters and non-picky eaters. Being a picky eater was associated with higher scores on sensory sensitivity and sensation avoiding, and lower thresholds for taste and smell, touch, and auditory stimuli than being a non-picky eater. Of the picky eaters, 58% and 100% were at a high risk for folate and iron deficiencies, respectively, compared to 35% and 81% of non-picky eaters. Nutrition education for picky eaters in reproductive age to increase vegetable dishes comfortably in their diet is suggested to prevent anemia during their future pregnancy.

Changing genetic architecture of body mass index from infancy to early adulthood: an individual based pooled analysis of 25 twin cohorts.

BACKGROUND: Body mass index (BMI) shows strong continuity over childhood and adolescence and high childhood BMI is the strongest predictor of adult obesity. Genetic factors strongly contribute to this continuity, but it is still poorly known how their contribution changes over childhood and adolescence. Thus, we used the genetic twin design to estimate the genetic correlations of BMI from infancy to adulthood and compared them to the genetic correlations of height. METHODS: We pooled individual level data from 25 longitudinal twin cohorts including 38,530 complete twin pairs and having 283,766 longitudinal height and weight measures. The data were analyzed using Cholesky decomposition offering genetic and environmental correlations of BMI and height between all age combinations from 1 to 19 years of age. RESULTS: The genetic correlations of BMI and height were stronger than the trait correlations. For BMI, we found that genetic correlations decreased as the age between the assessments increased, a trend that was especially visible from early to middle childhood. In contrast, for height, the genetic correlations were strong between all ages. Age-to-age correlations between environmental factors shared by co-twins were found for BMI in early childhood but disappeared altogether by middle childhood. For height, shared environmental correlations persisted from infancy to adulthood. CONCLUSIONS: Our results suggest that the genes affecting BMI change over childhood and adolescence leading to decreasing age-to-age genetic correlations. This change is especially visible from early to middle childhood indicating that new genetic factors start to affect BMI in middle childhood. Identifying mediating pathways of these genetic factors can open possibilities for interventions, especially for those children with high genetic predisposition to adult obesity.

Rare case of real-time observation of paralytic deterioration after cervical dislocation in the hyperacute phase.

BACKGROUND: There have been no prior reports of real-time detailed records leading to complete quadriplegia immediately after fracture dislocation in high-energy trauma. Here, we report a case of cervical dislocation in which the deterioration to complete motor paralysis (modified Frankel B1) and complete recovery (Frankel E) could be monitored in real time after reduction in the hyperacute phase. CASE PRESENTATION: A 65-year-old man was involved in a car accident and sustained a dislocation at the C5/6 level (Allen-Ferguson classification: distractive flexion injury stage IV). His paralysis gradually deteriorated from Frankel D to C 2 hours after the injury and from Frankl C to B 5 hours after the injury. His final neurological status immediately before reduction was Frankel B1 (complete motor paralysis with sensation only in the perianal region). Reduction was completed within 6 h and 5 min after injury, and spinal fusion was subsequently performed. The patient exhibited rapid motor recovery immediately after surgery, and was able to walk independently on postoperative day 14. CONCLUSIONS: This case suggests that there is a mixture of cases in which the spinal cord has not been catastrophically damaged, even if the patient has complete motor paralysis. Prompt reduction has the potential to improve neurological function in such cases.

Later chronotype is associated with unhealthful plant-based diet quality in young Japanese women.

BACKGROUND: Having a late chronotype, that is, the tendency to go to sleep and wake up at later hours, influences an individual's physical and mental health. Despite a few studies noting the association of chronotype with healthy dietary patterns, this relationship remains unclear. PURPOSE: This study aimed to describe the association of chronotype with healthful and unhealthful plant-based diet quality in female Japanese undergraduate students. DESIGN: Cross-sectional. PARTICIPANTS AND SETTING: A total of 218 female university students in Tokyo, Japan. MAIN OUTCOME MEASURES: Healthful and unhealthful plant-based dietary index-Japanese version (hPDI-J and uPDI-J), calculated using the validated brief-type self-administered diet history questionnaire. STATISTICAL ANALYSES PERFORMED: A five-model stepwise multiple linear regression analysis was conducted. Independent variables were hPDI-J and uPDI-J scores, and dependent variables were various lifestyle habits related to the circadian rhythm and demographic characteristics. RESULTS: Mean (standard deviation) sleep duration, midpoint of sleep, sleep latency time, and social jetlag were 411 (60) min, 03:56 (00:57), 21 (27) min, and 50 (39) min, respectively. Chronotype and several variables, such as residential status, energy and alcohol intake, and nutritional knowledge, were associated with healthful and unhealthful plant-based diet quality. Individuals who had higher hPDI-J scores were more likely to have an earlier chronotype (ß = -0.168, P = 0.019) and better nutritional knowledge (ß = 0.164, P = 0.022) than those with lower hPDI-J scores. Individuals were more likely to have higher uPDI-J scores if they were living alone (ß = -0.301, P < 0.001), had a later chronotype (ß = 0.181, P = 0.001), higher frequency of snacking (ß = 0.164, P = 0.019), lower total energy (ß = -0.445, P < 0.001), and worse nutritional knowledge (ß = -0.172, P = 0.001). CONCLUSION: This study provided new evidence as to the relationship between sleep and dietary habits, the interaction of which may affect women's health.

Is mindful eating sustainable and healthy? A focus on nutritional intake, food consumption, and plant-based dietary patterns among lean and normal-weight female university students in Japan.

PURPOSE: This study aimed to investigate the correlation between mindful eating and nutritional intake, food consumption, and healthful and unhealthful plant-based dietary patterns in young Japanese women. METHODS: The sample comprised 215 female undergraduates who responded to a two-questionnaire anonymous survey conducted in Tokyo, Japan in 2018 and 2019 from November to December. We measured mindful eating status using the Expanded Mindful Eating Scale (EMES) and used Japanese plant-based dietary indices to determine plant-based dietary patterns. Partial correlation analyses were conducted to determine the correlation of mindful eating with energy and nutrient intake, food consumption, and plant-based dietary patterns, after adjusting for demographics and body mass index. RESULTS: Participants with higher sub-scores in "health of the planet" and "awareness and appreciation for food" ate higher quantities of several micronutrients and plant-based foods and were more likely to have a healthful plant-based dietary pattern. They were also less likely to have an unhealthful plant-based dietary pattern. In contrast, participants with higher scores in "non-judgmental awareness" ate less protein, whole grains, and vegetables, and were likely to have an unhealthful plant-based dietary pattern. CONCLUSION: This study is the first to show that young Japanese women with normal or lean body weight were more likely to consume healthful plant-based foods when they ate mindfully. LEVEL V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Recent developments in undergraduate education in psychiatry in Japan.

The 2010 announcement by the Education Commission for Foreign Medical Graduates, related to accreditation by the World Federation for Medical Education, accelerated medical education reform in Japan. This article reviews reports on reforms undertaken in undergraduate medical education in psychiatry in Japan after 2010, and discusses resulting implications. While Japanese medical education has made significant progress, achieving global standards in less than a decade, there remain issues related to utilisation of active learning - inclusion of self-directed learning, problem-based learning, team-based and small group learning, and clinical training - as well as the provision of opportunities for students to be involved in certain medical procedures, and the integration of behavioural and social sciences, including communication skills, decision making, medical ethics, medical psychology, and general health promotion perspectives. These issues imply considerable paradigm shifts for psychiatry in Japan. It remains to be seen whether these progressive perspectives in undergraduate education can be effectively incorporated into postgraduate training, as well. There is also an issue of balance with specific important areas. The question of how undergraduate education in psychiatry in Japan can assimilate issues relevant to the practice of psychiatry in Japan, while ensuring conformity with high-level global standards, remains a serious challenge.

Development and validation of the Expanded Mindful Eating Scale.

PURPOSE: To develop and validate the Expanded Mindful Eating Scale (EMES), an expanded mindful eating model created for the promotion of health and sustainability. DESIGN/METHODOLOGY/APPROACH: A cross-sectional study using self-administered questionnaire surveys on Ochanomizu Health Study (OHS) was conducted. The survey was provided to 1,388 female university students in Tokyo, Japan. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and a partial correlation analysis were used to confirm construct and criterion validity. Internal consistency of the EMES was confirmed to calculate Cronbach's alpha. FINDINGS: The response rate was 38.7 % (n = 537). Mean BMI was 20.21 ± 2.12, and 18.8% of them were classified as "lean" (BMI < 18.5). The authors listed 25 items and obtained a final factor structure of five factors and 20 items, as a result of EFA. Through CFA, the authors obtained the following fit indices for a final model: GFI = 0.914, AGFI = 0.890, CFI = 0.870 and RMSEA = 0.061. The total EMES score was significantly correlated with BMI, mindfulness, body dissatisfaction, drive for thinness and life satisfaction (r = -0.138, -0.315, -0.339, -0.281 and 0.149, p < 0.01, respectively). Cronbach's alpha for all items in this scale was 0.687. PRACTICAL IMPLICATIONS: The authors suggest the possibility that practitioners and researchers of mindful eating that includes this new concept can use authors' novel scale as an effective measurement tool. ORIGINALITY/VALUE: The EMES, which can multidimensionally measure the concept of the expanded model of mindful eating was first developed in this study.

Quality of life in Japanese couples during the transition to parenthood.

OBJECTIVE: This study aimed to examine the quality of life (QOL) in Japanese couples during the transition to parenthood with their first child. BACKGROUND: Relevant literature suggests that the health status of women drop during pregnancy and the postpartum period. However, less is known about their partner's well-being during the transition to parenthood and little research has addressed the relationship between couples' QOL across multiple domains. METHOD: Participants included 9216 married Japanese men and women, including 3729 couples, who were expecting or raising their first child under the age of three. They independently completed questionnaires on baseline demographics and on WHOQOL-BREF. RESULTS: Men showed higher scores for psychological QOL, while women had higher scores for social and environment QOL. A significant interaction between gender and stage of transition to parenthood was found. The moderating effect of age between the stage and QOL was found for men on the physical and psychological domains. Couples' QOL scores were weakly to moderately correlated. CONCLUSION: Findings suggest that both men and women had lower QOL, with the exception of women's physical QOL, after childbirth, but they showed different trends during the transition to parenthood across different domains of QOL.

QOL and sociodemographic factors among first-time parents in Japan: a multilevel analysis.

PURPOSE: The present study aimed to examine the relationship between sociodemographic factors and domains of quality of life (QOL) among married adults in Japan who were either rearing or expecting their first child. Our research focus was on whether different sociodemographic variables interacted with each other in predicting the first-time parents' QOL. METHOD: In total, 4374 (mean age = 34.9 years, SD = 8.4, range 18-71) community-based married couples pooled from two surveys provided their sociodemographic information (i.e., age, years of education, and annual income) and responded to the brief version of the QOL instrument developed by the World Health Organization (WHOQOL-BREF in Psychological Medicine 28(3):551-555, 1998). RESULTS: Series of multilevel regression analyses revealed that household annual income and education were associated with all domains of QOL, and other sociodemographic variables worked in a domain-specific manner. In addition, the effect of educational attainment on psychological domain was significant for mothers only, whereas the effects of household income on psychological and environmental domains were stronger for the younger (below age 26) than the older (over 43) couples. CONCLUSION: The effects of sociodemographic factors at couple as well as individual levels on the first-time parents' QOL were examined for the first time in Japan using couple data. In addition to corroborating previous findings on the main effects concerning these variables, the present study demonstrated the complex patterns of interaction across different levels. These findings provide evidence for the need for financial and health measures targeted at specific parent populations.

Characteristics of female mentally disordered offenders culpable under the new legislation in Japan: A gender comparison study.

BACKGROUND: Although a substantial increase in the number of female offenders has drawn interest towards understanding their unique characteristics, few studies have investigated the characteristics of female mentally disordered offenders in Japan and none since the legislation enacted in 2005 in Japan, which provided for special services for them. AIMS: The aim of this study is to identify those characteristics of people detained under this legislation, which distinguish the women from the men and may indicate special needs among the women. METHODS: A retrospective records-based study of all patients admitted to one secure unit in the 8 years since its opening in July 2005 until a census date of 31 October 2013. RESULTS: Thirty-six (15%) of the patients were women. Marriage, mood disorders, past suicide attempts and homicide were more common among the women than the men. Six of the female offender-patients had committed filicides, of which four were infanticides. CONCLUSION: There appears to be a particularly vulnerable sub-group of women with severe mood disorders, a history of serious suicide attempts and young children at risk of harming those children. Our sample was small and from a single unit so, given the potential importance of improving understanding of who is at risk in such circumstances, extending our study nationally seems indicated.

Relationship between parental autistic traits and parenting difficulties in a Japanese community sample.

BACKGROUND: Previous studies have suggested an association between higher levels of parental autistic traits and negative aspects of parenting; however, the domain of autistic traits specifically associated with parenting difficulties has not been investigated yet. Moreover, it remains to be determined whether this association exists even after controlling for children's characteristics. AIMS: This study examined the relationship between each domain of parental autistic traits and parenting difficulties after controlling for children's characteristics in a Japanese community sample. METHODS AND PROCEDURES: Surveys were administered to 1373 Japanese adults who were parents to children in kindergartens, nursery schools, and elementary schools. OUTCOMES AND RESULTS: The results showed that parents with higher levels of autistic traits had more parenting difficulties. Even after controlling for children's sex, age, and emotional/behavioral problems, paternal impaired communication and maternal poor attention switching, impaired communication, and lack of imagination were related to higher parenting difficulties, while a higher maternal level of attention to detail was associated with lower difficulties in parenting. CONCLUSIONS AND IMPLICATIONS: The findings of this study highlight the importance of focusing on parental autistic traits and providing appropriate parenting support considering these traits.

Mediating role of sensory differences in the relationship between autistic traits and internalizing problems.

BACKGROUND: Sensory differences are related to the autistic traits, and previous studies have shown a positive correlation between sensory differences and internalizing problems. In this study, we hypothesized that sensory differences and suffering due to sensory differences mediates the relationships between autistic traits and internalizing problems. METHODS: A total of 346 female Japanese university students completed questionnaires regarding their autistic traits, suffering due to sensory differences, and internalizing problems. Moreover, 114 participants completed a questionnaire related to sensory differences. RESULTS: Autistic traits were correlated with Low Registration and Sensation Avoiding. These sensory differences were also correlated with suffering due to sensory differences and internalizing problems. Moreover, path analysis indicated that the higher the suffering due to Low Registration and Sensation Avoiding was, the greater the internalizing problems in those who showed these sensory differences. CONCLUSIONS: Female university students with serious suffering due to sensory differences may need support in managing their suffering and internalizing problems. Further research will help suggest support that these people require, at school and elsewhere.

Association of healthy eating literacy and resident status with energy, nutrients, and food consumption among lean and normal-weight female university students.

BACKGROUND & AIMS: This study aimed to describe the association of healthy eating literacy (HEL) with energy, nutrients, and food consumption in young women who had normal and lean weight at a Japanese university, considering their resident status. METHODS: Cross-sectional data from the Ochanomizu Health Study were used in this study. Participants answered a self-administered, two-part, anonymous survey in 2018 and 2019. A total of 203 female undergraduate students with lean and normal body mass index (BMI) were included in the analysis. Single and stepwise multiple linear regression analysis was used to examine the association of HEL and resident status with healthy food consumption, such as vegetables, fish, and shellfish. The dependent variables were HEL and resident status, and the covariates were age, BMI, and the total metabolic equivalents. RESULTS: The median (25th and 75th percentiles) age, BMI, and total HEL score were 20 (19, 21) years, 20.2 (18.9, 21.3) kg/m 2, and 18 (16, 20), respectively. Resident status and HEL were independently associated with vegetables, fish, and shellfish intake. Participants who had higher total HEL scores and lived in their family home consumed significantly more vegetables (ß = 0.17 and -0.34, p < 0.05) and fish and shellfish (ß = 0.24, -0.28, p < 0.001). CONCLUSION: This study provides an insight into the association between HEL and dietary consumption in young women with normal and lean BMI.

Resilience building for mood disorders: Theoretical introduction and the achievements of the Re-Work program in Japan.

Mood disorders are common, tend to recur, cause sickness absence, and lead to economic loss. Since past experiences of mood disorder episodes often increase future vulnerability, it is imperative to assist those mood disorder patients who want to resume working to build resilience to prevent relapse. Paralleling efforts in the West, a resilience-building program utilizing the principles of the Illness Management and Recovery program was first developed in Japan in 1997. The purpose of this survey is to introduce the concept and theory behind the Re-Work program and to review studies that report on program assessment, content, effects and associated factors, and prognosis of participants. A literature search performed with PubMed and Igaku chuou zasshi (Ichushi) identified 30 relevant studies. One of these reported on a tool developed to assess readiness for returning to work. Concerning program content, a group therapy setting and cognitive behavioral therapy were found to be effective. Physical exercise and relaxation techniques may be useful as secondary program components. Several studies report on program effects, but there may be factors that limit these effects. The prognosis for relapse prevention after the resumption of work may be better for Re-Work program participants than for a control group. Further research in this area is needed to confirm program effectiveness and related factors.

Assessing Knowledge-Based and Perceived Health Literacy Among Japanese Adolescents: A Cross-Sectional Study.

Health literacy assessment is a major aspect of planning health education for adolescents. We evaluated the health literacy of Japanese adolescents using both perceived and knowledge-based health literacy scales. Study questionnaires were administered to 773 junior and senior high school students aged 12 to 18 years. We tested a model describing the hierarchical relations between functional, communicative, critical, and knowledge-based health literacy using path analysis. Critical health literacy was found to be influenced by functional, communicative, and knowledge-based health literacy, while functional and knowledge-based health literacy were correlated. The model, with slight modification, was supported. The result indicates that perceived functional health literacy scores did not directly correlate with higher perceived critical health literacy; rather, they only informed critical health literacy when participants had high knowledge-based health literacy.

Genetic and environmental influences on human height from infancy through adulthood at different levels of parental education.

Genetic factors explain a major proportion of human height variation, but differences in mean stature have also been found between socio-economic categories suggesting a possible effect of environment. By utilizing a classical twin design which allows decomposing the variation of height into genetic and environmental components, we tested the hypothesis that environmental variation in height is greater in offspring of lower educated parents. Twin data from 29 cohorts including 65,978 complete twin pairs with information on height at ages 1 to 69 years and on parental education were pooled allowing the analyses at different ages and in three geographic-cultural regions (Europe, North America and Australia, and East Asia). Parental education mostly showed a positive association with offspring height, with significant associations in mid-childhood and from adolescence onwards. In variance decomposition modeling, the genetic and environmental variance components of height did not show a consistent relation to parental education. A random-effects meta-regression analysis of the aggregate-level data showed a trend towards greater shared environmental variation of height in low parental education families. In conclusion, in our very large dataset from twin cohorts around the globe, these results provide only weak evidence for the study hypothesis.

Temperament and melancholic type: path analysis of a prospective study of depressive mood change in a nonclinical population.

BACKGROUND: Recent studies suggest that mood-disorder-related personality traits predict depressive mood changes (DMC) in nonclinical populations. SAMPLING AND METHODS: In this study we examined the predictability of DMC in a nonclinical sample consisting of 351 Japanese company employees, with temperament and melancholic type personality as measured by the Temperament Evaluation of Memphis, Pisa, Paris and San Diego and the Munich Personality Test. We also analyzed the mediating roles of dysfunctional attitudes and coping styles. Subjects were assessed for depressive mood, temperament and personality traits in May 2002 (time 1) and May 2004 (time 2), and dysfunctional attitudes and coping styles at time 2. RESULTS AND CONCLUSION: Results of hierarchical multiple regressions showed that depressive, cyclothymic and hyperthymic temperaments and melancholic type at time 1 significantly predicted DMC from time 1 to time 2, after controlling for demographic variables and the level of depressive mood at time 1. Path analysis results showed that depressive, cyclothymic and hyperthymic temperaments and melancholic type significantly predicted DMC, a certain part of the influence of depressive, cyclothymic and hyperthymic temperaments and melancholic type was significantly mediated via coping styles and that the influence of melancholic type was also mediated via dysfunctional attitudes. These findings provide clues for the targeting of interventions.

Time Course of Respiratory Dysfunction and Motor Paralysis for 12 Weeks in Cervical Spinal Cord Injury without Bone Injury.

INTRODUCTION: Cervical spinal cord injury without bone injury (SCIWOBI) is a common cervical injury in the elderly population and is most likely to occur at the C3/C4 level. Respiratory dysfunction (RD) related to the damage of the spinal respiratory center, which is close to the C4 segment, is one of the greatest obstacles in improving the activities of daily living of patients with severe paralysis. We evaluated the time course of RD and motor function in cervical SCIWOBI to identify effective medical strategies. METHODS: We followed 54 patients (49 men, 5 women; mean age: 65 years old) who were treated for SCIWOBI at our medical center from 2011 to 2014. The patients were evaluated within 72 hours of injury and were monitored for at least 12 weeks. All patients began respiratory-muscle training the day after admission regardless of whether they were treated conservatively or surgically. The percent vital capacity (%VC), forced expiratory volume (FEV) in one second/forced vital capacity ratio (FEV 1.0%), and American Spinal Injury Association motor score (MS) were recorded at admission and again at weeks 4 and 12. We calculated the %VC rate of change and the MS improvement rate over the entire period. RESULTS: Fifty patients (92.6%) had restrictive ventilatory impairment at admission. The %VC correlated with the upper- and lower-limb MSs at admission, and the %VC and upper- and lower-limb MSs had improved by weeks 4 and 12 after the injury. The %VC rate of change was significantly correlated with the rate of improvement in lower-limb MS throughout the entire period. CONCLUSIONS: Lung capacity decreased in SCIWOBI owing to respiratory-muscle paralysis and upper- and lower-limb motor paralyses. Lung capacity improved as the lower limbs recovered their motor function. Respiratory rehabilitation should be continued for at least 12 weeks after SCIWOBI.

Parental Education and Genetics of BMI from Infancy to Old Age: A Pooled Analysis of 29 Twin Cohorts.

OBJECTIVE: The objective of this study was to analyze how parental education modifies the genetic and environmental variances of BMI from infancy to old age in three geographic-cultural regions. METHODS: A pooled sample of 29 cohorts including 143,499 twin individuals with information on parental education and BMI from age 1 to 79 years (299,201 BMI measures) was analyzed by genetic twin modeling. RESULTS: Until 4 years of age, parental education was not consistently associated with BMI. Thereafter, higher parental education level was associated with lower BMI in males and females. Total and additive genetic variances of BMI were smaller in the offspring of highly educated parents than in those whose parents had low education levels. Especially in North American and Australian children, environmental factors shared by co-twins also contributed to the higher BMI variation in the low education level category. In Europe and East Asia, the associations of parental education with mean BMI and BMI variance were weaker than in North America and Australia. CONCLUSIONS: Lower parental education level is associated with higher mean BMI and larger genetic variance of BMI after early childhood, especially in the obesogenic macro-environment. The interplay among genetic predisposition, childhood social environment, and macro-social context is important for socioeconomic differences in BMI.

Two-stage corrective surgery for severe rigid cervical kyphotic deformity with unilateral vertebral artery occlusion after old blunt trauma: a case report.

INTRODUCTION: There are considerable risks for vertebral artery (VA) injury in case of corrective surgery for a severe and rigid cervical kyphotic deformity. This case report describes a rare case of surgical management for pre-existing traumatic rigid cervical kyphosis associated with unilateral VA occlusion. CASE PRESENTATION: A 73-year-old male fell down and injured his neck. He was referred to our hospital 10 months after injury because his degree of head drop progressed gradually to a chin-on-chest position such that he could not look straight forward. On plain X-ray, the C2-7 angles in the neutral, flexion, and extension positions were 61°, 71°, and 50°, respectively. CT revealed a collapse of the C5 vertebral body and bone fusion between C4 and C5 in the anterior vertebrae, and unilateral VA occlusion was confirmed by angiography. Two-stage surgery was planned to correct the kyphosis. In the first stage, anterior release of the C4/5 bone-spur fusion and dissection of the intervertebral disk were performed. After release, angiography confirmed neither occlusion nor rupture of the VA. In the second stage, anterior and posterior fixation was performed at correcting position while maintaining slight kyphosis in order to avoid excessive distortion of the VA. The postoperative C2-7 kyphosis angle improved to 16° without any VA injury, and the patient could look forward easily. DISCUSSION: The degree of correction as well as risk management of VAs should be considered carefully during corrective surgery for severe and rigid cervical kyphosis, especially with unilateral VA occlusion.