Ectopic gas in the fibular graft after anterior cervical corpectomy and fusion.

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.

A Japanese nationwide multicenter survey on perioperative complications of corrective fusion for elderly patients with adult spinal deformity.

BACKGROUND: Recently, corrective fusion surgery for patients with adult spinal deformity (ASD) has become common in Japan. This study aimed to clarify the status of surgeries for ASD in Japan, focusing on perioperative complications. A nationwide multicenter survey gathering information on surgically treated ASD patients was conducted by the committee for Adult Spinal Deformity of the Japanese Scoliosis Society. METHODS: This study was a review of retrospectively collected data from 18 spine scoliosis centers belonging to the Japanese Scoliosis Society. Patients who underwent corrective fusion surgery for ASD between 2011 and 2013 were included. Demographics, comorbidities, surgical data, and complications were investigated. RESULTS: A total of 1192 patients (mean age, 57.7 years) were included in this study. Of these, 611 patients were aged less than 65 years and 581 patients were aged 65 years or greater. The age distribution had two peaks, in the third and eighth decades. Deformities caused by degeneration represented 67% of the pathology in patients aged over 65 years; however, non-degenerative disease such as adult idiopathic scoliosis and syndromic or congenital deformity represented over 60% of pathology in patients aged less than 65 years. The iatrogenic deformity and reoperation rates were both less than 3%. The mean operation time and estimated blood loss were 370 min and 1642 ml, respectively. Major perioperative complications occurred in 160 patients (14.5%). The incidence of complications was significantly higher in patients aged over 65 years, including neurological deficits, hemorrhagic shock, hematoma, heart failure, and surgical site infection (p < 0.05). CONCLUSIONS: Older (aged over 65 years) ASD patients showed greater rates of deformity due to the occurrence of degeneration and vertebral fractures, as well as a higher incidence of peri-and postoperative complications. Efforts to reduce perioperative complications are therefore imperative, especially for elderly ASD patients in our aging society.

Lower incidence of adjacent segment degeneration after anterior cervical fusion found with those fusing C5-6 and C6-7 than those leaving C5-6 or C6-7 as an adjacent level.

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.

Kidney-type intervertebral spacers should be located anteriorly in cantilever transforaminal lumbar interbody fusion: analyses of risk factors for spacer subsidence for a minimum of 2 years.

STUDY DESIGN: Retrospective analysis of factors related to kidney-type interbody spacer subsidence (SS) in transforaminal interbody fusion (TLIF). OBJECTIVE: To determine the risk factors for SS in TLIF using kidney-type spacers. SUMMARY OF BACKGROUND DATA: SS into the vertebral body, a major complication of TLIF, has not been studied extensively. METHODS: Between July 2004 and May 2006, 54 consecutive patients with lumbar dysplastic changes or degenerative disc diseases underwent TLIF using 82 kidney-type spacers with iliac bone grafts. All were followed-up for more than 2 years (mean, 2 y, 11 mo). SS was defined as disc height loss >2 mm. Risk factors analyzed for SS included spacer location in the intervertebral space (IVS, anterior, center, and posterior), sex, age, body mass index, and disease (spondylolisthesis, degenerative disc disease). Clinical outcomes were assessed using the Japanese Orthopedic Associated Score for back pain, as were adjacent segment disorder and nonunion. RESULTS: Of the 82 spacers, 66 were located in the center of the IVS and 16 anteriorly. There were 18 SS. Spacer position at the center of the IVS (P<0.001) and older age (P<0.001) were significantly associated with SS, with the first 2 factors having a synergistic effect. Adjacent level disorder (n=5) and nonunion (n=3) were observed only in patients with spacers positioned at the center of the IVS. CONCLUSIONS: Kidney-type spacers should be located in the anterior portion of the IVS to prevent subsidence of the intervertebral body, especially in patients with elderly age.

Comparative study on the efficacy of two-staged (posterior followed by anterior) surgical treatment using spinal instrumentation on pyogenic and tuberculotic spondylitis.

INTRODUCTION: Between 1997 and 2006, we treated 11 patients with tuberculotic spondylitis and 19 with pyogenic spondylitis using a two-staged operation (posterior spinal instrumentation, followed by anterior debridement and fusion). METHOD: We compared changes in inflammatory reactions, postoperative complications, organisms obtained during anterior debridement, neurological status, bone union, and suppression of the infection between the patients with tuberculotic and pyogenic spondylitis. PATIENTS: All patients in both groups achieved bone union and suppression of the infected sites. Decreases in C-reactive protein and erythrocyte sedimentation rate were significantly slower in the patients with tuberculotic spondylitis. Positive bacterial cultures at the second anterior debridement were obtained from 26% of patients with pyogenic spondylitis and 55% of patients with tuberculotic spondylitis. Frankel types improved in 57% of patients, but there were no differences in neurological improvement. The efficacy of the two-staged operation did not differ between the patients with pyogenic and tuberculotic spondylitis. RESULTS: Although the baselines were different, there were no significant differences in relative operating parameters, neurological improvement, or postoperative complications between the two groups. At the final follow-up, all patients finally achieved suppression of spinal infection and solid bone fusion in both groups, although the decline in inflammatory parameters was slower in the T group than in the P group.

Anterior cervical multilevel decompression and fusion using fibular strut as revision surgery for failed cervical laminoplasty.

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.

Surgical outcome of 2-stage (posterior and anterior) surgical treatment using spinal instrumentation for tuberculous spondylitis.

STUDY DESIGN: A prospective study on the clinical outcomes in patients with tuberculous spondylitis treated by a 2-stage operation (posterior and anterior) using posterior spinal instrumentation. OBJECTIVE: To evaluate the clinical outcomes of the 2-stage surgical treatment (first stage: placement of posterior instrumentation and second stage: anterior debridement and bone grafting) for tuberculous spondylitis. SUMMARY OF BACKGROUND DATA: There have been few reports describing the effects of 2-stage surgical treatment for tuberculous spondylitis. METHODS: Ten patients (5 men and 5 women) with tuberculous spondylitis were treated by 2-stage operations. Age at the initial operation was 64.6+/-14.8 years (average+/-SD) (range: 47 to 83 y). The clinical outcomes were evaluated before and after the surgery in terms of hematologic examination, pain level, and neurologic status. Bone fusion and changes in sagittal alignment were examined radiographically. RESULTS: All patients showed suppression of infection, bony fusion, relief of pain, and recovery of neurologic function. No significant changes were observed in kyphosis angle at the final follow-up. There were no incidences of severe complications or recurrence. CONCLUSIONS: Our results showed that posterior and anterior 2-stage surgical treatment for tuberculous spondylitis is a viable surgical option for cases in which conservative treatment has failed. However, the changes in sagittal alignment showed that this strategy provides limited kyphosis correction.

Postsurgical recurrence of osteophytes causing dysphagia in patients with diffuse idiopathic skeletal hyperostosis.

Although cervical anterior osteophytes accompanying diffuse idiopathic skeletal hyperostosis (DISH) are generally asymptomatic, large osteophytes sometimes cause swallowing disorders. Surgical resection of the osteophyte has been reported to be an effective treatment; however, little study has been given to the recurrences of osteophytes. A prospective study was performed for seven patients who underwent surgical resection of cervical anterior osteophytes for the treatment of recalcitrant dysphagia caused by osteophytes that accompanied DISH. The seven patients were six men and one woman ranging in age from 55 to 78 years (mean age = 65 years). After a mean postoperative follow-up period of 9 years (range: 6-13 years), surgical outcomes were evaluated by symptom severity and plain radiographs of the cervical spine. On all operated intervertebral segments, the effect of postoperative intervertebral mobility (range of movement > 1 degree) on the incidence of recurrent osteophytic formation (width > 2 mm) was analyzed by Fisher's exact test. Complete relief of the dysphagia was obtained within one month postoperatively in five patients, while it was delayed for 3 months in two patients. All of the patients developed recurrent cervical osteophytic formation, with an average increase rate of approximately 1 mm/year following surgical resection. Of the 20 operated intervertebral segments, the incidence of recurrent osteophytes was significantly higher (P = 0.0013) in the 16 segments with mobility than in the four segments without mobility. Five of the seven patients remained asymptomatic, although radiological recurrence of osteophytes was seen at the final follow-up. The two remaining patients complained of moderate dysphagia 10 and 11 years after surgery, respectively; one of these two required re-operation due to progressive dysphagia 11 years postoperatively. In patients with cervical DISH and dysphagia, surgical resection of osteophytes resulted in a high likelihood of the recurrence of osteophytes. Therefore, attending surgeons should continue to follow these patients postoperatively for more than 10 years in order to assess the regrowth of osteophytes that may contribute to recurrent symptoms.

Surgical treatment of multiple spinal canal stenoses associated with vitamin D-resistant rickets.

We describe a 44-year-old woman who was diagnosed in childhood with vitamin D-resistant rickets, and who had paraparesis due to multiple spinal canal stenoses between C5 and L1 with ossification of the posterior longitudinal ligament and the yellow ligament. She was treated surgically with laminoplasty of the C2 through C7 levels and laminectomy from T8 through T11. Four months later, she underwent anterior fusion using an ilium graft by thoracotomy from the T12 to L1 levels. Six months after surgery, her symptoms improved. After 5 years, and with oral vitamin D, no progression of symptoms has been observed.

One-staged combined cervical and lumbar decompression for patients with tandem spinal stenosis on cervical and lumbar spine: analyses of clinical outcomes with minimum 3 years follow-up.

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.

Double-level posterior spinal shortening for paralytic osteoporotic vertebral collapse of two vertebral bodies with a normal vertebra in between: a case report.

INTRODUCTION: Spinal shortening is indicated for osteoporotic vertebral collapse. However, this surgical procedure has not been indicated for more than two vertebral levels that are not adjacent. We experienced a rare case of paraparesis due to osteoporotic vertebral collapse of two vertebral bodies with a normal vertebra in between and treated successfully by the double-level posterior shortening procedure. MATERIALS AND METHODS: A 79-year-old woman suffered from delayed paraparesis 2 years after L1 and Th11 vertebral body compression fracture. Plain X-ray photographs showed Th11 and L1 vertebral body collapse, Th7 compression fracture and a kyphosis angle of 30 degrees from Th10 to L2. Plain magnetic resonance imaging showed spinal canal stenosis at Th11 and L1 vertebral body levels. She was treated by double-level posterior spinal shortening using pedicle screw and hook systems. RESULTS: After the procedure, the patient's kyphosis angle decreased to 10 degrees and her back pain, leg pain, and sensory deficits improved. She was able to walk by herself. Although new vertebral compression fractures occurred at L4 and L5 in the follow-up period, there has been no deterioration of the neurological symptoms 5 years after the operation. CONCLUSION: Delayed paraparesis after double-level thoracolumbar vertebral collapse due to osteoporosis was treated successfully by double-level posterior spinal shortening using a pedicle screw and hook system.

The Japanese Scoliosis Society Morbidity and Mortality Survey in 2014: The Complication Trends of Spinal Deformity Surgery from 2012 to 2014.

INTRODUCTION: The Japanese Scoliosis Society (JSS) created a longitudinal complication survey of spinal deformity surgery and established the Morbidity and Mortality (M&M) Committee in 2012. The purpose of this study was to analyze the results of the complication survey in 2014 and to report the differences in the complication rates between the years 2012 and 2014. METHODS: A request to participate in this survey was mailed to all JSS members. The questionnaires were sent through e-mail to the members who took part in this survey, and the responses were returned through the same. Diagnosis was grouped into idiopathic scoliosis, congenital scoliosis, neuromuscular scoliosis, spondylolisthesis, pediatric kyphosis and adult spinal deformity. Complication was grouped into death, blindness, neurological deficit (motor or sensory deficit), infection, massive bleeding, hematoma, pneumonia, cardiac failure, DVT/PE, gastrointestinal perforation and instrumentation failure. RESULTS: A total of 2,012 patients were reported from 71 institutes. Overall, complications were observed in 326 patients, and the complication rate increased from 10.4% in 2012 to 15.3% in 2014. The complication rate decreased from 8.8% to 3.7% in idiopathic scoliosis, 21.9% to 15.8% in neuromuscular scoliosis and 26.8% to 0% in kyphosis. The complication rate increased from 6.6% to 14.4% in congenital scoliosis, 9.3% to 12.0% in other types of scoliosis, 3.5% to 14.3% in spondylolisthesis and 21.6% to 26.0% in adult spinal deformity. The rate of neurological deficit, especially in motor deficit, increased from 3.2% to 7.7% in older patients with adult spinal deformity. Instrumentation failure was also more common in patients with adult spinal deformity (5.2% to 5.8%), especially in patients aged 40-65 years (4.4% to 9.1%). CONCLUSIONS: The major complication trends were an increasing rate of neurological deficit and instrumentation failure, especially in adult spinal deformity.

Symptomatic lumbar mobile segment with spinal canal stenosis in a fused spine associated with diffused idiopathic skeletal hyperostosis.

BACKGROUND CONTEXT: Chronic, continuous stress at the junction of a stable/unstable site of the spine in diffuse idiopathic skeletal hyperostosis (DISH) has been reported to cause a nonunion. Back pain resulting from the nonunion has been rarely reported and few operative treatments have been suggested. PURPOSE: To report and discuss the pathogenesis, treatment, and surgical outcome of a rare cause of back pain. STUDY DESIGN: Case report of back pain caused by a single lumbar segment is lacking bony union at the caudal end of a fused spine associated with diffuse idiopathic skeletal hyperostosis. METHODS: Back pain in a 66-year-old man who had suffered for 10 years worsened. The back pain and thigh pain became intolerable, and the left buttock and thigh became numb. Radiographs and computed tomography images showed continuous hyperostosis in the anterior aspect of the vertebral bodies from C2 to L2. At the caudal adjacent level of these fused segments, L2/3 level was mobile and had canal stenosis. Decompression and posterior lumbar interbody fusion (PLIF) were performed. RESULTS: The pain disappeared soon after the operation. The nonunited segment showed bony union at the 5-year follow-up. CONCLUSIONS: PLIF may be an option for surgically treating symptomatic nonunited lumbar segments at the caudal end of a fused spine with DISH in cases unresponsive to conservative treatment.

Segmental wire fixation for lumbar spondylolysis associated with spina bifida occulta.

INTRODUCTION: The effectiveness of segmental wire fixation technique in repairing lumbar spondylolysis has already been reported. However, whether the technique can be indicated for spondylolysis associated with spina bifida, which is occasionally found with spondylolysis, is not well known. In this study, the authors report the mid-term clinical outcome of the procedure performed in patients with symptomatic lumbar spondylolysis associated with spina bifida occulta. MATERIALS AND METHODS: Among 20 patients with symptomatic lumbar spondylolysis who underwent segmental wire fixation between 1996 and 2001, four patients associated with spina bifida occulta were evaluated with an average of 32 months follow-up. Bony union at spondylolysis sites and spina bifida was evaluated using plain X-rays and computed tomography (CT) scans. Clinical symptoms were assessed using Japanese Orthopedic Association scores for back pain (JOA scores) and Henderson's evaluation of functional capacity. RESULTS: The radiographic examinations of the latest follow-ups revealed the following results. Pars defect; in three cases with bilateral defect, one case healed bilaterally and two healed only unilaterally. One case with unilateral defect healed. Spina bifida; two cases showed bony union and two showed no union. Of the four patients operated, two were rated excellent with the remaining two good according to Henderson's evaluation. The recovery rate of JOA score was averaged at 69.7 +/- 23.5%. No serious complications were noted. CONCLUSIONS: In four cases associated with lumbar spondylolysis and spina bifida, segmental wire fixation provided satisfactory clinical outcomes.

Solitary fibrous tumor in the cervical spine with destructive vertebral involvement: a case report and review of the literature.

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.

Spondylolysis of the second lumbar vertebra treated with segmental wiring and bone grafting.

Spondylolysis affects mostly the lower lumbar spine and rarely the upper lumbar spine. In a literature research, we found that the descriptions of spondylolysis of the upper lumbar spine had been reported mainly with the outcomes of conservative treatment using lumbosacral supports. However, an indication of surgical treatment has rarely been reported. Ravichandran et al reported 2 cases of spinal fusion, decompression or a combination of these procedures, but the procedures have not proved satisfactory in cases of upper lumbar spondylolysis. We found no reports of segmental wire fixation and bone grafting for upper lumbar spondylolysis. Herein, we report spondylolysis of the second lumbar vertebra in a 27-year-old man. He presented with pain and tenderness at the L2 spinous process, and swollen paravertebral muscles. The patient first became aware of lumbago at age 24 years. Much of his work involved heavy labor. He was diagnosed with spondylolysis of L2 and treated conservatively by a general orthopedist from age 25 to 27 years, but without improvement. We performed segmental wire fixation of the transverse and spinous processes of L2, followed by a bone graft. Six months after surgery, the lumbago had resolved and the patient was able to return to work. Three years after surgery, his pain is completely resolved. This is the first report in the English literature in which a successful indication for symptomatic spondylolysis in the upper lumbar spine is described.

Scoliosis associated with Prader-Willi syndrome.

BACKGROUND CONTEXT: Prader-Willi syndrome is a rare disease associated with a variety of musculoskeletal abnormalities, including scoliosis, joint hyperlaxity, and delayed bone age. To the authors' knowledge, only a few cases of surgical treatment for scoliosis associated with Prader-Willi syndrome have been reported. PURPOSE: To report a rare case of scoliosis associated with Prader-Willi syndrome and the effect of surgical treatment and to review the literature on this condition. STUDY DESIGN/SETTING: Case report of a patient treated in Gifu, Japan. METHODS: The patient, a 16-year-old girl with Prader-Willi syndrome, had severe scoliosis with triple curves (T1 to T5, 43 degrees T5 to T11, 60 degrees; T11 to L3, 52 degrees), making it difficult for her to maintain balance while standing or walking. She underwent surgical correction and fusion for the scoliosis via the posterior approach. She was followed up for 2 years, and her clinical symptoms and plain X-ray films were evaluated. RESULTS: The thoracic curve was corrected to 21 degrees (correction rate, 65%) and the lumbar curve to 28 degrees (correction rate, 46%). Her symptoms were relieved. CONCLUSION: A case of scoliosis with Prader-Willi syndrome was successfully treated surgically using a posterior approach and minimizing possible risks associated with surgery in patients with this syndrome.

Failure of reconstruction surgery using anterior fibular strut grafting to correct postlaminectomy kyphosis.

A patient with postlaminectomy kyphosis with a neurological deficit which developed following the initial surgical treatment is reported. A 49-year-old man, complaining of neck pain, sought treatment in 1995. An extramedullary cervical spinal tumor was diagnosed and C2-C4 laminectomy and resection of the tumor were performed. Recurrence of the tumor was seen 1 year later and a second tumor resection and radiation therapy were performed. One year after the second resection of the tumor, X-rays of the cervical spine revealed kyphosis. Anterior spinal fusion without instrumentation was performed followed by immobilization using a halo vest for 4 months. However, pseudoarthrosis and progression of the kyphosis occurred postoperatively. Iliac bone grafting at the pseudoarthrosis site and posterior internal fixation with lateral mass plates was performed. Bony fusion between the graft and C6 vertebra was obtained after these procedures, but the neurological deficits were not completely resolved. Clinicians who treat spinal cord tumors may learn from this treatment failure.

Total spondylectomy of a symptomatic hemangioma of the lumbar spine.

A vertebral hemangioma with dural compression and neurological deficit is rare. We report a symptomatic lumbar vertebral hemangioma which was successfully managed with total spondylectomy. The patient was a 31-year-old man whose chief complaint was low back pain. He had a slight sensory disturbance in the right thigh. Plain radiography and magnetic resonance imaging (MRI) revealed a tumor in the second lumbar vertebra, which extended into the spinal canal, compressing the dura. A percutaneous needle biopsy did not provide a pathological diagnosis. Before surgery, the arteries feeding the tumor were embolized using coils. We performed a total spondylectomy of the second lumbar vertebra with anterior reconstruction with a glass ceramic spacer and posterior instrumentation. The intraoperative pathological examination revealed a hemangioma of the lumbar spine. At the 4-year follow-up examination, the patient is completely asymptomatic without evidence of tumor recurrence.

Surgical treatment of scoliosis associated with central core disease: minimizing the effects of malignant hyperthermia with provocation tests.

We report the case of a 7-year-old boy with thoracolumbar scoliosis and central core disease who had a history of malignant hyperthermia. He had scoliosis with Cobb's angle deteriorating to 67 degrees (thoracic) and 59 degrees (lumbar). A provocation test of general anesthesia was performed to confirm no hyperthermic reaction. Then, he underwent surgical correction by a posterior approach. The thoracic curve was reduced to 38 degrees and the lumbar curve to 42 degrees . He has been followed up for 2 years without any complications. This is the first report with a detailed description of perioperative management on surgical treatment of scoliosis associated with central core disease.