Analysis of Medical Treatment Interest Trend in Rural Environment by Big Data / 의료커뮤니케이션

BACKGROUND: In the rural environment, medicine treatment has analyzed the health behavior of some rural areas, but it is necessary to study and generalize trends of interest in the whole country. Therefore, The objective of this study is to analyze interest trends of rural health care services of rural residents in rural areas by Big Data.METHODS: Big medical data collection related to rural environment medicine treatment used portal site data of social networks. The Big Data was analyzed utilizing a Textom and Ucinet6 analysis tools.RESULTS: Among the major keywords of Big Data are ‘hospital’, ‘university’, ‘management’, ‘seat’, ‘improvement’, ‘residents’, ‘information’, ‘exercise’, ‘development’, ‘problem’, ‘Pain’, ‘Possibility’, ‘Post’, ‘Work’, ‘Relationship’ etc occupy a high rank in all analyzes such as frequency ranking, total network analysis, 4 centrality and CONCOR analysis. In rural environment medicine, the individual diseases of interest were skin, scars, atopy, acne, eyes, hyperlipidemia, stress and so on. It is also possible to find out whether the program, the longevity person, the cultivation, the village, the farm, the activity, the program, the education, the experience, etc.CONCLUSION: In the rural areas, they are interested in the folk medicine that can be used in the rural areas for the treatment of the diseases related to the rural areas.The lack of treatment for children and women indicated that professional information was needed, and they also expressed interest in food, life, and spatial location for long-lived villages. Specially, “atopy” and “earnestness” were included in the main words. The word ‘health center’, which is the subject of various health promotion projects, was not included in the 170 main words.

The Nutritional Status and the Clinical Outcomes of Patients With a Spinal Cord Injury Using Nutritional Screening Tools

OBJECTIVE: To assess the nutritional status of Korean patients with spinal cord injury (SCI), identify the predictors of undernutrition, and investigate the relationship between undernutrition and clinical outcomes. METHODS: A retrospective study design was used to determine the nutritional status of 130 patients over 19 years old admitted to the rehabilitation hospital of Yonsei University Health System between June 2015 and February 2017. The nutritional status was assessed using the malnutrition universal screening tool (MUST) and the spinal nutrition screening tool (SNST). The relationship between undernutrition and clinical outcomes was examined by comparing a low-risk group with an at-risk group using a t-test. RESULTS: Among the SCI patients, 70 (50.8%) were confirmed with undernutrition based on the MUST scores, while 60 (46.2%) had undernutrition based on the SNST scores. It was found that undernutrition has an effect on functional outcomes. CONCLUSION: We assessed the undernutrition risk in Korean SCI patients, and found that approximately 50% of the patients were at risk of undernutrition. We also found that undernutrition can affect functional recovery.

Successful Application of Veno-Venoarterial Extracorporeal Membrane Oxygenation for Acute Exacerbation of Asthma Followed by Stress Cardiomyopathy

No abstract available.

Massive Hemothorax Occurring with Intramural Hematoma of the Descending Aorta in the Early Postpartum Period

Postpartum aortic intramural hematoma (IMH) is a rare but potentially lethal condition. We report a case of aortic IMH with massive hemothorax in a postpartum woman. The patient was a 31-year-old woman who had delivered twins by cesarean section. Two days after delivery, she complained of sudden-onset dyspnea. Chest computed tomography revealed a massive left hemothorax. Exploratory thoracotomy was performed, and we found a defect measuring approximately 6 mm in the adventitial layer of the thoracic aorta and an IMH. We repaired the defect primarily, and no more bleeding was observed. The patient was discharged on the 19th postoperative day without any complications.

Blunt Traumatic Cardiac Rupture: Single-Institution Experiences over 14 Years

BACKGROUND: Blunt traumatic cardiac rupture is rare. However, such cardiac ruptures carry a high mortality rate. This study reviews our experience treating blunt traumatic cardiac rupture. METHODS: This retrospective study included 21 patients who experienced blunt traumatic cardiac rupture from 1999 to 2015. Every patient underwent surgery. Several variables were compared between survivors and fatalities. RESULTS: Sixteen of the 21 patients survived, and 5 (24%) died. No instances of intraoperative mortality occurred. The most common cause of injury was a traffic accident (81%). The right atrium was the most common location of injury (43%). Ten of the 21 patients were suspected to have cardiac tamponade. Significant differences were found in preoperative creatine kinase–myocardial band (CK-MB) levels (p=0.042) and platelet counts (p= 0.004) between the survivors and fatalities. The patients who died had higher preoperative Glasgow Coma Scale scores (p=0.007), worse Trauma and Injury Severity Scores (p=0.007), and higher Injury Severity Scores (p=0.004) than those who survived. CONCLUSION: We found that elevated CK-MB levels, a low platelet count, and multi-organ traumatic injury were prognostic factors predicting poor outcomes of blunt cardiac rupture. If a patient with blunt traumatic cardiac rupture has these factors, clinicians should be especially attentive and respond promptly in order to save the patient’s life.

Successful Left-Heart Decompression during Extracorporeal Membrane Oxygenation in an Adult Patient by Percutaneous Transaortic Catheter Venting

Venoarterial extracorporeal membrane oxygenation (VA ECMO) is widely used in patients with cardiogenic shock. Insufficient decompression of the left ventricle (LV) is considered a major factor preventing adequate LV recovery. A 40-year-old male was diagnosed with acute myocardial infarction, and revascularization was performed using percutaneous stenting. However, cardiogenic shock occurred, and VA ECMO was initiated. Severe LV failure developed, and percutaneous transaortic catheter venting (TACV) was incorporated into the venous circuit of VA ECMO under transthoracic echocardiography guidance. The patient was successfully weaned from VA ECMO. Percutaneous TACV is an effective, relatively noninvasive, and rapid method of LV decompression in patients undergoing VA ECMO.

Anaplastic Large Cell Lymphoma Involving Anterior Segment of the Eye

A 36-year-old woman was diagnosed with anaplastic large cell lymphoma (ALCL) by excisional biopsy of a left frontal skin lesion. During the first cycle of chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisolone), the patient complained of right ocular pain and inflammation. Cytologic examination using aqueous humor revealed atypical lymphocytes, suggesting intraocular ALCL involvement. Acute angle closure developed in the anterior chamber due to rapid progression of ALCL, causing pupillary block. Laser and surgical interventions were attempted but failed to relieve the pupillary block. Finally, radiation therapy resolved the pupillary block to restore the anterior chamber and normalize intraocular pressure. This is the first case in the English literature of ALCL involving the iris to cause acute secondary angle closure.

Anaplastic Large Cell Lymphoma Involving Anterior Segment of the Eye

A 36-year-old woman was diagnosed with anaplastic large cell lymphoma (ALCL) by excisional biopsy of a left frontal skin lesion. During the first cycle of chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisolone), the patient complained of right ocular pain and inflammation. Cytologic examination using aqueous humor revealed atypical lymphocytes, suggesting intraocular ALCL involvement. Acute angle closure developed in the anterior chamber due to rapid progression of ALCL, causing pupillary block. Laser and surgical interventions were attempted but failed to relieve the pupillary block. Finally, radiation therapy resolved the pupillary block to restore the anterior chamber and normalize intraocular pressure. This is the first case in the English literature of ALCL involving the iris to cause acute secondary angle closure.

Aortic Valve Replacement Using Balloon Catheter for Thoracic Endovascular Aortic Repair to Patient with Calcified Aorta

A 79-year-old man was admitted to Samsung Changwon Hospital due to chest pain and dyspnea. The ejection fraction was 31% and mean pressure gradient between the left ventricle and aorta was 69.4 mmHg on echocardiography. Chest computed tomography showed severe calcification of the ascending aorta. Aortic valve replacement was successfully performed using a thoracic endovascular aortic repair balloon catheter without classic aortic cross clamping. The patient was discharged on the eleventh postoperative day.

Aortic Valve Replacement Using Balloon Catheter for Thoracic Endovascular Aortic Repair to Patient with Calcified Aorta

A 79-year-old man was admitted to Samsung Changwon Hospital due to chest pain and dyspnea. The ejection fraction was 31% and mean pressure gradient between the left ventricle and aorta was 69.4 mmHg on echocardiography. Chest computed tomography showed severe calcification of the ascending aorta. Aortic valve replacement was successfully performed using a thoracic endovascular aortic repair balloon catheter without classic aortic cross clamping. The patient was discharged on the eleventh postoperative day.

Fibroma of the Medial Canthal Tendon: a Case Report

PURPOSE: To report a case of medial canthal tendon fibroma, a rarely observed tumor at the eye or ocular adnexa. CASE SUMMARY: A 47-year-old female visited our clinic with a two-year history of a hard mass in the medial canthal region. On examination, a 7 x 5 mm2 sized, hard and unmovable subcutaneous mass was palpated. The mass was slowly enlarging and the patient had no symptoms including tearing or pain. To confirm the diagnosis, a total excision of the mass was performed under local anesthesia. The tumor was a well-demarcated, 7 x 5 x 2 mm3 sized, white oval mass. The histopathologic examination of the specimen revealed dense collagen bundles with scattered fibroblasts. Based on these findings, the lesion was diagnosed as a fibroma. Although rare, fibromas should be included in the differential diagnosis of medial canthal tumors.

Prostate Cancer in Patients with Metabolic Syndrome Is Associated with Low Grade Gleason Score When Diagnosed on Biopsy

PURPOSE: Studies on the relationship of metabolic syndrome (MS) and prostate cancer are controversial. We evaluated the association between MS and prostate cancer characteristics in patients who underwent transrectal ultrasound-guided prostate biopsy. MATERIALS AND METHODS: From October 2003 to May 2011, patients with a prostate-specific antigen (PSA) value> or =4 ng/ml or abnormal digital rectal examination (DRE) result underwent transrectal ultrasound-guided prostate biopsy. MS was diagnosed according to the Adult Treatment Panel III. Clinicopathologic factors including PSA, DRE, prostate volume, age, waist circumference, body mass index (BMI), lipid profiles, fasting blood sugar level, and MS were considered for analysis. RESULTS: Three hundred fifty-four patients were enrolled (mean age, 68.86+/-8.95 years; mean PSA, 13.97+/-20.42 ng/ml). Seventy-five patients (21.2%) had MS and 90 patients (25.4%) were diagnosed as having prostate cancer, including 27 (30%) with MS and 63 (70%) without MS. Total PSA value and prostate volume were significant predictors for prostate cancer. However, MS and BMI were not significantly related to increased cancer risk. Prostate cancer patients with MS had significantly lower Gleason scores (average, 6.63+/-1.92) than did prostate cancer patients without MS (average, 7.54+/-1.71; p=0.029). CONCLUSIONS: Presence of MS was associated with a significantly decreased risk of high-grade prostate cancer. A larger, prospective, multicenter investigation is mandatory to clarify the relationship between MS and prostate cancer.

Management of Patients with Traumatic Rupture of the Diaphragm

BACKGROUND: Traumatic rupture of the diaphragm is an unusual type of trauma. In addition, it is difficult to diagnose because it can be accompanied by injuries to other organs. If it is not detected early, the mortality rate can increase due to serious complications. Diaphragmatic rupture is an important indicator of the severity of the trauma. The aim of this study was to investigate the factors affecting the incidence of complications and mortality in patients who had surgery to treat traumatic rupture of the diaphragm. MATERIALS AND METHODS: The subjects were patients who had undergone a diaphragmatic rupture by blunt trauma or stab wounds except patients who were transferred to other hospitals within 3 days of hospitalization, from January 2000 to December 2007. This study was a retrospective study. 43 patients were hospitalized, and 40 patients were included during the study period. Among them, 28 were male, 12 were female, and the average age was 42 (from 18 to 80). Outcome predictive factors including hypoxia, ventilator application days, revised trauma score (RTS), injury severity score (ISS), age, herniated organs, complications, and the mortality rate were investigated. RESULTS: Causes of trauma included motor vehicle crashes for 20 patients (50%), falls for 10 (25%), stab wounds for 8 (20%), and agricultural machinery accidents for 2 (5%). Most of the patients (36 patients; 90%) had wound sites on the left. Diagnosis was performed within 12 hours for most patients. The diaphragmatic rupture was diagnosed preoperatively in 27 patients (70%) and in 12 patients (30%) during other surgeries. For surgical treatment, thoracotomy was performed in 14 patients (35%), laparotomy in 11 (27.5%), and a surgery combining thoracotomy and laparotomy in 15 patients (37.5%). Herniated organs in the thoracic cavity included the stomach for 23 patients (57.5%), the omentum for 15 patients (37.5%), the colon for 10 patients (25%), and the spleen for 6 patients (15%). Accompanying surgeries included splenectomy for 13 patients (32.5%), lung suture for 6 patients (15%), and liver suture for 5 patients (12.5%). The average hospital stay was 47.80+/-56.72 days, and the period of ventilation was 3.90+/-5.8 days. The average ISS was 35.90+/-16.81 (11~75), and the average RTS was 6.46+/-1.88 (1.02~7.84). The mortality rate was 17.5% (7 patients). Factors affecting complications were stomach hernia and age. Factors affecting the mortality rate were ISS and RTS. CONCLUSION: There are no typical symptoms of the traumatic rupture of the diaphragm by blunt trauma. Nor are there any special methods of diagnosis; in fact, it is difficult to diagnose because it accompanies injuries to other organs. Stab wounds are also not easy to diagnose, though they are relatively easy to diagnose compared to blunt trauma because the accompanying injuries are more limited. Suture of the diaphragm can be performed through the chest, the abdomen, or the thoracoabdomen. These surgical methods are chosen based on accompanying organ injuries. When there are many organ injuries, there are a great number of complications. Significant factors affecting the complication rate were stomach hernia and age. ISS and RTS were significant as factors affecting the mortality rate. In the case of severe trauma such as pelvic fractures, frequent physical examinations and chest X-rays are necessary to confirm traumatic rupture of the diaphragm because it does not have specific symptoms, and there are no clear diagnosis methods. Complications and the mortality rate should be reduced with early diagnosis and with treatment by confirming diaphragmatic rupture in the thoracic cavity and the abdomen during surgery.

Myxofibrosarcoma of the Chest Wall / 대한흉부외과학회지

Myxofibrosarcoma is one of the most common soft tissue tumors in elderly patients, mostly arising in the extremities, and rarely arising in the chest wall. A 53-year-old women presented with a painful chest wall mass in the manubrium. We excised the mass. The mass was located subdermally, but had infiltrated the underlying muscle layer, and was histologically diagnosed as an intermediate grade myxofibrosarcoma showing myxoid changes and hypercellularity. Here we report a rare case of chest wall myxofibrosarcoma and present a review of the literature.

Comparison of Saphenous Vein and PTFE Grafts for Above the Knee Femoropopliteal Bypass Grafting / 대한흉부외과학회지

BACKGROUND: Femoropopliteal artery bypss grafting is an effective form of treatment for infrainguinal artery occlusive disease in those patients who have either intermittent claudication or resting critical ischemia. The objective of this analysis was to evaluate the long-term patency of a femoropopliteal bypass graft that is classified as an above- the-knee saphenous vein graft or an above-the-knee PTFE (polytetrafluoroethylene) graft. MATERIAL AND METHOD: From January 1998 to February 2005, 103 above-the-knee femoro-popliteal bypasses were performed on 87 patients. There were 74 male and 13 female patients with a mean age of 65.7+/-9.6 (range: 31~82). The surgical indications were intermittent claudication in 65 cases (74.7%), foot ulceration in 2 cases (2.3%), foot necrosis in 10 cases (11.5%) and toe necrosis in 10 cases (11.5%). For the bypass graft, a reversed saphenous vein was used in 31 limbs and a polytetrafluoroethylene (PTFE) prosthesis was used in 72 limbs (6 mm: 27 limbs, 8 mm: 45 limbs). The perioperative risk factors were diabetes mellitus in 33 cases (37.9%), hypertension in 47 cases (54.0%), a history of ischemic heart disease in 13 cases (14.9%) and smoking in 72 cases (82.8%). RESULT: There were three perioperative deaths (3.4%) and seven late deaths (8.3%). Major leg amputation was necessary in 12 patients (13.8%) during the entire course of the study. The primary patency rate at 5 years for the vein grafts, the 8 mm-PTFE grafts and the 6 mm-PTFE grafts were 84.7%, 77.4% and 74.2%, respectively and the overall primary patency rate was 78.7%, and there were no significant statistical differences among the graft groups. By using multivariate analysis, the number of patent tibial arteries was determined to be a significant factor that influenced the primary graft patency rate (p<0.005), but risk factors such as diabetes mellitus, ischemic heart disease, smoking and age had no statistically significant affect on the primary graft patency rates. CONCLUSION: The great saphenous vein is considered the most durable conduit for infrainguinal revascularization, but the overall results of this study show that saphenous vein and PTFE grafts have comparable patency rates when used above the knee in patients with claudication or critical ischemia. The use of PTFE above the knee is a reasonable alternative for a femoro-poplitael bypass and it is associated with acceptable long term patency rates.

Trial of a Synthetic Absorbable Staple Line Reinforcement for Preventing Recurrence after Performing Video-assisted Thoracoscopic Bullectomy for the Treatment of Primary Pneumothorax / 대한흉부외과학회지

BACKGROUND: Postoperative recurrence is a major problem after performing video-assisted thoracic surgery for the treatment of primary pneumothorax. This study was designed to evaluate the efficacy and safety of a bioabsorbable staple line reinforcement (GORE SEAMGUARD(R)) for preventing recurrence after bullectomy. MATERIAL AND METHOD: From January 2000 to December 2004, 300 patients underwent video assisted thoracoscopic surgery for the treatment of primary penumothorax. 143 patients were treated with bioabsorbable staple line reinforcement (Group A) and 142 patients were treated with stapling of the bullae (Group B). Mechanical pleural abrasion was performed in all the patients. The operating time, the duration of the indwelling chest tube, the length of the hospital stay and the number of recurrences after operation were compared between the groups. RESULT: No operative deaths occurred. The conversion rate to an open procedure was 5% (15/300). Comparison with these groups (Group A versus Group B) showed the following results: the operating time (49.6+/-5.6 vs 51.8+/-0.4 minutes, respectively, p=0.514), the duration of an indwelling chest tube (5.8+/-.5 vs 7.2+/-.3 days, respectively, p<0.005), the hospital stay (10.9+/-4.3 vs 12.5+/-4.3 days, respectively, p<0.005) and the number of recurrences (14 (9.8%) vs 10 (7.0%), respectively, the over all rate: 8.4% p=0.523), and the mean follow up period (48.1+/-36.6 vs 36.5+/-24.4 months, respectively). CONCLUSION: There were advantages to use synthetic absorbable staple line reinforcement over the usual method for the treatment of primary pneumothorax in regard to the duration of an indwelling chest tube and the hospital stay, but here was no significant difference between the groups for postoperative recurrence.

Management of Vascular Injuries to the Extremities after Trauma / 대한흉부외과학회지

BACKGROUND: Vascular injuries to the extremities are potentially devastating and they can lead to limb loss and mortality if they are not appropriately managed. The vascular trauma caused by traffic and industrial accidents has recently increased according to the developing industry and transport system in Korea. Early recognition and treatment of these injuries are mandatory to achieve satisfactory outcomes. MATERIAL AND METHOD: We retrospective reviewed 43 patients with vascular injuries that were due to blunt and penetrating trauma and they underwent emergency operations from January of 1998 to December of 2006. RESULT: There were 38 men and 5 women patients with a mean age of 42.0+/-16.8 years (range: 17~77). The cause of vascular injuries were 28 traffic accidents (65%), 6 industrial accidents (14%), 6 glass injuries (14%) and 3 knife injuries (7%). The average time from admission to the operating room was 319.0+/-482.2 minutes (range: 27~2,400 minutes). The average time from admission to discharge was 53.1+/-56.0 days (range: 2~265 days). The anatomic injuries included the femoral artery in 16 cases (37%), the popliteal artery in 8 cases (19%), the brachial artery in 8 cases (19%), and the subclavian and axillary arteries in 7 cases (16%). The associated injuries were 23 bone fractures (53%), 18 muscle injuries (42%) 5 nerve injuries (12%) and 11 vein injuries (26%). The operation methods were 20 end to end anastomoses (46%), 16 interposition grafts (36%), 2 repairs with using patches (5%) and 5 others (12%). The number of amputations and cases of mortality were 3 cases (7%) and 4 cases (9%), respectively. CONCLUSION: Minimizing ischemia is an important factor for maximizing salvage of extremities. Prompt diagnosis and treatment can reduce the amputation and mortality rates.

Leiomyosarcoma of the Inferior Vena Cava: A case report / 대한흉부외과학회지

Leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant tumor. Yet tumors of a smooth muscle origin are the most common primary neoplasms of the major veins, and the inferior vena cava is the most common site of origin. We report here on a 65-year-old female patient who had been suffering from dyspnea and abdominal discomfort for 3 weeks before admission. The abdominal computed tomography (CT) scan and IVC cavogram showed an IVC mass extending from the right atrium to above the level of the right renal vein, obstructing the IVC, and the radiological findings were suggestive of an IVC leiomyosarcoma. We resected the tumor and reconstructed the IVC with a patch PTFE graft. The follow-up abdominal CT revealed no recurrence and obstruction of the IVC for 6 months after the operation.

Total Cervical Disc Replacement using Artificial Disc in Cervical Disc Herniations

OBJECTIVE: Anterior discectomy and fusion(ACDF) is still the 'gold-standard' treatment for diseases of the cervical disc. However, concerns over adjacent level degeneration and loss of motion have led us to consider total disc replacement with artificial disc as an alternative solution. This study aimed to evaluate the clinical results and radiological changes after cervical artificial disc replacement. METHODS: Twenty consecutive patients underwent cervical arthroplasty for radiculopathy and were assessed at 1 and 12 months. Clinical outcomes were assessed using a numerical rating scale(NRS) score for radicular pain. Radiological results were evaluated by cervical lordosis(Cobb's angle), cervical range of motion(ROM), segmental lordosis, segmental ROM and segmental ROM of adjacent disc levels. RESULTS: The mean NRS scores of all patients were significantly improved from 8.0+/-1.2 to 1.3+/-1.9 after 12 months. Cervical lordosis was improved in all patients(preoperative mean lordosis score 14.5degrees+/-8.8; postoperative mean lordosis score at 12 months 25.3degrees+/-9.2). There was no intraoperative or postoperative complication. CONCLUSION: Preliminary results showed excellent in clinical and radiological outcomes after at least 20 months follow-up period. It seems that the cervical arthroplasty can be considerd an alternative method for anterior cervical discectomy and fusion(ACDF) and has benefits for postoperative cervical motion maintenance.

Results of Surgical Treatment for Metastatic Cervical Spine Tumor

OBJECTIVE: The incidence of spinal metastases continues to increase, likely a result of increasing survival times for patients with cancer. This retrospective study was undertaken to analyze the results of surgery and the outcome of patients with extradural metastases in the cervical spine. METHODS: Thirty-three patients with cervical spine metastases who underwent spinal surgery by two surgeon at a single center in a 14-year period(1993-2007) were analyzed. Indications for surgery include intractable pain, neurological deficits, spinal cord compression, and the need for stabilization of impending pathological fractures. Numerous factors affect outcome including the nature of the primary cancer, the presence of fracture or dislocation, approach of surgery, and the severity of spinal cord compression. The change of predominant symptoms and survival time were evaluated after surgery. RESULTS: There were 17 male and 16 female patients aged from 29 to 78 years old(mean age, 59.9 years). Among the metastatic tumors, colon, breast, and liver were the most common primary sites of origin, and lung, kidney, stomach and thyroid were also common. All patients had bony invasion and 24 patients had pathologic vertebral fracture and 6 patients had dislocation. Based on the tumor location, approaches included 12 anterior, 6 posterior and 15 combined. Epidural spinal cord compression on the axial T2-weighted magnetic resonance(MR) image was noted in 31 patients(93.9%). The American Spinal Injury Association(ASIA) impairment scale scores in preoperative state were stable in 29 patients(87.9%) who presented with ASIA Score D and E. The most common predominant symptoms of patients were cervical and/or radiating pain(26 patients) and 23 patients had neurological deficits. At Follow-up, predominant preoperative symptoms improved in 28(84.8%) patients who had pain or neurological deficits. The overall mean survival duration for patients with cervical metastatic tumors after diagnosis was 7.4 months in 28 expired patients and 17.4 months in 5 survived patients. There were four major early and late complications in this study. One patient suffered from the immediate postoperative epidural hematoma and improved after evacuation of hematoma. There were three cases of instrumentation failure. One of them was symptomatic and underwent second-look surgery. CONCLUSION: Surgery for the treatment of cervical spine metastases is effective for improvement of the neurological deficits and relief the local pain in a significant proportion of patients with acceptable complication rates. The tech- nical evolution of cervical implants has improved our ability to achieve long-term rigid fixation, particularly over the cervicothoracic junction.