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Study Design: Retrospective study comparing postoperative clinical outcomes after cervical laminoplasty between K-line (-) ossification of the posterior longitudinal ligament (OPLL) and K-line (+) OPLL in the neck-flexed position., Objective: To investigate postoperative outcomes using Japanese Orthopedic Association (JOA) scores, and grip-and-release (GR) and foot-tap (FT) test scores after laminoplasty in patients with K-line (-) OPLL in the neck-flexed position., Summary of Background Data: Cervical laminoplasty has been reported to lead to poor outcomes in K-line (-) OPLL and good outcomes in K-line (+) OPLL. The cervical spine, however, continues moving in the extension and flexion direction after laminoplasty., Methods: Patients with cervical myelopathy were divided into K-line (+) and (-) in the neck-flexed position. We compared postoperative outcomes after cervical laminoplasty using recovery rate, as assessed by the JOA score and degree of improvement in the six JOA score items, and performance, as assessed by GR and (FT) tests, between patients with K-line (+) OPLL (n = 18) and K-line (-) OPLL (n = 23) in the neck-flexed position., Results: Recovery rate of JOA score (23.8%) of patients in the K-line (-) group was significantly lower (P = 0.028) than that (46.3%) of K-line (+) group in the neck-flexed position. In the K-line (+) group, significant improvements were seen in all JOA-score items except bladder function; however, in the K-line (-) group, improvements were seen only in upper- and the lower-extremity sensory functions. In the K-line (+) group, mean GR and FT tests significantly improved, but in the K-line (-) group, only mean FT test significantly improved., Conclusion: The K-line (-) OPLL in the neck-flexed position is a risk factor for poor clinical outcome after cervical laminoplasty., Level of Evidence: 4.

Study Design: Prospective cohort study., Objective: To investigate the dynamic changes of cervical spinal cord with postural change after cervical laminoplasty by means of postoperative percutaneous ultrasonography., Summary of Background Data: Many reports have been published about intraoperative ultrasonographic evaluation of the spinal cord. Few reports have described postoperative diagnostic ultrasonographic findings of the spinal cord after a previous laminectomy. To date, there are no studies that have examined the changes in pulsation pattern and intensity of the spinal cord at different body positions with percutaneous ultrasonography., Methods: Thirty-three patients after cervical laminoplasty were evaluated postoperatively by percutaneous ultrasonography of the cervical spinal cord. Ultrasonographic images were obtained from 5 different body positions sitting with neck neutral, sitting with neck flexion, sitting with neck extension, prone, and supine position., Results: The pattern and intensity of cervical spinal cord pulsation and the anteroposterior position of the cervical spinal cord changed according to posture. Pulsation of the cervical spinal cord was more common in sitting position, whereas wave motion was more common in supine position.Supine, prone, sitting with neck extension, sitting with neck neutral, and sitting with neck flexion position were ranked in descending order of spinal cord pulsating intensity. Subarachnoidal space ventral to the cervical spinal cord was more likely to appear in the supine position., Conclusion: Assuming that good spinal cord pulsation represents good spinal circulation, these results suggest that the supine position will provide the most favorable condition for recovery of the cervical spinal cord.

Study Design: Results of C4-C7 laminoplasty with C3 laminectomy and C3-C7 laminoplasty were compared., Objectives: To clarify prospectively whether the modified laminoplasty preserving the semispinalis cervicis inserted into C2 could reduce the axial symptoms compared with conventional laminoplasty reattaching the muscle to C2., Summary of Background Data: Intraoperative damage of the semispinalis cervicis is relevant to the development of axial symptoms after laminoplasty. In C3-C7 laminoplasty, however, it is difficult to preserve the muscle insertion into C2 while opening the C3 lamina., Methods: The axial symptoms of 40 patients (Group A) with C4-C7 laminoplasty with C3 laminectomy were compared with those of 16 patients (Group B) with C3-C7 laminoplasty. The cross-sectional areas of the cervical posterior muscles were measured on magnetic resonance images., Results: The number of patients with no postoperative axial symptoms increased (P = 0.035) from 19% to 52.5%, and the number of patients whose symptoms worsened after surgery decreased (P = 0.020) from 50% to 17.5%. The average atrophy rate of cross-sectional area was smaller (P < 0.001) in Group A (2.4%) than in Group B (10.8%)., Conclusions: This method was less invasive to the cervical posterior muscles than C3-C7 laminoplasty. This is an effective procedure for preventing postoperative axial symptoms.

Study Design: Familial cases of "idiopathic" scoliosis associated with neurologic abnormalities are reported with a review of the literature., Objective: To investigate the prevalence of neurologic abnormalities such as syringomyelia, Chiari 1 malformation, and tonsillar ectopia in patients with genetically determined "idiopathic" scoliosis., Summary of Background Data: Idiopathic scoliosis is widely considered to be a genetic disorder of unknown etiology. Magnetic resonance imaging (MRI) studies have shown that several cases of "idiopathic" scoliosis show neurologic abnormalities including syringomyelia and Chiari 1 malformation. Recently, several familial cases of either syringomyelia or Chiari malformation were reported, and it is suspected that genetic factors may influence the development of the craniovertebral malformation. It was hypothesized that some cases of "idiopathic" scoliosis include a craniovertebral malformation that is genetically determined., Methods: This study, using clinical examinations and MRI, investigated 71 patients with scoliosis and a family history of "idiopathic" scoliosis in third-degree relatives for the presence of neurologic abnormalities. If neurologic abnormalities were confirmed with MRI, the relatives affected with scoliosis were also examined., Results: Nine (13%) patients showed neurologic abnormalities on MRI. Magnetic resonance imaging showed syringomyelia with Chiari 1 malformation in four patients, Chiari 1 malformation in three patients, and tonsillar ectopia in two patients. Among the relatives of these patients, 4 of 15 individuals affected with scoliosis also showed neurologic abnormalities on MRI., Conclusions: It is suggested that familial neurologic abnormalities may have a wide range of expression, and that some patients with "idiopathic" scoliosis present with genetically determined craniovertebral malformations such as syringomyelia, Chiari 1 malformation, and tonsillar ectopia.

Study Design: A case of cervical myelopathy caused by an anomalous vertebral artery is reported., Objectives: To report a case of high cervical myelopathy resulting from spinal cord compression by an anomalous vertebral artery. Authors believe that this is the first reported case in which the nutrient artery to the abnormal artery originated from the posterior inferior cerebellar artery., Summary of Background Data: Although fenestration of the vertebral artery is net an unusual anomaly to the best of the authors knowledge, three cases of high cervical myelopathy resulting from the anomaly were reported. There is no reported case in which an abnormal artery originated from the posterior inferior cerebellar artery., Methods: The clinical features of the case are reported and discussed with a review of the previously documented cases., Results: The cord compression war relieved surgically, and the patient's symptoms improved postoperatively., Conclusions: A fenestrated vertebral artery should be included in the differential diagnosis of the upper cervical or the craniovertebral junctional lesions of unknown origin. Magnetic resonance imaging is useful for the diagnosis. In the present case, there was an anomalous branch entered as a nutrient artery from the posterior inferior cerebellar artery. Careful management for similar abnormal arteries includes surgery.