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Vertebroplasty and kyphoplasty are widely accepted treatment for painful osteoporotic vertebral compression fractures through improving the strength and stability of the injured vertebra. Although vertebroplasty and kyphoplasty are minimally invasive interventions, it can be accompanied by various complications. Especially, postoperative infection can develop into life-threatening complications, therefore, accurate diagnosis and systemic examination of the patient should be performed before surgery to prevent complications.

Background Despite its growing popularity, no comparative studies have explored the minimum clinically important difference (MCID) of health-related quality of life scores following lumbar interbody fusion (LIF) performed on a single-level adult low-grade isthmic spondylolisthesis (LGIS). Objective The purpose of this study is to investigate factors related to MCID of health-related quality of life scores following instrumented LIF performed on a single-level adult LGIS. Methods Consecutive patients who underwent instrumented LIF for single-level LGIS were reviewed. The inclusion criteria were adult patients who underwent L4-5 or L5-S1, underwent anterior lumbar interbody fusion or transforaminal lumbar interbody fusion with a posterior screw fixation, and had a minimum 36-month postoperative follow-up period. MCID was defined as having an improved score of visual analog scale (VAS) back and leg pain >3 and Oswestry Disability Index (ODI) >12. Patients were subdivided into groups named “achievement” (A) and “nonachievement” (N) depending on their postoperative MCID for each health-related quality of life score category. Results One-hundred and five patients met the inclusion criteria. The overall achievement of MCID for VAS back, leg, and ODI was 80%, 73.3%, and 82.9%. MCID-VAS leg and ODI were less achieved at the L5-S1 level than at the L4-5 level. Postoperatively, disk height was higher and segmental lordosis (SL) was lower in group A of MCID-VAS leg. SL was lower in group A of MCID-ODI. Conclusions We postulate that excessive SL does not affect lumbar lordosis; rather, it can result in lowering posterior disk height. The decrease in posterior DH may lead to a decreased foraminal height that, in turn, can lead to nerve root compression. Proper restoration of disk height and bone fusion is more important than restoration of more segmental lordosis or slip reduction for isthmic spondylolisthesis.

Anterior endoscopic cervical discectomy (AECD) using laser and micro forceps for cervical intervertebral disc herniation has been considered as an effective treatment modality in selected cases. However, several spine surgeons are concerned about the adverse outcomes of discectomy without fusion, such as postoperative instability, disc space narrowing, and segmental kyphosis. We report two cases of AECD that was performed 19 and 21 years ago. First case was a 44-year-old female with C56 cervical soft disc rupture and second case was a 42-year-old male with C67 cervical soft disc rupture. These patients suffered from cervical intervertebral disc herniation and underwent AECD. The surgical method followed the general AECD method that removed selectively-ruptured particle only. In both cases, the symptoms improved after AECD, and these patients did not experience any problems until recently. Good clinical results have been shown over the long-term, as seen in the two cases described here. In the radiological evaluation, it was confirmed that the postoperative level was stable and disc height was preserved. Furthermore, sagittal alignment and segmental motion of the cervical vertebra were both maintained. In these two cases, disc height was insignificantly different before and after surgery over a long period. Thus, AECD provides good results, even in long-term follow-up, without acceleration of disc degeneration.

OBJECTIVE: Pituitary apoplexy is one of the most serious life-threatening complications of pituitary adenoma. The purpose of this study is to investigate the visual outcome after early transsphenoidal surgery for the patients with pituitary apoplexy. METHODS: We retrospectively reviewed the 31 patients with pituitary apoplexy who were admitted due to acute visual acuity or field impairment and treated by transsphenoidal surgery. Five patients were excluded because of the decreased conscious level. The visual acuity of each individual eye was evaluated by Snellen's chart. Visual fields were also checked using automated perimetry. To compare the visual outcome according to the surgical timing, we divided the patients into 2 groups. The first group, 21 of the patients have been undertaken transsphenoidal approach (TSA) within at least 48 hours after admission. The second group included 8 patients who have been undertaken TSA beyond 48 hours. All patients were monitored at least 12 months after surgery. RESULTS: Patients were 21 males and 8 females (M : F=2.6 : 1) with the mean age of 42.4 years. Among the enrolled 29 patients, 26 patients presented with decreased visual acuity and 23 patients revealed the defective visual field respectively. Postoperatively, improvement in the visual acuity was seen in 15 patients (83.3%) who underwent surgery within the first 48 hours of presentation, as compared to those in whom surgery was delayed beyond 48 hours (n=5; 62.5%) (p=0.014). Improvement in the visual field deficits was observed in 15 (88.2%) of patients who had been operated on within the first 48 hours of presentation, as compared to those in whom surgery was delayed beyond 48 hours (n=3; 50.0%) (p=0.037). CONCLUSION: This study suggests that rapid transsphenoidal surgery is effective to recover the visual impairment in patients with pituitary apoplexy. If there are associated abnormalities of visual acuity or visual fields in patients with hemorrhagic pituitary apoplexy, early neurosurgical intervention within 48 hours should be also required to recover visual impairment.