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Purpose: The purpose of this study was to analyse changes of spinopelvic parameters and stability in the treatment of degenerative lumbar deformity. Methods: A retrospective review was carried out on 70 cases of degenerative lumbar deformity treated by long fusion with uni-cortical S1 fixation alone (US1F group, n = 20), bi-cortical S1 fixation alone (BS1F group, n = 20), additional diagonal S2 fixation (DS2F group, n = 14), and additional iliac fixation (ILF group, n = 16) from July 2003 to April 2010. The sagittal vertical axis (SVA), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and stability were used to evaluate radiologic outcomes. The clinical outcome was evaluated using the Oswestry Disability Index (ODI). Results: In all groups, the LL was significantly increased at three months ( p < 0.05). The PI and the SS of ILF patients significantly increased at three months ( p < 0.05), while none of these values changed over time in non-ILF patients. The PT did not change postoperatively in any groups. The LL, SS, and PI were significantly greater in the ILF group at three months postoperatively and later ( p < 0.05). DS2F and ILF had statistically significant stability compared to US1F and BS1F ( p < 0.05). The ODI scores were significantly improved after surgery in all groups compared to before surgery ( p < 0.05). Conclusions: Patients who had ILF in long fusion for the treatment of degenerative lumbar deformity had significant restoration of spinopelvic parameters compared to the other groups. In addition, DS2F and ILF provided more stability of distal instruments. [ABSTRACT FROM AUTHOR]

Purpose: To develop a clinically relevant anterior cervical approach (ACA) to the C2-3 level. Methods: Frequently encountered nerves [hypoglossal (HyN), internal (ISLN) and external superior laryngeal nerves (ESLN)] and vessels [lingual (LiA), superior laryngeal (SLA) and superior thyroid arteries (STA)] in the field of high ACA and the anatomic spatial markers [submandibular gland (SMG); sling for digastrics muscle (SDG); hyoid bone (HyB), and thyroid cartilage (ThC)] were evaluated using 18 fresh cadavers. The vertical distance of each structure at the carotid sheath and larynx and each disc for cervical level were measured from the suprasternal notch. Results: The cervical levels of SDG, SMG and HyB were mostly C3 and that of ThC was C5. The vertical locations of HyN and LiA were not significantly different and the levels corresponded to C2. The levels for ISLN and ESLN were C3 at carotid and C4 and C5 at larynx sides, respectively. The vertical locations of ISLN and HyN were significantly different at carotid ( p = 0.001) and larynx ( p < 0.001) sides. The vertical locations and cervical levels of SLA and STA at carotid and larynx sides were not significantly different with those of ISLN and ESLN, respectively. The HyN traversed C2 with accompanying LiA. The ISLN passed C3 and C4 from carotid to larynx sides and accompanied SLA. Conclusions: The C2-3 level can be exposed through the space between the HyN and the ISLN by retracting the LiA superiorly, the SLA inferiorly, the HyB medially, and the carotid sheath laterally. [ABSTRACT FROM AUTHOR]

Introduction: Pure hyperextension thoracolumbar spinal fractures are unusual and occur primarily in patients with ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis due to the rigidity of the spine. Material and methods: A 62-year-old female with osteoporosis presented with a significantly displaced fourth vertebral body fracture after being hit by a motorcycle. An imaging study showed widening of the vertebral height of L4 anteriorly with a horizontal fracture extending across the vertebral body. An in situ instrumented lumbar fusion from the second to fifth lumbar vertebrae was performed. Postoperatively, the patient complained of abdominal pain and difficulty in voiding. Computed tomography and intravenous pyelography showed that the right ureter was impinged between the fractured gaps of the vertebral body of L4. Results: Solid bony union was obtained with surgical intervention. Conclusions: This case reports a rare distractive extension injury in the lower lumbar spine with ureteral impingement. One should be aware of possible complications such as ureteral impingement following a pure hyperextension injury in the lower lumbar spine. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to investigate thoracic myelopathy caused by ossification of the yellow ligament (OYL) in patients with posterior instrumented lumbar fusion. Methods: Seven patients, who had undergone posterior instrumented lumbar fusion, presented with thoracic myelopathy caused by OYL. No patient had a history of thoracic myelopathy at previous surgery. Instrumented fusions were performed from L1-5 in two patients, L2-5 in three patients and L1-S1 and L2-S1 in one patient each, respectively. MRI and CT scans were performed to confirm cord compression by OYL. Of the seven patients, six patients underwent decompressive laminectomy and OYL removal while one was treated conservatively. Results: The average time to presentation after first surgery was 63.4 months. OYL was located at T9-10 in two patients, T11-12 in three patients, and T10-11 and T9-11 in one patient each, respectively. All patients had a myelopathic gait and the average Japanese Orthopaedic Association (JOA) score was 3.9, preoperatively. The average JOA score improved from 3.7 to 8 and the average recovery rate was 58.9 % in the six patients who underwent surgical intervention. However, the JOA score fell from 5 to 4 in the one patient who was treated conservatively. Conclusions: We report seven patients who suffered from thoracic myelopathy after instrumented lumbar fusion. Surgeons must be aware of the possibility of thoracic myelopathy caused by OYL at the thoracolumbar junction, especially in patients with a complaint of gait disturbance after long instrumented lumbar fusion. [ABSTRACT FROM AUTHOR]

Sacral bone remodeling with abnormal dilatation of intervertebral foramina is usually associated with Tarlov's perineurial cysts but can also be caused by slow-growth lesions. In this case report, an atypical inflammatory sacral cyst with bone scalloping was found and some possible causes are suggested. A 77-year-old woman complained of severe back pain and claudication with anal tone weakness. A plain roentgenogram and CT showed spinal canal expansion and characteristic border scalloping of the sacrum. MRI showed septated cystic content with peripheral enhancement. Laminectomy was performed. The cyst contained yellowish viscous material that was easily removed. The neurological symptoms improved after surgery. The cystic wall was composed of dense fibrous tissue without epithelial cell lining; the cystic content was, on histology, inflammatory cells including neutrophils and lymphocytes. Patients who have sacral intraspinal cysts should be identified before doing the treatment such as acupuncture and epidural steroid injection to avoid infection to those cysts. [ABSTRACT FROM AUTHOR]

Intraspinal extradural ganglion cysts rarely occur in the cervical spine, and their etiology is unknown. A 77-year-old female complaining of right upper extremity weakness presented with a cystic mass located in the spinal canal of the right C3-4 facet joint. A C3-4 right hemilaminectomy and excision of the cysts were performed. The cyst contained a translucent viscous material and was easily decompressed. No communication between the cyst and facet joints was found in the surgical field. The neurologic symptoms improved rapidly after surgery. The histology examination showed that the cystic wall was composed of dense fibrous tissue without a synovial cell lining concordant with a ganglion cyst. This report describes a rare case of a ganglion cyst of the cervical spine arising at the C3-4. This case highlights the need to consider a ganglion cyst as one of the causes of cervical radiculo-myelopathy. [ABSTRACT FROM AUTHOR]

Spinal extradural arachnoid cysts are rare expanding lesions, and their etiology is mainly unknown. The authors present a rare case of metastatic pancreatic cancer presenting as an arachnoid cyst of the cervical spine. A 61-year-old woman with progressive neurological deficits was presented with a very large cystic mass from C3 to C6 and C7 and T1 that was a metastatic lesion causing severe collapse of vertebral bodies and subluxation. A posterior laminectomy from C3 to C6 for excision of the cysts and marginal excision including laminectomy around C7 and T1 were performed with instrumented fusion to prevent further collapse and subluxation of T1. No communication between the cysts and the subarachnoid space was found in the surgical field. The neurological symptoms rapidly improved immediately after the surgery. The histology of resected specimens was metastatic mucin-producing adenocarcinoma. This report describes a rare case of metastasis of pancreatic cancer presenting as an arachnoid cyst of the cervical spine. The significance of this study is that metastatic cystic lesions from pancreatic cancer should be considered in the differential diagnosis of arachnoid cysts of the spinal canal. [ABSTRACT FROM AUTHOR]

Background: Spinal metastasis is a common manifestation of bony metastasis, but for surgeons involved in the treatment of individual patients, it is not easy to choose optimal treatments. Various scoring systems have been designed to predict survival periods and to select optimal treatments, but prognosis is still unpredictable. Objectives are to evaluate the efficiency of the predictive value of preoperative Tokuhashi scores for life expectancy in patients with spinal metastasis and to estimate other prognostic factors affected survival of patients with spinal metastasis. Methods: A total of 52 patients that had been surgically treated for vertebral metastasis were enrolled in this study. Twenty were men and 32 were women, and average overall age at operation was 60.6 years (range, 41 to 95 years). Preoperative Tokuhashi scores were calculated and Tomita classifications were determined for all patients. The prognostic value of Tokuhashi scores and the total number of what sort of points were calculated for all patients. Furthermore, the variables used to calculate Tokuhashi scores were categorized for statistical analysis. Fifteen parameters were analyzed with regard to risk factors using the log-rank test for univariate analysis and the Cox proportional hazards model for multivariate analysis. Survival curves were generated by Kaplan-Meier life-table analysis. Results: By univariate survival analysis, primary cancer site and preoperative albumin level were found to be significantly associated with survival, and multivariate analysis, which included all fifteen parameters assessed, confirmed that primary cancer site and preoperative albumin were the only significant parameters. When the single variables of Takuhashi scores were analyzed, ''primary cancer site'' and 'preoperative albumin level,' a surrogate of nutritional status were found to significantly predict survival. Conclusions: In the present study, the mean survival time of patients with spinal metastasis was 10.4 months (median 3.7 months). The most important parameters associated with survival were found to be primary cancer site and nutritional status. This study demonstrates that other parameters are considered for survival prediction in patients with spinal metastasis by the application of Tokuhashi scoring system. [ABSTRACT FROM AUTHOR]

Purpose: To (1) clarify the role of various risk factors in the development of ASD, (2) compare instrumentation configuration with the development of ASD, (3) correlate the radiological incidence of ASD and its clinical outcome and (4) compare the clinical outcome between patients with radiological evidence of ASD and without ASD. Methods: This study prospectively examined 74 consecutive patients who underwent instrumented lumbar/lumbosacral fusion for degenerative disease with a minimum follow-up of 5 years. Among the patients, 68 were enrolled in the study. All of the patients had undergone preoperative radiological assessment and postoperative radiological assessment at regular intervals. The onset and progression of ASD changes were evaluated. The patients were divided in two groups: patients with radiographic evidence of ASD (group 1) and patients without ASD changes (group 2). Comprehensive analysis of various risk factors between group 1 and group 2 patients was performed. The Visual Analog Scale (VAS) was used to evaluate the clinical outcome and the functional outcome was evaluated using the Oswestry Disability Index (ODI) before and after surgery along with radiological assessment. Results: Radiographic ASD occurred in 20.6% (14/68) of patients. Preoperative disc degeneration at an adjacent segment was a significant risk factor for ASD. Other risk factors such as the age of a patient at the time of surgery, gender, preoperative diagnosis, length of fusion, instrumentation configuration, sagittal alignment and lumbar or lumbosacral fusion were not significant risk factors for the development of ASD. There was no correlation between ASD and its clinical outcome as determined at the final follow-up session. In addition, clinical outcome of patients with ASD and without ASD were not comparable. Conclusions: Patients with preoperative disc degeneration at an adjacent segment were more at risk for the development of ASD. Other risk factors including instrumentation configuration were not significantly associated with ASD. There was no correlation between both the radiological development of ASD and its clinical outcome and the clinical outcome of patients with and without ASD. [ABSTRACT FROM AUTHOR]

Abstract: Background context: It was recently demonstrated that the postnatal transition from a notochordal to a fibrocartilaginous nucleus pulposus (NP) is accomplished exogenously by chondrocytes migrating from hyaline cartilage end plates (CEs) into the ectopic notochordal NP region. Although our previous in vivo studies showed evidences for the migration of CE chondrocyte from hyaline CEs into the notochordal NP, it is unknown whether CE chondrocytes of the intervertebral disc (IVD) really have a motile property. In addition, the effect of notochordal cells on this property has not been elucidated. Purpose: The purpose of this in vitro study was to demonstrate whether CE chondrocytes of the IVD are capable of migration, and whether there is any biological link between notochordal cells and CE chondrocytes that may regulate the CE chondrocyte migration. Study design/setting: In vitro cell migration assays were performed using rat IVDs. Methods: Notochordal cells and chondrocytes were obtained from the NP and CE tissues, respectively, and were cultured separately. The different numbers of notochordal cells and the supernatant (conditioned medium) that contained soluble factors produced by notochordal cells were used to demonstrate their effects on the migration of CE chondrocytes. Bovine serum albumin (BSA) and lysophosphatidic acid (LPA) were used as negative and positive controls, respectively. Results: Compared with BSA, LPA, notochordal cells (N=4×, 2×, 1×, and 0.5×105), and its conditioned media (unconcentrated and fivefold concentrated) significantly increased migration of CE chondrocytes (p<.05 in all comparisons). Particularly, notochordal cells and its conditioned media increased migration in a number- and concentration-dependent manner, respectively. Conclusions: This study demonstrates that CE chondrocytes of the IVD are capable of migration and that soluble factors produced by notochordal cells stimulate the migration. These results provide a plausible explanation to the question of why CE chondrocytes of the IVD migrate into the ectopic NP region during the natural transition from the notochordal to fibrocartilaginous NP. [Copyright &y& Elsevier]

The over-expression of excitotoxic neurotransmitter, such as glutamate, is an important mechanism of secondary injury after spinal cord injury. The authors examined the neuroprotective effect of pregabalin (GP) which is known as to reduce glutamate secretion, in a rat model of spinal cord injury. Thirty-two male Sprague–Dawley rats were randomly allocated to four groups; the control group (contusion injury only), the methylprednisolone treated group, the minocycline treated group and the GP treated group. Spinal cord injury was produced by contusion using the New York University impactor (25 g-cm, at the 9th–10th thoracic). Functional evaluations were done using the inclined plane test and a motor rating scale. Anti-apoptotic and anti-inflammatory effects were evaluated by in situ nick-end labeling staining technique (TUNEL) and immunofluorescence staining of cord tissues obtained at 7 days post-injury. Pregabalin treated animals showed significantly better functional recovery, and anti-apoptotic and anti-inflammatory effects. Mean numbers of TUNEL positive cells in the respective groups were 63.5 ± 7.4, 53.6 ± 4.0, 44.2 ± 3.9 and 36.5 ± 3.6. Double staining (TUNEL and anti-CC1) for oligodendrocyte apoptosis, was used to calculate oligodendrocyte apoptotic indexes (AI), using the following formula AI = (No. of doubly stained cells/No. of anti-CC1 positive cells) × 100. Mean group AIs were 88.6, 46.7, 82.1 and 70.3%, respectively. Mean numbers of activated microglia (anti-OX-42 positive cells) in high power fields were 29.8 ± 3.9, 22.7 ± 4.1, 21.0 ± 3.9 and 17.8 ± 4.3, respectively. This experiment demonstrates that GP can act as a neuroprotector after SCI in rats, and its anti-apoptotic and anti-inflammatory effects are related to its neuroprotective effect. Further studies are needed to unveil the specific mechanism involved at the receptor level. [ABSTRACT FROM AUTHOR]

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Background: There is a paucity of reports clarifying the implication of knee osteoarthritis (OA) on spinal sagittal alignment of patients undergone surgery for lumbar spine. This study aimed to analyze how osteoarthritic knee affects radiographic and clinical results of degenerative lumbar disease patients undergone lumbar fusion.Methods: We retrospectively reviewed the medical records and radiographs of 74 consecutive degenerative lumbar disease patients who underwent posterior instrumentation and fusion surgery between May 2016 and June 2017 and were followed up for minimum 3 years postoperatively. The patients were divided into 2 groups according to the severity of knee OA by Kellgren-Lawrence grading (KLG) scale (group I, KLG 1 or 2 [n = 39]; group II, KLG 3 or 4 [n = 35]). Patient demographic data, comorbidities, spinal sagittal parameters and clinical scores were extracted and compared at preoperative, postoperative 1 month and the ultimate follow-up between the groups. In radiographic assessment, sagittal alignment parameters and sagittal balance were used. In clinical assessment, the scores of Oswestry disability index (ODI) and Scoliosis Research Society questionnaire (SRS-22) were used. For the frequency analysis of categorical variables across the groups, chi-square test was used and student t tests was used to compare the differences of continuous variables.Results: In radiographic assessment, TLK (thoracolumbar kyphosis), LL (lumbar lordosis), PT (pelvic tilt), C7 SVA (sagittal vertical axis) in both groups improved significantly after surgery (p <  0.05). However, LL, PT, C7SVA improved at postoperative 1 month in the group II were not maintained at the ultimate postoperative follow-up. In clinical assessment, preoperative Oswestry disability index (ODI, %) and all SRS-22 subscores of the group I and II were not different (p > 0.05). There were significant differences between the groups at the ultimate follow-up in ODI (- 25.6 vs - 12.1, p <  0.001), SRS total score (%) (28 vs 20, p = 0.037), function subscore (1.4 vs 0.7, p = 0.016), and satisfaction subscore (1.6 vs 0.6, p < 0.001).Conclusion: Osteoarthritic knee with KLG 3 or 4 have a negative influence on maintaining postoperative spinal sagittal alignment, balance, and the clinical outcomes achieved immediately by posterior instrumentation and fusion for lumbar degenerative disease.Trial Registration: This study was retrospectively registered with approval by the institutional review board (IRB) of our institution (approval number: 2018-11-007). [ABSTRACT FROM AUTHOR]

Background: Sparganosis is a rare parasitic infection caused by the plerocercoid tapeworm larva of the genus Spirometra.Case Description: We report the case of a 67-year-old man with a mass over the anteromedial surface of the proximal extremity of the tibia. We surgically excised a bursa containing Spirometra larvae.Literature Review: Sparganosis is a rare parasitic infection. We found no cases of lower extremity sparganosis combined with bursitis reported in the literature.Purposes and Clinical Relevance: Sparganosis should be considered in the differential diagnosis of soft tissue tumors, especially among patients who frequently have consumed mountain water or raw snakes or frogs. [ABSTRACT FROM AUTHOR]