• Accurate and Simple Screw Insertion Procedure with Patient-Specific Screw Guide Templates for Posterior C1-C2 Fixation

    Background: Posterior C1 lateral mass screw (LMS) and C2 pedicle screw (PS) fixation, also known as the Goel-Harms method can provide immediate rigid fixation, but the screw insertion carries a potential risk for injury to neuronal and vascular structures. It is also sometimes problematic to dissect venous plexus and C2 nerve root to confirm the insertion point of C1 LMS. To solve these problems, we developed an intraoperative screw guiding method using patient-specific laminar templates. Methods: Preoperative bone images of the computed tomography (CT) scans were analyzed using three-dimensional (3D)/multiplanar imaging software and the trajectories of the screws were planned.
  • What Happens to the Disc Bulge after Posterior Laminectomy and Fusion in Patients with Cervical Myelopathy?

    Introduction: Cervical myelopathy is a disabling condition that often presents with a loss of fine motor skills in the hand with lower limb ataxia. The most common cause of myelopathy is degeneration of the cervical discs with resulting compression of the spinal cord. Treatment often consists of surgical decompression and fixation, performed through ugh an anterior, posterior, or combined approach. Posterior laminectomy and fusion is recommended for patients with multilevel compression with preserved cervical lordosis.  This approach affords an indirect decompression of the spinal cord by allowing it to drift away posteriorly from the anteriorly bulging discs. Although this approach effectively decompresses the spinal cord there has been no study that critically analyzes the degree of remaining stenosis due to the anterior bulging discs.
  • What is the Most Accurate Radiographic Anterior Cervical Fusion Criteria?

    Introduction: Determination of anterior cervical fusion status is an integral part as evaluating or comparing the surgical outcome after anterior cervical arthrodesis. The determination has been dependent on the various radiographic criteria because the “gold standard”, surgical exploration is mostly impractical. Despite its clinical significance, most radiographic fusion criteria are still not validated or standardized. The purpose of this study is to demonstrate the diagnostic accuracy of the criteria for determining anterior cervical fusion status correlated with the results of surgical exploration.
  • A Novel Radiographic Indicator of Developmental Cervical Stenosis

    Introduction: Developmental cervical stenosis (DCS) predisposes patients to neurologic compression and loss of function through cervical cord neurapraxia and myelopathy. The historical plain film measurement to assess DCS, the Torg ratio, has been shown to provide high sensitivity, but low specificity for identifying DCS. Despite efforts to better approximate true sagittal canal diameter from plain film measurements, a more sensitive and specific radiographic index has not been reported. The goal of this study is to develop a novel index for DCS which utilizes a previously unreported spinal measurement, the distance between the spinolaminar line and the posterior border of the lateral mass (SL).
  • Over 10-Year Aggravation of Cervical Spine Instabilities in Rheumatoid Arthritis: A Prospective Cohort Study of Outpatients

    Introduction: It is essential to understand the natural history of cervical spine involvement in rheumatoid arthritis (RA). A prospective over 10-year cohort study was designed to clarify the aggravation of cervical spine instabilities which might introduce severe compression myelopathy in patients with RA.
  • Evaluation of Vancomycin Powder on Bone Healing in a Rat Spinal Arthrodesis Model

    Introduction: Surgical site infections (SSIs) after cervical spinal surgery occur in 0.9% to 15.0% of patients. Such complications are devastating to patients and the healthcare system. As Staphylococcus aureus is the most common organism responsible for SSIs, vancomycin powder has the potential to serve as a simple, cost-effective solution to the problem. It is poorly absorbed from the wound avoiding potential systemic side effects while maintaining high local wound concentrations. Although in vitro studies suggest that vancomycin is cytotoxic to differentiating osteoblasts, the effect of vancomycin powder application on the rates of spinal arthrodesis has not been properly evaluated.
  • Can C3 Laminectomy Reduce Interlaminar Bony Fusion and Preserve Cervical Range of Motion after Cervical Laminoplasty?

    Introduction: Interlaminar bony fusion after cervical laminoplasty is one of causes to decrease postoperative cervical range of motion (ROM). It was reported to occur in 53% of patients, with marked frequency at C2-3. In a previous report, C3 laminectomy, instead of laminoplasty, could minimize muscle detachment at C2 and decrease the postoperative neck pain. Our hypothesis in this study is if C3 lamina is resected rather than opened during multi-level laminoplasty, the bony fusion between C2-3-4 laminae could be prevented and postoperative motion would be preserved more.
  • ignal Intensity Ratio on Magnetic Resonance Imaging and Neurological Status as Prognostic Factors in Patients with Cervical Compressive Myelopathy

    Objectives: Many authors have reported prognostic factors that may influence the neurological outcome such as, patient age, symptom duration, the severity of symptoms, the compression ratio of spinal cord, and the signal changes on magnetic resonance imaging (MRI). Particularly, intramedullary signal intensity (SI) changes on T2-weighted imaging (T2WI) have been discussed to be a controversial issue in cervical compressive myelopathy. Some authors reported that patients with increased intramedullary SI show a poor prognosis after surgical decompression, while others asserted that there is no clear relationship between the SI and the prognosis after the surgery.