Objective This study compared the efficacy of posterior pedicle screw fixation with 5.5-mm rods (PPSF5.5) with anterior corpectomy (AC) for metastatic cervicothoracic junction (CTJ) tumors.
Methods This retrospective analysis included patients with CTJ tumors who underwent PPSF5.5 or AC from January 2000 to December 2023. Data collected included demographics, surgical details, clinical outcomes (visual analogue scale scores for neck or back pain, Spinal Instability Neoplastic Scale score, McCormick scale, Nurick grade, and Eastern Cooperative Oncology Group score), radiologic results (cervical segmental Cobb angle), and surgical complications (instrumentation failure, tumor regrowth, and wound infection).
Results The AC group showed a tendency for short-level fusion. Patients in this group had tumors primarily located near C7 and generally confined to the vertebral body. AC was associated with more significant postoperative kyphotic changes in the index vertebra during follow-up than PPSF5.5. Moreover, AC was associated with a higher incidence of instrumentation failure, necessitating revision surgeries. Conversely, patients in the PPSF5.5 group tended to require revision surgery due to tumor regrowth.
Conclusion For CTJ metastatic tumors, PPSF5.5 provides superior resistance to forward bending and collapse prevention and minimizes instrumentation failure rate compared to AC. Moreover, AC may reduce the risk of tumor recurrence, but this approach is recommended only if the tumor is confined to the vertebral body and located at the upper level of the CTJ.
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The efficacy of 5.5-mm diameter rods combined with cervical pedicle screws for the treatment of challenging spinal disease in cervicothoracic junction: Is it a game-changer? Younggyu Oh, Subum Lee, Sang Hyub Lee, Danbi Park, Chongman Kim, Sun Woo Jang, Jin Hoon Park Medicine.2025; 104(36): e44369. CrossRef
Objective We propose that cervical intrafacetal fusion (cIFF) using bone chip insertion into the facetal joint space additional to minimal PLF is a supplementary fusion method to conventional posterolateral fusion (PLF).
Methods Patients who underwent posterior cervical fixation accompanied by cIFF with minimal PLF or conventional PLF for cervical myelopathy from 2012 to 2023 were investigated retrospectively. Radiological parameters including Cobb angle and C2–7 sagittal vertical axis (SVA) were compared between the 2 groups. In cIFF with minimal PLF group, cIFF location and PLF location were carefully divided, and the fusion rates of each location were analyzed by computed tomography scan.
Results Among enrolled 46 patients, 31 patients were in cIFF group, 15 in PLF group. The postoperative change of Cobb angle in 1-year follow-up in cIFF with minimal PLF group and conventional PLF group were 0.1° ± 4.0° and -9.7° ± 8.4° respectively which was statistically lower in cIFF with minimal PLF group (p = 0.022). Regarding the fusion rate in cIFF with minimal PLF group in postoperative 6 months, the rates was achieved in 267 facets (98.1%) in cIFF location, and 244 facets (89.7%) in PLF location (p < 0.001).
Conclusion Postoperative sagittal alignment was more preserved in cIFF with minimal PLF group compared with conventional PLF group. Additionally, in cIFF with minimal PLF group, the bone fusion rate of cIFF location was higher than PLF location. Considering the concerns of bone chip migration onto the spinal cord and relatively low fusion rate in PLF method, applying cIFF method using minimized PLF might be a beneficial alternative for posterior cervical decompression and fixation.
Sang Hyub Lee, Sun Woo Jang, Hong Kyung Shin, Jeoung Hee Kim, Danbi Park, Chang-Min Ha, Sun-Ho Lee, Dong Ho Kang, Young Hyun Cho, Sang Ryong Jeon, Sung Woo Roh, Jin Hoon Park
Neurospine 2024;21(1):293-302. Published online January 31, 2024
Objective Stereotactic radiosurgery (SRS) has been performed for spinal tumors. However, the quantitative effect of SRS on postoperative residual cervical dumbbell tumors remains unknown. This study aimed to quantitatively evaluate the efficacy of SRS for treating postoperative residual cervical dumbbell tumors.
Methods We retrospectively reviewed cases of postoperative residual cervical dumbbell tumors from 1995 to 2020 in 2 tertiary institutions. Residual tumors underwent SRS (SRS group) or were observed with clinical and magnetic resonance imaging (MRI) follow-up (observation group). Tumor regrowth rates were compared between the SRS and observation groups. Additionally, risk factors for tumor regrowth were analyzed.
Results A total of 28 cervical dumbbell tumors were incompletely resected. Eight patients were in the SRS group, and 20 in the observation group. The mean regrowth rate was not significantly lower (p = 0.784) in the SRS group (0.18 ± 0.29 mm/mo) than in the observation group (0.33 ± 0.40 mm/mo). In the multivariable Cox regression analysis, SRS was not a significant variable (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.18–1.79; p = 0.336).
Conclusion SRS did not significantly decrease the tumor regrowth rate in our study. We believe that achieving maximal resection during the initial operation is more important than postoperative adjuvant SRS.
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Preoperative 3D surgical planning using Mimics significantly decreased the rate of internal fixation in cervical dumbbell tumor resection and improved the postoperative outcome: a single-center retrospective study Hui Wang, Zhiwen Qin, Hailin Lyu, Lu Gao, Ke Zhang European Spine Journal.2026;[Epub] CrossRef
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A Complete Facet Resection and Cervical Pedicle Screw Placement Enhances Both Gross Total Resection and Motion Preservation for the Cervical Spinal Dumbbell Tumor Sungsoo Bae, Dae-Jean Jo, Sun Woo Jang, Danbi Park, Sang Hyub Lee, Jinuk Kim, Chongman Kim, Jin Hoon Park World Neurosurgery.2024; 192: e486. CrossRef
Objective Cerebrospinal fluid (CSF) leakage is a major concern related to anterior cervical decompression and fusion for ossification of the posterior longitudinal ligament (OPLL). We propose a management algorithm for CSF leakage following anterior cervical decompression and fusion for OPLL involving the use of pump-regulated volumetric continuous lumbar drainage.
Methods We retrospectively reviewed patients who underwent anterior cervical decompression and fusion for OPLL and were managed with the proposed algorithm between March 2018 and July 2022. The proposed management algorithm for CSF leakage by pump-regulated volumetric continuous lumbar drainage was as follows. On exposure of the arachnoid membrane with or without CSF leakage, a dural sealant patch was applied to manage the dural defect. In case of persistent CSF leakage despite application of the dural sealant patch, patients underwent pump-regulated volumetric continuous lumbar drainage.
Results Fifty-one patients were included in the study. CSF leakage occurred in 14 patients. Of these 14 patients, 9 patients underwent lumbar drain insertion according to the proposed management algorithm. Successful resolution of CSF leakage was observed in 8 of the 9 patients who underwent lumbar drainage. All patients were encouraged to ambulate without concern of CSF overdrainage due to gravity, because it could be avoided with pump-regulated volumetric continuous CSF drainage. Therefore, complications associated with absolute bed rest or CSF overdrainage were not observed.
Conclusion The proposed management algorithm with pump-regulated volumetric continuous lumbar drainage showed safety and efficacy for management of CSF leakage following anterior decompression and fusion for OPLL.
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Hong Kyung Shin, Jin Hoon Park, Sang Ryong Jeon, Sung Woo Roh, Dae Jean Jo, Seung-Jae Hyun, Yong-Jae Cho, for the Korean Spinal Deformity Society (KSDS)
Neurospine 2023;20(4):1469-1476. Published online December 31, 2023
Objective Two commonly used techniques for spinopelvic fixation in adult deformity surgery are iliac screw (IS) and sacral 2 alar-iliac screw (S2AI) fixations. In this article, we systematically meta-analyzed the complications of sacropelvic fixation for adult deformity surgery comparing IS and S2AI.
Methods The PubMed, Embase, Web of Science, and Cochrane clinical trial databases were systematically searched until March 29, 2023. The proportion of postoperative complications, including implant failure, revision, screw prominence, and wound complications after sacropelvic fixation, were pooled with a random-effects model. Subgroup analyses for the method of sacropelvic fixation were conducted.
Results Ten studies with a total of 1,931 patients (IS, 925 patients; S2AI, 1,006 patients) were included. The pooled proportion of implant failure was not statistically different between the IS and S2AI groups (21.9% and 18.9%, respectively) (p = 0.59). However, revision was higher in the IS group (21.0%) than that in the S2AI group (8.5%) (p = 0.02). Additionally, screw prominence was higher in the IS group (9.6%) than that in the S2AI group (0.0%) (p < 0.01), and wound complication was also higher in the IS group (31.7%) than that in the S2AI group (3.9%) (p < 0.01).
Conclusion IS and S2AI fixations showed that both techniques had similar outcomes in terms of implant failure. However, S2AI was revealed to have better outcomes than IS in terms of revision, screw prominence, and wound complications.
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Objective Acute spinal cord injury (SCI) can result in debilitating motor, sensory, and autonomic dysfunction. As a treatment option, therapeutic hypothermia has been researched to inadequate pharmaceutical treatment, except for methylprednisolone. In this article, we systematically meta-analyzed to clarify the effect of hypothermia in acute SCI on neurological outcomes.
Methods The PubMed, Embase, Web of Science, and Cochrane clinical trial databases were systematically searched until June 30, 2022. The proportion of cases with improved neurological status after hypothermia in acute SCI were pooled with a random-effects model. Subgroup analyses for the method of hypothermia and injury level were conducted.
Results Eight studies with a total of 103 patients were included. Hypothermia in acute SCI improved neurological function by 55.8% (95% confidence interval [CI]: 39.4%–72.1%). The subgroup analysis revealed that the pooled proportion of cases showing neurological improvement was higher with systemic hypothermia (70.9%) (95% CI, 14.9%–100%) than with local hypothermia (52.5%) (95% CI, 40.4%–64.5%), although the subgroup difference was not statistically significant (p = 0.53). Another subgroup analysis revealed that the proportion of cases with neurological improvement did not differ statistically between the cervical spine (61.4%) (95% CI, 42.2%–80.6%) and thoracic spine injury groups (59.4%) (95% CI, 34.8%–84.0%) (p = 0.90).
Conclusion This meta-analysis identified that more than 50% of patients showed neurological improvement after hypothermia following acute SCI in general. A multicenter, randomized, double-blind study with larger sample size is necessary to validate the findings further.
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Objective Considering the adverse natural history of spinal dural arteriovenous fistula (sDAVF), clinical outcomes may be worsened if the initial occlusive trial does not achieve complete fistula occlusion. We aimed to analyze the initial success rate of microsurgery and embolization and confirm the effects of initial treatment success on the clinical outcomes of sDAVF patients. In addition, we investigated the factors associated with initial treatment failure.
Methods A total of 38 patients treated for sDAVF at a single institution over a 14-year period were retrospectively reviewed. Clinical outcomes according to the initial treatment modality were quantitatively analyzed. Demographic characteristics and angioarchitecture data were evaluated to identify factors associated with initial treatment failure.
Results In the study population, 34 patients underwent embolization as the initial treatment, and complete occlusion of the fistula was achieved in 13 patients (38%). However, all patients who underwent microsurgery showed complete fistula occlusion. Among patients with initial treatment success, gait and micturition were improved with statistical significance (p < 0.001 each). However, in cases of initial treatment failure, only mild improvements in gait and micturition were observed, which were not statistically significant (p = 0.097 and p = 0.375, respectively). A narrow feeding artery diameter (p = 0.007) and embolization of the artery only (p = 0.002) were identified as factors associated with initial treatment failure.
Conclusion To achieve symptomatic improvement and prevent neurological deterioration due to recurrence, the initial definite occlusion of the fistula is important. Despite advances in endovascular techniques, microsurgical occlusion is still superior in terms of initial complete obliteration.
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Dysphagia is a common symptom in elderly individuals, and anterior cervical osteophytes have been implicated as a rare, but surgically correctible cause of dysphagia. In previous studies, surgical treatment of such cases has been associated with immediate symptomatic relief. The surgical outcome of three cases was reviewed retrospectively. A 74-year-old male with progressive dysphagia and aspiration pneumonia attributed to diffuse ossification of anterior longitudinal ligaments (OALL) from C3 to T1 was treated by standard anterior approach and subtotal resection was done.
The second case was a 64-year-old male with dysphagia due to diffuse idiopathic skeletal hyperostosis (DISH) underwent anterior DISH resection. The last was a 79-year-old male with progressive dysphagia and aspiration pneumonia due to OALL treated with osteophyte resection. Symptomatic relief was achieved immediately in the first two cases, however, recurrence occurred after seven years in the first case and osteophyte regrowth without symptom in the second case after 33 months follow up. The last case did not have any symptomatic improvement and mechanical obstruction was noted intraoperatively within esophagus. Surgical complication resulting emergency hematoma evacuation and tracheostomy occurred in the second case with complete recovery. Surgical complications, reossification with symptomatic recurrence, and possible plural or mixed causes of dysphagia are all reasons for caution prior to the decision to intervene surgically in such cases.
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.
OBJECTIVE The purpose of our retrospective study is to evaluate the surgical outcome of patients who underwent unila- teral approach for bilateral decompression surgery for lumbar spinal stenosis and to compare outcomes between geriatric and younger patients. METHODS We reviewed records of 85 patients with an average age of 64 years at the time of surgery after the unilateral laminotomy for bilateral decompression of degenerative lumbar spinal stenosis between 2005 and 2007. To compare clinical and functional outcomes between younger and geriatric patients, they were divided by age into 2 groups: Group A included patients 65 years of age or older and Group B contained patients younger than 65 years. The study parameters were set to ensure a follow-up period of at least 3 months and hospital records and phone-call review were analyzed for patients' clinical and demographic data, co-morbidity, type of stenosis, clinical and functional outcomes. Clinical outcomes were measured using the scale of Finneson and Cooper and the visual analog scale score for leg and back pain. Functional outcome was assessed with change of walking distance of patients. RESULTS Follow-up was completed in 80(94.1%) of 85 patients and Group A included 44 patients and Group B did 36 patients. The number of decompressed level showed 2.26 with similar results in both groups(group A, 2.25; Group B, 2.28). The number of co-morbidity was significantly higher incidence of 2.36 in geriatric patients than that of 1.67 in younger individuals. Other demographic data and type of stenosis were similar between two groups. For each back and leg pain, 86.3%(Group A: 86.4%; Group B, 80.6%) and 83.8%(Group A: 90.9%; Group B: 80.6%) had an excellent-to-fair operative result under the scale of Finneson and Cooper. Improvement rate of walking distance was 81.5% of patients and higher in group B(89.3%) than in group A(75.6%), however, there was not statistical significance. Three major complications were occurred in all patient groups, the first patient with chronic renal failure suffered from immediately postoperative epidural hematoma and the second patient had wound dehiscence. The third patient with no improvement was operated with fusion surgery at the other hospital nonetheless she had not improved until now. CONCLUSIONS The ULBD allowed sufficient and safe decompression of the neural structures and adequate preservation of vertebral stability with acceptable complication rates. This technique could provide a minimally invasive approach for LSS in elderly patients frequently having comorbidities as well as younger one.
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.
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