[Objective]The present study was undertaken to investigate the incidence of symptomatic adjacent segment disease after anterior cervical interbody fusion(ACIF),and to identify the factors which are related to the development of this disease.[Method]From 1981 to 1997,a total of 160 patients underwent anterior cervical in terbody fusion for intervertebral disc herniation and cervical spondylosis.A total of 112 patients were followed up clinically and radiologically for more than two years.Of them,74 were men and 38 were women,the average age at operation was 51 years(ranged,31~70 years).Of the 112 patients,66 had one,44 had two and 2 had three levels of fusion.Follow-up evaluation was primarily viaclinical visited.The post-operative course of any symptoms,the findings of neurological examination and serial follow-up radiographs were performed in all patients.The diagnosis of symptomatic adjacent segment disease was based on the presence of new radiculopathy or myelopathy symptoms referable to an adjacent level,and the presence of a compressive lesion at an adjacent level by magnetic resonance imaging or myelography.We evaluated the correlation between the incidence of symptomatic adjacent segment disease and the following clinical parameters(age at operation sex,number of the levels fused)and radiological parameters(preoperative cervical spine alignment,preoperative range of motion of C_(2~7) cervical spine,antero-posterior spinal canal diameter,preoperative existence of an adjacent segment degeneration on plain radiograph,myelography and magnetic resonance imaging(MRI).[Result]The average length of follow-up was 9.4 years(ranged,2 to 19 years).Symptomatic adjacent segment disease developed in 19 out of 112 patients(19%)followed.A Kaplan-Meier survival analysis was performed in order to follow the disease-free survival of the entire series of patients.The disease free survival rates were 89% at 5 years,84% at 10 years and 67% at 17 years.The incidences of indentation of dura matter on pre-operative myelography or disc protrusion on MRI at the adjacent level were significantly higher in disease cases(P=(0.0 087),(0.0 299),respectively;Chi-square test).Howerer,the other parameters did not show a statistically significant difference.There were 7 cases(37%)who had failure of non-operative treatment and additional operations were performed.[Conclusion]The incidence of symptomatic adjacent segment disease after ACIF was higher when pre-operative myelography or MRI revealed asymptomatic disc degeneration at that level regardless of the number of the level number fused,pre-operative alignment,spinal canal diameter of fusion alignment.

[Objective]To explore the characteristics and management of pyogenic osteomyelitis of the spine.[Method]Thirty-nine patients with pyogenic osteomyelitis of the spine,who were treated by single-stage anterior debridement and interbody bone graft fusion,were included.The clinical presentations,laboratory,biological as well as radiological characteristics and surgical outcomes were investigated.[Result]The mean follow-up duration was 8.5 years,ranging from 2 to 17 years.All the patients had marked improvement in their back pain,17 of whom obtained complete recovery,the remaining 22 patients had occasional mild pain.Sensory deficit aggravated in 1 patient,the remaining 38 patients had marked improvement in the neurological function of the lower extremity.The recovery rate of clinical symptoms and signs ranged from 20% to 100%(averaged,75.6%).Bony fusion was obtained in all the patients in 4 months on average(ranged,2～6 months).ESR decreased from 73mm/h preoperatively to 29mm/h at 4 months after operation,while C reactive protein decreased to normal.There was no death and no other complication relating to opertion.Species of pathogen:culture positive in 19 cases(48.7%).Of these,S.aureus in 10 cases,et al.[Conclusion]The underlying diseases of patients were risk factors of pyogenic osteomyelitis of the spine,pathogens involved not only S.aureus but also other low virulent organisms.CRP was more sensitive than ESR or white cell counts,it may also be the parameter to evaluate outcomes of therapy.MRI has been shown to have the highest sensitivity,specificity and accuracy in the diagnosis of pyogenic osteomyelitis of the spine.Single-stage anterior debridement and interbody bone graft fusion are save and effective to treat pyogenic osteomyelitis of the spine.

Objective To investigate the factors that may contribute to radiculopathy in degenerative lumbar stenosis associated with scoliosis(DLSS) and their relationship with the pattern of the scoliosis. Methods 22 consecutive DLSS patients with radiculopathy with a mean age of 71 years were analyzed retrospectively. The involved symptomatic roots were judged by pain distribution, neurological findings, nerve root infiltration with lidocaine, and confirmed by intraoperative findings and postoperative alleviation of symptoms. The compression factors were determined by myelography (22 cases), discography (3 cases), CT myelography (14 cases), or CT discography (3 cases), MR (6 cases) and radiculography (14 cases). The upper end vertebra, the lower end vertebra, the Cobb's angle, and the lateral displacement of the vertebrae were measured on the plane radiographs. The vertebral displacement was classified into two groups: slip group (more than 10 mm) and nonslip group (less than 10 mm). Results 5 of L3 nerve roots were affected (14%), L4 roots 15 (42%), L5 roots 12 (33%) and S1 roots 4 (11%). Of these, both L3 and L4, and both L5 and S1 were involved in 5 and 4 patients respectively. L3 and L4 were more compressed by foraminal or extra-foraminal stenosis, while L5 and S1 were commonly affected by lateral recess stenosis (?2=10.08, P

We describe a rare case of lumbar spinal stenosis due to a large calcified mass in the ligamentum flavum. This patient presented with a 12-month history of severe right leg pain and intermittent claudication. A computed tomography scan was performed, revealing a large calcified mass on the ligamentum flavum at the right-hand side of the lumbar spinal canal. We performed a laminotomy at the L4/5 level with resection of the calcified mass from the ligamentum flavum. The findings of various analyses suggested that the calcified mass consisted mostly of Ca3(PO4)2 and calcium phosphate intermixed with protein and water. The calcified mass in the ligamentum flavum was causing lumbar spinal stenosis. Surgical decompression by resection of the mass was effective in this patient. The calcified material was composed mainly of elements derived from calcium phosphate. Degenerative changes in the ligamentum flavum of the lumbar spine may have been involved in the production of this calcified mass.
Calcium ; Calcium Phosphates ; Decompression, Surgical ; Humans ; Intermittent Claudication ; Laminectomy ; Leg ; Ligamentum Flavum ; Spinal Canal ; Spinal Stenosis ; Spine ; Water

The Common Achievement Tests for medical students consists of Computer Based Testing (CBT) conducted before clinical training, and Objective Structured Clinical Examination (OSCE) conducted before and after clinical training. Since the publicization of the Common Achievement Tests for medical students before clinical training in 2023, the Committee for Reasonable Accommodation has been established within the Common Achievement Tests Organization (CATO), where reasonable accommodations for each exam are being considered. Reasonable accommodations begin with an assessment based on requests from candidates and proceed through constructive dialogue between candidates and universities. Additionally, recordings of practical training sessions are provided to facilitate objective assessments, enabling the provision of reasonable accommodations tailored to candidates’ participation in clinical training and internships, thereby ensuring smooth examination processes.