PURPOSE: This study aimed to predict the surgical outcomes of diffuse idiopathic skeletal hyperostosis (DISH)-related dysphagia (DISH-phagia) and to evaluate the importance of prevertebral soft tissue thickness (PVST).MATERIALS AND METHODS: In total, 21 surgeries (anterior osteophytectomy or anterior cervical decompression and fixation) were included in this study for DISH-phagia from 2003 to 2019. Clinical outcomes were assessed using the Dysphagia Outcome and Severity Scale (DOSS) preoperatively, at 1 month postoperatively, and last follow up (mean 29.5 months). PVST was measured using lateral plain radiographs. Paired t-test and Spearman's correlation test was used to identify relationships between various PVST indices and DOSS.RESULTS: Comparisons were made from 17 patients out of 21, in which the record had all of three measurements. The narrowest PVST preoperatively was 2.55±0.90 mm, with a DOSS score of 4.47±1.61, and that at 1 month after surgery was 5.02±2.33 mm, with a DOSS score of 6.12±1.32. At last follow up, PVST and DOSS values were 3.78±0.92 mm and 5.82±1.34, and three patients experienced symptom relapse. Significant relationships were found between PVST and DOSS at all time points: before surgery (R=0.702, p<0.001), 1 month after surgery (R=0.539, p=0.012), and last follow up (R=0.566, p=0.020).CONCLUSION: Surgical removal of anterior osteophytes is an effective treatment option for DISH-phagia, and PVST is a useful parameter in DISH-phagia. The goal of DISH surgery should be to remove DISH as much as possible to ensure sufficient PVST postoperatively.

No abstract available.
Korea ; Spondylitis

PURPOSE: Chemotherapy targets all rapidly growing cells, not only cancer cells, and thus is often associated with unpleasant side effects. Therefore, examination of the chemosensitivity based on genotypes is needed in order to reduce the side effects. MATERIALS AND METHODS: Various computational approaches have been proposed for predicting chemosensitivity based on gene expression profiles. A linear regression model can be used to predict the response of cancer cells to chemotherapeutic drugs, based on genomic features of the cells, and appropriate sample size for this method depends on the number of predictors. We used principal component analysis and identified a combined gene expression profile to reduce the number of predictors. RESULTS: The coefficients of determinanation (R²) of prediction models with combined gene expression and several independent gene expressions were similar. Corresponding F values, which represent model significances were improved by use of a combined gene expression profile, indicating that the use of a combined gene expression profile is helpful in predicting drug sensitivity. Even better, a prediction model can be used even with small samples because of the reduced number of predictors. CONCLUSION: Combined gene expression analysis is expected to contribute to more personalized management of breast cancer cases by enabling more effective targeting of existing therapies. This procedure for identifying a cell-type-specific gene expression profile can be extended to other chemotherapeutic treatments and many other heterogeneous cancer types.
Breast Neoplasms* ; Breast* ; Drug Therapy ; Gene Expression* ; Genotype ; Humans ; Linear Models ; Methods ; Principal Component Analysis ; Sample Size ; Transcriptome*

We report a case of neurilemmoma of deep peroneal nerve sensory branch that triggered sensory change with compression test on lower extremity. After resection of tumor, there are evoked thermal changes on pre- and post-operative infrared (IR) thermographic images. A 52-year-old female presented with low back pain, sciatica, and sensory change on the dorsal side of the right foot and big toe that has lasted for 9 months. She also presented with right tibial mass sized 1.2 cm by 1.4 cm. Ultrasonographic imaging revealed a peripheral nerve sheath tumor arising from the peroneal nerve. IR thermographic image showed hyperthermia when the neurilemoma induced sensory change with compression test on the fibular area, dorsum of foot, and big toe. After surgery, the symptoms and thermographic changes were relieved and disappeared. The clinical, surgical, radiographic, and thermographic perspectives regarding this case are discussed.
Female ; Fever ; Foot ; Humans ; Low Back Pain ; Lower Extremity ; Middle Aged ; Neurilemmoma* ; Peripheral Nerves ; Peroneal Nerve* ; Sciatica ; Toes

OBJECTIVE: Box-shape cervical expansive laminoplasty is a procedure that utilizes a Miniplate(R) or Maxpacer(R) to achieve maximal canal expansion. This method is expected to show much larger canal expansion and good clinical outcome. So we investigated the clinical and radiological outcome of Box-shape cervical expansive laminoplasty. METHODS: Between June 2008 and July 2013, we performed cervical expansive laminoplasty in 87 and 48 patients using the Box-shape cervical expansive laminoplasty, respectively. We analyzed the clinical results of these operations using the Japanese Orthopedic Association (JOA) scoring system and by assessing the position of intralaminar screws with postoperative computed tomography (CT) at POD-6 months. RESULTS: A total of 48 patients with ossification of the posterior longitudinal ligament (OPLL) (36 pts), cervical spondylotic myelopathy (CSM) (12 pts) were enrolled. Overall JOA scores improved from 11.49 to 14.22 at POD-6 months (OPLL: 11.32 -->14.3; CSM: 12-->14). Postoperative CT scans were performed in 39 patients at 177 levels for a total of 354 screws. The malpositioning rate of intralaminar screws was 3.4% and hardware-related neurologic complications did not occur. CONCLUSION: Box-shape cervical expansive laminoplasty creates maximal spinal canal expansion and leads to improved cervical myelopathy. The use of intralaminar screws to fix the remodeled lamina-facet does not represent a significant difficulty.
Asian Continental Ancestry Group ; Humans ; Longitudinal Ligaments ; Orthopedics ; Spinal Canal ; Spinal Cord Diseases ; Tomography, X-Ray Computed

OBJECTIVE: Cervical OPLL is a relatively common cause of developing cervical myelopathy or radiculopathy in Asians. Cervical OPLL is sometimes missed in lateral radiography or MRI. In the present study, we analyzed the diagnostic accuracy of cervical OPLL in lateral radiography and MRI compared to CT scan. METHODS: This is a retrospective study of forty-six patients who underwent decompressive surgery anteriorly or posteriorly in our institute. All patients were diagnosed with cervical OPLL by CT scan. The patients were grouped into continuous type, segmental type, mixed type, and localized type. We then evaluated lateral radiographs and MRI compared to CT scans. The diagnostic accuracy and false negative rates in lateral radiograph and MRI were evaluated. RESULTS: In a total of 46 patients diagnosed with cervical OPLL in CT scans, diagnostic accuracy using lateral radiograph and MRI were 52.2%(24/46) and 58.7%(27/46), respectively. In the continuous type group, diagnostic accuracy using lateral radiograph and MRI were 85.7%(6/7) and 100.0%(7/7). In the segmental type group, diagnostic accuracy using lateral radiograph and MRI were 27.3%(6/22) and 31.8%(7/22). In the mixed type group, diagnostic accuracy was 91.7%(11/12) in lateral radiograph and 83.3%(10/12) in MRI. In the localized group, diagnostic accuracy was 20.0%(1/5) in lateral radiograph and 60.0%(3/5) in MRI. CONCLUSION: The diagnostic accuracy of cervical OPLL using lateral radiograph and MRI was less than using CT scan. For the best treatment plan, preoperative CT scan should be performed to detect conditions of ossifications such as cervical OPLL.
Asian Continental Ancestry Group ; Humans ; Magnetic Resonance Imaging ; Radiculopathy ; Retrospective Studies ; Spinal Cord Diseases

OBJECTIVE: The aim of this study is to introduce the surgical method with miniplate and compared the expansion rate of the spinal canal area with other kinds of lamina spacers. METHODS: Between June. 2008 and May 2011, we performed expansive cervical laminoplasty on 61 patients. We analyzed the results of these operations, examining type of lamina spacer used, spinal canal areas between pre- and postoperative CT scans, and operative methods. RESULTS: 39 patients were analyzed retrospectively. Miniplates were used in 21 patients with 103 levels. Hydroxyapatite (HA) was used in 6 patients with 29 levels, and Centerpiece(R) was used in 12 patients with 54 levels. The expansion area was calculated using Photoshop CS3(R). The expansion rate of the miniplates was 76.5%, that of HA was 49.8%, and that obtained with Centerpiece was 50.6%. The excellent 90degrees box-shaped widening of the laminae achieved through the surgery can be checked easily by AP X-ray. All miniplates are positioned horizontally and parallel, and the lamina is seen as a pedicle of thoracic or lumbar spine due to its 90degrees erect position. Neurologic improvement and clinical outcomes will be discussed. No complications were reported with miniplates. CONCLUSION: Box-shaped laminoplasty with miniplates is the widest spinal canal expansion method among the three types of implants examined.
Durapatite ; Humans ; Retrospective Studies ; Spinal Canal ; Spine

OBJECTIVE: The authors conducted a retrospective study of patients with degenerative lumbar spinal disorders who received a posterior lumbar interbody fusion (PLIF) with the IS(R) cage. METHODS: We assessed 105 patients who underwent on a PLIF with or without pedicle screws using the IS(R) cage in our institute from November 2007 to December 2008. Clinical outcomes were analyzed with a Visual Analog Scale (VAS) for back and leg pain. Radiographs were obtained before and after the surgery. In some cases, a lumbar spinal computed tomography scan was obtained. Radiological outcomes of intercage distance, fusion rate, and intervertebral disc height were assessed. In scoliosis or lateral translation, the extent of correction was examined. RESULTS: The mean VAS score for back pain improved from 6.86 preoperatively to 2.66 at postoperative month 12, and the score for leg pain decreased from 7.92 to 1.78. The mean intervertebral disc height was 8.71+/-2.35mm before the surgery, and it increased to 11.67+/-1.77mm at 7 days postoperative and decreased to 9.57+/-1.90mm at 6 months postoperative. The fusion rate was 95.65%. For scoliosis or lateral translation, thesegmental angle of scoliosis decreased from 11.10+/-5.82degrees before the surgery to 5.61+/-3.71degrees by month 6 postoperative. The extent of the lateral translation changed from 6.04+/-1.73mm before the surgery to 3.56+/-4.99mm at month 6 postoperative. CONCLUSION: There have been low complication rates with the IS(R) cage during the follow-up period, and the results of this study demonstrates a wide fusion area, partial reduction of lateral translation and scoliosis, good clinical success, and a high fusion rate.
Back Pain ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Leg ; Retrospective Studies ; Scoliosis ; Spinal Fusion

OBJECTIVE: It is well known that plate-to-disc distance (PDD) is closely related to adjacent-level ossification following anterior cervical plate placement. The study was undertaken to compare the outcomes of two different anterior cervical plating methods for degenerative cervical condition. Specifically, the new method involves making holes for plate screws first with an air drill and then choosing a plate size. The other method was standard, that is, decide on the plate size first, locate the plate on the anterior vertebral body, and then drilling the screw holes. Our null hypothesis was that the new technical tip may increase PDD as compared with the standard anterior cervical plating procedure. METHODS: We retrospectively reviewed 49 patients who had a solid fusion after anterior cervical arthrodesis with a plate for the treatment of cervical disc degeneration. Twenty-three patients underwent the new anterior cervical plating technique (Group A) and 26 patients underwent the standard technique (Group B). PDD and ratios between PDD to anterior body heights (ABH) were measured using postoperative lateral radiographs. In addition, operating times and clinical results were reviewed in all cases. RESULTS: The mean durations of follow-up were 16.42+/-5.99 (Group A) and 19.83+/-6.71 (Group B) months, range 12 to 35 months. Of these parameters mentioned above, cephalad PDD (5.43 versus 3.46 mm, p=0.005) and cephalad PDD/ABH (0.36 versus 0.23, p=0.004) were significantly greater in the Group A, whereas operation time for two segment arthrodesis (141.9 versus 170.6 minutes, p=0.047) was significantly lower in the Group A. There were no significant difference between the two groups in caudal PDD (5.92 versus 5.06 mm), caudal PDD/ABH (0.37 versus 0.32) and clinical results. CONCLUSION: The new anterior cervical plating method represents an improvement over the standard method in terms of cephalad plate-to-disc distance and operating time.
Arthrodesis ; Body Height ; Cervical Vertebrae ; Diskectomy ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Mandrillus ; Retrospective Studies ; Spinal Fusion

The authors describe the revision case of a 58-year-old man who presented with pain in the neck and both shoulders after C4-5 cervical total disc replacement (C-TDR) and C5-6 anterior cervical discectomy and fusion (ACDF), and in whom there was evidence of instability with sagittal translation at the C4-5 TDR level and of a herniated cervical disc (HCD) at the left side of C3-4. The revision surgery was performed as follows: previous plate removal at the C5-6 level, artificial disc removal and ACDF at the C4-5 level with cage and previous plate insertion, and TDR at the C3-4 level using the previously implanted C4/5 artificial disc. If instability develops at the level of an artificial disc, we perform additional posterior fusion or anterior removal of the artificial disc and fusion. However, if we encounter combined adjacent segment disc disease, we may reuse the unstable segment artificial disc at the adjacent segment and perform salvage anterior fusion on the unstable segment. This is the first report issued on the management of instability after previous C-TDR involving a switch to ACDF and the use of new TDR at the adjacent level. Furthermore, we conceptually recommend a solution to an emerging problem of adjacent segment disease due to the heterotopic ossification(HO) after C-TDR.
Diskectomy ; Humans ; Middle Aged ; Neck ; Ossification, Heterotopic ; Recycling ; Shoulder ; Total Disc Replacement