This study aimed to describe the technical feasibility and clinical outcome of unilateral biportal endoscopy (UBE)-assisted posterior C1–2 fusion for irreducible traumatic atlantoaxial rotatory dislocation (AARD) with facet fracture and locking. A 67-year-old man presented with severe neck pain following a motor vehicle accident. Computed tomography revealed C1–2 rotatory dislocation with a right C2 facet fracture and locking, while magnetic resonance imaging demonstrated left vertebral artery hypoplasia without cord compression. Traction for 3 days failed to achieve reduction. Surgery was subsequently performed using UBE under continuous saline irrigation. Following muscle-splitting exposure, facet release and reduction were achieved with a curette. Because the bulky right C2 nerve root obstructed access, it was transected proximal to the dorsal root ganglion. Facet distraction was then performed, the articular cartilage removed, and the subchondral bone prepared. Bilateral screws were inserted, and a polyether ether ketone cage filled with demineralized bone matrix was placed for fusion. The procedure was completed successfully without complications. Blood loss was minimal. The patient’s visual analogue scale score improved from 8 preoperatively to 2 on postoperative day 1. He was discharged uneventfully on postoperative day 7. At the 3-month follow-up, he remained pain-free with stable fixation and no loss of reduction on imaging. UBE-assisted posterior C1–2 fusion enables precise facet release, safe instrumentation, and minimal tissue trauma in irreducible AARD with facet fracture and locking. This minimally invasive approach may yield favorable short-term outcomes and represents a viable alternative to conventional open posterior fusion techniques.

This study aimed to describe the technical feasibility and clinical outcome of endoscope-assisted anterior odontoid lag screw fixation in a patient with ankylosing spondylitis, in whom the conventional open anterior approach was limited due to cervical rigidity. A 56-year-old man with longstanding ankylosing spondylitis presented with severe neck pain and right-sided tingling sensations following trauma. Imaging revealed a type III odontoid fracture. Because of rigid cervical alignment, adequate neck extension required for the conventional open anterior approach was not achievable. Endoscope-assisted anterior odontoid screw fixation was performed using a biplane C-arm. The procedure involved endoscopic dissection of the prevertebral corridor and insertion of the cannulated lag screw under fluoroscopic guidance. The screw was successfully placed across the fracture site without intraoperative complications. Postoperative imaging confirmed appropriate screw trajectory and fracture reduction. The patient’s pain improved immediately, allowing early ambulation. He was discharged uneventfully, and follow-up examinations demonstrated stable fixation. Endoscope-assisted anterior odontoid lag screw fixation appears to be a safe and effective alternative for treating odontoid fractures in patients with ankylosing spondylitis. This technique minimizes soft-tissue injury and facilitates optimal screw trajectory in cases where rigid cervical alignment precludes the conventional open approach.

Full-thickness skin grafting (FTSG) is frequently used to reconstruct facial soft tissue defects because it provides favorable color and texture matching. Secondary cystic lesions, including milia or epidermal cysts, that develop after FTSG are rare. A 29-year-old woman sustained a dog-bite injury resulting in a 4.5× 2.5 cm defect involving the philtrum and upper lip. The philtrum was reconstructed using a full-thickness skin graft harvested from the retroauricular area, while the upper lip was repaired using a mucosal V-Y advancement flap. Ten months later, hypertrophic scarring developed, and a second FTSG was performed using contralateral retroauricular skin. Despite repeated intralesional triamcinolone injections, the grafted area became tender and pruritic, with the appearance of multiple milia-like lesions. Over the subsequent 9 months, three recurrent cystic nodules developed within the scar tissue and were serially excised. Histopathological examination confirmed the diagnosis of secondary milia. After complete excision, no recurrence was observed for over 3 years. We discuss possible contributing mechanisms, including adnexal survival within grafts and the role of remnant epidermis or ductal obstruction. Awareness of this complication may help guide donor-site selection and wound-bed preparation in perioral reconstruction.

Objective: Minimally invasive surgery (MIS) techniques, which were initially used for the lumbar spine, are now being increasingly used for the cervical spine as well. This study compared the outcomes of posterior C1–2 fusion performed via MIS versus conventional surgery, as well as the changes in radiologic parameters after surgery. Methods: This study compared patients who underwent MIS and conventional surgery for atlantoaxial instability using Harm technique with interlaminar fusion and miniplate to maximize bone fusion between February 2012 and January 2021. Demographic characteristics and radiologic parameters were analyzed preoperatively, immediately postoperatively, and at 2 years postoperatively. Results: The study included 17 patients with more than 2 years of postoperative follow-up, including 7 patients who underwent MIS. Statistically significant differences were found between the 2 groups at the postoperative and intraoperative C1–2 angles (p=0.027 and p=0.001, respectively). There were no significant differences between the preoperative and 2-year postoperative C1–2 angles, or in the radiologic parameters between the MIS and conventional surgery groups. Both groups showed significant positive correlations between the C1–7 angle and T1 slope angle at 2 years postoperatively. Conclusion The MIS and conventional surgery groups exhibited comparable surgical outcomes, suggesting the potential of MIS as an alternative treatment option. Nevertheless, finding the ideal C1–2 angle remains a challenge, because an inadequate angle can cause subaxial kyphosis.

Background: We aimed to evaluate the clinical efficacy of cervical epidural block (CEB) in enhancing upper extremity (UE) muscle strength in patients with cervical disc herniation (CDH). Methods: Ten patients with CDH underwent a single CEB session. Follow-up assessments were conducted weekly for 2 weeks through outpatient visits. Handgrip strength on the affected side (AHGS) and the interlateral difference in handgrip strength (DHGS) between the affected and unaffected sides were measured using a dynamometer before, immediately after, 1 and 2 weeks after CEB. Neck pain and radiating UE pain were assessed using a visual analog scale (VAS) at baseline and 2 weeks posttreatment. Results: The median patient age was 46.4 years (range, 35–78 years). The affected disc levels were C5–6 in five patients, C6–7 in three, and C5–6–7 in two. The left side was affected in six patients and the right in four. The mean VAS score for neck pain decreased from 7.2 to 2.9, whereas that for radiating UE pain decreased from 6.3 to 2.8 after treatment. Both the AHGS and DHGS improved significantly compared to the baseline values at all posttreatment times. However, no significant differences were observed among the posttreatment time points. These findings remained consistent even after adjusting for age and sex. Conclusion CEB may offer therapeutic benefits by alleviating pain and improving UE muscle weakness in patients with CDH. However, further large-scale prospective studies are required to validate these preliminary results and determine the long-term efficacy of CEB in managing CDH.

Background: Global Lung Function Initiative (GLI)-2012 reference equation is currently suggested for interpretation of spirometry results and a new local reference equation has been developed in South Korea. However, lung function profiles according to the different reference equations and their clinical relevance have not been identified in chronic obstructive pulmonary disease (COPD) patients. Methods: Our cross-sectional study evaluated Choi’s, Korean National Health and National Examination Survey (KNHANES)-VI, and GLI-2012 reference equations. We estimated the percentages of predictive forced expiratory volume in one second (FEV 1) and airflow limitation severity according to reference equations and analyzed their associations with patient reported outcomes (PROs): COPD assessment test (CAT) score, St. George's Respiratory Questionnaire for COPD patients (SGRQ-C) score, and six minute walk distance (6MWD). Results: In the eligible 2,180 COPD patients, lower predicted values of FEV 1 and forced vital capacity (FVC) were found in GLI-2012 compared to Choi's and KNHANES-VI equations.GLI-2012 equation resulted in a lower proportion of patients being classified as FEV 1 < 80% or FVC < 80% compared to the other equations. However, the Z-scores of FEV 1 and FVC were similar between the KNHANES-VI and GLI-2012 equations. Three reference equations exhibited significant associations between FEV 1 (%) and patient-reported outcomes (CAT score, SGRQ-C score, and 6MWD). Conclusion GLI-2012 reference equation may not accurately reflect FEV 1 (%) in the Korean population, but the Z-score using GLI-2012 equation can be a viable option for assessing FEV 1 and airflow limitation in COPD patients. Similar to the other two equations, the GLI-2012 equation demonstrated significant associations with PROs.

Background: As the prevalence of hypertension increases with age and the proportion of the older population is also on the rise, research on the characteristics of older hypertensive patients and the importance of frailty is necessary. This study aimed to identify clinical characteristics of older hypertension in Korea and to investigate these characteristics based on frailty status. Methods: The HOW to Optimize eLDerly systolic BP (HOWOLD-BP) is a prospective, multicenter, open-label, randomized clinical trial that aims to compare intensive (target systolic blood pressure [SBP] ≤ 130 mmHg) with standard (target SBP ≤ 140 mmHg) treatment to reduce cardiovascular events in older hypertensive Korean patients aged ≥ 65 years. Data were analyzed through a screening assessment of 2,085 patients recruited from 11 university hospitals. Demographic, functional (physical and cognitive), medical history, laboratory data, quality of life, and medication history of antihypertensive drugs were assessed. Results: The mean age was 73.2 years (standard deviation ± 5.60), and 48.0% (n = 1,001) were male. Prevalent conditions included dyslipidemia (66.5%), obesity (body mass index ≥ 25 kg/m 2 , 53.6%), and diabetes (28.9%). Dizziness and orthostatic hypotension were self-reported by 1.6% (n = 33) and 1.2% (n = 24), respectively. The majority of patients were on two antihypertensive drugs (48.4%), while 27.5% (n = 574) and 20.8% (n = 433) were on 1 and 3 antihypertensive medications, respectively. Frail to pre-frail patients were older and also tended to have dependent instrumental activities of daily living, slower gait speed, weaker grip strength, lower quality of life, and lower cognitive function. The frail to pre-frail group reported more dizziness (2.6% vs. 1.2%, P < 0.001) and had concerning clinical factors, including lower glomerular filtration rate, more comorbidities such as diabetes, stroke, and a history of admission. Frail to pre-frail older hypertensive patients used slightly more antihypertensive medications than robust older hypertensive patients (1.95 vs. 2.06, P = 0.003). Pre-frail to frail patients often chose beta-blockers as a third medication over diuretics. Conclusion This study described the general clinical characteristics of older hypertensive patients in Korea. Frail hypertensive patients face challenges in achieving positive clinical outcomes because of multifactorial causes: they are older, have more morbidities, decreased function, lower quality of life and cognitive function, and take more antihypertensive medications. Therefore, it is essential to comprehensively evaluate and monitor diseaserelated or drug-related adverse events more frequently during regular check-ups, which is necessary for pre-frail to frail older patients with hypertension.

Objective: Multilevel posterior cervical fusion (PCF) and decompression surgery is a viable treatment option for multilevel ossification of posterior longitudinal ligament (OPLL) and spondylotic myelopathy. Since OPLL is known to affect bone formation, this study aimed to examine the effect of OPLL on the incidence of pseudarthrosis following PCF in a cohort study. Methods: We conducted a retrospective cohort study of patients with PCF and laminectomy at our institution. This study included patients who underwent C3 to C6 posterior fusion surgery involving lateral mass screw fixation without anterior surgery for OPLL or spondylotic myelopathy. Fusion status was evaluated 1 year postoperatively with computed tomography. Bone mineral density (BMD) and sagittal parameters were also evaluated as potential contributing factors to the fusion rate. Results: Eighty patients were included. Pseudarthrosis was observed in 22.5% (n=18) of patients. Pseudarthrosis incidence was lower in patients with OPLL (spondylosis vs. OPLL, 33.3% vs. 12.2%; p=0.003), and a higher BMD T-score (pseudarthrosis vs. fusion, -1.9 ± 0.7 vs. -0.6 ± 1.3; p<0.01), a larger preoperative range of motion (ROM) (26.7 ± 13.3 vs. 17.6 ± 10.9; p=0.01), and a greater preoperative-to-postoperative decrease in cervical lordosis (-8.1 ± 7.9 vs. -2.7 ± 7.9; p<0.01). Pseudarthrosis was associated with worsening neck pain after surgery. Conclusion The absence of OPLL, lower BMD, larger preoperative ROM, and a greater decrease in postoperative cervical lordosis were identified as risk factors for pseudarthrosis after multiple PCF.

Objective: : A chronic subdural hematoma (CSDH) is a collection of bloody fluid located in the subdural space and encapsulated by neo-membranes. An inner subdural hygroma (ISH) is observed between the inner membrane of a CSDH and the brain surface. We present six cases of CSDH combined with ISH treated via endoscopy. Methods: : Between 2011 and 2022, among the 107 patients diagnosed with CSDH in our institute, six patients were identified as presenting with CSDH combined with ISH and were included in this study. Preoperative computerized tomography (CT) and magnetic resonance imaging (MRI) were performed simultaneously, and endoscopic surgery for aspiration of the hematoma was performed in all cases of CSDH combined with ISH. Results: : The mean age of patients was 71 years (range, 66 to 79). The patients were all male. In two cases, the ISH was not identified on CT, but was clearly seen on MRI in all patients. The inner membrane of the CSDH was tense and bulging after draining of the CSDH in endoscopic view due to the high pressure of the ISH. After fenestration of the inner membrane of the CSDH and aspiration of the ISH, the membrane was sunken down due to the decreasing pressure of the ISH. There was one recurrence in post-operative 2-month follow up. The symptoms improved in all patients after surgery, and there were no surgery-related complications. Conclusion : CSDH combined with ISH can be diagnosed on imaging, and endoscopic surgery facilitates safe and effective treatment.

Solitary fibrous tumor (SFT) is an uncommon tumor that typically originates in the pleural cavity but may also be found in extra-pleura sites like the head and neck, spine, lungs, mediastinum, peritoneum, and pelvis. There are few reports of SFT of the scalp, and malignant SFT of the scalp appears to be so rare that only two cases of it were reported previously. A 47-year-old woman was admitted to our institution with a large, rapidly growing mass on the left parietal scalp. An analysis of her scalp condition and imaging findings of the mass revealed two different appearances between the superior and inferior halves; the scalp of the inferior half looked normal, but that of the superior half did not. Also, computed tomography findings of the mass confirmed different patterns between the superior and inferior halves. The mass with the abnormal superior half scalp was removed totally. The pathological diagnosis was malignant SFT, but the inferior mass was revealed to have a benign nature. The patient underwent prophylactic radiotherapy and experienced no local recurrence or distant metastasis at the final follow-up at 12 months. We present a third case of malignant SFT originating on the scalp and describe our clinical and surgical experience managing malignant SFT of the scalp.