Background: In the cervicothoracic junction (CTJ), there is limited working space to perform the posterior-only approach. Therefore, a combined anterior approach is required in some cases. However, the great vessels and sternum obstruct the anterior corridor and make the anterior approach difficult. We analyzed relevant anatomical structures encountered during the anterior approach in the CTJ and evaluated the feasibility of previously reported surgical corridors. Methods: We retrospectively examined 49 patients who underwent neck computed tomography angiography between January 2015 and May 2020. Using the coronal images, we measured the intercarotid artery angle (ICAA), intercarotid artery distance (ICAD), shape of the brachiocephalic trunk (BCT), and position of the BCT base. We then measured the most cranial level requiring manubriotomy for the anterior approach (ML), the most caudal level accessible through the superior corridor (SC), and the most caudal level through the inferior corridor (IC) according to the surgeon’s line of sight using the sagittal axis image. Results: The mean ICAA and ICAD were 50.83° ± 15.23° and 33.38 ± 12.11 mm, respectively. Notably, BCT shape was of the convex type in most cases (42.9%), followed by the straight type (36.7%). In addition, the base of BCT was most commonly located inside the body (49%). Moreover, ICAA and ICAD were significantly greater in men. Although men mostly had the BCT base inside the body (64.3%), female mostly had it on the edge of the body (47.6%). Notably, ML showed the highest frequency (16.3%) in the T1 lower and upper bodies. Furthermore, through SC and IC, it was possible to approach the T4 lower body and T6 midbody, respectively. SC showed the highest frequency (16.3%) in the T3 lower body, and IC showed the highest frequency (20.4%) in the T5 midbody. Conclusions ICAA and ICAD were larger and higher in men. BCT was convex and located inside the body in most cases. The accessible level of ML, SC, and IC were T1, T3, and T5, respectively. For the anterior approach in the CTJ, preoperative vascular and accessible level analysis of corridors is essential to decide on the appropriate corridor and reduce complications.

Brace treatment is a well-documented conservative treatment method for adolescent idiopathic scoliosis. On the other hand, previous studies reported skin problems, decreased lung capacity, and chest wall deformity as complications. This paper reports a case of spontaneous rib fracture during brace treatment for adolescent idiopathic scoliosis, a complication in a 14-year-old female who eventually underwent surgical correction.

Objectives: To evaluate and compare the clinical outcomes of cervical transforaminal epidural block (CTEB) using local anesthetics with or without a steroid for cervical spondylotic radiculopathy (CSR).Summary of Literature Review: The typical mixture for a CTEB is a combination of local anesthetics with a non-particulate steroid.However, there are potential complications related to steroid injections such as steroid-induced osteoporosis, hypothalamus-pituitaryadrenal gland axis suppression, and hyperglycemia. Materials and Methods: From January 2018 to October 2019, 35 patients who underwent CTEB for CSR were enrolled in this study.Cases with arm pain over 4 on a visual analog scale (VAS) were included. In the first 19 cases, a combination of 1 mL of 1% lidocaine and 1 mL of dexamethasone was used (group A), and in the next 16 cases, 1 mL of 1% lidocaine mixed with 1 mL of normal saline was used (group B). Arm pain VAS and the Neck Disability Index (NDI) were obtained perioperatively. Results: Baseline characteristics were not significantly different between the two groups. In both groups, the arm pain VAS significantly decreased at 30 minutes, 2 weeks, and 6 weeks post-injection compared to pre-injection values. However, the arm pain aggravated 12 weeks post-injection. The NDI of both groups significantly improved 6 weeks post-injection compared to pre-injection. The clinical outcomes of arm pain VAS and NDI at 30 minutes, 2 weeks, and 6 weeks post-injection, as well as the amounts of change, were not significantly different between both groups. Conclusions CTEB for CSR without a steroid improved symptoms by 6 weeks. The degree of improvement was similar to when CTEB was performed with a steroid in terms of VAS and NDI.

STUDY DESIGN: Review of the literature.OBJECTIVES: To present up-to-date information on the use of cages in anterior cervical fusion for degenerative cervical disease.SUMMARY OF LITERATURE REVIEW: The use of cages in anterior cervical fusion for degenerative cervical disease remains controversial.MATERIALS AND METHODS: Review of the relevant literature.RESULTS: The use of cages in anterior cervical fusion of one and multiple disc levels was effective in terms of biomechanical stability and clinical outcomes without complications at the donor site compared with use of an autograft. However, the use of only a cage had many drawbacks, so the combined use of a cage and a cervical plate is recommended.CONCLUSIONS: The use of cages in anterior cervical fusion was effective in terms of clinical outcomes, and the combined use of a cage and a cervical plate is recommended.
Autografts ; Humans ; Tissue Donors ; Treatment Outcome

OBJECTIVES: To present up-to-date information on the use of cages in anterior cervical fusion for degenerative cervical disease.SUMMARY OF LITERATURE REVIEW: The use of cages in anterior cervical fusion for degenerative cervical disease remains controversial. MATERIALS AND METHODS: Review of the relevant literature. RESULTS: The use of cages in anterior cervical fusion of one and multiple disc levels was effective in terms of biomechanical stability and clinical outcomes without complications at the donor site compared with use of an autograft. However, the use of only a cage had many drawbacks, so the combined use of a cage and a cervical plate is recommended. CONCLUSIONS The use of cages in anterior cervical fusion was effective in terms of clinical outcomes, and the combined use of a cage and a cervical plate is recommended.

PURPOSE: To compare the time intervals to magnetic resonance imaging (MRI) and surgical treatment in patients having traumatic cervical spinal cord injury (SCI) with and without bony lesions. METHODS: Retrospectively analyzed adult patients visited Kyungpook National University Hospital and underwent surgical treatment for cervical SCI within 24 hours. The patients who were suspected of having cervical SCI underwent plain radiography and computed tomography (CT) upon arrival. After the initial evaluation, we evaluated the MRI findings to determine surgical treatment. Waiting times for MRI and surgery were evaluated. RESULTS: Thirty-four patients were included. Patients' mean age was 57 (range, 23–80) years. Patients with definite bony lesions were classified into group A, and 10 cases were identified (fracture-dislocation, seven; fracture alone, three). Patients without bony lesions were classified into group B, and 24 cases were identified (ossification of the posterior longitudinal ligament, 16; cervical spondylotic myelopathy, eight). Mean intervals between emergency room arrival and start of MRI were 93.60 (±60.08) minutes in group A and 313.75 (±264.89) minutes in group B, and the interval was significantly shorter in group A than in group B (p=0.01). The mean times to surgery were 248.4 (±76.03) minutes in group A and 560.5 (±372.56) minutes in group B, and the difference was statistically significant (p=0.001). The American Spinal Injury Association scale at the time of arrival showed that group A had a relatively severe neurologic deficit compared with group B (p=0.046). There was no statistical significance, but it seems to be good neurological recovery, if we start treatment sooner among patients treated within 24 hours (p=0.198). CONCLUSIONS If fracture or dislocation is detected by CT, cervical SCI can be easily predicted resulting in MRI and surgical treatment being performed more rapidly. Additionally, fracture or dislocation tends to cause more severe neurological damage, so it is assumed that rapid diagnosis and treatment are possible.

STUDY DESIGN: A noninterventional, multicenter, cross-sectional study. PURPOSE: We investigated the prevalence of neuropathic pain (NP) and patient-reported outcomes (PROs) of the quality of life (QoL) and functional disability in Korean adults with chronic low back pain (CLBP). OVERVIEW OF LITERATURE: Among patients with CLBP, 20%–55% had NP. METHODS: Patients older than 20 years with CLBP lasting for longer than three months, with a visual analog scale (VAS) pain score higher than four, and with pain medications being used for at least four weeks before enrollment were recruited from 27 general hospitals between December 2014 and May 2015. Medical chart reviews were performed to collect demographic/clinical features and diagnosis of NP (douleur neuropathique 4, DN4). The QoL (EuroQoL 5-dimension, EQ-5D; EQ-VAS) and functional disability (Quebec Back Pain Disability Scale, QBPDS) were determined through patient surveys. Multiple linear regression analyses were performed to compare PROs between the NP (DN4≥4) and non-NP (DN4 < 4) groups. RESULTS: A total of 1,200 patients (females: 65.7%; mean age: 63.4±13.0 years) were enrolled. The mean scores of EQ-5D, EQ-VAS, and QBPDS were 0.5±0.3, 55.7±19.4, and 40.4±21.1, respectively. Among all patients, 492 (41.0%; 95% confidence interval, 38.2%–43.8%) suffered from NP. The prevalence of NP was higher in male patients (46.8%; p < 0.01), in patients who had pain based on radiological and neurological findings (59.0%; p < 0.01), and in patients who had severe pain (49.0%; p < 0.01). There were significant mean differences in EQ-5D (NP group vs. non-NP group: 0.4±0.3 vs. 0.5±0.3; p < 0.01) and QBPDS (NP group vs. non-NP group: 45.8±21.2 vs. 36.3±20.2; p < 0.01) scores. In the multiple linear regression, patients with NP showed lower EQ-5D (β=−0.1; p < 0.01) and higher QBPDS (β=7.0; p < 0.01) scores than those without NP. CONCLUSIONS: NP was highly prevalent in Korean patients with CLBP. Patients with CLBP having NP had a lower QoL and more severe dysfunction than those without NP. To enhance the QoL and functional status of patients with CLBP, this study highlights the importance of appropriately diagnosing and treating NP.
Adult* ; Back Pain ; Cross-Sectional Studies ; Diagnosis ; Hospitals, General ; Humans ; Linear Models ; Low Back Pain* ; Male ; Neuralgia* ; Prevalence* ; Quality of Life ; Visual Analog Scale

STUDY DESIGN: Case Report. OBJECTIVES: The aim of this study was to report 2 cases of calcified spinal meningioma that displayed differences in appearance during resection, and to review the current literature on calcified and ossified spinal meningiomas. SUMMARY OF LITERATURE REVIEW: Calcified and ossified spinal meningiomas are rare, and tumor calcification is a risk factor for poor neurological outcomes resulting from the additional manipulations required to dissect the tumor. MATERIALS AND METHODS: We describe the clinical course and intraoperative findings of 2 female patients who presented with symptoms of myelopathy. Magnetic resonance imaging showed calcified spinal meningiomas of the thoracic spine. The type of tumor resection performed was dependent on the solidity and texture of the individual tumors. RESULTS: Pathologic evaluation revealed psammoma bodies, which suggested calcified meningioma. The patients' neurologic symptoms resolved with no neurologic sequelae. CONCLUSIONS: Although there are a few pathologic differences regarding the main type and pathogenesis of ossified and calcified meningioma, both are thought to have a poor prognosis. For these tumors, adequately accounting for the expected poor prognosis and performing a wide laminectomy in order to ensure an adequate surgical margin are important factors for achieving a favorable outcome.
Female ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Meningioma* ; Neurologic Manifestations ; Prognosis ; Risk Factors ; Spinal Cord Diseases ; Spine

STUDY DESIGN: A literature review regarding the correlation between a kyphotic neck and its clinical outcomes. OBJECTIVES: This review examines normal cervical alignment, methods for assessing alignment, a specific correlation between kyphotic neck and clinical outcomes, and indications and methods of surgical treatment. SUMMARY OF LITERATURE REVIEW: Cervical kyphotic deformity is problematic in terms of HRQOL due to nerve damage or loss of horizontal gaze. MATERIALS AND METHODS: Review of the literature. RESULTS: Cervical kyphosis can be caused by postlaminectomy, degenerative disc disease, and trauma, and the symptoms exhibit diverse clinical progression including compensatory mechanisms, adjacent segment disease, changes in quality of life, and cervical myelopathy. Given the serious complications of cervical surgery, we need a deep understanding of spine anatomy, preoperative planning, and correction methods. CONCLUSIONS: It is vital to investigate cervical sagittal alignment and to perform intensive treatment and corrective surgery to achieve better clinical outcomes.
Congenital Abnormalities ; Kyphosis ; Neck* ; Quality of Life ; Spinal Cord Diseases ; Spine

BACKGROUND: In the present study, we aimed to compare clinical and radiographic outcomes between hook plate fixation and coracoclavicular (CC) ligament reconstruction for the treatment of acute unstable acromioclavicular (AC) joint dislocation. METHODS: Forty-two patients who underwent surgery for an unstable acute dislocation of the AC joint were included. We divided them into two groups according to the treatment modality: internal fixation with a hook plate (group I, 24 cases) or CC ligament reconstruction (group II, 18 cases). We evaluated the clinical outcomes using a visual analog scale (VAS) for pain and Constant-Murley score, and assessed the radiographic outcomes based on the reduction and loss of CC distance on preoperative, postoperative, and final follow-up plain radiographs. RESULTS: The mean VAS scores at the final follow-up were 1.6 +/- 1.5 and 1.3 +/- 1.3 in groups I and II, respectively, which were not significantly different. The mean Constant-Murley scores were 90.2 +/- 9.9 and 89.2 +/- 3.5 in groups I and II, respectively, which were also not significantly different. The AC joints were well reduced in both groups, whereas CC distance improved from a mean of 215.7% +/- 50.9% preoperatively to 106.1% +/- 10.2% at the final follow-up in group I, and from 239.9% +/- 59.2% preoperatively to 133.6% +/- 36.7% at the final follow-up in group II. The improvement in group I was significantly superior to that in group II (p < 0.001). Furthermore, subluxation was not observed in any case in group I, but was noted in six cases (33%) in group II. Erosions of the acromion undersurface were observed in 9 cases in group I. CONCLUSIONS: In cases of acute unstable AC joint dislocation, hook plate fixation and CC ligament reconstruction yield comparable satisfactory clinical outcomes. However, radiographic outcomes based on the maintenance of reduction indicate that hook plate fixation is a better treatment option.
Acromioclavicular Joint/injuries/radiography/*surgery ; Acute Disease ; Adult ; Arthroscopy ; Bone Plates ; Dislocations/radiography/*surgery ; Female ; Humans ; Ligaments, Articular/surgery ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome