Radiologic Findings and Risk Factors of Adjacent Segment Degeneration after Anterior Cervical Discectomy and Fusion : A Retrospective Matched Cohort Study with 3-Year Follow-Up Using MRI

OBJECTIVE: The purpose of this study was to figure out the radiologic findings and risk factors related to adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF) using 3-year follow-up radiography, computed tomography (CT), and magnetic resonance image (MRI). METHODS: A retrospective matched comparative study was performed for 64 patients who underwent single-level ACDF with a cage and plate. Radiologic parameters, including upper segment range of motion (USROM), lower segment range of motion (LSROM), upper segment disc height (UDH), and lower segment disc height (LDH), clinical outcomes assessed with neck and arm visual analogue scale (VAS), and risk factors were analyzed. RESULTS: Patients were categorized into the ASD (32 patients) and non-ASD (32 patients) group. The decrease of UDH was significantly greater in the ASD group at each follow-up visit. At 36 months postoperatively, the difference for USROM value from the preoperative one significantly increased in the ASD group than non-ASD group. Preoperative other segment degeneration was significantly associated with the increased incidence of ASD at 36 months. However, pain intensity for the neck and arm was not significantly different between groups at any post-operative follow-up visit. CONCLUSION: The main factor affecting ASD is preoperative other segment degeneration out of the adjacent segment. In addition, patients over the age of 50 are at higher risk of developing ASD. Although there was definite radiologic degeneration in the ASD group, no significant difference was observed between the ASD and non-ASD groups in terms of the incidence of symptomatic disease.

Learning Curve of Percutaneous Endoscopic Lumbar Discectomy Based on the Period (Early vs. Late) and Technique (in-and-out vs. in-and-out-and-in): A Retrospective Comparative Study

OBJECTIVE: To report the learning curve of percutaneous endoscopic lumbar discectomy (PELD) for a surgeon who had not been previously exposed to this procedure based on the period and detailed technique with a retrospective matched comparative design. METHODS: Of 213 patients with lumbar disc herniation encountered during the reference period, 35 patients who were followed up for 1 year after PELD were enrolled in this study. The patients were categorized by the period and technique of operation : group A, the first 15 cases, who underwent by the 'in-and-out' technique; group B, the next 20 cases, who underwent by the 'in-and-out-and-in' technique. The operation time, failure rate, blood loss, complication rate, re-herniation rate, the Visual Analogue Scale (VAS) for back and leg were checked. The alteration of dural sac cross-sectional area (DSCSA) between the preoperative and the postoperative MRI was checked. RESULTS: Operative time was rapidly reduced in the early phase, and then tapered to a steady state for the 35 cases receiving the PELD. After surgery, VAS scores for the back and leg were decreased significantly in both groups. Complications occurred in 2 patients in group A and 2 patients in group B. Between the two groups, there were significant differences in operative time, improvement of leg VAS, and expansion of DSCSA. CONCLUSION: PELD learning curve seems to be acceptable with sufficient preparation. However, because of their high tendency to delayed operation time, operation failure, and re-herniation, caution should be exercised at the early phase of the procedure.

Primary Meningeal Melanocytoma in the Thoracic Spine: A Case Report

Meningeal melanocytoma is a rare benign melanotic tumor arising from melanocytic cells in the leptomeninges. Preoperative differential diagnosis of meningeal melanocytoma from other melanotic tumors is difficult based on magnetic resonance imaging (MRI). Definitive diagnosis of meningeal melanocytoma from other melanotic tumors is done on the basis of histopathological and immunohistochemical analyses. The prognosis of this tumor is not always favorable with occasional local recurrence, especially in cases of subtotal gross resection. The authors report on a case of a 58-year-old man who presented with a melanocytoma located at the T7-8 level. The patient underwent on a total surgical excision for successful control of the tumor. During a follow-up period of 2 years, the patient presented no signs of recurrence. We emphasize the importance of discrimination of meningeal melanocytoma from other melanotic tumors to facilitate appropriate treatment. Complete resection is the treatment of choice for spinal melanocytoma. Radiation therapy should be reserved for those cases in which complete resection is not possible or in which there is recurrence.

Clinical Experience and Management of Cervico-Thoracic Epidural Hematoma

Spinal epidural hematoma (SEH) causing acute myelopathy is rare. The usual clinical presentation of a SEH is sudden severe neck or back pain that progresses toward paraparesis or quadriparesis, depending on the level of the lesion. Recent studies have shown that early decompressive surgery is very important for patient's recovery. We experienced five patients of cervico-thoracic epidural hematomas associated with neurologic deficits that were treated successfully with surgical intervention.

Clinical Analysis of Carotid Artery Stenting in Symptomatic High-Risk Patients : A Single Stroke Center Study / 대한뇌혈관외과학회지

OBJECTIVE: The early management of patients with acute symptoms due to carotid stenosis remains a subject of debate. Carotid endarterectomy (CEA) has been shown to reduce the risk of stroke in patients with symptomatic extracranial carotid artery stenosis. Carotid artery stenting (CAS) has recently emerged as an alternative to CEA for the primary and secondary prevention of stroke in patients who are at a high risk for complications from surgery. The aim of this study is to evaluate and analyze the clinical outcome of symptomatic high-risk patients with carotid stenosis that was treated with early CAS in a single stroke center. METHODS: From January 2008 to October 2009, we retrospectively analyzed 75 symptomatic high-risk carotid stenosis patients who had been admitted to the stroke center of our neurosurgical department and who were treated with early CAS. Twenty-five patients had transient ischemic attack (TIA) and 50 patients had minor or major stroke and all of them were at a high medical and surgical risk for carotid endarterectomy. They were treated with early CAS as soon as possible (treatment was done within 2 weeks from the onset of symptoms). RESULTS: At three months, 15 patients (20%) in the TIA and stroke group experienced an improvement in their initial neurologic deficit (a decreased modified Rankin scale greater than 2), while in 59 patients (78.4%) the deficit remained stable, and only one patient had a neurological impairment. CONCLUSION: Our data indicates that urgent assessment and early initiation of a combination of existing preventive treatments can reduce the risk of early recurrent stroke after TIA and minor or major stroke in the symptomatic high-risk patients with carotid stenosis.