Vertebral Distraction during Anterior Cervical Discectomy and Fusion Causes Postoperative Neck Pain

OBJECTIVE: Vertebral distraction is routinely performed during anterior cervical discectomy and fusion (ACDF). Overdistraction can injure the facet joints and may cause postoperative neck pain consequently. The purpose of this study was to investigate the clinical relevance of distraction force during ACDF. METHODS: This study included 24 consecutive patients with single level cervical disc disease undergoing single level ACDF. We measure the maximum torque just before the the arm of the Caspar retractor was suspended by the rachet mechanism by turning the lever on the movable arm using a torque meter. In order to turn the lever using the torque driver, we made a linear groove on the top of the lever. We compared the neck disability index (NDI) and visual analogue scale (VAS) scores between the high torque group (distraction force>6 kgf.cm) and the low torque group (distraction force< or =6 kgf.cm) at routine postoperative intervals of 1, 3, 5 days and 1, 3, 6 months. RESULTS: The VAS scores for posterior neck pain had a linear correlation with torque at postoperative 1st and 3rd days (y=0.99x-1.1, r2=0.82; y=0.77x-0.63, r2=0.73, respectively). VAS scores for posterior neck pain were lower in the low torque group than in the high torque group on both 1 and 3 days postoperatively (3.1+/-1.3, 2.6+/-1.0 compared with 6.0+/-0.6, 4.9+/-0.8, p<0.01). However, the difference in NDI scores was not statistically significant in all postoperative periods. CONCLUSION: Vertebral distraction may cause posterior neck pain in the immediate postoperative days. We recommend not to distract the intervertebral disc space excessively with a force of more than 6.0 kgf.cm.

Intradural Extramedullary Ependymoma with Spinal Root Attachment: A Case Report

A 36-year-old female patient presented with shoulder pain experienced over a period of one year and progressive weakness in both legs for one month. A magnetic resonance imaging scan revealed an intradural extramedullary (IDEM) fusiform mass about 9.8 cm in length, heterogeneously enhanced at the level of C6-T4 with spinal cord compression. At the time of surgery, the surgeon found an encapsulated IDEM tumor with spinal root attachment. The tumor was completely resected and the histologic diagnosis revealed ependymoma. The patient showed a favorable outcome with no recurrence at the 6-month follow-up. This paper reports a rare case of intradural extramedullary ependymoma with spinal root attachment.