Imaging Characterization of Non-Rheumatoid Retro-Odontoid Pseudotumors: Comparison with Atlantoaxial Manifestation of Rheumatoid Arthritis.

Backgroundand Objectives: To date, imaging characterization of non-rheumatic retro-odontoid pseudotumors (NRROPs) has been lacking; therefore, NRROPs have been confused with atlantoaxial joint involvement of rheumatoid arthritis (RA). It is important to differentiate these two disease because the treatment strategies may differ. The purpose of this study is to characterize imaging findings of NRROPs and compare them with those of RA. Material and Methods: From January 2015 to December 2019, 27 patients (14 women and 13 men) with NRROPs and 19 patients (15 women and 4 men) with RA were enrolled in this study. We evaluated various imaging findings, including atlantoaxial instability (AAI), and measured the maximum diameter of preodontoid and retro-odontoid spaces with magnetic resonance imaging (MRI) and computed tomography (CT). Results: Statistical significance was considered for p < 0.05. AAI was detected in eight patients with NRROPs and in all patients with RA (p < 0.0001). Seventeen patients with NRROPs and six patients with RA showed spinal cord compression (p = 0.047). Compressive myelopathy was observed in 14 patients with NRROPs and in 4 patients with RA (p = 0.048). Subaxial degeneration was observed in 25 patients with NRROPs and in 9 patients with RA (p = 0.001). Moreover, C2-3 disc abnormalities were observed in 11 patients with NRROPs and in 2 patients with RA (p = 0.02). Axial and longitudinal diameter of retro-odontoid soft tissue and preodontoid and retro-odontoid spaces showed significant differences between NRROP and RA patients (p < 0.0001). Furthermore, CT AAI measurements were differed significantly between NRROP and RA patients (p < 0.05). Conclusions: NRROPs showed prominent retro-odontoid soft tissue thickening, causing compressive myelopathy and a high frequency of subaxial and C2-3 degeneration without AAI.

Preclinical mouse model of optical coherence tomography for subcortical brain imaging without dissection.

The purpose of this study was to investigate the feasibility of using optical coherence tomography (OCT) to identify internal brain lesions, specifically intracerebral hemorrhage, without dissection. Mice with artificially injected brain hematomas were used to test the OCT system, and the recorded images were compared with microscopic images of the same mouse brains after hematoxylin and eosin staining. The intracranial structures surrounding the hematomas were clearly visualized by the OCT system without dissection. These images reflect the ability of OCT to determine the extent of a lesion in several planes. OCT is a useful technology, and these findings could be used as a starting point for future research in intraoperative imaging.

Pharmacological target therapy of neuropathic pain and patient-reported outcomes in patients with chronic low back pain in Korea: Results from the NLBP Outcomes Research.

A number of studies have demonstrated an association of neuropathic pain and chronic low back pain (CLBP), but the outcome difference in each medical management is poorly understood. This study is aimed to investigate treatment patterns of neuropathic pain in CLBP patients and to explore patient-reported outcomes (PROs) including quality of life (QoL) and functional disability by treatment patterns.Data were extracted from the neuropathic low back pain (NLBP) outcomes research. It was a multicenter and cross-sectional study in which 1200 patients were enrolled at 27 general hospitals, from 2014 to 2015. Of total, 478 patients classified as neuropathic pain were used for this subgroup analysis. The patients were divided into 2 groups according to treatment patterns (with vs. without the targeted therapy [TT] of neuropathic pain). Demographic and clinical features were collected by chart reviews and PROs were measured by patient's survey. QoL was assessed by EuroQoL 5-dimension (EQ-5D) questionnaire. Functional disability was measured by the Quebec Back Pain Disability Scale (QBPDS). Multiple linear regression analyses were conducted to compare the PROs between TT group and non-targeted therapy (nTT) group.Among the NLBP patients (mean age 63years, female 62%), EQ-5D index, EuroQoL-Visual Analog Scale (EQ-VAS), and QBPDS Scores (mean ±â€Šstandard deviation) were 0.40 ±â€Š0.28, 54.98 ±â€Š19.98, and 46.03 ±â€Š21.24, respectively. Only 142 (29.7%) patients had pharmacological TT of neuropathic pain. Univariate analyses revealed no significant mean differences between TT group and nTT group in the EQ-5D index (0.41 ±â€Š0.27 and 0.39 ±â€Š0.28), EQ-VAS (56.43 ±â€Š18.17 and 54.37 ±â€Š20.69), and QBPDS (45.31 ±â€Š21.32 and 46.31 ±â€Š21.24). After adjustment with covariates, TT group had higher scores of EQ-5D index (ß = 0.07; P < 0.01) and EQ-VAS (ß = 4.59; P < 0.05) than the nTT group. The TT group's QBPDS score was lower than the nTT group, although its statistical significance still has not been reached (ß = -4.13; P = 0.07).We found that considerable proportion of the NLBP patients remains untreated or undertreated. Although TT group had significantly better QoL than nTT group, only 29.7% of NLBP patients had pharmacological TT. Therefore, clinicians should consider using TT for better QoL of neuropathic pain patients.

Prevalence of Neuropathic Pain and Patient-Reported Outcomes in Korean Adults with Chronic Low Back Pain Resulting from Neuropathic Low Back Pain.

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 (ß=-0.1; p<0.01) and higher QBPDS (ß=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.

Preoperative Incidence of Deep Vein Thrombosis after Hip Fractures in Korean.

BACKGROUND: The purpose of the current study was to investigate the incidence of preoperative deep vein thrombosis (DVT) after hip fractures in Korea. METHODS: In this prospective study, we enrolled 152 Korean geriatric patients who had suffered hip fractures due to a simple fall and were hospitalized between January 2013 and December 2013. There were 52 male and 100 female patients, and their mean age was 78.2 years. There were 96 trochanteric fractures and 56 femoral neck fractures. All patients were examined for DVT: 26 by ultrasonography and 126 by computed tomography venography. The patients having DVT underwent inferior vena cava filter insertion before the surgical intervention. RESULTS: Preoperatively, none of the patients had any signs or symptoms of DVT; however, 4 patients were identified as having asymptomatic DVT. The overall incidence of DVT was 2.6% (4/152). The mean time to arrival at emergency room after injury was 32.6 hours. Mean time elapsed to undergo surgery after hospitalization was 24.9 hours. The average time to hospitalization after injury was 237 hours for patients with DVT versus 27.5 hours for patients without DVT. DVT developed within 72 hours in two of the 137 patients (1.4%) and after 72 hours in two of the remaining 15 patients (13.3%) hospitalized. CONCLUSIONS: While the preoperative incidence of DVT after hip fractures was relatively low (2.6%) in the Korean geriatric population, we confirmed that getting no treatment within 72 hours after injury increased the incidence of DVT. Thus, we conclude from this study that a workup for DVT should be considered in cases where admission or surgery has been delayed for more than 72 hours after injury.

Unusual Cause of Hip Pain: Intrusion of the Acetabular Labrum.

Femoroacetabular impingement and dysplatic hip joint is well known cause of osteoarthritis. In these diseases, labral tear and subsequent cartilage damage is thought to be main pathophysiology of development of osteoarthritis. If there are no known bony abnormalities, we called it as idiopathic osteoarthritis. Normal appearance of acetabular labrum is a continuous, usually triangular structure that attaches to the bony rim of the acetabulum and is completed at the inferior portion by the transverse acetabular ligament over the acetabular notch. A few authors reported intra-articular labrum and its relation to the development of osteoarthritis. But they didn't comment the primary bony abnormality especially acetabulum. We'd like to report x-ray, computed tomogram, magnetic resonance arthrogram and arthroscopic findings of a case had double contour sign of acetabular dome combined with intrusion of acetabular labrum.

Lumbar spinal chondroma presenting with acute sciatica.

A 47-year-old woman visited with lumbago and severe left leg pain that had been presented for 1 week. The patient complained of severe radiating pain on left L3 sensory dermatome area and reported aggravation of leg pain at 20 degrees of hip flexion by straight leg raising test (SLRT). However, there was no motor weakness on neurological examination. Magnetic resonance imaging (MRI) demonstrated contrast enhancing spinal extradural mass at L2-3 level that was iso-signal intensity (SI) on T1-weighted images (WI), hypo-SI on T2WI. She was not able to walk and sleep due to incapacitating pain. Thus, surgical removal was performed via left partial laminectomy. Postoperatively, the radiating pain was relieved completely. Histopathologic examination revealed that the tumor consisted of chondroma, which had mature hyaline cartilage with nests of benign-appearing cells and calcium deposits in lacunae.

Pregnancy and spinal problems.

PURPOSE OF REVIEW: To review recent publications in spinal problems during pregnancy, diagnosis, and management. RECENT FINDINGS: Pregnancy-related low back pain (LBP) is the most common problem which can occur during pregnancy. Among the various factors of pregnancy-related LBP, previous LBP and LBP during menstruation seem to be significant risk factors of pregnancy-related LBP. Patient counseling and wearing of a nonelastic pelvic belt are effective for the control of pelvic girdle pain. Lumbar pain can be treated with exercise such as water gymnastics during the second and third trimesters. Although rare, pregnancy can cause osteoporotic compression fractures and symptoms in spinal tumors, especially in vertebral hemangiomas. Lumbar disc herniation is the most common spinal disorder during pregnancy and can cause permanent neurologic deficit in pregnant women. Most cases can be treated by conservative management, but operation can also be safely performed maintaining a healthy pregnancy. SUMMARY: Recent concern about spinal problems in pregnancy is still pregnancy-related LBP. The further studies about its prevalence, risk factors, and treatment will be expected to continue. In both general spinal diseases and pregnancy-induced spinal diseases, there is no significant difference in treatment between pregnant women and ordinary people. Therefore, if consideration of possible spinal problems, exact diagnosis and adequate treatment are performed, good prognosis may be enough achieved in pregnant women.

Types and prevalence of coexisting spine lesions on whole spine sagittal MR images in surgical degenerative spinal diseases.

PURPOSE: We investigated types and prevalence of coexisting lesions found on whole spine sagittal T2-weighted images (WSST2I) acquired from magnetic resonance imaging (MRI) and evaluated their clinical significance in surgical degenerative spinal diseases. MATERIALS AND METHODS: Coexisting spinal lesions were investigated using WSST2I from 306 consecutive patients with surgical degenerative spinal diseases. Severity of coexisting lesions was classified into four grades (0-3). Lesions of grade 2 and 3 were defined as "meaningful coexisting spine lesions" (MCSL). Degenerative spinal diseases were classified into three pathologies: simple disc herniation, degenerative spinal stenosis, and ligament ossification disease. The relationships between MCSL, gender, age, and primary spine lesions were analyzed. RESULTS: MCSL were found in 95 patients: a prevalence of 31.1%. Five out of 95 MCSL were surgically managed. The most common types of MCSL were disc herniation with 13.1% prevalence, followed by degenerative stenosis (9.5%) and ligament ossification diseases (6.8%). Older patients (age >or= 40) showed a significantly higher prevalence of MCSL than younger patients. There was no significant difference between male and female patients. The prevalence of MCSL was significantly higher (52.4%) in ligament ossification diseases than in disc herniation or spinal stenosis. CONCLUSION: Degenerative spinal diseases showed a high prevalence of MCSL, especially in old ages and ligament ossification diseases. WSST2I is useful for diagnosing coexisting spinal diseases and to avoid missing a significant cord-compressing lesion.

Clinical review of factors leading to perioperative dissatisfaction related to orthognathic surgery.

PURPOSE: The purpose of the study was to obtain information on factors leading to perioperative dissatisfaction of patients who undergo orthognathic surgery for dentofacial deformities. MATERIALS AND METHODS: A total of 44 patients who underwent orthognathic surgery between January 1, 2003, and September 30, 2005, were included in this study. All patients completed 21-item questionnaires, which were analyzed using the frequency distribution and the chi(2) test. RESULTS: The patients lost 6.4% of their body weight after 1-jaw surgery and 6.7% after 2-jaw surgery. The patients returned to their everyday life 4.8 weeks after 1-jaw surgery and 5.2 weeks after 2-jaw surgery. Restoration of sensory function after jaw surgery required almost 10 weeks. CONCLUSION: Written information about possible sequelae and the recovery period and patients' consent to the surgical procedure may be helpful in proper communication, which may reduce patients' perioperative dissatisfaction.

Intradural lumbar disc herniations associated with epidural adhesion : report of two cases.

Intradural lumbar disc herniation (ILDH) is rare. In this report, authors present 2 cases of ILDHs associated with severe adhesion between the dural sac and posterior longitudinal ligament. In a 40-year-old man, ILDH occurred in association with epidural adhesion due to ossification of the posterior longitudinal ligament (OPLL). In other 31-year-old man, ILDH occurred in presence of epidural adhesion due to previous spine surgery.

Spinal surgery in patients with end-stage renal disease undergoing hemodialysis therapy.

STUDY DESIGN: Case series retrospective review. OBJECTIVE: To present the surgical treatment guideline for spinal diseases with end-stage renal disease (ESRD) patients undergoing hemodialysis. SUMMARY OF BACKGROUND DATA: Treatment for spinal diseases with ESRD patients in is a special clinical challenge because of complex medical and clinical problems. METHODS: We retrospectively reviewed 12 patients who underwent spinal surgeries among patients with chronic renal failure at our hospital from May 2000 to September 2007. The medical records and radiologic findings for these patients were reviewed and concomitant medical diseases, laboratory findings, pre- and postoperative care, clinical outcomes, and complications were investigated. RESULTS: One patient died of pneumonia and sepsis 2 months after fusion surgery. Other postoperative complications included postoperative delirium in 3 patients and terminal ileitis and delayed primary spondylodiscitis in 1 patient each. There were no postoperative wound infections associated with the spinal surgery.The preoperative mean visual analogue scale score was 7.9 +/- 0.61, which improved to 2.2 +/- 1.25 at the time of final follow-up for 11 patients. Among 5 patients who underwent fusion surgery, solid bone fusion was achieved in only 3 patients and included those who underwent posterior lumbar interbody fusion with pedicle screw fixation. In 2 patients who underwent posterior lumbar interbody fusion with cage alone, solid fusion was not achieved. In 1 of 2 patients who underwent anterior cervical fusion with plating, solid fusion was achieved. The overall fusion rate was 57.1% in patients with ESRD undergoing hemodialysis. CONCLUSION: Spinal surgeries in ESRD patients undergoing hemodialysis can be performed with acceptable outcomes; however, the complication rates and mortality rates are relatively high and the fusion rate is low. To obtain a better outcome, multiple factors such as comorbid medical diseases, laboratory abnormalities, and osteoporosis should be carefully considered.

Cervical osteochondroma presenting as brown-sequard syndrome in a child with hereditary multiple exostosis.

Cervical cord compression due to osteochondroma in hereditary multiple exostosis (HME) is a rare condition, especially in young children. In this report, we discuss a rare case of cervical osteochondroma presenting as Brown-Sequard syndrome (BSS) in a 7-year-old boy with HME. The child was admitted because of hemiparesis involving the right limbs and hypoesthesia on the left side following mild trauma. MR image revealed cord compression by osteochondroma of the C7 lamina. We removed the osteocondroma and the neurological deficit was improved.

Magnetic resonance imaging findings of subsequent fractures after vertebroplasty.

OBJECTIVE: The biomechanical effect of injected cement has been considered as the cause of adjacent vertebral fracture (AVF) after vertebroplasty, but the clinical evidence supporting this hypothesis is still insufficient. METHODS: We retrospectively reviewed 33 patients with subsequent fractures among 278 patients who underwent percutaneous vertebroplasty at our hospital from January 2002 to December 2005. The bone marrow edema pattern of subsequent fractures on magnetic resonance imaging was analyzed in 33 patients. In addition, the relationship between the location and distribution pattern of inserted cement and site of subsequent fractures was investigated. RESULTS: Among 33 subsequent fractures, we found 13 cranial AVFs, 7 caudal AVFs, and 13 remote fractures. The incidence rate of AVFs was 7.3% of 273 patients. Among 33 subsequent vertebral fractures, 13 were cranial AVFs (Group 1), 3 were superior, 7 were inferior, and 3 were overall (23.1%, 53.8%, and 23.1%, respectively). Of 7 caudal AVFs (Group 2), 7 were superior (100%). In 13 remote fractures (Group 3), 10 were superior, 1 was inferior, 2 were overall (76.9%, 7.7%, and 15.4%, respectively). In AVFs, bone marrow edema appeared mainly toward injected cement (P = 0.005). When injected cement made a solid mass rather than interdigitation, the occurrence rate of cranial AVFs was high (P = 0.004). CONCLUSION: Bone marrow edema of AVFs appeared significantly toward the previous injected cement. This phenomenon supports the idea that the biomechanical effect of injected cement is one of the causative factors which affect the occurrence of AVF after percutaneous vertebroplasty. In particular, when injected cement forms a solid mass rather than interdigitation, the risk of cranial AVF may increase.

Effects of polycaprolactone-tricalcium phosphate, recombinant human bone morphogenetic protein-2 and dog mesenchymal stem cells on bone formation: pilot study in dogs.

PURPOSE: The aim of this study was to evaluate the survival, proliferation, and bone formation of dog mesenchymal stem cells (dMSCs) in the graft material by using Polycaprolactone-tricalcium phosphate (PCL-TCP), auto-fibrin glue (AFG), recombinant human bone morphogenetic protein-2 (rhBMP-2), and dMSCs after a transplantation to the scapula of adult beagle dogs. MATERIALS AND METHODS: The subjects were two beagle dogs. Total dose of rhBMP-2 on each block was 10 microg with 50 microg/mg concentration. The cortical bone of the scapula of the dog was removed which was the same size of PCL-TCP block (Osteopore International Pte, Singapore; 5.0x5.0x8.0 mm in size), and the following graft material then was fixed with orthodontic mini-implant, Dual-top (Titanium alloy, Jeil Co. Seoul, Korea). Four experimental groups were prepared for this study, Group 1: PCL-TCP + aFG; Group 2: PCL-TCP + aFG + dMSCs; Group 3: PCL-TCP + aFG + dMSCs + rhBMP-2; Group 4: PCL-TCP + aFG + dMSCs + rhBMP-2 + PCL membrane. The survival or proliferation of dMSCs cells was identified with an extracted tissue through a fluorescence microscope, H-E staining and Von-Kossa staining in two weeks and four weeks after the transplantation. RESULTS: The survival and proliferation of dMSCs were identified through a fluorescence microscope from both Group 1 and Group 2 in two weeks and four weeks after the transplantation. Histological observation also found that the injected cells were proliferating well in the G2, G3, and G4 scaffolds. CONCLUSION: This study concluded that bone ingrowth occurred in PCL-TCP scaffold which was transplanted with rhBMP-2, and MSCs did not affect bone growth. More sufficient healing time would be needed to recognize effects of dMSCs on bone formation.

A comparison of the implant stability among various implant systems: clinical study.

PURPOSE: To determine the change in stability of single-stage, three different design of implant systems in humans utilizing resonance frequency analysis for early healing period (24 weeks), without loading. MATERIAL AND METHODS: Twenty-five patients were included into this study. A total of 45 implants, three different design of implant systems (group A,C,R) were placed in the posterior maxilla or mandible. The specific transducer for each implant system was used. ISQ (implant stability quotient) reading were obtained for each implant at the time of surgery, 3, 6, 8, 10, 12, 24 weeks postoperatively. Data were analyzed for different implant type, bone type, healing time, anatomical locations. RESULTS: For each implant system, a two-factor mixed-model ANOVA demonstrated that a significant effect on ISQ values (group A = 0.0022, C = 0.017, R = 0.0018). For each implant system, in a two-factor mixed model ANOVA, and two-sample t-test, the main effect of jaw position (P > .005) on ISQ values were not significant. CONCLUSIONS: All the implant groups A, C and R, the change patterns of ISQ over time differed by bone type. Implant stability increased greatly between week 0 and week six and showed slow increase between week six and six months (plateau effect).

Surgical treatment of primary spinal tumors in the conus medullaris.

OBJECTIVE: The objective of this study was to evaluate the characteristics and surgical outcome of the conus medullaris tumors. METHODS: We retrospectively reviewed 26 patients who underwent surgery for conus medullaris tumor from August 1986 to July 2007. We analyzed clinical manifestation, preoperative MRI findings, extent of surgical resection, histopathologic type, adjuvant therapy, and outcomes. RESULTS: There were ependymoma (13), hemangioblastoma (3), lipoma (3), astrocytoma (3), primitive neuroectodermal tumor (PNET) (2), mature teratoma (1), and capillary hemangioma (1) on histopathologic type. Leg pain was the most common symptom and was seen in 80.8% of patients. Pain or sensory change in the saddle area was seen in 50% of patients and 2 patients had severe pain in the perineum and genitalia. Gross total or complete tumor resection was obtained in 80.8% of patients. On surgical outcome, modified JOA score worsened in 26.9% of patients, improved in 34.6%, and remained stable in 38.5%. The mean VAS score was improved from 5.4 to 1.8 among 21 patients who had lower back pain and leg pain. CONCLUSION: The surgical outcome of conus medullaris tumor mainly depends on preoperative neurological condition and pathological type. The surgical treatment of conus medullaris tumor needs understanding the anatomical and functional characteristics of conus meudllaris tumor for better outcome.

Clinical approach and surgical strategy for spinal diseases in pregnant women: a report of ten cases.

STUDY DESIGN: Case series retrospective review. OBJECTIVE: To present the treatment guideline for spinal diseases in pregnant women. SUMMARY OF BACKGROUND DATA: Treatment for spinal diseases in pregnant women is a special clinical challenge because of complex medical and surgical clinical problems. METHODS: We retrospectively reviewed 10 patients who underwent surgery for spinal diseases, who were diagnosed during pregnancy at our hospital from February 1992 to October 2005. Six patients had herniated lumbar discs, 3 patients had spinal tumors, and 1 patient had spinal tuberculosis. RESULTS: Five patients with HLDs underwent partial hemilaminectomy and discectomy during pregnancy and maintained the pregnancy. One patient underwent posterior lumbar interbody fusion and had a therapeutic abortion 6 days after lumbar surgery. In 1 patient with hemangioblastoma at the level of T8-T9 level, prepartum surgery was performed maintaining pregnancy in gestational age, 29 weeks. In another patient with hemangioblastoma at the T10 level, a preoperative cesarean section and tumor removal surgery were performed under the same anesthesia in gestational age 34 weeks. One patient had recurrent intramedullary ependymoma at the C3-T2 level. She had the preterm baby by vaginal delivery before spinal operation in gestational age 33 weeks and underwent tumor removal surgery. One patient with tuberculous spondylitis at the level of T3-T5 level, therapeutic abortion performed in gestational age, 16 weeks because of inevitable radiation exposure during fusion surgery. CONCLUSION: In most spinal diseases, including HLD and tumors, prepartum surgical treatment can be safely performed maintaining pregnancy. For patients with progressive neurologic deficit at 34 to 36 weeks gestation or later, spine surgery should be performed following the induction of delivery or a cesarean section, or at the same time.