Correction surgery for adult spinal deformity improves not only spinopelvic alignment but also the three-dimensional alignment of the lower extremities.

BACKGROUND: It is well known that correction surgery for adult spinal deformity (ASD) improves sagittal and coronal spinopelvic alignment, but the surgery effect on lower extremities (LE) is not well clarified. The aim of this study was to test the hypothesis that LE alignment also improves following spinopelvic correction surgery for ASD as a function of compensatory mechanism, and to clarify an effect of the severity of knee osteoarthritis (OA) on the improvement. METHODS: We retrospectively evaluated spinopelvic alignment, hip knee ankle angle (HKA), knee flexion angle (KF), and severity of the knee OA in thirty-nine patients with ASD before, two weeks and three months after the surgery. The grade of knee OA was evaluated by Kellgren Lawrence grading, and classified grade 0 to 2 into mild, and 3, 4 into severe OA. All the values were compared by paired t test or Wilcoxon signed rank test with significant p value of <0.05. RESULTS: Following the surgery, not only spinopelvic, but also bilateral HKA and KF were significantly improved. HKA in mild OA side was more normalized compared to that in severe side. Although KF of both bilateral mild and bilateral severe OA groups improved, the improvement of mild group was more significant. CONCLUSION: The 3D alignment of LE improved following spinopelvic correction surgery. The improvement was inadequate in cases with severe knee OA.

En Bloc Spondylectomy for Spinal Metastases: Detailed Oncological Outcomes at a Minimum of 2 Years after Surgery.

STUDY DESIGN: Retrospective case series. PURPOSE: To investigate the oncological outcomes, including distant relapse, after en bloc spondylectomy (EBS) for spinal metastases in patients with a minimum of 2-year follow-up. OVERVIEW OF LITERATURE: Although EBS has been reported to be locally curative and extend survival in select patients with spinal metastases, detailed reports regarding the control of distant relapse after EBS are lacking. METHODS: We conducted a retrospective review of 18 consecutive patients (median age at EBS, 62 years; range, 40-77 years) who underwent EBS for spinal metastases between 1991 and 2015. The primary cancer sites included the kidney (n=7), thyroid (n=4), liver (n=3), and other locations (n=4). Survival rates were estimated using the Kaplan-Meier method, and groups were compared using the log-rank method. RESULTS: The median operative time and intraoperative blood loss were 767.5 minutes and 2,375 g, respectively. Twelve patients (66.7%) experienced perioperative complications. Five patients (27.8%) experienced local recurrence of the tumor at a median of 12.5 months after EBS, four of which had a positive resection margin status. Thirteen patients (72.2%) experienced distant relapse at a median of 21 months after EBS. The estimated median survival period after distant relapse was 20 months (95% confidence interval, 0.71-39.29 months). No association was found between resection margin status and distant relapse. Overall, the 2-year, 5-year, and 10-year survival rates after EBS were 72.2%, 48.8%, and 27.1%, respectively. Importantly, the era in which EBS was performed did not impact the oncological outcomes. CONCLUSIONS: Our results suggest that EBS by itself, even if margin-free, cannot prevent further dissemination, which occurred in >70% of patients at a median of 21 months after EBS. These results should be considered and conveyed to patients for clinical decision-making.

Standing sagittal alignment of the whole axial skeleton with reference to the gravity line in humans.

Human beings stand upright with the chain of balance beginning at the feet, progressing to the lower limbs (ankles, knees, hip joints, pelvis), each of the spinal segments, and then ending at the cranium to achieve horizontal gaze and balance using minimum muscle activity. The details of the alignment and balance of the chain, however, are not clearly understood, due to the lack of information regarding the three-dimensional (3D) orientation of all bony elements in relation to the gravity line (GL). We performed a clinical study to clarify the standing sagittal alignment of whole axial skeletons in reference to the GL using the EOS slot-scanning 3D X-ray imaging system with simultaneous force plate measurement in a healthy human population. The GL was defined as a vertical line drawn through the centre of vertical pressure measured by the force plate. The present study yielded a complete set of physiological alignment measurements of the standing axial skeleton from the database of 136 healthy subjects (a mean age of 39.7 years, 20-69 years; men: 40, women: 96). The mean offset of centre of the acoustic meati from the GL was 0.0 cm. The offset of the cervical and thoracic vertebrae was posterior to the GL with the apex of thoracic kyphosis at T7, 5.0 cm posterior to the GL. The sagittal alignment changed to lordosis at the level of L2. The apex of the lumbar lordosis was L4, 0.6 cm anterior to the GL, and the centre of the base of the sacrum (CBS) was just posterior to the GL. The hip axis (HA) was 1.4 cm anterior to the GL. The knee joint was 2.4 cm posterior and the ankle joint was 4.8 cm posterior to the GL. L4-, L5- and the CBS-offset in subjects in the age decades of 40s, 50s and 60s were significantly posterior to those of subjects in their 20s. The L5- and CBS-offset in subjects in their 50s and 60s were also significantly posterior to those in subjects in their 30s. HA was never posterior to the GL. In the global alignment, there was a positive correlation between offset of C7 vertebra from the sagittal vertical axis (a vertical line drawn through the posterior superior corner of the sacrum in the sagittal plane) and age, but no correlation was detected between the centre of the acoustic meati-GL offset and age. Cervical lordosis (CL), pelvic tilt (PT), pelvic incidence, hip extension, knee flexion and ankle dorsiflexion increased significantly with age. Our results revealed that aging induces trunk stooping, but the global alignment is compensated for by an increase in the CL, PT and knee flexion, with the main function of CL and PT to maintain a horizontal gaze in a healthy population.

Lumbar degenerative spondylolisthesis is not always unstable: clinicobiomechanical evidence.

STUDY DESIGN: A clinicobiomechanical study. OBJECTIVE: To clarify the clinicobiomechanical characteristics of a segment with lumbar degenerative spondylolisthesis (LDS) using an original intraoperative measurement system. SUMMARY OF BACKGROUND DATA: Although radiographical evaluation of LDS is extensively performed, the diagnosis of segmental instability remains controversial. The intraoperative measurement system used in this study is the first clinically available system that performs cyclic flexion-extension displacement of the segment with all ligamentous structures intact and can determine both the stiffness (N/mm) and neutral zone (NZ, [mm/N]). METHODS: Forty-eight patients with LDS (males/females = 19/29, 68.5 yr; group D) were compared with 48 patients with lumbar spinal stenosis without LDS (males/females = 33/15, 64.8 yr, group N) in terms of symptoms, radiological, and biomechanical results. Instability was defined as a segment with NZ more than 2 mm. Symptoms (36-Item Short Form Health Survey), radiographical findings (radiographs, magnetic resonance images, computed tomographic scans), stiffness, NZ, and frequency of instability were also compared. Risk factors for instability were analyzed by multivariate logistic regression with a forward stepwise procedure. RESULTS: None of the physical function categories or radiological findings of 36-Item Short Form Health Survey and low back pain (visual analogue scale) differed significantly between the groups. Although NZ was significantly greater in group D (1.97) than in group N (1.73) (P < 0.05), the frequency of instability did not differ significantly between groups. Facet opening (odds ratio, 11.0; P < 0.01) and facet type (odds ratio, 6.0; P < 0.05) were significant risk factors for instability. CONCLUSION: Neither the symptoms nor the frequency of instability differed significantly between groups. The radiological findings of spondylolisthesis did not indicate instability, but facet opening and sagittally oriented facets were indicative of instability. The results of this study demonstrated that LDS is not always unstable in the measurement setting, suggesting that the instability of LDS can stabilize spontaneously during the natural course. LEVEL OF EVIDENCE: N/A.

Can recumbent magnetic resonance imaging replace myelography or computed tomography myelography for detecting lumbar spinal stenosis?

OBJECTIVE: To compare the diagnostic efficacy of recumbent magnetic resonance imaging (MRI), computed tomography myelography (CTM), and myelography, with regard to indications for surgery for lumbar stenosis. BACKGROUND DATA: In patients with lumbar spinal stenosis-like disorders, small compressions are sometimes observed in magnetic resonance images acquired in the recumbent position, leading to potential misdiagnosis. Few prospective studies have compared the diagnostic accuracy of MRI, myelography, and CTM. Therefore, it is not clear whether myelography is necessary or not. METHODS: Fifty-four patients fulfilled the criteria. All patients underwent MRI, myelography, and CTM. MRI was performed with the patient in a normal recumbent position, and CTM was performed with the patients in both a recumbent and extended positions. All patients underwent surgery for lumbar spinal stenosis. Findings from visual examinations (sagittal images of MR, axial images of MR, axial reconstruction images of CTM and myelograms) were defined as compression + or -. We analyzed the sensitivity of the different examinations for diagnosis and the relationship among the types of images. RESULTS: Sensitivity was as follows: CTM 94.4 %, myelography 87.0 %, and MRI 75.9 %. In myelography, the images of 37 patients were worsened by dynamic synthesis (Dyn+). Among patients without compression on MRI, 11 showed compression on myelography. Of these 11, 8 of these patients were Dyn+, and 2 patients showed compression on myelography, but not on CTM and were Dyn+. Thus, some compression can be revealed only with myelography. CTM was more sensitive than axial MRI and showed compression in 12 patients that was not detected by axial MRI. CONCLUSION: Myelography revealed stenosis that was not detected by MRI. CTM with extension is more sensitive for detecting stenosis than MRI. Recumbent MRI cannot replace myelography or CTM in terms of dynamic findings and sensitivity.

New surgical technique to secure the bone strut during anterior cervical corpectomy and fusion: kusabi fixation technique--technical note.

Fixation using an anterior cervical plate is frequently used in anterior cervical discectomy or corpectomy and fusion procedures because of the higher fusion rate than without instrumentation. The surgical outcomes with the anterior plate technique are acceptable, but various hardware-related complications have been reported. The authors describe a new surgical technique, called the kusabi fixation technique, for securing the bone strut during anterior cervical corpectomy using cylindrical cages. Following corpectomy, the trimmed bone strut was placed into the space drilled-out. Two small holes of 5-6-mm diameter and 5-mm depth were drilled out at the interface of two bones at the top and bottom of the bone strut in a diagonal orientation. Two cylindrical cages filled with autologous bone tips were tapped into the interface. Eight patients with myelopathy were treated by this method. All procedures were uneventfully performed as a single level surgery (two vertebral bodies and one disk level). Solid bone union was obtained in all patients at 6 months after the operation. Apparent alignment change in the cervical spine was observed in only one patient, who developed asymptomatic kyphosis. No instrumentation failure or significant complications related to the surgery occurred. Precise biomechanical aspects and long-term radiographic analysis compared with the plate fixation technique should be established, but this new method provides another way to secure the bone strut in anterior cervical corpectomy and fusion.

Indications for cervical pedicle screw instrumentation in nontraumatic lesions.

STUDY DESIGN: Retrospective clinical study. OBJECTIVE: To evaluate clinical results of patients with nontraumatic cervical lesions treated by cervical pedicle screw (PS) fixation and to discuss the surgical indications. SUMMARY OF BACKGROUND DATA: PS fixation provides an outstanding stability for cervical lesions with instability. This technique, however, has a potential risk of vertebral artery, spinal cord, and nerve root injuries, which may be catastrophic. METHODS: Fifty-eight patients were divided into 2 groups: patients with cervical kyphosis with vertebral destructive lesions (group D, n = 38) and those without destructive lesions (group ND, n = 20). Clinical results of the 2 groups were compared. The results of decompression and PS fixation for cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) in this series were also compared with those of previous laminoplasty alone in patients with CSM and OPLL. RESULTS: Nape pain in group D improved in 86.7% of the patients. Overall neurologic status was improved in both groups. Bony fusion was confirmed in 100% of the cases that were alive in group D and 95% in group ND. Eight complications including 2 vertebral artery injuries occurred. The incidence of postoperative cervical complications in group ND was significantly higher than that in group D. Although PS fixation significantly corrected cervical kyphosis and maintained in both CSM and OPLL, operation time and intraoperative blood loss in cases treated by PS were significantly higher than those treated by laminoplasty alone. Improvement of nape pain and neurologic status did not differ with and without using PS fixation. CONCLUSION: There is an indication of cervical PS fixation for destructive lesions because of a high fusion rate with improvement of nape pain. On the other hand, there is no indication in cases of typical CSM and OPLL if a potential risk of vertebral artery or nerve injury is taken into account.

Evaluation of lumbar segmental instability in degenerative diseases by using a new intraoperative measurement system.

OBJECT: In vivo quantitative measurement of lumbar segmental stability has not been established. The authors developed a new measurement system to determine intraoperative lumbar stability. The objective of this study was to clarify the biomechanical properties of degenerative lumbar segments by using the new method. METHODS: Twenty-two patients with a degenerative symptomatic segment were studied and their measurements compared with those obtained in normal or asymptomatic degenerative segments (Normal group). The measurement system produces cyclic flexion-extension through spinous process holders by using a computer-controlled motion generator with all ligamentous structures intact. The following biomechanical parameters were determined: stiffness, absorption energy (AE), and neutral zone (NZ). Discs with degeneration were divided into 2 groups based on magnetic resonance imaging grading: degeneration without collapse (Collapse[-]) and degeneration with collapse (Collapse[+]). Biomechanical parameters were compared among the groups. Relationships among the biomechanical parameters and age, diagnosis, or radiographic parameters were analyzed. RESULTS: The mean stiffness value in the Normal group was significantly greater than that in Collapse(-) or Collapse(+) group. There was no significant difference in the average AE value among the Normal, Collapse(-), and Collapse(+) groups. The NZ in the Collapse(-) was significantly higher than in the Normal or Collapse(+) groups. Stiffness was negatively and NZ was positively correlated with age. Stiffness demonstrated a significant negative and NZ a significant positive relationship with disc height, however. CONCLUSIONS: There were no significant differences in stiffness between spines in the Collapse(-) and Collapse(+) groups. The values of a more sensitive parameter, NZ, were higher in Collapse(-) than in Collapse(+) groups, demonstrating that degenerative segments with preserved disc height have a latent instability compared to segments with collapsed discs.

Upper extremity palsy following cervical decompression surgery results from a transient spinal cord lesion.

STUDY DESIGN: Retrospective analysis. OBJECTIVE: To test the hypothesis that spinal cord lesions cause postoperative upper extremity palsy. SUMMARY OF BACKGROUND DATA: Postoperative paresis, so-called C5 palsy, of the upper extremities is a common complication of cervical surgery. Although there are several hypotheses regarding the etiology of C5 palsy, convincing evidence with a sufficient study population, statistical analysis, and clear radiographic images illustrating the nerve root impediment has not been presented. We hypothesized that the palsy is caused by spinal cord damage following the surgical decompression performed for chronic compressive cervical disorders. METHODS: The study population comprised 857 patients with chronic cervical cord compressive lesions who underwent decompression surgery. Anterior decompression and fusion was performed in 424 cases, laminoplasty in 345 cases, and laminectomy in 88 cases. Neurologic characteristics of patients with postoperative upper extremity palsy were investigated. Relationships between the palsy, and patient sex, age, diagnosis, procedure, area of decompression, and preoperative Japanese Orthopaedic Association score were evaluated with a risk factor analysis. Radiographic examinations were performed for all palsy cases. RESULTS: Postoperative upper extremity palsy occurred in 49 cases (5.7%). The common features of the palsy cases were solely chronic compressive spinal cord disorders and decompression surgery to the cord. There was no difference in the incidence of palsy among the procedures. Cervical segments beyond C5 were often disturbed with frequent multiple segment involvement. There was a tendency for spontaneous improvement of the palsy. Age, decompression area (anterior procedure), and diagnosis (ossification of the posterior longitudinal ligament) are the highest risk factors of the palsy. CONCLUSIONS: The results of the present study support our hypothesis that the etiology of the palsy is a transient disturbance of the spinal cord following a decompression procedure. It appears to be caused by reperfusion after decompression of a chronic compressive lesion of the cervical cord. We recommend that physicians inform patients and surgeons of the potential risk of a spinal cord deficit after cervical decompression surgery.

Margin-free spondylectomy for extended malignant spine tumors: surgical technique and outcome of 13 cases.

STUDY DESIGN: Description of surgical technique and retrospective review of 13 cases. OBJECTIVES: To describe the surgical technique of margin-free spondylectomy and the outcome of 13 cases and to discuss the advantages and limitations of the procedure. SUMMARY OF BACKGROUND DATA: Recently, spondylectomy became a standard procedure by several pioneers. For extended malignant spine tumors involving pedicles or epidural space, however, performing an "en bloc" resection with a tumor-free margin remains a challenge. METHODS: Our procedure consists of a combined anterior and posterior procedure with one or two stages. In the anterior procedure, tumor vertebrae are covered by the pleura or psoas muscles as a barrier. The posterior procedure includes decompression through the intact posterior elements, coverage of the tumor with all possible soft tissue barriers, and en bloc extirpation by rotating the tumor vertebrae around the spinal cord. We performed this procedure in 13 cases: 3 chondrosarcoma, 3 giant cell tumor, 1 osteosarcoma, 1 chordoma, and 5 metastases. RESULTS: Neurologic status and pain improved in all cases except asymptomatic cases. There was no local recurrence, except in 2 cases (chondrosarcoma with extirpation of 5 vertebrae, chordoma with multiple previous surgeries). Two cases of chondrosarcoma were disease-free 14 years and 13 years after surgery, respectively. CONCLUSION: Although the best chance for a cure in extended malignant tumors of the spine is realized through wide resection, the procedure is not yet standardized. Margin-free spondylectomy is technically demanding, but the procedure can be used with a confidence as a more radical surgery for tumors extending to the epidural space and the unilateral pedicle. A key to success is the surgical technique, including a 360 degree dissection around the tumor vertebrae, instrumentation, and removal of the lesion with all possible soft tissues maintained intact to function as a barrier, like the dura mater.

Anterior spinal decompression and fusion for cervical flexion myelopathy in young patients.

OBJECT: The mechanism underlying cervical flexion myelopathy (CFM) is unclear. The authors report the results of anterior decompression and fusion (ADF) in terms of neurological status and radiographically documented status in young patients and discuss the pathophysiological mechanism of the entity. METHODS: Twelve patients underwent ADF in which autogenous iliac bone graft was placed. The fusion area was one segment in four cases, two segments in seven, and three segments in one. Neurological status, as determined by the Japanese Orthopaedic Association (JOA) score, radiographic findings, and intraoperative findings were evaluated. The mean follow-up period was 63.3 months (range 20-180 months). Grip strength was significantly improved and sensory disturbances resolved completely. Intrinsic muscle atrophy, however, persisted in all patients at the final follow-up examination. Local kyphosis in the flexed-neck position at the fusion levels was corrected by surgery. Preoperative computerized tomography myelography revealed that the cord compression index, which was calculated by anteroposterior and transverse diameters of the spinal cord, decreased to 33 +/- 6.2% in the flexed-neck position from 39.7 +/- 9.9% in the extended-neck position. The anterior dura mater-spinal cord distance decreased to 1.9 +/- 0.7 mm in the flexed-neck position from 4 +/- 1.2 mm in extended-neck position. The posterior dura mater-spinal cord distance increased to 2.5 +/- 1.1 mm in the flexed-neck position from 1.3 +/- 0.5 mm in the extended-neck position. CONCLUSIONS: Postoperative neurological status was improved in terms of grip strength, sensory disturbance, and JOA score, and local kyphosis in the flexed-neck position at the fusion levels was reduced and stabilized by ADF. In most cases local kyphosis in the flexed-neck position was demonstrated at the corresponding disc level, as were cervical cord compression and decrease of the anterior wall of the dura mater-spinal cord distance in the flexed-neck position. Therefore, the contact pressure between the spinal cord and anterior structures (intact vertebral bodies and intervertebral discs) in the mobile and kyphotic segments was considered to contribute to the onset of CFM. The ADF-related improvement of the clinical symptoms, preventing kyphotic alignment in flexion and decreasing movement of the cervical spine, supports the idea of a contact pressure mechanism. Furthermore, short ADF performed only at the corresponding segments can preserve more mobile segments compared with posterior fusion. Thus, ADF should be the first choice in the treatment of CFM.

Quercetin enhances melanogenesis by increasing the activity and synthesis of tyrosinase in human melanoma cells and in normal human melanocytes.

Quercetin (3,3',4',5,7-pentahydroxyflavone) is a diphenyl propanoid widely distributed in edible plants. In this study, we examined the effect of quercetin on melanogenesis in human HMVII melanoma cells and in normal human epidermal melanocytes (NHEM) in the absence of ultraviolet radiation. Upon the addition of quercetin to the culture medium, the melanin content in melanoma cells (HMVII) increased remarkably in time- and dose-dependent manners. In addition, quercetin induced melanogenesis in cultured NHEM. As compared with controls, melanin content was increased about sevenfold by treatment with 20 microM (HMVII) or 1 microM (NHEM) quercetin for 7 d. Tyrosinase activity was also increased, to 61.8-fold higher than the control. The expression of tyrosinase protein was slightly increased by the addition of quercetin. However, quercetin did not affect the expression of tyrosinase mRNA. Tyrosinase activation by quercetin was blocked by actinomycin-D or by cycloheximide demonstrating that its actions in stimulating melanogenesis may involve both transcriptional and translational events. Tyrosinase activity was increased dramatically whereas the level of melanogenic inhibitor was remarkably decreased following quercetin treatment. Taken together, these results demonstrate that in human melanoma cells and in NHEM, quercetin stimulates melanogenesis by increasing tyrosinase activity and decreasing other factors such as melanogenic inhibitors.

A novel and potent biological antioxidant, Kinobeon A, from cell culture of safflower.

Kinobeon A was originally isolated from cultured cells of safflower (Carthamus tinctorius L., Compositae). It had never previously been directly isolated from safflower or other plants, animals or microorganisms. In this report, we demonstrate the anti-oxidative effects of kinobeon A and compare the results with those two known natural antioxidants, lignan (nordihydroguaiaretic acid) and quercetin. The NADPH-induced microsomal lipid peroxidation system was employed to assess anti-oxidative effects of kinobeon A. Addition of kinobeon A to the system significantly decreased the formation of thiobarbituric acid reactive substances (TBARS) in a dose-dependent manner with effects similar to those of lignan and quercetin. Formation of TBARS was completely inhibited at 10 microM of kinobeon A. Employing the xanthine/xanthine oxidase/nitroblue tetrazolium system and the KO2/XTT system, the superoxide anion scavenging activity of kinobeon A was greater than that of lignan or quercetin. IC50 values calculated for kinobeon A in these two systems were 1 microM and 0.8 microM, respectively. Kinobeon A exerted cytoprotective effects following oxidative treatments with hydrogen peroxide, cumene hydroperoxide, menadione and xanthine oxidase (XOD). Addition of kinobeon A to the systems markedly enhanced survival ratios of Madin-Darby bovine kidney cells, while their survival significantly decreased with the oxidative treatment alone. Kinobeon A exhibited stronger effect on the cell viability than lignan or quercetin when menadion or XOD were used as inducing reagents of oxidative stress. The present study demonstrates for the first time that kinobeon A prevents oxidative stresses and could be a useful cytoprotective reagent.

One-stage three-dimensional correction and fusion: a multilevel posterior lumbar interbody fusion procedure for degenerative lumbar kyphoscoliosis. Technical note.

Surgery for degenerative lumbar kyphoscoliosis (DLKS) is very challenging because the curve has become rigid due to circumferential osteoarthritic changes. Therefore, a standard procedure involving correction and fusion after decompression of the nerves has not yet been established. The authors have been searching for an effective procedure that provides adequate decompression and three-dimensional (3D) correction for symptomatic DLKS. In this report they describe a new 3D correction and fusion technique involving multilevel posterior lumbar interbody fusion. They analyze the results obtained in the first 23 cases and discuss the advantages and disadvantages of the procedure. The correction effect was excellent, and compared with other instrumentation-assisted procedures, this surgery is not remarkably invasive. Although the procedure is limited in achieving normal sagittal alignment and the acceleration rate of adjacent-disc degeneration remains relatively high, it is an option for the rigid deformity characterized by DLKS.

Kinobeon A as a potent tyrosinase inhibitor from cell culture of safflower: in vitro comparisons of kinobeon A with other putative inhibitors.

Kinobeon A is produced from cell cultures of the medicinal plant, safflower. Mushroom tyrosinase activity was inhibited in a concentration-dependent manner when treated with kinobeon A using L-tyrosine or L-3,4-dihydroxyphenylalannine (L-DOPA) as substrates. IC50 values were 22 microM (substrate: L-tyrosine) and 27 microM (L-DOPA). Inhibition of human tyrosinase activity also increased with increasing concentrations of kinobeon A using L-DOPA as the substrate, with an IC50 value of 2.5 microM. Kinobeon A was a more potent competitive inhibitor than kojic acid, arbutin or L-ascorbic acid for both mushroom and human tyrosinase as determined from Lineweaver-Burk plots. These results suggested that kinobeon A could be a potent natural tyrosinase inhibitor.

Effects of surgical treatment for cervical spondylotic myelopathy in patients > or = 70 years of age: a retrospective comparative study.

The objective of this study was to compare efficacy of cervical surgery for myelopathy in patients > or = 70 and < or = 60 years of age. Forty patients > or = 70 years and 50 patients < or = 60 years of age with MRI and CT proven myelopathy were neurologically assessed using the JOA score. Three operative procedures were performed: anterior spinal fusion, laminoplasty, and laminectomy. Postoperatively, patients exhibited comparable outcomes irrespective of age or operative procedure performed. The only exception was the increase in postoperative neurologic complications noted for the older individuals with greater comorbidities.