Comprehensive analysis of microRNA expression in lumbar facet joint capsules and synovium of patients with osteoarthritis: Comparison between early-stage and late-stage osteoarthritis samples from a single individual.

BACKGROUND: MicroRNA is attracting attention as a therapeutic target for osteoarthritis. We focused on joint capsules and synovium in lumbar facet joint osteoarthritis. The purpose of this study was to identify microRNAs that are upregulated in lumbar facet joint capsules and synovium with osteoarthritis. METHODS: We included patients who underwent spinal fusion for degenerative lumbar spine diseases. We selected patients who had both early-stage and late-stage facet joint osteoarthritis in a single individual. We extracted joint capsule and synovium samples from these patients and isolated microRNAs. During the screening phase, we compared early-stage and late-stage osteoarthritis samples from the same individual. We identified microRNAs with >2-fold change in expression in 75% or more of patients with late-stage osteoarthritis using next generation sequencing. During the technical validation phase, the same samples were used for real-time polymerase chain reaction. We identified microRNAs with >2-fold change in expression in 62.5% or more of patients with late-stage osteoarthritis. RESULTS: Of 40 patients who underwent spinal fusion, we selected eight patients with both early-stage and late-stage facet joint osteoarthritis. During the screening phase, we identified eight upregulated microRNAs out of 2274 microRNAs in late-stage OA. In late-stage OA, two microRNAs (miR-133a-5p and miR-144-3p) were upregulated in seven patients and six microRNAs (miR-133a-3p, miR-133b, miR-206, miR-20a-5p, miR-301a-3p, and miR-32-5p) were upregulated in six patients. During the technical validation phase, we found significant upregulation of miR-144-3p expression in late-stage osteoarthritis compared with early-stage osteoarthritis. Expression of the other microRNAs was not significantly different according to the paired-t test. However, miR-133a-3p, miR-133b, and miR-206 were upregulated >2-fold in 62.5% or more of patients with late-stage osteoarthritis. CONCLUSIONS: Some of the microRNAs identified in this study might be involved in joint capsule degeneration or synovitis.

Evaluation of age-related changes in lumbar facet joints using T2 mapping.

BACKGROUND: The purpose in this study is to investigate the T2 value of lumbar facet joint (FJ) in subjects without lumbar spinal disorders, age from 20s to 70s, using T2 mapping, and to evaluate the correlation between age and T2 value. And also, we investigated the T2 value of lumbar intervertebral disc (IVD) in the same way as FJ, and evaluated the correlation between the T2 value of FJ and that of IVD. METHODS: We investigated 60 volunteers (30 male, 30 female), who were recruited from six age groups, 20s-70s (10 subjects in each decade; 5 male, 5 female). We measured the T2 values of FJ at the L4/5 level in axial image and those of IVD (nucleus pulposus; NP, anterior and posterior annulus fibrosus; AAF and PAF) at the L4/5 level in midline sagittal image. We investigated the correlation between age and T2 value of FJ, and the correlation between the T2 value of FJ and that of IVD. RESULTS: There was a strong positive correlation between age and T2 value of FJ (r = 0.717). Age and T2 values of IVD were negatively correlated (NP; r = -0.728, AAF; r = -0.696, PAF; r = -0.580). There was a negative correlation between T2 value of FJ and that of IVD (NP; r = -0.575, AAF; r = -0.617, PAF; r = -0.492). CONCLUSIONS: T2 value of FJ was significantly increased as age rose. Our results suggest that T2 mapping could detect the degenerative changes of FJ related to aging even in subjects without lumbar spinal disorders. The results of this study will be the reference data of FJ T2 value in order to evaluate the relationship between low back pain and FJ using T2 mapping.

Influence of Diabetes Mellitus on Surgical Outcomes in Patients with Cervical Myelopathy: A Prospective, Multicenter Study.

STUDY DESIGN: Multicenter, prospective study. PURPOSE: To investigate the effects of diabetes mellitus (DM) on surgical outcomes in patients with cervical myelopathy. OVERVIEW OF LITERATURE: To date, few studies have investigated the influence of postoperative blood glucose or glycated hemoglobin (HbA1c) levels on surgical outcomes. METHODS: The participants were patients who underwent surgery for the treatment of cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. The 61 cases were evaluated preoperatively and 1 year postoperatively using the Japanese Orthopaedic Association (JOA) scores and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). The study variables included fasting blood glucose and HbA1c levels measured preoperatively and at 1 week, 4 weeks, and 1 year postoperatively; the F-wave conduction velocity, latency, rate of occurrence, and M-wave latency in the ulnar and tibial nerves were measured preoperatively and at 1 year postoperatively. The patients were divided into a group without diabetes (N group, 42 patients) and a group with diabetes (DM group, 19 patients). We then assessed the associations between the surgical outcomes and each of the study variables. RESULTS: JOA scores significantly improved in both groups; however, no significant between-group differences were found. There was no significant improvement in the JOACMEQ scores, which assessed cervical function, upper and lower limb function, and bladder function in both groups. We then subdivided the DM group into those with a good control of HbA1c after 1 year (DMG group, 12 patients) and those with HbA1c deterioration after 1 year (DMB group, seven patients), prior to comparing the surgical outcomes. The JOACMEQ scores for upper and lower limb function significantly improved in the DMG group (p<0.01). Compared with the DMB group, there were no significant increases in upper or lower limb function scores in the DMG group. CONCLUSIONS: Poor glycemic control might prevent postoperative functional recovery of the spinal cord.

Effect of a cathepsin K inhibitor on arthritis and bone mineral density in ovariectomized rats with collagen-induced arthritis.

OBJECTIVES: Cathepsin K is expressed by osteoclasts and synovial fibroblasts and degrades key components of bone and cartilage. Inhibition of cathepsin K protease activity may be beneficial for the prevention of bone erosion and cartilage degradation in rheumatoid arthritis (RA). The collagen-induced arthritis (CIA) rat model is well established for studying the pathology and treatment of RA. We investigated the effect of ONO-KK1-300-01, a cathepsin K inhibitor (CKI), on arthritis and bone mineral density (BMD) in rats with CIA. METHODS: Seven-month-old female Sprague Dawley rats were divided into 5 groups: rats without CIA (CNT); CIA rats that underwent ovariectomy (OVX) and were treated with CKI; CIA rats that underwent OVX and were treated with vehicle (Veh); CIA rats that underwent sham surgery and were treated with CKI; and CIA rats that underwent sham surgery and were treated with Veh. CKI was orally administered at a dose of 15 mg/kg, thus initiating collagen sensitization, until death at 4 weeks. We evaluated hind paw thickness and the arthritis score every week until death. Radiographs of the resected left foot were obtained with a soft X-ray apparatus. Destruction of bone and cartilage was classified and scored as previously described by Engelhardt et al. BMD was measured by bone densitometry at the halfway point between the distal metaphysis and the diaphysis of the resected right femur. We also performed histomorphometry of the proximal left tibia, histological evaluation of arthritis, and a bone strength test. RESULTS: CKI administration significantly reduced hind paw thickness and the arthritis score, and prevented a decrease in BMD. The radiographic score was significantly lower in the CKI group than in the Veh group. In the histomorphometric analysis, bone-resorption parameters were significantly lower in the CKI groups than in the Veh groups. CKI significantly inhibited synovial proliferation in the CIA rats. In the bone strength test, the ultimate stress was significantly higher in the CKI groups than in the Veh groups. CONCLUSION: Our findings indicate that cathepsin K inhibitors may inhibit systemic and local bone loss, ameliorate arthritis, and attenuate the decrease of bone strength in an animal model of arthritis.

Histological Evaluation of Lumbar Spine Changes in Rats with Collagen-induced Arthritis.

BACKGROUND: To histologically evaluate lumbar involvement in rheumatoid arthritis (RA) by investigating rats with collagen-induced arthritis (CIA) and to assess the potential effects of RA on the discovertebral joints and facet joints. METHODS: Seven-month-old female Sprague-Dawley rats were divided into groups with CIA and without CIA (control). All rats were sacrificed at 8 weeks after initial sensitization and the lumbar spine (L5/6) was harvested. Then the lumbar spine block specimens were stained with Villaneuva bone stain and sectioned in the midsagittal plane. The left facet joints were also sectioned in the midaxial plane. Specimens were studied under a microscope and infiltration of inflammatory cells was investigated. RESULTS: In the CIA group, lumbar lesions were observed in 13/18 rats (76%). Lymphocytes infiltrated into the anterior rim of the vertebral bodies only in 2 rats, while lymphocytes infiltrated the facet joints only in 4 rats. Both sites were involved in 7 rats. In addition, osteoclasts invaded the anterior rim of the vertebral bodies and formed cavities that also contained lymphocytes. Formation of pannus was seen in the facet joints in 11/18 rats. CONCLUSION: In CIA rats, infiltration of inflammatory cells into the anterior rim of the vertebral bodies alone or into the facet joints alone was demonstrated in 2 rats and 4 rats, respectively, while both sites were involved in 7 rats. Therefore, lesions at the anterior rim of the vertebral body did not arise secondary to facet joint involvement, but were caused by CIA along with synovial lesions of the facet joints.

Diagnosis and management of spinal infections.

The number of spinal infections has been increasing due to aging populations and larger numbers of immunocompromised hosts and intravenous drug users. Magnetic resonance imaging is a useful tool for the early diagnosis of spinal infections, and can yield positive findings just 3-5 days after disease onset. Before antibiotic administration, cultures must be initiated from blood and from specimens collected from the locus of infection. Based on the pathogens identified by culture, appropriate antibiotics should be selected with careful consideration of antimicrobial susceptibility and spinal tissue penetration. Antibiotic treatment of spinal infections should be continued for longer than for most other types of infections, although the optimal duration remains unknown. The indications for surgical treatment include progressive neurologic deficits, progressive deformity, spinal instability, persistent or recurrent infection, and unbearable pain. In most patients with spinal infection, the gold standard surgical treatment is anterior radical debridement followed by autologous strut bone grafting. The addition of posterior instrumentation has recently become popular. This procedure may be performed alone as an alternative surgical option in patients in poor condition, and if it dramatically reduces pain, subsequent observation may be reasonable. If progressive deformity is observed or pain relief is inadequate after posterior instrumentation, additional anterior debridement and bone grafting should be scheduled.

Selective Spinal Fusion for Neuromuscular Scoliosis in a Patient with Pompe Disease: A Case Report and Review of the Literature.

CASE: A 16-year-old girl with Pompe disease underwent surgery for scoliosis. She had been able to walk without any assistance, and kept her balance by swinging her waist. Therefore, we performed posterior selective spinal correction and fusion to avoid any adverse effects on walking ability that could occur with immobilization of the lumbosacral spine. After surgery, she was highly satisfied with her ability to perform the activities of daily living. CONCLUSION: For nonambulatory patients with scoliosis and Pompe disease, long fusion from the upper thoracic spine to the pelvis is generally required. However, in ambulatory patients, in order to maintain the ability to walk, selective spinal fusion is an alternative.

Conservative treatment for lumbar compartment syndrome shows efficacy over 2-year follow-up: a case report and literature review.

BACKGROUND: Since in all studies of conservative treatment of lumbar compartment syndrome the follow-up duration was less than 6 months, it is difficult to draw firm conclusions. PURPOSE: To report a patient with lumbar paraspinal compartment syndrome who was treated conservatively over a follow-up period of 2 years. STUDY DESIGN: This is a case report of a 23-year-old male college student with lumbar paraspinal compartment syndrome who was treated conservatively. METHODS: We report a case of a 23-year-old male college student with lumbar paraspinal compartment syndrome who was treated conservatively. We repeatedly checked his physical examination, laboratory tests, lumbar compartment pressures, and magnetic resonance imaging, and surgical teams were readily prepared to operate should the patient's condition worsen. To prevent complications of rhabdomyolysis, hydration and alkalization were performed. We followed him up to 2 years after discharge. RESULT: Although the temporal changes on MRI up to the 1-year point, the patient continued to have no symptoms. CONCLUSIONS: Conservative therapy can be recommended if rhabdomyolysis is under control.

Spinal cord infarction at the level of ossification of the posterior longitudinal ligament.

INTRODUCTION: We report a case of acute tetraplegia, without any trauma or symptoms prior to onset, who presented with ossification of the posterior longitudinal ligament (OPLL) in the cervical spine with concomitant spinal cord infarction. CASE PRESENTATION: A 64-year-old man with a number of risk factors for vascular disease was admitted to our hospital with progressive motor weakness in the bilateral upper and lower extremities. He had initially felt numbness in his left upper extremity and had no previous neurological symptoms or trauma. The night after the initial symptoms, he developed spastic tetraplegia requiring respiratory support. Computed tomography images of the cervical spine demonstrated the segmental type of OPLL. Spinal cord compression and signal intensity changes were identified at the level of C3/4 on magnetic resonance imaging (MRI). He underwent emergency surgery consisting of posterior decompression with laminoplasty of C3-6. Despite the surgery, the patient's tetraplegia did not improve and he continued to require respirator support. There was still no improvement in his neurological status at 10 days postoperatively, and MRI demonstrated evidence of marked spinal cord infarction. DISCUSSION: Mechanical compression of spinal arteries by OPLL and pre-existing vascular compromise had a role in the pathogenesis of spinal cord infarction. Chronic spinal compression may be characterized by 3 important factors, namely an uncommonly devastating clinical course, vascular risk factors and persistent findings on MRI, and these might lead to early diagnosis of spinal cord infarction.

Etanercept Promotes Bone Formation via Suppression of Dickkopf-1 Expression in Rats with Collagen-Induced Arthritis.

BACKGROUND: Various clinical reports suggest etanercept (ETN) has some efficacy in bone formation in rheumatoid arthritis (RA). To examine this effect, we investigated the gene expression of cytokines relevant to osteoblast/osteoclast differentiation, and evaluated histomorphometric findings in mature rats with collagen-induced arthritis (CIA). METHODS: Total RNA was extracted from knee joints with CIA after ETN or placebo administration. Subsequently, realtime-PCR was carried out to quantify the mRNAs encoding Wnt-1, Dickkopf-1 (DKK-1), receptor activator of nuclear factor kappa-B ligand (RANKL), osteoprotegelin (OPG) and TNF (tumor necrosis factor)-alpha. In histomorphometric analysis, the infiltrating pannus volume and pannus surface, and the following items in contact with pannus surface were measured: osteoclast number, osteoid surface, osteoid volume and labeling surface. These were evaluated in the distal femur with CIA with or without ETN administration. RESULTS: TNF-alpha, RANKL and OPG mRNA expressions, linked to osteoclastogenesis, were not significantly different with or without ETN administration. ETN administration significantly increased Wnt-1 mRNA expression, the osteoblast promoter, and decreased DKK-1 mRNA expression, the Wnt signal inhibitor. In histomorphometric analysis, pannus volume, pannus surface and osteoclast number, parameters of bone destruction, were not significantly different among groups. Osteoid volume, osteoid surface and labeling surface, parameters of bone formation, increased significantly with ETN administration. CONCLUSION: Our results suggest that ETN suppresses DDK-1 expression, and, as a result, Wnt expression is promoted and osteoblastogenesis becomes more active, independent of the regulation of osteoclast activity. Marked bone formation is attributed to the fact that ETN directly promotes osteoblastogenesis, not as a result of suppressing osteoclastogenesis.

Morphological and volumetric analysis of the development of atlantoaxial vertical subluxation in rheumatoid arthritis.

BACKGROUND: Cervical disorders in rheumatoid arthritis (RA) patients have been an important problem for a long time. Although the recent progression of the treatment strategies for RA might change the progression of atlantoaxial vertical subluxation (VS) in RA patients, to reveal the risk factors for VS progression should be important at present. Osteoporosis (OP) and RA share the same risk factors. The purposes of this study were to identify the progression of VS in RA, and to evaluate the relationship between the VS development and OP. METHODS: Eighty female patients with RA and 18 female patients with OP were retrospectively analyzed. The RA patients were divided into VS (10 patients) and non-VS groups (70 patients). Morphological parameters on coronal reconstructed computed tomography images were evaluated. Three-dimensional analysis was used to measure volumes and volumetric bone mineral densities (vBMDs) at the upper cervical spine (UCS). RESULTS: The VS group had higher age, longer RA symptom duration, and lower BMD at the lumbar spine compared to the non-VS group. Volumes and vBMDs at the UCS in RA group were greater than those in the OP group. In accordance with VS development, the lateral masses at the UCS became shorter, the C1 facet angle became sharper, and the volumes at the UCS decreased. However, there was no statistically significant relationship between vBMDs at the UCS and the VS development. CONCLUSION: The C1 facet angle became sharper with VS progression. Although 3-dimensional analysis revealed that decreases in the volumes at the UCS were associated with VS development, no significant relationship between OP and the VS development was observed.

Clinical features and surgical outcomes of lumbar spinal stenosis in patients aged 80 years or older: a multi-center retrospective study.

INTRODUCTION: With increased aging of the population, spine surgeons have more opportunity to treat elderly patients for lumbar spinal stenosis (LSS). The purpose of this study was to clarify the clinical features and surgical outcomes for LSS in the elderly aged 80 years or older. MATERIALS AND METHODS: We retrospectively reviewed 702 consecutive patients with LSS who underwent decompression surgery without fusion between 2006 and 2010. Patients with other conditions that could affect functional status were excluded from this study. Of the remaining 304 patients, 241 with LSS whose condition could be evaluated 6 months at least after surgery were analyzed. The mean follow-up period was 14.4 months (range 6-60 months). There were 144 males and 97 females aged 45-93 years old (average: 72.2 years old). Patients were divided into two age groups: 80 years or older (Group A, 46 patients) and under 80 years of age (Group B, 195 patients). We evaluated differences in the clinical features and surgical outcomes between the two groups. RESULTS: There were no significant differences in surgical levels, the number of operation levels, operation times, or the amount of intraoperative bleeding between Groups A and B. The percentages of patients with comorbidities were 73.9 % in Group A and 60.0 % in Group B, which were not significantly different. There were no significant differences in Japanese Orthopaedic Association scores preoperatively, 6 months postoperatively, and at the final follow-up between the two groups. Furthermore, recovery ratios 6 months postoperatively and at final follow-up were similar between the two groups. The percentages of patients with postoperative complications were 19.6 % in Group A and 13.3 % in Group B, which were not significantly different. CONCLUSIONS: This multi-center retrospective study demonstrated that the benefits and risks of decompression surgery for LSS were similar between patients aged over 80 years and those under 80 years. Therefore, decompression surgery is a reasonable treatment even for elderly patients aged over 80 years.

Influence of spinous process spacers on surgical outcome of laminoplasty for OPLL.

Expansive laminoplasty for ossification of the posterior longitudinal ligament (OPLL) has had favorable outcomes. Many modifications of expansive laminoplasty have been developed, including expansive laminoplasty with and without spinous process spacers (SPS). The purpose of this study was to determine whether surgical outcomes were similar between expansive laminoplasty surgeries with and without SPS.Of 109 consecutive patients undergoing surgery for OPLL, 68 patients undergoing expansive laminoplasty were included in the study after excluding patients with other conditions affecting their functional status. The patients were divided into 2 groups based on their K-line, which connects the midpoints of the spinal canal at C2 and C7. Patients were further divided into 2 subgroups: those undergoing expansive laminoplasty without SPS (without SPS group) and those undergoing expansive laminoplasty with SPS (with SPS group). Surgical outcomes were evaluated between K-line (+) and K-line (-) groups. After dividing those groups further into the with SPS and without SPS groups, the differences in surgical outcomes were evaluated again.No significant difference existed in the recovery rate between the with SPS and without SPS groups and between the K-line (+) and K-line (-) groups. When the surgical outcome was only evaluated in the K-line (+) group, the recovery rate 1 year postoperatively was higher in patients without SPS than in those with SPS. Therefore, for patients with K-line (+), the possibility exists that SPS can restrict the posterior shift of the spinal cord and affect the surgical outcome.

Early surgical intervention for spinal infection in patients with malignancy requiring chemotherapy: report of two cases and review of the literature.

Advances in chemotherapy for various malignancies have contributed to the increased life expectancy of patients. If such a patient has a concurrent infection, his/her oncologist would hesitate to perform prompt chemotherapy owing to the risk of inducing sepsis. Therefore, the treatment of infection would have priority over initiating chemotherapy for the malignancy. We present a 69-year-old female with malignant lymphoma requiring prompt chemotherapy who also demonstrated spinal infection with Mycobacterium tuberculosis and a 66-year-old male with esophageal cancer who also demonstrated spinal infection with Staphylococcus aureus. Anterior debridement and interbody fusion were performed for both patients. One patient died of malignant lymphoma 4 years after surgery, and the other is still alive and has remained disease-free 4 years after surgery. Saving the life of a patient with malignancy would be difficult without prompt chemotherapy. Conservative treatment for spinal infection requires prolonged antibiotic treatment, and there is no guarantee that the spinal infection would be controlled only with antibiotics. Therefore, early surgical intervention would be an alternative option under such a condition.

Clinical features of spinal infection in individuals older than eighty years.

PURPOSE: Japan has one of the most rapidly increasing numbers of elderly individuals; therefore, future trends in spinal infections in the elderly in other countries may be predicted by studying such characteristics in Japan. The purposes of this study were to identify whether the incidence of spinal infection in individuals more than 80 years old is increasing and to define its clinical characteristics. METHODS: We retrospectively reviewed the medical records of 98 patients treated in our hospital for spinal infection between 1999 and 2008. Patients were divided into two groups: those admitted to our hospital during the initial five year period, and those admitted during the latter five year period. We evaluated changes in the percentage of individuals over the age of 80 years. To define the clinical characteristics of spinal infection, patients were also divided into another set of two groups: those over 80 years and those around the age of 80 years. RESULTS: The percentage of patients over 80 years with spinal infection was significantly increasing. There was no significant difference in the gender distribution, prevalence of immunocompromised hosts, common involved levels, or mortality rate between the two age groups. The pathogenic organism was isolated in 78.6%, and of these, the rate of methicillin-resistant Staphylococcus aureus or epidermidis was 2.46 times higher in the elderly group than in the younger group. CONCLUSIONS: The number of patients over 80 years with spinal infection is expected to rapidly increase in aging societies. This advanced age group is more susceptible to infection with drug-resistant organisms, which makes infection management more difficult.

Surgical outcomes and prognostic factors of cervical spondylotic myelopathy in diabetic patients.

BACKGROUND: There have been a few reports on the surgical outcomes of cervical myelopathy in diabetic patients; however, those studies included ossification of the posterior longitudinal ligament. This study investigated whether surgical outcome of expansive laminoplasty (ELAP) for diabetic patients with cervical spondylotic myelopathy (CSM) differs from that for non-diabetic patients and determined prognostic factors in diabetic patients. METHODS: We retrospectively reviewed 78 patients with CSM after excluding the cases with other medical conditions, which could affect surgical outcome from 222 consecutive patients who had undergone ELAP between 2000 and 2008 in our hospital. The patients were divided into two groups: diabetic patients (Group 1) and non-diabetic patients (Group 2). We evaluated differences in age, gender, pre- and postoperative Japanese Orthopaedic Association (JOA) score, recovery rate (RR), symptom duration, and postoperative complications between the two groups. In Group 1, the correlation between RR and factors indicating the severity of diabetes mellitus was assessed. RESULTS: There were 13 patients in Group 1 and 65 in Group 2. There was no significant difference in age, gender, JOA score before or after surgery, or symptom duration between the two groups. Group 1 showed poorer recovery of sensory and motor function in the lower extremities. A negative correlation was observed between RR and the preoperative hemoglobin A(1c) (HbA(1c)) level in Group 1. CONCLUSIONS: Diabetic patients experienced benefits from ELAP similar to non-diabetic patients. A negative correlation between RR and preoperative HbA(1c) level suggests that strict blood sugar control is recommended before surgery.

Clinical features and surgical outcomes of cervical spondylotic myelopathy in patients aged 80 years or older: a multi-center retrospective study.

With the aging of the population in developed countries, spine surgeons have recently been more likely to encounter elderly patients in need of treatment. This study investigated whether decompression surgery for cervical spondylotic myelopathy (CSM) in elderly patients aged 80 years or older would likely be a reasonable treatment. We retrospectively reviewed 605 consecutive patients with cervical myelopathy who underwent decompression surgery between 2004 and 2008. Patients with other conditions that could affect functional status or compression factors other than spondylosis were excluded from this study. Of the remaining 189 patients, 161 with CSM whose condition could be evaluated 6 months after surgery were analyzed. The patients were divided into two age groups: 80 years or older (Group A, 37 patients) and younger than 80 years of age (Group B, 124 patients). We evaluated the differences in symptom duration, clinical data, involved levels, surgical outcome, comorbidities, and postoperative complications between the two groups. The symptom duration was significantly shorter in Group A. The average JOA scores preoperatively and 6 months postoperatively were significantly lower in Group A; however, there was no significant difference in the recovery ratio. There were no significant differences in the percentages of patients with comorbidities or those with postoperative complications. Elderly patients aged 80 years or older regained approximately 40% of their function postoperatively, and the incidence of postoperative complication was similar to that in younger patients. Since this age group shows a rapid deterioration after onset, prompt decompression surgery is required.

Spinal subdural haematoma concurrent with cranial subdural haematoma: Report of two cases and review of literature.

Subdural haematomas co-existing in the cranium and spine are considered extremely rare. We report 2 cases demonstrating the condition described here with a review of literature. One of these 2 patients was the first case in which the spinal lesion was found before the cranial lesion. A 66-year-old man without trauma presented with paraparesis accompanied by severe leg pain. The patient was diagnosed as having spinal subdural haematoma extending from L1 to S1 vertebral levels with magnetic resonance images (MRI). Two days after admission, the patient developed disorientation and abnormal behavior; therefore, computed tomography (CT) of brain was performed, and chronic cranial subdural haematoma was observed. A 60-year-old man who developed headache showing gradually progressive was diagnosed as having cranial subdural haematoma on CT. Three days after admission, he became insomnolent due to severe low back pain radiating to ankle. On MRI, subdural haematoma was found extending from L3/4 to S2 vertebral levels. Only brain surgery was performed for all cases by the neurosurgeons. Paraparesis and severe leg pain, which were derived from spinal lesions, showed recovery approximately 2 weeks after onset and spinal subdural haematoma was completely resolved on MRI obtained 2 or 5 months after onset, respectively. There is a possibility that the incidence of spinal subdural haematoma concurrent with cranial subdural haematoma could be underestimated because the doctor had not obtained CT or MRI of the brain. Doctors should aware of such a condition and check patients with spinal subdural haematoma for neurological signs derived from brain lesions. Spontaneous resolution of spinal subdural haematoma was observed; therefore, surgery for this condition should be indicated only for patients with moderate or severe paraparesis or paraparesis deteriorated.

Case report: osteoid osteoma of the C2 pedicle: surgical technique using a navigation system.

An osteoid osteoma of the cervical spinal pedicle is rare and carries a high surgical risk because of the close anatomic relationship to the spinal cord, nerve root, and vertebral artery. We report the case of a 12-year-old girl with an osteoid osteoma of the C2 pedicle. Computed tomograms showed an oval nidus and marked sclerosis around this lesion at the right C2 pedicle. There also was expansion of the medial and inferior cortical bone of the C2 pedicle. After failure of nonoperative treatment, we planned surgery. Owing to concerns regarding thermal damage to the spinal cord, nerve root, and/or vertebral artery using computed tomography (CT)-guided radiofrequency ablation, we curetted the nidus using a navigation system. Twenty-eight months after surgery, her pain was relieved with no limitation of cervical movement and there has been no evidence of recurrence. Navigation allowed safe curettage of the nidus through a small hole while maintaining spinal stability.