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Study Design: A retrospective study. Objectives: To evaluate the sagittal alignment of cervical spine in AIS. Summary of Literature Review: Little has been known about the sagittal curve patterns of cervical spine in AIS patients. Materials and Methods: One-hundred-thirty-three AIS patients were checked by scanographs and followed up for more than 2 years were divided into cervical kyphosis (≥+5°), lordosis (≤-5°) and straight (-4°~+4°) groups according to the sagittal curves of cervical spine (C2~C7). Each group was evaluated for thoracic kyphosis, lumbar lordosis, sagittal balance and Cobb’s angle on coronal plane. Of the patients, 49 were treated by braces, 84 were surgically corrected (rod derotation in 52, direct vertebral rotation (DVR) in 32). Results: At the initial radiographs, cervical kyphosis was found in 97, lordosis in 23 and straight in 13 patients. In the kyphosis group,cervical kyphosis showed typical patterns of angular kyphosis. Thoracic and upper T-kyphosis (T1~T5) were lower than those in the cervical lordosis group (p=0.000, 0.001, respectively.) Other factors showed no significant differences between the groups. Patients treated by conservative management or by rod derotation had no significant differences in cervical kyphosis during the follow-up periods, though the thoracic hypokyphosis was surgically corrected. On the contrary, patients who were treated by DVR restored cervical lordosis (14/32=43.8%) from initial state showed significant differences in both conservative and rod derotation groups (p=0.008, 0.002,respectively)Conclusions: Cervical kyphosis in AIS was a compensatory curve correlated with both thoracic hypokyphosis and rotational deformity. Rotational corrections should be considered during the surgical treatment.

Study Design: A retrospective comparative analysis of the short-segment and long-segment posterior fixation in thoracolumbar burst fractures that are 7 points or above in load-sharing score was performed. Objectives: The purpose of this study is to demonstrate the appropriate level of fixation by comparing the results of short-segment and long-segment posterior fixation. Summary of Literature Review: There is general consensus that short-segment fixation should be done in thoracolumbar burst fractures that are 6 points or less in load-sharing classification. There is some controversy regarding whether short-segment or long-segment fixation should be done in thoracolumbar burst fractures that are 7 points or above in load-sharing classification Materials and Methods: From 1998 through 2008, 32 patients with thoracolumbar burst fractures above 7 points in load-sharing classification had been operated with short-segment (1 segment above and 1 segment below: 23 patients) or long-segment (2 segments above and 1 segment below: 9 patients) transpedicular screw fixation at the author’s institution. They were divided by two groups (group I: short-segment fixation, group II: long-segment fixation). The mean age of patients was 49.2 years old and the mean follow-up period was 2.4 years (1-7 years). In preoperative and postoperative simple radiographs, the bony unions, breakages or loosening of implants were assessed, and the losses of correction angle and anterior vertebral body height were measured. Results: In all cases, non-union or loosening of implants were not observed. There was 1 screw breakage in short-segment fixation group during the follow up period, but bony union was obtained at final follow-up. The mean score of load sharing classification was 7.3 in Group I and 7.1 in Group II, and there was no significant difference between two groups. (p>0.05) The mean anterior vertebral body height loss was 5.3% in Group I and 3.6% in Group II and the mean loss of correction angle were 4.72 in Group I and 3.38 in Group II. There was no significant difference between the two groups for both. (p>0.05)Conclusions: There was no significant difference in radiologic parameters between two groups. Short-segment fixation could be used successfully in selected cases of thoracolumbar burst fractures that are 7 points or above in load-sharing classification.

Study Design: Retrospective radiological evaluation. Objectives: This purpose of this study is to determine how much lumbar lordosis and disc heights are restored after posterior lumbar interbody fusion (PLIF) with cage in degenerative spinal disease. Summary of Literature Review: Restoration of lumbar lordosis in lumbar spine surgery is crucial for clinical outcomes, but there are few studies about the relationship between restoration of lumbar lordosis and cage. Material and Method: Eighty-one patients with degenerative spinal diseases underwent PLIF using metal cage with 4o lordotic angle. The mean age was 61 year-old (range 38-83 years). Cases with late complications including nonunion, subsidence of cage and instrument failure were excluded in this study. Lumbar lordosis, segmental lordosis, disc height, and sagittal alignment were analyzed on radiographs. Results: The fused level was one segment in 62 patients and two segments in 19 patients. All patients had the fusion from L3 to the sacrum. Preoperative lumbar lordosis was 34.2o, improved to 34.6o after surgery, and then changed to 32.2o at the final follow-up,demonstrating that the cage with 4o lordotic angle was not effective to restore lumbar lordosis. Segmental lordosis at the level of cage decreased at the final follow-up as compared to preoperative value at all segments. Disc height was improved at the final follow-up as compared to preoperative value. Conclusion: Disc height was restored after PLIF using cage in the surgery for degenerative lumbar spine. However, lumbar lordosis and segmental lordosis were decreased at the final follow-up as compared to preoperative lordosis.

Study Design: A case report. Objectives: This case report presents an elderly male who sustained compression fractures twice on the instrumented end vertebra following a spinal fusion with pedicle screws. Summary of Literature Review: Because of its low incidence, there is considerable debate regarding an optimal treatment of adjacent segment fracture after long lumbar fusion. Almost all of the reports about adjacent segment fracture are about adjacent vertebral fractures rather than the instrumented vertebral fractures. Materials and Methods: A 69 year-old male who was admitted with low back pains of no apparent physical injury underwent pedicle subtraction osteotomy and posterolateral fusion for L3 vertebral fracture and post-traumatic kyphosis. Extension of the fusion segment was performed two months after the initial operation to correct his compression fracture of the instrumented end vertebra, followed by conservative treatments due to a second compression fracture of the instrumented end vertebra two months after the second surgery. Results: Conservative treatment was performed with TLSO brace, after which the fracture was gradually stabilized. Conclusions: Further research via additional case studies is required to better understand its cause and to develop effective treatment options.

Study Design: A case report. Objective: We present a rare case of acute spinal cord infarction and usefulness of diffusion weighted MR imaging. Summary of Literature Review: T1-weighted and T2-weighted images are often normal in a patient with acute spinal cord infarction. Material and Methods: An 82-year-old presented with acute onset of paraplegia and urinary retention. His symptoms developed 6 days ago without any trauma. He had a history of vertebroplasty due to compression fracture of 12th thoracic vertebral body 6 years ago. There was no evidence of spinal cord compression on routine T1-and T2-weighted MRI. Results: In diffusion-weighted MRI, a high intensity signal intensity lesion in the spinal cord and conus medullaris was observed. Conclusion: We report an example for the usefulness of diffusion-weighted image for early and accurate diagnosis of acute spinal cord infarction.

Study Design: Case report. Objectives: To report a huge epidural hematoma after epidural neurolysis. Summary of Literature Review: No complications have been reported regarding to hematoma formations after neurolysis using NaviCath®. Material and Methods: A 67-year-old male with normal serum coagulation parameter experienced excruciating back and leg pains after neurolysis using NaviCath®. Results: After performing prompt multilevel laminotomy with hematoma evacuation, the patient recovered from pains without any neurological sequelae. Conclusions: It is important to be cautious while performing neurolysis with NaviCath® to avoid the epidural hematoma. Surgical treatment is an effective option to resolve the spinal epidural hematoma.