• Journal of Korean Neurosurgical Society
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• 제29권9호
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• pp.1258-1261
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• 2000

Intraspinal neurenteric cyst is rare congenital lesion derived from disorder of notochord formation. Most of these are located ventral to the spinal cord and conventional posterior approach is considered to be effective method as initial treatment modality. This cyst can recur, but the risk of reccurence after partial removal through long term follow-up has not been determined. We experienced one case of cervical neurenteric cyst which recurred after partial removal through laminectomy. The magnetic resonance imaging and postmyelography computerized tomography revealed an intradural extramedullary cystic lesion anterior to the cervical cord at the fifth cervical vertebra level. We performed anterior cervical corpectomy and cyst was totally removed. The patient's neurological symptom was improved postoperatively. Neurenteric cyst located ventrally to the cervical spinal cord should be removed through anterior route for direct visualization of the relationship between the cyst wall and the spinal cord.

• Journal of Korean Neurosurgical Society
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• 제63권2호
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• pp.202-209
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• 2020

Objective : The purpose of this study was to evaluate the efficacy of the anterior approach following intraoperative reduction under general anesthesia in patients with cervical facet fracture and dislocation. Methods : Twenty-three patients with single level cervical facet fracture and dislocation who were subjected to the anterior approach alone following immediate intraoperative reduction under general anesthesia from March 2013 to December 2017 were enrolled in this study. Neurological status, clinical outcome, and radiological studies were evaluated preoperatively, postoperatively, and during the follow-up period. Results : The cohort comprised 15 men and eight women with a mean age of 57 years (from 24 to 81). All patients were operated on within the first 8 hours following the injury. After gentle manual reduction or closed reduction with Gardner-Wells traction, under general anesthesia monitored by somatosensory-evoked potentials, all operations were successfully completed using the anterior approach alone except in two patients, who had a risk of over-distraction. In them, a satisfactory gentle manual reduction or closed reduction was not possible, and required open posterior reduction of the locked facets followed by anterior cervical discectomy and fusion. In one patient, screw retropulsion was observed in 1 month after surgery. There were no reduction-related complications or neurological aggravations after surgery. All patients showed evidence of stability at the instrumented level at the final follow-up (mean follow-up, 12 months). Conclusion : Anterior approach following intraoperative reduction monitored by somatosensory-evoked potentials under general anesthesia for cervical dislocation and locked facets is a relatively safe and effective alternative when cervical alignment is achieved by intraoperative reduction.

• Journal of Korean Neurosurgical Society
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• 제30권7호
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• pp.870-875
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• 2001

Objectives : Anterior tunnelling technique consist of anterior cervical fractional interspace decompression without fusion. This method provides sufficient space for adequate neuroforaminal decompression but avoids the need for fusion or fixation. We report early clinical results of 32 cases that underwent anterior tunnelling operation for treatment of cervical radiculopathy. Methods : This method is identical to conventional approach until the exposure of anterior cervical body and bilateral retraction of longus colli is made. A vertical window is then made at the vertebral bodies and disc space lateral to the insertion site of the longus colli. The window is deepened with drilling that follows a tunnelling fashion down to the compressive lesion. We analyzed clinical results from 32 patients who treated between December 1998 and August 2000. Results : Satisfactory results were obtained in 87% of the patients. Two patients required revision surgery. None revealed surgical spinal instability on last follow-up. Conclusion : Anterior tunnelling operation is an acceptable surgical option for the treatment of cervical radiculopathy. Its advantages are short hospitalization, minimal postoperative discomfort, and technical feasibility.

• Journal of Korean Neurosurgical Society
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• 제39권3호
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• pp.188-191
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• 2006

Objective : The purpose of this study is to evaluate the efficacy and necessity of combined anterior approach [discectomy and fusion] and posterior approach[open-door laminoplasty] in the treatment of cervical spondylotic myelopathy. Methods : The authors reviewed 14 cases in whom combined anterior and posterior approach performed for cervical myelopathy due to simultaneous anterior and posterior pathology such as huge central disc herniation with narrow spinal canal between January 2000 and December 2002. Clinical symptoms were evaluated by Japanese Orthopaedic Association [JOA] score and then the cervical curvature, change of spinal canal to vertebral body[SC/VB] ratio and canal widening were measured and compared to the clinical symptoms. Results : The mean JOA score increased from $10.4{\pm}3.1$ preoperatively to $14.8{\pm}1.2$ at the final follow up with a mean recovery rate 66.4%. In all cases, there were not neurologic deterioration. Mild postoperative complications developed in two cases. One patient had a limitation of range of neck motion and the other one showed kyphotic change. Postoperative radiography showed an improvement of body to canal ratios [average $0.70{\pm}0.08$ before surgery to $1.05{\pm}0.12$ after surgery and mainte nance or recovery of cervical lordosis. Canal widening of antero-posterior diameter and dimension after operation is 6.8mm. $116.61mm^2$. Conclusion : Combined anterior and posterior procedure could be helpful in decompression of the spinal cord and good functional recovery in spondylotic myelopathy patients with combined anterior and posterior pathology such as huge disc herniation accompanying narrow spinal canal.

• Journal of Korean Neurosurgical Society
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• 제29권1호
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• pp.87-94
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• 2000

Objective : Various surgical approaches have been implemented to fulfill the ideal goals of treatment for cervical spondylotic lesions. Conventional approaches are represented by anterior approach with or without fusion and posterior approach. The authors has applied newly developed anterior cervical microforaminotomy for these lesions on minimally invasive basis. Materials and Method : Twenty-one patients, with cervical HIVD, or stenosis, or both, underwent anterior cervical microforaminotomy between March, 1998 and April, 1999. Fifteen patients underwent unilateral decompression, and 6 bilateral decompression via unilateral foraminotomy. Operation of one level was performed in 16 patients, 2 levels in 4 patients, and 3 in 1 patient. The foraminotomy was accomplished by resecting the uncovertebral joint. Through this hole, compressed nerve root was decompressed by removing the spondylotic spur or disc fragment, and diagonal removing of posterior osteophyte from foraminotomy site to begining of contralateral nerve root made spinal cord decompression. Results : The outcome was excellent in 17 patients(81%) and good in 4 patients(19%) based on Odom's criteria. No complication was encounterd, and average post-operation hospital stay was 3.7 days. Conclusions : These results indicate that anterior cervical microforaminotomy provide adequate neural decompression, minimum postoperative discomfort and fast recovery.

• Journal of Korean Neurosurgical Society
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• 제40권6호
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• pp.450-454
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• 2006

The incidence of vertebral artery injury during the anterior approach to the cervical spine is rare, but potentially lethal. The authors describe two cases of vertebral artery injury during anterior cervical decompression surgery. In the first case, infection was the cause of the vertebral artery injury. During aggressive irrigation and pus drainage, massive bleeding was encountered, and intraoperative direct packing with hemostatic agents provided effective control of hemorrhage. Ten days after surgery, sudden neck swelling and mental deterioration occurred because of rebleeding from a pseudoaneurysm. In the second case, the vertebral artery was injured during decompression of cervical spondylosis while drilling the neural foramen. After intraoperative control of bleeding, the patient was referred to our hospital, and a pseudoaneurysm was detected by angiography four days after surgery. Both pseudoaneurysms were successfully occluded by an endovascular technique without any neurological sequelae. Urgent vertebral angiography, following intraoperative control of bleeding by hemostatic compression in cases of vertebral artery injury during anterior cervical decompression, should be performed to avoid life-threatening complications. Prompt recognition of pseudoaneurysm is mandatory, and endovascular treatment can be life saving.

• Journal of Korean Neurosurgical Society
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• 제29권2호
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• pp.261-264
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• 2000

We report a case of anterior spinal epidural hematoma, after removal of cervical meningioma by posterior approach, which occurred in a 61-year-old man who presented with left hemiparesis and hypalgesia. A cervical mass surgically confirmed as meningioma was removed by posterior approach. 3 hours after operation, the patient revealed quadriparesis with respiratory difficulty. We herewith report a rare case of anterior spinal epidural hematoma which caused a catastrophic aggrevation of postoperative course.

• Journal of Korean Neurosurgical Society
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• 제30권10호
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• pp.1170-1176
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• 2001

Objective : The purpose of the study was to evaluate the clinical and radiological results after discectomy and Lubboc bone graft in the surgical management of the cervical diseases with a new titanium interbody implant and integrated screw fixation(PCB) by anterior approach. Methods : The authors retrospectively analyzed 28 cases of anterior cervical fusion with PCB system and Lubboc bone(xeno graft) from september 1998 to december 2000. Twenty-eight patients with cervical diseases underwent decompression cervical lesion and followed from 5 to 27 months with a mean follow-up of 14 months. There patients were evaluated with clinically and radiologically at immediate postoperative period and at 3, 6, 9, and 12 months. Result : The authors investigated the pre- and postoperative intervertebral disc space, clinical outcomes, radiography fusion rate, and Cobb angle in the fixed segments by anterior approach. The lordotic angles and height of disc space were increased after the operation. The clinical outcome of patients follow-up was good or excellent result based on Odom's criteria with improvement of clinical symptom in about 92.9% of the cervical diseases. Two patients showed loosening of the lower and upper cervical screw of PCB instruments, and two patients showed swallowing difficulty and wound infection Conclusion : The PCB system is a new implant for anterior cervical interbody fusion in the degenerative cervical disease and disc herniations. It provides immediate stability and segment distraction. The results of this study indicate that the PCB system is safe, easy handling of hardware, less complications, high fusion rate, and has provide the keeping the intervertebral disc space height and lordotic angles.

• Journal of Korean Neurosurgical Society
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• 제45권1호
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• pp.32-34
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• 2009

The common carotid artery generally bifurcates into the internal and external carotid arteries at the level of C3-4. Injury to the common carotid artery during anterior cervical discectomy is a complication that is very much feared but encountered rarely. Knowing the anatomic variations of the common carotid artery and using an operating microscope during the anterior cervical approach for cases with low-lying bifurcation of the common carotid artery would prevent injuries to this artery. We present a 42-year-old female who has successfully undergone anterior cervical discectomy at the level of C5-6 and C6-7. She had a low-lying bifurcation of the common carotid artery.

• Journal of Korean Neurosurgical Society
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• 제30권12호
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• pp.1388-1393
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• 2001

Objective : In the retrospective analyzing 19 consecutive patients with subaxial cervical spine(C3~T1) injury treated by posterior cervical fixation and fusion, clinical manifestation, radiologic finding, operative technique, and postoperative results following 6 months were analyzed. Materials and Methods : Most common fracture level was C4-5, mean age 41, and male to female ratio 13 : 6. The most common cause of injury was motor vehicle accident(17 cases). In 19 cervical procedures, interspinous triple wiring was done in 14 cases, lateral mass plating in 5 cases, and additional anterior fusion in 2 cases. Results : Twelve weeks after operation, all cases were reviewed by plain cervical radiogram. In 17 cases that treated by posterior fusion only, 14 cases(81%) had kyphotic angle change less than $5^{\circ}$, 2 cases(12%) $5-20^{\circ}$, and 1 case(6%) more than $20^{\circ}$. Overall fusion rate was 88%, and there was no significant difference of bone fusion rate between autogenous bone graft and allogenous bone graft. Conclusion : In the case of severe posterior column injury or displacement, posterior approach seems superior to anterior approach, but in the case of combined anterior column injury, anterior approach is considered necessary. In this study, posterior fixation and fusion might be acceptable procedure for subaxial cervical fracture and dislocation, owing to its high fusion rate, low kyphotic angulation and low operation related complication rate.