• Journal of Korean Neurosurgical Society
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• v.29 no.9
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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.

• The Korean Journal of Pain
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• v.19 no.1
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• pp.51-55
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• 2006

Background: A cervical transforaminal steroid injection is an effective therapeutic modality for radiculopathy of a herniated cervical disc or a cervical foraminal stenosis. However, there is some debate regarding the safety of the transforaminal approach under C-arm guidance compared with the posterior interlaminar approach. We report a new technique for cervical transforaminal steroid injection guided by MDCT. Methods: Patients presenting with radiating pain on their shoulder or arm were diagnosed using CT or MRI of a cervical herniated disc or a foraminal stenosis. Each patient whose symptoms were compatible with the image scan was enrolled in this study. They received a cervical transforaminal steroid injection under CT guidance, and the effectiveness and complications of this technique were evaluated over a 2-month period. Results: According to the CT scan, none of the participants had an internal jugular vein or a carotid artery invasion during the procedure. No vertebral artery injection was noted, and no patient developed a hematoma after the injection. The VAS score had improved significantly by 2, 4 and 8 weeks after the injection. Conclusions: While a conventional C-arm guided cervical transforaminal steroid injection does not appear to differentiate between the major vessels and structures in images, a CT guided approach is a more useful and safer technique for the precise placement of a needle.

• Journal of Korean Neurosurgical Society
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• v.61 no.2
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• pp.224-232
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• 2018

Objective : Cervical ossification of the posterior longitudinal ligament (OPLL) can be treated via anterior or posterior approach, or both. The optimal approach depends on the characteristics of OPLL and cervical curvature. Although most patients can be successfully treated by a single surgery with the proper approach, renewed or newly developed neurological deterioration often requires repeat surgery. Methods : Twenty-seven patients with renewed or newly developed neurological deterioration requiring salvage surgery for multi-segment cervical OPLL were enrolled. Ten patients (group AP) underwent anterior approach, and 17 patients (group PA) underwent posterior approach at the initial surgery. Clinical and radiological data from initial and repeat surgeries were obtained and analyzed retrospectively. Results : The intervals between the initial and repeat surgeries were $102.80{\pm}60.08months$ (group AP) and $61.00{\pm}8.16months$ (group PA) (p<0.05). In group AP, the main OPLL lesions were removed during the initial surgery. There was a tendency that the site of main OPLL lesions causing renewed or newly developed neurological deterioration were different from that of the initial surgery (8/10, p<0.05). Repeat surgery was performed for progressed OPLL lesions at another segment as the main pathology. In group PA, the main OPLL lesions at the initial surgery continued as the main pathology for repeat surgery. Progression of kyphosis in the cervical curvature (Cobb's angle on C2-7 and segmental angle on the main OPLL lesion) was noted between the initial and repeat surgeries. Group PA showed more kyphotic cervical curvature compared to group AP at the time of repeat surgery (p<0.05). Conclusion : The reasons for repeat surgery depend on the type of initial surgery. The main factors leading to repeat surgery are progression of remnant OPLL at a different segment in group AP and kyphotic change of the cervical curvature in group PA.

• Journal of Korean Neurosurgical Society
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• v.30 no.5
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• pp.600-604
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• 2001

Objective : The authors report the microsurgical anterolateral tunnel approach for the treatment of the cervical disc diseases and its postoperative surgical results. Methods : All surgical procedures followed the method of classical microsurgical anterior discectomy. Small tunnel(7-8mm) was made on the disc space reaching to the posterior longitudinal ligament. The disc materials and bony spurs were removed through this tunnel. Thirty-one patients of cervical disc herniation(24 cases with pure disc herniation, 7 cases with combined cervical spondylosis) were evaluated on the symptoms, conformation in plain X-ray, C-T, and MRI. The follow up time was over 2 years. Results : Postoperatively the result(following the out come scale) was excellent and good in Twenty-nine patients. One with fair result showed remnant disc particle and spur and another one is combined with cord contusion. One patient with lesion in C 3-4 space and two cervicothoracic junction showed excellent result. Two patients with osteoporosis also showed good results. Cervical spine curvature and disc space height were not changed on the plain X-ray and MRI in all patients. Twenty-nine patients were discharged within 3 days after surgery without any postoperative complications. Conclusions : The microsurgical anterolateral tunnel approach could be indicated for the treatment of patients with cervical disc diseases and with difficulty in achieving interbody fusion(the higher cervical level and cervicothoracic junction, osteoporosis etc.).

• Journal of Korean Neurosurgical Society
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• v.63 no.2
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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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• v.29 no.1
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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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• v.39 no.3
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• pp.231-233
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• 2006

The C2 level is the transition zone between the cranial and cervical spine. Because of its high position and anatomic relationship to vital structures, exposing C2 is challenging and the surgical approach is controversial. We report a of a recurred chordoma in C2 portion, occupying the osseous intraspinal portion. The patient underwent total corpectomy of C3 and gross total removal of tumor by right submandibular approach 3 years previously. We performed a lateral extrapharyngeal approach from contralateral left side with resection C2 central portion followed by gross total removal of mass and placement of graft bone. Although there was transient hypoglossal nerve palsy postoperatively, the patient had full recovery.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.16
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• pp.6489-6494
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• 2014

Cervical cytology remains the principal screening method to detect pre-invasive and invasive cervical lesions. Management of abnormal cervical cytology depends on the risk of encountering a significant cervical lesion or high-grade cervical disease. These risks may vary in different areas across the country. Thus, determining the rate of significant cervical lesion associated with each type of abnormal cervical cytology in each area is of critical importance for designing area-specific management approach. This review was conducted to evaluate the rate of high-grade cervical disease among Thai women with abnormal cervical cytology. A relatively high incidence of underlying significant lesions including invasive disease was demonstrated even in those having only minimal smear abnormality. This baseline information is crucial and must be taken into consideration in management of women with abnormal cytological screening to achieve the goals of comprehensive cervical cancer control in Thailand.

• Journal of Korean Neurosurgical Society
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• v.30 no.12
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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.

• Journal of Korean Neurosurgical Society
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• v.29 no.2
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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.