• Journal of Korean Neurosurgical Society
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• v.57 no.1
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• pp.42-49
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• 2015

Objective : The cervicothoracic junction (CTJ) is a biomechanically and anatomically complex region that has traditionally posed problems for surgical access. In this retrospective study, we describe our clinical experiences of the treatment of metastatic spinal tumors at the CTJ and the results. Methods : From June 2006 to December 2011, 23 patients who underwent surgery for spinal tumors involving the CTJ were enrolled in our study. All of the patients were operated on through the posterior approach, and extent of resection was classified as radical, debulking, and simple neural decompression. Adjuvant radiation therapy (RT) was also considered. Visual analog scale score for pain assessment and Medical Research Council (MRC) grade for motor weakness were used, while pre- and post-operative performance status was evaluated using the Eastern Cooperative Oncology Group (ECOG). Results : Almost all of the patients were operated using palliative surgical methods (91.3%, 21/23). Ten complications following surgery occurred and revision was performed in four patients. Of the 23 patients of this study, 22 showed significant pain relief according to their visual analogue scale scores. Concerning the aspect of neurological and functional recovery, mean MRC grade and ECOG score was significantly improved after surgery (p<0.05). In terms of survival, radiation therapy had a significant role. Median overall survival was 124 days after surgery, and the adjuvant-RT group (median 214 days) had longer survival times than prior-RT (63 days) group. Conclusion : Although surgical procedure in CTJ may be difficult, we expect good clinical results by adopting a palliative posterior surgical method with appropriate preoperative preparation and postoperative treatment.

• Investigative Magnetic Resonance Imaging
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• v.19 no.4
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• pp.224-230
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• 2015

Purpose: To determine whether we should recommend ultrasonography (US) for an incidental thyroid nodule identified by additional cervicothoracic sagittal T2-weighted image (C-T sag T2WI) of lumbar spine magnetic resonance imaging (MRI). Materials and Methods: A retrospective study of 61 patients who underwent both lumbar spine MRI and thyroid US between December 2011 and April 2015 was conducted. For all US-found thyroid nodules > 1 cm, investigators evaluated whether there was any correlation between thyroid nodule detectability by C-T sag T2WI and US features such as echogenicity, composition, or suspicion of malignancy. Results: Solid hypoechoic (2/4; 50%) or mixed echoic nodules (4/8; 50%) appeared to be found relatively more easily by C-T sag T2WI than more benign-looking solid isoechoic (1/4; 25%) or spongiform nodules (0/6; 0%). Among six nodules with ultrasonographic suspicion for malignancy, only one nodule was detected by C-T sag T2WI. Conclusion: If an incidental thyroid nodule is seen by C-T sag T2WI, it would be better to recommend thyroid US for identifying malignancy.

• Journal of the Korean Orthopaedic Association
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• v.54 no.6
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• pp.562-566
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• 2019

Osteochondroma is a common benign bone tumor, but relatively rare in the spine. Spinal osteochondroma originates mainly from the posterior column and sometimes invades the spinal canal causing cord compression and myelopathy. A 36-year-old man was admitted to the authors' institution with a two-year history of neck pain. A radiology examination revealed osteochondroma, arising from the left superior articular process of the T1 vertebra with significant central canal narrowing. Most cases of the spinal osteochondroma originate in the cervical vertebra, but there are few reports of an origin of the cervicothoracic junction. This paper reports a case of osteochondroma at the cervicothoracic junction with a review of the relevant literature.

• Investigative Magnetic Resonance Imaging
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• v.17 no.2
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• pp.91-100
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• 2013

Purpose : To evaluate the usefulness of cervicothoracic spine sagittal T2-weighted images (CT SAG T2WIs) included in routine lumbar spine MRI. Materials and Methods: Institutional review board approval was obtained and informed consents were waived for this retrospective study. The study group comprised 2,113 patients who underwent lumbar spine MRI from January 2005 to December 2005. CT SAG T2WIs were added in the routine lumbar spine MRIs. Radiologic reports were reviewed retrospectively for pathologic lesions on CT SAG T2WIs by one radiologist. Information of additional cervical or thoracic spine MRI and/or CT for further evaluation of positive findings on CT SAG T2WIs and their treatment were collected by retrospectively reviewing medical records. Results: The CT SAG T2WIs revealed 142 pathologic lesions in 139 (6.58%) of the 2,113 patients. They were easily obtained without positional change in a scan time of less than 2 minutes. Additional cervical or thoracic spine MRI and/or CT for positive findings on CT SAG T2WIs were performed in 13 patients. Seven patients underwent surgical treatment. Conclusion: CT SAG T2WIs included in routine lumbar spine MRI were useful in finding the pathologic lesions in cervicothoracic spine for the patients who assumed to have lesions in lumbar spine.

• Journal of Korean Neurosurgical Society
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• v.54 no.4
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• pp.363-365
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• 2013

Split cord malformations (SCMs) usually present in childhood, and are rarely reported in adults. And also, a cervicothoracic SCM associated with tethered cord syndrome has very rarely been reported in the literature. We report a case of SCM associated with tethered cord and spina bifida in an adult. This report describes the case of a 34-year-old woman who presented for evaluation of neck pain, back pain, and intermittent paraparesis of several months duration. The MRI and CT showed a SCM at the cervicothoracic level and a fibrous septum at the thoracic level. She underwent surgery for the SCM and tethered cord syndrome, and was followed for 7 years. Patient presented complete recovery in the follow-up. The authors discuss this unusual lesion and describe the anatomical relationship of the level of cord duplication and fibrous septum.

• 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.58 no.3
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• pp.236-241
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• 2015

Objective : We report on the technical feasibility and limitations of the transmanubrial approach for cervicothoracic junction (CTJ) lesions and emphasize the advantage of bisecting the upper part of the manubrium in an inverted Y-shape. Methods : Thirteen patients who underwent the fourteen transmanubrial approach for various CTJ lesions were enrolled during 2005-2014. For the evaluation of the accessibility for the CTJ lesion, we analyzed the two parallel line defined as a straight line parallel to the inferior and superior plateau of the upper and lower healthy vertebrae, the angle of the two parallel lines and the distance from the sternal notch to lines at the sternum on preoperative magnetic resonance images. Surgical limitations and perspectives, as well as postoperative clinical outcomes were evaluated retrospectively. Results : The CTJ lesions were six metastases, three primary bone tumors, two herniated discs, and one each of a traumatic dislocation with syrinx formation and tuberculous spondylitis and ossification of the posterior longitudinal ligament. If two parallel lines pass below the sternal notch, the manubriotomy should be inevitably performed. The mean preoperative Visual analogue scale score was 8 (range, 5-10), which improved to 4 (range, 0-6) postoperatively. Seven cases showed an increase in Frankel score postoperatively. Conclusion : The spatial relationship between the sternal notch and the two parallel lines to the lesion was rational to determine the feasibility of manubriotomy. The transmanubrial approach for CTJ lesions can achieve favorable clinical outcomes by providing direct decompression of lesion and effective reconstruction.

• Korean Journal of Head & Neck Oncology
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• v.22 no.2
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• pp.155-158
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• 2006

Intrathoracic goiters can be classified anterior and posterior mediastinal goiter with its locations. Most intrathoracic goiters are retrosternally situated in the anterior mediastinal compartment. Posterior mediastinal goiters are rare, but might present a difficult diagnostic and surgical problem. Although thyroid goiters are nearly always amenable to a cervical approach, posterior mediastinal goiters may require a combined cervicothoracic approach with sternotomy or thoracothomy. We herein describe a case of posterior mediastinal goiter which was excised only by cervical approach. The relevant literature is briefly reviewed.

• Journal of Chest Surgery
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• v.18 no.2
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• pp.345-351
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• 1985

Tracheal stenosis is due to tracheostomy or prolonged intubation. Development of tracheal stenosis following tracheostomy is very serious complication. In recent practice, tracheostomy has became more popular because of increased occasions of major and minor traumas. At the Dept. of thoracic surgery, Chonbuk national university hospital, we have experienced one case of tracheal stenosis following tracheostomy for assisted ventilation. Chest X-ray revealed the narrowing of trachea at cervicothoracic junction due to previous tracheostomy. We resected the narrow segment & tracheal reconstruction was performed with an excellent result in postoperative periods. Postoperative air tracheogram did not reveal demonstrable narrowing of air filled trachea.

• Archives of Reconstructive Microsurgery
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• v.6 no.1
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• pp.111-116
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• 1997

The treatment of chronic digital pain and cold intolerance due to Raynaud's phenomenon is quite difficult especially it is combined with scleroderma. Several surgical trial such as cervicothoracic sympathectomy have been attempted for the medically unresponsible Raynaud's phenomenon, but their results were unsatisfactory. We have tried peripheral periarterial sympathectomy for the 44 years old female patient who had medically unresponsible severe Raynaud's phenomenon with scleroderma. Periarterial adventitial stripping was performed at the level of wrist, superficial palmar arch, common digital artery and proper digital artery about 1.5-2 cm in length. Preoperative angiography and radioactive angiography were done and preoperatively and postoperatively the blood flow was measured by the desk top computer-aided histogram. Both hands digital pain were markedly reduced after operation and blood flow increased as compaired with the preoperative measure.