Introduction: This study aimed to investigate the clinical management and outcome of patients with spontaneous spinal epidural hematoma (SSEH) and clarify the appropriate treatment and characteristics of SSEH.

Methods: We retrospectively reviewed ten patients with SSEH who were treated at our hospital between January 2014 and September 2021. The patients were divided into surgical and conservative treatment groups (S and C groups, respectively), and the difference in etiology, image findings, and treatment outcomes between the two groups were investigated.

Results: The patients included four females and six males, with a mean age of 71.2 (62-84) years. Of the ten patients, six were treated surgically (S group) and four conservatively (C group). In the C group, all the patients showed dramatic improvement in neurological deficit within two hours following onset, whereas the patients in the S group displayed no improvement on the day of the onset. All the patients in the C group and five patients in the S group regained walking ability after a month, while two patients in the S group did not. Three patients (two in the S group, one in the C group) had been undergoing hemodialysis. Five hematomas were located in the cervical lesion and two in the thoracic lesion. Thoracic hematomas were both observed in the S group. Three patients were administered with antithrombotic medication, and five patients showed high signal changes (HSCs) in the spinal cord during MRI. These findings were exclusive to the S-group.

Conclusions: Conservative treatment is effective in patients who show an early improvement in neurological deficit, whereas those with no improvement should undergo surgical treatment. The patients with hematomas in the thoracic lesion, HSCs in the spinal cord detected by MRI, and a history of antithrombotic medication may require more attention.

Eighty-seven spine surgeries performed on rheumatoid arthritis patients between 2001 and 2020 were reviewed. The main lesions were cervical spine in 28 cases, thoracic spine in 1 case, and lumbar spine in 58 cases. The main trends were a significant increase in age and lumbar spine surgery, and a significant decrease in fusion surgery with subaxial subluxation; there was a significant increase in MTX or biologics use in surgery after 2011. The revision rate for implant use was 23% (18/77), and the revision rate was significantly higher in patients with a history of THA/TKA (46%/17%, p<0.05). 7 patients (8%) had postoperative infection, and 2 patients (2%) died within 1 year after surgery (including 1 during hospitalization). In recent years, with the introduction of biologics, the number of fixed surgeries due to rheumatoid cervical lesions has significantly decreased, and lumbar degenerative diseases now account for majority of cases, as in non-rheumatoid patients. On the other hand, the revision rate is significantly higher in cases of major joint replacement, which requires particularly careful follow-up.

Introduction: The relationship between the serial changes in the status of the injured spinal cord and the outcome of treatment in patients with spinal cord injury remains unknown.

Methods: Nineteen patients with spinal cord injury without radiographic evidence of trauma (SCIWORET) were included in this study. They were classified into two groups [5 patients (conservative group) and 14 patients (surgical group)]. All patients underwent magnetic resonance imaging (MRI) immediately after the injury or within 1 month after the injury.

Results: The level of the injured spinal cord was C3-4 in 9 cases, C4-5 in 6 cases, C5-6 in 3 cases, and C6-7 in 1 case. The mean contraction rate of the spinal cord area and the recovery score of the American Spinal Injury Association (ASIA) motor score were 86.0% and 11.8 points in the conservative group and 85.4% and 10.6 points in the surgical group, respectively. There were no significant differences in the mean contraction rate of the spinal cord area and the recovery score of the ASIA motor score between the two groups.

Conclusions: The spinal cord edema in many patients recovered on delayed MRI compared to acute-phase MRI. Evaluation of the injured spinal cord on delayed MRI is one of the most important methods to confirm spinal cord compression reduction in patients with SCIWORET.

Introduction: In recent years, the incidence of traumatic spinal cord injury in elderly patients has increased. This study aimed to investigate the prognosis and in-hospital mortality rate of elderly patients with traumatic cervical spinal cord injury and cervical spine fractures.

Methods: We retrospectively reviewed 38 patients (11 females and 27 males) with cervical spinal cord injury aged ≥65 years who were treated at our hospital between January 2012 and December 2021. The patients had a mean age of 76 years and were divided into surgical and conservative groups.

Results: The conservative group had higher rates of patients with Frankel grade A than the surgical group. Additionally, 28.9% of the patients died during hospitalization. The mortality rates were higher in the conservative group than in the surgical group (64.2% vs.8.3%, respectively). In patients with Frankel grade A and/or B, the rate of respiratory support (ventilation or oxygen inhalation) and tube feeding tended to be higher in the surgical group (p = 0.07 and p = 0.05, respectively). Furthermore, 81.8% of patients with Frankel grade A or B in the surgical group required respiratory support and/or tube feeding, while 70% of the patients in the conservative group died during hospitalization.

Conclusion: These results may be used to inform clinical decision-making and discussions with elderly patients with spinal cord injury and their families.

Introduction: We performed scoliosis correction and fusion in a patient with scoliosis and cerebral palsy. We report the results of our study with regard to the timing of the surgery.

Case report: A 14-year-old boy with mixed cerebral palsy was diagnosed with scoliosis in childhood and treated at a children's hospital. He was referred to our hospital because of the progressing disease; however, he was able to drive a foot-pedal wheelchair and walk about 10 m (Gross Motor Function Classification System Level III). During the initial examination, the main curve of scoliosis was 52°, but no pelvic obliquity was noted. To prevent further advancement of scoliosis, an operation was planned on a priority basis. While waiting for surgery, the patient's scoliosis progressed to more than 20° and the pelvic obliquity was 10° hence, a surgery to avoid pelvic fusion was performed. No postoperative deterioration occurred, and the patient experienced a satisfactory outcome of the surgery.

Conclusion: Even in cases without pelvic obliquity at the time of initial diagnosis, scoliosis may still progress early, and surgery should be planned as soon as possible.

5P minus syndrome (5P−), also known as Cri-du-chat syndrome, is a rare genetic disorder caused by deletion of the short arm of chromosome 5. First reported by Lejeune in 1963, its incidence is approximately 1 in every 50,000 live births.

Patients suffering from 5P-display characteristic traits, such as cat-like meowing, mental retardation, and peculiar facial features. In the orthopedic field, scoliosis is eligible for treatment. However, most cases reported in the literature are treated surgically depending on the severity, and no reports have presented the natural history and the effect of conservative treatment.

This case report presents three patients with 5P−: two were treated surgically (8-year-old boy, growth-friendly surgery with growing rods; 8-year-old girl, corrective fusion) and one was treated conservatively (11-year-old girl, brace-wearing). Although short-term results have been acceptable so far, the natural history of scoliosis is still unclear and long-term outcomes have not been reported yet. A long-term follow-up of at least 10-20 years is necessary to determine whether the recovery of these three patients followed a smooth course.