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Yasuhiko Matsukado, Collin S. MacCarty and James W. Kernohan

locate a tumor in an early stage and to remove it widely with surrounding brain tissue. The feasibility of extensive hemispheral removal has been investigated in primates in our laboratories. 16, 17 The limitations of surgical excision of brain structures have been expanded to include the lenticular, caudate, amygdaloid nuclei and thalamus unilaterally. 16, 17 In recent years we have performed wide excision of these tumors, including removal of a portion of the basal ganglia and thalamus. 9 One of us (C.S.M. 8 ) has mentioned that in most instances when a glioma had

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Anterior surgery for cervical disc disease

Part 2: Treatment of cervical spondylotic myelopathy in 32 cases

L. Dade Lunsford, David J. Bissonette and David S. Zorub

C ervical spondylotic myelopathy (CSM) is the most serious consequence of cervical intervertebral disc degeneration, especially when associated with a narrow spinal canal due to laminar, dural, or ligamentous hypertrophy. Since the early studies of the 19th century, the etiology, pathogenesis, natural history, and clinical spectrum have been lucidly defined 2, 5, 7, 10, 23, 24, 26, 28–36, 44 and even reproduced experimentally. 18, 19, 25 Despite earlier recognition and improved surgical techniques, not all authors agree that surgery significantly improves

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Ossama Al-Mefty, Louis H. Harkey, Troy H. Middleton, Robert R. Smith and John L. Fox

I n 1981, Lucci, et al. , 20 reported on two cases in which computerized tomography (CT) demonstrated hypodense intramedullary cavitation of the spinal cord at, and extending beyond, levels of cord compression from cervical spondylosis. In 1983, Mossman and Jestico 24 illustrated a large syrinx in a postlaminectomy case of cervical spondylotic myelopathy (CSM); this was demonstrated by enhancement on CT 6 hours after intrathecal injection of metrizamide. Recently, investigators from Japan 14 and Saudi Arabia, 18 using delayed CT scanning after

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Yasutaka Matsuda, Kazumi Miyazaki, Kenji Tada, Atsushi Yasuda, Tomitaka Nakayama, Hitoshi Murakami and Michimasa Matsuo

Cloward C4–5 − − 3 71, M 12 16 CSM 10 Cloward C4–5 − − 4 41, M 11 17 herniation 6 Cloward C4–5 − − 5 46, M 14 17 herniation 10 Cloward C6–7 − − 6 62, M 12 16 CSM 3 Smith-Robinson C3–4 − − 7 68, M 13 16 CSM 2 vertebrectomy C5–7 − − 8 41, M 14 17 herniation 5 Cloward C4–5 − − 9 62, M 14 17 herniation 3 Cloward C6–7 − − 10 54, M 12 16 CSM 6 Smith-Robinson C4–6 − − 11 54

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Michael J. Ebersold, Michel C. Pare and Lynn M. Quast

C ervical spondylitic myelopathy (CSM) is the most common spinal cord disorder affecting people older than 55 years of age. Since its characterization by Brain, et al. , 9 in 1952, researchers have gathered much experimental and clinical evidence on its etiology and pathophysiology. 8, 13, 46, 49, 51 It is generally accepted that a combination of compressive factors, both anatomical 41 and dynamic, 9, 40 as well as vascular phenomena 16, 23, 25 are responsible for the clinical syndrome; however, its clinical manifestations and natural history are

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H. Louis Harkey, Ossama Al-Mefty, Isam Marawi, Dudley F. Peeler, Duane E. Haines and Lon F. Alexander

R eports investigating the natural history of cervical spondylotic myelopathy (CSM) indicate that the disease process is benign and self-limiting; however, the preferred treatment remains controversial. 4, 21, 24, 28 Although there was some early resistance to surgical management, numerous decompressive procedures have been devised and advocated for CSM. 8, 31, 33 When the outcomes of various surgical and conservative treatments have been analyzed and compared, many patients were found to have improved as a result of surgery; however, some remained unchanged

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Hidenori Inoue, Kazuo Ohmori, Yoshihiro Ishida, Kazuhiro Suzuki and Tetsuro Takatsu

achieved that goal. Recently, we encountered four patients who required additional laminectomy for reconstriction of the spinal canal due to progression of the ossification of the posterior longitudinal ligament (OPLL) 8 to 10 years after surgery. In this study, the long-term results of suspension laminotomy for cervical compression myelopathy are analyzed and discussed, comparing cervical spondylotic myelopathy (CSM) with OPLL. Clinical Material and Methods Patient Population Between 1981 and 1991, suspension laminotomy was performed in 120 patients with

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Yohei Hidai, Sohei Ebara, Mikio Kamimura, Yutaka Tateiwa, Hidehiro Itoh, Tetsuya Kinoshita, Kunio Takaoka and Kuniyoshi Ohtsuka

were examined and interviewed several months postoperatively. The average follow-up period was 35.5 months (range 6–110 months). There were 17 men and women whose age at operation ranged from 33 to 77 years (average 60.6 years; Table 1 ). TABLE 1 Data obtained in 26 patients with cervical myelopathy* Characteristic CSM OPLL OYL Total no. of patients 19 3 4 26 sex (F/M) 5:14 2:1 2:2 9:17 age (yrs) at op  mean 61.5 58.0 58.3 60.6  range 34–77 49–74 33–75 33

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Maurizio Fornari, Giovanni Luccarelli, Sergio Giombini and Luisa Chiapparini

M ultilevel cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament or a combination of these diseases is fairly common, and their recognition has become markedly increased, probably because of the enlarged elderly population and improved diagnostic procedures. 3, 20, 24, 26, 29, 33, 34 The natural history of the disease seems quite unpredictable, but in the case of rapidly progressing motor deficit, surgical decompressive surgery in which stabilization is performed should be recommended. 3, 33 The most relevant

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Romeo Roselli, Angelo Pompucci, Francesco Formica, Domenico Restuccia, Vincenzo Di Lazzaro, Massimiliano Valeriani and Massimo Scerrati

A lthough the syndrome of CSM was defined by Brain and coworkers 8 in 1952, the actual incidence of CSM is still unclear and its treatment remains debated. 23, 28, 34, 47 However, CSM is the most frequent and underdiagnosed spinal disorder in patients who are older than 50 years of age. 11, 28, 35, 37, 44, 49 In retrospective analysis of the surgical series, some variables have been identified as favorable prognostic factors including young age, duration of symptoms less than 1 year, and lower degree of disability. 7, 28, 30, 39, 40, 43 Unfortunately, the