Ossification of the posterior longitudinal ligament (OPLL) is most commonly found in men, the elderly, and Asian patients. There are many diseases associated with OPLL, such as diffuse idiopathic skeletal hyperostosis, ankylosing spondylitis, and other spondyloarthropathies. Several factors have been reported to be associated with OPLL formation and progression, including genetic, hormonal, environmental, and lifestyle factors. However, the pathogenesis of OPLL is still unclear. Most symptomatic patients with OPLL present with neurological deficits such as myelopathy, radiculopathy, and/or bowel and bladder symptoms. There are some reports of asymptomatic OPLL. Both static and dynamic factors are related to the development of myelopathy. Plain radiography, CT, and MR imaging are used to evaluate OPLL extension and the area of spinal cord compression. Management of OPLL continues to be controversial. Each surgical technique has some advantages and disadvantages, and the choice of operation should be made case by case, depending on the patient's condition, level of pathology, type of OPLL, and the surgeon's experience. In this paper, the authors attempt to review the incidence, pathology, pathogenesis, natural history, clinical presentation, classification, radiological evaluation, and management of OPLL.

Object This study analyzes 84 cases of peroneal nerve injuries associated with sports-related knee injuries and their surgical outcome and management. Methods The authors retrospectively reviewed the cases of peroneal nerve injury associated with sports between the years 1970 and 2010. Each patient was evaluated for injury mechanism, preoperative neurological status, electrophysiological studies, lesion type, and operative technique (neurolysis and graft repair). Preoperative status of injury was evaluated by using a grading system published by the senior authors. All lesions in continuity had intraoperative nerve action potential recordings. Results Eighty-four (approximately 18%) of 448 cases of peroneal nerve injury were found to be sports related, which included skiing (42 cases), football (23 cases), soccer (8 cases), basketball (6 cases), ice hockey (2 cases), track (2 cases) and volleyball (1 case). Of these 84 cases, 48 were identified as not having fracture/dislocation and 36 cases were identified with fracture/dislocation for surgical interventions. Good functional outcomes from graft repair of graft length < 6 cm (70%) and neurolysis (85%) in low-intensity peroneal nerve injuries associated with sports were obtained. Recovery from graft repair of graft length between 6 and 12 cm (43%) was good and measured between Grades 3 and 4. However, recovery from graft repair of graft length between 13 and 24 cm was obtained in only 25% of patients. Conclusions Traumatic knee-level peroneal nerve injury due to sports is usually associated with stretch/contusion, which more often requires graft repair. Graft length is the factor to be considered for the prognosis of nerve repair.

268hospital and was classified as grade 1. An examination found hypoesthesia at the T8 level and below and the deep tendon reflexes were reduced. We performed a chest computed tomography (CT) scan, but aortic dissection was not observed. We suspected hypokalemic periodic paralysis of both lower extremities and conducted laboratory studies; however, the results were negative. We then suspected thoracic myelopathy and thus provided steroid mega-dose therapy and conducted magnetic resonance imaging (MRI). The motor paralysis was gradually relieved so that the motor function were grade 2 on the right side and grade 3 on the left side four hours after the onset of symptoms. It was grade 4 on both sides after five hours. The MRI showed acute subdural hematoma at levels C2-T6 (Fig. 1A, C). Paralysis almost completely disappeared by 55 hours after onset. A cervical MRI conducted at that time revealed reduced cervicaldorsal SSDH (Fig. 1B, D). Case 2A 38-year-old male patient experienced headache, back pain, cold sweating, and dizziness that began when he was lifting weights one month earlier. These symptoms were relieved after he was treated at a clinic of pain medicine near his home. Three days later, he came to the emergency room with vertigo, which was relieved with intravenous hydration. Approximately one month later, his chest and back pain was aggravated by stretching exercises and he came to the emergency room. A brain MRI with contrast enhancement was conducted, which revealed thickening of the dura mater. The patient was then admitted to the neurologic department of the hospital with suspected spontaneous intracranial hypotension. The chest and back pain worsened and INTRODUCTIONSpinal subdural hematoma (SSDH) is a rare condition in which the spinal subdural hematoma compresses the spinal cord and the cauda equina, causing symptoms that may occur in relation to trauma, hemostatic disorders, anticoagulant drug administration, arteriovenous malformations, tumors, and lumbar punctures. Various unknown causes of SSDH have also been reported 4,11) . Its clinical symptoms are sudden pain, hypesthesia, motor paralysis, and neurologic defects in some cases [4][5][6]8,11,13) . Treatment generally consists of surgical decompression 3,15) . We experienced two cases of nontraumatic acute spinal subdural hematoma (NASSDH), treated conservatively without surgery. CASE REPORT Case 1A 55-year-old female patient came to the emergency room due to serious back pain that occurred during sleep. The patient had a past history of taking antihypertensive drugs and drugs to treat diabetes mellitus. Blood tests conducted in the emergency room did not reveal anything in particular. Paralysis of both lower extremities occurred after the patient came to the Department of Neurosurgery, Ewha Womans University School of Medicine, Mokdong Hospital, Seoul, KoreaSpinal subdural hematoma (SSDH) is an extremely uncommon condition. Causative factors include trauma, anticoagulant drug administration, hemostatic disorders, and vascular disor...

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Object The thoracolumbar junction is frequently accessed through an anterolateral approach with the incision and muscle dissection extending from the lower thoracic region to the lateral border of the rectus abdominis muscle. This approach is frequently associated with the subsequent development of an unsightly and uncomfortable relaxation of the ipsilateral abdominal wall, or flank bulge, caused by denervation injury to the intercostal nerves. However, the etiology of this complication is not widely recognized by spine surgeons. The object of this study was to better define the relevant anatomy and innervation of the anterolateral abdominal wall musculature. Methods The authors performed 32 cadaveric dissections and 6 intraoperative electromyography (EMG) evaluations. Results The cadaveric dissection studies and intraoperative EMG evaluations provided detailed anatomy of the anterolateral abdominal wall and its innervation. Cadaveric dissections revealed that the most significant intercostal nerve contributions to the anterolateral abdominal wall arise from T11 and T12. Electrophysiological confirmation of these findings was accomplished through intraoperative stimulation in 6 patients undergoing anterolateral retroperitoneal approaches to the thoracolumbar junction. The authors confirmed T11 and T12 innervation of the anterolateral abdominal wall musculature by direct intraoperative EMG recording in all 6 patients. Conclusions The authors classified the 3 potential zones of injury that can be affected during an anterolateral approach to the thoracolumbar junction. Modifications to the operative technique are suggested to avoid the complication of flank bulge. The most significant intercostal nerve contributions to the anterolateral abdominal wall arise from T11 and T12.