Surgical fixation of A-A joint in a hyperlordotic position will lead the lower cervical spine to a kyphotic sagittal alignment after surgery. To maintain the physiologic sagittal alignment of the subaxial cervical spine, C1-C2 should not be fixed in a hyperlordotic position.

Malposition rate of PS placement in the cervical spine by freehand technique was high in rheumatoid patients even when being performed by experienced spine surgeons. Any guidance tools including navigation systems are recommended for placement of cervical PSs in patients with RA.

These findings suggest that higher PI in the younger individual may contribute to the development of HOA in later life without both lumbar kyphosis and acetabular dysplasia because of the anterior uncovering of the acetabulum. More investigation will be expected to analyze the spinopelvic alignment in patients with hip spine syndrome.

The survey observed many hidden alcoholic patients, and showed the possibility that the healthcare facilities and health screening became the place of screening and intervention for alcohol dependence.

✓Discal cysts are rare lesions that can result in refractory sciatica. Because they are so rare, their exact origin and details of the clinical manifestations are still unknown. The authors report on five men treated for discal cysts. The mean age of the patients at the time of the surgery was 32 years (range 25–38 years). All patients suffered from lower-extremity pain and the results of the straight leg–raising test were positive in all cases. Three patients reported motor weakness and four had sensory disturbance—symptoms similar to those found in patients with lumbar disc herniation. Magnetic resonance imaging demonstrated spherically shaped extradural lesions of various sizes with low and high signal intensities on T1- and T2-weighted images, respectively. Discography revealed obvious communication between the cyst and the intervertebral disc with reproducible leg pain in all patients. All patients underwent posterior decompression and excision of the cysts either with or without additional discectomy. The radicular symptoms were remarkably improved in all patients immediately after surgery, and no recurrent lesions were noted during follow up.

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To combine preoperative epidural anesthesia with other anesthetic procedure for spinal fusion contributes to maintain more stable hypotension during surgery. As a result, it will be possible to lessen the bleeding during surgery. In addition, the postoperative pain was easily controlled with administration of fewer analgesic agents in patients who underwent the epidural anesthesia. The effectiveness of pre-emptive analgesia should be emphasized to diminish the postoperative pain.

Cervical pedicle screw is thought to be the most stable instrumentation for reconstructive surgery of the cervical spine. However, because of the unresolved and inherent risk of neurovascular injuries due to screw perforation, it remains not widespread nowadays despite the excellent biomechanical property. Fifty-two consecutive cases having undergone spinal reconstruction using cervical pedicle screw were investigated. There were 24 females and 28 males. The mean follow-up period was 53 months. Those patients were stratified into three groups according to the period of screw insertion. A total of 280 screws were inserted. Ninety-two screws in 19 cases, 100 screws in 18 cases and 88 screws in 15 cases were inserted in the earlier, the middle and the later periods, respectively. Clinical results including complications were recorded in all cases. Screw perforations were evaluated in both plain X-ray and CT. Screw perforations occurred in 11 (12.0%), 7 (7.0%) and 1 (1.1%) screws in each period. There were no complications, such as infection, neurological deterioration and neurovascular injury directly related to screw insertion. The learning curve showed a significant improvement especially in the later period. However, the perforation rates in both the earlier and middle periods must not be underestimated. Surgeons with less experience must insert cervical pedicle screws with the assistance of a senior surgeon to avoid lethal complications.