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Chen K, Dong X, Lu Y, Zhang J, Liu X, Jia L, Guo Y, Chen X. Anterior decompression and posterior total laminectomy with fusion for ossification of the cervical posterior longitudinal ligament. Bone Jt Open 2024; 5:768-775. [PMID: 39288938 PMCID: PMC11407878 DOI: 10.1302/2633-1462.59.bjo-2024-0041.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
Aims Surgical approaches to cervical ossification of the posterior longitudinal ligament (OPLL) remain controversial. The purpose of the present study was to analyze and compare the long-term neurological recovery following anterior decompression with fusion (ADF) and posterior laminectomy and fusion with bone graft and internal fixation (PLF) based on > ten-year follow-up outcomes in a single centre. Methods Included in this retrospective cohort study were 48 patients (12 females; mean age 55.79 years (SD 8.94)) who were diagnosed with cervical OPLL, received treatment in our centre, and were followed up for 10.22 to 15.25 years. Of them, 24 patients (six females; mean age 52.88 years (SD 8.79)) received ADF, and the other 24 patients (five females; mean age 56.25 years (SD 9.44)) received PLF. Clinical data including age, sex, and the OPLL canal-occupying ratio were analyzed and compared. The primary outcome was Japanese Orthopaedic Association (JOA) score, and the secondary outcome was visual analogue scale neck pain. Results Compared with the baseline, neurological function improved significantly after surgery in all patients of both groups (p < 0.001). The JOA recovery rate in the ADF group was significantly higher than that in the PLF group (p < 0.001). There was no significant difference in postoperative cervical pain between the two groups (p = 0.387). The operating time was longer and intraoperative blood loss was greater in the PLF group than the ADF group. More complications were observed in the ADF group than in the PLF group, although the difference was not statistically significant. Conclusion Long-term neurological function improved significantly after surgery in both groups, with the improvement more pronounced in the ADF group. There was no significant difference in postoperative neck pain between the two groups. The operating time was shorter and intraoperative blood loss was lower in the ADF group; however, the incidence of perioperative complications was higher.
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Affiliation(s)
- Kefu Chen
- Department of Orthopaedics, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xingcheng Dong
- Orthopedics Department, Changde Hospital, Xiangya School of Medicine, Central South University (The First People's Hospital of Changde City), Changde, China
- Department of Orthopaedics, Suzhou Dushu Lake Hospital, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University, Suzhou, China
| | - Yiwei Lu
- Department of Anaesthesiology Operating Room, Changzheng Hospital, Shanghai, China
| | - Jian Zhang
- Department of Spinal Surgery Jining First People's Hospital, Shandong First Medical University, Jining, China
| | - Xiaodong Liu
- Department of Orthopaedics, Shanghai Jing'an District Zhabei Central Hospital, Shanghai, China
| | - Lianshun Jia
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ying Guo
- Department of Orthopaedics, The No. 928 hospital of Joint Logistic Support Force, Shanghai, China
| | - Xiongsheng Chen
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
- Shanghai First Hospital, Shanghai Jiao Tong University, Shanghai, China
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Miyagi M, Inoue G, Yoshii T, Egawa S, Sakai K, Kusano K, Nakagawa Y, Hirai T, Wada K, Katsumi K, Kimura A, Furuya T, Nagoshi N, Kanchiku T, Nagamoto Y, Oshima Y, Nakashima H, Ando K, Takahata M, Mori K, Nakajima H, Murata K, Matsunaga S, Kaito T, Yamada K, Kobayashi S, Kato S, Ohba T, Inami S, Fujibayashi S, Katoh H, Kanno H, Koda M, Takahashi H, Ikeda S, Imagama S, Kawaguchi Y, Takeshita K, Matsumoto M, Takaso M, Okawa A, Yamazaki M. Residual Neuropathic Pain in Postoperative Patients With Cervical Ossification of Posterior Longitudinal Ligament. Clin Spine Surg 2023; 36:E277-E282. [PMID: 36823706 DOI: 10.1097/bsd.0000000000001449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 01/25/2023] [Indexed: 02/25/2023]
Abstract
STUDY DESIGN A prospective multi-institutional observational study. OBJECTIVE To investigate and identify risk factors for residual neuropathic pain after surgery in patients with cervical ossification of posterior longitudinal ligament (c-OPLL). SUMMARY OF BACKGROUND DATA Patients with c-OPLL often require surgery for numbness and paralysis of the extremities; however, postoperative neuropathic pain can considerably deteriorate their quality of life. METHODS Out of 479 patients identified from multicenter c-OPLL registries between 2014 and 2017, 292 patients who could be followed up for 2 years postoperatively were reviewed, after excluding patients with nervous system comorbidities. Demographic details; medical history; radiographic factors including the K-line, spinal canal occupancy rate of OPLL, cervical kyphosis angle, and presence of spinal cord myelomalacia; preoperative Japanese Orthopaedic Association (JOA) score; surgical procedure (fusion or decompression surgery); postoperative neurological deterioration; and the visual analogue scale for pain and numbness in the upper extremities (U/E) or trunk/lower extremities (L/E) at baseline and at 2 years postoperatively were assessed. Patients were grouped into residual and non-residual groups based on a postoperative visual analogue scale ≥40 mm. Risk factors for residual neuropathic pain were evaluated by multiple logistic regression analysis. RESULTS The prevalence of U/E and L/E residual pain in postoperative c-OPLL patients was 51.7% and 40.4%, respectively. The U/E residual group had a poor preoperative JOA score and longer illness duration, and fusion surgery was more common in the residual group than in non-residual group. The L/E residual group was older with a poorer preoperative JOA score. On multivariate analysis, risk factors for U/E residual pain were long illness duration and poor preoperative JOA score, whereas those for L/E residual pain were age and poor preoperative JOA score. CONCLUSIONS The risk factors for residual spinal neuropathic pain after c-OPLL surgery were age, long duration of illness, and poor preoperative JOA score. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Masayuki Miyagi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
| | - Gen Inoue
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
| | - Toshitaka Yoshii
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Yushima, Bunkyo Ward, Tokyo
| | - Satoru Egawa
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Yushima, Bunkyo Ward, Tokyo
| | - Kenichiro Sakai
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Nishikawaguchi, Kawaguchishi, Saitama
| | - Kazuo Kusano
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Kudanzaka Hospital, Kudanminami, Chiyadaku
| | - Yukihiro Nakagawa
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopaedic Surgery, Wakayama Medical University Kihoku hospital, Myoji, Katsuragi-cho, Itogun, Wakayama
| | - Takashi Hirai
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Yushima, Bunkyo Ward, Tokyo
| | - Kanichiro Wada
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Zaifucho, Hirosaki, Aomori
| | - Keiichi Katsumi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Niigata University Medicine and Dental General Hospital, Asahimachidori, Chuo Ward, Niigata, Niigata
| | - Atsushi Kimura
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedics, Jichi Medical University, Yakushiji, Shimotsuke, Tochigi
| | - Takeo Furuya
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Inohana, Chuo Ward, Chiba, Chiba
| | - Narihito Nagoshi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Shinanomachi, Shinjuku Ward, Tokyo
| | - Tsukasa Kanchiku
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine Kogushi, Ube, Yamaguchi
| | - Yukitaka Nagamoto
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Nagasonecho, Sakaishi, Osaka
| | - Yasushi Oshima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hongo, Bunkyo-ku, Tokyo
| | - Hiroaki Nakashima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Tsurumaicho, Showa Ward, Nagoya, Aichi
| | - Kei Ando
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Tsurumaicho, Showa Ward, Nagoya, Aichi
| | - Masahiko Takahata
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita, Nishi, Sapporo
| | - Kanji Mori
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga
| | - Hideaki Nakajima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui
| | - Kazuma Murata
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Tokyo Medical University, Nishishinjuku, Shinjuku-ku, Tokyo
| | - Shunji Matsunaga
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Imakiire General Hospital, Shimotatsuocho, Kagoshimashi
| | - Takashi Kaito
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University Yamadaoka, Suita-shi, Osaka
| | - Kei Yamada
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopaedic Surgery, Kurume University School of Medicine Asahi-machi, Kurume-shi, Fukuoka
| | - Sho Kobayashi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Handayama, Hamamatsu, Shizuoka
| | - Satoshi Kato
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Takara-machi, Kanazawa
| | - Tetsuro Ohba
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, University of Yamanashi, Shimokato, Chuo Ward, Yamanashi
| | - Satoshi Inami
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi
| | - Shunsuke Fujibayashi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto
| | - Hiroyuki Katoh
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Shimokasuya, Isehara, Kanagawa
| | - Haruo Kanno
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Seiryomachi, Aoba Ward, Sendai, Miyagi
| | - Masao Koda
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tennodai, Tsukuba, Ibaraki
| | - Hiroshi Takahashi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tennodai, Tsukuba, Ibaraki
| | - Shinsuke Ikeda
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
| | - Shiro Imagama
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga
| | - Yoshiharu Kawaguchi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Sugitani, Toyama, Japan
| | - Katsushi Takeshita
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedics, Jichi Medical University, Yakushiji, Shimotsuke, Tochigi
| | - Morio Matsumoto
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Shinanomachi, Shinjuku Ward, Tokyo
| | - Masashi Takaso
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
| | - Atsushi Okawa
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Yushima, Bunkyo Ward, Tokyo
| | - Masashi Yamazaki
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Department of Orthopaedic Surgery, Kitasato University, Tokyo
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tennodai, Tsukuba, Ibaraki
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Inoue T, Maki S, Yoshii T, Furuya T, Egawa S, Sakai K, Kusano K, Nakagawa Y, Hirai T, Wada K, Katsumi K, Fujii K, Kimura A, Nagoshi N, Kanchiku T, Nagamoto Y, Oshima Y, Ando K, Takahata M, Mori K, Nakajima H, Murata K, Matsunaga S, Kaito T, Yamada K, Kobayashi S, Kato S, Ohba T, Inami S, Fujibayashi S, Katoh H, Kanno H, Imagama S, Koda M, Kawaguchi Y, Takeshita K, Matsumoto M, Ohtori S, Yamazaki M, Okawa A. Is anterior decompression and fusion more beneficial than laminoplasty for K-line (+) cervical ossification of the posterior longitudinal ligament? An analysis using propensity score matching. J Neurosurg Spine 2022; 37:13-20. [PMID: 35171838 DOI: 10.3171/2021.11.spine211205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/04/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE It is unclear whether anterior cervical decompression and fusion (ADF) or laminoplasty (LMP) results in better outcomes for patients with K-line-positive (+) cervical ossification of the posterior longitudinal ligament (OPLL). The purpose of the study is to compare surgical outcomes and complications of ADF versus LMP in patients with K-line (+) OPLL. METHODS The study included 478 patients enrolled in the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament and who underwent surgical treatment for cervical OPLL. The patients who underwent anterior-posterior combined surgery or posterior decompression with instrumented fusion were excluded. The patients with a follow-up period of fewer than 2 years were also excluded, leaving 198 patients with K-line (+) OPLL. Propensity score matching was performed on 198 patients with K-line (+) OPLL who underwent ADF (44 patients) or LMP (154 patients), resulting in 39 pairs of patients based on the following predictors for surgical outcomes: age, preoperative Japanese Orthopaedic Association (JOA) score, C2-7 angle, and the occupying ratio of OPLL. Clinical outcomes were assessed 1 and 2 years after surgery using the recovery rate of the JOA score. Complications and reoperation rates were also investigated. RESULTS The mean recovery rate of the JOA score 1 year after surgery was 55.3% for patients who underwent ADF and 42.3% (p = 0.06) for patients who underwent LMP. Two years after surgery, the recovery rate was 53.4% for those who underwent ADF and 38.7% for LMP (p = 0.07). Although both surgical procedures yielded good results, the mean recovery rate of JOA scores tended to be higher in the ADF group. The incidence of surgical complications, however, was higher following ADF (33%) than LMP (15%; p = 0.06). The reoperation rate was also higher in the ADF group (15%) than in the LMP group (0%; p = 0.01). CONCLUSIONS Clinical outcomes were good for both ADF and LMP, indicating that ADF and LMP are appropriate procedures for patients with K-line (+) OPLL. Clinical outcomes of ADF 1 and 2 years after surgery tended to be better than LMP, but the analysis did not detect any significant difference in clinical outcomes between the groups. Conversely, patients who underwent ADF had a higher incidence of surgery-related complications. When considering indications for ADF or LMP, benefits and risks of the surgical procedures should be carefully weighed.
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Affiliation(s)
- Takaki Inoue
- 1Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba
| | - Satoshi Maki
- 1Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba
| | - Toshitaka Yoshii
- 2Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo
| | - Takeo Furuya
- 1Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba
| | - Satoru Egawa
- 2Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo
| | - Kenichiro Sakai
- 3Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Saitama
| | - Kazuo Kusano
- 4Department of Orthopedic Surgery, Kudanzaka Hospital, Chiyoda-yu, Tokyo
| | - Yukihiro Nakagawa
- 5Department of Orthopedic Surgery, Wakayama Medical University Kihoku Hospital, Ito-gun, Wakayama
| | - Takashi Hirai
- 2Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo
| | - Kanichiro Wada
- 6Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori
| | - Keiichi Katsumi
- 7Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Niigata
| | - Kengo Fujii
- 8Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Atsushi Kimura
- 9Department of Orthopedics, Jichi Medical University, Shimotsuke, Tochigi
| | - Narihito Nagoshi
- 10Department of Orthopedic Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo
| | - Tsukasa Kanchiku
- 11Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi
| | - Yukitaka Nagamoto
- 12Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakai, Osaka
| | - Yasushi Oshima
- 13Department of Orthopedic Surgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo
| | - Kei Ando
- 14Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi
| | - Masahiko Takahata
- 15Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido
| | - Kanji Mori
- 16Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga
| | - Hideaki Nakajima
- 17Department of Orthopedics and Rehabilitation Medicine, University of Fukui Faculty of Medical Sciences, Yoshida-gun, Fukui
| | - Kazuma Murata
- 18Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo
| | - Shunji Matsunaga
- 19Department of Orthopedic Surgery, Imakiire General Hospital, Kagoshima
| | - Takashi Kaito
- 20Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka
| | - Kei Yamada
- 21Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume, Fukuoka
| | - Sho Kobayashi
- 22Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka
| | - Satoshi Kato
- 23Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa
| | - Tetsuro Ohba
- 24Department of Orthopedic Surgery, University of Yamanashi, Chuo, Yamanashi
| | - Satoshi Inami
- 25Department of Orthopedic Surgery, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi
| | - Shunsuke Fujibayashi
- 26Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto
| | - Hiroyuki Katoh
- 27Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa
| | - Haruo Kanno
- 28Department of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi; and
| | - Shiro Imagama
- 14Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi
| | - Masao Koda
- 8Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Yoshiharu Kawaguchi
- 29Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Japan
| | - Katsushi Takeshita
- 9Department of Orthopedics, Jichi Medical University, Shimotsuke, Tochigi
| | - Morio Matsumoto
- 10Department of Orthopedic Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo
| | - Seiji Ohtori
- 1Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba
| | - Masashi Yamazaki
- 8Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki
| | - Atsushi Okawa
- 2Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo
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