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Wakabayashi N, Kimura R, Kuwatani M, Matsui A, Ino N, Mitsuhashi T, Kishi K, Tsuneta S, Nakagawa J, Nishioka N, Sakamoto K, Kato F, Shimizu A, Hirano S, Kudo K. Gastrointestinal: Solid pseudopapillary neoplasm of the pancreas with high-grade malignant transformation. J Gastroenterol Hepatol 2024; 39:618-619. [PMID: 38224676 DOI: 10.1111/jgh.16455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/11/2023] [Indexed: 01/17/2024]
Affiliation(s)
- N Wakabayashi
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - R Kimura
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - M Kuwatani
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan
| | - A Matsui
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - N Ino
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - T Mitsuhashi
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - K Kishi
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan
| | - S Tsuneta
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - J Nakagawa
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - N Nishioka
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - K Sakamoto
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - F Kato
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - A Shimizu
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - S Hirano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - K Kudo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Nitori N, Deguchi T, Kato A, Kato F, Shinoda M, Itano O. Ileal interposition reconstruction for ileo-rectal fistula following sex reassignment surgery: A case report. Int J Surg Case Rep 2023; 109:108523. [PMID: 37481975 PMCID: PMC10391648 DOI: 10.1016/j.ijscr.2023.108523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/01/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023] Open
Abstract
INTRODUCTION Ileorectal fistulas following sigmoid colon vaginoplasty are rare. Reports on the management of the surgical complications of sex reassignment operations among transgender patients are few. PRESENTATION OF CASE A 40-year-old patient with a male-to-female sex identity disorder underwent sigmoid vaginoplasty for sex reassignment 4 months prior to presentation. The patient was referred for persistent diarrhea and postoperative lower abdominal pain. Proctoscopy, gastrografin enema, and small bowel enterography revealed rectal anastomotic stenosis and an ileorectal fistula. The prior anastomotic site and ileal rectal fistula were resected, and ileal interposition reconstruction was performed to avoid damaging the blood supply to the artificial vagina. Routine follow-up after the closure of the diverting ileostomy showed no new pathologies. DISCUSSION This case highlighted the management of surgical complications after sex reassignment surgery. CONCLUSION Ileal interposition was a useful reconstruction method after resecting the colonic anastomotic site to preserve the artificial vagina.
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Affiliation(s)
- Nobuhiro Nitori
- Center of Digestive Diseases, International University of Health and Welfare Mita Hospital, Mita 1-4-3, Minato-ku, Tokyo 108-8329, Japan.
| | - Tomoaki Deguchi
- Department of Surgery, Machida Hospital, Kiso-higasi 4-21-43, Machida-shi, Tokyo 194-0036, Japan
| | - Ayu Kato
- Center of Digestive Diseases, International University of Health and Welfare Mita Hospital, Mita 1-4-3, Minato-ku, Tokyo 108-8329, Japan
| | - Fumihiko Kato
- Center of Digestive Diseases, International University of Health and Welfare Mita Hospital, Mita 1-4-3, Minato-ku, Tokyo 108-8329, Japan
| | - Masahiro Shinoda
- Center of Digestive Diseases, International University of Health and Welfare Mita Hospital, Mita 1-4-3, Minato-ku, Tokyo 108-8329, Japan
| | - Osamu Itano
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852 Hatakeda Narita, Chiba 286-0124, Japan
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Machino M, Nakashima H, Ito K, Ando K, Ito S, Kato F, Imagama S. Cervical disc degeneration is associated with a reduction in mobility: A cross-sectional study of 1211 asymptomatic healthy subjects. J Clin Neurosci 2022; 99:342-348. [PMID: 35344872 DOI: 10.1016/j.jocn.2022.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/13/2022] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
The aim of this study was to establish the age-related changes and gender-specific differences of cervical disc degeneration using magnetic resonance image (MRI) and to evaluate the correlation between the severity of cervical disc degeneration and mobility in asymptomatic subjects. A total of 1,211 relatively healthy volunteers (606 males and 605 females, mean age 49.5 years) without neurological symptoms underwent MRI. At least 100 males and 100 females in each decade of life between the 20 s and the 70 s were included. This study was part of a larger project and used some previously published data. Cervical disc degeneration was defined according to the modified Pfirrmann classification system. A total disc degeneration score (DDS) was calculated by the summation of individual Pfirrmann scores from C2/C3 to C7/T1. Cervical range of motion (ROM) was measured by radiograph. The total DDS increased gradually with increasing age in both genders. DDSs were lower in females than in males in all decades. A DDS of 13 or more was found in more than half the cases in the 40 s or older age groups. The total DDS was 13 or more in over 95% of the cases in the 70 s age group. The total DDS was significantly and negatively correlated with cervical ROM overall (r = - 0.46, p < 0.0001) and in both men (r = - 0.52, p < 0.0001) and women (r = - 0.40, p < 0.0001). This large-scale cross-sectional analysis of cervical spine MRI data in healthy subjects demonstrated that cervical disc degeneration progresses with age, and is correlated with a reduction in mobility.
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Affiliation(s)
- Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan.
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Keigo Ito
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, 1-10-6 Komei, Minato-ku, Nagoya, Aichi 455-8530, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, 1-10-6 Komei, Minato-ku, Nagoya, Aichi 455-8530, Japan; Chubu Rosai Nursing School, Japan Organization of Occupational Health and Safety, Nagoya, Japan, 1-10-6 Komei, Minato-ku, Nagoya, Aichi 455-8530, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan
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Yamada T, Ueno T, Kato F, Matsuyama Y, Yamada H, Yukawa Y. Intraforaminal cervical gas cyst with vacuum disc treated by anterior cervical discectomy and fusion: illustrative case. Journal of Neurosurgery: Case Lessons 2022; 3:CASE21638. [PMID: 36273861 PMCID: PMC9379676 DOI: 10.3171/case21638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/27/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The authors report an extremely rare presentation of a patient with an intraforaminal cervical gas cyst with radiculopathy. The patient’s condition was refractory to conservative treatment, and he was treated by anterior cervical discectomy and fusion (ACDF). Several intraspinal gas cysts with lumbar disc herniation have been treated surgically. However, no cases of intraforaminal cervical gas requiring ACDF have been reported. OBSERVATIONS A 70-year-old male patient presented with right-sided neck and shoulder pain, aggravating in the supine position. Cervical radiography showed vacuum disc phenomenon at C4–5, and multiplanar computed tomography showed intraforaminal gas along the right C5 nerve root. The patient experienced severe pain with impaired sleep and daytime fatigue. After confirming C5 radiculopathy using an echo-guided technique using ultrasonography guidance, the authors performed C4–5 ACDF. Postoperatively, the patient’s neck and shoulder pain disappeared immediately. There was no recurrence at the 2-year follow-up. LESSONS This is the first case report of an intraspinal cervical gas cyst with radiculopathy treated by ACDF surgery. The vacuum disc had been implicated as the genesis of the intraforaminal cervical gas cyst, leading to radiculopathy. ACDF surgery provides favorable outcomes in cases of intraspinal gas refractory to conservative therapy.
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Affiliation(s)
- Tomohiro Yamada
- Department of Orthopedic Surgery, Nagoya Kyoritsu Hospital, Aichi, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan; and
| | - Takeru Ueno
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Nagoya Kyoritsu Hospital, Aichi, Japan
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan; and
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Yasutsugu Yukawa
- Department of Orthopedic Surgery, Nagoya Kyoritsu Hospital, Aichi, Japan
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
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Tokunaga R, Takahashi Y, Touj S, Hotta H, Leblond H, Kato F, Piché M. Attenuation of widespread hypersensitivity to noxious mechanical stimuli by inhibition of GABAergic neurons of the right amygdala in a rat model of chronic back pain. Eur J Pain 2022; 26:911-928. [DOI: 10.1002/ejp.1921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/06/2022] [Indexed: 11/06/2022]
Affiliation(s)
- R. Tokunaga
- Department of Anatomy Université du Québec à Trois‐Rivières Trois‐Rivières QC Canada G9A 5H7
- CogNAC Research Group Université du Québec à Trois‐Rivières Trois‐Rivières QC Canada G9A 5H7
| | - Y. Takahashi
- Department of Neuroscience Jikei University School of Medicine Tokyo Japan
| | - S. Touj
- Department of Anatomy Université du Québec à Trois‐Rivières Trois‐Rivières QC Canada G9A 5H7
- CogNAC Research Group Université du Québec à Trois‐Rivières Trois‐Rivières QC Canada G9A 5H7
| | - H. Hotta
- Department of Autonomic Neuroscience Tokyo Metropolitan Institute of Gerontology Tokyo Japan
| | - H. Leblond
- Department of Anatomy Université du Québec à Trois‐Rivières Trois‐Rivières QC Canada G9A 5H7
- CogNAC Research Group Université du Québec à Trois‐Rivières Trois‐Rivières QC Canada G9A 5H7
| | - F. Kato
- Department of Neuroscience Jikei University School of Medicine Tokyo Japan
| | - M. Piché
- Department of Anatomy Université du Québec à Trois‐Rivières Trois‐Rivières QC Canada G9A 5H7
- CogNAC Research Group Université du Québec à Trois‐Rivières Trois‐Rivières QC Canada G9A 5H7
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Kobayashi K, Sato K, Kato F, Kanemura T, Yoshihara H, Sakai Y, Shinjo R, Ohara T, Yagi H, Matsubara Y, Ando K, Nakashima H, Imagama S. Trends in the numbers of spine surgeries and spine surgeons over the past 15 years. Nagoya J Med Sci 2022; 84:155-162. [PMID: 35392003 PMCID: PMC8971033 DOI: 10.18999/nagjms.84.1.155] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/12/2021] [Indexed: 11/20/2022]
Abstract
The purpose of this study is to examine trends in spine surgeries at ten facilities over 15 years, and to analyze relationships with the number of spine surgeons at these facilities. The subjects were patients who underwent spine surgery at the ten facilities from 2003 to 2017. Data were collected every year via a questionnaire designed to obtain clinicopathological and surgical information. There were 37,601 spine surgeries (60.2% male) recorded in the registry at 9 facilities in the Nagoya Spine Group (NSG) between 2003 and 2017, with an increase in the annual number of surgeries by 2.4 times over 15 years. On the other hand, the number of spine surgeons has increased by just under 1.5 times. Instrumentation surgeries increased from 959 in 2003 to 2,276 in 2017 (2.3 times). There was a particularly marked increase in surgeries for spinal degenerative disease from 1,075 in 2003 to 2,821 in 2017 (2.6 times). The number of surgeries performed per surgeon increased from 61.4 in 2003 to 102.8 in 2017, while the average number of spine surgeons per hospital increased from 2.6 in 2003 to 3.7 in 2017. In conclusion, with heavier burden on spine surgeons and the major changes in the spine surgery environment, training and increasing surgeons with advanced expertise and skills will become increasingly important.
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Affiliation(s)
- Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Sato
- Department of Orthopaedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Fumihiko Kato
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Tokumi Kanemura
- Department of Orthopaedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Hisatake Yoshihara
- Department of Orthopaedic Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Yoshihito Sakai
- Department of Orthopaedic Surgery, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Ryuichi Shinjo
- Department of Orthopaedic Surgery, Anjo Kosei Hospital, Anjo, Japan
| | - Tetsuya Ohara
- Department of Orthopaedic Surgery, Meijo Hospital, Nagoya, Japan
| | - Hideki Yagi
- Department of Orthopaedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Yuji Matsubara
- Department of Orthopaedic Surgery, Kariya Toyota General Hospital, Kariya, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Takagi Y, Hatori T, Itano O, Shinoda M, Kato A, Nitori N, Kato F, Kato A, Nakao A, Tamura T, Uemura S, Miyazaki M, Aida S. Pancreatic serous cystadenocarcinoma diagnosed with liver metastasis at 7 years after the resection of the primary serous neoplastic lesion. Clin J Gastroenterol 2022; 15:505-512. [PMID: 35013932 DOI: 10.1007/s12328-021-01570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/02/2021] [Indexed: 11/28/2022]
Abstract
Pancreatic serous neoplasms are rare tumors that are usually benign. However, histopathological differentiation between benign (serous cystadenoma) and malignant (serous cystadenocarcinoma) lesions is difficult. We present the case of a patient with pancreatic serous cystadenocarcinoma that was diagnosed with liver metastasis 7 years after the resection of the primary serous neoplastic lesion. A woman in her 60 s was diagnosed with pancreatic serous cystadenoma based on imaging and histopathological examination findings. The tumor was resected, and the patient was followed up every 6 months to monitor tumor progression. At 7 years after the resection of the primary lesion, liver tumors showing marked flare-like contrast enhancements were detected on arterial phase computed tomography findings and on dynamic magnetic resonance imaging findings acquired 60 s after the administration of a contrast agent. Laparoscopic segmental hepatectomy of S4 and S6 was performed to resect these tumors. Histopathological examination revealed that these tumors were metastatic and developed from the primary lesion. Therefore, a diagnosis of serous cystadenocarcinoma was confirmed. The flare-like contrast enhancement around the metastatic liver lesions on computed tomography and dynamic magnetic resonance images may be an indicator of serous cystadenocarcinoma with liver metastasis that could assist in diagnosis.
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Affiliation(s)
- Yutaka Takagi
- Digestive Disease Center, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan.
| | - Takashi Hatori
- Digestive Disease Center, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Osamu Itano
- Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, Narita Hospital, 852 Hatakeda, Narita, Chiba Prefecture, 286-0124, Japan
| | - Masahiro Shinoda
- Digestive Disease Center, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Atsushi Kato
- Digestive Disease Center, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Nobuhiro Nitori
- Digestive Disease Center, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Fumihiko Kato
- Digestive Disease Center, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Ayu Kato
- Digestive Disease Center, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Atsushi Nakao
- Digestive Disease Center, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Takuya Tamura
- Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, Narita Hospital, 852 Hatakeda, Narita, Chiba Prefecture, 286-0124, Japan
| | - Shuichiro Uemura
- Institute of Gastroenterology, Department of Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masaru Miyazaki
- Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, Narita Hospital, 852 Hatakeda, Narita, Chiba Prefecture, 286-0124, Japan
| | - Shinsuke Aida
- Department of Pathology, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan
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Yoshimura T, Nishioka K, Hashimoto T, Kogame S, Seki K, Sugimori H, Yamashina H, Kato F, Aoyama H, Kudo K, Shimizu S. Evaluation of Visualizing the Prostatic Urinary Tract in MRI With a Super Resolution Deep Learning Model for Urethra Sparing Radiotherapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kobayashi K, Ando K, Kato F, Kanemura T, Sato K, Hachiya Y, Matsubara Y, Sakai Y, Yagi H, Shinjo R, Ishiguro N, Imagama S. Seasonal variation in incidence and causal organism of surgical site infection after PLIF/TLIF surgery: A multicenter study. J Orthop Sci 2021; 26:555-559. [PMID: 32800525 DOI: 10.1016/j.jos.2020.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/21/2020] [Accepted: 05/26/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Postoperative SSI is a common and potentially serious complication in spine surgery. Seasonal variation occurs in rates of nosocomial infection, with higher rates found in the summer, during which hot, humid conditions may be optimal for proliferation of bacteria. This might also influence the rate of SSI. The purpose of the study was to examine seasonal variation in SSI after PLIF/TLIF surgery, including relationships with experience of surgeons and causal organisms. METHODS Cases with SSI after PLIF/TLIF surgery at 10 facilities between January 1, 2012, and December 31, 2014 were retrieved from a database. Infection was defined based on CDC guidelines for SSIs. Patients were followed for at least two years after surgery. Surgeries were examined in spring (April-June), summer (July-September), autumn (October-December), and winter (January-March). Seasonal variation and other factors with a potential association with SSIs were evaluated. RESULTS A total of 1174 patients (607 males, 567 females) who underwent PLIF/TLIF surgery were identified. The operations were PLIF (n = 667), TLIF (n = 443), MIS-PLIF (n = 27), and MIS-TLIF (n = 37). The total SSI rate for the 2-year period was 2.5% (29/1174), and the 2-year average SSI rates for surgeries in each season were spring, 2.6% (7/266); summer, 3.9% (13/335); fall, 1.3% (4/302); winter, 1.8% (5/271). The SSI rate was significantly higher in summer than non-summer (3.9% vs. 1.9%, p < 0.05). SSIs were caused by a variety of pathogens, including Gram-positive cocci, and Staphylococcus aureus was the most common pathogenic organism to cause SSI. CONCLUSION Seasonality should be taken into account in strategies for SSI prevention, with particular attention on mitigation of increased temperature and humidity in the summer and on infection caused by Gram-positive cocci and S. aureus.
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Affiliation(s)
- Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Fumihiko Kato
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6, Komei, Minato-ku, Nagoya, 455-8530, Japan
| | - Tokumi Kanemura
- Department of Orthopaedic Surgery, Konan Kosei Hospital, 137, Omatsubara, Takaya-cho, Konan, Aichi, 483-8704, Japan
| | - Koji Sato
- Department of Orthopaedic Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| | - Yudo Hachiya
- Department of Orthopaedic Surgery, Hachiya Orthopaedic Hospital, 2-4, Suemoridori, Chikusa-ku, Nagoya, 464-0821, Japan
| | - Yuji Matsubara
- Department of Orthopaedic Surgery, Kariya Toyota General Hospital, 15, Sumiyoshi-cho 5, Kariyashi, Aichi, 448-8505, Japan
| | - Yoshihito Sakai
- Department of Orthopaedic Surgery, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu, Aichi, 474-8511, Japan
| | - Hideki Yagi
- Department of Orthopaedic Surgery, Japanese Red Cross Nagoya Daiichi Hospital, 3-35, Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Ryuichi Shinjo
- Department of Orthopaedic Surgery, Anjo Kosei Hospital, 28, Higashi-Kohan, Anjo-cho, Anjo, Aichi, 446-8602, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan.
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Machino M, Ito K, Ando K, Kobayashi K, Nakashima H, Kato F, Imagama S. Normative Magnetic Resonance Imaging Data of Age-Related Degenerative Changes in Cervical Disc Morphology. World Neurosurg 2021; 152:e502-e511. [PMID: 34098133 DOI: 10.1016/j.wneu.2021.05.123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Few studies have examined a possible correlation between cervical disc degeneration and disc height. The aim of this study was to establish age-related changes and sex-specific differences of cervical disc height using magnetic resonance imaging (MRI) and to evaluate the relationship between degree of cervical disc degeneration and disc height in asymptomatic subjects. METHODS We measured the intervertebral disc anteroposterior diameter and disc height in each disc level using MRI in 1211 relatively healthy volunteers (606 men and 605 women, mean age 49.5 years). We included at least 100 males and 100 females in each decade of life between the 20s and the 70s. Cervical disc degeneration was defined according to the modified Pfirrmann classification system, and disc index and intervertebral disc height narrowing ratio were evaluated on sagittal plane MRI. RESULTS Intervertebral disc height decreased gradually with increasing age in both sexes. The grade of disc degeneration significantly increased with age in both sexes at every level. Mild disc degeneration was observed even in subjects their 20s. Disc degeneration occurred around the C5-C6 level. The average disc height decreased with aging after the 40s. Disc index and intervertebral disc height narrowing ratio decreased with a progression in the disc degeneration grade in both sexes. CONCLUSIONS This large-scale cross-sectional analysis of cervical spine MRI data in healthy subjects demonstrated that cervical disc height narrowing progresses with age. Cervical disc height narrowing is highly correlated with the progression of disc degeneration.
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Affiliation(s)
- Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Nagoya, Aichi, Japan.
| | - Keigo Ito
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Aichi, Nagoya, Aichi, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Nagoya, Aichi, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Nagoya, Aichi, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Nagoya, Aichi, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Aichi, Nagoya, Aichi, Japan; Chubu Rosai Nursing School, Japan Organization of Occupational Health and Safety, Japan, Nagoya, Aichi, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Nagoya, Aichi, Japan
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11
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Kato F, Koyanagi K, Sugihara S, Nakagawa T, Hayashi K, Shintoku J. Long-term survival case of esophageal carcinosarcoma coexisting with alcoholic liver cirrhosis successfully treated by staged operation: A case report. Int J Surg Case Rep 2021; 83:105946. [PMID: 33975200 PMCID: PMC8129925 DOI: 10.1016/j.ijscr.2021.105946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/26/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Patients with esophageal cancers including carcinosarcoma sometimes have underlying liver cirrhosis because of a history of heavy drinking. It is definitely required to determine the appropriate surgical strategy and to manage the patients promptly when performing esophagectomy for the esophageal carcinosarcoma coexisting with alcoholic liver cirrhosis. Presentation of case A 56-year-old male patient with a history of chest pain and difficulty swallowing was admitted to our hospital. He had a history of drinking 250 g of alcohol per day. Endoscopy revealed an irregular protruding tumor on the left wall of the lower-third thoracic esophagus. Computed tomography showed a tumor lesion in the lower-third thoracic esophagus; the images also showed irregularities on the surface of the liver, suggestive of coexisting alcoholic liver cirrhosis. The preoperative diagnosis was T3N2M0, Stage III esophageal leiomyosarcoma. In consideration of the underlying alcoholic liver cirrhosis, a staged operation was planned for this patient as a curative treatment. The patient had an uneventful postoperative clinical course and was discharged on the 47th day after the first surgery. Final histopathological diagnosis was T2N0M0, Stage II esophageal carcinosarcoma. The patient is alive without recurrence three years after surgery. Discussion This is the first report of long-term survival case of esophageal carcinosarcoma with alcoholic liver cirrhosis that was treated successfully by staged operation. Conclusions Despite coexisting with alcoholic liver cirrhosis, staged operation could reduce the surgical invasiveness, so that very good short-term outcome and long-term survival was obtained in the patient with esophageal carcinosarcoma. Patients with esophageal carcinosarcoma sometimes have underlying liver cirrhosis because of a history of heavy drinking. Postoperative severe complications often occur after esophagectomy in patients with liver cirrhosis. Staged operation could reduce the surgical invasiveness and manage these patients.
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Affiliation(s)
- Fumihiko Kato
- Department of Surgery, Ota Memorial Hospital, 455-1 Oshima-cho, Ota, Gunma 373-8585, Japan
| | - Kazuo Koyanagi
- Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
| | | | - Tomohiko Nakagawa
- Department of Surgery, Ota Memorial Hospital, 455-1 Oshima-cho, Ota, Gunma 373-8585, Japan
| | - Koji Hayashi
- Department of Surgery, Ota Memorial Hospital, 455-1 Oshima-cho, Ota, Gunma 373-8585, Japan
| | - Junichi Shintoku
- Department of Surgery, Ota Memorial Hospital, 455-1 Oshima-cho, Ota, Gunma 373-8585, Japan
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12
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Nakashima H, Ishikawa Y, Kato F, Kanemura T, Shinjo R, Ando K, Kobayashi K, Ishiguro N, Imagama S. Postoperative iatrogenic spinal cord herniation: three case reports with a literature review. Nagoya J Med Sci 2021; 82:383-389. [PMID: 32581417 PMCID: PMC7276416 DOI: 10.18999/nagjms.82.2.383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although a majority of spinal cord herniation reportedly occurs idiopathically, postoperative iatrogenic spinal cord herniation is rare. Therefore, the incidence rate, pathogenic mechanism, and clinical outcomes are not clear. We present three cases of postoperative iatrogenic spinal cord herniation and present a literature review. Our data base included 32253 patients who underwent spinal surgery, and among these patients, 3 showed postoperative spinal cord herniation. Postoperative spinal cord herniation was observed in a 55-year-old man and a 60-year-old man. Both these patients underwent cervical laminoplasty for degenerative cervical myelopathy; however, intraoperative dural tear was reported. They presented with severe quadriplegia and sensory disorders at 8 years and 2 months after initial surgery. The third case of postoperative spinal cord herniation was of a 47-year-old woman who underwent Th11/12 schwannoma resection. Her neurological symptoms did not improve after tumor resection, and MRI at 2 months after surgery revealed spinal cord herniation. All the 3 patients underwent spinal cord reduction surgery; one patient showed sufficient neurological improvement while 2 patients with cervical spinal cord herniation showed limited neurological improvement due to preoperative severe quadriplegia. Although postoperative iatrogenic spinal cord herniation is a relatively rare pathology, careful observation with postoperative MRI is required in cases of patients with new neurological symptoms after dural injury and durotomy.
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Affiliation(s)
- Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Spine & Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Yoshimoto Ishikawa
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Spine & Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Tokumi Kanemura
- Department of Spine & Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Ryuichi Shinjo
- Department of Spine & Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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13
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Koshimizu H, Nakashima H, Ito K, Ando K, Kobayashi K, Kato F, Sato K, Deguchi M, Matsubara Y, Inoue H, Kanemura T, Urasaki T, Yoshihara H, Wakao N, Shinjo R, Imagama S. Risk factors of non-union in Anderson-D'Alonzo type III odontoid fractures with conservative treatment. J Orthop 2021; 24:280-283. [PMID: 33897130 DOI: 10.1016/j.jor.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022] Open
Abstract
Objective The purpose of this study was retrospectively to analyze the risk factors for non-union in Anderson-D'Alonzo type III odontoid fractures with conservative treatment. Methods 25 patients with type III fractures were analyzed. Coronal and sagittal tilt as well as sagittal and lateral mass gaps were measured by using computed tomography. Results The non-union group had significantly higher age, greater coronal tilt and lateral mass gap. Especially, the lateral mass gap was >2 mm in all cases with non-union. Conclusions Higher age, coronal tilt, and lateral mass gap were significant risk factors for non-union.
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Affiliation(s)
- Hiroyuki Koshimizu
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Nagoya Spine Group, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Nagoya Spine Group, Japan
| | - Keigo Ito
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, Nagoya, Aichi, Japan.,Nagoya Spine Group, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Nagoya Spine Group, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Nagoya Spine Group, Japan
| | - Fumihiko Kato
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, Nagoya, Aichi, Japan.,Nagoya Spine Group, Japan
| | - Koji Sato
- Department of Orthopaedic Surgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan.,Nagoya Spine Group, Japan
| | - Masao Deguchi
- Department of Orthopaedic Surgery, Nagano Red Cross Hospital, Nagano, Nagano, Japan.,Nagoya Spine Group, Japan
| | - Yuji Matsubara
- Department of Orthopaedic Surgery, Kariya Toyota General Hospital, Kariya, Aichi, Japan.,Nagoya Spine Group, Japan
| | - Hidenori Inoue
- Department of Orthopaedic Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Aichi, Japan.,Nagoya Spine Group, Japan
| | - Tokumi Kanemura
- Department of Orthopaedic Surgery, Konan Kosei Hospital, Konan, Aichi, Japan.,Nagoya Spine Group, Japan
| | - Tetsuya Urasaki
- Department of Orthopaedic Surgery, Chutoen General Medical Center, Kakegawa, Shizuoka, Japan.,Nagoya Spine Group, Japan
| | - Hisatake Yoshihara
- Department of Orthopaedic Surgery, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan.,Nagoya Spine Group, Japan
| | - Norimitsu Wakao
- Department of Orthopaedic Surgery, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.,Nagoya Spine Group, Japan
| | - Ryuichi Shinjo
- Department of Orthopaedic Surgery, Anjo Kosei Hospital, Anjo, Aichi, Japan.,Nagoya Spine Group, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Nagoya Spine Group, Japan
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14
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Machino M, Ito K, Kato F, Ando K, Kobayashi K, Nakashima H, Kanbara S, Ito S, Inoue T, Koshimizu H, Imagama S. Kinetic changes in the spinal cord occupation rate of dural sac in cervical spondylotic myelopathy. J Orthop 2021; 24:222-226. [PMID: 33767534 DOI: 10.1016/j.jor.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/07/2021] [Indexed: 11/18/2022] Open
Abstract
Objective The study aimed to establish the spinal cord occupation rate of the dural sac during flexion and extension. Methods We measured the cross-sectional area of the dural sac and the spinal cord between C2/C3 and C7/T1 disc levels in 100 patients with cervical spondylotic myelopathy and 1211 asymptomatic subjects. Results The spinal cord occupation rate of the dural sac in the cross-sectional area was higher on extension than on flexion at the mid-lower cervical spine. Conclusions The spinal cord occupation rate of the dural sac in the cross-sectional area was highest at the C4/C5 and C5/C6 levels on extension.
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Affiliation(s)
- Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keigo Ito
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Kanbara
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taro Inoue
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Koshimizu
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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15
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Machino M, Ando K, Kobayashi K, Nakashima H, Kanbara S, Ito S, Inoue T, Ito K, Kato F, Ishiguro N, Imagama S. Risk Factors for Poor Outcome of Cervical Laminoplasty: Multivariate Analysis in 505 Patients with Cervical Spondylotic Myelopathy. Spine (Phila Pa 1976) 2021; 46:329-336. [PMID: 33156275 DOI: 10.1097/brs.0000000000003783] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The risk factors for poor outcome after cervical laminoplasty in patients with cervical spondylotic myelopathy (CSM) were demonstrated. These findings suggest that advanced age, long-term CSM symptoms, and lower score of preoperative 10-second step test are risk factors for poor cervical laminoplasty outcomes in patients with CSM.
Study Design..
A prospective study.
Objective..
The aim of this study was to characterize the risk factors for poor outcome following cervical laminoplasty in patients with cervical spondylotic myelopathy (CSM).
Summary of Background Data..
Previous research has identified a variety of potential predictive factors that might affect outcomes after cervical laminoplasty. However, no study till date has assessed the effects of such risk factors, including internal medicine comorbidity and quantitative performance tests, on the outcome of laminoplasty in a large series of patients with CSM.
Methods..
A total of 505 consecutive patients with CSM (311 males; 194 females; mean age, 66.6 years; age range, 41–91 years) who underwent double-door laminoplasty were prospectively included. The average postoperative follow-up period was 26.5 months (range, 12–66 months). We evaluated the recovery rate (RR) on the basis of the Japanese Orthopaedic Association score. Logistic regression analysis was performed to identify the risk factors for poor outcome, which was defined as a postoperative RR of <50%. Relationship between outcome and various clinical and imaging predictors was examined.
Results..
Two hundred ninety-five patients had good outcomes with RR >50%, whereas 210 patients had poor outcomes with RR <50%. Compared with the good-outcome group, the poor-outcome group had a significantly higher prevalence of diabetes and hypertension and use of anticoagulant/antiplatelet agent and smoking history (P < 0.05). Multivariate logistic regression analysis showed independent risks associated with increased age (odds ratio [ORs] = 1.029, 95% confidence interval [CI] = 1.004–1054, P = 0.023). Logistic regression analysis determined that symptom duration of CSM (OR = 1.017, 95% CI = 1.008–1.026, P < 0.001) and preoperative 10-second step test (OR = 0.922, 95% CI = 0.865–0.983, P = 0.013) were significant risk factors for poor outcome.
Conclusion..
These findings suggest that advanced age, long-term CSM symptoms, and lower score of preoperative 10-second step test are risk factors for poor outcome in patients with CSM.
Level of Evidence: 2
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Affiliation(s)
- Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Kanbara
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taro Inoue
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keigo Ito
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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16
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Inoue T, Ando K, Kobayashi K, Nakashima H, Ito K, Katayama Y, Machino M, Kanbara S, Ito S, Yamaguchi H, Koshimizu H, Segi N, Kato F, Imagama S. Primary cervical decompression surgery may improve lumbar symptoms in patients with tandem spinal stenosis. Eur Spine J 2021; 30:899-906. [PMID: 33409728 DOI: 10.1007/s00586-020-06693-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 11/08/2020] [Accepted: 12/05/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Tandem spinal stenosis (TSS) refers to coexisting lumbar and cervical canal stenosis. Evidence regarding whether cervical decompression improves lumbar symptoms in TSS is insufficient. Therefore, we determined the effectiveness of cervical decompression surgery for patients with lumbar spinal stenosis (LSS) and cervical spinal stenosis. METHODS The records of 64 patients with TSS experiencing lumbar symptoms who underwent cervical decompression surgery between April 2013 and July 2017 at a single institution were retrospectively reviewed. We categorized patients into the Non-improved (n = 20), Relapsed (n = 30), and Maintained-improvement (n = 14) groups according to the presence or absence of improvement and relapse in lower limb symptoms in TSS following cervical decompression surgeries. RESULTS Of 64 patients, 44 (69%) showed improved lower limb or low back symptoms, with 14 (22%) patients maintaining improvement. The preoperative cervical myelopathy-Japanese Orthopedic Association score and the preoperative number of steps determined using the 10-s step test were significantly lower in the Non-improved group than in the Maintained-improvement group. Receiver operating characteristic curve of preoperative 10-s step test results revealed 12 steps as a predictor for maintained improvement. CONCLUSION The improvement of LSS symptoms following cervical decompression surgeries may be associated with the severity of cervical myelopathy as determined in clinical findings rather than in imaging findings. Patients with TSS having a 10-s step test result of < 12 steps were more likely to experience a relapse of lower limb symptoms following cervical decompression surgeries.
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Affiliation(s)
- Taro Inoue
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Keigo Ito
- Department of Orthopedic Surgery, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Yoshito Katayama
- Department of Orthopedic Surgery, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Shunsuke Kanbara
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Hidetoshi Yamaguchi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Hiroyuki Koshimizu
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Naoki Segi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8560, Japan.
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17
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Machino M, Ando K, Kobayashi K, Nakashima H, Kanbara S, Ito S, Inoue T, Koshimizu H, Ito K, Kato F, Imagama S. Prediction of outcome following laminoplasty of cervical spondylotic myelopathy: Focus on the minimum clinically important difference. J Clin Neurosci 2020; 81:321-327. [PMID: 33222939 DOI: 10.1016/j.jocn.2020.09.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/13/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
Abstract
The minimum clinically important difference (MCID) of the Japanese Orthopaedic Association (JOA) score has been reported to be around 2.5 points in cervical myelopathy. This study sought to define significant predictive factors on achieving the MCID following laminoplasty in a large series of patients with cervical spondylotic myelopathy (CSM). A total of 485 consecutive patients with CSM (295 males and 190 females; mean age: 67.0 years; age range: 42-91 years) who underwent laminoplasty were prospectively enrolled. The average postoperative follow-up period was 26.6 months (range: 12-66 months). We calculated the achieved JOA score. The relationships between outcomes and various clinical and imaging predictors including comorbidity and quantitative performance tests were examined. Logistic regression analysis was conducted to identify the predictors correlated with a JOA score of 2.5 points or more. Clinically meaningful gains were exhibited in 299 patients (61.6%) with a JOA score of ≥2.5 points, whereas 186 patients (38.4%) achieved a JOA score of <2.5 points. Univariate logistic regression analysis showed the predictive factors with a shorter duration of CSM symptoms, lower preoperative JOA scores, absence of hypertension, no use of anticoagulant/antiplatelet agents, and nonsmoking status. Multivariate logistic regression analysis determined that the duration of CSM symptoms (odds ratio: 0.771, 95% confidence interval: 0.705-0.844; p < 0.01) was the only significant predictive factor for achieving JOA scores of ≥2.5 points. An important predictor of MCID achievement following laminoplasty was shorter duration of CSM symptoms.
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Affiliation(s)
- Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Kanbara
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taro Inoue
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Koshimizu
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keigo Ito
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan.
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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18
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Machino M, Ando K, Kobayashi K, Nakashima H, Kanbara S, Ito S, Inoue T, Yamaguchi H, Koshimizu H, Ito K, Kato F, Ishiguro N, Imagama S. Postoperative changes in spinal cord signal intensity in patients with spinal cord injury without major bone injury: comparison between preoperative and postoperative magnetic resonance images. J Neurosurg Spine 2020; 34:259-266. [PMID: 33126220 DOI: 10.3171/2020.6.spine20761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/19/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although increased signal intensity (ISI) on MRI is observed in patients with cervical spinal cord injury (SCI) without major bone injury, alterations in ISI have not been evaluated. The association between postoperative ISI and surgical outcomes remains unclear. This study elucidated whether or not the postoperative classification and alterations in MRI-based ISI of the spinal cord reflected the postoperative symptom severity and surgical outcomes in patients with SCI without major bone injury. METHODS One hundred consecutive patients with SCI without major bone injury (79 male and 21 female) with a mean age of 55 years (range 20-87 years) were included. All patients were treated with laminoplasty and underwent MRI pre- and postoperatively (mean 12.5 ± 0.8 months). ISI was classified into three groups on the basis of sagittal T2-weighted MRI: grade 0, none; grade 1, light (obscure); and grade 2, intense (bright). The neurological statuses were evaluated according to the Japanese Orthopaedic Association (JOA) scoring system and the American Spinal Injury Association Impairment Scale (AIS). RESULTS Preoperatively, 8 patients had grade 0 ISI, 49 had grade 1, and 43 had grade 2; and postoperatively, 20 patients had grade 0, 24 had grade 1, and 56 had grade 2. The postoperative JOA scores and recovery rate (RR) decreased significantly with increasing postoperative ISI grade. The postoperative ISI grade tended to increase with the postoperative AIS grade. Postoperative grade 2 ISI was observed in severely paralyzed patients. The postoperative ISI grade improved in 23 patients (23%), worsened in 25 (25%), and remained unchanged in 52 (52%). Patients with an improved ISI grade had a better RR than those with a worsened ISI grade. CONCLUSIONS Postoperative ISI reflected postoperative symptom severity and surgical outcomes. Alterations in ISI were seen postoperatively in 48 patients (48%) and were associated with surgical outcomes.
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Affiliation(s)
- Masaaki Machino
- 1Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine; and
| | - Kei Ando
- 1Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine; and
| | - Kazuyoshi Kobayashi
- 1Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine; and
| | - Hiroaki Nakashima
- 1Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine; and
| | - Shunsuke Kanbara
- 1Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine; and
| | - Sadayuki Ito
- 1Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine; and
| | - Taro Inoue
- 1Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine; and
| | - Hidetoshi Yamaguchi
- 1Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine; and
| | - Hiroyuki Koshimizu
- 1Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine; and
| | - Keigo Ito
- 2Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan
| | - Fumihiko Kato
- 2Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan
| | - Naoki Ishiguro
- 1Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine; and
| | - Shiro Imagama
- 1Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine; and
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Kobayashi K, Imagama S, Ando K, Nakashima H, Kato F, Sato K, Kanemura T, Matsubara Y, Yoshihara H, Hirasawa A, Deguchi M, Shinjo R, Sakai Y, Inoue H, Ishiguro N. Trends in Reoperation for Surgical Site Infection After Spinal Surgery With Instrumentation in a Multicenter Study. Spine (Phila Pa 1976) 2020; 45:1459-1466. [PMID: 32453234 DOI: 10.1097/brs.0000000000003545] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A multicenter retrospective analysis of a prospectively maintained database. OBJECTIVE To examine the characteristics of reoperation for surgical site infection (SSI) after spinal instrumentation surgery, including the efficacy of treatment for SSI and instrumentation retention. SUMMARY OF BACKGROUND DATA Aging of the population and advances in surgical techniques have increased the demand for spinal surgery in elderly patients. Treatment of SSI after this surgery has the main goals of eliminating infection and retaining instrumentation. METHODS The subjects were 16,707 patients who underwent spine surgery with instrumentation in 11 hospitals affiliated with the Nagoya Spine Group from 2004 to 2015. Details of those requiring reoperations for SSI were obtained from surgical records at each hospital. RESULTS There were significant increases in the mean age at the time of surgery (54.6-63.7 years) and the number of instrumentation surgeries (726-1977) from 2004 to 2015. The incidence of reoperation for SSI varied from 0.9% to 1.8%, with a decreasing trend over time. Reoperation for SSI was performed in 206 cases (115 men, 91 women; mean age 63.2 years). The average number of reoperations (1.4 vs. 2.3, P < 0.05), time from SSI to first reoperation (4.3 vs. 9.5 days, P < 0.05), and the methicillin-resistant Staphylococcus identification rate (20% vs. 37%, P < 0.01) were all significantly lower in cases with instrumentation retention (n = 145) compared to those with instrumentation removal (n = 61). CONCLUSION There were marked trends of aging of patients and an increase in operations over the study period; however, the incidences of reoperation and instrumentation removal due to SSI significantly decreased over the same period. Rapid debridement after SSI diagnosis may have contributed to instrumentation retention. These results can serve as a guide for developing strategies for SSI treatment and for improved planning of spine surgery in an aging society. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | - Fumihiko Kato
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, Minato-ku, Nagoya, Japan
| | - Koji Sato
- Department of Orthopaedic Surgery, Japanese Red Cross Nagoya Daini Hospital, Showa-ku, Nagoya, Japan
| | - Tokumi Kanemura
- Department of Orthopaedic Surgery, Konan Kousei Hospital, Konan, Aichi, Japan
| | - Yuji Matsubara
- Department of Orthopaedic Surgery, Kariya Toyota General Hospital, Aichi, Japan
| | - Hisatake Yoshihara
- Department of Orthopaedic Surgery, Toyohashi municipal Hospital, Aichi, Japan
| | - Atsuhiko Hirasawa
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Masao Deguchi
- Department of Orthopaedic Surgery, Japanese Red Cross Nagano Hospital, Nagano, Japan
| | - Ryuichi Shinjo
- Department of Orthopaedic Surgery, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Yoshihito Sakai
- Department of Orthopaedic Surgery, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Hidenori Inoue
- Department of Orthopaedic Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nakamura-ku, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
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20
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Machino M, Morita D, Ando K, Kobayashi K, Nakashima H, Kanbara S, Ito S, Inoue T, Koshimizu H, Ito K, Kato F, Imagama S. Dynamic changes in longitudinal stretching of the spinal cord in thoracic spine: Focus on the spinal cord occupation rate of dural sac. Clin Neurol Neurosurg 2020; 198:106225. [PMID: 32942132 DOI: 10.1016/j.clineuro.2020.106225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/30/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study aimed to evaluate the anteroposterior diameters and cross-sectional areas of the dural sac and spinal cord in the thoracic spine, to elucidate the spinal cord occupation rate of the dural sac in these dynamic changes for each level using multidetector-row computed tomography (MDCT). PATIENTS AND METHODS Fifty patients with cervical or lumbar spinal disease were prospectively enrolled. After preoperative myelography, MDCT was performed at maximum passive flexion and extension. The anteroposterior diameter and cross-sectional area of the dural sac and spinal cord in the axial plane and the thoracic spinal cord length in the sagittal plane were measured. The spinal cord occupation rate in the dural sac was calculated. RESULTS The spinal cord occupation rate of the dural sac in anteroposterior diameter was lower on flexion than on extension, with significant differences from the T1/T2 to T11/T12 levels (p < 0.0001). The spinal cord occupation rate of the dural sac in cross-sectional area was lower on flexion than on extension, with significant differences except from T3/T4 to T6/T7 levels (p < 0.01). There was a bimodal increase in the occupation rate with elevations at the cervicothoracic junction and thoracolumbar junction. The thoracic spinal cord length on flexion was significantly longer than that on extension (p < 0.0001). CONCLUSIONS The spinal cord occupation rate of the dural sac was lower on flexion than on extension, despite thoracic spine being considered a rigid region. The dynamic changes in longitudinal stretching and shrinkage of the spinal cord affected the occupation rate.
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Affiliation(s)
- Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daigo Morita
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Kanbara
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taro Inoue
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Koshimizu
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keigo Ito
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Nakashima H, Ishikawa Y, Kanemura T, Kato F, Satake K, Ito K, Ito K, Ando K, Kobayashi K, Ishiguro N, Imagama S. Neurological function following early versus delayed decompression surgery for drop foot caused by lumbar degenerative diseases. J Clin Neurosci 2020; 72:39-42. [PMID: 31982275 DOI: 10.1016/j.jocn.2020.01.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/05/2020] [Indexed: 12/22/2022]
Abstract
The purpose of this study was to investigate the effectiveness of early (<72 h) versus late (≥72 h) decompression surgery after the onset of drop foot caused by root disorder in lumbar degenerative diseases (LDDs). Data were included from 60 patients who underwent decompression surgery for drop foot caused by LDDs, including lumbar disk herniation or lumbar spinal stenosis. The primary outcome was ordinal change in the manual muscle test (MMT) at 2 years follow-up. Secondary outcomes included changes in the Japanese Orthopedic Association's (JOA) score. The early- and late-stage surgery groups included 20 and 40 patients with mean durations from the onset of drop foot to operation of 0.8 days (range, 0-3 days) and 117.1 days (range, 10-891 days), respectively. There was no significant difference (p = 0.33) between the early- and late-stage surgery groups in the improvement of MMT scores to >4 (90% versus 80%, respectively). However, more patients in the early-stage group achieved an MMT score >5 compared with those in the late-stage surgery group (80% versus 45%; p = 0.03). Furthermore, the recovery rate of JOA scores was significantly higher in the early-stage (89.1%) compared with the late-stage surgery group (68.6%; p < 0.001). Early decompression surgery produced better neurological recovery; however, an improvement of >4 in the MMT score was achieved in 80% of cases with late decompression.
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Affiliation(s)
- Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Spine & Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Yoshimoto Ishikawa
- Department of Spine & Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Tokumi Kanemura
- Department of Spine & Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Kotaro Satake
- Department of Spine & Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Keigo Ito
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Kenyu Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Spine & Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Machino M, Ando K, Kobayashi K, Ota K, Morozumi M, Tanaka S, Ito K, Kato F, Ishiguro N, Imagama S. A comparative study of two reconstruction procedures for osteoporotic vertebral fracture with lumbar spinal stenosis: Posterior lumbar interbody fusion versus posterior and anterior and combined surgery. J Orthop Sci 2020; 25:52-57. [PMID: 30853275 DOI: 10.1016/j.jos.2019.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/23/2018] [Accepted: 02/14/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Optimal treatment of lumbar spinal stenosis (LSS) with neurological deficit due to osteoporotic vertebral fractures (OVFs) has been controversial. We assessed the usefulness, safety, and efficacy of posterior lumbar interbody fusion (PLIF) for LSS with neurological deficit due to OVFs and compared this procedure to posterior/anterior combined surgery (PACS). METHODS Of 36 consecutive patients with LSS with neurological deficit due to OVFs, 15 underwent PLIF (6 males, 9 females; mean age, 74 years), and 21 underwent PACS (4 males, 17 females; mean age, 70 years). Surgical complications, clinical outcomes (operative time, blood loss, American Spinal Injury Association Impairment Scale [AIS], activities of daily living [ADLs]), and sagittal alignment were investigated. Bony fusion was assessed using plain and functional X-rays and computed tomography scans. RESULTS There were no significant differences in age, sex, or disease or follow-up duration between the groups. Operative time was significantly shorter and intraoperative blood loss significantly less in the PLIF than in the PACS groups. AIS and ADL improved significantly postoperatively in both groups. No significant difference was observed in neurological improvement, correction angle, loss of correction, and surgical complications. No pseudarthrosis occurred, and no patient required additional surgery in the PLIF group. CONCLUSIONS PLIF for LSS with neurological deficit due to OVFs achieves posterior rigid fixation with instrumentation, anterior column reconstruction by interbody fusion, and adequate decompression using a single posterior approach. This less invasive procedure is a useful reconstructive surgery option.
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Affiliation(s)
- Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kyotaro Ota
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masayoshi Morozumi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Tanaka
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keigo Ito
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Machino M, Ando K, Kobayashi K, Morozumi M, Tanaka S, Ito K, Kato F, Ishiguro N, Imagama S. Cut off value in each gender and decade of 10-s grip and release and 10-s step test: A comparative study between 454 patients with cervical spondylotic myelopathy and 818 healthy subjects. Clin Neurol Neurosurg 2019; 184:105414. [DOI: 10.1016/j.clineuro.2019.105414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/01/2019] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
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Machino M, Ando K, Kobayashi K, Morozumi M, Tanaka S, Ito K, Kato F, Ishiguro N, Imagama S. Differences in clinical outcomes between traumatic cervical myelopathy and degenerative cervical myelopathy: A comparative study of cervical spinal cord injury without major bone injury and cervical spondylotic myelopathy. J Clin Neurosci 2019; 70:127-131. [PMID: 31427237 DOI: 10.1016/j.jocn.2019.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022]
Abstract
A comparative study to examine the surgical outcomes of traumatic cervical myelopathy (TCM) patients was designed. The study aim was to compare the surgical outcomes between TCM and degenerative cervical myelopathy (DCM) and to characterize the preoperative symptoms and postoperative residual symptoms in TCM patients. One hundred consecutive patients with TCM (81 men, 19 women; mean age, 57.7 years; range, 31-79 years) and 100 consecutive patients with DCM (88 men, 12 women; mean age, 58.4 years; range, 36-78 years) were included in this study. All patients were treated by laminoplasty. The pre- and postoperative neurological statuses were evaluated according to the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. The recovery rate (RR) of each function was compared between the two groups. The mean preoperative JOA scores of motor function of the upper extremity in the TCM and DCM groups were 1.9 and 2.3, respectively (P < 0.01). After surgery, the mean RRs of motor function of the upper extremity in the TDM and DCM groups were 36.4% and 55.7%, respectively (P < 0.01) and in the lower extremity were 32.3% and 46.5%, respectively (P < 0.05). The RR for sensory function of the lower extremity was significantly lower in TCM patients than in DCM patients (39.6 vs 68.2, respectively; P < 0.0001). Motor function impairments of the upper and lower extremities and sensory function impairments of the lower extremities after surgery were more persistent in the TCM group than in the DCM group.
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Affiliation(s)
- Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masayoshi Morozumi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Tanaka
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keigo Ito
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Kobayashi K, Ando K, Kato F, Kanemura T, Sato K, Hachiya Y, Matsubara Y, Kamiya M, Sakai Y, Yagi H, Shinjo R, Ishiguro N, Imagama S. Predictors of Prolonged Length of Stay After Lumbar Interbody Fusion: A Multicenter Study. Global Spine J 2019; 9:466-472. [PMID: 31431867 PMCID: PMC6686383 DOI: 10.1177/2192568218800054] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective analysis of a prospectively database. OBJECTIVES To identify factors associated with prolonged length of stay (LOS) in posterior /transforaminal lumbar interbody fusion (PLIF/TLIF). METHODS The subjects were patients who underwent PLIF/TLIF at 10 facilities from 2012 to 2014. A total of 1168 such patients with a mean age of 65.9 ± 12.5 years (range 18-87 years) were identified in the database. Operations were PLIF (n = 675), TLIF (n = 443), minimally invasive surgery (MIS)-PLIF (n = 22), and MIS-TLIF (n = 32). Age, gender, body mass index, ambulatory status, comorbidities, perioperative American Society of Anesthesiologists (ASA) grade, operative factors, and complications were examined. LOS was defined as the number of calendar days from the operation to hospital discharge. LOS was categorized as normal (<75th percentile) or prolonged (≥75th percentile). RESULTS The average LOS was 20.8 ± 9.8 days (range 7-77 days). There was a significant correlation between LOS and age (P < .05). Reoperation during hospitalization was performed in 20 cases for surgical site infection (n = 12), epidural hematoma (n = 5), and screw misplacement (n = 3). In multivariate analysis, prolonged LOS was associated with preoperative variables of age ≥70 years (odds ratio [OR] 1.87, 95% CI 1.38-2.54), and ASA class ≥III (OR 1.52, 95% CI 1.04-2.25); surgical variables of open procedures (OR 5.84, 95% CI 1.74-19.63), fused levels ≥3 (OR 5.17, 95% CI 3.17-8.43), operative time ≥300 minutes (OR 1.88, 95% CI 1.15-3.07), and estimated blood loss ≥500 mL (OR 1.71, 95% 1.07-2.75). CONCLUSIONS The factors identified in this study should help with obtaining informed consent, surgical planning and complication prevention to reduce health care costs associated with prolonged LOS.
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Affiliation(s)
| | - Kei Ando
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | - Koji Sato
- Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | | | | | | | - Yoshihito Sakai
- National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Hideki Yagi
- Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | | | - Naoki Ishiguro
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Nagoya University Graduate School of Medicine, Nagoya, Japan,Shiro Imagama, Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Aichi 466-8550, Japan.
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Nakashima H, Kanemura T, Kanbara S, Satake K, Ito K, Ishiguro N, Kato F, Imagama S. What Are the Important Predictors of Postoperative Functional Recovery in Patients With Cervical OPLL? Results of a Multivariate Analysis. Global Spine J 2019; 9:315-320. [PMID: 31192100 PMCID: PMC6542163 DOI: 10.1177/2192568218794665] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE The objective of this study was to identify important predictors of poor functional recovery in patients undergoing surgery for cervical ossification of the posterior longitudinal ligament (OPLL). METHODS This was a retrospective cohort study of 142 OPLL patients with laminoplasty; 135 had complete radiographical data and were followed up for ≥2 years. The following OPLL characteristics were compared between patients with "good" and "poor" outcomes (Japanese Orthopedic Association [JOA] recovery rate ≥50% and <50%, respectively): number of ossified levels, OPLL classification, ossification shape, K-line, canal-occupying ratio, and increased magnetic resonance imaging (MRI) signal intensity. Predictors of functional recovery were identified. RESULTS Pre- and postoperative (2 years following surgery) JOA scores were 10.6 ± 2.9 and 14.1 ± 2.2, respectively, indicating significant improvement following laminoplasty (P < .001). The average JOA recovery rate was 53.4% ± 34.7%, with 81 (60.0%) and 54 (40.0%) patients in the better and poorer neurological outcome groups, respectively. The canal occupation ratio of OPLL ≤60%/>60% were 117 (86.7%) and 18 (13.3%) patients, respectively. In the stepwise logistic regression analysis, an occupation ratio greater than 60% was identified as a significant factor for poor postoperative neurological outcome (relative risk, 4.82; 95% confidential interval, 1.61-14.46, P = .005). CONCLUSIONS This multivariate analysis demonstrated a large size OPLL (occupying ratio >60%) was associated with a risk of poor neurological recovery roughly 5 times greater, and therefore other types of surgery are recommended in cases with such a ratio.
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Affiliation(s)
- Hiroaki Nakashima
- Nagoya University Graduate School of Medicine, Nagoya, Japan
,Konan Kosei Hospital, Aichi, Japan
| | | | | | | | | | - Naoki Ishiguro
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Shiro Imagama
- Nagoya University Graduate School of Medicine, Nagoya, Japan
,Shiro Imagama, Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, 65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560, Japan.
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27
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Yukawa Y, Matsumoto T, Kollor H, Minamide A, Hashizume H, Yamada H, Kato F. Local Sagittal Alignment of the Lumbar Spine and Range of Motion in 627 Asymptomatic Subjects: Age-Related Changes and Sex-Based Differences. Asian Spine J 2019; 13:663-671. [PMID: 30909677 PMCID: PMC6680033 DOI: 10.31616/asj.2018.0187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/18/2018] [Indexed: 11/23/2022] Open
Abstract
Study Design Prospective cohort imaging study. Purpose This study aimed to evaluate lumbar sagittal alignment and range of motion (ROM) using radiographs in a large asymptomatic cohort and identify sex-based differences and age-related changes in the subjects. Overview of Literature Several researchers have tried to establish normal alignment and kinematic behavior of the lumbar spine, using plain radiographs. Few studies have employed a large and sex-and age-balanced cohort. Methods Total 627 healthy volunteers (at least 50 males and 50 females in each age decade, from the 3rd to the 8th decade) underwent whole spine radiography in the standing position; lumbar spine radiography was performed for all subjects in the recumbent position. Lumbar lordosis (LL, T12-S1) and ROM during flexion and extension were measured using a computer digitizer. Results The mean LL was 36.8°±13.2° in the recumbent position and 49.8°±11.2° in the standing position. The LL was greater in the standing position than in the recumbent position; further, LL was higher in females as compared to that in males. Local lordosis at each disk level increased incrementally with distal progression through the lumbar spine in both the positions. Local lordosis at L4- S1 was 29.8°±8.0° in the recumbent position and 34.2°±8.3° in the standing position and occupied 85.1% and 70.8% of the total LL, respectively. However, local lordosis in the standing position decreased with age at L2-3, L3-4, and L4-5 levels. Total lumbar ROM (T12-S1) decreased with age. The ROM in females was higher than that in males. Conclusions We established the standard value and age-related changes in the lumbar alignment and ROM in each age decade in asymptomatic subjects. These data will be useful and provide the normal values for comparison in clinical practice to identify sexbased differences and age-related changes.
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Affiliation(s)
- Yasutsugu Yukawa
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan.,Department of Orthopaedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Taro Matsumoto
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Heiko Kollor
- Spine and Scoliosis Center, Schön Klinik Vogtareuth, Vogtareuth Germany
| | - Akihito Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Fumihiko Kato
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
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Kato F, Wada N, Hayashida T, Fukuda K, Nakamura R, Takahashi T, Kawakubo H, Takeuchi H, Kitagawa Y. Experimental and clinicopathological analysis of HOXB9 in gastric cancer. Oncol Lett 2019; 17:3097-3102. [PMID: 30867739 PMCID: PMC6396214 DOI: 10.3892/ol.2019.10008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 12/03/2018] [Indexed: 01/23/2023] Open
Abstract
The association between homeobox (HOX)B9 expression and tumor malignancy was identified recently. It was reported that HOXB9 induced tumor angiogenesis, and associated with poor prognosis in patients with breast and colon cancer. On the other hand, regional lymph nodes are the most common site of tumor spread, and lymph node metastasis is a major prognostic factor in gastric cancer. It was hypothesized that HOXB9 promotes tumor lymphangiogenesis and induces tumor progression, invasion and metastasis in gastric cancer. The aim of the present study was to evaluate the correlation between HOXB9 expression, prognosis and clinicopathologic factors in patients with gastric cancer, and to assess the contribution of HOXB9 expression to tumor cell lymphangiogenesis in vitro. HOXB9 expression was evaluated by immunohistochemistry in resected tumor tissues from 58 patients with gastric cancer, and the association between prognosis and clinicopathologic factors was determined. HOXB9 gene was overexpressed in human gastric cancer TMK-1 cells and the effect of HOXB9 overexpression on the expression of vascular endothelial growth factor (VEGF)-C, VEGF-D and VEGF receptor (R)-3 was determined. It was demonstrated that the depth of tumor invasion, the number of node metastases, lymphatic invasion and vascular invasion were significantly associated with HOXB9 expression. Overall survival was decreased in patients with HOXB9 expression. The mRNA expression of VEGF-D but not of VEGF-C and VEGFR-3 was increased in HOXB9-overexpressing TMK-1 cells compared with control cells. In conclusion, HOXB9 expression was positively correlated with gastric cancer progression and lymphangiogenesis marker expression. HOXB9 may be associated with lymphogenic metastasis.
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Affiliation(s)
- Fumihiko Kato
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Norihito Wada
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Tetsu Hayashida
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kazumasa Fukuda
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Rieko Nakamura
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Tsunehiro Takahashi
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
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Kobayakawa A, Kato F, Ito K, Machino M, Kanbara S, Morita D, Matsumoto T. Evaluation of sagittal alignment and range of motion of the cervical spine using multi-detector- row computed tomography in asymptomatic subjects. Nagoya J Med Sci 2019; 80:583-589. [PMID: 30587872 PMCID: PMC6295422 DOI: 10.18999/nagjms.80.4.583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To evaluate the sagittal alignment and range of motion (ROM) of the cervical spine during cervical flexion and extension ,using multi-detector-row-computed tomography (MDCT) in asymptomatic subjects.Understanding the normal alignment and range of motion of the cervical spine is very important while evaluating patients with cervical spine instability and abnormal alignment. Several reports using plain radiographic data have assessed the alignment and ROM of the cervical spine during flexion and extension. However, there has been no such report using MDCT. Ninety-eight subjects who did not have cervical spine-related symptoms were enrolled. After myelography, all subjects underwent cervical MDCT in cervical flexion and extension. Sagittal alignment and ROM between C2 and C7 were measured.The sagittal alignment between C2 and C7 was -11.7°±8.3° (mean ± standard deviation) in flexion and 26.5°± 12.9° in extension. The C5/6 level showed maximum kyphosis in flexion. The C6/C7 level demonstrated maximum lordosis in extension. ROM between C2 and C7 was 37.9°±11.2°. The C2/3 level showed the lowest ROM and the C5/C6 level showed the highest ROM among the intervertebral levels evaluated.The sagittal alignment and ROM of the cervical spine during flexion and extension in asymptomatic subjects were measured using MDCT. Each level between C2 and C7 could be evaluated in detail without any influence due to degenerative changes in the spine or soft tissues of the shoulder. MDCT generated a more precise understanding of the dynamic changes at each evaluated intervertebral level in the cervical spine. Level of Evidence : Level II
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Affiliation(s)
- Akinori Kobayakawa
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, Nagoya, Japan
| | - Keigo Ito
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, Nagoya, Japan
| | - Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Kanbara
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daigo Morita
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taro Matsumoto
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, Nagoya, Japan
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Machino M, Imagama S, Ito K, Ando K, Kobayashi K, Kato F, Nishida Y, Ishiguro N. Thoracic spinal cord injury without major bone injury associated with ossification of the ligamentum flavum. J Orthop Sci 2019; 24:174-177. [PMID: 27793439 DOI: 10.1016/j.jos.2016.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/18/2016] [Accepted: 10/04/2016] [Indexed: 02/09/2023]
Affiliation(s)
- Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Keigo Ito
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, Nagoya, Japan
| | - Yoshihiro Nishida
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Kobayashi K, Ando K, Kato F, Kanemura T, Sato K, Hachiya Y, Matsubara Y, Kamiya M, Sakai Y, Yagi H, Shinjo R, Ishiguro N, Imagama S. Trends of postoperative length of stay in spine surgery over 10 years in Japan based on a prospective multicenter database. Clin Neurol Neurosurg 2018; 177:97-100. [PMID: 30640049 DOI: 10.1016/j.clineuro.2018.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/22/2018] [Accepted: 12/28/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To identify factors associated with prolonged length of stay (LOS) in spine surgery, with the goal of establishing details of LOS for multiple diseases and surgical procedures. PATIENTS AND METHODS The subjects were patients who underwent spine surgery at 10 facilities in the Nagoya Spine Group from January 2005 to December 2015. Data were collected for patient background, primary spinal pathology, anatomical location of the lesion, and surgical methods. The primary outcome was LOS, which was defined as the calendar days from surgery to hospital discharge. RESULTS A total of 10,829 patients (5953 males, 4876 females; age 5-93 years, mean 60.2 ± 28.8 years) were identified in the database. Average follow-up was 61 months (range: 13-120 months). Average LOS was 22.3 ± 21.3 days, and there was a gradual decrease in LOS over the study period. LOS was significantly correlated with age, and prolonged LOS was significantly associated with thoracic spine surgery and significantly longer after surgery with instrumentation. Average LOS was >30 days for intramedullary tumor resection and posterior cervical fusion, but only 10.2 days for microendoscopic discectomy. Reoperation was performed in 210 patients (1.9%) and these patients had a significantly higher average LOS of 43.1 days. CONCLUSION These results will assist quality improvement in spine surgery. The identified risk factors for prolonged LOS will also assist in planning of surgery, postoperative care, and discharge, with the goal of reducing health care costs.
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Affiliation(s)
- Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Fumihiko Kato
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6, Komei, Minato-ku, Nagoya, 455-8530, Japan
| | - Tokumi Kanemura
- Department of Orthopaedic Surgery, Konan Kosei Hospital, 137, Omatsubara, Takaya-cho, Konan, Aichi, 483-8704, Japan
| | - Koji Sato
- Department of Orthopaedic Surgery, Japanese Red Cross Nagoya Daini Hospital, 2-9, Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan
| | - Yudo Hachiya
- Department of Orthopaedic Surgery, Hachiya Orthopaedic Hospital, 2-4, Suemoridori, Chikusa-ku, Nagoya, 464-0821, Japan
| | - Yuji Matsubara
- Department of Orthopaedic Surgery, Kariya Toyota General Hospital, 15, Sumiyoshi-cho5, Kariyashi, Aichi, 448-8505, Japan
| | - Mitsuhiro Kamiya
- Department of Orthopaedic Surgery, Aichi Medical University, 1-1, Iwasaku, Nagakute, Aichi, 480-1195, Japan
| | - Yoshihito Sakai
- Department of Orthopaedic Surgery, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu, Aichi, 474-8511, Japan
| | - Hideki Yagi
- Department of Orthopaedic Surgery, Japanese Red Cross Nagoya Daiichi Hospital, 3-35, Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Ryuichi Shinjo
- Department of Orthopaedic Surgery, Anjo Kosei Hospital, 28, Higashi-Kohan, Anjo-cho, Anjo, Aichi, 446-8602, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan.
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Machino M, Ando K, Kobayashi K, Ota K, Morozumi M, Tanaka S, Ito K, Kato F, Ishiguro N, Imagama S. MR T2 image classification in adult patients of cervical spinal cord injury without radiographic abnormality: A predictor of surgical outcome. Clin Neurol Neurosurg 2018; 177:1-5. [PMID: 30579047 DOI: 10.1016/j.clineuro.2018.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/05/2018] [Accepted: 12/13/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Although patients with cervical spinal cord injury without radiographic abnormality (SCIWORA) present increased signal intensity (ISI) on magnetic resonance imaging (MRI), its degree has not been examined. This study evaluated the clinical effectiveness of MRI-based ISI in adult patients of SCIWORA. Its predictive value for symptom severity was also evaluated. PATIENTS AND METHODS One-hundred consecutive SCIWORA patients who had undergone expansive laminoplasty were enrolled. Among them, 79 were male and 21 were female. The mean age was 55 years (range 20-87). All patients underwent MRI in the acute phase, and ISI was classified into three groups based on sagittal T2-weighted MRI: Grade 0, none; Grade 1, light (obscure); and Grade 2, intense (bright). The pre- and postoperative neurological status was evaluated using the Japanese Orthopaedic Association scoring system for cervical myelopathy (JOA score) and the ASIA impairment scale (AIS). RESULTS Preoperative MRI showed Grade 0 in 8 patients, Grade 1 in 49 patients, and Grade 2 in 43 patients. There were no differences in age and gender among three groups. The pre- and postoperative JOA scores decreased significantly with an increasing ISI grade. The recovery rate of JOA score decreased with the ISI grade. The ISI grade tended to increase with the pre- and postoperative AIS grades. ISI Grade 2 on MRI was observed in severely paralyzed cases. CONCLUSIONS MRI-based ISI classification is correlated with preoperative symptom severity in adult patients with SCIWORA and can be a predictor of surgical outcome.
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Affiliation(s)
- Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kyotaro Ota
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masayoshi Morozumi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Tanaka
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keigo Ito
- Department of Orthopedic Surgery and Radiology, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery and Radiology, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Kobayashi K, Imagama S, Sato K, Kato F, Kanemura T, Yoshihara H, Sakai Y, Shinjo R, Hachiya Y, Osawa Y, Matsubara Y, Ando K, Nishida Y, Ishiguro N. Postoperative Complications Associated With Spine Surgery in Patients Older Than 90 Years: A Multicenter Retrospective Study. Global Spine J 2018; 8:887-891. [PMID: 30560042 PMCID: PMC6293421 DOI: 10.1177/2192568218767430] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN A review of a prospective database. OBJECTIVES Surgery for elderly patients is increasing yearly due to aging of society and the desire for higher quality of life. The goal of the study was to examine perioperative complications in spine surgery in such patients. METHODS A multicenter study of surgical details and perioperative complications was performed in 35 patients aged older than 90 years who underwent spinal surgery, based on a review of a prospective database. The frequency and severity of complications were assessed, and the effects of patient-specific and surgical factors were examined. Major complications were defined as those that were life threatening, required reoperation in the perioperative period or left a permanent injury. Ambulatory function before and after surgery was also analyzed. RESULTS Perioperative complications occurred in 19 of the 35 cases (54%), and included 11 cases of postoperative delirium, most of which occurred after cervical spine surgery. There were 8 major complications (23%), including cerebral infarction (n = 3), coronary heart disease (n = 3), pulmonary embolism (n = 1), and angina (n = 1). Preoperative motor deficit, operative time, estimated blood loss, and instrumented fusion were significantly associated with major complications. An improved postoperative ambulatory status occurred in 61% of cases, with no change in 33%, and worsening in 2 cases (6%). CONCLUSIONS Timing of surgery before paralysis progression and reduced surgical invasiveness are important considerations in treatment of the very elderly. Improved outcomes can be obtained with better management of spine surgery for patients aged 90 years or older.
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Affiliation(s)
| | - Shiro Imagama
- Nagoya University Graduate School of Medicine, Nagoya, Japan,Shiro Imagama, Department of Orthopedic
Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward,
Aichi 466-8550, Japan.
| | - Koji Sato
- Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | | | | | | | - Yoshihito Sakai
- National Center for Geriatrics and Gerontology, Aichi, Japan
| | | | | | | | | | - Kei Ando
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Naoki Ishiguro
- Nagoya University Graduate School of Medicine, Nagoya, Japan
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Koyanagi K, Kato F, Nakanishi K, Ozawa S. Lateral thermal spread and recurrent laryngeal nerve paralysis after minimally invasive esophagectomy in bipolar vessel sealing and ultrasonic energy devices: a comparative study. Esophagus 2018; 15:249-255. [PMID: 30225743 DOI: 10.1007/s10388-018-0621-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 05/15/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study aimed to compare the extent of lateral thermal spread of surrounding tissues after the use of advanced bipolar and ultrasonic coagulation and shearing devices. Association between recurrent laryngeal nerve paralysis (RLNP) and such devices was assessed in patients who underwent minimally invasive esophagectomy (MIE). METHODS LigaSure™ (LS) and Sonicision™ (SONIC) were used. In ex vivo experiments using the porcine muscle, blade temperature and tissue temperature were measured using a thermometer after the activation of both devices. For the clinical assessment, 46 consecutive patients who received MIE were retrospectively assessed. RESULTS The temperature generated at the blade of both devices increased with the activation time. The blade temperature of LS was significantly lower than that of SONIC (P < 0.001). The blade temperature of SONIC exceeded 100 °C after 3-s activation. The temperature of surrounding tissues after a single activation of the devices decreased with the tissue distance from activation blade. The temperatures of tissues at 1 and 2 mm away from the blade side of LS were significantly lower than those of SONIC (P = 0.001 and P < 0.001, respectively). The temperature of tissue 2 mm away from the blade side of LS increased 6.4 °C from the baseline temperature. Furthermore, the incidence of RLNP in the LS group was lower than that in the SONIC group (P = 0.044). CONCLUSION This study highlights the necessity of spatial and temporal recognition of the thermal spread of coagulation and shearing devices to reduce the thermal injuries following MIE.
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Affiliation(s)
- Kazuo Koyanagi
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Fumihiko Kato
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Keita Nakanishi
- Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Soji Ozawa
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan
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Kobayashi K, Ando K, Kato F, Kanemura T, Sato K, Kamiya M, Nishida Y, Ishiguro N, Imagama S. Surgical outcomes of spinal cord and cauda equina ependymoma: Postoperative motor status and recurrence for each WHO grade in a multicenter study. J Orthop Sci 2018; 23:614-621. [PMID: 29610008 DOI: 10.1016/j.jos.2018.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 03/07/2018] [Accepted: 03/13/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The goals of the study are to analyze postoperative outcomes and recurrence in cases of spinal cord and cauda equina ependymoma in each World Health Organization (WHO) Grade, and to examine the influence of extent of surgical removal on prognosis. Spinal ependymoma has a relatively high frequency among intramedullary spinal cord tumors. The tumor is classified in WHO guidelines as grades I, II, and III, but few studies have examined postoperative prognosis based on these grades. METHODS The records of 80 patients undergoing surgery for spinal cord and cauda equina ependymoma were examined in a multicenter study using a retrospective database. Neurological motor status, pathological type, extent of resection, and tumor recurrence were evaluated. RESULTS The histopathological types were grade I in 23 cases (myxopapillary: 21, subependymoma: 2), grade II in 52 cases, and grade III in 5 cases (including all anaplastic cases). Total resection was performed in 60 cases (83%), and eight cases had recurrence, including 2 in WHO grade I, 2 in grade II, and 4 in grade III. The 5-year recurrence-free survival rates were 90%, 91%, and 20% in grades I, II and III, respectively. Adjuvant radiotherapy for the local site was performed in 8 cases, including 3 in grade I and 5 in grade III; however, 4 of the 5 grade III cases (80%) had recurrence after radiotherapy. Among 59 patients with normal ambulation or independence without external assistance (McCormick Grade I or II), 53 (90%) maintained the same mobility after surgery. In cases that underwent total resection, the recurrence rate was significantly lower (p < 0.01). A good preoperative motor status also resulted in significantly better postoperative recovery of motor status (p < 0.05). CONCLUSIONS Total resection of spinal cord and cauda equina ependymoma leads to postoperative motor recovery and may reduce tumor recurrence. Therefore, early surgery for this tumor is recommended before aggravation of paralysis.
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Affiliation(s)
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University, Japan
| | - Fumihiko Kato
- Department of Orthopaedic Surgery, Chubu-Rosai Hospital, Japan
| | - Tokumi Kanemura
- Department of Orthopaedic Surgery, Konan-Kosei Hospital, Japan
| | - Koji Sato
- Department of Orthopaedic Surgery, Japanese Red Cross Nagoya Daini Hospital, Japan
| | - Mitsuhiro Kamiya
- Department of Orthopaedic Surgery, Aichi Medical University, Japan
| | | | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University, Japan.
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Kato F, Monma S, Koyanagi K, Kanamori J, Daiko H, Igaki H, Tachimori Y. Long-term outcome after resection for recurrent oesophageal cancer. J Thorac Dis 2018; 10:2691-2699. [PMID: 29997931 DOI: 10.21037/jtd.2018.05.17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background The efficacy of surgical resection for lymph node (LN) or distant recurrence of oesophageal cancer has not been sufficiently investigated. The objective of this study was to reveal appropriate indications for a surgical approach. Methods A total of 42 patients who underwent resection for recurrent or residual oesophageal squamous cell carcinoma after surgery or definitive chemoradiotherapy (dCRT) between April 2004 and August 2016 were identified. These resections did not include salvage oesophagectomy. The long-term outcomes of these patients were retrospectively analysed. Results Thirty-three patients underwent LN resection, 6 patients underwent lung resection, and 3 patients underwent resection for other recurrent tumours. The 5-year overall survival (OS) of patients who underwent salvage abdominal lymphadenectomy after dCRT was significantly better than that of patients who underwent salvage cervical or mediastinal lymphadenectomy (46.9% vs. 0.0%, P=0.006). The 5-year OS of patients who underwent salvage resection for LNs outside the radiation field was significantly better than that of patients who underwent resection inside the radiation field (47.6% vs. 8.9%, P=0.027). The 5-year OS of patients who underwent salvage resection for recurrent LNs was significantly better than that of patients who underwent salvage resection for residual LNs (21.7% vs. 0.0%, P<0.001). Among the 42 patients, 9 survived more than 3 years: 4 after salvage abdominal lymphadenectomy, 3 after resection for solitary lung recurrence, and 2 others. Conclusions The use of the appropriate surgical approach might improve the prognosis of patients with abdominal LN recurrence, LN recurrence outside the radiation field, or a solitary lung recurrence of oesophageal cancer.
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Affiliation(s)
- Fumihiko Kato
- Department of Esophageal Surgery, National Cancer Center Hospital, Tsukiji, Tokyo, Japan
| | - Satoko Monma
- Department of Surgery, Gyotoku General Hospital, Ichikawa-Shi, Chiba, Japan
| | - Kazuo Koyanagi
- Department of Esophageal Surgery, National Cancer Center Hospital, Tsukiji, Tokyo, Japan
| | - Jun Kanamori
- Department of Esophageal Surgery, National Cancer Center Hospital, Tsukiji, Tokyo, Japan
| | - Hiroyuki Daiko
- Department of Esophageal Surgery, National Cancer Center Hospital, Tsukiji, Tokyo, Japan
| | - Hiroyasu Igaki
- Department of Gastrointestinal Surgery, Keiyukai Sapporo Hospital, Sapporo, Hokkaido, Japan
| | - Yuji Tachimori
- Cancer Care Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
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Koyanagi K, Kato F, Kanamori J, Daiko H, Ozawa S, Tachimori Y. Clinical significance of esophageal invasion length for the prediction of mediastinal lymph node metastasis in Siewert type II adenocarcinoma: A retrospective single-institution study. Ann Gastroenterol Surg 2018; 2:187-196. [PMID: 29863189 PMCID: PMC5980392 DOI: 10.1002/ags3.12069] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 03/12/2018] [Indexed: 01/13/2023] Open
Abstract
AIM This study investigated whether esophageal invasion length (EIL) of a tumor from the esophagogastric junction could be a possible indicator of mediastinal lymph node metastasis and survival in patients with Siewert type II adenocarcinoma. METHODS One hundred and sixty-eight patients with Siewert type II tumor who underwent surgery were enrolled. Metastatic stations and recurrent lymph node sites were classified into cervical, upper/middle/lower mediastinal, and abdominal zones. EIL was correlated with overall metastasis or recurrence in individual zones and with survival. RESULTS Siewert type II patients with an EIL of more than 25 mm (>25 mm EIL group) had a higher incidence of overall metastasis or recurrence in the upper and middle mediastinal zones than those with an EIL of less than or equal to 25 mm (≤25 mm EIL group) (P = .001 and P < .001). Disease-free and overall survival in the >25 mm EIL group were significantly lower than those of the ≤25 mm EIL group (P < .001). None of the Siewert type II patients with metastasis or recurrence in the upper and middle mediastinal zones survived for more than 5 years. Only an EIL of more than 25 mm was a significant preoperative predictor of overall metastasis or recurrence in the upper and middle mediastinal zones (odds ratio, 8.85; 95% CI, 2.31-33.3; P = .001). CONCLUSION A multimodal-therapeutic strategy should be investigated in Siewert type II patients once the tumor has invaded more than 25 mm to the esophageal wall.
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Affiliation(s)
- Kazuo Koyanagi
- Department of Esophageal SurgeryNational Cancer Center HospitalTokyoJapan
| | - Fumihiko Kato
- Department of Esophageal SurgeryNational Cancer Center HospitalTokyoJapan
| | - Jun Kanamori
- Department of Esophageal SurgeryNational Cancer Center HospitalTokyoJapan
| | - Hiroyuki Daiko
- Department of Esophageal SurgeryNational Cancer Center HospitalTokyoJapan
| | - Soji Ozawa
- Department of Gastroenterological SurgeryTokai University School of MedicineIseharaJapan
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Kanbara S, Imagama S, Ito K, Ito K, Ishiguro N, Kato F. A retrospective imaging study of surgical outcomes and range of motion in patients with cervical ossification of the posterior longitudinal ligament. Eur Spine J 2017; 27:1416-1422. [PMID: 28766019 DOI: 10.1007/s00586-017-5246-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 07/02/2017] [Accepted: 07/27/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE The K line was introduced in a previous study, but did not include the cervical range of motion (ROM) as a parameter for evaluating surgical outcomes for patients with cervical ossification of the posterior longitudinal ligament (OPLL), and few reports have used both the K line and X-ray evaluations of the cervical ROM to describe the surgical outcomes in such patients. METHODS Double-door C2-C7 or C3-C7 laminoplasty was performed in 100 patients with cervical OPLL who were classified according to the K line [86 patients, K line (+) and 14 patients, K line (-)]. Preoperative and 1-year postoperative Japanese Orthopedic Association (JOA) scores were used to evaluate recovery rates. Preoperative and postoperative C2-C7 lordotic angles were measured using the Cobb method. In addition, preoperative and postoperative sagittal alignments in flexion and extension were studied, and the flexion values were calculated by subtracting the preoperative and postoperative flexion ROM from extension ROM. RESULTS The mean JOA scores recovery rate were 57.3% in the K line (+) and 37.7% in the K line (-) groups (p < 0.05), and the respective corresponding mean postoperative C2-C7 lordotic angles were 9.1° and -3.4° (p < 0.001). In the K line (+) group, the JOA score recovery rate for a postoperative flexion value >0 was significantly lower than that for a postoperative flexion value ≤0 (p < 0.01), and the mean JOA score recovery rate worsened with an increased signal intensity on 1-year postoperative magnetic resonance imaging. CONCLUSIONS K line (+) patients exhibited sufficient neurological improvement after laminoplasty. However, even patients in this group had a low JOA score recovery rate if the postoperative flexion value was >0 and the 1-year postoperative increased signal intensity grade was 2 or 3.
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Affiliation(s)
- Shunsuke Kanbara
- Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University Hospital, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University Hospital, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan.
| | - Keigo Ito
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Kenyu Ito
- Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University Hospital, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Graduate School of Medicine, Nagoya University Hospital, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
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Yukawa Y, Kato F, Suda K, Yamagata M, Ueta T, Yoshida M. Normative data for parameters of sagittal spinal alignment in healthy subjects: an analysis of gender specific differences and changes with aging in 626 asymptomatic individuals. Eur Spine J 2016; 27:426-432. [PMID: 27771788 DOI: 10.1007/s00586-016-4807-7] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/05/2016] [Accepted: 10/03/2016] [Indexed: 01/07/2023]
Abstract
PURPOSE This study aims to establish normative data for parameters of spino-pelvic and spinal sagittal alignment, gender related differences and age-related changes in asymptomatic subjects. METHODS A total of 626 asymptomatic volunteers from Japanese population were enrolled in this study, including 50 subjects at least for each gender and each decade from 3rd to 8th. Full length, free-standing spine radiographs were obtained. Cervical lordosis (CL; C3-7), thoracic kyphosis (TK; T1-12), lumbar lordosis (LL; T12-S1), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and sagittal vertical axis (SVA) were measured. RESULTS The average values (degrees) are 4.1 ± 11.7 for CL, 36.0 ± 10.1 for TK, 49.7 ± 11.2 for LL, 53.7 ± 10.9 for PI, 14.5 ± 8.4 for PT, and 39.4 ± 8.0 for SS. Mean SVA is 3.1 ± 12.6 mm. Advancing age caused an increase in CL, PT and SVA, and a decrease in LL and SS. There was a significant gender difference in CL, TK, LL, PI, PT and SVA. From 7th decade to 8th decade, remarkable decrease of LL & TK and increase of PT were seen. A large increase of SVA was also seen between 60' and 70'. CONCLUSION Standard values of spino-pelvic sagittal alignment were established in each gender and each decade from 20' to 70'. A remarkable change of spino-pelvic sagittal alignment was seen from 7th decade to 8th decade in asymptomatic subjects.
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Affiliation(s)
- Yasutsugu Yukawa
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan. .,Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan.
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Kota Suda
- Department of Orthopedic Surgery, Hokkaido Chuo Rosai Hospital Sekison Center, Bibai, Japan
| | | | - Takayoshi Ueta
- Department of Orthopedic Surgery, Spinal Injuries Center, Iizuka, Japan
| | - Munehito Yoshida
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
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Nakashima H, Imagama S, Matsui H, Yukawa Y, Sato K, Kanemura T, Kamiya M, Ito K, Matsuyama Y, Ishiguro N, Kato F. Comparative Study of Untethering and Spine-Shortening Surgery for Tethered Cord Syndrome in Adults. Global Spine J 2016; 6:535-41. [PMID: 27555994 PMCID: PMC4993609 DOI: 10.1055/s-0035-1569004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/22/2015] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective multicenter study. OBJECTIVE Although untethering surgery has been a standard treatment in patients with adult tethered cord syndrome (TCS), spine-shortening osteotomy (SSO) has recently been performed as an alternative technique. The purpose of this study was to compare the clinical outcomes of the two procedures for TCS in adults. METHODS Fourteen patients (37.7 ± 12.5 years) with TCS were enrolled at 6 hospitals. Their clinical charts, operative records, and follow-up data were reviewed. The categories of tethering lesions were tight terminal filum in 1 patient, lipoma in 5 patients, and lipomyelomeningocele in 8 patients. Eleven patients underwent untethering surgery, and 3 patients underwent SSO surgery. RESULTS There were no significant differences in age, sex, types of preoperative symptoms, or duration of follow-up between the two groups. The preoperative duration of symptoms was significantly longer (25 ± 12.4 years) and the percentage of those with prior surgery was higher in the SSO group (66.7%). The preoperative pathology was lipomeningocele in all SSO group and lipoma or tight terminal filum in the untethering group. Cerebrospinal fluid leakage and urinary infection occurred in 1 patient each among those with untethering, and massive intraoperative bleeding occurred in 1 patient with SSO. SSO provided better clinical improvement than untethering surgery (p = 0.003). CONCLUSIONS Based on this small retrospective case series, SSO appears to provide clinical improvement at least comparable to the untethering procedure, especially in more challenging cases.
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Affiliation(s)
- Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan,Address for correspondence Shiro Imagama, MD, PhD Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine65 Tsurumai, Showa-ku, Nagoya, Aichi 466-8560Japan
| | - Hiroki Matsui
- Department of Orthopedic Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Yasutsugu Yukawa
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Koji Sato
- Department of Orthopedic Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konan Kosei Hospital, Aichi, Japan
| | - Mitsuhiro Kamiya
- Department of Orthopedic Surgery, Aichi Medical University, Aichi, Japan
| | - Kenyu Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu Medical University, Shizuoka, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
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Hida T, Yukawa Y, Ito K, Machino M, Imagama S, Ishiguro N, Kato F. Intrathecal morphine for postoperative pain control after laminoplasty in patients with cervical spondylotic myelopathy. J Orthop Sci 2016; 21:425-430. [PMID: 27083315 DOI: 10.1016/j.jos.2016.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 03/10/2016] [Accepted: 03/12/2016] [Indexed: 02/09/2023]
Abstract
OBJECTIVES To examine the clinical efficacy of intrathecal morphine as postoperative analgesia for cervical laminoplasty. SUMMARY OF BACKGROUND DATA Patients who undergo posterior cervical spinal surgery frequently experience significant postoperative pain. Postoperative pain contributes to patient morbidity because of decreasing early voluntary mobilization and delayed rehabilitation. Intrathecal morphine is known to be a simple and effective analgesia. However, the effectiveness of intrathecal morphine for cervical spinal surgery has not yet been reported. METHODS Seventy-eight patients with cervical spondylotic myelopathy were divided into two groups prospectively, a diclofenac suppository (DS) group who received 50 mg diclofenac suppository at the end of the surgery, and an intrathecal morphine (ITM) group who were preoperatively administered 0.3 mg of morphine chloride, intrathecally, via a lumbar puncture. All patients underwent double-door laminoplasty of C3-6 or C3-7 level. Visual analog scale (VAS) of cervical pain, self-rating pain impression, supplemental analgesic usage, and complication rate were evaluated until the seventh postoperative day. RESULTS Thirty-one patients in the DS group and 32 patients in the ITM group were finally assessed. No baseline variable differences between the two groups were observed. The VAS was significantly lower in the ITM group at 4 h and 24 h until the seventh postoperative day. Self-rating pain impression was significantly better in the ITM group. No significant difference was observed in complication rate. CONCLUSIONS Intrathecal morphine was an effective and safe analgesic method for cervical laminoplasty in patients with cervical spondylotic myelopathy.
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Affiliation(s)
- Tetsuro Hida
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan; Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Japan.
| | | | - Keigo Ito
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan
| | - Masaaki Machino
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan
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Nakashima H, Yukawa Y, Suda K, Yamagata M, Ueta T, Kato F. Narrow cervical canal in 1211 asymptomatic healthy subjects: the relationship with spinal cord compression on MRI. Eur Spine J 2016; 25:2149-54. [PMID: 27230783 DOI: 10.1007/s00586-016-4608-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 05/07/2016] [Accepted: 05/07/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Narrow cervical canal (NCC) has been a suspected risk factor for later development of cervical myelopathy. However, few studies have evaluated the prevalence in asymptomatic subjects. The purpose of this study was to investigate the prevalence of NCC in a large cohort of asymptomatic volunteers. METHODS This study was a cross-sectional study of 1211 asymptomatic volunteers. Approximately 100 men and 100 women representing each decade of life from the 20s to the 70s were included in this study. Cervical canal anteroposterior diameters at C5 midvertebral level on X-rays, and the prevalence of spinal cord compression (SCC) and increased signal intensity (ISI) changes on MRI were evaluated. Receiver operating characteristic analysis was performed to determine the cut-off value of the severity of canal stenosis resulting in SCC. RESULTS NCC (<14 mm) was observed in 123 (10.2 %) subjects. SCC and ISI were found in 64 (5.3 %) and 28 (2.3 %) subjects, respectively. The prevalence of NCC was significantly higher in females and older subjects, but the occurrence of severe NCC (<12 mm) did not increase with age. The canal size in subjects with SCC or ISI was significantly smaller than in those without SCC (p < 0.0001). The cut-off values of cervical canal stenosis resulting in SCC were 14.8 and 13.9 mm in males and females, respectively. CONCLUSIONS The prevalence of NCC was considerably lower among asymptomatic healthy volunteers; the cervical canal diameter in subjects with SCC or ISI was significantly smaller than in asymptomatic subjects; NCC is a risk factor for SCC.
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Affiliation(s)
- Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Shouwa-ku, Nagoya, Aichi, 466-8560, Japan.
| | - Yasutsugu Yukawa
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Kota Suda
- Department of Orthopedic Surgery, Hokkaido Chuo Rosai Hospital Sekison Center, Hokkaido, Japan
| | | | - Takayoshi Ueta
- Department of Orthopedic Surgery, Spinal Injuries Center, Iizuka, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
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Amada E, Takeuchi H, Kato F, Kawakubo H, Fukuda K, Nakamura R, Takahashi T, Wada N, Kitagawa Y. The influence of venous thromboembolism on prognosis of esophageal cancer patients. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
29 Background: Venous thromboembolism (VTE) is sometimes found in esophageal cancer patients who underwent surgical treatment. VTE contains deep vein thrombosis, pulmonary embolism and catheter-related thrombosis. Our previous study revealed that pre-therapeutic plasma fibrinogen level, C-reactive protein level, adenocarcinoma histology and neck lymph node dissection are the risk factors for venous thromboembolism in patients[Surg Today, 2015]. However, the correlation between VTE and prognosis is not clear in esophageal cancer. We hypothesized that VTE may have an impact on prognosis of esophageal cancer patients. Methods: One hundred and seventy-two patients who underwent radical esophagectomy from March 2008 to December 2012 in our hospital were reviewed in this study. The existence of VTE was assessed from the neck to the pelvis with computed tomography at the initial visit and after neo-adjuvant chemotherapy (NAC) and 6thpostoperative day. The patient and tumor characteristics, neo-adjuvant chemotherapy were compared between patients with VTE (VTE group) and those without VTE (non-VTE group). The primary outcome is disease-free survival (DFS) and the secondary outcome is overall survival (OS). Results: Twenty-one VTE events among 172 patients (12%) were observed. Six of which occurred preoperatively and were considered to be associated with NAC, 14 were detected postoperatively and one occurred just after inserting a peripherally inserted central catheter preoperatively. The VTE group and the non-VTE group have homogenous characteristics in patients’ backgrounds and tumor features. We found no significant difference in median DFS and OS between two groups. However, in patients with pathologically N 0 or 1(7thedition of UICC TNM classification, n = 157), the median DFS was significantly shorter in VTE group compared with non-VTE group (41 months versus 64 months, p = 0.04). The recurrence risk increased 50.9% in VTE group in comparison with non VTE group (p = 0.048). By using logistic regression analysis, we found that existence of VTE is an independent risk factor with Odd’s ratio 2.964 (p = 0.026). Conclusions: Our study suggests that VTE may be the risk factor for recurrence in esophageal cancer patients.
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Affiliation(s)
- En Amada
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Fumihiko Kato
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazumasa Fukuda
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Rieko Nakamura
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | - Norihito Wada
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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Takeda K, Yamaguchi Y, Hino M, Kato F. Potentiation of Acetylcholine-Mediated Facilitation of Inhibitory Synaptic Transmission by an Azaindolizione Derivative, ZSET1446 (ST101), in the Rat Hippocampus. ACTA ACUST UNITED AC 2015; 356:445-55. [DOI: 10.1124/jpet.115.229021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/16/2015] [Indexed: 11/22/2022]
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Morita D, Yukawa Y, Nakashima H, Ito K, Yoshida G, Machino M, Kanbara S, Iwase T, Kato F. Dynamic changes in the cross-sectional area of the dural sac and spinal cord in the thoracic spine. Eur Spine J 2015; 26:64-70. [PMID: 26254782 DOI: 10.1007/s00586-015-4173-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 08/01/2015] [Accepted: 08/01/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE The thoracic spine is considered a rigid region because it is restricted by the rib cage. Previously, we reported functional alignments and range of motion (ROM) at all segmental levels. The purpose of this study was to investigate dynamic changes of the dural sac and spinal cord in the thoracic spine using a multidetector-row computed tomography (MDCT). METHODS Fifty patients with cervical or lumbar spinal disease were prospectively enrolled. After preoperative myelography, MDCT was performed at maximum passive flexion and extension. The anteroposterior diameter and cross-sectional area of the dural sac and spinal cord in the axial plane were measured using Scion imaging software. We also evaluated the correlation between the change ratio of the cross-sectional area and segmental kyphotic angle and ROM. RESULTS In flexion, the anteroposterior diameter of the dural sac was larger than in extension. The cross-sectional area in the upper and middle regions was smaller, but was larger in the lower region. The anteroposterior diameter and cross-sectional area of the spinal cord in the upper and middle regions were smaller than in extension, but these values were nearly the same in both flexion and extension in the lower region. Change ratios of the cross-sectional area were correlated with segmental kyphotic angle rather than ROM. CONCLUSIONS The thoracic spine showed some dynamic changes of the dural sac and spinal cord in the axial plane within functional motion. Segmental kyphotic angle, rather than segmental ROM, was the more important factor affecting dimensions of the dural sac and spinal cord.
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Affiliation(s)
- Daigo Morita
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-8530, Japan. .,Department of Orthopaedic Surgery, Hamamatsu Medical Center, 328 Tomitsuka-cho, Naka-ku, Hamamatsu, Shizuoka, 432-8580, Japan.
| | - Yasutsugu Yukawa
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Keigo Ito
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Go Yoshida
- Department of Orthopaedic Surgery, Hamamatsu Medical Center, 328 Tomitsuka-cho, Naka-ku, Hamamatsu, Shizuoka, 432-8580, Japan
| | - Masaaki Machino
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Syunsuke Kanbara
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-8530, Japan
| | - Toshiki Iwase
- Department of Orthopaedic Surgery, Hamamatsu Medical Center, 328 Tomitsuka-cho, Naka-ku, Hamamatsu, Shizuoka, 432-8580, Japan
| | - Fumihiko Kato
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, 1-10-6 Komei, Minato-ku, Nagoya, Aichi, 455-8530, Japan
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Kitagawa Y, Idani H, Inoue H, Udagawa H, Uyama I, Osugi H, Katada N, Takeuchi H, Akutsu Y, Asami S, Ishikawa K, Okamura A, Ono T, Kato F, Kawabata T, Suda K, Takesue T, Tanaka T, Tsutsui M, Hosoda K, Matsuda S, Matsuda T, Mani M, Miyazaki T. Gastroenterological surgery: esophagus. Asian J Endosc Surg 2015; 8:114-24. [PMID: 25913582 DOI: 10.1111/ases.12185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 11/10/2014] [Indexed: 01/25/2023]
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Goto O, Takeuchi H, Kawakubo H, Matsuda S, Kato F, Sasaki M, Fujimoto A, Ochiai Y, Horii J, Uraoka T, Kitagawa Y, Yahagi N. Feasibility of non-exposed endoscopic wall-inversion surgery with sentinel node basin dissection as a new surgical method for early gastric cancer: a porcine survival study. Gastric Cancer 2015; 18:440-5. [PMID: 24619187 DOI: 10.1007/s10120-014-0358-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 02/13/2014] [Indexed: 02/07/2023]
Abstract
Non-exposed endoscopic wall-inversion surgery (NEWS) has been developed as an endoscopic full-thickness resection technique without translumenal communication to avoid intraabdominal infection or tumor seeding. We aimed to investigate the feasibility and safety of NEWS with sentinel node basin dissection (SNBD), which can minimize the area of lymphadenectomy for early gastric cancer (EGC), in 10 porcine survival models. After placing laparoscopic ports and making markings on both the mucosal and serosal sides of a simulated lesion, indocyanine green fluid was endoscopically injected into the submucosa at 4 quadrants around the lesion. An SN basin including the stained SNs was dissected, and a circumferential sero-muscular incision around the lesion and sero-muscular suturing were performed laparoscopically, with the lesion inverted toward the inside of the stomach. Finally, circumferential mucosal incision and transoral retrieval were made endoscopically. In all cases, the lesion was resected in an en bloc fashion, and all pigs survived without adverse events. After 1 week of observation, pigs were sacrificed for macroscopic investigation. The average procedural duration was 170 min (range 130-253 min). Intraoperative perforation occurred in 1 case, which could be safely treated by laparoscopic suturing. The number of dissected SN basins was 1 in 9 cases and 2 in 1 case. Necropsy revealed no signs of severe complication. This animal survival study demonstrated that NEWS with SNBD was safe and feasible. It may provide patients with possibly node-positive EGC a minimally-sized local resection and minimally-ranged lymphadenectomy without the risk of tumor dissemination.
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Affiliation(s)
- Osamu Goto
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan,
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Ito K, Yukawa Y, Ito K, Machino M, Kanbara S, Nakashima H, Hida T, Ishiguro N, Imagama S, Kato F. Dynamic changes in the spinal cord cross-sectional area in patients with myelopathy due to cervical ossification of posterior longitudinal ligament. Spine J 2015; 15:461-6. [PMID: 25463397 DOI: 10.1016/j.spinee.2014.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 08/04/2014] [Accepted: 10/07/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Dynamic changes in the spinal cord cross-sectional area due to cervical ossification of the posterior longitudinal ligament (C-OPLL) are unknown, but dynamic multidetector-row computed tomography (MDCT) may be a useful tool. PURPOSE The purpose of this study was to evaluate the influence of dynamic factors on the spinal cord in patients with C-OPLL using MDCT during flexion and extension after myelography. STUDY DESIGN/SETTING This was a prospective cohort study. PATIENT SAMPLE Participants included 107 prospectively enrolled consecutive patients with C-OPLL and myelopathy. OUTCOME MEASURE The outcome measure was the extension/flexion ratio at the spinal cord cross-sectional area at the most stenotic cervical level (SCASL). METHODS Dynamic MDCT was performed, and the SCASL was measured. Patients were divided into the kyphosis group or lordosis group according to C2-C7 alignment. They were divided further into the K-line (-) group or K-line (+) group. The Japanese Orthopedic Association (JOA) score was used to determine myelopathy severity. RESULTS All patients with C-OPLL had myelopathy, with a mean JOA score of 10.7 and mean disease duration of 16.7 months. The average extension/flexion ratio at all disc levels was less than 100%, suggesting that the spinal cord was compressed more during extension. In the kyphosis group, the spinal cord was compressed slightly more during flexion than during extension. In the K-line (-) group, the spinal cord was compressed more during flexion, although C2-C7 alignment was slightly lordotic on average. Large changes in the spinal cord cross-sectional area during extension-flexion and disease duration significantly influenced the severity of myelopathy. CONCLUSIONS Dynamic MDCT was useful for evaluating dynamic changes in the spinal cord. At the most stenotic level, the spinal cord became narrower during extension at all disc levels. In the kyphosis group and K-line (-) group, it became narrower during flexion. Cervical flexion may induce greater spinal cord compression in patients with kyphosis and K-line (-).
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Affiliation(s)
- Kenyu Ito
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Koumei Minato-ward, Nagoya-city, Aichi 444-8530, Japan; Department of Orthopaedic Surgery, Nagoya University Hospital, Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya-city, Aichi 466-8550, Japan.
| | - Yasutsugu Yukawa
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Koumei Minato-ward, Nagoya-city, Aichi 444-8530, Japan
| | - Keigo Ito
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Koumei Minato-ward, Nagoya-city, Aichi 444-8530, Japan
| | - Masaaki Machino
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Koumei Minato-ward, Nagoya-city, Aichi 444-8530, Japan
| | - Shunske Kanbara
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Koumei Minato-ward, Nagoya-city, Aichi 444-8530, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Hospital, Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya-city, Aichi 466-8550, Japan
| | - Tetsuro Hida
- Department of Orthopaedic Surgery, Nagoya University Hospital, Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya-city, Aichi 466-8550, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Hospital, Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya-city, Aichi 466-8550, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Hospital, Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya-city, Aichi 466-8550, Japan
| | - Fumihiko Kato
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1-10-6 Koumei Minato-ward, Nagoya-city, Aichi 444-8530, Japan
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Nakashima H, Imagama S, Ito Z, Ando K, Yagi H, Ishikawa Y, Ishiguro N, Kato F. Essential Surgical Technique for French-Door (Double-Door) Laminoplasty. JBJS Essent Surg Tech 2015; 5:e2. [PMID: 30473910 PMCID: PMC6221424 DOI: 10.2106/jbjs.st.n.00100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction We describe the surgical technique and the pitfalls of French-door laminoplasty. Step 1: Patient Positioning Position the patient to keep the cervical spine “parallel to the floor” or in the “reverse Trendelenburg position” with only a slight incline and place intraoperative neurological monitors to prevent intraoperative neurological deterioration. Step 2: Surgical Approach Use the common cervical posterior approach to expose the lamina and ligamentum flavum. Step 3: Create Grooves Cut the center of each lamina and create bilateral grooves using a high-speed burr. Step 4: Open the Lamina Open the lamina bilaterally and create a small hole in each one using a high-speed burr. Step 5: Create Bone Struts Create bone struts from the spinous processes and tie them to each lamina. Step 6: Wound Closure Perform meticulous closure of the wound to avoid wound-healing complications. Results In our original study12, we treated forty-six patients with French-door laminoplasty and compared the surgical results of this procedure with those of open-door laminoplasty in a prospective, randomized controlled manner. Indications Contraindications Pitfalls & Challenges
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Affiliation(s)
- Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Shouwa-ku, Nagoya, Aichi 466-8560, Japan. E-mail address for H. Nakashima:
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Shouwa-ku, Nagoya, Aichi 466-8560, Japan. E-mail address for H. Nakashima:
| | - Zenya Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Shouwa-ku, Nagoya, Aichi 466-8560, Japan. E-mail address for H. Nakashima:
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Shouwa-ku, Nagoya, Aichi 466-8560, Japan. E-mail address for H. Nakashima:
| | - Hideki Yagi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Shouwa-ku, Nagoya, Aichi 466-8560, Japan. E-mail address for H. Nakashima:
| | - Yoshimoto Ishikawa
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Shouwa-ku, Nagoya, Aichi 466-8560, Japan. E-mail address for H. Nakashima:
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Shouwa-ku, Nagoya, Aichi 466-8560, Japan. E-mail address for H. Nakashima:
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya, Aichi 455-0018, Japan
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Kanbara S, Yukawa Y, Ito K, Machino M, Kato F. Surgical outcomes of modified lumbar spinous process-splitting laminectomy for lumbar spinal stenosis. J Neurosurg Spine 2015; 22:353-7. [PMID: 25594729 DOI: 10.3171/2014.9.spine1457] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The lumbar spinous process-splitting laminectomy (LSPSL) procedure was developed as an alternative to lumbar laminectomy. In the LSPSL procedure, the spinous process is evenly split longitudinally and then divided at its base from the posterior arch, leaving the bilateral paravertebral muscle attached to the lateral aspects. This procedure allows for better exposure of intraspinal nerve tissues, comparable to that achieved by conventional laminectomy while minimizing damage to posterior supporting structures. In this study, the authors make some modifications to the original LSPSL procedure (modified LSPSL), in which laminoplasty is performed instead of laminectomy. The purpose of this study was to compare postoperative outcomes in modified LSPSL with those in conventional laminectomy (CL) and to evaluate bone unions between the split spinous process and residual laminae following modified LSPSL. Forty-seven patients with lumbar spinal stenosis were enrolled in this study. Twenty-six patients underwent modified LSPSL and 21 patients underwent CL. Intraoperative blood loss and surgical duration were evaluated. The Japanese Orthopaedic Association (JOA) scale scores were used to assess parameters before surgery and 12 months after surgery. The recovery rates were also evaluated. Postoperative paravertebral muscle atrophy was assessed using MRI. Bone union rates between the split spinous process and residual laminae were also examined. The mean surgical time and intraoperative blood loss were 25.7 minutes and 42.4 ml per 1 level in modified LSPSL, respectively, and 22.7 minutes and 29.5 ml in CL, respectively. The recovery rate of the JOA score was 64.2% in modified LSPSL and 68.7% in CL. The degree of paravertebral muscle atrophy was 7.8% in modified LSPSL and 22.2% in CL at 12 months after surgery (p < 0.05). The fusion rates of the spinous process with the arcus vertebrae at 6 and 12 months in modified LSPSL were 56.3% and 81.3%, respectively. The modified LSPSL procedure was less invasive to the paravertebral muscles and could be a laminoplasty; therefore, the modified LSPSL procedure presents an effective alternative to lumbar laminectomy.
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Affiliation(s)
- Shunsuke Kanbara
- Department of Orthopedic Surgery, Chutoen General Medical Center, Shizuoka; and
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