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Ueda H, Iimura T, Inami S, Moridaira H, Yazawa T, Seo Y, Taneichi H. Histology and chronological magnetic resonance images of congenital spinal deformity: An experimental study in mice model. BMC Musculoskelet Disord 2024; 25:334. [PMID: 38671403 PMCID: PMC11046745 DOI: 10.1186/s12891-024-07460-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The natural history of the congenital spinal deformity and its clinical magnitude vary widely in human species. However, we previously reported that the spinal deformities of congenital scoliosis mice did not progress throughout our observational period according to soft X-ray and MRI data. In this study, congenital vertebral and intervertebral malformations in mice were assessed via magnetic resonance (MR) and histological images. METHODS Congenital spinal anomalies were chronologically assessed via soft X-ray and 7 T MR imaging. MR images were compared to the histological images to validate the findings around the malformations. RESULTS Soft X-ray images showed the gross alignment of the spine and the contour of the malformed vertebrae, with the growth plate and cortical bone visible as higher density lines, but could not be used to distinguish the existence of intervertebral structures. In contrast, MR images could be used to distinguish each structure, including the cortical bone, growth plate, cartilaginous end plate, and nucleus pulposus, by combining the signal changes on T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI). The intervertebral structure adjacent to the malformed vertebrae also exhibited various abnormalities, such as growth plate and cartilaginous end plate irregularities, nucleus pulposus defects, and bone marrow formation. In the chronological observation, the thickness and shape of the malformed structures on T1WI did not change. CONCLUSIONS Spinal malformations in mice were chronologically observed via 7 T MRI and histology. MR images could be used to distinguish the histological structures of normal and malformed mouse spines. Malformed vertebrae were accompanied by adjacent intervertebral structures that corresponded to the fully segmented structures observed in human congenital scoliosis, but the intervertebral conditions varied. This study suggested the importance of MRI and histological examinations of human congenital scoliosis patients with patterns other than nonsegmenting patterns, which may be used to predict the prognosis of patients with spinal deformities associated with malformed vertebrae.
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Affiliation(s)
- Haruki Ueda
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, Japan.
| | - Takuya Iimura
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, Japan
| | - Satoshi Inami
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, Japan
| | - Hiroshi Moridaira
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, Japan
| | - Takuya Yazawa
- Department of Pathology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, Japan
| | - Yoshiteru Seo
- Department of Homeostatic Regulation, National Institute for Physiological Sciences, 38, Nishigonaka, Myodaiji, Okazaki, Aichi, Japan
| | - Hiroshi Taneichi
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, Japan
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Tanaka N, Inami S, Moridaira H, Sorimachi T, Ueda H, Aoki H, Takada S, Nohara Y, Haro H, Taneichi H. Anterior fusion surgery with overcorrection in the treatment of adolescent idiopathic scoliosis with Lenke 1 AR curve type: how to achieve overcorrection and its effect on postoperative spinal alignment. BMC Musculoskelet Disord 2023; 24:865. [PMID: 37936125 PMCID: PMC10631176 DOI: 10.1186/s12891-023-06989-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The efficacy of anterior fusion with overcorrection in the instrumented vertebra for Lenke 1 AR type curves has been reported, but how to achieve overcorrection and how overcorrection affects spinal alignment are unclear. The purpose of this study was to identify the factors that cause overcorrection, and to investigate how overcorrection affects postoperative spinal alignment in the surgical treatment of Lenke 1 AR type curves. METHODS Patients who had anterior surgery for a Lenke type 1 or 2 and lumbar modifier AR (L4 vertebral tilt to the right) type scoliosis and minimum 2-year follow-up were included. The radiographic data were measured at preoperative, postoperative 1 month, and final follow-up. The UIV-LIV Cobb angle was determined as the Cobb angle between the upper instrumented vertebra (UIV) and the lower instrumented vertebra (LIV), and a negative number for this angle was considered overcorrection. The screw angle was determined to be the sum of the angle formed by the screw axis and the lower and upper endplates in the LIV and UIV, respectively. The change (Δ) in the parameters from postoperative to final follow-up was calculated. The relationships between the UIV-LIV Cobb angle and other radiographic parameters were evaluated by linear regression analyses. RESULTS Fourteen patients met the inclusion criteria. Their median age was 15.5 years, and the median follow-up period was 53.6 months. The median UIV-LIV Cobb angle was -1.4° at postoperative 1 month. The median screw angle was 4.7°, and overcorrection was achieved in 11 (79%) cases at postoperative 1 month. The screw angle (r2 = 0.42, p = 0.012) and Δ FDUV-CSVL (the deviation of the first distal uninstrumented vertebra from the central sacral vertical line, r2 = 0.53, p = 0.003) were significantly correlated with the UIV-LIV Cobb angle. CONCLUSIONS Screw placement in the UIV and LIV not parallel to the endplate, but angled, was an effective method to facilitate overcorrection in the instrumented vertebrae. The results of the present study suggest that overcorrection could bring spontaneous improvement of coronal balance below the instrumented segment during the postoperative period.
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Affiliation(s)
- Nobuki Tanaka
- Department of Orthopaedic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotuga-Gun, Tochigi, 321-0293, Japan
- Department of Orthopaedic Surgery, University of Yamanashi, Chuo, Japan
| | - Satoshi Inami
- Department of Orthopaedic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotuga-Gun, Tochigi, 321-0293, Japan.
| | - Hiroshi Moridaira
- Department of Orthopaedic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotuga-Gun, Tochigi, 321-0293, Japan
| | | | - Haruki Ueda
- Department of Orthopaedic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotuga-Gun, Tochigi, 321-0293, Japan
| | - Hiromichi Aoki
- Department of Orthopaedic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotuga-Gun, Tochigi, 321-0293, Japan
| | - Satoshi Takada
- Department of Orthopaedic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotuga-Gun, Tochigi, 321-0293, Japan
| | - Yutaka Nohara
- Department of Orthopaedic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotuga-Gun, Tochigi, 321-0293, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, University of Yamanashi, Chuo, Japan
| | - Hiroshi Taneichi
- Department of Orthopaedic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Shimotuga-Gun, Tochigi, 321-0293, Japan
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Takasawa E, Iizuka Y, Mieda T, Inoue H, Kimura A, Takeshita K, Sonoda H, Takakura K, Sorimachi Y, Ara T, Arai A, Shida K, Nakajima T, Tsutsumi S, Arai H, Moridaira H, Taneichi H, Funayama T, Noguchi H, Miura K, Kobayashi R, Iizuka H, Chazono M, Chikuda H. Trends in cervical laminoplasty and 30-day postoperative complications: 10-year results from a retrospective, multi-institutional study of 1095 patients. Eur Spine J 2023; 32:3575-3582. [PMID: 37624437 DOI: 10.1007/s00586-023-07902-2] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/05/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE This study aimed to investigate the recent 10-year trends in cervical laminoplasty and 30-day postoperative complications. METHODS This retrospective multi-institutional cohort study enrolled patients who underwent laminoplasty for cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament. The primary outcome was the occurrence of all-cause 30-day complications. Trends were investigated and compared in the early (2008-2012) and late (2013-2017) periods. RESULTS Among 1095 patients (mean age, 66 years; 762 [70%] male), 542 and 553 patients were treated in the early and late periods, respectively. In the late period, patients were older at surgery (65 years vs. 68 years), there were more males (66% vs. 73%), and open-door laminoplasty (50% vs. 69%) was the preferred procedure, while %CSM (77% vs. 78%) and the perioperative JOA scores were similar to the early period. During the study period, the rate of preservation of the posterior muscle-ligament complex attached to the C2/C7-spinous process (C2, 89% vs. 93%; C7, 62% vs. 85%) increased and the number of laminoplasty levels (3.7 vs. 3.1) decreased. While the 30-day complication rate remained stable (3.9% vs. 3.4%), C5 palsy tended to decrease (2.4% vs. 0.9%, P = 0.059); superficial SSI increased significantly (0% vs. 1.3%, P = 0.015), while the decreased incidence of deep SSI did not reach statistical significance (0.6% vs. 0.2%). CONCLUSIONS From 2008 to 2017, there were trends toward increasing age at surgery and surgeons' preference for refined open-door laminoplasty. The 30-day complication rate remained stable, but the C5 palsy rate halved.
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Affiliation(s)
- Eiji Takasawa
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan.
| | - Yoichi Iizuka
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Tokue Mieda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Hirokazu Inoue
- Department of Orthopaedic Surgery, Jichi Medical University, Simotsuke, Tochigi, Japan
| | - Atsushi Kimura
- Department of Orthopaedic Surgery, Jichi Medical University, Simotsuke, Tochigi, Japan
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, Jichi Medical University, Simotsuke, Tochigi, Japan
| | - Hiroyuki Sonoda
- Department of Orthopaedic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Kenta Takakura
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
- Department of Orthopaedic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Yasunori Sorimachi
- Department of Orthopaedic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Tsuyoshi Ara
- Department of Orthopaedic Surgery, NHO Takasaki General Medical Center, Takasaki, Gunma, Japan
| | - Atsushi Arai
- Department of Orthopaedic Surgery, NHO Takasaki General Medical Center, Takasaki, Gunma, Japan
| | - Kosuke Shida
- Department of Orthopaedic Surgery, NHO Takasaki General Medical Center, Takasaki, Gunma, Japan
| | - Takashi Nakajima
- Department of Orthopaedic Surgery, JCHO Gunma Central Hospital, Maebashi, Gunma, Japan
| | - Satoshi Tsutsumi
- Department of Orthopaedic Surgery, JCHO Gunma Central Hospital, Maebashi, Gunma, Japan
| | - Hidekazu Arai
- Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Hiroshi Moridaira
- Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Hiroshi Taneichi
- Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Toru Funayama
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroshi Noguchi
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kousei Miura
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ryoichi Kobayashi
- Department of Orthopaedic Surgery, Isesaki Municipal Hospital, Isesaki, Gunma, Japan
| | - Haku Iizuka
- Department of Orthopaedic Surgery, Isesaki Municipal Hospital, Isesaki, Gunma, Japan
| | - Masaaki Chazono
- Department of Orthopaedic Surgery, NHO Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
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Matsukura Y, Egawa S, Inose H, Sakai K, Kusano K, Tsutsui S, Hirai T, Wada K, Katsumi K, Koda M, Kimura A, Furuya T, Maki S, Nagoshi N, Nishida N, Nagamoto Y, Oshima Y, Ando K, Nakashima H, Takahata M, Mori K, Nakajima H, Murata K, Miyagi M, Kaito T, Yamada K, Banno T, Kato S, Ohba T, Moridaira H, Fujibayashi S, Katoh H, Kanno H, Taneichi H, Imagama S, Kawaguchi Y, Takeshita K, Nakamura M, Matsumoto M, Yamazaki M, Okawa A, Yoshii T. Preoperative Symptom Duration Influences Neurological Recovery and Patient-Reported Outcome Measures After Surgical Treatment of Cervical Ossification of the Posterior Longitudinal Ligament. Spine (Phila Pa 1976) 2023; 48:1259-1265. [PMID: 37368973 DOI: 10.1097/brs.0000000000004762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/02/2023] [Accepted: 06/20/2023] [Indexed: 06/29/2023]
Abstract
STUDY DESIGN A prospective multicenter study. OBJECTIVE To investigate the effect of preoperative symptom duration on neurological recovery for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA The optimal timing to perform surgery in the setting of cervical OPLL remains unknown. It is important to know the influence of symptom duration on postoperative outcomes to facilitate discussions regarding the timing of surgery. PATIENTS AND METHODS The study included 395 patients (291 men and 104 women; mean age, 63.7 ± 11.4 yr): 204 were treated with laminoplasty, 90 with posterior decompression and fusion, 85 with anterior decompression and fusion, and 16 with other procedures. The Japanese Orthopedic Association (JOA) score and patient-reported outcomes of the JOA Cervical Myelopathy Evaluation Questionnaire were used to assess clinical outcomes preoperatively and 2 years after surgery. Logistic regression analysis was used to identify factors associated with the achievement of minimum clinically important difference (MCID) after surgery. RESULTS The recovery rate was significantly lower in the group with symptom duration of ≥5 years compared with the groups with durations of <0.5 years, 0.5 to 1 year, and 1 to 2 years. Improvement of JOA Cervical Myelopathy Evaluation Questionnaire in the upper extremity function score ( P < 0.001), lower extremity function ( P = 0.039), quality of life ( P = 0.053), and bladder function ( P = 0.034) were all decreased when the symptom duration exceeded 2 years. Duration of symptoms ( P = 0.001), age ( P < 0.001), and body mass index ( P < 0.001) were significantly associated with the achievement of MCID. The cutoff value we established for symptom duration was 23 months (area under the curve, 0.616; sensitivity, 67.4%; specificity, 53.5%). CONCLUSIONS Symptom duration had a significant impact on neurological recovery and patient-reported outcome measures in this series of patients undergoing surgery for cervical OPLL. Patients with symptom duration exceeding 23 months may be at greater risk of failing to achieve MCID after surgery. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Yu Matsukura
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
| | - Satoru Egawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
| | - Hiroyuki Inose
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
| | - Kenichiro Sakai
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital Kawaguchishi, Saitama, Japan
| | - Kazuo Kusano
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Kudanzaka Hospital, Chiyadaku, Japan
| | - Shunji Tsutsui
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
| | - Kanichiro Wada
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Keiichi Katsumi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Niigata, Niigata, Japan
| | - Masao Koda
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Atsushi Kimura
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takeo Furuya
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Satoshi Maki
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Narihito Nagoshi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Norihiro Nishida
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube City, Yamaguchi Prefecture, Japan
| | - Yukitaka Nagamoto
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Yasushi Oshima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kei Ando
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hiroaki Nakashima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masahiko Takahata
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Hokkaido University, Sapporo, Japan
| | - Kanji Mori
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, Japan
| | - Hideaki Nakajima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedics and Rehabilitation Medicine, University of Fukui, Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, Japan
| | - Kazuma Murata
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Masayuki Miyagi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Kitazato Universiy Hospital, Minami-ku, Sagamiharashi, Kanagawa, Japan
| | - Takashi Kaito
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Suita-shi, Osaka, Japan
| | - Kei Yamada
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan
| | - Tomohiro Banno
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Satoshi Kato
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Tetsuro Ohba
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, University of Yamanashi, Yamanashi, Japan
| | - Hiroshi Moridaira
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Shunsuke Fujibayashi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Hiroyuki Katoh
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Haruo Kanno
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Hiroshi Taneichi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Shiro Imagama
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshiharu Kawaguchi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, University of Toyama, Toyama, Toyama, Japan
| | - Katsushi Takeshita
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Masaya Nakamura
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Morio Matsumoto
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Masashi Yamazaki
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
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5
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Nagoshi N, Yoshii T, Egawa S, Sakai K, Kusano K, Tsutsui S, Hirai T, Matsukura Y, Wada K, Katsumi K, Koda M, Kimura A, Furuya T, Sato Y, Maki S, Nishida N, Nagamoto Y, Oshima Y, Ando K, Nakashima H, Takahata M, Mori K, Nakajima H, Murata K, Miyagi M, Kaito T, Yamada K, Banno T, Kato S, Ohba T, Moridaira H, Fujibayashi S, Katoh H, Kanno H, Watanabe K, Taneichi H, Imagama S, Kawaguchi Y, Takeshita K, Nakamura M, Matsumoto M, Yamazaki M. Comparison of Surgical Outcomes of Anterior and Posterior Fusion Surgeries for K-line (-) Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Multicenter Study. Spine (Phila Pa 1976) 2023; 48:937-943. [PMID: 36940262 DOI: 10.1097/brs.0000000000004634] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/18/2023] [Accepted: 03/09/2023] [Indexed: 03/22/2023]
Abstract
STUDY DESIGN A prospective multicenter study. OBJECTIVE The objective of this study is to compare the surgical outcomes of anterior and posterior fusion surgeries in patients with K-line (-) cervical ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA Although laminoplasty is effective for patients with K-line (+) OPLL, fusion surgery is recommended for those with K-line (-) OPLL. However, whether the anterior or posterior approach is preferable for this pathology has not been effectively determined. MATERIALS AND METHODS A total of 478 patients with myelopathy due to cervical OPLL from 28 institutions were prospectively registered from 2014 to 2017 and followed up for two years. Of the 478 patients, 45 and 46 with K-line (-) underwent anterior and posterior fusion surgeries, respectively. After adjusting for confounders in baseline characteristics using a propensity score-matched analysis, 54 patients in both the anterior and posterior groups (27 patients each) were evaluated. Clinical outcomes were assessed using the cervical Japanese Orthopaedic Association and the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire. RESULTS Both approaches showed comparable neurological and functional recovery. The cervical range of motion was significantly restricted in the posterior group because of the large number of fused vertebrae compared with the anterior group. The incidence of surgical complications was comparable between the cohorts, but the posterior group demonstrated a higher frequency of segmental motor paralysis, whereas the anterior group more frequently reported postoperative dysphagia. CONCLUSIONS Clinical improvement was comparable between anterior and posterior fusion surgeries for patients with K-line (-) OPLL. The ideal surgical approach should be informed based on the balance between the surgeon's technical preference and the risk of complications.
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Affiliation(s)
- Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
| | - Toshitaka Yoshii
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoru Egawa
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenichiro Sakai
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchishi, Saitama, Japan
| | - Kazuo Kusano
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Kudanzaka Hospital, Chiyadaku, Japan
| | - Shunji Tsutsui
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Takashi Hirai
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yu Matsukura
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kanichiro Wada
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Keiichi Katsumi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Niigata, Niigata, Japan
| | - Masao Koda
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Atsushi Kimura
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takeo Furuya
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Maki
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Norihiro Nishida
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube City, Yamaguchi, Japan
| | - Yukitaka Nagamoto
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan
| | - Yasushi Oshima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kei Ando
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hiroaki Nakashima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masahiko Takahata
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kanji Mori
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta, Otsu, Shiga, Japan
| | - Hideaki Nakajima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, Yoshida-gun, Fukui, Japan
| | - Kazuma Murata
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Masayuki Miyagi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Kitasato University, School of Medicine, Sagamiharashi, Kanagawa, Japan
| | - Takashi Kaito
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kei Yamada
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan
| | - Tomohiro Banno
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Satoshi Kato
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Tetsuro Ohba
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, University of Yamanashi, Yamanashi, Japan
| | - Hiroshi Moridaira
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
| | - Shunsuke Fujibayashi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Hiroyuki Katoh
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Haruo Kanno
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Miyagi, Japan; and Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Toyama, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
| | - Hiroshi Taneichi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
| | - Shiro Imagama
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshiharu Kawaguchi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
| | - Katsushi Takeshita
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
| | - Masashi Yamazaki
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Nakashima H, Imagama S, Yoshii T, Egawa S, Sakai K, Kusano K, Tsutsui S, Hirai T, Matsukura Y, Wada K, Katsumi K, Koda M, Kimura A, Furuya T, Maki S, Nagoshi N, Nishida N, Nagamoto Y, Oshima Y, Ando K, Takahata M, Mori K, Nakajima H, Murata K, Miyagi M, Kaito T, Yamada K, Banno T, Kato S, Ohba T, Moridaira H, Fujibayashi S, Katoh H, Kanno H, Taneichi H, Kawaguchi Y, Takeshita K, Nakamura M, Okawa A, Yamazaki M. Factors Associated with Loss of Cervical Lordosis after Laminoplasty for Patients with Cervical Ossification of the Posterior Longitudinal Ligament: Data from a Prospective Multicenter Study. Spine (Phila Pa 1976) 2023:00007632-990000000-00343. [PMID: 37146070 DOI: 10.1097/brs.0000000000004706] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/26/2022] [Accepted: 04/21/2023] [Indexed: 05/07/2023]
Abstract
STUDY DESIGN A prospective multicenter study. OBJECTIVE To investigate the incidence of loss of cervical lordosis after laminoplasty for cervical ossification of the posterior longitudinal ligament (OPLL). We also sought to determine associated risk factors and the relationship with patient-reported outcomes. SUMMARY OF BACKGROUND DATA Loss of cervical lordosis is a sequalae often observed after laminoplasty, which may adversely impact surgical outcomes. Cervical kyphosis, especially in OPLL, is associated with reoperation, but risk factors and relationship to postoperative outcomes remain understudied at this time. METHODS This study was conducted by the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. We included 165 patients who underwent laminoplasty and completed Japanese Orthopaedic Association (JOA) score or Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaires (JOACMEQ), as well as visual analog scales (VAS) for pain, with imaging. The participants were divided into two groups: those with loss of cervical lordosis of>10° or 20° after surgery and those without loss of cervical lordosis. A paired t-test was applied to evaluate the association between changes in cervical spinal angles, ROM, and cervical JOA and VAS scores before and at 2 years postoperatively. Mann-Whitney U-test was used for JOACMEQ. RESULTS Postoperative loss of cervical lordosis>10° and>20° was observed in 32 (19.4%) and 7 (4.2%), respectively. JOA, JOACMEQ, and VAS scores were not significantly different between those with, and without, loss of cervical lordosis. Preoperative small extension range of motion (eROM) was significantly associated with postoperative loss of cervical lordosis, and the cutoff values of eROM were 7.4° [area under the curve (AUC): 0.76] and 8.2° (AUC: 0.92) for loss of cervical lordosis>10° and>20°, respectively. A large occupation ratio of OPLL was also associated with loss of cervical lordosis, with a cutoff value of 39.9% (AUC: 0.94). Laminoplasty resulted in functional improvement in most patient-reported outcomes; however, neck pain and bladder function tended to become worse postoperatively in cases with postoperative loss of cervical lordosis>20°. CONCLUSION JOA, JOACMEQ, and VAS scores were not significantly different between those with, and without, loss of cervical lordosis. Preoperative small eROM and large OPLL may represent factors associated with loss of cervical lordosis after laminoplasty in patients with OPLL.
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Affiliation(s)
- Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa Ward, Nagoya, Aichi, 466-8550, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa Ward, Nagoya, Aichi, 466-8550, Japan
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
| | - Toshitaka Yoshii
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan
| | - Satoru Egawa
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan
| | - Kenichiro Sakai
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchishi, Saitama, 332-8558, Japan
| | - Kazuo Kusano
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Kudanzaka Hospital, 1-6-12 Kudanminami, Chiyodaku, 102-0074, Japan
| | - Shinji Tsutsui
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-city, Wakayama, 641-8510, Japan
| | - Takashi Hirai
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan
| | - Yu Matsukura
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan
| | - Kanichiro Wada
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, Aomori, 036-8562, Japan
| | - Keiichi Katsumi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Niigata University Medicine and Dental General Hospital, 1-754 Asahimachidori, Chuo Ward, Niigata, Niigata, 951-8520, Japan
| | - Masao Koda
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575 Japan
| | - Atsushi Kimura
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthoaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Takeo Furuya
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo Ward, Chiba, Chiba, 260-8670, Japan
| | - Satoshi Maki
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo Ward, Chiba, Chiba, 260-8670, Japan
| | - Narihito Nagoshi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Keio University school of Medicine, 35 Shinanomachi, Shinjuku Ward, Tokyo, 160-8582, Japan
| | - Norihiro Nishida
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Yukitaka Nagamoto
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Sakaishi, Osaka, 591-8025, Japan
| | - Yasushi Oshima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kei Ando
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Myokencho 2-9, Showa Ward, Nagoya, Aichi, 466-8650, Japan
| | - Masahiko Takahata
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Sapporo, 060-8638, Japan
| | - Kanji Mori
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan
| | - Hideaki Nakajima
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Kazuma Murata
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Masayuki Miyagi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopedic Surgery, Kitasato University, School of Medicine, 1-15-1 Kitazato, Minami-ku, Sagamiharashi, Kanagawa, 252-0375, Japan
| | - Takashi Kaito
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Kei Yamada
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume-shi, Fukuoka, 830-0011, Japan
| | - Tomohiro Banno
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka, 431-3125, Japan
| | - Satoshi Kato
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Tetsuro Ohba
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo Ward, Yamanashi, 409-3898, Japan
| | - Hiroshi Moridaira
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, 321-0293, Japan
| | - Shunsuke Fujibayashi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroyuki Katoh
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Haruo Kanno
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryomachi, Aoba Ward, Sendai, Miyagi, 980-8574, Japan
| | - Hiroshi Taneichi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, 321-0293, Japan
| | - Yoshiharu Kawaguchi
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Katsushi Takeshita
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthoaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Masaya Nakamura
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Keio University school of Medicine, 35 Shinanomachi, Shinjuku Ward, Tokyo, 160-8582, Japan
| | - Atsushi Okawa
- Japanese Multicenter Research Organization for Ossification of the Spinal Ligament
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo Ward, Tokyo, 113-8519, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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Iimura T, Ueda H, Inami S, Moridaira H, Takeuchi D, Aoki H, Taneichi H. Thoracic kyphosis in light of lumbosacral alignment in thoracic adolescent idiopathic scoliosis: recognition of thoracic hypokyphosis and therapeutic implications. BMC Musculoskelet Disord 2022; 23:414. [PMID: 35505303 PMCID: PMC9063219 DOI: 10.1186/s12891-022-05379-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/28/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The uniqueness of spinal sagittal alignment in thoracic adolescent idiopathic scoliosis (AIS), for example, the drastically smaller thoracic kyphosis seen in some patients, has been recognized but not yet fully understood. The purpose of this study was to clarify the characteristics of sagittal alignment of thoracic AIS and to determine the contributing factors. METHODS Whole spine radiographs of 83 thoracic AIS patients (73 females) were analyzed. The measured radiographic parameters were the Cobb angle of thoracic scoliosis, thoracic kyphosis (TK), lumbar lordosis (LL), C7 sagittal vertical axis (C7 SVA), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Additionally, max-LL, which was defined as the maximum lordosis angle from the S1 endplate, the inflection point between thoracic kyphosis and lumbar lordosis, and the SVA of the inflection point (IP SVA) were measured. The factors significantly related to a decrease in TK were assessed by stepwise logistic regression analysis. In addition, cluster analysis was performed to classify the global sagittal alignment. RESULTS The significant factors for a decrease in TK were an increase in SS (p = 0.0003, [OR]: 1.16) and a decrease in max-LL (p = 0.0005, [OR]: 0.89). According to the cluster analysis, the global sagittal alignment was categorized into the following three types: Type 1 (low SS, low max-LL, n = 28); Type 2 (high SS, low max-LL, n = 22); and Type 3 (high SS, high max-LL, n = 33). CONCLUSIONS In thoracic AIS, a decreased TK corresponded to an increased SS or a decreased max-LL. The sagittal alignment of thoracic AIS patients could be classified into three types based on SS and max-LL. One of these three types includes the unique sagittal profile of very small TK.
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Affiliation(s)
- Takuya Iimura
- Department of Orthopaedic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, Shimotuga, 321-0293, Japan
| | - Haruki Ueda
- Department of Orthopaedic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, Shimotuga, 321-0293, Japan.
| | - Satoshi Inami
- Department of Orthopaedic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, Shimotuga, 321-0293, Japan
| | - Hiroshi Moridaira
- Department of Orthopaedic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, Shimotuga, 321-0293, Japan
| | - Daisaku Takeuchi
- Department of Orthopaedic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, Shimotuga, 321-0293, Japan
| | - Hiromichi Aoki
- Department of Orthopaedic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, Shimotuga, 321-0293, Japan
| | - Hiroshi Taneichi
- Department of Orthopaedic Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, Shimotuga, 321-0293, Japan
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Inami S, Moridaira H, Takeuchi D, Sorimachi T, Ueda H, Aoki H, Iimura T, Nohara Y, Taneichi H. Anterior instrumentation surgery for the treatment of Lenke type 1AR curve patterns. J Neurosurg Spine 2022; 36:246-253. [PMID: 34598161 DOI: 10.3171/2021.4.spine2152] [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: 01/13/2021] [Accepted: 04/12/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Previous studies have demonstrated that Lenke lumbar modifier A contains 2 distinct types (AR and AL), and the AR curve pattern is likely to develop adding-on (i.e., a progressive increase in the number of vertebrae included within the primary curve distally after posterior surgery). However, the results of anterior surgery are unknown. The purpose of this study was to present the surgical results in a cohort of patients undergoing scoliosis treatment for type 1AR curves and to compare anterior and posterior surgeries to consider the ideal indications and advantages of anterior surgery for type 1AR curves. METHODS Patients with a Lenke type 1 or 2 and lumbar modifier AR (L4 vertebral tilt to the right) and a minimum 2-year postoperative follow-up were included. The incidence of adding-on and radiographic data were compared between the anterior and posterior surgery groups. The numbers of levels between the end, stable, neutral, and last touching vertebra to the lower instrumented vertebra (LIV) were also evaluated. RESULTS Forty-four patients with a mean follow-up of 57 months were included. There were 14 patients in the anterior group and 30 patients in the posterior group. The main thoracic Cobb angle was not significantly different between the groups preoperatively and at final follow-up. At final follow-up, the anterior group had significantly less tilting of the LIV than the posterior group (-0.8° ± 4.5° vs 3° ± 4°). Distal adding-on was observed in no patient in the anterior group and in 6 patients in the posterior group at final follow-up (p = 0.025). In the anterior group, no LIV was set below the end vertebra, and all LIVs were set above last touching vertebra. The LIV was significantly more proximal in the anterior group than in the posterior surgery patients without adding-on for all reference vertebrae (p < 0.001). CONCLUSIONS This is the first study to investigate the surgical results of anterior surgery for Lenke type 1AR curve patterns, and it showed that anterior surgery for the curves could minimize the distal extent of the instrumented fusion without adding-on. This would leave more mobile disc space below the fusion.
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Affiliation(s)
- Satoshi Inami
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Hiroshi Moridaira
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Daisaku Takeuchi
- 2Department of Orthopaedic Surgery, Nasu Red Cross Hospital, Tochigi, Japan; and
| | - Tsuyoshi Sorimachi
- 3Department of Orthopaedic Surgery, Gotenyama Hospital, Kanuma, Tochigi, Japan
| | - Haruki Ueda
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Hiromichi Aoki
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Takuya Iimura
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Yutaka Nohara
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Hiroshi Taneichi
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
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Chikuda H, Koyama Y, Matsubayashi Y, Ogata T, Ohtsu H, Sugita S, Sumitani M, Kadono Y, Miura T, Tanaka S, Akiyama T, Ando K, Anno M, Azuma S, Endo K, Endo T, Fujiyoshi T, Furuya T, Hayashi H, Higashikawa A, Hiyama A, Horii C, Iimoto S, Iizuka Y, Ikuma H, Imagama S, Inokuchi K, Inoue H, Inoue T, Ishii K, Ishii M, Ito T, Itoi A, Iwamoto K, Iwasaki M, Kaito T, Kato T, Katoh H, Kawaguchi Y, Kawano O, Kimura A, Kobayashi K, Koda M, Komatsu M, Kumagai G, Maeda T, Makino T, Mannoji C, Masuda K, Masuda K, Matsumoto K, Matsumoto M, Matsunaga S, Matsuyama Y, Mieda T, Miyoshi K, Mochida J, Moridaira H, Motegi H, Nakagawa Y, Nohara Y, Oae K, Ogawa S, Okazaki R, Okuda A, Onishi E, Ono A, Oshima M, Oshita Y, Saita K, Sasao Y, Sato K, Sawakami K, Seichi A, Seki S, Shigematsu H, Suda K, Takagi Y, Takahashi M, Takahashi R, Takasawa E, Takenaka S, Takeshita K, Takeshita Y, Tokioka T, Tokuhashi Y, Tonosu J, Uei H, Wada K, Watanabe M, Yahata T, Yamada K, Yasuda T, Yasui K, Yoshii T. Effect of Early vs Delayed Surgical Treatment on Motor Recovery in Incomplete Cervical Spinal Cord Injury With Preexisting Cervical Stenosis: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2133604. [PMID: 34751757 PMCID: PMC8579238 DOI: 10.1001/jamanetworkopen.2021.33604] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE The optimal management for acute traumatic cervical spinal cord injury (SCI) is unknown. OBJECTIVE To determine whether early surgical decompression results in better motor recovery than delayed surgical treatment in patients with acute traumatic incomplete cervical SCI associated with preexisting canal stenosis but without bone injury. DESIGN, SETTING, AND PARTICIPANTS This multicenter randomized clinical trial was conducted in 43 tertiary referral centers in Japan from December 2011 through November 2019. Patients aged 20 to 79 years with motor-incomplete cervical SCI with preexisting canal stenosis (American Spinal Injury Association [ASIA] Impairment Scale C; without fracture or dislocation) were included. Data were analyzed from September to November 2020. INTERVENTIONS Patients were randomized to undergo surgical treatment within 24 hours after admission or delayed surgical treatment after at least 2 weeks of conservative treatment. MAIN OUTCOMES AND MEASURES The primary end points were improvement in the mean ASIA motor score, total score of the spinal cord independence measure, and the proportion of patients able to walk independently at 1 year after injury. RESULTS Among 72 randomized patients, 70 patients (mean [SD] age, 65.1 [9.4] years; age range, 41-79 years; 5 [7%] women and 65 [93%] men) were included in the full analysis population (37 patients assigned to early surgical treatment and 33 patients assigned to delayed surgical treatment). Of these, 56 patients (80%) had data available for at least 1 primary outcome at 1 year. There was no significant difference among primary end points for the early surgical treatment group compared with the delayed surgical treatment group (mean [SD] change in ASIA motor score, 53.7 [14.7] vs 48.5 [19.1]; difference, 5.2; 95% CI, -4.2 to 14.5; P = .27; mean [SD] SCIM total score, 77.9 [22.7] vs 71.3 [27.3]; P = .34; able to walk independently, 21 of 30 patients [70.0%] vs 16 of 26 patients [61.5%]; P = .51). A mixed-design analysis of variance revealed a significant difference in the mean change in ASIA motor scores between the groups (F1,49 = 4.80; P = .03). The early surgical treatment group, compared with the delayed surgical treatment group, had greater motor scores than the delayed surgical treatment group at 2 weeks (mean [SD] score, 34.2 [18.8] vs 18.9 [20.9]), 3 months (mean [SD] score, 49.1 [15.1] vs 37.2 [20.9]), and 6 months (mean [SD] score, 51.5 [13.9] vs 41.3 [23.4]) after injury. Adverse events were common in both groups (eg, worsening of paralysis, 6 patients vs 6 patients; death, 3 patients vs 3 patients). CONCLUSIONS AND RELEVANCE These findings suggest that among patients with cervical SCI, early surgical treatment produced similar motor regain at 1 year after injury as delayed surgical treatment but showed accelerated recovery within the first 6 months. These exploratory results suggest that early surgical treatment leads to faster neurological recovery, which requires further validation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01485458; umin.ac.jp/ctr Identifier: UMIN000006780.
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Affiliation(s)
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
| | - Yurie Koyama
- Kitasato University School of Nursing, Sagamihara, Japan
| | | | - Toru Ogata
- Department of Rehabilitation Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Ohtsu
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Shurei Sugita
- Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | | | | | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Toru Akiyama
- Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kei Ando
- Nagoya University Hospital, Nagoya, Japan
| | - Masato Anno
- Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | | | | | - Toru Endo
- Wakayama Medical University Hospital, Wakayama, Japan
| | | | | | | | | | | | - Chiaki Horii
- Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Seiji Iimoto
- Hokkaido Spinal Cord Injury Center, Bibai, Japan
| | - Yoichi Iizuka
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
| | | | | | - Koichi Inokuchi
- Saitama Medical University Saitama Medical Center, Kawagoe, Japan
| | - Hirokazu Inoue
- Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
| | - Tomoo Inoue
- Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | | | | | - Takui Ito
- Niigata City General Hospital, Niigata, Japan
| | - Akira Itoi
- Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Kohei Iwamoto
- Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | | | | | - Tsuyoshi Kato
- Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | | | | | | | - Atsushi Kimura
- Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
| | | | | | - Miki Komatsu
- Hokkaido Spinal Cord Injury Center, Bibai, Japan
| | | | | | | | | | | | | | | | | | | | | | - Tokue Mieda
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
| | | | | | | | | | | | | | - Kazunori Oae
- Saitama Medical University Saitama Medical Center, Kawagoe, Japan
| | | | | | | | - Eijiro Onishi
- Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Atsushi Ono
- Hirosaki University Hospital, Hirosaki, Japan
| | | | - Yusuke Oshita
- Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Kazuo Saita
- Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yutaka Sasao
- St Marianna University Hospital, Kawasaki, Japan
| | | | | | - Atsushi Seichi
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Shoji Seki
- Toyama University Hospital, Toyama, Japan
| | | | - Kota Suda
- Hokkaido Spinal Cord Injury Center, Bibai, Japan
| | | | | | | | - Eiji Takasawa
- Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan
| | | | | | | | | | | | | | - Hiroshi Uei
- Nihon University Itabashi Hospital, Tokyo, Japan
| | | | | | - Tadashi Yahata
- Saitama Medical University Saitama Medical Center, Kawagoe, Japan
| | - Kei Yamada
- Kurume University Hospital, Kurume, Japan
| | | | - Keigo Yasui
- Hokkaido Spinal Cord Injury Center, Bibai, Japan
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10
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Koda M, Hanaoka H, Fujii Y, Hanawa M, Kawasaki Y, Ozawa Y, Fujiwara T, Furuya T, Ijima Y, Saito J, Kitamura M, Miyamoto T, Ohtori S, Matsumoto Y, Abe T, Takahashi H, Watanabe K, Hirano T, Ohashi M, Shoji H, Mizouchi T, Kawahara N, Kawaguchi M, Orita Y, Sasamoto T, Yoshioka M, Fujii M, Yonezawa K, Soma D, Taneichi H, Takeuchi D, Inami S, Moridaira H, Ueda H, Asano F, Shibao Y, Aita I, Takeuchi Y, Mimura M, Shimbo J, Someya Y, Ikenoue S, Sameda H, Takase K, Ikeda Y, Nakajima F, Hashimoto M, Hasue F, Fujiyoshi T, Kamiya K, Watanabe M, Katoh H, Matsuyama Y, Hasegawa T, Yoshida G, Arima H, Yamato Y, Oe S, Togawa D, Kobayashi S, Akeda K, Kawamoto E, Imai H, Sakakibara T, Sudo A, Ito Y, Kikuchi T, Takigawa T, Morita T, Tanaka N, Nakanishi K, Kamei N, Kotaka S, Baba H, Okudaira T, Konishi H, Yamaguchi T, Ito K, Katayama Y, Matsumoto T, Matsumoto T, Kanno H, Aizawa T, Hashimoto K, Eto T, Sugaya T, Matsuda M, Fushimi K, Nozawa S, Iwai C, Taguchi T, Kanchiku T, Suzuki H, Nishida N, Funaba M, Sakai T, Imajo Y, Yamazaki M. Randomized trial of granulocyte colony-stimulating factor for spinal cord injury. Brain 2021; 144:789-799. [PMID: 33764445 PMCID: PMC8041047 DOI: 10.1093/brain/awaa466] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/07/2020] [Accepted: 10/24/2020] [Indexed: 12/03/2022] Open
Abstract
Attenuation of the secondary injury of spinal cord injury (SCI) can suppress the spread of spinal cord tissue damage, possibly resulting in spinal cord sparing that can improve functional prognoses. Granulocyte colony-stimulating factor (G-CSF) is a haematological cytokine commonly used to treat neutropenia. Previous reports have shown that G-CSF promotes functional recovery in rodent models of SCI. Based on preclinical results, we conducted early phase clinical trials, showing safety/feasibility and suggestive efficacy. These lines of evidence demonstrate that G-CSF might have therapeutic benefits for acute SCI in humans. To confirm this efficacy and to obtain strong evidence for pharmaceutical approval of G-CSF therapy for SCI, we conducted a phase 3 clinical trial designed as a prospective, randomized, double-blinded and placebo-controlled comparative trial. The current trial included cervical SCI [severity of American Spinal Injury Association (ASIA) Impairment Scale (AIS) B or C] within 48 h after injury. Patients are randomly assigned to G-CSF and placebo groups. The G-CSF group was administered 400 μg/m2/day × 5 days of G-CSF in normal saline via intravenous infusion for five consecutive days. The placebo group was similarly administered a placebo. Allocation was concealed between blinded evaluators of efficacy/safety and those for laboratory data, as G-CSF markedly increases white blood cell counts that can reveal patient treatment. Efficacy and safety were evaluated by blinded observer. Our primary end point was changes in ASIA motor scores from baseline to 3 months after drug administration. Each group includes 44 patients (88 total patients). Our protocol was approved by the Pharmaceuticals and Medical Device Agency in Japan and this trial is funded by the Center for Clinical Trials, Japan Medical Association. There was no significant difference in the primary end point between the G-CSF and the placebo control groups. In contrast, one of the secondary end points showed that the ASIA motor score 6 months (P = 0.062) and 1 year (P = 0.073) after drug administration tend to be higher in the G-CSF group compared with the placebo control group. The present trial failed to show a significant effect of G-CSF in primary end point.
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Affiliation(s)
- Masao Koda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
- Correspondence to: Masao Koda, MD, PhD Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba City Ibaraki 305-8575 Japan E-mail:
| | - Hideki Hanaoka
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yasuhisa Fujii
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Michiko Hanawa
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yoshihito Ozawa
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Tadami Fujiwara
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Takeo Furuya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yasushi Ijima
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Junya Saito
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Mitsuhiro Kitamura
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takuya Miyamoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Seiji Ohtori
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yukei Matsumoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Abe
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Takahashi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | - Kei Watanabe
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Toru Hirano
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Masayuki Ohashi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Hirokazu Shoji
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Tatsuki Mizouchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Norio Kawahara
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Masahito Kawaguchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Yugo Orita
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Takeshi Sasamoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Masahito Yoshioka
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Masafumi Fujii
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Katsutaka Yonezawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Daisuke Soma
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Hiroshi Taneichi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Daisaku Takeuchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Satoshi Inami
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Hiroshi Moridaira
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Haruki Ueda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Futoshi Asano
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Yosuke Shibao
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Ikuo Aita
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tsukuba Medical Center, Tsukuba, Japan
| | - Yosuke Takeuchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tsukuba Medical Center, Tsukuba, Japan
| | - Masaya Mimura
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Jun Shimbo
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Yukio Someya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Sumio Ikenoue
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Hiroaki Sameda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Kan Takase
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Yoshikazu Ikeda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba Rosai Hospital, Chiba, Japan
| | - Fumitake Nakajima
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba Rosai Hospital, Chiba, Japan
| | - Mitsuhiro Hashimoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba Rosai Hospital, Chiba, Japan
| | - Fumio Hasue
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kimitsu Chuo Hospital, Chiba, Japan
| | - Takayuki Fujiyoshi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kimitsu Chuo Hospital, Chiba, Japan
| | - Koshiro Kamiya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kimitsu Chuo Hospital, Chiba, Japan
| | - Masahiko Watanabe
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Hiroyuki Katoh
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tokai University School of Medicine, Kanagawa, Japan
| | - Yukihiro Matsuyama
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiko Hasegawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Go Yoshida
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideyuki Arima
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yu Yamato
- G-SPIRIT Study Group, Chiba, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shin Oe
- G-SPIRIT Study Group, Chiba, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Daisuke Togawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kindai University, Nara Hospital, Nara, Japan
| | - Sho Kobayashi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Koji Akeda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Eiji Kawamoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Hiroshi Imai
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Toshihiko Sakakibara
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Akihiro Sudo
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Mie, Japan
| | - Yasuo Ito
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Hyogo, Japan
| | - Takeshi Kikuchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Hyogo, Japan
| | - Tomoyuki Takigawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Hyogo, Japan
| | - Takuya Morita
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Hyogo, Japan
| | - Nobuhiro Tanaka
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, JR Hiroshima Hospital, Hiroshima, Japan
| | - Kazuyoshi Nakanishi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nihon University, Tokyo, Japan
| | - Naosuke Kamei
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinji Kotaka
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Hideo Baba
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Tsuyoshi Okudaira
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Hiroaki Konishi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Takayuki Yamaguchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Keigo Ito
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Aichi, Japan
| | - Yoshito Katayama
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Aichi, Japan
| | - Taro Matsumoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Aichi, Japan
| | - Tomohiro Matsumoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Aichi, Japan
| | - Haruo Kanno
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Toshimi Aizawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Ko Hashimoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Toshimitsu Eto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Takehiro Sugaya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Michiharu Matsuda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Miyagi, Japan
| | - Kazunari Fushimi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Satoshi Nozawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Chizuo Iwai
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Toshihiko Taguchi
- G-SPIRIT Study Group, Chiba, Japan
- Yamaguchi Rosai Hospital, Japan Organization of Occupational Health and Safety, Japan
| | - Tsukasa Kanchiku
- G-SPIRIT Study Group, Chiba, Japan
- Department of Spine and Spinal Cord Surgery, Yamaguchi Rosai Hospital, Japan
| | - Hidenori Suzuki
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Norihiro Nishida
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Masahiro Funaba
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takashi Sakai
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yasuaki Imajo
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Masashi Yamazaki
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
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Moridaira H, Inami S, Takeuchi D, Ueda H, Aoki H, Imura T, Taneichi H. Can we use shorter constructs while maintaining satisfactory sagittal plane alignment for adult spinal deformity? J Neurosurg Spine 2020; 34:589-596. [PMID: 33361482 DOI: 10.3171/2020.7.spine20917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Issues with spinopelvic fixation for adult spinal deformity (ASD) include loss of the physiological mobility of the entire lumbar spine, perioperative complications, and medical costs. Little is known about the factors associated with successful short fusion for ASD. The authors evaluated radiographic and clinical outcomes after shorter fusion for different subtypes of ASD at 2 years postoperatively and examined factors associated with successful short fusion. METHODS This was a single-center study of 37 patients who underwent short fusion and a minimum 2 years of follow-up for ASD in which lumbar kyphosis was the main deformity. The exclusion criteria were 1) age < 40 years, 2) previous lumbar vertebral fracture, 3) severe osteoporosis, 4) T10-L2 kyphosis > 20°, 5) scoliotic deformity with an upper end vertebra (UEV) above T12, and 6) concomitant Parkinson's disease or neurological disease. The surgical procedures, radiographic course, and Oswestry Disability Index (ODI) were assessed, and correlations between radiographic parameters and postoperative ODI at 2 years were analyzed. RESULTS A mean of 3.5 levels were fused. The mean radiographic parameters preoperatively, at 2 weeks, and at 2 years, respectively, were as follows: coronal Cobb angle: 22.9°, 11.5°, and 12.6°; lumbar lordosis (LL): 12.9°, 35.8°, and 32.2°; pelvic incidence (PI) minus LL: 35.5°, 14.7°, and 19.2°; pelvic tilt: 29.4°, 23.1°, and 25.0°; and sagittal vertical axis 85.3, 36.7, and 59.2 mm. Abnormal proximal junctional kyphosis occurred in 8 cases. Revision surgery was performed to extend the length of fusion from a lower thoracic vertebra to the pelvis in 2 cases. The mean ODI scores preoperatively and at 2 years were 50.7% and 24.1%, respectively. Patient age, number of fused intervertebral segments, and radiographic parameters were analyzed by the stepwise method to identify factors contributing to the ODI score at 2 years, preoperative PI, and sagittal vertical axis at 2 years. On receiver operating characteristic curve analysis of the minimal clinically important difference of ODI (15%) and preoperative PI, the cutoff value of the preoperative PI was 47° (area under the curve 0.75). CONCLUSIONS In terms of subtypes of ASD in which lumbar kyphosis is the main deformity, if the PI is < 47°, then the use of short fusion preserving mobile intervertebral segments can produce adequate LL for the PI, improving both postoperative global spinal alignment and quality of life.
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12
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Chiba T, Inami S, Moridaira H, Takeuchi D, Nohara Y, Taneichi H. Unique Growing Rod Treatment with Prior Foundation Surgery for Spondylo-Epi-Metaphyseal Dysplasia with Severe Kyphoscoliosis: A Case Report. Spine Surg Relat Res 2020; 4:284-286. [PMID: 32864499 PMCID: PMC7447341 DOI: 10.22603/ssrr.2019-0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 10/30/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Takafumi Chiba
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, Shimotsuga, Japan
| | - Satoshi Inami
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, Shimotsuga, Japan
| | - Hiroshi Moridaira
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, Shimotsuga, Japan
| | - Daisaku Takeuchi
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, Shimotsuga, Japan
| | - Yutaka Nohara
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, Shimotsuga, Japan
| | - Hiroshi Taneichi
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, Shimotsuga, Japan
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13
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Chiba T, Inami S, Moridaira H, Takeuchi D, Sorimachi T, Ueda H, Ohe M, Aoki H, Iimura T, Nohara Y, Taneichi H. Growing rod technique with prior foundation surgery and sublaminar taping for early-onset scoliosis. J Neurosurg Spine 2020; 33:607-612. [PMID: 32590351 DOI: 10.3171/2020.4.spine2036] [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: 01/09/2020] [Accepted: 04/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to show the surgical results of growing rod (GR) surgery with prior foundation surgery (PFS) and sublaminar taping at an apex vertebra. METHODS Twenty-two early-onset scoliosis (EOS) patients underwent dual GR surgery with PFS and sublaminar taping. PFS was performed prior to rod placement, including exposure of distal and proximal anchor areas and anchor instrumentation filled with a local bone graft. After a period of 3-5 months for the anchors to become solid, dual rods were placed for distraction. The apex vertebra was exposed and fastened to the concave side of the rods using sublaminar tape. Preoperative, post-GR placement, and final follow-up radiographic parameters were measured. Complications during the treatment period were evaluated using the patients' clinical records. RESULTS The median age at the initial surgery was 55.5 months (range 28-99 months), and the median follow-up duration was 69.5 months (range 25-98 months). The median scoliotic curves were 81.5° (range 39°-126°) preoperatively, 30.5° (range 11°-71°) after GR placement, and 33.5° (range 12°-87°) at the final follow-up. The median thoracic kyphotic curves were 45.5° (range 7°-136°) preoperatively, 32.5° (range 15°-99°) after GR placement, and 42° (range 11°-93°) at the final follow-up. The median T1-S1 lengths were 240.5 mm (range 188-305 mm) preoperatively, 286.5 mm (range 232-340 mm) after GR placement, and 337.5 mm (range 206-423 mm) at the final follow-up. Complications occurred in 6 patients (27%). Three patients had implant-related complications, 2 patients had alignment-related complications, and 1 patient had a wound-related complication. CONCLUSIONS A dual GR technique with PFS and sublaminar taping showed effective correction of scoliotic curves and a lower complication rate than previous reports when a conventional dual GR technique was used.
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Affiliation(s)
- Takafumi Chiba
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu
| | - Satoshi Inami
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu
| | | | - Daisaku Takeuchi
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu
| | | | - Haruki Ueda
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu
| | - Makoto Ohe
- 3Department of Orthopaedic Surgery, Kamitsuga General Hospital, Kanuma, Tochigi, Japan
| | - Hiromichi Aoki
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu
| | - Takuya Iimura
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu
| | - Yutaka Nohara
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu
| | - Hiroshi Taneichi
- 1Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu
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14
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Ohe M, Moridaira H, Inami S, Takeuchi D, Nohara Y, Taneichi H. Pedicle screws with a thin hydroxyapatite coating for improving fixation at the bone-implant interface in the osteoporotic spine: experimental study in a porcine model. J Neurosurg Spine 2018; 28:679-687. [DOI: 10.3171/2017.10.spine17702] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEInstrumentation failure caused by the loosening of pedicle screws (PSs) in patients with osteoporosis is a serious problem after spinal surgery. The addition of a thin hydroxyapatite (HA) surface coating applied by using a sputtering process was reported recently to be a promising method for providing bone conduction around an implant without a significant risk of coating-layer breakage. In this study, the authors evaluated the biomechanical and histological features of the bone-implant interface (BII) of PSs with a thin HA coating in an in vivo porcine osteoporotic spine model.METHODSThree types of PSs (untreated/standard [STPS], sandblasted [BLPS], and HA-coated [HAPS] PSs) were implanted into the thoracic and lumbar spine (T9–L6) of 8 mature Clawn miniature pigs (6 ovariectomized [osteoporosis group] and 2 sham-operated [control group] pigs). The spines were harvested from the osteoporosis group at 0, 2, 4, 8, 12, or 24 weeks after PS placement and from the control group at 0 or 24 weeks. Their bone mineral density (BMD) was measured by peripheral quantitative CT. Histological evaluation of the BIIs was conducted by performing bone volume/tissue volume and bone surface/implant surface measurements. The strength of the BII was evaluated with extraction torque testing.RESULTSThe BMD decreased significantly in the osteoporosis group (p < 0.01). HAPSs exhibited the greatest mean extraction peak torque at 8 weeks, and HAPSs and BLPSs exhibited significantly greater mean torque than the STPSs at 12 weeks (p < 0.05). The bone surface/implant surface ratio was significantly higher for HAPSs than for STPSs after 2 weeks (p < 0.05), and bonding between bone and the implant surface was maintained until 24 weeks with no detachment of the coating layer. In contrast, the bone volume/tissue volume ratio was significantly higher for HAPSs than for BLPSs or STPSs only at 4 weeks.CONCLUSIONSUsing PSs with a thin HA coating applied using a sputtering process strengthens bonding at the BII, which might improve early implant fixation after spinal surgery for osteoporosis. However, the absence of increased bone mass around the screw remains a concern; prescribing osteoporosis treatment to improve bone quality might be necessary to prevent fractures around the screws.
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15
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Koda M, Hanaoka H, Sato T, Fujii Y, Hanawa M, Takahashi S, Furuya T, Ijima Y, Saito J, Kitamura M, Ohtori S, Matsumoto Y, Abe T, Watanabe K, Hirano T, Ohashi M, Shoji H, Mizouchi T, Takahashi I, Kawahara N, Kawaguchi M, Orita Y, Sasamoto T, Yoshioka M, Fujii M, Yonezawa K, Soma D, Taneichi H, Takeuchi D, Inami S, Moridaira H, Ueda H, Asano F, Shibao Y, Aita I, Takeuchi Y, Mimura M, Shimbo J, Someya Y, Ikenoue S, Sameda H, Takase K, Ikeda Y, Nakajima F, Hashimoto M, Ozawa T, Hasue F, Fujiyoshi T, Kamiya K, Watanabe M, Katoh H, Matsuyama Y, Yamamoto Y, Togawa D, Hasegawa T, Kobayashi S, Yoshida G, Oe S, Banno T, Arima H, Akeda K, Kawamoto E, Imai H, Sakakibara T, Sudo A, Ito Y, Kikuchi T, Osaki S, Tanaka N, Nakanishi K, Kamei N, Kotaka S, Baba H, Okudaira T, Konishi H, Yamaguchi T, Ito K, Katayama Y, Matsumoto T, Matsumoto T, Idota M, Kanno H, Aizawa T, Hashimoto K, Eto T, Sugaya T, Matsuda M, Fushimi K, Nozawa S, Iwai C, Taguchi T, Kanchiku T, Suzuki H, Nishida N, Funaba M, Yamazaki M. Study protocol for the G-SPIRIT trial: a randomised, placebo-controlled, double-blinded phase III trial of granulocyte colony-stimulating factor-mediated neuroprotection for acute spinal cord injury. BMJ Open 2018; 8:e019083. [PMID: 29730616 PMCID: PMC5942478 DOI: 10.1136/bmjopen-2017-019083] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Granulocyte colony-stimulating factor (G-CSF) is generally used for neutropaenia. Previous experimental studies revealed that G-CSF promoted neurological recovery after spinal cord injury (SCI). Next, we moved to early phase of clinical trials. In a phase I/IIa trial, no adverse events were observed. Next, we conducted a non-randomised, non-blinded, comparative trial, which suggested the efficacy of G-CSF for promoting neurological recovery. Based on those results, we are now performing a phase III trial. METHODS AND ANALYSIS The objective of this study is to evaluate the efficacy of G-CSF for acute SCI. The study design is a prospective, multicentre, randomised, double-blinded, placebo-controlled comparative study. The current trial includes cervical SCI (severity of American Spinal Injury Association (ASIA) Impairment Scale B/C) within 48 hours after injury. Patients are randomly assigned to G-CSF and placebo groups. The G-CSF group is administered 400 µg/m2/day×5 days of G-CSF in normal saline via intravenous infusion for 5 consecutive days. The placebo group is similarly administered a placebo. Our primary endpoint is changes in ASIA motor scores from baseline to 3 months. Each group includes 44 patients (88 total patients). ETHICS AND DISSEMINATION The study will be conducted according to the principles of the World Medical Association Declaration of Helsinki and in accordance with the Japanese Medical Research Involving Human Subjects Act and other guidelines, regulations and Acts. Results of the clinical study will be submitted to the head of the respective clinical study site as a report after conclusion of the clinical study by the sponsor-investigator. Even if the results are not favourable despite conducting the clinical study properly, the data will be published as a paper. TRIAL REGISTRATION NUMBER UMIN000018752.
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Affiliation(s)
- Masao Koda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba City, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hideki Hanaoka
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Takatoshi Sato
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yasuhisa Fujii
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Michiko Hanawa
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Sho Takahashi
- G-SPIRIT Study Group, Chiba, Japan
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Takeo Furuya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yasushi Ijima
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Junya Saito
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Mitsuhiro Kitamura
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yukei Matsumoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba City, Japan
| | - Tetsuya Abe
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba City, Japan
| | - Kei Watanabe
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Toru Hirano
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Masayuki Ohashi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Hirokazu Shoji
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Tatsuki Mizouchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Ikuko Takahashi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
| | - Norio Kawahara
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Masahito Kawaguchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Yugo Orita
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Takeshi Sasamoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Masahito Yoshioka
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Masafumi Fujii
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Katsutaka Yonezawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Daisuke Soma
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kanazawa Medical University, Uchinada, Japan
| | - Hiroshi Taneichi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Shimotsuga-gun, Japan
| | - Daisaku Takeuchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Shimotsuga-gun, Japan
| | - Satoshi Inami
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Shimotsuga-gun, Japan
| | - Hiroshi Moridaira
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Shimotsuga-gun, Japan
| | - Haruki Ueda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Shimotsuga-gun, Japan
| | - Futoshi Asano
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Shimotsuga-gun, Japan
| | - Yosuke Shibao
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Dokkyo Medical University, Shimotsuga-gun, Japan
| | - Ikuo Aita
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tsukuba Medical Center, Tsukuba City, Japan
| | - Yosuke Takeuchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tsukuba Medical Center, Tsukuba City, Japan
| | - Masaya Mimura
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Jun Shimbo
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Yukio Someya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Sumio Ikenoue
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Hiroaki Sameda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Kan Takase
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Yoshikazu Ikeda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba Rosai Hospital, Ichihara, Japan
| | - Fumitake Nakajima
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba Rosai Hospital, Ichihara, Japan
| | - Mitsuhiro Hashimoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba Rosai Hospital, Ichihara, Japan
| | - Tomoyuki Ozawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chiba Rosai Hospital, Ichihara, Japan
| | - Fumio Hasue
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kimitsu Chuo Hospital, Kisarazu, Japan
| | - Takayuki Fujiyoshi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kimitsu Chuo Hospital, Kisarazu, Japan
| | - Koshiro Kamiya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kimitsu Chuo Hospital, Kisarazu, Japan
| | - Masahiko Watanabe
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Hiroyuki Katoh
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Yukihiro Matsuyama
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yu Yamamoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Daisuke Togawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiko Hasegawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Sho Kobayashi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Go Yoshida
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shin Oe
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Banno
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideyuki Arima
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Koji Akeda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Eiji Kawamoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Hiroshi Imai
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Toshihiko Sakakibara
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Akihiro Sudo
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yasuo Ito
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Kobe, Japan
| | - Tsuyoshi Kikuchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Kobe, Japan
| | - Shuhei Osaki
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, Kobe, Japan
| | - Nobuhiro Tanaka
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuyoshi Nakanishi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Naosuke Kamei
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinji Kotaka
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Hideo Baba
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Sasebo, Japan
| | - Tsuyoshi Okudaira
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Sasebo, Japan
| | - Hiroaki Konishi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Sasebo, Japan
| | - Takayuki Yamaguchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Nagasaki Rosai Hospital, Sasebo, Japan
| | - Keigo Ito
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Yoshito Katayama
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Taro Matsumoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Tomohiro Matsumoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Masaru Idota
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Haruo Kanno
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Toshimi Aizawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Ko Hashimoto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Toshimitsu Eto
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Takehiro Sugaya
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Michiharu Matsuda
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kazunari Fushimi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Satoshi Nozawa
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Chizuo Iwai
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Toshihiko Taguchi
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Tsukasa Kanchiku
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hidenori Suzuki
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Norihiro Nishida
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Masahiro Funaba
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Masashi Yamazaki
- G-SPIRIT Study Group, Chiba, Japan
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba City, Japan
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16
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Namikawa T, Taneichi H, Inami S, Moridaira H, Takeuchi D, Shiba Y, Nohara Y. Multiple concave rib head resection improved correction rate of posterior spine fusion in treatment of adolescent idiopathic scoliosis. J Orthop Sci 2017; 22:415-419. [PMID: 28202300 DOI: 10.1016/j.jos.2017.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/06/2016] [Revised: 01/14/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hybrid constructs have been widely used to surgically correct thoracic adolescent idiopathic scoliosis (AIS). To enhance the correction obtained with hybrid constructs, we perform concave rib head resection and convex costovertebral release as posterior release procedures. The objective of the study was to evaluate coronal and sagittal curve correction in patients with adolescent idiopathic scoliosis (AIS) treated with hybrid constructs combined with concave rib head resection and convex transverse process resection as posterior release procedures. METHODS The records of 24 patients with Lenke type 1 or 2 AIS treated with hybrid constructs combined with posterior release procedures were retrospectively reviewed. The mean age at surgery was 14.3 years. The mean follow-up period was 33.0 months (range, 24-60 months). Radiographs were evaluated before surgery, immediately postoperatively, and at latest follow-up. RESULTS The average preoperative Cobb angle of the main thoracic (MT) curve was 58.1 ± 12.6° (range, 45-88°). The MT curve was corrected to 12.8 ± 9.0° (range, 0-38°) immediately after surgery. At the latest follow-up, the average Cobb angle was 13.6 ± 9.9° (range, 0-44°; correction, 77.5 ± 14.0%). The average loss of coronal correction was 0.8°. The average preoperative flexibility of the MT curve was 54.6 ± 17.4%. The average Cincinnati correction index was 1.53 ± 0.48 at the latest follow-up. The average preoperative thoracic kyphosis (TK) was 13.7 ± 12.0° (range, -12-34°). Immediately after surgery, TK was corrected to 18.6 ± 5.9° (range, 10-29°). At the latest follow-up, TK measured 18.1 ± 6.5° (range, 6-32°). CONCLUSIONS Hybrid instrumentation combined with concave rib head resection and convex transverse process resection as posterior release procedures achieved satisfactory coronal and sagittal curve correction with little loss of correction at 2-year follow-up.
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Affiliation(s)
- Takashi Namikawa
- Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan; Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Hiroshi Taneichi
- Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan.
| | - Satoshi Inami
- Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Hiroshi Moridaira
- Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Daisaku Takeuchi
- Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Yo Shiba
- Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Yutaka Nohara
- Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan
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17
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Shiba Y, Taneichi H, Inami S, Moridaira H, Takeuchi D, Ohe M, Nohara Y. Dynamic sagittal balance evaluated by 3-dimentional gait analysis in patients with degenerative lumbar kyphosis. Scoliosis 2015. [PMCID: PMC4341135 DOI: 10.1186/1748-7161-10-s1-p11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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Matsumura A, Taneichi H, Suda K, Kajino T, Moridaira H, Kaneda K. Comparative study of radiographic disc height changes using two different interbody devices for transforaminal lumbar interbody fusion: open box vs. fenestrated tube interbody cage. Spine (Phila Pa 1976) 2006; 31:E871-6. [PMID: 17077723 DOI: 10.1097/01.brs.0000244593.86975.27] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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
STUDY DESIGN Retrospective comparative study of the postoperative subsidence of two interbody devices following posterior or transforaminal lumbar interbody fusion (PLIF/TLIF) for degenerative spondylolisthesis of the lumbar spine. OBJECTIVE To assess certain radiograph characteristics of PLIF/TLIF using two interbody fusion devices at L4-L5. SUMMARY OF BACKGROUND DATA PLIF can achieve spinal stabilization with vertebral body support and direct neural decompression. Although various interbody devices have been used in PLIF procedures, no radiographic studies have compared the load-bearing capabilities of open box and fenestrated tube interbody cages. METHODS Seventy-five patients who underwent one-level PLIF in the L4-L5 [corrected] segment for degenerative spondylolisthesis were retrospectively reviewed with a minimum 2-year follow-up. Fenestrated tube (Group FT: n = 30 [corrected]) or open box (Group OB: n = 45 [corrected]) cages were used for the PLIF procedure. The following radiographic parameters were evaluated to compare the load-bearing capabilities: disc space height (DH); percent increase and decrease of disc height (% IDH and % DDH, respectively); and percent coverage of the cage on the endplate (% CC). RESULTS There were no significant differences in the baseline data, including age, segmental instability and osteoporotic status, between the two groups. Anterior %IDH and % CC were significantly higher in Group OB than in Group FT (% IDH: 69.4% vs. 57.3%; % OC: 24.5% vs. 12.9%), and anterior and posterior % DDH were significantly higher in Group FT than in Group OB (anterior: -2.9% vs. -.1%; posterior: -6.6% vs. -.3%). Although the restored DH gradually reduced over time in both groups, significant reduction to the preoperative level only occurred in Group FT. CONCLUSIONS The load-bearing capabilities of the open box cage are superior to those of the fenestrated tube cage. Since there were no significant differences between the baseline status of the two groups, the larger cross-sectional area and stable framework design of the open box cage appears to bring about a greater load-bearing capability. Therefore, the open box cage seems to be biomechanically more advantageous as an interbody device for PLIF than the fenestrated tube cage.
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Affiliation(s)
- Akira Matsumura
- Center for Spinal Disorder and Injury, Bibai Rosai Hospital, Hokkaido, Japan
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19
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Taneichi H, Suda K, Kajino T, Matsumura A, Moridaira H, Kaneda K. Unilateral transforaminal lumbar interbody fusion and bilateral anterior-column fixation with two Brantigan I/F cages per level: clinical outcomes during a minimum 2-year follow-up period. J Neurosurg Spine 2006; 4:198-205. [PMID: 16572618 DOI: 10.3171/spi.2006.4.3.198] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT There are no published reports of unilateral transforaminal lumbar interbody fusion (TLIF) in which two Brantigan I/F cages were placed per level through a single portal to achieve bilateral anterior-column support. The authors describe such a surgical technique and evaluate the clinical outcomes of this procedure. METHODS Data obtained in 86 (93.5%) of the first 92 consecutive patients who underwent the procedure were retrospectively reviewed; the minimum follow-up duration was 2 years. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) scoring system. Disc height, disc angle, cage positioning in the axial plane, and fusion status were radiographically evaluated. The mean follow-up period was 33.8 months. The mean improvement in the JOA score was 77.2%. Fusion was successful in 93% of the cases. According to the Farfan method, the mean anterior and posterior disc heights increased from 20.2 and 16.9% preoperatively to 35.9 and 22.7% at follow up, respectively (p < 0.01). The mean disc angle increased from 4.8degrees preoperatively to 7.5degrees at last follow-up examination (p < 0.01). Two cages were correctly placed to achieve bilateral anterior-column support in greater than 85% of the cases. The following complications occurred: hardware migration in two patients and deep infection cured by intravenous antibiotic therapy in one patient. CONCLUSIONS Unilateral TLIF involving the placement of two Brantigan cages per level led to good clinical results. Two Brantigan cages were adequately placed via a single portal, and reliable bilateral anterior-column support was achieved. Although the less invasive unilateral approach was used, the outcomes were as good as those in many reported series of posterior lumbar interbody fusion in which the Brantigan cages were placed via the bilateral approach.
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Affiliation(s)
- Hiroshi Taneichi
- Center for Spinal Disorder and Injury, Bibai Rosai Hospital, Japan.
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Ito M, Abumi K, Moridaira H, Shono Y, Kotani Y, Minami A, Kaneda K. Iliac crest reconstruction with a bioactive ceramic spacer. Eur Spine J 2005; 14:99-102. [PMID: 15241670 PMCID: PMC3476679 DOI: 10.1007/s00586-004-0765-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2003] [Revised: 05/21/2004] [Accepted: 05/28/2004] [Indexed: 11/24/2022]
Abstract
This study aimed to investigate the long-term clinical results of the apatite wollastonite-containing glass ceramic (AWGC) iliac spacer and to discuss its efficacy in reconstruction of the bone graft donor site at the iliac crest. Thirty-one patients were studied for more than 10 years. All patients underwent anterior spinal fusion using autogenous tricortical iliac bone graft. After harvest of tricortical iliac bone graft, an AWGC iliac spacer ranging from 15 mm to 70 mm in length was press-fitted into the gap. Long-term clinical results were obtained from radiological and blood examinations. Thirty patients (97%) were satisfied with the spacer. There was new bone formation around the spacer on the radiograph. There was no abnormal silicon concentration in blood examinations. AWGC iliac spacer appears to be useful in the reconstruction of harvested iliac crest. New bone formation occurs, reducing the defect size.
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Affiliation(s)
- Manabu Ito
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7 Kita-ku, 060-8638, Sapporo, Japan.
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Moridaira H. [Long-term effects of chondroitinase ABC on porcine intervertebral discs]. Hokkaido Igaku Zasshi 2003; 78:357-64. [PMID: 12911011] [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] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- Hiroshi Moridaira
- Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
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Shimada K, Sakaguchi T, Sato Y, Moridaira H, Omata K. [Simultaneous determination of ephedrine and glycyrrhizin in human breast milk by high performance liquid chromatography]. YAKUGAKU ZASSHI 1984; 104:347-50. [PMID: 6491873 DOI: 10.1248/yakushi1947.104.4_347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Kanazawa K, Moridaira H, Hirogami T, Hando T, Takeuchi S. [Studies on treatment of invasive mole and subsequent reproductive performance, a report of 39 cases (author's transl)]. Nihon Sanka Fujinka Gakkai Zasshi 1980; 32:69-74. [PMID: 6263994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Thirty-nine invasive mole patients treated during the last 6 years (1971-1976) in our clinic, were studied. The data were summarized in the following items. 1. Surgical treatment was done in 31 cases (79.5%), and methods of operation were removal of focus in 13 cases and hysterectomy in 18. Chemotherapy was performed in 31 cases (79.5%). 2. In 31 operated patients, all of invasive lesions were in uterine bodies. A degree of chorial invasion into myometrium was shallow in 12 cases, medium in 12 and deep in 7. Molar vesicles were observed in 17 cases and trophoblastic tissues were microscopically confirmed in 14. 3. Anti-cancer agents, such as ACTD and MTX, were required 1-4 courses in 8 patients received chemotherapy alone and 1-6 courses in 23 patients received operation combined with chemotherapy. 4. Up to the present time, 14 pregnancies in 11 cases out of these patients occurred, but 2 of them ended in spontaneous abortion and one was molar pregnancy. 5. Malignant sequela, that is, choriocarcinoma was occurred in 2 cases. But, these 2 cases are in remission. 6. Thirty-seven patients, including 2 choriocarcinoma cases, are healthy at present.
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