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Murata S, Nagata K, Iwasaki H, Hashizume H, Minamide A, Nakagawa Y, Tsutsui S, Takami M, Ishimoto Y, Teraguchi M, Iwahashi H, Murakami K, Taiji R, Kozaki T, Kitano Y, Yoshida M, Yamada H. Long-term efficacy of microendoscopic laminotomy for lumbar spinal stenosis in advanced degenerative spondylolisthesis with or without dynamic spinal instability: a propensity score-matching analysis. J Neurosurg Spine 2024:1-8. [PMID: 38669704 DOI: 10.3171/2024.2.spine231075] [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: 09/28/2023] [Accepted: 02/07/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE In this study, the authors aimed to determine the mid- to long-term outcomes of microendoscopic laminotomy (MEL) for lumbar spinal stenosis (LSS) with degenerative spondylolisthesis (DS) and identify preoperative predictors of poor mid- to long-term outcomes. METHODS The authors retrospectively reviewed the medical records of 274 patients who underwent spinal MEL for symptomatic LSS. The minimum postoperative follow-up duration was 5 years. Patients were classified into two groups according to DS: those with DS (the DS+ group) and those without DS (the DS- group). The patients were subjected to propensity score matching based on sex, age, BMI, surgical segments, and preoperative leg pain visual analog scale scores. Clinical outcomes were evaluated 1 year and > 5 years after surgery. RESULTS Surgical outcomes of MEL for LSS were not significantly different between the DS+ and DS- groups at the final follow-up (mean 7.8 years) in terms of Oswestry Disability Index (p = 0.498), satisfaction (p = 0.913), and reoperation rate (p = 0.154). In the multivariate analysis, female sex (standard β -0.260), patients with slip angle > 5° in the forward bending position (standard β -0.313), and those with dynamic progression of Meyerding grade (standard β -0.325) were at a high risk of poor long-term outcomes. CONCLUSIONS MEL may have good long-term results in patients with DS without dynamic instability. Women with dynamic instability may require additional fusion surgery in approximately 25% of cases for a period of ≥ 5 years.
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Affiliation(s)
- Shizumasa Murata
- 1Department of Orthopedic Surgery, Shingu Municipal Medical Center, Wakayama
- 2Department of Orthopedic Surgery, Wakayama Medical University, Wakayama
| | - Keiji Nagata
- 2Department of Orthopedic Surgery, Wakayama Medical University, Wakayama
| | - Hiroshi Iwasaki
- 2Department of Orthopedic Surgery, Wakayama Medical University, Wakayama
| | - Hiroshi Hashizume
- 2Department of Orthopedic Surgery, Wakayama Medical University, Wakayama
| | - Akihito Minamide
- 3Spine Center, Dokkyo Medical University Nikko Medical Center, Nikko City, Tochigi
| | - Yukihiro Nakagawa
- 4Spine Care Center, Wakayama Medical University Kihoku Hospital, Katsuragi-cho, Ito-gun, Wakayama; and
| | - Shunji Tsutsui
- 2Department of Orthopedic Surgery, Wakayama Medical University, Wakayama
| | - Masanari Takami
- 2Department of Orthopedic Surgery, Wakayama Medical University, Wakayama
| | - Yuyu Ishimoto
- 2Department of Orthopedic Surgery, Wakayama Medical University, Wakayama
| | | | - Hiroki Iwahashi
- 1Department of Orthopedic Surgery, Shingu Municipal Medical Center, Wakayama
| | - Kimihide Murakami
- 2Department of Orthopedic Surgery, Wakayama Medical University, Wakayama
| | - Ryo Taiji
- 2Department of Orthopedic Surgery, Wakayama Medical University, Wakayama
| | - Takuhei Kozaki
- 2Department of Orthopedic Surgery, Wakayama Medical University, Wakayama
| | - Yoji Kitano
- 1Department of Orthopedic Surgery, Shingu Municipal Medical Center, Wakayama
| | - Munehito Yoshida
- 5Department of Orthopedic Surgery, Sumiya Orthopaedic Hospital, Wakayama, Japan
| | - Hiroshi Yamada
- 2Department of Orthopedic Surgery, Wakayama Medical University, Wakayama
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Tsutsui S, Hashizume H, Iwasaki H, Takami M, Ishimoto Y, Nagata K, Yamada H. Long-term Outcomes After Adult Spinal Deformity Surgery Using Lateral Interbody Fusion: Short Versus Long Fusion. Clin Spine Surg 2024:01933606-990000000-00262. [PMID: 38366331 DOI: 10.1097/bsd.0000000000001583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 01/22/2024] [Indexed: 02/18/2024]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To investigate long-term outcomes after short or long fusion for adult spinal deformity using lateral interbody fusion. SUMMARY OF BACKGROUND DATA Lateral interbody fusion is commonly used in adult spinal deformity surgery. Favorable short-term outcomes have been reported, but not long-term outcomes. Lateral interbody fusion with strong ability to correct deformity may allow the selection of short fusion techniques. MATERIALS AND METHODS We retrospectively reviewed adults who underwent this surgery with a minimum of 5 years of follow-up. Short fusion with the uppermost instrumented vertebra in the lumbar spine was performed in patients without degenerative changes at the thoracolumbar junction (S-group); others underwent long fusion with the uppermost instrumented vertebra in the thoracic spine (L-group). We assessed radiographic and clinical outcomes. RESULTS Short fusion was performed in 29 of 54 patients. One patient per group required revision surgery. Of the remainder, with similar preoperative characteristics and deformity correction between groups, correction loss (pelvic incidence-lumbar lordosis, P=0.003; pelvic tilt, P=0.005; sagittal vertical axis, P˂0.001) occurred within 2 years postoperatively in the S-group, and sagittal vertical axis continued to increase until the 5-year follow-up (P=0.021). Although there was a significant change in Oswestry disability index in the S-group (P=0.031) and self-image of Scoliosis Research Society 22r score in both groups (P=0.045 and 0.02) from 2- to 5-year follow-up, minimum clinically important differences were not reached. At 5-year follow-up, there was a significant difference in Oswestry Disability Index (P=0.013) and Scoliosis Research Society 22r scores (function: P=0.028; pain: P=0.003; subtotal: P=0.006) between the groups, but satisfaction scores were comparable and Oswestry Disability Index score (29.8%) in the S-group indicated moderate disability. CONCLUSIONS Health-related quality of life was maintained between 2- and 5-year follow-up in both groups. Short fusion may be an option for patients without degenerative changes at the thoracolumbar junction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Shunji Tsutsui
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
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Murata S, Takami M, Iwasaki H, Hashizume H, Yukawa Y, Minamide A, Nakagawa Y, Tsutsui S, Okada M, Nagata K, Ishimoto Y, Teraguchi M, Iwahashi H, Murakami K, Taiji R, Kozaki T, Kitano Y, Yoshida M, Yamada H. Outcomes and Vertebral Osteophytes and Bulging Intervertebral Discs Occupancy as a Decision-Making Tool for Surgical Success in Patients Undergoing Microendoscopic Foraminotomy for Lumbar Foraminal Stenosis. World Neurosurg 2024; 182:e570-e578. [PMID: 38052363 DOI: 10.1016/j.wneu.2023.11.150] [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] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/30/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE The objective of this study was to determine the long-term outcomes of microendoscopic foraminotomy in treating lumbar foraminal stenosis and identify the optimal extent of decompression that yields improved results and fewer complications. METHODS A retrospective cohort study reviewed the medical records of 95 consecutive patients who underwent microendoscopic foraminotomy for lumbar foraminal stenosis. Clinical outcomes were assessed using the Japanese Orthopaedic Association scoring system and visual analog scale for low back and leg pain. Surgical success was determined by meeting significant improvement thresholds for back and leg pain at 2 years postoperatively. Multiple regression analysis identified factors associated with improved pain scores. Receiver operating characteristic curve analysis determined the cut-off values for successful surgeries. RESULTS Significant improvements were observed in Japanese Orthopaedic Association and visual analog scale scores for back and leg pain 2 years postoperatively compared with preoperative scores (P < 0.0001) and sustained over a ≥5-year follow-up period. Reoperation rates were low and did not significantly increase over time. Multiple regression analysis identified occupancy of the vertebral osteophytes and bulging intervertebral discs (O/D complex) as surgical success predictors. A 45.0% O/D complex occupancy cutoff value was determined, displaying high sensitivity and specificity for predicting surgical success. CONCLUSIONS This study provides evidence supporting the long-term efficacy of microendoscopic foraminotomy for lumbar foraminal stenosis and predicting surgical success. The 45.0% O/D complex occupancy cut-off value can guide patient selection and outcome prediction. These insights contribute to informed surgical decision-making and underscore the importance of evaluating the O/D complex in preoperative planning and predicting outcomes.
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Affiliation(s)
- Shizumasa Murata
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, Shingu, Wakayama, Japan; Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masanari Takami
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan.
| | - Hiroshi Iwasaki
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Hashizume
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | | | - Akihito Minamide
- Spine Center, Dokkyo Medical University Nikko Medical Center, Nikko City, Tochigi, Japan
| | - Yukihiro Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Katsuragi, Wakayama, Japan
| | - Shunji Tsutsui
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Motohiro Okada
- Department of Orthopedic Surgery, Sumiya Orthopaedic Hospital, Wakayama, Japan
| | - Keiji Nagata
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Yuyu Ishimoto
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masatoshi Teraguchi
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroki Iwahashi
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, Shingu, Wakayama, Japan
| | - Kimihide Murakami
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Ryo Taiji
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Takuhei Kozaki
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Yoji Kitano
- Department of Orthopedic Surgery, Shingu Municipal Medical Center, Shingu, Wakayama, Japan
| | - Munehito Yoshida
- Department of Orthopedic Surgery, Sumiya Orthopaedic Hospital, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
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Takami M, Tsutsui S, Nagata K, Taiji R, Iwasaki H, Okada M, Minamide A, Yukawa Y, Hashizume H, Yamada H. Risk factors of postoperative coronal malalignment following long-segment spinal fusion surgery in which multilevel lateral lumbar interbody fusion was used for degenerative lumbar kyphoscoliosis. J Neurosurg Spine 2024; 40:70-76. [PMID: 37856375 DOI: 10.3171/2023.8.spine23520] [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] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/08/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE In patients with adult spinal deformity, especially degenerative lumbar kyphoscoliosis (DLKS), preoperative sagittal malalignment and coronal malalignment (CM) often coexist. Lateral lumbar interbody fusion (LLIF) has recently been widely chosen for DLKS treatment due to its minimal invasiveness and excellent sagittal alignment correction. However, postoperative CM may remain or occur due to an oblique takeoff phenomenon following multilevel LLIF, resulting in poor clinical outcomes. The authors investigated the risk factors for postoperative CM after long-segment fusion corrective surgery in which multilevel LLIF was used in patients with DLKS. METHODS Fifty-four consecutive patients with DLKS, main Cobb angle ≥ 20°, and lumbar lordosis ≤ 20° who underwent corrective spinal fusion surgery, including extreme lateral interbody fusion at ≥ 3 segments, were included at the authors' institute between April 2014 and October 2019. Patients who underwent suitable 3-column osteotomy, classified as grade 3-6 per the Scoliosis Research Society-Schwab criteria, were excluded. Patients were divided into CM and non-CM groups based on postoperative CM evaluated using standard standing-position radiographs obtained 2 years postoperatively. CM was defined as an absolute C7-CSVL (deviation of C7 plumb line off central sacral vertical line; calculated by defining the convex side of the CSVL as positive numerical values) value of ≥ 3.0 cm. Patient demographics and preoperative sagittal alignment parameters were evaluated. The following variables were measured to assess coronal alignment: main Cobb angle; preoperative C7-CSVL; amount of lateral listhesis; L4, L5, and sacral coronal tilt angles; coronal vertebral deformity angles; and coronal spine rigidity. RESULTS Regarding risk factors for postoperative CM, patient characteristics, preoperative sagittal parameters, and coronal parameters did not significantly differ between the 2 groups, except for preoperative C7-CSVL (p = 0.016). Multivariate logistic regression analysis revealed that preoperative C7-CSVL (+1 cm; OR 1.23, 95% CI 1.05-1.50; p = 0.007) was a significant predictor of postoperative CM. Receiver operating characteristic curve analysis demonstrated that the cutoff value for preoperative C7-CSVL was +0.3 cm, the sensitivity was 85.7%, the specificity was 60.6%, and the area under the curve was 0.70. CONCLUSIONS In corrective fusion surgery for DLKS in which multilevel LLIF was used, the occurrence of postoperative CM was associated with preoperative C7-CSVL. According to the C7-CSVL, which was evaluated by defining the convex side of the CSVL as positive numerical values and the concave side as negative numerical values, the CM group had a significantly higher value of preoperative C7-CSVL than did the non-CM group. Alternative corrective fusion methods, other than multiple LLIFs, may be considered in DLKS cases with a C7-CSVL of +0.3 cm or greater.
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Affiliation(s)
- Masanari Takami
- 1Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Shunji Tsutsui
- 1Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Keiji Nagata
- 1Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Ryo Taiji
- 1Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Hiroshi Iwasaki
- 1Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Motohiro Okada
- 1Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
- 2Department of Orthopaedic Surgery, Sumiya Orthopaedic Hospital, Wakayama
| | - Akihito Minamide
- 1Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
- 3Spine Center, Dokkyo Medical University Nikko Medical Center, Nikko City, Tochigi; and
| | - Yasutsugu Yukawa
- 1Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
- 4Spine Center, Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - Hiroshi Hashizume
- 1Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Hiroshi Yamada
- 1Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
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Kanchiku T, Taguchi T, Sekiguchi M, Toda N, Hosono N, Matsumoto M, Tanaka N, Akeda K, Hashizume H, Kanayama M, Orita S, Takeuchi D, Kawakami M, Fukui M, Kanamori M, Wada E, Kato S, Hongo M, Ando K, Iizuka Y, Ikegami S, Kawamura N, Takami M, Yamato Y, Takahashi S, Watanabe K, Takahashi J, Konno S, Chikuda H. Preoperative factors affecting the two-year postoperative patient-reported outcome in single-level lumbar grade I degenerative spondylolisthesis. N Am Spine Soc J 2023; 16:100269. [PMID: 37731461 PMCID: PMC10507637 DOI: 10.1016/j.xnsj.2023.100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/22/2023]
Abstract
Background The choice of operative method for lumbar spinal stenosis with Meyerding grade I degenerative spondylolisthesis remains controversial. The purpose of this study was to identify the preoperative factors affecting the 2-year postoperative patient-reported outcome in Meyerding grade I degenerative spondylolisthesis. Methods Seventy-two consecutive patients who had minimally invasive decompression alone (D group; 28) or with fusion (DF group; 44) were enrolled. The parameters investigated were the Japanese Orthopaedic Association back pain evaluation questionnaire as patient-reported assessment, and L4 slippage (L4S), lumbar lordosis (LL), and lumbar axis sacral distance (LASD) as an index of sagittal alignment for radiological evaluation. Data collected prospectively at 2 years postoperatively were examined by statistical analysis. Results Sixty-two cases (D group; 25, DF group; 37) were finally evaluated. In multiple logistic regression analysis, preoperative L4S and LASD were extracted as significant preoperative factors affecting the 2-year postoperative outcome. Patients with preoperative L4S of 6 mm or more have a lower rate of improvement in lumbar spine dysfunction due to low back pain (risk ratio=0.188, p=.043). Patients with a preoperative LASD of 30 mm or more have a higher rate of improvement in lumbar dysfunction due to low back pain (risk ratio=11.48, p=.021). The results of multiple logistic analysis by operative method showed that there was a higher rate of improvement in lumbar spine dysfunction due to low back pain in patients with preoperative LASD of 30 mm or more in DF group (risk ratio=172.028, p=.01). Conclusions Preoperative L4S and LASD were extracted as significant preoperative factors affecting patient-reported outcomes at 2 years postoperatively. Multiple logistic analyses by the operative method suggested that DF may be advantageous in improving lumbar dysfunction due to low back pain in patients with preoperative LASD of 30 mm or more.
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Affiliation(s)
- Tsukasa Kanchiku
- Department of Spine and Spinal Cord Surgery, Yamaguchi Rosai Hospital, 1315-4 Onoda, Sanyo-Onoda City, Yamaguchi Prefecture 756-0095, Japan
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi Prefecture 755-8505, Japan
| | - Toshihiko Taguchi
- Department of Spine and Spinal Cord Surgery, Yamaguchi Rosai Hospital, 1315-4 Onoda, Sanyo-Onoda City, Yamaguchi Prefecture 756-0095, Japan
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi Prefecture 755-8505, Japan
| | - Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima Prefecture 960-1295, Japan
| | - Naofumi Toda
- Department of Orthopaedic Surgery, Gunma Spine Center (Harunaso Hospital), 828-1 Kamitoyooka-cho, Takasaki City, Gunma Prefecture 370-0871, Japan
| | - Noboru Hosono
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Osaka Hospital, 4-2-78 Fukusima, Fukushima-ku, Osaka City, Osaka Prefecture 553-0003, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo Prefecture 160-8582, Japan
| | - Nobuhiro Tanaka
- Department of Orthopaedic Surgery, JR Hiroshima Hospital, 1-36 Niyonosato, Hiroshimahigasi-ku, Hiroshima Prefecture 732-0057, Japan
| | - Koji Akeda
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie Prefecture 514-8507, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama Prefecture 641-8509, Japan
| | - Masahiro Kanayama
- The Spine Center, Hakodate Central General Hospital, 33-2 Motomachi, Hakodate City, Hokkaido Prefecture 040-8585, Japan
| | - Sumihisa Orita
- Chiba University Center for Frontier Medical Engineering, Chiba, Japan, Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohara, Chuo-ku, Chiba City, Chiba Prefecture 260-8677, Japan
| | - Daisaku Takeuchi
- Department of Orthopaedic Surgery, Nasu Red-Cross Hospital, 1081-4 Nakatahara, Otahara City, Tochigi Prefecture 324-0062, Japan
| | - Mamoru Kawakami
- Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital, 45 Junibancho, Wakayama City, Wakayama Prefecture 640-8158, Japan
| | - Mitsuru Fukui
- Laboratory of Statistics, Osaka Metropolitan University Faculty of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka Prefecture 545-8585, Japan
| | - Masahiko Kanamori
- Department of Human Science 1, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama City, Toyama Prefecture 930-0194, Japan
| | - Eiji Wada
- Spine and Spinal Cord Center, Osaka Police Hospital, 10-31 Kitayamacho, Tennoji-ku, Osaka City, Osaka Prefecture 543-0035, Japan
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo Prefecture 113-8655, Japan
| | - Michio Hongo
- Department of Orthopaedic Surgery, Akita University Graduate School of Medicine, 44-2 Hasunuma Hiroomote, Akita City, Akita Prefecture 010-8543, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myokencho, Syowa-ku, Nagoya City, Aichi Prefecture 466-8650, Japan
| | - Yoichi Iizuka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, 3-39-15 Showacho, Maebashi City, Gunma Prefecture, 371-8511, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto City, Nagano Prefecture 390-8621, Japan
| | - Naohiro Kawamura
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo Prefecture 150-8935, Japan
| | - Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama Prefecture 641-8509, Japan
| | - Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu City, Shizuoka Prefecture 431-3192, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka Metropolitan University Hospital, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka Prefecture 545-8585, Japan
| | - Kei Watanabe
- Department of Orthopaedic Surgery, Niigata University Medical and Dental General Hospital, 754 Asahimachidoriichibancho, Chuo-ku, Niigata City, Niigata Prefecture 951-5820, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto City, Nagano Prefecture 390-8621, Japan
| | - Shinichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima Prefecture 960-1295, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, 3-39-15 Showacho, Maebashi City, Gunma Prefecture, 371-8511, Japan
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Kozaki T, Yukawa Y, Hashizume H, Iwasaki H, Tsutsui S, Takami M, Nagata K, Taiji R, Murata S, Yamada H. Clinical and radiographic characteristics of increased signal intensity of the spinal cord at the vertebral body level in patients with cervical myelopathy. J Orthop Sci 2023; 28:1240-1245. [PMID: 36396505 DOI: 10.1016/j.jos.2022.10.010] [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: 05/19/2022] [Revised: 09/14/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Increased signal intensity (ISI) is usually recognized at the disc level of the responsible lesion in the patients with cervical myelopathy. However, it is occasionally seen at the vertebral body level, below the level of compression. We aimed to investigate the clinical significance and the radiographic characteristics of ISI at the vertebral body level. METHODS This retrospective study included 135 patients with cervical spondylotic myelopathy who underwent surgery and with local ISI. We measured the local and C2-7 angle at flexion, neutral, and extension. We also evaluated the local range of motion (ROM) and C2-7 ROM. The patients were classified into group D (ISI at disc level) and group B (ISI at vertebral body level). RESULTS The prevalence was 80.7% (109/135) and 19.3% (26/135) for groups D and B, respectively. Local angle at flexion and neutral were more kyphotic in group B than in group D. The local ROM was larger in group B than in group D. Moreover, C2-7 angle at flexion, neutral and extension were more kyphotic in group B than in group D. Two years later, local angle at flexion, neutral, and extension were also kyphotic in group B than group D; however, local and C2-7 ROM was not significantly different between the two groups. There was no significant difference of clinical outcomes 2 years postoperatively between both groups. CONCLUSIONS Group B was associated with the kyphotic alignment and local greater ROM, compared to group D. As the spinal cord is withdrawn in flexion, the ISI lesion at vertebral body might be displaced towards the disc level, which impacted by the anterior components of the vertebrae. ISI at the vertebral body level might be related to cord compression or stretching at flexion position. This should be different from the conventionally held pincer-mechanism concept.
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Affiliation(s)
- Takuhei Kozaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan.
| | - Yasutsugu Yukawa
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan; Spine Center, Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Keiji Nagata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Ryo Taiji
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Shizumasa Murata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
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Tsutsui S, Hashizume H, Iwasaki H, Takami M, Ishimoto Y, Nagata K, Yamada H. Sarcopenia at the upper instrumented vertebra is more significantly associated with proximal junctional kyphosis after long fusion for adult spinal deformity surgery than osteopenia. J Clin Neurosci 2023; 116:13-19. [PMID: 37597329 DOI: 10.1016/j.jocn.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 08/21/2023]
Abstract
Proximal junctional kyphosis (PJK) is a major mechanical complication after adult spinal deformity (ASD) surgery, and is multifactorial. Osteopenia and sarcopenia are patient risk factors, but it has not yet been well-documented which of them is the more significant risk factor. We retrospectively studied patients older than 50 years who underwent ASD surgery from the lower thoracic spine to the pelvis. In addition to patient demographic data and pre- and post-operative radiographic sagittal parameters (PI: pelvic incidence; LL: lumbar lordosis; SVA: sagittal vertical axis; PT: pelvic tilt), Hounsfield unit (HU) values on preoperative computed tomography and cross sectional area (CSA) and fatty infiltration ratio (FI%) of the paraspinal musculature (PSM) on preoperative magnetic resonance image were measured from the upper-instrumented vertebra (UIV) to UIV + 2 and averaged. PJK was observed in 11 of 29 patients. There was no statistical difference between the patients with and without PJK in age at surgery, sex, body mass index, bone mineral density, preoperative PI-LL, SVA, PT, postoperative PI-LL, SVA, PT, HU, and CSA. FI% in patients with PJK (25.0) was significantly higher than that (15.3) in patients without PJK (P = 0.001). Logistic regression analysis identified FI% of PSM as a significant independent factor of PJK (odds ratio, 1.973; 95% confidence interval, 1.290-5.554; P < 0.0001). After successful elimination of possible factors related to PJK other than sarcopenia and osteopenia, sarcopenia assessed by fatty degeneration of the PSM at the UIV was shown to be a more important factor than osteopenia for PJK after long fusion for ASD.
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Affiliation(s)
- Shunji Tsutsui
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan.
| | - Hiroshi Hashizume
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Hiroshi Iwasaki
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Masanari Takami
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Yuyu Ishimoto
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Keiji Nagata
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
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Kozaki T, Hashizume H, Tsutsui S, Takami M, Taniguchi T, Yamada H. Acetabular Rim Fracture after Adult Spinal Deformity Surgery-Induced Secondary Hip Osteoarthritis: Two Case Reports. Spine Surg Relat Res 2023; 7:464-467. [PMID: 37841040 PMCID: PMC10569802 DOI: 10.22603/ssrr.2023-0035] [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: 02/21/2023] [Accepted: 03/20/2023] [Indexed: 10/17/2023] Open
Affiliation(s)
- Takuhei Kozaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Takaya Taniguchi
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
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Takami M, Tsutsui S, Okada M, Nagata K, Iwasaki H, Minamide A, Yukawa Y, Hashizume H, Taiji R, Murata S, Kozaki T, Yamada H. Unique Characteristics of New Bone Formation Induced by Lateral Lumbar Interbody Fusion Procedure. Spine Surg Relat Res 2023; 7:450-457. [PMID: 37841039 PMCID: PMC10569808 DOI: 10.22603/ssrr.2022-0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 03/31/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Despite the absence of bone grafting in the area outside the cage, lateral bridging callus outside cages (LBC) formation is often observed here following extreme lateral interbody fusion (XLIF) conversely to conventional methods of transforaminal lumbar interbody fusion and posterior lumbar interbody fusion. The LBC, which may increase stabilization and decrease nonunion rate in treated segments, has rarely been described. This study aimed to identify the incidence and associated factors of LBC following XLIF. Methods We enrolled 136 consecutive patients [56 males, 80 females; mean age 69.6 (42-85) years] who underwent lumbar fusion surgery using XLIF, including L4/5 level with posterior fixation at a single institution between February 2013 and February 2018. One year postoperatively, the treated L4/5 segments were divided into the LBC formation and non-formation groups. Potential influential factors, such as age, sex, body mass index, bone density, height of cages, cage material (titanium or polyetheretherketone [PEEK]), presence or absence of diffuse idiopathic skeletal hyperostosis (DISH), and radiological parameters, were evaluated. Multivariate logistic regression analysis was performed for factors significantly different from the univariate analysis. Results The incidence of LBC formation was 58.8%. Multivariate logistic regression analysis showed that the length of osteophytes [+1 mm; odds ratio, 1.29; 95% confidence interval, 1.17-1.45; p<0.0001] was significant LBC formation predictive factors. Receiver operating characteristic curve analysis demonstrated that the cut-off value for osteophyte length was 14 mm, the sensitivity was 58.8%, the specificity was 84.4%, and the area under the ROC curve for this model was 0.79. Conclusions The incidence of LBC formation was 58.8% in L4/5 levels one year after the XLIF procedure. We demonstrated that the length of the osteophyte was significantly associated with LBC formation.
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Affiliation(s)
- Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Motohiro Okada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Keiji Nagata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Akihito Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Yasutsugu Yukawa
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Ryo Taiji
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Shizumasa Murata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Takuhei Kozaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
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Murata S, Hashizume H, Tsutsui S, Oka H, Teraguchi M, Ishomoto Y, Nagata K, Takami M, Iwasaki H, Minamide A, Nakagawa Y, Tanaka S, Yoshimura N, Yoshida M, Yamada H. Publisher Correction: Pelvic compensation accompanying spinal malalignment and back pain-related factors in a general population: the Wakayama spine study. Sci Rep 2023; 13:12791. [PMID: 37550444 PMCID: PMC10406805 DOI: 10.1038/s41598-023-39895-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Affiliation(s)
- Shizumasa Murata
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan.
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Hiroyuki Oka
- Division of Musculoskeletal AI System Development, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Masatoshi Teraguchi
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Yuyu Ishomoto
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Keiji Nagata
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Akihito Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
- Spine Center, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Nikko City, Tochigi, Japan
| | - Yukihiro Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyoku, Tokyo, Japan
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
- Department of Orthopedic Surgery, Sumiya Orthopaedic Hospital, 337 Yoshida, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
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Murata S, Hashizume H, Tsutsui S, Oka H, Teraguchi M, Ishomoto Y, Nagata K, Takami M, Iwasaki H, Minamide A, Nakagawa Y, Tanaka S, Yoshimura N, Yoshida M, Yamada H. Pelvic compensation accompanying spinal malalignment and back pain-related factors in a general population: the Wakayama spine study. Sci Rep 2023; 13:11862. [PMID: 37481604 PMCID: PMC10363166 DOI: 10.1038/s41598-023-39044-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 07/19/2023] [Indexed: 07/24/2023] Open
Abstract
Some older adults with spinal deformity maintain standing posture via pelvic compensation when their center of gravity moves forward. Therefore, evaluations of global alignment should include both pelvic tilt (PT) and seventh cervical vertebra-sagittal vertical axis (C7-SVA). Here, we evaluate standing postures of older adults using C7-SVA with PT and investigate factors related to postural abnormality. This cross-sectional study used an established population-based cohort in Japan wherein 1121 participants underwent sagittal whole-spine radiography in a standing position and bioelectrical impedance analysis for muscle mass measurements. Presence of low back pain (LBP), visual analog scale (VAS) of LBP, and LBP-related disability (Oswestry Disability Index [ODI]) were evaluated. Based on the PT and C7-SVA, the participants were divided into four groups: normal, compensated, non-compensated, and decompensated. We defined the latter three categories as "malalignment" and examined group characteristics and factors. There were significant differences in ODI%, VAS and prevalence of LBP, and sarcopenia among the four groups, although these were non-significant between non-compensated and decompensated groups on stratified analysis. Moreover, the decompensated group was significantly associated with sarcopenia. Individuals with pelvic compensation are at increased risk for LBP and related disorders even with the C7-SVA maintained within normal range.
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Affiliation(s)
- Shizumasa Murata
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan.
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Hiroyuki Oka
- Division of Musculoskeletal AI System Development, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Masatoshi Teraguchi
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Yuyu Ishomoto
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Keiji Nagata
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Akihito Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
- Spine Center, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Nikko City, Tochigi, Japan
| | - Yukihiro Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyoku, Tokyo, Japan
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
- Department of Orthopedic Surgery, Sumiya Orthopaedic Hospital, 337 Yoshida, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
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12
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Murata S, Takami M, Endo T, Hashizume H, Iwasaki H, Tsutsui S, Nagata K, Murakami K, Taiji R, Kozaki T, Heller JG, Yamada H. Using Electrical Stimulation of the Ulnar Nerve Trunk to Predict Postoperative Improvement in Hand Clumsiness in Patients With Cervical Spondylotic Myelopathy. Spine (Phila Pa 1976) 2023; 48:702-709. [PMID: 36730659 DOI: 10.1097/brs.0000000000004539] [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: 07/28/2022] [Accepted: 10/21/2022] [Indexed: 02/04/2023]
Abstract
STUDY DESIGN A prospective cohort study. OBJECTIVE To investigate whether the immediate and short-term effects of preoperative electrical peripheral nerve stimulation (ePNS) on performance of the 10-second test could predict the early postoperative outcomes of patients with cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA Previous studies have shown that early clinical improvement in CSM patients may be because of reversal of spinal cord ischemia after spinal cord compression. MATERIALS AND METHODS We conducted a 10-second test before surgery, after ePNS, and at discharge (one week after surgery) in 44 patients with CSM who underwent C3-C7 laminoplasty and evaluated their correlations. The effects of the procedures (ePNS or operation) and sides (stimulated or nonstimulated side) for the 10-second test were analyzed using repeated measures analysis of variance. The Pearson correlation coefficient was used to measure the relationship between the 10-second test values according to the method (after ePNS vs. surgery). In addition, the Bland-Altman method was used to evaluate the degree of agreement between the 10-second test obtained after ePNS versus shortly after surgery. RESULTS The preoperative 10-second test showed the most improvement immediately after the administration of ePNS, with a gradual decrease for the first 30 minutes after completion. After the initial 30 minutes, performance decreased rapidly, and by 60 minutes performance essentially returned to baseline. The 10-second post-ePNS had a strong positive correlation with the 10-second test in the early postoperative period (at discharge=one week after surgery). These phenomena were observed with the left hand, the side stimulated with ePNS, as well as the right hand, the side not stimulated. CONCLUSIONS Early postoperative outcomes after CSM surgery may be predicted by the results of preoperative ePNS. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Shizumasa Murata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Toru Endo
- Department of Orthopaedic Surgery, Endo Clinic, Otsu, Shiga, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Keiji Nagata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Kimihide Murakami
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Ryo Taiji
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Takuhei Kozaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - John G Heller
- Department of Orthopaedic Surgery, The Emory Spine Center, Emory Muskuloskeletal Institute, Atlanta, GA
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
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Teraguchi M, Hashizume H, Asai Y, Oka H, Nagata K, Ishimoto Y, Iwasaki H, Tsutsui S, Takami M, Tanaka S, Yoshida M, Yoshimura N, Yamada H. Association between modic changes, disc degeneration, and pelvic incidence-lumbar lordosis mismatch in a large population based cohort: the Wakayama spine study. Eur Spine J 2023:10.1007/s00586-023-07702-8. [PMID: 37100965 DOI: 10.1007/s00586-023-07702-8] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE Sagittal plane alignment is crucial for treating spinal malalignment and low back pain. Pelvic incidence-lumbar lordosis (PI-LL) mismatch is commonly used to evaluate clinical outcomes in patients with sagittal malalignment. The association between PI-LL mismatch and changes surrounding the intervertebral disc is very important to understand the compensatory mechanisms involved. This study aimed to examine the association between PI-LL mismatch and magnetic resonance imaging (MRI) changes surrounding the intervertebral disc in a large population-based cohort. METHODS We evaluated participants from the second Wakayama Spine Study, recruiting the general population aged 20 years or older, irrespective of sex, who were registered residents in one region in 2014. In total, 857 individuals underwent an MRI of the whole spine; however, 43 MRI results were not included due to incomplete or inadequate quality images. PI-LL mismatch was defined as > 11°. We compared the MRI changes, such as Modic change (MC), disc degeneration (DD), and high-intensity zones (HIZ), between PI-LL mismatch and non-PI-LL mismatch groups. Multivariate logistic regression analysis was conducted to determine the association between the MRI changes and PI-LL mismatch with adjustment for age, sex, and body mass index in the lumbar region and at each level. RESULTS A total of 795 participants (243 men, 552 women, mean age 63.5 ± 13.1 years old) were evaluated; 181 were included in the PI-LL mismatch group. MC and DD in the lumbar region were significantly higher in the PI-LL mismatch group. MC in the lumbar region was significantly associated with PI-LL mismatch (odds ratio (OR); 1.81, 95% confidence interval (CI) 1.2-2.7). MC at each level was significantly associated with PI-LL mismatch (OR; 1.7-1.9, 95%CI 1.1-3.2), and DD at L1/2, L3/4, and L4/5 was associated with PI-LL mismatch (OR; 2.0- 2.4. 95%CI 1.2-3.9). CONCLUSION MC and DD were significantly associated with PI-LL mismatch. Therefore, profiling MC may be helpful in improving the targeted treatment of LBP associated with the adult spinal deformity.
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Affiliation(s)
- Masatoshi Teraguchi
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan.
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Yoshiki Asai
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22Nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Keiji Nagata
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Yuyu Ishimoto
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyoku, Tokyo, Japan
| | - Munehito Yoshida
- Department of Medical Research and Management for Musculoskeletal Pain, 22Nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
- Department of Orthopaedic Surgery, Sumiya Orthopaedic Hospital, Wakayama, Wakayama, Japan
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
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Ishimoto Y, Iwasaki H, Sonekatsu M, Murata S, Kozaki T, Hashizume H, Tsutsui S, Takami M, Nagata K, Hira K, Kato S, Yamada H. Ultrasonography is an effective tool for the evaluation of traumatic vertebral artery injuries distal to fourth cervical vertebra in the emergency room. BMC Musculoskelet Disord 2023; 24:314. [PMID: 37087444 PMCID: PMC10122399 DOI: 10.1186/s12891-023-06426-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 04/12/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND This study aimed to determine the feasibility of ultrasonography in the assessment of cervical vertebral artery (VA) injury as an alternative to computed tomography angiography (CTA) in the emergency room. METHODS We analyzed 50 VAs from 25 consecutive patients with cervical spine injury that had been admitted to our emergency room. Ultrasonography and CTA were performed to assess the VA in patients with cervical spine injury. We examined the sensitivity and specificity of ultrasonography compared with CTA. RESULTS Among these VAs, six were occluded on CTA. The agreement between ultrasonography and CTA was 98% (49/50) with 0.92 Cohen's Kappa index. The sensitivity, specificity, and positive and negative predictive values of ultrasonography were 100%, 97.7%, 85.7%, and 100%, respectively. In one case with hypoplastic VA, the detection of flow in the VA by ultrasonography differed from detection by CTA. Meanwhile, there were two cases in which VAs entered at C5 transverse foramen rather than at C6 level. However, ultrasonography could detect the blood flow in these VAs. CONCLUSIONS Ultrasonography had a sensitivity of 100% compared with CTA in assessment of the VA. Ultrasonography can be used as an initial screening test for VA injury in the emergency room.
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Affiliation(s)
- Yuyu Ishimoto
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Hiroshi Iwasaki
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan.
| | - Mayumi Sonekatsu
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Shizumasa Murata
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Takuhei Kozaki
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Hiroshi Hashizume
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Shunji Tsutsui
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Masanari Takami
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Keiji Nagata
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Kazuhiro Hira
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Seiya Kato
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
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15
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Kozaki T, Hashizume H, Oka H, Ohashi S, Kumano Y, Yamamoto E, Minamide A, Yukawa Y, Iwasaki H, Tsutsui S, Takami M, Nakata K, Taniguchi T, Fukui D, Nishiyama D, Yamanaka M, Tamai H, Taiji R, Murata S, Murata A, Yamada H. Erratum for Lumbar Fusion including Sacroiliac Joint Fixation Increases the Stress and Angular Motion at the Hip Joint: A Finite Element Study. Spine Surg Relat Res 2023; 7:199. [PMID: 37041871 PMCID: PMC10083080 DOI: 10.22603/ssrr.2021-0231-er] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/02/2023] [Indexed: 03/28/2023] Open
Abstract
[This corrects the article DOI: 10.22603/ssrr.2021-0231.].
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16
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Takami M, Yukawa Y, Noda Y, Yoshida M, Yamada H. Salvage Surgery for Symptomatic Recurrence of Retro-Odontoid Pseudotumor after a C1 Laminectomy. Acta Med Okayama 2022; 76:749-754. [PMID: 36549779 DOI: 10.18926/amo/64127] [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] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We provide the first report of successful salvage surgery for a post-C1 laminectomy symptomatic recurrence of a retro-odontoid pseudotumor (ROP) that caused myelopathy. The 72-year-old Japanese woman presented with an ROP causing symptomatic cervical myelopathy. With ultrasonography support, we performed the enucleation of the ROP via a transdural approach and fusion surgery for the recurrence of the mass. At the final observation 2-year post-surgery, MRI demonstrated the mass's regression and spinal cord decompression, and the patient's symptoms had improved. Our strategy is an effective option for a symptomatic recurrence of ROP.
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Affiliation(s)
- Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University
| | | | - Yusuke Noda
- Department of Orthopaedic Surgery, Wakayama Rosai Hospital
| | | | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University
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17
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Murata S, Tsutsui S, Hashizume H, Minamide A, Nakagawa Y, Iwasaki H, Takami M, Nagata K, Murakami K, Taiji R, Kozaki T, Yamada H. Importance of physiological age in determining indications for adult spinal deformity surgery in patients over 75 years of age: a propensity score matching analysis. Eur Spine J 2022; 31:3060-3068. [PMID: 36098830 DOI: 10.1007/s00586-022-07379-5] [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: 06/14/2022] [Revised: 08/19/2022] [Accepted: 09/03/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Physiologically, people age at different rates, which leads to a discrepancy between physiological and chronological age. Physiological age should be a priority when considering the indications for adult spinal deformity (ASD) surgery. The primary objective of this study was to determine the characteristics of the postoperative course, surgical outcomes, and complication rates to extend the healthy life expectancy of older ASD patients (≥ 75 years). The secondary objective was to clarify the importance of physiological age in the surgical treatment of older ASD patients, considering frailty. METHODS A retrospective review of 109 consecutive patients aged ≥ 65 years with symptomatic ASD who underwent a corrective long fusion with lateral interbody fusion from the lower thoracic spine to the pelvis from 2015 to 2019 was conducted. Patients were classified into two groups according to age (group Y [65-74 years], group O [≥ 75 years]) and further divided into four groups according to the ASD-frailty index score (Y-F, Y-NF, O-F, and O-NF groups). To account for potential risk factors for perioperative course characteristics, complication rates, and surgical outcomes, patients from the database were subjected to propensity score matching based on sex, BMI, and preoperative sagittal spinal alignment (C7 sagittal vertical axis, pelvic incidence-lumbar lordosis, and pelvic tilt). Clinical outcomes were evaluated 2 years postoperatively, using three patient-reported outcome measures of health-related quality of life: the Oswestry Disability Index, Scoliosis Research Society questionnaire (SRS-22), and Short Form 36 (SF-36). Additionally, the postoperative time-to-first ambulation, as well as minor, major, and mechanical complications, were evaluated. RESULTS In the comparison between Y and O groups, patients in group O were at a higher risk of minor complications (delirium and urinary tract infection). In contrast, other surgical outcomes of group O were comparable to those of group Y, except for SRS-22 (satisfaction) and time to ambulation after surgery, with better outcomes in Group O. Patients in the O-NF group had better postoperative outcomes (time to ambulation after surgery, SRS-22 (function, self-image, satisfaction), SF-36 [PCS]) than those in the Y-F group. CONCLUSIONS Older age warrants monitoring of minor complications in the postoperative management of patients. However, the outcomes of ASD surgery depended more on frailty than on chronological age. Older ASD patients without frailty might tolerate corrective surgery and have satisfactory outcomes when minimally invasive techniques are used. Physiological age is more important than chronological age when determining the indications for surgery in older patients with ASD.
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Affiliation(s)
- Shizumasa Murata
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Akihito Minamide
- Spine Center, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Tochigi, Nikko City, 321-2593, Japan
| | - Yukihiro Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama, 649-7113, Japan
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Keiji Nagata
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Kimihide Murakami
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Ryo Taiji
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Takuhei Kozaki
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
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18
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Kozaki T, Hashizume H, Taniguchi T, Nishiyama D, Iwasaki H, Tsutsui S, Takami M, Nagata K, Fukui D, Yamanaka M, Tamai H, Taiji R, Murata S, Oka H, Yamada H. S2 alar-iliac screw loosening as a preventive factor for hip joint osteoarthritis after adult spinal deformity surgery: a case-control study. Eur Spine J 2022; 31:3081-3088. [PMID: 35999305 DOI: 10.1007/s00586-022-07344-2] [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] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 06/12/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE This study aimed to evaluate the progression of hip pathology and risk factors after ASD surgery. METHODS This case-control study enrolled 123 patients (246 hips); seven hips underwent hip arthroplasty were excluded. We measured the center-edge (CE) angle, joint space width (JSW), and Kellgren-Lawrence (KL) grade. We defined a CE angle˂25° as developmental dysplasia of the hip (DDH). We evaluated S2 alar-iliac (AI) screw loosening at final follow-up. RESULTS The annual decrease in the JSW was 0.31 mm up to 1 year, and 0.13 mm after 1 year (p = 0.001). KL grade progression occurred in 24 hips (10.0%; group P), while no progression occurred in 215 (90.0%; group N) hips. Nonparametric analysis between groups P and N revealed that significant differences were observed in sex, DDH, KL grade, ratio of S2AI screw fixation at baseline, and ratio of S2AI screw loosening at final follow-up. Multiple logistic regression analysis revealed that DDH (p = 0.018, odds ratio (OR) = 3.0, 95%CI = 1.2-7.3), baseline KL grade (p < 0.0001, OR = 37.7, 95%CI = 7.0-203.2), and S2AI screw fixation (p = 0.035, OR = 3.4, 95%CI = 1.1-10.4) were significant factors. We performed sub-analysis to elucidate the relationship between screw loosening and hip osteoarthritis in 131 hips that underwent S2AI screw fixation. Non-loosening of the S2AI screw was a significant factor for KL grade progression (p < 0.0001, OR = 8.9, 95%CI = 3.0-26.4). CONCLUSION This study identified the prevalence and risk factors for the progression of hip osteoarthritis after ASD surgery. Physicians need to pay attention to the hip joint pathology after ASD surgery.
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Affiliation(s)
- Takuhei Kozaki
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Japan
| | - Hiroshi Hashizume
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Japan.
- School of Health and Nursing Science, Wakayama Medical University, 580 Mikazura, Wakayama City, Japan.
| | - Takaya Taniguchi
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Japan
| | - Daisuke Nishiyama
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Japan
| | - Hiroshi Iwasaki
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Japan
| | - Shunji Tsutsui
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Japan
| | - Masanari Takami
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Japan
| | - Keiji Nagata
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Japan
| | - Daisuke Fukui
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Japan
| | - Manabu Yamanaka
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Japan
| | - Hidenobu Tamai
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Japan
| | - Ryo Taiji
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Japan
| | - Shizumasa Murata
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22Nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Japan
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19
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Takami M, Kawakami M, Hashizume H, Tsutsui S, Oka H, Shinozaki T, Iwasaki H, Yamada H. Psychometric Evaluation and External Validity of the Japanese Version of Lumbar Stiffness Disability Index. Spine Surg Relat Res 2022; 6:696-703. [PMID: 36561157 PMCID: PMC9747221 DOI: 10.22603/ssrr.2022-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/25/2022] [Indexed: 02/01/2023] Open
Abstract
Introduction Long fusion surgery for adult spinal deformity may restrict activities of daily living due to lumbar stiffness. While the Lumbar Stiffness Disability Index (LSDI) can help assess lumbar stiffness, in Asia the external validity of this questionnaire has not been sufficiently examined. We performed the psychometric evaluation and external validation of the Japanese version of the LSDI (LSDI-J). Methods Fifty consecutive patients (14 males and 36 females; mean age 70.6 years) who underwent lumbar fusion surgery at our institution a minimum of one year after surgery and who visited the outpatient clinic between April and May 2019, were surveyed using the LSDI-J. The mean number of fusion levels was 4.4. Cronbach's alpha coefficients were calculated for internal consistency, and the intraclass correlation coefficient (ICC) was calculated to evaluate reliability. External validity was assessed by comparisons with the Oswestry Disability Index (ODI), the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and the lumbar range of motion (LROM) with LSDI-J scores. Results Cronbach's alpha coefficient was 0.652 overall, and 0.849 after excluding Question 10 due to a low response rate. The ICC was 0.824 overall and 0.851 after excluding Question 10. The correlation with the ODI was 0.684, and the correlation coefficients with each domain of the JOABPEQ ranged from -0.590 to -0.413, indicating moderate correlation. However, LROM and the LSDI-J were not correlated (r=-0.055, P=0.734). Conclusions The LSDI-J may not be suitable in Japan because there was no correlation with LROM, the most important factor for external validity. It may be necessary to investigate why the LSDI-J did not apply to the Japanese population in terms of lower limb function. Alternatively, a unique method may be needed to assess lumbar stiffness disability that is more suitable for actual clinical practice in Japan.
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Affiliation(s)
- Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Mamoru Kawakami
- Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, The University of Tokyo, Tokyo, Japan
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
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20
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Yamashita M, Nagata K, Takami M, Okada M, Takiguchi N, Enyo Y, Nishi H, Nakashima T, Ueda K, Yamada H, Kato S. Mortality and complications in elderly patients with cervical spine injuries. Injury 2022; 53:2114-2120. [PMID: 35513939 DOI: 10.1016/j.injury.2022.04.015] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/24/2022] [Accepted: 04/15/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the complications and mortality in elderly individuals with cervical spine injuries. METHODS This retrospective observational study was conducted in a tertiary care hospital in a rural area in Japan. Data sets from the trauma registry (January 2011 to March 2018) were analyzed. Patients with cervical spine injury were divided into those aged ≥ 65 years (group Y) and > 65 years (group E). We then analyzed age, sex, 30-day mortality, hospital stay, level of cervical spine injury, presence of cervical vertebral fracture, perioperative complications (pneumonia, urinary tract infection, and severe bedsore), neurological deficit (Frankel classification), Abbreviated Injury Scale (AIS) score, and Injury Severity Score (ISS). RESULTS We evaluated a total of 398 patients; among them, 177 were included in group Y and 221 in group E. The assessed parameters were as follows: age (group Y/E; 48.7/75.9 years), men (78.0/72.3%), 30-day mortality (8.5/10.0%, p = 0.159), hospital stay (17.2/19.1 days, p = 0.36), level of cervical spine injury (C1 [5.7/4.5%], C2 [12.4/15.8%], C3 [10.2/17.2%], C4 [14.1/16.3%], C5 [26.6/22.2%], C6 [22.0/12.2%], and C7 [11.3/10.9%]), vertebral fracture (56.6/61.9%), central cord syndrome (36.2/33%), operation (18.6/13.1%), pneumonia (6.8/11.8%, p = 0.077), urinary tract infection (4.0/6.3%, p = 0.26), severe bedsore (0/1.8%, p = 0.068), Frankel classification (grade A [5.7/6.3%], grade B [6.8/7.7%], grade C [24.9/28.5%], grade D [17.5/11.8%], and grade E [34.5/33.9%]), mean AIS score in the cervical spine (3.3/3.5, p = 0.04), and mean ISS (23.2/22.2, p = 0.38). C3 injuries tended to be higher in group E. CONCLUSION Mortality and morbidity associated with cervical spine injuries did not differ between younger and older patients. Nevertheless, vigilance is required for the detection of C3 injury in elderly individuals.
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Affiliation(s)
- Masashi Yamashita
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama City, Japan
| | - Keiji Nagata
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama City, Japan.
| | - Masanari Takami
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama City, Japan
| | - Motohiro Okada
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama City, Japan
| | - Noboru Takiguchi
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama City, Japan
| | - Yoshio Enyo
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama City, Japan
| | - Hideto Nishi
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama City, Japan
| | - Tsuyoshi Nakashima
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama City, Japan
| | - Kentaro Ueda
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama City, Japan
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama City, Japan
| | - Seiya Kato
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama City, Japan
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21
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Murata S, Iwasaki H, Oka H, Hashizume H, Yukawa Y, Minamide A, Tsutsui S, Takami M, Nagata K, Taiji R, Kozaki T, Yamada H. A novel technique using ultrasonography in upper airway management after anterior cervical decompression and fusion. BMC Med Imaging 2022; 22:67. [PMID: 35413818 PMCID: PMC9004088 DOI: 10.1186/s12880-022-00792-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/31/2022] [Indexed: 11/11/2022] Open
Abstract
Background Airway complications are the most serious complications after anterior cervical decompression and fusion (ACDF) and can have devastating consequences if their detection and intervention are delayed. Plain radiography is useful for predicting the risk of dyspnea by permitting the comparison of the prevertebral soft tissue (PST) thickness before and after surgery. However, it entails frequent radiation exposure and is inconvenient. Therefore, we aimed to overcome these problems by using ultrasonography to evaluate the PST and upper airway after ACDF and investigate the compatibility between X-ray and ultrasonography for PST evaluation. Methods We included 11 radiculopathy/myelopathy patients who underwent ACDF involving C5/6, C6/7, or both segments. The condition of the PST and upper airway was evaluated over 14 days. The Bland–Altman method was used to evaluate the degree of agreement between the PST values obtained using radiography versus ultrasonography. The Pearson correlation coefficient was used to determine the relationship between the PST measurement methods. Single-level and double-level ACDF were performed in 8 and 3 cases, respectively. Results PST and upper airway thickness peaked on postoperative day 3, with no airway complications. The Bland–Altman bias was within the prespecified clinically nonsignificant range: 0.13 ± 0.36 mm (95% confidence interval 0.04–0.22 mm). Ultrasonography effectively captured post-ACDF changes in the PST and upper airway thickness and detected airway edema. Conclusions Ultrasonography can help in the continuous assessment of the PST and the upper airway as it is simple and has no risk of radiation exposure risk. Therefore, ultrasonography is more clinically useful to evaluate the PST than radiography from the viewpoint of invasiveness and convenience.
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Affiliation(s)
- Shizumasa Murata
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan.
| | - Hiroshi Iwasaki
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Hiroyuki Oka
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan.,Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroshi Hashizume
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Yasutsugu Yukawa
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Akihito Minamide
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan.,Spine Center, Dokkyo Medical University Nikko Medical Center, 632 Takatoku, Nikko City, Tochigi, 321-2593, Japan
| | - Shunji Tsutsui
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Masanari Takami
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Keiji Nagata
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Ryo Taiji
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Takuhei Kozaki
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
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22
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Kozaki T, Hashizume H, Oka H, Ohashi S, Kumano Y, Yamamoto E, Minamide A, Yukawa Y, Iwasaki H, Tsutsui S, Takami M, Nakata K, Taniguchi T, Fukui D, Nishiyama D, Yamanaka M, Tamai H, Taiji R, Murata S, Murata A, Yamada H. Lumbar Fusion including Sacroiliac Joint Fixation Increases the Stress and Angular Motion at the Hip Joint: A Finite Element Study. Spine Surg Relat Res 2022; 6:681-688. [PMID: 36561150 PMCID: PMC9747219 DOI: 10.22603/ssrr.2021-0231] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/14/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction Adult spinal fusion surgery improves lumbar alignment and patient satisfaction. Adult spinal deformity surgery improves saggital balance not only lumbar lesion, but also at hip joint coverage. It was expected that hip joint coverage rate was improved and joint stress decreased. However, it was reported that adjacent joint disease at hip joint was induced by adult spinal fusion surgery including sacroiliac joint fixation on an X-ray study. The mechanism is still unclear. We aimed to investigate the association between lumbosacral fusion including sacroiliac joint fixation and contact stress of the hip joint. Methods A 40-year-old woman with intact lumbar vertebrae underwent computed tomography. A three-dimensional nonlinear finite element model was constructed from the L4 vertebra to the femoral bone with triangular shell elements (thickness, 2 mm; size, 3 mm) for the cortical bone's outer surface and 2-mm (lumbar spine) or 3-mm (femoral bone) tetrahedral solid elements for the remaining bone. We constructed the following four models: a non-fusion model (NF), a L4-5 fusion model (L5F), a L4-S1 fusion model (S1F), and a L4-S2 alar iliac screw fixation model (S2F). A compressive load of 400 N was applied vertically to the L4 vertebra and a 10-Nm bending moment was additionally applied to the L4 vertebra to stimulate flexion, extension, left lateral bending, and axial rotation. Each model's hip joint's von Mises stress and angular motion were analyzed. Results The hip joint's angular motion in NF, L5F, S1F, and S2F gradually increased; the S2F model presented the greatest angular motion. Conclusions The average and maximum contact stress of the hip joint was the highest in the S2F model. Thus, lumbosacral fusion surgery with sacroiliac joint fixation placed added stress on the hip joint. We propose that this was a consequence of adjacent joint spinopelvic fixation. Lumbar-to-pelvic fixation increases the angular motion and stress at the hip joint.
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Affiliation(s)
- Takuhei Kozaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, Faculty of Medicine, 22nd Century Medical and Research Center, The University of Tokyo, Tokyo, Japan
| | - Satoru Ohashi
- Department of Orthopaedic Surgery, Sagamihara Hospital, National Hospital Organization, Sagamihara, Kanagawa, Japan
| | - Yoh Kumano
- Department of Spine Surgery, Tokyo Yamate Medical Center, Japan Community Healthcare Organization, Tokyo, Japan
| | - Ei Yamamoto
- Department of Biomedical Engineering, Faculty of Biology-Oriented Science and Technology, KinDai University, Kinokawa, Wakayama, Japan
| | - Akihito Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Yasutsugu Yukawa
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Keiji Nakata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Takaya Taniguchi
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Daisuke Fukui
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Daisuke Nishiyama
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Manabu Yamanaka
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Hidenobu Tamai
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Ryo Taiji
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Shizumasa Murata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Akimasa Murata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
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Takami M, Tsutsui S, Yukawa Y, Hashizume H, Minamide A, Iwasaki H, Nagata K, Taiji R, Schoenfeld AJ, Simpson AK, Yamada H. Lateral interbody release for fused vertebrae via transpsoas approach in adult spinal deformity surgery: a preliminary report of radiographic and clinical outcomes. BMC Musculoskelet Disord 2022; 23:245. [PMID: 35287645 PMCID: PMC8922844 DOI: 10.1186/s12891-022-05204-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lateral interbody release (LIR) via a transpsoas lateral approach is a surgical strategy to address degenerative lumbar scoliosis (DLS) patients with anterior autofusion of vertebral segments. This study aimed to characterize the clinical and radiographic outcomes of this lumbar reconstruction strategy using LIR to achieve anterior column correction. METHODS Data for 21 fused vertebrae in 17 consecutive patients who underwent LIR between January 2014 and March 2020 were reviewed. Demographic and intraoperative data were recorded. Radiographic parameters were assessed preoperatively and at final follow-up, including segmental lordotic angle (SLA), segmental coronal angle (SCA), bone union rate, pelvic incidence (PI), lumbar lordosis (LL), pelvic tilt, sacral slope, PI-LL mismatch, sagittal vertical axis, Cobb angle, and deviation of the C7 plumb line from the central sacral vertical line. Clinical outcomes were evaluated using Oswestry Disability Index (ODI), visual analog scale (VAS) scores for low back and leg pain, and the short form 36 health survey questionnaire (SF-36) postoperatively and at final follow-up. Complications were also assessed. RESULTS Mean patient age was 70.3 ± 4.8 years and all patients were female. Average follow-up period was 28.4 ± 15.3 months. Average procedural time to perform LIR was 21.3 ± 9.7 min and was not significantly different from traditional lateral interbody fusion at other levels. Blood loss per single segment during LIR was 38.7 ± 53.2 mL. Fusion rate was 100.0% in this cohort. SLA improved significantly from - 7.6 ± 9.2 degrees preoperatively to 7.0 ± 8.8 degrees at final observation and SCA improved significantly from 19.1 ± 7.8 degrees preoperatively to 8.7 ± 5.9 degrees at final observation (P < 0.0001, and < 0.0001, respectively). All spinopelvic and coronal parameters, as well as ODI and VAS, improved significantly. Incidence of peri- and postoperative complications such as iliopsoas muscle weakness and leg numbness in patients who underwent LIR was as much as XLIF. Incidence of postoperative mechanical failure following LIR was also similar to XLIF. Reoperation rate was 11.8%. However, there were no reoperations associated with LIR segments. CONCLUSIONS The LIR technique for anterior column realignment of fused vertebrae in the context of severe ASD may be an option of a safe and effective surgical strategy.
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Affiliation(s)
- Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Yasutsugu Yukawa
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Akihito Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Keiji Nagata
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Ryo Taiji
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Andrew K Simpson
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
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Tsutsui S, Hashizume H, Yukawa Y, Minamide A, Nakagawa Y, Iwasaki H, Takami M, Yamada H. Optimal Anchor at the Uppermost Instrumented Vertebra in Long Fusion From the Pelvis to the Lower Thoracic Spine in Elderly Patients With Degenerative Spinal Deformity: Hook Versus Pedicle Screw. Clin Spine Surg 2022; 35:E280-E284. [PMID: 34039893 DOI: 10.1097/bsd.0000000000001204] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The objective of this study was to compare pedicle screws (PSs) and transverse process hooks (TPHs) as anchors at the uppermost instrumented vertebra (UIV) in the lower thoracic spine in elderly patients with adult spinal deformity. SUMMARY OF BACKGROUND DATA Less-rigid fixation using hooks at the UIV are thought to best prevent proximal junctional kyphosis (PJK) in long spinal fusion surgery. Although adult spinal deformity is commonly treated via spinal fusion from the pelvis to the lower thoracic spine, few studies have focused on UIV anchors in the lower thoracic spine. MATERIALS AND METHODS We retrospectively reviewed 53 patients aged 65 years and above who underwent spinal fusion from the pelvis to T9 or T10, with a minimum follow-up of 1 year. Radiographic outcomes including the incidence of PJK and implant failure were compared between 28 patients with TPHs and 25 patients PSs at the UIV. RESULTS The TPH and PS groups had similar radiographic values for pelvic incidence-lumbar lordosis (preoperative: 42.8 vs. 49.0 degrees, postoperative: 9.9 vs. 7.3 degrees) and the sagittal vertical axis (preoperative: 109.3 vs. 106.8 mm; postoperative: 21.9 vs. 11.2 mm). However, the incidence of PJK was significantly higher in the TPH group (35.7%) than that in the PS group (8.0%) at the 1-year follow-up (P=0.012). PJK in the TPH group was associated with UIV or UIV±1 fracture accompanied by posterior dislodgement of the TPH. CONCLUSION Rigid fixation using PSs at the UIV in the lower thoracic spine produced better radiographic outcomes than did TPHs in elderly patients undergoing spinopelvic fusion. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Shunji Tsutsui
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Wakayama Prefecture, Japan
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Murata S, Iwasaki H, Takami M, Nagata K, Hashizume H, Tsutsui S, Taiji R, Kozaki T, Yamada H. Sacroiliac Joint Pain Should Be Suspected In Early Buttock And Groin Pain After Adult Spinal Deformity Surgery: An Observational Study. Spine Surg Relat Res 2022; 6:472-479. [DOI: 10.22603/ssrr.2021-0196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/05/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
| | - Hiroshi Iwasaki
- Department of Orthopedic Surgery, Wakayama Medical University
| | - Masanari Takami
- Department of Orthopedic Surgery, Wakayama Medical University
| | - Keiji Nagata
- Department of Orthopedic Surgery, Wakayama Medical University
| | | | - Shunji Tsutsui
- Department of Orthopedic Surgery, Wakayama Medical University
| | - Ryo Taiji
- Department of Orthopedic Surgery, Wakayama Medical University
| | - Takuhei Kozaki
- Department of Orthopedic Surgery, Wakayama Medical University
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University
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Takami M, Iwasaki Y, Okada M, Nagata K, Shibata N, Kato S, Yamada H. Incidence And Predictive Factors Of Massive Hemothorax Due To Thoracic Vertebral Fractures. Spine Surg Relat Res 2022; 6:464-471. [DOI: 10.22603/ssrr.2022-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/01/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University
| | - Yasuhiro Iwasaki
- Department of Emergency and Critical Care Medicine, Wakayama Rosai Hospital
| | - Motohiro Okada
- Department of Orthopaedic Surgery, Wakayama Medical University
| | - Keiji Nagata
- Department of Orthopaedic Surgery, Wakayama Medical University
| | - Naoaki Shibata
- Department of Emergency and Critical Care Medicine, Wakayama Medical University
| | - Seiya Kato
- Department of Emergency and Critical Care Medicine, Wakayama Medical University
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University
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Murata S, Nagata K, Iwasaki H, Hashizume H, Yukawa Y, Minamide A, Nakagawa Y, Tsutsui S, Takami M, Taiji R, Kozaki T, Schoenfeld AJ, Simpson AK, Yoshida M, Yamada H. Long-Term Outcomes After Selective Microendoscopic Laminotomy For Multilevel Lumbar Spinal Stenosis With And Without Remaining Radiographic Stenosis: A 10-Year Follow-Up Study. Spine Surg Relat Res 2022; 6:488-496. [DOI: 10.22603/ssrr.2021-0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/10/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
| | - Keiji Nagata
- Department of Orthopedic Surgery, Wakayama Medical University
| | - Hiroshi Iwasaki
- Department of Orthopedic Surgery, Wakayama Medical University
| | | | | | | | | | - Shunji Tsutsui
- Department of Orthopedic Surgery, Wakayama Medical University
| | - Masanari Takami
- Department of Orthopedic Surgery, Wakayama Medical University
| | - Ryo Taiji
- Department of Orthopedic Surgery, Wakayama Medical University
| | - Takuhei Kozaki
- Department of Orthopedic Surgery, Wakayama Medical University
| | - Andrew J. Schoenfeld
- Department of Orthopaedic Surgery, Harvard Medical School Brigham and Women's Hospital
| | - Andrew K. Simpson
- Department of Orthopaedic Surgery, Harvard Medical School Brigham and Women's Hospital
| | | | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University
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Minamide A, Yoshida M, Nakagawa Y, Okada M, Takami M, Iwasaki H, Tsutsui S, Kozaki T, Murata S, Taiji R, Murakami K, Hashizume H, Yukawa Y, Taneichi H, Yamada H, Schoenfeld AJ, Simpson AK. Long-term Clinical Outcomes of Microendoscopic Laminotomy for Cervical Spondylotic Myelopathy: A 5-Year Follow-up Study Compared With Conventional Laminoplasty. Clin Spine Surg 2021; 34:383-390. [PMID: 34121073 DOI: 10.1097/bsd.0000000000001200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The objective of this study was to characterize the long-term clinical and radiographic results of articular segmental decompression surgery using endoscopy [cervical microendoscopic laminotomy (CMEL)] for cervical spondylotic myelopathy (CSM) and to compare outcomes to conventional expansive laminoplasty (ELAP). SUMMARY OF BACKGROUND DATA The spinal cord compression in CSM consists of a pincer mechanism due to bulging disk and a hypertrophied ligamentum flavum. The long-term clinical benefits of segmental decompression surgery, which removes the dorsal compressive elements of articular segment in CSM patients, have not yet been elucidated. MATERIALS AND METHODS Consecutive patients with CSM who required surgical treatment were enrolled. All enrolled patients (n=81) underwent CMEL or ELAP. All patients were followed postoperatively for >5 years. The preoperative and 5-year follow-up evaluation included neurological assessment [Japanese Orthopaedic Association (JOA) score], JOA recovery rates, axial neck pain (visual analog scale), and cervical sagittal alignment (C2-C7 subaxial cervical angle). RESULTS Sixty-four patients (CMEL group: 33, ELAP group: 31) were included for analysis. The preoperative JOA score was 10.1 points in the CMEL group and 11.1 points in the ELAP group (P=0.15). The JOA recovery rates were similar, 58.6% in the CMEL group and 55.2% in the ELAP group (P=0.55). The axial neck pain in the CMEL group was significantly lower than that in the ELAP group (P<0.01). At 5-year follow-up, cervical alignment was more favorable in the CMEL group, with an average 2.9 degrees gain in lordosis [vs. 2.3 degrees loss of lordosis in the ELAP group (P<0.05)] and lower incidence of postoperative kyphosis. CONCLUSIONS CMEL is a novel, less invasive, technique that allows for multilevel posterior cervical decompression for treatment of CSM. Our 5-year follow-up data demonstrates that patients after CMEL have similar neurological outcomes to conventional laminoplasty, with significantly less postoperative axial pain and improved subaxial cervical lordosis when compared with their traditional laminoplasty counterparts.
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Affiliation(s)
- Akihito Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
- Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Yukihiro Nakagawa
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Motohiro Okada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Takuhei Kozaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Shizumasa Murata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Ryo Taiji
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Kimihide Murakami
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Yasutsugu Yukawa
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Hiroshi Taneichi
- Department of Orthopaedic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Andrew K Simpson
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Nakasone K, Fukuzawa K, Kiuchi K, Takami M, Takemoto M, Sakai J, Nakamura T, Yatomi A, Sonoda Y, Takahara H, Yamamoto K, Suzuki Y, Tani K, Hirata K. VT recurrence and predictors in patients with VT inducibility at the end of VT ablation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
A successful Radiofrequency (RF) ablation of ventricular tachycardia (VT) can prevent VT recurrence. It has been reported that VT non-inducibility at the end of RF ablation is associated with less likely VT recurrence in ischemic cardiomyopathy (ICM) and non-ICM (NCIM). However, it is not clear whether we should use VT non-inducibility as routine end point in RF ablation of VT.
Purpose
The aim of this study was to evaluate VT recurrence in patients who couldn't be achieved VT non-inducibility at the end of RF ablation and the factors attributed to VT recurrence in ICM and NICM patients.
Methods
Between January 2009 and April 2020, 84 consecutive patients (ICM: 34, NICM: 50) underwent RF ablation for drug-resistant VT in our hospital. VT non-inducibility was defined as any ventricular tachy-arrhythmia, including clinical VT, non-clinical VT, and VF, was not induced by programed stimuli at the end of session. Non-inducibility was achieved in 37 patients but it was not achieved in 47 patients (ICM: 18, NICM: 29). To evaluate the validity of “non-inducibility” as an end point of VT ablation, 47 patients (male: 40, mean age: 66±15 years) in whom non-inducibility of any ventricular tachyarrhythmia was not achieved were studied. The primary endpoint was recurrence of any sustained VT and VF during follow up period (mean follow-up period was 1.4 (range, 0.0, 2.0) years.)
Results
Mean left ventricular ejection fraction (LVEF) was 36±13%. Epicardial ablation was required in 8 patients. 32 patients had electrical storm at the time of ablation. Among them, 21 patients had VT recurrence and 26 patients had non-VT recurrence during follow-up period. VT recurrence rate was significantly lower in patients with LVEF≥35% than those with LVEF<35% (HR=0.31, 95% CI 1.25–9.92). Multivariate survival analysis identified LVEF≥35% (HR=0.34, 95% CI 0.10–0.98) and ablation of VT isthmus (HR=0.18, 95% CI 0.02–0.78) as independent predictors of non-VT recurrence.
Conclusions
Even if non-inducibility of any ventricular tachyarrhythmia wasn't achieved at the end of ablation, the patients with LVEF≥35% or who had ablated of VT isthmus might prevent VT recurrence. The validity of non-inducibility of any ventricular tachyarrhythmia should be evaluated in each patient's background.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Abbott, Medtronic
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Affiliation(s)
| | | | | | | | | | - J Sakai
- Kobe University, Kobe, Japan
| | | | | | | | | | | | | | - K Tani
- Kobe University, Kobe, Japan
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Takami M, Taiji R, Tsutsui S, Iwasaki H, Okada M, Minamide A, Yukawa Y, Hashizume H, Yamada H. Impact of an intraoperative coronal spinal alignment measurement technique using a navigational tool for a 3D spinal rod bending system in adult spinal deformity cases. J Neurosurg Spine 2021; 36:62-70. [PMID: 34479187 DOI: 10.3171/2021.3.spine201856] [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: 10/27/2020] [Accepted: 03/04/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In corrective spinal surgery for adult spinal deformity (ASD), the focus has been on achieving optimal spinopelvic alignment. However, the correction of coronal spinal alignment is equally important. The conventional intraoperative measurement methods currently used for coronal alignment are not ideal. Here, the authors have developed a new intraoperative coronal alignment measurement technique using a navigational tool for a 3D spinal rod bending system (CAMNBS). The purpose of this study was to test the feasibility of using the CAMNBS for coronal spinal alignment and to evaluate its usefulness in corrective spinal surgery for ASD. METHODS In this retrospective cohort study, patients with degenerative lumbar kyphoscoliosis, a Cobb angle ≥ 20°, and lumbar lordosis ≤ 20° who had undergone corrective surgery (n = 67) were included. The pelvic teardrops on both sides, the S1 spinous process, the central point of the apex, a point on the 30-mm cranial (or caudal) side of the apex, and the central point of the upper instrumented vertebra (UIV) and C7 vertebra were registered using the CAMNBS. The positional information of all registered points was displayed as 2D figures on a monitor. Deviation of the UIV plumb line from the central sacral vertical line (UIV-CSVL) and deviation of the C7 plumb line from the CSVL (C7-CSVL) were measured using the 2D figures. Nineteen patients evaluated using the CAMNBS (BS group) were compared with 48 patients evaluated using conventional intraoperative radiography (XR group). The UIV-CSVL measured intraoperatively using the CAMNBS was compared with that measured using postoperative radiography. The prevalence of postoperative coronal malalignment (CM) and the absolute value of postoperative C7-CSVL were compared between the groups on radiographs obtained in the standing position within 4 weeks after surgery. Postoperative CM was defined as the absolute value of C7-CSVL ≥ 30 mm. Further, the measurement time and amount of radiation exposure were measured. RESULTS No significant differences in demographic, sagittal, and coronal parameters were observed between the two groups. UIV-CSVL was 2.3 ± 9.5 mm with the CAMNBS and 1.8 ± 16.6 mm with the radiographs, showing no significant difference between the two methods (p = 0.92). The prevalence of CM was 2/19 (10.5%) in the BS group and 18/48 (37.5%) in the XR group, and absolute values of C7-CSVL were 15.2 ± 13.1 mm in the BS group and 25.0 ± 18.0 mm in the XR group, showing statistically significant differences in both comparisons (p = 0.04 and 0.03, respectively). The CAMNBS method required 3.5 ± 0.9 minutes, while the conventional radiograph method required 13.3 ± 1.5 minutes; radiation exposure was 2.1 ± 1.1 mGy in the BS group and 2.9 ± 0.6 mGy in the XR group. Statistically significant differences were demonstrated in both comparisons (p = 0.0002 and 0.03, respectively). CONCLUSIONS From this study, it was evident that the CAMNBS did not increase postoperative CM compared with that seen using the conventional radiographic method, and hence can be used in clinical practice.
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Tamaki T, Ando M, Nakagawa Y, Iwasaki H, Tsutsui S, Takami M, Yamada H. Intraoperative Spinal Cord Monitoring: Focusing on the Basic Knowledge of Orthopedic Spine Surgeon and Neurosurgeon as Members of a Team Performing Spine Surgery under Neuromonitoring. Spine Surg Relat Res 2021; 5:120-132. [PMID: 34179547 PMCID: PMC8208958 DOI: 10.22603/ssrr.2020-0194] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/30/2021] [Indexed: 11/22/2022] Open
Abstract
An intraoperative functional spinal cord monitoring system is a technology used by spine and spinal cord surgeons to perform a safe surgery and to gain further surgical proficiency. However, no existing clinical neurophysiological method used in the operating room can monitor all complex spinal cord functions. Therefore, by observing the activities of certain neural action potentials transferred via limited neural tissues, surgeons need to deductively estimate the function of the whole spinal cord. Thus, as the number of spinal cord functions that need to be observed increases, spinal cord monitoring can be more reliable. However, in some situations, critical decision-making is affected by the limited capability of these methods. Nevertheless, good teamwork enables sharing of seamless information within the team composed of a surgeon, anesthesiologist, monitoring technician and nurses greatly contributes to making quick and accurate decisions. The surgeon, who is the person in charge of the team, should communicate with multidisciplinary team members using common technical terms. For this reason, spine and spinal cord surgeons must have appropriate knowledge of the methods currently used, especially of their utility and limitations. To date, at least six electrophysiological methods are available for clinical utilization: three are used to monitor sensory-related tracts, and three are used to monitor motor-related spinal cord functions. If surgeons perform electrode setting, utilizing their expertise, then the range of available methods is broadened, and more meticulous intraoperative functional spinal cord monitoring can be carried out. Furthermore, if the team members share information effectively by utilizing a clinically feasible judicious checklist or tools, then spinal cord monitoring will be more reliable.
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Affiliation(s)
- Tetsuya Tamaki
- Department of Orthopaedic Surgery, Aitoku Medical and Welfare Center, Wakayama, Japan
| | - Muneharu Ando
- Department of Orthopaedic Surgery, Kansai Medical University, Hirakata, Japan
| | - Yukihiro Nakagawa
- Department of Orthopaedic Surgery, Kihoku Hospital of Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
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Takami M, Yoshida M, Minamide A, Hashizume H, Yukawa Y, Nakagawa Y, Iwasaki H, Tsutsui S, Nagata K, Taiji R, Nishi H, Schoenfeld AJ, Simpson AK, Yamada H. Does prophylactic use of topical gelatin-thrombin matrix sealant affect postoperative drainage volume and hematoma formation following microendoscopic spine surgery? A randomized controlled trial. Spine J 2021; 21:446-454. [PMID: 33189909 DOI: 10.1016/j.spinee.2020.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Microendoscopic spinal surgery has demonstrated efficacy and is increasingly utilized as a minimally invasive approach to neural decompression, but there is a theoretical concern that bleeding and postoperative epidural hematoma (PEH) may occur with increased frequency in a contained small surgical field. Hemostatic agents, such as topical gelatin-thrombin matrix sealant (TGTMS), are routinely used in spine surgery procedures, yet there has been no data on whether PEH is suppressed by these agents when administered in microendoscopic spine surgery. PURPOSE The purpose of this study was to investigate the effect of TGTMS on bleeding and PEH formation in lumbar micoroendoscopic surgery. STUDY DESIGN This is a randomized controlled trial (RCT) with additional prospective observational cohort. PATIENT SAMPLE Patients were registered from July 2017 to September 2018 and a hundred and three patients undergoing microendoscopic laminectomy for lumbar spinal stenosis at a single institution were enrolled in this study. OUTCOME MEASURES The primary outcome was the drainage volume within 48 hours after surgery. Secondary outcomes were the numerical rating scale (NRS) of leg pain on the second (NRS2) and seventh day (NRS7) after surgery and the hematoma area ratio (HAR) in horizontal images on magnetic resonance image (MRI). METHODS In the RCT, 41 cases that received TGTMS (F group) were compared with 41 control group cases (C group) that did not receive TGTMS at the end of the procedure. Drainage volume, NRS2, NRS7, and HAR on MRI were evaluated. Nineteen cases were excluded from the RCT (I group) due to difficulty of hemostasis during surgery and the intentional use of TGTMS for hemostasis. I group was compared with C group in the drainage volume and NRS of leg pain as a prospective observational study. RESULTS The RCT demonstrated no statistically significant difference in drainage volume between those receiving TGTMS (117.0±71.7; mean±standard deviation) and controls (125.0±127.0; p=.345). The NRS2 and NRS7 was 3.5±2.6 and 2.8±2.5 in the F group, respectively, and 3.1±2.6 and 2.1±2.3 in the C group, respectively. The HAR on MRI was 0.19±0.19 in the F group and 0.17±0.13 in the C group. There was no significant difference in postoperative leg pain and HAR (p=.644 for NRS2, p=.129 for NRS7, and p=.705 for HAR). In the secondary observational cohort, the drainage volume in the I group was 118.3±151.4, and NRS2 and NRS7 was 3.5±2.0 and 2.6±2.6, respectively. There were no statistically significant differences in drainage volume (p=.386) or postoperative NRS of leg pain between these two groups (p=.981 and .477 for NRS2 and NRS7, respectively). CONCLUSIONS The prophylactic use of TGTMS in patients undergoing microendoscopic laminotomy for lumbar spinal stenosis did not demonstrate any difference in postoperative bleeding or PEH. Nonetheless, for patients that had active bleeding that required the use of TGTMS, there was no evidence of difference in postoperative clinical outcomes relative to controls.
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Affiliation(s)
- Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan.
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Akihito Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Yasutsugu Yukawa
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Yukihiro Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Wakayama 649-7113, Japan
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Keiji Nagata
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Ryo Taiji
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Hideto Nishi
- Department of Orthopaedic Surgery, Hidaka Hospital, 116-2 Sono, Gobo-city, Wakayama 644-0002, Japan
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Andrew K Simpson
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan
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Murata S, Minamide A, Takami M, Iwasaki H, Okada S, Nonaka K, Taneichi H, Schoenfeld AJ, Simpson AK, Yamada H. Microendoscopic decompression for lumbar spinal stenosis caused by facet-joint cysts: a novel technique with a cyst-dyeing protocol and cohort comparison study. J Neurosurg Spine 2021; 34:573-579. [PMID: 33450739 DOI: 10.3171/2020.8.spine201209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Facet cysts may represent a sign of intrinsic facet disease and instability, increasing the importance of less-invasive approaches that limit tissue dissection and improve visualization. The authors developed an intraoperative cyst-dyeing technique, involving the injection of indigo carmine from the facet joint into the cyst, as an adjunct during decompression. This study aimed to evaluate the clinical outcomes and perioperative complication rates of microendoscopic spinal decompression for lumbar spinal stenosis (LSS) and lumbar foraminal stenosis (LFS), caused by facet cysts and to elucidate the efficacy of the cyst-dyeing method in microendoscopic surgery for facet cysts. METHODS Forty-eight consecutive patients who underwent surgical treatment with microendoscopic decompression for symptomatic LSS or LFS caused by facet cysts from 2011 to 2018 were reviewed. These patients were divided into two groups: a group that did not receive dye (N), with the patients undergoing surgery from April 2011 to May 2015; and a group that received dye (D), with patients undergoing surgery from June 2015 to March 2018. The authors evaluated the operative time, blood loss, perioperative complications, visual analog scale scores for low-back and leg pain, and Japanese Orthopaedic Association scores. Surgical outcome was evaluated 2 years postoperatively and was compared between groups D and N. RESULTS The clinical outcomes were generally excellent or good. Group N consisted of 36 patients and group D of 12 patients. Comparing the clinical results, it was found that the cyst-dyeing method reduced the perioperative complication rate, including reduction in dural tears to 0%, and shortened the average operative time by approximately 40 minutes. CONCLUSIONS In this study, the authors demonstrated that the clinical outcomes of microendoscopic spinal decompression in patients with LSS or LFS caused by facet-joint cysts are generally favorable. Additionally, the adjunctive cyst-dyeing method effectively delineated the cystic and dural boundaries, facilitating safer and more effective cyst separation and neural decompression. Microendoscopic surgery combined with this novel facet cyst-dyeing method is a safe and effective minimally invasive technique for facet-joint cysts.
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Affiliation(s)
- Shizumasa Murata
- 1Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Akihito Minamide
- 1Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama.,2Spine Center, Department of Orthopaedic Surgery, Dokkyo Medical University Nikko Medical Center, Nikko, Tochigi.,3Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan; and
| | - Masanari Takami
- 1Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Hiroshi Iwasaki
- 1Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Sae Okada
- 1Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Kento Nonaka
- 1Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
| | - Hiroshi Taneichi
- 3Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan; and
| | - Andrew J Schoenfeld
- 4Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew K Simpson
- 4Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hiroshi Yamada
- 1Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama
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Takami M, Taiji R, Okada M, Minamide A, Hashizume H, Yamada H. Lateral lumbar interbody fusion after reduction using the percutaneous pedicle screw system in the lateral position for Meyerding grade II spondylolisthesis: a preliminary report of a new lumbar reconstruction strategy. BMC Musculoskelet Disord 2021; 22:17. [PMID: 33402131 PMCID: PMC7786473 DOI: 10.1186/s12891-020-03935-6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 12/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Utilization of a cage with a large footprint in lateral lumbar interbody fusion (LLIF) for the treatment of spondylolisthesis leads to a high fusion rate and neurological improvement owing to the indirect decompression effect and excellent alignment correction. However, if an interbody space is too narrow for insertion of an LLIF cage for cases of spondylolisthesis of Meyerding grade II or higher, LLIF cannot be used. Therefore, we developed a novel strategy, LLIF after reduction by the percutaneous pedicle screw (PPS) insertion system in the lateral position (LIFARL), for surgeons to perform accurate and safe LLIF with PPS in patients with such pathology. This study aimed to introduce the new surgical strategy and to present preliminary clinical and radiological results of patients with spondylolisthesis of Meyerding grade II. METHODS Six consecutive patients (four men and two women; mean age, 72.7 years-old; mean follow-up period, 15.3 months) with L4 spondylolisthesis of Meyerding grade II were included. Regarding the surgical procedure, first, PPSs were inserted into the L4 and L5 vertebrae fluoroscopically, and both rods were placed in the lateral position. The L5 set screws were fixed tightly, and the L4 side of the rod was floated. Second, the L4 vertebra was reduced by fastening the L4 set screws so that they expanded the anteroposterior width of the interbody space. At that time, the L4 set screws were not fully tightened to the rods to prevent the endplate injury. Finally, the LLIF procedure was started. After inserting the cage, a compression force was added to the PPSs, and the L4 set screws were completely fastened. RESULTS The mean operative time was 183 min, and the mean blood loss was 90.8 mL. All cages were positioned properly. Visual analog scale score and Oswestry disability index improved postoperatively. Bone union was observed using computed tomography 12 months after surgery. CONCLUSION For cases with difficulty in LLIF cage insertion for Meyerding grade II spondylolisthesis due to the narrow anteroposterior width of interbody space, LIFARL is an option to achieve LLIF combined with posterior PPS accurately and safely. TRIAL REGISTRATION UMIN-Clinical Trials Registry, UMIN000040268, Registered 29 April 2020, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000045938.
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Affiliation(s)
- Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
| | - Ryo Taiji
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Motohiro Okada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Akihito Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
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Kozaki T, Hashizume H, Nishiyama D, Iwasaki H, Tsutsui S, Takami M, Yukawa Y, Minamide A, Taniguchi T, Nagata K, Fukui D, Tamai H, Taiji R, Murata S, Oka H, Yamada H. Adjacent segment disease on hip joint as a complication of spinal fusion surgery including sacroiliac joint fixation. Eur Spine J 2021; 30:1314-1319. [PMID: 33389138 DOI: 10.1007/s00586-020-06700-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/07/2020] [Accepted: 12/12/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Recently, the number of adult spinal deformity surgeries including sacroiliac joint fixation (SIJF) by using an S2 alar iliac screw or iliac screw has increased to avoid the distal junctional failure. However, we occasionally experienced patients who suffered from hip pain after a long instrumented spinal fusion. We hypothesized that long spinal fusion surgery including SIJF influenced the hip joint as an adjacent joint. The aim of this paper was to evaluate the association between spinal deformity surgery including SIJF and radiographic progression of hip osteoarthritis (OA). METHODS This study was retrospective cohort study. In total, 118 patients who underwent spinal fusion surgery at single center from January 2013 to August 2018 were included. We measured joint space width (JSW) at central space of the hip joint. We defined reduction of more than 0.5 mm/year in JSW as hip OA progression. The patients were divided into two groups depending on either a progression of hip osteoarthritis (Group P), or no progression (Group N). RESULTS The number of patients in Group P and Group N was 47 and 71, respectively. Factor that was statistically significant for hip OA was SIJF (p = 0.0065, odds ratio = 7.1, 95% confidence interval = 1.6-31.6). There were no other significant differences by the multiple logistic regression analysis. CONCLUSION This study identified spinal fixation surgery that includes SIJF as a predictor for radiographic progression of hip OA over 12 months. We should pay attention to hip joint lesions after adult spinal deformity surgery, including SIJF.
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Affiliation(s)
- Takuhei Kozaki
- Department of Orthopeadic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Hiroshi Hashizume
- Department of Orthopeadic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan.
| | - Daisuke Nishiyama
- Department of Orthopeadic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Hiroshi Iwasaki
- Department of Orthopeadic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Shunji Tsutsui
- Department of Orthopeadic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Masanari Takami
- Department of Orthopeadic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Yasutsugu Yukawa
- Department of Orthopeadic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Akihito Minamide
- Department of Orthopeadic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Takaya Taniguchi
- Department of Orthopeadic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Keiji Nagata
- Department of Orthopeadic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Daisuke Fukui
- Department of Orthopeadic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Hidenobu Tamai
- Department of Orthopeadic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Ryo Taiji
- Department of Orthopeadic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Shizumasa Murata
- Department of Orthopeadic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Yamada
- Department of Orthopeadic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, Japan
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Taiji R, Takami M, Yukawa Y, Hashizume H, Minamide A, Nakagawa Y, Nishi H, Iwasaki H, Tsutsui S, Okada M, Okada S, Teraguchi M, Murata S, Kozaki T, Yamada H. A short-segment fusion strategy using a wide-foot-plate expandable cage for vertebral pseudarthrosis after an osteoporotic vertebral fracture. J Neurosurg Spine 2020; 33:862-869. [PMID: 32823261 DOI: 10.3171/2020.5.spine2062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/12/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Various surgical treatments have been reported for vertebral pseudarthrosis after osteoporotic vertebral fracture (OVF). However, the outcomes are not always good. The authors now have some experience with combined anterior-posterior short-segment spinal fusion (1 level above and 1 level below the fracture) using a wide-foot-plate expandable cage. Here, they report their surgical outcomes with this procedure. METHODS Between June 2016 and August 2018, 16 consecutive patients (4 male and 12 female; mean age 75.1 years) underwent short-segment spinal fusion for vertebral pseudarthrosis or delayed collapse after OVF. The mean observation period was 20.1 months. The level of the fractured vertebra was T12 in 4 patients, L1 in 3, L2 in 4, L3 in 3, and L4 in 2. Clinical outcomes were assessed using the lumbar Japanese Orthopaedic Association (JOA) scale and 100-mm visual analog scale for low-back pain. Local kyphotic angle, intervertebral height, bone union rate, and instrumentation-related adverse events were investigated as imaging outcomes. The data were analyzed using the Wilcoxon signed-rank test. RESULTS The mean operating time was 334.3 minutes (range 256-517 minutes), and the mean blood loss was 424.9 ml (range 30-1320 ml). The only perioperative complication was a superficial infection of the posterior wound that was cured by irrigation. The lumbar JOA score and visual analog scale value improved from 11.2 and 58.8 mm preoperatively to 20.6 and 18.6 mm postoperatively, respectively. The mean local kyphotic angle and mean intervertebral height were 22.6° and 28.0 mm, respectively, before surgery, -1.5° and 40.5 mm immediately after surgery, and 7.0° and 37.1 mm at the final observation. Significant improvement was observed in both parameters immediately after surgery and at the final observation when compared with the preoperative values. Intraoperative endplate injury occurred in 8 cases, and progression of cage subsidence of 5 mm or more was observed in 2 of these cases. Proximal junctional kyphosis was observed in 2 cases. There were no cases of screw loosening. No cases required reoperation due to instrument-related adverse events. Bone union was observed in all 14 cases that had CT evaluation. CONCLUSIONS This short-segment fusion procedure is relatively minimally invasive, and local reconstruction and bone fusion have been achieved. This procedure is considered to be attempted for the surgical treatment of osteoporotic vertebral pseudarthrosis after OVF.
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Affiliation(s)
- Ryo Taiji
- 1Department of Orthopaedic Surgery, Wakayama Medical University
| | - Masanari Takami
- 1Department of Orthopaedic Surgery, Wakayama Medical University
| | | | | | | | - Yukihiro Nakagawa
- 2Spine Care Center, Wakayama Medical University Kihoku Hospital, Katsuragi-cho
| | - Hideto Nishi
- 3Department of Orthopaedic Surgery, Hidaka Hospital; and
| | - Hiroshi Iwasaki
- 1Department of Orthopaedic Surgery, Wakayama Medical University
| | - Shunji Tsutsui
- 1Department of Orthopaedic Surgery, Wakayama Medical University
| | - Motohiro Okada
- 1Department of Orthopaedic Surgery, Wakayama Medical University
| | - Sae Okada
- 4Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan
| | - Masatoshi Teraguchi
- 2Spine Care Center, Wakayama Medical University Kihoku Hospital, Katsuragi-cho
| | | | - Takuhei Kozaki
- 1Department of Orthopaedic Surgery, Wakayama Medical University
| | - Hiroshi Yamada
- 1Department of Orthopaedic Surgery, Wakayama Medical University
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Murata S, Minamide A, Iwasaki H, Nakagawa Y, Hashizume H, Yukawa Y, Tsutsui S, Takami M, Okada M, Nagata K, Yoshida M, Schoenfeld AJ, Simpson AK, Yamada H. Microendoscopic decompression for lumbosacral foraminal stenosis: a novel surgical strategy based on anatomical considerations using 3D image fusion with MRI/CT. J Neurosurg Spine 2020; 33:789-795. [PMID: 32764174 DOI: 10.3171/2020.5.spine20352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/11/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Persistent lumbar foraminal stenosis (LFS) is one of the most common reasons for poor postoperative outcomes and is a major contributor to "failed back surgery syndrome." The authors describe a new surgical strategy for LFS based on anatomical considerations using 3D image fusion with MRI/CT analysis. METHODS A retrospective review was conducted on 78 consecutive patients surgically treated for LFS at the lumbosacral junction (2013-2017). The location and extent of stenosis, including the narrowest site and associated pathology (bone or soft tissue), were measured using 3D image fusion with MRI/CT. Stenosis was defined as medial intervertebral foraminal (MF; inner edge to pedicle center), lateral intervertebral foraminal (LF; pedicle center to outer edge), or extraforaminal (EF; outside the pedicle). Lumbar (low-back pain, leg pain) and patient satisfaction visual analog scale (VAS) scores and Japanese Orthopaedic Association (JOA) scores were evaluated. Surgical outcome was evaluated 2 years postoperatively. RESULTS Most instances of stenosis existed outside the pedicle's center (94%), including LF (58%), EF (36%), and MF (6%). In all MF cases, stenosis resulted from soft-tissue structures. The narrowest stenosis sites were localized around the pedicle's outer border. The areas for sufficient nerve decompression were extended in MF+LF (10%), MF+LF+EF (14%), LF+EF (39%), LF (11%), and EF (26%). No iatrogenic pars interarticularis damage occurred. The JOA score was 14.9 ± 2.6 points preoperatively and 22.4 ± 3.5 points at 2 years postoperatively. The JOA recovery rate was 56.0% ± 18.6%. The VAS score (low-back and leg pain) was significantly improved 2 years postoperatively (p < 0.01). According to patients' self-assessment of the minimally invasive surgery, 62 (79.5%) chose "surgery met my expectations" at follow-up. Nine patients (11.5%) selected "I did not improve as much as I had hoped but I would undergo the same surgery for the same outcome." CONCLUSIONS Most LFS existed outside the pedicle's center and was rarely noted in the pars region. The main regions of stenosis were localized to the pedicle's outer edge. Considering this anatomical distribution of LFS, the authors recommend that lateral fenestration should be the first priority for foraminal decompression. Other surgical options including foraminotomy, total facetectomy, and hemilaminectomy likely require more bone resections than LFS treatment. The microendoscopic surgery results were very good, indicating that this minimally invasive surgery was suitable for treating this disease.
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Affiliation(s)
- Shizumasa Murata
- 1Department of Orthopedic Surgery, Wakayama Medical University, Wakayama
| | - Akihito Minamide
- 1Department of Orthopedic Surgery, Wakayama Medical University, Wakayama
| | - Hiroshi Iwasaki
- 1Department of Orthopedic Surgery, Wakayama Medical University, Wakayama
| | - Yukihiro Nakagawa
- 2Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama
| | - Hiroshi Hashizume
- 1Department of Orthopedic Surgery, Wakayama Medical University, Wakayama
| | - Yasutsugu Yukawa
- 1Department of Orthopedic Surgery, Wakayama Medical University, Wakayama
| | - Shunji Tsutsui
- 1Department of Orthopedic Surgery, Wakayama Medical University, Wakayama
| | - Masanari Takami
- 1Department of Orthopedic Surgery, Wakayama Medical University, Wakayama
| | - Motohiro Okada
- 1Department of Orthopedic Surgery, Wakayama Medical University, Wakayama
| | - Keiji Nagata
- 1Department of Orthopedic Surgery, Wakayama Medical University, Wakayama
| | - Munehito Yoshida
- 3Department of Orthopedic Surgery, Sumiya Orthopaedic Hospital, Wakayama, Japan; and
| | - Andrew J Schoenfeld
- 4Microendoscopic Spine Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew K Simpson
- 4Microendoscopic Spine Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hiroshi Yamada
- 1Department of Orthopedic Surgery, Wakayama Medical University, Wakayama
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Hosonuma M, Sakai N, Furuya H, Tsubokura Y, Nishimi S, Ikari Y, Ishii S, Maeoka A, Tokunaga T, Wakabayashi K, Kasama T, Takami M, Isozaki T. SAT0005 INHIBITION OF HEPATOCYTE GROWTH FACTOR/C-MET SIGNALING ABROGATES JOINT DESTRUCTION BY SUPPRESSING MIGRATION OF MONOCYTES TO SYNOVIUM IN RHEUMATOID ARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Hepatocyte growth factor (HGF), originally discovered as a mitogen of hepatocytes, binds to receptor-tyrosine kinase c-Met and has been shown to be a multi-functional cytokine that promotes processes such as cell proliferation, survival, differentiation, migration, and angiogenesis1. Since HGF/c-Met signaling also leads to tumorigenesis and cancer invasion, that has recently attracted attention as a target for anticancer agents2. However, in reports of rheumatoid arthritis (RA), though anti-inflammatory and antiangiogenic mechanisms related to HGF/c-Met signal inhibition have been reported, the role of HGF in RA bone destruction through monocyte migration remains unclear3.Objectives:To determine the expression of HGF in RA biological fluids, the role it plays in monocyte migration and the therapeutic effect of a savolitinib, a specific c-Met inhibitor, in arthritis model mice.Methods:HGF/c-Met expression in serum, synovial fluid (SF), and synovial tissues (STs) obtained from RA patients and control subjects, as well as RA fibroblast-like synoviocytes (FLSs) was evaluated by ELISA and immunostaining. To determine the function of HGF in RA SFs, we preincubated RA SFs with a neutralizing anti-HGF antibody and measured the ability of these SFs to induce the human acute monocytic leukemia cell line (THP-1) chemotaxis. Additionally, examinations of SKG mice treated with savolitinib (2.5 mg/kg/day) for 4 weeks were conducted.Results:HGF level in serum from RA patients was significantly higher as compared to the controls (930 ± 97 vs. 476 ± 97 pg/mL, p <0.01) and decreased by drug treatment for 24 weeks (1147 ± 284 vs. 539 ± 160 pg/mL, p <0.05). Additionally, HGF level in SF from RA patients was higher as compared to SF from osteoarthritis patients (1632 ± 366 vs. 566 ± 140 pg/mL, p <0.05). HGF and c-Met expressions were also noted in RA STs. Stimulation of RA-FLS with TNF-α increased HGF/c-Met expression in a concentration-dependent manner, and c-Met signal inhibition by SU11274 suppressed production of fractalkine/CX3CL1, CXCL16, and MIP-1α/CCL3 (mean 50%, 56%, 90%, respectively). When HGF was removed by immunoprecipitation, migration of THP-1 in RA-SF was suppressed (mean 23%). In SKG mice, savolitinib significantly suppressed ankle bone damage on µCT, with an associated reduction in number of tartrate-resistant acid phosphatase-positive osteoclasts.Conclusion:HGF is produced by inflammation in synovium associated with RA, and then activates monocyte migration to synovium tissue and promotes bone destruction through its own chemotactic effect as well as enhanced chemokine production. These results indicate that a strategy that targets c-Met signaling may be important for resolving bone destruction in RA.References:[1] Nakamura T, Nishizawa T, Hagiya M, Seki T, Shimonishi M, Sugimura A, Tashiro K, Shimizu S. Molecular cloning and expression of human hepatocyte growth factor. Nature. 1989 Nov 23;342(6248):440-3[2] Lee D, Sung ES, Ahn JH, An S, Huh J, You WK. Development of antibody-based c-Met inhibitors for targeted cancer therapy. Immunotargets Ther. 2015 Feb 9;4:35-44.[3] Koch AE, Halloran MM, Hosaka S, Shah MR, Haskell CJ, Baker SK, Panos RJ, Haines GK, Bennett GL, Pope RM, Ferrara N. Hepatocyte growth factor. A cytokine mediating endothelial migration in inflammatory arthritis. Arthritis Rheum. 1996 Sep;39(9):1566-75Disclosure of Interests:None declared
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Iwasaki H, Tsutsui S, Takami M, Shibasaki Y, Nakamura K, Nakagawa Y, Tamaki T, Yamada H. S9-3. The clinical use of the spinal cord evoked potential after electrical stimulation to the spinal cord. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2019.06.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Takami M, Yamada H, Yukawa Y, Kudo Y. Combined Fractures Involving the Odontoid and Unilateral Superior Articular Processes of the Axis: A Report of Three Cases and Literature Review. J Orthop Case Rep 2018; 8:3-8. [PMID: 30167401 PMCID: PMC6114210 DOI: 10.13107/jocr.2250-0685.1022] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction A treatment strategy has not yet been established for combined fractures involving the odontoid and unilateral superior articular processes of the axis. Such injuries are rare, with only 17 reported cases in the literature. A lateral flexion force with a rotated position of the atlas on the axis is considered to be the mechanism of injury. Case Report Herein, we present three cases (two female; 1 male; and age range 65-years) of combined fractures involving the odontoid and unilateral superior articular processes of the axis, with a mean follow-up period of 17 months. Two patients were treated surgically, while one patient was treated non-surgically. In the present cases, two new findings were obtained regarding the mechanism of injury. First, both clockwise and counterclockwise rotated positions result in such fractures. Second, a comminuted-type fracture of the superior articular process of the axis was observed. Neck pain, limitations in the range of motion of the neck, and torticollis remained after treatment in non-surgical cases, while there were no such symptoms in surgical cases. Conclusion Of importance, the combined fractures shown in the current study may be considered as Type III odontoid fractures when diagnosed only by X-rays. Therefore, when observing a great dislocation, the presence of comminuted fractures or torticollis of the odontoid should be ascertained on X-ray and computed tomography images (especially coronal images). To avoid lingering symptoms in the neck, surgery is recommended for the treatment of these fractures.
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Affiliation(s)
- Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Yasutsugu Yukawa
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Yoshifumi Kudo
- Department of Orthopaedic Surgery, Showa University, Shinagawa-Ku, Tokyo, Japan
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Takami M, Nagatal K, Yamada H. Microendoscopic Surgery with an Ultrasonic Bone Curette for a Patient with Intraforaminal Stenosis of the Lumbar Spine Due to an Ossification Lesion: A Technical Case Report. J Orthop Case Rep 2018; 8:57-60. [PMID: 29854695 PMCID: PMC5974679 DOI: 10.13107/jocr.2250-0685.998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: We present a rare case with radiculopathy resulting from intraforaminal stenosis of the lumbar spine due to an ossification lesion. Microendoscopic surgery was chosen because of two strong advantages. One was the ease to reach the nerve foramen and ossification lesion and the other was the non-invasiveness at the posterior supporting structures of the spine. Moreover, an ultrasonic bone curette developed for microendoscopic spine surgery was applied. This is the first detailed case report of microendoscopic surgery using an ultrasonic bone curette for a patient with radiculopathy due to intraforaminal free ossification. Case Report: A 49-year-old woman born in Japan had complained of severe left leg pain for over 7 months in spite of conservative treatment including selective nerve root block. There was no lumbago, muscle weakness, or loss of sensation in her leg. Plain radiography revealed spondylolytic spondylolisthesis classified as Grade II at L4-L5, but there was no instability on dynamic assessment. Computed tomography (CT) showed a free ossification lesion in the foramen at L4-L5. Considering a diagnosis of left L4 radiculopathy due to the free ossification, ossification resection and nerve decompression were performed with posterior spinal microendoscopic surgery using an ultrasonic bone curette. A tubular retractor was introduced into the extraforaminal zone using Wiltse approach. After a part of the ossification lesion and the nerve root were exposed, an ultrasonic bone curette was applied to remove the ossification mass. After decompression, the nerve root was found to be relaxed. The surgical time was 83 min, and blood loss was 5 g. According to the Japanese Orthopedic Association scoring system, her score improved from 21/29 preoperatively to 29/29 postoperatively, and the full score was maintained at the final observation. Post-operative CT revealed the absence of an ossification lesion. Conclusions: For a rare case with radiculopathy resulting from intraforaminal stenosis of the lumbar spine due to an ossification lesion, microendoscopic surgery with an ultrasonic bone curette was very effective. The use of ultrasonic bone curette is easy and safe in microendoscopic surgery and it helps achieve less invasiveness and ideal decompression, without injuring the nerve root.
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Affiliation(s)
- Masanari Takami
- Department of Orthopaedic Surgery, Shingu Municipal Medical Center, 18-7 Hachibuse, Shingu, Japan.,Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Japan
| | - Keiji Nagatal
- Department of Orthopaedic Surgery, Shingu Municipal Medical Center, 18-7 Hachibuse, Shingu, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Japan
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Kadotani H, Takami M, Nishikawa K, Sumi Y, Nakabayashi T, Fujii Y, Matsuo M, Yamada N. 0354 Insomnia Is Associated With Presenteeism In Japanese City Government Employees. Sleep 2018. [DOI: 10.1093/sleep/zsy061.353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Kadotani
- Shiga University of Medical Science, Otsu, JAPAN
| | - M Takami
- Shiga University of Medical Science, Otsu, JAPAN
| | | | - Y Sumi
- Department of Psychiatry, Shiga University of Medical Science, Seta, JAPAN
| | - T Nakabayashi
- Department of Psychiatry, Shiga University of Medical Science, Seta, JAPAN
| | - Y Fujii
- Department of Psychiatry, Shiga University of Medical Science, Seta, JAPAN
| | - M Matsuo
- Department of Psychiatry, Shiga University of Medical Science, Seta, JAPAN
| | - N Yamada
- Department of Psychiatry, Shiga University of Medical Science, Seta, JAPAN
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Minamide A, Yoshida M, Simpson AK, Nakagawa Y, Iwasaki H, Tsutsui S, Takami M, Hashizume H, Yukawa Y, Yamada H. Minimally invasive spinal decompression for degenerative lumbar spondylolisthesis and stenosis maintains stability and may avoid the need for fusion. Bone Joint J 2018; 100-B:499-506. [PMID: 29629597 DOI: 10.1302/0301-620x.100b4.bjj-2017-0917.r1] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to investigate the clinical and radiographic outcomes of microendoscopic laminotomy in patients with lumbar stenosis and concurrent degenerative spondylolisthesis (DS), and to determine the effect of this procedure on spinal stability. Patients and Methods A total of 304 consecutive patients with single-level lumbar DS with concomitant stenosis underwent microendoscopic laminotomy without fusion between January 2004 and December 2010. Patients were divided into two groups, those with and without advanced DS based on the degree of spondylolisthesis and dynamic instability. A total of 242 patients met the inclusion criteria. There were 101 men and 141 women. Their mean age was 68.1 years (46 to 85). Outcome was assessed using the Japanese Orthopaedic Association and Roland Morris Disability Questionnaire scores, a visual analogue score for pain and the Short Form Health-36 score. The radiographic outcome was assessed by measuring the slip and the disc height. The clinical and radiographic parameters were evaluated at a mean follow-up of 4.6 years (3 to 7.5). Results There were no significant differences in the preoperative measurements between the group and no significant differences between the clinical parameters at the final follow-up. The mean percentage slip was 17.1% preoperatively and 17.7% at the final follow-up (p = 0.35). Progressive instability was noted in 13 patients (8.2%) with DS and 6 patients (7.0%) with advanced DS, respectively (p = 0.81). There was radiological evidence of restabilization of the spine in 30 patients (35%) with preoperative instability. The success rate of microendoscopic laminotomy was good/excellent in 166 (69%), fair in 49 (20%) and poor in 27 patients (11%) in both groups. Conclusion Microendoscopic laminotomy is an effective form of surgical treatment for patients with DS and stenosis. Preservation of the stabilizing structures using this technique prevents postoperative instability. Cite this article: Bone Joint J 2018;100-B:499-506.
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Affiliation(s)
- A Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8510, Japan
| | - M Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8510, Japan
| | - A K Simpson
- Microendoscopic Spine Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Y Nakagawa
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8510, Japan
| | - H Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8510, Japan
| | - S Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8510, Japan
| | - M Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8510, Japan
| | - H Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8510, Japan
| | - Y Yukawa
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8510, Japan
| | - H Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8510, Japan
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Ando M, Tamaki T, Matsumoto T, Maio K, Teraguchi M, Takiguchi N, Iwahashi H, Onishi M, Nakagawa Y, Iwasaki H, Tsutsui S, Takami M, Yamada H. Can postoperative deltoid weakness after cervical laminoplasty be prevented by using intraoperative neurophysiological monitoring? J Clin Monit Comput 2018; 33:123-132. [PMID: 29667095 DOI: 10.1007/s10877-018-0141-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/06/2018] [Indexed: 11/25/2022]
Abstract
Laminoplasty, frequently performed in patients with cervical myelopathy, is safe and provides relatively good results. However, motor palsy of the upper extremities, which occurs after decompression surgery for cervical myelopathy, often reduces muscle strength of the deltoid muscle, mainly in the C5 myotome. The aim of this study was to investigate prospectively whether postoperative deltoid weakness (DW) can be predicted by performing intraoperative neurophysiological monitoring (IONM) during cervical laminoplasty and to clarify whether it is possible to prevent palsy using IONM. We evaluated the 278 consecutive patients (175 males and 103 females) who underwent French-door cervical laminoplasty for cervical myelopathy under IONM between November 2008 and December 2016 at our hospital. IONM was performed using muscle evoked potential after electrical stimulation to the brain [Br(E)-MsEP] from the deltoid muscle. Seven patients (2.5%) developed DW after surgery (2 with acute and 5 with delayed onset). In all patients, deltoid muscle strength recovered to ≥ 4 on manual muscle testing 3-6 months after surgery. Persistent IONM alerts occurred in 2 patients with acute-onset DW. To predict the acute onset of DW, Br(E)-MsEP alerts in the deltoid muscle had both a sensitivity and specificity of 100%. The PPV of persistent Br(E)-MsEP alerts had both a sensitivity and specificity of 100% for acute-onset DW. There was no change in Br(E)-MsEP in patients with delayed-onset palsy. The incidence of deltoid palsy was relatively low. Persistent Br(E)-MsEP alerts of the deltoid muscle had a 100% sensitivity and specificity for predicting a postoperative acute deficit. IONM was unable to predict delayed-onset DW. In only 1 patient were we able to prevent postoperative DW by performing a foraminotomy.
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Affiliation(s)
- Muneharu Ando
- Department of Orthopedic Surgery, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama, Wakayama, 640-8505, Japan.
| | - Tetsuya Tamaki
- Aitoku Medical and Welfare Center, 3-5-41 Imafuku, Wakayama, Wakayama, 641-0044, Japan
| | - Takuji Matsumoto
- Department of Orthopedic Surgery, Nokami Kosei General Hospital, 198 Kobata, Nokami cho, Kaiso gun, 640-1141, Japan
| | - Kazuhiro Maio
- Department of Orthopedic Surgery, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama, Wakayama, 640-8505, Japan
| | - Masatoshi Teraguchi
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi cho, Ito gun, 649-7113, Japan
| | - Noboru Takiguchi
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Hiroki Iwahashi
- Department of Orthopedic Surgery, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama, Wakayama, 640-8505, Japan
| | - Makiko Onishi
- Department of Orthopedic Surgery, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama, Wakayama, 640-8505, Japan
| | - Yukihiro Nakagawa
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Hiroshi Iwasaki
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Shunji Tsutsui
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Masanari Takami
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Hiroshi Yamada
- Department of Orthopedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
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Kadotani H, Takami M, Nishikawa K, Masahiro M, Naoto Y. Relationship between absenteeism/presenteeism and weekday sleep debt in government employees of a Japanese city. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kuriyama K, Suzuki M, Kadotani H, Yoshinaka H, Yamanaka M, Omori T, Mori A, Tsuboi H, Ueda T, Kashiwagi K, Yoshimura A, Yoshiike T, Takahashi M, Matsuo M, Morita S, Takami M, Fujii Y, Nakabayashi T, Yoshida M, Kutsumi H, Uchiyama M, Yamada N. A research project aimed at developing practical use of sleep EEG for diagnosis of major depressive disorder: multicenter exploratory prospective study. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Shibata H, Kijima Y, Nagoshi R, Takami M, Kozuki A, Fujiwara R, Mochizuki Y, Nakano S, Fukuyama Y, Kakizaki S, Fujimoto D, Kurimoto H, Masuko E, Shite J. 5712Clinical outcome of very severe calcified lesions guided by optical coherence tomography. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Shibata H, Kijima Y, Nagoshi R, Takami M, Kozuki A, Fujiwara R, Mochizuki Y, Nakano S, Fukuyama Y, Kakizaki S, Fujimoto D, Kurimoto H, Masuko E, Shite J. 5708Incidence and predictors of target lesion revascularization in lesions with moderate to severe calcification which underwent percutaneous coronary intervention guided by optical coherence tomography. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Minamide A, Yoshida M, Simpson AK, Yamada H, Hashizume H, Nakagawa Y, Iwasaki H, Tsutsui S, Okada M, Takami M, Nakao SI. Microendoscopic laminotomy versus conventional laminoplasty for cervical spondylotic myelopathy: 5-year follow-up study. J Neurosurg Spine 2017; 27:403-409. [PMID: 28708041 DOI: 10.3171/2017.2.spine16939] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to characterize the long-term clinical and radiological results of articular segmental decompression surgery using endoscopy (cervical microendoscopic laminotomy [CMEL]) for cervical spondylotic myelopathy (CSM) and to compare outcomes to conventional expansive laminoplasty (ELAP). METHODS Consecutive patients with CSM who required surgical treatment were enrolled. All enrolled patients (n = 78) underwent CMEL or ELAP. All patients were followed postoperatively for more than 5 years. The preoperative and 5-year follow-up evaluations included neurological assessment (Japanese Orthopaedic Association [JOA] score), JOA recovery rates, axial neck pain (using a visual analog scale), the SF-36, and cervical sagittal alignment (C2-7 subaxial cervical angle). RESULTS Sixty-one patients were included for analysis, 31 in the CMEL group and 30 in the ELAP group. The mean preoperative JOA score was 10.1 points in the CMEL group and 10.9 points in the ELAP group (p > 0.05). The JOA recovery rates were similar, 57.6% in the CMEL group and 55.4% in the ELAP group (p > 0.05). The axial neck pain in the CMEL group was significantly lower than that in the ELAP group (p < 0.01). At the 5-year follow-up, cervical alignment was more favorable in the CMEL group, with an average 2.6° gain in lordosis (versus 1.2° loss of lordosis in the ELAP group [p < 0.05]) and lower incidence of postoperative kyphosis. CONCLUSIONS CMEL is a novel, less invasive technique that allows for multilevel posterior cervical decompression for the treatment of CSM. This 5-year follow-up data demonstrates that after undergoing CMEL, patients have similar neurological outcomes to conventional laminoplasty, with significantly less postoperative axial pain and improved subaxial cervical lordosis when compared with their traditional ELAP counterparts.
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Affiliation(s)
- Akihito Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; and
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; and
| | | | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; and
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; and
| | - Yukihiro Nakagawa
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; and
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; and
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; and
| | - Motohiro Okada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; and
| | - Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; and
| | - Shin-Ichi Nakao
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan; and
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Takami M, Okada M, Enyo Y, Iwasaki H, Yamada H, Yoshida M. Noncontiguous double-level unstable spinal injuries. Eur J Orthop Surg Traumatol 2016; 27:79-86. [DOI: 10.1007/s00590-016-1855-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 09/06/2016] [Indexed: 11/29/2022]
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