Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.neuroscience.2022.03.023

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：English   Publishing type：Research paper (scientific journal)  

The aim of this study was to analyze the 5-year natural course of frailty status assessed with the Kihon Checklist (KCL) and the risk factors of transition towards frailty in community-dwelling older adults. We used the data from the postal KCL survey conducted by the municipal government between 2011 and 2016. The sample of the current study consisted of 551 older adults (265 men and 286 women) aged 65-70 years in 2011. The median KCL score increased from 2 (interquartile range 1-3) in 2011 to 3 (1-5) in 2016 (p < 0.001). Hence, the prevalence of frailty increased from 8.0 to 12.3% (p < 0.001). Regarding the 5-year transitions in frailty status, 68.3% of participants remained unchanged, while 21.4% transitioned towards a worse frailty status, and 10.3% towards an improved status. Of the 507 respondents who were robust or prefrail at the baseline, 44 experienced a transition towards frailty, indicating that the 5-year incidence of frailty was 8.7%. These 44 individuals had higher body mass indexes (BMI) and lower physical activity scores on the KCL than others (p < 0.05), the latter of which was an independent predictor of transition toward frailty in the multivariate analysis. This study was the first to evaluate the 5-year natural course of frailty status assessed using the KCL in community-dwelling elderly adults, in which the prevalence of frailty increased by 4.3%. To prevent transition towards frailty, maintaining optimal physical activity is recommended.

DOI： 10.1038/s41598-021-91979-6

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STUDY DESIGN: Retrospective multicenter study. OBJECTIVE: To evaluate mid- to long-term surgical outcomes of thoracic dumbbell tumors managed by laminectomy and unilateral total facetectomy without instrumented fusion. METHODS: A total of 15 patients with thoracic dumbbell tumors who underwent primary resection by laminectomy and unilateral total facetectomy without spinal instrumented fusion between 2000 and 2015 were reviewed. Patient characteristics, surgical outcomes (including spinal alignment and stability), disc degeneration, pain, disability, and health-related quality of life were evaluated. Additionally, to analyze the impact of the affected levels on these outcomes, we divided the patients into 2 groups: a middle thoracic group and a thoracolumbar group. RESULTS: The mean duration of follow-up was 100.5 months (range, 36-190 months). The affected level was T3-T4 or below in all patients. Although the local kyphosis angle (8.1° to 12.7°), thoracic kyphosis angle (25.6° to 33.9°), and coronal Cobb angle (6.6° to 9.5°) significantly increased from preoperative to the final visit (P ≤ .02), no patient demonstrated spinal instability. From magnetic resonance imaging, no patient had a worse grade of disc degeneration in the affected level than those in the adjacent levels. The percentage of patients who presented with an Oswestry disability index ≤ 22% was 80%. Moreover, the surgical region did not adversely affect the outcomes. No patient required additional surgery due to spinal instability or deformity. CONCLUSIONS: Unilateral total facetectomy without fusion to resect thoracic dumbbell tumors caused neither spinal deformity nor instability requiring additional surgery at the mid- to long-term follow-up.

DOI： 10.1177/21925682211008836

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Proper identification of lumbosacral transitional vertebrae (LSTV) is important to characterize the relationship between the transitional segment and adjacent levels. Classical classification schemes are inaccurate with respect to the whole spine. We propose a precise vertebral numbering method and investigated the relationship between LSTV and whole-body sagittal alignment. METHODS: A total of 291 healthy adult volunteers with no history of spinal disease were evaluated with biplanar slot scanning full body stereoradiography to determine the prevalence of LSTV. Vertebrae were counted from the first cervical vertebra using both coronal and sagittal plane images. We then investigated the influence of LSTV on whole-body sagittal alignment in 279 participants. Whole-body key parameters descriptive statistics were compared among groups according to the number of vertebrae (L4, L5, and L6). Statistical analysis was performed between normal and LSTV cases using the Steel-Dwass analysis. RESULTS: Of the 291 subjects, 14 (4.8%) had 23 vertebrae and 16 (5.5%) had 25 vertebrae. Eleven (3.8%) had Th11, 3 (1.0%) had L4, and 1 (0.3%) had Th11 + L6, 16 (5.5%) had L6. Compared with the normal group, the sacral base in relation to the pelvis was higher in the L4 group and lower in the L6 group. The C2-C7 angle and lumbar lordosis (LL) were increased in both the L4 and L6 groups. All remaining parameters were decreased in the L4 group and increased in the L6 group. The relationship between LL and PI was similar in the normal and LSTV groups, despite the difference in the sacral base location. CONCLUSIONS: We propose a precise method for numbering the vertebrae using coronal and sagittal full body images. The spinopelvic parameters of the LSTV population significantly differed from those in the normal spine population due to differences in the sacral base location.

DOI： 10.1016/j.jos.2021.03.009

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Attenuation of the secondary injury of spinal cord injury (SCI) can suppress the spread of spinal cord tissue damage, possibly resulting in spinal cord sparing that can improve functional prognoses. Granulocyte colony-stimulating factor (G-CSF) is a haematological cytokine commonly used to treat neutropenia. Previous reports have shown that G-CSF promotes functional recovery in rodent models of SCI. Based on preclinical results, we conducted early phase clinical trials, showing safety/feasibility and suggestive efficacy. These lines of evidence demonstrate that G-CSF might have therapeutic benefits for acute SCI in humans. To confirm this efficacy and to obtain strong evidence for pharmaceutical approval of G-CSF therapy for SCI, we conducted a phase 3 clinical trial designed as a prospective, randomized, double-blinded and placebo-controlled comparative trial. The current trial included cervical SCI [severity of American Spinal Injury Association (ASIA) Impairment Scale (AIS) B or C] within 48 h after injury. Patients are randomly assigned to G-CSF and placebo groups. The G-CSF group was administered 400 μg/m2/day × 5 days of G-CSF in normal saline via intravenous infusion for five consecutive days. The placebo group was similarly administered a placebo. Allocation was concealed between blinded evaluators of efficacy/safety and those for laboratory data, as G-CSF markedly increases white blood cell counts that can reveal patient treatment. Efficacy and safety were evaluated by blinded observer. Our primary end point was changes in ASIA motor scores from baseline to 3 months after drug administration. Each group includes 44 patients (88 total patients). Our protocol was approved by the Pharmaceuticals and Medical Device Agency in Japan and this trial is funded by the Center for Clinical Trials, Japan Medical Association. There was no significant difference in the primary end point between the G-CSF and the placebo control groups. In contrast, one of the secondary end points showed that the ASIA motor score 6 months (P = 0.062) and 1 year (P = 0.073) after drug administration tend to be higher in the G-CSF group compared with the placebo control group. Moreover, in patients aged over 65 years old, motor recovery 6 months after drug administration showed a strong trend towards a better recovery in the G-CSF treated group (P = 0.056) compared with the control group. The present trial failed to show a significant effect of G-CSF in primary end point although the subanalyses of the present trial suggested potential G-CSF benefits for specific population.

DOI： 10.1093/brain/awaa466

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：English   Publishing type：Research paper (scientific journal)  

A 21-year-old man consulted our hospital for treatment of a spinal giant cell tumor (GCT) of Enneking stage III. Lower lumbar-spine tumors and severe spinal canal stenosis are associated with high risk for surgical mor-bidity. Stability was temporarily secured with a percutaneous pedicle screw fixation in combination with deno-sumab, which shrank the tumor. Total en bloc spondylectomy was then performed 6 months after initiation of denosumab, and the patient was followed for 3 years. There was no local recurrence, and bony fusion was obtained. Minimally invasive surgery and denosumab allowed safer and easier treatment of a collapsing lower lumbar extra-compartmental GCT.

DOI： 10.18926/AMO/61442

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BACKGROUND: This study aimed to determine the indications for drainage in extended haematogenous iliopsoas abscesses (IPAs), which include both primary and vertebral osteomyelitis-related IPAs. METHODS: Sixty-three IPA patients who were initially treated with only antibiotics and no drainage were enrolled. The success (S) group included patients who were cured without drainage, while the failure (F) group included those who required open or percutaneous drainage or died. RESULTS: Compared with patients in the S group, patients in the F group (n = 15) had a higher incidence of end-stage renal disease on hemodialysis, compromised immunity, vertebral osteomyelitis of the cervicothoracic spine, other musculoskeletal infections, and multilocular abscesses. The IPAs in the F group had larger transverse and longitudinal diameters. In receiver operating characteristic curve analyses for the diameter of IPAs, the most valuable cut-off points predicting the F group were a longitudinal diameter of 5.0 cm (sensitivity, 1.0; specificity, 0.67) and a transverse diameter of 2.3 cm (sensitivity, 0.73; specificity, 0.73). A combination of both diameter cut-offs had high specificity (sensitivity, 0.73; specificity, 0.90). CONCLUSIONS: Drainage should be applied in case of a larger abscess with transverse diameter ≥ 2.3 cm and longitudinal diameter ≥ 5.0 cm. Conversely, IPAs with longitudinal diameter <5 cm do not require drainage. Haemodialysis, compromised immunity, vertebral osteomyelitis of the cervicothoracic spine, and musculoskeletal infections are risk factors of conservative treatment failure.

DOI： 10.1016/j.jos.2020.10.023

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STUDY DESIGN: Retrospective study. OBJECTIVE: To analyze the relationships between three-dimensional (3D) measurements of spinal deformity and Scoliosis Research Society-22 (SRS-22) scores in preoperative patients with major thoracic adolescent idiopathic scoliosis (AIS). Previous studies reported 2D measurements were not or only weakly correlated with preoperative SRS-22 scores. However, 2D measures do not always accurately represent the 3D deformity. METHODS: A multicenter prospective registry of surgically treated AIS patients was reviewed for patients with right major thoracic AIS (Lenke type 1-4) who underwent biplanar radiography and completed the SRS-22 questionnaire preoperatively. For the 3D measurements, two reference frames were utilized: global (gravity/patient-based) and local (vertebra/disc-based). To obtain regional measurements, the individual segments in the appropriate reference plane were summed between the levels of interest. Patients were divided into two groups for each SRS-22 domain according to their scores: low (< 4) and high (≥ 4) score groups. Group differences and correlations with SRS-22 scores were analyzed with p < 0.01 as the threshold for significance. RESULTS: There were 405 eligible patients (mean age, 14.4 years). The mean 3D thoracic curve was 59° (45°-115°). The only significant group difference of 3D measurements occurred in the local lumbar lordosis (LL) with a small mean difference (- 3.4°, p = 0.008) in the mental health domain. In the correlation analyses, global and local thoracic kyphosis (TK) and TK/LL ratio demonstrated significant, but weak, correlations with function and total scores (|r|< 0.2, p < 0.01). CONCLUSION: 3D measurements of scoliosis severity have only weak associations with preoperative SRS-22 scores, which might indicate a limit to the discriminative capacity of the SRS-22 within surgical range major thoracic AIS curves. Interestingly, the sagittal plane was the principle 3D plane in which significant correlations existed. LEVEL OF EVIDENCE: II, prognostic.

DOI： 10.1007/s43390-020-00150-0

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STUDY DESIGN: This was a retrospective case control study. OBJECTIVE: The objective was to determine the impact of single-level interbody fusion at L4/5 with or without concomitant decompression on various spinopelvic parameters and health-related quality-of-life (HRQOL) outcomes. SUMMARY OF BACKGROUND DATA: Recently, focus has swayed from a regional concern to a global sagittal alignment, more comprehensive approach in multilevel, corrective fusion for adult spinal deformity. However, only a few comprehensive studies have investigated the relationships between the various related spinopelvic parameters and HRQOL outcomes using single-level interbody fusion. MATERIALS AND METHODS: In total, 119 patients with lumbar degenerative disorders (mean age, 68 y; 38 males and 81 females) who underwent L4/5 single-level posterior interbody fusion with a minimum 2-year follow-up were included. Participants were divided into 2 groups according to preoperative sagittal modifiers of the SRS-Schwab adult spinal deformity classification. The correlation between spinopelvic parameters and HRQOL outcomes was investigated. Negative or positive values indicated lordosis. HRQOL outcomes were assessed using visual analog scale scores, Japanese Orthopedic Association Back Pain Evaluation Questionnaires (JOABPEQ), and short form-36 (SF-36). RESULTS: L4/5 local lordosis increased from 6.4±4.4 degrees preoperatively to 11.3±4.5 degrees at 2 years postoperatively (P<0.0001). Further analysis of the results also showed a correlation between change in L4/5 local lordosis and change in lumbar lordosis (LL) (rs=0.229, P=0.0143). The high pelvic incidence-LL (≥20 degrees, n=28) and high sagittal vertical axis groups (≥5 cm, n=29) had lower scores in walking ability, social life domains of JOABPEQ, and physical component summary scores of SF-36 preoperatively, and 2 years postoperatively. Fusion status did not affect the HRQOL outcomes, except that concomitant decompression at the adjacent disk level yielded lower SF-36 physical component summary scores 2 years postoperatively. CONCLUSIONS: Improvement in L4/5 local lordosis possibly triggers a simultaneous sequence of change in total LL after posterior single-level fusion. HRQOL outcomes were negatively affected by both preoperative and postoperative pelvic incidence-LL mismatch and global sagittal malalignment. LEVEL OF EVIDENCE: Level III.

DOI： 10.1097/BSD.0000000000001013

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BACKGROUND: We aimed to investigate the impact of long corrective fusion to the ilium on the physical function in elderly patients with adult spinal deformity and its correlation with spinopelvic parameters and health-related quality of life outcomes. METHODS: We included 60 female patients who underwent long corrective fusion from T9 or T10 to the pelvis for adult spinal deformities (mean age of 69.8 years, range 55-78 years). The radiographic parameters, health-related quality of life outcomes using the Scoliosis Research Society Outcome Instrument-22 and physical function assessments were reviewed preoperatively and at 1-year postoperatively. RESULTS: All spinopelvic parameters, except for thoracolumbar kyphosis, and all domains of the Scoliosis Research Society Outcome Instrument-22 significantly improved at 1-year postoperatively (p < 0.0001). Physical function results, including those for one-leg standing time, timed up-and-go test, and 6-min walk tests, significantly improved at 1-year postoperatively (p < 0.005). Based on forward stepwise multivariate logistic regression, the predicted timed up-and-go test and 6-min walk test outcomes at 1-year postoperatively were as follows: timed up-and-go test, 7.8 + 0.47 × preoperative timed up-and-go test - 0.21 × 1-year postoperative grasping power +0.015 × 1-year postoperative C1 sagittal vertical axis (R2 = 0.6209, p < 0.0001); 6-min walk test, 309.2-9.1 × body mass index + 11.6 × 1-year postoperative grasping power + 3.3 × 1-year postoperative thoracolumbar kyphosis - 0.59 × 1-year postoperative C1 sagittal vertical axis (R2 = 0.4409, p < 0.0001). CONCLUSIONS: Corrective long fusion surgery for adult spinal deformity in normalizing sagittal alignment improves trunk balance and gait performance. Postoperative physical function depends on the preoperative physical performance status and skeletal muscle status; thus, preoperative interventions for improved physical function are recommended.

DOI： 10.1016/j.jos.2020.09.016

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AIMS: The aim of this study is to test the hypothesis that three grades of sagittal compensation for standing posture (normal, compensated, and decompensated) correlate with health-related quality of life measurements (HRQOL). METHODS: A total of 50 healthy volunteers (normal), 100 patients with single-level lumbar degenerative spondylolisthesis (LDS), and 70 patients with adult to elderly spinal deformity (deformity) were enrolled. Following collection of demographic data and HRQOL measured by the Scoliosis Research Society-22r (SRS-22r), radiological measurement by the biplanar slot-scanning full body stereoradiography (EOS) system was performed simultaneously with force-plate measurements to obtain whole body sagittal alignment parameters. These parameters included the offset between the centre of the acoustic meatus and the gravity line (CAM-GL), saggital vertical axis (SVA), T1 pelvic angle (TPA), McGregor slope, C2-7 lordosis, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), PI-LL, sacral slope (SS), pelvic tilt (PT), and knee flexion. Whole spine MRI examination was also performed. Cluster analysis of the SRS-22r scores in the pooled data was performed to classify the subjects into three groups according to the HRQOL, and alignment parameters were then compared among the three cluster groups. RESULTS: On the basis of cluster analysis of the SRS-22r subscores, the pooled subjects were divided into three HRQOL groups as follows: almost normal (mean 4.24 (SD 0.32)), mildly disabled (mean 3.32 (SD 0.24)), and severely disabled (mean 2.31 (SD 0.35)). Except for CAM-GL, all the alignment parameters differed significantly among the cluster groups. The threshold values of key alignment parameters for severe disability were TPA > 30°, C2-7 lordosis > 13°, PI-LL > 30°, PT > 28°, and knee flexion > 8°. Lumbar spinal stenosis was found to be associated with the symptom severity. CONCLUSION: This study provides evidence that the three grades of sagittal compensation in whole body alignment correlate with HRQOL scores. The compensation grades depend on the clinical diagnosis, whole body sagittal alignment, and lumbar spinal stenosis. The threshold values of key alignment parameters may be an indication for treatment. Cite this article: Bone Joint J 2020;102-B(10):1359-1367.

DOI： 10.1302/0301-620X.102B10.BJJ-2019-1581.R2

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BACKGROUND: Morphological features of foraminal stenosis in cervical spondylotic radiculopathy and the adequate extent of facet resection in posterior cervical foraminotomy remain uncertain. Herein, we evaluated quantitatively foraminal widths in cervical spondylotic radiculopathy on dynamic flexion-extension computed tomography using a novel three-dimensional analysis method and determined the extent of facet resection in posterior cervical foraminotomy. METHODS: Seventeen patients undergoing posterior cervical foraminotomy for cervical spondylotic radiculopathy were evaluated. A neuroforamen three-dimensional model was built from preoperative images of flexion-extension computed tomography myelography, and an ordinary cervical spine coordinate system and an original neuroforaminal coordinate system, were established. In the neuroforaminal coordinate system, minimum areas perpendicular to the long axis by the slices from inlet to outlet of neuroforamen and narrowest foraminal width in a slice of minimum area were measured. The location of the narrowest region from inlet of the foramen was calculated. Ratios of minimum and sufficient facet resection were obtained from the location of the narrowest region in the neuroforaminal coordinate system. RESULTS: The narrowest foraminal widths (flexion/extension) in the cervical spine coordinate system and the neuroforaminal coordinate system were 2.9/2.3 and 2.6/1.9 mm, respectively. The mean values of the location of the narrowest region (flexion/extension) were 0.27/0.22 and 0.50/0.45 mm, respectively, and the narrowest region in the neuroforaminal coordinate system was located on the outer side than in the cervical spine coordinate system (p < 0.001). The ratios of minimum and sufficient facet resection were 23 ± 8% and 32 ± 9%, respectively. CONCLUSIONS: The narrowest regions both in flexion and extension are located at the middle of the foramen based on the neuroforaminal coordinate system. Ordinary evaluation of axial computed tomography images likely underestimates the extent of facet resection, whereas certain extent of facet resection does not exceed 50% in cases with single-level cervical spondylotic radiculopathy. STUDY DESIGN: A retrospective case control study.

DOI： 10.1016/j.jos.2019.11.002

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BACKGROUND: Vertebroplasty with posterior spinal fusion (VP + PSF) is one of the most widely accepted surgical techniques for treating osteoporotic vertebral collapse (OVC). Nevertheless, the effect of the extent of fusion on surgical outcomes remains to be established. This study aimed to evaluate the surgical outcomes of short- versus long-segment VP + PSF for OVC with neurological impairment in thoracolumbar spine. METHODS: We retrospectively collected data from 133 patients (median age, 77 years; 42 men and 91 women) from 27 university hospitals and their affiliated hospitals. We divided patients into two groups: a short-segment fusion group (S group) with 2- or 3-segment fusion (87 patients) and a long-segment fusion group (L group) with 4- through 6-segment fusion (46 patients). Surgical invasion, clinical outcomes, local kyphosis angle (LKA), and complications were evaluated. RESULTS: No significant differences between the two groups were observed in terms of neurological recovery, pain scale scores, and complications. Surgical time was shorter and blood loss was less in the S group, whereas LKA at the final follow-up and correction loss were superior in the L group. CONCLUSION: Although less invasiveness and validity of pain and neurological relief are secured by short-segment VP + PSF, surgeons should be cautious regarding correction loss.

DOI： 10.1186/s12891-020-03539-0

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BACKGROUND: The optimal treatment of osteoporosis after reconstruction surgery for osteoporotic vertebral fractures (OVF) remains unclear. In this multicentre retrospective study, we investigated the effects of typically used agents for osteoporosis, namely, bisphosphonates (BP) and teriparatide (TP), on surgical results in patients with osteoporotic vertebral fractures. METHODS: Retrospectively registered data were collected from 27 universities and affiliated hospitals in Japan. We compared the effects of BP vs TP on postoperative mechanical complication rates, implant-related reoperation rates, and clinical outcomes in patients who underwent posterior instrumented fusion for OVF. Data were analysed according to whether the osteoporosis was primary or glucocorticoid-induced. RESULTS: A total of 159 patients who underwent posterior instrumented fusion for OVF were included. The overall mechanical complication rate was significantly lower in the TP group than in the BP group (BP vs TP: 73.1% vs 58.2%, p = 0.045). The screw backout rate was significantly lower and the rates of new vertebral fractures and pseudoarthrosis tended to be lower in the TP group than in the BP group. However, there were no significant differences in lumbar functional scores and visual analogue scale pain scores or in implant-related reoperation rates between the two groups. The incidence of pseudoarthrosis was significantly higher in patients with glucocorticoid-induced osteoporosis (GIOP) than in those with primary osteoporosis; however, the pseudoarthrosis rate was reduced by using TP. The use of TP also tended to reduce the overall mechanical complication rate in both primary osteoporosis and GIOP. CONCLUSIONS: The overall mechanical complication rate was lower in patients who received TP than in those who received a BP postoperatively, regardless of type of osteoporosis. The incidence of pseudoarthrosis was significantly higher in patients with GIOP, but the use of TP reduced the rate of pseudoarthrosis in GIOP patients. The use of TP was effective to reduce postoperative complications for OVF patients treated with posterior fusion.

DOI： 10.1186/s12891-020-03452-6

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BACKGROUND: Although several radiographic predictors for pulmonary function in adolescent patients have been reported, those in adult patients remain unclear. Therefore, we aimed to investigate the associations between spinal deformity and pulmonary function in nonoperatively treated adult patients with adolescent idiopathic scoliosis (AIS). METHODS: Of 319 patients treated nonoperatively for AIS, 90 (average age, 40.0 ± 6.5 years) underwent both full-length standing radiographs and pulmonary function test. Standard two-dimensional (2-D) radiographic measurements were performed. Three-dimensional thoracic kyphosis (3-D TK) was calculated from 2-D standing radiograph data using a validated formula: 3-D TK (°) = 18.1 + 0.81 × (2-D TK) + 0.54 × (Cobb angle of thoracic curve). 3-D TK was defined as the sum of segmental kyphosis between T5 and T12, which eliminates the overestimation of TK in 2-D measurements due to rotational deformity. Bivariable correlation analysis, followed by a stepwise multiple linear regression analysis, was performed. RESULTS: The average Cobb angle of the thoracic curve at the time of survey was 49.4° ± 14.6° with flexibility of 37.5% ± 18.2%. Thoracic curve magnitude, flexibility, apical vertebral rotation and translation, and 3-D TK were significantly correlated with percent-predicted forced vital capacity (%FVC) and expiratory volume in 1 s (%FEV1.0). Stepwise multiple regression analysis showed that curve flexibility and 3-D TK were significant, independent predictors of %FVC (R2 = 0.358) and %FEV1.0 (R2 = 0.335), curve flexibility having a greater impact (standardized coefficient > 0.45) than 3-D TK (<0.32). CONCLUSIONS: Our results indicate that nonoperatively treated patients with AIS should be recommended to maintain flexibility of the thoracic curve to prevent future pulmonary impairment. Moreover, 3-D TK is another independent predictor of pulmonary function, which suggests that segmental sagittal alignment is a component of deformity correction to focus on.

DOI： 10.1016/j.jos.2019.06.015

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STUDY DESIGN: A prospective multicenter study. OBJECTIVE: To evaluate the effects of sparing lumbar motion segments on spinal mobility and Scoliosis Research Society-22 scores at 10 years after spinal fusion for major thoracic adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: In surgical correction for major thoracic AIS, the long-term benefits of sparing lumbar motion segments remain unclear. METHODS: A prospective multicenter registry was reviewed and patients with major thoracic AIS (Lenke types 1-4) and availability of both preoperative and 10-year postoperative mobility data were included. Spinal fusions ending at L1 or above were defined as thoracic fusions (T), and at L2 or below as thoracic and lumber fusions (T + L). Spinal mobility was evaluated with a measuring tape. The excursions between the starting and ending positions were measured using the distance from the spinous processes of C7 to S1 for forward flexion (FF), and the distance from the tip of the middle finger to the floor for lateral flexion (LF). Substantial reduction of mobility was defined as a reduction rate (a ratio of postoperative change divided by preoperative mobility) of 40% or more. Motion data were correlated with lowest instrumented vertebra levels and group comparisons were performed. RESULTS: We identified 151 patients (average age, 25.1 years). The spinal mobility decreased with more distal lowest instrumented vertebrae (FF, rho = 0.208; right LF, 0.257; left LF, 0.371; P ≤ 0.01). Consequently, the incidence of substantial reduction of mobility was lower in the T group (n = 109) than in the T + L group (n = 42) (FF: 17.4% vs. 50%, LF: 14.8% vs. 51.2%; P < 0.001). Patients with substantial reduction in LF had lower Scoliosis Research Society-22 scores for pain, function, satisfaction, and total scores than those without substantial reduction at 10-year follow-up (P < 0.05). CONCLUSION: The sparing of lumbar motion segments demonstrated clinically significant benefits at 10-year postoperatively. LEVEL OF EVIDENCE: 2.

DOI： 10.1097/BRS.0000000000003373

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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STUDY DESIGN: Prospective registry. The evolution of spinal instrumentation has provided better outcomes in adolescent idiopathic scoliosis (AIS); however, there is a paucity of reliable prospective information on 10-year post-operative outcomes of modern surgical techniques. METHODS: A prospective multicenter registry of patients who had surgical correction of AIS was reviewed. Patients with major thoracic scoliosis (Lenke types 1-4) operated on between 1997 and 2007, with 10-year post-operative follow-up data were included. Radiographic and clinical outcomes including Scoliosis Research Society (SRS)-22 scores and revision surgeries were evaluated. RESULTS: One hundred and seventy-four patients (mean 25.0 years of age at most recent evaluation) were included. Pedicle screw constructs were used in 102 patients (58%), hook or hybrid constructs in 22 (13%), and anterior screw-rod constructs in 50 (29%). The mean pre-operative thoracic Cobb angle was corrected from 53° to 18° initially. At 10-year follow-up, the mean thoracic curve was 22° (mean 57% correction), with 29 patients (16.7%) having loss of correction (LOC) ≥ 10°. There were a total of 14 revision surgeries performed in 13 patients (7.5%). SRS-22 pain (p = 0.035), self-image (p < 0.001), and total scores (p < 0.001) significantly improved at 2-year follow-up. The mean pain score at 10-year follow-up was similar to pre-operative scores and lower (more pain) than previously published mean scores of normal adults aged 20-40 years (p < 0.05). CONCLUSIONS: Spinal fusion patients report SRS-22 quality of life 10 years after scoliosis surgery that is minimally reduced compared to healthy peers and substantially better than an un-operated cohort of comparably aged scoliosis patients. Adolescents with thoracic idiopathic scoliosis should expect little if any change in their health-related quality of life compared to before surgery, high satisfaction, and a 7.5% chance of revision surgery 10 years after their index spinal fusion. LEVEL OF EVIDENCE: Therapeutic II.

DOI： 10.1007/s43390-019-00015-1

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STUDY DESIGN: A retrospective long-term follow-up study. OBJECTIVE: To investigate the health-related quality of life (HRQOL) status in middle-aged patients with adolescent idiopathic scoliosis (AIS) treated non-surgically. SUMMARY OF BACKGROUND DATA: The HRQOL status using various established questionnaires for non-operated AIS patients has not been fully investigated in long-term follow-up surveys. METHODS: Inclusion criteria were non-surgical treatment for AIS, more than or equl to 30° major scoliosis at skeletal maturity (Risser grade ≥4), and age more than or equl to 30 years at the time of the survey. A total of 107 AIS patients were included and divided into three groups (single main thoracic [MT] curve group; n = 50, single thoracolumbar/lumbar [TL/L] curve group; n = 19, and double-major [DM] curve group; n = 38) based on curve location at skeletal maturity. Age- and sex-matched volunteers were selected as the control group. RESULTS: There were no significant differences in age at survey, body mass index, bone mineral density of the femoral neck, and skeletal muscle mass index among the groups. In all groups, major scoliosis progressed by approximately 0.5°/yr from the time of skeletal maturity to the survey. The thoracolumbar (TL/L) and double-major (DM) groups showed significantly worse visual analog scale scores for low back pain compared with the main thoracice (MT) group (P < 0.05). The all-scoliosis groups showed significantly worse scores for self-image domain of the Scoliosis Research Society Outcome Instrument-22 (SRS-22) than the control group (P < 0.0001). The TL/L group showed significantly worse scores for walking ability and social function domains of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) (P < 0.05). There were no significant differences in Oswestory Disability Index and Short-Form-12 among the four groups. CONCLUSION: AIS patients with single MT curve maintain equal HRQOL status compared with healthy controls. Patients with structural TL/L curves are likely to experience greater annual TL/L curve progression and have substantial low back pain or worse low back pain-specific HRQOL status during middle age. LEVEL OF EVIDENCE: 4.

DOI： 10.1097/BRS.0000000000003216

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BACKGROUND: A consensus on the optimal surgical procedure for thoracolumbar OVF has yet to be reached due to the previous relatively small number of case series. The study was conducted to investigate surgical outcomes for osteoporotic vertebral fracture (OVF) in the thoracolumbar spine. METHODS: In total, 315 OVF patients (mean age, 74 years; 68 men and 247 women) with neurological symptoms who underwent spinal fusion with a minimum 2-year follow-up were included. The patients were divided into 5 groups by procedure: anterior spinal fusion alone (ASF group, n = 19), anterior/posterior combined fusion (APSF group, n = 27), posterior spinal fusion alone (PSF group, n = 40), PSF with 3-column osteotomy (3CO group, n = 92), and PSF with vertebroplasty (VP + PSF group, n = 137). RESULTS: Mean operation time was longer in the APSF group (p < 0.05), and intraoperative blood loss was lower in the VP + PSF group (p < 0.05). The amount of local kyphosis correction was greater in the APSF and 3CO groups (p < 0.05). Clinical outcomes were approximately equivalent among all groups. CONCLUSION: All 5 procedures resulted in acceptable neurological outcomes and functional improvement in walking ability. Moreover, they were similar with regard to complication rates, prevalence of mechanical failure related to the instrumentation, and subsequent vertebral fracture. Individual surgical techniques can be adapted to suit patient condition or severity of OVF.

DOI： 10.1016/j.jos.2019.07.018

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PURPOSE: The recovery rate of Japanese Orthopedic Association (JOA) score with K-line (-) cervical ossification of the posterior longitudinal ligament (OPLL) for posterior decompression with in-situ fusion (PDF) tends to be lower than that of anterior decompression with fusion (ADF). However, ADF is a technically demanding operation and has ADF-specific complications. This prospective report introduced a novel concept of PDF with selective lordotic correction as well as prophylactic foraminal decompression. METHODS: Six consecutive patients (four men and two women; mean age, 61.8 years) were included. PDF was performed, attempting to create cervical lordosis to acquire a posterior shift of the spinal cord, while preventing postoperative C5 palsy by prophylactic facetectomy and selective lordotic correction. RESULTS: The mean recovery rate of JOA score at the final follow-up was 70.9 ± 20.3%. The mean C2-C7 angle preoperatively and at final follow-up was 5.5 ± 3.9° and 12.2 ± 4.8°, respectively. No symptomatic nerve root palsy, except one case with transient C7 root iatrogenic palsy, was found. CONCLUSIONS: A novel concept of PDF with selective lordotic correction obtained recovery rates of JOA scores comparable to those of ADF. We believe that this method can improve PDF outcomes in patients with K-line (-) OPLL.

DOI： 10.1016/j.jocn.2019.07.040

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Few studies have performed detailed radiographic evaluation of the cause of recurrent cervical radiculopathy. In this study, we aimed to perform quantitative analyses of foraminal re-stenosis after posterior cervical foraminotomy (PCF) concomitant with laminoplasty. Seventy-eight consecutive patients (50 males and 28 females, mean age of 62 years at surgery) with cervical spondylotic radiculomyelopathy who underwent PCF concomitant with open-door laminoplasty were included. A total of 133 foramina undergoing PCF were radiographically evaluated using the following parameters: disc height, focal range of motion at the corresponding disc level, foraminal diameter (FD) and facet joint width (FJW) in the axial view on computed tomography, and re-stenosis rate (RR) of foramina. RR was calculated as follows: (foraminal regrowth at 2 years after surgery)/(foraminal enlargement immediate postoperatively) × 100% (RR2y). FDs preoperatively, postoperatively, and at 2-year follow-up were 2.2, 6.6, and 4.6 mm, respectively, and FJWs were 14.5, 9.0, and 10.6 mm, respectively. Both parameters significantly increased at the 2-year follow-up (p < 0.001). The mean RR2y was 42% (range, -16 to 108%). On logistic regression analysis of risk factors for higher RR2y (>50%), only preoperative posterior disc height (PDH) (OR = 0.33; 95% CI = 0.193-0.563; p < 0.001) was identified. Receiver operating characteristic curve analysis showed that the cut-off value of RR2y 50% was 1-mm PDH (AUC 0.73, sensitivity 52%, specificity 86%, p value < 0.001). After posterior foraminotomy with laminoplasty, the enlarged foraminal space gradually decreased during the 2-year follow-up. Foraminal re-stenosis was mainly due to bone regrowth of the resected facet joint, which is caused by disc degeneration with loss of PDH.

DOI： 10.1016/j.jocn.2019.06.012

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STUDY DESIGN: A retrospective, long-term follow-up study. OBJECTIVE: We aimed to investigate the long-term impacts of brace treatment for adolescent idiopathic scoliosis (AIS) on the musculoskeletal system. SUMMARY OF BACKGROUND DATA: Although full-time brace treatment is the mainstay of conservative treatment for AIS, the restrictive nature of brace treatment for lumbosacral motion might negatively affect the musculoskeletal system. METHODS: Of 319 patients treated nonoperatively for AIS, 80 patients completed clinical and imaging examinations. Body composition, including body fat mass, lean mass, fat percent, and muscle mass, was estimated via bioelectrical impedance analysis. Bone mineral density (BMD) was measured at the lumbar spine and left hip. In 73 patients, the measurement of cross-sectional area and fatty degeneration of paraspinal muscles at the superior endplate of L4 were performed using axial T2-weighted magnetic resonance imaging. Patients were divided into the full-time brace (FB; >13 hours per day) and nonfull-time brace (NFB; observation, part-time bracing, or drop out from FB within a year) groups. RESULTS: There were 44 patients in the FB group and 36 in the NFB group. Patients in the FB group were significantly younger at the initial visit (12.7 ± 1.3 years) and older at the final follow-up (41.5 ± 5.6 years) than those in the NFB group (14.2 ± 3.2 and 37.4 ± 7.1 years, respectively; P < 0.01). The rate of patients engaging in mild or moderate sports activity in adulthood tended to be higher in the FB group (47.7%) than in the NFB group (25%) (P = 0.11). However, there were no significant differences in body composition, paraspinal muscle morphology, and BMD between the two groups both before and after adjusting for age. CONCLUSION: Full-time brace wearing during adolescence did not have any negative impacts on the musculoskeletal system in adulthood. This information will be helpful for improving the compliance of full-time bracing. LEVEL OF EVIDENCE: 4.

DOI： 10.1097/BRS.0000000000003069

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Lamina X is localized in the spinal cord within the region surrounding the central canal and receives descending projections from the supraspinal nuclei. Norepinephrine (NE) is a neurotransmitter in descending pathways emanating from the brain stem; NE-containing fibers terminate in the spinal dorsal cord, particularly in the substantia gelatinosa (SG). NE enhances inhibitory synaptic transmission in SG neurons by activating presynaptic α1-receptors and hyperpolarizes the membranes of SG neurons by acting on α2-receptors; NE may thus act directly on SG neurons of the dorsal spinal cord and inhibit nociceptive transmission at the spinal level. NE-containing fibers also reportedly terminate in lamina X, suggesting that NE also modulates synaptic transmission in lamina X. However, the cellular mechanisms underlying such action have not been investigated. We hypothesized that NE might directly act on lamina X and enhance inhibitory synaptic transmission therein. Using rat spinal cord slices and in vitro whole-cell patch-clamps, we found that the bath-application of NE to lamina X does not affect the excitatory interneurons but enhances GABAergic and glycinergic miniature inhibitory postsynaptic currents (mIPSCs) and induces an outward current. NE-induced enhancement of mIPSCs was blocked by α1A-receptor antagonists, and NE-induced outward current was blocked by α2-receptor antagonists. NE did not affect GABA- or glycine- induced outward currents. These findings are similar to those obtained from SG neurons: NE may act at presynaptic terminals of GABAergic and glycinergic interneurons on lamina X to facilitate inhibitory-transmitter release through α1A-receptor activation and directly induce inhibitory interneuron membrane hyperpolarization through α2-receptors activation.

DOI： 10.1016/j.neuroscience.2019.04.004

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Noradrenaline (NA) modulates the spinal motor networks for locomotion and facilitates neuroplasticity, possibly assisting neuronal network activation and neuroplasticity in the recovery phase of spinal cord injuries. However, neither the effects nor the mechanisms of NA on synaptic transmission and neuronal excitability in spinal ventral horn (VH) neurons are well characterized, especially in rats aged 7 postnatal days or older. To gain insight into NA regulation of VH neuronal activity, we used a whole-cell patch-clamp approach in late neonatal rats (postnatal day 7-15). In voltage-clamp recordings at -70 mV, NA increased the frequency and amplitude of excitatory postsynaptic currents via the activation of somatic α1- and β-adrenoceptors of presynaptic neurons. Moreover, NA induced an inward current through the activation of postsynapticα1- and β-adrenoceptors. At a holding potential of 0 mV, NA also increased frequency and amplitude of both GABAergic and glycinergic inhibitory postsynaptic currents via the activation of somatic adrenoceptors in presynaptic neurons. In current-clamp recordings, NA depolarized resting membrane potentials and increased the firing frequency of action potentials in VH neurons, indicating that it enhances the excitability of these neurons. Our findings provide new insights that establish NA-based pharmacological therapy as an effective method to activate neuronal networks of the spinal VH in the recovery phase of spinal cord injuries.

DOI： 10.1016/j.neuroscience.2019.03.026

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PURPOSE: To determine whether posterior implant removal prevents stress-shielding-induced vertebral osteopenia within the posterior fusion area in surgically treated patients with adolescent idiopathic scoliosis (AIS). METHODS: Eighteen patients with major thoracic AIS (mean age, 43.3 years; range, 32-56 years; mean follow-up, 28.8 years, range, 20-39 years) who underwent posterior spinal fusion (PSF) alone between 1973 and 1994 were included. Participants were divided into implant removal (group R, n = 10, mean interval until implant removal, 50 months) and implant non-removal groups (group NR, n = 8). Bone mineral density was evaluated using the Hounsfield units (HU) of the computed tomography image of the full spine. The HU values of the UIV-1 (one level below the uppermost instrumented vertebra), apex, LIV+1 (one level above the lowermost instrumented vertebra), and LIV-1 (one level below the lowermost instrumented vertebra; as a standard value) were obtained. Stress-shielding-induced osteopenia was assessed as the UIV-1/LIV-1, apex/LIV-1, and LIV+1/LIV-1 HU ratios (× 100). RESULTS: Overall (median, 25th-75th percentile), the apex (144.7, 108.6-176.0) and LIV+1 (159.4, 129.7-172.3) demonstrated lower HU values than LIV-1 (180.3, 149.2-200.2) (both comparisons, p < .05). Comparison of groups R and NR showed no significant differences in the scoliosis correction rate, bone mineral density of the proximal femur, the HU absolute values of all investigated vertebrae, or in the HU ratios of the investigated vertebrae to LIV-1. CONCLUSION: Instrumented PSF causes stress-shielding-induced osteopenia of the vertebral body within the fusion area in adulthood, which cannot be prevented by posterior implant removal, probably due to firm fusion mass formation. These slides can be retrieved under Electronic Supplementary Material.

DOI： 10.1007/s00586-019-05921-6

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Introduction: Approximately 3% of osteoporotic vertebral fractures develop osteoporotic vertebral collapse (OVC) with neurological deficits, and such patients are recommended to be treated surgically. However, a proximal junctional fracture (PJFr) following surgery for OVC can be a serious concern. Therefore, the aim of this study is to identify the incidence and risk factors of PJFr following fusion surgery for OVC. Methods: This study retrospectively analyzed registry data collected from facilities belonging to the Japan Association of Spine Surgeons with Ambition (JASA) in 2016. We retrospectively analyzed 403 patients who suffered neurological deficits due to OVC below T10 and underwent corrective surgery; only those followed up for ≥2 years were included. Potential risk factors related to the PJFr and their cut-off values were calculated using multivariate logistic regression analysis and receiver operating characteristic (ROC) analysis. Results: Sixty-three patients (15.6%) suffered PJFr during the follow-up (mean 45.7 months). In multivariate analysis, the grade of osteoporosis (grade 2, 3: adjusted odds ratio (aOR) 2.92; p=0.001) and lower instrumented vertebra (LIV) level (sacrum: aOR 6.75; p=0.003) were independent factors. ROC analysis demonstrated that lumbar bone mineral density (BMD) was a predictive factor (area under curve: 0.72, p=0.035) with optimal cut-off value of 0.61 g/cm2 (sensitivity, 76.5%; specificity, 58.3%), but that of the hip was not (p=0.228). Conclusions: PJFr was found in 16% cases within 4 years after surgery; independent risk factors were severe osteoporosis and extended fusion to the sacrum. The lumbar BMD with cut-off value 0.61 g/cm2 may potentially predict PJFr. Our findings can help surgeons select perioperative adjuvant therapy, as well as a surgical strategy to prevent PJFr following surgery.

DOI： 10.22603/ssrr.2018-0068

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STUDY DESIGN: Retrospective case series. PURPOSE: To investigate the oncological outcomes, including distant relapse, after en bloc spondylectomy (EBS) for spinal metastases in patients with a minimum of 2-year follow-up. OVERVIEW OF LITERATURE: Although EBS has been reported to be locally curative and extend survival in select patients with spinal metastases, detailed reports regarding the control of distant relapse after EBS are lacking. METHODS: We conducted a retrospective review of 18 consecutive patients (median age at EBS, 62 years; range, 40-77 years) who underwent EBS for spinal metastases between 1991 and 2015. The primary cancer sites included the kidney (n=7), thyroid (n=4), liver (n=3), and other locations (n=4). Survival rates were estimated using the Kaplan-Meier method, and groups were compared using the log-rank method. RESULTS: The median operative time and intraoperative blood loss were 767.5 minutes and 2,375 g, respectively. Twelve patients (66.7%) experienced perioperative complications. Five patients (27.8%) experienced local recurrence of the tumor at a median of 12.5 months after EBS, four of which had a positive resection margin status. Thirteen patients (72.2%) experienced distant relapse at a median of 21 months after EBS. The estimated median survival period after distant relapse was 20 months (95% confidence interval, 0.71-39.29 months). No association was found between resection margin status and distant relapse. Overall, the 2-year, 5-year, and 10-year survival rates after EBS were 72.2%, 48.8%, and 27.1%, respectively. Importantly, the era in which EBS was performed did not impact the oncological outcomes. CONCLUSIONS: Our results suggest that EBS by itself, even if margin-free, cannot prevent further dissemination, which occurred in >70% of patients at a median of 21 months after EBS. These results should be considered and conveyed to patients for clinical decision-making.

DOI： 10.31616/asj.2018.0145

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BACKGROUND: To date, there have been little published data on surgical outcomes for patients with PD with thoracolumbar OVF. We conducted a retrospective multicenter study of registry data to investigate the outcomes of fusion surgery for patients with Parkinson's disease (PD) with osteoporotic vertebral fracture (OVF) in the thoracolumbar junction. METHODS: Retrospectively registered data were collected from 27 universities and their affiliated hospitals in Japan. In total, 26 patients with PD (mean age, 76 years; 3 men and 23 women) with thoracolumbar OVF who underwent spinal fusion with a minimum of 2 years of follow-up were included (PD group). Surgical invasion, perioperative complications, radiographic sagittal alignment, mechanical failure (MF) related to instrumentation, and clinical outcomes were evaluated. A control group of 296 non-PD patients (non-PD group) matched for age, sex, distribution of surgical procedures, number of fused segments, and follow-up period were used for comparison. RESULTS: The PD group showed higher rates of perioperative complications (p < 0.01) and frequency of delirium than the non-PD group (p < 0.01). There were no significant differences in the degree of kyphosis correction, frequency of MF, visual analog scale of the symptoms, and improvement according to the Japanese Orthopaedic Association scoring system between the two groups. However, the PD group showed a higher proportion of non-ambulators and dependent ambulators with walkers at the final follow-up (p < 0.01). CONCLUSIONS: A similar surgical strategy can be applicable to patients with PD with OVF in the thoracolumbar junction. However, physicians should pay extra attention to intensive perioperative care to prevent various adverse events and implement a rehabilitation regimen to regain walking ability.

DOI： 10.1186/s12891-019-2473-8

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STUDY DESIGN: A retrospective, long-term follow-up study. OBJECTIVE: We investigated the natural course of compensatory lumbar curves in patients with primary thoracic adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: The natural course of compensatory lumbar curves in primary thoracic AIS remains unknown. METHODS: Inclusion criteria were right-sided primary thoracic AIS ≥30° with a Lenke lumbar modifier of A or B at skeletal maturity and ≥30 years of age at the time of the survey. Fifty-one patients (mean age, 40.2 yr) returned for a follow-up evaluation (follow-up rate, 34.2%). Patients were classified into three groups based on the lumbar modifier (A or B) and direction of L4 tilt [right (R) or left (L)] (AR, n.11; AL, n.18; and B, n.22). At the time of the survey, 42 patients underwent radiological examinations and 37 underwent lumbar magnetic resonance imaging. Quality of life questionnaires were completed in all patients and in a 1:1 matched control group (no history of scoliosis). RESULTS: The thoracic curves had significantly progressed in all patient groups, while the compensatory lumbar curve progressed only in the B group. The C7 translation and L4 tilt shifted to the right in the AR and AL groups, but did not change in the B group. As a result, the L4 tilt (median, 11°) and C7 translation (18.6 mm) tended to be the greatest in the AR group. The incidences of Modic changes at L4/5 discs and ≥3 cm on the visual analogue scale for low back pain were significantly higher in the AR group (77.8% and 54.5%, respectively) compared with that in the other groups. CONCLUSION: The natural course of compensatory lumbar curves is dependent on the lumbar modifier and direction of L4 tilt. Adolescent patients with right-sided primary thoracic AIS (≥30°) with L4 tilted to the right should be considered for periodic follow-ups into adulthood. LEVEL OF EVIDENCE: 4.

DOI： 10.1097/BRS.0000000000002779

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STUDY DESIGN: A retrospective, long-term follow-up study. OBJECTIVE: We aimed to clarify the predicting factors at skeletal maturity for future curve progression and low back pain (LBP) in adolescent idiopathic scoliosis (AIS) with thoracolumbar/lumbar (TL/L) curve. SUMMARY OF BACKGROUND DATA: TL/L curves are likely to progress after skeletal maturity and cause LBP. METHODS: Of 147 patients treated nonoperatively for AIS with TL/L curve, 56 (55 females; average age at the time of survey, 39.5 ± 7.1 years; average follow-up duration after maturity, 24.9 ± 6.9 years) completed questionnaires, including the visual analogue scale (VAS) for LBP and Oswestry disability index (ODI). Forty-nine patients underwent a radiological examination, and 48 underwent lumbar magnetic resonance imaging (MRI). RESULTS: The mean Cobb angle of the TL/L curve increased from 37.3° ± 7.5° to 47.8° ± 12.6° (0.41° ± 0.39° per year). The factors at skeletal maturity that were associated with the annual progression of the TL/L curve included a cranially located apical vertebra, and great apical vertebral translation and L3 tilt. In addition, the VAS for LBP was positively correlated with L4 tilt, and the ODI was positively correlated with L4 tilt and apical vertebral rotation. Multivariate analyses and receiver-operating characteristic curves demonstrated that L3 tilt at skeletal maturity independently predicted a curve progression ≥0.5° per year (odds ratio [OR], 1.17), while L4 tilt at skeletal maturity independently predicted a VAS ≥3 cm (OR, 1.20) and ODI ≥21% (OR, 1.25) in adulthood, with a cutoff value of approximately 16° for each factor. Moreover, lumbar disc degeneration on MRI was associated with L4 tilt at skeletal maturity and LBP in adulthood. CONCLUSION: Great L3 and L4 tilt at skeletal maturity, especially those >16°, are predictors of future curve progression and LBP in adulthood, respectively. For adolescent patients with these risk factors, periodic follow-ups into adulthood should be considered. LEVEL OF EVIDENCE: 4.

DOI： 10.1097/BRS.0000000000002716

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PURPOSE: Posterior decompression with instrumented fusion (PDF) is a suitable surgical treatment for K-line (-)-type cervical ossification of the posterior longitudinal ligament (OPLL). However, the adequate indications of PDF have not been clarified yet. The purpose of this study was to investigate the surgical results of PDF and perioperative factors that influence the surgical outcome, and to clarify the adequate indications of PDF. METHODS: Twenty-seven patients (21 men and 6 women, mean age: 61.4 years) who were diagnosed with a K-line (-)-type OPLL that was treated with PDF were included in this study. We evaluated these patients clinically and radiologically to investigate the outcomes of PDF and perioperative factors that influence improvements in the Japanese Orthopedic Association (JOA) score. RESULTS: The mean recovery rate of JOA score at the final follow-up examination was 53.3%. In the statistical analysis, the preoperative C2-C7 angle and the C2-C7 angle immediately postoperatively significantly predicted the surgical outcome. The C2-C7 angle immediately postoperatively was the only most important predictor. Using a receiver operating characteristic curve analysis, we found that the cutoff value of the C2-C7 angle immediately postoperatively for good outcomes (recovery rate of JOA score ≥50%) was -2.0°. CONCLUSIONS: PDF for K-line (-)-type OPLL patients with preoperative lordotic alignment can be expected to have favorable outcomes, which is the adequate indication for PDF. Since the C2-C7 angle immediately postoperatively was the most important predictor, the physician should pay attention to maintain the cervical lordotic alignment to enhance the surgical outcomes in surgical planning.

DOI： 10.1016/j.jocn.2018.08.033

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DOI： 10.1016/j.jos.2016.08.008

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INTRODUCTION: Granulocyte colony-stimulating factor (G-CSF) is generally used for neutropaenia. Previous experimental studies revealed that G-CSF promoted neurological recovery after spinal cord injury (SCI). Next, we moved to early phase of clinical trials. In a phase I/IIa trial, no adverse events were observed. Next, we conducted a non-randomised, non-blinded, comparative trial, which suggested the efficacy of G-CSF for promoting neurological recovery. Based on those results, we are now performing a phase III trial. METHODS AND ANALYSIS: The objective of this study is to evaluate the efficacy of G-CSF for acute SCI. The study design is a prospective, multicentre, randomised, double-blinded, placebo-controlled comparative study. The current trial includes cervical SCI (severity of American Spinal Injury Association (ASIA) Impairment Scale B/C) within 48 hours after injury. Patients are randomly assigned to G-CSF and placebo groups. The G-CSF group is administered 400 µg/m2/day×5 days of G-CSF in normal saline via intravenous infusion for 5 consecutive days. The placebo group is similarly administered a placebo. Our primary endpoint is changes in ASIA motor scores from baseline to 3 months. Each group includes 44 patients (88 total patients). ETHICS AND DISSEMINATION: The study will be conducted according to the principles of the World Medical Association Declaration of Helsinki and in accordance with the Japanese Medical Research Involving Human Subjects Act and other guidelines, regulations and Acts. Results of the clinical study will be submitted to the head of the respective clinical study site as a report after conclusion of the clinical study by the sponsor-investigator. Even if the results are not favourable despite conducting the clinical study properly, the data will be published as a paper. TRIAL REGISTRATION NUMBER: UMIN000018752.

DOI： 10.1136/bmjopen-2017-019083

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BACKGROUND: In spinal instrumentation surgeries, surgical site infection (SSI) is one of the complications to be avoided. However, spinal instrumentation surgeries have a higher rate of SSI than other clean orthopedic surgeries. The purpose of this study was to investigate the risk factors for SSI following spinal instrumentation surgeries and contribute to the prevention of SSIs by identifying high-risk patients. METHODS: Records of 431 patients who underwent spinal instrumentation surgeries from 2011 to 2014 with a minimum follow-up period of 90 days were retrospectively reviewed. Associations of SSI with various preoperative, operative, and postoperative factors were statistically analyzed with univariate and stepwise multivariate logistic regression analysis. RESULTS: Deep or superficial SSIs were observed in 15 patients (3.5%). Univariate analysis revealed significant association of SSI with diabetes mellitus (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.5-14.4; p = 0.012) and serum albumin ≤3.5 g/dl (OR 3.35, 95% CI 1.1-10.38, p = 0.012). The number of regular medications prescribed in patients with SSI (8.2 ± 5.4) was significantly more than that in patients without SSI (3.8 ± 4.4) (p = 0.001), and the cut-off value of the number of medications was 7, as derived from receiver operating characteristics analysis. Multivariate analysis revealed that the number of regular medications ≥7 was an independent risk factor significantly associated with SSIs (OR 7.3, 95% CI 2.3-24.0, p = 0.001). CONCLUSIONS: Our study demonstrated that an important risk factor for SSI after spinal instrumentation surgery was number of regular medications ≥7. Number of regular medications is a simple and valuable risk index for SSI, which reflects the influence of medications and comorbidities.

DOI： 10.1016/j.jos.2018.02.008

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PURPOSE: Three-dimensional (3D) imaging using computed tomography (CT) has made it possible to accurately evaluate ossification of the posterior longitudinal ligament (OPLL). Recently, we developed a novel technique to measure ossification volume using the 3D analysis. The purpose of this study was to investigate the natural course of OPLL and the risk factors for volume progression. METHODS: Forty-one patients (22 males and 19 females) diagnosed with cervical OPLL who had been non-surgically treated were included in this study. We evaluated clinical examination, radiological findings, and the volume of ossified lesions during at least 1-year intervals. Furthermore, we performed risk factor analysis for OPLL volume progression. RESULTS: The mean ossification volume was 2047.4 ± 1437.3 mm3 in the first examination and 2201.0 ± 1524.1 mm3 in the final examination, indicating a significant increase during the follow-up period (p < 0.001). The mean annual rate of lesion increase was 4.1 ± 2.7%. Univariate regression analysis demonstrated significant relationships between the annual rate of lesion increase and age (β = -0.48; p = 0.001), body weight (BW) (β = 0.36; p = 0.02), and body mass index (BMI) (β = 0.35; p = 0.03). Furthermore, age was the only significant predictor of OPLL progression (R2 = 0.23; p = 0.001) in multivariate liner regression analysis. CONCLUSIONS: Younger age, higher BW, and higher BMI are predictors of OPLL progression. Younger age is the most significant predictor in non-surgically treated patients.

DOI： 10.1007/s00264-017-3667-z

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STUDY DESIGN: Retrospective case series. OBJECTIVE: The aim of this study was to investigate clinical outcomes after posterior spinal fusion (PSF) using cervical pedicle screw (CPS) constructs for cervical disorders associated with athetoid cerebral palsy (CP). SUMMARY OF BACKGROUND DATA: Traditionally, most patients with cervical myelopathy associated with CP have required combined anterior and posterior fusion to achieve solid stability against severe involuntary movement. METHODS: Thirty-one CP patients with cervical disorders who underwent PSF alone with a minimum 2-year follow-up (mean 58 months) were analyzed. All patients were treated with PSF using CPS constructs with or without decompression procedures. The average number of fused segments was 5.1 (range, 1-10 segments), and a halo jacket was applied in 16 patients for at least 2 months after surgery. Clinical outcomes using the Japanese Orthoedic Association scoring system (JOA score) and walking ability, radiographic sagittal alignment, fusion status, and surgery-related complications were evaluated. RESULTS: The JOA score improved from 8.3 points preoperatively to 10.9 points at the final follow-up (P < 0.05). Although no patients experienced deterioration in their walking ability postoperatively, 10 patients were unable to walk at the final follow-up. Sagittal alignment, including C0-2 angle, C2-7 angle, and local alignment in fused segments, was maintained postoperatively. Twenty-five patients achieved fusion at the final follow-up (fusion rate: 81%), and fivepatients with nonunion required additional surgery. With regard to complications, 5 patients encountered postoperative upper extremity palsy. CONCLUSION: The CPS construct is amenable to achieve a relatively high fusion rate without correction loss, and good clinical outcomes can be achieved with a posterior single approach for CP patients. In the future, efforts should be made to make appropriate decisions regarding the fusion area, take preventative measures against postoperative upper extremity palsy, and simplify external orthoses after surgery, especially with the use of a halo jacket. LEVEL OF EVIDENCE: 4.

DOI： 10.1097/BRS.0000000000002257

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A novel strategy of one-stage surgery in combination with thoracic endovascular grafting and resection for T4 lung cancer invading the thoracic aorta and spine is described. A 56-year-old man with locally advanced lung cancer infiltrating the aortic wall and spine underwent neoadjuvant chemotherapy and thoracic irradiation, followed by en bloc resection of the aortic wall and spine with thoracic endovascular grafting. He developed postoperative chylothorax, but there were no stent graft-related events. After 3 months, computed tomography (CT) did not show aortic stent graft stenosis, migration, or deformation.

DOI： 10.21037/jtd.2017.10.101

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BACKGROUND: The widely used analgesic acetaminophen is metabolized to N-acylphenolamine, which induces analgesia by acting directly on transient receptor potential vanilloid 1 or cannabinoid 1 receptors in the brain. Although these receptors are also abundant in the spinal cord, no previous studies have reported analgesic effects of acetaminophen or N-acylphenolamine mediated by the spinal cord dorsal horn. We hypothesized that clinical doses of acetaminophen induce analgesia via these spinal mechanisms. METHODS: We assessed our hypothesis in a rat model using behavioral measures. We also used in vivo and in vitro whole cell patch-clamp recordings of dorsal horn neurons to assess excitatory synaptic transmission. RESULTS: Intravenous acetaminophen decreased peripheral pinch-induced excitatory responses in the dorsal horn (53.1 ± 20.7% of control; n = 10; P < 0.01), while direct application of acetaminophen to the dorsal horn did not reduce these responses. Direct application of N-acylphenolamine decreased the amplitudes of monosynaptic excitatory postsynaptic currents evoked by C-fiber stimulation (control, 462.5 ± 197.5 pA; N-acylphenolamine, 272.5 ± 134.5 pA; n = 10; P = 0.022) but not those evoked by stimulation of Aδ-fibers. These phenomena were mediated by transient receptor potential vanilloid 1 receptors, but not cannabinoid 1 receptors. The analgesic effects of acetaminophen and N-acylphenolamine were stronger in rats experiencing an inflammatory pain model compared to naïve rats. CONCLUSIONS: Our results suggest that the acetaminophen metabolite N-acylphenolamine induces analgesia directly via transient receptor potential vanilloid 1 receptors expressed on central terminals of C-fibers in the spinal dorsal horn and leads to conduction block, shunt currents, and desensitization of these fibers.

DOI： 10.1097/ALN.0000000000001700

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PURPOSE: The characteristics and pathogenesis of spinopelvic alignment in Parkinsons's disease (PD) patients-including differences compared to non-PD subjects and their relationships with the severity of PD-have not been clarified. The aim of this study was to investigate the characteristics of spinopelvic alignment in patients with PD. METHODS: Forty-eight PD patients complaining of chronic low back pain were included (PD group). The PD condition, determined using the Hoehn and Yahr (H&Y) stage and Unified Parkinson Disease Rating Scale (UPDRS) score; radiographic spinopelvic alignment; lumbar range of motion (ROM); and low back pain-related quality of life assessments were evaluated. Fifty age- and sex-matched patients with adult spinal deformities were included as controls (ASD group). RESULTS: The spinopelvic alignments of the PD/ASD groups demonstrated sagittal vertical axes of 120.9/106.3 mm and pelvic incidences of 49.7/52.9°, with no significant differences. Conversely, there were significant differences in the thoracic kyphosis (TK; 27.6/16.7°), lumbar lordosis (-22.7/-7.9°), and pelvic tilt (25.3/34.4°) (all, p < 0.05). With regard to correlations with the PD condition, the H&Y stage demonstrated significant correlations with the sagittal vertical axis, thoracolumbar kyphosis, and lumbar ROM (all, p < 0.05), and the UPDRS score tended to correlate with the TK and thoracolumbar kyphosis (both, p < 0.01). CONCLUSION: Characteristic spinal conditions in PD exist, with progressed PD condition causing stooped posture with increased thoracic or thoracolumbar kyphosis and decreased lumbar ROM; moreover, global sagittal malalignment progresses without sufficient compensatory mechanisms such as loss of TK and pelvic retroversion.

DOI： 10.1016/j.jos.2016.09.013

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PURPOSE: This study aimed to investigate radiographic outcomes after posterior spinal fusion (PSF) for pediatric patients younger than 10 years with upper cervical disorders. METHODS: Thirteen patients (mean age at surgery, 5.9 years; range, 1 to 9 years) who underwent PSF with a minimum of 2 years of follow-up (mean, 5.8 years) were included. Diagnoses were atlanto-axial instability due to congenital disorders for 11 patients and atlanto-axial rotatory fixation for 2 patients. The fusion area was occipito-cervical for 7 patients and C1/2 for 6 patients. PSF was performed using rigid screw-rod constructs for 6 patients and conventional techniques for 7 patients. Ten patients required halo immobilization after surgery. Fusion status, perioperative complications, radiographic alignment, and range of motion (ROM) from C2 to C7 were evaluated. RESULTS: Twelve patients successfully achieved bony fusion (fusion rate, 92%), but complications occurred in 5 patients. Regarding radiographic measures (preoperative/postoperative/final follow-up), the mean atlanto-dental interval was significantly reduced (8.0 mm/2.7 mm/3.5 mm) and the C2-7 ROM was increased (from 49.4 degrees to 66.0 degrees) at the final follow-up (both comparisons, p<0.05). Sagittal alignment was unchanged. CONCLUSION: Use of rigid screw-rod instrumentation in the upper cervical spine with careful radiological evaluation is amenable for pediatric patients younger than 10 years. However, conventional procedures such as wiring fixation with rigid external immobilization are still alternative options for preventing serious neurological and vascular complications.

DOI： 10.22603/ssrr.1.2016-0013

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BACKGROUND: We recently reported that tranexamic acid (TXA) evokes pain in rats by inhibiting γ-aminobutyric acid and glycine receptors on neurons in the spinal dorsal horn. Although TXA is commonly used to reduce perioperative blood loss during various surgeries, its potential to induce intraoperative nociception, thereby increasing the need for more analgesics during surgery, has not been investigated. Therefore, this study aimed to investigate whether TXA evokes pain and increases the need for a higher infusion rate of remifentanil in patients undergoing surgery for adolescent idiopathic scoliosis (AIS). METHODS: Data were collected from patients with AIS who underwent posterior spinal fusion surgery from January 2008 to December 2015. All surgical procedures were performed under total intravenous anesthesia with propofol and remifentanil, by the same team of orthopedic surgeons and anesthesiologists at a single institution. Patients in the TXA group were administered TXA (loading and maintenance doses, 1000 mg and 100 mg/h) whereas those in the control group were not. Our primary outcome was the infusion rate of the intraoperative opioid analgesic remifentanil. RESULTS: The final analysis was based on data collected from 33 and 30 patients in the control and TXA groups, respectively. No differences were observed in the demographic data or the hemodynamic parameters between the two groups of patients. In the TXA group, the durations of surgery and anesthesia were shorter, intravascular fluid volume and total blood loss were lower, and the doses of fentanyl and ketamine administered were higher than they were in the control group (P < 0.05 for all). The mean infusion rate of intraoperative remifentanil was significantly higher in the TXA group than in the control group (control group: 0.23 ± 0.04 μg/kg/min; TXA group: 0.28 ± 0.12 μg/kg/min; P = 0.014). CONCLUSIONS: Patients who received TXA during the AIS surgery required a higher infusion rate of remifentanil, indicating that TXA evoked pain during the surgery.

DOI： 10.1371/journal.pone.0173622

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INTRODUCTION: Transcranial motor evoked potential (TcMEP) monitoring is the gold standard for intra-operative neurological monitoring (IOM) of motor pathways during complex spine surgery because of its high sensitivity and specificity. However, although it is very low, the rate of false-negatives in TcMEP monitoring is not zero. Therefore, over-reliance on TcMEP monitoring can cause potentially preventable motor deficits. CASE PRESENTATION: We report a case of motor deficits due to nerve root stretch after surgical correction of a congenital lumbar kyphoscoliosis in a 56-year-old woman. TcMEPs did not show any significant changes during surgery, whereas free-run electromyography (EMG) demonstrated a long-lasting train activity in the left quadriceps femoris muscle (QF) after correction at the osteotomy area. According to the normal findings on TcMEP monitoring, we did not release the correction. Postoperatively, a significant decrease (grade 2-) in the manual muscle test for the left QF and iliopsoas muscle and hypesthesia of the left anterior thigh was revealed. Fortunately, muscle strength was fully recovered without revision surgery at 6 months postoperatively; however, numbness in the left anterior thigh persisted at 2 years after surgery. DISCUSSION: Our report suggests that the possibility of false-negative TcMEPs should be kept in mind, especially during surgery with a risk of nerve root injury. When abnormal findings in the free-run EMG, including long-lasting train activity, are observed, surgeons should consider performing appropriate responses, such as the release of the correction, even when no substantial changes are seen in the TcMEPs.

DOI： 10.1038/scsandc.2017.53

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PURPOSE: The study aimed to investigate the clinical outcomes and limitations after vertebroplasty with posterior spinal fusion (VP+PSF) without neural decompression for osteoporotic vertebral collapse. METHODS: We conducted a prospective multicenter study including 45 patients (12 men and 33 women, mean age: 77.0 years) evaluated between 2008 and 2012. Operation time, blood loss, visual analog scale (VAS) of back pain, neurological status, kyphosis angle in the fused area, and vertebral union of the collapsed vertebra were evaluated. RESULTS: The mean operation time was 162 min and blood loss was 381 mL. The postoperative VAS score significantly improved, and the neurological status improved in 35 patients (83 %), and none of the remaining patients demonstrated a deteriorating neurological status at two years post-operatively. The mean kyphosis angle pre-operatively, immediately post-operatively, and two years post-operatively was 23.8°, 10.7°, and 24.3°, respectively, and there was no significant difference between the angles pre-operatively and two years post-operatively. The extensive correction of kyphosis >16° was a risk factor for a higher correction loss and subsequent fracture. Union of the collapsed vertebra was observed in 43 patients (95 %) at two years post-operatively. CONCLUSIONS: The present study suggests that spinal stabilization rather than neural decompression is essential to treat OVC. Short-segment VP+PSF can achieve a high union rate of collapsed vertebra and provide a significant improvement in back pain or neurological status with less invasive surgery, but has a limit of kyphosis correction more than 16°.

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Hydrogen peroxide (H2O2), a reactive oxygen species, is an important signaling molecule for synaptic and neuronal activity in the central nervous system; it is produced excessively in brain ischemia and spinal cord injury. Although H2O2-mediated modulations of synaptic transmission have been reported in ventral horn (VH) neurons of the rat spinal cord, the effects of H2O2 on neuronal excitability and membrane properties remain poorly understood. Accordingly, the present study investigated such effects using a whole-cell patch-clamp technique. The bath-application of H2O2 decreased neuronal excitability accompanied by decreased input resistance, firing frequency, and action potential amplitude and by increased rheobase. These H2O2-mediated changes were induced by activation of extrasynaptic, but not synaptic, GABAA receptors. Indeed, GABAergic tonic currents were enhanced by H2O2. On the other hand, the amplitude of medium and slow afterhyperpolarization (mAHP and sAHP), which plays important roles in controlling neuronal excitability and is mediated by small-conductance calcium-activated potassium (SK) channels, was significantly decreased by H2O2. When extrasynaptic GABAA receptors were completely blocked, these decreases of mAHP and sAHP persisted, and H2O2 increased excitability, suggesting that H2O2 per se might have the potential to increase neuronal excitability via decreased SK channel conductance. These findings indicate that activating extrasynaptic GABAA receptors or SK channels may attenuate acute neuronal damage caused by H2O2-induced hyperexcitability and therefore represent a novel therapeutic target for the prevention and treatment of H2O2-induced motor neuron disorders.

DOI： 10.1016/j.neuroscience.2016.06.033

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PURPOSE: There is no definitive evidence that additional instrumented fusion following laminoplasty suppresses the progression of ossification of the posterior longitudinal ligament (OPLL). Recently, we reported a novel method involving the creation of three-dimensional (3D) model from computed tomography images to measure the volume of OPLL accurately. The study aim was to evaluate whether laminoplasty with instrumented fusion suppresses the progression of OPLL in comparison with stand-alone laminoplasty by our novel 3D analysis. METHODS: The present study comprised of a group of 19 patients (14 men, five women) with OPLL treated with posterior decompression and fusion (PDF group), and a group of 22 patients (14 men, eight women) treated with laminoplasty alone (LP group). The volume of OPLL was evaluated three times during the follow-up period, and the volume change of OPLL was compared between the two groups. RESULTS: The PDF group (2.0 ± 1.7 %/year; range, -3.0 to 5.3) demonstrated lower annual rate of lesion increase compared to the LP group (7.5 ± 5.6 %/year; range, 1.0-19.2) (p < 0.001). In a notable thing, the annual rate of increase from the 2nd to the 3rd measurement significantly decreased compared with that from the 1st to the 2nd measurement in the PDF group (p < 0.05). CONCLUSION: This is the first study to prove a possible suppressant effect of additional posterior instrumented fusion on OPLL progression using novel 3D analysis.

DOI： 10.1007/s00586-015-4328-9

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PURPOSE: To elucidate clinico-radiological features, therapeutic outcomes, and survival factors of vertebral osteomyelitis patients infected by methicillin-resistant staphylococci (MRS). METHODS: Vertebral osteomyelitis patients admitted to the orthopaedic department between 2007 and 2011 (n = 248) were selected for this multicenter study. We compared patients' backgrounds, therapeutic course, and in-hospital mortality between MRS and methicillin-susceptible staphylococci (MSS). We also examined survival factors of vertebral osteomyelitis due to MRS. RESULTS: Sixteen patients of MRS vertebral osteomyelitis and 55 patients of MSS were included in this study. In MRS vertebral osteomyelitis, the rates of comorbid diabetes mellitus, involvement of >2 vertebral bodies, in-hospital mortality, and operation of surgical debridement were higher compared to those in MSS vertebral osteomyelitis. Univariate analysis showed that operation of surgical debridement was a factor related to survival in MRS patients. CONCLUSIONS: Higher rate of comorbid diabetes mellitus, involvement of >2 vertebral bodies, in-hospital mortality, and performing surgical debridement are peculiar features of MRS vertebral osteomyelitis compared to MSS vertebral osteomyelitis. If patients with MRS vertebral osteomyelitis respond poorly to antibiotic therapy, it might be better to consider surgical debridement not to lose an opportunity of operation due to exacerbation of systemic conditions.

DOI： 10.1016/j.jos.2016.01.009

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KEY POINTS: Excessive production of reactive oxygen species (ROS) is implicated in many central nervous system disorders; however, the physiological role of ROS in spinal ventral horn (VH) neurons remains poorly understood. We investigated how pathological levels of H2O2, an abundant ROS, regulate synaptic transmission in VH neurons of rats using a whole-cell patch clamp approach. H2O2 increased the release of glutamate and GABA from presynaptic terminals. The increase in glutamate release involved N-type voltage-gated calcium channels (VGCCs), ryanodine receptors (RyRs), and inositol trisphosphate receptors (IP3 Rs); the increase in GABA release, which inhibited glutamatergic transmission, involved IP3 R. Inhibiting N-type VGCCs and RyRs attenuates excitotoxicity resulting from increased glutamatergic activity while preserving the neuroprotective effects of GABA, and may represent a novel strategy for treating H2O2-induced motor neuron disorders resulting from trauma or ischaemia-reperfusion injury. Excessive production of reactive oxygen species (ROS) is a critical component of the cellular and molecular pathophysiology of many central nervous system (CNS) disorders, including trauma, ischaemia-reperfusion injury, and neurodegenerative diseases. Hydrogen peroxide (H2O2), an abundant ROS, modulates synaptic transmission and contributes to neuronal damage in the CNS; however, the pathophysiological role of H2O2 in spinal cord ventral horn (VH) neurons remains poorly understood, despite reports that these neurons are highly vulnerable to oxidative stress and ischaemia. This was investigated in the present study using a whole-cell patch clamp approach in rats. We found that exogenous application of H2O2 increased the release of glutamate from excitatory presynaptic terminals and γ-aminobutyric acid (GABA) from inhibitory presynaptic terminals. The increase of glutamate release was induced in part by an increase in Ca(2+) influx through N-type voltage-gated calcium channels (VGCCs) as well as by ryanodine receptor (RyR)- and inositol trisphosphate receptor-mediated Ca(2+) release from the endoplasmic reticulum (ER). In inhibitory presynaptic neurons, increased IP3 R-mediated Ca(2+) release from the ER increased GABAergic transmission, which served to rescue VH neurons from excessive release of glutamate from presynaptic terminals. These findings indicate that inhibiting N-type VGCCs or RyRs may attenuate excitotoxicity resulting from increased glutamatergic activity while preserving the neuroprotective effects of GABA, and may therefore represent a novel and targeted strategy for preventing and treating H2O2-induced motor neuron disorders.

DOI： 10.1113/JP271449

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BACKGROUND: The aim of this study was to determine the exacerbating factors of chronic low back pain (LBP) and strategic points against LBP in patients with Parkinson's disease (PD). METHODS: Forty-four consecutive PD patients complaining of LBP were included. Clinical characteristics of PD and LBP, spinal musculoskeletal condition, and clinical health status were evaluated. RESULTS: Patient age at PD and LBP onset was contiguous, and LBP time period was mainly described as constant or upon waking up. Exacerbating factors of LBP included modified Hoehn and Yahr stage and motor complications of PD, such as the wearing-off phenomenon and dyskinesia. Bone quality demonstrated osteopenia due to elevated bone resorption, with vitamins K and D insufficiencies. Spinal alignment demonstrated an increased sagittal vertical axis (120.2 ± 65.4 mm) with decreased lumbar lordosis (-24.0 ± 20.6°) and lumbar range of motion (28.7 ± 10.2°), which were significantly related to severity of LBP and quality of life assessments. CONCLUSIONS: This study demonstrated that exacerbating factors of LBP include stage of motor function, motor complications of PD and stooped posture with decreased lumbar lordosis and range of lumbar movement. Therefore, control of PD, including motor complications, active treatment for osteoporosis and therapeutic exercise, are important for treating chronic LBP in patients with PD.

DOI： 10.1007/s00264-015-3011-4

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Tranexamic acid (TXA) is an antifibrinolytic agent widely used to reduce blood loss during surgery. However, a serious adverse effect of TXA is seizure due to inhibition of γ-aminobutyric acid (GABA) and glycine receptors in cortical neurons. These receptors are also present in the spinal cord, and antagonism of these receptors in spinal dorsal horn neurons produces pain-related phenomena, such as allodynia and hyperalgesia, in experimental animals. Moreover, some patients who are injected intrathecally with TXA develop severe back pain. However, the effect of TXA on spinal dorsal horn neurons remain poorly understood. Here, we investigated the effects of TXA by using behavioral measures in rats and found that TXA produces behaviors indicative of spontaneous pain and mechanical allodynia. We then performed whole-cell patch-clamp experiments that showed that TXA inhibits GABAA and glycine receptors in spinal dorsal horn neurons. Finally, we also showed that TXA facilitates activation of the extracellular signal-regulated kinase in the spinal cord. These results indicated that TXA produces pain by inhibiting GABAA and glycine receptors in the spinal dorsal horn.

DOI： 10.1038/srep13458

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OBJECTIVE: Fifty percent of patients with amyotrophic lateral sclerosis (ALS) have cervical spondylotic myelopathy (CSM) as a complication. Because patients with ALS do not develop bulbar signs and symptoms at onset, differentiating them from patients with CSM is sometimes difficult. We aimed to determine whether the apparent diffusion coefficients (ADCs) of intracranial corticospinal tracts can be used to distinguish between patients with ALS and those with CSM. METHODS: We evaluated 19 consecutive patients with ALS who did not have CSM by cervical MRI, 16 patients with CSM, and 11 healthy controls. We examined the mean ADCs in the precentral gyrus, the corona radiata, the posterior limbs of the internal capsule (PLIC), and the cerebral peduncle by 3T magnetic resonance imaging (MRI). The mean ADCs in the intracranial corticospinal tracts in patients with ALS were compared with those in patients with CSM. RESULTS: The mean ADCs in the intracranial corticospinal tracts in patients with ALS were compared with those in patients with CSM (p<0.05). Additionally, the mean ADCs in the precentral gyrus, the PLIC, and the cerebral peduncle in the patients with ALS, including the patients who were initially diagnosed as having clinically possible ALS on the basis of the revised El Escorial criteria and did not develop bulbar symptoms at onset, were also higher than those in patients with CSM (p<0.05). CONCLUSIONS: Elevated ADCs in the intracranial corticospinal tracts might be useful for distinguishing ALS from CSM in the early stage of the disease.

DOI： 10.1016/j.clineuro.2015.02.009

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Cervical radiculopathy of the C2-4 spinal nerves is a rare condition and is poorly documented in terms of clinical symptoms, hindering its detection during initial patient screening based on imaging diagnostics. The authors describe in detail the clinical symptoms and successful surgical treatment of a patient diagnosed with isolated C-4 radiculopathy. This 41-year-old man suffered from sleep disturbance because of pain behind the right ear, along the right clavicle, and at the back of his neck on the right side. The Jackson and Spurling tests were positive, with pain radiating to the area behind the patient's ear. Unlike in cases of radiculopathy involving the C5-8 spinal nerves, no loss of upper-extremity motor function was seen. Magnetic resonance imaging showed foraminal stenosis at the C3-4 level on the right side, and multiplanar reconstruction CT revealed a beak-type ossification of the posterior longitudinal ligament in the foraminal region at the same level. In the absence of intracranial lesions or spinal cord compressive lesions, the positive Jackson and Spurling tests and the C3-4 foraminal stenosis were indicative of isolated C-4 radiculopathy. Microscopic foraminotomy was performed at the C3-4 vertebral level and the ossified lesion was resected. The patient's symptoms completely resolved immediately after surgery. To the authors' knowledge, this report is the first to describe the symptomatic features of isolated C-4 radiculopathy, in a case in which the diagnosis has been confirmed by both radiological findings and surgical outcome. Based on this case study, the authors conclude that the characteristic symptoms of C-4 radiculopathy are the presence of pain behind the ear and in the clavicular region in the absence of upper-limb involvement.

DOI： 10.3171/2014.2.SPINE13500

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STUDY DESIGN: A prospective study. OBJECTIVE: To evaluate the 2-year outcomes of open-door cervical laminoplasty with prophylactic bilateral C4-C5 foraminotomy. SUMMARY OF BACKGROUND DATA: A prospective trial of prophylactic bilateral C4-C5 foraminotomy with open-door laminoplasty for cervical compression myelopathy showed a significant efficacy for preventing postoperative C5 palsy. However, in bilateral foraminotomy, there are concerns such as postoperative instability, hinge fracture, or nonunion, which may cause deterioration of neurological symptoms and neck pain. METHODS: A prospective trial was performed in 141 patients between 2009 and 2010 (group F). A group of 141 patients who underwent open-door laminoplasty without prophylactic foraminotomy from 2006 to 2008 served as a control group (group NF). Here, we report 2-year radiological and clinical data for 121 patients (follow-up rate: 85.8%) in group F and 115 patients (81.6%) in group NF. The 2 groups were demographically similar, except for the operation time. RESULTS: In group F, the mean rate of facet joint preservation was 71.4%. C2-C7 and C4-C5 lordosis and C4 translational movement were maintained postoperatively in both groups. The range of motion of C2-C7 and C4-C5 significantly decreased to about 80% of the preoperative values in both groups (P < 0.01). These radiological parameters and the incidence of hinge fracture and nonunion did not differ significantly between the groups. Visual analogue scale scores for neck pain were unchanged and significant recoveries (P < 0.001) in Japanese Orthopaedic Association scores were found in both groups. There were no significant differences in these clinical scores between the groups. The incidences of C5 palsy were 1.7% and 7.0% in groups F and NF, respectively (P = 0.043). CONCLUSION: Prophylactic bilateral C4-C5 foraminotomy did not adversely affect the 2-year radiological and clinical outcomes. Therefore, we conclude that this approach is an effective and desirable procedure for preventing postoperative C5 palsy. LEVEL OF EVIDENCE: 3.

DOI： 10.1097/BRS.0000000000000251

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STUDY DESIGN: A retrospective study. OBJECTIVE: To determine the clinical and imaging characteristics of postoperative C5 palsy after cervical open-door laminoplasty. SUMMARY OF BACKGROUND DATA: Postoperative C5 palsy is a common complication of cervical laminoplasty, and although there are several hypotheses regarding its etiology, the pathogenesis and preventive measures remain unidentified and many controversies remain. METHODS: A total of 141 consecutive patients (100 men and 41 women) who had undergone open-door laminoplasty for cervical myelopathy between 2006 and 2009 were included in this study. Postoperative C5 palsy was defined as deltoid muscle weakness of a grade <3 in manual muscle test. The patients were divided into 2 groups: 1 that had experienced C5 palsy (PG; the palsy group) and the other that had not (NPG; the nonpalsy group). The parameters evaluated were the incidence of C5 palsy, the level at which spinal cord compression appeared preoperatively, the spinal cord level showing a T2 high-signal intensity lesion on magnetic resonance imaging, T2 high-signal intensity lesions newly appearing postoperatively, and the diameters of the C4/5 and C5/6 foramens. RESULTS: The incidence of C5 palsy was 6.4% (9/141 cases). There were no significant differences between the 2 groups in sex, age, diagnosis, operation time, blood loss, level of spinal cord compression, level of T2 high-signal lesion, or new T2 high-signal lesions. The average diameter of the C4/5 foramen was 1.99 mm in the PG and 2.76 mm in the NPG (P<0.005). In contrast, the average diameter of the C5/6 foramen was 2.35 mm in PG and 2.50 mm in the NPG. CONCLUSIONS: There was a significant difference in the diameter of the C4/5 foramen between the PG and the NPG. The results suggest that the main etiology of C5 palsy is impairment of the C5 nerve root induced by preexisting C4/5 foraminal stenosis.

DOI： 10.1097/BSD.0b013e31823db346

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Language：Japanese   Publisher：JAPANESE ASSOCIATION FOR STUDY OF PAIN  

Tranexamic acid (TXA) is an antifibrinolytic agent widely used to reduce blood loss during surgery. However, a serious adverse effect of TXA is seizure due to inhibition of γ–aminobutyric acid (GABA) and glycine receptors in cortical neurons. These receptors are also present in the spinal cord, and antagonism of these receptors in spinal dorsal horn neurons produces painrelated phenomena, such as allodynia and hyperalgesia. Moreover, some patients who are injected intrathecally with TXA develop severe back pain. However, no previous studies have investigated whether TXA modulates the GABA and glycine receptors in dorsal horn neurons. We hypothesized that TXA inhibits both GABA and glycine receptors in dorsal horn neurons,resulting in producing pain. Here, we investigated the effects of TXA by using behavioral measures in rats and found that TXA produces behaviors indicative of spontaneous pain and allodynia. We then performed wholecell patch–clamp experiments that showed that TXA inhibits GABAA and glycine receptors in spinal dorsal horn neurons. Finally, we also showed that TXA facilitates activation of the extracellular signal–regulated kinase in the spinal cord. These results indicated that TXA produces pain by inhibiting GABAA and glycine receptors directly located on postsynaptic sites of the recorded SG neurons. In addition, TXA enhances the excitability of excitatory interneurons via blockade of GABAergic and glycinergic postsynaptic inhibition, which facilitates excitatory transmission to the SG neurons indirectly.

DOI： 10.11154/pain.31.9

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Other Link： http://search.jamas.or.jp/link/ui/2016213404

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STUDY DESIGN: A prospective study. OBJECTIVE: To evaluate the effectiveness of prophylactic C4/C5 microforaminotomy with open-door laminoplasty for cervical myelopathy in preventing postoperative C5 palsy. SUMMARY OF BACKGROUND DATA: Postoperative C5 palsy is a common complication of cervical laminoplasty. Although the etiology of C5 palsy and preventive measures remain unclear, we hypothesize that C5 palsy is caused by C5 nerve root impairment induced by potential C4/C5 foraminal stenosis and posterior shifting of the spinal cord after laminoplasty. METHODS: The study included 141 consecutive patients with cervical myelopathy (103 men and 38 women) who underwent open-door laminoplasty with prophylactic bilateral C4/C5 foraminotomy between 2009 and 2010. These were designated as the foraminotomy group (FG). One hundred forty-one consecutive patients (100 men and 41 women) who underwent open-door laminoplasty without prophylactic foraminotomy during 2006 to 2008 served as a control group. This was the nonforaminotomy group (NFG). The incidence of C5 palsy, operation time, blood loss, and the number of decompressed disc levels were recorded. RESULTS: The incidence of C5 palsy was 1.4% (2 of 141 cases) in the FG, and 6.4% (9 of 141 cases) in the NFG. The mean operation times were 129 and 102 minutes, respectively. There were significant differences in the incidence of C5 palsy and operation time (both comparisons, P < 0.05). There were no significant differences in blood loss or the number of decompressed disc levels (both comparisons, P > 0.05). CONCLUSION: Prophylactic bilateral C4/C5 microforaminotomy significantly decreased the incidence of postoperative C5 palsy. These results suggest that the main etiology of C5 palsy was C5 root impairment. However, 2 patients experienced C5 palsy despite undergoing prophylactic foraminotomy, which indicated that other factors including spinal cord impairment after acute decompression against cervical canal stenosis may also be considered as minor etiologies of C5 palsy. We conclude that prophylactic C4/C5 foraminotomy was an effective preventive measure against postoperative C5 palsy after laminoplasty.

DOI： 10.1097/BRS.0b013e3182326957

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STUDY DESIGN: An analysis of computed tomography images of the spine in adult Japanese patients. OBJECTIVE: To evaluate the variation of the position of the aorta relative to a spine with a thoracic kyphotic angle and to verify the safety margin for transpedicular screw fixation. SUMMARY OF BACKGROUND DATA: Recent studies have suggested that the aorta is positioned more laterally and posteriorly in patients with idiopathic scoliosis than in normal patients; however, variation of the position of the aorta in thoracic sagittal alignment has not been performed. METHODS: T4-T12 vertebrae were studied using computer tomography images in 58 Japanese patients (aged 31-90 years) with normal coronal alignment of the spine. Pedicle diameter, pedicle length, chord length, closest distance from the aorta, and pedicle-aorta angle (PAA) were evaluated using a Mann-Whitney U test and Spearman rank correlation analysis. RESULTS: Pedicle diameter showed an increase in size from T4 (4.7 mm) to T12 (8.2 mm), pedicle length had an almost constant size of about 20 mm, and chord length increased from T4 (37.7 mm) to T12 (47.2 mm). Closest distance from the aorta decreased from T4 (29.6 mm) to T6 (24.6 mm) and then increased to T12 (49.3 mm). PAA increased from T4 (31.5°) to T6 (38.6°) and then decreased to T12 (5.0°). Sagittal curvature showed a correlation with PAA, with an increasing sagittal thoracic Cobb angle related to decreases in PAA at the T5 (r = -0.31, P = 0.034), T6 (r = -0.37, P = 0.008), and T7 (r = -0.29, P = 0.036) levels. CONCLUSION: The descending aorta is positioned more medially at the T5, T6, and T7 levels in patients with a kyphotic spine. These spatial relationships should be considered when planning pedicle screw insertion for a kyphotic spine.

DOI： 10.1097/BRS.0b013e31821cc6b6

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

STUDY DESIGN: A retrospective case study of the use of posterior lumbar interbody fusion (PLIF) to treat lumbar foraminal stenosis (LFS). OBJECTIVES: To characterize the features of clinical symptoms, radiographic evaluation, and surgical outcomes of PLIF in LFS. SUMMARY OF BACKGROUND DATA: There is no gold standard for the surgical treatment of foraminal stenosis, which occurs in 8% to 10% of surgical cases of lumbar degenerative disease. METHODS: Data from 31 patients (33 segments) who underwent PLIF from 2001 to 2005 at our institution were analyzed. Exclusion criteria included the patients having both LFS and central canal stenosis, plus extraforaminal or intraforaminal disc herniation. There were 22 males and 9 females, with an average age of 61 (31~78 y). The affected levels were as follows: L3/4 in 1 patient, L4/5 in 4, and L5/S1 in 28. All patients underwent PLIF with the combination of segmental pedicle screws, interbody cages, and autogenous local bone graft. RESULTS: The frequencies of Kemp sign (+), intermittent claudication, leg pain in a sitting position, and leg pain at night, were high. Radiographic evaluation showed severe disc degeneration such as loss of disc height, massive osteophyte formation, and transverse offset angles of the nerve root at the corresponding level. Magnetic resonance imaging and 3D-reconstraction computed tomography clearly showed intraforaminal stenosis in sagittal, axial, and coronal planes. The PLIF procedure provided complete root decompression, restoration of disc height, and preservation of lumbar lordosis at final follow-up. The Japanese Orthopedic Association score improved from 17.1 points preoperatively to 24.9 points at final follow-up, and the overall fusion rate was 100%. CONCLUSION: Lumbar foraminal stenosis could be reliably diagnosed by distinctive clinical symptoms, and various radiographic examinations such as plain x-ray, Magnetic resonance imaging, and 3D-reconstraction computed tomography. The PLIF procedure, in combination with segmental pedicle screws, interbody cages, and autogenous local bone graft provides excellent clinical outcomes, and is a rational and useful surgical option for lumbar foraminal stenosis.

DOI： 10.1097/BSD.0b013e3181e1cd99

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

An aneurysmal bone cyst (ABC) is a rare skeletal tumor that accounts for approximately 1% of all bone tumors. A spinal location for an ABC is very rare. Methods for treatment of an ABC include resection, curettage, embolization, and intralesional injection of a variety of agents. The patient in this case was a 9-year-old girl presenting with neck pain who was diagnosed with an ABC involving the C-2 spinal level. Percutaneous intralesional injections of calcitonin and methylprednisolone were performed. Two years and 7 months after the initial injection, a CT scan showed massive bone formation and cortical thickening without a change in the size of the lesion. To the authors' knowledge, this is the third reported case of intralesional injection of calcitonin and methylprednisolone for treatment of an ABC. This method is safe and effective, and is an important alternative to surgery, especially when a surgical procedure is technically difficult or unsafe in high-risk patients.

DOI： 10.3171/PED.2008.2.11.365

PubMed

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J-GLOBAL

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Language：Japanese   Publisher：(株)三輪書店  

＜文献概要＞はじめに 脊柱変形をきたす疾患群は多岐にわたっており,治療方針の決定には脊柱変形のみならず,原因疾患の自然経過も含めて総合的な判断が必要である.そのため,脊柱変形の診療において,正確な病態把握は重要であり,その基盤となる脊柱変形をきたし得る疾患・病態に関する知識は不可欠である.本稿では,Scoliosis Research Society(SRS)による,成因に基づいた脊柱変形の分類について解説する.

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：日本レックリングハウゼン病学会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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20歳以上の脊椎手術患者337例のうち、術前Dダイマー>1.0μg/mLを主な適応として画像検査(エコーまたは造影CT)を行った82例を対象とした。術前深部静脈血栓症(DVT)を15例(遠位型12例、近位型3例、無症候性無血栓塞栓症合併3例)に認めた。単変量解析で有意になった因子に対し多変量解析を行ったところ、女性、ADL床上、高血圧症が術前DVTの危険因子であった。これらの場合はDVT高リスクとして画像検索を考慮すべきである。(著者抄録)

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：(公社)日本薬学会  

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胸腰椎/腰椎(TL/L)側彎を有する思春期特発性側彎症の非手術例では、TL/L側彎の平均Cobb角は骨成熟後平均25年間で37.3°から47.8°へ進行した。側彎は頂椎が頭側であるほど、頂椎側方偏位(AVT)、L3傾斜または側方すべりが大きいほど進行し、腰痛はAVT、L4傾斜が大きいほど強かった。特に骨成熟時にAVT>35mm、L3またはL4傾斜>16°の場合、長期的な経過観察を考慮すべきである。(著者抄録)

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(株)南江堂  

急性期病院に勤務する看護師578名を対象に腰痛および健康関連QOLに関するアンケート調査を行った。その結果、腰痛有訴率は73.7%であった。腰痛の程度はVAS<30mmの軽度腰痛が69.5%を占めていたが、年齢および経験年数の増加とともに腰痛が悪化していた。腰痛あり群426名と腰痛なし群152名で比較すると、JOABPEQとSF-12は全ての下位尺度で腰痛あり群が有意に低値を示し、特に腰痛あり群ではSF-12の身体的側面に関する下位尺度の平均がすべて国民水準値より低値であった。腰痛あり群ではSF-12の身体機能、日常役割機能(身体)、身体の痛み、全体的健康感と弱い負の相関を認め、心の健康と弱い正の相関が認められた。JOABPEQについては全ての下位尺度が年齢や経験年数と弱い負の相関を認め、腰痛VASは弱い正の相関がみられた。腰痛の原因と思われる動作の調査では体位交換介助、移乗介助、オムツ交換、清潔ケアが多くあげられた。

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2013〜2016年迄に当科でMRI、CT、脊髄血管造影で診断を確認し、硬膜内導出静脈焼灼術が施行された脊髄硬膜動静脈瘻(dural AVF)5例と硬膜外動静脈瘻(extradural AVF)3例の治療成績を後方視的に検討した。手術時平均年齢は64.5歳で、性別は男性5例、女性3例であった。当科での手術手技として、まず観血的手術を行い、マイクロドップラーでシャント音を確認することで、AVFの遠位で、硬膜通過直後の導出静脈を同定した。次にクリップで導出静脈の血行を一時的に遮断し、シャント音の消失を確認した。約5分間待機した後に、脊髄モニタリングに変化がないことを確認し、導出静脈を十分焼灼した後に切離した。Dural AVFでは、全例で歩行機能が改善した。術前に2例が歩行不能であったが、最終的には全例が歩行可能となった。膀胱機能は1例のみ不変で、他の4例は完全に回復した。Extradural AVFについては、歩行機能は1例で改善が認められ、膀胱機能は全例で改善が認められた。画像所見として、Dural AVFでは、全例でT2髄内高信号領域とflow voidが共に消失した。Extradural AVFでは、3例中1例で術後1年7ヵ月の時点で再発が認められた。

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

骨成熟時に30°以上の側彎を有していた思春期特発性側彎症(AIS)保存治療例の長期成績を調査した(86例、調査時平均39.9歳)。構築性側彎は年間0.4〜0.5°進行し、負の自己イメージを持ち、腰痛有訴率は約80%であった。成人期QOLにはC7側方偏位、胸腰椎/腰椎側彎、中下位腰椎椎体傾斜、胸腰椎移行部後彎が影響しており、成人期も含めたAISの治療において考慮すべきである。(著者抄録)

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新潟市(人口約80万)で施行された平成28年度運動器検診における側彎症検診の結果から、校医・養護教諭による1次検診のみの場合と、整形外科専門医による2次検診を行った場合の事後措置に必要な医療費を試算し、比較した。専門医による側彎症2次検診を行った場合、1次検診のみの場合に比べて、総医療費、保険者負担額では94%、こども医療費助成の市負担額では98%もの削減効果が見込まれた。運動器検診に専門医が参画することは、医療費削減の観点からも検討に値する。(著者抄録)

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Language：Japanese   Publisher：新潟医学会  

思春期特発性側彎症(AIS)[全例女児、平均年齢14歳]に対する後方矯正固定術(PSF)前後のX線パラメータ、呼吸機能、3D-CTと画像解析ソフトを用いた肺容積の変化を検討した。側彎Cobb角と頂椎側方偏位距離は、術後有意に改善した(p<0.0001)。呼吸機能検査は術前後で有意差を認めなかった。肺容積は術前2.8±0.4Lから、術後2年2.6±0.4Lへと減少する傾向を認めたが、統計学的有意差は認めなかった。また肺活量と肺容積は相関する傾向を認めた(p=0.07)。肺容積計測の検者間および検者内ICCはともに1と非常に高い再現性を認めた。AISに対するPSFでは、X線パラメータ上の変形矯正は良好であったが、呼吸機能と肺容積は変化しなかった。新規に導入した3D-CTと3次元画像解析による肺容積評価法は、再現性の高い定量的な評価が可能であり、側彎症術前後の呼吸機能評価において有用と考える。(著者抄録)

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Language：Japanese   Publisher：(一社)日本運動器疼痛学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：新潟整形外科研究会  

71歳女。両下肢のしびれを主訴とした。T3-7の胸椎後縦靱帯骨化症に対して後方進入脊髄前方除圧術(大塚法)とT3-5後方固定術を受けたが、再度歩行障害と両下肢のしびれの増悪を認め、癒着性くも膜炎に伴う脊髄空洞症と診断された。空洞-胸腔シャント術を行い、術後早期に脊髄神経症状の改善と画像上の空洞縮小が得られたが、経過中に意識障害、頭蓋内の硬膜下血腫と右胸腔内の胸水貯留を認め、空洞-胸腔シャントの過剰な陰圧のドレナージによって低髄圧症候群が生じ、二次的に硬膜下血腫が生じたと判断した。再シャント手術の際には、術後に体外から圧を調節できる圧可変式バルブを併用し、シャント先を陰圧の胸腔から弱陽圧の腹腔内に変更することで適度なドレナージが得られ、良好に神経症状が改善した。

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：(一社)日本骨・関節感染症学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

特発性側彎症(IS)手術後20年以上経過した27例(平均44.6歳、平均観察期間30.5年)の左股関節骨密度は平均0.67g/cm2、Tスコアは平均-1.2であり、70%の症例は骨量減少または骨粗鬆症であった。Tスコアは調査時年齢、観察期間、骨吸収マーカー、体重、body mass indexと相関した。IS術後は体重管理と成人期以降の定期的な骨密度検査により、骨粗鬆症予防に努めるべきである。(著者抄録)

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(株)三輪書店  

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Language：Japanese   Publisher：(株)三輪書店  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(株)三輪書店  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

成人脊柱変形に対して仙骨を含む4椎間以上の後方矯正固定術を施行した54例の術後PI-LLと臨床成績の関係を検討した。術後PI-LL<10°で最も成績良好であり、目標値になりうる。術後PI-LL≧30°では改善が得られず、少なくともPI-LL<30°は満たすべきである。術後PI-LL=10°〜30°では有意な改善は部分的であったが、成績良好例も存在し、その許容条件・範囲に関して更なる検討を要する。(著者抄録)

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Language：Japanese   Publisher：新潟医学会  

ロコモティブシンドローム(以下ロコモ)は、各種運動器の障害により移動能力の低下をきたし、社会参加や生活活動の制限および要介護を要する状態である。成人期の脊柱変形はロコモの原因となり、その背景には体幹筋から臀筋力の低下が強く関連している。同じくロコモの原因となる筋肉量の減少と移動能力の低下をきたす加齢性筋減弱症(サルコペニア)も体幹筋力機能不全の原因となる。成人期の脊柱変形の病態評価としては、X線やMRIなど各種画像検査による脊柱アライメント評価が行われてきたが、歩行機能など動的な評価が本病態の本質的な理解と診断には不可欠である。近年ではMRIなどに加え超音波診断装置を用いた体幹筋の量的および質的評価が可能となっており、また理学療法士による歩行機能、体幹筋力評価も加えて、成人期の脊柱変形の総合的な評価を行っている。また治療介入については、理学療法士の指導下にリハビリ手帳を用いての体幹筋力や可動域訓練とホームエクササイズを行っており、その実際について代表症例を提示しつつ報告する。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00990&link_issn=&doc_id=20170315130004&doc_link_id=%2Fdg3nigta%2F2016%2F013010%2F004%2F0567-0575%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2016%2F013010%2F004%2F0567-0575%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

成人脊柱変形に対して仙骨を含む4椎間以上の後方矯正固定術を施行した68例のproximal junctional kyphosis(PJK)発生率は44.1%(30例)であり、腰椎前彎とpelvic tiltの矯正不足が危険因子であった。PJK群の26.7%(8例)に再手術を要し、その予防策として胸腰椎移行部を固定範囲に含め、近位固定端にはフックを使用すべきである。(著者抄録)

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Language：Japanese   Publisher：新潟医学会  

ロコモティブシンドローム(以下ロコモ)は、各種運動器の障害により移動能力の低下をきたし、社会参加や生活活動の制限および要介護を要する状態である。成人期の脊柱変形はロコモの原因となり、その背景には体幹筋から臀筋力の低下が強く関連している。同じくロコモの原因となる筋肉量の減少と移動能力の低下をきたす加齢性筋減弱症(サルコペニア)も体幹筋力機能不全の原因となる。成人期の脊柱変形の病態評価としては、X線やMRIなど各種画像検査による脊柱アライメント評価が行われてきたが、歩行機能など動的な評価が本病態の本質的な理解と診断には不可欠である。近年ではMRIなどに加え超音波診断装置を用いた体幹筋の量的および質的評価が可能となっており、また理学療法士による歩行機能、体幹筋力評価も加えて、成人期の脊柱変形の総合的な評価を行っている。また治療介入については、理学療法士の指導下にリハビリ手帳を用いての体幹筋力や可動域訓練とホームエクササイズを行っており、その実際について代表症例を提示しつつ報告する。(著者抄録)

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

多施設調査にて、培養検査を行った化膿性脊椎炎218例の治療成績を検討した。起炎菌同定率は66%。Kulowski分類別の血培陽性率は急性型68%、亜急性型64%、慢性型27%と慢性型で低く、経皮的生検の培養陽性率に有意差はなかった。MRSA8例は全例易感染性宿主であり、保存治療奏効率が低く、院内死亡率が高く、成績不良であった。一方培養陰性75例は抗菌薬選択の指標がないものの保存治療奏効率が高かった。(著者抄録)

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Language：Japanese   Publisher：(公社)日本整形外科学会  

骨粗鬆症性椎体偽関節に対し、椎体形成術と2 above 1 belowの後方固定による短範囲後方固定併用椎体形成術を施行し、2年以上観察し得た胸腰椎移行部(T10-L2)椎体偽関節47例(女性38例、男性9例、手術時年齢60〜93歳、平均年齢77歳)について、治療成績を検討、報告した。プロトコールは、「T10-L2の胸腰椎移行部椎体偽関節において、麻痺のない症例、および麻痺があっても骨片占拠率が40%未満の症例に対しては標準術式を行い、麻痺があり、かつ骨片占拠率40%以上の症例に対する術式は除圧術の併用や骨切り術の選択なども含め術者の判断に一任する」というものである。治療成績は、脊髄損傷患者の神経学的重症度の診断評価として一般的に使用されるFrankel分類を予後の違いから細分化した評価法である改良Frankel分類では、1段階以上の麻痺の改善は、術前E(「回復」)であった3例を除く44例中38例(86%)で得られており、術前歩行不能16例のうち15例が歩行可能となった。腰痛VAS値については、術前8.1が術後1年で3.6、術後2年でも3.9と、いずれの時点でも術前に比べて有意に低下していた。一方、著者らの標準術式では、グローバルな矢状面アライメントの改善に関しては限界があり、術前より矢状面アライメントが良好な例、全身状態不良例、感染のリスクが高い易感染性宿主などで、骨片の脊柱管前後径が40%未満であれば、同術式による疼痛と麻痺の改善が期待できると考えられた。

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：(一社)日本骨・関節感染症学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

2008年4月〜2013年6月迄に麻痺を有し、骨片脊柱管占拠率40%以上の骨粗鬆症性椎体圧潰に対し手術を施行した25例を対象に、後方短縮骨切り術8例、後方椎体置換術5例を行った13例および標準術式を行った12例の臨床成績について比較検討した。椎体形成術+後方固定術(VP+PSF)は高度圧潰を伴う麻痺例に対しても、低侵襲で骨癒合や麻痺の改善に有用であるが、アライメント矯正には限界がある。一方で後方椎体骨切り術は矢状面アライメントの矯正に有用であるが、適応の症例の選択と続発骨折の予防対策が重要である。

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Language：Japanese   Publisher：東北整形災害外科学会  

腰椎すべり症(DL)を伴う腰部脊柱管狭窄症(LSS)に対し手術を施行し、術後2年以上経過観察を行った97例(男性39例、女性58例、55〜88歳、平均71歳)を対象に、除圧術と固定術の治療成績を比較検討した。6例は椎間孔狭窄を合併し、経過観察期間は平均27ヵ月(24〜48ヵ月)であった。術式により椎弓切除術を施行した47例(除圧群)、2椎間以下の後方進入腰椎椎体間固定術を施行した50例(固定群)の2群に分類し比較検討した。その結果、腰椎前彎角は両群で術後に前彎が増加していたが、2群間で差はなかった。除圧群の椎間板高は術後にわずかに減少し、局所屈曲角・伸展角・可動域は術前後で維持された。不安定性についてはX線では固定群で高頻度に認められたが、椎間関節固定(FE)とファセット・オープニング(FO)の頻度については差を認めず、以上の三つの評価を合わせた不安定性の頻度はそれぞれ28例に認められ、2群間で差を認めなかった。JOAスコアについては両群とも術後に改善が得られ、平林法の改善率も含め差がなかった。

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：東日本整形災害外科学会  

環椎後方脱臼を伴った軸椎歯突起骨折は、まれな損傷であり、手術加療の適応となる。症例1は環軸椎後方固定により、良好な成績を得た。症例2は環椎破裂骨折を合併し、再手術で後頭-頸椎後方固定を要した。環椎骨折合併例では、その骨折型によっては、固定範囲の延長が必要となる可能性があり、注意を要する。(著者抄録)

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Language：Japanese   Publisher：(一社)日本疼痛学会  

トラネキサム酸(TXA)の脊髄後角を介する痛みの機序について検討した。6〜8週齢のWistar系成熟雄性ラットを用いた。腰部脊椎(L4/5)を椎弓切除し、脊髄クモ膜下にポリエチレンカテーテルを留置した。脊髄クモ膜下投与は、術後3日以上経過してから、カテーテルより濃度の異なるTXAを投与した。腹腔内投与は、直接腹腔内へ濃度の異なるTXAを投与した。TXAは大脳皮質だけではなく、脊髄後角ニューロンへも作用し、シナプス後性にGABAAおよびグリシン受容体を直接的に抑制することで痛みを誘発した。TXAは、一次求心性線維のシナプス前終末には作用せず、興奮性介在ニューロンのGABAAおよびグリシン受容体をシナプス後性に抑制することで脱抑制を生じ、間接的に記録SGニューロンへの興奮性伝達を増強することで痛みを誘発した。TXAの灌流投与により脊髄後角浅層のpERKの発現が増加した。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J02781&link_issn=&doc_id=20160414560002&doc_link_id=%2Fci3painr%2F2016%2F003101%2F002%2F0009-0020%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci3painr%2F2016%2F003101%2F002%2F0009-0020%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese  

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Language：Japanese   Publisher：東日本整形災害外科学会  

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Language：Japanese   Publisher：東日本整形災害外科学会  

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Language：Japanese   Publisher：東日本整形災害外科学会  

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Language：Japanese   Publisher：東日本整形災害外科学会  

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Language：Japanese   Publisher：東日本整形災害外科学会  

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Language：Japanese   Publisher：東日本整形災害外科学会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：(株)医学書院  

症例は79歳女性で,心房細動に対してワーファリン内服中であった.突然の背部痛と両下肢のしびれで発症し,MRIで第1〜5胸椎高位に脊柱管内血腫を認め,脊髄は高度に圧排されていた.麻痺は進行性で,発症16時間後には下肢筋力がMMT0〜1となり,緊急手術を行った.硬膜外腔には血腫を認めず,くも膜下腔に多量の血腫を認め,脊髄くも膜下出血と診断した.術後1年の時点でFrankel分類Cの麻痺が遺残していた.術後3ヵ月のMRIでくも膜嚢胞を認めたが,神経症状の悪化や嚢腫の増大傾向を認めず,現在,経過観察中である.(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J01554&link_issn=&doc_id=20150601190023&doc_link_id=10.11477%2Fmf.1408200253&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1408200253&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：エーザイ(株)  

静脈投与したリドカインの鎮痛作用の機序について、リドカインが脊髄後角ニューロンにおける興奮性シナプス伝達を修飾しているとの仮説を立て、成熟ラットの脊髄標本を用いてブラインドホールセルパッチクランプ記録による検討を行った。その結果、自発性興奮性シナプス後電流(EPSC)の発生頻度はリドカイン投与により減少し、濃度依存的、可逆的な変化を示した。振幅に関しては有意な変化がなかった。またpinch刺入による誘発性EPSCもリドカイン投与により抑制された。リドカインを脊髄表面に灌流投与した場合は、自発性EPSCの頻度・振幅とも変化はなかった。リドカインは脊髄後角ニューロンにおいてシナプス前終末からのグルタミン酸の放出を抑制し、その結果として脳への痛覚伝達が抑制され、鎮痛作用を発揮している可能性が示唆された。

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Language：Japanese   Publisher：エーザイ(株)  

脊髄前角ニューロンに対する過酸化水素(H2O2)の作用機序について検討するため、ラット脊髄横断スライスを用いてホールセルパッチクランプ記録を行った。まずグルコン酸カリウムベースの電極内液を用い、保持膜電位-70mVの条件下でH2O2を灌流投与したところ、外向き電流が誘起された。その振幅はH2O2の繰り返し投与による変化は認めず、K+チャネル阻害薬であるセシウム(Cs)およびtetraethylammoniumを含んだ電極内液で有意に抑制された。またCsベースの電極内液を用いて自発性興奮性シナプス後電流の頻度と振幅を調べたところ、H2O2の灌流投与により振幅は有意な変化を認めず、頻度は一過性に増加した後に減少に転じ、減少は遷延した。電位依存性Na+チャネル阻害薬であるテトロドトキシン存在下でも、微小興奮性シナプス後電流が同様の変化を示した。

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Language：Japanese   Publisher：エーザイ(株)  

トラネキサム酸(TXA)の痛みに対する作用・機序について検討するため、まずラットを用いて行動学実験を行った。クモ膜下腔に留置したカテーテルよりTXAを投与して自発痛様行動を観察した結果、その持続時間は濃度依存性に延長した。次に電気生理学的実験として、脊髄後角膠様質細胞を用いてホールセルパッチクランプ記録を行い、TXAの灌流投与に対する自発性抑制性シナプス後電流(sIPSC)の反応を調べた。sIPSCの振幅はTXA投与により減少し、頻度は変化がなかった。またグリシン受容体拮抗薬のstrychnineまたはガンマアミノ酪酸(GABA)受容体拮抗薬のbicucullineを灌流投与したところ、strychnine存在下ではGABA作動性sIPSC、bicuculline存在下ではグリシン作動性sIPSCの振幅は減少した。TXAは脊髄後角ニューロンのGABAおよびグリシン受容体をシナプス後性に抑制し、それによって自発痛を増強させる可能性が示唆された。

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

側彎症外来受診者の受診契機、Cobb角、在籍学校、各校の視診による1次検診陽性率などの情報から、検診の意義と問題点を検討した。装具療法の適応となる中等度側彎例の8割は検診で発見されていたことは、検診の重要性を支持するものであった。一方、1次検診陽性率の低い学校の生徒では初診時Cobb角が有意に大きく、検診以外で発見される例が有意に多かった。これらの情報を現場と共有し、検診精度を向上させる必要がある。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J05510&link_issn=&doc_id=20141203070001&doc_link_id=%2Ffg7spine%2F2014%2F000511%2F002%2F1514-1517%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffg7spine%2F2014%2F000511%2F002%2F1514-1517%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

Perched facetとは椎間関節において、上位椎の下関節突起が下位椎の上関節突起に乗り上げた状態をいう。われわれは本疾患に椎間板ヘルニアを合併した3例を経験したので報告する。perched facetは、全身麻酔下にて意図せず整復され、ヘルニアの圧迫による脊髄障害をきたす可能性がある。そのため、整復する際は迅速に除圧術を施行できる環境で行い、手術では前方除圧を先行させるべきと思われた。(著者抄録)

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：東日本整形災害外科学会  

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Language：Japanese   Publisher：東日本整形災害外科学会  

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Language：Japanese   Publisher：東日本整形災害外科学会  

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Language：Japanese   Publisher：東日本整形災害外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：東日本整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：日本骨形態計測学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

われわれは、骨粗鬆症性椎体偽関節に対し、後方固定併用椎体形成術を標準術式としている。今回、本法の適応・限界を検討した。手術時間158分、出血量360ml、重篤な全身合併症はなく、比較的低侵襲で、椎体癒合や麻痺の改善も高率に得られた。一方、固定範囲後彎角は術後1年で術前同程度まで矯正損失し、後彎過矯正例、HAブロック過充填例、新規骨折例で損失が大きかった。本法は矯正損失がやや大きいが、良好な臨床成績が得られた。(著者抄録)

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

3椎間以上の胸椎、腰椎固定術131例における固定上位端(UIV)周辺椎体骨折の発生率は23.7%で、再手術率は22.6%であった。骨折の危険因子は女性、骨粗鬆症、原疾患が椎体骨折偽関節、過度の矢状面アライメント矯正、UIVが胸腰椎移行部であることであった。また、UIV骨折は術後2ヵ月以内に、UIV隣接椎体骨折は術後1年程度で発症することが多く、術直後から長期的な予防が必要である。(著者抄録)

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

頸椎pedicle screw固定43例で医原性椎間孔狭窄症(IFS)発生率は、除圧なしで4.3%(5/117根)、foraminotomyで8.3%(4/48根)、facetectomyで0%(0/25根)であった。椎間孔径は、foraminotomyなしのIFS発生5根では平均1.3mm(0.8〜1.7mm)とIFS非発生112根より小さく(p<0.001)、1.7mm以下では5/13根(38%)にIFSが発生した。foraminotomyのIFS発生4根では1.7mm(1.3〜1.8mm)とIFS非発生44根より小さく(p<0.05)、1.8mm以下では4/22根(18%)にIFSが発生した。IFS予防にはforaminotomyよりfacetectomyが有効である。(著者抄録)

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

腰椎後方椎体間固定術を行い2年以上観察した163例のうち、27例(16%)に椎体終板の骨嚢腫が出現した。骨嚢腫例の術後2年時の骨癒合率は8.7%で、骨嚢腫のない例の95.6%に比べ、有意に低かった。骨癒合不全27例のうち骨嚢腫のある例は、固定椎間の可動域が有意に大きかった。骨嚢腫の成因は四肢関節と同様に椎体終板にかかる力学的負荷と推察される。(著者抄録)

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Language：Japanese   Publisher：東日本整形災害外科学会  

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Language：Japanese   Publisher：東日本整形災害外科学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

椎体内cleftを有する骨粗鬆症性骨折に対しBKP(balloon kyphoplasty)を行った14例の術後平均6.5ヵ月の短期成績を検討した。女性12例、男性2例で、手術時年齢は平均79歳であった。BKPは手技的な問題もなく安全で、侵襲も小さく、除痛効果もあり、骨癒合、局所後彎、疼痛の改善は従来の椎体形成術+後方固定術(VP+PSF)と同様に良好である。しかし術後も骨癒合が遅れ、セメントが椎間板内へ逸脱する例もあり、厳重な外固定が必要である。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J05510&link_issn=&doc_id=20130702070010&doc_link_id=%2Ffg7spine%2F2013%2F000406%2F011%2F1039-1044%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffg7spine%2F2013%2F000406%2F011%2F1039-1044%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

頸椎片開き式椎弓形成術おける両側椎間孔拡大術の併用が頸椎安定性に及ぼす影響を検討した。椎弓拡大の前に両側C4/5椎間孔拡大術を施行した131例を椎間関節切除率により4群別し、術前および術後1年の単純X線側面屈曲-伸展機能撮影におけるC4/5可動域、C4前方移動量を計測した。可動域に関しては椎間関節部分切除の併用による椎間可動性の増加は認めず、C4前後移動量においても両側椎間関節切除率が50%以下であれば、椎間可動性は術前と同等または減少傾向であった。椎間関節部分切除では関節としての支持機能は部分的に損なわれるものの、関節周囲での瘢痕形成と関節拘縮を生じ、椎間関節切除率50%以下であれば椎弓形成術と同様に可動性は減少傾向を示すと推察されるため、固定術の追加を要するような不安定性を生じる可能性は低いと考えられた。

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：(株)医学書院  

背景:骨粗鬆症性腰椎椎体骨折に伴う椎間孔狭窄症の病態や治療に関する報告は少ない.対象と方法:手術治療を行った22例を対象とし,椎間孔狭窄の病態と術式別の臨床成績を検討した.結果:約82%は当該椎間孔の上位椎体尾側終板骨折を合併していた.手術術式では,後方除圧固定術と後方固定術の臨床成績は同等であった.結論:椎体尾側終板骨折に下肢痛を伴っている場合,椎間孔狭窄の関与を念頭に置くべきである.手術では後方要素をできる限り温存した後方固定術が望ましいと考える.(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J01554&link_issn=&doc_id=20130430090020&doc_link_id=10.11477%2Fmf.1408102709&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1408102709&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(株)南江堂  

CTナビゲーションシステム(CTナビ)を使用せずにX線透視下に頸椎椎弓根スクリュー(CPS)を刺入した16例(A群)と、CTナビを使用してCPSを刺入した39例(B群)を対象とし、術後CTを撮影してCPSの精度を調査した。内外側逸脱について水平断像を、頭尾側逸脱について再構成された矢状断像および冠状断像を用いて測定し、Neoらの報告に準じてgrade 0:逸脱なし、grade 1:2mm以下の逸脱、grade 2:2〜4mmの逸脱、grade 3:4mm以上の逸脱または完全逸脱、と評価した。その結果、神経血管損傷のリスクが高いgrade 2以上の逸脱率はA群21.1%、B群7.4%であり、B群で有意に減少していた。しかし、実際には両群ともCPS逸脱に伴う神経血管合併症は認めなかった。B群のgrade 2以上のCPS逸脱の方向は外側11本、尾側3本であり、高位別逸脱率はC4とC5で高い傾向にあった。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J00764&link_issn=&doc_id=20130221240001&doc_link_id=10.15106%2FJ00764.2013191384&url=https%3A%2F%2Fdoi.org%2F10.15106%2FJ00764.2013191384&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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