2022/12/01 更新

写真a

オオハシ マサユキ
大橋 正幸
OHASHI Masayuki
所属
教育研究院 医歯学系 医学系列 助教
医歯学総合研究科 生体機能調節医学専攻 機能再建医学 助教
職名
助教
外部リンク

学位

  • 博士(医学) ( 2016年3月   新潟大学 )

研究キーワード

  • 脊椎外科

  • 整形外科

研究分野

  • ライフサイエンス / 整形外科学  / 脊椎外科

経歴(researchmap)

  • 新潟大学大学院医歯学総合研究科 機能再建医学講座 整形外科学分野

    2020年4月 - 現在

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    国名:日本国

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経歴

  • 新潟大学   医歯学総合研究科 生体機能調節医学専攻 機能再建医学   助教

    2020年4月 - 現在

  • 新潟大学   医歯学総合研究科   特任准教授

    2019年4月 - 2020年3月

所属学協会

▶ 全件表示

 

論文

  • Analgesic effect of ivabradine against inflammatory pain mediated by hyperpolarization-activated cyclic nucleotide–gated cation channels expressed on primary afferent terminals in the spinal dorsal horn

    Nobuko Ohashi, Daisuke Uta, Masayuki Ohashi, Hiroshi Baba

    Pain   163 ( 7 )   1356 - 1369   2022年7月

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    掲載種別:研究論文(学術雑誌)   出版者・発行元:Ovid Technologies (Wolters Kluwer Health)  

    DOI: 10.1097/j.pain.0000000000002523

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  • 全身性疾患に伴う脊椎病変 頸椎除圧術後の上肢型筋萎縮側索硬化症の臨床経過

    五十嵐 哲也, 渡辺 慶, 大橋 正幸, 川島 寛之, 三瓶 一弘, 五十嵐 修一, 黒羽 泰子, 小池 亮子, 石原 智彦, 大津 裕, 小野寺 理

    東北整形災害外科学会雑誌   65 ( 1 )   167 - 168   2022年6月

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    記述言語:日本語   出版者・発行元:東北整形災害外科学会  

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  • Norepinephrine restores inhibitory tone of spinal lamina X circuitry, thus contributing to analgesia against inflammatory pain

    Nobuko Ohashi, Daisuke Uta, Masayuki Ohashi, Hiroshi Baba

    Neuroscience   2022年3月

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    掲載種別:研究論文(学術雑誌)   出版者・発行元:Elsevier BV  

    DOI: 10.1016/j.neuroscience.2022.03.023

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  • 症候性脊椎転移で発見され早期手術を要した悪性腫瘍患者の近年の動向 COVID-19前後で変化はあったか

    牧野 達夫, 渡邊 慶, 大橋 正幸, 田仕 英希, 湊 圭太郎, 田中 裕貴

    新潟整形外科研究会会誌   37 ( 1 )   64 - 64   2021年12月

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    記述言語:日本語   出版者・発行元:新潟整形外科研究会  

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  • Five-year longitudinal study of frailty prevalence and course assessed using the Kihon Checklist among community-dwelling older adults in Japan. 国際誌

    Masayuki Ohashi, Takuya Yoda, Norio Imai, Toshihide Fujii, Kei Watanabe, Hideki Tashi, Yohei Shibuya, Jin Watanabe, Naoto Endo

    Scientific reports   11 ( 1 )   12399 - 12399   2021年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Mid- to Long-Term Outcomes After Resection of Thoracic Dumbbell Tumors Managed by Laminectomy and Unilateral Total Facetectomy Without Instrumented Fusion. 国際誌

    Yuya Ishikawa, Masayuki Ohashi, Toru Hirano, Michiharu Matsuda, Takeru Akabane, Haruo Kanno, Ko Hashimoto, Kyoichi Handa, Toshimi Aizawa, Tomoto Suzuki, Yukihide Shimamura, Kei Watanabe

    Global spine journal   21925682211008836 - 21925682211008836   2021年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Influence of lumbosacral transitional vertebrae on spinopelvic parameters using biplanar slot scanning full body stereoradiography-analysis of 291 healthy volunteers.

    Masashi Okamoto, Kazuhiro Hasegawa, Shun Hatsushikano, Koichi Kobayashi, Makoto Sakamoto, Masayuki Ohashi, Kei Watanabe

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association   2021年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Randomized trial of granulocyte colony-stimulating factor for spinal cord injury. 国際誌

    Masao Koda, Hideki Hanaoka, Yasuhisa Fujii, Michiko Hanawa, Yohei Kawasaki, Yoshihito Ozawa, Tadami Fujiwara, Takeo Furuya, Yasushi Ijima, Junya Saito, Mitsuhiro Kitamura, Takuya Miyamoto, Seiji Ohtori, Yukei Matsumoto, Tetsuya Abe, Hiroshi Takahashi, Kei Watanabe, Toru Hirano, Masayuki Ohashi, Hirokazu Shoji, Tatsuki Mizouchi, Norio Kawahara, Masahito Kawaguchi, Yugo Orita, Takeshi Sasamoto, Masahito Yoshioka, Masafumi Fujii, Katsutaka Yonezawa, Daisuke Soma, Hiroshi Taneichi, Daisaku Takeuchi, Satoshi Inami, Hiroshi Moridaira, Haruki Ueda, Futoshi Asano, Yosuke Shibao, Ikuo Aita, Yosuke Takeuchi, Masaya Mimura, Jun Shimbo, Yukio Someya, Sumio Ikenoue, Hiroaki Sameda, Kan Takase, Yoshikazu Ikeda, Fumitake Nakajima, Mitsuhiro Hashimoto, Fumio Hasue, Takayuki Fujiyoshi, Koshiro Kamiya, Masahiko Watanabe, Hiroyuki Katoh, Yukihiro Matsuyama, Tomohiko Hasegawa, Go Yoshida, Hideyuki Arima, Yu Yamato, Shin Oe, Daisuke Togawa, Sho Kobayashi, Koji Akeda, Eiji Kawamoto, Hiroshi Imai, Toshihiko Sakakibara, Akihiro Sudo, Yasuo Ito, Takeshi Kikuchi, Tomoyuki Takigawa, Takuya Morita, Nobuhiro Tanaka, Kazuyoshi Nakanishi, Naosuke Kamei, Shinji Kotaka, Hideo Baba, Tsuyoshi Okudaira, Hiroaki Konishi, Takayuki Yamaguchi, Keigo Ito, Yoshito Katayama, Taro Matsumoto, Tomohiro Matsumoto, Haruo Kanno, Toshimi Aizawa, Ko Hashimoto, Toshimitsu Eto, Takehiro Sugaya, Michiharu Matsuda, Kazunari Fushimi, Satoshi Nozawa, Chizuo Iwai, Toshihiko Taguchi, Tsukasa Kanchiku, Hidenori Suzuki, Norihiro Nishida, Masahiro Funaba, Takashi Sakai, Yasuaki Imajo, Masashi Yamazaki

    Brain : a journal of neurology   144 ( 3 )   789 - 799   2021年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Minimally Invasive Spinal Stabilization with Denosumab before Total Spondylectomy for a Collapsing Lower Lumbar Spinal Giant Cell Tumor.

    Keitaro Minato, Toru Hirano, Hiroyuki Kawashima, Tetsuro Yamagishi, Kei Watanabe, Masayuki Ohashi, Akira Ogose, Naoto Endo

    Acta medica Okayama   75 ( 1 )   95 - 101   2021年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Indication for drainage for a hematogenous iliopsoas abscess: Analysis of patients initially treated without drainage.

    Hirokazu Shoji, Masayuki Ohashi, Yoichi Yajiri, Keitaro Minato, Mio Yahata, Masashi Wakasugi, Kimihiko Sawakami, Kei Watanabe

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association   26 ( 6 )   1130 - 1134   2020年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Associations between three-dimensional measurements of the spinal deformity and preoperative SRS-22 scores in patients undergoing surgery for major thoracic adolescent idiopathic scoliosis. 国際誌

    Masayuki Ohashi, Tracey P Bastrom, Carrie E Bartley, Burt Yaszay, Vidyadhar V Upasani, Peter O Newton

    Spine deformity   8 ( 6 )   1253 - 1260   2020年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Impact of L4/5 Posterior Interbody Fusion With or Without Decompression on Spinopelvic Alignment and Health-related Quality-of-Life Outcomes. 国際誌

    Marvin Karlo T Lugue, Kei Watanabe, Akiyoshi Yamazaki, Tomohiro Izumi, Hideki Tashi, Masashi Wakasugi, Keiichi Katsumi, Masayuki Ohashi, Naoto Endo

    Clinical spine surgery   33 ( 10 )   E504-E511   2020年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Significance of long corrective fusion to the ilium for physical function in patients with adult spinal deformity.

    Kei Watanabe, Masayuki Ohashi, Toru Hirano, Keiichi Katsumi, Norifumi Nirasawa, Shinji Kimura, Wataru Ohya, Haruka Shimoda, Kazuhiro Hasegawa

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association   2020年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Compensation for standing posture by whole-body sagittal alignment in relation to health-related quality of life. 国際誌

    Kazuhiro Hasegawa, Masashi Okamoto, Shun Hatsushikano, Kei Watanabe, Masayuki Ohashi, Jean-Marc Vital, Jean Dubousset

    The bone & joint journal   102-B ( 10 )   1359 - 1367   2020年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Three-dimensional morphological analysis of cervical foraminal stenosis using dynamic flexion-extension computed tomography images.

    Tatsuki Mizouchi, Keiichi Katsumi, Tomohiro Izumi, Akiyoshi Yamazaki, Hirokazu Shoji, Hideki Tashi, Masayuki Ohashi, Toru Hirano, Naoto Endo, Kei Watanabe

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association   25 ( 5 )   805 - 811   2020年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Short- versus long-segment posterior spinal fusion with vertebroplasty for osteoporotic vertebral collapse with neurological impairment in thoracolumbar spine: a multicenter study. 国際誌

    Yuya Ishikawa, Kei Watanabe, Keiichi Katsumi, Masayuki Ohashi, Yohei Shibuya, Tomohiro Izumi, Toru Hirano, Naoto Endo, Takashi Kaito, Tomoya Yamashita, Hiroyasu Fujiwara, Yukitaka Nagamoto, Yuji Matsuoka, Hidekazu Suzuki, Hirosuke Nishimura, Hidetomi Terai, Koji Tamai, Atsushi Tagami, Shuta Yamada, Shinji Adachi, Toshitaka Yoshii, Shuta Ushio, Katsumi Harimaya, Kenichi Kawaguchi, Nobuhiko Yokoyama, Hidekazu Oishi, Toshiro Doi, Atsushi Kimura, Hirokazu Inoue, Gen Inoue, Masayuki Miyagi, Wataru Saito, Atsushi Nakano, Daisuke Sakai, Tadashi Nukaga, Shota Ikegami, Masayuki Shimizu, Toshimasa Futatsugi, Seiji Ohtori, Takeo Furuya, Sumihisa Orita, Shiro Imagama, Kei Ando, Kazuyoshi Kobayashi, Katsuhito Kiyasu, Hideki Murakami, Katsuhito Yoshioka, Shoji Seki, Michio Hongo, Kenichiro Kakutani, Takashi Yurube, Yasuchika Aoki, Masashi Oshima, Masahiko Takahata, Akira Iwata, Hirooki Endo, Tetsuya Abe, Toshinori Tsukanishi, Kazuyoshi Nakanishi, Kota Watanabe, Tomohiro Hikata, Satoshi Suzuki, Norihiro Isogai, Eijiro Okada, Haruki Funao, Seiji Ueda, Yuta Shiono, Kenya Nojiri, Naobumi Hosogane, Ken Ishii

    BMC musculoskeletal disorders   21 ( 1 )   513 - 513   2020年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Effect of bisphosphonates or teriparatide on mechanical complications after posterior instrumented fusion for osteoporotic vertebral fracture: a multi-center retrospective study. 国際誌

    Atsuyuki Kawabata, Toshitaka Yoshii, Takashi Hirai, Shuta Ushio, Takashi Kaito, Tomoya Yamashita, Hiroyasu Fujiwara, Yukitaka Nagamoto, Yuji Matsuoka, Hidekazu Suzuki, Hirosuke Nishimura, Hidetomi Terai, Koji Tamai, Atsushi Tagami, Syuta Yamada, Shinji Adachi, Kei Watanabe, Keiichi Katsumi, Masayuki Ohashi, Yohei Shibuya, Katsumi Harimaya, Kenichi Kawaguchi, Nobuhiko Yokoyama, Hidekazu Oishi, Toshiro Doi, Atsushi Kimura, Hirokazu Inoue, Gen Inoue, Masayuki Miyagi, Wataru Saito, Atsushi Nakano, Daisuke Sakai, Tadashi Nukaga, Shota Ikegami, Masayuki Shimizu, Toshimasa Futatsugi, Seiji Ohtori, Takeo Furuya, Sumihisa Orita, Shiro Imagama, Kei Ando, Kazuyoshi Kobayashi, Katsuhito Kiyasu, Hideki Murakami, Katsuhito Yoshioka, Shoji Seki, Michio Hongo, Kenichiro Kakutani, Takashi Yurube, Yasuchika Aoki, Masashi Oshima, Masahiko Takahata, Akira Iwata, Hirooki Endo, Tetsuya Abe, Toshinori Tsukanishi, Kazuyoshi Nakanishi, Kota Watanabe, Tomohiro Hikata, Satoshi Suzuki, Norihiro Isogai, Eijiro Okada, Haruki Funao, Seiji Ueda, Yuta Shiono, Kenya Nojiri, Naobumi Hosogane, Ken Ishii

    BMC musculoskeletal disorders   21 ( 1 )   420 - 420   2020年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Flexibility of the thoracic curve and three-dimensional thoracic kyphosis can predict pulmonary function in nonoperatively treated adult patients with adolescent idiopathic scoliosis.

    Masayuki Ohashi, Kei Watanabe, Toru Hirano, Kazuhiro Hasegawa, Keiichi Katsumi, Hirokazu Shoji, Tatsuki Mizouchi, Naoto Endo

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association   25 ( 4 )   551 - 556   2020年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • The Benefits of Sparing Lumbar Motion Segments in Spinal Fusion for Adolescent Idiopathic Scoliosis Are Evident at 10 Years Postoperatively. 国際誌

    Masayuki Ohashi, Tracey P Bastrom, Michelle C Marks, Carrie E Bartley, Peter O Newton

    Spine   45 ( 11 )   755 - 763   2020年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • 後方固定併用椎体形成術の術後矢状面アライメントと臨床成績の関連性

    渋谷 洋平, 渡辺 慶, 大橋 正幸, 田仕 英希, 渡辺 仁, 勝見 敬一, 菊池 廉, 澤上 公彦, 平野 徹

    東北整形災害外科学会雑誌   63 ( 1 )   167 - 168   2020年6月

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    記述言語:日本語   出版者・発行元:東北整形災害外科学会  

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  • K-line(-)頸椎後縦靱帯骨化症に対する前彎位矯正する新しい後方固定術

    勝見 敬一, 渡辺 慶, 平野 徹, 山崎 昭義, 大橋 正幸, 溝内 龍樹, 若杉 正嗣, 澤上 公彦, 傳田 博司, 和泉 智博, 牧野 達夫, 石川 裕也, 竹末 祐也, 遠藤 直人

    Journal of Spine Research   11 ( 3 )   668 - 668   2020年3月

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    記述言語:日本語   出版者・発行元:(一社)日本脊椎脊髄病学会  

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  • LLIFにおけるケージ内充填材 コラーゲン使用人工骨の混合率の検討

    勝見 敬一, 渡辺 慶, 平野 徹, 若杉 正嗣, 牧野 達夫, 石川 裕也, 竹末 祐也, 大橋 正幸, 溝内 龍樹, 山崎 昭義, 遠藤 直人

    Journal of Spine Research   11 ( 3 )   240 - 240   2020年3月

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    記述言語:日本語   出版者・発行元:(一社)日本脊椎脊髄病学会  

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  • 思春期特発性側彎症遺残例における成人期腰椎側彎の柔軟性と腰椎椎間板変性・腰痛の関連

    大橋 正幸, 渡辺 慶, 平野 徹, 長谷川 和宏, 勝見 敬一, 溝内 龍樹, 田仕 英希, 渋谷 洋平, 渡邉 仁, 遠藤 直人

    Journal of Spine Research   11 ( 3 )   182 - 182   2020年3月

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    記述言語:日本語   出版者・発行元:(一社)日本脊椎脊髄病学会  

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  • 頸椎後縦靱帯骨化症の骨化進展と骨代謝動態の解析

    勝見 敬一, 渡辺 慶, 平野 徹, 和泉 智博, 大橋 正幸, 牧野 達夫, 石川 裕也, 竹末 祐也, 山崎 昭義, 遠藤 直人

    Journal of Spine Research   11 ( 3 )   131 - 131   2020年3月

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    記述言語:日本語   出版者・発行元:(一社)日本脊椎脊髄病学会  

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  • 成人脊柱変形による慢性腰痛に対する3ヵ月間の個別化プログラムによる理学療法の効果

    渡辺 慶, 北村 拓也, 佐藤 成登志, 神田 賢, 大橋 正幸, 溝内 龍樹, 田仕 英希, 渋谷 洋平, 渡邉 仁, 遠藤 直人, 山本 智章

    Journal of Spine Research   11 ( 3 )   74 - 74   2020年3月

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    記述言語:日本語   出版者・発行元:(一社)日本脊椎脊髄病学会  

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  • Prospective 10-year follow-up assessment of spinal fusions for thoracic AIS: radiographic and clinical outcomes. 国際誌

    Peter O Newton, Masayuki Ohashi, Tracey P Bastrom, Carrie E Bartley, Burt Yaszay, Michelle C Marks, Randal Betz, Lawrence G Lenke, David Clements

    Spine deformity   8 ( 1 )   57 - 66   2020年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Health-Related Quality of Life in Nonoperated Patients With Adolescent Idiopathic Scoliosis in the Middle Years: A Mean 25-Year Follow-up Study. 国際誌

    Kei Watanabe, Masayuki Ohashi, Toru Hirano, Keiichi Katsumi, Tatsuki Mizouchi, Hideki Tashi, Keitaro Minato, Kazuhiro Hasegawa, Naoto Endo

    Spine   45 ( 2 )   E83-E89   2020年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Surgical outcomes of spinal fusion for osteoporotic vertebral fracture in the thoracolumbar spine: Comprehensive evaluations of 5 typical surgical fusion techniques.

    Kei Watanabe, Keiichi Katsumi, Masayuki Ohashi, Yohei Shibuya, Toru Hirano, Naoto Endo, Takashi Kaito, Tomoya Yamashita, Hiroyasu Fujiwara, Yukitaka Nagamoto, Yuji Matsuoka, Hidekazu Suzuki, Hirosuke Nishimura, Hidetomi Terai, Koji Tamai, Atsushi Tagami, Syuta Yamada, Shinji Adachi, Toshitaka Yoshii, Shuta Ushio, Katsumi Harimaya, Kenichi Kawaguchi, Nobuhiko Yokoyama, Hidekazu Oishi, Toshiro Doi, Atsushi Kimura, Hirokazu Inoue, Gen Inoue, Masayuki Miyagi, Wataru Saito, Atsushi Nakano, Daisuke Sakai, Tadashi Nukaga, Shota Ikegami, Masayuki Shimizu, Toshimasa Futatsugi, Seiji Ohtori, Takeo Furuya, Sumihisa Orita, Shiro Imagama, Kei Ando, Kazuyoshi Kobayashi, Katsuhito Kiyasu, Hideki Murakami, Katsuhito Yoshioka, Shoji Seki, Michio Hongo, Kenichiro Kakutani, Takashi Yurube, Yasuchika Aoki, Masashi Oshima, Masahiko Takahata, Akira Iwata, Hirooki Endo, Tetsuya Abe, Toshinori Tsukanishi, Kazuyoshi Nakanishi, Kota Watanabe, Tomohiro Hikata, Satoshi Suzuki, Norihiro Isogai, Eijiro Okada, Haruki Funao, Seiji Ueda, Yuta Shiono, Kenya Nojiri, Naobumi Hosogane, Ken Ishii

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association   24 ( 6 )   1020 - 1026   2019年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • A novel concept of posterior decompression and instrumented fusion with selective lordotic correction for cervical ossification of the posterior longitudinal ligament. 国際誌

    Keiichi Katsumi, Toru Hirano, Kei Watanabe, Masayuki Ohashi, Tatsuki Mizouchi, Masashi Wakasugi, Tatsuo Makino, Akiyoshi Yamazaki, Naoto Endo

    Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia   68   312 - 316   2019年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Long-term Impacts of Brace Treatment for Adolescent Idiopathic Scoliosis on Body Composition, Paraspinal Muscle Morphology, and Bone Mineral Density. 国際誌

    Masayuki Ohashi, Kei Watanabe, Toru Hirano, Kazuhiro Hasegawa, Keiichi Katsumi, Hirokazu Shoji, Tatsuki Mizouchi, Naoto Endo

    Spine   44 ( 18 )   E1075-E1082   2019年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Quantitative radiographic analysis of foraminal re-stenosis after posterior cervical foraminotomy with laminoplasty. 国際誌

    Tatsuki Mizouchi, Kei Watanabe, Tomohiro Izumi, Keiichi Katsumi, Hirokazu Shoji, Masayuki Ohashi, Hideki Tashi, Toru Hirano, Akiyoshi Yamazaki, Naoto Endo

    Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia   67   99 - 104   2019年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Action of Norepinephrine on Lamina X of the Spinal Cord. 国際誌

    Nobuko Ohashi, Masayuki Ohashi, Hiroshi Baba

    Neuroscience   408   214 - 225   2019年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Mechanisms of noradrenergic modulation of synaptic transmission and neuronal excitability in ventral horn neurons of the rat spinal cord. 国際誌

    Hirokazu Shoji, Masayuki Ohashi, Toru Hirano, Kei Watanabe, Naoto Endo, Hiroshi Baba, Tatsuro Kohno

    Neuroscience   408   161 - 176   2019年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Can posterior implant removal prevent device-related vertebral osteopenia after posterior fusion in adolescent idiopathic scoliosis? A mean 29-year follow-up study. 国際誌

    Kei Watanabe, Masayuki Ohashi, Toru Hirano, Keiichi Katsumi, Hirokazu Shoji, Tatsuki Mizouchi, Yuya Ishikawa, Kazuhiro Hasegawa, Naoto Endo, Hideaki E Takahashi

    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society   28 ( 6 )   1314 - 1321   2019年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Risk Factors for Proximal Junctional Fracture Following Fusion Surgery for Osteoporotic Vertebral Collapse with Delayed Neurological Deficits: A Retrospective Cohort Study of 403 Patients.

    Koji Tamai, Hidetomi Terai, Akinobu Suzuki, Hiroaki Nakamura, Kei Watanabe, Keiichi Katsumi, Masayuki Ohashi, Yohei Shibuya, Tomohiro Izumi, Toru Hirano, Takashi Kaito, Tomoya Yamashita, Hiroyasu Fujiwara, Yukitaka Nagamoto, Yuji Matsuoka, Hidekazu Suzuki, Hirosuke Nishimura, Atsushi Tagami, Syuta Yamada, Shinji Adachi, Toshitaka Yoshii, Shuta Ushio, Katsumi Harimaya, Kenichi Kawaguchi, Nobuhiko Yokoyama, Hidekazu Oishi, Toshiro Doi, Atsushi Kimura, Hirokazu Inoue, Gen Inoue, Masayuki Miyagi, Wataru Saito, Atsushi Nakano, Daisuke Sakai, Tadashi Nukaga, Shota Ikegami, Masayuki Shimizu, Toshimasa Futatsugi, Seiji Ohtori, Takeo Furuya, Sumihisa Orita, Shiro Imagama, Kei Ando, Kazuyoshi Kobayashi, Katsuhito Kiyasu, Hideki Murakami, Katsuhito Yoshioka, Shoji Seki, Michio Hongo, Kenichiro Kakutani, Takashi Yurube, Yasuchika Aoki, Masashi Oshima, Masahiko Takahata, Akira Iwata, Hirooki Endo, Tetsuya Abe, Toshinori Tsukanishi, Kazuyoshi Nakanishi, Kota Watanabe, Tomohiro Hikata, Satoshi Suzuki, Norihiro Isogai, Eijiro Okada, Haruki Funao, Seiji Ueda, Yuta Shiono, Kenya Nojiri, Naobumi Hosogane, Ken Ishii

    Spine surgery and related research   3 ( 2 )   171 - 177   2019年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • En Bloc Spondylectomy for Spinal Metastases: Detailed Oncological Outcomes at a Minimum of 2 Years after Surgery. 国際誌

    Masayuki Ohashi, Toru Hirano, Kei Watanabe, Kazuhiro Hasegawa, Takui Ito, Keiichi Katsumi, Hirokazu Shoji, Tatsuki Mizouchi, Ikuko Takahashi, Takao Homma, Naoto Endo

    Asian spine journal   13 ( 2 )   296 - 304   2019年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Surgical outcomes of spinal fusion for osteoporotic thoracolumbar vertebral fractures in patients with Parkinson's disease: what is the impact of Parkinson's disease on surgical outcome? 国際誌

    Kei Watanabe, Keiichi Katsumi, Masayuki Ohashi, Yohei Shibuya, Tomohiro Izumi, Toru Hirano, Naoto Endo, Takashi Kaito, Tomoya Yamashita, Hiroyasu Fujiwara, Yukitaka Nagamoto, Yuji Matsuoka, Hidekazu Suzuki, Hirosuke Nishimura, Hidetomi Terai, Koji Tamai, Atsushi Tagami, Syuta Yamada, Shinji Adachi, Toshitaka Yoshii, Shuta Ushio, Katsumi Harimaya, Kenichi Kawaguchi, Nobuhiko Yokoyama, Hidekazu Oishi, Toshiro Doi, Atsushi Kimura, Hirokazu Inoue, Gen Inoue, Masayuki Miyagi, Wataru Saito, Atsushi Nakano, Daisuke Sakai, Tadashi Nukaga, Shota Ikegami, Masayuki Shimizu, Toshimasa Futatsugi, Seiji Ohtori, Takeo Furuya, Sumihisa Orita, Shiro Imagama, Kei Ando, Kazuyoshi Kobayashi, Katsuhito Kiyasu, Hideki Murakami, Katsuhito Yoshioka, Shoji Seki, Michio Hongo, Kenichiro Kakutani, Takashi Yurube, Yasuchika Aoki, Masashi Oshima, Masahiko Takahata, Akira Iwata, Hirooki Endo, Tetsuya Abe, Toshinori Tsukanishi, Kazuyoshi Nakanishi, Kota Watanabe, Tomohiro Hikata, Satoshi Suzuki, Norihiro Isogai, Eijiro Okada, Haruki Funao, Seiji Ueda, Yuta Shiono, Kenya Nojiri, Naobumi Hosogane, Ken Ishii

    BMC musculoskeletal disorders   20 ( 1 )   103 - 103   2019年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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.

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  • The Natural Course of Compensatory Lumbar Curves in Nonoperated Patients With Thoracic Adolescent Idiopathic Scoliosis. 国際誌

    Masayuki Ohashi, Kei Watanabe, Toru Hirano, Kazuhiro Hasegawa, Keiichi Katsumi, Hirokazu Shoji, Tatsuki Mizouchi, Ikuko Takahashi, Naoto Endo

    Spine   44 ( 2 )   E89-E98   2019年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Predicting Factors at Skeletal Maturity for Curve Progression and Low Back Pain in Adult Patients Treated Nonoperatively for Adolescent Idiopathic Scoliosis With Thoracolumbar/Lumbar Curves: A Mean 25-year Follow-up. 国際誌

    Masayuki Ohashi, Kei Watanabe, Toru Hirano, Kazuhiro Hasegawa, Keiichi Katsumi, Hirokazu Shoji, Tatsuki Mizouchi, Naoto Endo

    Spine   43 ( 23 )   E1403-E1411   2018年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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.

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  • Perioperative factors associated with favorable outcomes of posterior decompression and instrumented fusion for cervical ossification of the posterior longitudinal ligament: A retrospective multicenter study. 国際誌

    Keiichi Katsumi, Toru Hirano, Kei Watanabe, Masayuki Ohashi, Hirokazu Shoji, Tatsuki Mizouchi, Akiyoshi Yamazaki, Tomohiro Izumi, Kimihiko Sawakami, Hiroshi Denda, Kazuo Takahashi, Naoto Endo

    Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia   57   74 - 78   2018年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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.

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  • Direct decompression combined with occipitocervical fusion for median occipital condyle-induced ventral cerviomedullary junction compression causing myelopathy.

    Masashi Wakasugi, Kei Watanabe, Toru Hirano, Keiichi Katsumi, Masayuki Ohashi, Naoto Endo

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association   23 ( 4 )   701 - 705   2018年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

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  • Study protocol for the G-SPIRIT trial: a randomised, placebo-controlled, double-blinded phase III trial of granulocyte colony-stimulating factor-mediated neuroprotection for acute spinal cord injury. 国際誌

    Masao Koda, Hideki Hanaoka, Takatoshi Sato, Yasuhisa Fujii, Michiko Hanawa, Sho Takahashi, Takeo Furuya, Yasushi Ijima, Junya Saito, Mitsuhiro Kitamura, Seiji Ohtori, Yukei Matsumoto, Tetsuya Abe, Kei Watanabe, Toru Hirano, Masayuki Ohashi, Hirokazu Shoji, Tatsuki Mizouchi, Ikuko Takahashi, Norio Kawahara, Masahito Kawaguchi, Yugo Orita, Takeshi Sasamoto, Masahito Yoshioka, Masafumi Fujii, Katsutaka Yonezawa, Daisuke Soma, Hiroshi Taneichi, Daisaku Takeuchi, Satoshi Inami, Hiroshi Moridaira, Haruki Ueda, Futoshi Asano, Yosuke Shibao, Ikuo Aita, Yosuke Takeuchi, Masaya Mimura, Jun Shimbo, Yukio Someya, Sumio Ikenoue, Hiroaki Sameda, Kan Takase, Yoshikazu Ikeda, Fumitake Nakajima, Mitsuhiro Hashimoto, Tomoyuki Ozawa, Fumio Hasue, Takayuki Fujiyoshi, Koshiro Kamiya, Masahiko Watanabe, Hiroyuki Katoh, Yukihiro Matsuyama, Yu Yamamoto, Daisuke Togawa, Tomohiko Hasegawa, Sho Kobayashi, Go Yoshida, Shin Oe, Tomohiro Banno, Hideyuki Arima, Koji Akeda, Eiji Kawamoto, Hiroshi Imai, Toshihiko Sakakibara, Akihiro Sudo, Yasuo Ito, Tsuyoshi Kikuchi, Shuhei Osaki, Nobuhiro Tanaka, Kazuyoshi Nakanishi, Naosuke Kamei, Shinji Kotaka, Hideo Baba, Tsuyoshi Okudaira, Hiroaki Konishi, Takayuki Yamaguchi, Keigo Ito, Yoshito Katayama, Taro Matsumoto, Tomohiro Matsumoto, Masaru Idota, Haruo Kanno, Toshimi Aizawa, Ko Hashimoto, Toshimitsu Eto, Takehiro Sugaya, Michiharu Matsuda, Kazunari Fushimi, Satoshi Nozawa, Chizuo Iwai, Toshihiko Taguchi, Tsukasa Kanchiku, Hidenori Suzuki, Norihiro Nishida, Masahiro Funaba, Masashi Yamazaki

    BMJ open   8 ( 5 )   e019083   2018年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Risk factors for surgical site infection following spinal instrumentation surgery.

    Hirokazu Shoji, Toru Hirano, Kei Watanabe, Masayuki Ohashi, Tatsuki Mizouchi, Naoto Endo

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association   23 ( 3 )   449 - 454   2018年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Natural history of the ossification of cervical posterior longitudinal ligament: a three dimensional analysis. 国際誌

    Keiichi Katsumi, Kei Watanabe, Tomohiro Izumi, Toru Hirano, Masayuki Ohashi, Tatsuki Mizouchi, Takui Ito, Naoto Endo

    International orthopaedics   42 ( 4 )   835 - 842   2018年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Surgical Outcomes of Posterior Spinal Fusion Alone Using Cervical Pedicle Screw Constructs for Cervical Disorders Associated With Athetoid Cerebral Palsy. 国際誌

    Kei Watanabe, Toru Hirano, Keiichi Katsumi, Masayuki Ohashi, Hirokazu Shoji, Akiyoshi Yamazaki, Tomohiro Izumi, Kazuhiro Hasegawa, Takui Ito, Naoto Endo

    Spine   42 ( 24 )   1835 - 1843   2017年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • One-stage surgery in combination with thoracic endovascular grafting and resection of T4 lung cancer invading the thoracic aorta and spine. 国際誌

    Seijiro Sato, Tatsuya Goto, Terumoto Koike, Takeshi Okamoto, Hirokazu Shoji, Masayuki Ohashi, Kei Watanabe, Masanori Tsuchida

    Journal of thoracic disease   9 ( 11 )   E1009-E1012   2017年11月

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    記述言語:英語  

    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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  • Acetaminophen Metabolite N-Acylphenolamine Induces Analgesia via Transient Receptor Potential Vanilloid 1 Receptors Expressed on the Primary Afferent Terminals of C-fibers in the Spinal Dorsal Horn. 国際誌

    Nobuko Ohashi, Daisuke Uta, Mika Sasaki, Masayuki Ohashi, Yoshinori Kamiya, Tatsuro Kohno

    Anesthesiology   127 ( 2 )   355 - 371   2017年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Characteristics of spinopelvic alignment in Parkinson's disease: Comparison with adult spinal deformity.

    Kei Watanabe, Toru Hirano, Keiichi Katsumi, Masayuki Ohashi, Hirokazu Shoji, Kazuhiro Hasegawa, Akiyoshi Yamazaki, Atsushi Ishikawa, Ryoko Koike, Naoto Endo, Masatoyo Nishizawa, Takayoshi Shimohata

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association   22 ( 1 )   16 - 21   2017年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Radiographic Outcomes of Upper Cervical Fusion for Pediatric Patients Younger Than 10 Years.

    Kei Watanabe, Toru Hirano, Keiichi Katsumi, Masayuki Ohashi, Hirokazu Shoji, Kazuhiro Hasegawa, Takui Ito, Naoto Endo

    Spine surgery and related research   1 ( 1 )   14 - 19   2017年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Administration of tranexamic acid to patients undergoing surgery for adolescent idiopathic scoliosis evokes pain and increases the infusion rate of remifentanil during the surgery. 国際誌

    Nobuko Ohashi, Masayuki Ohashi, Naoto Endo, Tatsuro Kohno

    PloS one   12 ( 3 )   e0173622   2017年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • False-negative transcranial motor evoked potentials (TcMEPs) during surgery for congenital lumbar kyphoscoliosis: a case report. 国際誌

    Masayuki Ohashi, Kei Watanabe, Kenta Furutani, Toru Hirano, Keiichi Katsumi, Hirokazu Shoji, Tatsuki Mizouchi, Naoto Endo

    Spinal cord series and cases   3   17053 - 17053   2017年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Surgical treatment for osteoporotic thoracolumbar vertebral collapse using vertebroplasty with posterior spinal fusion: a prospective multicenter study. 国際誌

    Keiichi Katsumi, Toru Hirano, Kei Watanabe, Masayuki Ohashi, Akiyoshi Yamazaki, Takui Ito, Kimihiko Sawakami, Atsuki Sano, Ren Kikuchi, Naoto Endo

    International orthopaedics   40 ( 11 )   2309 - 2315   2016年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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 modulates neuronal excitability and membrane properties in ventral horn neurons of the rat spinal cord. 国際誌

    Masayuki Ohashi, Toru Hirano, Kei Watanabe, Hirokazu Shoji, Nobuko Ohashi, Hiroshi Baba, Naoto Endo, Tatsuro Kohno

    Neuroscience   331   206 - 20   2016年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Posterior instrumented fusion suppresses the progression of ossification of the posterior longitudinal ligament: a comparison of laminoplasty with and without instrumented fusion by three-dimensional analysis. 国際誌

    Keiichi Katsumi, Tomohiro Izumi, Takui Ito, Toru Hirano, Kei Watanabe, Masayuki Ohashi

    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society   25 ( 5 )   1634 - 1640   2016年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Clinical features, outcomes, and survival factor in patients with vertebral osteomyelitis infected by methicillin-resistant staphylococci.

    Hirokazu Shoji, Takaaki Urakawa, Kei Watanabe, Toru Hirano, Keiichi Katsumi, Masayuki Ohashi, Tsuyoshi Sato, Akiyoshi Yamazaki, Yoichi Yajiri, Ren Kikuchi, Noboru Hosaka, Kimihiko Sawakami, Kazuto Miura, Ichiro Nakamura, Ryuta Fujikawa, Masashi Wakasugi, Naoto Endo

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association   21 ( 3 )   282 - 6   2016年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Hydrogen peroxide modulates synaptic transmission in ventral horn neurons of the rat spinal cord. 国際誌

    Masayuki Ohashi, Toru Hirano, Kei Watanabe, Keiichi Katsumi, Nobuko Ohashi, Hiroshi Baba, Naoto Endo, Tatsuro Kohno

    The Journal of physiology   594 ( 1 )   115 - 34   2016年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Characteristics and exacerbating factors of chronic low back pain in Parkinson's disease. 国際誌

    Kei Watanabe, Toru Hirano, Keiichi Katsumi, Masayuki Ohashi, Atsushi Ishikawa, Ryoko Koike, Naoto Endo, Masatoyo Nishizawa, Takayoshi Shimohata

    International orthopaedics   39 ( 12 )   2433 - 8   2015年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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 evokes pain by modulating neuronal excitability in the spinal dorsal horn. 国際誌

    Nobuko Ohashi, Mika Sasaki, Masayuki Ohashi, Yoshinori Kamiya, Hiroshi Baba, Tatsuro Kohno

    Scientific reports   5   13458 - 13458   2015年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Apparent diffusion coefficients distinguish amyotrophic lateral sclerosis from cervical spondylotic myelopathy. 国際誌

    Yuka Koike, Masato Kanazawa, Kenshi Terajima, Kei Watanabe, Masayuki Ohashi, Naoto Endo, Takayoshi Shimohata, Masatoyo Nishizawa

    Clinical neurology and neurosurgery   132   33 - 6   2015年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • The characteristic clinical symptoms of C-4 radiculopathy caused by ossification of the posterior longitudinal ligament. 国際誌

    Keiichi Katsumi, Akiyoshi Yamazaki, Kei Watanabe, Toru Hirano, Masayuki Ohashi, Naoto Endo

    Journal of neurosurgery. Spine   20 ( 5 )   480 - 4   2014年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Two-year clinical and radiological outcomes of open-door cervical laminoplasty with prophylactic bilateral C4-C5 foraminotomy in a prospective study. 国際誌

    Masayuki Ohashi, Akiyoshi Yamazaki, Kei Watanabe, Keiichi Katsumi, Hirokazu Shoji

    Spine   39 ( 9 )   721 - 7   2014年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Analysis of C5 palsy after cervical open-door laminoplasty: relationship between C5 palsy and foraminal stenosis. 国際誌

    Keiichi Katsumi, Akiyoshi Yamazaki, Kei Watanabe, Masayuki Ohashi, Hirokazu Shoji

    Journal of spinal disorders & techniques   26 ( 4 )   177 - 82   2013年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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.

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  • トラネキサム酸の脊髄後角を介する痛みの機序の解明

    大橋 宣子, 佐々木 美佳, 大橋 正幸, 紙谷 義孝, 馬場 洋, 河野 達郎

    PAIN RESEARCH   31 ( 1 )   9 - 20   2013年

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    記述言語:日本語   出版者・発行元:日本疼痛学会  

    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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    その他リンク: http://search.jamas.or.jp/link/ui/2016213404

  • Can prophylactic bilateral C4/C5 foraminotomy prevent postoperative C5 palsy after open-door laminoplasty?: a prospective study. 国際誌

    Keiichi Katsumi, Akiyoshi Yamazaki, Kei Watanabe, Masayuki Ohashi, Hirokazu Shoji

    Spine   37 ( 9 )   748 - 54   2012年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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.

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  • Variation of the position of the aorta relative to a kyphotic thoracic spine: safety margin for pedicle screw placement in the adult Japanese population. 国際誌

    Masayuki Ohashi, Takui Ito, Toru Hirano, Naoto Endo

    Spine   37 ( 4 )   261 - 5   2012年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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.

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  • Clinical outcomes of posterior lumbar interbody fusion for lumbar foraminal stenosis: preoperative diagnosis and surgical strategy. 国際誌

    Kei Watanabe, Akiyoshi Yamazaki, Osamu Morita, Atsuki Sano, Keiichi Katsumi, Masayuki Ohashi

    Journal of spinal disorders & techniques   24 ( 3 )   137 - 41   2011年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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.

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  • Percutaneous intralesional injection of calcitonin and methylprednisolone for treatment of an aneurysmal bone cyst at C-2. 国際誌

    Masayuki Ohashi, Takui Ito, Toru Hirano, Naoto Endo

    Journal of neurosurgery. Pediatrics   2 ( 5 )   365 - 9   2008年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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.

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