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

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

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

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

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

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

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

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

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

DOI： 10.1097/01.BRS.0000085099.47800.DF

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

DOI： 10.3171/spi.2003.98.1.0077

Language：Japanese   Publisher：West-Japanese Society of Orthopedics & Traumatology  

<p>【はじめに】本研究の目的はJOABPEQやJOACMEQが他の質問表と比べて正確に記入されているか，medical staffの協力により記入率は改善するのか評価すること．【対象と方法】2015年4月から2017年3月に脊椎手術を受けた342名を対象とした．2016年4月より質問表が正確に記入されているのかチェックを開始した．チェックなし期間のJOABPEQ，JOACMEQの正確記入率とチェックあり期間のJOABPEQ，JOACMEQ，ODI，NDI，EQ-5Dの正確記入率を比較した．正確に記入された質問票とは全ての設問が埋められているものと定義した．正確記入率は正しく記入された質問票の数を全質問票の数で除したものとした．また，medical staffの協力で正確記入率が改善するのか調査した．【結果】JOABPEQとJOACMEQの正確記入率はチェックの有無に関わらずODI，NDI，EQ-5Dと比べて低かった．Medical staffの協力で正確記入率は改善した．【結語】JOABPEQとJOACMEQがさらに広く使用してもらうために，今後問題点を少しずつ改善していく必要があると考えられた．</p>

DOI： 10.5035/nishiseisai.73.295

CiNii Research

Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】本研究の目的はJOABPEQやJOACMEQが他の質問表と比べて正確に記入されているか,medical staffの協力により記入率は改善するのか評価すること.【対象と方法】2015年4月から2017年3月に脊椎手術を受けた342名を対象とした.2016年4月より質問表が正確に記入されているのかチェックを開始した.チェックなし期間のJOABPEQ,JOACMEQの正確記入率とチェックあり期間のJOABPEQ,JOACMEQ,ODI,NDI,EQ-5Dの正確記入率を比較した.正確に記入された質問票とは全ての設問が埋められているものと定義した.正確記入率は正しく記入された質問票の数を全質問票の数で除したものとした.また,medical staffの協力で正確記入率が改善するのか調査した.【結果】JOABPEQとJOACMEQの正確記入率はチェックの有無に関わらずODI,NDI,EQ-5Dと比べて低かった.Medical staffの協力で正確記入率は改善した.【結語】JOABPEQとJOACMEQがさらに広く使用してもらうために,今後問題点を少しずつ改善していく必要があると考えられた.(著者抄録)

Language：English   Publisher：Oxford University Press  

脊椎外科またはリウマチ性疾患を担う地域中核病院4施設のデータベースを用いて、2000～2019年の間に脊椎手術が施行された強直性脊椎炎(AS)患者13例(男性9例、女性4例、年齢37～82歳)を対象とする後ろ向き研究を行い、臨床的特徴と外科治療の治療成績を評価した。罹病期間は平均25.1±16.4年、術後経過観察期間は平均7.15±5.64年であった。13例中9例で椎体骨折、2例で脊柱後彎症、2例で脊髄症が認められた。骨折症例には、保存療法の失敗による二次性偽関節/遅発性麻痺が5例含まれていた。全例に脊椎固定術が施行され、脊柱後彎症に対してはpedicle subtraction osteotomy、脊髄症に対しては椎弓切除術も施行された。全例が術後に改善した。脊柱後彎症の1例は追加で両側人工股関節置換術が施行され、術後に脊椎のアライメントが改善していた。周術期合併症が4例で認められた。

Language：English   Publisher：Spine  

Study design: Retrospective study of prospectively collected data. Objective: To investigate the influence of cartilaginous endplates (CEs) in herniated discs on clinical symptoms and postoperative outcomes in patients with lumbar disc herniation (LDH) in different age groups. Summary of Background Data: LDH involving CEs, which are hard and less resorptive, is frequently observed with increasing age and appears to affect the natural course and clinical outcomes following discectomy. Methods: Overall, 239 patients who underwent microscopic discectomy were included. Main outcomes were evaluated using motor strength, visual analog scale (VAS) for back and leg pain, and Rolland-Morris Disability Questionnaire. The effects of CEs on clinical variables and postoperative outcomes were compared between two groups (<50 years and >50 years). Furthermore, we investigated the characteristics of CE avulsions in each group and examined the association between CE occupancy rate and clinical symptoms. Results: CEs were predominantly observed with increasing age and were more frequently detected in patients with Modic changes in both groups (p < 0.001). A higher proportion of LDH with a >20% occupancy rate was found in patients aged <50 years (p = 0.009) and was associated with a decrease in motor strength preoperatively (p = 0.007). Postoperative VAS score for low back pain (LBP) was higher in patients with CEs than in those without CEs in the >50-year-old group (p < 0.001). In multiple regression analysis, the presence of CEs was independently associated with residual LBP at 1 year postoperatively in older patients (β = 0.46, p < 0.001). Conclusion: Avulsion-type herniations in patients aged <50 years had a higher CE occupancy rate, which is a potential cause of preoperative motor weakness. Clinical outcomes following discectomy improved regardless of the presence of CEs, however, cartilaginous herniation in patients aged >50 years may affect residual LBP at 1 year.

DOI： 10.1097/BRS.0000000000005178

Scopus

PubMed

Language：English   Publisher：The Japan Neurosurgical Society  

<p>Lumbar canal stenosis (LCS) has been reported as a precipitating factor by which a tethered spinal cord, which is asymptomatic during childhood, develops into tethered cord syndrome (TCS) in adulthood. However, only a few reports on surgical strategies for such cases are available. A 64-year-old woman presented with unbearable pain in the left buttock and dorsal aspect of the thigh approximately 1 year ago. Magnetic resonance imaging showed cord tethering with a filar-type spinal lipoma and LCS due to the thickening of the ligamentum flavum at the L4-5 vertebral level. Five months after the decompressive laminectomy for the treatment of LCS, an untethering surgery was performed at the dural cul-de-sac at the S4 level. The severed end of the filum was elevated rostrally by 7 mm, and the pain subsided postoperatively. This case study shows that surgeries for both lesions should be indicated for adult-onset TCS triggered by LCS.</p>

DOI： 10.2176/jns-nmc.2022-0347

PubMed

CiNii Research

Language：English   Publisher：Global Spine Journal  

Study Design: Retrospective study. Objective: To investigate the characteristics of newly developing Modic changes following discectomy and their impact on residual low back pain (LBP) in the early postoperative stage of lumbar disc herniation. Methods: We included 96 patients who underwent microscopic discectomy. Through MRI, we assessed new developments of Modic changes and the progression of disc degeneration at the surgical level. The presence of cartilaginous endplates was evaluated using resected specimens, and the main outcome was assessed using the visual analog scale (VAS). Further, the prevalence and time course of Modic changes, and their effects on clinical outcomes in the early postoperative period were examined. Results: A new development of Modic changes was detected in 28% of cartilaginous herniations at 6 months. Modic changes were observed more frequently in patients with cartilaginous herniation than in those without cartilaginous herniation postoperatively (P <.001). The VAS scores for LBP up to 6 months were greater in patients with Modic changes (P <.001) than those without; however, no significant differences were identified in the presence or absence of Modic changes over the year follow-up. The development of Modic changes was closely associated with residual LBP at 6 months (β:0.511, P <.001). Conclusions: Modic changes develop predominantly in patients with avulsion-type herniation than in those with annular rupture at an earlier phase after discectomy. Furthermore, disc herniation with cartilaginous endplates may be associated with a slower decrease in LBP for up to 6 months, supporting the notion that newly developing endplate changes may cause residual LBP.

DOI： 10.1177/21925682231220893

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Language：English   Publisher：(一社)日本脳神経外科学会  

症例は64歳女性で、約1年前に左臀部および大腿背部に耐え難い疼痛を呈し、当院を受診した。同時に腰痛も訴えていた。MRI検査にて、L4-5椎体に終糸脂肪腫および黄色靭帯肥厚による腰部脊柱管狭窄症を認めた。6ヵ月間の内科的治療により、疼痛の改善が認められなかったため、腰部脊柱管狭窄症に対する除圧的椎弓切除を施行した。その5ヵ月後、S4レベルのdural cul-de-sacでuntethering surgeryを施行した。切断された終糸末端を吻側へ7mm持ち上げた。術後、左臀部および大腿背部の疼痛は1ヵ月で軽快した。病理組織学的検査の結果、線維脂肪組織の中心にGFAP陽性の神経膠組織を認めた。しかし、中心管様構造は観察されなかった。

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Modern Rheumatology  

Objectives: The study aimed to comprehend the clinical features and outcomes of surgical treatments for spinal disorders in patients with ankylosing spondylitis (AS). Methods: This retrospective study enrolled patients with AS who underwent spine surgery between 2000 and 2019 in our facility. Results: Thirteen patients with AS underwent spine surgeries. The mean age was 56.2 years, and the mean disease duration was 25.1 years at the time of surgery. Nine patients had vertebral fracture, two had kyphotic deformity, and two had myelopathy due to the spinal ligament ossification. Fracture cases included five patients with secondary pseudarthrosis/delayed palsy due to conservative treatment failure. Spinal fixation was performed in all patients. Pedicle subtraction osteotomy for kyphosis and laminectomy for myelopathy were also conducted. All patients improved after surgeries. One patient with kyphotic deformity underwent additional surgery of bilateral hip prosthesis, which resulted in better spine alignment. Four cases of perioperative complications were observed. Conclusion: Myelopathy was newly found as the aetiology requiring surgery in patients with AS. This summarized case series could help physicians to identify patients with surgically treatable spinal disorders among patients with AS.

DOI： 10.1093/mr/roac142

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

マイクロ内視鏡下椎弓切除術(MEL)における周術期持続経口低用量アスピリン(LDA)投与の安全性について検討した。腰部脊柱管狭窄症に対して単一レベルMELを施行された88例を抗凝固薬非投与群(A群)65例(男性20例、女性45例、平均70.4±1.2歳)、周術期における抗凝固薬中止群(B群)9例(男性7例、女性2例、平均77.7±1.1歳)、経口LDA持続投与群(C群)14例(男性8例、女性6例、平均78.1±1.4歳)に分類した。各群の手術時間、術中出血量、術前後のヘモグロビン(Hb)値と血小板数(Plt)、周術期合併症のほか、術後1週と6ヵ月以上経過時の血腫面積と硬膜嚢面積を比較した。さらに、臨床アウトカムとしてEQ-5D、Oswestry障害度指数(ODI)、日本整形外科学会背部痛評価質問票(JOABPEQ)スコアを評価した。手術時間、術中合併症、Hbの変化、Pltの変化に関してA群、B群、C群の間に有意差は認められず、EQ-5D、ODI、JOABPEQにも有意な群間差はみられなかった。術後合併症としてA群のうち1例に血腫形成がみられたが、B群とC群に合併症の発症はなかった。このほか、MRI上の血腫面積と硬膜嚢面積についても有意な群間差はみられなかった。MEL施行時の周術期経口LDA投与は周術期合併症や臨床アウトカムに影響を及ぼさないことが示された。

Language：English   Publisher：Frontiers in Endocrinology  

Introduction: Adolescent idiopathic scoliosis (AIS) is a disorder with a three-dimensional spinal deformity and is a common disease affecting 1-5% of adolescents. AIS is also known as a complex disease involved in environmental and genetic factors. A relation between AIS and body mass index (BMI) has been epidemiologically and genetically suggested. However, the causal relationship between AIS and BMI remains to be elucidated. Material and methods: Mendelian randomization (MR) analysis was performed using summary statistics from genome-wide association studies (GWASs) of AIS (Japanese cohort, 5,327 cases, 73,884 controls; US cohort: 1,468 cases, 20,158 controls) and BMI (Biobank Japan: 173430 individual; meta-analysis of genetic investigation of anthropometric traits and UK Biobank: 806334 individuals; European Children cohort: 39620 individuals; Population Architecture using Genomics and Epidemiology: 49335 individuals). In MR analyses evaluating the effect of BMI on AIS, the association between BMI and AIS summary statistics was evaluated using the inverse-variance weighted (IVW) method, weighted median method, and Egger regression (MR-Egger) methods in Japanese. Results: Significant causality of genetically decreased BMI on risk of AIS was estimated: IVW method (Estimate (beta) [SE] = -0.56 [0.16], p = 1.8 × 10-3), weighted median method (beta = -0.56 [0.18], p = 8.5 × 10-3) and MR-Egger method (beta = -1.50 [0.43], p = 4.7 × 10-3), respectively. Consistent results were also observed when using the US AIS summary statistic in three MR methods; however, no significant causality was observed when evaluating the effect of AIS on BMI. Conclusions: Our Mendelian randomization analysis using large studies of AIS and GWAS for BMI summary statistics revealed that genetic variants contributing to low BMI have a causal effect on the onset of AIS. This result was consistent with those of epidemiological studies and would contribute to the early detection of AIS.

DOI： 10.3389/fendo.2023.1089414

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

DOI： 10.3389/fendo.2023.108941

Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Society for Spine Surgery and Related Research  

<p>Introduction: It remains controversial whether it is better to continue oral low-dose aspirin (LDA) during the perioperative period in spinal surgery. This study aims to evaluate the safety of continued LDA administration in the perioperative periods of microendoscopic laminectomy (MEL) by assessing perioperative complications and clinical outcomes.</p><p>Methods: We ultimately included 88 patients (35 males, 53 females) who underwent one level of MEL for lumbar spinal canal stenosis from April 2016 to March 2022. Patients who did not undergo anticoagulation therapy were classified into Group A (65 patients), those who stopped anticoagulation therapy at the perioperative periods were classified into Group B (9 patients), and those who continued oral administration of LDA throughout the perioperative periods were classified into Group C (14 patients). Surgery time, intraoperative estimate blood loss (EBL), differences between hemoglobin (Hb) and platelet (Plt) before and after surgery, perioperative complications, and cross-sectional area of hematoma and dural sac on MRI taken within 1 week and at 6 months or more after surgery were assessed between three groups. The EuroQol-5 dimensions (EQ-5D), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were also evaluated as the clinical outcomes.</p><p>Results: There was no statistically significant difference between the three groups in operation time, intraoperative EBL, differences between Hb and Plt before and after surgery, and cross-sectional area of hematoma and dural sac on MRI. A case of hematoma removal was confirmed in Group A. There was also no statistically significant difference between the three groups in EQ-5D, ODI, and each domain of JOABPEQ.</p><p>Conclusions: The continuation of LDA throughout the perioperative periods did not affect perioperative complications and clinical outcomes of one-level MEL. In MEL, it might be possible to continue oral administration of LDA throughout the perioperative periods.</p>

DOI： 10.22603/ssrr.2022-0224

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CiNii Research

Language：English   Publisher：The Japanese Society for Spine Surgery and Related Research  

DOI： 10.22603/ssrr.2022-0107

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CiNii Research

Language：English   Publisher：The Japanese Society for Spine Surgery and Related Research  

<p>Introduction: Tumor size is an important factor in determining the appropriate clinical management of intradural-extramedullary schwannoma. A tumor volume reduction may be achieved by conservative targeted therapy instead of invasive surgery if a molecular event related to tumor size is discovered. Insulin-like growth factor II messenger RNA-binding protein 3 (IMP3), an oncofetal tumor-associated antigen that is expected to be a target for immunotherapy, was focused on in this study.</p><p>Methods: The IMP3 status was assessed by immunohistochemistry in 64 samples of intradural-extramedullary schwannoma, and the correlation between IMP3 expression and tumor size was evaluated.</p><p>Results: Immunohistochemically, high IMP3 expression was observed in ~85% of schwannomas. The maximum tumor diameter of the high IMP3 expression group was significantly larger than that of the low IMP3 expression group (34.3 mm vs 18.5 mm, <i>p</i>=0.002). The receiver operating characteristic curve demonstrated that a maximum tumor diameter of 24 mm was a predictable factor for IMP3 expression (sensitivity, 0.7; 1−specificity, 0.2; area under the curve, 0.82).</p><p>Conclusions: Upregulated IMP3 expression was associated with large tumor size, suggesting a possible therapeutic approach.</p>

DOI： 10.22603/ssrr.2022-0063

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CiNii Research

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

硬膜内髄外神経鞘腫におけるインスリン様成長因子IIメッセンジャーRNA結合蛋白3(IMP3)の発現状況を検討した。硬膜内髄外神経鞘腫患者64例(男性32例、女性32例、年齢中央値53歳)を対象に、免疫組織化学染色によりIMP3の発現を測定し、腫瘍サイズとの相関の有無を評価した。腫瘍最大径中央値は26mmで、腫瘍の局在は頸椎が18例、胸椎が23例、腰椎が17例、仙骨が6例であった。免疫組織化学染色では64例のうち54例(84.4%)にIMP3の高発現を認めた。腫瘍径26mm以上の大型腫瘍35例のうち33例(94.3%)、26mm未満の小型腫瘍29例のうち21例(72.4%)がIMP3の高発現を呈していた。大型腫瘍の方がIMP3の高発現率が有意に高く、多重ロジスティック回帰分析ではIMP3スコアと腫瘍サイズとの間に有意な関連が認められた。また、最大腫瘍径の平均はIMP3高発現群が34.3±21.1mm、IMP3低発現群が18.5±7.4mmであり(p=0.002)、ROC曲線解析ではIMP3の高発現を予測する腫瘍径の至適カットオフ値は24mmと算出され、感度は0.7、1-特異度は0.2、曲線下面積は0.82であった。硬膜内髄外神経鞘腫にみられるIMP3の高発現は腫瘍サイズ増大と有意に関連することが示された。

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

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

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

症例は43歳男性。軽度の左腰痛を自覚し、1週間後に改善したが、左前外側大腿部、鼠径部および臀部に疼痛が出現し、その2週後に疼痛増悪をきたして救急受診となった。NSAIDs投与と硬膜外神経ブロックを行うも効果は得られず、第2病日に加療目的に当院転院となった。下肢神経検査では運動障害なく深部腱反射は正常であり、知覚検査にて左臀部、近位前外側大腿、鼠径部に感覚異常および疼痛を認め、明らかな感覚鈍麻はみられなかった。腰椎X線検査では移行椎や不安定性はみられず、MRIとdisco-CTにてL1神経根を圧迫するL1-L2の左椎間孔外ヘルニア髄核が検出された。Oswestry Disability Indexは40%、臀部と下肢の疼痛、しびれのVASスコアはいずれも6/10を示しており、入院当日に待期的左L1神経根ブロックを施行した。直後に疼痛緩和が得られたものの、翌日には症状増悪を呈したため、第10病日に顕微鏡下椎間板切除術を行った。その後は症状の緩和が得られ6日目に退院、3ヵ月後にしびれ消失が認められた。

Language：English   Publisher：Journal of Bone and Mineral Research  

Adolescent idiopathic scoliosis (AIS) is a serious health problem affecting 3% of live births all over the world. Many loci associated with AIS have been identified by previous genome wide association studies, but their biological implication remains mostly unclear. In this study, we evaluated the AIS-associated variants in the 7p22.3 locus by combining in silico, in vitro, and in vivo analyses. rs78148157 was located in an enhancer of UNCX, a homeobox gene and its risk allele upregulated the UNCX expression. A transcription factor, early growth response 1 (EGR1), transactivated the rs78148157-located enhancer and showed a higher binding affinity for the risk allele of rs78148157. Furthermore, zebrafish larvae with UNCX messenger RNA (mRNA) injection developed body curvature and defective neurogenesis in a dose-dependent manner. rs78148157 confers the genetic susceptibility to AIS by enhancing the EGR1-regulated UNCX expression. © 2022 American Society for Bone and Mineral Research (ASBMR).

DOI： 10.1002/jbmr.4738

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PubMed

Language：Japanese   Publisher：Kyushu Physical Therapy Association  

<p>【はじめに】 今回脊椎関節炎（spondyloarthritis：SpA）と診断され薬物療法後のCRP低下後に残存した仙腸関節部の動作時痛に対して、理学療法介入による運動療法にて改善を得た症例を経験したので報告を行う。</p><p>【症例】 60歳代女性。X年4月の仕事後から両側腰部・殿部・大腿部の疼痛が出現し歩行困難となったため他院へ入院。化膿性脊椎炎の診断で治療継続されていたが、炎症反応高値が遷延したため同年5月に当院内科に精査入院となりSpAと診断された。入院時に両殿部に自発痛（安静時・起居動作時NRS：4）があり、MRIにて両側仙腸関節にSTIR高信号域を認めた。入院時の血液検査はCRP：28.23 ㎎/㎗と高値であった。股関節伸展制限（右−30度／左−10度）、Patrick test両側陽性であった。BI：25点であり日常動作全般において介助を要した。</p><p>　入院後早期にステロイド投与開始し、投与後24日目でCRPが沈静化し、安静時痛の軽減を認めた。しかし起き上がり動作・歩行動作時の疼痛は依然として持続していた。</p><p>【理学療法アプローチ】 理学療法介入は入院後10日目から開始し、脊椎や股関節の関節可動域訓練・起居動作訓練を実施。入院後27日目にCRP値が沈静化するも、One finger testにて動作時の仙結節靭帯部痛が持続していたため、プログラムの再構築を行なった。起き上がり動作では上肢により柵を引っ張ることで腰椎過前弯が生じ疼痛を誘発していた。また歩行動作では右下肢立脚中期～後期にかけて股関節伸展制限の代償として腰椎過前弯が生じ疼痛を誘発していた。このような動作を繰り返していたことで多裂筋の筋緊張が亢進し、付着する仙結節靭帯部の疼痛を誘発していると考えた。さらに腰椎過前弯が生じる原因として腹部低緊張が認められ、ASLRが困難であったことから骨盤帯周囲筋の機能不全と考えた。アプローチとして骨盤帯の安定性に寄与する腹横筋、横隔膜、骨盤底筋群、多裂筋のコアユニットに着目し、ドローイン、四つ這い運動、座位バランスクッション上運動を段階的に実施した。結果、起き上がり動作時・歩行時の疼痛は消失（NRS：0）し、BI：90点となり入院後85日目で杖歩行自立となったため自宅退院することが可能となった。</p><p>【考察】 SpAは脊椎や仙腸関節といった体軸関節や、手指関節などの末梢関節に炎症を来す疾患である。治療の第一選択薬は生物学的製剤やステロイドであり、反応は比較的良好とされる。仙腸関節の関節包や靭帯組織には侵害受容器が多数存在し疼痛の発生源となる事や、関節の不安定性を有した仙腸関節で反復動作が行われることで疼痛が生じるとの報告もされている。仙腸関節への負荷軽減にはコアユニットを同時に働かせることが重要であるとされており、本症例に行なった治療は効果的であったと考えられる。</p><p>【まとめ】 近年薬物療法の進歩により早期からの治療効果が期待できるが、殿部痛が遺残した場合には仙結節靭帯部の評価・治療介入が有用である症例が存在することが示唆された。</p><p>【倫理的配慮】 ヘルシンキ宣言に基づき、本報告の目的や内容について書面を用いて説明し、署名を持って同意を得た。</p>

DOI： 10.32298/kyushupt.2023.0_31

CiNii Research

Language：English   Publisher：Medicine (United States)  

A retrospective multicenter study. Body mass index (BMI) is recognized as an important determinant of osteoporosis and spinal postoperative outcomes; however, the specific impact of BMI on surgery for osteoporotic vertebral fractures (OVFs) remains inconclusive. This retrospective multicenter study investigated the impact of BMI on clinical outcomes following fusion surgery for OVFs. 237 OVF patients (mean age, 74.3 years; 48 men and 189 women) with neurological symptoms who underwent spinal fusion were included in this study. Patients were grouped by World Health Organization BMI categories: low BMI (<18.5 kg/m2), normal BMI (≥18.5 and <25 kg/m2), and high BMI (≥25 kg/m2). Patients' backgrounds, surgical method, radiological findings, pain measurements, activities of daily living (ADL), and postoperative complications were compared after a mean follow-up period of 4 years. As results, the proportion of patients able to walk independently was significantly smaller in the low BMI group (75.0%) compared with the normal BMI group (89.9%; P = .01) and the high BMI group (94.3%; P = .04). Improvement in the visual analogue scale for leg pain was significantly less in the low BMI group than the high BMI group (26.7 vs 42.8 mm; P = .046). Radiological evaluation, the Frankel classification, and postoperative complications were not significantly different among all 3 groups. Improvement of pain intensity and ADL in the high BMI group was equivalent or non-significantly better for some outcome measures compared with the normal BMI group. Leg pain and independent walking ability after fusion surgery for patients with OVFs improved less in the low versus the high BMI group. Surgeons may want to carefully evaluate at risk low BMI patients before fusion surgery for OVF because poor clinical results may occur.

DOI： 10.1097/MD.0000000000032330

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PubMed

Publisher：金原出版  

DOI： 10.18888/se.0000002372

CiNii Research

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

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

Language：English   Publisher：BMC Musculoskeletal Disorders  

Background: The 1-year mortality and functional prognoses of patients who received surgery for cervical trauma in the elderly remains unclear. The aim of this study is to investigate the rates of, and factors associated with mortality and the deterioration in walking capacity occurring 1 year after spinal fusion surgery for cervical fractures in patients 65 years of age or older. Methods: Three hundred thirteen patients aged 65 years or more with a traumatic cervical fracture who received spinal fusion surgery were enrolled. The patients were divided into a survival group and a mortality group, or a maintained walking capacity group and a deteriorated walking capacity group. We compared patients’ backgrounds, trauma, and surgical parameters between the two groups. To identify factors associated with mortality or a deteriorated walking capacity 1 year postoperatively, a multivariate logistic regression analysis was conducted. Results: One year postoperatively, the rate of mortality was 8%. A higher Charlson comorbidity index (CCI) score, a more severe the American Spinal Cord Injury Association impairment scale (AIS), and longer surgical time were identified as independent factors associated with an increase in 1-year mortality. The rate of deterioration in walking capacity between pre-trauma and 1 year postoperatively was 33%. A more severe AIS, lower albumin (Alb) and hemoglobin (Hb) values, and a larger number of fused segments were identified as independent factors associated with the increased risk of deteriorated walking capacity 1 year postoperatively. Conclusions: The 1-year rate of mortality after spinal fusion surgery for cervical fracture in patients 65 years of age or older was 8%, and its associated factors were a higher CCI score, a more severe AIS, and a longer surgical time. The rate of deterioration in walking capacity was 33%, and its associated factors were a more severe AIS, lower Alb, lower Hb values, and a larger number of fused segments.

DOI： 10.1186/s12891-022-05752-5

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PubMed

Language：English   Publisher：The Japanese Society for Spine Surgery and Related Research  

<p>Introduction: In elderly patients with cervical spinal cord injury, comorbidities such as cardiovascular and cerebrovascular diseases are common, with frequent administration of antiplatelet/anticoagulant (APAC) drugs. Such patients may bleed easily or unexpectedly during surgery despite prior withdrawal of APAC medication. Few reports have examined the precise relationship between intraoperative blood loss and history of APAC use regarding surgery for cervical spine injury in the elderly. The present multicenter database survey aimed to answer the question of whether the use of APAC drugs affected the amount of intraoperative blood loss in elderly patients with cervical spinal cord trauma.</p><p>Methods: The case histories of 1512 patients with cervical spine injury at 33 institutes were retrospectively reviewed. After excluding cases without spinal surgery or known blood loss volume, 797 patients were enrolled. Blood volume loss was the outcome of interest. We calculated propensity scores using the inverse probability of treatment weighting (IPTW) method. As an alternative sensitivity analysis, linear mixed model analyses were conducted as well.</p><p>Results: Of the 776 patients (mean age: 75.1±6.4 years) eligible for IPTW calculation, 157 (20.2%) were taking APAC medications before the injury. After weighting, mean estimated blood loss was 204 mL for non-APAC patients and 215 mL for APAC patients. APAC use in elderly patients was not significantly associated with surgical blood loss according to the IPTW method with propensity scoring or linear mixed model analyses. Thus, it appeared possible to perform surgery expecting comparable blood loss in APAC and non-APAC cases.</p><p>Conclusions: This multicenter study revealed no significant increase in surgical blood loss in elderly patients with cervical trauma taking APAC drugs. Surgeons may be able to prioritize patient background, complications, and preexisting conditions over APAC use before injury when examining the surgical indications for cervical spine trauma in the elderly.</p>

DOI： 10.22603/ssrr.2021-0183

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PubMed

CiNii Research

Language：English   Publisher：The Japanese Society for Spine Surgery and Related Research  

<p>Introduction: Facet joints are anatomical structures that are known to be crucial for determining spinal biomechanical motion; however, the potential relationship between facet orientation and the development of cervical spondylolisthesis remains unclear. Thus, in this study, we aimed to explore the relationship between facet orientation and cervical spondylolisthesis as well as myelopathy.</p><p>Methods: Facet orientation in the cervical spine was investigated using computed tomography in 103 patients with cervical myelopathy, and facet inclination was measured on axial, coronal, and sagittal reconstructed images. Patients were divided into anterolisthesis, retrolisthesis, and no spondylolisthesis groups at each intervertebral level (C2/3-C6/7 levels).</p><p>Results: Facet joints in the anterolisthesis and retrolisthesis groups tended to slope posterolaterally and downward laterally compared with those in the no spondylolisthesis group at C3/4, C4/5, and C5/6 levels (P<0.001).</p><p>Conclusions: The posterolaterally oriented and laterally downward sloping facet at C3/4 and C4/5 levels may be a risk factor for the development of cervical spondylolisthesis as well as symptomatic myelopathy.</p>

DOI： 10.22603/ssrr.2021-0181

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PubMed

CiNii Research

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

椎間関節の配向性と頸椎変性すべり症、骨髄症発症との関連を検討した。頸髄症患者103例(男性60例、女性43例、平均72.5歳)を対象にCT画像を用いて頸椎における椎間関節の配向性を測定し、軸方向、冠状方向、矢状方向への椎間関節の傾斜度を評価した。被験者はC2/3-C6/7レベルでの前方すべり症群、後方すべり症群、無すべり症群に分類した。検討の結果、頸椎変性すべり症(DSL)を66例(64.1%)に認め、このうち30例が単一レベル、36例が複数レベルの発症であった。DSL計113件のうち、C2/3は5件、C3/4は37件、C4/5は35件、C5/6は30件、C6/7は6件となっており、C3/4とC4/5では前方すべり症が多く、C3/4-C5/6において後方すべり症が多かった。椎間関節の配向性に関して、軸方向の配位はC3/4とC4/5においてすべり症群の方が無すべり症群より有意に小さく、冠状方向の配位はC3/4において前方すべり症群が有意に小さく、C4/5では後方すべり症が有意に小さかった。無すべり症群との比較において、前方すべり症群、後方すべり症群ともにC3/4、C4/5およびC5/6の各レベルで椎間関節の後側方傾斜と側方下方傾斜が生じていた。椎間関節の後側方傾斜と側方下方傾斜は頸髄症と症候性脊髄症発症のリスク因子と成り得ることが示された。

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

頸椎損傷をきたした高齢患者において抗血小板剤/抗凝固薬(APAC)の服用が術中出血量に影響を及ぼすのかどうか検討した。日本国内の33施設で頸椎損傷に対して手術を受けた797例のうち、inverse probability weighting(IPTW)を用いて傾向スコアを算出した776例を解析対象とした。このうちAPAC服用群が157例(男性123例、女性34例、平均76.3±6.1歳)、APAC非服用群が619例(男性411例、女性208例、平均74.7±6.4歳)であった。検討の結果、平均推定出血量はAPAC非服用群が204mL、APAC服用群が215mLと有意な群間差は認められず、受傷翌日までに手術を受けた患者に限定してもAPAC非服用群が250±315mL、服用群が334±318mLであり有意差はなかった。また、抗血小板剤服用群と非服用群、抗凝固剤服用群と非服用群に分類した場合も術中出血量に有意な差はみられなかった。このほか、術中合併症の発症を認めたのはAPAC非服用群が20例(3.2%)、服用群が7例(4.5%)と有意差はなく、1000mL以上の大量出血がみられたのはAPAC非服用群が14例(2.3%)、服用群が5例(3.2%)であり有意な群間差はなかった。APACを服用している高齢患者において、頸椎損傷に対する手術中の出血量の有意な増大は認められなかった。

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

脊柱および後部胸壁に浸潤する悪性腫瘍に対する外科治療の長期成績を評価した。1999～2007年に脊柱周囲の悪性腫瘍に対して後部胸壁を含めた一括切除を施行した10例(男性6例、女性4例、平均年齢40.9歳)を対象とした。術後の経過観察期間は平均159.7ヵ月であった。全例、前方+後方アプローチにて手術を施行し、切除椎骨数は平均3.1、切除肋骨数は平均4.1、肺下葉または上葉切除術を4例、横隔膜部分切除術を2例に行った。術後、5例に呼吸器合併症を認めたが迅速に改善し、呼吸不全をきたした症例はなかった。骨肉腫の1例は肺転移をきたして術後99ヵ月に死亡した。最終経過観察時、局所再発が1例、無病生存が5例、生存が3例であった。脊柱と後部胸壁に生じた悪性腫瘍の患者に対する一括切除および再建術は良好な長期成績を示した。

Language：English   Publisher：Journal of Orthopaedic Science  

Background: Malignant tumors occurring around both the spinal column and posterior chest wall are uncommon. Surgical resection of chest wall tumors adjacent to the spinal column is still challenging due to the surrounding anatomical structures. The purpose of the present study was to evaluate the long-term outcomes of surgical management in malignant tumors involving the spinal column and posterior chest wall. Methods: Between 1999 and 2007, 10 consecutive patients underwent en bloc resection combined with the posterior chest wall in the treatment of malignant tumors around the spinal column. There were 6 males and 4 females with a mean age at the surgery of 40.9 years old (range, 14–62 years old). The mean postoperative follow-up period was 159.7 months (range, 84–245 months). The clinical history, physical examination, laboratory data, radiological findings, and operative findings for each patient were retrospectively reviewed. Results: All surgeries were performed via a combined anterior and posterior approach. The mean numbers of partially resected vertebrae and ribs were 3.1 and 4.1, respectively. Lower or upper lobectomy was performed in four patients, and the diaphragm was partially resected in two patients. The surgical margin was wide in seven patients and marginal in two patients. Although five patients had postoperative respiratory problem, all patients improved immediately without life-threatening complications. There were no patients with respiratory insufficiency after surgery. One patient with osteosarcoma died of lung metastases 99 months after surgery. At the final follow-up, only one patient had local recurrence, five had been continuously disease-free, and three were alive with no evidence of disease. Conclusions: En bloc resection and reconstruction in selected patients with malignant tumors involving both the spinal column and posterior chest wall demonstrated good long-term results for local control and the respiratory function.

DOI： 10.1016/j.jos.2021.03.017

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PubMed

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

前庭神経鞘腫を伴わない多発性脊椎神経鞘腫患者のX線学的所見と治療法について検討した。多発性脊椎神経鞘腫患者19例(男性13例、女性6例、平均45.2歳)を対象とした。神経線維腫症1(NF1)とNF2を除く孤発性脊椎神経鞘腫162例(男性84例、女性78例、平均50.8歳)との比較では、男女比は多発性神経鞘腫群の方が高く、年齢は低い傾向にあったが有意差はみられなかった。多発性脊椎神経鞘腫19例のうち7例(36.8%)は脊椎神経根や馬尾のほか末梢神経にも神経鞘腫の発症が認められ、術前のMRIまたはCT脊髄造影によって計140以上の脊髄腫瘍が検出された。罹患部位は頸椎が5例(26.3%)、胸椎が11例(57.9%)、胸腰椎が16例(84.2%)、仙骨が1例(5.3%)となっていた。初発症状としては体幹または四肢の疼痛が17例(89.5%)と最も多く、知覚障害や四肢の運動機能低下、膀胱機能障害といった神経症状を15例(78.9%)に認めた。19例に対して計28回の脊椎手術を施行し、単回手術が13例、複数回の手術が6例で、術後の病理所見に関して単回手術群と複数回手術群との間に明らかな差はみられなかった。全例手術によって症状の改善が得られ、最終経過観察時におけるJOAスコアの平均回復率は63.6±31.8%であった。前庭神経鞘腫を伴わない多発性脊椎神経鞘腫に対する手術療法は安全かつ有効な治療法であることが示された。

Language：English   Publisher：Journal of Orthopaedic Science  

Background: Multiple spinal cord tumors in a single patient are very rare and most often seen in cases of neurofibromatosis and associated disorders. Schwannomatosis, which is characterized by the development of multiple schwannomas without vestibular schwannomas, has been newly defined as a distinct form of neurofibromatosis. The purpose of the present study was to describe and review the clinical and radiological features and the management of patients with multiple spinal schwannomas without vestibular schwannomas. Methods: Between 1986 and 2016, 19 patients with multiple spinal schwannomas without vestibular schwannoma were diagnosed and treated. Of the 19 patients, 13 were males, and 6 were females. The mean age at the first surgery for spinal schwannoma was 45.2 years old. The mean follow-up period was 123.4 months. The clinical features and radiological findings of the patients with multiple spinal schwannomas were retrospectively reviewed. Results: Among the 19 patients, there were more than 140 spinal schwannomas. The most common area of spinal schwannoma was the thoracolumbar-lumbar region. Initial symptoms and chief complaints caused by spinal schwannomas were primarily pain in the trunk or extremities in 17 (89.5%) of 19 patients. More than 60 spinal schwannomas were surgically resected. Multiple spinal surgeries were required in six patients. In all 19 patients, surgical treatment has provided successful relief of symptoms and neurological recovery. Conclusions: Surgical treatment was safe and effective in patients with multiple spinal schwannomas without vestibular schwannomas. After surgery, we recommend that all patients be followed with magnetic resonance imaging to monitor for asymptomatic tumors or detect new tumors early.

DOI： 10.1016/j.jos.2021.02.014

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DOI： 10.1186/s12891-020-03539-0.

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DOI： 10.1007/s00586-019-06092-0.

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DOI： 10.1186/s12891-020-03452-6.

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DOI： 10.1016/j.jor.2020.05.021.

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DOI： 10.22603/ssrr.2019-0079.

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DOI： 10.1016/j.jos.2019.07.018.

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DOI： 10.1097/01.BRS.0000113891.27658.5F

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

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

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

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

DOI： 10.1245/aso.2001.8.10.807

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

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

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

DOI： 10.1023/A:1006791723233

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

DOI： 10.1359/jbmr.1999.14.12.2089

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

DOI： 10.1016/S0883-5403(99)90078-5

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

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

DOI： 10.1172/JCI119152

Responsible for pages：160-163   Language：Japanese   Book type：Scholarly book

Responsible for pages：166-183   Language：Japanese   Book type：Scholarly book

Responsible for pages：64-72   Language：Japanese   Book type：Scholarly book

Responsible for pages：320-325   Language：Japanese   Book type：Scholarly book

Responsible for pages：104-105   Language：Japanese   Book type：Scholarly book

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Responsible for pages：81-84   Language：Japanese   Book type：Scholarly book

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Responsible for pages：22-26   Language：Japanese   Book type：Scholarly book

Responsible for pages：22-26   Language：Japanese   Book type：General book, introductory book for general audience

Responsible for pages：63   Language：Japanese   Book type：Scholarly book

Responsible for pages：34-37   Language：Japanese   Book type：Scholarly book

Responsible for pages：38   Language：Japanese   Book type：Scholarly book

Responsible for pages：39-41   Language：Japanese   Book type：Scholarly book

Responsible for pages：201   Language：Japanese   Book type：Scholarly book

Responsible for pages：117-119   Language：Japanese   Book type：Scholarly book

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Responsible for pages：709-732   Language：Japanese   Book type：Scholarly book

Responsible for pages：21-37   Language：Japanese   Book type：Scholarly book

Responsible for pages：pp. 34-39   Language：Japanese   Book type：Scholarly book

Responsible for pages：pp. 680-682   Language：Japanese   Book type：Scholarly book

Responsible for pages：p. 682   Language：Japanese   Book type：Scholarly book

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Responsible for pages：72-74   Language：Japanese   Book type：Scholarly book

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Responsible for pages：Vol.39、 80-91   Language：Japanese   Book type：Scholarly book

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Responsible for pages：46-49   Language：Japanese   Book type：Scholarly book

Responsible for pages：Vol 21 (11): 1139   Language：Japanese   Book type：Scholarly book

Responsible for pages：206-210   Language：Japanese   Book type：Scholarly book

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Safety and Accuracy of Pedicle Screws Placed in Infantile and Juvenile Patients

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Venue：福岡   Country：Japan  

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Venue：神戸   Country：Japan  

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Venue：神戸   Country：Japan  

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Venue：神戸   Country：Japan  

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Venue：神戸   Country：Japan  

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Venue：神戸   Country：Japan  

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Venue：高知   Country：Japan  

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Venue：大阪   Country：Japan  

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Venue：幕張   Country：Japan  

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Venue：福岡   Country：Japan  

Venue：岐阜   Country：Japan  

Venue：広島   Country：Japan  

Venue：岡山   Country：Japan  

Venue：福岡   Country：Japan  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publisher：大道学館出版部  

Language：Japanese   Publisher：大道学館出版部  

Language：Japanese   Publisher：(株)メディカ出版  

Language：Japanese   Publisher：(株)メディカ出版  

Language：Japanese   Publisher：(株)メディカ出版  

Language：English   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Internal/External technical report, pre-print, etc.  

Language：Japanese   Publishing type：Internal/External technical report, pre-print, etc.  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Internal/External technical report, pre-print, etc.  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Type：Peer review 

Number of peer-reviewed articles in foreign language journals：6

Number of peer-reviewed articles in Japanese journals：2

Proceedings of domestic conference Number of peer-reviewed papers：52

Type：Peer review 

Number of peer-reviewed articles in foreign language journals：3

Number of peer-reviewed articles in Japanese journals：3

Proceedings of International Conference Number of peer-reviewed papers：0

Proceedings of domestic conference Number of peer-reviewed papers：62

Type：Competition, symposium, etc. 

Type：Competition, symposium, etc. 

Type：Competition, symposium, etc. 

Type：Competition, symposium, etc. 

Type：Competition, symposium, etc. 

Type：Competition, symposium, etc. 

Type：Competition, symposium, etc. 

Type：Competition, symposium, etc.