Updated on 2023/07/19

写真a

 
NAKASHIMA Hiroaki
 
Organization
Graduate School of Medicine Program in Integrated Medicine Biomedical Regulation Associate professor
Graduate School
Graduate School of Medicine
Undergraduate School
School of Medicine Department of Medicine
Title
Associate professor

Degree 1

  1. 博士(医学) ( 2016.10   名古屋大学 ) 

Research Interests 4

  1. 骨再生

  2. 神経再生

  3. 脊柱変形

  4. 難治性脊椎・脊髄疾患

Awards 9

  1. 第12回Nagoya Spine Groupアワード 論文部門 銀賞

    2019   Nagoya Spine Group  

  2. 日本整形外科学会 JOA-AOA Traveling Fellow

    2019   日本整形外科学会  

  3. Asia Traveling Fellow

    2018   日本脊椎脊髄病学会  

  4. 第11回Nagoya Spine Groupアワード 論文部門 金賞

    2018   Nagoya Spine Group  

  5. 日本整形外科学会・香港骨科医学会 Exchange Traveling Fellow

    2018   日本整形外科学会  

  6. 優秀論文賞 金賞

    2017   東海骨関節疾患研究会  

  7. 第10回Nagoya Spine Groupアワード 発表部門 金賞

    2017   Nagoya Spine Group  

  8. 日本脊椎脊髄病学会奨励賞 大正富山Award

    2017   日本脊椎脊髄病学会  

  9. 日本整形外科学会奨励賞

    2017   日本整形外科学会  

▼display all

 

Papers 153

  1. Age-related degenerative changes and sex-specific differences in osseous anatomy and intervertebral disc height of the thoracolumbar spine

    Machino M., Nakashima H., Ito K., Katayama Y., Matsumoto T., Tsushima M., Ando K., Kobayashi K., Imagama S.

    Journal of Clinical Neuroscience   Vol. 90   page: 317 - 324   2021.8

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    Language:Japanese   Publisher:Journal of Clinical Neuroscience  

    The aim of this study was to determine age-related changes and sex-specific differences in sagittal alignment, range of motion (ROM), and intervertebral disc height of the thoracolumbar spine in healthy subjects. Lateral neutral and flexion–extension radiographs of the thoracolumbar spine of 627 asymptomatic subjects (307 males and 320 females; average age, 49.6 ± 16.5 years) were evaluated. We included at least 50 males and 50 females in each decade of life between the 20s and the 70s. Intervertebral disc height from T10/T11 to L5/S1, local lordotic alignment, and ROM from T10–T11 to L5–S1 were measured. T10–L2 kyphosis and T12–S1 lordosis as well as flexion, extension, and total ROM were measured. T10–L2 kyphosis did not markedly change with age in subjects of either sex but a sudden increase was noted in the 70s females. T12–S1 lordosis increased with age in both sexes, except the 70s. Flexion, extension, and total ROM at T10–L2 and T12–S1 decreased with age in most subjects. The levels from L3–L4 to L5–S1 were conspicuous as mobile segments. Intervertebral disc height gradually increased from T10/T11 to L4/L5; the shortest was at T10/T11 and the longest at L3/L4 or L4/L5 in all subjects. Age-related decreases in intervertebral disc height were most prominent at L4/L5 in middle-aged and elderly individuals of both sexes. Normative values of sagittal alignment, ROM, and intervertebral disc height at each segmental level were established in both sexes and all age groups in healthy subjects.

    DOI: 10.1016/j.jocn.2021.06.020

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  2. Characteristics of cases with and without calcification in spinal meningiomas.

    Kobayashi K, Ando K, Nakashima H, Machino M, Kanbara S, Ito S, Inoue T, Yamaguchi H, Koshimizu H, Segi N, Imagama S

    Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia   Vol. 89   page: 20 - 25   2021.7

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    Purpose: To quantify calcification in spinal meningiomas using Hounsfield unit (HU) values on CT, and to analyze the characteristics of cases with and without calcification and with different histologic subtypes. Methods: The subjects were 53 patients who underwent surgical resection of spinal meningioma between January 1999 and December 2019. Clinical and surgical data were collected, and all patients were examined neurologically preoperatively and at final follow-up using the modified McCormick scale and the American Spinal Injury Association scale. Calcification was quantified on CT of the spine prior to surgery. A HU value >60 was considered to indicate calcification. Results: The 53 patients (11 males, 42 females) were aged 62.4 ± 14.3 (range 19 to 91) years at surgery, and had a symptom duration of 10.8 ± 9.0 (1–36) months. The histological type was meningothelial in 35 cases, psammomatous in 13, and others in 5. The mean tumor volume was 1166 ± 350 (593–2176) mm3, and the mean HU value was 212.2 ± 192.8 (43–648). Forty cases (75%) had calcification (HU value > 60). HU values were significantly related to duration of symptoms (R = 0.590, p < 0.05) and significantly higher in psammomatous cases (p < 0.05). Cases with calcification had longer operative times and greater blood loss, and a significantly lower rate of neurological improvement. Conclusion: CT was effective for detecting calcification based on HU values. Detection of a HU value > 60 in spinal meningioma may be useful to narrow the differential diagnosis, evaluate the difficulty of resection, and improve intraoperative management, all of which may improve outcomes.

    DOI: 10.1016/j.jocn.2021.04.019

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  3. Does pulmonary function improve after surgical correction of adult idiopathic scoliosis?

    Nakashima H, Kawakami N, Ohara T, Saito T, Tauchi R, Imagama S, Redding GJ

    Spine deformity     2021.6

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    DOI: 10.1007/s43390-021-00379-3

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  4. Normative Magnetic Resonance Imaging Data of Age-Related Degenerative Changes in Cervical Disc Morphology.

    Machino M, Ito K, Ando K, Kobayashi K, Nakashima H, Kato F, Imagama S

    World neurosurgery     2021.6

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    DOI: 10.1016/j.wneu.2021.05.123

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  5. Lumbar Thecal Sac Dimensions and Axial Spinal Cord Areas on Magnetic Resosnace Imaging in 626 Healthy Subjects.

    Nakashima H, Ito K, Katayama Y, Matsumoto T, Tsushima M, Ando K, Kobayashi K, Machino M, Imagama S

    Spine     2021.6

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    DOI: 10.1097/BRS.0000000000004143

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  6. Neurological improvement is associated with neck pain attenuation after surgery for cervical ossification of the posterior longitudinal ligament.

    Koda M, Yoshii T, Egawa S, Sakai K, Kusano K, Nakagawa Y, Hirai T, Wada K, Katsumi K, Kimura A, Furuya T, Maki S, Nagoshi N, Watanabe K, Kanchiku T, Nagamoto Y, Oshima Y, Ando K, Nakashima H, Takahata M, Mori K, Nakajima H, Murata K, Matsunaga S, Kaito T, Yamada K, Kobayashi S, Kato S, Ohba T, Inami S, Fujibayashi S, Katoh H, Kanno H, Takahashi H, Fujii K, Miyagi M, Inoue G, Takaso M, Imagama S, Kawaguchi Y, Takeshita K, Nakamura M, Matsumoto M, Okawa A, Yamazaki M

    Scientific reports   Vol. 11 ( 1 ) page: 11910   2021.6

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    Although favourable surgical outcomes for myelopathy caused by cervical ossification of the posterior longitudinal ligament (OPLL) have been reported, factors significantly associated with post-operative neck pain attenuation still remain unclear. The primary aim of the present study was to determine factors significantly associated with post-operative neck pain attenuation in patients with cervical OPLL using a prospective multi-centre registry of surgically treated cervical OPLL. Significant postoperative neck pain reduction (50% reduction of neck pain) was achieved in 31.3% of patients. There was no significant difference in neck pain attenuation between surgical procedures. Statistical analyses with univariate analyses followed by stepwise logistic regression revealed neurological recovery as a factor having a significant positive association with post-operative neck pain attenuation (p = 0.04, odds ratio 5.68 (95% confidence interval: 1.27–22.2)). In conclusion, neurological recovery was an independent factor having a significant positive association with post-operative neck pain attenuation in patients with cervical myelopathy caused by OPLL who underwent cervical spine surgery.

    DOI: 10.1038/s41598-021-91268-2

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  7. Zonisamide upregulates neuregulin-1 expression and enhances acetylcholine receptor clustering at the in vitro neuromuscular junction.

    Inoue T, Ohkawara B, Bushra S, Kanbara S, Nakashima H, Koshimizu H, Tomita H, Ito M, Masuda A, Ishiguro N, Imagama S, Ohno K

    Neuropharmacology   Vol. 195   page: 108637   2021.6

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    DOI: 10.1016/j.neuropharm.2021.108637

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  8. Clinical features and prognostic factors in spinal meningioma surgery from a multicenter study.

    Kobayashi K, Ando K, Matsumoto T, Sato K, Kato F, Kanemura T, Yoshihara H, Sakai Y, Hirasawa A, Nakashima H, Imagama S

    Scientific reports   Vol. 11 ( 1 ) page: 11630   2021.6

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    Meningiomas are benign tumors that are treated surgically. Local recurrence is likely if the dura is preserved, and en bloc tumor and dura resection (Simpson grade I) is recommended. In some cases the dura is cauterized and preserved after tumor resection (Simpson grade II). The purpose of this study was performed to analyze clinical features and prognostic factors associated with spinal meningioma, and to identify the most effective surgical treatment. The subjects were 116 patients (22 males, 94 females) with spinal meningioma who underwent surgery at seven NSG centers between 1998 and 2018. Clinical data were collected from the NSG database. Pre- and postoperative neurological status was defined using the modified McCormick scale. The patients had a mean age of 61.2 ± 14.8 years (range 19–91 years) and mean symptom duration of 11.3 ± 14.7 months (range 1–93 months). Complete resection was achieved in 108 cases (94%), including 29 Simpson grade I and 79 Simpson grade II resections. The mean follow-up period was 84.8 ± 52.7 months. At the last follow-up, neurological function had improved in 73 patients (63%), was stable in 34 (29%), and had worsened in 9 (8%). Eight patients had recurrence, and recurrence rates did not differ significantly between Simpson grades I and II in initial surgery. Kaplan–Meier analysis of recurrence-free survival showed that Simpson grade III or IV, male, and dural tail sign were significant factors associated with recurrence (P < 0.05). In conclusion, Simpson I resection is anatomically favorable for spinal meningiomas. Younger male patients with a dural tail and a high-grade tumor require close follow-up. The tumor location and feasibility of surgery can affect the surgical morbidity in Simpson I or II resection. All patients should be carefully monitored for long-term outcomes, and we recommend lifelong surveillance after surgery.

    DOI: 10.1038/s41598-021-91225-z

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  9. Pedicle screw placement with use of a navigated surgical drill at subaxial cervical spine

    Satake Kotaro, Kanemura Tokumi, Ito Kenyu, Tanaka Satoshi, Morita Yoshinori, Nakashima Hiroaki, Ouchida Jun, Imagama Shiro

    JOURNAL OF CLINICAL NEUROSCIENCE   Vol. 88   page: 28 - 33   2021.6

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    Language:Japanese   Publisher:Journal of Clinical Neuroscience  

    Study design: Retrospective cohort study. Objective: This study was performed to evaluate the accuracy of cervical pedicle screw (CPS) placement with use of a navigated surgical drill (ND) and to compare it with navigated manual probe (MP) at C3–C6. Methods: 47 consecutive patients (27 males and 20 females, 67.2 [33–91] years) underwent a posterior cervical fixation using CPSs under an intraoperative 3D - – CT based navigation system (total 207 CPSs). For initial probing, ND with 2.2-mm steel burr was used since Apr. 2017 (Group ND; 33 patients, 152 CPSs). MP was used earlier (Group MP; 14 patients, 55 CPSs). There were no other different procedures between the two groups. The accuracy of CPS placement was graded with postoperative CT and compared between the two groups. Results: There were no significant differences in the total perforation rates both in axial and sagittal planes between Groups ND and MP (axial; 7.2% vs. 14.5%, p = 0.25, sagittal; 10.5% vs. 14.5%, p = 0.46). However, the lateral and rostral perforation rates were significantly reduced in Group ND compared to Group MP (lateral: 36.4% vs. 87.5%, p = 0.04; rostral: 6.3% vs. 100%, p = 0.001). Conclusion: Although ND did not decrease the total perforation rate significantly, it reduced the incidence of lateral and rostral perforation. ND is likely to make initial probing easier without a forcible manipulation which might cause vertebral rotation.

    DOI: 10.1016/j.jocn.2021.03.009

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  10. Human Nonmercaptalbumin Is a New Biomarker of Motor Function

    Ito Sadayuki, Nakashima Hiroaki, Ando Kei, Kobayashi Kazuyoshi, Machino Masaaki, Seki Taisuke, Ishizuka Shinya, Kanbara Shunsuke, Inoue Taro, Koshimizu Hiroyuki, Fujii Ryosuke, Yamada Hiroya, Ando Yoshitaka, Ueyama Jun, Kondo Takaaki, Suzuki Koji, Hasegawa Yukiharu, Imagama Shiro

    JOURNAL OF CLINICAL MEDICINE   Vol. 10 ( 11 )   2021.6

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  11. MeCP2 controls neural stem cell fate specification through miR-199a-mediated inhibition of BMP-Smad signaling

    Nakashima Hideyuki, Tsujimura Keita, Irie Koichiro, Imamura Takuya, Trujillo Cleber A., Ishizu Masataka, Uesaka Masahiro, Pan Miao, Noguchi Hirofumi, Okada Kanako, Aoyagi Kei, Andoh-Noda Tomoko, Okano Hideyuki, Muotri Alysson R., Nakashima Kinichi

    CELL REPORTS   Vol. 35 ( 7 )   2021.5

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    Language:Japanese   Publisher:Cell Reports  

    Rett syndrome (RTT) is a severe neurological disorder, with impaired brain development caused by mutations in MECP2; however, the underlying mechanism remains elusive. We know from previous work that MeCP2 facilitates the processing of a specific microRNA, miR-199a, by associating with the Drosha complex to regulate neuronal functions. Here, we show that the MeCP2/miR-199a axis regulates neural stem/precursor cell (NS/PC) differentiation. A shift occurs from neuronal to astrocytic differentiation of MeCP2- and miR-199a-deficient NS/PCs due to the upregulation of a miR-199a target, Smad1, a downstream transcription factor of bone morphogenetic protein (BMP) signaling. Moreover, miR-199a expression and treatment with BMP inhibitors rectify the differentiation of RTT patient-derived NS/PCs and development of brain organoids, respectively, suggesting that facilitation of BMP signaling accounts for the impaired RTT brain development. Our study illuminates the molecular pathology of RTT and reveals the MeCP2/miR-199a/Smad1 axis as a potential therapeutic target for RTT.

    DOI: 10.1016/j.celrep.2021.109124

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  12. Risk factors for second hip fracture in elderly patients: an age, sex, and fracture type matched case-control study

    Fujita Tomoki, Takegami Yasuhiko, Ando Kei, Sakai Yasuomi, Nakashima Hiroatsu, Takatsu Shiro, Imagama Shiro

    EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY     2021.5

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    Language:Japanese   Publisher:European Journal of Orthopaedic Surgery and Traumatology  

    Purpose: Prevention of second hip fracture is mandatory for orthopedic surgeons. We aimed to clarify the incidence and duration of second hip fracture, to compare survival rate and walking ability of patients with a second hip fracture to that of patients with a unilateral fracture, and to identify risk factors for second hip fracture using matched case–control methods. Methods: This retrospective study conducted in a single tertiary emergency center comprised 119 patients with second hip fractures who underwent bilateral operations at our institution from 2007 to 2017 (second hip fracture group [Group A]). The control group (Group B) comprised 357 patients matched to Group A for age, sex, and fracture type. Results: The incidence of second hip fracture was 7.6%, and the average interval from initial fracture to second hip fracture was 22.8 months. Significantly more patients in Group A had decreased postoperative walking ability. Five-year survival rates from initial fracture were 65.0% in Group A and 50.6% in Group B (P = 0.346). Dementia and heart disease were identified as independent risk factors (dementia: HR 2.08, 95% CI 1.27–3.41, P = 0.004; heart disease: HR 1.27, 95% CI1.11–3.22, P = 0.019). Valvular disease was also revealed to be a risk factor for heart disease (P = 0.0272). Conclusions: The incidence of second hip fracture was not low. Although survival rates did not differ between the patients with or without second hip fracture, walking ability of patients with second hip fracture worsened. Dementia and cardiac disease could be risk factors for second hip fracture in elderly patients, and valvular disease might be associated with second hip fracture in patients with heart disease.

    DOI: 10.1007/s00590-021-02996-0

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  13. Comparison of Surgical Outcomes After Open- and Double-Door Laminoplasties for Patients with Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Multicenter Study.

    Nagoshi N, Yoshii T, Egawa S, Sakai K, Kusano K, Nakagawa Y, Hirai T, Wada K, Katsumi K, Fujii K, Kimura A, Furuya T, Kanchiku T, Nagamoto Y, Oshima Y, Nakashima H, Ando K, Takahata M, Mori K, Nakajima H, Murata K, Matsunaga S, Kaito T, Yamada K, Kobayashi S, Kato S, Ohba T, Inami S, Fujibayashi S, Katoh H, Kanno H, Watanabe K, Imagama S, Koda M, Kawaguchi Y, Takeshita K, Nakamura M, Matsumoto M, Yamazaki M, Okawa A

    Spine     2021.5

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    DOI: 10.1097/BRS.0000000000004094

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  14. Overcoming locomotive syndrome: The Yakumo Study

    Kobayashi Kazuyoshi, Ando Kei, Nakashima Hiroaki, Machino Masaaki, Kanbara Shunsuke, Ito Sadayuki, Inoue Taro, Yamaguchi Hidetoshi, Koshimizu Hiroyuki, Ishiguro Naoki, Hasegawa Yukiharu, Imagama Shiro

    MODERN RHEUMATOLOGY   Vol. 31 ( 3 ) page: 750 - 754   2021.5

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    Language:Japanese   Publisher:Modern Rheumatology  

    Objectives: Improvement of life expectancy is increasingly important with the aging of society. The aim of the study was to compare physical performance in elderly people in two 3-year periods (2001–2003) and (2016–2018). Methods: The participants were healthy Japanese elderly adults who attended public health check-ups in Yakumo. Results for 10 m gait time, two-step test, back muscle strength, and grip strength were examined prospectively for participants in 2001–2003 (Group A: n = 488) and 2016–2018 (Group B: n = 309) by gender and age (65–74 and 75–84 years). Results: There were significant differences between Groups A and B for 10 m gait time (age 65–74: male: 5.6 vs. 5.2 s, female: 6.3 vs. 5.5 s; age 75–84: male: 6.1 vs. 5.5 s, female: 6.7 vs. 5.8 s; all p <.05) and two-step test (age 65–74: male: 1.41 vs. 1.48, female: 1.35 vs. 1.44; age 75–84: male: 1.32 vs. 1.41, female: 1.30 vs. 1.38; all p <.05), but not for back muscle strength or grip strength. Conclusion: Our results suggest a phenomenon of ‘overcoming locomotive syndrome’, in which physical performance changed by aging, including motor functions such as 10 m gait time and two-step test, has improved in the current population compared with a similar population from 15 years ago.

    DOI: 10.1080/14397595.2021.1879413

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  15. Trends in PM2.5 Concentration in Nagoya, Japan, from 2003 to 2018 and Impacts of PM2.5 Countermeasures

    Yamagami Makiko, Ikemori Fumikazu, Nakashima Hironori, Hisatsune Kunihiro, Ueda Kayo, Wakamatsu Shinji, Osada Kazuo

    ATMOSPHERE   Vol. 12 ( 5 )   2021.5

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    In Japan, various countermeasures have been undertaken to reduce the atmospheric concentration of fine particulate matter (PM2.5). We evaluated the extent to which these countermeasures were effective in reducing PM2.5 concentrations by analyzing the long-term concentration trends of the major components of PM2.5 and their emissions in Nagoya City. PM2.5 concentrations decreased by 53% over the 16-year period from fiscal years 2003 to 2018 in Nagoya City. Elemental carbon (EC) was the component of PM2.5 with the greatest decrease in concentration over the 16 years, decreasing by 4.3 µg/m3, followed by SO42- (3.0 µg/m3), organic carbon (OC) (2.0 µg/m3), NH4+ (1.6 µg/m3), and NO3- (1.3 µg/m3). The decrease in EC concentration was found to be caused largely by the effect of diesel emission control. OC concentrations decreased because of the effects of volatile organic compound (VOC) emission regulations for stationary sources and reductions in VOCs emitted by vehicles and construction machinery. NO3- concentrations decreased alongside decreased contributions from vehicles, construction machinery, and stationary sources, in descending order of the magnitude of decrease. Although these findings identify some source control measures that have been effective in reducing PM2.5, they also reveal the ineffectiveness of some recent countermeasures for various components, such as those targeting OC concentrations.

    DOI: 10.3390/atmos12050590

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  16. Ossification of the posterior longitudinal ligament located on the concave side of the apex vertebra in adult spinal deformity

    Koshimizu Hiroyuki, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Machino Masaaki, Ito Sadayuki, Kanbara Shunsuke, Inoue Taro, Yamaguchi Hidetoshi, Imagama Shiro

    NAGOYA JOURNAL OF MEDICAL SCIENCE   Vol. 83 ( 2 ) page: 387 - 392   2021.5

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    A 48-year-old female patient presented with discomfort in the front of the chest. Whole spinal X-ray revealed a thoracic curve of 52°, and thoracic computed tomography (CT) myelography and magnetic resonance imaging (MRI) showed that ossification of the posterior longitudinal ligament (OPLL) on the concave side of the apex vertebra (T9) had highly compressed the spinal cord. Cervical MRI also showed that the C4-C5 intervertebral disc herniation mildly compressed the spinal nerve. In concomitant surgery, the patient underwent cervical laminoplasty, in which OPLL was removed by decompressive laminectomy and posterior correction surgery.In patients with adult spinal deformity (ASD), asymmetric mechanical stress at the apex vertebra can cause various abnormal conditions. Long-term local mechanical stress on the concave side of the apex vertebra might have affected OPLL formation in the present case. This is the first report of a surgical case for an ossification located on the concave side of the apex vertebra in a patient with ASD. Mechanical stress at the concave side of the apex vertebra was suspected to be a cause of formation of OPLL.

    DOI: 10.18999/nagjms.83.2.387

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  17. Age-related Changes in T1 and C7 Slope and the Correlation Between Them in More Than 300 Asymptomatic Subjects.

    Inoue T, Ando K, Kobayashi K, Nakashima H, Ito K, Katayama Y, Machino M, Kanbara S, Ito S, Yamaguchi H, Koshimizu H, Segi N, Kato F, Imagama S

    Spine   Vol. 46 ( 8 ) page: E474 - E481   2021.4

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    STUDY DESIGN: A cross-sectional analysis using T1 slope (T1S) and C7 slope (C7S) in asymptomatic individuals. OBJECTIVE: The aim of this study was to identify normative values, ranges of motion (ROMs), age-related changes in T1S and C7S, and correlation between the two slopes. SUMMARY OF BACKGROUND DATA: Few studies have reported age-related changes in the T1S and C7S angles. Additionally, studies investigating the effects of cervical position on these slopes are limited. METHODS: A total of 388 asymptomatic subjects (162 males and 226 females) for whom T1S measurement was performed on radiographs were enrolled in the study. The T1S and C7S angles were measured using neutral radiography of the cervical spine. ROMs were assessed by measuring the difference in alignment in the neutral position, flexion, and extension. RESULTS: The mean C7S and T1S angles were 19.6° (22.2° in males, 17.9° in females) and 24.0° (26.7° in men and 22.1° in women), respectively. The T1S angle was significantly greater than the C7S angle. Both the C7S and T1S angles significantly increased with age. The flexion ROM of C7S was higher than that of T1S, whereas no significant difference was detected between the extension ROMs of the two slopes. The flexion ROMs of the two slopes did not change, whereas the extension ROMs significantly increased with age. A significant positive correlation was observed between the C7S and T1S angles (r2 = 0.75). CONCLUSION: The normative values and age-related changes in C7S and T1S were analyzed. Both the C7S and T1S angles increased with age. The C7S angle was strongly correlated with the T1S angle, suggesting that C7S can substitute T1S on radiographic images.Level of Evidence: 3.

    DOI: 10.1097/BRS.0000000000003813

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  18. Conservative treatment of spondylolysis involving exercise initiated early and sports activities resumed with a lumbar-sacral brace.

    Nakashima H, Yoneda M, Kanemura T, Satake K, Ito K, Ouchida J, Ando K, Kobayashi K, Imagama S

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association     2021.4

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    Background: Conservative treatment including the use of a brace and cessation of sports activities is known to be effective in spondylolysis. However, there is some controversy regarding [1] the type of brace, and [2] the endpoint for bracing, and [3] the timing of resumption of sports activities. The aim of the current study was to investigate the appropriateness of early exercise and resumption of sports activities with a lumbar-sacral brace in very early- and early-stage lumbar spondylolysis. Methods: This prospective cohort study enrolled 45 patients with very early- and early-stage lumbar spondylolysis. A lumbar-sacral brace, structured to be a hard brace in the back and a mesh brace in the front, was used. Isometric exercises/stretching was started immediately after the initial visit. The number of patients for whom bone fusion was fully achieved on CT and the disappearance of signal intensity change on MRI were investigated. Results: In 12 cases of very early-stage spondylolysis, the average elapsed time until signal intensity disappearance as confirmed on MRI was 4.3 ± 1.6 months. Bony union on CT was confirmed in all cases. In 33 cases of early spondylolysis, signal intensity change disappeared on MRI within 5.2 ± 2.4 months. The rate of bony union was 94.3%, and the average period required to achieve bony union observable on CT was 3.7 ± 1.0 months. Conclusions: Sufficient bony union can be achieved by conservative treatment with early exercise and a lumbar-sacral brace in cases of very early and early spondylolysis.

    DOI: 10.1016/j.jos.2021.01.013

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  19. An ectomycorrhizal fungus, Cenococcum geophilum, in a coastal pine forest has a high tolerance for an insecticide used to control pine wilt disease

    Nakashima Hirofumi, Matsuda Yosuke, Hijii Naoki

    LANDSCAPE AND ECOLOGICAL ENGINEERING     2021.4

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    Language:Japanese   Publisher:Landscape and Ecological Engineering  

    Cenococcum geophilum Fr., one of several ectomycorrhizal species associated with black pine (Pinus thunbergii Parl.), is dominant in the coastal forests of Japan, even under adverse abiotic environmental conditions. In these forests, many tonnes of Sumipine® (fenitrothion) are applied every year to protect P. thunbergii from pine wilt disease, which is transmitted by a beetle. Here, we examined the effect of this insecticide on the species of fungi found as ectomycorrhizae on naturally regenerated P. thunbergii seedlings collected from coastal forest sites that had or had not been sprayed with fenitrothion. The proportion of C. geophilum ectomycorrhizae on black pine root tips was significantly higher in areas where fenitrothion had been applied than in areas where it had not. We measured the in vitro mycelial growth of C. geophilum as well as other ectomycorrhizal fungi of coastal black pine, Rhizopogon roseolus (Corda) Th. Fr. and Pisolithus arhizus (Scop.) Rauschert, at three levels of fenitrothion (density: 1.32 g/cm3), i.e., 0, 0.1 and 0.2 mL L−1. The growth of all three species decreased significantly as the fenitrothion dosage increased. However, the reduction of mycelial growth in response to fenitrothion was lower in C. geophilum than in the other two species. These results suggest that C. geophilum has a high tolerance for fenitrothion, which may explain its dominance over other ectomycorrhizal species in coastal forests in Japan where fenitrothion is routinely sprayed.

    DOI: 10.1007/s11355-021-00455-w

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  20. Synthesis of poly(N-isopropylacrylamide) by plasma-in-liquid process

    Hieda Junko, Nakashima Hitoshi, Hirano Manabu

    JAPANESE JOURNAL OF APPLIED PHYSICS   Vol. 60 ( 4 )   2021.4

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    Polymer synthesis was demonstrated by way of a plasma generated in bubbles in a monomer aqueous solution without a polymerization initiator reagent. Poly(N-isopropylacrylamide) (PNIPAM) was successfully synthesized by the plasma-in-liquid process. Radicals were generated by the plasma in the monomer solution, leading to the polymerization reaction. The molecular weights of PNIPAM synthesized at the discharge treatment time of 60 and 90 min were higher than those of PNIPAM synthesized at the discharge time of 10 and 30 min. The maximum m/z of PNIPAM synthesized at the discharge treatment time of 60 min was approximately 17 000. However, it decreased at the discharge treatment time of 90 min. This was attributed to the decomposition of the polymer, which occurred in the plasma-in-liquid process. Polymerization of the monomer proceeded only during the discharge process, in contrast with conventional polymerization processes. Thus, the generated radicals acted as both polymerization initiators and inhibitors.

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  21. Primary cervical decompression surgery may improve lumbar symptoms in patients with tandem spinal stenosis

    Inoue Taro, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Ito Keigo, Katayama Yoshito, Machino Masaaki, Kanbara Shunsuke, Ito Sadayuki, Yamaguchi Hidetoshi, Koshimizu Hiroyuki, Segi Naoki, Kato Fumihiko, Imagama Shiro

    EUROPEAN SPINE JOURNAL   Vol. 30 ( 4 ) page: 899 - 906   2021.4

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    Purpose: Tandem spinal stenosis (TSS) refers to coexisting lumbar and cervical canal stenosis. Evidence regarding whether cervical decompression improves lumbar symptoms in TSS is insufficient. Therefore, we determined the effectiveness of cervical decompression surgery for patients with lumbar spinal stenosis (LSS) and cervical spinal stenosis. Methods: The records of 64 patients with TSS experiencing lumbar symptoms who underwent cervical decompression surgery between April 2013 and July 2017 at a single institution were retrospectively reviewed. We categorized patients into the Non-improved (n = 20), Relapsed (n = 30), and Maintained-improvement (n = 14) groups according to the presence or absence of improvement and relapse in lower limb symptoms in TSS following cervical decompression surgeries. Results: Of 64 patients, 44 (69%) showed improved lower limb or low back symptoms, with 14 (22%) patients maintaining improvement. The preoperative cervical myelopathy-Japanese Orthopedic Association score and the preoperative number of steps determined using the 10-s step test were significantly lower in the Non-improved group than in the Maintained-improvement group. Receiver operating characteristic curve of preoperative 10-s step test results revealed 12 steps as a predictor for maintained improvement. Conclusion: The improvement of LSS symptoms following cervical decompression surgeries may be associated with the severity of cervical myelopathy as determined in clinical findings rather than in imaging findings. Patients with TSS having a 10-s step test result of < 12 steps were more likely to experience a relapse of lower limb symptoms following cervical decompression surgeries.

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  22. A preliminary examination of the association between locomotive syndrome and circulating miRNA-199 in community-dwelling people: The Yakumo study.

    Takegami Y, Seki T, Osawa Y, Makida K, Ochiai S, Nakashima H, Fujii R, Yamada H, Suzuki K, Hasegawa Y, Imagama S

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association     2021.3

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    Background: The risk of locomotive syndrome (LS) has been proposed as a criterion for evaluating physical ability. The expression levels of circulating miRNAs (c-miRNAs) are predictors of various diseases. This preliminary study aimed to evaluate the relationship between serum levels of several miRNAs and LS. Methods: We enrolled 423 participants in whom we conducted a survey with the 25-question Geriatric Locomotive Function Scale (GLFS-25) and measured the serum levels of 21 c-miRNAs. The relationship between the GLFS-25 and each c-miRNA was evaluated with a linear regression analysis, and independent associations between the GLFS-25 and each c-miRNA were assessed with a multiple regression analysis using various independent variables. Results: Only the serum level of miR-199 was significantly associated with LS after adjustment for age, BMI, sex, and all comorbidities. The receiver operating characteristics curve for the predictive value of the miR-199 level to indicate the presence or absence of LS risk had an area under the curve (AUC) of 0.576 (95% confidence interval: 0.501–0.651). Conclusion: The expression level of miRNA-199 was associated with the risk of LS in community-dwelling Japanese people.

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  23. Bioelectrical Impedance Analysis and Manual Measurements of Neck Circumference Are Interchangeable, and Declining Neck Circumference Is Related to Presarcopenia

    Machino Masaaki, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Tanaka Satoshi, Kanbara Shunsuke, Ito Sadayuki, Inoue Taro, Koshimizu Hiroyuki, Seki Taisuke, Ishizuka Shinya, Takegami Yasuhiko, Hasegawa Yukiharu, Imagama Shiro

    BIOMED RESEARCH INTERNATIONAL   Vol. 2021   page: 6622398   2021.3

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    Purpose. Preventive medicine is important in an aging society. Presarcopenia is the preliminary stage of sarcopenia. Recent advances in bioelectrical impedance analysis (BIA) devices have enabled automatic estimation of neck circumference (NC). However, the agreement between and interchangeability of NC measured manually and that calculated with BIA have not been evaluated. We performed these analyses in the context of health checkups and investigated their associations with presarcopenia. Methods. We enrolled 318 participants who underwent anthropometric measurements, including NC measured manually and by BIA; assessment of physical function; and blood testing. We used Bland-Altman analysis to calculate the agreement between and interchangeability of NC measurements by BIA and by the manual method. We then statistically compared normal participants and those with presarcopenia. Using multivariable analysis, we subsequently investigated significant risk factors for presarcopenia. We defined presarcopenia according to the appendicular skeletal muscle index (aSMI; the ratio of arm and leg skeletal muscle mass to height2). Results. Bland-Altman analysis showed that bias (BIA-manual) was negative overall (-1.07), for male participants (-1.23), and for female participants (-0.96). This finding suggests that BIA measurement is an underestimate in comparison with manual measurement. NC measurement by BIA was found to be interchangeable with that by manual methods, inasmuch as the percentage error was less than 5% overall (4.38%), for male participants (3.81%), and for female participants (4.58%). Univariable analysis revealed that NC was significantly smaller in the participants with presarcopenia than in those without. Multivariable analysis, adjusted for confounding factors, revealed that a decrease in NC was significantly correlated with presarcopenia. Conclusions. BIA measurements of NC are interchangeable within about 95% with manual measurements. The decrease in NC measured by BIA was significantly associated with presarcopenia in both genders. NC measurement can be used for early detection of presarcopenia.

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  24. Effects of long sleep time and irregular sleep-wake rhythm on cognitive function in older people

    Okuda Masato, Noda Akiko, Iwamoto Kunihiro, Nakashima Honoka, Takeda Kozue, Miyata Seiko, Yasuma Fumihiko, Ozaki Norio, Shimouchi Akito

    SCIENTIFIC REPORTS   Vol. 11 ( 1 )   2021.3

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    Sleep disturbances and cognitive decline are common in older adults. We aimed to investigate the effects of the total sleep time (TST) and sleep–wake rhythm on executive function and working memory in older adults. In 63 older participants, we measured the TST, wake after sleep onset (WASO), and sleep timing (midpoint between bedtime and wake-up time) using actigraphy. Executive function was evaluated with the trail making test B (TMT-B) and Wisconsin card sorting test (WCST). The number of back task (N-back task) was used to measure working memory. Participants with a TST ≥ 8 h had a significantly lower percentage of correct answers (% correct) on the 1-back task than those with a TST < 8 h. The % correct on the 1-back task was significantly correlated with the TST, WASO, and sleep timing. Multiple regression analyses revealed that the TST and sleep timing were significant factors of the % correct on the 1-back task. The TMT-B score was significantly correlated with the sleep timing. Category achievement on the WCST was significantly correlated with the standard deviation of the sleep timing. Therefore, a long sleep time and an irregular sleep–wake rhythm could have adverse effects on executive function and working memory in older people.

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  25. Differences in the prevalence of locomotive syndrome and osteoporosis in Japanese urban and rural regions: The Kashiwara and Yakumo studies

    Tanaka Satoshi, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Seki Taisuke, Ishizuka Shinya, Machino Masaaki, Ito Sadayuki, Kanbara Shunsuke, Kanemura Tokumi, Hasegawa Yukiharu, Imagama Shiro

    MODERN RHEUMATOLOGY     page: 1 - 6   2021.3

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    Objectives: To clarify whether the prevalence of locomotive syndrome (LS) and osteoporosis differed according to region, gender, and physical functions in Japan. Methods: Data were collected in Kashiwara City (urban region) and Yakumo Town (rural region). Totally, 208 participants from the urban region and 782 participants from the rural region were included in this study. LS was assessed using the 25-item Geriatric Locomotive Function Scale and osteoporosis was assessed using a quantitative ultrasound. Physical functions were measured using grip strength and the 3-m timed up-and-go test. Differences between urban and rural regions were investigated using standardized incidence ratio and multivariate analysis. Results: The prevalence of LS and osteoporosis was 24.5% and 42.8% in the urban region and 10.9% and 28.8% in the rural region, respectively. The standardized incidence ratio of the urban region versus the rural region was 1.80 (95% confidence intervals [CI] = 1.35–2.39) for LS and 1.21 (95% CI = 1.32–2.43) for osteoporosis, showing that the prevalence of LS was significantly higher in the urban region. Multivariate analysis indicated that LS was significantly associated with the urban sample and timed up-and-go was significantly longer in the urban sample. Conclusion: Regional differences may be considered when evaluating LS in health checkups. Understanding the results of this study may help reduce LS prevalence.

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  26. Risk Factors for Poor Outcome of Cervical Laminoplasty Multivariate Analysis in 505 Patients with Cervical Spondylotic Myelopathy

    Machino Masaaki, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Kanbara Shunsuke, Ito Sadayuki, Inoue Taro, Ito Keigo, Kato Fumihiko, Ishiguro Naoki, Imagama Shiro

    SPINE   Vol. 46 ( 5 ) page: 329 - 336   2021.3

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  27. Intraoperative pedicle screw migration to the abdominal cavity in a severe osteoporotic spine surgery

    Ouchida Jun, Kanemura Tokumi, Satake Kotaro, Nakashima Hiroaki, Ishikawa Yoshimoto, Segi Naoki, Yamaguchi Hidetoshi, Imagama Shiro

    INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT   Vol. 23   2021.3

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    Study Design: A case report. Objective: To report a dangerous intraoperative complication of spinal instrumentation surgery. Summary of Background Data: Spinal instrumentation is indispensable for surgical treatment of degenerative spinal disorders. Revision surgeries in cases with severe osteoporosis involve high risks of intraoperative complications. Methods: We present a case of a 79-year-old female who underwent revision surgery for thoracolumbar deformity. She had a medical history of rheumatoid arthritis and severe osteoporosis due to long time steroid medication. In the pedicle screw replacement procedure, the implant fell into the abdominal cavity through the vertebrae, as confirmed by fluoroscopy. Results: An emergent surgical survey with intraoperative computed tomography revealed that the implant was buried in the abdominal wall. General surgeons performed abdominal surgery; ascending colon mesentery and ovarian vein injuries were repaired. The patient recovered without any permanent disorders and was discharged from the hospital on schedule. Conclusions: Although intraoperative pedicle screw drop into the abdominal cavity is rare, this complication could occur in cases with severe osteoporosis and a revision surgery accompanied by screw loosening. Therefore, preoperative detailed radiographic evaluation and meticulous attention during surgery are mandatory for treatment of patients with severe osteoporosis.

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  28. A New Global Spinal Balance Classification Based on Individual Pelvic Anatomical Measurements in Patients With Adult Spinal Deformity

    Nakashima Hiroaki, Kawakami Noriaki, Ohara Tetsuya, Saito Toshiki, Tauchi Ryoji, Imagama Shiro

    SPINE   Vol. 46 ( 4 ) page: 223 - 231   2021.2

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    Study Design. A retrospective study. Objective. This study aims to establish a new, easy-to-implement global spinal balance (GSB) classification based on individual pelvic anatomical measurements in adult spinal deformity patients, and to validate this classification in terms of patients' quality of life (QOL). Summary of Background Data. Coronal (central sacral vertical line) and sagittal (C7 sagittal vertical axis [C7 SVA]) lines are standard parameters to evaluate GSB. However, these parameters do not consider individual differences in height and physique. Therefore, a new classification to more simply evaluate GSB related to QOL would be a beneficial tool. Methods. This study included 279 patients with adult spinal deformity. The enrollment criteria included age >18 years and scoliosis >308. GSB was evaluated based on C7 coronal vertical axis and C7 SVA, and was graded with our sagittal (Grades 1-3) and coronal classifications (Grades 1-3), where larger values represented worse GSB. In addition, total global balance classification (Grades 1-3) was also established based on both coronal and sagittal classifications. Patient self-assessment measures of health status were collected using the Scoliosis Research Society patient questionnaire (SRS-22). The relationships between responses to the SRS-22 and GSB were evaluated using partial correlation coefficients, adjusted by age. Results. A newly described coronal classification correlated with the preoperative function (P < 0.02), pain (P=0.001), subtotal (P < 0.001) domains in the SRS-22, whereas a newly described sagittal classification was correlated with the preoperative subtotal domain (P < 0.001). There were also significant correlations between total global balance and the preoperative function (P=0.03) and subtotal domains (P < 0.001) in the SRS- 22. Conclusion. We present a simple new classification for GSB that strongly correlates with QOL in patients with adult spinal deformity, thereby translating clinical data into meaningful patient outcomes and livelihoods.

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  29. Challenges for Joint Commission International accreditation: performance of orthopedic surgeons based on International Patient Safety Goals

    Kobayashi Kazuyoshi, Ando Kei, Nakashima Hiroaki, Machin Masaaki, Kanbara Shunsuke, Ito Sadayuki, Inoue Taro, Yamaguchi Hidctoshi, Ishiguro Naoki, Imagama Shiro

    NAGOYA JOURNAL OF MEDICAL SCIENCE   Vol. 83 ( 1 ) page: 87 - 92   2021.2

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    The Joint Commission International (JCI) is a US-based organization that accredits and certifies hospitals worldwide. Among the requirements for accreditation, the JCI emphasizes continuous quality improvement (CQI) with regard to international patient safety goals (IPSGs). Our university hospital treats about 26,000 hospitalized patients and 600,000 outpatients annually, and our goal is patient safety in compliance with IPSGs. The purpose of this study is to examine the activities of orthopedic surgeons in preparation for JCI accreditation, including clear identification of patients, preoperative timeout and marking to ensure correct surgery, timely approval of CT/MRI reports, care with pain management, prevention of infection, setting of quality indicators and daily monitoring, and teamwork. Examiners from the JCI visited our hospital to review medical records and documents, and to interview patients, nurses and doctors. There were 1270 evaluation items covering 16 fields, including reviews of IPSGs, patient evaluation and care, infection prevention and control, and governance and leadership. Most importantly, the efforts of all the medical staff in our hospital in obtaining the first JCI accreditation among national university hospitals in Japan have promoted the safety and quality of medical care from the perspective of the patient

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  30. Postoperative changes in spinal cord signal intensity in patients with spinal cord injury without major bone injury: comparison between preoperative and postoperative magnetic resonance images

    Machino Masaaki, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Kanbara Shunsuke, Ito Sadayuki, Inoue Taro, Yamaguchi Hidetoshi, Koshimizu Hiroyuki, Ito Keigo, Kato Fumihiko, Ishiguro Naoki, Imagama Shiro

    JOURNAL OF NEUROSURGERY-SPINE   Vol. 34 ( 2 ) page: 259 - 266   2021.2

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    OBJECTIVE Although increased signal intensity (ISI) on MRI is observed in patients with cervical spinal cord injury (SCI) without major bone injury, alterations in ISI have not been evaluated. The association between postoperative ISI and surgical outcomes remains unclear. This study elucidated whether or not the postoperative classification and alterations in MRI-based ISI of the spinal cord reflected the postoperative symptom severity and surgical outcomes in patients with SCI without major bone injury. METHODS One hundred consecutive patients with SCI without major bone injury (79 male and 21 female) with a mean age of 55 years (range 20–87 years) were included. All patients were treated with laminoplasty and underwent MRI pre- and postoperatively (mean 12.5 ± 0.8 months). ISI was classified into three groups on the basis of sagittal T2-weighted MRI: grade 0, none; grade 1, light (obscure); and grade 2, intense (bright). The neurological statuses were evaluated according to the Japanese Orthopaedic Association (JOA) scoring system and the American Spinal Injury Association Impairment Scale (AIS). RESULTS Preoperatively, 8 patients had grade 0 ISI, 49 had grade 1, and 43 had grade 2; and postoperatively, 20 patients had grade 0, 24 had grade 1, and 56 had grade 2. The postoperative JOA scores and recovery rate (RR) decreased significantly with increasing postoperative ISI grade. The postoperative ISI grade tended to increase with the postoperative AIS grade. Postoperative grade 2 ISI was observed in severely paralyzed patients. The postoperative ISI grade improved in 23 patients (23%), worsened in 25 (25%), and remained unchanged in 52 (52%). Patients with an improved ISI grade had a better RR than those with a worsened ISI grade. CONCLUSIONS Postoperative ISI reflected postoperative symptom severity and surgical outcomes. Alterations in ISI were seen postoperatively in 48 patients (48%) and were associated with surgical outcomes.

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  31. Poor derivation of Tc-MEP baseline waveforms in surgery for ventral thoracic intradural extramedullary tumor: Efficacy of use of the abductor hallucis in cases with a preoperative non-ambulatory status.

    Kobayashi K, Ando K, Nakashima H, Machino M, Kanbara S, Ito S, Inoue T, Yamaguchi H, Koshimizu H, Imagama S

    Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia   Vol. 84   page: 60 - 65   2021.2

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    Most thoracic intradural extramedullary tumors (IDEMT) are benign lesions that are treated by gross total resection and spinal cord decompression. Intraoperative transcranial-motor evoked potential (Tc-MEP) monitoring is important for reducing postoperative neurological complications. The purpose of this study is to examine the characteristics of Tc-MEP waveforms in surgery for thoracic IDEMT resection based on location of the tumor relative to the spinal cord. The subjects were 56 patients who underwent surgery for thoracic IDEMT from 2010 to 2018. The waveform derivation rate for each lower muscle was examined at baseline and intraoperatively. 56 patients had a mean age of 61.7 years, and 21 (38%) were non-ambulatory before surgery. The tumors were schwannoma (n = 28, 50%), meningioma (n = 25, 45%), and neurofibroma (n = 3, 5%); and the lesions were dorsal (n = 29, 53%) and ventral (n = 27, 47%). There was a significantly higher rate of undetectable waveforms in all lower limb muscles in the ventral group compared to the dorsal group (15% vs. 3%, p < 0.05). In non-ambulatory cases, the derivation rate at baseline was significantly lower for ventral thoracic IDMETs (47% vs. 68%, p < 0.05). The abductor hallucis (AH) had the highest waveform derivation rate of all lower limb muscles in non-ambulatory cases with a ventral thoracic IDMET. Spinal cord compression by a ventral lesion may be increased, and this may be reflected in greater waveform deterioration. Of all lower limb muscles, the AH had the highest derivation rate, even in non-ambulatory cases with a ventral IDEMT, which suggests the efficacy of multichannel monitoring including the AH.

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  32. The dual presence of frailty and locomotive syndrome is associated with a greater decrease in the EQ-5D-5L index

    Tanaka Satoshi, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Seki Taisuke, Ishizuka Shinya, Machino Masaaki, Morozumi Masayoshi, Kanbara Shunsuke, Ito Sadayuki, Kanemura Tokumi, Ishiguro Naoki, Hasegawa Yukiharu, Imagama Shiro

    NAGOYA JOURNAL OF MEDICAL SCIENCE   Vol. 83 ( 1 ) page: 159 - 167   2021.2

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    Japan’s aging society is facing an increase in the prevalence of frailty and locomotive syndrome (LS) among older adults. To evaluate the association of these age-related declines on health-related quality of life (QOL) in Japan, we investigated this relationship among Japanese middle-aged and older adults who underwent general checkups and examined whether LS or frailty has a stronger association with the Japanese version of EuroQol’s five-level EQ-5D (EQ-5D-5L) index. Participants were 231 middle-aged and older Japanese adults receiving routine health checkups. The study utilized the 25-item Geriatric Locomotive Function Scale, the Japanese version of the Cardiovascular Health Study, and the Japanese version of the EQ-5D-5L. Univariate and multivariate analyses were performed to examine how frailty and LS are related to the EQ-5D-5L index. Patients with both frailty (p = 0.003) and LS (p < 0.001) had a significantly lower EQ-5D-5L index. After adjusting for age, gender, and body mass index, LS was significantly associated with a decrease in the EQ-5D-5L index (p < 0.001), whereas frailty had no significant association with the EQ-5D-5L index (p = 0.052). Further analysis showed no significant decrease in the EQ-5D-5L index among those with frailty but no LS, and a significant decrease among those with frailty and LS. The results suggest that frailty and LS are associated with a decrease in the EQ-5D-5L index, but LS has a more pronounced effect. In evaluating frailty’s effects on health-related QOL, we determined the importance of separately assessing frailty both with and without LS, even within the same frailty group.

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  33. Automated Detection of Spinal Schwannomas Utilizing Deep Learning Based on Object Detection From Magnetic Resonance Imaging

    Ito Sadayuki, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Oda Masahiro, Machino Masaaki, Kanbara Shunsuke, Inoue Taro, Yamaguchi Hidetoshi, Koshimizu Hiroyuki, Mori Kensaku, Ishiguro Naoki, Imagama Shiro

    SPINE   Vol. 46 ( 2 ) page: 95 - 100   2021.1

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    STUDY DESIGN: A retrospective analysis of magnetic resonance imaging (MRI) was conducted. OBJECTIVE: This study aims to develop an automated system for the detection of spinal schwannoma, by employing deep learning based on object detection from MRI. The performance of the proposed system was verified to compare the performances of spine surgeons. SUMMARY OF BACKGROUND DATA: Several MRI scans were conducted for the diagnoses of patients suspected to suffer from spinal diseases. Typically, spinal diseases do not involve tumors on the spinal cord, although a few tumors may exist at the unexpectable level or without symptom by chance. It is difficult to recognize these tumors; in some cases, these tumors may be overlooked. Hence, a deep learning approach based on object detection can minimize the probability of overlooking these tumors. METHODS: Data from 50 patients with spinal schwannoma who had undergone MRI were retrospectively reviewed. Sagittal T1- and T2-weighted magnetic resonance imaging (T1WI and T2WI) were used in the object detection training and for validation. You Only Look Once version3 was used to develop the object detection system, and its accuracy was calculated. The performance of the proposed system was compared to that of two doctors. RESULTS: The accuracies of the proposed object detection based on T1W1, T2W1, and both T1W1 and T2W1 were 80.3%, 91.0%, and 93.5%, respectively. The accuracies of the doctors were 90.2% and 89.3%. CONCLUSION: Automated object detection of spinal schwannoma was achieved. The proposed system yielded a high accuracy that was comparable to that of the doctors.Level of Evidence: 4.

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  34. A Longitudinal Study of Lumbar Sagittal Change in Middle-Aged Healthy Volunteers

    Ito Kenyu, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Hasegawa Yukihiro, Imagama Shiro

    SPINE SURGERY AND RELATED RESEARCH   Vol. 5 ( 3 ) page: 160 - 164   2021

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    Introduction: Recent research has shown that spinal sagittal alignment plays a critical role in health-related quality of life. However, most of these studies were cross-sectional in nature, and longitudinal studies of lumbar lordosis (LL) in healthy subjects were few. This study aims to evaluate the change in lumbar sagittal parameters during a 10-year period. Methods: The study population included 45 individuals (mean age, 65.7 years; male, n=20; female, n=25) who underwent sagittal lumbar radiography and a basic health checkup during a 10-year period. The radiologic parameters were LL, disc angle, sacral slope angle (SS), and pelvic incidence (PI). The change of LL during the 10-year period was defined as ?LL. The subjects were divided into the LL maintenance group (n=33) and the LL non-maintenance group (n=12) based on their LL values. Results: The radiologic baseline/final parameters were as follows: LL, 45/34 degrees (P<0.001); L1/L2 disc angle, 4.5/2.5 degrees; L2/L3 disc angle, 5.5/2.7 degrees; L3/L4 disc angle, 6.2/4.2 degrees; L4/L5 disc angle, 8.1/5.1 degrees; L5/S disc angle, 14.2/12.2 degrees; and SS, 32.0/32.1 degrees. The mean PI (50.5 degrees) was tended to be associated with the final LL (R=0.31, P=0.044) and was correlated with the ?LL (R=0.43, P<0.01). The data of the LL maintenance/non-maintenance groups were as follows: Age, 65.0/67.0; primary LL, 43.2/50.2 degrees (P<0.05); final LL, 36.2/27.8 degrees (P<0.05); and PI, 52.8/43.8 degrees (P<0.01). Conclusions: During the 10-year study period, the LL in middle-aged and elderly volunteers decreased by 11 degrees. The factor of maintenance of LL was PI.

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  35. Is cervical total disc replacement able to achieve a lordotic alignment?

    Satake Kotaro, Kanemura Tokumi, Ito Kenyu, Tanaka Satoshi, Nakashima Hiroaki, Ouchida Jun, Imagama Shiro

    Journal of Spine Research   Vol. 12 ( 4 ) page: 657 - 662   2021

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    <p><b>Introduction: </b>A retrospective review was performed to evaluate clinical symptoms and the alignment of cervical spine for patients who underwent a cervical total disc replacement (C-TDR).</p><p><b>Methods: </b>10 patients underwent a single-level C-TDR. Their JOA score, EQ5D, EQ-VAS, range of motion (ROM), segmental lordosis, and C2-C7 angle were evaluated at preoperation and at 6 months postoperation.</p><p><b>Results: </b>JOA score, EQ5D, and EQ-VAS, ROM, and segmental lordosis were significantly improved at 6 months compared with the preoperative state though C2-C7 angle did not change significantly.</p><p><b>Conclusions: </b>C-TDR increases the local lordosis but does not affect the global lordosis of the cervical spine at 6 months postoperation.</p>

    DOI: 10.34371/jspineres.2021-0402

  36. Transdiaphragmatic approach as a novel less invasive retroperitoneal approach at thoracolumbar junction: Comparison with conventional diaphragmatic incision

    Nakashima Hiroaki, Imagama Shiro, Kanemura Tokumi, Satake Kotaro, Ito Kenyu, Tanaka Satoshi, Segi Naoki, Ouchida Jun, Ando Kei, Kobayashi Kazuyoshi

    Spine Surgery and Related Research     2021

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    <p><b>Introduction: </b>Lateral corpectomy has been considered a minimally invasive surgery, allowing a "transdiaphragmatic approach" at the thoracolumbar junction. This approach allows for a small diaphragmatic incision directly in the retroperitoneal space and the affected vertebra. However, its effectiveness in comparison to a conventional approach remains unclear. Thus, in this present study, we compared the surgical outcomes between conventional diaphragmatic detachment and the transdiaphragmatic approach in patients with vertebral fracture at the thoracolumbar junction.</p><p><b>Methods: </b>In total, 31 patients with a vertebral fracture at the thoracolumbar junction (T12–L2) were included in this study: 17 underwent a conventional approach, whereas 14 underwent a transdiaphragmatic approach, with a minimum 2-year follow-up. The effectiveness of surgery was evaluated in each category of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ).</p><p><b>Results: </b>Operative time and estimated blood loss were determined to be significantly shorter in the transdiaphragmatic than in the conventional approach. Perioperative complications were observed in the conventional approach (one atelectasis and one pleural effusion), while no complication was noted in the transdiaphragmatic approach. There were no significant differences in postoperative quality of life as assessed by JOABPEQ in terms of pain-related disorders, lumbar spine dysfunction, gait disturbance, social life dysfunction, or psychological disorders between the conventional and transdiaphragmatic approaches.</p><p><b>Conclusions:</b> A "transdiaphragmatic approach" using lateral access surgery has been found to be associated with a shorter operative time and less blood loss with fewer complications than the conventional approach. Given that equivalent clinical outcomes were achieved in both conventional and transdiaphragmatic approaches, this "transdiaphragmatic approach" could be useful because of its minimal invasiveness.</p>

    DOI: 10.22603/ssrr.2020-0191

  37. Risk factors of non-union in Anderson-D'Alonzo type III odontoid fractures with conservative treatment

    Koshimizu Hiroyuki, Nakashima Hiroaki, Ito Keigo, Ando Kei, Kobayashi Kazuyoshi, Kato Fumihiko, Sato Koji, Deguchi Masao, Matsubara Yuji, Inoue Hidenori, Kanemura Tokumi, Urasaki Tetsuya, Yoshihara Hisatake, Wakao Norimitsu, Shinjo Ryuichi, Imagama Shiro

    JOURNAL OF ORTHOPAEDICS   Vol. 24   page: 280 - 283   2021

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    Objective: The purpose of this study was retrospectively to analyze the risk factors for non-union in Anderson–D'Alonzo type III odontoid fractures with conservative treatment. Methods: 25 patients with type III fractures were analyzed. Coronal and sagittal tilt as well as sagittal and lateral mass gaps were measured by using computed tomography. Results: The non-union group had significantly higher age, greater coronal tilt and lateral mass gap. Especially, the lateral mass gap was >2 mm in all cases with non-union. Conclusions: Higher age, coronal tilt, and lateral mass gap were significant risk factors for non-union.

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  38. Kinetic changes in the spinal cord occupation rate of dural sac in cervical spondylotic myelopathy

    Machino Masaaki, Ito Keigo, Kato Fumihiko, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Kanbara Shunsuke, Ito Sadayuki, Inoue Taro, Koshimizu Hiroyuki, Imagama Shiro

    JOURNAL OF ORTHOPAEDICS   Vol. 24   page: 222 - 226   2021

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    Objective: The study aimed to establish the spinal cord occupation rate of the dural sac during flexion and extension. Methods: We measured the cross-sectional area of the dural sac and the spinal cord between C2/C3 and C7/T1 disc levels in 100 patients with cervical spondylotic myelopathy and 1211 asymptomatic subjects. Results: The spinal cord occupation rate of the dural sac in the cross-sectional area was higher on extension than on flexion at the mid-lower cervical spine. Conclusions: The spinal cord occupation rate of the dural sac in the cross-sectional area was highest at the C4/C5 and C5/C6 levels on extension.

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  39. Association between Low Muscle Mass and Inflammatory Cytokines.

    Ito S, Nakashima H, Ando K, Kobayashi K, Machino M, Seki T, Ishizuka S, Fujii R, Takegami Y, Yamada H, Ando Y, Suzuki K, Hasegawa Y, Imagama S

    BioMed research international   Vol. 2021   page: 5572742   2021

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    Sarcopenia is a multifaceted geriatric syndrome associated with the loss of muscle mass. We examined the relationship between low muscle mass and inflammatory cytokines in the context of aging. This study involved 299 participants (127 men and 172 women; mean age 63.3±9.8 years) who underwent health checkups for body composition and inflammatory cytokine (TNF-alpha, IL-6, and MCP-1) levels. Muscle mass was determined using the skeletal muscle mass index. We divided the participants into the normal (N) and low muscle mass (L) groups and compared the levels of inflammatory cytokines in nonelderly (<65 years) and elderly (≥65 years) participants. Among the nonelderly subjects, C-reactive protein was significantly lower in the L group than in the N group (p<0.05). However, there was no significant difference in the inflammatory cytokine levels between the groups. Among the elderly subjects, the TNF-alpha level was significantly lower in the L group than in the N group (p<0.05), whereas there were no significant differences in the IL-6 and MCP-1 levels. Moreover, TNF-alpha was identified as a risk factor for the L group in the logistic regression analysis (Exp (B) 0.935, 95% CI: 0.876-0.997, p=0.04). Although a low TNF-alpha level is a risk factor for low muscle mass, inflammatory cytokine levels are not necessarily elevated in elderly individuals with the loss of muscle mass.

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  40. Cicatricial Fibromatosis causing Cervical Myelopathy due to Rapid Growth after Removal of Meningioma: A Case Report

    Kanbara Shunsuke, Segi Naoki, Imagama Shiro, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Machino Masaaki, Ito Sadayuki, Inoue Taro, Yamaguchi Hidetoshi, Koshimizu Hiroyuki

    Spine Surgery and Related Research     2021

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    DOI: 10.22603/ssrr.2021-0010

  41. Impact of Neck and Shoulder Pain on Health-Related Quality of Life in a Middle-Aged Community-Living Population.

    Machino M, Ando K, Kobayashi K, Nakashima H, Morozumi M, Kanbara S, Ito S, Inoue T, Koshimizu H, Seki T, Ishizuka S, Takegami Y, Hasegawa Y, Imagama S

    BioMed research international   Vol. 2021   page: 6674264   2021

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    Purpose. Neck and shoulder pain (NSP) is very common in the general population. However, scarce information exists on the relationship between NSP and health-related quality of life (HRQOL) outcomes in this population. The present study described NSP prevalence and its impact on the HRQOL of middle-aged and older persons undergoing a routine medical checkup. Methods. This study recruited 318 subjects (125 males and 193 females; average age, 63.4 years) in good health, collected underwent anthropometric measurements, physical function examinations, and blood testing. This study defined NSP as the presence of muscle tension, stiffness, pressure, or dull pain in areas between the neck and the arch of the scapular. Study subjects were divided into two groups (NSP (+) and NSP (-) groups). The subjects completed questions on the Medical Outcomes Study 36-item short-form health survey (SF-36) and the EuroQol 5-dimension, 5-level version (EQ-5D-5L) tool. Results. Of the patients, 150 and 168 were NSP (+) and NSP (-), respectively. The NSP complaint rate was 47.2%. The NSP (+) group had younger and more female participants than the NSP (-) group. In the multivariate regression analysis, the NSP (+) group had lower physical QOL based on the SF-36 physical component summary (odds ratio (OR), 2.45) and lower mental QOL based on the SF-36 mental component summary (OR, 2.05). Overall, the NSP (+) group had a higher risk of having low QOL scores (EQ-5D-5L index; OR, 1.76). Conclusions. The NSP (+) rate in healthy middle-aged and older persons was 47.2%. Furthermore, NSP (+) status was directly related poor HRQOL. NSP is a predictor of suboptimal physical and mental QOL. Therefore, NSP prevention or intervention for NSP may improve middle-aged and older adults' QOL.

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  42. Assessment of ureters at dangerous locations in lateral lumbar interbody fusion

    Kagami Yujiro, Kobayashi Kazuyoshi, Machino Masaaki, Imagama Shiro, Kanemura Tokumi, Nakashima Hiroaki, Satake Kotaro, Ito Kenyu, Tanaka Satoshi, Segi Naoki, Ouchida Jun, Morita Masanori, Ando Kei

    Spine Surgery and Related Research     2021

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    <p><b>Introduction:</b> This study aimed to investigate the ureteral running position from the viewpoint of the spine, and to identify the spinal level and left–right difference in the ureter at a dangerous location of ureteral injury during surgery.</p><p><b>Methods:</b> This retrospective study included 100 consecutive patients (39 males and 61 females; average age, 70.4 years). Preoperative contrast-enhanced computerized tomography (CT) scans obtained in the supine position for patients who underwent lateral lumbar interbody fusion (LLIF) were analyzed. The ureter location was divided into four regions on the axial CT images based on the lumbar disk levels as follows: A (ventral–medial), B (ventral–lateral), C (dorsal–medial), and D (dorsal–lateral). The C region surrounded by the vertebral body and the psoas muscle was assumed to have the highest probability of ureteral injury. We examined the characteristics of the ureteral position at each disc level.</p><p><b>Results: </b>In the upper lumbar spine, the ureter was outside the lateral dorsoventral axis from the contact point of the psoas muscle, while in the lower lumbar spine, it was inside the axis. The ureters located in the C region increased significantly in the lower lumbar disk levels (L1-L2 and L2-L3: 0%; L3-L4: 5.5%; L4-L5: 14.8%; L5-S: 31.5%). Comparing the left and right sides, especially at L4-L5, the ureter in the C region was observed in 21% of all ureters on the left side and in 9% on the right side. With respect to gender differences, the ureters present in the C region were significantly more common in women at lumbar disk levels L3-L4, L4-L5, and L5-S.</p><p><b>Conclusions: </b>The ureters in the C region were common on the left side and at lower lumbar disk levels. To avoid ureteral injury, it is necessary to confirm the location of the ureter by using preoperative images and performing LLIF carefully.</p>

    DOI: 10.22603/ssrr.2021-0013

  43. Sacroiliac Joint Degeneration After Lumbopelvic Fixation. Reviewed

    Nakashima H, Kanemura T, Satake K, Ito K, Tanaka S, Segi N, Ouchida J, Kagami Y, Ando K, Kobayashi K, Imagama S

    Global spine journal     page: 2192568220978235   2020.12

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    Study Design: Retrospective Study. Objectives: Sacroiliac buttress screws (SBS) and S2 alar iliac screws (SAI) are used as distal screws in cases with long fusion to the pelvis. Distal fixation ends, whether exceeding the sacroiliac joint (SIJ), may affect postoperative degenerative changes in the SIJ. The aim of this study was to investigate SIJ degeneration after lumbosacral and lumbopelvic fixation, using SBS and SAI in degenerative spine diseases, respectively. Methods: This study included 70 patients aged ≥50 years with lumbosacral fusion (>3 levels). They were divided into 2 groups (SBS 20 and SAI 50 cases) based on the type of distal screws. Radiographical and clinical data were reviewed with a minimum 2-year follow-up. Radiographical SIJ degeneration was analyzed using computed tomography; clinical outcomes were evaluated using visual analog scale (VAS) and Japanese Orthopaedic Association Back Pain Questionnaire (JOABPEQ). Results: No significant differences were observed in patients’ preoperative characteristics between the 2 groups. The incidence of SIJ degeneration, including osteophyte formation (30.0% and 8.0%, p = 0.03), intraarticular air (75.0% and 16.0%, p < 0.001), and subchondral cyst (20.0% and 2.0%. p = 0.02) in SBS and SAI groups, respectively, at the follow-up, was significantly higher in the SBS group. Although SIJ degenerative changes were significantly different between the SBS and SAI groups, there was no significant difference in VAS and JOABPEQ scores between the groups at 2 years post-surgery. Conclusions: Lumbosacral fusion can cause SIJ degeneration, which is more frequent when SBS are used in fixation to the sacrum.

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  44. Zonisamide ameliorates neuropathic pain partly by suppressing microglial activation in the spinal cord in a mouse model

    Koshimizu Hiroyuki, Ohkawara Bisei, Nakashima Hiroaki, Ota Kyotaro, Kanbara Shunsuke, Inoue Taro, Tomita Hiroyuki, Sayo Akira, Kiryu-Seo Sumiko, Konishi Hiroyuki, Ito Mikako, Masuda Akio, Ishiguro Naoki, Imagama Shiro, Kiyama Hiroshi, Ohno Kinji

    LIFE SCIENCES   Vol. 263   page: 118577   2020.12

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    Neuropathic pain is caused by a lesion or a functional impairment of the sensory nervous system and allodynia is one of the frequently observed symptoms in neuropathic pain. Allodynia represents abnormal pain due to a non-noxious stimulus that does not normally provoke pain. Cellular mechanisms underlying neuropathic pain remain mostly elusive, and partial pain relief can be achieved in a limited number of patients by antidepressants, anticonvulsants topical anesthetics, and others. Zonisamide (ZNS) is widely used as an anti-epileptic and anti-Parkinson's disease drug. A recent report shows that ZNS suppresses neuropathic pain associated with diabetes mellitus in a mouse model. We made a mouse model of neuropathic pain in the hindlimb by cutting the nerve at the intervertebral canal at lumbar level 4 (L4). At 28 days after nerve injury, ZNS ameliorated allodynic pain, and reduced the expression of inflammatory cytokines and the nerve injury-induced increase of Iba1-positive microglia in the spinal dorsal horn at L4. In BV2 microglial cells, ZNS reduced the number of lipopolysaccharide-induced amoeboid-shaped cells, representing activated microglia. These results suggest that ZNS is a potential therapeutic agent for neuropathic pain partly by suppressing microglia-mediated neuroinflammation.

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  45. Scoliosis Caused by Limb-Length Discrepancy in Children.

    Kobayashi K, Ando K, Nakashima H, Machino M, Morozumi M, Kanbara S, Ito S, Inoue T, Yamaguchi H, Mishima K, Ishiguro N, Imagama S

    Asian spine journal   Vol. 14 ( 6 ) page: 801 - 807   2020.12

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  46. An intraoperative 3D image-based navigation error during cervical pedicle screw insertion Reviewed

    Nakashima Hiroaki, Ishikawa Yoshimoto, Ando Kei, Kobayashi Kazuyoshi, Ishiguro Naoki, Imagama Shiro

    NAGOYA JOURNAL OF MEDICAL SCIENCE   Vol. 82 ( 4 ) page: 799 - 805   2020.11

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    A 67-year-old man underwent posterior cervical decompression surgery for ossification of the posterior longitudinal ligament (OPLL) with fixation using cervical pedicle screws (CPSs) guided by intraoperative 3D image-based navigation. Intraoperatively, while creating the screw hole using the navigation probe, the virtual trajectory on the intraoperative navigation screen showed a 10-degree angle discrepancy in the axial plane depending on whether a probing force was or was not applied for making the hole. This was potentially caused by vertebra rotation and a bent probe. Consequently, the CPSs were placed more laterally than the ideal trajectory, which resulted in <2 mm lateral perforation to the foramen transversarium. There were no screw insertion-related perioperative complications. Based on this case, we conclude that navigation error during CPS insertion can occur even with intraoperative 3D image-based navigation. The risk of a bowed navigation probe caused by posterior cervical muscle and vertebra rotation should be considered, even with use of a navigation reference frame.

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  47. Surgical outcomes and factors related to postoperative motor and sensory deficits in resection for 244 cases of spinal schwannoma

    Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Machino Masaaki, Ito Sadayuki, Kanbara Shunsuke, Inoue Taro, Segi Naoki, Koshimizu Hiroyuki, Imagama Shiro

    JOURNAL OF CLINICAL NEUROSCIENCE   Vol. 81   page: 6 - 11   2020.11

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    In a large cohort the clinical presentation, management and outcomes of spinal schwannoma and factors related to postoperative motor and sensory deficits were invesgtigated. In 244 patients (males: 126, females: 118, average age 51.8 y) at one center, significant factors related to postoperative motor and sensory deficits were identified. Tumors were in the cervical (n = 79, 32.4%), lumbar (n = 66), thoracolumbar (T11-L1) (n = 55), and thoracic (n = 39) regions, and 5 patients had sacrum tumors. The rates of postoperative motor and sensory deterioration were 13.1% and 20.5%, respectively. The risk factors for motor deterioration were preoperative motor weakness, preoperative gait disturbance, dumbbell Eden type II, subtotal resection, and operative time, and those for postoperative sensory deficit were preoperative gait disturbance and subtotal resection. Of 12 patients with significant TcMEP changes, 11 had a new motor deficit after surgery; and of 216 patients with stable TcMEP data, 196 were neurologically intact after surgery (true negative) and 20 (11.0%) had deficits in the immediate postoperative stage (false negative). These deficits resolved during hospitalization for most patients. Of 15 patients with TcMEP deterioration and recovery, 11 (93.3%) had no motor deficits after surgery (p < 0.01).

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  48. Prediction of outcome following laminoplasty of cervical spondylotic myelopathy: Focus on the minimum clinically important difference

    Machino Masaaki, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Kanbara Shunsuke, Ito Sadayuki, Inoue Taro, Koshimizu Hiroyuki, Ito Keigo, Kato Fumihiko, Imagama Shiro

    JOURNAL OF CLINICAL NEUROSCIENCE   Vol. 81   page: 321 - 327   2020.11

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    The minimum clinically important difference (MCID) of the Japanese Orthopaedic Association (JOA) score has been reported to be around 2.5 points in cervical myelopathy. This study sought to define significant predictive factors on achieving the MCID following laminoplasty in a large series of patients with cervical spondylotic myelopathy (CSM). A total of 485 consecutive patients with CSM (295 males and 190 females; mean age: 67.0 years; age range: 42–91 years) who underwent laminoplasty were prospectively enrolled. The average postoperative follow-up period was 26.6 months (range: 12–66 months). We calculated the achieved JOA score. The relationships between outcomes and various clinical and imaging predictors including comorbidity and quantitative performance tests were examined. Logistic regression analysis was conducted to identify the predictors correlated with a JOA score of 2.5 points or more. Clinically meaningful gains were exhibited in 299 patients (61.6%) with a JOA score of ≥2.5 points, whereas 186 patients (38.4%) achieved a JOA score of <2.5 points. Univariate logistic regression analysis showed the predictive factors with a shorter duration of CSM symptoms, lower preoperative JOA scores, absence of hypertension, no use of anticoagulant/antiplatelet agents, and nonsmoking status. Multivariate logistic regression analysis determined that the duration of CSM symptoms (odds ratio: 0.771, 95% confidence interval: 0.705–0.844; p < 0.01) was the only significant predictive factor for achieving JOA scores of ≥2.5 points. An important predictor of MCID achievement following laminoplasty was shorter duration of CSM symptoms.

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  49. Larger muscle mass of the upper limb correlates with lower amplitudes of deltoid MEPs following transcranial stimulation

    Ito Sadayuki, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Machino Masaaki, Kanbara Shunsuke, Inoue Taro, Yamaguchi Hidetoshi, Segi Naoki, Koshimizu Hiroyuki, Imagama Shiro

    JOURNAL OF CLINICAL NEUROSCIENCE   Vol. 81   page: 426 - 430   2020.11

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    To perform spinal surgery safely, it is important to understand the risk factors, including factors that negatively influence intraoperative neuromonitoring (IONM). Transcranial motor evoked potentials (TcMEPs) are important in IONM. Therefore, we aimed to investigate whether muscle mass affects the waveforms of TcMEPs to understand the risk factors influencing TcMEPs. We enrolled 48 patients with thoracolumbar spinal diseases who underwent surgery at our facility between April 2015 and March 2018. Before surgery, the body composition, including muscle mass and fat mass, of all patients was measured using bioelectrical impedance analysis (BIA). During surgery, cranial stimulation under general anesthesia was used to derive TcMEPs, enabling us to measure the amplitude, using the control wave of the TcMEPs of the deltoid muscles and the abductor digiti minimi (ADM) muscles. We found a negative correlation between the amplitude of deltoid-muscle TcMEPs and muscle mass of the upper limb. The amplitude of deltoid-muscle TcMEPs did not correlate with the skeletal muscle index (SMI), muscle mass of the lower limb, or body fat mass. The amplitude of ADM-muscle TcMEPs did not correlate with SMI, muscle mass of any limb, or body fat mass. In conclusion, a larger muscle mass of the upper limb correlated with a lower amplitude of deltoid-muscle TcMEPs. By contrast, there was no correlation between the muscle mass of the upper limb and the amplitude of ADM-muscle TcMEPs. These findings suggest that TcMEPs of the ADM are less influenced by muscle mass and are more stable than those of the deltoid.

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  50. Dynamic changes in longitudinal stretching of the spinal cord in thoracic spine: Focus on the spinal cord occupation rate of dural sac

    Machino Masaaki, Morita Daigo, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Kanbara Shunsuke, Ito Sadayuki, Inoue Taro, Koshimizu Hiroyuki, Ito Keigo, Kato Fumihiko, Imagama Shiro

    CLINICAL NEUROLOGY AND NEUROSURGERY   Vol. 198   page: 106225   2020.11

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    Objectives: This study aimed to evaluate the anteroposterior diameters and cross-sectional areas of the dural sac and spinal cord in the thoracic spine, to elucidate the spinal cord occupation rate of the dural sac in these dynamic changes for each level using multidetector-row computed tomography (MDCT). Patients and Methods: Fifty patients with cervical or lumbar spinal disease were prospectively enrolled. After preoperative myelography, MDCT was performed at maximum passive flexion and extension. The anteroposterior diameter and cross-sectional area of the dural sac and spinal cord in the axial plane and the thoracic spinal cord length in the sagittal plane were measured. The spinal cord occupation rate in the dural sac was calculated. Results: The spinal cord occupation rate of the dural sac in anteroposterior diameter was lower on flexion than on extension, with significant differences from the T1/T2 to T11/T12 levels (p < 0.0001). The spinal cord occupation rate of the dural sac in cross-sectional area was lower on flexion than on extension, with significant differences except from T3/T4 to T6/T7 levels (p < 0.01). There was a bimodal increase in the occupation rate with elevations at the cervicothoracic junction and thoracolumbar junction. The thoracic spinal cord length on flexion was significantly longer than that on extension (p < 0.0001). Conclusions: The spinal cord occupation rate of the dural sac was lower on flexion than on extension, despite thoracic spine being considered a rigid region. The dynamic changes in longitudinal stretching and shrinkage of the spinal cord affected the occupation rate.

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  51. Evaluation of the Association between Neck Pain and the Trapezius Muscles in Patients with Cervical Myelopathy Using Motor Evoked Potential: A Retrospective Study.

    Ito S, Sakai Y, Harada A, Ando K, Kobayashi K, Nakashima H, Machino M, Kambara S, Inoue T, Hida T, Ito K, Ishiguro N, Imagama S

    Asian spine journal     2020.10

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  52. Trends in Reoperation for Surgical Site Infection after Spinal Surgery with Instrumentation in a Multicenter Study.

    Kobayashi K, Imagama S, Ando K, Nakashima H, Kato F, Sato K, Kanemura T, Matsubara Y, Yoshihara H, Hirasawa A, Deguchi M, Shinjo R, Sakai Y, Inoue H, Ishiguro N

    Spine   Vol. 45 ( 20 ) page: 1459 - 1466   2020.10

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  53. Preoperative 6-Minute Walk Performance in Children With Congenital Scoliosis

    Nakashima Hiroaki, Kawakami Noriaki, Matsumoto Hiroko, Redding Gregory J.

    JOURNAL OF PEDIATRIC ORTHOPAEDICS   Vol. 40 ( 9 ) page: E818 - E821   2020.10

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    BACKGROUND: The 6-minute walk test (6MWT) is used to assess the function of cardiopulmonary and neuromuscular conditions in adults and children. The primary research question was to determine the relationship between 6MWT distance and forced vital capacity (FVC) and the major curve among children with congenital scoliosis with rib anomalies. METHODS: The authors recorded 6MWT distance in meters, FVC as a percentage of predicted normal value using arm span for height (FVC%), and Cobb angle in 20 children (13 girls; average age, 6.7±1.3 y) with congenital scoliosis before outpatient surgical treatment. The 6MWT uses a standardized protocol and measures distance traveled in 6 minutes on a flat surface. The authors then determined the correlation between these measures using linear regression analysis. RESULTS: The Cobb angle of the major curvature was 55.4±20.5 degrees. The type of vertebral anomaly was mixed in 17 cases, formation failure in 2 cases, and segmentation failure in 1 case. The range of rib anomalies was 3.4±3.9 levels; 15 and 5 patients, respectively, had unilateral and bilateral rib anomalies. FVC and FVC% were 0.7±0.2 L and 60%±19%, respectively. The ratio of forced expiratory volume at 1 second to FVC (FEV1/FVC), which indicates obstructive lung disease, was normal at 93%±7%. The 6MWT distance was 386.3±59.4 m, which was ≤10% of the predicted distance for normal children. No child was able to walk the normal distance on the basis of published norms. 6MWT distance was significantly correlated with arm span (ρ=0.46, P=0.04) and major curve (ρ=-0.61, P=0.004), but not with FVC% (ρ=0.17, P=0.49). CONCLUSIONS: The 6MWT distance is a feasible measure of function and is substantially reduced before surgery in children with thoracic congenital scoliosis with rib anomalies. The 6MWT distance was significantly correlated with a major curve but not with FVC%. 6MWT distance is not affected by moderate lung function impairment. LEVEL OF EVIDENCE: Level IV-retrospective cohort study.

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  54. Influence of Global Spine Sagittal Balance and Spinal Degenerative Changes on Locomotive Syndrome Risk in a Middle-Age and Elderly Community-Living Population Reviewed

    Machino Masaaki, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Kanbara Shunsuke, Ito Sadayuki, Inoue Taro, Yamaguchi Hidetoshi, Koshimizu Hiroyuki, Seki Taisuke, Ishizuka Shinya, Takegami Yasuhiko, Ishiguro Naoki, Hasegawa Yukiharu, Imagama Shiro

    BIOMED RESEARCH INTERNATIONAL   Vol. 2020   page: 3274864   2020.9

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    Purpose. The aim of this study was to describe the characteristics of each locomotive syndrome (LS) risk stage, including global spine sagittal alignment, spinal degenerative changes evident on plain radiographs, low back pain (LBP), muscle strength, and physical ability in middle-aged and elderly people in a health checkup. Methods. This study included 211 healthy Japanese volunteers (89 men and 122 women; mean age, 64.0 years) who underwent assessment with both radiographs and Spinal Mouse. Spinal sagittal parameters included thoracic kyphosis angle (TKA), lumbar lordosis angle (LLA), sagittal vertical axis, and spinal inclination angle (SIA). Lumbar disc height (LDH) and lumbar osteophyte formation (LOF) at each level were evaluated as the spinal degenerative changes. The LS assessment comprised three tests: Stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale (GLFS-25). The subjects were divided into three groups (no risk, stage 1 LS, or stage 2 LS) according to LS risk test criteria. The prevalence of LBP was investigated with a visual analogue scale (VAS), and physical performances were also compared among the groups. Results. Of the participants, 122 had no risk of LS, 56 had stage 1 LS risk, and 29 had stage 2 LS risk. With increasing LS risk stage, the prevalence of and VAS score for LBP increased significantly, and back muscle strength and physical abilities decreased significantly. The TKA did not differ among the three groups. The LLA decreased gradually with LS risk stage (P=0.0001). At each level except L1-L2 and L5-S1, LDH decreased gradually with LS risk stage. The prevalence of LOF increased significantly with increasing LS risk stage. The SIA increased significantly with LS risk stage (P=0.0167). Conclusions. Participants with LS had higher prevalence of spinal degeneration, small LLA, and global spinal imbalance by anterior spinal inclination.

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  55. Patient-Reported Quality of Life Following Posterior Lumbar Interbody Fusion or Indirect Decompression Using Lateral Lumbar Interbody Fusion.

    Nakashima H, Kanemura T, Satake K, Ito K, Tanaka S, Ouchida J, Segi N, Kobayashi K, Ando K, Ishiguro N, Imagama S

    Spine   Vol. 45 ( 18 ) page: E1172 - E1178   2020.9

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  56. Differences of locomotive syndrome and frailty in community-dwelling middle-aged and elderly people: Pain, osteoarthritis, spinal alignment, body balance, and quality of life. Reviewed

    Imagama S, Ando K, Kobayashi K, Machino M, Tanaka S, Morozumi M, Kanbara S, Ito S, Seki T, Ishizuka S, Nakashima H, Ishiguro N, Hasegawa Y

    Modern rheumatology   Vol. 30 ( 5 ) page: 921 - 929   2020.9

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  57. Impact of pelvic incidence on lumbar osteophyte formation and disc degeneration in middle-aged and elderly people in a prospective cross-sectional cohort Reviewed

    Imagama Shiro, Ando Kei, Kobayashi Kazuyoshi, Machino Masaaki, Tanaka Satoshi, Morozumi Masayoshi, Kanbara Shunsuke, Ito Sadayuki, Inoue Taro, Seki Taisuke, Ishizuka Shinya, Nakashima Hiroaki, Ishiguro Naoki, Hasegawa Yukiharu

    EUROPEAN SPINE JOURNAL   Vol. 29 ( 9 ) page: 2262 - 2271   2020.9

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  58. Age-related changes in upper and lower cervical alignment and range of motion: normative data of 600 asymptomatic individuals Reviewed

    Inoue Taro, Ito Keigo, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Katayama Yoshito, Machino Masaaki, Kanbara Shunsuke, Ito Sadayuki, Yamaguchi Hidetoshi, Koshimizu Hiroyuki, Kato Fumihiko, Imagama Shiro

    EUROPEAN SPINE JOURNAL   Vol. 29 ( 9 ) page: 2378 - 2383   2020.9

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    Purpose: To identify age-related changes and the relationship between upper and lower cervical sagittal alignment and the range of motion (ROM). Methods: A total of 600 asymptomatic volunteers were enrolled. There were 50 males and 50 females in each decade of life between the third and the eighth. The O–C2 angle and the C2–7 angle were measured using the neutral radiographs of the cervical spine. ROM was assessed by measuring the difference in alignment in the neutral, flexion, and extension positions. Results: The mean O–C2 angle in the neutral position was 14.0° lordotic. The mean ROM of the O–C2 angle was 23.1°. The mean C2–7 angle in the neutral position was 14.3° lordotic. The mean ROM of the C2–7 angle was 56.0°. The O–C2 angle was 16.1° in the third decade and gradually decreased to 11.4° in the eighth decade. There were no significant age-related changes in the ROM of the O–C2 angle. The C2–7 angle was 7.2° in the third decade and gradually increased to 20.8° in the eighth decade, and the ROM gradually decreased with increasing age. Significant negative correlation was observed between O–C2 angle and C2–7 angle. Conclusion: The O–C2 angle gradually decreased and the C2–7 angle increased with age. The ROM of the O–C2 angle did not change, but the ROM of the C2–7 angle decreased with age. The upper and lower cervical spine showed different age-related changes.

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  59. Functional equations of zeta functions associated with homogeneous cones Reviewed

    Nakashima H.

    Tohoku Mathematical Journal   Vol. 72 ( 3 ) page: 349 - 378   2020.9

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    In this paper, we focus on solvable prehomogeneous vector spaces associated with homogeneous cones, and consider the associated zeta functions in several variables. We discuss Q-structures of these prehomogeneous vector spaces, and give explicit formulas of functional equations of the zeta functions by using the data of homogeneous cones. The associated b-functions are also described explicitly.

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  60. True accuracy of percutaneous pedicle screw placement in thoracic and lumbar spinal fixation with a CT-based navigation system: Intraoperative and postoperative assessment of 763 percutaneous pedicle screws Reviewed

    Ouchida Jun, Kanemura Tokumi, Satake Kotaro, Nakashima Hiroaki, Segi Naoki, Suzuki Kanae, Imagama Shiro

    JOURNAL OF CLINICAL NEUROSCIENCE   Vol. 79   page: 1 - 6   2020.9

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    Purpose: To investigate intraoperative reinsertion of percutaneous pedicle screw (PPS) with intraoperative CT-based navigation and to evaluate the rate of deviation of PPS at postoperative radiographic examination. Methods: Seven hundred sixty-three screws were inserted in 138 patients. We investigated the rate of occurrence of intraoperative PPS reinsertion after the diagnosis of screw deviation by fluoroscopy and the causes of each screw deviation. The subsequent distribution of PPS deviation was evaluated by postoperative CT. We also assess the difference in variance between the group judged to be PPS misplaced intra-/postoperatively (IOD group/POD group) and appropriate PPS placement (ND group). Results: Among all the screws inserted, 10 (1.3%) were diagnosed as being deviated by fluoroscopy during surgery, and 74 (9.7%) screws were found to be deviated at postoperative CT evaluation. We found more pedicle screw mismatch in the POD group than in the ND group (52.7 vs 11.0%, P < 0.001). The distance between the screw and the reference was greater in the IOD group than that in the ND group (1.4 ± 1.2 vs 2.4 ± 1.1 vertebral levels, P = 0.016). In one patient in the IOD group, a motor function deficit was observed postoperatively. Conclusion: PPS fixation under intraoperative CT-based navigation did not prevent screw deviation completely. It is necessary to consider errors that occur during surgery and to confirm placement with real-time assistance such as fluoroscopy even in a surgery performed under CT navigation assistance.

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  61. Zonisamide ameliorates progression of cervical spondylotic myelopathy in a rat model

    Kanbara Shunsuke, Ohkawara Bisei, Nakashima Hiroaki, Ohta Kyotaro, Koshimizu Hiroyuki, Inoue Taro, Tomita Hiroyuki, Ito Mikako, Masuda Akio, Ishiguro Naoki, Imagama Shiro, Ohno Kinji

    SCIENTIFIC REPORTS   Vol. 10 ( 1 ) page: 13138   2020.8

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    Cervical spondylotic myelopathy (CSM) is caused by chronic compression of the spinal cord and is the most common cause of myelopathy in adults. No drug is currently available to mitigate CSM. Herein, we made a rat model of CSM by epidurally implanting an expanding water-absorbent polymer underneath the laminae compress the spinal cord. The CSM rats exhibited progressive motor impairments recapitulating human CSM. CSM rats had loss of spinal motor neurons, and increased lipid peroxidation in the spinal cord. Zonisamide (ZNS) is clinically used for epilepsy and Parkinson's disease. We previously reported that ZNS protected primary spinal motor neurons against oxidative stress. We thus examined the effects of ZNS on our rat CSM model. CSM rats with daily intragastric administration of 0.5% methylcellulose (n = 11) and ZNS (30 mg/kg/day) in 0.5% methylcellulose (n = 11). Oral administration of ZNS ameliorated the progression of motor impairments, spared the number of spinal motor neurons, and preserved myelination of the pyramidal tracts. In addition, ZNS increased gene expressions of cystine/glutamate exchange transporter (xCT) and metallothionein 2A in the spinal cord in CSM rats, and also in the primary astrocytes. ZNS increased the glutathione (GSH) level in the spinal motor neurons of CSM rats. ZNS potentially ameliorates loss of the spinal motor neurons and demyelination of the pyramidal tracts in patients with CSM.

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  62. Reoperation for Late Neurological Deterioration After Laminoplasty in Individuals with Degenerative Cervical Myelopathy: Comparison of Cases of Cervical Spondylosis and Ossification of the Posterior Longitudinal Ligament. Reviewed

    Nakashima H, Kanemura T, Satake K, Ito K, Ouchida J, Morita D, Ando K, Kobayashi K, Ishiguro N, Imagama S

    Spine   Vol. 45 ( 15 ) page: E909 - E916   2020.8

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  63. Lateral approach corpectomy and reconstruction after anterior longitudinal ligament release in cases with fixed kyphosis: A technical note and a preliminary case series. Reviewed

    Nakashima H, Kanemura T, Satake K, Ito K, Tanaka S, Segi N, Ouchida J, Ando K, Kobayashi K, Ishiguro N, Imagama S

    Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia   Vol. 78   page: 164 - 169   2020.8

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  64. Risk Factors for Neuropathic Pain in Middle-Aged and Elderly People: A Five-Year Longitudinal Cohort in the Yakumo Study. Reviewed

    Imagama S, Ando K, Kobayashi K, Nakashima H, Seki T, Hamada T, Machino M, Ota K, Tanaka S, Morozumi M, Kanbara S, Ito S, Ishiguro N, Hasegawa Y

    Pain medicine (Malden, Mass.)   Vol. 21 ( 8 ) page: 1604 - 1610   2020.8

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  65. Dynapenia and physical performance in community-dwelling elderly people in Japan Reviewed

    Kobayashi Kazuyoshi, Imagama Shiro, Ando Kei, Nakashima Hiroaki, Machino Masaaki, Morozumi Masayoshi, Kanbara Shunsuke, Ito Sadayuki, Inoue Taro, Yamaguchi Hidetoshi, Ishiguro Naoki, Hasegawa Yukiharu

    NAGOYA JOURNAL OF MEDICAL SCIENCE   Vol. 82 ( 3 ) page: 415 - 424   2020.8

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    Aging of society has increased the incidence of physical disability. The goal of this study was to examine the physical ability of elderly people classified as having sarcopenia, presarcopenia, or dynapenia (a low muscle function without low muscle mass) in a community in Japan. The subjects were volunteers aged >60 years who were participants in a health checkup in Yakumo, Hokkaido and were in good general health. Demographic data were collected and physical performance tests were performed to measure grip strength, walking speed, back muscle strength, maximum stride length, and 3-m timed-up-and-go (3m TUG) time. A measurement of skeletal muscle mass was used as a basis for calculating the appendicular skeletal muscle index (aSMI). The rates of sarcopenia, presarcopenia, and dynapenia were 10%, 22%, and 8% in males (n=101, age 69.7±5.4 years), and 19%, 23%, and 13% in females (n=112, 68.5±5.9 years). Body mass index in subjects with dynapenia was significantly higher compared to that in subjects with sarcopenia and presarcopenia (p<0.01). Back muscle strength, maximum stride length and 3m TUG were similar in dynapenia and sarcopenia, but differed significantly with those in presarcopenia in both males and females without the influence of age (p<0.05). Further studies are needed to evaluate the benefits of dynapenia intervention programs and to explore the underlying pathophysiology of dynapenia.

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  66. Associations of Serum MicroRNA with Bone Mineral Density in Community-Dwelling Subjects: The Yakumo Study Reviewed

    Nakashima Hiroaki, Ando Kei, Kobayashi Kazuyoshi, Seki Taisuke, Ishizuka Shinya, Fujii Ryosuke, Takegami Yasuhiko, Yamada Hiroya, Ando Yoshitaka, Suzuki Koji, Hasegawa Yukiharu, Imagama Shiro

    BIOMED RESEARCH INTERNATIONAL   Vol. 2020   page: 5047243   2020.7

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    Osteoporosis is a disease characterized by deterioration of bone tissue and mass, with an increasing global prevalence. Therefore, the discovery of biomarkers for osteoporosis would help to guide appropriate treatment. Circulating microRNAs (miRNAs) have become increasingly recognized as biomarkers for detecting diseases. However, few studies have investigated the association of circulating miRNA with osteoporosis in the general population. The aim of this study was to identify miRNA associated with osteoporosis in a general resident health check-up for potential use as an osteoporosis biomarker. We conducted a cross-sectional study as part of a health check-up program and recruited 352 volunteers (139 men, 213 women, mean age 64.1±9.6 years). Osteoporosis was diagnosed according to the WHO classification. Twenty-two candidate microRNAs were screened through real-time quantitative PCR, and miRNAs associated with osteoporosis were analyzed using logistic regression analysis including other risk factors. In total, 95 females and 30 males were diagnosed with osteoporosis with bone mineral density tests (BMD: T-score<-2.5). We found that miR195 was significantly lower in females, while miR150 and miR222 were significantly higher in males. The results of the logistic regression analysis indicated that in females, higher age and lower miR195 (odds ratio: 0.45, 95% confidential interval: 0.03-0.98) were significant risk factors for lower BMD, while the presence of a smoking habit and lower miR150 (odds ratio: 1.35, 95% confidential interval: 1.02-1.79) were significant risk factors for osteoporosis. Serum levels of miR195 and miR150 are independently associated with low bone mineral density in females and males, respectively.

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  67. Prognostic Factors in the New Katagiri Scoring System After Palliative Surgery for Spinal Metastasis. Reviewed

    Kobayashi K, Ando K, Nakashima H, Sato K, Kanemura T, Yoshihara H, Hirasawa A, Kato F, Ishiguro N, Imagama S

    Spine   Vol. 45 ( 13 ) page: E813 - E819   2020.7

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    DOI: 10.1097/BRS.0000000000003415

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  68. Locomotive syndrome and the power spectral characteristics of body sway Reviewed

    Tanaka Satoshi, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Seki Taisuke, Ishizuka Shinya, Machino Masaaki, Kanbara Shunsuke, Ito Sadayuki, Kanemura Tokumi, Ishiguro Naoki, Hasegawa Yukiharu, Imagama Shiro

    GERIATRICS & GERONTOLOGY INTERNATIONAL   Vol. 20 ( 7 ) page: 691 - 696   2020.7

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  69. Indirect Decompression Using Lateral Lumbar Interbody Fusion for Restenosis after an Initial Decompression Surgery.

    Nakashima H, Kanemura T, Satake K, Ito K, Ishikawa Y, Ouchida J, Segi N, Yamaguchi H, Imagama S

    Asian spine journal   Vol. 14 ( 3 ) page: 305 - 311   2020.6

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  70. Simultaneous single-position lateral interbody fusion and percutaneous pedicle screw fixation using O-arm-based navigation reduces the occupancy time of the operating room Reviewed

    Ouchida Jun, Kanemura Tokumi, Satake Kotaro, Nakashima Hiroaki, Ishikawa Yoshimoto, Imagama Shiro

    EUROPEAN SPINE JOURNAL   Vol. 29 ( 6 ) page: 1277 - 1286   2020.6

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  71. Postoperative iatrogenic spinal cord herniation: three case reports with a literature review Reviewed

    Nakashima Hiroaki, Ishikawa Yoshimoto, Kato Fumihiko, Kanemura Tokumi, Shinjo Ryuichi, Ando Kei, Kobayashi Kazuyoshi, Ishiguro Naoki, Imagama Shiro

    NAGOYA JOURNAL OF MEDICAL SCIENCE   Vol. 82 ( 2 ) page: 383 - 389   2020.5

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  72. Subtype-specific gout susceptibility loci and enrichment of selection pressure on ABCG2 and ALDH2 identified by subtype genome-wide meta-analyses of clinically defined gout patients Reviewed

    Nakayama Akiyoshi, Nakatochi Masahiro, Kawamura Yusuke, Yamamoto Ken, Nakaoka Hirofumi, Shimizu Seiko, Higashino Toshihide, Koyama Teruhide, Hishida Asahi, Kuriki Kiyonori, Watanabe Miki, Shimizu Toru, Ooyama Keiko, Ooyama Hiroshi, Nagase Mitsuo, Hidaka Yuji, Matsui Daisuke, Tamura Takashi, Nishiyama Takeshi, Shimanoe Chisato, Katsuura-Kamano Sakurako, Takashima Naoyuki, Shirai Yuya, Kawaguchi Makoto, Takao Mikiya, Sugiyama Ryo, Takada Yuzo, Nakamura Takahiro, Nakashima Hiroshi, Tsunoda Masashi, Danjoh Inaho, Hozawa Atsushi, Hosomichi Kazuyoshi, Toyoda Yu, Kubota Yu, Takada Tappei, Suzuki Hiroshi, Stiburkova Blanka, Major Tanya J., Merriman Tony R., Kuriyama Nagato, Mikami Haruo, Takezaki Toshiro, Matsuo Keitaro, Suzuki Sadao, Hosoya Tatsuo, Kamatani Yoichiro, Kubo Michiaki, Ichida Kimiyoshi, Wakai Kenji, Inoue Ituro, Okada Yukinori, Shinomiya Nariyoshi, Matsuo Hirotaka

    ANNALS OF THE RHEUMATIC DISEASES   Vol. 79 ( 5 ) page: 657 - 665   2020.5

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  73. The Prevalence and Risk Factors for S2 Alar-Iliac Screw Loosening with a Minimum 2-Year Follow-up

    Nakashima Hiroaki, Kanemura Tokumi, Satake Kotaro, Ito Kenyu, Ishikawa Yoshimoto, Ouchida Jun, Segi Naoki, Yamaguchi Hidetoshi, Imagama Shiro

    ASIAN SPINE JOURNAL   Vol. 14 ( 2 ) page: 177 - 184   2020.4

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  74. Differences of lumbopelvic sagittal parameters among community-dwelling middle-age and elderly individuals: Relations with locomotor physical function Reviewed

    Machino Masaaki, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Morozumi Masayoshi, Tanaka Satoshi, Kanbara Shunsuke, Ito Sadayuki, Seki Taisuke, Ishizuka Shinya, Ishiguro Naoki, Hasegawa Yukiharu, Imagama Shiro

    JOURNAL OF CLINICAL NEUROSCIENCE   Vol. 73   page: 80 - 84   2020.3

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  75. Outcomes of Surgery for Thoracic Myelopathy Owing to Thoracic Ossification of the Ligamentum Flavum in a Nationwide Multicenter Prospectively Collected Study in 223 Patients: Is Instrumented Fusion Necessary? Reviewed

    Ando K.

    Spine   Vol. 45 ( 3 ) page: E170 - E178   2020.2

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  76. Neurological function following early versus delayed decompression surgery for drop foot caused by lumbar degenerative diseases Reviewed

    Nakashima Hiroaki, Ishikawa Yoshimoto, Kanemura Tokumi, Kato Fumihiko, Satake Kotaro, Ito Keigo, Ito Kenyu, Ando Kei, Kobayashi Kazuyoshi, Ishiguro Naoki, Imagama Shiro

    JOURNAL OF CLINICAL NEUROSCIENCE   Vol. 72   page: 39 - 42   2020.2

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  77. Standardization of phototherapy for neonatal hyperbilirubinemia using multiple-wavelength irradiance integration Reviewed

    Kato S.

    Pediatrics and Neonatology   Vol. 61 ( 1 ) page: 100 - 105   2020.2

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  78. GDNF rescues the fate of neural progenitor grafts by attenuating Notch signals in the injured spinal cord in rodents.

    Khazaei M, Ahuja CS, Nakashima H, Nagoshi N, Li L, Wang J, Chio J, Badner A, Seligman D, Ichise A, Shibata S, Fehlings MG

    Science translational medicine   Vol. 12 ( 525 )   2020.1

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  79. Dysfunctional missense variant of OAT10/SLC22A13 decreases gout risk and serum uric acid levels Reviewed

    Higashino Toshihide, Morimoto Keito, Nakaoka Hirofumi, Toyoda Yu, Kawamura Yusuke, Shimizu Seiko, Nakamura Takahiro, Hosomichi Kazuyoshi, Nakayama Akiyoshi, Ooyama Keiko, Ooyama Hiroshi, Shimizu Toru, Ueno Miki, Ito Toshimitsu, Tamura Takashi, Naito Mariko, Nakashima Hiroshi, Kawaguchi Makoto, Takao Mikiya, Kawai Yosuke, Osada Naoki, Ichida Kimiyoshi, Yamamoto Ken, Suzuki Hiroshi, Shinomiya Nariyoshi, Inoue Ituro, Takada Tappei, Matsuo Hirotaka

    ANNALS OF THE RHEUMATIC DISEASES   Vol. 79 ( 1 ) page: 164 - 166   2020.1

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  80. Japan-Retinal Detachment Registry Report I: preoperative findings in eyes with primary retinal detachment Reviewed

    Sakamoto Taiji, Kawano Sumihiro, Kawasaki Ryo, Hirakata Akito, Yamashita Hidetoshi, Yamamoto Shuichi, Ishibashi Tatsuro, Yamamoto Shuichi, Baba Takayuki, Sato Eiju, Kitahashi Masayasu, Tatsumi Tomoaki, Miura Gen, Niizawa Tomohiro, Sakamoto Taiji, Yamakiri Keita, Yamashita Toshifumi, Otsuka Hiroki, Sameshima Seiji, Yoshinaga Narimasa, Sonoda Shozo, Hirakata Akito, Koto Takashi, Inoue Makoto, Hirota Kazunari, Itoh Yuji, Orihara Tadashi, Emoto Yoshinobu, Sano Masahiko, Takahashi Hiroyuki, Tokizawa Ryo, Yamashita Hidetoshi, Nishitsuka Koichi, Kaneko Yutaka, Nishi Katsuhiro, Yoshida Akitoshi, Ono Shinji, Hirokawa Hiroyuki, Sogawa Kenji, Omae Tsuneaki, Ishibazawa Akihiro, Kishi Shoji, Akiyama Hideo, Matsumoto Hidetaka, Mukai Ryo, Morimoto Masahiro, Nakazawa Mitsuru, Suzuki Yukihiko, Kudo Takashi, Adachi Kobu, Ishida Susumu, Noda Kousuke, Kase Satoru, Mori Syouhei, Ando Ryo, Saito Michiyuki, Suzuki Tomohiro, Takahashi Kanji, Nagai Yoshimi, Nakauchi Tadashi, Yamada Haruiko, Kusaka Shuji, Tsujioka Daishi, Tsujikawa Akitaka, Suzuma Kiyoshi, Ishibashi Tatsuro, Sonoda Koh-Hei, Ikeda Yasuhiro, Kohno Riichiro, Ishikawa Keijiro, Kondo Mineo, Kozawa Maki, Kitaoka Takashi, Tsuiki Eiko, Ogura Yuichiro, Yoshida Munenori, Morita Hiroshi, Kato Aki, Hirano Yoshio, Sugitani Kazuhiko, Terasaki Hiroko, Iwase Takeshi, Ito Yasuki, Ueno Shinji, Kaneko Hiroki, Nonobe Norie, Kominami Taro, Azuma Noriyuki, Yokoi Tadashi, Shimada Hiroyuki, Nakashizuka Hiroyuki, Hattori Takayuki, Shinojima Ari, Kutagawa Yorihisa, Shiraga Fumio, Morizane Yuki, Kimura Shuhei, Ikeda Tsunehiko, Kida Teruyo, Sato Takaki, Fukumoto Masanori, Emi Kazuyuki, Nakashima Hiroshi, Ohji Masahito, Kakinoki Masashi, Sawada Osamu, Takeuchi Shinobu, Tanaka Sumiyoshi, Iida Tomohiro, Koizumi Hideki, Maruko Ichiro, Hasegawa Taiji, Kogure Akiko, Iijima Hiroyuki, Oshiro Tomohiro, Tateno Yasushi, Kikushima Wataru, Sugiyama Atsushi, Yoneyama Seigo, Kadonosono Kazuaki, Sato Shimpei, Yamane Shin

    JAPANESE JOURNAL OF OPHTHALMOLOGY   Vol. 64 ( 1 ) page: 1 - 12   2020.1

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  81. Higher extracellular water-to-total body water ratio more strongly reflects the locomotive syndrome risk and frailty than sarcopenia Reviewed

    Tanaka Satoshi, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Seki Taisuke, Ishizuka Shinya, Machino Masaaki, Morozumi Masayoshi, Kanbara Shunsuke, Ito Sadayuki, Inoue Taro, Kanemura Tokumi, Ishiguro Naoki, Hasegawa Yukiharu, Imagama Shiro

    ARCHIVES OF GERONTOLOGY AND GERIATRICS   Vol. 88   page: 104042   2020

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  82. The Surgical Treatment for Occipito-atlantoaxial Rotatory Fixation: a Case Report

    Kagami Yujiro, Ouchida Jun, Nakashima Hiroaki, Satake Kotaro, Ito Kenyu, Ishikawa Yoshimoto, Imagama Shiro, Kanemura Tokumi

    Journal of Spine Research   Vol. 11 ( 4 ) page: 779-782   2020

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    <p>A 10-year-old boy complaining of neck pain without any inducement was referred to our hospital. Images at the first visit showed an atlantoaxial rotatory fixation (AARF). He received conservative treatment for 14 months with a cervical collar, Glisson traction and halo vest fixation after manual reduction under general anesthesia. However, residual rotational position and cervical pain recurred. Finally, he required surgical intervention with posterior C1-2 fixation. An atlantoaxial rotation with O-C1 joint lesion (OAARF) may result in worse treatment outcome as conservative treatment compared to AARF. It is necessary to evaluate the pathological condition at an early stage of OAARF and consider decision making including the surgical treatment.</p>

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  83. FUNCTIONAL EQUATIONS OF ZETA FUNCTIONS ASSOCIATED WITH HOMOGENEOUS CONES Reviewed

    Nakashima Hideto

    TOHOKU MATHEMATICAL JOURNAL   Vol. 72 ( 3 ) page: 349 - 378   2020

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  84. Short physical performance battery discriminates clinical outcomes in hospitalized patients aged 75 years and over Reviewed

    Fujita Kosuke, Nakashima Hirotaka, Kako Masato, Shibata Atsushi, Cheng Yu-ting, Tanaka Shinya, Nishida Yoshihiro, Kuzuya Masafumi

    ARCHIVES OF GERONTOLOGY AND GERIATRICS   Vol. 90   2020

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    Aim: Low physical function is associated with poor outcomes in hospitalized patients; however, little is known about vulnerable populations such as those aged ≥ 75 years. We examined whether the Short Physical Performance Battery (SPPB) was associated with clinical outcomes in hospitalized patients aged ≥ 75 years. Methods: In total, 147 patients aged ≥ 75 years (mean age, 86.5 ± 4.7 years; 89 males) completed the SPPB and Mini-Mental State Examination (MMSE) before hospital discharge. Patients were divided into three groups by SPPB score: 0 (unable to perform SPPB), 1–6 (low performance), and 7–12 (high performance). The first occurrence of all-cause unplanned readmission or all-cause mortality within 1 year after discharge was set as the endpoint. Results: The median SPPB score of the study population was 2; 41 % were unable to perform SPPB, 33 % had low performance, and 26 % had high performance. High SPPB was associated with younger age, higher body weight, and higher MMSE score. During the follow-up period, 35 (23.8 %) patients were readmitted to hospital and 19 (12.9 %) died. Even after adjusting for covariates, SPPB score was a significant and independent predictor of poor outcomes (hazard ratio for 1 point increase in SPPB, 0.88; P = .002). The subgroup analysis showed SPPB was inversely associated with the occurrence of poor outcomes in patients with cognitive impairment. Conclusions: SPPB is inversely associated with risks for readmission and mortality in hospitalized patients aged ≥ 75 years, especially those with cognitive impairment. The present results indicate the SPPB is useful for accurate prognosis in hospital settings.

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  85. Poor spinal alignment in females with obesity: The Yakumo study

    Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Machino Masaaki, Ito Sadayuki, Kanbara Shunsuke, Inoue Taro, Hasegawa Yoshiharu, Imagama Shiro

    JOURNAL OF ORTHOPAEDICS   Vol. 21   page: 512 - 516   2020

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    Objective: The goal of this prospective study was prospectively to investigate the relationship between obesity and spinal sagittal alignment. Methods: 286 were referred for orthopedic evaluation. Differences in spinal parameters among these groups and between males and females were evaluated. Results: Obese subjects had significantly higher C2S, CPA, CTPA, PI-LL, and lower cervical lordosis, L4S1, lumbar lordosis, and sacral slope. In multivariate logistic regression analysis adjusted for age in females, CTPA was identified as the only independent and significant factor associated with obesity. Conclusions: Obesity in females has significant relationships with spinal sagittal alignment and results in poorer physical QOL.

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  86. Intramedullary cavernous hemangioma of the spinal cord with intra- and extramedullary hematomas Reviewed

    Koshimizu H.

    Journal of Orthopaedic Science     2020

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  87. Indirect Decompression on MRI Chronologically Progresses After Immediate Postlateral Lumbar Interbody Fusion: The Results From a Minimum of 2 Years Follow-Up. Reviewed International journal

    Hiroaki Nakashima, Tokumi Kanemura, Kotaro Satake, Yoshimoto Ishikawa, Jun Ouchida, Naoki Segi, Hidetoshi Yamaguchi, Shiro Imagama

    Spine   Vol. 44 ( 24 ) page: E1411 - E1418   2019.12

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    MINI: On magnetic resonance imaging, indirect decompression using lateral lumbar interbody fusion and posterior fixation was confirmed immediately after surgery and also continuously progressed after surgery, particularly during the first 6 months. Thecal sac enlargement was also confirmed, and is suspected to be caused by the atrophy of the ligamentum flavum and the disc. STUDY DESIGN: A prospective cohort study. OBJECTIVE: The aim of this study was to investigate radiographical changes related to indirect decompression using lateral lumbar interbody fusion (LLIF) with posterior fixation. SUMMARY OF BACKGROUND DATA: Indirect lumbar decompression via LLIF is used to treat degenerative lumbar diseases requiring neural decompression. Although evidence suggests that thecal sac enlargement follows shortly after surgery, few studies have described the postoperative changes on MRIs. METHODS: This study involved 102 patients who underwent indirect decompression at 136 levels, with LLIF and posterior fixation. Magnetic resonance imaging (MRIs) were collected preoperatively and several times postoperatively (over a 2-year period starting immediately after surgery). We then quantified the cross-sectional areas of the thecal sac and ligamentum flavum, as well as the anteroposterior diameter of disc bulging, and qualitatively assessed lumbar spinal stenosis according to a modified version of Schizas' classification [Grades A (mild) to C (severe)]. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was used for the assessment of the clinical symptoms. RESULTS: All changes were observable immediately after surgery, progressed over time, and were significantly different statistically at 2 years after surgery. The thecal sac was significantly larger (189% of preoperative; P < 0.0001), while the ligamentum flavum and disc bulge were significantly smaller [58.9% and 67.3% of preoperative (P < 0.001), respectively]. The number of patients with grade C (severe) lumbar stenosis also dropped significantly (preoperative, 17.6%; 2 years postoperative, 0%). There were no significant differences in JOABPEQ results at 6 months, 1 year, and 2 years postsurgery. CONCLUSION: Indirect decompression produces immediate positive results that continue to improve over time. The cross-sectional area of the thecal sac doubled by 2 years after surgery, and the ligamentum flavum cross-sectional area and disc bulging both shrank significantly. At the same time, however, postoperative radiographical improvements do not appear to correlate with clinical symptoms. LEVEL OF EVIDENCE: 3.

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  88. Changes in Sagittal Alignment Following Short-Level Lumbar Interbody Fusion: Comparison between Posterior and Lateral Lumbar Interbody Fusions. Reviewed International journal

    Hiroaki Nakashima, Tokumi Kanemura, Kotaro Satake, Yoshimoto Ishikawa, Jun Ouchida, Naoki Segi, Hidetoshi Yamaguchi, Shiro Imagama

    Asian spine journal   Vol. 13 ( 6 ) page: 904 - 912   2019.12

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    Study Design: Retrospective case-control study. Purpose: We aimed to compare radiologic outcomes between posterior (PLIF) and lateral lumbar interbody fusion (LLIF) in short-level spinal fusion surgeries. Overview of Literature: Although LLIF enables surgeons to insert large lordotic cages, it is unknown whether LLIF more effectively corrects local and global sagittal alignments compared with PLIF in short-level spinal fusion surgeries. Methods: Radiographic data acquired from patients with lumbar interbody fusion (≤3 levels) using PLIF or LLIF for degenerative lumbar diseases were analyzed. The following radiographic parameters were evaluated preoperatively and at 2 years postoperatively: segmental lordotic angle, disk height, lumbar lordosis (LL), pelvic tilt (PT), C7 sagittal vertical axis, and thoracic kyphosis (TK). Results: In total, 144 patients with PLIF (193 fused levels) and 101 with LLIF (159 fused levels) were included. Patients' backgrounds and preoperative radiographic parameters for any level of fusion did not differ significantly between PLIF and LLIF procedures. The LLIF group exhibited significantly greater changes at 1-level fusion compared to the PLIF group in the parameters of segmental lordotic angle (5.1°±5.8° vs. 2.1°±5.0°, p<0.001), disk height (4.2±2.3 mm vs. 2.2±2.0 mm, p<0.001), LL (7.8°±7.6° vs. 3.9°±8.6°, p=0.004), and PI-LL (-6.9°±6.8° vs. -3.6°±10.1°, p=0.03). While, a similar trend was observed regarding 2-level fusion, significantly greater changes were only observed in LL (12.1°±11.1° vs. 4.2°±9.1°, p=0.047) and PI-LL (-11.2°±11.3° vs. -3.0°±9.3°, p=0.043), PT (-6.4°±4.9° vs. -2.5°±5.3°, p=0.049) and TK (7.8°±11.8° vs. -0.3°±9.7°, p=0.047) in the LLIF group at 3-level fusion. Conclusions: LLIF provides significantly better local sagittal alignment than PLIF in 1- or 2-level fusion cases and improves spinopelvic alignment and local alignment for 3-level fusion cases. Thus, LLIF was demonstrated to be a useful lumbar interbody fusion technique, constituting a powerful tool for achieving sagittal realignment with minimal surgical invasiveness.

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  89. Musculoskeletal Factors and Geriatric Syndromes Related to the Absence of Musculoskeletal Degenerative Disease in Elderly People Aged over 70 Years Reviewed

    Imagama Shiro, Ando Kei, Kobayashi Kazuyoshi, Seki Taisuke, Ishizuka Shinya, Machino Masaaki, Tanaka Satoshi, Morozumi Masayoshi, Kanbara Shunsuke, Ito Sadayuki, Inoue Taro, Nakashima Hiroaki, Ishiguro Naoki, Hasegawa Yukiharu

    BIOMED RESEARCH INTERNATIONAL   Vol. 2019   page: 7097652   2019.11

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  90. Clinical Features of Thoracic Myelopathy: A Single-Center Study

    Ando Kei, Imagama Shiro, Kobayashi Kazuyoshi, Ito Kenyu, Tsushima Mikito, Morozumi Masayoshi, Tanaka Satoshi, Machino Masaaki, Ota Kyotaro, Nakashima Hiroaki, Nishida Yoshihiro, Ishiguro Naoki

    JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS   Vol. 3 ( 11 )   2019.11

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  91. Increase in lumbar kyphosis and spinal inclination, declining back muscle strength, and sarcopenia are risk factors for onset of GERD: a 5-year prospective longitudinal cohort study. Reviewed International journal

    Shiro Imagama, Kei Ando, Kazuyoshi Kobayashi, Masaaki Machino, Satoshi Tanaka, Masayoshi Morozumi, Shunsuke Kanbara, Sadayuki Ito, Taisuke Seki, Takashi Hamada, Shinya Ishizuka, Hiroaki Nakashima, Naoki Ishiguro, Yukiharu Hasegawa

    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   Vol. 28 ( 11 ) page: 2619 - 2628   2019.11

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    PURPOSE: The objective was to identify risk factors for new development of gastroesophageal reflux disease (GERD) 5 years later in a prospective longitudinal cohort study. METHODS: A total of 178 subjects (male 72, female 106, mean age 68 years) without GERD in 2013 were examined for GERD in 2018. A Frequency Scale for Symptoms of GERD score ≥ 8 was used for diagnosis of GERD. Body mass index, spinal alignment, muscle strength, physical ability, number of oral drugs per day, sarcopenia, and frailty determined in 2013 and 2018 were compared between the GERD(+) and GERD(-) groups in 2018. Aggravation of lumbar kyphosis and spinal inclination from 2013 to 2018 was defined as a change of ≥ 5° or ≥ 10°, and weakening of back muscle strength as a change of ≥ 10 kg. QOL (SF-36) was also examined. RESULTS: Of the 178 subjects, 38 (21%) were diagnosed as GERD(+) in 2018. Sarcopenia in 2018 was significantly related to a GERD(+) status (p < 0.05). The GERD(+) group had significantly higher rates of changes of lumbar kyphosis ≥ 5° (p < 0.005) and ≥ 10° (p < 0.0001), of spinal inclination ≥ 5° (p < 0.0001), and of decreased back muscle strength ≥ 10 kg (p < 0.05). SF-36 were also significantly worse in the GERD(+) group (p < 0.05). CONCLUSIONS: This prospective longitudinal study firstly demonstrated that lumbar kyphotic change, aggravation of spinal inclination, decreased back muscle strength, and sarcopenia are significant risk factors for new development of GERD. Management and prevention of these factors may contribute to reduction of GERD symptoms and increased QOL in middle-aged and elderly people. These slides can be retrieved under Electronic Supplementary Material.

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  92. Plasma orexin-A levels in patients with delirium Reviewed International journal

    Nakashima Hirotaka, Umegaki Hiroyuki, Yanagawa Madoka, Komiya Hitoshi, Watanabe Kazuhisa, Kuzuya Masafumi

    PSYCHOGERIATRICS   Vol. 19 ( 6 ) page: 628 - 630   2019.11

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  93. Multivariate analysis of factors related to the absence of musculoskeletal degenerative disease in middle-aged and older people. Reviewed International journal

    Imagama S, Ando K, Kobayashi K, Machino M, Tanaka S, Morozumi M, Kanbara S, Ito S, Inoue T, Seki T, Ishizuka S, Nakashima H, Ishiguro N, Hasegawa Y

    Geriatrics & gerontology international   Vol. 19 ( 11 ) page: 1141 - 1146   2019.11

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  94. Factors Affecting Postoperative Sagittal Alignment after Lateral Lumbar Interbody Fusion in Adult Spinal Deformity: Posterior Osteotomy, Anterior Longitudinal Ligament Rupture, and Endplate Injury. Reviewed International journal

    Hiroaki Nakashima, Tokumi Kanemura, Kotaro Satake, Yoshimoto Ishikawa, Jun Ouchida, Naoki Segi, Hidetoshi Yamaguchi, Shiro Imagama

    Asian spine journal   Vol. 13 ( 5 ) page: 738 - 745   2019.10

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    Study Design: Prospective cohort study. Purpose: To identify factors that affect sagittal alignment correction in lateral lumbar interbody fusion (LIF) surgery for adult spinal deformity (ASD) and to investigate the degree of correction in each condition. Overview of Literature: LIF is a useful procedure for ASD, but the degree of correction can be affected by posterior osteotomy, intraoperative endplate injury, or anterior longitudinal ligament (ALL) rupture. Methods: Radiographical data for 30 patients who underwent LIF for ASD were examined prospectively. All underwent two-stage surgery (LIF followed by posterior fixation). Radiographical parameters were measured preoperatively, after LIF, and after posterior fixation; these included the segmental lordotic angle, lumbar lordosis (LL), and other sagittal alignment factors. Results: LL was corrected from 16.5°±16.7° preoperatively to 33.4°±13.8° after LIF (p <0.001) and then to 52.1°±7.9° following posterior fixation (p <0.001). At levels where Schwab grade 2 osteotomy was performed, the acquired segmental lordotic angles from the preoperative value to after posterior fixation and from after LIF to after posterior fixation were 19.5°±9.2° and 9.9°±3.9°, respectively. On average, 12.4° more was added than in cases without osteotomy. Endplate injury was identified at 21 levels (19.4%) after LIF, with a mean loss of 3.4° in the acquired segmental lordotic angle (5.3°±8.4° and 1.9°±5.9° without and with endplate injury, respectively). ALL rupture was identified at seven levels (6.5%), and on average 19.3° more was added in these cases between the preoperative and postoperative values than in cases without ALL rupture. Conclusions: LIF provides adequate sagittal alignment restoration for ASD, but the degree of correction is affected by grade 2 osteotomy, intraoperative endplate injury, and ALL rupture.

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  95. Genome-wide association study revealed novel loci which aggravate asymptomatic hyperuricaemia into gout Reviewed International journal

    Kawamura Yusuke, Nakaoka Hirofumi, Nakayama Akiyoshi, Okada Yukinori, Yamamoto Ken, Higashino Toshihide, Sakiyama Masayuki, Shimizu Toru, Ooyama Hiroshi, Ooyama Keiko, Nagase Mitsuo, Hidaka Yuji, Shirahama Yuko, Hosomichi Kazuyoshi, Nishida Yuichiro, Shimoshikiryo Ippei, Hishida Asahi, Katsuura-Kamano Sakurako, Shimizu Seiko, Kawaguchi Makoto, Uemura Hirokazu, Ibusuki Rie, Hara Megumi, Naito Mariko, Takao Mikiya, Nakajima Mayuko, Iwasawa Satoko, Nakashima Hiroshi, Ohnaka Keizo, Nakamura Takahiro, Stiburkova Blanka, Merriman Tony R., Nakatochi Masahiro, Ichihara Sahoko, Yokota Mitsuhiro, Takada Tappei, Saitoh Tatsuya, Kamatani Yoichiro, Takahashi Atsushi, Arisawa Kokichi, Takezaki Toshiro, Tanaka Keitaro, Wakai Kenji, Kubo Michiaki, Hosoya Tatsuo, Ichida Kimiyoshi, Inoue Ituro, Shinomiya Nariyoshi, Matsuo Hirotaka

    ANNALS OF THE RHEUMATIC DISEASES   Vol. 78 ( 10 ) page: 1430 - 1437   2019.10

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  96. The Influence of Age on the Outcomes of Traumatic Brain Injury: Findings from a Japanese Nationwide Survey (J-ASPECT Study-Traumatic Brain Injury) Reviewed International journal

    Yamagami K.

    World Neurosurgery   Vol. 130   page: e26 - e46   2019.10

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  97. Plasma orexin-A-like immunoreactivity levels and renal function in patients in a geriatric ward Reviewed International journal

    Nakashima Hirotaka, Umegaki Hiroyuki, Yanagawa Madoka, Komiya Hitoshi, Watanabe Kazuhisa, Kuzuya Masafumi

    PEPTIDES   Vol. 118   2019.8

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  98. Unplanned Second-Stage Decompression for Neurological Deterioration Caused by Central Canal Stenosis after Indirect Lumbar Decompression Surgery. Reviewed International journal

    Hiroaki Nakashima, Tokumi Kanemura, Kotaro Satake, Yoshimoto Ishikawa, Jun Ouchida, Naoki Segi, Hidetoshi Yamaguchi, Shiro Imagama

    Asian spine journal   Vol. 13 ( 4 ) page: 584 - 591   2019.8

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    Study Design: Prospective cohort study. Purpose: This study aimed to identify risk factors for unplanned second-stage decompression for postoperative neurological deficit after indirect decompression using lateral lumbar interbody fusion (LLIF) with posterior fixation. Overview of Literature: Indirect lumbar decompression with LLIF has been used as a minimally invasive alternative to direct decompression to treat degenerative lumbar diseases requiring neural decompression. However, evidence on the prevalence of neurological deficits caused by spinal canal stenosis after indirect decompression is limited. Methods: This study included 158 patients (mean age, 71.13±7.98 years; male/female ratio, 67/91) who underwent indirect decompression with LLIF and posterior fixation. Indirect decompression was performed at 271 levels (mean level, 1.71±0.97). Logistic regression analysis was used to identify the risk factors for postoperative neurological deficits. The variables included were age, sex, body mass index, presence of primary diseases, diabetes mellitus, preoperative motor deficit, levels operated on, preoperative severity of lumbar stenosis, and preoperative Japanese Orthopedic Association (JOA) score. Results: Postoperative neurological deficit due to spinal canal stenosis occurred in three patients (1.9%). Spinal stenosis due to hemodialysis (p<0.001), ligament ossification (p<0.001), presence of preoperative motor paralysis (p<0.001), low JOA score (p=0.004), and severe canal stenosis (p=0.02) were significantly more frequent in the paralysis group. Conclusions: Severe preoperative canal stenosis and neurological deficit were identified as risk factors for postoperative neurological deterioration caused by spinal canal stenosis. Additionally, uncommon diseases, such as spinal stenosis due to hemodialysis and ligament ossification, increased the risk of postoperative neurological deficit; therefore, in such cases, indirect decompression is contraindicated.

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  99. Both common and rare genetic variants of ABCG2 are risks for gout Reviewed

    Higashino T., Takada T., Nakaoka H., Toyoda Y., Stiburkova B., Miyata H., Ikebuchi Y., Nakashima H., Shimizu S., Kawaguchi M., Sakiyama M., Nakayama A., Akashi A., Tanahashi Y., Kawamura Y., Nakamura T., Wakai K., Okada R., Yamamoto K., Hosomichi K., Hosoya T., Ichida K., Ooyama H., Suzuki H., Inoue I., Merriman T. R., Shinomiya N., Matsuo H.

    EUROPEAN JOURNAL OF HUMAN GENETICS   Vol. 27   page: 645 - 646   2019.7

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  100. Effects of Oral Morphine on Dyspnea in Patients with Cancer: Response Rate, Predictive Factors, and Clinically Meaningful Change (CJLSG1101) Reviewed International journal

    Takahashi Kosuke, Kondo Masashi, Ando Masahiko, Shiraki Akira, Nakashima Harunori, Wakayama Hisashi, Kataoka Kensuke, Yamamoto Masashi, Sugino Yasuteru, Nishikawa Mitsunori, Imaizumi Kazuyoshi, Kojima Eiji, Sumida Atsushi, Takeyama Yoshihiro, Saito Hiroshi, Hasegawa Yoshinori

    ONCOLOGIST   Vol. 24 ( 7 ) page: E583 - E589   2019.7

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  101. Comparative Radiographic Outcomes of Lateral and Posterior Lumbar Interbody Fusion in the Treatment of Degenerative Lumbar Kyphosis. Reviewed International journal

    Hiroaki Nakashima, Tokumi Kanemura, Kotaro Satake, Yoshimoto Ishikawa, Jun Ouchida, Naoki Segi, Hidetoshi Yamaguchi, Shiro Imagama

    Asian spine journal   Vol. 13 ( 3 ) page: 395 - 402   2019.6

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    STUDY DESIGN: Retrospective case-control study. PURPOSE: To compare surgical invasiveness and radiological outcomes between posterior lumbar interbody fusion (PLIF) and lateral lumbar interbody fusion (LLIF) for degenerative lumbar kyphosis. OVERVIEW OF LITERATURE: LLIF is a minimally invasive interbody fusion technique; however, few reports compared the clinical outcomes of conventional PLIF and LLIF for degenerative lumbar kyphosis. METHODS: Radiographic data for patients who have undergone lumbar interbody fusion (≥3 levels) using PLIF or LLIF for degenerative lumbar kyphosis (lumbar lordosis [LL] <20°) were retrospectively examined. The following radiographic parameters were retrospectively evaluated preoperatively and 2 years postoperatively: segmental lordotic angle, LL, pelvic tilt (PT), pelvic incidence (PI), C7 sagittal vertical axis, and T1 pelvic angle. RESULTS: Nineteen consecutive cases with PLIF and 27 cases with LLIF were included. There were no significant differences in patients' backgrounds or preoperative radiographic parameters between the PLIF and the LLIF groups. The mean fusion level was 5.5±2.5 levels and 5.8±2.5 levels in the PLIF and LLIF groups, respectively (p=0.69). Although there was no significant difference in surgical times (p=0.58), the estimated blood loss was significantly greater in the PLIF group (p<0.001). Two years postoperatively, comparing the PLIF and LLIF groups, the segmental lordotic angle achieved (7.4°±7.6° and 10.6°±9.4°, respectively; p=0.03), LL (27.8°±13.9° and 39.2°±12.7°, respectively; p=0.006), PI-LL (19.8°±14.8° and 3.1°±17.5°, respectively; p=0.002), and PT (22.6°±7.1° and 14.2°±13.9°, respectively; p=0.02) were significantly better in the LLIF group. CONCLUSIONS: LLIF provided significantly better sagittal alignment restoration in the context of degenerative lumbar kyphosis, with less blood loss.

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  102. What Are the Important Predictors of Postoperative Functional Recovery in Patients With Cervical OPLL? Results of a Multivariate Analysis. Reviewed International journal

    Hiroaki Nakashima, Tokumi Kanemura, Shunsuke Kanbara, Kotaro Satake, Keigo Ito, Naoki Ishiguro, Fumihiko Kato, Shiro Imagama

    Global spine journal   Vol. 9 ( 3 ) page: 315 - 320   2019.5

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    Study Design: A retrospective cohort study. Objective: The objective of this study was to identify important predictors of poor functional recovery in patients undergoing surgery for cervical ossification of the posterior longitudinal ligament (OPLL). Methods: This was a retrospective cohort study of 142 OPLL patients with laminoplasty; 135 had complete radiographical data and were followed up for ≥2 years. The following OPLL characteristics were compared between patients with "good" and "poor" outcomes (Japanese Orthopedic Association [JOA] recovery rate ≥50% and <50%, respectively): number of ossified levels, OPLL classification, ossification shape, K-line, canal-occupying ratio, and increased magnetic resonance imaging (MRI) signal intensity. Predictors of functional recovery were identified. Results: Pre- and postoperative (2 years following surgery) JOA scores were 10.6 ± 2.9 and 14.1 ± 2.2, respectively, indicating significant improvement following laminoplasty (P < .001). The average JOA recovery rate was 53.4% ± 34.7%, with 81 (60.0%) and 54 (40.0%) patients in the better and poorer neurological outcome groups, respectively. The canal occupation ratio of OPLL ≤60%/>60% were 117 (86.7%) and 18 (13.3%) patients, respectively. In the stepwise logistic regression analysis, an occupation ratio greater than 60% was identified as a significant factor for poor postoperative neurological outcome (relative risk, 4.82; 95% confidential interval, 1.61-14.46, P = .005). Conclusions: This multivariate analysis demonstrated a large size OPLL (occupying ratio >60%) was associated with a risk of poor neurological recovery roughly 5 times greater, and therefore other types of surgery are recommended in cases with such a ratio.

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  103. Genome-wide meta-analysis identifies multiple novel loci associated with serum uric acid levels in Japanese individuals

    Nakatochi Masahiro, Kanai Masahiro, Nakayama Akiyoshi, Hishida Asahi, Kawamura Yusuke, Ichihara Sahoko, Akiyama Masato, Ikezaki Hiroaki, Furusyo Norihiro, Shimizu Seiko, Yamamoto Ken, Hirata Makoto, Okada Rieko, Kawai Sayo, Kawaguchi Makoto, Nishida Yuichiro, Shimanoe Chisato, Ibusuki Rie, Takezaki Toshiro, Nakajima Mayuko, Takao Mikiya, Ozaki Etsuko, Matsui Daisuke, Nishiyama Takeshi, Suzuki Sadao, Takashima Naoyuki, Kita Yoshikuni, Endoh Kaori, Kuriki Kiyonori, Uemura Hirokazu, Arisawa Kokichi, Oze Isao, Matsuo Keitaro, Nakamura Yohko, Mikami Haruo, Tamura Takashi, Nakashima Hiroshi, Nakamura Takahiro, Kato Norihiro, Matsuda Koichi, Murakami Yoshinori, Matsubara Tatsuaki, Naito Mariko, Kubo Michiaki, Kamatani Yoichiro, Shinomiya Nariyoshi, Yokota Mitsuhiro, Wakai Kenji, Okada Yukinori, Matsuo Hirotaka

    COMMUNICATIONS BIOLOGY   Vol. 2 ( 1 )   2019.4

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  104. Anatomic evaluation of retroperitoneal organs for lateral approach surgery: a prospective imaging study using computed tomography in the lateral decubitus position. Reviewed

    Ouchida J, Kanemura T, Satake K, Nakashima H, Segi N

    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   Vol. 28 ( 4 ) page: 835 - 841   2019.4

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  105. EFFECTS OF AROMATHERAPY ON SLEEP AND COGNITIVE FUNCTION IN THE ELDERLY

    Noda Akiko, Funaki Narumi, Hirashita Rie, Nakashima Honoka, Mita Yasuaki, Masato Okuda, Miyata Seiko, Iwamoto Kunihiro, Ozaki Norio, Urakami Katsuya

    SLEEP   Vol. 42   page: .   2019.4

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  106. [(10)Surgical Strategy for Adult Spinal Deformity in Elderly Patients]. Reviewed

    Tokumi Kanemura, Kotaro Satake, Hiroaki Nakashima, Yoshimoto Ishikawa, Jun Ouchida, Hidetoshi Yamaguchi, Naoki Segi, Shiro Imagama

    No shinkei geka. Neurological surgery   Vol. 47 ( 3 ) page: 271 - 285   2019.3

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    DOI: 10.11477/mf.1436203933

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  107. Decreasing trend of elemental carbon concentration with changes in major sources at Mega city Nagoya, Central Japan

    Yamagami Makiko, Ikemori Fumikazu, Nakashima Hironori, Hisatsune Kunihiro, Osada Kazuo

    ATMOSPHERIC ENVIRONMENT   Vol. 199   page: 155 - 163   2019.2

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    DOI: 10.1016/j.atmosenv.2018.11.014

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  108. A Systematic Review of Classification Systems for Cervical Ossification of the Posterior Longitudinal Ligament. Reviewed International journal

    Lindsay Tetreault, Hiroaki Nakashima, So Kato, Michael Kryshtalskyj, Nagoshi Nagoshi, Aria Nouri, Anoushka Singh, Michael G Fehlings

    Global spine journal   Vol. 9 ( 1 ) page: 85 - 103   2019.2

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    Design: Systematic review. Objective: To conduct a systematic review to (1) summarize various classification systems used to describe cervical ossification of the posterior longitudinal ligament (OPLL) and (2) evaluate the diagnostic accuracy of various imaging modalities and the reliability of these classification systems. Methods: A search was performed to identify studies that used a classification system to categorize patients with OPLL. Furthermore, studies were included if they reported the diagnostic accuracy of various imaging modalities or the reliability of a classification system. Results: A total of 167 studies were deemed relevant. Five classification systems were developed based on X-ray: the 9-classification system (0.60%); continuous, segmental, mixed, localized or focal, circumscribed and others (92.81%); hook, staple, bridge, and total types (2.40%); distribution of OPLL (2.40%); and K-line classification (4.19%). Six methods were based on computed tomography scans: free-type, contiguous-type, and broken sign (0.60%); hill-, plateau-, square-, mushroom-, irregular-, or round-shaped (5.99%); rectangular, oval, triangular, or pedunculate (1.20%); centralized or laterally deviated (1.80%); plank-, spindle-, or rod-shaped (0.60%); and rule of nine (0.60%). Classification systems based on 3-dimensional computed tomography were bridging and nonbridging (1.20%) and flat, irregular, and localized (0.60%). A single classification system was based on magnetic resonance imaging: triangular, teardrop, or boomerang. Finally, a variation of methods was used to classify OPLL associated with the dura mater (4.19%). Conclusions: The most common method of classification was that proposed by the Japanese Ministry of Health, Labour and Welfare. Other important methods include K-line (+/-), signs of dural ossification, and patterns of distribution.

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  109. Complaint of poor night sleep is correlated with physical function impairment in mild Alzheimer's disease patients

    Fujisawa Chisato, Umegaki Hiroyuki, Nakashima Hirotaka, Kuzuya Masafumi, Toba Kenji, Sakurai Takashi

    GERIATRICS & GERONTOLOGY INTERNATIONAL   Vol. 19 ( 2 ) page: 171-172   2019.2

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    DOI: 10.1111/ggi.13593

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  110. Is Pregabalin Effective Against Acute Lumbar Radicular Pain ? Reviewed

    Hiroaki Nakashima, Tokumi Kanemura, Kei Ando, Kazuyoshi Kobayashi, Minoru Yoneda, Naoki Ishiguro, Shiro Imagama

    Spine surgery and related research   Vol. 3 ( 1 ) page: 61 - 66   2019

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    Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for acute lumbar radicular pain accompanying lumbar disc herniation (LDH), but their effects are minimal. The purpose of this study was to evaluate the efficacy and safety of pregabalin (PGB) as an alternative therapy for this condition. Methods: Patients with acute lumbar radicular pain accompanying LDH were randomly administered either NSAIDs plus PGB (30 patients) or NSAIDs alone (30 patients) for up to 4 weeks. The primary outcome was leg pain at 2 and 4 weeks. Secondary outcomes were reduction in sleep disturbances and patient global impressions of change (PGIC) at 2 and 4 weeks. Results: Four patients in the NSAIDs plus PGB group were deemed ineligible and excluded from the study. Fewer sleep disturbances were reported by patients administered NSAIDs plus PGB compared with the NSAID monotherapy group at both 2 and 4 weeks. Additionally, the NSAIDs plus PGB group showed greater improvement in pain than the NSAID monotherapy group at 4 weeks, although this difference was not significant. PGIC was also significantly better in the NSAIDs plus PGB group than in the NSAID monotherapy group at 4 weeks. The incidence of adverse events was significantly greater in the NSAIDs plus PGB group than in the NSAID monotherapy group. Conclusions: The combination of NSAIDs plus PGB is more effective against sleep disturbance than NSAIDs alone in patients with acute LDH, although the control of sciatic pain is minimal. Patients reported satisfactory recoveries could also be obtained, and thus, this combination therapy could be a good option for the conservative treatment of acute lumbar radicular pain, including LDH.

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  111. Factors Affecting the Severity of Neurological Disorders in Thoracic Idiopathic Spinal Cord Herniation. Reviewed International journal

    Hiroaki Nakashima, Tokumi Kanemura, Hideki Yagi, Fumihiko Kato, Koji Sato, Mitsuhiro Kamiya, Hisatake Yoshihara, Kenyu Ito, Yukihiro Matsuyama, Naoki Ishiguro, Shiro Imagama

    Spine   Vol. 43 ( 22 ) page: 1552 - 1558   2018.11

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    STUDY DESIGN: Retrospective multicenter case-controlled study. OBJECTIVE: The objective of this study was to quantitatively examine imaging findings of idiopathic spinal cord herniation (ISCH) and determine the relationship between the image findings and the severity of pre- and postoperative neurological symptoms. SUMMARY OF BACKGROUND DATA: Many radiographic types of ISCH have been identified with regard to the location of the hernial opening or amount of herniated spinal cord. However, few previous studies have investigated the relationship between radiographic findings and the severity of neurological symptoms. METHODS: Of 30,469 patients who underwent spinal surgery at 7 hospitals, 18 patients who underwent surgery for ISCH were identified. Their preoperative neurological severity, disease duration, magnetic resonance imaging findings, computed tomography myelography findings, surgical findings, and postoperative improvements were retrospectively examined. The spinal cord kink angle and minimum cord occupancy rate within the dural tube were measured. In addition, herniation was classified according to the location of the hiatus as either central (type C) or lateral (type L) type. RESULTS: A negative correlation was found between the spinal cord kink angle and the minimum cord occupancy rate. Patient age was significantly higher in the severe paralysis group than in the mild paralysis group. In addition, the number of patients with type C herniation and the kink angle were significantly higher in the severe paralysis group. The number of patients with type L herniation was higher in the significant recovery group than in the mild recovery group; however, the difference was not significant. CONCLUSION: Patients with a large spinal cord kink angle had a smaller spinal cord occupancy rate within the dural tube, and this resulted in severe preoperative conditions. Type C ISCH cases had a severe preoperative neurological deficit and poor postoperative neurological recovery, and the spinal cord in such cases might be damaged irreversibly. LEVEL OF EVIDENCE: 4.

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  112. Nonunion of Transpsoas Lateral Lumbar Interbody Fusion Using an Allograft: Clinical Assessment and Risk Factors. Reviewed

    Satake K, Kanemura T, Nakashima H, Ishikawa Y, Segi N, Ouchida J

    Spine surgery and related research   Vol. 2 ( 4 ) page: 270 - 277   2018.10

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    DOI: 10.22603/ssrr.2017-0096

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  113. Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery: results of the Scoli-RISK-1 study Reviewed

    Michael G. Fehlings, So Kato, Lawrence G. Lenke, Hiroaki Nakashima, Narihito Nagoshi, Christopher I. Shaffrey, Kenneth M.C. Cheung, Leah Carreon, Mark B. Dekutoski, Frank J. Schwab, Oheneba Boachie-Adjei, Khaled M. Kebaish, Christopher P. Ames, Yong Qiu, Yukihiro Matsuyama, Benny T. Dahl, Hossein Mehdian, Ferran Pellisé-Urquiza, Stephen J. Lewis, Sigurd H. Berven

    Spine Journal   Vol. 18 ( 10 ) page: 1733 - 1740   2018.10

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    Background Context: Significant variability in neurologic outcomes after surgical correction for adult spinal deformity (ASD) has been reported. Risk factors for decline in neurologic motor outcomes are poorly understood. Purpose: The objective of the present investigation was to identify the risk factors for postoperative neurologic motor decline in patients undergoing complex ASD surgery. Study Design/Setting: This is a prospective international multicenter cohort study. Patient Sample: From September 2011 to October 2012, 272 patients undergoing complex ASD surgery were prospectively enrolled in a multicenter, international cohort study in 15 sites. Outcome Measures: Neurologic decline was defined as any postoperative deterioration in American Spinal Injury Association lower extremity motor score (LEMS) compared with preoperative status. Methods: To identify risk factors, 10 candidate variables were selected for univariable analysis from the dataset based on clinical relevance, and a multivariable logistic regression analysis was used with backward stepwise selection. Results: Complete datasets on 265 patients were available for analysis and 61 (23%) patients showed a decline in LEMS at discharge. Univariable analysis showed that the key factors associated with postoperative neurologic deterioration included older age, lumbar-level osteotomy, three-column osteotomy, and larger blood loss. Multivariable analysis revealed that older age (odds ratio [OR]=1.5 per 10 years, 95% confidence interval [CI] 1.1–2.1, p=.005), larger coronal deformity angular ratio [DAR] (OR=1.1 per 1 unit, 95% CI 1.0–1.2, p=.037), and lumbar osteotomy (OR=3.3, 95% CI 1.2–9.2, p=.022) were the three major predictors of neurologic decline. Conclusions: Twenty-three percent of patients undergoing complex ASD surgery experienced a postoperative neurologic decline. Age, coronal DAR, and lumbar osteotomy were identified as the key contributing factors.

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  114. Comprehensive Association Analysis between Rare and Common ABCG2 Variants and Gout Susceptibility

    Matsuo Hirotaka, Higashino Toshihide, Takada Tappei, Nakaoka Hirofumi, Toyoda Yu, Stiburkova Blanka, Nakashima Hiroshi, Shimizu Seiko, Kawaguchi Makoto, Nakayama Akiyoshi, Aoki Yuka, Ishino Misaki, Kawamura Yusuke, Wakai Kenji, Okada Rieko, Hosoya Tatsuo, Ichida Kimiyoshi, Ooyama Hiroshi, Suzuki Hiroshi, Inoue Ituro, Major Tanya J., Merriman Tony R., Shinomiya Nariyoshi

    ARTHRITIS & RHEUMATOLOGY   Vol. 70   page: .   2018.9

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  115. Maximum gait speed is associated with a wide range of cognitive functions in Japanese older adults with a Clinical Dementia Rating of 0.5

    Umegaki Hiroyuki, Makino Taeko, Yanagawa Madoka, Nakashima Hirotaka, Kuzuya Masafumi, Sakurai Takashi, Toba Kenji

    GERIATRICS & GERONTOLOGY INTERNATIONAL   Vol. 18 ( 9 ) page: 1323 - 1329   2018.9

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    DOI: 10.1111/ggi.13464

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  116. Correlation between regional cerebral blood flow and body composition in healthy older women: A single-photon emission computed tomography study

    Fujisawa Chisato, Umegaki Hiroyuki, Kato Takashi, Nakashima Hirotaka, Kuzuya Masafumi, Ito Kengo, Toba Kenji, Sakurai Takashi

    GERIATRICS & GERONTOLOGY INTERNATIONAL   Vol. 18 ( 8 ) page: 1303-1304   2018.8

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    DOI: 10.1111/ggi.13444

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  117. Prediction of thrombotic and bleeding events after percutaneous coronary intervention: CREDO-Kyoto thrombotic and bleeding risk scores

    Natsuaki M.

    Journal of the American Heart Association   Vol. 7 ( 11 )   2018.6

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    DOI: 10.1161/JAHA.118.008708

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  118. Canonical TGF-beta Signaling Negatively Regulates Neuronal Morphogenesis through TGIF/Smad Complex-Mediated CRMP2 Suppression

    Nakashima Hideyuki, Tsujimura Keita, Irie Koichiro, Ishizu Masataka, Pan Miao, Kameda Tomonori, Nakashima Kinichi

    JOURNAL OF NEUROSCIENCE   Vol. 38 ( 20 ) page: 4791 - 4810   2018.5

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    DOI: 10.1523/JNEUROSCI.2423-17.2018

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  119. Cilostazol for the prevention of pneumonia: a systematic review

    Nakashima Hirotaka, Watanabe Kazuhisa, Umegaki Hiroyuki, Suzuki Yusuke, Kuzuya Masafumi

    PNEUMONIA   Vol. 10   2018.4

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    DOI: 10.1186/s41479-018-0046-5

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  120. Lack of Fgf18 causes abnormal clustering of motor nerve terminals at the neuromuscular junction with reduced acetylcholine receptor clusters Reviewed

    Kenyu Ito, Bisei Ohkawara, Hideki Yagi, Hiroaki Nakashima, Mikito Tsushima, Kyotaro Ota, Hiroyuki Konishi, Akio Masuda, Shiro Imagama, Hiroshi Kiyama, Naoki Ishiguro, Kinji Ohno

    Scientific Reports   Vol. 8 ( 1 ) page: 434   2018.1

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    FGF receptor 2 is involved in the formation of the neuromuscular junction (NMJ), but its in vivo ligand remains to be determined. Laser capture microdissection of the mouse spinal motor neurons (SMNs) revealed that Fgf18 mRNA is highly expressed in SMNs in adults. Expression of Fgf18 mRNA was the highest in the spinal cord at embryonic day (E) 15.5, which gradually decreased to postnatal day 7. FGF18 protein was localized at the NMJs of the tibialis anterior muscle at E18.5 and in adults. Fgf18-/- mice at E18.5 showed decreased expressions of the NMJ-specific Chrne and Colq genes in the diaphragm. In Fgf18-/- diaphragms, the synaptophysin-positive areas at the nerve terminals and the acetylcholine receptor (AChR)-positive areas at the motor endplates were both approximately one-third of those in wild-type embryos. Fgf18-/- diaphragms ultrastructurally showed abnormal aggregation of multiple nerve terminals making a gigantic presynapse with sparse synaptic vesicles, and simplified motor endplates. In Fgf18-/- diaphragms, miniature endplate potentials were low in amplitude with markedly reduced frequency. In C2C12 myotubes, FGF18 enhanced AChR clustering, which was blocked by inhibiting FGFRs or MEK1. We propose that FGF18 plays a pivotal role in AChR clustering and NMJ formation in mouse embryogenesis.

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  121. A common variant of MAF/c-MAF, transcriptional factor gene in the kidney, is associated with gout susceptibility

    Higashino Toshihide, Matsuo Hirotaka, Okada Yukinori, Nakashima Hiroshi, Shimizu Seiko, Sakiyama Masayuki, Tadokoro Shin, Nakayama Akiyoshi, Kawaguchi Makoto, Komatsu Mako, Hishida Asahi, Nakatochi Masahiro, Ooyama Hiroshi, Imaki Junko, Shinomiya Nariyoshi

    HUMAN CELL   Vol. 31 ( 1 ) page: 10 - 13   2018.1

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    DOI: 10.1007/s13577-017-0186-6

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  122. How Many Passes Are Needed for Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Sarcoidosis? A Prospective Multicenter Study

    Oki Masahide, Saka Hideo, Ando Masahiko, Nakashima Harunori, Shiraki Akira, Murakami Yasushi, Kogure Yoshihito, Kitagawa Chiyoe, Kato Tatsuo

    RESPIRATION   Vol. 95 ( 4 ) page: 251 - 257   2018

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  123. Factors for a good surgical outcome in posterior decompression and dekyphotic corrective fusion with instrumentation for thoracic ossification of the posterior longitudinal ligament: Prospective single-center study Reviewed International journal

    Shiro Imagama, Kei Ando, Kazuyoshi Kobayashi, Tetsuro Hida, Kenyu Ito, Mikito Tsushima, Yoshimoto Ishikawa, Akiyuki Matsumoto, Masayoshi Morozumi, Satoshi Tanaka, Masaaki Machino, Kyotaro Ota, Hiroaki Nakashima, Yoshihiro Nishida, Yukihiro Matsuyama, Naoki Ishiguro

    Operative Neurosurgery   Vol. 13 ( 6 ) page: 661 - 669   2017.12

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    BACKGROUND: Surgery for thoracic ossification of the posterior longitudinal ligament (T-OPLL) is still challenging, and factors for good surgical outcomes are unknown. OBJECTIVE: To identify factors for good surgical outcomes with prospective and comparative study. METHODS: Seventy-one consecutive patients who underwent posterior decompression and instrumented fusion were divided into good or poor outcome groups based on =50% and &lt
    50% recovery rates for the Japanese Orthopaedic Association score. Preoperative, intraoperative, and postoperative findings were compared in the 2 groups, and significant factors for a good outcome were analyzed. RESULTS: Patients with a good outcome (76%) had significantly lower nonambulatory rate and positive prone and supine position tests preoperatively
    lower rates of T-OPLL, ossification of the ligamentum flavum, high-intensity area at the same level, thoracic spinal cord alignment difference, and spinal canal stenosis on preoperative magnetic resonance imaging
    lower estimated blood loss
    higher rates of intraoperative spinal cord floating and absence of deterioration of intraoperative neurophysiological monitoring
    and lower rates of postoperative complications (P&lt
    .0005). In multivariate logistic regression analysis, negative prone and supine position test (odds ratio [OR]: 17.00), preoperative ambulatory status (OR: 6.05), absence of T-OPLL, ossification of the ligamentum flavum, high-intensity area at the same level (OR: 5.84), intraoperative spinal cord floating (OR: 4.98), and lower estimated blood loss (OR: 1.01) were significant factors for a good surgical outcome. CONCLUSION: This study demonstrated that early surgery is recommended during these positive factors. Appropriate surgical planning based on preoperative thoracic spinal cord alignment difference, as well as sufficient spinal cord decompression and reduction of complications using intraoperative ultrasonography and intraoperative neurophysiological monitoring, may improve surgical outcomes.

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  124. Identification of a Gene Encoding Slow Skeletal Muscle Troponin T as a Novel Marker for Immortalization of Retinal Pigment Epithelial Cells

    Kuroda T.

    Scientific Reports   Vol. 7 ( 1 )   2017.12

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    DOI: 10.1038/s41598-017-08014-w

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  125. Efficacy of Early Fusion With Local Bone Graft and Platelet-Rich Plasma in Lumbar Spinal Fusion Surgery Followed Over 10 Years Reviewed International journal

    Shiro Imagama, Kei Ando, Kazuyoshi Kobayashi, Yoshimoto Ishikawa, Hiroshi Nakamura, Tetsuro Hida, Kenyu Ito, Mikito Tsushima, Akiyuki Matsumoto, Masayoshi Morozumi, Satoshi Tanaka, Masaaki Machino, Kyotaro Ota, Hiroaki Nakashima, Junki Takamatsu, Tadashi Matsushita, Yoshihiro Nishida, Naoki Ishiguro, Yukihiro Matsuyama

    Global Spine Journal   Vol. 7 ( 8 ) page: 749 - 755   2017.12

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    Study Design: Prospective clinical study. Objective: Many oral surgeons use platelet-rich plasma (PRP) for bone defects, but the efficacy of PRP for spinal arthrodesis remains uncertain. The objective was to compare the efficacy of autologous local bone graft and PRP with local bone graft alone for promotion of bony union in posterolateral lumbar fusion (PLF) surgery, with investigation of the safety of PRP over 10 years. Methods: A prospective study was conducted in 29 consecutive patients who underwent one-level PLF at L4/5 for degenerative lumbar disease. Local bone on the left (control) side and local bone with PRP on the right side were grafted. The fusion area and absorption of grafted bone at 58 regions were determined using computed tomography at 2 weeks and 3, 6, and 12 months after surgery. Results: Average bone fusion areas on the PRP side were significantly wider at 3 and 6 months after surgery (P &lt
    .05). Average absorption values were significantly lower on the PRP side than on the control side at 3 and 6 months after surgery (P &lt
    .05). The PRP/control ratio was significantly different at 3 and 6 months compared to that at 2 weeks (P &lt
    .005). No adverse events related to PRP occurred with good clinical outcome over 10 years follow-up. Conclusions: Local application of PRP combined with autologous local bone graft has a positive impact on early fusion for lumbar arthrodesis with no adverse events over 10 years, and thus is a safe and low cost autologous option in spinal fusion.

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  126. Genome-Wide Association Study of Clinically-Ascertained Gout and Subtypes Identifies Multiple Susceptibility Loci Including Transporter Genes

    Matsuo Hirotaka, Nakayama Akiyoshi, Nakaoka Hirofumi, Yamamoto Ken, Sakiyama Masayuki, Shaukat Amara, Toyoda Yu, Okada Yukinori, Kamatani Yoichiro, Nakatochi Masahiro, Nakamura Takahiro, Takada Tappei, Nakashima Hiroshi, Shimizu Seiko, Kawaguchi Makoto, Hishida Asahi, Wakai Kenji, Stiburkova Blanka, Pavelka Karel, Stamp Lisa K., Dalbeth Nicola, Hosoya Tatsuo, Kubo Michiaki, Ooyama Hiroshi, Shimizu Toru, Ichida Kimiyoshi, Merriman Tony R., Shinomiya Nariyoshi

    ARTHRITIS & RHEUMATOLOGY   Vol. 69   page: .   2017.10

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  127. Multiple common and rare variants of ABCG2 cause gout

    Higashino Toshihide, Takada Tappei, Nakaoka Hirofumi, Toyoda Yu, Stiburkova Blanka, Miyata Hiroshi, Ikebuchi Yuki, Nakashima Hiroshi, Shimizu Seiko, Kawaguchi Makoto, Sakiyama Masayuki, Nakayama Akiyoshi, Akashi Airi, Tanahashi Yuki, Kawamura Yusuke, Nakamura Takahiro, Wakai Kenji, Okada Rieko, Yamamoto Ken, Hosomichi Kazuyoshi, Hosoya Tatsuo, Ichida Kimiyoshi, Ooyama Hiroshi, Suzuki Hiroshi, Inoue Ituro, Merriman Tony R., Shinomiya Nariyoshi, Matsuo Hirotaka

    RMD OPEN   Vol. 3 ( 2 )   2017.10

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    DOI: 10.1136/rmdopen-2017-000464

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  128. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury and Central Cord Syndrome: Recommendations on the Timing (≤24 Hours Versus &gt;24 Hours) of Decompressive Surgery Reviewed International journal

    Michael G. Fehlings, Lindsay A. Tetreault, Jefferson R. Wilson, Bizhan Aarabi, Paul Anderson, Paul M. Arnold, Darrel S. Brodke, Anthony S. Burns, Kazuhiro Chiba, Joseph R. Dettori, Julio C. Furlan, Gregory Hawryluk, Langston T. Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark Kotter, Shekar Kurpad, Ralph J. Marino, Allan R. Martin, Eric Massicotte, Geno Merli, James W. Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Anoushka Singh, Andrea C. Skelly, Eve C. Tsai, Alexander Vaccaro, Albert Yee, James S. Harrop

    Global Spine Journal   Vol. 7 ( 3 Suppl ) page: 195S - 202S   2017.9

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    Objective: To develop recommendations on the timing of surgical decompression in patients with traumatic spinal cord injury (SCI) and central cord syndrome. Methods: A systematic review of the literature was conducted to address key relevant questions. A multidisciplinary guideline development group used this information, along with their clinical expertise, to develop recommendations for the timing of surgical decompression in patients with SCI and central cord syndrome. Based on GRADE, a strong recommendation is worded as “we recommend,” whereas a weak recommendation is presented as “we suggest.” Results: Conclusions from the systematic review included (1) isolated studies reported statistically significant and clinically important improvements following early decompression at 6 months and following discharge from inpatient rehabilitation
    (2) in one study on acute central cord syndrome without instability, a marginally significant improvement in total motor scores was reported at 6 and 12 months in patients managed with early versus late surgery
    and (3) there were no significant differences in length of acute care/rehabilitation stay or in rates of complications between treatment groups. Our recommendations were: “We suggest that early surgery be considered as a treatment option in adult patients with traumatic central cord syndrome” and “We suggest that early surgery be offered as an option for adult acute SCI patients regardless of level.” Quality of evidence for both recommendations was considered low. Conclusions: These guidelines should be implemented into clinical practice to improve outcomes in patients with acute SCI and central cord syndrome by promoting standardization of care, decreasing the heterogeneity of management strategies, and encouraging clinicians to make evidence-informed decisions.

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  129. A Clinical Practice Guideline for the Management of Patients With Degenerative Cervical Myelopathy: Recommendations for Patients With Mild, Moderate, and Severe Disease and Nonmyelopathic Patients With Evidence of Cord Compression Reviewed International journal

    Michael G. Fehlings, Lindsay A. Tetreault, K. Daniel Riew, James W. Middleton, Bizhan Aarabi, Paul M. Arnold, Darrel S. Brodke, Anthony S. Burns, Simon Carette, Robert Chen, Kazuhiro Chiba, Joseph R. Dettori, Julio C. Furlan, James S. Harrop, Langston T. Holly, Sukhvinder Kalsi-Ryan, Mark Kotter, Brian K. Kwon, Allan R. Martin, James Milligan, Hiroaki Nakashima, Narihito Nagoshi, John Rhee, Anoushka Singh, Andrea C. Skelly, Sumeet Sodhi, Jefferson R. Wilson, Albert Yee, Jeffrey C. Wang

    Global Spine Journal   Vol. 7 ( 3 Suppl ) page: 70S - 83S   2017.9

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    Study Design: Guideline development. Objectives: The objective of this study is to develop guidelines that outline how to best manage (1) patients with mild, moderate, and severe myelopathy and (2) nonmyelopathic patients with evidence of cord compression with or without clinical symptoms of radiculopathy. Methods: Five systematic reviews of the literature were conducted to synthesize evidence on disease natural history
    risk factors of disease progression
    the efficacy, effectiveness, and safety of nonoperative and surgical management
    the impact of preoperative duration of symptoms and myelopathy severity on treatment outcomes
    and the frequency, timing, and predictors of symptom development. A multidisciplinary guideline development group used this information, and their clinical expertise, to develop recommendations for the management of degenerative cervical myelopathy (DCM). Results: Our recommendations were as follows: (1) “We recommend surgical intervention for patients with moderate and severe DCM.” (2) “We suggest offering surgical intervention or a supervised trial of structured rehabilitation for patients with mild DCM. If initial nonoperative management is pursued, we recommend operative intervention if there is neurological deterioration and suggest operative intervention if the patient fails to improve.” (3) “We suggest not offering prophylactic surgery for non-myelopathic patients with evidence of cervical cord compression without signs or symptoms of radiculopathy. We suggest that these patients be counseled as to potential risks of progression, educated about relevant signs and symptoms of myelopathy, and be followed clinically.” (4) “Non-myelopathic patients with cord compression and clinical evidence of radiculopathy with or without electrophysiological confirmation are at a higher risk of developing myelopathy and should be counselled about this risk. We suggest offering either surgical intervention or nonoperative treatment consisting of close serial follow-up or a supervised trial of structured rehabilitation. In the event of myelopathic development, the patient should be managed according to the recommendations above.” Conclusions: These guidelines will promote standardization of care for patients with DCM, decrease the heterogeneity of management strategies and encourage clinicians to make evidence-informed decisions.

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  130. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Use of Methylprednisolone Sodium Succinate Reviewed International journal

    Michael G. Fehlings, Jefferson R. Wilson, Lindsay A. Tetreault, Bizhan Aarabi, Paul Anderson, Paul M. Arnold, Darrel S. Brodke, Anthony S. Burns, Kazuhiro Chiba, Joseph R. Dettori, Julio C. Furlan, Gregory Hawryluk, Langston T. Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark Kotter, Shekar Kurpad, Brian K. Kwon, Ralph J. Marino, Allan R. Martin, Eric Massicotte, Geno Merli, James W. Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Andrea C. Skelly, Anoushka Singh, Eve C. Tsai, Alexander Vaccaro, Albert Yee, James S. Harrop

    Global Spine Journal   Vol. 7 ( 3 Suppl ) page: 203S - 211S   2017.9

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    Introduction: The objective of this guideline is to outline the appropriate use of methylprednisolone sodium succinate (MPSS) in patients with acute spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MPSS in acute SCI. A multidisciplinary Guideline Development Group used this information, in combination with their clinical expertise, to develop recommendations for the use of MPSS. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: The main conclusions from the systematic review included the following: (1) there were no differences in motor score change at any time point in patients treated with MPSS compared to those not receiving steroids
    (2) when MPSS was administered within 8 hours of injury, pooled results at 6- and 12-months indicated modest improvements in mean motor scores in the MPSS group compared with the control group
    and (3) there was no statistical difference between treatment groups in the risk of complications. Our recommendations were: (1) “We suggest not offering a 24-hour infusion of high-dose MPSS to adult patients who present after 8 hours with acute SCI”
    (2) “We suggest a 24-hour infusion of high-dose MPSS be offered to adult patients within 8 hours of acute SCI as a treatment option”
    and (3) “We suggest not offering a 48-hour infusion of high-dose MPSS to adult patients with acute SCI.” Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in SCI patients.

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  131. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Type and Timing of Rehabilitation Reviewed International journal

    Michael G. Fehlings, Lindsay A. Tetreault, Bizhan Aarabi, Paul Anderson, Paul M. Arnold, Darrel S. Brodke, Kazuhiro Chiba, Joseph R. Dettori, Julio C. Furlan, James S. Harrop, Gregory Hawryluk, Langston T. Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark Kotter, Shekar Kurpad, Brian K. Kwon, Ralph J. Marino, Allan R. Martin, Eric Massicotte, Geno Merli, James W. Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Anoushka Singh, Andrea C. Skelly, Eve C. Tsai, Alexander Vaccaro, Jefferson R. Wilson, Albert Yee, Anthony S. Burns

    Global Spine Journal   Vol. 7 ( 3 Suppl ) page: 231S - 238S   2017.9

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    Introduction: The objective of this study is to develop guidelines that outline the appropriate type and timing of rehabilitation in patients with acute spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to rehabilitation in patients with acute SCI. A multidisciplinary guideline development group used this information, and their clinical expertise, to develop recommendations for the type and timing of rehabilitation. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest. Results: Based on the findings from the systematic review, our recommendations were: (1) We suggest rehabilitation be offered to patients with acute spinal cord injury when they are medically stable and can tolerate required rehabilitation intensity (no included studies
    expert opinion)
    (2) We suggest body weight–supported treadmill training as an option for ambulation training in addition to conventional overground walking, dependent on resource availability, context, and local expertise (low evidence)
    (3) We suggest that individuals with acute and subacute cervical SCI be offered functional electrical stimulation as an option to improve hand and upper extremity function (low evidence)
    and (4) Based on the absence of any clear benefit, we suggest not offering additional training in unsupported sitting beyond what is currently incorporated in standard rehabilitation (low evidence). Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in patients with SCI by promoting standardization of care, decreasing the heterogeneity of management strategies and encouraging clinicians to make evidence-informed decisions.

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  132. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Type and Timing of Anticoagulant Thromboprophylaxis Reviewed International journal

    Michael G. Fehlings, Lindsay A. Tetreault, Bizhan Aarabi, Paul Anderson, Paul M. Arnold, Darrel S. Brodke, Anthony S. Burns, Kazuhiro Chiba, Joseph R. Dettori, Julio C. Furlan, Gregory Hawryluk, Langston T. Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark Kotter, Shekar Kurpad, Brian K. Kwon, Ralph J. Marino, Allan R. Martin, Eric Massicotte, Geno Merli, James W. Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Anoushka Singh, Andrea C. Skelly, Eve C. Tsai, Alexander Vaccaro, Jefferson R. Wilson, Albert Yee, James S. Harrop

    Global Spine Journal   Vol. 7 ( 3 Suppl ) page: 212S - 220S   2017.9

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    Introduction: The objective of this study is to develop evidence-based guidelines that recommend effective, safe and cost-effective thromboprophylaxis strategies in patients with spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions relating to thromboprophylaxis in SCI. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: Based on conclusions from the systematic review and expert panel opinion, the following recommendations were developed: (1) “We suggest that anticoagulant thromboprophylaxis be offered routinely to reduce the risk of thromboembolic events in the acute period after SCI
    ” (2) “We suggest that anticoagulant thromboprophylaxis, consisting of either subcutaneous low-molecular-weight heparin or fixed, low-dose unfractionated heparin (UFH) be offered to reduce the risk of thromboembolic events in the acute period after SCI. Given the potential for increased bleeding events with the use of adjusted-dose UFH, we suggest against this option
    ” (3) “We suggest commencing anticoagulant thromboprophylaxis within the first 72 hours after injury, if possible, in order to minimize the risk of venous thromboembolic complications during the period of acute hospitalization.” Conclusions: These guidelines should be implemented into clinical practice in patients with SCI to promote standardization of care, decrease heterogeneity of management strategies and encourage clinicians to make evidence-informed decisions.

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  133. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role of Baseline Magnetic Resonance Imaging in Clinical Decision Making and Outcome Prediction Reviewed International journal

    Michael G. Fehlings, Allan R. Martin, Lindsay A. Tetreault, Bizhan Aarabi, Paul Anderson, Paul M. Arnold, Darrel Brodke, Anthony S. Burns, Kazuhiro Chiba, Joseph R. Dettori, Julio C. Furlan, Gregory Hawryluk, Langston T. Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark Kotter, Shekar Kurpad, Brian K. Kwon, Ralph J. Marino, Eric Massicotte, Geno Merli, James W. Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Anoushka Singh, Andrea C. Skelly, Eve C. Tsai, Alexander Vaccaro, Jefferson R. Wilson, Albert Yee, James S. Harrop

    Global Spine Journal   Vol. 7 ( 3 Suppl ) page: 221S - 230S   2017.9

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    Introduction: The objective of this guideline is to outline the role of magnetic resonance imaging (MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI. This review focused on longitudinal studies that controlled for baseline neurologic status. A multidisciplinary Guideline Development Group (GDG) used this information, their clinical expertise, and patient input to develop recommendations on the use of MRI for SCI patients. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: Based on the limited available evidence and the clinical expertise of the GDG, our recommendations were: (1) “We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention, when feasible, to facilitate improved clinical decision-making” (quality of evidence, very low) and (2) “We suggest that MRI should be performed in adult patients in the acute period following SCI, before or after surgical intervention, to improve prediction of neurologic outcome” (quality of evidence, low). Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI.

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  134. Clinical and Radiographical Differences Between Thoracic Idiopathic Spinal Cord Herniation and Spinal Arachnoid Cyst Reviewed International journal

    Hiroaki Nakashima, Shiro Imagama, Hideki Yagi, Fumihiko Kato, Tokumi Kanemura, Koji Sato, Noriaki Kawakami, Mitsuhiro Kamiya, Hisatake Yoshihara, Kenyu Ito, Yukihiro Matsuyama, Yoshihiro Nishida, Naoki Ishiguro

    SPINE   Vol. 42 ( 16 ) page: E963 - E968   2017.8

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    Study Design. A retrospective, multicenter, case-controlled study.
    Objective. The aim of this study was to investigate the clinical and radiographical differences between thoracic idiopathic spinal cord herniation (ISCH) and spinal arachnoid cyst (SAC).
    Summary of Background Data. ISCH and SAC are relatively rare diseases. Preoperative misdiagnose was frequently reported in both; however, these clinical and radiographical differences remain unclear.
    Methods. Of 30,469 patients who underwent spinal surgery, 18 (0.059%) and 22 (0.072%) patients were diagnosed as ISCH or SAC at nine hospitals, respectively, and their clinical and radiographical data were retrospectively evaluated. The spinal cord kink angle was measured on magnetic resonance or computed tomography myelography sagittal images; the kink angle was the exterior angle formed between the two tangents to the dorsal-side inflection points at the maximally affected level.
    Results. There were no significant differences in age, gender, and duration of symptoms. Preoperative motor deficit was significantly higher (94.4%) and severer (manual muscle testing: 3.1 +/- 1.1) in ISCH. Brown-Sequard syndrome was observed in 38.9% of ISCH, while no patients in SAC. In addition, leg sensory disorder and bladder rectal disorder were significantly more common in ISCH, while back pain was significantly frequent in SAC. With respect to radiographical findings, the length of disease (5.1 +/- 2.7 levels) and altered cerebrospinal flow (CSF) (81.8%) in the lesion was significantly longer and more common in SAC. On the contrary, the kink angle was significantly greater in ISCH (54.0 +/- 23.18) than in SAC (14.1 +/- 12.08) (P&lt; 0.001). The cut-off value of the kink angle to distinguish ISCH and SAC was 32.88.
    Conclusion. Patients with ISCH commonly had severe preoperative neurological deficit, Brown-Sequard syndrome, and higher kink angle, while patients with SAC had back pain, longer length of disease, and altered CSF in the lesion.

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  135. Risk Factors for Ineffectiveness of Posterior Decompression and Dekyphotic Corrective Fusion with Instrumentation for Beak-Type Thoracic Ossification of the Posterior Longitudinal Ligament: A Single Institute Study (vol 80, pg 800, 2017)

    Ando Kei, Ito Zenya, Kobayashi Kazuyoshi, Hida Tetsuro, Ito Kenyu, Tsushima Mikito, Ishikawa Yoshimoto, Matsumoto Akiyuki, Morozumi Masayoshi, Tanaka Satoshi, Machino Masaaki, Ota Kyotaro, Nakashima Hiroaki, Nishida Yoshihiro, Ishiguro Naoki

    NEUROSURGERY   Vol. 81 ( 2 ) page: 403-403   2017.8

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    DOI: 10.1093/neuros/nyx358

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  136. MRI Analysis of the Combined Prospectively Collected AOSpine North America and International Data The Prevalence and Spectrum of Pathologies in a Global Cohort of Patients With Degenerative Cervical Myelopathy Reviewed

    Aria Nouri, Allan R. Martin, Lindsay Tetreault, Anick Nater, So Kato, Hiroaki Nakashima, Narihito Nagoshi, Hamed Reihani-Kermani, Michael G. Fehlings

    SPINE   Vol. 42 ( 14 ) page: 1058 - 1067   2017.7

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    Study Design. An ambispective analysis.
    Objective. The aim of this study was to report the global prevalence of specific degenerative cervical pathologies in patients with degenerative cervical myelopathy (DCM) through detailed review of magnetic resonance imaging (MRIs).
    Summary of Background Data. DCM encompasses a spectrum of age-related conditions that result in progressive spinal cord injury.
    Methods. MRIs of 458 patients (age 56.4 +/- 11.8, 285 male, 173 female) were reviewed for specific degenerative features, directionality of cord compression, levels of spinal cord compression, and signal changes on sagittal T2-weighted imaging (T2WI) and sagittal T1-weighted imaging (T1WI). Data were analyzed for differences between sex using Chi-square tests and geographic variations using Kruskal-Wallis tests.
    Results. Spondylosis was frequently present (89.7%) and was commonly accompanied by enlargement of the ligamentum flavum (LF) (59.9%). Single-level disc pathology, ossification of posterior longitudinal ligament (OPLL), and spondylolisthesis had a prevalence of similar to 10% each. OPLL was accompanied by spondylosis in 91.7%. Klippel-Feil syndrome was observed in 2.0%. The Asia-Pacific region had more OPLL (29%, P - 3 x 10(-11)) and less spondylolisthesis (1.9%, P = 0.002). Females presented more commonly with single-level disc pathology (13.9% vs. 6.7%; P = 0.013), and males with spondylosis (92.3% vs. 85.6%; P - 0.02) and enlargement of LF (61.4% vs. 49.1%; P = 0.01). C5 to C6 was the most frequent maximum compressed site (39.5%) and region for T2WI hyperintensity (38.9%). T2WI hyperintensity more commonly presented in males (82.4% vs. 66.7%; P&lt; 0.001).
    Conclusion. This is the largest report on the prevalence and spectrum of pathology in patients with DCM. Herein, it has been demonstrated that degenerative features are highly interrelated, that females presented with milder MRI evidence of DCM, and that variations exist in the prevalence of pathologies between geographical regions.

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  137. Risk Factors for and Clinical Outcomes of Dysphagia After Anterior Cervical Surgery for Degenerative Cervical Myelopathy Results from the AOSpine International and North America Studies Reviewed

    Narihito Nagoshi, Lindsay Tetreault, Hiroaki Nakashima, Paul M. Arnold, Giuseppe Barbagallo, Branko Kopjar, Michael G. Fehlings

    JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME   Vol. 99 ( 13 ) page: 1069 - 1077   2017.7

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    Background: Although dysphagia is a common complication after anterior cervical decompression and fusion, important risk factors have not been rigorously evaluated. Furthermore, the impact of dysphagia on neurological and quality-of-life outcomes is not fully understood. The aim of this study was to determine the prevalence of and risk factors for dysphagia, and the impact of this complication on short and long-term clinical outcomes, in patients treated with anterior cervical decompression and fusion.
    Methods: Four hundred and seventy patients undergoing a 1-stage anterior or 2-stage anteroposterior cervical decompression and fusion were enrolled in the prospective AOSpine CSM (Cervical Spondylotic Myelopathy) North America or International study at 26 global sites. Logistic regression analyses were conducted to determine important clinical and surgical predictors of perioperative dysphagia. Preoperatively and at each follow-up visit, patients were evaluated using the modified Japanese Orthopaedic Association scale (mJOA), Nurick score, Neck Disability Index (NDI), and Short Form-36 Health Survey (SF-36). A 2-way repeated-measures analysis of covariance was used to evaluate differences in outcomes at 6 and 24 months between patients with and those without dysphagia, while controlling for relevant baseline characteristics and surgical factors.
    Results: The overall prevalence of dysphagia was 6.2%. Bivariate analysis showed the major risk factors for perioperative dysphagia to be a higher comorbidity score, older age, a cardiovascular or endocrine disorder, a lower SF-36 Physical Component Summary score, 2-stage surgery, and a greater number of decompressed levels. Multivariable analysis showed patients to be at an increased risk of perioperative dysphagia if they had an endocrine disorder, a greater number of decompressed segments, or 2-stage surgery. Both short and long-termimprovements in functional, disability, and quality-of-life scores were comparable between patients with and those without dysphagia.
    Conclusions: The most important predictors of dysphagia are an endocrine disorder, a greater number of decompressed levels, and 2-stage surgery. At the time of both short and long-termfollow-up, patients with perioperative dysphagia exhibited improvements in functional, disability, and quality-of life scores that were similar to those of patients without dysphagia.

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  138. Independent effects of ADH1B and ALDH2 common dysfunctional variants on gout risk

    Sakiyama Masayuki, Matsuo Hirotaka, Akashi Airi, Shimizu Seiko, Higashino Toshihide, Kawaguchi Makoto, Nakayama Akiyoshi, Naito Mariko, Kawai Sayo, Nakashima Hiroshi, Sakurai Yutaka, Ichida Kimiyoshi, Shimizu Toru, Ooyama Hiroshi, Shinomiya Nariyoshi

    SCIENTIFIC REPORTS   Vol. 7 ( 1 )   2017.5

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    DOI: 10.1038/s41598-017-02528-z

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  139. GWAS of clinically defined gout and subtypes identifies multiple susceptibility loci that include urate transporter genes

    Nakayama Akiyoshi, Nakaoka Hirofumi, Yamamoto Ken, Sakiyama Masayuki, Shaukat Amara, Toyoda Yu, Okada Yukinori, Kamatani Yoichiro, Nakamura Takahiro, Takada Tappei, Inoue Katsuhisa, Yasujima Tomoya, Yuasa Hiroaki, Shirahama Yuko, Nakashima Hiroshi, Shimizu Seiko, Higashino Toshihide, Kawamura Yusuke, Ogata Hiraku, Kawaguchi Makoto, Ohkawa Yasuyuki, Danjoh Inaho, Tokumasu Atsumi, Ooyama Keiko, Ito Toshimitsu, Kondo Takaaki, Wakai Kenji, Stiburkova Blanka, Pavelka Karel, Stamp Lisa K., Dalbeth Nicola, Consortium Eurogout, Sakurai Yutaka, Suzuki Hiroshi, Hosoyamada Makoto, Fujimori Shin, Yokoo Takashi, Hosoya Tatsuo, Inoue Ituro, Takahashi Atsushi, Kubo Michiaki, Ooyama Hiroshi, Shimizu Toru, Ichida Kimiyoshi, Shinomiya Nariyoshi, Merriman Tony R., Matsuo Hirotaka

    ANNALS OF THE RHEUMATIC DISEASES   Vol. 76 ( 5 ) page: 869 - 877   2017.5

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    DOI: 10.1136/annrheumdis-2016-209632

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  140. Risk Factors for Ineffectiveness of Posterior Decompression and Dekyphotic Corrective Fusion with Instrumentation for Beak-Type Thoracic Ossification of the Posterior Longitudinal Ligament: A Single Institute Study Reviewed International journal

    Shiro Imagama, Kei Ando, Zenya Ito, Kazuyoshi Kobayashi, Tetsuro Hida, Kenyu Ito, Mikito Tsushima, Yoshimoto Ishikawa, Akiyuki Matsumoto, Masayoshi Morozumi, Satoshi Tanaka, Masaaki Machino, Kyotaro Ota, Hiroaki Nakashima, Norimitsu Wakao, Yoshihiro Nishida, Yukihiro Matsuyama, Naoki Ishiguro

    NEUROSURGERY   Vol. 80 ( 5 ) page: 800 - 808   2017.5

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    BACKGROUND: Thoracic ossification of the posterior longitudinal ligament (T-OPLL) is treated surgically with instrumented posterior decompression and fusion. However, the factors determining the outcome of this approach and the efficacy of additional resection of T-OPLL are unknown.
    OBJECTIVE: To identify these factors in a prospective study at a single institution.
    METHODS: The subjects were 70 consecutive patients with beak-type T-OPLL who underwent posterior decompression and dekyphotic fusion and had an average of 4.8 years of follow-up (minimum of 2 years). Of these patients, 4 (6%; group R) had no improvement or aggravation, were not ambulatory for 3 weeks postoperatively, and required additional T-OPLL resection; while 66 (group N) required no further T-OPLL resection. Clinical records, gait status, intraoperative ultrasonography, intraoperative neurophysiological monitoring (IONM), plain radiography, computed tomography and magnetic resonance imaging findings, and Japanese Orthopaedic Association (JOA) score were compared between the groups.
    RESULTS: Preoperatively, patients in group R had significantly higher rates of severe motor paralysis, nonambulatory status, positive prone and supine position test, no spinal cord floating in intraoperative ultrasonography, and deterioration of IONM at the end of surgery (P &lt; .05). In preoperative radiography, the OPLL spinal cord kyphotic angle difference in fused area, OPLL length, and OPLL canal stenosis were significantly higher in group R (P &lt; .05). At final follow-up, JOA scores improved similarly in both groups.
    CONCLUSION: Preoperative severe motor paralysis, nonambulatory status, positive prone and supine position test, radiographic spinal cord compression due to beak-type T-OPLL, and intraoperative residual spinal cord compression and deterioration of IONM were associated with ineffectiveness of posterior decompression and fusion with instrumentation. Our 2-stage strategy may be appropriate for beak-type T-OPLL surgery.

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  141. Ponte Osteotomy During Dekyphosis for Indirect Posterior Decompression With Ossification of the Posterior Longitudinal Ligament of the Thoracic Spine. Reviewed

    Ando K, Imagama S, Ito Z, Kobayashi K, Ukai J, Muramoto A, Shinjo R, Matsumoto T, Nakashima H, Matsuyama Y, Ishiguro N

    Clinical spine surgery   Vol. 30 ( 4 ) page: E358 - E362   2017.5

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    DOI: 10.1097/BSD.0000000000000188

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  142. Ponte Osteotomy During Dekyphosis for Indirect Posterior Decompression With Ossification of the Posterior Longitudinal Ligament of the Thoracic Spine

    Ando Kei, Imagama Shiro, Ito Zenya, Kobayashi Kazuyoshi, Ukai Junichi, Muramoto Akio, Shinjo Ryuichi, Matsumoto Tomohiro, Nakashima Hiroaki, Matsuyama Yukihiro, Ishiguro Naoki

    CLINICAL SPINE SURGERY   Vol. 30 ( 4 ) page: E358-E362   2017.5

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  143. Optimal timing of surgery for intramedullary cavernous hemangioma of the spinal cord in relation to preoperative motor paresis, disease duration, and tumor volume and location Reviewed International journal

    Shiro Imagama, Zenya Ito, Kei Ando, Kazuyoshi Kobayashi, Tetsuro Hida, Kenyu Ito, Mikito Tsushima, Yoshimoto Ishikawa, Akiyuki Matsumoto, Masayoshi Morozumi, Satoshi Tanaka, Masaaki Machino, Kyotaro Ota, Hiroaki Nakashima, Norimitsu Wakao, Yoshihito Sakai, Yukihiro Matsuyama, Naoki Ishiguro

    Global Spine Journal   Vol. 7 ( 3 ) page: 246 - 253   2017.5

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    Study Design: Prospective study. Objective: Investigate factors associated with preoperative motor paresis, recovery, ambulatory status, and intraoperative neurophysiological monitoring (IONM) among patients with no preoperative paresis (N group), complete preoperative motor recovery (CR group), and no complete recovery (NCR group) in patients with intramedullary spinal cavernous hemangioma to determine the optimal timing of surgery. Methods: The study evaluated 41 surgical cases in our institute. Disease duration, tumor lesion, manual muscle testing (MMT), and gait at onset, just before surgery, and final follow-up (FU), tumor and lesion volume, IONM, extent of tumor resection, and tumor recurrence were evaluated among N, CR, and NCR groups. Results: Motor paresis at onset was found in 26 patients (63%), with 42% of those in CR group. Disease duration from onset negatively affected stable gait just before surgery and FU as well as lower preoperative MMT (P &lt
    .05). Thoracic tumors were associated with patients with unstable gait before surgery (P &lt
    .05). Tumor volume was larger in NCR group (P &lt
    .05). IONM significantly decreased in NCR and CR groups than in N group (P &lt
    .05). The NCR group had residual mild motor paresis at FU (P &lt
    .05). Stable gait at FU was similar in N group and CR group, though lower in NCR group (P &lt
    .05). Conclusions: Early surgery is generally recommended for thoracic tumors and large tumors during stable gait without motor paresis before long disease duration. Surgery may be postponed until patients recover from preoperative motor paresis to allow optimal surgical outcome. IONM should be carefully monitored in patients with a history of preoperative paresis even with preoperative complete motor recovery.

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  144. Physical Function Differences Between the Stages From Normal Cognition to Moderate Alzheimer Disease

    Fujisawa Chisato, Umegaki Hiroyuki, Okamoto Kazushi, Nakashima Hirotaka, Kuzuya Masafumi, Toba Kenji, Sakurai Takashi

    JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION   Vol. 18 ( 4 ) page: 368.e9 - 368.e15   2017.4

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  145. Prevalence and outcomes in patients undergoing reintubation after anterior cervical Spine surgery: Results from the AOSpine North America multicenter study on 8887 patients Reviewed International journal

    Narihito Nagoshi, Michael G. Fehlings, Hiroaki Nakashima, Lindsay Tetreault, Jeffrey L. Gum, Zachary A. Smith, Wellington K. Hsu, Chadi A. Tannoury, Tony Tannoury, Vincent C. Traynelis, Paul M. Arnold, Thomas E. Mroz, Ziya L. Gokaslan, Mohamad Bydon, Anthony F. De Giacomo, Bruce C. Jobse, Eric M. Massicotte, K. Daniel Riew

    Global Spine Journal   Vol. 7 ( 1 Suppl ) page: 965 - 1025   2017.4

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    Study Design: A multicenter, retrospective cohort study. Objective: To evaluate clinical outcomes in patients with reintubation after anterior cervical spine surgery. Methods: A total of 8887 patients undergoing anterior cervical spine surgery were enrolled in the AOSpine North America Rare Complications of Cervical Spine Surgery study. Patients with or without complications after surgery were included. Demographic and surgical information were collected for patients with reintubation. Patients were evaluated using a variety of assessment tools, including the modified Japanese Orthopedic Association scale, Nurick score, Neck Disability Index, and Short Form-36 Health Survey. Results: Nine cases of postoperative reintubation were identified. The total prevalence of this complication was 0.10% and ranged from 0% to 0.59% across participating institutions. The time to development of airway symptoms after surgery was within 24 hours in 6 patients and between 5 and 7 days in 3 patients. Although 8 patients recovered, 1 patient died. At final follow-up, patients with reintubation did not exhibit significant and meaningful improvements in pain, functional status, or quality of life. Conclusions: Although the prevalence of reintubation was very low, this complication was associated with adverse clinical outcomes. Clinicians should identify their high-risk patients and carefully observe them for up to 2 weeks after surgery.

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  146. Impact of Depression and Bipolar Disorders on Functional and Quality of Life Outcomes in Patients Undergoing Surgery for Degenerative Cervical Myelopathy Analysis of a Combined Prospective Dataset Reviewed International journal

    Lindsay Tetreault, Narihito Nagoshi, Hiroaki Nakashima, Anoushka Singh, Branko Kopjar, Paul Arnold, Michael G. Fehlings

    SPINE   Vol. 42 ( 6 ) page: 372 - 378   2017.3

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    Study Design. Analysis of a combined prospective dataset.
    Objective. To compare clinical outcomes in patients with and without preexisting depression or bipolar disorder undergoing surgery for degenerative cervical myelopathy (DCM).
    Summary of Background Data. Psychiatric comorbidities, including depression, have been associated with worse clinical outcomes after lumbar spine surgery; however, it is unclear whether these psychiatric disorders are also predictive of outcomes in patients undergoing surgery for the treatment of DCM.
    Methods. Four hundred and one patients with symptomatic DCM were enrolled in the prospective AOSpine International or North America study at twelve North American sites. Patients were evaluated preoperatively and at 6, 12, and 24 months using the modified Japanese Orthopedic Association scale (mJOA), Nurick score, Neck Disability Index (NDI), and Short-Form 36v2 (SF-36v2) Health Survey. A mixed model analytic approach was used to evaluate differences in outcomes at 24 months among patients with and without psychiatric disorders, while controlling for relevant baseline characteristics and surgical factors.
    Results. Ninety-seven patients (24.19%) were diagnosed with preexisting depression or bipolar disorder. There were more females (65.98%) with these psychiatric disorders than males (34.02%) (P&lt; 0.0001). Patients with psychiatric comorbidities were more likely to have cardiovascular (P = 0.0177), respiratory (P &lt; 0.0001), gastrointestinal (P &lt; 0.0001), rheumatologic (P = 0.0109), and neurologic (P = 0.0309) disorders. At 24 months after surgery, patients in both groups demonstrated significant improvements on the mJOA, Nurick, NDI, and SF-36v2 Physical Component Score (PCS). Patients with depression or bipolar disorder, however, did not exhibit a significant or clinically important change on the SF-36v2 Mental Component Score (MCS). There were no differences in mJOA and Nurick scores at 24 months among patients in each group. Improvement in NDI, SF-36v2 PCS, and MCS, however, were smaller in patients with depression or bipolar disorder than those without.
    Conclusion. Patients with depression or bipolar disorder have smaller functional and quality of life improvements after surgery compared to patients without psychiatric comorbidities.

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  147. Prediction of outcome following surgical treatment of cervical myelopathy based on features of ossification of the posterior longitudinal ligament a systematic review Reviewed

    Hiroaki Nakashima, Lindsay Tetreault, So Kato, Michael T. Kryshtalskyj, Narihito Nagoshi, Aria Nouri, Anoushka Singh, Michael G. Fehlings

    JBJS Reviews   Vol. 5 ( 2 )   2017.2

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    Background: Ossification of the posterior longitudinal ligament (OPLL) is defined as ectopic bone formation within the posterior longitudinal ligament. Although various OPLL features (including the extent, shape, and thickness of the OPLL as well as the presence of dural ossification) have been defined in the literature, we are not aware of any systematic reviews that have summarized theassociationsbetween these featuresand clinical outcomes following surgery. The objective of the present study was to conduct a systematic review of the literature to determine whether OPLL characteristics are predictive of outcome in patients undergoing surgery for the treatment of cervical myelopathy. Methods: An extensive search was performed using 4 electronic databases: MEDLINE, MEDLINE In-Process, Embase, and the Cochrane Central Register of Controlled Trials. Our search terms were OPLL and cervical. We identified studies in English or Japanese that evaluated the association between cervical OPLL features and surgical outcome. The overall body of evidence was assessed with use of a scoring system developed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group with recommendations from the Agency for Healthcare Research and Quality (AHQR). The present systematic literature review is formatted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: The search yielded a total of 2,318 citations. A total of 28 prognostic cohort studies were deemed relevant following a rigorous review process. Among them, only 7 retrospective studies involved a multivariate analysis that controlled for potential confounding variables. Sample sizes ranged from 47 to 133 patients. The main outcome was the postoperative Japanese Orthopaedic Association (JOA) score and/or recovery rate in 6 studies and the Nurick grade in 1. Of these, 2 were rated as Level-II evidence and 5 were rated as Level-III evidence. On the basis of our results, there was low evidence that patients with a hill-shaped ossification have a worse postoperative JOA score following laminoplasty than those with a plateau-shaped lesion
    low evidence that the space available for the spinal cord cannot predict postoperative JOA scores
    moderate evidence that there is no association between the occupying ratio and improvement on the Nurick scale
    and insufficient evidence to determine the association between JOA outcomes and the type of OPLL, the presence of dural ossification, and the occupying ratio. Conclusions: Patients with hill-shaped OPLL have a worse postoperative JOA score than those with plateau-shaped ossification after laminoplasty. Because of limited evidence, it is unclear whether the occupying ratio, the type of OPLL, and the presence of dural ossification are predictive of surgical outcomes following either anterior or posterior decompression. A limited number of studies have used a multivariate analysis to evaluate the association between clinical outcomes and OPLL features. Additional studies representing high-quality evidence are needed. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

    DOI: 10.2106/JBJS.RVW.16.00023

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  148. Return to play in athletes with spinal cord concussion: a systematic literature review Reviewed International journal

    Narihito Nagoshi, Lindsay Tetreault, Hiroaki Nakashima, Aria Nouri, Michael G. Fehlings

    SPINE JOURNAL   Vol. 17 ( 2 ) page: 291 - 302   2017.2

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    STUDY DESIGN: This is a systematic review.
    PURPOSE: The study aimed to evaluate whether spinal cord concussion (SCC) patients can safely return to play sports and if there are factors that can predict SCC recurrence or the development of a spinal cord injury (SCI).
    BACKGROUND CONTEXT: Although SCC is a reversible neurologic disturbance of spinal cord function, its management and the implications for return to play are controversial. METHODS: We conducted a systematic search of the literature using the keywords Cervical Spine AND Sports AND Injuries in six databases. We examined return to play in patients (1) without stenosis, (2) with stenosis, and (3) who underwent single-level anterior cervical discectomy and fusion (ACDF). We also investigated predictors for the risk of SCC recurrence or SCI.
    RESULTS: We identified 3,655 unique citations, 16 of which met our inclusion criteria. The included studies were case-control studies or case series and reports. Two studies reported on patients without stenosis: pediatric cases returned without recurrence, whereas an adult case experienced recurrent SCC after returning to play. Seven studies described patients with stenosis. These studies included cases with and without recurrence after return to play, as well as patients who suffered SCI with permanent neurologic deficits. Three studies reported on patients who underwent an ACDF. Although some patients played after surgery without problems, several patients experienced recurrent SCC due to herniation at levels adjacent to the surgical sites. With respect to important predictors, a greater frequency of patients who experienced recurrence of symptoms or SCI following return to play had a " long" duration of symptoms (&gt;24 hours; 36.36%) compared with those who were problem-free (11.11%; p=. 0311).
    CONCLUSIONS: There is limited evidence on current practice standards for return to play following SCC and important risk factors for SCC recurrence or SCI. Because of small sample sizes, future prospective multicenter studies are needed to determine important predictive factors of poor outcomes following return to play after SCC. (C) 2016 Published by Elsevier Inc.

    DOI: 10.1016/j.spinee.2016.09.013

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  149. Rapid Worsening of Symptoms and High Cell Proliferative Activity in Intra- and Extramedullary Spinal Hemangioblastoma Reviewed International journal

    Shiro Imagama, Zenya Ito, Kei Ando, Kazuyoshi Kobayashi, Tetsuro Hida, Kenyu Ito, Yoshimoto Ishikawa, Mikito Tsushima, Akiyuki Matsumoto, Hiroaki Nakashima, Norimitsu Wakao, Yoshihito Sakai, Yukihiro Matsuyama, Naoki Ishiguro

    Global Spine Journal   Vol. 7 ( 1 ) page: 6 - 13   2017.2

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    Study Design A retrospective analysis of a prospective database. Objective To compare preoperative symptoms, ambulatory ability, intraoperative spinal cord monitoring, and pathologic cell proliferation activity between intramedullary only and intramedullary plus extramedullary hemangioblastomas, with the goal of determining the optimal timing for surgery. Methods The subjects were 28 patients (intramedullary only in 23 cases [group I] and intramedullary plus extramedullary in 5 cases [group IE]) who underwent surgery for spinal hemangioblastoma. Preoperative symptoms, ambulatory ability on the McCormick scale, intraoperative spinal cord monitoring, and pathologic findings using Ki67 were compared between the groups. Results In group IE, preoperative motor paralysis was significantly higher (100 versus 26%, p &lt
    0.005), the mean period from initial symptoms to motor paralysis was significantly shorter (3.5 versus 11.9 months, p &lt
    0.05), and intraoperative spinal cord monitoring aggravation was higher (65 versus 6%, p &lt
    0.05). All 5 patients without total resection in group I underwent reoperation. Ki67 activity was higher in group IE (15% versus 1%, p &lt
    0.05). Preoperative ambulatory ability was significantly poorer in group IE (p &lt
    0.05), but all cases in this group improved after surgery, and postoperative ambulatory ability did not differ significantly between the two groups. Conclusions Intramedullary plus extramedullary spinal hemangioblastoma is characterized by rapid preoperative progression of symptoms over a short period, severe spinal cord damage including preoperative motor paralysis, and poor gait ability compared with an intramedullary tumor only. Earlier surgery with intraoperative spinal cord monitoring is recommended for total resection and good surgical outcome especially for an IE tumor compared with an intramedullary tumor.

    DOI: 10.1055/s-0036-1580612

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  150. Dynamic changes in the cross-sectional area of the dural sac and spinal cord in the thoracic spine Reviewed

    Daigo Morita, Yasutsugu Yukawa, Hiroaki Nakashima, Keigo Ito, Go Yoshida, Masaaki Machino, Syunsuke Kanbara, Toshiki Iwase, Fumihiko Kato

    EUROPEAN SPINE JOURNAL   Vol. 26 ( 1 ) page: 64 - 70   2017.1

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    The thoracic spine is considered a rigid region because it is restricted by the rib cage. Previously, we reported functional alignments and range of motion (ROM) at all segmental levels. The purpose of this study was to investigate dynamic changes of the dural sac and spinal cord in the thoracic spine using a multidetector-row computed tomography (MDCT).
    Fifty patients with cervical or lumbar spinal disease were prospectively enrolled. After preoperative myelography, MDCT was performed at maximum passive flexion and extension. The anteroposterior diameter and cross-sectional area of the dural sac and spinal cord in the axial plane were measured using Scion imaging software. We also evaluated the correlation between the change ratio of the cross-sectional area and segmental kyphotic angle and ROM.
    In flexion, the anteroposterior diameter of the dural sac was larger than in extension. The cross-sectional area in the upper and middle regions was smaller, but was larger in the lower region. The anteroposterior diameter and cross-sectional area of the spinal cord in the upper and middle regions were smaller than in extension, but these values were nearly the same in both flexion and extension in the lower region. Change ratios of the cross-sectional area were correlated with segmental kyphotic angle rather than ROM.
    The thoracic spine showed some dynamic changes of the dural sac and spinal cord in the axial plane within functional motion. Segmental kyphotic angle, rather than segmental ROM, was the more important factor affecting dimensions of the dural sac and spinal cord.

    DOI: 10.1007/s00586-015-4173-x

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  151. Cage subsidence in lateral interbody fusion with transpsoas approach: intraoperative endplate injury or late-onset settling. Reviewed

    Satake K, Kanemura T, Nakashima H, Yamaguchi H, Segi N, Ouchida J

    Spine surgery and related research   Vol. 1 ( 4 ) page: 203 - 210   2017

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    DOI: 10.22603/ssrr.1.2017-0004

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  152. Understanding Retroperitoneal Anatomy for Lateral Approach Spine Surgery. Reviewed

    Tokumi Kanemura, Kotaro Satake, Hiroaki Nakashima, Naoki Segi, Jun Ouchida, Hidetoshi Yamaguchi, Shiro Imagama

    Spine surgery and related research   Vol. 1 ( 3 ) page: 107 - 120   2017

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    Lateral approach spine surgery provides effective interbody stabilization, and correction and indirect neural decompression with minimal-incision and less invasive surgery compared with conventional open anterior lumbar fusion. It may also avoid the trauma to paraspinal muscles or facet joints found with transforaminal lumbar interbody fusion and posterior lumbar interbody fusion. However, because lateral approach surgery is fundamentally retroperitoneal approach surgery, it carries potential risk to intra- and retroperitoneal structures, as seen in a conventional open anterior approach. There is an innovative lateral approach technique that reveals different anatomical views; however, it requires reconsideration of the traditional surgical anatomy in more detail than a traditional open anterior approach. The retroperitoneum is the compartmentalized space bounded anteriorly by the posterior parietal peritoneum and posteriorly by the transversalis fascia. The retroperitoneum is divided into three compartments by fascial planes: anterior and posterior pararenal spaces and the perirenal space. Lateral approach surgery requires mobilization of the peritoneum and its content and accurate exposure to the posterior pararenal space. The posterior pararenal space is confined anteriorly by the posterior renal fascia, anteromedially by the lateroconal fascia, and posteriorly by the transversalis fascia. The posterior renal fascia, the lateroconal fascia or the peritoneum should be detached from the transversalis fascia and the psoas fascia to allow exposure to the posterior pararenal space. The posterior pararenal space, however, does not allow a clear view and identification of these fasciae as this relationship is variable and the medial extent of the posterior pararenal space varies among patients. Correct anatomical recognition of the retroperitoneum is essential to success in lateral approach surgery. Spine surgeons must be aware that the retroperitoneal membrane and fascia is multilayered and more complex than is commonly understood. Preoperative abdominal images would facilitate more efficient surgical considerations of retroperitoneal membrane and fascia in lateral approach surgery.

    DOI: 10.22603/ssrr.1.2017-0008

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  153. Pathobiology of Spinal Cord Injury

    Nakashima Hiroaki, Nagoshi Narihito, Fehlings Michael G.

    AOSPINE MASTERS SERIES, VOL 7: SPINAL CORD INJURY AND REGENERATION     page: 1 - 10   2017

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  1. Intramedullary cavernous hemangioma of the spinal cord with intra- and extramedullary hematomas

    Koshimizu H, Ando K, Kobayashi K, Nakashima H, Machino M, Ito S, Kanbara S, Inoue T, Yamaguchi H, Imagama S

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association     2020.11

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    DOI: 10.1016/j.jos.2020.10.003

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  2. LIFとPPSを用いた腰椎固定術における腰椎局所アライメントの隣接椎間への影響

    大内田 隼, 金村 徳相, 佐竹 宏太郎, 中島 宏彰, 石川 喜資, 世木 直喜, 今釜 史郎

    Journal of Spine Research   Vol. 10 ( 4 ) page: 825 - 828   2019.4

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    側方経路腰椎椎体間固定(LIF)と経皮的椎弓根スクリュー(PPS)を用いた腰椎固定術を施行した53例において、術後2年の単純X線、MRI軸位像での硬膜管面積から画像的隣接椎間障害を評価し、術後X線パラメータと比較を行った。LLやL4-S角などの局所アライメント不良が隣接椎間障害の発生に関与していることが示唆された。(著者抄録)

  3. 脊椎疾患精査中に偶然血管病変が発見された3例

    石川 喜資, 金村 徳相, 佐竹 宏太郎, 中島 宏彰, 大内田 隼, 岩瀬 敏樹, 今釜 史郎

    Journal of Spine Research   Vol. 10 ( 4 ) page: 808 - 811   2019.4

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    症例1:74歳、男性。腰部脊柱管狭窄症(以下LSS)にて紹介受診。MRIで腹部大動脈瘤を認めた。症例2:74歳、男性。LSSで紹介受診。腰椎MRIにて右総腸骨動脈瘤を認めた。症例3:83歳、女性。両下肢不全麻痺。MRIでTH12高位の脊髄浮腫および大動脈解離を認め、脊髄梗塞と診断された。症例1、2は血管手術が施行され、症例3は下肢麻痺の原因であった。脊椎外の血管病変を見落とさないように注意が必要である。(著者抄録)

  4. 【脊椎脊髄外科の最近の進歩】各種疾患に対する治療法・モダリティ 成人脊柱変形における腰仙椎部固定術

    中島 宏彰, 金村 徳相, 佐竹 宏太郎, 石川 喜資, 大内田 隼, 今釜 史郎

    整形・災害外科   Vol. 62 ( 5 ) page: 613 - 621   2019.4

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    <文献概要>腰仙椎部固定術では偽関節やインストゥルメント折損などの割合が高い。特に成人脊柱変形に対して高度な変形矯正を行う症例での合併症の割合は高く,未だに課題が多い領域である。Jackson法を発展させたdistal sacral screw, iliac screwに加え,S2-alar-iliac screw(SAI screw)が登場したことで,腰仙椎部固定術は飛躍的な発展を遂げてきた。近年報告されたSAI screwはiliac screwのように腸骨翼まで軟部組織を剥離する必要がなく,インプラントが突出する危険性も少ない。仙腸関節をscrewが貫くため,仙腸関節の骨皮質をとらえることができ,iliac screwに比べ強固な固定力も期待できる。一方で,仙腸関節前方には動静脈が存在しているため,誤って前方に穿破すると重大な合併症を招く。また,適切な位置にscrew設置が行われないと,SAI screwの強みの一つである強固な内固定が得られにくいため,screw挿入の際の技術的な注意点が多く存在する。術前画像評価とともに,術中の解剖学的指標の熟知,正確な透視操作を行い,注意深く手術を完遂させたい。

  5. Anterior Colum Realignment 初期9症例の短期報告

    中島 宏彰, 金村 徳相, 佐竹 宏太郎, 石川 喜資, 大内田 隼, 今釜 史郎

    Journal of Spine Research   Vol. 10 ( 3 ) page: 716 - 716   2019.3

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  6. 頸椎椎弓形成術後の神経学的悪化 再手術例からの検討

    中島 宏彰, 金村 徳相, 佐竹 宏太郎, 石川 喜資, 大内田 隼, 今釜 史郎

    日本整形外科学会雑誌   Vol. 93 ( 2 ) page: S215 - S215   2019.3

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  7. 腰椎椎体間固定術におけるチタンコートPEEKケージとPEEKケージの比較

    横井 寛之, 中島 宏彰, 佐竹 宏太郎, 石川 喜資, 大内田 隼, 鏡味 佑志朗, 平松 泰, 金村 徳相

    Journal of Spine Research   Vol. 10 ( 3 ) page: 498 - 498   2019.3

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  8. 腰椎変性すべり症に対する術式の違いが傍脊柱筋量や脂肪変性に与える影響 LLIFとPLIFの比較研究

    山口 英敏, 金村 徳相, 佐竹 宏太郎, 飛田 哲朗, 中島 宏彰, 石川 喜資, 大内田 隼, 平松 泰, 世木 直喜, 小林 和克, 安藤 圭, 今釜 史郎

    Journal of Spine Research   Vol. 10 ( 3 ) page: 621 - 621   2019.3

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  9. 腰椎固定手術時の傍脊柱筋への侵襲による術後の筋変性が遺残腰痛に与える影響

    平松 泰, 中島 宏彰, 佐竹 宏太郎, 飛田 哲朗, 石川 喜資, 山口 英敏, 大内田 隼, 横井 寛之, 鏡味 佑志朗, 金村 徳相

    Journal of Spine Research   Vol. 10 ( 3 ) page: 495 - 495   2019.3

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  10. 腰椎側方侵入椎体間固定術を用いた間接除圧術 術後2年以上経過例での臨床成績はPLIFを超えるか

    中島 宏彰, 金村 徳相, 佐竹 宏太郎, 石川 喜資, 大内田 隼, 今釜 史郎

    Journal of Spine Research   Vol. 10 ( 3 ) page: 491 - 491   2019.3

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  11. 腰椎側方侵入椎体間固定術と腰椎後方侵入椎体間固定術の術後2年時の臨床成績

    中島 宏彰, 金村 徳相, 佐竹 宏太郎, 石川 喜資, 大内田 隼, 今釜 史郎

    日本整形外科学会雑誌   Vol. 93 ( 3 ) page: S869 - S869   2019.3

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  12. 脳神経外科コントロバーシー2019 増え続ける高齢者の成人脊柱変形に整形外科医としてどのように対峙するか

    金村 徳相, 佐竹 宏太郎, 中島 宏彰, 石川 喜資, 大内田 隼, 山口 英敏, 世木 直喜, 今釜 史郎

    Neurological Surgery   Vol. 47 ( 3 ) page: 271 - 285   2019.3

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  13. 成人脊柱変形に対する仙骨骨盤を含む矯正固定術の術中全脊柱正面画像 XPとO-arm画像の比較

    佐竹 宏太郎, 金村 徳相, 中島 宏彰, 石川 喜資, 大内田 隼

    Journal of Spine Research   Vol. 10 ( 3 ) page: 260 - 260   2019.3

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  14. 大腰筋への手術侵襲は術後成績に影響するのか? 側方侵入椎体間固定術における検討

    飛田 哲朗, 佐竹 宏太郎, 中島 宏彰, 石川 喜資, 世木 直喜, 大内田 隼, 山口 英敏, 平松 泰, 金村 徳相

    Journal of Spine Research   Vol. 10 ( 3 ) page: 621 - 621   2019.3

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  15. 側臥位単一体位(single position)腰椎前後方固定手術のlearning curve

    大内田 隼, 金村 徳相, 佐竹 宏太郎, 中島 宏彰, 石川 喜資, 今釜 史郎

    中部日本整形外科災害外科学会雑誌   Vol. 62 ( 春季学会 ) page: 138 - 138   2019.3

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  16. 側方経路腰椎椎体間固定術の侵入経路に存在する危険な尿管はどれくらいあるのか?

    鏡味 佑志朗, 中島 宏彰, 佐竹 宏太郎, 石川 喜資, 大内田 隼, 横井 寛之, 平松 泰, 金村 徳相

    Journal of Spine Research   Vol. 10 ( 3 ) page: 485 - 485   2019.3

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  17. 側方経路腰椎椎体間固定(LIF)における大腿周囲症状回復遷延の術中危険因子

    世木 直喜, 金村 徳相, 佐竹 宏太郎, 中島 宏彰, 石川 喜資, 大内田 隼, 山口 英敏, 今釜 史郎

    Journal of Spine Research   Vol. 10 ( 3 ) page: 624 - 624   2019.3

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  18. 側方アプローチ椎体ケージによる脊柱再建術におけるcage subsidenceの検討

    石川 喜資, 金村 徳相, 佐竹 宏太郎, 中島 宏彰, 大内田 隼, 世木 直喜, 今釜 史郎

    Journal of Spine Research   Vol. 10 ( 3 ) page: 659 - 659   2019.3

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  19. 側方アプローチ手術による矢状面矯正

    金村 徳相, 佐竹 宏太郎, 中島 宏彰, 石川 喜資, 大内田 準, 世木 直喜, 山口 英俊, 今釜 史郎

    Journal of Spine Research   Vol. 10 ( 3 ) page: 694 - 694   2019.3

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  20. Single position(側臥位単一体位)LIF-PPSのlearning curveと体位交換を要する従来法との比較

    大内田 隼, 金村 徳相, 佐竹 宏太郎, 中島 宏彰, 石川 喜資, 今釜 史郎

    日本整形外科学会雑誌   Vol. 93 ( 3 ) page: S709 - S709   2019.3

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  21. S2 alar iliac screw挿入後の仙腸関節の変性変化

    中島 宏彰, 金村 徳相, 佐竹 宏太郎, 石川 喜資, 大内田 隼, 今釜 史郎

    Journal of Spine Research   Vol. 10 ( 3 ) page: 481 - 481   2019.3

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  22. LIFを用いた腰椎固定術における隣接椎間障害の発生因子

    大内田 隼, 金村 徳相, 松原 祐二, 佐竹 宏太郎, 村本 明生, 中島 宏彰, 石川 喜資, 森田 圭則, 今釜 史郎

    Journal of Spine Research   Vol. 10 ( 3 ) page: 489 - 489   2019.3

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  23. 頸椎椎弓形成術後の遅発性神経学的悪化に対する再手術

    中島 宏彰, 金村 徳相, 佐竹 宏太郎, 石川 喜資, 大内田 隼, 今釜 史郎

    Journal of Spine Research   Vol. 10 ( 3 ) page: 521 - 521   2019.3

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  24. 【とことん頸椎 解剖・治療・看護 思うぞんぶん詰め込みました】頸椎手術の合併症と対策 C5麻痺

    中島 宏彰

    整形外科看護   Vol. 24 ( 2 ) page: 158 - 159   2019.2

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  25. 【腰部脊柱管狭窄症 私の治療戦略】腰部脊柱管狭窄症の再狭窄例に対する腰椎側方進入椎体間固定術(LIF)(間接除圧派)

    中島 宏彰, 金村 徳相, 佐竹 宏太郎, 石川 喜資, 大内田 隼, 今釜 史郎

    Orthopaedics   Vol. 32 ( 2 ) page: 39 - 43   2019.2

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    腰部脊柱管狭窄症の腰椎除圧術後の再手術症例に対する直接除圧では、神経周囲の瘢痕組織を処理する必要があるため、硬膜損傷や神経障害が起きる危険性も高い。近年、腰椎側方進入椎体間固定術を用いた間接除圧術が登場し、本疾患に対してもその有効性が期待されている。間接除圧術は変性に伴い減少した椎間板高やすべりを矯正することで、間接的に脊柱管を拡大する方法である。側方から椎間板操作を行うため、瘢痕組織や癒着した神経組織の操作なく除圧することが可能で、経皮的椎弓根スクリューと組み合わせることで、後方の初回手術創を展開することなく固定することも可能となる。当院では、腰椎除圧術後にすべりや不安定性を伴った再狭窄例で、椎間板ヘルニアや靱帯骨化症を認めず、下肢麻痺や安静時症状のない症例を間接除圧の適応とし、良好な臨床症状の改善を認めた。手術侵襲や周術期合併症も少なく、再狭窄例に対しても有効な可能性が高いが、手術手技への習熟と適応症例の選択が重要である。(著者抄録)

  26. 【とことん頸椎 解剖・治療・看護 思うぞんぶん詰め込みました】頸椎手術の合併症と対策 髄液漏

    中島 宏彰

    整形外科看護   Vol. 24 ( 2 ) page: 156 - 157   2019.2

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  27. 【とことん頸椎 解剖・治療・看護 思うぞんぶん詰め込みました】頸椎手術の合併症と対策 術後血腫・浮腫

    中島 宏彰

    整形外科看護   Vol. 24 ( 2 ) page: 152 - 153   2019.2

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  28. 【とことん頸椎 解剖・治療・看護 思うぞんぶん詰め込みました】頸椎手術の合併症と対策 創部感染

    中島 宏彰

    整形外科看護   Vol. 24 ( 2 ) page: 154 - 155   2019.2

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  29. 整形外科 知ってるつもり 脊髄ヘルニアの画像診断と治療

    今釜 史郎, 中島 宏彰, 八木 秀樹, 安藤 圭, 小林 和克, 石黒 直樹

    臨床整形外科   Vol. 53 ( 12 ) page: 1110 - 1114   2018.12

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    <文献概要>はじめに 脊髄ヘルニアは脊髄が硬膜管から嵌頓して多彩な脊髄症状を呈する疾患である(図1).その原因として,特発性のほかに外傷や炎症,医原性(脊椎手術後)などが考えられている.本疾患は,比較的稀な疾患とされているが,近年のMRI検査の普及や画像精度向上により整形外科診療で遭遇する機会が少なくない.その診断や治療のためにはまず,脊髄ヘルニアを疑うことと,その特徴を知らなければならない.脊髄ヘルニアは胸椎,中年女性に多く,Brown-Sequard症候群を呈する頻度が高いとされるが,脊髄ヘルニアの症状や画像診断,手術予後などについて不明な点が多かった.われわれ名古屋脊椎グループ(NSG)では特発性脊髄ヘルニアに関する多施設研究を行っており,そのデータを紹介するとともに脊髄ヘルニアについて概説する.

  30. 【ハイテク機器を利用した最新の脊椎脊髄手術】「O-arm」の最新の応用法

    金村 徳相, 佐竹 宏太郎, 中島 宏彰, 石川 喜資, 大内田 隼, 山口 英敏, 世木 直喜, 今釜 史郎

    脊椎脊髄ジャーナル   Vol. 31 ( 11 ) page: 938 - 951   2018.11

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    <文献概要>はじめに あらゆる分野でハイテク器機の革新はわれわれの想像をはるかに超えており,脊椎外科領域においても例外ではない.この10年の脊椎ナビゲーションの進歩はめざましく,それに伴い使用施設も増えてきている.現在の脊椎外科手術において脊椎インストゥルメンテーション手術(spinal instrumentation surgery:SIS)の果たす役割は大きく,著しい進歩を遂げてきた.SISにおいて椎弓根スクリュー(pedicle screw:PS)などの脊椎インプラントは,不適切な位置に設置されれば重篤な合併症を引き起こすため,脊椎インプラントを適切な位置に設置することはSISで最も優先すべき安全対策である.術中X線や透視,脊髄モニタリング,インプラントデバイスの工夫などさまざまな方法がとられているが,コンピュータ支援整形外科手術(computer assisted orthopaedic surgery:CAOS)のSISの安全対策における有用性は数多く報告されている.O-arm(R)(Medtronic)は,360度完全回転型の術中2D・3D画像システムであり,2009年より本邦に導入され脊椎外科領域におけるCAOSの一翼を担い,2018年9月現在,日本国内で約80台が導入されている.O-armの普及に伴い徐々に脊椎ナビゲーションやO-arm周辺器機も整備され,2016年には第2世代O-arm(O-arm2)も登場した(図1).本邦導入後9年を超え,その適応も広がってきたので,O-armを用いた最新の応用方法について概説する.

  31. 整形外科最新トピックス 脊椎外科領域におけるコンピューター支援技術の進歩

    佐竹 宏太郎, 金村 徳相, 中島 宏彰, 石川 喜資, 世木 直喜, 大内田 隼

    整形外科Surgical Technique   Vol. 8 ( 3 ) page: 370 - 375   2018.6

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  32. X-Core2による脊柱前方支柱再建の特性、問題点 当院の初期症例による評価

    世木 直喜, 金村 徳相, 佐竹 宏太郎, 中島 宏彰, 大内田 隼, 山口 英敏, 今釜 史郎

    東海脊椎外科   Vol. 32   page: 35 - 35   2018.4

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  33. 頸椎化膿性脊椎炎に対する手術治療の検討

    佐竹 宏太郎, 金村 徳相, 中島 宏彰, 世木 直喜, 大内田 隼

    東海脊椎外科   Vol. 32   page: 39 - 39   2018.4

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  34. 術中再挿入を要したO-armナビゲーション下PPS誤挿入症例の検討

    鈴木 香菜恵, 金村 徳相, 佐竹 宏太郎, 中島 宏彰, 世木 直喜, 大内田 隼

    東海脊椎外科   Vol. 32   page: 37 - 37   2018.4

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  35. 【脊椎脊髄手術の安全性を高める予防と対策】(第2章)術後 術後C5麻痺に対する予防と対策

    小林 和克, 今釜 史郎, 安藤 圭, 中島 宏彰, 石黒 直樹

    脊椎脊髄ジャーナル   Vol. 31 ( 4 ) page: 377 - 381   2018.4

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    <文献概要>はじめに 頸椎術後に,片側の三角筋,上腕二頭筋などの主にC5髄節が支配する近位筋の筋力低下をきたすC5麻痺は古くから認識され,さまざまな研究が行われてきたが,いまだ発生を完全に予測することはできない.術後C5麻痺の発生頻度は,最新のsystematic reviewによると頸椎後方除圧術後の5.8%とされ,術式別の発生率は片開き式椎弓形成術4.5%,両開き式椎弓形成術3.1%,椎弓切除術11.3%と報告されている.また,後方固定術を併用することにより,発生のリスクは11.6倍となったとの報告もある.さらに,後方固定術後のC5麻痺は椎弓形成術単独と比較して,筋力低下が強く回復が悪いという報告もあることから,頸椎矯正固定術においても,特に問題となる合併症である.

  36. 骨粗鬆症性脊椎骨折の治療 Cutting Edge 骨粗鬆性椎体骨折後偽関節に対する手術療法 術式間の手術成績の比較と治療法の選択

    中島 宏彰, 今釜 史郎, 佐竹 宏太郎, 石川 喜資, 世木 直喜, 大内田 隼, 金村 徳相

    臨床整形外科   Vol. 53 ( 4 ) page: 299 - 305   2018.4

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    <文献概要>骨粗鬆性椎体骨折後偽関節に対するさまざまな術式が報告されてきた.前方固定術は前方からの直接除圧とともに脊柱再建が可能だが,その固定力は十分とはいえず,約20%に後方固定の追加が必要となる.後方固定に椎体形成を併用する術式は,侵襲が少なく麻痺の改善も良好であるが,術後インストゥルメント障害や後彎変形の進行例を認める.前後脊椎再建術は強固な固定性が得られるが,手術侵襲が大きい.近年,lateral corpectomyを用いた低侵襲化が行われ,幅広い伸延型椎体ケージが使用可能となり,治療成績の向上が期待されている.

  37. S2 alar iliac screwの緩みと腰仙椎骨癒合率

    中島 宏彰, 金村 徳相, 佐竹 宏太郎, 世木 直喜, 大内田 隼, 石川 喜資, 今釜 史郎

    Journal of Spine Research   Vol. 9 ( 3 ) page: 253 - 253   2018.3

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  38. 頸椎後縦靱帯骨化症の骨化形態が術後機能回復に影響を与えるか 多変量解析をふまえた検討

    中島 宏彰, 今釜 史郎, 金村 徳相, 神原 俊輔, 加藤 文彦

    日本整形外科学会雑誌   Vol. 92 ( 2 ) page: S124 - S124   2018.3

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  39. 頸椎後縦靱帯骨化症の術後機能回復と骨化形態との関係

    中島 宏彰, 今釜 史郎, 金村 徳相, 神原 俊輔, 佐竹 宏太郎, 伊藤 圭吾, 加藤 文彦

    Journal of Spine Research   Vol. 9 ( 3 ) page: 507 - 507   2018.3

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  40. 腰椎変性疾患に対するLLIF

    金村 徳相, 佐竹 宏太郎, 中島 宏彰, 石川 喜資, 世木 直喜, 大内田 準, 山口 英敏, 今釜 史郎

    Journal of Spine Research   Vol. 9 ( 3 ) page: 408 - 408   2018.3

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  41. 腰椎変性すべり症に対する腰椎側方進入椎体間固定術を用いた間接除圧術

    中島 宏彰, 金村 徳相, 佐竹 宏太郎, 世木 直喜, 大内田 隼, 今釜 史郎, 石黒 直樹

    日本整形外科学会雑誌   Vol. 92 ( 2 ) page: S116 - S116   2018.3

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  42. 腰椎分離症の保存治療において運動制限はどの程度必要か?

    中島 宏彰, 今釜 史郎, 米田 實, 金村 徳相

    Journal of Spine Research   Vol. 9 ( 3 ) page: 251 - 251   2018.3

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  43. 腰椎側方侵入椎体間固定術を用いた腰椎間接除圧術後の経時的画像変化

    中島 宏彰, 金村 徳相, 佐竹 宏太郎, 世木 直喜, 大内田 隼, 石川 喜資, 今釜 史郎

    Journal of Spine Research   Vol. 9 ( 3 ) page: 423 - 423   2018.3

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  44. 脊椎低侵襲手術の進歩と安全性の担保 LIFを用いた低侵襲手術のリスクとベネフィット

    金村 徳相, 佐竹 宏太郎, 中島 宏彰, 石川 喜資, 世木 直喜, 大内田 隼, 山口 英敏, 今釜 史郎

    日本整形外科学会雑誌   Vol. 92 ( 2 ) page: S331 - S331   2018.3

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  45. 胸腰椎移行部に対する前方アプローチ 経横隔膜アプローチは横隔膜輪状切開に比べ有用か?

    中島 宏彰, 金村 徳相, 佐竹 宏太郎, 世木 直喜, 大内田 隼, 石川 喜資, 今釜 史郎

    Journal of Spine Research   Vol. 9 ( 3 ) page: 447 - 447   2018.3

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  46. 経大腰筋側方進入腰椎椎体間固定術(LLIF)の骨癒合不全

    佐竹 宏太郎, 金村 徳相, 中島 宏彰, 石川 喜資, 世木 直喜, 大内田 隼

    Journal of Spine Research   Vol. 9 ( 3 ) page: 449 - 449   2018.3

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  47. 椎弓根スクリューのLLIF骨癒合不全への影響

    佐竹 宏太郎, 金村 徳相, 中島 宏彰, 石川 喜資, 世木 直喜, 大内田 隼

    Journal of Spine Research   Vol. 9 ( 3 ) page: 766 - 766   2018.3

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  48. 最先端の術中画像ナビゲーションを用いてもなぜ椎弓根逸脱が防止できないのか 経皮的椎弓根スクリュー(PPS)での検討

    大内田 隼, 金村 徳相, 佐竹 宏太郎, 中島 宏彰, 石川 喜資, 世木 直喜, 鈴木 香菜恵, 今釜 史郎

    Journal of Spine Research   Vol. 9 ( 3 ) page: 663 - 663   2018.3

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  49. 日本人成人健常者におけるWhole Body Sagittal Alignment 多施設研究による基準値

    大内田 隼, 金村 徳相, 長谷川 和宏, 岡本 昌士, 佐竹 宏太郎, 中島 宏彰, 石川 喜資, 世木 直喜, 初鹿野 駿

    Journal of Spine Research   Vol. 9 ( 3 ) page: 457 - 457   2018.3

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  50. X-Core2を用いた骨粗鬆症性椎体骨折の側方アプローチ椎体再建 術後1年間における従来法との比較

    世木 直喜, 金村 徳相, 佐竹 宏太郎, 中島 宏彰, 石川 喜資, 大内田 隼, 山口 英敏, 今釜 史郎

    Journal of Spine Research   Vol. 9 ( 3 ) page: 706 - 706   2018.3

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  51. Hip-spine syndrome 矢状面における脊椎・股関節・下肢アライメント評価

    金村 徳相, 川崎 雅史, 佐竹 宏太郎, 笠井 健広, 中島 宏彰, 世木 直喜, 落合 聡史, 岡本 昌典, 大内田 準, 隈部 香里

    日本関節病学会誌   Vol. 36 ( 3 ) page: 345 - 345   2017.10

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  52. 【側方進入腰椎椎体間固定術(LLIF)-手術手技,成績,合併症】腰椎側方アプローチにおける解剖 後腹膜腔の膜の解剖を中心に

    金村 徳相, 佐竹 宏太郎, 中島 宏彰, 世木 直喜, 大内田 隼

    脊椎脊髄ジャーナル   Vol. 30 ( 10 ) page: 872 - 883   2017.10

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  53. 低K血症を合併し下肢麻痺を呈した硬膜外膿瘍の1例

    横井 寛之, 大内田 隼, 鈴木 香菜恵, 世木 直喜, 中島 宏彰, 佐竹 宏太郎, 金村 徳相

    中部日本整形外科災害外科学会雑誌   Vol. 60 ( 5 ) page: 979 - 979   2017.9

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  54. 脊椎疾患精査中に脊椎MRIで偶然発見され血管病変の3例

    石川 喜資, 安田 達也, 金村 徳相, 今釜 史郎, 中島 宏彰, 山口 英敏, 岩瀬 俊樹, 石黒 直樹, 西田 佳弘

    静岡整形外科医学雑誌   Vol. 10 ( 1 ) page: 84 - 84   2017.6

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  55. 成人脊柱変形の目指すポイント PI-LL≦10°,PT<20°はすべての年齢層に当てはまるのか 成人脊柱変形における至適な矢状面アライメント矯正 術中にどのように目的とするアライメントを獲得するのか?

    中島 宏彰, 金村 徳相, 佐竹 宏太郎, 世木 直喜, 大内田 隼, 今釜 史郎

    臨床整形外科   Vol. 52 ( 5 ) page: 439 - 447   2017.5

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    近年,超高齢社会を迎え,日本人の生理的脊椎アライメントを基に,骨盤形態を踏まえたさまざまな計算式が報告され,日本人における理想的な脊椎矢状面アライメントが明らかとなってきた.しかし,いかに目標とするアライメントを手術の際に獲得するかは大きな課題であり,当院ではコンピューター・アシスト・ロッド・ベンディング(Bendini,NuVasive社)を用いて,定量的なロッドベンディングを行っている.本ベンディング法の利点と限界を中心に検討し,理想的なアライメント獲得への当院での取り組みを紹介する.(著者抄録)

  56. DO-LIF 側方経路腰椎椎体間固定の新たなアプローチは重要臓器損傷リスクを低減し、大腿周囲症状の発生率を下げる

    世木 直喜, 金村 徳相, 佐竹 宏太郎, 中島 宏彰, 山口 英敏, 大内田 隼, 今釜 史郎

    Journal of Spine Research   Vol. 8 ( 4 ) page: 950 - 954   2017.4

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    側方経路腰椎椎体間固定(LIF)においてdirect lateralアプローチでは腰神経叢、oblique lateralアプローチでは大血管・尿管に近く、これらの損傷は重篤な合併症となるためその危険性をより低減するアプローチが望まれる。当院ではこれら重要臓器損傷をできるだけ回避するアプローチでLIF(DO-LIF)を施行している。DO-LIFは従来法に比較して下肢麻痺と大腿周囲症状の発生率を低減できており、重要臓器損傷の危険を減少させる可能性が示唆され、有用と考えられた。(著者抄録)

  57. 脊髄症を呈した先天性後彎による頸胸椎移行部重度後彎症の1例

    山口 英敏, 金村 徳相, 佐竹 宏太郎, 中島 宏彰, 世木 直樹, 大内田 隼, 松本 明之, 伊藤 全哉

    東海脊椎外科   Vol. 31   page: 48 - 48   2017.4

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  58. 【高齢者の脊柱変形Up to Date】(第2章)治療 高齢者脊柱変形に対する側方経路腰椎椎体間固定術の応用

    中島 宏彰, 金村 徳相, 佐竹 宏太郎, 世木 直喜, 大内田 隼, 今釜 史郎

    脊椎脊髄ジャーナル   Vol. 30 ( 4 ) page: 437 - 443   2017.4

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  59. 同種骨を用いた側方椎体間固定術の術後2年の骨癒合評価

    佐竹 宏太郎, 金村 徳相, 中島 宏彰, 世木 直喜, 大内田 隼

    日本整形外科学会雑誌   Vol. 91 ( 2 ) page: S121 - S121   2017.3

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  60. 頸椎後縦靱帯骨化症術後の神経学的回復と骨化形態の関係

    中島 宏彰, Tetreault Lindsay, 名越 慈人, Fehlings Michael

    日本整形外科学会雑誌   Vol. 91 ( 2 ) page: S485 - S485   2017.3

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  61. 腰椎側方侵入椎体間固定術後の間接除圧固定効果の検討

    中島 宏彰, 金村 徳相, 佐竹 宏太郎, 山口 英敏, 世木 直喜, 大内田 隼, 今釜 史郎

    日本整形外科学会雑誌   Vol. 91 ( 3 ) page: S1022 - S1022   2017.3

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  62. 発育性脊柱管狭窄は脊髄圧迫の危険因子となるのか 1211人の無症候性ボランティアのデータからみた解析

    中島 宏彰, 加藤 文彦, 須田 浩太, 山縣 正庸, 植田 尊善

    日本整形外科学会雑誌   Vol. 91 ( 3 ) page: S1030 - S1030   2017.3

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  63. 圧迫性頸髄症の術後成績は高齢者で劣るのか 世界16施設479例前向き調査からの解析

    中島 宏彰

    日本整形外科学会雑誌   Vol. 91 ( 3 ) page: S697 - S697   2017.3

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  64. LLIFとPLIFどちらがより腰椎前彎を獲得できるか 矢状面矯正効果の比較

    山口 英敏, 金村 徳相, 佐竹 宏太郎, 中島 宏彰, 世木 直喜, 大内田 隼, 今釜 史郎

    Journal of Spine Research   Vol. 8 ( 3 ) page: 604 - 604   2017.3

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  65. 頸椎前方固定術後の嚥下障害に対する危険因子と術後成績

    名越 慈人, Tetreault Lindsay, 中島 宏彰, 中村 雅也, 松本 守雄, Fehlings Michael G

    Journal of Spine Research   Vol. 8 ( 3 ) page: 681 - 681   2017.3

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  66. 頸椎前方固定術後の嚥下障害に対する危険因子と術後成績

    名越 慈人, Tetreault Lindsay, 中島 宏彰, 中村 雅也, 松本 守雄, Fehlings Michael

    日本整形外科学会雑誌   Vol. 91 ( 3 ) page: S1103 - S1103   2017.3

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  67. 腰椎変性後彎症に対する腰椎側方侵入椎体間固定術を用いた矯正固定術 多椎間PLIF症例との比較

    中島 宏彰, 金村 徳相, 佐竹 宏太郎, 世木 直喜, 大内田 隼, 山口 英敏, 今釜 史郎

    Journal of Spine Research   Vol. 8 ( 3 ) page: 475 - 475   2017.3

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  68. 腰椎変性すべり症に対する腰椎側方侵入椎体間固定術を用いた間接除圧の適応と限界

    中島 宏彰, 金村 徳相, 佐竹 宏太郎, 世木 直喜, 大内田 隼, 山口 英敏, 今釜 史郎

    Journal of Spine Research   Vol. 8 ( 3 ) page: 505 - 505   2017.3

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  69. 脊髄ヘルニアと脊髄くも膜嚢腫の症状と画像所見 多施設研究からみた違いと相同性

    中島 宏彰, 今釜 史郎, 八木 秀樹, 加藤 文彦, 佐藤 公治, 川上 紀明, 伊藤 研悠, 石黒 直樹

    Journal of Spine Research   Vol. 8 ( 3 ) page: 294 - 294   2017.3

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  70. 無症候ボランティアにおける骨性脊柱管狭窄の割合 骨性脊柱管狭窄は本当に頸髄症発症の危険因子となっているのか?

    中島 宏彰, 加藤 文彦, 須田 浩太, 山縣 正庸, 植田 尊善

    Journal of Spine Research   Vol. 8 ( 3 ) page: 222 - 222   2017.3

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  71. 椎体と後腹膜臓器の体位による解剖学的位置関係の検討 側臥位で重要臓器は安全域へ移動するか?

    大内田 隼, 金村 徳相, 佐竹 宏太郎, 中島 宏彰, 世木 直喜, 山口 英敏

    Journal of Spine Research   Vol. 8 ( 3 ) page: 245 - 245   2017.3

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  72. 成人脊柱変形矯正手術 LLIF vs.骨切り 成人脊柱変形における側方アプローチ手技を用いた冠状面・矢状面矯正

    金村 徳相, 佐竹 宏太郎, 中島 宏彰, 世木 直喜, 大内田 隼, 鈴木 香菜恵, 山口 英敏, 今釜 史郎

    Journal of Spine Research   Vol. 8 ( 3 ) page: 188 - 188   2017.3

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  73. 同種骨を用いた側方椎体間固定術の術後2年の骨癒合評価

    佐竹 宏太郎, 金村 徳相, 中島 宏彰, 世木 直喜, 大内田 隼, 松本 明之, 都島 幹人, 神原 俊輔, 今釜 史郎

    Journal of Spine Research   Vol. 8 ( 3 ) page: 506 - 506   2017.3

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  74. 全脊椎矢状面バランス不良は頸椎椎弓形成術後の頸部痛や下肢症状遷延の危険因子となりうる 165症例に対する前向き研究

    大内田 隼, 中島 宏彰, 金村 徳相, 加藤 文彦

    Journal of Spine Research   Vol. 8 ( 3 ) page: 739 - 739   2017.3

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  75. 側方アプローチ椎体ケージによる脊柱前方支柱再建 従来ケージと比較した有用性と問題点

    世木 直喜, 金村 徳相, 佐竹 宏太郎, 中島 宏彰, 大内田 隼, 山口 英敏, 今釜 史郎

    Journal of Spine Research   Vol. 8 ( 3 ) page: 606 - 606   2017.3

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  76. 側方アプローチによる脊柱矢状面矯正 安全に行うための解剖学的理解といかに矢状面フォーミュラを手術に反映させるか

    金村 徳相, 佐竹 宏太郎, 中島 宏彰, 世木 直喜, 大内田 隼, 鈴木 香菜恵, 今釜 史郎, 山口 英敏

    Journal of Spine Research   Vol. 8 ( 3 ) page: 218 - 218   2017.3

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  77. アスリートは脊髄振とう後にスポーツ復帰できるか? システマティックレビューの結果から

    名越 慈人, Tetreault Lindsay, 中島 宏彰, 中村 雅也, 松本 守雄, Fehlings Michael G

    Journal of Spine Research   Vol. 8 ( 3 ) page: 655 - 655   2017.3

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  78. 【頸椎後方固定術-適応と手技の変遷】中下位頸椎椎弓根スクリューの実際

    中島 宏彰, 金村 徳相, 佐竹 宏太郎, 世木 直喜, 大内田 隼

    脊椎脊髄ジャーナル   Vol. 30 ( 1 ) page: 39 - 45   2017.1

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KAKENHI (Grants-in-Aid for Scientific Research) 2

  1. 術中脊髄モニタリング波形解析による術後麻痺予防に向けた新たなアラームポイント策定

    Grant number:20K09499  2020.4 - 2024.3

    小林 和克

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    Authorship:Coinvestigator(s) 

    術中脊髄モニタリングは、麻痺の発生を未然に防ぐために多く用いられてきた。とくに経頭蓋電気刺激による誘発筋電図(Muscle Evoked Potential, MEP)は脊髄運動路をリアルタイムにモニタリングする上で最も鋭敏な方法とされ、脊髄手術のモニタリングとしてゴールドスタンダードと位置づけられている。本研究の概要としては、ラット等の実験動物を用いた基礎的実験および多施設前向き研究による手術波形解析により、脊髄損傷時のMEP波形変化の特性を明らかにし、不可逆的脊髄損傷を防ぐための術中MEPモニタリングについてアラームポイントを決定する基礎的知見を見出すことである。

  2. Rspo2を用いた新たな骨再生治療

    Grant number:20K18059  2020.4 - 2023.3

    若手研究

    中島 宏彰

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    Authorship:Principal investigator 

    Grant amount:\4160000 ( Direct Cost: \3200000 、 Indirect Cost:\960000 )

    高齢者の増加に伴い骨粗鬆症が増加し、骨折後に偽関節となる症例も多く認める。本研究ではRspo2を用いて内在性の骨芽細胞を適切に偽関節部へ誘導する。精製タンパクを用いた新たな骨折治癒促進法を研究することで、高額な医療費を要する細胞移植を用いない新たな偽関節治療の確立を目指す。研究代表者の研究室は、Wnt活性化因子であるRspo2に着目し、(1) 骨芽細胞においてRspo2は独自の受容体Lgr5を利用してWntシグナルを活性化すること、 (2)Rspo2は組織再生で重要な血管新生を促進することを明らかとしてきた。今回の研究ではこれらの知見を活用し、Rspo2を用いた、より効率の良い骨再生治療法を確立する。