Faculty Profiles - NAKASHIMA Hiroaki

特集始まった! 脊椎ロボット手術ロボット支援脊椎手術-Mazor Xを用いた脊椎手術の有用性と課題

金村徳相, 都島幹人, 富田浩之, 森下和明, 大島和馬, 中島宏彰

脊椎脊髄ジャーナル Vol. 37 ( 1 ) page： 25 - 38 2024.1

連載最新原著レビュー地域住民中高齢者における頚部痛と神経障害性疼痛の関係

町野正明, 中島宏彰, 今釜史郎

整形外科 Vol. 75 ( 1 ) page： 71 - 75 2024.1

Koshimizu, H; Nakashima, H; Ohara, T; Tauchi, R; Kanemura, T; Shinjo, R; Machino, M; Ito, S; Ando, K; Imagama, S

GLOBAL SPINE JOURNAL Vol. 14 ( 1 ) page： 74 - 81 2024.1

Language：English Publisher：Global Spine Journal

Study Design: Retrospective analysis of prospectively database Objective: Implant-related complications are an extremely important issue because they pose a burden to patients who underwent surgery. An understanding of these complications can help improve the postoperative management of patients undergoing spinal surgery. The current large-scale multicenter study aimed to identify postoperative implant-related complications that may require revision surgery. Methods: In total, 3447 patients who underwent spinal fusion surgery were included in the analysis. Data about age at surgery, sex, preoperative diagnosis, surgical level, type of implant-related complications, causes of reoperation, and time from the initial to revision surgery were reviewed. Moreover, the characteristics of reoperation in 3 periods (within 30, 31–90, and over 90 days) were assessed. Result: The overall incidence of implant-related complications was 4.6%. Adult spinal deformity was the most common diagnosis (9.9%), and thoracic-lumbar-sacral (42.9%) was the most common surgical level among patients with implant-related complications. Further, screw malposition was the most frequent implant-related complication (42.8%). In total, 89 (2.6%) patients underwent reoperation due to implant-related complications. The main causes of reoperation within 30, 31–90, and over 90 days were screw malposition (72.2%), screw loosening or pull out (81.8%), and rod or screw fracture (60.9%), respectively. Conclusion: To the best of our knowledge, this was the first large-scale multicenter study that assessed the characteristics of patients who underwent reoperation due to spinal implant-related complications. The study results could improve the preoperative informed consent procedure about spinal fusion.

DOI： 10.1177/21925682221094267

Prognostic Factors for Respiratory Dysfunction for Cervical Spinal Cord Injury and/or Cervical Fractures in Elderly Patients: A Multicenter Survey Reviewed

Hirota, R; Terashima, Y; Ohnishi, H; Yamashita, T; Yokogawa, N; Sasagawa, T; Ando, K; Nakashima, H; Segi, N; Funayama, T; Eto, F; Yamaji, A; Watanabe, K; Yamane, J; Takeda, K; Furuya, T; Yunde, A; Nakajima, H; Yamada, T; Hasegawa, T; Suzuki, H; Imajo, Y; Ikegami, S; Uehara, M; Tonomura, H; Sakata, M; Hashimoto, K; Onoda, Y; Kawaguchi, K; Haruta, Y; Suzuki, N; Kato, K; Uei, H; Sawada, H; Nakanishi, K; Misaki, K; Terai, H; Tamai, K; Shirasawa, E; Inoue, G; Kakutani, K; Kakiuchi, Y; Kiyasu, K; Tominaga, H; Tokumoto, H; Iizuka, Y; Takasawa, E; Akeda, K; Takegami, N; Funao, H; Oshima, Y; Kaito, T; Sakai, D; Yoshii, T; Ohba, T; Otsuki, B; Seki, S; Miyazaki, M; Ishihara, M; Okada, S; Imagama, S; Kato, S

GLOBAL SPINE JOURNAL Vol. 14 ( 1 ) page： 101 - 112 2024.1

Language：English Publisher：Global Spine Journal

Study design: Retrospective Cohort Study Objective: The purpose of this study was to investigate the prognosis of respiratory function in elderly patients with cervical spinal cord injury (SCI) and to identify predictive factors. Methods: We included 1353 cases of elderly cervical SCI patients collected from 78 institutions in Japan. Patients who required early tracheostomy and ventilator management and those who developed respiratory complications were defined as the respiratory disability group. Patients’ background characteristics, injury mechanism, injury form, neurological disability, complications, and treatment methods were compared between the disability and non-disability groups. Multiple logistic regression analysis was used to examine the independent factors. Patients who required respiratory management for 6 months or longer after injury and those who died of respiratory complications were classified into the severe disability group and were compared with minor cases who were weaned off the respirator. Results: A total of 104 patients (7.8%) had impaired respiratory function. Comparisons between the disabled and non-disabled groups and between the severe and mild injury groups yielded distinct trends. In multiple logistic regression analysis, age, blood glucose level, presence of ossification of posterior longitudinal ligament (OPLL), anterior vertebral hematoma, and critical paralysis were selected as independent risk factors. Conclusion: Age, OPLL, severe paralysis, anterior vertebral hematoma, hypoalbuminemia, and blood glucose level at the time of injury were independent factors for respiratory failure. Hyperglycemia may have a negative effect on respiratory function in this condition.

DOI： 10.1177/21925682221095470

Pedicular kinking during posterior corrective procedure for thoracolumbar kyphoscoliosis with unstable osteoporotic fracture Reviewed

Koshimizu, H; Nakashima, H; Tomita, H; Segi, N; Ito, S; Machino, M; Ando, K; Imagama, S

JOURNAL OF ORTHOPAEDIC SCIENCE Vol. 29 ( 1 ) page： 409 - 412 2024.1

Reply to "Letter to the Editor Concerning 'Trabecular Bone Remodeling as a New Indicator of Osteointegration After Posterior Lumbar Interbody Fusion.' by Segi et al. " Reviewed

Segi, N; Nakashima, H; Shinjo, R; Kagami, Y; Machino, M; Ito, S; Ouchida, J; Imagama, S

GLOBAL SPINE JOURNAL Vol. 14 ( 1 ) page： 353 - 354 2024.1

Trabecular Bone Remodeling as a New Indicator of Osteointegration After Posterior Lumbar Interbody Fusion Reviewed

Segi, N; Nakashima, H; Shinjo, R; Kagami, Y; Ando, K; Machino, M; Ito, S; Koshimizu, H; Tomita, H; Ouchida, J; Imagama, S

GLOBAL SPINE JOURNAL Vol. 14 ( 1 ) page： 25 - 32 2024.1

Language：English Publisher：Global Spine Journal

Study Design: Retrospective cohort study. Objectives: We newly found that trabecular bone remodeling (TBR) often appeared in the fixed adjacent vertebrae during bony fusion. Thus, TBR might indicate osteointegration. Hence, we aimed to investigate whether TBR in the early postoperative period could predict future bony fusion after posterior lumbar interbody fusion (PLIF). Methods: We retrospectively analyzed 78 patients who underwent one-level PLIF. Demographic data were reviewed. Using computed tomography (CT) images taken at 3 months and 1 year postoperatively, we investigated the vertebral endplate cyst (VEC) formation, TBR in the vertebral body, cage subsidence, and clear zone around pedicle screw (CZPS). Results: TBR had high interobserver reliability regardless of cage materials. VECs, TBR, and both were found in 30, 53, and 16 patients at 3 months postoperatively and in 30, 65, and 22 patients at 1 year postoperatively, respectively. The incidence of VEC, which indicates poor fixation, was lower in early (3 months postoperatively) TBR-positive patients, with a significant difference at 1 year postoperatively (3 months, P =.074; 1 year, P =.003). Furthermore, 3 (5.7%) of the 53 early TBR-positive patients had CZPS without instability at 1 year postoperatively. In 25 TBR-negative patients, 1 (4.0%) had pedicle screw cutout requiring reoperation, 1 (4.0%) had pseudarthrosis, and 4 (16%) had CZPS. Conclusions: Patients with early TBR (3 months) did not experience pedicle screw cutout nor pseudarthrosis and had significantly fewer VECs than those without early TBR. Thus, TBR may be a new radiological marker of initial fixation after PLIF.

DOI： 10.1177/21925682221090484

Comparative Analysis of Characteristics of Lower- and Mid-Cervical Spine Injuries in the Elderly Reviewed

術中脊髄モニタリングにおける運動誘発電位に基づいた機械学習による脊髄機能の評価 Reviewed Open Access

伊達俊坪, 藤原幸一, 世木直喜, 中島宏彰, 伊藤定之, 大内田隼, 大石遼太郎, 宮入祐一, 山内一平, 森田圭則, 今釜史郎

生体医工学 Vol. Annual62 ( Abstract ) page： 186_1 - 186_1 2024

Language：Japanese Publisher：公益社団法人日本生体医工学会

術中脊髄モニタリングでは，運動誘発電位の正確な評価法が十分に確立されておらず，術中に迅速かつ客観的に脊髄機能を評価することが難しいという課題がある．本研究では，機械学習を用いて術中に得られる運動誘発電位の異常を検出する機械学習モデルの開発を試みた．患者797名の術中脊髄モニタリングで得られた各部位の軽頭蓋刺激運動誘発電位の波形データ，術前後に行われる徒手筋力検査（MMT）のスコアを利用した．本解析では，次の条件を満たす症例を除外した； 1）両足の大腿四頭筋，前脛骨筋，ハムストリング，下腿三頭筋のうちどれかが取得されていない．2）総取得数の8割以上で波形が取得できていない．術前のMMTスコアが全て５かつ術後も全て5の症例を正常，術前のスコアが全て5かつ術後が全て5でない症例を異常と定義した．本研究では，異常検知手法の一つであるLong Short Term Memory Autoencoderを用いて正常波形を学習し，MMT評価が低下した症例について術中での異常波形を検知する機械学習モデルの構築した．正常データを学習：検証：テスト＝7:1:2に分割し，異常データは全てテストデータとして使用した．モデルをテストデータに適用した結果，偽陽性率は4%，感度は0.48，AUCは0.79であった．正しく異常と判定できた10例中6例は手術終盤に異常判定が頻発しており，脊髄の異常を反映している可能性がある．

DOI： 10.11239/jsmbe.annual62.186_1

Open Access

CiNii Research

Segi Naoki, Nakashima Hiroaki, Ito Sadayuki, Ouchida Jun, Yokogawa Noriaki, Sasagawa Takeshi, Furuya Takeo, Yunde Atsushi, Funayama Toru, Eto Fumihiko, Watanabe Kota, Nori Satoshi, Ikegami Shota, Uehara Masashi, Hashimoto Ko, Onoda Yoshito, Nakajima Hideaki, Suzuki Hidenori, Imajo Yasuaki, Yamada Tomohiro, Hasegawa Tomohiko, Kawaguchi Kenichi, Haruta Yohei, Terashima Yoshinori, Hirota Ryosuke, Tonomura Hitoshi, Sakata Munehiro, Iizuka Yoichi, Uei Hiroshi, Suzuki Nobuyuki, Akeda Koji, Tominaga Hiroyuki, Seki Shoji, Oshima Yasushi, Kaito Takashi, Otsuki Bungo, Nakanishi Kazuo, Kakutani Kenichiro, Funao Haruki, Yoshii Toshitaka, Sakai Daisuke, Ohba Tetsuro, Miyazaki Masashi, Terai Hidetomi, Inoue Gen, Okada Seiji, Imagama Shiro, Kato Satoshi

Spine Surgery and Related Research Vol. 8 ( 6 ) page： 560 - 567 2024

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

Introduction: Elderly patients have a higher frequency of upper cervical fractures caused by minor trauma; nevertheless, the clinical differences between mid- and lower-cervical (C6-C7) injuries are unclear. The aim of this study was to compare the epidemiology of lower- and mid-cervical injuries in the elderly.Methods: This multicenter, retrospective study included 451 patients aged 65 years or older who had mid- or lower-cervical fractures/dislocations. Patients' demographic and treatment data were examined and compared based on mid- and lower-cervical injuries.Results: There were 139 patients (31%) with lower-cervical injuries and 312 (69%) with mid-cervical injuries. High-energy trauma (60% vs. 47%, p=0.025) and dislocation (55% vs. 45%, p=0.054) were significantly experienced more often by elderly patients with lower-cervical injuries than by patients with mid-cervical injuries. Although the incidence of key muscle weakness at the C5 to T1 levels were all significantly lower in patients with lower-cervical injuries than those with mid-cervical injuries, impairments at C5 occurred in 49% of them, and at C6, in 65%. No significant differences were found in the rates of death, pneumonia, or tracheostomy requirements, and no significant differences existed in ambulation or ASIA impairment scale grade for patients after 6 months of treatment.Conclusions: Elderly patients with lower-cervical fractures/dislocations were injured by high-energy trauma significantly more often than patients with mid-cervical injuries. Furthermore, half of the patients with lower-cervical injuries had mid-cervical level neurological deficits with a relatively high rate of respiratory complications.

DOI： 10.22603/ssrr.2024-0030

Indirect Decompression in Vertebral Reconstruction for Osteoporotic Vertebral Fractures with Neurological Symptoms: A Preliminary Case Series

Morita Yoshinori, Nakashima Hiroaki, Segi Naoki, Ito Sadayuki, Ouchida Jun, Oishi Ryotaro, Yamauchi Ippei, Miyairi Yuichi, Tsushima Mikito, Ito Kenyu, Tomita Hiroyuki, Morishita Kazuaki, Kanemura Tokumi, Imagama Shiro

Spine Surgery and Related Research Vol. 8 ( 6 ) page： 623 - 630 2024

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

Introduction: This study aimed to investigate the clinical and radiological outcome of "indirect decompression" using lateral-posterior combined surgery for osteoporotic vertebral fracture (OVF) with neurological symptoms.Methods: A total of 17 patients who underwent lateral and posterior combined indirect decompressive spinal reconstruction (LP-IDR) for single-level OVF with neurological symptoms were included in this study. The neurological symptoms (sensory disturbance and muscle weakness) and imaging findings (local angle and height of the fracture segment and bone fragment occupancy in the spinal canal) were investigated preoperatively, postoperatively, and at the 1-year follow-up.Results: Muscle weakness was observed preoperatively in ten patients. Nine patients had complete recovery of muscle weakness (p<0.001), whereas one had residual muscle weakness at the 1-year follow-up. The presence of sensory disturbance was observed in 16 patients preoperatively, and it was significantly reduced to 8 patients at the 1-year follow-up (p=0.003). The bony fragment occupancy rate in the spinal canal was decreased from 44.0% to 40.2% postoperatively (p=0.04) and to 33.1% at 1 year (p=0.002). The local angle was corrected from 8.3° to −2.6° postoperatively (p=0.003) and to 1.2° at 1 year. The local height was corrected from 26.7 to 32.0 mm postoperatively (p<0.001) and to 29.8 mm at 1 year.Conclusions: LP-IDR for OVF with neurological symptoms provided sufficient neurological improvement with expansion of the spinal canal over time.

DOI： 10.22603/ssrr.2024-0013

Reply to "Letter to the Editor Concerning 'Clinical Outcomes of Condoliase Injection Therapy for Lateral Lumbar Disc Herniation' by Kagami et al."

Kagami Yujiro, Nakashima Hiroaki, Segi Naoki, Shinjo Ryuichi, Imagama Shiro

Spine Surgery and Related Research Vol. 8 ( 3 ) page： 353 - 353 2024

Low Nutrition before Injury Is a Risk Factor for Dysphagia in Older Patients with Cervical Spinal Cord Injury: Based on a Multicenter Data of 707 Patients

Segi Naoki, Nakashima Hiroaki, Ito Sadayuki, Ouchida Jun, Yokogawa Noriaki, Sasagawa Takeshi, Funayama Toru, Eto Fumihiko, Watanabe Kota, Nori Satoshi, Furuya Takeo, Yunde Atsushi, Terashima Yoshinori, Hirota Ryosuke, Nakajima Hideaki, Yamada Tomohiro, Hasegawa Tomohiko, Kawaguchi Kenichi, Haruta Yohei, Hashimoto Ko, Onoda Yoshito, Nakanishi Kazuo, Misaki Kosuke, Ikegami Shota, Uehara Masashi, Suzuki Hidenori, Imajo Yasuaki, Uei Hiroshi, Sawada Hirokatsu, Terai Hidetomi, Tamai Koji, Kuroda Akiyoshi, Inoue Gen, Suzuki Nobuyuki, Kato Kenji, Akeda Koji, Takegami Norihiko, Iizuka Yoichi, Oshima Yasushi, Tonomura Hitoshi, Kiyasu Katsuhito, Funao Haruki, Yoshii Toshitaka, Ishihara Masayuki, Kaito Takashi, Seki Shoji, Kakutani Kenichiro, Tominaga Hiroyuki, Ohba Tetsuro, Sakai Daisuke, Otsuki Bungo, Miyazaki Masashi, Okada Seiji, Imagama Shiro, Kato Satoshi

Spine Surgery and Related Research Vol. 8 ( 5 ) page： 473 - 479 2024

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

Introduction: For older adults, dysphagia is a serious problem that can occur after spinal cord injury (SCI), but its risk factors are unclear. This study aimed to identify risk factors for dysphagia in elderly patients (≥65 years) with cervical SCI.Methods: This multicenter study included 707 patients with cervical SCI (mean age 75.3 years). Univariate and multivariate analyses were conducted for patient characteristics and geriatric nutritional risk index (GNRI).Results: Dysphagia occurred in 69 patients (9.8%). The significant factors were as follows: male sex (odds ratio [OR] 3.43), GNRI <92 (1.83), dementia (2.94), fracture (3.40), complete paralysis (3.61), anterior surgery (3.74), and tracheostomy (17.06). Age was not identified as a risk factor.Conclusions: Low GNRI before injury was one of the independent risk factors for dysphagia after geriatric cervical SCI. GNRI represents the comprehensive nutritional status of the elderly and reflects feeding function and its recovery capacity.

DOI： 10.22603/ssrr.2023-0227

Is Intraoperative Blood Loss Volume in Elderly Cervical Spine Injury Surgery Greater in Patients with Ankylosis? A Multicenter Survey Reviewed

Uehara Masashi, Ikegami Shota, Takizawa Takashi, Oba Hiroki, Yokogawa Noriaki, Sasagawa Takeshi, Nakashima Hiroaki, Segi Naoki, Ito Sadayuki, Funayama Toru, Eto Fumihiko, Yamaji Akihiro, Watanabe Kota, Nori Satoshi, Takeda Kazuki, Furuya Takeo, Yunde Atsushi, Nakajima Hideaki, Yamada Tomohiro, Hasegawa Tomohiko, Terashima Yoshinori, Hirota Ryosuke, Suzuki Hidenori, Imajo Yasuaki, Tonomura Hitoshi, Sakata Munehiro, Hashimoto Ko, Onoda Yoshito, Kawaguchi Kenichi, Haruta Yohei, Suzuki Nobuyuki, Kato Kenji, Uei Hiroshi, Sawada Hirokatsu, Nakanishi Kazuo, Misaki Kosuke, Terai Hidetomi, Tamai Koji, Kuroda Akiyoshi, Inoue Gen, Kakutani Kenichiro, Kakiuchi Yuji, Kiyasu Katsuhito, Tominaga Hiroyuki, Tokumoto Hiroto, Iizuka Yoichi, Takasawa Eiji, Akeda Koji, Takegami Norihiko, Funao Haruki, Oshima Yasushi, Kaito Takashi, Sakai Daisuke, Yoshii Toshitaka, Ohba Tetsuro, Otsuki Bungo, Seki Shoji, Miyazaki Masashi, Ishihara Masayuki, Okada Seiji, Imagama Shiro, Kato Satoshi

Spine Surgery and Related Research Vol. 8 ( 6 ) page： 575 - 582 2024

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

Introduction: Preoperative estimations of blood loss are important when planning surgery for cervical spine injuries in older adults. The association between ankylosis and blood loss in perioperative management is of particular interest. This multicenter database review aimed to evaluate the impact of ankylosis on surgical blood loss volume in elderly patients with cervical spine injury.Methods: The case histories of 1512 patients with cervical spine injury at among 33 institutions were reviewed. After the exclusion of patients without surgery or whose blood loss or ankylosis status was unclear, 793 participants were available for analysis. Differences in blood loss volume were compared between the Ankylosis (+) group with ankylosis at the cervical level and the Ankylosis (−) group without by the inverse probability of treatment weighting (IPTW) method using a propensity score.Results: Of the 779 patients (mean age: 75.0±6.3 years) eligible for IPTW calculation, 257 (32.4%) had ankylosis at the cervical level. The mean blood loss volume was higher in Ankylosis (+) patients than in Ankylosis (−) patients (P<0.001). This difference did not reach statistical significance when weighted by background factors, with mean blood loss of 244 mL and 188 mL, respectively, after adjustment.Conclusions: This study revealed that ankylosis was significantly associated with increased blood loss volume when unadjusted by surgical time. Elderly patients with cervical spine injury accompanied by ankylosis appear predisposed to higher bleeding and severe hemorrhage, both as a result of the condition and their particular demographic characteristics.

DOI： 10.22603/ssrr.2023-0118

Automated Detection of the Thoracic Ossification of the Posterior Longitudinal Ligament Using Deep Learning and Plain Radiographs Reviewed Open Access

Ito, S; Nakashima, H; Segi, N; Ouchida, J; Oda, M; Yamauchi, I; Oishi, R; Miyairi, Y; Mori, K; Imagama, S

BIOMED RESEARCH INTERNATIONAL Vol. 2023 page： 8495937 2023.11

Language：English Publisher：Biomed Research International

Ossification of the ligaments progresses slowly in the initial stages, and most patients are unaware of the disease until obvious myelopathy symptoms appear. Consequently, treatment and clinical outcomes are not satisfactory. This study is aimed at developing an automated system for the detection of the thoracic ossification of the posterior longitudinal ligament (OPLL) using deep learning and plain radiography. We retrospectively reviewed the data of 146 patients with thoracic OPLL and 150 control cases without thoracic OPLL. Plain lateral thoracic radiographs were used for object detection, training, and validation. Thereafter, an object detection system was developed, and its accuracy was calculated. The performance of the proposed system was compared with that of two spine surgeons. The accuracy of the proposed object detection model based on plain lateral thoracic radiographs was 83.4%, whereas the accuracies of spine surgeons 1 and 2 were 80.4% and 77.4%, respectively. Our findings indicate that our automated system, which uses a deep learning-based method based on plain radiographs, can accurately detect thoracic OPLL. This system has the potential to improve the diagnostic accuracy of thoracic OPLL.

DOI： 10.1155/2023/8495937

Deep learning-based prediction model for postoperative complications of cervical posterior longitudinal ligament ossification Reviewed

Ito, S; Nakashima, H; Yoshii, T; Egawa, S; Sakai, K; Kusano, K; Tsutui, S; Hirai, T; Matsukura, Y; Wada, K; Katsumi, K; Koda, M; Kimura, A; Furuya, T; Maki, S; Nagoshi, N; Nishida, N; Nagamoto, Y; Oshima, Y; Ando, K; Takahata, M; Mori, K; Nakajima, H; Murata, K; Miyagi, M; Kaito, T; Yamada, K; Banno, T; Kato, S; Ohba, T; Inami, S; Fujibayashi, S; Katoh, H; Kanno, H; Oda, M; Mori, K; Taneichi, H; Kawaguchi, Y; Takeshita, K; Matsumoto, M; Yamazaki, M; Okawa, A; Imagama, S

EUROPEAN SPINE JOURNAL Vol. 32 ( 11 ) page： 3797 - 3806 2023.11

Language：English Publisher：European Spine Journal

Purpose: Postoperative complication prediction helps surgeons to inform and manage patient expectations. Deep learning, a model that finds patterns in large samples of data, outperform traditional statistical methods in making predictions. This study aimed to create a deep learning-based model (DLM) to predict postoperative complications in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Methods: This prospective multicenter study was conducted by the 28 institutions, and 478 patients were included in the analysis. Deep learning was used to create two predictive models of the overall postoperative complications and neurological complications, one of the major complications. These models were constructed by learning the patient's preoperative background, clinical symptoms, surgical procedures, and imaging findings. These logistic regression models were also created, and these accuracies were compared with those of the DLM. Results: Overall complications were observed in 127 cases (26.6%). The accuracy of the DLM was 74.6 ± 3.7% for predicting the overall occurrence of complications, which was comparable to that of the logistic regression (74.1%). Neurological complications were observed in 48 cases (10.0%), and the accuracy of the DLM was 91.7 ± 3.5%, which was higher than that of the logistic regression (90.1%). Conclusion: A new algorithm using deep learning was able to predict complications after cervical OPLL surgery. This model was well calibrated, with prediction accuracy comparable to that of regression models. The accuracy remained high even for predicting only neurological complications, for which the case number is limited compared to conventional statistical methods.

DOI： 10.1007/s00586-023-07562-2

Laterality of lumbar disc herniation Reviewed Open Access

Ito, S; Nakashima, H; Sato, K; Deguchi, M; Matsubara, Y; Kanemura, T; Urasaki, T; Yoshihara, H; Sakai, Y; Ito, K; Shinjo, R; Ando, K; Machino, M; Segi, N; Tomita, H; Koshimizu, H; Imagama, S

JOURNAL OF ORTHOPAEDIC SCIENCE Vol. 28 ( 6 ) page： 1207 - 1213 2023.11

Language：English Publisher：Journal of Orthopaedic Science

Background: Lumbar disc herniation (LDH) is most common in men aged 20–40 at the L4/5 level; however, left-right differences have not been reported. Improving our understanding of left- and right-side LDH may facilitate the estimation of mechanical load on intervertebral discs. Here, we assessed left-right differences in LDH via a retrospective analysis of LDH cases. Methods: Among 10,972 surgical cases of LDH identified in the Nagoya Spine Group database, 2899 in which right- and left-LDH sides were observable in a single vertebral segment were identified (mean age 46.3 ± 16.6 years, 2028 males). The following characteristics of patients with right- and left-LDH were compared: age, LDH level, surgical technique, operative time, blood loss, length of hospital stay, preoperative Japan Orthopaedic Association (JOA) score, and JOA recovery rate. Results: LDH occurred on the right and left sides in 1358 and 1541 patients, respectively, with patients with right-side LDH significantly older than those with left (47.9 ± 16.6 versus 45.0 ± 16.5, respectively; p < 0.001). No between-group differences in sex, age, LDH level, surgical technique, operative time, blood loss, length of hospital stay, preoperative JOA score, or JOA recovery rate were observed. The occurrence of right-side LDH increased with age, occurring in 42.7%, 45.1%, 49.9%, and 54.7% of patients aged 10–29, 30–49, 50–69, and 70–89 years, respectively. Conclusion: Left-side LDH was observed more frequently than right; however, right-side LDH incidence increased with age. No significant between-group differences regarding symptoms, treatments, or outcomes were observed.

DOI： 10.1016/j.jos.2022.10.003

Prognostic impact of respiratory dysfunction in elderly patients with cervical spinal cord injury and/or fractures: a multicenter survey Reviewed

Hirota, R; Terashima, Y; Ohnishi, H; Yamashita, T; Yokogawa, N; Sasagawa, T; Nakashima, H; Segi, N; Ito, S; Funayama, T; Eto, F; Yamaji, A; Watanabe, K; Nori, S; Takeda, K; Furuya, T; Yunde, A; Nakajima, H; Yamada, T; Hasegawa, T; Suzuki, H; Imajo, Y; Ikegami, S; Uehara, M; Tonomura, H; Sakata, M; Hashimoto, K; Onoda, Y; Kawaguchi, K; Haruta, Y; Suzuki, N; Kato, K; Uei, H; Sawada, H; Nakanishi, K; Misaki, K; Terai, H; Tamai, K; Kuroda, A; Inoue, G; Kakutani, K; Kakiuchi, Y; Kiyasu, K; Tominaga, H; Tokumoto, H; Iizuka, Y; Takasawa, E; Akeda, K; Takegami, N; Funao, H; Oshima, Y; Kaito, T; Sakai, D; Yoshii, T; Ohba, T; Otsuki, B; Seki, S; Miyazaki, M; Ishihara, M; Okada, S; Imagama, S; Kato, S

EUROPEAN SPINE JOURNAL Vol. 32 ( 10 ) page： 3522 - 3532 2023.10

Language：English Publisher：European Spine Journal

Purpose: To investigate the impact of early post-injury respiratory dysfunction for neurological and ambulatory ability recovery in patients with cervical spinal cord injury (SCI) and/or fractures. Methods: We included 1,353 elderly patients with SCI and/or fractures from 78 institutions in Japan. Patients who required early tracheostomy and ventilator management and those who developed respiratory complications were included in the respiratory dysfunction group, which was further classified into mild and severe respiratory groups based on respiratory weaning management. Patient characteristics, laboratory data, neurological impairment scale scores, complications at injury, and surgical treatment were evaluated. We performed a propensity score-matched analysis to compare neurological outcomes and mobility between groups. Results: Overall, 104 patients (7.8%) had impaired respiratory function. In propensity score-matched analysis, the respiratory dysfunction group had a lower home discharge and ambulation rates (p = 0.018, p = 0.001, respectively), and higher rate of severe paralysis (p < 0.001) at discharge. At the final follow-up, the respiratory dysfunction group had a lower ambulation rate (p = 0.004) and higher rate of severe paralysis (p < 0.001). Twenty-six patients with severe disability required respiratory management for up to 6 months post-injury and died of respiratory complications. The mild and severe respiratory dysfunction groups had a high percentage of severe paraplegic cases with low ambulatory ability; there was no significant difference between them. The severe respiratory dysfunction group tended to have a poorer prognosis. Conclusion: Respiratory dysfunction in elderly patients with SCI and/or cervical fracture in the early post-injury period reflects the severity of the condition and may be a useful prognostic predictor.

DOI： 10.1007/s00586-023-07828-9

Racial differences in whole-body sagittal alignment between Asians and Caucasians based on international multicenter data Reviewed

Ouchida, J; Nakashima, H; Kanemura, T; Okamoto, M; Hatsushikano, S; Imagama, S; Le Huec, JC; Hasegawa, K

EUROPEAN SPINE JOURNAL Vol. 32 ( 10 ) page： 3608 - 3615 2023.10

Language：English Publisher：European Spine Journal

Purpose: To examine inherent differences adjusted for age and clinical score in whole-body sagittal (WBS) alignment involving the lower extremities between Asians and Caucasians, and to determine the relationship between age and WBS parameters by race and sex. Methods: A total of 317 individuals consisting of 206 Asians and 111 Caucasians participated. WBS parameters including C2-7 lordotic angle, lower lumbar lordosis (lower LL, L4-S), pelvic incidence (PI), pelvic thickness, knee flexion (KF), sagittal vertical axis (SVA), and T1 pelvic angle (TPA) were evaluated radiologically. Propensity score-matching adjustments for age and the Oswestry Disability Index scores for comparative analysis between the two race cohorts and correlation analysis between age and WBS parameters for all subjects by race and sex were conducted. Results: The comparative analysis included 136 subjects (age: Asians 41.1 ± 13.5, Caucasians 42.3 ± 16.2 years, p = 0.936). Racial differences in WBS parameters were observed in C2-7 lordotic angle (−1.8 ± 12.3 vs. 6.3 ± 12.2 degrees, p = 0.001), and lower LL (34.0 ± 6.6 vs. 38.0 ± 6.1 degrees, p <.001). In correlation analysis with age, moderate or more significant correlations with age were found in KF for all groups, and in SVA and TPA for females of both racial groups. Age-related changes in pelvic parameters of PI and pelvic thickness were more significant in Caucasian females. Conclusion: Analysis of the correlation between age and WBS parameters suggested that age-related WBS changes vary between races and should be considered during corrective spinal surgery.

DOI： 10.1007/s00586-023-07829-8

Human Spinal Oligodendrogenic Neural Progenitor Cells Enhance Pathophysiological Outcomes and Functional Recovery in a Clinically Relevant Cervical Spinal Cord Injury Rat Model. Reviewed Open Access

Pieczonka K, Nakashima H, Nagoshi N, Yokota K, Hong J, Badner A, Chio JCT, Shibata S, Khazaei M, Fehlings MG

Stem cells translational medicine Vol. 12 ( 9 ) page： 603 - 616 2023.9

Language：English Publisher：Stem Cells Translational Medicine

Traumatic spinal cord injury (SCI) results in the loss of neurons, oligodendrocytes, and astrocytes. Present interventions for SCI include decompressive surgery, anti-inflammatory therapies, and rehabilitation programs. Nonetheless, these approaches do not offer regenerative solutions to replace the lost cells, fiber tracts, and circuits. Neural stem/progenitor cell (NPC) transplantation is a promising strategy that aims to encourage regeneration. However, NPC differentiation remains inconsistent, thus, contributing to suboptimal functional recovery. As such, we have previously engineered oligodendrogenically biased NPCs (oNPCs) and demonstrated their efficacy in a thoracic model of SCI. Since the majority of patients with SCI experience cervical injuries, our objective in the current study was to generate human induced pluripotent stem cell-derived oNPCs (hiPSC-oNPCs) and to characterize these cells in vitro and in vivo, utilizing a clinically relevant rodent model of cervical SCI. Following transplantation, the oNPCs engrafted, migrated to the rostral and caudal regions of the lesion, and demonstrated preferential differentiation toward oligodendrocytes. Histopathological evaluations revealed that oNPC transplantation facilitated tissue preservation while diminishing astrogliosis. Moreover, oNPC transplantation fostered remyelination of the spared tissue. Functional analyses indicated improved forelimb grip strength, gait, and locomotor function in the oNPC-Transplanted rats. Importantly, oNPC transplantation did not exacerbate neuropathic pain or induce tumor formation. In conclusion, these findings underscore the therapeutic potential of oNPCs in promoting functional recovery and histopathological improvements in cervical SCI. This evidence warrants further investigation to optimize and advance this promising cell-based therapeutic approach.

DOI： 10.1093/stcltm/szad044

Open Access