Papers - NAKASHIMA Hiroaki

Preoperative Symptom Duration Influences Neurological Recovery and Patient-Reported Outcome Measures After Surgical Treatment of Cervical Ossification of the Posterior Longitudinal Ligament Reviewed

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

SPINE   Vol. 48 ( 18 ) page： 1259 - 1265   2023.9

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Study Design: A prospective multicenter study. Objective: To investigate the effect of preoperative symptom duration on neurological recovery for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL). Summary of Background Data: The optimal timing to perform surgery in the setting of cervical OPLL remains unknown. It is important to know the influence of symptom duration on postoperative outcomes to facilitate discussions regarding the timing of surgery. Patients and Methods: The study included 395 patients (291 men and 104 women; mean age, 63.7 ± 11.4 yr): 204 were treated with laminoplasty, 90 with posterior decompression and fusion, 85 with anterior decompression and fusion, and 16 with other procedures. The Japanese Orthopedic Association (JOA) score and patient-reported outcomes of the JOA Cervical Myelopathy Evaluation Questionnaire were used to assess clinical outcomes preoperatively and 2 years after surgery. Logistic regression analysis was used to identify factors associated with the achievement of minimum clinically important difference (MCID) after surgery. Results: The recovery rate was significantly lower in the group with symptom duration of ≥5 years compared with the groups with durations of <0.5 years, 0.5 to 1 year, and 1 to 2 years. Improvement of JOA Cervical Myelopathy Evaluation Questionnaire in the upper extremity function score (P < 0.001), lower extremity function (P = 0.039), quality of life (P = 0.053), and bladder function (P = 0.034) were all decreased when the symptom duration exceeded 2 years. Duration of symptoms (P = 0.001), age (P < 0.001), and body mass index (P < 0.001) were significantly associated with the achievement of MCID. The cutoff value we established for symptom duration was 23 months (area under the curve, 0.616; sensitivity, 67.4%; specificity, 53.5%). Conclusions: Symptom duration had a significant impact on neurological recovery and patient-reported outcome measures in this series of patients undergoing surgery for cervical OPLL. Patients with symptom duration exceeding 23 months may be at greater risk of failing to achieve MCID after surgery. Level of Evidence. 3.

DOI： 10.1097/BRS.0000000000004762

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Association between Locomotive Syndrome and Hearing Loss in Community-Dwelling Adults Reviewed Open Access

Ito, S; Nakashima, H; Segi, N; Ouchida, J; Ishizuka, S; Takegami, Y; Yoshida, T; Hasegawa, Y; Imagama, S

JOURNAL OF CLINICAL MEDICINE   Vol. 12 ( 17 )   2023.9

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The relationship between hearing and motor function as a function of aging is unclear. Therefore, we aimed to clarify the relationship between age-related hearing loss and locomotive syndrome. In total, 240 participants aged ≥40 years, whose hearing acuity and motor function had been measured, were included in this study. Patients with a hearing acuity of <35 dB and ≥35 dB were categorized into normal and low hearing acuity groups, respectively. Motor function was compared according to sex between the groups. Among men, those in the low hearing acuity group (51/100) were older, had a significantly slower walking speed, and had a higher prevalence of locomotive syndrome than those in the normal group. Among women, those in the low hearing group (14/140) were older and had a significantly slower gait speed than those in the normal group. The multivariate analysis showed that, in the low hearing acuity group, age and gait speed were risk factors in men, while age was the only risk factor in women. In conclusion, hearing loss was associated with walking speed. The association between hearing loss and locomotive syndrome was observed only in men. In the multivariate analysis, hearing loss was associated with walking speed only in men.

DOI： 10.3390/jcm12175626

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Utility of ultrasonography in the diagnosis of lumbar spondylolysis in adolescent patients Reviewed Open Access

Nakashima, H; Yoneda, M; Machino, M; Ito, S; Segi, N; Tomita, H; Ouchida, J; Imagama, S

JOURNAL OF ORTHOPAEDIC SCIENCE   Vol. 28 ( 5 ) page： 955 - 960   2023.9

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Background: This study aims to investigate the utility of the Doppler effect on ultrasonography for the diagnosis of very early- and early-stage lumbar spondylolysis in adolescent patients. Methods: In total, 76 adolescent patients with acute and subacute low back pain were prospectively enrolled, with 46 having lumbar spondylolysis and the remaining 30 having low back pain without spondylolysis. MRI and/or computed tomograms scans revealed very early- and early-stage lumbar spondylolysis. Furthermore, positive Doppler findings in ultrasonography around the area from the facet joint to the laminae were investigated. Results: There were no significant differences in age (p > 0.99) and body mass index (p = 0.11) between cases with and without spondylolysis. Very early- and early-stage spondylolysis were observed in 27.6% and 72.4% of patients, respectively. Positive power Doppler was 91.3% and 33.3% in cases with and without spondylolysis, respectively, which was significantly higher in spondylolysis (p < 0.001). The sensitivity and specificity of this positive power Doppler were 91.4% and 66.7%, respectively. Furthermore, the rate of positive power Doppler was significantly higher in early-stage spondylolysis (p = 0.02), with 75.0% and 97.6% sensitivity in very early- and early-stage spondylolysis, respectively. Conclusions: A positive Doppler effect on ultrasonography is effective for screening very early- and early-stage spondylolysis in adolescent patients in an outpatient clinic.

DOI： 10.1016/j.jos.2022.06.019

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Factors Associated With Loss of Cervical Lordosis After Laminoplasty for Patients With Cervical Ossification of the Posterior Longitudinal Ligament Data From a Prospective Multicenter Study Reviewed

Nakashima, H; Imagama, S; Yoshii, T; Egawa, S; Sakai, K; Kusano, K; Tsutsui, 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; Moridaira, H; Fujibayashi, S; Katoh, H; Kanno, H; Taneichi, H; Kawaguchi, Y; Takeshita, K; Nakamura, M; Okawa, A; Yamazaki, M

SPINE   Vol. 48 ( 15 ) page： 1047 - 1056   2023.8

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Study Design. A prospective multicenter study. Objective. The objective of this study was to investigate the incidence of loss of cervical lordosis after laminoplasty for cervical ossification of the posterior longitudinal ligament (OPLL). We also sought to determine associated risk factors and the relationship with patient-reported outcomes. Summary of Background Data. Loss of cervical lordosis is a sequelae often observed after laminoplasty, which may adversely impact surgical outcomes. Cervical kyphosis, especially in OPLL, is associated with reoperation, but risk factors and relationship to postoperative outcomes remain understudied at this time. Materials and Methods. This study was conducted by the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. We included 165 patients who underwent laminoplasty and completed Japanese Orthopaedic Association (JOA) score or Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaires (JOACMEQ), as well as Visual Analog Scales (VAS) for pain, with imaging. The participants were divided into two groups: those with loss of cervical lordosis of >10° or 20° after surgery and those without loss of cervical lordosis. A paired t test was applied to evaluate the association between changes in cervical spinal angles, range of motion, and cervical JOA and VAS scores before and at 2 years postoperatively. Mann-Whitney U test was used for JOACMEQ. Results. Postoperative loss of cervical lordosis >10° and >20° was observed in 32 (19.4%) and 7 (4.2%), respectively. JOA, JOACMEQ, and VAS scores were not significantly different between those with, and without, loss of cervical lordosis. Preoperative small extension range of motion (eROM) was significantly associated with postoperative loss of cervical lordosis, and the cutoff values of eROM were 7.4° [area under the curve (AUC): 0.76] and 8.2° (AUC: 0.92) for loss of cervical lordosis >10° and >20°, respectively. A large occupation ratio of OPLL was also associated with loss of cervical lordosis, with a cutoff value of 39.9% (AUC: 0.94). Laminoplasty resulted in functional improvement in most patient-reported outcomes; however, neck pain and bladder function tended to become worse postoperatively in cases with postoperative loss of cervical lordosis >20°. Conclusions. JOA, JOACMEQ, and VAS scores were not significantly different between those with, and without, loss of cervical lordosis. Preoperative small eROM and large OPLL may represent factors associated with loss of cervical lordosis after laminoplasty in patients with OPLL.

DOI： 10.1097/BRS.0000000000004706

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Automated Detection and Diagnosis of Spinal Schwannomas and Meningiomas Using Deep Learning and Magnetic Resonance Imaging Reviewed Open Access

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

JOURNAL OF CLINICAL MEDICINE   Vol. 12 ( 15 )   2023.8

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Spinal cord tumors are infrequently identified spinal diseases that are often difficult to diagnose even with magnetic resonance imaging (MRI) findings. To minimize the probability of overlooking these tumors and improve diagnostic accuracy, an automatic diagnostic system is needed. We aimed to develop an automated system for detecting and diagnosing spinal schwannomas and meningiomas based on deep learning using You Only Look Once (YOLO) version 4 and MRI. In this retrospective diagnostic accuracy study, the data of 50 patients with spinal schwannomas, 45 patients with meningiomas, and 100 control cases were reviewed, respectively. Sagittal T1-weighted (T1W) and T2-weighted (T2W) images were used for object detection, classification, training, and validation. The object detection and diagnosis system was developed using YOLO version 4. The accuracies of the proposed object detections based on T1W, T2W, and T1W + T2W images were 84.8%, 90.3%, and 93.8%, respectively. The accuracies of the object detection for two spine surgeons were 88.9% and 90.1%, respectively. The accuracies of the proposed diagnoses based on T1W, T2W, and T1W + T2W images were 76.4%, 83.3%, and 84.1%, respectively. The accuracies of the diagnosis for two spine surgeons were 77.4% and 76.1%, respectively. We demonstrated an accurate, automated detection and diagnosis of spinal schwannomas and meningiomas using the developed deep learning-based method based on MRI. This system could be valuable in supporting radiological diagnosis of spinal schwannomas and meningioma, with a potential of reducing the radiologist’s overall workload.

DOI： 10.3390/jcm12155075

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Genetic insights into ossification of the posterior longitudinal ligament of the spine Reviewed Open Access

Koike, Y; Takahata, M; Nakajima, M; Otomo, N; Suetsugu, H; Liu, XX; Endo, T; Imagama, S; Kobayashi, K; Kaito, T; Kato, S; Kawaguchi, Y; Kanayama, M; Sakai, H; Tsuji, T; Miyamoto, T; Inose, H; Yoshii, T; Kashii, M; Nakashima, H; Ando, K; Taniguchi, Y; Takeuchi, K; Ito, S; Tomizuka, K; Hikino, K; Iwasaki, Y; Kamatani, Y; Maeda, S; Nakajima, H; Mori, K; Seichi, A; Fujibayashi, S; Kanchiku, T; Watanabe, K; Tanaka, T; Kida, K; Kobayashi, S; Takahashi, M; Yamada, K; Takuwa, H; Lu, HF; Niida, S; Ozaki, K; Momozawa, Y; Yamazaki, M; Okawa, A; Matsumoto, M; Iwasaki, N; Terao, C; Ikegawa, S

ELIFE   Vol. 12   2023.7

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Ossification of the posterior longitudinal ligament of the spine (OPLL) is an intractable disease leading to severe neurological deficits. Its etiology and pathogenesis are primarily unknown. The relationship between OPLL and comorbidities, especially type 2 diabetes (T2D) and high body mass index (BMI), has been the focus of attention; however, no trait has been proven to have a causal relationship. We conducted a meta-analysis of genome-wide association studies (GWASs) using 22,016 Japanese individuals and identified 14 significant loci, 8 of which were previously unreported. We then conducted a gene-based association analysis and a transcriptome-wide Mendelian randomization approach and identified three candidate genes for each. Partitioning heritability enrichment analyses observed significant enrichment of the polygenic signals in the active enhancers of the connective/bone cell group, especially H3K27ac in chondrogenic differentiation cells, as well as the immune/hematopoietic cell group. Single-cell RNA sequencing of Achilles tendon cells from a mouse Achilles tendon ossification model confirmed the expression of genes in GWAS and post-GWAS analyses in mesenchymal and immune cells. Genetic correlations with 96 complex traits showed positive correlations with T2D and BMI and a negative correlation with cerebral aneurysm. Mendelian randomization analysis demonstrated a significant causal effect of increased BMI and high bone mineral density on OPLL. We evaluated the clinical images in detail and classified OPLL into cervical, thoracic, and the other types. GWAS subanalyses identified subtype-specific signals. A polygenic risk score for BMI demonstrated that the effect of BMI was particularly strong in thoracic OPLL. Our study provides genetic insight into the etiology and pathogenesis of OPLL and is expected to serve as a basis for future treatment development.

DOI： 10.7554/eLife.86514

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Comparison of Surgical Outcomes of Anterior and Posterior Fusion Surgeries for K-line (-) Cervical Ossification of the Posterior Longitudinal Ligament A Prospective Multicenter Study Reviewed

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

SPINE   Vol. 48 ( 13 ) page： 937 - 943   2023.7

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Study Design. A prospective multicenter study. Objective. The objective of this study is to compare the surgical outcomes of anterior and posterior fusion surgeries in patients with K-line (-) cervical ossification of the posterior longitudinal ligament (OPLL). Summary of Background Data. Although laminoplasty is effective for patients with K-line (+) OPLL, fusion surgery is recommended for those with K-line (-) OPLL. However, whether the anterior or posterior approach is preferable for this pathology has not been effectively determined. Materials and Methods. A total of 478 patients with myelopathy due to cervical OPLL from 28 institutions were prospectively registered from 2014 to 2017 and followed up for two years. Of the 478 patients, 45 and 46 with K-line (-) underwent anterior and posterior fusion surgeries, respectively. After adjusting for confounders in baseline characteristics using a propensity score-matched analysis, 54 patients in both the anterior and posterior groups (27 patients each) were evaluated. Clinical outcomes were assessed using the cervical Japanese Orthopaedic Association and the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire. Results. Both approaches showed comparable neurological and functional recovery. The cervical range of motion was significantly restricted in the posterior group because of the large number of fused vertebrae compared with the anterior group. The incidence of surgical complications was comparable between the cohorts, but the posterior group demonstrated a higher frequency of segmental motor paralysis, whereas the anterior group more frequently reported postoperative dysphagia. Conclusions. Clinical improvement was comparable between anterior and posterior fusion surgeries for patients with K-line (-) OPLL. The ideal surgical approach should be informed based on the balance between the surgeon's technical preference and the risk of complications.

DOI： 10.1097/BRS.0000000000004634

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Intramedullary cavernous hemangioma of the spinal cord with intra- and extramedullary hematomas Reviewed Open Access

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

JOURNAL OF ORTHOPAEDIC SCIENCE   Vol. 28 ( 4 ) page： 937 - 941   2023.7

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DOI： 10.1016/j.jos.2020.10.003

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Cervical Spinal Cord Compression in Adult Scoliosis Reviewed Open Access

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

GLOBAL SPINE JOURNAL   Vol. 13 ( 6 ) page： 1576 - 1581   2023.7

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Study Design: Retrospective cohort study. Objectives: The aim was to examine cervical spinal cord compression (SCC) in adult scoliosis and clarify the prevalence of and risk factors for cervical SCC. Methods: This study included 270 adult scoliosis patients and 1211 healthy volunteers. Cervical SCC was evaluated on cervical magnetic resonance imaging (MRI). The rates of SCC for those with adult scoliosis and the healthy volunteers were compared. Logistic regression analysis was conducted to examine the factors associated with cervical SCC on MRI. Results: In cases with adult scoliosis, preoperative major scoliosis curve was 56.0° ± 18.8°, and cervical SCC was detected in 25 patients (9.3%). Among the healthy volunteers, 64 cases with cervical SCC were detected. Only in cases with adult scoliosis, logistic regression analysis revealed higher age (OR 1.09, 95% CI 1.04–1.14, P <.001), narrow canal diameter (OR 2.27, 95% CI 1.35–3.85, P =.002), and inferior sagittal balance (OR 2.45, 95% CI 1.02–5.89, P =.04) as significant risk factors. In the logistic regression analysis in all subjects (including adult scoliosis and healthy volunteers), higher age (OR 1.08, 95% CI 1.06–1.10, P <.001) and narrow canal diameter (OR 1.62, 95% CI 1.37–1.92, P <.001) were also found to be significant risk factors, but the presence of scoliosis was not a significant factor. Conclusions: Adult scoliosis itself was not significantly associated with cervical SCC. Inferior sagittal balance in addition to scoliosis constituted a significant risk factor for cervical SCC.

DOI： 10.1177/21925682211041979

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Differences in Involvement of Whole-Body Compensatory Alignment for Decompensated Spinopelvic Sagittal Balance Reviewed Open Access

Ouchida, J; Nakashima, H; Kanemura, T; Ito, K; Tsushima, M; Machino, M; Ito, S; Segi, N; Ode, Y; Imagama, S

JOURNAL OF CLINICAL MEDICINE   Vol. 12 ( 14 )   2023.7

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Language：English   Publisher：Journal of Clinical Medicine  

Background: The aim of this study was to investigate the differences in the involvement of whole-body compensatory alignment in different conditions of spinopelvic sagittal balance (compensated/decompensated). Methods: We enrolled 330 individuals who underwent medical checkups and divided them according to sagittal vertical axis (SVA): for the compensated group, this was <4 cm, (group C) and for the decompensated group, it was ≥4 cm, (group D). The correlation between the lack of ideal lumbar lordosis (iLL), which was calculated by using the Schwab formula, and the compensatory radiographic parameters in each group was analyzed. The threshold value of knee flexion (KF) angle, which indicated spinopelvic sagittal imbalance (SVA ≥ 4), was determined by a ROC-curve analysis. Results: The correlation analysis of the lack of iLL and each compensatory parameter showed a strong correlation for pelvic tilt (PT) (r = −0.723), and a weak correlation for thoracic kyphosis (TK) (r = 275) in Group C. In Group D, the correlations were strong for PT (r = −0.796), and moderate for TK (r = 0.462) and KF (r = −0.415). The optimal cutoff value for the KF angle was determined to be 8.4 degrees (sensitivity 89%, specificity 46%). Conclusions: The present study shows differences between compensated/decompensated spinopelvic sagittal balance in the correlation strength between lack of iLL and whole-body compensatory parameters.

DOI： 10.3390/jcm12144690

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Residual Neuropathic Pain in Postoperative Patients With Cervical Ossification of Posterior Longitudinal Ligament Reviewed

Miyagi, M; Inoue, G; Yoshii, T; Egawa, S; Sakai, K; Kusano, K; Nakagawa, Y; Hirai, T; Wada, K; Katsumi, K; Kimura, A; Furuya, T; Nagoshi, N; 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; Koda, M; Takahashi, H; Ikeda, S; Imagama, S; Kawaguchi, Y; Takeshita, K; Matsumoto, M; Takaso, M; Okawa, A; Yamazaki, M

CLINICAL SPINE SURGERY   Vol. 36 ( 6 ) page： E277 - E282   2023.7

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Study Design: A prospective multi-institutional observational study. Objective: To investigate and identify risk factors for residual neuropathic pain after surgery in patients with cervical ossification of posterior longitudinal ligament (c-OPLL). Summary of Background Data: Patients with c-OPLL often require surgery for numbness and paralysis of the extremities; however, postoperative neuropathic pain can considerably deteriorate their quality of life. Methods: Out of 479 patients identified from multicenter c-OPLL registries between 2014 and 2017, 292 patients who could be followed up for 2 years postoperatively were reviewed, after excluding patients with nervous system comorbidities. Demographic details; medical history; radiographic factors including the K-line, spinal canal occupancy rate of OPLL, cervical kyphosis angle, and presence of spinal cord myelomalacia; preoperative Japanese Orthopaedic Association (JOA) score; surgical procedure (fusion or decompression surgery); postoperative neurological deterioration; and the visual analogue scale for pain and numbness in the upper extremities (U/E) or trunk/lower extremities (L/E) at baseline and at 2 years postoperatively were assessed. Patients were grouped into residual and non-residual groups based on a postoperative visual analogue scale ≥40 mm. Risk factors for residual neuropathic pain were evaluated by multiple logistic regression analysis. Results: The prevalence of U/E and L/E residual pain in postoperative c-OPLL patients was 51.7% and 40.4%, respectively. The U/E residual group had a poor preoperative JOA score and longer illness duration, and fusion surgery was more common in the residual group than in non-residual group. The L/E residual group was older with a poorer preoperative JOA score. On multivariate analysis, risk factors for U/E residual pain were long illness duration and poor preoperative JOA score, whereas those for L/E residual pain were age and poor preoperative JOA score. Conclusions: The risk factors for residual spinal neuropathic pain after c-OPLL surgery were age, long duration of illness, and poor preoperative JOA score. Level of Evidence: IV.

DOI： 10.1097/BSD.0000000000001449

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Spinopelvic Imbalance Is Associated With Increased Sway in the Center of Gravity: Validation of the "Cone of Economy" Concept in Healthy Subjects Reviewed Open Access

Segi, N; Nakashima, H; Ando, K; Kobayashi, K; Seki, T; Ishizuka, S; Takegami, Y; Machino, M; Ito, S; Koshimizu, H; Tomita, H; Hasegawa, Y; Imagama, S

GLOBAL SPINE JOURNAL   Vol. 13 ( 6 ) page： 1502 - 1508   2023.7

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Study Design: Cross-sectional study. Objectives: To investigate the effects of pelvic compensation on standing balance in healthy volunteers. Methods: The 180 healthy volunteers were recruited at a basic health checkup. The inclusion criteria were: 1) age ≥ 65 years, 2) underwent a whole spine radiograph and stabilometry, 3) well-balanced standing posture with a sagittal vertical axis <50 mm, and 4) a visual analog scale of lower back pain of <20 mm. Based on the pelvic incidence (PI) and lumbar lordosis (LL) mismatch, subjects were divided into harmonious (PI–LL ≤ 10°) or unharmonious (PI–LL > 10°) groups. Results: Participants in the unharmonious group were significantly older compared with the harmonious group (70.2 ± 4.4 vs. 72.0 ± 4.6 years, P <.01). The PI minus LL values were −2.2° ± 7.5° and 16.6° ± 7.0° in the harmonious and unharmonious groups, respectively (P <.001). Anteroposterior LNG/TIME (average center of pressure sway speed) was significantly greater in the unharmonious group with both open and closed eyes (1.04 ± 0.38 cm/s vs. 1.25 ± 0.47 cm/s, P <.001 and 1.22 ± 0.54 cm/s vs. 1.58 ± 0.77 cm/s, P <.001, respectively). Lateral LNG/TIME was significantly greater in the unharmonious group only with closed eyes (1.24 ± 0.54 cm/s vs. 1.47 ± 0.79 cm/s, P =.03). Conclusions: Healthy elderly subjects with poor spinopelvic harmony had relatively unstable standing balance. The “cone of economy” was demonstrated, showing that unharmonious spinopelvic balance had a non-economic effect on standing.

DOI： 10.1177/21925682211038897

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Blunt Cerebrovascular Injury in the Elderly With Traumatic Cervical Spine Injuries: Results of a Retrospective Multi-Center Study of 1512 Cases in Japan Reviewed Open Access

Suzuki, H; Funaba, M; Imajo, Y; Yokogawa, N; Sasagawa, T; Ando, K; Nakashima, H; Segi, N; Funayama, T; Eto, F; Watanabe, K; Yamane, J; Furuya, T; Nakajima, H; Hasegawa, T; Terashima, Y; Ikegami, S; Inoue, G; Kaito, T; Kato, S

JOURNAL OF NEUROTRAUMA   Vol. 40 ( 11-12 ) page： 1164 - 1172   2023.6

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This study is nationwide retrospective multi-center study to investigate the incidence and characteristics of blunt cerebrovascular injury (BCVI) in elderly Japanese patients with traumatic cervical spine injuries (CSI) including spinal cord injury (SCI) without major bone injury. The study enrolled 1512 patients (average age: 75.8 ± 6.9 years; 1007 males, 505 females) from 33 nationwide institutions, and 391 (26%) of the participants had digital subtraction angiography and/or computed tomography angiography. Fifty-three patients were diagnosed as having BCVI by angiography. We assessed neurological evaluation, comorbidities and classification of CSI in the elderly patients with/without BCVI and collected 6-month follow-up data on treatment, complications, and patient outcome. We also statistically analyzed the relative risk (RR) and relationship between BCVI and other factors. Significant differences were identified between BCVI (+) (n = 53) and (-) (n = 1459) patients with American Spinal Injury Association Impairment Scale (ASIA) A, C, D, cervical fracture, C3-7 injury level (AO type F and/or C), cervical dislocation, spinal surgery for CSI, tetraplegia type of SCI, and/or head injury. Fifty-three (3.5%) elderly patients had CSI complicated by BCVI including 10 (19%) cases of Denver grade I, four (7%) of grade II, 1 (2%) of grade III, 29 (55%) of grade IV, and nine (17%) of grade V. Sixteen cases were treated by interventional radiology. Rates of mortality and brain infarction from BCVI were 0.13% and 0.40%, respectively. RR of BCVI was significantly higher in the elderly cervical injury patients with head injury, severe neurological deficit, ASIA A (RR: 4.33), cervical fracture at the C3-7 level (RR: 7.39), and cervical dislocation at the C1-6 level (RR: 3.06-7.18). In conclusion, 53 (3.5%) elderly patients were complicated with BCVI. BCVI more frequently complicated head injury, severe neurological deficit (ASIA A or tetraplegia), AO type F, and/or C fractures and cervical dislocation in these patients. Six patients (11%) suffered brain infarction and two patients died from BCVI.

DOI： 10.1089/neu.2022.0180

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Relationship between lumbosacral transitional vertebra and postoperative outcomes of patients with Lenke 5C adolescent idiopathic scoliosis: a minimum 5-year follow-up study Reviewed

Yamauchi, I; Nakashima, H; Machino, M; Ito, S; Segi, N; Tauchi, R; Ohara, T; Kawakami, N; Imagama, S

EUROPEAN SPINE JOURNAL   Vol. 32 ( 6 ) page： 2221 - 2227   2023.6

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Language：English   Publisher：European Spine Journal  

Purpose: To assess the incidence of lumbosacral transitional vertebra (LSTV) in Lenke 5C adolescent idiopathic scoliosis (AIS) and evaluate the relationship between postoperative outcomes and LSTV when the lowest instrumented vertebra (LIV) is fixed at L3. Methods: The study included 61 patients with Lenke 5C AIS who underwent fusion surgery of L3 as the LIV who were followed-up for a minimum of 5 years. Patients were divided into two groups: LSTV + and LSTV-. Demographic, surgical, and radiographic data, including L4 tilt and thoracolumbar/lumbar (TL/L) Cobb angle, were obtained and analyzed. Results: LSTV was observed in 15 patients (24.5%). The L4 tilt was not significantly different between the two groups preoperatively (P = 0.54); however, it was significantly greater in the LSTV group postoperatively (2 weeks: LSTV + = 11.7 ± 3.1, LSTV − = 8.8 ± 3.2, P = 0.013; 2 years: LSTV + = 11.5 ± 3.5, LSTV − = 7.9 ± 4.1, P = 0.006; 5 years: LSTV + = 9.8 ± 3.1, LSTV − = 7.3 ± 4.5, P= 0.042). The postoperative TL/L curve was greater in the LSTV + group, with significant differences at 2 weeks and 2 years postoperatively (preoperative: LSTV + = 53.5 ± 11.2, LSTV − = 51.7 ± 10.3,P = 0.675; 2 weeks: LSTV + = 16.1 ± 5.0, LSTV- = 12.2 ± 6.6, P = 0.027; 2 years: LSTV + = 21.7 ± 5.9, LSTV − = 17.6 ± 5.9, P = 0.035; 5 years: LSTV + = 18.7 ± 5.8, LSTV − = 17.0 ± 6.1, P = 0.205). Conclusion: The prevalence of LSTV in Lenke 5C AIS patients was 24.5%. Lenke 5C AIS patients with LSTV with the LIV at L3 had a significantly greater postoperative L4 tilt than those without LSTV and retained the TL/L curve.

DOI： 10.1007/s00586-023-07752-y

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新しい医療技術 新しいLLIFの手術手技　ACR法

伊藤 研悠, 金村 徳相, 中島 宏彰, 都島 幹人, 富田 浩之, 種市 洋

整形・災害外科   Vol. 66 ( 6 ) page： 737 - 742   2023.5

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DOI： 10.18888/se.0000002585

Metabolic syndrome reduces spinal range of motion: The Yakumo study Reviewed Open Access

Kanbara, S; Ando, K; Kobayashi, K; Nakashima, H; Machino, M; Seki, T; Ishizuka, S; Ito, S; Inoue, T; Yamaguchi, H; Koshimizu, H; Segi, N; Tomita, H; Hasegawa, Y; Imagama, S

JOURNAL OF ORTHOPAEDIC SCIENCE   Vol. 28 ( 3 ) page： 547 - 553   2023.5

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Language：English   Publisher：Journal of Orthopaedic Science  

Background: Excess visceral fat can accumulate owing to lack of exercise. The relationship between metabolic syndrome (MetS) and spinal range of motion (ROM) is not clear. The purpose of this study was to investigate the relationship between MetS and spinal alignment and ROM. Methods: Orthopedic evaluation was prospectively performed in 544 participants. The participants were classified into two groups on the basis of the Japanese-specific MetS criteria proposed by the Japanese Committee of the Criteria for MetS (JCCMS). Lower back pain (LBP), knee joint pain with the visual analog scale (VAS), Kellgren–Lawrence (K–L) grade for knee osteoarthritis, body mass index (BMI), and spinal alignment and ROM were evaluated. Results: Forty-four (8.1%) were diagnosed as having MetS. The prevalence rate of K–L grade 4 in the MetS group was significantly higher than that in the non-MetS group (p < 0.05). When sex, age, and BMI were evaluated as covariates, there were significant differences in the VAS score for knee pain (non-MetS group vs MetS group: 13.7 vs 23.3, p < 0.05), L1–S1 flexion spinal ROM (44.1° vs 38.1°, p < 0.001), flexion spinal inclination angle (SIA) ROM (107.6° vs 99.3°, p < 0.01), and SIA ROM (135.4° vs 124.0°, p < 0.05). Conclusions: Knee pain increased and flexion spinal ROM decreased significantly in the MetS group as compared with non-MetS group. Systemic factors associated with MetS may have a specific impact on spinal ROM while promoting knee osteoarthrosis and increased knee pain.

DOI： 10.1016/j.jos.2022.02.008

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特集 脊椎脊髄領域の画像診断-最新の知識と進歩 Ⅴ.AIを用いた脊椎脊髄疾患の画像診断の進歩 深層学習を用いたMRIでの脊髄腫瘍自動診断システム

伊藤 定之, 中島 宏彰, 町野 正明, 小田 昌宏, 森 健策, 今釜 史郎

整形・災害外科   Vol. 66 ( 5 ) page： 657 - 665   2023.4

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Publisher：南江堂  

DOI： 10.18888/se.0000002560

Anatomical Analysis of the Gonadal Veins and Spine in Lateral Lumbar Interbody Fusion Reviewed Open Access

Kagami, Y; Nakashima, H; Satake, K; Ito, K; Tsushima, M; Segi, N; Tomita, H; Ouchida, J; Morita, Y; Ode, Y; Imagama, S; Kanemura, T

JOURNAL OF CLINICAL MEDICINE   Vol. 12 ( 8 )   2023.4

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Language：English   Publisher：Journal of Clinical Medicine  

Background: The current study aimed to investigate the anatomical position of the gonadal veins (GVs) from the viewpoint of spine surgery and the risk factors associated with lateral lumbar interbody fusion (LLIF). Methods: This retrospective study included 99 consecutive patients. The GV locations were divided into the ventral (V), dorsal medial (DM), and dorsal lateral (DL) sides based on lumbar disk levels on axial contrast-enhanced computed tomography images. The DM region surrounded by the vertebral body and psoas muscle had the highest risk of GV injury. The GV at each intervertebral disk level was examined in terms of laterality and sex. The patients were divided into group M (which included those with GV in the DM region at any vertebral level) and group O (which included those without GV in the DM region at any vertebral level). Then, the two groups were compared. Results: In the case of lower lumbar levels and in women, the GVs were commonly observed in the DM region. Group M had a higher incidence of degenerative scoliosis than group O and a significantly larger Cobb angle. Conclusions: We should pay close attention to the GV location on the preoperative image when using LLIF, particularly in female patients with degenerative scoliosis.

DOI： 10.3390/jcm12083041

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Association between Postoperative Neck Pain and Intraoperative Transcranial Motor-Evoked Potential Waveforms of the Trapezius Muscles in Patients with Cervical Myelopathy Who Underwent Cervical Laminoplasty Reviewed Open Access

Ito, S; Sakai, Y; Ando, K; Nakashima, H; Machino, M; Segi, N; Tomita, H; Koshimizu, H; Hida, T; Ito, K; Harada, A; Imagama, S

ASIAN SPINE JOURNAL   Vol. 17 ( 2 ) page： 330 - 337   2023.4

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Language：English   Publisher：Asian Spine Journal  

Study Design: Retrospective study. Purpose: Cervical laminoplasty is safe and effective for treating cervical myelopathy but has a higher frequency of postoperative axial pain compared to other methods. Several studies have reported on the causes of postoperative axial pain, but none have fully elucidated them. This study aimed to investigate the association between postoperative neck pain and intraoperative transcranial motor-evoked potential (MEP) waveforms of the trapezius muscles using transcranial MEPs. Overview of Literature: Few studies have investigated the association between postoperative neck pain and intraoperative transcranial MEP waveforms of the trapezius muscles in patients with cervical laminoplasty. Methods: A total of 79 patients with cervical myelopathy who underwent cervical laminoplasty at our facility between June 2010 and March 2013 were included in this study. Intraoperative control and final waveform were evaluated based on the trapezius muscle MEPs by measuring the latency and amplitude. A neck pain group comprised patients with higher neck pain Visual Analog Scale scores from preoperative value to 1 year postoperatively. The cross-sectional areas of the trapezius muscles and the MEP latencies and amplitudes were compared between patients with and without neck pain. Results: The latency and amplitude of the control waveforms were not significantly different between groups. The neck pain group had a significantly shorter final waveform latency (neck pain: 23.6±2.5, no neck pain: 25.8±4.5; p =0.019) and significantly larger amplitude (neck pain: 2,125±1,077, no neck pain: 1,630±966; p =0.041) than the no neck pain group. Conclusions: Postoperative neck pain was associated with the final waveform latency and amplitude of the trapezius muscle MEPs during cervical laminoplasty. Intraoperative electrophysiological trapezius muscle abnormalities could cause postoperative neck pain

DOI： 10.31616/asj.2022.0120

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頸椎由来の頸肩腕症状に対する薬物治療の臨床経済研究

若尾 典充, 古矢 丈雄, 有馬 秀幸, 中島 宏彰, 吉井 俊貴, 今城 靖明, 宮本 裕史, 井上 玄, 神原 俊輔, 海渡 貴司, 橋爪 洋, 山田 宏

Journal of Spine Research   Vol. 14 ( 3 ) page： 120 - 120   2023.4

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