Faculty Profiles - NAKASHIMA Hiroaki

Papers - NAKASHIMA Hiroaki

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

Satake, K; Kanemura, T; Ito, K; Tanaka, S; Morita, Y; Nakashima, H; Ouchida, J; Imagama, S

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

Language：English 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

Human Nonmercaptalbumin Is a New Biomarker of Motor Function Open Access

Ito, S; Nakashima, H; Ando, K; Kobayashi, K; Machino, M; Seki, T; Ishizuka, S; Kanbara, S; Inoue, T; Koshimizu, H; Fujii, R; Yamada, H; Ando, Y; Ueyama, J; Kondo, T; Suzuki, K; Hasegawa, Y; Imagama, S

JOURNAL OF CLINICAL MEDICINE Vol. 10 ( 11 ) 2021.6

Language：English Publisher：Journal of Clinical Medicine

The ratio of human nonmercaptalbumin (HNA) and reduced albumin (HMA) may be a new marker for oxidative stress. Locomotive syndrome (LS) is reduced mobility due to impairment of locomotive organs. We investigated whether the HNA/HMA ratio could be a new biomarker of LS. This study included 306 subjects (mean age 64.24 ± 10.4 years) who underwent LS tests, grip strength, walking speed, and tests for HNA and HMA. Oxidative stress was measured by the ratio of HMA (f(HMA) = (HMA/(HMA + HNA) × 100)), and the subjects were divided into normal (N group; f[HMA] ≥ 70%) and low (L group; f[HMA] < 70%) groups. There were 124 non-elderly (<65 years) and 182 elderly subjects (≥65 years). There were no significant differences in LS, grip strength, and walking speed between the L and N groups in the non-elderly subjects. However, significant differences were found in the elderly subjects. In logistic regression analysis, there was an association between f(HMA) and the LS severity at older ages. LS in the elderly is associated with a decline in HMA and, thus, an increase in oxidative stress. Thus, f(HMA) is a new biomarker of LS.

DOI： 10.3390/jcm10112464

Sagittal alignment at 3 years old determines future thoracolumbar kyphosis in achondroplasia: A prospective study with minimum 5-year follow-up from infancy Reviewed Open Access

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

NORTH AMERICAN SPINE SOCIETY JOURNAL Vol. 6 page： 100070 2021.6

Language：English Publisher：North American Spine Society Journal

Background: Little is known about the progression of Thoracolumbar kyphosis (TLK) in achondroplasia. The aim of the study was to evaluate natural progression of TLK and establish risk factors for progression. Methods: We reviewed 21 patients (11 males, 10 females) diagnosed clinically and radiographically with achondroplasia as infants and followed for a minimum of 5 years from infancy, and analyzed to compare differences between data at 0, 1, 3, 5, 7-10, and 11-18 years old. Subjects (n=21) were divided into two groups with and without TLK >20° at the thoracolumbar junction on lateral standing radiographs at age 3. Results: TLK >20° occurs in 76.2% of infants in the first 7 months of life. Sagittal parameters at 0, 1, 3, 5, 7-10, and 11-18 years old differed significantly for cervical lordosis (CL), thoracic kyphosis (TK), TLK, lumbar lordosis (LL), pelvic tilt (PT), and sacral slope (SS). TK, LL, and SS increased significantly with increasing age, whereas CL, TLK, and PT were significantly lower in older age groups (P < 0.05). In 6 of 7 patients with TLK >20° at age 3, TLK had progressed or was still >20° at age 5. The prevalence of TLK >20° at age 3 was 33.3% (7/21). There was a significant difference in age at independent walking among subjects with and without TLK at age 3 (31.4±17.1 vs. 16.1±3.4 months, P < 0.01). Radiologic parameters associated with TLK showed significant differences between subjects with and without TLK at age 3, including TLK, TK, TLK, LL, and SVA at age 5; and TLK at ages 7-10 and 11-18. Conclusions: These results suggest that sagittal alignment at 3 years old determines future TLK in achondroplasia. Progression of deformity and neurological impairments require consideration in treatment planning.

DOI： 10.1016/j.xnsj.2021.100070

特集ロコモティブシンドロームの現況 Ⅳ.住民コホートによる評価 4.Yakumoスタディで行っている運動器検診

中島宏彰, 今釜史郎, 安藤圭, 小林和克, 町野正明, 関泰輔, 石塚真哉, 長谷川幸治

整形外科 Vol. 72 ( 6 ) page： 623 - 627 2021.5

特集ロコモティブシンドロームの現況 Ⅵ.疾患とロコモ 1.脊椎アライメントとロコモ

町野正明, 安藤圭, 小林和克, 中島宏彰, 長谷川幸治, 今釜史郎

整形外科 Vol. 72 ( 6 ) page： 659 - 662 2021.5

Overcoming locomotive syndrome: The Yakumo Study

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

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

Language：English 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

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

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

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

Language：English Publisher：Nagoya Journal of Medical Science

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

Association between Low Muscle Mass and Inflammatory Cytokines Reviewed Open Access

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 2021.4

Language：English Publisher：Biomed Research International

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.

DOI： 10.1155/2021/5572742

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 2021.4

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

<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

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

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

Language：English Publisher：Spine

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 (r<sup>2</sup> = 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

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

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

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

Language：English Publisher：European Spine Journal

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.

DOI： 10.1007/s00586-020-06693-0

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

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

BIOMED RESEARCH INTERNATIONAL Vol. 2021 page： 6622398 2021.3

Language：English Publisher：Biomed Research International

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.

DOI： 10.1155/2021/6622398

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

Machino, M; Ando, K; Kobayashi, K; Nakashima, H; Kanbara, S; Ito, S; Inoue, T; Ito, K; Kato, F; Ishiguro, N; Imagama, S

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

Language：English Publisher：Spine

The risk factors for poor outcome after cervical laminoplasty in patients with cervical spondylotic myelopathy (CSM) were demonstrated. These findings suggest that advanced age, long-term CSM symptoms, and lower score of preoperative 10-second step test are risk factors for poor cervical laminoplasty outcomes in patients with CSM.

DOI： 10.1097/BRS.0000000000003783

Intraoperative pedicle screw migration to the abdominal cavity in a severe osteoporotic spine surgery Open Access

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

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

Language：Japanese Publisher：Interdisciplinary Neurosurgery Advanced Techniques and Case Management

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.

DOI： 10.1016/j.inat.2020.100943

Kinetic changes in the spinal cord occupation rate of dural sac in cervical spondylotic myelopathy Open Access

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

JOURNAL OF ORTHOPAEDICS Vol. 24 page： 222 - 226 2021.3

Language：English Publisher：Journal of Orthopaedics

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.

DOI： 10.1016/j.jor.2021.03.005

Risk factors of non-union in Anderson-D'Alonzo type III odontoid fractures with conservative treatment Reviewed Open Access

Koshimizu, H; Nakashima, H; Ito, K; Ando, K; Kobayashi, K; Kato, F; Sato, K; Deguchi, M; Matsubara, Y; Inoue, H; Kanemura, T; Urasaki, T; Yoshihara, H; Wakao, N; Shinjo, R; Imagama, S

JOURNAL OF ORTHOPAEDICS Vol. 24 page： 280 - 283 2021.3

Language：English Publisher：Journal of Orthopaedics

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.

DOI： 10.1016/j.jor.2021.03.012

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

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

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

Language：English Publisher：Spine

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.

DOI： 10.1097/BRS.0000000000003780

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

Kobayashi, K; Ando, K; Nakashima, H; Machin, M; Kanbara, S; Ito, S; Inoue, T; Yamaguchi, H; Ishiguro, N; Imagama, S

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

Language：English Publisher：Nagoya Journal of Medical Science

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

DOI： 10.18999/nagjms.83.1.87

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

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

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

Language：English Publisher：Nagoya Journal of Medical Science

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.

DOI： 10.18999/nagjms.83.1.159

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, M; Ando, K; Kobayashi, K; Nakashima, H; Kanbara, S; Ito, S; Inoue, T; Yamaguchi, H; Koshimizu, H; Ito, K; Kato, F; Ishiguro, N; Imagama, S

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

Language：English Publisher：Journal of Neurosurgery Spine

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.

DOI： 10.3171/2020.6.SPINE20761

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