研究者詳細 - 中島　宏彰

論文 - 中島　宏彰

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Indirect Decompression Using Lateral Lumbar Interbody Fusion for Restenosis after an Initial Decompression Surgery Open Access

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

ASIAN SPINE JOURNAL 14 巻 ( 3 ) 頁： 305 - 311 2020年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Asian Spine Journal

Purpose: We compared clinical and radiographical outcomes after lumbar decompression revision surgery for restenosis by lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF). Overview of Literature: Indirect lumbar decompression with LLIF was used to treat degenerative lumbar diseases requiring neural decompression. However, only a few studies have focused on the effectiveness of this technique for restenosis after lumbar decompression. Methods: We retrospectively investigated 52 cases involving lumbar interbody fusions for restenosis with spondylolisthesis after lumbar decompressions; these cases consisted of 15 patients who underwent indirect decompression with LLIF and posterior fixation and 37 patients who underwent the same procedure with PLIF. We compared Japanese Orthopaedic Association (JOA) scores and perioperative complications between groups. The cross-sectional areas of the thecal sac on magnetic resonance imaging were measured before, immediately after, and 2 years after surgery. We conducted statistical analyses using unpaired t-test and Fisher's exact tests, and a p-value <0.05 was considered statistically significant. Results: The operative time was significantly shorter in the LLIF group than in the PLIF group (115.3±33.6 min vs. 186.2±34.2 min, respectively; p <0.001). In addition, the intraoperative blood loss was significantly lower in the LLIF group than in the PLIF group (58.2±32.7 mL vs. 303.2±140.1 mL, respectively; p <0.001). We found two cases of transient lateral thigh weakness (13.3%) in the LLIF group and five cases of incidental durotomy, one case of deep infection, and one case of neurological deterioration in the PLIF group-resulting in a higher complication incidence (18.9%), although it did not reach (p =0.63). The JOA scores improved significantly in both groups. Conclusions: Indirect decompression using LLIF provided acceptable clinical and radiographical outcomes in patients with restenosis with spondylolisthesis after lumbar decompression; no revision-surgery-specific complications were found. Our results suggest that LLIF is a safe and minimally invasive procedure for revision surgery.

DOI： 10.31616/asj.2019.0194

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

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

EUROPEAN SPINE JOURNAL 29 巻 ( 6 ) 頁： 1277 - 1286 2020年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：European Spine Journal

Purpose: Lateral interbody fusion and posterior percutaneous pedicle screw (LIF-PPS) fixation has been performed in two-stage positioning. The aim of this study was to investigate the surgical outcomes of simultaneous single-position LIF-PPS fixation using O-arm-based navigation. Methods: Overall, 102 consecutive subjects underwent indirect decompression surgery for spondylolisthesis with LIF-PPS fixation. Fifty-one subjects underwent surgery with repositioning, and 51 in the right lateral decubitus position. We compared these two groups in terms of the surgery time, occupancy time in the operating room, intraoperative blood loss, Japanese Orthopaedic Association (JOA) score, local lordosis acquisition in postoperative radiographs, and accuracy of screw insertion using postoperative CT scans. Results: In the single-position group, surgery time, occupancy time of the operating room, and estimated blood loss were 93.3 ± 19.3 min (vs. the repositioning group: 121.0 ± 37.1 min; p < 0.001), 176.3 ± 36.4 min (vs. 272.4 ± 42.7 min; p < 0.001), and 93.4 ± 78.8 ml (vs. 40.9 ± 28.7 ml; p < 0.001), respectively. The JOA scores (pre-/postoperative) were 15.1 ± 3.0/24.4 ± 2.8 (p < 0.001) for the single-position group and 15.1 ± 4.0/24.8 ± 3.0 (p < 0.001) for the repositioning group. The rate of misplacement was 1.8% versus 4.0%, respectively (p = 0.267), and the lordosis acquisition was 4.2° ± 4.1° versus 4.4° ± 3.2°, respectively (p = 0.516). Conclusions: Single-position surgery exhibited comparable clinical outcomes and local lordosis acquisition with conventional repositioning LIF-PPS fixation. This single-position minimally invasive technique reduces the occupancy time of the operating room and workforce requirements. Graphic abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].

DOI： 10.1007/s00586-020-06388-6

Postoperative iatrogenic spinal cord herniation: three case reports with a literature review 査読有り Open Access

Nakashima, H; Ishikawa, Y; Kato, F; Kanemura, T; Shinjo, R; Ando, K; Kobayashi, K; Ishiguro, N; Imagama, S

NAGOYA JOURNAL OF MEDICAL SCIENCE 82 巻 ( 2 ) 頁： 383 - 389 2020年5月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Nagoya Journal of Medical Science

Although a majority of spinal cord herniation reportedly occurs idiopathically, postoperative iatrogenic spinal cord herniation is rare. Therefore, the incidence rate, pathogenic mechanism, and clinical outcomes are not clear. We present three cases of postoperative iatrogenic spinal cord herniation and present a literature review. Our data base included 32253 patients who underwent spinal surgery, and among these patients, 3 showed postoperative spinal cord herniation. Postoperative spinal cord herniation was observed in a 55-year-old man and a 60-year-old man. Both these patients underwent cervical laminoplasty for degenerative cervical myelopathy; however, intraoperative dural tear was reported. They presented with severe quadriplegia and sensory disorders at 8 years and 2 months after initial surgery. The third case of postoperative spinal cord herniation was of a 47-year-old woman who underwent Th11/12 schwannoma resection. Her neurological symptoms did not improve after tumor resection, and MRI at 2 months after surgery revealed spinal cord herniation. All the 3 patients underwent spinal cord reduction surgery; one patient showed sufficient neurological improvement while 2 patients with cervical spinal cord herniation showed limited neurological improvement due to preoperative severe quadriplegia. Although postoperative iatrogenic spinal cord herniation is a relatively rare pathology, careful observation with postoperative MRI is required in cases of patients with new neurological symptoms after dural injury and durotomy.

DOI： 10.18999/nagjms.82.2.383

Higher extracellular water-to-total body water ratio more strongly reflects the locomotive syndrome risk and frailty than sarcopenia 査読有り

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

ARCHIVES OF GERONTOLOGY AND GERIATRICS 88 巻頁： 104042 2020年5月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Archives of Gerontology and Geriatrics

Objective: Among body composition parameters measured by bioelectrical impedance analysis, the extracellular water-to-total body water (ECW/TBW) ratio is a known prognostic or related factor for various diseases. While concepts such as locomotive syndrome risk, frailty, and sarcopenia are gaining popularity in Japan, their relationship with the ECW/TBW ratio has not been examined in detail. This study aimed to investigate the relationships between them. Methods: Of 1081 individuals who underwent health checkups, 550 were included in this study. The evaluations included a two-step test, stand-up test, and a 25-question geriatric locomotive function scale questionnaire. Frailty was diagnosed based on the Japanese version of the Cardiovascular Health Study criteria. Sarcopenia was evaluated according to the Asian Working Group for Sarcopenia criteria. The aforementioned ratio was measured using bioelectrical impedance analysis. Results: The ECW/TBW ratio significantly increased with locomotive syndrome risk, frailty, and sarcopenia (p < 0.001 each). Nevertheless, no significant difference was found between robust and pre-frailty groups (p = 0.71) and normal and pre-sarcopenia groups (p = 0.93). Furthermore, after correcting for age, sex, and body mass index, multiple regression analysis revealed that locomotive syndrome risk (p < 0.001) and frailty (p = 0.001) were significantly associated with an increase in the ECW/TBW ratio, whereas sarcopenia was not (p = 0.97). Conclusions: An increase in the ECW/TBW ratio may reflect locomotive syndrome risk and frailty, but not sarcopenia. In bioelectric impedance analysis, this ratio is an important indicator; if it is high, it is necessary to consider locomotive syndrome risk and frailty.

DOI： 10.1016/j.archger.2020.104042

手術治療を要した後頭骨環軸椎回旋位固定（OAARF）の1例

鏡味佑志朗, 大内田隼, 中島宏彰, 佐竹宏太郎, 伊藤研悠, 石川喜資, 今釜史郎, 金村徳相

Journal of Spine Research 11 巻 ( 4 ) 頁： 779 - 782 2020年4月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：一般社団法人日本脊椎脊髄病学会

<p>症例は10歳男児．誘因のない頚部痛を主訴に受診し，画像検査で環軸椎回旋位固定を認めた．カラー装着やグリソン牽引，全身麻酔下での整復後ハローベスト固定など約14ヶ月にわたる保存加療を行うも，回旋位固定が改善されず頚部痛も再発したため手術治療となった．O-C1関節病変を伴う環軸椎回旋位固定（OAARF）は環軸椎回旋位固定（AARF）と比べ保存治療の効果が悪い可能性があり，発症早期に評価し，手術治療の是非について検討を行う必要がある．</p>

DOI： 10.34371/jspineres.2020-0411

The Prevalence and Risk Factors for S2 Alar-Iliac Screw Loosening with a Minimum 2-Year Follow-up 査読有り Open Access

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

ASIAN SPINE JOURNAL 14 巻 ( 2 ) 頁： 177 - 184 2020年4月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Asian Spine Journal

Study Design: A retrospective cohort study. Purpose: The purpose of this study was to investigate the prevalence and risk factors for S2 alar-iliac (SAI) screw loosening following lumbosacral fixation, with a minimum 2-year follow-up. Overview of Literature: Although SAI screws allow surgeons to perform lumbosacral fixation with a low profile and enhanced biomechanical strength, screw loosening following surgery can occur in some cases. However, few studies have investigated the prevalence and risk factors for SAI screw loosening. Methods: This retrospective study included 35 patients (mean age, 72.8±8.0 years; male, 10; female, 25) who underwent lumbosacral fixation using SAI screws with at least 2 years of follow-up. SAI screw loosening and L5-S bony fusion were assessed using computed tomography. The period for which the screws appeared loose and the risk factors for SAI screw loosening were investigated 2 years after surgery. Results: A total of 70 SAI screws and 70 S1 pedicle screws were inserted. Loosening was observed 0.5, 1, and 2 years after surgery in 17 (24.3%), 35 (50.0%), and 35 (50.0%) SAI screws, respectively. Bony fusion rate at L5-S was significantly lower in patients with SAI screw loosening than in those without screw loosening (65.0% vs. 93.3%, p=0.048). The score for SAI screw contact with the iliac cortical bone and the bony fusion rate at L5-S were significantly lower in the loosening group than in the non-loosening group (1.8±0.5 vs. 2.2±0.3, p<0.001, respectively). Postoperative pelvic incidence-lumbar lordosis was significantly higher in the loosening group than in the non-loosening group (7.9°±15.4° vs. 0.5°±8.7°, p=0.02, respectively). Conclusions: SAI screw loosening is closely correlated with pseudoarthrosis at L5-S. Appropriate screw insertion and optimal lumbar lordosis restoration are important to prevent postoperative complications related to SAI screws.

DOI： 10.31616/asj.2019.0127

特集頚椎を含めたグローバルアライメント頭蓋から足部までの全身アライメント-人種間の違いと成人脊柱変形手術における矯正目標

中島宏彰, 今釜史郎, 安藤圭, 小林和克, 大内田隼, 金村徳相

臨床整形外科 55 巻 ( 3 ) 頁： 247 - 252 2020年3月

Differences of lumbopelvic sagittal parameters among community-dwelling middle-age and elderly individuals: Relations with locomotor physical function 査読有り

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

JOURNAL OF CLINICAL NEUROSCIENCE 73 巻頁： 80 - 84 2020年3月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Clinical Neuroscience

This study aims to establish radiographic parameters of lumbopelvic sagittal alignment, gender related differences, and age-related changes in a middle-aged community, to investigate whether age-related changes of lumbopelvic alignment reflect the risk of locomotive syndrome (LS). This study included 448 healthy Japanese volunteers who attended a basic health checkup supported by the local government. The subjects (184 males and 264 females, mean age: 62.7 years) were grouped according to their age by decade. Sagittal lumbopelvic parameters were collected by lateral spine radiographs including lumbar lordosis (L1–S1, LL), lower lumbar lordosis (L4–S1, LLL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). The three tests (stand-up test, two-step test, and 25-question geriatric locomotive function scale [GLFS-25]) composing the LS risk test were performed. LL was significantly lower in males than in the females. A significant decrease of LL and LLL was observed from 60 s to 70 s in the females. PI did not markedly change with aging in either gender but was lower in males. A remarkable increase of PT was seen from 60 s to 70 s in the females. SS did not markedly change with aging and was lower in males in all decades. The prevalence of LS risk in males and females increased gradually with age and was greater in females in any decade. 70 s females with LS risk had significantly lower LL and higher PT compared to them without LS risk. Radiographic parameters of lumbopelvic sagittal alignment were established in community-dwelling middle-age and elderly individuals.

DOI： 10.1016/j.jocn.2020.01.033

特集脊柱靭帯骨化症UP TO DATE 胸椎後縦靭帯骨化症の手術治療-最近の進歩

今釜史郎, 安藤圭, 小林和克, 中島宏彰, 石黒直樹, 松山幸弘, 松本守雄, 川口善治, 大川淳

脊椎脊髄ジャーナル 33 巻 ( 2 ) 頁： 119 - 125 2020年2月

Neurological function following early versus delayed decompression surgery for drop foot caused by lumbar degenerative diseases 査読有り

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

JOURNAL OF CLINICAL NEUROSCIENCE 72 巻頁： 39 - 42 2020年2月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Clinical Neuroscience

The purpose of this study was to investigate the effectiveness of early (<72 h) versus late (≥72 h) decompression surgery after the onset of drop foot caused by root disorder in lumbar degenerative diseases (LDDs). Data were included from 60 patients who underwent decompression surgery for drop foot caused by LDDs, including lumbar disk herniation or lumbar spinal stenosis. The primary outcome was ordinal change in the manual muscle test (MMT) at 2 years follow-up. Secondary outcomes included changes in the Japanese Orthopedic Association's (JOA) score. The early- and late-stage surgery groups included 20 and 40 patients with mean durations from the onset of drop foot to operation of 0.8 days (range, 0–3 days) and 117.1 days (range, 10–891 days), respectively. There was no significant difference (p = 0.33) between the early- and late-stage surgery groups in the improvement of MMT scores to >4 (90% versus 80%, respectively). However, more patients in the early-stage group achieved an MMT score >5 compared with those in the late-stage surgery group (80% versus 45%; p = 0.03). Furthermore, the recovery rate of JOA scores was significantly higher in the early-stage (89.1%) compared with the late-stage surgery group (68.6%; p < 0.001). Early decompression surgery produced better neurological recovery; however, an improvement of >4 in the MMT score was achieved in 80% of cases with late decompression.

DOI： 10.1016/j.jocn.2020.01.039

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

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

Science translational medicine 12 巻 ( 525 ) 2020年1月

Changes in Sagittal Alignment Following Short-Level Lumbar Interbody Fusion: Comparison between Posterior and Lateral Lumbar Interbody Fusions. 査読有り国際誌 Open Access

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

Asian spine journal 13 巻 ( 6 ) 頁： 904 - 912 2019年12月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Asian Spine Journal

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

DOI： 10.31616/asj.2019.0011

Indirect Decompression on MRI Chronologically Progresses After Immediate Postlateral Lumbar Interbody Fusion 査読有り国際誌

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

SPINE 44 巻 ( 24 ) 頁： E1411 - E1418 2019年12月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Spine

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

DOI： 10.1097/BRS.0000000000003180

Musculoskeletal Factors and Geriatric Syndromes Related to the Absence of Musculoskeletal Degenerative Disease in Elderly People Aged over 70 Years 査読有り Open Access

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

BIOMED RESEARCH INTERNATIONAL 2019 巻頁： 7097652 2019年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：BioMed Research International

Purpose. To investigate factors with a significant relationship with the absence of musculoskeletal disease (MSD: osteoporosis, knee osteoarthritis (K-OA), and lumbar spondylosis (L-OA)) in elderly people ≥70 years old. Methods. The subjects were 279 people (134 males, 145 females, mean age: 75.2 years) who attended an annual health checkup and were prospectively included in the study. Osteoporosis was defined as %YAM ≤70%, K-OA as Kellgren-Lawrence grade ≥2, and L-OA as osteophytes of Nathan class ≥3. Subjects were divided into those with (group D) and without (group N) any MSD. Clinical variables including locomotive syndrome (LS), frailty, sarcopenia, and QOL (SF-36) were compared between the groups. Results. There was no significant difference in age or gender between group N (n=54) and group D (n=225). Lower BMI and pain, including neuropathic pain; greater back muscle strength, physical ability, and balance with eyes closed; larger lumbar lordosis, sacral inclination, and lumbar ROM; and smaller spinal inclination were found in group N. The rates of LS and sarcopenia were significantly lower and QOL was significantly higher in group N. Conclusions. This study firstly revealed the significant musculoskeletal factors and geriatric syndromes related to an absence of MSD, which may form the basis of interventions to improve QOL in elderly people ≥70 years old.

DOI： 10.1155/2019/7097652

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

Ando K, Imagama S, Kobayashi K, Ito K, Tsushima M, Morozumi M, Tanaka S, Machino M, Ota K, Nakashima H, Nishida Y, Ishiguro N

Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews 3 巻 ( 11 ) 2019年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews

Introduction: Thoracic myelopathy is relatively uncommon because few degenerative changes occur as a result of the restricted range of motion surrounding the rib cage. Methods: A retrospective study was performed in 300 consecutive surgical cases of thoracic disorders with myelopathy treated in our department from 2000 to 2015. Girdle pain, back pain, low back pain, leg numbness, leg pain, gait disturbance, leg paresis, and bowel bladder disturbance as initial and preoperative symptoms; patellar tendon reflex, ankle tendon reflex, and ankle clonus as preoperative neurologic findings; MRI and CT findings; and surgical procedure, intraoperative findings, and postoperative recovery were investigated. Results: The disease distribution included ossification of the ligamentum flavum (OLF) (n = 48), ossification of the posterior longitudinal ligament (OPLL) (n = 30), OPLL with OLF (n = 27), intradural extramedullary tumor (n = 98), intramedullary spinal cord tumor (n = 64), vertebral tumor (n = 17), spinal cord herniation (n = 7), vertebral fracture (n = 4), and thoracic disk herniation (n = 5). There were notable associations of gait disturbance with OPLL and OPLL + OLF; back pain at initial diagnosis with disease at upper levels; and low back pain with disease at a lower level. Conclusion: These findings suggest that patients with gait disturbance, back pain, and low back pain on physical examination may have thoracic disease that results in myelopathy.

DOI： 10.5435/JAAOSGlobal-D-18-00090

Multivariate analysis of factors related to the absence of musculoskeletal degenerative disease in middle-aged and older people 査読有り国際誌 Open Access

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

GERIATRICS & GERONTOLOGY INTERNATIONAL 19 巻 ( 11 ) 頁： 1141 - 1146 2019年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Geriatrics and Gerontology International

Aim: Musculoskeletal degenerative disease (MSD; osteoporosis, knee arthritis and lumbar spondylosis) decreases the quality of life (QOL) of older people. The objective of the present study was to identify the factors related to the absence of MSD in multivariate logistic regression analysis. Methods: The participants were 1034 volunteers (444 men, 590 women, mean age 63.5 years) in the Yakumo study. Osteoporosis (percentage of young adult mean ≤70%), knee arthritis (Kellgren–Lawrence grade ≥2), and lumbar spondylosis (Nathan class ≥3) were prospectively examined. Participants were divided into those with and without MSD. Age, sex, body mass index, muscle strength, gait ability, pain, body balance, spinal sagittal alignment, geriatric syndrome (locomotive syndrome, frailty and sarcopenia) and QOL (Short Form Health Survey) were compared between these groups to identify the factors associated with the absence of MSD. Results: Significantly lower age, body mass index and pain; higher gait speed, grip and back muscle strength; more stable body balance; better sagittal spinal alignment; and lower rates of locomotive syndrome, frailty and sarcopenia were observed in the group without MSD (n = 445, 43%), with significantly better QOL (P < 0.0001). In multivariate logistic regression analysis adjusted for age and sex, lower body mass index (odds ratio [OR] 1.10, P < 0.001), lower spinal inclination (OR 1.08, P < 0.01), higher back muscle strength (OR 1.01, P < 0.05), no locomotive syndrome (OR 1.80, P < 0.05) and good body balance (OR: 1.12, P < 0.05) were significant factors for the absence of MSD. Conclusions: Factors related to an absence of MSD are also related to good QOL, and should be a focus of health interventions in healthy middle-aged and older people. Geriatr Gerontol Int 2019; 19: 1141–1146.

DOI： 10.1111/ggi.13786

Increase in lumbar kyphosis and spinal inclination, declining back muscle strength, and sarcopenia are risk factors for onset of GERD: a 5-year prospective longitudinal cohort study 査読有り国際誌

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

EUROPEAN SPINE JOURNAL 28 巻 ( 11 ) 頁： 2619 - 2628 2019年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：European Spine Journal

Purpose: The objective was to identify risk factors for new development of gastroesophageal reflux disease (GERD) 5 years later in a prospective longitudinal cohort study. Methods: A total of 178 subjects (male 72, female 106, mean age 68 years) without GERD in 2013 were examined for GERD in 2018. A Frequency Scale for Symptoms of GERD score ≥ 8 was used for diagnosis of GERD. Body mass index, spinal alignment, muscle strength, physical ability, number of oral drugs per day, sarcopenia, and frailty determined in 2013 and 2018 were compared between the GERD(+) and GERD(−) groups in 2018. Aggravation of lumbar kyphosis and spinal inclination from 2013 to 2018 was defined as a change of ≥ 5° or ≥ 10°, and weakening of back muscle strength as a change of ≥ 10 kg. QOL (SF-36) was also examined. Results: Of the 178 subjects, 38 (21%) were diagnosed as GERD(+) in 2018. Sarcopenia in 2018 was significantly related to a GERD(+) status (p < 0.05). The GERD(+) group had significantly higher rates of changes of lumbar kyphosis ≥ 5° (p < 0.005) and ≥ 10° (p < 0.0001), of spinal inclination ≥ 5° (p < 0.0001), and of decreased back muscle strength ≥ 10 kg (p < 0.05). SF-36 were also significantly worse in the GERD(+) group (p < 0.05). Conclusions: This prospective longitudinal study firstly demonstrated that lumbar kyphotic change, aggravation of spinal inclination, decreased back muscle strength, and sarcopenia are significant risk factors for new development of GERD. Management and prevention of these factors may contribute to reduction of GERD symptoms and increased QOL in middle-aged and elderly people. Graphic abstract: These slides can be retrieved under Electronic Supplementary Material. [Figure not available: see fulltext.].

DOI： 10.1007/s00586-019-06139-2

特集ついに始まった頸椎人工椎間板置換術頸椎人工椎間板の適応と短期成績-Mobi-C

金村徳相, 佐竹宏太郎, 伊藤研悠, 田中智史, 中島宏彰, 今釜史郎

脊椎脊髄ジャーナル 32 巻 ( 10 ) 頁： 919 - 928 2019年10月

Factors Affecting Postoperative Sagittal Alignment after Lateral Lumbar Interbody Fusion in Adult Spinal Deformity: Posterior Osteotomy, Anterior Longitudinal Ligament Rupture, and Endplate Injury. 査読有り国際誌 Open Access

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

Asian spine journal 13 巻 ( 5 ) 頁： 738 - 745 2019年10月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Asian Spine Journal

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

DOI： 10.31616/asj.2018.0275

Unplanned Second-Stage Decompression for Neurological Deterioration Caused by Central Canal Stenosis after Indirect Lumbar Decompression Surgery. 査読有り国際誌 Open Access

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

Asian spine journal 13 巻 ( 4 ) 頁： 584 - 591 2019年8月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Asian Spine Journal

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

DOI： 10.31616/asj.2018.0232

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