研究者詳細 - 中島　宏彰

A Clinical Practice Guideline for the Management of Patients With Degenerative Cervical Myelopathy: Recommendations for Patients With Mild, Moderate, and Severe Disease and Nonmyelopathic Patients With Evidence of Cord Compression 査読有り国際誌

Efficacy of Early Fusion With Local Bone Graft and Platelet-Rich Plasma in Lumbar Spinal Fusion Surgery FollowedOver 10 Years 査読有り国際誌 Open Access

Imagama, S; Ando, K; Kobayashi, K; Ishikawa, Y; Nakamura, H; Hida, T; Ito, K; Tsushima, M; Matsumoto, A; Morozumi, M; Tanaka, S; Machino, M; Ota, K; Nakashima, H; Takamatsu, J; Matsushita, T; Nishida, Y; Ishiguro, N; Matsuyama, Y

GLOBAL SPINE JOURNAL 7 巻 ( 8 ) 頁： 749 - 755 2017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：Global Spine Journal

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

DOI： 10.1177/2192568217696690

A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury and Central Cord Syndrome: Recommendations on the Timing (≤24 Hours Versus >24 Hours) of Decompressive Surgery 査読有り国際誌 Open Access

Fehlings, MG; Tetreault, LA; Wilson, JR; Aarabi, B; Anderson, P; Arnold, PM; Brodke, DS; Burns, AS; Chiba, K; Dettori, JR; Furlan, JC; Hawryluk, G; Holly, LT; Howley, S; Jeji, T; Kalsi-Ryan, S; Kotter, M; Kurpad, S; Marino, RJ; Martin, AR; Massicotte, E; Merli, G; Middleton, JW; Nakashima, H; Nagoshi, N; Palmieri, K; Singh, A; Skelly, AC; Tsai, EC; Vaccaro, A; Yee, A; Harrop, JS

GLOBAL SPINE JOURNAL 7 巻 ( 3 Suppl ) 頁： 195S - 202S 2017年9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：Global Spine Journal

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

DOI： 10.1177/2192568217706367

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

GLOBAL SPINE JOURNAL 7 巻 ( 3 Suppl ) 頁： 70S - 83S 2017年9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：Global Spine Journal

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

DOI： 10.1177/2192568217701914

A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Use of Methylprednisolone Sodium Succinate 査読有り国際誌

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

GLOBAL SPINE JOURNAL 7 巻 ( 3 Suppl ) 頁： 203S - 211S 2017年9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：Global Spine Journal

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

DOI： 10.1177/2192568217703085

A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Type and Timing of Rehabilitation 査読有り国際誌

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

GLOBAL SPINE JOURNAL 7 巻 ( 3 Suppl ) 頁： 231S - 238S 2017年9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：Global Spine Journal

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

DOI： 10.1177/2192568217701910

A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Type and Timing of Anticoagulant Thromboprophylaxis 査読有り国際誌

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

GLOBAL SPINE JOURNAL 7 巻 ( 3 Suppl ) 頁： 212S - 220S 2017年9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：Global Spine Journal

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

DOI： 10.1177/2192568217702107

A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role of Baseline Magnetic Resonance Imaging in Clinical Decision Making and Outcome Prediction 査読有り国際誌

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

GLOBAL SPINE JOURNAL 7 巻 ( 3 Suppl ) 頁： 221S - 230S 2017年9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：Global Spine Journal

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

DOI： 10.1177/2192568217703089

Clinical and Radiographical Differences Between Thoracic Idiopathic Spinal Cord Herniation and Spinal Arachnoid Cyst 査読有り国際誌

Nakashima, H; Imagama, S; Yagi, H; Kato, F; Kanemura, T; Sato, K; Kawakami, N; Kamiya, M; Yoshihara, H; Ito, K; Matsuyama, Y; Nishida, Y; Ishiguro, N

SPINE 42 巻 ( 16 ) 頁： E963 - E968 2017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：Spine

Study Design. A retrospective, multicenter, case-controlled study. Objective. The aim of this study was to investigate the clinical and radiographical differences between thoracic idiopathic spinal cord herniation (ISCH) and spinal arachnoid cyst (SAC). Summary of Background Data. ISCH and SAC are relatively rare diseases. Preoperative misdiagnose was frequently reported in both; however, these clinical and radiographical differences remain unclear. Methods. Of 30,469 patients who underwent spinal surgery, 18 (0.059%) and 22 (0.072%) patients were diagnosed as ISCH or SAC at nine hospitals, respectively, and their clinical and radiographical data were retrospectively evaluated. The spinal cord kink angle was measured on magnetic resonance or computed tomography myelography sagittal images; the kink angle was the exterior angle formed between the two tangents to the dorsal-side inflection points at the maximally affected level. Results. There were no significant differences in age, gender, and duration of symptoms. Preoperative motor deficit was significantly higher (94.4%) and severer (manual muscle testing: 3.1±1.1) in ISCH. Brown-Séquard syndrome was observed in 38.9% of ISCH, while no patients in SAC. In addition, leg sensory disorder and bladder rectal disorder were significantly more common in ISCH, while back pain was significantly frequent in SAC. With respect to radiographical findings, the length of disease (5.1±2.7 levels) and altered cerebrospinal flow (CSF) (81.8%) in the lesion was significantly longer and more common in SAC. On the contrary, the kink angle was significantly greater in ISCH (54.0±23.1°) than in SAC (14.1±12.0°) (P<0.001). The cut-off value of the kink angle to distinguish ISCH and SAC was 32.8°. Conclusion. Patients with ISCH commonly had severe preoperative neurological deficit, Brown-Séquard syndrome, and higher kink angle, while patients with SAC had back pain, longer length of disease, and altered CSF in the lesion.

DOI： 10.1097/BRS.0000000000002013

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

Ando, K; Ito, Z; Kobayashi, K; Hida, T; Ito, K; Tsushima, M; Ishikawa, Y; Matsumoto, A; Morozumi, M; Tanaka, S; Machino, M; Ota, K; Nakashima, H; Nishida, Y; Ishiguro, N

NEUROSURGERY 81 巻 ( 2 ) 頁： 403 - 403 2017年8月

Risk Factors for and Clinical Outcomes of Dysphagia After Anterior Cervical Surgery for Degenerative Cervical Myelopathy Results from the AOSpine International and North America Studies 査読有り

Nagoshi, N; Tetreault, L; Nakashima, H; Arnold, PM; Barbagallo, G; Kopjar, B; Fehlings, MG

JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME 99 巻 ( 13 ) 頁： 1069 - 1077 2017年7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 Bone and Joint Surgery - American Volume

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

DOI： 10.2106/JBJS.16.00325

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

Nouri A, Martin AR, Tetreault L, Nater A, Kato S, Nakashima H, Nagoshi N, Reihani-Kermani H, Fehlings MG

Spine 42 巻 ( 14 ) 頁： 1058 - 1067 2017年7月

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

中島宏彰, 金村徳相, 佐竹宏太郎, 世木直喜, 大内田隼, 今釜史郎

臨床整形外科 52 巻 ( 5 ) 頁： 439 - 447 2017年5月

Optimal Timing of Surgery for Intramedullary Cavernous Hemangioma of the Spinal Cord in Relation to Preoperative Motor Paresis, Disease Duration, and Tumor Volume and Location 査読有り国際誌 Open Access

Imagama, S; Ito, Z; Ando, K; Kobayashi, K; Hida, T; Ito, K; Tsushima, M; Ishikawa, Y; Matsumoto, A; Morozumi, M; Tanaka, S; Machino, M; Ota, K; Nakashima, H; Wakao, N; Sakai, Y; Matsuyama, Y; Ishiguro, N

GLOBAL SPINE JOURNAL 7 巻 ( 3 ) 頁： 246 - 253 2017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：Global Spine Journal

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

DOI： 10.1177/2192568217707938

Imagama, S; Ando, K; Ito, Z; Kobayashi, K; Hida, T; Ito, K; Tsushima, M; Ishikawa, Y; Matsumoto, A; Morozumi, M; Tanaka, S; Machino, M; Ota, K; Nakashima, H; Wakao, N; Nishida, Y; Matsuyama, Y; Ishiguro, N

NEUROSURGERY 80 巻 ( 5 ) 頁： 800 - 808 2017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：Clinical Neurosurgery

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

DOI： 10.1093/neuros/nyw130

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

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

Clinical spine surgery 30 巻 ( 4 ) 頁： E358 - E362 2017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：Clinical Spine Surgery

Study Design: Retrospective clinical study. Purpose: To investigate the outcomes after indirect posterior decompression and dekyphosis using multilevel Ponte osteotomies for ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine. Summary of Background Data: There are no previous reports on the use of Ponte osteotomy to treat thoracic OPLL. Methods: The subjects were 10 patients with an average age at surgery of 47 years, who underwent indirect posterior decompression and dekyphosis using multilevel Ponte osteotomies at our institute. Minimum follow-up period was 2 years, and averaged 2 year 6 months. Using radiographs and CT images, we investigated fusion range, preoperative and postoperative Cobb angles of thoracic fusion levels, intraoperative ultrasonography, and clinical results. Results: The mean fusion area was 9.8 vertebraes, with average laminectomy of 7.3 laminas. The mean preoperative thoracic kyphosis of fusion levels on standing radiograph measured 35 degrees and was changed to 21 degrees after surgery. The mean number of Ponte osteotomies was 3 levels. The mean preoperative and postoperative (at the 1 y follow-up) JOA scores were 3.5 and 7.5 points, respectively, and the recovery rate was 56%. On intraoperative ultrasonography, 7 of the cases were included in the floating (+) and 3 in the floating (-) groups, and the recovery rates were 66.0% and 33.4%, respectively. Conclusions: "The Ponte procedure for indirect spinal cord decompression" is a novel concept used for the first time with thoracic OPLL in our study, and we consider it a useful method to achieve more effectively dekyphosis and indirect spinal cord decompression if there is not the spinal cord free from OPLL on intraoperative ultrasonography after only laminectomies.

DOI： 10.1097/BSD.0000000000000188