研究者詳細 - 中島　宏彰

論文 - 中島　宏彰

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Both common and rare genetic variants of ABCG2 are risks for gout 査読有り

Higashino T., Takada T., Nakaoka H., Toyoda Y., Stiburkova B., Miyata H., Ikebuchi Y., Nakashima H., Shimizu S., Kawaguchi M., Sakiyama M., Nakayama A., Akashi A., Tanahashi Y., Kawamura Y., Nakamura T., Wakai K., Okada R., Yamamoto K., Hosomichi K., Hosoya T., Ichida K., Ooyama H., Suzuki H., Inoue I., Merriman T. R., Shinomiya N., Matsuo H.

EUROPEAN JOURNAL OF HUMAN GENETICS 27 巻頁： 645 - 646 2019年7月

Comparative Radiographic Outcomes of Lateral and Posterior Lumbar Interbody Fusion in the Treatment of Degenerative Lumbar Kyphosis. 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 ( 3 ) 頁： 395 - 402 2019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

Study Design: Retrospective case-control study. Purpose: To compare surgical invasiveness and radiological outcomes between posterior lumbar interbody fusion (PLIF) and lateral lumbar interbody fusion (LLIF) for degenerative lumbar kyphosis. Overview of Literature: LLIF is a minimally invasive interbody fusion technique; however, few reports compared the clinical outcomes of conventional PLIF and LLIF for degenerative lumbar kyphosis. Methods: Radiographic data for patients who have undergone lumbar interbody fusion (≥3 levels) using PLIF or LLIF for degenerative lumbar kyphosis (lumbar lordosis [LL] < 20°) were retrospectively examined. The following radiographic parameters were retrospectively evaluated preoperatively and 2 years postoperatively: segmental lordotic angle, LL, pelvic tilt (PT), pelvic incidence (PI), C7 sagittal vertical axis, and T1 pelvic angle. Results: Nineteen consecutive cases with PLIF and 27 cases with LLIF were included. There were no significant differences in patients' backgrounds or preoperative radiographic parameters between the PLIF and the LLIF groups. The mean fusion level was 5.5±2.5 levels and 5.8±2.5 levels in the PLIF and LLIF groups, respectively (p=0.69). Although there was no significant difference in surgical times (p=0.58), the estimated blood loss was significantly greater in the PLIF group (p < 0.001). Two years postoperatively, comparing the PLIF and LLIF groups, the segmental lordotic angle achieved (7.4°±7.6° and 10.6°±9.4°, respectively; p=0.03), LL (27.8°±13.9° and 39.2°±12.7°, respectively; p=0.006), PI-LL (19.8°±14.8° and 3.1°±17.5°, respectively; p=0.002), and PT (22.6°±7.1° and 14.2°±13.9°, respectively; p=0.02) were significantly better in the LLIF group. Conclusions: LLIF provided significantly better sagittal alignment restoration in the context of degenerative lumbar kyphosis, with less blood loss.

DOI： 10.31616/asj.2018.0204

What Are the Important Predictors of Postoperative Functional Recovery in Patients With Cervical OPLL? Results of a Multivariate Analysis 査読有り国際誌 Open Access

Nakashima, H; Kanemura, T; Kanbara, S; Satake, K; Ito, K; Ishiguro, N; Kato, F; Imagama, S

GLOBAL SPINE JOURNAL 9 巻 ( 3 ) 頁： 315 - 320 2019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: A retrospective cohort study. Objective: The objective of this study was to identify important predictors of poor functional recovery in patients undergoing surgery for cervical ossification of the posterior longitudinal ligament (OPLL). Methods: This was a retrospective cohort study of 142 OPLL patients with laminoplasty; 135 had complete radiographical data and were followed up for ≥2 years. The following OPLL characteristics were compared between patients with “good” and “poor” outcomes (Japanese Orthopedic Association [JOA] recovery rate ≥50% and <50%, respectively): number of ossified levels, OPLL classification, ossification shape, K-line, canal-occupying ratio, and increased magnetic resonance imaging (MRI) signal intensity. Predictors of functional recovery were identified. Results: Pre- and postoperative (2 years following surgery) JOA scores were 10.6 ± 2.9 and 14.1 ± 2.2, respectively, indicating significant improvement following laminoplasty (P <.001). The average JOA recovery rate was 53.4% ± 34.7%, with 81 (60.0%) and 54 (40.0%) patients in the better and poorer neurological outcome groups, respectively. The canal occupation ratio of OPLL ≤60%/>60% were 117 (86.7%) and 18 (13.3%) patients, respectively. In the stepwise logistic regression analysis, an occupation ratio greater than 60% was identified as a significant factor for poor postoperative neurological outcome (relative risk, 4.82; 95% confidential interval, 1.61-14.46, P =.005). Conclusions: This multivariate analysis demonstrated a large size OPLL (occupying ratio >60%) was associated with a risk of poor neurological recovery roughly 5 times greater, and therefore other types of surgery are recommended in cases with such a ratio.

DOI： 10.1177/2192568218794665

Anatomic evaluation of retroperitoneal organs for lateral approach surgery: a prospective imaging study using computed tomography in the lateral decubitus position. 査読有り

Ouchida J, Kanemura T, Satake K, Nakashima H, Segi N

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 28 巻 ( 4 ) 頁： 835 - 841 2019年4月

特別寄稿脳神経外科コントロバーシー2019 (10)増え続ける高齢者の成人脊柱変形に整形外科医としてどのように対峙するか査読有り

金村徳相, 佐竹宏太郎, 中島宏彰, 石川喜資, 大内田隼, 山口英敏, 世木直喜, 今釜史郎

Neurological Surgery 脳神経外科 47 巻 ( 3 ) 頁： 271 - 285 2019年3月

A Systematic Review of Classification Systems for Cervical Ossification of the Posterior Longitudinal Ligament 査読有り国際誌 Open Access

Tetreault, L; Nakashima, H; Kato, S; Kryshtalskyj, M; Nagoshi, N; Nouri, A; Singh, A; Fehlings, MG

GLOBAL SPINE JOURNAL 9 巻 ( 1 ) 頁： 85 - 103 2019年2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

Design: Systematic review. Objective: To conduct a systematic review to (1) summarize various classification systems used to describe cervical ossification of the posterior longitudinal ligament (OPLL) and (2) evaluate the diagnostic accuracy of various imaging modalities and the reliability of these classification systems. Methods: A search was performed to identify studies that used a classification system to categorize patients with OPLL. Furthermore, studies were included if they reported the diagnostic accuracy of various imaging modalities or the reliability of a classification system. Results: A total of 167 studies were deemed relevant. Five classification systems were developed based on X-ray: the 9-classification system (0.60%); continuous, segmental, mixed, localized or focal, circumscribed and others (92.81%); hook, staple, bridge, and total types (2.40%); distribution of OPLL (2.40%); and K-line classification (4.19%). Six methods were based on computed tomography scans: free-type, contiguous-type, and broken sign (0.60%); hill-, plateau-, square-, mushroom-, irregular-, or round-shaped (5.99%); rectangular, oval, triangular, or pedunculate (1.20%); centralized or laterally deviated (1.80%); plank-, spindle-, or rod-shaped (0.60%); and rule of nine (0.60%). Classification systems based on 3-dimensional computed tomography were bridging and nonbridging (1.20%) and flat, irregular, and localized (0.60%). A single classification system was based on magnetic resonance imaging: triangular, teardrop, or boomerang. Finally, a variation of methods was used to classify OPLL associated with the dura mater (4.19%). Conclusions: The most common method of classification was that proposed by the Japanese Ministry of Health, Labour and Welfare. Other important methods include K-line (+/−), signs of dural ossification, and patterns of distribution.

DOI： 10.1177/2192568217720421

Is Pregabalin Effective Against Acute Lumbar Radicular Pain ? 査読有り Open Access

Nakashima H, Kanemura T, Ando K, Kobayashi K, Yoneda M, Ishiguro N, Imagama S

Spine surgery and related research 3 巻 ( 1 ) 頁： 61 - 66 2019年1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 Surgery and Related Research

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for acute lumbar radicular pain accompanying lumbar disc herniation (LDH), but their effects are minimal. The purpose of this study was to evaluate the efficacy and safety of pregabalin (PGB) as an alternative therapy for this condition. Methods: Patients with acute lumbar radicular pain accompanying LDH were randomly administered either NSAIDs plus PGB (30 patients) or NSAIDs alone (30 patients) for up to 4 weeks. The primary outcome was leg pain at 2 and 4 weeks. Secondary outcomes were reduction in sleep disturbances and patient global impressions of change (PGIC) at 2 and 4 weeks. Results: Four patients in the NSAIDs plus PGB group were deemed ineligible and excluded from the study. Fewer sleep disturbances were reported by patients administered NSAIDs plus PGB compared with the NSAID monotherapy group at both 2 and 4 weeks. Additionally, the NSAIDs plus PGB group showed greater improvement in pain than the NSAID monotherapy group at 4 weeks, although this difference was not significant. PGIC was also significantly better in the NSAIDs plus PGB group than in the NSAID monotherapy group at 4 weeks. The incidence of adverse events was significantly greater in the NSAIDs plus PGB group than in the NSAID monotherapy group. Conclusions: The combination of NSAIDs plus PGB is more effective against sleep disturbance than NSAIDs alone in patients with acute LDH, although the control of sciatic pain is minimal. Patients reported satisfactory recoveries could also be obtained, and thus, this combination therapy could be a good option for the conservative treatment of acute lumbar radicular pain, including LDH.

DOI： 10.22603/ssrr.2018-0003

整形外科/知ってるつもり脊髄ヘルニアの画像診断と治療

今釜史郎, 中島宏彰, 八木秀樹, 安藤圭, 小林和克, 石黒直樹

臨床整形外科 53 巻 ( 12 ) 頁： 1110 - 1114 2018年12月

特集ハイテク機器を利用した最新の脊椎脊髄手術「O－arm」の最新の応用法

金村徳相, 佐竹宏太郎, 中島宏彰, 石川喜資, 大内田隼, 山口英敏, 世木直喜, 今釜史郎

脊椎脊髄ジャーナル 31 巻 ( 11 ) 頁： 938 - 951 2018年11月

Factors Affecting the Severity of Neurological Disorders in Thoracic Idiopathic Spinal Cord Herniation 査読有り国際誌

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

SPINE 43 巻 ( 22 ) 頁： 1552 - 1558 2018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：Spine

Study Design. Retrospective multicenter case-controlled study. Objective. The objective of this study was to quantitatively examine imaging findings of idiopathic spinal cord herniation (ISCH) and determine the relationship between the image findings and the severity of pre- and postoperative neurological symptoms. Summary of Background Data. Many radiographic types of ISCH have been identified with regard to the location of the hernial opening or amount of herniated spinal cord. However, few previous studies have investigated the relationship between radiographic findings and the severity of neurological symptoms. Methods. Of 30,469 patients who underwent spinal surgery at 7 hospitals, 18 patients who underwent surgery for ISCH were identified. Their preoperative neurological severity, disease duration, magnetic resonance imaging findings, computed tomography myelography findings, surgical findings, and postoperative improvements were retrospectively examined. The spinal cord kink angle and minimum cord occupancy rate within the dural tube were measured. In addition, herniation was classified according to the location of the hiatus as either central (type C) or lateral (type L) type. Results. A negative correlation was found between the spinal cord kink angle and the minimum cord occupancy rate. Patient age was significantly higher in the severe paralysis group than in the mild paralysis group. In addition, the number of patients with type C herniation and the kink angle were significantly higher in the severe paralysis group. The number of patients with type L herniation was higher in the significant recovery group than in the mild recovery group; however, the difference was not significant. Conclusion. Patients with a large spinal cord kink angle had a smaller spinal cord occupancy rate within the dural tube, and this resulted in severe preoperative conditions. Type C ISCH cases had a severe preoperative neurological deficit and poor postoperative neurological recovery, and the spinal cord in such cases might be damaged irreversibly.

DOI： 10.1097/BRS.0000000000002574

Web of Science

Scopus

PubMed

Nonunion of Transpsoas Lateral Lumbar Interbody Fusion Using an Allograft: Clinical Assessment and Risk Factors. 査読有り

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

Spine surgery and related research 2 巻 ( 4 ) 頁： 270 - 277 2018年10月

特集脊椎脊髄手術の安全性を高める予防と対策第2章　各論 3.術後術後C5麻痺に対する予防と対策

小林和克, 今釜史郎, 安藤圭, 中島宏彰, 石黒直樹

脊椎脊髄ジャーナル 31 巻 ( 4 ) 頁： 377 - 381 2018年4月

誌上シンポジウム骨粗鬆症性脊椎骨折の治療 Cutting Edge 骨粗鬆性椎体骨折後偽関節に対する手術療法-術式間の手術成績の比較と治療法の選択

中島宏彰, 今釜史郎, 佐竹宏太郎, 石川喜資, 世木直喜, 大内田隼, 金村徳相

臨床整形外科 53 巻 ( 4 ) 頁： 299 - 305 2018年4月

Lack of Fgf18 causes abnormal clustering of motor nerve terminals at the neuromuscular junction with reduced acetylcholine receptor clusters 査読有り Open Access

Ito, K; Ohkawara, B; Yagi, H; Nakashima, H; Tsushima, M; Ota, K; Konishi, H; Masuda, A; Imagama, S; Kiyama, H; Ishiguro, N; Ohno, K

SCIENTIFIC REPORTS 8 巻 ( 1 ) 頁： 434 2018年1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：Scientific Reports

FGF receptor 2 is involved in the formation of the neuromuscular junction (NMJ), but its in vivo ligand remains to be determined. Laser capture microdissection of the mouse spinal motor neurons (SMNs) revealed that Fgf18 mRNA is highly expressed in SMNs in adults. Expression of Fgf18 mRNA was the highest in the spinal cord at embryonic day (E) 15.5, which gradually decreased to postnatal day 7. FGF18 protein was localized at the NMJs of the tibialis anterior muscle at E18.5 and in adults. Fgf18-/- mice at E18.5 showed decreased expressions of the NMJ-specific Chrne and Colq genes in the diaphragm. In Fgf18-/- diaphragms, the synaptophysin-positive areas at the nerve terminals and the acetylcholine receptor (AChR)-positive areas at the motor endplates were both approximately one-third of those in wild-type embryos. Fgf18-/- diaphragms ultrastructurally showed abnormal aggregation of multiple nerve terminals making a gigantic presynapse with sparse synaptic vesicles, and simplified motor endplates. In Fgf18-/- diaphragms, miniature endplate potentials were low in amplitude with markedly reduced frequency. In C2C12 myotubes, FGF18 enhanced AChR clustering, which was blocked by inhibiting FGFRs or MEK1. We propose that FGF18 plays a pivotal role in AChR clustering and NMJ formation in mouse embryogenesis.

DOI： 10.1038/s41598-017-18753-5

Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery: results of the Scoli-RISK-1 study. 査読有り

Fehlings MG, Kato S, Lenke LG, Nakashima H, Nagoshi N, Shaffrey CI, Cheung KMC, Carreon L, Dekutoski MB, Schwab FJ, Boachie-Adjei O, Kebaish KM, Ames CP, Qiu Y, Matsuyama Y, Dahl BT, Mehdian H, Pellisé-Urquiza F, Lewis SJ, Berven SH

The spine journal : official journal of the North American Spine Society 18 巻 ( 10 ) 頁： 1733 - 1740 2018年

Factors for a Good Surgical Outcome in Posterior Decompression and Dekyphotic Corrective Fusion with Instrumentation for Thoracic Ossification of the Posterior Longitudinal Ligament: Prospective Single-Center Study. 査読有り国際誌

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

Operative neurosurgery (Hagerstown, Md.) 13 巻 ( 6 ) 頁： 661 - 669 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：Operative Neurosurgery

BACKGROUND: Surgery for thoracic ossification of the posterior longitudinal ligament (T-OPLL) is still challenging, and factors for good surgical outcomes are unknown. OBJECTIVE: To identify factors for good surgical outcomes with prospective and comparative study. METHODS: Seventy-one consecutive patients who underwent posterior decompression and instrumented fusion were divided into good or poor outcome groups based on =50% and <50% recovery rates for the Japanese Orthopaedic Association score. Preoperative, intraoperative, and postoperative findings were compared in the 2 groups, and significant factors for a good outcome were analyzed. RESULTS: Patients with a good outcome (76%) had significantly lower nonambulatory rate and positive prone and supine position tests preoperatively; lower rates of T-OPLL, ossification of the ligamentum flavum, high-intensity area at the same level, thoracic spinal cord alignment difference, and spinal canal stenosis on preoperative magnetic resonance imaging; lower estimated blood loss; higher rates of intraoperative spinal cord floating and absence of deterioration of intraoperative neurophysiological monitoring; and lower rates of postoperative complications (P<.0005). In multivariate logistic regression analysis, negative prone and supine position test (odds ratio [OR]: 17.00), preoperative ambulatory status (OR: 6.05), absence of T-OPLL, ossification of the ligamentum flavum, high-intensity area at the same level (OR: 5.84), intraoperative spinal cord floating (OR: 4.98), and lower estimated blood loss (OR: 1.01) were significant factors for a good surgical outcome. CONCLUSION: This study demonstrated that early surgery is recommended during these positive factors. Appropriate surgical planning based on preoperative thoracic spinal cord alignment difference, as well as sufficient spinal cord decompression and reduction of complications using intraoperative ultrasonography and intraoperative neurophysiological monitoring, may improve surgical outcomes.

DOI： 10.1093/ons/opx043

Scopus

PubMed

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

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

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

Web of Science

Scopus

PubMed

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

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論文 - 中島 宏彰

<中島　宏彰>

論文 - 中島　宏彰