Faculty Profiles - NAKASHIMA Hiroaki

Papers - NAKASHIMA Hiroaki

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Factors Affecting the Severity of Neurological Disorders in Thoracic Idiopathic Spinal Cord Herniation. Reviewed International journal

Hiroaki Nakashima, Tokumi Kanemura, Hideki Yagi, Fumihiko Kato, Koji Sato, Mitsuhiro Kamiya, Hisatake Yoshihara, Kenyu Ito, Yukihiro Matsuyama, Naoki Ishiguro, Shiro Imagama

Spine Vol. 43 ( 22 ) page： 1552 - 1558 2018.11

Language：English Publishing type：Research paper (scientific journal)

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. LEVEL OF EVIDENCE: 4.

DOI： 10.1097/BRS.0000000000002574

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

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

Spine surgery and related research Vol. 2 ( 4 ) page： 270 - 277 2018.10

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 Vol. 31 ( 4 ) page： 377 - 381 2018.4

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 Vol. 53 ( 4 ) page： 299 - 305 2018.4

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

Kenyu Ito, Bisei Ohkawara, Hideki Yagi, Hiroaki Nakashima, Mikito Tsushima, Kyotaro Ota, Hiroyuki Konishi, Akio Masuda, Shiro Imagama, Hiroshi Kiyama, Naoki Ishiguro, Kinji Ohno

Scientific Reports Vol. 8 ( 1 ) page： 434 2018.1

Language：English Publishing type：Research paper (scientific journal) Publisher：Nature Publishing Group

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 Reviewed Open Access

Michael G. Fehlings, So Kato, Lawrence G. Lenke, Hiroaki Nakashima, Narihito Nagoshi, Christopher I. Shaffrey, Kenneth M.C. Cheung, Leah Carreon, Mark B. Dekutoski, Frank J. Schwab, Oheneba Boachie-Adjei, Khaled M. Kebaish, Christopher P. Ames, Yong Qiu, Yukihiro Matsuyama, Benny T. Dahl, Hossein Mehdian, Ferran Pellisé-Urquiza, Stephen J. Lewis, Sigurd H. Berven

Spine Journal Vol. 18 ( 10 ) page： 1733 - 1740 2018

Language：English Publishing type：Research paper (scientific journal) Publisher：Elsevier Inc.

Background Context: Significant variability in neurologic outcomes after surgical correction for adult spinal deformity (ASD) has been reported. Risk factors for decline in neurologic motor outcomes are poorly understood. Purpose: The objective of the present investigation was to identify the risk factors for postoperative neurologic motor decline in patients undergoing complex ASD surgery. Study Design/Setting: This is a prospective international multicenter cohort study. Patient Sample: From September 2011 to October 2012, 272 patients undergoing complex ASD surgery were prospectively enrolled in a multicenter, international cohort study in 15 sites. Outcome Measures: Neurologic decline was defined as any postoperative deterioration in American Spinal Injury Association lower extremity motor score (LEMS) compared with preoperative status. Methods: To identify risk factors, 10 candidate variables were selected for univariable analysis from the dataset based on clinical relevance, and a multivariable logistic regression analysis was used with backward stepwise selection. Results: Complete datasets on 265 patients were available for analysis and 61 (23%) patients showed a decline in LEMS at discharge. Univariable analysis showed that the key factors associated with postoperative neurologic deterioration included older age, lumbar-level osteotomy, three-column osteotomy, and larger blood loss. Multivariable analysis revealed that older age (odds ratio [OR]=1.5 per 10 years, 95% confidence interval [CI] 1.1–2.1, p=.005), larger coronal deformity angular ratio [DAR] (OR=1.1 per 1 unit, 95% CI 1.0–1.2, p=.037), and lumbar osteotomy (OR=3.3, 95% CI 1.2–9.2, p=.022) were the three major predictors of neurologic decline. Conclusions: Twenty-three percent of patients undergoing complex ASD surgery experienced a postoperative neurologic decline. Age, coronal DAR, and lumbar osteotomy were identified as the key contributing factors.

DOI： 10.1016/j.spinee.2018.02.001

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 Reviewed International journal

Shiro Imagama, Kei Ando, Kazuyoshi Kobayashi, Tetsuro Hida, Kenyu Ito, Mikito Tsushima, Yoshimoto Ishikawa, Akiyuki Matsumoto, Masayoshi Morozumi, Satoshi Tanaka, Masaaki Machino, Kyotaro Ota, Hiroaki Nakashima, Yoshihiro Nishida, Yukihiro Matsuyama, Naoki Ishiguro

Operative Neurosurgery Vol. 13 ( 6 ) page： 661 - 669 2017.12

Language：English Publishing type：Research paper (scientific journal) Publisher：Oxford University Press

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 &lt
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&lt
.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

Efficacy of Early Fusion With Local Bone Graft and Platelet-Rich Plasma in Lumbar Spinal Fusion Surgery Followed Over 10 Years Reviewed International journal Open Access

Shiro Imagama, Kei Ando, Kazuyoshi Kobayashi, Yoshimoto Ishikawa, Hiroshi Nakamura, Tetsuro Hida, Kenyu Ito, Mikito Tsushima, Akiyuki Matsumoto, Masayoshi Morozumi, Satoshi Tanaka, Masaaki Machino, Kyotaro Ota, Hiroaki Nakashima, Junki Takamatsu, Tadashi Matsushita, Yoshihiro Nishida, Naoki Ishiguro, Yukihiro Matsuyama

Global Spine Journal Vol. 7 ( 8 ) page： 749 - 755 2017.12

Language：English Publishing type：Research paper (scientific journal) Publisher：SAGE Publications Ltd

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 &lt
.05). Average absorption values were significantly lower on the PRP side than on the control side at 3 and 6 months after surgery (P &lt
.05). The PRP/control ratio was significantly different at 3 and 6 months compared to that at 2 weeks (P &lt
.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 Reviewed International journal Open Access

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

Global Spine Journal Vol. 7 ( 3 Suppl ) page： 195S - 202S 2017.9

Language：English Publishing type：Research paper (scientific journal) Publisher：SAGE Publications Ltd

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 Acute Spinal Cord Injury: Recommendations on the Type and Timing of Anticoagulant Thromboprophylaxis Reviewed International journal

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

Global Spine Journal Vol. 7 ( 3 Suppl ) page： 212S - 220S 2017.9

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：SAGE Publications Ltd

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 Reviewed International journal

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

Global Spine Journal Vol. 7 ( 3 Suppl ) page： 221S - 230S 2017.9

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：SAGE Publications Ltd

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

A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Type and Timing of Rehabilitation Reviewed International journal

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

Global Spine Journal Vol. 7 ( 3 Suppl ) page： 231S - 238S 2017.9

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：SAGE Publications Ltd

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 Degenerative Cervical Myelopathy: Recommendations for Patients With Mild, Moderate, and Severe Disease and Nonmyelopathic Patients With Evidence of Cord Compression Reviewed International journal

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

Global Spine Journal Vol. 7 ( 3 Suppl ) page： 70S - 83S 2017.9

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：SAGE Publications Ltd

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 Reviewed International journal

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

Global Spine Journal Vol. 7 ( 3 Suppl ) page： 203S - 211S 2017.9

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：SAGE Publications Ltd

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

Clinical and Radiographical Differences Between Thoracic Idiopathic Spinal Cord Herniation and Spinal Arachnoid Cyst Reviewed International journal

Hiroaki Nakashima, Shiro Imagama, Hideki Yagi, Fumihiko Kato, Tokumi Kanemura, Koji Sato, Noriaki Kawakami, Mitsuhiro Kamiya, Hisatake Yoshihara, Kenyu Ito, Yukihiro Matsuyama, Yoshihiro Nishida, Naoki Ishiguro

SPINE Vol. 42 ( 16 ) page： E963 - E968 2017.8

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

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-Sequard 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 +/- 23.18) than in SAC (14.1 +/- 12.08) (P< 0.001). The cut-off value of the kink angle to distinguish ISCH and SAC was 32.88.
Conclusion. Patients with ISCH commonly had severe preoperative neurological deficit, Brown-Sequard 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 Kei, Ito Zenya, Kobayashi Kazuyoshi, Hida Tetsuro, Ito Kenyu, Tsushima Mikito, Ishikawa Yoshimoto, Matsumoto Akiyuki, Morozumi Masayoshi, Tanaka Satoshi, Machino Masaaki, Ota Kyotaro, Nakashima Hiroaki, Nishida Yoshihiro, Ishiguro Naoki

NEUROSURGERY Vol. 81 ( 2 ) page： 403 - 403 2017.8

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 Reviewed

Narihito Nagoshi, Lindsay Tetreault, Hiroaki Nakashima, Paul M. Arnold, Giuseppe Barbagallo, Branko Kopjar, Michael G. Fehlings

JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME Vol. 99 ( 13 ) page： 1069 - 1077 2017.7

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

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-termimprovements in functional, disability, and quality-of-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-termfollow-up, patients with perioperative dysphagia exhibited improvements in functional, disability, and quality-of life scores that were similar to those of patients without dysphagia.

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 Reviewed

Aria Nouri, Allan R. Martin, Lindsay Tetreault, Anick Nater, So Kato, Hiroaki Nakashima, Narihito Nagoshi, Hamed Reihani-Kermani, Michael G. Fehlings

SPINE Vol. 42 ( 14 ) page： 1058 - 1067 2017.7

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

Study Design. An ambispective analysis.
Objective. The aim of this study was to report the global prevalence of specific degenerative cervical pathologies in patients with degenerative cervical myelopathy (DCM) through detailed review of magnetic resonance imaging (MRIs).
Summary of Background Data. DCM encompasses a spectrum of age-related conditions that result in progressive spinal cord injury.
Methods. MRIs of 458 patients (age 56.4 +/- 11.8, 285 male, 173 female) were reviewed for specific degenerative features, directionality of cord compression, levels of spinal cord compression, and signal changes on sagittal T2-weighted imaging (T2WI) and sagittal T1-weighted imaging (T1WI). Data were analyzed for differences between sex using Chi-square tests and geographic variations using Kruskal-Wallis tests.
Results. Spondylosis was frequently present (89.7%) and was commonly accompanied by enlargement of the ligamentum flavum (LF) (59.9%). Single-level disc pathology, ossification of posterior longitudinal ligament (OPLL), and spondylolisthesis had a prevalence of similar to 10% each. OPLL was accompanied by spondylosis in 91.7%. Klippel-Feil syndrome was observed in 2.0%. The Asia-Pacific region had more OPLL (29%, P - 3 x 10(-11)) and less spondylolisthesis (1.9%, P = 0.002). Females presented more commonly with single-level disc pathology (13.9% vs. 6.7%; P = 0.013), and males with spondylosis (92.3% vs. 85.6%; P - 0.02) and enlargement of LF (61.4% vs. 49.1%; P = 0.01). C5 to C6 was the most frequent maximum compressed site (39.5%) and region for T2WI hyperintensity (38.9%). T2WI hyperintensity more commonly presented in males (82.4% vs. 66.7%; P< 0.001).
Conclusion. This is the largest report on the prevalence and spectrum of pathology in patients with DCM. Herein, it has been demonstrated that degenerative features are highly interrelated, that females presented with milder MRI evidence of DCM, and that variations exist in the prevalence of pathologies between geographical regions.

DOI： 10.1097/BRS.0000000000001981

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 Vol. 52 ( 5 ) page： 439 - 447 2017.5

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 Reviewed International journal Open Access

Shiro Imagama, Zenya Ito, Kei Ando, Kazuyoshi Kobayashi, Tetsuro Hida, Kenyu Ito, Mikito Tsushima, Yoshimoto Ishikawa, Akiyuki Matsumoto, Masayoshi Morozumi, Satoshi Tanaka, Masaaki Machino, Kyotaro Ota, Hiroaki Nakashima, Norimitsu Wakao, Yoshihito Sakai, Yukihiro Matsuyama, Naoki Ishiguro

Global Spine Journal Vol. 7 ( 3 ) page： 246 - 253 2017.5

Language：English Publishing type：Research paper (scientific journal) Publisher：Thieme Medical Publishers, Inc.

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 &lt
.05). Thoracic tumors were associated with patients with unstable gait before surgery (P &lt
.05). Tumor volume was larger in NCR group (P &lt
.05). IONM significantly decreased in NCR and CR groups than in N group (P &lt
.05). The NCR group had residual mild motor paresis at FU (P &lt
.05). Stable gait at FU was similar in N group and CR group, though lower in NCR group (P &lt
.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

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