研究者詳細 - 中島　宏彰

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

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

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

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

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

Ando Kei, Imagama Shiro, Ito Zenya, Kobayashi Kazuyoshi, Ukai Junichi, Muramoto Akio, Shinjo Ryuichi, Matsumoto Tomohiro, Nakashima Hiroaki, Matsuyama Yukihiro, Ishiguro Naoki

CLINICAL SPINE SURGERY 30 巻 ( 4 ) 頁： E358-E362 2017年5月

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

特集高齢者の脊柱変形Up to Date 第2章　治療高齢者脊柱変形に対する側方経路腰椎椎体間固定術の応用

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

脊椎脊髄ジャーナル 30 巻 ( 4 ) 頁： 437 - 443 2017年4月

Prevalence and Outcomes in Patients Undergoing Reintubation After Anterior Cervical Spine Surgery: Results From the AOSpine North America Multicenter Study on 8887 Patients 査読有り国際誌 Open Access

Nagoshi, N; Fehlings, MG; Nakashima, H; Tetreault, L; Gum, JL; Smith, ZA; Hsu, WK; Tannoury, CA; Tannoury, T; Traynelis, VC; Arnold, PM; Mroz, TE; Gokaslan, ZL; Bydon, M; De Giacomo, AF; Jobse, BC; Massicotte, EM; Riew, KD

GLOBAL SPINE JOURNAL 7 巻 ( 1 Suppl ) 頁： 965 - 1025 2017年4月

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

Study Design: A multicenter, retrospective cohort study. Objective: To evaluate clinical outcomes in patients with reintubation after anterior cervical spine surgery. Methods: A total of 8887 patients undergoing anterior cervical spine surgery were enrolled in the AOSpine North America Rare Complications of Cervical Spine Surgery study. Patients with or without complications after surgery were included. Demographic and surgical information were collected for patients with reintubation. Patients were evaluated using a variety of assessment tools, including the modified Japanese Orthopedic Association scale, Nurick score, Neck Disability Index, and Short Form-36 Health Survey. Results: Nine cases of postoperative reintubation were identified. The total prevalence of this complication was 0.10% and ranged from 0% to 0.59% across participating institutions. The time to development of airway symptoms after surgery was within 24 hours in 6 patients and between 5 and 7 days in 3 patients. Although 8 patients recovered, 1 patient died. At final follow-up, patients with reintubation did not exhibit significant and meaningful improvements in pain, functional status, or quality of life. Conclusions: Although the prevalence of reintubation was very low, this complication was associated with adverse clinical outcomes. Clinicians should identify their high-risk patients and carefully observe them for up to 2 weeks after surgery.

DOI： 10.1177/2192568216687753

Impact of Depression and Bipolar Disorders on Functional and Quality of Life Outcomes in Patients Undergoing Surgery for Degenerative Cervical Myelopathy Analysis of a Combined Prospective Dataset 査読有り国際誌

Tetreault, L; Nagoshi, N; Nakashima, H; Singh, A; Kopjar, B; Arnold, P; Fehlings, MG

SPINE 42 巻 ( 6 ) 頁： 372 - 378 2017年3月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Spine

Study Design. Analysis of a combined prospective dataset. Objective. To compare clinical outcomes in patients with and without preexisting depression or bipolar disorder undergoing surgery for degenerative cervical myelopathy (DCM). Summary of Background Data. Psychiatric comorbidities, including depression, have been associated with worse clinical outcomes after lumbar spine surgery; however, it is unclear whether these psychiatric disorders are also predictive of outcomes in patients undergoing surgery for the treatment of DCM. Methods. Four hundred and one patients with symptomatic DCM were enrolled in the prospective AOSpine International or North America study at twelve North American sites. Patients were evaluated preoperatively and at 6, 12, and 24 months using the modified Japanese Orthopedic Association scale (mJOA), Nurick score, Neck Disability Index (NDI), and Short- Form 36v2 (SF-36v2) Health Survey. A mixed model analytic approach was used to evaluate differences in outcomes at 24 months among patients with and without psychiatric disorders, while controlling for relevant baseline characteristics and surgical factors. Results. Ninety-seven patients (24.19%) were diagnosed with preexisting depression or bipolar disorder. There were more females (65.98%) with these psychiatric disorders than males (34.02%) (P < 0.0001). Patients with psychiatric comorbidities were more likely to have cardiovascular (P = 0.0177), respiratory (P < 0.0001), gastrointestinal (P < 0.0001), rheumatologic (P = 0.0109), and neurologic (P = 0.0309) disorders. At 24 months after surgery, patients in both groups demonstrated significant improvements on the mJOA, Nurick, NDI, and SF-36v2 Physical Component Score (PCS). Patients with depression or bipolar disorder, however, did not exhibit a significant or clinically important change on the SF-36v2 Mental Component Score (MCS). There were no differences in mJOA and Nurick scores at 24 months among patients in each group. Improvement in NDI, SF-36v2 PCS, and MCS, however, were smaller in patients with depression or bipolar disorder than those without. Conclusion. Patients with depression or bipolar disorder have smaller functional and quality of life improvements after surgery compared to patients without psychiatric comorbidities. Level of Evidence:

DOI： 10.1097/BRS.0000000000001777

Prediction of Outcome Following Surgical Treatment of Cervical Myelopathy Based on Features of Ossification of the Posterior Longitudinal Ligament: A Systematic Review. 査読有り

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

JBJS reviews 5 巻 ( 2 ) 2017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：JBJS Reviews

Background: Ossification of the posterior longitudinal ligament (OPLL) is defined as ectopic bone formation within the posterior longitudinal ligament. Although various OPLL features (including the extent, shape, and thickness of the OPLL as well as the presence of dural ossification) have been defined in the literature, we are not aware of any systematic reviews that have summarized theassociationsbetween these featuresand clinical outcomes following surgery. The objective of the present study was to conduct a systematic review of the literature to determine whether OPLL characteristics are predictive of outcome in patients undergoing surgery for the treatment of cervical myelopathy. Methods: An extensive search was performed using 4 electronic databases: MEDLINE, MEDLINE In-Process, Embase, and the Cochrane Central Register of Controlled Trials. Our search terms were OPLL and cervical. We identified studies in English or Japanese that evaluated the association between cervical OPLL features and surgical outcome. The overall body of evidence was assessed with use of a scoring system developed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group with recommendations from the Agency for Healthcare Research and Quality (AHQR). The present systematic literature review is formatted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: The search yielded a total of 2,318 citations. A total of 28 prognostic cohort studies were deemed relevant following a rigorous review process. Among them, only 7 retrospective studies involved a multivariate analysis that controlled for potential confounding variables. Sample sizes ranged from 47 to 133 patients. The main outcome was the postoperative Japanese Orthopaedic Association (JOA) score and/or recovery rate in 6 studies and the Nurick grade in 1. Of these, 2 were rated as Level-II evidence and 5 were rated as Level-III evidence. On the basis of our results, there was low evidence that patients with a hill-shaped ossification have a worse postoperative JOA score following laminoplasty than those with a plateau-shaped lesion; low evidence that the space available for the spinal cord cannot predict postoperative JOA scores; moderate evidence that there is no association between the occupying ratio and improvement on the Nurick scale; and insufficient evidence to determine the association between JOA outcomes and the type of OPLL, the presence of dural ossification, and the occupying ratio. Conclusions: Patients with hill-shaped OPLL have a worse postoperative JOA score than those with plateau-shaped ossification after laminoplasty. Because of limited evidence, it is unclear whether the occupying ratio, the type of OPLL, and the presence of dural ossification are predictive of surgical outcomes following either anterior or posterior decompression. A limited number of studies have used a multivariate analysis to evaluate the association between clinical outcomes and OPLL features. Additional studies representing high-quality evidence are needed. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

DOI： 10.2106/JBJS.RVW.16.00023

Rapid Worsening of Symptoms and High Cell Proliferative Activity in Intra- and Extramedullary Spinal Hemangioblastoma: A Need for Earlier Surgery 査読有り国際誌 Open Access

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

GLOBAL SPINE JOURNAL 7 巻 ( 1 ) 頁： 6 - 13 2017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

Study Design A retrospective analysis of a prospective database. Objective To compare preoperative symptoms, ambulatory ability, intraoperative spinal cord monitoring, and pathologic cell proliferation activity between intramedullary only and intramedullary plus extramedullary hemangioblastomas, with the goal of determining the optimal timing for surgery. Methods The subjects were 28 patients (intramedullary only in 23 cases [group I] and intramedullary plus extramedullary in 5 cases [group IE]) who underwent surgery for spinal hemangioblastoma. Preoperative symptoms, ambulatory ability on the McCormick scale, intraoperative spinal cord monitoring, and pathologic findings using Ki67 were compared between the groups. Results In group IE, preoperative motor paralysis was significantly higher (100 versus 26%, p < 0.005), the mean period from initial symptoms to motor paralysis was significantly shorter (3.5 versus 11.9 months, p < 0.05), and intraoperative spinal cord monitoring aggravation was higher (65 versus 6%, p < 0.05). All 5 patients without total resection in group I underwent reoperation. Ki67 activity was higher in group IE (15% versus 1%, p < 0.05). Preoperative ambulatory ability was significantly poorer in group IE (p < 0.05), but all cases in this group improved after surgery, and postoperative ambulatory ability did not differ significantly between the two groups. Conclusions Intramedullary plus extramedullary spinal hemangioblastoma is characterized by rapid preoperative progression of symptoms over a short period, severe spinal cord damage including preoperative motor paralysis, and poor gait ability compared with an intramedullary tumor only. Earlier surgery with intraoperative spinal cord monitoring is recommended for total resection and good surgical outcome especially for an IE tumor compared with an intramedullary tumor.

DOI： 10.1055/s-0036-1580612

Return to play in athletes with spinal cord concussion: a systematic literature review 査読有り国際誌

Nagoshi, N; Tetreault, L; Nakashima, H; Nouri, A; Fehlings, MG

SPINE JOURNAL 17 巻 ( 2 ) 頁： 291 - 302 2017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：Spine Journal

Study Design This is a systematic review. Purpose The study aimed to evaluate whether spinal cord concussion (SCC) patients can safely return to play sports and if there are factors that can predict SCC recurrence or the development of a spinal cord injury (SCI). Background Context Although SCC is a reversible neurologic disturbance of spinal cord function, its management and the implications for return to play are controversial. Methods We conducted a systematic search of the literature using the keywords Cervical Spine AND Sports AND Injuries in six databases. We examined return to play in patients (1) without stenosis, (2) with stenosis, and (3) who underwent single-level anterior cervical discectomy and fusion (ACDF). We also investigated predictors for the risk of SCC recurrence or SCI. Results We identified 3,655 unique citations, 16 of which met our inclusion criteria. The included studies were case-control studies or case series and reports. Two studies reported on patients without stenosis: pediatric cases returned without recurrence, whereas an adult case experienced recurrent SCC after returning to play. Seven studies described patients with stenosis. These studies included cases with and without recurrence after return to play, as well as patients who suffered SCI with permanent neurologic deficits. Three studies reported on patients who underwent an ACDF. Although some patients played after surgery without problems, several patients experienced recurrent SCC due to herniation at levels adjacent to the surgical sites. With respect to important predictors, a greater frequency of patients who experienced recurrence of symptoms or SCI following return to play had a “long” duration of symptoms (>24 hours; 36.36%) compared with those who were problem-free (11.11%; p=.0311). Conclusions There is limited evidence on current practice standards for return to play following SCC and important risk factors for SCC recurrence or SCI. Because of small sample sizes, future prospective multicenter studies are needed to determine important predictive factors of poor outcomes following return to play after SCC.

DOI： 10.1016/j.spinee.2016.09.013