Faculty Profiles - NAKASHIMA Hiroaki

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

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 Vol. 30 ( 4 ) page： E358 - E362 2017.5

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 Vol. 30 ( 4 ) page： E358-E362 2017.5

Multilevel Lateral Lumbar Interbody Fusion for Degenerative Spinal Deformity in Elderly

Vol. 30 ( 4 ) page： 437 - 443 2017.4

Prevalence and outcomes in patients undergoing reintubation after anterior cervical Spine surgery: Results from the AOSpine North America multicenter study on 8887 patients Reviewed International journal Open Access

Narihito Nagoshi, Michael G. Fehlings, Hiroaki Nakashima, Lindsay Tetreault, Jeffrey L. Gum, Zachary A. Smith, Wellington K. Hsu, Chadi A. Tannoury, Tony Tannoury, Vincent C. Traynelis, Paul M. Arnold, Thomas E. Mroz, Ziya L. Gokaslan, Mohamad Bydon, Anthony F. De Giacomo, Bruce C. Jobse, Eric M. Massicotte, K. Daniel Riew

Global Spine Journal Vol. 7 ( 1 Suppl ) page： 965 - 1025 2017.4

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

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 Reviewed International journal

Lindsay Tetreault, Narihito Nagoshi, Hiroaki Nakashima, Anoushka Singh, Branko Kopjar, Paul Arnold, Michael G. Fehlings

SPINE Vol. 42 ( 6 ) page： 372 - 378 2017.3

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

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.

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 Reviewed

Hiroaki Nakashima, Lindsay Tetreault, So Kato, Michael T. Kryshtalskyj, Narihito Nagoshi, Aria Nouri, Anoushka Singh, Michael G. Fehlings

JBJS Reviews Vol. 5 ( 2 ) 2017.2

Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Bone and Joint Surgery Inc.

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 Reviewed International journal Open Access

Shiro Imagama, Zenya Ito, Kei Ando, Kazuyoshi Kobayashi, Tetsuro Hida, Kenyu Ito, Yoshimoto Ishikawa, Mikito Tsushima, Akiyuki Matsumoto, Hiroaki Nakashima, Norimitsu Wakao, Yoshihito Sakai, Yukihiro Matsuyama, Naoki Ishiguro

Global Spine Journal Vol. 7 ( 1 ) page： 6 - 13 2017.2

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

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 &lt
0.005), the mean period from initial symptoms to motor paralysis was significantly shorter (3.5 versus 11.9 months, p &lt
0.05), and intraoperative spinal cord monitoring aggravation was higher (65 versus 6%, p &lt
0.05). All 5 patients without total resection in group I underwent reoperation. Ki67 activity was higher in group IE (15% versus 1%, p &lt
0.05). Preoperative ambulatory ability was significantly poorer in group IE (p &lt
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 Reviewed International journal

Narihito Nagoshi, Lindsay Tetreault, Hiroaki Nakashima, Aria Nouri, Michael G. Fehlings

SPINE JOURNAL Vol. 17 ( 2 ) page： 291 - 302 2017.2

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE INC

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. (C) 2016 Published by Elsevier Inc.

DOI： 10.1016/j.spinee.2016.09.013

Dynamic changes in the cross-sectional area of the dural sac and spinal cord in the thoracic spine Reviewed

Daigo Morita, Yasutsugu Yukawa, Hiroaki Nakashima, Keigo Ito, Go Yoshida, Masaaki Machino, Syunsuke Kanbara, Toshiki Iwase, Fumihiko Kato

EUROPEAN SPINE JOURNAL Vol. 26 ( 1 ) page： 64 - 70 2017.1

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

The thoracic spine is considered a rigid region because it is restricted by the rib cage. Previously, we reported functional alignments and range of motion (ROM) at all segmental levels. The purpose of this study was to investigate dynamic changes of the dural sac and spinal cord in the thoracic spine using a multidetector-row computed tomography (MDCT).
Fifty patients with cervical or lumbar spinal disease were prospectively enrolled. After preoperative myelography, MDCT was performed at maximum passive flexion and extension. The anteroposterior diameter and cross-sectional area of the dural sac and spinal cord in the axial plane were measured using Scion imaging software. We also evaluated the correlation between the change ratio of the cross-sectional area and segmental kyphotic angle and ROM.
In flexion, the anteroposterior diameter of the dural sac was larger than in extension. The cross-sectional area in the upper and middle regions was smaller, but was larger in the lower region. The anteroposterior diameter and cross-sectional area of the spinal cord in the upper and middle regions were smaller than in extension, but these values were nearly the same in both flexion and extension in the lower region. Change ratios of the cross-sectional area were correlated with segmental kyphotic angle rather than ROM.
The thoracic spine showed some dynamic changes of the dural sac and spinal cord in the axial plane within functional motion. Segmental kyphotic angle, rather than segmental ROM, was the more important factor affecting dimensions of the dural sac and spinal cord.

DOI： 10.1007/s00586-015-4173-x