Faculty Profiles - NAKASHIMA Hiroaki

Papers - NAKASHIMA Hiroaki

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Recent progress in surgical treatment of cervical spine myelopathy – A narrative review

Ouchida J., Nakashima H., Ito S., Segi N., Yamauchi I., Imagama S.

Journal of Clinical Orthopaedics and Trauma Vol. 68 2025.9

Publisher：Journal of Clinical Orthopaedics and Trauma

Surgical techniques and technology for cervical spondylotic myelopathy (CSM) have demonstrated remarkable advancement during the past decade. This narrative review examines the evolution of surgical approaches and technological innovations, focusing on both anterior and posterior techniques. Anterior approaches have progressed through the development of endoscopic procedures, novel decompression methods such as vertebral body sliding osteotomy, and advanced implant materials including 3D-printed customized devices. Posterior approaches have evolved with the integration of endoscopic techniques and refined fixation methods, demonstrating reduced tissue trauma and improved outcomes. The integration of surgical assistance technologies, including navigation systems, robotics, and augmented reality, has enhanced surgical precision while potentially reducing procedural risks. While these advances show promising outcomes in terms of surgical precision and patient recovery, challenges persist regarding technology implementation and cost-effectiveness. Emerging technologies such as artificial intelligence for surgical planning, patient-specific implants, and adjunctive biological therapies may further improve CSM treatment. The optimal application of these innovations requires continued research and careful evaluation to establish their long-term efficacy and safety in clinical practice.

DOI： 10.1016/j.jcot.2025.103074

Risk factors for nonunion in femoral neck fracture patients with internal fixation: A multicenter (TRON group) retrospective study. Reviewed

Kurahashi S, Takegami Y, Tokutake K, Nakashima H, Mishima K, Yamauchi K, Imagama S

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association Vol. 30 ( 4 ) page： 672 - 677 2025.7

Language：English Publisher：Journal of Orthopaedic Science

Introduction: Femoral neck fractures (FNFs) are common in elderly individuals. When minimally displaced, they are typically treated with internal fixation. Nonunion is a complication of internal fixation of FNF, that sometimes necessitates reoperation. Radiographic parameters, including the Pauwels angle and posterior tilt angle, are risk factors for nonunion. However, these parameters are assessed solely in a two-dimensional context. We developed a novel radiographic parameter named the “Kindex.” This multicenter investigation aimed to identify risk factors for nonunion following FNF fixation and evaluate the validity of this index. Methods: This retrospective multicenter study collected data from 939 FNF patients who underwent internal fixation between 2016 and 2020 at 11 facilities (TRON group). The following exclusion criteria were applied: age <65, insufficient data, and Garden Stage III or IV fracture. Patient data, including age, sex, BMI, ASA classification, alcohol and smoking history, and comorbidities, were recorded. Radiographic measurements of the Pauwels angle and posterior tilt angle at the time of injury were used to calculate the Kindex. Correlations between the Pauwels angle, posterior tilt angle, Kindex, and nonunion were evaluated. A multivariate logistic regression analysis was performed to investigate independent risk factors for nonunion. A receiver operating characteristic (ROC) analysis was performed to determine the cutoff value of the Kindex, and the area under the curve (AUC) was calculated. Results: The study included 594 patients (males, n = 151; females, n = 443; average age, 80.9 years). Nonunion was observed in 13 cases (2.2 %). While the Pauwels angle and posterior tilt angle did not show significant correlations, the Kindex exhibited strong correlations with both parameters. In the multivariate analysis, the Kindex and renal impairment were independent risk factors for nonunion (Kindex: OR 1.06, p = 0.015; renal impairment: OR 1.48, p = 0.021). In the ROC analysis, a Kindex of 50 was identified as the optimal cutoff value (AUC 0.72). Conclusion: The nonunion rate after internal fixation of FNF was 2.2 %. Renal impairment and the Kindex were identified as independent risk factors. The Kindex at the time of injury may serve as a novel radiographic parameter to consider when evaluating the need for internal fixation in FNF cases.

DOI： 10.1016/j.jos.2024.09.002

Incremental cost-effectiveness ratio between titanium plate and hydroxyapatite block spacers in cervical laminoplasty for degenerative cervical myelopathy Reviewed

Kagami, Y; Nakashima, H; Segi, N; Ito, S; Ouchida, J; Ogura, K; Shinjo, R; Imagama, S

JOURNAL OF ORTHOPAEDIC SCIENCE Vol. 30 ( 4 ) page： 569 - 574 2025.7

Language：English Publisher：Journal of Orthopaedic Science

Introduction: Laminoplasty is a widely used surgical procedure to decompress the cervical spinal cord. Recently, titanium plates (TPs) have been used instead of conventional hydroxyapatite block (HA) spacers to prevent laminar reclosure. However, no study has compared the cost-effectiveness of TP and HA. Therefore, this study aimed to compare the cost-effectiveness and postoperative outcomes of laminoplasty using TP or HA. Methods: A total of 167 patients who underwent cervical laminoplasty at our institution were included in this study. Patients with cervical spinal cord injury, epidural hematoma, or follow-up of <1 year were excluded. Of the 167 patients, 69 underwent laminoplasty using TP (the TP group), and 98 underwent laminoplasty using HA (the HA group). The surgical costs and incremental cost-effectiveness ratio (ICER) were compared between the two groups. Additionally, the operation time, complications, Japanese Orthopaedic Association score, Hirabayashi recovery rate, and pre and postoperative cervical alignment on X-ray images were investigated. Results: The surgical costs were significantly higher in the TP group than in the HA group (HA, 7255 ± 1504 USD vs. TP, 11,642 ± 2492 USD, p < 0.01). The ICER was 21,935 USD per quality-adjusted life year in the TP group. The operation time was shorter in the TP group than in the HA group (HA, 70.0 ± 22.5 min vs. TP, 63.6 ± 19.3 min, p = 0.06). The Hirabayashi recovery rate and radiographic parameters were similar between the two groups. Implant displacements were significantly more common in the HA group than in the TP group (HA, 11.2 % vs. TP, 0 %, p < 0.01). Conclusions: The surgical costs and ICER with TPs were higher than those with HA spacers. However, no difference in the Hirabayashi recovery rate and postoperative radiological parameters was observed between the two groups, although the HA group had more implant displacements.

DOI： 10.1016/j.jos.2024.10.003

Comparative clinical outcomes of K-wire fixation versus screw fixation in Lisfranc joint injuries: A multicenter (TRON group) retrospective study.

Adachi A, Takegami Y, Nakashima H, Mishima K, Kobayashi K, Imagama S

The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons 2025.6

C2 Pelvic Angle as a Predictive Measure for Decompensated Spinopelvic Alignment and Its Impact on Health-Related Quality of Life. Reviewed

Ouchida J, Nakashima H, Ito S, Segi N, Yamauchi I, Ode Y, Imagama S

Spine 2025.6

Language：English Publisher：Spine

Study Design. Retrospective cohort. Objective. To evaluate the C2 pelvic angle (C2PA) as a novel compensatory parameter integrating C2 (center of gravity) and pelvic morphology, and its association with physical function and health-related quality of life (HRQOL). The T4-L1-Hip axis concept was applied to assess individualized spinal alignment. Background. Adult spinal deformity (ASD) impairs physical function and HRQOL in older adults. Pelvic retroversion compensates for spinal degeneration to maintain posture, but standardized evaluative indices linking pelvic parameters to outcomes remain limited. Methods. Cross-sectional analysis of 383 community-dwelling adults (mean age 64.1 ± 10.3 y). Whole-spine radiographs, physical function tests (Timed Up and Go, 10-meter walk), and SF-36 HRQOL scores were analyzed. C2PA mismatch (measured C2PA minus normative value [0.4 × pelvic incidence - 13]) and thoracolumbar decompensation (T4PA-L1PA ≥4°) were assessed. ROC analysis identified optimal C2PA mismatch thresholds; propensity score matching (age/sex/BMI) compared groups. Results. C2PA mismatch correlated strongly with lumbar (r=0.668) and thoracolumbar (r=0.707) mismatches. A 13° C2PA mismatch threshold optimally identified decompensated thoracolumbar alignment (AUC=0.819). Participants with>13° C2PA mismatch demonstrated decreased physical function (Timed Up and Go: 6.4 vs. 5.8 seconds; 10-meter walk: 1.4 vs. 1.5 m/s) and lower SF-36 scores (physical functioning: 65.9 vs. 72.8; bodily pain: 63.1 vs. 70.8; physical component summary: 41.8 vs. 45.7). Conclusions. C2PA is a reliable indicator of decompensated spinopelvic alignment, with>13° mismatch (measured C2PA>0.4 × pelvic incidence) The C2PA threshold correlates with decreased physical function and lower HRQOL, providing a clinical benchmark for evaluating and managing patients with spinal alignment degeneration.

DOI： 10.1097/BRS.0000000000005436

Nationwide analysis of spinal surgery in Japan from 1994 to 2021 Reviewed

Ito, S; Imagama, S; Nakashima, H; Machino, M; Sakai, T; Aizawa, T; Arima, H; Hamanaka, H; Ishimoto, Y; Kato, S; Kawaguchi, Y; Konishi, H; Miyakoshi, N; Murakami, H; Nagamoto, Y; Nakanishi, K; Nishida, K; Ohba, T; Okuda, S; Otani, K; Suda, K; Suzuki, N; Takasawa, E; Terai, H; Tezuka, F; Yamato, Y; Yukawa, Y; Kanemura, T; Takaso, M; Takahashi, H

EUROPEAN SPINE JOURNAL 2025.6

Language：English Publisher：European Spine Journal

Purpose: In this study, we aimed to compare the latest 2021 survey data with findings from 1994, 2001, and 2011 to elucidate the trends and transformations in spinal surgery over the past quarter-century. Methods: Data from the 2021 survey were compared with retrospective data from previous surveys. The 2021 survey collected data on patient demographics, surgical techniques, and perioperative complications of spinal surgeries performed in November 2021 from 739 facilities. Trends in patient age, disease type, surgical approach, and complication rates were analyzed over time. Results: The most common age group shifted from 40 to 59 years in 1994 to the 70s by 2011 and 2021. Degenerative diseases, particularly lumbar spinal stenosis, remain prevalent with an increase in trauma and osteoporotic fractures. Surgical techniques have evolved with a decline in anterior approaches and an increase in minimally invasive and posterior surgeries. Complication rates remained stable, ranging from 8.6 to 10.4%, with a slight increase by 2021 (8.8%). However, dural tears have become more common, likely because of the technical demands of minimally invasive and instrumented surgeries. Conclusions: The aging population of Japan has influenced spinal surgery demographics, and minimally invasive techniques have become more common, underscoring the need for enhanced training, improved techniques, and strategies tailored to older patients to improve future spinal surgery outcomes and support policy development.

DOI： 10.1007/s00586-025-08999-3

Comparative analysis of single-stage versus two-stage fusion surgeries for adult spinal deformity: radiographic outcomes, clinical improvements, and complication rates Reviewed

Ouchida, J; Nakashima, H; Ito, S; Segi, N; Yamauchi, I; Morita, Y; Kanemura, T; Ohara, T; Tsuji, T; Shinjo, R; Morishita, K; Imagama, S

EUROPEAN SPINE JOURNAL 2025.6

Language：English Publisher：European Spine Journal

Purpose: To compare single-stage and two-stage corrective fusion surgeries for adult spinal deformity (ASD), focusing on radiographic and clinical outcomes, and surgery-related complications. Methods: A retrospective cohort study of 245 ASD patients who underwent spinal fusion surgery involving three or more vertebral levels was conducted. Patients were categorized into single-stage and two-stage groups. Propensity score matching was performed to adjust for age, surgical procedure, and radiographical parameters. Radiographic parameters, complication rates, and the Japanese Orthopaedics Association (JOA) score were compared Results: After matching for clinical background, the two-stage group showed longer surgery times (493.7 ± 157.2 min vs. 271.3 ± 125.7 min, p < 0.001) and greater estimated blood loss (1617.1 ± 1276.9 mL vs. 1067.5 ± 1274.0 mL, p < 0.001). Surgery-related complication rates were similar between the two groups (20.0% vs. 20.0%, p = 1.000). At two years post-surgery, the two-stage group demonstrated significantly superior JOA score improvement (100.9 ± 84.5% vs. 68.2 ± 62.6%, p = 0.017), lower pelvic tilt (23.6 ± 11.3° vs. 29.1 ± 14.7°, p = 0.023) and a trend towards smaller sagittal vertical axis (40.6 ± 42.7 mm vs. 58.9 ± 58.7 mm, p = 0.075). Conclusions: Comparative analysis with matched clinical backgrounds revealed that the two-stage approach maintained equivalent complication rates while achieving sufficient correction effects and favorable clinical score improvements at two years post-surgery. To elucidate the relationship between individual surgical strategies and personalized complication risks, further research is necessary.

DOI： 10.1007/s00586-025-09036-z

Japanese 2021 nationwide survey on complications from spine surgery Reviewed

Ito, S; Imagama, S; Nakashima, H; Machino, M; Sakai, T; Aizawa, T; Arima, H; Hamanaka, H; Ishimoto, Y; Kato, S; Kawaguchi, Y; Konishi, H; Miyakoshi, N; Murakami, H; Nagamoto, Y; Nakanishi, K; Nishida, K; Ohba, T; Okuda, S; Otani, K; Suda, K; Suzuki, N; Takasawa, E; Terai, H; Tezuka, F; Yamato, Y; Yukawa, Y; Kanemura, T; Takaso, M; Takahashi, H

EUROPEAN SPINE JOURNAL 2025.6

Language：English Publisher：European Spine Journal

Purpose: To provide an updated analysis of perioperative complications, patient demographics, and surgical techniques in spinal surgeries across Japan and examine their impact on risk management. Methods: Data were collected prospectively from 739 of 1,106 registered facilities across Japan using the JSSR database. All spinal surgeries conducted in November 2021 were included, capturing complications within 1 month post-surgery. Data analyzed included patient demographics, disease classification, surgical techniques, site, approach, and complications. Descriptive statistics determined complication rates and trends. Results: The survey included 11,559 surgeries (average patient age: 67.0 years). Degenerative diseases comprised 71.0% of cases. Posterior surgical approaches were predominant (87.9%), and minimally invasive techniques were widely adopted. The overall complication rate was 8.8%, with dural tears (2.4%) being the most common. Minimally invasive techniques improved outcomes but posed technical challenges, highlighting the need for advanced training and equipment. Conclusion: Japan’s aging surgical population and the adoption of minimally invasive techniques are evident. While complication rates remain stable, specific complications such as dural tears require targeted management. These findings underscore tailored surgical strategies for older patients and innovation in techniques, providing critical evidence for improving outcomes and informing healthcare policy in Japan.

DOI： 10.1007/s00586-025-08981-z

Does Advanced Age Negatively Impact Treatment Outcomes of Cervical Ossification of the Posterior Longitudinal Ligament? A Prospective Multicenter Study. Reviewed

Nagoshi N, Egawa S, Sakai K, Kusano K, Tsutsui S, Hirai T, Matsukura Y, Wada K, Katsumi K, Koda M, Kimura A, Furuya T, Maki S, Nishida N, Nagamoto Y, Oshima Y, Ando K, Nakashima H, Endo T, Mori K, Nakajima H, Murata K, Miyagi M, Kaito T, Yamada K, Banno T, Kato S, Ohba T, Takahata M, Moridaira H, Fujibayashi S, Katoh H, Kanno H, Watanabe K, Taneichi H, Imagama S, Kawaguchi Y, Takeshita K, Nakamura M, Matsumoto M, Yamazaki M, Yoshii T

Spine 2025.6

Language：English Publisher：Spine

Study Design. A multicenter prospective cohort study. Objective. To comprehensively evaluate the surgical impact, including patient-reported outcomes (PROs), in elderly patients with cervical ossification of the posterior longitudinal ligament (OPLL). Summary of Background Data. With the rise of aging populations worldwide, understanding the impact of age on treatment outcomes for cervical OPLL has become increasingly important. Previous studies on degenerative cervical myelopathy have highlighted inconsistent outcomes for elderly patients, with limited focus on OPLL and PROs. Methods. This prospective, multi-institutional study included 402 cervical OPLL patients from 2014 to 2017, categorized into elderly (≥75 y, n=79) and non-elderly (<75 y, n=323) groups. Clinical outcomes were assessed preoperatively and two years postoperatively using cervical Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS) scores, and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). Multivariable regression analyses were conducted, adjusting for potential confounders, including demographic variables and imaging characteristics. Results. Elderly patients had worse preoperative JOA scores (9.6 vs. 11.1, P<0.01) and lower postoperative scores at two years (12.3 vs. 14.0, P<0.01). However, the improvement in JOA scores was comparable (2.7 vs. 3.0, P=0.48), with both exceeding the minimum clinically important difference (MCID). Complication rates and VAS score improvements were also comparable. JOACMEQ outcomes demonstrated significantly poorer upper extremity function in the elderly group following surgery (P=0.02), whereas no significant differences were observed between the two groups in other functional domains. Conclusion. Despite worse baseline neurological function, elderly OPLL patients achieved similar degrees of postoperative neurological improvement as non-elderly patients. However, upper extremity function is unlikely to show significant improvement following surgery in elderly patients.

DOI： 10.1097/BRS.0000000000005415

Comparison of Clinical Outcomes of Periprosthetic Fractures Between Cemented vs Cementless Stem Methods After Initial Total Hip Arthroplasty or Bipolar Hemiarthroplasty: A Multicenter Analysis (TRON Study) Reviewed Open Access

Tachi, H; Takegami, Y; Okura, T; Tokutake, K; Nakashima, H; Mishima, K; Kasai, T; Imagama, S

ARTHROPLASTY TODAY Vol. 33 2025.6

Publisher：Arthroplasty Today

Background: Periprosthetic femoral fractures are challenging complications after total hip arthroplasty (THA) or bipolar hemiarthroplasty (BHA). This multicenter study compared clinical outcomes of surgical periprosthetic femoral fracture (PFF) treatment following initial implantation of cemented vs cementless femoral stems. Methods: This retrospective multicenter study included 201 patients from multiple hospitals who had PFFs treated surgically between 2010 and 2022. They were divided into THA (n = 71) and BHA (n = 130) cohorts based on initial arthroplasty. Clinical outcomes of mortality, radiographic bone union, operative metrics, and complications were compared after the patients were matched for age. Results: In the matched THA cohorts (n = 15 each), there were no significant differences in mortality, bone union, operative time, blood loss, or complications between cemented and cementless stems. In the matched BHA cohorts (n = 27 each), mortality and bone union were similar, but cementless stems showed higher intraoperative blood loss. Furthermore, Type B fractures were more common with cementless stems, whereas Type C fractures were predominated with cemented stems. Conclusions: Among patients who underwent THA or BHA, mortality and bone union following treatment of PFFs did not differ between cemented and cementless stems. However, patients who underwent BHA with cementless stems required longer operations and lost more blood. Type B fractures requiring revision occurred more frequently with cementless stems, whereas Type C fractures treated with open reduction and internal fixation were more frequent with cemented stems, which thus influenced perioperative factors. Cement use for initial arthroplasty was associated with certain favorable characteristics and positive treatment outcomes of PFFs.

DOI： 10.1016/j.artd.2025.101699

Trabecular Bone Remodeling After Posterior Lumbar Interbody Fusion: Comparison of the Osseointegration in Three-Dimensional Porous Titanium Cages and Polyether-Ether-Ketone Cages Open Access

Segi, N; Nakashima, H; Ito, S; Ouchida, J; Yamauchi, I; Matsumoto, T; Kanbara, S; Ito, K; Imagama, S

GLOBAL SPINE JOURNAL Vol. 15 ( 5 ) page： 2841 - 2843 2025.6

Impact of T1 Slope Visibility on Cervical Sagittal Alignment: A Comparative Study of Radiographic Parameters According to T1 Slope Visibility Reviewed Open Access

Nakashima Hiroaki, Matsumoto Akiyuki, Ito Sadayuki, Segi Naoki, Ouchida Jun, Yamauchi Ippei, Morita Yoshinori, Imagama Shiro

Spine Surgery and Related Research Vol. 9 ( 3 ) page： 307 - 312 2025.5

Authorship：Lead author Language：English Publisher：The Japanese Society for Spine Surgery and Related Research

<p>Introduction: Proper cervical sagittal alignment is essential for maintaining overall spinal stability and function. A crucial measure of this alignment is the T1 slope, which is an important indicator. However, lateral cervical spine radiographs often fail to clearly show the T1 slope owing to several factors, such as shoulder anatomy or variations in body shape. In this study, we aimed to evaluate the differences in cervical alignment between individuals with visible and invisible T1 slopes.</p><p>Methods: This study was a retrospective cohort analysis involving 60 patients diagnosed with cervical spine conditions and evaluated via radiographic imaging. The patients were categorized into two groups based on whether the T1 slope was clearly visible or not. Key radiographic measurements, such as the C2-C7 sagittal vertical axis (SVA) and C2-C7 Cobb angles in the neutral, flexion, and extension postures, were recorded and statistically analyzed.</p><p>Results: Significant differences were observed in the C2-C7 SVA between the groups, particularly among men. Men in the invisible T1 slope group had an average SVA of 28.9 mm, whereas those in the visible group had a mean SVA of 16.0 mm (<i>P</i><0.05). Although no notable differences were observed in the Cobb angles for the neutral and flexion positions, a substantial reduction in the extension Cobb angle was noted in the invisible than in the visible group (24.4° vs. 37.6°, <i>P</i><0.05).</p><p>Conclusions: Male patients with obscured T1 slopes exhibited unique radiographic features, including higher C2-C7 SVA and diminished extension capacity. This suggests that the visibility of the T1 slope plays a pivotal role in the evaluation of cervical alignment. Furthermore, the exclusion of patients with an invisible T1 slope from research studies could lead to biased results.</p>

DOI： 10.22603/ssrr.2024-0253

特集　整形外科領域におけるAIの応用 Ⅵ章. AIによる手術・治療成績予測 1.AIを用いた頚椎・頚髄損傷予後予測因子の探索 Reviewed

伊藤定之, 中島宏彰, 世木直喜, 大内田隼, 小田昌宏, 今釜史郎

整形外科 Vol. 76 ( 6 ) page： 627 - 632 2025.5

Influence of Diabetes Mellitus on Neurological Recovery in Older Patients With Cervical Spinal Cord Injury Without Bone Injury: A Retrospective Multicenter Study Reviewed Open Access

Takeda, K; Watanabe, K; Nori, S; Yamane, J; Kono, H; Yokogawa, N; Sasagawa, T; Nakashima, H; Segi, N; Funayama, T; Eto, F; Furuya, T; Yunde, A; Nakajima, H; Yamada, T; Hasegawa, T; Terashima, Y; Hirota, R; Suzuki, H; Imajo, Y; Ikegami, S; Tonomura, H; Sakata, M; Hashimoto, K; Kawaguchi, K; Suzuki, N; Uei, H; Nakanishi, K; Terai, H; Inoue, G; Kiyasu, K; Iizuka, Y; Akeda, K; Funao, H; Oshima, Y; Kaito, T; Yoshii, T; Ishihara, M; Okada, S; Imagama, S; Kato, S

GLOBAL SPINE JOURNAL Vol. 15 ( 4 ) page： 2274 - 2285 2025.5

Language：English Publisher：Global Spine Journal

Study Design: Retrospective study. Objectives: To investigate the impact of diabetes mellitus on neurological recovery and determine the relationship between moderate-severe diabetes and neurological recovery in patients with cervical spinal cord injury (CSCI) without bone injury. Methods: A retrospective study was conducted on 389 consecutive patients aged ≥65 years with CSCI without bone injury across 33 medical institutes. The patients were divided into a nondiabetic group (n = 270) and a diabetic group (n = 119). Neurological outcomes were compared between the two groups through propensity score matching. The impact of moderate-severe diabetes (defined as hemoglobin A1c ≥ 7.0% or requiring insulin treatment) on neurological recovery was evaluated through multiple linear regression analysis. Results: Propensity score matching revealed no significant differences between the diabetic and nondiabetic groups in terms of American Spinal Injury Association (ASIA) impairment scale grade and mean total ASIA motor scores (AMS) at 6 months post-injury. Multiple linear regression analysis indicated that age on admission (B = −0.34; 95% confidence interval [CI], −0.59 to −0.08; P = 0.01), dementia (B = −16.50; 95% CI, −24.99 to −8.01; P < 0.01), and baseline total AMS (B = −0.62; 95% CI, −0.72 to −0.51; P < 0.01) were negative predictors of neurological recovery at 6 months post-injury. The presence of moderate-severe diabetes did not influence neurological recovery at 6 months post-injury. Conclusions: Diabetic patients with CSCI without bone injury achieved improvements in neurological function comparable to those of nondiabetic patients. Moderate-severe diabetes did not affect neurological recovery in patients with CSCI without bone injury.

DOI： 10.1177/21925682241297587

Effects of Palliative Surgical Treatment for Spinal Metastases on the Patient's Quality of Life With a Focus on the Segment of the Metastasis: A Prospective Multicenter Study Reviewed Open Access

Segi, N; Nakashima, H; Ito, S; Ouchida, J; Shiratani, Y; Shimizu, T; Suzuki, A; Terai, H; Kakutani, K; Kanda, Y; Tominaga, H; Kawamura, I; Ishihara, M; Paku, M; Takahashi, Y; Funaba, M; Funayama, T; Nakajima, H; Akeda, K; Hirai, T; Inoue, H; Nakanishi, K; Funao, H; Oshigiri, T; Otsuki, B; Kobayakawa, K; Tanishima, S; Hashimoto, K; Iimura, T; Sawada, H; Uotani, K; Manabe, H; Iwai, C; Yamabe, D; Hiyama, A; Seki, S; Goto, Y; Miyazaki, M; Watanabe, K; Nakamae, T; Kaito, T; Nagoshi, N; Kato, S; Watanabe, K; Imagama, S; Inoue, G; Furuya, T

GLOBAL SPINE JOURNAL Vol. 15 ( 4 ) page： 2286 - 2299 2025.5

Language：English Publisher：Global Spine Journal

Study Design: Prospective multicenter study. Objectives: Palliative surgery is crucial for maintaining the quality of life (QOL) in patients with spinal metastases. This study aimed to compare the short-term outcomes of QOL after palliative surgery between patients with metastatic spinal tumors at different segments. Methods: We prospectively compared the data of 203 patients with spinal metastases at 2-3 consecutive segments who were divided into the following three groups: cervical, patients with cervical spine lesions; thoracic, patients with upper–middle thoracic spine lesions; and TL/L/S, patients with lesions at the thoracolumbar junction and lumbar and sacral regions. Preoperative and postoperative EuroQol 5-dimension (EQ5D) 5-level were compared. Results: All groups exhibited improvement in the Frankel grade, performance status, pain, Barthel index, EQ5D health state utility value (HSUV), and EQ5D visual analog scale (VAS) postoperatively. Although preoperative EQ5D HSUVs did not significantly differ between the groups (cervical, 0.461 ± 0.291; thoracic, 0.321 ± 0.292; and TL/L/S, 0.376 ± 0.272), the thoracic group exhibited significantly lower postoperative EQ5D HSUVs than the other two groups (cervical, 0.653 ± 0.233; thoracic, 0.513 ± 0.252; and TL/L/S, 0.624 ± 0.232). However, postoperative EQ5D VAS was not significantly different between the groups (cervical, 63.4 ± 25.8; thoracic, 54.7 ± 24.5; and TL/L/S, 61.7 ± 21.9). Conclusions: Palliative surgery for metastatic spinal tumors provided comparable QOL improvement, irrespective of the spinal segment involved. Patients with upper and middle thoracic spinal metastases had poorer QOL outcomes than those with metastases in other segments; however, sufficient QOL improvement was achieved.

DOI： 10.1177/21925682241297948

Impact of surgical treatment on patient reported outcome in patients with spinal metastases from prostate cancer Reviewed

Hirota, R; Oshigiri, T; Iesato, N; Emori, M; Teramoto, A; Shiratani, Y; Suzuki, A; Terai, H; Shimizu, T; Kakutani, K; Kanda, Y; Tominaga, H; Kawamura, I; Ishihara, M; Paku, M; Takahashi, Y; Funayama, T; Miura, K; Shirasawa, E; Inoue, H; Kimura, A; Iimura, T; Moridaira, H; Nakajima, H; Watanabe, S; Akeda, K; Takegami, N; Nakanishi, K; Sawada, H; Matsumoto, K; Funaba, M; Suzuki, H; Funao, H; Hirai, T; Otsuki, B; Kobayakawa, K; Uotani, K; Manabe, H; Tanishima, S; Hashimoto, K; Iwai, C; Yamabe, D; Hiyama, A; Seki, S; Goto, Y; Miyazaki, M; Watanabe, K; Nakamae, T; Kaito, T; Nakashima, H; Nagoshi, N; Kato, S; Imagama, S; Watanabe, K; Inoue, G; Furuya, T

JOURNAL OF ORTHOPAEDIC SCIENCE Vol. 30 ( 3 ) page： 423 - 432 2025.5

Language：English Publisher：Journal of Orthopaedic Science

Objective: This study aimed to elucidate postoperative outcomes in patients with spinal metastases of prostate cancer, with a focus on patient-oriented assessments. Methods: This was a prospective multicenter registry study involving 35 centers. A total of 413 patients enrolled in the Japanese Association for Spine Surgery and Oncology Multicenter Prospective Study of Surgery for Metastatic Spinal Tumors were evaluated for inclusion. The eligible patients were followed for at least 1 year after surgery. The Frankel Classification, Eastern Cooperative Oncology Group Performance Status, visual analog scale for pain, face scale, Barthel Index, vitality index, indications for oral pain medication, and the EQ-5D-5L questionnaire were used for evaluating functional status, activities of daily living, and patient motivation. Results: Of the 413 eligible patients, 41 with primary prostate cancer were included in the study. The patient-oriented assessments indicated that the patients experienced postoperative improvements in quality of life and motivation in most items, with the improvements extending for up to 6 months. More than half of the patients with Frankel classifications B or C showed improved neurological function at 1 month after surgery, and most patients presented maintained or improved their classification at 6 months. Conclusion: Surgical intervention for spinal metastases of prostate cancer significantly improved neurological function, quality of life, and motivation of the patients. Consequently, our results support the validity of surgical intervention for improving the neurological function and overall well-being of patients with spinal metastases of prostate cancer.

DOI： 10.1016/j.jos.2024.07.012

Meflin/Islr is a marker of fibroblasts that arise in fibrotic regions after spinal cord injury Reviewed

Morita, Y; Shiraki, Y; Kato, A; Nagatani, Y; Ando, R; Nakashima, H; Imagama, S; Enomoto, A

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 87 ( 2 ) page： 305 - 319 2025.5

Publisher：Nagoya Journal of Medical Science

Scar formation after spinal cord injury (SCI) hampers axonal regeneration and functional recovery. Previous studies have shown that scar formation is attributable to both gliosis and fibrosis, the latter requiring fibroblast proliferation and extracellular matrix deposition. In this setting, there are essentially two cell types generating new fibroblasts: pericytes and tissue-resident fibroblasts. Here, we showed that Meflin, a glycosylphosphatidylinositol-anchored protein (a specific marker of fibroblasts across multiple organs) is expressed by fibroblasts in the normal mouse spinal cord. An in situ hybridization analysis showed that Meflin<sup>+</sup> cells arose from the meninges and perivascular region of the spinal parenchyma after spinal cord compression injury. That finding was corroborated by single-cell transcriptomic data from normal and injured mouse spinal cords. Interestingly, Meflin<sup>+</sup> cells are positive for the fibroblast markers collagen type I and platelet-derived growth factor receptor (PDGFR) α but not for pericyte markers such as PDGFRβ and chondroitin sulfate proteoglycan 4 in the normal spinal cord. Those findings are consistent with the recent view that tissue-resident fibroblasts play a central role in many other types of fibrotic disease. A lineage-tracing experiment using a knock-in mouse line that expressed inducible Cre recombinase under the control of the Meflin promoter showed that Meflin<sup>+</sup> cells yield PDGFRβ<sup>+</sup> myofibroblasts but not glial cells positive for glial fibrillary acidic protein. These findings suggest that the Meflin<sup>+</sup> population contains the cells of origin of myofibroblasts that are involved in scar formation after SCI.

DOI： 10.18999/nagjms.87.2.305

Comparative outcomes of in-situ fixation and fixation after reduction in geriatric patients with severe valgus-impacted femoral neck fractures: a retrospective multicenter (TRON group) study Reviewed

Nobori, T; Takegami, Y; Tokutake, K; Nakashima, H; Mishima, K; Okamoto, M; Okui, N; Imagama, S

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 87 ( 2 ) page： 295 - 304 2025.5

Publisher：Nagoya Journal of Medical Science

The objective of this study was to evaluate and compare the clinical and radiographic outcomes between in situ fixation and fixation after reduction of severe valgus-impacted femoral neck fractures in patients aged 65 years or older. This was a multicenter retrospective study of 561 patients who underwent open reduction and internal fixation for femoral neck fracture. From this population, we selected patients aged 65 years and older with severe valgus-impacted femoral neck fractures characterized by a Garden alignment index greater than 15 degrees compared to that on the non-injury side. After exclusion criteria were applied, the study included 92 patients who were categorized into two groups: in situ fixation group (n = 56) and fixation after reduction group (n = 36). Our analysis covered patient demographics, surgical details, postoperative complications, radiographic evaluations, Numeric Rating Scale for pain, and Parker’s Mobility Score for clinical outcomes. Bone union was achieved in all patients. The incidence of avascular necrosis was consistent between the groups. Patients in the reduction group reported lower Numeric Rating Scale scores (mean: 0 vs 2, p = 0.003) and higher Parker’s Mobility Score scores (mean: 7 vs 6, p = 0.009) compared with the in situ group. Radiographically, the reduction group showed significantly lower femoral neck shortening (mean: 4.75 mm vs 5.75 mm, p = 0.049) and a reduced length of cannulated cancellous screw backout (mean: 3.4 mm vs 5.4 mm, p = 0.007) at the final follow-up. Fixation after reduction for severe valgus-impacted femoral neck fractures in patients aged 65 and above appears to be a safe and effective approach.

DOI： 10.18999/nagjms.87.2.295

Longitudinal transitions in frailty and health-related quality of life investigated by a 5-year community study Reviewed Open Access

Oishi, R; Segi, N; Okazaki, M; Ito, S; Ouchida, J; Yamauchi, I; Seki, T; Takegami, Y; Ishizuka, S; Hashizume, A; Hasegawa, Y; Imagama, S; Nakashima, H

SCIENTIFIC REPORTS Vol. 15 ( 1 ) page： 15162 2025.4

Language：English Publisher：Scientific Reports

The purpose of this study was to determine the association between frailty and quality of life (QOL) in a five-year longitudinal cohort of community-dwelling middle-aged and older adults and determine how to identify health-related QOL changes. This study included 124 volunteers (67 women; mean 65 years at baseline) who underwent health checkups in 2014 and 2019. The association between frailty status (robust, prefrail, frail), according to the Japanese Cardiovascular Health Study criteria, and health-related QOL, measured with the SF-36 questionnaire, were investigated. Five-year changes in frailty status were categorized into improved, maintained, and worsened groups. The baseline prevalence of prefrailty and frailty were 44.4% and 7.2%, respectively. Five years later, the frailty of 20 participants improved, 66 maintained frailty status, and frailty worsened in 38 participants. Significant trends toward higher scores on the physical component summary (PCS), role/social component summary (RCS), and subscales of physical functioning, role-physical, vitality, social functioning, and role-emotional were detected across groups with improvements in their frailty status from 2014 to 2019. The fully adjusted multivariable regression model revealed significantly higher PCS scores (β, 12.9; 95% confidence interval (CI), 6.0 to 19.9) and RCS scores (β, 13.6; 95% CI, 6.6 to 20.6) compared with the worsened group. In conclusion, this longitudinal cohort study demonstrates that frailty status is not static and improvements or maintenance of frailty are associated with better physical and social QOL outcomes. Addressing frailty early may reverse or mitigate its impact and improve the overall well-being of older adults.

DOI： 10.1038/s41598-025-99843-7

脊柱変形up-to-date Ⅲ.成人脊柱変形 2.診断成人脊柱変形における手術での矢状面アライメントの目標値 Reviewed

大内田隼, 中島宏彰, 伊藤定之, 世木直喜, 山内一平, 今釜史郎

別冊整形外科 Vol. 1 ( 87 ) page： 95 - 99 2025.4

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