研究者詳細 - 中島　宏彰

論文 - 中島　宏彰

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Clinical Outcomes Associated with Screw Loosening in S2 Alar-Iliac Fixation in Adult Spinal Deformity 査読有り Open Access

Nagatani, Y; Nakashima, H; Kanemura, T; Tsushima, M; Tomita, H; Morishita, K; Oyama, H; Ito, S; Segi, N; Ouchida, J; Yamauchi, I; Ode, Y; Okada, Y; Imagama, S

JOURNAL OF CLINICAL MEDICINE 14 巻 ( 6 ) 2025年3月

記述言語：英語出版者・発行元：Journal of Clinical Medicine

Purpose: To explore the clinical outcomes associated with screw loosening after S2 alar-iliac (SAI) screw fixation for adult spinal deformity (ASD). Overview of the literature: SAI fixation is widely used in ASD corrective surgery; despite the biomechanical advantages of this screw, complications such as screw loosening remain a significant concern. Methods: We retrospectively reviewed 27 patients undergoing corrective surgery for ASD using SAI as the distal fixation point at a single institution between February 2013 and February 2018. Patients were divided into non-loosening (N) and loosening (L) groups based on radiological evidence of screw loosening (radiolucent area of 1 mm around the screw) and compared for demographic characteristics, bone mineral density (T-score), spinal alignment parameters, and patient-reported outcome using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) scores. Results: Screw loosening was observed in 78% of patients (n = 21/27); however, there were no statistically significant differences between the N and L groups in terms of the preoperative and 5-year postoperative JOABPEQ scores (p > 0.05 across all domains) and spinal sagittal alignment (p > 0.05). The improvements achieved through corrective surgery were largely maintained regardless of the presence of screw loosening. Conclusions: SAI screw loosening is a common sequela in ASD surgery; however, its loosening might not affect long-term clinical outcomes. Therefore, the choice of fixation should be individualized based on patient factors such as age and bone quality.

DOI： 10.3390/jcm14061881

Pelvic ring ratio: a novel indicator of comprehensive pelvic alignment assessment Open Access

Nakashima, H; Kawakami, N; Ito, S; Segi, N; Ouchida, J; Yamauchi, I; Kanemura, T; Imagama, S

ASIAN SPINE JOURNAL 2025年3月

Predicting Postoperative Neurological Outcomes in Metastatic Spinal Tumor Surgery Using Machine Learning. 査読有り

Maki S, Shiratani Y, Orita S, Suzuki A, Tamai K, 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, Oshigiri T, Hirai T, Otsuki B, Kobayakawa K, Uotani K, Manabe H, Tanishima S, Hashimoto K, Iwai C, Yamabe D, Hiyama A, Seki S, Kato K, Miyazaki M, Watanabe K, Nakamae T, Kaito T, Nakashima H, Nagoshi N, Inoue G, Imagama S, Watanabe K, Kato S, Ohtori S, Furuya T, JASA Study Group

Spine 2025年3月

記述言語：英語出版者・発行元：Spine

Study Design. Retrospective analysis of data collected across multiple centers. Objective. To develop machine learning models for predicting neurological outcomes one month postoperatively in patients with metastatic spinal tumors undergoing surgery, and to identify key factors influencing neurological recovery. Summary of Background Data. The increasing prevalence of spinal metastases has led to a growing need for surgical intervention to address mechanical instability and neurological deficits. Predicting postoperative neurological status, as assessed by the Frankel classification, can provide valuable insights for surgical planning and patient counseling. Traditional prognostic models have shown limitations in capturing the complexity of neurological recovery patterns. Methods. We analyzed data from 244 patients who underwent spinal surgery for metastatic disease across 38 institutions. The primary outcome was functional ambulation, defined as Frankel grades D or E at one month postoperatively. Four machine learning algorithms (Random Forest, XGBoost, LightGBM, and CatBoost) were used to build predictive models. Feature selection employed the Boruta algorithm and Variance Inflation Factor analysis to reduce multicollinearity. Results. Among the 244 patients, the proportion of ambulatory patients (Frankel grades D or E) increased from 36.8% preoperatively to 63.1% at one month postoperatively. The Random Forest model achieved the highest area under the receiver operating characteristic curve (AUC-ROC) of 0.8516, followed by XGBoost (0.8351), CatBoost (0.8331), and LightGBM (0.8098). SHapley Additive exPlanations analysis identified preoperative Frankel classification, transfer ability, inflammatory markers (C-reactive protein, white blood cell-lymphocyte), and surgical timing as the most important predictors of postoperative outcomes. Conclusions. Machine learning models showed strong predictive performance in assessing postoperative neurological status for patients with metastatic spinal tumors. Key factors including preoperative neurological function, functional ability, and inflammation markers significantly influenced outcomes. These findings could inform surgical decision-making and help set realistic postoperative expectations while potentially improving patient care through more accurate outcome prediction.

DOI： 10.1097/BRS.0000000000005322

Early Versus Delayed Surgery for Elderly Traumatic Cervical Spinal Injury: A Nationwide Multicenter Study in Japan 査読有り Open Access

Segi, N; Nakashima, H; Ito, S; Yokogawa, N; Sasagawa, T; Watanabe, K; Nori, S; Funayama, T; Eto, F; Nakajima, H; Terashima, Y; Hirota, R; Hashimoto, K; Onoda, Y; Furuya, T; Yunde, A; Ikegami, S; Uehara, M; Suzuki, H; Imajo, Y; Uei, H; Sawada, H; Kawaguchi, K; Nakanishi, K; Suzuki, N; Oshima, Y; Hasegawa, T; Iizuka, Y; Tonomura, H; Terai, H; Akeda, K; Seki, S; Ishihara, M; Inoue, G; Funao, H; Yoshii, T; Kaito, T; Kiyasu, K; Tominaga, H; Kakutani, K; Sakai, D; Ohba, T; Otsuki, B; Miyazaki, M; Murotani, K; Okada, S; Imagama, S; Kato, S

GLOBAL SPINE JOURNAL 15 巻 ( 2 ) 頁： 1143 - 1154 2025年3月

記述言語：英語出版者・発行元：Global Spine Journal

Study Design: Retrospective multicenter study. Objectives: The effectiveness of early surgery for cervical spinal injury (CSI) has been demonstrated. However, whether early surgery improves outcomes in the elderly remains unclear. This study investigated whether early surgery for CSI in elderly affects complication rates and neurological outcomes. Methods: This retrospective multicenter study included 462 patients. We included patients with traumatic acute cervical spinal cord injury aged ≥65 years who were treated surgically, whereas patients with American Spinal Injury Association (ASIA) Impairment Scale E, those with unknown operative procedures, and those waiting for surgery for >1 month were excluded. The minimum follow-up period was 6 months. Sixty-five patients (early group, 14.1%) underwent surgical treatment within 24 hours, whereas the remaining 397 patients (85.9%) underwent surgery on a standby basis (delayed group). The propensity score-matched cohorts of 63 cases were compared. Results: Patients in the early group were significantly younger, had significantly more subaxial dislocations (and fractures), tetraplegia, significantly lower ASIA motor scores, and ambulatory abilities 6 months after injury. However, no significant differences in the rate of complications, ambulatory abilities, or ASIA Impairment Scale scores 6 months after injury were observed between the matched cohorts. At 6 months after injury, 61% of the patients in the early group (25% unsupported and 36% supported) and 53% of the patients in the delayed group (34% unsupported and 19% supported) were ambulatory. Conclusions: Early surgery is possible for CSI in elderly patients as the matched cohort reveals no significant difference in complication rates and neurological or ambulatory recovery between the early and delayed surgery groups.

DOI： 10.1177/21925682241227430

Fracture of the patella involving inferior pole is associated with postoperative patella baja - A retrospective multicenter study 査読有り

Murase, F; Takegami, Y; Tokutake, K; Oyama, H; Arakawa, O; Takatsu, T; Nakashima, H; Mishima, K; Imagama, S

JOURNAL OF ORTHOPAEDIC SCIENCE 30 巻 ( 2 ) 頁： 379 - 384 2025年3月

記述言語：英語出版者・発行元：Journal of Orthopaedic Science

Background: The patella fracture involving of inferior pole fractures (IPF) may be associated with patella baja, However, the clinical impact of this condition remains unclear. This study aims to clarify 1) the incidence of patella baja following patellar fracture surgery, 2) the associated clinical outcomes with and without the presence of patella baja, and 3) the potential correlation between the detection of IPF on CT and the occurrence of patella baja. Methods: We conducted a retrospective multicenter study involving 251 patients who underwent surgical treatment for patellar fractures. Patients were divided into the patella baja (PB; n = 49) group and patella norma (PN; n = 202) group. Data collected included demographics, radiographic findings, surgical details, and postoperative complications. We compared these items between PB group and PN group. Logistic regression analyses were used to identify risk factors for patella baja. Results: Immediately following surgery, 36 (14.3%) patients presented with patella baja which increased to 49 cases (19.5%) at six months postoperatively. There is no statistically significant difference in the demographics, surgical details, clinical outcomes and complication between PB group and PN group. While, in the radiographical assessment, the prevalence of IPF on CT scan in the patella baja group was significantly higher than that in the patella norma group. By logistic regression analysis, IPFP on CT was identified as an independent risk factor for patella baja. (odds ratio 2.11, 95% confidence interval: 1.03–4.33, p = 0.042). Conclusion: In patients with patellar fractures, the incidence of patella baja increased from 14.3% immediately post-surgery to 19.5% at the six-month check-up. No significant differences were observed in clinical outcomes between the patella baja group and the norma group. The patella fracture involving IPF on CT emerged as a predictive factor for patella baja.

DOI： 10.1016/j.jos.2024.03.008

Impact of Preoperative Motor Status for the Positive Predictive Value of Transcranial Motor-Evoked Potentials Alerts in Thoracic Spine Surgery: A Prospective Multicenter Study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research 査読有り Open Access

Funaba, M; Kanchiku, T; Yoshida, G; Machino, M; Ushirozako, H; Kawabata, S; Ando, M; Yamada, K; Iwasaki, H; Shigematsu, H; Fujiwara, Y; Tadokoro, N; Takahashi, M; Taniguchi, S; Wada, K; Yamamoto, N; Yasuda, A; Morito, S; Hashimoto, J; Takatani, T; Kobayashi, K; Ando, K; Kurosu, K; Segi, N; Nakashima, H; Nakanishi, K; Takeshita, K; Matsuyama, Y; Imagama, S

GLOBAL SPINE JOURNAL 15 巻 ( 2 ) 頁： 506 - 517 2025年3月

記述言語：英語出版者・発行元：Global Spine Journal

Study Design: Prospective multicenter study. Objective: To investigate the validity of transcranial motor-evoked potentials (Tc-MEP) in thoracic spine surgery and evaluate the impact of specific factors associated with positive predictive value (PPV). Methods: One thousand hundred and fifty-six cases of thoracic spine surgeries were examined by comparing patient backgrounds, disease type, preoperative motor status, and Tc-MEP alert timing. Tc-MEP alerts were defined as an amplitude decrease of more than 70% from the baseline waveform. Factors were compared according to preoperative motor status and the result of Tc-MEP alerts. Factors that showed significant differences were identified by univariate and multivariate analysis. Results: Overall sensitivity was 91.9% and specificity was 88.4%. The PPV was significantly higher in the preoperative motor deficits group than in the preoperative no-motor deficits group for both high-risk (60.3% vs 38.3%) and non-high-risk surgery groups (35.1% vs 12.8%). In multivariate logistic analysis, the significant factors associated with true positive were surgical maneuvers related to ossification of the posterior longitudinal ligament (odds ratio = 11.88; 95% CI: 3.17–44.55), resection of intradural intramedullary spinal cord tumor (odds ratio = 8.83; 95% CI: 2.89–27), preoperative motor deficit (odds ratio = 3.46; 95% CI: 1.64–7.3) and resection of intradural extramedullary spinal cord tumor (odds ratio = 3.0; 95% CI: 1.16–7.8). The significant factor associated with false positive was non-attributable alerts (odds ratio =.28; 95% CI:.09–.85). Conclusion: Surgeons are strongly encouraged to use Tc-MEP in patients with preoperative motor deficits, regardless of whether they are undergoing high-risk spine surgery or not. Knowledge of PPV characteristics will greatly assist in effective Tc-MEP enforcement and minimize neurological complications with appropriate interventions.

DOI： 10.1177/21925682231196454

Prognosis of Cervical Diffuse Idiopathic Skeletal Hyperostosis-Related Spine Injuries in Elderly Patients: Analyses of Both Fracture and Spinal Cord Injury Without Fracture 査読有り Open Access

Segi, N; Nakashima, H; Machino, M; Ito, S; Yokogawa, N; Sasagawa, T; Funayama, T; Eto, F; Yamaji, A; Watanabe, K; Nori, S; Takeda, K; Furuya, T; Yunde, A; Nakajima, H; Yamada, T; Hasegawa, T; Terashima, Y; Hirota, R; Suzuki, H; Imajo, Y; Ikegami, S; Uehara, M; Tonomura, H; Sakata, M; Hashimoto, K; Onoda, Y; Kawaguchi, K; Haruta, Y; Suzuki, N; Kato, K; Uei, H; Sawada, H; Nakanishi, K; Misaki, K; Terai, H; Tamai, K; Shirasawa, E; Inoue, G; Kakutani, K; Kakiuchi, Y; Iizuka, Y; Takasawa, E; Akeda, K; Takegami, N; Kiyasu, K; Tominaga, H; Tokumoto, H; Funao, H; Oshima, Y; Yoshii, T; Kaito, T; Sakai, D; Ohba, T; Seki, S; Otsuki, B; Ishihara, M; Miyazaki, M; Okada, S; Imagama, S; Kato, S

GLOBAL SPINE JOURNAL 15 巻 ( 2 ) 頁： 321 - 331 2025年3月

記述言語：英語出版者・発行元：Global Spine Journal

Study Design: Retrospective multicenter study. Objective: The purpose of this study was to compare the prognosis of elderly patients with injuries related to cervical diffuse idiopathic skeletal hyperostosis (cDISH) to matched control for each group, with and without fractures. Methods: The current multicenter study was a retrospective analysis of 140 patients aged 65 years or older with cDISH-related cervical spine injuries; 106 fractures and 34 spinal cord injuries without fracture were identified. Propensity score–matched cohorts from 1363 patients without cDISH were generated and compared. Logistic regression analysis was performed to determine the risk of early mortality for patients with cDISH-related injury. Results: Patients with cDISH-related injuries with fracture did not differ significantly in the incidence of each complication and ambulation or severity of paralysis compared to matched controls. In patients with cDISH-related injury without fracture, those who were nonambulatory at discharge comprised 55% vs 34% of controls, indicating significantly poorer ambulation in those with cDISH-related injuries (P =.023). There was no significant difference in the incidence of complications and ambulation or paralysis severity at 6 months as compared with controls. Fourteen patients died within 3 months. Logistic regression analysis identified complete paralysis (odds ratio [OR] 36.99) and age (OR 1.24) as significant risk factors for mortality. Conclusions: The current study showed no significant differences in the incidence of complications, ambulation outcomes between patients with cDISH-related injury with fracture and matched controls, and that the ambulation at discharge for patients with cDISH-related injury without fractures were significantly inferior to those of matched controls.

DOI： 10.1177/21925682231186757

Hangman's Fracture in Geriatric Population: A Nationwide Multicenter Study in Japan 査読有り Open Access

Yunde, A; Furuya, T; Orita, S; Ohtori, S; Yokogawa, N; Nakashima, H; Segi, N; Funayama, T; Ikegami, S; Nakajima, H; Watanabe, K; Hasegawa, T; Tonomura, H; Terashima, Y; Hashimoto, K; Suzuki, N; Uei, H; Kiyasu, K; Tominaga, H; Sakai, D; Kaito, T; Inoue, G; Okada, S; Imagama, S; Kato, S

GLOBAL SPINE JOURNAL 15 巻 ( 2 ) 頁： 921 - 929 2025年3月

出版者・発行元：Global Spine Journal

Study Design: Retrospective multicenter study. Objectives: To investigate the treatments of the geriatric population with hangman’s fractures using a multicenter database under the Japan Association of Spine Surgeons with Ambition (JASA). Methods: The multicenter database included data from 1512 patients. We employed the Levine and Edwards classification for categorizing hangman’s fractures. The study incorporated epidemiological data, including the prevalence of hangman’s fractures, patient age, and follow-up duration. Bony fusion rates and length of hospitalization were recorded for Type I and Type II fractures, and the degree of neurological impairment was assessed. Results: Hangman’s fractures represented 62 cases, accounting for 7.4% of all cervical spine injuries. The patients had an average age of 76.6 ± 6.5 years, and the mean duration of follow-up was 21.5 ± 23.6 months. The study found that the bony fusion rate for hangman’s fractures in the geriatric population was 88.9%. Surgical treatment was associated with a shorter hospitalization period for Type II fractures compared to conservative treatment. Thirteen cases of hangman’s fractures in the geriatric population, accounting for 21%, were complicated by spinal cord injury. Conclusions: This is the largest study to date on hangman’s fractures in geriatric population ≥65 years. Type I and Type II fractures, according to the Levine and Edwards classification, had a bony fusion rate of up to 90%. In patients with Type II fractures, surgical treatment led to a shorter initial hospital stay. Geriatric patients are at risk of spinal cord injury due to hangman’s fractures.

DOI： 10.1177/21925682231216925

Impact of Fixation Length for Single-Level Spinal Metastasis Surgery in the Elderly: A Multicenter Study. 査読有り Open Access

Ito H, Takegami Y, Nakashima H, Mishima K, Yamauchi K, Imagama S

Cureus 17 巻 ( 3 ) 頁： e80886 2025年3月

Impact of Paraspinal Muscle Degeneration on Surgical Outcomes and Radiographical Sagittal Alignment in Adult Spinal Deformity: A Multicenter Study 査読有り Open Access

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

NEUROSPINE 22 巻 ( 1 ) 頁： 30 - 37 2025年3月

記述言語：英語出版者・発行元：Neurospine

Objective: This multicenter study aimed to evaluate the impact of paravertebral muscles (PVMs) degeneration, particularly fat infiltration, on preoperative sagittal imbalance, and postoperative complications and sagittal alignment change in patients with adult spinal deformity (ASD). Methods: A retrospective analysis was conducted on 454 patients who underwent ASD surgery across 5 institutions. Patients were classified into 2 groups based on paraspinal muscle fat infiltration on MRI: those with significant infiltration (FI-PVM(+)) and those with minimal or no infiltration (FI-PVM(-)). Propensity score matching was performed to adjust for demographic factors and preoperative radiographical parameters. Spinopelvic parameters were assessed preoperatively, postoperatively, and at a 2-year follow-up. Mechanical complications were compared between the groups. Results: The FI-PVM(+) group showed greater sagittal vertical axis (86.4 ± 57.5 vs. 51.8 ± 59.2, p < 0.001) preoperatively and required more extensive surgical correction with a significantly greater number of fused vertebral levels (7.3 ± 3.7 vs. 6.7 ± 3.7, p < 0.039). After propensity score matching, both groups showed significant improvement in spinopelvic alignment postoperatively, maintained throughout the 2-year follow-up. However, the FI-PVM(+) group demonstrated a trend toward a higher incidence of distal junctional kyphosis (6.3% vs. 0.9%, p = 0.070) and exhibited significantly greater decrease in pelvic tilt postoperatively (4.3° ± 7.6° vs. 1.3° ± 8.2°, p = 0.006). Conclusion: Fat infiltration in PVM is associated with increased surgical complexity and a higher risk of mechanical complications. Preoperative assessment of muscle quality, along with targeted rehabilitation and closer postoperative monitoring, may be crucial for improving long-term outcomes in ASD surgery.

DOI： 10.14245/ns.2550248.124

特集これだけは避けたい! 脊椎脊髄手術の重篤な合併症とその対策胸椎OPLLに伴う脊髄障害査読有り

伊藤定之, 中島宏彰, 世木直喜, 大内田隼, 今釜史郎

脊椎脊髄ジャーナル 38 巻 ( 3 ) 頁： 147 - 154 2025年2月

Risk factors for residual neuropathic pain using specific screening tools in postoperative patients with ossification of the posterior longitudinal ligament of the cervical spine 査読有り

Ikeda, S; Miyagi, M; Inoue, G; Yoshii, T; Egawa, S; Sakai, K; Takahata, M; Endo, T; Tsutsui, S; Koda, M; Takahashi, H; Kato, S; Mori, K; Nakajima, H; Furuya, T; Maki, S; Kawaguchi, Y; Nishida, N; Kusano, K; Nakashima, H; Yokozeki, Y; Takaso, M; Yamazaki, M

EUROPEAN SPINE JOURNAL 2025年2月

記述言語：英語出版者・発行元：European Spine Journal

Purpose: Ageing, long illness duration, and poor preoperative Japanese Orthopaedic Association (JOA) score were reported to be risk factors for residual pain after cervical ossification of the posterior longitudinal ligament (cOPLL). In this study, we focused on residual neuropathic pain (NeP) and aimed to elucidate risk factors for residual NeP after cOPLL. Methods: Total of 234 patients who underwent cOPLL surgery were included. NeP was evaluated using painDETECT (PDQ) and Spine painDETECT (SPDQ) questionnaires. Score of ≥ 13 / ≥ 0 was defined as NeP for PDQ/SPDQ. Patient backgrounds factors, preoperative radiographic factors and surgical factors were reviewed, and comparisons between the NeP(+) and NeP(−) groups were made. Independent risk factors for residual NeP were evaluated using multiple logistic regression analysis. Results: Prevalence of residual NeP after cOPLL was 22.6% on PDQ and 55.1% on SPDQ. Preoperative JOA score was significantly lower in the NeP(+) group for PDQ compared with that in the NeP(−) group. Additionally, cervical lordosis angle was significantly lower in the NeP(+) group for SPDQ compared with that in the NeP(−) group. Following multiple logistic regression analysis, poor preoperative JOA score was identified as a risk factor for NeP on the PDQ. Poor preoperative JOA score and low cervical lordosis angle were identified as risk factors using the SPDQ. Conclusions: We found high prevalence of residual NeP after cOPLL. Patients with a poor preoperative JOA score and low cervical lordosis angle might be at risk for residual NeP after surgery evaluated by PDQ or SPDQ and should be monitored with greater care after surgery.

DOI： 10.1007/s00586-025-08722-2

A deep learning-based prediction model for prognosis of cervical spine injury: a Japanese multicenter survey 査読有り

Ito, S; Nakashima, H; Segi, N; Yokogawa, N; Sasagawa, T; Funayama, T; Eto, F; Yamaji, A; Watanabe, K; Nori, S; Takeda, K; Furuya, T; Yunde, A; Nakajima, H; Yamada, T; Hasegawa, T; Terashima, Y; Hirota, R; Suzuki, H; Imajo, Y; Ikegami, S; Uehara, M; Tonomura, H; Sakata, M; Hashimoto, K; Onoda, Y; Kawaguchi, K; Haruta, Y; Suzuki, N; Kato, K; Uei, H; Sawada, H; Nakanishi, K; Misaki, K; Terai, H; Tamai, K; Kuroda, A; Inoue, G; Kakutani, K; Kakiuchi, Y; Kiyasu, K; Tominaga, H; Tokumoto, H; Iizuka, Y; Takasawa, E; Akeda, K; Takegami, N; Funao, H; Oshima, Y; Kaito, T; Sakai, D; Yoshii, T; Ohba, T; Otsuki, B; Seki, S; Miyazaki, M; Ishihara, M; Oda, M; Okada, S; Imagama, S; Kato, S

EUROPEAN SPINE JOURNAL 2025年2月

記述言語：英語出版者・発行元：European Spine Journal

Purpose: Cervical spine injuries in the elderly (defined as individuals aged 65 years and older) are increasing, often resulting from falls and minor trauma. Prognosis varies widely, influenced by multiple factors. This study aimed to develop a deep-learning–based predictive model for post-injury outcomes. Methods: This study analyzed a nationwide dataset from the Japan Association of Spine Surgeons with Ambition, comprising 1512 elderly patients (aged 65 years and older) with cervical spine injuries from 2010 to 2020. Deep learning predictive models were constructed for residence, mobility, and the American Spinal Injury Association Impairment Scale (AIS). The model’s performance was compared with that of a traditional statistical analysis. Results: The deep-learning model predicted the residence and AIS outcomes with varying accuracies. The highest accuracy was observed in predicting residence one year post-injury. The model also identified that the AIS score at discharge was significantly predicted by upper extremity trauma, mobility, and elbow extension strength. The deep learning model highlighted factors, such as upper extremity trauma, that were not considered significant in the traditional statistical analysis. Conclusion: Our deep learning-based model offers a novel method for predicting outcomes following cervical spine injuries in the elderly population. The model is highly accurate and provides additional insights into potential prognostic factors. Such models can improve patient care and individualize future interventions.

DOI： 10.1007/s00586-025-08708-0

Surgical strategy for metastatic spinal tumors based on Spine Instability Neoplastic Score and patient-reported outcomes: JASA multicenter prospective study. 査読有り Open Access

Nakajima H, Watanabe S, Honjoh K, Kubota 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, Akeda K, Takegami N, Nakanishi K, Sawada H, Matsumoto K, Funaba M, Suzuki H, Funao H, Oshigiri T, 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 neurosurgery. Spine 42 巻 ( 2 ) 頁： 203 - 214 2025年2月

記述言語：英語出版者・発行元：Journal of Neurosurgery Spine

OBJECTIVE Instrumentation surgery in combination with radiotherapy (RT) is one of the key management strategies for patients with spinal metastases. However, the use of materials can affect the RT dose delivered to the tumor site and surrounding tissues, as well as hinder optimal postoperative tumor evaluation. The association of the preoperative Spine Instability Neoplastic Score (SINS) with the need for spinal stabilization and life expectancy are unclear. This multicenter prospective study aimed to investigate the current situation and make recommendations regarding the choice of surgical procedure based on the preoperative SINS and prospectively collected postoperative patient-reported outcomes (PROs). METHODS The study prospectively included 317 patients with spinal metastases who underwent palliative surgery and had a minimum follow-up period of 6 months. The survey items included SINS, patient background, and clinical data including surgical procedure, history of RT, prognosis, and PROs (i.e., the visual analog scale score, Faces Scale, Barthel Index, Vitality Index, and 5-level EQ-5D health survey) at baseline, and at 1 and 6 months after surgery. The association of preoperative SINS with life expectancy, PROs, and surgical procedures was examined using statistical analysis. RESULTS Preoperative SINS (three categories) had no association with life expectancy. All PROs evaluated in the study improved up to 6 months after surgery. Pain categories (visual analog scale score and/or Faces Scale) at baseline were correlated with preoperative SINS. As many as 90.9% of enrolled patients underwent fusion surgery, and even in SINS 0–6 cases, implants were used in 64.3% of patients. Postoperative RT was performed in 42.9% of the patients. However, prospective assessments of PROs showed no significant difference between surgical procedures (with and without fusion) in patients with SINS 0–9. In addition, no cases required conversion from noninstrumentation surgery to fusion surgery. CONCLUSIONS Although the choice of surgical procedure should be made on a case-by-case basis on the NOMS (neurological, oncological, mechanical, and systemic) framework, careful consideration is required to determine whether spinal stabilization is needed in patients with SINS ≤ 9, considering the patient’s background and the plan for postoperative adjuvant therapy.

DOI： 10.3171/2024.7.SPINE24340

Patterns of sitting spinal alignment in non-ambulatory scoliosis patients with paraplegia: an observational study 査読有り

Ouchida, J; Nakashima, H; Ohara, T; Machino, M; Ito, S; Segi, N; Yamauchi, I; Imagama, S

EUROPEAN SPINE JOURNAL 34 巻 ( 2 ) 頁： 556 - 564 2025年2月

記述言語：英語出版者・発行元：European Spine Journal

Purpose: To classify sagittal spinopelvic alignment patterns of non-ambulatory scoliosis patients with paraplegia based on lateral sitting radiographs and explore their relation to clinical background and physical function. Methods: We reviewed non-ambulatory scoliosis patients with paraplegia, excluding those with prior spinal surgery from a single-center database. Alignment patterns in sitting postures were classified into slump sitting (SS) and erect sitting (ES) based on the most posterior edge of the spine's location on lateral sitting radiographs. Radiographical spinopelvic sagittal alignment, demographics, and physical functions were analyzed. Clinical scoring for physical functions included Hoffer’s ambulator classification, Hoffer’s modified sitting classification, and the Modified Ashworth Score (MAS) for the severity of spasticity in the lower extremities. Percentages of patients without spasticity, with MAS of 0 indicating "no spasticity." were also compared between the two alignment patterns. Results: Of 172 patients screened, 86 met inclusion criteria, revealing two distinct alignment patterns: SS showed greater thoracic kyphosis, smaller lumbar lordosis, pelvic retroversion, and hip hyperflexion compared to ES. No significant differences in demographic data or curve patterns were observed between groups. The SS group had a significantly higher percentage of patients without spasticity compared to the ES group (39.2% vs. 14.3%, P = 0.016). Conclusion: Identified were two distinct sagittal alignment patterns in seated scoliosis patients with paraplegia, with potential influences from spasticity in the lower extremities. Recognizing these patterns can aid in assessing the function of sitting balance that includes the hip joint and in optimizing strategies for the treatment of scoliosis patients with paraplegia.

DOI： 10.1007/s00586-024-08584-0

Outcomes following instrumentation removal after posterior corrective fixation in adolescent idiopathic scoliosis 査読有り

Yamauchi, I; Nakashima, H; Ito, S; Segi, N; Ouchida, J; Morita, Y; Ode, Y; Nagatani, Y; Okada, Y; Tauchi, R; Ohara, T; Kawakami, N; Imagama, S

EUROPEAN SPINE JOURNAL 34 巻 ( 2 ) 頁： 635 - 642 2025年2月

記述言語：英語出版者・発行元：European Spine Journal

Purpose: To evaluate the complications and postoperative outcomes of implant removal after posterior fixation in adolescent idiopathic scoliosis. Methods: We retrospectively reviewed the data of patients who underwent implant removal after posterior corrective fixation for adolescent idiopathic scoliosis between 2002 and 2014. Complications were evaluated in the 116 patients who underwent implant removal at their choice. Radiological evaluations were performed and analyzed in 71 patients who were followed up for > 2 years after implant removal. Moreover, the patients were divided into two groups: those with increased thoracic kyphosis after implant removal and those without. Results: Overall, 14 of the 116 patients had complications. Two of the three patients with fractures required reoperation. Radiological examination revealed no significant difference in the scoliosis curvature in the coronal plane after implant removal. In the sagittal plane, the lowest instrumented vertebral tilt, cervical lordosis, T1 slope, T1–12 kyphosis angle, and T5–12 kyphosis angle were significantly increased. Moreover, patients with an increased T5–12 kyphosis angle after implant removal had greater pelvic incidence (PI) and sacral slope (SS) before implant removal. Conclusion: The prevalence of complications after implant removal in adolescent idiopathic scoliosis was 12.1%. Spinal alignment is more variable in the sagittal plane than in the coronal plane, and patients with increased thoracic kyphosis after implant removal have greater preoperative PI and SS. Sufficient preoperative explanation is necessary if a patient wishes to undergo implant removal.

DOI： 10.1007/s00586-024-08519-9

Impact of diffuse idiopathic skeletal hyperostosis on quality of life and locomotive syndrome in community-dwelling older adults: the Yakumo study 査読有り Open Access

Ohshima, K; Nakashima, H; Segi, N; Ito, S; Ouchida, J; Takegami, Y; Ishizuka, S; Yamauchi, I; Hasegawa, Y; Murotani, K; Imagama, S

SCIENTIFIC REPORTS 15 巻 ( 1 ) 頁： 3582 2025年1月

記述言語：英語出版者・発行元：Scientific Reports

Diffuse idiopathic skeletal hyperostosis (DISH) is a common disease in older adults that causes extensive spinal ankylosis. However, its impact on quality of life (QOL) and locomotive syndrome (LS) remains unknown. Thus, we aimed to evaluate the DISH effect on QOL and LS in community-dwelling middle-aged and older adults. Data of community volunteers who attended a health checkup in 2018–2019 were assessed. A total of 455 subjects were included. Whole spine lateral radiographs were obtained to detect DISH according to the Resnik criteria. QOL was evaluated using SF-36 and EQ5D HUSV. LS was evaluated using the stand-up and two-step tests and GLFS-25. Multivariate regression analysis was performed, adjusting for sex, age, body mass index, and knee osteoarthritis. Additionally, a sex-stratified analysis was performed. DISH was detected in 83 (18.2%) participants. Multivariate analysis demonstrated that DISH was significantly associated with low EQ5D HSUV. Multivariate analysis in men demonstrated that DISH was associated with low PCS, low EQ5D HSUV, high LS stage. Multivariate analysis in women demonstrated that DISH was not associated with any QOL or LS. DISH may be associated with a poor QOL. Additionally, DISH is more common and produces a greater clinical impact in men than in women.

DOI： 10.1038/s41598-025-87878-9

Difference of Disk Degeneration and Segmental Range of Motion due to Lumbar Disk Level among Age and Gender: 639 Asymptomatic Volunteer Data. Open Access

Yamada T, Nakashima H, Machino M, Matsuyama Y, Kato F, Yukawa Y

Spine surgery and related research 9 巻 ( 1 ) 頁： 87 - 92 2025年1月

記述言語：英語出版者・発行元：Spine Surgery and Related Research

Introduction: There is limited evidence between lumbar disk degeneration and normal lumbar segmental range of motions (SRMs), because previous studies were skewed by age and lacked large cohort of asymptomatic data. We aimed to characterize the normal lumbar SRMs according to age and gender and determine its association with disk degeneration. Methods: A total of 639 healthy Japanese volunteers (250 individuals of each decade of age from 20 to 79) without any symptom or morphological spinal abnormalities, who underwent lumbar radiograph and magnetic resonance image (MRI), were selected retrospectively. SRMs were evaluated by the flexion-extension radiographs taken in the recumbent position. Disk degenerations were assessed according to the Pfirrmann grade using MRI T2 imaging. Results: The mean SRMs became larger in the lower lumbar level. The range of the mean SRMs was smallest at L1-2 and largest at L4-5: 6 to 9 degrees at L1/2, to peaking at 11-14 degrees at L4/5 in male, and 6-8 degrees at L1/2, to peaking at 11-17 degrees at L4/5 in female. Lumbar disk degeneration progressed faster with age in the lower lumbar spine than in the upper lumbar level. SRM did not change depending on the severity of disk degeneration in upper lumbar spine, but significantly decreased with progressive disk degeneration in the lower lumbar spine. Conclusions: These findings could help to identify the normal lumbar SRMs that might be useful to evaluate the instability or inflexibility in the clinical situation. Furthermore, our results demonstrated the transition of the normative lumbar SRMs based on age, gender, and lumbar level.

DOI： 10.22603/ssrr.2024-0087

Trabecular Bone Remodeling after Lateral Lumbar Interbody Fusion: Indirect Findings for Stress Transmission between Vertebrae after Spinal Fusion Surgery. 査読有り Open Access

Segi N, Nakashima H, Ito S, Ouchida J, Oishi R, Yamauchi I, Miyairi Y, Morita Y, Tsushima M, Tomita H, Morishita K, Ohshima K, Kanemura T, Imagama S

Spine surgery and related research 9 巻 ( 1 ) 頁： 51 - 60 2025年1月

記述言語：英語出版者・発行元：Spine Surgery and Related Research

Introduction: After posterior lumbar interbody fusion (PLIF), trabecular bone remodeling (TBR) occurs in the vertebral body. This study aimed to investigate whether imaging findings obtained with PLIF are applicable to lateral lumbar interbody fusion (LLIF). Methods: A total of 53 cases who underwent one- or two-level LLIF with polyether ether ketone cage and posterior spinal fixation/fusion (PSF) were retrospectively included in this study. TBR, vertebral endplate cyst (VEC), facet union, and pseudarthrosis were investigated on computed tomography (CT) images at 3 months, 1 year, and 2 years postoperatively. Of the 53 patients, 36 (68%) who underwent CT examination at approximately 5 years postoperatively were subanalyzed. Results: TBR was commonly observed anterior to the cage on CT sagittal images. The TBR-positive rate was 21%, 67%, and 73% at 3 months, 1 year, and 2 years postoperatively, respectively. The 3-month TBR-positive segments showed significantly less VEC (0% vs. 29%, P=0.029) at 1 year postoperatively. The 1-year TBR-positive segments showed a significantly higher facet union rate (83% vs. 57%, P=0.019) and less pseudoarthrosis (0% vs. 13%, P=0.041) at 2 years postoperatively. At 5 years postoperatively, 50% of the 2-year TBR-positive segments turned negative with solid intervertebral bony fusion. Conclusions: TBR-positive segments had significantly lower future VEC positivity, higher future facet union rates, and lower future pseudarthrosis rates. In LLIF-PSF, TBR suggests the establishment of intervertebral stability and allows consideration of intervertebral biomechanics.

DOI： 10.22603/ssrr.2024-0054

特集びまん性特発性骨増殖症(DISH)に対する治療の現状 DISHの総論と疫学査読有り

中島宏彰, 伊藤定之, 世木直喜, 大内田隼, 山内一平, 都島幹人, 今釜史郎

脊椎脊髄ジャーナル 38 巻 ( 2 ) 頁： 56 - 60 2025年1月

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