論文 - 中島　宏彰

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

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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

Open Access

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Scopus

PubMed

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

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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

Open Access

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PubMed

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

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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

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PubMed

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

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記述言語：英語  

DOI： 10.7759/cureus.80886

Open Access

PubMed

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

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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

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PubMed

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

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出版者・発行元：三輪書店  

DOI： 10.11477/mf.091444120380030147

CiNii Research

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

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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

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PubMed

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

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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

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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

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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

Open Access

Scopus

PubMed

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

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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

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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

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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

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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

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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

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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

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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

Open Access

Scopus

PubMed

CiNii Research

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

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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

Open Access

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CiNii Research

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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担当区分：筆頭著者   出版者・発行元：三輪書店  

DOI： 10.11477/mf.091444120380020056

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腰仙椎手術における脊髄モニタリングの有効性―日本脊椎脊髄病学会脊髄モニタリング委員会6,196例の解析― 査読有り Open Access

高橋 雅人, 今釜 史郎, 重松 英樹, 舩場 真裕, 後迫 宏紀, 中西 一義, 町野 正明, 谷口 愼一郎, 藤原 靖, 小林 和克, 山本 直也, 山田 圭, 寒竹 司, 岩崎 博, 和田 簡一郎, 田所 伸朗, 安藤 圭, 安田 明正, 橋本 淳, 森戸 伸治, 黒須 健太, 中島 宏彰, 世木 直喜, 荒川 保雄, 高谷 恒範, 川端 茂徳, 安藤 宗治, 松山 幸弘, 竹下 克志, 吉田 剛

Journal of Spine Research   16 巻 ( 1 ) 頁： 9 - 16   2025年1月

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記述言語：日本語   出版者・発行元：一般社団法人 日本脊椎脊髄病学会  

<p><b>はじめに：</b>脊髄高位以外，すなわち馬尾高位である腰仙椎手術における脊髄モニタリングの有効性を，脊髄高位の頚胸椎手術と比較し検討した．</p><p><b>対象と方法：</b>多機関共同前向き研究．脊椎脊髄手術6,196例で頚胸椎群と腰仙椎群に分類した．アラームポイントは経頭蓋刺激-運動誘発電位（Tc-MEP）振幅変化率70%以上低下とした．主要評価項目は，感度，特異度，陽性・陰性的中率，陽性・陰性尤度比とした．副次評価項目は術後麻痺発生率，術後麻痺を生じるTc-MEP振幅変化率のカットオフ値とした．</p><p><b>結果：</b>頚胸椎群の感度，特異度，陽性・陰性的中率，陽性・陰性尤度比はそれぞれ77.6%，90.1%，21.1%，99.2%，7.9，0.2だった．腰仙椎群はそれぞれ60.7%，95.9%，23.0%，99.2%，14.8，0.4だった．腰仙椎群の感度は低い傾向だったが，特異度，陽性尤度比は有意に高かった．術後麻痺発生率は，頚胸椎群3.1%，腰仙椎群1.9%だった．Tc-MEP振幅変化率の最適カットオフ値は30%（ベースライン波形の70%低下）で，感度64.7%，特異度87.5%だった．</p><p><b>結語：</b>腰仙椎手術の脊髄モニタリングは，頚胸椎手術に比し感度が低い傾向にあったが，特異度，陽性尤度比は有意に高く，有効であった．</p>

DOI： 10.34371/jspineres.2023-0031

Open Access

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A nationwide multicenter study of the cost effectiveness of fi ve leading drugs for pharmacological management of cervicobrachial symptoms 査読有り

Wakao, N; Furuya, T; Yoshii, T; Arima, H; Yamato, Y; Nakashima, H; Imagama, S; Imajo, Y; Miyamoto, H; Inoue, G; Miyagi, M; Kanbara, S; Iizuka, Y; Chikuda, H; Watanabe, K; Kobayashi, K; Tsushima, M; Miyazaki, M; Yagi, M; Suzuki, S; Takahata, M; Hongo, M; Koda, M; Nagata, K; Mori, K; Suzuki, A; Kaito, T; Murotani, K; Miyakoshi, N; Hashizume, H; Matsuyama, Y; Kawakami, M; Haro, H

JOURNAL OF ORTHOPAEDIC SCIENCE   30 巻 ( 1 ) 頁： 18 - 24   2025年1月

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

Background: Cervicobrachial pain frequently affects the quality of life (QOL) of the general public and has a significant economic impact on the health care systems of various countries. There are a number of treatment options for this disease, including widely-used drug therapy, but the effectiveness of each option is indeterminate, and there have been no published cost-effectiveness analysis studies so far. This prospective observational study aimed to examine the cost-effectiveness of drug treatment for cervicobrachial symptoms. Methods: A 6-month medication regimen for each of five frequently-prescribed drugs for cervicobrachial symptoms was administered to 322 patients at 24 centers in Japan. Outcome measures, including of the EuroQol Group 5D, Short Form-8, and Visual Analog Scale (VAS), were investigated at baseline and every month thereafter. Incremental cost-effectiveness ratios (ICERs) of the drug cost to quality-adjusted life years (QALYs) were calculated. A stratified analysis of patient characteristics was also performed to identify baseline factors potentially affecting cost-effectiveness. Results: The ICER of entire drug treatment for cervicobrachial symptoms was 7,491,640 yen. Compared with the reference willingness-to-pay, the ICER was assumed to not be cost-effective. A certain number of QALYs were gained during the first 3 months after the treatment intervention, but almost no QALYs were gained during the following 3 months. Stratified analysis showed that cost-effectiveness was extremely low for patients with high baseline VAS and high QOL. Conclusions: The available medications for cervicobrachial symptoms did not have excellent cost-effectiveness. Although a certain number of QALYs were gained during the first 3 months after medication, no QALYs were gained in the latter half of the study period, suggesting that it is not advisable to continue the medication needlessly. Level of evidence: II, prospective cohort study.

DOI： 10.1016/j.jos.2023.12.004

Web of Science

Scopus

PubMed

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

Segi, N; Nakashima, H; Ito, S; Ouchida, J; Oishi, R; Yamauchi, I; Miyairi, Y; Morita, Y; Matsumoto, T; Kanbara, S; Ito, K; Imagama, S

GLOBAL SPINE JOURNAL   15 巻 ( 1 ) 頁： 66 - 75   2025年1月

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記述言語：英語   出版者・発行元：Global Spine Journal  

Study Design: Retrospective cohort study. Objectives: Imaging changes in the vertebral body after posterior lumbar interbody fusion (PLIF) are determined to be trabecular bone remodeling (TBR). This study aimed to investigate the influence of cage materials on TBR and segment stabilization in PLIF by studying image changes. Methods: This was a retrospective study reviewing 101 cases who underwent one-level PLIF with three-dimensional porous titanium (3DTi) cages (53 patients) or polyether-ether-ketone (PEEK) cages (48 patients). Computed tomography images obtained 3 months, 1 year, and 2 years postoperatively were examined for TBR, vertebral endplate cyst formation as an instability sign, cage subsidence, and clear zone around pedicle screw (CZPS). Results: No significant differences in the TBR-positivity rates were observed between the two cages at 3 months, 1 year, and 2 years postoperatively. However, all 3DTi cage segments that were TBR-positive at 3 months postoperatively showed no CZPS and fewer final instability segments than the TBR-negative segments (0% vs 9%). In contrast, although the PEEK cage segments that were TBR-positive at 3 months postoperatively were not associated with future segmental stabilization, those that were TBR-positive at 1 year postoperatively had fewer final instability segments than the TBR-negative segments (0% vs 33%). Conclusions: The 3DTi cage segments with TBR 3 months postoperatively showed significant final segmental stabilization, whereas TBR at 1 year rather than 3 months postoperatively was useful in determining final segmental stabilization for the PEEK cage segments. The timing of TBR, a new osseointegration assessment, were associated with the cage material.

DOI： 10.1177/21925682241255686

Open Access

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Scopus

PubMed

Characteristics of Poor Recordability of Intraoperative Neurophysiological Monitoring during Metastatic Spinal Tumor Surgery: A Multicenter Study 査読有り Open Access

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

SPINE SURGERY AND RELATED RESEARCH   9 巻 ( 2 ) 頁： 164 - 172   2025年

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

Introduction: The objective of this study is to investigate the poor recordability characteristics of intraoperative neurophysiological monitoring (IONM) for metastatic spinal tumors, focusing on tumor status or preoperative muscle weakness. Methods: A total of 132 patients (age 65.3±11.8 years; 82 men) with or without preoperative lower extremity muscle weakness were included in this study. The patients’ background characteristics, the presence and degree of pre- and postoperative muscle weakness, and the IONM outcome, including the availability of transcranial motor evoked potential (Tc-MEP) recording and the occurrence of Tc-MEP alarms, were investigated. The data between the groups with and without preoperative muscle weakness were compared. Logistic regression analysis was performed to identify the risk factors for unrecordable Tc-MEP. Results: Sixty-seven patients with muscle weakness had significantly more unrecordable Tc-MEP (19% vs. 5%, p=0.009) than the 65 patients without muscle weakness. The highest percentage of recordable Tc-MEP in the group with muscle weakness was noted in the plantar muscle (72%). Multivariate analysis identified manual muscle test (MMT) score of !3 (odds ratio [OR] 4.529) and ventral spinal cord compression by metastatic tumor (OR 3.924) as independent significant factors for unrecordable Tc-MEP. Conclusions: IONM for metastatic spinal cord tumors with muscle weakness had a high rate of unrecordable Tc-MEP. Additionally, Tc-MEP may not be detectable in cases of ventral spinal cord compression by a tumor; therefore, preoperative imaging should be thoroughly evaluated.

DOI： 10.22603/ssrr.2024-0260

Open Access

Web of Science

Scopus

PubMed

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Does Somatosensory-Evoked Potential Simultaneously Decrease with Transcranial Motor-Evoked Potential Alarm? A Multicenter Study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research 査読有り Open Access

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

SPINE SURGERY AND RELATED RESEARCH   9 巻 ( 2 ) 頁： 173 - 178   2025年

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

Introduction: Multimodal intraoperative neurophysiological monitoring (IONM)―such as monitoring muscle-evoked potentials after transcranial electrical stimulation (Tc-MEP) with somatosensory-evoked potential (SEP) after electrical stimulation of the peripheral nerve―is recommended in spine surgeries to prevent iatrogenic neurological complications. However, the effect of using Tc-MEP with SEP to protect against neurological complications, particularly motor function, remains unknown. In clinical settings, changes due to Tc-MEP meeting the alarm points must be a potential neurological injury. This retrospective study, focusing on true-positive (TP) cases, aimed to clarify the change in the SEP waveform simultaneously with the Tc-MEP alarm. Methods: We included 68 patients with TP who had Tc-MEP changes and new postoperative motor weakness at more than one level of the manual muscle test after surgery. We compared the cases based on the category of spine surgery and paralysis type. We evaluated sex, age at spine surgery (high- or non high-risk), and paralysis type (segmental, long tract, or both). We defined the alarm points as follows: >70% decrease in Tc-MEP wave amplitudes, >50% decrease in wave amplitudes, or 10% extension of SEP latency. Next, we evaluated the SEP wave changes with a Tc-MEP alarm. Results: All patients showed progressive motor weakness after surgery, and 21 patients (31%) showed SEP changes at the same time as the Tc-MEP alarm. There were no statistically significant differences in the ratio of SEP change between the two groups according to the spine surgery category or among the three groups according to the paralysis type. Conclusions: Multimodal IONM is an important tool. However, the SEP changes do not necessarily appear immediately after the Tc-MEP alarm. Spine surgeons should appropriately treat Tc-MEP alarms to preserve motor function, regardless of SEP changes.

DOI： 10.22603/ssrr.2024-0229

Open Access

Web of Science

Scopus

PubMed

CiNii Research