Faculty Profiles - NAKASHIMA Hiroaki

Papers - NAKASHIMA Hiroaki

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Serum oxidative stress is associated with the progression of knee osteoarthritis: A 5-year longitudinal cohort in the Yakumo study

Ido, H; Nakashima, H; Seki, T; Takegami, Y; Osawa, Y; Iida, H; Ishizuka, S; Hasegawa, Y; Imagama, S

KNEE Vol. 56 page： 323 - 331 2025.10

Language：English Publisher：Knee

Introduction: Knee osteoarthritis (KOA) is a chronic degenerative disease characterized by a reduction in joint cartilage in the in-knee joint. However, few reports have investigated the relationship between serum reactive oxygen species (ROS) and KOA. We aimed to investigate whether oxidative stress, assessed using d-ROM and biological antioxidant potential (BAP), is associated with the severity and progression of KOA in community-dwelling individuals. Method: We enrolled 95 participants (190 knees) who participated in the Yakumo Study. We used a computer-aided diagnosis system for KOA to obtain the average joint space width (aJSW), minimal joint space width (mJSW), joint space area (JSA), and femorotibial angle; calculated the difference between JSW and JSA at 5 years and at baseline; and divided the study population into two groups based on median d-ROM and BAP values. Statistical analyses were conducted between the groups, including propensity score matching based on age, sex, body mass index, and medial mJSW at baseline between high d-ROMs (HD) and low d-ROMs (LD) groups. Results: The median values for the lateral and medial mJSW, aJSW, and JSA were significantly narrower in the HD group than in the LD group. The medial mJSW, aJSW and JSA at the 5-year follow-up were significantly narrower in the HD group than those in the LD group. Conclusions: Oxidative stress level was found to be associated with joint space narrowing and progression of joint space narrowing over the course of five years in clinical settings.

DOI： 10.1016/j.knee.2025.05.023

Recent progress in surgical treatment of cervical spine myelopathy - A narrative review. Open Access

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

Journal of clinical orthopaedics and trauma Vol. 68 page： 103074 2025.9

Language：English 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

住民検診におけるサルコペニアと酸化ストレスの関連

関泰輔, 竹上靖彦, 大澤郁介, 中島宏彰, 石塚真哉, 伊藤定之, 船橋洋人, 世木直喜, 井戸洋旭, 田中真矢, 今釜史郎

日本整形外科学会雑誌 Vol. 99 ( 8 ) page： S1760 - S1760 2025.9

腰椎椎間板ヘルニアによる神経障害性疼痛患者を対象にミロガバリンをNSAIDsに追加併用した際の有効性と安全性 Miro-Hers

鈴木秀典, 海渡貴司, 中島宏彰, 高橋浩, 山本周平, 田畑隼介, 豊田宏光

日本整形外科学会雑誌 Vol. 99 ( 8 ) page： S1856 - S1856 2025.9

Impact of Signal Intensity Change in MRI on the Clinical Outcomes of Cervical Ossification of the Posterior Longitudinal Ligament Reviewed

Nagoshi, N; Egawa, S; Yoshii, T; 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; Takahata, M; Mori, K; Nakajima, H; Murata, K; Miyagi, M; Kaito, T; Yamada, K; Banno, T; Kato, S; Ohba, T; Moridaira, H; Fujibayashi, S; Katoh, H; Kanno, H; Watanabe, K; Taneichi, H; Imagama, S; Kawaguchi, Y; Takeshita, K; Nakamura, M; Matsumoto, M; Yamazaki, M

SPINE Vol. 50 ( 15 ) page： 1019 - 1024 2025.8

Language：English Publisher：Spine

Study Design. A multicenter prospective cohort study. Objective. To evaluate the clinical significance of intramedullary signal intensity (SI) changes on T2-weighted magnetic resonance imaging (MRI) in patients with cervical ossification of the posterior longitudinal ligament (OPLL) and assess their impact on surgical outcomes. Summary of Background Data. In OPLL, SI changes on MRI are frequently observed, but their prognostic significance remains unclear. While some studies associate SI changes with poor neurological function and recovery, others report a weak correlation. Methods. A total of 402 patients with cervical OPLL were analyzed. Patients were classified into SI (+) and SI (-) groups based on preoperative T2-weighted MRI. Clinical outcomes, including the Japanese Orthopaedic Association (JOA) score, the visual analog scale, and the JOA Cervical Myelopathy Evaluation Questionnaire, were evaluated preoperatively and at two years postoperatively. Multiple regression and logistic regression were performed to adjust for confounders. Results. A total of 348 cases (86.6%) were in the SI (+) group. Patients in the SI (+) group were older and had greater cervical range of motion (ROM). They exhibited lower preoperative JOA scores and more severe extremity pain. However, at two-year follow-up, neurological improvement, pain reduction, and patient-reported outcomes did not differ significantly between groups. Conclusion. SI changes on MRI are associated with worse preoperative neurological function and greater pain but do not predict inferior surgical outcomes. Surgical decompression remains effective regardless of SI changes, which can be valuable information for explaining the prognosis to patients in clinical practice.

DOI： 10.1097/BRS.0000000000005355

Clinical outcomes of posterior lumbar interbody fusion in chronic renal failure patients on hemodialysis. Open Access

Hiroaki Nakashima, Sadayuki Ito, Naoki Segi, Jun Ouchida, Ippei Yamauchi, Koji Sato, Shiro Imagama

Nagoya journal of medical science Vol. 87 ( 3 ) page： 528 - 537 2025.8

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

Chronic kidney disease (CKD) and its treatment with hemodialysis (HD) pose unique challenges for spinal surgery due to complications such as destructive spondyloarthropathy (DSA). This study retrospectively compared the surgical outcomes of posterior lumbar interbody fusion (PLIF) between 48 HD patients and 57 non-HD controls. Patients with tumors, infections, prior spinal surgery, or severe osteoporosis were excluded. HD patients had a mean dialysis duration of 16.2 years, while controls were treated for degenerative lumbar conditions. HD patients exhibited significantly higher intraoperative blood loss (415.8 ± 231.7 mL vs 293.4 ± 57.3 mL, P < 0.001) and lower 2-year bony fusion rates (72.9% vs 94.7%, P = 0.008). Pseudoarthrosis and adjacent segment disease (ASD) were more common in the HD group, necessitating reoperation in five cases versus one in controls. Neurological recovery at 2 years was worse in the HD group, with a mean Japanese Orthopaedic Association score of 19.6 ± 4.3 compared to 26.5 ± 2.2 in controls (P < 0.01). Despite facilitating initial neurological recovery, PLIF outcomes in HD patients were compromised by greater complication rates, including pseudoarthrosis and ASD. Thus, PLIF facilitates early neurological improvement in HD patients, but long-term functional outcomes are compromised due to higher rates of pseudoarthrosis and ASD, necessitating careful long-term management. Strategies minimizing mechanical stress and maintaining spinal alignment could further support long-term patient recovery.

DOI： 10.18999/nagjms.87.3.528

Incidence and risk factors of cerebrospinal fluid leakage related complications after spinal intradural tumor resection. Open Access

Hiroaki Nakashima, Kyotaro Ota, Sadayuki Ito, Naoki Segi, Jun Ouchida, Ippei Yamauchi, Yukihito Ode, Shiro Imagama

Nagoya journal of medical science Vol. 87 ( 3 ) page： 521 - 527 2025.8

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

Cerebrospinal fluid (CSF) leakage is a common and serious complication of spinal surgery, particularly after intradural tumor resection. CSF leakage can lead to debilitating headaches, neurological deficits, and other symptoms, with an incidence rate of 0.3%-16%. This study aimed to investigate the incidence, risk factors, and outcomes of CSF-related complications in patients who underwent spinal intradural tumor surgery. This was a retrospective cohort study including 102 patients who underwent resection of intradural tumors, including ependymomas, astrocytomas, and meningiomas. Data were collected, including patient demographics, surgical details, and postoperative outcomes. The extent of CSF accumulation was evaluated using magnetic resonance imaging (MRI) findings. Statistical analyses were performed to identify risk factors for symptomatic CSF leakage. Postoperative CSF accumulation was observed in 94.1% of patients. Among them, 28.1% experienced symptomatic complications, such as severe headache (20.8%), unexplained fever (6.3%), and CSF leakage (3.1%). Patients with larger CSF accumulation, particularly subcutaneous accumulation, had a significantly higher incidence of symptomatic complications, with the highest rate observed in subfascial accumulation cases (P = 0.0002). Symptomatic patients did not show significant differences in age, sex, surgical level, drainage duration, or blood loss compared to asymptomatic patients. Additionally, the use of artificial dura mater did not significantly affect symptomatic outcomes. Predicting the occurrence of symptoms based on preoperative and surgical factors remains challenging. However, patients with subfascial CSF accumulation were more likely to develop symptoms, highlighting the necessity of confirming CSF accumulation using MRI for appropriate postoperative management.

DOI： 10.18999/nagjms.87.3.521

Dietary intake and its association with sarcopenia in older adults: a cross-sectional analysis. Open Access

Hiroaki Nakashima, Sadayuki Ito, Naoki Segi, Jun Ouchida, Ippei Yamauchi, Yasuhiko Takegami, Shinya Ishizuka, Kenji Wakai, Yukiharu Hasegawa, Shiro Imagama

Nagoya journal of medical science Vol. 87 ( 3 ) page： 451 - 461 2025.8

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

Sarcopenia, a condition characterized by the loss of muscle mass and function, poses a major health challenge among older adults. Identifying nutritional factors and dietary patterns associated with sarcopenia is critical for developing targeted interventions. This study analyzed data from 584 community-dwelling older adults (245 male, 339 female) enrolled in the Yakumo Study to investigate the relationship between dietary factors and sarcopenia. Nutritional intake was assessed using a validated Food Frequency Questionnaire (FFQ), while dietary diversity was evaluated using dietary variety score (DVS). Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) criteria, based on skeletal muscle mass, hand grip strength, and walking speed. The prevalence of sarcopenia in the study population was 7.4%. Nutritional intake of individual nutrients, such as protein and vitamin D, did not significantly differ between sarcopenic and non-sarcopenic participants. However, the intake rates for total calories, dietary fiber, vitamin B1, vitamin B2, and vitamin C were significantly higher in the sarcopenia group. No significant differences were found in DVS, and no correlations were found between DVS scores and skeletal muscle mass index, grip strength, or walking speed. These results may indicate that factors beyond nutrient intake-such as nutrient absorption, utilization, and metabolic efficiency-play a pivotal role in sarcopenia development.

DOI： 10.18999/nagjms.87.3.451

Current status of indirect decompression with lateral lumbar interbody fusion. Open Access

Hiroaki Nakashima, Sadayuki Ito, Naoki Segi, Jun Ouchida, Ippei Yamauchi, Yoshinori Morita, Tokumi Kanemura, Shiro Imagama

Nagoya journal of medical science Vol. 87 ( 3 ) page： 381 - 391 2025.8

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

The adoption of lumbar fusion techniques, particularly lateral lumbar interbody fusion (LLIF), has significantly evolved the management of degenerative lumbar spinal conditions. LLIF, introduced as a minimally invasive surgical procedure, offers the advantage of indirect neural decompression and robust bone fusion using large interbody cages, reducing complications such as cage subsidence and nerve injuries. Systematic reviews have indicated that LLIF was effective for foraminal decompression, although evidence regarding its effectiveness for spinal canal and lateral recess decompression remains limited. Comparisons between indirect decompression techniques like LLIF and direct methods (posterior lumbar interbody fusion and transforaminal lumbar interbody fusion) have revealed that while indirect approaches generally promoted lower surgical times and blood loss, outcomes related to pain, disability, and complications were comparable. Indirect decompression with LLIF should be approached cautiously or avoided in patients with severe stenosis or preoperative neurological impairments due to the increased risk for postoperative complications. Furthermore, meticulous surgical planning and advanced imaging techniques are essential for mitigating risks such as vascular, bowel, and ureteral injuries. Continued advancements in surgical instrumentation and navigation technologies are expected to further refine the utility of LLIF in treating complex spinal pathologies, offering a promising minimally invasive option for achieving effective spinal stabilization and decompression.

DOI： 10.18999/nagjms.87.3.381

Comparative analysis of bone regeneration in critical-sized defects using self-assembling peptide hydrogel-178, bone morphogenetic protein-2, and calcium phosphate scaffolds in a rat femur model. Open Access

Ippei Yamauchi, Hiroaki Nakashima, Sadayuki Ito, Naoki Segi, Jun Ouchida, Yoshinori Morita, Yukihito Ode, Yasuhiro Nagatani, Yuya Okada, Kei Ando, Shiro Imagama

Nagoya journal of medical science Vol. 87 ( 3 ) page： 421 - 430 2025.8

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

Bone regeneration is a highly demanded but challenging clinical endeavor in orthopedic surgery, necessitating the development of alternative bone grafting materials. This study aimed to evaluate the bone regenerative potential of self-assembling peptide hydrogel (0.8%), bone morphogenetic protein-2 (50 ng/μL), hydroxyapatite, and β-tricalcium phosphate, both individually and in combination with bone chips, in a rat femoral defect model. Ten-week-old female Wistar rats underwent surgical implantation of a polyetheretherketone cage into a 5-mm bony defect within the left femoral mid-shaft, maintained by an external fixator. Polyetheretherketone cages were filled with bone substitute materials alone in the first experiment and with bone substitute materials combined with bone chips in the second experiment. Radiographic and histological analyses were conducted following sacrifice at 56 weeks. While self-assembling peptide hydrogel alone exhibited moderate bone formation, with a bone-volume-to-total-volume ratio of 0.34 ± 0.09, this value was not significantly higher than that of the control group with an empty polyetheretherketone cage. Conversely, the combination of bone morphogenetic protein-2 with bone chips produced the highest level of bone regeneration, with a bone-volume-to-total-volume ratio of 0.78 ± 0.05, significantly surpassing bone chips alone (p < 0.01) and self-assembling peptide hydrogel with bone chips (p < 0.05). These findings suggest that while self-assembling peptide hydrogel holds potential as a scaffold material, particularly in minimally invasive applications, its efficacy in promoting robust bone regeneration may benefit from the inclusion of osteoinductive factors, such as bone morphogenetic protein-2.

DOI： 10.18999/nagjms.87.3.421

Preliminary observations on neuromuscular pathways of the lower extremities: findings from intraoperative nerve root stimulation. Open Access

Hiroaki Nakashima, Go Yoshida, Tokumi Kanemura, Sadayuki Ito, Naoki Segi, Jun Ouchida, Mikito Tsushima, Hiroyuki Tomita, Kazuaki Morishita, Shiro Imagama

Nagoya journal of medical science Vol. 87 ( 3 ) page： 538 - 545 2025.8

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

The segmental innervation patterns of lower extremity muscles remain poorly defined, despite their critical importance in both clinical diagnosis and surgical planning for lumbar spinal conditions. Variability in these patterns, particularly under chronic nerve root compression, complicates the development of accurate diagnostic and therapeutic strategies. This study aimed to elucidate the segmental innervation patterns of lower extremity muscles through intraoperative nerve root stimulation during lumbar spinal surgery combined with motor evoked potential (MEP) during lumbar spinal surgery. A total of 30 patients diagnosed with unilateral nerve root impairment due to degenerative lumbar canal stenosis were enrolled in this study. All patients provided informed consent, demonstrated lower extremity muscle strength graded 4 or higher on the manual muscle test, and were scheduled for surgeries that enabled direct visualization of bilateral nerve roots. During the surgical procedures, 128 lumbosacral nerve roots (L2-S1) were stimulated using a monopolar stimulator, and MEPs were recorded from key lower extremity muscles, including the vastus lateralis, tibialis anterior, and medial gastrocnemius. The vastus lateralis muscle was consistently innervated by the L2 root in 100% of cases, confirming a stable and reproducible pattern. In contrast, stimulation of the L5 root revealed notable anomalies in 8% of cases, where compensatory mechanisms or anatomical anomalies appeared to alter the expected innervation patterns. Furthermore, differences in muscle innervation between the left and right sides were observed in 39% of tested nerve roots, with variability being particularly pronounced in lower lumbar levels, such as L4, L5, and S1.

DOI： 10.18999/nagjms.87.3.538

The significance of adding posterior decompression to spine stabilization in metastatic spinal surgery: a multicenter prospective study. International journal Open Access

Hiroyuki Tominaga, Ichiro Kawamura, Hirofumi Shimada, Hiromi Sasaki, Noboru Taniguchi, Yuki Shiratani, Akinobu Suzuki, Hidetomi Terai, Takaki Shimizu, Kenichiro Kakutani, Yutaro Kanda, Masayuki Ishihara, Masaaki Paku, Yohei Takahashi, Toru Funayama, Kousei Miura, Eiki Shirasawa, Hirokazu Inoue, Atsushi Kimura, Takuya Iimura, Hiroshi Moridaira, Hideaki Nakajima, Shuji Watanabe, Koji Akeda, Norihiko Takegami, Kazuo Nakanishi, Hirokatsu Sawada, Koji Matsumoto, Masahiro Funaba, Hidenori Suzuki, Haruki Funao, Tsutomu Oshigiri, Takashi Hirai, Bungo Otsuki, Kazu Kobayakawa, Koji Uotani, Hiroaki Manabe, Shinji Tanishima, Ko Hashimoto, Chizuo Iwai, Daisuke Yamabe, Akihiko Hiyama, Shoji Seki, Yuta Goto, Masashi Miyazaki, Kazuyuki Watanabe, Toshio Nakamae, Takashi Kaito, Hiroaki Nakashima, Narihito Nagoshi, Satoshi Kato, Shiro Imagama, Kota Watanabe, Gen Inoue, Takeo Furuya

Scientific reports Vol. 15 ( 1 ) page： 27684 - 27684 2025.7

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

The usefulness of spine stabilization for treating metastatic spinal tumors with tumor-induced instability has been reported. However, no reports have prospectively evaluated the effectiveness of adding posterior decompression to stabilization surgery for improving symptoms. This multicenter prospective study aimed to determine whether adding posterior decompression to spine stabilization surgery for metastatic spinal tumors affects postoperative outcomes and complications. A total of 263 patients who underwent spine stabilization with (n = 189) or without (n = 74) decompression were analyzed. Patient demographics, the Spinal Instability Neoplastic Score (SINS), and the Epidural Spinal Cord Compression (ESCC) score were recorded. The outcomes were assessed preoperatively and at 1 and 6 months postoperatively in terms of neurological status, the Barthel Index, the EQ-5D-5 L, and the visual analog scale (VAS). Decompression was primarily performed in patients with severe neurological deficits and high-grade ESCC. Both groups showed postoperative improvement. Propensity score matching was applied to adjust for baseline differences. After matching, there were no significant differences in functional improvement between the decompression and nondecompression groups, and the complication rates were comparable. In matched patients presenting primarily with spinal instability and pain, the addition of decompression did not appear to confer a significant functional benefit within 6 months postoperatively.

DOI： 10.1038/s41598-025-12485-7

The Utility of a Prediction Model Using Neurological Examination Findings for Diagnosing Degenerative Cervical Myelopathy.

Funaba M, Nakashima H, Tetreault L, Suzuki H, Yukawa Y, Nishida N, Fujimoto K, Ichihara K, Ito S, Segi N, Ouchida J, Imagama S, Sakai T

The Journal of bone and joint surgery. American volume 2025.7

Survival days of patients with metastatic spinal tumors of lung cancer requiring surgery: a prospective multicenter study

Takahashi, T; Hirai, T; Shiratani, Y; Suzuki, A; Kakutani, K; Kato, S; Tominaga, H; Inoue, H; Sawada, H; Takegami, N; Nakanishi, K; Nakajima, H; Ishihara, M; Oshigiri, T; Funayama, T; Iimura, T; Tanishima, S; Nakashima, H; Yamabe, D; Hashimoto, K; Uotani, K; Funaba, M; Nagoshi, N; Kobayakawa, K; Yoshii, T; Watanabe, K; Nakamae, T; Kaito, T; Inoue, G; Imagama, S; Watanabe, K; Furuya, T

SCIENTIFIC REPORTS Vol. 15 ( 1 ) page： 24117 2025.7

Language：English Publisher：Scientific Reports

Surgery for metastatic spinal tumors has improved postoperative activities of daily living. A few studies reported on prognostic factors assessed in large multicenter prospective studies for metastatic spinal tumors of lung cancer origin. This study aimed to determine preoperative prognostic factors in patients undergoing surgery for metastatic spinal tumors associated with lung cancer. This prospective registry study included 74 patients diagnosed and operated with metastatic spine tumors derived from lung cancer in 39 high-volume cancer centers. We examined the postoperative survival period and the preoperative factors related to postoperative survival time. We conducted univariate and multivariate Cox regression analyses to determine preoperative prognostic factors. The mean postoperative survival period was 343 days. Multivariate Cox regression analysis revealed a higher feeding score of vitality index, indications for molecularly targeted therapy, and a higher mobility score of Barthel index as independent factors associated with postoperative survival time in metastatic spinal tumors derived from lung cancer. Patients with indications for molecular-targeted therapy and good vitality exhibited longer survival. These results may help in surgical selection for patients with metastatic spinal tumors derived from lung cancer.

DOI： 10.1038/s41598-025-08775-9

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 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

Preoperative Low Lumbar Hounsfield Units and Global Alignment Predict Postoperative Mechanical Complications After Adult Spinal Deformity Surgery: A Multicenter Retrospective Study

Yamauchi, I; Nakashima, H; Ito, S; Segi, N; Ouchida, J; Morita, Y; Ode, Y; Nagatani, Y; Okada, Y; Takeichi, Y; Kagami, Y; Tachi, H; Ohshima, K; Oyama, H; Ogura, K; Miyairi, Y; Oishi, R; Morishita, K; Shinjo, R; Ohara, T; Tsuji, T; Kanemura, T; Imagama, S

JOURNAL OF CLINICAL MEDICINE Vol. 14 ( 12 ) 2025.6

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

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