論文 - 中島　宏彰

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

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CiNii Research

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

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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

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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

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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

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Preoperative Planning for Cervical Pedicle Screw Placement: Identifying Key Morphological Parameters Open Access

Okada Y., Nakashima H., Ito S., Segi N., Ouchida J., Urasaki T., Imagama S.

Spine Surgery and Related Research   9 巻 ( 3 ) 頁： 313 - 320   2025年

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

Introduction: Cervical pedicle screw (CPS) placement is crucial for posterior cervical fusion surgery due to its strong fixation ability. However, CPS insertion is associated with risks, including screw perforation, which can lead to complications such as vertebral artery injury and neurological deficits. Although previous studies have explored some morphological factors affecting CPS placement, comprehensive data on specific parameters contributing to perforation remains limited. This study aimed to investigate cervical vertebrae features associated with CPS perforation and established threshold values for improved preoperative planning. Methods: A retrospective analysis of 36 patients who underwent posterior cervical fusion surgery with CPS placement was conducted using preoperative computed tomography (CT)-based navigation. Cases with CPS insertion at C1 or C2 were excluded. The key morphological parameters―optimal screw trajectory angle, pedicle diameter, and distance from the entry point to the pedicle isthmus (DEP)―were measured on preoperative CT images. CPS placement accuracy was assessed postoperatively using Neo’s classification. The receiver operating characteristic (ROC) curve analysis determined the cutoff values for predicting CPS perforation. Results: Among the 102 CPSs placed from C3 to C7, the overall perforation rate was 25.5%. C3 had the highest perforation rate (45.5%), whereas C7 had the lowest (3.1%). The vertebrae with CPS perforation exhibited a significantly larger optimal screw trajectory angle (45.5° vs. 38.0°, p<0.001), smaller pedicle diameter (4.2 mm vs. 5.2 mm, p<0.001), and longer DEP (13.2 mm vs. 11.9 mm, p=0.002). The ROC analysis identified the following cutoff values: 44.0° for the optimal angle, 4.35 mm for the pedicle diameter, and 12.7 mm for the DEP. These morphological parameters strongly predicted the risk of CPS perforation. Conclusions: Establishing key morphological thresholds enhances preoperative planning for CPS placement, improves accuracy and patient safety, and minimizes complications.

DOI： 10.22603/ssrr.2024-0243

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Impact of Nutritional Risk on Complications and Recovery in the Older People: A Geriatric Nutritional Risk Index-Based Study 査読有り Open Access

Ode Yukihito, Segi Naoki, Ito Sadayuki, Ouchida Jun, Yamauchi Ippei, Nagatani Yasuhiro, Okada Yuya, Takeichi Yosuke, Kagami Yujiro, Morishita Kazuaki, Oishi Ryotaro, Miyairi Yuichi, Morita Yoshinori, Tachi Hiroto, Ohshima Kazuma, Oyama Hiroki, Ogura Keisuke, Shinjo Ryuichi, Ohara Tetsuya, Tsuji Taichi, Kanemura Tokumi, Imagama Shiro, Nakashima Hiroaki

Spine Surgery and Related Research   advpub 巻 ( 0 )   2025年

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記述言語：英語   出版者・発行元：The Japanese Society for Spine Surgery and Related Research  

<p><b>Introduction: </b>The geriatric nutritional risk index (GNRI) has emerged as a useful predictor of surgical risk and postoperative outcomes. This study aimed to explore the utility of GNRI as a semiquantitative tool for predicting systemic and local complications after multilevel thoracolumbar fusion surgery in older patients and to evaluate the broader implications of nutritional status on postoperative recovery and independence.</p><p><b>Methods: </b>This multicenter study included 249 patients aged 65 years or older who underwent thoracolumbar fusion of at least four vertebrae. The nutrition-related risk grades were defined by the GNRI values, and the patients were divided into four groups: risk absent (GNRI > 98), low risk (GNRI 92 to ≤98), moderate risk (GNRI 82 to <92), and major risk (GNRI < 82). The occurrence of systemic complications, surgical site infection (SSI), length of stay in the hospital, place of discharge, and occurrence of proximal junctional kyphosis or failure (PJK/PJF) within 2 years after surgery were examined.</p><p><b>Results: </b>The risk-absent group consisted of 165 patients, the low-risk group of 40, the moderate-risk group of 36, and the major-risk group of eight. The incidence of any systemic complications (p = 0.016), PJK/PJF (p < 0.001), and hospital stay (p = 0.028) significantly increased with worsening GNRI. Furthermore, the number of patients who were discharged home significantly decreased as GNRI worsened (p < 0.001). SSI occurred most frequently in the risk-absent group (4.2%).</p><p><b>Conclusions: </b>The GNRI serves as a semiquantitative assessment tool that enables the identification of high-risk patients who may benefit from preoperative nutritional interventions.</p>

DOI： 10.22603/ssrr.2025-0016

Open Access

CiNii Research

Multimodal Deep Learning-based Radiomics Approach for Predicting Surgical Outcomes in Patients with Cervical Ossification of the Posterior Longitudinal Ligament 査読有り

Maki, S; Furuya, T; Katsumi, K; Nakajima, H; Honjoh, K; Watanabe, S; Kaito, T; Takenaka, S; Kanie, Y; Iwasaki, M; Furuya, M; Inoue, G; Miyagi, M; Ikeda, S; Imagama, S; Nakashima, H; Ito, S; Takahashi, H; Kawaguchi, Y; Futakawa, H; Murata, K; Yoshii, T; Hirai, T; Koda, M; Ohtori, S; Yamazaki, M

SPINE   49 巻 ( 22 ) 頁： 1561 - 1569   2024年11月

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記述言語：英語   出版者・発行元：Spine  

Study Design. A retrospective analysis. Objective. This research sought to develop a predictive model for surgical outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL) using deep learning and machine learning (ML) techniques. Summary of Background Data. Determining surgical outcomes assists surgeons in communicating prognosis to patients and setting their expectations. Deep learning and ML are computational models that identify patterns from large data sets and make predictions. Methods. Of the 482 patients, 288 patients were included in the analysis. A minimal clinically important difference (MCID) was defined as gain in Japanese Orthopaedic Association (JOA) score of 2.5 points or more. The predictive model for MCID achievement at 1 year postsurgery was constructed using patient background, clinical symptoms, and preoperative imaging features (x-ray, CT, MRI) analyzed through LightGBM and deep learning with RadImagenet. Results. The median preoperative JOA score was 11.0 (IQR: 9.0-12.0), which significantly improved to 14.0 (IQR: 12.0-15.0) at 1 year after surgery (P < 0.001, Wilcoxon signed-rank test). The average improvement rate of the JOA score was 44.7%, and 60.1% of patients achieved the MCID. Our model exhibited an area under the receiver operating characteristic curve of 0.81 and the accuracy of 71.9% in predicting MCID at 1 year. Preoperative JOA score and certain preoperative imaging features were identified as the most significant factors in the predictive models. Conclusion. A predictive ML and deep learning model for surgical outcomes in OPLL patients is feasible, suggesting promising applications in spinal surgery.

DOI： 10.1097/BRS.0000000000005088

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Prospective Registration Study for Establishing Minimal Clinically Important Differences in Patients Undergoing Surgery for Spinal Metastases 査読有り

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

SPINE   49 巻 ( 22 ) 頁： 1539 - 1547   2024年11月

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記述言語：英語   出版者・発行元：Spine  

Study Design. Multicenter, prospective registry study. Objective. To clarify minimal clinically important differences (MCIDs) for surgical interventions for spinal metastases, thereby enhancing patient care by integrating quality of life assessments with clinical outcomes. Background. Despite its proven usefulness in degenerative spinal diseases and deformities, the MCID remains unexplored regarding surgery for spinal metastases. Patients and Methods. This study included 171 (out of 413) patients from the multicenter "Prospective Registration Study on Surgery for Metastatic Spinal Tumors"by the Japan Association of Spine Surgeons. These were evaluated preoperatively and at 6 months postoperatively using the Face Scale, EuroQol-5 Dimensions-5 Levels (EQ-5D-5L), including the Visual Analog Scale, and performance status. The MCIDs were calculated using an anchor-based method, classifying participants into the improved, unchanged, and deteriorated groups based on the Face Scale scores. Focusing on the improved and unchanged groups, the change in the EQ-5D-5L values from before to after treatment was analyzed, and the cutoff value with the highest sensitivity and specificity was determined as the MCID through receiver operating characteristic curve analysis. The validity of the MCIDs was evaluated using a distribution-based calculation method for patient-reported outcomes. Results. The improved, unchanged, and deteriorated groups comprised 121, 28, and 22 participants, respectively. The anchor-based MCIDs for the EQ-5D-5L index, EQ-Visual Analog Scale, and domains of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression were 0.21, 15.50, 1.50, 0.50, 0.50, 0.50, and 0.50, respectively; the corresponding distribution-based MCIDs were 0.17, 15,99, 0.77, 0.80, 0.78, 0.60, and 0.70, respectively. Conclusion. We identified MCIDs for surgical treatment of spinal metastases, providing benchmarks for future clinical research. By retrospectively examining whether the MCIDs are achieved, factors favoring their achievement and risks affecting them can be explored. This could aid in decisions on surgical candidacy and patient counseling.

DOI： 10.1097/BRS.0000000000005062

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特集放射線科と人工知能　脊椎・脊髄疾患の画像診断におけるAI利用の現状 査読有り

伊藤 定之, 中島 宏彰, 世木 直喜, 大内田 隼, 小田 昌宏, 山内 一平, 大出 幸史, 長谷 康弘, 岡田 裕也, 鏡味 佑志朗, 森 健策, 今釜 史郎

臨床放射線   69 巻 ( 6 ) 頁： 787 - 792   2024年11月

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DOI： 10.18888/rp.0000002786

Safety and feasibility of intravenous administration of a single dose of allogenic-Muse cells to treat human cervical traumatic spinal cord injury: a clinical trial (vol 15, 259, 2024) 査読有り Open Access

Koda, M; Imagama, S; Nakashima, H; Ito, S; Segi, N; Ouchida, J; Suda, K; Matsumoto, SH; Komatsu, M; Endo, T; Suzuki, S; Inami, S; Ueda, H; Miyagi, M; Inoue, G; Takaso, M; Nagata, K; Yamada, H; Kamei, N; Nakamae, T; Suzuki, H; Nishida, N; Funaba, M; Kumagai, G; Furuya, T; Yamato, Y; Funayama, T; Takahashi, H; Yamazaki, M

STEM CELL RESEARCH & THERAPY   15 巻 ( 1 ) 頁： 402   2024年11月

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記述言語：英語   出版者・発行元：Stem Cell Research and Therapy  

The original article contains two errors which the authors wish to address: On line 3 of page 3, the sentence should simply read, ‘B1 and B2, which indicates complete […]’, and the word ‘(Ref)’ should be disregarded. In Fig. 2C, the Y-axis label should instead read as ‘Change in total motor score’, and the word ‘lower’ should be disregarded’.

DOI： 10.1186/s13287-024-04044-0

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Circulating miRNA-122 is associated with knee osteoarthritis progression: A 6-year longitudinal cohort study in the Yakumo study 査読有り

Funahashi, H; Takegami, Y; Osawa, Y; Nakashima, H; Ishizuka, S; Fujii, R; Yamada, H; Suzuki, K; Hasegawa, Y; Imagama, S

JOURNAL OF ORTHOPAEDIC SCIENCE   29 巻 ( 6 ) 頁： 1411 - 1416   2024年11月

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

Objective: The association between knee osteoarthritis (OA) and miRNAs has been widely reported. However, the utility of miRNAs as predictors of knee osteoarthritis (KOA) progression in longitudinal studies has not been reported. We aimed to identify circulating miRNAs (c-miRNAs) associated with KOA progression in the general population and to examine their potential use as predictors of KOA progression. Methods: In 2012 and 2018, 66 participants (128 knees) took part in a resident health check-up in the Yakumo study. If the KL classification progressed two or more levels, the patient was classified as having progressive OA. Quantitative real-time polymerase chain reaction was used to screen 21 c-miRNAs. The expression levels of those c-miRNAs were compared between the progressive OA group and non-progressive OA group using student-t-test. Logistic analysis was performed in c-miRNAs less than p < 0.10 in univariate analysis. Results: The progressive OA group consisted of 78 knees. The results of the comparison between the progressive OA group and the non-progressive OA group showed that six c-miRNAs as follows; let7d (p = 0.030), c-miRNA-122 (p < 0.001), 150 (p = 0.070), 199 (p = 0.078), 21 (p = 0.016) and 320 (p = 0.093) were extracted as factors related to the progression of knee OA. In addition, logistic regression analysis identified c-miRNA-122 as an independent factor involved in the progression of knee osteoarthritis (odds ratio: 1.510, 95% confidence interval: 1.060–2.140, p = 0.023). The ROC curve showed by c-miRNA-122 for the progression of OA risk had an area under the curve of 0.702 (95% CI: 0.609–0.795). The threshold of c-miRNA-122 was −4.609. Conclusion: The expression level of c-miRNA-122 was associated with the risk of KOA progression in community dwelling Japanese people.

DOI： 10.1016/j.jos.2023.10.004

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Prevalence and treatment rates of osteoporosis among individuals with rotator cuff tears 査読有り

Kawashima, I; Ishizuka, S; Oba, H; Sakaguchi, T; Nakashima, H; Takegami, Y; Imagama, S

JOURNAL OF SHOULDER AND ELBOW SURGERY   33 巻 ( 11 ) 頁： e606 - e609   2024年11月

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記述言語：英語   出版者・発行元：Journal of Shoulder and Elbow Surgery  

Background: The relationship between osteoporosis and rotator cuff tears has been reported previously. However, the treatment rate of osteoporosis in individuals with rotator cuff tear is still unknown. The aim of this study was to investigate the prevalence and treatment rate of osteoporosis in individuals with rotator cuff tears. Methods: In this cross-sectional study, we enrolled 207 participants. Participants underwent comprehensive assessments, including shoulder ultrasonographic examinations and quantitative ultrasound measurements for bone status evaluation. Osteoporosis diagnosis was predicated on a calcaneus ultrasound bone densitometry, and the cutoff value was set as a T score of −1.455, with reference to a previous report. Results: One hundred fifty-six participants were classified as individuals without rotator cuff tears (group A), and 51 participants were classified as those with (group B). The mean age in group A was significantly lower than that in group B (63 ± 10 vs. 68 ± 9, respectively; P = .003). In terms of the T score examined by quantitative ultrasound, the mean T score in group A was significantly higher than that in group B (−1.4 ± 1.3 vs. −1.9 ± 1.6, respectively; P = .0412). The percentage of subjects with a T score of −1.455 or less in group B was 60.8% (31/51). The proportion of subjects with a T score of −1.455 or less undergoing osteoporosis treatment was 14.5% (12/83) in group A and 12.9% (4/27) in group B, showing no significant difference. Conclusions: Participants with a rotator cuff tear had relatively high prevalence of osteoporosis. Among those with both a rotator cuff tear and osteoporosis, the proportion receiving osteoporosis treatment was l2.9%, a very low rate.

DOI： 10.1016/j.jse.2024.02.026

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The prevalence and characteristics of diffuse idiopathic skeletal hyperostosis in the community-living middle-aged and elderly population: The Yakumo study 査読有り

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

JOURNAL OF ORTHOPAEDIC SCIENCE   29 巻 ( 6 ) 頁： 1346 - 1352   2024年11月

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

Background: The incidence of diffuse idiopathic skeletal hyperostosis (DISH) is increasing with the aging of the population. Asymptomatic DISH can decrease the spinal range of motion (ROM) and cause fractures. However, the prevalence or physical function of patients with DISH before experiencing fractures and other serious conditions is unclear. This study aimed to investigate the prevalence of DISH in the community residents on the basis of age and sex and characterize their physical function, ROM, and bone fragility. Methods: The subjects were community volunteers who attended a health checkup in 2018 and 2019. Overall, 455 subjects (mean age, 64.2 ± 9.7 years; 177 men) were included for analysis. We performed whole-spine lateral radiography for detecting DISH according to the criteria reported by Resnick. We compared the age, sex, body mass index (BMI), results of muscle strength and walking tests, ROM measured by SpinalMouse®, and quantitative ultrasound (QUS) of calcaneus with and without DISH. Results: DISH was detected in 83 (18.2%) cases. The DISH group was older (69.8 y.o. vs. 63.0 y.o.; p < 0.05) and comprised more men (prevalence: men, 27.7%; women, 12.2%; p < 0.001). BMI was high in the DISH group (24.8 vs. 23.3 kg/m², p < 0.05). SpinalMouse measurements showed the DISH group had a significantly decreased ROM in the lumbar spine (43.2°, 57.2°, p < 0.05). The DISH group had a significantly lower T-score on the QUS measurement in the calcaneus (−2.0, −1.5, p < 0.05). There were, however, no significant differences between groups in both muscle strength test and walking test. Conclusion: Subjects with DISH had decreased ROM in the lumbar spine and bone mineral density in calcaneal QUS. However, physical functions such as muscle strength and walking ability were similar among subjects with and without DISH without subjective symptoms.

DOI： 10.1016/j.jos.2023.10.005

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A class of chemical compounds enhances clustering of muscle nicotinic acetylcholine receptor in cultured myogenic cells 査読有り Open Access

Miyairi, Y; Ohkawara, B; Sato, A; Sawada, R; Ishii, H; Tomita, H; Inoue, T; Nakashima, H; Ito, M; Masuda, A; Hosono, Y; Imagama, S; Ohno, K

BIOCHEMICAL AND BIOPHYSICAL RESEARCH COMMUNICATIONS   731 巻   頁： 150400   2024年10月

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記述言語：英語   出版者・発行元：Biochemical and Biophysical Research Communications  

Neuromuscular signal transmission is affected in various diseases including myasthenia gravis, congenital myasthenic syndromes, and sarcopenia. We used an ATF2-luciferase system to monitor the phosphorylation of MuSK in HEK293 cells introduced with MUSK and LRP4 cDNAs to find novel chemical compounds that enhanced agrin-mediated acetylcholine receptor (AChR) clustering. Four compounds with similar chemical structures carrying benzene rings and heterocyclic rings increased the luciferase activities 8- to 30-folds, and two of them showed continuously graded dose dependence. The effects were higher than that of disulfiram, a clinically available aldehyde dehydrogenase inhibitor, which we identified to be the most competent preapproved drug to enhance ATF2-luciferase activity in the same assay system. In C2C12 myotubes, all the compounds increased the area, intensity, length, and number of AChR clusters. Three of the four compounds increased the phosphorylation of MuSK, but not of Dok7, JNK. ERK, or p38. Monitoring cell toxicity using the neurite elongation of NSC34 neuronal cells as a surrogate marker showed that all the compounds had no effects on the neurite elongation up to 1 μM. Extensive docking simulation and binding structure prediction of the four compounds with all available human proteins using AutoDock Vina and DiffDock showed that the four compounds were unlikely to directly bind to MuSK or Dok7, and the exact target remained unknown. The identified compounds are expected to serve as a seed to develop a novel therapeutic agent to treat defective NMJ signal transmission.

DOI： 10.1016/j.bbrc.2024.150400

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Does global spinal alignment affect the use of walking aids after multi-segment spinal fixation for patients with ASD? A multicenter retrospective study 査読有り Open Access

Ouchida, J; Nakashima, H; Ito, S; Segi, N; Yamauchi, I; Oishi, R; Miyairi, Y; Morita, Y; Ode, Y; Nagatani, Y; Okada, Y; Tsushima, M; Machino, M; Ota, K; Tachi, H; Kagami, Y; Shinjo, R; Ohara, T; Tsuji, T; Kanemura, T; Imagama, S

EUROPEAN SPINE JOURNAL   33 巻 ( 10 ) 頁： 3833 - 3841   2024年10月

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

Purpose: This study aimed to clarify the relation between global spinal alignment and the necessity of walking aid use in patients with adult spinal deformity (ASD) and to investigate the impact of spinal fixation on mobility status after surgery. Methods: In total, 456 older patients with ASD who had multi-segment spinal fixation surgery and were registered in a multi-center database were investigated. Patients under 60 years of age and those unable to walk preoperatively were excluded. Patients were classified by their mobility status into the independent, cane, and walker groups. Comparison analysis was conducted using radiographic spinopelvic parameters and the previously reported global spine balance (GSB) classification. In addition, preoperative and 2 years postoperative mobility statuses were investigated. Results: Of 261 patients analyzed, 66 used walking aids (canes, 46; walkers, 20). Analysis of preoperative radiographical parameters showed increased pelvic incidence and pelvic incidence-lumbar lordosis mismatch in the walker group and increased sagittal vertebral axis in the cane and walker groups versus the independent group. Analysis of GSB classification showed a higher percentage of walker use in those with severe imbalance (grade 3) in the sagittal classification but not in the coronal classification. While postoperative radiographical improvements were noted, there was no significant difference in the use of walking aids before and 2 years after surgery (P = 0.085). Conclusion: A significant correlation was found between “sagittal” spinal imbalance and increased reliance on walking aids, particularly walkers. However, the limitation of improvement in postoperative mobility status suggested that multiple factors influence the mobility ability of elderly patients with ASD.

DOI： 10.1007/s00586-024-08380-w

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Longitudinal impact of multi-segment spinal fixation surgery on mobility status and clinical outcomes in adult spinal deformity: a multicenter retrospective study 査読有り Open Access

Ouchida, J; Nakashima, H; Ito, S; Segi, N; Yamauchi, I; Oishi, R; Miyairi, Y; Morita, Y; Ode, Y; Nagatani, Y; Okada, Y; Tsushima, M; Kanemura, T; Machino, M; Ohara, T; Ota, K; Tachi, H; Tsuji, T; Kagami, Y; Shinjo, R; Imagama, S

EUROPEAN SPINE JOURNAL   33 巻 ( 10 ) 頁： 3894 - 3903   2024年10月

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

Purpose: To investigate changes in postoperative mobility status in patients with ASD, and the determining factors that influence these changes and their impact on clinical outcomes, including the rate of home discharge and long-term mobility. Methods: A total of 299 patients with ASD who underwent multi-segment posterior spinal fusion were registered in a multi-center database were investigated. Patient mobility status was assessed using walking aids and classified into five levels (1: independent, 2: cane, 3: walker, 4: assisted, and 5: wheelchair) preoperatively, at discharge, and after 2 years. We determined improvements or declines in the patient's mobility based on changes in the classification levels. The analysis focused on the factors contributing to the deterioration of postoperative mobility. Results: Two years postoperatively, 87% of patients maintained or improved mobility. However, 27% showed decreased mobility status at discharge, associated with a lower rate of home discharge (49% vs. 80% in the maintained mobility group) and limited improvement in mobility status (35% vs. 5%) after 2 years. Notably, postoperative increases in thoracic kyphosis (7.0 ± 12.1 vs. 2.0 ± 12.4°, p = 0.002) and lower lumbar lordosis (4.2 ± 13.1 vs. 1.8 ± 12.6°, p = 0.050) were substantial factors in mobility decline. Conclusion: Postoperative mobility often temporarily decreases but generally improves after 2 years. However, an overcorrection in sagittal alignment, evidenced by increased TK, could detrimentally affect patients’ mobility status. Transient mobility decline associated with overcorrection may require further rehabilitation or hospitalization. Further studies are required to determine the biomechanical effects of surgical correction on mobility.

DOI： 10.1007/s00586-024-08397-1

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Peri-implant fractures after Intramedullary fixation for femoral trochanteric fracture: a multicenter (TRON Group) study 査読有り

Kaneda, T; Takegami, Y; Tokutake, K; Nakashima, H; Mishima, K; Mabuchi, M; Imagama, S

EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY   50 巻 ( 5 ) 頁： 2587 - 2594   2024年10月

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記述言語：英語   出版者・発行元：European Journal of Trauma and Emergency Surgery  

Background: With the rise in elderly populations, the incidence of femoral trochanteric fractures has also increased. Although intramedullary nail therapy is commonly used, the incidence of peri-implant fractures (PIFs) as a complication and its associated factors are not fully understood. The purpose of this study was to determine the incidence of PIFs and treatment strategies and outcomes. Methods: A retrospective study across 11 hospitals from 2016 to 2020 examined 1855 patients with femoral trochanter fracture. After excluding 69 patients treated without intramedullary nailing, 1786 patients were analyzed. Parameters studied included age, sex, body mass index, medical history, and treatment methods. PIFs were categorized using the Chan classification. Treatment outcomes and patient mobility were assessed using the Parker Mobility Score, and postoperative complications and one-year survival data were compiled. Results: The incidence of PIFs was 8 in 1786 cases. Chan classification showed 1 case of N1A, 6 of N2A, and 1 of N2B. Only the type N1 case was a transverse fracture, whereas all cases of type N2 were oblique fractures. Among these cases, five patients had fractures extending to the upper part of the femoral condyle. The patient with N1A and one bedridden patient with N2A fracture underwent conservative treatment, one patient with N2A in which the fracture did not extend to the condyle was treated with nail replacement, and 5 patients (N2A: 4, N2B: 1) with fractures extending to the condyle were treated with additional plate fixation. All patients had survived at one year after treatment for PIF, and no reoperations were required. Conclusions: The incidence of PIF was very low (0.45%). Of the 6 PIF cases, excluding the bedridden patients, the treatment of choice for PIF was an additional plate if the fracture line extended to the femoral condyle; otherwise, the nail was replaced. All patients achieved bony fusion. Level of evidence: Therapeutic Level IV.

DOI： 10.1007/s00068-024-02567-y

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Ten-Year Follow-up of Posterior Decompression and Fusion Surgery for Thoracic Ossification of the Posterior Longitudinal Ligament 査読有り Open Access

Ito, S; Nakashima, H; Segi, N; Ouchida, J; Oishi, R; Yamauchi, I; Miyairi, Y; Morita, Y; Ode, Y; Imagama, S

JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME   106 巻 ( 17 ) 頁： 1600 - 1609   2024年9月

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記述言語：英語   出版者・発行元：Journal of Bone and Joint Surgery  

Background: We evaluated the clinical, functional, and quality of life (QoL) outcomes of surgical treatment of thoracic ossification of the posterior longitudinal ligament (T-OPLL). Methods: We retrospectively evaluated 51 patients followed for ‡10 years after posterior decompression and corrective fusion surgery for T-OPLL. The data collected included demographics, comorbidities, and pre- and postoperative symptoms. The Japanese Orthopaedic Association (JOA) score, numerical rating scale (NRS) for back and leg pain, and EuroQol-5 Dimension-5 Level (EQ-5D-5L) were used to assess neurological function, pain, and QoL. Imaging evaluations were conducted to assess changes in kyphotic angles and ossification progression. Results: A significant improvement was observed in the JOA score from preoperatively (3.7) to 2 years postoperatively (7.9) (p < 0.05); the score remained stable thereafter. The mean EQ-5D-5L score improved from 0.53 preoperatively to 0.68 at 10 years postoperatively (p < 0.001). NRS scores for back and leg pain decreased from 5.4 to 3.5 and 4.0 to 3.0, respectively, from preoperatively to 10 years (p < 0.001 for both). Radiographic outcomes showed changes in kyphotic angles and ossification areas, with no significant progression after 2 years. Fourteen (27.5%) of the patients experienced postoperative complications. Of these, 8 (15.7%) required reoperation, 6 (11.8%) in the perioperative period and 2 (3.9%) later. Four (7.8%) of the patients underwent additional surgeries for conditions including lumbar spinal canal stenosis and cervical OPLL. Nonetheless, physical function in all cases with postoperative complications or additional surgery remained stable over the decade. Conclusions: Surgical treatment of T-OPLL is effective in improving neurological function, QoL, and pain management over an extended period. The long-term outcomes of T-OPLL surgery revealed that, although cervical and lumbar spinal lesions led to reoperations, they did not affect QoL, and relative improvement was maintained even after 10 years. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

DOI： 10.2106/JBJS.23.01475

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Trabecular Bone Remodeling After Posterior Lumbar Interbody Fusion: Comparison of Three-Dimensional Porous Tantalum and Titanium-Coated Polyetheretherketone Interbody Cages 査読有り Open Access

Segi, N; Nakashima, H; Shinjo, R; Kagami, Y; Machino, M; Ito, S; Ouchida, J; Morishita, K; Oishi, R; Yamauchi, I; Imagama, S

GLOBAL SPINE JOURNAL   14 巻 ( 7 ) 頁： 2106 - 2115   2024年9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: The criteria for determining completion of intervertebral stability after posterior lumbar interbody fusion (PLIF) remain controversial. Several new radiological indicators of bone growth and osteointegration have been established. We compared computed tomography (CT) findings related to osteointegration after PLIF with interbody cages of two different materials and designs. Methods: We retrospectively analyzed data from 103 patients who underwent PLIF with three-dimensional porous tantalum (Tn) cages or titanium-coated polyetheretherketone (TiP) cages. CT images obtained 3 months and 1 year after surgery were examined for trabecular bone remodeling (TBR), cancellous condensation (CC), and vertebral endplate cyst (VEC) formation. The incidences of each finding were compared by cage type, and rates of instrument failure and pseudarthrosis were determined. Results: Three months postoperatively, 87% of the levels with Tn cages exhibited TBR, whereas 96% of those with TiP cages did not (P <.001). Most levels with Tn cages levels exhibited TBR and no CC 3 months (81%) and 1 year (94%) after surgery. Although 78% of levels with TiP cages exhibited CC and no TBR 3 months after surgery, 59% exhibited both CC and TBR 1 year after surgery. Significantly fewer VECs formed around the Tn cages than around the TiP cages both 3 months (P =.002) and 1 year (P <.001) after surgery. Implant-related problems occurred at levels that exhibited neither TBR nor CC. Conclusions: The porous tantalum cage may enable intervertebral stability that is comparable to bony fusion soon after surgery.

DOI： 10.1177/21925682231170613

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