論文 - 中島　宏彰

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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Incremental cost-effectiveness ratio between titanium plate and hydroxyapatite block spacers in cervical laminoplasty for degenerative cervical myelopathy. 査読有り

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

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association     2024年11月

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記述言語：英語   出版者・発行元：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

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PubMed

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

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

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association     2024年10月

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記述言語：英語   出版者・発行元：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

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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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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 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： 259   2024年8月

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

Introduction: Spinal cord injury (SCI) is a devastating injury and remains one of the largest medical and social burdens because of its intractable nature. According to the recent advances in stem cell biology, the possibility of spinal cord regeneration and functional restoration has been suggested by introducing appropriate stem cells. Multilineage-differentiating stress enduring (Muse) cells are a type of nontumorigenic endogenous reparative stem cell. The positive results of Muse cell transplantation for SCI was shown previously. As a first step for clinical application in human SCI, we conducted a clinical trial aiming to confirm the safety and feasibility of intravenously injected donor-Muse cells. Methods: The study design of the current trial was a prospective, multicenter, nonrandomized, nonblinded, single-arm study. The clinical trial registration number was JRCT1080224764. Patients with a cervical SCI with a neurological level of injury C4 to C7 with the severity of modified Frankel classification B1 and B2 were included. A primary endpoint was set for safety and feasibility. Our protocol was approved by the PMDA, and the trial was funded by the Life Science Institute, Tokyo, Japan. The present clinical trial recruited 10 participants (8 males and 2 females) with an average age of 49.3 ± 21.2 years old. All 10 participants received a single dose of allogenic CL2020 (a total of 15 × 106 cells, 2.1–2.7 × 105 cells/kg of body weight), which is a Muse cell-based product produced from human mesenchymal stem cells, by an intravenous drip. Results: There were two reported severe adverse events, both of which were determined to have no causal relationship with Muse cell treatment. The change in the ISNCSCI motor score, the activity of daily living and quality of life scores showed statistically significant improvements compared to those data at the time of CL2020 administration. Conclusion: In the present trial, no safety concerns were identified, and Muse cell product transplantation demonstrated good tolerability. Future clinical trials with appropriate study designs incorporating a control arm will clarify the definitive efficacy of single-dose allogenic Muse cell treatment with intravenous administration to treat SCI. Trial registration: jRCT, JRCT1080224764. Registered 03 July 2019, https://jrct.niph.go.jp/latest-detail/jRCT1080224764.

DOI： 10.1186/s13287-024-03842-w

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Neuromodulation with transcranial direct current stimulation contributes to motor function recovery via microglia in spinal cord injury 査読有り Open Access

Oishi, R; Takeda, I; Ode, Y; Okada, Y; Kato, D; Nakashima, H; Imagama, S; Wake, H

SCIENTIFIC REPORTS   14 巻 ( 1 ) 頁： 18031   2024年8月

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記述言語：英語   出版者・発行元：Scientific Reports  

Spinal cord injury (SCI) is damage or trauma to the spinal cord, which often results in loss of function, sensation, or mobility below the injury site. Transcranial direct current stimulation (tDCS) is a non-invasive and affordable brain stimulation technique used to modulate neuronal circuits, which changes the morphology and activity of microglia in the cerebral cortex. However, whether similar morphological changes can be observed in the spinal cord remains unclear. Therefore, we evaluated neuronal population activity in layer 5 (L5) of M1 following SCI and investigated whether changes in the activities of L5 neurons affect microglia-axon interactions using C57BL/6J mice. We discovered that L5 of the primary motor cortex (corticospinal neurons) exhibited reduced synchronized activity after SCI that correlates with microglial morphology, which was recovered using tDCS. This indicates that tDCS promotes changes in the morphological properties and recovery of microglia after SCI. Combining immunotherapy with tDCS may be effective in treating SCI.

DOI： 10.1038/s41598-024-69127-7

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連載 What's new by subspecialty What's New in Spine Surgery

中島 宏彰, 今釜 史郎

整形外科   75 巻 ( 9 ) 頁： 937 - 945   2024年8月

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出版者・発行元：南江堂  

DOI： 10.15106/j_seikei75_937

CiNii Research

A novel technique for C1-C2 posterior screw insertion using patient-specific guides created by CT-based 3D printing 査読有り Open Access

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

NAGOYA JOURNAL OF MEDICAL SCIENCE   86 巻 ( 3 ) 頁： 487 - 496   2024年8月

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

C1-C2 fixation has been developed for the rigid fusion of atlantoaxial instability. C1 lateral mass screw (C1 LMS)-C2 pedicle screw fixation is used more frequently due to its rigid fixation and high bone fusion rate. However, C1 screw placement is relatively unsafe even with recently developed image-based navigation systems. Patient-specific screw guide templates (PSGT) were developed to improve the accuracy and safety of C1 screw placement. Herein, we investigated the outcomes of the C1-C2 posterior fixation technique using PSGT. This was a retrospective study of six patients who underwent posterior cervical spinal fusion using the PSGT between January 2022 and April 2023. Operative time, estimated blood loss, intraoperative radiation dose, surgical cost, and screw placement accuracy were evaluated and compared with those achieved with preoperative CT-based navigation (navigation group, n = 15). Screw accuracy was assessed using Neo’s classification. PSGT showed good results, although the differences were not statistically significant (operation time: 104.3 ± 9.7 min vs 116.4 ± 20.8 min; estimated blood loss: 56.7 ± 72.4 mL vs 123.2 ± 162.3 mL; and radiation dose: 1.8 ± 1.2 mSv vs 2.6 ± 0.8 mSv, respectively). PSGT was particularly better in terms of the accuracy of C1 LMS (PSGT: 100%, navigation: 83.3%). The deviation at the entry point was minimal, and the difference between the sagittal and transversal angles from the preoperative plan was small. We investigated the clinical efficacy of using the PSGT for C1-C2 posterior fixation. PSGT improved the accuracy of C1 LMS insertion.

DOI： 10.18999/nagjms.86.3.487

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