Faculty Profiles - NAKASHIMA Hiroaki

Japanese 2021 nationwide survey on complications from spine surgery 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: To provide an updated analysis of perioperative complications, patient demographics, and surgical techniques in spinal surgeries across Japan and examine their impact on risk management. Methods: Data were collected prospectively from 739 of 1,106 registered facilities across Japan using the JSSR database. All spinal surgeries conducted in November 2021 were included, capturing complications within 1 month post-surgery. Data analyzed included patient demographics, disease classification, surgical techniques, site, approach, and complications. Descriptive statistics determined complication rates and trends. Results: The survey included 11,559 surgeries (average patient age: 67.0 years). Degenerative diseases comprised 71.0% of cases. Posterior surgical approaches were predominant (87.9%), and minimally invasive techniques were widely adopted. The overall complication rate was 8.8%, with dural tears (2.4%) being the most common. Minimally invasive techniques improved outcomes but posed technical challenges, highlighting the need for advanced training and equipment. Conclusion: Japan’s aging surgical population and the adoption of minimally invasive techniques are evident. While complication rates remain stable, specific complications such as dural tears require targeted management. These findings underscore tailored surgical strategies for older patients and innovation in techniques, providing critical evidence for improving outcomes and informing healthcare policy in Japan.

DOI： 10.1007/s00586-025-08981-z

Does Advanced Age Negatively Impact Treatment Outcomes of Cervical Ossification of the Posterior Longitudinal Ligament? A Prospective Multicenter Study. Reviewed

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

Spine 2025.6

Language：English Publisher：Spine

Study Design. A multicenter prospective cohort study. Objective. To comprehensively evaluate the surgical impact, including patient-reported outcomes (PROs), in elderly patients with cervical ossification of the posterior longitudinal ligament (OPLL). Summary of Background Data. With the rise of aging populations worldwide, understanding the impact of age on treatment outcomes for cervical OPLL has become increasingly important. Previous studies on degenerative cervical myelopathy have highlighted inconsistent outcomes for elderly patients, with limited focus on OPLL and PROs. Methods. This prospective, multi-institutional study included 402 cervical OPLL patients from 2014 to 2017, categorized into elderly (≥75 y, n=79) and non-elderly (<75 y, n=323) groups. Clinical outcomes were assessed preoperatively and two years postoperatively using cervical Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS) scores, and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). Multivariable regression analyses were conducted, adjusting for potential confounders, including demographic variables and imaging characteristics. Results. Elderly patients had worse preoperative JOA scores (9.6 vs. 11.1, P<0.01) and lower postoperative scores at two years (12.3 vs. 14.0, P<0.01). However, the improvement in JOA scores was comparable (2.7 vs. 3.0, P=0.48), with both exceeding the minimum clinically important difference (MCID). Complication rates and VAS score improvements were also comparable. JOACMEQ outcomes demonstrated significantly poorer upper extremity function in the elderly group following surgery (P=0.02), whereas no significant differences were observed between the two groups in other functional domains. Conclusion. Despite worse baseline neurological function, elderly OPLL patients achieved similar degrees of postoperative neurological improvement as non-elderly patients. However, upper extremity function is unlikely to show significant improvement following surgery in elderly patients.

DOI： 10.1097/BRS.0000000000005415

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

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

ASIAN SPINE JOURNAL Vol. 19 ( 3 ) page： 380 - 388 2025.6

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

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

EUROPEAN SPINE JOURNAL Vol. 34 ( 6 ) page： 2239 - 2246 2025.6

Language：English Publisher：European Spine Journal

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

DOI： 10.1007/s00586-025-08722-2

Comparison of Clinical Outcomes of Periprosthetic Fractures Between Cemented vs Cementless Stem Methods After Initial Total Hip Arthroplasty or Bipolar Hemiarthroplasty: A Multicenter Analysis (TRON Study) Reviewed

Tachi, H; Takegami, Y; Okura, T; Tokutake, K; Nakashima, H; Mishima, K; Kasai, T; Imagama, S

ARTHROPLASTY TODAY Vol. 33 page： 101699 2025.6

Language：English Publisher：Arthroplasty Today

Background: Periprosthetic femoral fractures are challenging complications after total hip arthroplasty (THA) or bipolar hemiarthroplasty (BHA). This multicenter study compared clinical outcomes of surgical periprosthetic femoral fracture (PFF) treatment following initial implantation of cemented vs cementless femoral stems. Methods: This retrospective multicenter study included 201 patients from multiple hospitals who had PFFs treated surgically between 2010 and 2022. They were divided into THA (n = 71) and BHA (n = 130) cohorts based on initial arthroplasty. Clinical outcomes of mortality, radiographic bone union, operative metrics, and complications were compared after the patients were matched for age. Results: In the matched THA cohorts (n = 15 each), there were no significant differences in mortality, bone union, operative time, blood loss, or complications between cemented and cementless stems. In the matched BHA cohorts (n = 27 each), mortality and bone union were similar, but cementless stems showed higher intraoperative blood loss. Furthermore, Type B fractures were more common with cementless stems, whereas Type C fractures were predominated with cemented stems. Conclusions: Among patients who underwent THA or BHA, mortality and bone union following treatment of PFFs did not differ between cemented and cementless stems. However, patients who underwent BHA with cementless stems required longer operations and lost more blood. Type B fractures requiring revision occurred more frequently with cementless stems, whereas Type C fractures treated with open reduction and internal fixation were more frequent with cemented stems, which thus influenced perioperative factors. Cement use for initial arthroplasty was associated with certain favorable characteristics and positive treatment outcomes of PFFs.

DOI： 10.1016/j.artd.2025.101699

Trabecular Bone Remodeling After Posterior Lumbar Interbody Fusion: Comparison of the Osseointegration in Three-Dimensional Porous Titanium Cages and Polyether-Ether-Ketone Cages

Segi, N; Nakashima, H; Ito, S; Ouchida, J; Yamauchi, I; Matsumoto, T; Kanbara, S; Ito, K; Imagama, S

GLOBAL SPINE JOURNAL Vol. 15 ( 5 ) page： 2841 - 2843 2025.6

特集　整形外科領域におけるAIの応用 Ⅵ章. AIによる手術・治療成績予測 1.AIを用いた頚椎・頚髄損傷予後予測因子の探索 Reviewed

伊藤定之, 中島宏彰, 世木直喜, 大内田隼, 小田昌宏, 今釜史郎

整形外科 Vol. 76 ( 6 ) page： 627 - 632 2025.5

Influence of Diabetes Mellitus on Neurological Recovery in Older Patients With Cervical Spinal Cord Injury Without Bone Injury: A Retrospective Multicenter Study Reviewed

Takeda, K; Watanabe, K; Nori, S; Yamane, J; Kono, H; Yokogawa, N; Sasagawa, T; Nakashima, H; Segi, N; Funayama, T; Eto, F; Furuya, T; Yunde, A; Nakajima, H; Yamada, T; Hasegawa, T; Terashima, Y; Hirota, R; Suzuki, H; Imajo, Y; Ikegami, S; Tonomura, H; Sakata, M; Hashimoto, K; Kawaguchi, K; Suzuki, N; Uei, H; Nakanishi, K; Terai, H; Inoue, G; Kiyasu, K; Iizuka, Y; Akeda, K; Funao, H; Oshima, Y; Kaito, T; Yoshii, T; Ishihara, M; Okada, S; Imagama, S; Kato, S

GLOBAL SPINE JOURNAL Vol. 15 ( 4 ) page： 2274 - 2285 2025.5

Language：English Publisher：Global Spine Journal

Study Design: Retrospective study. Objectives: To investigate the impact of diabetes mellitus on neurological recovery and determine the relationship between moderate-severe diabetes and neurological recovery in patients with cervical spinal cord injury (CSCI) without bone injury. Methods: A retrospective study was conducted on 389 consecutive patients aged ≥65 years with CSCI without bone injury across 33 medical institutes. The patients were divided into a nondiabetic group (n = 270) and a diabetic group (n = 119). Neurological outcomes were compared between the two groups through propensity score matching. The impact of moderate-severe diabetes (defined as hemoglobin A1c ≥ 7.0% or requiring insulin treatment) on neurological recovery was evaluated through multiple linear regression analysis. Results: Propensity score matching revealed no significant differences between the diabetic and nondiabetic groups in terms of American Spinal Injury Association (ASIA) impairment scale grade and mean total ASIA motor scores (AMS) at 6 months post-injury. Multiple linear regression analysis indicated that age on admission (B = −0.34; 95% confidence interval [CI], −0.59 to −0.08; P = 0.01), dementia (B = −16.50; 95% CI, −24.99 to −8.01; P < 0.01), and baseline total AMS (B = −0.62; 95% CI, −0.72 to −0.51; P < 0.01) were negative predictors of neurological recovery at 6 months post-injury. The presence of moderate-severe diabetes did not influence neurological recovery at 6 months post-injury. Conclusions: Diabetic patients with CSCI without bone injury achieved improvements in neurological function comparable to those of nondiabetic patients. Moderate-severe diabetes did not affect neurological recovery in patients with CSCI without bone injury.

DOI： 10.1177/21925682241297587

Effects of Palliative Surgical Treatment for Spinal Metastases on the Patient's Quality of Life With a Focus on the Segment of the Metastasis: A Prospective Multicenter Study Reviewed

Segi, N; Nakashima, H; Ito, S; Ouchida, J; Shiratani, Y; Shimizu, T; Suzuki, A; Terai, H; Kakutani, K; Kanda, Y; Tominaga, H; Kawamura, I; Ishihara, M; Paku, M; Takahashi, Y; Funaba, M; Funayama, T; Nakajima, H; Akeda, K; Hirai, T; Inoue, H; Nakanishi, K; Funao, H; Oshigiri, T; Otsuki, B; Kobayakawa, K; Tanishima, S; Hashimoto, K; Iimura, T; Sawada, H; Uotani, K; Manabe, H; Iwai, C; Yamabe, D; Hiyama, A; Seki, S; Goto, Y; Miyazaki, M; Watanabe, K; Nakamae, T; Kaito, T; Nagoshi, N; Kato, S; Watanabe, K; Imagama, S; Inoue, G; Furuya, T

GLOBAL SPINE JOURNAL Vol. 15 ( 4 ) page： 2286 - 2299 2025.5

Language：English Publisher：Global Spine Journal

Study Design: Prospective multicenter study. Objectives: Palliative surgery is crucial for maintaining the quality of life (QOL) in patients with spinal metastases. This study aimed to compare the short-term outcomes of QOL after palliative surgery between patients with metastatic spinal tumors at different segments. Methods: We prospectively compared the data of 203 patients with spinal metastases at 2-3 consecutive segments who were divided into the following three groups: cervical, patients with cervical spine lesions; thoracic, patients with upper–middle thoracic spine lesions; and TL/L/S, patients with lesions at the thoracolumbar junction and lumbar and sacral regions. Preoperative and postoperative EuroQol 5-dimension (EQ5D) 5-level were compared. Results: All groups exhibited improvement in the Frankel grade, performance status, pain, Barthel index, EQ5D health state utility value (HSUV), and EQ5D visual analog scale (VAS) postoperatively. Although preoperative EQ5D HSUVs did not significantly differ between the groups (cervical, 0.461 ± 0.291; thoracic, 0.321 ± 0.292; and TL/L/S, 0.376 ± 0.272), the thoracic group exhibited significantly lower postoperative EQ5D HSUVs than the other two groups (cervical, 0.653 ± 0.233; thoracic, 0.513 ± 0.252; and TL/L/S, 0.624 ± 0.232). However, postoperative EQ5D VAS was not significantly different between the groups (cervical, 63.4 ± 25.8; thoracic, 54.7 ± 24.5; and TL/L/S, 61.7 ± 21.9). Conclusions: Palliative surgery for metastatic spinal tumors provided comparable QOL improvement, irrespective of the spinal segment involved. Patients with upper and middle thoracic spinal metastases had poorer QOL outcomes than those with metastases in other segments; however, sufficient QOL improvement was achieved.

DOI： 10.1177/21925682241297948

Impact of surgical treatment on patient reported outcome in patients with spinal metastases from prostate cancer Reviewed

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

JOURNAL OF ORTHOPAEDIC SCIENCE Vol. 30 ( 3 ) page： 423 - 432 2025.5

Language：English Publisher：Journal of Orthopaedic Science

Objective: This study aimed to elucidate postoperative outcomes in patients with spinal metastases of prostate cancer, with a focus on patient-oriented assessments. Methods: This was a prospective multicenter registry study involving 35 centers. A total of 413 patients enrolled in the Japanese Association for Spine Surgery and Oncology Multicenter Prospective Study of Surgery for Metastatic Spinal Tumors were evaluated for inclusion. The eligible patients were followed for at least 1 year after surgery. The Frankel Classification, Eastern Cooperative Oncology Group Performance Status, visual analog scale for pain, face scale, Barthel Index, vitality index, indications for oral pain medication, and the EQ-5D-5L questionnaire were used for evaluating functional status, activities of daily living, and patient motivation. Results: Of the 413 eligible patients, 41 with primary prostate cancer were included in the study. The patient-oriented assessments indicated that the patients experienced postoperative improvements in quality of life and motivation in most items, with the improvements extending for up to 6 months. More than half of the patients with Frankel classifications B or C showed improved neurological function at 1 month after surgery, and most patients presented maintained or improved their classification at 6 months. Conclusion: Surgical intervention for spinal metastases of prostate cancer significantly improved neurological function, quality of life, and motivation of the patients. Consequently, our results support the validity of surgical intervention for improving the neurological function and overall well-being of patients with spinal metastases of prostate cancer.

DOI： 10.1016/j.jos.2024.07.012

Comparative outcomes of in-situ fixation and fixation after reduction in geriatric patients with severe valgus-impacted femoral neck fractures: a retrospective multicenter (TRON group) study Reviewed

Nobori, T; Takegami, Y; Tokutake, K; Nakashima, H; Mishima, K; Okamoto, M; Okui, N; Imagama, S

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 87 ( 2 ) page： 295 - 304 2025.5

Publisher：Nagoya Journal of Medical Science

The objective of this study was to evaluate and compare the clinical and radiographic outcomes between in situ fixation and fixation after reduction of severe valgus-impacted femoral neck fractures in patients aged 65 years or older. This was a multicenter retrospective study of 561 patients who underwent open reduction and internal fixation for femoral neck fracture. From this population, we selected patients aged 65 years and older with severe valgus-impacted femoral neck fractures characterized by a Garden alignment index greater than 15 degrees compared to that on the non-injury side. After exclusion criteria were applied, the study included 92 patients who were categorized into two groups: in situ fixation group (n = 56) and fixation after reduction group (n = 36). Our analysis covered patient demographics, surgical details, postoperative complications, radiographic evaluations, Numeric Rating Scale for pain, and Parker’s Mobility Score for clinical outcomes. Bone union was achieved in all patients. The incidence of avascular necrosis was consistent between the groups. Patients in the reduction group reported lower Numeric Rating Scale scores (mean: 0 vs 2, p = 0.003) and higher Parker’s Mobility Score scores (mean: 7 vs 6, p = 0.009) compared with the in situ group. Radiographically, the reduction group showed significantly lower femoral neck shortening (mean: 4.75 mm vs 5.75 mm, p = 0.049) and a reduced length of cannulated cancellous screw backout (mean: 3.4 mm vs 5.4 mm, p = 0.007) at the final follow-up. Fixation after reduction for severe valgus-impacted femoral neck fractures in patients aged 65 and above appears to be a safe and effective approach.

DOI： 10.18999/nagjms.87.2.295

Meflin/Islr is a marker of fibroblasts that arise in fibrotic regions after spinal cord injury Reviewed

Morita, Y; Shiraki, Y; Kato, A; Nagatani, Y; Ando, R; Nakashima, H; Imagama, S; Enomoto, A

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 87 ( 2 ) page： 305 - 319 2025.5

Publisher：Nagoya Journal of Medical Science

Scar formation after spinal cord injury (SCI) hampers axonal regeneration and functional recovery. Previous studies have shown that scar formation is attributable to both gliosis and fibrosis, the latter requiring fibroblast proliferation and extracellular matrix deposition. In this setting, there are essentially two cell types generating new fibroblasts: pericytes and tissue-resident fibroblasts. Here, we showed that Meflin, a glycosylphosphatidylinositol-anchored protein (a specific marker of fibroblasts across multiple organs) is expressed by fibroblasts in the normal mouse spinal cord. An in situ hybridization analysis showed that Meflin+ cells arose from the meninges and perivascular region of the spinal parenchyma after spinal cord compression injury. That finding was corroborated by single-cell transcriptomic data from normal and injured mouse spinal cords. Interestingly, Meflin+ cells are positive for the fibroblast markers collagen type I and platelet-derived growth factor receptor (PDGFR) α but not for pericyte markers such as PDGFRβ and chondroitin sulfate proteoglycan 4 in the normal spinal cord. Those findings are consistent with the recent view that tissue-resident fibroblasts play a central role in many other types of fibrotic disease. A lineage-tracing experiment using a knock-in mouse line that expressed inducible Cre recombinase under the control of the Meflin promoter showed that Meflin+ cells yield PDGFRβ+ myofibroblasts but not glial cells positive for glial fibrillary acidic protein. These findings suggest that the Meflin+ population contains the cells of origin of myofibroblasts that are involved in scar formation after SCI.

DOI： 10.18999/nagjms.87.2.305

Longitudinal transitions in frailty and health-related quality of life investigated by a 5-year community study Reviewed

Oishi, R; Segi, N; Okazaki, M; Ito, S; Ouchida, J; Yamauchi, I; Seki, T; Takegami, Y; Ishizuka, S; Hashizume, A; Hasegawa, Y; Imagama, S; Nakashima, H

SCIENTIFIC REPORTS Vol. 15 ( 1 ) page： 15162 2025.4

Language：English Publisher：Scientific Reports

The purpose of this study was to determine the association between frailty and quality of life (QOL) in a five-year longitudinal cohort of community-dwelling middle-aged and older adults and determine how to identify health-related QOL changes. This study included 124 volunteers (67 women; mean 65 years at baseline) who underwent health checkups in 2014 and 2019. The association between frailty status (robust, prefrail, frail), according to the Japanese Cardiovascular Health Study criteria, and health-related QOL, measured with the SF-36 questionnaire, were investigated. Five-year changes in frailty status were categorized into improved, maintained, and worsened groups. The baseline prevalence of prefrailty and frailty were 44.4% and 7.2%, respectively. Five years later, the frailty of 20 participants improved, 66 maintained frailty status, and frailty worsened in 38 participants. Significant trends toward higher scores on the physical component summary (PCS), role/social component summary (RCS), and subscales of physical functioning, role-physical, vitality, social functioning, and role-emotional were detected across groups with improvements in their frailty status from 2014 to 2019. The fully adjusted multivariable regression model revealed significantly higher PCS scores (β, 12.9; 95% confidence interval (CI), 6.0 to 19.9) and RCS scores (β, 13.6; 95% CI, 6.6 to 20.6) compared with the worsened group. In conclusion, this longitudinal cohort study demonstrates that frailty status is not static and improvements or maintenance of frailty are associated with better physical and social QOL outcomes. Addressing frailty early may reverse or mitigate its impact and improve the overall well-being of older adults.

DOI： 10.1038/s41598-025-99843-7

Response to Letter to the Editor Regarding: Multimodal Deep Learning-Based Radiomics Approach for Predicting Surgical Outcomes in Patients With Cervical Ossification of the Posterior Longitudinal Ligament Reviewed

脊柱変形up-to-date Ⅲ.成人脊柱変形 2.診断成人脊柱変形における手術での矢状面アライメントの目標値 Reviewed

大内田隼, 中島宏彰, 伊藤定之, 世木直喜, 山内一平, 今釜史郎

別冊整形外科 Vol. 1 ( 87 ) page： 95 - 99 2025.4

Dropped head syndrome suspected as a long-term complication after radiation therapy; a case report Reviewed Open Access

Ohshima Kazuma, Tsushima Mikito, Tomita Hiroyuki, Morishita Kazuaki, Oyama Hiroki, Nakashima Hiroaki, Ouchida Jun, Nagatani Yasuhiro, Imagama Shiro, Kanemura Tokumi

Journal of Spine Research Vol. 16 ( 4 ) page： 726 - 731 2025.4

Language：Japanese Publisher：The Japanese Society for Spine Surgery and Related Research

Introduction: Dropped head syndrome is a disease caused by cervical kyphosis that results in head drooping.There are various causes for dropped head syndrome, including neuromuscular diseases and Parkinson's disease.Recently, the treatment of malignant tumors has made significant progress, and the number of patients with long-term survival has been increasing. However, reports of dropped head syndrome as a late complication after radiotherapy are becoming more common.We report a case of dropped head syndrome as a long-term complication after radiotherapy for hypopharyngeal carcinoma.Case: This report included a 65-year-old male with a history of anticancer drug treatment for hypopharyngeal cancer at age 53 who underwent left neck dissection and radiation as an intensification therapy.He had neck pain at age 61 and experienced symptoms of head drooping at age 63.Because the patient was neurologically asymptomatic, a close examination of the underlying disease was conducted first, but no diagnosis was made.After surgery, the patient's primary disease remained unknown, and it was determined that radiation was the cause.Conclusions: The number of cancer survivors is expected to increase with the development of medical treatment in the future, and the incidence of dropped head syndrome due to radiation injury may increase, which should be noted as one of the causes of dropped head syndrome.

DOI： 10.34371/jspineres.2025-0405

Open Access

CiNii Research

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 Vol. 50 ( 8 ) page： E159 - E160 2025.4

Risk Factors for Early 3-Month Postoperative Mortality in Metastatic Spinal Tumor Surgery: A JASA Multicenter Prospective Study. Reviewed

Uto T, Kato S, Yokogawa N, Shimizu T, Demura S, Shiratani Y, Suzuki A, Tamai K, Kakutani K, Kanda Y, Tominaga H, Kawamura I, Ishihara M, Paku M, Funayama T, Miura K, Shirasawa E, Inoue H, Kimura A, Iimura T, Moridaira H, Akeda K, Takegami N, Nakanishi K, Sawada H, Matsumoto K, Funaba M, Suzuki H, Nakajima H, Oshigiri T, Hirai T, Otsuki B, Kobayakawa K, Funao H, Uotani K, Tanishima S, Sairyo K, Hashimoto K, Iwai C, Seki S, Miyazaki M, Watanabe K, Nakamae T, Kaito T, Nakashima H, Nagoshi N, Imagama S, Watanabe K, Inoue G, Furuya T

Spine 2025.4

Language：English Publisher：Spine

Study Design. Prospective multicenter study. Objective. To investigate risk factors for 3-month postoperative mortality in metastatic spinal tumor surgery, focusing on nutritional biomarkers and prognostic scores alongside clinical indicators. Summary of Background Data. Metastatic spinal tumors affect patient morbidity and mortality. Although prognostic tools exist, they have limitations, particularly in emergency situations requiring rapid assessment. Nutritional biomarkers and prognostic scores may influence outcomes, but their role in predicting early postoperative mortality after spinal tumor surgery, particularly in prospective, multicenter studies, warrants investigation. Methods. Data from 336 patients undergoing palliative surgery for metastatic spinal tumors were collected from 35 centers. The primary outcome was 3-month postoperative mortality. Univariate and multivariate logistic regression analyses with bootstrapping were performed to identify predictors of early mortality, including demographics, prognostic scores (revised Tokuhashi, Tomita, modified Glasgow Prognostic Score [mGPS], and the New England Spinal Metastasis Score [NESMS]), and nutritional biomarkers. The discriminative ability of these factors was evaluated using the receiver operating characteristic curve analysis. Results. Results: The 3-month postoperative mortality rate was 15.5%, with primary cancer progression accounting for 54% of the deaths. Multivariate analysis revealed that high mGPS (OR=1.989, P=0.008) and low preoperative performance status (PS) (OR=1.412, P=0.034) were significant independent predictors of early mortality, the Tomita score showed a trend towards significance (OR=1.234, P=0.050). The mGPS demonstrated a high discriminative ability, with an area under the curve of 0.716. Conclusion. High mGPS and low preoperative PS are significant predictors of 3-month postoperative mortality in patients undergoing surgery for metastatic spinal tumors. Incorporating the mGPS, which reflects nutritional and inflammatory status, into preoperative risk stratification is crucial for optimizing surgical decision-making. Level of Evidence. 2.

DOI： 10.1097/BRS.0000000000005359

Is routine implant removal necessary after open reduction internal fixation of Lisfranc injuries? Comparing functional outcomes of routine and on-demand removal: A multicenter study Reviewed

Muto, S; Takegami, Y; Nakashima, H; Mishima, K; Kumagai, H; Imagama, S

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED Vol. 56 ( 4 ) page： 112240 2025.4

Language：English Publisher：Injury

Introduction: Lisfranc joint injuries are a severe cause of disruption of foot stability and function, often requiring surgical intervention such as open reduction and internal fixation (ORIF). The necessity of routine implant removal after healing remains controversial. This study aimed to compare functional recovery and postoperative complications among patients undergoing routine, on-demand, or no implant removal following ORIF for Lisfranc fracture-dislocations. Materials and Methods: This multicenter retrospective study analyzed 188 patients treated with ORIF for Lisfranc fracture-dislocations. Patients were divided into three groups: routine removal (RR), on-demand removal (ODR), and no removal (NR). Functional outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) midfoot score at the final follow-up. Complications were categorized as implant-related or post-removal. AOFAS midfoot scores and complication rates were compared between the three groups. Results: The median AOFAS midfoot scores at the final follow-up were 92 (IQR 83.00–95.00) in the RR group, 95 (IQR 85.00–95.00) in the ODR group, and 95 (IQR 82.00–95.00) in the NR group, with no significant differences among the three groups (p > 0.05). Implant-related complications were comparable across the groups, although irritation was significantly more frequent in the ODR group (42.9 %) than in the RR (24.4 %) and NR (11.9 %) groups (p = 0.013). Post-removal complications occurred in two cases in the RR group, including one case of loss of correction requiring reoperation. Conclusion: Routine implant removal did not show superior outcomes in functional recovery or complication rates compared to selective removal or retention. Implant retention or selective removal based on individual needs minimizes complications and optimizes patient outcomes.

DOI： 10.1016/j.injury.2025.112240

Development of a YOLOv3-Based Model for Automated Detection of Thoracic Ossification of the Posterior Longitudinal Ligament and the Ligamentum Flavum on Plain Radiographs Reviewed

Ito, S; Nakashima, H; Segi, N; Ouchida, J; Yamauchi, I; Hirai, T; Oda, M; Mori, K; Yamazaki, M; Yoshii, T; Imagama, S

JOURNAL OF CLINICAL MEDICINE Vol. 14 ( 7 ) 2025.3

Language：English Publisher：Journal of Clinical Medicine

Background/Objectives: This study aims to develop and validate a YOLOv3-based deep learning model for detecting ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) on lateral thoracic radiographs, improving early diagnosis and screening accessibility. Methods: A retrospective dataset of 356 lateral thoracic radiographs, including 176 with OPLL or OLF and 180 controls, was annotated by spine surgeons. The YOLOv3 model was trained using data augmentation and evaluated via five-fold cross-validation, with accuracy, precision, recall, and F1-score compared to two spine surgeons. Results: The model achieved 80.6% accuracy, 70.3% precision, 92.6% recall, and 79.9% F1-score, surpassing spine surgeons in accuracy and recall, especially for combined OPLL and OLF cases. Detection accuracy was 81.1% for OPLL, 53.3% for OLF, and 86.3% for combined cases. Conclusions: The YOLOv3-based model provides high accuracy and robust detection of OPLL and OLF on plain radiographs, offering an efficient and accessible screening tool.

DOI： 10.3390/jcm14072389