研究者詳細 - 中島　宏彰

Indirect Decompression in Vertebral Reconstruction for Osteoporotic Vertebral Fractures with Neurological Symptoms: A Preliminary Case Series Open Access

術中脊髄モニタリングにおける運動誘発電位に基づいた機械学習による脊髄機能の評価査読有り

伊達俊坪, 藤原幸一, 世木直喜, 中島宏彰, 伊藤定之, 大内田隼, 大石遼太郎, 宮入祐一, 山内一平, 森田圭則, 今釜史郎

生体医工学 Annual62 巻 ( Abstract ) 頁： 186_1 - 186_1 2024年

記述言語：日本語出版者・発行元：公益社団法人日本生体医工学会

術中脊髄モニタリングでは，運動誘発電位の正確な評価法が十分に確立されておらず，術中に迅速かつ客観的に脊髄機能を評価することが難しいという課題がある．本研究では，機械学習を用いて術中に得られる運動誘発電位の異常を検出する機械学習モデルの開発を試みた．患者797名の術中脊髄モニタリングで得られた各部位の軽頭蓋刺激運動誘発電位の波形データ，術前後に行われる徒手筋力検査（MMT）のスコアを利用した．本解析では，次の条件を満たす症例を除外した； 1）両足の大腿四頭筋，前脛骨筋，ハムストリング，下腿三頭筋のうちどれかが取得されていない．2）総取得数の8割以上で波形が取得できていない．術前のMMTスコアが全て５かつ術後も全て5の症例を正常，術前のスコアが全て5かつ術後が全て5でない症例を異常と定義した．本研究では，異常検知手法の一つであるLong Short Term Memory Autoencoderを用いて正常波形を学習し，MMT評価が低下した症例について術中での異常波形を検知する機械学習モデルの構築した．正常データを学習：検証：テスト＝7:1:2に分割し，異常データは全てテストデータとして使用した．モデルをテストデータに適用した結果，偽陽性率は4%，感度は0.48，AUCは0.79であった．正しく異常と判定できた10例中6例は手術終盤に異常判定が頻発しており，脊髄の異常を反映している可能性がある．

DOI： 10.11239/jsmbe.annual62.186_1

CiNii Research

Comparative Analysis of Characteristics of Lower- and Mid-Cervical Spine Injuries in the Elderly Open Access

Segi, N; Nakashima, H; Ito, S; Ouchida, J; Yokogawa, N; Sasagawa, T; Furuya, T; Yunde, A; Funayama, T; Eto, F; Watanabe, K; Nori, S; Ikegami, S; Uehara, M; Hashimoto, K; Onoda, Y; Nakajima, H; Suzuki, H; Imajo, Y; Yamada, T; Hasegawa, T; Kawaguchi, K; Haruta, Y; Terashima, Y; Hirota, R; Tonomura, H; Sakata, M; Iizuka, Y; Uei, H; Suzuki, N; Akeda, K; Tominaga, H; Seki, S; Oshima, Y; Kaito, T; Otsuki, B; Nakanishi, K; Kakutani, K; Funao, H; Yoshii, T; Sakai, D; Ohba, T; Miyazaki, M; Terai, H; Inoue, G; Okada, S; Imagama, S; Kato, S

SPINE SURGERY AND RELATED RESEARCH 8 巻 ( 6 ) 頁： 560 - 567 2024年

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

Introduction: Elderly patients have a higher frequency of upper cervical fractures caused by minor trauma; nevertheless, the clinical differences between mid- and lower-cervical (C6-C7) injuries are unclear. The aim of this study was to compare the epidemiology of lower- and mid-cervical injuries in the elderly. Methods: This multicenter, retrospective study included 451 patients aged 65 years or older who had mid- or lower-cervical fractures/dislocations. Patients’ demographic and treatment data were examined and compared based on mid- and lower-cervical injuries. Results: There were 139 patients (31%) with lower-cervical injuries and 312 (69%) with mid-cervical injuries. High-energy trauma (60% vs. 47%, p=0.025) and dislocation (55% vs. 45%, p=0.054) were significantly experienced more often by elderly patients with lower-cervical injuries than by patients with mid-cervical injuries. Although the incidence of key muscle weakness at the C5 to T1 levels were all significantly lower in patients with lower-cervical injuries than those with mid-cervical injuries, impairments at C5 occurred in 49% of them, and at C6, in 65%. No significant differences were found in the rates of death, pneumonia, or tracheostomy requirements, and no significant differences existed in ambulation or ASIA impairment scale grade for patients after 6 months of treatment. Conclusions: Elderly patients with lower-cervical fractures/dislocations were injured by high-energy trauma significantly more often than patients with mid-cervical injuries. Furthermore, half of the patients with lower-cervical injuries had mid-cervical level neurological deficits with a relatively high rate of respiratory complications.

DOI： 10.22603/ssrr.2024-0030

Morita, Y; Nakashima, H; Segi, N; Ito, S; Ouchida, J; Oishi, R; Yamauchi, I; Miyairi, Y; Tsushima, M; Ito, K; Tomita, H; Morishita, K; Kanemura, T; Imagama, S

SPINE SURGERY AND RELATED RESEARCH 8 巻 ( 6 ) 頁： 623 - 630 2024年

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

Introduction: This study aimed to investigate the clinical and radiological outcome of “indirect decompression” using lateral-posterior combined surgery for osteoporotic vertebral fracture (OVF) with neurological symptoms. Methods: A total of 17 patients who underwent lateral and posterior combined indirect decompressive spinal reconstruction (LP-IDR) for single-level OVF with neurological symptoms were included in this study. The neurological symptoms (sensory disturbance and muscle weakness) and imaging findings (local angle and height of the fracture segment and bone fragment occupancy in the spinal canal) were investigated preoperatively, postoperatively, and at the 1-year follow-up. Results: Muscle weakness was observed preoperatively in ten patients. Nine patients had complete recovery of muscle weakness (p<0.001), whereas one had residual muscle weakness at the 1-year follow-up. The presence of sensory disturbance was observed in 16 patients preoperatively, and it was significantly reduced to 8 patients at the 1-year follow-up (p= 0.003). The bony fragment occupancy rate in the spinal canal was decreased from 44.0% to 40.2% postoperatively (p=0.04) and to 33.1% at 1 year (p=0.002). The local angle was corrected from 8.3° to −2.6° postoperatively (p=0.003) and to 1.2° at 1 year. The local height was corrected from 26.7 to 32.0 mm postoperatively (p<0.001) and to 29.8 mm at 1 year. Conclusions: LP-IDR for OVF with neurological symptoms provided sufficient neurological improvement with expansion of the spinal canal over time.

DOI： 10.22603/ssrr.2024-0013

Reply to "Letter to the Editor Concerning 'Clinical Outcomes of Condoliase Injection Therapy for Lateral Lumbar Disc Herniation' by Kagami et al." Open Access

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

SPINE SURGERY AND RELATED RESEARCH 8 巻 ( 3 ) 頁： 353 - 353 2024年

Low Nutrition before Injury Is a Risk Factor for Dysphagia in Older Patients with Cervical Spinal Cord Injury: Based on a Multicenter Data of 707 Patients Open Access

Segi, N; Nakashima, H; Ito, S; Ouchida, J; Yokogawa, N; Sasagawa, T; Funayama, T; Eto, F; Watanabe, K; Nori, S; Furuya, T; Yunde, A; Terashima, Y; Hirota, R; Nakajima, H; Yamada, T; Hasegawa, T; Kawaguchi, K; Haruta, Y; Hashimoto, K; Onoda, Y; Nakanishi, K; Misaki, K; Ikegami, S; Uehara, M; Suzuki, H; Imajo, Y; Uei, H; Sawada, H; Terai, H; Tamai, K; Kuroda, A; Inoue, G; Suzuki, N; Kato, K; Akeda, K; Takegami, N; Iizuka, Y; Oshima, Y; Tonomura, H; Kiyasu, K; Funao, H; Yoshii, T; Ishihara, M; Kaito, T; Seki, S; Kakutani, K; Tominaga, H; Ohba, T; Sakai, D; Otsuki, B; Miyazaki, M; Okada, S; Imagama, S; Kato, S

SPINE SURGERY AND RELATED RESEARCH 8 巻 ( 5 ) 頁： 473 - 479 2024年

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

Introduction: For older adults, dysphagia is a serious problem that can occur after spinal cord injury (SCI), but its risk factors are unclear. This study aimed to identify risk factors for dysphagia in elderly patients (!65 years) with cervical SCI. Methods: This multicenter study included 707 patients with cervical SCI (mean age 75.3 years). Univariate and multivariate analyses were conducted for patient characteristics and geriatric nutritional risk index (GNRI). Results: Dysphagia occurred in 69 patients (9.8%). The significant factors were as follows: male sex (odds ratio [OR] 3.43), GNRI <92 (1.83), dementia (2.94), fracture (3.40), complete paralysis (3.61), anterior surgery (3.74), and tracheostomy (17.06). Age was not identified as a risk factor. Conclusions: Low GNRI before injury was one of the independent risk factors for dysphagia after geriatric cervical SCI. GNRI represents the comprehensive nutritional status of the elderly and reflects feeding function and its recovery capacity.

DOI： 10.22603/ssrr.2023-0227

Is Intraoperative Blood Loss Volume in Elderly Cervical Spine Injury Surgery Greater in Patients with Ankylosis? A Multicenter Survey Open Access

Uehara, M; Ikegami, S; Takizawa, T; Oba, H; Yokogawa, N; Sasagawa, T; Nakashima, H; Segi, N; Ito, S; Funayama, T; Eto, F; Yamaji, A; Watanabe, K; Nori, S; Takeda, K; Furuya, T; Yunde, A; Nakajima, H; Yamada, T; Hasegawa, T; Terashima, Y; Hirota, R; Suzuki, H; Imajo, Y; Tonomura, H; Sakata, M; Hashimoto, K; Onoda, Y; Kawaguchi, K; Haruta, Y; Suzuki, N; Kato, K; Uei, H; Sawada, H; Nakanishi, K; Misaki, K; Terai, H; Tamai, K; Kuroda, A; Inoue, G; Kakutani, K; Kakiuchi, Y; Kiyasu, K; Tominaga, H; Tokumoto, H; Iizuka, Y; Takasawa, E; Akeda, K; Takegami, N; Funao, H; Oshima, Y; Kaito, T; Sakai, D; Yoshii, T; Ohba, T; Otsuki, B; Seki, S; Miyazaki, M; Ishihara, M; Okada, S; Imagama, S; Kato, S

SPINE SURGERY AND RELATED RESEARCH 8 巻 ( 6 ) 頁： 575 - 582 2024年

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

Introduction: Preoperative estimations of blood loss are important when planning surgery for cervical spine injuries in older adults. The association between ankylosis and blood loss in perioperative management is of particular interest. This multicenter database review aimed to evaluate the impact of ankylosis on surgical blood loss volume in elderly patients with cervical spine injury. Methods: The case histories of 1512 patients with cervical spine injury at among 33 institutions were reviewed. After the exclusion of patients without surgery or whose blood loss or ankylosis status was unclear, 793 participants were available for analysis. Differences in blood loss volume were compared between the Ankylosis (+) group with ankylosis at the cervical level and the Ankylosis (−) group without by the inverse probability of treatment weighting (IPTW) method using a propensity score. Results: Of the 779 patients (mean age: 75.0±6.3 years) eligible for IPTW calculation, 257 (32.4%) had ankylosis at the cervical level. The mean blood loss volume was higher in Ankylosis (+) patients than in Ankylosis (−) patients (P<0.001). This difference did not reach statistical significance when weighted by background factors, with mean blood loss of 244 mL and 188 mL, respectively, after adjustment. Conclusions: This study revealed that ankylosis was significantly associated with increased blood loss volume when unadjusted by surgical time. Elderly patients with cervical spine injury accompanied by ankylosis appear predisposed to higher bleeding and severe hemorrhage, both as a result of the condition and their particular demographic characteristics.

DOI： 10.22603/ssrr.2023-0118

Impact of T1 Slope Visibility on Cervical Sagittal Alignment: a Comparative Study of Radiographic Parameters According to T1 Slope Visibility

Nakashima Hiroaki, Matsumoto Akiyuki, Ito Sadayuki, Segi Naoki, Ouchida Jun, Yamauchi Ippei, Morita Yoshinori, Imagama Shiro

Spine Surgery and Related Research advpub 巻 ( 0 ) 2024年

担当区分：筆頭著者記述言語：英語出版者・発行元：The Japanese Society for Spine Surgery and Related Research

Introduction: Proper cervical sagittal alignment is essential for maintaining overall spinal stability and function. A crucial measure of this alignment is the T1 slope, which is an important indicator. However, lateral cervical spine radiographs often fail to clearly show the T1 slope owing to several factors, such as shoulder anatomy or variations in body shape. In this study, we aimed to evaluate the differences in cervical alignment between individuals with visible and invisible T1 slopes.Methods: This study was a retrospective cohort analysis involving 60 patients diagnosed with cervical spine conditions and evaluated via radiographic imaging. The patients were categorized into two groups based on whether the T1 slope was clearly visible or not. Key radiographic measurements, such as the C2–C7 sagittal vertical axis (SVA) and C2–C7 Cobb angles in the neutral, flexion, and extension postures, were recorded and statistically analyzed.Results: Significant differences were observed in the C2–C7 SVA between the groups, particularly among men. Men in the invisible T1 slope group had an average SVA of 28.9 mm, whereas those in the visible group had a mean SVA of 16.0 mm (P < 0.05). Although no notable differences were observed in the Cobb angles for the neutral and flexion positions, a substantial reduction in the extension Cobb angle was noted in the invisible than in the visible group (24.4° vs. 37.6°, P < 0.05).Conclusions: Male patients with obscured T1 slopes exhibited unique radiographic features, including higher C2–C7 SVA and diminished extension capacity. This suggests that the visibility of the T1 slope plays a pivotal role in the evaluation of cervical alignment. Furthermore, the exclusion of patients with an invisible T1 slope from research studies could lead to biased results.

DOI： 10.22603/ssrr.2024-0253

CiNii Research

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

Okada Yuya, Nakashima Hiroaki, Ito Sadayuki, Segi Naoki, Ouchida Jun, Urasaki Tetsuya, Imagama Shiro

Spine Surgery and Related Research advpub 巻 ( 0 ) 2024年

担当区分：責任著者記述言語：英語出版者・発行元：The Japanese Society for 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

CiNii Research

Automated Detection of the Thoracic Ossification of the Posterior Longitudinal Ligament Using Deep Learning and Plain Radiographs 査読有り Open Access

Ito, S; Nakashima, H; Segi, N; Ouchida, J; Oda, M; Yamauchi, I; Oishi, R; Miyairi, Y; Mori, K; Imagama, S

BIOMED RESEARCH INTERNATIONAL 2023 巻頁： 8495937 2023年11月

記述言語：英語出版者・発行元：BioMed Research International

Ossification of the ligaments progresses slowly in the initial stages, and most patients are unaware of the disease until obvious myelopathy symptoms appear. Consequently, treatment and clinical outcomes are not satisfactory. This study is aimed at developing an automated system for the detection of the thoracic ossification of the posterior longitudinal ligament (OPLL) using deep learning and plain radiography. We retrospectively reviewed the data of 146 patients with thoracic OPLL and 150 control cases without thoracic OPLL. Plain lateral thoracic radiographs were used for object detection, training, and validation. Thereafter, an object detection system was developed, and its accuracy was calculated. The performance of the proposed system was compared with that of two spine surgeons. The accuracy of the proposed object detection model based on plain lateral thoracic radiographs was 83.4%, whereas the accuracies of spine surgeons 1 and 2 were 80.4% and 77.4%, respectively. Our findings indicate that our automated system, which uses a deep learning-based method based on plain radiographs, can accurately detect thoracic OPLL. This system has the potential to improve the diagnostic accuracy of thoracic OPLL.

DOI： 10.1155/2023/8495937

Hangman's Fracture in Geriatric Population: A Nationwide Multicenter Study in Japan 査読有り Open Access

Yunde, A; Furuya, T; Orita, S; Ohtori, S; Yokogawa, N; Nakashima, H; Segi, N; Funayama, T; Ikegami, S; Nakajima, H; Watanabe, K; Hasegawa, T; Tonomura, H; Terashima, Y; Hashimoto, K; Suzuki, N; Uei, H; Kiyasu, K; Tominaga, H; Sakai, D; Kaito, T; Inoue, G; Okada, S; Imagama, S; Kato, S

GLOBAL SPINE JOURNAL 2023年11月

出版者・発行元：Global Spine Journal

Study Design: Retrospective multicenter study. Objectives: To investigate the treatments of the geriatric population with hangman’s fractures using a multicenter database under the Japan Association of Spine Surgeons with Ambition (JASA). Methods: The multicenter database included data from 1512 patients. We employed the Levine and Edwards classification for categorizing hangman’s fractures. The study incorporated epidemiological data, including the prevalence of hangman’s fractures, patient age, and follow-up duration. Bony fusion rates and length of hospitalization were recorded for Type I and Type II fractures, and the degree of neurological impairment was assessed. Results: Hangman’s fractures represented 62 cases, accounting for 7.4% of all cervical spine injuries. The patients had an average age of 76.6 ± 6.5 years, and the mean duration of follow-up was 21.5 ± 23.6 months. The study found that the bony fusion rate for hangman’s fractures in the geriatric population was 88.9%. Surgical treatment was associated with a shorter hospitalization period for Type II fractures compared to conservative treatment. Thirteen cases of hangman’s fractures in the geriatric population, accounting for 21%, were complicated by spinal cord injury. Conclusions: This is the largest study to date on hangman’s fractures in geriatric population ≥65 years. Type I and Type II fractures, according to the Levine and Edwards classification, had a bony fusion rate of up to 90%. In patients with Type II fractures, surgical treatment led to a shorter initial hospital stay. Geriatric patients are at risk of spinal cord injury due to hangman’s fractures.

DOI： 10.1177/21925682231216925

Deep learning-based prediction model for postoperative complications of cervical posterior longitudinal ligament ossification 査読有り

Ito, S; Nakashima, H; Yoshii, T; Egawa, S; Sakai, K; Kusano, K; Tsutui, S; Hirai, T; Matsukura, Y; Wada, K; Katsumi, K; Koda, M; Kimura, A; Furuya, T; Maki, S; Nagoshi, N; Nishida, N; Nagamoto, Y; Oshima, Y; Ando, K; Takahata, M; Mori, K; Nakajima, H; Murata, K; Miyagi, M; Kaito, T; Yamada, K; Banno, T; Kato, S; Ohba, T; Inami, S; Fujibayashi, S; Katoh, H; Kanno, H; Oda, M; Mori, K; Taneichi, H; Kawaguchi, Y; Takeshita, K; Matsumoto, M; Yamazaki, M; Okawa, A; Imagama, S

EUROPEAN SPINE JOURNAL 32 巻 ( 11 ) 頁： 3797 - 3806 2023年11月

記述言語：英語出版者・発行元：European Spine Journal

Purpose: Postoperative complication prediction helps surgeons to inform and manage patient expectations. Deep learning, a model that finds patterns in large samples of data, outperform traditional statistical methods in making predictions. This study aimed to create a deep learning-based model (DLM) to predict postoperative complications in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Methods: This prospective multicenter study was conducted by the 28 institutions, and 478 patients were included in the analysis. Deep learning was used to create two predictive models of the overall postoperative complications and neurological complications, one of the major complications. These models were constructed by learning the patient's preoperative background, clinical symptoms, surgical procedures, and imaging findings. These logistic regression models were also created, and these accuracies were compared with those of the DLM. Results: Overall complications were observed in 127 cases (26.6%). The accuracy of the DLM was 74.6 ± 3.7% for predicting the overall occurrence of complications, which was comparable to that of the logistic regression (74.1%). Neurological complications were observed in 48 cases (10.0%), and the accuracy of the DLM was 91.7 ± 3.5%, which was higher than that of the logistic regression (90.1%). Conclusion: A new algorithm using deep learning was able to predict complications after cervical OPLL surgery. This model was well calibrated, with prediction accuracy comparable to that of regression models. The accuracy remained high even for predicting only neurological complications, for which the case number is limited compared to conventional statistical methods.

DOI： 10.1007/s00586-023-07562-2

Laterality of lumbar disc herniation 査読有り Open Access

Ito, S; Nakashima, H; Sato, K; Deguchi, M; Matsubara, Y; Kanemura, T; Urasaki, T; Yoshihara, H; Sakai, Y; Ito, K; Shinjo, R; Ando, K; Machino, M; Segi, N; Tomita, H; Koshimizu, H; Imagama, S

JOURNAL OF ORTHOPAEDIC SCIENCE 28 巻 ( 6 ) 頁： 1207 - 1213 2023年11月

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

Background: Lumbar disc herniation (LDH) is most common in men aged 20–40 at the L4/5 level; however, left-right differences have not been reported. Improving our understanding of left- and right-side LDH may facilitate the estimation of mechanical load on intervertebral discs. Here, we assessed left-right differences in LDH via a retrospective analysis of LDH cases. Methods: Among 10,972 surgical cases of LDH identified in the Nagoya Spine Group database, 2899 in which right- and left-LDH sides were observable in a single vertebral segment were identified (mean age 46.3 ± 16.6 years, 2028 males). The following characteristics of patients with right- and left-LDH were compared: age, LDH level, surgical technique, operative time, blood loss, length of hospital stay, preoperative Japan Orthopaedic Association (JOA) score, and JOA recovery rate. Results: LDH occurred on the right and left sides in 1358 and 1541 patients, respectively, with patients with right-side LDH significantly older than those with left (47.9 ± 16.6 versus 45.0 ± 16.5, respectively; p < 0.001). No between-group differences in sex, age, LDH level, surgical technique, operative time, blood loss, length of hospital stay, preoperative JOA score, or JOA recovery rate were observed. The occurrence of right-side LDH increased with age, occurring in 42.7%, 45.1%, 49.9%, and 54.7% of patients aged 10–29, 30–49, 50–69, and 70–89 years, respectively. Conclusion: Left-side LDH was observed more frequently than right; however, right-side LDH incidence increased with age. No significant between-group differences regarding symptoms, treatments, or outcomes were observed.

DOI： 10.1016/j.jos.2022.10.003

Prognostic impact of respiratory dysfunction in elderly patients with cervical spinal cord injury and/or fractures: a multicenter survey 査読有り

Hirota, R; Terashima, Y; Ohnishi, H; Yamashita, T; Yokogawa, N; Sasagawa, T; Nakashima, H; Segi, N; Ito, S; Funayama, T; Eto, F; Yamaji, A; Watanabe, K; Nori, S; Takeda, K; Furuya, T; Yunde, A; Nakajima, H; Yamada, T; Hasegawa, T; Suzuki, H; Imajo, Y; Ikegami, S; Uehara, M; Tonomura, H; Sakata, M; Hashimoto, K; Onoda, Y; Kawaguchi, K; Haruta, Y; Suzuki, N; Kato, K; Uei, H; Sawada, H; Nakanishi, K; Misaki, K; Terai, H; Tamai, K; Kuroda, A; Inoue, G; Kakutani, K; Kakiuchi, Y; Kiyasu, K; Tominaga, H; Tokumoto, H; Iizuka, Y; Takasawa, E; Akeda, K; Takegami, N; Funao, H; Oshima, Y; Kaito, T; Sakai, D; Yoshii, T; Ohba, T; Otsuki, B; Seki, S; Miyazaki, M; Ishihara, M; Okada, S; Imagama, S; Kato, S

EUROPEAN SPINE JOURNAL 32 巻 ( 10 ) 頁： 3522 - 3532 2023年10月

記述言語：英語出版者・発行元：European Spine Journal

Purpose: To investigate the impact of early post-injury respiratory dysfunction for neurological and ambulatory ability recovery in patients with cervical spinal cord injury (SCI) and/or fractures. Methods: We included 1,353 elderly patients with SCI and/or fractures from 78 institutions in Japan. Patients who required early tracheostomy and ventilator management and those who developed respiratory complications were included in the respiratory dysfunction group, which was further classified into mild and severe respiratory groups based on respiratory weaning management. Patient characteristics, laboratory data, neurological impairment scale scores, complications at injury, and surgical treatment were evaluated. We performed a propensity score-matched analysis to compare neurological outcomes and mobility between groups. Results: Overall, 104 patients (7.8%) had impaired respiratory function. In propensity score-matched analysis, the respiratory dysfunction group had a lower home discharge and ambulation rates (p = 0.018, p = 0.001, respectively), and higher rate of severe paralysis (p < 0.001) at discharge. At the final follow-up, the respiratory dysfunction group had a lower ambulation rate (p = 0.004) and higher rate of severe paralysis (p < 0.001). Twenty-six patients with severe disability required respiratory management for up to 6 months post-injury and died of respiratory complications. The mild and severe respiratory dysfunction groups had a high percentage of severe paraplegic cases with low ambulatory ability; there was no significant difference between them. The severe respiratory dysfunction group tended to have a poorer prognosis. Conclusion: Respiratory dysfunction in elderly patients with SCI and/or cervical fracture in the early post-injury period reflects the severity of the condition and may be a useful prognostic predictor.

DOI： 10.1007/s00586-023-07828-9

Racial differences in whole-body sagittal alignment between Asians and Caucasians based on international multicenter data 査読有り

Ouchida, J; Nakashima, H; Kanemura, T; Okamoto, M; Hatsushikano, S; Imagama, S; Le Huec, JC; Hasegawa, K

EUROPEAN SPINE JOURNAL 32 巻 ( 10 ) 頁： 3608 - 3615 2023年10月

記述言語：英語出版者・発行元：European Spine Journal

Purpose: To examine inherent differences adjusted for age and clinical score in whole-body sagittal (WBS) alignment involving the lower extremities between Asians and Caucasians, and to determine the relationship between age and WBS parameters by race and sex. Methods: A total of 317 individuals consisting of 206 Asians and 111 Caucasians participated. WBS parameters including C2-7 lordotic angle, lower lumbar lordosis (lower LL, L4-S), pelvic incidence (PI), pelvic thickness, knee flexion (KF), sagittal vertical axis (SVA), and T1 pelvic angle (TPA) were evaluated radiologically. Propensity score-matching adjustments for age and the Oswestry Disability Index scores for comparative analysis between the two race cohorts and correlation analysis between age and WBS parameters for all subjects by race and sex were conducted. Results: The comparative analysis included 136 subjects (age: Asians 41.1 ± 13.5, Caucasians 42.3 ± 16.2 years, p = 0.936). Racial differences in WBS parameters were observed in C2-7 lordotic angle (−1.8 ± 12.3 vs. 6.3 ± 12.2 degrees, p = 0.001), and lower LL (34.0 ± 6.6 vs. 38.0 ± 6.1 degrees, p <.001). In correlation analysis with age, moderate or more significant correlations with age were found in KF for all groups, and in SVA and TPA for females of both racial groups. Age-related changes in pelvic parameters of PI and pelvic thickness were more significant in Caucasian females. Conclusion: Analysis of the correlation between age and WBS parameters suggested that age-related WBS changes vary between races and should be considered during corrective spinal surgery.

DOI： 10.1007/s00586-023-07829-8

Human Spinal Oligodendrogenic Neural Progenitor Cells Enhance Pathophysiological Outcomes and Functional Recovery in a Clinically Relevant Cervical Spinal Cord Injury Rat Model. 査読有り Open Access

Pieczonka K, Nakashima H, Nagoshi N, Yokota K, Hong J, Badner A, Chio JCT, Shibata S, Khazaei M, Fehlings MG

Stem cells translational medicine 12 巻 ( 9 ) 頁： 603 - 616 2023年9月

記述言語：英語出版者・発行元：Stem Cells Translational Medicine

Traumatic spinal cord injury (SCI) results in the loss of neurons, oligodendrocytes, and astrocytes. Present interventions for SCI include decompressive surgery, anti-inflammatory therapies, and rehabilitation programs. Nonetheless, these approaches do not offer regenerative solutions to replace the lost cells, fiber tracts, and circuits. Neural stem/progenitor cell (NPC) transplantation is a promising strategy that aims to encourage regeneration. However, NPC differentiation remains inconsistent, thus, contributing to suboptimal functional recovery. As such, we have previously engineered oligodendrogenically biased NPCs (oNPCs) and demonstrated their efficacy in a thoracic model of SCI. Since the majority of patients with SCI experience cervical injuries, our objective in the current study was to generate human induced pluripotent stem cell-derived oNPCs (hiPSC-oNPCs) and to characterize these cells in vitro and in vivo, utilizing a clinically relevant rodent model of cervical SCI. Following transplantation, the oNPCs engrafted, migrated to the rostral and caudal regions of the lesion, and demonstrated preferential differentiation toward oligodendrocytes. Histopathological evaluations revealed that oNPC transplantation facilitated tissue preservation while diminishing astrogliosis. Moreover, oNPC transplantation fostered remyelination of the spared tissue. Functional analyses indicated improved forelimb grip strength, gait, and locomotor function in the oNPC-Transplanted rats. Importantly, oNPC transplantation did not exacerbate neuropathic pain or induce tumor formation. In conclusion, these findings underscore the therapeutic potential of oNPCs in promoting functional recovery and histopathological improvements in cervical SCI. This evidence warrants further investigation to optimize and advance this promising cell-based therapeutic approach.

DOI： 10.1093/stcltm/szad044

Open Access