論文 - 中島　宏彰

特集 整形外科ロボット支援手術 脊椎編 脊椎手術におけるナビゲーション支援とロボット支援手術

金村 徳相, 伊藤 研悠, 都島 幹人, 富田 浩之, 長谷 康弘, 大出 幸史, 大内田 隼, 中島 宏彰, 今釜 史郎

臨床整形外科   57 巻 ( 8 ) 頁： 981 - 996   2022年8月

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1408202414

CiNii Research

Impact of Adjacent Facet Joint Osteoarthritis on Adjacent Segment Degeneration after Short-Segment Lateral Lumbar Interbody Fusion for Indirect Decompression: Minimum 5-Year Follow-Up Open Access

Ouchida, J; Nakashima, H; Kanemura, T; Satake, K; Ito, K; Tsushima, M; Ando, K; Machino, M; Ito, S; Segi, N; Morita, Y; Ode, Y; Imagama, S

BIOMED RESEARCH INTERNATIONAL   2022 巻   頁： 3407681   2022年8月

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

Purpose. Lumbar fusion combined with lateral lumbar interbody fusion (LLIF) and percutaneous pedicle screws (PPS) is a widely used, minimally invasive surgical treatment, but studies on incidence and risk factors for subsequent adjacent segment degeneration (ASD) are limited. This study was aimed at investigating midterm incidence and reoperation rate of ASD after indirect decompression (IDD) with LLIF and PPS and at clarifying the impact of preexisting adjacent facet osteoarthritis on development of ASD after IDD. Methods. Forty-one patients who underwent short-segment (1- or 2-level) lumbar fusion with LLIF and PPS with a minimum 5-year follow-up were analyzed. Cephalad adjacent facet osteoarthritis was classified as 1 (normal) to 4 (severe) by an established classification system on preoperative CT. ASD was diagnosed with plain radiographs taken preoperatively and up to 5 years postoperatively, and preoperative degree of facet osteoarthritis was compared between the ASD+ group and ASD- group (control). We also divided patients into two groups according to severity of facet degeneration, mild (grades 1-2) group and severe (grades 3-4) group, and investigated ASD-free survival of the groups by the Kaplan-Meier method. Results. The incidence of ASD at 5 years postoperatively was 34.1%, and the reoperation rate for ASD was 4.9%. The degree of preexisting facet joint osteoarthritis was significantly different between the ASD+ and ASD- groups (grade 1/2/3/4: 0/29/64/7% and 29/62/29/10%, P=0.008). Kaplan-Meier analysis showed the severe group to have significantly lower ASD-free survival than the mild group (P=0.017) at 5 years postoperatively. Conclusion. Comparative analysis of the ASD+ versus ASD- group showed preexisting facet joint osteoarthritis to be a risk factor for ASD progression after IDD. Additional longitudinal studies with long-term follow-up are needed to understand the causal relationship between facet joint degeneration and progression of adjacent segment deterioration following IDD.

DOI： 10.1155/2022/3407681

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A multicenter study of 1-year mortality and walking capacity after spinal fusion surgery for cervical fracture in elderly patients Open Access

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

BMC MUSCULOSKELETAL DISORDERS   23 巻 ( 1 ) 頁： 798   2022年8月

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記述言語：英語   出版者・発行元：BMC Musculoskeletal Disorders  

Background: The 1-year mortality and functional prognoses of patients who received surgery for cervical trauma in the elderly remains unclear. The aim of this study is to investigate the rates of, and factors associated with mortality and the deterioration in walking capacity occurring 1 year after spinal fusion surgery for cervical fractures in patients 65 years of age or older. Methods: Three hundred thirteen patients aged 65 years or more with a traumatic cervical fracture who received spinal fusion surgery were enrolled. The patients were divided into a survival group and a mortality group, or a maintained walking capacity group and a deteriorated walking capacity group. We compared patients’ backgrounds, trauma, and surgical parameters between the two groups. To identify factors associated with mortality or a deteriorated walking capacity 1 year postoperatively, a multivariate logistic regression analysis was conducted. Results: One year postoperatively, the rate of mortality was 8%. A higher Charlson comorbidity index (CCI) score, a more severe the American Spinal Cord Injury Association impairment scale (AIS), and longer surgical time were identified as independent factors associated with an increase in 1-year mortality. The rate of deterioration in walking capacity between pre-trauma and 1 year postoperatively was 33%. A more severe AIS, lower albumin (Alb) and hemoglobin (Hb) values, and a larger number of fused segments were identified as independent factors associated with the increased risk of deteriorated walking capacity 1 year postoperatively. Conclusions: The 1-year rate of mortality after spinal fusion surgery for cervical fracture in patients 65 years of age or older was 8%, and its associated factors were a higher CCI score, a more severe AIS, and a longer surgical time. The rate of deterioration in walking capacity was 33%, and its associated factors were a more severe AIS, lower Alb, lower Hb values, and a larger number of fused segments.

DOI： 10.1186/s12891-022-05752-5

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Clinical Indicators of Surgical Outcomes After Laminoplasty for Patients With Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Multicenter Study

Nagoshi, N; Yoshii, T; 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; 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; Watanabe, K; Taneichi, H; Imagama, S; Kawaguchi, Y; Takeshita, K; Nakamura, M; Matsumoto, M; Yamazaki, M; Okawa, A

SPINE   47 巻 ( 15 ) 頁： 1077 - 1083   2022年8月

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記述言語：英語   出版者・発行元：Spine  

Study Design. A prospective multicenter study. Objective. This study aims to evaluate patient-reported outcomes using the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) and clarify clinical factors that affect the therapeutic effects for patients with cervical ossification of the posterior longitudinal ligament (OPLL). Summary of Background Data. Although previous studies identified factors that affected the surgical outcomes, their assessment was mainly based on the Japanese Orthopedic Association score, which only includes neurological function. Investigating this pathology through multiple functions and quality of life (QOL) is pivotal to understanding the comprehensive clinical pictures of the cervical OPLL and its therapeutic outcomes. Materials and Methods. This study was performed by the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. A total of 478 patients with myelopathy caused by cervical OPLL from 28 institutions were prospectively registered from 2014 to 2017 and followed up for 2 years. Of the patients, 168 received laminoplasties and fully completed questionnaires. Demographic information, imaging findings, and clinical outcomes were collected. Patients were grouped according to effective or ineffective surgical outcomes as defined by the JOACMEQ using logistic regression analyses. Results. Laminoplasty resulted in functional improvement in the cervical spine and upper extremity around 40% of the patients, while QOL showed only 21.4% (P<0.01). Multivariable analyses revealed that younger age and a postoperative decrease in arm or hand pain were correlated with significantly improved function of the upper extremities. A reduction in lower limb pain favorably affected the postoperative lower extremity function. A postoperative reduction in upper extremity pain enhanced the QOL recovery. Conclusions. Surgeons should recognize the diversity of surgical outcomes after laminoplasty and understand the necessity of pain management even after the surgery to enhance bodily functions and QOL in patients with cervical OPLL.

DOI： 10.1097/BRS.0000000000004359

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Paraplegia due to spinal epidural lipoma without spinal dysraphism in an adolescent patient: a case report 査読有り Open Access

Segi, N; Nakashima, H; Ando, K; Machino, M; Ito, S; Matsumoto, A; Koshimizu, H; Tomita, H; Nojima, T; Imagama, S

NAGOYA JOURNAL OF MEDICAL SCIENCE   84 巻 ( 3 ) 頁： 656 - 663   2022年8月

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

We report the case of a rare lipoma arising in the epidural space of a 14-year-old boy without spinal dysraphism. Lipomas are rare in pediatric soft tissue tumors, accounting for only about 4% of cases. The incidence of an intraspinal epidural lipoma without spinal dysraphism is extremely rare in pediatric patients. In this case, the patient had progressive motor deficits in the lower extremities and difficulty in urination and defecation. Magnetic resonance imaging showed an extradural tumor compressing the spinal cord at the T3–T7 level. Because of the progressive neurological deficits, we performed an emergency surgery. The tumor was completely resected en bloc, and histopathology revealed mature adipose tissue with fibrous septa, diagnosed as atypical lipomatous tumor / well-differentiated liposarcoma. The patient fully recovered and there was no tumor recurrence for 6 years since the surgery. However, re-examination using fluorescence in situ hybridization after 6 years of surgery changed the diagnosis to lipoma as no amplification of murine double-minute type 2 oncogene was observed. In liposarcoma, histopathological diagnosis using fluorescence in situ hybridization is mandatory. Our case illustrates that immunohistochemical diagnosis alone can be misleading. Hence, prompt surgery is required for progressive neuropathy

DOI： 10.18999/nagjms.84.3.656

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Patient factors influencing a delay in diagnosis in pediatric spinal cord tumors 査読有り Open Access

Koshimizu, H; Nakashima, H; Ando, K; Kobayashi, K; Nishimura, Y; Machino, M; Ito, S; Kanbara, S; Inoue, T; Yamaguchi, H; Segi, N; Tomita, H; Imagama, S

NAGOYA JOURNAL OF MEDICAL SCIENCE   84 巻 ( 3 ) 頁： 516 - 525   2022年8月

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

The diagnosis of pediatric spinal cord tumor is frequently delayed due to the presence of non-specific symptoms. We investigated the factors influencing the delay between the first symptom presentation and the diagnosis for pediatric spinal cord tumor. We retrospectively analyzed 31 patients of age <20 years (18 men, 13 women) who underwent surgery for spinal cord tumor at a single center during 1998–2018. We extracted the relevant data on patients’ symptoms, affected spinal location (cervical: C1-7, thoracic: T1-T12, and lumbosacral: L1-S), and tumor anatomical location (extradural, intradural extramedullary, and intramedullary tumor) that could potentially affect the duration of symptom presentation prior to the diagnosis. The most common symptom presented in the patients was pain (n = 22, 71.0 %). Motor symptoms such as paralysis was associated with early diagnosis (P = 0.039). The duration of symptoms prior to diagnosis was found to be significantly longer in patients with spinal tumor in the lumbar-sacral region than in those with the involvement of the cervical and thoracic regions (2.1 ± 1.7 months vs 13.6 ± 12.1 months; P = 0.006 and 2.9 ± 2.2 months vs 13.6 ± 12.1 months; P = 0.012, respectively). Our study results demonstrated that pain was the most common symptom in the examined patients, although it did not affect the delay in diagnosis, whereas the presentation of motor symptoms was helpful in the diagnosis of pediatric spinal cord tumor and the diagnosis could be delayed in lumbar-sacral spinal tumors

DOI： 10.18999/nagjms.84.3.516

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Treatment for the Thoracic Ossification of the Posterior Longitudinal Ligament and Ossification of the Ligamentum Flavum

Machino, M; Sakai, K; Yoshii, T; Furuya, T; Ito, S; Segi, N; Ouchida, J; Imagama, S; Nakashima, H

JOURNAL OF CLINICAL MEDICINE   11 巻 ( 16 )   2022年8月

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記述言語：英語   出版者・発行元：Journal of Clinical Medicine  

DOI： 10.3390/jcm11164690

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Sacroiliac Joint Degeneration After Lumbopelvic Fixation 査読有り

Nakashima, H; Kanemura, T; Satake, K; Ito, K; Tanaka, S; Segi, N; Ouchida, J; Kagami, Y; Ando, K; Kobayashi, K; Imagama, S

GLOBAL SPINE JOURNAL   12 巻 ( 6 ) 頁： 1158 - 1164   2022年7月

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

Study Design: Retrospective Study. Objectives: Sacroiliac buttress screws (SBS) and S2 alar iliac screws (SAI) are used as distal screws in cases with long fusion to the pelvis. Distal fixation ends, whether exceeding the sacroiliac joint (SIJ), may affect postoperative degenerative changes in the SIJ. The aim of this study was to investigate SIJ degeneration after lumbosacral and lumbopelvic fixation, using SBS and SAI in degenerative spine diseases, respectively. Methods: This study included 70 patients aged ≥50 years with lumbosacral fusion (>3 levels). They were divided into 2 groups (SBS 20 and SAI 50 cases) based on the type of distal screws. Radiographical and clinical data were reviewed with a minimum 2-year follow-up. Radiographical SIJ degeneration was analyzed using computed tomography; clinical outcomes were evaluated using visual analog scale (VAS) and Japanese Orthopaedic Association Back Pain Questionnaire (JOABPEQ). Results: No significant differences were observed in patients’ preoperative characteristics between the 2 groups. The incidence of SIJ degeneration, including osteophyte formation (30.0% and 8.0%, p = 0.03), intraarticular air (75.0% and 16.0%, p < 0.001), and subchondral cyst (20.0% and 2.0%. p = 0.02) in SBS and SAI groups, respectively, at the follow-up, was significantly higher in the SBS group. Although SIJ degenerative changes were significantly different between the SBS and SAI groups, there was no significant difference in VAS and JOABPEQ scores between the groups at 2 years post-surgery. Conclusions: Lumbosacral fusion can cause SIJ degeneration, which is more frequent when SBS are used in fixation to the sacrum.

DOI： 10.1177/2192568220978235

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Clinical Characteristics of Patients with Ossification of the Posterior Longitudinal Ligament and a High OP Index: A Multicenter Cross-Sectional Study (JOSL Study) Open Access

Hirai, T; Yoshii, T; Hashimoto, J; Ushio, S; Mori, K; Maki, S; Katsumi, K; Nagoshi, N; Takeuchi, K; Furuya, T; Watanabe, K; Nishida, N; Nishimura, S; Watanabe, K; Kaito, T; Kato, S; Nagashima, K; Koda, M; Nakashima, H; Imagama, S; Murata, K; Matsuoka, Y; Wada, K; Kimura, A; Ohba, T; Katoh, H; Watanabe, M; Matsuyama, Y; Ozawa, H; Haro, H; Takeshita, K; Matsumoto, M; Nakamura, M; Egawa, S; Matsukura, Y; Inose, H; Okawa, A; Yamazaki, M; Kawaguchi, Y

JOURNAL OF CLINICAL MEDICINE   11 巻 ( 13 )   2022年7月

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記述言語：英語   出版者・発行元：Journal of Clinical Medicine  

Background: The purpose of this study was to clarify the clinical features of ossification of the posterior longitudinal ligament (OPLL) and extreme ossification at multiple sites. Methods: This prospective study involved patients with a diagnosis of cervical OPLL at 16 institutions in Japan. Patient-reported outcome measures, including responses on the Japanese Orthopaedic Association (JOA) Cervical Myelopathy Evaluation Questionnaire (JOA-CMEQ), JOA Back Pain Evaluation Questionnaire (JOA-BPEQ), and visual analog scale pain score, were collected to investigate clinical status. In each patient, the sum of the levels at which OPLL was located (OP index) was evaluated on whole-spine computed tomography, along with ossification of other spinal ligaments including the anterior longitudinal ligament (OALL), ligament flavum (OLF), supra-and intraspinous ligaments (SSL), and diffuse idiopathic skeletal hyperostosis (DISH). The distribution of OP index values in the study population was investigated, and the clinical and radiologic characteristics of patients in the top 10% were assessed. Results: In total, 236 patients (163 male, 73 female; mean age 63.5 years) were enrolled. Twenty-five patients with OP index ≥ 17 were categorized into a high OP index group and the remainder into a moderate/low OP index group. There were significantly more women in the high OP index group. Patients in the high OP index group also had significantly poorer scores for lower extremity function and quality of life on the JOA-CMEQ and in each domain but not for body pain on the JOA-BPEQ compared with those in the moderate/low OP index group. Patients in the high OP index group had more OALL in the cervical spine and more OLF and SSL in the thoracic spine. The prevalence of DISH was also significantly higher in the high OP index group. In the high OP index group, interestingly, OPLL was likely to be present adjacent to DISH in the cervicothoracic and thoracolumbar spine, especially in men, and often coexisted with DISH in the thoracic spine in women. Conclusion: This prospective cohort registry study is the first to demonstrate the clinical and radiologic features of patients with OPLL and a high OP index. In this study, patients with a high OP index had poorer physical function in the lumbar spine and lower extremities and were also predisposed to extreme ossification of spinal ligaments other than the OPLL.

DOI： 10.3390/jcm11133694

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Association between Occupation and Cervical Disc Degeneration in 1211 Asymptomatic Subjects Open Access

Machino, M; Nakashima, H; Ito, K; Ando, K; Ito, S; Kato, F; Imagama, S

JOURNAL OF CLINICAL MEDICINE   11 巻 ( 12 )   2022年6月

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記述言語：英語   出版者・発行元：Journal of Clinical Medicine  

Magnetic resonance imaging (MRI) system has frequently observed degenerative changes in the cervical discs of healthy subjects. Although there are concerns regarding the link between an individual’s occupation and intervertebral disc degeneration (IDD) in the cervical spine, whether the occupation affects IDD is still not clear. This study aimed to evaluate the occupation and IDD interplay using cervical spine MRI among a cohort of healthy individuals, and to evaluate any association between the type of labor and IDD. Using MRI, we prospectively measured at every level, the anteroposterior (AP) intervertebral disc diameter and disc height, in a cohort of 1211 healthy volunteers (606 (50%) male; mean age, 49.5 years). Using a minimum of 100 male and female each from the third to eighth decades of age (20–79 years), IDD was evaluated based on the modified Pfirrmann classification system to derive a disc degeneration score (DDS). We also measured the AP diameters of disc protrusion and of the dural sac as well as the spinal cord. The overall DDS and number of disc protrusions increased with age. Among 11 occupations, there were no significant differences in AP diameter of the dural sac as well as the spinal cord. For the four labor types (heavy object handling, same position maintenance, cervical extension position, and cervical flexion position), there were no significant differences in overall DDS and number of disc protrusions, with or without work. Also, among the four labor types, there were no significant differences in the AP diameter of the dural sac as well as the spinal cord. In this cross-sectional survey of cervical spine MRI data among healthy adult volunteers, occupation and type of labor might have no effect on IDD in the cervical spine.

DOI： 10.3390/jcm11123301

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Postoperative progression of ligamentum flavum ossification after posterior instrumented surgery for thoracic posterior longitudinal ligament ossification: long-term outcomes during a minimum 10-year follow-up

Ando, K; Nakashima, H; Machino, M; Ito, S; Segi, N; Tomita, H; Koshimizu, H; Imagama, S

JOURNAL OF NEUROSURGERY-SPINE   36 巻 ( 6 ) 頁： 986 - 996   2022年6月

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出版者・発行元：Journal of Neurosurgery: Spine  

OBJECTIVE The authors sought to investigate clinical and radiological outcomes after thoracic posterior fusion surgery during a minimum of 10 years of follow-up, including postoperative progression of ossification, in patients with thoracic ossification of the posterior longitudinal ligament (T-OPLL). METHODS The study participants were 34 consecutive patients (15 men, 19 women) with an average age at surgery of 53.6 years (range 36–80 years) who underwent posterior decompression and fusion surgery with instrumentation at the authors’ hospital. The minimum follow-up period was 10 years. Estimated blood loss, operative time, pre- and postoperative Japanese Orthopaedic Association (JOA) scores, and JOA score recovery rates were investigated. Dekyphotic changes were evaluated on plain radiographs of thoracic kyphotic angles and fusion levels pre- and postoperatively and 10 years after surgery. The distal junctional angle (DJA) was measured preoperatively and at 10 years after surgery to evaluate distal junctional kyphosis (DJK). Ossification progression at distal intervertebrae was investigated on CT. RESULTS The Cobb angles at T1–12 were 46.8°, 38.7°, and 42.6°, and those at the fusion level were 39.6°, 31.1°, and 34.1° pre- and postoperatively and at 10 years after surgery, respectively. The changes in the kyphotic angles from pre- to postoperatively and to 10 years after surgery were 8.0° and 7.2° at T1–12 and 8.4° and 7.9° at the fusion level, respectively. The DJA changed from 4.5° postoperatively to 10.9° at 10 years after surgery. There were 11 patients (32.3%) with DJK during follow-up, including 4 (11.8%) with vertebral compression fractures at lower instrumented vertebrae or adjacent vertebrae. Progression of ossification of the ligamentum flavum (OLF) on the caudal side occurred in 8 cases (23.6%), but none had ossification of the posterior longitudinal ligament (OPLL) progression. Cases with OLF progression had a significantly lower rate of DJK (0% vs 38.5%, p < 0.01), a lower DJA (3.4° vs 13.2°, p < 0.01), and a smaller change in DJA at 10 years after surgery (0.8° vs 8.1°, p < 0.01). CONCLUSIONS Posterior decompression and fusion surgery with instrumentation for T-OPLL was found to be a relatively safe and stable surgical procedure based on the long-term outcomes. Progression of OLF on the caudal side occurred in 23.6% of cases, but cases with OLF progression did not have DJK. Progression of DJK shifts the load in the spinal canal forward and the load on the ligamentum flavum is decreased. This may explain the lack of ossification in cases with DJK.

DOI： 10.3171/2021.10.SPINE211091

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Impact of obesity on cervical ossification of the posterior longitudinal ligament: a nationwide prospective study Open Access

Mori, K; Yoshii, T; Egawa, S; Sakai, K; Kusano, K; Tsutsui, 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; Nakashima, H; Takahata, M; Nakajima, H; Murata, K; Miyagi, M; Kaito, T; Yamada, K; Banno, T; Kato, S; Ohba, T; Inami, S; Fujibayashi, S; Katoh, H; Kanno, H; Taneichi, H; Imagama, S; Kawaguchi, Y; Takeshita, K; Matsumoto, M; Yamazaki, M; Okawa, A

SCIENTIFIC REPORTS   12 巻 ( 1 ) 頁： 8884   2022年5月

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

Positive association between ossification of the posterior longitudinal ligament of the spine (OPLL) and obesity is widely recognized; however, few studies focused on the effects of obesity on treatment of cervical OPLL. The effects of obesity on surgical treatment of cervical OPLL were investigated by a Japanese nationwide, prospective study. Overall, 478 patients with cervical myelopathy due to OPLL were prospectively enrolled. To clarify the effects of obesity on the surgical treatment for cervical OPLL, patients were stratified into two groups, non-obese (< BMI 30.0 kg/m2) and obese (≥ BMI 30.0 kg/m2) groups. The mean age of the obese group was significantly younger than that of non-obese group. There were no significant differences between the two groups in other demographic information, medical history, and clinical and radiographical findings. Alternatively, the obese group had a significantly higher rate of surgical site infection (SSI) than that of non-obese group. Approach-specific analyses revealed that the SSI was significantly higher in the obese group than in the non-obese group. A logistic regression analysis revealed that age, BMI, and duration of symptoms were significant factors affecting the postoperative minimum clinically important difference success. The result of this study provides useful information for future cervical OPLL treatment.

DOI： 10.1038/s41598-022-12625-3

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ダウン症小児上位頸椎病変に対する後頭頸椎，上位頸椎固定術後の画像変化―術後の成長について―

安藤 圭, 中島 宏彰, 町野 正明, 伊藤 定之, 世木 直喜, 富田 浩之, 小清水 宏之, 大内田 隼, 今釜 史郎

Journal of Spine Research   13 巻 ( 5 ) 頁： 763 - 769   2022年5月

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記述言語：日本語   出版者・発行元：一般社団法人 日本脊椎脊髄病学会  

<p><b>はじめに：</b>小児ダウン症に対する後頭骨頸椎，上位頸椎後方固定術後の5年間の頸椎アライメント，椎体，椎間板，脊柱管の変化を調査する．</p><p><b>対象と方法：</b>ダウン症上位頸椎病変に対する後方固定術を施行し，5年以上経過観察が可能であった7例を対象にO-2 angle，C1-2 angle，C2-7angle，各椎体高，椎体前後径，椎体横径，椎間板高，脊柱管前後径，左右径を術前，術後1，2，3，5年時にそれぞれ計測した．</p><p><b>結果：</b>後頭骨―軸椎4例，環椎―軸椎固定3例に施行された．C2-7椎体高，椎体前後径，C6/7椎間板高は術後有意に増加した一方で，脊柱管前後，横径に各群間で有意差を認めなかった．</p><p><b>結語：</b>小児ダウン症上位頸椎後方固定術後，固定尾側端である軸椎にも椎体高，椎体前後への成長を認めた．一方で，脊柱管内は成長に伴う変化は少なかった．軸椎にスクリュー刺入しても残存する骨端核より成長が望めること，脊柱管は5歳で成人に近い面積に成長することが明らかとなった．</p>

DOI： 10.34371/jspineres.2021-0068

CiNii Research

A preliminary examination of the association between locomotive syndrome and circulating miRNA-199 in community-dwelling people: The Yakumo study Open Access

Takegami, Y; Seki, T; Osawa, Y; Makida, K; Ochiai, S; Nakashima, H; Fujii, R; Yamada, H; Suzuki, K; Hasegawa, Y; Imagama, S

JOURNAL OF ORTHOPAEDIC SCIENCE   27 巻 ( 3 ) 頁： 696 - 700   2022年5月

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

Background: The risk of locomotive syndrome (LS) has been proposed as a criterion for evaluating physical ability. The expression levels of circulating miRNAs (c-miRNAs) are predictors of various diseases. This preliminary study aimed to evaluate the relationship between serum levels of several miRNAs and LS. Methods: We enrolled 423 participants in whom we conducted a survey with the 25-question Geriatric Locomotive Function Scale (GLFS-25) and measured the serum levels of 21 c-miRNAs. The relationship between the GLFS-25 and each c-miRNA was evaluated with a linear regression analysis, and independent associations between the GLFS-25 and each c-miRNA were assessed with a multiple regression analysis using various independent variables. Results: Only the serum level of miR-199 was significantly associated with LS after adjustment for age, BMI, sex, and all comorbidities. The receiver operating characteristics curve for the predictive value of the miR-199 level to indicate the presence or absence of LS risk had an area under the curve (AUC) of 0.576 (95% confidence interval: 0.501–0.651). Conclusion: The expression level of miRNA-199 was associated with the risk of LS in community-dwelling Japanese people.

DOI： 10.1016/j.jos.2021.02.003

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Cervical disc degeneration is associated with a reduction in mobility: A cross-sectional study of 1211 asymptomatic healthy subjects

Machino, M; Nakashima, H; Ito, K; Ando, K; Ito, S; Kato, F; Imagama, S

JOURNAL OF CLINICAL NEUROSCIENCE   99 巻   頁： 342 - 348   2022年5月

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記述言語：英語   出版者・発行元：Journal of Clinical Neuroscience  

The aim of this study was to establish the age-related changes and gender-specific differences of cervical disc degeneration using magnetic resonance image (MRI) and to evaluate the correlation between the severity of cervical disc degeneration and mobility in asymptomatic subjects. A total of 1,211 relatively healthy volunteers (606 males and 605 females, mean age 49.5 years) without neurological symptoms underwent MRI. At least 100 males and 100 females in each decade of life between the 20 s and the 70 s were included. This study was part of a larger project and used some previously published data. Cervical disc degeneration was defined according to the modified Pfirrmann classification system. A total disc degeneration score (DDS) was calculated by the summation of individual Pfirrmann scores from C2/C3 to C7/T1. Cervical range of motion (ROM) was measured by radiograph. The total DDS increased gradually with increasing age in both genders. DDSs were lower in females than in males in all decades. A DDS of 13 or more was found in more than half the cases in the 40 s or older age groups. The total DDS was 13 or more in over 95% of the cases in the 70 s age group. The total DDS was significantly and negatively correlated with cervical ROM overall (r = − 0.46, p < 0.0001) and in both men (r = − 0.52, p < 0.0001) and women (r = − 0.40, p < 0.0001). This large-scale cross-sectional analysis of cervical spine MRI data in healthy subjects demonstrated that cervical disc degeneration progresses with age, and is correlated with a reduction in mobility.

DOI： 10.1016/j.jocn.2022.03.035

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Associations Between Neck and Shoulder Pain and Neuropathic Pain in a Middle-aged Community-living Population Open Access

Machino, M; Ando, K; Kobayashi, K; Nakashima, H; Ito, S; Morozumi, M; Kanbara, S; Segi, N; Tomita, H; Koshimizu, H; Seki, T; Ishizuka, S; Takegami, Y; Hasegawa, Y; Imagama, S

SPINE   47 巻 ( 8 ) 頁： 632 - 639   2022年4月

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記述言語：英語   出版者・発行元：Spine  

Study Design.A cross-sectional study.Objective.The present study aimed to investigate the prevalence of NeP in subjects suffering from NSP to reveal the impact of NeP on the health-related QOL (HRQOL) in middle-Aged and elderly people with NSP in a health checkup.Summary of Background Data.No previous studies have established the relationship between NSP and NeP as potential risk factors contributing to a decreased QOL in the general population.Methods.The present study involved 203 participants (men: 84, women: 119; mean age: 63.3 yr). For each subject, anthro-pometric measurements, physical function examinations, and blood testing were performed. A cut-off score of >0 on the short-form spine painDETECT questionnaire defined the presence of NeP. Subsequently, the NSP (+) subjects were divided into 2 sub-groups: The NeP (+) and NeP (-) groups. For the assessment of QOL, the short form 36 health survey and the EuroQol 5 dimension 5 level version (EQ-5D-5L) tool were used.Results.The study included 100 NSP (+) and 103 NSP (-) subjects. Among the NSP (+) subjects, 46 and 54 subjects were found to be NeP (+) and NeP (-), respectively. For the short form 36 health survey, the multivariate regression analysis revealed that the prevalence of NeP was associated with a lower physical QOL (OR 3.56) and lower mental QOL (OR 4.04). Similarly, the NeP prevalence was found to be the predictor for low QOL scores in EQ-5D-5L (EQ-5D-5L index value <0.875; OR 3.61).Conclusion.The prevalence of NeP was reported to be 46.0% in healthy middle-Aged and elderly population suffering from NSP, where it was associated with poor HRQOL. Therefore, strategies aimed at alleviating NeP may contribute significantly to the improvement of QOL in middle-Aged and elderly people with NSP.Level of Evidence: 2.

DOI： 10.1097/BRS.0000000000004207

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Risk factors for second hip fracture in elderly patients: an age, sex, and fracture type matched case-control study

Fujita, T; Takegami, Y; Ando, K; Sakai, Y; Nakashima, H; Takatsu, S; Imagama, S

EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY   32 巻 ( 3 ) 頁： 437 - 442   2022年4月

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記述言語：英語   出版者・発行元：European Journal of Orthopaedic Surgery and Traumatology  

Purpose: Prevention of second hip fracture is mandatory for orthopedic surgeons. We aimed to clarify the incidence and duration of second hip fracture, to compare survival rate and walking ability of patients with a second hip fracture to that of patients with a unilateral fracture, and to identify risk factors for second hip fracture using matched case–control methods. Methods: This retrospective study conducted in a single tertiary emergency center comprised 119 patients with second hip fractures who underwent bilateral operations at our institution from 2007 to 2017 (second hip fracture group [Group A]). The control group (Group B) comprised 357 patients matched to Group A for age, sex, and fracture type. Results: The incidence of second hip fracture was 7.6%, and the average interval from initial fracture to second hip fracture was 22.8 months. Significantly more patients in Group A had decreased postoperative walking ability. Five-year survival rates from initial fracture were 65.0% in Group A and 50.6% in Group B (P = 0.346). Dementia and heart disease were identified as independent risk factors (dementia: HR 2.08, 95% CI 1.27–3.41, P = 0.004; heart disease: HR 1.27, 95% CI1.11–3.22, P = 0.019). Valvular disease was also revealed to be a risk factor for heart disease (P = 0.0272). Conclusions: The incidence of second hip fracture was not low. Although survival rates did not differ between the patients with or without second hip fracture, walking ability of patients with second hip fracture worsened. Dementia and cardiac disease could be risk factors for second hip fracture in elderly patients, and valvular disease might be associated with second hip fracture in patients with heart disease.

DOI： 10.1007/s00590-021-02996-0

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Adjacent Segment Degeneration after Short-Segment Lateral Lumbar Interbody Fusion (LLIF) Open Access

Ouchida, J; Nakashima, H; Kanemura, T; Matsubara, Y; Satake, K; Muramoto, A; Ito, K; Tsushima, M; Morozumi, M; Segi, N; Morita, Y; Imagama, S

BIOMED RESEARCH INTERNATIONAL   2022 巻   頁： 5161503   2022年3月

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

Purpose. To investigate the influence on the adjacent segment degeneration (ASD) of short-segment lateral lumbar interbody fusion (LLIF) at 2 years postoperatively. Methods. Ninety-seven consecutive patients who underwent one- or two-level LLIF were included from two institutions. We diagnosed radiographical adjacent segment degeneration with the appearance of adjacent spondylolisthesis (>3 mm) or deterioration of adjacent disk height (>3 mm) on plain radiographs or decrease of the intervertebral angle (>5 degrees). The differences between the two groups with and without radiographical ASD were investigated using univariate and multivariate analyses to determine the risk factors for ASD. The variables included extent of adjacent decompression, posterior fixation method (open method or percutaneous method), and facet violation on postoperative CT. Results. In total, 19 patients (19.6%) were diagnosed as radiographical ASD 2 years after surgery. Univariate analysis showed that the ASD (+) group had a high frequency of adjacent decompression (21.1 vs. 3.8%, p=0.035) compared with the ASD (-) group. There were no differences between the two groups in posterior fusion method (percutaneous method 42.1 vs. 57.7%, p=0.221) or facet joint violation (15.8 vs. 14.1%, p=0.860). The multivariate analysis found adjacent intervertebral decompression to be a risk factor for ASD 2 years after surgery (odds ratio: 9.95; 95% confidence interval: 1.2-82.1). Conclusions. Adjacent intervertebral decompression was considered to be a potential risk factor for the development of ASD after spinal fusion with LLIF.

DOI： 10.1155/2022/5161503

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特集 頸椎椎弓形成術の現在と今後 頸椎椎弓形成術-片開き式と両開き式の比較

中島 宏彰, 今釜 史郎

脊椎脊髄ジャーナル   34 巻 ( 10 ) 頁： 641 - 645   2022年3月

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出版者・発行元：三輪書店  

DOI： 10.11477/mf.5002201711

CiNii Research

Conservative treatment of spondylolysis involving exercise initiated early and sports activities resumed with a lumbar-sacral brace 査読有り Open Access

Nakashima, H; Yoneda, M; Kanemura, T; Satake, K; Ito, K; Ouchida, J; Ando, K; Kobayashi, K; Imagama, S

JOURNAL OF ORTHOPAEDIC SCIENCE   27 巻 ( 2 ) 頁： 360 - 365   2022年3月

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

Background: Conservative treatment including the use of a brace and cessation of sports activities is known to be effective in spondylolysis. However, there is some controversy regarding [1] the type of brace, and [2] the endpoint for bracing, and [3] the timing of resumption of sports activities. The aim of the current study was to investigate the appropriateness of early exercise and resumption of sports activities with a lumbar-sacral brace in very early- and early-stage lumbar spondylolysis. Methods: This prospective cohort study enrolled 45 patients with very early- and early-stage lumbar spondylolysis. A lumbar-sacral brace, structured to be a hard brace in the back and a mesh brace in the front, was used. Isometric exercises/stretching was started immediately after the initial visit. The number of patients for whom bone fusion was fully achieved on CT and the disappearance of signal intensity change on MRI were investigated. Results: In 12 cases of very early-stage spondylolysis, the average elapsed time until signal intensity disappearance as confirmed on MRI was 4.3 ± 1.6 months. Bony union on CT was confirmed in all cases. In 33 cases of early spondylolysis, signal intensity change disappeared on MRI within 5.2 ± 2.4 months. The rate of bony union was 94.3%, and the average period required to achieve bony union observable on CT was 3.7 ± 1.0 months. Conclusions: Sufficient bony union can be achieved by conservative treatment with early exercise and a lumbar-sacral brace in cases of very early and early spondylolysis.

DOI： 10.1016/j.jos.2021.01.013

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