Faculty Profiles - NAKASHIMA Hiroaki

Papers - NAKASHIMA Hiroaki

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Factors Affecting the Waiting Time from Injury to Surgery in Elderly Patients with a Cervical Spine Injury: A Japanese Multicenter Survey

Uehara M., Ikegami S., Takizawa T., Oba H., Yokogawa N., Sasagawa T., Ando K., Nakashima H., Segi N., 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., Shirasawa E., 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., Otsuki B., Seki S., Miyazaki M., Ishihara M., Okada S., Imagama S., Kato S.

World Neurosurgery Vol. 166 page： e815 - e822 2022.10

Publisher：World Neurosurgery

Objective: The management of cervical spine injuries in the elderly is often complicated by the presence of multiple medical comorbidities, and it is not uncommon for preoperative testing to reveal other conditions that require the postponement of surgery. However, the factors that affect the waiting time from injury to surgery have not been clarified. The purpose of this multicenter database study was to analyze the clinical features and identify the factors affecting the number of days waited between injury and surgery in elderly patients with a cervical spine injury. Methods: We retrospectively reviewed the case histories of 1512 Japanese patients with a cervical spinal injury, who were seen at 33 institutions. After excluding patients who were not initially receiving a surgery for cervical spinal injury, 694 patients were ultimately analyzed. Based on a multivariate mixed model, we determined the factors related to the number of days from injury to surgery. Results: The mean time from injury to surgery was 12.3 days. Multivariate analysis revealed delays of 10.7 days for a renal disorder, 7.3 days for anticoagulant use, and 15.2 days for non-surgical thoracolumbar fracture as factors prolonging wait time. In contrast, a C3 or lower spine injury was significantly associated with a shortening of 9.5 days to surgery. Conclusions: This multicenter database study identified several factors influencing the time between injury and cervical spine surgery in elderly patients. While renal impairment, anticoagulant use, and non-surgical thoracolumbar fracture may increase the number of days to surgery, trauma to C3 or lower may expedite surgical treatment.

DOI： 10.1016/j.wneu.2022.07.104

Factors Affecting the Waiting Time from Injury to Surgery in Elderly Patients with a Cervical Spine Injury: A Japanese Multicenter Survey

Uehara, M; Ikegami, S; Takizawa, T; Oba, H; Yokogawa, N; Sasagawa, T; Ando, K; Nakashima, H; Segi, N; 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; Shirasawa, E; 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; Otsuki, B; Seki, S; Miyazaki, M; Ishihara, M; Okada, S; Imagama, S; Kato, S

WORLD NEUROSURGERY Vol. 166 page： E815 - E822 2022.10

A clinical trial of a unidirectional porous tricalcium phosphate filling for defects after resection of benign bone lesions: a prospective multicenter study Reviewed Open Access

Ikuta, K; Nishida, Y; Ota, T; Tsukushi, S; Kozawa, E; Nakashima, H; Yamada, K; Yamashita, S; Imagama, S

SCIENTIFIC REPORTS Vol. 12 ( 1 ) page： 16060 2022.9

Language：English Publisher：Scientific Reports

Affinos (Kuraray, Japan) is a β-tricalcium phosphate bone substitute with a unidirectional porous structure. This study aimed to investigate its efficacy on the healing process after filling for bone defects. Fifty-six patients who met the inclusion criteria were divided into cohort 1 (n = 30), including bones other than phalanges and metacarpal/tarsal bones, and cohort 2 (n = 26), including phalanges and metacarpal/tarsal bones. Semi-quantified scores for material resorption and trabeculation through the defect were evaluated with radiographs after surgery. In some patients, levels of bone metabolic markers were assessed. The values of resorption and trabeculation increased steadily with time, and trabeculation progressed compared with resorption in both cohorts. In cohort 1, multiple regression analyses showed that the diaphyseal lesion, smaller defect volume, and increased resorption values at 3 months were associated with increased values of resorption 12 months after surgery (R<sup>2</sup> = 0.66, p < 0.001). The trabeculation values at 2 months were positively related to the trabeculation values 12 months after surgery (R<sup>2</sup> = 0.35, p = 0.002). In cohort 2, the increased resorption values at 2 months and smaller defect volume significantly correlated with the increased resorption values 12 months after surgery (R<sup>2</sup> = 0.58, p < 0.001). The ratio from the baseline of pyridinoline cross-linked carboxyterminal telopeptide of type I collagen at 3 months was negatively associated with the trabeculation values 12 months after surgery (R = − 0.791, p = 0.004). Evaluation of radiographic images and bone metabolic markers in the early postoperative period may predict the healing status at 12 months postoperatively in the defects followed by Affinos filling.

DOI： 10.1038/s41598-022-20359-5

Differences in clinical characteristics of cervical spine injuries in older adults by external causes: a multicenter study of 1512 cases Open Access

Yokogawa, N; Kato, S; Sasagawa, T; Hayashi, H; Tsuchiya, H; Ando, K; Nakashima, H; Segi, N; Funayama, T; Eto, F; Yamaji, A; Nori, S; Yamane, J; Furuya, T; Yunde, A; Nakajima, H; Yamada, T; Hasegawa, T; Terashima, Y; Hirota, R; 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; Shirasawa, E; 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; Watanabe, K

SCIENTIFIC REPORTS Vol. 12 ( 1 ) page： 15867 2022.9

Language：English Publisher：Scientific Reports

Although traumatic cervical spine injuries in older adults are commonly caused by minor traumas, such as ground-level falls, their prognosis is often unfavorable. Studies examining the clinical characteristics of cervical spine injuries in older adults according to the external cause of injury are lacking. This study included 1512 patients of ≥ 65 years of age with traumatic cervical spine injuries registered in a Japanese nationwide multicenter database. The relationship between the external causes and clinical characteristics, as well as factors causing unfavorable outcomes at the ground-level falls, were retrospectively reviewed and examined. When fall-induced cervical spine injuries were categorized and compared based on fall height, the patients’ backgrounds and injury statuses differed significantly. Of note, patients injured from ground-level falls tended to have poorer pre-injury health conditions, such as medical comorbidities and frailty, compared with those who fell from higher heights. For ground-level falls, the mortality, walking independence, and home-discharge rates at 6 months post-injury were 9%, 67%, and 80%, respectively, with preexisting medical comorbidities and frailty associated with unfavorable outcomes, independent of age or severity of neurological impairment at the time of injury.

DOI： 10.1038/s41598-022-19789-y

Impact of the hip joint mobility on whole-body sagittal alignment: prospective analysis in case with hip arthroplasty

Ouchida, J; Nakashima, H; Kanemura, T; Satake, K; Ando, K; Ito, K; Tsushima, M; Machino, M; Ito, S; Yamaguchi, H; Segi, N; Koshimizu, H; Tomita, H; Imagama, S

EUROPEAN SPINE JOURNAL Vol. 31 ( 9 ) page： 2399 - 2407 2022.9

Language：English Publisher：European Spine Journal

Purpose: To clarify the impact of restriction of hip extension on radiographic whole-body sagittal alignment with using postoperative changes of radiographical parameters for hip osteoarthritis. Methods: We prospectively enrolled 68 patients with hip osteoarthritis scheduled for arthroplasty. Variables included manual examination of hip range of motion (H-ROM) and radiographic whole-body sagittal alignment parameters including sagittal vertical axis (SVA), center of acoustic meatus and femoral head offset (CAM-HA), thoracic kyphosis (TK), lumbar lordosis, sacral slope (SS), and knee flexion angle (KF). We divided patients with preoperative hip extension angle < 0 into the extension restriction (ER) + group and ≥ 0 into the ER− group. Differences in H-ROM, radiographic parameters between groups and postoperative changes were comparatively analyzed. Results: Fifty-seven patients (The ER + group included 28 patients and the ER− group included 29 patients.) were available for the analysis. Pre-/postoperative H-ROM were 99.7 ± 24.9/118.1 ± 16.0 degrees (p <.01). Greater increases in SVA (5.4 ± 3.4 vs 3.4 ± 2.8 cm, p =.02) and in CAM-HA (3.9 ± 3.9 vs 2.8 ± 3.4 cm, p = 013) were found in the ER + group versus ER− group. Postoperatively, the ER + group showed an increase in TK (pre-/postoperative: 35.2 ± 9.7/37.4 ± 8.8 degrees, p =.04) and decreases in SS (36.5 ± 9.6/33.7 ± 9.9 degrees, p <.01) and KF (9.5 ± 7.0/6.9 ± 6.0 degrees, p =.02). Postoperative changes in radiographic parameters in the ER− group were not significant. Conclusion: Patients with restriction of hip extension showed global spine imbalance, and significant changes in TK, SS, and KF were observed after arthroplasty. The presence of hip joint disorder and H-ROM restriction must be considered when evaluating spinopelvic alignment and whole-body sagittal alignment.

DOI： 10.1007/s00586-022-07251-6

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 Vol. 57 ( 8 ) page： 981 - 996 2022.8

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 Reviewed 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 Vol. 2022 page： 3407681 2022.8

Language：English Publisher：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

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 Vol. 23 ( 1 ) page： 798 2022.8

Language：English Publisher：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

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 Vol. 47 ( 15 ) page： 1077 - 1083 2022.8

Language：English Publisher：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

Paraplegia due to spinal epidural lipoma without spinal dysraphism in an adolescent patient: a case report Reviewed 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 Vol. 84 ( 3 ) page： 656 - 663 2022.8

Language：English Publisher：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

Patient factors influencing a delay in diagnosis in pediatric spinal cord tumors Reviewed 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 Vol. 84 ( 3 ) page： 516 - 525 2022.8

Language：English Publisher：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

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

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

JOURNAL OF CLINICAL MEDICINE Vol. 11 ( 16 ) 2022.8

Sacroiliac Joint Degeneration After Lumbopelvic Fixation Reviewed Open Access

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 Vol. 12 ( 6 ) page： 1158 - 1164 2022.7

Language：English Publisher：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

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 Vol. 11 ( 13 ) 2022.7

Language：English Publisher：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

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 Vol. 11 ( 12 ) 2022.6

Language：English Publisher：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

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 Vol. 36 ( 6 ) page： 986 - 996 2022.6

Publisher：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

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 Vol. 12 ( 1 ) page： 8884 2022.5

Language：English Publisher：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/m<sup>2</sup>) and obese (≥ BMI 30.0 kg/m<sup>2</sup>) 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

Mid-term Surgical Outcome in Occipitocervical or C1-2 Fusion in Pediatric Upper Cervical Lesion with Down Syndrome

Ando Kei, Nakashima Hiroaki, Machino Masaaki, Ito Sadayuki, Segi Naoki, Tomita Hiroyuki, Koshimizu Hiroyuki, Ouchida Jun, Imagama Shiro

Journal of Spine Research Vol. 13 ( 5 ) page： 763 - 769 2022.5

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

<p><b>Introduction: </b>Retrospective review was performed to investigate the radiological change and growing following occipitocervical (OC) or C1-C2 fusion in pediatric patients with Down syndrome.</p><p><b>Methods: </b>In total, seven patients underwent OC or C1-2 fusion. Their O-2 angle, C1-2 angle, C2-7 angle, vertebral body height, vertebral body diameter, intervertebral disc height, and canal diameter of each vertebra were evaluated at preoperation, 1, 2, 3, and 5 years postoperation.</p><p><b>Results: </b>Vertebral body height, vertebral body diameter, and intervertebral disc height (C6/7) were significantly increased at 5 years compared with the preoperative state although canal diameter did not change significantly.</p><p><b>Conclusions: </b>C2 vertebra increased through the caudal side because the epiphyseal ossification center remained. The spinal canal diameter in the cervical spine has been expanded until 5-7 years.</p>

DOI： 10.34371/jspineres.2021-0068

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 Vol. 27 ( 3 ) page： 696 - 700 2022.5

Language：English Publisher：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

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 Vol. 99 page： 342 - 348 2022.5

Language：English Publisher：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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