Faculty Profiles - NAKASHIMA Hiroaki

Papers - NAKASHIMA Hiroaki

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Recent progress in surgical treatment of cervical spine myelopathy – A narrative review

Ouchida J., Nakashima H., Ito S., Segi N., Yamauchi I., Imagama S.

Journal of Clinical Orthopaedics and Trauma Vol. 68 2025.9

Publisher：Journal of Clinical Orthopaedics and Trauma

Surgical techniques and technology for cervical spondylotic myelopathy (CSM) have demonstrated remarkable advancement during the past decade. This narrative review examines the evolution of surgical approaches and technological innovations, focusing on both anterior and posterior techniques. Anterior approaches have progressed through the development of endoscopic procedures, novel decompression methods such as vertebral body sliding osteotomy, and advanced implant materials including 3D-printed customized devices. Posterior approaches have evolved with the integration of endoscopic techniques and refined fixation methods, demonstrating reduced tissue trauma and improved outcomes. The integration of surgical assistance technologies, including navigation systems, robotics, and augmented reality, has enhanced surgical precision while potentially reducing procedural risks. While these advances show promising outcomes in terms of surgical precision and patient recovery, challenges persist regarding technology implementation and cost-effectiveness. Emerging technologies such as artificial intelligence for surgical planning, patient-specific implants, and adjunctive biological therapies may further improve CSM treatment. The optimal application of these innovations requires continued research and careful evaluation to establish their long-term efficacy and safety in clinical practice.

DOI： 10.1016/j.jcot.2025.103074

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

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

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association Vol. 30 ( 4 ) page： 672 - 677 2025.7

Language：English Publisher：Journal of Orthopaedic Science

Introduction: Femoral neck fractures (FNFs) are common in elderly individuals. When minimally displaced, they are typically treated with internal fixation. Nonunion is a complication of internal fixation of FNF, that sometimes necessitates reoperation. Radiographic parameters, including the Pauwels angle and posterior tilt angle, are risk factors for nonunion. However, these parameters are assessed solely in a two-dimensional context. We developed a novel radiographic parameter named the “Kindex.” This multicenter investigation aimed to identify risk factors for nonunion following FNF fixation and evaluate the validity of this index. Methods: This retrospective multicenter study collected data from 939 FNF patients who underwent internal fixation between 2016 and 2020 at 11 facilities (TRON group). The following exclusion criteria were applied: age <65, insufficient data, and Garden Stage III or IV fracture. Patient data, including age, sex, BMI, ASA classification, alcohol and smoking history, and comorbidities, were recorded. Radiographic measurements of the Pauwels angle and posterior tilt angle at the time of injury were used to calculate the Kindex. Correlations between the Pauwels angle, posterior tilt angle, Kindex, and nonunion were evaluated. A multivariate logistic regression analysis was performed to investigate independent risk factors for nonunion. A receiver operating characteristic (ROC) analysis was performed to determine the cutoff value of the Kindex, and the area under the curve (AUC) was calculated. Results: The study included 594 patients (males, n = 151; females, n = 443; average age, 80.9 years). Nonunion was observed in 13 cases (2.2 %). While the Pauwels angle and posterior tilt angle did not show significant correlations, the Kindex exhibited strong correlations with both parameters. In the multivariate analysis, the Kindex and renal impairment were independent risk factors for nonunion (Kindex: OR 1.06, p = 0.015; renal impairment: OR 1.48, p = 0.021). In the ROC analysis, a Kindex of 50 was identified as the optimal cutoff value (AUC 0.72). Conclusion: The nonunion rate after internal fixation of FNF was 2.2 %. Renal impairment and the Kindex were identified as independent risk factors. The Kindex at the time of injury may serve as a novel radiographic parameter to consider when evaluating the need for internal fixation in FNF cases.

DOI： 10.1016/j.jos.2024.09.002

Incremental cost-effectiveness ratio between titanium plate and hydroxyapatite block spacers in cervical laminoplasty for degenerative cervical myelopathy Reviewed

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

JOURNAL OF ORTHOPAEDIC SCIENCE Vol. 30 ( 4 ) page： 569 - 574 2025.7

Language：English Publisher：Journal of Orthopaedic Science

Introduction: Laminoplasty is a widely used surgical procedure to decompress the cervical spinal cord. Recently, titanium plates (TPs) have been used instead of conventional hydroxyapatite block (HA) spacers to prevent laminar reclosure. However, no study has compared the cost-effectiveness of TP and HA. Therefore, this study aimed to compare the cost-effectiveness and postoperative outcomes of laminoplasty using TP or HA. Methods: A total of 167 patients who underwent cervical laminoplasty at our institution were included in this study. Patients with cervical spinal cord injury, epidural hematoma, or follow-up of <1 year were excluded. Of the 167 patients, 69 underwent laminoplasty using TP (the TP group), and 98 underwent laminoplasty using HA (the HA group). The surgical costs and incremental cost-effectiveness ratio (ICER) were compared between the two groups. Additionally, the operation time, complications, Japanese Orthopaedic Association score, Hirabayashi recovery rate, and pre and postoperative cervical alignment on X-ray images were investigated. Results: The surgical costs were significantly higher in the TP group than in the HA group (HA, 7255 ± 1504 USD vs. TP, 11,642 ± 2492 USD, p < 0.01). The ICER was 21,935 USD per quality-adjusted life year in the TP group. The operation time was shorter in the TP group than in the HA group (HA, 70.0 ± 22.5 min vs. TP, 63.6 ± 19.3 min, p = 0.06). The Hirabayashi recovery rate and radiographic parameters were similar between the two groups. Implant displacements were significantly more common in the HA group than in the TP group (HA, 11.2 % vs. TP, 0 %, p < 0.01). Conclusions: The surgical costs and ICER with TPs were higher than those with HA spacers. However, no difference in the Hirabayashi recovery rate and postoperative radiological parameters was observed between the two groups, although the HA group had more implant displacements.

DOI： 10.1016/j.jos.2024.10.003

Comparative clinical outcomes of K-wire fixation versus screw fixation in Lisfranc joint injuries: A multicenter (TRON group) retrospective study.

Adachi A, Takegami Y, Nakashima H, Mishima K, Kobayashi K, Imagama S

The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons 2025.6

C2 Pelvic Angle as a Predictive Measure for Decompensated Spinopelvic Alignment and Its Impact on Health-Related Quality of Life. Reviewed

Ouchida J, Nakashima H, Ito S, Segi N, Yamauchi I, Ode Y, Imagama S

Spine 2025.6

Language：English Publisher：Spine

Study Design. Retrospective cohort. Objective. To evaluate the C2 pelvic angle (C2PA) as a novel compensatory parameter integrating C2 (center of gravity) and pelvic morphology, and its association with physical function and health-related quality of life (HRQOL). The T4-L1-Hip axis concept was applied to assess individualized spinal alignment. Background. Adult spinal deformity (ASD) impairs physical function and HRQOL in older adults. Pelvic retroversion compensates for spinal degeneration to maintain posture, but standardized evaluative indices linking pelvic parameters to outcomes remain limited. Methods. Cross-sectional analysis of 383 community-dwelling adults (mean age 64.1 ± 10.3 y). Whole-spine radiographs, physical function tests (Timed Up and Go, 10-meter walk), and SF-36 HRQOL scores were analyzed. C2PA mismatch (measured C2PA minus normative value [0.4 × pelvic incidence - 13]) and thoracolumbar decompensation (T4PA-L1PA ≥4°) were assessed. ROC analysis identified optimal C2PA mismatch thresholds; propensity score matching (age/sex/BMI) compared groups. Results. C2PA mismatch correlated strongly with lumbar (r=0.668) and thoracolumbar (r=0.707) mismatches. A 13° C2PA mismatch threshold optimally identified decompensated thoracolumbar alignment (AUC=0.819). Participants with>13° C2PA mismatch demonstrated decreased physical function (Timed Up and Go: 6.4 vs. 5.8 seconds; 10-meter walk: 1.4 vs. 1.5 m/s) and lower SF-36 scores (physical functioning: 65.9 vs. 72.8; bodily pain: 63.1 vs. 70.8; physical component summary: 41.8 vs. 45.7). Conclusions. C2PA is a reliable indicator of decompensated spinopelvic alignment, with>13° mismatch (measured C2PA>0.4 × pelvic incidence) The C2PA threshold correlates with decreased physical function and lower HRQOL, providing a clinical benchmark for evaluating and managing patients with spinal alignment degeneration.

DOI： 10.1097/BRS.0000000000005436

Nationwide analysis of spinal surgery in Japan from 1994 to 2021 Reviewed

Ito, S; Imagama, S; Nakashima, H; Machino, M; Sakai, T; Aizawa, T; Arima, H; Hamanaka, H; Ishimoto, Y; Kato, S; Kawaguchi, Y; Konishi, H; Miyakoshi, N; Murakami, H; Nagamoto, Y; Nakanishi, K; Nishida, K; Ohba, T; Okuda, S; Otani, K; Suda, K; Suzuki, N; Takasawa, E; Terai, H; Tezuka, F; Yamato, Y; Yukawa, Y; Kanemura, T; Takaso, M; Takahashi, H

EUROPEAN SPINE JOURNAL 2025.6

Language：English Publisher：European Spine Journal

Purpose: In this study, we aimed to compare the latest 2021 survey data with findings from 1994, 2001, and 2011 to elucidate the trends and transformations in spinal surgery over the past quarter-century. Methods: Data from the 2021 survey were compared with retrospective data from previous surveys. The 2021 survey collected data on patient demographics, surgical techniques, and perioperative complications of spinal surgeries performed in November 2021 from 739 facilities. Trends in patient age, disease type, surgical approach, and complication rates were analyzed over time. Results: The most common age group shifted from 40 to 59 years in 1994 to the 70s by 2011 and 2021. Degenerative diseases, particularly lumbar spinal stenosis, remain prevalent with an increase in trauma and osteoporotic fractures. Surgical techniques have evolved with a decline in anterior approaches and an increase in minimally invasive and posterior surgeries. Complication rates remained stable, ranging from 8.6 to 10.4%, with a slight increase by 2021 (8.8%). However, dural tears have become more common, likely because of the technical demands of minimally invasive and instrumented surgeries. Conclusions: The aging population of Japan has influenced spinal surgery demographics, and minimally invasive techniques have become more common, underscoring the need for enhanced training, improved techniques, and strategies tailored to older patients to improve future spinal surgery outcomes and support policy development.

DOI： 10.1007/s00586-025-08999-3

Comparative analysis of single-stage versus two-stage fusion surgeries for adult spinal deformity: radiographic outcomes, clinical improvements, and complication rates Reviewed

Ouchida, J; Nakashima, H; Ito, S; Segi, N; Yamauchi, I; Morita, Y; Kanemura, T; Ohara, T; Tsuji, T; Shinjo, R; Morishita, K; Imagama, S

EUROPEAN SPINE JOURNAL 2025.6

Language：English Publisher：European Spine Journal

Purpose: To compare single-stage and two-stage corrective fusion surgeries for adult spinal deformity (ASD), focusing on radiographic and clinical outcomes, and surgery-related complications. Methods: A retrospective cohort study of 245 ASD patients who underwent spinal fusion surgery involving three or more vertebral levels was conducted. Patients were categorized into single-stage and two-stage groups. Propensity score matching was performed to adjust for age, surgical procedure, and radiographical parameters. Radiographic parameters, complication rates, and the Japanese Orthopaedics Association (JOA) score were compared Results: After matching for clinical background, the two-stage group showed longer surgery times (493.7 ± 157.2 min vs. 271.3 ± 125.7 min, p < 0.001) and greater estimated blood loss (1617.1 ± 1276.9 mL vs. 1067.5 ± 1274.0 mL, p < 0.001). Surgery-related complication rates were similar between the two groups (20.0% vs. 20.0%, p = 1.000). At two years post-surgery, the two-stage group demonstrated significantly superior JOA score improvement (100.9 ± 84.5% vs. 68.2 ± 62.6%, p = 0.017), lower pelvic tilt (23.6 ± 11.3° vs. 29.1 ± 14.7°, p = 0.023) and a trend towards smaller sagittal vertical axis (40.6 ± 42.7 mm vs. 58.9 ± 58.7 mm, p = 0.075). Conclusions: Comparative analysis with matched clinical backgrounds revealed that the two-stage approach maintained equivalent complication rates while achieving sufficient correction effects and favorable clinical score improvements at two years post-surgery. To elucidate the relationship between individual surgical strategies and personalized complication risks, further research is necessary.

DOI： 10.1007/s00586-025-09036-z

Japanese 2021 nationwide survey on complications from spine surgery Reviewed

Ito, S; Imagama, S; Nakashima, H; Machino, M; Sakai, T; Aizawa, T; Arima, H; Hamanaka, H; Ishimoto, Y; Kato, S; Kawaguchi, Y; Konishi, H; Miyakoshi, N; Murakami, H; Nagamoto, Y; Nakanishi, K; Nishida, K; Ohba, T; Okuda, S; Otani, K; Suda, K; Suzuki, N; Takasawa, E; Terai, H; Tezuka, F; Yamato, Y; Yukawa, Y; Kanemura, T; Takaso, M; Takahashi, H

EUROPEAN SPINE JOURNAL 2025.6

Language：English Publisher：European Spine Journal

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

DOI： 10.1007/s00586-025-08981-z

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

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

Spine 2025.6

Language：English Publisher：Spine

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

DOI： 10.1097/BRS.0000000000005415

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

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

ARTHROPLASTY TODAY Vol. 33 2025.6

Publisher：Arthroplasty Today

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

DOI： 10.1016/j.artd.2025.101699

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

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

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

Impact of T1 Slope Visibility on Cervical Sagittal Alignment: A Comparative Study of Radiographic Parameters According to T1 Slope Visibility Reviewed Open Access

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

Spine Surgery and Related Research Vol. 9 ( 3 ) page： 307 - 312 2025.5

Authorship：Lead author Language：English Publisher：The Japanese Society for Spine Surgery and Related Research

<p>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.</p><p>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.</p><p>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 (<i>P</i><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°, <i>P</i><0.05).</p><p>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.</p>

DOI： 10.22603/ssrr.2024-0253

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

伊藤定之, 中島宏彰, 世木直喜, 大内田隼, 小田昌宏, 今釜史郎

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

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

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

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

Language：English Publisher：Global Spine Journal

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

DOI： 10.1177/21925682241297587

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

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

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

Language：English Publisher：Global Spine Journal

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

DOI： 10.1177/21925682241297948

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

Hirota, R; Oshigiri, T; Iesato, N; Emori, M; Teramoto, A; Shiratani, Y; Suzuki, A; Terai, H; Shimizu, T; Kakutani, K; Kanda, Y; Tominaga, H; Kawamura, I; Ishihara, M; Paku, M; Takahashi, Y; Funayama, T; Miura, K; Shirasawa, E; Inoue, H; Kimura, A; Iimura, T; Moridaira, H; Nakajima, H; Watanabe, S; Akeda, K; Takegami, N; Nakanishi, K; Sawada, H; Matsumoto, K; Funaba, M; Suzuki, H; Funao, H; Hirai, T; Otsuki, B; Kobayakawa, K; Uotani, K; Manabe, H; Tanishima, S; Hashimoto, K; Iwai, C; Yamabe, D; Hiyama, A; Seki, S; Goto, Y; Miyazaki, M; Watanabe, K; Nakamae, T; Kaito, T; Nakashima, H; Nagoshi, N; Kato, S; Imagama, S; Watanabe, K; Inoue, G; Furuya, T

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

Language：English Publisher：Journal of Orthopaedic Science

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

DOI： 10.1016/j.jos.2024.07.012

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

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

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

Publisher：Nagoya Journal of Medical Science

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

DOI： 10.18999/nagjms.87.2.305

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

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

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

Publisher：Nagoya Journal of Medical Science

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

DOI： 10.18999/nagjms.87.2.295

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

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

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

Language：English Publisher：Scientific Reports

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

DOI： 10.1038/s41598-025-99843-7

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

大内田隼, 中島宏彰, 伊藤定之, 世木直喜, 山内一平, 今釜史郎

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

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

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

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

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

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

DOI： 10.34371/jspineres.2025-0405

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

Maki, S; Furuya, T; Katsumi, K; Nakajima, H; Honjoh, K; Watanabe, S; Kaito, T; Takenaka, S; Kanie, Y; Iwasaki, M; Furuya, M; Inoue, G; Miyagi, M; Ikeda, S; Imagama, S; Nakashima, H; Ito, S; Takahashi, H; Kawaguchi, Y; Futakawa, H; Murata, K; Yoshii, T; Hirai, T; Koda, M; Ohtori, S; Yamazaki, M

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

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

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

Spine 2025.4

Impact of Signal Intensity Change in MRI on the Clinical Outcomes of Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Multicenter Study. Reviewed

Nagoshi N, Egawa S, Yoshii T, 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, Moridaira H, Fujibayashi S, Katoh H, Kanno H, Watanabe K, Taneichi H, Imagama S, Kawaguchi Y, Takeshita K, Nakamura M, Matsumoto M, Yamazaki M

Spine 2025.4

Language：English Publisher：Spine

Study Design. A multicenter prospective cohort study. Objective. To evaluate the clinical significance of intramedullary signal intensity (SI) changes on T2-weighted magnetic resonance imaging (MRI) in patients with cervical ossification of the posterior longitudinal ligament (OPLL) and assess their impact on surgical outcomes. Summary of Background Data. In OPLL, SI changes on MRI are frequently observed, but their prognostic significance remains unclear. While some studies associate SI changes with poor neurological function and recovery, others report a weak correlation. Methods. A total of 402 patients with cervical OPLL were analyzed. Patients were classified into SI (+) and SI (-) groups based on preoperative T2-weighted MRI. Clinical outcomes, including the Japanese Orthopaedic Association (JOA) score, the visual analog scale, and the JOA Cervical Myelopathy Evaluation Questionnaire, were evaluated preoperatively and at two years postoperatively. Multiple regression and logistic regression were performed to adjust for confounders. Results. A total of 348 cases (86.6%) were in the SI (+) group. Patients in the SI (+) group were older and had greater cervical range of motion (ROM). They exhibited lower preoperative JOA scores and more severe extremity pain. However, at two-year follow-up, neurological improvement, pain reduction, and patient-reported outcomes did not differ significantly between groups. Conclusion. SI changes on MRI are associated with worse preoperative neurological function and greater pain but do not predict inferior surgical outcomes. Surgical decompression remains effective regardless of SI changes, which can be valuable information for explaining the prognosis to patients in clinical practice.

DOI： 10.1097/BRS.0000000000005355

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

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

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

Language：English Publisher：Injury

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

DOI： 10.1016/j.injury.2025.112240

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

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

JOURNAL OF CLINICAL MEDICINE Vol. 14 ( 7 ) 2025.3

Language：English Publisher：Journal of Clinical Medicine

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

DOI： 10.3390/jcm14072389

特集人工知能(AI)革命-脊椎脊髄診療の将来像は? AIによる後縦靭帯骨化症の画像診断と手術合併症リスク予測 Reviewed

伊藤定之, 中島宏彰, 世木直喜, 大内田隼, 今釜史郎

脊椎脊髄ジャーナル Vol. 38 ( 4 ) page： 229 - 233 2025.3

Clinical Outcomes Associated with Screw Loosening in S2 Alar-Iliac Fixation in Adult Spinal Deformity Reviewed Open Access

Nagatani, Y; Nakashima, H; Kanemura, T; Tsushima, M; Tomita, H; Morishita, K; Oyama, H; Ito, S; Segi, N; Ouchida, J; Yamauchi, I; Ode, Y; Okada, Y; Imagama, S

JOURNAL OF CLINICAL MEDICINE Vol. 14 ( 6 ) 2025.3

Language：English Publisher：Journal of Clinical Medicine

Purpose: To explore the clinical outcomes associated with screw loosening after S2 alar-iliac (SAI) screw fixation for adult spinal deformity (ASD). Overview of the literature: SAI fixation is widely used in ASD corrective surgery; despite the biomechanical advantages of this screw, complications such as screw loosening remain a significant concern. Methods: We retrospectively reviewed 27 patients undergoing corrective surgery for ASD using SAI as the distal fixation point at a single institution between February 2013 and February 2018. Patients were divided into non-loosening (N) and loosening (L) groups based on radiological evidence of screw loosening (radiolucent area of 1 mm around the screw) and compared for demographic characteristics, bone mineral density (T-score), spinal alignment parameters, and patient-reported outcome using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) scores. Results: Screw loosening was observed in 78% of patients (n = 21/27); however, there were no statistically significant differences between the N and L groups in terms of the preoperative and 5-year postoperative JOABPEQ scores (p > 0.05 across all domains) and spinal sagittal alignment (p > 0.05). The improvements achieved through corrective surgery were largely maintained regardless of the presence of screw loosening. Conclusions: SAI screw loosening is a common sequela in ASD surgery; however, its loosening might not affect long-term clinical outcomes. Therefore, the choice of fixation should be individualized based on patient factors such as age and bone quality.

DOI： 10.3390/jcm14061881

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

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

ASIAN SPINE JOURNAL 2025.3

Predicting Postoperative Neurological Outcomes in Metastatic Spinal Tumor Surgery Using Machine Learning. Reviewed

Maki S, Shiratani Y, Orita S, Suzuki A, Tamai K, Shimizu T, Kakutani K, Kanda Y, Tominaga H, Kawamura I, Ishihara M, Paku M, Takahashi Y, Funayama T, Miura K, Shirasawa E, Inoue H, Kimura A, Iimura T, Moridaira H, Nakajima H, Watanabe S, Akeda K, Takegami N, Nakanishi K, Sawada H, Matsumoto K, Funaba M, Suzuki H, Funao H, Oshigiri T, Hirai T, Otsuki B, Kobayakawa K, Uotani K, Manabe H, Tanishima S, Hashimoto K, Iwai C, Yamabe D, Hiyama A, Seki S, Kato K, Miyazaki M, Watanabe K, Nakamae T, Kaito T, Nakashima H, Nagoshi N, Inoue G, Imagama S, Watanabe K, Kato S, Ohtori S, Furuya T, JASA Study Group

Spine 2025.3

Language：English Publisher：Spine

Study Design. Retrospective analysis of data collected across multiple centers. Objective. To develop machine learning models for predicting neurological outcomes one month postoperatively in patients with metastatic spinal tumors undergoing surgery, and to identify key factors influencing neurological recovery. Summary of Background Data. The increasing prevalence of spinal metastases has led to a growing need for surgical intervention to address mechanical instability and neurological deficits. Predicting postoperative neurological status, as assessed by the Frankel classification, can provide valuable insights for surgical planning and patient counseling. Traditional prognostic models have shown limitations in capturing the complexity of neurological recovery patterns. Methods. We analyzed data from 244 patients who underwent spinal surgery for metastatic disease across 38 institutions. The primary outcome was functional ambulation, defined as Frankel grades D or E at one month postoperatively. Four machine learning algorithms (Random Forest, XGBoost, LightGBM, and CatBoost) were used to build predictive models. Feature selection employed the Boruta algorithm and Variance Inflation Factor analysis to reduce multicollinearity. Results. Among the 244 patients, the proportion of ambulatory patients (Frankel grades D or E) increased from 36.8% preoperatively to 63.1% at one month postoperatively. The Random Forest model achieved the highest area under the receiver operating characteristic curve (AUC-ROC) of 0.8516, followed by XGBoost (0.8351), CatBoost (0.8331), and LightGBM (0.8098). SHapley Additive exPlanations analysis identified preoperative Frankel classification, transfer ability, inflammatory markers (C-reactive protein, white blood cell-lymphocyte), and surgical timing as the most important predictors of postoperative outcomes. Conclusions. Machine learning models showed strong predictive performance in assessing postoperative neurological status for patients with metastatic spinal tumors. Key factors including preoperative neurological function, functional ability, and inflammation markers significantly influenced outcomes. These findings could inform surgical decision-making and help set realistic postoperative expectations while potentially improving patient care through more accurate outcome prediction.

DOI： 10.1097/BRS.0000000000005322

Early Versus Delayed Surgery for Elderly Traumatic Cervical Spinal Injury: A Nationwide Multicenter Study in Japan Reviewed Open Access

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

GLOBAL SPINE JOURNAL Vol. 15 ( 2 ) page： 1143 - 1154 2025.3

Language：English Publisher：Global Spine Journal

Study Design: Retrospective multicenter study. Objectives: The effectiveness of early surgery for cervical spinal injury (CSI) has been demonstrated. However, whether early surgery improves outcomes in the elderly remains unclear. This study investigated whether early surgery for CSI in elderly affects complication rates and neurological outcomes. Methods: This retrospective multicenter study included 462 patients. We included patients with traumatic acute cervical spinal cord injury aged ≥65 years who were treated surgically, whereas patients with American Spinal Injury Association (ASIA) Impairment Scale E, those with unknown operative procedures, and those waiting for surgery for >1 month were excluded. The minimum follow-up period was 6 months. Sixty-five patients (early group, 14.1%) underwent surgical treatment within 24 hours, whereas the remaining 397 patients (85.9%) underwent surgery on a standby basis (delayed group). The propensity score-matched cohorts of 63 cases were compared. Results: Patients in the early group were significantly younger, had significantly more subaxial dislocations (and fractures), tetraplegia, significantly lower ASIA motor scores, and ambulatory abilities 6 months after injury. However, no significant differences in the rate of complications, ambulatory abilities, or ASIA Impairment Scale scores 6 months after injury were observed between the matched cohorts. At 6 months after injury, 61% of the patients in the early group (25% unsupported and 36% supported) and 53% of the patients in the delayed group (34% unsupported and 19% supported) were ambulatory. Conclusions: Early surgery is possible for CSI in elderly patients as the matched cohort reveals no significant difference in complication rates and neurological or ambulatory recovery between the early and delayed surgery groups.

DOI： 10.1177/21925682241227430

Fracture of the patella involving inferior pole is associated with postoperative patella baja - A retrospective multicenter study Reviewed

Murase, F; Takegami, Y; Tokutake, K; Oyama, H; Arakawa, O; Takatsu, T; Nakashima, H; Mishima, K; Imagama, S

JOURNAL OF ORTHOPAEDIC SCIENCE Vol. 30 ( 2 ) page： 379 - 384 2025.3

Language：English Publisher：Journal of Orthopaedic Science

Background: The patella fracture involving of inferior pole fractures (IPF) may be associated with patella baja, However, the clinical impact of this condition remains unclear. This study aims to clarify 1) the incidence of patella baja following patellar fracture surgery, 2) the associated clinical outcomes with and without the presence of patella baja, and 3) the potential correlation between the detection of IPF on CT and the occurrence of patella baja. Methods: We conducted a retrospective multicenter study involving 251 patients who underwent surgical treatment for patellar fractures. Patients were divided into the patella baja (PB; n = 49) group and patella norma (PN; n = 202) group. Data collected included demographics, radiographic findings, surgical details, and postoperative complications. We compared these items between PB group and PN group. Logistic regression analyses were used to identify risk factors for patella baja. Results: Immediately following surgery, 36 (14.3%) patients presented with patella baja which increased to 49 cases (19.5%) at six months postoperatively. There is no statistically significant difference in the demographics, surgical details, clinical outcomes and complication between PB group and PN group. While, in the radiographical assessment, the prevalence of IPF on CT scan in the patella baja group was significantly higher than that in the patella norma group. By logistic regression analysis, IPFP on CT was identified as an independent risk factor for patella baja. (odds ratio 2.11, 95% confidence interval: 1.03–4.33, p = 0.042). Conclusion: In patients with patellar fractures, the incidence of patella baja increased from 14.3% immediately post-surgery to 19.5% at the six-month check-up. No significant differences were observed in clinical outcomes between the patella baja group and the norma group. The patella fracture involving IPF on CT emerged as a predictive factor for patella baja.

DOI： 10.1016/j.jos.2024.03.008

Impact of Preoperative Motor Status for the Positive Predictive Value of Transcranial Motor-Evoked Potentials Alerts in Thoracic Spine Surgery: A Prospective Multicenter Study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research Reviewed Open Access

Funaba, M; Kanchiku, T; Yoshida, G; Machino, M; Ushirozako, H; Kawabata, S; Ando, M; Yamada, K; Iwasaki, H; Shigematsu, H; Fujiwara, Y; Tadokoro, N; Takahashi, M; Taniguchi, S; Wada, K; Yamamoto, N; Yasuda, A; Morito, S; Hashimoto, J; Takatani, T; Kobayashi, K; Ando, K; Kurosu, K; Segi, N; Nakashima, H; Nakanishi, K; Takeshita, K; Matsuyama, Y; Imagama, S

GLOBAL SPINE JOURNAL Vol. 15 ( 2 ) page： 506 - 517 2025.3

Language：English Publisher：Global Spine Journal

Study Design: Prospective multicenter study. Objective: To investigate the validity of transcranial motor-evoked potentials (Tc-MEP) in thoracic spine surgery and evaluate the impact of specific factors associated with positive predictive value (PPV). Methods: One thousand hundred and fifty-six cases of thoracic spine surgeries were examined by comparing patient backgrounds, disease type, preoperative motor status, and Tc-MEP alert timing. Tc-MEP alerts were defined as an amplitude decrease of more than 70% from the baseline waveform. Factors were compared according to preoperative motor status and the result of Tc-MEP alerts. Factors that showed significant differences were identified by univariate and multivariate analysis. Results: Overall sensitivity was 91.9% and specificity was 88.4%. The PPV was significantly higher in the preoperative motor deficits group than in the preoperative no-motor deficits group for both high-risk (60.3% vs 38.3%) and non-high-risk surgery groups (35.1% vs 12.8%). In multivariate logistic analysis, the significant factors associated with true positive were surgical maneuvers related to ossification of the posterior longitudinal ligament (odds ratio = 11.88; 95% CI: 3.17–44.55), resection of intradural intramedullary spinal cord tumor (odds ratio = 8.83; 95% CI: 2.89–27), preoperative motor deficit (odds ratio = 3.46; 95% CI: 1.64–7.3) and resection of intradural extramedullary spinal cord tumor (odds ratio = 3.0; 95% CI: 1.16–7.8). The significant factor associated with false positive was non-attributable alerts (odds ratio =.28; 95% CI:.09–.85). Conclusion: Surgeons are strongly encouraged to use Tc-MEP in patients with preoperative motor deficits, regardless of whether they are undergoing high-risk spine surgery or not. Knowledge of PPV characteristics will greatly assist in effective Tc-MEP enforcement and minimize neurological complications with appropriate interventions.

DOI： 10.1177/21925682231196454

Prognosis of Cervical Diffuse Idiopathic Skeletal Hyperostosis-Related Spine Injuries in Elderly Patients: Analyses of Both Fracture and Spinal Cord Injury Without Fracture Reviewed Open Access

Segi, N; Nakashima, H; Machino, M; Ito, S; Yokogawa, N; Sasagawa, T; 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; 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; Iizuka, Y; Takasawa, E; Akeda, K; Takegami, N; Kiyasu, K; Tominaga, H; Tokumoto, H; Funao, H; Oshima, Y; Yoshii, T; Kaito, T; Sakai, D; Ohba, T; Seki, S; Otsuki, B; Ishihara, M; Miyazaki, M; Okada, S; Imagama, S; Kato, S

GLOBAL SPINE JOURNAL Vol. 15 ( 2 ) page： 321 - 331 2025.3

Language：English Publisher：Global Spine Journal

Study Design: Retrospective multicenter study. Objective: The purpose of this study was to compare the prognosis of elderly patients with injuries related to cervical diffuse idiopathic skeletal hyperostosis (cDISH) to matched control for each group, with and without fractures. Methods: The current multicenter study was a retrospective analysis of 140 patients aged 65 years or older with cDISH-related cervical spine injuries; 106 fractures and 34 spinal cord injuries without fracture were identified. Propensity score–matched cohorts from 1363 patients without cDISH were generated and compared. Logistic regression analysis was performed to determine the risk of early mortality for patients with cDISH-related injury. Results: Patients with cDISH-related injuries with fracture did not differ significantly in the incidence of each complication and ambulation or severity of paralysis compared to matched controls. In patients with cDISH-related injury without fracture, those who were nonambulatory at discharge comprised 55% vs 34% of controls, indicating significantly poorer ambulation in those with cDISH-related injuries (P =.023). There was no significant difference in the incidence of complications and ambulation or paralysis severity at 6 months as compared with controls. Fourteen patients died within 3 months. Logistic regression analysis identified complete paralysis (odds ratio [OR] 36.99) and age (OR 1.24) as significant risk factors for mortality. Conclusions: The current study showed no significant differences in the incidence of complications, ambulation outcomes between patients with cDISH-related injury with fracture and matched controls, and that the ambulation at discharge for patients with cDISH-related injury without fractures were significantly inferior to those of matched controls.

DOI： 10.1177/21925682231186757

Hangman's Fracture in Geriatric Population: A Nationwide Multicenter Study in Japan Reviewed 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 Vol. 15 ( 2 ) page： 921 - 929 2025.3

Publisher：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

Impact of Fixation Length for Single-Level Spinal Metastasis Surgery in the Elderly: A Multicenter Study. Reviewed Open Access

Ito H, Takegami Y, Nakashima H, Mishima K, Yamauchi K, Imagama S

Cureus Vol. 17 ( 3 ) page： e80886 2025.3

Impact of Paraspinal Muscle Degeneration on Surgical Outcomes and Radiographical Sagittal Alignment in Adult Spinal Deformity: A Multicenter Study Reviewed Open Access

Ouchida, J; Morita, Y; Ito, S; Segi, N; Yamauchi, I; Kanemura, T; Ohara, T; Tsuji, T; Shinjyo, R; Imagama, S; Nakashima, H

NEUROSPINE Vol. 22 ( 1 ) page： 30 - 37 2025.3

Language：English Publisher：Neurospine

Objective: This multicenter study aimed to evaluate the impact of paravertebral muscles (PVMs) degeneration, particularly fat infiltration, on preoperative sagittal imbalance, and postoperative complications and sagittal alignment change in patients with adult spinal deformity (ASD). Methods: A retrospective analysis was conducted on 454 patients who underwent ASD surgery across 5 institutions. Patients were classified into 2 groups based on paraspinal muscle fat infiltration on MRI: those with significant infiltration (FI-PVM(+)) and those with minimal or no infiltration (FI-PVM(-)). Propensity score matching was performed to adjust for demographic factors and preoperative radiographical parameters. Spinopelvic parameters were assessed preoperatively, postoperatively, and at a 2-year follow-up. Mechanical complications were compared between the groups. Results: The FI-PVM(+) group showed greater sagittal vertical axis (86.4 ± 57.5 vs. 51.8 ± 59.2, p < 0.001) preoperatively and required more extensive surgical correction with a significantly greater number of fused vertebral levels (7.3 ± 3.7 vs. 6.7 ± 3.7, p < 0.039). After propensity score matching, both groups showed significant improvement in spinopelvic alignment postoperatively, maintained throughout the 2-year follow-up. However, the FI-PVM(+) group demonstrated a trend toward a higher incidence of distal junctional kyphosis (6.3% vs. 0.9%, p = 0.070) and exhibited significantly greater decrease in pelvic tilt postoperatively (4.3° ± 7.6° vs. 1.3° ± 8.2°, p = 0.006). Conclusion: Fat infiltration in PVM is associated with increased surgical complexity and a higher risk of mechanical complications. Preoperative assessment of muscle quality, along with targeted rehabilitation and closer postoperative monitoring, may be crucial for improving long-term outcomes in ASD surgery.

DOI： 10.14245/ns.2550248.124

特集これだけは避けたい! 脊椎脊髄手術の重篤な合併症とその対策胸椎OPLLに伴う脊髄障害 Reviewed

伊藤定之, 中島宏彰, 世木直喜, 大内田隼, 今釜史郎

脊椎脊髄ジャーナル Vol. 38 ( 3 ) page： 147 - 154 2025.2

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

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

EUROPEAN SPINE JOURNAL 2025.2

Language：English Publisher：European Spine Journal

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

DOI： 10.1007/s00586-025-08722-2

A deep learning-based prediction model for prognosis of cervical spine injury: a Japanese multicenter survey Reviewed

Ito, S; Nakashima, H; Segi, N; Yokogawa, N; Sasagawa, T; 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; 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; Oda, M; Okada, S; Imagama, S; Kato, S

EUROPEAN SPINE JOURNAL 2025.2

Language：English Publisher：European Spine Journal

Purpose: Cervical spine injuries in the elderly (defined as individuals aged 65 years and older) are increasing, often resulting from falls and minor trauma. Prognosis varies widely, influenced by multiple factors. This study aimed to develop a deep-learning–based predictive model for post-injury outcomes. Methods: This study analyzed a nationwide dataset from the Japan Association of Spine Surgeons with Ambition, comprising 1512 elderly patients (aged 65 years and older) with cervical spine injuries from 2010 to 2020. Deep learning predictive models were constructed for residence, mobility, and the American Spinal Injury Association Impairment Scale (AIS). The model’s performance was compared with that of a traditional statistical analysis. Results: The deep-learning model predicted the residence and AIS outcomes with varying accuracies. The highest accuracy was observed in predicting residence one year post-injury. The model also identified that the AIS score at discharge was significantly predicted by upper extremity trauma, mobility, and elbow extension strength. The deep learning model highlighted factors, such as upper extremity trauma, that were not considered significant in the traditional statistical analysis. Conclusion: Our deep learning-based model offers a novel method for predicting outcomes following cervical spine injuries in the elderly population. The model is highly accurate and provides additional insights into potential prognostic factors. Such models can improve patient care and individualize future interventions.

DOI： 10.1007/s00586-025-08708-0

Surgical strategy for metastatic spinal tumors based on Spine Instability Neoplastic Score and patient-reported outcomes: JASA multicenter prospective study. Reviewed Open Access

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

Journal of neurosurgery. Spine Vol. 42 ( 2 ) page： 203 - 214 2025.2

Language：English Publisher：Journal of Neurosurgery Spine

OBJECTIVE Instrumentation surgery in combination with radiotherapy (RT) is one of the key management strategies for patients with spinal metastases. However, the use of materials can affect the RT dose delivered to the tumor site and surrounding tissues, as well as hinder optimal postoperative tumor evaluation. The association of the preoperative Spine Instability Neoplastic Score (SINS) with the need for spinal stabilization and life expectancy are unclear. This multicenter prospective study aimed to investigate the current situation and make recommendations regarding the choice of surgical procedure based on the preoperative SINS and prospectively collected postoperative patient-reported outcomes (PROs). METHODS The study prospectively included 317 patients with spinal metastases who underwent palliative surgery and had a minimum follow-up period of 6 months. The survey items included SINS, patient background, and clinical data including surgical procedure, history of RT, prognosis, and PROs (i.e., the visual analog scale score, Faces Scale, Barthel Index, Vitality Index, and 5-level EQ-5D health survey) at baseline, and at 1 and 6 months after surgery. The association of preoperative SINS with life expectancy, PROs, and surgical procedures was examined using statistical analysis. RESULTS Preoperative SINS (three categories) had no association with life expectancy. All PROs evaluated in the study improved up to 6 months after surgery. Pain categories (visual analog scale score and/or Faces Scale) at baseline were correlated with preoperative SINS. As many as 90.9% of enrolled patients underwent fusion surgery, and even in SINS 0–6 cases, implants were used in 64.3% of patients. Postoperative RT was performed in 42.9% of the patients. However, prospective assessments of PROs showed no significant difference between surgical procedures (with and without fusion) in patients with SINS 0–9. In addition, no cases required conversion from noninstrumentation surgery to fusion surgery. CONCLUSIONS Although the choice of surgical procedure should be made on a case-by-case basis on the NOMS (neurological, oncological, mechanical, and systemic) framework, careful consideration is required to determine whether spinal stabilization is needed in patients with SINS ≤ 9, considering the patient’s background and the plan for postoperative adjuvant therapy.

DOI： 10.3171/2024.7.SPINE24340

Patterns of sitting spinal alignment in non-ambulatory scoliosis patients with paraplegia: an observational study Reviewed

Ouchida, J; Nakashima, H; Ohara, T; Machino, M; Ito, S; Segi, N; Yamauchi, I; Imagama, S

EUROPEAN SPINE JOURNAL Vol. 34 ( 2 ) page： 556 - 564 2025.2

Language：English Publisher：European Spine Journal

Purpose: To classify sagittal spinopelvic alignment patterns of non-ambulatory scoliosis patients with paraplegia based on lateral sitting radiographs and explore their relation to clinical background and physical function. Methods: We reviewed non-ambulatory scoliosis patients with paraplegia, excluding those with prior spinal surgery from a single-center database. Alignment patterns in sitting postures were classified into slump sitting (SS) and erect sitting (ES) based on the most posterior edge of the spine's location on lateral sitting radiographs. Radiographical spinopelvic sagittal alignment, demographics, and physical functions were analyzed. Clinical scoring for physical functions included Hoffer’s ambulator classification, Hoffer’s modified sitting classification, and the Modified Ashworth Score (MAS) for the severity of spasticity in the lower extremities. Percentages of patients without spasticity, with MAS of 0 indicating "no spasticity." were also compared between the two alignment patterns. Results: Of 172 patients screened, 86 met inclusion criteria, revealing two distinct alignment patterns: SS showed greater thoracic kyphosis, smaller lumbar lordosis, pelvic retroversion, and hip hyperflexion compared to ES. No significant differences in demographic data or curve patterns were observed between groups. The SS group had a significantly higher percentage of patients without spasticity compared to the ES group (39.2% vs. 14.3%, P = 0.016). Conclusion: Identified were two distinct sagittal alignment patterns in seated scoliosis patients with paraplegia, with potential influences from spasticity in the lower extremities. Recognizing these patterns can aid in assessing the function of sitting balance that includes the hip joint and in optimizing strategies for the treatment of scoliosis patients with paraplegia.

DOI： 10.1007/s00586-024-08584-0

Outcomes following instrumentation removal after posterior corrective fixation in adolescent idiopathic scoliosis Reviewed

Yamauchi, I; Nakashima, H; Ito, S; Segi, N; Ouchida, J; Morita, Y; Ode, Y; Nagatani, Y; Okada, Y; Tauchi, R; Ohara, T; Kawakami, N; Imagama, S

EUROPEAN SPINE JOURNAL Vol. 34 ( 2 ) page： 635 - 642 2025.2

Language：English Publisher：European Spine Journal

Purpose: To evaluate the complications and postoperative outcomes of implant removal after posterior fixation in adolescent idiopathic scoliosis. Methods: We retrospectively reviewed the data of patients who underwent implant removal after posterior corrective fixation for adolescent idiopathic scoliosis between 2002 and 2014. Complications were evaluated in the 116 patients who underwent implant removal at their choice. Radiological evaluations were performed and analyzed in 71 patients who were followed up for > 2 years after implant removal. Moreover, the patients were divided into two groups: those with increased thoracic kyphosis after implant removal and those without. Results: Overall, 14 of the 116 patients had complications. Two of the three patients with fractures required reoperation. Radiological examination revealed no significant difference in the scoliosis curvature in the coronal plane after implant removal. In the sagittal plane, the lowest instrumented vertebral tilt, cervical lordosis, T1 slope, T1–12 kyphosis angle, and T5–12 kyphosis angle were significantly increased. Moreover, patients with an increased T5–12 kyphosis angle after implant removal had greater pelvic incidence (PI) and sacral slope (SS) before implant removal. Conclusion: The prevalence of complications after implant removal in adolescent idiopathic scoliosis was 12.1%. Spinal alignment is more variable in the sagittal plane than in the coronal plane, and patients with increased thoracic kyphosis after implant removal have greater preoperative PI and SS. Sufficient preoperative explanation is necessary if a patient wishes to undergo implant removal.

DOI： 10.1007/s00586-024-08519-9

Impact of diffuse idiopathic skeletal hyperostosis on quality of life and locomotive syndrome in community-dwelling older adults: the Yakumo study Reviewed Open Access

Ohshima, K; Nakashima, H; Segi, N; Ito, S; Ouchida, J; Takegami, Y; Ishizuka, S; Yamauchi, I; Hasegawa, Y; Murotani, K; Imagama, S

SCIENTIFIC REPORTS Vol. 15 ( 1 ) page： 3582 2025.1

Language：English Publisher：Scientific Reports

Diffuse idiopathic skeletal hyperostosis (DISH) is a common disease in older adults that causes extensive spinal ankylosis. However, its impact on quality of life (QOL) and locomotive syndrome (LS) remains unknown. Thus, we aimed to evaluate the DISH effect on QOL and LS in community-dwelling middle-aged and older adults. Data of community volunteers who attended a health checkup in 2018–2019 were assessed. A total of 455 subjects were included. Whole spine lateral radiographs were obtained to detect DISH according to the Resnik criteria. QOL was evaluated using SF-36 and EQ5D HUSV. LS was evaluated using the stand-up and two-step tests and GLFS-25. Multivariate regression analysis was performed, adjusting for sex, age, body mass index, and knee osteoarthritis. Additionally, a sex-stratified analysis was performed. DISH was detected in 83 (18.2%) participants. Multivariate analysis demonstrated that DISH was significantly associated with low EQ5D HSUV. Multivariate analysis in men demonstrated that DISH was associated with low PCS, low EQ5D HSUV, high LS stage. Multivariate analysis in women demonstrated that DISH was not associated with any QOL or LS. DISH may be associated with a poor QOL. Additionally, DISH is more common and produces a greater clinical impact in men than in women.

DOI： 10.1038/s41598-025-87878-9

Difference of Disk Degeneration and Segmental Range of Motion due to Lumbar Disk Level among Age and Gender: 639 Asymptomatic Volunteer Data Open Access

Yamada Tomohiro, Nakashima Hiroaki, Machino Masaaki, Matsuyama Yukihiro, Kato Fumihiko, Yukawa Yasutsugu

Spine Surgery and Related Research Vol. 9 ( 1 ) page： 87 - 92 2025.1

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

<p>Introduction: There is limited evidence between lumbar disk degeneration and normal lumbar segmental range of motions (SRMs), because previous studies were skewed by age and lacked large cohort of asymptomatic data. We aimed to characterize the normal lumbar SRMs according to age and gender and determine its association with disk degeneration.</p><p>Methods: A total of 639 healthy Japanese volunteers (≥50 individuals of each decade of age from 20 to 79) without any symptom or morphological spinal abnormalities, who underwent lumbar radiograph and magnetic resonance image (MRI), were selected retrospectively. SRMs were evaluated by the flexion-extension radiographs taken in the recumbent position. Disk degenerations were assessed according to the Pfirrmann grade using MRI T2 imaging.</p><p>Results: The mean SRMs became larger in the lower lumbar level. The range of the mean SRMs was smallest at L1-2 and largest at L4-5: 6 to 9 degrees at L1/2, to peaking at 11-14 degrees at L4/5 in male, and 6-8 degrees at L1/2, to peaking at 11-17 degrees at L4/5 in female. Lumbar disk degeneration progressed faster with age in the lower lumbar spine than in the upper lumbar level. SRM did not change depending on the severity of disk degeneration in upper lumbar spine, but significantly decreased with progressive disk degeneration in the lower lumbar spine.</p><p>Conclusions: These findings could help to identify the normal lumbar SRMs that might be useful to evaluate the instability or inflexibility in the clinical situation. Furthermore, our results demonstrated the transition of the normative lumbar SRMs based on age, gender, and lumbar level.</p>

DOI： 10.22603/ssrr.2024-0087

Trabecular Bone Remodeling after Lateral Lumbar Interbody Fusion: Indirect Findings for Stress Transmission between Vertebrae after Spinal Fusion Surgery Reviewed Open Access

Segi Naoki, Nakashima Hiroaki, Ito Sadayuki, Ouchida Jun, Oishi Ryotaro, Yamauchi Ippei, Miyairi Yuichi, Morita Yoshinori, Tsushima Mikito, Tomita Hiroyuki, Morishita Kazuaki, Ohshima Kazuma, Kanemura Tokumi, Imagama Shiro

Spine Surgery and Related Research Vol. 9 ( 1 ) page： 51 - 60 2025.1

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

<p>Introduction: After posterior lumbar interbody fusion (PLIF), trabecular bone remodeling (TBR) occurs in the vertebral body. This study aimed to investigate whether imaging findings obtained with PLIF are applicable to lateral lumbar interbody fusion (LLIF).</p><p>Methods: A total of 53 cases who underwent one- or two-level LLIF with polyether ether ketone cage and posterior spinal fixation/fusion (PSF) were retrospectively included in this study. TBR, vertebral endplate cyst (VEC), facet union, and pseudarthrosis were investigated on computed tomography (CT) images at 3 months, 1 year, and 2 years postoperatively. Of the 53 patients, 36 (68%) who underwent CT examination at approximately 5 years postoperatively were subanalyzed.</p><p>Results: TBR was commonly observed anterior to the cage on CT sagittal images. The TBR-positive rate was 21%, 67%, and 73% at 3 months, 1 year, and 2 years postoperatively, respectively. The 3-month TBR-positive segments showed significantly less VEC (0% vs. 29%, <i>P</i>=0.029) at 1 year postoperatively. The 1-year TBR-positive segments showed a significantly higher facet union rate (83% vs. 57%, <i>P</i>=0.019) and less pseudoarthrosis (0% vs. 13%, <i>P</i>=0.041) at 2 years postoperatively. At 5 years postoperatively, 50% of the 2-year TBR-positive segments turned negative with solid intervertebral bony fusion.</p><p>Conclusions: TBR-positive segments had significantly lower future VEC positivity, higher future facet union rates, and lower future pseudarthrosis rates. In LLIF-PSF, TBR suggests the establishment of intervertebral stability and allows consideration of intervertebral biomechanics.</p>

DOI： 10.22603/ssrr.2024-0054

特集びまん性特発性骨増殖症(DISH)に対する治療の現状 DISHの総論と疫学 Reviewed

中島宏彰, 伊藤定之, 世木直喜, 大内田隼, 山内一平, 都島幹人, 今釜史郎

脊椎脊髄ジャーナル Vol. 38 ( 2 ) page： 56 - 60 2025.1

Effectiveness of Intraoperative Neurophysiological Spinal Cord Monitoring in Lumbosacral Spine Surgery: Analysis of 6,196 Patients from Spinal Cord Monitoring Committee of the Japanese Society for Spine Surgery and Related Research Reviewed Open Access

Takahashi Masahito, Imagama Shiro, Shigematsu Hideki, Funaba Masahiro, Ushirozako Hiroki, Nakanishi Kazuyoshi, Machino Masaaki, Taniguchi Shinichirou, Fujiwara Yasushi, Kobayashi Kazuyoshi, Yamamoto Naoya, Yamada Kei, Kanchiku Tsukasa, Iwasaki Hiroshi, Wada Kanichiro, Tadokoro Nobuaki, Ando Kei, Yasuda Akimasa, Hashimoto Jun, Morito Shinji, Kurosu Kenta, Nakashima Hiroaki, Segi Naoki, Arakawa Yasuo, Takatani Tsunenori, Kawabata Shigenori, Ando Muneharu, Matsuyama Yukihiro, Takeshita Katsushi, Yoshida Go

Journal of Spine Research Vol. 16 ( 1 ) page： 9 - 16 2025.1

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

<p><b>Introduction: </b>In high-risk surgeries, those involving pathologies such as ossification of the posterior longitudinal ligament in the spine, spinal cord tumors, and spinal deformities, utilization of intraoperative neurophysiological monitoring (IONM) has been reported to be beneficial. However, efficacy of IONM for lumbosacral spinal surgery remains debated. Therefore, this study aimed to evaluate the efficacy of IONM in lumbosacral spinal surgeries in comparison with its use in cervical and/or thoracic spine surgeries.</p><p><b>Methods: </b>This was a multi-institutional prospective cohort study. The patients underwent spinal surgery with intraoperative neurophysiological monitoring in the hospitals of the Spinal Cord Monitoring Committee of the Japanese Society for Spine Surgery and Related Research. Patients were divided into two groups at the surgical level: 'cervical and/or thoracic' and 'lumbar and/or sacral'. Primary endpoints were sensitivity, specificity, positive and negative predictive values (PPV and NPV), and positive and negative likelihood ratios (PLR and NLR), and secondary endpoints were the incidence of postoperative motor palsy and the cutoff value of the rate of decrease of Tc-MEP amplitude in lumbar and/or sacral surgery.</p><p><b>Results: </b>The number of patients with cervical and/or thoracic surgery were 4,765, and those with lumbar and/or sacral surgery were 1,431. Furthermore, the sensitivity, specificity, PPV, NPV, PLR, and NLR were 77.6, 90.1, 21.1, 99.2, 7.9, and 0.2 in cervical and/or thoracic surgery, and 60.7, 95.9, 23.0, 99.2, 14.8, and 0.4 in lumbar and/or sacral surgery respectively. Specificity and PLR for lumbar and/or sacral surgery were significantly higher. Incidence of postoperative motor palsy was 3.1% (152/4,765) in the cervical and/or thoracic surgery group and 1.9% (27/1,431) in the lumbar and/or sacral surgery group. Cutoff value of the rate of Tc-MEP amplitude was 30%, with a 70% decrease compared to the baseline, and the sensitivity and specificity were 64.7% and 87.5%, respectively. The AUC was 0.69.</p><p><b>Conclusions: </b>Considering the substantially high specificity and PLR observed in lumbar and/or sacral surgeries, IONM can be considered effective within the context of lumbosacral spinal surgery.</p>

DOI： 10.34371/jspineres.2023-0031

A nationwide multicenter study of the cost effectiveness of fi ve leading drugs for pharmacological management of cervicobrachial symptoms Reviewed

Wakao, N; Furuya, T; Yoshii, T; Arima, H; Yamato, Y; Nakashima, H; Imagama, S; Imajo, Y; Miyamoto, H; Inoue, G; Miyagi, M; Kanbara, S; Iizuka, Y; Chikuda, H; Watanabe, K; Kobayashi, K; Tsushima, M; Miyazaki, M; Yagi, M; Suzuki, S; Takahata, M; Hongo, M; Koda, M; Nagata, K; Mori, K; Suzuki, A; Kaito, T; Murotani, K; Miyakoshi, N; Hashizume, H; Matsuyama, Y; Kawakami, M; Haro, H

JOURNAL OF ORTHOPAEDIC SCIENCE Vol. 30 ( 1 ) page： 18 - 24 2025.1

Language：English Publisher：Journal of Orthopaedic Science

Background: Cervicobrachial pain frequently affects the quality of life (QOL) of the general public and has a significant economic impact on the health care systems of various countries. There are a number of treatment options for this disease, including widely-used drug therapy, but the effectiveness of each option is indeterminate, and there have been no published cost-effectiveness analysis studies so far. This prospective observational study aimed to examine the cost-effectiveness of drug treatment for cervicobrachial symptoms. Methods: A 6-month medication regimen for each of five frequently-prescribed drugs for cervicobrachial symptoms was administered to 322 patients at 24 centers in Japan. Outcome measures, including of the EuroQol Group 5D, Short Form-8, and Visual Analog Scale (VAS), were investigated at baseline and every month thereafter. Incremental cost-effectiveness ratios (ICERs) of the drug cost to quality-adjusted life years (QALYs) were calculated. A stratified analysis of patient characteristics was also performed to identify baseline factors potentially affecting cost-effectiveness. Results: The ICER of entire drug treatment for cervicobrachial symptoms was 7,491,640 yen. Compared with the reference willingness-to-pay, the ICER was assumed to not be cost-effective. A certain number of QALYs were gained during the first 3 months after the treatment intervention, but almost no QALYs were gained during the following 3 months. Stratified analysis showed that cost-effectiveness was extremely low for patients with high baseline VAS and high QOL. Conclusions: The available medications for cervicobrachial symptoms did not have excellent cost-effectiveness. Although a certain number of QALYs were gained during the first 3 months after medication, no QALYs were gained in the latter half of the study period, suggesting that it is not advisable to continue the medication needlessly. Level of evidence: II, prospective cohort study.

DOI： 10.1016/j.jos.2023.12.004

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

Segi, N; Nakashima, H; Ito, S; Ouchida, J; Oishi, R; Yamauchi, I; Miyairi, Y; Morita, Y; Matsumoto, T; Kanbara, S; Ito, K; Imagama, S

GLOBAL SPINE JOURNAL Vol. 15 ( 1 ) page： 66 - 75 2025.1

Language：English Publisher：Global Spine Journal

Study Design: Retrospective cohort study. Objectives: Imaging changes in the vertebral body after posterior lumbar interbody fusion (PLIF) are determined to be trabecular bone remodeling (TBR). This study aimed to investigate the influence of cage materials on TBR and segment stabilization in PLIF by studying image changes. Methods: This was a retrospective study reviewing 101 cases who underwent one-level PLIF with three-dimensional porous titanium (3DTi) cages (53 patients) or polyether-ether-ketone (PEEK) cages (48 patients). Computed tomography images obtained 3 months, 1 year, and 2 years postoperatively were examined for TBR, vertebral endplate cyst formation as an instability sign, cage subsidence, and clear zone around pedicle screw (CZPS). Results: No significant differences in the TBR-positivity rates were observed between the two cages at 3 months, 1 year, and 2 years postoperatively. However, all 3DTi cage segments that were TBR-positive at 3 months postoperatively showed no CZPS and fewer final instability segments than the TBR-negative segments (0% vs 9%). In contrast, although the PEEK cage segments that were TBR-positive at 3 months postoperatively were not associated with future segmental stabilization, those that were TBR-positive at 1 year postoperatively had fewer final instability segments than the TBR-negative segments (0% vs 33%). Conclusions: The 3DTi cage segments with TBR 3 months postoperatively showed significant final segmental stabilization, whereas TBR at 1 year rather than 3 months postoperatively was useful in determining final segmental stabilization for the PEEK cage segments. The timing of TBR, a new osseointegration assessment, were associated with the cage material.

DOI： 10.1177/21925682241255686

Characteristics of Poor Recordability of Intraoperative Neurophysiological Monitoring during Metastatic Spinal Tumor Surgery: A Multicenter Study Reviewed Open Access

Segi Naoki, Nakashima Hiroaki, Funaba Masahiro, Hashimoto Jun, Kawabata Shigenori, Takahashi Masahito, Yoshida Go, Ushirozako Hiroki, Kurosu Kenta, Shigematsu Hideki, Takatani Tsunenori, Morito Shinji, Yamada Kei, Iwasaki Hiroshi, Fujiwara Yasushi, Yasuda Akimasa, Ando Muneharu, Taniguchi Shinichirou, Wada Kanichiro, Tadokoro Nobuaki, Kobayashi Kazuyoshi, Yamamoto Naoya, Nakanishi Kazuyoshi, Kanchiku Tsukasa, Takeshita Katsushi, Matsuyama Yukihiro, Imagama Shiro

Spine Surgery and Related Research Vol. 9 ( 2 ) page： 164 - 172 2025

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

<p>Introduction: The objective of this study is to investigate the poor recordability characteristics of intraoperative neurophysiological monitoring (IONM) for metastatic spinal tumors, focusing on tumor status or preoperative muscle weakness.</p><p>Methods: A total of 132 patients (age 65.3±11.8 years; 82 men) with or without preoperative lower extremity muscle weakness were included in this study. The patients' background characteristics, the presence and degree of pre- and postoperative muscle weakness, and the IONM outcome, including the availability of transcranial motor evoked potential (Tc-MEP) recording and the occurrence of Tc-MEP alarms, were investigated. The data between the groups with and without preoperative muscle weakness were compared. Logistic regression analysis was performed to identify the risk factors for unrecordable Tc-MEP.</p><p>Results: Sixty-seven patients with muscle weakness had significantly more unrecordable Tc-MEP (19% vs. 5%, p=0.009) than the 65 patients without muscle weakness. The highest percentage of recordable Tc-MEP in the group with muscle weakness was noted in the plantar muscle (72%). Multivariate analysis identified manual muscle test (MMT) score of ≤3 (odds ratio [OR] 4.529) and ventral spinal cord compression by metastatic tumor (OR 3.924) as independent significant factors for unrecordable Tc-MEP.</p><p>Conclusions: IONM for metastatic spinal cord tumors with muscle weakness had a high rate of unrecordable Tc-MEP. Additionally, Tc-MEP may not be detectable in cases of ventral spinal cord compression by a tumor; therefore, preoperative imaging should be thoroughly evaluated.</p>

DOI： 10.22603/ssrr.2024-0260

Does Somatosensory-Evoked Potential Simultaneously Decrease with Transcranial Motor-Evoked Potential Alarm? A Multicenter Study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research Reviewed Open Access

Shigematsu Hideki, Yoshida Go, Ushirozako Hiroki, Kurosu Kenta, Tadokoro Nobuaki, Funaba Masahiro, Kawabata Shigenori, Hashimoto Jun, Ando Muneharu, Taniguchi Shinichirou, Takahashi Masahito, Segi Naoki, Nakashima Hiroaki, Imagama Shiro, Morito Shinji, Yamada Kei, Takatani Tsunenori, Kanchiku Tsukasa, Fujiwara Yasushi, Iwasaki Hiroshi, Wada Kanichiro, Yamamoto Naoya, Kobayashi Kazuyoshi, Yasuda Akimasa, Nakanishi Kazuyoshi, Tanaka Yasuhito, Matsuyama Yukihiro, Takeshita Katsushi

Spine Surgery and Related Research Vol. 9 ( 2 ) page： 173 - 178 2025

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

<p>Introduction: Multimodal intraoperative neurophysiological monitoring (IONM) -such as monitoring muscle-evoked potentials after transcranial electrical stimulation (Tc-MEP) with somatosensory-evoked potential (SEP) after electrical stimulation of the peripheral nerve-is recommended in spine surgeries to prevent iatrogenic neurological complications. However, the effect of using Tc-MEP with SEP to protect against neurological complications, particularly motor function, remains unknown. In clinical settings, changes due to Tc-MEP meeting the alarm points must be a potential neurological injury. This retrospective study, focusing on true-positive (TP) cases, aimed to clarify the change in the SEP waveform simultaneously with the Tc-MEP alarm.</p><p>Methods: We included 68 patients with TP who had Tc-MEP changes and new postoperative motor weakness at more than one level of the manual muscle test after surgery. We compared the cases based on the category of spine surgery and paralysis type. We evaluated sex, age at spine surgery (high- or non high-risk), and paralysis type (segmental, long tract, or both). We defined the alarm points as follows: >70% decrease in Tc-MEP wave amplitudes, >50% decrease in wave amplitudes, or 10% extension of SEP latency. Next, we evaluated the SEP wave changes with a Tc-MEP alarm.</p><p>Results: All patients showed progressive motor weakness after surgery, and 21 patients (31%) showed SEP changes at the same time as the Tc-MEP alarm. There were no statistically significant differences in the ratio of SEP change between the two groups according to the spine surgery category or among the three groups according to the paralysis type.</p><p>Conclusions: Multimodal IONM is an important tool. However, the SEP changes do not necessarily appear immediately after the Tc-MEP alarm. Spine surgeons should appropriately treat Tc-MEP alarms to preserve motor function, regardless of SEP changes.</p>

DOI： 10.22603/ssrr.2024-0229

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

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

Spine Surgery and Related Research Vol. 9 ( 3 ) page： 313 - 320 2025

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

<p>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.</p><p>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.</p><p>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.</p><p>Conclusions: Establishing key morphological thresholds enhances preoperative planning for CPS placement, improves accuracy and patient safety, and minimizes complications.</p>

DOI： 10.22603/ssrr.2024-0243

Impact of Nutritional Risk on Complications and Recovery in the Older People: A Geriatric Nutritional Risk Index-Based Study Reviewed Open Access

Ode Yukihito, Segi Naoki, Ito Sadayuki, Ouchida Jun, Yamauchi Ippei, Nagatani Yasuhiro, Okada Yuya, Takeichi Yosuke, Kagami Yujiro, Morishita Kazuaki, Oishi Ryotaro, Miyairi Yuichi, Morita Yoshinori, Tachi Hiroto, Ohshima Kazuma, Oyama Hiroki, Ogura Keisuke, Shinjo Ryuichi, Ohara Tetsuya, Tsuji Taichi, Kanemura Tokumi, Imagama Shiro, Nakashima Hiroaki

Spine Surgery and Related Research Vol. advpub ( 0 ) 2025

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

<p><b>Introduction: </b>The geriatric nutritional risk index (GNRI) has emerged as a useful predictor of surgical risk and postoperative outcomes. This study aimed to explore the utility of GNRI as a semiquantitative tool for predicting systemic and local complications after multilevel thoracolumbar fusion surgery in older patients and to evaluate the broader implications of nutritional status on postoperative recovery and independence.</p><p><b>Methods: </b>This multicenter study included 249 patients aged 65 years or older who underwent thoracolumbar fusion of at least four vertebrae. The nutrition-related risk grades were defined by the GNRI values, and the patients were divided into four groups: risk absent (GNRI > 98), low risk (GNRI 92 to ≤98), moderate risk (GNRI 82 to <92), and major risk (GNRI < 82). The occurrence of systemic complications, surgical site infection (SSI), length of stay in the hospital, place of discharge, and occurrence of proximal junctional kyphosis or failure (PJK/PJF) within 2 years after surgery were examined.</p><p><b>Results: </b>The risk-absent group consisted of 165 patients, the low-risk group of 40, the moderate-risk group of 36, and the major-risk group of eight. The incidence of any systemic complications (p = 0.016), PJK/PJF (p < 0.001), and hospital stay (p = 0.028) significantly increased with worsening GNRI. Furthermore, the number of patients who were discharged home significantly decreased as GNRI worsened (p < 0.001). SSI occurred most frequently in the risk-absent group (4.2%).</p><p><b>Conclusions: </b>The GNRI serves as a semiquantitative assessment tool that enables the identification of high-risk patients who may benefit from preoperative nutritional interventions.</p>

DOI： 10.22603/ssrr.2025-0016

Comparison of anterior spinal bridging and sagittal spinal parameters in Diffuse Idiopathic Skeletal Hyperostosis and Axial Spondylitis: A multicenter study

Takahashi Takuya, Mori Kanji, Kobayashi Shigeto, Inoue Hisashi, Tada Kurisu, Tamura Naoto, Hirai Takashi, Matsukura Yu, Egawa Satoru, Tamura Satoshi, Nagoshi Narihito, Maki Satoshi, Katsumi Keiichi, Koda Masao, Murata Kazuma, Takeuchi Kazuhiro, Nakashima Hiroaki, Imagama Shiro, Kawaguchi Yoshiharu, Yoshii Toshitaka

Spine Surgery and Related Research Vol. advpub ( 0 ) 2025

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

<p><b>Introduction: </b>To evaluate the differences in anterior spinal bridging and sagittal spinal parameters between patients with diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS) using whole-spine computed tomography (CT).</p><p><b>Methods:</b> This retrospective study included patients with DISH (n = 111) and AS (n = 27). The number of anterior spinal bridges and sagittal spinal parameters was evaluated. The sagittal vertical axis (SVA) evaluated by whole-spine CT was defined as sup-SVA. Patients were further evaluated by matching their age and sex.</p><p><b>Results: </b>Anterior spinal bridging frequently occurred in the thoracic spine in DISH and AS. In AS, bridging occurred in the lumbar spine according to the number of anterior spinal bridges. Sup-SVA and T5-T12 thoracic kyphosis (TK) were significantly greater in AS, and lumbar lordosis (LL) was significantly smaller in AS. TK was greater according to the number of anterior spinal bridges in both DISH and AS. Sup-SVA in DISH was greater according to the number of anterior spinal bridges, especially in the thoracic spine, whereas it was greater according to the lumbar in AS. LL in AS was smaller according to the number of lumbar bridges. Sup-SVA in DISH correlated with TK, whereas it correlated with both TK and LL in AS.</p><p><b>Conclusions:</b> In patients with AS, the spine tends to bridge from the lumbar to the thoracic spine, causing kyphosis in the thoracolumbar spine. In patients with DISH, the spine tends to bridge from the thoracic spine, causing kyphosis in the thoracic spine. Thus, sup-SVA is greater in AS than in DISH.</p>

DOI： 10.22603/ssrr.2024-0345

Characteristics and Clinical Outcomes of Transition from Conservative Therapy to Surgical Intervention in Older Patients with Cervical Spinal Cord Injury Without Major Bone Injury: A Nationwide Retrospective Study Reviewed

Yokogawa Noriaki, Sasagawa Takeshi, Hayashi Hiroyuki, Demura Satoru, Nakashima Hiroaki, Segi Naoki, Watanabe Kota, Nori Satoshi, Funayama Toru, Eto Fumihiko, Nakajima Hideaki, Furuya Takeo, Yunde Atsushi, Terashima Yoshinori, Hirota Ryosuke, Yamada Tomohiro, Hasegawa Tomohiko, Suzuki Hidenori, Imajo Yasuaki, Kawaguchi Kenichi, Haruta Yohei, Tonomura Hitoshi, Sakata Munehiro, Terai Hidetomi, Tamai Koji, Inoue Gen, Ikegami Shota, Akeda Koji, Nakanishi Kazuo, Uei Hiroshi, Funao Haruki, Oshima Yasushi, Yoshii Toshitaka, Hashimoto Ko, Iizuka Yoichi, Kiyasu Katsuhito, Ishihara Masayuki, Kaito Takashi, Okada Seiji, Imagama Shiro, Kato Satoshi

Spine Surgery and Related Research Vol. advpub ( 0 ) 2025

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

<p><b>Background: </b>Cervical spinal cord injury (CSCI) without major bone injury is increasing among older adults, particularly in aging societies like Japan. The optimal treatment strategies remain unclear, with conservative therapy often preferred, especially for older patients. However, surgery is frequently necessary due to poor improvement or progression of paralysis during conservative treatment. This study investigated the characteristics and outcomes of older patients with CSCI without major bone injury who transitioned from conservative treatment to surgery.</p><p><b>Methods: </b>This nationwide, retrospective study examined data from patients aged ≥65 years with CSCI without major bone injury. The patients were categorized into 3 groups: conservative treatment, planned surgery, and those who switched from conservative treatment to surgery. The study aimed to identify the risk factors for conservative therapy failure that necessitate surgical intervention and to compare the outcomes between patients who had planned surgery and those who required surgery after conservative management failed.</p><p><b>Results: </b>Among 615 patients, 422 (68.6%) received conservative treatment, 193 (31.4%) had planned surgery, and 116 (18.9%) transitioned from conservative to surgical treatment. Transition to surgery was mainly due to poor improvement or progression of neurological deficits. Significant risk factors for transitioning to surgery included younger age, presence of ossification of the posterior longitudinal ligament, and spinal cord signal changes on magnetic resonance imaging. Comparative analysis showed no significant differences in neurological outcomes between patients who had surgery as planned and those who required surgery after failed conservative treatment.</p><p><b>Conclusions: </b>A significant proportion of older patients with CSCI without major bone injury who were initially managed conservatively eventually required surgery due to insufficient neurological improvement. The outcomes of patients who transitioned to surgery were similar to those who had surgery as initially planned, indicating that careful monitoring of conservative treatment followed by surgery, if necessary, may be an effective approach.</p>

DOI： 10.22603/ssrr.2024-0291

Multimodal Deep Learning-based Radiomics Approach for Predicting Surgical Outcomes in Patients with Cervical Ossification of the Posterior Longitudinal Ligament Reviewed

Maki, S; Furuya, T; Katsumi, K; Nakajima, H; Honjoh, K; Watanabe, S; Kaito, T; Takenaka, S; Kanie, Y; Iwasaki, M; Furuya, M; Inoue, G; Miyagi, M; Ikeda, S; Imagama, S; Nakashima, H; Ito, S; Takahashi, H; Kawaguchi, Y; Futakawa, H; Murata, K; Yoshii, T; Hirai, T; Koda, M; Ohtori, S; Yamazaki, M

SPINE Vol. 49 ( 22 ) page： 1561 - 1569 2024.11

Language：English Publisher：Spine

Study Design. A retrospective analysis. Objective. This research sought to develop a predictive model for surgical outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL) using deep learning and machine learning (ML) techniques. Summary of Background Data. Determining surgical outcomes assists surgeons in communicating prognosis to patients and setting their expectations. Deep learning and ML are computational models that identify patterns from large data sets and make predictions. Methods. Of the 482 patients, 288 patients were included in the analysis. A minimal clinically important difference (MCID) was defined as gain in Japanese Orthopaedic Association (JOA) score of 2.5 points or more. The predictive model for MCID achievement at 1 year postsurgery was constructed using patient background, clinical symptoms, and preoperative imaging features (x-ray, CT, MRI) analyzed through LightGBM and deep learning with RadImagenet. Results. The median preoperative JOA score was 11.0 (IQR: 9.0-12.0), which significantly improved to 14.0 (IQR: 12.0-15.0) at 1 year after surgery (P < 0.001, Wilcoxon signed-rank test). The average improvement rate of the JOA score was 44.7%, and 60.1% of patients achieved the MCID. Our model exhibited an area under the receiver operating characteristic curve of 0.81 and the accuracy of 71.9% in predicting MCID at 1 year. Preoperative JOA score and certain preoperative imaging features were identified as the most significant factors in the predictive models. Conclusion. A predictive ML and deep learning model for surgical outcomes in OPLL patients is feasible, suggesting promising applications in spinal surgery.

DOI： 10.1097/BRS.0000000000005088

Prospective Registration Study for Establishing Minimal Clinically Important Differences in Patients Undergoing Surgery for Spinal Metastases Reviewed

Hirota, R; Oshigiri, T; Iesato, N; Emori, M; Teramoto, A; Shiratani, Y; Suzuki, A; Terai, H; Shimizu, T; Kakutani, K; Kanda, Y; Tominaga, H; Kawamura, I; Ishihara, M; Paku, M; Takahashi, Y; Funayama, T; Miura, K; Shirasawa, E; Inoue, H; Kimura, A; Iimura, T; Moridaira, H; Nakajima, H; Watanabe, S; Akeda, K; Takegami, N; Nakanishi, K; Sawada, H; Matsumoto, K; Funaba, M; Suzuki, H; Funao, H; Hirai, T; Otsuki, B; Kobayakawa, K; Uotani, K; Manabe, H; Tanishima, S; Hashimoto, K; Iwai, C; Yamabe, D; Hiyama, A; Seki, S; Goto, Y; Miyazaki, M; Watanabe, K; Nakamae, T; Kaito, T; Nakashima, H; Nagoshi, N; Kato, S; Imagama, S; Watanabe, K; Inoue, G; Furuya, T

SPINE Vol. 49 ( 22 ) page： 1539 - 1547 2024.11

Language：English Publisher：Spine

Study Design. Multicenter, prospective registry study. Objective. To clarify minimal clinically important differences (MCIDs) for surgical interventions for spinal metastases, thereby enhancing patient care by integrating quality of life assessments with clinical outcomes. Background. Despite its proven usefulness in degenerative spinal diseases and deformities, the MCID remains unexplored regarding surgery for spinal metastases. Patients and Methods. This study included 171 (out of 413) patients from the multicenter "Prospective Registration Study on Surgery for Metastatic Spinal Tumors"by the Japan Association of Spine Surgeons. These were evaluated preoperatively and at 6 months postoperatively using the Face Scale, EuroQol-5 Dimensions-5 Levels (EQ-5D-5L), including the Visual Analog Scale, and performance status. The MCIDs were calculated using an anchor-based method, classifying participants into the improved, unchanged, and deteriorated groups based on the Face Scale scores. Focusing on the improved and unchanged groups, the change in the EQ-5D-5L values from before to after treatment was analyzed, and the cutoff value with the highest sensitivity and specificity was determined as the MCID through receiver operating characteristic curve analysis. The validity of the MCIDs was evaluated using a distribution-based calculation method for patient-reported outcomes. Results. The improved, unchanged, and deteriorated groups comprised 121, 28, and 22 participants, respectively. The anchor-based MCIDs for the EQ-5D-5L index, EQ-Visual Analog Scale, and domains of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression were 0.21, 15.50, 1.50, 0.50, 0.50, 0.50, and 0.50, respectively; the corresponding distribution-based MCIDs were 0.17, 15,99, 0.77, 0.80, 0.78, 0.60, and 0.70, respectively. Conclusion. We identified MCIDs for surgical treatment of spinal metastases, providing benchmarks for future clinical research. By retrospectively examining whether the MCIDs are achieved, factors favoring their achievement and risks affecting them can be explored. This could aid in decisions on surgical candidacy and patient counseling.

DOI： 10.1097/BRS.0000000000005062

特集放射線科と人工知能　脊椎・脊髄疾患の画像診断におけるAI利用の現状 Reviewed

伊藤定之, 中島宏彰, 世木直喜, 大内田隼, 小田昌宏, 山内一平, 大出幸史, 長谷康弘, 岡田裕也, 鏡味佑志朗, 森健策, 今釜史郎

臨床放射線 Vol. 69 ( 6 ) page： 787 - 792 2024.11

Safety and feasibility of intravenous administration of a single dose of allogenic-Muse cells to treat human cervical traumatic spinal cord injury: a clinical trial (vol 15, 259, 2024) Reviewed Open Access

Koda, M; Imagama, S; Nakashima, H; Ito, S; Segi, N; Ouchida, J; Suda, K; Matsumoto, SH; Komatsu, M; Endo, T; Suzuki, S; Inami, S; Ueda, H; Miyagi, M; Inoue, G; Takaso, M; Nagata, K; Yamada, H; Kamei, N; Nakamae, T; Suzuki, H; Nishida, N; Funaba, M; Kumagai, G; Furuya, T; Yamato, Y; Funayama, T; Takahashi, H; Yamazaki, M

STEM CELL RESEARCH & THERAPY Vol. 15 ( 1 ) page： 402 2024.11

Language：English Publisher：Stem Cell Research and Therapy

The original article contains two errors which the authors wish to address: On line 3 of page 3, the sentence should simply read, ‘B1 and B2, which indicates complete […]’, and the word ‘(Ref)’ should be disregarded. In Fig. 2C, the Y-axis label should instead read as ‘Change in total motor score’, and the word ‘lower’ should be disregarded’.

DOI： 10.1186/s13287-024-04044-0

Circulating miRNA-122 is associated with knee osteoarthritis progression: A 6-year longitudinal cohort study in the Yakumo study Reviewed

Funahashi, H; Takegami, Y; Osawa, Y; Nakashima, H; Ishizuka, S; Fujii, R; Yamada, H; Suzuki, K; Hasegawa, Y; Imagama, S

JOURNAL OF ORTHOPAEDIC SCIENCE Vol. 29 ( 6 ) page： 1411 - 1416 2024.11

Language：English Publisher：Journal of Orthopaedic Science

Objective: The association between knee osteoarthritis (OA) and miRNAs has been widely reported. However, the utility of miRNAs as predictors of knee osteoarthritis (KOA) progression in longitudinal studies has not been reported. We aimed to identify circulating miRNAs (c-miRNAs) associated with KOA progression in the general population and to examine their potential use as predictors of KOA progression. Methods: In 2012 and 2018, 66 participants (128 knees) took part in a resident health check-up in the Yakumo study. If the KL classification progressed two or more levels, the patient was classified as having progressive OA. Quantitative real-time polymerase chain reaction was used to screen 21 c-miRNAs. The expression levels of those c-miRNAs were compared between the progressive OA group and non-progressive OA group using student-t-test. Logistic analysis was performed in c-miRNAs less than p < 0.10 in univariate analysis. Results: The progressive OA group consisted of 78 knees. The results of the comparison between the progressive OA group and the non-progressive OA group showed that six c-miRNAs as follows; let7d (p = 0.030), c-miRNA-122 (p < 0.001), 150 (p = 0.070), 199 (p = 0.078), 21 (p = 0.016) and 320 (p = 0.093) were extracted as factors related to the progression of knee OA. In addition, logistic regression analysis identified c-miRNA-122 as an independent factor involved in the progression of knee osteoarthritis (odds ratio: 1.510, 95% confidence interval: 1.060–2.140, p = 0.023). The ROC curve showed by c-miRNA-122 for the progression of OA risk had an area under the curve of 0.702 (95% CI: 0.609–0.795). The threshold of c-miRNA-122 was −4.609. Conclusion: The expression level of c-miRNA-122 was associated with the risk of KOA progression in community dwelling Japanese people.

DOI： 10.1016/j.jos.2023.10.004

Prevalence and treatment rates of osteoporosis among individuals with rotator cuff tears Reviewed

Kawashima, I; Ishizuka, S; Oba, H; Sakaguchi, T; Nakashima, H; Takegami, Y; Imagama, S

JOURNAL OF SHOULDER AND ELBOW SURGERY Vol. 33 ( 11 ) page： e606 - e609 2024.11

Language：English Publisher：Journal of Shoulder and Elbow Surgery

Background: The relationship between osteoporosis and rotator cuff tears has been reported previously. However, the treatment rate of osteoporosis in individuals with rotator cuff tear is still unknown. The aim of this study was to investigate the prevalence and treatment rate of osteoporosis in individuals with rotator cuff tears. Methods: In this cross-sectional study, we enrolled 207 participants. Participants underwent comprehensive assessments, including shoulder ultrasonographic examinations and quantitative ultrasound measurements for bone status evaluation. Osteoporosis diagnosis was predicated on a calcaneus ultrasound bone densitometry, and the cutoff value was set as a T score of −1.455, with reference to a previous report. Results: One hundred fifty-six participants were classified as individuals without rotator cuff tears (group A), and 51 participants were classified as those with (group B). The mean age in group A was significantly lower than that in group B (63 ± 10 vs. 68 ± 9, respectively; P = .003). In terms of the T score examined by quantitative ultrasound, the mean T score in group A was significantly higher than that in group B (−1.4 ± 1.3 vs. −1.9 ± 1.6, respectively; P = .0412). The percentage of subjects with a T score of −1.455 or less in group B was 60.8% (31/51). The proportion of subjects with a T score of −1.455 or less undergoing osteoporosis treatment was 14.5% (12/83) in group A and 12.9% (4/27) in group B, showing no significant difference. Conclusions: Participants with a rotator cuff tear had relatively high prevalence of osteoporosis. Among those with both a rotator cuff tear and osteoporosis, the proportion receiving osteoporosis treatment was l2.9%, a very low rate.

DOI： 10.1016/j.jse.2024.02.026

The prevalence and characteristics of diffuse idiopathic skeletal hyperostosis in the community-living middle-aged and elderly population: The Yakumo study Reviewed

Ohshima, K; Nakashima, H; Segi, N; Ito, S; Ouchida, J; Takegami, Y; Ishizuka, S; Hasegawa, Y; Imagama, S

JOURNAL OF ORTHOPAEDIC SCIENCE Vol. 29 ( 6 ) page： 1346 - 1352 2024.11

Language：English Publisher：Journal of Orthopaedic Science

Background: The incidence of diffuse idiopathic skeletal hyperostosis (DISH) is increasing with the aging of the population. Asymptomatic DISH can decrease the spinal range of motion (ROM) and cause fractures. However, the prevalence or physical function of patients with DISH before experiencing fractures and other serious conditions is unclear. This study aimed to investigate the prevalence of DISH in the community residents on the basis of age and sex and characterize their physical function, ROM, and bone fragility. Methods: The subjects were community volunteers who attended a health checkup in 2018 and 2019. Overall, 455 subjects (mean age, 64.2 ± 9.7 years; 177 men) were included for analysis. We performed whole-spine lateral radiography for detecting DISH according to the criteria reported by Resnick. We compared the age, sex, body mass index (BMI), results of muscle strength and walking tests, ROM measured by SpinalMouse®, and quantitative ultrasound (QUS) of calcaneus with and without DISH. Results: DISH was detected in 83 (18.2%) cases. The DISH group was older (69.8 y.o. vs. 63.0 y.o.; p < 0.05) and comprised more men (prevalence: men, 27.7%; women, 12.2%; p < 0.001). BMI was high in the DISH group (24.8 vs. 23.3 kg/m<sup>2</sup>, p < 0.05). SpinalMouse measurements showed the DISH group had a significantly decreased ROM in the lumbar spine (43.2°, 57.2°, p < 0.05). The DISH group had a significantly lower T-score on the QUS measurement in the calcaneus (−2.0, −1.5, p < 0.05). There were, however, no significant differences between groups in both muscle strength test and walking test. Conclusion: Subjects with DISH had decreased ROM in the lumbar spine and bone mineral density in calcaneal QUS. However, physical functions such as muscle strength and walking ability were similar among subjects with and without DISH without subjective symptoms.

DOI： 10.1016/j.jos.2023.10.005

A class of chemical compounds enhances clustering of muscle nicotinic acetylcholine receptor in cultured myogenic cells Reviewed Open Access

Miyairi, Y; Ohkawara, B; Sato, A; Sawada, R; Ishii, H; Tomita, H; Inoue, T; Nakashima, H; Ito, M; Masuda, A; Hosono, Y; Imagama, S; Ohno, K

BIOCHEMICAL AND BIOPHYSICAL RESEARCH COMMUNICATIONS Vol. 731 page： 150400 2024.10

Language：English Publisher：Biochemical and Biophysical Research Communications

Neuromuscular signal transmission is affected in various diseases including myasthenia gravis, congenital myasthenic syndromes, and sarcopenia. We used an ATF2-luciferase system to monitor the phosphorylation of MuSK in HEK293 cells introduced with MUSK and LRP4 cDNAs to find novel chemical compounds that enhanced agrin-mediated acetylcholine receptor (AChR) clustering. Four compounds with similar chemical structures carrying benzene rings and heterocyclic rings increased the luciferase activities 8- to 30-folds, and two of them showed continuously graded dose dependence. The effects were higher than that of disulfiram, a clinically available aldehyde dehydrogenase inhibitor, which we identified to be the most competent preapproved drug to enhance ATF2-luciferase activity in the same assay system. In C2C12 myotubes, all the compounds increased the area, intensity, length, and number of AChR clusters. Three of the four compounds increased the phosphorylation of MuSK, but not of Dok7, JNK. ERK, or p38. Monitoring cell toxicity using the neurite elongation of NSC34 neuronal cells as a surrogate marker showed that all the compounds had no effects on the neurite elongation up to 1 μM. Extensive docking simulation and binding structure prediction of the four compounds with all available human proteins using AutoDock Vina and DiffDock showed that the four compounds were unlikely to directly bind to MuSK or Dok7, and the exact target remained unknown. The identified compounds are expected to serve as a seed to develop a novel therapeutic agent to treat defective NMJ signal transmission.

DOI： 10.1016/j.bbrc.2024.150400

Does global spinal alignment affect the use of walking aids after multi-segment spinal fixation for patients with ASD? A multicenter retrospective study Reviewed Open Access

Ouchida, J; Nakashima, H; Ito, S; Segi, N; Yamauchi, I; Oishi, R; Miyairi, Y; Morita, Y; Ode, Y; Nagatani, Y; Okada, Y; Tsushima, M; Machino, M; Ota, K; Tachi, H; Kagami, Y; Shinjo, R; Ohara, T; Tsuji, T; Kanemura, T; Imagama, S

EUROPEAN SPINE JOURNAL Vol. 33 ( 10 ) page： 3833 - 3841 2024.10

Language：English Publisher：European Spine Journal

Purpose: This study aimed to clarify the relation between global spinal alignment and the necessity of walking aid use in patients with adult spinal deformity (ASD) and to investigate the impact of spinal fixation on mobility status after surgery. Methods: In total, 456 older patients with ASD who had multi-segment spinal fixation surgery and were registered in a multi-center database were investigated. Patients under 60 years of age and those unable to walk preoperatively were excluded. Patients were classified by their mobility status into the independent, cane, and walker groups. Comparison analysis was conducted using radiographic spinopelvic parameters and the previously reported global spine balance (GSB) classification. In addition, preoperative and 2 years postoperative mobility statuses were investigated. Results: Of 261 patients analyzed, 66 used walking aids (canes, 46; walkers, 20). Analysis of preoperative radiographical parameters showed increased pelvic incidence and pelvic incidence-lumbar lordosis mismatch in the walker group and increased sagittal vertebral axis in the cane and walker groups versus the independent group. Analysis of GSB classification showed a higher percentage of walker use in those with severe imbalance (grade 3) in the sagittal classification but not in the coronal classification. While postoperative radiographical improvements were noted, there was no significant difference in the use of walking aids before and 2 years after surgery (P = 0.085). Conclusion: A significant correlation was found between “sagittal” spinal imbalance and increased reliance on walking aids, particularly walkers. However, the limitation of improvement in postoperative mobility status suggested that multiple factors influence the mobility ability of elderly patients with ASD.

DOI： 10.1007/s00586-024-08380-w

Longitudinal impact of multi-segment spinal fixation surgery on mobility status and clinical outcomes in adult spinal deformity: a multicenter retrospective study Reviewed Open Access

Ouchida, J; Nakashima, H; Ito, S; Segi, N; Yamauchi, I; Oishi, R; Miyairi, Y; Morita, Y; Ode, Y; Nagatani, Y; Okada, Y; Tsushima, M; Kanemura, T; Machino, M; Ohara, T; Ota, K; Tachi, H; Tsuji, T; Kagami, Y; Shinjo, R; Imagama, S

EUROPEAN SPINE JOURNAL Vol. 33 ( 10 ) page： 3894 - 3903 2024.10

Language：English Publisher：European Spine Journal

Purpose: To investigate changes in postoperative mobility status in patients with ASD, and the determining factors that influence these changes and their impact on clinical outcomes, including the rate of home discharge and long-term mobility. Methods: A total of 299 patients with ASD who underwent multi-segment posterior spinal fusion were registered in a multi-center database were investigated. Patient mobility status was assessed using walking aids and classified into five levels (1: independent, 2: cane, 3: walker, 4: assisted, and 5: wheelchair) preoperatively, at discharge, and after 2 years. We determined improvements or declines in the patient's mobility based on changes in the classification levels. The analysis focused on the factors contributing to the deterioration of postoperative mobility. Results: Two years postoperatively, 87% of patients maintained or improved mobility. However, 27% showed decreased mobility status at discharge, associated with a lower rate of home discharge (49% vs. 80% in the maintained mobility group) and limited improvement in mobility status (35% vs. 5%) after 2 years. Notably, postoperative increases in thoracic kyphosis (7.0 ± 12.1 vs. 2.0 ± 12.4°, p = 0.002) and lower lumbar lordosis (4.2 ± 13.1 vs. 1.8 ± 12.6°, p = 0.050) were substantial factors in mobility decline. Conclusion: Postoperative mobility often temporarily decreases but generally improves after 2 years. However, an overcorrection in sagittal alignment, evidenced by increased TK, could detrimentally affect patients’ mobility status. Transient mobility decline associated with overcorrection may require further rehabilitation or hospitalization. Further studies are required to determine the biomechanical effects of surgical correction on mobility.

DOI： 10.1007/s00586-024-08397-1

Peri-implant fractures after Intramedullary fixation for femoral trochanteric fracture: a multicenter (TRON Group) study Reviewed

Kaneda, T; Takegami, Y; Tokutake, K; Nakashima, H; Mishima, K; Mabuchi, M; Imagama, S

EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY Vol. 50 ( 5 ) page： 2587 - 2594 2024.10

Language：English Publisher：European Journal of Trauma and Emergency Surgery

Background: With the rise in elderly populations, the incidence of femoral trochanteric fractures has also increased. Although intramedullary nail therapy is commonly used, the incidence of peri-implant fractures (PIFs) as a complication and its associated factors are not fully understood. The purpose of this study was to determine the incidence of PIFs and treatment strategies and outcomes. Methods: A retrospective study across 11 hospitals from 2016 to 2020 examined 1855 patients with femoral trochanter fracture. After excluding 69 patients treated without intramedullary nailing, 1786 patients were analyzed. Parameters studied included age, sex, body mass index, medical history, and treatment methods. PIFs were categorized using the Chan classification. Treatment outcomes and patient mobility were assessed using the Parker Mobility Score, and postoperative complications and one-year survival data were compiled. Results: The incidence of PIFs was 8 in 1786 cases. Chan classification showed 1 case of N1A, 6 of N2A, and 1 of N2B. Only the type N1 case was a transverse fracture, whereas all cases of type N2 were oblique fractures. Among these cases, five patients had fractures extending to the upper part of the femoral condyle. The patient with N1A and one bedridden patient with N2A fracture underwent conservative treatment, one patient with N2A in which the fracture did not extend to the condyle was treated with nail replacement, and 5 patients (N2A: 4, N2B: 1) with fractures extending to the condyle were treated with additional plate fixation. All patients had survived at one year after treatment for PIF, and no reoperations were required. Conclusions: The incidence of PIF was very low (0.45%). Of the 6 PIF cases, excluding the bedridden patients, the treatment of choice for PIF was an additional plate if the fracture line extended to the femoral condyle; otherwise, the nail was replaced. All patients achieved bony fusion. Level of evidence: Therapeutic Level IV.

DOI： 10.1007/s00068-024-02567-y

Ten-Year Follow-up of Posterior Decompression and Fusion Surgery for Thoracic Ossification of the Posterior Longitudinal Ligament Reviewed Open Access

Ito, S; Nakashima, H; Segi, N; Ouchida, J; Oishi, R; Yamauchi, I; Miyairi, Y; Morita, Y; Ode, Y; Imagama, S

JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME Vol. 106 ( 17 ) page： 1600 - 1609 2024.9

Language：English Publisher：Journal of Bone and Joint Surgery

Background: We evaluated the clinical, functional, and quality of life (QoL) outcomes of surgical treatment of thoracic ossification of the posterior longitudinal ligament (T-OPLL). Methods: We retrospectively evaluated 51 patients followed for ‡10 years after posterior decompression and corrective fusion surgery for T-OPLL. The data collected included demographics, comorbidities, and pre- and postoperative symptoms. The Japanese Orthopaedic Association (JOA) score, numerical rating scale (NRS) for back and leg pain, and EuroQol-5 Dimension-5 Level (EQ-5D-5L) were used to assess neurological function, pain, and QoL. Imaging evaluations were conducted to assess changes in kyphotic angles and ossification progression. Results: A significant improvement was observed in the JOA score from preoperatively (3.7) to 2 years postoperatively (7.9) (p < 0.05); the score remained stable thereafter. The mean EQ-5D-5L score improved from 0.53 preoperatively to 0.68 at 10 years postoperatively (p < 0.001). NRS scores for back and leg pain decreased from 5.4 to 3.5 and 4.0 to 3.0, respectively, from preoperatively to 10 years (p < 0.001 for both). Radiographic outcomes showed changes in kyphotic angles and ossification areas, with no significant progression after 2 years. Fourteen (27.5%) of the patients experienced postoperative complications. Of these, 8 (15.7%) required reoperation, 6 (11.8%) in the perioperative period and 2 (3.9%) later. Four (7.8%) of the patients underwent additional surgeries for conditions including lumbar spinal canal stenosis and cervical OPLL. Nonetheless, physical function in all cases with postoperative complications or additional surgery remained stable over the decade. Conclusions: Surgical treatment of T-OPLL is effective in improving neurological function, QoL, and pain management over an extended period. The long-term outcomes of T-OPLL surgery revealed that, although cervical and lumbar spinal lesions led to reoperations, they did not affect QoL, and relative improvement was maintained even after 10 years. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

DOI： 10.2106/JBJS.23.01475

Trabecular Bone Remodeling After Posterior Lumbar Interbody Fusion: Comparison of Three-Dimensional Porous Tantalum and Titanium-Coated Polyetheretherketone Interbody Cages Reviewed Open Access

Segi, N; Nakashima, H; Shinjo, R; Kagami, Y; Machino, M; Ito, S; Ouchida, J; Morishita, K; Oishi, R; Yamauchi, I; Imagama, S

GLOBAL SPINE JOURNAL Vol. 14 ( 7 ) page： 2106 - 2115 2024.9

Language：English Publisher：Global Spine Journal

Study Design: Retrospective cohort study Objectives: The criteria for determining completion of intervertebral stability after posterior lumbar interbody fusion (PLIF) remain controversial. Several new radiological indicators of bone growth and osteointegration have been established. We compared computed tomography (CT) findings related to osteointegration after PLIF with interbody cages of two different materials and designs. Methods: We retrospectively analyzed data from 103 patients who underwent PLIF with three-dimensional porous tantalum (Tn) cages or titanium-coated polyetheretherketone (TiP) cages. CT images obtained 3 months and 1 year after surgery were examined for trabecular bone remodeling (TBR), cancellous condensation (CC), and vertebral endplate cyst (VEC) formation. The incidences of each finding were compared by cage type, and rates of instrument failure and pseudarthrosis were determined. Results: Three months postoperatively, 87% of the levels with Tn cages exhibited TBR, whereas 96% of those with TiP cages did not (P <.001). Most levels with Tn cages levels exhibited TBR and no CC 3 months (81%) and 1 year (94%) after surgery. Although 78% of levels with TiP cages exhibited CC and no TBR 3 months after surgery, 59% exhibited both CC and TBR 1 year after surgery. Significantly fewer VECs formed around the Tn cages than around the TiP cages both 3 months (P =.002) and 1 year (P <.001) after surgery. Implant-related problems occurred at levels that exhibited neither TBR nor CC. Conclusions: The porous tantalum cage may enable intervertebral stability that is comparable to bony fusion soon after surgery.

DOI： 10.1177/21925682231170613

Safety and feasibility of intravenous administration of a single dose of allogenic-Muse cells to treat human cervical traumatic spinal cord injury: a clinical trial Reviewed Open Access

Koda, M; Imagama, S; Nakashima, H; Ito, S; Segi, N; Ouchida, J; Suda, K; Matsumoto, SH; Komatsu, M; Endo, T; Suzuki, S; Inami, S; Ueda, H; Miyagi, M; Inoue, G; Takaso, M; Nagata, K; Yamada, H; Kamei, N; Nakamae, T; Suzuki, H; Nishida, N; Funaba, M; Kumagai, G; Furuya, T; Yamato, Y; Funayama, T; Takahashi, H; Yamazaki, M

STEM CELL RESEARCH & THERAPY Vol. 15 ( 1 ) page： 259 2024.8

Language：English Publisher：Stem Cell Research and Therapy

Introduction: Spinal cord injury (SCI) is a devastating injury and remains one of the largest medical and social burdens because of its intractable nature. According to the recent advances in stem cell biology, the possibility of spinal cord regeneration and functional restoration has been suggested by introducing appropriate stem cells. Multilineage-differentiating stress enduring (Muse) cells are a type of nontumorigenic endogenous reparative stem cell. The positive results of Muse cell transplantation for SCI was shown previously. As a first step for clinical application in human SCI, we conducted a clinical trial aiming to confirm the safety and feasibility of intravenously injected donor-Muse cells. Methods: The study design of the current trial was a prospective, multicenter, nonrandomized, nonblinded, single-arm study. The clinical trial registration number was JRCT1080224764. Patients with a cervical SCI with a neurological level of injury C4 to C7 with the severity of modified Frankel classification B1 and B2 were included. A primary endpoint was set for safety and feasibility. Our protocol was approved by the PMDA, and the trial was funded by the Life Science Institute, Tokyo, Japan. The present clinical trial recruited 10 participants (8 males and 2 females) with an average age of 49.3 ± 21.2 years old. All 10 participants received a single dose of allogenic CL2020 (a total of 15 × 10<sup>6</sup> cells, 2.1–2.7 × 10<sup>5</sup> cells/kg of body weight), which is a Muse cell-based product produced from human mesenchymal stem cells, by an intravenous drip. Results: There were two reported severe adverse events, both of which were determined to have no causal relationship with Muse cell treatment. The change in the ISNCSCI motor score, the activity of daily living and quality of life scores showed statistically significant improvements compared to those data at the time of CL2020 administration. Conclusion: In the present trial, no safety concerns were identified, and Muse cell product transplantation demonstrated good tolerability. Future clinical trials with appropriate study designs incorporating a control arm will clarify the definitive efficacy of single-dose allogenic Muse cell treatment with intravenous administration to treat SCI. Trial registration: jRCT, JRCT1080224764. Registered 03 July 2019, https://jrct.niph.go.jp/latest-detail/jRCT1080224764.

DOI： 10.1186/s13287-024-03842-w

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

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

SCIENTIFIC REPORTS Vol. 14 ( 1 ) page： 18031 2024.8

Language：English Publisher：Scientific Reports

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

DOI： 10.1038/s41598-024-69127-7

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

中島宏彰, 今釜史郎

整形外科 Vol. 75 ( 9 ) page： 937 - 945 2024.8

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

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

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 86 ( 3 ) page： 487 - 496 2024.8

Language：English Publisher：Nagoya Journal of Medical Science

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

DOI： 10.18999/nagjms.86.3.487

Analysis of spinopelvic parameters in adult patients with lumbosacral transitional vertebrae Reviewed Open Access

Ouchida, J; Nakashima, H; Kanemura, T; Tsushima, M; Ito, S; Segi, N; Tomita, H; Morishita, K; Oyama, H; Oshima, K; Imagama, S

EUROPEAN SPINE JOURNAL Vol. 33 ( 8 ) page： 2952 - 2959 2024.8

Language：English Publisher：European Spine Journal

Purpose: Spinopelvic sagittal alignment is crucial for assessing balance and determining treatment efficacy in patients with adult spinal deformity (ASD). Only a limited number of reports have addressed spinopelvic parameters and lumbosacral transitional vertebrae (LSTV). Our primary objective was to study spinopelvic sagittal parameter changes in patients with LSTV. A secondary objective was to investigate clinical symptoms and quality of life (QOL) in patients with LSTV. Methods: In this study, we investigated 371 participants who had undergone medical check-ups for the spine. LSTV was evaluated using Castellvi’s classification, and patients were divided into LSTV+ (type II-IV, L5 vertebra articulated or fused with the sacrum) and LSTV- groups. After propensity score matching for demographic data, we analyzed spinopelvic parameters, sacroiliac joint degeneration, clinical symptoms, and QOL for these two participant groups. Oswestry Disability Index (ODI) scores and EQ-5D (EuroQol 5 dimensions) indices were compared between the two groups. Results: Forty-four patients each were analyzed in the LSTV + and LSTV- groups. The LSTV + group had significantly greater pelvic incidence (52.1 ± 11.2 vs. 47.8 ± 10.0 degrees, P = 0.031) and shorter pelvic thickness (10.2 ± 0.9 vs. 10.7 ± 0.8 cm, P = 0.018) compared to the LSTV- group. The “Sitting” domain of ODI (1.1 ± 0.9 vs. 0.6 ± 0.7, P = 0.011) and “Pain/Discomfort” domain of EQ-5D (2.0 ± 0.8 vs. 1.6 ± 0.7, P = 0.005) were larger in the LSTV + group. Conclusion: There was a robust association between LSTV and pelvic sagittal parameters. Clinical symptoms also differed between the two groups in some domains. Surgeons should be aware of the relationship between LSTV assessment, radiographic parameters and clinical symptoms. Level of evidence: 3.

DOI： 10.1007/s00586-024-08378-4

Adenosine triphosphate release inhibitors targeting pannexin1 improve recovery after spinal cord injury Reviewed Open Access

Morishita, K; Nakashima, H; Machino, M; Ito, S; Segi, N; Miyairi, Y; Morita, Y; Imagama, S

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 86 ( 3 ) page： 392 - 406 2024.8

Language：English Publisher：Nagoya Journal of Medical Science

Traumatic spinal cord injury is characterized by immediate and irreversible tissue loss at the lesion site and secondary tissue damage. Secondary injuries should, in principle, be preventable, although no effective treatment options currently exist for patients with acute spinal cord injury. Traumatized tissues release excessive amounts of adenosine triphosphate and activate the P2X purinoceptor 7/pannexin1 complex, which is associated with secondary injury. We investigated the neuroprotective effects of the blue dye Brilliant Blue FCF, a selective inhibitor of P2X purinoceptor 7/pannexin1 that is approved for use as a food coloring, by comparing it with Brilliant Blue G, a P2X7 purinoceptor antagonist, and carbenoxolone, which attenuates P2X purinoceptor 7/pannexin1 function, in a rat spinal cord injury model. Brilliant Blue FCF administered early after spinal cord injury reduced spinal cord anatomical damage and improved motor recovery without apparent toxicity. Brilliant Blue G had the highest effect on this neurological recovery, with Brilliant Blue FCF and carbenoxolone having comparable improvement. Furthermore, Brilliant Blue FCF administration reduced local astrocytic and microglial activation and neutrophil infiltration, and no differences in these histological effects were observed between compounds. Thus, Brilliant Blue FCF protects spinal cord neurons after spinal cord injury and suppresses local inflammatory responses as well as Brilliant Blue G and carbenoxolone.

DOI： 10.18999/nagjms.86.3.392

特集胸椎後縦靭帯骨化症-手術治療の進歩胸椎後縦靭帯骨化症における術後遺残疼痛

中島宏彰, 伊藤定之, 世木直喜, 大内田隼, 今釜史郎

脊椎脊髄ジャーナル Vol. 37 ( 6 ) page： 455 - 459 2024.7

特集胸椎後縦靭帯骨化症-手術治療の進歩胸椎後縦靭帯骨化症に対する当科の2期的後方手術strategy-特に後方除圧矯正固定術について

今釜史郎, 中島宏彰, 伊藤定之, 世木直喜, 大内田隼

脊椎脊髄ジャーナル Vol. 37 ( 6 ) page： 393 - 398 2024.7

Descriptive analysis of incidence and risk factors for short intramedullary nail breakage in femoral intertrochanteric fractures: a multicenter (TRON group) retrospective study Reviewed

Noritake, H; Takegami, Y; Tokutake, K; Nakashima, H; Mishima, K; Ito, T; Imagama, S

EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY Vol. 34 ( 5 ) page： 2605 - 2611 2024.7

Language：English Publisher：European Journal of Orthopaedic Surgery and Traumatology

Background: The incidence of hip fractures is increasing. Femoral intertrochanteric fractures make up 50% of hip fractures and are treated by intramedullary nails. Implant breakage is a recognized complication that can have rare and serious implications. This study aimed to investigate implant breakage rates after surgical treatment for femoral intertrochanteric fractures. Methods: This was a retrospective multicenter analysis. All 1854 patients who underwent surgical treatment for femoral intertrochanteric fractures were selected from 12 hospitals (TRON group) between 2016 and 2020. Exclusion criteria included implants other than those specified and follow-up periods less than three months. Demographic data, surgical details, and radiographic assessments were collected from medical records and X-ray evaluations. Results: Among the 983 study patients, consisting of 245 males (24.9%) and 738 females (75.1%), the implant breakage rate was 0.31%, with three confirmed cases. The average age was 83.9 years. The mean follow-up period was 640.9 days. Two cases were linked to ASULOCK implants, and one to an OLSII implant. Statistical analysis showed a significantly higher incidence of ASULOCK implant breakage (p < 0.001). In the two cases of ASULOCK implant breakage and one case of OLSII implant breakage, breakage in all three implants occurred at the anti-rotation screws. Conclusions: There were no implant breakages of the main body of the implants; all breakages occurred in the additional anti-rotation screw. The necessity of the anti-rotation screw will require further discussion. These results can potentially inform clinical decisions and guide further research in preventing implant breakage.

DOI： 10.1007/s00590-024-03957-z

Neurologic recovery following laminectomy and tumor resection of a pediatric cervical synovial osteochondromatosis causing paralysis Reviewed

Yamauchi, I; Nakashima, H; Inoue, T; Nojima, T; Imagama, S

EUROPEAN SPINE JOURNAL Vol. 33 ( 7 ) page： 2904 - 2908 2024.7

Language：English Publisher：European Spine Journal

Purpose: To report the surgical outcome of synovial osteochondromatosis, a rare tumor of the cervical spine, in a 6-year-old boy. Methods: A 6-year-old boy presented with muscle weakness in the right deltoid (2) and biceps (4) during a manual muscle test. Magnetic resonance imaging showed a 3 × 2 × 1.5 cm mass within the spinal canal at the C4–6 level, compressing the cervical spinal cord from the right side. Computed tomography revealed hyperintense areas within the tumor and ballooning of the right C4–5 and C5–6 facet joints. Results: After a biopsy confirmed the absence of malignancy, a gross total resection was performed. The pathological diagnosis of synovial osteochondromatosis was established. Postoperatively, muscle weakness improved fully in the manual muscle test, and there were no neurological findings after 3 months. However, the patient is under careful follow-up owing to the detection of a regrowth site within the right C4–5 and C5–6 intervertebral foramen 2 years postoperatively. Conclusions: Synovial osteochondromatosis of the cervical spine in children is rare, and this is the first report of its regrowth after surgery. Synovial osteochondromatosis should be included in the differential diagnosis of pediatric cervical spine tumors.

DOI： 10.1007/s00586-024-08304-8

Preoperative low Hounsfield units in the lumbar spine are associated with postoperative mechanical complications in adult spinal deformity Reviewed

Yamauchi, I; Nakashima, H; Ito, S; Segi, N; Ouchida, J; Oishi, R; Miyairi, Y; Morita, Y; Ode, Y; Nagatani, Y; Okada, Y; Morishita, K; Takeichi, Y; Kagami, Y; Tachi, H; Ohshima, K; Ogura, K; Shinjo, R; Ohara, T; Tsuji, T; Kanemura, T; Imagama, S

EUROPEAN SPINE JOURNAL Vol. 33 ( 7 ) page： 2824 - 2831 2024.7

Language：English Publisher：European Spine Journal

Purpose: To determine the most valid bone health parameter to predict mechanical complications (MCs) following surgery for adult spinal deformity (ASD). Methods: This multicenter study retrospectively examined the records of patients who had undergone fusion of three or more motion segments, including the pelvis, with a minimum two-year follow-up period. Patients with moderate and severe global alignment and proportion scores were included in the study and divided into two groups: those who developed MCs and those who did not. Bone mineral density (BMD) of the lumbar spine and femoral neck was measured using dual-energy X-ray absorptiometry, and Hounsfield units (HUs) were measured in the lumbar spine on computed tomography. Radiographic parameters were evaluated preoperatively, immediately after surgery, and at final follow-up. Results: Of 108 patients, 30 (27.8%) developed MCs, including 26 cases of proximal junctional kyphosis/failure, 2 of distal junctional failure, 6 of rod fracture, and 11 reoperations. HUs were significantly lower in patients who experienced MCs (113.7 ± 41.1) than in those who did not (137.0 ± 46.8; P = 0.02). BMD did not differ significantly between the two groups. The preoperative and two-year postoperative global tilt, as well as the immediately postoperative sagittal vertical axis, were significantly greater in patients who developed MCs than in those who did not (P = 0.02, P < 0.01, and P = 0.01, respectively). Conclusion: Patients who experienced MCs following surgery for ASD had lower HUs than those who did not. HUs may therefore be more useful than BMD for predicting MCs following surgery for ASD.

DOI： 10.1007/s00586-024-08261-2

Risk factors of periprosthetic joint infection after hemiarthroplasty for displaced femoral neck fracture in the elderly: Analysis of 1619 cases in the multicenter database Reviewed

Sumi, S; Takegami, Y; Tokutake, K; Nakashima, H; Mishima, K; Takatsu, T; Imagama, S

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED Vol. 55 ( 7 ) page： 111603 2024.7

Language：English Publisher：Injury

Purpose: This multicenter retrospective study focuses on understanding the incidence, causative bacteria, and risk factors for Periprosthetic Joint Infection (PJI) following hemiarthroplasty in elderly patients with displaced femoral neck fractures (FNF). Methods: From 2016 to 2020, 1,619 patients were diagnosed with displaced FNFs and treated surgically across 11 centers. After exclusions, 1,438 patients (399 men and 1,039 women) were included in the study, averaging 82.1 years in age and 20.2 kg/m² in BMI, observed over 25.7 months on average. Data on demographics, medical history, surgical details, and complications were described. Results: PJI occurred in 20 of the 1438 patients (1.4%). The causative organism was methicillin-susceptible Staphylococcus aureus in 6 patients and methicillin-resistant S. aureus in 6 patients. In patients' backgrounds, the average age was slightly higher in the non-PJI group (82.1 years) compared to the PJI group (80.4 years). There was a higher percentage of males in the PJI group (45%) than in the non-PJI group (27.5%). Drug history showed that the prevalence of anticoagulant use in the PJI group was 25%. Peripheral vascular disease and diabetes mellitus were more prevalent in the PJI group. Most patients in both groups were independent in daily activities. The blood transfusion rate was significantly higher in the PJI group (50%) than in the non-PJI group (23.8%). Notably, the incidence of hematoma was higher in the PJI group (40%). Conclusion: This multicenter retrospective study demonstrates a low incidence (1.4%) of PJI in elderly patients undergoing hemiarthroplasty for FNF, primarily due to Staphylococcus aureus. Increased usage of antiplatelets and anticoagulants, as well as comorbidities related to atherosclerosis, like peripheral vascular disease and diabetes mellitus, were observed in patients with PJI. Additionally, these patients experienced higher rates of blood transfusion and postoperative hematomas, highlighting the need for careful management. It should be noted, however, that this finding is a conclusion limited by study design issues, including the retrospective design, small PJI sample size, and variability in treatment approaches.

DOI： 10.1016/j.injury.2024.111603

Worsening ambulation in elderly patients with cervical odontoid fractures: A nationwide multicenter study in Japan Reviewed

Segi, N; Nakashima, H; Ito, S; Yokogawa, N; Ikegami, S; Watanabe, K; Funayama, T; Hasegawa, T; Tonomura, H; Kakutani, K; Furuya, T; Suzuki, N; Kiyasu, K; Tominaga, H; Miyazaki, M; Terashima, Y; Suzuki, H; Hashimoto, K; Uei, H; Funao, H; Kaito, T; Kawaguchi, K; Sakai, D; Seki, S; Otsuki, B; Inoue, G; Okada, S; Imagama, S; Kato, S

JOURNAL OF ORTHOPAEDIC SCIENCE Vol. 29 ( 4 ) page： 927 - 932 2024.7

Language：English Publisher：Journal of Orthopaedic Science

Background: Despite the increasing prevalence of cervical odontoid fractures in older adults, the treatment strategy is controversial. The objectives of the current study are to investigate the prognosis and complications of cervical odontoid fractures in elderly patients and to identify factors associated with worsening of ambulation after 6 months. Methods: This multicenter, retrospective study included 167 patients aged 65 years or older with odontoid fractures. Patient demographic and treatment data were investigated and compared according to the treatment strategy. To determine associations with worsening ambulation after 6 months, we focused on the treatment strategies (nonsurgical treatment [collar immobilization or halo vest], conversion to surgery, or initial surgery) and patients’ background. Results: Patients who received nonsurgical treatment were significantly older, and patients who underwent surgery had more Anderson-D'Alonzo type 2 fractures. Of the patients initially treated nonsurgically, 26% later underwent surgery. Numbers of complications, including death, and degrees of ambulation after 6 months did not differ significantly among treatment strategies. Patients who had worsened ambulation after 6 months were significantly more likely to be older than 80 years, to have needed assistance with walking before injury, and to have cerebrovascular disease. Multivariable analysis showed that a score of ≥2 on the 5-item modified frailty index (mFI-5) was significantly associated with worsening ambulation. Conclusions: Preinjury mFI-5 scores of ≥2 were significantly associated with worsening ambulation 6 months after treatment of cervical odontoid fractures in older adults.

DOI： 10.1016/j.jos.2023.05.006

Association between advanced glycation end-products and fall risk in older adults: The Yakumo Study Reviewed

Iida, H; Takegami, Y; Osawa, Y; Funahashi, H; Ozawa, Y; Ido, H; Asamoto, T; Otaka, K; Tanaka, S; Nakashima, H; Ishizuka, S; Seki, T; Hasegawa, Y; Imagama, S

GERIATRICS & GERONTOLOGY INTERNATIONAL Vol. 24 ( 6 ) page： 517 - 522 2024.6

Language：English Publisher：Geriatrics and Gerontology International

Aim: Advanced glycation end-products (AGEs) are irreversibly and heterogeneously formed compounds during the non-enzymatic modification of macromolecules, such as proteins. Aging and lifestyle habits, such as high-fat and high-protein diets, and smoking, promote AGEs accumulation. This study aimed to investigate the relationship between fall risk and AGEs in community-dwelling older adults. Methods: This cross-sectional study included patients from the 2022 Yakumo Study who were evaluated for fall risk index 5-items version, locomotive syndrome stage and AGEs. AGEs were evaluated using Skin autofluorescence (SAF) measured by the AGE reader (DiagnOptics Technologies BV, Groningen, the Netherlands). We divided the participants into two groups according to the presence or absence of fall risk (fall risk index 5-items version ≥6 or not), and investigated the factors associated with fall risk. Results: The fall risk group had a higher age and SAF, and a higher proportion of locomotive syndrome stage >2 than the without fall risk group in patients aged ≥65 years (P < 0.01). The multivariate logistic regression analysis after adjustment of age, sex and body mass index showed that locomotive syndrome stage ≥2 and SAF were independent associators of fall risk in older adults (odds ratio 3.26, P < 0.01, odds ratio 2.96, P < 0.05, respectively). The optimal cutoff value of the SAF for fall risk was 2.4 (area under the curve 0.631; 95% CI 0.53–0.733; sensitivity 0.415; specificity 0.814; P < 0.05). Conclusion: The accumulation of AGEs in skin tissues can be used to screen for fall risk comprehensively. Geriatr Gerontol Int 2024; 24: 517–522.

DOI： 10.1111/ggi.14871

Epidemiology of Cervical Fracture/Cervical Spinal Cord Injury and Changes in Surgical Treatment Modalities in Elderly Individuals During a 10-year Period: A Nationwide Multicenter Study in Japan Reviewed Open Access

Segi, N; Nakashima, H; Machino, M; Ito, S; Yokogawa, N; Sasagawa, T; Funayama, T; Eto, F; Watanabe, K; Nori, S; Furuya, T; Yunde, A; Nakajima, H; Hasegawa, T; Yamada, 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; Inoue, G; Shirasawa, E; Kakutani, K; Iizuka, Y; Takasawa, E; Akeda, K; Kiyasu, K; Tominaga, H; Tokumoto, H; Funao, H; Oshima, Y; Yoshii, T; Kaito, T; Sakai, D; Ohba, T; Seki, S; Otsuki, B; Ishihara, M; Miyazaki, M; Okada, S; Imagama, S; Kato, S

GLOBAL SPINE JOURNAL Vol. 14 ( 5 ) page： 1583 - 1594 2024.6

Language：English Publisher：Global Spine Journal

Study Design: Retrospective multicenter study Objectives: To investigate changes over a 10-years period in the profile of cervical spine and spinal cord injuries among the elderly in Japan. Methods: The current multicenter study was a retrospective analysis of inpatients aged ≥65 years, suffering cervical fracture (CF) and/or cervical spinal cord injury (CSCI). We analyzed 1413 patients’ epidemiology (from 2010 to 2019). Moreover, 727 patients who underwent surgical treatment were analyzed in 2 groups: the early (2010-2014) and late period (2015-2019). Results: Both the number of patients and number of surgical patients showed a significant increasing trend (P <.001), while the mean age, the distribution of injury levels and paralysis severity, and the proportion of surgical indications remained the same. The number of surgical patients doubled from 228 to 499 from the early to late periods. Posterior surgery was the most common approach (90.4%), instrumentation surgery with screws increased significantly, and the range of fusion was significantly longer in the late period (2.1 vs 2.7 levels, P =.001). Significantly worsening neurological symptoms were recorded in the late period (1.3% vs 5.8%, P =.006), with C5 palsy being the major one. Otherwise, perioperative, major, and other complications, including mortality, did not differ significantly in incidence. Conclusions: Both the number of elderly CF and/or CSCI patients and number of patients undergoing surgery increased dramatically over the decade without any change in profile. Instrumentation surgeries with screws increased, without an increase in systemic complications.

DOI： 10.1177/21925682231151643

Is spinopelvic compensation associated with unstable gait?: Analysis using whole spine X-rays and a two-point accelerometer during gait in healthy adults Reviewed

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

GAIT & POSTURE Vol. 111 page： 22 - 29 2024.6

Language：English Publisher：Gait and Posture

Background: Pelvic incidence (PI)–lumbar lordosis (LL) mismatch has a significant destabilizing effect on the center of gravity sway in the static standing position. However, the association between spinopelvic alignment and balance during gait in healthy volunteers is poorly understood. Research question: The degree of PI–LL mismatch and trunk anterior tilt in the static standing posture influences dynamic balance during gait. Methods: In this study, 131 healthy volunteers were divided into two groups: harmonious group (PI − LL ≤ 10°; n = 91) and unharmonious group (PI − LL > 10°; n = 40). A two-point accelerometer system was used for gait analysis; accelerometers were attached to the pelvis and upper trunk to measure acceleration in the forward–backward, right–left, and vertical directions so that sagittal (front–back) deviation width, coronal (right–left) width, and vertical width and their ratios were calculated. Measurements were compared between the two groups, and correlations between alignment and accelerometer data were examined. Results: The harmonious group showed a negative correlation between pelvic sagittal width and PI – LL, pelvic tilt (PT), and sagittal vertical axis (SVA) (correlation coefficient ρ = −0.42, −0.38, and −0.4, respectively), and a positive correlation between sagittal ratio and PI − LL (ρ = 0.35). The unharmonious group showed a positive correlation between pelvic sagittal width and PI and PT (ρ = 0.43 and 0.33, respectively) and between sagittal ratio and SVA (ρ = 0.32). The unharmonious group showed a positive correlation between upper trunk sagittal width and PI − LL and PT (ρ = 0.38 and 0.36, respectively). Significance: The association between spinal alignment and gait parameters differs depending on the presence or absence of PI–LL mismatch. The degree of pelvic compensation and trunk anterior tilt during static standing were associated with unstable gait balance.

DOI： 10.1016/j.gaitpost.2024.04.013

Reply to "Letter to the Editor Concerning 'Implant-Related Complications After Spinal Fusion: A Multicenter Study.' by Koshimizu et al." Reviewed Open Access

Koshimizu, H; Nakashima, H; Ohara, T; Tauchi, R; Kanemura, T; Shinjo, R; Machino, M; Ito, S; Ando, K; Imagama, S

GLOBAL SPINE JOURNAL Vol. 14 ( 5 ) page： 1682 - 1683 2024.6

整形トピックス胸椎靱帯骨化症に対する後方除圧固定術と最近の進歩

中島宏彰

整形外科 Vol. 75 ( 5 ) page： 464 - 464 2024.5

Relationship between locomotive syndrome and advanced glycation end products measured by skin autofluorescence in community-dwelling patients: the Yakumo Study. Reviewed Open Access

Ozawa Y, Takegami Y, Seki T, Osawa Y, Iida H, Okamoto M, Nakashima H, Ishizuka S, Hasegawa Y, Imagama S

Nagoya journal of medical science Vol. 86 ( 2 ) page： 314 - 325 2024.5

Language：English Publisher：Nagoya Journal of Medical Science

Advanced glycation end products (AGEs) have been reported to be associated with osteoporosis, aging, sarcopenia, and frailty. This study aimed to investigate the association AGEs with locomotive syndrome (LS). Participants were Japanese individuals aged 39 years or older who participated in the Yakumo Study (n=230). AGEs were measured by skin autofluorescence (SAF) using an AGE reader. We investigated SAF values for each locomotive stage. Multivariate logistic regression models were used to calculate the odds ratios of LS-associated factors. The relationships between SAF and physical performance and bone mineral density (BMD) were investigated. A receiver operating characteristic (ROC) curves were generated to determine the optimal cut-off value of SAF for predicting LS. SAF values tended to increase correspondingly with LS severity. SAF was an independently explanatory factor for LS (odds ratio 2.70; 95% confidence interval [CI] 1.040–6.990). SAF was positively correlated with the 10-m walking speed, The Timed Up and Go test results, and was negatively correlated with BMD. ROC curve represented by SAF for the presence or absence of LS risk had an area under the curve of 0.648 (95% CI: 0.571–0.726). High SAF values were identified as an independent risk factor for LS. AGEs could be a potential screening tool for people for LS.

DOI： 10.18999/nagjms.86.2.314

Comparing short vs. intermediate and long nails in elderly patients with unstable multifragmental femoral trochanteric fractures (AO type A2): Multicenter (TRON group) retrospective study Reviewed

Tsugeno, H; Takegami, Y; Tokutake, K; Mishima, K; Nakashima, H; Kobayashi, K; Imagama, S

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED Vol. 55 ( 4 ) page： 111420 2024.4

Language：English Publisher：Injury

Background: Unstable femoral trochanteric fractures (FTFs), especially Arbeitsgemeinschaft für Osteosynthesefragen/ the Orthopedic Trauma Association (AO/OTA) 31-A2 fractures, which are multifragment fractures, occur in elderly individuals with osteoporosis and are associated with high mortality and complication rates due to prolonged immobilization. Longer nails (LNs) were developed to obtain superior fracture site stabilization in unstable FTFs. We hypothesized that the postoperative outcomes of elderly patients with unstable FTFs treated with LNs would be superior to those of patients treated with short nails (SNs), with fewer complications. Methods: This multicenter retrospective study aimed to compare the outcomes of SNs versus LNs in elderly patients with unstable FTFs. From the Trauma Research Group of our university (TRON) database, 1854 trochanteric fractures treated between January 2016 and December 2020 were extracted. A total of 174 patients>65 years of age with AO/OTA 31-A2 fractures were included in the present study. They were divided into the SN group and the LN group and matched for age and sex. Parameters such as operative time, blood loss, survival rate, Parker Mobility Score (PMS), and numerical rating scale (NRS) for pain, complications, and radiographic findings were analyzed. Results: Both groups included 67 patients with an average age of 87.32 years. The LN group had a longer operative time (76.52 min vs. 51.61 min, P < 0.001) and more blood loss (106.79 mL vs. 49.98 mL, P = 0.014) in comparison to the SN group. However, the 1-year survival rate, PMS, and NRS for pain did not differ to a statistically significant extent between the groups. The rates of complications, including screw cutout, nonunion, implant breakage, osteonecrosis of the femoral head, and surgical site infections, were comparable. The radiographic findings, including the nail/canal ratio, progression of varus, and sliding distance, were also similar. Conclusion: Although LNs are associated with longer operative times and increased blood loss, the overall outcomes and complication rates are comparable to those of SNs in elderly patients with AO/OTA 31-A2 type unstable FTFs. The use of LNs did not confer any distinct advantages for this specific type of fracture.

DOI： 10.1016/j.injury.2024.111420

Obesity Is Associated with Asymptomatic Vertebral Fractures: A Yakumo Study Reviewed Open Access

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

JOURNAL OF CLINICAL MEDICINE Vol. 13 ( 7 ) 2024.4

Language：English Publisher：Journal of Clinical Medicine

(1) Background: Patients with primary vertebral fracture (VF) are at high risk of re-fracture and mortality. However, approximately two-thirds of patients with VFs receive minimal clinical attention. (2) Methods: The current study aimed to investigate the factors associated with asymptomatic VFs in middle-aged and elderly individuals who underwent resident health examinations. (3) Results: The current study included 217 participants aged > 50 years. VFs were diagnosed based on lateral radiographic images using Genant’s semiquantitative (SQ) method. The participants were divided into non-VF (N; SQ grade 0) and asymptomatic VF (F; SQ grades 1–3) groups. Data on body composition, blood tests, quality of life measures, and radiographic parameters were assessed. A total of 195 participants were included in the N group (mean age, 64.8 ± 7.8 years), and 22 were in the F group (mean age, 66.1 ± 7.9 years). The F group had a significantly higher body mass index (BMI), body fat percentage (BF%), and proportion of patients with knee osteoarthritis (KOA) than the N group. The F group had a significantly higher knee joint pain visual analog scale (VAS) score and painDETECT score than the N group. Logistic regression analysis showed that BF% was associated with asymptomatic VFs. (4) Conclusions: Middle-aged and elderly individuals with asymptomatic VF presented with high BMIs, BF%, and incidence of KOA.

DOI： 10.3390/jcm13072063

Neurological recovery rate and predictive factors of incomplete AIS grade C spinal cord injury in the older aged population Reviewed

Tamai, K; Terai, H; Nakamura, H; Yokogawa, N; Sasagawa, T; Nakashima, H; Segi, N; Ito, S; Funayama, T; Eto, F; Yamaji, A; Watanabe, K; Yamane, J; Takeda, K; 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; 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

SPINAL CORD Vol. 62 ( 4 ) page： 149 - 155 2024.4

Language：English Publisher：Spinal Cord

Study design: Retrospective cohort study. Objectives: To define the prognosis and predictive factors for neurological improvement in older patients with incomplete spinal cord injury (SCI) of American Spinal Injury Association Impairment Scale grade C (AIS-C). Settings: Multi-institutions in Japan. Methods: We included patients aged ≥65 years with traumatic SCI of AIS-C who were treated conservatively or surgically with >3 follow-up months. To identify factors related to neurological improvement, patients were divided into three groups according to their neurological status at the final follow-up, with univariate among-group comparisons of demographics, radiographic, and therapeutic factors. Significant variables were included in the multivariate logistic regression analysis. Results: Overall, 296 older patients with SCI of AIS-C on admission were identified (average age: 75.2 years, average follow-up: 18.7 months). Among them, 190 (64.2%) patients improved to AIS-D and 21 (7.1%) patients improved to AIS-E at final follow-up. There were significant among-group differences in age (p = 0.026), body mass index (p = 0.007), status of pre-traumatic activities of daily living (ADL) (p = 0.037), and serum albumin concentrations (p = 0.011). Logistic regression analysis showed no significant differences in variables in the stratified group of patients who improved to AIS-D. Meanwhile, serum albumin was a significant variable in patients who improved to AIS-E (p = 0.026; OR: 6.20, pre-traumatic ADL was omitted due to data skewness). Conclusions: Most older patients with incomplete AIS-C SCI demonstrated at least 1 grade of neurological improvement. However, <10% of patients achieved complete recovery. Key predictors of complete recovery were high serum albumin levels on admission and independent pre-traumatic ADL. Sponsorship: No funding was received for this study.

DOI： 10.1038/s41393-024-00963-0

地域在住高齢者の転倒と転倒予防〜ロコモティブシンドロームおよび脊椎グローバルアライメントの観点から〜

世木直喜, 中島宏彰, 伊藤定之, 大内田隼, 飯田浩貴, 竹上靖彦, 田中智史, 両角正義, 村本明生, 小林和克, 石塚真哉, 関泰輔, 長谷川幸治, 今釜史郎

日本転倒予防学会誌 Vol. 10 ( 1 ) page： 19 - 25 2024.3

Impact of malnutrition on mortality and neurological recovery of older patients with spinal cord injury Reviewed Open Access

Tamai, K; Terai, H; Nakamura, H; Yokogawa, N; Sasagawa, T; Nakashima, H; Segi, N; Ito, S; Funayama, T; Eto, F; Yamaji, A; Watanabe, K; Yamane, J; Takeda, K; 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; 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

SCIENTIFIC REPORTS Vol. 14 ( 1 ) page： 5853 2024.3

Language：English Publisher：Scientific Reports

This retrospective cohort study established malnutrition’s impact on mortality and neurological recovery of older patients with cervical spinal cord injury (SCI). It included patients aged ≥ 65 years with traumatic cervical SCI treated conservatively or surgically. The Geriatric Nutritional Risk Index was calculated to assess nutritional-related risk. Overall, 789 patients (mean follow-up: 20.1 months) were examined and 47 had major nutritional-related risks on admission. One-year mortality rate, median survival time, neurological recovery, and activities of daily living (ADL) at 1 year post-injury were compared between patients with major nutrition-related risk and matched controls selected using 1:2 propensity score matching to adjust for age, pre-traumatic neurological impairment, and activity. In the Kaplan–Meier analysis, the median survival times were 44.9 and 76.5 months for patients with major nutrition-related risk and matched controls, respectively (p = 0.015). Matched controls had more individuals with a neurological improvement of American Spinal Injury Association Impairment Scale ≥ 1 grade (p = 0.039) and independence in ADL at 1 year post-injury than patients with major nutrition-related risk (p < 0.05). In conclusion, 6% of older patients with cervical SCI had major nutrition-related risks; they showed a significantly higher 1 year mortality rate, shorter survival time, poorer neurological improvement, and lower ADL at 1 year post-injury than matched controls.

DOI： 10.1038/s41598-024-56527-y

A Longitudinal Study on the Effect of Exercise Habits on Locomotive Syndrome and Quality of Life during the Coronavirus Disease 2019 Pandemic Reviewed Open Access

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

JOURNAL OF CLINICAL MEDICINE Vol. 13 ( 5 ) 2024.3

Language：English Publisher：Journal of Clinical Medicine

During the COVID-19 pandemic, this study investigated the potential of exercise habits to improve quality of life (QOL) and prevent locomotive syndrome (LS) in residents of Yakumo-cho, Hokkaido, Japan. Participants from the 2018 health checkup were surveyed in February 2022, focusing on 200 respondents. These individuals were divided based on their 2018 exercise habits (at least 1 h per week): the exercise group (E group) and the non-exercise group (N group), further categorized in 2022 into the 2022E and 2022N groups. QOL was measured using the SF-36 (physical functioning, general health, physical role, physical pain, vitality, social functioning, emotional role, and mental health) and EuroQoL 5-dimension 5-level questionnaires (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), and LS was assessed with the 25-question geriatric locomotive function scale. These showed no significant change in exercise habits from 2018 to 2022. In the non-LS group, the 2022E group had higher vitality and emotional role functioning scores compared to the 2022N group. For those with LS, the 2022E group reported less physical pain. Notably, the LS incidence was significantly lower in the 2022E group. This study concludes that consistent exercise habits positively impact QOL and reduce the LS risk, underscoring the importance of regular physical activity, especially during challenging times like a pandemic. These findings highlight the broader benefits of maintaining exercise routines for public health, particularly in periods of global health crises. Based on our findings, we recommend that people continue to exercise at least one hour per week to prevent LS.

DOI： 10.3390/jcm13051385

An Update of a Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role and Timing of Decompressive Surgery Reviewed Open Access

Fehlings, MG; Tetreault, LA; Hachem, L; Evaniew, N; Ganau, M; Mckenna, SL; Neal, CJ; Nagoshi, N; Rahimi-Movaghar, V; Aarabi, B; Hofstetter, CP; Wengel, VT; Nakashima, H; Martin, AR; Kirshblum, S; Pinto, RR; Marco, RAW; Wilson, JR; Kahn, DE; Newcombe, VFJ; Zipser, CM; Douglas, S; Kurpad, SN; Lu, Y; Saigal, R; Samadani, U; Arnold, PM; Hawryluk, GWJ; Skelly, AC; Kwon, BK

GLOBAL SPINE JOURNAL Vol. 14 ( 3_SUPPL ) page： 174S - 186S 2024.3

Language：English Publisher：Global Spine Journal

Study Design: Clinical practice guideline development. Objectives: Acute spinal cord injury (SCI) can result in devastating motor, sensory, and autonomic impairment; loss of independence; and reduced quality of life. Preclinical evidence suggests that early decompression of the spinal cord may help to limit secondary injury, reduce damage to the neural tissue, and improve functional outcomes. Emerging evidence indicates that “early” surgical decompression completed within 24 hours of injury also improves neurological recovery in patients with acute SCI. The objective of this clinical practice guideline (CPG) is to update the 2017 recommendations on the timing of surgical decompression and to evaluate the evidence with respect to ultra-early surgery (in particular, but not limited to, <12 hours after acute SCI). Methods: A multidisciplinary, international, guideline development group (GDG) was formed that consisted of spine surgeons, neurologists, critical care specialists, emergency medicine doctors, physical medicine and rehabilitation professionals, as well as individuals living with SCI. A systematic review was conducted based on accepted methodological standards to evaluate the impact of early (within 24 hours of acute SCI) or ultra-early (in particular, but not limited to, within 12 hours of acute SCI) surgery on neurological recovery, functional outcomes, administrative outcomes, safety, and cost-effectiveness. The GRADE approach was used to rate the overall strength of evidence across studies for each primary outcome. Using the “evidence-to-recommendation” framework, recommendations were then developed that considered the balance of benefits and harms, financial impact, patient values, acceptability, and feasibility. The guideline was internally appraised using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. Results: The GDG recommended that early surgery (≤24 hours after injury) be offered as the preferred option for adult patients with acute SCI regardless of level. This recommendation was based on moderate evidence suggesting that patients were 2 times more likely to recover by ≥ 2 ASIA Impairment Score (AIS) grades at 6 months (RR: 2.76, 95% CI 1.60 to 4.98) and 12 months (RR: 1.95, 95% CI 1.26 to 3.18) if they were decompressed within 24 hours compared to after 24 hours. Furthermore, patients undergoing early surgery improved by an additional 4.50 (95% 1.70 to 7.29) points on the ASIA Motor Score compared to patients undergoing surgery after 24 hours post-injury. The GDG also agreed that a recommendation for ultra-early surgery could not be made on the basis of the current evidence because of the small sample sizes, variable definitions of what constituted ultra-early in the literature, and the inconsistency of the evidence. Conclusions: It is recommended that patients with an acute SCI, regardless of level, undergo surgery within 24 hours after injury when medically feasible. Future research is required to determine the differential effectiveness of early surgery in different subpopulations and the impact of ultra-early surgery on neurological recovery. Moreover, further work is required to define what constitutes effective spinal cord decompression and to individualize care. It is also recognized that a concerted international effort will be required to translate these recommendations into policy.

DOI： 10.1177/21925682231181883

An appropriate method for predicting the femoral angle on whole-body X-ray images from full-spine X-ray images Reviewed

Ito, K; Nakashima, H; Kagami, Y; Ouchida, J; Satake, K; Tsushima, M; Tomita, H; Ode, Y; Nagatani, Y; Imagama, S; Kanemura, T

JOURNAL OF ORTHOPAEDIC SCIENCE Vol. 29 ( 2 ) page： 489 - 493 2024.3

Language：English Publisher：Journal of Orthopaedic Science

Introduction: The importance of lower-limb compensation in patients with spinal malalignment due to spinal pathologies has been emphasized. The latest whole-body X-ray images (WBX) have enabled evaluations of whole-body alignment from head to toe. However, WBX is still not commonly available. Thus, the present study aimed to examine an alternative measurement method of the femoral angle on usual full-spine X-ray images (FSX) that approximates the femoral angle on WBX. Methods: A total of 50 patients (age, 52.8 ± 25.3 years; female, n = 26; male, n = 24) underwent WBX and FSX. The following parameters were measured on lateral view X-rays: WBX and FSX femoral angle (angle between the femoral axis and a perpendicular line); FSX femoral distance (distance from the center of femoral head to the distal femur on FSX); WBX intersection length (length between the center of the femoral head and the intersection point [the point at which the line connecting the center of the femoral head and the midpoint of the femoral condyle intersects the center line of the femur] on WBX). Results: The WBX femoral angle, and FSX femoral angle were 0.16 ± 4.2°, and −0.53 ± 4.1°, respectively. The FSX femoral distance was 102.7 ± 41.1 mm. An ROC curve analysis revealed that the cut-off value of the FSX femoral distance associated with minimal difference in the WBX and FSX femoral angles (<3°) was 73 mm (sensitivity 83.3%, specificity 87.5%, AUC 0.80). The WBX intersection length was 105.3 ± 27.3 mm. Conclusion: To calculate the femoral angle on FSX that approximates the WBX femoral angle, the femoral distance on FSX ≥73 mm is preferable. We suggest using the FSX femoral distance within the range of 80 mm–130 mm as a simple numerical value that meets all criteria.

DOI： 10.1016/j.jos.2023.02.007

Calcitriol ameliorates motor de fi cits and prolongs survival of<i> Chrne</i>-de fi cient mouse, a model for congenital myasthenic syndrome, by inducing Rspo2 Reviewed Open Access

Ohkawara, B; Tomita, H; Inoue, T; Zhang, SC; Kanbara, S; Koshimizu, H; Miyasaka, Y; Takeda, JI; Nishiwaki, H; Nakashima, H; Ito, M; Masuda, A; Ishiguro, N; Ogi, T; Ohno, T; Imagama, S; Ohno, K

NEUROTHERAPEUTICS Vol. 21 ( 2 ) page： e00318 2024.3

Language：English Publisher：Neurotherapeutics

Signal transduction at the neuromuscular junction (NMJ) is compromised in a diverse array of diseases including congenital myasthenic syndromes (CMS). Germline mutations in CHRNE encoding the acetylcholine receptor (AChR) ε subunit are the most common cause of CMS. An active form of vitamin D, calcitriol, binds to vitamin D receptor (VDR) and regulates gene expressions. We found that calcitriol enhanced MuSK phosphorylation, AChR clustering, and myotube twitching in co-cultured C2C12 myotubes and NSC34 motor neurons. RNA-seq analysis of co-cultured cells showed that calcitriol increased the expressions of Rspo2, Rapsn, and Dusp6. ChIP-seq of VDR revealed that VDR binds to a region approximately 15 kbp upstream to Rspo2. Biallelic deletion of the VDR-binding site of Rspo2 by CRISPR/Cas9 in C2C12 myoblasts/myotubes nullified the calcitriol-mediated induction of Rspo2 expression and MuSK phosphorylation. We generated Chrne knockout (Chrne KO) mouse by CRISPR/Cas9. Intraperitoneal administration of calcitriol markedly increased the number of AChR clusters, as well as the area, the intensity, and the number of synaptophysin-positive synaptic vesicles, in Chrne KO mice. In addition, calcitriol ameliorated motor deficits and prolonged survival of Chrne KO mice. In the skeletal muscle, calcitriol increased the gene expressions of Rspo2, Rapsn, and Dusp6. We propose that calcitriol is a potential therapeutic agent for CMS and other diseases with defective neuromuscular signal transmission.

DOI： 10.1016/j.neurot.2024.e00318

Influence of the timing of surgery forcervical spinal cord injury without bone injury in the elderly: A retrospective multicenter study Reviewed Open Access

Nori, S; Watanabe, K; Takeda, K; Yamane, J; Kono, H; Yokogawa, N; Sasagawa, T; Ando, K; Nakashima, H; Segi, N; Funayama, T; Eto, F; Yamaji, A; 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; Uei, H; Sawada, H; Nakanishi, K; Misaki, K; Terai, H; Tamai, K; Shirasawa, E; Inoue, G; Kiyasu, K; Iizuka, Y; Takasawa, E; Funao, H; Kaito, T; Yoshii, T; Ishihara, M; Okada, S; Imagama, S; Kato, S

JOURNAL OF ORTHOPAEDIC SCIENCE Vol. 29 ( 2 ) page： 480 - 485 2024.3

Language：English Publisher：Journal of Orthopaedic Science

Background: Although previous studies have demonstrated the advantages of early surgery for traumatic spinal cord injury (SCI), the appropriate surgical timing for cervical SCIs (CSCIs) without bone injury remains controversial. Here, we investigated the influence of relatively early surgery within 48 h of injury on the neurological recovery of elderly patients with CSCI and no bone injury. Methods: In this retrospective multicenter study, we reviewed data from 159 consecutive patients aged ≥65 years with CSCI without bone injury who underwent surgery in participating centers between 2010 and 2020. Patients were followed up for at least 6 months following CSCI. We divided patients into relatively early (≤48 h after CSCI, n = 24) and late surgery (>48 h after CSCI, n = 135) groups, and baseline characteristics and neurological outcomes were compared between them. Multivariate analysis was performed to identify factors associated with neurological recovery. Results: The relatively early surgery group demonstrated a lower prevalence of cardiac disease, poorer baseline American Spinal Injury Association (ASIA) impairment scale grade, and lower baseline ASIA motor score (AMS) than those of the late surgery group (P < 0.030, P < 0.001, and P < 0.001, respectively). Although the AMS was lower in the relatively early surgery group at 6 months following injury (P = 0.001), greater improvement in this score from baseline to 6-months post injury was observed (P = 0.010). Multiple linear regression analysis revealed that relatively early surgery did not affect postoperative improvement in AMS, rather, lower baseline AMS was associated with better AMS improvement (P < 0.001). Delirium (P = 0.006), pneumonia (P = 0.030), and diabetes mellitus (P = 0.039) negatively influenced postoperative improvement. Conclusions: Although further validation by future studies is required, relatively early surgery did not show a positive influence on neurological recovery after CSCI without bone injury in the elderly.

DOI： 10.1016/j.jos.2023.01.004

The anatomical relationship between the celiac artery and the median arch ligament in degenerative spinal surgery Reviewed

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

JOURNAL OF ORTHOPAEDIC SCIENCE Vol. 29 ( 2 ) page： 502 - 507 2024.3

Language：English Publisher：Journal of Orthopaedic Science

Background: This study aimed to characterize the anatomical relationship between the spine, the celiac artery (CA), and the median arcuate ligament using preoperative contrast-enhanced computed tomography (CT) images of patients with spinal deformity who underwent surgical correction. Methods: This retrospective study included 81 consecutive patients (34 males, 47 females; average age: 70.2 years). The spinal level at which the CA originated, the diameter, extent of stenosis, and calcification were determined using CT sagittal images. Patients were divided into two groups: CA stenosis group and non-stenosis group. Factors associated with stenosis were examined. Results: CA stenosis was observed in 17 (21%) patients. CA stenosis group had significantly higher body mass index (24.9 ± 3.9 vs. 22.7 ± 3.7, p = 0.03). In the CA stenosis group, J-type CA (upward angling of the course by more than 90° immediately after descending) was more frequently observed (64.7% vs. 18.8%, p < 0.001). The CA stenosis group had lower pelvic tilt (18.6 ± 6.7 vs. 25.1 ± 9.9, p = 0.02) than non-stenosis group. Conclusions: High BMI, J-type, and shorter distance between CA and MAL were risk factors for CA stenosis in this study. Patients with high BMI undergoing fixation of multiple intervertebral corrective fusions at the thoracolumbar junction should undergo preoperative CT evaluation of the anatomy of CA to assess the poteitial risk of celiac artery compression syndrome.

DOI： 10.1016/j.jos.2023.02.015

特集整形外科領域における医療安全最前線各論脊椎脊髄手術を安全に施行するための術中脊髄モニタリング

世木直喜, 中島宏彰, 今釜史郎

関節外科　基礎と臨床 Vol. 43 ( 2 ) page： 168 - 176 2024.2

Cellular senescence is associated with osteonecrosis of the femoral head while mesenchymal stem cell conditioned medium inhibits bone collapse Reviewed Open Access

Okamoto, M; Nakashima, H; Sakai, K; Takegami, Y; Osawa, Y; Watanabe, J; Ito, S; Hibi, H; Imagama, S

SCIENTIFIC REPORTS Vol. 14 ( 1 ) page： 3329 2024.2

Language：English Publisher：Scientific Reports

Osteonecrosis of the femoral head (ONFH) is a type of ischemic osteonecrosis that causes pain, loss of function, and femoral head collapse. Here, we analyzed samples of femoral heads excised from patients with ONFH to clarify the relationship between ischemic osteonecrosis and cellular senescence. X-gal staining was strong and p16INK4a-positive cells were abundant in the transitional region of ONFH. The β-galactosidase-positive cells in the transitional region were also positive for nestin, periostin, or DMP-1. In contrast, no β-galactosidase-positive cells were detected in the healthy region. The senescence-associated p16INK4a, p21, and p53 were upregulated in ONFH tissue. We also examined and analyzed a mouse ischemic femoral osteonecrosis model in vivo to verify the association between ONFH and cellular senescence. Human mesenchymal stem cell-conditioned medium (MSC-CM) was administered to determine its therapeutic efficacy against cellular senescence and bone collapse. MSC-CM reduced the number of senescent cells and downregulated the aforementioned senescence-related genes. It also decreased the number of empty lacunae 4 weeks after ischemia induction and promoted bone formation. At 6 weeks post-surgery, MSC-CM increased the trabecular bone volume, thereby suppressing bone collapse. We conclude that cellular senescence is associated with ONFH and that MSC-CM suppresses bone collapse in this disorder.

DOI： 10.1038/s41598-024-53400-w

Do Postural and Walking Stabilities Change over a Decade by Aging? A Longitudinal Study Reviewed Open Access

Segi, N; Nakashima, H; Ito, S; Ouchida, J; Oishi, R; Yamauchi, I; Miyairi, Y; Morita, Y; Takegami, Y; Ishizuka, S; Seki, T; Hasegawa, Y; Imagama, S

JOURNAL OF CLINICAL MEDICINE Vol. 13 ( 4 ) 2024.2

Language：English Publisher：Journal of Clinical Medicine

Background: Previous studies have demonstrated that the center of gravity (COG) is more unstable in the elderly than in young people. However, it is unclear whether aging itself destabilizes the COG. This study aimed to investigate changes in COG sway and gait kinematics over time by a longitudinal study of middle-aged and elderly adults. Methods: This study included 198 healthy middle-aged and elderly people who underwent stabilometry at ten-year intervals. The participants’ mean age at baseline was 62.9 ± 6.5 years, and 77 (39%) of them were male. The results of stabilometry (mean velocity, sway area, postural sway center in the medial–lateral direction [X center], and postural sway center in the anterior–posterior direction [Y center]), and results of exercise tests (the height-adjusted maximum stride length [HMSL] and the 10 m walk test [10MWT]) were analyzed. The destabilized group with 11 participants, whose mean velocity exceeded 3 cm/s after 10 years, was compared with the stable group with 187 participants, whose mean velocity did not exceed 3 cm/s. Results: Mean velocity increased significantly over ten years (open-eye, from 1.53 ± 0.42 cm to 1.86 ± 0.67 cm, p < 0.001); however, the sway area did not change significantly. X center showed no significant change, whereas Y center showed a significant negative shift (open-eye, from −1.03 ± 1.28 cm to −1.60 ± 1.56 cm, p < 0.001). Although the results of 10MWT and initial HMSL did not differ significantly, the HMSL in the destabilized group at ten years was 0.64, which was significantly smaller than the 0.72 of others (p = 0.019). Conclusions: The ten-year changes in COG sway in middle-aged and elderly adults were characterized by a significant increase in mean velocity but no significant difference in sway area. Because the destabilized group had significantly smaller HMSL at ten years, instability at the onset of movement is likely to be affected by COG instability.

DOI： 10.3390/jcm13041081

Early versus delayed weight bearing after internal fixation for femoral neck fracture in younger adults: A multicenter retrospective study Reviewed

Hasegawa, K; Takegami, Y; Tokutake, K; Nakashima, H; Mishima, K; Kobayashi, K; Imagama, S

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED Vol. 55 ( 2 ) page： 111292 2024.2

Language：English Publisher：Injury

Introduction: Femoral neck fracture (FNF) is among the most common and devastating injuries that orthopedic surgeons encounter. However, the incidence of FNF is lower in younger adults than in elderly individuals. In elderly FNF patients, early weight bearing (EWB) is preferred to prevent loss of function and decreased activity. In younger adults, some surgeons decide on delayed-weight bearing (DWB) after surgery because EWB may cause femoral neck shortening. We aimed to compare the postoperative results (clinical outcome, radiological evaluation, and complications) of EWB and DWB after FNF surgery in younger adults. Methods: The study included 151 younger adults (age: ≤65 years at injury; nondisplaced, n = 100; displaced, n = 51) who underwent internal fixation at 11 university-affiliated hospitals in 2016–2020, and who were followed for ≥1 year. Patients were divided into the EWB (EWB in early postoperative period) and DWB (beginning weight bearing at 4 weeks after surgery) groups. The two groups were matched for age, and nondisplaced (EWB and DWB, both n = 24) and displaced (EWB and DWB, both n = 11) FNF were analyzed. The study items were age, sex, body mass index (BMI), Charlson Comorbidity Index (CCI), presence of diabetes, days waiting for surgery, fracture type, Parker mobility score (PMS) at last follow-up examination, pain (Numerical Rating Scale: NRS), radiological evaluation (femoral neck shortening, Canulated Cancellous screws (CCS) backout, and complications (nonunion, femoral head osteonecrosis). Results: The patient backgrounds of the nondisplaced and displaced types did not differ. The PMS was significantly higher in the DWB group at the last follow-up examination (nondisplaced: 8.00±2.20 vs. 6.67±2.22, p = 0.005, displaced: 8.67±0.89 vs. 6.91±2.77, p<0.001). NRS and the amount of femoral neck shortening were significantly lower in the DWB group (nondisplaced: 1.65±0.70 mm vs. 3.94±3.03 mm, p<0.001, displaced: 4.26± 2.64 mm vs. 8.91±5.69 mm, p<0.001). CCS backout did not differ between the groups. One case of each of nonunion and femoral head osteonecrosis were observed in the displaced EWB and DWB groups; these differences were not significant. Conclusions: DWB after internal fixation for FNF in younger adults was associated with better outcomes than EWB.

DOI： 10.1016/j.injury.2023.111292

Response to the Letter to the Editor: Evaluation of the Association between Neck Pain and the Trapezius Muscles in Patients with Cervical Myelopathy Using Motor Evoked Potential: A Retrospective Study Reviewed Open Access

Ito, S; Sakai, Y; Harada, A; Ando, K; Kobayashi, K; Nakashima, H; Machino, M; Kambara, S; Inoue, T; Hida, T; Ito, K; Ishiguro, N; Imagama, S

ASIAN SPINE JOURNAL Vol. 18 ( 1 ) page： 160 - 161 2024.2

Rod fracture after multiple-rod technique for adult spinal deformity: a case report Reviewed Open Access

Yamauchi, I; Nakashima, H; Machino, M; Ito, S; Segi, N; Tauchi, R; Ohara, T; Kawakami, N; Imagama, S

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 86 ( 1 ) page： 135 - 141 2024.2

Language：English Publisher：Nagoya Journal of Medical Science

Here we report the case of a 71-year-old woman who complained of lower back and left leg pain due to rod fracture following instrumented fusion using the lateral lumbar interbody fusion and multi-rod technique to treat adult spinal deformity. Radiographic images revealed bilateral rod fractures at L4-5 and pseudoarthrosis at L2-5; lower lumbar lordosis was minimal, but upper lumbar hyperlordosis was noted. The patient underwent revision surgery, which included posterior spinal instrument replacement, L3-4 and L4-5 lateral lumbar interbody fusion cage removal, and L4 vertebral body replacement via the anterior approach. This is a rare case of reoperation with the multi-rod technique. Revision surgery should be performed in consideration of the proportion of lumbar lordosis and anterior bony fusion as the posterior component is resected and bony fusion can only be achieved anteriorly.

DOI： 10.18999/nagjms.86.1.135

特集始まった! 脊椎ロボット手術ロボット支援脊椎手術-Mazor Xを用いた脊椎手術の有用性と課題

金村徳相, 都島幹人, 富田浩之, 森下和明, 大島和馬, 中島宏彰

脊椎脊髄ジャーナル Vol. 37 ( 1 ) page： 25 - 38 2024.1

連載最新原著レビュー地域住民中高齢者における頚部痛と神経障害性疼痛の関係

町野正明, 中島宏彰, 今釜史郎

整形外科 Vol. 75 ( 1 ) page： 71 - 75 2024.1

Implant-Related Complications after Spinal Fusion: A Multicenter Study Reviewed Open Access

Koshimizu, H; Nakashima, H; Ohara, T; Tauchi, R; Kanemura, T; Shinjo, R; Machino, M; Ito, S; Ando, K; Imagama, S

GLOBAL SPINE JOURNAL Vol. 14 ( 1 ) page： 74 - 81 2024.1

Language：English Publisher：Global Spine Journal

Study Design: Retrospective analysis of prospectively database Objective: Implant-related complications are an extremely important issue because they pose a burden to patients who underwent surgery. An understanding of these complications can help improve the postoperative management of patients undergoing spinal surgery. The current large-scale multicenter study aimed to identify postoperative implant-related complications that may require revision surgery. Methods: In total, 3447 patients who underwent spinal fusion surgery were included in the analysis. Data about age at surgery, sex, preoperative diagnosis, surgical level, type of implant-related complications, causes of reoperation, and time from the initial to revision surgery were reviewed. Moreover, the characteristics of reoperation in 3 periods (within 30, 31–90, and over 90 days) were assessed. Result: The overall incidence of implant-related complications was 4.6%. Adult spinal deformity was the most common diagnosis (9.9%), and thoracic-lumbar-sacral (42.9%) was the most common surgical level among patients with implant-related complications. Further, screw malposition was the most frequent implant-related complication (42.8%). In total, 89 (2.6%) patients underwent reoperation due to implant-related complications. The main causes of reoperation within 30, 31–90, and over 90 days were screw malposition (72.2%), screw loosening or pull out (81.8%), and rod or screw fracture (60.9%), respectively. Conclusion: To the best of our knowledge, this was the first large-scale multicenter study that assessed the characteristics of patients who underwent reoperation due to spinal implant-related complications. The study results could improve the preoperative informed consent procedure about spinal fusion.

DOI： 10.1177/21925682221094267

Pedicular kinking during posterior corrective procedure for thoracolumbar kyphoscoliosis with unstable osteoporotic fracture Reviewed Open Access

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

JOURNAL OF ORTHOPAEDIC SCIENCE Vol. 29 ( 1 ) page： 409 - 412 2024.1

Prognostic Factors for Respiratory Dysfunction for Cervical Spinal Cord Injury and/or Cervical Fractures in Elderly Patients: A Multicenter Survey Reviewed Open Access

Hirota, R; Terashima, Y; Ohnishi, H; Yamashita, T; Yokogawa, N; Sasagawa, T; Ando, K; Nakashima, H; Segi, N; Funayama, T; Eto, F; Yamaji, A; Watanabe, K; Yamane, J; 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; 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; Kato, S

GLOBAL SPINE JOURNAL Vol. 14 ( 1 ) page： 101 - 112 2024.1

Language：English Publisher：Global Spine Journal

Study design: Retrospective Cohort Study Objective: The purpose of this study was to investigate the prognosis of respiratory function in elderly patients with cervical spinal cord injury (SCI) and to identify predictive factors. Methods: We included 1353 cases of elderly cervical SCI patients collected from 78 institutions in Japan. Patients who required early tracheostomy and ventilator management and those who developed respiratory complications were defined as the respiratory disability group. Patients’ background characteristics, injury mechanism, injury form, neurological disability, complications, and treatment methods were compared between the disability and non-disability groups. Multiple logistic regression analysis was used to examine the independent factors. Patients who required respiratory management for 6 months or longer after injury and those who died of respiratory complications were classified into the severe disability group and were compared with minor cases who were weaned off the respirator. Results: A total of 104 patients (7.8%) had impaired respiratory function. Comparisons between the disabled and non-disabled groups and between the severe and mild injury groups yielded distinct trends. In multiple logistic regression analysis, age, blood glucose level, presence of ossification of posterior longitudinal ligament (OPLL), anterior vertebral hematoma, and critical paralysis were selected as independent risk factors. Conclusion: Age, OPLL, severe paralysis, anterior vertebral hematoma, hypoalbuminemia, and blood glucose level at the time of injury were independent factors for respiratory failure. Hyperglycemia may have a negative effect on respiratory function in this condition.

DOI： 10.1177/21925682221095470

Trabecular Bone Remodeling as a New Indicator of Osteointegration After Posterior Lumbar Interbody Fusion Reviewed Open Access

Segi, N; Nakashima, H; Shinjo, R; Kagami, Y; Ando, K; Machino, M; Ito, S; Koshimizu, H; Tomita, H; Ouchida, J; Imagama, S

GLOBAL SPINE JOURNAL Vol. 14 ( 1 ) page： 25 - 32 2024.1

Language：English Publisher：Global Spine Journal

Study Design: Retrospective cohort study. Objectives: We newly found that trabecular bone remodeling (TBR) often appeared in the fixed adjacent vertebrae during bony fusion. Thus, TBR might indicate osteointegration. Hence, we aimed to investigate whether TBR in the early postoperative period could predict future bony fusion after posterior lumbar interbody fusion (PLIF). Methods: We retrospectively analyzed 78 patients who underwent one-level PLIF. Demographic data were reviewed. Using computed tomography (CT) images taken at 3 months and 1 year postoperatively, we investigated the vertebral endplate cyst (VEC) formation, TBR in the vertebral body, cage subsidence, and clear zone around pedicle screw (CZPS). Results: TBR had high interobserver reliability regardless of cage materials. VECs, TBR, and both were found in 30, 53, and 16 patients at 3 months postoperatively and in 30, 65, and 22 patients at 1 year postoperatively, respectively. The incidence of VEC, which indicates poor fixation, was lower in early (3 months postoperatively) TBR-positive patients, with a significant difference at 1 year postoperatively (3 months, P =.074; 1 year, P =.003). Furthermore, 3 (5.7%) of the 53 early TBR-positive patients had CZPS without instability at 1 year postoperatively. In 25 TBR-negative patients, 1 (4.0%) had pedicle screw cutout requiring reoperation, 1 (4.0%) had pseudarthrosis, and 4 (16%) had CZPS. Conclusions: Patients with early TBR (3 months) did not experience pedicle screw cutout nor pseudarthrosis and had significantly fewer VECs than those without early TBR. Thus, TBR may be a new radiological marker of initial fixation after PLIF.

DOI： 10.1177/21925682221090484

Reply to "Letter to the Editor Concerning 'Trabecular Bone Remodeling as a New Indicator of Osteointegration After Posterior Lumbar Interbody Fusion.' by Segi et al. " Reviewed Open Access

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

GLOBAL SPINE JOURNAL Vol. 14 ( 1 ) page： 353 - 354 2024.1

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 Reviewed

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 Vol. Annual62 ( Abstract ) page： 186_1 - 186_1 2024

Language：Japanese Publisher：公益社団法人日本生体医工学会

<p>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．</p><p>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．</p><p>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．</p><p>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．</p><p>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．</p><p>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．</p><p>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．</p>

DOI： 10.11239/jsmbe.annual62.186_1

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

Segi Naoki, Nakashima Hiroaki, Ito Sadayuki, Ouchida Jun, Yokogawa Noriaki, Sasagawa Takeshi, Furuya Takeo, Yunde Atsushi, Funayama Toru, Eto Fumihiko, Watanabe Kota, Nori Satoshi, Ikegami Shota, Uehara Masashi, Hashimoto Ko, Onoda Yoshito, Nakajima Hideaki, Suzuki Hidenori, Imajo Yasuaki, Yamada Tomohiro, Hasegawa Tomohiko, Kawaguchi Kenichi, Haruta Yohei, Terashima Yoshinori, Hirota Ryosuke, Tonomura Hitoshi, Sakata Munehiro, Iizuka Yoichi, Uei Hiroshi, Suzuki Nobuyuki, Akeda Koji, Tominaga Hiroyuki, Seki Shoji, Oshima Yasushi, Kaito Takashi, Otsuki Bungo, Nakanishi Kazuo, Kakutani Kenichiro, Funao Haruki, Yoshii Toshitaka, Sakai Daisuke, Ohba Tetsuro, Miyazaki Masashi, Terai Hidetomi, Inoue Gen, Okada Seiji, Imagama Shiro, Kato Satoshi

Spine Surgery and Related Research Vol. 8 ( 6 ) page： 560 - 567 2024

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

<p>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.</p><p>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.</p><p>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.</p><p>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.</p>

DOI： 10.22603/ssrr.2024-0030

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

Morita Yoshinori, Nakashima Hiroaki, Segi Naoki, Ito Sadayuki, Ouchida Jun, Oishi Ryotaro, Yamauchi Ippei, Miyairi Yuichi, Tsushima Mikito, Ito Kenyu, Tomita Hiroyuki, Morishita Kazuaki, Kanemura Tokumi, Imagama Shiro

Spine Surgery and Related Research Vol. 8 ( 6 ) page： 623 - 630 2024

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

<p>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.</p><p>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.</p><p>Results: Muscle weakness was observed preoperatively in ten patients. Nine patients had complete recovery of muscle weakness (<i>p</i><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 (<i>p</i>=0.003). The bony fragment occupancy rate in the spinal canal was decreased from 44.0% to 40.2% postoperatively (<i>p</i>=0.04) and to 33.1% at 1 year (<i>p</i>=0.002). The local angle was corrected from 8.3° to −2.6° postoperatively (<i>p</i>=0.003) and to 1.2° at 1 year. The local height was corrected from 26.7 to 32.0 mm postoperatively (<i>p</i><0.001) and to 29.8 mm at 1 year.</p><p>Conclusions: LP-IDR for OVF with neurological symptoms provided sufficient neurological improvement with expansion of the spinal canal over time.</p>

DOI： 10.22603/ssrr.2024-0013

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 Naoki, Nakashima Hiroaki, Ito Sadayuki, Ouchida Jun, Yokogawa Noriaki, Sasagawa Takeshi, Funayama Toru, Eto Fumihiko, Watanabe Kota, Nori Satoshi, Furuya Takeo, Yunde Atsushi, Terashima Yoshinori, Hirota Ryosuke, Nakajima Hideaki, Yamada Tomohiro, Hasegawa Tomohiko, Kawaguchi Kenichi, Haruta Yohei, Hashimoto Ko, Onoda Yoshito, Nakanishi Kazuo, Misaki Kosuke, Ikegami Shota, Uehara Masashi, Suzuki Hidenori, Imajo Yasuaki, Uei Hiroshi, Sawada Hirokatsu, Terai Hidetomi, Tamai Koji, Kuroda Akiyoshi, Inoue Gen, Suzuki Nobuyuki, Kato Kenji, Akeda Koji, Takegami Norihiko, Iizuka Yoichi, Oshima Yasushi, Tonomura Hitoshi, Kiyasu Katsuhito, Funao Haruki, Yoshii Toshitaka, Ishihara Masayuki, Kaito Takashi, Seki Shoji, Kakutani Kenichiro, Tominaga Hiroyuki, Ohba Tetsuro, Sakai Daisuke, Otsuki Bungo, Miyazaki Masashi, Okada Seiji, Imagama Shiro, Kato Satoshi

Spine Surgery and Related Research Vol. 8 ( 5 ) page： 473 - 479 2024

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

<p>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.</p><p>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).</p><p>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.</p><p>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.</p>

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 Reviewed Open Access

Uehara Masashi, Ikegami Shota, Takizawa Takashi, Oba Hiroki, Yokogawa Noriaki, Sasagawa Takeshi, Nakashima Hiroaki, Segi Naoki, Ito Sadayuki, Funayama Toru, Eto Fumihiko, Yamaji Akihiro, Watanabe Kota, Nori Satoshi, Takeda Kazuki, Furuya Takeo, Yunde Atsushi, Nakajima Hideaki, Yamada Tomohiro, Hasegawa Tomohiko, Terashima Yoshinori, Hirota Ryosuke, Suzuki Hidenori, Imajo Yasuaki, Tonomura Hitoshi, Sakata Munehiro, Hashimoto Ko, Onoda Yoshito, Kawaguchi Kenichi, Haruta Yohei, Suzuki Nobuyuki, Kato Kenji, Uei Hiroshi, Sawada Hirokatsu, Nakanishi Kazuo, Misaki Kosuke, Terai Hidetomi, Tamai Koji, Kuroda Akiyoshi, Inoue Gen, Kakutani Kenichiro, Kakiuchi Yuji, Kiyasu Katsuhito, Tominaga Hiroyuki, Tokumoto Hiroto, Iizuka Yoichi, Takasawa Eiji, Akeda Koji, Takegami Norihiko, Funao Haruki, Oshima Yasushi, Kaito Takashi, Sakai Daisuke, Yoshii Toshitaka, Ohba Tetsuro, Otsuki Bungo, Seki Shoji, Miyazaki Masashi, Ishihara Masayuki, Okada Seiji, Imagama Shiro, Kato Satoshi

Spine Surgery and Related Research Vol. 8 ( 6 ) page： 575 - 582 2024

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

<p>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.</p><p>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.</p><p>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.</p><p>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.</p>

DOI： 10.22603/ssrr.2023-0118

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 Yujiro, Nakashima Hiroaki, Segi Naoki, Shinjo Ryuichi, Imagama Shiro

Spine Surgery and Related Research Vol. 8 ( 3 ) page： 353 - 353 2024

Automated Detection of the Thoracic Ossification of the Posterior Longitudinal Ligament Using Deep Learning and Plain Radiographs Reviewed 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 Vol. 2023 page： 8495937 2023.11

Language：English Publisher：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

Deep learning-based prediction model for postoperative complications of cervical posterior longitudinal ligament ossification Reviewed

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 Vol. 32 ( 11 ) page： 3797 - 3806 2023.11

Language：English Publisher：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 Reviewed 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 Vol. 28 ( 6 ) page： 1207 - 1213 2023.11

Language：English Publisher：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 Reviewed

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 Vol. 32 ( 10 ) page： 3522 - 3532 2023.10

Language：English Publisher：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 Reviewed

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

EUROPEAN SPINE JOURNAL Vol. 32 ( 10 ) page： 3608 - 3615 2023.10

Language：English Publisher：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. Reviewed 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 Vol. 12 ( 9 ) page： 603 - 616 2023.9

Language：English Publisher：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

Preoperative Symptom Duration Influences Neurological Recovery and Patient-Reported Outcome Measures After Surgical Treatment of Cervical Ossification of the Posterior Longitudinal Ligament Reviewed

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

SPINE Vol. 48 ( 18 ) page： 1259 - 1265 2023.9

Language：English Publisher：Spine

Study Design: A prospective multicenter study. Objective: To investigate the effect of preoperative symptom duration on neurological recovery for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL). Summary of Background Data: The optimal timing to perform surgery in the setting of cervical OPLL remains unknown. It is important to know the influence of symptom duration on postoperative outcomes to facilitate discussions regarding the timing of surgery. Patients and Methods: The study included 395 patients (291 men and 104 women; mean age, 63.7 ± 11.4 yr): 204 were treated with laminoplasty, 90 with posterior decompression and fusion, 85 with anterior decompression and fusion, and 16 with other procedures. The Japanese Orthopedic Association (JOA) score and patient-reported outcomes of the JOA Cervical Myelopathy Evaluation Questionnaire were used to assess clinical outcomes preoperatively and 2 years after surgery. Logistic regression analysis was used to identify factors associated with the achievement of minimum clinically important difference (MCID) after surgery. Results: The recovery rate was significantly lower in the group with symptom duration of ≥5 years compared with the groups with durations of <0.5 years, 0.5 to 1 year, and 1 to 2 years. Improvement of JOA Cervical Myelopathy Evaluation Questionnaire in the upper extremity function score (P < 0.001), lower extremity function (P = 0.039), quality of life (P = 0.053), and bladder function (P = 0.034) were all decreased when the symptom duration exceeded 2 years. Duration of symptoms (P = 0.001), age (P < 0.001), and body mass index (P < 0.001) were significantly associated with the achievement of MCID. The cutoff value we established for symptom duration was 23 months (area under the curve, 0.616; sensitivity, 67.4%; specificity, 53.5%). Conclusions: Symptom duration had a significant impact on neurological recovery and patient-reported outcome measures in this series of patients undergoing surgery for cervical OPLL. Patients with symptom duration exceeding 23 months may be at greater risk of failing to achieve MCID after surgery. Level of Evidence. 3.

DOI： 10.1097/BRS.0000000000004762

Association between Locomotive Syndrome and Hearing Loss in Community-Dwelling Adults Reviewed Open Access

Ito, S; Nakashima, H; Segi, N; Ouchida, J; Ishizuka, S; Takegami, Y; Yoshida, T; Hasegawa, Y; Imagama, S

JOURNAL OF CLINICAL MEDICINE Vol. 12 ( 17 ) 2023.9

Language：English Publisher：Journal of Clinical Medicine

The relationship between hearing and motor function as a function of aging is unclear. Therefore, we aimed to clarify the relationship between age-related hearing loss and locomotive syndrome. In total, 240 participants aged ≥40 years, whose hearing acuity and motor function had been measured, were included in this study. Patients with a hearing acuity of <35 dB and ≥35 dB were categorized into normal and low hearing acuity groups, respectively. Motor function was compared according to sex between the groups. Among men, those in the low hearing acuity group (51/100) were older, had a significantly slower walking speed, and had a higher prevalence of locomotive syndrome than those in the normal group. Among women, those in the low hearing group (14/140) were older and had a significantly slower gait speed than those in the normal group. The multivariate analysis showed that, in the low hearing acuity group, age and gait speed were risk factors in men, while age was the only risk factor in women. In conclusion, hearing loss was associated with walking speed. The association between hearing loss and locomotive syndrome was observed only in men. In the multivariate analysis, hearing loss was associated with walking speed only in men.

DOI： 10.3390/jcm12175626

Utility of ultrasonography in the diagnosis of lumbar spondylolysis in adolescent patients Reviewed Open Access

Nakashima, H; Yoneda, M; Machino, M; Ito, S; Segi, N; Tomita, H; Ouchida, J; Imagama, S

JOURNAL OF ORTHOPAEDIC SCIENCE Vol. 28 ( 5 ) page： 955 - 960 2023.9

Language：English Publisher：Journal of Orthopaedic Science

Background: This study aims to investigate the utility of the Doppler effect on ultrasonography for the diagnosis of very early- and early-stage lumbar spondylolysis in adolescent patients. Methods: In total, 76 adolescent patients with acute and subacute low back pain were prospectively enrolled, with 46 having lumbar spondylolysis and the remaining 30 having low back pain without spondylolysis. MRI and/or computed tomograms scans revealed very early- and early-stage lumbar spondylolysis. Furthermore, positive Doppler findings in ultrasonography around the area from the facet joint to the laminae were investigated. Results: There were no significant differences in age (p > 0.99) and body mass index (p = 0.11) between cases with and without spondylolysis. Very early- and early-stage spondylolysis were observed in 27.6% and 72.4% of patients, respectively. Positive power Doppler was 91.3% and 33.3% in cases with and without spondylolysis, respectively, which was significantly higher in spondylolysis (p < 0.001). The sensitivity and specificity of this positive power Doppler were 91.4% and 66.7%, respectively. Furthermore, the rate of positive power Doppler was significantly higher in early-stage spondylolysis (p = 0.02), with 75.0% and 97.6% sensitivity in very early- and early-stage spondylolysis, respectively. Conclusions: A positive Doppler effect on ultrasonography is effective for screening very early- and early-stage spondylolysis in adolescent patients in an outpatient clinic.

DOI： 10.1016/j.jos.2022.06.019

Factors Associated With Loss of Cervical Lordosis After Laminoplasty for Patients With Cervical Ossification of the Posterior Longitudinal Ligament Data From a Prospective Multicenter Study Reviewed

Nakashima, H; Imagama, S; 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; Takahata, M; Mori, K; Nakajima, H; Murata, K; Miyagi, M; Kaito, T; Yamada, K; Banno, T; Kato, S; Ohba, T; Moridaira, H; Fujibayashi, S; Katoh, H; Kanno, H; Taneichi, H; Kawaguchi, Y; Takeshita, K; Nakamura, M; Okawa, A; Yamazaki, M

SPINE Vol. 48 ( 15 ) page： 1047 - 1056 2023.8

Language：English Publisher：Spine

Study Design. A prospective multicenter study. Objective. The objective of this study was to investigate the incidence of loss of cervical lordosis after laminoplasty for cervical ossification of the posterior longitudinal ligament (OPLL). We also sought to determine associated risk factors and the relationship with patient-reported outcomes. Summary of Background Data. Loss of cervical lordosis is a sequelae often observed after laminoplasty, which may adversely impact surgical outcomes. Cervical kyphosis, especially in OPLL, is associated with reoperation, but risk factors and relationship to postoperative outcomes remain understudied at this time. Materials and Methods. This study was conducted by the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. We included 165 patients who underwent laminoplasty and completed Japanese Orthopaedic Association (JOA) score or Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaires (JOACMEQ), as well as Visual Analog Scales (VAS) for pain, with imaging. The participants were divided into two groups: those with loss of cervical lordosis of >10° or 20° after surgery and those without loss of cervical lordosis. A paired t test was applied to evaluate the association between changes in cervical spinal angles, range of motion, and cervical JOA and VAS scores before and at 2 years postoperatively. Mann-Whitney U test was used for JOACMEQ. Results. Postoperative loss of cervical lordosis >10° and >20° was observed in 32 (19.4%) and 7 (4.2%), respectively. JOA, JOACMEQ, and VAS scores were not significantly different between those with, and without, loss of cervical lordosis. Preoperative small extension range of motion (eROM) was significantly associated with postoperative loss of cervical lordosis, and the cutoff values of eROM were 7.4° [area under the curve (AUC): 0.76] and 8.2° (AUC: 0.92) for loss of cervical lordosis >10° and >20°, respectively. A large occupation ratio of OPLL was also associated with loss of cervical lordosis, with a cutoff value of 39.9% (AUC: 0.94). Laminoplasty resulted in functional improvement in most patient-reported outcomes; however, neck pain and bladder function tended to become worse postoperatively in cases with postoperative loss of cervical lordosis >20°. Conclusions. JOA, JOACMEQ, and VAS scores were not significantly different between those with, and without, loss of cervical lordosis. Preoperative small eROM and large OPLL may represent factors associated with loss of cervical lordosis after laminoplasty in patients with OPLL.

DOI： 10.1097/BRS.0000000000004706

Automated Detection and Diagnosis of Spinal Schwannomas and Meningiomas Using Deep Learning and Magnetic Resonance Imaging Reviewed Open Access

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

JOURNAL OF CLINICAL MEDICINE Vol. 12 ( 15 ) 2023.8

Language：English Publisher：Journal of Clinical Medicine

Spinal cord tumors are infrequently identified spinal diseases that are often difficult to diagnose even with magnetic resonance imaging (MRI) findings. To minimize the probability of overlooking these tumors and improve diagnostic accuracy, an automatic diagnostic system is needed. We aimed to develop an automated system for detecting and diagnosing spinal schwannomas and meningiomas based on deep learning using You Only Look Once (YOLO) version 4 and MRI. In this retrospective diagnostic accuracy study, the data of 50 patients with spinal schwannomas, 45 patients with meningiomas, and 100 control cases were reviewed, respectively. Sagittal T1-weighted (T1W) and T2-weighted (T2W) images were used for object detection, classification, training, and validation. The object detection and diagnosis system was developed using YOLO version 4. The accuracies of the proposed object detections based on T1W, T2W, and T1W + T2W images were 84.8%, 90.3%, and 93.8%, respectively. The accuracies of the object detection for two spine surgeons were 88.9% and 90.1%, respectively. The accuracies of the proposed diagnoses based on T1W, T2W, and T1W + T2W images were 76.4%, 83.3%, and 84.1%, respectively. The accuracies of the diagnosis for two spine surgeons were 77.4% and 76.1%, respectively. We demonstrated an accurate, automated detection and diagnosis of spinal schwannomas and meningiomas using the developed deep learning-based method based on MRI. This system could be valuable in supporting radiological diagnosis of spinal schwannomas and meningioma, with a potential of reducing the radiologist’s overall workload.

DOI： 10.3390/jcm12155075

Genetic insights into ossification of the posterior longitudinal ligament of the spine Reviewed Open Access

Koike, Y; Takahata, M; Nakajima, M; Otomo, N; Suetsugu, H; Liu, XX; Endo, T; Imagama, S; Kobayashi, K; Kaito, T; Kato, S; Kawaguchi, Y; Kanayama, M; Sakai, H; Tsuji, T; Miyamoto, T; Inose, H; Yoshii, T; Kashii, M; Nakashima, H; Ando, K; Taniguchi, Y; Takeuchi, K; Ito, S; Tomizuka, K; Hikino, K; Iwasaki, Y; Kamatani, Y; Maeda, S; Nakajima, H; Mori, K; Seichi, A; Fujibayashi, S; Kanchiku, T; Watanabe, K; Tanaka, T; Kida, K; Kobayashi, S; Takahashi, M; Yamada, K; Takuwa, H; Lu, HF; Niida, S; Ozaki, K; Momozawa, Y; Yamazaki, M; Okawa, A; Matsumoto, M; Iwasaki, N; Terao, C; Ikegawa, S

ELIFE Vol. 12 2023.7

Language：English Publisher：Elife

Ossification of the posterior longitudinal ligament of the spine (OPLL) is an intractable disease leading to severe neurological deficits. Its etiology and pathogenesis are primarily unknown. The relationship between OPLL and comorbidities, especially type 2 diabetes (T2D) and high body mass index (BMI), has been the focus of attention; however, no trait has been proven to have a causal relationship. We conducted a meta-analysis of genome-wide association studies (GWASs) using 22,016 Japanese individuals and identified 14 significant loci, 8 of which were previously unreported. We then conducted a gene-based association analysis and a transcriptome-wide Mendelian randomization approach and identified three candidate genes for each. Partitioning heritability enrichment analyses observed significant enrichment of the polygenic signals in the active enhancers of the connective/bone cell group, especially H3K27ac in chondrogenic differentiation cells, as well as the immune/hematopoietic cell group. Single-cell RNA sequencing of Achilles tendon cells from a mouse Achilles tendon ossification model confirmed the expression of genes in GWAS and post-GWAS analyses in mesenchymal and immune cells. Genetic correlations with 96 complex traits showed positive correlations with T2D and BMI and a negative correlation with cerebral aneurysm. Mendelian randomization analysis demonstrated a significant causal effect of increased BMI and high bone mineral density on OPLL. We evaluated the clinical images in detail and classified OPLL into cervical, thoracic, and the other types. GWAS subanalyses identified subtype-specific signals. A polygenic risk score for BMI demonstrated that the effect of BMI was particularly strong in thoracic OPLL. Our study provides genetic insight into the etiology and pathogenesis of OPLL and is expected to serve as a basis for future treatment development.

DOI： 10.7554/eLife.86514

Comparison of Surgical Outcomes of Anterior and Posterior Fusion Surgeries for K-line (-) Cervical Ossification of the Posterior Longitudinal Ligament A Prospective Multicenter Study Reviewed

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; Sato, Y; 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; Moridaira, H; Fujibayashi, S; Katoh, H; Kanno, H; Watanabe, K; Taneichi, H; Imagama, S; Kawaguchi, Y; Takeshita, K; Nakamura, M; Matsumoto, M; Yamazaki, M

SPINE Vol. 48 ( 13 ) page： 937 - 943 2023.7

Language：English Publisher：Spine

Study Design. A prospective multicenter study. Objective. The objective of this study is to compare the surgical outcomes of anterior and posterior fusion surgeries in patients with K-line (-) cervical ossification of the posterior longitudinal ligament (OPLL). Summary of Background Data. Although laminoplasty is effective for patients with K-line (+) OPLL, fusion surgery is recommended for those with K-line (-) OPLL. However, whether the anterior or posterior approach is preferable for this pathology has not been effectively determined. Materials and Methods. A total of 478 patients with myelopathy due to cervical OPLL from 28 institutions were prospectively registered from 2014 to 2017 and followed up for two years. Of the 478 patients, 45 and 46 with K-line (-) underwent anterior and posterior fusion surgeries, respectively. After adjusting for confounders in baseline characteristics using a propensity score-matched analysis, 54 patients in both the anterior and posterior groups (27 patients each) were evaluated. Clinical outcomes were assessed using the cervical Japanese Orthopaedic Association and the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire. Results. Both approaches showed comparable neurological and functional recovery. The cervical range of motion was significantly restricted in the posterior group because of the large number of fused vertebrae compared with the anterior group. The incidence of surgical complications was comparable between the cohorts, but the posterior group demonstrated a higher frequency of segmental motor paralysis, whereas the anterior group more frequently reported postoperative dysphagia. Conclusions. Clinical improvement was comparable between anterior and posterior fusion surgeries for patients with K-line (-) OPLL. The ideal surgical approach should be informed based on the balance between the surgeon's technical preference and the risk of complications.

DOI： 10.1097/BRS.0000000000004634

Intramedullary cavernous hemangioma of the spinal cord with intra- and extramedullary hematomas Reviewed Open Access

Koshimizu, H; Ando, K; Kobayashi, K; Nakashima, H; Machino, M; Ito, S; Kanbara, S; Inoue, T; Yamaguchi, H; Imagama, S

JOURNAL OF ORTHOPAEDIC SCIENCE Vol. 28 ( 4 ) page： 937 - 941 2023.7

Cervical Spinal Cord Compression in Adult Scoliosis Reviewed Open Access

Nakashima, H; Kawakami, N; Ohara, T; Saito, T; Tauchi, R; Imagama, S

GLOBAL SPINE JOURNAL Vol. 13 ( 6 ) page： 1576 - 1581 2023.7

Language：English Publisher：Global Spine Journal

Study Design: Retrospective cohort study. Objectives: The aim was to examine cervical spinal cord compression (SCC) in adult scoliosis and clarify the prevalence of and risk factors for cervical SCC. Methods: This study included 270 adult scoliosis patients and 1211 healthy volunteers. Cervical SCC was evaluated on cervical magnetic resonance imaging (MRI). The rates of SCC for those with adult scoliosis and the healthy volunteers were compared. Logistic regression analysis was conducted to examine the factors associated with cervical SCC on MRI. Results: In cases with adult scoliosis, preoperative major scoliosis curve was 56.0° ± 18.8°, and cervical SCC was detected in 25 patients (9.3%). Among the healthy volunteers, 64 cases with cervical SCC were detected. Only in cases with adult scoliosis, logistic regression analysis revealed higher age (OR 1.09, 95% CI 1.04–1.14, P <.001), narrow canal diameter (OR 2.27, 95% CI 1.35–3.85, P =.002), and inferior sagittal balance (OR 2.45, 95% CI 1.02–5.89, P =.04) as significant risk factors. In the logistic regression analysis in all subjects (including adult scoliosis and healthy volunteers), higher age (OR 1.08, 95% CI 1.06–1.10, P <.001) and narrow canal diameter (OR 1.62, 95% CI 1.37–1.92, P <.001) were also found to be significant risk factors, but the presence of scoliosis was not a significant factor. Conclusions: Adult scoliosis itself was not significantly associated with cervical SCC. Inferior sagittal balance in addition to scoliosis constituted a significant risk factor for cervical SCC.

DOI： 10.1177/21925682211041979

Differences in Involvement of Whole-Body Compensatory Alignment for Decompensated Spinopelvic Sagittal Balance Reviewed Open Access

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

JOURNAL OF CLINICAL MEDICINE Vol. 12 ( 14 ) 2023.7

Language：English Publisher：Journal of Clinical Medicine

Background: The aim of this study was to investigate the differences in the involvement of whole-body compensatory alignment in different conditions of spinopelvic sagittal balance (compensated/decompensated). Methods: We enrolled 330 individuals who underwent medical checkups and divided them according to sagittal vertical axis (SVA): for the compensated group, this was <4 cm, (group C) and for the decompensated group, it was ≥4 cm, (group D). The correlation between the lack of ideal lumbar lordosis (iLL), which was calculated by using the Schwab formula, and the compensatory radiographic parameters in each group was analyzed. The threshold value of knee flexion (KF) angle, which indicated spinopelvic sagittal imbalance (SVA ≥ 4), was determined by a ROC-curve analysis. Results: The correlation analysis of the lack of iLL and each compensatory parameter showed a strong correlation for pelvic tilt (PT) (r = −0.723), and a weak correlation for thoracic kyphosis (TK) (r = 275) in Group C. In Group D, the correlations were strong for PT (r = −0.796), and moderate for TK (r = 0.462) and KF (r = −0.415). The optimal cutoff value for the KF angle was determined to be 8.4 degrees (sensitivity 89%, specificity 46%). Conclusions: The present study shows differences between compensated/decompensated spinopelvic sagittal balance in the correlation strength between lack of iLL and whole-body compensatory parameters.

DOI： 10.3390/jcm12144690

Residual Neuropathic Pain in Postoperative Patients With Cervical Ossification of Posterior Longitudinal Ligament Reviewed

Miyagi, M; Inoue, G; Yoshii, T; Egawa, S; Sakai, K; Kusano, K; Nakagawa, Y; Hirai, T; Wada, K; Katsumi, K; Kimura, A; Furuya, T; Nagoshi, N; Kanchiku, T; Nagamoto, Y; Oshima, Y; Nakashima, H; Ando, K; Takahata, M; Mori, K; Nakajima, H; Murata, K; Matsunaga, S; Kaito, T; Yamada, K; Kobayashi, S; Kato, S; Ohba, T; Inami, S; Fujibayashi, S; Katoh, H; Kanno, H; Koda, M; Takahashi, H; Ikeda, S; Imagama, S; Kawaguchi, Y; Takeshita, K; Matsumoto, M; Takaso, M; Okawa, A; Yamazaki, M

CLINICAL SPINE SURGERY Vol. 36 ( 6 ) page： E277 - E282 2023.7

Language：English Publisher：Clinical Spine Surgery

Study Design: A prospective multi-institutional observational study. Objective: To investigate and identify risk factors for residual neuropathic pain after surgery in patients with cervical ossification of posterior longitudinal ligament (c-OPLL). Summary of Background Data: Patients with c-OPLL often require surgery for numbness and paralysis of the extremities; however, postoperative neuropathic pain can considerably deteriorate their quality of life. Methods: Out of 479 patients identified from multicenter c-OPLL registries between 2014 and 2017, 292 patients who could be followed up for 2 years postoperatively were reviewed, after excluding patients with nervous system comorbidities. Demographic details; medical history; radiographic factors including the K-line, spinal canal occupancy rate of OPLL, cervical kyphosis angle, and presence of spinal cord myelomalacia; preoperative Japanese Orthopaedic Association (JOA) score; surgical procedure (fusion or decompression surgery); postoperative neurological deterioration; and the visual analogue scale for pain and numbness in the upper extremities (U/E) or trunk/lower extremities (L/E) at baseline and at 2 years postoperatively were assessed. Patients were grouped into residual and non-residual groups based on a postoperative visual analogue scale ≥40 mm. Risk factors for residual neuropathic pain were evaluated by multiple logistic regression analysis. Results: The prevalence of U/E and L/E residual pain in postoperative c-OPLL patients was 51.7% and 40.4%, respectively. The U/E residual group had a poor preoperative JOA score and longer illness duration, and fusion surgery was more common in the residual group than in non-residual group. The L/E residual group was older with a poorer preoperative JOA score. On multivariate analysis, risk factors for U/E residual pain were long illness duration and poor preoperative JOA score, whereas those for L/E residual pain were age and poor preoperative JOA score. Conclusions: The risk factors for residual spinal neuropathic pain after c-OPLL surgery were age, long duration of illness, and poor preoperative JOA score. Level of Evidence: IV.

DOI： 10.1097/BSD.0000000000001449

Spinopelvic Imbalance Is Associated With Increased Sway in the Center of Gravity: Validation of the "Cone of Economy" Concept in Healthy Subjects Reviewed Open Access

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

GLOBAL SPINE JOURNAL Vol. 13 ( 6 ) page： 1502 - 1508 2023.7

Language：English Publisher：Global Spine Journal

Study Design: Cross-sectional study. Objectives: To investigate the effects of pelvic compensation on standing balance in healthy volunteers. Methods: The 180 healthy volunteers were recruited at a basic health checkup. The inclusion criteria were: 1) age ≥ 65 years, 2) underwent a whole spine radiograph and stabilometry, 3) well-balanced standing posture with a sagittal vertical axis <50 mm, and 4) a visual analog scale of lower back pain of <20 mm. Based on the pelvic incidence (PI) and lumbar lordosis (LL) mismatch, subjects were divided into harmonious (PI–LL ≤ 10°) or unharmonious (PI–LL > 10°) groups. Results: Participants in the unharmonious group were significantly older compared with the harmonious group (70.2 ± 4.4 vs. 72.0 ± 4.6 years, P <.01). The PI minus LL values were −2.2° ± 7.5° and 16.6° ± 7.0° in the harmonious and unharmonious groups, respectively (P <.001). Anteroposterior LNG/TIME (average center of pressure sway speed) was significantly greater in the unharmonious group with both open and closed eyes (1.04 ± 0.38 cm/s vs. 1.25 ± 0.47 cm/s, P <.001 and 1.22 ± 0.54 cm/s vs. 1.58 ± 0.77 cm/s, P <.001, respectively). Lateral LNG/TIME was significantly greater in the unharmonious group only with closed eyes (1.24 ± 0.54 cm/s vs. 1.47 ± 0.79 cm/s, P =.03). Conclusions: Healthy elderly subjects with poor spinopelvic harmony had relatively unstable standing balance. The “cone of economy” was demonstrated, showing that unharmonious spinopelvic balance had a non-economic effect on standing.

DOI： 10.1177/21925682211038897

Blunt Cerebrovascular Injury in the Elderly With Traumatic Cervical Spine Injuries: Results of a Retrospective Multi-Center Study of 1512 Cases in Japan Reviewed Open Access

Suzuki, H; Funaba, M; Imajo, Y; Yokogawa, N; Sasagawa, T; Ando, K; Nakashima, H; Segi, N; Funayama, T; Eto, F; Watanabe, K; Yamane, J; Furuya, T; Nakajima, H; Hasegawa, T; Terashima, Y; Ikegami, S; Inoue, G; Kaito, T; Kato, S

JOURNAL OF NEUROTRAUMA Vol. 40 ( 11-12 ) page： 1164 - 1172 2023.6

Language：English Publisher：Journal of Neurotrauma

This study is nationwide retrospective multi-center study to investigate the incidence and characteristics of blunt cerebrovascular injury (BCVI) in elderly Japanese patients with traumatic cervical spine injuries (CSI) including spinal cord injury (SCI) without major bone injury. The study enrolled 1512 patients (average age: 75.8 ± 6.9 years; 1007 males, 505 females) from 33 nationwide institutions, and 391 (26%) of the participants had digital subtraction angiography and/or computed tomography angiography. Fifty-three patients were diagnosed as having BCVI by angiography. We assessed neurological evaluation, comorbidities and classification of CSI in the elderly patients with/without BCVI and collected 6-month follow-up data on treatment, complications, and patient outcome. We also statistically analyzed the relative risk (RR) and relationship between BCVI and other factors. Significant differences were identified between BCVI (+) (n = 53) and (-) (n = 1459) patients with American Spinal Injury Association Impairment Scale (ASIA) A, C, D, cervical fracture, C3-7 injury level (AO type F and/or C), cervical dislocation, spinal surgery for CSI, tetraplegia type of SCI, and/or head injury. Fifty-three (3.5%) elderly patients had CSI complicated by BCVI including 10 (19%) cases of Denver grade I, four (7%) of grade II, 1 (2%) of grade III, 29 (55%) of grade IV, and nine (17%) of grade V. Sixteen cases were treated by interventional radiology. Rates of mortality and brain infarction from BCVI were 0.13% and 0.40%, respectively. RR of BCVI was significantly higher in the elderly cervical injury patients with head injury, severe neurological deficit, ASIA A (RR: 4.33), cervical fracture at the C3-7 level (RR: 7.39), and cervical dislocation at the C1-6 level (RR: 3.06-7.18). In conclusion, 53 (3.5%) elderly patients were complicated with BCVI. BCVI more frequently complicated head injury, severe neurological deficit (ASIA A or tetraplegia), AO type F, and/or C fractures and cervical dislocation in these patients. Six patients (11%) suffered brain infarction and two patients died from BCVI.

DOI： 10.1089/neu.2022.0180

Relationship between lumbosacral transitional vertebra and postoperative outcomes of patients with Lenke 5C adolescent idiopathic scoliosis: a minimum 5-year follow-up study Reviewed

Yamauchi, I; Nakashima, H; Machino, M; Ito, S; Segi, N; Tauchi, R; Ohara, T; Kawakami, N; Imagama, S

EUROPEAN SPINE JOURNAL Vol. 32 ( 6 ) page： 2221 - 2227 2023.6

Language：English Publisher：European Spine Journal

Purpose: To assess the incidence of lumbosacral transitional vertebra (LSTV) in Lenke 5C adolescent idiopathic scoliosis (AIS) and evaluate the relationship between postoperative outcomes and LSTV when the lowest instrumented vertebra (LIV) is fixed at L3. Methods: The study included 61 patients with Lenke 5C AIS who underwent fusion surgery of L3 as the LIV who were followed-up for a minimum of 5 years. Patients were divided into two groups: LSTV + and LSTV-. Demographic, surgical, and radiographic data, including L4 tilt and thoracolumbar/lumbar (TL/L) Cobb angle, were obtained and analyzed. Results: LSTV was observed in 15 patients (24.5%). The L4 tilt was not significantly different between the two groups preoperatively (P = 0.54); however, it was significantly greater in the LSTV group postoperatively (2 weeks: LSTV + = 11.7 ± 3.1, LSTV − = 8.8 ± 3.2, P = 0.013; 2 years: LSTV + = 11.5 ± 3.5, LSTV − = 7.9 ± 4.1, P = 0.006; 5 years: LSTV + = 9.8 ± 3.1, LSTV − = 7.3 ± 4.5, P= 0.042). The postoperative TL/L curve was greater in the LSTV + group, with significant differences at 2 weeks and 2 years postoperatively (preoperative: LSTV + = 53.5 ± 11.2, LSTV − = 51.7 ± 10.3,P = 0.675; 2 weeks: LSTV + = 16.1 ± 5.0, LSTV- = 12.2 ± 6.6, P = 0.027; 2 years: LSTV + = 21.7 ± 5.9, LSTV − = 17.6 ± 5.9, P = 0.035; 5 years: LSTV + = 18.7 ± 5.8, LSTV − = 17.0 ± 6.1, P = 0.205). Conclusion: The prevalence of LSTV in Lenke 5C AIS patients was 24.5%. Lenke 5C AIS patients with LSTV with the LIV at L3 had a significantly greater postoperative L4 tilt than those without LSTV and retained the TL/L curve.

DOI： 10.1007/s00586-023-07752-y

新しい医療技術新しいLLIFの手術手技　ACR法

伊藤研悠, 金村徳相, 中島宏彰, 都島幹人, 富田浩之, 種市洋

整形・災害外科 Vol. 66 ( 6 ) page： 737 - 742 2023.5

Metabolic syndrome reduces spinal range of motion: The Yakumo study Reviewed Open Access

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

JOURNAL OF ORTHOPAEDIC SCIENCE Vol. 28 ( 3 ) page： 547 - 553 2023.5

Language：English Publisher：Journal of Orthopaedic Science

Background: Excess visceral fat can accumulate owing to lack of exercise. The relationship between metabolic syndrome (MetS) and spinal range of motion (ROM) is not clear. The purpose of this study was to investigate the relationship between MetS and spinal alignment and ROM. Methods: Orthopedic evaluation was prospectively performed in 544 participants. The participants were classified into two groups on the basis of the Japanese-specific MetS criteria proposed by the Japanese Committee of the Criteria for MetS (JCCMS). Lower back pain (LBP), knee joint pain with the visual analog scale (VAS), Kellgren–Lawrence (K–L) grade for knee osteoarthritis, body mass index (BMI), and spinal alignment and ROM were evaluated. Results: Forty-four (8.1%) were diagnosed as having MetS. The prevalence rate of K–L grade 4 in the MetS group was significantly higher than that in the non-MetS group (p < 0.05). When sex, age, and BMI were evaluated as covariates, there were significant differences in the VAS score for knee pain (non-MetS group vs MetS group: 13.7 vs 23.3, p < 0.05), L1–S1 flexion spinal ROM (44.1° vs 38.1°, p < 0.001), flexion spinal inclination angle (SIA) ROM (107.6° vs 99.3°, p < 0.01), and SIA ROM (135.4° vs 124.0°, p < 0.05). Conclusions: Knee pain increased and flexion spinal ROM decreased significantly in the MetS group as compared with non-MetS group. Systemic factors associated with MetS may have a specific impact on spinal ROM while promoting knee osteoarthrosis and increased knee pain.

DOI： 10.1016/j.jos.2022.02.008

特集脊椎脊髄領域の画像診断-最新の知識と進歩 Ⅴ.AIを用いた脊椎脊髄疾患の画像診断の進歩深層学習を用いたMRIでの脊髄腫瘍自動診断システム

伊藤定之, 中島宏彰, 町野正明, 小田昌宏, 森健策, 今釜史郎

整形・災害外科 Vol. 66 ( 5 ) page： 657 - 665 2023.4

Anatomical Analysis of the Gonadal Veins and Spine in Lateral Lumbar Interbody Fusion Reviewed Open Access

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

JOURNAL OF CLINICAL MEDICINE Vol. 12 ( 8 ) 2023.4

Language：English Publisher：Journal of Clinical Medicine

Background: The current study aimed to investigate the anatomical position of the gonadal veins (GVs) from the viewpoint of spine surgery and the risk factors associated with lateral lumbar interbody fusion (LLIF). Methods: This retrospective study included 99 consecutive patients. The GV locations were divided into the ventral (V), dorsal medial (DM), and dorsal lateral (DL) sides based on lumbar disk levels on axial contrast-enhanced computed tomography images. The DM region surrounded by the vertebral body and psoas muscle had the highest risk of GV injury. The GV at each intervertebral disk level was examined in terms of laterality and sex. The patients were divided into group M (which included those with GV in the DM region at any vertebral level) and group O (which included those without GV in the DM region at any vertebral level). Then, the two groups were compared. Results: In the case of lower lumbar levels and in women, the GVs were commonly observed in the DM region. Group M had a higher incidence of degenerative scoliosis than group O and a significantly larger Cobb angle. Conclusions: We should pay close attention to the GV location on the preoperative image when using LLIF, particularly in female patients with degenerative scoliosis.

DOI： 10.3390/jcm12083041

Association between Postoperative Neck Pain and Intraoperative Transcranial Motor-Evoked Potential Waveforms of the Trapezius Muscles in Patients with Cervical Myelopathy Who Underwent Cervical Laminoplasty Reviewed Open Access

Ito, S; Sakai, Y; Ando, K; Nakashima, H; Machino, M; Segi, N; Tomita, H; Koshimizu, H; Hida, T; Ito, K; Harada, A; Imagama, S

ASIAN SPINE JOURNAL Vol. 17 ( 2 ) page： 330 - 337 2023.4

Language：English Publisher：Asian Spine Journal

Study Design: Retrospective study. Purpose: Cervical laminoplasty is safe and effective for treating cervical myelopathy but has a higher frequency of postoperative axial pain compared to other methods. Several studies have reported on the causes of postoperative axial pain, but none have fully elucidated them. This study aimed to investigate the association between postoperative neck pain and intraoperative transcranial motor-evoked potential (MEP) waveforms of the trapezius muscles using transcranial MEPs. Overview of Literature: Few studies have investigated the association between postoperative neck pain and intraoperative transcranial MEP waveforms of the trapezius muscles in patients with cervical laminoplasty. Methods: A total of 79 patients with cervical myelopathy who underwent cervical laminoplasty at our facility between June 2010 and March 2013 were included in this study. Intraoperative control and final waveform were evaluated based on the trapezius muscle MEPs by measuring the latency and amplitude. A neck pain group comprised patients with higher neck pain Visual Analog Scale scores from preoperative value to 1 year postoperatively. The cross-sectional areas of the trapezius muscles and the MEP latencies and amplitudes were compared between patients with and without neck pain. Results: The latency and amplitude of the control waveforms were not significantly different between groups. The neck pain group had a significantly shorter final waveform latency (neck pain: 23.6±2.5, no neck pain: 25.8±4.5; p =0.019) and significantly larger amplitude (neck pain: 2,125±1,077, no neck pain: 1,630±966; p =0.041) than the no neck pain group. Conclusions: Postoperative neck pain was associated with the final waveform latency and amplitude of the trapezius muscle MEPs during cervical laminoplasty. Intraoperative electrophysiological trapezius muscle abnormalities could cause postoperative neck pain

DOI： 10.31616/asj.2022.0120

特集低侵襲脊椎手術の功罪腰椎変性疾患に対するLLIFの功罪

金村徳相, 伊藤研悠, 都島幹人, 富田浩之, 長谷康弘, 大島和馬, 大内田隼, 中島宏彰, 今釜史郎

脊椎脊髄ジャーナル Vol. 35 ( 9 ) page： 593 - 601 2023.3

Comparison of the Relationship between Visual Acuity and Motor Function in Non-Elderly and Elderly Adults Reviewed Open Access

Ito, S; Nakashima, H; Machino, M; Segi, N; Ishizuka, S; Takegami, Y; Takeuchi, J; Ouchida, J; Hasegawa, Y; Imagama, S

JOURNAL OF CLINICAL MEDICINE Vol. 12 ( 5 ) 2023.3

Language：English Publisher：Journal of Clinical Medicine

This study aimed to clarify the relationship between visual acuity and motor function in younger and elderly participants and to compare differences between non-elderly and elderly participants. In total, 295 participants who underwent visual and motor functional examinations were included; participants with visual acuity ≥0.7 were assigned to the normal group (N group) and those with visual acuity ≤0.7 were assigned to the low-visual-acuity group (L group). Motor function was compared between the N and L groups; the analysis was performed by grouping participants into those aged >65 years (elderly) and those aged <65 years (non-elderly). The non-elderly group (average age, 55.6 ± 6.7 years) had 105 and 35 participants in the N and L groups, respectively. Back muscle strength was significantly lower in the L group than in the N group. The elderly group (average age, 71.1 ± 5.1 years) had 102 and 53 participants in the N and L groups, respectively. Gait speed was significantly lower in the L group than in the N group. These results reveal differences in the relationship between vision and motor function in non-elderly and elderly adults and indicate that poor vision is associated with lower back-muscle strength and walking speed in younger and elderly participants, respectively.

DOI： 10.3390/jcm12052008

Effects of Dementia on Outcomes after Cervical Spine Injuries in Elderly Patients: Evaluation of 1512 Cases in a Nationwide Multicenter Study in Japan Reviewed Open Access

Yamada, Y; Yokogawa, N; Kato, S; Sasagawa, T; Tsuchiya, H; Nakashima, H; Segi, N; Ito, S; Funayama, T; Eto, F; Yamaji, A; Yamane, J; Nori, S; 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; 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; Watanabe, K

JOURNAL OF CLINICAL MEDICINE Vol. 12 ( 5 ) 2023.3

Language：English Publisher：Journal of Clinical Medicine

We aimed to retrospectively investigate the demographic characteristics and short-term outcomes of traumatic cervical spine injuries in patients with dementia. We enrolled 1512 patients aged ≥ 65 years with traumatic cervical injuries registered in a multicenter study database. Patients were divided into two groups according to the presence of dementia, and 95 patients (6.3%) had dementia. Univariate analysis revealed that the dementia group comprised patients who were older and predominantly female and had lower body mass index, higher modified 5-item frailty index (mFI-5), lower pre-injury activities of daily living (ADLs), and a larger number of comorbidities than patients without dementia. Furthermore, 61 patient pairs were selected through propensity score matching with adjustments for age, sex, pre-injury ADLs, American Spinal Injury Association Impairment Scale score at the time of injury, and the administration of surgical treatment. In the univariate analysis of the matched groups, patients with dementia had significantly lower ADLs at 6 months and a higher incidence of dysphagia up to 6 months than patients without dementia. Kaplan–Meier analysis revealed that patients with dementia had a higher mortality than those without dementia until the last follow-up. Dementia was associated with poor ADLs and higher mortality rates after traumatic cervical spine injuries in elderly patients.

DOI： 10.3390/jcm12051867

Delirium Risk Score in Elderly Patients with Cervical Spinal Cord Injury and/or Cervical Fracture Reviewed Open Access

Tamai, K; Terai, H; Nakamura, H; Yokogawa, N; Sasagawa, T; Nakashima, H; Segi, N; Ito, S; Funayama, T; Eto, F; Yamaji, A; Watanabe, K; Yamane, J; Takeda, K; 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; 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

JOURNAL OF CLINICAL MEDICINE Vol. 12 ( 6 ) 2023.3

Language：English Publisher：Journal of Clinical Medicine

The number of elderly patients with cervical trauma is increasing. Such patients are considered to be at high risk for delirium, which is an acute neuropsychological disorder that reduces the patient’s capacity to interact with their environment due to impairments in cognition. This study aimed to establish a risk score that predicts delirium in elderly patients with cervical SCI and/or cervical fracture regardless of treatment type. This retrospective cohort study included 1512 patients aged ≥65 years with cervical SCI and/or cervical fracture. The risk factors for delirium according to treatment type (surgical or conservative) were calculated using multivariate logistic regression. A delirium risk score was established as the simple arithmetic sum of points assigned to variables that were significant in the multivariate analyses. Based on the statistical results, the delirium risk score was defined using six factors: old age (≥80 years), hypoalbuminemia, cervical fracture, major organ injury, dependence on pre-injury mobility, and comorbid diabetes. The score’s area under the curve for the prediction of delirium was 0.66 (p < 0.001). Although the current scoring system must be validated with an independent dataset, the system remains beneficial because it can be used after screening examinations upon hospitalization and before deciding the treatment strategy.

DOI： 10.3390/jcm12062387

Characteristics of the cervical spine and cervical cord injuries in older adults with cervical ossification of the posterior longitudinal ligament Reviewed Open Access

Okuwaki, S; Funayama, T; Koda, M; Eto, F; Yamaji, A; Yokogawa, N; Sasagawa, T; Ando, K; Nakashima, H; Segi, N; Watanabe, K; Nori, S; Takeda, K; 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; Kato, S

SCIENTIFIC REPORTS Vol. 13 ( 1 ) page： 2689 2023.2

Language：English Publisher：Scientific Reports

Although the incidence of cervical spinal cord injury (CSCI) with ossification of the posterior longitudinal ligament (OPLL) has increased in older adults, its etiology and neurological outcomes remain unknown. We identified OPLL characteristics and determined whether they influence neurological severity and improvement of CSCI in older patients. This multicenter retrospective cohort study identified 1512 patients aged ≥ 65 years diagnosed with CSCI on admission during 2010–2020. We analyzed CSCI etiology in OPLL patients. We performed propensity score-adjusted analyses to compare neurological outcomes between patients with and without OPLL. Cases were matched based on variables influencing neurological prognosis. The primary neurological outcome was rated according to the American Spine Injury Association (ASIA) impairment scale (AIS) and ASIA motor score (AMS). In 332 OPLL patients, the male-to-female ratio was approximately 4:1. Half of all patients displayed low-energy trauma-induced injury and one-third had CSCI without a bony injury. Propensity score matching created 279 pairs. There was no significant difference in the AIS grade and AMS between patients with and without OPLL during hospitalization, 6 months, and 12 months following injury. OPLL patients tended to exhibit worse neurological findings during injury; nevertheless, OPLL was not associated with poor neurological improvement in older CSCI patients.

DOI： 10.1038/s41598-023-29877-2

Comparison of radiological characteristics between diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis: a multicenter study Reviewed Open Access

Takahashi, T; Yoshii, T; Mori, K; Kobayashi, S; Inoue, H; Tada, K; Tamura, N; Hirai, T; Sugimura, N; Nagoshi, N; Maki, S; Katsumi, K; Koda, M; Murata, K; Takeuchi, K; Nakashima, H; Imagama, S; Kawaguchi, Y; Yamazaki, M; Okawa, A

SCIENTIFIC REPORTS Vol. 13 ( 1 ) page： 1849 2023.2

Language：English Publisher：Scientific Reports

To evaluate the radiological differences between diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS) using whole spine computed tomography (CT), including the spine and sacroiliac joint (SIJ). The ossification and bridging of spinal ligament and fusion of the facet joint and SIJ were evaluated in 111 patients who were diagnosed with DISH and 27 patients with AS on the whole spine CT. The number of anterior bridging and shape of bridging (candle-wax-type/ smooth-type) were also evaluated. We further evaluated patients with DISH and AS by matching their age and sex. Complete SIJ fusion was more common in AS, whereas anterior and posterior bony bridging around SIJ was more common in DISH. However, 63% of patients with DISH had a partial or complete fusion. In spinal anterior bony bridging, the majority of patients with AS had the smooth-type, whereas those with DISH had the candle-wax-type. However, some of the patients with DISH (11%) had smooth-type. Intervertebral facet joint fusion is more common in AS. The number of anterior spinal bony bridging was greater in AS than in DISH, especially in the lumbar spine. These results are useful in differentiating DISH from AS and should therefore be considered when making a diagnosis.

DOI： 10.1038/s41598-023-28946-w

Neck pain after cervical laminoplasty is associated with postoperative atrophy of the trapezius muscle Reviewed Open Access

Ito, S; Sakai, Y; Ando, K; Nakashima, H; Machino, M; Segi, N; Tomita, H; Koshimizu, H; Hida, T; Ito, K; Harada, A; Imagama, S

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 85 ( 1 ) page： 103 - 112 2023.2

Language：English Publisher：Nagoya Journal of Medical Science

Cervical laminoplasty is a safe and effective treatment for cervical myelopathy. However, it has a higher frequency of postoperative axial pain than other methods. A variety of causes of postoperative axial pain have been reported, but these have not been fully elucidated. This study aimed to investigate the association between postoperative axial pain and changes in the posterior neck muscles before and after surgery. The study included 93 patients with cervical myelopathy who underwent surgery at our institute between June 2010 and March 2013. The patients with greater preoperative and 1-year postoperative neck pain visual analog scale scores comprised the neck pain group. The cross-sectional area of the cervical posterior extensor muscles and the trapezius muscle were measured by magnetic resonance imaging before and 1 year after surgery at the C3/4, C4/5, and C5/6 levels to compare with neck pain. The total cross-sectional area atrophy rate (C3/C4, C4/C5, and C5/C6) of the trapezius muscle was significantly larger in patients with neck pain (12.8 ± 13.2) than in those without (6.2 ± 14.4; p<0.05). The cross-sectional area atrophy rate of the trapezius muscle at only the C5/6 level was significantly higher in patients with neck pain (16.7 ± 11.7) compared to those without (3.3 ± 14.4; p<0.001). No significant differences were found in the cross-sectional areas of the cervical posterior extensor muscles. Trapezius atrophy, especially at the lower cervical vertebrae, was associated with neck pain after cervical laminoplasty.

DOI： 10.18999/nagjms.85.1.103

The age-specific normative values of standing whole-body sagittal alignment parameters in healthy adults: based on international multicenter data Reviewed Open Access

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

EUROPEAN SPINE JOURNAL Vol. 32 ( 2 ) page： 562 - 570 2023.2

Language：English Publisher：European Spine Journal

Purpose: To investigate the age-specific normative values of whole-body sagittal alignment (WBSA) including global balance parameters in healthy adults and to clarify the correlations among parameters based on the data from three international multicenter. Methods: Three hundred and seventeen healthy subjects (range: 20–84 y.o., mean: 43.8 ± 14.7 y.o.) were included and underwent whole-body biplanar X-ray imaging system. Spinopelvic parameters and knee flexion (KF), the center of acoustic meatus (CAM)-hip axis (HA), and C2 dentiform apophyse (OD)-HA, the cranial center (Cr)-HA were evaluated radiologically. Sub-analysis for correlation analysis between age and parameters and among parameters was performed to investigate age-specific change and compensatory mechanisms. Results: For age-related change, C2-7 angle (r =.326 for male/.355 for female), KF (r =.427/.429), and SVA (r =.234/.507) increased with age in both male and female group. For global parameters related to the center of the gravity, correlations with age were not significant (r =.120/.161 for OD-HA, r =.163/.275 for Cr-HA, r =.149/.262 for CAM-HA). Knee flexion (KF) has correlation with global parameters (i.e., SVA, OD-HA, Cr-HA, CAM-HA) and does not have correlations with local spinopelvic alignment. Conclusion: While several local alignment changes with age were found, changes in global parameters related to the center of gravity were kept relatively mild by the chain of compensation mechanisms including the lower limbs. We showed the normative values for a comprehensive WBSA in standing posture from large international healthy subjects’ database.

DOI： 10.1007/s00586-022-07445-y

Vertebral Endplate Concavity in Lateral Lumbar Interbody Fusion: Tapered 3D-Printed Porous Titanium Cage versus Squared PEEK Cage Reviewed Open Access

Segi, N; Nakashima, H; Shinjo, R; Kagami, Y; Machino, M; Ito, S; Ouchida, J; Morishita, K; Oishi, R; Yamauchi, I; Imagama, S

MEDICINA-LITHUANIA Vol. 59 ( 2 ) 2023.2

Language：English Publisher：Medicina Lithuania

Background and Objectives: To prevent postoperative problems in extreme lateral interbody fusion (XLIF), it is critical that the vertebral endplate not be injured. Unintentional endplate injuries may depend on the cage. A novel porous titanium cage for XLIF has improved geometry with a tapered tip and smooth surface. We hypothesized that this new cage should lead to fewer endplate injuries. Materials and Methods: This retrospective study included 32 patients (mean 74.1 ± 6.7 years, 22 females) who underwent anterior and posterior combined surgery with XLIF for lumbar degenerative disease or adult spinal deformity from January 2018 to June 2022. A tapered 3D porous titanium cage (3DTi; 11 patients) and a squared PEEK cage (sPEEK; 21 patients) were used. Spinal alignment values were measured on X-ray images. Vertebral endplate concavity (VEC) was defined as concavity ≥ 1 mm of the endplate on computed tomography (CT) images, which were evaluated preoperatively and at 1 week and 3 months postoperatively. Results: There were no significant differences in the patient demographic data and preoperative and 3-month postoperative spinal alignments between the groups. A 3DTi was used for 25 levels and an sPEEK was used for 38 levels. Preoperative local lordotic angles were 4.3° for 3DTi vs. 4.7° for sPEEK (p = 0.90), which were corrected to 12.3° and 9.1° (p = 0.029), respectively. At 3 months postoperatively, the angles were 11.6° for 3DTi and 8.2° for sPEEK (p = 0.013). VEC was present in 2 levels (8.0%) for 3DTi vs. 17 levels (45%) for sPEEK (p = 0.002). After 3 months postoperatively, none of the 3DTi had VEC progression; however, eight (21%) levels in sPEEK showed VEC progression (p = 0.019). Conclusions: The novel 3DTi cage reduced endplate injuries by reducing the endplate load during cage insertion.

DOI： 10.3390/medicina59020372

Risk Factors for Early Mortality in Older Patients with Traumatic Cervical Spine Injuries-A Multicenter Retrospective Study of 1512 Cases Reviewed Open Access

Kobayashi, M; Yokogawa, N; Kato, S; Sasagawa, T; Tsuchiya, H; Nakashima, H; Segi, N; Ito, S; Funayama, T; Eto, F; Yamaji, A; Yamane, J; Nori, S; 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; 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; Watanabe, K

JOURNAL OF CLINICAL MEDICINE Vol. 12 ( 2 ) 2023.1

Language：English Publisher：Journal of Clinical Medicine

For older patients with decreased reserve function, traumatic cervical spine injuries frequently lead to early mortality. However, the prognostic factors for early mortality remain unclear. This study included patients aged ≥65 years and hospitalized for treatment of traumatic cervical spine injuries in 78 hospitals between 2010 and 2020. Early mortality was defined as death within 90 days after injury. We evaluated the relationship between early mortality and the following factors: age, sex, body mass index, history of drinking and smoking, injury mechanisms, presence of a cervical spine fracture and dislocation, cervical ossification of the posterior longitudinal ligament, diffuse idiopathic skeletal hyperostosis, American Spinal Injury Association Impairment Scale, concomitant injury, pre-existing comorbidities, steroid administration, and treatment plan. Overall, 1512 patients (mean age, 75.8 ± 6.9 years) were included in the study. The early mortality rate was 4.0%. Multivariate analysis identified older age (OR = 1.1, p < 0.001), male sex (OR = 3.7, p = 0.009), cervical spine fracture (OR = 4.2, p < 0.001), complete motor paralysis (OR = 8.4, p < 0.001), and chronic kidney disease (OR = 5.3, p < 0.001) as risk factors for early mortality. Older age, male sex, cervical spine fracture, complete motor paralysis, and chronic kidney disease are prognostic factors for early mortality in older patients with traumatic cervical spine injuries.

DOI： 10.3390/jcm12020708

Clinical Outcomes of Condoliase Injection Therapy for Lateral Lumbar Disc Herniation Open Access

Kagami Yujiro, Nakashima Hiroaki, Segi Naoki, Shinjo Ryuichi, Imagama Shiro

Spine Surgery and Related Research Vol. 7 ( 4 ) page： 363 - 370 2023

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

<p>Introduction: This study aimed to evaluate the efficacy of condoliase injection therapy (CIT) for lateral lumbar disc herniation (LLDH).</p><p>Methods: This retrospective study included 157 of 180 enrolled patients (70 males, 87 females; mean age: 52.6±16.9 years). These patients were divided into two groups (group L: LLDH, group M: medial LDH [subligamentous and transligamentous]). From baseline to 1 year after injection (final follow-up), leg pain was assessed using the visual analog scale (VAS) and the Japanese Orthopedic Association (JOA) scoring for CIT's clinical efficacy of CIT. Radiography and magnetic resonance imaging conducted before and 3 months after the injection were assessed. Patients with a VAS improvement of ≥50% at the final follow-up were defined as responders. The responder and nonresponder LLDH groups were also compared.</p><p>Results: Groups L and M showed comparable responder rates (75.0% and 77.4%, respectively) (<i>P</i>=0.80). VAS and JOA scores at 1 year showed no significant differences between the groups (<i>P</i>=0.82 and 0.80, respectively). VAS score at 1 month after injection reduced considerably in the responder group compared with that in the nonresponder group (19.7 vs. 66.0, <i>P</i><0.01) and continued to decrease at the last follow-up (3.5 vs. 52.0, <i>P</i><0.001). Nonresponders had significantly lower disc heights after 3 months. However, intervertebral instability, alignment, and disc degeneration did not differ between the responders and nonresponders.</p><p>Conclusions: The response rate of CIT for LLDH was comparable to that for medial LDH. Therefore, CIT is an effective treatment for LLDH.</p>

DOI： 10.22603/ssrr.2022-0189

Impact of Obesity, Osteopenia, and Scoliosis on Interobserver Reliability of Measures of the Spinopelvic Sagittal Radiographic Parameters Open Access

Ouchida Jun, Nakashima Hiroaki, Kanemura Tokumi, Ito Kenyu, Tsushima Mikito, Machino Masaaki, Ito Sadayuki, Segi Naoki, Nagatani Yasuhiro, Kagami Yujiro, Imagama Shiro

Spine Surgery and Related Research Vol. 7 ( 6 ) page： 519 - 525 2023

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

<p>Introduction: We investigated the relationships between patient factors, including obesity, osteopenia, and scoliosis, and the reliability of measures of the spinopelvic sagittal parameters using conventional X-radiography (Xp) and slot-scanning Xp devices (EOS) and examined the differences in interobserver measurement reliability between them.</p><p>Methods: We retrospectively enrolled 55 patients (52.7±25.3 years, 27 females) with conventional whole-spine Xp and EOS images taken within three months. Patients were classified according to obesity (Body mass index≥25 kg/m<sup>2</sup>), osteopenia (T score<−1), and scoliosis (Cobb angle>20°). The associations between patient factors and reliability of radiological parameter measurements were examined with interobserver intraclass correlation coefficient (ICC), defined as poor, <.40; good, 40-.79; and excellent, ≥.80.</p><p>Results: All parameters measured with EOS showed excellent reliability except for L4-S (ICC:.760, 95% CI:.295-.927) in the obesity+ group. All parameters measured with conventional Xp were excellent except for those classified as good: L4-S (.608,.093-.868) and pelvic incidence (PI) (.512,.078-.832) in the obese+ group; T1 slope (.781,.237-.952), L4-S (.718,.112-.936), sacral slope (SS) (.792,.237-.955), pelvic tilt (PT) (.787,.300-.952), and center of acoustic meatus and femoral head offset (CAM-HA) (.690,.090-.928) in the osteopenia+ group; and lumbar lordosis (LL, L4-S) (.712,.349-.889), SS (.608,.178-.843), and CAM-HA (.781,.480-.917) in the scoliosis+ group.</p><p>Conclusions: Reliability of EOS measurements was preferable except for L4-S in patients with obesity. The reliability of conventional Xp measurements of pelvic parameters SS, PT, and PI was affected by patient factors, including obesity, osteopenia, and scoliosis. When evaluating lower lumbar and pelvic parameters in patients with these factors, we recommend substituting thoracic parameters, LL (L1-S), sagittal vertical axis (SVA), and T1 pelvic angle (TPA), or combining computed tomography (CT) measurements.</p>

DOI： 10.22603/ssrr.2023-0050

Nationwide Survey of the Surgical Complications Associated with Lateral Lumbar Interbody Fusion in 2015-2020 Open Access

Yagi Mitsuru, Fujita Nobuyuki, Hasegawa Tomohiko, Inoue Gen, Kotani Yoshihisa, Ohtori Seiji, Orita Sumihisa, Oshima Yasushi, Sakai Daisuke, Sakai Toshinori, Taneichi Hiroshi, Togawa Daisuke, Nakanishi Kazuo, Nakashima Hiroaki, Yoshii Toshitaka, Nakamura Masaya, Iwasaki Motoki, Watanabe Masahiko, Haro Hirotaka, Kanemura Tokumi, Hosogane Naobumi, New Technology Assessment Committee of The Japanese Society for Spine Surgery and Related Research

Spine Surgery and Related Research Vol. 7 ( 3 ) page： 249 - 256 2023

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

<p>Introduction: Lateral lumbar interbody fusion (LLIF) has been introduced in Japan in 2013. Despite the effectiveness of this procedure, several considerable complications have been reported. This study reported the results of a nationwide survey performed by the Japanese Society for Spine Surgery and Related Research (JSSR) on the complications associated with LLIF performed in Japan.</p><p>Methods: JSSR members conducted a web-based survey following LLIF between 2015 and 2020. Any complications meeting the following criteria were included: (1) major vessel, (2) urinary tract, (3) renal, (4) visceral organ, (5) lung, (6) vertebral, (7) nerve, and (8) anterior longitudinal ligament injury; (9) weakness of psoas; (10) motor and (11) sensory deficit; (12) surgical site infection; and (13) other complications. The complications were analyzed in all LLIF patients, and the differences in incidence and type of complications between the transpsoas (TP) and prepsoas (PP) approaches were compared.</p><p>Results: Among the 13,245 LLIF patients (TP 6,198 patients [47%] and PP 7,047 patients [53%]), 389 complications occurred in 366 (2.76%) patients. The most common complication was sensory deficit (0.5%), followed by motor deficit (0.43%) and weakness of psoas muscle (0.22%). Among the patient cohort, 100 patients (0.74%) required revision surgery during the survey period. Almost half of the complications developed in patients with spinal deformity (183 patients [47.0%]). Four patients (0.03%) died from complications. Statistically more frequent complications occurred in the TP approach than in the PP approach (TP vs. PP, 220 patients [3.55%] vs. 169 patients [2.40%]; p<0.001).</p><p>Conclusions: The overall complication rate was 2.76%, and 0.74% of the patients required revision surgery because of complications. Four patients died from complications. LLIF may be beneficial for degenerative lumbar conditions with acceptable complications; however, the indication for spinal deformity should be carefully determined by the experience of the surgeon and the extent of the deformity.</p>

DOI： 10.22603/ssrr.2022-0194

Wedge-Shaped Deformity of the First Sacral Vertebra Associated with Adolescent Idiopathic Scoliosis: A Comparison of Cases with and without Scoliosis Reviewed Open Access

Yamauchi Ippei, Nakashima Hiroaki, Ito Sadayuki, Segi Naoki, Ouchida Jun, Tauchi Ryoji, Ohara Tetsuya, Kawakami Noriaki, Imagama Shiro

Spine Surgery and Related Research Vol. 7 ( 6 ) page： 540 - 546 2023

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

<p>Introduction: Scoliosis is the three-dimensional (3D) deformity of the spine. Scoliosis curvatures, such as the lower lumbar curve and the angle of the upper endplate of the sacrum observable on radiographs, are associated with postoperative outcomes; however, the relationship between postoperative outcomes and sacral morphology remains unknown. This study aimed to investigate sacral morphology in patients with adolescent idiopathic scoliosis (AIS) and to clarify its relationship with wedge-shaped deformity of the first sacral vertebra and radiographic parameters.</p><p>Methods: This study included 94 patients who underwent fusion surgery for AIS (scoliosis group). As the control group, 25 patients without scoliosis (<10°) under 50 years of age were also investigated. S1 wedging angle (S1WA) using 3D Computed tomography (CT) and Cobb angle, L4 tilt, and sacral slanting using radiography were measured. The relationship between S1WA and other radiographic parameters was analyzed using correlation coefficients. Differences in sacral morphology between the Lenke lumbar modifier types A and C were also investigated.</p><p>Results: S1WA was significantly larger in the scoliosis group than the control group (scoliosis: 1.7°±2.5°, control: 0.1°±1.5°, p=0.002). Furthermore, the number of patients with S1WA >3° or >5° was significantly higher in the scoliosis group (>3°: 33%, 8%, p=0.012; >5°: 16%, 0%, p=0.039). S1WA correlated with sacral slanting (r=0.45, p<0.001) and L4 tilt (r=0.35, p<0.001) and was significantly greater with Lenke lumbar modifier C than A (2.4°±2.6°, 0.8°±2.0°; p<0.001).</p><p>Conclusions: The S1 vertebra was deformed and wedge-shaped in AIS, especially in cases with a large lumbar curve. Additionally, S1WA is associated with sacral slanting and L4 tilt on radiography in AIS.</p>

DOI： 10.22603/ssrr.2023-0134

Prospective Investigation of Surgical Outcomes after Anterior Decompression with Fusion and Laminoplasty for the Cervical Ossification of the Posterior Longitudinal Ligament: A Propensity Score Matching Analysis Reviewed Open Access

Yoshii, T; Morishita, S; 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; 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; Taneichi, H; Imagama, S; Kawaguchi, Y; Takeshita, K; Matsumoto, M; Yamazaki, M; Okawa, A

JOURNAL OF CLINICAL MEDICINE Vol. 11 ( 23 ) 2022.12

Language：English Publisher：Journal of Clinical Medicine

The ideal surgical strategy for cervical ossification of the posterior longitudinal ligament (OPLL) remains controversial due to the lack of high-quality evidence. Herein, we prospectively investigated the surgical outcomes of anterior cervical decompression with fusion (ADF) and laminoplasty (LAMP) with cervical OPLL. Three hundred patients were included in this study (ADF: n = 89; LAMP: n = 211 patients), and propensity score matching yielded 67 pairs of patients with ADF and LAMP, in which clinical outcomes were compared. Crude analysis revealed that the ADF group showed greater neurological recovery in cervical Japanese Orthopedic Association scores at two years, compared with that in the LAMP group (53.1% vs. 44.3%, p = 0.037). The ratio of minimum clinically important difference (MCID) success was significantly greater in the ADF group (59.6% vs. 43.6%, p = 0.016). Multivariate analysis showed that the factors affecting MCID success were age, body mass index, duration of symptoms, and choice of ADF. In the 1:1 matched analysis, neurological improvement was more favorable in the ADF group (57.2%) compared to the LAMP group (46.8%) at two years (p = 0.049). However, perioperative complications, such as dysphagia and graft-related complications, were more common in the ADF group.

DOI： 10.3390/jcm11237012

特集整形外科領域における人工知能の応用各論深層学習を用いたMRIでの脊髄腫瘍自動位置検出システムの構築

伊藤定之, 中島宏彰, 町野正明, 世木直喜, 小田昌宏, 大内田隼, 森下和明, 森健策, 今釜史郎

臨床整形外科 Vol. 57 ( 10 ) page： 1189 - 1195 2022.10

Does surgery improve neurological outcomes in older individuals with cervical spinal cord injury without bone injury? A multicenter study

Nori, S; Watanabe, K; Takeda, K; Yamane, J; Kono, H; Yokogawa, N; Sasagawa, T; Ando, K; Nakashima, H; Segi, N; Funayama, T; Eto, F; Yamaji, A; 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; Kiyasu, K; Iizuka, Y; Takasawa, E; Funao, H; Kaito, T; Yoshii, T; Ishihara, M; Okada, S; Imagama, S; Kato, S

SPINAL CORD Vol. 60 ( 10 ) page： 895 - 902 2022.10

Language：English Publisher：Spinal Cord

Study design: Retrospective multicenter study. Objectives: To investigate the neurological outcomes of older individuals treated with surgery versus conservative treatment for cervical spinal cord injury (CSCI) without bone injury. Setting: Thirty-three medical institutions in Japan. Methods: This study included 317 consecutive persons aged ≥65 years with CSCI without bone injury in participating institutes between 2010 and 2020. The participants were followed up for at least 6 months after the injury. Individuals were divided into surgery (n = 114) and conservative treatment (n = 203) groups. To compare neurological outcomes and complications between the groups, propensity score matching of the baseline factors (characteristics, comorbidities, and neurological function) was performed. Results: After propensity score matching, the surgery and conservative treatment groups comprised 89 individuals each. Surgery was performed at a median of 9.0 (3–17) days after CSCI. Baseline factors were comparable between groups, and the standardized difference in the covariates in the matched cohort was <10%. The American Spinal Injury Association (ASIA) impairment scale grade and ASIA motor score (AMS) 6 months after injury and changes in the AMS from baseline to 6 months after injury were not significantly different between groups (P = 0.63, P = 0.24, and P = 0.75, respectively). Few participants who underwent surgery demonstrated perioperative complications such as dural tear (1.1%), surgical site infection (2.2%), and C5 palsy (5.6%). Conclusion: Conservative treatment is suggested to be a more favorable option for older individuals with CSCI without bone injuries, but this finding requires further validation.

DOI： 10.1038/s41393-022-00818-6

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

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 Vol. 47 ( 8 ) page： 632 - 639 2022.4

Language：English Publisher：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

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

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

EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY Vol. 32 ( 3 ) page： 437 - 442 2022.4

Language：English Publisher：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

Adjacent Segment Degeneration after Short-Segment Lateral Lumbar Interbody Fusion (LLIF) Reviewed 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 Vol. 2022 page： 5161503 2022.3

Language：English Publisher：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

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 Vol. 34 ( 10 ) page： 641 - 645 2022.3

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

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

JOURNAL OF ORTHOPAEDIC SCIENCE Vol. 27 ( 2 ) page： 360 - 365 2022.3

Language：English Publisher：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

Intradural Lumbar Disc Herniation From the Lateral Inner Surface of the Dura Without a Penetration Hole: A Case Report

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

CUREUS JOURNAL OF MEDICAL SCIENCE Vol. 14 ( 2 ) page： e22418 2022.2

Meclozine ameliorates skeletal muscle pathology and increases muscle forces in<i> mdx</i> mice Open Access

Kawamura, Y; Hida, T; Ohkawara, B; Matsushita, M; Kobayashi, T; Ishizuka, S; Hiraiwa, H; Tanaka, S; Tsushima, M; Nakashima, H; Ito, K; Imagama, S; Ito, M; Masuda, A; Ishiguro, N; Ohno, K

BIOCHEMICAL AND BIOPHYSICAL RESEARCH COMMUNICATIONS Vol. 592 page： 87 - 92 2022.2

Language：English Publisher：Biochemical and Biophysical Research Communications

We screened pre-approved drugs for the survival of the Hu5/KD3 human myogenic progenitors. We found that meclozine, an anti-histamine drug that has long been used for motion sickness, promoted the proliferation and survival of Hu5/KD3 cells. Meclozine increased expression of MyoD, but reduced expression of myosin heavy chain and suppressed myotube formation. Withdrawal of meclozine, however, resumed the ability of Hu5/KD3 cells to differentiate into myotubes. We examined the effects of meclozine on mdx mouse carrying a nonsense mutation in the dystrophin gene and modeling for Duchenne muscular dystrophy. Intragastric administration of meclozine in mdx mouse increased the body weight, the muscle mass in the lower limbs, the cross-sectional area of the paravertebral muscle, and improved exercise performances. Previous reports show that inhibition of phosphorylation of ERK1/2 improves muscle functions in mouse models for Emery-Dreifuss muscular dystrophy and cancer cachexia, as well as in mdx mice. We and others previously showed that meclozine blocks the phosphorylation of ERK1/2 in cultured cells. We currently showed that meclozine decreased phosphorylation of ERK1/2 in muscles in mdx mice but not in wild-type mice. This was likely to be one of the underlying mechanisms of the effects of meclozine on mdx mice.

DOI： 10.1016/j.bbrc.2022.01.003

Degenerative Cervical Myelopathy: Development and Natural History [AO Spine RECODE-DCM Research Priority Number 2] Open Access

Nouri, A; Tessitore, E; Molliqaj, G; Meling, T; Schaller, K; Nakashima, H; Yukawa, Y; Bednarik, J; Martin, AR; Vajkoczy, P; Cheng, JS; Kwon, BK; Kurpad, SN; Fehlings, MG; Harrop, JS; Aarabi, B; Rahimi-Movaghar, V; Guest, JD; Davies, BM; Kotter, MRN; Wilson, JR

GLOBAL SPINE JOURNAL Vol. 12 ( 1_SUPPL ) page： 39S - 54S 2022.2

Language：English Publisher：Global Spine Journal

Study Design: Narrative review. Objectives: To discuss the current understanding of the natural history of degenerative cervical myelopathy (DCM). Methods: Literature review summarizing current evidence pertaining to the natural history and risk factors of DCM. Results: DCM is a common condition in which progressive arthritic disease of the cervical spine leads to spinal cord compression resulting in a constellation of neurological symptoms, in particular upper extremity dysfunction and gait impairment. Anatomical factors including cord-canal mismatch, congenitally fused vertebrae and genetic factors may increase individuals’ risk for DCM development. Non-myelopathic spinal cord compression (NMSCC) is a common phenomenon with a prevalence of 24.2% in the healthy population, and 35.3% among individuals >60 years of age. Clinical radiculopathy and/or electrophysiological signs of cervical cord dysfunction appear to be risk factors for myelopathy development. Radiological progression of incidental Ossification of the Posterior Longitudinal Ligament (OPLL) is estimated at 18.3% over 81-months and development of myelopathy ranges between 0-61.5% (follow-up ranging from 40 to 124 months between studies) among studies. In patients with symptomatic DCM undergoing non-operative treatment, 20-62% will experience neurological deterioration within 3-6 years. Conclusion: Current estimates surrounding the natural history of DCM, particularly those individuals with mild or minimal impairment, lack precision. Clear predictors of clinical deterioration for those treated with non-operative care are yet to be identified. Future studies are needed on this topic to help improve treatment counseling and clinical prognostication.

DOI： 10.1177/21925682211036071

DNA methylation is associated with muscle loss in community-dwelling older men -the Yakumo study- : a preliminary experimental study Reviewed Open Access

Kato, D; Takegami, Y; Seki, T; Nakashima, H; Osawa, Y; Suzuki, K; Yamada, H; Hasegawa, Y; Imagama, S

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 84 ( 1 ) page： 60 - 68 2022.2

Language：English Publisher：Nagoya Journal of Medical Science

Frailty is a state of reduced muscle strength and activity in older people. DNA methylation is associated with osteoporosis and muscle loss in murine and other animal studies, but there are no epidemiological studies in humans. This study aimed to assess the association of osteoporosis and muscle loss with DNA methylation in community-dwelling older people. This cross-sectional study was performed in a rural part of Japan. We analyzed 204 subjects (98 men and 106 women). In univariate analysis, the two groups were compared according to the presence or absence of osteoporosis and of muscle loss. Logistic regression analysis was performed to determine predictors of frailty in the muscle loss group. We used age, sex, body mass index, smoking history, drinking history, serum albumin and C-reactive protein levels, diabetes, hypertension, hyperlipidemia, heart disease history, and LINE-1 DNA methylation as the factors. Probability values < 0.05 were considered to be statistically significant. The levels of LINE-1 DNA methylation in leukocytes were associated with muscle loss in men over the age of 60. LINE-1 DNA methylation levels were not associated with bone mineral density in either the men or women over the age of 60. LINE-1 DNA methylation levels in leukocytes correlated significantly with the risk of frailty in men over the age of 60. Promoting an understanding of DNA methylation may lead to a better understanding of the pathophysiology of muscle loss

DOI： 10.18999/nagjms.84.1.60

Nutritional Influences on Locomotive Syndrome Open Access

Ito, S; Nakashima, H; Ando, K; Machino, M; Seki, T; Ishizuka, S; Takegami, Y; Wakai, K; Hasegawa, Y; Imagama, S

JOURNAL OF CLINICAL MEDICINE Vol. 11 ( 3 ) 2022.2

Language：English Publisher：Journal of Clinical Medicine

Healthy dietary habits are important to prevent locomotive syndrome (LS). We investi-gated the relationship between LS and nutritional intake using community health checkup data. We included 368 participants who underwent LS staging, blood sampling, and nutritional intake assessments. Participants (163 adults < 65: 205 older adults ≥ 65) were divided into normal (N; LS stage 0) and LS (L; LS stage 1–2) groups, and blood sample data and nutritional intake were compared between groups. Among adults (N group, 71; L group, 92), low-density lipoprotein cholesterol (LDL-C) was significantly lower, and Vitamin B<inf>1</inf> intake was significantly higher in the L than in the N group; LDL-C, p = 0.033; Vitamin B1, 0.029. Among older adults (N group, 85; L group, 120), hemoglobin (Hb), albumin, and calcium levels were significantly lower, and sodium, monounsatu-rated fatty acids (MUFA), and n-6 polyunsaturated fatty acids (n-6 PUFA) were significantly higher in the L than the N group; Hb, p = 0.036; albumin, 0.030; calcium, 0.025; sodium; 0.029; MUFA; 0.047, n-6 PUFA; 0.0233). Logistic regression analysis indicated that sodium was the risk factor for the L group (exp (B) 1.001, 95% CI: 1–1.001, p = 0.032). In conclusion, salt intake was associated with LS.

DOI： 10.3390/jcm11030610

Trends in the numbers of spine surgeries and spine surgeons over the past 15 years Reviewed Open Access

Kobayashi, K; Sato, K; Kato, F; Kanemura, T; Yoshihara, H; Sakai, Y; Shinjo, R; Ohara, T; Yagi, H; Matsubara, Y; Ando, K; Nakashima, H; Imagama, S

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 84 ( 1 ) page： 155 - 162 2022.2

Language：English Publisher：Nagoya Journal of Medical Science

The purpose of this study is to examine trends in spine surgeries at ten facilities over 15 years, and to analyze relationships with the number of spine surgeons at these facilities. The subjects were patients who underwent spine surgery at the ten facilities from 2003 to 2017. Data were collected every year via a questionnaire designed to obtain clinicopathological and surgical information. There were 37,601 spine surgeries (60.2% male) recorded in the registry at 9 facilities in the Nagoya Spine Group (NSG) between 2003 and 2017, with an increase in the annual number of surgeries by 2.4 times over 15 years. On the other hand, the number of spine surgeons has increased by just under 1.5 times. Instrumentation surgeries increased from 959 in 2003 to 2,276 in 2017 (2.3 times). There was a particularly marked increase in surgeries for spinal degenerative disease from 1,075 in 2003 to 2,821 in 2017 (2.6 times). The number of surgeries performed per surgeon increased from 61.4 in 2003 to 102.8 in 2017, while the average number of spine surgeons per hospital increased from 2.6 in 2003 to 3.7 in 2017. In conclusion, with heavier burden on spine surgeons and the major changes in the spine surgery environment, training and increasing surgeons with advanced expertise and skills will become increasingly important

DOI： 10.18999/nagjms.84.1.155

Comparison of laminoplasty and posterior fusion surgery for cervical ossification of posterior longitudinal ligament Reviewed Open Access

Nakashima, H; Imagama, S; Yoshii, T; Egawa, S; Sakai, K; Kusano, K; Nakagawa, Y; Hirai, T; Wada, K; Katsumi, K; Fujii, K; Kimura, A; Furuya, T; Kanchiku, T; Nagamoto, Y; Oshima, Y; Nagoshi, N; Ando, K; Takahata, M; Mori, K; Nakajima, H; Murata, K; Matsunaga, S; Kaito, T; Yamada, K; Kobayashi, S; Kato, S; Ohba, T; Inami, S; Fujibayashi, S; Katoh, H; Kanno, H; Li, YY; Yatsuya, H; Koda, M; Kawaguchi, Y; Takeshita, K; Matsumoto, M; Yamazaki, M; Okawa, A

SCIENTIFIC REPORTS Vol. 12 ( 1 ) page： 748 2022.1

Language：English Publisher：Scientific Reports

This prospective multicenter study, established by the Japanese Ministry of Health, Labour and Welfare and involving 27 institutions, aimed to compare postoperative outcomes between laminoplasty (LM) and posterior fusion (PF) for cervical ossification of the posterior longitudinal ligament (OPLL), in order to address the controversy surrounding the role of instrumented fusion in cases of posterior surgical decompression for OPLL. 478 patients were considered for participation in the study; from among them, 189 (137 and 52 patients with LM and PF, respectively) were included and evaluated using the Japanese Orthopaedic Association (JOA) scores, the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and radiographical measurements. Basic demographic and radiographical data were reviewed, and the propensity to choose a surgical procedure was calculated. Preoperatively, there were no significant differences among the participants in terms of patient backgrounds, radiographical measurements (K-line or cervical alignment on X-ray, OPLL occupation ratio on computed tomography, increased signal intensity change on magnetic resonance imaging), or clinical status (JOA score and JOACMEQ) after adjustments. The overall risk of perioperative complications was found to be lower with LM (odds ratio [OR] 0.40, p = 0.006), and the rate of C5 palsy occurrence was significantly lower with LM (OR 0.11, p = 0.0002) than with PF. The range of motion (20.91° ± 1.05° and 9.38° ± 1.24°, p < 0.0001) in patients who had PF was significantly smaller than in those who had LM. However, multivariable logistic regression analysis showed no significant difference among the participants in JOA score, JOA recovery rate, or JOACMEQ improvement at two years. In contrast, OPLL progression was greater in the LM group than in the PF group (OR 2.73, p = 0.0002). Both LM and PF for cervical myelopathy due to OPLL had resulted in comparable postoperative outcomes at 2 years after surgery.

DOI： 10.1038/s41598-021-04727-1

Differences in the prevalence of locomotive syndrome and osteoporosis in Japanese urban and rural regions: The Kashiwara and Yakumo studies Reviewed

Tanaka, S; Ando, K; Kobayashi, K; Nakashima, H; Seki, T; Ishizuka, S; Machino, M; Ito, S; Kanbara, S; Kanemura, T; Hasegawa, Y; Imagama, S

MODERN RHEUMATOLOGY Vol. 32 ( 1 ) page： 199 - 204 2022.1

Language：English Publisher：Modern Rheumatology

Objectives: To clarify whether the prevalence of locomotive syndrome (LS) and osteoporosis differed according to region, gender, and physical functions in Japan. Methods: Data were collected in Kashiwara City (urban region) and Yakumo Town (rural region). Totally, 208 participants from the urban region and 782 participants from the rural region were included in this study. LS was assessed using the 25-item Geriatric Locomotive Function Scale and osteoporosis was assessed using a quantitative ultrasound. Physical functions were measured using grip strength and the 3-m timed up-and-go test. Differences between urban and rural regions were investigated using standardized incidence ratio and multivariate analysis. Results: The prevalence of LS and osteoporosis was 24.5% and 42.8% in the urban region and 10.9% and 28.8% in the rural region, respectively. The standardized incidence ratio of the urban region versus the rural region was 1.80 (95% confidence intervals [CI] = 1.35-2.39) for LS and 1.21 (95% CI = 1.32-2.43) for osteoporosis, showing that the prevalence of LS was significantly higher in the urban region. Multivariate analysis indicated that LS was significantly associated with the urban sample and timed up-and-go was significantly longer in the urban sample. Conclusion: Regional differences may be considered when evaluating LS in health checkups. Understanding the results of this study may help reduce LS prevalence.

DOI： 10.1080/14397595.2021.1899890

Differences in Demographic and Radiographic Characteristics between Patients with Visible and Invisible T1 Slopes on Lateral Cervical Radiographic Images Reviewed Open Access

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

JOURNAL OF CLINICAL MEDICINE Vol. 11 ( 2 ) 2022.1

Language：English Publisher：Journal of Clinical Medicine

Introduction: The T1 slope is important for cervical surgical planning, and it may be invisible on radiographic images. The prevalence of T1 invisible cases and the differences in demographic and radiographic characteristics between patients whose T1 slopes are visible or invisible remains unexplored. Methods: This pilot study aimed to evaluate the differences in these characteristics between outpatients whose T1 slopes were visible or invisible on radiographic images. Patients (n = 60) who underwent cervical radiography, whose T1 slope was confirmed clearly, were divided into the visible (V) group and invisible (I) group. The following radiographic parameters were measured: (1) C2-7 sagittal vertical axis (SVA), (2) C2-7 angle in neutral, flexion, and extension positions. Results: Based on the T1 slope visibility, 46.7% of patients were included in group I. The I group had significantly larger C2-7 SVA than the V group for males (p < 0.05). The C2-7 SVA tended to be larger in the I group, without significant difference for females (p = 0.362). Discussion: The mean C2-7 angle in neutral and flexion positions was not significantly different between the V and I groups for either sex. The mean C2-7 angle in the extension position was greater in the V group. The T1 slope was invisible in males with high C2-7 SVA.

DOI： 10.3390/jcm11020411

Cicatricial Fibromatosis Causing Cervical Myelopathy Due to Rapid Growth after Removal of Meningioma: A Case Report Open Access

Kanbara Shunsuke, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Machino Masaaki, Ito Sadayuki, Inoue Taro, Yamaguchi Hidetoshi, Koshimizu Hiroyuki, Segi Naoki, Imagama Shiro

Spine Surgery and Related Research Vol. 6 ( 1 ) page： 90 - 92 2022

Assessment of Ureters at Dangerous Locations in Lateral Lumbar Interbody Fusion Open Access

Kagami Yujiro, Nakashima Hiroaki, Satake Kotaro, Ito Kenyu, Tanaka Satoshi, Segi Naoki, Ouchida Jun, Morita Masanori, Ando Kei, Kobayashi Kazuyoshi, Machino Masaaki, Imagama Shiro, Kanemura Tokumi

Spine Surgery and Related Research Vol. 6 ( 1 ) page： 38 - 44 2022

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

<p>Introduction: This study aimed to investigate the ureteral running position from the viewpoint of the spine, and to identify the spinal level and left-right difference in the ureter at a dangerous location of ureteral injury during surgery.</p><p>Methods: This retrospective study included 100 consecutive patients (39 males and 61 females; average age, 70.4 years). Preoperative contrast-enhanced computerized tomography (CT) scans obtained in the supine position for patients who underwent lateral lumbar interbody fusion (LLIF) were analyzed. The ureter location was divided into four regions on the axial CT images based on the lumbar disk levels as follows: A (ventral-medial), B (ventral-lateral), C (dorsal-medial), and D (dorsal-lateral). The C region surrounded by the vertebral body and the psoas muscle was assumed to have the highest probability of ureteral injury. We examined the characteristics of the ureteral position at each disc level.</p><p>Results: In the upper lumbar spine, the ureter was outside the lateral dorsoventral axis from the contact point of the psoas muscle, while in the lower lumbar spine, it was inside the axis. The ureters located in the C region increased significantly in the lower lumbar disk levels (L1-L2 and L2-L3: 0%; L3-L4: 5.5%; L4-L5: 14.8%; L5-S: 31.5%). Comparing the left and right sides, especially at L4-L5, the ureter in the C region was observed in 21% of all ureters on the left side and in 9% on the right side. With respect to gender differences, the ureters present in the C region were significantly more common in women at lumbar disk levels L3-L4, L4-L5, and L5-S.</p><p>Conclusions: The ureters in the C region were common on the left side and at lower lumbar disk levels. To avoid ureteral injury, it is necessary to confirm the location of the ureter by using preoperative images and performing LLIF carefully.</p>

DOI： 10.22603/ssrr.2021-0013

Influence of Age and Gender on Intervertebral Disk Degeneration and Height in the Thoracolumbar Spine Open Access

Machino Masaaki, Nakashima Hiroaki, Ito Keigo, Tsushima Mikito, Ando Kei, Kobayashi Kazuyoshi, Imagama Shiro

Spine Surgery and Related Research Vol. 6 ( 4 ) page： 379 - 387 2022

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

<p>Introduction: Intervertebral disk degeneration is a universal and natural process. However, no reports have summarized anatomical age-related intervertebral disk height and disk degenerative changes in the thoracolumbar spine or examined sex-specific differences. This study aimed to establish age-related changes and gender-specific differences of intervertebral disk height and disk degeneration of the thoracolumbar spine in a large cohort of relatively healthy subjects and also to evaluate the relationship between the degree of thoracolumbar disk height and disk degeneration.</p><p>Methods: Six hundred and twenty-seven relatively healthy subjects (307 males and 320 females; average age, 49.6±16.5 years) were enrolled. We included at least 50 males and 50 females in each decade of life between the 20s and the 70s. We measured intervertebral disk height from T10/T11 to L5/S1, vertebral body height from T10 to S1 on lateral neutral radiographs. Lumbar disk degeneration was deﬁned according to the Pﬁrrmann classiﬁcation in sagittal plane magnetic resonance imaging.</p><p>Results: Age-related decreases in intervertebral disk height were most prominent at L4/L5 in middle-aged and elderly individuals of both sexes. The grade of disk degeneration signiﬁcantly increased with age in both genders at every level. Mild disk degeneration was observed even in the 20s. The disk degeneration occurred around the L4/L5 level. Although grade V disk degeneration was not identiﬁed for males in the 20s and the 30s, it appeared after the 40s and then increased further with age. The intervertebral disk height at the lower lumbar disks decreased with a progression in the disk degeneration grade in both genders.</p><p>Conclusions: This large-scale cross-sectional analysis of the thoracolumbar spine in relatively healthy subjects demonstrated that lumbar disk height narrowing progresses with age and is correlated with the progression of disk degeneration.</p>

DOI： 10.22603/ssrr.2021-0187

Is Blood Loss Greater in Elderly Patients under Antiplatelet or Anticoagulant Medication for Cervical Spine Injury Surgery? A Japanese Multicenter Survey Open Access

Uehara Masashi, Ikegami Shota, Takizawa Takashi, Oba Hiroki, Yokogawa Noriaki, Sasagawa Takeshi, Ando Kei, Nakashima Hiroaki, Segi Naoki, Funayama Toru, Eto Fumihiko, Yamaji Akihiro, Watanabe Kota, Nori Satoshi, Takeda Kazuki, Furuya Takeo, Orita Sumihisa, Nakajima Hideaki, Yamada Tomohiro, Hasegawa Tomohiko, Terashima Yoshinori, Hirota Ryosuke, Suzuki Hidenori, Imajo Yasuaki, Tonomura Hitoshi, Sakata Munehiro, Hashimoto Ko, Onoda Yoshito, Kawaguchi Kenichi, Haruta Yohei, Suzuki Nobuyuki, Kato Kenji, Uei Hiroshi, Sawada Hirokatsu, Nakanishi Kazuo, Misaki Kosuke, Terai Hidetomi, Tamai Koji, Shirasawa Eiki, Inoue Gen, Kakutani Kenichiro, Kakiuchi Yuji, Kiyasu Katsuhito, Tominaga Hiroyuki, Tokumoto Hiroto, Iizuka Yoichi, Takasawa Eiji, Akeda Koji, Takegami Norihiko, Funao Haruki, Oshima Yasushi, Kaito Takashi, Sakai Daisuke, Yoshii Toshitaka, Ohba Tetsuro, Otsuki Bungo, Seki Shoji, Miyazaki Masashi, Ishihara Masayuki, Okada Seiji, Aoki Yasuchika, Harimaya Katsumi, Murakami Hideki, Ishii Ken, Ohtori Seiji, Imagama Shiro, Kato Satoshi

Spine Surgery and Related Research Vol. 6 ( 4 ) page： 366 - 372 2022

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

<p>Introduction: In elderly patients with cervical spinal cord injury, comorbidities such as cardiovascular and cerebrovascular diseases are common, with frequent administration of antiplatelet/anticoagulant (APAC) drugs. Such patients may bleed easily or unexpectedly during surgery despite prior withdrawal of APAC medication. Few reports have examined the precise relationship between intraoperative blood loss and history of APAC use regarding surgery for cervical spine injury in the elderly. The present multicenter database survey aimed to answer the question of whether the use of APAC drugs affected the amount of intraoperative blood loss in elderly patients with cervical spinal cord trauma.</p><p>Methods: The case histories of 1512 patients with cervical spine injury at 33 institutes were retrospectively reviewed. After excluding cases without spinal surgery or known blood loss volume, 797 patients were enrolled. Blood volume loss was the outcome of interest. We calculated propensity scores using the inverse probability of treatment weighting (IPTW) method. As an alternative sensitivity analysis, linear mixed model analyses were conducted as well.</p><p>Results: Of the 776 patients (mean age: 75.1±6.4 years) eligible for IPTW calculation, 157 (20.2%) were taking APAC medications before the injury. After weighting, mean estimated blood loss was 204 mL for non-APAC patients and 215 mL for APAC patients. APAC use in elderly patients was not significantly associated with surgical blood loss according to the IPTW method with propensity scoring or linear mixed model analyses. Thus, it appeared possible to perform surgery expecting comparable blood loss in APAC and non-APAC cases.</p><p>Conclusions: This multicenter study revealed no significant increase in surgical blood loss in elderly patients with cervical trauma taking APAC drugs. Surgeons may be able to prioritize patient background, complications, and preexisting conditions over APAC use before injury when examining the surgical indications for cervical spine trauma in the elderly.</p>

DOI： 10.22603/ssrr.2021-0183

Thoracic myelopathy due to ossification of the posterior longitudinal ligament shown on dynamic MR. Reviewed Open Access

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

Surgical neurology international Vol. 13 page： 51 2022

Language：English Publisher：Surgical Neurology International

Background: Magnetic resonance (MR) and computed tomography (CT) studies combined are the optimal studies for diagnosing thoracic ossification of the posterior longitudinal ligament (OPLL) contributing to myelopathy. Here, we report a 71-year-old female, whose additional dynamic thoracic MR demonstrated transient T6-T9 anterior OPLL with cord compression. Case Description: A 71-year-old female presented with a progressive myelopathy originally attributed to cervical cord compression resulting in a cervical laminoplasty. However, when she failed to improve postoperatively, a dynamic thoracic MR was performed. On the flexion study, it demonstrated significant although transient T6-T9 anterior thoracic cord compression due to both OPLL and kyphosis. The patient's symptoms resolved following a posterior thoracic fusion alone (i.e., no decompression was warranted). Conclusion: Dynamic MR studies (i.e., flexion studies) in addition to the routine MR and CT evaluations should be performed for patients with myelopathy attributed to thoracic OPLL/kyphosis.

DOI： 10.25259/SNI_14_2022

Recurrent ossification of the posterior longitudinal ligament in the upper thoracic region 10 years after initial decompression. Reviewed Open Access

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

Surgical neurology international Vol. 13 page： 17 2022

Language：English Publisher：Surgical Neurology International

Background: Posterior decompression surgery consisting of laminoplasty is generally considered be the treatment of choice for upper thoracic OPLL. Here, we describe a patient who, 10 years following a C3-T4 level laminectomy, developed recurrent OPLL at the T2-3 level with kyphosis requiring a posterior fusion. Case Description: A 64-year-old male with CT documented OPLL at the C3-4, C6-7, and T1-4 levels, originally underwent a cervicothoracic laminectomy with good results. However, 10 years later, when T2-3 OPLL recurred along with kyphosis, he warranted an additional posterior fusion. Conclusion: Due to the long-term risks of developing kyphotic deformity/instability, more patients undergoing initial decompressive surgery alone for upper thoracic OPLL should be considered for primary fusions.

DOI： 10.25259/SNI_1187_2021

Lumbar Thecal Sac Dimensions and Axial Spinal Cord Areas on Magnetic Resosnace Imaging in 626 Healthy Subjects

Nakashima, H; Ito, K; Katayama, Y; Matsumoto, T; Tsushima, M; Ando, K; Kobayashi, K; Machino, M; Imagama, S

SPINE Vol. 46 ( 24 ) page： E1327 - E1333 2021.12

Language：English Publisher：Spine

Study Design. A cross-sectional study. Objective. The aim of this study was to investigate the lumbar thecal sac dimensions and spinal cord area on magnetic resonance (MR) imaging in healthy volunteers. Summary of Background Data. There are few reports regarding lumbar spine MRI in healthy subjects, and the difference in spinal canal dimensions by age remains unclear. Methods. A total of 629 healthy volunteers were enrolled, including ≥50 males, females, and subjects in each of the 20s to 70s age decades. The anteroposterior and transverse diameters of the thecal sac and axial areas of the thecal sac and spinal cord were measured at the disc levels on T2-weighted axial MR images. The anteroposterior-to-transverse ratio of the thecal sac (APTR) was calculated. Results. The thecal sac area from T12/L1 to L4/5 was reduced in older age group, but there was no significant difference in L5/ S1. The thecal sac area was significantly reduced in older age group: 89.9%, 86.0%, 84.6%, 80.3% at T12/L1, L1/2, L2/3, and L3/4, respectively, and 79.9% at L4/5 in subjects in their 70 s relative to that in subjects in their 20 s. The APTR was significantly reduced in older age group from T11/12 to L2/L3 in males and at T10/11, L3/4 and from T11/12 to L2/3 in females. Narrow thecal sac areas <80mm<sup>2</sup> were found in 10 subjects. The spinal cord area was significantly reduced in older age group at T10/11 in males and at T9/10, T10/11, and T11/12 in females. The area was 92.0% at T10/11 in subjects in their 70s relative to the area of subjects in their 20s. Conclusion. The thecal sac area was reduced in older age group from T12/L1 to L4/5, and the thecal sac area was reduced in the anteroposterior and all directions in the upper and lower lumbar area in age group, respectively. Approximately, 3.0% of healthy population in their 50s or older will have severe asymptomatic stenosis.

DOI： 10.1097/BRS.0000000000004143

Comparison of Surgical Outcomes After Open- and Double-Door Laminoplasties for Patients with Cervical Ossification of the Posterior Longitudinal Ligament <i>A Prospective Multicenter Study</i> Reviewed

Nagoshi, N; Yoshii, T; Egawa, S; Sakai, K; Kusano, K; Nakagawa, Y; Hirai, T; Wada, K; Katsumi, K; Fujii, K; Kimura, A; Furuya, T; Kanchiku, T; Nagamoto, Y; Oshima, Y; Nakashima, H; Ando, K; Takahata, M; Mori, K; Nakajima, H; Murata, K; Matsunaga, S; Kaito, T; Yamada, K; Kobayashi, S; Kato, S; Ohba, T; Inami, S; Fujibayashi, S; Katoh, H; Kanno, H; Watanabe, K; Imagama, S; Koda, M; Kawaguchi, Y; Takeshita, K; Nakamura, M; Matsumoto, M; Yamazaki, M; Okawa, A

SPINE Vol. 46 ( 23 ) page： E1238 - E1245 2021.12

Language：English Publisher：Spine

Study Design.A prospective multicenter study.Objective.To evaluate and compare the surgical outcomes after open-door (OD) and double-door (DD) laminoplasties in subjects with cervical ossification of the posterior longitudinal ligament (OPLL).Summary of Background Data.Although previous studies compared clinical results after OD and DD laminoplasties, they were performed at a single institution with a relatively small sample size targeting mixed pathologies, including cervical spondylotic myelopathy.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 these, 41 and 164 patients received OD and DD laminoplasties, respectively. Demographic information, medical history, and imaging findings were collected. Clinical outcomes were assessed using the cervical Japanese Orthopaedic Association, Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, and visual analog scale scores.Results.Age, sex, symptom duration, and comorbidities were not significantly different between the groups. Segmental ossification was the most frequent in both the groups. No significant differences in K-line type, canal occupying ratio, C2 to C7 angles, and range of motion were found. Both the procedures reduced the cervical range of motion postoperatively. A comparable frequency of perioperative complications was observed between the groups. The cervical Japanese Orthopaedic Association scores showed a similar improvement at 2 years postopera- tively. The reduction in visual analog scale score for neck pain was favorable in the OD group (P = 0.02), while other pain assessments did not show any significant differences between the groups. The functional outcomes assessed using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire presented equivalent effective rates.Conclusion.The results demonstrated almost comparable surgical outcomes between OD and DD laminoplasties. Lamino- plasty is a valuable technique as a therapeutic option for cervical OPLL.Level of Evidence: 2.

DOI： 10.1097/BRS.0000000000004094

Comparison of Outcomes between Minimally Invasive Lateral Approach Vertebral Reconstruction Using a Rectangular Footplate Cage and Conventional Procedure Using a Cylindrical Footplate Cage for Osteoporotic Vertebral Fracture Open Access

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

JOURNAL OF CLINICAL MEDICINE Vol. 10 ( 23 ) 2021.12

Language：English Publisher：Journal of Clinical Medicine

The aim of the current study was to compare outcomes between lateral access vertebral reconstruction (LAVR) using a rectangular footplate cage and the conventional procedure using a cylindrical footplate cage in patients with osteoporotic vertebral fracture (OVF). We included 46 patients who underwent anterior–posterior combined surgery for OVF: 24 patients underwent LAVR (Group L) and 22 underwent the conventional procedure (Group C). Preoperative, postoperative, and 1‐ and 2‐year follow‐up X‐ray images were used to measure local lordotic angle, correction loss, and cage subsidence (>2 mm in vertebral endplate depression). In anterior surgery, the operation time was significantly shorter (183 vs. 248 min, p < 0.001) and the blood loss was significantly less (148 vs. 406 mL, p = 0.01) in Group L than in Group C. In Group C, two patients had anterior instrumentation failure. Correction loss was significantly smaller in Group L than in Group C (1.9° vs. 4.9° at 1 year, p = 0.02; 2.5° vs. 6.5° at 2 years, p = 0.04, respectively). Cage subsidence was significantly less in Group L than in Group C (29% vs. 80%, p < 0.001). LAVR using a rectangular footplate cage is an effective treatment for OVF to minimize surgical invasiveness and postoperative correction loss.

DOI： 10.3390/jcm10235664

Does pulmonary function improve after surgical correction of adult idiopathic scoliosis? Reviewed

Nakashima, H; Kawakami, N; Ohara, T; Saito, T; Tauchi, R; Imagama, S; Redding, GJ

SPINE DEFORMITY Vol. 9 ( 6 ) page： 1609 - 1616 2021.11

Language：English Publisher：Spine Deformity

Purpose: The aim was to investigate pulmonary function after surgical correction of adult idiopathic scoliosis. Methods: This study included 146 adult scoliosis patients aged 20–50 years (main curve in thoracic spine). Respiratory function was assessed as predicted forced vital capacity (%FVC) and the ratio of forced expiratory volume in 1 s / FVC (%FEV<inf>1</inf>) preoperatively and 2 years postoperatively and classified as a normal function (≥ 80%), mild impairment (≥ 65% and < 80%), and moderate impairment (< 65%). Results: Preoperative %FVC and %FEV<inf>1</inf> were 85.3% and 85.4%, which were 81.5% and 87.5% at 2 years post-surgery. The preoperative %FVC was mild and moderate in 39 (26.7%) and 12 patients (11.6%), respectively. The %FVC significantly improved (+ 6.2% ± 11.4%, P < 0.001) postoperatively for moderate severity but significantly decreased postoperatively (− 6.4% ± 9.4%, P < 0.001) for normal function. The preoperative %FEV<inf>1</inf> was mild and moderate in 27 (18.5%) and 0 patients, respectively. The %FEV1 significantly improved postoperatively (6.3% ± 5.3%, P < 0.001) for mild severity but did not significantly change for normal severity. Twenty-three (15.8%) and 41 (28.1%) patients showed improved ⊿%FVC and ⊿% FEV<inf>1</inf> > 5%. Logistic regression analysis showed that preoperative %FVC and %FEV<inf>1</inf> severities were independent factors affecting postoperative recovery of %FVC (OR 0.95) and %FEV<inf>1</inf> (OR 0.85). Conclusion: Pulmonary function improved in patients with preoperative pulmonary impairment of < 65% in %FVC and < 80% in %FEV<inf>1</inf>, and the real improvement was limited to patients with severe preoperative impairment.

DOI： 10.1007/s43390-021-00379-3

Factors Significantly Associated with Postoperative Neck Pain Deterioration after Surgery for Cervical Ossification of the Posterior Longitudinal Ligament: Study of a Cohort Using a Prospective Registry Open Access

Koda, M; Yoshii, T; Egawa, S; Sakai, K; Kusano, K; Nakagawa, Y; Hirai, T; Wada, K; Katsumi, K; Kimura, A; Furuya, T; Maki, S; Nagoshi, N; Watanabe, K; Kanchiku, T; Nagamoto, Y; Oshima, Y; Ando, K; Nakashima, H; Takahata, M; Mori, K; Nakajima, H; Murata, K; Matsunaga, S; Kaito, T; Yamada, K; Kobayashi, S; Kato, S; Ohba, T; Inami, S; Fujibayashi, S; Katoh, H; Kanno, H; Takahashi, H; Fujii, K; Miyagi, M; Inoue, G; Takaso, M; Imagama, S; Kawaguchi, Y; Takeshita, K; Nakamura, M; Matsumoto, M; Okawa, A; Yamazaki, M

JOURNAL OF CLINICAL MEDICINE Vol. 10 ( 21 ) 2021.11

Language：English Publisher：Journal of Clinical Medicine

Postoperative neck pain has been reported as an unsolved postoperative complication of surgery for cervical ossification of the posterior longitudinal ligament (OPLL). The aim of the present study was to elucidate factors having a significant association with postoperative deterioration of neck pain in cervical OPLL patients. We studied a cohort of patients in a prospective registry of 478 patients who had undergone cervical spine surgery for cervical OPLL. We excluded those without evaluation of preoperative neck pain. Therefore, 438 patients were included in the present study. Neck pain was evaluated with the visual analogue scale (VAS, 0–100 mm). Postoperative neck pain deterioration was defined as a ≥20 mm increase of VAS neck pain. Patient factors, neurological status, imaging factors and surgical factors were assessed. Univariate analyses followed by multivariate analysis using stepwise logistic regression was performed. Six months after surgery, 50 (11.6%) patients showed postoperative neck pain deterioration and 76 (17.4%) patients showed postoperative neck pain deterioration 2 years after surgery. Six months after surgery, the rate of neck pain deterioration was significantly higher in patients who had undergone posterior surgery. Two years after surgery, the number of levels fused was significantly correlated with neck pain deterioration.

DOI： 10.3390/jcm10215026

Relationship between use of sleep medication and accidental falls during hospitalization Open Access

Kobayashi, K; Ando, K; Nakashima, H; Suzuki, Y; Nagao, Y; Imagama, S

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 83 ( 4 ) page： 851 - 860 2021.11

Language：English Publisher：Nagoya Journal of Medical Science

Falls are common in elderly patients, and prevention of fall is important for safety and for reduction of health care costs. Sleep medications are among many potential causes of fall. In this study, we examined relationship of sleep medication with fall from January 2017 to December 2017. 726 falls occurred in 442 patients, and the average age at the time of fall was 60.7 ± 23.8 years. Fall was most common in patients with neurological disease, followed by gastroenterological, ophthalmological, respiratory, and orthopedic conditions. Sleep medication was used in 223 falls (31%). Fall occurred at all times of day, but with a different distribution in patients with and without use of sleep medication. Thus, the rate of falls from 22:00 to 6:00 was significantly higher in patients using sleep medication (62% vs. 18%, p<0.01). There was also a significantly higher rate of multiple falls in patient using sleep medication (p<0.01). Zolpidem (25%, n=63), a non-benzodiazepine, was the most frequently used sleep medication, followed by brotizolam (16%, n=41) and etizolam (13%, n=32), which are both benzodiazepines. Multiple falls from 22:00 to 6:00 occurred significantly more frequently in patients using ≥2 types of sleep medications compared to one (53% vs. 17%, p<0.01). Taking multiple sleeping pills makes it easier to fall, and even drugs with a short half-life, which are considered to be safe, can cause falls at night in elderly patients. The results of this study show that careful selection of sleep medications is required to prevent fall in elderly patients.

DOI： 10.18999/nagjms.83.4.851

Relationship of frequency of participation in a physical checkup and physical fitness in middle-aged and elderly people: the Yakumo study Open Access

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

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 83 ( 4 ) page： 841 - 850 2021.11

Language：English Publisher：Nagoya Journal of Medical Science

An annual physical checkup is provided as part of the long-term Yakumo study. The checkup is voluntary and there is variation in the frequency of participation. The aim of this study was to examine relationship of physical fitness with frequency of participation in this checkup. The subjects had all attended at least one annual physical checkup from 2006 to 2018. Data from 1,804 initial checkups were used for analysis. At the checkups, age, gender, height, weight, body mass index (BMI), and bone mineral density (BMD) were recorded, and physical activity was measured. The average number of physical checkups per participant for 13 years was 2.4 (1–13). Daily exercise habits were found to be significantly associated with higher participation in physical checkups. Furthermore, between groups with low (1–5 times; <90th percentile of participants) and high (≥6 times) participation, weight and BMI were significantly higher, and BMD, grip strength, 10-m gait time, back muscle strength, and two-step test were all significantly lower in the group with lower frequency of participation in the checkup. In conclusions, our results show that frequency of participation in a voluntary annual physical checkup is significantly associated with physical fitness in middle-aged and elderly people.

DOI： 10.18999/nagjms.83.4.841

Evaluation of the Association between Neck Pain and the Trapezius Muscles in Patients with Cervical Myelopathy Using Motor Evoked Potential: A Retrospective Study Open Access

Ito, S; Sakai, Y; Harada, A; Ando, K; Kobayashi, K; Nakashima, H; Machino, M; Kambara, S; Inoue, T; Hida, T; Ito, K; Ishiguro, N; Imagama, S

ASIAN SPINE JOURNAL Vol. 15 ( 5 ) page： 604 - 610 2021.10

Language：English Publisher：Asian Spine Journal

Study Design: Retrospective study.Purpose: We aimed to use motor evoked potentials (MEPs) to examine the association of electrophysiological assessment of thetrapezius muscle with neck pain.Overview of Literature: Previous reports on the association of neck pain with the trapezius muscle have focused on surface electromyogramsand muscle oxygenation; however, to our knowledge, none of these studies included detailed data on MEPs.Methods: The study included 100 patients with cervical myelopathy who underwent surgery at the National Center for Geriatrics andGerontology in Obu, Japan from June 2010 to March 2013. Before the surgery, neck pain was evaluated using a Visual Analog Scale(a score ≥50 indicated neck pain and a score <50 indicated no neck pain). The preoperative cross-sectional areas of the trapeziusmuscles were measured with cervical magnetic resonance imaging sagittal T2-weighted images. Cranial stimulation under generalanesthesia was used to derive the MEPs, enabling the measurement of latency and amplitude, using preoperative MEPs of the trapeziusmuscles.Results: The MEP of the trapezius muscle in patients with neck pain had significantly shorter latencies than those in patients whodid not have neck pain. However, there was no significant difference in the amplitude between patients with and without neck pain.However, this tended to be greater in patients with neck pain as compared to that in those without neck pain. The cross-sectionalarea of the trapezius muscle in patients with neck pain was significantly smaller than that in those who did not have neck pain.Conclusions: MEPs revealed electrophysiological abnormalities of the trapezius muscles in patients with neck pain, supporting arelationship of neck pain with the trapezius muscles

DOI： 10.31616/asj.2020.0186

Association between Severity of Diffuse Idiopathic Skeletal Hyperostosis and Ossification of Other Spinal Ligaments in Patients with Ossification of the Posterior Longitudinal Ligament Open Access

Nishimura, S; Hirai, T; Nagoshi, N; Yoshii, T; Hashimoto, J; Mori, K; Maki, S; Katsumi, K; Takeuchi, K; Ushio, S; Furuya, T; Watanabe, K; Nishida, N; 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; Matsukura, Y; Inose, H; Yamazaki, M; Watanabe, K; Matsumoto, M; Nakamura, M; Okawa, A; Kawaguchi, Y

JOURNAL OF CLINICAL MEDICINE Vol. 10 ( 20 ) 2021.10

Language：English Publisher：Journal of Clinical Medicine

Background: Although diffuse idiopathic skeletal hyperostosis (DISH) is known to coexist with the ossification of spinal ligaments (OSLs), details of the radiographic relationship remain unclear. Methods: We prospectively collected data of 239 patients with symptomatic cervical ossification of the posterior longitudinal ligament (OPLL) and analyzed the DISH severity on whole-spine computed tomography images, using the following grades: grade 0, no DISH; grade 1, DISH at T3–T10; grade 2, DISH at both T3–T10 and C6–T2 and/or T11–L2; and grade 3, DISH beyond C5 and/or L3. Ossification indices were calculated as the sum of vertebral and intervertebral levels with OSL for each patient. Results: DISH was found in 107 patients (44.8%), 65 (60.7%) of whom had grade 2 DISH. We found significant associations of DISH grade with the indices for cervical OPLL (r = 0.45, p < 0.0001), thoracic ossification of the ligamentum flavum (OLF; r = 0.41, p < 0.0001) and thoracic ossification of the supra/interspinous ligaments (OSIL; r = 0.53, p < 0.0001). DISH grade was also correlated with the index for each OSL in the whole spine (OPLL: r = 0.29, p < 0.0001; OLF: r = 0.40, p < 0.0001; OSIL: r = 0.50, p < 0.0001). Conclusion: The DISH grade correlated with the indices of OSL at each high-prevalence level as well as the whole spine.

DOI： 10.3390/jcm10204690

Zonisamide upregulates neuregulin-1 expression and enhances acetylcholine receptor clustering at the in vitro neuromuscular junction Reviewed

Inoue, T; Ohkawara, B; Bushra, S; Kanbara, S; Nakashima, H; Koshimizu, H; Tomita, H; Ito, M; Masuda, A; Ishiguro, N; Imagama, S; Ohno, K

NEUROPHARMACOLOGY Vol. 195 page： 108637 2021.9

Language：English Publisher：Neuropharmacology

Decreased acetylcholine receptor (AChR) clustering compromises signal transmission at the neuromuscular junction (NMJ) in myasthenia gravis, congenital myasthenic syndromes, and motor neuron diseases. Although the enhancement of AChR clustering at the NMJ is a promising therapeutic strategy for these maladies, no drug is currently available for this enhancement. We previously reported that zonisamide (ZNS), an anti-epileptic and anti-Parkinson's disease drug, enhances neurite elongation of the primary spinal motor neurons (SMNs). As nerve sprouting occurs to compensate for the loss of AChR clusters in human diseases, we examined the effects of ZNS on AChR clustering at the NMJ. To this end, we established a simple and quick co-culture system to reproducibly make in vitro NMJs using C2C12 myotubes and NSC34 motor neurons. ZNS at 1–20 μM enhanced the formation of AChR clusters dose-dependently in co-cultured C2C12 myotubes but not in agrin-treated single cultured C2C12 myotubes. We observed that molecules that conferred responsiveness to ZNS were not secreted into the co-culture medium. We found that 10 μM ZNS upregulated the expression of neuregulin-1 (Nrg1) in co-cultured cells but not in single cultured C2C12 myotubes or single cultured NSC34 motor neurons. In accordance with this observation, inhibition of the Nrg1/ErbB signaling pathways nullified the effect of 10 μM ZNS on the enhancement of AChR clustering in in vitro NMJs. Although agrin was not induced by 10 μM ZNS in co-cultured cells, anti-agrin antibody attenuated ZNS-mediated enhancement of AChR clustering. We conclude that ZNS enhances agrin-dependent AChR-clustering by upregulating the Nrg1/ErbB signaling pathways in the presence of NMJs.

DOI： 10.1016/j.neuropharm.2021.108637

Associations between Clinical Findings and Severity of Diffuse Idiopathic Skeletal Hyperostosis in Patients with Ossification of the Posterior Longitudinal Ligament Open Access

Hirai, T; Nishimura, S; Yoshii, T; Nagoshi, N; Hashimoto, J; Mori, K; Maki, S; Katsumi, K; Takeuchi, K; Ushio, S; Furuya, T; Watanabe, K; Nishida, N; 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; Yamazaki, M; Matsukura, Y; Inose, H; Okawa, A; Kawaguchi, Y

JOURNAL OF CLINICAL MEDICINE Vol. 10 ( 18 ) 2021.9

Language：English Publisher：Journal of Clinical Medicine

Background: This study investigated how diffuse idiopathic skeletal hyperostosis (DISH) influences clinical characteristics in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Although DISH is considered unlikely to promote neurologic dysfunction, this relationship remains unclear. Methods: Patient data were prospectively collected from 16 Japanese institutions. In total, 239 patients with cervical OPLL were enrolled who had whole-spine computed tomography images available. The primary outcomes were visual analog scale pain scores and the results of other self-reported clinical questionnaires. Correlations were sought between clinical symptoms and DISH using the following grading system: 1, DISH at T3-T10; 2, DISH at both T3–10 and C6–T2 and/or T11–L2; and 3, DISH beyond the C5 and/or L3 levels. Results: DISH was absent in 132 cases, grade 1 in 23, grade 2 in 65, and grade 3 in 19. There were no significant correlations between DISH grade and clinical scores. However, there was a significant difference in the prevalence of neck pain (but not in back pain or low back pain) among the three grades. Interestingly, DISH localized in the thoracic spine (grade 1) may create overload at the cervical spine and lead to neck pain in patients with cervical OPLL. Conclusion: This study is the first prospective multicenter cross-sectional comparison of subjective outcomes in patients with cervical OPLL according to the presence or absence of DISH. The severity of DISH was partially associated with the prevalence of neck pain.

DOI： 10.3390/jcm10184137

Normative Magnetic Resonance Imaging Data of Age-Related Degenerative Changes in Cervical Disc Morphology

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

WORLD NEUROSURGERY Vol. 152 page： E502 - E511 2021.8

Language：English Publisher：World Neurosurgery

Objective: Few studies have examined a possible correlation between cervical disc degeneration and disc height. The aim of this study was to establish age-related changes and sex-specific differences of cervical disc height using magnetic resonance imaging (MRI) and to evaluate the relationship between degree of cervical disc degeneration and disc height in asymptomatic subjects. Methods: We measured the intervertebral disc anteroposterior diameter and disc height in each disc level using MRI in 1211 relatively healthy volunteers (606 men and 605 women, mean age 49.5 years). We included at least 100 males and 100 females in each decade of life between the 20s and the 70s. Cervical disc degeneration was defined according to the modified Pfirrmann classification system, and disc index and intervertebral disc height narrowing ratio were evaluated on sagittal plane MRI. Results: Intervertebral disc height decreased gradually with increasing age in both sexes. The grade of disc degeneration significantly increased with age in both sexes at every level. Mild disc degeneration was observed even in subjects their 20s. Disc degeneration occurred around the C5-C6 level. The average disc height decreased with aging after the 40s. Disc index and intervertebral disc height narrowing ratio decreased with a progression in the disc degeneration grade in both sexes. Conclusions: This large-scale cross-sectional analysis of cervical spine MRI data in healthy subjects demonstrated that cervical disc height narrowing progresses with age. Cervical disc height narrowing is highly correlated with the progression of disc degeneration.

DOI： 10.1016/j.wneu.2021.05.123

Age-related degenerative changes and sex-specific differences in osseous anatomy and intervertebral disc height of the thoracolumbar spine Open Access

Machino, M; Nakashima, H; Ito, K; Katayama, Y; Matsumoto, T; Tsushima, M; Ando, K; Kobayashi, K; Imagama, S

JOURNAL OF CLINICAL NEUROSCIENCE Vol. 90 page： 317 - 324 2021.8

Language：English Publisher：Journal of Clinical Neuroscience

The aim of this study was to determine age-related changes and sex-specific differences in sagittal alignment, range of motion (ROM), and intervertebral disc height of the thoracolumbar spine in healthy subjects. Lateral neutral and flexion–extension radiographs of the thoracolumbar spine of 627 asymptomatic subjects (307 males and 320 females; average age, 49.6 ± 16.5 years) were evaluated. We included at least 50 males and 50 females in each decade of life between the 20s and the 70s. Intervertebral disc height from T10/T11 to L5/S1, local lordotic alignment, and ROM from T10–T11 to L5–S1 were measured. T10–L2 kyphosis and T12–S1 lordosis as well as flexion, extension, and total ROM were measured. T10–L2 kyphosis did not markedly change with age in subjects of either sex but a sudden increase was noted in the 70s females. T12–S1 lordosis increased with age in both sexes, except the 70s. Flexion, extension, and total ROM at T10–L2 and T12–S1 decreased with age in most subjects. The levels from L3–L4 to L5–S1 were conspicuous as mobile segments. Intervertebral disc height gradually increased from T10/T11 to L4/L5; the shortest was at T10/T11 and the longest at L3/L4 or L4/L5 in all subjects. Age-related decreases in intervertebral disc height were most prominent at L4/L5 in middle-aged and elderly individuals of both sexes. Normative values of sagittal alignment, ROM, and intervertebral disc height at each segmental level were established in both sexes and all age groups in healthy subjects.

DOI： 10.1016/j.jocn.2021.06.020

Current Advances in Spinal Diseases of the Elderly: Introduction to the Special Issue Open Access

Hirai, T; Uehara, M; Miyagi, M; Takahashi, S; Nakashima, H

JOURNAL OF CLINICAL MEDICINE Vol. 10 ( 15 ) 2021.8

Impact of Diabetes Mellitus on Cervical Spine Surgery for Ossification of the Posterior Longitudinal Ligament Open Access

Kimura, A; Takeshita, K; Yoshii, T; Egawa, S; Hirai, T; Sakai, K; Kusano, K; Nakagawa, Y; Wada, K; Katsumi, K; Fujii, K; Furuya, T; Nagoshi, N; Kanchiku, T; Nagamoto, Y; Oshima, Y; Nakashima, H; Ando, K; Takahata, M; Mori, K; Nakajima, H; Murata, K; Matsunaga, S; Kaito, T; Yamada, K; Kobayashi, S; Kato, S; Ohba, T; Inami, S; Fujibayashi, S; Katoh, H; Kanno, H; Watanabe, K; Imagama, S; Koda, M; Kawaguchi, Y; Nakamura, M; Matsumoto, M; Yamazaki, M; Okawa, A

JOURNAL OF CLINICAL MEDICINE Vol. 10 ( 15 ) 2021.8

Language：English Publisher：Journal of Clinical Medicine

Ossification of the posterior longitudinal ligament (OPLL) is commonly associated with diabetes mellitus (DM); however, the impact of DM on cervical spine surgery for OPLL remains unclear. This study was performed to evaluate the influence of diabetes DM on the outcomes following cervical spine surgery for OPLL. In total, 478 patients with cervical OPLL who underwent surgical treatment were prospectively recruited from April 2015 to July 2017. Functional measurements were conducted at baseline and at 6 months, 1 year, and 2 years after surgery using JOA and JOACMEQ scores. The incidence of postoperative complications was categorized into early (_30 days) and late (>30 days), depending on the time from surgery. From the initial group of 478 patients, 402 completed the 2-year follow-up and were included in the analysis. Of the 402 patients, 127 (32%) had DM as a comorbid disease. The overall incidence of postoperative complications was significantly higher in patients with DM than in patients without DM in both the early and late postoperative periods. The patients with DM had a significantly lower JOA score and JOACMEQ scores in the domains of lower extremity function and quality of life than those without DM at the 2-year follow-up.

DOI： 10.3390/jcm10153375

Characteristics of cases with and without calcification in spinal meningiomas Reviewed

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

JOURNAL OF CLINICAL NEUROSCIENCE Vol. 89 page： 20 - 25 2021.7

Language：English Publisher：Journal of Clinical Neuroscience

Purpose: To quantify calcification in spinal meningiomas using Hounsfield unit (HU) values on CT, and to analyze the characteristics of cases with and without calcification and with different histologic subtypes. Methods: The subjects were 53 patients who underwent surgical resection of spinal meningioma between January 1999 and December 2019. Clinical and surgical data were collected, and all patients were examined neurologically preoperatively and at final follow-up using the modified McCormick scale and the American Spinal Injury Association scale. Calcification was quantified on CT of the spine prior to surgery. A HU value >60 was considered to indicate calcification. Results: The 53 patients (11 males, 42 females) were aged 62.4 ± 14.3 (range 19 to 91) years at surgery, and had a symptom duration of 10.8 ± 9.0 (1–36) months. The histological type was meningothelial in 35 cases, psammomatous in 13, and others in 5. The mean tumor volume was 1166 ± 350 (593–2176) mm<sup>3</sup>, and the mean HU value was 212.2 ± 192.8 (43–648). Forty cases (75%) had calcification (HU value > 60). HU values were significantly related to duration of symptoms (R = 0.590, p < 0.05) and significantly higher in psammomatous cases (p < 0.05). Cases with calcification had longer operative times and greater blood loss, and a significantly lower rate of neurological improvement. Conclusion: CT was effective for detecting calcification based on HU values. Detection of a HU value > 60 in spinal meningioma may be useful to narrow the differential diagnosis, evaluate the difficulty of resection, and improve intraoperative management, all of which may improve outcomes.

DOI： 10.1016/j.jocn.2021.04.019

The Level of Conus Medullaris in 629 Healthy Japanese Individuals Reviewed Open Access

Nakashima, H; Ito, K; Katayama, Y; Tsushima, M; Ando, K; Kobayashi, K; Machino, M; Ito, S; Koshimizu, H; Segi, N; Tomita, H; Imagama, S

JOURNAL OF CLINICAL MEDICINE Vol. 10 ( 14 ) 2021.7

Language：English Publisher：Journal of Clinical Medicine

The conus medullaris typically terminates at the L1 level; however, variations in its level and the factors associated with the conus medullaris level are unclear. We investigated the level of conus medullaris on magnetic resonance imaging in healthy volunteers. In total, 629 healthy adult volunteers (≥50 individuals of each sex and in each decade of age from 20 to 70 ) were enrolled. The level of the conus medullaris was assessed based on the T2-weighted sagittal magnetic resonance images, and factors affecting its level were investigated employing multivariate regression analysis including the participants’ background and radiographical parameters. L1 was the most common conus medullaris level. Participant height was significantly shorter in the caudally placed conus medullaris (p = 0.013). With respect to the radiographical parameters, pelvic incidence (p = 0.003), and pelvic tilt (p = 0.03) were significantly smaller in participants with a caudally placed conus medullaris. Multiple regression analysis showed that the pelvic incidence (p < 0.0001) and height (p < 0.0001) were significant factors affecting the conus medullaris level. These results indicated that the length of the spinal cord varies little among individuals and that skeletal differences affect the level of the conus medullaris.

DOI： 10.3390/jcm10143182

Impact of Neck and Shoulder Pain on Health-Related Quality of Life in a Middle-Aged Community-Living Population Open Access

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

BIOMED RESEARCH INTERNATIONAL Vol. 2021 page： 6674264 2021.6

Language：English Publisher：Biomed Research International

Purpose. Neck and shoulder pain (NSP) is very common in the general population. However, scarce information exists on the relationship between NSP and health-related quality of life (HRQOL) outcomes in this population. The present study described NSP prevalence and its impact on the HRQOL of middle-aged and older persons undergoing a routine medical checkup. Methods. This study recruited 318 subjects (125 males and 193 females; average age, 63.4 years) in good health, collected underwent anthropometric measurements, physical function examinations, and blood testing. This study defined NSP as the presence of muscle tension, stiffness, pressure, or dull pain in areas between the neck and the arch of the scapular. Study subjects were divided into two groups (NSP (+) and NSP (-) groups). The subjects completed questions on the Medical Outcomes Study 36-item short-form health survey (SF-36) and the EuroQol 5-dimension, 5-level version (EQ-5D-5L) tool. Results. Of the patients, 150 and 168 were NSP (+) and NSP (-), respectively. The NSP complaint rate was 47.2%. The NSP (+) group had younger and more female participants than the NSP (-) group. In the multivariate regression analysis, the NSP (+) group had lower physical QOL based on the SF-36 physical component summary (odds ratio (OR), 2.45) and lower mental QOL based on the SF-36 mental component summary (OR, 2.05). Overall, the NSP (+) group had a higher risk of having low QOL scores (EQ-5D-5L index; OR, 1.76). Conclusions. The NSP (+) rate in healthy middle-aged and older persons was 47.2%. Furthermore, NSP (+) status was directly related poor HRQOL. NSP is a predictor of suboptimal physical and mental QOL. Therefore, NSP prevention or intervention for NSP may improve middle-aged and older adults' QOL.

DOI： 10.1155/2021/6674264

Neurological improvement is associated with neck pain attenuation after surgery for cervical ossification of the posterior longitudinal ligament Open Access

Koda, M; Yoshii, T; Egawa, S; Sakai, K; Kusano, K; Nakagawa, Y; Hirai, T; Wada, K; Katsumi, K; Kimura, A; Furuya, T; Maki, S; Nagoshi, N; Watanabe, K; Kanchiku, T; Nagamoto, Y; Oshima, Y; Ando, K; Nakashima, H; Takahata, M; Mori, K; Nakajima, H; Murata, K; Matsunaga, S; Kaito, T; Yamada, K; Kobayashi, S; Kato, S; Ohba, T; Inami, S; Fujibayashi, S; Katoh, H; Kanno, H; Takahashi, H; Fujii, K; Miyagi, M; Inoue, G; Takaso, M; Imagama, S; Kawaguchi, Y; Takeshita, K; Nakamura, M; Matsumoto, M; Okawa, A; Yamazaki, M

SCIENTIFIC REPORTS Vol. 11 ( 1 ) page： 11910 2021.6

Language：English Publisher：Scientific Reports

Although favourable surgical outcomes for myelopathy caused by cervical ossification of the posterior longitudinal ligament (OPLL) have been reported, factors significantly associated with post-operative neck pain attenuation still remain unclear. The primary aim of the present study was to determine factors significantly associated with post-operative neck pain attenuation in patients with cervical OPLL using a prospective multi-centre registry of surgically treated cervical OPLL. Significant postoperative neck pain reduction (50% reduction of neck pain) was achieved in 31.3% of patients. There was no significant difference in neck pain attenuation between surgical procedures. Statistical analyses with univariate analyses followed by stepwise logistic regression revealed neurological recovery as a factor having a significant positive association with post-operative neck pain attenuation (p = 0.04, odds ratio 5.68 (95% confidence interval: 1.27–22.2)). In conclusion, neurological recovery was an independent factor having a significant positive association with post-operative neck pain attenuation in patients with cervical myelopathy caused by OPLL who underwent cervical spine surgery.

DOI： 10.1038/s41598-021-91268-2

Clinical features and prognostic factors in spinal meningioma surgery from a multicenter study Open Access

Kobayashi, K; Ando, K; Matsumoto, T; Sato, K; Kato, F; Kanemura, T; Yoshihara, H; Sakai, Y; Hirasawa, A; Nakashima, H; Imagama, S

SCIENTIFIC REPORTS Vol. 11 ( 1 ) page： 11630 2021.6

Language：English Publisher：Scientific Reports

Meningiomas are benign tumors that are treated surgically. Local recurrence is likely if the dura is preserved, and en bloc tumor and dura resection (Simpson grade I) is recommended. In some cases the dura is cauterized and preserved after tumor resection (Simpson grade II). The purpose of this study was performed to analyze clinical features and prognostic factors associated with spinal meningioma, and to identify the most effective surgical treatment. The subjects were 116 patients (22 males, 94 females) with spinal meningioma who underwent surgery at seven NSG centers between 1998 and 2018. Clinical data were collected from the NSG database. Pre- and postoperative neurological status was defined using the modified McCormick scale. The patients had a mean age of 61.2 ± 14.8 years (range 19–91 years) and mean symptom duration of 11.3 ± 14.7 months (range 1–93 months). Complete resection was achieved in 108 cases (94%), including 29 Simpson grade I and 79 Simpson grade II resections. The mean follow-up period was 84.8 ± 52.7 months. At the last follow-up, neurological function had improved in 73 patients (63%), was stable in 34 (29%), and had worsened in 9 (8%). Eight patients had recurrence, and recurrence rates did not differ significantly between Simpson grades I and II in initial surgery. Kaplan–Meier analysis of recurrence-free survival showed that Simpson grade III or IV, male, and dural tail sign were significant factors associated with recurrence (P < 0.05). In conclusion, Simpson I resection is anatomically favorable for spinal meningiomas. Younger male patients with a dural tail and a high-grade tumor require close follow-up. The tumor location and feasibility of surgery can affect the surgical morbidity in Simpson I or II resection. All patients should be carefully monitored for long-term outcomes, and we recommend lifelong surveillance after surgery.

DOI： 10.1038/s41598-021-91225-z

Pedicle screw placement with use of a navigated surgical drill at subaxial cervical spine

Satake, K; Kanemura, T; Ito, K; Tanaka, S; Morita, Y; Nakashima, H; Ouchida, J; Imagama, S

JOURNAL OF CLINICAL NEUROSCIENCE Vol. 88 page： 28 - 33 2021.6

Language：English Publisher：Journal of Clinical Neuroscience

Study design: Retrospective cohort study. Objective: This study was performed to evaluate the accuracy of cervical pedicle screw (CPS) placement with use of a navigated surgical drill (ND) and to compare it with navigated manual probe (MP) at C3–C6. Methods: 47 consecutive patients (27 males and 20 females, 67.2 [33–91] years) underwent a posterior cervical fixation using CPSs under an intraoperative 3D - – CT based navigation system (total 207 CPSs). For initial probing, ND with 2.2-mm steel burr was used since Apr. 2017 (Group ND; 33 patients, 152 CPSs). MP was used earlier (Group MP; 14 patients, 55 CPSs). There were no other different procedures between the two groups. The accuracy of CPS placement was graded with postoperative CT and compared between the two groups. Results: There were no significant differences in the total perforation rates both in axial and sagittal planes between Groups ND and MP (axial; 7.2% vs. 14.5%, p = 0.25, sagittal; 10.5% vs. 14.5%, p = 0.46). However, the lateral and rostral perforation rates were significantly reduced in Group ND compared to Group MP (lateral: 36.4% vs. 87.5%, p = 0.04; rostral: 6.3% vs. 100%, p = 0.001). Conclusion: Although ND did not decrease the total perforation rate significantly, it reduced the incidence of lateral and rostral perforation. ND is likely to make initial probing easier without a forcible manipulation which might cause vertebral rotation.

DOI： 10.1016/j.jocn.2021.03.009

Human Nonmercaptalbumin Is a New Biomarker of Motor Function Open Access

Ito, S; Nakashima, H; Ando, K; Kobayashi, K; Machino, M; Seki, T; Ishizuka, S; Kanbara, S; Inoue, T; Koshimizu, H; Fujii, R; Yamada, H; Ando, Y; Ueyama, J; Kondo, T; Suzuki, K; Hasegawa, Y; Imagama, S

JOURNAL OF CLINICAL MEDICINE Vol. 10 ( 11 ) 2021.6

Language：English Publisher：Journal of Clinical Medicine

The ratio of human nonmercaptalbumin (HNA) and reduced albumin (HMA) may be a new marker for oxidative stress. Locomotive syndrome (LS) is reduced mobility due to impairment of locomotive organs. We investigated whether the HNA/HMA ratio could be a new biomarker of LS. This study included 306 subjects (mean age 64.24 ± 10.4 years) who underwent LS tests, grip strength, walking speed, and tests for HNA and HMA. Oxidative stress was measured by the ratio of HMA (f(HMA) = (HMA/(HMA + HNA) × 100)), and the subjects were divided into normal (N group; f[HMA] ≥ 70%) and low (L group; f[HMA] < 70%) groups. There were 124 non-elderly (<65 years) and 182 elderly subjects (≥65 years). There were no significant differences in LS, grip strength, and walking speed between the L and N groups in the non-elderly subjects. However, significant differences were found in the elderly subjects. In logistic regression analysis, there was an association between f(HMA) and the LS severity at older ages. LS in the elderly is associated with a decline in HMA and, thus, an increase in oxidative stress. Thus, f(HMA) is a new biomarker of LS.

DOI： 10.3390/jcm10112464

Sagittal alignment at 3 years old determines future thoracolumbar kyphosis in achondroplasia: A prospective study with minimum 5-year follow-up from infancy Reviewed Open Access

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

NORTH AMERICAN SPINE SOCIETY JOURNAL Vol. 6 page： 100070 2021.6

Language：English Publisher：North American Spine Society Journal

Background: Little is known about the progression of Thoracolumbar kyphosis (TLK) in achondroplasia. The aim of the study was to evaluate natural progression of TLK and establish risk factors for progression. Methods: We reviewed 21 patients (11 males, 10 females) diagnosed clinically and radiographically with achondroplasia as infants and followed for a minimum of 5 years from infancy, and analyzed to compare differences between data at 0, 1, 3, 5, 7-10, and 11-18 years old. Subjects (n=21) were divided into two groups with and without TLK >20° at the thoracolumbar junction on lateral standing radiographs at age 3. Results: TLK >20° occurs in 76.2% of infants in the first 7 months of life. Sagittal parameters at 0, 1, 3, 5, 7-10, and 11-18 years old differed significantly for cervical lordosis (CL), thoracic kyphosis (TK), TLK, lumbar lordosis (LL), pelvic tilt (PT), and sacral slope (SS). TK, LL, and SS increased significantly with increasing age, whereas CL, TLK, and PT were significantly lower in older age groups (P < 0.05). In 6 of 7 patients with TLK >20° at age 3, TLK had progressed or was still >20° at age 5. The prevalence of TLK >20° at age 3 was 33.3% (7/21). There was a significant difference in age at independent walking among subjects with and without TLK at age 3 (31.4±17.1 vs. 16.1±3.4 months, P < 0.01). Radiologic parameters associated with TLK showed significant differences between subjects with and without TLK at age 3, including TLK, TK, TLK, LL, and SVA at age 5; and TLK at ages 7-10 and 11-18. Conclusions: These results suggest that sagittal alignment at 3 years old determines future TLK in achondroplasia. Progression of deformity and neurological impairments require consideration in treatment planning.

DOI： 10.1016/j.xnsj.2021.100070

特集ロコモティブシンドロームの現況 Ⅳ.住民コホートによる評価 4.Yakumoスタディで行っている運動器検診

中島宏彰, 今釜史郎, 安藤圭, 小林和克, 町野正明, 関泰輔, 石塚真哉, 長谷川幸治

整形外科 Vol. 72 ( 6 ) page： 623 - 627 2021.5

特集ロコモティブシンドロームの現況 Ⅵ.疾患とロコモ 1.脊椎アライメントとロコモ

町野正明, 安藤圭, 小林和克, 中島宏彰, 長谷川幸治, 今釜史郎

整形外科 Vol. 72 ( 6 ) page： 659 - 662 2021.5

Overcoming locomotive syndrome: The Yakumo Study

Kobayashi, K; Ando, K; Nakashima, H; Machino, M; Kanbara, S; Ito, S; Inoue, T; Yamaguchi, H; Koshimizu, H; Ishiguro, N; Hasegawa, Y; Imagama, S

MODERN RHEUMATOLOGY Vol. 31 ( 3 ) page： 750 - 754 2021.5

Language：English Publisher：Modern Rheumatology

Objectives: Improvement of life expectancy is increasingly important with the aging of society. The aim of the study was to compare physical performance in elderly people in two 3-year periods (2001–2003) and (2016–2018). Methods: The participants were healthy Japanese elderly adults who attended public health check-ups in Yakumo. Results for 10 m gait time, two-step test, back muscle strength, and grip strength were examined prospectively for participants in 2001–2003 (Group A: n = 488) and 2016–2018 (Group B: n = 309) by gender and age (65–74 and 75–84 years). Results: There were significant differences between Groups A and B for 10 m gait time (age 65–74: male: 5.6 vs. 5.2 s, female: 6.3 vs. 5.5 s; age 75–84: male: 6.1 vs. 5.5 s, female: 6.7 vs. 5.8 s; all p <.05) and two-step test (age 65–74: male: 1.41 vs. 1.48, female: 1.35 vs. 1.44; age 75–84: male: 1.32 vs. 1.41, female: 1.30 vs. 1.38; all p <.05), but not for back muscle strength or grip strength. Conclusion: Our results suggest a phenomenon of ‘overcoming locomotive syndrome’, in which physical performance changed by aging, including motor functions such as 10 m gait time and two-step test, has improved in the current population compared with a similar population from 15 years ago.

DOI： 10.1080/14397595.2021.1879413

Ossification of the posterior longitudinal ligament located on the concave side of the apex vertebra in adult spinal deformity Open Access

Koshimizu, H; Ando, K; Kobayashi, K; Nakashima, H; Machino, M; Ito, S; Kanbara, S; Inoue, T; Yamaguchi, H; Imagama, S

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 83 ( 2 ) page： 387 - 392 2021.5

Language：English Publisher：Nagoya Journal of Medical Science

A 48-year-old female patient presented with discomfort in the front of the chest. Whole spinal X-ray revealed a thoracic curve of 52°, and thoracic computed tomography (CT) myelography and magnetic resonance imaging (MRI) showed that ossification of the posterior longitudinal ligament (OPLL) on the concave side of the apex vertebra (T9) had highly compressed the spinal cord. Cervical MRI also showed that the C4-C5 intervertebral disc herniation mildly compressed the spinal nerve. In concomitant surgery, the patient underwent cervical laminoplasty, in which OPLL was removed by decompressive laminectomy and posterior correction surgery.In patients with adult spinal deformity (ASD), asymmetric mechanical stress at the apex vertebra can cause various abnormal conditions. Long-term local mechanical stress on the concave side of the apex vertebra might have affected OPLL formation in the present case. This is the first report of a surgical case for an ossification located on the concave side of the apex vertebra in a patient with ASD. Mechanical stress at the concave side of the apex vertebra was suspected to be a cause of formation of OPLL.

DOI： 10.18999/nagjms.83.2.387

Association between Low Muscle Mass and Inflammatory Cytokines Reviewed Open Access

Ito, S; Nakashima, H; Ando, K; Kobayashi, K; Machino, M; Seki, T; Ishizuka, S; Fujii, R; Takegami, Y; Yamada, H; Ando, Y; Suzuki, K; Hasegawa, Y; Imagama, S

BIOMED RESEARCH INTERNATIONAL Vol. 2021 page： 5572742 2021.4

Language：English Publisher：Biomed Research International

Sarcopenia is a multifaceted geriatric syndrome associated with the loss of muscle mass. We examined the relationship between low muscle mass and inflammatory cytokines in the context of aging. This study involved 299 participants (127 men and 172 women; mean age 63.3±9.8 years) who underwent health checkups for body composition and inflammatory cytokine (TNF-alpha, IL-6, and MCP-1) levels. Muscle mass was determined using the skeletal muscle mass index. We divided the participants into the normal (N) and low muscle mass (L) groups and compared the levels of inflammatory cytokines in nonelderly (<65 years) and elderly (≥65 years) participants. Among the nonelderly subjects, C-reactive protein was significantly lower in the L group than in the N group (p<0.05). However, there was no significant difference in the inflammatory cytokine levels between the groups. Among the elderly subjects, the TNF-alpha level was significantly lower in the L group than in the N group (p<0.05), whereas there were no significant differences in the IL-6 and MCP-1 levels. Moreover, TNF-alpha was identified as a risk factor for the L group in the logistic regression analysis (Exp (B) 0.935, 95% CI: 0.876-0.997, p=0.04). Although a low TNF-alpha level is a risk factor for low muscle mass, inflammatory cytokine levels are not necessarily elevated in elderly individuals with the loss of muscle mass.

DOI： 10.1155/2021/5572742

Is cervical total disc replacement able to achieve a lordotic alignment?

Satake Kotaro, Kanemura Tokumi, Ito Kenyu, Tanaka Satoshi, Nakashima Hiroaki, Ouchida Jun, Imagama Shiro

Journal of Spine Research Vol. 12 ( 4 ) page： 657 - 662 2021.4

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

<p><b>Introduction: </b>A retrospective review was performed to evaluate clinical symptoms and the alignment of cervical spine for patients who underwent a cervical total disc replacement (C-TDR).</p><p><b>Methods: </b>10 patients underwent a single-level C-TDR. Their JOA score, EQ5D, EQ-VAS, range of motion (ROM), segmental lordosis, and C2-C7 angle were evaluated at preoperation and at 6 months postoperation.</p><p><b>Results: </b>JOA score, EQ5D, and EQ-VAS, ROM, and segmental lordosis were significantly improved at 6 months compared with the preoperative state though C2-C7 angle did not change significantly.</p><p><b>Conclusions: </b>C-TDR increases the local lordosis but does not affect the global lordosis of the cervical spine at 6 months postoperation.</p>

DOI： 10.34371/jspineres.2021-0402

Age-related Changes in T1 and C7 Slope and the Correlation Between Them in More Than 300 Asymptomatic Subjects Reviewed

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

SPINE Vol. 46 ( 8 ) page： E474 - E481 2021.4

Language：English Publisher：Spine

Study Design.A cross-sectional analysis using T1 slope (T1S) and C7 slope (C7S) in asymptomatic individuals.Objective.The aim of this study was to identify normative values, ranges of motion (ROMs), age-related changes in T1S and C7S, and correlation between the two slopes.Summary of Background Data.Few studies have reported age-related changes in the T1S and C7S angles. Additionally, studies investigating the effects of cervical position on these slopes are limited.Methods.A total of 388 asymptomatic subjects (162 males and 226 females) for whom T1S measurement was performed on radiographs were enrolled in the study. The T1S and C7S angles were measured using neutral radiography of the cervical spine. ROMs were assessed by measuring the difference in alignment in the neutral position, flexion, and extension.Results.The mean C7S and T1S angles were 19.6° (22.2° in males, 17.9° in females) and 24.0° (26.7° in men and 22.1° in women), respectively. The T1S angle was significantly greater than the C7S angle. Both the C7S and T1S angles significantly increased with age. The flexion ROM of C7S was higher than that of T1S, whereas no significant difference was detected between the extension ROMs of the two slopes. The flexion ROMs of the two slopes did not change, whereas the extension ROMs significantly increased with age. A significant positive correlation was observed between the C7S and T1S angles (r<sup>2</sup> = 0.75).Conclusion.The normative values and age-related changes in C7S and T1S were analyzed. Both the C7S and T1S angles increased with age. The C7S angle was strongly correlated with the T1S angle, suggesting that C7S can substitute T1S on radiographic images.Level of Evidence: 3.

DOI： 10.1097/BRS.0000000000003813

Primary cervical decompression surgery may improve lumbar symptoms in patients with tandem spinal stenosis

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

EUROPEAN SPINE JOURNAL Vol. 30 ( 4 ) page： 899 - 906 2021.4

Language：English Publisher：European Spine Journal

Purpose: Tandem spinal stenosis (TSS) refers to coexisting lumbar and cervical canal stenosis. Evidence regarding whether cervical decompression improves lumbar symptoms in TSS is insufficient. Therefore, we determined the effectiveness of cervical decompression surgery for patients with lumbar spinal stenosis (LSS) and cervical spinal stenosis. Methods: The records of 64 patients with TSS experiencing lumbar symptoms who underwent cervical decompression surgery between April 2013 and July 2017 at a single institution were retrospectively reviewed. We categorized patients into the Non-improved (n = 20), Relapsed (n = 30), and Maintained-improvement (n = 14) groups according to the presence or absence of improvement and relapse in lower limb symptoms in TSS following cervical decompression surgeries. Results: Of 64 patients, 44 (69%) showed improved lower limb or low back symptoms, with 14 (22%) patients maintaining improvement. The preoperative cervical myelopathy-Japanese Orthopedic Association score and the preoperative number of steps determined using the 10-s step test were significantly lower in the Non-improved group than in the Maintained-improvement group. Receiver operating characteristic curve of preoperative 10-s step test results revealed 12 steps as a predictor for maintained improvement. Conclusion: The improvement of LSS symptoms following cervical decompression surgeries may be associated with the severity of cervical myelopathy as determined in clinical findings rather than in imaging findings. Patients with TSS having a 10-s step test result of < 12 steps were more likely to experience a relapse of lower limb symptoms following cervical decompression surgeries.

DOI： 10.1007/s00586-020-06693-0

Bioelectrical Impedance Analysis and Manual Measurements of Neck Circumference Are Interchangeable, and Declining Neck Circumference Is Related to Presarcopenia Open Access

Machino, M; Ando, K; Kobayashi, K; Nakashima, H; Tanaka, S; Kanbara, S; Ito, S; Inoue, T; Koshimizu, H; Seki, T; Ishizuka, S; Takegami, Y; Hasegawa, Y; Imagama, S

BIOMED RESEARCH INTERNATIONAL Vol. 2021 page： 6622398 2021.3

Language：English Publisher：Biomed Research International

Purpose. Preventive medicine is important in an aging society. Presarcopenia is the preliminary stage of sarcopenia. Recent advances in bioelectrical impedance analysis (BIA) devices have enabled automatic estimation of neck circumference (NC). However, the agreement between and interchangeability of NC measured manually and that calculated with BIA have not been evaluated. We performed these analyses in the context of health checkups and investigated their associations with presarcopenia. Methods. We enrolled 318 participants who underwent anthropometric measurements, including NC measured manually and by BIA; assessment of physical function; and blood testing. We used Bland-Altman analysis to calculate the agreement between and interchangeability of NC measurements by BIA and by the manual method. We then statistically compared normal participants and those with presarcopenia. Using multivariable analysis, we subsequently investigated significant risk factors for presarcopenia. We defined presarcopenia according to the appendicular skeletal muscle index (aSMI; the ratio of arm and leg skeletal muscle mass to height2). Results. Bland-Altman analysis showed that bias (BIA-manual) was negative overall (-1.07), for male participants (-1.23), and for female participants (-0.96). This finding suggests that BIA measurement is an underestimate in comparison with manual measurement. NC measurement by BIA was found to be interchangeable with that by manual methods, inasmuch as the percentage error was less than 5% overall (4.38%), for male participants (3.81%), and for female participants (4.58%). Univariable analysis revealed that NC was significantly smaller in the participants with presarcopenia than in those without. Multivariable analysis, adjusted for confounding factors, revealed that a decrease in NC was significantly correlated with presarcopenia. Conclusions. BIA measurements of NC are interchangeable within about 95% with manual measurements. The decrease in NC measured by BIA was significantly associated with presarcopenia in both genders. NC measurement can be used for early detection of presarcopenia.

DOI： 10.1155/2021/6622398

Risk Factors for Poor Outcome of Cervical Laminoplasty Multivariate Analysis in 505 Patients with Cervical Spondylotic Myelopathy Reviewed

Machino, M; Ando, K; Kobayashi, K; Nakashima, H; Kanbara, S; Ito, S; Inoue, T; Ito, K; Kato, F; Ishiguro, N; Imagama, S

SPINE Vol. 46 ( 5 ) page： 329 - 336 2021.3

Language：English Publisher：Spine

The risk factors for poor outcome after cervical laminoplasty in patients with cervical spondylotic myelopathy (CSM) were demonstrated. These findings suggest that advanced age, long-term CSM symptoms, and lower score of preoperative 10-second step test are risk factors for poor cervical laminoplasty outcomes in patients with CSM.

DOI： 10.1097/BRS.0000000000003783

Intraoperative pedicle screw migration to the abdominal cavity in a severe osteoporotic spine surgery Open Access

Ouchida, J; Kanemura, T; Satake, K; Nakashima, H; Ishikawa, Y; Segi, N; Yamaguchi, H; Imagama, S

INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT Vol. 23 2021.3

Language：Japanese Publisher：Interdisciplinary Neurosurgery Advanced Techniques and Case Management

Study Design: A case report. Objective: To report a dangerous intraoperative complication of spinal instrumentation surgery. Summary of Background Data: Spinal instrumentation is indispensable for surgical treatment of degenerative spinal disorders. Revision surgeries in cases with severe osteoporosis involve high risks of intraoperative complications. Methods: We present a case of a 79-year-old female who underwent revision surgery for thoracolumbar deformity. She had a medical history of rheumatoid arthritis and severe osteoporosis due to long time steroid medication. In the pedicle screw replacement procedure, the implant fell into the abdominal cavity through the vertebrae, as confirmed by fluoroscopy. Results: An emergent surgical survey with intraoperative computed tomography revealed that the implant was buried in the abdominal wall. General surgeons performed abdominal surgery; ascending colon mesentery and ovarian vein injuries were repaired. The patient recovered without any permanent disorders and was discharged from the hospital on schedule. Conclusions: Although intraoperative pedicle screw drop into the abdominal cavity is rare, this complication could occur in cases with severe osteoporosis and a revision surgery accompanied by screw loosening. Therefore, preoperative detailed radiographic evaluation and meticulous attention during surgery are mandatory for treatment of patients with severe osteoporosis.

DOI： 10.1016/j.inat.2020.100943

Kinetic changes in the spinal cord occupation rate of dural sac in cervical spondylotic myelopathy Open Access

Machino, M; Ito, K; Kato, F; Ando, K; Kobayashi, K; Nakashima, H; Kanbara, S; Ito, S; Inoue, T; Koshimizu, H; Imagama, S

JOURNAL OF ORTHOPAEDICS Vol. 24 page： 222 - 226 2021.3

Language：English Publisher：Journal of Orthopaedics

Objective: The study aimed to establish the spinal cord occupation rate of the dural sac during ﬂexion and extension. Methods: We measured the cross-sectional area of the dural sac and the spinal cord between C2/C3 and C7/T1 disc levels in 100 patients with cervical spondylotic myelopathy and 1211 asymptomatic subjects. Results: The spinal cord occupation rate of the dural sac in the cross-sectional area was higher on extension than on ﬂexion at the mid-lower cervical spine. Conclusions: The spinal cord occupation rate of the dural sac in the cross-sectional area was highest at the C4/C5 and C5/C6 levels on extension.

DOI： 10.1016/j.jor.2021.03.005

Risk factors of non-union in Anderson-D'Alonzo type III odontoid fractures with conservative treatment Reviewed Open Access

Koshimizu, H; Nakashima, H; Ito, K; Ando, K; Kobayashi, K; Kato, F; Sato, K; Deguchi, M; Matsubara, Y; Inoue, H; Kanemura, T; Urasaki, T; Yoshihara, H; Wakao, N; Shinjo, R; Imagama, S

JOURNAL OF ORTHOPAEDICS Vol. 24 page： 280 - 283 2021.3

Language：English Publisher：Journal of Orthopaedics

Objective: The purpose of this study was retrospectively to analyze the risk factors for non-union in Anderson–D'Alonzo type III odontoid fractures with conservative treatment. Methods: 25 patients with type III fractures were analyzed. Coronal and sagittal tilt as well as sagittal and lateral mass gaps were measured by using computed tomography. Results: The non-union group had significantly higher age, greater coronal tilt and lateral mass gap. Especially, the lateral mass gap was >2 mm in all cases with non-union. Conclusions: Higher age, coronal tilt, and lateral mass gap were significant risk factors for non-union.

DOI： 10.1016/j.jor.2021.03.012

A New Global Spinal Balance Classification Based on Individual Pelvic Anatomical Measurements in Patients With Adult Spinal Deformity

Nakashima, H; Kawakami, N; Ohara, T; Saito, T; Tauchi, R; Imagama, S

SPINE Vol. 46 ( 4 ) page： 223 - 231 2021.2

Language：English Publisher：Spine

Study Design. A retrospective study. Objective. This study aims to establish a new, easy-to-implement global spinal balance (GSB) classification based on individual pelvic anatomical measurements in adult spinal deformity patients, and to validate this classification in terms of patients' quality of life (QOL). Summary of Background Data. Coronal (central sacral vertical line) and sagittal (C7 sagittal vertical axis [C7 SVA]) lines are standard parameters to evaluate GSB. However, these parameters do not consider individual differences in height and physique. Therefore, a new classification to more simply evaluate GSB related to QOL would be a beneficial tool. Methods. This study included 279 patients with adult spinal deformity. The enrollment criteria included age >18 years and scoliosis >308. GSB was evaluated based on C7 coronal vertical axis and C7 SVA, and was graded with our sagittal (Grades 1-3) and coronal classifications (Grades 1-3), where larger values represented worse GSB. In addition, total global balance classification (Grades 1-3) was also established based on both coronal and sagittal classifications. Patient self-assessment measures of health status were collected using the Scoliosis Research Society patient questionnaire (SRS-22). The relationships between responses to the SRS-22 and GSB were evaluated using partial correlation coefficients, adjusted by age. Results. A newly described coronal classification correlated with the preoperative function (P < 0.02), pain (P=0.001), subtotal (P < 0.001) domains in the SRS-22, whereas a newly described sagittal classification was correlated with the preoperative subtotal domain (P < 0.001). There were also significant correlations between total global balance and the preoperative function (P=0.03) and subtotal domains (P < 0.001) in the SRS- 22. Conclusion. We present a simple new classification for GSB that strongly correlates with QOL in patients with adult spinal deformity, thereby translating clinical data into meaningful patient outcomes and livelihoods.

DOI： 10.1097/BRS.0000000000003780

Challenges for Joint Commission International accreditation: performance of orthopedic surgeons based on International Patient Safety Goals Open Access

Kobayashi, K; Ando, K; Nakashima, H; Machin, M; Kanbara, S; Ito, S; Inoue, T; Yamaguchi, H; Ishiguro, N; Imagama, S

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 83 ( 1 ) page： 87 - 92 2021.2

Language：English Publisher：Nagoya Journal of Medical Science

The Joint Commission International (JCI) is a US-based organization that accredits and certifies hospitals worldwide. Among the requirements for accreditation, the JCI emphasizes continuous quality improvement (CQI) with regard to international patient safety goals (IPSGs). Our university hospital treats about 26,000 hospitalized patients and 600,000 outpatients annually, and our goal is patient safety in compliance with IPSGs. The purpose of this study is to examine the activities of orthopedic surgeons in preparation for JCI accreditation, including clear identification of patients, preoperative timeout and marking to ensure correct surgery, timely approval of CT/MRI reports, care with pain management, prevention of infection, setting of quality indicators and daily monitoring, and teamwork. Examiners from the JCI visited our hospital to review medical records and documents, and to interview patients, nurses and doctors. There were 1270 evaluation items covering 16 fields, including reviews of IPSGs, patient evaluation and care, infection prevention and control, and governance and leadership. Most importantly, the efforts of all the medical staff in our hospital in obtaining the first JCI accreditation among national university hospitals in Japan have promoted the safety and quality of medical care from the perspective of the patient

DOI： 10.18999/nagjms.83.1.87

The dual presence of frailty and locomotive syndrome is associated with a greater decrease in the EQ-5D-5L index Reviewed Open Access

Tanaka, S; Ando, K; Kobayashi, K; Nakashima, H; Seki, T; Ishizuka, S; Machino, M; Morozumi, M; Kanbara, S; Ito, S; Kanemura, T; Ishiguro, N; Hasegawa, Y; Imagama, S

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 83 ( 1 ) page： 159 - 167 2021.2

Language：English Publisher：Nagoya Journal of Medical Science

Japan’s aging society is facing an increase in the prevalence of frailty and locomotive syndrome (LS) among older adults. To evaluate the association of these age-related declines on health-related quality of life (QOL) in Japan, we investigated this relationship among Japanese middle-aged and older adults who underwent general checkups and examined whether LS or frailty has a stronger association with the Japanese version of EuroQol’s five-level EQ-5D (EQ-5D-5L) index. Participants were 231 middle-aged and older Japanese adults receiving routine health checkups. The study utilized the 25-item Geriatric Locomotive Function Scale, the Japanese version of the Cardiovascular Health Study, and the Japanese version of the EQ-5D-5L. Univariate and multivariate analyses were performed to examine how frailty and LS are related to the EQ-5D-5L index. Patients with both frailty (p = 0.003) and LS (p < 0.001) had a significantly lower EQ-5D-5L index. After adjusting for age, gender, and body mass index, LS was significantly associated with a decrease in the EQ-5D-5L index (p < 0.001), whereas frailty had no significant association with the EQ-5D-5L index (p = 0.052). Further analysis showed no significant decrease in the EQ-5D-5L index among those with frailty but no LS, and a significant decrease among those with frailty and LS. The results suggest that frailty and LS are associated with a decrease in the EQ-5D-5L index, but LS has a more pronounced effect. In evaluating frailty’s effects on health-related QOL, we determined the importance of separately assessing frailty both with and without LS, even within the same frailty group.

DOI： 10.18999/nagjms.83.1.159

Postoperative changes in spinal cord signal intensity in patients with spinal cord injury without major bone injury: comparison between preoperative and postoperative magnetic resonance images

Machino, M; Ando, K; Kobayashi, K; Nakashima, H; Kanbara, S; Ito, S; Inoue, T; Yamaguchi, H; Koshimizu, H; Ito, K; Kato, F; Ishiguro, N; Imagama, S

JOURNAL OF NEUROSURGERY-SPINE Vol. 34 ( 2 ) page： 259 - 266 2021.2

Language：English Publisher：Journal of Neurosurgery Spine

OBJECTIVE Although increased signal intensity (ISI) on MRI is observed in patients with cervical spinal cord injury (SCI) without major bone injury, alterations in ISI have not been evaluated. The association between postoperative ISI and surgical outcomes remains unclear. This study elucidated whether or not the postoperative classification and alterations in MRI-based ISI of the spinal cord reflected the postoperative symptom severity and surgical outcomes in patients with SCI without major bone injury. METHODS One hundred consecutive patients with SCI without major bone injury (79 male and 21 female) with a mean age of 55 years (range 20–87 years) were included. All patients were treated with laminoplasty and underwent MRI pre- and postoperatively (mean 12.5 ± 0.8 months). ISI was classified into three groups on the basis of sagittal T2-weighted MRI: grade 0, none; grade 1, light (obscure); and grade 2, intense (bright). The neurological statuses were evaluated according to the Japanese Orthopaedic Association (JOA) scoring system and the American Spinal Injury Association Impairment Scale (AIS). RESULTS Preoperatively, 8 patients had grade 0 ISI, 49 had grade 1, and 43 had grade 2; and postoperatively, 20 patients had grade 0, 24 had grade 1, and 56 had grade 2. The postoperative JOA scores and recovery rate (RR) decreased significantly with increasing postoperative ISI grade. The postoperative ISI grade tended to increase with the postoperative AIS grade. Postoperative grade 2 ISI was observed in severely paralyzed patients. The postoperative ISI grade improved in 23 patients (23%), worsened in 25 (25%), and remained unchanged in 52 (52%). Patients with an improved ISI grade had a better RR than those with a worsened ISI grade. CONCLUSIONS Postoperative ISI reflected postoperative symptom severity and surgical outcomes. Alterations in ISI were seen postoperatively in 48 patients (48%) and were associated with surgical outcomes.

DOI： 10.3171/2020.6.SPINE20761

Poor derivation of Tc-MEP baseline waveforms in surgery for ventral thoracic intradural extramedullary tumor: Efficacy of use of the abductor hallucis in cases with a preoperative non-ambulatory status

Kobayashi, K; Ando, K; Nakashima, H; Machino, M; Kanbara, S; Ito, S; Inoue, T; Yamaguchi, H; Koshimizu, H; Imagama, S

JOURNAL OF CLINICAL NEUROSCIENCE Vol. 84 page： 60 - 65 2021.2

Language：English Publisher：Journal of Clinical Neuroscience

Most thoracic intradural extramedullary tumors (IDEMT) are benign lesions that are treated by gross total resection and spinal cord decompression. Intraoperative transcranial-motor evoked potential (Tc-MEP) monitoring is important for reducing postoperative neurological complications. The purpose of this study is to examine the characteristics of Tc-MEP waveforms in surgery for thoracic IDEMT resection based on location of the tumor relative to the spinal cord. The subjects were 56 patients who underwent surgery for thoracic IDEMT from 2010 to 2018. The waveform derivation rate for each lower muscle was examined at baseline and intraoperatively. 56 patients had a mean age of 61.7 years, and 21 (38%) were non-ambulatory before surgery. The tumors were schwannoma (n = 28, 50%), meningioma (n = 25, 45%), and neurofibroma (n = 3, 5%); and the lesions were dorsal (n = 29, 53%) and ventral (n = 27, 47%). There was a significantly higher rate of undetectable waveforms in all lower limb muscles in the ventral group compared to the dorsal group (15% vs. 3%, p < 0.05). In non-ambulatory cases, the derivation rate at baseline was significantly lower for ventral thoracic IDMETs (47% vs. 68%, p < 0.05). The abductor hallucis (AH) had the highest waveform derivation rate of all lower limb muscles in non-ambulatory cases with a ventral thoracic IDMET. Spinal cord compression by a ventral lesion may be increased, and this may be reflected in greater waveform deterioration. Of all lower limb muscles, the AH had the highest derivation rate, even in non-ambulatory cases with a ventral IDEMT, which suggests the efficacy of multichannel monitoring including the AH.

DOI： 10.1016/j.jocn.2020.11.045

Automated Detection of Spinal Schwannomas Utilizing Deep Learning Based on Object Detection From Magnetic Resonance Imaging

Ito, S; Ando, K; Kobayashi, K; Nakashima, H; Oda, M; Machino, M; Kanbara, S; Inoue, T; Yamaguchi, H; Koshimizu, H; Mori, K; Ishiguro, N; Imagama, S

SPINE Vol. 46 ( 2 ) page： 95 - 100 2021.1

Language：English Publisher：Spine

Study Design.A retrospective analysis of magnetic resonance imaging (MRI) was conducted.Objective.This study aims to develop an automated system for the detection of spinal schwannoma, by employing deep learning based on object detection from MRI. The performance of the proposed system was verified to compare the performances of spine surgeons.Summary of Background Data.Several MRI scans were conducted for the diagnoses of patients suspected to suffer from spinal diseases. Typically, spinal diseases do not involve tumors on the spinal cord, although a few tumors may exist at the unexpectable level or without symptom by chance. It is difficult to recognize these tumors; in some cases, these tumors may be overlooked. Hence, a deep learning approach based on object detection can minimize the probability of overlooking these tumors.Methods.Data from 50 patients with spinal schwannoma who had undergone MRI were retrospectively reviewed. Sagittal T1- and T2-weighted magnetic resonance imaging (T1WI and T2WI) were used in the object detection training and for validation. You Only Look Once version3 was used to develop the object detection system, and its accuracy was calculated. The performance of the proposed system was compared to that of two doctors.Results.The accuracies of the proposed object detection based on T1W1, T2W1, and both T1W1 and T2W1 were 80.3%, 91.0%, and 93.5%, respectively. The accuracies of the doctors were 90.2% and 89.3%.Conclusion.Automated object detection of spinal schwannoma was achieved. The proposed system yielded a high accuracy that was comparable to that of the doctors.Level of Evidence: 4.

DOI： 10.1097/BRS.0000000000003749

Transdiaphragmatic Approach as a Novel Less Invasive Retroperitoneal Approach at Thoracolumbar Junction: Comparison with Conventional Diaphragmatic Incision Reviewed Open Access

Nakashima Hiroaki, Kanemura Tokumi, Satake Kotaro, Ito Kenyu, Tanaka Satoshi, Segi Naoki, Ouchida Jun, Ando Kei, Kobayashi Kazuyoshi, Imagama Shiro

Spine Surgery and Related Research Vol. 5 ( 6 ) page： 405 - 411 2021

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

<p>Introduction: Lateral corpectomy has been considered a minimally invasive surgery, allowing a "transdiaphragmatic approach" at the thoracolumbar junction. This approach allows for a small diaphragmatic incision directly in the retroperitoneal space and the affected vertebra. However, its effectiveness in comparison to a conventional approach remains unclear. Thus, in this present study, we compared the surgical outcomes between conventional diaphragmatic detachment and the transdiaphragmatic approach in patients with vertebral fracture at the thoracolumbar junction.</p><p>Methods: In total, 31 patients with a vertebral fracture at the thoracolumbar junction (T12-L2) were included in this study: 17 underwent a conventional approach, whereas 14 underwent a transdiaphragmatic approach, with a minimum 2-year follow-up. The effectiveness of surgery was evaluated in each category of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ).</p><p>Results: Operative time and estimated blood loss were determined to be significantly shorter in the transdiaphragmatic than in the conventional approach. Perioperative complications were observed in the conventional approach (one atelectasis and one pleural effusion), while no complication was noted in the transdiaphragmatic approach. There were no significant differences in postoperative quality of life as assessed by JOABPEQ in terms of pain-related disorders, lumbar spine dysfunction, gait disturbance, social life dysfunction, or psychological disorders between the conventional and transdiaphragmatic approaches.</p><p>Conclusions: A "transdiaphragmatic approach" using lateral access surgery has been found to be associated with a shorter operative time and less blood loss with fewer complications than the conventional approach. Given that equivalent clinical outcomes were achieved in both conventional and transdiaphragmatic approaches, this "transdiaphragmatic approach" could be useful because of its minimal invasiveness.</p>

DOI： 10.22603/ssrr.2020-0191

A Longitudinal Study of Lumbar Sagittal Change in Middle-Aged Healthy Volunteers Open Access

Ito Kenyu, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Hasegawa Yukihiro, Imagama Shiro

Spine Surgery and Related Research Vol. 5 ( 3 ) page： 160 - 164 2021

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

<p>Introduction: Recent research has shown that spinal sagittal alignment plays a critical role in health-related quality of life. However, most of these studies were cross-sectional in nature, and longitudinal studies of lumbar lordosis (LL) in healthy subjects were few. This study aims to evaluate the change in lumbar sagittal parameters during a 10-year period.</p><p>Methods: The study population included 45 individuals (mean age, 65.7 years; male, n=20; female, n=25) who underwent sagittal lumbar radiography and a basic health checkup during a 10-year period. The radiologic parameters were LL, disc angle, sacral slope angle (SS), and pelvic incidence (PI). The change of LL during the 10-year period was defined as ΔLL. The subjects were divided into the LL maintenance group (n=33) and the LL non-maintenance group (n=12) based on their LL values.</p><p>Results: The radiologic baseline/final parameters were as follows: LL, 45/34 degrees (P<0.001); L1/L2 disc angle, 4.5/2.5 degrees; L2/L3 disc angle, 5.5/2.7 degrees; L3/L4 disc angle, 6.2/4.2 degrees; L4/L5 disc angle, 8.1/5.1 degrees; L5/S disc angle, 14.2/12.2 degrees; and SS, 32.0/32.1 degrees.</p><p>The mean PI (50.5 degrees) was tended to be associated with the final LL (R=0.31, P=0.044) and was correlated with the ΔLL (R=0.43, P<0.01).</p><p>The data of the LL maintenance/non-maintenance groups were as follows: age, 65.0/67.0; primary LL, 43.2/50.2 degrees (P<0.05); final LL, 36.2/27.8 degrees (P<0.05); and PI, 52.8/43.8 degrees (P<0.01).</p><p>Conclusions: During the 10-year study period, the LL in middle-aged and elderly volunteers decreased by 11 degrees. The factor of maintenance of LL was PI.</p>

DOI： 10.22603/ssrr.2020-0123

Zonisamide ameliorates neuropathic pain partly by suppressing microglial activation in the spinal cord in a mouse model Reviewed

Koshimizu, H; Ohkawara, B; Nakashima, H; Ota, K; Kanbara, S; Inoue, T; Tomita, H; Sayo, A; Kiryu-Seo, S; Konishi, H; Ito, M; Masuda, A; Ishiguro, N; Imagama, S; Kiyama, H; Ohno, K

LIFE SCIENCES Vol. 263 page： 118577 2020.12

Language：English Publisher：Life Sciences

Neuropathic pain is caused by a lesion or a functional impairment of the sensory nervous system and allodynia is one of the frequently observed symptoms in neuropathic pain. Allodynia represents abnormal pain due to a non-noxious stimulus that does not normally provoke pain. Cellular mechanisms underlying neuropathic pain remain mostly elusive, and partial pain relief can be achieved in a limited number of patients by antidepressants, anticonvulsants topical anesthetics, and others. Zonisamide (ZNS) is widely used as an anti-epileptic and anti-Parkinson's disease drug. A recent report shows that ZNS suppresses neuropathic pain associated with diabetes mellitus in a mouse model. We made a mouse model of neuropathic pain in the hindlimb by cutting the nerve at the intervertebral canal at lumbar level 4 (L4). At 28 days after nerve injury, ZNS ameliorated allodynic pain, and reduced the expression of inflammatory cytokines and the nerve injury-induced increase of Iba1-positive microglia in the spinal dorsal horn at L4. In BV2 microglial cells, ZNS reduced the number of lipopolysaccharide-induced amoeboid-shaped cells, representing activated microglia. These results suggest that ZNS is a potential therapeutic agent for neuropathic pain partly by suppressing microglia-mediated neuroinflammation.

DOI： 10.1016/j.lfs.2020.118577

Scoliosis Caused by Limb-Length Discrepancy in Children.

Kobayashi K, Ando K, Nakashima H, Machino M, Morozumi M, Kanbara S, Ito S, Inoue T, Yamaguchi H, Mishima K, Ishiguro N, Imagama S

Asian spine journal Vol. 14 ( 6 ) page： 801 - 807 2020.12

An intraoperative 3D image-based navigation error during cervical pedicle screw insertion Reviewed Open Access

Nakashima, H; Ishikawa, Y; Ando, K; Kobayashi, K; Ishiguro, N; Imagama, S

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 82 ( 4 ) page： 799 - 805 2020.11

Language：English Publisher：Nagoya Journal of Medical Science

A 67-year-old man underwent posterior cervical decompression surgery for ossification of the posterior longitudinal ligament (OPLL) with fixation using cervical pedicle screws (CPSs) guided by intraoperative 3D image-based navigation. Intraoperatively, while creating the screw hole using the navigation probe, the virtual trajectory on the intraoperative navigation screen showed a 10-degree angle discrepancy in the axial plane depending on whether a probing force was or was not applied for making the hole. This was potentially caused by vertebra rotation and a bent probe. Consequently, the CPSs were placed more laterally than the ideal trajectory, which resulted in <2 mm lateral perforation to the foramen transversarium. There were no screw insertion-related perioperative complications. Based on this case, we conclude that navigation error during CPS insertion can occur even with intraoperative 3D image-based navigation. The risk of a bowed navigation probe caused by posterior cervical muscle and vertebra rotation should be considered, even with use of a navigation reference frame.

DOI： 10.18999/nagjms.82.4.799

Surgical outcomes and factors related to postoperative motor and sensory deficits in resection for 244 cases of spinal schwannoma

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

JOURNAL OF CLINICAL NEUROSCIENCE Vol. 81 page： 6 - 11 2020.11

Language：English Publisher：Journal of Clinical Neuroscience

In a large cohort the clinical presentation, management and outcomes of spinal schwannoma and factors related to postoperative motor and sensory deficits were invesgtigated. In 244 patients (males: 126, females: 118, average age 51.8 y) at one center, significant factors related to postoperative motor and sensory deficits were identified. Tumors were in the cervical (n = 79, 32.4%), lumbar (n = 66), thoracolumbar (T11-L1) (n = 55), and thoracic (n = 39) regions, and 5 patients had sacrum tumors. The rates of postoperative motor and sensory deterioration were 13.1% and 20.5%, respectively. The risk factors for motor deterioration were preoperative motor weakness, preoperative gait disturbance, dumbbell Eden type II, subtotal resection, and operative time, and those for postoperative sensory deficit were preoperative gait disturbance and subtotal resection. Of 12 patients with significant TcMEP changes, 11 had a new motor deficit after surgery; and of 216 patients with stable TcMEP data, 196 were neurologically intact after surgery (true negative) and 20 (11.0%) had deficits in the immediate postoperative stage (false negative). These deficits resolved during hospitalization for most patients. Of 15 patients with TcMEP deterioration and recovery, 11 (93.3%) had no motor deficits after surgery (p < 0.01).

DOI： 10.1016/j.jocn.2020.09.025

Prediction of outcome following laminoplasty of cervical spondylotic myelopathy: Focus on the minimum clinically important difference

Machino, M; Ando, K; Kobayashi, K; Nakashima, H; Kanbara, S; Ito, S; Inoue, T; Koshimizu, H; Ito, K; Kato, F; Imagama, S

JOURNAL OF CLINICAL NEUROSCIENCE Vol. 81 page： 321 - 327 2020.11

Language：English Publisher：Journal of Clinical Neuroscience

The minimum clinically important difference (MCID) of the Japanese Orthopaedic Association (JOA) score has been reported to be around 2.5 points in cervical myelopathy. This study sought to define significant predictive factors on achieving the MCID following laminoplasty in a large series of patients with cervical spondylotic myelopathy (CSM). A total of 485 consecutive patients with CSM (295 males and 190 females; mean age: 67.0 years; age range: 42–91 years) who underwent laminoplasty were prospectively enrolled. The average postoperative follow-up period was 26.6 months (range: 12–66 months). We calculated the achieved JOA score. The relationships between outcomes and various clinical and imaging predictors including comorbidity and quantitative performance tests were examined. Logistic regression analysis was conducted to identify the predictors correlated with a JOA score of 2.5 points or more. Clinically meaningful gains were exhibited in 299 patients (61.6%) with a JOA score of ≥2.5 points, whereas 186 patients (38.4%) achieved a JOA score of <2.5 points. Univariate logistic regression analysis showed the predictive factors with a shorter duration of CSM symptoms, lower preoperative JOA scores, absence of hypertension, no use of anticoagulant/antiplatelet agents, and nonsmoking status. Multivariate logistic regression analysis determined that the duration of CSM symptoms (odds ratio: 0.771, 95% confidence interval: 0.705–0.844; p < 0.01) was the only significant predictive factor for achieving JOA scores of ≥2.5 points. An important predictor of MCID achievement following laminoplasty was shorter duration of CSM symptoms.

DOI： 10.1016/j.jocn.2020.09.065

Larger muscle mass of the upper limb correlates with lower amplitudes of deltoid MEPs following transcranial stimulation

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

JOURNAL OF CLINICAL NEUROSCIENCE Vol. 81 page： 426 - 430 2020.11

Language：English Publisher：Journal of Clinical Neuroscience

To perform spinal surgery safely, it is important to understand the risk factors, including factors that negatively influence intraoperative neuromonitoring (IONM). Transcranial motor evoked potentials (TcMEPs) are important in IONM. Therefore, we aimed to investigate whether muscle mass affects the waveforms of TcMEPs to understand the risk factors influencing TcMEPs. We enrolled 48 patients with thoracolumbar spinal diseases who underwent surgery at our facility between April 2015 and March 2018. Before surgery, the body composition, including muscle mass and fat mass, of all patients was measured using bioelectrical impedance analysis (BIA). During surgery, cranial stimulation under general anesthesia was used to derive TcMEPs, enabling us to measure the amplitude, using the control wave of the TcMEPs of the deltoid muscles and the abductor digiti minimi (ADM) muscles. We found a negative correlation between the amplitude of deltoid-muscle TcMEPs and muscle mass of the upper limb. The amplitude of deltoid-muscle TcMEPs did not correlate with the skeletal muscle index (SMI), muscle mass of the lower limb, or body fat mass. The amplitude of ADM-muscle TcMEPs did not correlate with SMI, muscle mass of any limb, or body fat mass. In conclusion, a larger muscle mass of the upper limb correlated with a lower amplitude of deltoid-muscle TcMEPs. By contrast, there was no correlation between the muscle mass of the upper limb and the amplitude of ADM-muscle TcMEPs. These findings suggest that TcMEPs of the ADM are less influenced by muscle mass and are more stable than those of the deltoid.

DOI： 10.1016/j.jocn.2020.10.004

Dynamic changes in longitudinal stretching of the spinal cord in thoracic spine: Focus on the spinal cord occupation rate of dural sac

Machino, M; Morita, D; Ando, K; Kobayashi, K; Nakashima, H; Kanbara, S; Ito, S; Inoue, T; Koshimizu, H; Ito, K; Kato, F; Imagama, S

CLINICAL NEUROLOGY AND NEUROSURGERY Vol. 198 page： 106225 2020.11

Language：English Publisher：Clinical Neurology and Neurosurgery

Objectives: This study aimed to evaluate the anteroposterior diameters and cross-sectional areas of the dural sac and spinal cord in the thoracic spine, to elucidate the spinal cord occupation rate of the dural sac in these dynamic changes for each level using multidetector-row computed tomography (MDCT). Patients and Methods: Fifty patients with cervical or lumbar spinal disease were prospectively enrolled. After preoperative myelography, MDCT was performed at maximum passive ﬂexion and extension. The anteroposterior diameter and cross-sectional area of the dural sac and spinal cord in the axial plane and the thoracic spinal cord length in the sagittal plane were measured. The spinal cord occupation rate in the dural sac was calculated. Results: The spinal cord occupation rate of the dural sac in anteroposterior diameter was lower on ﬂexion than on extension, with signiﬁcant differences from the T1/T2 to T11/T12 levels (p < 0.0001). The spinal cord occupation rate of the dural sac in cross-sectional area was lower on ﬂexion than on extension, with signiﬁcant differences except from T3/T4 to T6/T7 levels (p < 0.01). There was a bimodal increase in the occupation rate with elevations at the cervicothoracic junction and thoracolumbar junction. The thoracic spinal cord length on ﬂexion was signiﬁcantly longer than that on extension (p < 0.0001). Conclusions: The spinal cord occupation rate of the dural sac was lower on ﬂexion than on extension, despite thoracic spine being considered a rigid region. The dynamic changes in longitudinal stretching and shrinkage of the spinal cord affected the occupation rate.

DOI： 10.1016/j.clineuro.2020.106225

Trends in Reoperation for Surgical Site Infection after Spinal Surgery with Instrumentation in a Multicenter Study. Reviewed

Kobayashi K, Imagama S, Ando K, Nakashima H, Kato F, Sato K, Kanemura T, Matsubara Y, Yoshihara H, Hirasawa A, Deguchi M, Shinjo R, Sakai Y, Inoue H, Ishiguro N

Spine Vol. 45 ( 20 ) page： 1459 - 1466 2020.10

Preoperative 6-Minute Walk Performance in Children With Congenital Scoliosis

Nakashima, H; Kawakami, N; Matsumoto, H; Redding, GJ

JOURNAL OF PEDIATRIC ORTHOPAEDICS Vol. 40 ( 9 ) page： E818 - E821 2020.10

Language：English Publisher：Journal of Pediatric Orthopaedics

Background:The 6-minute walk test (6MWT) is used to assess the function of cardiopulmonary and neuromuscular conditions in adults and children. The primary research question was to determine the relationship between 6MWT distance and forced vital capacity (FVC) and the major curve among children with congenital scoliosis with rib anomalies.Methods:The authors recorded 6MWT distance in meters, FVC as a percentage of predicted normal value using arm span for height (FVC%), and Cobb angle in 20 children (13 girls; average age, 6.7±1.3 y) with congenital scoliosis before outpatient surgical treatment. The 6MWT uses a standardized protocol and measures distance traveled in 6 minutes on a flat surface. The authors then determined the correlation between these measures using linear regression analysis.Results:The Cobb angle of the major curvature was 55.4±20.5 degrees. The type of vertebral anomaly was mixed in 17 cases, formation failure in 2 cases, and segmentation failure in 1 case. The range of rib anomalies was 3.4±3.9 levels; 15 and 5 patients, respectively, had unilateral and bilateral rib anomalies. FVC and FVC% were 0.7±0.2 L and 60%±19%, respectively. The ratio of forced expiratory volume at 1 second to FVC (FEV<inf>1</inf>/FVC), which indicates obstructive lung disease, was normal at 93%±7%. The 6MWT distance was 386.3±59.4 m, which was ≤10% of the predicted distance for normal children. No child was able to walk the normal distance on the basis of published norms. 6MWT distance was significantly correlated with arm span (ρ=0.46, P=0.04) and major curve (ρ=-0.61, P=0.004), but not with FVC% (ρ=0.17, P=0.49).Conclusions:The 6MWT distance is a feasible measure of function and is substantially reduced before surgery in children with thoracic congenital scoliosis with rib anomalies. The 6MWT distance was significantly correlated with a major curve but not with FVC%. 6MWT distance is not affected by moderate lung function impairment.Level of Evidence:Level IV - retrospective cohort study.

DOI： 10.1097/BPO.0000000000001641

特集脊椎硬膜病変-最近の話題脊髄ヘルニアの病態と治療

中島宏彰, 今釜史郎, 安藤圭, 小林和克, 八木秀樹

脊椎脊髄ジャーナル Vol. 33 ( 9 ) page： 865 - 869 2020.9

Influence of Global Spine Sagittal Balance and Spinal Degenerative Changes on Locomotive Syndrome Risk in a Middle-Age and Elderly Community-Living Population Reviewed Open Access

Machino, M; Ando, K; Kobayashi, K; Nakashima, H; Kanbara, S; Ito, S; Inoue, T; Yamaguchi, H; Koshimizu, H; Seki, T; Ishizuka, S; Takegami, Y; Ishiguro, N; Hasegawa, Y; Imagama, S

BIOMED RESEARCH INTERNATIONAL Vol. 2020 page： 3274864 2020.9

Language：English Publisher：Biomed Research International

Purpose. The aim of this study was to describe the characteristics of each locomotive syndrome (LS) risk stage, including global spine sagittal alignment, spinal degenerative changes evident on plain radiographs, low back pain (LBP), muscle strength, and physical ability in middle-aged and elderly people in a health checkup. Methods. This study included 211 healthy Japanese volunteers (89 men and 122 women; mean age, 64.0 years) who underwent assessment with both radiographs and Spinal Mouse. Spinal sagittal parameters included thoracic kyphosis angle (TKA), lumbar lordosis angle (LLA), sagittal vertical axis, and spinal inclination angle (SIA). Lumbar disc height (LDH) and lumbar osteophyte formation (LOF) at each level were evaluated as the spinal degenerative changes. The LS assessment comprised three tests: Stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale (GLFS-25). The subjects were divided into three groups (no risk, stage 1 LS, or stage 2 LS) according to LS risk test criteria. The prevalence of LBP was investigated with a visual analogue scale (VAS), and physical performances were also compared among the groups. Results. Of the participants, 122 had no risk of LS, 56 had stage 1 LS risk, and 29 had stage 2 LS risk. With increasing LS risk stage, the prevalence of and VAS score for LBP increased significantly, and back muscle strength and physical abilities decreased significantly. The TKA did not differ among the three groups. The LLA decreased gradually with LS risk stage (P=0.0001). At each level except L1-L2 and L5-S1, LDH decreased gradually with LS risk stage. The prevalence of LOF increased significantly with increasing LS risk stage. The SIA increased significantly with LS risk stage (P=0.0167). Conclusions. Participants with LS had higher prevalence of spinal degeneration, small LLA, and global spinal imbalance by anterior spinal inclination.

DOI： 10.1155/2020/3274864

Patient-Reported Quality of Life Following Posterior Lumbar Interbody Fusion or Indirect Decompression Using Lateral Lumbar Interbody Fusion.

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

Spine Vol. 45 ( 18 ) page： E1172 - E1178 2020.9

Differences of locomotive syndrome and frailty in community-dwelling middle-aged and elderly people: Pain, osteoarthritis, spinal alignment, body balance, and quality of life. Reviewed

Imagama S, Ando K, Kobayashi K, Machino M, Tanaka S, Morozumi M, Kanbara S, Ito S, Seki T, Ishizuka S, Nakashima H, Ishiguro N, Hasegawa Y

Modern rheumatology Vol. 30 ( 5 ) page： 921 - 929 2020.9

Impact of pelvic incidence on lumbar osteophyte formation and disc degeneration in middle-aged and elderly people in a prospective cross-sectional cohort Reviewed

Imagama Shiro, Ando Kei, Kobayashi Kazuyoshi, Machino Masaaki, Tanaka Satoshi, Morozumi Masayoshi, Kanbara Shunsuke, Ito Sadayuki, Inoue Taro, Seki Taisuke, Ishizuka Shinya, Nakashima Hiroaki, Ishiguro Naoki, Hasegawa Yukiharu

EUROPEAN SPINE JOURNAL Vol. 29 ( 9 ) page： 2262 - 2271 2020.9

Age-related changes in upper and lower cervical alignment and range of motion: normative data of 600 asymptomatic individuals Reviewed

Inoue, T; Ito, K; Ando, K; Kobayashi, K; Nakashima, H; Katayama, Y; Machino, M; Kanbara, S; Ito, S; Yamaguchi, H; Koshimizu, H; Kato, F; Imagama, S

EUROPEAN SPINE JOURNAL Vol. 29 ( 9 ) page： 2378 - 2383 2020.9

Language：English Publisher：European Spine Journal

Purpose: To identify age-related changes and the relationship between upper and lower cervical sagittal alignment and the range of motion (ROM). Methods: A total of 600 asymptomatic volunteers were enrolled. There were 50 males and 50 females in each decade of life between the third and the eighth. The O–C2 angle and the C2–7 angle were measured using the neutral radiographs of the cervical spine. ROM was assessed by measuring the difference in alignment in the neutral, flexion, and extension positions. Results: The mean O–C2 angle in the neutral position was 14.0° lordotic. The mean ROM of the O–C2 angle was 23.1°. The mean C2–7 angle in the neutral position was 14.3° lordotic. The mean ROM of the C2–7 angle was 56.0°. The O–C2 angle was 16.1° in the third decade and gradually decreased to 11.4° in the eighth decade. There were no significant age-related changes in the ROM of the O–C2 angle. The C2–7 angle was 7.2° in the third decade and gradually increased to 20.8° in the eighth decade, and the ROM gradually decreased with increasing age. Significant negative correlation was observed between O–C2 angle and C2–7 angle. Conclusion: The O–C2 angle gradually decreased and the C2–7 angle increased with age. The ROM of the O–C2 angle did not change, but the ROM of the C2–7 angle decreased with age. The upper and lower cervical spine showed different age-related changes.

DOI： 10.1007/s00586-020-06547-9

True accuracy of percutaneous pedicle screw placement in thoracic and lumbar spinal fixation with a CT-based navigation system: Intraoperative and postoperative assessment of 763 percutaneous pedicle screws Reviewed

Ouchida, J; Kanemura, T; Satake, K; Nakashima, H; Segi, N; Suzuki, K; Imagama, S

JOURNAL OF CLINICAL NEUROSCIENCE Vol. 79 page： 1 - 6 2020.9

Language：English Publisher：Journal of Clinical Neuroscience

Purpose: To investigate intraoperative reinsertion of percutaneous pedicle screw (PPS) with intraoperative CT-based navigation and to evaluate the rate of deviation of PPS at postoperative radiographic examination. Methods: Seven hundred sixty-three screws were inserted in 138 patients. We investigated the rate of occurrence of intraoperative PPS reinsertion after the diagnosis of screw deviation by fluoroscopy and the causes of each screw deviation. The subsequent distribution of PPS deviation was evaluated by postoperative CT. We also assess the difference in variance between the group judged to be PPS misplaced intra-/postoperatively (IOD group/POD group) and appropriate PPS placement (ND group). Results: Among all the screws inserted, 10 (1.3%) were diagnosed as being deviated by fluoroscopy during surgery, and 74 (9.7%) screws were found to be deviated at postoperative CT evaluation. We found more pedicle screw mismatch in the POD group than in the ND group (52.7 vs 11.0%, P < 0.001). The distance between the screw and the reference was greater in the IOD group than that in the ND group (1.4 ± 1.2 vs 2.4 ± 1.1 vertebral levels, P = 0.016). In one patient in the IOD group, a motor function deficit was observed postoperatively. Conclusion: PPS fixation under intraoperative CT-based navigation did not prevent screw deviation completely. It is necessary to consider errors that occur during surgery and to confirm placement with real-time assistance such as fluoroscopy even in a surgery performed under CT navigation assistance.

DOI： 10.1016/j.jocn.2020.07.012

Poor spinal alignment in females with obesity: The Yakumo study Open Access

Ando, K; Kobayashi, K; Nakashima, H; Machino, M; Ito, S; Kanbara, S; Inoue, T; Hasegawa, Y; Imagama, S

JOURNAL OF ORTHOPAEDICS Vol. 21 page： 512 - 516 2020.9

Language：English Publisher：Journal of Orthopaedics

Objective: The goal of this prospective study was prospectively to investigate the relationship between obesity and spinal sagittal alignment. Methods: 286 were referred for orthopedic evaluation. Differences in spinal parameters among these groups and between males and females were evaluated. Results: Obese subjects had significantly higher C2S, CPA, CTPA, PI-LL, and lower cervical lordosis, L4S1, lumbar lordosis, and sacral slope. In multivariate logistic regression analysis adjusted for age in females, CTPA was identified as the only independent and significant factor associated with obesity. Conclusions: Obesity in females has significant relationships with spinal sagittal alignment and results in poorer physical QOL.

DOI： 10.1016/j.jor.2020.09.006

Zonisamide ameliorates progression of cervical spondylotic myelopathy in a rat model Reviewed Open Access

Kanbara, S; Ohkawara, B; Nakashima, H; Ohta, K; Koshimizu, H; Inoue, T; Tomita, H; Ito, M; Masuda, A; Ishiguro, N; Imagama, S; Ohno, K

SCIENTIFIC REPORTS Vol. 10 ( 1 ) page： 13138 2020.8

Language：English Publisher：Scientific Reports

Cervical spondylotic myelopathy (CSM) is caused by chronic compression of the spinal cord and is the most common cause of myelopathy in adults. No drug is currently available to mitigate CSM. Herein, we made a rat model of CSM by epidurally implanting an expanding water-absorbent polymer underneath the laminae compress the spinal cord. The CSM rats exhibited progressive motor impairments recapitulating human CSM. CSM rats had loss of spinal motor neurons, and increased lipid peroxidation in the spinal cord. Zonisamide (ZNS) is clinically used for epilepsy and Parkinson's disease. We previously reported that ZNS protected primary spinal motor neurons against oxidative stress. We thus examined the effects of ZNS on our rat CSM model. CSM rats with daily intragastric administration of 0.5% methylcellulose (n = 11) and ZNS (30 mg/kg/day) in 0.5% methylcellulose (n = 11). Oral administration of ZNS ameliorated the progression of motor impairments, spared the number of spinal motor neurons, and preserved myelination of the pyramidal tracts. In addition, ZNS increased gene expressions of cystine/glutamate exchange transporter (xCT) and metallothionein 2A in the spinal cord in CSM rats, and also in the primary astrocytes. ZNS increased the glutathione (GSH) level in the spinal motor neurons of CSM rats. ZNS potentially ameliorates loss of the spinal motor neurons and demyelination of the pyramidal tracts in patients with CSM.

DOI： 10.1038/s41598-020-70068-0

Reoperation for Late Neurological Deterioration After Laminoplasty in Individuals with Degenerative Cervical Myelopathy: Comparison of Cases of Cervical Spondylosis and Ossification of the Posterior Longitudinal Ligament. Reviewed

Nakashima H, Kanemura T, Satake K, Ito K, Ouchida J, Morita D, Ando K, Kobayashi K, Ishiguro N, Imagama S

Spine Vol. 45 ( 15 ) page： E909 - E916 2020.8

Lateral approach corpectomy and reconstruction after anterior longitudinal ligament release in cases with fixed kyphosis: A technical note and a preliminary case series. Reviewed

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

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia Vol. 78 page： 164 - 169 2020.8

Risk Factors for Neuropathic Pain in Middle-Aged and Elderly People: A Five-Year Longitudinal Cohort in the Yakumo Study. Reviewed

Imagama S, Ando K, Kobayashi K, Nakashima H, Seki T, Hamada T, Machino M, Ota K, Tanaka S, Morozumi M, Kanbara S, Ito S, Ishiguro N, Hasegawa Y

Pain medicine (Malden, Mass.) Vol. 21 ( 8 ) page： 1604 - 1610 2020.8

Dynapenia and physical performance in community-dwelling elderly people in Japan Reviewed Open Access

Kobayashi, K; Imagama, S; Ando, K; Nakashima, H; Machino, M; Morozumi, M; Kanbara, S; Ito, S; Inoue, T; Yamaguchi, H; Ishiguro, N; Hasegawa, Y

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 82 ( 3 ) page： 415 - 424 2020.8

Language：English Publisher：Nagoya Journal of Medical Science

Aging of society has increased the incidence of physical disability. The goal of this study was to examine the physical ability of elderly people classified as having sarcopenia, presarcopenia, or dynapenia (a low muscle function without low muscle mass) in a community in Japan. The subjects were volunteers aged >60 years who were participants in a health checkup in Yakumo, Hokkaido and were in good general health. Demographic data were collected and physical performance tests were performed to measure grip strength, walking speed, back muscle strength, maximum stride length, and 3-m timed-up-and-go (3m TUG) time. A measurement of skeletal muscle mass was used as a basis for calculating the appendicular skeletal muscle index (aSMI). The rates of sarcopenia, presarcopenia, and dynapenia were 10%, 22%, and 8% in males (n=101, age 69.7±5.4 years), and 19%, 23%, and 13% in females (n=112, 68.5±5.9 years). Body mass index in subjects with dynapenia was significantly higher compared to that in subjects with sarcopenia and presarcopenia (p<0.01). Back muscle strength, maximum stride length and 3m TUG were similar in dynapenia and sarcopenia, but differed significantly with those in presarcopenia in both males and females without the influence of age (p<0.05). Further studies are needed to evaluate the benefits of dynapenia intervention programs and to explore the underlying pathophysiology of dynapenia.

DOI： 10.18999/nagjms.82.3.415

Associations of Serum MicroRNA with Bone Mineral Density in Community-Dwelling Subjects: The Yakumo Study Reviewed Open Access

Nakashima, H; Ando, K; Kobayashi, K; Seki, T; Ishizuka, S; Fujii, R; Takegami, Y; Yamada, H; Ando, Y; Suzuki, K; Hasegawa, Y; Imagama, S

BIOMED RESEARCH INTERNATIONAL Vol. 2020 page： 5047243 2020.7

Language：English Publisher：Biomed Research International

Osteoporosis is a disease characterized by deterioration of bone tissue and mass, with an increasing global prevalence. Therefore, the discovery of biomarkers for osteoporosis would help to guide appropriate treatment. Circulating microRNAs (miRNAs) have become increasingly recognized as biomarkers for detecting diseases. However, few studies have investigated the association of circulating miRNA with osteoporosis in the general population. The aim of this study was to identify miRNA associated with osteoporosis in a general resident health check-up for potential use as an osteoporosis biomarker. We conducted a cross-sectional study as part of a health check-up program and recruited 352 volunteers (139 men, 213 women, mean age 64.1±9.6 years). Osteoporosis was diagnosed according to the WHO classification. Twenty-two candidate microRNAs were screened through real-time quantitative PCR, and miRNAs associated with osteoporosis were analyzed using logistic regression analysis including other risk factors. In total, 95 females and 30 males were diagnosed with osteoporosis with bone mineral density tests (BMD: T-score<-2.5). We found that miR195 was significantly lower in females, while miR150 and miR222 were significantly higher in males. The results of the logistic regression analysis indicated that in females, higher age and lower miR195 (odds ratio: 0.45, 95% confidential interval: 0.03-0.98) were significant risk factors for lower BMD, while the presence of a smoking habit and lower miR150 (odds ratio: 1.35, 95% confidential interval: 1.02-1.79) were significant risk factors for osteoporosis. Serum levels of miR195 and miR150 are independently associated with low bone mineral density in females and males, respectively.

DOI： 10.1155/2020/5047243

特集脊椎手術-前方か後方か? 胸腰椎移行部破裂骨折に対する前方除圧椎体置換術

中島宏彰, 今釜史郎, 安藤圭, 小林和克, 町野正明, 金村徳相

臨床整形外科 Vol. 55 ( 7 ) page： 811 - 817 2020.7

Prognostic Factors in the New Katagiri Scoring System After Palliative Surgery for Spinal Metastasis. Reviewed

Kobayashi K, Ando K, Nakashima H, Sato K, Kanemura T, Yoshihara H, Hirasawa A, Kato F, Ishiguro N, Imagama S

Spine Vol. 45 ( 13 ) page： E813 - E819 2020.7

Locomotive syndrome and the power spectral characteristics of body sway Reviewed

Tanaka Satoshi, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Seki Taisuke, Ishizuka Shinya, Machino Masaaki, Kanbara Shunsuke, Ito Sadayuki, Kanemura Tokumi, Ishiguro Naoki, Hasegawa Yukiharu, Imagama Shiro

GERIATRICS & GERONTOLOGY INTERNATIONAL Vol. 20 ( 7 ) page： 691 - 696 2020.7

Superficial Siderosis With Verrucous Vegetation Around a Dural Defect Confirmed by Intraoperative Ultrasonography. Reviewed Open Access

Machino M, Imagama S, Ando K, Kobayashi K, Nakashima H, Kanbara S, Ito S, Ishiguro N

Journal of medical cases Vol. 11 ( 7 ) page： 192 - 195 2020.7

Language：English Publisher：Journal of Medical Cases

Superficial siderosis (SS) of the central nervous system (CNS) is a rare disease caused by repeated hemorrhages in the subarachnoid space. We describe surgical treatment of an SS case in which a dural defect with verrucous vegetation in the spinal canal was detected by intraoperative ultrasonography (US). After laminectomy, intraoperative US imaging confirmed verrucous vegetation and epidural fluid collection around the ventral dural defect before incision of the posterior dura mater. As intraoperative US also showed a dural defect at the ventral and right sides of the spinal cord, the posterior dural incision was made in a manner that was slightly more right lateral than standard midline. The ventral dural defect was repaired by direct sutures. After repair, intraoperative US imaging confirmed dural hole closure, removal of vegetation and resolution of the collected fluid. Dural closure was successful and symptoms partially improved despite the patient’s long history of SS. Intraoperative US can help surgeons make decisions about precise dural incision before repair. Intraoperative US is useful for detecting the level of dural defect and verrucous vegetation before repair and confirming closure of the dural defect, successful removal of vegetation and resolution of fluid collection after repair.

DOI： 10.14740/jmc3495

Indirect Decompression Using Lateral Lumbar Interbody Fusion for Restenosis after an Initial Decompression Surgery. Open Access

Nakashima H, Kanemura T, Satake K, Ito K, Ishikawa Y, Ouchida J, Segi N, Yamaguchi H, Imagama S

Asian spine journal Vol. 14 ( 3 ) page： 305 - 311 2020.6

Simultaneous single-position lateral interbody fusion and percutaneous pedicle screw fixation using O-arm-based navigation reduces the occupancy time of the operating room Reviewed

Ouchida Jun, Kanemura Tokumi, Satake Kotaro, Nakashima Hiroaki, Ishikawa Yoshimoto, Imagama Shiro

EUROPEAN SPINE JOURNAL Vol. 29 ( 6 ) page： 1277 - 1286 2020.6

Higher extracellular water-to-total body water ratio more strongly reflects the locomotive syndrome risk and frailty than sarcopenia Reviewed

Tanaka Satoshi, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Seki Taisuke, Ishizuka Shinya, Machino Masaaki, Morozumi Masayoshi, Kanbara Shunsuke, Ito Sadayuki, Inoue Taro, Kanemura Tokumi, Ishiguro Naoki, Hasegawa Yukiharu, Imagama Shiro

ARCHIVES OF GERONTOLOGY AND GERIATRICS Vol. 88 page： 104042 2020.5

Postoperative iatrogenic spinal cord herniation: three case reports with a literature review Reviewed Open Access

Nakashima Hiroaki, Ishikawa Yoshimoto, Kato Fumihiko, Kanemura Tokumi, Shinjo Ryuichi, Ando Kei, Kobayashi Kazuyoshi, Ishiguro Naoki, Imagama Shiro

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 82 ( 2 ) page： 383 - 389 2020.5

The Surgical Treatment for Occipito-atlantoaxial Rotatory Fixation: a Case Report

Kagami Yujiro, Ouchida Jun, Nakashima Hiroaki, Satake Kotaro, Ito Kenyu, Ishikawa Yoshimoto, Imagama Shiro, Kanemura Tokumi

Journal of Spine Research Vol. 11 ( 4 ) page： 779 - 782 2020.4

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：The Japanese Society for Spine Surgery and Related Research

<p>A 10-year-old boy complaining of neck pain without any inducement was referred to our hospital. Images at the first visit showed an atlantoaxial rotatory fixation (AARF). He received conservative treatment for 14 months with a cervical collar, Glisson traction and halo vest fixation after manual reduction under general anesthesia. However, residual rotational position and cervical pain recurred. Finally, he required surgical intervention with posterior C1-2 fixation. An atlantoaxial rotation with O-C1 joint lesion (OAARF) may result in worse treatment outcome as conservative treatment compared to AARF. It is necessary to evaluate the pathological condition at an early stage of OAARF and consider decision making including the surgical treatment.</p>

DOI： 10.34371/jspineres.2020-0411

The Prevalence and Risk Factors for S2 Alar-Iliac Screw Loosening with a Minimum 2-Year Follow-up Reviewed Open Access

Nakashima Hiroaki, Kanemura Tokumi, Satake Kotaro, Ito Kenyu, Ishikawa Yoshimoto, Ouchida Jun, Segi Naoki, Yamaguchi Hidetoshi, Imagama Shiro

ASIAN SPINE JOURNAL Vol. 14 ( 2 ) page： 177 - 184 2020.4

特集頚椎を含めたグローバルアライメント頭蓋から足部までの全身アライメント-人種間の違いと成人脊柱変形手術における矯正目標

中島宏彰, 今釜史郎, 安藤圭, 小林和克, 大内田隼, 金村徳相

臨床整形外科 Vol. 55 ( 3 ) page： 247 - 252 2020.3

Differences of lumbopelvic sagittal parameters among community-dwelling middle-age and elderly individuals: Relations with locomotor physical function Reviewed

Machino Masaaki, Ando Kei, Kobayashi Kazuyoshi, Nakashima Hiroaki, Morozumi Masayoshi, Tanaka Satoshi, Kanbara Shunsuke, Ito Sadayuki, Seki Taisuke, Ishizuka Shinya, Ishiguro Naoki, Hasegawa Yukiharu, Imagama Shiro

JOURNAL OF CLINICAL NEUROSCIENCE Vol. 73 page： 80 - 84 2020.3

特集脊柱靭帯骨化症UP TO DATE 胸椎後縦靭帯骨化症の手術治療-最近の進歩

今釜史郎, 安藤圭, 小林和克, 中島宏彰, 石黒直樹, 松山幸弘, 松本守雄, 川口善治, 大川淳

脊椎脊髄ジャーナル Vol. 33 ( 2 ) page： 119 - 125 2020.2

Neurological function following early versus delayed decompression surgery for drop foot caused by lumbar degenerative diseases Reviewed

Nakashima Hiroaki, Ishikawa Yoshimoto, Kanemura Tokumi, Kato Fumihiko, Satake Kotaro, Ito Keigo, Ito Kenyu, Ando Kei, Kobayashi Kazuyoshi, Ishiguro Naoki, Imagama Shiro

JOURNAL OF CLINICAL NEUROSCIENCE Vol. 72 page： 39 - 42 2020.2

GDNF rescues the fate of neural progenitor grafts by attenuating Notch signals in the injured spinal cord in rodents.

Khazaei M, Ahuja CS, Nakashima H, Nagoshi N, Li L, Wang J, Chio J, Badner A, Seligman D, Ichise A, Shibata S, Fehlings MG

Science translational medicine Vol. 12 ( 525 ) 2020.1

Changes in Sagittal Alignment Following Short-Level Lumbar Interbody Fusion: Comparison between Posterior and Lateral Lumbar Interbody Fusions. Reviewed International journal Open Access

Hiroaki Nakashima, Tokumi Kanemura, Kotaro Satake, Yoshimoto Ishikawa, Jun Ouchida, Naoki Segi, Hidetoshi Yamaguchi, Shiro Imagama

Asian spine journal Vol. 13 ( 6 ) page： 904 - 912 2019.12

Language：English Publishing type：Research paper (scientific journal)

Study Design: Retrospective case-control study. Purpose: We aimed to compare radiologic outcomes between posterior (PLIF) and lateral lumbar interbody fusion (LLIF) in short-level spinal fusion surgeries. Overview of Literature: Although LLIF enables surgeons to insert large lordotic cages, it is unknown whether LLIF more effectively corrects local and global sagittal alignments compared with PLIF in short-level spinal fusion surgeries. Methods: Radiographic data acquired from patients with lumbar interbody fusion (≤3 levels) using PLIF or LLIF for degenerative lumbar diseases were analyzed. The following radiographic parameters were evaluated preoperatively and at 2 years postoperatively: segmental lordotic angle, disk height, lumbar lordosis (LL), pelvic tilt (PT), C7 sagittal vertical axis, and thoracic kyphosis (TK). Results: In total, 144 patients with PLIF (193 fused levels) and 101 with LLIF (159 fused levels) were included. Patients' backgrounds and preoperative radiographic parameters for any level of fusion did not differ significantly between PLIF and LLIF procedures. The LLIF group exhibited significantly greater changes at 1-level fusion compared to the PLIF group in the parameters of segmental lordotic angle (5.1°±5.8° vs. 2.1°±5.0°, p<0.001), disk height (4.2±2.3 mm vs. 2.2±2.0 mm, p<0.001), LL (7.8°±7.6° vs. 3.9°±8.6°, p=0.004), and PI-LL (-6.9°±6.8° vs. -3.6°±10.1°, p=0.03). While, a similar trend was observed regarding 2-level fusion, significantly greater changes were only observed in LL (12.1°±11.1° vs. 4.2°±9.1°, p=0.047) and PI-LL (-11.2°±11.3° vs. -3.0°±9.3°, p=0.043), PT (-6.4°±4.9° vs. -2.5°±5.3°, p=0.049) and TK (7.8°±11.8° vs. -0.3°±9.7°, p=0.047) in the LLIF group at 3-level fusion. Conclusions: LLIF provides significantly better local sagittal alignment than PLIF in 1- or 2-level fusion cases and improves spinopelvic alignment and local alignment for 3-level fusion cases. Thus, LLIF was demonstrated to be a useful lumbar interbody fusion technique, constituting a powerful tool for achieving sagittal realignment with minimal surgical invasiveness.

DOI： 10.31616/asj.2019.0011

Indirect Decompression on MRI Chronologically Progresses After Immediate Postlateral Lumbar Interbody Fusion: The Results From a Minimum of 2 Years Follow-Up. Reviewed International journal

Hiroaki Nakashima, Tokumi Kanemura, Kotaro Satake, Yoshimoto Ishikawa, Jun Ouchida, Naoki Segi, Hidetoshi Yamaguchi, Shiro Imagama

Spine Vol. 44 ( 24 ) page： E1411 - E1418 2019.12

Language：English Publishing type：Research paper (scientific journal)

MINI: On magnetic resonance imaging, indirect decompression using lateral lumbar interbody fusion and posterior fixation was confirmed immediately after surgery and also continuously progressed after surgery, particularly during the first 6 months. Thecal sac enlargement was also confirmed, and is suspected to be caused by the atrophy of the ligamentum flavum and the disc. STUDY DESIGN: A prospective cohort study. OBJECTIVE: The aim of this study was to investigate radiographical changes related to indirect decompression using lateral lumbar interbody fusion (LLIF) with posterior fixation. SUMMARY OF BACKGROUND DATA: Indirect lumbar decompression via LLIF is used to treat degenerative lumbar diseases requiring neural decompression. Although evidence suggests that thecal sac enlargement follows shortly after surgery, few studies have described the postoperative changes on MRIs. METHODS: This study involved 102 patients who underwent indirect decompression at 136 levels, with LLIF and posterior fixation. Magnetic resonance imaging (MRIs) were collected preoperatively and several times postoperatively (over a 2-year period starting immediately after surgery). We then quantified the cross-sectional areas of the thecal sac and ligamentum flavum, as well as the anteroposterior diameter of disc bulging, and qualitatively assessed lumbar spinal stenosis according to a modified version of Schizas' classification [Grades A (mild) to C (severe)]. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was used for the assessment of the clinical symptoms. RESULTS: All changes were observable immediately after surgery, progressed over time, and were significantly different statistically at 2 years after surgery. The thecal sac was significantly larger (189% of preoperative; P < 0.0001), while the ligamentum flavum and disc bulge were significantly smaller [58.9% and 67.3% of preoperative (P < 0.001), respectively]. The number of patients with grade C (severe) lumbar stenosis also dropped significantly (preoperative, 17.6%; 2 years postoperative, 0%). There were no significant differences in JOABPEQ results at 6 months, 1 year, and 2 years postsurgery. CONCLUSION: Indirect decompression produces immediate positive results that continue to improve over time. The cross-sectional area of the thecal sac doubled by 2 years after surgery, and the ligamentum flavum cross-sectional area and disc bulging both shrank significantly. At the same time, however, postoperative radiographical improvements do not appear to correlate with clinical symptoms. LEVEL OF EVIDENCE: 3.

DOI： 10.1097/BRS.0000000000003180

Musculoskeletal Factors and Geriatric Syndromes Related to the Absence of Musculoskeletal Degenerative Disease in Elderly People Aged over 70 Years Reviewed Open Access

Imagama Shiro, Ando Kei, Kobayashi Kazuyoshi, Seki Taisuke, Ishizuka Shinya, Machino Masaaki, Tanaka Satoshi, Morozumi Masayoshi, Kanbara Shunsuke, Ito Sadayuki, Inoue Taro, Nakashima Hiroaki, Ishiguro Naoki, Hasegawa Yukiharu

BIOMED RESEARCH INTERNATIONAL Vol. 2019 page： 7097652 2019.11

Clinical Features of Thoracic Myelopathy: A Single-Center Study Reviewed Open Access

Ando Kei, Imagama Shiro, Kobayashi Kazuyoshi, Ito Kenyu, Tsushima Mikito, Morozumi Masayoshi, Tanaka Satoshi, Machino Masaaki, Ota Kyotaro, Nakashima Hiroaki, Nishida Yoshihiro, Ishiguro Naoki

JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS Vol. 3 ( 11 ) 2019.11

Multivariate analysis of factors related to the absence of musculoskeletal degenerative disease in middle-aged and older people. Reviewed International journal Open Access

Imagama S, Ando K, Kobayashi K, Machino M, Tanaka S, Morozumi M, Kanbara S, Ito S, Inoue T, Seki T, Ishizuka S, Nakashima H, Ishiguro N, Hasegawa Y

Geriatrics & gerontology international Vol. 19 ( 11 ) page： 1141 - 1146 2019.11

Increase in lumbar kyphosis and spinal inclination, declining back muscle strength, and sarcopenia are risk factors for onset of GERD: a 5-year prospective longitudinal cohort study. Reviewed International journal

Shiro Imagama, Kei Ando, Kazuyoshi Kobayashi, Masaaki Machino, Satoshi Tanaka, Masayoshi Morozumi, Shunsuke Kanbara, Sadayuki Ito, Taisuke Seki, Takashi Hamada, Shinya Ishizuka, Hiroaki Nakashima, Naoki Ishiguro, Yukiharu Hasegawa

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society Vol. 28 ( 11 ) page： 2619 - 2628 2019.11

Language：English Publishing type：Research paper (scientific journal)

PURPOSE: The objective was to identify risk factors for new development of gastroesophageal reflux disease (GERD) 5 years later in a prospective longitudinal cohort study. METHODS: A total of 178 subjects (male 72, female 106, mean age 68 years) without GERD in 2013 were examined for GERD in 2018. A Frequency Scale for Symptoms of GERD score ≥ 8 was used for diagnosis of GERD. Body mass index, spinal alignment, muscle strength, physical ability, number of oral drugs per day, sarcopenia, and frailty determined in 2013 and 2018 were compared between the GERD(+) and GERD(-) groups in 2018. Aggravation of lumbar kyphosis and spinal inclination from 2013 to 2018 was defined as a change of ≥ 5° or ≥ 10°, and weakening of back muscle strength as a change of ≥ 10 kg. QOL (SF-36) was also examined. RESULTS: Of the 178 subjects, 38 (21%) were diagnosed as GERD(+) in 2018. Sarcopenia in 2018 was significantly related to a GERD(+) status (p < 0.05). The GERD(+) group had significantly higher rates of changes of lumbar kyphosis ≥ 5° (p < 0.005) and ≥ 10° (p < 0.0001), of spinal inclination ≥ 5° (p < 0.0001), and of decreased back muscle strength ≥ 10 kg (p < 0.05). SF-36 were also significantly worse in the GERD(+) group (p < 0.05). CONCLUSIONS: This prospective longitudinal study firstly demonstrated that lumbar kyphotic change, aggravation of spinal inclination, decreased back muscle strength, and sarcopenia are significant risk factors for new development of GERD. Management and prevention of these factors may contribute to reduction of GERD symptoms and increased QOL in middle-aged and elderly people. These slides can be retrieved under Electronic Supplementary Material.

DOI： 10.1007/s00586-019-06139-2

特集ついに始まった頸椎人工椎間板置換術頸椎人工椎間板の適応と短期成績-Mobi-C

金村徳相, 佐竹宏太郎, 伊藤研悠, 田中智史, 中島宏彰, 今釜史郎

脊椎脊髄ジャーナル Vol. 32 ( 10 ) page： 919 - 928 2019.10

Factors Affecting Postoperative Sagittal Alignment after Lateral Lumbar Interbody Fusion in Adult Spinal Deformity: Posterior Osteotomy, Anterior Longitudinal Ligament Rupture, and Endplate Injury. Reviewed International journal Open Access

Hiroaki Nakashima, Tokumi Kanemura, Kotaro Satake, Yoshimoto Ishikawa, Jun Ouchida, Naoki Segi, Hidetoshi Yamaguchi, Shiro Imagama

Asian spine journal Vol. 13 ( 5 ) page： 738 - 745 2019.10

Language：English Publishing type：Research paper (scientific journal)

Study Design: Prospective cohort study. Purpose: To identify factors that affect sagittal alignment correction in lateral lumbar interbody fusion (LIF) surgery for adult spinal deformity (ASD) and to investigate the degree of correction in each condition. Overview of Literature: LIF is a useful procedure for ASD, but the degree of correction can be affected by posterior osteotomy, intraoperative endplate injury, or anterior longitudinal ligament (ALL) rupture. Methods: Radiographical data for 30 patients who underwent LIF for ASD were examined prospectively. All underwent two-stage surgery (LIF followed by posterior fixation). Radiographical parameters were measured preoperatively, after LIF, and after posterior fixation; these included the segmental lordotic angle, lumbar lordosis (LL), and other sagittal alignment factors. Results: LL was corrected from 16.5°±16.7° preoperatively to 33.4°±13.8° after LIF (p <0.001) and then to 52.1°±7.9° following posterior fixation (p <0.001). At levels where Schwab grade 2 osteotomy was performed, the acquired segmental lordotic angles from the preoperative value to after posterior fixation and from after LIF to after posterior fixation were 19.5°±9.2° and 9.9°±3.9°, respectively. On average, 12.4° more was added than in cases without osteotomy. Endplate injury was identified at 21 levels (19.4%) after LIF, with a mean loss of 3.4° in the acquired segmental lordotic angle (5.3°±8.4° and 1.9°±5.9° without and with endplate injury, respectively). ALL rupture was identified at seven levels (6.5%), and on average 19.3° more was added in these cases between the preoperative and postoperative values than in cases without ALL rupture. Conclusions: LIF provides adequate sagittal alignment restoration for ASD, but the degree of correction is affected by grade 2 osteotomy, intraoperative endplate injury, and ALL rupture.

DOI： 10.31616/asj.2018.0275

Unplanned Second-Stage Decompression for Neurological Deterioration Caused by Central Canal Stenosis after Indirect Lumbar Decompression Surgery. Reviewed International journal Open Access

Hiroaki Nakashima, Tokumi Kanemura, Kotaro Satake, Yoshimoto Ishikawa, Jun Ouchida, Naoki Segi, Hidetoshi Yamaguchi, Shiro Imagama

Asian spine journal Vol. 13 ( 4 ) page： 584 - 591 2019.8

Language：English Publishing type：Research paper (scientific journal)

Study Design: Prospective cohort study. Purpose: This study aimed to identify risk factors for unplanned second-stage decompression for postoperative neurological deficit after indirect decompression using lateral lumbar interbody fusion (LLIF) with posterior fixation. Overview of Literature: Indirect lumbar decompression with LLIF has been used as a minimally invasive alternative to direct decompression to treat degenerative lumbar diseases requiring neural decompression. However, evidence on the prevalence of neurological deficits caused by spinal canal stenosis after indirect decompression is limited. Methods: This study included 158 patients (mean age, 71.13±7.98 years; male/female ratio, 67/91) who underwent indirect decompression with LLIF and posterior fixation. Indirect decompression was performed at 271 levels (mean level, 1.71±0.97). Logistic regression analysis was used to identify the risk factors for postoperative neurological deficits. The variables included were age, sex, body mass index, presence of primary diseases, diabetes mellitus, preoperative motor deficit, levels operated on, preoperative severity of lumbar stenosis, and preoperative Japanese Orthopedic Association (JOA) score. Results: Postoperative neurological deficit due to spinal canal stenosis occurred in three patients (1.9%). Spinal stenosis due to hemodialysis (p<0.001), ligament ossification (p<0.001), presence of preoperative motor paralysis (p<0.001), low JOA score (p=0.004), and severe canal stenosis (p=0.02) were significantly more frequent in the paralysis group. Conclusions: Severe preoperative canal stenosis and neurological deficit were identified as risk factors for postoperative neurological deterioration caused by spinal canal stenosis. Additionally, uncommon diseases, such as spinal stenosis due to hemodialysis and ligament ossification, increased the risk of postoperative neurological deficit; therefore, in such cases, indirect decompression is contraindicated.

DOI： 10.31616/asj.2018.0232

Both common and rare genetic variants of ABCG2 are risks for gout Reviewed

Higashino T., Takada T., Nakaoka H., Toyoda Y., Stiburkova B., Miyata H., Ikebuchi Y., Nakashima H., Shimizu S., Kawaguchi M., Sakiyama M., Nakayama A., Akashi A., Tanahashi Y., Kawamura Y., Nakamura T., Wakai K., Okada R., Yamamoto K., Hosomichi K., Hosoya T., Ichida K., Ooyama H., Suzuki H., Inoue I., Merriman T. R., Shinomiya N., Matsuo H.

EUROPEAN JOURNAL OF HUMAN GENETICS Vol. 27 page： 645 - 646 2019.7

Comparative Radiographic Outcomes of Lateral and Posterior Lumbar Interbody Fusion in the Treatment of Degenerative Lumbar Kyphosis. Reviewed International journal Open Access

Hiroaki Nakashima, Tokumi Kanemura, Kotaro Satake, Yoshimoto Ishikawa, Jun Ouchida, Naoki Segi, Hidetoshi Yamaguchi, Shiro Imagama

Asian spine journal Vol. 13 ( 3 ) page： 395 - 402 2019.6

Language：English Publishing type：Research paper (scientific journal)

STUDY DESIGN: Retrospective case-control study. PURPOSE: To compare surgical invasiveness and radiological outcomes between posterior lumbar interbody fusion (PLIF) and lateral lumbar interbody fusion (LLIF) for degenerative lumbar kyphosis. OVERVIEW OF LITERATURE: LLIF is a minimally invasive interbody fusion technique; however, few reports compared the clinical outcomes of conventional PLIF and LLIF for degenerative lumbar kyphosis. METHODS: Radiographic data for patients who have undergone lumbar interbody fusion (≥3 levels) using PLIF or LLIF for degenerative lumbar kyphosis (lumbar lordosis [LL] <20°) were retrospectively examined. The following radiographic parameters were retrospectively evaluated preoperatively and 2 years postoperatively: segmental lordotic angle, LL, pelvic tilt (PT), pelvic incidence (PI), C7 sagittal vertical axis, and T1 pelvic angle. RESULTS: Nineteen consecutive cases with PLIF and 27 cases with LLIF were included. There were no significant differences in patients' backgrounds or preoperative radiographic parameters between the PLIF and the LLIF groups. The mean fusion level was 5.5±2.5 levels and 5.8±2.5 levels in the PLIF and LLIF groups, respectively (p=0.69). Although there was no significant difference in surgical times (p=0.58), the estimated blood loss was significantly greater in the PLIF group (p<0.001). Two years postoperatively, comparing the PLIF and LLIF groups, the segmental lordotic angle achieved (7.4°±7.6° and 10.6°±9.4°, respectively; p=0.03), LL (27.8°±13.9° and 39.2°±12.7°, respectively; p=0.006), PI-LL (19.8°±14.8° and 3.1°±17.5°, respectively; p=0.002), and PT (22.6°±7.1° and 14.2°±13.9°, respectively; p=0.02) were significantly better in the LLIF group. CONCLUSIONS: LLIF provided significantly better sagittal alignment restoration in the context of degenerative lumbar kyphosis, with less blood loss.

DOI： 10.31616/asj.2018.0204

What Are the Important Predictors of Postoperative Functional Recovery in Patients With Cervical OPLL? Results of a Multivariate Analysis. Reviewed International journal Open Access

Hiroaki Nakashima, Tokumi Kanemura, Shunsuke Kanbara, Kotaro Satake, Keigo Ito, Naoki Ishiguro, Fumihiko Kato, Shiro Imagama

Global spine journal Vol. 9 ( 3 ) page： 315 - 320 2019.5

Language：English Publishing type：Research paper (scientific journal)

Study Design: A retrospective cohort study. Objective: The objective of this study was to identify important predictors of poor functional recovery in patients undergoing surgery for cervical ossification of the posterior longitudinal ligament (OPLL). Methods: This was a retrospective cohort study of 142 OPLL patients with laminoplasty; 135 had complete radiographical data and were followed up for ≥2 years. The following OPLL characteristics were compared between patients with "good" and "poor" outcomes (Japanese Orthopedic Association [JOA] recovery rate ≥50% and <50%, respectively): number of ossified levels, OPLL classification, ossification shape, K-line, canal-occupying ratio, and increased magnetic resonance imaging (MRI) signal intensity. Predictors of functional recovery were identified. Results: Pre- and postoperative (2 years following surgery) JOA scores were 10.6 ± 2.9 and 14.1 ± 2.2, respectively, indicating significant improvement following laminoplasty (P < .001). The average JOA recovery rate was 53.4% ± 34.7%, with 81 (60.0%) and 54 (40.0%) patients in the better and poorer neurological outcome groups, respectively. The canal occupation ratio of OPLL ≤60%/>60% were 117 (86.7%) and 18 (13.3%) patients, respectively. In the stepwise logistic regression analysis, an occupation ratio greater than 60% was identified as a significant factor for poor postoperative neurological outcome (relative risk, 4.82; 95% confidential interval, 1.61-14.46, P = .005). Conclusions: This multivariate analysis demonstrated a large size OPLL (occupying ratio >60%) was associated with a risk of poor neurological recovery roughly 5 times greater, and therefore other types of surgery are recommended in cases with such a ratio.

DOI： 10.1177/2192568218794665

Anatomic evaluation of retroperitoneal organs for lateral approach surgery: a prospective imaging study using computed tomography in the lateral decubitus position. Reviewed

Ouchida J, Kanemura T, Satake K, Nakashima H, Segi N

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society Vol. 28 ( 4 ) page： 835 - 841 2019.4

[(10)Surgical Strategy for Adult Spinal Deformity in Elderly Patients]. Reviewed

Tokumi Kanemura, Kotaro Satake, Hiroaki Nakashima, Yoshimoto Ishikawa, Jun Ouchida, Hidetoshi Yamaguchi, Naoki Segi, Shiro Imagama

No shinkei geka. Neurological surgery Vol. 47 ( 3 ) page： 271 - 285 2019.3

A Systematic Review of Classification Systems for Cervical Ossification of the Posterior Longitudinal Ligament. Reviewed International journal Open Access

Lindsay Tetreault, Hiroaki Nakashima, So Kato, Michael Kryshtalskyj, Nagoshi Nagoshi, Aria Nouri, Anoushka Singh, Michael G Fehlings

Global spine journal Vol. 9 ( 1 ) page： 85 - 103 2019.2

Language：English Publishing type：Research paper (scientific journal)

Design: Systematic review. Objective: To conduct a systematic review to (1) summarize various classification systems used to describe cervical ossification of the posterior longitudinal ligament (OPLL) and (2) evaluate the diagnostic accuracy of various imaging modalities and the reliability of these classification systems. Methods: A search was performed to identify studies that used a classification system to categorize patients with OPLL. Furthermore, studies were included if they reported the diagnostic accuracy of various imaging modalities or the reliability of a classification system. Results: A total of 167 studies were deemed relevant. Five classification systems were developed based on X-ray: the 9-classification system (0.60%); continuous, segmental, mixed, localized or focal, circumscribed and others (92.81%); hook, staple, bridge, and total types (2.40%); distribution of OPLL (2.40%); and K-line classification (4.19%). Six methods were based on computed tomography scans: free-type, contiguous-type, and broken sign (0.60%); hill-, plateau-, square-, mushroom-, irregular-, or round-shaped (5.99%); rectangular, oval, triangular, or pedunculate (1.20%); centralized or laterally deviated (1.80%); plank-, spindle-, or rod-shaped (0.60%); and rule of nine (0.60%). Classification systems based on 3-dimensional computed tomography were bridging and nonbridging (1.20%) and flat, irregular, and localized (0.60%). A single classification system was based on magnetic resonance imaging: triangular, teardrop, or boomerang. Finally, a variation of methods was used to classify OPLL associated with the dura mater (4.19%). Conclusions: The most common method of classification was that proposed by the Japanese Ministry of Health, Labour and Welfare. Other important methods include K-line (+/-), signs of dural ossification, and patterns of distribution.

DOI： 10.1177/2192568217720421

Is Pregabalin Effective Against Acute Lumbar Radicular Pain ? Reviewed Open Access

Hiroaki Nakashima, Tokumi Kanemura, Kei Ando, Kazuyoshi Kobayashi, Minoru Yoneda, Naoki Ishiguro, Shiro Imagama

Spine surgery and related research Vol. 3 ( 1 ) page： 61 - 66 2019.1

Language：English Publishing type：Research paper (scientific journal) Publisher：The Japanese Society for Spine Surgery and Related Research

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for acute lumbar radicular pain accompanying lumbar disc herniation (LDH), but their effects are minimal. The purpose of this study was to evaluate the efficacy and safety of pregabalin (PGB) as an alternative therapy for this condition. Methods: Patients with acute lumbar radicular pain accompanying LDH were randomly administered either NSAIDs plus PGB (30 patients) or NSAIDs alone (30 patients) for up to 4 weeks. The primary outcome was leg pain at 2 and 4 weeks. Secondary outcomes were reduction in sleep disturbances and patient global impressions of change (PGIC) at 2 and 4 weeks. Results: Four patients in the NSAIDs plus PGB group were deemed ineligible and excluded from the study. Fewer sleep disturbances were reported by patients administered NSAIDs plus PGB compared with the NSAID monotherapy group at both 2 and 4 weeks. Additionally, the NSAIDs plus PGB group showed greater improvement in pain than the NSAID monotherapy group at 4 weeks, although this difference was not significant. PGIC was also significantly better in the NSAIDs plus PGB group than in the NSAID monotherapy group at 4 weeks. The incidence of adverse events was significantly greater in the NSAIDs plus PGB group than in the NSAID monotherapy group. Conclusions: The combination of NSAIDs plus PGB is more effective against sleep disturbance than NSAIDs alone in patients with acute LDH, although the control of sciatic pain is minimal. Patients reported satisfactory recoveries could also be obtained, and thus, this combination therapy could be a good option for the conservative treatment of acute lumbar radicular pain, including LDH.

DOI： 10.22603/ssrr.2018-0003

整形外科/知ってるつもり脊髄ヘルニアの画像診断と治療

今釜史郎, 中島宏彰, 八木秀樹, 安藤圭, 小林和克, 石黒直樹

臨床整形外科 Vol. 53 ( 12 ) page： 1110 - 1114 2018.12

特集ハイテク機器を利用した最新の脊椎脊髄手術「O－arm」の最新の応用法

金村徳相, 佐竹宏太郎, 中島宏彰, 石川喜資, 大内田隼, 山口英敏, 世木直喜, 今釜史郎

脊椎脊髄ジャーナル Vol. 31 ( 11 ) page： 938 - 951 2018.11

Factors Affecting the Severity of Neurological Disorders in Thoracic Idiopathic Spinal Cord Herniation. Reviewed International journal

Hiroaki Nakashima, Tokumi Kanemura, Hideki Yagi, Fumihiko Kato, Koji Sato, Mitsuhiro Kamiya, Hisatake Yoshihara, Kenyu Ito, Yukihiro Matsuyama, Naoki Ishiguro, Shiro Imagama

Spine Vol. 43 ( 22 ) page： 1552 - 1558 2018.11

Language：English Publishing type：Research paper (scientific journal)

STUDY DESIGN: Retrospective multicenter case-controlled study. OBJECTIVE: The objective of this study was to quantitatively examine imaging findings of idiopathic spinal cord herniation (ISCH) and determine the relationship between the image findings and the severity of pre- and postoperative neurological symptoms. SUMMARY OF BACKGROUND DATA: Many radiographic types of ISCH have been identified with regard to the location of the hernial opening or amount of herniated spinal cord. However, few previous studies have investigated the relationship between radiographic findings and the severity of neurological symptoms. METHODS: Of 30,469 patients who underwent spinal surgery at 7 hospitals, 18 patients who underwent surgery for ISCH were identified. Their preoperative neurological severity, disease duration, magnetic resonance imaging findings, computed tomography myelography findings, surgical findings, and postoperative improvements were retrospectively examined. The spinal cord kink angle and minimum cord occupancy rate within the dural tube were measured. In addition, herniation was classified according to the location of the hiatus as either central (type C) or lateral (type L) type. RESULTS: A negative correlation was found between the spinal cord kink angle and the minimum cord occupancy rate. Patient age was significantly higher in the severe paralysis group than in the mild paralysis group. In addition, the number of patients with type C herniation and the kink angle were significantly higher in the severe paralysis group. The number of patients with type L herniation was higher in the significant recovery group than in the mild recovery group; however, the difference was not significant. CONCLUSION: Patients with a large spinal cord kink angle had a smaller spinal cord occupancy rate within the dural tube, and this resulted in severe preoperative conditions. Type C ISCH cases had a severe preoperative neurological deficit and poor postoperative neurological recovery, and the spinal cord in such cases might be damaged irreversibly. LEVEL OF EVIDENCE: 4.

DOI： 10.1097/BRS.0000000000002574

Nonunion of Transpsoas Lateral Lumbar Interbody Fusion Using an Allograft: Clinical Assessment and Risk Factors. Reviewed

Satake K, Kanemura T, Nakashima H, Ishikawa Y, Segi N, Ouchida J

Spine surgery and related research Vol. 2 ( 4 ) page： 270 - 277 2018.10

特集脊椎脊髄手術の安全性を高める予防と対策第2章　各論 3.術後術後C5麻痺に対する予防と対策

小林和克, 今釜史郎, 安藤圭, 中島宏彰, 石黒直樹

脊椎脊髄ジャーナル Vol. 31 ( 4 ) page： 377 - 381 2018.4

誌上シンポジウム骨粗鬆症性脊椎骨折の治療 Cutting Edge 骨粗鬆性椎体骨折後偽関節に対する手術療法-術式間の手術成績の比較と治療法の選択

中島宏彰, 今釜史郎, 佐竹宏太郎, 石川喜資, 世木直喜, 大内田隼, 金村徳相

臨床整形外科 Vol. 53 ( 4 ) page： 299 - 305 2018.4

Lack of Fgf18 causes abnormal clustering of motor nerve terminals at the neuromuscular junction with reduced acetylcholine receptor clusters Reviewed Open Access

Kenyu Ito, Bisei Ohkawara, Hideki Yagi, Hiroaki Nakashima, Mikito Tsushima, Kyotaro Ota, Hiroyuki Konishi, Akio Masuda, Shiro Imagama, Hiroshi Kiyama, Naoki Ishiguro, Kinji Ohno

Scientific Reports Vol. 8 ( 1 ) page： 434 2018.1

Language：English Publishing type：Research paper (scientific journal) Publisher：Nature Publishing Group

FGF receptor 2 is involved in the formation of the neuromuscular junction (NMJ), but its in vivo ligand remains to be determined. Laser capture microdissection of the mouse spinal motor neurons (SMNs) revealed that Fgf18 mRNA is highly expressed in SMNs in adults. Expression of Fgf18 mRNA was the highest in the spinal cord at embryonic day (E) 15.5, which gradually decreased to postnatal day 7. FGF18 protein was localized at the NMJs of the tibialis anterior muscle at E18.5 and in adults. Fgf18-/- mice at E18.5 showed decreased expressions of the NMJ-specific Chrne and Colq genes in the diaphragm. In Fgf18-/- diaphragms, the synaptophysin-positive areas at the nerve terminals and the acetylcholine receptor (AChR)-positive areas at the motor endplates were both approximately one-third of those in wild-type embryos. Fgf18-/- diaphragms ultrastructurally showed abnormal aggregation of multiple nerve terminals making a gigantic presynapse with sparse synaptic vesicles, and simplified motor endplates. In Fgf18-/- diaphragms, miniature endplate potentials were low in amplitude with markedly reduced frequency. In C2C12 myotubes, FGF18 enhanced AChR clustering, which was blocked by inhibiting FGFRs or MEK1. We propose that FGF18 plays a pivotal role in AChR clustering and NMJ formation in mouse embryogenesis.

DOI： 10.1038/s41598-017-18753-5

Incidence and risk factors of postoperative neurologic decline after complex adult spinal deformity surgery: results of the Scoli-RISK-1 study Reviewed Open Access

Michael G. Fehlings, So Kato, Lawrence G. Lenke, Hiroaki Nakashima, Narihito Nagoshi, Christopher I. Shaffrey, Kenneth M.C. Cheung, Leah Carreon, Mark B. Dekutoski, Frank J. Schwab, Oheneba Boachie-Adjei, Khaled M. Kebaish, Christopher P. Ames, Yong Qiu, Yukihiro Matsuyama, Benny T. Dahl, Hossein Mehdian, Ferran Pellisé-Urquiza, Stephen J. Lewis, Sigurd H. Berven

Spine Journal Vol. 18 ( 10 ) page： 1733 - 1740 2018

Language：English Publishing type：Research paper (scientific journal) Publisher：Elsevier Inc.

Background Context: Significant variability in neurologic outcomes after surgical correction for adult spinal deformity (ASD) has been reported. Risk factors for decline in neurologic motor outcomes are poorly understood. Purpose: The objective of the present investigation was to identify the risk factors for postoperative neurologic motor decline in patients undergoing complex ASD surgery. Study Design/Setting: This is a prospective international multicenter cohort study. Patient Sample: From September 2011 to October 2012, 272 patients undergoing complex ASD surgery were prospectively enrolled in a multicenter, international cohort study in 15 sites. Outcome Measures: Neurologic decline was defined as any postoperative deterioration in American Spinal Injury Association lower extremity motor score (LEMS) compared with preoperative status. Methods: To identify risk factors, 10 candidate variables were selected for univariable analysis from the dataset based on clinical relevance, and a multivariable logistic regression analysis was used with backward stepwise selection. Results: Complete datasets on 265 patients were available for analysis and 61 (23%) patients showed a decline in LEMS at discharge. Univariable analysis showed that the key factors associated with postoperative neurologic deterioration included older age, lumbar-level osteotomy, three-column osteotomy, and larger blood loss. Multivariable analysis revealed that older age (odds ratio [OR]=1.5 per 10 years, 95% confidence interval [CI] 1.1–2.1, p=.005), larger coronal deformity angular ratio [DAR] (OR=1.1 per 1 unit, 95% CI 1.0–1.2, p=.037), and lumbar osteotomy (OR=3.3, 95% CI 1.2–9.2, p=.022) were the three major predictors of neurologic decline. Conclusions: Twenty-three percent of patients undergoing complex ASD surgery experienced a postoperative neurologic decline. Age, coronal DAR, and lumbar osteotomy were identified as the key contributing factors.

DOI： 10.1016/j.spinee.2018.02.001

Factors for a good surgical outcome in posterior decompression and dekyphotic corrective fusion with instrumentation for thoracic ossification of the posterior longitudinal ligament: Prospective single-center study Reviewed International journal

Shiro Imagama, Kei Ando, Kazuyoshi Kobayashi, Tetsuro Hida, Kenyu Ito, Mikito Tsushima, Yoshimoto Ishikawa, Akiyuki Matsumoto, Masayoshi Morozumi, Satoshi Tanaka, Masaaki Machino, Kyotaro Ota, Hiroaki Nakashima, Yoshihiro Nishida, Yukihiro Matsuyama, Naoki Ishiguro

Operative Neurosurgery Vol. 13 ( 6 ) page： 661 - 669 2017.12

Language：English Publishing type：Research paper (scientific journal) Publisher：Oxford University Press

BACKGROUND: Surgery for thoracic ossification of the posterior longitudinal ligament (T-OPLL) is still challenging, and factors for good surgical outcomes are unknown. OBJECTIVE: To identify factors for good surgical outcomes with prospective and comparative study. METHODS: Seventy-one consecutive patients who underwent posterior decompression and instrumented fusion were divided into good or poor outcome groups based on =50% and &lt
50% recovery rates for the Japanese Orthopaedic Association score. Preoperative, intraoperative, and postoperative findings were compared in the 2 groups, and significant factors for a good outcome were analyzed. RESULTS: Patients with a good outcome (76%) had significantly lower nonambulatory rate and positive prone and supine position tests preoperatively
lower rates of T-OPLL, ossification of the ligamentum flavum, high-intensity area at the same level, thoracic spinal cord alignment difference, and spinal canal stenosis on preoperative magnetic resonance imaging
lower estimated blood loss
higher rates of intraoperative spinal cord floating and absence of deterioration of intraoperative neurophysiological monitoring
and lower rates of postoperative complications (P&lt
.0005). In multivariate logistic regression analysis, negative prone and supine position test (odds ratio [OR]: 17.00), preoperative ambulatory status (OR: 6.05), absence of T-OPLL, ossification of the ligamentum flavum, high-intensity area at the same level (OR: 5.84), intraoperative spinal cord floating (OR: 4.98), and lower estimated blood loss (OR: 1.01) were significant factors for a good surgical outcome. CONCLUSION: This study demonstrated that early surgery is recommended during these positive factors. Appropriate surgical planning based on preoperative thoracic spinal cord alignment difference, as well as sufficient spinal cord decompression and reduction of complications using intraoperative ultrasonography and intraoperative neurophysiological monitoring, may improve surgical outcomes.

DOI： 10.1093/ons/opx043

Efficacy of Early Fusion With Local Bone Graft and Platelet-Rich Plasma in Lumbar Spinal Fusion Surgery Followed Over 10 Years Reviewed International journal Open Access

Shiro Imagama, Kei Ando, Kazuyoshi Kobayashi, Yoshimoto Ishikawa, Hiroshi Nakamura, Tetsuro Hida, Kenyu Ito, Mikito Tsushima, Akiyuki Matsumoto, Masayoshi Morozumi, Satoshi Tanaka, Masaaki Machino, Kyotaro Ota, Hiroaki Nakashima, Junki Takamatsu, Tadashi Matsushita, Yoshihiro Nishida, Naoki Ishiguro, Yukihiro Matsuyama

Global Spine Journal Vol. 7 ( 8 ) page： 749 - 755 2017.12

Language：English Publishing type：Research paper (scientific journal) Publisher：SAGE Publications Ltd

Study Design: Prospective clinical study. Objective: Many oral surgeons use platelet-rich plasma (PRP) for bone defects, but the efficacy of PRP for spinal arthrodesis remains uncertain. The objective was to compare the efficacy of autologous local bone graft and PRP with local bone graft alone for promotion of bony union in posterolateral lumbar fusion (PLF) surgery, with investigation of the safety of PRP over 10 years. Methods: A prospective study was conducted in 29 consecutive patients who underwent one-level PLF at L4/5 for degenerative lumbar disease. Local bone on the left (control) side and local bone with PRP on the right side were grafted. The fusion area and absorption of grafted bone at 58 regions were determined using computed tomography at 2 weeks and 3, 6, and 12 months after surgery. Results: Average bone fusion areas on the PRP side were significantly wider at 3 and 6 months after surgery (P &lt
.05). Average absorption values were significantly lower on the PRP side than on the control side at 3 and 6 months after surgery (P &lt
.05). The PRP/control ratio was significantly different at 3 and 6 months compared to that at 2 weeks (P &lt
.005). No adverse events related to PRP occurred with good clinical outcome over 10 years follow-up. Conclusions: Local application of PRP combined with autologous local bone graft has a positive impact on early fusion for lumbar arthrodesis with no adverse events over 10 years, and thus is a safe and low cost autologous option in spinal fusion.

DOI： 10.1177/2192568217696690

A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury and Central Cord Syndrome: Recommendations on the Timing (≤24 Hours Versus >24 Hours) of Decompressive Surgery Reviewed International journal Open Access

Michael G. Fehlings, Lindsay A. Tetreault, Jefferson R. Wilson, Bizhan Aarabi, Paul Anderson, Paul M. Arnold, Darrel S. Brodke, Anthony S. Burns, Kazuhiro Chiba, Joseph R. Dettori, Julio C. Furlan, Gregory Hawryluk, Langston T. Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark Kotter, Shekar Kurpad, Ralph J. Marino, Allan R. Martin, Eric Massicotte, Geno Merli, James W. Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Anoushka Singh, Andrea C. Skelly, Eve C. Tsai, Alexander Vaccaro, Albert Yee, James S. Harrop

Global Spine Journal Vol. 7 ( 3 Suppl ) page： 195S - 202S 2017.9

Language：English Publishing type：Research paper (scientific journal) Publisher：SAGE Publications Ltd

Objective: To develop recommendations on the timing of surgical decompression in patients with traumatic spinal cord injury (SCI) and central cord syndrome. Methods: A systematic review of the literature was conducted to address key relevant questions. A multidisciplinary guideline development group used this information, along with their clinical expertise, to develop recommendations for the timing of surgical decompression in patients with SCI and central cord syndrome. Based on GRADE, a strong recommendation is worded as “we recommend,” whereas a weak recommendation is presented as “we suggest.” Results: Conclusions from the systematic review included (1) isolated studies reported statistically significant and clinically important improvements following early decompression at 6 months and following discharge from inpatient rehabilitation
(2) in one study on acute central cord syndrome without instability, a marginally significant improvement in total motor scores was reported at 6 and 12 months in patients managed with early versus late surgery
and (3) there were no significant differences in length of acute care/rehabilitation stay or in rates of complications between treatment groups. Our recommendations were: “We suggest that early surgery be considered as a treatment option in adult patients with traumatic central cord syndrome” and “We suggest that early surgery be offered as an option for adult acute SCI patients regardless of level.” Quality of evidence for both recommendations was considered low. Conclusions: These guidelines should be implemented into clinical practice to improve outcomes in patients with acute SCI and central cord syndrome by promoting standardization of care, decreasing the heterogeneity of management strategies, and encouraging clinicians to make evidence-informed decisions.

DOI： 10.1177/2192568217706367

A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Type and Timing of Anticoagulant Thromboprophylaxis Reviewed International journal

Michael G. Fehlings, Lindsay A. Tetreault, Bizhan Aarabi, Paul Anderson, Paul M. Arnold, Darrel S. Brodke, Anthony S. Burns, Kazuhiro Chiba, Joseph R. Dettori, Julio C. Furlan, Gregory Hawryluk, Langston T. Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark Kotter, Shekar Kurpad, Brian K. Kwon, Ralph J. Marino, Allan R. Martin, Eric Massicotte, Geno Merli, James W. Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Anoushka Singh, Andrea C. Skelly, Eve C. Tsai, Alexander Vaccaro, Jefferson R. Wilson, Albert Yee, James S. Harrop

Global Spine Journal Vol. 7 ( 3 Suppl ) page： 212S - 220S 2017.9

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：SAGE Publications Ltd

Introduction: The objective of this study is to develop evidence-based guidelines that recommend effective, safe and cost-effective thromboprophylaxis strategies in patients with spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions relating to thromboprophylaxis in SCI. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: Based on conclusions from the systematic review and expert panel opinion, the following recommendations were developed: (1) “We suggest that anticoagulant thromboprophylaxis be offered routinely to reduce the risk of thromboembolic events in the acute period after SCI
” (2) “We suggest that anticoagulant thromboprophylaxis, consisting of either subcutaneous low-molecular-weight heparin or fixed, low-dose unfractionated heparin (UFH) be offered to reduce the risk of thromboembolic events in the acute period after SCI. Given the potential for increased bleeding events with the use of adjusted-dose UFH, we suggest against this option
” (3) “We suggest commencing anticoagulant thromboprophylaxis within the first 72 hours after injury, if possible, in order to minimize the risk of venous thromboembolic complications during the period of acute hospitalization.” Conclusions: These guidelines should be implemented into clinical practice in patients with SCI to promote standardization of care, decrease heterogeneity of management strategies and encourage clinicians to make evidence-informed decisions.

DOI： 10.1177/2192568217702107

A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role of Baseline Magnetic Resonance Imaging in Clinical Decision Making and Outcome Prediction Reviewed International journal

Michael G. Fehlings, Allan R. Martin, Lindsay A. Tetreault, Bizhan Aarabi, Paul Anderson, Paul M. Arnold, Darrel Brodke, Anthony S. Burns, Kazuhiro Chiba, Joseph R. Dettori, Julio C. Furlan, Gregory Hawryluk, Langston T. Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark Kotter, Shekar Kurpad, Brian K. Kwon, Ralph J. Marino, Eric Massicotte, Geno Merli, James W. Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Anoushka Singh, Andrea C. Skelly, Eve C. Tsai, Alexander Vaccaro, Jefferson R. Wilson, Albert Yee, James S. Harrop

Global Spine Journal Vol. 7 ( 3 Suppl ) page： 221S - 230S 2017.9

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：SAGE Publications Ltd

Introduction: The objective of this guideline is to outline the role of magnetic resonance imaging (MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI. This review focused on longitudinal studies that controlled for baseline neurologic status. A multidisciplinary Guideline Development Group (GDG) used this information, their clinical expertise, and patient input to develop recommendations on the use of MRI for SCI patients. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: Based on the limited available evidence and the clinical expertise of the GDG, our recommendations were: (1) “We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention, when feasible, to facilitate improved clinical decision-making” (quality of evidence, very low) and (2) “We suggest that MRI should be performed in adult patients in the acute period following SCI, before or after surgical intervention, to improve prediction of neurologic outcome” (quality of evidence, low). Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI.

DOI： 10.1177/2192568217703089

A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Type and Timing of Rehabilitation Reviewed International journal

Michael G. Fehlings, Lindsay A. Tetreault, Bizhan Aarabi, Paul Anderson, Paul M. Arnold, Darrel S. Brodke, Kazuhiro Chiba, Joseph R. Dettori, Julio C. Furlan, James S. Harrop, Gregory Hawryluk, Langston T. Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark Kotter, Shekar Kurpad, Brian K. Kwon, Ralph J. Marino, Allan R. Martin, Eric Massicotte, Geno Merli, James W. Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Anoushka Singh, Andrea C. Skelly, Eve C. Tsai, Alexander Vaccaro, Jefferson R. Wilson, Albert Yee, Anthony S. Burns

Global Spine Journal Vol. 7 ( 3 Suppl ) page： 231S - 238S 2017.9

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：SAGE Publications Ltd

Introduction: The objective of this study is to develop guidelines that outline the appropriate type and timing of rehabilitation in patients with acute spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to rehabilitation in patients with acute SCI. A multidisciplinary guideline development group used this information, and their clinical expertise, to develop recommendations for the type and timing of rehabilitation. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest. Results: Based on the findings from the systematic review, our recommendations were: (1) We suggest rehabilitation be offered to patients with acute spinal cord injury when they are medically stable and can tolerate required rehabilitation intensity (no included studies
expert opinion)
(2) We suggest body weight–supported treadmill training as an option for ambulation training in addition to conventional overground walking, dependent on resource availability, context, and local expertise (low evidence)
(3) We suggest that individuals with acute and subacute cervical SCI be offered functional electrical stimulation as an option to improve hand and upper extremity function (low evidence)
and (4) Based on the absence of any clear benefit, we suggest not offering additional training in unsupported sitting beyond what is currently incorporated in standard rehabilitation (low evidence). Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in patients with SCI by promoting standardization of care, decreasing the heterogeneity of management strategies and encouraging clinicians to make evidence-informed decisions.

DOI： 10.1177/2192568217701910

A Clinical Practice Guideline for the Management of Patients With Degenerative Cervical Myelopathy: Recommendations for Patients With Mild, Moderate, and Severe Disease and Nonmyelopathic Patients With Evidence of Cord Compression Reviewed International journal

Michael G. Fehlings, Lindsay A. Tetreault, K. Daniel Riew, James W. Middleton, Bizhan Aarabi, Paul M. Arnold, Darrel S. Brodke, Anthony S. Burns, Simon Carette, Robert Chen, Kazuhiro Chiba, Joseph R. Dettori, Julio C. Furlan, James S. Harrop, Langston T. Holly, Sukhvinder Kalsi-Ryan, Mark Kotter, Brian K. Kwon, Allan R. Martin, James Milligan, Hiroaki Nakashima, Narihito Nagoshi, John Rhee, Anoushka Singh, Andrea C. Skelly, Sumeet Sodhi, Jefferson R. Wilson, Albert Yee, Jeffrey C. Wang

Global Spine Journal Vol. 7 ( 3 Suppl ) page： 70S - 83S 2017.9

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：SAGE Publications Ltd

Study Design: Guideline development. Objectives: The objective of this study is to develop guidelines that outline how to best manage (1) patients with mild, moderate, and severe myelopathy and (2) nonmyelopathic patients with evidence of cord compression with or without clinical symptoms of radiculopathy. Methods: Five systematic reviews of the literature were conducted to synthesize evidence on disease natural history
risk factors of disease progression
the efficacy, effectiveness, and safety of nonoperative and surgical management
the impact of preoperative duration of symptoms and myelopathy severity on treatment outcomes
and the frequency, timing, and predictors of symptom development. A multidisciplinary guideline development group used this information, and their clinical expertise, to develop recommendations for the management of degenerative cervical myelopathy (DCM). Results: Our recommendations were as follows: (1) “We recommend surgical intervention for patients with moderate and severe DCM.” (2) “We suggest offering surgical intervention or a supervised trial of structured rehabilitation for patients with mild DCM. If initial nonoperative management is pursued, we recommend operative intervention if there is neurological deterioration and suggest operative intervention if the patient fails to improve.” (3) “We suggest not offering prophylactic surgery for non-myelopathic patients with evidence of cervical cord compression without signs or symptoms of radiculopathy. We suggest that these patients be counseled as to potential risks of progression, educated about relevant signs and symptoms of myelopathy, and be followed clinically.” (4) “Non-myelopathic patients with cord compression and clinical evidence of radiculopathy with or without electrophysiological confirmation are at a higher risk of developing myelopathy and should be counselled about this risk. We suggest offering either surgical intervention or nonoperative treatment consisting of close serial follow-up or a supervised trial of structured rehabilitation. In the event of myelopathic development, the patient should be managed according to the recommendations above.” Conclusions: These guidelines will promote standardization of care for patients with DCM, decrease the heterogeneity of management strategies and encourage clinicians to make evidence-informed decisions.

DOI： 10.1177/2192568217701914

A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Use of Methylprednisolone Sodium Succinate Reviewed International journal

Michael G. Fehlings, Jefferson R. Wilson, Lindsay A. Tetreault, Bizhan Aarabi, Paul Anderson, Paul M. Arnold, Darrel S. Brodke, Anthony S. Burns, Kazuhiro Chiba, Joseph R. Dettori, Julio C. Furlan, Gregory Hawryluk, Langston T. Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark Kotter, Shekar Kurpad, Brian K. Kwon, Ralph J. Marino, Allan R. Martin, Eric Massicotte, Geno Merli, James W. Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Andrea C. Skelly, Anoushka Singh, Eve C. Tsai, Alexander Vaccaro, Albert Yee, James S. Harrop

Global Spine Journal Vol. 7 ( 3 Suppl ) page： 203S - 211S 2017.9

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：SAGE Publications Ltd

Introduction: The objective of this guideline is to outline the appropriate use of methylprednisolone sodium succinate (MPSS) in patients with acute spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MPSS in acute SCI. A multidisciplinary Guideline Development Group used this information, in combination with their clinical expertise, to develop recommendations for the use of MPSS. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: The main conclusions from the systematic review included the following: (1) there were no differences in motor score change at any time point in patients treated with MPSS compared to those not receiving steroids
(2) when MPSS was administered within 8 hours of injury, pooled results at 6- and 12-months indicated modest improvements in mean motor scores in the MPSS group compared with the control group
and (3) there was no statistical difference between treatment groups in the risk of complications. Our recommendations were: (1) “We suggest not offering a 24-hour infusion of high-dose MPSS to adult patients who present after 8 hours with acute SCI”
(2) “We suggest a 24-hour infusion of high-dose MPSS be offered to adult patients within 8 hours of acute SCI as a treatment option”
and (3) “We suggest not offering a 48-hour infusion of high-dose MPSS to adult patients with acute SCI.” Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and reduce morbidity in SCI patients.

DOI： 10.1177/2192568217703085

Clinical and Radiographical Differences Between Thoracic Idiopathic Spinal Cord Herniation and Spinal Arachnoid Cyst Reviewed International journal

Hiroaki Nakashima, Shiro Imagama, Hideki Yagi, Fumihiko Kato, Tokumi Kanemura, Koji Sato, Noriaki Kawakami, Mitsuhiro Kamiya, Hisatake Yoshihara, Kenyu Ito, Yukihiro Matsuyama, Yoshihiro Nishida, Naoki Ishiguro

SPINE Vol. 42 ( 16 ) page： E963 - E968 2017.8

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

Study Design. A retrospective, multicenter, case-controlled study.
Objective. The aim of this study was to investigate the clinical and radiographical differences between thoracic idiopathic spinal cord herniation (ISCH) and spinal arachnoid cyst (SAC).
Summary of Background Data. ISCH and SAC are relatively rare diseases. Preoperative misdiagnose was frequently reported in both; however, these clinical and radiographical differences remain unclear.
Methods. Of 30,469 patients who underwent spinal surgery, 18 (0.059%) and 22 (0.072%) patients were diagnosed as ISCH or SAC at nine hospitals, respectively, and their clinical and radiographical data were retrospectively evaluated. The spinal cord kink angle was measured on magnetic resonance or computed tomography myelography sagittal images; the kink angle was the exterior angle formed between the two tangents to the dorsal-side inflection points at the maximally affected level.
Results. There were no significant differences in age, gender, and duration of symptoms. Preoperative motor deficit was significantly higher (94.4%) and severer (manual muscle testing: 3.1 +/- 1.1) in ISCH. Brown-Sequard syndrome was observed in 38.9% of ISCH, while no patients in SAC. In addition, leg sensory disorder and bladder rectal disorder were significantly more common in ISCH, while back pain was significantly frequent in SAC. With respect to radiographical findings, the length of disease (5.1 +/- 2.7 levels) and altered cerebrospinal flow (CSF) (81.8%) in the lesion was significantly longer and more common in SAC. On the contrary, the kink angle was significantly greater in ISCH (54.0 +/- 23.18) than in SAC (14.1 +/- 12.08) (P< 0.001). The cut-off value of the kink angle to distinguish ISCH and SAC was 32.88.
Conclusion. Patients with ISCH commonly had severe preoperative neurological deficit, Brown-Sequard syndrome, and higher kink angle, while patients with SAC had back pain, longer length of disease, and altered CSF in the lesion.

DOI： 10.1097/BRS.0000000000002013

Risk Factors for Ineffectiveness of Posterior Decompression and Dekyphotic Corrective Fusion with Instrumentation for Beak-Type Thoracic Ossification of the Posterior Longitudinal Ligament: A Single Institute Study (vol 80, pg 800, 2017)

Ando Kei, Ito Zenya, Kobayashi Kazuyoshi, Hida Tetsuro, Ito Kenyu, Tsushima Mikito, Ishikawa Yoshimoto, Matsumoto Akiyuki, Morozumi Masayoshi, Tanaka Satoshi, Machino Masaaki, Ota Kyotaro, Nakashima Hiroaki, Nishida Yoshihiro, Ishiguro Naoki

NEUROSURGERY Vol. 81 ( 2 ) page： 403 - 403 2017.8

Risk Factors for and Clinical Outcomes of Dysphagia After Anterior Cervical Surgery for Degenerative Cervical Myelopathy Results from the AOSpine International and North America Studies Reviewed

Narihito Nagoshi, Lindsay Tetreault, Hiroaki Nakashima, Paul M. Arnold, Giuseppe Barbagallo, Branko Kopjar, Michael G. Fehlings

JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME Vol. 99 ( 13 ) page： 1069 - 1077 2017.7

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

Background: Although dysphagia is a common complication after anterior cervical decompression and fusion, important risk factors have not been rigorously evaluated. Furthermore, the impact of dysphagia on neurological and quality-of-life outcomes is not fully understood. The aim of this study was to determine the prevalence of and risk factors for dysphagia, and the impact of this complication on short and long-term clinical outcomes, in patients treated with anterior cervical decompression and fusion.
Methods: Four hundred and seventy patients undergoing a 1-stage anterior or 2-stage anteroposterior cervical decompression and fusion were enrolled in the prospective AOSpine CSM (Cervical Spondylotic Myelopathy) North America or International study at 26 global sites. Logistic regression analyses were conducted to determine important clinical and surgical predictors of perioperative dysphagia. Preoperatively and at each follow-up visit, patients were evaluated using the modified Japanese Orthopaedic Association scale (mJOA), Nurick score, Neck Disability Index (NDI), and Short Form-36 Health Survey (SF-36). A 2-way repeated-measures analysis of covariance was used to evaluate differences in outcomes at 6 and 24 months between patients with and those without dysphagia, while controlling for relevant baseline characteristics and surgical factors.
Results: The overall prevalence of dysphagia was 6.2%. Bivariate analysis showed the major risk factors for perioperative dysphagia to be a higher comorbidity score, older age, a cardiovascular or endocrine disorder, a lower SF-36 Physical Component Summary score, 2-stage surgery, and a greater number of decompressed levels. Multivariable analysis showed patients to be at an increased risk of perioperative dysphagia if they had an endocrine disorder, a greater number of decompressed segments, or 2-stage surgery. Both short and long-termimprovements in functional, disability, and quality-of-life scores were comparable between patients with and those without dysphagia.
Conclusions: The most important predictors of dysphagia are an endocrine disorder, a greater number of decompressed levels, and 2-stage surgery. At the time of both short and long-termfollow-up, patients with perioperative dysphagia exhibited improvements in functional, disability, and quality-of life scores that were similar to those of patients without dysphagia.

DOI： 10.2106/JBJS.16.00325

MRI Analysis of the Combined Prospectively Collected AOSpine North America and International Data The Prevalence and Spectrum of Pathologies in a Global Cohort of Patients With Degenerative Cervical Myelopathy Reviewed

Aria Nouri, Allan R. Martin, Lindsay Tetreault, Anick Nater, So Kato, Hiroaki Nakashima, Narihito Nagoshi, Hamed Reihani-Kermani, Michael G. Fehlings

SPINE Vol. 42 ( 14 ) page： 1058 - 1067 2017.7

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

Study Design. An ambispective analysis.
Objective. The aim of this study was to report the global prevalence of specific degenerative cervical pathologies in patients with degenerative cervical myelopathy (DCM) through detailed review of magnetic resonance imaging (MRIs).
Summary of Background Data. DCM encompasses a spectrum of age-related conditions that result in progressive spinal cord injury.
Methods. MRIs of 458 patients (age 56.4 +/- 11.8, 285 male, 173 female) were reviewed for specific degenerative features, directionality of cord compression, levels of spinal cord compression, and signal changes on sagittal T2-weighted imaging (T2WI) and sagittal T1-weighted imaging (T1WI). Data were analyzed for differences between sex using Chi-square tests and geographic variations using Kruskal-Wallis tests.
Results. Spondylosis was frequently present (89.7%) and was commonly accompanied by enlargement of the ligamentum flavum (LF) (59.9%). Single-level disc pathology, ossification of posterior longitudinal ligament (OPLL), and spondylolisthesis had a prevalence of similar to 10% each. OPLL was accompanied by spondylosis in 91.7%. Klippel-Feil syndrome was observed in 2.0%. The Asia-Pacific region had more OPLL (29%, P - 3 x 10(-11)) and less spondylolisthesis (1.9%, P = 0.002). Females presented more commonly with single-level disc pathology (13.9% vs. 6.7%; P = 0.013), and males with spondylosis (92.3% vs. 85.6%; P - 0.02) and enlargement of LF (61.4% vs. 49.1%; P = 0.01). C5 to C6 was the most frequent maximum compressed site (39.5%) and region for T2WI hyperintensity (38.9%). T2WI hyperintensity more commonly presented in males (82.4% vs. 66.7%; P< 0.001).
Conclusion. This is the largest report on the prevalence and spectrum of pathology in patients with DCM. Herein, it has been demonstrated that degenerative features are highly interrelated, that females presented with milder MRI evidence of DCM, and that variations exist in the prevalence of pathologies between geographical regions.

DOI： 10.1097/BRS.0000000000001981

誌上シンポジウム成人脊柱変形の目指すポイント　PI-LL≦10°,PT＜20°はすべての年齢層に当てはまるのか成人脊柱変形における至適な矢状面アライメント矯正-術中にどのように目的とするアライメントを獲得するのか?

中島宏彰, 金村徳相, 佐竹宏太郎, 世木直喜, 大内田隼, 今釜史郎

臨床整形外科 Vol. 52 ( 5 ) page： 439 - 447 2017.5

Optimal timing of surgery for intramedullary cavernous hemangioma of the spinal cord in relation to preoperative motor paresis, disease duration, and tumor volume and location Reviewed International journal Open Access

Shiro Imagama, Zenya Ito, Kei Ando, Kazuyoshi Kobayashi, Tetsuro Hida, Kenyu Ito, Mikito Tsushima, Yoshimoto Ishikawa, Akiyuki Matsumoto, Masayoshi Morozumi, Satoshi Tanaka, Masaaki Machino, Kyotaro Ota, Hiroaki Nakashima, Norimitsu Wakao, Yoshihito Sakai, Yukihiro Matsuyama, Naoki Ishiguro

Global Spine Journal Vol. 7 ( 3 ) page： 246 - 253 2017.5

Language：English Publishing type：Research paper (scientific journal) Publisher：Thieme Medical Publishers, Inc.

Study Design: Prospective study. Objective: Investigate factors associated with preoperative motor paresis, recovery, ambulatory status, and intraoperative neurophysiological monitoring (IONM) among patients with no preoperative paresis (N group), complete preoperative motor recovery (CR group), and no complete recovery (NCR group) in patients with intramedullary spinal cavernous hemangioma to determine the optimal timing of surgery. Methods: The study evaluated 41 surgical cases in our institute. Disease duration, tumor lesion, manual muscle testing (MMT), and gait at onset, just before surgery, and final follow-up (FU), tumor and lesion volume, IONM, extent of tumor resection, and tumor recurrence were evaluated among N, CR, and NCR groups. Results: Motor paresis at onset was found in 26 patients (63%), with 42% of those in CR group. Disease duration from onset negatively affected stable gait just before surgery and FU as well as lower preoperative MMT (P &lt
.05). Thoracic tumors were associated with patients with unstable gait before surgery (P &lt
.05). Tumor volume was larger in NCR group (P &lt
.05). IONM significantly decreased in NCR and CR groups than in N group (P &lt
.05). The NCR group had residual mild motor paresis at FU (P &lt
.05). Stable gait at FU was similar in N group and CR group, though lower in NCR group (P &lt
.05). Conclusions: Early surgery is generally recommended for thoracic tumors and large tumors during stable gait without motor paresis before long disease duration. Surgery may be postponed until patients recover from preoperative motor paresis to allow optimal surgical outcome. IONM should be carefully monitored in patients with a history of preoperative paresis even with preoperative complete motor recovery.

DOI： 10.1177/2192568217707938

Risk Factors for Ineffectiveness of Posterior Decompression and Dekyphotic Corrective Fusion with Instrumentation for Beak-Type Thoracic Ossification of the Posterior Longitudinal Ligament: A Single Institute Study Reviewed International journal

Shiro Imagama, Kei Ando, Zenya Ito, Kazuyoshi Kobayashi, Tetsuro Hida, Kenyu Ito, Mikito Tsushima, Yoshimoto Ishikawa, Akiyuki Matsumoto, Masayoshi Morozumi, Satoshi Tanaka, Masaaki Machino, Kyotaro Ota, Hiroaki Nakashima, Norimitsu Wakao, Yoshihiro Nishida, Yukihiro Matsuyama, Naoki Ishiguro

NEUROSURGERY Vol. 80 ( 5 ) page： 800 - 808 2017.5

Language：English Publishing type：Research paper (scientific journal) Publisher：OXFORD UNIV PRESS INC

BACKGROUND: Thoracic ossification of the posterior longitudinal ligament (T-OPLL) is treated surgically with instrumented posterior decompression and fusion. However, the factors determining the outcome of this approach and the efficacy of additional resection of T-OPLL are unknown.
OBJECTIVE: To identify these factors in a prospective study at a single institution.
METHODS: The subjects were 70 consecutive patients with beak-type T-OPLL who underwent posterior decompression and dekyphotic fusion and had an average of 4.8 years of follow-up (minimum of 2 years). Of these patients, 4 (6%; group R) had no improvement or aggravation, were not ambulatory for 3 weeks postoperatively, and required additional T-OPLL resection; while 66 (group N) required no further T-OPLL resection. Clinical records, gait status, intraoperative ultrasonography, intraoperative neurophysiological monitoring (IONM), plain radiography, computed tomography and magnetic resonance imaging findings, and Japanese Orthopaedic Association (JOA) score were compared between the groups.
RESULTS: Preoperatively, patients in group R had significantly higher rates of severe motor paralysis, nonambulatory status, positive prone and supine position test, no spinal cord floating in intraoperative ultrasonography, and deterioration of IONM at the end of surgery (P < .05). In preoperative radiography, the OPLL spinal cord kyphotic angle difference in fused area, OPLL length, and OPLL canal stenosis were significantly higher in group R (P < .05). At final follow-up, JOA scores improved similarly in both groups.
CONCLUSION: Preoperative severe motor paralysis, nonambulatory status, positive prone and supine position test, radiographic spinal cord compression due to beak-type T-OPLL, and intraoperative residual spinal cord compression and deterioration of IONM were associated with ineffectiveness of posterior decompression and fusion with instrumentation. Our 2-stage strategy may be appropriate for beak-type T-OPLL surgery.

DOI： 10.1093/neuros/nyw130

Ponte Osteotomy During Dekyphosis for Indirect Posterior Decompression With Ossification of the Posterior Longitudinal Ligament of the Thoracic Spine. Reviewed

Ando K, Imagama S, Ito Z, Kobayashi K, Ukai J, Muramoto A, Shinjo R, Matsumoto T, Nakashima H, Matsuyama Y, Ishiguro N

Clinical spine surgery Vol. 30 ( 4 ) page： E358 - E362 2017.5

Ponte Osteotomy During Dekyphosis for Indirect Posterior Decompression With Ossification of the Posterior Longitudinal Ligament of the Thoracic Spine

Ando Kei, Imagama Shiro, Ito Zenya, Kobayashi Kazuyoshi, Ukai Junichi, Muramoto Akio, Shinjo Ryuichi, Matsumoto Tomohiro, Nakashima Hiroaki, Matsuyama Yukihiro, Ishiguro Naoki

CLINICAL SPINE SURGERY Vol. 30 ( 4 ) page： E358-E362 2017.5

Multilevel Lateral Lumbar Interbody Fusion for Degenerative Spinal Deformity in Elderly

Vol. 30 ( 4 ) page： 437 - 443 2017.4

Prevalence and outcomes in patients undergoing reintubation after anterior cervical Spine surgery: Results from the AOSpine North America multicenter study on 8887 patients Reviewed International journal Open Access

Narihito Nagoshi, Michael G. Fehlings, Hiroaki Nakashima, Lindsay Tetreault, Jeffrey L. Gum, Zachary A. Smith, Wellington K. Hsu, Chadi A. Tannoury, Tony Tannoury, Vincent C. Traynelis, Paul M. Arnold, Thomas E. Mroz, Ziya L. Gokaslan, Mohamad Bydon, Anthony F. De Giacomo, Bruce C. Jobse, Eric M. Massicotte, K. Daniel Riew

Global Spine Journal Vol. 7 ( 1 Suppl ) page： 965 - 1025 2017.4

Language：English Publishing type：Research paper (scientific journal) Publisher：Thieme Medical Publishers, Inc.

Study Design: A multicenter, retrospective cohort study. Objective: To evaluate clinical outcomes in patients with reintubation after anterior cervical spine surgery. Methods: A total of 8887 patients undergoing anterior cervical spine surgery were enrolled in the AOSpine North America Rare Complications of Cervical Spine Surgery study. Patients with or without complications after surgery were included. Demographic and surgical information were collected for patients with reintubation. Patients were evaluated using a variety of assessment tools, including the modified Japanese Orthopedic Association scale, Nurick score, Neck Disability Index, and Short Form-36 Health Survey. Results: Nine cases of postoperative reintubation were identified. The total prevalence of this complication was 0.10% and ranged from 0% to 0.59% across participating institutions. The time to development of airway symptoms after surgery was within 24 hours in 6 patients and between 5 and 7 days in 3 patients. Although 8 patients recovered, 1 patient died. At final follow-up, patients with reintubation did not exhibit significant and meaningful improvements in pain, functional status, or quality of life. Conclusions: Although the prevalence of reintubation was very low, this complication was associated with adverse clinical outcomes. Clinicians should identify their high-risk patients and carefully observe them for up to 2 weeks after surgery.

DOI： 10.1177/2192568216687753

Impact of Depression and Bipolar Disorders on Functional and Quality of Life Outcomes in Patients Undergoing Surgery for Degenerative Cervical Myelopathy Analysis of a Combined Prospective Dataset Reviewed International journal

Lindsay Tetreault, Narihito Nagoshi, Hiroaki Nakashima, Anoushka Singh, Branko Kopjar, Paul Arnold, Michael G. Fehlings

SPINE Vol. 42 ( 6 ) page： 372 - 378 2017.3

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

Study Design. Analysis of a combined prospective dataset.
Objective. To compare clinical outcomes in patients with and without preexisting depression or bipolar disorder undergoing surgery for degenerative cervical myelopathy (DCM).
Summary of Background Data. Psychiatric comorbidities, including depression, have been associated with worse clinical outcomes after lumbar spine surgery; however, it is unclear whether these psychiatric disorders are also predictive of outcomes in patients undergoing surgery for the treatment of DCM.
Methods. Four hundred and one patients with symptomatic DCM were enrolled in the prospective AOSpine International or North America study at twelve North American sites. Patients were evaluated preoperatively and at 6, 12, and 24 months using the modified Japanese Orthopedic Association scale (mJOA), Nurick score, Neck Disability Index (NDI), and Short-Form 36v2 (SF-36v2) Health Survey. A mixed model analytic approach was used to evaluate differences in outcomes at 24 months among patients with and without psychiatric disorders, while controlling for relevant baseline characteristics and surgical factors.
Results. Ninety-seven patients (24.19%) were diagnosed with preexisting depression or bipolar disorder. There were more females (65.98%) with these psychiatric disorders than males (34.02%) (P< 0.0001). Patients with psychiatric comorbidities were more likely to have cardiovascular (P = 0.0177), respiratory (P < 0.0001), gastrointestinal (P < 0.0001), rheumatologic (P = 0.0109), and neurologic (P = 0.0309) disorders. At 24 months after surgery, patients in both groups demonstrated significant improvements on the mJOA, Nurick, NDI, and SF-36v2 Physical Component Score (PCS). Patients with depression or bipolar disorder, however, did not exhibit a significant or clinically important change on the SF-36v2 Mental Component Score (MCS). There were no differences in mJOA and Nurick scores at 24 months among patients in each group. Improvement in NDI, SF-36v2 PCS, and MCS, however, were smaller in patients with depression or bipolar disorder than those without.
Conclusion. Patients with depression or bipolar disorder have smaller functional and quality of life improvements after surgery compared to patients without psychiatric comorbidities.

DOI： 10.1097/BRS.0000000000001777

Prediction of outcome following surgical treatment of cervical myelopathy based on features of ossification of the posterior longitudinal ligament a systematic review Reviewed

Hiroaki Nakashima, Lindsay Tetreault, So Kato, Michael T. Kryshtalskyj, Narihito Nagoshi, Aria Nouri, Anoushka Singh, Michael G. Fehlings

JBJS Reviews Vol. 5 ( 2 ) 2017.2

Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Bone and Joint Surgery Inc.

Background: Ossification of the posterior longitudinal ligament (OPLL) is defined as ectopic bone formation within the posterior longitudinal ligament. Although various OPLL features (including the extent, shape, and thickness of the OPLL as well as the presence of dural ossification) have been defined in the literature, we are not aware of any systematic reviews that have summarized theassociationsbetween these featuresand clinical outcomes following surgery. The objective of the present study was to conduct a systematic review of the literature to determine whether OPLL characteristics are predictive of outcome in patients undergoing surgery for the treatment of cervical myelopathy. Methods: An extensive search was performed using 4 electronic databases: MEDLINE, MEDLINE In-Process, Embase, and the Cochrane Central Register of Controlled Trials. Our search terms were OPLL and cervical. We identified studies in English or Japanese that evaluated the association between cervical OPLL features and surgical outcome. The overall body of evidence was assessed with use of a scoring system developed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group with recommendations from the Agency for Healthcare Research and Quality (AHQR). The present systematic literature review is formatted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: The search yielded a total of 2,318 citations. A total of 28 prognostic cohort studies were deemed relevant following a rigorous review process. Among them, only 7 retrospective studies involved a multivariate analysis that controlled for potential confounding variables. Sample sizes ranged from 47 to 133 patients. The main outcome was the postoperative Japanese Orthopaedic Association (JOA) score and/or recovery rate in 6 studies and the Nurick grade in 1. Of these, 2 were rated as Level-II evidence and 5 were rated as Level-III evidence. On the basis of our results, there was low evidence that patients with a hill-shaped ossification have a worse postoperative JOA score following laminoplasty than those with a plateau-shaped lesion
low evidence that the space available for the spinal cord cannot predict postoperative JOA scores
moderate evidence that there is no association between the occupying ratio and improvement on the Nurick scale
and insufficient evidence to determine the association between JOA outcomes and the type of OPLL, the presence of dural ossification, and the occupying ratio. Conclusions: Patients with hill-shaped OPLL have a worse postoperative JOA score than those with plateau-shaped ossification after laminoplasty. Because of limited evidence, it is unclear whether the occupying ratio, the type of OPLL, and the presence of dural ossification are predictive of surgical outcomes following either anterior or posterior decompression. A limited number of studies have used a multivariate analysis to evaluate the association between clinical outcomes and OPLL features. Additional studies representing high-quality evidence are needed. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

DOI： 10.2106/JBJS.RVW.16.00023

Rapid Worsening of Symptoms and High Cell Proliferative Activity in Intra- and Extramedullary Spinal Hemangioblastoma Reviewed International journal Open Access

Shiro Imagama, Zenya Ito, Kei Ando, Kazuyoshi Kobayashi, Tetsuro Hida, Kenyu Ito, Yoshimoto Ishikawa, Mikito Tsushima, Akiyuki Matsumoto, Hiroaki Nakashima, Norimitsu Wakao, Yoshihito Sakai, Yukihiro Matsuyama, Naoki Ishiguro

Global Spine Journal Vol. 7 ( 1 ) page： 6 - 13 2017.2

Language：English Publishing type：Research paper (scientific journal) Publisher：Thieme Medical Publishers, Inc.

Study Design A retrospective analysis of a prospective database. Objective To compare preoperative symptoms, ambulatory ability, intraoperative spinal cord monitoring, and pathologic cell proliferation activity between intramedullary only and intramedullary plus extramedullary hemangioblastomas, with the goal of determining the optimal timing for surgery. Methods The subjects were 28 patients (intramedullary only in 23 cases [group I] and intramedullary plus extramedullary in 5 cases [group IE]) who underwent surgery for spinal hemangioblastoma. Preoperative symptoms, ambulatory ability on the McCormick scale, intraoperative spinal cord monitoring, and pathologic findings using Ki67 were compared between the groups. Results In group IE, preoperative motor paralysis was significantly higher (100 versus 26%, p &lt
0.005), the mean period from initial symptoms to motor paralysis was significantly shorter (3.5 versus 11.9 months, p &lt
0.05), and intraoperative spinal cord monitoring aggravation was higher (65 versus 6%, p &lt
0.05). All 5 patients without total resection in group I underwent reoperation. Ki67 activity was higher in group IE (15% versus 1%, p &lt
0.05). Preoperative ambulatory ability was significantly poorer in group IE (p &lt
0.05), but all cases in this group improved after surgery, and postoperative ambulatory ability did not differ significantly between the two groups. Conclusions Intramedullary plus extramedullary spinal hemangioblastoma is characterized by rapid preoperative progression of symptoms over a short period, severe spinal cord damage including preoperative motor paralysis, and poor gait ability compared with an intramedullary tumor only. Earlier surgery with intraoperative spinal cord monitoring is recommended for total resection and good surgical outcome especially for an IE tumor compared with an intramedullary tumor.

DOI： 10.1055/s-0036-1580612

Return to play in athletes with spinal cord concussion: a systematic literature review Reviewed International journal

Narihito Nagoshi, Lindsay Tetreault, Hiroaki Nakashima, Aria Nouri, Michael G. Fehlings

SPINE JOURNAL Vol. 17 ( 2 ) page： 291 - 302 2017.2

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE INC

STUDY DESIGN: This is a systematic review.
PURPOSE: The study aimed to evaluate whether spinal cord concussion (SCC) patients can safely return to play sports and if there are factors that can predict SCC recurrence or the development of a spinal cord injury (SCI).
BACKGROUND CONTEXT: Although SCC is a reversible neurologic disturbance of spinal cord function, its management and the implications for return to play are controversial. METHODS: We conducted a systematic search of the literature using the keywords Cervical Spine AND Sports AND Injuries in six databases. We examined return to play in patients (1) without stenosis, (2) with stenosis, and (3) who underwent single-level anterior cervical discectomy and fusion (ACDF). We also investigated predictors for the risk of SCC recurrence or SCI.
RESULTS: We identified 3,655 unique citations, 16 of which met our inclusion criteria. The included studies were case-control studies or case series and reports. Two studies reported on patients without stenosis: pediatric cases returned without recurrence, whereas an adult case experienced recurrent SCC after returning to play. Seven studies described patients with stenosis. These studies included cases with and without recurrence after return to play, as well as patients who suffered SCI with permanent neurologic deficits. Three studies reported on patients who underwent an ACDF. Although some patients played after surgery without problems, several patients experienced recurrent SCC due to herniation at levels adjacent to the surgical sites. With respect to important predictors, a greater frequency of patients who experienced recurrence of symptoms or SCI following return to play had a " long" duration of symptoms (>24 hours; 36.36%) compared with those who were problem-free (11.11%; p=. 0311).
CONCLUSIONS: There is limited evidence on current practice standards for return to play following SCC and important risk factors for SCC recurrence or SCI. Because of small sample sizes, future prospective multicenter studies are needed to determine important predictive factors of poor outcomes following return to play after SCC. (C) 2016 Published by Elsevier Inc.

DOI： 10.1016/j.spinee.2016.09.013

Dynamic changes in the cross-sectional area of the dural sac and spinal cord in the thoracic spine Reviewed

Daigo Morita, Yasutsugu Yukawa, Hiroaki Nakashima, Keigo Ito, Go Yoshida, Masaaki Machino, Syunsuke Kanbara, Toshiki Iwase, Fumihiko Kato

EUROPEAN SPINE JOURNAL Vol. 26 ( 1 ) page： 64 - 70 2017.1

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER

The thoracic spine is considered a rigid region because it is restricted by the rib cage. Previously, we reported functional alignments and range of motion (ROM) at all segmental levels. The purpose of this study was to investigate dynamic changes of the dural sac and spinal cord in the thoracic spine using a multidetector-row computed tomography (MDCT).
Fifty patients with cervical or lumbar spinal disease were prospectively enrolled. After preoperative myelography, MDCT was performed at maximum passive flexion and extension. The anteroposterior diameter and cross-sectional area of the dural sac and spinal cord in the axial plane were measured using Scion imaging software. We also evaluated the correlation between the change ratio of the cross-sectional area and segmental kyphotic angle and ROM.
In flexion, the anteroposterior diameter of the dural sac was larger than in extension. The cross-sectional area in the upper and middle regions was smaller, but was larger in the lower region. The anteroposterior diameter and cross-sectional area of the spinal cord in the upper and middle regions were smaller than in extension, but these values were nearly the same in both flexion and extension in the lower region. Change ratios of the cross-sectional area were correlated with segmental kyphotic angle rather than ROM.
The thoracic spine showed some dynamic changes of the dural sac and spinal cord in the axial plane within functional motion. Segmental kyphotic angle, rather than segmental ROM, was the more important factor affecting dimensions of the dural sac and spinal cord.

DOI： 10.1007/s00586-015-4173-x

Cage subsidence in lateral interbody fusion with transpsoas approach: intraoperative endplate injury or late-onset settling. Reviewed Open Access

Satake K, Kanemura T, Nakashima H, Yamaguchi H, Segi N, Ouchida J

Spine surgery and related research Vol. 1 ( 4 ) page： 203 - 210 2017

Language：English Publishing type：Research paper (scientific journal) Publisher：The Japanese Society for Spine Surgery and Related Research

<p>Introduction: Few studies have investigated the influence of cage subsidence patterns (intraoperative endplate injury or late-onset cage settling) on bony fusion and clinical outcomes in lateral interbody fusion (LIF). This retrospective study was performed to compare the fusion rate and clinical outcomes of cage subsidence patterns in LIF at one year after surgery.</p><p>Methods: Participants included 93 patients (aged 69.0±0.8 years; 184 segments) who underwent LIF with bilateral pedicle screw fixation. All segments were evaluated by computed tomography and classified into three groups: Segment E (intraoperative endplate injury, identified immediately postoperatively); Segment S (late-onset settling, identified at 3 months or later); or Segment N (no subsidence). We compared patient characteristics, surgical parameters and fusion status at 1 year for the three subsidence groups. Patients were classified into four groups: Group E (at least one Segment E), Group S (at least one Segment S), Group ES (both Segments E and S), or Group N (Segment N alone). Visual analog scales (VASs) and the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were compared for the four patient groups.</p><p>Results: 184 segments were classified: 31 as Segment E (16.8%), 21 as Segment S (11.4%), and 132 as Segment N (71.7%). Segment E demonstrated significantly lower bone mineral density (-1.7 SD of T-score, p=0.003). Segment S demonstrated a significantly higher rate of polyetheretherketone (PEEK) cages (100%, p=0.03) and a significantly lower fusion rate (23.8%, p=0.01). There were no significant differences in VAS or in any of the JOABPEQ domains among the four patient groups.</p><p>Conclusions: Intraoperative endplate injury was significantly related to bone quality, and late-onset settling was related to PEEK cages. Late-onset settling demonstrated a worse fusion rate. However, there were no significant differences in clinical outcomes among the subsidence patterns.</p>

DOI： 10.22603/ssrr.1.2017-0004

Understanding Retroperitoneal Anatomy for Lateral Approach Spine Surgery. Reviewed Open Access

Tokumi Kanemura, Kotaro Satake, Hiroaki Nakashima, Naoki Segi, Jun Ouchida, Hidetoshi Yamaguchi, Shiro Imagama

Spine surgery and related research Vol. 1 ( 3 ) page： 107 - 120 2017

Language：English Publishing type：Research paper (scientific journal) Publisher：The Japanese Society for Spine Surgery and Related Research

Lateral approach spine surgery provides effective interbody stabilization, and correction and indirect neural decompression with minimal-incision and less invasive surgery compared with conventional open anterior lumbar fusion. It may also avoid the trauma to paraspinal muscles or facet joints found with transforaminal lumbar interbody fusion and posterior lumbar interbody fusion. However, because lateral approach surgery is fundamentally retroperitoneal approach surgery, it carries potential risk to intra- and retroperitoneal structures, as seen in a conventional open anterior approach. There is an innovative lateral approach technique that reveals different anatomical views; however, it requires reconsideration of the traditional surgical anatomy in more detail than a traditional open anterior approach. The retroperitoneum is the compartmentalized space bounded anteriorly by the posterior parietal peritoneum and posteriorly by the transversalis fascia. The retroperitoneum is divided into three compartments by fascial planes: anterior and posterior pararenal spaces and the perirenal space. Lateral approach surgery requires mobilization of the peritoneum and its content and accurate exposure to the posterior pararenal space. The posterior pararenal space is confined anteriorly by the posterior renal fascia, anteromedially by the lateroconal fascia, and posteriorly by the transversalis fascia. The posterior renal fascia, the lateroconal fascia or the peritoneum should be detached from the transversalis fascia and the psoas fascia to allow exposure to the posterior pararenal space. The posterior pararenal space, however, does not allow a clear view and identification of these fasciae as this relationship is variable and the medial extent of the posterior pararenal space varies among patients. Correct anatomical recognition of the retroperitoneum is essential to success in lateral approach surgery. Spine surgeons must be aware that the retroperitoneal membrane and fascia is multilayered and more complex than is commonly understood. Preoperative abdominal images would facilitate more efficient surgical considerations of retroperitoneal membrane and fascia in lateral approach surgery.

DOI： 10.22603/ssrr.1.2017-0008

Pathobiology of Spinal Cord Injury

Nakashima, H; Nagoshi, N; Fehlings, MG

AOSPINE MASTERS SERIES, VOL 7: SPINAL CORD INJURY AND REGENERATION page： 1 - 10 2017

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