Publishing type：Research paper (scientific journal)  

<p>Introduction: The risk factors for the development of progressive segment degeneration (PSD) after decompression surgery are still unknown. In this study, the risk factors for PSD in patients who undergo decompression surgery for lumbar spinal stenosis with and without coexisting spondylolisthesis and scoliosis were examined, focusing on decompression and non-decompression segments.</p><p>Methods: We reviewed the data of patients with >5 years of postoperative follow up. Radiographic PSD was defined as either the development of an anterolisthesis or retrolisthesis of >3 mm or a decrease in disc height of >3 mm during the 5-year follow up. On the basis of intervertebral segments, the association between PSD and other preoperative clinical findings was analyzed.</p><p>Results: Overall, 840 lumbar segments (L1-L2 to L5-S1) in 168 patients, with a mean age of 69.5±9.2 years, met the inclusion criteria. PSD was observed in 162 (19.3%) lumbar segments. A logistic regression model identified that Cobb angle ≥10° (OR 2.53, 95% CI 1.50-4.24), spondylolisthesis ≥3 mm (OR 4.447, 95% CI 2.06-9.58), and level of segments were more likely to have PSD at the non-decompression level; additionally, lateral listhesis ≥3 mm (OR 2.91, 95% CI 1.08-7.81) was more likely to have PSD in the decompression segments. In clinical outcomes in patients with PSD at baseline and the 5-year follow-up, no significant difference was found.</p><p>Conclusions: Even though PSD does not correlate with worsening symptoms, our study confirms that a higher degree of pre-existing disc degeneration is indicative of a higher PSD in 5 years.</p>

DOI： 10.22603/ssrr.2024-0014

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.2106/JBJS.24.00245

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

STUDY DESIGN: Multicenter retrospective cohort study. OBJECTIVE: To evaluate the efficacy and safety of using cement-augmented pedicle screw (CAPS) fixation only for the cephalad and caudal vertebral bodies. SUMMARY OF BACKGROUND DATA: Pedicle screw fixation is less effective in patients with low-quality bone. Although CAPS fixation has shown promise in improving stability and reducing screw loosening in such cases, cement leakage can have serious consequences. METHODS: This study included 65 patients who underwent spinal surgery using CAPS and were followed up for >3 months. Four CAPSs were used in each patient, and 254 CAPSs were included in the analysis. RESULTS: Of the 65 patients, 36.9% showed intravenous cement leakage, and a low bone mineral density (BMD) was associated with a higher risk of cement leakage. The use of a CAPS on the right side was also potentially associated with a higher risk of leakage. However, the shape and location of the leaked cement remained stable over time. Screw loosening occurred in 3.5% of the CAPSs and was associated with a lower cement volume. CONCLUSION: Cement leakage was related to lower BMD. Using CAPS exclusively at the lower or upper instrumentation levels might minimize the risk of cement leakage in osteoporotic patients.

DOI： 10.1097/BSD.0000000000001757

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Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.spinee.2024.12.021

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DOI： 10.1016/j.bbrc.2024.150512

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DOI： 10.1016/j.spinee.2024.08.002

PubMed

Publishing type：Research paper (scientific journal)  

<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

PubMed

Publishing type：Research paper (scientific journal)  

<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

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.bbrc.2024.150787

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

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 (QoL) assessments with clinical outcomes. SUMMARY OF BACKGROUND DATA: Despite its proven usefulness in degenerative spinal diseases and deformities, the MCID remains unexplored regarding surgery for spinal metastases. 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 (VAS), 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-VAS, 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

PubMed

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: The study aimed to investigate the related factors affecting physical activity-related quality of life (QOL) after 2 years of cervical laminoplasty for degenerative cervical myelopathy (DCM), focusing on the degree of preoperative degeneration of the cervical multifidus muscles. SUMMARY OF BACKGROUND DATA: The association between paraspinal muscle degeneration and clinical outcomes after spinal surgery is being investigated. The effect of preoperative degeneration of the cervical multifidus muscles in patients undergoing cervical laminoplasty is ambiguous. METHODS: Patients who underwent laminoplasty for DCM and followed up for more than 2 years were reviewed. To evaluate physical QOL, the physical component summary (PCS) of the 36-Item Short-Form Health Survey (SF-36) was recorded at 2 years postoperatively. The degree of preoperative degeneration in the multifidus muscles at the C4 and C7 levels on axial T2-weighted magnetic resonance imaging (MRI) was categorized according to the Goutallier grading system. The correlation between 2-year postoperative PCS and each preoperative clinical outcome, radiographic parameter, and MRI finding, including Goutallier classification, was analyzed. Variables with a P value <0.10 in univariate analysis were included in multiple linear regression analysis. RESULTS: In total, 106 consecutive patients were included. The 2-year postoperative PCS demonstrated significant correlation with age (R=-0.358, P=0.002), preoperative JOA score (R=0.286, P=0.021), preoperative PCS (R=0.603, P<0.001), C2-C7 lordotic angle (R=-0.284, P=0.017), stenosis severity (R=-0.271, P=0.019), and Goutallier classification at the C7 level (R=-0.268, P=0.021). In multiple linear regression analysis, sex (β=-0.334, P=0.002), age (β=-0.299, P=0.013), preoperative PCS (β=0.356, P=0.009), and Goutallier classification at the C7 level (β=-0.280, P=0.018) were significantly related to 2-year postoperative PCS. CONCLUSIONS: Increased degeneration of the multifidus muscle at the C7 level negatively affected physical activity-related QOL postoperatively. These results may guide spine surgeons in predicting physical activity-related QOL in patients with DCM after laminoplasty. LEVEL OF EVIDENCE: Level III.

DOI： 10.1097/BSD.0000000000001585

PubMed

Publishing type：Research paper (scientific journal)  

<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

PubMed

Publishing type：Research paper (scientific journal)  

<p>Introduction: Few studies have assessed the minimum clinically important difference (MCID) of each Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) domain. This study assessed MCIDs of JOABPEQ in patients with lumbar spine disease by generation.</p><p>Methods: We evaluated the JOABPEQ score of 805 consecutive patients with lumbar spine disease undergoing posterior surgery preoperatively and 1 year postoperatively. MCIDs of each JOABPEQ domain were determined using anchor- and distribution-based methods according to age. A question based on the concept of a health transition item was used as the anchor for the MCID decision.</p><p>Results: Overall, MCIDs of the JOABPEQ were 28.6 and 27.3 points for pain-related disorder and gait disturbance, respectively. The MCID for the lumbar spine dysfunction domain did not reach 0.6 over the area under the curve. Regarding the differences among generations, MCIDs of pain-related disorder and gait disturbance domains differed slightly between the elderly and middle-aged. The psychological disorder domain did not reflect clinically meaningful changes in the elderly. MCIDs of the social life disturbance domain decreased with age.</p><p>Conclusions: Focusing on achieving the ideal responsiveness of patient-reported outcomes across generations, MCIDs of the pain-related disorder and gait disturbance domains may be valuable for patients, regardless of age, when adopting the JOABPEQ for patients with lumbar spine disease undergoing surgery. This study only evaluated cases that underwent posterior lumbar surgery. Future research will necessitate conducting surveys concerning the outcomes of various treatments for lumbar spine disease.</p>

DOI： 10.22603/ssrr.2023-0293

PubMed

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

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

PubMed

Publishing type：Research paper (scientific journal)  

<p>Osteoporotic vertebral fractures (OVF) are the most common osteoporotic fractures, affecting patients' quality of life and activity of daily life. Although orthotics is generally the treatment of choice for conservative treatment of OVF, the current evidence for orthotics is limited. Prospective studies without orthotics for the conservative treatment of OVF are difficult due to an ethical point of view because it is common sense that orthotics are the treatment of choice. In fact, there are very few reports that have verified the effectiveness of orthotics compared to no orthotics in the past. Therefore, we compared data from a cohort without orthotics and a cohort with orthotics using propensity score matching to demonstrate the effect of orthotics. In this review, we summarize the effects of orthotics in OVF based on reports of orthotics, including our previous study.</p>

DOI： 10.34371/jspineres.2024-0610

Publishing type：Research paper (scientific journal)  

骨粗鬆症性椎体骨折は,最も頻度の高い骨粗鬆症骨折であり,患者のQOLやADLに影響を与える.椎体骨折の保存加療では,一般的に装具療法を選択することが多いが,現状そのエビデンスは乏しい.新鮮骨粗鬆症性椎体骨折に対しては装具治療を行うというのが一般常識化していることから,倫理的観点から装具を装着しない前向き研究は行うことが難しい.実際に装具の有無で装具の効果を検証した研究は極めて少ない.そこで我々は過去に装具なしのコホートと装具ありのコホートのデータを傾向スコアマッチングで比較し,装具の効果を検証した研究を実施した.本総説では過去の我々の研究も含めた装具に関する報告をもとに,OVFにおける装具の効果を総括したい.(著者抄録)

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s43465-024-01115-5

PubMed

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DOI： 10.18888/se.0000002971

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DOI： 10.18888/se.0000002934

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

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

PubMed

Publishing type：Research paper (scientific journal)  

＜文献概要＞ムコ多糖症は先天的な酵素欠損により体内にムコ多糖が蓄積するライソゾーム病(LSDs)の一つであり,全身的かつ進行性の遺伝性代謝疾患である。I～IX型に分類されており,それぞれ原因となる欠損酵素が異なる。病態の解明と遺伝子工学の応用により人工合成した各種欠損酵素を投与する酵素補充療法(ERT)が開発された。ERTは呼吸器や皮膚などの軟部組織には効果的であるが,骨組織に対する効果はまだ不十分であるとされる。その理由は胎生期や出生直後の骨化核形成時期にGAGs蓄積による影響が既にあるためだと考えられる。ERTにより生命予後の延長が期待されるが,それに伴って整形外科で対処が必要である病態が増加していくのではないかと考えられる。

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＜文献概要＞年間発生420万件とも試算される骨粗鬆症性椎体骨折(OVF)の診療成績の改善や標準化は大きな社会課題である。診断に関しては臨床OVF,骨粗鬆症,OVFの予後予測について,治療に関しては保存治療,椎体形成術,手術治療について,それぞれ最新の話題をレビューした。コクランシステマティック・レビューを含めて様々なシステマティック・レビュー,メタ解析が報告され,各国の骨粗鬆症ガイドラインも更新されている。CTハンスフィールド値の有用性のエビデンスが積み上げられ,人工知能(AI)は今後の医療には不可欠な技術になるであろう。椎体形成術に最大の課題は適応の最適化である。手術治療の標準化ははるか先と思える。

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

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

PubMed

Publishing type：Research paper (scientific journal)  

高齢者の骨損傷を伴わない頸髄損傷(CSCI)に対する受傷48時間以内の手術施行が神経学的回復に及ぼす影響を検討した。2010～2020年に手術を受けた65歳以上のCSCI患者159例を対象に多施設共同後ろ向き研究を行い、受傷48時間以内の早期手術施行群24例(男性62.5%、平均73.5±6.12歳)と48時間以降の後期手術施行群135例(男性73.3%、平均74.1±6.02歳)に分類した。全例のうち97.5%に後方アプローチが採用されており、術式、手術時間、出血量のほか、硬膜断裂、手術部位感染症、C5麻痺、神経学的増悪、心筋梗塞、脳梗塞、せん妄、嚥下障害、呼吸不全、肺塞栓症などの合併症の発症に関して早期手術群と後期手術群との間に有意差はみられなかった。受傷後6ヵ月におけるAmerican Spinal Injury Association Motor Score(AMS)は後期手術群の方が早期手術群より有意に高値を示していたが、ベースライン時から6ヵ月後までのAMSの変化は早期手術群の方が有意に大きかった。線形重回帰分析では、ベースライン時のAMS、せん妄、肺炎、糖尿病が術後のAMSの変化に有意な負の影響を及ぼすことが判明し、早期手術施行とAMSの変化との間に有意な関連は認められなかった。

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DOI： 10.15106/j_seikei75_165

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

STUDY DESIGN: Level 3 retrospective cohort case-control study. PURPOSE: This study aimed to investigate the risk factors for distal junctional kyphosis (DJK) caused by osteoporotic vertebral fractures following spinal reconstruction surgery, with a focus on the sagittal stable vertebra. OVERVIEW OF LITERATURE: Despite the rarity of reports on DJK in this setting, DJK was reported to reduce when the lower instrumented vertebra (LIV) was extended to the sagittal stable vertebra in the posterior corrective fixation for Scheuermann's disease. METHODS: This study included 46 patients who underwent spinal reconstruction surgery for thoracolumbar osteoporotic vertebral fractures and kyphosis and were followed up for 1 year postoperatively. DJK was defined as an advanced kyphosis angle >10° between the LIV and one lower vertebra. The patients were divided into groups with and without DJK. The risk factors of the two groups, such as patient background, surgery-related factors, radiographic parameters, and clinical outcomes, were analyzed. RESULTS: The DJK and non-DJK groups included 14 and 32 patients, respectively, without significant differences in patient background. Those with instability in the distal adjacent LIV disc had a significantly higher risk of DJK occurrence (28.6% vs. 3.2%, p=0.027). DJK occurrence significantly increased in those with the sagittal stable vertebra not included in the fixation range (57.1% vs. 18.8%, p=0.020). Other preoperative radiographic parameters were not significantly different. Instability in the distal adjacent LIV disc (adjusted odds ratio, 14.50; p=0.029) and the exclusion of the sagittal stable vertebra from the fixation range (adjusted odds ratio, 5.29; p=0.020) were significant risk factors for DJK occurrence. CONCLUSIONS: Regarding spinal reconstruction surgery in patients with osteoporotic vertebral fractures, instability in the distal adjacent LIV disc and the exclusion of the sagittal stable vertebra from the fixation range were risk factors for DJK occurrence in the short term.

DOI： 10.31616/asj.2023.0174

PubMed

Publishing type：Research paper (scientific journal)  

<p><b>Introduction: </b>Adult spinal deformity (ASD) is prevalent among older adults, considerably affecting their quality of life. Although surgical interventions are effective, they have high complication rates and medical costs. Furthermore, there is a lack of evidence supporting the effectiveness of nonsurgical treatments (e.g., physical therapy) in patients with ASD. This study aimed to investigate the impact of "Koshimagari exercise," a specific home-based exercise regimen designed for patients with ASD, and to evaluate its effects on clinical outcomes in older adults.</p><p><b>Methods: </b>A total of 144 participants aged 50–80 years with chronic low back pain (LBP) due to spinal deformities were included in this multicenter prospective study. Qualified physiotherapists conducted intervention sessions at the hospital once a week, and self-exercise was performed at home three times a week. After 3 months, the frequency of self-exercise at home increased to four times a week. Clinical evaluations were conducted using the Oswestry Disability Index (ODI), five-level classification system of EuroQol-5 Dimensions (EQ-5D), Japanese edition of Scoliosis Research Society-22r (SRS-22r), and visual analog scale (VAS) for LBP at baseline and 3, 6, and 12 months. Radiographic evaluations were performed in standing and supine positions.</p><p><b>Results: </b>Of 130 participants who provided written informed consent, 98 completed the 6-month follow-up and were included in the analysis. Significant improvements observed in ODI, EQ-5D, and VAS scores were observed at 3 months, with SRS-22r scores improving throughout the study period. Radiographically, there were significant differences in the sagittal vertical axis and pelvic tilt at 12 months. Sufficient compliance with the self-exercise program was reported by 96%, 86%, and 73% of participants at 3, 6, and 12 months, respectively.</p><p><b>Conclusions: </b>The "Koshimagari Exercise" program led to significant short-term improvements in health-related quality of life and pain among elderly patients with ASD. This home-based self-exercise program is an excellent nonsurgical treatment option for patients with ASD.</p>

DOI： 10.22603/ssrr.2024-0273

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

STUDY DESIGN: Multi-center, prospective cohort study. OBJECTIVE: The current study aimed to identify the incidence of residual paresthesias after surgery for degenerative cervical myelopathy (DCM), and to demonstrate the impact of these symptoms on clinical outcomes and patient satisfaction. SUMMARY OF BACKGROUND DATA: Surgery for DCM aims to improve and/or prevent further deterioration of physical function and quality-of-life (QOL) in the setting of DCM. However, patients are often not satisfied with their treatment for myelopathy when they have severe residual paresthesias, even when physical function and QOL are improved after surgery. METHODS: We included 187 patients who underwent laminoplasty for DCM. All patients were divided into two groups based on their visual analog scale score for paresthesia of the upper extremities at 1 year postoperatively (>40 vs ≤40 mm). Preoperative factors, change in clinical scores and radiographic factors, and satisfaction scales at 1 year postoperatively were compared between groups. We used mixed-effect linear and logistic regression modeling to adjust for confounders. RESULTS: Overall, 86 of 187 patients had severe residual paresthesia at 1 year postoperatively. Preoperative patient-oriented pain scale scores were significantly associated with postoperative residual paresthesia(P=0.032). A mixed-effect model demonstrated that patients with severe postoperative residual paresthesia showed significantly smaller improvements in QOL (P=0.046) and myelopathy (P=0.037) than patients with no/mild residual paresthesia. Logistic regression analysis identified that residual paresthesia was significantly associated with the lower treatment satisfaction, independent of improvements in myelopathy and QOL (adjusted odds ratio: 2.5, P=0.010). CONCLUSION: In total, 45% of patients with DCM demonstrated severe residual paresthesia at 1 year postoperatively. These patients showed significantly worse treatment satisfaction, even after accounting for improvements in myelopathy and QOL. As such, in patients who experience higher preoperative pain, multidisciplinary approaches for residual paresthesia, including medications for neuropathic pain might lead to greater clinical satisfaction. LEVEL OF EVIDENCE: III.

DOI： 10.1097/BRS.0000000000004907

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.32118/j02606.2024044247

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Study Design. Prospective cohort study. Objective. To identify the effects of multidisciplinary approaches (MAs) to improve social functioning (SF) on 1-year surgical outcomes in patients with cervical myelopathy. Summary of Background Data. Despite significant improvement in cervical myelopathy, a patient's quality of life (QOL) sometimes does not improve postoperatively. A previous study revealed that SF, rather than myelopathy severity, correlated with QOL improvement after decompression surgery for cervical myelopathy. Patients and Methods. This study compared two prospective cohorts in Japan. Patients who underwent cervical laminoplasty for cervical myelopathy from 2018 to 2020 were enrolled in the control cohort. Patients who underwent the same surgery with the same indications between 2020 and 2021 were enrolled in the MA cohort. Patients in the control cohort were treated with a standard care protocol, and those in the MA cohort were treated with a multidisciplinary protocol that focused on SF improvement. The changes in the total Japanese Orthopedic Association (JOA) score and in the domains of the JOA scores (upper limb function, lower limb function, upper limb sensory, and lower limb sensory) from preoperatively to 1 year postoperatively were compared between the control and MA cohorts using a mixed-effect model. Results. The control and MA cohorts comprised 140 and 31 patients, respectively. The improvement in the JOA score was significantly better in the MA cohort than in the control cohort (P = 0.040). In analyses of each JOA score domain, the improvement of upper limb function was significantly better in the MA cohort than in the control cohort (P = 0.033). Similarly, the MA cohort demonstrated significantly higher patient-reported outcomes for upper extremity function than the control cohort (P < 0.001). In addition, the self-care domain of QOL score at 1 year postoperatively was significantly higher in the MA cohort than in the control cohort (P = 0.047). Conclusion. MAs to improve/rebuild a patient's SF were effective in improving cervical myelopathy and the self-care domain of QOL. This study is the first to demonstrate the effectiveness of postoperative MAs in patients with cervical myelopathy. Level of Evidence.

DOI： 10.1097/BRS.0000000000004764

PubMed

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)   International / domestic magazine：International 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

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.18888/se.0000002701

Publishing type：Research paper (scientific journal)  

＜文献概要＞椎体骨折において,適切な診断や治療介入の遅れは患者の著しい生活の質の低下を引き起こし,問題となる。よって診断の質の確保は喫緊の課題であり,その中で画像診断は重要な役割を担う。高齢者では陳旧性椎体骨折を有することが多く,新鮮骨粗鬆症性椎体骨折(OVF)の診断に加え,脊椎腫瘍や感染性脊椎炎などによる病的骨折との鑑別も必要となるため,画像診断に難渋することが多い。近年,人工知能(AI)を活用した椎体骨折画像診断システムの報告が増加しており,診断精度の向上にかかる期待は大きい。われわれが構築したMRIにおける新鮮・陳旧性OVFのAI識別システム1)の識別能は良好であり,脊椎外科医と同等であった。AIを活用した椎体骨折画像診断システム開発の今後のさらなる発展が望まれる。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Osteoporotic vertebral fractures (OVFs) can hinder physical motor function, daily activities, and the quality of life in elderly patients when treated conservatively. Vertebral augmentation, which includes vertebroplasty and balloon kyphoplasty, is a commonly used procedure for OVFs. However, there have been reports of complications. Although serious complications are rare, there have been instances of adjacent vertebral fractures, cement dislocation, and insufficient pain relief due to cement failure, sometimes necessitating revision surgery. This narrative review discusses the common risks associated with vertebral augmentation for OVFs, such as cement leakage and adjacent vertebral fractures, and highlights the risk of revision surgery. The pooled incidence of revision surgery was 0.04 (0.02-0.06). The risks for revision are reported as follows: female sex, advanced age, diabetes mellitus, cerebrovascular disease, dementia, blindness or low vision, hypertension, hyperlipidemia, split type fracture, large angular motion, and large endplate deficit. Various treatment strategies exist for OVFs, but they remain a subject of controversy. Current literature underscores the lack of substantial evidence to guide treatment strategies based on the risks of vertebral augmentation. In cases with a high risk of failure, other surgeries and conservative treatments should also be considered as treatment options.

DOI： 10.14245/ns.2346560.280

PubMed

Publishing type：Research paper (scientific journal)  

日本における選択的脊椎手術前の抗血栓薬の投与状況について検討した。日本脊椎脊髄病学会(JSSR)の会員を対象にウェブベースの質問票サーベイ調査を行い、手術経験、抗血栓薬の中止・継続の方針とその理由、周術期合併症の経験などを評価項目とした。脊椎外科医1181名から回答が得られ、回答率は32.0%、JSSR認定外科医が75.1%であった。経験年数は11～20年の外科医が最も多く、経験手術件数は100例未満が9.2%、100～500例が21.3%、500～1000例が26.8%、1000例超が42.6%、年間手術件数は100例未満が46.5%、100～200例が35.0%、200～500例が13.2%、500例超が5.3%となっていた。術前における抗血栓薬投与の中止・継続に関して、中止の方針を示す外科医(A群)、継続の方針を示す外科医(B群)、患者ごとに方針を決定する外科医(C群)、無回答の外科医(N群)に分類され、PCI施行の際、A群が72.8%、B群が4.5%、C群が22.3%、N群が0.4%、CABG施行ではA群が73.1%、B群が4.4%、C群が21.8%、N群が0.7%、発作性心房細動患者に対してはA群が81.0%、B群が2.5%、C群が16.1%、N群が0.3%であった。抗血小板薬を常に静注ヘパリンに切り替えていたのは5.5%、抗凝固薬を常に静注ヘパリンに切り替えていたのは10.1%であった。このほか、周術期合併症に関して、抗血小板薬の中止後に虚血性心疾患(3.7%)、脳梗塞(20.4%)、抗凝固薬の中止後に脳塞栓(13.6%)、肺塞栓(5.4%)の経験を有しており、投与継続時には術中出血量増加、赤血球輸血、術後脊髄硬膜外血腫の発症がみられた。

Publishing type：Research paper (scientific journal)  

脊椎アライメントの異常は腰背部痛や歩行障害,QOL低下などの要因となりうる.脊椎アライメント不良の関連因子として年齢や骨粗鬆症性椎体骨折(osteoporotic vertebral fracture:OVF),体幹筋低下などが報告されている.OVFは脊椎および骨盤のパラメーターを変化させるが,筋力により代償機構がはたらくと脊椎のバランスを保持できる.しかし体幹筋量が減少すると脊椎アライメントや腰痛,QOLに影響を及ぼすことが示されている.さらに,縦断研究では,ロコモ度2が脊椎アライメント悪化の予測因子であり,運動介入が予防に有効である可能性も示唆された.これらの知見は,高齢者の健康寿命維持に重要な情報となりうる.(著者抄録)

Publishing type：Research paper (scientific 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

PubMed

Publishing type：Research paper (scientific journal)  

COVID-19アウトブレイク前後における高齢者のロコモティブシンドローム(LS)の有病率の変化とリスク因子を検討した。COVID-19パンデミック前後に5項目Geriatric Locomotive Function Scale(GLFS-5)質問票に回答が得られた65歳以上の高齢者12197名を対象に横断サーベイ研究を行った。GLFS-5に基づいて2～3点をLSステージ1、4～5点をステージ2、6点以上をステージ3と判定し、パンデミック期間中のライフスタイルの変化を評価した。LSの有病率はパンデミック前が41.3%、パンデミック後が47.1%と増加しており、パンデミック後の新規LS発症は765名(6.3%)、LS-3発症は296名であった。LS発症群と非LS群の比較では、LS群には女性および75歳超が多く、運動習慣の減少が生じていた。多重ロジスティック回帰分析では、パンデミック後のLS発症のリスク因子として高齢、女性、運動レベル低下が抽出された。また、LS-3発症群ではLS-1/2群と比較して年齢が高く、運動習慣が著明に減少しており、多重ロジスティック回帰分析では高齢と運動習慣の減少がLS-3発症と有意に関連していた。このほか、腰痛、関節痛、しびれの有病率はLSの新規発症群、LS-3発症群において有意に高値を示していた。今回の解析結果から、日本人全体ではCOVID-19パンデミック後に約200万人の高齢者がLSを新規に発症し、軽度～中等度のLS患者のうち10%ほどが重症に移行したと推測された。

Publishing type：Research paper (scientific journal)  

BACKGROUND CONTEXT: Implementing machine learning techniques, such as decision trees, known as prediction models that use logical construction diagrams, are rarely used to predict clinical outcomes. PURPOSE: To develop a clinical prediction rule to predict clinical outcomes in patients who undergo minimally invasive lumbar decompression surgery for lumbar spinal stenosis with and without coexisting spondylolisthesis and scoliosis using a decision tree model. STUDY DESIGN/SETTING: A retrospective analysis of prospectively collected data. PATIENT SAMPLE: This study included 331 patients who underwent minimally invasive surgery for lumbar spinal stenosis and were followed up for ≥2 years at 1 institution. OUTCOME MEASURES: Self-report measures: The Japanese Orthopedic Association (JOA) scores and low back pain (LBP)/leg pain/leg numbness visual analog scale (VAS) scores. Physiologic measures: Standing sagittal spinopelvic alignment, computed tomography, and magnetic resonance imaging results. METHODS: Low achievement in clinical outcomes were defined as the postoperative JOA score at the 2-year follow-up <25 points. Univariate and multiple logistic regression analysis and chi-square automatic interaction detection (CHAID) were used for analysis. RESULTS: The CHAID model for JOA score <25 points showed spontaneous numbness/pain as the first decision node. For the presence of spontaneous numbness/pain, sagittal vertical axis ≥70 mm was selected as the second decision node. Then lateral wedging, ≥6° and pelvic incidence minus lumbar lordosis (PI-LL) ≥30° followed as the third decision node. For the absence of spontaneous numbness/pain, sex and lateral olisthesis, ≥3mm and American Society of Anesthesiologists physical status classification system score were selected as the second and third decision nodes. The sensitivity, specificity, and the positive predictive value of this CHAID model was 65.1, 69.8, and 64.7% respectively. CONCLUSIONS: The CHAID model incorporating basic information and functional and radiologic factors is useful for predicting surgical outcomes.

DOI： 10.1016/j.spinee.2023.01.023

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND CONTEXT: Implementing machine learning techniques, such as decision trees, known as prediction models that use logical construction diagrams, are rarely used to predict clinical outcomes. PURPOSE: To develop a clinical prediction rule to predict clinical outcomes in patients who undergo minimally invasive lumbar decompression surgery for lumbar spinal stenosis with and without coexisting spondylolisthesis and scoliosis using a decision tree model. STUDY DESIGN/SETTING: A retrospective analysis of prospectively collected data. PATIENT SAMPLE: This study included 331 patients who underwent minimally invasive surgery for lumbar spinal stenosis and were followed up for ≥2 years at 1 institution. OUTCOME MEASURES: Self-report measures: The Japanese Orthopedic Association (JOA) scores and low back pain (LBP)/leg pain/leg numbness visual analog scale (VAS) scores. Physiologic measures: Standing sagittal spinopelvic alignment, computed tomography, and magnetic resonance imaging results. METHODS: Low achievement in clinical outcomes were defined as the postoperative JOA score at the 2-year follow-up <25 points. Univariate and multiple logistic regression analysis and chi-square automatic interaction detection (CHAID) were used for analysis. RESULTS: The CHAID model for JOA score <25 points showed spontaneous numbness/pain as the first decision node. For the presence of spontaneous numbness/pain, sagittal vertical axis ≥70 mm was selected as the second decision node. Then lateral wedging, ≥6° and pelvic incidence minus lumbar lordosis (PI-LL) ≥30° followed as the third decision node. For the absence of spontaneous numbness/pain, sex and lateral olisthesis, ≥3mm and American Society of Anesthesiologists physical status classification system score were selected as the second and third decision nodes. The sensitivity, specificity, and the positive predictive value of this CHAID model was 65.1, 69.8, and 64.7% respectively. CONCLUSIONS: The CHAID model incorporating basic information and functional and radiologic factors is useful for predicting surgical outcomes.

DOI： 10.1016/j.spinee.2023.01.023

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.spinee.2023.01.023

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

In cases of suspected spinal tumors on imaging studies, a biopsy is often necessary for establishing the diagnosis. Predictive factors for tumors or malignancies may help in scheduling biopsies or avoiding unnecessary ones. However, there have been few studies on determining these factors. We aimed to determine the factors associated with the final diagnosis in cases requiring spinal biopsy. This study included 117 patients who underwent image-guided (fluoroscopy- or computed tomography [CT]-guided) needle biopsy of the spine. Data on patient demographic, pathological diagnoses, and final diagnoses were retrospectively collected from the medical records. The imaging features and location of lesions were also evaluated on CT and magnetic resonance imaging. Furthermore, factors related to tumors or malignancies were analyzed. The diagnostic accuracy of biopsy was 94.0%, and there was no difference in the diagnostic accuracy between the fluoroscopic and CT-guided biopsies. Sixty-six and fifty-six patients were diagnosed with spinal tumors and malignant tumors, respectively. Multivariate analysis revealed that a history of malignant tumors and the presence of pedicle lesions and/or extravertebral lesions were related factors for both tumors or malignancy in the final diagnosis. These findings can help determine the necessity for or timing of biopsy in patients with suspected spinal tumors.

DOI： 10.3390/jcm12134292

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Sarcopenia is defined as decreasing in muscle strength and mass, and dynapenia is defined as decreasing in muscle strength and maintained muscle mass. This study elucidated the prevalence and characteristics of sarcopenia and dynapenia and evaluate in elderly spinal disorders patients. 1039 spinal disorders patients aged ≥ 65 years were included. We measured age, grip strength, muscle mass, spinal sagittal alignment parameters, low back pain (LBP) scores and health-related quality of life (HR-QoL) scores. Based on the previous reports, patients were categorised into normal group: NG, pre-sarcopenia group: PG, dynapenia group: DG, and sarcopenia group: SG. Pre-sarcopenia, dynapenia, and sarcopenia were found in 101 (9.7%), 249 (19.2%), and 91 (8.8%) patients, respectively. The spinal sagittal alignment parameters, trunk muscle mass, LBP, and HR-QoL scores were significantly worse in DG and SG compared with those in PG and NG. Spinal alignment, trunk muscle mass, and clinical outcomes, including LBP and HR-QoL scores, were maintained in the PG and poor in the DG and SG. Thus, intervention for muscle strength may be a treatment option for changes of spinal sagittal alignment and low back pain.

DOI： 10.1038/s41598-023-37125-w

PubMed

Publishing type：Research paper (scientific journal)  

<p><b>Introduction: </b>Poor prognostic factors (PPF) on magnetic resonance imaging (MRI) (confined high intensity area or diffuse low intensity area in fractured vertebrae on T2-weighted MR images) predict delayed union after osteoporotic vertebral fractures (OVF). However, although we have treated OVF without PPF on MRI conservatively, there have been a few cases with residual low back pain. Therefore, the objectives of this study were to identify the risk factors of residual low back pain despite the absence of PPF on MRI, and to investigate clinical and radiographical characteristics during follow-up in such patients.</p><p><b>Methods: </b>This retrospective cohort study included 55 patients (mean age 75.1 years, 47 females) who were followed up for over 6 months after conservative treatment for OVF. The cases with PPF on MRI or with cauda equina or nerve root compressed on MRI were excluded. The participants were divided into two groups: the residual low back pain group (VAS in low back pain ≥40 at 6 months; 16 patients) and the control group (39 patients). Evaluation items included radiographic parameters on dynamic films (sitting/supine lateral views) and whole spine X-ray, VAS in low back pain/buttock pain at the initial examination and 6 months after injury.</p><p><b>Results: </b>Firstly, to identify the risk factors, univariate analysis showed significant differences in VAS in buttock pain at initial examination (p = 0.002), motion angle of fractured vertebrae (p = 0.047), TK (p = 0.046), and LL (p = 0.031). Multivariate analysis showed that VAS in buttock pain at first examination was an independent risk factor for residual low back pain 6 months after injury (adjusted odds ratio = 1.526, p = 0.019). Secondly, the patients in the residual low back pain group were significantly larger SVA at 6 months and more change in the height of anterior wall of fractured vertebrae in dynamic films at 6 months than those in the control group (p = 0.029 and p = 0.011, respectively). Moreover, the cases with confined high intensity area on T2-weighted images at 6 months were significantly more in the residual low back pain group than in the control group (p = 0.006). </p><p><b>Conclusions: </b>The risk factor for residual low back pain after conservative treatment for OVF without PPF on MRI was buttock pain at the initial examination. The causes of residual low back pain were a larger SVA and delayed union of the fractured vertebrae. Patients with buttock pain at the initial examination should be carefully followed up, and surgical intervention such as vertebroplasty might be considered as necessary.</p>

DOI： 10.34371/jspineres.2022-0050

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Palliative surgery is performed to improve the quality of life of patients with spinal metastases. However, it is sometimes difficult to achieve the expected results because the patient’s condition, and risk factors related to poor outcomes have not been well elucidated. This study aimed to evaluate the functional outcomes and investigate the risk factors for poor outcomes after palliative surgery for spinal metastasis. We retrospectively reviewed the records of 117 consecutive patients who underwent palliative surgery for spinal metastases. Neurological and ambulatory statuses were evaluated pre- and post-operatively. Poor outcomes were defined as no improvement or deterioration in functional status or early mortality, and the related risk factors were analyzed using multivariate logistic regression analysis. The results showed neurological improvement in 48% and ambulatory improvement in 70% of the patients with preoperative impairment, whereas 18% of the patients showed poor outcomes. In the multivariate analysis, low hemoglobin levels and low revised Tokuhashi scores were identified as risk factors for poor outcomes. The present results suggest that anemia and low revised Tokuhashi scores are related not only to life expectancy but also to functional recovery after surgery. Treatment options should be carefully selected for the patients with these factors.

DOI： 10.3390/jcm12103442

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.11359/chubu.2023.507

Publishing type：Research paper (scientific journal)  

DOI： 10.1038/s41588-023-01375-1

Publishing type：Research paper (scientific journal)  

はじめに:新鮮OVFのうちMRI予後不良因子(T2強調像で高信号限局型,低信号広範囲型)がないにも関わらず腰痛が遺残した症例について検討した.対象と方法:後ろ向きコホート研究.対象はOVFに対し保存加療を選択し,6ヶ月以上経過観察できた55例(平均年齢75.1歳,女性47例).MRIの予後不良因子を有する症例,馬尾・神経根の圧排を認める症例は除外した.6ヶ月時の腰痛VAS≧40の症例を腰痛遺残群(16例),その他を対照群(39例)に群分けした.評価項目は,初診時のX線動態撮影(座位・仰臥位側面)や全脊柱X線各種パラメーター,腰痛/臀部痛VAS,ODIを用いた.結果:単変量解析にて,初診時の臀部痛VAS(p=0.002),椎体可動角(p=0.047),TK(p=0.046),LL(p=0.031)に有意差があった.以上の有意な項目に年齢,性別,初診時腰痛VASを加えた多変量解析の結果,初診時の臀部痛VASが独立した腰痛遺残の危険因子であった(調整Odds比=1.526,p=0.019).結語:OVF受傷後6ヶ月時の腰痛遺残の危険因子は,初診時の臀部痛であった.(著者抄録)

Publishing type：Research paper (scientific journal)  

高齢のロコモティブシンドローム(LS)患者の検出に用いられる人工知能(AI)ベースの決定システムを開発し、その有用性について検討した。高齢者409名(男性164名、女性245名、平均73.5±5.4歳)を対象に、横断研究を実施して足部スキャン圧システムとして歩行中の足底圧分布を測定し、さらに画像処理システムには畳み込みニューラルネットワーク(CNN)を用いて足底圧をベースにLSの発症可能性を推定した。AIモデルのロジスティック回帰段階では、年齢、性別、身長、体重およびCNNの出力にもとづいて発症予測方程式を作成した。開発コホートの対象者は300名で、このうち104名(34.7%)がLSと診断された。三分割交差検証データセットの平均確度はトレーニングセットが0.71、検証セットが0.68を示しており、CNN出力はLS発症群の方が健常者群より有意に高かった。開発コホートにおける平均AUCは0.84、臨床モデルの平均AUCは0.80であった。足底圧分布をベースとしたAIモデルはLSのスクリーニングに有用なツールであることが示された。

Publishing type：Research paper (scientific journal)  

症例は54歳女性で、人間ドックにて全身に多発する骨硬化性病変を指摘され、精査目的に当院紹介となった。経過中に腰痛が出現し、MRIで第9胸椎に病的骨折を認めた。血液検査や骨生検では異常所見は認めず、入院後に硬性コルセット装着にて安静加療を行ったが、徐々に骨折部の圧壊の進行を認めたため、第21病日に第7～12胸椎の後方除圧固定術を施行した。術中迅速病理検査では急性骨髄炎の診断であったが、術後の病理組織検査では悪性リンパ腫を否定できず、その後の精査結果よりSAPHO症候群の診断に至った。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Study design. Cross-sectional study. Objective. Validate the diagnostic accuracy of a deep-learning algorithm for cervical cord compression due to degenerative canal stenosis on radiography. Summary of Background Data. The diagnosis of degenerative cervical myelopathy is often delayed, resulting in improper management. Screening tools for suspected degenerative cervical myelopathy would help identify patients who require detailed physical evaluation. Materials and Methods. Data from 240 patients (120 with cervical stenosis on magnetic resonance imaging and 120 age and sex-matched controls) were randomly divided into training (n = 198) and test (n = 42) data sets. The deep-learning algorithm, designed to identify the suspected stenosis level on radiography, was constructed using a convolutional neural network model called EfficientNetB2, and radiography and magnetic resonance imaging data from the training data set. The accuracy and area under the curve of the receiver operating characteristic curve were calculated for the independent test data set. Finally, the number of correct diagnoses was compared between the algorithm and 10 physicians using the test cohort. Results. The diagnostic accuracy and area under the curve of the deep-learning algorithm were 0.81 and 0.81, respectively, in the independent test data set. The rate of correct responses in the test data set was significantly higher for the algorithm than for the physician's consensus (81.0% vs. 66.2%; P = 0.034). Furthermore, the accuracy of the algorithm was greater than that of each individual physician. Conclusions. We developed a deep-learning algorithm capable of suggesting the presence of cervical spinal cord compression on cervical radiography and highlighting the suspected levels on radiographic imaging when cord compression is identified. The diagnostic accuracy of the algorithm was greater than that of spine physicians. Level of Evidence. Level IV.

DOI： 10.1097/BRS.0000000000004595

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

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

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

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

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

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

PubMed

Publishing type：Research paper (scientific journal)  

Purpose: To clarify the relationship between body mass index (BMI) and spinal pathologies including spinal sagittal balance, back extensor strength (BES), paraspinal muscle mass, prevalent vertebral fracture, disc degeneration, Modic changes, low back pain, and quality of life (QOL) in community-dwelling older adults. Methods: This study included 380 participants (age: ≥ 65 years, male/female: 152/228) from the Shiraniwa Study. Multivariate nonlinear regression analysis was used to investigate the relationship between BMI and sagittal vertical axis (SVA), BES, paraspinal muscle mass, visual analog scale (VAS) for low back pain, Oswestry Disability Index (ODI), and EuroQoL-5 Dimension (EQ5D) score after adjusting for sex, age, Hospital Anxiety and Depression Scale score, and Charlson Comorbidity Index. In addition, multiple logistic regression analysis was used to investigate the association between BMI and prevalent vertebral fracture, disc degeneration, and Modic changes. Results: BMI was significantly correlated with SVA, BES, paraspinal muscle mass, VAS, ODI, and EQ5D score. The increase in BMI was associated with the deterioration of all outcomes, which accelerated when the BMI increased from approximately 22–23 kg/m2. Moreover, overweight/obesity was significantly correlated with disc degeneration and Modic changes. Conclusion: Increased BMI is significantly associated with spinal pathologies such as SVA, BES, paraspinal muscle mass, VAS, QOL, disc degeneration, and Modic changes. The findings suggest that measures for controlling overweight and obesity among older adults can play an important role in the prevention and treatment of spinal pathologies.

DOI： 10.1007/s00586-022-07495-2

PubMed

Publishing type：Research paper (scientific journal)  

Ligamentum flavum (LF) hypertrophy is a major cause of lumbar spinal canal stenosis. Although mechanical stress is thought to be a major factor involved in LF hypertrophy, the exact mechanism by which it causes hypertrophy has not yet been fully elucidated. Here, changes in gene expression due to long-term mechanical stress were analyzed using RNA-seq in a rabbit LF hypertrophy model. In combination with previously reported analysis results, periostin was identified as a molecule whose expression fluctuates due to mechanical stress. The expression and function of periostin were further investigated using human LF tissues and primary LF cell cultures. Periostin was abundantly expressed in human hypertrophied LF tissues, and periostin gene expression was significantly correlated with LF thickness. In vitro, mechanical stress increased gene expressions of periostin, transforming growth factor-β1, α-smooth muscle actin, collagen type 1 alpha 1, and interleukin-6 (IL-6) in LF cells. Periostin blockade suppressed the mechanical stress-induced gene expression of IL-6 while periostin treatment increased IL-6 gene expression. Our results suggest that periostin is upregulated by mechanical stress and promotes inflammation by upregulating IL-6 expression, which leads to LF degeneration and hypertrophy. Periostin may be a pivotal molecule for LF hypertrophy and a promising therapeutic target for lumbar spinal stenosis.

DOI： 10.1096/fj.202200917RR

PubMed

Publishing type：Research paper (scientific journal)  

Purpose: Clinical outcomes after decompression procedures are reportedly worse for lumbar spinal stenosis (LSS) with diffuse idiopathic skeletal hyperostosis (DISH), especially DISH extended to the lumbar segment (L-DISH). However, no studies have compared the effect of less-invasive surgery versus conventional decompression techniques for LSS with DISH. The purpose of this study was to compare the long-term risk of reoperation after decompression surgery focusing on LSS with L-DISH. Methods: This study compared open procedure cohort (open conventional fenestration) and less-invasive procedure cohort (bilateral decompression via a unilateral approach) with ≥ 5 years of follow-up. After stratified analysis by L-DISH, patients with L-DISH were propensity score-matched by age and sex. Results: There were 57 patients with L-DISH among 489 patients in the open procedure cohort and 41 patients with L-DISH among 297 patients in the less-invasive procedure cohort. The reoperation rates in L-DISH were higher in the open than less-invasive procedure cohort for overall reoperations (25% and 7%, p = 0.026) and reoperations at index levels (18% and 5%, p = 0.059). Propensity score-matched analysis in L-DISH demonstrated that open procedures were significantly associated with increased overall reoperations (hazard ratio [HR], 6.18; 95% confidence interval [CI], 1.37–27.93) and reoperations at index levels (HR, 4.80; 95% CI, 1.04–22.23); there was no difference in reoperation at other lumbar levels. Conclusions: Less-invasive procedures had a lower risk of reoperation, especially at index levels for LSS with L-DISH. Preserving midline-lumbar posterior elements could be desirable as a decompression procedure for LSS with L-DISH.

DOI： 10.1007/s00586-022-07496-1

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

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

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

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

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.15106/j_seikei74_32

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

<p><b>Introduction: </b>The number of patients on antithrombotic drugs for coronary heart disease or cerebrovascular disease has been increasing with the aging of society. We occasionally need to decide whether to continue or discontinue antithrombotic drugs before spine surgery. The purpose of this study is to understand the current perioperative management of antithrombotic drugs before elective spine surgery in Japan.</p><p><b>Methods: </b>In 2021, members of the Japanese Society for Spine Surgery and Related Research (JSSR) were asked to complete a web-based questionnaire survey that included items concerning the respondents' surgical experience, their policy regarding discontinuation or continuation of antithrombotic drugs, their reasons for decisions concerning the management of antithrombotic drugs, and their experience of perioperative complications related to the continuation or discontinuation of these drugs.</p><p><b>Results: </b>A total of 1,181 spine surgeons returned completed questionnaires, giving a response rate of 32.0%. JSSR board-certified spine surgeons comprised 75.1% of the respondents. Depending on the management policy regarding antithrombotic drugs for each comorbidity, approximately 73% of respondents discontinued these drugs before elective spine surgery, and about 80% also discontinued anticoagulants. Only 4%–5% of respondents reported continuing antiplatelet drugs, and 2.5% reported continuing anticoagulants. Among the respondents who discontinued antiplatelet drugs, 20.4% reported having encountered cerebral infarction and 3.7% reported encountering myocardial infarction; among those who discontinued anticoagulants, 13.6% reported encountering cerebral embolism and 5.4% reported encountering pulmonary embolism. However, among the respondents who continued antiplatelet drugs and those who continued anticoagulants, 26.3% and 27.2%, respectively, encountered an unexpected increase in intraoperative bleeding, and 10.3% and 8.7%, respectively, encountered postoperative spinal epidural hematoma requiring emergency surgery.</p><p><b>Conclusions:</b></p><p>Our findings indicate that, in principle, >70% of JSSR members discontinue antithrombotic drugs before elective spine surgery. However, those with a discontinuation policy have encountered thrombotic complications, while those with a continuation policy have encountered hemorrhagic complications.</p>

DOI： 10.22603/ssrr.2023-0015

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International 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

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

<p><b>Objectives: </b>Patients with severe coronavirus disease 2019 (COVID-19) who develop pneumonia face the risk of ventilatory muscle disuse in the acute phase, which can result in persistent respiratory impairments in the subacute phase. Although rehabilitation during the acute phase is considered effective, there are limited reports on this topic. Therefore, this study aimed to investigate the effectiveness of acute-phase rehabilitation in patients with severe COVID-19.</p><p><b>Methods: </b>The study included 57 patients (45 men and 12 women; mean age: 63.2±12.1 years) admitted between April and June 2021, all of whom required intubation for respiratory management. Among them, 34 patients underwent acute-phase rehabilitation interventions based on the early goal-directed mobilization protocol. The primary objectives were to assess the occurrence of medical accidents related to acute-phase rehabilitation and evaluate their impact on survival and mobility upon hospital discharge. Statistical techniques and machine learning algorithms were employed for data analysis.</p><p><b>Results: </b>Remarkably, no medical accidents occurred during the acute-phase rehabilitation among the patients. Furthermore, our findings indicated that acute-phase rehabilitation did not influence survival outcomes. However, it did have a positive impact on the mobility of patients upon hospital discharge.</p><p><b>Conclusions: </b>Acute-phase rehabilitation can be safely administered to patients with severe COVID-19 by following an early goal-directed mobilization protocol. This approach may also contribute to improved activities of daily living after discharge.</p>

DOI： 10.2490/prm.20230027

PubMed

Publishing type：Research paper (scientific journal)  

2021年4月～6月に単一施設に搬送され、呼吸管理のために挿管を行った重症COVID-19患者57例(男性45例、女性12例、平均63.2±12.1歳)を対象に、急性期リハビリテーション(リハ)の有効性を従来の統計法、機械学習、特徴量重要度を用いて評価した。34例に対して急性期リハを行った。入院からリハ開始までの期間は平均6.2±7.1日であった。急性期リハ中に医療事故の発生は認めなかった。急性期リハ施行患者と非施行患者で生存率には有意差を認めなかったが、退院時の集中治療室活動度スケールスコアはリハ施行患者で有意に高かった。重症COVID-19患者に対し、急性期リハは安全に行え、退院後の日常生活動作の改善に寄与することが示された。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

A retrospective multicenter study. Body mass index (BMI) is recognized as an important determinant of osteoporosis and spinal postoperative outcomes; however, the specific impact of BMI on surgery for osteoporotic vertebral fractures (OVFs) remains inconclusive. This retrospective multicenter study investigated the impact of BMI on clinical outcomes following fusion surgery for OVFs. 237 OVF patients (mean age, 74.3 years; 48 men and 189 women) with neurological symptoms who underwent spinal fusion were included in this study. Patients were grouped by World Health Organization BMI categories: low BMI (<18.5 kg/m2), normal BMI (≥18.5 and <25 kg/m2), and high BMI (≥25 kg/m2). Patients' backgrounds, surgical method, radiological findings, pain measurements, activities of daily living (ADL), and postoperative complications were compared after a mean follow-up period of 4 years. As results, the proportion of patients able to walk independently was significantly smaller in the low BMI group (75.0%) compared with the normal BMI group (89.9%; P = .01) and the high BMI group (94.3%; P = .04). Improvement in the visual analogue scale for leg pain was significantly less in the low BMI group than the high BMI group (26.7 vs 42.8 mm; P = .046). Radiological evaluation, the Frankel classification, and postoperative complications were not significantly different among all 3 groups. Improvement of pain intensity and ADL in the high BMI group was equivalent or non-significantly better for some outcome measures compared with the normal BMI group. Leg pain and independent walking ability after fusion surgery for patients with OVFs improved less in the low versus the high BMI group. Surgeons may want to carefully evaluate at risk low BMI patients before fusion surgery for OVF because poor clinical results may occur.

DOI： 10.1097/MD.0000000000032330

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1038/s41467-022-32276-2

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Congenital scoliosis (CS) is a lateral curvature of the spine characterized by the presence of vertebral anomalies. Pathogenic genetic variants in the TBX6 gene are one of the causes of CS. However, since many clinically diagnosed cases of CS are without known TBX6 gene variations, this study aims to uncover new genes related to disease susceptibility of CS by exome sequencing (ES). This study employed ES in a cohort of 5 Japanese patients with CS and their healthy parents or a sister for a total of 16 samples among 5 families. Variant interpretation was performed using SIFT, PolyPhen-2, Mutation Taster, and CADD. Four de novo variants were identified by ES and confirmed by Sanger sequencing: 1 frameshift variant ( SHISA3 ) and 3 missense variants ( AGBL5 , HDAC4 , and PDE2A ). ES also uncovered 1 homozygous variant in the MOCOS gene. All of these variants were predicted to be deleterious by SIFT, PolyPhen-2, Mutation Taster, and/or CADD. The number of de novo variants identified in this study was exactly what would be expected by chance. Additional functional studies or gathering matched patients using Gene Matcher are needed.

DOI： 10.1055/s-0041-1726282

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Old age and spinal surgery significantly increase the risk of postoperative hyponatremia. However, detailed analyses of postoperative hyponatremia after spinal surgery in elderly patients are lacking. Therefore, we retrospectively reviewed the records of 582 consecutive patients aged > 60 years who underwent spinal surgery to evaluate the frequency, risk factors, and symptoms of postoperative hyponatremia after spinal surgery in the elderly population. Postoperative hyponatremia was defined as a postoperative blood sodium level < 135 meq/L at postoperative day (POD)1, POD3, and/or after POD6. A total of 92 (15.8%) patients showed postoperative hyponatremia. On a multivariate analysis, a diagnosis of a spinal tumor/infection, decompression and fusion surgery, and lower preoperative sodium levels were significant independent factors of postoperative hyponatremia (p = 0.014, 0.009, and < 0.001, respectively). In total, 47/92 (51%) cases could have been symptomatic; vomiting was noted in 34 cases (37%), nausea in 19 cases (21%), headache in 14 cases (15%), and disturbances in consciousness, including delirium, in ten cases (21%); all incidences of these symptoms were significantly higher in elderly patients with postoperative hyponatremia than in the matched control group without postoperative hyponatremia (p < 0.05, respectively). Additionally, the length of stay was 2 days longer in patients than in the matched controls (p = 0.002).

DOI： 10.1038/s41598-022-23583-1

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

No reports have previously evaluated the association between surgical technique and the incidence of postoperative spinal epidural hematoma (PSEH) following microendoscopic decompression surgery (MED). This study aimed to evaluate the association between the development of radiographic PSEH (rPSEH) following MED and microendoscopic surgical experience and postoperative clinical outcomes related to the quality of life (QoL). This retrospective cohort study included 3922 patients who had undergone MED performed by a single surgeon. rPSEH was defined as a hematoma that was identified via routine magnetic resonance images performed 3−4 days postoperatively. Patients were divided into rPSEH and control groups to identify the risk factor of rPSEH and assess clinical outcomes. In the multivariate analysis, age (p = 0.002), surgical experience (p = 0.003), surgical time (p = 0.038), multilevel decompression (p < 0.001), and diagnosis (p = 0.004) were identified as independent variables associated with rPSEH. Moreover, in mixed-effect models, the rPSEH group showed less improvement in Oswestry Disability Index (p = 0.014) than the control group. In conclusion, the surgical experience was identified as a risk factor for rPSEH that could lead to poor QoL. The sharing of microendoscopic surgical techniques among surgeons may reduce rPSEH incidence and improve patients’ QoL.

DOI： 10.3390/jcm11216495

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jtocrr.2022.100404

Publishing type：Research paper (scientific journal)  

DOI： 10.11477/mf.1408202457

Publishing type：Research paper (scientific journal)  

Purpose: An osteoporotic vertebral fracture (OVF) is a common disease that causes disabilities in elderly patients. In particular, patients with nonunion following an OVF often experience severe back pain and require surgical intervention. However, nonunion diagnosis generally takes more than six months. Although several studies have advocated the use of magnetic resonance imaging (MRI) observations as predictive factors, they exhibit insufficient accuracy. The purpose of this study was to create a predictive model for OVF nonunion using machine learning (ML). Methods: We used datasets from two prospective cohort studies for OVF nonunion prediction based on conservative treatment. Among 573 patients with acute OVFs exceeding 65 years in age enrolled in this study, 505 were analyzed. The demographic data, fracture type, and MRI observations of both studies were analyzed using ML. The ML architecture utilized in this study included a logistic regression model, decision tree, extreme gradient boosting (XGBoost), and random forest (RF). The datasets were processed using Python. Results: The two ML algorithms, XGBoost and RF, exhibited higher area under the receiver operating characteristic curves (AUCs) than the logistic regression and decision tree models (AUC = 0.860 and 0.845 for RF and XGBoost, respectively). The present study found that MRI findings, anterior height ratio, kyphotic angle, BMI, VAS, age, posterior wall injury, fracture level, and smoking habit ranked as important features in the ML algorithms. Conclusion: ML-based algorithms might be more effective than conventional methods for nonunion prediction following OVFs.

DOI： 10.1007/s00586-022-07431-4

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

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

PubMed

Publishing type：Research paper (scientific journal)  

＜文献概要＞畳み込みニューラルネットワーク(CNN)を用いてMR画像(T1強調画像,矢状断)による新鮮骨粗鬆症性椎体骨折(OVF)の診断を行い,その精度を2人の脊椎外科医と比較した.新鮮OVFの診断においてCNNのROC曲線下面積は0.949であった.感度,特異性および精度は(CNN/脊椎外科医1/脊椎外科医2)感度:0.881/0.881/1.000,特異度:0.879/0.862/0.655,精度:0.880/0.870/0.800であった.MR画像を用いた新鮮OVF診断において,CNN分類器の診断能は良好であり,また脊椎外科医と同等であった.

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

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

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1038/s41586-022-05163-5

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Patient satisfaction is crucial in pay-for-performance initiatives. To achieve further improvement in satisfaction, modifiable factors should be identified according to the surgery type. Using a prospective cohort, we compared the overall treatment satisfaction after microendoscopic lumbar decompression between patients treated postoperatively with a conventional physical therapy (PT) program (control; n = 100) and those treated with a PT program focused on low back pain (LBP) improvement (test; n = 100). Both programs included 40 min outpatient sessions, once per week for 3 months postoperatively. Adequate compliance was achieved in 92 and 84 patients in the control and test cohorts, respectively. There were no significant differences in background factors; however, the patient-reported pain score at 3 months postoperatively was significantly better, and treatment satisfaction was significantly higher in the test than in the control cohort (-0.02 ± 0.02 vs. -0.03 ± 0.03, p = 0.029; 70.2% vs. 55.4%, p = 0.045, respectively). In the multivariate logistic regression analysis, patients treated with the LBP program tended to be more satisfied than those treated with the conventional program, independent of age, sex, and diagnosis (adjusted odds ratio = 2.34, p = 0.012). Postoperative management with the LBP program could reduce pain more effectively and aid spine surgeons in achieving higher overall satisfaction after minimally invasive lumbar decompression, without additional pharmacological therapy.

DOI： 10.3390/jcm11195566

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

The mid-term surgical outcomes of cervical spondylotic myelopathy (CSM), evaluated using the cervical Japanese Orthopedic Association (cJOA) score, are reported to be satisfactory. However, there remains room for improvement in quality-of-life (QOL), especially after short-term follow-up. We aimed to demonstrate changes in mental and physical QOL between short- and mid-term follow-ups and determine the predictive factors for deterioration of QOL. In this retrospective cohort study, 80 consecutive patients underwent laminoplasty for CSM. The outcome measures were Short Form-36 Physical Component Summary (PCS), Mental Component Summary (MCS), and cJOA scores. PCS and MCS scores were compared at the 2- and 5-year postoperative time points. Additionally, a multivariate logistic regression model was used to identify the predictive factors for deterioration. Significant factors in the logistic regression analysis were analyzed using receiver-operating characteristic curves. The results showed that MCS scores did not deteriorate after 2 years postoperatively (p = 0.912). Meanwhile, PCS significantly declined between 2 and 5 years postoperatively (p = 0.008). cJOA scores at 2 years postoperatively were significantly associated with PCS deterioration at 2-year follow-up. In conclusion, only physical QOL might show deterioration after short-term follow-up. Such deterioration is likely in patients with a cJOA score <13.0 at 2 years postoperatively.

DOI： 10.3390/jcm11175230

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

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

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUNDS: The current prolonging state of the coronavirus disease (COVID-19), could affect many aspects of people's lives, especially the elderly population who experience a decrease in regular exercise. However, whether this decrease in regular exercise affects health-related quality of life (HRQOL) of the elderly population, remains unclear. METHODS: The current population-based cross-sectional survey aimed to identify the relationship between the decrease in regular exercise since the COVID-19 pandemic and any changes in the HRQOL in the general elderly Japanese population. This study was conducted as a part of the COVID-19 vaccination program in Habikino city in Japan, between June and July 2021 using printed questionnaires. The participants included residents of the city who were aged ≥ 65 years, and were being vaccinated for COVID-19 at the city's center. The EuroQoL 5-dimension 5-level (EQ-5D-5L) was assessed at two different time points (pre-pandemic and current). Data on lifestyle changes, including their regular exercise routine since the pandemic, were collected. RESULTS: Finally, 14,494 participants (45.3% of the city's total elderly residents) were enrolled. Among them, 4321 participants (29.8%) had experienced a decrease in regular exercise since the pandemic. These participants showed a significantly higher rate of deterioration in all the EQ-5D-5L domains than the participants who did not experience a decrease in regular exercise. In the multivariate logistic regression analysis, participants with a decrease in regular exercise were significantly related to the EQ-5D-5L index deterioration compared to those with an unchanged regular exercise routine (p < 0.001, adjusted odds ratio = 5.60) independent of age, sex, body mass index (BMI), and the existence of back pain, joint pain, and/or numbness of extremities. CONCLUSION: The current survey that included 45% of the elderly people living in a city revealed that up to 30% of them had experienced a decrease in the regular exercise since the COVID-19 pandemic. This decrease was significantly related to HRQOL deterioration independent of age, sex, BMI, baseline activities of daily living status, and musculoskeletal symptoms. Our data could be useful for understanding the current problem and provide a strong basis for the creation of exercise guidelines for the post-COVID-19 era.

DOI： 10.1186/s12877-022-03316-9

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.11477/mf.5002201812

Publishing type：Research paper (scientific journal)  

＜文献概要＞はじめに　近年,人口の高齢化に伴って脊椎感染症の発生も増加している.脊椎感染症の治療戦略は,基本的に適切な抗菌薬投与と局所安静による保存療法である.しかし,抗菌薬投与のみで感染を鎮静化できない場合,疼痛を制御できない場合,神経障害を生じている場合,椎体破壊が進行し脊柱不安定性を生じる場合などでは手術加療を検討しなければならない.手術療法として,ドレナージ,後方除圧術,後方固定術,前方固定術などさまざまな方法が報告されている.個々の症例の状態に応じた手術療法を選択すべきであるが,骨粗鬆症,糖尿病といった併存症の多い高齢者,ステロイド・免疫抑制剤の使用や血液透析患者などの易感染性宿主など本来手術を避けたい症例にこそ手術加療が必要になることも多く,可能な限り低侵襲な治療法が望まれる.近年,経皮的スクリューや低侵襲前方アプローチといった低侵襲脊椎手術の発展とともに,脊椎感染症の治療も変化してきている.本稿では,脊椎感染症に対する手術療法としてドレナージ,後方除圧,後方固定,前方固定(椎体間固定)の各手技について概説する.

Publishing type：Research paper (scientific journal)  

頸椎損傷をきたした高齢患者において抗血小板剤/抗凝固薬(APAC)の服用が術中出血量に影響を及ぼすのかどうか検討した。日本国内の33施設で頸椎損傷に対して手術を受けた797例のうち、inverse probability weighting(IPTW)を用いて傾向スコアを算出した776例を解析対象とした。このうちAPAC服用群が157例(男性123例、女性34例、平均76.3±6.1歳)、APAC非服用群が619例(男性411例、女性208例、平均74.7±6.4歳)であった。検討の結果、平均推定出血量はAPAC非服用群が204mL、APAC服用群が215mLと有意な群間差は認められず、受傷翌日までに手術を受けた患者に限定してもAPAC非服用群が250±315mL、服用群が334±318mLであり有意差はなかった。また、抗血小板剤服用群と非服用群、抗凝固剤服用群と非服用群に分類した場合も術中出血量に有意な差はみられなかった。このほか、術中合併症の発症を認めたのはAPAC非服用群が20例(3.2%)、服用群が7例(4.5%)と有意差はなく、1000mL以上の大量出血がみられたのはAPAC非服用群が14例(2.3%)、服用群が5例(3.2%)であり有意な群間差はなかった。APACを服用している高齢患者において、頸椎損傷に対する手術中の出血量の有意な増大は認められなかった。

Publishing type：Research paper (scientific journal)  

<p>The Shiraniwa Study, a longitudinal observational study, has evaluated the physical symptoms, physical function, and radiological findings in 409 elderly people (aged 65 years or older) living in a suburban area since August 2016.</p><p>Cross-sectional analysis of the study data identified spinal sagittal imbalance, obesity, prevalent vertebral fractures, and anxiety as independent factors associated with low back pain. Interventions against these factors appeared to be effective in preventing low back pain. Longitudinal analysis revealed stage 2 locomotive syndrome (LS) as an independent predictor of deteriorating spinal sagittal imbalance. In addition, elderly in whom the locomotion level improved over time also showed weight loss, which suggests that weight loss may contribute to preventing the progression of spinal imbalance. Weight loss affects two factors associated with low back pain in the elderly (obesity and spinal imbalance) and might therefore be an effective countermeasure against low back pain in this population.</p>

DOI： 10.34371/jspineres.2022-0602

Publishing type：Research paper (scientific journal)  

<p>The prevalence of osteoporotic fractures continues to increase due to an aging society. In particular, osteoporotic vertebral fracture (OVF) affects activities of daily living and quality of life in elderly persons. Therefore, early diagnosis and treatment of OVF are important. Magnetic resonance (MR) image is useful in diagnosis, but it is sometimes difficult to diagnose whether fractures are fresh. In this review, we introduce our previous report and summarize previous papers on the diagnosis of OVF and artificial intelligence related to OVF. Our study included 814 patients with fresh OVF. A total of 1,624 slices of T1-weighted MR images were obtained and used for CNN training and validation. Furthermore, two spine surgeons independently evaluated 100 vertebrae, which were randomly extracted from the test data. To evaluate the performance of the CNN, we plotted a receiver operating characteristic (ROC) curve and calculated the area under the curve (AUC). We then compared the sensitivity, specificity, and accuracy of the diagnosis by CNN and that of the two spine surgeons. The AUC was 0.95. The evaluation metrics of the diagnosis (CNN/surgeon 1/surgeon 2) for 100 vertebrae were as follows: sensitivity 0.88 / 0.88 / 1.00; specificity 0.88 / 0.86 / 0.66; and accuracy 0.88 / 0.87 / 0.80. The performance of the CNN was comparable to that of the two spine surgeons in diagnosing fresh OVF on MR images. The performance of some diagnostic support tools using CNN has become comparable to that of specialists in various medical fields. Thus,such tools are expected to contribute to the highly accurate diagnosis of OVF in the near future.</p>

DOI： 10.34371/jspineres.2022-0607

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

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

PubMed

Publishing type：Research paper (scientific journal)  

Background: Restrictions during the coronavirus disease 2019 (COVID-19) pandemic have decreased physical activity levels, which may result in locomotive syndrome. This study evaluated the change in locomotive syndrome prevalence and associated risk factors among an elderly population before and after a coronavirus outbreak. Methods: This written self-administered cross-sectional survey was conducted in conjunction with the coronavirus disease vaccination program in Habikino City, Japan. Participants who were aged ≥65 years completed the five-question Geriatric Locomotive Function Scale before and during the pandemic. The diagnosis of locomotive syndrome and its stage was based on the Geriatric Locomotive Function Scale score: stage 1 (2–3 points), 2 (4–5 points), and 3 (≥6 points). Data on lifestyle changes, including regular exercise, during the pandemic were collected. Results: This study included 12,197 participants (36.7% of the city's total elderly residents). The prevalence of locomotive syndrome increased from 41.3% to 47.1% after the outbreak. In total, 765 (6.3% of overall population) and 295 (9.5% of the participants who had stages 1–2 before the pandemic) participants developed locomotive syndrome and stage 3 locomotive syndrome, respectively. The multivariate logistic regression analysis indicated that a decrease in exercise was significantly associated with the onset of locomotive syndrome (all stages) (odds ratio = 2.5, p < 0.001) and locomotive syndrome stage 3 (odds ratio = 2.6, p < 0.001). Conclusions: Extrapolation of the study's findings to the entire population of Japan suggests that approximately 2 million elderly individuals might develop locomotive syndrome after the coronavirus outbreak. Additionally, 10% of the participants with mild-moderate locomotive syndrome before the pandemic may develop severe locomotive syndrome after the outbreak. The greatest risk factor for new-onset or worsening locomotive syndrome was a decrease in daily exercise. Thus, there is an urgent need for adequate exercise guidelines during the coronavirus pandemic, especially for the elderly population.

DOI： 10.1016/j.jos.2022.05.012

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: Correction surgeries for spinal malalignment showed good clinical outcomes; however, there were concerns including increased invasiveness, complications, and impact on medico-economics. Ideally, an early intervention is needed. To better understand the patho-mechanism and natural course of spinal alignment, the effect of factors such as muscle mass and strength on spinal sagittal imbalance were determined in a multicenter cross-sectional study. METHODS: After excluding metal implant recipients, 1823 of 2551 patients (mean age: 69.2 ± 13.8 years; men 768, women 1055) were enrolled. Age, sex, past medical history (Charlson comorbidity index), body mass index (BMI), grip strength (GS), and trunk muscle mass (TM) were reviewed. Spinal sagittal imbalance was determined by the SRS-Schwab classification. Multiple comparison analysis among four groups (Normal, Mild, Moderate, Severe) and multinomial logistic regression analysis were performed. RESULTS: On multiple comparison analysis, with progressing spinal malalignment, age in both sexes tended to be higher; further, TM in women and GS in both sexes tended to be low. On multinomial logistic regression analysis, age and BMI were positively associated with spinal sagittal malalignment in Mild, Moderate, and Severe groups. TM in Moderate and Severe groups and GS in the Moderate group were negatively associated with spinal sagittal malalignment. CONCLUSION: Aging, obesity, low TM, and low GS are potential risk factors for spinal sagittal malalignment. Especially, low TM and low GS are potentially associated with more progressed spinal sagittal malalignment. Thus, early intervention for muscles, such as exercise therapy, is needed, while the spinal sagittal alignment is normal or mildly affected.

DOI： 10.1007/s00586-022-07151-9

PubMed

Publishing type：Research paper (scientific journal)  

我々は2016年8月より都市圏在住65歳以上の高齢者409名を対象に,腰痛を含めた身体症状や,身体機能評価,画像検査からなる観察研究(Shiraniwa Study)を行っている.その横断解析の結果より,高齢者腰痛の独立した関連因子は脊柱インバランス(SVA>95),肥満(BMI≧25.0),既存椎体骨折,不安の強さであり,腰痛対策としてこれらに介入することが有効と考えた.縦断的に脊柱インバランス進行を生じた高齢者の特徴を解析したところ,ロコモ度2は独立した脊柱インバランス進行の予測因子であった.また,経時的にロコモ度が改善した高齢者は体重減少を認めていたことから,減量はロコモ度改善を介して脊柱インバランス進行の抑制に寄与する可能性があると考えられた.減量は高齢者腰痛の関連因子である,肥満,脊柱インバランスの両者に影響することから,有効な高齢者腰痛対策となり得ると注目している.(著者抄録)

Publishing type：Research paper (scientific journal)  

高齢化社会の進行に伴い,骨粗鬆症患者数も増加の一途をたどっている.骨粗鬆症性椎体骨折は高齢者のADLやQOLを低下させるため,早期に適切な治療介入を行う必要があり,精度の高い診断が重要となる.近年,人工知能による物体認識は畳み込みニューラルネットワーク(Convolutional neural network:CNN)の開発により著しく改善を認め,画像診断サポートツールに応用されている.過去に我々はCNNを用いてMR画像で新鮮椎体骨折を検出するシステムを構築した.本稿ではその研究成果を述べるとともに骨粗鬆症性椎体骨折に関する診断や画像診断サポートツールとしての人工知能の有用性についてレビューした.(著者抄録)

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND CONTEXT: Recently, the number of patients with lumbar spinal stenosis (LSS) who present with a coexisting spinal deformity such as degenerative spondylolisthesis (DS) and scoliosis (DLS) has been increasing. Lumbar decompression without fusion can lead to a reactive improvement in the lumbar and sagittal spinopelvic alignment, even if a sagittal imbalance exists preoperatively. However, the mid- to long-term impact of the coexistence of DS and DLS on the change in sagittal spinopelvic alignment and clinical outcomes after decompression surgery remains unknown. PURPOSE: This study aimed to investigate whether the coexistence of DS or DLS in patients with LSS is associated with differences in radiological and clinical outcomes after minimally invasive lumbar decompression surgery. STUDY DESIGN/SETTING: A retrospective analysis of prospectively collected data. PATIENT SAMPLE: A total of 169 patients who underwent minimally invasive lumbar decompression surgery and follow-up >5 years postoperatively. OUTCOME MEASURES: Self-report measures: Low back pain (LBP) and/or leg pain and/or leg numbness visual analog scale (VAS) scores and the Japanese Orthopedic Association scores. PHYSIOLOGIC MEASURES: Standing sagittal spinopelvic alignment. METHODS: In total, 81 patients with LSS, 50 patients with LSS and DS (≥3 mm anterior slippage), and 38 patients with LSS and DLS (≥15° coronal Cobb angle) were included in the current study. Clinical and radiological outcome results before surgery and at 2 and 5 years after surgery were compared among the groups. RESULTS: In patients with LSS with coexisting DS, the clinical outcomes at 2, and 5 years after surgery were similar to those of patients with only LSS. In patients with LSS with coexisting DLS, the VAS LBP and leg pain at 2 years after surgery was significantly higher (34.7 vs. 27.8, p=0.014; 27.8 vs. 14.7, p=0.028) and the achievement rate of the minimal clinically important difference in VAS LBP and leg pain was significantly lower than that of the LSS group (36.1% vs. 54.2%, p=0.036; 58.3% vs. 69.9%, p=0.10). The clinical outcomes except VAS leg numbness at 5 years after surgery were similar to those of patients with only LSS. The reoperation rate of the DS group was significantly lower than that of the LSS group (4.0% vs. 14.8%; p=0.01); however, the reoperation rate of the DLS group was comparable to that of the LSS group (15.8% vs. 14.8%; p=0.493). Lumbar lordosis (LL), sacral slope, pelvic tilt, and pelvic incidence-LL had significantly improved and been maintained for 5 years after the surgery in both the DS and the DLS groups. The sagittal vertical axis had improved at two-year follow-up; however, no significant difference was observed at the 5-year follow-up in both the DS, and the DLS groups. CONCLUSIONS: Mid-term clinical outcomes in patients with LSS with and without deformity were comparable. Lumbar decompression without fusion can result in a reactive improvement in the lumbar and sagittal spinopelvic alignment, even with coexisting DS or DLS. Minimally invasive surgery could be considered for most patients with LSS.

DOI： 10.1016/j.spinee.2021.11.012

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1253/circj.CJ-21-1024

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

STUDY DESIGN: Retrospective longitudinal cohort study. OBJECTIVE: To investigate the impact of facet joint opening (FJO) on clinical outcomes after minimally invasive decompression surgery for lumbar spinal stenosis. SUMMARY OF BACKGROUND DATA: Although FJOs have previously been identified as indicators of segmental spinal instability, their impact on clinical outcomes after decompression alone surgery has yet to be investigated. METHODS: This study included 296 patients from a single institution who underwent minimally invasive surgery for lumbar spinal stenosis and were followed up for ≥5 years. Our analysis focused on identifying FJOs at the index decompression level (d-FJO) and at multiple levels (m-FJO) (i.e., ≥3 levels within the lumbar segment) using preoperative computed tomography. Clinical outcomes including reoperations, improvement ratio for Japanese Orthopaedic Association score, and achievement of a minimal clinically important difference in visual analogue scale scores for low back pain or leg pain at 5 years were compared between patients with and without d-FJO or m-FJO. RESULTS: There were 129 (44%) and 62 (21%) patients with d-FJO (more common with lateral olisthesis) and m-FJO (less common with spondylolisthesis), respectively. Reoperations were more common in patients with d-FJO than in those without (16% vs. 5%). On Cox proportional hazards analysis, d-FJO was identified as a predictor for revision at the index decompression level (hazard ratio 4.04, P = 0.03), whereas m-FJO was a predictor for revision at other lumbar levels (hazard ratio 3.71, P = 0.03). Patients with m-FJO had slightly lower rates of achieving minimal clinically important difference in visual analogue scale scores for low back pain (34% vs. 52%, P = 0.03) and poorer improvement ratio for Japanese Orthopaedic Association scores (74% vs. 80%, P = 0.03) than those without. CONCLUSION: FJO at both index decompression level and multiple level were predictors of poor outcomes; patients with FJOs require careful surgical planning or special follow-up.Level of Evidence: 3.

DOI： 10.1097/BRS.0000000000004262

PubMed

Publishing type：Research paper (scientific journal)  

肥大黄色靱帯(LF)と非肥大黄色靱帯にみられる線維芽細胞増殖因子1(FGF-1)の発現状況とFGF-1の機能を検討した。腰痛脊柱管狭窄症(LSS)患者10例(男性7例、女性3例、平均77.8±4.8歳)から肥大LF、対照群7例(男性3例、女性4例、平均35.0±14.4歳)から非肥大LFをそれぞれ採取し、免疫組織化学染色と定量的PCRによってLFにおけるFGF-1の発現を測定すると共に、初代LF細胞培養によってFGF-1と形質転換増殖因子β1(TGF-β1)の機能を解析した。H&E染色ではFGF-1陽性細胞数は肥大LFの方が非肥大LFより有意に多く、PCR解析でもFGF-1発現が有意に多いことが示された。細胞形態をみるとTGF-β1の刺激による細胞骨格の変化は細胞体の肥大をもたらしており、FGF-1でインキュベートした細胞では糸状突起の伸展は認められなかった。また、FGF-1の処理ではα-SMAの蛋白発現は減少しており対照群との間に有意差はみられなかったが、TGF-β1を添加したところα-SMA発現の上昇が認められた。さらに、線維化マーカーとしての1型コラーゲンと3型コラーゲンの発現に及ぼす影響に関して、FGF-1による有意な減少が生じていた。FGF-1はLF肥大の病態形成において抗線維化作用を有する可能性が示唆された。

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

BACKGROUND: Fibrosis is one of the main pathologies caused by hypertrophy of the ligamentum flavum (LF), which leads to lumbar spinal stenosis (LSS). The fibroblast growth factor (FGF) family is a key mediator of fibrosis. However, acidic fibroblast growth factor (FGF-1) expression and function are not well understood in LF. This study sought to evaluate FGF-1 expression in the hypertrophied and non-hypertrophied human LF, and to investigate its function using primary human LF cell cultures. METHODS: We obtained hypertrophied lumbar LF from LSS patients and non-hypertrophied lumbar LF from control patients during surgery. Immunohistochemistry and qPCR were performed to evaluate FGF-1 expression in LF tissue. The function of FGF-1 and transforming growth factor beta 1 (TGF-β1) was also investigated using primary LF cell culture. The effects on cell morphology and cell proliferation were examined using a crystal violet staining assay and MTT assay, respectively. Immunocytochemistry, western blotting, and qPCR were performed to evaluate the effect of FGF-1 on TGF-β1-induced myofibroblast differentiation and fibrosis. RESULTS: Immunohistochemistry and qPCR showed higher FGF-1 expression in hypertrophied LF compared to control LF. Crystal violet staining and MTT assay revealed that FGF-1 decreases LF cell size and inhibits their proliferation in a dose-dependent manner, whereas TGF-β1 increases cell size and promotes proliferation. Immunocytochemistry and western blotting further demonstrated that TGF-β1 increases, while FGF-1 decreases, α-SMA expression in LF cells. Moreover, FGF-1 also caused downregulation of collagen type 1 and type 3 expression in LF cells. CONCLUSION: FGF-1 is highly upregulated in the LF of LSS patients. Meanwhile, in vitro, FGF-1 exhibits antagonistic effects to TGF-β1 by inhibiting cell proliferation and decreasing LF cell size as well as the expression of fibrosis markers. These results suggest that FGF-1 has an anti-fibrotic role in the pathophysiology of LF hypertrophy.

DOI： 10.1016/j.jos.2021.01.004

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jep.2021.114763

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

The cervical ossification of the posterior longitudinal ligament (cOPLL) is sometimes misdiagnosed or overlooked on radiography. Thus, this study aimed to validate the diagnostic yield of our deep learning algorithm which diagnose the presence/absence of cOPLL on cervical radiography and highlighted areas of ossification in positive cases and compare its diagnostic accuracy with that of experienced spine physicians. Firstly, the radiographic data of 486 patients (243 patients with cOPLL and 243 age and sex matched controls) who received cervical radiography and a computer tomography were used to create the deep learning algorithm. The diagnostic accuracy of our algorithm was 0.88 (area under curve, 0.94). Secondly, the numbers of correct diagnoses were compared between the algorithm and consensus of four spine physicians using 50 independent samples. The algorithm had significantly more correct diagnoses than spine physicians (47/50 versus 39/50, respectively; p = 0.041). In conclusion, the accuracy of our deep learning algorithm for cOPLL diagnosis was significantly higher than that of experienced spine physicians. We believe our algorithm, which uses different diagnostic criteria than humans, can significantly improve the diagnostic accuracy of cOPLL when radiography is used.

DOI： 10.1038/s41598-022-06140-8

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Publishing type：Research paper (scientific journal)  

Background: Identifying elderly individuals with locomotive syndrome is important to prevent disability in this population. Although screening tools for locomotive syndrome are available, these require time commitment and are limited by an individual's ability to complete questionnaires independently. To improve on this limitation, we developed a screening tool that uses information on the distribution of pressure on the plantar surface of the foot with an artificial intelligence (AI)-based decision system to identify patients with locomotor syndrome. Herein, we describe our AI-based system and evaluate its performance. Methods: This was a cross-sectional study of 409 participants (mean age, 73.5 years). A foot scan pressure system was used to record the planter pressure distribution during gait. In the image processing step, we developed a convolutional neural network (CNN) to return the logit of the probability of locomotive syndrome based on foot pressure images. In the logistic regression step of the AI model, we estimated the predictor coefficients, including age, sex, height, weight, and the output of the CNN, based on foot pressure images. Results: The AI model improved the identification of locomotive syndrome among elderly individuals compared to clinical data, with an area under curve of 0.84 (95% confidence interval, 0.79–0.88) for the AI model compared to 0.80 (95% confidence interval, 0.75–0.85) for the clinical model. Including the footprint force distribution image significantly improved the prediction algorithm (the net reclassification improvement was 0.675 [95% confidence interval, 0.45–0.90] P < 0.01; the integrated discrimination improvement was 0.059 [95% confidence interval, 0.039–0.088] P < 0.01). Conclusions: The AI system, which includes force distribution over the plantar surface of the foot during gait, is an effective tool to screen for locomotive syndrome.

DOI： 10.1016/j.jos.2022.01.010

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVE: There are several reported studies on the incidence of adjacent segment disease (ASD) after lumbar fusion surgery; however, the incidence of ASD after decompression surgery has not been well studied. In this study the authors aimed to investigate the incidence of progressive segment degeneration (PSD) at the decompression and adjacent segments 5 years after minimally invasive lumbar decompression surgery. METHODS: We investigated data from 168 patients (mean age, 69.5 ± 9.2 years) who underwent bilateral microscopic or microendoscopic decompression surgery via a unilateral approach and were followed up for more than 5 years. Outcomes were self-reported visual analog scale (VAS) scores for low-back pain, leg pain, and leg numbness and physician-assessed Japanese Orthopaedic Association (JOA) scores for back pain. Changes in the disc height and movement of the adjacent lumbar segments were compared using preoperative and 5-year postoperative lateral full-length standing whole-spine radiographic images. PSD was defined as loss of disc height > 3 mm and progression of anterior or posterior slippage > 3 mm. The incidence and clinical impact of PSD were investigated. RESULTS: The mean JOA score improved significantly in all patients from 13.4 points before surgery to 24.1 points at the latest follow-up (mean recovery rate 67.8%). PSD at the decompression site was observed in 43.5% (73/168) of the patients. The proportions of patients with loss of disc height > 3 mm and slippage progression were 16.1% (27/168) and 36.9%, respectively (62/168: 41 anterior and 21 posterior). The proportion of patients with PSD at the adjacent segment was 20.5% (35/168), with 5.4% (9/168) of the patients with loss of disc height > 3 mm and 16.0% (27/168: 13 anterior and 14 posterior) with slippage progression. There was no significant difference in the clinical outcomes between patients with and those without PSD. CONCLUSIONS: Radiological ASD was observed even in the case of decompression surgery alone. However, there was no correlation with symptom deterioration, measured by the VAS and JOA scores.

DOI： 10.3171/2021.12.SPINE211151

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DOI： 10.1093/ehjcvp/pvac008

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DOI： 10.1161/CIRCINTERVENTIONS.121.011387

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: To verify changes in the health-related quality of life (HRQOL) of patients with musculoskeletal disorders after the coronavirus disease 2019 (COVID-19) pandemic and to assess the relationship between the patients' change in several activities of daily living and in the HRQOL to discover factors related to the deterioration in HRQOL. METHODS: A multi-centre cross-sectional questionnaire survey was administered between November 1, 2020, and December 31, 2020, in Japan. The participants included those who visited the orthopaedics clinic within the survey period and had experienced the first and second waves of COVID-19 in Japan and the first stay-at-home order issued by the government. Patients' HRQOL at the two different time points (pre-outbreak and post-second wave of COVID-19) was assessed with the EuroQoL-5 dimensions 5-level (EQ-5D). RESULTS: The survey was completed by 1254 patients (average age: 52.5 ± 21.9 years; 644 women). Among them, 431 patients (34.3%) reported a decrease in the EQ-5D index after the pandemic. The largest decrease was in the pain domain followed by the mobility domain. Multivariate logistic regression analysis revealed that the patients with decreased regular exercise habits were significantly related to deterioration in HRQOL compared with those with stable regular exercise (adjusted odds ratio = 1.76, p < 0.001) independently from age, sex, and change of symptoms. CONCLUSIONS: Up to 35% of patients with musculoskeletal disorders reported deterioration of HRQOL after the COVID-19 pandemic. Pain and mobility rather than anxiety were the two leading factors of the HRQOL decrease. The decrease in regular exercise was related to the HRQOL decrease.

DOI： 10.1007/s00264-021-05256-2

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DOI： 10.3390/jcm11030602

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Publishing type：Research paper (scientific journal)  

<p><b>Introduction: </b>Osteoporotic vertebral fracture (OVF) is one of the most common fractures among the elderly, and its impact on the cost of care is a concern. Balloon kyphoplasty (BKP) is a widely used treatment for OVF. The purpose of this study is to estimate the cost of conservative treatment and BKP, including the cost of nursing care and the loss of productivity of caregivers, based on previous reports.</p><p><b>Methods: </b>For the distribution of activities of daily living (ADLs) after OVF, we used data from our multicenter prospective study that evaluated BKP and conservative treatment for 6 months in patients aged ≥65 years within 2 months of the onset. Estimates of nursing care costs and informal care costs were estimated mainly based on data published by the Ministry of Health, Labor and Welfare.</p><p><b>Results: </b>To compare nursing care costs, we summed up the distribution of ADLs, the level of nursing care required, and the level of independence in daily living at the end of 6 months of treatment. The per capita nursing care costs by level of nursing care required at the end of 6 months were 39,497 yen/month in the BKP group and 58,298 yen/month in the conservative therapy group with a difference of 18,801 yen/month. The per capita informal care costs by level of care required at the end of 6 months of treatment were 35,722 yen/month in the BKP group and 44,102 yen/month in the conservative therapy group, with a difference of 8,380 yen/month.</p><p><b>Conclusions: </b>For patients with OVF, improvement of ADL via BKP may reduce the cost of care and caregiver productivity loss.</p>

DOI： 10.34371/jspineres.2021-0041

CiNii Article

Publishing type：Research paper (scientific journal)  

DOI： 10.15106/j_seikei73_28

Publishing type：Research paper (scientific journal)  

頸椎減圧手術または腰椎減圧手術を受けた患者の2年後における精神衛生の変化とその予測因子を検討した。頸椎減圧手術施行群121例(男性50例、女性71例、平均65.8±11.7歳)と腰椎減圧手術施行群111例(男性67例、女性34例、平均67.3±10.8歳)を対象に、SF-36精神的サマリースコア(MCS)を測定し、その変化と関連する術前臨床スコアを評価した。傾向スコアマッチング法により両群85例を解析対象としたところ、平均MCSはいずれも術後2年において術前と比較して有意に改善しており、頸椎減圧群と腰椎減圧群に有意差は認められなかった。単変量解析ではMCSの改善度と術前のSF-36身体的日常役割機能、SF-36活力、SF-36社会的機能(SF)およびSF-36精神的日常役割機能(RE)との間に有意な相関がみられ、c-JOAスコア、VASスコアとの関連はなかった。また、年齢と性別を補正後の線形回帰分析ではMCSの改善度は術前のSF-36 SF、SF-36 REと独立して関連していた。頸椎減圧手術、腰椎減圧手術後にMCSの改善が得られ、腰椎減圧群では術前の背部痛と活動、頸椎減圧群では社会的機能がMCS改善に繋がる因子であることが示された。

Publishing type：Research paper (scientific journal)  

はじめに:骨粗鬆症性椎体骨折(OVF)は高齢者の多くが罹患する骨折であり介護費用に与える影響が懸念される.一方でBalloon kyphoplasty(BKP)はOVFに対して広く行われている治療の一つである.本研究目的は過去の報告をもとに介護費用及び介護者の生産性損失を含めた保存治療およびBKPの費用を推計することである.対象と方法:OVF後のADL分布は,新規にOVFを発症した受傷後2ヵ月以内の65歳以上の者を対象としてBKPあるいは保存治療を実施した6ヵ月間の多施設前向き研究のデータを使用した.介護費用の推計やインフォーマルケア費用の推計について,主に厚生労働省が公表しているデータを基に推計した.結果:介護費用は,治療実施6ヵ月後時点のADL分布と要介護度と日常生活自立度の分布を基に算出した.治療実施6ヵ月後時点の要介護度別の1人あたり介護費は,BKP群39,497円/月,保存療法群58,298円/月,差分18,801円/月であった.インフォーマルケア費用の比較として,治療実施6ヵ月後時点の要介護度別の1人あたりインフォーマルケア費用は,BKP群で35,722円/月,保存療法群で44,102円/月,差分は8,380円/月であった.結語:BKPによるADLの改善が,介護費用および介護者の生産性損失を削減する可能性がある.(著者抄録)

Publishing type：Research paper (scientific journal)  

症例は77歳女性で、両下肢痛、両下肢しびれ、腰痛を主訴とした。腰部脊椎管狭窄症の診断でL4/L5前側方進入椎体間固定術を施行した。術後3日に低Na血症(129mEq/l)を認め、食塩経口負荷で一旦改善傾向を認めたが、術後12日のリハビリテーション後よりNa 116mEq/lの重篤な低Na血症を認めた。アンジオテンシンII受容体拮抗薬系降圧薬とNSAIDsを定期内服し、初回の腰椎後方除圧術後にも低Na血症で入院加療した既往が判明し、鉱質コルチコイド反応性低Na血症の可能性を考えた。イルベサルタン・アムロジピンベシル酸塩配合、セレコキシブの内服を中止し、1.7%生理食塩水投与を開始した。翌日にNa 124mEq/lまで改善したため1.2%生理食塩水投与に変更し、術後17日より食塩経口負荷を、術後19日よりフルドロコルチゾン酢酸エステル投与を開始した。術後22日にNa 133mEq/lで自宅退院し、退院後4ヵ月でフルドロコルチゾン酢酸エステルを終了した。

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

<p>Introduction: Mental well-being is essential for patient satisfaction. Therefore, a better understanding of the changes in the mental well-being of patients following spinal surgery can be useful to surgeons. We compared the 2-year postoperative change in the mental well-being of patients who underwent cervical and lumbar decompression surgery. Additionally, the predictive factors for improvement in mental well-being associated with both methods were evaluated.</p><p>Methods: The patients who underwent spinal decompression surgery and were followed >2 years postoperatively were enrolled (lumbar cohort: n=111, cervical cohort: n=121). The 36-item Short-Form Health Survey (SF-36) mental component summary (MCS) was set as the mental well-being parameter, and the minimal clinically important difference (MCID) was defined as 4.0. After adjusting the cervical and lumbar cohorts using propensity scores, the improvements in the MCS were compared between the groups using a mixed-effect model. To identify predictors for improvements, the correlation between the MCS changes and preoperative clinical scores was evaluated. Subsequently, multivariate linear regression was applied, which included variables with p<0.10 in the former analysis as explanatory variables, and the change of MCS as the objective variable.</p><p>Results: There were no significant differences in the MCS improvement between the adjusted cervical and lumbar cohorts; 47% and 49%, respectively, had MCS improvement score >MCIDs. However, predictors for the improvement were different between the two cohorts: SF-36 Social functioning in cervical surgery and lower back pain and SF-36 Role physical in lumbar surgery.</p><p>Conclusions: Although there was no significant difference in the improvement in the mental well-being between patients who underwent either cervical or lumbar decompression surgery, less than half of the patients in both groups achieved a meaningful improvement. Preoperative back pain and personal activity were independent predictors in the lumbar cohort, while social functioning was the only predictor in the cervical cohort.</p><p>Level of evidence: III</p>

DOI： 10.22603/ssrr.2021-0060

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CiNii Article

Publishing type：Research paper (scientific 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

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Publishing type：Research paper (scientific journal)  

DOI： 10.1038/s41598-021-03632-x

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

STUDY DESIGN: This was a retrospective cohort study. OBJECTIVE: The objective of this study was to assess the effectiveness and invasiveness of a combined screw insertion technique [using cortical bone trajectory (CBT) screw and transarticular surface screw (TASS)] for patients with L5 isthmic spondylolisthesis. SUMMARY OF BACKGROUND DATA: Lumbosacral posterior fixation using TASS is safe, with high biomechanical strength. However, data regarding its clinical outcomes, effectiveness, and invasiveness, are lacking. MATERIALS AND METHODS: This study included 111 patients who underwent single-level L5-S1 posterior lumbar interbody fusion (PLIF) for L5 isthmic spondylolisthesis. The cohort was stratified into 2 groups: the Wiltse group included patients who underwent PLIF between 2008 and 2013 with standard pedicle screw fixation via Wiltse approach and the CBT/TASS group included those who underwent PLIF from 2014 onward with CBT/TASS fixation. After propensity score matching of the CBT/TASS and Wiltse groups, the surgical times, estimated blood loss (EBL), length of in-hospital stays, clinical scores, serum creatine kinase concentration, radiographic parameters, and bone union rate were compared using the χ2 test or Mann-Whitney U test. In addition, multivariate linear regression analyses, with surgical time and EBL as objective variables applied after Box-Cox transformation, were performed. RESULTS: The matched CBT/TASS group showed significantly shorter surgical times (P<0.001), lower EBL (P=0.032), shorter in-hospital stays (P=0.005), and lower 3-day postoperative serum creatine kinase concentrations (P=0.014) than the matched Wiltse group. However, neither the postoperative grade of spondylolisthesis, the L5-S1 lordotic angle, nor the clinical scores were significantly different between matched groups. The bone union rates were 94.7% and 96.2% in the matched CBT/TASS and Wiltse groups, respectively (P=1.000). Regression analysis showed that CBT/TASS was an independent factor significantly related to shorter surgical times and lower EBL (P<0.001 and P=0.001, respectively). CONCLUSION: Compared with Wiltse approach, CBT/TASS is a less invasive technique, with a shorter surgical time and sufficient clinical outcomes for patients with L5 isthmic spondylolisthesis. LEVEL OF EVIDENCE: Level III-treatment benefits.

DOI： 10.1097/BSD.0000000000001170

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DOI： 10.15106/j_seikei72_1327

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DOI： 10.1152/jn.00343.2021

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DOI： 10.1016/j.lungcan.2021.10.006

PubMed

Publishing type：Research paper (scientific journal)  

2020年11〜12月に大阪府内で行われた大規模アンケート調査から、COVID-19流行以後の生活様式の変化に対して運動指導を希望する整形外科患者の特徴について分析した。その結果、運動指導の希望がある患者は高齢、女性、膝関節疾患や股関節疾患、外出頻度が低下した患者、運動頻度が低下した患者、運動頻度が増加した患者で有意に多かった。また、運動指導の希望がない患者でも運動習慣の低下が約1/3、ADLの増悪が約1割の患者に存在することが明らかになった。

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超高齢社会の到来に伴い、すべての整形外科医にとって骨粗鬆症性椎体骨折は向き合わなければならない疾患となった。骨粗鬆症性椎体骨折は1つの疾患として呼称されているが、病期によって様々な症状と病態を呈し、それらを一括りにすることはできない。治療方法は病態に即した方法を選択しなければ十分な治療効果が望めないため、正確な病期・病態の把握が治療の第一歩となる。骨粗鬆症性椎体骨折の病期・病態の把握には症状や身体所見とあわせ、画像診断を欠かすことはできない。限られた医療資源のなかで必要な画像検査を取捨選択し、適切な治療方針を立てる必要がある。本稿では各病期・病態に応じた画像検査とその解釈を示し、どのように治療戦略を立てていくのかを解説する。(著者抄録)

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DOI： 10.3390/medicina57111225

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DOI： 10.1136/bmjresp-2021-001015

PubMed

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COVID-19パンデミックに伴う外出頻度の減少が脊椎疾患患者に及ぼす影響を検討した。脊椎クリニックを受診する脊椎疾患患者855例を対象に多施設共同横断質問紙調査研究を実施した。外出頻度減少群160例と非減少群695例に分類し、運動習慣、ロコモティブシンドローム(LS)の有病率および健康関連QOL(HRQOL)をパンデミックの前後に評価した。その結果、HRQOLに関してEQ-5D-5Lスコアは外出減少群の方が非減少群より有意に低下していた。多変量ロジスティック回帰分析では、COVID-19パンデミック後に外出頻度が減少した患者においてパンデミック前と比較して、運動習慣の減少、LSの発症率増加、HRQOLの悪化が認められた。また、外出頻度の減少がみられた160例を軽度減少群116例と高度減少群44例に分けてサブ解析を実施したところ、脊椎疾患の重症度、運動習慣、LSの有病率およびHRQOLに関して有意な群間差はなかった。COVID-19パンデミックに伴う外出制限によって、脊椎疾患患者において運動習慣の有意な減少、LSの発症率増加、HRQOLの悪化が生じていた。

Publishing type：Research paper (scientific journal)  

症例は78歳女性で、T12の骨粗鬆症性椎体骨折に対して椎体切除術が施行され、椎弓根スクリューのゆるみが生じる可能性が考えられたため、セメント注入型椎弓根スクリュー留置術を行うこととした。T10、T11、L1、L2にスクリューを挿入後、T10スクリュー内に骨セメントを注入し、数分後にL2スクリューにもセメント注入を行った。しかし、この時点でL2椎弓根スクリューから静脈への骨セメント漏出が認められ、セメントは徐々に頭側に移動して心臓レベルまで達したため手術を中止した。血圧、心拍数、心電図所見には変化はみられず、セメント周囲の血栓形成予防目的にヘパリンを投与し、肺動脈塞栓術を施行した。経食道心エコー検査では遊走したセメントは右房に流入して心房中隔に達していた。カテーテルを用いたセメント除去を計画し、超音波ガイド下に右大腿静脈を介して下大静脈に16Fシースを進め、回収カテーテルを右房まで到達させた。トリプルループスネアを用いて遊走セメントを捕捉することができ、長さ6.5cmで針状の外観を呈していた。術後の造影CTでは肺塞栓症や心穿孔は認められず、背部痛の改善が得られた。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Restless legs syndrome (RLS) is a neurological disorder that causes uncomfortable sensations in the legs. The purpose of this study was to evaluate the symptoms of RLS in patients with spinal disorders and the impact of RLS on the clinical outcomes of lumbar spinal stenosis (LSS). The records of 278 patients (age range 65-92 years) with spinal disorders who visited our outpatient clinic were reviewed. We used a survey to identify subjects with RLS based on the International RLS Study Group diagnostic criteria. We further recorded patient characteristics, surgical outcomes, sleeping time, mental health condition, and the occurrence of leg cramps. Thirty-two patients (11.5%) met the criteria for RLS. The prevalence of anxiety (46.9% vs. 26.6%, p = 0.023) and leg cramps (90.6% vs. 73.2%, p = 0.030) was higher in patients with RLS than in those without. RLS was present in 12.3% of LSS patients. The visual analog scale score for lower back pain before surgery and at the final follow-up was significantly higher in LSS patients with RLS than in those without. However, the Japanese Orthopaedic Association (JOA) score, JOA score improvement ratio, and VAS score for leg numbness were not significantly different between the groups.

DOI： 10.3390/jcm10215001

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVE: Both facet joint opening (FJO) on CT and facet joint effusion (FJE) on MRI are reportedly indicators of segmental instability in the lumbar facet joints of patients with lumbar spinal stenosis (LSS). However, no study has investigated both parameters simultaneously. Therefore, the association between these findings and which parameter is better for predicting clinical outcomes after surgical treatment remains unclear. The purpose of this study was to investigate the relationship between FJO and FJE in patients who underwent less invasive decompression procedures for LSS and to investigate the impact of these findings on clinical outcomes. METHODS: This study included 1465 lumbar levels (L1-2 to L5-S1) in 293 patients who underwent less invasive surgery for LSS and had ≥ 5 years of follow-up. FJO was defined as joint space widening ≥ 2 mm on preoperative axial CT images. FJE was defined as fluid effusion in the facet joint on preoperative axial T2-weighted MR images. The characteristics and distributions of FJO and FJE were investigated with other preoperative radiological findings. The association between need for further surgery and FJO/FJE was analyzed according to intervertebral level. RESULTS: FJO was observed at 402 levels (27%), and FJE was found at 306 levels (21%). The correspondence rate between FJO and FJE was 70% (kappa 0.195, p < 0.01). One hundred thirty-seven levels (9%) had both FJO and FJE. Levels with both FJO and FJE more commonly had lateral olisthesis, lateral wedging, and axial intervertebral rotation than other levels (p < 0.001). Levels with both FJO and FJE were more likely than other levels to need further surgery (OR 2.42, p = 0.027). CONCLUSIONS: The correspondence rate between FJO and FJE was not high. However, multivariate analysis showed that levels with both FJO and FJE had a higher risk of requiring further surgery than those with other radiological findings, such as lateral olisthesis, lateral wedging, and axial intervertebral rotation. Patients with levels with both FJO and FJE need careful long-term follow-up after undergoing a less invasive decompression procedure.

DOI： 10.3171/2021.6.SPINE21721

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND CONTEXT: Accurate diagnosis of osteoporotic vertebral fracture (OVF) is important for improving treatment outcomes; however, the gold standard has not been established yet. A deep-learning approach based on convolutional neural network (CNN) has attracted attention in the medical imaging field. PURPOSE: To construct a CNN to detect fresh OVF on magnetic resonance (MR) images. STUDY DESIGN/SETTING: Retrospective analysis of MR images PATIENT SAMPLE: This retrospective study included 814 patients with fresh OVF. For CNN training and validation, 1624 slices of T1-weighted MR image were obtained and used. OUTCOME MEASURE: We plotted the receiver operating characteristic (ROC) curve and calculated the area under the curve (AUC) in order to evaluate the performance of the CNN. Consequently, the sensitivity, specificity, and accuracy of the diagnosis by CNN and that of the two spine surgeons were compared. METHODS: We constructed an optimal model using ensemble method by combining nine types of CNNs to detect fresh OVFs. Furthermore, two spine surgeons independently evaluated 100 vertebrae, which were randomly extracted from test data. RESULTS: The ensemble method using VGG16, VGG19, DenseNet201, and ResNet50 was the combination with the highest AUC of ROC curves. The AUC was 0.949. The evaluation metrics of the diagnosis (CNN/surgeon 1/surgeon 2) for 100 vertebrae were as follows: sensitivity: 88.1%/88.1%/100%; specificity: 87.9%/86.2%/65.5%; accuracy: 88.0%/87.0%/80.0%. CONCLUSIONS: In detecting fresh OVF using MR images, the performance of the CNN was comparable to that of two spine surgeons.

DOI： 10.1016/j.spinee.2021.03.006

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.3390/life11101029

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Although the clinical efficacy of laminoplasty in adult cervical spondylotic myelopathy or ossification of posterior longitudinal ligament has been frequently reported, there are only few reports of laminoplasty for patients with lysosome storage diseases (LSDs). Therefore, this study aimed to report the midterm clinical and radiological outcomes of patients with LSDs after cervical laminoplasty. METHODS: Six patients with LSD who underwent laminoplasty with/without C1 laminectomy for cervical myelopathy were enrolled. Clinical evaluations, including the cervical Japanese Orthopedic Association (cJOA) score and visual analog scale (VAS) scores for upper extremity numbness, and radiographic parameters, including C2-C7 lordotic angle, atlanto-dens interval (ADI), and ⊿ADI, were evaluated preoperatively, at 2 years postoperatively, and at the final follow-up. RESULTS: Five patients had mucopolysaccharidoses (type I: n = 1, II: n = 3, VII: n = 1) and one patient had mucolipidoses type III. The mean age of patients at surgery was 27.5 years, and the mean postoperative follow-up period was 61 months. All mucopolysaccharidoses cases required C1 posterior arch resection with C2-C7 laminoplasty. No critical complications were observed postoperatively. There were no significant differences in C2-C7 angle (p = 0.724) and ⊿ADI (p = 0.592) between the preoperative and final follow-ups. The cJOA score and VAS for numbness significantly improved at the final follow-up (p = 0.004 and p = 0.007, respectively). CONCLUSIONS: The cervical myelopathy in patients with LSD could be safely and effectively treated with laminoplasty with/without C1 posterior arch resection after excluding patients with atlantoaxial instability. Atlantoaxial stability and symptom improvement could be maintained at an average of 5 years postoperatively.

DOI： 10.1186/s13023-021-02031-9

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To compare the clinical outcomes 5 years after minimally invasive posterior decompression for lumber spinal stenosis (LSS) between patients with and without degenerative spondylolisthesis (DS). SUMMARY OF BACKGROUND DATA: Indications for surgical procedures for patients with LSS and DS are still under investigation. Since minimally invasive surgery does not affect most anatomical structures, preoperative DS may not negatively affect the clinical outcomes of minimally invasive posterior decompression. METHODS: Overall, 198 patients with LSS who underwent microendoscopic or microscopic decompression and were followed up for more than 5 years postoperatively were included in the present study. Patients who showed a segmental kyphosis >5° at the surgical level during flexion were treated with fusion surgery. However, other patients, including those with DS, were treated with posterior decompression. The patients were divided into two groups: the DS group included 82 patients with >3-mm slip and the non-DS group included 112 patients with ≤3-mm slip or without slip. A mixed-effects model adjusted for age and sex was used to compare the improvements in the visual analog scale score for low-back pain and the Japanese Orthopaedic Association score of the two groups. For subgroup analysis (n = 53), the changes in the preoperative physical component summary and the mental component summary of Short Form-36 of the two groups at 5 years after surgery were evaluated. RESULTS: There was no significant difference in the improvement of preoperative low-back pain visual analog scale score and Japanese Orthopaedic Association score 5 years after surgery between the two groups. Subgroup analysis showed no significant difference between the two groups in the improvement of preoperative physical component summary and mental component summary 5 years after surgery. CONCLUSION: After carefully eliminating patients with segmental instability, DS did not affect the clinical outcomes of minimally invasive decompression surgery.Level of Evidence: 3.

DOI： 10.1097/BRS.0000000000003997

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Recently, an expandable cage equipped with rectangular footplates has been used for anterior vertebral replacement in osteoporotic vertebral fracture (OVF). However, the postoperative changes in global alignment have not been elucidated. The purpose of this study was to evaluate local and global spinal alignment after anterior and posterior spinal fixation (APSF) using an expandable cage in elderly OVF patients. This retrospective multicenter review assessed 54 consecutive patients who underwent APSF for OVF. Clinical outcomes were compared between postoperative sagittal vertical axis (SVA) > 95 mm and ≤95 mm groups to investigate the impact of malalignment. SVA improved by only 18.7 mm (from 111.8 mm to 93.1 mm). VAS score of back pain at final follow-up was significantly higher in patients with SVA > 95 mm than SVA ≤ 95 mm (42.4 vs. 22.6, p = 0.007). Adjacent vertebral fracture after surgery was significantly more frequent in the SVA > 95 mm (37% vs. 11%, p = 0.038). Multiple logistic regression showed significantly increased OR for developing adjacent vertebral fracture (OR = 4.76, 95% CI 1.10-20.58). APSF using the newly developed cage improves local kyphotic angle but not SVA. The main cause for the spinal malalignment after surgery was postoperative development of adjacent vertebral fractures.

DOI： 10.3390/jcm10174012

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1177/23094990211060967

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

STUDY DESIGN: Retrospective radiological comparative design. PURPOSE: To investigate whether conventional magnetic resonance imaging (MRI) could substitute three-dimensional (3D)-MRI for the calculation of the foraminal stenotic ratio (FSR) and clarification of which patients can be assessed more accurately using 3D-MRI. OVERVIEW OF LITERATURE: Previous studies have indicated that 3D-MRI is useful for diagnosing lumbar foraminal stenosis. The FSR obtained using 3D-MRI, described as the ratio of stenosis length, characterized by perineural fat obliteration, to the length of the entire foramen, could indicate the stenosis severity; however, this method is time-consuming and expensive. The FSR also can be calculated using conventional MRI. METHODS: We investigated 154 foramina at L5-S1 in 77 patients. All the patients had degenerative lumbar disorders and had undergone both conventional MRI and 3D-MRI during the same visit. Differences between the FSRs calculated from conventional and 3D-MRI reconstructions and any correlations with the plain radiography findings were assessed. RESULTS: In foramina that had a FSR of <50% on conventional MRI, the difference between the FSR obtained using conventional MRI and 3D-MRI was 5.1%, with a correlation coefficient of 0.777. For foramina with a FSR ≥50% on conventional MRI, the difference was 20.2%, with a correlation coefficient of 0.54. FSR obtained using 3D-MRI was significantly greater in patients who required surgery than in those who were successfully treated with conservative methods (88% and 42%, respectively). Segments with spondylolisthesis or lateral wedging showed higher FSRs than those without these conditions on both types of MRI. CONCLUSIONS: FSRs <50% obtained using conventional MRI were sufficiently reliable; however, the results were inaccurate for FSRs ≥50%. Patients with high FSRs on 3D-MRI were more likely to require surgical treatment. Therefore, 3D-MRI is recommended in patients with suspected stenosis detected using conventional MRI or plain radiographs.

DOI： 10.31616/asj.2020.0133

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.32118/ayu2780188

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVE: To evaluate prevalence and prognosis of postoperative coronal imbalance (CIB) and factors related to its onset and spontaneous improvement in patients with Lenke 5C adolescent idiopathic scoliosis who underwent selective thoracolumbar-lumbar fusion. METHODS: We measured radiographic parameters and evaluated clinical outcomes using the Scoliosis Research Society-22 questionnaire in patients with Lenke 5C adolescent idiopathic scoliosis and a minimum 2-year follow-up. CIB was defined as >2 cm distance between C7 plumb line and central sacral vertical line. We compared parameters between patients with CIB (CIB group) and without CIB (coronal balanced group). RESULTS: Inclusion criteria were met by 29 patients (mean age at surgery:17.0 years; average follow-up period: 45.6 months). CIB was found in 10 patients 1 week after surgery (34.5%); this decreased to 6.9% at final follow-up. Comparative analysis indicated significant values as follows: age at surgery (17.5 years vs. 14.7 years, P = 0.005), lumbosacral curve (5.9° vs. 11.2°, P = 0.02), and L5 tilt (-3.6° vs. -8.1°, P = 0.02) in bending film. Greater changes of lowest instrumented vertebra disc angle, which means scoliotic angles between LIV and LIV+1, were significantly associated with spontaneous improvement of CIB (P = 0.04). Clinical outcomes were comparable between the coronal balanced and CIB groups. CONCLUSIONS: Although CIB was frequently detected in the early postoperative period after selective thoracolumbar-lumbar fusion, it mostly corrected spontaneously. Relatively younger age at surgery and less flexible lumbosacral curve may be related to postoperative CIB, and greater changes of LIV disc angle may be associated with spontaneous improvement of CIB.

DOI： 10.1016/j.wneu.2021.04.024

PubMed

Publishing type：Research paper (scientific journal)  

痛みの克服は高齢者の日常生活動作(ADL)や生活の質(QOL)の向上に大きく寄与するため重要テーマであり、骨粗鬆症性椎体骨折(OVF)は高齢者の痛みの原因となる代表的疾患である。急性期臨床椎体骨折の治療に関する文献的考察と自験データをまとめたところ、「骨粗鬆症性椎体骨折の治療にエビデンスはあるのか?」への答えは「いいえ」であった。われわれ整形外科医が第一義的責任を持ってその治療体系の策定を行うべきであり、超高齢社会におけるその責務は大きい。(著者抄録)

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVE: Several studies have examined the relationship between sagittal spinopelvic alignment and clinical outcomes after spinal surgery. However, the long-term reciprocal changes in sagittal spinopelvic alignment in patients with lumbar spinal stenosis after decompression surgery remain unclear. The aim of this study was to investigate radiographic changes in sagittal spinopelvic alignment and clinical outcomes at the 2-year and 5-year follow-ups after minimally invasive lumbar decompression surgery. METHODS: The authors retrospectively studied the medical records of 110 patients who underwent bilateral decompression via a unilateral approach for lumbar spinal stenosis. Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores for low-back pain (LBP), leg pain, leg numbness, and spinopelvic parameters were evaluated before surgery and at the 2-year and 5-year follow-ups. Sagittal malalignment was defined as a sagittal vertical axis (SVA) ≥ 50 mm. RESULTS: Compared with baseline, lumbar lordosis significantly increased after decompression surgery at the 2-year (30.2° vs 38.5°, respectively; p < 0.001) and 5-year (30.2° vs 35.7°, respectively; p < 0.001) follow-ups. SVA significantly decreased at the 2-year follow-up compared with baseline (36.1 mm vs 51.5 mm, respectively; p < 0.001). However, there was no difference in SVA at the 5-year follow-up compared with baseline (50.6 mm vs 51.5 mm, respectively; p = 0.812). At the 5-year follow-up, 82.5% of patients with preoperative normal alignment maintained normal alignment, whereas 42.6% of patients with preoperative malalignment developed normal alignment. Preoperative sagittal malalignment was associated with the VAS score for LBP at baseline and 2-year and 5-year follow-ups and the JOA score at the 5-year follow-up. Postoperative sagittal malalignment was associated with the VAS score for LBP at the 2-year and 5-year follow-ups and the VAS score for leg pain at the 5-year follow-up. There was a trend toward deterioration in clinical outcomes in patients with persistent postural malalignment compared with other patients. CONCLUSIONS: After minimally invasive surgery, spinal sagittal malalignment can convert to normal alignment at both short-term and long-term follow-ups. Sagittal malalignment has a negative impact on the VAS score for LBP and a weakly negative impact on the JOA score after decompression surgery.

DOI： 10.3171/2020.11.SPINE201552

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Anterior and posterior spinal fixation (APSF) can provide rigid structural anterior column support in patients with osteoporotic vertebral fracture (OVF). A new rectangular footplate designed based on biomechanical studies of endplates provides better resistance to subsidence. However, differences in characteristics exist between the thoracolumbar and lower lumbar spine. The purpose of this study was to evaluate the surgical outcomes following APSF using an expandable cage with rectangular footplates in the thoracolumbar/lumbar region. METHODS: Consecutive patients who underwent APSF for OVF at multiple centers were retrospectively reviewed. Clinical and radiographic evaluations were performed by dividing the patients into thoracolumbar (TL, T10-L2) and lumbar (L, L3-L5) groups. Surgical indications were incomplete neurologic deficit or intractable back pain with segmental spinal instability. Surgical outcomes including the Japanese Orthopaedic Association (JOA) score and reoperation rate were compared between TL and L groups. RESULTS: Sixty-nine patients were followed-up for more than 12 months and analyzed. Operative intervention was required for 35 patients in the TL group and 34 patients in the L group. Mean ages in the TL and L groups were 76.5 years and 75.1 years, respectively. Intra-vertebral instability was more frequent in the TL group (p<0.001). Screw fixation range was significantly longer in the TL group (p=0.012). The rate of cage subsidence did not differ significantly between the TL group (46%) and L group (44%). Reoperation rate tended to be higher in the TL group (p=0.095). Improvement ratio of JOA score was significantly better in the L group (60%) than in the TL group (46.9%, p=0.029). CONCLUSION: APSF using an expandable cage was effective to treat OVF at both lumbar and thoracolumbar levels. However, the improvement ratio of the JOA score was better in the L group than in the TL group.

DOI： 10.1016/j.xnsj.2021.100071

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND CONTEXT: Ligamentum flavum (LF) hypertrophy plays a dominant role in lumbar spinal stenosis (LSS). A previous study found that fibroblast growth factor 9 (FGF9) was upregulated with mechanical stress in rabbit LF. However, the expression and function of FGF9 are not well understood in human LF. PURPOSE: To evaluate FGF9 expression and function in human LF with and without hypertrophy. STUDY DESIGN: This study employed a basic research study design utilizing human LF tissue for histological analyses. PATIENT SAMPLES: Hypertrophied LF tissue sample from patients with LSS, and nonhypertrophied (control) LFs from patients with lumbar disc herniation or other diseases were obtained during surgery. METHODS: LF specimens were histologically analyzed for FGF9 and vascular endothelial growth factor A (VEGF-A) by immunohistochemistry. The number of total and FGF9 immuno-positive cells and blood vessels were counted and compared between LF with and without hypertrophy. For functional analysis, the effect of FGF9 on cell proliferation and migration was examined using a primary cell culture of human LF. RESULTS: Histological studies revealed that the total cell number was significantly higher in the LF of patients with LSS than in the LF of control patients. Immunohistochemistry showed that the percentage of FGF9-positive cells was significantly higher in the LF of patients with LSS than in the controls, and it positively correlated with patients' age, regardless of disease. Double immune-positive cells for FGF9 and VEGF-A were often observed in vascular endothelial cells and fibroblasts in the fibrotic area of hypertrophied LF, and the number of double positive vessels was significantly higher in LF of LSS patients than in the LF of controls. Primary cell culture of human LF revealed that FGF9 promoted the proliferation and migration of LF cells. CONCLUSION: The present study demonstrated that FGF9 expression is highly upregulated in hypertrophied human LF. FGF9 potentially plays a pivotal role in the process of hypertrophy of LF, which is associated with mechanical stress, through cell proliferation and migration. CLINICAL SIGNIFICANCE: The results from this study partially reveal the molecular mechanisms of LF hypertrophy and suggest that FGF9 may be involved in the process of LF degeneration in elderly patients.

DOI： 10.1016/j.spinee.2021.02.004

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.15106/j_seikei72_642

Publishing type：Research paper (scientific journal)  

<p><b>Introduction: </b>Spinal sagittal imbalance is reported to be associated with a decline in patients' quality of life; however, the cause of its progression has not been investigated. The purpose of this study was to clarify the characteristics of elderly patients with deteriorating spinal sagittal imbalance over a 2-year period.</p><p><b>Methods: </b>A total of 321 participants (133 males and 188 females; mean age 72.9±4.9 years) from the Shiraniwa study were included in this analysis. Based on the SVA measured from whole spine radiographs, we classified the participants into the following three groups: SVA≤40 mm, 40 mm<SVA≤95 mm, and SVA>95 mm. Participants who showed disease progression from the first year to the third year were defined as the deteriorating spinal sagittal imbalance (DSI) group.</p><p>We compared the following items between DSI and non-DSI groups: the incidence of prevalent vertebral fractures, disc degeneration, and back muscle strength; locomotive syndrome (LS) stage 2; and sarcopenia. Using multiple logistic regression analysis, we investigated the predictors for DSI. Moreover, body composition measured using a bio-impedance analysis machine (BIA) was compared between the two groups.</p><p><b>Results: </b>Overall, 45 (14.0%) participants were classified into the DSI group. The prevalence of LS stage 2 was significantly higher in the DSI group than in the non-DSI group (55.6% vs. 28.0%; p<0.01). LS stage 2 was an independent predictor of DSI with an adjusted odds ratio of 2.35 (95% CI: 1.08-5.12). Regarding the body composition measured by BIA, the ratio of trunk muscle to trunk weight percentage was significantly lower in the DSI group (male: 74.1%/78.2%, p=0.02; women: 63.7%/70.9%, p<0.01).</p><p><b>Conclusions: </b>LS stage 2 was an independent predictor of deteriorating spinal sagittal imbalance over a 2-year period. Elderly patients with deteriorating spinal sagittal imbalance showed a significantly lower ratio of trunk muscle to trunk weight percentage.</p>

DOI： 10.34371/jspineres.2021-0014

CiNii Article

Publishing type：Research paper (scientific journal)  

DOI： 10.15106/j_seikei72_667

Publishing type：Research paper (scientific journal)  

DOI： 10.18885/jjs.0000000631

Publishing type：Research paper (scientific journal)  

DOI： 10.18885/jjs.0000000637

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To clarify the poor patient satisfaction after lumbar spinal surgery in elderly patients. SUMMARY OF BACKGROUND DATA: As the global population continues to age, it is important to consider the surgical outcome and patient satisfaction in the elderly. No studies have assessed patient satisfaction in elderly patients undergoing surgical treatment and risk factors for poor satisfaction in elderly patients after lumbar spinal surgery. MATERIALS AND METHODS: A retrospective multicenter survey was performed in 169 patients aged above 80 years who underwent lumbar spinal surgery. Patients were followed up for at least 1 year after surgery. We assessed patient satisfaction from the results of surgery by using a newly developed patient questionnaire. Patients were assessed by demographic data, surgical procedures, complications, reoperation rate, pain improvement, and risk factors for poor patient satisfaction with surgery for lumbar spinal disease. RESULTS: In total, 131 patients (77.5%, G-group) were satisfied and 38 patients (22.5%, P-group) were dissatisfied with surgery. The 2 groups did not differ significantly in baseline characteristics and surgical data. Postoperative visual analog scale score for low back pain and leg pain were significantly higher in the P-group than in the G-group (low back pain: G-group, 1.7±1.9 vs. P-group, 5.2±2.5, P<0.001; leg pain: G-group, 1.4±2.0 vs. P-group, 5.5±2.6, P<0.001). Multivariate regression analysis revealed that postoperative vertebral fracture (P=0.049; odds ratio, 3.096; 95% confidence interval, 1.004-9.547) and reoperation (P=0.025; odds ratio, 5.692; 95% confidence interval, 1.250-25.913) were significantly associated with the patient satisfaction after lumbar spinal surgery. CONCLUSIONS: Postoperative vertebral fracture and reoperation were found to be risk factors for poor patient satisfaction after lumbar spinal surgery in elderly patients, which suggests a need for careful treatment of osteoporosis in addition to careful determination of surgical indication and procedure in elderly patients. LEVEL OF EVIDENCE: Level III.

DOI： 10.1097/BSD.0000000000001101

PubMed

Publishing type：Research paper (scientific journal)  

＜文献概要＞はじめに　本邦の超高齢社会への対策上の課題として,高齢者の実数や,今後の高齢者増加率が都市部で圧倒的に高いという現状を考慮すると,都市部在住高齢者の健康実態,特に整形外科にとっては運動器の実態調査をする必要がある.そこでわれわれは2016年8月より,第三次産業に従事してきた高齢者を中心とする大都市圏ベッドタウンである奈良県生駒市において都市圏高齢者運動器コホート研究(Shiraniwaスタディ)を開始した.対象は歩行可能な65歳以上の高齢者で,縦断5年間,計6回の運動器調査に参加する意志がある方とし,自治体回覧板および院内掲示により参加を募った.初年度409名(男性164名,女性245名,平均年齢73.5歳)が参加し,現在進行形で調査中である.本稿ではShiraniwaスタディより得たロコモティブシンドローム(ロコモ)に関する知見について述べる.

Publishing type：Research paper (scientific journal)  

はじめに:本研究の目的は脊柱インバランスが進行する高齢者の特徴を示すことである.対象と方法:Shiraniwa Study初年度,3年次のいずれにも参加した321名(男性133名,女性188名,平均72.9±4.9歳)を対象とした.全脊柱X線写真より計測したC7SVAより,≦40mm,40mm〜95mm,>95mmの3段階に分け,2年の経過で1段階以上増悪したものを進行群とし,その特徴を評価した.結果:14.0%(45名)が進行群に該当した.ロコモ度2該当者は進行群で有意に多く(55.6%/28.0%,p<0.01),調整オッズ比2.35(95%信頼区間:1.08〜5.12)と脊柱インバランス進行の独立した予測因子であった一方で,既存椎体骨折,椎間板変性,背筋力,サルコペニア有病率に有意差は認めなかった.また,体幹部重量に占める筋量が進行群で有意に低かった(男:74.1%/78.2%,p=0.02,女:63.7%/70.9%,p<0.01).結語:ロコモ度2は脊柱インバランス進行の予測因子であり,進行群で体幹部重量に占める筋量が有意に低かった.(著者抄録)

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

＜文献概要＞Balloon kyphoplasty(BKP)は,骨粗鬆症性椎体骨折(osteoporotic vertebral fracture;OVF)に対してよく行われる手技ではあるが,BKPが適応となる骨折型にはまだまだ議論の余地がある。患者の全身状態やOVFが多発している場合など後方固定を選択しにくい状況もあるが,その場合にBKPでどこまで対応可能かは未知な部分も多い。本稿ではBKPがどういった症例に有用なのか,筆者らの過去のデータを示しながら具体例を論じている。本稿を参考にしていただき今後の診療に役立てていただきたい。

Publishing type：Research paper (scientific journal)  

＜文献概要＞診断の目的は大きく2つであり,1つは骨粗鬆症治療に重要な形態骨折を判別すること,もう1つは骨折治療が必要な臨床骨折を判別することである。「疼痛持続・ADL(activities of daily living)低下」や単純X線で「強い椎体圧壊やクレフト」がみられた患者にはMRIを撮像し精度の高い予後予測を行うべきであり,予後不良が予見される患者には慎重な経過観察を施さなくてはならない。

Publishing type：Research paper (scientific journal)  

脊柱インバランスは運動器疼痛のみならず、高齢者のQOLを著しく損なうことが知られているが、その原因については十分に解明されていない。われわれが実施している都市圏高齢者運動器コホート研究(Shiraniwa Study)の結果より、加齢、椎間板変性、背筋力低下、ロコモ度2はそれぞれ独立した脊柱インバランスの関連因子であることが判明した。また、ロコモ度2は2年の経過で新たに脊柱インバランスが進行することを予測する因子でもあり、脊柱インバランス進行を予防する上でのターゲットとなり得る。(著者抄録)

Publishing type：Research paper (scientific journal)  

＜文献概要＞はじめに　超高齢社会において脊椎疾患の病的意義はますます大きい.特に脊柱矢状面アライメントの悪化は腰痛や生活の質(QOL)に大きな影響を及ぼし,高齢者の日常生活を著しく障害する.手術機器,技術の進歩により脊柱変形に対する矯正固定術が行われるようになってはいるが,高齢者では高い合併症率や高コストが報告されており,予防的治療を中心とした治療戦略への見直しが必要である.近年ではサルコペニアをはじめ,筋量減少と疾病との関係に注目が集まっている.体幹筋は脊柱の支持に不可欠な要素であり,体幹筋への介入により脊柱変形を予防できる可能性はあるが,脊柱アライメントと体幹筋量や筋力との関係は十分に解明されていない.本稿では脊柱アライメントと,特に体幹部の筋量,筋力との関係について筆者らの研究成果を最新の知見をふまえて考察する.

Publishing type：Research paper (scientific journal)  

＜文献概要＞診断の目的は大きく2つであり,1つは骨粗鬆症治療に重要な形態骨折を判別すること,もう1つは骨折治療が必要な臨床骨折を判別することである。「疼痛持続・ADL(activities of daily living)低下」や単純X線で「強い椎体圧壊やクレフト」がみられた患者にはMRIを撮像し精度の高い予後予測を行うべきであり,予後不良が予見される患者には慎重な経過観察を施さなくてはならない。

Publishing type：Research paper (scientific journal)  

＜文献概要＞Balloon kyphoplasty(BKP)は,骨粗鬆症性椎体骨折(osteoporotic vertebral fracture;OVF)に対してよく行われる手技ではあるが,BKPが適応となる骨折型にはまだまだ議論の余地がある。患者の全身状態やOVFが多発している場合など後方固定を選択しにくい状況もあるが,その場合にBKPでどこまで対応可能かは未知な部分も多い。本稿ではBKPがどういった症例に有用なのか,筆者らの過去のデータを示しながら具体例を論じている。本稿を参考にしていただき今後の診療に役立てていただきたい。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

We investigated the relationship between trunk muscle mass and spinal pathologies by gender. This multicenter cross-sectional study included patients aged ≥ 30 years who visited a spinal outpatient clinic. Trunk and appendicular muscle mass were measured using bioelectrical impedance analysis. The Oswestry Disability Index (ODI), visual analog scale (VAS) score for low back pain, sagittal vertical axis (SVA), and EuroQol 5 Dimension (EQ5D) score were investigated to evaluate spinal pathology. The association between trunk muscle mass and these parameters was analyzed by gender using a non-linear regression model adjusted for patients' demographics. We investigated the association between age and trunk muscle mass. We included 781 men and 957 women. Trunk muscle mass differed significantly between men and women, although it decreased with age after age 70 in both genders. Lower trunk muscle mass was significantly associated with ODI, SVA, and EQ5D score deterioration in both genders; its association with VAS was significant only in men. Most parameters deteriorated when trunk muscle mass was < 26 kg in men and < 19 kg in women. Lower trunk muscle mass was associated with lumbar disability, spinal imbalance, and poor quality of life in both genders, with significant difference in muscle mass.

DOI： 10.1038/s41598-021-87334-4

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: Residual symptoms indicating incomplete remission of lower leg numbness or low back pain may occur after spine surgery. The purpose was to elucidate the pattern of residual symptoms 5 years after minimally invasive lumbar decompression surgery using a cluster analysis. METHODS: The study comprised 193 patients with lumbar spinal stenosis (LSS) (108 men, 85 women) ranging in age from 40 to 86 years (mean, 67.9 years). Each patient underwent 5-year follow-up. The Japanese Orthopedic Association score and visual analog scale scores for low back pain, leg pain, and leg numbness at 5 years were entered into the cluster analysis to characterize postoperative residual symptoms. Other clinical data were analyzed to detect the factors significantly related to each cluster. RESULTS: The analysis yielded four clusters representing different patterns of residual symptoms. Patients in cluster 1 (57.0%) were substantially improved and had few residual symptoms of LSS. Patients in cluster 2 (11.4%) were poorly improved and had major residual symptoms. Patients in cluster 3 (17.6%) were greatly improved but had mild residual low back pain. Patients in cluster 4 (14.0%) were improved but had severe residual leg numbness. Prognostic factors of cluster 2 were a short maximum walking distance, motor weakness, resting lower leg numbness, cofounding scoliosis, and high sagittal vertical axis. CONCLUSIONS: This is the first study to identify specific patterns of residual symptoms of LSS after decompression surgery. Our results will contribute to acquisition of preoperative informed consent and identification of patients with the best chance of postoperative improvement.

DOI： 10.1007/s00586-021-06754-y

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Trunk muscles play an important role in supporting the spinal column. A decline in trunk muscle mass, as measured by bioelectrical impedance analysis (TMM-BIA), is associated with low back pain and poor quality of life. The purpose of this study was to determine whether TMM-BIA correlates with quantitative and functional assessments traditionally used for the trunk muscles. We included 380 participants (aged ≥ 65 years; 152 males, 228 females) from the Shiraniwa Elderly Cohort (Shiraniwa) study, for whom the following data were available: TMM-BIA, lumbar magnetic resonance imaging (MRI), and back muscle strength (BMS). We measured the cross-sectional area (CSA) and fat-free CSA of the paravertebral muscles (PVM), including the erector spinae (ES), multifidus (MF), and psoas major (PM), on an axial lumbar MRI at L3/4. The correlation between TMM-BIA and the CSA of PVM, fat-free CSA of PVM, and BMS was investigated. TMM-BIA correlated with the CSA of total PVM and each individual PVM. A stronger correlation between TMM-BIA and fat-free CSA of PVM was observed. The TMM-BIA also strongly correlated with BMS. TMM-BIA is an easy and reliable way to evaluate the trunk muscle mass in a clinical setting.

DOI： 10.3390/jcm10061187

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Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Hypertrophy of the ligamentum flavum (LF) is a major cause of lumbar spinal stenosis (LSS), and the pathology involves disruption of elastic fibers, fibrosis with increased cellularity and collagens, and/or calcification. Previous studies have implicated the increased expression of the proteoglycan family in hypertrophied LF. Furthermore, the gene expression profile in a rabbit experimental model of LF hypertrophy revealed that biglycan (BGN) is upregulated in hypertrophied LF by mechanical stress. However, the expression and function of BGN in human LF has not been well elucidated. To investigate the involvement of BGN in the pathomechanism of human ligamentum hypertrophy, first we confirmed increased expression of BGN by immunohistochemistry in the extracellular matrix of hypertrophied LF of LSS patients compared to LF without hypertrophy. Experiments using primary cell cultures revealed that BGN promoted cell proliferation. Furthermore, BGN induces changes in cell morphology and promotes myofibroblastic differentiation and cell migration. These effects are observed for both cells from hypertrophied and non-hypertrophied LF. The present study revealed hyper-expression of BGN in hypertrophied LF and function of increased proteoglycan in LF cells. BGN may play a crucial role in the pathophysiology of LF hypertrophy through cell proliferation, myofibroblastic differentiation, and cell migration.

DOI： 10.1038/s41598-021-84363-x

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To elucidate the postoperative time course of improvements in physical and mental well-being in patients with cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA: Spinal surgeons should understand the postoperative course in detail. However, data are still needed regarding the time course of improvements in well-being, a fundamental aspect of human life, after cervical surgery for CSM. METHODS: One hundred consecutive patients who underwent laminoplasty for CSM, with complete clinical data preoperatively and 3 months and 2 years postoperatively, were enrolled. The Short Form-36 physical component summary (PCS) and mental component summary (MCS) scores were used as parameters of physical and mental well-being, respectively, and 4.0 was defined as the minimal clinically important difference (MCID) for both parameters. RESULTS: On average, PCS and MCS scores were significantly improved after surgery (P < 0.001, P=0.004, respectively). Moreover, 64 and 48 patients achieved meaningful improvement (>MCID) in PCS and MCS scores at 3 months postoperatively, with maintained improvement (to 2 yr) in 46/64 (71.9%) and 34/48 patients (70.8%), respectively (PCS vs. MCS: P = 0.912). Additionally, 15 of 36 patients (41.7%) and 8 of 52 patients (15.4%) achieved late improvement (meaningful improvement at 2 yr but not at 3 months) in PCS and MCS scores, respectively (PCS vs. MCS: P = 0.007). In multivariate regression analysis, improvement in cJOA score was significantly associated with PCS improvement, but not MCS improvement, at both 3 months and 2 years (P = 0.001, P > 0.001, respectively). CONCLUSION: The overall outcome of physical well-being improvement is decided within 3 months postoperatively, in proportion to the recovery in myelopathy, with a relatively high chance of meaningful improvement over the next 21 months. The outcome of improvement in mental well-being is decided within 3 months postoperatively, independently from the recovery in myelopathy, with a low chance of meaningful improvement over the next 21 months.Level of Evidence: 3.

DOI： 10.1097/BRS.0000000000003787

PubMed

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

UNLABELLED: This study demonstrated that number of three specific radiological risk factors (MR T2WI confined high-intensity pattern and diffuse low-intensity pattern, thoracolumbar vertebrae involvement, middle column injury) added prognostic information for delayed union, kyphotic deformity, and prolonged pain. PURPOSE: Delayed union after osteoporotic vertebral fracture (OVF) causes prolonged pain, QOL impairment, progression of collapse, kyphotic deformity, and neurologic impairment. Some specific radiological findings can be useful for predicting delayed union. We aimed to explore the prevalence and concomitance of various types of radiological risk factors for delayed union after osteoporotic vertebral fracture (OVF) and to assess the impact of risk factor number on clinical outcomes. METHODS: A total of 508 patients with fresh OVF from 25 institutes were evaluated. All patients were treated conservatively without surgical interventions. At the 6-month follow-up, the patients were classified into bone union and delayed union groups based on plain X-ray findings. We examined the presence and absence of three specific radiological risk factors (MR T2WI confined high-intensity pattern and diffuse low-intensity pattern, thoracolumbar vertebrae involvement, middle column injury) and analyzed clinical outcomes according to numbers of radiological risk factors. RESULTS: Delayed union was observed in 101 patients (19.9%) at the 6-month follow-up. The most common radiological risk factor was thoracolumbar vertebrae involvement (73.8%), followed by middle column injury (33.9%) and specific MRI findings (T2WI confined high-intensity pattern and diffuse low-intensity pattern) (29.7%). Overall, 85 (16.7%) patients had zero radiological risk factors, 212 (42.7%) had one, 137 (27.0%) had two, and 69 (13.6%) had three. When assessing the number of radiographic risk factors which included the MRI findings (the 3-risk factor method), the odds ratio for delayed union after acute OVF was 5.8 in the 2/3-risk factor group and 13.1 in the 3/3-risk factor group. Even when assessing the number of radiographic risk factors without MRI findings (2-risk factor method), the odds ratio was 3.2 in the 1/2-risk factor group and 10.2 in the 2/2-risk factor group. CONCLUSION: Number of radiological risk factors added prognostic information for delayed union, kyphotic deformity, and prolonged pain.

DOI： 10.1007/s11657-021-00884-y

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Sarcopenia has been associated with poor clinical outcomes in several diseases. Herein, the clinical results of balloon kyphoplasty (BKP) for acute osteoporotic vertebral fracture (OVF) treatment were assessed and compared between sarcopenia and non-sarcopenia patients. Sixty patients who underwent BKP for treatment of acute OVF with poor prognostic factors between April 2016 and September 2017 and were assessed for sarcopenia were enrolled. Clinical results (back pain on visual analogue scale [VAS]; short-form [SF] 36; vertebral deformity; activities of daily living levels; and incidence of adjacent vertebral fractures) were compared between the two groups at 6 months post-BKP. Data analysis revealed that back pain on VAS, SF-36 scores, and vertebral deformity improved from baseline to 6 months after BKP. Thirty-nine patients (65.0%) were diagnosed with sarcopenia and demonstrated a lower body mass index (21.2 vs. 23.3 kg/m2, p = 0.02), skeletal muscle mass index (5.32 vs. 6.55 kg/m2, p < 0.01), hand-grip strength (14.7 vs. 19.2 kg, p = 0.01), and bone mineral density of the femoral neck (0.57 vs. 0.76 g/cm2, p < 0.01) than those of patients without sarcopenia. However, no significant differences were observed in the clinical results between these groups. Therefore, BKP's clinical results for the treatment of acute OVF are not associated with sarcopenia.

DOI： 10.1038/s41598-020-80129-z

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1177/2309499021994969

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.2147/CMAR.S330103

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Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

<p>Introduction: Because of adolescent idiopathic scoliosis (AIS), most surgeons use rod rotation on the concave side for Lenke types 1 and 2 curves. Nevertheless, the accurate placement of pedicle screws within dysplastic pedicles, especially on the concave side, is sometimes challenging. Conversely, there is a concern that apical rotation might be exacerbated after convex rod rotation maneuver (RRM) because the rod is rotated in the same direction as vertebral rotation. This study aims to demonstrate the surgical technique and outcomes of a convex RRM with direct vertebral rotation (DVR) for the correction of AIS.</p><p>Technical Note: Multilevel pedicle screws were inserted into the vertebrae. The pre-bent pure titanium rod was set on the convex side and then derotated to nearly 90°. DVR was conducted for the desired vertebrae. Another pre-bent titanium alloy rod, for placement on the concave side, was contoured the same as the rod on the convex side. Using a reduction tube that allowed easier capture of the rod, the rod was connected to the concave side screws. DVR was again conducted for the desired vertebrae. Among the 59 patients, the correction rate of the main thoracic curve in Lenke types 1 and 2 AIS was 75.1% and 65.0%, respectively. The absolute value of the change in apical vertebral rotation between pre- and post-operative computed tomography (CT) scans in Lenke types 1 and 2 curves was 4.8° and 4.2°, respectively.</p><p>Conclusions: The convex RRM improved vertebral rotation in Lenke types 1 and 2 AIS. This procedure should be regarded as one of the surgical options for AIS, especially in patients with a narrow pedicle width on the concave side.</p>

DOI： 10.22603/ssrr.2020-0185

PubMed

CiNii Article

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

<p>Introduction: The coronavirus disease 2019 (COVID-19) pandemic has greatly changed the lifestyles of individuals due to the need to prevent disease spread. Globally, governments have enforced various policies, including travel bans, quarantine, home confinement, and lockdowns, as safety measures. Consequently, the frequency of individuals going out has decreased. This survey aimed to assess how decreasing the frequency of going out due to the COVID-19 pandemic impacts patients with spinal disorders.</p><p>Methods: This multicenter cross-sectional questionnaire survey included patients who visited four private spine clinics for any symptoms. Participants completed questionnaires pre- and post-pandemic that assessed the following topics: frequency of leaving home, exercise habits, locomotive syndrome, and health-related quality of life (HRQOL). Patients were divided into decreased and non-decreased frequency of going out groups, according to observed changes in their frequencies of leaving home. Both groups were statistically compared using univariate and multivariate logistic regression analyses to identify factors associated with the frequency of going out.</p><p>Results: Among 855 patients, 160 (18.7%; the decreased group) reported that they went out less frequently, and 695 (81.3%; the non-decreased group) reported that they left home equally frequently post- versus pre-pandemic. Multivariate analyses showed that exercise habits significantly decreased (adjusted odds ratio (aOR) = 2.67, p = 0.004), the incidence of locomotive syndrome significantly increased (aOR = 2.86, p = 0.012), and HRQOL significantly deteriorated (aOR = 4.14, p < 0.001) in the decreased group compared to the non-decreased group.</p><p>Conclusions: Restrictions regarding leaving home due to the COVID-19 pandemic significantly decreased exercise frequency, increased the occurrence of locomotive syndrome, and were associated with deterioration of HRQOL in patients with spine disorders. It may be beneficial for spine surgeons to encourage patients with spinal disorders to leave home at a frequency similar to what they did pre-pandemic while avoiding crowded areas, despite the presence of the COVID-19 pandemic.</p>

DOI： 10.22603/ssrr.2021-0088

PubMed

CiNii Article

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

DOI： 10.22603/ssrr.2021-0011

PubMed

CiNii Article

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

<p><b>Background: </b>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.<b></b>The present<b></b>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><b>Methods:</b> 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><b>Results:</b> 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><b>Conclusions:</b> 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

PubMed

CiNii Article

Publishing type：Research paper (scientific journal)  

DOI： 10.11477/mf.5002201543

Publishing type：Research paper (scientific journal)  

＜文献概要＞はじめに　人生100年時代といわれる超長寿社会において,疫学的に医療の重要課題は"老化"といわれている.骨粗鬆症は老化に典型的な伴う疾患であり,人類に与える影響は各種がん以上とされる.基礎的臨床的集学的な研究が進み,骨粗鬆症が治療可能な時代となった理由のうち最も中心的な役割を担うのが薬物療法である.一方で,われわれ脊椎外科医が最前線に立って治療にあたるべき骨粗鬆症性椎体骨折(osteoporotic vertebral fracture:OVF)の治療成績は改善されているのであろうか.本稿では,われわれが15年以上にわたって注力してきた臨床OVFのデータとともに現在進行形の研究を紹介し,OVF研究の問題点と今後の展望を私見ながら提案したい.

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVE: Although minimally invasive endoscopic surgery techniques are established standard treatment choices for various degenerative conditions of the lumbar spine, the surgical indications of such techniques for specific cases, such as segments with ossification of the ligamentum flavum (OLF) or calcification of the ligamentum flavum (CLF), remain under investigation. Therefore, the authors aimed to demonstrate the short-term outcomes of minimally invasive endoscopic surgery in patients with degenerative lumbar disease with CLF or OLF. METHODS: This is a retrospective cohort study including consecutive patients who underwent microendoscopic posterior decompression at the authors' institution, where the presence of OLF and CLF did not influence the surgical indication. Fifty-nine patients with OLF and 39 patients with CLF on preoperative CT were identified from the database. Subsequently, two matched control groups (one each matched to the OLF and CLF groups) were created using propensity scores to adjust for age, sex, preoperative Japanese Orthopaedic Association (JOA) score and Oswestry Disability Index, and diagnosis. The background, surgical outcomes, and changes in clinical scores were compared between the matched groups. If there was a significant difference in the improvement of clinical scores, a multivariate linear regression model was applied. RESULTS: On performing univariate analysis, patients with OLF were found to have a higher body mass index (Mann-Whitney U-test, p = 0.001), higher incidence of preoperative motor weakness (chi-square test, p = 0.019), longer operative time (Mann-Whitney U-test, p < 0.001), and lower improvement in the JOA score (mixed-effects model, p = 0.023) than the matched controls. On performing multivariate analysis, the presence of OLF was identified as an independent variable associated with a poor recovery rate based on the JOA score (multivariate linear regression, p < 0.001). In contrast, there were no significant differences between patients with CLF and their matched controls in terms of preoperative and surgical data and postoperative improvements in clinical scores. CONCLUSIONS: Although the perioperative surgical outcomes, including the surgical complications, and the in-hospital period did not significantly differ, the short-term improvement in the JOA score was significantly lower in patients with degenerative lumbar disease accompanied by OLF than in the patients from the matched control group. In contrast, there were no significant differences in the short-term improvement in clinical scores and perioperative outcomes between patients with CLF and their matched control group. Thus, the surgical indications of minimally invasive posterior decompression for patients with CLF can be the same as those for patients without CLF; however, the indications for patients with OLF should be further investigated in future studies, including the other surgical methods.

DOI： 10.3171/2020.6.SPINE20946

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jinf.2020.08.052

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Although carpal tunnel syndrome (CTS) is exceedingly rare in children, its prevalence in those with Hunter syndrome, mucopolysaccharidosis type II, is high. With the advent of hematopoietic stem cell transplantation and enzyme replacement therapy, the survival of patients with Hunter syndrome has dramatically improved. With improved longevity in these patients, CTS continues to progress with age. However, most patients with Hunter syndrome with CTS have generally been treated with an open carpal tunnel release (OCTR) only, without considering the severity. Here, we present a mid-term follow-up of a 16-year-old patient with Hunter syndrome associated with severe bilateral CTS successfully treated by the simultaneous opposition tendon transfer with an OCTR to improve the thumb function. Intraoperatively, the median nerve was constricted and flattened with congestion by the transverse carpal ligament. External and internal neurolysis of the scarred median nerve were performed and found epineural fibrosis and tethered epineurium. An intraneural lipoma of the left median nerve was especially resected with epineurotomy. During neurolysis and tendon transfer, the soft tissue was very viscous, a characteristic of mucopolysaccharidoses. Transferring the tension of the palmaris longus tendon to the abductor pollicis brevis for the thumb palmar abduction should be stronger than routine adult patients because the soft tissue such as the tendon excursion is stickier and more contracted in patients with Hunter syndrome. Postoperatively, a thumb spica splint was applied for 3 weeks, and then active motion exercises were cautiously started to prevent joint contracture. Early recognition and surgical intervention for CTS are essential in patients with Hunter syndrome.

DOI： 10.1097/GOX.0000000000003251

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The aim of this study was to evaluate the impact of cervical disc degeneration (CDD) severity on 2-year postoperative outcomes following laminoplasty. SUMMARY OF BACKGROUND DATA: The impact of CDD on postoperative outcomes of cervical laminoplasty has not been well established. METHODS: A total of 144 patients who underwent open-door laminoplasty for cervical spondylotic myelopathy (CSM) were enrolled. Six cervical discs were independently analyzed for degeneration severity using a previously reported grading system (grade 0: none, grade 3: severest). The relationship between the segmental range of motion (ROM) and the severity of CDD was evaluated. Subsequently, after dividing overall patients into mild and severe CDD groups by the average of CDD scores, the mixed-effect model was applied to assess 2-year postoperative outcomes, including physician-assessed myelopathy scores, patient-reported outcomes, and preoperative radiographic parameters. Finally, as additional analysis, the severe CDD group was further divided into two groups: group 1 included patients with a grade 3 CDD change in their most stenotic level and group 2 included the others. The 2-year postoperative myelopathy score was compared between groups 1 and 2. RESULTS: The cervical segments with grade 3 CDD showed significantly smaller ROM compared with those with grade 0, 1, or 2 CDD (P < 0.01). There were no significant differences in postoperative improvements in myelopathy, pain, patient-reported physical and mental status, and radiographic parameters, except for quality of life (QOL) scores between CDD groups. A significant (P = 0.02) postoperative improvement in QOL scores was noted in the severe CDD group. In an additional analysis, myelopathy score at 2 years postoperatively was significantly higher in group 1 than group 2 (P = 0.041). CONCLUSION: The severity of CDD did not negatively impact 2-year postoperative laminoplasty outcomes. The postulated reason is that the decreased segmental instability in the level with severe CDD may affect surgical outcomes positively. LEVEL OF EVIDENCE: 3.

DOI： 10.1097/BRS.0000000000003528

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s12891-020-03539-0

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVE: Although numbness is one of the chief complaints of patients with cervical spondylotic myelopathy (CSM), preoperative factors relating to residual numbness of the upper extremity (UE) and impact of the outcomes on cervical surgery are not well established. The authors hypothesized that severe preoperative UE numbness could be a risk factor for residual UE numbness after surgery and that the residual UE numbness could have a negative impact on postoperative outcomes. Therefore, this study aimed to identify the preoperative factors that are predictive of residual UE numbness after cervical surgery and demonstrate the effects of residual UE numbness on clinical scores and radiographic parameters. METHODS: The study design was a retrospective cohort study. The authors analyzed data of 103 patients who underwent cervical laminoplasty from January 2012 to December 2014 and were followed up for more than 2 years postoperatively. The patients were divided into two groups: the severe residual-numbness group (postoperative visual analog scale [VAS] score for UE numbness > 40 mm) and the no/mild residual-numbness group (VAS score ≤ 40 mm). The outcome measures were VAS score, Japanese Orthopaedic Association scores for cervical myelopathy, physical and mental component summaries of the 36-Item Short-Form Health Survey (SF-36), radiographic film parameters (C2-7 sagittal vertical axis, range of motion, C2-7 lordotic angle, and C7 slope), and MRI findings (severity of cervical canal stenosis, snake-eye appearance, severity of foraminal stenosis). Following univariate analysis, which compared the preoperative factors between groups, the variables with p values < 0.1 were included in the multivariate linear regression analysis. Additionally, the changes in clinical scores and radiographic parameters after 2 years of surgery were compared using a mixed-effects model. RESULTS: Among 103 patients, 42 (40.8%) had residual UE numbness. In the multivariate analysis, sex and preoperative UE pain were found to be independent variables correlating with residual UE numbness (p = 0.017 and 0.046, respectively). The severity of preoperative UE numbness did not relate to the residual UE numbness (p = 0.153). The improvement in neck pain VAS score and physical component summary of the SF-36 was significantly low in the severe residual-numbness group (p < 0.001 and 0.040, respectively). CONCLUSIONS: Forty-one percent of the CSM patients experienced residual UE numbness for at least 2 years after cervical posterior decompression surgery. Female sex and preoperative severe UE pain were the predictive factors for residual UE numbness. The patients with residual UE numbness showed less improvement of neck pain and lower physical status compared to the patients without numbness.

DOI： 10.3171/2020.4.SPINE191566

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s12891-020-03452-6

PubMed

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DOI： 10.1007/s00586-019-06092-0

PubMed

Publishing type：Research paper (scientific journal)  

神経障害を伴う骨粗鬆症性椎体骨折患者403例を対象に、脊椎固定術を施行して、下位腰椎椎体骨折患者と胸腰椎移行部の椎体骨折患者における臨床的および放射線学的転帰を比較した。患者を、骨折部位に応じて下位腰椎(L3〜5)群76例(男性17例、女性59例、平均73.2±8.0歳)と腰椎移行部(T10〜L2)群327例(男性72例、女性255例、平均74.0±7.8歳)の2群に分類した。骨密度は下位腰椎群(0.59±0.21g/cm2)の方が胸腰椎移行部群(0.65±0.21g/cm2)より有意に低かった。年齢、性別、骨密度をマッチングし、下位腰椎群の患者1人に対して胸腰椎移行部群の患者2人を割り付け、L群73例とT群146例の2群に再分類した。手術時間および術中出血量に有意な群間差はなかった。融合セグメント数はT群(4.2±2.0)の方がL群(3.4±2.2)より有意に多かった(P<0.01)。内固定の機械的破綻率(mechanical failure)はL群(64%)の方がT群(39%)より有意に高かった(P<0.001)。周術期合併症および修正手術の発生率に有意な群間差はなく、臨床的および放射線学的転帰にも有意な群間差はなかった。

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

<p><b>Purpose: </b>There is no consensus of regarding the indication of surgical treatment of the less invasive decompression procedure for lumbar spinal stenosis (LSS). Although facet joint opening (FO) on preoperative computed tomography (CT) images has been reported as a parameter indicating segmental instability, there is no report on how FO affects on postoperative outcomes. The purpose of this study was to investigate risk factors for revision surgery after less invasive decompression surgery for LSS including FO by a minimum-5-year postoperative survey.</p><p><b>Materials and Methods: </b>A total of 244 patients who underwent microscopic or microendoscopic decompression surgery for LSS and followed for ≥5 years were included in this study. We investigated revision lumbar surgeries at the same levels or other lumbar levels based on medical records. Revision surgeries due to postoperative hematoma or infection were excluded. FO was defined as a ≥2 mm opening on preoperative axial CT images at each lumbar intervertebral level. We evaluated the FO at index decompression levels and sum of FO-positive levels from L1-2 to L5-S. Risk factors for further surgeries were investigated among demographics, preoperative symptoms, and radiological parameters other than FO using univariate and cox proportional hazard regression analysis.</p><p><b>Results: </b>There was 26 reoperations (10.7%) at a mean of 3.9 years after primary surgeries. FO at index decompression levels was significantly more frequent in patients with than without revision surgeries (69 and 39%, respectively, p=0.003). The sum of FO-positive levels among lumbar segments was significantly higher in patients with than without revision surgeries (2.0 and 1.2 levels, respectively, p=0.001). The cox proportional hazard regression analysis indicated that the sum of FO-positive levels among lumbar segments was one of the risk factors for revision surgery (p=0.003, adjusted hazard ratio: 1.47).</p><p><b>Conclusions: </b>The FO of index decompression levels and sum of FO were associated with the need for further lumbar surgeries after less invasive surgery. FO might indicate not only segmental instability but also predictive parameter for progression of degenerative change.</p>

DOI： 10.34371/jspineres.2020-0512

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Publishing type：Research paper (scientific journal)  

CTにおけるfacet joint opening(FO)は不安定性の指標になるとの報告がある一方で,腰椎変性疾患に対して低侵襲除圧術の限界について一定した見解がない.本研究は低侵襲除圧術で手術加療を行い最低5年の経過観察をしえた244例の再手術についてFOを含めて危険因子解析を行った.その結果,除圧椎間のFOのみならず,腰椎全体でFOをきたす椎間が多いことも再手術の危険因子であることが示された.(著者抄録)

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DOI： 10.1097/BRS.0000000000003337

PubMed

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DOI： 10.11359/chubu.2020.461

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17歳男。頸部痛を主訴とした。多発性線維性骨異形成症による併存症、L2・L3の動脈瘤様骨嚢腫に対してハイドロキシアパタイト(HA)を用いた椎体形成術の既往があり、頸椎単純CTでは後頭骨・頭蓋底および各頸椎椎体のすりガラス状陰影、C2椎体に骨溶解像と後壁の菲薄化、病的骨折を疑わせる後壁の一部途絶を認めた。線維性骨異形成症に伴うC2動脈瘤様骨嚢腫による切迫骨折と診断して内視鏡と術中CT navigation下に頸椎前方アプローチでHAを用いたC2椎体形成術を選択し、最小侵襲で安全に椎体形成術を行うことができた。病理診断は線維性骨異形成症に伴う動脈瘤性骨嚢腫で、術後1週の単純CTではC2内にHAが充填されており、脱出や隣接椎体に明らかな骨折などは認めなかった。

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DOI： 10.1364/OE.388302

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DOI： 10.3390/ijms21031171

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DOI： 10.3390/ijms21031171

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DOI： 10.18888/se.0000001183

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DOI： 10.1097/BSD.0000000000000849

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＜文献概要＞骨粗鬆症性椎体骨折は背部痛だけでなく,神経圧排や脊柱変形など様々な脊椎障害の原因となる。骨粗鬆症性椎体骨折に対する治療は薬物治療を含む保存治療から外科的治療まで多岐にわたり現在もエビデンスの構築が進んでいる。椎体形成術に対するエビデンスは本邦を中心として蓄積が進んでいるが,椎体形成術以外の外科的治療に関しては病態のバリエーションが多く,一定の見解が得られていないのが現状である。椎体形成術以外の外科的手術方法の選択には病態の把握が重要であり,病態に即してin situ固定,椎体形成術+後方固定,前方固定,骨切り術を含めた変形矯正などが選択され,時にはそれらを同時に行うこともある。前方固定術では局所後彎の矯正は可能であるが,短い後方固定では脊柱アライメント矯正は得られないが満足な除痛効果とADLの改善は得られることから,病態に即した術式選択が重要であるといえる。

Publishing type：Research paper (scientific journal)  

Most complications related to posterior spinal fusion (PSF) are reported to be caused by direct injury of the pedicle screws or by an indirect mechanical load generated by the deformity correction during surgery. Primary spontaneous pneumothorax (PSP) is caused by the rupture of bulla/bleb, and is a very rare complication after scoliosis surgery. Herein, we present two cases of delayed-onset PSP after scoliosis surgery. In Case 1, an 18-year-old woman with adolescent idiopathic scoliosis (Lenke 1CN) underwent PSF at T2-L2. The correction rate was 80%. The patient was discharged at 2 weeks after the operation. On the 18th postoperative day, she suddenly felt dyspnea after back pain at home, and walked to an outpatient clinic. She was diagnosed with PSP of the left lung by whole spine X-ray. In Case 2, a 20-year-old woman with idiopathic scoliosis (Lenke 6CN) underwent PSF at T3-L4. The correction rate was 73.6% in the thoracic region and 67.5% in the lumbar region. The patient felt dyspnea at three months after the operation. She was diagnosed with PSP (tension pneumothorax) in the left lung by whole spine X-ray. Both cases underwent video-assisted bulla resection following several days of emergency thoracic drainage, after which the subjects became asymptomatic. PSP should be considered as a complication of PSF when patients show dyspnea following back pain at several weeks after the operation. The presence of bullae/blebs should be examined by perioperative computed tomography to predict the occurrence of PSP.

DOI： 10.4103/isj.isj_16_19

Publishing type：Research paper (scientific journal)  

<p><b>Introduction</b>: Osteoporotic vertebral fracture (OVF) is the most common osteoporotic fracture, and some patients require surgical intervention to improve their impaired activities of daily living with neurological deficits. However, many previous reports have focused on OVF around the thoracolumbar junction, and the surgical outcomes of lumbar OVF have not been thoroughly discussed. We aimed to investigate the surgical outcomes for lumbar OVF with a neurological deficit.</p><p><b>Methods: </b>Patients who underwent fusion surgery for thoracolumbar OVF with a neurological deficit were enrolled at 28 institutions. Clinical information, comorbidities, perioperative complications, Japanese Orthopaedic Association scores, visual analog scale scores, and radiographic parameters were compared between patients with lower lumbar fracture (L3-5) and those with thoracolumbar junction fracture (T10-L2). Each patient with lower lumbar fracture (L group) was matched with to patients with thoracolumbar junction fracture (T group).</p><p><b>Results: </b>A total 403 patients (89 males and 314 females, mean age: 73.8 ± 7.8 years, mean follow-up: 3.9 ± 1.7 years) were included in this study. Lower lumbar OVF was frequently found in patients with lower bone mineral density. After matching, mechanical failure was more frequent in the L group (L group: 64%, T group: 39%; p < 0.001). There was no difference between groups in the clinical and radiographical outcomes, although the rates of complication and revision surgery were still high in both groups.</p><p><b>Conclusions: </b>The surgical intervention for OVF is effective in patients with myelopathy or radiculopathy regardless of the surgical level, although further study is required to improve clinical and radiographical outcomes.</p>

DOI： 10.22603/ssrr.2019-0079

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DOI： 10.1371/journal.pone.0239440

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<p>Introduction: Osteoporotic vertebral fracture (OVF) is the most common osteoporotic fracture, and some patients require surgical intervention to improve their impaired activities of daily living with neurological deficits. However, many previous reports have focused on OVF around the thoracolumbar junction, and the surgical outcomes of lumbar OVF have not been thoroughly discussed. We aimed to investigate the surgical outcomes for lumbar OVF with a neurological deficit.</p><p>Methods: Patients who underwent fusion surgery for thoracolumbar OVF with a neurological deficit were enrolled at 28 institutions. Clinical information, comorbidities, perioperative complications, Japanese Orthopaedic Association scores, visual analog scale scores, and radiographic parameters were compared between patients with lower lumbar fracture (L3-5) and those with thoracolumbar junction fracture (T10-L2). Each patient with lower lumbar fracture (L group) was matched with to patients with thoracolumbar junction fracture (T group).</p><p>Results: A total 403 patients (89 males and 314 females, mean age: 73.8 ± 7.8 years, mean follow-up: 3.9 ± 1.7 years) were included in this study. Lower lumbar OVF was frequently found in patients with lower bone mineral density. After matching, mechanical failure was more frequent in the L group (L group: 64%, T group: 39%; p < 0.001). There was no difference between groups in the clinical and radiographical outcomes, although the rates of complication and revision surgery were still high in both groups.</p><p>Conclusions: The surgical intervention for OVF is effective in patients with myelopathy or radiculopathy regardless of the surgical level, although further study is required to improve clinical and radiographical outcomes.</p><p>Level of evidence: Level III</p>

DOI： 10.22603/ssrr.2019-0079

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Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

DOI： 10.22603/ssrr.2020-0033

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DOI： 10.3389/fpsyg.2020.02149

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DOI： 10.1038/s41598-019-55054-5

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DOI： 10.1038/s41598-019-55054-5

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DOI： 10.1097/BRS.0000000000003337

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DOI： 10.1038/s41598-019-53053-0

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DOI： 10.1016/j.jos.2019.07.018

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DOI： 10.1159/000503051

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DOI： 10.1016/j.jos.2019.08.015

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DOI： 10.1007/s00280-019-03934-y

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胸腰椎の骨粗鬆症性椎体骨折(OVF)に対する脊椎固定術の術後成績について検討した。脊椎固定術を施行され、2年以上の経過観察が可能であったOVF症例315例を対象とし、術式に基づいて前方固定群(ASF群)19例(男性6例、女性13例、中央値70歳)、前方/後方併用固定群(APSF群)27例(男性5例、女性22例、中央値72歳)、後方固定群(PSF群)40例(男性11例、女性29例、中央値75歳)、3-カラム骨切り+後方固定群(3CO群)92例(男性4例、女性88例、中央値72歳)、椎体形成+後方固定群(VP+PSF群)137例(男性42例、女性95例、中央値77歳)に分類した。平均手術時間はAPSF群が最も長く、術中出血量は3CO群の方がPSF群、VP+PSF群より多かった。周術期合併症の発症率に有意な群間差はなかった。術後の局所後彎角はPSF群を除く各群で有意に改善しており、改善度はAPSF群と3CO群が他の手技群と比較して良好であった。器具破損は59例(18.7%)にみられ、有意な群間差はみられなかった。また、腰痛と下肢痛のVASスコアは各群とも術後に有意に改善し、有意な群間差はなかった。JOAスコアも各群で有意に改善したが、ASF群の回復率は他の手技群と比較して低値を示していた。今回検討した5種類の脊椎固定術はいずれも神経学的・機能的成績の改善に優れていると考えられた。

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神経障害を伴う骨粗鬆症性椎体圧潰(OVC)に対する脊椎固定術後の合併症の発症率とリスク因子について検討した。OVC患者403例(男性89例、女性314例、平均73.8±7.8歳)を対象とする後ろ向き多施設共同研究を実施した。年齢、性別、BMI等の患者データを収集するとともに、術後6週以内に生じた合併症を調査した。その結果、術中合併症を15例(3.7%)に認め、硬膜断裂、神経障害、大量出血、静脈損傷などがみられた。6週以内の術後合併症の発症は57例(14.1%)であり、せん妄、硬膜外血腫、手術部位感染症、深部静脈血栓症、肺炎、尿路感染症、脳梗塞、心不全がみられた。このうち、せん妄が23例(5.7%)と最も多く、死亡例はなかった。脊椎固定に際して5種類の手技が用いられていたが、合併症の発症率に差はみられなかった。単変量解析では術後合併症の発症は高齢者、男性、肝疾患、パーキンソン病に多く、BMI、喫煙歴、ステロイドの服用、疼痛VAS、JOAスコア、手術手技、手術時間、予測出血量と合併症発症との関連はみられなかった。単変量解析では、術後合併症発症の独立リスク因子として、年齢、肝疾患、パーキンソン病が抽出された。

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DOI： 10.1016/j.jos.2019.07.018

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DOI： 10.1016/j.jos.2019.08.015

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DOI： 10.1097/BRS.0000000000003089

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DOI： 10.1097/BRS.0000000000003089

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DOI： 10.1016/j.spinee.2019.06.001

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骨粗鬆症性椎体圧迫骨折(OVF)偽関節に対する外科的治療のアウトカムについて検討した。後ろ向き多施設研究を実施し、OVF後に椎体圧潰または偽関節による神経障害をきたし、骨折固定術を施行した403例(男性89例、女性314例、平均73.8±7.8歳)を対象とした。術後1年以上にわたり経過観察を行い、術前と最終観察時のX線学的・臨床的アウトカムを評価した。平均手術時間は256.8±115.0分、平均出血量は676.3±1166.9gであり、周術期合併症の発症率は18.1%、せん妄を23例、硬膜破砕を5例、深部感染を4例、表在性感染を4例、血腫を4例、肺炎を3例、深部静脈血栓を3例に認めた。また、機器不全が41.2%にみられ、椎弓根スクリューの緩みが最も多かった。術前局所後彎角は22.0±16.9°であったが、5.2±13.1°に補正され、最終観察時には12.0±15.2°となっていた。腰痛と下肢痛のVASスコアは術後に有意に改善を示し、JOAスコアも最終観察時に有意な改善を認めた。歩行不能であったのは術前が52.4%であったが、最終観察時には7.5%に減少していた。偽関節を有する骨粗鬆症性椎体圧迫骨折に対して、骨折固定法は有用であることが示された。

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DOI： 10.1007/s00586-019-06066-2

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DOI： 10.1007/s00586-019-06066-2

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DOI： 10.1007/s00586-019-06092-0

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DOI： 10.11477/mf.5002201171

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DOI： 10.11477/mf.5002201177

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DOI： 10.15106/j_seikei70_857

CiNii Article

Publishing type：Research paper (scientific journal)  

＜文献概要＞はじめに　Diffuse idiopathic skeletal hyperostosis(DISH)は,Resnickらにより定義された椎体に骨性架橋を認める病態である.DISHの弊害の中で脊椎脊髄外科医にとって最も特徴的なものは,DISHに伴う椎体骨折である.DISHによる椎体骨折は低エネルギー外傷で起こり得,遅発性神経麻痺,また骨折部の高度な不安定性に留意するべきと報告されている.これらはDISHによる骨性架橋による長いレバーアームのため,骨折部へ応力が集中され引き起こされると考えられている.同様の機序で,慢性疾患である腰部脊柱管狭窄症に対してもDISHは負の影響があると推察されるが,古くにDISHと脊柱管狭窄に関する症例報告がなされて以降,まとまった症例での報告は数少ない.本稿では,著者らの臨床研究結果も交えて,DISHの腰椎変性疾患への影響に焦点を当てて解説する.

Publishing type：Research paper (scientific journal)  

＜文献概要＞はじめに　近年,びまん性特発性骨増殖症(diffuse idiopathic skeletal hyperostosis:DISH)に対する関心が高まりつつある.DISHは前縦靱帯骨化を主病変とする病態から脊柱不撓性をもたらすものの,後縦靱帯骨化症(ossification of the posterior longitudinal ligament:OPLL)や黄色靱帯骨化症(ossification of the yellow ligament:OYL)とは異なり単独で神経障害や著しい疼痛をもたらすことはまれな疾患である.しかしながら,高齢者の脊椎疾患の治療を行っていると,DISHが背景に存在する脊椎外傷や変性疾患に遭遇することは少なくない.本稿では,DISHに関する本邦の臨床研究の歴史を振り返り,疫学知見に関するレビューを行った.

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.spinee.2019.02.013

PubMed

Publishing type：Research paper (scientific journal)  

71歳女性。右下肢痛が出現し、黄色靱帯石灰化症による右L2/L3椎間孔部狭窄症と診断され、L2/L3右椎間孔拡大術が施行された。その後、黄色靱帯石灰化症による右L3/L4椎間孔部狭窄症に対しL3/L4椎間孔拡大術を施行した。今回、右下肢痛、しびれが再度出現し、黄色靱帯石灰化症によるL2/L3、L3/L4腰部脊柱管狭窄を認めたため、L2/L3、L3/L4顕微鏡下後方除圧術を行った。その結果、術後は右下肢の疼痛は速やかに改善したが、しびれは残存した。

Publishing type：Research paper (scientific journal)  

＜文献概要＞はじめに　Diffuse idiopathic skeletal hyperostosis(DISH)は,Resnickらにより定義された椎体に骨性架橋を認める病態である.DISHの弊害の中で脊椎脊髄外科医にとって最も特徴的なものは,DISHに伴う椎体骨折である.DISHによる椎体骨折は低エネルギー外傷で起こり得,遅発性神経麻痺,また骨折部の高度な不安定性に留意するべきと報告されている.これらはDISHによる骨性架橋による長いレバーアームのため,骨折部へ応力が集中され引き起こされると考えられている.同様の機序で,慢性疾患である腰部脊柱管狭窄症に対してもDISHは負の影響があると推察されるが,古くにDISHと脊柱管狭窄に関する症例報告がなされて以降,まとまった症例での報告は数少ない.本稿では,著者らの臨床研究結果も交えて,DISHの腰椎変性疾患への影響に焦点を当てて解説する.

Publishing type：Research paper (scientific journal)  

＜文献概要＞はじめに　近年,びまん性特発性骨増殖症(diffuse idiopathic skeletal hyperostosis:DISH)に対する関心が高まりつつある.DISHは前縦靱帯骨化を主病変とする病態から脊柱不撓性をもたらすものの,後縦靱帯骨化症(ossification of the posterior longitudinal ligament:OPLL)や黄色靱帯骨化症(ossification of the yellow ligament:OYL)とは異なり単独で神経障害や著しい疼痛をもたらすことはまれな疾患である.しかしながら,高齢者の脊椎疾患の治療を行っていると,DISHが背景に存在する脊椎外傷や変性疾患に遭遇することは少なくない.本稿では,DISHに関する本邦の臨床研究の歴史を振り返り,疫学知見に関するレビューを行った.

Publishing type：Research paper (scientific journal)  

DOI： 10.1097/BSD.0000000000000849

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00586-019-05942-1

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00586-019-05904-7

PubMed

Publishing type：Research paper (scientific journal)  

<p>Introduction: Despite ongoing improvements in both dialysis and surgical techniques, spinal surgery in patients undergoing hemodialysis (HD) is a challenge to surgeons because of the high mortality rate. However, no previous studies have examined clinical outcomes after lumbar surgery in HD patients. The purpose of this study is to compare clinical outcomes and complication rates after lumbar spinal surgery in patients with or without hemodialysis.</p><p>Methods: This retrospective, matched cohort study was conducted to compare surgical outcomes between HD vs non-HD patients who underwent lumbar surgery at our hospital. Controls were individually matched to cases at a ratio of 1:2. Clinical outcomes, complications, and mortality rates were compared between the two groups.</p><p>Results: Twenty-nine patients in the HD group and 57 in the non-HD group were included in the current study. Five patients in the HD group died during the follow-up period, whereas no patients died in the non-HD group (mortality rate, 17.2% vs. 0%, <i>P</i> = 0.003). Japanese Orthopaedic Association (JOA) scores were significantly less improved in the HD group than in the non-HD group (11.9 vs. 14.2 preoperatively, <i>P</i> = 0.001; 19.9 vs. 25.1 at final follow-up, <i>P</i> < 0.001). Five patients underwent repeat surgery in the HD group, which was significantly higher than the non-HD group (17.2% vs. 3.5%, <i>P</i> = 0.041).</p><p>Conclusions: The current study indicates that patients undergoing HD had poor outcomes after lumbar spinal surgery. Moreover, 5 of 29 patients died within a mean 2.4-years follow-up. The indications for lumbar spine surgery in HD patients must be carefully considered because of poor surgical outcomes and high mortality rate.</p>

DOI： 10.22603/ssrr.2018-0025

PubMed

CiNii Article

Publishing type：Research paper (scientific journal)  

<p>Introduction: Approximately 3% of osteoporotic vertebral fractures develop osteoporotic vertebral collapse (OVC) with neurological deficits, and such patients are recommended to be treated surgically. However, a proximal junctional fracture (PJFr) following surgery for OVC can be a serious concern. Therefore, the aim of this study is to identify the incidence and risk factors of PJFr following fusion surgery for OVC.</p><p>Methods: This study retrospectively analyzed registry data collected from facilities belonging to the Japan Association of Spine Surgeons with Ambition (JASA) in 2016. We retrospectively analyzed 403 patients who suffered neurological deficits due to OVC below T10 and underwent corrective surgery; only those followed up for ≥2 years were included. Potential risk factors related to the PJFr and their cut-off values were calculated using multivariate logistic regression analysis and receiver operating characteristic (ROC) analysis.</p><p>Results: Sixty-three patients (15.6%) suffered PJFr during the follow-up (mean 45.7 months). In multivariate analysis, the grade of osteoporosis (grade 2, 3: adjusted odds ratio (aOR) 2.92; p=0.001) and lower instrumented vertebra (LIV) level (sacrum: aOR 6.75; p=0.003) were independent factors. ROC analysis demonstrated that lumbar bone mineral density (BMD) was a predictive factor (area under curve: 0.72, p=0.035) with optimal cut-off value of 0.61 g/cm² (sensitivity, 76.5%; specificity, 58.3%), but that of the hip was not (p=0.228).</p><p>Conclusions: PJFr was found in 16% cases within 4 years after surgery; independent risk factors were severe osteoporosis and extended fusion to the sacrum. The lumbar BMD with cut-off value 0.61 g/cm² may potentially predict PJFr. Our findings can help surgeons select perioperative adjuvant therapy, as well as a surgical strategy to prevent PJFr following surgery.</p>

DOI： 10.22603/ssrr.2018-0068

PubMed

CiNii Article

Publishing type：Research paper (scientific journal)  

DOI： 10.11477/mf.1408201329

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)   Kind of work：Single Work  

＜文献概要＞超高齢社会の現在,骨粗鬆症性椎体骨折(OVFs)に対する治療は大きな問題である.従来,保存療法と薬物療法が基本とされてきたが,奏効しない場合には外科的介入が必要となる.椎体形成術の登場によりOVFsに対する治療戦略は大きく変化したが,椎体形成術だけで解決できない椎体骨折例も多数存在し,それらに対しては脊椎固定術が必要となる.脊椎固定の手術手技はIn situ固定,椎体形成術+後方固定,骨切り,前方固定など多岐にわたり,病態に応じた術式の選択と合併症を回避する高度な技術力が要求される.

Publishing type：Research paper (scientific journal)  

腰椎手術後の臨床転帰と合併症率を血液透析(HD)の有無で比較した。2010年1月〜2015年12月に当施設で腰椎手術を施行されたHD患者と非HD患者を比較する後ろ向き対応コホート研究を実施した。臨床転帰は日本整形外科学会(JOA)スコアで、腰痛、下肢痛、下肢のしびれは視覚アナログスケール(VAS)で評価した。HD群29例(男性58.6%、平均69.7±6.8歳)と非HD群57例(男性57.9%、平均70.1±6.7歳)を比較した。HD群のJOAスコアは8.0改善し、非HD群の10.9よりも改善度が有意に低かった。腰痛、下肢痛、下肢のしびれに対するVASスコアの改善はHD群と非HD群で差はなかった。経過観察期間中、HD群では5例が死亡したのに対し、非HD群では死亡が認められず、死亡率はHD群が有意に高かった。再手術率はHD群が17.2%で非HD群の3.5%よりも有意に高かった。

Publishing type：Research paper (scientific journal)  

骨粗鬆症性椎体圧潰(OVC)に対する外科的治療後のproximal junctional fracture(PJFr)の発生率と独立危険因子を同定した。Japan Association of Spine Surgeons with Ambitionに所属する機関の2016年の登録データを後ろ向きに解析した。T10以下のOVCによる神経障害に対して矯正手術を実施し、2年以上経過観察を行った403例(女性331例、男性72例、平均73.8±7.8歳)を解析した。63例にPJFrを認めた。多重ロジスティック回帰分析の結果、骨粗鬆症のグレードとlower instrumented vertebraレベルがPJFrの独立危険因子であった。受信者動作特性曲線解析では、腰椎骨密度が良好な予測能の有意な因子であったが、股関節骨密度は有意な因子ではなかった。初回手術後のPJFrの予測に対する最適カットオフ値は腰椎骨密度0.61g/cm2であった。

Publishing type：Research paper (scientific journal)  

＜文献概要＞超高齢社会の現在,骨粗鬆症性椎体骨折(OVFs)に対する治療は大きな問題である.従来,保存療法と薬物療法が基本とされてきたが,奏効しない場合には外科的介入が必要となる.椎体形成術の登場によりOVFsに対する治療戦略は大きく変化したが,椎体形成術だけで解決できない椎体骨折例も多数存在し,それらに対しては脊椎固定術が必要となる.脊椎固定の手術手技はIn situ固定,椎体形成術+後方固定,骨切り,前方固定など多岐にわたり,病態に応じた術式の選択と合併症を回避する高度な技術力が要求される.

Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s12891-019-2473-8

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s12891-019-2473-8

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00586-019-05942-1

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1097/BRS.0000000000002829

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.spinee.2019.02.013

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1097/BRS.0000000000002829

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00586-019-05904-7

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.spinee.2018.06.343

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00586-018-5858-8

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.spinee.2018.06.343

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00586-018-5858-8

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1097/BRS.0000000000002769

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1097/BRS.0000000000002769

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jos.2018.08.023

PubMed

Publishing type：Research paper (scientific journal)  

手術を必要とする腰部脊柱管狭窄症(LSS)患者とLSSの症状のない被験者における広汎性特発性骨増殖症(DISH)の有病率を調査し、手術を必要とするLSSとDISHとの関連を明らかにした。症候性LSSに対して手術を実施した患者2363例(男性49.8%、平均68.0±8.4歳)とLSSのない対照787例(男性33.4%、平均67.2±12.4歳)を調査した。DISHの有病率はX線検査でLSSのない無症候性対照では14.4%、X線検査でLSSのある無症候性対照では21.1%、手術を必要とするLSS患者では31.7%で、有意に増加した。DISHの分布は群間で同様であったが、手術を必要とするLSS患者では胸郭下部と上部中央腰椎域の頻度が高かった。年齢、性別、BMI、糖尿病の補正後、多変量解析ではDISHが手術を必要とするLSSに関連する独立因子であった。手術を必要とするLSS患者では、DISHのない患者よりも手術を必要とするDISH患者において、腰椎上部での狭窄と多層狭窄の高発生率が観察された。DISHによる下部可動域における減少によって、LSSの発症または重度が増加することが示唆された。

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jos.2018.08.023

PubMed

Publishing type：Research paper (scientific journal)  

防腐処理死体20検体を用いて、胸椎黄色靱帯の解剖学的解明を試みた。全椎体を採取後に椎弓根を垂直面で切断、T1/T2からT12/L1の黄色靱帯を造影剤で染色し、CT像によって形状と椎体骨構造との関係を評価した。その結果、胸椎の層間腔内に左右二つの黄色靱帯が存在しており、腹側でcranial laminae、背側でcaudal laminaeを被覆していた。正中における黄色靱帯の高さは頭側から尾側に向かって徐々に増大しており、平均高はT1/T2で11.8±1.6mm、T12/L1で15.1±0.1mmを示していた。黄色靱帯の幅も頭側から尾側にかけて緩やかに増加しており、平均幅はT1/T2で13.8±1.4mm、T12/L1で17.8±1.6mmであった。なお、いずれの脊椎レベルでも幅に有意な左右差はなかった。また、黄色靱帯によるcaudal laminaの被覆率は上位脊椎から下位脊椎に向かって徐々に増加し、平均被覆率はT1で31.7%、T12で41.7%であったが、cranial laminaの被覆率は減少しており、平均被覆率はT2で12.6%、L1で4.3%であった。黄色靱帯で被覆されない空白域に関して脊椎レベルでの差はなく、平均53.9±2.5%を示していた。胸椎椎間孔において、黄色靱帯は椎間関節をT2/T3からT12/L1のレベルで被覆していたが、T1/T2レベルでの被覆はみられなかった。

Publishing type：Research paper (scientific journal)  

手術を必要とする腰部脊柱管狭窄症(LSS)患者とLSSの症状のない被験者における広汎性特発性骨増殖症(DISH)の有病率を調査し、手術を必要とするLSSとDISHとの関連を明らかにした。症候性LSSに対して手術を実施した患者2363例(男性49.8%、平均68.0±8.4歳)とLSSのない対照787例(男性33.4%、平均67.2±12.4歳)を調査した。DISHの有病率はX線検査でLSSのない無症候性対照では14.4%、X線検査でLSSのある無症候性対照では21.1%、手術を必要とするLSS患者では31.7%で、有意に増加した。DISHの分布は群間で同様であったが、手術を必要とするLSS患者では胸郭下部と上部中央腰椎域の頻度が高かった。年齢、性別、BMI、糖尿病の補正後、多変量解析ではDISHが手術を必要とするLSSに関連する独立因子であった。手術を必要とするLSS患者では、DISHのない患者よりも手術を必要とするDISH患者において、腰椎上部での狭窄と多層狭窄の高発生率が観察された。DISHによる下部可動域における減少によって、LSSの発症または重度が増加することが示唆された。

Publishing type：Research paper (scientific journal)  

症例は48歳女性で、右遠位上手部と前腕の進行性脱力を呈していた。症状は15歳時に始まり、右手の冷感も伴っていた。3年後には右手指の伸展が困難となり、寒冷気候中では巧緻運動障害も経験していた。筋力低下の悪化も進行し、近位同側下肢の緩徐な進行性脱力も現れたため当院に来院した。神経学的検査で、右遠位上肢の顕著な萎縮と鷲手変形が明らかとなり、罹患した前腕の尺骨側と手で中程度から重度の感覚障害が観察された。頸部MRIでは、C4-5、C5-6、C6-7レベルでのT2強調画像上に高輝度領域を伴う非対称な前後方向平坦化が見られ、屈位の頸部MRIでは後部硬膜壁の変位がない脊髄前方移動、当該脊髄のC4-5およびC5-6レベルでの圧迫が明らかとなった。C4-5およびC5-6レベルでの前方除圧固定術を行い、ポリエーテルエーテルケトンケージを各椎体間スペースに配置して頸椎前彎を達成した。術後2年で右足は完全な強さを維持しているが、右遠位上肢の顕著な萎縮と鷲手変形は残存している。

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.lungcan.2018.11.039

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00774-017-0901-0

PubMed

Publishing type：Research paper (scientific journal)  

<p>Introduction: The prevalence of patients with osteoporosis continues to increase in aging societies, including Japan. The first choice for managing osteoporotic vertebral compression fracture (OVF) is conservative treatment. Failure in conservative treatment for OVF may lead to non-union or vertebral collapse, resulting in neurological deficit and subsequently requiring surgical intervention. This multicenter nationwide study in Japan was conducted to comprehensively understand the outcomes of surgical treatments for OVF non-union.</p><p>Methods: This multicenter, retrospective study included 403 patients (89 males, 314 females, mean age 73.8 ± 7.8 years, mean follow-up 3.9 ± 1.7 years) with neurological deficit due to vertebral collapse or non-union after OVF at T10-L5 who underwent fusion surgery with a minimum 1-year follow-up. Radiological and clinical outcomes at baseline and at the final follow-up (FU) were evaluated.</p><p>Results: OVF was present at a thoracolumbar junction such as T12 (124 patients) and L1 (117 patients). A majority of OVF occurred after a minor trauma, such as falling down (55.3%) or lifting objects (8.4%). Short segment fusion, including affected vertebra, was conducted (mean 4.0 ± 2.0 vertebrae) with 256.8 minutes of surgery and 676.1 g of blood loss. A posterior approach was employed in 86.6% of the patients, followed by a combined anterior and posterior (8.7%), and an anterior (4.7%) approach. Perioperative complications and implant failures were observed in 18.1% and 41.2%, respectively. VAS scores of low back pain (74.7 to 30.8 mm) and leg pain (56.8 to 20.7 mm) improved significantly at FU. Preoperatively, 52.6% of the patients were unable to walk and the rate of non-ambulatory patients decreased to 7.5% at FU.</p><p>Conclusions: This study demonstrated that substantial improvement in activity of daily living (ADL) was achieved by fusion surgery. Although there was a considerable rate of complications, fusion surgery is beneficial for elderly OVF patients with non-union.</p>

DOI： 10.22603/ssrr.2019-0004

CiNii Article

Publishing type：Research paper (scientific journal)  

DOI： 10.1159/000503051

PubMed

Publishing type：Research paper (scientific journal)  

<p>Introduction: The prevalence of patients with osteoporosis continues to increase in aging societies, including Japan. The first choice for managing osteoporotic vertebral compression fracture (OVF) is conservative treatment. Failure in conservative treatment for OVF may lead to non-union or vertebral collapse, resulting in neurological deficit and subsequently requiring surgical intervention. This multicenter nationwide study in Japan was conducted to comprehensively understand the outcomes of surgical treatments for OVF non-union.</p><p>Methods: This multicenter, retrospective study included 403 patients (89 males, 314 females, mean age 73.8 ± 7.8 years, mean follow-up 3.9 ± 1.7 years) with neurological deficit due to vertebral collapse or non-union after OVF at T10-L5 who underwent fusion surgery with a minimum 1-year follow-up. Radiological and clinical outcomes at baseline and at the final follow-up (FU) were evaluated.</p><p>Results: OVF was present at a thoracolumbar junction such as T12 (124 patients) and L1 (117 patients). A majority of OVF occurred after a minor trauma, such as falling down (55.3%) or lifting objects (8.4%). Short segment fusion, including affected vertebra, was conducted (mean 4.0 ± 2.0 vertebrae) with 256.8 minutes of surgery and 676.1 g of blood loss. A posterior approach was employed in 86.6% of the patients, followed by a combined anterior and posterior (8.7%), and an anterior (4.7%) approach. Perioperative complications and implant failures were observed in 18.1% and 41.2%, respectively. VAS scores of low back pain (74.7 to 30.8 mm) and leg pain (56.8 to 20.7 mm) improved significantly at FU. Preoperatively, 52.6% of the patients were unable to walk and the rate of non-ambulatory patients decreased to 7.5% at FU.</p><p>Conclusions: This study demonstrated that substantial improvement in activity of daily living (ADL) was achieved by fusion surgery. Although there was a considerable rate of complications, fusion surgery is beneficial for elderly OVF patients with non-union.</p>

DOI： 10.22603/ssrr.2019-0004

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CiNii Article

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jocn.2018.08.032

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DOI： 10.1055/s-0038-1666847

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Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jocn.2018.08.032

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Publishing type：Research paper (scientific journal)  

DOI： 10.1055/s-0038-1666847

PubMed

Publishing type：Research paper (scientific journal)  

関節リウマチ(RA)の腰椎病変にはすべり・側彎・椎体骨折が含まれるが、これらはいずれも非RA患者でもみられる。本研究はRA腰椎病変を合併する脊柱管狭窄症手術を行った15例と年齢・性別・病態・手術術式をmatchさせた非RA患者25例の術後成績を比較検討した。その結果、術前画像が同様のRA群/非RA群で臨床成績に差がなかったものの固定後隣接椎間障害・除圧後すべり増強がRAで多くみられる傾向にあった。(著者抄録)

Publishing type：Research paper (scientific journal)  

関節リウマチ(RA)の腰椎病変にはすべり・側彎・椎体骨折が含まれるが、これらはいずれも非RA患者でもみられる。本研究はRA腰椎病変を合併する脊柱管狭窄症手術を行った15例と年齢・性別・病態・手術術式をmatchさせた非RA患者25例の術後成績を比較検討した。その結果、術前画像が同様のRA群/非RA群で臨床成績に差がなかったものの固定後隣接椎間障害・除圧後すべり増強がRAで多くみられる傾向にあった。(著者抄録)

Publishing type：Research paper (scientific journal)  

予後不良因子(MRI・T2強調画像における高信号あるいは低信号広範)を持つ骨粗鬆症性新鮮椎体骨折に対するBKP早期介入の多施設単群前向き介入試験における中間解析では、BKP早期介入の45例は、同一の予後不良因子を持ち保存治療を受けた患者で性・年齢・骨折高位をマッチさせた45例との比較で、有意にADLの低下を防ぎ、QOLを回復させ、椎体変形を改善した。しかし隣接椎体骨折の発生は高率に認められた。(著者抄録)

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jdsr.2017.12.001

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Publishing type：Research paper (scientific journal)  

予後不良因子(MRI・T2強調画像における高信号あるいは低信号広範)を持つ骨粗鬆症性新鮮椎体骨折に対するBKP早期介入の多施設単群前向き介入試験における中間解析では、BKP早期介入の45例は、同一の予後不良因子を持ち保存治療を受けた患者で性・年齢・骨折高位をマッチさせた45例との比較で、有意にADLの低下を防ぎ、QOLを回復させ、椎体変形を改善した。しかし隣接椎体骨折の発生は高率に認められた。(著者抄録)

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DOI： 10.11477/mf.5002200823

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DOI： 10.1097/BSD.0000000000000617

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DOI： 10.1097/BSD.0000000000000590

Publishing type：Research paper (scientific journal)  

DOI： 10.1097/BSD.0000000000000617

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Publishing type：Research paper (scientific journal)  

＜文献概要＞はじめに　腰椎椎間板ヘルニアに対する手術療法(椎間板摘出術)として,顕微鏡下椎間板ヘルニア摘出術(microscopic discectomy:MD)や内視鏡下椎間板ヘルニア摘出術(microendoscopic discectomy:MED),経皮的内視鏡下椎間板ヘルニア摘出術(percutaneous endoscopic lumbar discectomy:PELD)など,さまざまな低侵襲手術手技が確立している.一般患者におけるそれら低侵襲手術手技の成績は非常に良好であり,術式間で大きな差はないとされている5).しかし,アプローチやワーキングスペースの大きさなど各術式の特徴とそれらの手技に適するヘルニアのタイプについて知っておく必要がある.本稿では,アスリートの腰椎椎間板ヘルニアの手術に関して,どのような場合にMEDが適しているか,実際にMEDを行う際の注意点,MED術後のスポーツ復帰の状況などについて述べる.

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DOI： 10.1158/0008-5472.CAN-17-1904

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DOI： 10.1007/s00774-017-0901-0

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DOI： 10.1016/j.jos.2017.09.019

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2012年1月-2016年1月にバルーン後彎形成術を受けた連続患者72例を対象とした多施設共同コホート研究を行った。患者を有痛性骨粗鬆症性椎体骨折(OVF)発症後の後彎形成術時期に応じた2群(早期群(2ヵ月以内):女性19名、男性8名、平均年齢79.9歳、晩期群(2ヵ月より後):女性31名、男性14名、平均年齢77.9歳)に分けて解析した。6ヵ月超継続して追跡した。晩期群では術前の骨折椎体の角運動と前方椎体高の圧迫が大きかった。年齢および術前転帰について調整した最終転帰では、早期群で晩期群よりも腰痛の視覚的アナログ尺度(VAS)スコアが低くなった。最終の相対前方椎体高および後彎角は、早期群で晩期群よりも大きく維持されたが、絶対差は有意ではなかった。

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jos.2017.09.019

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Publishing type：Research paper (scientific journal)  

2012年1月-2016年1月にバルーン後彎形成術を受けた連続患者72例を対象とした多施設共同コホート研究を行った。患者を有痛性骨粗鬆症性椎体骨折(OVF)発症後の後彎形成術時期に応じた2群(早期群(2ヵ月以内):女性19名、男性8名、平均年齢79.9歳、晩期群(2ヵ月より後):女性31名、男性14名、平均年齢77.9歳)に分けて解析した。6ヵ月超継続して追跡した。晩期群では術前の骨折椎体の角運動と前方椎体高の圧迫が大きかった。年齢および術前転帰について調整した最終転帰では、早期群で晩期群よりも腰痛の視覚的アナログ尺度(VAS)スコアが低くなった。最終の相対前方椎体高および後彎角は、早期群で晩期群よりも大きく維持されたが、絶対差は有意ではなかった。

Publishing type：Research paper (scientific journal)  

<p><b>Introduction: </b>Despite ongoing improvements in both dialysis and surgical techniques, spinal surgery in patients undergoing hemodialysis (HD) is a challenge to surgeons because of the high mortality rate. However, no previous studies have examined clinical outcomes after lumbar surgery in HD patients. The purpose of this study is to compare clinical outcomes and complication rates after lumbar spinal surgery in patients with or without hemodialysis.</p><p><b>Methods:</b> This retrospective, matched cohort study was conducted to compare surgical outcomes between HD vs non-HD patients who underwent lumbar surgery at our hospital. Controls were individually matched to cases at a ratio of 1:2. Clinical outcomes, complications, and mortality rates were compared between the two groups.</p><p><b>Results: </b>Twenty-nine patients in the HD group and 57 in the non-HD group were included in the current study. Five patients in the HD group died during the follow-up period, whereas no patients died in the non-HD group (mortality rate, 17.2% vs. 0%, <i>P</i> = 0.003). Japanese Orthopaedic Association (JOA) scores were significantly less improved in the HD group than in the non-HD group (11.9 vs. 14.2 preoperatively, <i>P</i> = 0.001; 19.9 vs. 25.1 at final follow-up, <i>P</i> < 0.001). Five patients underwent repeat surgery in the HD group, which was significantly higher than the non-HD group (17.2% vs. 3.5%, <i>P</i> = 0.041).</p><p><b>Conclusions:</b> The current study indicates that patients undergoing HD had poor outcomes after lumbar spinal surgery. Moreover, 5 of 29 patients died within a mean 2.4-years follow-up. The indications for lumbar spine surgery in HD patients must be carefully considered because of poor surgical outcomes and high mortality rate.</p>

DOI： 10.22603/ssrr.2018-0025

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DOI： 10.22603/ssrr.2018-0037

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Publishing type：Research paper (scientific journal)  

<p><b>Introduction</b></p><p>Approximately 3% of osteoporotic vertebral fractures develop osteoporotic vertebral collapse (OVC) with neurological deficits, and such patients are recommended to be treated surgically. However, a proximal junctional fracture (PJFr) following surgery for OVC can be a serious concern. Therefore, the aim of this study is to identify the incidence and risk factors of PJFr following fusion surgery for OVC.</p><p><b>Methods</b></p><p>This study retrospectively analyzed registry data collected from facilities belonging to the Japan Association of Spine Surgeons with Ambition (JASA) in 2016. We retrospectively analyzed 403 patients who suffered neurological deficits due to OVC below T10 and underwent corrective surgery; only those followed up for ≥2 years were included. Potential risk factors related to the PJFr and their cut-off values were calculated using multivariate logistic regression analysis and receiver operating characteristic (ROC) analysis.</p><p><b>Results</b></p><p>Sixty-three patients (15.6%) suffered PJFr during the follow-up (mean 45.7 months). In multivariate analysis, the grade of osteoporosis (grade 2, 3: adjusted odds ratio (aOR) 2.92; p=0.001) and lower instrumented vertebra (LIV) level (sacrum: aOR 6.75; p=0.003) were independent factors. ROC analysis demonstrated that lumbar bone mineral density (BMD) was a predictive factor (area under curve: 0.72, p=0.035) with optimal cut-off value of 0.61 g/cm² (sensitivity, 76.5%; specificity, 58.3%), but that of the hip was not (p=0.228).</p><p><b>Conclusion</b></p><p>PJFr was found in 16% cases within 4 years after surgery; independent risk factors were severe osteoporosis and extended fusion to the sacrum. The lumbar BMD with cut-off value 0.61 g/cm² may potentially predict PJFr. Our findings can help surgeons select perioperative adjuvant therapy, as well as a surgical strategy to prevent PJFr following surgery.</p>

DOI： 10.22603/ssrr.2018-0068

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DOI： 10.1007/s11657-017-0411-7

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DOI： 10.1007/s11657-017-0411-7

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DOI： 10.1016/j.jocn.2017.06.001

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DOI： 10.1016/j.jos.2017.07.008

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ヒト頸椎黄色靱帯(LF)の寸法、付着部、被覆範囲、LFと神経孔または椎間関節との関連性を検討した。ホルマリン固定死体15体(男性7体、女性8体、平均死亡時年齢83歳)から全脊柱を一塊として摘出し、椎弓根基部で2つに切離した。C2-C3〜C7-T1のLF90本を背側から測定した後、鉄材含有造影剤を塗布してCT撮影を行った。CT画像データから3次元CT画像を構築し、腰椎後方視認時の黄色靱帯の位置や、黄色靱帯と椎弓峡部、椎間間隙との正確な位置関係を計測した。LF高はC2-C3からC7-T1にかけて次第に長くなり、各レベルで内側部から外側部にかけて次第に縮小していた。LF幅およびLF厚は、頭側端から尾側端まで比較的一定であった。頸椎椎間関節の頭側端は平均4.6±0.7mmのLFで被覆されていたが、頸椎神経孔へのLFの進入はみられなかった。

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jos.2017.07.008

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Publishing type：Research paper (scientific journal)  

ヒト頸椎黄色靱帯(LF)の寸法、付着部、被覆範囲、LFと神経孔または椎間関節との関連性を検討した。ホルマリン固定死体15体(男性7体、女性8体、平均死亡時年齢83歳)から全脊柱を一塊として摘出し、椎弓根基部で2つに切離した。C2-C3〜C7-T1のLF90本を背側から測定した後、鉄材含有造影剤を塗布してCT撮影を行った。CT画像データから3次元CT画像を構築し、腰椎後方視認時の黄色靱帯の位置や、黄色靱帯と椎弓峡部、椎間間隙との正確な位置関係を計測した。LF高はC2-C3からC7-T1にかけて次第に長くなり、各レベルで内側部から外側部にかけて次第に縮小していた。LF幅およびLF厚は、頭側端から尾側端まで比較的一定であった。頸椎椎間関節の頭側端は平均4.6±0.7mmのLFで被覆されていたが、頸椎神経孔へのLFの進入はみられなかった。

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DOI： 10.1016/j.jocn.2017.06.001

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DOI： 10.1038/s41598-017-13360-w

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DOI： 10.1038/s41598-017-13360-w

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DOI： 10.15106/j04037.2018088649

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DOI： 10.1177/2192568217716144

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80歳以上の高齢患者に頸部手術を施行する場合における手術合併症の危険因子を同定するため、多施設の登録症例データを後ろ向きに解析した。35施設にてdegenerative cervical myelopathyと診断され頸部手術を施行された80歳以上患者の登録症例66例(女性35例、年齢80〜91歳)の診療録を解析した。全合併症発生例は21例(32%)で、そのうち重大な合併症は7例(11%)、軽度の合併症は14例(21%)であった。年齢調整済みの多重ロジスティック回帰分析の結果、全合併症の発生に関する有意な危険因子として術前の脳血管障害の存在が、また重大な合併症の発生に関する有意な危険因子として癌の既往歴の存在が、それぞれ同定された。年齢、糖尿病の存在、診断疾患、の各因子は合併症の有意な予測因子とは認められなかった。

Publishing type：Research paper (scientific journal)  

80歳以上の高齢患者に頸部手術を施行する場合における手術合併症の危険因子を同定するため、多施設の登録症例データを後ろ向きに解析した。35施設にてdegenerative cervical myelopathyと診断され頸部手術を施行された80歳以上患者の登録症例66例(女性35例、年齢80〜91歳)の診療録を解析した。全合併症発生例は21例(32%)で、そのうち重大な合併症は7例(11%)、軽度の合併症は14例(21%)であった。年齢調整済みの多重ロジスティック回帰分析の結果、全合併症の発生に関する有意な危険因子として術前の脳血管障害の存在が、また重大な合併症の発生に関する有意な危険因子として癌の既往歴の存在が、それぞれ同定された。年齢、糖尿病の存在、診断疾患、の各因子は合併症の有意な予測因子とは認められなかった。

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DOI： 10.1177/2192568217716144

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DOI： 10.1016/j.jos.2017.04.008

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DOI： 10.1177/2192568217700115

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骨粗鬆症性椎体骨折患者339例(男性58例、女性281例)を対象に、認知機能の変化、認知機能低下の危険因子を前向き多施設共同コホート研究によって検討した。ミニメンタルステート検査(MMSE)を実施して認知機能を評価し、認知機能低下の危険因子として病歴、X線学的所見、ADLについて検討した。5例に外科術を施行し、234例が急性期に数日間の入院、109例が外来治療を受けていた。コルセットの装着は305例であった。ベースライン時、認知障害なしが283例(83.5%)、軽度認知障害が56例(16.5%)であり、6ヵ月後のフォローアップ時に認知機能低下をきたしたのは26例(7.7%)であった。認知機能低下群と非低下群に関して、年齢、性別、骨密度、教育レベル、喫煙習慣、スポーツ習慣に差はなく、ベースライン時のMMSEスコアにも差は認められなかった。病歴については、糖尿病患者の比率が認知機能低下群に高い傾向にあった。また、認知機能低下のオッズ比の上昇は骨折遷延治癒、6ヵ月後のADL低下と関連していた。骨粗鬆症性椎体骨折患者において、骨折遷延治癒とADL低下が認知機能低下の危険因子と成りうることが示された。

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DOI： 10.1016/j.jos.2017.04.008

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DOI： 10.1177/2192568217700115

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骨粗鬆症性椎体骨折患者339例(男性58例、女性281例)を対象に、認知機能の変化、認知機能低下の危険因子を前向き多施設共同コホート研究によって検討した。ミニメンタルステート検査(MMSE)を実施して認知機能を評価し、認知機能低下の危険因子として病歴、X線学的所見、ADLについて検討した。5例に外科術を施行し、234例が急性期に数日間の入院、109例が外来治療を受けていた。コルセットの装着は305例であった。ベースライン時、認知障害なしが283例(83.5%)、軽度認知障害が56例(16.5%)であり、6ヵ月後のフォローアップ時に認知機能低下をきたしたのは26例(7.7%)であった。認知機能低下群と非低下群に関して、年齢、性別、骨密度、教育レベル、喫煙習慣、スポーツ習慣に差はなく、ベースライン時のMMSEスコアにも差は認められなかった。病歴については、糖尿病患者の比率が認知機能低下群に高い傾向にあった。また、認知機能低下のオッズ比の上昇は骨折遷延治癒、6ヵ月後のADL低下と関連していた。骨粗鬆症性椎体骨折患者において、骨折遷延治癒とADL低下が認知機能低下の危険因子と成りうることが示された。

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DOI： 10.1097/BRS.0000000000001874

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DOI： 10.1097/BRS.0000000000001861

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DOI： 10.1097/BRS.0000000000001874

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DOI： 10.1097/BRS.0000000000001861

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DOI： 10.3171/2016.9.PEDS16298

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DOI： 10.4184/asj.2017.11.2.285

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DOI： 10.3171/2016.9.PEDS16298

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DOI： 10.4184/asj.2017.11.2.285

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DOI： 10.1016/j.jos.2016.11.020

PubMed

Publishing type：Research paper (scientific journal)  

骨性隆起と黄色靱帯との正確な位置関係を明らかにした。20体のホルマリン固定屍体から脊柱を離断した後に椎弓根基部にて椎弓根を切離し、椎弓と黄色靱帯を取り出した。黄色靱帯と椎弓の位置関係を計測した後、CT撮影を行った。CT撮影で得られたDICOMデータを用いて三次元CT画像解析装置により解析し、腰椎を後方からみた場合の黄色靱帯の位置を視覚化した。また、黄色靱帯と脊椎後方骨性隆起との正確な位置関係を調べた。両側LFはV型であり、付随する椎弓の形に沿っていた。LFの形状は腰上部において変化が認められたが、L5-S1のLFの形状は他の位置のLFとは異なっており、L5-S1のLFは各例で多様であった。椎弓根の内側縁とLFの外側縁の平均幅は腰上部から腰下部にかけて拡大していた。正中部における層間の空間とLFの頭蓋境界との幅は徐々に拡大し、L1で8.2mm、L4で11.1mm、L5で9.3mmであった。コントラストLFおよび再構成CTを用いた解剖学的解析により、骨性隆起とLF境界との関連が明らかとなった。

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jos.2016.11.020

PubMed

Publishing type：Research paper (scientific journal)  

骨性隆起と黄色靱帯との正確な位置関係を明らかにした。20体のホルマリン固定屍体から脊柱を離断した後に椎弓根基部にて椎弓根を切離し、椎弓と黄色靱帯を取り出した。黄色靱帯と椎弓の位置関係を計測した後、CT撮影を行った。CT撮影で得られたDICOMデータを用いて三次元CT画像解析装置により解析し、腰椎を後方からみた場合の黄色靱帯の位置を視覚化した。また、黄色靱帯と脊椎後方骨性隆起との正確な位置関係を調べた。両側LFはV型であり、付随する椎弓の形に沿っていた。LFの形状は腰上部において変化が認められたが、L5-S1のLFの形状は他の位置のLFとは異なっており、L5-S1のLFは各例で多様であった。椎弓根の内側縁とLFの外側縁の平均幅は腰上部から腰下部にかけて拡大していた。正中部における層間の空間とLFの頭蓋境界との幅は徐々に拡大し、L1で8.2mm、L4で11.1mm、L5で9.3mmであった。コントラストLFおよび再構成CTを用いた解剖学的解析により、骨性隆起とLF境界との関連が明らかとなった。

Publishing type：Research paper (scientific journal)  

DOI： 10.1038/ncomms13984

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.4184/asj.2017.11.1.63