Spine Surgery and Related Research
Online ISSN : 2432-261X
ISSN-L : 2432-261X
Advance online publication
Showing 1-27 articles out of 27 articles from Advance online publication
  • Kumiko Yotsuya, Tomohiko Hasegawa, Yu Yamato, Go Yoshida, Tatsuya Yasu ...
    Article ID: 2020-0056
    Published: 2020
    [Advance publication] Released: May 15, 2020
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  • Satoshi Baba, Mitsumasa Hayashida, Kazuki Kitade, Eiji Kinoshita, Kenj ...
    Article ID: 2020-0023
    Published: 2020
    [Advance publication] Released: April 20, 2020
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  • Tomoka Endo, Tetsuro Ohba, Hiroki Oba, Kotaro Oda, Nobuki Tanaka, Hiro ...
    Article ID: 2020-0028
    Published: 2020
    [Advance publication] Released: April 20, 2020
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    Introduction. There is a significant relationship between pulmonary function and degree of spinal deformity, location of apical vertebrae, and coronal imbalance in patients with childhood spinal deformity. By contrast, the pathophysiology, epidemiology, and influence of deformity on respiratory dysfunction in patients with adult spinal deformity (ASD) remain largely unknown. We sought to clarify and compare the prevalence of pulmonary function impairment in patients with ASD with that in patients with lumbar spinal stenosis (LSS), to determine radiographically which spinal malalignment parameters are associated with a risk of respiratory dysfunction, and to determine the association of respiratory dysfunction with corrective surgery.

    Methods. We conducted a prospective study of consecutive patients with a diagnosis of ASD or LSS who underwent spinal surgery. We included data from 122 consecutive patients with ASD and 121 consecutive patients with LSS. Parameters were obtained from full-length lateral radiographs taken with the patients standing and in supine and prone positions. We compared respiratory dysfunction between a group of patients with ASD and LSS and determined correlations between respiratory dysfunction and spinopelvic parameters.

    Results. Preoperative % forced vital capacity (FVC) of patients with ASD was significantly lower than that of patients with LSS, and the frequency of restrictive ventilatory impairment was significantly higher in those with ASD (15.7%) than those with LSS (7.4%). Thoracolumbar kyphotic curvature (TK) while the patients were in supine position was significantly greater in the group with restrictive ventilatory impairment, and a significant negative correlation was found between %FVC and TK with the patients in supine position. We found no significant improvement of respiratory dysfunction 1 year after surgery.

    Conclusions. Spinal deformity is a potential risk factor for restrictive ventilatory impairment in the elderly. We propose that radiographs obtained when patients are in supine position are valuable for evaluating the flexibility of the TK. Rigid TK might be an etiology of restrictive ventilatory impairment in patients with ASD.

    Level of Evidence: 3

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  • Zachary T. Sharfman, Yaroslav Gelfand, Priyam Shah, Ari J. Holtzman, J ...
    Article ID: 2019-0122
    Published: 2020
    [Advance publication] Released: March 31, 2020
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    Introduction: The effect of pelvic fixation on postoperative medical complications, blood transfusion, length of hospital stay, and discharge disposition is poorly understood. Determining factors that predispose patients to increased complications after spinopelvic fusion will help surgeons to plan these complex procedures and optimize patients preoperatively.

    Methods: We conducted a retrospective cohort study using data from the ACS-NSQIP database between 2006 and 2016 of patients who underwent lumbar fusion with and without spinopelvic fixation. Data regarding demographics, complications, hospital stay, and discharge disposition were collected.

    Results: A total of 57,417 (98.5%) cases of lumbar fusion without spinopelvic fixation (LF) and 887 (1.5%) cases of lumbar fusion with spinopelvic fixation (SPF) were analyzed. The transfusion rate in the SPF group was 59.3% vs 13% in the LF group (p < 0.001). The mean length of stay (LOS) and discharge to skilled nursing facility (SNF) were significantly different (LOS: SPF 6.5 days vs LF 3.5 days p < 0.001; SNF: SPF 21.3% vs LF 10.4% p < 0.001). After controlling for demographic differences, the overall complication rates were not significantly different between the groups (p = 0.531). The odds ratio for transfusion in the SPF group was 2.9 (p < 0.001). The odds ratio for increased LOS and increased care discharge disposition were elevated in the SPF group (LOS OR: 1.3, p < 0.012, Discharge disposition OR: 1.8, p < 0.001).

    Conclusion: Patients who underwent SPF had increased complications, transfusion rate, LOS, and discharge to SNF or subacute rehab facilities as compared with patients who underwent LF. SPF remains an effective technique for achieving lumbosacral arthrodesis. Surgeons should consider the implications of the associated complication profile for SPF and the value of preoperative optimization in a select cohort of patients.

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  • Ruben Schwartz, Ivan Urits, Alan D. Kaye, Omar Viswanath
    Article ID: 2020-0006
    Published: 2020
    [Advance publication] Released: March 31, 2020
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    Osteoporotic vertebral fractures have become a common occurrence in the elderly population. In this commentary, on the article "Surgical Treatment of Osteoporotic Fracture with Neurological Deficit—A Nationwide Multicenter Study in Japan" by Hosogane et al., we acknowledge the benefit of spinal fusion surgery for those patients with neurological compromise but also emphasize the importance of minimally invasive procedures. Balloon kyphoplasty and vertebroplasty are two viable options that have been proven to improve patients' quality of life and activities of daily living. Minimally invasive and conservative therapies should be the standard of care at first. Surgical options should be considered when these approaches have been exhausted.

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  • Naobumi Hosogane, Kenya Nojiri, Satoshi Suzuki, Haruki Funao, Eijiro O ...
    Article ID: 2020-0033
    Published: 2020
    [Advance publication] Released: March 31, 2020
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    We herein respond to the authors of the Letter to the Editor regarding our article entitled "Surgical Treatment of Osteoporotic Vertebral Fracture with Neurological Deficit—A Nationwide Multicenter Study in Japan." As osteoporotic vertebral fractures (OVFs) predominantly occur in the elderly population, initial management should include less invasive methods, such as conservative treatment. Generally, most patients can be managed without surgery; however, if surgery is unavoidable, minimally invasive techniques, such as balloon kyphoplasty, should be considered. Patients with neurological deficits due to vertebral collapse with apparent posterior wall injury or nonunion, who have failed to respond to conservative treatment, are the candidates for spinal fusion surgery. The aim of the present study is to reveal the relevance of performing spinal fusion surgery in elderly patients with OVFs who exhibit severe symptoms, who do not respond to conservative treatment, and in whom fusion surgery is not recommended as the first choice of treatment.

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  • Takumi Takeuchi, Naobumi Hosogane, Kenichiro Yamagishi, Kazuhiko Satom ...
    Article ID: 2019-0084
    Published: 2020
    [Advance publication] Released: March 19, 2020
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    Introduction

    We have developed the single or double endplates penetrating screw (SEPS/DEPS) technique, which is a novel percutaneous pedicle screw (PPS) insertion technique suitable for osteoporotic vertebral body fracture (OVF) patients with diffuse idiopathic skeletal hyperostosis (DISH). This study aims to compare the effectiveness of this SEPS/DEPS technique with the conventional pedicle screw technique.

    Methods

    The screw is inserted upward from the outer caudal side of the pedicle toward the inner cranial side. Vertebrae affected with DISH were inserted with screws using the SEPS/DEPS technique, whereas non-fused vertebrae were inserted with screws using the conventional PPS technique. Twelve OVF patients with DISH were included in this study; three with SEPS/DEPS technique only and nine with a hybrid of both the DEPS and the conventional PPS techniques. As a control group, 12 OVF patients with DISH treated by conventional PPS. The rates of implant failures and of surgical complications were compared between the SEPS/DEPS group and the control group. The insertion torque was measured and compared between DEPS and conventional PPS in three hybrid patients.

    Results

    In the SEPS/DEPS group, 70 screws were inserted with the SEPS/DEPS technique and 56 screws were inserted with the conventional PPS technique. In the control group, 116 screws were inserted using the conventional PPS and the PS techniques. The loosening of screws was significantly less in screws inserted with the SEPS/DEPS technique (0/70 screws, 0%) than with screws inserted with the conventional technique (12/116 screws, 10.3%). The average insertion torque of DEPS was 2.25 Nm, which was 134% higher than that of conventional PPS which was 1.64 Nm (p = 0.04).

    Conclusion

    This novel SEPS/DEPS technique has a higher insertion torque compared with the conventional PPS techniques and demonstrated itself to be an effective option for patients with concomitant bone fragility due to DISH.

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  • Saeed S. Sadrameli, Zain Boghani, William J. Steele III, Paul J. Holma ...
    Article ID: 2019-0101
    Published: 2020
    [Advance publication] Released: March 19, 2020
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    Introduction

    Patient-specific instrumentation is an emerging technology with the promise of a better fit to patient anatomy. With the advent of deformity correction planning software, prefabricated rods can mitigate the need to bend rods in the operating room. Prefabricated rods allow the surgeon to provide a deformity correction closely in line with the surgical plan.

    Methods

    A retrospective chart review was completed, and all patients with Medicrea UNiD rod were included. A minimum of 3 week follow up upright 36-inch lateral radiograph was necessary for analysis. Overall 21 patients had Medicrea UNiD rods placed; four were excluded (one for cervicothoracic fusion, three for incomplete follow up). Pelvic parameters were documented from the preoperative, surgical plan, and postoperative radiographs using Surgimap (Nemaris Inc, NY). The parameters for the rods were based on the surgical plan. Paired t-tests were used to compare the preoperative, surgical plan, and postoperative pelvic parameters.

    Results

    Average lumbar lordosis, pelvic tilt, sacral slope, and sagittal vertical axis in preoperative radiographs were 35.12°, 24.82°, 28.65°, and 65.65 mm, respectively. In postoperative imaging, lumbar lordosis, pelvic tilt, sacral slope, and sagittal vertical axis were 57.00°, 18.00°, 35.71°, and 21.59 mm, respectively. There was a statistically significant difference in pelvic tilt, sacral slope, lumbar lordosis, and sagittal vertical axis between the preoperative film and surgical plan (p < 0.001), whereas no statistically significant difference was found between the surgical plan and postoperative pelvic parameters (p > 0.05).

    Conclusions

    Cases in which prefabricated rods were utilized demonstrated improved spinopelvic alignment. Additionally, there was no statistical difference between the surgical plan and postoperative imaging in terms of pelvic parameters. Future studies are needed to investigate the possible benefits of prefabricated rods.

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  • Takashi Hirai, Toshitaka Yoshii, Satoru Egawa, Kenichiro Sakai, Hiroyu ...
    Article ID: 2019-0102
    Published: 2020
    [Advance publication] Released: March 19, 2020
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    Introduction: Anterior decompression and fusion have shown favorable neurologic outcomes in patients with cervical myelopathy. However, implant migration sometimes occurs immediately after multilevel anterior cervical corpectomy with fusion (ACCF). Risk factors associated with early bone graft migration have not been precisely documented. The study aimed to investigate how frequently bone graft subsidence occurs after ACCF and to determine the factors affecting implant migration.

    Methods: Forty-seven consecutive patients who underwent ACCF for ossification of the posterior longitudinal ligament at our hospital between 2007 and 2015 and were able to complete 1 year of follow-up were enrolled. Patients treated with hybrid fixation were excluded. Data on demographics and radiographic findings, namely, fused segment angle and fused segment height (FSH), were collected. Implant migration was defined as subsidence of >3 mm. The patients were divided into 2-segment (2F), 3-segment (3F), and ≥4-segment (4F) groups. Results were compared between the groups using one-way analysis of variance, the Mann–Whitney U test, and the chi-square test.

    Results: Mean age was 61.6 years in the 2F group (n = 17), 62.1 years in the 3F group (n = 21), and 69 years in the 4F group (n = 9). There were no significant between-group differences in demographics or clinical characteristics. Implant subsidence occurred in 3 cases (17.6%) in the 2F group, 4 (19%) in the 3F group, and 3 (33.3%) in the 4F group. Revision surgery was required in 2 cases (1 patient each in the 3F and 4F groups). Logistic regression analysis showed a significant association of increased FSH and increased risk of postoperative implant subsidence.

    Conclusion: A postoperative increase in FSH may affect graft stability and lead to early implant migration.

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  • Kazuo Nakanishi, Kazuya Uchino, Seiya Watanabe, Hideaki Iba, Toru Hase ...
    Article ID: 2019-0105
    Published: 2020
    [Advance publication] Released: March 19, 2020
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    Introduction

    The cancer board system employed at many hospitals and treatment centers involves multidisciplinary healthcare teams, including physicians, and the timing of treatment generally follows that of a consultation model. Thus, it is difficult to detect spinal metastases using the current implementation of the cancer board system, which can lead to delays in treatment. A new multidisciplinary treatment strategy for patients with metastatic spinal tumors was designed, and 745 patients were treated based on this strategy.

    Methods

    In the first 5 years using the liaison treatment approach, 745 patients were diagnosed with metastatic spinal tumor. Tumors were discovered before a skeletal-related event (SRE) in 704 patients and after an SRE in 41 patients. We conducted our analysis in two patient groups: those with and without an SRE at the time of treatment initiation.

    Results

    In most patients, the average spinal instability neoplastic score was 5.2, which indicates that we were able to detect the spinal tumor before a significant breakdown of the spinal support system. Ninety-five percent of patients were classified according to the Frankel grade classification during their initial diagnosis, and many patients initially underwent treatment before the onset of paralysis. Of patients with an SRE, 33% were Frankel grade E, indicating that approximately half were paralyzed at initial diagnosis. The median survival duration was prolonged by approximately 9 months in patients without an SRE compared with those with an SRE.

    Conclusions

    Orthopedic spine surgeons are responsible for maintaining activities of daily living, improving quality of life, and prolonging life expectancy in patients with metastatic spinal tumors. The results of this study revealed that the liaison treatment system for metastatic spinal tumors has made it possible to successfully prevent SREs without neurological deficits and to prolong survival.

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  • Yohei Ishihara, Masutaro Morishita, Koji Kanzaki, Tomoaki Toyone
    Article ID: 2019-0113
    Published: 2020
    [Advance publication] Released: March 19, 2020
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    Introduction: Degenerative lumbar kyphoscoliosis is a serious clinical condition that affects activities of daily living. This study aimed to investigate the age-related progression of nonoperative degenerative lumbar kyphoscoliosis, to clarify its final state in elderly people, and to identify factors associated with its progression.

    Methods: This retrospective longitudinal study included115 nonoperative cases (mean age at first consultation, 70.9 years; range, 50–89 years). All were followed up for >6 years. The analysis included changes between initial and latest measurements in the coronal parameters (Cobb angle, L4 tilt angle, intervertebral angle, lateral spondylolisthesis, and C7-central sacral vertical line) and sagittal parameters (thoracic kyphosis, lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, sagittal vertical axis, and vertebral wedging rate). Factors in scoliosis progression were investigated by analyzing the correlations between the initial parameter values and the increase in Cobb angle.

    Results: Changes in the coronal parameters increased with age from 50s to 70s but decreased significantly in those aged 80s. Sagittal parameters increased by the age group, accelerating in those aged 80s, with the progression of vertebral wedging. In patients aged 50s–70s, the increase in Cobb angle correlated significantly with the initial Cobb angle, L4 tilt angle, and L4/L5 intervertebral angle. However, in the cases without initial scoliosis, the increase in Cobb angle correlated significantly only with the L4 tilt angle. There were no significant differences in any parameter according to the use of a trunk brace or medication for osteoporosis.

    Conclusions: L4 tilt angle is an important factor in the progression of degenerative scoliosis. The progression of scoliosis gradually ends after the age of 80 years with the decreasing variation of L4 tilt angle, whereas kyphosis accelerates with aging, especially in those aged >80 years, with the progression of vertebral wedging.

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  • Ahmed Bakhsh, Ali Hassan Aljuzair, Hany Eldawoody
    Article ID: 2019-0118
    Published: 2020
    [Advance publication] Released: March 19, 2020
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    Introduction:

    The World Report on Road Traffic Injury Prevention indicates that by 2020, road traffic injuries will be a major killer, accounting for half a million deaths and 15 million disability-adjusted life years. The Kingdom of Saudi Arabia (KSA) has one of the highest rates of spinal cord injuries in the world, with 62 people injured per 1 million, and the injuries are mostly due to traffic accidents.

    Materials and Methods:

    All polytrauma patients associated with spinal injuries admitted to Prince Mohammed bin Abdul Aziz Hospital (PMAH), Riyadh, from January 2017 to June 2018, were included in this study. Patients with old spinal injuries, any previous spinal surgery, spine infection, or concomitant diagnosed malignancies or osteoporotic collapse with or without falls were excluded. All patients underwent whole-spine computed tomography scan and, in selective cases, magnetic resonance imaging of the spine.

    Results:

    Of the 230 patients, 90.0% were male, and 60% were in the second and third decades. Motor vehicle accidents were responsible for 83% of the cases, of which 50% of the victims were the drivers, and 80% were passengers with no seatbelt on. Nearly 50% of the spinal injuries were associated with injuries in the other body parts. Cervical spine injury accounted for 44% of the cases, followed by the lumbar spine injury. Twenty five percent of the patients presented with fixed neurologic deficit in the form of quadriplegia or paraplegia (ASIA-A). The mortality rate was 1.3%.

    Conclusion:

    This study revealed that motor vehicle accidents are a major cause of spinal injuries in the KSA. One-fourth of the spinal Injuries are associated with complete spinal cord injuries. Therefore, in order to prevent lifelong disability in the young population, a nationwide program should be initiated to prevent road traffic accidents.

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  • Mitsuru Furukawa, Kunimasa Okuyama, Yusuke Kawano, Kentaro Kikuchi, Ta ...
    Article ID: 2020-0001
    Published: 2020
    [Advance publication] Released: March 19, 2020
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    Introduction: When spinal fracture occurred in ankylosing spinal disorder (ASD) patients, it is important to evaluate not only the long lever arm but also bone density and bone quality for the determination of treatment strategies. This case-controlled study examined bone mineral density (BMD), bone metabolism markers, and pentosidine levels in patients with ASD.

    Methods: Subjects with bridging of minimum four contiguous vertebral bodies were classified into ASD group and the rest into non-ASD group. The former was further divided into two subgroups based on the presence/absence of sacroiliac joint ankylosis (SJA). We compared BMD, bone metabolism markers, and pentosidine levels in these groups.

    Results: The BMD T and Z scores of the femur proximal extremity were lower in the ASD with SJA group than those in the ASD without SJA group. When groups were matched for age, weight, and eGFR, compared with the non-ASD group, the ASD with SJA group had lower BMD of the lumbar spine and femur proximal extremity and the ASD without SJA group had significantly higher BMDs of the lumbar spine and femur proximal extremity. After matching, the ASD without SJA group showed a significantly higher pentosidine level than the non-ASD group.

    Conclusions: Patients with SJA have low femur proximal extremity BMD, whereas those with ASD without SJA have a higher BMD of the femur proximal extremity with high pentosidine level. Investigating the presence or absence of SJA is important for the determination of treatment strategies in fractured ASD patients.

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  • Shunsuke Kanbara, Ayato Nohara, Tetsuya Ohara, Toshiki Saito, Ryoji Ta ...
    Article ID: 2020-0015
    Published: 2020
    [Advance publication] Released: March 19, 2020
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    Introduction: In patients with lumbosacral agenesis (SA), Renshaw type III or IV, lumbosacral instability is the primary cause of major clinical complications. Although they are usually treated with spinopelvic fusion, nonunion at the spinopelvic junction is a major complication due to the congenital sacropelvic abnormalities. The purpose of this study was to evaluate whether a combination of lumbosacral fixation and rigid fixation at the pubic symphysis could lead to postoperative bone union in patients with SA (Renshaw type III).

    Methods: Retrospective case series study. We present the cases of two patients with SA, Renshaw type III, who were surgically treated by lumbosacral fusion using a posterior approach, and they exhibited nonunion at the lumbosacral junction.

    Results: Case 1. A 10-year-old male underwent T8-S posterior fixation followed by multiple augmentations using allografts at the lumbosacral junction for delayed union. All additional procedures with bone graft using a posterior approach failed to achieve bone union; however, additional rigid fixation at the pubic symphysis resulted in a successful lumbosacral bone union.

    Case 2. A 6-year-old male underwent vertical expandable prosthetic titanium rib (VEPTR) surgery with multiple rod extension procedures. Subsequently, at the age of 10 years, a combined two-stage anterior (L1-3) and posterior (T8-iliac) fixation with T9 hemivertebrectomy was performed. As a result of subsequent nonunion with screw loosening, additional rigid fixation at the pubic symphysis was performed 1 month after posterior fixation. Bone union was finally achieved 1 year after all the surgical interventions.

    Conclusion: Rigid fixation at the pubic symphysis may play a significant role in achieving rigid bone union for unstable lumbopelvic connection, such as SA, Renshaw type III or IV.

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  • Takeshi Inoue, Shigeru Soshi, Makoto Kubota, Keishi Marumo
    Article ID: 2019-0076
    Published: 2020
    [Advance publication] Released: February 26, 2020
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    Introduction: Cervical myelopathy frequently manifests as sensory disturbances, including numbness, and their distribution pattern aids in neurological level diagnosis. However, the objective assessment of sensory disturbances is challenging. In this study, we attempted to quantitatively evaluate sensory symptoms in patients with cervical myelopathy according to lesion level using PainVision®.

    Methods: Dermal sensations were evaluated in patients (n = 158) and healthy volunteers (n = 100) using PainVision® PS-2100, which measured the current perception threshold (CPT). The results were analyzed for their correlation with magnetic resonance imaging (MRI) data, visual analog scale (VAS) scores, and patient functional status assessed by the Japanese Orthopaedic Association (JOA) and JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) scores.

    Results: Forearm and palm CPT values were significantly higher in patients with cervical myelopathy (both sites, P < 0.001) and were negatively correlated with the JOA score (forearm, r = −0.33; palm, r = −0.35; P < 0.001) and the JOACMEQ scores for upper extremity function (forearm, r = −0.37; palm, r = −0.39; P < 0.001), lower extremity function (forearm, r = −0.39; palm, r = −0.40; P < 0.001), and quality of life (forearm r = −0.27, P = 0.0025); however, no correlation was observed with the VAS score. Stratification of patients according to their lesion levels determined by MRI revealed that the C3/C4 subgroup had significantly higher forearm CPT values than the C4/C5 (P = 0.024) and C5/C6 (P = 0.0013) subgroups and higher palm CPT values than the C5/C6 subgroup (P = 0.009).

    Conclusions: Quantitative measurements of sensory disturbances using the PainVision® device correspond to the degree of patient functional disability and the lesion level. This indicates that both the distribution and intensity of sensory abnormalities are important for neurological level diagnosis in patients with cervical myelopathy.

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  • Satoshi Ujigo, Kazuhiko Kishi, Hideaki Imada, Hayatoshi Shibuya, Kazuy ...
    Article ID: 2019-0096
    Published: 2020
    [Advance publication] Released: February 26, 2020
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  • Tomoaki Koakutsu, Toshimi Aizawa, Eiji Itoi
    Article ID: 2019-0114
    Published: 2020
    [Advance publication] Released: February 26, 2020
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    Introduction: Cervical pedicle screw (CPS) fixation provides the strongest mechanical stability. It needs, however, wide soft tissue detachment to expose the entry point and carries the potential risk of iatrogenic damage to neurovascular structures. Malposition of the CPS cannot be completely avoided even using the navigation system.

    Technical Note: Using the bone biopsy needle as drill guide, we developed a novel accurate CPS insertion technique. (1) The entry point of CPS was exposed using Southwick's technique for anterior fixation or Tokioka's technique for posterior fixation. (2) A 13G bone biopsy needle was inserted from the entry point established by the fluoroscopy-assisted pedicle axis view technique described by Yukawa et al. to within a few millimeters of the pedicle. (3) The external sleeve of the bone biopsy needle was left in place as a drill guide, and the 1.25 mm guidewire for a 4.0 mm cannulated screw was then inserted into the pedicle cavity. (4) The external sleeve of the bone biopsy needle was removed, and the screw trajectory was created by a 2.7 mm cannulated drill bit over the guidewire. (5) Tapping was conducted prior to CPS insertion.

    Using this method, 29 CPSs in nine patients were inserted. Postoperative computed tomography scans revealed that all the CPSs were placed accurately.

    Conclusions: Utilizing the bone biopsy needle as drill guide, our procedure enables accurate positioning of CPS without expensive instruments.

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  • Daisuke Nishiyama, Hiroshi Iwasaki, Takuhei Kozaki, Takaya Taniguchi, ...
    Article ID: 2019-0119
    Published: 2020
    [Advance publication] Released: February 26, 2020
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    Introduction

    Hip dislocation rates in patients with combined total hip arthroplasty (THA) and spinal deformity fixation are significantly higher than those of THA alone. Nevertheless, there are no treatment recommendations for patients who undergo THA and require a spine deformity correction later.

    Methods

    Twenty-eight patients underwent spinal fixation surgery for adult spinal deformity. Sagittal spinopelvic alignment was analyzed on lateral radiographs taken preoperatively and postoperatively in the sitting and standing positions. Univariate linear regression analysis was conducted to identify the factors affecting the pelvic inclination in the sitting position after spinal fixation. Multiple regression analysis was conducted to determine the most efficient combination of radiographic parameters for predicting postoperative pelvic inclination while sitting.

    Results

    There were significantly weak associations between postoperative sacral slope (SS) in the sitting position and the following factors: the number of vertebral levels fused (β = 0.30, p = 0.003); the presence of sacral fixation (β = 0.22, p = 0.01); the presence of sacroiliac joint fixation (β = 0.24, p = 0.008); and preoperative SS while standing and sitting (β = 0.21, p = 0.01 and β = 0.34, p = 0.001). Postoperative lumbar lordosis (LL) while standing was strongly associated with postoperative SS in the sitting position (β = 0.67, p <.0001). The combination of postoperative LL in the standing position and preoperative SS in the sitting position was the best fit, and the adjusted R-squared was 0.82.

    Conclusions

    We devised a prediction formula for pelvic inclination while sitting after spinal fixation that has high predictability: postoperative SS while sitting = 11.7+ (0.4 × postoperative planned LL while standing) + (0.16 × preoperative SS while sitting). This study could be the basis for treatment recommendations for patients who have undergone THA and require a spine deformity correction later.

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  • Akira Honda, Yoichi Iizuka, Masahiko Okamoto, Shintaro Shiba, Hiromi K ...
    Article ID: 2019-0100
    Published: 2020
    [Advance publication] Released: February 10, 2020
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    Introduction: Spinal malignant peripheral nerve sheath tumors (MPNSTs) are extremely rare. Because of vital surroundings, en bloc resection can be difficult in MPNSTs of the cervical spine. Herein, we report three cases of MPNST followed by radiotherapy or carbon ion radiotherapy (CIRT) after surgery.

    Technical Note: In case 1, the patient underwent subtotal resection from both a posterior and anterior approach following by adjuvant X-ray radiotherapy. The patient died 13 years after surgery due to liver cancer unrelated to MPNST. In case 2, recurrence spread to the spinal canal in 10 months after primary CIRT. The patient underwent resection of the spinal canal lesion with the residual lesion treated by additional CIRT. Recurrence could be controlled for at least 1 year. In case 3, the patient underwent partial resection for the spinal canal lesion with the residual lesion treated by CIRT. Intradural and extradural recurrences from outside of the CIRT field were observed at 3 years after surgery.

    Conclusions: Complete resection and adjuvant X-ray radiotherapy would be an effective treatment for MPNST of the cervical spine, even if en bloc resection with a wide margin is impossible. CIRT for the residual tumor after incomplete resection may have the potential to be an additional treatment option; however, further investigation is warranted.

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  • Masafumi Nakagawa, Mamoru Kawakami, Masatoshi Teraguchi, Ryohei Kagota ...
    Article ID: 2019-0116
    Published: 2020
    [Advance publication] Released: February 10, 2020
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    Introduction: Sarcopenia, a condition characterized by decreased skeletal muscle mass, has increasingly been attracting attention in Japan, which has an aged society. The association between chronic low back pain (CLBP) and muscle mass is important. This study aimed to investigate the effect of exercise therapy for CLBP with or without sarcopenia.

    Methods: This study was a prospective cohort study. Patients who were aged >65 years during 2017–2018 and had CLBP, with pain lasting >12 weeks and pain intensity being 3, were included in the study. The patients were divided into two groups: sarcopenia (S) and nonsarcopenia (NS) groups. The numerical rating scale (NRS) for pain intensity, Roland–Morris Disability Questionnaire (RMDQ), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Hospital Anxiety and Depression Scale (HADS), trunk muscle strength, a European Quality of Life instrument, and an NRS of treatment satisfaction were assessed. All patients underwent a high-intensity exercise therapy during 2 weeks of hospitalization and were followed up for 1 and 3 months.

    Results: Twenty-eight patients with CLBP were included. The prevalence rate of sarcopenia was 42.9%. The NRS and RMDQ scores and gait function were clinically improved at the end points in all patients with or without sarcopenia. Moreover, high treatment satisfaction was achieved. The quality of life, treatment satisfaction, psychological disorder subscale score of the JOABPEQ, and HADS score tended to be lower in the S group than in the NS group.

    Conclusion: Our short-term exercise therapy was effective for low back pain, disability, and gait disturbance in elderly patients with CLBP with or without sarcopenia. However, the prevalence of sarcopenia was high in elderly patients with CLBP. Although low back pain and disability in patients in the S group were improved by exercise therapy, their quality of life and treatment satisfaction might be lower than those of patients without sarcopenia.

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  • Toru Maeda, Kosaku Higashino, Satoshi Hattori, Koichi Sairyo
    Article ID: 2019-0075
    Published: 2020
    [Advance publication] Released: January 29, 2020
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION
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  • Norihiro Isogai, Naobumi Hosogane, Haruki Funao, Kenya Nojiri, Satoshi ...
    Article ID: 2019-0079
    Published: 2020
    [Advance publication] Released: January 29, 2020
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    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.

    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).

    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.

    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.

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  • Tomohiro Yamada, Yu Yamato, Tomohiko Hasegawa, Go Yoshida, Tatsuya Yas ...
    Article ID: 2019-0082
    Published: 2020
    [Advance publication] Released: January 29, 2020
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Background: Falling is an age-related problem that increases with age. Compared with younger people, elderly people possess increased risk factors for falls, and falling among the elderly is associated with increased mortality. Risk factors for falls have been reported in elderly outpatients; however, whether sagittal spinal posture affect the risk of falls in community residents remains unclear. Therefore, we aimed to investigate the influence of sagittal spinal posture on the risk of falls in elderly community-dwelling people using spino-plevic sagittal parameters in a retrospective longitudinal study.

    Methods: A total of 463 volunteers (96 men and 367 women; mean age, 72.8 years) who underwent a routine physical checkup were evaluated. Baseline whole spine and lower limb radiography, physical tests, bone mineral density (BMD), number of medications and comorbidities, patient-reported outcomes (PROs), and a history of falls in the previous four years period were examined.

    Results: Univariate analysis revealed older age, lower height and weight, higher prevalence of vertebral fractures, higher number of medications, poor physical test scores including one-leg standing test and prone trunk extension, poor PROs, a higher sagittal vertical axis, and higher pelvic tilt (PT) as factors significantly associated with the risk of falls, and multivariate analysis revealed a higher sagittal vertical axis [odds ratio (OR), 1.08; 95% confidence interval (CI), 1.002–1.013; P = 0.02] and locomotive syndrome assessed using the 25-Question Geriatric Locomotive Function Scale score (OR, 1.028; 95% CI, 1.004–1.053; P = 0.03) to be associated with the risk of falls, independent of other factors in the univariate analysis.

    Conclusions: The sagittal vertical axis was an independent risk factor for falls, and the prevalence of vertebral fractures and prone truck extension correlated with the sagittal vertical axis. Prospective and intervention studies are needed to prevent future falls in elderly community volunteers with a higher sagittal vertical axis.

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  • Naohisa Miyakoshi, Daisuke Kudo, Yukihiro Matsuyama, Toshihiko Yamashi ...
    Article ID: 2019-0111
    Published: 2020
    [Advance publication] Released: January 29, 2020
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION

    Introduction: Chronic low back pain (CLBP) is a major health burden worldwide and requires patient satisfaction with treatment. Consultation length can be an important factor in patient satisfaction, but few studies have investigated the impact of consultation length on satisfaction in patients with CLBP. This study tried to elucidate the impact of consultation length on clinical outcomes in patients with CLBP.

    Methods: This study is part of an analysis using the database of the nationwide, multicenter cohort for CLBP performed by the Project Committee of the Japanese Society for Spine Surgery and Related Research. A total of 427 patients aged 20–85 years (median age, 73.0 years; female, 58.6%) with CLBP were prospectively followed-up monthly for 6 months. Multivariable nonlinear regression analyses were performed to assess the effect of consultation length on outcome measures including subjective satisfaction score, EuroQol 5-dimension, Japanese Orthopaedic Association (JOA) score, Roland–Morris Disability Questionnaire, JOA Back Pain Evaluation Questionnaire, visual analog scale (VAS) and Medical Outcome Survey short-form 8-item health survey that evaluated at the next phase. Furthermore, we assessed whether the effect of consultation length on patient satisfaction was modified by the baseline Brief Scale for Psychiatric Problems in Orthopaedic Patients (BS-POP) score for patient and physician versions.

    Results: VAS for CLBP was the only score that correlated significantly with consultation length (P = 0.018). Satisfaction score showed a significant positive correlation with consultation length in patients with the highest baseline BS-POP scores (P < 0.2). Moreover, consultation lengths more than 7.6 min and 15.1 min offered increase of satisfaction if patients show the highest BS-POP scores on patient and physician versions, respectively.

    Conclusions: These findings suggest that a sufficiently long consultation is an important factor for subjective satisfaction in the patients with CLBP, particularly in patients with psychological problems.

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  • Takafumi Chiba, Satoshi Inami, Hiroshi Moridaira, Daisaku Takeuchi, Yu ...
    Article ID: 2019-0077
    Published: 2019
    [Advance publication] Released: December 03, 2019
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION
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  • Naoki Morozumi, Toshimi Aizawa, Morichika Sasaki, Yutaka Koizumi, Shoi ...
    Article ID: 2019-0074
    Published: 2019
    [Advance publication] Released: November 20, 2019
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION
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  • Takaki Nakashima, Bungo Otsuki, Takayoshi Shimizu, Shunsuke Fujibayash ...
    Article ID: 2019-0073
    Published: 2019
    [Advance publication] Released: September 20, 2019
    JOURNALS OPEN ACCESS ADVANCE PUBLICATION
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