Spine Surgery and Related Research
Online ISSN : 2432-261X
Advance online publication
Showing 1-29 articles out of 29 articles from Advance online publication
  • Yawara Eguchi, Munetaka Suzuki, Takashi Sato, Hajime Yamanaka, Hiroshi ...
    Article ID: 2018-0086
    Published: 2019
    [Advance publication] Released: January 25, 2019
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    Objective: To investigate the risk of epidural hematoma after spinous process-splitting laminectomy (SPSL).

    Methods: A total of 137 cases (mean age, 72.4 years; 68 men) of SPSL were included. Of these, there were instances (3.7%; mean age, 70.5 years; all male) of postoperative development of new neurologic deficit due to epidural hematoma requiring reoperation. The 133 subjects (72.5 years; 64 men) with normal postoperative course were used as controls, and comparisons were made between both groups using chi-squared and Student's t-tests. Regarding our investigation of risk factors for epidural hematoma, logistic regression was conducted with presence or absence of hematoma as our primary outcome variable, and age, gender, disease duration, number of laminectomies, which levels were decompressed, blood loss, length of case, drain output, coagulopathy, and whether or not there was an intraoperative dural tear were our explanatory variables.

    Results: All cases of hematoma were single-level laminectomies; there was one case of T9-10 and 3 cases of L2–3. In our direct comparison of both groups (hematoma versus control), the proportion of men was significantly higher in the hematoma group (100% versus 48%, p < 0.05); levels decompressed were also significantly higher (p < 0.05) in the hematoma group, and drain outputs were significantly lower (113 mL versus 234 mL, p < 0.05). From our logistic regression analysis, the levels were significantly higher (χ2 = 15, p = 0.0001) and the drain outputs were smaller (χ2 = 4.6, p = 0.03) in the hematoma group.

    Discussion: Single-level decompression higher than the L2–3 level and reduced drain output were risk factors for spinal epidural hematoma. With this method of spinous process suturing and reconstruction there is less decompression compared with more conventional methods; therefore, the effect of hematoma may be more pronounced at higher vertebral levels with reduced canal width, and drain failure may also occur with this limited space.

    Download PDF (756K)
  • Shigeto Ebata, Hiroki Oba, Tetsuro Ohba, Jun Takahashi, Shota Ikegami, ...
    Article ID: 2018-0090
    Published: 2019
    [Advance publication] Released: January 25, 2019
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    Introduction. We recently demonstrated that pelvic incidence (PI) decreases after long fusion using iliac screws (ISs) and plays a role in good sagittal balance postoperatively. By contrast, the IS loosening rate may cause reversion, increasing the PI and causing loss of sagittal balance. The aim of this study was to determine the effect of the number of ISs inserted into the iliac bone for long fusion to correct adult spinal deformities (ASDs) on the frequency of IS loosening, postoperative PI, and surgical outcomes. Methods. We included data from 70 consecutive patients. Cases in which two ISs were inserted bilaterally comprised the dual IS group (Group D), whereas cases in which one IS was inserted bilaterally comprised the single IS group (Group S). Results. IS loosening was observed in four patients in Group D (9%) and 14 patients in Group S (61%). Both early and one-year postoperative PI were significantly smaller in Group D (P < 0.001). The sagittal vertical axis (SVA) one-year postoperatively was significantly smaller in Group D (P = 0.003). Conclusions. The loosening rate of dual ISs was as low as about one-seventh that of single ISs. Using dual ISs, postoperative PI can be kept small, possibly resulting in a smaller SVA.

    Download PDF (1087K)
  • Soichiro Masuda, Eijiro Onishi, Satoshi Ota, Satoshi Fujita, Tatsuya S ...
    Article ID: 2018-0102
    Published: 2019
    [Advance publication] Released: January 25, 2019
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    Introduction: In general, osteoporotic vertebral fractures with neurological deficits require surgery. However, the ideal surgical method remains controversial. We evaluated the efficacy of combining posterior instrumented fusion and vertebroplasty using allograft bone chips.

    Methods: Twelve patients (five men, seven women; age 68–84 years, mean age 75.9 years) with osteoporotic vertebral fractures with neurological deficits were reviewed retrospectively. They underwent posterior instrumented fusion and vertebroplasty, using allograft bone, at our institution between January 2007 and June 2016. We assessed the surgical results, radiologically and neurologically, after a mean follow-up of 37.3 months.

    Results: The mean local kyphosis angle was 10° before surgery, −3.3° immediately after surgery, and 4.4° at follow-up. The average spinal canal compromise was 26.9% before surgery and 19.5% at follow-up. All patients achieved bony fusion and none needed additional surgery. All patients improved by at least one grade on the modified Frankel grading system.

    Conclusions: Combining vertebroplasty, using allograft bone chips, and posterior instrumented fusion appears to be an effective option for osteoporotic vertebral fractures with neurological deficits.

    Download PDF (1488K)
  • Hayato Enoki, Toshikazu Tani, Kenji Ishida
    Article ID: 2018-0033
    Published: 2019
    [Advance publication] Released: January 15, 2019
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    Objective: Leg spasticity in degenerative compression myelopathy causes impairment of fast and rapid repetitive movements, which tends to appear despite the disproportionate paucity of clinical weakness. As clinically useful measures used to quantify the slowness of voluntary leg movements in this pathological condition, we compared the foot tapping test (FTT) with the simple walking test, which is now considered the gold standard in this field.

    Methods: We compared the FTT with the simple walking test, the grip-and-release test, and the functional scales of Nurick and the Japanese Orthopedic Association (JOA) in 77 patients with cervical compression myelopathy and 56 age-matched healthy subjects. The FTT was conducted on both sides separately, and the subject, while being seated on a chair, moved his/her toes up and down repeatedly to tap the floor as fast and as vigorously as possible for 10 sec with his/her heels planted on the floor.

    Results: The number of 10-sec foot tapping in the patient group significantly correlated with the Nurick grades (r = −0.566; P < 0.0001), the JOA scores (r = 0.520; P < 0.0001), and the grip-and-release rates (r = 0.609; P < 0.0001). It also significantly correlated with the 30-m walking time (r = −0.507; P < 0.0001) and the number of steps taken (r = −0.494; P < 0.0001). Assessments of wheelchair-dependent patients and side-to-side comparison, in which the simple walking test plays no role, revealed significantly fewer FTT taps in wheelchair-bound patients than in the ambulatory patients and a significant trend for cervical compression myelopathy to dominantly affect the upper and lower limbs on the same side.

    Conclusions: This study contributes to the reassessment of the currently underutilized FTT as part of a routine neurologic examination of degenerative compression myelopathy.

    Download PDF (919K)
  • Ken Nagahama, Manabu Ito, Yuichiro Abe, Eihiro Murota, Shigeto Hiratsu ...
    Article ID: 2018-0058
    Published: 2018
    [Advance publication] Released: December 28, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    Background: Lumbar interbody fusion is used to treat degenerative lumbar spondylolisthesis with instability. We developed a device that safely expands a percutaneous path through Kambin's Triangle and used it via a new technique: percutaneous endoscopic transforaminal lumbar interbody fusion (PETLIF). We report in this study the details and outcomes of this procedure after a one-year follow-up.

    Methods: Twenty-five patients requiring interbody fusion for degenerative spondylolisthesis of the L4 vertebra were enrolled in this study. The procedure involved percutaneous posterior pedicle screw placement to correct spondylolisthesis. After the exterior of the L5 vertebra superior articular protrusion was shaved with a percutaneous endoscopic drill in order to expand the safe zone, the oval sleeve was inserted through Kambin's Triangle and was rotated to expand the disk height and create a path towards the vertebral disk. The interbody cage was inserted against the J-shaped nerve retractor, with the exiting nerve root retracted. Indirect decompression of spinal canal stenosis was expected because the vertebral body spondylolisthesis had been corrected, and the interbody distance was expanded. Thus, no direct decompression was performed posterolaterally.

    Results: The mean follow-up period, surgery time, and blood loss were 22.7 months, 125.4 min, and 64.8 mL, respectively. The Japanese Orthopedic Association score improved from 13.3 to 28.0. The Roland-Morris Disability Questionnaire score improved from 10.3 to 3.3. All items were evaluated both preoperatively and one-year postoperatively. Bone fusion was observed one year postoperatively in 22 out of 25 patients.

    Conclusions: These results demonstrate the feasibility and efficacy of PETLIF for treating degenerative lumbar spondylolisthesis. This minimally invasive procedure is useful and has wide applicability. To obtain safe and favorable results, necessary surgical techniques must be mastered, and surgical equipment, including that for neural monitoring, is required.

    Download PDF (3882K)
  • Ryo Sugawara, Katsushi Takeshita, Yasushi Inomata, Yasuhisa Arai, Masa ...
    Article ID: 2018-0067
    Published: 2018
    [Advance publication] Released: December 01, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    Introduction: The Japanese Scoliosis Society (JSS) created a longitudinal complication survey of spinal deformity surgery and established the Morbidity and Mortality (M&M) Committee in 2012. The purpose of this study was to analyze the results of the complication survey in 2014 and to report the differences in the complication rates between the years 2012 and 2014.

    Methods: A request to participate in this survey was mailed to all JSS members. The questionnaires were sent through e-mail to the members who took part in this survey, and the responses were returned through the same. Diagnosis was grouped into idiopathic scoliosis, congenital scoliosis, neuromuscular scoliosis, spondylolisthesis, pediatric kyphosis and adult spinal deformity. Complication was grouped into death, blindness, neurological deficit (motor or sensory deficit), infection, massive bleeding, hematoma, pneumonia, cardiac failure, DVT/PE, gastrointestinal perforation and instrumentation failure.

    Results: A total of 2,012 patients were reported from 71 institutes. Overall, complications were observed in 326 patients, and the complication rate increased from 10.4% in 2012 to 15.3% in 2014. The complication rate decreased from 8.8% to 3.7% in idiopathic scoliosis, 21.9% to 15.8% in neuromuscular scoliosis and 26.8% to 0% in kyphosis. The complication rate increased from 6.6% to 14.4% in congenital scoliosis, 9.3% to 12.0% in other types of scoliosis, 3.5% to 14.3% in spondylolisthesis and 21.6% to 26.0% in adult spinal deformity. The rate of neurological deficit, especially in motor deficit, increased from 3.2% to 7.7% in older patients with adult spinal deformity. Instrumentation failure was also more common in patients with adult spinal deformity (5.2% to 5.8%), especially in patients aged 40–65 years (4.4% to 9.1%).

    Conclusions: The major complication trends were an increasing rate of neurological deficit and instrumentation failure, especially in adult spinal deformity.

    Download PDF (259K)
  • Kazuo Saita, Yoshiro Monobe, Satoshi Ogihara, Yosuke Kobayashi, Kei Sa ...
    Article ID: 2018-0071
    Published: 2018
    [Advance publication] Released: December 01, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION
    Download PDF (335K)
  • Tsutomu Akazawa, Masahiro Iinuma, Shingo Kuroya, Yoshiaki Torii, Tasuk ...
    Article ID: 2018-0075
    Published: 2018
    [Advance publication] Released: December 01, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    Introduction

    The purpose of this study is to investigate thoracic deformity correction and pulmonary function changes in patients with adolescent idiopathic scoliosis (AIS) five years or more after undergoing posterior spinal fusion with thoracoplasty for correction of a thoracic deformity.

    Methods

    Subjects were 57 patients with AIS who underwent posterior spinal fusion between 2004 and 2010. 24 patients who had undergone thoracoplasty at least five years earlier agreed to participate in this research. X-rays, pulmonary function tests, and thoracic cage computed tomography (CT) were performed, and the Scoliosis Research Society Outcomes Questionnaire (SRS-22) was administered. CT axial images were used at the apex of the main thoracic (MT) curve. Apical vertebral rotation was evaluated using rotation angle to the sagittal plane (RAsag). Thoracic deformities were evaluated using the rib hump index (RHi) and the posterior hemithoracic symmetry ratio (PHSr).

    Results

    There were no significant differences between the preoperative and the final observation forced vital capacity (FVC) or the preoperative and the final observation %FVC. The forced expiratory volume in 1 s (FEV1) and %FEV1 were significantly improved at the final observation: FEV1 (preoperative: 1.88 L, final observation: 2.05 L, p = 0.045) and %FEV1 (preoperative: 57.1%, final observation: 66.2%, p = 0.001). FEV1/FVC was also significantly improved at the final observation (preoperative: 83.0%, final observation: 86.4%, p = 0.019). The peak expiratory flow (PEF) was significantly improved at the final observation (preoperative: 3.67 L/s, final observation: 4.38 L/s, p = 0.029). On the CT assessment for thoracic deformities, there were no significant changes in RAsag or RHi. PHSr was significantly increased at the final observation compared with the preoperative period.

    Conclusions

    With posterior spinal fusion in combination with thoracoplasty for AIS, although the correction of deformities was limited, the pulmonary function testing demonstrated the preservation of vital capacity (VC) and improvements in the forced expiratory volume in 1 s and expiratory flow.

    Download PDF (1801K)
  • Mitsunori Yoshimoto, Noriyuki Iesato, Yoshinori Terashima, Katsumasa T ...
    Article ID: 2018-0076
    Published: 2018
    [Advance publication] Released: December 01, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    Introduction. There have been several reports on surgical techniques involving microendoscopy or percutaneous endoscopy for treating lumbar foraminal stenosis (LFS). However, no studies have assessed the mid-term clinical results of endoscopic techniques in spite of their relatively long history. In this study, we report 20 consecutive cases of LFS treated by our microendoscopic technique focusing on clinical results with a follow-up of at least two years.

    Methods. Twenty consecutive cases of LFS treated with microendoscopic decompression were followed up at 1, 2, 6, and 12 months postoperatively and annually thereafter. The patients were 14 males and 6 females, and the mean age at the time of surgery was 64.7 years. The Japanese Orthopaedic Association (JOA) score was used as the clinical outcome index.

    Results. Of the 20 patients, 16 were monitored successfully for more than 2 years. The follow-up rate was 80.0%, and the mean follow-up period was 66.3 months. The JOA score improved from 13.8 points before surgery to 24.6 points at final follow-up. Revision fusion surgeries were performed in two cases for LFS recurrence.

    Conclusions. The microendoscopic technique effectively treats LFS.

    Download PDF (696K)
  • Kenyu Ito, Izumi Kadono, Takashi Okada, Aika Hishida, Kei Ando, Kazuyo ...
    Article ID: 2018-0083
    Published: 2018
    [Advance publication] Released: December 01, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION
    Download PDF (772K)
  • Ryosuke Hirota, Hideto Irifune, Nobuyuki Takahashi, Makoto Emori, Atsu ...
    Article ID: 2018-0049
    Published: 2018
    [Advance publication] Released: November 20, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION
    Download PDF (2670K)
  • Tadashi Nukaga, Akihiko Hiyama, Hiroyuki Katoh, Masahiko Watanabe
    Article ID: 2018-0053
    Published: 2018
    [Advance publication] Released: November 20, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION
    Download PDF (1198K)
  • Hirotsugu Omi, Taito Itabashi, Toshihide Nagaoki, Tetsuya Ogawa, Takas ...
    Article ID: 2018-0056
    Published: 2018
    [Advance publication] Released: November 10, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    Introduction: Fluoroscopy-guided selective nerve root block (SNRB) is useful for the diagnosis and treatment of nerve root pain. However, the procedure exposes the surgeon' s hands to radiation. Therefore, the purpose of this randomized prospective study was to assess the radiation exposure per unit time of the surgeon' s fingers during performance of a lumbosacral SNRB and to calculate the annual exposure time limits for four hand-protection methods.

    Methods: We prospectively recruited patients scheduled for an SNRB and measured the radiation exposure using a ring-type passive radiation dosimetry device attached to the distal phalanx of the index finger of the hand performing the needle placement. Patients were randomly divided into the following four groups: a) the direct exposure group, b) the 0.03-mmPb glove group, c) the 0.25-mmPb glove group, and d) the forceps group (in which the needle was held using forceps such that the fingers did not enter the irradiation field).

    Results: We recruited 40 consecutive patients (16 men and 24 women), with a mean age of 69 years. In all cases, SNRB was successfully performed without complications. The average exposure per hour for each of the four groups was as follows: 0.67 ± 0.56 mSv/s in the direct exposure group, 0.12 ± 0.07 mSv/s in the 0.03-mmPb glove group, 0.019 ± 0.02 mSv/s in the 0.25-mmPb glove group, and 0.001 ± 0.004 mSv/s in the forceps group (p < 0.01). The average annual exposure time limit was 12.4 min in the direct exposure group, 67.9 min in the 0.03-mmPb glove group, 7.5 h in the 0.25-mmPb glove group, and 5.0 days in the forceps group.

    Conclusions: Using a radiation reduction glove or forceps greatly decreased the radiation exposure and increased the annual exposure time limit for SNRB.

    Download PDF (456K)
  • Hideaki Kashiro, Keiji Wada, Mitsuru Yui, Ryo Tamaki, Daisuke Numaguch ...
    Article ID: 2018-0065
    Published: 2018
    [Advance publication] Released: November 10, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION
    Download PDF (1067K)
  • Tetsuji Inoue
    Article ID: 2018-0032
    Published: 2018
    [Advance publication] Released: October 19, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    Introduction: Conus medullaris syndrome (CMS) is a rare pathology. The conus medullaris is located at the end of the spinal cord and continues to the cauda equina. Conus medullaris lesions can cause variable symptoms and neurological deficits, usually involving the lower extremities; CMS that does not affect the lower limbs is extremely rare. No reports have described isolated CMS caused by intradural disc herniation (IDH). This report describes a case of CMS without lower extremity involvement associated with IDH at L1/2.

    Case Report: A 52-year-old man with a 10-year history of lower back pain complained of dysuria and lumbago with no leg symptoms at his first visit to the urology department. Neurological examination revealed mild perineal hypoalgesia; however, motor function and lower extremity sensation were normal with except for left ankle dorsiflexion weakness (manual muscle test, 4/5). Magnetic resonance imaging revealed conus medullaris compression by a mass, continuous with the L1/2 disc, and severe spinal canal stenosis at vertebral levels L3/4 and L4/5. Postmyelographic computed tomography indicated direct conus medullaris compression by an intradural and extramedullary mass continuous with the L1/2 disc. Without recovery of his dysuria, the patient underwent surgery, including partial laminectomy of the L1/2 disc, incision of the dura mater, and removal of the herniated disc. Immediately after surgery, his dysuria completely resolved. More than one year postoperatively, the patient remained active with no change in his neurological condition.

    Conclusions: Although CMS without lower limb symptoms is extremely rare, we experienced an isolated case of CMS associated with IDH causing direct conus medullaris compression. Without lower extremity involvement, the CMS diagnosis was relatively easy. Surgical treatment for CMS without lower extremity involvement caused by IDH was effective.

    Download PDF (1120K)
  • Mitsunori Yoshimoto, Makoto Emori, Atsushi Teramoto, Toshihiko Yamashi ...
    Article ID: 2018-0064
    Published: 2018
    [Advance publication] Released: October 19, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION
    Download PDF (2326K)
  • Koji Tamai, Hidetomi Terai, Akinobu Suzuki, Hiroaki Nakamura, Kei Wata ...
    Article ID: 2018-0068
    Published: 2018
    [Advance publication] Released: October 19, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    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.

    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.

    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).

    Conclusion

    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.

    Download PDF (483K)
  • Izaya Ogon, Tsuneo Takebayashi, Hiroyuki Takashima, Tomonori Morita, M ...
    Article ID: 2018-0023
    Published: 2018
    [Advance publication] Released: October 10, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    Introduction: Magnetic resonance spectroscopy (MRS) enables detailed analysis of the composition of muscular fat tissues such as intramyocellular lipids (IMCLs) and extramyocellular lipids (EMCLs). The aim of this study was to analyze the EMCL and IMCL of the multifidus muscle (Mm) using MRS in chronic low-back pain (CLBP) patients and identify their possible correlations with age, body mass index (BMI), low-back pain (LBP) visual analog scale (VAS) score, cross-sectional area (CSA), and fat infiltration of the Mm.

    Methods: Eighty patients (32 men and 48 women; mean age, 64.7 ± 1.3 years; range, 22–83 years) with VAS scores >30 mm for CLBP were included. We analyzed the gender difference and the possible correlations of age, BMI, LBP VAS, CSA, and fat infiltration of the Mm with the IMCL and EMCL of the Mm. The subjects were divided into five groups as per their age range: <40s, 50s, 60s, 70s, and 80s. We also analyzed the EMCL and IMCL of the Mm as per the fat infiltration classification.

    Results: CSA was larger in the male group, EMCL was higher in the female group, and there was no significant difference in IMCL between the female and male groups. There was a significant positive correlation of EMCL with age (r = 0.33, p < 0.01) and BMI (r = 0.42, p < 0.01) and a significant negative correlation of EMCL with CSA (r = -0.61, p < 0.01). There was a significant positive correlation between IMCL and VAS (r = 0.43, p < 0.01). The EMCL and CSA of the Mm decreased with age, whereas fat infiltration increased with age.

    Conclusion: These results suggest that EMCL could indicate Mm degeneration associated with aging, and IMCL could be an effective objective indicator of CLBP. The EMCL and IMCL of the Mm may be useful prognostic markers in rehabilitation strategies.

    Download PDF (995K)
  • Masayuki Ishikawa, Makoto Nishiyama, Michihiro Kamata
    Article ID: 2018-0047
    Published: 2018
    [Advance publication] Released: October 10, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    Introduction: Controversies still exist in the surgical indications and outcomes of selective thoracic fusion (STF) for a primary thoracic curve with a compensatory large lumbar curve (King-Moe type II/Lenke 1C curve) in adolescent idiopathic scoliosis (AIS). Issues of the greatest concern regarding this curve type include curve criteria that indicate STF to prevent postoperative coronal decompensation and postoperative radiographic outcomes, including curve correction, coronal balance, and thoracolumbar kyphosis, after STF.

    Methods: This review comprehensively documents the issues raised in the literature regarding surgical indications and radiographic outcomes of STF for King-Moe type II/Lenke 1C curve in AIS.

    Results: Studies suggest that radiographic curve criteria indicating STF for this curve type include the preoperative dominance of the thoracic curve to the lumbar curve in the Cobb angle and the characteristics of the lumbar curve in magnitude and flexibility. Studies warn the need for a careful clinical evaluation of the thoracic and lumbar rotational prominences. Documented radiographic outcomes of importance include the postoperative behavior of the unfused lumbar curve, coronal or sagittal decompensation after STF, and factors associated with these issues.

    A comprehensive review of the literature suggests that the use of a segmental pedicle screw construct and better instrumented thoracic curve correction achieve better spontaneous lumbar curve correction. Although the causes of postoperative coronal decompensation remain multifactorial, preoperative coronal decompensation to the left and an inappropriate selection of the lowest instrumented vertebra are consistently reported to be the major causative factors.

    Conclusions: STF has been validated in general for the treatment of King-Moe type II or Lenke 1C curve in AIS; however, controversies remain regarding the surgical indications and outcomes.

    Long-term impacts of residual lumbar curve, coronal decompensation, and mild thoracolumbar kyphosis on clinical outcomes after STF, along with optimal indications and strategy for STF, should further be assessed.

    Download PDF (2508K)
  • Tatsunori Ikemoto, Kenji Miki, Takako Matsubara, Norimitsu Wakao
    Article ID: 2018-0050
    Published: 2018
    [Advance publication] Released: October 10, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    Studies have indicated that chronic low back pain (LBP) should be approached according to its morphological basis and in consideration of biopsychosocial interventions. This study presents an updated review on available psychological assessments and interventions for patients with chronic LBP. Psychosocial factors, including fear-avoidance behavior, low mood/withdrawal, expectation of passive treatment, and negative pain beliefs, are known as risk factors for the development of chronic LBP. The Örebro Musculoskeletal Pain Questionnaire, STarT Back Screening Tool, and Brief Scale for Psychiatric Problems in Orthopaedic Patients have been used as screening tools to assess the development of chronicity or identify possible psychiatric problems. The Pain Catastrophizing Scale, Pain Self-Efficacy Questionnaire, and Injustice Experience Questionnaire are also widely used to assess psychosocial factors in patients with chronic pain. With regard to interventions, the placebo effect can be enhanced by preferable patient–clinician relationship. Reassurance to patients with non-specific pain is advised by many guidelines. Cognitive behavioral therapy focuses on restructuring the negative cognition of the patient into realistic appraisal. Mindfulness may help improve pain acceptance. Self-management strategies with appropriate goal setting and pacing theory have proved to improve long-term pain-related outcomes in patients with chronic pain.

    Download PDF (577K)
  • Venkata Ramakrishna Tukkapuram, Abumi Kuniyoshi, Manabu Ito
    Article ID: 2018-0055
    Published: 2018
    [Advance publication] Released: October 10, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    Cervical spine instrumentation is evolving with an aim of stabilizing traumatic and non-traumatic cases of the cervical spine with a beneficial reduction, better biomechanical strength, and a strong construct with minimal intraoperative, as well as immediate and late postoperative complications. The evolution from interspinous wiring till cervical pedicle screws has changed the outlook in treating the cervical spine pathologies with maximum 3D stability, decreasing the duration of postoperative immobilization and hospital stay. Some complications associated with the use of cervical pedicle screw can be catastrophic. This review article discusses the morphometry of cervical pedicle; indications, biomechanical superiority, tricks, and pitfalls of cervical pedicle screw; complications and technical advancements in targeting safe surgery; and future directions of cervical pedicle screw instrumentation.

    Download PDF (584K)
  • Daisuke Numaguchi, Keiji Wada, Mitsuru Yui, Ryo Tamaki, Ken Okazaki
    Article ID: 2018-0019
    Published: 2018
    [Advance publication] Released: August 25, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    Introduction: The incidence of remote cerebellar hemorrhage (RCH) in patients with a dural tear during spinal surgery is unclear. The purpose of this study was to determine the incidence of RCH and the causative factors in these patients.

    Methods: Two hundred and thirty-nine patients underwent spinal surgery at our institution between March 2015 and September 2016. Eleven of these patients needed dural suturing intraoperatively. All patients underwent CT of the head on the first postoperative day and were categorized according to whether they had RCH or not. The mean values for the amount of intraoperative bleeding, maximum perioperative blood pressure, postoperative drainage volume, and complaints of headache during the first 24 h postoperatively were compared between the two groups using the Welch's two-sample t-test and Fisher's exact test. The follow-up duration was 12 months.

    Results: There were four patients in the RCH group and seven in the non-RCH group. The incidence of RCH was 36.4%. There were three cerebellar hemorrhages and one interhemispheric fissure hemorrhage in the RCH group. The mean intraoperative bleeding volume was 284 mL in the RCH group and 569 mL in the non-RCH group. The mean respective values for maximum perioperative blood pressure and postoperative drainage volume were 132 mmHg and 547 mL in the RCH group and 144 mmHg and 567 mL in the non-RCH group; none of the differences was statistically significant. However, complaints of headache in the first 24 h postoperatively were significantly more common in the RCH group than in the non-RCH group (100% vs. 14.3%; p = 0.01). All patients with intracranial bleeding had recovered 3 months after surgery.

    Conclusions: The incidence of RCH following a dural tear during spinal surgery was 36.4%. There was a significant association between RCH and increased reporting of headache during the first 24 h postoperatively.

    Download PDF (235K)
  • Tsuyoshi Goto, Toshinori Sakai, Kosuke Sugiura, Hiroaki Manabe, Masato ...
    Article ID: 2018-0020
    Published: 2018
    [Advance publication] Released: August 25, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    Purpose: In past biomechanical studies, repetitive motion of lumbar extension, rotation, or a combination of both, frequently seen in batting or pitching practice in baseball, shooting practice in soccer, and spiking practice in volleyball, have been considered important risk factors of lumbar spondylolysis. However, clinically, these have been identified in many athletes performing on a running track or on the field, which requires none of the practices described above. The purpose of this study was to verify how much impact running has on the pathologic mechanism of lumbar spondylolysis.

    Methods: In study 1, 89 consecutive pediatric patients diagnosed with lumbar spondylolysis at a single outpatient clinic between January 2012 and February 2017 were retrospectively analyzed. In study 2, motion analysis was performed on 17 male volunteers who had played on a soccer team without experiencing low back pain or any type of musculoskeletal injury. A Vicon motion capture system was used to evaluate four movements: maximal effort sprint (Dash), comfortable running (Jog), instep kick (Shoot), and inside kick (Pass).

    Results: In study 1, 13 of the 89 patients with lumbar spondylolysis were track and field athletes. In study 2, motion analysis revealed that the hip extension angle, spine rotation angle, and hip flexion moment were similar in Dash and Shoot during the maximum hip extension phase. The pelvic rotation angle was significantly greater in the kicking conditions than in the running conditions.

    Conclusions: Kinematically and kinetically, the spinopelvic angles in Dash were considered similar to those in Shoot. Dash could cause mechanical stress at the pars interarticularis of the lumbar spine, similar to that caused by Shoot, thus leading to spondylolysis.

    Download PDF (523K)
  • Yusuke Hori, Shinji Takahashi, Hidetomi Terai, Masatoshi Hoshino, Hiro ...
    Article ID: 2018-0025
    Published: 2018
    [Advance publication] Released: August 25, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    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.

    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.

    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%, P = 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, P = 0.001; 19.9 vs. 25.1 at final follow-up, P < 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%, P = 0.041).

    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.

    Download PDF (246K)
  • Ryoma Aoyama, Tateru Shiraishi, Junichi Yamane, Ken Ninomiya, Kazuya K ...
    Article ID: 2018-0034
    Published: 2018
    [Advance publication] Released: August 25, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    Introduction: The purpose of this study was to elucidate the duration for which the dural tube continues to expand after muscle-preserving cervical laminectomy and the extent to which the expansion affects surgical outcomes.

    Methods: We analyzed 83 patients with cervical myelopathy who underwent muscle-preserving selective laminectomy of three consecutive laminae between C4 and C6. On the lateral radiographs, parameters considered were C2–7 Cobb angles, range of flexion–extension neck motions, and C2–7 sagittal vertical axis. Neck alignment was classified into four types with lateral radiographs. Anteroposterior (AP) diameter of the dural tube was measured at mid-level of the C5 vertebral body on T2 sagittal image. Expansion ratio (ER) was defined as the extent of expansion at a particular time divided by the final extent of expansion of the dural tube diameter. Operative outcomes were examined using the Japanese Orthopaedic Association scores.

    Results: The mean age was 62.3 years, and the mean follow-up period was 2 years and 9 months. AP diameter of the dural tube had been expanding until 1-year after surgery. ER in cases with kyphosis was lower at 6 months than that in cases without kyphosis, indicating that the speed of dural expansion was slower in cases with kyphosis. There was no correlation between the extent of expansion of the dural tube and neurological recovery.

    Conclusions: The dural tube continued to expand for approximately 1-year after surgery. The dural tube of patients with kyphosis slowly expanded possibly because of the hardness of the dura mater. A small extent of dural expansion does not necessarily indicate bad surgical outcomes.

    Download PDF (600K)
  • Yuyu Ishimoto, Mamoru Kawakami, Elizabeth Curtis, Cyrus Cooper, Nichol ...
    Article ID: 2018-0051
    Published: 2018
    [Advance publication] Released: August 25, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    Introduction: Musculoskeletal diseases and spinal malalignment are associated with poorer quality of life (QOL) in the elderly. However, to date, few general population cohort studies have focused on these conditions together. Our objectives were to clarify the associations between musculoskeletal degenerative diseases and/or spinal malalignment with QOL measures in a group of Japanese older adults.

    Methods: In this cross-sectional study, we analyzed data from 334 individuals recruited from the local population (120 men, 214 women; mean age 62.7 years; range 40–75). Low back pain (LBP) was assessed by questionnaire, and lumbar spinal stenosis (LSS) was diagnosed using a validated lumbar spinal stenosis support tool. Knee osteoarthritis (KOA) was diagnosed by the presence of clinical knee pain plus radiographic KOA. Spinal radiographs were used to assess the degree of lumbar lordosis (LL) and sagittal vertical alignment (SVA). QOL assessment was performed using the Oswestry Disability Index (ODI). A score of 12 was used as a cut-off point for poor QOL.

    Results: Overall, 107 (32.0%) participants had an ODI > 12 (cases), and the remaining 227 individuals were designated controls. LBP, LSS, KOA, and LL were associated with poorer QOL, both in basic models and models adjusted for age, sex, and BMI. Associations persisted after adjustment for other musculoskeletal outcomes.

    Conclusion: In a free-living Japanese population, the poor QOL odds are increased by LBP, LSS, KOA, and certain spinal radiographic features, loss of LL, and increased SVA. Poor QOL odds were greatest in those diagnosed with LSS or KOA. From spinal radiographs, decreased LL and increased SVA were also predictors of poor QOL.

    Download PDF (339K)
  • Toshio Nakamae, Kiyotaka Yamada, Yasuyuki Tsuchida, Nobuo Adachi, Yosh ...
    Article ID: 2018-0035
    Published: 2018
    [Advance publication] Released: July 25, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    Introduction:

    Spinal lesions in synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome generally have a good prognosis and rarely cause structural destruction or neurological deterioration. We described a surgical case of posterior instrumented surgery without anterior reconstruction and bone graft in a patient with SAPHO syndrome with destructive spondylitis and reviewed the literature on surgical treatment for this entity.

    Case Report:

    We describe the case of a 73-year-old male who presented with palmoplantar pustulosis. He experienced progressive low back and leg pain for the past 3 months. Destructive spondylitis and lumbar canal stenosis were detected with magnetic resonance imaging (MRI), and aspiration biopsy was used to exclude pyogenic spondylitis and spinal tumors. He underwent posterior decompression and fixation surgery without anterior reconstruction and bone grafting. Low back and leg pain improved after surgery. Postoperative radiography and computed tomography showed boney bridge between vertebral bodies, and MRI showed the decrease of bone marrow edema.

    Conclusions:

    Posterior fusion without anterior reconstruction produced a bony bridge between the vertebral bodies. Taking the pathophysiology of SAPHO syndrome into consideration, anterior reconstructed fusion for patients with SAPHO syndrome might not be needed.

    Download PDF (426K)
  • Hiroaki Manabe, Toshinori Sakai, Fumitake Tezuka, Kazuta Yamashita, Yo ...
    Article ID: 2018-0015
    Published: 2018
    [Advance publication] Released: May 29, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    Introduction: C4 radiculopathy due to cervical spondylosis has rarely been reported as a cause of hemidiaphragmatic paralysis.

    Case Report: A 70-year-old man presented with hemidiaphragmatic paralysis due to right C3-C4 foraminal stenosis. The diagnosis was made preoperatively from findings on plain chest radiographs, respiratory function tests, and electrophysiologic tests. All the patient's test results and symptoms improved immediately after surgical treatment for cervical spondylosis.

    Conclusions: Although it may be difficult to make a correct diagnosis based only on radiological findings at the cervical spine, we should be aware of the existence of this entity and pay close attention to chest radiographs.

    Download PDF (1350K)
  • Ryunosuke Fukushi, Satoshi Kawaguchi, Goichi Watanabe, Keiko Horigome, ...
    Article ID: 2018-0017
    Published: 2018
    [Advance publication] Released: May 29, 2018
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    Introduction: Vertebral fractures associated with ankylosing spinal disorders pose significant diagnostic and therapeutic challenges. Notably, the ankylosed spine remains in ankylosis after fracture treatment, and the underlying susceptibility to further fractures still remains. Nevertheless, information is scarce in the literature concerning patients with ankylosing spinal disorders who have multiple episodes of vertebral fractures.

    Case report: Case 1 involves an 83-year-old male patient with diffuse idiopathic skeletal hyperostosis (ankylosis from C2 to L4) who had three episodes of vertebral fractures. The first episode involved a C5–C6 extension-type fracture, which was treated with posterior segmental screw instrumentation. Five years later, the patient sustained a three-column fracture at the L1 vertebra following another fall. The fracture was managed with percutaneous segmental screw instrumentation. One year and two months postoperatively, the patient fell again and had a refracture of the healed L1 fracture. The patient was treated with a hard brace, and the fracture healed. Case 2 involves a 76-year-old female patient with ankylosing spondylitis (ankylosis from C7 to L2) who had two episodes. At the first episode, she suffered paraplegia due to a T8 vertebra fracture. The patient was treated with laminectomy and posterior segmental screw instrumentation. The patient recovered well and had all the hardware removed at 10 months postoperatively. Five years later, she had another fall and suffered a three-column fracture at L1. The patient underwent percutaneous segmental screw instrumentation. The patient required revision surgery with L1 laminectomy and L1 right pediclectomy for persistent right inguinal pain. At one-year follow-up, the patient recovered well, and the fracture healed.

    Conclusion: The abovementioned cases show that an age older than 75 years and a long spinal ankylosis from the cervical spine to the lumbar spine may serve as risk factors for the repetition of vertebral fractures associated with ankylosed spinal disorders.

    Download PDF (671K)
feedback
Top