研究者詳細 - 鈴木　悟士

鈴木　悟士（スズキ　サトシ）

Suzuki, Satoshi

写真a

所属（所属キャンパス）: 医学部整形外科学教室（信濃町）

職名: 専任講師（有期）

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Spinal fractures in patients with diffuse idiopathic skeletal hyperostosis: Clinical characteristics by fracture level

Okada E., Shimizu K., Kato M., Fukuda K., Kaneko S., Ogawa J., Yagi M., Fujita N., Tsuji O., Suzuki S., Nagoshi N., Tsuji T., Nakamura M., Matsumoto M., Watanabe K.

Journal of Orthopaedic Science （Journal of Orthopaedic Science） 24 （ 3 ） 393 - 399 2019年05月

ISSN 09492658

　概要を見る

© 2018 The Japanese Orthopaedic Association Background: Diffuse idiopathic skeletal hyperostosis (DISH) makes the spine prone to unstable fractures with neurological deterioration. This study was conducted to assess clinical and radiographic features of spinal fractures in DISH by the level of spinal injury, and to evaluate the optimal treatment for each level. Methods: A multicenter retrospective study over a 5-year period, including 46 patients (35 males; 11 females) with a mean age of 77.2 ± 9.7 years at the time of injury. By fracture level, there were 7 cervical (15.2%), 25 thoracic (54.3%), and 14 lumbar (30.4%) fractures. We recorded the cause of injury, whether diagnosis was delayed, and neurological status by Frankel grade. Ossification and fracture patterns were assessed by CT-multi-planar reconstruction (MPR). Results: Neurological status immediately after the cervical-spine injury was C (28.6%) or E (71.4%); after thoracic injury, C (12.0%) or E (88.0%); and after lumbar injury, D (21.4%) or E (78.6%). Inability to walk at admission was more frequent in patients with a spinal-cord injury above the lumbar level (P = .033). Vertebral-body fractures were observed in 14.3% of the cervical injuries, 80.0% of the thoracic injuries, and 50.0% of the lumbar injuries (P = .004). Most patients with a cervical fracture had a disc-level fracture (85.7%). Posterior-column ankylosis was observed in 14.3% of the cervical-fracture group, 72.0% of the thoracic-fracture group, and 78.6% of the lumbar-fracture group (P = .008). Conclusion: Ossification and fracture patterns in patients with DISH varied distinctly by the level of spinal injury. Intervertebral-disc fractures were frequently observed in the cervical spine. Delayed diagnosis, vertebral-body fracture, and posterior-column ankylosis were observed in the thoracolumbar spine. This study recommends 3 above and 3 below fusion, to avoid instrumentation failure in the fixation of spinal fracture in patients with DISH.
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Surgical risk stratification based on preoperative risk factors in adult spinal deformity

Yagi M., Hosogane N., Fujita N., Okada E., Suzuki S., Tsuji O., Nagoshi N., Asazuma T., Tsuji T., Nakamura M., Matsumoto M., Watanabe K.

Spine Journal （Spine Journal） 19 （ 5 ） 816 - 826 2019年05月

ISSN 15299430

　概要を見る

© 2018 Elsevier Inc. BACKGROUND CONTEXT: Corrective surgery for adult spinal deformity (ASD) improves health-related quality of life but has high complication rates. Predicting a patient's risk of perioperative and late postoperative complications is difficult, although several potential risk factors have been reported. PURPOSE: To establish an accurate, ASD-specific model for predicting the risk of postoperative complications, based on baseline demographic, radiographic, and surgical invasiveness data in a retrospective case series. STUDY DESIGN/SETTING: Multicentered retrospective review and the surgical risk stratification. PATIENT SAMPLE: One hundred fifty-one surgically treated ASD at our hospital for risk analysis and model building and 89 surgically treated ASD at 2 other our hospitals for model validation. OUTCOME MEASURES: HRQoL measures and surgical complications. METHODS: We analyzed demographic and medical data, including complications, for 151 adults with ASD who underwent surgery at our hospital and were followed for at least 2years. Each surgical risk factor identified by univariate analyses was assigned a value based on its odds ratio, and the values of all risk factors were summed to obtain a surgical risk score (range 0–20). We stratified risk scores into grades (A–D) and analyzed their correlations with complications. We validated the model using data from 89 patients who underwent ASD surgery at two other hospitals. RESULTS: Complications developed in 48% of the patients in the model-building cohort. Univariate analyses identified 10 demographic, physical, and surgical risk indicators, with odds ratios from 5.4 to 1.4, for complications. Our risk-grading system showed good calibration and discrimination in the validation cohort. The complication rate increased with and correlated well with the risk grade using receiver operating characteristic curves. CONCLUSIONS: This simple, ASD-specific model uses readily accessible indicators to predict a patient's risk of perioperative and postoperative complications and can help surgeons adjust treatment strategies for best outcomes in high-risk patients.
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Potential involvement of semaphorin 3A in maintaining intervertebral disc tissue homeostasis

Mima Y., Suzuki S., Fujii T., Morikawa T., Tamaki S., Takubo K., Shimoda M., Miyamoto T., Watanabe K., Matsumoto M., Nakamura M., Fujita N.

Journal of Orthopaedic Research （Journal of Orthopaedic Research） 37 （ 4 ） 972 - 980 2019年04月

ISSN 07360266

　概要を見る

© 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. Intervertebral discs (IVDs) are avascular; however, ingrowth of blood vessels into their outer regions has been noted during the progression of degeneration. The mechanisms underlying vascularization in IVD degeneration are not completely understood. Semaphorin 3A (Sema3A), originally characterized as a chemorepulsive factor for growing axons in the developing nervous system, inhibits angiogenesis. This study aimed to elucidate the potential involvement of Sema3A in maintaining tissue homeostasis within the avascular IVD. We demonstrated that the mRNA expression of Sema3A was higher in rat annulus fibrosus (AF) than in nucleus pulposus (NP) and that its expression level decreased with age. Both mRNA and protein expression level of Sema3A was also markedly suppressed in AF tissues of a rat IVD degeneration model. Both real-time RT-PCR and Western blot clearly indicated that Sema3A expression significantly reduced by treating inflammatory cytokines in rat AF cells. In a gain- and loss-of-function study, we observed that Sema3A reduced the catabolic shift in rat AF cells. In addition, our results indicated that Sema3A potentially inhibited the IL-6/JAK/STAT pathway. Finally, BrdU assay and tube formation assay revealed that treatment of recombinant Sema3A significantly blocks both proliferation and tube formation of HUVEC. Our results indicate that Sema3A may help maintain IVD tissue homeostasis. Thus, although further studies are needed, Sema3A may be a potential molecular target for suppressing IVD degeneration. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Surgical outcomes of spinal fusion for osteoporotic thoracolumbar vertebral fractures in patients with Parkinson's disease: What is the impact of Parkinson's disease on surgical outcome?

Watanabe K., Katsumi K., Ohashi M., Shibuya Y., Izumi T., Hirano T., Endo N., Kaito T., Yamashita T., Fujiwara H., Nagamoto Y., Matsuoka Y., Suzuki H., Nishimura H., Terai H., Tamai K., Tagami A., Yamada S., Adachi S., Yoshii T., Ushio S., Harimaya K., Kawaguchi K., Yokoyama N., Oishi H., Doi T., Kimura A., Inoue H., Inoue G., Miyagi M., Saito W., Nakano A., Sakai D., Nukaga T., Ikegami S., Shimizu M., Futatsugi T., Ohtori S., Furuya T., Orita S., Imagama S., Ando K., Kobayashi K., Kiyasu K., Murakami H., Yoshioka K., Seki S., Hongo M., Kakutani K., Yurube T., Aoki Y., Oshima M., Takahata M., Iwata A., Endo H., Abe T., Tsukanishi T., Nakanishi K., Watanabe K., Hikata T., Suzuki S., Isogai N., Okada E., Funao H., Ueda S., Shiono Y., Nojiri K., Hosogane N., Ishii K.

BMC Musculoskeletal Disorders （BMC Musculoskeletal Disorders） 20 （ 1 ） 2019年03月

　概要を見る

© 2019 The Author(s). Background: To date, there have been little published data on surgical outcomes for patients with PD with thoracolumbar OVF. We conducted a retrospective multicenter study of registry data to investigate the outcomes of fusion surgery for patients with Parkinson's disease (PD) with osteoporotic vertebral fracture (OVF) in the thoracolumbar junction. Methods: Retrospectively registered data were collected from 27 universities and their affiliated hospitals in Japan. In total, 26 patients with PD (mean age, 76 years; 3 men and 23 women) with thoracolumbar OVF who underwent spinal fusion with a minimum of 2 years of follow-up were included (PD group). Surgical invasion, perioperative complications, radiographic sagittal alignment, mechanical failure (MF) related to instrumentation, and clinical outcomes were evaluated. A control group of 296 non-PD patients (non-PD group) matched for age, sex, distribution of surgical procedures, number of fused segments, and follow-up period were used for comparison. Results: The PD group showed higher rates of perioperative complications (p < 0.01) and frequency of delirium than the non-PD group (p < 0.01). There were no significant differences in the degree of kyphosis correction, frequency of MF, visual analog scale of the symptoms, and improvement according to the Japanese Orthopaedic Association scoring system between the two groups. However, the PD group showed a higher proportion of non-ambulators and dependent ambulators with walkers at the final follow-up (p < 0.01). Conclusions: A similar surgical strategy can be applicable to patients with PD with OVF in the thoracolumbar junction. However, physicians should pay extra attention to intensive perioperative care to prevent various adverse events and implement a rehabilitation regimen to regain walking ability.
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Impact of lumbar hypolordosis on the incidence of symptomatic postoperative spinal epidural hematoma after decompression surgery for lumbar spinal canal stenosis

Fujita N., Michikawa T., Yagi M., Suzuki S., Tsuji O., Nagoshi N., Okada E., Tsuji T., Nakamura M., Matsumoto M., Watanabe K.

European Spine Journal （European Spine Journal） 28 （ 1 ） 87 - 93 2019年01月

ISSN 09406719

　概要を見る

© 2018, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: Potential associations between radiographic parameters and the incidence of symptomatic postoperative spinal epidural hematoma (PSEH) have not been identified. This study aimed to identify risk factors including radiographic parameters for symptomatic PSEH after posterior decompression surgery for lumbar spinal canal stenosis (LSS). Methods: We retrospectively reviewed 1007 consecutive patients who underwent lumbar decompression surgery for lumbar spinal canal stenosis (LSS) at our institution. We identified 35 cases of symptomatic PSEH, defined by clinical symptoms and MRI findings, and selected 3 or 4 age- and sex-matched control subjects for each PSEH subject (124 controls). We compared radiographic parameters and previously reported risk factors between PSEH and control subjects. Results: Compared to the control group, PSEH patients had significantly higher preoperative systolic (p =.020) and diastolic (p =.048) blood pressure, and more levels of decompression (p =.001). PSEH and control subjects had significant differences in lumbar lordosis (PSEH 24.8° ± 14.6°, control 34.8° ± 14.5°), pelvic tilt (25.1° ± 11.7° vs. 20.8° ± 8.4°), sacral slope (23.4° ± 9.4° vs. 27.6° ± 8.3°), and pelvic incidence minus lumbar lordosis (23.7° ± 15.0° vs. 13.7° ± 14.6°). Multivariate analysis revealed two significant risk factors for PSEH: decompression of two or more levels and lumbar lordosis < 25°. Conclusions: Multilevel decompression and hypolordosis are significant risk factors for symptomatic PSEH after decompression surgery for LSS. LSS patients with lumbar hypolordosis or multilevel stenosis should be carefully observed for PSEH after decompression surgery. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].
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