慶應義塾研究者情報データベース

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• Impact of leg numbness on patient satisfaction following decompression surgery for lumbar spinal stenosis

  Ogura Y., Takahashi Y., Kitagawa T., Yonezawa Y., Yoshida K., Takeda K., Kobayashi Y., Takahashi Y., Alhammoud A., Yasuda A., Shinozaki Y., Ogawa J.

  Journal of Clinical Neuroscience （Journal of Clinical Neuroscience)  93   112 - 115 2021年11月

  ISSN  09675868

  　概要を見る

  Decompression surgery is the most common surgical treatment for lumbar spinal stenosis (LSS). Relatively low satisfaction rate was reported. Patients often complaint of residual numbness despite significant pain relief. We hypothesized that numbness had a significant impact on patient satisfaction, but had not been evaluated, which is associated with low satisfaction rate. This study aimed to examine how much numbness is associated with patient satisfaction. We retrospectively reviewed prospectively collected data from consecutive patients who underwent decompression without fusion for LSS. We evaluated the Numeric Rating Scale (NRS) scores of low back pain (LBP), leg pain, and leg numbness preoperatively and at the final follow-up visit. Improvement was evaluated using minimum clinically important differences (MCIDs). Patient satisfaction was evaluated using the question, “How satisfied are you with the overall result of your back operation?”. There are four possible answers consisting of “very satisfied (4-point)”, “somewhat satisfied (3-point)”, “somewhat dissatisfied (2-point)”, or “very dissatisfied (1-point)”. Spearman correlation was used to evaluate the association between patient satisfaction and reaching MCIDs. A total of 116 patients were included. All three components had correlation with patient satisfaction with the correlation efficient of 0.30 in LBP, 0.22 in leg pain, and 0.33 in numbness. Numbness had greatest correlation efficient value. We showed that numbness has a greater impact than leg/back pain on patient satisfaction in patients undergoing decompression for LSS. We suggest not only LBP and leg pain but also numbness should be evaluated pre- and postoperatively.

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• Rate of Scoliosis Correction After Anterior Spinal Growth Tethering for Idiopathic Scoliosis

  Takahashi Y., Saito W., Yaszay B., Bartley C.E., Bastrom T.P., Newton P.O.

  The Journal of bone and joint surgery. American volume （The Journal of bone and joint surgery. American volume)  103 （ 18 ） 1718 - 1723 2021年09月

  　概要を見る

  BACKGROUND: The purpose of the present study was to evaluate associations between changes in segmental vertebral coronal angulation (screw angulation) and overall height after anterior spinal growth tethering for the treatment of idiopathic scoliosis and to compare the rates of coronal angulation change using the preoperative Sanders stage. METHODS: Patients with idiopathic scoliosis who underwent anterior spinal growth tethering between 2012 and 2016 and had ≥2 years of follow-up were retrospectively studied. We calculated each segment's screw angulation rate of change (degrees/month) and each patient's height velocity (cm/month) between each of the visits (3 to 12 visits/patient) and divided the visits into 4 groups by postoperative duration (<1 year, 1 to 2 years, >2 to 3 years, >3 years). Patients were divided into 2 groups according to the preoperative Sanders stage. Generalized estimating equations and repeated-measures correlation were utilized for analyses with non-independent samples. RESULTS: We analyzed 23 patients (16 female, 7 male) with a mean age (and standard deviation) of 12.2 ± 1.6 years who had right thoracic idiopathic scoliosis (mean, 53° ± 8°). All patients were immature at the time of surgery (Risser stage 0 or 1, Sanders stage 2 or 3). The mean duration of follow-up was 3.4 ± 1.1 years (range, 2 to 5 years). The rate of change for each segment's screw angulation after anterior spinal growth tethering was -0.16°, -0.14°, -0.05°, and 0.03° per month (with negative values indicating a reduction in scoliosis) for <1 year, 1 to 2 years, >2 to 3 years, and >3 years, respectively (p ≤ 0.001), and the mean height velocity was 0.65, 0.57, 0.30, and 0.19 cm per month for <1 year, 1 to 2 years, >2 to 3 years, and >3 years, respectively (p < 0.001). Changes in screw angulation correlated with height increases after anterior spinal growth tethering (r = -0.46, p < 0.001). Scoliosis correction for patients in the Sanders stage-2 group continued for 3 years (0.23°, 0.23°, and 0.09° per level per month for the first 3 years, respectively) and occurred at more than twice the rate for patients in the Sanders stage-3 group, for whom scoliosis correction ceased 2 years postoperatively (0.11° and 0.09° per level per month for the first 2 years, respectively). CONCLUSIONS: Scoliosis correction was associated with overall height changes and occurred primarily within 2 to 3 years after surgery in this cohort of largely Risser stage-0 patients. The correction rate was 2.8° per segment per year for the first 2 years in the Sanders stage-2 group, compared with 1.2° per segment per year for the Sanders stage-3 group. Surgical timing that considers the patient's skeletal maturity is an important factor in generating proper postoperative correction after anterior spinal growth tethering. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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• Polygenic Risk Score of Adolescent Idiopathic Scoliosis for Potential Clinical Use

  Otomo N., Lu H.F., Koido M., Kou I., Takeda K., Momozawa Y., Kubo M., Kamatani Y., Ogura Y., Takahashi Y., Nakajima M., Minami S., Uno K., Kawakami N., Ito M., Sato T., Watanabe K., Kaito T., Yanagida H., Taneichi H., Harimaya K., Taniguchi Y., Shigematsu H., Iida T., Demura S., Sugawara R., Fujita N., Yagi M., Okada E., Hosogane N., Kono K., Nakamura M., Chiba K., Kotani T., Sakuma T., Akazawa T., Suzuki T., Nishida K., Kakutani K., Tsuji T., Sudo H., Iwata A., Kaneko K., Inami S., Kochi Y., Chang W.C., Matsumoto M., Watanabe K., Ikegawa S., Terao C.

  Journal of Bone and Mineral Research （Journal of Bone and Mineral Research)  36 （ 8 ） 1481 - 1491 2021年08月

  ISSN  08840431

  　概要を見る

  Adolescent idiopathic scoliosis (AIS) is a common disease causing three-dimensional spinal deformity in as many as 3% of adolescents. Development of a method that can accurately predict the onset and progression of AIS is an immediate need for clinical practice. Because the heritability of AIS is estimated as high as 87.5% in twin studies, prediction of its onset and progression based on genetic data is a promising option. We show the usefulness of polygenic risk score (PRS) for the prediction of onset and progression of AIS. We used AIS genomewide association study (GWAS) data comprising 79,211 subjects in three cohorts and constructed a PRS based on association statistics in a discovery set including 31,999 female subjects. After calibration using a validation data set, we applied the PRS to a test data set. By integrating functional annotations showing heritability enrichment in the selection of variants, the PRS demonstrated an association with AIS susceptibility (p = 3.5 × 10−40 with area under the receiver-operating characteristic [AUROC] = 0.674, sensitivity = 0.644, and specificity = 0.622). The decile with the highest PRS showed an odds ratio of as high as 3.36 (p = 1.4 × 10−10) to develop AIS compared with the fifth in decile. The addition of a predictive model with only a single clinical parameter (body mass index) improved predictive ability for development of AIS (AUROC = 0.722, net reclassification improvement [NRI] 0.505 ± 0.054, p = 1.6 × 10−8), potentiating clinical use of the prediction model. Furthermore, we found the Cobb angle (CA), the severity measurement of AIS, to be a polygenic trait that showed a significant genetic correlation with AIS susceptibility (rg = 0.6, p = 3.0 × 10−4). The AIS PRS demonstrated a significant association with CA. These results indicate a shared polygenic architecture between onset and progression of AIS and the potential usefulness of PRS in clinical settings as a predictor to promote early intervention of AIS and avoid invasive surgery. © 2021 American Society for Bone and Mineral Research (ASBMR).

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• Improvement of Lower Back Pain in Lumbar Spinal Stenosis After Decompression Surgery and Factors That Predict Residual Lower Back Pain

  Kitagawa T., Ogura Y., Kobayashi Y., Takahashi Y., Yonezawa Y., Yoshida K., Takahashi Y., Yasuda A., Shinozaki Y., Ogawa J.

  Global Spine Journal （Global Spine Journal)  11 （ 2 ） 212 - 218 2021年03月

  ISSN  21925682

  　概要を見る

  Study Design: Retrospective observational study. Objectives: There is no consensus to predict improvement of lower back pain (LBP) in lumbar spinal stenosis after decompression surgery. The aim of this study was to evaluate the improvement of LBP and analyze the preoperative predicting factors for residual LBP. Methods: We retrospectively reviewed 119 patients who underwent lumbar decompression surgery without fusion and had a minimum follow-up of 1 year. LBP was evaluated using the numerical rating scale (NRS), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) LBP score, and Roland-Morris Disability Questionnaire (RMDQ). All patients were divided into LBP improved group (group I) and LBP residual group (group R) according to the NRS score. Radiographic images were examined preoperatively and at the final follow-up. We evaluated spinopelvic radiological parameters and analyzed the differences between group I and group R. Results: LBP was significantly improved after decompression surgery (LBP NRS, 5.7 vs 2.6, P <.001; JOABPEQ LBP score, 41.3 vs 79.6, P <.001; RMDQ, 10.3 vs 3.6, P <.001). Of 119 patients, 94 patients were allocated to group I and 25 was allocated to group R. There was significant difference in preoperative thoracolumbar kyphosis between group I and group R. Conclusions: Most cases of LBP in lumbar spinal stenosis were improved after decompression surgery without fusion. Preoperative thoracolumbar kyphosis predicted residual LBP after decompression surgery.

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• Postoperative tongue deviation by hypoglossal nerve palsy and Tapia's syndrome after cervical laminoplasty: report of two cases

  Ishihara H., Tsuji O., Okada E., Izawa Y., Kato J., Suzuki S., Takahashi Y., Nori S., Nagoshi N., Yagi M., Watanabe K., Nakamura M., Matsumoto M.

  Journal of Orthopaedic Science （Journal of Orthopaedic Science)  2021年

  ISSN  09492658

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• Response

  Inoue T., Ito K., Nishiyama Y., Takahashi Y., Tsuji T., Hirose Y.

  Journal of Neurosurgery: Spine (Journal of Neurosurgery: Spine)  29 ( 5 ) 609 - 610 2018年11月

  ISSN  15475654

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• 急性期病態学各論

  2023年度