Details of a Researcher - Nakamura, Masaya

Papers - Nakamura, Masaya

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Recombinant human hepatocyte growth factor promotes functional recovery after spinal cord injury

Kitamura Kazuya, Iwanami Akio, Fujiyoshi Kanehiro, Yamane Jun Ichi, Hikishima Keigo, Funakoshi Hiroshi, Nakamura Toshikazu, Aoki Masashi, Toyama Yoshiaki, Okano Hideyuki, Nakamura Masaya

147 - 167 2013.11

Hepatocyte growth factor (HGF), which is a potent mitogen for mature hepatocytes and a mediator of the inflammatory responses to tissue injury, was recently highlighted as a potent neurotrophic factor in the central nervous system. We revealed that introducing exogenous HGF into the injured rat spinal cord using a herpes simplex virus-1 vector significantly reduces the area of damaged tissue and promotes functional recovery. However, this rat study did not examine the therapeutic effects of administering HGF after injury, which is the most critical issue for clinical application. To translate this strategy to human treatment, we induced a contusive cervical SCI in the common marmoset, a primate, and then administered recombinant human HGF (rhHGF) intrathecally. Motor function was assessed using an original open-field scoring system focusing on manual function, including reach-and-grasp performance and hand placement in walking. The intrathecal rhHGF preserved the corticospinal fibers and myelinated areas, thereby promoting functional recovery. This study demonstrates the therapeutic effects, safety, and clinical efficacy of intrathecal rhHGF treatment for SCI in adult nonhuman primates and the possibility that this novel therapy may be suitable for clinical application.

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Assessment of injured spinal cord using diffusion tensor tractography

Fujiyoshi Kanehiro, Konomi Tsunehiko, Tsuji Osahiko, Yamada Masayuki, Hikishima Keigo, Momoshima Suketaka, Okano Hideyuki, Toyama Yoshiaki, Nakamura Masaya

345 - 365 2013.11

In spinal cord injury (SCI), the evaluation of axonal fibers is important to assess the severity of injury and efficacy of any treatment protocol, but conventional methods such as tracer injection in the brain parenchyma are highly invasive and require histological evaluation, precluding clinical applications. Magnetic resonance imaging (MRI) is essential for predicting prognosis and planning treatment of patients with SCI noninvasively. However, the information provided by conventional T1- and T2-weighted MRI of the spinal cord is essentially limited to the differentiation of the white matter from the gray matter. By contrast, diffusion-weighted magnetic resonance imaging (DWI) provides much information about biological structures. In particular, diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) are powerful tools for evaluating white matter fibers in the central nervous system. We previously established a reproducible SCI model in adult common marmosets and demonstrated that DTT could be used to trace the neural tracts in the intact and injured spinal cord of these animals in vivo. Recently, many reports using DTT to analyze the spinal cord area have been published. Based on the findings from our experimental studies, we are now routinely performing DTT of the human spinal cord clinically. In this chapter, we outline the basic principles of DTT and describe the characteristics, limitations, and clinical application of DTT in the spinal cord.

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Neuroprotection and regeneration of the spinal cord

Uchida Kenzo, Ozawa Hiroshi, Toyama Yoshiaki, Nakamura Masaya, Katoh Shinsuke

2013.11

Neuroprotection and Regeneration of the Spinal Cord comprehensively covers the most recent research in the field of spinal cord injury. The first part of this book focuses on the latest animal models and clinically oriented work, providing extensive information on morphological factors and, biomechanical analysis, in addition to the mechanism of functional recovery. The book goes on to provide information on clinical relevance introducing analysis of spinal cord injuries using MRI and PET. Edited by renowned experts in the field, this book will provide clinical physicians, basic researchers, and postgraduate students with valuable insight into the cutting-edge research and progress in the field of spinal cord injury, treatment, and repair.

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Blockade of interleukin-6 effects on cytokine profiles and macrophage activation after spinal cord injury in mice

Guerrero Alexander Rodriguez, Uchida Kenzo, Nakajima Hideaki, Watanabe Shuji, Nakamura Masaya, Okada Seiji, Johnson William E B, Baba Hisatoshi

203 - 212 2013.11

The objective of this study was to clarify the effects of a temporal blockade of IL-6/IL-6 receptor (IL-6R) engagement, using an anti-mouse IL-6R monoclonal antibody (MR16-1), on macrophage activation and the inflammatory response in the acute phase after spinal cord injury (SCI) in mice. MR16-1 antibodies versus isotype control antibodies or saline alone was administered immediately after thoracic SCI in mice. MR16-1-treated group samples showed increased neuronal regeneration and locomotor recovery compared with controls. Immunoblot analysis of the MR16-1-treated samples identified downregulation of Th1 and upregulation of Th2 cytokines. MR16-1 treatment promoted arginase-1-positive, CD206-positive M2 macrophages, with preferential localization of these cells at the injury site and enhanced positivity for Mac-2 and Mac-3, suggestive of increased phagocytic behavior. The results suggest that temporal blockade of IL-6 signaling after SCI abrogates damaging inflammatory activity and promotes functional recovery by promoting the formation of alternatively activated M2 macrophages.

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Spinal kyphosis causes demyelination and neuronal loss in the spinal cord

Nakamura Masaya, Shimizu Kentaro, Toyama Yoshiaki

129 - 138 2013.11

The spinal cord has remarkable ability to resist chronic compression; however, delayed paralysis is sometimes seen following the development of spinal kyphosis. In the past, no animal model to clarify the mechanism of spinal cord damage due to spinal kyphotic deformity has been available. We developed a new experimental model of chronic spinal cord compression using a bird, to evaluate the effects of chronic compression associated with kyphotic deformity of the cervical spine on the spinal cord. As kyphosis progressed, the spinal cord flattening became more marked, causing histopathological changes, including demyelination and neuronal loss. Demyelination of the axons progressed in the order of the anterior, lateral, and then posterior funiculus. Furthermore, microangiography suggested that vascular disturbance in addition to mechanical compression may have contributed to the development of histological changes. In conclusion, progressive kyphosis of the cervical spine resulted in demyelination of nerve fibers in the funiculi and neuronal loss in the anterior horn due to chronic compression of the spinal cord. These histological changes seem to be associated with both continuous mechanical compression and vascular changes in the spinal cord.

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Microenvironment within the injured spinal cord focusing on IL-6

Nakamura Masaya

11 - 18 2013.11

In recent years, a variety of studies have been conducted towards the goal of achieving regeneration of the central nervous system using neural stem cells. However, various complex factors are involved in the regulation of neural stem cell differentiation, and many unresolved questions remain. It has been reported that after spinal cord injury, the intrinsic neural stem cells do not differentiate into neurons but into astrocytes, resulting in the formation of glial scars. Based on reports that the expression of IL-6 and the IL-6 receptor is sharply increased in the acute stages after spinal cord injury and that IL-6 may serve as a factor strongly inducing the differentiation of neural stem cells into astrocytes, we examined the effects of an antibody to the IL-6 receptor in cases of spinal cord injury and found that the antibody indeed suppressed secondary injury (caused by inflammatory reactions) and glial scar formation, facilitating functional recovery. In this paper, we present the data from this investigation and discuss the relationship between IL-6 signals and spinal cord injury.

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A rare case of dumbbell meningioma of the upper cervical spinal cord

Ozaki Masahiro, Nakamura Masaya, Tsuji Osahiko, Iwanami Akio, Toyama Yoshiaki, Chiba Kazuhiro, Matsumoto Morio

Journal of Orthopaedic Science 18 ( 6 ) 1042 - 1045 2013.11

ISSN 0949-2658

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Spinal coronal profiles and proximal femur bone mineral density in adolescent idiopathic scoliosis

Chen Rui Qiang, Watanabe Kota, Hosogane Naobumi, Hikata Tomohiro, Iwanami Akio, Ishii Ken, Nakamura Masaya, Toyama Yoshiaki, Matsumoto Morio

European Spine Journal 22 ( 11 ) 2433 - 2437 2013.11

ISSN 0940-6719

Purpose: Although the occurrence and progression of AIS has been linked to low bone mineral density (BMD), the relationships between spinal curvature and bilateral differences in proximal femur BMD are controversial. Few correlation studies have stratified patients by curve type. The purpose of this study was to evaluate the relationships between spinal coronal profile and bilateral differences in proximal femur BMD in patients with adolescent idiopathic scoliosis (AIS). Methods: This study included 67 patients with AIS who underwent posterior correction and fusion surgery between January 2009 and October 2011. The mean age at the time of surgery was 17.4 ± 4.1 years. Bilateral proximal femur BMD was measured before surgery by dual-energy X-ray absorptiometry. We compared the proximal femur BMDs by determining the bilateral BMD ratio (left proximal femur BMD divided by that of the right). We evaluated correlations between coronal parameters, obtained from preoperative radiographs, and the BMD ratio using Pearson's correlation analysis. Results: Patients with Lenke type 1 curve (48; all with a right convex curve) had a mean bilateral proximal femur BMD ratio of 1.00 ± 0.04. Patients with Lenke type 5 curve (19; all with a left convex curve) had a mean bilateral proximal femur BMD ratio of 0.94 ± 0.04, indicating that the BMD in the proximal femur on the right side (concave) was greater than that in the left (convex). Coronal balance was significantly correlated with the BMD ratio in both the Lenke type 1 and type 5 groups, with a correlation coefficient of 0.46 and 0.50, respectively. Conclusions: The bilateral proximal femur BMD ratio was significantly correlated with the coronal balance in AIS patients. When the C7 plumb line was shifted toward one side, the BMD was greater in the contralateral proximal femur. © 2013 Springer-Verlag Berlin Heidelberg.

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[110th Scientific Meeting of the Japanese Society of Internal Medicine

Nakamura Masaya, Okano Hideyuki, Toyama Yoshiaki

Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 102 ( 9 ) 2247 - 2253 2013.09

ISSN 0021-5384

Nondura-based clear cell meningioma of the cauda equina in an adult

Kobayashi Yoshiomi, Nakamura Masaya, Tsuji Osahiko, Iwanami Akio, Ishii Ken, Watanabe Kota, Hosogane Naobumi, Tsuji Takashi, Kameyama Kaori, Toyama Yoshiaki, Chiba Kazuhiro, Matsumoto Morio

Journal of Orthopaedic Science 18 ( 5 ) 861 - 865 2013.09

ISSN 0949-2658

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Total en bloc spondylectomy for spinal metastasis of differentiated thyroid cancers

Matsumoto Morio, Tsuji Takashi, Iwanami Akio, Watanabe Kota, Hosogane Naobumi, Ishii Ken, Nakamura Masaya, Morioka Hideo, Toyama Yoshiaki

Journal of Spinal Disorders and Techniques 26 ( 4 ) 2013.06

ISSN 1536-0652

Study Design: A retrospective case series. Objective: To evaluate the long-term effectiveness and problems of total en bloc spondylectomy (TES) for treating metastatic thyroid cancer of the spine. Summary of Background Data: Although TES is indicated for low-grade malignant spinal tumors, its efficacy in treating thyroid cancer metastases in the spine is uncertain. Methods: This study followed 8 patients who underwent TES for spinal metastasis of thyroid cancer (5 males, 3 females; mean age, 55.3 y; mean follow-up period, 6.4 y), 6 with follicular carcinomas and 2 with papillary carcinomas. In 6 patients without a marked paravertebral tumor extension, TES was performed using a posterior approach. Two patients had prominent anterior or anterolateral tumor extension into the thoracic and retroperitoneal cavities, and a combined anterior and posterior approach was used. We evaluated the patients' clinical symptoms, operative procedures, complications, and prognoses. Results: Before surgery, the patients' neurological status was evaluated by the Frankel classification (grade C, 4 patients; grade D, 1 patient; grade E, 3 patients) and Tokuhashi scores (9, 1 patient; 11, 2 patients; 13 and 14, 1 patient each; 15, 3 patients). One year after surgery, all the patients had improved by at least a Frankel grade, and 4 patients classified as grade C before surgery had become ambulatory. At the final follow-up (average of 6.4 y), 5 patients had a grade E Frankel classification and 1 had grade D, but 2 patients had suffered neurological deterioration, because of tumor recurrence, at the same level as the TES in one patient and at an adjacent level in the other. At follow-up, all patients were alive; 5 showed no evidence of disease. Two patients experienced rod breakage, at 2.8 and at 3.3 years after TES, and 1 patient suffered an endplate fracture 6 months after TES; this patient developed a late infection, 7 years after TES. Conclusions: TES was effective in controlling spinal thyroid cancer metastasis locally and in preserving the ability to walk. However, instrumentation failure and other late complications arose during the patients' long survival times after TES. Copyright © 2012 by Lippincott Williams & Wilkins.

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Health Survey of Numbness/Pain and Its Associated Factors in Kotohira, Japan

Inoue Shinsuke, Ikeuchi Masahiko, Okumura Keiko, Nakamura Masaya, Kawakami Chihiro, Ikemoto Tatsunori, Kawasaki Motohiro, Tani Toshikazu, Ushida Takahiro

PLoS ONE 8 ( 4 ) 2013.04

We conducted a survey of adults in Kotohira, a town of about 10,000 people located in the Nakatado District of Kagawa Prefecture, Japan. The survey was distributed to 8184 individuals, and effective responses were received from 3863 persons (response rate, 47.2%) during the survey period. Results regarding numbness and pain showed numbness alone in 7.7%, pain alone in 7.2%, both numbness and pain in 6.0%, and neither numbness nor pain in 79.6%. Spine and spinal cord damage was reported present by 5.4%, and absent by 94.6%. Analysis using the Short-Form Health Survey questionnaire, with comparison between subjects reporting both numbness and pain in the extremities and subjects with either numbness or pain alone, showed lower scores for in Short-Form Health Survey subscales (physical functioning, role [physical, emotional], bodily pain, vitality, and mental health). Subjects with numbness alone generally reported no disability in daily life. In a secondary survey, analysis of neurological findings by specialists identified 6 cases of "pain following spinal cord damage" in which spinal cord-related pain developed in the hands or feet. This represented 0.15% of the survey population starting from the primary survey. © 2013 Inoue et al.

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Diffusion tensor imaging and tractography of the spinal cord

Fujiyoshi Kanehiro, Konomi Tsunehiko, Yamada Masayuki, Hikishima Keigo, Tsuji Osahiko, Komaki Yuji, Momoshima Suketaka, Toyama Yoshiaki, Nakamura Masaya, Okano Hideyuki

Experimental Neurology 242 74 - 82 2013.04

ISSN 0014-4886

Diffusion-weighted magnetic resonance imaging provides detailed information about biological structures. In particular, diffusion tensor imaging and diffusion tensor tractography (DTT) are powerful tools for evaluating white matter fibers in the central nervous system. We previously established a reproducible spinal cord injury model in adult common marmosets and showed that DTT could be used to trace the neural tracts in the intact and injured spinal cord of these animals in vivo. Recently, many reports using DTT to analyze the spinal cord area have been published. Based on the findings from our experimental studies, we are now routinely performing DTT of the human spinal cord in the clinic. In this review we outline the basic principles of DTT, and describe the characteristics, limitations, and future uses of DTT to examine the spinal cord. © 2012.

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PML mediates glioblastoma resistance to mammalian target of rapamycin (mTOR)-targeted therapies

Iwanami Akio, Gini Beatrice, Zanca Ciro, Matsutani Tomoo, Assuncao Alvaro, Nael Ali, Dang Julie, Yang Huijun, Zhu Shaojun, Kohyama Jun, Kitabayashi Issay, Cavenee Webster K., Cloughesy Timothy F., Furnari Frank B., Nakamura Masaya, Toyam Yoshiaki, Okano Hideyuki, Mischel Paul S.

Proceedings of the National Academy of Sciences of the United States of America 110 ( 11 ) 4339 - 4344 2013.03

ISSN 0027-8424

Despite their nearly universal activation of mammalian target of rapamycin (mTOR) signaling, glioblastomas (GBMs) are strikingly resistant to mTOR-targeted therapy. We analyzed GBM cell lines, patient-derived tumor cell cultures, and clinical samples from patients in phase 1 clinical trials, and find that the promyelocytic leukemia (PML) gene mediates resistance to mTOR-targeted therapies. Direct mTOR inhibitors and EGF receptor (EGFR) inhibitors that block downstreammTOR signaling promote nuclear PML expression in GBMs, and genetic overexpression and knockdown approaches demonstrate that PML prevents mTOR and EGFR inhibitor-dependent cell death. Low doses of the PML inhibitor, arsenic trioxide, abrogate PML expression and reverse mTOR kinase inhibitor resistance in vivo, thus markedly inhibiting tumor growth and promoting tumor cell death in mice. These results identify a unique role for PML in mTOR and EGFR inhibitor resistance and provide a strong rationale for a combination therapeutic strategy to overcome it.

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Epigenetic transcriptional activation of monocyte chemotactic protein 3 contributes to long-lasting neuropathic pain

Imai Satoshi, Narita Minoru, Ikegami Daigo, Yamashita Akira, Shimizu Toshikazu, Narita Michiko, Niikura Keiichi, Furuya Masaharu, Kobayashi Yasuhisa, Miyashita Kazuhiko, Okutsu Daiki, Kato Akira, Nakamura Atsushi, Araki Akiko, Omi Kazuo, Nakamura Masaya, James Okano Hirotaka, Okano Hideyuki, Ando Takayuki, Takeshima Hideyuki, Ushijima Toshikazu, Kuzumaki Naoko, Suzuki Tsutomu

Brain 136 ( 3 ) 828 - 843 2013.03

ISSN 0006-8950

A multiplex analysis for profiling the expression of candidate genes along with epigenetic modification may lead to a better understanding of the complex machinery of neuropathic pain. In the present study, we found that partial sciatic nerve ligation most remarkably increased the expression of monocyte chemotactic protein 3 (MCP-3, known as CCL7) a total of 33 541 genes in the spinal cord, which lasted for 4 weeks. This increase in MCP-3 gene transcription was accompanied by the decreased trimethylation of histone H3 at Lys27 at the MCP-3 promoter. The increased MCP-3 expression associated with its epigenetic modification observed in the spinal cord was almost abolished in interleukin 6 knockout mice with partial sciatic nerve ligation. Consistent with these findings, a single intrathecal injection of recombinant proteins of interleukin 6 significantly increased MCP-3 messenger RNA with a decrease in the level of Lys27 trimethylation of histone H3 at the MCP-3 promoter in the spinal cord of mice. Furthermore, deletion of the C-C chemokine receptor type 2 (CCR2) gene, which encodes a receptor for MCP-3, failed to affect the acceleration of MCP-3 expression in the spinal cord after partial sciatic nerve ligation. A robust increase in MCP-3 protein, which lasted for up to 2 weeks after surgery, in the dorsal horn of the spinal cord of mice with partial sciatic nerve ligation was seen mostly in astrocytes, but not microglia or neurons. On the other hand, the increases in both microglia and astrocytes in the spinal cord by partial sciatic nerve ligation were mostly abolished in interleukin 6 knockout mice. Moreover, this increase in microglia was almost abolished by CCR2 gene deletion, whereas the increase in astrocytes was not affected in nerve-ligated mice that lacked the CCR2 gene. We also found that either in vivo or in vitro treatment with MCP-3 caused robust microglia activation. Under these conditions, intrathecal administration of MCP-3 antibody suppressed the increase in microglia within the mouse spinal cord and neuropathic pain-like behaviours after nerve injury. With the use of a functional magnetic resonance imaging analysis, we demonstrated that a single intrathecal injection of MCP-3 induced dramatic increases in signal intensity in pain-related brain regions. These findings suggest that increased MCP-3 expression associated with interleukin 6 dependent epigenetic modification at the MCP-3 promoter after nerve injury, mostly in spinal astrocytes, may serve to facilitate astrocyte-microglia interaction in the spinal cord and could play a critical role in the neuropathic pain-like state. © 2013 The Author (2013). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved.

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Cervical intramedullary ependymoma masquerading as cervical spondylotic myelopathy on MRI analysis

Tsuji Osahiko, Nakamura Masaya, Fujiyoshi Kanehiro, Ishii Ken, Watanabe Kota, Hosogane Naobumi, Tsuji Takashi, Momoshima Suketaka, Toyama Yoshiaki, Chiba Kazuhiro, Matsumoto Morio

Journal of Orthopaedic Science 18 ( 2 ) 355 - 358 2013.03

ISSN 0949-2658

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Surgical correction of severe cervical kyphosis in patients with neurofibromatosis Type 1

Kawabata Soya, Watanabe Kota, Hosogane Naobumi, Ishii Ken, Nakamura Masaya, Toyama Yoshiaki, Matsumoto Morio

Journal of Neurosurgery: Spine 18 ( 3 ) 274 - 279 2013.03

ISSN 1547-5654

Severe cervical kyphosis requiring surgical treatment is rare in patients with neurofibromatosis Type 1 (NF1). When it occurs, however, dystrophic changes in the vertebrae make surgical correction and fusion of the deformity extremely difficult. The authors report on 3 cases of severe cervical kyphosis associated with NF1 that were successfully treated with combined anterior and posterior correction and fusion. All patients underwent halo-gravity traction for approximately 1 month prior to surgery to correct the deformity gradually. Posterior correction and fusion were performed with segmental spinal instrumentation consisting of lateral mass screws, lamina screws, pedicle screws, and polyethylene tape for sublaminar wiring. Anterior spinal fusion was performed using a fibula strut to induce solid bone fusion. All patients used a halo vest for postoperative external fixation. Preoperative CT scans showed dystrophic cervical spine changes, and MR images demonstrated extensive neurofibromas outside the cervical spine in all 3 patients. The preoperative kyphotic angles were as follows: Case 1, 140°; Case 2, 81°; and Case 3, 72°; after halo-gravity traction, the kyphosis angles improved to 50°, 55°, and 51°, respectively; and after surgery, they were 50°, 15°, and 27°, respectively. Solid bone union was observed in all patients at the latest follow-up. All three patients experienced postoperative complications consisting of superficial infection, severe pneumonia, and partial dislocation of the distal fibula graft after removing the halo vest, in one patient each. Although dystrophic cervical vertebral changes in these patients with NF1 complicated the correction of severe cervical kyphosis, the use of preoperative halo-gravity traction, a combination of spinal instrumentations, an anterior strut bone graft, and postoperative halo-vest fixation made it possible to correct the kyphosis, maintain the correction, and achieve solid bone fusion. © 2013 AANS.

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Steps toward safe cell therapy using induced pluripotent stem cells

Okano Hideyuki, Nakamura Masaya, Yoshida Kenji, Okada Yohei, Tsuji Osahiko, Nori Satoshi, Ikeda Eiji, Yamanaka Shinya, Miura Kyoko

Circulation Research 112 ( 3 ) 523 - 533 2013.02

ISSN 0009-7330

The enthusiasm for producing patient-specific human embryonic stem cells using somatic nuclear transfer has somewhat abated in recent years because of ethical, technical, and political concerns. However, the interest in generating induced pluripotent stem cells (iPSCs), in which pluripotency can be obtained by transcription factor transduction of various somatic cells, has rapidly increased. Human iPSCs are anticipated to open enormous opportunities in the biomedical sciences in terms of cell therapies for regenerative medicine and stem cell modeling of human disease. On the other hand, recent reports have emphasized the pitfalls of iPSC technology, including the potential for genetic and epigenetic abnormalities, tumorigenicity, and immunogenicity of transplanted cells. These constitute serious safety-related concerns for iPSC-based cell therapy. However, preclinical data supporting the safety and efficacy of iPSCs are also accumulating. In this Review, recent achievements and future tasks for safe iPSC-based cell therapy are summarized, using regenerative medicine for repair strategies in the damaged central nervous system (CNS) as a model. Insights on safety and preclinical use of iPSCs in cardiovascular repair model are also discussed. © 2013 American Heart Association, Inc.

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[Reconstruction for spinal cord injury].

Hori Keiko, Nakamura Masaya, Okano Hideyuki

Nihon Jibiinkoka Gakkai kaiho 116 ( 2 ) 53 - 59 2013.02

ISSN 0030-6622

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Minimally invasive endoscopic resection of a solitary bone cyst of the lumbar vertebrae

Matsubayashi Kohei, Tsuji Osahiko, Watanabe Kota, Hosogane Naobumi, Tsuji Takashi, Ishii Ken, Nakamura Masaya, Toyama Yoshiaki, Chiba Kazuhiro, Matsumoto Morio

Neurosurgery Quarterly 23 ( 1 ) 66 - 69 2013.02

ISSN 1050-6438

Solitary bone cysts of the lumbar vertebrae are extremely rare. We report a 20-year-old man, who presented with a 5-year history of persistent low back pain. Radiographic examination, magnetic resonance imaging, and subsequent computed tomography revealed a well-circumscribed osteolytic and cystic lesion at the right pedicle of the L3 vertebra. On the basis of the radiologic findings, a simple bone cyst was considered the most probable diagnosis. The patient underwent a minimally invasive operation with the assistance of an endoscope. The gross total curettage resection of the lesion including the cyst walls was accomplished, followed by a combined graft consisting of granulated β-tricalcium phosphate and autologous iliac crest cancellous bone. At the 1-year follow-up, the patient's symptoms were resolved, bone union at the lesion site had been achieved, and he had returned to his previous level of physical activity. Copyright © 2013 by Lippincott Williams & Wilkins.

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