研究者詳細 - 松本　守雄

論文 - 松本　守雄

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Long-term impact of atlantoaxial arthrodesis on the pediatric cervical spine

Ishikawa Masayuki, Matsumoto Morio, Chiba Kazuhiro, Toyama Yoshiaki, Kobayashi Keiji

Journal of Orthopaedic Science 14 （ 3 ） 274 - 278 2009年05月

ISSN 0949-2658

Background: This study was conducted to elucidate radiographically the long-term impact of atlantoaxial arthrodesis on the pediatric cervical spine. Methods: The records of eight children who underwent atlantoaxial arthrodesis for the treatment of upper cervical spinal disorders and were followed up to their adulthood were retrospectively reviewed. Changes in the curvature of the whole cervical spine, and anteroposterior diameters of the spinal canal at C1 and C2 levels were investigated on lateral radiographs before surgery, at 6 months after surgery, and at the final follow-up. Results: The cervical curvature was lordosis or straight before surgery in all children and became sigmoid in six children at 6 months after surgery. At the final follow-up, three of the six children with postoperative sigmoid curvatures regained some degree of lordosis and became straight. The anteroposterior diameters of the spinal canal at C1 and C2 levels did not increase during the follow-up period. Conclusions: Development of postoperative malalignment of the lower cervical spine and impaired growth of the spinal canal at C1 and C2 levels are common after atlantoaxial arthrodesis in children. Postoperative malalignment diminishes during the follow-up period possibly due to remodeling of the pediatric cervical spine, although remodeling of the spinal canal diameter cannot be expected, suggesting the importance of anatomical reduction before or at the time of surgery. © 2009 The Japanese Orthopaedic Association.

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Aging of the cervical spine in healthy volunteers

Okada Eijiro, Matsumoto Morio, Ichihara Daisuke, Chiba Kazuhiro, Toyama Yoshiaki, Fujiwara Hirokazu, Momoshima Suketaka, Nishiwaki Yuji, Hashimoto Takeshi, Ogawa Jun, Watanabe Masahiko, Takahata Takeshi

Spine 34 （ 7 ） 706 - 712 2009年04月

ISSN 0362-2436

STUDY DESIGN.: Prospective longitudinal study, mean follow-up period; 11.7 ± 0.8 years was conducted from 1995 to 2007. OBJECTIVE.: To clarify normal aging process of cervical spine and correlation between progression of disc degeneration and development of clinical symptoms. SUMMARY OF BACKGROUND DATA.: Aging of the cervical spine can inevitably occur in anyone. Long-term longitudinal studies following the same individuals are necessary to elucidate the accurate aging processes of the cervical spine. METHODS.: Two hundred twenty-three subjects of 497 original cohorts (123 men, 100 women, mean age: 39.0 ± 15.0, follow-up rate: 44.9%). Subjects, who underwent MRI 10 years ago, underwent another MRI, neurologic examination, and questionnaire survey regarding symptoms related to cervical spine and life style. Following 5 MR findings representing intervertebral disc degeneration were evaluated: (1) decrease in signal intensity of disc, (2) anterior compression of dura and spinal cord, (3) posterior disc protrusion (PDP), (4) disc space narrowing (DSN), and (5) foraminal stenosis (FS). RESULTS.: Progression of degenerative findings was observed in 189 subjects (81.1%). Progression of decrease in signal intensity of disc was observed in 59.6%, anterior compression of dura and spinal cord in 61.4%, PDP in 70.0%, DSN in 26.9%, and FS in 9.0%. Logistic regression analysis revealed that incidence of progression of PDP, DSN, FS was higher in elderly subjects. There were no correlations between any degenerative MR findings and sex, smoking, alcohol, sport, or body mass index. Neck pain, shoulder stiffness, and numbness in upper extremities were recognized in 9.9%, 30.0%, and 4.0% of subjects, and 1 or more clinical symptoms have developed in 34.1% during 10 years. CONCLUSION.: Progression of degeneration of cervical spine on MRI was frequently observed during 10-year period, with development of symptoms in 34% of subjects. No factor related to progression of degeneration of cervical spine was identified except for age. © 2009, Lippincott Williams & Wilkins.

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Nocturnal leg cramps

Matsumoto Morio, Watanabe Kota, Tsuji Takashi, Ishii Ken, Takaishi Hironari, Nakamura Masaya, Toyama Yoshiaki, Chiba Kazuhiro, Michikawa Takehiro, Nishiwaki Yuji

Spine 34 （ 5 ） 2009年03月

ISSN 0362-2436

STUDY DESIGN.: Questionnaire survey on leg cramps for patients with lumbar spinal canal stenosis (LCS). OBJECTIVE.: To evaluate the prevalence of leg cramps in patients with LCS treated surgically and the relationship between leg cramps and the surgical outcomes. SUMMARY OF BACKGROUND DATA.: Although it has been anecdotally reported that LCS patients have suffered from leg cramps, the true prevalence remains unknown. METHODS.: One hundred twenty LCS patients who underwent decompression surgery (men 85, women 35, mean age 73.5) and 370 elderly subjects from the general population (men 162, women 208, mean age 75.6) were enrolled in the study. The participants filled in a questionnaire regarding: (all participants) (1) experience of leg cramps, (2) frequency and time of the day of the cramp attacks; (for LCS patients only), (3) changes in cramps before and after surgery, (4) activities of daily living disturbance because of leg cramps, (5) satisfaction with surgery and walking ability, (6) the Roland-Morris Disability Questionnaire, and (7) the Oswestry Disability Index. RESULTS.: Eighty-five (70.8%) patients with LCS and 137 (37.2%) of the control population experienced leg cramps (age and sex adjusted odds ratio; 4.6, P < 0.01). Leg cramps occurred once or twice a week in 34.9% of the LCS group and once in several months in 44.5% of the control group, and occurred nocturnally in 73.3% of the LCS patients and in 91.6% of the control group. In LCS patients, leg cramps improved after surgery in 18.2%, remained unchanged in 45.5%, and worsened in 26.1%, and activities of daily living were disturbed in 47.6%. There was no significant difference in satisfaction with surgery, the Oswestry Disability Index, the Roland-Morris Disability Questionnaire scores, or walking ability between the LCS patients with or without leg cramps. CONCLUSION.: LCS patients had significantly more frequent attacks of nocturnal leg cramps than the control population, and leg cramps disturbed the quality of the patients' life, and they rarely improved after decompression surgery. Leg cramps should be recognized as one of the symptoms of LCS, which disturb the patients' quality of life. © 2009, Lippincott Williams & Wilkins.

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A rigid body and spring model of the lumbar spine which considers the mechanical loads at the bone-screw interface

Kiriyama Yoshimori, Matsumoto Morio, Toyama Yoshiaki, Andriacchi Thomas P., Nagura Takeo

1241 - 1242 2009年

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Response

Matsumoto Morio, Chiba Kazuhiro, Toyama Yoshiaki

Journal of Neurosurgery: Spine 9 （ 6 ） 528 - 529 2008年12月

ISSN 1547-5654

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Risk factors for closure of lamina after open-door laminoplasty

Matsumoto Morio, Watanabe Kota, Tsuji Takashi, Ishii Ken, Takaishi Hironari, Nakamura Masaya, Toyama Yoshiaki, Chiba Kazuhiro

Journal of Neurosurgery: Spine 9 （ 6 ） 530 - 537 2008年12月

ISSN 1547-5654

Object. This retrospective study was conducted to evaluate the prevalence and clinical consequences of postoperative lamina closure after open-door laminoplasty and to identify the risk factors. Methods. Eighty-two consecutive patients with cervical myelopathy who underwent open-door laminoplasty without plates or spacers in the open side (Hirabayashi's original method) were included (62 men and 20 women with a mean age of 62 years and a mean follow-up of 1.8 years). In 67 patients the cause of cervical myelopathy was spondylotic myelopathy, and in 15 it was caused by ossification of posterior longitudinal ligament. Radiographic measurements were made of the anteroposterior diameters of the spinal canal and vertebral bodies from C3-6, and the presence of kyphosis were assessed. Lamina closure was defined as ≥ 10% decrease in the canal-to-body ratio at the final follow-up compared with that immediately after surgery at ≥ 1 vertebral level. The impact of lamina closure on neck pain, patient satisfaction, Japanese Orthopaedic Association scores, and recovery rates were also evaluated. Results. The mean canal-to-body ratio at C3-6 was 0.69-0.72 preoperatively, 1.25-1.28 immediately after surgery, and 1.18-1.24 at the final follow-up examination. Lamina closure was observed in 34% of patients and was not associated with sex, age, or cause of myelopathy, but was significantly associated with the presence of preoperative kyphosis (p = 0.014). Between patients with and without lamina closure, there was no significant difference in preoperative (9.7 ± 3.1 vs 10.6 ± 2.5) and postoperative (13.7 ± 2.4 vs 13.1 ± 2.7) Japanese Orthopaedic Association scores, recovery rates (53.9 ± 29.9% vs 44.3 ± 29.5%), neck pain scores (3.5 ± 0.7 vs 3.3 ± 1.0), or patient satisfaction level (4.0 ± 1.4 vs 4.8 ± 1.0). Conclusions. Lamina closure at ≥ 1 vertebral level occurred in 34% of patients. Although patients with lamina closure obtained equivalent recovery from myelopathy in a short-term follow-up, they tended to be less satisfied with surgery compared with those who did not have closure. The only significant risk factor identified was the presence of preoperative cervical kyphosis, and preventative methods for lamina closure, therefore, should be considered for patients with preoperative kyphosis.

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Vascular endothelial growth factor-A is a survival factor for nucleus pulposus cells in the intervertebral disc

Fujita Nobuyuki, Imai Jun ichi, Suzuki Toru, Yamada Masayuki, Ninomiya Ken, Miyamoto Kana, Iwasaki Ryotaro, Morioka Hideo, Matsumoto Morio, Chiba Kazuhiro, Watanabe Shinya, Suda Toshio, Toyama Yoshiaki, Miyamoto Takeshi

Biochemical and Biophysical Research Communications 372 （ 2 ） 367 - 372 2008年07月

ISSN 0006-291X

The intervertebral disc (IVD) is composed of two avascular tissue types, the nucleus pulposus (NP) and the annulus fibrosus (AF). IVDs is the largest avascular tissue in the human body, however, how these tissues are maintained without a blood supply is poorly understood. Here we show that vascular endothelial growth factor-A (VEGF-A) is highly expressed in NP and that VEGF-A plays a role in NP survival. High VEGF-A expression in NP was detected by microarray analysis, and NP was positive for the hypoxic probe pimonidazole and hypoxia-responsive genes. VEGF-A expression in NP was promoted by hypoxic conditions in vitro. NP cells also expressed the membrane-bound VEGF receptor-1 (VEGFR-1), and the number of apoptotic cells in cultured cell model of NP increased following treatment with VEGFR-1-Fc, which traps VEGF-A in NP. These results indicate that NP is a hypoxic tissue, and that VEGF-A functions in NP survival in an autocrine/paracrine manner. © 2008 Elsevier Inc. All rights reserved.

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Radiographic predictors of residual low back pain after laminectomy for lumbar spinal canal stenosis

Xia Yingpeng, Ishii Ken, Matsumoto Morio, Nakamura Masaya, Toyama Yoshiaki, Chiba Kazuhiro

Journal of Spinal Disorders and Techniques 21 （ 3 ） 153 - 158 2008年05月

ISSN 1536-0652

STUDY DESIGN: Retrospective study of patients who underwent laminectomy for unification. OBJECTIVE: To identify radiographic predictors of residual low back pain (LBP) after laminectomy for lumbar spinal canal stenosis (LCS). SUMMARY OF BACKGROUND DATA: Residual LBP is a common complication of laminectomy and no radiographic predictors of its occurrence have been identified previously. METHODS: Clinical results and radiographic findings in 49 patients (21 males and 28 females, minimum 5-year follow-up) who underwent single level laminectomy for LCS were retrospectively reviewed. Patients who had an improvement in LBP scores in the Japanese Orthopedic Association (JOA) scoring system during the follow-up periods were classified as the recovery group, whereas those without improvements were classified as the nonrecovery group. Patients' clinical data (sex, duration of symptoms, age at surgery, JOA scores) and radiographic parameters (including lumbar lordotic angle, lumbar range of motion (ROM) and the intervertebral rotational angle) were analyzed to detect the factors significantly related with the occurrence of residual LBP. RESULTS: The average preoperative JOA score of 14.8±5.1 points improved to 21.6±5.5 points at the final follow-up providing an average recovery rate of 48.1±36.8%. Thirty-four and 15 patients were classified into the recovery and the nonrecovery groups, respectively. Binary logistic regression analysis revealed that significant predictors of residual LBP were preoperative lumbar lordosis angle and lumbar ROM. The mean preoperative lumbar lordosis and ROM in the nonrecovery group were significantly smaller than those in the recovery group (lordosis: 25.3±15.8 degrees vs. 37.8±13.6 degrees, P=0.006 and ROM: 22.1±10.6 degrees vs. 31.2±9.9 degrees, P=0.006). In addition, increase of the postoperative lumbar ROM was significantly larger in the nonrecovery than that in the recovery group (P=0.009). CONCLUSIONS: Our results indicate that preoperative lordosis angle and lumbar ROM were the significant radiographic predictors for residual LBP after laminectomy for LCS. Patient with flatback and limited lumbar mobility before surgery are prone to suffer residual LBP. It is suggested that these sagittal radiographic parameters should be taken into account when choosing laminectomy as the surgical option for LCS. © 2008 Lippincott Williams & Wilkins, Inc.

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Surgical treatment of intramedullary spinal cord tumors

Nakamura M., Ishii K., Watanabe K., Tsuji T., Takaishi H., Matsumoto M., Toyama Y., Chiba K.

Spinal Cord 46 （ 4 ） 282 - 286 2008年04月

ISSN 1362-4393

Study design: Retrospective case series. Objective: To evaluate our recent treatment strategy for intramedullary spinal cord tumors. Setting: Department of Orthopaedic Surgery, Keio University, Japan. Methods: We reviewed 68 cases of intramedullary tumors (ependymoma, 33; astrocytoma, 23; hemangioblastoma, 12), treated surgically between 1994 and 2003. There were 42 males and 26 females whose mean age at the time of surgery was 43 years. The mean follow-up period was 6.2 years. The tumor malignancy grade according to the WHO classification was astrocytoma grade I, 3; grade II, 8 (low-grade: 11 cases); grade III, 10; grade IV, 2 (high-grade: 12 cases). All ependymomas were grade II. Three of the 12 hemangioblastomas were associated with von Hippel-Lindau disease. Results: Total excision was achieved in 90% of the ependymomas and functional improvement was obtained when the preoperative neurological deficit was mild. Approximately 50% of low-grade astrocytomas could be totally excised with favorable survival outcomes, suggesting that total excision should be attempted for low-grade astrocytomas. However, total excision of high-grade tumors was difficult and the functional outcomes were poor. Cordotomy should be considered in patients with a thoracic high-grade astrocytoma. Total resection was possible in 92% of hemangioblastoma, and the functional outcomes were good, however, more attention should be paid for tumors with feeding arteries on the ventral side and for those associated with von Hippel-Lindau disease. Conclusions: Predictors of good surgical outcome for intramedullary spinal cord tumors were histological grades of the tumors, surgical margins, and neurological status of the patient before surgery. © 2008 International Spinal Cord Society All rights reserved.

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Surgical results and related factors for ossification of posterior longitudinal ligament of the thoracic spine

Matsumoto Morio, Chiba Kazuhiro, Toyama Yoshiaki, Takeshita Katsushi, Seichi Atsushi, Nakamura Kozo, Arimizu Jun, Fujibayashi Shunsuke, Hirabayashi Shigeru, Hirano Toru, Iwasaki Motoki, Kaneoka Kouji, Kawaguchi Yoshiharu, Ijiri Kosei, Maeda Takeshi, Matsuyama Yukihiro, Mikami Yasuo, Murakami Hideki, Nagashima Hideki, Nagata Kensei, Nakahara Shinnosuke, Nohara Yutaka, Oka Shiro, Sakamoto Keizo, Saruhashi Yasuo, Sasao Yutaka, Shimizu Katsuji, Taguchi Toshihiko, Takahashi Makoto, Tanaka Yasuhisa, Tani Toshikazu, Tokuhashi Yasuaki, Uchida Kenzo, Yamamoto Kengo, Yamazaki Masashi, Yokoyama Toru, Yoshida Munehito, Nishiwaki Yuji

Spine 33 （ 9 ） 1034 - 1041 2008年04月

ISSN 0362-2436

STUDY DESIGN. Retrospective multi-institutional study OBJECTIVE. To describe the surgical outcomes in patients with ossification of the posterior longitudinal ligament in the thoracic spine (T-OPLL) and to clarify factors related to the surgical outcomes. SUMMARY OF BACKGROUND DATA. Detailed analyses of surgical outcomes of T-OPLL have been difficult because of the rarity of this disease. METHODS. The subjects were 154 patients with T-OPLL who were surgically treated at 34 institutions between 1998 and 2002. The surgical procedures were laminectomy in 36, laminoplasty in 51, anterior decompression via anterior approach in 25 and via posterior approach in 29, combined anterior and posterior fusion in 8, and sternum splitting approach in 5 patients. Instrumentation was conducted in 52 patients. Assessments were made on (1) The Japanese Orthopedic Association (JOA) scores (full score, 11 points), its recovery rates, (2) factors related to surgical results, and (3) complications and their consequences. RESULTS. (1) The mean JOA score before surgery was 4.6 ± 2.0 and, 7.1 ± 2.5 after surgery. The mean recovery rate was 36.8% ± 47.4%. (2) The recovery rate was 50% or higher in 72 patients (46.8%). Factors significantly related to this were location of the maximum ossification (T1-T4) (odds ratio, 2.43-4.17) and the use of instrumentation (odds ratio, 3.37). (3) The frequent complications were deterioration of myelopathy immediately after surgery in 18 (11.7%) and dural injury in 34 (22.1%) patients. CONCLUSION. The factors significantly associated with favorable surgical results were maximum ossification located at the upper thoracic spine and use of instrumentation. T-OPLL at the nonkyphotic upper thoracic spine can be treated by laminoplasty that is relatively a safe surgical procedure for neural elements. The use of instrumentation allows correction of kyphosis or prevention of progression of kyphosis, thereby, enhancing and maintaining decompression effect, and its use should be considered with posterior decompression. © 2008 Lippincott Williams & Wilkins, Inc.

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Biological evaluation of chelate-setting apatite cement using inositol phosphate

Kida K., Horiguchf Y., Oribe K., Morisue H., Matsumoto M., Toyama Y., Aizawa M.

Key Engineering Materials 361-363 I 335 - 338 2008年

ISSN 1013-9826

We have successfully developed novel "chelate-setting apatite cement" using hydroxyapatite (HAp) particles surface-modified with inositol phosphate (IP₆) . The HAp particles surface-modified with IP ₆ were mixed with water (HAp/water ratio = 1.00/0.50[w/w]) to fabricate apatite cements. We have examined the biocompatibility of the apatite cement using the culture system of MC3T3-E1 cells and the rabbit model. The cell-culture test using MC3T3-E1 cells has shown that the apatite cement has noncytotoxicity. This cement has been implanted into tibiae of rabbits. When tissue response was examined histologically up to 24 weeks, new bone formation was observed around the surface of the cement. The present work demonstrates that this apatite cement is useful as a material for artificial bone grafting.

Microendoscopic discectomy for lumbar disc herniation with bony fragment due to apophyseal separation

Matsumoto M., Watanabe K., Tuji T., Ishii K., Takaishi H., Nakamura M., Chiba K., Toyama Y.

Minimally Invasive Neurosurgery 50 （ 6 ） 335 - 339 2007年12月

ISSN 0946-7211

The purpose of this study was to elucidate the feasibility of microendoscopic discectomy (MED) for the treatment of lumbar disc herniation with a bony fragment due to apophyseal separation. Eighteen patients with low back pain and unilateral sciatic pain due to lumbar disc herniation with a bony fragment were treated by MED using the unilateral approach (15 males and three females; mean age, of 28.9 years; mean follow-up period, 21.1 months); 18 age-and sex-matched patients with lumbar disc herniation without a bony fragment treated by MED served as the control group. The clinical outcomes were evaluated using the Japanese Orthopedic Association Score for Low Back Pain (JOA scores; maximum score, 29 points). Evaluation of the results revealed that good surgical outcomes equivalent to those in the control group were obtained in the subjects of LDH with a bony fragment (JOA scores; 14.1±3.5 in the patient group vs. 15.4±2.6 in the control group before surgery; 26.3±1.8 in the patient group vs. 26.9±1.3 at follow-up after the surgery). Although the mean surgical time was significantly longer in the patient group, there were no intra- or postoperative complications in either group. We conclude that MED using the unilateral approach is a feasible minimally invasive surgical option for patients of lumbar disc herniation with an apophyseal bony fragment. © Georg Thieme Verlag KG Stuttgart.

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Traction versus supine side-bending radiographs in determining flexibility

Watanabe Kota, Kawakami Noriaki, Nishiwaki Yuji, Goto Manabu, Tsuji Taichi, Obara Tetsuya, Imagama Shiro, Matsumoto Morio

Spine 32 （ 23 ） 2604 - 2609 2007年11月

ISSN 0362-2436

STUDY DESIGN. Prospective clinical, radiologic study of adolescent idiopathic scoliosis (AIS). OBJECTIVE. We evaluated a Cobb angle in standing position, patient age, the level of the apex, and the number of involved vertebrae in patients with AIS to determine whether the corrective ability of traction or side-bending radiographs was superior. SUMMARY OF BACKGROUND DATA. Side-bending and traction radiographs are used to evaluate curve flexibility during corrective surgery for AIS despite notable differences in the flexibilities of identical curves. Thus, interpretation for the differences among these techniques should be investigated. METHODS. A total of 229 consecutive patients with AIS who were surgically treated were evaluated. Standing, supine side-bending, and traction radiographs were obtained before surgery. Curves were divided into main thoracic (MT) or thoracolumbar/lumbar (TL/L) curves, and proximal thoracic (PT) curves. We evaluated the Cobb angle in standing position, the level of the apex, the number of involved vertebrae, kyphosis angle of main thoracic curve, and patient age in patients with AIS to determine whether the corrective ability of traction or side-bending radiographs was superior. RESULTS. A total of 219 curves were observed in MT lesions. The traction flexibility rate (FR) was higher than the side-bending FR at angle of ≥60° (P = 0.02), in patients younger than 15 years (P = 0.02), in curves whose apex was located at T4-T8/T9(P = 0.01), in curves whose involved vertebrae were 6 or 7 (P = 0.02), and at kyphosis angle between 10° and 39° (P = 0.02). In 96 TL/L curves, side-bending FR was higher at angle of <60° (P < 0.01). In 163 PT curves, traction FR was higher at angles of ≥40° (P = 0.02). CONCLUSION. In addition to a Cobb angle, patient age, the level of the apex, and the number of involved vertebrae also influence the conditions under which the corrective ability of traction radiographs is superior to that of side-bending radiographs. © 2007 Lippincott Williams & Wilkins, Inc.

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The validity of intraoperative angiography for the treatment of spinal arteriovenous fistula

Xia Yingpeng, Ishii Ken, Nakamura Masaya, Onozuka Satoshi, Ueda Ryo, Matsumoto Morio, Chiba Kazuhiro, Toyama Yoshiaki

Journal of Spinal Disorders and Techniques 20 （ 6 ） 442 - 448 2007年08月

ISSN 1536-0652

STUDY DESIGN: Retrospective study of patients with spinal arteriovenous fistula (AVF) who underwent surgical treatment. OBJECTIVE: To evaluate the validity of the intraoperative angiography (IA) for the surgical treatment of spinal AVF. SUMMARY OF BACKGROUND DATA: Owing to the development of interventional techniques, endovascular embolization has become the treatment of choice for AVF, but it is not applicable for every spinal AVF owing to anatomic complexity of the spinal cord vessels. To get effective occlusion of the AVF, IA has been routinely used in the management of cerebral vascular diseases, but report of its use for spinal AVF is rare. METHODS: Since 2004, 4 consecutive cases of spinal AVF (3 males and 1 female, 3 thoracic, and 1 thoracolumbar) were involved in this study. The mean age at the time of operation was 62.3 years (range from 48 to 76 y). Types of AVFs and surgical techniques were reviewed retrospectively and the outcomes were assessed using the Japanese Orthopedic Association scoring system. RESULTS: AVFs in 3 patients were diagnosed as the dural type and that in the remaining patient as the perimedullary type; all feeding arteries were derived from the ninth to 10th intercostal arteries. Preoperative angiography demonstrated that the feeding arteries in 2 patients with a dural AVF were the branches of Adamkiewicz artery and in another dural AVF case, the Adamkiewicz artery could not be determined, therefore, endovascular embolization was not feasible. Including a patient with perimedullary AVF, a microsurgical clipping combined with IA was selected as the treatment. Complete occlusion of the fistula was achieved in all cases, the mean preoperative Japanese Orthopedic Association score of 4.5 improved to 6 at the final follow-up, and no perioperative complications were observed during the follow-up period. CONCLUSIONS: The favorable clinical results in our spinal AVF cases confirmed that IA ensures safe and accurate occlusion of the fistula. This technique provides satisfactory surgical results for spinal AVFs. © 2007 Lippincott Williams & Wilkins, Inc.

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Extensive total spondylectomy for recurrent giant cell tumor in the thoracic spine. Case report

Matsumoto Morio, Ishii Ken, Takaishi Hironari, Nakamura Masaya, Morioka Hideo, Chiba Kazuhiro, Takahata Takeshi, Toyama Yoshiaki

Journal of Neurosurgery: Spine 6 （ 6 ） 600 - 605 2007年06月

ISSN 1547-5654

The authors report the case of a 47-year-old woman who harbored a giant cell tumor at the T-5 level. She had undergone curettage of the tumor via a combined anterior and posterior approach at a regional hospital and was later referred to the authors' institution for treatment after the tumor recurred. On examination she exhibited progressive paraparesis and was nonambulatory due to cord compression caused by the tumor, which had invaded the spinal canal and extended to the right paravertebral muscles and right thoracic cavity. A spondylectomy was performed through a single posterior approach. The tumor, together with a portion of the dura mater, pleura, and muscles, was resected en bloc from T-4 to T-6. After resection, spinal reconstruction was performed by placement of an anterior titanium mesh cage as well as posterior pedicle screw and rod instrumentation. The patient's postoperative course was uneventful, and she exhibited substantial neurological recovery and became ambulatory. Two and a half years after surgery, the patient was tumor free. En bloc resection of a recurrent giant cell tumor was successfully achieved through a single posterior approach. This surgical technique can be an effective option for this pathological condition, which is difficult to manage using other conventional treatment options including repeated curettage and radiotherapy.

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A functional polymorphism in COL11A1, which encodes the α1 chain of type XI collagen, is associated with susceptibility to lumbar disc herniation

Mio Futoshi, Chiba Kazuhiro, Hirose Yuichiro, Kawaguchi Yoshiharu, Mikami Yasuo, Oya Takeshi, Mori Masaki, Kamata Michihiro, Matsumoto Morio, Ozaki Kouichi, Tanaka Toshihiro, Takahashi Atsushi, Kubo Toshikazu, Kimura Tomoatsu, Toyama Yoshiaki, Ikegawa Shiro

American Journal of Human Genetics 81 （ 6 ） 1271 - 1277 2007年

ISSN 0002-9297

Lumbar disc herniation (LDH), degeneration and herniation of the nucleus pulposus of the intervertebral disc (IVD) of the lumbar spine, is one of the most common musculoskeletal diseases. Its etiology and pathogenesis, however, remain unclear. Type XI collagen is important for cartilage collagen formation and for organization of the extracellular matrix. We identified an association between one of the type XI collagen genes, COL11A1, and LDH in Japanese populations. COL11A1, which encodes the a1 chain of type XI collagen, was highly expressed in IVD, but its expression was decreased in the IVD of patients with LDH. The expression level was inversely correlated with the severity of disc degeneration. A single-nucleotide polymorphism (c.4603C→T [rs1676486]) had the most significant association with LDH (P = 3.3 × 10^-6), and the transcript containing the disease-associated allele was decreased because of its decreased stability. These observations indicate that type XI collagen is critical for IVD metabolism and that its decrease is related to LDH. © 2007 by The American Society of Human Genetics. All rights reserved.

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Surgical outcomes of spinal cord astrocytomas

Nakamura M., Chiba K., Ishii K., Ogawa Y., Takaishi H., Matsumoto M., Toyama Y.

Spinal Cord 44 （ 12 ） 740 - 745 2006年12月

ISSN 1362-4393

Study design:Retrospective case series.Objectives:To analyze prognostic factors for patients with spinal cord astrocytomas.Setting:Department of Orthopaedic Surgery, Keio University, Japan.Methods:Seven patients received total excisions (group T), eight underwent partial excisions (group P), and 15 had excisional biopsies (group B). Impacts of the tumor histological grade, the level of the tumor, the types of surgical interventions, and the use of adjuvant radiotherapies on the survival and functional outcomes of 30 patients (18 in low-grade and 12 high-grade malignancy tumors) were analyzed.Results:The survival rate of the low-grade malignancy group was significantly higher than that of the high-grade group. The survival rate of the patients with thoracic astrocytomas was significantly higher than those with cervical astrocytomas. In both the low- and high-grade groups, the survival rates in groups P/T were significantly higher than those in group B. In the low-grade group, five patients, whose preoperative functional statuses were classified as 'fair' or better, remained 'fair' or better after surgery. In the high-grade group, the postoperative functional statuses were classified as 'no change' or 'aggravated' in all except two patients. No significant difference in the survival rates was detected between patients with and without adjuvant radiotherapy.Conclusions: The tumor grade and the extent of tumor resection were significant prognostic factors for survival rate. In low-grade malignancy group, good motor function was retained when surgeries were performed before substantial neurological deterioration. The efficacy of postoperative radiotherapy has yet to be determined and needs further study. © 2006 International Spinal Cord Society All rights reserved.

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Long-term results of expansive open-door laminoplasty for cervical myelopathy - Average 14-year follow-up study

Chiba Kazuhiro, Ogawa Yuto, Ishii Ken, Takaishi Hironari, Nakamura Masaya, Maruiwa Hirofumi, Matsumoto Morio, Toyama Yoshiaki

Spine 31 （ 26 ） 2998 - 3005 2006年12月

ISSN 0362-2436

STUDY DESIGN. Retrospective case series on long-term follow-up results of original expansive open-door laminoplasty for cervical myelopathy due to cervical spondylosis (CSM) and ossification of posterior longitudinal ligament (OPLL). OBJECTIVES. To elucidate efficacy and problems of original open-door laminoplasty to improve future surgical outcomes. SUMMARY OF BACKGROUND DATA. Little information is available on long-term outcomes of original open-door laminoplasty without grafts, implants, or instruments. METHOD. The study group included 80 patients who underwent original open-door laminoplasty and were followed for minimum 10 years. Clinical results, including Japanese Orthopedic Association scores, recovery rates, occurrences of complications, and long-term deterioration were investigated. Cervical alignments, type of OPLL, cervical range of motion, anteroposterior diameter of spinal canal, and progression of OPLL were assessed on plain radiographs. Spinal cord decompression was verified on magnetic resonance imaging. RESULTS. Average Japanese Orthopedic Association score and recovery rate improved significantly until 3 years after surgery and remained at an acceptable level in both cervical spondylosis and OPLL patients with slight deterioration after 5 years. Segmental motor palsy developed in 8 patients. Late deterioration, mainly lower extremity motor score decline, developed in 8 CSM and 16 OPLL patients. Overall cervical range of motion decreased by 36%. Patients with cervical lordosis decreased gradually in both patient groups. Such changes in alignments did not affect surgical results in CSM patients, while OPLL patients with preoperative kyphosis had lower recovery rates than those with straight and lordotic alignments. OPLL progression that was detected in 66% of patients did not affect clinical results. Although infrequent, magnetic resonance imaging revealed atrophy of spinal cord, spinal cord compression at adjacent segments due to degenerative changes and OPLL progression. CONCLUSIONS. Long-term results of open-door laminoplasty without bone graft, graft substitutes, or instruments were satisfactory. However, segmental motor paralysis, kyphosis, established before and after surgery, OPLL progression, and late deterioration due to age-related degeneration remain challenging problems. © 2006 Lippincott Williams & Wilkins, Inc.

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Postoperative factors affecting neurological recovery after surgery for cervical spondylotic myelopathy

Ogawa Yuto, Chiba Kazuhiro, Matsumoto Morio, Nakamura Masaya, Takaishi Hironari, Toyama Yoshiaki

Journal of Neurosurgery: Spine 5 （ 6 ） 483 - 487 2006年12月

ISSN 1547-5654

Object. Many prognostic factors associated with surgery for cervical spondylotic myelopathy (CSM) have been detailed in the literature. All of these factors, however, are defined preoperatively. If it is possible to clarify factors influencing surgical results that can be modulated after surgery, then the overall results of surgery may improve. The purpose of this study was to elucidate such postoperative factors affecting neurological recovery. Methods. The authors assessed the surgical outcomes obtained in 183 patients with CSM who underwent expansive open-door laminoplasty between 1993 and 2004 and who underwent follow up for a minimum of 1 year. They classified the cases into two groups according to the degree of neurological recovery: an excellent recovery group, comprising patients in whom the recovery rates were greater than 75%, and a poor recovery group, composed of patients in whom the recovery rates were lower than 30%. Comparisons of various clinical and imaging parameters revealed that the mean age at surgery was significantly lower in patients in the excellent recovery group than that in the poor recovery group. Therefore, the authors repeated the same analyses after adjustment for age. Postoperative cervical range of motion (ROM) was significantly more reduced in the excellent recovery group than in the poor recovery group. There was a significant positive correlation between reduced cervical ROM and recovery rate in the poor recovery group. Conclusions. Dynamic stress may deteriorate functional recovery of the degenerated spinal cord even after sufficient decompression. Postoperative preservation of cervical ROM may not always be beneficial for neurological recovery in patients with CSM.

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Pathognomonic radiological signs for predicting prognosis in patients with chronic atlantoaxial rotatory fixation

Ishii Ken, Chiba Kazuhiro, Maruiwa Hirofumi, Nakamura Masaya, Matsumoto Morio, Toyama Yoshiaki

Journal of Neurosurgery: Spine 5 （ 5 ） 385 - 391 2006年11月

ISSN 1547-5654

Object. The authors conducted a study to assess the correlation between radiological features and clinical courses in patients with chronic atlantoaxial rotatory fixation (AARF) and to determine diagnostic imaging signs for predicting prognosis. Methods. There were 24 patients (eight boys and 16 girls) whose mean age was 7.8 years (range 4-14 years) and in whom AARF was diagnosed. The mean follow-up duration was 3.7 years (range 5 weeks-12 years). There were two groups of patients: 15 patients who visited the hospital less than 8 weeks after symptom (torticollis) onset comprised the acute group, and nine patients in whom the diagnosis of AARF was established later than 3 months after symptom onset comprised the chronic group. The chronic group was divided into two subgroups: those in whom the closed reduction could be achieved and those in whom it could not. Clinical data and radiographic studies, including plain radiographs and plain and three-dimensional (3D) computed tomography (CT) reconstructions, were reviewed retrospectively. A deformity of the superior C-2 facet joint was frequently observed in the group of patients with chronic AARF (p < 0.0001). This sign represented a risk factor for recurrent dislocation (p = 0.0003, Fisher exact test). Prominent lateral inclination of C-1 was an impeding factor for reduction of chronic AARF (p < 0.0001, analysis of variance with Fisher post hoc test). Greater than 20° of lateral inclination of the atlas indicated an irreducible subluxation (p = 0.0023, Fisher exact test). Conclusions. Both facet joint deformity and lateral inclination observed on 3D CT reconstructions can be useful signs to predict the prognosis and the treatment of choice in patients with chronic AARFs.

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松本 守雄

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松本　守雄

論文 - 松本　守雄