Details of a Researcher - Matsumoto, Morio

Papers - Matsumoto, Morio

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Fabrication of bone like composites material and evaluation of its ossiferous ability

Hisamori Noriyuki, Kimura Megumi, Morisue Hikaru, Matsumoto Morio, Toyama Yoshiaki

International Journal of Modern Physics B 20 ( 25-27 ) 3567 - 3572 2006.10

ISSN 0217-9792

Many kinds of materials are currently used as artificial bone substitutes. Hydroxyapatite (HA), the same as the main inorganic component of bone, is one of commonly used bio-ceramics and has excellent bioactivity and biocompatibility with hard tissues. However, it has problems as the bone filler or bone tissue-engineering scaffold due to low fracture toughness and low degradation rate. Recently, biodegradable materials for bone tissue have been developed to respond the requirement. Collagen, the same as the main organic component of bone, is biocompatible, biodegradable and promotes cell adhesion. A composites associated with HA is expected to have early osteoconduction and bone replacement ability. The present study was to fabricate bone-like composites consist of HA and collagen. Besides the ossiferous ability of the material in vivo is evaluated by using rabbits. Bone-like composites were successfully fabricated in this study, associating the collagen with HA. And the composites presented good osteoconductive and bone replacement potential. © World Scientific Publishing Company.

Posterior osteotomy and instrumentation for thoracolumbar kyphosis in patients with achondroplasia

Qi Xin, Matsumoto Morio, Ishii Ken, Nakamura Masaya, Chiba Kazuhiro, Toyama Yoshiaki

Spine 31 ( 17 ) 2006.08

ISSN 0362-2436

STUDY DESIGN. A retrospective case series of surgically treated achondroplastic patients with severe thoracolumbar kyphosis. OBJECTIVE. To evaluate the outcome of surgical treatment for thoracolumbar kyphosis in patients associated with achondroplasia presenting with paraparesis. SUMMARY OF BACKGROUND DATA. Thoracolumbar kyphosis is one of the frequent skeletal manifestations in patients with achondroplasia. Few papers have been published on the surgical treatment of this condition, especially in skeletally mature patients. METHODS. Four patients with achondroplasia who developed neurologic deficit due to severe thoracolumbar kyphosis and underwent surgical treatment were evaluated (mean age, 32.5 years; mean follow-up, 3.0 years). Posterior osteotomy with segmental instrumentation was performed in all cases. The surgical procedures included pedicle subtraction osteotomy in 2 patients without a hypoplastic apical vertebra and spondylectomy with reconstruction of the anterior column in 2 patients with a hypoplastic apical vertebra. Neurologic outcomes (JOA scores), correction of kyphosis, and operative complications were assessed. RESULTS. All patients had gait disturbance, and 2 patients were unambulatory before surgery. The average preoperative JOA score was 5.8 points, which was improved to 9.3 points at the final follow-up (mean recovery rate, 75%). All patients obtained neurologic improvement and became ambulatory either with or without crutches after surgery. The mean preoperative kyphotic angle was 96.3° (range, 57°-117°). The postoperative angles averaged 55.3° (range, 30°-110°), yielding a mean correction rate of 43.6%. Neither loss of correction nor pseudarthrosis has been observed during the follow-up period. Partial nerve root laceration and dural tear resulting in transient postoperative muscle weakness were observed in 2 patients as complications. CONCLUSIONS. Posterior spinal osteotomy with segmental instrumentation is a reasonable surgical option for thoracolumbar kyphosis in patients with achondroplasia. Modification of the surgical procedures depending on the presence or absence of the dysplastic changes of the apical vertebra is necessary to obtain optimal results. ©2006, Lippincott Williams & Wilkins, Inc.

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A large-scale genetic association study of ossification of the posterior longitudinal ligament of the spine

Horikoshi Taizo, Maeda Koichi, Kawaguchi Yoshiharu, Chiba Kazuhiro, Mori Kanji, Koshizuka Yu, Hirabayashi Shigeru, Sugimori Kazuhito, Matsumoto Morio, Kawaguchi Hiroshi, Takahashi Makoto, Inoue Hisashi, Kimura Tomoatsu, Matsusue Yoshitaka, Inoue Itsuro, Baba Hisatoshi, Nakamura Kozo, Ikegawa Shiro

Human Genetics 119 ( 6 ) 611 - 616 2006.07

ISSN 0340-6717

Research to date has identified several genes that are implicated in the etiology of ossification of the posterior longitudinal ligament of the spine (OPLL); however, their pathogenetic relevance remains obscure. The aim of this study is to identify susceptibility genes for OPLL through a large-scale case-control association study and to re-examine previously reported associations. A total of 109 single nucleotide polymorphisms (SNPs) in 35 candidate genes were genotyped for 711 sporadic OPLL patients and 896 controls. The differences in allelic and genotypic distribution between patients and controls were assessed using the χ² test with Bonferroni's correction. We also analyzed the association by separating patients into subgroups according to sex, age and the number of ossified vertebrae. The nominal P values fell below 0.05 for five SNPs in three genes. An intronic SNP in the TGF3 gene (P = 0.00040) showed the most significant association. Previously reported associations of COL11A2, NPPS and TGFB1 with OPLL could not be reproduced. Further, no significant associations were detected in stratified analyses based on sex, age or the number of ossified vertebrae. TGFB3 warrants further investigation because it is located within a genomic region that has been positively linked with OPLL. © Springer-Verlag 2006.

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Pleomorphic xanthoastrocytoma of the spinal cord

Nakamura Masaya, Chiba Kazuhiro, Matsumoto Morio, Ikeda Eiji, Toyama Yoshiaki

Journal of Neurosurgery: Spine 5 ( 1 ) 72 - 75 2006.07

ISSN 1547-5654

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Prediction of deformity correction by pedicle screw instrumentation in thoracolumbar scoliosis surgery (Computer simulation study)

Kiriyama Yoshimori, Yamazaki Nobutoshi, Nagura Takeo, Matsumoto Morio, Chiba Kazuhiro, Toyama Yoshiaki

JSME International Journal, Series C: Mechanical Systems, Machine Elements and Manufacturing 48 ( 4 ) 577 - 585 2006.06

ISSN 1344-7653

In segmental pedicle screw instrumentation, the relationship between the combinations of pedicle screw placements and the degree of deformity correction was investigated with a three-dimensional rigid body and spring model. The virtual thoracolumbar scoliosis (Cobb's angle of 47 deg.) was corrected using six different combinations of pedicle-screw placements. As a result, better correction in the axial rotation was obtained with the pedicle screws placed at or close to the apical vertebra than with the screws placed close to the end vertebrae, while the correction in the frontal plane was better with the screws close to the end vertebrae than with those close to the apical vertebra. Additionally, two screws placed in the convex side above and below the apical vertebra provided better correction than two screws placed in the concave side. Effective deformity corrections of scoliosis were obtained with the proper combinations of pedicle screw placements. Copyright © 2006 by The Japan Society of Mechanical Engineers.

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Lateral translation of the lumbar spine

Okushima Yuichiro, Yamazaki Nobutoshi, Matsumoto Morio, Chiba Kazuhiro, Nagura Takeo, Toyama Yoshiaki

Journal of Applied Biomechanics 22 ( 2 ) 83 - 92 2006.05

ISSN 1065-8483

A biomechanical study of lateral translation in lumbar spine with human cadavers was performed in order to explore the direction of the force increasing lateral translation and the contributions of discs and facet joints to lateral translation. Whole lumbar spines from 12 fresh cadavers were attached to a specially designed loading apparatus whose five cables simulated the muscles of the trunk without restricting natural movement. Three-dimensional positions of each vertebra were recorded with position-sensitive detectors. Force in the anterolateral direction increased the lateral translation more than force in the posterolateral direction. Lateral translation was increased to a significantly greater extent when the facet joints were removed than when the discs were removed at L4-5 at the levels of shear loading applied in this study. © 2006 Human Kinetics, Inc.

Open-door laminoplasty for cervical myelopathy resulting from adjacent-segment disease in patients with previous anterior cervical decompression and fusion

Matsumoto Morio, Nojiri Kenya, Chiba Kazuhiro, Toyama Yoshiaki, Fukui Yasuyuki, Kamata Michihiro

Spine 31 ( 12 ) 1332 - 1337 2006.05

ISSN 0362-2436

STUDY DESIGN.: This is a retrospective study of patients with cervical myelopathy resulting from adjacent-segment disease who were treated by open-door expansive laminoplasty. OBJECTIVES.: The purpose of this study was to evaluate the effectiveness of laminoplasty for cervical myelopathy resulting from adjacent-segment disease. SUMMARY OF BACKGROUND DATA.: Adjacent-segment disease is one of the problems associated with anterior cervical decompression and fusion. However, the optimal surgical management strategy is still controversial. METHODS.: Thirty-one patients who underwent open-door expansive laminoplasty for cervical myelopathy resulting from adjacent-segment disease and age- and sex-matched 31 patients with myelopathy who underwent laminoplasty as the initial surgery were enrolled in the study. The pre- and postoperative Japanese Orthopedic Association scores (JOA scores) and the recovery rate were compared between the two groups. RESULTS.: The average JOA scores in the patients with adjacent-segment disease and the controls were 9.2 ± 2.6 and 9.4 ± 2.3 before the expansive laminoplasty and 11.9 ± 2.8 and 13.3 ± 1.7 at the follow-up examination, respectively; the average recovery rates in the two groups were 37.1 ± 22.4% and 50.0 ± 21.3%, respectively (P = 0.04). The mean number of segments covered by the high-intensity lesions on the T2-weighted magnetic resonance images was 1.87 and 0.9, respectively (P = 0.001). CONCLUSIONS.: Moderate neurologic recovery was obtained after open-door laminoplasty in patients with cervical myelopathy resulting from adjacent-segment disc disease, although the results were not as satisfactory as those in the control group. This may be attributed to the irreversible damage of the spinal cord caused by persistent compression at the adjacent segments. ©2006, Lippincott Williams & Wilkins, Inc.

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A novel hydroxyapatite fiber mesh as a carrier for recombinant human bone morphogenetic protein-2 enhances bone union in rat posterolateral fusion model

Morisue Hikaru, Matsumoto Morio, Chiba Kazuhiro, Matsumoto Hideo, Toyama Yoshiaki, Aizawa Mamoru, Kanzawa Nobuyuki, Fujimi Takahiro J., Uchida Hiroshi, Okada Isao

Spine 31 ( 11 ) 1194 - 1200 2006.05

ISSN 0362-2436

Study Design. An experimental study, in which spinal fusion in rats was conducted using a hydroxyapatite fiber mesh (HAM) as a carrier for recombinant human bone morphogenetic protein (rhBMP)-2. Objectives. To study the usefulness of the HAM as a carrier and seek the possibility of clinical application in spinal fusion. Summary of Background Data. Several biomaterials have been used as a carrier for BMP to achieve spine fusion, however, to our knowledge, the most effective carrier has not been established. Methods. In experiment No. 1, HAMs and the controls (commercially available hydroxyapatite ceramic body), loaded with rhBMP-2, were immersed in phosphate-buffered saline to evaluate the time course of the release of rhBMP-2. In experiment No. 2, posterolateral fusion was conducted in rats using HAM and the control loaded with rhBMP-2. The fusion status was evaluated radiologically and histologically after surgery. Results. In experiment No. 1, HAMs released a larger amount of rhBMP-2 for up to 28 days than the controls (49.5% vs 7.8%). In experiment No. 2, the fusion rate was significantly higher in the HAM group (>80%) than in the control group (20%). Dense new bone formed close to the spine, and the HAMs were markedly absorbed compared with the controls. Conclusion. HAM provided more solid fusion mass than the control, suggesting that HAM is an efficient carrier for BMP. ©2006, Lippincott Williams & Wilkins, Inc.

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Microendoscopic partial resection of the sacral ala to relieve extraforaminal entrapment of the L-5 spinal nerve at the lumbosacral tunnel

Matsumoto Morio, Chiba Kazuhiro, Ishii Ken, Watanabe Kota, Nakamura Masaya, Toyama Yoshiaki

Journal of Neurosurgery: Spine 4 ( 4 ) 342 - 346 2006.04

ISSN 1547-5654

The authors report the cases of three patients with L-5 radiculopathy caused by extraforaminal entrapment of the L-5 spinal nerve at the lumbosacral tunnel; this structure comprises the lumbosacral ligament, the sacral ala, and the L-5 and S-1 vertebral bodies. All three patients suffered severe leg pain and neurological deficits compatible with L-5 radiculopathy. Decompressive surgery involved the microendoscopic partial resection of the sacral ala along the L-5 spinal nerve. All patients experienced immediate pain relief postoperatively. Microendoscopic partial resection of the sacral ala is an effective and minimally invasive surgical option for patients with extraforaminal entrapment of the L-5 spinal nerve.

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Molecular pathology of Shprintzen-Goldberg syndrome [4]

Kosaki Kenjiro, Takahashi Daisuke, Udaka Toru, Kosaki Rika, Matsumoto Morio, Ibe Shigeharu, Isobe Takeshi, Tanaka Yoko, Takahashi Takao

American Journal of Medical Genetics 140 A ( 1 ) 104 - 108 2006.01

ISSN 1552-4825

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Clinical manifestations of thoracic OPLL and OLF

Matsumoto Morio, Chiba Kazuhiro, Toyama Yoshiaki

121 - 125 2006

Introduction Ossification of the posterior longitudinal ligament (OPLL) is far less common in the thoracic spine than in the cervical spine; and the rate of occurrence, natural history, and optimal treatment of this condition are yet to be investigated. Because progressive deterioration of the neurological symptoms due to thoracic OPLL often severely impairs patients? activities of daily living and quality of life, awareness of this clinical entity is important. Ossification of the ligamentum fl avum (OLF) is mostly found in the thoracic spine and is a frequent cause of thoracic myelopathy. In this chapter, the clinical and neurological manifestations of thoracic OPLL and OLF are reviewed. © Springer 2006.

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Expansive open-door laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine

Chiba Kazuhiro, Ogawa Yuto, Matsumoto Morio, Toyama Yoshiaki

193 - 199 2006

Introduction In 1968, Kirita devised a sophisticated extensive laminectomy technique in which the laminae were thinned and divided at the midline by a high-speed drill followed by en bloc resection of the laminae to achieve decompression of the spinal cord safely in patients with cervical spondylosis and ossification of the posterior longitudinal ligament (OPLL) [1]. This technique added much safety to conventional laminectomy and signifi - cantly reduced the rate of neurological complications. Hirabayashi et al. simplifi ed Kirita's method, in which the bilateral bony gutters at the junction of the laminae and the facet joints were made using a high-speed drill followed by en bloc removal of the laminae [2]. The idea of open-door laminoplasty evolved when they noticed dural pulsation when one side of the laminae was lifted before their total removal. They performed the fi rst case using this technique in 1977, leaving the ventral cortex on one side as a hinge and lifting the lamina on the other side, just like opening a book cover; they named it "expansive open-door laminoplasty (ELAP)" [3,4]. The advent of ELAP has contributed signifi cantly to the establishment of the concept "laminoplasty," which later became the treatment of choice for cervical myelopathy in Japan and has also led to the development of various technical modifi cations. Laminoplasty has become the treatment of choice for cervical myelopathy, and satisfactory results have been reported [2,5-7]. Although ELAP is not radical decompression surgery that directly removes the ossifi ed ligament, it has a total decompression effect induced by the dorsal shift of the spinal cord in addition to local decompression of the spinal cord by posterior displacement of the laminae (Fig. 1) [8]. Several studies have proven that the decompression effect of ELAP is virtually equivalent to that of laminectomy and anterior corpectomy and fusion [9]. The posterior structures, including the lamina and the supraspinous and interspinous ligaments, are preserved; and the cervical muscles are reattached to reconstruct the spinal canal, thereby maintaining the preoperative cervical alignments and at the same time restoring cervical stability. Herkowitz concluded from his biomechanical study that the stability of the cervical spine after ELAP was not signifi cantly different from that of the intact spine [10]. Indeed, kyphotic deformity or instability after ELAP that required salvage surgery has rarely been experienced in our institution [6,11]. Moreover, the incidence of adjacent-segment disease, which may also lead to a salvage operation, was much lower after ELAP than after anterior decompression and fusion [2]. © Springer 2006.

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CD24 is expressed specifically in the nucleus pulposus of intervertebral discs

Fujita Nobuyuki, Miyamoto Takeshi, Imai Jun Ichi, Hosogane Naobumi, Suzuki Toru, Yagi Mitsuru, Morita Kozo, Ninomiya Ken, Miyamoto Kana, Takaishi Hironari, Matsumoto Morio, Morioka Hideo, Yabe Hiroo, Chiba Kazuhiro, Watanabe Shinya, Toyama Yoshiaki, Suda Toshio

Biochemical and Biophysical Research Communications 338 ( 4 ) 1890 - 1896 2005.12

ISSN 0006-291X

Intervertebral disc (IVD) consists of a soft gelatinous material in its center, the nucleus pulposus (NP), bounded peripherally by fibrocartilage, annulus fibrosus (AF). Despite the number of patients with IVD degeneration, gene expression analysis has not been undertaken in NP and therefore little is known about the molecular markers expressed in NP. Here, we undertook a microarray screen in NP with the other nine tissues to identify the specific cell surface markers for NP. Five membrane associating molecules out of 10,490 genes were identified as highly expressing genes in NP compared with the other tissues. Among them, we identified CD24, a glycosylphosphatidylinositol (GPI) anchor protein as a cell surface marker for NP. CD24 expression was also detected in the herniated NP and chordoma, a malignant primary tumor derived from notochordal cells, while it was absent in chondrosarcoma. Therefore, CD24 is a molecular marker for NP as well as the diseases of IVD. © 2005 Elsevier Inc. All rights reserved.

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Comparative assessment of pedicle morphology of the lumbar spine in various degenerative diseases

Nojiri Kenya, Matsumoto Morio, Chiba Kazuhiro, Toyama Yoshiaki, Momoshima Suketaka

Surgical and Radiologic Anatomy 27 ( 4 ) 317 - 321 2005.11

ISSN 0930-1038

Measurement of the morphological dimensions of the pedicles of the lumbar spine was conducted using computed tomography (CT) to clarify the difference in pedicle morphology among different lumbar degenerative diseases. The subjects were 136 patients with lumbar spinal disorders who underwent myelography followed by CT scans. They were divided into four groups, that is a group of 25 patients with degenerative spondylolisthesis (DS group), a group of 54 patients with lumbar canal stenosis (LCS group), a group of 42 patients with lumbar disc herniation (LDH group), and a control group of 15 patients with spinal cord tumor in cervicothoracic region but without lumbar diseases (control group). Measurements of the transverse diameter, axial length, and axial angle of the pedicles were performed on CT slices obtained at the middle of the pedicle. The transverse diameter was the width of the isthmus, the axial length was the distance between the anterior of the vertebral body and the posterior of the vertebral arch on a line perpendicular to the line bisecting the isthmus, and the axial angle was the angle between the line perpendicular to the line bisecting the isthmus and the midline of the vertebral body. While there were no significant differences in the mean transverse diameter or axial length among the four groups, the mean axial angle was significantly smaller in the DS and LCS groups when compared to that in the LDH and control groups. In the DS and LCS groups, the pedicles were more sagitally oriented than in the LDH and control groups. Such difference in the axial angle of the pedicles in different lumbar diseases should be taken into consideration when placing at the insertion of pedicle screws, because precise orientation of screw insertion would scarcely allow penetration of the pedicle wall. © Springer-Verlag 2005.

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Lumbar spinous process-splitting laminectomy for lumbar canal stenosis. Technical note.

Watanabe Kota, Hosoya Toshihiko, Shiraishi Tateru, Matsumoto Morio, Chiba Kazuhiro, Toyama Yoshiaki

Journal of neurosurgery. Spine. 3 ( 5 ) 405 - 408 2005.11

ISSN 1547-5654

In conventional laminectomy for lumbar canal stenosis (LCS), intraoperative damage of posterior supporting structures can lead to irreversible atrophy of paraspinal muscles. In 2001, the authors developed a new procedure for lumbar laminectomy, the lumbar spinous process-splitting laminectomy (LSPSL). In this new procedure, the spinous process is split longitudinally in the middle and then divided at its base from the posterior arch, leaving the bilateral paraspinal muscles attached to the lateral aspects. Ample working space for laminectomy is obtained by retracting the split spinous process laterally together with its attached paraspinal muscles. After successfully decompressing nerve tissues, each half of the split spinous process is reapproximated using a strong suture. Thus, the supra- and interspinous ligaments are preserved, as is the spinous process, and damage to the paraspinal muscles is minimal. Eighteen patients with LCS underwent surgery in which this new technique was used. Twenty patients in whom conventional laminectomy was undertaken were chosen as controls. At 2 years, the clinical outcomes (as determined using the Japanese Orthopaedic Association [JOA] scores and recovery rate) and the rate of measured magnetic resonance imaging-documented paravertebral muscle atrophy were evaluated and compared between the two groups. The mean JOA score recovery rates were 67.6 and 59.2%, respectively, for patients treated with LSPSL and conventional laminectomy; the mean rates of paravertebral muscle atrophy were 5.3 and 23.9%, respectively (p = 0.0005). Preservation of posterior supporting structures and satisfactory recovery rate after 2 years indicated that this technique can be a useful alternative to conventional decompression surgery for lumbar canal stenosis.

Long-term results after expansive open-door laminoplasty for the segmental-type of ossification of the posterior longitudinal ligament of the cervical spine

Ogawa Yuto, Chiba Kazuhiro, Matsumoto Morio, Nakamura Masaya, Takaishi Hironari, Hirabayashi Hisashi, Hirabayashi Kiyoshi, Nishiwaki Yuji, Toyama Yoshiaki

Journal of neurosurgery. Spine 3 ( 3 ) 198 - 204 2005.09

ISSN 1547-5654

OBJECT: The segmental-type of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine is distinct from other types in its morphological features. Whether the results of expansive open-door laminoplasty for the segmental-type are different from those for other types remains unclear. To clarify this issue, the long-term results after surgical treatment of segmental-type OPLL were compared with those of other types. METHODS: Clinical results were documented in 57 patients who underwent expansive open-door laminoplasty and were followed for a minimum of 7 years, results were quantified using the Japanese Orthopaedic Association (JOA) scoring system to determine function. Segmental-type OPLL was observed in 10 patients (Group 1) and other types in 47 patients (Group 2). Preoperative JOA scores were not significantly different between the two groups. As many as 5 years after surgery, clinical results were favorable and maintained in both groups, and no significant intergroup difference in postoperative JOA scores was observed; however, after 5 years postoperatively, JOA scores decreased in both groups. The decrease was greater in Group 1, and a significant intergroup difference in JOA scores was demonstrated when analyzing final follow-up data. In Group 1, the authors found that the degree of late-onset deterioration relating to cervical myelopathy positively correlated with the cervical range of motion. CONCLUSIONS: The long-term results of expansive open-door laminoplasty in the treatment of segmental-type OPLL were inferior to those for other types. Cervical mobility may contribute to the development of late deterioration of cervical myelopathy.

Endoscopic resection of cystic lesions in the lumbar spinal canal. A report of two cases

Ishii Ken, Matsumoto M., Watanabe K., Nakamura M., Chiba K., Toyama Y.

Minimally Invasive Neurosurgery 48 ( 4 ) 240 - 243 2005.08

ISSN 0946-7211

We report excellent outcomes in two patients with cystic lesions in the lumbar spinal canal who underwent resection using the METRx™ microendoscopic discectomy (MED) system. Pathological examinations revealed the diagnoses of a synovial cyst and a discal cyst, respectively. Both of them were allowed to walk the next day after surgery with complete pain relief. Microendoscopic surgery provides excellent visualization of the spinal canal and allows minimally invasive removal of the pathological lesions. This technique can be an effective alternative to conventional open surgery for cystic lesions in the lumbar spine. © Georg Thieme Verlag KG Stuttgart.

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Usefulness of neurological examination for diagnosis of the affected level in patients with cervical compressive myelopathy

Matsumoto Morio, Ishikawa Masayuki, Ishii Ken, Nishizawa Takashi, Maruiwa Hirofumi, Nakamura Masaya, Chiba Kazuhiro, Toyama Yoshiaki

Journal of neurosurgery. Spine 2 ( 5 ) 535 - 539 2005.05

ISSN 1547-5654

OBJECT: Although neurological examination is the key step to reaching a correct diagnosis of cervical compressive myelopathy (CCM), the accuracy of diagnosis of the affected spinal level for CCM has not yet been tested. METHODS: The authors conducted a prospective study to elucidate how accurately the affected intervertebral level can be determined and decompressed based on neurological examination. Fifty patients who underwent successful decompressive surgery for cervical myelopathy caused by single-level disc herniation or spondylosis were included in this study (38 men and 12 women, mean age 60 years). Three board-certified spine surgeons participated in establishing the neurological diagnoses. One of the three surgeons made a diagnosis of CCM, and the other two conducted the neurological examination including deep tendon reflex, pinprick response, muscle weakness, and numbness in the hand only, knowing that the patient had CCM, and established the neurological-level diagnosis. A single intervertebral level responsible for patient's symptoms was determined concordantly based on magnetic resonance imaging and myelography findings by two spine surgeons, and this served as the standard. Agreement between neurological and neuroimaging/radiological level diagnoses was determined. The rate of agreement between neurological and neuroimaging diagnosis was 66%. Among the neurological tests, patient-perceived location of numbness in the hands was the most useful for establishing the affected level. For the other three tests the agreement rate was lower than 50% and thus each individual test may not be reliable for diagnosing the affected level. CONCLUSIONS: The results of this study suggested that neurological examination in patients with CCM is moderately accurate and reliable for determining the neurological level of disease.

Morphometric analysis of the thoracic and lumbar spine in Japanese on the use of pedicle screws

Nojiri Kenya, Matsumoto Morio, Chiba Kazuhiro, Toyama Yoshiaki

Surgical and Radiologic Anatomy 27 ( 2 ) 123 - 128 2005.04

ISSN 0930-1038

The pedicle screw and hook have become popular instruments in treating spinal deformity and disease. This study gathered morphological data on thoracic and lumbar spines in a Japanese population that should serve as useful reference for posterior instrumentation surgery. One hundred and three dry bones were used to investigate the morphology of pedicle and facet in thoracic and lumbar spines. Measurements included the diameter and axial length of pedicle from T8 to L5, height and width of facets and thickness of articular processes from T1 to T12, and axial angle of pedicle from T1 to L5. The diameter and axial length of pedicle were smallest at T8, diameter was largest at L5 and axial length was largest at L3. Height of facets and thickness of articular processes were largest at T12. Men tended to have larger pedicles and facets than women. Transverse angle of pedicle was smallest at T12. These precise data may provide useful information when performing posterior instrumentation surgery and when developing new spinal implant systems for Asians. © Springer-Verlag 2005.

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Impact of interlaminar graft materials on the fusion status in atlantoaxial transarticular screw fixation.

Matsumoto Morio, Chiba Kazuhiro, Nakamura Masaya, Ogawa Yuto, Toyama Yoshiaki, Ogawa Jun

Journal of neurosurgery. Spine 2 ( 1 ) 23 - 26 2005.01

ISSN 1547-5654

OBJECT: Structural interlaminar graft materials were used for atlantoaxial transarticular screw fixation (TSF), and its impact on the fusion status was investigated. METHODS: Forty-two patients (10 men, 32 women, mean age 51 years, mean follow-up period 45 months; 30 with rheumatoid arthritis, and 12 with os odontoideum) underwent TSF and modified Brooks posterior wiring involving titanium cables. As interlaminar graft materials, autologous bone from posterior iliac crest alone was used in 20 patients (Group A), and a structural spacer (13 ceramic spacers, nine titanium mesh cages) in 22 (Group B). Lateral radiographs were evaluated to determine bone fusion, alignment of the cervical spine, and wire loosening. Solid osseous fusion was obtained in 95% of Group A and 96% of Group B patients. The mean atlantoaxial angle was 19.1+/-9.7 degrees and 16.7+/-10.4 degrees before surgery (p = 0.45), and 27.4+/-7.8 degrees and 22.1+/-5.5 degrees after surgery (p = 0.02) in Groups A and B, respectively. Atlantoaxial hyperlordosis (atlantoaxial angle > or = 30 degrees) was observed in 32% of Group A and 18% of Group B patients (p = 0.26). Postoperative kyphosis occurred in 40% of Group A and 23% of Group B patients (p = 0.28). Loosening of the cable was demonstrated in 50% of Group A and 36% of Group B patients(p = 0.37). In Group B patients maintenance of cervical lordosis was more likely than in those in Group A, although the differences did not reach statistical significance. CONCLUSIONS: These results indicate that structural interlaminar spacers can maintain proper cervical alignment without a decease in the fusion rate; the authors recommend their use in conjunction with TSF.

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