Details of a Researcher - Matsumoto, Morio

Papers - Matsumoto, Morio

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C1 posterior arch screw as an auxiliary anchor in posterior reconstruction for atlantoaxial dislocation associated with type II odontoid fracture

Nagoshi Narihito, Suda Kota, Morita Tomonori, Matsumoto Satoko, Iimoto Seiji, Yasui Keigo, Komatsu Miki, Kobayashi Yosuke, Minami Akio, Toyama Yoshiaki, Matsumoto Morio, Nakamura Masaya

SpringerPlus 3 ( 1 ) 2014

Introduction: Although pedicle or lateral mass screws are usually chosen to fix atlantoaxial (C1-C2) instability, there is an increased risk for vertebral artery (VA) injury when used in patients with bone or arterial anomalies or osteoporotic bone. Here we report the C1 posterior arch screw as a new technique for upper cervical fixation.Case description: A 90-year-old man complained of upper cervical pain after falling in his house. The initial computed tomography (CT) scan showed C1-C2 posterior dislocation with a type II odontoid fracture. The patient underwent C2 fracture reduction and posterior C1-C2 fixation. On the right side of C1, because lateral mass screw placement could cause injury to the dominant VA considering a risk in oldest-old osteoporotic patients, a posterior arch screw was chosen instead as an auxiliary anchor. An intralaminar screw was placed on the right side of C2 because a high-riding VA was observed. A lateral mass screw and a pars interarticularis screw were placed on the left side of C1 and C2, respectively. Ten months later, the odontoid fracture had healed, with normal anatomical alignment. Although the patient experienced slight weakness when spreading his bilateral fingers, his overall condition was good.Discussion and evaluation: We have presented a novel technique using C1 posterior arch screws for the fixation of a C1-C2 dislocation. Such a screw is an alternative to the C1 lateral mass screw in patients who are at risk for a VA injury because of anomalous bone and arterial structures or poor bone quality.Conclusions: Although there have been few comparable studies, and the long-term outcome is unknown, fixation with a posterior arch screw could be a beneficial choice for surgeries involving the upper cervical region.

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Surgeons' exposure to radiation in single- and multi-level minimally invasive transforaminal lumbar interbody fusion; a prospective study

Funao Haruki, Ishii Ken, Momoshima Suketaka, Iwanami Akio, Hosogane Naobumi, Watanabe Kota, Nakamura Masaya, Toyama Yoshiaki, Matsumoto Morio

PLoS ONE 9 ( 4 ) e95233 2014

Although minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has widely been developed in patients with lumbar diseases, surgeons risk exposure to fluoroscopic radiation. However, to date, there is no studies quantifying the effective dose during MIS-TLIF procedure, and the radiation dose distribution is still unclear. In this study, the surgeons' radiation doses at 5 places on the bodies were measured and the effective doses were assessed during 31 consecutive 1- to 3-level MIS-TLIF surgeries. The operating surgeon, assisting surgeon, and radiological technologist wore thermoluminescent dosimeter on the unshielded thyroid, chest, genitals, right middle finger, and on the chest beneath a lead apron. The doses at the lens and the effective doses were also calculated. Mean fluoroscopy times were 38.7, 53.1, and 58.5 seconds for 1, 2, or 3 fusion levels, respectively. The operating surgeon's mean exposures at the lens, thyroid, chest, genitals, finger, and the chest beneath the shield, respectively, were 0.07, 0.07, 0.09, 0.14, 0.32, and 0.05 mSv in 1-level MIS-TLIF; 0.07, 0.08, 0.09, 0.18, 0.34, and 0.05 mSv in 2-level; 0.08, 0.09, 0.14, 0.15, 0.36, and 0.06 mSv in 3-level; and 0.07, 0.08, 0.10, 0.15, 0.33, and 0.05 mSv in all cases. Mean dose at the operating surgeon's right finger was significantly higher than other measurements parts (P<0.001). The operating surgeon's effective doses (0.06, 0.06, and 0.07 mSv for 1, 2, and 3 fusion levels) were low, and didn't differ significantly from those of the assisting surgeon or radiological technologist. Revision MIS-TLIF was not associated with higher surgeons' radiation doses compared to primary MIS-TLIF. There were significantly higher surgeons' radiation doses in over-weight than in normal-weight patients. The surgeons' radiation exposure during MIS-TLIF was within the safe level by the International Commission on Radiological Protection's guidelines. The accumulated radiation exposure, especially to surgeon's hands, should be carefully monitored.

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In vitro and in vivo antimicrobial properties of silver-containing hydroxyapatite prepared via ultrasonic spray pyrolysis route

Honda Michiyo, Kawanobe Yusuke, Ishii Ken, Konishi Toshiisa, Mizumoto Minori, Kanzawa Nobuyuki, Matsumoto Morio, Aizawa Mamoru

Materials Science and Engineering C 33 ( 8 ) 5008 - 5018 2013.12

ISSN 0928-4931

Hydroxyapatite (HAp), with its high biocompatibility and osteoconductivity, readily absorbs proteins, amino acids and other substances, which in turn favor the adsorption and colonization of bacteria. To prevent bacterial growth and biofilm formation on HAp discs, silver-containing (1-20 mol%) HAp (Ag-HAp) powders were synthesized using an ultrasonic spray pyrolysis (USSP) technique. The X-ray diffraction (XRD) peaks were very broad, indicating low crystallinity, and this induced the release of Ag⁺ ions from Ag-HAp powders. In addition, a gradual increase in Ca²⁺ ion release was observed. These results suggest that dissolution of Ca²⁺ ion in Ag-HAp triggered the release of Ag⁺ ions. The antimicrobial efficacy of Ag-HAp disc was tested against Staphylococcus aureus. Samples with Ag contents of more than 5 mol%were found to be highly effective against bacterial colonization and biofilm formation in vitro. In vivo antibacterial tests using bioluminescent strains also showed reductions in the viability of bacteria with Ag-HAp (5 mol%) discs. Biocompatibility tests using a modified Transwell® insert method showed that Ag-HAp (5 mol%) discs have negative effects on osteoblast proliferation. These results indicate that Ag-HAp (5 mol%) has effective antibacterial activity and good biocompatibility both in vitro and in vivo together with good biocompatibility, thus confirming its utility as a bactericidal material. © 2013 Elsevier B.V. All rights reserved.

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FOXC2 mutations in familial and sporadic spinal extradural arachnoid cyst

Ogura Yoji, Yabuki Shoji, Iida Aritoshi, Kou Ikuyo, Nakajima Masahiro, Kano Hiroki, Shiina Masaaki, Kikuchi Shinichi, Toyama Yoshiaki, Ogata Kazuhiro, Nakamura Masaya, Matsumoto Morio, Ikegawa Shiro

PLoS ONE 8 ( 11 ) 2013.11

Spinal extradural arachnoid cyst (SEDAC) is a cyst in the spinal canal that protrudes into the epidural space from a defect in the dura mater. Most cases are sporadic; however, three familial SEDAC cases have been reported, suggesting genetic etiological factors. All familial cases are associated with lymphedema-distichiasis syndrome (LDS), whose causal gene is FOXC2. However, FOXC2 mutation analysis has been performed in only 1 family, and no mutation analysis has been performed on sporadic (non-familial) SEDACs. We recruited 17 SEDAC subjects consisting of 2 familial and 7 sporadic cases and examined FOXC2 mutations by Sanger sequencing and structural abnormalities by TaqMan copy number assay. We identified 2 novel FOXC2 mutations in 2 familial cases. Incomplete LDS penetrance was noted in both families. Four subjects presented with SEDACs only. Thus, SEDAC caused by the heterozygous FOXC2 loss-of-function mutation should be considered a feature of LDS, although it often manifests as the sole symptom. Seven sporadic SEDAC subjects had no FOXC2 mutations, no symptoms of LDS, and showed differing clinical characteristics from those who had FOXC2 mutations, suggesting that other gene(s) besides FOXC2 are likely to be involved in SEDAC. © 2013 Ogura et al.

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Lumbar disc degeneration is linked to a carbohydrate sulfotransferase 3 variant

Song You Qiang, Karasugi Tatsuki, Cheung Kenneth M C, Chiba Kazuhiro, Ho Daniel W H, Miyake Atsushi, Kao Patrick Y P, Sze Kit Ling, Yee Anita, Takahashi Atsushi, Kawaguchi Yoshiharu, Mikami Yasuo, Matsumoto Morio, Togawa Daisuke, Kanayama Masahiro, Shi Dongquan, Dai Jin, Jiang Qing, Wu Chengai, Tian Wei, Wang Na, Leong John C Y, Luk Keith D K, Yip Shea Ping, Cherny Stacey S., Wang Junwen, Mundlos Stefan, Kelempisioti Anthi, Eskola Pasi J., Männikkö Minna, Mäkelä Pirkka, Karppinen Jaro, Järvelin Marjo Riitta, O'Reilly Paul F., Kubo Michiaki, Kimura Tomoatsu, Kubo Toshikazu, Toyama Yoshiaki, Mizuta Hiroshi, Cheah Kathryn S E, Tsunoda Tatsuhiko, Sham Pak Chung, Ikegawa Shiro, Chan Danny

Journal of Clinical Investigation 123 ( 11 ) 4909 - 4917 2013.11

ISSN 0021-9738

Lumbar disc degeneration (LDD) is associated with both genetic and environmental factors and affects many people worldwide. A hallmark of LDD is loss of proteoglycan and water content in the nucleus pulposus of intervertebral discs. While some genetic determinants have been reported, the etiology of LDD is largely unknown. Here we report the findings from linkage and association studies on a total of 32,642 subjects consisting of 4,043 LDD cases and 28,599 control subjects. We identified carbohydrate sulfotransferase 3 (CHST3), an enzyme that catalyzes proteoglycan sulfation, as a susceptibility gene for LDD. The strongest genome-wide linkage peak encompassed CHST3 from a Southern Chinese family-based data set, while a genome-wide association was observed at rs4148941 in the gene in a meta-analysis using multiethnic population cohorts. rs4148941 lies within a potential microRNA-513a-5p (miR-513a-5p) binding site. Interaction between miR-513a-5p and mRNA transcribed from the susceptibility allele (A allele) of rs4148941 was enhanced in vitro compared with transcripts from other alleles. Additionally, expression of CHST3 mRNA was significantly reduced in the intervertebral disc cells of human subjects carrying the A allele of rs4148941. Together, our data provide new insights into the etiology of LDD, implicating an interplay between genetic risk factors and miRNA.

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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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HIF1? is required for osteoclast activation by estrogen deficiency in postmenopausal osteoporosis

Miyauchi Yoshiteru, Sato Yuiko, Kobayashi Tami, Yoshida Shigeyuki, Mori Tomoaki, Kanagawa Hiroya, Katsuyama Eri, Fujie Atsuhiro, Hao Wu, Miyamoto Kana, Tando Toshimi, Morioka Hideo, Matsumoto Morio, Chambon Pierre, Johnson Randall S., Kato Shigeaki, Toyama Yoshiaki, Miyamoto Takeshi

Proceedings of the National Academy of Sciences of the United States of America 110 ( 41 ) 16568 - 16573 2013.10

ISSN 0027-8424

In women, estrogen deficiency after menopause frequently accelerates osteoclastic bone resorption, leading to osteoporosis, the most common skeletal disorder. However, mechanisms underlying osteoporosis resulting from estrogen deficiency remain largely unknown. Here we show that in bone-resorbing osteoclasts, estrogendependent destabilization of hypoxia-inducible factor 1 alpha (HIF1?), which is unstable in the presence of oxygen, plays a pivotal role in promoting bone loss in estrogen-deficient conditions. In vitro, HIF1? was destabilized by estrogen treatment even in hypoxic conditions, and estrogen loss in ovariectomized (Ovx) mice stabilized HIF1? in osteoclasts and promoted their activation and subsequent bone loss in vivo. Osteoclast-specific HIF1? inactivation antagonized bone loss in Ovx mice and osteoclast-specific estrogen receptor alpha deficient mice, both models of estrogen-deficient osteoporosis. Oral administration of a HIF1? inhibitor protected Ovx mice from osteoclast activation and bone loss. Thus, HIF1? represents a promising therapeutic target in osteoporosis.

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Identification of a Susceptibility Locus for Severe Adolescent Idiopathic Scoliosis on Chromosome 17q24.3

Miyake Atsushi, Kou Ikuyo, Takahashi Yohei, Johnson Todd A., Ogura Yoji, Dai Jin, Qiu Xusheng, Takahashi Atsushi, Jiang Hua, Yan Huang, Kono Katsuki, Kawakami Noriaki, Uno Koki, Ito Manabu, Minami Shohei, Yanagida Haruhisa, Taneichi Hiroshi, Hosono Naoya, Tsuji Taichi, Suzuki Teppei, Sudo Hideki, Kotani Toshiaki, Yonezawa Ikuho, Kubo Michiaki, Tsunoda Tatsuhiko, Watanabe Kota, Chiba Kazuhiro, Toyama Yoshiaki, Qiu Yong, Matsumoto Morio, Ikegawa Shiro

PLoS ONE 8 ( 9 ) 2013.09

Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity, affecting around 2% of adolescents worldwide. Genetic factors play an important role in its etiology. Using a genome-wide association study (GWAS), we recently identified novel AIS susceptibility loci on chromosomes 10q24.31 and 6q24.1. To identify more AIS susceptibility loci relating to its severity and progression, we performed GWAS by limiting the case subjects to those with severe AIS. Through a two-stage association study using a total of ∼12,000 Japanese subjects, we identified a common variant, rs12946942 that showed a significant association with severe AIS in the recessive model (P = 4.00×10^-8, odds ratio [OR] = 2.05). Its association was replicated in a Chinese population (combined P = 6.43×10^-12, OR = 2.21). rs12946942 is on chromosome 17q24.3 near the genes SOX9 and KCNJ2, which when mutated cause scoliosis phenotypes. Our findings will offer new insight into the etiology and progression of AIS. © 2013 Miyake et al.

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Risk factors for lumbar disc degeneration in High School American Football Players

Nagashima Masaki, Abe Hitoshi, Amaya Kenji, Matsumoto Hideo, Yanaihara Hisashi, Nishiwaki Yuji, Toyama Yoshiaki, Matsumoto Morio

American Journal of Sports Medicine 41 ( 9 ) 2059 - 2064 2013.09

ISSN 0363-5465

Background: Several risk factors have been proposed for intervertebral disc degeneration (DD) among adolescent athletes. However, the causes of DD are not well understood, and there have been few prospective studies evaluating DD in adolescents. Purpose: To identify risk factors for DD among adolescent American football (AF) players. Study Design: Cohort study (prevalence); Level of evidence, 2. Methods: This study investigated the relationships between the progression of DD and the following factors: lumbar spine abnormalities on baseline radiographs, body mass index, AF position played (lineman or other), and length of playing career (2 full competitive AF seasons or<2 seasons). Included were 192 students who joined a top-ranked high school AF team from 2004 to 2008. Of these, 160 played for 2 full competitive AF seasons. The remaining 32 players, who stopped before completing 2 seasons, were used as a control group. Baseline radiographs and lumbar magnetic resonance imaging (MRI) scans were obtained when the players enrolled in the AF team in May, and follow-up lumbar MRI scans were obtained 2 years later at the end of their second academic year in March. Disc degeneration was measured by the signal intensity of the nucleus pulposus, and its progression was evaluated by multiple regression analysis of decreases in signal intensity. Also analyzed was the relationship between DD and low back pain (LBP). Results: The mean decrease in signal intensity of the nucleus pulposus was 4.30% ± 11.63% in players who completed 2 AF seasons and 1.41% ± 10.03% in those who did not (P = .12). Mean visual analog scale scores for LBP at follow-up were significantly higher (P = .001) in players who had played for 2 full seasons (2.67 ± 2.81) than in those with a shorter career (0.99 ± 1.61). Decreases in signal intensity of the nucleus pulposus after 2 years of playing AF related significantly to playing a lineman position (partial regression coefficient, 3.47%), the presence of Schmorl nodes (partial regression coefficient, 3.58%), and disc herniation (partial regression coefficient, 4.09%). Conclusion: Significant risk factors for DD progression in high school AF players included playing a lineman position, the presence of Schmorl nodes, and disc herniation. Continuing to play AF through 2 years of high school was a risk factor for the onset of LBP. © 2013 The Author(s).

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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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Optimal treatment for Spinal Cord Injury associated with cervical canal Stenosis (OSCIS)

Chikuda Hirotaka, Ohtsu Hiroshi, Ogata Toru, Sugita Shurei, Sumitani Masahiko, Koyama Yurie, Matsumoto Morio, Toyama Yoshiaki

Trials 14 ( 1 ) 2013.08

Background: The optimal management of acute cervical spinal cord injury (SCI) associated with preexisting canal stenosis remains to be established. The objective of this study is to examine whether early surgical decompression (within 24 hours after admission) would result in greater improvement in motor function compared with delayed surgery (later than two weeks) in cervical SCI patients presenting with canal stenosis, but without bony injury.Methods/design: OSCIS is a randomized, controlled, parallel-group, assessor-blinded, multicenter trial. We will recruit 100 cervical SCI patients who are admitted within 48 hours of injury (aged 20 to 79 years; without fractures or dislocations; American Spinal Injury Association (ASIA) grade C; preexisting spinal canal stenosis). Patients will be enrolled from 36 participating hospitals across Japan and randomly allocated in a 1:1 ratio to either early surgical decompression (within 24 hours after admission) or delayed surgery following at least two weeks of conservative treatment. The primary outcomes include: 1) the change from baseline to one year in the ASIA motor score; 2) the total score of the Spinal Cord Independence Measure and 3) the proportion of patients who are able to walk without human assistance. The secondary outcomes are: 1) the health-related quality of life as measured by the Medical Outcomes Study Short Form 36 and the EuroQol 5 Dimension; 2) the Neuropathic Pain Symptom Inventory and 3) the walking status as evaluated with the Walking Index for Spinal Cord Injury II. The analysis will be on an intention-to-treat basis. The primary analysis will be a comparison of the primary and secondary outcomes one year after the injury.Discussion: The results of this study will provide evidence of the potential benefit of early surgical decompression compared to the current 'watch and wait' strategy. © 2013 Chikuda et al.; licensee BioMed Central Ltd.

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A replication study for association of 53 single nucleotide polymorphisms in a scoliosis prognostic test with progression of adolescent idiopathic scoliosis in Japanese

Ogura Yoji, Takahashi Yohei, Kou Ikuyo, Nakajima Masahiro, Kono Katsuki, Kawakami Noriaki, Uno Koki, Ito Manabu, Minami Shohei, Yanagida Haruhisa, Taneichi Hiroshi, Yonezawa Ikuho, Tsuji Taichi, Suzuki Teppei, Sudo Hideki, Kotani Toshiaki, Watanabe Kota, Chiba Kazuhiro, Toyama Yoshiaki, Matsumoto Morio, Ikegawa Shiro

Spine 38 ( 16 ) 1375 - 1379 2013.07

ISSN 0362-2436

STUDY DESIGN.: A genetic association study of single nucleotide polymorphisms (SNPs) previously reported to be associated with curve progression of adolescent idiopathic scoliosis (AIS). OBJECTIVE.: To determine whether the association of 53 SNPs with curve progression reported in white patients with AIS are replicated in Japanese patients with AIS. SUMMARY OF BACKGROUND DATA.: Predicting curve progression is important in clinical practice of AIS. The progression of AIS is reported to be associated with a number of genes. Associations with 53 SNPs have been reported, and the SNPs are used for a progression test in white patients with AIS; however, there has been no replication study for their association. METHODS.: We recruited 2117 patients with AIS with 10 or more (Cobb angle) of scoliosis curves. They were divided into progression and nonprogression groups according to their Cobb angle. We defined the progression of the curve as Cobb angle more than 50 for skeletally mature subjects and more than 40 for immature patients, subjects. We defined the nonprogression of the curve as Cobb angle 50 or less only for skeletally mature subjects. Of the 2117 patients, 1714 patients with AIS were allocated to either the progression or nonprogression group. We evaluated the association of 53 SNPs with curve progression by comparing risk allele frequencies between the 2 groups. RESULTS.: We evaluated the progression (N = 600) and nonprogression (N = 1114) subjects. Their risk allele frequencies were not different significantly. We found no replication of the association on AIS curve progression in any of the SNPs. CONCLUSION.: The associations of the 53 SNPs with progression of AIS curve are not definite. Large-scale association studies based on appropriate criteria for progression would be necessary to identify SNPs associated with the curve progression. Copyright © 2013 Lippincott Williams & Wilkins.

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Genetic variants in GPR126 are associated with adolescent idiopathic scoliosis

Kou Ikuyo, Takahashi Yohei, Johnson Todd A., Takahashi Atsushi, Guo Long, Dai Jin, Qiu Xusheng, Sharma Swarkar, Takimoto Aki, Ogura Yoji, Jiang Hua, Yan Huang, Kono Katsuki, Kawakami Noriaki, Uno Koki, Ito Manabu, Minami Shohei, Yanagida Haruhisa, Taneichi Hiroshi, Hosono Naoya, Tsuji Taichi, Suzuki Teppei, Sudo Hideki, Kotani Toshiaki, Yonezawa Ikuho, Londono Douglas, Gordon Derek, Herring John A., Watanabe Kota, Chiba Kazuhiro, Kamatani Naoyuki, Jiang Qing, Hiraki Yuji, Kubo Michiaki, Toyama Yoshiaki, Tsunoda Tatsuhiko, Wise Carol A., Qiu Yong, Shukunami Chisa, Matsumoto Morio, Ikegawa Shiro

Nature Genetics 45 ( 6 ) 676 - 679 2013.06

ISSN 1061-4036

Adolescent idiopathic scoliosis (AIS) is the most common pediatric skeletal disease. We previously reported a locus on chromosome 10q24.31 associated with AIS susceptibility in Japanese using a genome-wide association study (GWAS) consisting of 1,033 cases and 1,473 controls. To identify additional AIS-associated loci, we expanded the study by adding X-chromosome SNPs in the GWAS and increasing the size of the replication cohorts. Through a stepwise association study including 1,819 cases and 25,939 controls, we identified a new susceptibility locus on chromosome 6q24.1 in Japanese (P = 2.25 × 10 ^-10; odds ratio (OR) = 1.28). The most significantly associated SNP, rs6570507, was in GPR126 (encoding G protein-coupled receptor 126). Its association was replicated in Han Chinese and European-ancestry populations (combined P = 1.27 × 10^-14; OR = 1.27). GPR126 was highly expressed in cartilage, and the knockdown of gpr126 in zebrafish caused delayed ossification of the developing spine. Our results should provide insights into the etiology and pathogenesis of AIS. © 2013 Nature America, Inc. All rights reserved.

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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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Modic changes of the cervical spine in patients with whiplash injury

Matsumoto Morio, Ichihara Daisuke, Okada Eijiro, Toyama Yoshiaki, Fujiwara Hirokazu, Momoshima Suketaka, Nishiwaki Yuji, Takahata Takeshi

Injury 44 ( 6 ) 819 - 824 2013.06

ISSN 0020-1383

Introduction: There are few studies on Modic changes of the cervical spine in patients suffering from whiplash. This study compared Modic changes seen in whiplash patients 10 years after the injury with those observed in asymptomatic volunteers. Methods: This is a follow-up study of 133 patients who suffered whiplash injuries in 1994-1996 and underwent MRI with a superconductive imager (63 men, 70 women, mean age 49.6 ± 15.3 years, mean follow-up 11.4 years). In addition, 223 healthy volunteers who underwent MRI during the same period were included as controls (123 men, 100 women, mean age 50.5 ± 15.0 years, mean follow-up 11.6 years). All participants underwent follow-up MRI. We examined all participants for Modic changes, and investigated relationships between Modic changes and clinical symptoms or potentially related factors. Results: Modic changes were observed in 4 patients (3%) and at 7 intervertebral levels in the initial study, and in 17 patients (12.8%) and at 30 intervertebral levels at the follow-up. Modic Type 2 changes were the most prevalent in the whiplash patients in both the initial and follow-up studies. There was no significant difference in the percentage of whiplash patients versus control subjects with positive Modic changes, either at the initial study or at follow-up. Modic changes were not related to clinical symptoms present at follow-up, but were associated with preexisting disc degeneration. There was no association between Modic changes and the details of the car accident that caused the injury. Conclusions: While Modic changes became more common in whiplash patients in the 10-year period after the accident, they occurred with a similar frequency in control subjects. We did not find any association between Modic changes and the nature of the car accident in which the whiplash occurred. Modic changes found in whiplash patients may be a result of the physiological ageing process rather than pathological findings relating to the whiplash injury. © 2012 Elsevier Ltd.

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Postoperative distal adding-on and related factors in Lenke type 1A curve

Matsumoto Morio, Watanabe Kota, Hosogane Naobumi, Kawakami Noriaki, Tsuji Taichi, Uno Koki, Suzuki Teppei, Ito Manabu, Yanagida Haruhisa, Yamaguchi Toru, Minami Shohei, Akazawa Tsutomu

Spine 38 ( 9 ) 737 - 744 2013.04

ISSN 0362-2436

Study Design: A retrospective, multicenter study. Objective: To investigate the occurrence of and factors related to postoperative adding-on in Lenke type 1A curve. Summary of Background Data: Although several studies have investigated factors associated with adding-on in Lenke type 1A curve, these factors have not been elucidated in a large study population. Methods: This study included 112 patients who were followed more than 2 years after undergoing selective posterior thoracic fusion surgery for Lenke Type 1A curve (8 males, 104 females; mean age at surgery, 16.1 yr; mean follow-up, 3.6 yr). The lower instrumented vertebra (LIV) was T12 in 22 patients, L1 in 55, L2 in 32, and L3 in 3. Distal to the main thoracic curve, the end vertebra, neutral vertebra, stable vertebra (SV), and the last vertebra touching the central sacral vertical line (last touching vertebra, LTV) were determined. The occurrence and factors associated with distal adding-on were investigated. Results: The mean Cobb angle and apical translation of the main thoracic curve were 54.6 ° ± 9.6 ° and 53.1 ± 20.4 mm before surgery, and 14.2 ± 7.4 and 16.2 ± 12.7 at follow-up, respectively. Distal adding-on was observed in 21 patients (18.8%) at follow-up. Univariate analyses identifi ed several factors signifi cantly associated with adding-on, including the preoperative proximal thoracic curve, the apical translation of the main thoracic curve, Miyanji's subclassifi cation, the postsurgical proximal and main thoracic curves, the postsurgical apical translation of the main thoracic curve, the correction rate of the main thoracic curve and the clavicle angle immediately after surgery and at follow-up, and the difference in levels between the LIV and the end vertebra, neutral vertebra, LTV, and stable vertebra. Logistic regression analysis showed that the apical translation of the main thoracic curve immediately after surgery (apical translation > 25 mm, odds ratio: 10.7, 95% confi dence interval: 3.1-37.0, P = 0.001) and the difference in levels between LIV and LTV (LIV-LTV) (LIV-LTV < 0, odds ratio: 6.7, 95% confi dence interval: 1.9-23.9, P = 0.003) were signifi cantly associated with adding-on. Conclusion: Since the residual apical translation of the main thoracic curve and the lowest instrumented vertebra more cranial to the last touching vertebra were signifi cantly associated with addingon, surgeons may need to obtain the maximum reduction of the apical translation of the main thoracic curve and to extend the LIV at least to the LTV to avoid postoperative adding-on. Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

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Risk factors for complications associated with growing-rod surgery for early-onset scoliosis

Watanabe Kota, Uno Koki, Suzuki Teppei, Kawakami Noriaki, Tsuji Taichi, Yanagida Haruhisa, Ito Manabu, Hirano Toru, Yamazaki Ken, Minami Shohei, Kotani Toshiaki, Taneichi Hiroshi, Imagama Shiro, Takeshita Katsushi, Yamamoto Takuya, Matsumoto Morio

Spine 38 ( 8 ) 2013.04

ISSN 0362-2436

STUDY DESIGN.: A retrospective multicenter study. OBJECTIVE.: To identify risk factors for postoperative complications associated with growing-rod (GR) surgery for early-onset scoliosis (EOS). SUMMARY OF BACKGROUND DATA.: Results and complications of GR surgery for EOS have not been adequately studied. METHODS.: We evaluated clinical and radiographical results from 88 patients with EOS who underwent GR surgery in 12 spine centers in Japan. The mean age at the time of initial surgery was 6.5 ± 2.2 years (range, 1.5-9.8 yr) and the mean follow-up period was 3.9 ± 2.6 years (range, 2.0-12.0 yr). Risk factors for postoperative complications were analyzed using binomial multiple logistic regression analysis. We considered the potential factors of sex, age, number of rod-lengthening procedures, whether a pedicle screw foundation was used, the uppermost level of the proximal foundation and lowermost level of the distal foundation, Cobb angles of the proximal thoracic, main thoracic, and lumbar curves, and the kyphosis angles in the proximal, main thoracic, thoracolumbar, and lumbar spine. Kaplan-Meier analysis was used to determine the complication-free survival rate of GR surgery as a function of the number of surgical procedures. RESULTS.: Complications affected 50 of the patients (57%) and were associated with 119 of 538 surgical procedures, with 86 implant-related failures (72%), 19 infections (16%), 3 neurological impairments (3%), and 11 other complications. The most frequent implant-related failure was dislodged implant (71%) and 95% of the dislodgements occurred at the proximal foundation. Kaplan-Meier analysis demonstrated a linear decrease in complication-free rates as the number of rod-lengthening procedures increased. Binomial multiple logistic regression analysis found the following significant independent risk factors: 6 or more rod-lengthening procedures (odds ratio [OR], 6.534), an increase of every 20 in the proximal thoracic Cobb angle (OR, 3.091), and an increase of every 25 in the lumbar lordosis angle (OR, 2.607) in the preoperative condition. CONCLUSION.: Increases in the upper thoracic scoliotic curve, thoracic kyphosis, and number of rod-lengthening procedures are positively associated with an increased risk of complications after GR surgery for EOS.Level of Evidence: 4 © 2013, Lippincott Williams & Wilkins.

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A replication study for association of 5 single nucleotide polymorphisms with curve progression of adolescent idiopathic scoliosis in japanese patients

Spine 38 ( 7 ) 571 - 575 2013.04

ISSN 0362-2436

STUDY DESIGN.: A genetic association study of single nucleotide polymorphisms (SNPs) previously reported to be associated with curve progression of adolescent idiopathic scoliosis (AIS). OBJECTIVE.: To determine whether the association of 5 SNPs with curve progression reported in Chinese with AIS are replicated in Japanese patients with AIS. SUMMARY OF BACKGROUND DATA.: AIS is a common spinal deformity and has a strong genetic predisposition. Predicting curve progression is important in clinical practice. The progression of AIS is reported to be associated with a number of genes. Associations with neurotrophin 3, G protein-coupled estrogen receptor, and tissue inhibitor of metalloproteinase 2 have been reported in Han Chinese with AIS; however, there has been no replication study for them. METHODS.: We recruited 2117 patients with AIS with a Cobb angle of 10 or greater of scoliosis curves. They were grouped into progression and nonprogression groups according to their scoliosis curves. Patients whose scoliotic curves were 40 or greater were included in the progression group, and those whose scoliotic curves were less than 30 and had reached skeletal maturation in the nonprogression group. We evaluated the association of 5 SNPs (rs11063714 in neurotrophin 3, rs3808351, rs10269151, and rs4266553 in G protein-coupled estrogen receptor, and rs8179090 in tissue inhibitor of metalloproteinase 2 with curve progression by comparing risk allele frequencies between the 2 groups and the mean Cobb angle for each genotype. RESULTS.: We evaluated the progression (N = 880) and nonprogression (N = 492) subjects, and their risk allele frequencies were not significantly different. The mean Cobb angle for each genotype also did not have statistical difference. We found no replication of the association on AIS curve progression in any of the SNPs. CONCLUSION.: The associations of the 5 SNPs with progression of AIS curve are not definite. Large-scale association studies based on appropriate criteria for progression would be necessary to identify SNPs associated with the curve progression. © 2013, Lippincott Williams & Wilkins.

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Short fusion strategy for lenke type 1 thoracic curve using pedicle screw fixation

Matsumoto Morio, Watanabe Kota, Ogura Yoji, Okada Eijiro, Hosogane Naobumi, Chiba Kazuhiro, Toyama Yoshiaki

Journal of Spinal Disorders and Techniques 26 ( 2 ) 93 - 97 2013.04

ISSN 1536-0652

STUDY DESIGN: A retrospective case-control study OBJECTIVE: Short fusion using pedicle screws (PSs) with an attempt to attain maximum correction of the main thoracic curve was conducted for patients with a Lenke type 1 curve, to prevent postoperative left shoulder elevation. The outcomes were compared with those of conventional surgery. SUMMARY OF BACKGROUND DATA: Excessive correction of the main thoracic curve by PSs causes problematic left shoulder elevation even in a Lenke type 1 curve. METHODS: Thirty-eight patients (3 male, 35 female, mean age 16.2 years, mean follow-up 24 mo) with Lenke type 1 curve underwent posterior corrective surgery using PSs. The upper instrumented vertebra was 1 level below the end vertebra in 14 patients (short, S group), and it was at the end vertebra in 24 patients (conventional, C group). There was no difference in the preoperative Cobb angle (51.8 vs. 58.0) or curve flexibility (49.7 vs. 46.1) between the 2 groups. Radiographic results, perioperative data, and scoliosis research society 22 scores were compared between the 2 groups. RESULTS: The postoperative Cobb angle of the main curve after surgery was 13.2±5.7 degrees in the S group and 10.6±7.3 degrees in the C group (not significant). The clavicle angle was -2.1±2.8 degrees versus -2.7±2.6 degrees before surgery (not significant), and 0.8±2.3 versus 3.8±2.4 after surgery (P<0.05). The number of fused vertebrae, mean surgical time, and estimated blood loss were significantly lower in the S group than in the C group. The scoliosis research society 22 score at follow-up was not different between the 2 groups. CONCLUSIONS: The short fusion strategy for a Lenke type 1 curve can produce equivalent correction of the main curve and clinical outcomes to conventional fusion strategy with less surgical time and blood loss, while maintaining better shoulder balance. Copyright © 2012 by Lippincott Williams & Wilkins.

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