Details of a Researcher - Matsumoto, Morio

Papers - Matsumoto, Morio

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Curve progression after decompression surgery in patients with mild degenerative scoliosis

Hosogane Naobumi, Watanabe Kota, Kono Hitoshi, Saito Masashi, Toyama Yoshiaki, Matsumoto Morio

Journal of Neurosurgery: Spine 18 ( 4 ) 321 - 326 2013.04

ISSN 1547-5654

Object. The authors undertook this study to evaluate curve progression, risk factors for curve progression, and outcomes after decompression surgery in patients with degenerative lumbar scoliosis with minimal to moderate curvature. Methods. Of 852 patients with lumbar canal stenosis treated by posterior decompression surgery, 50 patients had a lumbar curve greater than 10° at final follow-up. These patients were divided into 2 groups according to curve progression during the follow-up period: the P group (11 patients), with a curve progression of more than 5°, and the NP group (39 patients), with a curve progression of 5° or less. The authors compared preoperative parameters in these 2 groups to elucidate risk factors associated with curve progression and other surgical outcomes. Results. The average lumbar curve progression in the total group of 50 patients was 3.4° ± 3.9° (range -2.0° to 22.0°). In the P group the average curve progression was 8.5°, and in the NP group it was 2.0°. Multivariate logistic regression analysis showed no significant association between curve progression and any of the potential risk factors evaluated (including curve magnitude, decompression method, and degenerative intervertebral disc changes). Spur formation, evaluated with the Nathan classification at the concave side of the curve, tended to be greater in the P group, although the difference was not statistically significant. There was no significant difference in revision surgery rate, and none of the patients required arthrodesis due to curve progression. Clinical outcomes, evaluated with the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and the Scoliosis Research Society 22-question questionnaire, were also similar in the 2 groups. Conclusions. Surgical outcomes did not deteriorate in the P group. While curve progression after decompression surgery could not be predicted from the preoperative factors considered, spur formation at the concave side of the curve may be a candidate factor. The results of this study indicate that spinal fixation to halt deformity progression is not always necessary if the patient's pathological condition derives mainly from canal stenosis. Copyright © 1944-2012 American Association of Neurological Surgeons.

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Response

Hosogane Naobumi, Watanabe Kota, Kono Hitoshi, Saito Masashi, Toyama Yoshiaki, Matsumoto Morio

Journal of Neurosurgery: Spine 18 ( 4 ) 320 2013.04

ISSN 1547-5654

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Tandem age-related lumbar and cervical intervertebral disc changes in asymptomatic subjects

Matsumoto Morio, Okada Eijiro, Toyama Yoshiaki, Fujiwara Hirokazu, Momoshima Suketaka, Takahata Takeshi

European Spine Journal 22 ( 4 ) 708 - 713 2013.04

ISSN 0940-6719

Purpose To investigate the frequency of tandem lumbar and cervical intervertebral disc degeneration in asymptomatic subjects. Methods We evaluated magnetic resonance imaging (MRI) results from 94 volunteers (48 men and 46 women; mean age 48 years) for age-related intervertebral disc degeneration in the lumbar and cervical spine. Results MRI indicated degenerative changes in the lumbar spine in 79 subjects (84 %), with decreased disc signal intensity in 74.5 %, posterior disc protrusion in 78.7 %, anterior compression of the dura in 81.9 %, disc space narrowing in 21.3 %, and spinal canal stenosis in 12.8 %. These findings were more common in older subjects at caudal levels. MRI showed degenerative changes in both the lumbar and cervical spine in 78.7 % of the volunteers. Conclusions Degenerative findings in both the lumbar and cervical spine, suggesting tandem disc degeneration, was common in asymptomatic subjects. These results provide normative data for evaluating patients with degenerative lumbar and cervical disc diseases. © Springer-Verlag 2012.

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Curve progression. Response.

Hosogane Naobumi, Watanabe Kota, Kono Hitoshi, Saito Masashi, Toyama Yoshiaki, Matsumoto Morio

Journal of neurosurgery. Spine 18 ( 4 ) 320 2013.04

ISSN 1547-5654

Novel chelate-setting calcium-phosphate cements fabricated with wet-synthesized hydroxyapatite powder

Konishi Toshiisa, Horiguchi Yukiko, Mizumoto Minori, Honda Michiyo, Oribe Kazuya, Morisue Hikaru, Ishii Ken, Toyama Yoshiaki, Matsumoto Morio, Aizawa Mamoru

Journal of Materials Science: Materials in Medicine 24 ( 3 ) 611 - 621 2013.03

ISSN 0957-4530

The hydroxyapatite (HAp) powder preparation process was optimized to fabricate inositol phosphate-HAp (IP6-HAp) cement with enhanced mechanical properties. Starting HAp powders were synthesized via a wet chemical process. The effect of the powder preparation process on the morphology, crystallinity, median particle size, and specific surface area (SSA) of the cement powders was examined, together with the mechanical properties of the resulting cement specimens. The smallest crystallite and median particle sizes, and the highest SSA were obtained from ball-milling of as-synthesized HAp powder under wet conditions and then freeze-drying. IP6-HAp cement fabricated with this powder had a maximum compressive strength of 23.1 ± 2.1 MPa. In vivo histological studies using rabbit models revealed that the IP6-HAp cements were directly in contact with newly formed and host bones. Thus, the present chelate-setting HAp cement is promising for application as a novel paste-like artificial bone. © 2012 Springer Science+Business Media New York.

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Cervical intramedullary ependymoma masquerading as cervical spondylotic myelopathy on MRI analysis

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

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

ISSN 0949-2658

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

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

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

ISSN 1547-5654

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

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

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

Neurosurgery Quarterly 23 ( 1 ) 66 - 69 2013.02

ISSN 1050-6438

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

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The IRE1α-XBP1 pathway positively regulates parathyroid hormone (PTH)/PTH-related peptide receptor expression and is involved in PTH-induced osteoclastogenesis

Tohmonda Takahide, Yoda Masaki, Mizuochi Hiroshi, Morioka Hideo, Matsumoto Morio, Urano Fumihiko, Toyama Yoshiaki, Horiuchi Keisuke

Journal of Biological Chemistry 288 ( 3 ) 1691 - 1695 2013.01

ISSN 0021-9258

Background: XBP1 is a transcription factor that is activated by one of the ER stress sensors, IRE1. Results: XBP1 promotes the expression of PTH/PTH-related peptide receptor in osteoblasts and renders these cells responsive to PTH. Conclusion: The IRE1-XBP1 pathway indirectly regulates PTH-induced osteoclastogenesis. Significance: This study may be the first to reveal the potential link between ER stress sensors and the regulation of osteoclastogenesis. To address the "endoplasmic reticulum stress" triggered by the burden of protein synthesis, the unfolded protein response is induced during osteoblast differentiation. In this study, we show that the transcription of parathyroid hormone (PTH)/PTH-related peptide receptor (PTH1R) is regulated by one of the endoplasmic reticulum-stress mediators, the IRE1α-XBP1 pathway, in osteoblasts. We found that the increase in Pth1r transcription upon BMP2 treatment is significantly suppressed in mouse embryonic fibroblasts lacking IRE1α. As expected, gene silencing of Ire1α and Xbp1 resulted in a decrease in Pth1r transcripts in BMP2-treated embryonic fibroblasts. We identified two potential binding sites for XBP1 in the promoter region of Pth1r and found that XBP1 promotes the transcription of Pth1r by directly binding to those sites. Moreover, we confirmed that the gene silencing of Xbp1 suppresses PTH-induced Rankl expression in primary osteoblasts and thereby abolishes osteoclast formation in an in vitro model of osteoclastogenesis. Thus, the present study reveals potential involvement of the IRE1-XBP1 pathway in PTH-induced osteoclastogenesis through the regulation of PTH1R expression. © 2013 by The American Society for Biochemistry and Molecular Biology, Inc.

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Systemic Overexpression of TNFα-converting Enzyme Does Not Lead to Enhanced Shedding Activity In Vivo

Yoda Masaki, Kimura Tokuhiro, Tohmonda Takahide, Morioka Hideo, Matsumoto Morio, Okada Yasunori, Toyama Yoshiaki, Horiuchi Keisuke

PLoS ONE 8 ( 1 ) 2013.01

TNFα-converting enzyme (TACE/ADAM17) is a membrane-bound proteolytic enzyme with a diverse set of target molecules. Most importantly, TACE is indispensable for the release and activation of pro-TNFα and the ligands for epidermal growth factor receptor in vivo. Previous studies suggested that the overproduction of TACE is causally related to the pathogenesis of inflammatory diseases and cancers. To test this hypothesis, we generated a transgenic line in which the transcription of exogenous Tace is driven by a CAG promoter. The Tace-transgenic mice were viable and exhibited no overt defects, and the quantitative RT-PCR and Western blot analyses confirmed that the transgenically introduced Tace gene was highly expressed in all of the tissues examined. The Tace-transgenic mice were further crossed with Tace^-/+ mice to abrogate the endogenous TACE expression, and the Tace-transgenic mice lacking endogenous Tace gene were also viable without any apparent defects. Furthermore, there was no difference in the serum TNFα levels after lipopolysaccharide injection between the transgenic mice and control littermates. These observations indicate that TACE activity is not necessarily dependent on transcriptional regulation and that excess TACE does not necessarily result in aberrant proteolytic activity in vivo. © 2013 Yoda et al.

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Long-term surgical outcomes of cervical dumbbell neurinomas

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

Journal of Orthopaedic Science 18 ( 1 ) 8 - 13 2013.01

ISSN 0949-2658

Study design: Retrospective case series. Objective: To evaluate our treatment strategy for cervical dumbbell neurinoma. Summary of background data: In treating cervical dumbbell neurinoma, possible difficulties include reoperation due to recurrent tumor, denervation due to nerve root resection, and postoperative spinal deformity due to extensive bony removal. Methods: We reviewed 75 cases of cervical dumbbell neurinoma that were treated surgically between 1985 and 2006. Postoperative neurological deficits, effects of surgical margins on tumor recurrence, and surgical complications were investigated retrospectively. Results: Sensory and motor deficits due to resection of specific nerve roots appeared temporarily in 33 and 23 % of all cases, and persisted in 8 and 8 % at final evaluation, respectively. Total, subtotal, and partial resection was performed in 57, 13, and 5 cases, respectively. The total resection rate was low in the tumors that had large extraforaminal components. Of the subtotally resected 13 cases, only two cases of high tumor-growth rate required re-operation or showed tumor growth. Among the five partially resected cases, re-operation was necessary in two cases 13 and 15 years later because of aggravated neurological symptoms due to tumor growth. Two patients who underwent C2 laminectomy developed kyphosis, and three patients who underwent facet joint resection and curettage of vertebral body lesions developed scoliosis. Conclusion: Total resection should be attempted for cervical dumbbell tumors. In cases where total resection was potentially of high risk, however, subtotal resection (within the capsule) was found to be a practical choice yielding favorable long-term outcome when the tumor growth rate (MIB-1 index) was low. © 2012 The Japanese Orthopaedic Association.

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A genome-wide sib-pair linkage analysis of Ossification of the posterior longitudinal ligament of the spine

Karasugi Tatsuki, Nakajima Masahiro, Ikari Katsunori, Tsuji Takashi, Matsumoto Morio, Chiba Kazuhiro, Uchida Kenzo, Kawaguchi Yoshiharu, Mizuta Hiroshi, Ogata Naoshi, Iwasaki Motoki, Maeda Shingo, Numasawa Takuya, Abumi Kuniyoshi, Kato Tsuyoshi, Ozawa Hiroshi, Taguchi Toshihiko, Kaito Takashi, Neo Masashi, Yamazaki Masashi, Tadokoro Nobuaki, Yoshida Munehito, Nakahara Shinnosuke, Endo Kenji, Imagama Shiro, Demura Satoru, Sato Kimiaki, Seichi Atsushi, Ichimura Shoichi, Watanabe Masahiko, Watanabe Kei, Nakamura Yutaka, Mori Kanji, Baba Hisatoshi, Toyama Yoshiaki, Ikegawa Shiro

Journal of Bone and Mineral Metabolism 31 ( 2 ) 136 - 143 2013

ISSN 0914-8779

Ossification of the posterior longitudinal ligament of the spine (OPLL) is a common musculoskeletal disease among people after middle age. The OPLL presents with serious neurological abnormalities due to compression of the spinal cord and nerve roots. The OPLL is caused by genetic and environment factors; however, its etiology and pathogenesis still remain to be elucidated. To determine the susceptibility loci for OPLL, we performed a genome-wide linkage study using 214 affected sib-pairs of Japanese. In stratification analyses for definite cervical OPLL, we found loci with suggestive linkage on 1p21, 2p22-2p24, 7q22, 16q24 and 20p12. Fine mapping using additional markers detected the highest non-parametric linkage score (3.43, P = 0.00027) at D20S894 on chromosome 20p12 in a subgroup that had no complication of diabetes mellitus. Our result would shed a new light on genetic aspects of OPLL. © The Japanese Society for Bone and Mineral Research and Springer Japan 2012.

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Fabrication of novel biodegradable α-tricalcium phosphate cement set by chelating capability of inositol phosphate and its biocompatibility

Konishi Toshiisa, Mizumoto Minori, Honda Michiyo, Horiguchi Yukiko, Oribe Kazuya, Morisue Hikaru, Ishii Ken, Toyama Yoshiaki, Matsumoto Morio, Aizawa Mamoru

Journal of Nanomaterials 2013 2013

ISSN 1687-4110

Biodegradable α-tricalcium phosphate (α-TCP) cement based on the chelate-setting mechanism of inositol phosphate (IP6) was developed. This paper examined the effect of the milling time of α-TCP powder on the material properties of the cement. In addition, biocompatibility of the result cement in vitro using osteoblasts and in vivo using rabbit models will be studied as well. The α-TCP powders were ballmilled using ZrO₂ beads in pure water for various durations up to 270 minutes, with a single-phase α-TCP obtained at ballmilling for 120 minutes. The resulting cement was mostly composed of α-TCP phase, and the compressive strength of the cement was 8.5±1.1 MPa, which suggested that the cements set with keeping the crystallite phase of starting cement powder. The cell-culture test indicated that the resulting cements were biocompatible materials. In vivo studies showed that the newly formed bones increased with milling time at a slight distance from the cement specimens and grew mature at 24 weeks, and the surface of the cement was resorbed by tartrate-resistant acid phosphatase-(TRAP-)positive osteoclast-like cells until 24 weeks of implantation. The present α-TCP cement is promising for application as a novel paste-like artificial bone with biodegradability and osteoconductivity. © 2013 Toshiisa Konishi et al.

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Metastasis of intracranial meningeal hemangiopericytoma to thoracic spine 17 years after surgical excision

Fukuda Yoshitsugu, Watanabe Kota, Toyama Yoshiaki, Mikami Shuji, Matsumoto Morio

Journal of Orthopaedic Science 1 - 5 2013

ISSN 0949-2658

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Recurrence of lumbar disc herniation after microendoscopic discectomy

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

Journal of Neurological Surgery, Part A: Central European Neurosurgery 74 ( 4 ) 222 - 227 2013

ISSN 2193-6315

Background Although microendoscopic discectomy (MED) is a minimally invasive surgical method for lumbar disc herniation (LDH), early postoperative recurrence may outweigh that advantage. The purpose of the present study was to retrospectively investigate the recurrence rate after MED for LDH and to determine the risk factors for recurrence in patients treated by a single surgeon. Materials and Methods The study included 344 patients who underwent MED (213 males and 131 females; mean age, 39.3 years; age range, 11-82 years; mean follow-up, 3.6 years; follow-up range, 2.0-6.5 years). The clinical outcomes were evaluated using the Japanese Orthopedic Association Score for Low Back Pain (JOA score). Recurrence factors investigated by logistic regression analysis included age; sex; level, laterality, and classified type of LDH; occupation; sports activity; and learning curve of the surgeon. Results LDH recurrence was observed in 37 patients (10.8%). It was observed at the same level in the ipsilateral side as the original LDH in 30 patients, in the contralateral side in three patients, and at a level adjacent to the original level in four patients. The mean time interval between MED and the recurrence was 16.6 months (range, 0.5-52 months). Twenty patients (54.1%) developed recurrence within 1 year after MED. Twenty-two patients (59.5%) were treated by revision surgery (MED in 20 patients and microdiscectomy in two patients), and 15 patients (40.5%) were treated conservatively. The mean JOA score of all the patients was 14.7 ± 3.5 before surgery and 26.5 ± 2.2 at the final follow-up, yielding an average recovery rate of 82.3 ± 15.7%. The recovery rate was 83.1 ± 14.8% in patients without recurrence and 75.7 ± 20.4% in patients with recurrence (p = 0.006). By logistic regression analysis, we identified migration of LDH as a significant factor related to recurrence. The patients with caudal migration of LDH had recurrence more frequently (19.0%) than those with rostral migration (12.5%) or without migration (10.2%) (p = 0.04; odds ratio, 2.0; 95% confidence interval, 1.0-3.8). Conclusion The recurrence rate and reoperation rate for LDH after MED were comparable to those of conventional discectomy. More than half of the cases of recurrence occurred at an early postoperative phase, and patients with caudally migrated LDH experienced recurrence significantly more often than those with rostrally migrated or nonmigrated LDH. ©2013 Georg Thieme Verlag KG Stuttgart, New York.

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Acute respiratory failure due to hemothorax after posterior correction surgery for adolescent idiopathic scoliosis

Ogura Yoji, Watanabe Kota, Hosogane Naobumi, Toyama Yoshiaki, Matsumoto Morio

BMC Musculoskeletal Disorders 14 2013

Background: Although posterior correction and fusion surgery using pedicle screws carries the risk of vascular injury, a massive postoperative hemothorax in a patient with adolescent idiopathic scoliosis (AIS) is quite rare. We here report a case of a 12-year-old girl with AIS who developed a massive postoperative hemothorax. Case presentation. The patient had a double thoracic curve with Cobb angles of 63° at T2-7 and 54° at T7-12. Posterior correction and fusion surgery was performed using a segmental pedicle screw construct placed between T2 and T12. Although the patient's respiration was stable during the surgery, 20 minutes after removing the trachea tube, the patient's pulse oximetry oxygen saturation suddenly decreased to 80%. A contrast CT scan showed a massive left hemothorax, and a drainage tube was quickly inserted into the chest. The patient was re-intubated and a positive end-expiratory pressure of 5 cmH§ssub§2§esub§O applied, which successfully stopped the bleeding. The patient was extubated 4 days after surgery without incident. Based on contrast CT scans, it was suspected that the hemothorax was caused by damage to the intercostal arteries or branches during pedicle probing on the concave side of the upper thoracic curve. Extensive post-surgical blood tests, echograms, and CT and MRI radiographs did not detect coagulopathy, pulmonary or vascular malformation, or any other possible causative factors. Conclusion: This case underscores the potential risk of massive hemothorax related to thoracic pedicle screw placement, and illustrates that for this serious complication, respiratory management with positive airway pressure, along with a chest drainage tube, can be an effective treatment option. © 2013 Ogura et al.; licensee BioMed Central Ltd.

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Surgical correction of severe kyphoscoliosis resulting in a neurological complication in Marshall-Smith syndrome

Cao Kai, Watanabe Kota, Hosogane Naobumi, Toyama Yoshiaki, Matsumoto Morio

Journal of Orthopaedic Science 1 - 4 2013

ISSN 0949-2658

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Comparative study on bioresorbability of chelate-setting cements with various calcium-phosphate phase using rabbit model

Konishi Toshiisa, Takahashi Shuhei, Mizumoto Minori, Honda Michiyo, Kida Koki, Horiguchi Yukiko, Oribe Kazuya, Ishii Ken, Morisue Hikaru, Toyama Yoshiaki, Matsumoto Morio, Aizawa Mamoru

167 - 172 2013

We have developed novel calcium-phosphate cements (CPCs) based on the chelate-setting mechanism of inositol phosphate (IP6) using hydroxyapatite (HAp), β-tricalcium phosphate (β-TCP) and α-TCP as starting materials. These cements (IP6-HAp, IP6-β-TCP and IP6-α-TCP cements) have different bioresorbability due to the chemical composition of starting materials. In the present study, biocompatibility and bioresorbability of the above three cements and commercially available cement (BiopexR-R) was histologically evaluated in vivo using rabbit model for 4, 8, and 24 weeks, in addition to their dissolution in vitro. The dissolution of these cements increased in the order of IP6-HAp, IP6-β-TCP and IP6-α-TCP cements. The newly-formed bones were directly in contact with both the IP6-HAp and BiopexR-R cement specimens. As for the IP6-β-TCP and IP6-α-TCP cements, newly-formed bones were formed time-dependently slightly apart from the cement specimens. Resorption rate for BiopexR-R, IP6-HAp, IP6-β-TCP, and IP6-α-TCP cements after 24 weeks implantation were of 7.2, 5.0, 13.7, and 16.2%, respectively, compared to original cements. The present chelate-setting cements with different bioresorbability are promising candidates for application as the novel CPCs. © (2013) Trans Tech Publications, Switzerland.

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Comparison of stainless steel and titanium alloy instruments in posterior correction and fusion surgery for adolescent idiopathic scoliosis-prospective cohort study with minimum 2-year follow-up

Okada Eijiro, Watanabe Kota, Hosogane Naobumi, Shiono Yuta, Takahashi Yohei, Nishiwaki Yuji, Chiba Kazuhiro, Toyama Yoshiaki, Matsumoto Morio

Journal of Medical and Biological Engineering 33 ( 3 ) 325 - 330 2013

ISSN 1609-0985

This prospective study compares the radiographic and clinical results of posterior correction and fusion surgery for adolescent idiopathic scoliosis (AIS) using stainless steel and titanium alloy instruments. The subjects consisted of 65 AIS patients who underwent posterior correction and fusion surgeries using a 5.5-mm-diameter rod at a single institution. Of these, 27 patients were treated using stainless steel instruments (S group) and 38 were treated using titanium alloy instruments (T group). The mean age at the time of surgery was 14.4 ± 3.5 years. The radiographic findings, intra-operative time, estimated blood loss, perioperative complications, and SRS-22 (a patient questionnaire used in the clinical evaluation of idiopathic scoliosis outcomes) were examined. The mean preoperative Cobb angle of the major curve was 62.5 ± 17.2° in the S group and 57.8 ± 13.2° in the T group (p = 0.407). Postoperatively, the curves were corrected to 11.2 ± 10.5° and 10.3 ± 8.5° (p = 0.384), with mean correction rates of 83.4 ± 12.2% and 83.1 ± 11.6% (p = 0.940), respectively. At the final follow-up, although the mean correction loss was slightly larger in the S group (4.4 ± 5.2°) compared with that in the T group (2.3 ± 5.5°), the values were not significantly different (p = 0.118). The coronal balance and sagittal balance were also not significantly different between the two groups at the final follow-up. The function, pain, and mental health sub-scores and the total score for SRS-22 show a tendency for better outcomes in the T group; however, there were no significant differences between the two groups. Thus, there was no statistical difference in radiographical and clinical outcomes between AIS patients treated surgically using stainless steel instruments and those treated using titanium alloy instruments.

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Morphometric analysis of the lumbar intervertebral foramen in patients with degenerative lumbar scoliosis by multidetector-row computed tomography

Kaneko Yasuhito, Matsumoto Morio, Takaishi Hironari, Nishiwaki Yuji, Momoshima Suketaka, Toyama Yoshiaki

European Spine Journal 21 ( 12 ) 2594 - 2602 2012.12

ISSN 0940-6719

Purpose: How the lumbar neural foramina are affected by segmental deformities in patients in whom degenerative lumbar scoliosis (DLS) is unknown. Here, we used multidetector-row computed tomography (MDCT) to measure the morphology of the foramina in three dimensions, which allowed us to elucidate the relationships between foraminal morphology and segmental deformities in DLS. Methods: In 77 DLS patients (mean age, 69.4) and 19 controls (mean age, 69), the foraminal height (FH), foraminal width (FW), posterior disc height (PDH), interval between the pedicle and superior articular process (P-SAP), and cross-sectional foraminal area (FA) were measured on reconstructed MDCT data, using image-editing software, at the entrance, minimum-area point, and exit of each foramen. The parameters of segmental deformity included the intervertebral wedging angle and anteroposterior and lateral translation rate, measured on radiographs, and the vertebral rotation angle, measured using reconstructed MDCT images. Results: The FH, PDH, P-SAP, and FA were smaller at lower lumbar levels and on the concave side of intervertebral wedging (p < 0.05). In the DLS patients, the FH, P-SAP, and FA were significantly smaller than for the control group at all three foraminal locations and every lumbar level (p < 0.05). Intervertebral wedging strongly decreased the FA of the concave side (p < 0.05). Anteroposterior translation caused the greatest reduction in P-SAP (p < 0.05). Vertebral rotation decreased the P-SAP and FA at the minimum-area point on the same side as the rotation (p < 0.05). Conclusion: The new analysis method proposed here is useful for understanding the pathomechanisms of foraminal stenosis in DLS patients. © 2012 Springer-Verlag.

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