Details of a Researcher - Matsumoto, Morio

Papers - Matsumoto, Morio

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Primary primitive neuroectodermal tumor of the conus medullaris in an elderly patient

Shimosawa H., Matsumoto M., Yabe H., Mukai M., Toyama Y., Morioka H.

Case Reports in Oncology 4 ( 2 ) 267 - 274 2011.05

Primary spinal primitive neuroectodermal tumors (PNETs) are very rare conditions. Most of these tumors occur in children and young adults. A 63-year-old man with a primary spinal PNET in the conus medullaris from the L1 to L2 level is presented in this report. The optimal treatment of primary spinal PNETs is yet unknown. Surgical resection, radiation therapy, and chemotherapy have been advocated for the treatment of spinal PNET based on PNETs at other sites. However, the outcome is very poor. There are a few reports of cases with long-term survival and no recurrence. In these patients, en bloc resections were performed. Copyright © 2011 S. Karger AG, Basel.

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A rare case of spinal dumbbell tanycytic ependymoma

Ishihama Hiroko, Nakamura Masaya, Funao Hiroki, Ishii Ken, Matsumoto Morio, Toyama Yoshiaki, Chiba Kazuhiro

Spine 36 ( 9 ) 2011.04

ISSN 0362-2436

Study Design.: Case report. OBJECTIVE:: To report an extremely rare case of spinal dumbbell-type tanycyticependymoma. Summary of Background Data.: Only two previous cases of a dumbbell-type tanycyticependymoma in the spinal cordhave been reported. Methods.: A 40-year-old female presented with low back pain and numbness of the left leg. Magnetic resonance imaging revealed a dumbbell tumor at the Th10-11 level that compressed the spinal cord extensively. The diagnosis of extradural dumbell spinal tumor was made, and a total tumor excision was performed with a thoracic 10-11 laminectomy. Results.: After surgery, the patient's low back pain and numbness disappeared. Detailed immunohistological examinations confirmed the diagnosis of tanycyticependymoma. At 16 months, there was no evidence of tumor recurrence and no further treatment was needed. Conclusion.: A rare case of spinal dumbbell-type tanycyticependy-moma was presented. Detailed histologic examinations are essential to differentiate tanycyticependymoma from other tumors such as schwannoma and pilocyticastrocytoma. © 2011, Lippincott Williams & Wilkins.

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Kyphectomy for severe kyphosis with pyogenic spondylitis associated with myelomeningocele

Yoshioka Kenji, Watanabe Kota, Toyama Yoshiaki, Chiba Kazuhiro, Matsumoto Morio

Scoliosis 6 ( 1 ) 2011.04

A 32-year-old woman was referred to our hospital for a refractory ulcer on her back. She had a history of myelomeningocele with spina bifida that was treated surgically at birth. The ulcer was located at the apex of the kyphosis. An X-ray film revealed a kyphosis of 154° between L1 and 3 and a scoliosis of 60° between T11 and L5. Computed tomography, magnetic resonance imaging and laboratory data indicated the presence of a pyogenic spondylitis at L2/3. To correct the kyphosis and remove the infected vertebrae together with the skin ulcer, kyphectomy was performed. Pedicle screws were inserted from T8 to T12 and from L4 to S1. The dural sac was transected and ligated at L2, followed by total kyphectomy of the L1-L3 vertebrae. The spinal column was reconstructed by approximating the ventral wall of the T12 vertebral body and the cranial endplate of the L4 vertebra. Postoperatively, the kyphosis was corrected to 61° and the scoliosis was corrected to 22°. In the present case, we treated the skin ulcer and pyogenic spondylitis successfully by kyphectomy, thereby, preventing recurrence of the ulcer and infection, and simultaneously obtaining sufficient correction of the spinal deformity. © 2011 Yoshioka et al; licensee BioMed Central Ltd.

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Disc degeneration of cervical spine on MRI in patients with lumbar disc herniation

Okada Eijiro, Matsumoto Morio, Fujiwara Hirokazu, Toyama Yoshiaki

European Spine Journal 20 ( 4 ) 585 - 591 2011.04

ISSN 0940-6719

An association between progression of cervical disc degeneration and that of lumbar disc degeneration has been considered to exist. To date, however, this association has not yet been adequately studied. Age-related changes in the cervical intervertebral discs were evaluated by magnetic resonance imaging (MRI) in patients with lumbar disc herniation, and compared with the MRI findings of healthy volunteers without lower back pain. The purpose of this study was to clarify whether the prevalence of asymptomatic cervical disc degeneration is higher in patients with lumbar disc herniation than in healthy volunteers. The study was conducted on 51 patients who were diagnosed as having lumbar disc herniation and underwent cervical spine MRI. The patients consisted of 34 males and 17 females ranging in age from 21-83 years (mean 46.9 ± 14.5 years) at the time of the study. The control group was composed of 113 healthy volunteers (70 males and 43 females) aged 24-77 years (mean 48.9 ± 14.7 years), without neck pain or low back pain. The percentage of subjects with degenerative changes in the cervical discs was 98.0% in the lumbar disc herniation group and 88.5% in the control group (p = 0.034). The presence of lumbar disc herniation was associated significantly with decrease in signal intensity of intervertebral disc and posterior disc protrusion in the cervical spine. None of the MRI findings was significantly associated with the gender, smoking, sports activities, or BMI. As compared to healthy volunteers, patients with lumbar disc herniation showed a higher prevalence of decrease in signal intensity of intervertebral disc and posterior disc protrusion on MRI of the cervical spine. The result of this study suggests that disc degeneration appears to be a systemic phenomenon. © Springer-Verlag 2010.

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Wedging of vertebral bodies at the thoracolumbar junction in asymptomatic healthy subjects on magnetic resonance imaging

Matsumoto Morio, Okada Eijiro, Kaneko Yasuhito, Ichihara Daisuke, Watanabe Kota, Chiba Kazuhiro, Toyama Yoshiaki, Fujiwara Hirokazu, Momoshima Suketaka, Nishiwaki Yuji, Hashimoto Takeshi, Takahata Takeshi

Surgical and Radiologic Anatomy 33 ( 3 ) 223 - 228 2011.04

ISSN 0930-1038

Purpose: Wedging of the vertebral body on radiological examination is a valuable indicator of a vertebral compression fracture, although it can also be observed in subjects with no history of trauma. The purpose of this study was to elucidate the normative value of vertebral wedging at the thoracolumbar junction in asymptomatic healthy subjects for differential diagnosis of vertebral compression fractures using MRI. Methods: A total of 115 subjects without back pain at the time of the examination and without history of spinal trauma was included (68 males, 47 females, mean age 49.5 years). They underwent MRI of the thoracic and lumbar spine, and the ratio of anterior vertical height to posterior vertical height of the vertebral body (APR) was determined from T10 to L2 on T2 weighted sagittal images. Results: APR was 0.92 ± 0.08 at T10, 0.92 ± 0.08 at T11, 0.90 ± 0.06 at T12, 0.89 ± 0.06 at L1, and 0.90 ± 0.07 at L2, indicating that vertebral bodies at the thoracolumbar junction appear wedge-shaped rather than rectangular. Males, thinner subjects, smokers, and subjects with abnormalities of the endplates such as a Schmorl nodule had a significantly smaller APR than females, fatter subjects, non-smokers, and those without endplate abnormalities. Conclusion: The normative values of APR obtained in the present study can represent a valuable reference in the diagnosis of vertebral compression fracture to help prevent confusion with physiological vertebral wedging. © 2010 Springer-Verlag.

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Severe progressive scoliosis due to huge subcutaneous cavernous hemangioma

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

Scoliosis 6 ( 1 ) 2011.03

Cavernous hemangioma consists mainly of congenital vascular malformations present before birth and gradually increasing in size with skeletal growth. A small number of patients with cavernous hemangioma develop scoliosis, and surgical treatment for the scoliosis in such cases has not been reported to date. Here we report a 12-year-old male patient with severe progressive scoliosis due to a huge subcutaneous cavernous hemangioma, who underwent posterior correction and fusion surgery. Upon referral to our department, radiographs revealed a scoliosis of 85° at T6-L1 and a kyphosis of 58° at T4-T10. CT and MR images revealed a huge hemangioma extending from the subcutaneous region to the paraspinal muscles and the retroperitoneal space and invading the spinal canal. Posterior correction and fusion surgery using pedicle screws between T2 and L3 were performed. Massive hemorrhage from the hemangioma occurred during the surgery, with intraoperative blood loss reaching 2800 ml. The scoliosis was corrected to 59°, and the kyphosis to 45° after surgery. Seven hours after surgery, the patient suffered from hypovolemic shock and disseminated intravascular coagulation due to postoperative hemorrhage from the hemangioma. The patient developed sensory and conduction aphasia caused by cerebral hypoxia during the shock on the day of the surgery. At present, two years after the surgery, although the patient has completely recovered from the aphasia. This case illustrates that, in correction surgery for scoliosis due to huge subcutaneous cavernous hemangioma, intraoperative and postoperative intensive care for hemodynamics should be performed, since massive hemorrhage can occur during the postoperative period as well as the intraoperative period.© 2011 Ogura et al; licensee BioMed Central Ltd.

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Surgical treatment for scoliosis in patients with Shprintzen-Goldberg syndrome

Watanabe Kota, Okada Eijiro, Kosaki Kenjiro, Tsuji Takashi, Ishii Ken, Nakamura Masaya, Chiba Kazuhiro, Toyama Yoshiaki, Matsumoto Morio

Journal of Pediatric Orthopaedics 31 ( 2 ) 186 - 193 2011.03

ISSN 0271-6798

Background: Shprintzen-Goldberg syndrome (SGS) is characterized by craniosynostosis and marfanoid habitus. The clinical findings of SGS include neurological, cardiovascular, connective tissue, and skeletal abnormalities. Among these skeletal findings, developmental scoliosis is recognized in half of all patients with SGS. However, no earlier reports have described the surgical treatment of scoliosis associated with SGS. Methods: Four patients (2 boys and 2 girls; mean age at the time of surgery, 7.3±4.4 y) with SGS who underwent surgical treatment for progressive scoliosis were reviewed. The radiologic findings, operative findings, and perioperative complications were evaluated. Results: The mean preoperative Cobb angle was 102.8±16.9 degrees. The curve patterns were a double curve in 2 cases and a triple curve in 2 cases. Local kyphosis at the thoracolumbar area was recognized in all the cases with a mean kyphosis angle of 49±16 degrees. Growing rod procedures were performed in 2 patients, and posterior correction and fusion were performed in 2 patients. The mean correction rate was 45% in the patients who underwent the growing rod procedures at the time of growing rod placement and 51% in the patients who underwent posterior correction and fusion. Dislodgement of the proximal anchors occurred in 3 of the 4 patients. One patient developed pseudoarthrosis. Two patients developed deep wound infections, and implant removal was necessary in 1 patient. Conclusions: Surgical treatment for scoliosis in patients with SGS was associated with a high incidence of perioperative and postoperative complications including implant dislodgements and deep wound infections attributable to poor bone quality and a thin body habitus, which are characteristic clinical features of this syndrome. Careful preoperative surgical planning and postoperative care are critical for the surgical treatment of scoliosis associated with SGS, especially in infants requiring multiple surgeries. Level of evidence: Level IV. © 2011 by Lippincott Williams & Wilkins.

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Remodeling of C2 facet deformity prevents recurrent subluxation in patients with chronic atlantoaxial rotatory fixation

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

Spine 36 ( 4 ) 2011.02

ISSN 0362-2436

Study Design. A retrospective case series. Objective. To propose a novel treatment strategy for chronic atlantoaxial rotatory fixation (AARF). Summary Of Background Data. Treatment strategy for chronic or recurrent AARF remains controversial. We have previously reported that a deformity of the superior facet of the axis (C2 facet deformity), which is frequently observed in patients with chronic AARFs, is a risk factor for recurrent dislocation. In this article, we report seven consecutive cases of chronic AARF who underwent closed manipulation followed by external halo fixation and maintained good reduction with the remodeling of the C2 facet deformity. Methods. Seven girls with a chronic AARF who sustained torticollis for an average of 4.6 months after the onset were referred to our clinic. Closed manipulation by careful manipulation under general anesthesia followed by external immobilization with a halo vest was performed in all cases. Radiographic findings and clinical courses were retrospectively reviewed with approvals by the institutional review board. Results. Three-dimensional computed tomography images before reduction revealed persistent atlantoaxial subluxation and the C2 facet deformity in the dislocated side in all cases. Follow-up three-dimensional computed tomographic scans demonstrated the remodeling of the C2 facet deformity at an average of 2.8 months after successful reduction of subluxation. Subsequently, the halo vests were removed and gentle neck range of motion exercise was started in all cases. The normal cervical range of motion was obtained 2 weeks after the removal of halo vests in five cases, whereas the range of motion remained limited in two cases. At a mean follow-up of 17.4 months, neither symptoms nor recurrence of subluxation occurred in all cases. Conclusion. Chronic irreducible and recurrent unstable AARF can be managed successfully by careful closed manipulation followed by halo fixation, if the C1 and C2 have not been osseously fused. The remodeling of the C2 facet deformity detected on follow-up CT scans can be a useful radiographic parameter to determine the appropriate period of halo fixation in this new treatment strategy obviating the need for surgical intervention. Copyright © 2011 Lippincott Williams & Wilkins.

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Interpedicular graft using a titanium mesh cage in a patient with lumbar scoliosis associated with a congenital butterfly vertebra

Cui Guanyu, Watanabe Kota, Ishii Ken, Toyama Yoshiaki, Chiba Kazuhiro, Matsumoto Morio

Journal of Neurosurgery: Spine 14 ( 2 ) 215 - 218 2011.02

ISSN 1547-5654

A butterfly vertebra is a congenital anomaly often associated with a series of syndromic diseases and is often recognized incidentally without any presenting symptoms. The authors report the case of a 13-year-old girl with lumbar scoliosis and mild spondylolisthesis associated with a butterfly vertebra at L-6 causing radiculopathy. The L-5 and L-6 nerve roots were entrapped at the intervertebral foramina between L-5 and the butterfly vertebra (L-6) and between L-6 and S-1 in the concave side. To decompress and preserve the two nerve roots, correct the deformity, and obtain a solid bone fusion, surgery involving the thorough removal of the facet joints between L-5 and L-6 and between L-6 and S-1 in the concave side was performed, with a partial resection of the butterfly vertebra and the placement of a titanium mesh cage between the L-5 and S-1 pedicles dorsal to the nerve roots. Complete pain relief and correction of the deformity with solid bone fusion was obtained after a 2-year follow-up period.

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Reduced postoperative wound pain after lumbar spinous process-splitting laminectomy for lumbar canal stenosis

Watanabe Kota, Matsumoto Morio, Ikegami Takeshi, Nishiwaki Yuji, Tsuji Takashi, Ishii Ken, Ogawa Yuto, Takaishi Hironari, Nakamura Masaya, Toyama Yoshiaki, Chiba Kazuhiro

Journal of Neurosurgery: Spine 14 ( 1 ) 51 - 58 2011.01

ISSN 1547-5654

Object. To reduce intraoperative damage to the posterior supporting structures of the lumbar spine during decompressive surgery for lumbar canal stenosis (LCS), lumbar spinous process-splitting laminectomy (LSPSL or split laminectomy) was developed. This prospective, randomized, controlled study was conducted to clarify whether the split laminectomy decreases acute postoperative wound pain compared with conventional laminectomy. Methods. Forty-one patients with LCS were enrolled in this study. The patients were randomly assigned to either the LSPSL group (22 patients) or the conventional laminectomy group (19 patients). Questionnaires regarding wound pain (intensity, depth, and duration) and activities of daily living (ADL) were administered at postoperative days (PODs) 3 and 7. Additionally, the authors evaluated the pre- and postoperative serum levels of C-reactive protein and creatine phosphokinase, the amount of pain analgesics used during a 3-day postoperative period, and the muscle atrophy rate measured on 1-month postsurgical MR images. Results. Data obtained in patients in the LSPSL group and in 16 patients in the conventional laminectomy group were analyzed. The mean visual analog scale for wound pain on POD 7 was significantly lower in the LSPSL group (16 ± 17 mm vs 34 ± 31 mm, respectively; p = 0.04). The mean depth-of-pain scores on POD okinase level was significantly lower in the LSPSL group (126 ± 93 U/L) than in the other group (207 ± 150 U/L) (p = 0.02); on POD 7, the mean serum C-reactive protein level was significantly lower in the LSPSL group (1.1 ± 0.6 mg/dl) than in the conventional laminectomy group (1.9 ± 1.5 mg/dl) (p = 0.04). The number of pain analgesics taken during the 3-day postoperative period was lower in the LSPSL group than in the conventional laminectomy group (1.7 ± 1.3 tablets vs 2.3 ± 2.4 tablets, respectively; p = 0.22). The mean muscle atrophy rate was also significantly lower in the LSPSL group (24% ± 15% vs 43% ± 22%; p = 0.004). Conclusions. Lumbar spinous process-splitting laminectomy for the treatment of LCS reduced acute postoperative wound pain and prevented postoperative muscle atrophy compared with conventional laminectomy, possibly because of minimized damage to the paraspinal muscles.

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Central neuropathic pain after surgical resection in patients with spinal intramedullary tumor

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

Clinical Neurology 51 ( 11 ) 937 - 938 2011

ISSN 0009-918X

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A novel pedicle channel classification describing osseous anatomy

Watanabe Kota, Lenke Lawrence G., Matsumoto Morio, Harimaya Katsumi, Kim Yongjung J., Hensley Marsha, Stobbs Georgia, Toyama Yoshiaki, Chiba Kazuhiro

Spine 35 ( 20 ) 1836 - 1842 2010.09

ISSN 0362-2436

Study Design. Prospective clinical series. Objective. To determine how many thoracic scoliotic pedicles have cancellous versus cortical versus absent channels. Summary of Background Data. Although morphologic evaluations of thoracic pedicles have been well reported, the results do not practically reflect clinical findings during actual pedicle screw placement. We propose a novel pedicle channel classification describing the osseous anatomy encountered during pedicle probe insertion. Methods. We noted 4 pedicle types in 53 consecutive scoliosis patients. Type A: pedicle probe smoothly inserted without difficulty; the morphology is described as a "Large Cancellous Channel." Type B: pedicle probe inserted snugly with increased force; described as a "Small Cancellous Channel." Type C: pedicle probe cannot be manually pushed but must be tapped with a mallet down the pedicle into the body; described as a "Cortical Channel." Type D: pedicle probe cannot locate a channel thus necessitating a "juxtapedicular" screw position; described as a "Slit/Absent Channel." The average age at time of surgery was 23.4 ± 16.7 years. Diagnoses included idiopathic scoliosis (n = 38) and syndromic scoliosis (n = 15). The average main thoracic Cobb angle was 73° ± 26°. Evaluation of pedicle morphology of the 4 types was also performed in 21 consecutive cases of adolescent idiopathic scoliosis using preoperative computed tomography images. Results. A total of 1021 pedicles with screws placed were evaluated. The average percent per type was as follows: 61.0% type A; 29.2% type B, 6.8% type C, and 3.0% type D. On the convexity, 98.2% of pedicles were type A or B versus 81.5% on the concavity (P < 0.05). There were significant differences between adolescent versus adult idiopathic scoliosis (P = 0.007), and syndromic scoliosis versus adult idiopathic scoliosis (P = 0.017) regarding pedicle morphologic proportions. There was a significant tendency toward a decrease in the proportion of type A pedicles, an increase in the proportion of type B pedicles as the Cobb angle increased (P < 0.0001). Evaluation based on 312 thoracic pedicles in 21 consecutive adolescent idiopathic scoliosis patients using preoperative computed tomography axial images confirmed assumptions of the 4 pedicle types. Conclusion. We propose a classification for pedicle channels describing the osseous anatomy encountered during pedicle probe insertion. Based on the classification, surprisingly, we found during surgery that 90% of thoracic pedicles had a cancellous channel, whereas 7% had a cortical channel and only 3% had an absent channel. © 2010, Lippincott Williams & Wilkins.

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Prospective ten-year follow-up study comparing patients with whiplash-associated disorders and asymptomatic subjects using magnetic resonance imaging

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

Spine 35 ( 18 ) 1684 - 1690 2010.08

ISSN 0362-2436

Study Design: A prospective 10-year follow-up study of patients with whiplash-associated disorders (WAD) and asymptomatic volunteers. Objective: To clarify long-term impact of whiplash injury on patient's symptoms and on magnetic resonance imaging (MRI) findings of the cervical spine. Summary of background data: Long-term prognosis of WAD has not been fully elucidated. Methods: Between 1993 and 1996, we conducted cross-sectional comparative study of 508 acute WAD patients and 497 asymptomatic volunteers, all of whom underwent MRI of the cervical spine. For this follow-up study, 133 WAD patients and 223 control subjects were recruited again. All participants underwent follow-up MRI and physical examination, and answered to questionnaires regarding neck symptoms. Evaluation of MRI included decrease in signal intensity of discs, posterior disc protrusion, disc space narrowing, and foraminal stenosis using 2 to 4 numerical grades. Increase in the numerical grades by one or more was considered to be progression of degenerative changes. Results: Progression of decrease in signal intensity was observed in 109 WAD patients (82.0%), and 132 control subjects (59.2%), (age, sex adjusted odds ratio [OR]: 3.06), posterior disc protrusion in 101 (75.9%) and in 155 (69.5%) (OR = 1.46), disc space narrowing in 33 (24.8%) and in 59 (26.5%) (OR = 0.98), and foraminal stenosis in 6 (4.5%), and in 20 (9.0%) (OR = 0.52), respectively. Neck pain was observed in 34 WAD patients (25.6%) and 22 control subjects (9.9%) (P < 0.0001). There was no statistically significant correlation between neck pain and progression in each MR finding in either group. Conclusion: The results of this study suggest that, although some WAD patients are more likely to suffer from long-lasting neck pain, MRI findings cannot explain the symptoms. © 2010, Lippincott Williams & Wilkins.

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Ball tip technique for thoracic pedicle screw placement in patients with adolescent idiopathic scoliosis

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

Journal of Neurosurgery: Spine 13 ( 2 ) 246 - 252 2010.08

ISSN 1547-5654

Object. The aim in this study was to evaluate the efficacy of the ball tip technique in placing thoracic pedicle screws (TPSs), as compared with the conventional freehand technique, in both a cadaveric study and a clinical study of patients with adolescent idiopathic scoliosis. Although posterior spinal surgery using TPSs has been widely applied, these screws are associated with the potential risk of vascular, pulmonary, or neurological complications. To further enhance the accuracy and safety of TPS placement, the authors developed the ball tip technique. Methods. After creating an appropriate starting point for probe insertion, a specially designed ball tip probe consisting of a ball-shaped tip with a flexible metal shaft is used to make a guide hole into the pedicle. Holding the probe with the fingertips while using an appropriate amount of pressure or by tapping it gently and continuously with a hammer, one can safely insert the ball tip probe into the cancellous channel in the pedicle. In a cadaveric study, 5 spine fellows with similar levels of experience in placing TPSs applied the ball tip or the conventional technique to place screws in 5 cadavers with no spinal deformities. The incidence of misplaced screws was evaluated by dissecting the spines. In a clinical study, 40 patients with adolescent idiopathic scoliosis underwent posterior surgery with TPS placement via the ball tip or conventional technique (20 patients in each treatment group). The accuracy of the TPS placements was evaluated on postoperative axial CT scanning. Results. In the cadaveric study, 100 TPSs were evaluated, and the incidence of misplaced screws was 14% in the ball tip group and 34% in the conventional group (p = 0.0192). In the clinical study, 574 TPSs were evaluated. One hundred seventy-one intrapedicular screws (67%) were recognized in the conventional group and 288 (90%) in the ball tip group (p < 0.01). In the conventional and ball tip groups, the respective numbers of TPSs with a pedicle breach of ≤ 2 mm were 20 (8%) and 15 (5%), those with a pedicle breach of > 2 mm were 32 (13%) and 9 (3%; p < 0.01), and those located in the costovertebral joints were 32 (13%) and 7 (2%). Conclusions. In both cadaveric and clinical studies the ball tip technique enhanced the accuracy of TPS placement as compared with the conventional freehand technique. Thus, the ball tip technique is useful for the accurate and safe placement of TPSs in deformed spines.

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Risk factors for development of subaxial subluxations following atlantoaxial arthrodesis for atlantoaxial subluxations in rheumatoid arthritis

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

Spine 35 ( 16 ) 1551 - 1555 2010.07

ISSN 0362-2436

Study Design: Retrospective radiographic/imaging study. Objective: To evaluate preoperative and sequential postoperative radiographs following C1-C2 arthrodesis for atlantoaxial subluxation in patients with rheumatoid arthritis (RA) to determine risk factors for the development of subaxial subluxations (SAS). Summary of Background Data: The development of SAS has often been observed after C1-C2 arthrodesis. However, there have been no previous reports on the correlation between radiographic parameters and the incidence of postoperative SAS. Methods: The study group comprised of 58 patients with RA who underwent C1-C2 arthrodesis due to atlantoaxial subluxation. There were 5 men and 53 women with a mean age of 55.8 years. The mean follow-up period was 137 months. Nineteen patients with a postoperative SAS after C1-C2 arthrodesis were classified as the SAS+ group. Other 39 pat ents without a postoperative SAS were included in the SAS- group. Clinical outcomes and plain radiographs were reviewed retrospectively and compared between the 2 groups. Results: The difference between pre- and postoperative atlantoaxial (AA) angles in the SAS+ group was significantly greater than those in the SAS- group (P = 0.039). The C2-C7 angles changed significantly between pre- and postoperative periods in the SAS+ group (P = 0.039), but not in the SAS- group (P = 0.897). It was suggested that a large AA angle and a small C2-C7 angle observed at the early postoperative period were the risk factors for the development of SAS. We also demonstrated that a high incidence of the C3-C4 SAS resulted from excessive bone fusion at the C2-C3. Conclusion: Excessive correction of AA angle is likely to cause loss of cervical lordosis, resulting in the development of postoperative SAS. In addition, extensive bony union at C2-C3 following C1-C2 arthrodesis frequently leads to the development of extensive SAS at the C3-C4. © 2010, Lippincott Williams & Wilkins.

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GRIP1 enhances estrogen receptor α-dependent extracellular matrix gene expression in chondrogenic cells

Kato M., Takaishi H., Yoda M., Tohmonda T., Takito J., Fujita N., Hosogane N., Horiuchi K., Kimura T., Okada Y., Saito T., Kawaguchi H., Kikuchi T., Matsumoto M., Toyama Y., Chiba K.

Osteoarthritis and Cartilage 18 ( 7 ) 934 - 941 2010.07

ISSN 1063-4584

Objective: The role of postmenopause on the pathogenesis of cartilage degeneration has been an open question. We assessed cartilage degeneration in estrogen receptor (ER)α null mice and examined the role of glucocorticoid receptor-interacting protein 1 (GRIP1) in the ERα-dependent transcription of a type II collagen gene (col2a1) with special reference to a crosstalk with the transforming growth factor (TGF)-β signaling pathway. Methods: The vertebral cartilaginous endplate from female ERα null mice was subjected to histological analyses. Col2a1 expression of primary chondrocytes (PCs) obtained from ERα null mice after 17β-estradiol (E₂) and TGF-β1 stimulation was examined by reverse transcription polymerase chain reaction (RT-PCR). Estrogen response element (ERE) or col2a1 promoter-enhancer luciferase reporter system was used to investigate the crosstalk among ERα, GRIP1, and MKK6. Col2a1 expression and glycosaminoglycan (GAG) content were measured in ATDC5 cells treated with GRIP1 small interfering RNA (siRNA). Results: ERα deficiency clearly accelerated impairment of the vertebral cartilaginous endplate. E₂ and TGF-β1 stimulation increased col2a1 expression in PC from wild-type mice, but not that from ERα null mice. The same stimulation increased the col2a1 promoter-enhancer reporter activity, and the elevated activity was decreased by dominant-negative ERα and p38 mitogen-activated protein kinase (MAPK) inhibitor. GRIP1 increased the E₂-dependent ERE activation in the presence of ERα and constitutive-active MKK6. GRIP1 siRNA repressed col2a1 expression and GAG production in ATDC5 cells. Conclusions: Crosstalks between ERα/GRIP1 and TGF-β/MKK6/p38 MAPK pathway have protective roles on cartilage metabolism via regulating the extracellular matrices expression. The finding may lead to the development of a novel therapeutic approach for cartilage degeneration. © 2010 Osteoarthritis Research Society International.

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Inhibition of STAT1 accelerates bone fracture healing

Tajima Kosuke, Takaishi Hironari, Takito Jiro, Tohmonda Takahide, Yoda Masaki, Ota Norikazu, Kosaki Naoto, Matsumoto Morio, Ikegami Hiroyasu, Nakamura Toshiyasu, Kimura Tokuhiro, Okada Yasunori, Horiuchi Keisuke, Chiba Kazuhiro, Toyama Yoshiaki

Journal of Orthopaedic Research 28 ( 7 ) 937 - 941 2010.07

ISSN 0736-0266

Skeletal fracture healing involves a variety of cellular and molecular events; however, the mechanisms behind these processes are not fully understood. In the current study, we investigated the potential involvement of the signal transducer and activator of transcription 1 (STAT1), a critical regulator for both osteoclastogenesis and osteoblast differentiation, in skeletal fracture healing. Weused a fracture model and a cortical defect model in mice, and found that fracture callus remodeling and membranous ossification are highly accelerated in STAT1-deficient mice. Additionally, we found that STAT1 suppresses Osterix transcript levels and Osterix promoter activity in vitro, indicating the suppression of Osterix transcription as one of the mechanisms behind the inhibitory effect of STAT1 on osteoblast differentiation. Furthermore, we found that fludarabine, a potent STAT1 inhibitor, significantly increases bone formation in a heterotopic ossification model. These results reveal previously unknown functions of STAT1 in skeletal homeostasis and may have important clinical implications for the treatment of skeletal bone fracture. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

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Age-related changes of thoracic and cervical intervertebral discs in asymptomatic subjects

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

Spine 35 ( 14 ) 1359 - 1364 2010.06

ISSN 0362-2436

Study Design.: Magnetic resonance imaging (MRI) study on degeneration of the thoracic spine in asymptomatic subjects. Objective.: To investigate the incidence of degenerative MRI findings of the thoracic spine in asymptomatic subjects and to identify factors related to the degeneration of the thoracic discs. Summary of Background Data.: Studies on age-related degenerative changes of the thoracic spine are scarce. Methods.: Ninety-four asymptomatic Japanese volunteers (48 men and 46 women, mean age of 48.0 ± 13.4 years) underwent MRI of the thoracic and cervical spine and filled the questionnaire regarding life styles. The items evaluated on MRI using a numerical grading system were (1) decrease in the signal intensity of the intervertebral discs (DSI), (2) posterior disc protrusion (PDP), (3) anterior compression of the dural sac (ACD), and (4) disc space narrowing. Association between each degenerative MRI finding and several factors, including age, sex, smoking, sports, body mass index, and degeneration of cervical spine was investigated. Results.: Forty-four (46.8%) patients demonstrated positive degenerative MRI findings at 1 or more thoracic intervertebral levels. The percentage of the subjects with positive MRI findings was 37.2% in DSI, 30.9% in PDP, 29.8% in ACD, and 4.3% in disc space narrowing. The percentages of all MRI findings increased with aging. In 85 (90.4%) patients, degenerative MRI findings were positive in the cervical spine. DSI was significantly associated with age (odds ratio, 11.21, 95% confidence interval, 2.70-46.5), PDP with age (3.44, 1.02-16.61), smoking (4.94, 1.55-15.71) and presence of PDP in the cervical spine (4.25, 1.01-17.92), and ACD was associated with smoking (3.99, 1.28-12.44). Conclusion.: Degenerative changes in the thoracic spine on MRI was observed in approximately half of the asymptomatic subjects, whereas their incidences were less frequent than those in the cervical spine. Factors significantly associated with degenerative changes in the thoracic spine included age, smoking, and degeneration in the cervical spine. © 2010, Lippincott Williams & Wilkins.

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Complicated surgical resection of malignant tumors in the upper cervical spine after failed ion-beam radiation therapy

Matsumoto Morio, Watanabe Kota, Ishii Ken, Tsuji Takashi, Takaishi Hironari, Nakamura Masaya, Toyama Yoshiaki, Chiba Kazuhiro, Imanishi Yorihisa, Kishi Kazuo, Kawana Hiromasa

Spine 35 ( 11 ) 2010.05

ISSN 0362-2436

STUDY DESIGN.: Case report. OBJECTIVE.: To report 3 cases of malignant tumors in the upper cervical spine that were treated surgically by a combination of posterior tumor resection and stabilization and anterior tumor resection through a mandible-splitting approach after failed ion-beam radiation therapy. SUMMARY OF BACKGROUND DATA.: Few clinical reports have described in detail the postoperative complications associated with transoral surgical resection of tumors in the upper cervical spine after unsuccessful ion-beam radiation therapy. METHODS.: Three patients with malignant tumors in the upper cervical spine who had undergone ion-beam radiotherapy and experienced tumor recurrence were treated by a combination of posterior and anterior surgery through a mandible-splitting approach. One patient (patient 1, a 32-year-old man) had a hemangioendothelioma at the C2 and C3 level, whereas the other 2 patients (patient 2, a 66-year-old woman and patient 3, a 65-year-old man) had a chordoma at the C2 and C3 level. RESULTS.: The intralesional but macroscopic total resection of the tumors was achieved in all 3 patients. However, serious complications developed after surgery, including deep wound infection, cerebrospinal fluid leakage, and meningitis in patient 1, prolonged swallowing difficulty, subsidence of the strut graft, and recurrence in patient 2, and deep wound infection and discitis causing progressive paralysis in patient 3. All patients underwent salvage surgery, including debridement of the wound in patient 1, posterior reinforcement using instrumentation and posterior tumor resection for the recurrent tumor in patient 2, and anterior debridement of the wound with a pedicle flap using the pectoral major muscle in patient 3 to address these problems. Patients 1 and 3 had no signs of recurrence at the time of a follow-up examination. CONCLUSION.: Severe complications, mainly associated with the disturbance in healing of the retropharyngeal wall, were observed in all 3 patients. A preventive method, such as primary repair of the retropharyngeal wall using muscular/musculocutaneous flaps, should be considered for patients undergoing resection through a transoral approach after ion-beam irradiation. © 2010, Lippincott Williams & Wilkins.

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Receptor activator of NF-κB (RANK) ligand induces ectodomain shedding of RANK in murine RAW264.7 macrophages

Hakozaki Akihiro, Yoda Masaki, Tohmonda Takahide, Furukawa Mitsuru, Hikata Tomohiro, Uchikawa Shinichi, Takaishi Hironari, Matsumoto Morio, Chiba Kazuhiro, Horiuchi Keisuke, Toyama Yoshiaki

Journal of Immunology 184 ( 5 ) 2442 - 2448 2010.03

ISSN 0022-1767

Osteoclastogenesis is a highly sophisticated process that involves a variety of membrane-bound proteins expressed in osteoblasts and osteoclast precursors. Over the past several years, proteolytic cleavage and release of the ectodomain of membrane-bound proteins, also referred to as ectodomain shedding, has emerged as an important posttranslational regulatory mechanism for modifying the function of cell surface proteins. In line with this notion, several membrane-bound molecules involved in osteoclastogenesis, including CSF-1R and receptor activator of NF-κB ligand (RANKL), are proteolytically cleaved and released from the cell surface. In this study, we investigated whether receptor activator of NF-κB (RANK), one of the most essential molecules in osteoclastogenesis, undergoes ectodomain shedding. The results showed that RANK is released in the form of a soluble monomeric protein and that TNF-α-converting enzyme is involved in this activity. We also identified potential cleavage sites in the juxtamembrane domain of RANK and found that rRANKL induces RANK shedding in a macrophage-like cell line RAW264.7 via TNFR-associated factor 6 and MAPK pathways. Furthermore, we found that RANKL-induced osteoclastogenesis is accelerated in TNF-α-converting enzyme-deficient osteoclast precursors. These observations suggest the potential involvement of ectodomain shedding in the regulation of RANK functions and may provide novel insights into the mechanisms of osteoclastogenesis. Copyright © 2010 by The American Association of Immunologists, Inc.

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