Details of a Researcher - Matsumoto, Morio

Papers - Matsumoto, Morio

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Adjacent segment disease and degeneration after anterior cervical decompression and fusion

Matsumoto Morio, Okada Eijiro, Ichihara Daisuke, Watanabe Kota, Chiba Kazuhiro, Toyama Yoshiaki

Neurosurgery Quarterly 20 ( 1 ) 15 - 22 2010.03

ISSN 1050-6438

Anterior cervical decompression and fusion (ACDF) is one of the standard surgical techniques for the treatment of cervical spinal disorders including degenerative diseases, trauma, infection, and tumor. However, the surgical outcomes of ACDF can be deteriorated by the development of adjacent segment degeneration or disease in the postoperative time course. In this article, the biomechanical background, incidence, risk factors, prevention, and management of this disorder are discussed. The incidence rate of adjacent segment degeneration or disease varies according to different reports. The risk factors are reported to be a level of fusion, the number of fusion levels, the preexistence of degenerative changes at the adjacent segments, and the alignment of the entire cervical spine and the fused segments. Although adjacent segment disease can be a sequel of the natural aging of the patients, a comparative study with control population revealed that patients who underwent ACDF had significantly higher incidence of disc degeneration at the adjacent segments than the control population. Adjacent segment diseases can be prevented by the use of motion preservation techniques including artificial disc replacement and decompression surgery without fusion. It can be managed by repeated ACDF, expansive laminoplasty, and artificial disc replacement, although the efficacies of these revision surgical procedures remain to be tested in the larger case series. © 2010 Lippincott Williams & Wilkins, Inc.

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The effect of timing in the administration of hepatocyte growth factor to modulate BMP-2-induced osteoblast differentiation

Kawasaki Toshiki, Niki Yasuo, Miyamoto Takeshi, Horiuchi Keisuke, Matsumoto Morio, Aizawa Mamoru, Toyama Yoshiaki

Biomaterials 31 ( 6 ) 1191 - 1198 2010.02

ISSN 0142-9612

Development of bone morphogenetic protein (BMP) signaling modulators may provide useful therapeutic options for the treatment of large bony defects in clinical settings. Controversy remains over whether hepatocyte growth factor (HGF) is a positive or negative modulator of BMP-induced osteogenesis. This study analyzed osteogenic properties of HGF, particularly during BMP-2-induced bone formation. Using a mouse model of ectopic bone formation, HGF-impregnated gelatin sponges displayed significantly reduced bone formation induced by BMP-2, both radiologically and histologically. Abrogation of endogenous HGF production by knockdown of HGF mRNA resulted in upregulation of BMP-2-induced ALP activity for C2C12 myoblasts in vitro. In contrast, addition of exogenous HGF inhibited BMP-2-induced ALP activity and osteocalcin production by mouse embryonic fibroblasts (MEFs) through HGF-c-Met interactions. Inhibition of ALP activity by HGF was rescued by U0126, a MEK1/2 inhibitor, indicating that HGF suppresses the BMP-2-Smad axis via activation of ERK1/2. Importantly, treatment with HGF prior to administration of BMP-2 induced cellular proliferation of MEFs and did not influence subsequent osteoblast differentiation induced by BMP-2. The effects of HGF may differ according to the differentiation stage of mesenchymal stem cells, which would explain the inconsistencies seen in osteogenic properties of HGF in previous reports. The timing of HGF treatment is critical and should be carefully determined for successful induction of bone formation by BMPs. © 2009 Elsevier Ltd. All rights reserved.

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Anterior cervical decompression and fusion accelerates adjacent segment degeneration

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

Spine 35 ( 1 ) 36 - 43 2010.01

ISSN 0362-2436

Study Design. Prospective 10-year follow-up magnetic resonance imaging (MRI) study of patients who underwent anterior cervical decompression and fusion (ACDF) and healthy control subjects. Objective. To clarify the incidence of adjacent segment degeneration during 10 years after ACDF. Summary of Background Data. There have been few studies which investigated incidence of progression of degenerative changes at adjacent segments in patients treated by ACDF comparing with healthy subjects. Methods. Sixty-four patients who underwent ACDF (48 males, 16 females, mean age 47.3 years, mean follow-up 12.1 year) and 201 asymptomatic volunteers who underwent MRI in our previous study (113 males, 88 females, mean age; 41.1 year, mean follow-up; 11.7 years) were included in this study. The patients and control subjects underwent follow-up MRI in this study. Following MR findings were evaluated using a numerical grading system from C2-C3-C7-T1: (1) Decrease in signal intensity of disc (DSI), (2) Posterior disc protrusion (PDP), (3) Disc space narrowing, and (4) Foraminal stenosis. When an increase in at least one grade in any of the radiographic parameters was detected between the 2 time points, progression of disc degeneration was judged as present at the level of interest. Results. Progression of DSI was significantly more frequent in ACDF group than in control group at C4-C5, while progression of PDP was significantly more frequent in ACDF group than in control group at all levels except for C5-C6. Progression of disc space narrowing and foraminal stenosis was significantly more frequent in ACDF group at C3-C4 and at C6-C7, respectively. Conclusion. Although both ACDF patients and control subjects demonstrated progression of disc degeneration during 10 years, ACDF patients had significantly higher incidence of progression of disc degeneration at adjacent segments than control subjects, while progression of disc degeneration at adjacent segments was not always related to development of clinical symptoms. © 2009, Lippincott Williams & Wilkins.

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Posterior decompression surgery for extraforaminal entrapment of the fifth lumbar spinal nerve at the lumbosacral junction

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

Journal of Neurosurgery: Spine 12 ( 1 ) 72 - 81 2010.01

ISSN 1547-5654

Object. In this paper, the authors' goal was to elucidate the clinical features and results of decompression surgery for extraforaminal stenosis at the lumbosacral junction. Methods. Twenty-eight patients with severe leg pain caused by extraforaminal stenosis at the lumbosacral junction (18 men and 10 women; mean age 68.2 ± 8.9 years) were treated by posterior decompression without fusion using a microendoscope in 19 patients and a surgical microscope or loupe in 9 patients. The decompression procedures consisted of partial resection of the sacral ala, the L-5 transverse process, and the L5-S1 facet joint along the L-5 spinal nerve. The following items were investigated: 1) preoperative neurological findings; 2) preoperative radiological findings, including plain radiographs, CT scans, selective radiculography of L-5; 3) surgical outcome as evaluated using the Japanese Orthopaedic Association scale for low-back pain (JOA score); and 4) need for revision surgery. Results. All patients presented with neurological deficits compatible with a diagnosis of L-5 radiculopathy such as weakness of the extensor hallucis longus muscle and sensory disturbance in the L-5 area together with neurogenic claudication. On plain radiographs, 21 patients (75%) and 17 patients (60.7%) exhibited lumbar scoliosis (? 5° ) and wedging of the L5-S1 intervertebral space (≥ 3 ^o ), respectively. The CT scans demonstrated marked osteophyte formation at the posterolateral margin of the L5-S1 vertebral bodies, and a selective L-5 nerve root block was effective in all patients. All patients reported pain relief immediately after surgery. The mean JOA scores were 11.3 ± 3.8 before surgery and 24.3 ± 3.4 at the time of the final follow-up examination; the recovery rate was 68.6 ± 16.5%. The mean estimated blood loss was 66.6 ± 98.6 ml, and the mean surgical time was 135.3 ± 46.5 minutes. No significant difference in the recovery rate of the JOA scores or in the surgical time and blood loss was observed between the 2 surgical approaches. Four patients underwent revision posterior interbody fusion for the recurrence of radicular pain as a result of intraforaminal stenosis in 3 patients and insufficient decompression of the extraforaminal area in the remaining patient at an average of 19.5 months after surgery. Conclusions. Extraforaminal stenosis at the lumbosacral junction is a rare but distinct pathological condition causing L-5 radiculopathy. Decompression surgery without fusion using a microendoscope or a surgical microscope/loupe is a feasible and less invasive surgical option for elderly patients with extraforaminal stenosis at the lumbosacral junction.

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Incidence of complications associated with spinal endoscopic surgery

Matsumoto Morio, Hasegawa Toru, Ito Manabu, Aizawa Toshimi, Konno Shinichi, Yamagata Masatsune, Ebara Sohei, Hachiya Yudo, Nakamura Hiroaki, Yagi Shoji, Sato Kimiaki, Dezawa Akira, Yoshida Muneto, Shinomiya Kenichi, Toyama Yoshiaki, Shimizu Katsuji, Nagata Kensei

Journal of Orthopaedic Science 15 ( 1 ) 92 - 96 2010.01

ISSN 0949-2658

Background: This report was conducted to elucidate the current status of spinal endoscopic surgery and relevant incidents through analysis of the results of a questionnaire survey conducted in 2007 by the Committee on Spinal Endoscopic Surgical Skill Qualification of the Japanese Orthopaedic Association (JOA). Methods: Questionnaire forms were sent to 2011 training facilities nationwide certified by the JOA, and 1082 of these facilities returned the filled questionnaires (response rate 53.8%). Of these facilities, 257 (23.8% of the responding facilities) undertook spinal endoscopic surgery in 2007. These institutions were asked to fill in the survey form with the details of the operations and relevant incidents as well as the incident levels. Results: In total, the 257 facilities performed 6239 spinal endoscopic surgeries during 2007. Posterior spinal endoscopic surgery constituted most of the operations (6217 cases, 98.2%) including 4336 cases of microendoscopic discectomy (MED), 1273 cases of microendoscopic laminectomy or fenestration, and 379 cases of transforaminal or posterior lumbar interbody fusion. The total number of incidents was 133 (2.13%). The numbers of incidents by operative method were 75 (56.4%) during MED, 57 (42.9%) during microendoscopic laminectomy or fenestration, and 1 (0.8%) during interbody fusion. Of 133 incidents, dural tear occurred in 99 (74.4%), injury of the cauda equina or a nerve root in 7 (5.3%), facet fracture in 7 (5.3%), hematoma and wrong level in 6 each (4.5%), and wrong side and bedsore in 1 each (0.8%). The incident level was level 1 in 6, level 2 in 24, level 3a in 82, level 3b in 16, level 4 in 5, and level 5 (fatal) in 0. Conclusions: The results of this survey revealed an increasing trend of spinal endoscopic surgery and a decreasing trend of the complication rates. The complication rates of spinal endoscopic surgery were not higher than those of conventional surgery, indicating the safety of this surgical method. © 2010 The Japanese Orthopaedic Association.

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Cordotomy for patients with thoracic malignant astrocytoma

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

Journal of Neurosurgery: Spine 13 ( 4 ) 418 - 423 2010

ISSN 1547-5654

Object. The optimal management of malignant astrocytomas remains controversial, and the prognosis of these lesions has been dismal regardless of the administered treatment. In this study the authors investigated the surgical outcomes of cordotomy in patients with thoracic malignant astrocytomas to determine the effectiveness of this procedure. Methods. Cordotomy was performed in 5 patients with glioblastoma multiforme (GBM) and 2 with anaplastic astrocytoma (AA). A Kaplan-Meier survival analysis was performed, and the associations of the resection level with survival and postoperative complications were retrospectively examined. Results. Cordotomy was performed in a single stage in 2 patients with GBM and in 2 stages in 3 patients with GBM and 2 patients with AA. In the 2 patients with GBM, cordotomy was performed 2 and 3 weeks after a partial tumor resection. In the 2 patients with AA, the initial treatment consisted of partial tumor resection and subtotal resection combined with radiotherapy, and rostral tumor growth and progressive paralysis necessitated cordotomy 2 and 28 months later. One patient with a secondary GBM underwent cordotomy; the GBM developed 1 year after subtotal resection and radiotherapy for a WHO Grade II astrocytoma. Four patients died 4, 5, 24, and 42 months after the initial operation due to CSF dissemination, and 3 patients (2 with GBM and 1 with AA) remain alive (16, 39, and 71 months). No metastasis to any other organs was noted. Conclusions. One-stage cordotomy should be indicated for patients with thoracic GBM or AA presenting with complete paraplegia preoperatively. In patients with thoracic GBM, even if paralysis is incomplete, cordotomy should be performed before the tumor disseminates through the CSF. Radical resection should be attempted in patients with AA and incomplete paralysis. If the tumor persists, radiotherapy and chemotherapy are indicated, and cordotomy should be reserved for lesions growing progressively after such second-line treatments.

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Microendoscopic resection of lumbar discal cysts

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

Minimally Invasive Neurosurgery 53 ( 2 ) 69 - 73 2010

ISSN 0946-7211

Introduction: A lumbar discal cyst is a relatively rare cystic lesion that communicates with lumbar intervertebral discs. Surgical resection of the cyst is the reported treatment of choice. In this study, the authors report the minimally invasive surgical resection of lumbar discal cysts using a microendoscopy. Patients and Methods: Seven male patients with lumbar discal cysts underwent microendoscopic resections (mean age: 25.1?3.2 years and the mean follow-up period: 27.9 months). During the surgeries, the cysts were subtotally resected in a piecemeal fashion, and the fistulas forming the communications between the cysts and the corresponding intervertebral discs were coagulated using a bipolar coagulator. Results: All the patients obtained relief from their pain after surgery, and no recurrences occurred during a mean follow-up period of 28 months. The mean operation time was 72.6?20.2min, and the mean blood loss was 44.4?13.7 grams. No intra- or peri-operative complications were noted in any of the patients. Conclusions: Microendoscopic resection appears to be a minimally invasive and feasible surgical option for the treatment of lumbar discal cysts. © Georg Thieme Verlag KG Stuttgart.

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Development of stiff shoulder in asymptomatic volunteers during ten-year follow-up in Japan

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

Journal of Back and Musculoskeletal Rehabilitation 23 ( 2 ) 69 - 75 2010

ISSN 1053-8127

Objectives: The purpose of this study was to longitudinally evaluate relationships between the incidence of stiff shoulder and sagittal alignments of the cervical spine, age-related changes on magnetic resonance imaging (MRI) and life styles of the subjects. Methods: The subjects were 69 men and 93 women. The mean follow-up period was 11.3 ± 0.7 years. Sagittal alignments of the cervical spine were classified into the following 4 types: lordosis, straight, kyphosis and sigmoid. MRI findings were evaluated for the progression of 1) decrease in signal intensity of disc, 2) posterior disc protrusion, and 3) disc space narrowing. Results: Stiff shoulder was found in 29.6% of the subjects over the 10 years. In the group of subjects 30-49 years old, the incidence of stiff shoulder was 40.4%, and it was higher than those in other age groups. Stiff shoulder was significantly more frequent in women (45.2%) than in men. Its incidence was significantly lower in those who regularly participated in sports or exercise. There were no significant relationship between the incidence of stiff shoulder and the progressions in any of MRI findings during the follow-up period. Conclusions: Stiff shoulder was more frequent in middle-aged, female and non-exercising subjects. There was no correlation between the incidence of stiff shoulder and sagittal alignments of the cervical spine, or progression of age-related changes of the cervical disc on MRI. © 2010 - IOS Press and the authors. All rights reserved.

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Progressive kyphoscoliosis associated with tethered cord treated by posterior vertebral column resection

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

Spine 34 ( 26 ) 2009.12

ISSN 0362-2436

Study Design: A case report. OBJECTIVES.: To report a case of progressive yphoscoliosis associated with a tethered cord that was corrected by posterior vertebral column resection after complicated untethering surgery. Summary of Background Data: There have been few clinical reports on posterior vertebral column resection conducted for severe deformity associated with a tethered cord. Methods: A patient with progressive kyphoscoliosis associated with a tethered cord first underwent untethering surgery, resulting in neurologic deterioration. Posterior vertebral column resection was performed to correct the kyphoscoliosis while shortening the spinal column to prevent the spinal cord from stretch injury. Results: Good correction of kyphoscoliosis was obtained without further neurologic deterioration. The Cobb angles of scoliosis was 103° before surgery and 25° after surgery (correction rate; 75.7%), and that of kyphosis was 90° and 36°, respectively (correction rate; 60.0%). Conclusion: Correction of progressive kyphoscoliosis associated with a tethered cord can be achieved successfully by posterior vertebral column resection even after complicated untethering surgery. © 2009, Lippincott Williams & Wilkins.

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Accelerated cartilage resorption by chondroclasts during bone fracture healing in osteoprotegerin-deficient mice

Ota Norikazu, Takaishi Hironari, Kosaki Naoto, Takito Jiro, Yoda Masaki, Tohmonda Takahide, Kimura Tokuhiro, Okada Yasunori, Yasuda Hisataka, Kawaguchi Hiroshi, Matsumoto Morio, Chiba Kazuhiro, Ikegami Hiroyasu, Toyama Yoshiaki

Endocrinology 150 ( 11 ) 4823 - 4834 2009.11

ISSN 0013-7227

Receptor activator of nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPG), a decoy receptor of RANKL, maintain bone mass by regulating the differentiation of osteoclasts, which are bone-resorbing cells. Endochondral bone ossification and bone fracture healing involve cartilage resorption, a less well-understood process that is needed for replacement of cartilage by bone. Here we describe the role of OPG produced by chondrocytes in chondroclastogenesis. Fracture healing in OPG^-/- mice showed faster union of the fractured bone, faster resorption of the cartilaginous callus, and an increased number of chondroclasts at the chondroosseous junctions compared with that in wild-type littermates. When a cultured pellet of OPG^-/- chondrocytes was transplanted beneath the kidney capsule, the pellet recruited many chondroclasts. The pellet showed the ability to induce tartrate-resistant acid phosphatase-positive multinucleated cells from RAW 264.7 cells in vitro. Finally, OPG^-/- chondrocytes (but not wild-type chondrocytes) cultured with spleen cells induced many tartrate-resistant acid phosphatase-positive multinucleated cells. The expression of RANKL and OPG in chondrocytes was regulated by several osteotropic factors including 1,25-dihydroxyvitamin D₃, PTHrP, IL-1α, and TNF-α. Thus, local OPG produced by chondrocytes probably controls cartilage resorption as a negative regulator for chondrocyte-dependent chondroclastogenesis. Copyright © 2009 by The Endocrine Society.

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Does the sagittal alignment of the cervical spine have an impact on disk degeneration? Minimum 10-year follow-up of asymptomatic volunteers

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

European Spine Journal 18 ( 11 ) 1644 - 1651 2009.11

ISSN 0940-6719

There have been few studies that investigated and clarified the relationships between progression of degenerative changes and sagittal alignment of the cervical spine. The objective of the study was to longitudinally evaluate the relationships among progression of degenerative changes of the cervical spine with age, the development of clinical symptoms and sagittal alignment of the cervical spine in healthy subjects. Out of 497 symptom-free volunteers who underwent MRI and plain radiography of the cervical spine between 1994 and 1996, 113 subjects (45 males and 68 females) who responded to our contacts were enrolled. All subjects underwent another MRI at an average of 11.3 years after the initial study. Their mean age at the time of the initial imaging was 36.6 ± 14.5 years (11-65 years). The items evaluated on MRI were (1) decrease in signal intensity of the intervertebral disks, (2) posterior disk protrusion, and (3) disk space narrowing. Each item was evaluated using a numerical grading system. The subjects were divided into four groups according to the age and sagittal alignment of the cervical spine, i.e., subjects under or over the age of 40 years, and subjects with the lordosis or non-lordosis type of sagittal alignment of the cervical spine. During the 10-year period, progression of decrease in signal intensity of the disk, posterior disk protrusion, and disk space narrowing were recognized in 64.6, 65.5, and 28.3% of the subjects, respectively. Progression of posterior disk protrusion was significantly more frequent in subjects over 40 years of age with non-lordosis type of sagittal alignment. Logistic regression analysis revealed that stiff shoulder was closely correlated with females (P = 0.001), and that numbness of the upper extremity was closely correlated with age (P = 0.030) and male (P = 0.038). However, no significant correlation between the sagittal alignment of the cervical spine and clinical symptoms was detected. Sagittal alignment of the cervical spine had some impact on the progression of degenerative changes of the cervical spine with aging; however, it had no correlation with the occurrence of future clinical symptoms. © 2009 Springer-Verlag.

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Long-Term surgical outcomes for myxopapillary ependymomas of the Cauda equina

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

Spine 34 ( 21 ) 2009.10

ISSN 0362-2436

Study Design. Retrospective case series. Objective. To evaluate our treatment strategy for myxopapillary ependymomas of the cauda equina. Summary of Background Data. Some patients with myxopapillary ependymoma develop cerebrospinal fluid (CSF) dissemination leading to poor prognosis. Because of the rarity of this tumor, there is no consensus on its optimal treatment options and prognosis. Methods We reviewed 25 cases of myxopapillary ependymomas, treated surgically between 1972 and 2005. The mean postoperative follow-up period was 10.4 years. The effects of surgical margins at surgery and postoperative radiotherapy on tumor recurrence and prognosis were investigated. Results In 15 patients, total resection achieved (6 cases of en bloc resection without postoperative radiation, and in 9 cases piecemeal resection) was followed by whole brain and spinal cord radiation or local irradiation. Fourteen of these patients survived without tumor recurrence. In 1 case of total resection without radiotherapy, the tumor capsule was violated intraoperatively and local recurrence occurred 2 years after surgery. In 4 patients, the tumors were removed subtotally. Of these, 2 patients who received radiation (24 Gy) only to the whole brain and spinal cord developed recurrence, and 2 who received whole brain and spinal cord radiation (24 Gy) supplemented with local radiation (46 Gy) developed no recurrence. The remaining 6 patients received partial resection after local radiation (40-50 Gy) alone, and all 6 died of CSF dissemination. Conclusion. The results of the present study indicate that the surgical margin obtained at the initial surgery and the extent and amount of postoperative radiation can be crucial factors determining the prognosis of patients with myxopapillary ependymoma. Although this tumor is histologically benign, CSF dissemination can occur once tumor capsule is violated, before or during surgery. Therefore, early diagnosis is essential, and a therapeutic strategy including radiotherapy, on the assumption that this tumor is malignant, should be established. © 2009, Lippincott Williams & Wilkins.

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Updates on ossification of posterior longitudinal ligament. Bone metabolism in ossification of posterior longitudinal ligament

Takaishi Hironari, Shiono Yuta, Matsumoto Morio

Clinical calcium 19 ( 10 ) 1442 - 1447 2009.10

ISSN 0917-5857

Ossification of the longitudinal ligament in the spine is a disorder of unknown cause characterized by ectopic ossification. In the animal models of spinal hyperostosis, the vertebral ligament is gradually replaced by bony tissue forming an osseous bridge around enthesis, and a high turnover osteopenia occurs after the maturation in the trabecular bone of vertebrae. It has been suggested that the recruited vasculature facilitated the filling of the niche with host-derived haematopoietic cells during the ectopic ossification process. Recent data suggest that regulation of hematopoietic and osteogenic stem/progenitor cell populations may contribute to the formation of an ectopic spinal hyperostosis.

Novel apatite fiber scaffolds can promote three-dimensional proliferation of osteoblasts in rodent bone regeneration models.

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

Journal of biomedical materials research. Part A 90 ( 3 ) 811 - 818 2009.09

We have successfully synthesized hydroxyapatite fibers via a homogenous precipitation method. Using these hydroxyapatite fibers, we have produced the apatite fiber scaffolds (AFS) with well-controlled pore sizes (porosity above 95%). The AFS is relatively simple to synthesize, and its porosity and pore size are controllable. The usefulness of AFS as a scaffold for bone regeneration was evaluated by (1) seeding and culturing cells in the AFS in vitro, (2) implanting the AFS seeded with cells inside the subcutaneous tissue of mice. The AFS had biocompatibility to support cell adhesion, proliferation, and differentiation. Ectopic bone formation could be formed in the AFS at 12 weeks after implantation into the subcutaneous tissue. Because of its high interpore connection, pore diameters, and porosity, it was believed that AFS was an effective scaffold that provided a three-dimensional cell culture environment. In both in vitro and in vivo environments, the more porous AFS was more advantageous in cell proliferation, cell adhesion, proliferating capacity, robust cell differentiation, ultimately inducing bone ingrowth inside the scaffolds.

Longitudinal magnetic resonance imaging study on whiplash injury patients

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

Journal of Orthopaedic Science 14 ( 5 ) 602 - 610 2009.09

ISSN 0949-2658

Background: We conducted a prospective long-term follow-up study to assess associations between magnetic resonance imaging (MRI) findings and changes in clinical symptoms, as well as factors relating to the prognosis of symptoms. Methods: A total of 133 patients with acute whiplash injury between 1993 and 1996 participated in this follow-up study. They underwent neurological examinations by spine surgeons and second MRI scans of the cervical spine were obtained. They also filled out a questionnaire regarding cervical symptoms and the accident details. The items evaluated by MRI were (1) a decrease in the signal intensity of the intervertebral disc; (2) anterior compression of the dura and the spinal cord; (3) posterior disc protrusion; (4) disc space narrowing; and (5) foraminal stenosis. Relations between the presence/absence of degenerative changes on MRI, accident details, and patients' symptoms were assessed by calculating the adjusted odds ratio (OR). Results: Progression of some degenerative changes was recognized on MRI in 98.5% of the 133 whiplash injury patients, and clinical symptoms diminished in more than a half of the 133 patients. There were no statistically significant associations between MRI findings and changes in clinical symptoms. The prognosis for neck pain tended to be poor after accidents with double collisions (rear-end collision followed by frontend collision) [adjusted OR 5.83, 95% confidence interval (CI) 1.15-29.71] and accidents with serious car damage (2.87, 1.03-7.99). The prognosis for stiff shoulders tended to be poor in women (2.83, 1.23-6.51); and the prognosis for numbness in the upper extremities tended to be poor after accidents with serious car damage (3.39, 1.14-10.06). Conclusions: This study demonstrated that progression of degenerative changes of the cervical spine on MRI was not associated with clinical symptoms during the 10-year period after whiplash injury. © 2009 The Japanese Orthopaedic Association.

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IL-27 abrogates receptor activator of NF-κB ligand-mediated osteoclastogenesis of human granulocyte-macrophage colony-forming unit cells through STAT1-dependent inhibition of c-Fos

Furukawa Mitsuru, Takaishi Hironari, Takito Jiro, Yoda Masaki, Sakai Sadaoki, Hikata Tomohiro, Hakozaki Akihiro, Uchikawa Shinichi, Matsumoto Morio, Chiba Kazuhiro, Kimura Tokuhiro, Okada Yasunori, Matsuo Koichi, Yoshida Hiroki, Toyama Yoshiaki

Journal of Immunology 183 ( 4 ) 2397 - 2406 2009.08

ISSN 0022-1767

IL-27 was first discovered as a factor supporting initial Th1 immune responses. Subsequent studies revealed that this cytokine has pleiotropic effects, including inhibition of certain immune cells, a regulatory role in hemopoietic stem cell differentiation, and antitumor activities. However, the role of human IL (hIL)-27 in human osteoclast precursors and inflammatory bone disease is unclear. Here, we examined the direct effect of hIL-27 on human osteoclastogenesis. Human bone marrow cells cultured in MethoCult medium containing human (h) GM-CSF, human stem cell factor, and hIL-3 expressed Mac-1, c-kit, and c-Fms. These cells, called hCFU-GMs, also expressed the IL-27 receptor, an IL-27Rα (WSX-1)/gp130 heterodimer. Cultivation in hM-CSF and human receptor activator of NF-κB ligand induced the differentiation of tartrate-resistant acid phosphatase-positive multinucleated cells (osteoclasts) from hCFU-GMs, and hIL-27 inhibited this osteoclastogenesis in a dose-dependent manner. hIL-27 also repressed bone resorption by osteoclasts on a dentine slice. hIL-27 caused a remarkable increase in STAT1 phosphorylation and enhanced the STAT1 protein level. It also inhibited the expression of receptor activator of NF-κB ligand-induced c-Fos and cytoplasmic, calcineurin-dependent 1 NFAT (NFATc1), which are indispensable transcription factors for osteoclastogenesis. Fludarabine, a STAT1 inhibitor, and STAT1 small interfering RNA partially rescued the inhibition of osteoclastogenesis by IL-27. A WSX-1 deficiency caused severe inflammatory bone destruction primed by Escherichia coli cell wall lysate in vivo. Therefore, hIL-27 may act as an anti-inflammatory cytokine in human bone destruction, by inhibiting osteoclastogenesis from hCFU-GMs via STAT1-dependent down-regulation of the transcription factor c-Fos. Our results suggest that hIL-27 may prove useful as a therapeutic target for inflammatory bone destruction. Copyright © 2009 by The American Association of Immunologists, Inc.

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Letters

Matsumoto Morio

Spine 34 ( 17 ) 1886 2009.08

ISSN 0362-2436

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Intramedullary solitary fibrous tumor of the spinal cord

Ishii Ken, Nakamura Masaya, Matsumoto Morio, Mukai Makio, Toyama Yoshiaki, Chiba Kazuhiro

Journal of Orthopaedic Science 14 ( 4 ) 450 - 454 2009.07

ISSN 0949-2658

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Clinical significance and prognosis of idiopathic syringomyelia

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

Journal of Spinal Disorders and Techniques 22 ( 5 ) 372 - 375 2009.07

ISSN 1536-0652

STUDY DESIGN: Retrospective case series. OBJECTIVE: To determine the clinical significance and prognosis of idiopathic syringomyelia. SUMMARY OF BACKGROUND DATA: With the widespread use of magnetic resonance imaging, cases of syringomyelia are found occasionally. However, the clinical significance and optimum treatment strategy for idiopathic syringomyelia remain unclear, because there are few reports on details of this condition. METHODS: The clinical records and magnetic resonance images of 15 patients with idiopathic syringomyelia were reviewed to determine the changes in patient's neurologic status assessed by the Japanese Orthopedic Association scores for cervical myelopathy and the distribution of the syringomyelia on magnetic resonance imaging. Twelve cases were treated conservatively (conservative group) and syringo-subarachnoid shunt was performed in the remaining 3 cases (surgical group). The follow-up period ranged from 7 to 20 years (mean: 10.5 y). RESULTS: The localized type of idiopathic syringomyelia, which extended under 3 vertebras (mean: 2.1 vertebras), was observed in the 12 patients of the conservative group. There were no significant changes in either the size of the syringomyelia or the severity of the neurologic deficits during the follow-up period (mean: 10 y). In contrast, the extended type, which distributed over 4 or more vertebras (mean: 10.2 vertebras), was observed in the 3 patients of the surgical group. Because of severe and progressive neurologic deficits, syringo-subarachnoid shunt was performed and the surgery successfully prevented further neurologic deterioration. The mean Japanese Orthopedic Association score of the surgical group was significantly lower than that of the conservative group, both at the time of the initial examination and at the final follow-up. CONCLUSIONS: There are 2 types of idiopathic syringomyelia. One is a "localized" type, which might represents congenital enlargement of the central canal of the spinal cord, and can be managed conservatively. The other is an "extended" type, which causes progressive neurologic dysfunction, and should be treated surgically to prevent further neurologic deterioration. Further study should be needed to clarify the mechanism of the extended type of idiopathic syringomyelia. © 2009 Lippincott Williams & Wilkins, Inc.

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Diagnostic validity of space available for the spinal cord at C1 level for cervical myelopathy in patients with rheumatoid arthritis

Oda Takenori, Yonenobu Kazuo, Fujimura Yoshikazu, Ishii Yushin, Nakahara Shinnosuke, Matsunaga Shunji, Shimizu Takachika, Matsumoto Morio

Spine 34 ( 13 ) 1395 - 1398 2009.06

ISSN 0362-2436

STUDY DESIGN. Retrospective cohort study. OBJECTIVE. To evaluate diagnostic validity of space available for the spinal cord (SAC) at C1 level for myelopathy in patients with rheumatoid arthritis (RA). SUMMARY OF BACKGROUND DATA. The relationship of SAC at C1 level with myelopathy has been evaluated by relatively small number of the patients, and 2 criteria have been proposed. METHODS. Two cohorts of the patients with RA were established. Group A consisted of 140 patients with myeopathy due to upper cervical involvement selected from the database. Group B consisted of 99 patients with upper cervical subluxation, but not associated with myelopathy selected from the consecutive series of the hospitalized patients. Distributions of SAC at C1 level in both groups were evaluated. Efficacy indexes for screening (sensitivity, specificity, etc.) were calculated for these patients' population by previously demonstrated 2 criteria. In addition, analysis according to receiver operating characteristic (ROC) curve was performed. RESULTS. The average values of SAC were 11.1 mm in Group A and 16.5 mm in Group B. When cut-off point for myelopathy was defined as 13 mm or less, sensitivity and specificity were 82% and 85%, respectively. When it was defined as 14 mm or less, sensitivity increased (88%) while specificity decreased (74%). Accuracies by these 2 criteria were almost the same (83%, 82%). The left upper corner point of ROC curve was located between these 2 cut-off points. CONCLUSION. Distributions of SAC showed that SAC was a reliable parameter for relating myelopathy in patients with upper cervical subluxation in RA. The plots according to ROC curve showed adequacy of previously demonstrated 2 cut-off points. For the purpose to screen the patients with high risk for myelopathy, 14 mm or less was recommended as a cut-off point of SAC. © 2009 Lippincott Williams & Wilkins, Inc.

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