研究者詳細 - 渡邉　航太

論文 - 渡邉　航太

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Patients majoring in a healthcare field after scoliosis surgery: Comparison with the national census in Japan

Kotani T., Sakuma T., Nakayama K., Iijima Y., Watanabe K., Isogai N., Akazawa T., Sato K., Asada T., Kishida S., Muramatsu Y., Sasaki Y., Ueno K., Katogi T., Minami S., Inage K., Shiga Y., Ohtori S.

Journal of Orthopaedic Science （Journal of Orthopaedic Science） 25 （ 3 ） 394 - 399 2020年05月

ISSN 09492658

Background: Although scoliosis surgery early in life may affect the career choice of the patient in favor of a healthcare field, no study has analyzed this relationship. We investigated the career paths of patients after scoliosis surgery. Methods: A total of 212 patients with scoliosis who underwent corrective surgery at 12–17 years of age were mailed a questionnaire, of whom 98 (mean age at survey: 21.0 ± 1.7, years) responded. Choice of study major was determined by the same questions used in the Japanese national census. Results: Of the 98 patients, 35% chose a career in healthcare compared with 11% of the general population of the same age, based on the national census. Healthcare was the most popular career choice of patients, whereas it ranked fourth according to the national census. Furthermore, 87% of patients reported that their decision to pursue a healthcare-related career was affected by their own medical experiences. Among the healthcare-related occupations, nursing ranked first, accounting for 35% of all healthcare professions chosen by the patients. Compared with patients who chose a non-healthcare career, those choosing a healthcare career decided on their study major at a significantly lower age. Conclusions: One-third of patients with scoliosis who underwent spine surgery chose a career in a healthcare field. Furthermore, an earlier age at the time of making a career decision was a significant factor associated with choosing a healthcare career. These findings suggest that the patients' experiences in the hospital positively affected their future career paths.

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Characteristic cerebral structural changes identified using voxel-based morphometry in patients with post-surgical chronic myelopathic pain

Horiuchi Y., Tsuji O., Komaki Y., Fujiyoshi K., Hikishima K., Konomi T., Nagoshi N., Watanabe K., Matsumoto M., Horiuchi K., Nakamura M.

Spinal Cord （Spinal Cord） 58 （ 4 ） 467 - 475 2020年04月

ISSN 13624393

Study Design: Cross-sectional study. Objective: Patients who undergo intramedullary spinal surgery occasionally experience post-surgical chronic pain; however, the underlying mechanisms are not yet completely understood. Therefore, this study aimed to identify the cerebral structural changes in patients with post-surgical chronic myelopathic pain using voxel-based morphometry. Setting: Single university hospital in Tokyo, Japan. Methods: Forty-nine patients who had undergone intramedullary spinal surgery between January 2002 and April 2014 participated in this study. Participants were classified into two groups based on their post-surgical chronic pain intensity: control (numeric rating scale score of <3) and pain (numeric rating scale score of ≥3) groups. We compared pain questionnaire and brain MRI between two groups. Brain MRI data of each participants was analyzed using voxel-based morphometry. Results: Voxel-based morphometry revealed that the gray matter volume in the left supplementary motor area, left primary motor area, and left posterior cingulate cortex was higher in the pain group than that in the control group. In addition, the numeric rating scale score was significantly correlated with increased gray matter volume in the left primary motor area, left posterior cingulate cortex, and right superior parietal lobule. Conclusion: Present study elucidates the characteristic cerebral structural changes after an intramedullary spinal surgery using voxel-based morphometry and indicates that the structural changes in specific cerebral areas are associated with post-surgical chronic myelopathic pain.

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Midterm surgical outcomes of a short fusion strategy for adolescent idiopathic scoliosis with Lenke 5C curve

Ogura Y., Okada E., Fujii T., Yagi M., Fujita N., Suzuki S., Hosogane N., Kitagawa T., Tsuji O., Nagoshi N., Nakamura M., Matsumoto M., Watanabe K.

Spine Journal （Spine Journal） 20 （ 3 ） 361 - 368 2020年03月

ISSN 15299430

BACKGROUND CONTEXT: A previous study examined the short-term (2 years) outcomes of a short fusion strategy for Lenke type 5C curves. This strategy had a little less correction rate with no difference in coronal and sagittal balance and SRS-22 scores to those of a conventional strategy and was superior in operative time and intraoperative bleeding. However, its effectiveness in longer follow-up periods was unknown. PURPOSE: To assess midterm surgical outcomes of a short fusion strategy for adolescent idiopathic scoliosis (AIS) with Lenke type 5C curve, involving posterior correction and fusion surgery (PSF) using pedicle-screw constructs. STUDY DESIGN: Retrospective case series. PATIENT SAMPLE: Twenty-nine patients who underwent PSF for AIS with Lenke type 5C curve with a minimum 5-year follow-up. OUTCOME MEASURES: Radiographic parameters and SRS-22. METHODS: We compared radiographic parameters and clinical outcomes between patients with an upper instrumented vertebra (UIV) at the end vertebra (EV) (n=12) and those treated by short fusion (S), with a UIV one level caudal to the EV (n=17). RESULTS: A preoperative mean Cobb angle of 51.9±13.8° was corrected to 11.7±7.7° in the EV group, and an angle of 46.0±6.6° was corrected to 9.3±5.2° in the S group. The correction was maintained in both groups at the final follow-up, and the mean correction loss was 2.8±6.8° in the EV and 6.5±6.5° in the S group (p=.143). The mean correction rate at the final follow-up was not significantly different between the EV (71.4±11.8%) and S (64.9±13.7%) groups (p=.199). A Cobb angle of a thoracic curve was significantly improved immediately after surgery and maintained during the follow-up period in the both groups. Coronal and sagittal balance, thoracic kyphosis, lumbar lordosis, L4 tilt, UIV/LIV tilt, shoulder balance, and SRS-22 had no difference between the two groups. CONCLUSIONS: There was no difference in radiographic parameters and SRS-22 between patients treated with a UIV at the UEV and patients treated using a short fusion strategy, in which the UIV was one level caudal to the UEV. The short fusion strategy can be one of the alternatives in PSF for Lenke type 5C curves, at least in 5-year time frame.

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Clinical Outcomes, Complications, and Cost-effectiveness in Surgically Treated Adult Spinal Deformity over 70 Years: A Propensity score-Matched Analysis

Yagi M., Fujita N., Okada E., Tsuji O., Nagoshi N., Asazuma T., Nakamura M., Matsumoto M., Watanabe K.

Clinical Spine Surgery （Clinical Spine Surgery） 33 （ 1 ） E14 - E20 2020年02月

ISSN 23800186

Study Design:This is a multicentered retrospective study.Summary of Background Data:Surgical correction for the adult spinal deformity (ASD) is effective but carries substantial risks for complications. The diverse pathologies of ASD make it difficult to determine the effect of advanced age on outcomes.Objective:The objective of this study was to assess how advanced age affects outcomes and cost-effectiveness for corrective surgery for ASD.Materials and Methods:We used data from a multicenter database to conduct propensity score-matched comparisons of 50 patients who were surgically treated for ASD when at least 50 years old and were followed for at least 2 years, to clarify whether advanced age is a risk factor for inferior health-related quality of life and cost-effectiveness. Patients were grouped by age, 50-65 years (M group: 59±4 y) or >70 years (O group: 74±3 y), and were propensity score-matched for sex, body mass index, upper and lower instrumented vertebrae, the use of pedicle-subtraction osteotomy, and sagittal alignment. Cost-effectiveness was determined by cost/quality-adjusted life years.Results:Oswestry Disability Index and Scoliosis Research Society-22 (SRS-22) pain and self-image at the 2-year follow-up were significantly inferior in the O group (Oswestry Disability Index: 32±9% vs. 25±13%, P=0.01; SRS-22 pain: 3.5±0.7 vs. 3.9±0.6, P=0.05; SRS-22 self-image: 3.5±0.6 vs. 3.8±0.9, P=0.03). The O group had more complications than the M group (55% vs. 29%). The odds ratios in the O group were 4.0 for postoperative complications (95% confidence interval: 1.1-12.3) and 4.9 for implant-related complications (95% confidence interval: 1.2-21.1). Cost-utility analysis at 2 years after surgery indicated that the surgery was less cost-effective in the O group (cost/quality-adjusted life year: O group: $211,636 vs. M group: 125,887, P=0.01).Conclusions:Outcomes for corrective surgery for ASD were inferior in geriatric patients compared with middle-aged patients, in whom the extent of spinal deformity and the operation type were adjusted similarly. Special attention is needed when considering surgical treatment for geriatric ASD patients.

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Risk Factors for Postoperative Distal Adding-on in Lenke Type 1B and 1C and its Influence on Residual Lumbar Curve

Fujii T., Daimon K., Fujita N., Yagi M., Michikawa T., Hosogane N., Nagoshi N., Tsuji O., Kaneko S., Tsuji T., Nakamura M., Matsumoto M., Watanabe K.

Journal of Pediatric Orthopaedics （Journal of Pediatric Orthopaedics） 40 （ 2 ） e77 - e83 2020年02月

ISSN 02716798

Background:Distal adding-on (DA) in adolescent idiopathic scoliosis is a radiographic complication that can negatively affect clinical results. However, the risk factors for DA and the influences of DA on the residual lumbar curves have not been fully elucidated in Lenke type 1B and 1C curves. The objective of this study was to investigate risk factors for postoperative DA in Lenke type 1B and 1C curves, and the influence of DA on residual lumbar curves.Methods:We retrospectively evaluated 46 adolescent idiopathic scoliosis patients with Lenke type 1B or 1C curves who underwent posterior correction and fusion surgery with selective thoracic fusion. Patients were grouped according to the presence or absence of DA on radiographs at the 2-year follow-up. We compared coronal radiographic parameters between the 2 groups, including the Cobb angle, L4 tilt angle, apical translation, and relative positions of the end vertebra (EV), stable vertebra (SV), neutral vertebra (NV), and last touching vertebra (LTV) to the lower instrumented vertebra (LIV).Results:DA was present in 11 patients (24%) at the 2-year follow-up, and the mean LIV-EV, LIV-NV, LIV-SV, and LIV-LTV relative positions were significantly smaller in the DA than in the non-DA group. Preoperative radiographic parameters were similar between the 2 groups, including the mean L4 tilt angle (non-DA,-8±4 degrees; DA,-7±4 degrees). At the 2-year follow-up, the mean apical translation of the lumbar curve was smaller in the DA group (non-DA,-16±8 mm; DA,-7±11 mm) and the mean L4 tilt angle was significantly more horizontalized (non-DA,-8±4 degrees; DA,-1±5 degrees). Multivariate analysis showed that the number of levels between the LIV and LTV (LIV-LTV) was significantly associated with DA.Conclusions:A LIV at or cranial to the LTV was a significant risk factor for postoperative DA in Lenke type 1B and 1C curves. Spontaneous correction of the residual lumbar curve was superior in patients with DA.

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Outcomes of Surgery for Thoracic Myelopathy Owing to Thoracic Ossification of the Ligamentum Flavum in a Nationwide Multicenter Prospectively Collected Study in 223 Patients: Is Instrumented Fusion Necessary?

Ando K., Imagama S., Kaito T., Takenaka S., Sakai K., Egawa S., Shindo S., Watanabe K., Fujita N., Matsumoto M., Nakashima H., Wada K., Kimura A., Takeshita K., Kato S., Murakami H., Takeuchi K., Takahata M., Koda M., Yamazaki M., Watanabe M., Fujibayashi S., Furuya T., Kawaguchi Y., Matsuyama Y., Yoshii T., Okawa A.

Spine （Spine） 45 （ 3 ） E170 - E178 2020年02月

ISSN 03622436

Study Design.Prospectively collected, multicenter, nationwide study.Objective.The aim of this study was to investigate recent surgical methods and trends, outcomes, and perioperative complications in surgery for thoracic ossification of the ligamentum flavum (T-OLF).Summary of Background Data.A prospective multicenter study of surgical complications and risk factors for T-OLF has not been performed, and previous multicenter retrospective studies have lacked details for these items.Methods.Surgical methods, pre- A nd postoperative thoracic myelopathy (Japanese Orthopedic Association [JOA] score), symptoms, and intraoperative neurophysiological monitoring were investigated prospectively in 223 cases. Differences in these factors between fusion and nonfusion procedures for T-OLF were examined. The minimum follow-up period was 2 years after surgeryResults.The mean JOA score was 6.2 points preoperatively, and 7.9, 8.2, and 8.2 points at 6 months, 1, and 2 year postoperatively, giving mean recovery rates of 35.0%, 40.9%, and 41.4% respectively. Posterior decompression and fusion with instrumentation was performed in 109 cases (48.9%). There were 45 perioperative complications in 30 cases (13.5%), with aggravation of motor disturbance in the lower extremities being most common (4.0%, n=9). Patients treated with fusion had a significantly higher BMI, rate of gait disturbance, ossification occupation rate of OLF at computed tomography, and intramedullary high intensity area at magnetic resonance imaging (P<0.01). The preoperative JOA score was lower (P<0.05) and the JOA recovery rate at 1 year after surgery was significantly higher in cases treated without fusion (44.9% vs. 37.1%, P<0.05).Conclusion.The high rate of surgery with instrumentation of 48.9% reflects the current major trend toward posterior instrumented fusion surgery for T-OLF. Fusion surgery with instrumentation may be appropriate for patients with severe OLF and preoperative myelopathy. A further prospective study of long-term outcomes is required with a focus on optimal surgical timing and the surgical procedure for T-OPLL.Level of Evidence: 3.

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The surgical outcomes of spinal fusion for osteoporotic vertebral fractures in the lower lumbar spine with a neurological deficit

Isogai N., Hosogane N., Funao H., Nojiri K., Suzuki S., Okada E., Ueda S., Hikata T., Shiono Y., Watanabe K., Watanabe K., Kaito T., Yamashita T., Fujiwara H., Nagamoto Y., Terai H., Tamai K., Matsuoka Y., Suzuki H., Nishimura H., Tagami A., Yamada S., Adachi S., Ohtori S., Orita S., Furuya T., Yoshii T., Ushio S., Inoue G., Miyagi M., Saito W., Imagama S., Ando K., Sakai D., Nukaga T., Kiyasu K., Kimura A., Inoue H., Nakano A., Harimaya K., Kawaguchi K., Yokoyama N., Oishi H., Doi T., Ikegami S., Shimizu M., Futatsugi T., Kakutani K., Yurube T., Oshima M., Uei H., Aoki Y., Takahata M., Iwata A., Seki S., Murakami H., Yoshioka K., Endo H., Hongo M., Nakanishi K., Abe T., Tsukanishi T., Ishii K.

Spine Surgery and Related Research （Spine Surgery and Related Research） 4 （ 3 ） 199 - 207 2020年01月

Introduction: Osteoporotic vertebral fracture (OVF) is the most common osteoporotic fracture, and some patients require surgical intervention to improve their impaired activities of daily living with neurological deficits. However, many previous reports have focused on OVF around the thoracolumbar junction, and the surgical outcomes of lumbar OVF have not been thoroughly discussed. We aimed to investigate the surgical outcomes for lumbar OVF with a neurological deficit. Methods: Patients who underwent fusion surgery for thoracolumbar OVF with a neurological deficit were enrolled at 28 institutions. Clinical information, comorbidities, perioperative complications, Japanese Orthopaedic Association scores, visual analog scale scores, and radiographic parameters were compared between patients with lower lumbar fracture (L3-5) and those with thoracolumbar junction fracture (T10-L2). Each patient with lower lumbar fracture (L group) was matched with to patients with thoracolumbar junction fracture (T group). Results: A total 403 patients (89 males and 314 females, mean age: 73.8 ± 7.8 years, mean follow-up: 3.9 ± 1.7 years) were included in this study. Lower lumbar OVF was frequently found in patients with lower bone mineral density. After matching, mechanical failure was more frequent in the L group (L group: 64%, T group: 39%; p < 0.001). There was no difference between groups in the clinical and radiographical outcomes, although the rates of complication and revision surgery were still high in both groups. Conclusions: The surgical intervention for OVF is effective in patients with myelopathy or radiculopathy regardless of the surgical level, although further study is required to improve clinical and radiographical outcomes.

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A comparison of cervical and thoracolumbar fractures associated with diffuse idiopathic skeletal hyperostosis—A nationwide multicenter study

Katoh H., Okada E., Yoshii T., Yamada T., Watanabe K., Katsumi K., Hiyama A., Nakagawa Y., Okada M., Endo T., Shiraishi Y., Takeuchi K., Matsunaga S., Maruo K., Sakai K., Kobayashi S., Ohba T., Wada K., Ohya J., Mori K., Tsushima M., Nishimura H., Tsuji T., Watanabe K., Matsumoto M., Okawa A., Watanabe M.

Journal of Clinical Medicine （Journal of Clinical Medicine） 9 （ 1 ） 2020年01月

In diffuse idiopathic hyperostosis (DISH), the ankylosed spine becomes susceptible to spinal fractures and spinal cord injuries due to the long lever arms of the fractured segments that make the fracture extremely unstable. The aim of this retrospective multicenter study was to examine the differences in DISH-affected spine fractures according to fracture level. The data of 285 cases with fractures of DISH-ankylosed segments diagnosed through computed tomography (CT) imaging were studied and the characteristics of 84 cases with cervical fractures were compared to 201 cases with thoracolumbar fractures. Examination of the CT images revealed that cervical fracture cases were associated with ossification of the posterior longitudinal ligament and had fractures at the intervertebral disc level, while thoracolumbar fracture cases were associated with ankylosing of the posterior elements and had fractures at the vertebral body. Neurologically, cervical fracture cases had a higher ratio of spinal cord injury leading to higher mortality, while thoracolumbar fracture cases had lower rates of initial spinal cord injury. However, a subset of thoracolumbar fracture cases suffered from a delay in diagnosis that led to higher rates of delayed neurological deterioration. Some of these thoracolumbar fracture cases had no apparent injury episode but experienced severe neurological deterioration. The information provided by this study will hopefully aid in the education of patients with DISH and raise the awareness of clinicians to potential pitfalls in the assessment of DISH trauma patients.

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Influence of novel design alteration of pedicle screw on pull-out strength: A finite element study

Takenaka S., Kaito T., Ishii K., Watanabe K., Watanabe K., Shinohara A., Harada T., Nakada F., Majima Y., Matsumoto M.

Journal of Orthopaedic Science （Journal of Orthopaedic Science） 25 （ 1 ） 66 - 72 2020年01月

ISSN 09492658

Background: We conducted a finite element study to assess the effectiveness of a novel pedicle screw design with two alterations in the distal and proximal portions. Methods: Finite element (FE) models of 24 vertebrae were constructed using computed tomographic data. Pull-out strength of 4 different pedicle screws were compared. The basic screw design was a dual threaded one (PS0), in which the proximal portion is double-threaded (cortical thread), and the distal portion is single-threaded (cancellous thread). In PS1, the inter-thread double-core shape was added to PS0 in the distal portion. Compared to PS0, in PS2, the proximal portion was elongated by 5 mm. PS3 had both PS1 and PS2 features. In addition, the 24 vertebrae were classified into 3 groups based on volumetric bone mineral density (vBMD) of the vertebral body: low <120 mg/cm3, moderate 120–170 mg/cm3, and high >170 mg/cm3. Results: The mean pull-out strengths (±SD) were 1137 ± 500 N, 1188 ± 520 N, 1191 ± 512 N, and 1242 ± 538 N for PS0, PS1, PS2, and PS3, respectively. In PS1, there was significant difference in the incremental ratio of pull-out strength to PS0 between the low and high vBMD groups (3.7 ± 1.6% vs. 5.0 ± 1.0%, p = 0.006). In PS2, there was a significant difference in the incremental ratio to PS0 between the moderate and high vBMD groups (7.6 ± 4.0% vs. 3.3 ± 1.8%, p < 0.001). In PS3, there was a significant difference in the incremental ratio to PS0 between the moderate and high vBMD groups (12.1 ± 4.8% vs. 8.5 ± 2.1%, p = 0.003). Conclusions: The two design alterations showed the combined additive effect in the PS3 design. The moderate vBMD group has a balanced bone property to reflect the combined effects of the PS1 and PS2 design alterations.

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Clinical Effects of Anterior Cervical Spondylolisthesis on Cervical Spondylotic Myelopathy After Posterior Decompression Surgery: A Retrospective Multicenter Study of 732 Cases

Ninomiya K., Yamane J., Aoyama R., Suzuki S., Shiono Y., Takahashi Y., Fujita N., Okada E., Tsuji O., Yagi M., Watanabe K., Iga T., Nakamura M., Matsumoto M., Ishii K., Nagoshi N.

Global Spine Journal （Global Spine Journal） 2020年

ISSN 21925682

Study Design: Multicenter retrospective study. Objectives: We aim to investigate features of cervical spondylotic myelopathy (CSM) associated with anterior cervical spondylolisthesis (ACS) during posterior decompression surgery. Methods: A total of 732 patients with CSM were enrolled, who underwent posterior decompression surgery between July 2011 and November 2015 at 17 institutions. The patients with ACS (group A), defined as an anterior slippage of ≥2 mm on plain radiographs, were compared with those without ACS (group non-A). Also, the characteristics of patients with ACS progression (group P), defined as postoperative worsening of ACS ≥2 mm or newly developed ACS, were investigated. Moreover, kyphosis was defined as C2-C7 angle in neutral position ≤−5°. The Japanese Orthopedic Association (JOA) scoring system was used for clinical evaluation. Results: Group A consisting of 62 patients (8.5%) had worse preoperative clinical status but comparable surgical outcomes to group non-A. Furthermore, ACS was associated with greater age, and the degree of slippage did not affect myelopathy grades. Seventeen patients (2.3%) were observed in group P, and preoperative ACS was a significant predisposing factor for the progression without clinical impact. Among the patients in group A, preoperative cervical kyphosis was a risk factor for lower JOA recovery rate. Conclusions: Although the presence of ACS increases the risk of postoperative progression, it is not a contraindication for posterior decompression. However, surgeons need to consider the indication of fusion surgery for the patients who have ACS accompanied by kyphosis because of the poor surgical outcomes.

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Poor Prognostic Factors for Surgical Treatment of Spinal Intramedullary Ependymoma (World Health Organization Grade II)

Tsuji O., Nagoshi N., Ishii R., Nori S., Suzuki S., Okada E., Fujita N., Yagi M., Matsumoto M., Nakamura M., Watanabe K.

Asian Spine Journal （Asian Spine Journal） 14 （ 6 ） 821 - 828 2020年

ISSN 19761902

Study Design: Single-center retrospective study. Purpose: We aimed to explore the postoperative prognostic factors for spinal intramedullary ependymoma. Overview of Literature: Ependymoma (World Health Organization grade II) is the most frequent intramedullary spinal tumor and is treated by total resection. However, postoperative deterioration of motor function occasionally occurs. Methods: Eighty patients who underwent surgical resection at Keio University and Fujita Health University in Tokyo, Japan between 2003 and 2015 with more than 2 years of follow-up were enrolled. A good surgical result was defined as an improvement in the modified McCormick Scale score by one grade or more or having the same clinical grade as was observed preoperatively. Meanwhile, a poor result was defined as a reduction in the McCormick Scale score of one grade or more or remaining in grade IV or V at final follow-up. Univariate and multivariate logistic regression analyses of the following factors were performed in the two groups: sex, age, preoperative Visual Analog Scale (VAS), tumor location, the extent of tumor resection, hemosiderin caps, cavity length, and tumor length on magnetic resonance imaging. Results: At final follow-up, 15 patients were included in the poor results group and 65 in the good results group. In the univariate analysis, the factors related to poor results were as follows: higher age, preoperative McCormick Scale score severity, higher preoperative VAS, thoracic location, hemosiderin capped, and non-gross total resection (GTR). A multiple logistic regression analysis was conducted and showed that age, worse preoperative McCormick Scale score, and non-GTR were significant factors for poor prognosis. Conclusions: The independent risk factors for motor deterioration after ependymoma resection were age, worse preoperative Mc-Cormick Scale score, and non-GTR. Early surgery for patients with even mild neurological disorders could facilitate functional outcomes. These results may contribute to determining the optimal timing of surgery for spinal intramedullary ependymoma.

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Impact of Tobacco Smoking on Outcomes after Posterior Decompression Surgery in Patients with Cervical Spondylotic Myelopathy: A Retrospective Multicenter Study

Nagoshi N., Kono H., Tsuji O., Aoyama R., Fujiyoshi K., Shiono Y., Ishikawa M., Daimon K., Hosogane N., Takeuchi A., Okada E., Fujita N., Yagi M., Nakamura M., Matsumoto M., Watanabe K., Ishii K., Yamane J.

Clinical Spine Surgery （Clinical Spine Surgery） 33 （ 10 ） E493 - E498 2020年

ISSN 23800186

Study Design:This was a case-control study.Objective:The objective of this study was to clarify the surgical outcomes after cervical posterior decompression in patients who smoked.Summary of Background Data:Smoking is associated with poor outcomes in the field of spinal surgery. However, the impact of tobacco smoking on the outcomes after posterior decompression surgery has not been fully evaluated in patients with cervical spondylotic myelopathy.Materials and Methods:In this retrospective multicenter study, 587 patients with cervical spondylotic myelopathy were enrolled at 17 institutions in Japan. Patients underwent cervical laminoplasty or laminectomy and were followed up for at least 1 year after surgery. Outcome measures were: preoperative smoking status, perioperative complications, the Japanese Orthopedic Association scale, and the Visual Analog Scale for neck pain. After adjusting for age and sex by exact matching, smoking and nonsmoking groups were compared using an unpaired t test for continuous variables or a χ2test for categorical variables.Results:There were 182 (31%) current smokers and 405 (69%) nonsmokers including previous smokers. After matching, 158 patients were extracted from each group. Demographic data and surgical information were almost the same between the groups. Regarding postoperative complications, there was no significant difference in the rate of surgical site infection, cerebrospinal fluid leakage, hematoma, segmental motor paralysis, or neurological deficit. However, smokers showed a significantly higher risk for delirium (3.8% vs. 0.0%, P=0.039). Smokers and nonsmokers showed comparable changes in functional recovery according to Japanese Orthopedic Association scores (3.2±2.1 vs. 3.0±2.1, P=0.425) and in neck pain reduction using the Visual Analog Scale (-1.7±3.1 vs. -1.4±2.8, P=0.417) at the final follow-up.Conclusions:Smokers exhibited functional restoration and neck pain reduction after cervical posterior decompression. Attention is required, however, for the postoperative complication of delirium, which could be caused by the acute cessation of tobacco smoking after admission.Level of Evidence:Level III.

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Tenosynovial giant cell tumor of the cervical spine: a case report

Furuhata R., Iwanami A., Tsuji O., Nagoshi N., Suzuki S., Okada E., Fujita N., Yagi M., Matsumoto M., Nakamura M., Watanabe K.

Spinal Cord Series and Cases （Spinal Cord Series and Cases） 5 （ 1 ） 2019年12月

Introduction: Tenosynovial giant cell tumors (TSGCTs) generally occur in the limb joints, and only rarely in the spine. This case report describes a patient with TSGCT of the spine at C1–C2, which was treated surgically and diagnosed as TSGCT. Case presentation: A 32-year-old woman with a 4-month history of neck pain and numbness in both upper extremities was referred to our department. Magnetic resonance imaging (MRI) revealed a neoplastic lesion extending from the left epidural space to the erector spinae muscles at the C1–C2 vertebral level, which was isointense on T1-weighted images, heterogeneously hypointense on T2-weighted images, and showed heterogeneous enhancement on gadopentetate dimeglumine (Gd-DTPA)-enhanced T1-weighted images. Computed tomography showed no findings suggestive of bone destruction of the vertebral body. Because the neurological symptoms were progressive, total macroscopic resection of the tumor was performed via a posterior approach. Histopathological examination of the resected specimen revealed the diagnosis of TSGCT. Improvement of the both the neck pain and upper-extremity numbness was noted postoperatively. An MRI obtained 6 months after the surgery revealed no evidence of tumor recurrence and the postoperative course was uneventful. Discussion: TSGCT of the upper cervical spine (C1–C2) is rare, and this is the tenth reported case. If a tumor is heterogeneously hypointense on T2-weighted MRI, which reflects hemosiderosis, the possibility of this tumor should be considered in the differential diagnosis.

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Association of Susceptibility Genes for Adolescent Idiopathic Scoliosis and Intervertebral Disc Degeneration with Adult Spinal Deformity

Takeda K., Kou I., Hosogane N., Otomo N., Yagi M., Kaneko S., Kono H., Ishikawa M., Takahashi Y., Ikegami T., Nojiri K., Okada E., Funao H., Okuyama K., Tsuji T., Fujita N., Nagoshi N., Tsuji O., Ogura Y., Ishii K., Nakamura M., Matsumoto M., Ikegawa S., Watanabe K.

Spine （Spine） 44 （ 23 ） 1623 - 1629 2019年12月

ISSN 03622436

Study Design.Genetic case-control study of single nucleotide polymorphisms (SNPs).Objective.To examine the association of previously reported susceptibility genes for adolescent idiopathic scoliosis (AIS) and intervertebral disc (IVD) degeneration with adult spinal deformity (ASD).Summary of Background Data.ASD is a spinal deformity that develops and progresses with age. Its etiology is unclear. Several ASD susceptibility genes were recently reported using a candidate gene approach; however, the sample sizes were small and associations with ASD development were not determined.Methods.ASD was defined as structural scoliosis with a Cobb angle more than 15° on standing radiographs, taken of patients at age 40 to 75 years in this study. Subjects in whom scoliosis was diagnosed before age 20 were excluded. We recruited 356 Japanese ASD subjects and 3341 healthy controls for case-control association studies of previously reported SNPs. We genotyped four known AIS-associated SNPs (rs11190870 in LBX1, rs6570507 in GPR126, rs10738445 in BNC2, and rs6137473 in PAX1) and three IVD degeneration-associated SNPs (rs1245582 in CHST3, rs2073711 in CILP, and rs1676486 in COL11A1) by the Invader assay.Results.Among the AIS-associated SNPs, rs11190870 and rs6137473 showed strong and nominal associations with ASD (P=1.44×10-4, 1.00×10-2, respectively). Of the IVD degeneration-associated SNPs, rs1245582 and rs2073711 showed no association with ASD, while rs1676486 showed a nominal association (P=1.10×10-2). In a subgroup analysis, rs11190870 was significantly associated with a Cobb angle more than 20° in the minor thoracic curve (P=1.44×10-4) and with a left convex lumbar curve (P=6.70×10-4), and nominally associated with an apical vertebra higher than L1 (P=1.80×10-2).Conclusion.rs11190870 in LBX1, a strong susceptibility SNP for AIS, may also be a susceptibility SNP for ASD. Thus, ASD and AIS may share a common genetic background.Level of Evidence: 4.

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Effects of prophylactic dexamethasone on postoperative nausea and vomiting in scoliosis correction surgery: a double-blind, randomized, placebo-controlled clinical trial

Wakamiya R., Seki H., Ideno S., Ihara N., Minoshima R., Watanabe K., Sato Y., Morisaki H.

Scientific Reports （Scientific Reports） 9 （ 1 ） 2019年12月

Dexamethasone is widely used for postoperative nausea and vomiting (PONV) prophylaxis, but its effect on PONV prevention in paediatric patients is validated only in short minor surgical procedures. In this study, we aimed to determine whether a single dose of dexamethasone reduces PONV in highly invasive surgeries that require opioid-based postoperative analgesia. One hundred adolescents undergoing scoliosis correction surgery were randomized to receive intravenous dexamethasone 0.15 mg/kg (dexamethasone group) or saline (control group) at induction of anaesthesia. The primary outcome was the incidence of PONV in the 72 h postoperatively. Data for 98 patients were available for analysis. The 72-h incidence of PONV was significantly lower in the dexamethasone group than in the control group (62.5% vs 84.0%; RR 0.74, 95% CI 0.58–0.96, P = 0.02). During the first and second 24-h postoperative intervals, fewer patients in the dexamethasone group received rescue antiemetics. Visual analogue scale scores for nausea and pain were lower in the dexamethasone group than in the control group during the first 24 h postoperatively. Dexamethasone did not increase the number of adverse events. The results of this study showed that a single dose of dexamethasone was effective for reducing PONV after paediatric scoliosis correction surgery.

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Genome-wide association study identifies 14 previously unreported susceptibility loci for adolescent idiopathic scoliosis in Japanese

Kou I., Otomo N., Takeda K., Momozawa Y., Lu H.F., Kubo M., Kamatani Y., Ogura Y., Takahashi Y., Nakajima M., Minami S., Uno K., Kawakami N., Ito M., Yonezawa I., Watanabe K., Kaito T., Yanagida H., Taneichi H., Harimaya K., Taniguchi Y., Shigematsu H., Iida T., Demura S., Sugawara R., Fujita N., Yagi M., Okada E., Hosogane N., Kono K., Nakamura M., Chiba K., Kotani T., Sakuma T., Akazawa T., Suzuki T., Nishida K., Kakutani K., Tsuji T., Sudo H., Iwata A., Sato T., Inami S., Matsumoto M., Terao C., Watanabe K., Ikegawa S.

Nature Communications （Nature Communications） 10 （ 1 ） 2019年12月

Adolescent idiopathic scoliosis (AIS) is the most common pediatric spinal deformity. Several AIS susceptibility loci have been identified; however, they could explain only a small proportion of AIS heritability. To identify additional AIS susceptibility loci, we conduct a meta-analysis of the three genome-wide association studies consisting of 79,211 Japanese individuals. We identify 20 loci significantly associated with AIS, including 14 previously not reported loci. These loci explain 4.6% of the phenotypic variance of AIS. We find 21 cis-expression quantitative trait loci-associated genes in seven of the fourteen loci. By a female meta-analysis, we identify additional three significant loci. We also find significant genetic correlations of AIS with body mass index and uric acid. The cell-type specificity analyses show the significant heritability enrichment for AIS in multiple cell-type groups, suggesting the heterogeneity of etiology and pathogenesis of AIS. Our findings provide insights into etiology and pathogenesis of AIS.

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An application of artificial intelligence to diagnostic imaging of spine disease: Estimating spinal alignment from moiré images

Watanabe K., Aoki Y., Matsumoto M.

Neurospine （Neurospine） 16 （ 4 ） 697 - 702 2019年12月

ISSN 25866583

The use of artificial intelligence (AI) as a tool supporting the diagnosis and treatment of spinal diseases is eagerly anticipated. In the field of diagnostic imaging, the possible application of AI includes diagnostic support for diseases requiring highly specialized expertise, such as trauma in children, scoliosis, symptomatic diseases, and spinal cord tumors. Moiré topography, which describes the 3-dimensional surface of the trunk with band patterns, has been used to screen students for scoliosis, but the interpretation of the band patterns can be ambiguous. Thus, we created a scoliosis screening system that estimates spinal alignment, the Cobb angle, and vertebral rotation from moiré images. In our system, a convolutional neural network (CNN) estimates the positions of 12 thoracic and 5 lumbar vertebrae, 17 spinous processes, and the vertebral rotation angle of each vertebra. We used this information to estimate the Cobb angle. The mean absolute error (MAE) of the estimated vertebral positions was 3.6 pixels (~5.4 mm) per person. T1 and L5 had smaller MAEs than the other levels. The MAE per person between the Cobb angle measured by doctors and the estimated Cobb angle was 3.42°. The MAE was 4.38° in normal spines, 3.13° in spines with a slight deformity, and 2.74° in spines with a mild to severe deformity. The MAE of the angle of vertebral rotation was 2.9° ± 1.4°, and was smaller when the deformity was milder. The proposed method of estimating the Cobb angle and AVR from moiré images using a CNN is expected to enhance the accuracy of scoliosis screening.

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Negative impact of spinal epidural lipomatosis on the surgical outcome of posterior lumbar spinous-splitting decompression surgery: a multicenter retrospective study

Fujita N., Ishihara S., Michikawa T., Suzuki S., Tsuji O., Nagoshi N., Okada E., Yagi M., Tsuji T., Kono H., Nakamura M., Matsumoto M., Watanabe K.

Spine Journal （Spine Journal） 19 （ 12 ） 1977 - 1985 2019年12月

ISSN 15299430

BACKGROUND CONTEXT: Spinal epidural lipomatosis (SEL) results from excess lumbar epidural fat (EF) accumulation that compresses the cauda equina or nerve roots. Guidelines for the therapeutic management of SEL are not currently available. PURPOSE: To elucidate the efficacy of lumbar decompression surgery in SEL. STUDY DESIGN: Multicenter retrospective study. PATIENT SAMPLE: A total of 288 consecutive patients who underwent posterior lumbar spinous-splitting decompression surgery for lumbar spinal canal stenosis and followed up greater than 2 years at participating institutions were retrospectively reviewed. OUTCOME MEASURES: Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Roland-Morris Disability Questionnaire (RDQ). METHODS: Participants were divided into two groups according to the ratio of EF to anteroposterior diameter of the spinal canal (EF/SC-L) at the spinal level with maximum dural tube compression. Patients with EF/SC-L of ≥0.6 and <0.6 were defined as those with SEL and non-SEL, respectively. We assessed whether surgical treatment was “effective” or “not effective” using the JOABPEQ based on the following: an increase of ≥20 points in the postoperative score compared with the preoperative score, or a preoperative score <90 with a postoperative score ≥90 points. We constructed a multiple Poisson regression model by adjusting for confounding factors, and determined estimated relative risk (RR) for “not effective” with surgical treatment using the JOABPEQ. Additionally, we selected age-, sex-, BMI-, and decompression levels-matched patients with non-SEL and compared the frequency of “not effective” between SEL patients (n=60) and non-SEL patients (n=60). RESULTS: Analysis using the RDQ and JOABPEQ showed that the 1- and 2-year postoperative scores were significantly better than the preoperative scores in the both groups. Multivariable Poisson regression analysis demonstrated that SEL was significantly associated with “not effective” for decompression surgery in the 1-year postoperative outcomes of walking ability ([RR] 1.5, 95% confidence interval [CI] 1.0–2.2) and social life (RR 1.3, 95% CI 1.0–1.8) and the 2-year postoperative outcomes of walking ability (RR 1.6, 95% CI 1.2–2.3). Matching analysis showed that SEL was significantly associated with “not effective” with lumbar decompression surgery in the 2-year postoperative outcomes of walking ability (p=.02). CONCLUSIONS: Patients with SEL exhibited significant improvements in surgical outcomes at 1 and 2 years postoperatively. However, compared with the non-SEL group, the efficacy of posterior lumbar spinous-splitting decompression surgery was worse in the SEL group, especially for walking ability. These results indicate that EF accumulation should be considered when planning treatment for patients with lumbar spinal canal stenosis and estimating the efficacy of lumbar decompression surgery.

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Ten-year Longitudinal Follow-up MRI Study of Age-related Changes in Thoracic Intervertebral Discs in Asymptomatic Subjects

Okada E., Daimon K., Fujiwara H., Nishiwaki Y., Nojiri K., Watanabe M., Katoh H., Ishihama H., Fujita N., Tsuji T., Nakamura M., Matsumoto M., Watanabe K.

Spine （Spine） 44 （ 22 ） E1317 - E1324 2019年11月

ISSN 03622436

Study Design.Prospective longitudinal study.Objective.The aim of this study was to evaluate long-term degenerative changes in intervertebral discs in the thoracic spine in healthy asymptomatic subjects.Summary of Background Data.Longitudinal magnetic resonance imaging (MRI) studies of intervertebral disc degeneration have been reported for the cervical and lumbar but not the thoracic spine.Methods.In this longitudinal study (average follow-up 10.0 ± 0.6 years), we assessed degenerative changes in the thoracic spine of 103 volunteers (58 men) of 223 healthy volunteers in the initial MRI study of the thoracic spine (follow-up rate 46.2%). The mean age at the initial study was 45.0 ± 11.5 years (24-77 years). Initial and follow-up thoracic-spine MRIs were graded for the following 4 factors of degenerative changes: decrease in signal intensity of intervertebral disc (DSI), posterior disc protrusion (PDP), anterior compression of dura and spinal cord (AC), and disc-space narrowing (DSN) from T1-2 to T12-L1. We assessed associations between changes in MRI grade and demographical factors such as age, sex, body mass index, smoking habits, sports activities, and disc degeneration in the cervical spine.Results.MRIs revealed that 63.1% of the subjects had degenerative changes in the thoracic intervertebral discs that had progressed at least one grade during the follow-up period. DSI progressed in 44.7% of subjects, PDP in 21.4%, and AC in 18.4% during the 10-year period. No DSN progression was seen. DSI was frequently observed in the upper thoracic spine (T1-2 to T4-5). Disc degeneration was relatively scarce in the lower thoracic spine (T9-10 to T12-L1). PDP was frequently observed in the middle thoracic spine (T5-6 toT8-9). We found significant associations between DSI and cervical-spine degeneration (P = .004) and between AC and smoking (P = .04).Conclusion.Progressive thoracic disc degeneration, observed in 63.1% of subjects; was significantly associated with smoking and with cervical-spine degeneration.Level of Evidence: 2.

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Complications after spinal fixation surgery for osteoporotic vertebral collapse with neurological deficits: Japan Association of Spine Surgeons with ambition multicenter study

Sakai Y., Kaito T., Takenaka S., Yamashita T., Makino T., Hosogane N., Nojiri K., Suzuki S., Okada E., Watanabe K., Funao H., Isogai N., Ueda S., Hikata T., Shiono Y., Watanabe K., Katsumi K., Fujiwara H., Nagamoto Y., Terai H., Tamai K., Matsuoka Y., Suzuki H., Nishimura H., Tagami A., Yamada S., Adachi S., Ohtori S., Orita S., Furuya T., Yoshii T., Ushio S., Inoue G., Miyagi M., Saito W., Imagama S., Ando K., Sakai D., Nukaga T., Kiyasu K., Kimura A., Inoue H., Nakano A., Harimaya K., Doi T., Kawaguchi K., Yokoyama N., Oishi H., Ikegami S., Futatsugi T., Shimizu M., Kakutani K., Yurube T., Oshima M., Uei H., Aoki Y., Takahata M., Iwata A., Seki S., Murakami H., Yoshioka K., Endo H., Hongo M., Nakanishi K., Abe T., Tsukanishi T., Ishii K.

Journal of Orthopaedic Science （Journal of Orthopaedic Science） 24 （ 6 ） 985 - 990 2019年11月

ISSN 09492658

Background: There have been few reports on the incidence and risk factors of the complications after spinal fixation surgery for osteoporotic vertebral collapse (OVC) with neurological deficits. This study aimed to identify the incidence and risk factors of the complications after OVC surgery. Methods: In this retrospective multicenter study, a total of 403 patients (314 women and 89 men; mean age 73.8 years) who underwent spinal fixation surgery for OVC with neurological deficits between 2005 and 2014 were enrolled. Data on patient demographics were collected, including age, sex, body mass index, smoking, steroid use, medical comorbidities, and surgical procedures. All postoperative complications that occurred within 6 weeks were recorded. Patients were classified into two groups, namely, complication group and no complication group, and risk factors for postoperative complications were investigated by univariate and multivariate analyses. Results: Postoperative complications occurred in 57 patients (14.1%), and the most common complication was delirium (5.7%). In the univariate analysis, the complication group was found to be older (p = 0.039) and predominantly male (p = 0.049), with higher occurrence rate of liver disease (p = 0.001) and Parkinson's disease (p = 0.039) compared with the no-complication group. In the multivariate analysis, the significant independent risk factors were age (p = 0.021; odds ratio [OR] 1.051, 95% confidence interval [CI] 1.007–1.097), liver disease (p < 0.001; OR 8.993, 95% CI 2.882–28.065), and Parkinson's disease (p = 0.009; OR 3.636, 95% CI 1.378–9.599). Conclusions: Complications after spinal fixation surgery for OVC with neurological deficits occurred in 14.1%. Age, liver disease, and Parkinson's disease were demonstrated to be independent risk factors for postoperative complications.

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渡邉　航太

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