88 results on '"Naobumi Hosogane"'
Search Results
2. Impact of comorbidities on oncological outcomes of Japanese patients with high grade soft tissue sarcomas
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Takashi Tajima, Toru Udaka, Naobumi Hosogane, Shoichi Ichimura, and Takeshi Morii
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medicine.medical_specialty ,medicine.medical_treatment ,MEDLINE ,Soft Tissue Neoplasms ,Comorbidity ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Internal medicine ,mental disorders ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Significant risk ,Aged ,Retrospective Studies ,030222 orthopedics ,business.industry ,Incidence (epidemiology) ,Soft tissue sarcoma ,Soft tissue ,Sarcoma ,Prognosis ,medicine.disease ,Radiation therapy ,Charlson comorbidity index ,Surgery ,Neoplasm Recurrence, Local ,business ,030217 neurology & neurosurgery - Abstract
Considering the invasiveness of standard multidisciplinary approaches used for the treatment of soft tissue sarcoma, including surgery with wide margins, intensive chemotherapy, and radiotherapy, evaluation of comorbidities in high-grade soft tissue sarcoma patients is essential. Several previous studies have reported the impact of comorbidities on the survival of soft tissue sarcoma patients. Patient health status differs between nationalities or ethnic groups and only limited data has been reported with respect to the impact of comorbidities on Japanese soft tissue sarcoma patients.The incidence of each comorbidity, relationship between comorbidities and underlying clinicopathological factors, relationship between treatment status and comorbidities, and impact of comorbidities on disease-specific death in 136 patients with high-grade soft tissue sarcoma at the authors' institution were analyzed. For the evaluation of comorbidities, the updated Charlson comorbidity index was applied.Of the patients, 25% presented with more than one comorbidity. Elderly patients showed a significantly higher incidence of comorbidities (p 0.0001). Patients with congestive heart failure (p = 0.004), dementia (p 0.0001), hemiplegia/paraplegia (p 0.0001), and renal disease (p 0.0001) showed worse prognosis. Tumor grade (p = 0.01) and updated Charlson comorbidity index (p 0.0001) were independent risk factors for disease-specific death.Comorbidity status was a significant risk factor for disease-specific death in Japanese patients with high-grade soft tissue sarcoma. Innovations in comorbidity management may be a means for the improvement of oncological outcomes in soft tissue sarcoma. Given the difficulties in conducting standard randomized control studies in this field, data accumulation from real-world cases appears to be the most practical approach in establishing and applying strategies for the treatment of patients with comorbidities or elderly patients.
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- 2021
3. Identification of a Functional Susceptibility Variant for Adolescent Idiopathic Scoliosis that Upregulates Early Growth Response 1 (EGR1)-Mediated UNCX Expression
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Yoshiro Yonezawa, Long Guo, Hisaya Kakinuma, Nao Otomo, Soichiro Yoshino, Kazuki Takeda, Masahiro Nakajima, Toshiyuki Shiraki, Yoji Ogura, Yohei Takahashi, Yoshinao Koike, Shohei Minami, Koki Uno, Noriaki Kawakami, Manabu Ito, Ikuho Yonezawa, Kei Watanabe, Takashi Kaito, Haruhisa Yanagida, Hiroshi Taneichi, Katsumi Harimaya, Yuki Taniguchi, Hideki Shigematsu, Takahiro Iida, Satoru Demura, Ryo Sugawara, Nobuyuki Fujita, Mitsuru Yagi, Eijiro Okada, Naobumi Hosogane, Katsuki Kono, Kazuhiro Chiba, Toshiaki Kotani, Tsuyoshi Sakuma, Tsutomu Akazawa, Teppei Suzuki, Kotaro Nishida, Kenichiro Kakutani, Taichi Tsuji, Hideki Sudo, Akira Iwata, Tatsuya Sato, Satoshi Inami, Masaya Nakamura, Morio Matsumoto, Chikashi Terao, Kota Watanabe, Hitoshi Okamoto, and Shiro Ikegawa
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Endocrinology, Diabetes and Metabolism ,Orthopedics and Sports Medicine - Abstract
Adolescent idiopathic scoliosis (AIS) is a serious health problem affecting 3% of live births all over the world. Many loci associated with AIS have been identified by previous genome wide association studies, but their biological implication remains mostly unclear. In this study, we evaluated the AIS-associated variants in the 7p22.3 locus by combining in silico, in vitro, and in vivo analyses. rs78148157 was located in an enhancer of UNCX, a homeobox gene and its risk allele upregulated the UNCX expression. A transcription factor, early growth response 1 (EGR1), transactivated the rs78148157-located enhancer and showed a higher binding affinity for the risk allele of rs78148157. Furthermore, zebrafish larvae with UNCX messenger RNA (mRNA) injection developed body curvature and defective neurogenesis in a dose-dependent manner. rs78148157 confers the genetic susceptibility to AIS by enhancing the EGR1-regulated UNCX expression. © 2022 American Society for Bone and Mineral Research (ASBMR).
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- 2022
4. Risk factors for early reoperation in patients after posterior lumbar interbody fusion surgery. A propensity-matched cohort analysis
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Tomohiro Hikata, Yohei Takahashi, Shinichi Ishihara, Yoshio Shinozaki, Ken Nimoniya, Tsunehiko Konomi, Takeshi Fujii, Haruki Funao, Mitsuru Yagi, Naobumi Hosogane, Ken Ishii, Masaya Nakamura, Morio Matsumoto, and Kota Watanabe
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Orthopedics and Sports Medicine ,Surgery - Abstract
Reoperation is usually associated with poor results and increased morbidity and hospital costs. However, the rates, causes, and risk factors for reoperation in patients undergoing lumbar spinal fusion surgery remain controversial. This study aimed to identify the risk factors for early reoperation after posterior lumbar interbody fusion surgery and to compare the clinical outcomes between patients who underwent reoperation and those who did not.We investigated a multicenter medical record database of 1263 patients who underwent posterior lumbar interbody fusion surgery between 2012 and 2015. A total of 72 (5.7%) reoperations within two years after surgery were identified and were propensity-matched for age, sex, number of fusion segments, and surgeon's experience.We analyzed a total of 114 patients (57 who underwent reoperation (R group) and 57 who did not (C group)). The mean age was 62.6 ± 13.4 years, with 78 men and 36 women. The mean number of fused segments was 1.2 ± 0.5. Surgical site infection was the most common cause of reoperation. There were significant differences in the incidence of diabetes mellitus (p = 0.024), preoperative ambulation status (p = 0.046), and ASA grade (p 0.001) between the C and R groups. The recovery rate of the Japanese Orthopaedic Association score was significantly lower in the R group compared to the C group (R: 50.5 ± 28.8%, C: 63.9 ± 33.7%, p = 0.024). There were significant differences in the bone fusion rate (R: 63.2%, C: 96.5%, p 0.001) and incidence of screw loosening (R: 31.6%; C: 10.5%; p = 0.006).Diabetes mellitus, preoperative ambulation status, and ASA grade were significant risk factors for early reoperation following posterior lumbar interbody fusion surgery. The patients who underwent early reoperation had worse clinical outcomes than those who did not.
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- 2022
5. Polygenic Risk Score of Adolescent Idiopathic Scoliosis for Potential Clinical Use
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Tatsuya Sato, Yuki Taniguchi, Morio Matsumoto, Yohei Takahashi, Katsumi Harimaya, Mitsuru Yagi, Katsuki Kono, Ryo Sugawara, Koki Uno, Akira Iwata, Ikuyo Kou, Yukihide Momozawa, Masaru Koido, Kazuhiro Chiba, Kotaro Nishida, Masaya Nakamura, Kazuki Takeda, Masahiro Nakajima, Tsutomu Akazawa, Yoji Ogura, Nao Otomo, Taichi Tsuji, Kenichiro Kakutani, Kazuo Kaneko, Hiroshi Taneichi, Manabu Ito, Yuta Kochi, Noriaki Kawakami, Takahiro Iida, Toshiaki Kotani, Wei Chiao Chang, Hideki Shigematsu, Teppei Suzuki, Kota Watanabe, Eijiro Okada, Shohei Minami, Nobuyuki Fujita, Shiro Ikegawa, Haruhisa Yanagida, Chikashi Terao, Yoichiro Kamatani, Michiaki Kubo, Takashi Kaito, Naobumi Hosogane, Satoshi Inami, Satoru Demura, Kei Watanabe, Hsing Fang Lu, Tsuyoshi Sakuma, and Hideki Sudo
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Oncology ,medicine.medical_specialty ,Adolescent ,Cobb angle ,business.industry ,Endocrinology, Diabetes and Metabolism ,Genome-wide association study ,Odds ratio ,Heritability ,Twin study ,Genetic correlation ,Bone and Bones ,Decile ,Scoliosis ,Risk Factors ,Internal medicine ,medicine ,Humans ,Female ,Orthopedics and Sports Medicine ,Kyphosis ,business ,Body mass index ,Genome-Wide Association Study - Abstract
Adolescent idiopathic scoliosis (AIS) is a common disease causing three-dimensional spinal deformity in as many as 3% of adolescents. Development of a method that can accurately predict the onset and progression of AIS is an immediate need for clinical practice. Because the heritability of AIS is estimated as high as 87.5% in twin studies, prediction of its onset and progression based on genetic data is a promising option. We show the usefulness of polygenic risk score (PRS) for the prediction of onset and progression of AIS. We used AIS genomewide association study (GWAS) data comprising 79,211 subjects in three cohorts and constructed a PRS based on association statistics in a discovery set including 31,999 female subjects. After calibration using a validation data set, we applied the PRS to a test data set. By integrating functional annotations showing heritability enrichment in the selection of variants, the PRS demonstrated an association with AIS susceptibility (p = 3.5 × 10-40 with area under the receiver-operating characteristic [AUROC] = 0.674, sensitivity = 0.644, and specificity = 0.622). The decile with the highest PRS showed an odds ratio of as high as 3.36 (p = 1.4 × 10-10 ) to develop AIS compared with the fifth in decile. The addition of a predictive model with only a single clinical parameter (body mass index) improved predictive ability for development of AIS (AUROC = 0.722, net reclassification improvement [NRI] 0.505 ± 0.054, p = 1.6 × 10-8 ), potentiating clinical use of the prediction model. Furthermore, we found the Cobb angle (CA), the severity measurement of AIS, to be a polygenic trait that showed a significant genetic correlation with AIS susceptibility (rg = 0.6, p = 3.0 × 10-4 ). The AIS PRS demonstrated a significant association with CA. These results indicate a shared polygenic architecture between onset and progression of AIS and the potential usefulness of PRS in clinical settings as a predictor to promote early intervention of AIS and avoid invasive surgery. © 2021 American Society for Bone and Mineral Research (ASBMR).
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- 2021
6. Abrogation of LBX1 in skeletal muscle results in hypoplastic limbs and progressive kyphosis in mice
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Yusuke Matsuhashi, Keisuke Horiuchi, Takahiro Nakagawa, Yohei Takahashi, Hideaki Imabayashi, Naobumi Hosogane, Kota Watanabe, Morio Matsumoto, and Kazuhiro Chiba
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Orthopedics and Sports Medicine - Abstract
LBX1 is a gene located near a single-nucleotide polymorphism, rs11190870, which is highly associated with susceptibility to adolescent idiopathic scoliosis. However, the potential involvement of LBX1 in the etiology of this spinal deformity has not been elucidated. In this study, we aimed to determine whether the lack of LBX1 in skeletal muscle results in spinal deformities in mice. We generated mutant mice in which the Lbx1 allele was conditionally excised under the control of a human muscle actin promoter. Mice lacking LBX1 from the skeletal muscle were fertile and available. The mutant mice had hypoplastic forelimbs and weighed less than control animals, but otherwise, there were no overt anomalies. The mice did not exhibit a scoliosis-like spinal deformity; however, they developed moderate kyphosis as they grew old. These observations indicated that LBX1 is involved in limb development and potentially in the maintenance of spinal curvature/alignment in mice.
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- 2022
7. Optimal timing for intermittent administration of parathyroid hormone (1–34) for distraction osteogenesis in rabbits
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Narisaku, Inada, Tetsuya, Ohata, Hideto, Maruno, Takeshi, Morii, Naobumi, Hosogane, and Shoichi, Ichimura
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Bone Density ,Osteogenesis ,Parathyroid Hormone ,Osteogenesis, Distraction ,Animals ,Orthopedics and Sports Medicine ,Surgery ,Rabbits ,X-Ray Microtomography ,Bony Callus - Abstract
Background To date, the usefulness of parathyroid hormone [PTH (1–34)] in distraction osteogenesis has been reported in several studies. We aimed to determine the optimal timing of PTH (1–34) administration in a rabbit distraction osteogenesis model. Methods The lower hind leg of a Japanese white rabbit was externally fixed, and tibial osteotomy was performed. One week after the osteotomy, bone lengthening was carried out at 0.375 mm/12 h for 2 weeks. After 5 weeks, the lower leg bone was collected. Bone mineral density (BMD), peripheral quantitative computed tomography (pQCT), micro-computed tomography (micro-CT), and mechanical tests were performed on the distracted callus. The rabbits were divided into three groups according to the timing of PTH (1–34) administration: 4 weeks during the distraction and consolidation phases (group D + C), 2 weeks of the distraction phase (group D), and the first 2 weeks of the consolidation phase (group C). A control group (group N) was administered saline for 4 weeks during the distraction and consolidation phases. Furthermore, to obtain histological findings, lower leg bones were collected from each rabbit at 2, 3, and 4 weeks after osteotomy, and tissue sections of the distracted callus were examined histologically. Results The BMD was highest in group C and was significantly higher than group D. In pQCT, the total cross-sectional area was significantly higher in groups D + C, D, and C than group N, and the cortical bone area was highest in group C and was significantly higher than group D. In micro-CT, group C had the highest bone mass and number of trabeculae. Regarding the mechanical test, group C had the highest callus failure strength, and this value was significantly higher compared to group N. There was no significant difference between groups D and N. The histological findings revealed that the distracted callus mainly consisted of endochondral ossification in the distraction phase. In the consolidation phase, the chondrocytes were almost absent, and intramembranous ossification was the main type of ossification. Conclusion We found that the optimal timing of PTH (1–34) administration is during the consolidation phase, which is mainly characterized by intramembranous ossification.
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- 2022
8. Predictive Probability of the Global Alignment and Proportion Score for the Development of Mechanical Failure Following Adult Spinal Deformity Surgery in Asian Patients
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Osahiko Tsuji, Morio Matsumoto, Kota Watanabe, Masaya Nakamura, Mitsuru Yagi, Kenshi Daimon, Nobuyuji Fujita, Eijiro Okada, Narihito Nagoshi, Naobumi Hosogane, and Satoshi Suzuki
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Adult ,Male ,Reoperation ,medicine.medical_specialty ,Logistic regression ,Neurosurgical Procedures ,Cohort Studies ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Young adult ,Aged ,Probability ,Retrospective Studies ,030222 orthopedics ,Receiver operating characteristic ,business.industry ,Incidence (epidemiology) ,Retrospective cohort study ,Middle Aged ,Surgery ,Spinal Fusion ,ROC Curve ,Multicenter study ,Cohort ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Cohort study - Abstract
Study design This is a multicenter retrospective review of 257 surgically treated consecutive ASD patients who had a minimum of five fused segments, completed a 2-year follow-up (53 ± 19 yrs, females: 236 [92%]). Objective This study aimed to validate the predictive probability of the GAP score in an Asian ASD patient cohort. Summary of background data The GAP score is a recently established risk stratification model for MF following ASD surgery. However, the predictive ability of the GAP score is not well studied. This study aimed to validate the predictive probability of the GAP score in an Asian ASD patient cohort. Methods Comparisons of the immediate postoperative GAP scores between MF the and MF-free groups were performed. We evaluated the discriminative ability of the GAP score based on the area under the receiver operating characteristic curve (AUROC). The Cuzick test was performed to determine whether there is a trend between the GAP score and the incidence of MF or revision surgery. Univariate logistic regression analyses were performed to explore the associations between the GAP score and the incidence of MF or revision surgery. Results No difference was observed in the GAP score between the MF and MF-free groups (MF vs. MF-free; GAP: 5.9 ± 3.3 vs. 5.2 ± 2.7, P = 0.07). The Cuzick analysis showed no trend between the GAP score and the risk for MF or revision surgery. Likewise, the MF rate was not correlated with the GAP score, as shown by the ROC curve (AUC of 0.56 [95% CI 0.48-0.63], P = 0.124). Univariate logistic regression confirmed no associations between the GAP score and the incidence of MF or revision surgery (MF; moderately disproportioned [MD]: OR: 0.6 [95% CI: 0.3-1.2], P = 0.17, severely disproportioned [SD]: OR: 1.2 [95% CI: 0.6-2.3], P = 0.69, revision surgery; MD: OR: 0.8 [95% CI: 0.2-2.8], P = 0.71, SD: OR: 1.2 [95% CI: 0.9-8.7], P = 0.08). Conclusion In this multicenter study, in an Asian ASD patient cohort, the GAP score was not associated with the incidence of MF or revision surgery. Additional studies on the predictive ability of the GAP score in different patient cohorts are warranted.Level of Evidence: 3.
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- 2020
9. The Surgical Outcomes of Spinal Fusion for Osteoporotic Vertebral Fractures in the Lower Lumbar Spine with a Neurological Deficit
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Tomoya Yamashita, Yuta Shiono, Yasuchika Aoki, Hirosuke Nishimura, Masayuki Miyagi, Kenya Nojiri, Katsuhito Kiyasu, Shinji Adachi, Hidetomi Terai, Toshitaka Yoshii, Koji Tamai, Toshiro Doi, Masahiko Takahata, Shoji Seki, Shuta Ushio, Haruki Funao, Atsushi Nakano, Akira Iwata, Hidekazu Suzuki, Takashi Yurube, Daisuke Sakai, Kei Ando, Takashi Kaito, Nobuhiko Yokoyama, Hiroshi Uei, Shuta Yamada, Norihiro Isogai, Naobumi Hosogane, Masayuki Shimizu, Katsuhito Yoshioka, Toshimasa Futatsugi, Eijiro Okada, Ken Ishii, Seiji Ueda, Shota Ikegami, Gen Inoue, Masashi Oshima, Yukitaka Nagamoto, Kei Watanabe, Hirooki Endo, Katsumi Harimaya, Hidekazu Oishi, Hiroyasu Fujiwara, Tomohiro Hikata, Takeo Furuya, Wataru Saito, Hirokazu Inoue, Tadashi Nukaga, Atsushi Kimura, Michio Hongo, Yuji Matsuoka, Kazuyoshi Nakanishi, Kenichiro Kakutani, Tetsuya Abe, Hideki Murakami, Sumihisa Orita, Toshinori Tsukanishi, Shiro Imagama, Kota Watanabe, Kenichi Kawaguchi, Satoshi Suzuki, Atsushi Tagami, and Seiji Ohtori
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Bone mineral ,medicine.medical_specialty ,Visual analogue scale ,business.industry ,medicine.medical_treatment ,surgical outcome ,lcsh:Surgery ,osteoporotic vertebral fracture ,Perioperative ,lcsh:RD1-811 ,medicine.disease ,Surgery ,Myelopathy ,Lumbar ,Spinal fusion ,medicine ,lumbar vertebral fracture ,Original Article ,Orthopedics and Sports Medicine ,Neurology (clinical) ,Complication ,business ,Lumbar Vertebral Fracture ,neurological deficit - Abstract
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. Level of evidence: Level III
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- 2020
10. Impact of Tobacco Smoking on Outcomes After Posterior Decompression Surgery in Patients With Cervical Spondylotic Myelopathy
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Osahiko Tsuji, Hitoshi Kono, Ken Ishii, Narihito Nagoshi, Mitsuru Yagi, Morio Matsumoto, Junichi Yamane, Yuta Shiono, Ryoma Aoyama, Eijiro Okada, Masayuki Ishikawa, Ayano Takeuchi, Kanehiro Fujiyoshi, Kenshi Daimon, Naobumi Hosogane, Nobuyuki Fujita, Masaya Nakamura, and Kota Watanabe
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Decompression ,medicine.medical_specialty ,Visual analogue scale ,medicine.medical_treatment ,Spinal Cord Diseases ,03 medical and health sciences ,0302 clinical medicine ,Tobacco Smoking ,medicine ,Paralysis ,Humans ,Orthopedics and Sports Medicine ,Retrospective Studies ,030222 orthopedics ,Neck pain ,business.industry ,Laminectomy ,Postoperative complication ,Perioperative ,Surgery ,Treatment Outcome ,Case-Control Studies ,Orthopedic surgery ,Delirium ,Spondylosis ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
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 χ test 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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- 2020
11. Lower Satisfaction After Adult Spinal Deformity Surgery in Japan Than in the United States Despite Similar SRS-22 Pain and Function Scores
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Naobumi Hosogane, Virginie Lafage, Mitsuru Yagi, Morio Matsumoto, Christopher P. Ames, Christopher I. Shaffrey, Justin S. Smith, Shay Bess, Kota Watanabe, and Frank J. Schwab
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Pelvic tilt ,030222 orthopedics ,medicine.medical_specialty ,business.industry ,Scoliosis ,medicine.disease ,Sagittal plane ,Oswestry Disability Index ,Surgery ,Vertebra ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,medicine.anatomical_structure ,Propensity score matching ,medicine ,Orthopedics and Sports Medicine ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Pelvis - Abstract
Study design A multicenter retrospective case series. Objective The purpose of this study was to compare the clinical outcomes of a surgical treatment for adult spinal deformity (ASD) in the United States (US) with those in Japan (JP) in a matched cohort. Summary of background data Surgical outcomes of thoracic-lumbar-sacral (TLS) spinal fusions in adult spinal deformity ASD patients who live in Asian countries are poorly understood. Methods A total of 300 surgically treated ASDs of age more than 50 years with the lowest instrumented vertebra at the pelvis and a minimum follow-up of 2 years (2y) were consecutively included. Patients were propensity-score matched for age, sex, levels fused, and 2y postop sagittal spinal alignment. Demographic, surgical, and radiographic parameters were compared between the US and JP groups. Results A total of 186 patients were matched by propensity score and were almost identical within these parameters: age (US vs. JP: 66 ± 8 vs. 65 ± 7 yr), sex (females: 90% vs. 89%), levels fused (10 ± 3 vs. 10 ± 2), 2y C7 sagittal vertical axis (C7SVA) (5 ± 5 vs. 5 ± 4 cm), 2y Pelvic incidence minus lumbar lordosis (9 ± 15° vs. 9 ± 15°), and 2y pelvic tilt (PT) (25 ± 10° vs. 24 ± 10°). Oswestry Disability Index (ODI) scores and Scoliosis Research Society patient questionnaire ((SRS-22) function and pain scores were similar at 2y between the US and JP groups (ODI: 27 ± 19% vs. 28 ± 14%, P = 0.72; SRS-22 function: 3.6 ± 0.9 vs. 3.6 ± 0.7, P = 0.54; SRS-22 pain: 3.6 ± 1.0 vs. 3.8 ± 0.8, P = 0.11). However, significantly lower satisfaction was observed in JP than in the US (SRS-22 satisfaction: 4.3 ± 0.9 vs. 4.0 ± 0.8, P Conclusion Surgical treatment for ASD was similarly effective in patients in the US and in JP. However, satisfaction scores were lower in JP compared with the US. Differences in lifestyle and cultural expectations may impact patient satisfaction following ASD surgery. Level of evidence 3.
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- 2020
12. Results of Using a Novel Percutaneous Pedicle Screw Technique for Patients with Diffuse Idiopathic Skeletal Hyperostosis―The Single or Double Endplates Penetrating Screw (SEPS/DEPS) Technique
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Kenichiro Yamagishi, Naobumi Hosogane, Takumi Takeuchi, Shoichi Ichimura, Kazuhiko Satomi, and Keitaro Matsukawa
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Insertion torque ,musculoskeletal diseases ,osteoporotic vertebral body fracture (OVF) ,Percutaneous ,lcsh:Surgery ,Bone fragility ,complex mixtures ,Medicine ,Orthopedics and Sports Medicine ,single endplate penetrating screw (SEPS) technique ,Pedicle screw ,minimally invasive spine stabilization (MISt) ,Conventional technique ,Diffuse Idiopathic Skeletal Hyperostosis ,double endplates penetrating screw (DEPS) technique ,business.industry ,lcsh:RD1-811 ,respiratory system ,medicine.disease ,equipment and supplies ,musculoskeletal system ,diffuse idiopathic skeletal hyperostosis (DISH) ,Diffuse idiopathic skeletal hyperostosis (DISH) ,Surgery ,Original Article ,Neurology (clinical) ,Implant ,Nuclear medicine ,business ,percutaneous pedicle screw (PPS) - Abstract
Introduction We have developed the single or double endplates penetrating screw (SEPS/DEPS) technique, which is a novel percutaneous pedicle screw (PPS) insertion technique suitable for osteoporotic vertebral body fracture (OVF) patients with diffuse idiopathic skeletal hyperostosis (DISH). This study aims to compare the effectiveness of this SEPS/DEPS technique with the conventional pedicle screw technique. Methods The screw is inserted upward from the outer caudal side of the pedicle toward the inner cranial side. Vertebrae affected with DISH were inserted with screws using the SEPS/DEPS technique, whereas non-fused vertebrae were inserted with screws using the conventional PPS technique. Twelve OVF patients with DISH were included in this study; three with SEPS/DEPS technique only and nine with a hybrid of both the DEPS and the conventional PPS techniques. As a control group, 12 OVF patients with DISH treated by conventional PPS. The rates of implant failures and of surgical complications were compared between the SEPS/DEPS group and the control group. The insertion torque was measured and compared between DEPS and conventional PPS in three hybrid patients. Results In the SEPS/DEPS group, 70 screws were inserted with the SEPS/DEPS technique and 56 screws were inserted with the conventional PPS technique. In the control group, 116 screws were inserted using the conventional PPS and the PS techniques. The loosening of screws was significantly less in screws inserted with the SEPS/DEPS technique (0/70 screws, 0%) than with screws inserted with the conventional technique (12/116 screws, 10.3%). The average insertion torque of DEPS was 2.25 Nm, which was 134% higher than that of conventional PPS which was 1.64 Nm (p = 0.04). Conclusions This novel SEPS/DEPS technique has a higher insertion torque compared with the conventional PPS techniques and demonstrated itself to be an effective option for patients with concomitant bone fragility due to DISH.
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- 2020
13. Improvement and International Validation of the Predictive Probability of the Patient Demographics, Radiographic Index, and Surgical Invasiveness for Mechanical Failure (PRISM) Model for Preventive Procedures in Adult Spinal Deformity Surgery
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Kota Watanabe, Narihito Nagoshi, Osahiko Tsuji, R. Shay Bess, Morio Matsumoto, Christopher I. Shaffrey, Masaya Nakamura, Satoshi Suzuki, Mitsuru Yagi, Frank J. Schwab, Virginie Lafage, Nori Satoshi, Naobumi Hosogane, Justin S. Smith, Yohei Takahashi, and Christopher P. Ames
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Adult ,Male ,medicine.medical_specialty ,genetic structures ,Patient demographics ,Radiography ,Logistic regression ,Neurosurgical Procedures ,Cohort Studies ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,Demography ,Probability ,Retrospective Studies ,business.industry ,External validation ,Mechanical failure ,Middle Aged ,Surgery ,Spinal Fusion ,Cohort ,Spinal deformity ,Female ,Neurology (clinical) ,Prism ,business - Abstract
This is an international multicenter retrospective review of 219 surgically treated consecutive adult spinal deformity (ASD) patients who had a minimum of five fused segments, completed a 2-year follow-up.The purpose of this study was to add the indices of preventive procedures to improve and to validate the predictive probability of the PRISM (patient demographics, radiographic index, and surgical invasiveness for mechanical failure) for mechanical failure (MF) following ASD surgery.The PRISM was developed from the data of 321 ASD patients, which stratified the risk of MF from six types of risk.Data from 136 Japanese ASD patients (age 49 ± 21 yr, 88% female) were used to develop PRISM2, and data from 83 US ASD patients (age 58 ± 12 yr, 86% female) were used for the external validation. We analyzed the associations between three preventive procedures (UIV+1 tethering [TH], teriparatide [TP], and multirod [MR]) and MF by multivariate logistic regression analysis (MRA). The values for the nearest integer of the β of the procedures were added to the six indices of the original PRISM to establish the PRISM2. The discriminative ability of the PRISM/ PRISM2 for MF was evaluated using the area under the receiver operating characteristic curve (AUC) and the precision-recall (PR) curve. The Cochran-Armitage test was used to analyze the trend between PRISM/PRISM2 scores and MF.MF developed in 25% (34 cases). The β values for the preventive procedures calculated by MRA were TH: -2.5, TP: -3.0, and MR: -2.1. The Cochran-Armitage test showed an excellent trend between MF and PRISM/2. The diagnostic ability was superior for the PRISM2 compared with the PRISM (PRISM2; AUC = 0.94 [0.90-0.98], PRISM; AUC = 0.87 [0.81-0.93], difference = -0.07 [-0.11 to -0.03], P 0.01). The AUC of the PRISM2 was 0.70 [0.59-0.81, P 0.01] in the US patient cohort.We refined the PRISM by adding preventive procedures to the risk indices. Further validation and adjustment in a large different patient cohorts may improve the predictive probability of PRISM2.Level of Evidence: 3.
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- 2021
14. Comparable satisfaction and clinical outcomes after surgery for adolescent idiopathic scoliosis in the adult (AISA) between the US and Japan
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Naobumi Hosogane, Christopher I. Shaffrey, Frank J. Schwab, Morio Matsumoto, Virginie Lafage, Mitsuru Yagi, Shay Bess, Christopher P. Ames, Justin S. Smith, and Kota Watanabe
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Adult ,medicine.medical_specialty ,Adolescent ,Pain ,Idiopathic scoliosis ,Personal Satisfaction ,Japan ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Kyphosis ,Retrospective Studies ,business.industry ,Spinal surgery ,United States ,Spine ,Surgery ,Spinal Fusion ,Treatment Outcome ,Scoliosis ,Patient Satisfaction ,Surgery outcome ,Propensity score matching ,Female ,business - Abstract
Background The impact of ethnicity on the surgery outcomes of adolescent idiopathic scoliosis in the adult (AISA) is poorly understood. This study aimed to compare the surgery outcomes for AISA between the United States (US) and Japan (JP). Methods 171 surgically treated AISA (20-40y) were consecutively collected from 2 separate multicenter databases. Patients were propensity-score matched for age, gender, curve type, levels fused, and 2y postop spinal alignment. Demographic and radiographic parameters were compared between the US and JP at baseline and 2y post-op. Results A total of 108 patients were matched by propensity score (age; US vs. JP: 29 ± 6 vs. 29 ± 7y, females: 76 vs. 76%, curve type [Schwab-SRS TypeT; TypeD; TypeL; TypeN]: 35; 35; 30; 0 vs. 37; 33; 30; 0%)] levels fused: 10 ± 4 vs. 10 ± 4, 2y thoracic curve:17 ± 13 vs. 17 ± 12°, 2y CSVL: 10 ± 8 vs. 11 ± 9 mm). Similar clinical improvement was achieved between US and JP (function; 4.2 ± 0.9 vs 4.3 ± 0.6, p = 0.60, pain; 3.8 ± 0.9 vs 4.1 ± 0.8, p = 0.13, satisfaction; 4.3 ± 0.9 vs 4.2 ± 0.7, p = 0.61, total; 4.0 ± 0.8 vs 4.1 ± 0.5, p = 0.60). The correlation analyzes indicated that postoperative SRS-22 subdomains correlated differently with satisfaction (all subdomains moderately correlated with satisfaction in the US while only pain and mental health correlated moderately with satisfaction in JP ([function: r = 0.61 vs 0.29, pain: r = . 72 vs 0.54, self-image: r = 0.72 vs 0.37, mental health: r = 0.64 vs 0.55]). Conclusions Surgery for AISA was similarly effective in the US and JP. Satisfaction for spinal surgery among patients in different countries may not be different unless the procedure limits an individual's unique lifestyle that the patient expected to resume.
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- 2021
15. Risk, Recovery, and Clinical Impact of Neurological Complications in Adult Spinal Deformity Surgery
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Morio Matsumoto, Takehiro Michikawa, Osahiko Tsuji, Koota Watanabe, Eijiro Okada, Takashi Tsuji, Narihito Nagoshi, Nobuyuki Fujita, Mitsuru Yagi, Naobumi Hosogane, Takashi Asazuma, Masaya Nakamura, and Satoshi Suzuki
- Subjects
Adult ,medicine.medical_specialty ,Activities of daily living ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Quality of life ,Risk Factors ,medicine ,Humans ,Orthopedic Procedures ,Orthopedics and Sports Medicine ,Risk factor ,Spinal cord injury ,Retrospective Studies ,030222 orthopedics ,Univariate analysis ,business.industry ,Incidence (epidemiology) ,Retrospective cohort study ,medicine.disease ,Surgery ,Treatment Outcome ,Spinal Diseases ,Neurology (clinical) ,Nervous System Diseases ,Complication ,business ,030217 neurology & neurosurgery - Abstract
Study design Multicenter retrospective case series. Objective To report the risks, recovery, and clinical impact of neurological complications (NCs) in adult spinal deformity (ASD) surgery. Summary of background data Although recent studies have reported the incidence of NCs in ASD surgery, few have addressed the recovery from and clinical impacts of NC. Methods We reviewed records from a multicenter database for 285 consecutive surgically treated ASD patients who had reached a 2-year follow-up. NCs were categorized as sensory only or motor deficit (MD). Recovery was noted as none, partial, or complete, during hospitalization and at every postoperation visit. Uni- and multivariate risk analyses were performed to identify risk factors for MD. Results NC developed in 29 (10%) patients within 30 days of surgery, of which 11 were permanent deficits (seven no recovery, and four partial recovery). MD developed in 14 (5%) patients, including one spinal cord injury. Seven MD patients required physical assistance at the latest follow-up. While NC patients experienced significant improvements in health-related quality of life at the 2-year follow-up, the health-related quality of life was significantly worse for the NC versus no-NC group at this time point. Univariate analyses revealed that Schwab-SRS types N and L, pelvic tilt, modified frailty index physical function, and an inferior SRS22 function domain at baseline were risk factors for MD. Among them, modified frailty index physical function, which represented a preoperative decline in activities of daily living, was identified as an independent risk factor for MD (OR: 4.0, 95% CI: 1.2-13.5, P = 0.03). Conclusions NC developed in 10% of ASD surgery patients, with permanent deficits occurring in 4%. Half of the patients who developed MD required physical assistance, which contributed to the inferior clinical outcomes. Surgical intervention should be considered before severe activities of daily living decline to prevent NCs. Level of evidence 4.
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- 2019
16. Treatment for Frailty Does Not Improve Complication Rates in Corrective Surgery for Adult Spinal Deformity
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Takashi Asazuma, Morio Matsumoto, Eijiro Okada, Narihito Nagoshi, Naobumi Hosogane, Mitsuru Yagi, Takehiro Michikawa, Kota Watanabe, Masaya Nakamura, Takashi Tsuji, Nobuyuki Fujita, Satoshi Suzuki, and Osahiko Tsuji
- Subjects
Adult ,Male ,medicine.medical_specialty ,Scoliosis ,Corrective surgery ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Humans ,Orthopedic Procedures ,Orthopedics and Sports Medicine ,Aged ,Retrospective Studies ,030222 orthopedics ,Frailty ,business.industry ,Middle Aged ,medicine.disease ,Surgery ,Spinal deformity ,Female ,Neurology (clinical) ,Complication ,business ,030217 neurology & neurosurgery - Abstract
A retrospective multicenter database review of 240 consecutive patients at least 21 years of age (mean 58 ± 17, range 22-79) who underwent surgery for adult spinal deformity (ASD) and were followed at least 2 years.To investigate how treatment for frailty affects complications in surgery for ASD.Several recent studies have focused on associations between frailty and surgical complications. However, it is not clear whether treating frailty affects complication rates in surgery for ASD.Patients were categorized as robust (R group), prefrail, or frail based on the modified frailty index (mFI); prefrail and frail patients were divided by good control of frailty (G group), defined as treatment following the appropriate guidelines for each mFI factor, or poorly controlled frailty (PC group). We compared clinical outcomes and perioperative and 2-year complications between the three groups.Of the 240 patients, 142 (59%) were robust, 81 (34%) were prefrail, and 17 (7%) were frail. Among the frail and prefrail patients, 71 (72%) were classified as G and 27 (28%) as PC. The perioperative complication rate was similar in the G and PC groups (32% vs. 37%) but was significantly lower in the R group (15%, P 0.01). The age- and sex-adjusted odds ratio for 2-year complications was not different in the P group when the G group was referenced (odds ratio 1.3 [0.5-3.2], P = 0.63). In the G and PC groups, which had similar 2-year outcomes, the Scoliosis Research Society-22 function and total scores were significantly lower than in the R group (function: R 3.9 ± 0.7, G 3.5 ± 0.7, P 3.3 ± 0.6; total: R 3.9 ± 0.6, 3.7 ± 0.7, 3.4 ± 0.6; P 0.01).Regardless of its treatment status, frailty increases the risk of complications and inferior clinical outcomes in ASD surgery. Surgeons should routinely evaluate frailty and inform patients of frailty-related risks when considering surgery for ASD.4.
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- 2019
17. Risk Factors for Proximal Junctional Fracture Following Fusion Surgery for Osteoporotic Vertebral Collapse with Delayed Neurological Deficits: A Retrospective Cohort Study of 403 Patients
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Yuji Matsuoka, Kazuyoshi Kobayashi, Kazuyoshi Nakanishi, Hidetomi Terai, Eijiro Okada, Syuta Yamada, Satoshi Suzuki, Tomohiro Izumi, Hidekazu Suzuki, Masayuki Ohashi, Masayuki Shimizu, Kenichiro Kakutani, Daisuke Sakai, Naobumi Hosogane, Akinobu Suzuki, Toshinori Tsukanishi, Tetsuya Abe, Shinji Adachi, Tomoya Yamashita, Keiichi Katsumi, Toshimasa Futatsugi, Shota Ikegami, Katsuhito Yoshioka, Toru Hirano, Katsuhito Kiyasu, Kei Ando, Gen Inoue, Sumihisa Orita, Yuta Shiono, Norihiro Isogai, Hiroaki Nakamura, Koji Tamai, Hiroyasu Fujiwara, Masayuki Miyagi, Takeo Furuya, Haruki Funao, Shiro Imagama, Tomohiro Hikata, Hirosuke Nishimura, Masashi Oshima, Shoji Seki, Toshiro Doi, Toshitaka Yoshii, Ken Ishii, Yasuchika Aoki, Seiji Ueda, Kenichi Kawaguchi, Michio Hongo, Atsushi Tagami, Masahiko Takahata, Tadashi Nukaga, Takashi Kaito, Takashi Yurube, Yohei Shibuya, Kenya Nojiri, Hideki Murakami, Hidekazu Oishi, Kei Watanabe, Shuta Ushio, Atsushi Nakano, Hirooki Endo, Katsumi Harimaya, Yukitaka Nagamoto, Akira Iwata, Nobuhiko Yokoyama, Seiji Ohtori, Kota Watanabe, Hirokazu Inoue, Wataru Saito, and Atsushi Kimura
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medicine.medical_specialty ,Osteoporosis ,lcsh:Surgery ,proximal junctional kyphosis ,Lumbar ,proximal junctional fracture ,Medicine ,Orthopedics and Sports Medicine ,vertebral fracture ,Receiver operating characteristic ,business.industry ,Incidence (epidemiology) ,Retrospective cohort study ,Odds ratio ,lcsh:RD1-811 ,Sacrum ,medicine.disease ,Vertebra ,Surgery ,medicine.anatomical_structure ,corrective surgery ,Original Article ,Neurology (clinical) ,business - Abstract
Introduction: Approximately 3% of osteoporotic vertebral fractures develop osteoporotic vertebral collapse (OVC) with neurological deficits, and such patients are recommended to be treated surgically. However, a proximal junctional fracture (PJFr) following surgery for OVC can be a serious concern. Therefore, the aim of this study is to identify the incidence and risk factors of PJFr following fusion surgery for OVC. Methods: This study retrospectively analyzed registry data collected from facilities belonging to the Japan Association of Spine Surgeons with Ambition (JASA) in 2016. We retrospectively analyzed 403 patients who suffered neurological deficits due to OVC below T10 and underwent corrective surgery; only those followed up for ≥2 years were included. Potential risk factors related to the PJFr and their cut-off values were calculated using multivariate logistic regression analysis and receiver operating characteristic (ROC) analysis. Results: Sixty-three patients (15.6%) suffered PJFr during the follow-up (mean 45.7 months). In multivariate analysis, the grade of osteoporosis (grade 2, 3: adjusted odds ratio (aOR) 2.92; p=0.001) and lower instrumented vertebra (LIV) level (sacrum: aOR 6.75; p=0.003) were independent factors. ROC analysis demonstrated that lumbar bone mineral density (BMD) was a predictive factor (area under curve: 0.72, p=0.035) with optimal cut-off value of 0.61 g/cm(2) (sensitivity, 76.5%; specificity, 58.3%), but that of the hip was not (p=0.228). Conclusions: PJFr was found in 16% cases within 4 years after surgery; independent risk factors were severe osteoporosis and extended fusion to the sacrum. The lumbar BMD with cut-off value 0.61 g/cm(2) may potentially predict PJFr. Our findings can help surgeons select perioperative adjuvant therapy, as well as a surgical strategy to prevent PJFr following surgery.
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- 2019
18. Predictive model for major complications 2 years after corrective spine surgery for adult spinal deformity
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Nobuyuki Fujita, Mitsuru Yagi, Osahiko Tsuji, Takashi Tsuji, Morio Matsumoto, Naobumi Hosogane, Masaya Nakamura, Eijiro Okada, Kota Watanabe, Narihito Nagoshi, and Takashi Asazuma
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Male ,medicine.medical_specialty ,Multivariate analysis ,medicine.medical_treatment ,Osteotomy ,Spinal Curvatures ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Quality of life ,Bone Density ,Risk Factors ,Humans ,Medicine ,Orthopedic Procedures ,Orthopedics and Sports Medicine ,Aged ,030222 orthopedics ,Univariate analysis ,Models, Statistical ,Frailty ,Receiver operating characteristic ,business.industry ,Middle Aged ,Surgery ,Spinal deformity ,Female ,Neurosurgery ,Complication ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
ASD surgery improves a patient’s health-related quality of life, but it has a high complication rate. The aim of this study was to create a predictive model for complications after surgical treatment for adult spinal deformity (ASD), using spinal alignment, demographic data, and surgical invasiveness. This study included 195 surgically treated ASD patients who were > 50 years old and had 2-year follow-up from multicenter database. Variables which included age, gender, BMI, BMD, frailty, fusion level, UIV and LIV, primary or revision surgery, pedicle subtraction osteotomy, spinal alignment, Schwab-SRS type, surgical time, and blood loss were recorded and analyzed at least 2 years after surgery. Decision-making trees for 2-year postoperative complications were constructed and validated by a 7:3 data split for training and testing. External validation was performed for 25 ASD patients who had surgery at a different hospital. Complications developed in 48% of the training samples. Almost half of the complications developed in late post-op period, and implant-related complications were the most common complication at 2 years after surgery. Univariate analyses showed that BMD, frailty, PSO, LIV, PI-LL, and EBL were risk factors for complications. Multivariate analysis showed that low BMD, PI-LL > 30°, and frailty were independent risk factors for complications. In the testing samples, our predictive model was 92% accurate with an area under the receiver operating characteristic curve of 0.963 and 84% accurate in the external validation. A successful model was developed for predicting surgical complications. Our model could inform physicians about the risk of complications in ASD patients in the 2-year postoperative period. These slides can be retrieved under Electronic Supplementary Material.
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- 2018
19. Characterization of Patients with Poor Risk for Clinical Outcomes in Adult Symptomatic Lumbar Deformity Surgery
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Takashi Asazuma, Kota Watanabe, Masaya Nakamura, Narihito Nagoshi, Mitsuru Yagi, Satoshi Suzuki, Naobumi Hosogane, Osahiko Tsuji, Takehiro Michikawa, Morio Matsumoto, Eijiro Okada, Satoshi Nori, and Nobuyuki Fujita
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Adult ,Male ,medicine.medical_specialty ,MEDLINE ,Scoliosis ,Spinal Curvatures ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Lumbar ,Postoperative Complications ,Risk Factors ,Deformity ,medicine ,Humans ,Orthopedics and Sports Medicine ,Orthopedic Procedures ,Poisson regression ,Aged ,Retrospective Studies ,030222 orthopedics ,Lumbar Vertebrae ,business.industry ,Retrospective cohort study ,Odds ratio ,Lumbar Curve ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,symbols ,Female ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Retrospective review of 159 surgically treated consecutive adult symptomatic lumbar deformity (ASLD) (65 ± 9 years, female: 94%) from a multicenter database.The aim of this study was to provide a comprehensive analysis of the risk of a poor clinical outcome in ASLD surgery.Poor-risk patients with ASLD remain poorly characterized.ASLD was defined as age40 years with a lumbar curve ≥30° or C7SVA ≥5 cm and Scoliosis Research Society 22 (SRS22) pain or function4. Poor outcome was defined as 2y SRS22 total4 or pain, function or satisfaction ≤3. The outcomes of interest included age, sex, body mass index, bone mineral density, Schwab-SRS type, frailty, history of arthroplasty, upper-instrumented vertebral, lower-instrumented vertebral, levels involved, pedicle subtraction osteotomy, lumbar interbody fusion, sagittal alignment, global alignment and proportion (GAP) score, baseline SRS22r score, estimated blood loss, time of surgery, and severe adverse event (SAE). Poisson regression analyses were performed to identify the independent risks for poor clinical outcome. A patient was considered at poor risk if the number of risks was4.All SRS22 domains were significantly improved after surgery. In total, 21% (n = 34) reported satisfaction ≤3 and 29% (n = 46) reported pain or function ≤3. Poisson regression analysis revealed that frailty (odds ratio [OR]: 0.2 [0.1-0.8], P = .03), baseline mental-health (OR: 0.6 [0.4-0.9], P = .01) and function (OR: 1.9 [1.0-3.6], P .01), GAP score (OR: 4.6 [1.1-18.7], P = .03), and SAE (OR: 3.0 [1.7-5.2], P .01) were identified as independent risk for poor clinical outcome. Only 17% (n = 6) of the poor-risk patients reached SRS22 total score4.0 at 2 years.The overall clinical outcome was favorable for ASLD surgery. Poor-risk patients continue to have inferior outcomes, and alternative treatment strategies are needed to help improve outcomes in this patient population. Recognition and optimization of modifiable risk factors, such as physical function and mental health, and reduced SAEs may improve overall clinical outcomes of ASLD surgery.Level of Evidence: 3.
- Published
- 2021
20. Short- versus long-segment posterior spinal fusion with vertebroplasty for osteoporotic vertebral collapse with neurological impairment in thoracolumbar spine: a multicenter study
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Tomohiro Izumi, Daisuke Sakai, Masayuki Ohashi, Ken Ishii, Toshinori Tsukanishi, Masashi Oshima, Hideki Murakami, Michio Hongo, Masayuki Shimizu, Hirooki Endo, Katsumi Harimaya, Shinji Adachi, Kei Ando, Akira Iwata, Seiji Ueda, Kei Watanabe, Shota Ikegami, Katsuhito Kiyasu, Kazuyoshi Kobayashi, Nobuhiko Yokoyama, Sumihisa Orita, Toshimasa Futatsugi, Tomoya Yamashita, Hidetomi Terai, Yuji Matsuoka, Norihiro Isogai, Kazuyoshi Nakanishi, Masayuki Miyagi, Yuta Shiono, Shiro Imagama, Hiroyasu Fujiwara, Haruki Funao, Koji Tamai, Toru Hirano, Yuya Ishikawa, Yukitaka Nagamoto, Kenichiro Kakutani, Tetsuya Abe, Kenichi Kawaguchi, Keiichi Katsumi, Tomohiro Hikata, Kota Watanabe, Yasuchika Aoki, Satoshi Suzuki, Toshitaka Yoshii, Shoji Seki, Kenya Nojiri, Eijiro Okada, Hirosuke Nishimura, Hidekazu Suzuki, Toshiro Doi, Naoto Endo, Shuta Ushio, Atsushi Nakano, Takashi Yurube, Hidekazu Oishi, Katsuhito Yoshioka, Yohei Shibuya, Tadashi Nukaga, Naobumi Hosogane, Gen Inoue, Masahiko Takahata, Takashi Kaito, Shuta Yamada, Seiji Ohtori, Atsushi Tagami, Takeo Furuya, Wataru Saito, Atsushi Kimura, and Hirokazu Inoue
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Male ,medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,Posterior spinal fusion ,Long-segment ,Sports medicine ,medicine.medical_treatment ,Kyphosis ,Thoracic Vertebrae ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Thoracolumbar spine ,Internal medicine ,Epidemiology ,medicine ,Humans ,Orthopedics and Sports Medicine ,Osteoporotic vertebral collapse ,Aged ,Retrospective Studies ,030222 orthopedics ,Vertebroplasty ,Rehabilitation ,Lumbar Vertebrae ,business.industry ,Correction loss ,Short-segment ,Pain scale ,medicine.disease ,Decompression, Surgical ,Surgery ,Spinal Fusion ,Treatment Outcome ,Spinal fusion ,Orthopedic surgery ,Spinal Fractures ,Female ,Vertebral fracture ,lcsh:RC925-935 ,business ,030217 neurology & neurosurgery ,Osteoporotic Fractures ,Research Article - Abstract
Background Vertebroplasty with posterior spinal fusion (VP + PSF) is one of the most widely accepted surgical techniques for treating osteoporotic vertebral collapse (OVC). Nevertheless, the effect of the extent of fusion on surgical outcomes remains to be established. This study aimed to evaluate the surgical outcomes of short- versus long-segment VP + PSF for OVC with neurological impairment in thoracolumbar spine. Methods We retrospectively collected data from 133 patients (median age, 77 years; 42 men and 91 women) from 27 university hospitals and their affiliated hospitals. We divided patients into two groups: a short-segment fusion group (S group) with 2- or 3-segment fusion (87 patients) and a long-segment fusion group (L group) with 4- through 6-segment fusion (46 patients). Surgical invasion, clinical outcomes, local kyphosis angle (LKA), and complications were evaluated. Results No significant differences between the two groups were observed in terms of neurological recovery, pain scale scores, and complications. Surgical time was shorter and blood loss was less in the S group, whereas LKA at the final follow-up and correction loss were superior in the L group. Conclusion Although less invasiveness and validity of pain and neurological relief are secured by short-segment VP + PSF, surgeons should be cautious regarding correction loss.
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- 2020
21. Effect of bisphosphonates or teriparatide on mechanical complications after posterior instrumented fusion for osteoporotic vertebral fracture: a multi-center retrospective study
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Yasuchika Aoki, Masayuki Shimizu, Masayuki Ohashi, Hirooki Endo, Katsumi Harimaya, Syuta Yamada, Toshinori Tsukanishi, Koji Tamai, Tomoya Yamashita, Hirosuke Nishimura, Yuta Shiono, Ken Ishii, Eijiro Okada, Michio Hongo, Katsuhito Kiyasu, Hidekazu Suzuki, Masashi Oshima, Norihiro Isogai, Masayuki Miyagi, Shinji Adachi, Kei Watanabe, Shoji Seki, Atsuyuki Kawabata, Tadashi Nukaga, Kei Ando, Seiji Ohtori, Kazuyoshi Kobayashi, Hidetomi Terai, Haruki Funao, Kenya Nojiri, Akira Iwata, Toshitaka Yoshii, Shuta Ushio, Nobuhiko Yokoyama, Atsushi Nakano, Seiji Ueda, Shota Ikegami, Toshimasa Futatsugi, Hidekazu Oishi, Takeo Furuya, Takashi Yurube, Katsuhito Yoshioka, Atsushi Tagami, Daisuke Sakai, Kota Watanabe, Takashi Hirai, Yuji Matsuoka, Keiichi Katsumi, Kazuyoshi Nakanishi, Kenichiro Kakutani, Tetsuya Abe, Hiroyasu Fujiwara, Tomohiro Hikata, Hideki Murakami, Gen Inoue, Yukitaka Nagamoto, Naobumi Hosogane, Masahiko Takahata, Takashi Kaito, Toshiro Doi, Satoshi Suzuki, Yohei Shibuya, Hirokazu Inoue, Sumihisa Orita, Wataru Saito, Shiro Imagama, Atsushi Kimura, and Kenichi Kawaguchi
- Subjects
Male ,Reoperation ,medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,Visual analogue scale ,Osteoporosis ,030209 endocrinology & metabolism ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,Japan ,Rheumatology ,Teriparatide ,Internal medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Primary osteoporosis ,Glucocorticoids ,Aged ,Retrospective Studies ,Aged, 80 and over ,Glucocorticoid-induced osteoporosis ,Bone Density Conservation Agents ,Diphosphonates ,business.industry ,Retrospective cohort study ,Bisphosphonates ,medicine.disease ,Surgery ,Pseudarthrosis ,Spinal Fusion ,Orthopedic surgery ,Spinal Fractures ,Female ,Osteoporotic vertebral fractures ,lcsh:RC925-935 ,business ,Complication ,Osteoporotic Fractures ,030217 neurology & neurosurgery ,Research Article ,medicine.drug - Abstract
Background The optimal treatment of osteoporosis after reconstruction surgery for osteoporotic vertebral fractures (OVF) remains unclear. In this multicentre retrospective study, we investigated the effects of typically used agents for osteoporosis, namely, bisphosphonates (BP) and teriparatide (TP), on surgical results in patients with osteoporotic vertebral fractures. Methods Retrospectively registered data were collected from 27 universities and affiliated hospitals in Japan. We compared the effects of BP vs TP on postoperative mechanical complication rates, implant-related reoperation rates, and clinical outcomes in patients who underwent posterior instrumented fusion for OVF. Data were analysed according to whether the osteoporosis was primary or glucocorticoid-induced. Results A total of 159 patients who underwent posterior instrumented fusion for OVF were included. The overall mechanical complication rate was significantly lower in the TP group than in the BP group (BP vs TP: 73.1% vs 58.2%, p = 0.045). The screw backout rate was significantly lower and the rates of new vertebral fractures and pseudoarthrosis tended to be lower in the TP group than in the BP group. However, there were no significant differences in lumbar functional scores and visual analogue scale pain scores or in implant-related reoperation rates between the two groups. The incidence of pseudoarthrosis was significantly higher in patients with glucocorticoid-induced osteoporosis (GIOP) than in those with primary osteoporosis; however, the pseudoarthrosis rate was reduced by using TP. The use of TP also tended to reduce the overall mechanical complication rate in both primary osteoporosis and GIOP. Conclusions The overall mechanical complication rate was lower in patients who received TP than in those who received a BP postoperatively, regardless of type of osteoporosis. The incidence of pseudoarthrosis was significantly higher in patients with GIOP, but the use of TP reduced the rate of pseudoarthrosis in GIOP patients. The use of TP was effective to reduce postoperative complications for OVF patients treated with posterior fusion.
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- 2020
22. Variability in Assessing Spinopelvic Parameters With Lumbosacral Transitional Vertebrae
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Robert K. Eastlack, Shay Bess, Alan H. Daniels, Justin B. Ledesma, Mitsuru Yagi, Stacie Tran, Amrit S. Khalsa, Richard G. Fessler, Justin Iorio, Khoi D. Than, Paul Park, Gregory M. Mundis, and Naobumi Hosogane
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Observer Variation ,Surgeons ,030203 arthritis & rheumatology ,Orthodontics ,Lumbar Vertebrae ,business.industry ,Posture ,Intraobserver reliability ,Reproducibility of Results ,Pelvis ,03 medical and health sciences ,0302 clinical medicine ,Lordosis ,Humans ,Medicine ,Orthopedics and Sports Medicine ,In patient ,Neurology (clinical) ,Observer variation ,business ,030217 neurology & neurosurgery ,Lumbosacral joint - Abstract
Prospectively collected survey study OBJECTIVE.: The aim of this study was to determine the consistency with which spinopelvic parameters (SPP) are determined in patients with lumbosacral transitional vertebrae (LSTV).The incidence of LSTV in the general population is as high as 35.6%. The often fixed nature of LSTV relative to the pelvis, but lumbar-type appearance, may lead to differential use of the S1 endplate when performing SPP assessment. This could have significant impact on SPP derived from these landmarks, resulting in considerable variation in surgical planning and decision-making.Twenty patients demonstrating LSTV on standing lateral 36-inch spinal radiographs were randomly arranged and independently analyzed by 16 experienced spine surgeons using the same computer software. Pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), and T1 pelvic angle (TPA) were captured. Two weeks after the first assessment, surgeons repeated the measurements after image sequence re-randomization. Intraclass correlation coefficient (ICC) was calculated to evaluate interobserver reliability (IOR) for each SPP. Intraobserver reliability (IAOR) was assessed through an average Pearson correlation coefficient for each parameter for each surgeon.Sixteen surgeons completed initial measurements. IOR was poor for TPA (0.35, 95% confidence interval [CI] 0.20, 0.58) and PI (0.42, 95% CI 0.26, 0.65) and fair for LL (0.67, 95% CI 0.51, 0.82), and PT (0.63, 95% CI 0.47, 0.81). Fourteen surgeons completed phase-2 measurements to assess IAOR. Average parameter PPC showed excellent IAOR (LL 0.86, TPA 0.77, PI 0.78, PT 0.86). Kappa coefficient showed fair agreement for raters choosing the same endplate for measurement (Phase 1: 0.38, Phase 2: 0.32). By patient, the percentage of raters that chose the S1 endplate for measurement varied from 6.3% to 85.7%.Significant variability exists when surgeons measure SPP in patients with LSTV. These parameters are critical in determining the goals of surgical reconstruction and such variability may have considerable implications for radiographic goals and outcomes of surgical reconstruction.4.
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- 2018
23. Ethnic Variations in Radiographic Parameters and SRS-22 Scores in Adult Spinal Deformity
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Christopher P. Ames, Hiroshi Taneichi, Mitsuru Yagi, Morio Matsumoto, Daisaku Takeuchi, Frank J. Schwab, Virginie Lafage, Shay Bess, Christopher I. Shaffrey, Yukihiro Matsuyama, Yu Yamato, Naobumi Hosogane, and Justin S. Smith
- Subjects
Male ,Pelvic tilt ,Pediatrics ,medicine.medical_specialty ,Radiography ,Ethnic group ,Scoliosis ,Spinal Curvatures ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Deformity ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,030222 orthopedics ,business.industry ,Retrospective cohort study ,Middle Aged ,medicine.disease ,United States ,Sagittal plane ,Oswestry Disability Index ,medicine.anatomical_structure ,North America ,Female ,Surgery ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Study design Retrospective review of North American and Japanese adult spinal deformity (ASD) database. Objective To investigate the ethnical differences in radiographic parameters and Scoliosis Research Society (SRS)-22 between North American and Japanese ASD. Summary of background data Previous comparison study between North American and Japanese ASD patients has revealed Japanese patients had marked pelvic tilt deformity and had lower Oswestry Disability Index scores corresponding to established thresholds of radiographic deformity. However, the subjects of the previous study included relatively younger ASD patients (above 18 y) of idiopathic origin. Materials and methods Total 282 ASD patients older than 50 years, 211 patients from North America (United States) and 71 patients from Japan (JP), with minimum 2-year follow-up postoperatively were included in the study. Radiologic parameters were compared at the baseline and at 2-year follow-up. SRS-22 score was used for the comparison of clinical outcome. Results At baseline, Japan showed significantly worse sagittal alignment such as smaller lumbar lordosis (LL), larger pelvic incidence (PI), and larger sagittal vertical axis than United States. However, Japan had significantly fewer levels fused than United States (US, 12.66±4.6; JP, 8.49±2.7). At 2 years after the surgery, Japan still had significantly worse residual sagittal deformity. Comparison of SRS-22 scores revealed Japan had better pain but worse functional domain scores at baseline which improved to comparable levels to the United States at 2 years. Self-image and mental health scores in Japan were significantly worse both at baseline and at 2 years. Analysis of factors affecting SRS-22 satisfaction score at 2 years revealed that previous spinal fusion surgery in the United States and LL, PI-LL, and sagittal vertical axis at 2 years in Japan had significant correlation. Conclusions These similarities and discrepancies may be influenced by the cultural or lifestyle differences between both nations and should be considered when interpreting the results of ASD studies among different ethnicities.
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- 2018
24. Comparison of Pedicle Screw Fixation Strength Among Different Transpedicular Trajectories
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Takashi Asazuma, Yasuo Yoshihara, Richard A. Hynes, Keitaro Matsukawa, Hideaki Imabayashi, Koichi Nemoto, Naobumi Hosogane, and Yoshiyuki Yato
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Adult ,Male ,Materials science ,medicine.medical_treatment ,Finite Element Analysis ,Finite element study ,Young Adult ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,Bone Density ,Pedicle Screws ,X ray computed ,Cortical Bone ,medicine ,Humans ,Orthopedics and Sports Medicine ,Pedicle screw fixation ,Pedicle screw ,Aged ,Aged, 80 and over ,Orthodontics ,030222 orthopedics ,Background data ,Pullout strength ,Middle Aged ,Finite element method ,Biomechanical Phenomena ,Spinal fusion ,Female ,Surgery ,Neurology (clinical) ,Tomography, X-Ray Computed ,030217 neurology & neurosurgery - Abstract
Comparative biomechanical study by finite element (FE) method.To investigate the pullout strength of pedicle screws using different insertional trajectories.Pedicle screw fixation has become the gold standard for spinal fusion, however, not much has been done to clarify how the fixation strength of pedicle screws are affected by insertional trajectories and bone properties.Three-dimensional FE models of 20 L4 vertebrae were constructed from the computed tomographic data. Five different transpedicular trajectories were compared: the traditional trajectory, the vertical trajectory, and the 3 lateral trajectories with different sagittal directions (caudal, parallel, cranial). For a valid comparison, screws of the same shape and size were inserted into the same pedicle in each subject, and the pullout strength were compared with nonlinear FE analyses. In addition, the pullout strength was correlated with bone mineral density (BMD).The mean pullout strength showed a 3.9% increase for the vertical trajectory relative to the traditional trajectory, 6.1% for the lateral-caudal trajectory, 21.1% for the lateral-parallel trajectory, and 34.7% for the lateral-cranial trajectory. The lateral-cranial trajectory demonstrated the highest value among all trajectories (P0.001). In each trajectory, the correlation coefficient between the pullout strength and BMD of the femoral neck (r=0.74-0.83, P0.01) was higher than the mean BMD of all the lumbar vertebrae (r=0.49-0.75, P0.01), BMD of the L4 vertebra (r=0.39-0.64, P0.01), and regional BMD of the L4 pedicle (r=0.53-0.76, P0.01).Regional variation in the vertebral bone density and the amount of denser bone-screw interface contribute to the differences of stiffness among different screw trajectories. BMD of the femoral neck is considered to be a better objective predictor of pedicle screw stability than that of the lumbar vertebra.
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- 2017
25. Cortical Bone Trajectory for Thoracic Pedicle Screws
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Keitaro Matsukawa, Naobumi Hosogane, Toshiyasu Matsui, Richard A. Hynes, Yoshiyuki Yato, Koichi Nemoto, Takashi Asazuma, Yasushi Kobayashi, and Hideaki Imabayashi
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Adult ,Male ,musculoskeletal diseases ,Computed tomography ,Thoracic Vertebrae ,03 medical and health sciences ,0302 clinical medicine ,Pedicle Screws ,Cortical Bone ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Pedicle screw ,Aged ,Aged, 80 and over ,030222 orthopedics ,medicine.diagnostic_test ,business.industry ,Technical note ,Anatomy ,Middle Aged ,musculoskeletal system ,surgical procedures, operative ,medicine.anatomical_structure ,Torque ,Thoracic vertebrae ,Trajectory ,Female ,Surgery ,Cortical bone ,Neurology (clinical) ,business ,Cadaveric spasm ,030217 neurology & neurosurgery - Abstract
A morphometric measurement of new thoracic pedicle screw trajectory using computed tomography and a biomechanical study on cadaveric thoracic vertebrae using insertional torque.To introduce a new thoracic pedicle screw trajectory which maximizes engagement with denser bone.Cortical bone trajectory (CBT) which maximizes the thread contact with cortical bone provides enhanced screw purchase. Despite the increased use of CBT screws in the lumbar spine, no study has yet reported the insertional technique for thoracic CBT.First, the computed tomography scans of 50 adults were studied for morphometric measurement of lower thoracic CBT. The starting point was determined to be the intersection of the lateral two thirds of the superior articular process and the inferior border of the transverse process. The trajectory was straight forward in the axial plane angulated cranially targeting the posterior third of the superior endplate. The maximum diameter, length, and the cephalad angle were investigated. Next, the insertional torque of pedicle screws using this new technique was measured and compared with that of the traditional technique on 24 cadaveric thoracic vertebrae.All morphometric parameters of thoracic CBT increased from T9 to T12 (the mean diameter: from 5.8 mm at T9 to 8.5 mm at T12; the length: from 29.7 mm at T9 to 32.0 mm at T12; and the cephalad angle: from 21.4 degrees at T9 to 27.6 degrees at T12). The mean maximum insertional torque of CBT screws and traditional screws were 1.02±0.25 and 0.66±0.15 Nm, respectively. The new technique demonstrated average 53.8% higher torque than the traditional technique (P0.01).The detailed morphometric measurement and favorable screw fixation stability of thoracic CBT are reported. The insertional torque using thoracic CBT technique was 53.8% higher than that of the traditional technique.
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- 2017
26. Scoliosis is a Risk Factor for Gastroesophageal Reflux Disease in Adult Spinal Deformity
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Yoshiaki Toyama, Mitsuru Yagi, Morio Matsumoto, Naobumi Hosogane, Kota Watanabe, and Shinjiro Kaneko
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Adult ,Male ,musculoskeletal diseases ,medicine.medical_specialty ,Scoliosis ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,Risk Factors ,medicine ,Humans ,Orthopedics and Sports Medicine ,Risk factor ,Aged ,Demography ,Aged, 80 and over ,030222 orthopedics ,Cobb angle ,business.industry ,Middle Aged ,Lumbar Curve ,medicine.disease ,digestive system diseases ,humanities ,Sagittal plane ,Surgery ,body regions ,Logistic Models ,medicine.anatomical_structure ,Coronal plane ,Multivariate Analysis ,Gastroesophageal Reflux ,GERD ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
A prospective observational study.To evaluate whether scoliosis is a risk factor for gastroesophageal reflux disease (GERD) in elderly patients.Sagittal spinal deformities are reported to cause GERD, but its association with spinal deformity in the coronal plane is not well studied.We examined 190 patients with spinal disorders (mean age 70.6±8.6 y) who underwent standing whole-spine x-rays in the coronal and sagittal planes. GERD symptoms were assessed by Quest score, with a cutoff of 6 points. The relationship between GERD symptoms and radiographic parameters was evaluated. Right convex coronal curves were given negative values, and left convex curves positive values. Degenerative scoliosis was defined when the thoracolumbar/lumbar Cobb angle had an absolute value10 degrees. Risk factors for GERD were evaluated with univariate and multivariate logistic regression analyses.Of the patients, 126 had degenerative scoliosis at the thoracolumbar/lumbar spine (42 with right and 84 with left convex curve), and 59 had GERD. Multivariate logistic regression analysis revealed that the lumbar Cobb angle was significantly associated with GERD (P0.05, odds ratio=1.021). When patients were categorized by Cobb angle of the lumbar curve (-30 degrees, large right convex curve; -30 to +30 degrees, small curve; or+30 degrees, large left convex curve), a large left convex curve was strongly associated with GERD (P0.05, odds ratio=10.925).Left thoracolumbar/lumbar curve was a significant risk factor for GERD, and risk increased with a curve30 degrees. Organ disorders such as GERD should be considered when treating elderly patients with degenerative scoliosis.
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- 2017
27. Position of the major curve influences asymmetrical trunk kinematics during gait in adolescent idiopathic scoliosis
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Nobuyuki Fujita, Mitsuhiro Nishida, Morio Matsumoto, Koota Watanabe, Takashi Tsuji, Takeo Nagura, Masaya Nakamura, and Naobumi Hosogane
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Male ,Adolescent ,Adolescent Health ,Biophysics ,Curvature ,Rotation ,Thoracic Vertebrae ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Gait (human) ,medicine ,Humans ,Orthopedics and Sports Medicine ,Child ,Gait ,030222 orthopedics ,business.industry ,Rehabilitation ,Torso ,Anatomy ,Lumbar Curve ,Trunk ,Sagittal plane ,Biomechanical Phenomena ,Transverse plane ,medicine.anatomical_structure ,Scoliosis ,Coronal plane ,Female ,business ,030217 neurology & neurosurgery - Abstract
Adolescent idiopathic scoliosis (AIS) is a structural, lateral curvature with rotation of the spine that develops around puberty. The influence of this spinal deformity on three-dimensional trunk movements during gait has not yet been elucidated. The aim of this study was to determine the influence of spinal curve pattern (single thoracic curve vs. single lumbar curve) on trunk kinematics during gait.Twenty-two patients with a single thoracic curve (Lenke type 1) and 17 patients with a single lumbar curve (Lenke type 5) were included in this study. Trunk symmetry in the sagittal, coronal, and transverse planes during gait was evaluated using an optoelectronic motion capture system.In the type 1 group, the trunk was significantly rotated towards the concave side in the transverse plane during gait (mean difference of transverse rotation angle between concave side load and the convex side load, 8.8±0.6°, p0.01). In the type 5 group, the trunk was significantly rotated towards the convex side in the coronal plane throughout the stance phase of gait (mean difference of coronal inclination angle, 1.9±0.3°, p0.05).The AIS patients with a single thoracic curve showed asymmetrical trunk movement in the transverse plane, and patients with a single lumbar curve showed asymmetrical trunk movement in the coronal plane. These results indicate that the spinal curve pattern influenced trunk kinematics, and suggest that the global postural control strategy of patients with AIS differs according to the curve pattern.
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- 2017
28. P79. Prevalence and surgical outcomes of primary severe sagittal plane deformity (pSPD) in adult spinal deformity (ASD) surgery: comparison between Japan and the United States
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Mitsuru Yagi, Christopher P. Ames, Naobumi Hosogane, Justin S. Smith, Christopher I. Shaffrey, Frank J. Schwab, Virginie Lafage, Morio Matsumoto, Shay Bess, Kota Watanabe, and null International Spine Study Group
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Pediatrics ,medicine.medical_specialty ,Cobb angle ,business.industry ,Context (language use) ,Sagittal plane ,medicine.anatomical_structure ,Deformity ,medicine ,Spinal deformity ,Asian country ,Sagittal alignment ,Surgery ,Orthopedics and Sports Medicine ,Neurology (clinical) ,medicine.symptom ,business ,Complication - Abstract
BACKGROUND CONTEXT Primary severe sagittal plane deformity (pSPD) is a distinct form of ASD commonly seen in Asian countries. The prevalence and surgical outcomes of pSPD are still poorly understood. PURPOSE The aim of this study was to report the prevalence and to compare clinical outcomes of pSPD between Japan (JP) and the US. STUDY DESIGN/SETTING Multicenter retrospective case series of surgically treated ASD patients. PATIENT SAMPLE A total of 345 consecutive, surgically treated primary ASD patients (JP:181, US:164) with age >50y and minimum 2-yr followup were included (JP vs US; age: 63±9vs 65±9). OUTCOME MEASURES Baseline and 2yr postop SRS22 were used to assess the clinical outcomes. METHODS This was a retrospective review of two prospective multicenter databases in JP and US. pSPD included primary patients (no previous fusion) with C7SVA>9.5cm, PT>20o, PI-LL>30o, and Cobb angle RESULTS Prevalence of pSPD in surgically treated ASD was significantly higher in JP (20% vs 12%, p=0.01). In both countries, gender, BMI, and Charlson Comorbidity Index were comparable with other ASD types, while baseline ODI and SRS22 (function and appearance) for pSPDs were poorer than other ASD types in the US. Although pSPDs had worse sagittal alignment at 2 yrs, similar HRQL improvement was observed in both countries with equivalent complication rates compared with other ASDs (Table). Baseline SRS22 function, pain, and appearance were significantly worse in the US, while SRS22 mental health was worse in JP (function: 2.5±0.8vs 2.7±0.8, pain: 2.2±0.7vs 2.8±0.7, appearance: 2.1±0.7vs 2.4±0.8, mental health; 3.3±1.2vs 2.6±0.7, p CONCLUSIONS Prevalence of pSPD in surgically treated ASD was significantly higher in JP (20% vs 12%, p=0.01). pSPD patients had worse HRQL at baseline compared with other ASDs. However, equivalent improvement for HRQL was observed in both countries with comparable complication rates and similar surgical invasiveness. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
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- 2020
29. Reply to the Editor: Surgical Treatment of Osteoporotic Vertebral Fracture with Neurological Deficit-A Nationwide Multicenter Study in Japan
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Gen Inoue, Syuta Yamada, Takeo Furuya, Yukitaka Nagamoto, Shinji Adachi, Sumihisa Orita, Masahiko Takahata, Ken Ishii, Atsushi Kimura, Masashi Oshima, Kei Ando, Shiro Imagama, Toshitaka Yoshii, Takashi Kaito, Norihiro Isogai, Kota Watanabe, Hidekazu Suzuki, Koji Tamai, Katsuhito Yoshioka, Kenichi Kawaguchi, Hidetomi Terai, Toshinori Tsukanishi, Seiji Ueda, Satoshi Suzuki, Naobumi Hosogane, Hiroshi Uei, Seiji Ohtori, Michio Hongo, Wataru Saito, Takashi Yurube, Hideki Murakami, Toshimasa Futatsugi, Kenya Nojiri, Yuji Matsuoka, Kazuyoshi Nakanishi, Tadashi Nukaga, Eijiro Okada, Yasuchika Aoki, Shuta Ushio, Hiroyasu Fujiwara, Atsushi Nakano, Kenichiro Kakutani, Tetsuya Abe, Hirooki Endo, Katsumi Harimaya, Daisuke Sakai, Tomohiro Hikata, Hirokazu Inoue, Katsuhito Kiyasu, Haruki Funao, Kei Watanabe, Tomoya Yamashita, Atsushi Tagami, Masayuki Miyagi, Masayuki Shimizu, Hirosuke Nishimura, Yuta Shiono, Toshio Doi, Shoji Seki, Shota Ikegami, Akira Iwata, Hidekazu Oishi, and Nobuhiko Yokoyama
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medicine.medical_specialty ,Spinal fusion surgery ,business.industry ,lcsh:Surgery ,MEDLINE ,osteoporotic vertebral fracture ,conservative treatment ,lcsh:RD1-811 ,Surgery ,Conservative treatment ,compression fracture ,kyphoplasty ,Multicenter study ,spinal fusion ,medicine ,Orthopedics and Sports Medicine ,spinal fusion surgery ,Neurology (clinical) ,Surgical treatment ,business ,Letter to the Editor ,Neurological deficit - Published
- 2020
30. Association of Susceptibility Genes for Adolescent Idiopathic Scoliosis and Intervertebral Disc Degeneration With Adult Spinal Deformity
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Kenya Nojiri, Masaya Nakamura, Masayuki Ishikawa, Kota Watanabe, Nobuyuki Fujita, Takeshi Ikegami, Yoji Ogura, Shinjiro Kaneko, Naobumi Hosogane, Nao Otomo, Shiro Ikegawa, Mitsuru Yagi, Kazuki Takeda, Osahiko Tsuji, Yohei Takahashi, Ikuyo Kou, Ken Ishii, Narihito Nagoshi, Eijiro Okada, Morio Matsumoto, Haruki Funao, Hitoshi Kono, Kunimasa Okuyama, and Takashi Tsuji
- Subjects
Adult ,Male ,Pathology ,medicine.medical_specialty ,Genotype ,Idiopathic scoliosis ,Susceptibility gene ,Single-nucleotide polymorphism ,Intervertebral Disc Degeneration ,Polymorphism, Single Nucleotide ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Genetic Predisposition to Disease ,Genetic Association Studies ,Aged ,Homeodomain Proteins ,030222 orthopedics ,business.industry ,Case-control study ,Intervertebral disc ,Middle Aged ,medicine.anatomical_structure ,Scoliosis ,Case-Control Studies ,Spinal deformity ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Transcription Factors - Abstract
Genetic case-control study of single nucleotide polymorphisms (SNPs).To examine the association of previously reported susceptibility genes for adolescent idiopathic scoliosis (AIS) and intervertebral disc (IVD) degeneration with adult spinal deformity (ASD).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.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.Among the AIS-associated SNPs, rs11190870 and rs6137473 showed strong and nominal associations with ASD (P = 1.44 × 10, 1.00 × 10, 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). In a subgroup analysis, rs11190870 was significantly associated with a Cobb angle more than 20° in the minor thoracic curve (P = 1.44 × 10) and with a left convex lumbar curve (P = 6.70 × 10), and nominally associated with an apical vertebra higher than L1 (P = 1.80 × 10).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.4.
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- 2019
31. Risk predictors of perioperative complications for the palliative surgical treatment of spinal metastasis
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Mitsuru Yagi, Yuichiro Mima, Osahiko Tsuji, Ken Ishii, Narihito Nagoshi, Satoshi Suzuki, Morio Matsumoto, Naobumi Hosogane, Soraya Nishimura, Eijiro Okada, Mitsuhiro Nishida, Norihiro Isogai, Nobuyuki Fujita, Kota Watanabe, and Masaya Nakamura
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medicine.medical_specialty ,Palliative care ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Risk Factors ,Diabetes mellitus ,Activities of Daily Living ,medicine ,Humans ,Orthopedics and Sports Medicine ,Retrospective Studies ,030222 orthopedics ,Spinal Neoplasms ,business.industry ,Incidence (epidemiology) ,Palliative Care ,Cancer ,Retrospective cohort study ,Perioperative ,medicine.disease ,Surgery ,Spinal Fusion ,Spinal fusion ,business ,Complication ,030217 neurology & neurosurgery - Abstract
The complication rate for palliative surgery in spinal metastasis is relatively high, and major complications can impair the patient's activities of daily living. However, surgical indications are determined based primarily on the prognosis of the cancer, with the risk of complications not truly considered. We aimed to identify the risk predictors for perioperative complications in palliative surgery for spinal metastasis.A multicentered, retrospective review of 195 consecutive patients with spinal metastasis who underwent palliative surgeries with posterior procedures from 2001 to 2016 was performed. We evaluated the type and incidence of perioperative complications within 14 days after surgery. Patients were categorized into either the complication group (C) or no-complication group (NC). Univariate and multivariate analyses were used to identify potential predictors for perioperative complications.Thirty patients (15%) experienced one or more complications within 14 days of surgery. The most frequent complications were surgical site infection (4%) and motor weakness (3%). A history of diabetes mellitus (C; 37%, NC; 9%: p 0.01) and surgical time over 300 min (C; 27%, NC; 12%: p 0.05) were significantly associated with complications according to univariate analysis. Increased blood loss and non-ambulatory status were determined to be potential risk factors. Of these factors, multivariate logistic regression revealed that a history of diabetes mellitus (OR: 6.6, p 0.001) and blood loss over 1 L (OR: 2.7, p 0.05) were the independent risk factors for perioperative complications. There was no difference in glycated hemoglobin A1c between the diabetes patients with and without perioperative complications.Diabetes mellitus should be used for the risk stratification of surgical candidates regardless of the treatment status, and strict prevention of bleeding is needed in palliative surgeries with posterior procedures to mitigate the risk of perioperative complications.
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- 2019
32. Risk Factors for Postoperative Distal Adding-on in Lenke Type 1B and 1C and its Influence on Residual Lumbar Curve
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Naobumi Hosogane, Takeshi Fujii, Osahiko Tsuji, Mitsuru Yagi, Masaya Nakamura, Kota Watanabe, Takashi Tsuji, Morio Matsumoto, Nobuyuki Fujita, Shinjiro Kaneko, Takehiro Michikawa, Kenshi Daimon, and Narihito Nagoshi
- Subjects
Male ,Adolescent ,Radiography ,Residual ,Thoracic Vertebrae ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,Postoperative Complications ,Risk Factors ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Postoperative Period ,Retrospective Studies ,030222 orthopedics ,Lumbar Vertebrae ,Cobb angle ,business.industry ,General Medicine ,Lumbar Curve ,Vertebra ,medicine.anatomical_structure ,Spinal Fusion ,Scoliosis ,Coronal plane ,Pediatrics, Perinatology and Child Health ,Female ,Level iii ,business ,Nuclear medicine ,Follow-Up Studies - Abstract
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. Level of evidence Level III.
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- 2019
33. Midterm surgical outcomes of a short fusion strategy for adolescent idiopathic scoliosis with Lenke 5C curve
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Osahiko Tsuji, Nobuyuki Fujita, Takahiro Kitagawa, Morio Matsumoto, Satoshi Suzuki, Narihito Nagoshi, Takeshi Fujii, Mitsuru Yagi, Eijiro Okada, Kota Watanabe, Masaya Nakamura, Naobumi Hosogane, and Yoji Ogura
- Subjects
Adolescent ,Radiography ,Context (language use) ,Idiopathic scoliosis ,Thoracic Vertebrae ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Kyphosis ,Balance (ability) ,Retrospective Studies ,030222 orthopedics ,Lumbar Vertebrae ,Cobb angle ,business.industry ,Vertebra ,medicine.anatomical_structure ,Spinal Fusion ,Treatment Outcome ,Scoliosis ,Coronal plane ,Surgery ,Neurology (clinical) ,business ,Lumbar lordosis ,Nuclear medicine ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
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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- 2019
34. Complications after spinal fixation surgery for osteoporotic vertebral collapse with neurological deficits: Japan Association of Spine Surgeons with ambition multicenter study
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Shota Takenaka, Yuta Shiono, Toshio Doi, Satoshi Suzuki, Atsushi Tagami, Hidekazu Oishi, Shoji Seki, Eijiro Okada, Masashi Oshima, Wataru Saito, Hidekazu Suzuki, Hiroyasu Fujiwara, Tomohiro Hikata, Koji Tamai, Shinji Adachi, Hideki Murakami, Kenya Nojiri, Sumihisa Orita, Hirooki Endo, Katsumi Harimaya, Hidetomi Terai, Naobumi Hosogane, Shiro Imagama, Masayuki Shimizu, Atsushi Kimura, Daisuke Sakai, Yusuke Sakai, Kei Ando, Shuta Ushio, Toshimasa Futatsugi, Akira Iwata, Toshinori Tsukanishi, Shota Ikegami, Hiroshi Uei, Atsushi Nakano, Kenichi Kawaguchi, Michio Hongo, Nobuhiko Yokoyama, Yuji Matsuoka, Katsuhito Kiyasu, Kazuyoshi Nakanishi, Keiichi Katsumi, Ken Ishii, Katsuhito Yoshioka, Seiji Ueda, Hirosuke Nishimura, Yasuchika Aoki, Kenichiro Kakutani, Yukitaka Nagamoto, Tetsuya Abe, Norihiro Isogai, Haruki Funao, Toshitaka Yoshii, Masahiko Takahata, Hirokazu Inoue, Kota Watanabe, Kei Watanabe, Takashi Yurube, Takashi Kaito, Tomoya Yamashita, Shuta Yamada, Masayuki Miyagi, Seiji Ohtori, Takahiro Makino, Gen Inoue, Tadashi Nukaga, and Takeo Furuya
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Thoracic Vertebrae ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Postoperative Complications ,Japan ,Surveys and Questionnaires ,Fractures, Compression ,medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,Pain Measurement ,Retrospective Studies ,Aged, 80 and over ,030222 orthopedics ,Univariate analysis ,Lumbar Vertebrae ,business.industry ,Retrospective cohort study ,Odds ratio ,Middle Aged ,medicine.disease ,Surgery ,Spinal Fusion ,Spinal fusion ,Delirium ,Female ,medicine.symptom ,Nervous System Diseases ,business ,Complication ,Body mass index ,030217 neurology & neurosurgery ,Osteoporotic Fractures - Abstract
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.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.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).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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- 2019
35. Surgical outcomes of spinal fusion for osteoporotic thoracolumbar vertebral fractures in patients with Parkinson’s disease: what is the impact of Parkinson’s disease on surgical outcome?
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Yasuchika Aoki, Toshiro Doi, Michio Hongo, Hidekazu Suzuki, Naobumi Hosogane, Tomohiro Izumi, Kenya Nojiri, Katsuhito Kiyasu, Shinji Adachi, Masayuki Ohashi, Hidekazu Oishi, Shuta Ushio, Atsushi Nakano, Shota Ikegami, Kei Ando, Masahiko Takahata, Toshimasa Futatsugi, Haruki Funao, Yuta Shiono, Takashi Kaito, Seiji Ohtori, Norihiro Isogai, Hirokazu Inoue, Hideki Murakami, Koji Tamai, Seiji Ueda, Akira Iwata, Toshitaka Yoshii, Toshinori Tsukanishi, Gen Inoue, Nobuhiko Yokoyama, Shoji Seki, Kei Watanabe, Hiroyasu Fujiwara, Katsuhito Yoshioka, Tomohiro Hikata, Tadashi Nukaga, Eijiro Okada, Syuta Yamada, Naoto Endo, Takeo Furuya, Wataru Saito, Hirooki Endo, Katsumi Harimaya, Daisuke Sakai, Ken Ishii, Toru Hirano, Atsushi Tagami, Atsushi Kimura, Takashi Yurube, Yukitaka Nagamoto, Tomoya Yamashita, Masashi Oshima, Masayuki Miyagi, Kazuyoshi Kobayashi, Hidetomi Terai, Keiichi Katsumi, Hirosuke Nishimura, Masayuki Shimizu, Sumihisa Orita, Shiro Imagama, Kota Watanabe, Kenichi Kawaguchi, Yohei Shibuya, Satoshi Suzuki, Yuji Matsuoka, Kazuyoshi Nakanishi, Kenichiro Kakutani, and Tetsuya Abe
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Male ,medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,Sports medicine ,Visual analogue scale ,medicine.medical_treatment ,Parkinson's disease ,Osteoporosis ,Kyphosis ,Japanese orthopedic association score ,Thoracic Vertebrae ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Thoracolumbar spine ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Outcome ,Aged ,Retrospective Studies ,030203 arthritis & rheumatology ,Aged, 80 and over ,030222 orthopedics ,Rehabilitation ,Lumbar Vertebrae ,business.industry ,Perioperative complication ,Parkinson Disease ,Perioperative ,medicine.disease ,Surgery ,Spinal Fusion ,Treatment Outcome ,Spinal fusion ,Orthopedic surgery ,Parkinson’s disease ,Spinal Fractures ,Female ,Vertebral fracture ,lcsh:RC925-935 ,business ,Osteoporotic Fractures ,Research Article - Abstract
Background To date, there have been little published data on surgical outcomes for patients with PD with thoracolumbar OVF. We conducted a retrospective multicenter study of registry data to investigate the outcomes of fusion surgery for patients with Parkinson’s disease (PD) with osteoporotic vertebral fracture (OVF) in the thoracolumbar junction. Methods Retrospectively registered data were collected from 27 universities and their affiliated hospitals in Japan. In total, 26 patients with PD (mean age, 76 years; 3 men and 23 women) with thoracolumbar OVF who underwent spinal fusion with a minimum of 2 years of follow-up were included (PD group). Surgical invasion, perioperative complications, radiographic sagittal alignment, mechanical failure (MF) related to instrumentation, and clinical outcomes were evaluated. A control group of 296 non-PD patients (non-PD group) matched for age, sex, distribution of surgical procedures, number of fused segments, and follow-up period were used for comparison. Results The PD group showed higher rates of perioperative complications (p
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- 2019
36. The factors related to the poor ADL in the patients with osteoporotic vertebral fracture after instrumentation surgery
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Ken Ishii, Toshitaka Yoshii, Masahiko Takahata, Akihiko Hiyama, Kazuyoshi Kobayashi, Takashi Kaito, Hidetomi Terai, Norihiro Isogai, Hiroshi Uei, Atushi Tagami, Hidekazu Suzuki, Atsushi Kimura, Yasuchika Aoki, Takashi Yurube, Sumihisa Orita, Shiro Imagama, Daisuke Sakai, Kengo Yamamoto, Shoji Seki, Koji Tamai, Kenichi Kawaguchi, Hirosuke Nishimura, Michio Hongo, Naobumi Hosogane, Katsuhito Yoshioka, Seiji Ohtori, Yasunobu Sawaji, Hirooki Endo, Gen Inoue, Katsumi Harimaya, Yasumitsu Ajiro, Kota Watanabe, Eijiro Okada, Kazuma Murata, Kei Watanabe, Katsuhito Kiyasu, Shota Ikegami, Haruki Funao, Hideki Murakami, Taichiro Takamatsu, Takeo Furuya, Yuji Matsuoka, Kazuyoshi Nakanishi, Kenichiro Kakutani, Tetsuya Abe, Takuya Kusakabe, Takato Aihara, Asato Maekawa, Atsushi Nakano, and Kenji Endo
- Subjects
medicine.medical_specialty ,Activities of daily living ,Multivariate analysis ,Nonunion ,03 medical and health sciences ,0302 clinical medicine ,Statistical significance ,Activities of Daily Living ,medicine ,Humans ,Orthopedics and Sports Medicine ,In patient ,Retrospective Studies ,030222 orthopedics ,Univariate analysis ,business.industry ,Perioperative ,medicine.disease ,Spine ,Surgery ,Spinal Fractures ,business ,Complication ,030217 neurology & neurosurgery ,Osteoporotic Fractures - Abstract
Osteoporotic vertebral fracture (OVF) with nonunion or neurological deficit may be a candidate for surgical treatment. However, some patients do not show improvement as expected. Therefore, we conducted a nationwide multicenter study to determine the predictors for postoperative poor activity of daily living (ADL) in patients with OVF. We retrospectively reviewed the case histories of 309 patients with OVF who underwent surgery. To determine the factors predicting postoperative poor ADL, uni- and multivariate statistical analyses were performed. The frequency of poor ADL at final follow-up period was 9.1%. In univariate analysis, preoperative neurological deficit (OR, 4.1; 95% CI, 1.8–10.3; P
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- 2019
37. Epidemiological survey of ossification of the posterior longitudinal ligament by using clinical investigation registration forms
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Nobuyuki Fujita, Tomohiro Hikata, Takashi Tsuji, Kota Watanabe, Yoshiaki Toyama, Naobumi Hosogane, Kazuhiro Chiba, Morio Matsumoto, Masaya Nakamura, Ken Ishii, and Akio Iwanami
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Lumbar vertebrae ,Ossification of Posterior Longitudinal Ligament ,Risk Assessment ,Severity of Illness Index ,Thoracic Vertebrae ,03 medical and health sciences ,Age Distribution ,0302 clinical medicine ,Japan ,Epidemiology ,medicine ,Humans ,Orthopedic Procedures ,Orthopedics and Sports Medicine ,Registries ,Age of Onset ,Sex Distribution ,Family history ,Aged ,Retrospective Studies ,030222 orthopedics ,Chi-Square Distribution ,Lumbar Vertebrae ,Ossification ,business.industry ,Incidence ,Incidence (epidemiology) ,Retrospective cohort study ,Middle Aged ,Prognosis ,Radiography ,Treatment Outcome ,medicine.anatomical_structure ,Multivariate Analysis ,Thoracic vertebrae ,Cervical Vertebrae ,Female ,Surgery ,medicine.symptom ,Age of onset ,Tomography, X-Ray Computed ,business ,030217 neurology & neurosurgery - Abstract
Background In Japan, ossification of the posterior longitudinal ligament (OPLL) has been designated as an intractable disease by the Ministry of Health, Labour, and Welfare. Here we aimed to clarify the epidemiological characteristics of severe OPLL patients by analyzing a national registry of this disease that uses clinical investigation registration forms. Methods We retrospectively investigated clinical investigation registration forms for 24,502 patients with OPLL. We examined the sex distribution, age of disease onset, period from disease onset to registration, family history, site of ossification as determined by plain radiographs, Japanese Orthopaedic Association score, and number of OPLL surgeries. Results The male-to-female ratios were 2.7:1 and 1.9:1 for new and renewed registrations, respectively. The mean ages at disease onset were 61.1 and 59.7 years for new and renewed registrations, respectively. The mean periods from disease onset to registration were 2.6 and 8.4 years for new and renewed registrations, respectively. The percentages of new registrations with and without family history were 5.3% and 51.5%, respectively (unknown for 43.3%). Of the new registrations, 3511, 359, and 200 cases exhibited ossification in the cervical spine, thoracic spine, and lumbar spine, respectively; the corresponding numbers for renewed registrations were 13,710, 2484, and 1508. The Japanese Orthopaedic Association score was 9.9 ± 3.6 for new registrations, and the mean score recovery rate for renewed registrations was 6.0%. The number of OPLL surgeries was one or zero, two, three, four, or five for 21,785, 2167, 412, 99, and 39 patients, respectively, with 11.1% of all patients having undergone multiple surgeries. Conclusions This study offers new insight into the epidemiological characteristics of severe OPLL. In particular, we found that the age of disease onset was higher than previously reported, the period from disease onset to registration (surgery) was relatively short, and about 90% of the patients required only a single surgery.
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- 2016
38. The paravertebral muscle and psoas for the maintenance of global spinal alignment in patient with degenerative lumbar scoliosis
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Kota Watanabe, Takashi Asazuma, Naobumi Hosogane, Mitsuru Yagi, and Morio Matsumoto
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Radiography ,Paraspinal Muscles ,Context (language use) ,Pelvis ,03 medical and health sciences ,Absorptiometry, Photon ,Postoperative Complications ,Spinal Stenosis ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,In patient ,Aged ,Psoas Muscles ,030222 orthopedics ,medicine.diagnostic_test ,business.industry ,Lumbosacral Region ,Lumbar spinal stenosis ,Magnetic resonance imaging ,Anatomy ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Sagittal plane ,medicine.anatomical_structure ,Scoliosis ,Case-Control Studies ,Female ,Surgery ,Lumbar scoliosis ,Neurology (clinical) ,business ,Nuclear medicine ,Body mass index ,030217 neurology & neurosurgery - Abstract
Various factors are reported to affect the spinal alignment in degenerative lumbar scoliosis (DLS). Although trunk muscles also appear to affect spinal alignment, the role of the trunk muscles is not yet clear.The aim was to elucidate the role of the multifidus (MF) and psoas (PS) in maintaining global spinal alignment in patients with DLS.This was a multicenter retrospective matched cohort study.Surgically treated 60 paired DLS and lumbar spinal stenosis (LSS) female (120 patients), matched for age and body mass index (BMI; DLS age 68.0±6.8 vs. LSS 67.1±8.9 years; BMI 21.6±3.3 vs. 23.2±3.8 kg/m(2)), were included and were followed for at least 2 years.Spinal alignment, muscle area, and volume were measured from radiographs, magnetic resonance images (MRIs), and whole-body dual-energy X-ray absorptiometry (DXA) scans. Muscle strength was measured by grip power and peak expiratory flow (PEF).As a surrogate of muscle area, we obtained the cross-sectional area (CSA) at the L5-S level from preoperative MRIs.The MF and PS CSAs were significantly smaller in the DLS group than in the LSS group (MF 477.7±192.5 vs. 779.8±248.6 mm(2), p.01; PS 692.3±201.2 vs. 943.4±272.4 mm(2), p=.002), whereas percentage of difference between the right and left sides was significantly larger in the DLS group (MF 18.4±30.6 vs. 2.4±3.3%, p.01; PS 14.4±15.8 vs. 2.1±2.2%, p.01). In the extremities, there were no significant differences in the left- or right-side lean composition and grip strength or PEF tests between the groups. Correlation coefficient tests showed moderate correlations between the MF average CSA (avCSA) and global spinal alignment and spinopelvic alignment (pelvic incidence-lumbar lordosis; R=-0.37, -0.38) in the DLS group. The MF avCSA was correlated with the postoperative progression of kyphosis at the unfused thoracic vertebrae in the DLS group (R=0.34).The CSAs of the MF and PS were significantly smaller in the DLS group. Whole-body DXA showed no significant difference in the lean composition between the groups. There were significant correlations in the DLS patients between the MF CSA and sagittal spinal alignment. These findings suggest the causal relationship between muscles and global spine alignment.
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- 2016
39. Calculation of the Target Lumbar Lordosis Angle for Restoring an Optimal Pelvic Tilt in Elderly Patients With Adult Spinal Deformity
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Naobumi Hosogane, Shin Oe, Tatsuya Yasuda, Sho Kobayashi, Morio Matsumoto, Takahiro Iida, Akira Matsumura, Yu Yamato, Hideyuki Arima, Yukihiro Matsuyama, Tomohiko Hasegawa, and Daisuke Togawa
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Adult ,Male ,Pelvic tilt ,medicine.medical_specialty ,Pelvis ,03 medical and health sciences ,0302 clinical medicine ,Image Processing, Computer-Assisted ,medicine ,Humans ,Orthopedics and Sports Medicine ,In patient ,Aged ,Retrospective Studies ,Aged, 80 and over ,030222 orthopedics ,Lumbar Vertebrae ,Oswestry disability index score ,business.industry ,Pelvic incidence ,Retrospective cohort study ,Middle Aged ,Sagittal plane ,Surgery ,Cross-Sectional Studies ,medicine.anatomical_structure ,Lordosis ,Spinal deformity ,Female ,Neurology (clinical) ,Lumbar lordosis ,business ,Nuclear medicine ,030217 neurology & neurosurgery - Abstract
Study design This investigation consisted of a cross-sectional study and a retrospective multicenter case series. Objective This investigation sought to identify the ideal lumbar lordosis (LL) angle for restoring an optimal pelvic tilt (PT) in patients with adult spinal deformity (ASD). Summary of background data To achieve successful corrective fusion in ASD patients with sagittal imbalance, it is essential to correct the sagittal spinal alignment and obtain a suitable pelvic inclination. We determined the LL angle that would restore the optimal PT following ASD surgery. Methods The cross-sectional study included 184 elderly volunteers (mean age 64 years) with an Oswestry Disability Index score less than 20%. The relationship between PT or LL and the pelvic incidence (PI) in normal individuals was investigated. The second study included 116 ASD patients (mean age 66 years) who underwent thoracolumbar corrective fusion at 1 of 4 spine centers. The postoperative PT values were calculated using the parameters measured. On the basis of these studies, an ideal LL angle was determined. Results In the cross-sectional study, the linear regression equation for the optimal PT as a function of PI was "optimal PT = 0.47 × PI - 7.5." In the second study, the postoperative PT was determined as a function of PI and corrected LL, using the equation "postoperative PT = 0.7 × PI - 0.5 × corrected LL + 8.1." The target LL angle was determined by mathematically equalizing the PTs of these 2 equations: "target LL = 0.45 × PI + 31.8." Conclusion The ideal LL angle can be determined using the equation "LL = 0.45 × PI + 31.8," which can be used as a reference during surgical planning in ASD cases. Level of evidence 4.
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- 2016
40. Biomechanical Evaluation of Cross Trajectory Technique for Pedicle Screw Insertion: Combined Use of Traditional Trajectory and Cortical Bone Trajectory
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Naobumi Hosogane, Yoshiyuki Yato, Takashi Asazuma, Hideaki Imabayashi, Koichi Nemoto, and Keitaro Matsukawa
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musculoskeletal diseases ,Orthodontics ,medicine.medical_specialty ,Posterior fusion ,Combined use ,Mean age ,musculoskeletal system ,Surgery ,medicine.anatomical_structure ,Vertebral fixation ,medicine ,Orthopedics and Sports Medicine ,Cortical bone ,Fe model ,Pedicle screw ,Mathematics ,Fixation (histology) - Abstract
Objective To introduce a novel double-screw (cross trajectory) technique that combines use of the traditional trajectory (TT) and cortical bone trajectory (CBT) and to investigate its fixation strength quantitatively by finite element (FE) analysis. Methods Three-dimensional FE models of 30 osteoporotic L4 vertebrae (patients' mean age: 77.3 ± 7.4 years, 11 men and 19 women) were computationally created. Each vertebral model was implanted with bilateral pedicle screws by TT (using 7.5 mm × 40 mm screws), CBT (using 5.5 mm × 35 mm screws) and cross trajectory (combined use of TT screws of 5.5 mm × 40 mm and CBT screws of 5.5 mm × 35 mm) and compared among three groups. The vertebral fixation strength of a bilateral-screw construct was examined by applying forces simulating flexion, extension, lateral bending, and axial rotation to the vertebrae by non-linear FE analyses. Results Fixation strength using the cross trajectory was the highest among the three different techniques (P < 0.01). The cross trajectory construct demonstrated 320% higher strength than the TT construct in flexion, 293% higher in extension, 102% higher in lateral bending, and 40% higher in axial rotation (P < 0.01). Similarly, the cross trajectory construct showed 268% higher strength than the CBT construct in flexion, 269% higher in extension, 210% higher in lateral bending, and 178% in axial rotation (P < 0.01). Conclusions The cross trajectory technique offered superior fixation strength over the TT and CBT techniques in each plane of motion. This technique may be a valid option for posterior fusion, especially in osteoporotic spine.
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- 2015
41. 275. Opioid use after adult spinal deformity surgery: propensity-matched comparison of Japanese vs amAmerican cohorts
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Jeffrey L. Gum, Leah Y. Carreon, Mitsuru Yagi, Naobumi Hosogane, Kota Watanabe, Justin S. Smith, Christopher I. Shaffrey, Han Jo Kim, Eric O. Klineberg, Virginie Lafage, Renaud Lafage, Themistocles S. Protopsaltis, Peter G. Passias, Gregory M. Mundis, Robert K. Eastlack, Michael P. Kelly, Alan H. Daniels, Emmanuel McNeely, Alexandra Soroceanu, D. Kojo Hamilton, Munish C. Gupta, Douglas C. Burton, Richard A. Hostin, Khaled M. Kebaish, Robert A. Hart, Frank J. Schwab, Shay Bess, Christopher P. Ames, and null International Spine Study Group
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Opioid epidemic ,medicine.medical_specialty ,business.industry ,Opioid use ,Context (language use) ,Mental health ,Surgery ,Spine surgery ,Cohort ,Spinal deformity ,Medicine ,Orthopedics and Sports Medicine ,Neurology (clinical) ,Prospective cohort study ,business - Abstract
BACKGROUND CONTEXT Amidst a current US opioid epidemic, it is important to understand factors that contribute to long-term or sustained opioid use after elective spine surgery. Recent reports have reported up to 25% of opioid-naive patients are taking opioids at 2-year follow-up after adult spinal deformity (ASD) surgery. This suggests ASD surgery, or at least the postoperative course, could be a significant factor contributing to long-term or sustained opioid use. ln Asian countries, opioids are rarely prescribed for postoperative pain. Potentially, there is a significant cultural difference that can play a role in patient expectations in the postoperative period leading to long-term opioid use. PURPOSE To compare long-term or sustained (2-years) opioid use after ASD surgery between American and Japanese Cohorts STUDY DESIGN/SETTING Propensity-matched comparison of American and Japanese ASD patients PATIENT SAMPLE Patients from two (United States vs Japanese) prospective, multicenter ASD databases were compared OUTCOME MEASURES Baseline and 2-year opioid use and SRS-22 domains were compared METHODS We propensity matched 127 JPN to 619 US ASD patients based on age, sex, BMI, 3-column osteotomy, pelvic fixation, number of levels fused and preoperative SVA. Pre-op and 2-year postoperative opioid use was determined using responses to SRS22R Q11 and grouped into 3 categories (none, weekly, or daily). We have previously validated the use of SRS22R Q11 as an accurate measure for opioid use by comparing to a prospective study specifically designed to study opioid use and postoperative outcomes in ASD. RESULTS From each cohort, 34 cases were successfully matched, with no difference in baseline parameters, including baseline opioid use (p=0.095), between the cohorts. The relatively low numbers in each cohort arise from difficulty matching a lower BMI and lower baseline opioid use in the JPN cohort. At 2-years postop, 22 US (65%) vs 31 JPN (91%) reported no opioid use, 1 US (3%) vs 0 JPN (0%) reported weekly use, and 11 US (32%) vs 3 JPN (9%) reported daily use (p=0.009). There was no difference in 2-year SRS-22 Self-image and Mental Health between the two groups while US patients had better Satisfaction (4.29 vs 3.84, p=0.032) but lower Function scores (3.52 vs 3.90, p=0.029). CONCLUSIONS In propensity-matched ASD cohorts, 35% of US patients were still using opioids 2 years after surgery compared to 9% of JPN patients, with the most taking opioids daily. Further studies are needed to identify sources of this variability. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
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- 2020
42. Surgical risk stratification based on preoperative risk factors in adult spinal deformity
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Eijiro Okada, Kota Watanabe, Naobumi Hosogane, Mitsuru Yagi, Takashi Tsuji, Osahiko Tsuji, Narihito Nagoshi, Nobuyuki Fujita, Morio Matsumoto, Masaya Nakamura, Takashi Asazuma, and Satoshi Suzuki
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Risk analysis ,Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Context (language use) ,Risk Assessment ,Neurosurgical Procedures ,Spinal Curvatures ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Quality of life ,medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,030222 orthopedics ,Univariate analysis ,business.industry ,Odds ratio ,Perioperative ,Middle Aged ,Cohort ,Quality of Life ,Surgery ,Female ,Neurology (clinical) ,Complication ,business ,030217 neurology & neurosurgery - Abstract
BACKGROUND CONTEXT Corrective surgery for adult spinal deformity (ASD) improves health-related quality of life but has high complication rates. Predicting a patient's risk of perioperative and late postoperative complications is difficult, although several potential risk factors have been reported. PURPOSE To establish an accurate, ASD-specific model for predicting the risk of postoperative complications, based on baseline demographic, radiographic, and surgical invasiveness data in a retrospective case series. STUDY DESIGN/SETTING Multicentered retrospective review and the surgical risk stratification. PATIENT SAMPLE One hundred fifty-one surgically treated ASD at our hospital for risk analysis and model building and 89 surgically treated ASD at 2 other our hospitals for model validation. OUTCOME MEASURES HRQoL measures and surgical complications. METHODS We analyzed demographic and medical data, including complications, for 151 adults with ASD who underwent surgery at our hospital and were followed for at least 2years. Each surgical risk factor identified by univariate analyses was assigned a value based on its odds ratio, and the values of all risk factors were summed to obtain a surgical risk score (range 0–20). We stratified risk scores into grades (A–D) and analyzed their correlations with complications. We validated the model using data from 89 patients who underwent ASD surgery at two other hospitals. RESULTS Complications developed in 48% of the patients in the model-building cohort. Univariate analyses identified 10 demographic, physical, and surgical risk indicators, with odds ratios from 5.4 to 1.4, for complications. Our risk-grading system showed good calibration and discrimination in the validation cohort. The complication rate increased with and correlated well with the risk grade using receiver operating characteristic curves. CONCLUSIONS This simple, ASD-specific model uses readily accessible indicators to predict a patient's risk of perioperative and postoperative complications and can help surgeons adjust treatment strategies for best outcomes in high-risk patients.
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- 2018
43. 274. Opioid prescribing practice among adult spinal deformity surgeons: where are we in 2018?
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Michael P. Kelly, Khaled M. Kebaish, Douglas C. Burton, Alexandra Soroceanu, Naobumi Hosogane, Justin S. Smith, Paul Park, Christopher I. Shaffrey, Breton Line, D. Kojo Hamilton, Richard A. Hostin, Alan H. Daniels, Juan S. Uribe, Jeffrey L. Gum, Shay Bess, Robert A. Hart, and Munish C. Gupta
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medicine.medical_specialty ,business.industry ,Narcotic ,General surgery ,medicine.medical_treatment ,Specialty ,Context (language use) ,Opioid ,Cohort ,Orthopedic surgery ,Spinal deformity ,Medicine ,Surgery ,Orthopedics and Sports Medicine ,Neurology (clinical) ,Neurosurgery ,business ,medicine.drug - Abstract
BACKGROUND CONTEXT The opioid crisis in the US has created a backlash from the government and third- party payors with headlines appearing daily in the media. We sought to understand the current opioid prescribing practices of adult spinal deformity surgeons in this difficult environment. PURPOSE We wanted to investigate the opioid prescribing practices of surgeons from neurosurgical and orthopedic disciplines treating adult spinal deformity STUDY DESIGN/SETTING Survey of the prescribing practices of surgeons treating adult spinal deformity. PATIENT SAMPLE A total of 33 surgeons: 20 orthopedist and 13 neurosurgeons. OUTCOME MEASURES Survey of opioid prescribing practices. METHODS A questionnaire was given to adult deformity surgeons with varied years of practice. Years in practice and residency specialty (ortho vs neuro) were noted. Various questions regarding prescribing practice were asked. Descriptive statistics were performed to show the prevalence of the different prescribing practices among the cohort. RESULTS A total of 33 surgeons (20 ortho, 13 neuro) returned the survey. Years in practice were as follows: 20yrs, 4 (12.1%). The following questions were asked: Do you actively wean patients off narcotic medications before surgery? {Yes=18 (54.5%) [Neuro=4 (31%) and Ortho=14 (70%) (p=0.0270)]; No=15 (45.5%)}; Do you require them to be completely off of the narcotics? {Yes=0 No=33 (100%)}; Do you prescribe opioids to your patients postoperatively? {Yes=30 (90.9%) No=3 (9.1%)}; If no, who does? {Pain Management=2; Fellows=1 (Japan)}; If yes, do you have a cut-off time point postoperatively after which you no longer primarily prescribe narcotics? {Yes=28 (84.8%), No=2 (6.1%), N/A=3 (9.1%)}; If yes, how long do you prescribe? {6 weeks=5 (15.2%), 2 months=1 (3.0%), 3 months=19 (57.6%), 6 months=3 (9.1%), 1 year= None, indefinitely=2 (6.1%), N/A=3 (9.1%)}; Do you actively attempt to wean your patients off of opioids postoperatively? {Yes=30 (90.9%) [Neuro=10 (77%) and Ortho=20 (100%) (p=0.0242)], No=3 (9.1%)}. Differences between the group of surgeons in their training background of neurosurgery vs orthopedics was significantly different in actively weaning patients off narcotics either before or after surgery. CONCLUSIONS Surgeons operating on adult deformity patients in 2018 are limiting the amount of narcotics given to surgical patients preoperatively and postoperatively. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.
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- 2019
44. Postoperative behavior of thoracolumbar/lumbar curve and coronal balance after posterior thoracic fusion for Lenke 1C and 2C adolescent idiopathic scoliosis
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Masayuki Ishikawa, Mitsuru Yagi, Yasuyuki Fukui, Kai Cao, Makoto Nishiyama, Kota Watanabe, Morio Matsumoto, Masafumi Machida, Long Pang, Yuta Shiono, and Naobumi Hosogane
- Subjects
Male ,musculoskeletal diseases ,medicine.medical_specialty ,Adolescent ,Radiography ,medicine.medical_treatment ,Severity of Illness Index ,Thoracic Vertebrae ,Lumbar ,Pedicle Screws ,medicine ,Humans ,Orthopedics and Sports Medicine ,Decompensation ,Retrospective Studies ,Lumbar Vertebrae ,business.industry ,Retrospective cohort study ,Lumbar Curve ,Surgery ,Spinal Fusion ,Treatment Outcome ,Scoliosis ,Spinal fusion ,Coronal plane ,Orthopedic surgery ,Female ,business - Abstract
Controversy still exists around surgical strategies for Lenke type 1C and 2C curves with primary thoracic and compensatory lumbar curves in adolescent idiopathic scoliosis (AIS). The benefit of selective thoracic fusion (STF) for these curve types is spontaneous lumbar curve correction while saving more mobile lumbar segments. However, a risk of postoperative coronal decompensation after STF has also been reported. This multicenter retrospective study was conducted to evaluate postoperative behavior of thoracolumbar/lumbar (TLL) curve and coronal balance after posterior thoracic fusion for Lenke 1C and 2C AIS.Twenty-four Lenke 1C and 2C AIS patients who underwent posterior thoracic fusion were included. The mean age of patients was 15.7 years old at time of surgery. Constructs used for surgery in all cases were pedicle screw constructs ending at L3 or above. Radiographic measurements were performed on Cobb angles of the main thoracic and TLL curves and coronal balance. Factors related to final Cobb angle of TLL curve and postoperative change of coronal balance were investigated.Mean Cobb angles for main thoracic and TLL curves were 59.0° and 43.9° preoperatively, and were corrected to 21.5° and 22.0° at final follow-up, respectively. Mean coronal balance was -5.6 mm preoperatively and was corrected to -14.6 mm at final follow-up. Final Cobb angle of TLL curve was significantly correlated with immediate postoperative Cobb angle of main thoracic curve and tilt of lowest instrumented vertebra (LIV). Postoperative change of coronal balance was significantly correlated with selection of LIV relative to stable vertebra.Spontaneous correction of TLL curve occurred consistently by correcting the main thoracic curve and making the LIV more horizontal after posterior thoracic fusion for Lenke 1C and 2C AIS. The more distal fixation to stable vertebra resulted in coronal balance shifting more to the left postoperatively.
- Published
- 2015
45. Surgical correction of severe kyphoscoliosis resulting in a neurological complication in Marshall–Smith syndrome
- Author
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Yoshiaki Toyama, Kai Cao, Morio Matsumoto, Naobumi Hosogane, and Kota Watanabe
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Male ,medicine.medical_specialty ,Adolescent ,Gene mutation ,Severity of Illness Index ,Craniofacial Abnormalities ,Spinal Stenosis ,Marshall–Smith syndrome ,Septo-Optic Dysplasia ,medicine ,Humans ,Abnormalities, Multiple ,Orthopedics and Sports Medicine ,Spinal canal ,Kyphosis ,Intraoperative Complications ,Kyphoscoliosis ,Cervical canal ,Bone morphogenesis ,Bone Diseases, Developmental ,business.industry ,Dysostosis ,medicine.disease ,digestive system diseases ,Surgery ,Stenosis ,medicine.anatomical_structure ,Scoliosis ,Cervical Vertebrae ,business - Abstract
Marshall–Smith syndrome (MSS) is a rare syndrome characterized by facial dysostosis, respiratory difficulties, mental retardation, and short height [1]. MSS is thought to be associated with NFIX gene mutation [2]. Spine deformity due to a primary abnormality in bone morphogenesis is also reported in the literature [3]. Untreated progressive spinal deformity in a young MSS patient may cause serious health consequences. Therefore, surgical intervention for progressive kyphoscoliosis in a patient with MSS needs to be conducted at an appropriate time. So far, there has been no report regarding surgical correction of spinal deformity in MSS. However, because of dysostosis, spinal canal dysplasia such as cervical canal stenosis may also present in MSS patients [3–5]. Here, we report an MSS patient who underwent surgical correction of severe kyphoscoliosis and came through a neurological complication resulting from cervical canal stenosis.
- Published
- 2015
46. A Replication Study for the Association of rs11190870 With Curve Severity in Adolescent Idiopathic Scoliosis in Japanese
- Author
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Katsuki Kono, Shohei Minami, Nobuyuki Fujita, Kota Watanabe, Taichi Tsuji, Mitsuru Yagi, Atsushi Miyake, Masahiro Nakajima, Shiro Ikegawa, Yoji Ogura, Ikuho Yonezawa, Tsuyoshi Sakuma, Hideki Sudo, Morio Matsumoto, Naobumi Hosogane, Haruhisa Yanagida, Masaya Nakamura, Toshiaki Kotani, Teppei Suzuki, Kazuhiro Chiba, Yohei Takahashi, Katsumi Harimaya, Ikuyo Kou, Kazuki Takeda, Takashi Kaito, Noriaki Kawakami, Tsutomu Akazawa, Manabu Ito, Eijiro Okada, Yuki Taniguchi, Hideki Shigematsu, Satoru Demura, Takahiro Iida, Kei Watanabe, Kenichiro Kakutani, Kotaro Nishida, Hiroshi Taneichi, and Koki Uno
- Subjects
0301 basic medicine ,Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Genotype ,Single-nucleotide polymorphism ,Idiopathic scoliosis ,Genome-wide association study ,Scoliosis ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Severity of illness ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Association (psychology) ,Child ,Genetic Association Studies ,business.industry ,Skeletal maturity ,medicine.disease ,030104 developmental biology ,Physical therapy ,Female ,Neurology (clinical) ,business ,Risser sign ,030217 neurology & neurosurgery - Abstract
Case-only study.The aim of this study was to confirm the association of rs11190870 with adolescent idiopathic scoliosis (AIS) severity in Japanese patients with AIS.Although the association of rs11190870 with AIS susceptibility is replicated in multiple ethnics, the association of rs11190870 with curve severity is controversial. Since the previous studies are of small, we performed a replication study using far larger number of patients than previous studies.A total of 1860 Japanese patients with AIS who had reached skeletal maturity or undergone surgical fusion were included in the study. We evaluated the association between rs11190870 and AIS progression for the entire group, and then for patients grouped according to a severe curve (a Cobb angle of ≥40°) or mild curve (a Cobb angle30°). Because braces could affect the results of the present study, patients in the mild-curve group were divided according to whether or not they had worn a brace. We then evaluated associations between rs11190870 genotype and curve severity in these groups.The mean Cobb angles were 54.8° ± 12.1° in the severe-curve group and 24.4° ± 4.0° in the mild-curve group. The difference in rs11190870 risk-allele frequency between the severe- and mild-curve groups was evaluated. No significant differences were observed. We then examined the association of rs11190870 risk-allele frequency between patients in the mild- and severe-curve groups using the χ test for three models, and found a marginal association between rs11190870 and curve severity in the dominant model (P = 0.035, odds ratio = 1.51).We found no association between rs11190870 and curve severity using the criteria of previous study. However, we found a marginal association between rs11190870 and curve severity. Large-scale replication studies that consider skeletal maturity and brace history, including replication studies in other ethnic groups, would be helpful for clarifying the association.4.
- Published
- 2017
47. Onset and remodeling of coronal imbalance after selective posterior thoracic fusion for Lenke 1C and 2C adolescent idiopathic scoliosis (a pilot study)
- Author
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Masaya Nakamura, Makoto Nishiyama, Masayuki Ishikawa, Yasuyuki Fukui, Mitsuru Yagi, Morio Matsumoto, Takashi Tsuji, Shinichi Ishihara, Masafumi Machida, Kai Cao, Naobumi Hosogane, Long Pang, Kota Watanabe, and Nobuyuki Fujita
- Subjects
SRS-22 ,medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,Posterior spinal fusion ,Radiography ,Coronal decompensation ,Lenke 1C ,Adolescent idiopathic scoliosis ,Coronal balance ,03 medical and health sciences ,Selective thoracic fusion ,0302 clinical medicine ,Lumbar ,lcsh:Orthopedic surgery ,medicine ,Orthopedics and Sports Medicine ,Decompensation ,Coronal imbalance ,Balance (ability) ,Fixation (histology) ,Surgical outcome ,030222 orthopedics ,business.industry ,Research ,Remodeling ,Vertebra ,Surgery ,lcsh:RD701-811 ,medicine.anatomical_structure ,Coronal plane ,Orthopedic surgery ,lcsh:RC925-935 ,business ,030217 neurology & neurosurgery - Abstract
Background Postoperative coronal imbalance is a significant problem after selective thoracic fusion for primary thoracic and compensatory lumbar curves in adolescent idiopathic scoliosis (AIS). However, longitudinal studies on postoperative behavior of coronal balance are lacking. This multicenter retrospective study was conducted to analyze factors related to onset and remodeling of postoperative coronal imbalance after posterior thoracic fusion for Lenke 1C and 2C AIS. Methods Twenty-one Lenke 1C or 2C AIS patients, who underwent posterior thoracic fusion ending at L3 or above, were included with a minimum 2-year follow-up. The mean patients’ age was 15.1 years at the time of surgery. Radiographic measurements were performed on Cobb angles of the main thoracic (MT) and thoracolumbar/lumbar (TLL) curves and coronal balance. Factors related to the onset of immediately postoperative coronal decompensation (IPCD) and postoperative coronal balance remodeling (PCBR), defined as an improvement of coronal balance during postoperative follow-up, were investigated using comparative and correlation analyses. Results Mean Cobb angles for the MT and TLL curves were 57.3° and 42.3° preoperatively and were corrected to 22.8° and 22.5° at final follow-up, respectively. Mean preoperative coronal balance of −3.8 mm got worse to −21.2 mm postoperatively, and regained to −12.0 mm at final follow-up. Coronal decompensation was observed in two patients preoperatively, in ten patients immediately postoperatively, and in three patients at final follow-up. The preoperative coronal balance and lowest instrumented vertebra (LIV) selection relative to stable vertebra (SV) were significantly different between patients with IPCD and those without. PCBR had significantly negative correlation with immediately postoperative coronal balance. Conclusions IPCD after posterior thoracic fusion for Lenke 1C and 2C AIS was frequent and associated with preoperative coronal balance and LIV selection. However, most patients with IPCD regained coronal balance through PCBR, which was significantly associated with immediately postoperative coronal balance. A fixation more distal to SV shifted the coronal balance further to the left postoperatively.
- Published
- 2017
48. Role of Ethnicity in Alignment Compensation: Propensity Matched Analysis of Differential Compensatory Mechanism Recruitment Patterns for Sagittal Malalignment in 288 ASD Patients From Japan, Korea, and United States
- Author
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Seung Hwan Yoon, Hiroshi Taneichi, Isaac Gammal, Mitsuru Yagi, Morio Matsumoto, Christopher P. Ames, Frank J. Schwab, Byeongwoo Kim, Yoon Ha, Daisaku Takeuchi, Yu Yamato, Jae won Chang, Virginie Lafage, Bassel G. Diebo, and Naobumi Hosogane
- Subjects
Adult ,Male ,medicine.medical_specialty ,Radiography ,Ethnic group ,Thoracic Vertebrae ,Muscular Atrophy, Spinal ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Republic of Korea ,Deformity ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Kyphosis ,Aged ,Retrospective Studies ,030222 orthopedics ,business.industry ,Pelvic incidence ,Retrospective cohort study ,Middle Aged ,Sagittal plane ,United States ,Surgery ,medicine.anatomical_structure ,Scoliosis ,Propensity score matching ,Lordosis ,Female ,Neurology (clinical) ,medicine.symptom ,business ,Lumbar lordosis ,030217 neurology & neurosurgery - Abstract
STUDY DESIGN Retrospective review of adult spinal deformity patients in a multiethnic database. OBJECTIVE To investigate the role of ethnicity on recruitment of compensatory mechanisms for sagittal spinal deformity. SUMMARY OF BACKGROUND DATA While the impacts of age, sex, and pelvic morphology on the ability to compensate for sagittal malalignment have been investigated, the role of ethnicity in compensatory mechanism recruitment is poorly understood. METHODS Patients from USA (85% Caucasian) >25 y/o were propensity matched by age, sex, and pelvic incidence with patients from Korea and Japan. Only primary patients or those with existing fusion below T12 were retained for analysis. Groups were subclassified by deformity severity (aligned: sagittal vertical axis (SVA) 100 mm). Radiographic measurements including pelvic retroversion, thoracic kyphosis, loss of lumbar lordosis (PI minus LL), cervical lordosis, and cervical SVA were compared between the groups. RESULTS There were 288 patients (96 each in USA, KOR, JPN), with similar age (64-67 yr) and PI (49-53°). USA had smaller pelvic incidence minus lumbar lordosis in every alignment group (P
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- 2017
49. A cost-effectiveness comparisons of adult spinal deformity surgery in the United States and Japan
- Author
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Morio Matsumoto, R. Shay Bess, Naobumi Hosogane, Frank J. Schwab, Christopher P. Ames, Mitsuru Yagi, Justin S. Smith, Kota Watanabe, Christopher I. Shaffrey, Malla Keefe, and Virginie Lafage
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Male ,Reoperation ,medicine.medical_specialty ,Total cost ,Cost effectiveness ,Cost-Benefit Analysis ,Spinal Curvatures ,03 medical and health sciences ,Indirect costs ,0302 clinical medicine ,Quality of life ,Japan ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Orthopedic Procedures ,health care economics and organizations ,Retrospective Studies ,030222 orthopedics ,business.industry ,Middle Aged ,United States ,Surgery ,Cohort ,Spinal deformity ,Quality of Life ,Female ,Neurosurgery ,Quality-Adjusted Life Years ,Health Expenditures ,business ,Complication ,030217 neurology & neurosurgery - Abstract
Information about the cost-effectiveness of surgical procedures for adult spinal deformity (ASD) is critical for providing appropriate treatments for these patients. The purposes of this study were to compare the direct cost and cost-effectiveness of surgery for ASD in the United States (US) and Japan (JP). Retrospective analysis of 76 US and 76 JP patients receiving surgery for ASD with ≥2-year follow-up was identified. Data analysis included preoperative and postoperative demographic, radiographic, health-related quality of life (HRQOL), and direct cost for surgery. An incremental cost-effectiveness ratio (ICER) was determined using cost/quality-adjusted life years (QALY). The cost/QALY was calculated from the 2-year cost and HRQOL data. JP exhibited worse baseline spinopelvic alignment than the US (pelvic incidence and lumbar lordosis: 35.4° vs 22.7°, p
- Published
- 2017
50. Presence of Modic type 1 change increases risk of postoperative pyogenic discitis following decompression surgery for lumbar canal stenosis
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Yasuyuki Fukui, Mitsuru Yagi, Takashi Tsuji, Osahiko Tsuji, Tateru Shiraishi, Ken Ninomiya, Kota Watanabe, Morio Matsumoto, Naobumi Hosogane, Ken Ishii, Narihito Nagoshi, Nobuyuki Fujita, Takahiro Koyanagi, Shinjiro Kaneko, Masaya Nakamura, and Tomohiro Hikata
- Subjects
Adult ,Male ,Methicillin-Resistant Staphylococcus aureus ,medicine.medical_specialty ,Discitis ,Decompression ,medicine.medical_treatment ,Lumbar vertebrae ,Risk Assessment ,030218 nuclear medicine & medical imaging ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,Postoperative Complications ,Spinal Stenosis ,Reference Values ,Discectomy ,medicine ,Humans ,Orthopedics and Sports Medicine ,Prospective cohort study ,Aged ,Retrospective Studies ,Lumbar Vertebrae ,business.industry ,Laminectomy ,Retrospective cohort study ,Middle Aged ,Staphylococcal Infections ,medicine.disease ,Decompression, Surgical ,Combined Modality Therapy ,Magnetic Resonance Imaging ,Surgery ,Anti-Bacterial Agents ,medicine.anatomical_structure ,Treatment Outcome ,Case-Control Studies ,Drainage ,Female ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Study Design Multicenter retrospective study. Background Postoperative surgical site infection is one of the most serious complications following spine surgery. Previous studies do not appear to have investigated pyogenic discitis following lumbar laminectomy without discectomy. This study aimed to identify risk factors for postoperative pyogenic discitis following lumbar decompression surgery. Methods We examined data from 2721 patients undergoing lumbar laminectomy without discectomy in five hospitals from April 2007 to March 2012. Patients who developed postoperative discitis following laminectomy (Group D) and a 4:1 matched cohort (Group C) were included. Fisher's exact test was used to determine risk factors, with values of p Results The cumulative incidence of postoperative discitis was 0.29% (8/2721 patients). All patients in Group D were male, with a mean age of 71.6 ± 7.2 years. Postoperative discitis was at L1/2 in 1 patient, at L3/4 in 3 patients, and at L4/5 in 4 patients. Except for 1 patient with discitis at L1/2, every patient developed discitis at the level of decompression. The associated pathogens were methicillin-resistant Staphylococcus aureus (n = 3, 37.5%), methicillin-susceptible Staphylococcus epidermidis (n = 1, 12.5%), methicillin-sensitive S. aureus (n = 1, 12.5%), and unknown (n = 3, 37.5%). In the analysis of risk factors for postoperative discitis, Group D showed a significantly lower ratio of patients who underwent surgery in the winter and a significantly higher ratio of patients who had Modic type 1 in the lumbar vertebrae compared to Group C. Conclusions Although further prospective studies, in which other preoperative modalities are used for the evaluation, is needed, our data suggest the presence of Modic type 1 as a risk factor for discitis following laminectomy. Latent pyogenic discitis should be carefully ruled out in patients with Modic type 1. If lumbar laminectomy is performed for such patients, more careful observation is necessary to prevent the development of postoperative discitis.
- Published
- 2017
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