Search

Background Recently, corrective fusion surgery for patients with adult spinal deformity (ASD) has become common in Japan. This study aimed to clarify the status of surgeries for ASD in Japan, focusing on perioperative complications. A nationwide multicenter survey gathering information on surgically treated ASD patients was conducted by the committee for Adult Spinal Deformity of the Japanese Scoliosis Society. Methods This study was a review of retrospectively collected data from 18 spine scoliosis centers belonging to the Japanese Scoliosis Society. Patients who underwent corrective fusion surgery for ASD between 2011 and 2013 were included. Demographics, comorbidities, surgical data, and complications were investigated. Results A total of 1192 patients (mean age, 57.7 years) were included in this study. Of these, 611 patients were aged less than 65 years and 581 patients were aged 65 years or greater. The age distribution had two peaks, in the third and eighth decades. Deformities caused by degeneration represented 67% of the pathology in patients aged over 65 years; however, non-degenerative disease such as adult idiopathic scoliosis and syndromic or congenital deformity represented over 60% of pathology in patients aged less than 65 years. The iatrogenic deformity and reoperation rates were both less than 3%. The mean operation time and estimated blood loss were 370 min and 1642 ml, respectively. Major perioperative complications occurred in 160 patients (14.5%). The incidence of complications was significantly higher in patients aged over 65 years, including neurological deficits, hemorrhagic shock, hematoma, heart failure, and surgical site infection (p Conclusions Older (aged over 65 years) ASD patients showed greater rates of deformity due to the occurrence of degeneration and vertebral fractures, as well as a higher incidence of peri-and postoperative complications. Efforts to reduce perioperative complications are therefore imperative, especially for elderly ASD patients in our aging society.

To identify the effects of corrective long spinal fusion to the ilium on physical function in patients with adult spinal deformity (ASD). Thirty patients who underwent corrective long spinal fusion to the ilium were prospectively analysed. Patients were divided into the ++ group [sagittal vertical axis (SVA) ≥ 95 mm and pelvic tilt (PT) ≥ 30°, 14 patients] and 0+ group (SVA

Quantitative ultrasound (QUS) is now widely used for evaluating bone in vivo, because obtained ultrasonic wave properties directly reflect the visco-elasticity. Bone tissue is composed of minerals like hydroxyapatite (HAp) and a collagen matrix. HAp crystallites orientation is thus one parameter of bone elasticity. In this study, we experimentally investigated the anisotropy of ultrasonic wave velocity and the HAp crystallites orientation in the axial–radial and axial–tangential planes in detail, using cylindrical specimens obtained from the cortical bone of three bovine femurs. Longitudinal bulk wave propagation was investigated by using a conventional ultrasonic pulse system. We used the one cycle of sinusoidal pulse which was emitted from wide band transmitter. The nominal frequency of the pulse was 1 MHz. First, we investigated the anisotropy of longitudinal wave velocity, measuring the anisotropy of velocity in two planes using cylindrical specimens obtained from identical bone areas. The wave velocity changed due to the rotation angle, showing the maximum value in the direction a little off the bone axis. Moreover, X-ray pole figure measurements also indicated that there were small tilts in the HAp crystallites orientation from the bone axis. The tilt angles were similar to those of the highest velocity direction. There were good correlations between velocity and HAp crystallites orientation obtained in different directions. However, a comparatively low correlation was found in posterior bone areas, which shows the stronger effects of bone microstructure. In the radial–tangential plane, where the HAp crystallites hardly ever align, weak anisotropy of velocity was found which seemed to depend on the bone microstructure.

In some cases of adolescent idiopathic scoliosis, corrective surgery can improve pulmonary function. However, the effectiveness of corrective surgery in improving pulmonary function in adult spinal deformity (ASD) has not been reported. Therefore, the purpose of our study was to investigate the recovery of pulmonary function after corrective fusion surgery in 4 patients with severe ASD and associated pulmonary dysfunction. The first patient was a 42-year-old woman with spondylo-epiphyseal dysplasia, whose main presenting complaint was dyspnea. As a result of her respiratory dysfunction, associated with her severe spinal deformity, she required Home Oxygen Therapy (HOT). Prior to surgery, her %vital capacity (VC) was 25%, with a kyphosis angle of 170°. The second patient was a 55-year-old woman with a history of acromegaly, who presented with low back pain. Prior to surgery, she had a %VC of 48% and a Cobb angle of 85°. The third patient was a 59-year-old woman with adolescent idiopathic scoliosis, which had been previously treated, and who was now experiencing increasing low back pain. Prior to surgery, she had a %VC of 58% and a Cobb angle of 87°. The fourth patient was a 60-year-old man, with a history of tuberculous spine, who presented with low back pain. Prior to surgery, his %VC of 75% and Cobb angle of 100°. Pulmonary function improved after corrective fusion surgery in all cases. Halo traction with respiratory rehabilitation should be recommended before corrective spinal fusion surgery for patients with severe ASD and pulmonary dysfunction.

Quantitative ultrasonography (QUS) is a good method for measuring elastic properties of bone in vivo. Bovine cortical bone has two typical microstructures, plexiform and Haversian. In this study, the relationship between the speed of sound (SOS) and the hydroxyapatite (HAp) crystallite orientation in the axial direction was investigated in two different aged bovine cortical bones. The dependence of attenuation on anatomical position was also investigated. Two ring-permanent hyphen shaped cortical bone samples were obtained from 36- and 24-month-old bovine femurs. SOS was measured with a conventional ultrasonic pulse system. The integrated intensity of the (0002) peak obtained by X-ray diffraction was determine to evaluate the amount of preferred orientation. Regardless of the age of the bovine femurs, a significant correlation between SOS and the preferred orientation of HAp crystallites was observed in parts of the plexiform structure, and the gradient of the relationship showed a similar tendency. Attenuation seemed to depend on bone microstructure.

The mineral component of bone is mainly composed of calcium phosphate, constituting 70% of total bone mass almost entirely in the form of hydroxyapatite (HAp) crystals. HAp crystals have a hexagonal system and uniaxial elastic anisotropy. The objective of this study was to investigate the effect of HAp crystallite preference on macroscopic elasticity. Ultrasonic longitudinal wave velocity and the orientation of HAp crystallites in bovine cortical bone are discussed, considering microstructure, density, and bone mineral density (BMD). Eighty cube samples of cortical bone were made from two bovine femurs. The orientation of HAp crystallites was evaluated by integrated intensity ratio of (0002) peak using an X-ray diffractometer. Ultrasonic longitudinal wave velocity was investigated with a conventional pulse system. The intensity ratio of HAp crystallites and velocity were measured in three orthogonal directions; most HAp crystallites aligned in the axial direction of the femurs. Our results demonstrate a linear correlation between velocity and intensity ratio in the axial direction. Significant correlation between velocity and BMD values was observed; however, the correlation disappeared if we focused on the identical type of microstructure. In conclusion, differences in microstructure type have an impact on density and BMD, which clearly affects the velocity. In addition, at the nanoscopic level, HAp crystallites aligned in the axial direction also affected the velocity and anisotropy.

Recent progress in quantitative ultrasonic (QUS) techniques enables the in vivo evaluation of cortical bone, which is determinant in bone fragility. However, the interaction between ultrasound and cortical bone remains poorly understood. Most ultrasonic studies have been confined to longitudinal wave speed analysis and the frequency dependence of ultrasonic wave attenuation in this complex multiscale structure has not been extensively investigated. Our objective was to evaluate in vitro the frequency dependence of attenuation in bovine femoral cortical bone samples obtained from three specimens at different anatomical locations along the diaphysis axis and around the circumference. The frequency-dependent attenuation coefficient was evaluated after correction of transmission effects using a transmission device operating at 10 MHz. Attenuation exhibits a non linear variation versus frequency. However, the quasi-linearity of attenuation on a 1 MHz restricted bandwidth around 4 MHz enables broadband ultrasonic attenuation (BUA) evaluation. Our study demonstrates the feasibility of BUA measurements in the three directions (axial, radial and tangential) with reasonable precision (standardized coefficient of variation: 10% to 12%). Significant differences in BUA are obtained according to the anatomical location. BUA values are higher in the distal and proximal parts of the bone than in the midshaft and in the posterior and lateral parts than in the medial and anterior parts. Findings are consistent with results previously obtained and may be explained primarily by scattering phenomena but also by bone viscoelasticity.

Study design Large cohort study of volunteers aged over 50. Objective To investigate influence of age and sex on cervical sagittal alignment among volunteers aged over 50. Summary of background data Few large-scale studies have described normative values in cervical spine alignment regarding age and sex among volunteers aged over 50. Methods The study cohort included 656 volunteers aged 50 to 89 years. Pelvic tilt, sacral slope, pelvic incidence, lumbar lordosis, pelvic incidence-lumbar lordosis, thoracic kyphosis, T1 slope (T1S), cervical lordosis (CL), C7 sagittal vertical axis (C7 SVA), C2-C7 SVA, and T1S-CL were measured using whole spine and pelvic radiographs taken in the standing position. Health-related quality of life was assessed using the EuroQOL (EQ-5D) standardized instrument for measurement of health outcome and Oswestry Disability Index. Results There were 36 subjects aged 50 to 59 years, 174 aged 60 to 69 years, 311 aged 70 to 79 years, and 135 aged 80 to 89 years. Average T1S for each decade was 32°, 31°, 33°, and 36° for males, and 28°, 29°, 32°, and 37° for females, respectively. Average C2-C7 SVA was 25, 28, 34, and 35 mm for males, and 20, 21, 22, and 28 mm for females, respectively. C2-C7 SVA 40 mm or more, T1S 40° or more, and T1S-CL 20° or more pertaining to EQ-5D were significantly worse in other cases. Conclusion C2-C7 SVA was significantly greater in males among all age groups, particularly among those with C2-C7 SVA of 40 mm or more [males, 69% (82/118) vs. females, 33% (36/118)]. Sagittal parameters of cervical spine were significantly worse in males than females. C2-C7 SVA, T1S, and T1S-CL negatively influenced EQ-5D. These results help to explain the greater prevalence of cervical spondylotic myelopathy among elderly males. Level of evidence 3.

Study design Retrospective case series. Purpose To investigate the relationship between tumor location and clinical characteristics. Overview of literature Hemangioblastoma is a rare disease that develops in the central nervous system. Magnetic resonance imaging (MRI) is useful to evaluate hemangioblastomas. Hemangioblastoma's location is designated as intramedullary, intramedullary+extramedullary, or extramedullary by MRI. Methods We analyzed 11 patients who underwent surgery for spinal hemangioblastoma. Using T1 contrast axial MRI data, the cases were divided into three groups (intramedullary, intramedullary+extramedullary, and extramedullary). Patient demographics, MRI findings, and preoperative neurological status were analyzed and compared for each group. Results The average age of patients with intramedullary, intramedullary+extramedullary, and extramedullary hemangioblastoma was 34.0, 64.4, and 67.5 years, respectively. Patients in the intramedullary hemangioblastoma group were younger than the other groups. Extramedullary cases had a smaller syrinx compared to the other groups. Conclusions Age may play an important role in the hemangioblastoma tumor location and the subsequent diagnosis by an MRI.

Background and Aim Spinal kyphotic deformity occasionally results in gastroesophageal reflux disease (GERD). The effects of acid reflux on the esophagus in kyphotic patients are unclear, however, and it is unknown whether acid reflux, endoscopic GERD, and reflux-related symptoms improve following surgical spinal correction in these patients. Herein, we investigated the characteristics of GERD in kyphotic patients and the improvement in GERD following surgical correction. Methods In 48 patients with severe kyphotic deformity scheduled for surgical spinal correction, we conducted esophagogastroduodenoscopy, 24-h pH monitoring and three questionnaire surveys, including the frequency scale for the symptoms of GERD (FSSG). We repeated these measurements after surgical correction and compared pre- and post-surgery values. Results Of 48 patients, 70.8% [95% CI: 55.9–83.0%, 34/48] had endoscopically evaluated esophageal mucosal injury. Regarding pH before surgery, 64.9% (CI: 47.5–79.8%, 24/37) had abnormal acid reflux (intraesophageal pH

Objectives Spinal sagittal alignment has been reported that it is highly associated with health related QOL in adult spinal deformity patients. Optimal sagittal alignment is critical for the efficient function of the musculoskeletal system. In Japan as aging country, a number of elderly people with spinal deformity seems to be increasing. In general, sagittal alignment of elderly people is more forward than younger people. But there is no data to show the average sagittal alignment in elderly people. It is still unknown how much we can tolerate as normal sagittal vertical axis. The purpose of this study was to investigate the relationship between sagittal alignment and health related QOL in elderly volunteers.

Objectives Global sagittal spinal imbalance leads to compensatory pelvic retroversion and femoral flexion that is far from economical standing posture. Recent reports showed spinal instrumentation surgery provided remarkable restoration of spinal alignment and better health-related quality of life (HRQOL) by adult spinal deformity surgery. However, there is a few previous reports about the impact of pelvic and lower extremity sagittal alignment on HRQOL by adult deformity surgery. Thus, we analyzed the effect of compensatory mechanism in adult spinal deformity surgery. The purpose of this study was to report radiological and clinical outcome with the patients’ compensatory mechanism following adult deformity surgery.

Distribution and phylogenetic diversity of microbial communities in hot, deep underground environments in the Hishikari epithermal gold mine, southern part of Kyushu, Japan, were evaluated using molecular phylogenetic analyses. Samples included drilled cores such as andesitic volcanic rock (0.95-1.78 Ma) and the oceanic sedimentary basement rock of Shimanto-Supergroup (100 Ma), as well as geothermal hot aquifer waters directly collected from two different sites: AW-site (71.5 degrees C, pH 6.19) and XW-site (85.0 degrees C, pH 6.80) at a depth of 350 mbls (meters below land surface). Based on PCR-amplified 16S rRNA gene clone analysis, the microbial communities in the drilled cores and the hot aquifer water from the XW-site consisted largely of the 16S rRNA gene sequences, closely related to the sequences often found in marine environments, while the aquifer water from the AW-site contained 16S rRNA gene sequences representing members of Aquificales, thermophilic methanotrophs within the gamma-subdivision of the Proteobacteria and uncultivated strains within the beta-subdivision of Proteobacteria. The cultivable microbial community detected by enrichment cultivation analysis largely matched that detected by the culture-independent molecular analysis.

Study design Prospective radiographical analysis using the cranial center of gravity (CCG) of sagittal vertical axis (SVA) in elderly asymptomatic individuals. Objective To determine sex differences and age-related correlations of CCG and relationships between CCG and other spinopelvic parameters/health-related quality of life (HRQOL) measures. Summary of background data Few studies have investigated CCG in a relatively large sample of elderly asymptomatic individuals. Methods Six hundred seventy-one healthy participants older than 50 years (mean age, 72.9 yr; range, 50-92 yr) were enrolled. Whole-spine standing radiographs were obtained. The following radiographical measurements were obtained: (1) CCG-C7 SVA, (2) C7-SVA, (3) CCG-SVA, (4) C2-C7 lordosis angle, (5) thoracic kyphosis, (6) lumbar lordosis, (7) pelvic incidence, and (8) sacral slope. HRQOL measures included the EuroQol-5D and Oswestry Disability Index. Pearson product-moment correlation coefficients were calculated between pairs of radiographical measures and HRQOL. Results Sex differences were observed in CCG-C7 SVA, CCG-SVA, C2-C7 Cobb angle, thoracic kyphosis, and pelvic incidence. Three SVA parameters (CCG-C7 SVA, C7-SVA, CCG-SVA) rapidly increased between seventh and ninth decades and were approximately 40, 80, and 120 mm, respectively, in the ninth decade. Age-related correlations were observed for all parameters without pelvic incidence, and the CCG measurement correlated the most with age. Furthermore, CCG-SVA correlated with other spinopelvic measurements and HRQOL. Conclusion Age-related changes and sex difference in craniopelvic alignment were analyzed. Craniopelvic alignment became rapidly positive with age, particularly in the eighth decade. The CCG measurement correlated the most with age and may be a useful index marker of global spinal balance in decision making for surgical treatment of adult deformity involving cervical and thoracolumbar lesions. Level of evidence 4.

The Hishikari deposits comprise the Honko (Main), Yamada, and Sanjin deposits. The horizontal strain in the direction (approx. N40°W normal to the general NE-SW strike of the Hishikari vein system was calculated, based on the measured total vein widths to the distance along three crosscuts. Veins were assumed to accompany no significant fault displacement in the calculation. Veins in the eastern and the middle parts of the Honko-Sanjin deposits spatially occupy 3. 2% and 1. 3%, respectively, and veins in the Yamada deposit occupy 6. 7%. Significant local variation of strain is observed in some areas. Reported K-Ar ages on adularia-quartz veins indicate the duration of vein opening to be 2. 6 × 105 yr in the Honko-Sanjin deposits and 5. 9 × 105 yr in the Yamada deposit. Horizontal strain rates were calculated to be 5. 0–12 × 10-8 yr-1through the Hishikari deposits. The calculated strain rates at the Hishikari deposits are roughly comparable to the regional horizontal strain rate in the Recent. Widespread extensional movement in southern Kyushu seems to have been able to provide sufficient strain for the formation of the Hishikari deposits, rather than contribution of local movements.

At the nanoscopic level, bone consists of calcium phosphate, which forms incomplete hydroxyapatite (HAp) crystals. The preferred orientation of the c-axis of HAp crystallites induces anisotropy and inhomogeneity of elastic properties in bone. In this study, the effect of the preferred orientation of HAp crystallites on the spatial distribution of ultrasonic wave velocity was experimentally investigated, considering bone mineral density (BMD) and microstructure. Three ring-shaped cortical bone samples were made from a 36-month-old bovine femur. Longitudinal wave velocity was measured by a conventional ultrasonic pulse system, using self-made polyvinylidene fluoride transducers. The integrated intensity of the (0002) peak obtained using X-ray diffraction was estimated to evaluate the amount of preferred orientation. The velocity distribution pattern was similar to the distribution of integrated intensity of (0002). The effect of the preferred orientation of HAp crystallites on velocity was clearly observed in the plexiform structure, despite the fact that the BMD value was almost independent of the preferred orientation of HAp crystallites. Velocity measurement of cortical bone can reveal information about HAp crystallite orientation.

Recent progress in quantitative ultrasound (QUS) techniques (e.g. axial transmission) allows the in vivo evaluation of cortical bone. QUS for the characterization of this multiscale material is currently confined to wave velocity analysis. Additional parameters such as broadband ultrasonic attenuation (BUA) may help to gain deeper insight for cortical bone evaluation. However, the frequency dependence of attenuation has been sparsely investigated in cortical bone. The present study focuses on the feasibility of measurements of the slope of the frequency dependent attenuation coefficient in bovine cortical bone. BUA measurements are compared to other bone properties obtained following a multimodal approach. Samples are cut along the bone axis and circumference from three 36-month old bovine femurs. Ultrasonic measurements are performed in transmission using self-made PVDF transducers. BUA is evaluated for each sample between 3.5 and 4.5 MHz in three perpendicular directions. In addition, Bone Mineral Density (BMD) is assessed using a dual X-ray absorptiometry device. The microstructure of each sample is assessed with optical microscopy, allowing a classification of the samples into 4 groups: Haversian (H, osteons diameter 150~300 mum, pores size: 20~50 mum), plexiform (PI, lamellae thickness: 100~200 mum, pores size 8~12 mum), porotic (Po, largest pores size: 50~100 mum) and mixed microstructure (M). BUA is found to depend significantly on the anatomical location, propagation direction and microstructure. The distribution of BUA values according to the microstructure is similar to the pores size distribution, indicating that scattering regime is one of the important factors affecting attenuation. Axial BUA is significantly lower than radial and tangential BUA, which may also be explained by scattering effects, since osteons and lamellae are oriented in the axial direction. The Figure shows that axial BUA is significantly correlated to BMD. However, for plexiform samples, BUA is not correlated to BMD. In these samples with fewer pores, BUA seems to be affected by viscoelasticity, reflecting microscopic bone quality. Our results suggest that attenuation could be used as a complementary index of cortical bone status.

The development of the axial transmission technique now enables in vivo evaluation of cortical bone quality, which plays an important role in bone fragility. Cortical bone is a complex multiscale material, which may be made of different types of microstructure. The interaction between ultrasound and cortical bone remains unclear and most studies have been confined to wave speed analysis. The first aim of this study is to investigate the dependence of the frequency-dependent attenuation on the type of bone microstructure. The second goal is to determine whether broadband ultrasonic attenuation (BUA) is related to volumetric bone mineral density (vBMD) and mass density. Parallelepipedic samples of bovine cortical bone were cut from three specimens and tested in the axial, radial and tangential directions using an ultrasonic transmission device. BUA was evaluated over a 1-MHz wide bandwidth around 4 MHz. In addition, the microstructure of each sample was determined using an optical microscope. BUA values measured in porotic microstructure are significantly higher than in Haversian microstructure. The lowest BUA values are obtained for plexiform microstructure. For all structures, BUA in the axial direction is significantly smaller than in the radial and tangential directions. Moreover, BUA is correlated with both vBMD and density (determination coefficient ( R 2 ) equal to 0.44 and 0.65, respectively, in the axial direction). BUA variations can be explained by scattering and viscoelastic mechanisms. This study suggests that BUA measurements have the potential to discriminate among different cortical bone microstructures in addition to providing material properties.

Introduction Regression analysis of adult spinal deformity (ASD) databases in North America (NA) has yielded radiographic disability thresholds for sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence to lumbar lordosis (PI–LL), which have been used in formulating the Schwab–SRS ASD classification. These thresholds are often used as correction goals for surgery planning, but it is unclear whether these thresholds vary in other geographic regions or ethnicities. This is the first comparison of radiographic disability thresholds between NA and Asian populations of ASD. Patients and Methods Retrospective, multicenter case series of 595 operative patients with ASD with baseline radiographs and Oswestry disability index (ODI) from 11 sites across USA ( n = 402) and Japan (JPN, n = 193). Patients were compared at baseline in ODI, ODI need for improvement (ODIni, calculated from age/ethnic normative values), and radiographs. Linear regression was used to define thresholds for disability. Results Differences existed in mean age (USA 52.5 ± 22.5 years vs. JPN was 56.5 ± 15.4 years, p = 0.012) and revisions (USA 48% vs. JPN 2%, p Conclusion At baseline, patients in both cohorts had a similar sagittal deformity but different morphology. Disability thresholds for SVA appear to be maintained across ethnicities but with differences in pelvic morphology (PI–LL and PT). The JPN cohort had significantly smaller PI and multiple coronal curves compared with the USA cohort. Despite similar sagittal malalignment, the JPN cohort had a significantly lower ODI without a significant difference in ODIni.

Introduction Adult spinal deformity (ASD) research and treatment has continued to evolve and grow globally. International studies are now frequently presented at the SRS, but surgeons are unsure of the data comparisons and global relevance of conclusions across ethnicities. We compared HRQOL and radiographs between two countries (United States and Japan) to help define the effect of geographic variation. Materials and Methods Retrospective, multicenter case series of 337 operative patients with ASD with baseline radiographs and ODI from 11 sites across USA ( n = 235) and Japan (JPN, n = 102). Patients were compared preoperatively and postoperatively in ODI, ODI need for improvement (ODIni, using age/ethnic normative values), and radiographs. Regression was used to define thresholds for disability: USA ODI 41.9, JPN ODI 33.7. Results Differences in age (USA 55 years, JPN 65 years, p Conclusion Despite having a greater deformity at BL, there were no significant differences in BL ODI. Although both the groups improved in ODI and alignment, JPN cohort still had higher offset from the normative age-/ethnicity-matched values and more spino-pelvic malalignment at 2 years—for the same ODI, JPN patients may be masking a greater disability than represented by the score. When population-specific thresholds of disability were applied, JPN patients had a large percentage over the threshold, revealing that 60% were still with lower scores at 2 years. The ethnicity of a patient should be considered when interpreting ODI and comparing surgical outcomes for ASD using standard metrics.

MATERIAL AND METHODS We prospectively investigated 41 consecutive patients (mean age, 64 years; range, 22-81 years) who underwent corrective surgery for ASD from March 2011 to September 2012. The mean postoperative follow-up period was 26 (range, 15 33) months. Gait was analyzed before and 1 year after surgery, and the 4m walking status was recorded with a video camera. We measured the angle between the line connecting the greater trochanter and the pinna and a plumb line on the side during gait (gait-trunk tilt angle). We investigated the gait-trunk tilt angle (GTA) before and after corrective surgery. Patients were divided into two groups based on the postoperative GTA: Group A (28 patients; 0 10°) and Group B (13 patients, >10°). Differences in sagittal vertical axis (SVA), lumbar lordosis (LL), and pelvic tilt (PT) were examined in both groups.

We are extremely grateful for your interest in our manuscript. The report by Saunders et al. was very helpful. As you indicated, there are reports about hypoglossal nerve palsy (HNP) after soft tissue surgery of the neck. Although there are only three reports [1,2,3] of HNP after cervical spine surgery, more cases might exist. Therefore, we must pay attention to tongue movement after anterior cervical spine surgery. We think that HNP after anterior cervical spine surgery is caused by excessive intraoperative retraction. In our case, only osteophyte resection was performed. Therefore, the duration of operation time was markedly shorter than the other two cases [2,3]. The duration of pressure time is related to the extent of nerve damage. If the surgical time was longer, permanent HNP could have occurred in our case as with other two cases. We think that intermittent release of retraction is important to avoid hypoglossal nerve damage. We greatly appreciate for the opportunity to discuss the issues raised, and thank you for your interest in our study.

Study design Case series. Purpose The objective of this study was to investigate the change in pulmonary function in adult patients with a spinal deformity who underwent spinal corrective surgery. Overview of literature Degenerative lumbar and/or thoraco-lumbar deformities are is often prominent in adult spinal deformity cases, whereas a thoracic deformity involving the chest wall is inconspicuous. A lumbar spine deformity could affect the pulmonary function; however, few reports have investigated pulmonary function in adult patients with a spinal deformity. Methods This study included 14 adult patients with a spinal deformity who underwent posterior corrective fusion (3 males, 11 females; mean age, 67.4 years). We measured percent vital capacity (%VC) and percent forced expiratory volume in 1 second (%FEV1) before surgery and six months after surgery. We investigated the change in pulmonary function after corrective surgery and the correlation between radiographic parameters and pulmonary function. Results Mean preoperative %VC and %FEV1 values were 99.9% and 79.3%, respectively. Two cases were diagnosed with restrictive impairment, and two cases were diagnosed with obstructive impairment before surgery. %VC improved in the restrictive impairment cases six months after surgery. However, %FEV1 did not improve significantly after surgery in the obstructive impairment cases. Conclusions Restrictive impairment was improved in adult patients with a spinal deformity by corrective spinal surgery. However, spinal surgery did not improve obstructive impairment.

A recurrent laryngeal nerve injury is known as a complication referring to an anterior cervical spine surgery. However, hypoglossal nerve injury is not well known yet. Herein we report a rare case of a 39-years-old male with a hypoglossal nerve injury after C3/4 osteophyte resection with Smith-Robinson approach. In this case there appeared difficulties of articulation and tongue movement with deviation of the tongue to the left side after the surgery and we diagnosed a hypoglossal nerve injury due to retraction against the nerve during the operation. During the operative approach to the upper cervical spine we had to retract the internal carotid artery and the soft tissue to reach the vertebrae. This retract was the cause of the hypoglossal nerve injury. A gently traction and intermittent release is important to avoid a hypoglossal nerve damage.

The detailed spatial distributions of longitudinal ultrasonic velocity in cortical bone specimens obtained from three bovine femoral diaphysis were experimentally investigated using a pulse-echo system. The relationship between velocity, density, bone mineral density (BMD) and microstructure was investigated. Velocity was found to vary as a function of the direction of propagation and the location of the measured specimens in the bone diaphysis. A significant correlation was found between density and velocity, and between density and BMD. In some parts with plexiform structure, clear variations in velocity anisotropy were found despite no significant difference in density, BMD and microstructure.

For the evaluation of osteoporosis using ultrasonic technique, it is important to know the characteristics of ultrasonic waves in the bone. In this study, distribution of ultrasonic wave properties in bovine femur is investigated using an ultrasonic pulse technique, considering the structure in the microscopic level. Especially, focusing on the anisotropy of cortical bone, the effect of crystallites orientation of bone mineral phase (mainly hydroxyapatite) is discussed. To obtain the HAp crystallites alignment, XRD patterns of specimens were measured. The preference ratio of HAp crystallites c-axis was derived by dividing the integral strength of (0002) peak by that of (31-40) peak. One interesting result is the higher BMD and density values of plexiform specimens. The higher BMD and density values mean the existence of large amount of HAp in the plexiform structure. This also seems to affect the high velocities in the plexiform specimens

Change of bacterial community occurring along a hot water stream in the Hishikari gold mine, Japan, was investigated by applying a combination of various culture-independent techniques. The stream, which is derived from a subsurface anaerobic aquifer containing plentiful CO2, CH4, H2, and NH 4 + , emerges in a mine tunnel 320 m below the surface providing nutrients for a lush microbial community that extends to a distance of approximately 7 m in the absence of sunlight-irradiation. Over this distance, the temperature decreases from 69°C to 55°C, and the oxidation-reduction potential increases from −130 mV to +59 mV. In the hot upper reaches of the stream, the dominant phylotypes were: 1) a deeply branching lineage of thermophilic methane-oxidizing γ-Proteobacteria, and 2) a thermophilic hydrogen- and sulfur-oxidizing Sulfurihydrogenibium sp. In contrast, the prevailing phylotypes in the middle and lower parts of the stream were closely related to ammonia-oxidizing Nitrosomonas and nitrite-oxidizing Nitrospira spp.. Changes in the microbial metabolic potential estimated by competitive PCR analysis of genes encoding the enzymes, particulate methane monooxygenase (pmoA), ammonia monooxygenase (amoA), and putative nitrite oxidoreductase (norB), also substantiated the community shift indicated by 16S rRNA gene analysis. The diversity of putative norB lineages was assessed for the first time in the hot water environment. Estimation of dominant phylotypes by whole-cell fluorescent in situ hybridization and changes in inorganic nitrogen compounds such as decreasing ammonium and increasing nitrite and nitrate in the mat-interstitial water along the stream were consistent with the observed transition of the bacterial community structure in the stream.

Culture-dependent and -independent techniques were combined to characterize the physiological properties and the ecological impacts of culture-resistant phylotypes of thermophiles within the order Aquificales from a subsurface hot aquifer of a Japanese gold mine. Thermophilic bacteria phylogenetically associated with previously uncultured phylotypes of Aquificales were successfully isolated. 16S ribosomal DNA clone analysis of the entire microbial DNA assemblage and fluorescence in situ whole-cell hybridization analysis indicated that the isolates dominated the microbial population in the subsurface aquifer. The isolates were facultatively anaerobic, hydrogen- or sulfur/thiosulfate-oxidizing, thermophilic chemolithoautotrophs utilizing molecular oxygen, nitrate, ferric iron, arsenate, selenate, and selenite as electron acceptors. Their versatile energy-generating systems may reflect the geochemical conditions of their habitat in the geothermally active subsurface gold mine.

IntroductionRegression analysis of adult spinal deformity (ASD) databases in North America (NA) has yielded radiographic disability thresholds for sagittal vertical axis (SVA), pelvic tilt (PT), an...

Quantitative ultrasound (QUS) is a good method to measure elastic properties of bone (one indicator of bone quality) in vivo. Bovine cortical bone has two typical microstructures, plexiform and Haversian. In the nanoscopic level, bone consists of calcium phosphate, which forms incomplete hydroxyapatite (HAp) crystal. The preferred orientation of c‐axis of HAp crystallites induces anisotropy and inhomogeneity of elastic properties in bone. In this study, relationship between speed of sound (SOS) and HAp crystallites orientation in the axial direction were investigated in two foreign age bovine cortical bones. The dependence of attenuation on the anatomical position was also investigated. Two ring shaped cortical bone samples were made from 36 and 24‐month‐old bovine femur. SOS was measured by a conventional ultrasonic pulse system, using self‐made PVDF transducers. The integrated intensity of (0002) peak obtained using X‐ray diffraction was estimated to evaluate the amount of preferred orientation. Regardl...

The development of ultrasonic characterization devices for cortical bone requires a better understanding of ultrasonic propagation in this heterogeneous medium. The aim of this work is to investigate the frequency dependence of the attenuation coefficient and of phase velocity and to relate them with bone microstructure and anatomical position. One hundred twenty parallelepipedic samples (4–11 mm side) have been cut from three bovine specimens and measured four times with repositioning in transmission with a pair of 8‐MHz central frequency transducers. Phase velocity and BUA could be determined with acceptable precision: coefficients of variation of 0.8% and 13%, respectively. Velocity dispersion and BUA values are comprised between −13 and 40 m/s/MHz and 2 and 12 dB/MHz/cm, respectively. Negative dispersion values were measured (similarly to trabecular bone) for 2% of the measured samples. BUA values were found to be smaller in plexiform than in Haversian structure and higher for porotic structure. BUA values were found to be the greatest in the postero‐lateral distal part and the smallest in the anterior‐medial center part of the bone. The same tendency was found for velocity dispersion. Our results show the sensitivity of the frequency dependence of ultrasound to anatomical position and micro‐architectural properties of bone.

The distribution of longitudinal wave velocities and longitudinal moduli in a bovine femoral cortical bone was experimentally investigated. In all parts of the long cylindrical bone, the velocities and longitudinal moduli in the axial direction were the highest. In the anterior (A) part, the velocities in the axial direction were high and almost constant, whereas the velocities in the proximal postero medial (PM) and distal postero lateral (PL) parts markedly decreased. Classifying the cortical bone into three structures (plexiform, Haversian, and porotic), we clarify the velocity distributions in the bone with discussion from an anatomical point of view.