Search

Objective Precise knowledge regarding the mechanical stress applied to the intervertebral disc following each individual spine motion enables physicians and patients to understand how people with discogenic back pain should be guided in their exercises and which spine motions to specifically avoid. We created an intervertebral disc degeneration model and conducted a finite element (FE) analysis of loaded stresses following each spinal posture or motion. Methods A 3-dimensional FE model of intervertebral disc degeneration at L4–5 was constructed. The intervertebral disc degeneration model was created according to the modified Dallas discogram scale. The von Mises stress and range of motion (ROM) regarding the intervertebral discs and the endplates were analyzed. Results We observed that mechanical stresses loaded onto the intervertebral discs were similar during flexion, extension, and lateral bending, which were greater than those occurring during torsion. Based on the comparison among the grades divided by the modified Dallas discogram scale, the mechanical stress during extension was greater in grades 3–5 than it was during the others. During extension, the mechanical stress loaded onto the intervertebral disc and endplate was greatest in the posterior portion. Mechanical stresses loaded onto the intervertebral disc were greater in grades 3–5 compared to those in grades 0–2. Conclusion Our findings suggest that it might be beneficial for patients experiencing discogenic back pain to maintain a neutral posture in their lumbar spine when engaging in daily activities and exercises, especially those suffering from significant intravertebral disc degeneration.

Background : We conducted this study to assess the efficacy and safety of PF-72 (TGel Bio Co. Ltd., Seoul, Korea) combined with 0.75% ropivacaine hydrochloride in relieving the postoperative pain in patients undergoing single-level lumbar discectomy. Methods : A total of 95 eligible patients were randomized to either the trial group (n = 47; PF-72 combined with 0.75% ropivacaine hydrochloride) or the control group (n = 48; ramosetron hydrochloride 0.3 mg). The patients were monitored at 3, 6, 24, 48 and 72 hours postoperatively, for which the cumulative area under the curve (AUC0-72) of NRS pain scores was plotted and the amount of rescue analgesics used at 6, 24, 48 and 72 hours or 24, 48 and 72 hours postoperatively. Moreover, incidences of treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs) were analyzed. Results : The amount of analgesics used and the AUC0-72 of the NRS pain scores was significantly smaller and the NRS pain scores were significantly lower in the trial group as compared with the control group (P < 0.05). In addition, there was no significant difference in the number of the patients presenting with no pain (NRS pain scores ≤; 3) between the two groups at 48 and 72 hours postoperatively (P > 0.05). There were no significant differences in the incidences of TEAEs and SAEs between the two groups (P > 0.05). Conclusion : s: PF-72 combined with 0.75% ropivacaine hydrochloride is an effective, safe drug delivery system.

Abstract This cadaveric study aimed to evaluate the safety and usability of a novel robotic system for posterior cervical pedicle screw fixation. Three human cadaveric specimens and C2-T3 were included. Freshly frozen human cadaver specimens were prepared and subjected to robot-assisted posterior cervical pedicle screw fixation using the robotic system. The accuracy of screw placement, breach rate, and critical structure violations were evaluated. The results were statistically compared with those of previous studies that used different robotic systems for cervical pedicle screw fixation. The robotic system demonstrated a high accuracy rate in screw placement. A significant number of screws were placed within predetermined safe zones. The total entry offset was 1.08 ± 0.83 mm, the target offset was 1.86 ± 0.50 mm, and the angle offset was 2.14 ± 0.77°. Accuracy rates comparable with those of previous studies using different robotic systems were achieved. The system was also feasible, allowing precise navigation and real-time feedback during the procedure. This cadaveric study validated the safety and usability of the novel robotic system for posterior cervical pedicle screw fixation. The system exhibited high precision in screw placement, and the results support the extension of the indications for robot-assisted pedicle screw fixation from the lumbar spine to the cervical spine.

Objective: This study introduces a novel system that can simulate diverse mechanical properties of the human chest to enhance the experience of CPR training by reflecting realistic chest conditions of patients. Methods: The proposed system consists of Variable stiffness mechanisms (VSMs) and Variable damper (VD) utilizing stretching silicone bands and dashpot dampers with controllable valves to modulate stiffness and damping, respectively. Cyclic loading was applied with a robot manipulator to the system. Compression force and displacement were measured and analyzed to evaluate the system’s mechanical response. Long-term stability of the system was also validated. Results: A non-linear response of the human chest under compression is realized through this design. Test results indicated non-linear force-displacement curves with hysteresis, similar to those observed in the chest of patients. Controlling the VSM and VD allowed for intentional changes in the slope and area of curves that are related to stiffness and damping, respectively. Stiffness and damping of the system were computed using performance test results. The stiffness ranged from 5.34 N/mm to 13.59 N/mm and the damping ranges from 0.127 N $\cdot $ s/mm to 0.511 N $\cdot $ s/mm. These properties cover a significant portion of the reported mechanical properties of the human chests. The system demonstrated satisfactory stability even when it was subjected to maximum stiffness conditions of the long-term compression test. Conclusion: The system is capable of emulating the mechanical properties and behavior of the human chests, thereby enhancing the CPR training experience.

Objective The risks of nonunion and subsidence are high in patients with bone density loss undergoing spinal fusion surgery. The internal application of recombinant human bone morphogenic protein 2 (rhBMP-2) in an interbody cage improves spinal fusion; however, related complications have been reported. Denosumab, a human monoclonal antibody targeting the receptor activator of nuclear factor kappa B ligand (RANKL), hinders osteoblast differentiation and function. Therefore, this study aimed to observe the combined effect of the local application of rhBMP-2 in a lumbar cage and systemic RANKL inhibition on postoperative spinal fusion in patients with bone density loss undergoing posterior lumbar interbody fusion (PLIF). Methods This retrospective observational study included 251 consecutive patients with spinal stenosis who underwent PLIF at a single center between 2017 and 2021. Clinical outcomes were assessed, and radiographic evaluations included lumbar flexion, extension, range of motion, and subsidence. Statistical analyses were conducted to identify the combined effect of the treatment and the subsidence and spinal fusion status. Results One hundred patients were included in the final analysis. Denosumab treatment significantly reduced the rate of osteolysis (p = 0.013). When denosumab was administered in combination with rhBMP-2, the fusion status remained similar; however, the incidences of postoperative osteolysis and postoperative oozing day decreased. Conclusion The combined use of rhBMP-2 and RANKL inhibition in patients with bone density loss can enhance bone formation after PLIF with fewer complications than rhBMP-2 alone.

Objective The objective of this study was to evaluate the accuracy of pedicle screw placement in patients undergoing percutaneous pedicle screw fixation with robotic guidance, using a newly developed 3-dimensional quantitative measurement system. The study also aimed to assess the clinical feasibility of the robotic system in the field of spinal surgery. Methods A total of 113 patients underwent pedicle screw insertion using the CUVIS-spine pedicle screw guide system (CUREXO Inc.). Intraoperative O-arm images were obtained, and screw insertion pathways were planned accordingly. Image registration was performed using paired-point registration and iterative closest point methods. The accuracy of the robotic-guided pedicle screw insertion was assessed using 3-dimensional offset calculation and the Gertzbein-Robbins system (GRS). Results A total of 448 screws were inserted in the 113 patients. The image registration success rate was 95.16%. The average error of entry offset was 2.86 mm, target offset was 2.48 mm, depth offset was 1.99 mm, and angular offset was 3.07°. According to the GRS grading system, 88.39% of the screws were classified as grade A, 9.60% as grade B, 1.56% as grade C, 0.22% as grade D, and 0.22% as grade E. Clinically acceptable screws (GRS grade A or B) accounted for 97.54% of the total, with no reported neurologic complications. Conclusion Our study demonstrated that pedicle screw insertion using the novel robot-assisted navigation method is both accurate and safe. Further prospective studies are necessary to explore the potential benefits of this robot-assisted technique in comparison to conventional approaches.

BackgroundRecently, we developed a chest compression device that can move the chest compression position without interruption during CPR and be remotely controlled to minimize rescuer exposure to infectious diseases. The purpose of this study was to compare its performance with conventional mechanical CPR device in a mannequin and a swine model of cardiac arrest.Materials and methodsA prototype of a remote-controlled automatic chest compression device (ROSCER) that can change the chest compression position without interruption during CPR was developed, and its performance was compared with LUCAS 3 in a mannequin and a swine model of cardiac arrest. In a swine model of cardiac arrest, 16 male pigs were randomly assigned into the two groups, ROSCER CPR (n = 8) and LUCAS 3 CPR (n = 8), respectively. During 5 minutes of CPR, hemodynamic parameters including aortic pressure, right atrial pressure, coronary perfusion pressure, common carotid blood flow, and end-tidal carbon dioxide partial pressure were measured.ResultsIn the compression performance test using a mannequin, compression depth, compression time, decompression time, and plateau time were almost equal between ROSCER and LUCAS 3. In a swine model of cardiac arrest, coronary perfusion pressure showed no difference between the two groups (p = 0.409). Systolic aortic pressure and carotid blood flow were higher in the LUCAS 3 group than in the ROSCER group during 5 minutes of CPR (p < 0.001, p = 0.008, respectively). End-tidal CO2 level of the ROSCER group was initially lower than that of the LUCAS 3 group, but was higher over time (p = 0.022). A Kaplan-Meier survival analysis for ROSC also showed no difference between the two groups (p = 0.46).ConclusionThe prototype of a remote-controlled automated chest compression device can move the chest compression position without interruption during CPR. In a mannequin and a swine model of cardiac arrest, the device showed no inferior performance to a conventional mechanical CPR device.

Abstract Objective Although chronic exposure to air pollution is associated with an increased risk of dementia in normal elderlies, the effect of chronic exposure to air pollution on the rates of cognitive decline in Alzheimer's disease (AD) has not been elucidated. Methods In this longitudinal study, a total of 269 patients with mild cognitive impairment or early dementia due to AD with the evidence of brain β‐amyloid deposition were followed‐up for a mean period of 4 years. Five‐year normalized hourly cumulative exposure value of each air pollutant, such as carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and particulate matter (PM2.5 and PM10), was computed based on nationwide air pollution database. The effects of chronic exposure to air pollution on longitudinal cognitive decline rate were evaluated using linear mixed models. Results Higher chronic exposure to SO2 was associated with a faster decline in memory score, whereas chronic exposure to CO, NO2, and PM10 were not associated with the rate of cognitive decline. Higher chronic exposure to PM2.5 was associated with a faster decline in visuospatial score in apolipoprotein E ε4 carriers. These effects remained significant even after adjusting for potential confounders. Interpretation Our findings suggest that chronic exposure to SO2 and PM2.5 is associated with faster clinical progression in AD.

AbstractBackground Probabilistic graphical modelling (PGM) can be used to predict risk at the individual patient level and show multiple outcomes and exposures in a single model.Objective To develop PGM for the prediction of clinical outcome in patients with degenerative cervical myelopathy (DCM) after posterior decompression and to use PGM to identify causal predictors of the outcome.Methods We included data from 59 patients who had undergone cervical posterior decompression for DCM. The candidate predictive parameters were age, sex, body mass index, trauma history, symptom duration, preoperative and last Japanese Orthopaedic Association (JOA) scores, gait impairment, claudication, bladder dysfunction, Nurick grade, American Spinal Injury Association (ASIA) grade, smoking, diabetes mellitus, cardiopulmonary disorders, hypertension, stroke, Parkinson’s disease, dementia, psychiatric disorders, arthritis, ossification of the posterior longitudinal ligament, cord signal change, postoperative kyphosis and the cord compression ratio.Results In regression analyses, preoperative JOA (PreJOA) score, presence of a psychiatric disorder, and ASIA grade were identified as significant factors associated with the last JOS score. Dementia, sex, PreJOA score and gait impairment were causal factors in the PGM. Sex, dementia and PreJOA score were direct causal factors related to the last follow-up JOA (LastJOA) score. Being female, having dementia, and having a low PreJOA score were significantly related to having a low LastJOA score.Conclusions The causal predictors of surgical outcome for DCM were sex, dementia and PreJOA score. Therefore, PGM may be a useful personalized medicine tool for predicting the outcome of patients with DCM.

Background: Evogliptin tartrate inhibits dipeptidyl peptidase-4 (DPP-4), boosting glucagon-like peptide 1 (GLP-1) secretion and improving insulin release and glucose tolerance, while also exerting anti-inflammatory effects. We investigated its anti-inflammatory and analgesic effects. Methods: Forty male Sprague Dawley rats were divided into (N = 10 in each): (1) naïve, (2) complete Freund’s adjuvant (CFA) inflammation + evogliptin tartrate (once for 10 mg/kg) (CFAE), (3) CFA + vehicle (same volume with normal saline with evogliptin tartrate/once) (CFAV), and (4) CFA + indomethacin (5 mg/mL/kg/1 time) (CFAI) groups. CFA was injected subcutaneously into rat plantar regions, and medications (evogliptin tartrate, vehicle, and indomethacin) were administered orally for 5 days. Post treatment, blood from the heart and plantar inflammatory tissue were collected to assess inflammatory cytokines. Evogliptin tartrate effects on controlling inflammation and pain were evaluated by measuring rat plantar paw thickness, paw withdrawal threshold, dorsal root ganglion (DRG) resting membrane potential, DRG action potential firing, and cytokine (TNF-α and IL-1β) levels. Results: Compared with the naïve group, plantar paw thickness, cytokine (TNF-α and IL-1β) levels, DRG resting membrane potential, and DRG action potential firing increased, whereas the paw withdrawal threshold decreased in all CFA groups. However, CFAE and CFAI rats showed recovery. The degree of CFAE recovery resembled that observed in the CFAI group. Conclusions: Evogliptin tartrate mirrored the anti-inflammatory pain relief of indomethacin. We aim to broaden its use as an anti-inflammatory drug or pain relief drug.

Abstract Physicians often encounter surgical candidates with lumbar disc herniation (LDH) who request non-surgical management even though surgery is recommended. However, second opinions may differ among doctors. Therefore, a prospective comprehensive cohort study (CCS) was designed to assess outcomes of nonsurgical treatment for surgical candidates who were recommended to undergo surgery for LDH but requested a second opinion. The CCS includes both randomized and observational cohorts, comprising a nonsurgery cohort and surgery cohort, in a parallel fashion. Crossover between the nonsurgery and surgery cohorts was allowed at any time. The present study was an as-treated interim analysis of 128 cases (nonsurgery cohort, n = 71; surgery cohort, n = 57). Patient-reported outcomes included visual analogue scores for the back (VAS-B) and leg (VAS-L), the Oswestry Disability Index, the EuroQol 5-Dimension instrument, and the 36-Item Short-Form Health Survey (SF-36), which were evaluated at baseline and at 1, 3, 6, 12, and 24 months. At baseline, age and SF-36 physical function were significantly lower in the surgery cohort than in the nonsurgery cohort (p 0.01). Nonsurgical management may be a negotiable option even for surgical candidates in the shared decision-making process.

Abstract Hematological analysis is essential for patients who are supported by a mechanical circulatory support (MCS). The laboratory methods used to analyze blood components are conventional and accurate, but they require a mandatory turn-around-time for laboratory results, and because of toxic substances, can also be hazardous to analysis workers. Here, a simple and rapid point-of-care device is developed for the measurement of plasma free hemoglobin (PFHb) and hematocrit (Hct), based on colorimetry. The device consists of camera module, minimized centrifuge system, and the custom software that includes the motor control algorithm for the centrifuge system, and the image processing algorithm for measuring the color components of blood from the images. We show that our device measured PFHb with a detection limit of 0.75 mg/dL in the range of (0–100) mg/dL, and Hct with a detection limit of 2.14% in the range of (20–50)%. Our device had a high correlation with the measurement method generally used in clinical laboratories (PFHb R = 0.999, Hct R = 0.739), and the quantitative analysis resulted in precision of 1.44 mg/dL for PFHb value of 14.5 mg/dL, 1.36 mg/dL for PFHb value of 53 mg/dL, and 1.24% for Hct 30%. Also, the device can be measured without any pre-processing when compared to the clinical laboratory method, so results can be obtained within 5 min (about an 1 h for the clinical laboratory method). Therefore, we conclude that the device can be used for point-of-care measurement of PFHb and Hct for MCS.

Neuromuscular disorders (NMDs) are diseases involving the upper and lower motor neurons and muscles. In patients with NMDs, cervical spinal deformities are a very common issue; however, unlike thoracolumbar spinal deformities, few studies have investigated these disorders. The patients with NMDs have irregular spinal curvature caused by poor balance and poor coordination of their head, neck, and trunk. Particularly, cervical deformity occurs at younger age, and is known to show more rigid and severe curvature at high cervical levels. Muscular physiologic dynamic characteristics such as spasticity or dystonia combined with static structural factors such as curvature flexibility can result in deformity and often lead to traumatic spinal cord injury. In addition, postoperative complication rate is higher due to abnormal involuntary movement and muscle tone. Therefore, it is important to control abnormal involuntary movement perioperatively along with strong instrumentation for correction of deformity. Various methods such as botulinum toxin injection, physical therapy, muscle division technique, or intrathecal baclofen pump implant may help control abnormal involuntary movements and improve spinal stability. Surgical management for cervical deformities associated with NMDs requires a multidisciplinary effort and a customized strategy.

Cervical disc arthroplasty (CDA) is a safe and effective option to improve clinical outcomes (e.g., NDI, VAS, and JOA) in degenerative cervical disc disease and compressive myelopathy. CDA’s two main purported benefits have been that it maintains physiologic motion and thereby minimizes the biomechanical stresses placed on adjacent segments as compared to an ACDF. CDA might reduce the degeneration of adjacent segments, and the need for adjacent-level surgery. Reoperation rates of CDA have been reported to range from 1.8% to 5.4%, with a minimum 5-year follow-up. As the number of CDA procedures performed continues to increase, the need for revision surgery is also likely to increase. When performed skillfully in appropriate patients, CDA is an effective surgical technique to optimize clinical outcomes and radiological results. This review may assist surgical decision-making and enable a more effective and safer implementation of cervical arthroplasty for cervical degenerative disease.

Objective To investigate three-planar radiographic results and patient-reported outcomes (PROs) after correcting chronic atlantoaxial instability (AAI) by translaminar screw (TLS) and pedicle screw (PS) fixation, and to explore the potential association of atlantoaxial realignment with PRO improvements. Methods Twenty-three patients who underwent C1 lateral mass screw (LMS)-C2 TLS and 29 who underwent C1 LMS-C2 PS with ≥ 2 years of follow-up were retrospectively analyzed. Three-planar (sagittal, coronal, and axial) radiographic parameters were measured. PROs including the Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) score and the Short Form 36 Physical Component Summary (SF-36 PCS) were documented. Factors potentially associated with PROs were identified. Results The radiographic parameters significantly changed postoperatively except the C1–2 midlines’ intersection angle in the TLS group (p = 0.073) and posterior atlanto-dens interval in both groups (p = 0.283, p = 0.271, respectively). The difference in bilateral odontoid lateral mass interspaces at last follow-up was better corrected in the TLS group than in the PS group (p = 0.010). Postoperative PROs had significantly improved in both groups (all p < 0.05). Thereinto, NDI at last follow-up was significantly lower in the TLS group compared with PS group (p = 0.013). In addition, blood loss and operative time were obviously lesser in TLS group compared with PS group (p = 0.010, p = 0.004, respectively). Multivariable regression analysis revealed that a change in C1–2 Cobb angle was independently correlated to PROs improvement (NDI: β = -0.435, p = 0.003; JOA score: β = 0.111, p = 0.033; SF-36 PCS: β = 1.013, p = 0.024, respectively), also age ≤ 40 years was independently associated with NDI (β = 5.40, p = 0.002). Conclusion Three-planar AAI should be reconstructed by C1 LMS-C2 PS fixation, while sagittal or coronal AAI could be corrected by C1 LMS-C2 TLS fixation. PROs may improve after atlantoaxial reconstruction in patients with chronic AAI. The C1–2 Cobb angle is an independent predictor of PROs after correcting chronic AAI, as is age ≤ 40 years for postoperative NDI.

Epiduroscopy is a type of spinal intervention that visualizes the epidural space through the sacral hiatus using a fiberoptic scope. However, it is technically difficult to perform compared to conventional interventions and susceptible to complications. Surgery simulator has been shown to be a promising modality for medical education. To develop the epiduroscopy simulator and prove its usefulness for epiduroscopy training, we performed a case-control study including a total of 20 physicians. The participants were classified as the expert group with more than 30 epiduroscopy experiences and the beginner group with less experience. A virtual simulator (EpiduroSIM™, BioComputing Lab, KOREATECH, Cheonan, Republic of Korea) for epiduroscopy was developed by the authors. The performance of the participants was measured by three items: time to reach a virtual target, training score, and number of times the dura and nerve are violated. The training score was better in the expert group (75.00 vs. 67.50; P

Study Design In-vitro biomechanical investigation. Purpose To evaluate the biomechanical effects of the degeneration of the biodegradable cervical plates developed for anterior cervical discectomy and fusion (ACDF) on fusion and adjacent levels. Overview of Literature Biodegradable implants have been recently introduced for cervical spine surgery. However, their effectiveness and safety remains unclear. Methods A linear three-dimensional finite element (FE) model of the lower cervical spine, comprising the C4–C6 vertebrae was developed using computed tomography images of a 46-year-old woman. The model was validated by comparison with previous reports. Four models of ACDF were analyzed and compared: (1) a titanium plate and bone block (Tita), (2) strong biodegradable plate and bone block (PLA-4G) that represents the early state of the biodegradable plate with full strength, (3) weak biodegradable plate and bone block (PLA-1G) that represents the late state of the biodegradable plate with decreased strength, and (4) stand-alone bone block (Bloc). FE analysis was performed to investigate the relative motion and intervertebral disc stress at the surgical (C5–C6 segment) and adjacent (C4–C5 segment) levels. Results The Tita and PLA-4G models were superior to the other models in terms of higher segment stiffness, smaller relative motion, and lower bone stress at the surgical level. However, the maximal von Mises stress at the intervertebral disc at the adjacent level was significantly higher in the Tita and PLA-4G models than in the other models. The relative motion at the adjacent level was significantly lower in the PLA-1G and Bloc models than in the other models. Conclusions The use of biodegradable plates will enhance spinal fusion in the initial stronger period and prevent adjacent segment degeneration in the later, weaker period.

Prevalence of lumbar discal cyst is very low, it can cause low back pain and radiating leg pain when present. Currently, trans-sacral epiduroscopic-assisted, 1,414-nm Nd:YAG laser decompression (SELD) is commonly used for spinal pathologies. However, the use of the laser for spinal procedures can be limited due to the risk of thermal injury. We reviewed nine consecutive patients who underwent SELD ablation for discal cyst between 2014 and 2015. Each patient underwent diagnostic imaging, including simple radiographs, computed tomography with discography, and magnetic resonance imaging (MRI). Pain relief and clinical outcome assessment of patient satisfaction was the primary outcome measure. All patients presented with back pain and unilateral radiating pain. The discal cyst was located in the lumbar region in all patients. Preoperative MRI showed a connection between the cyst and the involved intervertebral disc. All patients obtained immediate relief of symptoms after the discal cyst was treated with a SELD-assisted, 1,414-nm Nd:YAG laser. The mean visual analogue scale (VAS) for back pain was 7.89±0.78 preoperatively, 1.67±1.50 at the 1-month follow up, and 0.38±0.5 at the final follow up (p

Objective The purpose of this study was to investigate the clinical presentation, radiological features, management, and outcomes of aseptic spondylodiscitis after Intradiscal radiofrequency ablation (IDRA). Methods Between 2014 and 2015, ten patients were diagnosed with aseptic spondylodiscitis due to significant back pain after IDRA and were assessed with medical record review, telephone interviews, and imaging. The follow-up period was 12 months. Results The patients developed significant axial pain after the procedure (VAS, 2±1.6 to 8±0.7, p

The sharing of international academic accomplishment and friendship is important; furthermore, to better understand and anticipate the future, we should look back and remember where we started. Regarding ASIA SPINE, the authors aimed to record how the pioneers of Asian spinal surgery started this spine meeting series more than 20 years ago and that later developed into the present state of the conference. The authors will also explore the possible future of this conference. In June 1996, when Professor Hiroshi Nakagawa organized the 11th Annual Meeting of the Japanese Society of Spinal Surgery, spinal neurosurgeons from Korea and Japan including Professor Young Soo Kim, Professor Jung Keun Suh, and Professor Nakagawa discussed the establishment of a multinational conference on spinal surgery via a partnership between the 2 countries. Finally, from September 18 to 20, 1997, the First Biennial Meeting of the Japan-Korea Conference on Spinal Surgery was held in Nagoya, Japan, with Professor Hiroshi Nakagawa as the first organizing President. From then, a biennial meeting was held every other year in Korea or Japan until 2009. In September 2010, the next generation of spinal neurosurgeons decided to organize the first meeting of ASIA SPINE in Incheon, Korea, in order to represent all Asian spine specialists. This meeting has been since held annually around the region including in Taiwan. Remembering the pioneers in the field of spinal surgery is invaluable and extremely important. The authors hope that interest in ASIA SPINE will further expand to other nations in Asia who have advanced philosophies and refined technologies. We wish ASIA SPINE continued success and the ability to promote prolonged international friendship among the Asian countries.

Abstract Background We examined the effectiveness and tolerability of transdermal buprenorphine (TDB) treatment in real-world setting in Asian patients with musculoskeletal pain. Methods This was an open-label study conducted in Hong Kong, Korea, and the Philippines between June 2013 and April 2015. Eligible patients fulfilled the following criteria: 18 to 80 years of age; clinical diagnosis of osteoarthritis, rheumatoid arthritis, low back pain, or joint/muscle pain; chronic non-malignant pain of moderate to severe intensity (Box-Scale-11 [BS-11] pain score ≥ 4), not adequately controlled with non-opioid analgesics and requiring an opioid for adequate analgesia; and no prior history of opioid treatment. Patients started with a 5 μg/h buprenorphine patch and were titrated as necessary to a maximum of 40 μg/h over a 6-week period to achieve optimal pain control. Patients continued treatment with the titrated dose for 11 weeks. The primary efficacy endpoint was the change in BS-11 pain scores. Other endpoints included patients’ sleep quality and quality of life as assessed by the 8-item Global Sleep Quality Assessment Scale (GSQA) questionnaire and the EuroQol Group 5-Dimension Self-Report Questionnaire-3 Level version (EQ-5D-3 L), respectively. Tolerability was assessed by collecting adverse events. Results A total of 114 eligible patients were included in the analysis. The mean BS-11 score at baseline was 6.2 (SD 1.6). Following initiation of TDB, there was a statistically significant improvement in BS-11 score from baseline to visit 3 (least squares [LS] mean change: -2.27 [95% CI -2.66 to −1.87]), which was maintained till the end of the study (visit 7) (LS mean change: −2.64 [95% -3.05 to −2.23]) (p

PurposeTo evaluate the relationship between comorbidities, medical cost, and surgical outcome in patients with lumbar spinal stenosis (LSS) and diabetes mellitus (DM).MethodsData on patients with LSS (n = 14,298) were collected from the Korean National Health Insurance Service database from 2005 to 2007. After 8 years of follow-up, a "DM group" (n = 3,478) and a "non-DM group" (n = 10,820) were compared according to outcome measures. Cox proportional hazard regressions were performed to examine the relationship between DM, hypertension (HTN), cardiovascular disease (CVD), chronic kidney disease (CKD), cerebrovascular disease (CbVD), and surgery for LSS. The admission rate and medical cost as well asthe overall survival rate for those who underwent lumbar surgery were also assessed among patients with DM and LSS.ResultsMortality was about 1.35 times higher in the DM group than in the non-DM group. Patients with DM and comorbidities including HTN (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.25-1.56; pConclusionsIn patients with LSS, DM was associated both with poor prognosis (most significantly in those with CKD), and increased medical cost in those who underwent surgery. Nevertheless, surgical treatment for LSS in patients with DM was related to favorable prognosis compared with conservative treatment.

Percutaneous epidural neuroplasty (PEN) is an effective and safe procedure for herniated lumbar disc (HLD). Although PEN has an advantage of adhesiolysis, this procedure cannot decompress the protruded disc. Recently, trans-sacral epiduroscopic laser decompression (SELD) for HLD has been introduced as a promising alternative methodology. This study evaluated the clinical efficacy and safety of SELD compared to PEN, as well as the change in protruded disc volume after SELD through pre- and postoperative magnetic resonance imaging (MRI), in patients with HLD. Thirty consecutive patients underwent SELD (SELD group), and 45 patients underwent PEN (PEN group). The Visual Analog Scale (VAS) for leg pain; Oswestry Disability Index (ODI); 12-Item Short-Form Health Survey (SF-12); preoperative and postoperative 4-, 12-, and 24-week Macnab criteria; and preoperative and 24-week postoperative lumbar spinal MRIs after SELD were obtained. There was no significant difference in age, sex, duration of symptoms, and the distributions of disc level between the two groups (all P>0.05). Between the SELD and PEN groups, preoperative VAS, ODI, and SF-12 scores had no significant differences. However, the VAS, ODI, and SF-12 scores improved significantly after the procedures by postoperative week 24 in each group (all P

The clinical features of postoperative delirium are similar to the core features of alpha synuclein-related cognitive disorders, such as Parkinson's disease dementia (PDD) or dementia with Lewy bodies (DLB). Therefore, we hypothesized that the non-motor symptoms (NMSs) in Parkinson's disease (PD), which precede the cardinal motor features of PD, are likely to be risk factors for developing postoperative delirium. We investigated the association between PD-related NMSs and postoperative delirium in old people undergoing elective spinal surgery.This study was a prospective study. Participants were aged 65 years and older and scheduled to undergo elective spinal surgery. During the enrollment period, 338 individuals were screened, 104 participants were included in the analysis. We assessed eight easily-assessed and representative PD-related NMSs 1 day before the scheduled surgery using tests or questionnaires for each symptom. The presence of delirium was determined by using the short version of the Confusion Assessment Method (CAM).Fifteen (14.4%) of the 104 participants (age, 71.7 ± 4.7 years; men, 34.6%) met the CAM criteria for post-operative delirium. Multivariate logistic analysis showed that decreased olfactory function (odds ratio [OR] 0.63, 95% CI 0.44-0.91) and exhibiting rapid eye movement sleep behavior disorder (RBD, OR 1.45, 95% CI 1.09-1.93) were significantly independent predictors of postoperative delirium.Our study shows that hyposmia and RBD are significantly independent risk factors for postoperative delirium in general elderly population. Considering that NMSs may represent burden of alpha synuclein deposit, we postulate that an underlying alpha synucleinopathy may correlates with postoperative delirium.This study gives a novel insight for the risk factor of postoperative delirium.

Background. The correlation between epidurography contrast patterns and the clinical outcomes of percutaneous epidural neuroplasty (PEN) remains unclear. Objective. To analyze the correlation between postadhesiolysis epidurography contrast patterns and the clinical outcomes of patients who undergo lumbar PEN. Design. This study is a retrospective analysis of 78 consecutive patients who underwent lumbar PEN between April 2012 and March 2013. Setting. The analysis was done in the university hospital center. Method. The clinical outcomes of all patients were assessed before and 1, 3, 6, and 12 months after undergoing lumbar PEN. Specifically, the intensity of back and leg pain, quality of life, and procedural outcomes were evaluated using a visual analog scale (VAS), the Oswestry Disability Index (ODI), and the 12-Item Short-Form Health Survey (SF-12). Results. The VAS scores for back and leg pain, ODI score, and SF-12 score exhibited a significant improvement during the follow-up period (P

Ossification of the posterior longitudinal ligament (OPLL) of the spine is considered a multifactorial and polygenic disease. We aimed to investigate the association between four single nucleotide polymorphisms (SNPs) of pre-miRNAs [miR-146aC>G (rs2910164), miR-149T>C (rs2292832), miR-196a2T>C (rs11614913), and miR-499A>G (rs3746444)] and the risk of cervical OPLL in the Korean population.The genotypic frequencies of these four SNPs were analyzed in 207 OPLL patients and 200 controls by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay.For four SNPs in pre-miRNAs, no significant differences were found between OPLL patients and controls. However, subgroup analysis based on OPLL subgroup (continuous: continuous type plus mixed type, segmental: segmental and localized type) showed that miR-499GG genotype was associated with an increased risk of segmental type OPLL (adjusted odds ratio = 4.314 with 95% confidence interval: 1.109-16.78). In addition, some allele combinations (C-T-T-G, G-T-T-A, and G-T-C-G of miR-146a/-149/-196a2/-499) and combined genotypes (miR-149TC/miR-196a2TT) were associated with increased OPLL risk, whereas the G-T-T-G and G-C-C-G allele combinations were associated with decreased OPLL risk.The results indicate that GG genotype of miR-499 is associated with significantly higher risks of OPLL in the segmental OPLL group. The miR-146a/-149/-196a2/-499 allele combinations may be a genetic risk factor for cervical OPLL in the Korean population.

Ischemic stroke mainly caused by middle cerebral artery occlusion (MCAo) represents the major type of stroke; however, there are still very limited therapeutic options for the stroke-damaged patients. In this study, we evaluated the neurogenic and therapeutic potentials of human neural stem cells (NSCs) overexpressing brain-derived neurotrophic factor (HB1.F3.BDNF) following transplantation into a rodent model of MCAo. F3.BDNF human NSCs (F3.BDNF) were transplanted into the contralateral side of striatum at 7 days after MCAo, and the transplanted animals were monitored up to 8 weeks using animal MRI and various behavioral tests before they were sacrificed for immunohistochemical analysis. Interestingly, animal MRI results indicate that the majority of contralaterally transplanted neural stem cells were migrated to the peri-infarct area, showing a pathotropism. Transplanted animals exhibited significant behavioral improvements in stepping, rotarod, and modified neurological severity score (mNSS) tests. We also found that the transplanted human cells were colocalized with nestin, DCX, MAP2, DARPP-32, TH, GAD65/67-positive cells, of which results can be correlated with neural regeneration and behavioral recovery in the transplanted animals. More importantly, we were able to detect high levels of human BDNF protein expression, presumably derived from the transplanted F3.BDNF. Taken together, these results provide strong evidence that human neural stem cells (F3.BDNF) are effective in treating stroke animal models.

Ischemic stroke mainly caused by middle cerebral artery occlusion (MCAo) is a major type of stroke, but there are currently very limited therapeutic options for its cure. Neural stem cells (NSCs) or neural precursor cells (NPCs) derived from various sources are known to survive and improve neurological functions when they are engrafted in animal models of stroke. Induced pluripotent stem cells (iPSCs) generated from somatic cells of patients are novel cells that promise the autologous cell therapy for stroke. In this study, we successfully differentiated iPSCs derived from human fibroblasts into NPCs and found their robust therapeutic potential in a rodent MCAo stroke model. We observed the significant graft-induced behavioral recovery, as well as extensive neural tissue formation. Animal MRI results indicated that the majority of contralaterally transplanted iPSC-derived NPCs migrated to the peri-infarct area, showing a pathotropism critical for tissue recovery. The transplanted animals exhibited the significant reduction of stroke-induced inflammatory response, gliosis and apoptosis, and the contribution to the endogenous neurogenesis. Our results demonstrate that iPSC-derived NPCs are effective cells for the treatment of stroke.