144 results on '"Yoshiharu Kawaguchi"'
Search Results
2. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of lumbar spinal stenosis, 2021 - Secondary publication
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Mamoru, Kawakami, Katsushi, Takeshita, Gen, Inoue, Miho, Sekiguchi, Yasushi, Fujiwara, Masatoshi, Hoshino, Takashi, Kaito, Yoshiharu, Kawaguchi, Masakazu, Minetama, Sumihisa, Orita, Masahiko, Takahata, Kuniyoshi, Tsuchiya, Takashi, Tsuji, Hiroshi, Yamada, and Kota, Watanabe
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Orthopedics and Sports Medicine ,Surgery - Abstract
The Japanese Orthopaedic Association (JOA) guideline for the management of lumbar spinal stenosis (LSS) was first published in 2011. Since then, the medical care system for LSS has changed and many new articles regarding the epidemiology and diagnostics of LSS, conservative treatments such as new pharmacotherapy and physical therapy, and surgical treatments including minimally invasive surgery have been published. In addition, various issues need to be examined, such as verification of patient-reported outcome measures, and the economic effect of revised medical management of patients with lumbar spinal disorders. Accordingly, in 2019 the JOA clinical guidelines committee decided to update the guideline and consequently established a formulation committee. The purpose of this study was to describe the formulation we implemented for the revision of the guideline, incorporating the recent advances of evidence-based medicine.The JOA LSS guideline formulation committee revised the previous guideline based on the method for preparing clinical guidelines in Japan proposed by the Medical Information Network Distribution Service in 2017. Background and clinical questions were determined followed by a literature search related to each question. Appropriate articles based on keywords were selected from all the searched literature. Using prepared structured abstracts, systematic reviews and meta-analyses were performed. The strength of evidence and recommendations for each clinical question was decided by the committee members.Eight background and 15 clinical questions were determined. Answers and explanations were described for the background questions. For each clinical question, the strength of evidence and the recommendation were both decided, and an explanation was provided.The 2021 clinical practice guideline for the management of LSS was completed according to the latest evidence-based medicine. We expect that this guideline will be useful for all medical providers as an index in daily medical care, as well as for patients with LSS.
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- 2023
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3. Usefulness of Wide-Awake Local Anesthesia No Tourniquet Surgery to Decide on Tendon Transfer Versus Grafting in Chronic Flexor Tendon Rupture
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Mineyuki Zukawa, Ryusuke Osada, Tatsurou Hirokawa, Kayo Suzuki, Hiroto Makino, and Yoshiharu Kawaguchi
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Rehabilitation ,Surgery ,Orthopedics and Sports Medicine - Abstract
We investigated the clinical outcomes of flexor tendon reconstruction for chronic rupture of the flexor tendon based on an evaluation of the voluntary active contraction distance (ACD) of the ruptured musculotendinous unit and changes in intraoperative total active motion (TAM) that could only be observed during wide-awake local anesthesia no tourniquet (WALANT) surgery.Reconstructions of 19 tendons of the flexor pollicis longus (FPL) and 18 tendons of the flexor digitorum profundus (FDP) were performed during WALANT surgery to evaluate the ACD of the ruptured musculotendinous unit and TAM observed during the surgery. Tendon grafting or tendon transfer was selected during the surgery based on ACD. TAM, pinch strength, and grip power were evaluated before the surgery, during the surgery, and at final follow-up, and they were surveyed based on Quick Disabilities of the Arm, Shoulder, and Hand (q-DASH) scores. The final outcomes of tendon grafting and tendon transfer were compared.In FPL tendon reconstruction, tendon grafting was performed in 10 patients with a total PDD and ACD value greater than 30 mm, and tendon transfer was performed in 9 patients with the value less than 30 mm. In FDP tendon reconstruction, tendon grafting was performed in 8 patients and tendon repair in 2 patients with a total PDD and ACD value greater than 40 mm, and tendon transfer was performed in 8 patients with the value less than 40 mm. The TAM value, q-DASH score, pinch power, and grip strength were improved in all patients. In both the tendon reconstructions, intraoperative TAM was significantly increased compared with preoperative TAM but significantly decreased at final follow-up. No significant differences were identified in final follow-up TAM and the q-DASH scores between tendon transfer and tendon grafting.The great advantage of WALANT surgery is that surgeons can evaluate the ruptured musculotendinous unit and measure TAM during the surgery.Therapeutic I.
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- 2022
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4. Association Between Vitamin A Intake and Disease Severity in Early-Onset Heterotopic Ossification of the Posterior Longitudinal Ligament of the Spine
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Satoshi Kato, Ryo Takagi, Tsutomu Endo, Kei Ando, Kazuyoshi Kobayashi, Kazufumi Okada, Masahiko Takahata, Shiro Imagama, Masahiro Kanayama, Takashi Kaito, Yoshiharu Kawaguchi, Hiroaki Sakai, Shiro Ikegawa, Yuichiro Hisada, Yoshinao Koike, Norimasa Iwasaki, and Itaru Oda
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medicine.medical_specialty ,severe obesity ,030209 endocrinology & metabolism ,Gastroenterology ,vitamin B6 ,vitamin A ,Vitamin A intake ,03 medical and health sciences ,0302 clinical medicine ,Disease severity ,Internal medicine ,medicine ,Posterior longitudinal ligament ,Orthopedics and Sports Medicine ,dietary habits ,030304 developmental biology ,Early onset ,early-onset OPLL ,0303 health sciences ,Ossification ,business.industry ,medicine.disease ,Spine (zoology) ,heterotopic ossification ,Surgery ,Heterotopic ossification ,Neurology (clinical) ,medicine.symptom ,Vitamin b6 ,business - Abstract
Study Design: A sex- and age-matched case-control study and a cross-sectional study. Objective: In our previous study, patients with early-onset (Methods: In Study 1, the simple brief-type self-administered diet history questionnaire (BDHQ) was used to compare nutrient intake levels of early-onset OPLL patients (n = 13) with those of sex- and age-matched non-OPLL controls (n = 39) or with those of common OPLL (onset age ≥ 50 years, n = 62). In Study 2, serological validation was conducted for thoracic OPLL patients (n = 77) and non-OPLL controls (n = 101) in a nationwide multicenter study in Japan. Results: The BDHQ showed that the early-onset OPLL patients had significantly lower intakes of vitamins A and B6 than non-OPLL controls. These results were validated by lower serum vitamins A and B6 levels in the early-onset thoracic OPLL patients. The severity of OPLL negatively correlated with serum vitamin A levels in male early-onset OPLL patients. The multiple regression analysis revealed that the severity of thoracic OPLL had an association with onset age and serum vitamin A level. Conclusions: Vitamin A deficiency resulting from unbalanced dietary habits is associated with exacerbation of male early-onset OPLL.
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- 2022
5. Factors Associated with Loss of Cervical Lordosis after Laminoplasty for Patients with Cervical Ossification of the Posterior Longitudinal Ligament
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Hiroaki Nakashima, Shiro Imagama, Toshitaka Yoshii, Satoru Egawa, Kenichiro Sakai, Kazuo Kusano, Shinji Tsutsui, Takashi Hirai, Yu Matsukura, Kanichiro Wada, Keiichi Katsumi, Masao Koda, Atsushi Kimura, Takeo Furuya, Satoshi Maki, Narihito Nagoshi, Norihiro Nishida, Yukitaka Nagamoto, Yasushi Oshima, Kei Ando, Masahiko Takahata, Kanji Mori, Hideaki Nakajima, Kazuma Murata, Masayuki Miyagi, Takashi Kaito, Kei Yamada, Tomohiro Banno, Satoshi Kato, Tetsuro Ohba, Hiroshi Moridaira, Shunsuke Fujibayashi, Hiroyuki Katoh, Haruo Kanno, Hiroshi Taneichi, Yoshiharu Kawaguchi, Katsushi Takeshita, Masaya Nakamura, Atsushi Okawa, and Masashi Yamazaki
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Orthopedics and Sports Medicine ,Neurology (clinical) - Published
- 2023
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6. Clinical Indicators of Surgical Outcomes After Laminoplasty for Patients With Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Multicenter Study
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Narihito Nagoshi, Toshitaka Yoshii, Satoru Egawa, Kenichiro Sakai, Kazuo Kusano, Shunji Tsutsui, Takashi Hirai, Yu Matsukura, Kanichiro Wada, Keiichi Katsumi, Masao Koda, Atsushi Kimura, Takeo Furuya, Satoshi Maki, Norihiro Nishida, Yukitaka Nagamoto, Yasushi Oshima, Kei Ando, Hiroaki Nakashima, Masahiko Takahata, Kanji Mori, Hideaki Nakajima, Kazuma Murata, Masayuki Miyagi, Takashi Kaito, Kei Yamada, Tomohiro Banno, Satoshi Kato, Tetsuro Ohba, Satoshi Inami, Shunsuke Fujibayashi, Hiroyuki Katoh, Haruo Kanno, Kota Watanabe, Hiroshi Taneichi, Shiro Imagama, Yoshiharu Kawaguchi, Katsushi Takeshita, Masaya Nakamura, Morio Matsumoto, Masashi Yamazaki, and Atsushi Okawa
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Pain ,Ossification of Posterior Longitudinal Ligament ,Spinal Cord Diseases ,Laminoplasty ,Longitudinal Ligaments ,Treatment Outcome ,Osteogenesis ,Cervical Vertebrae ,Quality of Life ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,Neurology (clinical) ,Retrospective Studies - Abstract
A prospective multicenter study.This study aims to evaluate patient-reported outcomes using the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) and clarify clinical factors that affect the therapeutic effects for patients with cervical ossification of the posterior longitudinal ligament (OPLL).Although previous studies identified factors that affected the surgical outcomes, their assessment was mainly based on the Japanese Orthopedic Association score, which only includes neurological function. Investigating this pathology through multiple functions and quality of life (QOL) is pivotal to understanding the comprehensive clinical pictures of the cervical OPLL and its therapeutic outcomes.This study was performed by the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. A total of 478 patients with myelopathy caused by cervical OPLL from 28 institutions were prospectively registered from 2014 to 2017 and followed up for 2 years. Of the patients, 168 received laminoplasties and fully completed questionnaires. Demographic information, imaging findings, and clinical outcomes were collected. Patients were grouped according to effective or ineffective surgical outcomes as defined by the JOACMEQ using logistic regression analyses.Laminoplasty resulted in functional improvement in the cervical spine and upper extremity around 40% of the patients, while QOL showed only 21.4% ( P0.01). Multivariable analyses revealed that younger age and a postoperative decrease in arm or hand pain were correlated with significantly improved function of the upper extremities. A reduction in lower limb pain favorably affected the postoperative lower extremity function. A postoperative reduction in upper extremity pain enhanced the QOL recovery.Surgeons should recognize the diversity of surgical outcomes after laminoplasty and understand the necessity of pain management even after the surgery to enhance bodily functions and QOL in patients with cervical OPLL.
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- 2022
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7. The characteristics of the young patients with cervical ossification of the posterior longitudinal ligament of the spine: A multicenter cross-sectional study
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Yuji Matsuoka, Keiichi Katsumi, Hirotaka Haro, Takashi Hirai, Toshitaka Yoshii, Katsuya Nagashima, Yukihiro Matsuyama, Atsushi Kimura, Masaya Nakamura, Masao Koda, Takeo Furuya, Shuta Ushio, Hiroshi Ozawa, Takashi Kaito, Masahiko Watanabe, Kenyu Ito, Morio Matsumoto, Tetsuro Ohba, Atsushi Okawa, Katsushi Takeshita, Kota Watanabe, Yoshiharu Kawaguchi, Kanji Mori, Kanichiro Wada, Satoshi Kato, Kei Watanabe, Satoshi Maki, Masashi Yamazaki, Norihiro Nishida, Kazuhiro Takeuchi, Shiro Imagama, Soraya Nishimura, Narihito Nagoshi, and Hiroyuki Katoh
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Adult ,Male ,medicine.medical_specialty ,Cross-sectional study ,Ossification of Posterior Longitudinal Ligament ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,Posterior longitudinal ligament ,Orthopedics and Sports Medicine ,030222 orthopedics ,business.industry ,Ossification ,Significant difference ,Ossification of the posterior longitudinal ligament ,Spine ,Longitudinal Ligaments ,Cross-Sectional Studies ,Bodily pain ,medicine.anatomical_structure ,Cervical Vertebrae ,Ligament ,Female ,Surgery ,Christian ministry ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Background Ossification of the posterior longitudinal ligament of the spine (OPLL) is characterized by heterotopic bone formation in the posterior longitudinal ligament of the spine. Although the patients with OPLL are more common in the 60s and 70s, we know that there are markedly young patients (e.g., early 40s). However, to the best of our knowledge, there is few reports characterize young patients with cervical OPLL in terms of the imaging features, subjective symptoms, and ADL problems. Methods This is the multicenter cross-sectional study. Two hundred and thirty-seven Japanese symptomatic patients with cervical OPLL confirmed by standard X-rays collected from 16 institutions belonging to the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament formed by the Japanese Ministry of Health, Labor and Welfare were recruited. Whole spine CT data as well as demographic data such as age, gender, patients-based evaluations, and the 36-item Short Form Health Survey (SF-36) were evaluated. Results Young group (≦ 45 years old) consisted of 23 patients (8 females and 15 males), accounting for 9.7% of the total. Their characteristics were high body mass index (BMI), significant involvement of trauma in the onset and deterioration of symptoms, and the predominance of thoracic OPLL. The patient-based evaluations did not show a significant difference between the young and non-young groups, or between the genders in the young group except for bodily pain (BP) of SF-36. Female patients in young group had significantly lower BP score of SF-36 than that of male in young group. Conclusions Characteristics of young patients with cervical OPLL were high BMI, significant involvement of trauma in the onset and deterioration of symptoms, lower BP score of SF-36 in female, and the predominance of thoracic OPLL.
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- 2022
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8. Biomarker Research Approach to the Pathogenesis of Ossification of the Spinal Ligament: A Review
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Yoshiharu, Kawaguchi
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Orthopedics and Sports Medicine ,Surgery ,Neurology (clinical) - Abstract
The ossification of the spinal ligaments (OSL) is characterized by ectopic new bone formation in the spinal ligament. However, the etiology of OSL has not yet been fully elucidated. This review paper summarizes the contents of previous reviews, introduces recent advances in the study of OSL and discusses future perspectives. A review of the literature that investigated the biomarkers involved in OPLL was published in 2019. The review cited 11 reports in which a calcium phosphate metabolism marker, bone turnover markers, sclerostin, dickkopf-1, secreted frizzled-related protein-1, fibroblast growth factor-23, fibronectin, menatetrenone, leptin, pentosidine, and hypersensitive C-reactive protein were examined as markers. Data published in 2021 noted that non-coding RNAs might be useful biomarkers for OSL. In addition, triglycerides, uric acid, gene expression levels of interleukin-17 receptor C, chemokine (C-X-C motif) ligand 7 (CXCL7) in the serum reportedly are biomarkers of OSL. However, several issues have been raised in previous studies. Therefore, biomarkers have yet to be conclusively investigated. Research using biomarkers is very important in clarifying pathomechanisms. Results for studies using biomarkers might also be useful for the treatment of patients with OSL in the near future.
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- 2022
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9. Effect of hyperdry amniotic membrane in preventing tendon adhesion in a rabbit model
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Mineyuki Zukawa, Yoshiharu Kawaguchi, Hiroto Makino, Toshiko Yoshida, Ryusuke Osada, Motonori Okabe, Tomoatsu Kimura, Makiko Nogami, and Shoji Seki
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musculoskeletal diseases ,medicine.medical_specialty ,Adhesion (medicine) ,Tissue Adhesions ,Tendons ,03 medical and health sciences ,0302 clinical medicine ,Tendon Injuries ,medicine ,Animals ,Orthopedics and Sports Medicine ,Amnion ,Tendon healing ,Wound Healing ,030222 orthopedics ,business.industry ,Significant difference ,musculoskeletal system ,medicine.disease ,Tendon ,Surgery ,Transplantation ,medicine.anatomical_structure ,Orthopedic surgery ,Rabbit model ,Rabbits ,Range of motion ,business ,030217 neurology & neurosurgery - Abstract
Background No anti-adhesive materials are currently in clinical use for orthopaedic surgery. We developed a hyperdry amniotic membrane (HD-AM) for easy storage and transplantation as amniotic membrane. The purpose of this study was to examine the application of HD-AM to reduce peritendinous adhesions without impairing tendon healing. Methods We randomly divided 3 digits (2nd, 3rd, and 4th digits) from each rabbit into three groups: a tendon repair group; a tendon repair with HD-AM group (HD-AM group); and a control group (cast only). The effects of HD-AM on peritendinous adhesions and tendon healing were examined using microscopic, histological, and mechanical analyses in a rabbit flexor digitorum profundus tendon model. Results Adhesions on macroscopic evaluation of the tendon repair site were significantly smaller in the HD-AM group than in the tendon repair group. Little adhesion formation or foreign body reactions were seen by on histologic evaluation in the HD-AM group. Range of motion following tendon repair was significantly better in the HD-AM group than in the tendon repair group. Maximal tensile strength required to pull the tendon from the site of adhesion was significantly smaller in the HD-AM group than in the tendon repair group. As for tendon repair site, no significant difference was seen between the tendon repair and HD-AM groups. Conclusions HD-AM prevented peritendinous adhesion macroscopically, pathologically, and mechanically without impairing the sutured tendon. HD-AM has already been clinically applied in neurosurgery, ophthalmology, and otolaryngology, and clinical application as an anti-adhesive materials may be achieved in the future.
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- 2022
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10. Improving Awareness Could Transform Outcomes in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 1]
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Benjamin M. Davies, Oliver Mowforth, Helen Wood, Zahabiya Karimi, Iwan Sadler, Lindsay Tetreault, Jamie Milligan, Jamie R. F. Wilson, Sukhvinder Kalsi-Ryan, Julio C. Furlan, Yoshiharu Kawaguchi, Manabu Ito, Carl Moritz Zipser, Timothy F Boerger, Alexander R. Vaccaro, Rory K. J. Murphy, Mike Hutton, Ricardo Rodrigues-Pinto, Paul A. Koljonen, James S. Harrop, Bizhan Aarabi, Vafa Rahimi-Movaghar, Shekar N Kurpad, James D. Guest, Jefferson R. Wilson, Brian K. Kwon, Mark R. N. Kotter, and Michael G. Fehlings
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Orthopedics and Sports Medicine ,Surgery ,Neurology (clinical) - Abstract
Study Design Literature Review (Narrative) Objective To introduce the number one research priority for Degenerative Cervical Myelopathy (DCM): Raising Awareness. Methods Raising awareness has been recognized by AO Spine RECODE-DCM as the number one research priority. This article reviews the evidence that awareness is low, the potential drivers, and why this must be addressed. Case studies of success from other diseases are also reviewed, drawing potential parallels and opportunities for DCM. Results DCM may affect as many as 1 in 50 adults, yet few will receive a diagnosis and those that do will wait many years for it. This leads to poorer outcomes from surgery and greater disability. DCM is rarely featured in healthcare professional training programs and has received relatively little research funding (Conclusion Despite the devastating burden on the patient, recognition across research, clinical practice, and healthcare policy are limited. DCM represents a significant unmet need that must become an international public health priority.
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- 2022
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11. Therapeutic strategy for atypical ulnar fracture in long use of bisphosphonate: A systematic review
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Tatsuro Hirokawa, Mineyuki Zukawa, Hiroto Makino, Ryusuke Osada, and Yoshiharu Kawaguchi
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Orthopedics and Sports Medicine ,Surgery - Published
- 2023
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12. Comparison of Surgical Outcomes of Anterior and Posterior Fusion Surgeries for K-line (−) Cervical Ossification of the Posterior Longitudinal Ligament
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Narihito Nagoshi, Toshitaka Yoshii, Satoru Egawa, Kenichiro Sakai, Kazuo Kusano, Shunji Tsutsui, Takashi Hirai, Yu Matsukura, Kanichiro Wada, Keiichi Katsumi, Masao Koda, Atsushi Kimura, Takeo Furuya, Yasunori Sato, Satoshi Maki, Norihiro Nishida, Yukitaka Nagamoto, Yasushi Oshima, Kei Ando, Hiroaki Nakashima, Masahiko Takahata, Kanji Mori, Hideaki Nakajima, Kazuma Murata, Masayuki Miyagi, Takashi Kaito, Kei Yamada, Tomohiro Banno, Satoshi Kato, Tetsuro Ohba, Hiroshi Moridaira, Shunsuke Fujibayashi, Hiroyuki Katoh, Haruo Kanno, Kota Watanabe, Hiroshi Taneichi, Shiro Imagama, Yoshiharu Kawaguchi, Katsushi Takeshita, Masaya Nakamura, Morio Matsumoto, and Masashi Yamazaki
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Orthopedics and Sports Medicine ,Neurology (clinical) - Published
- 2023
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13. Residual Neuropathic Pain in Postoperative Patients With Cervical Ossification of Posterior Longitudinal LigamentRisk Factors for Residual Neuropathic Pain
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Masayuki Miyagi, Gen Inoue, Toshitaka Yoshii, Satoru Egawa, Kenichiro Sakai, Kazuo Kusano, Yukihiro Nakagawa, Takashi Hirai, Kanichiro Wada, Keiichi Katsumi, Atsushi Kimura, Takeo Furuya, Narihito Nagoshi, Tsukasa Kanchiku, Yukitaka Nagamoto, Yasushi Oshima, Hiroaki Nakashima, Kei Ando, Masahiko Takahata, Kanji Mori, Hideaki Nakajima, Kazuma Murata, Shunji Matsunaga, Takashi Kaito, Kei Yamada, Sho Kobayashi, Satoshi Kato, Tetsuro Ohba, Satoshi Inami, Shunsuke Fujibayashi, Hiroyuki Katoh, Haruo Kanno, Masao Koda, Hiroshi Takahashi, Shinsuke Ikeda, Shiro Imagama, Yoshiharu Kawaguchi, Katsushi Takeshita, Morio Matsumoto, Masashi Takaso, Atsushi Okawa, and Masashi Yamazaki
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Orthopedics and Sports Medicine ,Surgery ,Neurology (clinical) - Published
- 2023
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14. Deep learning-based prediction model for postoperative complications of cervical posterior longitudinal ligament ossification
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Sadayuki Ito, Hiroaki Nakashima, Toshitaka Yoshii, Satoru Egawa, Kenichiro Sakai, Kazuo Kusano, Shinji Tsutui, Takashi Hirai, Yu Matsukura, Kanichiro Wada, Keiichi Katsumi, Masao Koda, Atsushi Kimura, Takeo Furuya, Satoshi Maki, Narihito Nagoshi, Norihiro Nishida, Yukitaka Nagamoto, Yasushi Oshima, Kei Ando, Masahiko Takahata, Kanji Mori, Hideaki Nakajima, Kazuma Murata, Masayuki Miyagi, Takashi Kaito, Kei Yamada, Tomohiro Banno, Satoshi Kato, Tetsuro Ohba, Satoshi Inami, Shunsuke Fujibayashi, Hiroyuki Katoh, Haruo Kanno, Masahiro Oda, Kensaku Mori, Hiroshi Taneichi, Yoshiharu Kawaguchi, Katsushi Takeshita, Morio Matsumoto, Masashi Yamazaki, Atsushi Okawa, and Shiro Imagama
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Orthopedics and Sports Medicine ,Surgery - Published
- 2023
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15. Perioperative Complications in Posterior Surgeries for Cervical Ossification of the Posterior Longitudinal Ligament
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Yoshiharu Kawaguchi, Kanji Mori, Satoshi Kato, Kanichiro Wada, Katsushi Takeshita, Kazuo Kusano, Atsushi Kimura, Shunsuke Fujibayashi, Hiroyuki Katoh, Kazuma Murata, Masahiko Takahata, Haruo Kanno, Satoshi Inami, Morio Matsumoto, Kei Ando, Shunji Matsunaga, Takashi Kaito, Masao Koda, Takeo Furuya, Kei Yamada, Narihito Nagoshi, Takashi Hirai, Atsushi Okawa, Kenichiro Sakai, Yasushi Oshima, Toshitaka Yoshii, Yukitaka Nagamoto, Keiichi Katsumi, Masashi Yamazaki, Yukihiro Nakagawa, Satoru Egawa, Kengo Fujii, Tetsuro Ohba, Tsukasa Kanchiku, Sho Kobayashi, Shiro Imagama, and Hideaki Nakajima
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medicine.medical_specialty ,medicine.medical_treatment ,Ossification of Posterior Longitudinal Ligament ,Laminoplasty ,Osteogenesis ,medicine ,Humans ,Orthopedics and Sports Medicine ,In patient ,Prospective Studies ,Retrospective Studies ,Univariate analysis ,Palsy ,business.industry ,Ossification of the posterior longitudinal ligament ,Perioperative ,Decompression, Surgical ,Longitudinal Ligaments ,Surgery ,Spinal Fusion ,Treatment Outcome ,Multicenter study ,Cervical Vertebrae ,Neurology (clinical) ,business ,Body mass index - Abstract
Study design This was a prospective multicenter study. Objective The aim of this study was to investigate the perioperative complications of posterior surgeries for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL). Summary of background data Surgical treatment for cervical OPLL has a high risk of various complications. Laminoplasty (LAMP) and posterior decompression and instrumented fusion (PDF) are effective for multilevel cervical OPLL; however, few studies have focused on the surgical complications of these 2 procedures. Materials and methods We prospectively included 380 patients undergoing posterior surgeries for cervical OPLL (LAMP: 270 patients, PDF: 110 patients), and investigated the systemic and local complications, including neurological complications. We further evaluated risk factors related to the neurological complications. Results Motor palsy was found in 40 patients (10.5%), and motor palsy in the upper extremity was most frequent (8.9%), especially in patients who received PDF (14.5%). Motor palsies involving the lower extremities was found in 6 patients (1.6%). Regarding local complications, dural tears (3.9%) and surgical site infections (2.6%) were common. In the univariate analysis, body mass index, preoperative cervical alignment, fusion surgery, and the number of operated segments were the factors related to motor palsy. Multivariate analysis revealed that fusion surgery and a small preoperative C2-C7 angle were the independent factors related to motor palsy. Motor palsy involving the lower extremities tended to be found at early time points after the surgery, and all the patients fully recovered. Motor palsy in the upper extremities occurred in a delayed manner, and 68.8% of patients with PDF showed good recovery, whereas 81.3% of patients with LAMP showed good recovery. Conclusions In posterior surgeries for cervical OPLL, segmental motor palsy in the upper extremity was most frequently observed, especially in patients who received PDF. Fusion and a small preoperative C2-C7 angle were the independent risk factors for motor palsy. Level of evidence Level III.
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- 2021
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16. Machine Learning Approach in Predicting Clinically Significant Improvements After Surgery in Patients with Cervical Ossification of the Posterior Longitudinal Ligament
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Seiji Ohtori, Narihito Nagoshi, Yoshiharu Kawaguchi, Masashi Yamazaki, Tsukasa Kanchiku, Katsushi Takeshita, Kazuo Kusano, Shunsuke Fujibayashi, Shunji Matsunaga, Keiichi Katsumi, Atsushi Kimura, Shiro Imagama, Hiroyuki Katoh, Yukitaka Nagamoto, Satoshi Inami, Kei Ando, Satoru Egawa, Takashi Hirai, Kenichiro Sakai, Kengo Fujii, Satoshi Maki, Kazuma Murata, Kanji Mori, Masao Koda, Hideaki Nakajima, Atsushi Okawa, Morio Matsumoto, Sho Kobayashi, Satoshi Kato, Kanichiro Wada, Haruo Kanno, Masahiko Takahata, Yasushi Oshima, Takashi Kaito, Takeo Furuya, Yukihiro Nakagawa, Tetsuro Ohba, Kei Yamada, and Toshitaka Yoshii
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medicine.medical_specialty ,Body weight ,Machine learning ,computer.software_genre ,Logistic regression ,Machine Learning ,Text mining ,Osteogenesis ,Humans ,Medicine ,Orthopedics and Sports Medicine ,In patient ,Retrospective Studies ,Receiver operating characteristic ,business.industry ,Minimal clinically important difference ,Ossification of the posterior longitudinal ligament ,humanities ,Longitudinal Ligaments ,Surgery ,Treatment Outcome ,Cervical Vertebrae ,Prognostic model ,Neurology (clinical) ,Artificial intelligence ,business ,computer - Abstract
Study design A retrospective analysis of prospectively collected data. Objective This study aimed to create a prognostic model for surgical outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL) using machine learning (ML). Summary of background data Determining surgical outcomes helps surgeons provide prognostic information to patients and manage their expectations. ML is a mathematical model that finds patterns from a large sample of data and makes predictions outperforming traditional statistical methods. Methods Out of 478 patients, 397 and 370 patients had complete follow-up information at 1 and 2 year respectively and were included in the analysis. A minimal clinically important difference (MCID) was defined as an acquired Japanese Orthopaedic Association (JOA) score of 2.5 points or more, after which a ML model that predicts whether MCID can be achieved 1 and 2 years after surgery was created. Patient background, clinical symptoms, and imaging findings were used as variables for analysis. The ML model was created using LightGBM, XGBoost, random forest, and logistic regression, after which the accuracy and area under the receiver operating characteristic curve (AUC) were calculated. Results The mean JOA score was 10.3 preoperatively, 13.4 at 1 year after surgery, and 13.5 at 2 years after surgery. XGBoost showed the highest AUC (0.72) and high accuracy (67.8) for predicting MCID at 1 year, while random forest had the highest AUC (0.75) and accuracy (69.6) for predicting MCID at 2 years. Among the included features, total preoperative JOA score, duration of symptoms, body weight, sensory function of the lower extremity sub-score of the JOA, and age were identified as having the most significance in most of ML models. Conclusion Constructing a prognostic ML model for surgical outcomes in patients with OPLL is feasible, suggesting the potential application of ML for predictive models of spinal surgery.Level of Evidence: 4.
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- 2021
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17. Comparison of Surgical Outcomes After Open- and Double-Door Laminoplasties for Patients with Cervical Ossification of the Posterior Longitudinal Ligament
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Shunji Matsunaga, Narihito Nagoshi, Atsushi Kimura, Haruo Kanno, Takeo Furuya, Toshitaka Yoshii, Keiichi Katsumi, Kei Ando, Tetsuro Ohba, Yukitaka Nagamoto, Hideaki Nakajima, Satoru Egawa, Kazuo Kusano, Masaya Nakamura, Hiroyuki Katoh, Kota Watanabe, Yasushi Oshima, Morio Matsumoto, Sho Kobayashi, Yukihiro Nakagawa, Kengo Fujii, Yoshiharu Kawaguchi, Shiro Imagama, Atsushi Okawa, Kazuma Murata, Masashi Yamazaki, Kei Yamada, Satoshi Inami, Kenichiro Sakai, Kanichiro Wada, Takashi Hirai, Katsushi Takeshita, Shunsuke Fujibayashi, Masao Koda, Tsukasa Kanchiku, Hiroaki Nakashima, Kanji Mori, Satoshi Kato, Masahiko Takahata, and Takashi Kaito
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medicine.medical_specialty ,Visual analogue scale ,Ossification of Posterior Longitudinal Ligament ,Laminoplasty ,Myelopathy ,Osteogenesis ,medicine ,Humans ,Orthopedics and Sports Medicine ,Medical history ,Prospective Studies ,Retrospective Studies ,Neck pain ,Ossification ,business.industry ,Perioperative ,medicine.disease ,Longitudinal Ligaments ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Cervical Vertebrae ,Ligament ,Neurology (clinical) ,medicine.symptom ,business ,Range of motion - Abstract
STUDY DESIGN A prospective multicenter study. OBJECTIVE To evaluate and compare the surgical outcomes after open-door (OD) and double-door (DD) laminoplasties in subjects with cervical ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA Although previous studies compared clinical results after OD and DD laminoplasties, they were performed at a single institution with a relatively small sample size targeting mixed pathologies, including cervical spondylotic myelopathy. METHODS This study was performed by the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. A total of 478 patients with myelopathy caused by cervical OPLL from 28 institutions were prospectively registered from 2014 to 2017 and followed up for 2 years. Of these, 41 and 164 patients received OD and DD laminoplasties, respectively. Demographic information, medical history, and imaging findings were collected. Clinical outcomes were assessed using the cervical Japanese Orthopaedic Association, Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, and visual analog scale scores. RESULTS Age, sex, symptom duration, and comorbidities were not significantly different between the groups. Segmental ossification was the most frequent in both the groups. No significant differences in K-line type, canal occupying ratio, C2 to C7 angles, and range of motion were found. Both the procedures reduced the cervical range of motion postoperatively. A comparable frequency of perioperative complications was observed between the groups. The cervical Japanese Orthopaedic Association scores showed a similar improvement at 2 years postopera- tively. The reduction in visual analog scale score for neck pain was favorable in the OD group (P = 0.02), while other pain assessments did not show any significant differences between the groups. The functional outcomes assessed using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire presented equivalent effective rates. CONCLUSION The results demonstrated almost comparable surgical outcomes between OD and DD laminoplasties. Lamino- plasty is a valuable technique as a therapeutic option for cervical OPLL.Level of Evidence: 2.
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- 2021
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18. Severity of Myelopathy is Closely Associated With Advanced Age and Signal Intensity Change in Cervical Ossification of the Posterior Longitudinal Ligament
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Tetsuro Ohba, Satoru Egawa, Kanichiro Wada, Shunji Matsunaga, Morio Matsumoto, Masashi Yamazaki, Yukitaka Nagamoto, Tsukasa Kanchiku, Haruo Kanno, Kei Yamada, Toshitaka Yoshii, Takeo Furuya, Masahiko Takahata, Atsushi Kimura, Sho Kobayashi, Takashi Kaito, Keiichi Katsumi, Yasushi Oshima, Narihito Nagoshi, Satoshi Inami, Yukihiro Nakagawa, Takashi Hirai, Kei Ando, Shiro Imagama, Kengo Fujii, Hiroyuki Katoh, Atsushi Okawa, Katsushi Takeshita, Shunsuke Fujibayashi, Kanji Mori, Satoshi Kato, Hideaki Nakajima, Masao Koda, Kazuma Murata, Yoshiharu Kawaguchi, Kenichiro Sakai, and Kazuo Kusano
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Male ,medicine.medical_specialty ,Radiography ,Ossification of Posterior Longitudinal Ligament ,Spinal Cord Diseases ,Laminoplasty ,Myelopathy ,Osteogenesis ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Prospective Studies ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Ossification of the posterior longitudinal ligament ,Magnetic resonance imaging ,medicine.disease ,Longitudinal Ligaments ,Treatment Outcome ,Orthopedic surgery ,Cervical Vertebrae ,Female ,Surgery ,Neurology (clinical) ,Radiology ,business ,Range of motion ,Body mass index ,Case series - Abstract
Study design Prospective, nationwide case series. Objective To identify preoperative factors associated with myelopathy and neurological impairment in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Summary of background data Various studies have reported clinical outcomes following the surgical treatment of OPLL. However, there has been no large-scale study of preoperative clinical features in patients with cervical OPLL. Materials and methods Data were prospectively collected from 28 institutions nationwide in Japan. In total, 512 patients with neurological impairment caused by cervical OPLL requiring surgery were enrolled. Basic demographic and clinical data, including age, sex, diabetes status, body mass index, smoking history, and disease duration were collected. C2-7 lordotic angle, canal narrowing ratio, range of motion in flexion-extension at C2-7, and type of OPLL were evaluated on lateral radiographs to identify factors influencing the clinical features of patients with OPLL in whom surgery was planned. Results Complete documentation was available for 490 patients (362 male, 128 female). In total, 34 patients had the localized type, 181 had the segmental type, 64 had the continuous type, and 211 had the mixed type. Although there were no significant differences in age, body mass index, disease duration, Japanese Orthopedic Association (JOA) score, and lordotic angle at C2-7 according to the type of OPLL, significant differences were observed in a range of motion at C2-7 and the canal narrowing ratio among the 4 types. Multiple regression analysis revealed that the JOA score was significantly associated with age and signal intensity change on magnetic resonance imaging. Conclusions This is the first large-scale, prospective, multicenter case series study to investigate factors influencing preoperative neurological status in patients with OPLL. Age and signal intensity change on magnetic resonance images were significantly associated with JOA score in patients requiring surgery. Level of evidence Level II.
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- 2021
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19. Is it possible to predict the final component gap in flexion before femoral posterior condylar osteotomy in cruciate-retaining and posterior-stabilized total knee arthroplasty?
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Hayato Mine, Ryuichi Gejo, Makiko Nogami, and Yoshiharu Kawaguchi
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Male ,musculoskeletal diseases ,Knee Joint ,medicine.medical_treatment ,Total knee arthroplasty ,Osteoarthritis ,Osteotomy ,Condyle ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Range of Motion, Articular ,Arthroplasty, Replacement, Knee ,Reduction (orthopedic surgery) ,Aged ,Aged, 80 and over ,Orthodontics ,030222 orthopedics ,business.industry ,Posterior stabilized ,030229 sport sciences ,Middle Aged ,Osteoarthritis, Knee ,Plastic Surgery Procedures ,musculoskeletal system ,medicine.disease ,medicine.anatomical_structure ,Posterior cruciate ligament ,Female ,Posterior Cruciate Ligament ,Patella ,business - Abstract
In total knee arthroplasty (TKA) with posterior condylar osteotomy using anatomical landmarks, predicting the final flexion gap is impossible, as it differs with the presence or absence of the posterior cruciate ligament. We compared the predicted flexion gap, based on pre-femoral posterior condylar osteotomy measurements, with the postsurgical final flexion gap in cruciate-retaining (CR) and posterior-stabilized (PS) TKA.One hundred knees of patients with osteoarthritis were included: 35 underwent CR, and 65 PS TKA. Distal femoral and proximal tibial osteotomy using the measured resection technique was performed. An anterior and posterior femoral osteotomy guide was set parallel to the surgical epicondylar axis, and the predicted flexion gap was measured using a seesaw tensor attached to the guide. After all procedures, the final component gap in flexion was measured using a similar seesaw tensor at the patella reduction position and was compared with the predicted gap.The correlation coefficients for predicted vs. final component gap were 0.45 (P 0.05) in CR and 0.82 (P 0.001) in PS. The mean differences between predicted and final gaps were 1.8 mm for CR and 1.0 mm for PS. In 34.3% of CR cases, the gap difference was more than 2 mm.It is possible to predict the final flexion gap before femoral posterior condylar osteotomy, with a strong correlation observed between predicted and final component gaps in PS TKA. However, in CR, more than 30% of the cases showed unexpectedly large final flexion gaps.
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- 2021
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20. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of ossification of the spinal ligament, 2019
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Kanji Mori, Tomohiko Hasegawa, Yoshiharu Kawaguchi, Masao Koda, Motoki Iwasaki, Hirotaka Chikuda, Shiro Imagama, Toshitaka Yoshii, and Takashi Kaito
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medicine.medical_specialty ,Ossification ,business.industry ,General surgery ,MEDLINE ,Ossification of Posterior Longitudinal Ligament ,Clinical Practice ,medicine.anatomical_structure ,medicine ,Ligament ,Humans ,Orthopedics and Sports Medicine ,Surgery ,medicine.symptom ,business - Published
- 2021
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21. Factors Affecting the Decision to Initiate Anticoagulation After Spine Surgery: Findings From the AOSpine Anticoagulation Global Initiative
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Dino Samartzis, Jens R. Chapman, Garrett K. Harada, Marcelo Valacco, Karsten Wiechert, Thomas E. Mroz, Michael G. Fehlings, Khalid Alsaleh, K. Daniel Riew, Sapan D. Gandhi, Yoshiharu Kawaguchi, Serena S. Hu, Venugopal K. Menon, Philip K. Louie, Krishn Khanna, Jeffrey C. Wang, Giovanni Barbanti Brodano, Shanmuganathan Rajasekaran, Luiz Roberto Vialle, James S. Harrop, Jong-Beom Park, and Michael Mayer
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medicine.medical_specialty ,Epidural hematoma ,Spine surgery ,business.industry ,General surgery ,Medicine ,Orthopedics and Sports Medicine ,Surgery ,Neurology (clinical) ,business ,medicine.disease ,Pulmonary embolism - Abstract
Study Design: Cross-sectional, international survey. Objectives: To identify factors influencing pharmacologic anticoagulation initiation after spine surgery based on the AOSpine Anticoagulation Global Survey. Methods: This survey was distributed to the international membership of AOSpine (n = 3805). A Likert-type scale described grade practice-specific factors on a scale from low (1) to high (5) importance, and patient-specific factors a scale from low (0) to high (3) importance. Analysis was performed to determine which factors were significant in the decision making surrounding the initiation of pharmacologic anticoagulation. Results: A total of 316 spine surgeons from 64 countries completed the survey. In terms of practice-specific factors considered to initiate treatment, expert opinion was graded the highest (mean grade ± SD = 3.2 ± 1.3), followed by fellowship training (3.2 ± 1.3). Conversely, previous studies (2.7 ± 1.2) and unspecified guidelines were considered least important (2.6 ± 1.6). Patient body mass index (2.0 ± 1.0) and postoperative mobilization (2.3 ± 1.0) were deemed most important and graded highly overall. Those who rated estimated blood loss with greater importance in anticoagulation initiation decision making were more likely to administer thromboprophylaxis at later times (hazard ratio [HR] = 0.68-0.71), while those who rated drain output with greater importance were likely to administer thromboprophylaxis at earlier times (HR = 1.32-1.43). Conclusion: Among our global cohort of spine surgeons, certain patient factors (ie, patient mobilization and body mass index) and practice-specific factors (ie, expert opinion and fellowship training) were considered to be most important when considering anticoagulation start times.
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- 2020
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22. The characteristics of the patients with radiologically severe cervical ossification of the posterior longitudinal ligament of the spine: A CT-based multicenter cross-sectional study
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Masahiko Abematsu, Masashi Yamazaki, Kazuhiro Takeuchi, Narihito Nagoshi, Tetsuro Ohba, Akio Iwanami, Takeo Furuya, Kei Watanabe, Takashi Hirai, Haruo Kanno, Morio Matsumoto, Yoshiharu Kawaguchi, Shuta Ushio, Masao Koda, Masahiko Watanabe, Hiroshi Ozawa, Kei Ando, Masaya Nakamura, Kanji Mori, Yukihiro Matsuyama, Mitsuru Furukawa, Tomohiko Hasegawa, Katsushi Takeshita, Hiroyuki Katoh, Shoji Seki, Shunsuke Fujibayashi, Kanichiro Wada, Soraya Nishimura, Hirotaka Haro, Atsushi Okawa, Kanehiro Fujiyoshi, Toshitaka Yoshii, Atsushi Kimura, Takashi Tsuji, Tsuyoshi Yamada, and Shiro Imagama
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Adult ,Male ,medicine.medical_specialty ,Cross-sectional study ,Radiography ,Ossification of Posterior Longitudinal Ligament ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Female patient ,medicine ,Humans ,Posterior longitudinal ligament ,Orthopedics and Sports Medicine ,Aged ,Aged, 80 and over ,030222 orthopedics ,Ossification ,business.industry ,Ossification of the posterior longitudinal ligament ,Middle Aged ,Surgery ,Cross-Sectional Studies ,medicine.anatomical_structure ,Cervical Vertebrae ,Ligament ,Female ,medicine.symptom ,Tomography, X-Ray Computed ,business ,Body mass index ,030217 neurology & neurosurgery - Abstract
Background Ossification of the posterior longitudinal ligament of the spine (OPLL) is characterized by heterotopic bone formation in the posterior longitudinal ligament of the spine. We know that the size and distribution of the ossified lesions in patients with OPLL are different in each case. However, the characteristics of the patients with radiologically severe cervical OPLL remain unknown. Methods The participants of our study were symptomatic patients with cervical OPLL who were diagnosed by standard radiographs of the cervical spine. Whole-spine CT data and demographic data such as age and sex were obtained from 20 institutions belonging to the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. According to the number of the levels involved by OPLL, we stratified the patients into two subgroups: severe group (S-group) and non-severe group (NS-group) to delineate the characteristics of radiologically severe patients with cervical OPLL. We also evaluated the most compressed level and the degree of occupying ratio of cervical spinal canal by OPLL at the most compressed level. Results A total of 234 patients with a mean age of 65 years were recruited. The S-group consisted of 48 patients (21%, 12 females and 36 males) and the NS-group consisted of 92 patients (79%, 22 females and 70 males). The mean age of males in the S-group (68 years old) was significantly higher than that of males in the NS-group (64 years old); however there was no significant difference in the mean age in females between the S-group (69 years old) and the NS-group (66 years old). No significant difference of body mass index, ossification of the nuchal ligament-positivity and presence of diabetes mellitus were found between the S- and the NS-group. Conclusions It is likely that the manner of extension of cervical OPLL is different between male and female patients.
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- 2020
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23. A novel screwing method to prevent decubitus and skin ulcer in severe kyphoscoliosis after spinal cord injury: A case report
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Yoshiharu Kawaguchi, Hayato Mine, Shoji Seki, and Tomoatsu Kimura
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030222 orthopedics ,medicine.medical_specialty ,business.industry ,Skin ulcer ,medicine.disease ,Surgery ,Scoliosis surgery ,03 medical and health sciences ,0302 clinical medicine ,Anesthesia ,medicine ,Orthopedics and Sports Medicine ,medicine.symptom ,business ,Kyphoscoliosis ,Spinal cord injury ,030217 neurology & neurosurgery - Published
- 2020
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24. Perioperative Anticoagulation Management in Spine Surgery: Initial Findings From the AO Spine Anticoagulation Global Survey
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Jens R. Chapman, Serena S. Hu, Jong-Beom Park, James S. Harrop, Giovanni Barbanti Brodano, Garrett K. Harada, Michael Mayer, Luiz Roberto Vialle, Yoshiharu Kawaguchi, Marcelo Valacco, Khalid Alsaleh, Dino Samartzis, Karsten Wiechert, Thomas E. Mroz, Sheeraz A. Qureshi, Philip K. Louie, K. Daniel Riew, Michael G. Fehlings, S. Rajasekaran, Venugopal K. Menon, and Jeffrey C. Wang
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medicine.medical_specialty ,business.industry ,General surgery ,bridging ,International survey ,Anticoagulation management ,Perioperative ,Spine (zoology) ,spine surgery ,Spine surgery ,Anticoagulation Special Section ,Medicine ,Orthopedics and Sports Medicine ,Surgery ,survey ,Neurology (clinical) ,guidelines ,thromboprophylaxis ,business ,anticoagulation - Abstract
Study Design: Cross-sectional, international survey. Objectives: This study addressed the global perspectives concerning perioperative use of pharmacologic thromboprophylaxis during spine surgery along with its risks and benefits. Methods: A questionnaire was designed and implemented by expert members in the AO Spine community. The survey was distributed to AO Spine’s spine surgeon members (N = 3805). Data included surgeon demographic information, type and region of practice, anticoagulation principles, different patient scenarios, and comorbidities. Results: A total of 316 (8.3% response rate) spine surgeons completed the survey, representing 64 different countries. Completed surveys were primarily from Europe (31.7%), South/Latin America (19.9%), and Asia (18.4%). Surgeons tended to be 35 to 44 years old (42.1%), fellowship-trained (74.7%), and orthopedic surgeons (65.5%) from academic institutions (39.6%). Most surgeons (70.3%) used routine anticoagulation risk stratification, irrespective of geographic location. However, significant differences were seen between continents with anticoagulation initiation and cessation methodology. Specifically, the length of a procedure ( P = .036) and patient body mass index ( P = .008) were perceived differently when deciding to begin anticoagulation, while the importance of medical clearance ( P < .001) and reference to literature ( P = .035) differed during cessation. For specific techniques, most providers noted use of mobilization, low-molecular-weight heparin, and mechanical prophylaxis beginning on postoperative 0 to 1 days. Conversely, bridging regimens were bimodal in distribution, with providers electing anticoagulant initiation on postoperative 0 to 1 days or days 5-6. Conclusion: This survey highlights the heterogeneity of spine care and accentuates geographical variations. Furthermore, it identifies the difficulty in providing consistent perioperative anticoagulation recommendations to patients, as there remains no widely accepted, definitive literature of evidence or guidelines.
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- 2020
25. Sacroiliac joint variation associated with diffuse idiopathic skeletal hyperostosis
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Yasuhito Yahara, Hiroto Makino, Miho Kondo, Kayo Suzuki, Taketoshi Yasuda, Shoji Seki, Katsuhiko Kamei, Yoshiharu Kawaguchi, Masahiko Kanamori, and Tomoatsu Kimura
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Male ,musculoskeletal diseases ,medicine.medical_specialty ,Degenerative lumbar disease ,lcsh:Diseases of the musculoskeletal system ,Thoracic spine ,Population ,Sacroiliac joint ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Internal medicine ,Humans ,Medicine ,Orthopedics and Sports Medicine ,education ,Aged ,Retrospective Studies ,Diffuse Idiopathic Skeletal Hyperostosis ,Diffuse idiopathic skeletal hyperostosis ,Aged, 80 and over ,030203 arthritis & rheumatology ,education.field_of_study ,Hyperostosis, Diffuse Idiopathic Skeletal ,business.industry ,Ossification ,Anatomic Variation ,Anatomy ,Enthesis ,Anterior paraarticular bridging ,medicine.anatomical_structure ,Orthopedic surgery ,Female ,medicine.symptom ,lcsh:RC925-935 ,Tomography, X-Ray Computed ,business ,030217 neurology & neurosurgery ,Research Article - Abstract
Background Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by the ossification of vertebral bodies and peripheral entheses. However, variations in sacroiliac (SI) joint change in patients with DISH have not been fully clarified. The purpose of this study was to evaluate SI joint variation in patients with DISH in comparison with a non-DISH population. Methods A total of 342 SI joints in 171 patients (DISH+, n = 86; DISH-, n = 85) who had undergone lumbar spine surgery were analyzed by computed tomography examination. SI joint variations were classified into four types: Type 1, normal or tiny peripheral bone irregularity; Type 2, subchondral bone sclerosis and osteophytes formation; Type 3, vacuum phenomenon; and Type 4, bridging osteophyte and bony fusion. The type of bridging osteophyte in SI joints and the prevalence of ossification in each spinal segment from C1 to SI joint were also examined. Results The most common SI joint variation in the DISH+ group was bony fusion (Type 4), with 71.6% exhibiting anterior paraarticular bridging. On the other hand, SI joint vacuum phenomenon (Type 3) was the most frequent change (57.1%) in the DISH- group. The middle to lower thoracic spine and SI joints were highly affected in DISH and caused bony ankylosis. Conclusions Anterior paraarticular bridging was the most common type of SI joint change in patients with DISH who underwent lumbar spine surgery. The present results regarding variations of SI joint changes in DISH should help understand the etiology of DISH.
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- 2020
26. Outcomes of Surgery for Thoracic Myelopathy Owing to Thoracic Ossification of The Ligamentum Flavum in a Nationwide Multicenter Prospectively Collected Study in 223 Patients
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Toshitaka Yoshii, Shota Takenaka, Kenichiro Sakai, Yukihiro Matsuyama, Kei Ando, Kanichiro Wada, Kota Watanabe, Takeo Furuya, Atsushi Okawa, Masao Koda, Yoshiharu Kawaguchi, Atsushi Kimura, Morio Matsumoto, Nobuyuki Fujita, Hideaki Nakashima, Masahiko Takahata, Takashi Kaito, Satoshi Kato, Shiro Imagama, Satoru Egawa, Masashi Yamazaki, Masahiko Watanabe, Kazuhiro Takeuchi, Shigeo Shindo, Katsushi Takeshita, Shunsuke Fujibayashi, and Hideki Murakami
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medicine.medical_specialty ,Intraoperative Neurophysiological Monitoring ,Spinal Cord Diseases ,Thoracic Vertebrae ,03 medical and health sciences ,Myelopathy ,Postoperative Complications ,0302 clinical medicine ,medicine ,Humans ,Orthopedic Procedures ,Orthopedics and Sports Medicine ,Prospective Studies ,Prospective cohort study ,030222 orthopedics ,medicine.diagnostic_test ,business.industry ,Ossification ,Ossification, Heterotopic ,Retrospective cohort study ,Magnetic resonance imaging ,Perioperative ,medicine.disease ,Surgery ,Ligamentum Flavum ,Treatment Outcome ,Orthopedic surgery ,Spinal Diseases ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Intraoperative neurophysiological monitoring - Abstract
STUDY DESIGN Prospectively collected, multicenter, nationwide study. OBJECTIVE The aim of this study was to investigate recent surgical methods and trends, outcomes, and perioperative complications in surgery for thoracic ossification of the ligamentum flavum (T-OLF). SUMMARY OF BACKGROUND DATA A prospective multicenter study of surgical complications and risk factors for T-OLF has not been performed, and previous multicenter retrospective studies have lacked details for these items. METHODS Surgical methods, pre- and postoperative thoracic myelopathy (Japanese Orthopedic Association [JOA] score), symptoms, and intraoperative neurophysiological monitoring were investigated prospectively in 223 cases. Differences in these factors between fusion and nonfusion procedures for T-OLF were examined. The minimum follow-up period was 2 years after surgery RESULTS.: The mean JOA score was 6.2 points preoperatively, and 7.9, 8.2, and 8.2 points at 6 months, 1, and 2 year postoperatively, giving mean recovery rates of 35.0%, 40.9%, and 41.4% respectively. Posterior decompression and fusion with instrumentation was performed in 109 cases (48.9%). There were 45 perioperative complications in 30 cases (13.5%), with aggravation of motor disturbance in the lower extremities being most common (4.0%, n = 9). Patients treated with fusion had a significantly higher BMI, rate of gait disturbance, ossification occupation rate of OLF at computed tomography, and intramedullary high intensity area at magnetic resonance imaging (P
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- 2020
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27. A deep convolutional neural network to predict the curve progression of adolescent idiopathic scoliosis: a pilot study
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Yasuhito Yahara, Manami Tamura, Shoji Seki, Yohan Kondo, Hiroto Makino, Kenta Watanabe, Katsuhiko Kamei, Hayato Futakawa, and Yoshiharu Kawaguchi
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Male ,Rheumatology ,Adolescent ,Scoliosis ,Disease Progression ,Humans ,Orthopedics and Sports Medicine ,Female ,Pilot Projects ,Kyphosis ,Neural Networks, Computer ,Child - Abstract
BackgroundAdolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity that predominantly occurs in girls. While skeletal growth and maturation influence the development of AIS, accurate prediction of curve progression remains difficult because the prognosis for deformity differs among individuals. The purpose of this study is to develop a new diagnostic platform using a deep convolutional neural network (DCNN) that can predict the risk of scoliosis progression in patients with AIS.MethodsFifty-eight patients with AIS (49 females and 9 males; mean age: 12.5 ± 1.4 years) and a Cobb angle between 10 and 25 degrees (mean angle: 18.7 ± 4.5) were divided into two groups: those whose Cobb angle increased by more than 10 degrees within two years (progression group, 28 patients) and those whose Cobb angle changed by less than 5 degrees (non-progression group, 30 patients). The X-ray images of three regions of interest (ROIs) (lung [ROI1], abdomen [ROI2], and total spine [ROI3]), were used as the source data for learning and prediction. Five spine surgeons also predicted the progression of scoliosis by reading the X-rays in a blinded manner.ResultsThe prediction performance of the DCNN for AIS curve progression showed an accuracy of 69% and an area under the receiver-operating characteristic curve of 0.70 using ROI3 images, whereas the diagnostic performance of the spine surgeons showed inferior at 47%. Transfer learning with a pretrained DCNN contributed to improved prediction accuracy.ConclusionOur developed method to predict the risk of scoliosis progression in AIS by using a DCNN could be a valuable tool in decision-making for therapeutic interventions for AIS.
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- 2022
28. Efficacy of surgeon-directed postoperative local injection with an analgesic mixture in posterior fusion surgery for adolescent idiopathic scoliosis
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Hiroto, Makino, Shoji, Seki, Katsuhiko, Kamei, Yasuhito, Yahara, and Yoshiharu, Kawaguchi
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Analgesics, Opioid ,Surgeons ,Pain, Postoperative ,Spinal Fusion ,Adolescent ,Morphine ,Scoliosis ,Rheumatology ,Humans ,Analgesia, Patient-Controlled ,Orthopedics and Sports Medicine ,Anesthetics, Local ,Retrospective Studies - Abstract
Background Severe postsurgical pain in posterior spinal fusion is common. Multimodality analgesia, including opioid-based patient-controlled analgesia (PCA), is commonly used, but opioid-related adverse events such as nausea and vomiting are sometimes a problem. We used a ropivacaine-epinephrine-dexamethasone mixture given as one-time local bilateral submyofascial injections at the operated levels added to conventional multimodality analgesia including PCA for postoperative pain control in one group of patients to confirm whether administration of this mixture reduced postoperative pain and opioid use status post posterior spinal fusion. Methods We retrospectively reviewed 67 consecutive patients who had undergone posterior fusion surgery for adolescent idiopathic scoliosis (AIS), 35 of whom were treated with conventional analgesia that consisted mainly of PCA (control group) and 32 of whom were treated with one-time submyofascial injections of a ropivacaine-epinephrine-dexamethasone mixture (submyofascial injection group) added to conventional multimodality analgesia. We compared postsurgical pain levels and the amount of opioid use over the first 48 h after surgery, as well as physical activity levels and adverse events 2 weeks after surgery. Results Postsurgical pain quantified by a numeric rating scale (1–10) in the submyofascial injection group was significantly lower than that in the control group. The amount of fentanyl use was significantly less in the submyofascial injection group at 24 h, 48 h, and all subsequent periods after surgery. In addition, Walking Recovery Time (WRT) defined as the number of days until the first event of ambulation was significantly less in the submyofascial injection group (3.3 d vs 4.1 d, P = 0.0007)). Laxative use was significantly less in the submyofascial injection group (0.3 times vs 1.3 times, P = 0.02). Conclusions One-time submyofascial injections at the operated levels with a ropivacaine-epinephrine-dexamethasone mixture after spinal fusion surgery reduced pain, opioid consumption, and opioid-related adverse events. This technique can contribute significantly to postoperative analgesia.
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- 2022
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29. Serum Periostin Level Reflects Progression of Ossification of the Posterior Longitudinal Ligament
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Yoshiharu, Kawaguchi, Isao, Kitajima, Taketoshi, Yasuda, Shoji, Seki, Kayo, Suzuki, Hiroto, Makino, Yasuhiro, Ujihara, Tomohiro, Ueno, Nguyen Tran, Canh Tung, and Yasuhito, Yahara
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Scientific Articles ,Orthopedics and Sports Medicine ,Surgery - Abstract
Background: Ossification of the posterior longitudinal ligament (OPLL), characterized by ectopic new bone formation in the spinal ligament, causes neurological impairment due to narrowing of the spinal canal. However, the etiology has not been fully elucidated yet. Several biomarkers may be related to the pathogenesis of OPLL. The present study focused on the serum level of periostin, which is recognized as an important bone formation regulator. Methods: This study included 92 patients with OPLL and 54 control patients without OPLL. For the case-control analysis, 54 age and sex-matched patients were randomly included in the OPLL group. The serum fibroblast growth factor-23 (FGF-23), creatinine, inorganic phosphate, calcium, alkaline phosphatase, and periostin levels were assessed. Furthermore, the calcium, creatinine, and inorganic phosphate levels in urine and the percentage of tubular reabsorption of phosphate were also analyzed. Moreover, the relationship between the biomarkers and the extent of OPLL was analyzed. The data were compared between patients with OPLL progression (the progression group) and without OPLL progression (the non-progression group). Results: The mean serum FGF-23 and periostin levels in the OPLL group were higher than that in the control group. The serum inorganic phosphate level in the OPLL group was lower than that in the control group. No correlation was found between any of the biomarkers and the extent of ossification. The serum periostin level in the progression group was higher than that in the non-progression group. No significant difference in the serum FGF-23 level was noted between the progression and non-progression groups. Moreover, no correlation was found between serum periostin and FGF-23 levels. Conclusions: The serum periostin level is related to OPLL progression. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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- 2022
30. Optimizing the Application of Surgery for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 10]
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Ricardo Rodrigues-Pinto, Thiago S. Montenegro, Benjamin M. Davies, So Kato, Yoshiharu Kawaguchi, Manabu Ito, Mehmet Zileli, Brian K. Kwon, Michael G. Fehlings, Paul A. Koljonen, Shekar N. Kurpad, James D. Guest, Bizhan Aarabi, Vafa Rahimi-Movaghar, Jefferson R. Wilson, Mark R. N. Kotter, and James S. Harrop
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Prognostic-Factors ,cervical spondylotic myelopathy ,Spondylotic Myelopathy ,Anterior Decompression ,cervical spine ,Conservative Treatment ,Laminoplasty ,spondylosis ,myelopathy ,Surgical Outcomes ,degenerative cervical myelopathy ,Risk-Factors ,Orthopedics and Sports Medicine ,Surgery ,Neurology (clinical) ,nontraumatic spinal cord injury ,Modified K-Line ,Posterior Longitudinal Ligament ,Canal Stenosis - Abstract
Study Design: Literature Review (Narrative). Objective: To introduce the number 10 research priority for Degenerative Cervical Myelopathy: Individualizing Surgery. Methods: This article summarizes the current recommendations and indications for surgery, including how known prognostic factors such as injury time, age, disease severity, and associated comorbidities impact surgical outcome. It also considers key areas of uncertainty that should be the focus of future research. Results: While a small proportion of conservatively managed patients may remain stable, the majority will deteriorate over time. To date, surgical decompression is the mainstay of treatment, able to halt disease progression and improve neurologic function and quality of life for most patients. Whilst this recognition has led to recommendations on when to offer surgery, there remain many uncertainties including the type of surgery, or timing in milder and/or asymptomatic cases. Their clarification has the potential to transform outcomes, by ensuring surgery offers each individual its maximum benefit. Conclusion: Developing the evidence to better guide surgical decision-making at the individual patient level is a research priority for Degenerative Cervical Myelopathy., AO Spine through the AO Spine Knowledge Forum Spinal Cord Injury; AO Spine Research Department; National Institute for Health Research (NIHR) Brain Injury MedTech Co-operative based at Cambridge University Hospitals NHS Foundation Trust; University of Cambridge; NIHR Clinical Doctoral Research Fellowship, The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The research priorities were organized and funded by AO Spine through the AO Spine Knowledge Forum Spinal Cord Injury, a focused group of international Spinal Cord Injury experts. AO Spine is a clinical division of the AO Foundation, which is an independent medicallyguided not-for-profit organization. Study support was provided directly through the AO Spine Research Department. MRNK is supported by the National Institute for Health Research (NIHR) Brain Injury MedTech Co-operative based at Cambridge University Hospitals NHS Foundation Trust and University of Cambridge, andBMD a NIHR Clinical Doctoral Research Fellowship. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care.
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- 2022
31. Prospective Investigation of Postoperative Complications in Anterior Decompression with Fusion for Severe Cervical Ossification of the Posterior Longitudinal Ligament: A Multi-institutional Study
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Yukitaka Nagamoto, Masao Koda, Satoru Egawa, Atsushi Kimura, Toshitaka Yoshii, Hiroyuki Katoh, Tsukasa Kanchiku, Kenichiro Sakai, Yukihiro Nakagawa, Masashi Yamazaki, Morio Matsumoto, Masahiko Takahata, Narihito Nagoshi, Takeo Furuya, Atsushi Okawa, Kazuo Kusano, Yoshiharu Kawaguchi, Kanji Mori, Takashi Hirai, Shiro Imagama, and Katsushi Takeshita
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medicine.medical_specialty ,Ossification of Posterior Longitudinal Ligament ,Postoperative Complications ,Osteogenesis ,medicine ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,Retrospective Studies ,Palsy ,Cerebrospinal fluid leak ,business.industry ,Incidence (epidemiology) ,Ossification of the posterior longitudinal ligament ,Postoperative complication ,Anterior decompression ,Odds ratio ,medicine.disease ,Decompression, Surgical ,Surgery ,Longitudinal Ligaments ,Spinal Fusion ,Treatment Outcome ,Multicenter study ,Cervical Vertebrae ,Neurology (clinical) ,business - Abstract
Study design A prospective multicenter study. Objective This study aims to investigate the postoperative complications of anterior decompression with fusion (ADF) for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL). Summary of background data Surgical treatment for cervical OPLL has a high risk of various complications. ADF is reported to be effective for cervical OPLL, especially for massive OPLL. However, few studies have focused on the surgical complications of ADF. Methods We prospectively included 102 patients undergoing ADF for severe cervical OPLL with average canal occupying ratio of 49.8%. We evaluated systemic and local complications, neurological complications, and risk factors related to the postoperative complications. Results Frequently observed complications included graft/ implant complications (18.6%), neurological complications (11.8%), and cerebrospinal fluid leak (11.8%). Motor palsy involving only the upper extremity was found in nine patients (8.8%), and other motor palsies involving the lower extremities were found in three patients (2.9%). None of the preoperative factors were significantly associated with the occurrence of neurological palsies, whereas the number of operated levels was a significant factor related to the postoperative graft/implant complications (P = 0.003; odds ratio, 2.112). The incidence of graft/implant complications and related reoperation increased as the number of operated levels increased (especially four levels or more). Most motor palsies were observed immediately after surgery. Of the motor palsies in the bilateral upper extremities and palsies involving the lower extremities, 85.7% showed good recovery, whereas only 40% of unilateral upper extremity motor palsies showed good recovery during the follow-up period. Conclusion In ADF for cervical OPLL, the number of operated levels was a significant factor related to the postoperative complication. Specifically, the incidence of graft/implant complications and reoperation rate increased in ADF with four or more levels.Level of Evidence: 3.
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- 2021
32. A systematic review and meta-analysis comparing anterior decompression with fusion and posterior laminoplasty for cervical ossification of the posterior longitudinal ligament
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Toshitaka Yoshii, Shiro Imagama, Takashi Hirai, Masahiro Yoshida, Tomohiko Hasegawa, Atsushi Okawa, Motoki Iwasaki, Kanji Mori, Hirotaka Chikuda, Satoru Egawa, Yoshiharu Kawaguchi, Masao Koda, and Takashi Kaito
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medicine.medical_specialty ,Decompression ,medicine.medical_treatment ,MEDLINE ,macromolecular substances ,Ossification of Posterior Longitudinal Ligament ,Cochrane Library ,Laminoplasty ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Prospective cohort study ,030222 orthopedics ,business.industry ,Anterior decompression ,Retrospective cohort study ,Decompression, Surgical ,Surgery ,Spinal Fusion ,Meta-analysis ,Cervical Vertebrae ,business ,030217 neurology & neurosurgery - Abstract
Background The optimal surgical procedure for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) remains controversial because there are few comprehensive studies investigating the surgical methods. Therefore, we conducted a systematic review and meta-analysis to evaluate evidence in the literature and compare the surgical outcomes of anterior decompression with fusion (ADF) and laminoplasty (LAMP), which are representative procedures for cervical OPLL. Methods An extensive literature search was performed using PubMed, Embase, and the Cochrane Library to identify comparative studies of ADF and LAMP for cervical OPLL. The language was restricted to English, and the year of publication was from January 1980 to December 2018. We extracted outcomes from the studies, such as preoperative and postoperative Japanese Orthopaedic Association (JOA) score, cervical alignment, surgical complications and reoperation rate. Then, meta-analysis was performed for these surgical outcomes. Results Twelve studies were obtained, including 1 prospective cohort study and 11 retrospective cohort studies. In the meta-analysis, neurological recovery rate in JOA score was greater in ADF than in LAMP, especially in patients with a large canal occupying ratio (≥60%) and preoperative kyphotic alignment. ADF also exhibited more favorable results in postoperative cervical alignment. In contrast, operating time and intraoperative blood loss were greater in ADF. Surgical complications were more frequently seen in ADF, leading to higher rates of reoperation. Conclusions This systematic review and meta-analysis showed both the merits and shortcomings of ADF and LAMP. ADF resulted in more favorable neurological recovery compared to LAMP, especially for patients with massive OPLL and kyphotic alignment. Postoperative cervical lordosis was also better preserved in ADF. However, ADF was associated with greater surgical invasion and higher incidences of surgical complications.
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- 2020
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33. Differential rod contouring on thoracolumbar/lumbar curvature in patients with adolescent idiopathic scoliosis: An analysis with intraoperative acquisition of three-dimensional imaging
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Shoji Seki, Norikazu Hirano, Kei Watanabe, Masato Nakano, Jun Takahashi, Yasuhito Yahara, Hiroto Makino, Tomoatsu Kimura, Yoshiharu Kawaguchi, and Kenji Kobayashi
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Male ,musculoskeletal diseases ,Adolescent ,medicine.medical_treatment ,Idiopathic scoliosis ,Scoliosis ,Thoracic Vertebrae ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,Lumbar ,parasitic diseases ,Humans ,Medicine ,Fluoroscopy ,Orthopedics and Sports Medicine ,In patient ,Child ,Reduction (orthopedic surgery) ,030222 orthopedics ,Contouring ,Lumbar Vertebrae ,medicine.diagnostic_test ,business.industry ,Lumbar Curve ,musculoskeletal system ,medicine.disease ,Spinal Fusion ,Female ,Surgery ,business ,Nuclear medicine ,030217 neurology & neurosurgery - Abstract
Differential rod contouring (DRC) is useful for periapical vertebral derotation and decreasing rib hump in patients with thoracic adolescent idiopathic scoliosis (AIS). However, it is unknown whether DRC in the thoracolumbar/lumbar spine also contributes to derotation. We assessed the contributions of rod contouring and of DRC to the reduction of apical axial vertebral body rotation in patients with AIS with thoracolumbar/lumbar curvatures.Forty-five (Lenke type 3 or 4, 17; Lenke type 5 or 6, 28) were analyzed for the contribution of DRC to thoracolumbar/lumbar spinal derotation. Rod contouring was assessed by comparing the preinsertion x-ray with the post-operative CT images. Intraoperative C-arm fluoroscopic scans of the periapical vertebrae of the thoracolumbar/lumbar curve of the scoliosis (135 vertebrae) were taken post-rod rotation (RR) and post-DRC in all patients. Three-dimensional images were automatically reconstructed from the taken x-ray images. The angle of vertebral body rotation in these apical vertebrae was measured, and the contribution of DRC to apical vertebral body derotation and rib hump index (RHi) for lumbar prominence was analyzed.The pre-implantation convex rod curvatures of both Lenke 3/4 and 5/6 groups decreased after surgery. The mean further reductions in vertebral rotation with post-RR DRC were 3.7° for Lenke 3/4 and 4.4° for Lenke 5/6 (P 0.01). Both changes in apical vertebral rotation and in RHi for evaluating lumbar prominence were significantly correlated with the difference between concave and convex rod curvature in preimplantation. Vertebral derotation was significantly higher in curves with a difference20° (P 0.05).DRC following rod rotation contributed substantial additional benefit to reducing vertebral rotation and decreasing lumbar prominence in thoracolumbar/lumbar scoliosis.
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- 2019
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34. Review of Subaxial Cervical Spine Injuries Presenting to a Tertiary-Level Hospital in Nepal: Challenges in Surgical Management in a Third World Scenario
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Siddartha Dhungana, Ganesh Gurung, Santosh Poudel, Ravi Bhandari, Gaurav Raj Dhakal, Yoshiharu Kawaguchi, and K. Daniel Riew
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medicine.medical_specialty ,Demographics ,injury ,Third world ,business.industry ,General surgery ,cervical ,challenges ,030208 emergency & critical care medicine ,Original Articles ,Cervical spine ,03 medical and health sciences ,0302 clinical medicine ,Epidemiology ,medicine ,Orthopedics and Sports Medicine ,Surgery ,Neurology (clinical) ,Tertiary level ,business ,management ,030217 neurology & neurosurgery - Abstract
Study Design: Epidemiological retrospective study. Objective: To describe the demographics, timing to surgery, delay, short-term neurological recovery, and complications in surgically treated subaxial cervical trauma in a resource-constrained country. Methods: Thirty consecutive subaxial cervical trauma patients presenting to a trauma hospital in Nepal between December 2015 and August 2017 were analyzed as a retrospective cohort. Patients were segregated into 4 groups based on the timing to surgery: within 2 days, 3 to 7 days, 8 to 30 days, and >31 days. Results: There were 27 male and 3 female patients with mean age 40 years. Twenty-four sustained fall injury, and 27 patients were from outside Kathmandu. No patients were treated within the first 48 hours; only 9 were treated between 3 and 7 days, 16 between 8 and 30 days, and 5 a month later. Major delay was finance and operating room availability. Thirteen patients had a C6C7 involvement followed by C5C6 in 6 patients. Seven patients had complete neurological deficit while 18 patients had incomplete deficit. A total of 46.7% improved their neurology in 6 months. No neurological recovery was observed in complete deficit patients. Conclusion: Seventy percent of our patients were treated longer than 1 week after injury, which would likely be considered unacceptable in most first world countries. As expected, the outcomes for many of these patients were far worse than reported in North American centers with early access to medical care and insurance. Despite this, nearly half of our patients improved neurologically following treatment; hence, surgery holds hope of some restoration of neurologic deficits.
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- 2019
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35. Clinical Impact of Ossification of the Posterior Longitudinal Ligament Progression After Cervical Laminoplasty
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Yoshiharu Kawaguchi, Kayo Suzuki, Yasuhito Yahara, Tomoatsu Kimura, Shoji Seki, Masahiko Kanamori, Masato Nakano, Kenji Kobayashi, Taketoshi Yasuda, and Hiroto Makino
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Ossification of Posterior Longitudinal Ligament ,Laminoplasty ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Japan ,medicine ,Second Look Surgery ,Humans ,Orthopedics and Sports Medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,030222 orthopedics ,business.industry ,Incidence (epidemiology) ,Disease progression ,Ossification of the posterior longitudinal ligament ,Retrospective cohort study ,Middle Aged ,Surgery ,Second-Look Surgery ,Cervical laminoplasty ,Cervical Vertebrae ,Disease Progression ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
This is a retrospective study.(1) To analyze the incidence of second surgery after initial laminoplasty for ossification of the posterior longitudinal ligament (OPLL) due to disease progression, (2) to examine factors associated with poor surgical outcome.Neurological deterioration after laminoplasty is frequently encountered due to OPLL progression.Of 201 OPLL patients treated by laminoplasty at a single-institution, the 153 monitored for3 years postsurgery were included in this analysis. Neurological findings were graded by the Japanese Orthopaedic Association (JOA) score. We retrospectively examined the incidence of second surgery due to OPLL progression. We also evaluated the clinical characteristics and the surgical outcomes after second operation to identify potential risk factors for poor outcome.Eight patients required a second surgery due to OPLL progression. Neurological recovery was achieved in 5 of these patients, whereas 3 exhibited continued dysfunction. Patients with poor recovery showed kyphotic changes of spinal alignment and high-intensity regions in the spinal cord on T2-weighted magnetic resonance images (T2-MRI).Only a small fraction of OPLL patients required a second surgery due to OPLL progression. Recovery was poor in those with clear high-intensity T2-MRI signals in the spinal cord.
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- 2019
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36. 206. Expert panel review for symptomatic Grade I degenerative spondylolisthesis
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Zoher Ghogawala, Melissa Dunbar, Adam S. Kanter, Praveen V. Mummaneni, Erica F. Bisson, Todd J. Albert, Daniel K. Resnick, Michael Y. Wang, Steven D. Glassman, David W. Polly, Mohamad Bydon, Subu N. Magge, Luis M. Tumialan, Robert Whitmore, Michael G. Fehlings, Michael P. Steinmetz, James S. Harrop, Yoshiharu Kawaguchi, Asdrubal Falavigna, Elnasri Ahmed, Edward C. Benzel, and Langston T. Holly
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Surgery ,Orthopedics and Sports Medicine ,Neurology (clinical) - Published
- 2022
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37. Accuracy of pedicle screw placement using patient-specific template guide system
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Yasuhito Yahara, Hirohito Takeuchi, Yoshiharu Kawaguchi, Ryo Fujita, Shigeki Oshima, Masanori Fujiya, and Itaru Oda
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musculoskeletal diseases ,Perforation (oil well) ,Effective solution ,03 medical and health sciences ,0302 clinical medicine ,Pedicle Screws ,medicine ,Humans ,Orthopedics and Sports Medicine ,Cervical fusion ,Pedicle screw ,Retrospective Studies ,Orthodontics ,030222 orthopedics ,business.industry ,Patient specific ,equipment and supplies ,musculoskeletal system ,Neurovascular bundle ,Sagittal plane ,Vertebra ,surgical procedures, operative ,medicine.anatomical_structure ,Spinal Fusion ,Cervical Vertebrae ,Surgery ,Spinal Diseases ,business ,030217 neurology & neurosurgery - Abstract
Background Despite repeated efforts for accurate cervical pedicle screw insertion, malpositioning of the inserted screw is commonly noted. To avoid neurovascular complications during cervical pedicle screw insertion, we have developed a new patient-specific screw guide system. This study aimed to evaluate the accuracy of cervical PS placement using the new patient-specific screw guide system. Methods This study is a retrospective clinical evaluation of prospectively enrolled patients. Seventeen consecutively enrolled patients who underwent posterior cervical fusion using the guide system were included. Firstly, three-dimensional planning of pedicle screw placement was done using simulation software. A screw guide for each vertebra was constructed preoperatively. A total of 77 screws were inserted with the guides. Postoperative computed tomography was used to evaluate pedicle perforation, and screw deviations, between the planned and actual screw positions, were measured. Results A total of 76 screws (98.7%) were completely inside the pedicle (C3-7), without neurovascular injuries. The mean screw deviations from the planned trajectory at the narrowest point of the pedicle and at the entry point in the axial and sagittal planes were 0.56 ± 0.43 mm and 0.43 ± 0.35 mm and 0.43 ± 0.30 mm and 0.63 ± 0.50 mm, respectively. There were no significant differences in any parameter at different spinal levels. Angular deviations in the sagittal and axial planes were 2.94 ± 2.04° and 2.53 ± 1.85°, respectively. Sagittal angular deviations tended to increase in the cranial vertebra (C3 and C4) compared to the middle cervical spine. Conclusions We demonstrated that our patient-specific screw guide is vital for guiding precise screw insertion in the cervical pedicle. This technique may be an effective solution for achieving precise screw insertion and reducing the incidence of complications.
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- 2020
38. Ossification of the posterior longitudinal ligament: Etiology, prevalence, progression, and surgical strategies
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Yoshiharu Kawaguchi
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musculoskeletal diseases ,medicine.medical_specialty ,natural history of opll ,ossification of the posterior longitudinal ligament (opll) ,surgery ,Myelopathy ,radiological characteristics ,medicine ,Orthopedics and Sports Medicine ,In patient ,Spinal canal ,Orthopedic surgery ,business.industry ,Ossification ,Ossification of the posterior longitudinal ligament ,medicine.disease ,Spinal cord ,Surgery ,medicine.anatomical_structure ,Etiology ,Lumbar spine ,Neurology (clinical) ,medicine.symptom ,business ,management ,RD701-811 - Abstract
Ossification of the posterior longitudinal ligament (OPLL) is characterized by replacement of the ligamentous tissue by ectopic new bone formation. OPLL often causes narrowing of the spinal canal and has been recognized as a cause of cervical myelopathy and/or radiculopathy. Although a clear inheritance of OPLL has not been identified, there is a strong genetic background for OPLL. A recent genome-wide association study using all Japan cohort reported that there were 6 susceptible loci for OPLL. In addition, there were several studies to seek the biomarkers of OPLL. OPLL is frequently found in the cervical spine. However, 53.4% had OPLL not only in the cervical spine, but also in other spinal regions in patients with cervical OPLL. Further, 65.2% with cervical OPLL had ossification of the ligamentum flavum (OLF) especially at the levels of the thoracic and the lumbar spine. There is no effective conservative treatment. Surgical decompression is considered in patients with severe and/or progressive myelopathy. Early surgical decompression of the spinal cord is recommended in patients with apparent myelopathy. Operative methods are divided into two procedures, anterior decompressive surgery and posterior decompressive surgery. The choice of the surgical procedure is determined according to several factors, such as local pathology of OPLL and spinal alignment.
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- 2019
39. Prevalence and Distribution of Diffuse Idiopathic Skeletal Hyperostosis on Whole-spine Computed Tomography in Patients With Cervical Ossification of the Posterior Longitudinal Ligament
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Soraya Nishimura, Atsushi Kimura, Yoshiharu Kawaguchi, Masahiko Abematsu, Narihito Nagoshi, Masaya Nakamura, Shoji Seki, Kei Ando, Akio Iwanami, Takashi Hirai, Masahiko Watanabe, Hiroshi Ozawa, Takashi Tsuji, Tetsuro Ohba, Tsuyoshi Yamada, Takeo Furuya, Kanji Mori, Shiro Imagama, Yukihiro Matsuyama, Kei Watanabe, Mitsuru Furukawa, Tomohiko Hasegawa, Katsushi Takeshita, Shunsuke Fujibayashi, Masashi Yamazaki, Ayano Takeuchi, Kazuhiro Takeuchi, Hiroyuki Katoh, Atsushi Okawa, Kota Watanabe, Morio Matsumoto, Hirotaka Haro, Masao Koda, Toshitaka Yoshii, Haruo Kanno, Kanehiro Fujiyoshi, and Kanichiro Wada
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Male ,Hyperostosis ,medicine.medical_specialty ,Computed tomography ,Ossification of Posterior Longitudinal Ligament ,03 medical and health sciences ,0302 clinical medicine ,X ray computed ,Prevalence ,medicine ,Cluster Analysis ,Humans ,Orthopedics and Sports Medicine ,In patient ,Aged ,Diffuse Idiopathic Skeletal Hyperostosis ,030203 arthritis & rheumatology ,Hyperostosis, Diffuse Idiopathic Skeletal ,medicine.diagnostic_test ,business.industry ,Background data ,Ossification of the posterior longitudinal ligament ,Middle Aged ,medicine.disease ,Multicenter study ,Female ,Surgery ,Neurology (clinical) ,Radiology ,Tomography, X-Ray Computed ,business ,030217 neurology & neurosurgery - Abstract
This was a retrospective multicenter study.To clarify the progression of diffuse idiopathic skeletal hyperostosis (DISH) using whole-spine computed tomography in patients with cervical ossification of the posterior longitudinal ligament (OPLL).DISH and cervical OPLL frequently coexist, and can cause ankylosing spinal fractures due to biomechanical changes and fragility of the affected vertebrae. The epidemiology and pathophysiology of DISH occurring with cervical OPLL are unclear.We used whole-spine computed tomography to determine the prevalence of DISH in 234 patients with a diagnosis of cervical OPLL based on plain cervical radiographs. We established a novel system for grading the progression of DISH based on a cluster analysis of the DISH distribution along the spine. We calculated the correlation coefficient between this grading system and patient age.The prevalence of DISH in patients with cervical OPLL was 48.7%. Patients with DISH were significantly older than those who did not have DISH (67.3 vs. 63.4 y; P=0.005). Cluster analysis classified the DISH distribution into 6 regions, based on the levels affected: C2-C5, C3-T1, C6-T5, T3-10, T8-L2, and T12-S1. DISH was observed most frequently at T3-T10. We defined a system for grading DISH progression based on the number of regions involved, from grade 0 to 6. DISH was distributed at T3-T10 in60% of the grade 1 patients, whereas most patients with DISH at the cervical or lumbar spine were grade 4 or 5. There was a weak but significant correlation between the DISH grade and patient age.DISH was present in nearly half of the patients with cervical OPLL. DISH was more common in older patients. DISH developed at the thoracic level and progressed into the cervical and/or lumbar spine with age.Level III.
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- 2018
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40. Increase of the Serum FGF-23 in Ossification of the Posterior Longitudinal Ligament
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Isao Kitajima, Shoji Seki, Taketoshi Yasuda, Masato Nakano, Yasuhito Yahara, Hiroto Makino, Yasuhiro Ujihara, Tomoatsu Kimura, Yoshiharu Kawaguchi, Kayo Suzuki, and Tomohiro Ueno
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Fibroblast growth factor 23 ,030222 orthopedics ,medicine.medical_specialty ,business.industry ,inorganic phosphate ,Ossification of the posterior longitudinal ligament ,Original Articles ,Serum concentration ,fibroblast growth factor 23 ,Pathogenesis ,03 medical and health sciences ,hypersensitive C-reactive protein ,0302 clinical medicine ,medicine.anatomical_structure ,Endocrinology ,Inorganic phosphate ,ossification of the posterior longitudinal ligament ,Internal medicine ,medicine ,Orthopedics and Sports Medicine ,Surgery ,Neurology (clinical) ,Fibroblast ,business ,030217 neurology & neurosurgery - Abstract
Study Design:Case-control study.Objectives:To determine the possible pathogenesis of ossification of the posterior longitudinal ligament (OPLL) in regard to the serum concentration of fibroblast growth factor 23 (FGF-23).Methods:The study included 95 patients with OPLL and a control group of 73 age- and sex-matched volunteers. The serum concentrations of FGF-23, creatinine (Cre), alkaline phosphatase, calcium (Ca), inorganic phosphate (Pi), and hypersensitive C-reactive protein (hs-CRP) were analyzed from blood samples, and Cre, Ca, Pi, and tubular reabsorption of phosphate were measured using urine samples. We evaluated the severity of ossified spinal lesions in patients with OPLL according to the ossification index (the OP index and the OS index). Data was compared between the OPLL and control group and between the OPLL progression and no progression group.Results:Serum FGF-23 and hs-CRP were higher, and serum Pi was lower in patients with OPLL than in the controls. There was a positive correlation between FGF-23 and hs-CRP and a negative correlation between serum Pi and the OS index; however, the correlations were very weak. Overall, 31.7% of patients had progression of OPLL during follow-up. FGF-23 and hs-CRP were higher in the progression group than in the no progression group.Conclusions:These results might indicate that FGF-23 and hs-CRP are positive markers for OPLL. Phosphate metabolism via FGF-23 might be a target for future study on the pathogenesis of OPLL.
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- 2018
41. Biomarkers of Ossification of the Spinal Ligament
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Yoshiharu Kawaguchi
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030222 orthopedics ,literature review ,business.industry ,Ossification ,ossification of the spinal ligament ,biomarkers ,Ossification of the posterior longitudinal ligament ,Anatomy ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,ossification of the posterior longitudinal ligament ,Ligament ,ossification of the ligament flavum ,Medicine ,Orthopedics and Sports Medicine ,Surgery ,In patient ,Neurology (clinical) ,medicine.symptom ,business ,Review Articles ,030217 neurology & neurosurgery - Abstract
Study Design: Literature review. Objectives: To review biomarkers in patients with ossification of the spinal ligament (OSL), including ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum and to raise the present issues. Methods: A literature search was performed using PubMed and MEDLINE databases. The biomarkers were classified according to category. The number of the subjects and reproducibility were assessed. Results: Eleven articles were included in this review. There were 9 articles from Japan, 1 article from Taiwan, and 1 article from China. The biomarkers were classified into calcium-phosphate metabolism markers, bone turnover markers, sclerostin, dickkopf-1, secreted frizzled-related protein-1, fibroblast growth factor-23, fibronectin, menatetrenone, leptin, pentosidine, and hypersensitive C-reactive protein. However, there were several limitations in the research studies, such as small research field, small number of subjects, and a lack of reproducibility. Conclusions: Although there have been several studies that have analyzed biomarkers for OSL, there are no definitive conclusions to date. Numerous issues will need to be resolved in the future. It is imperative to continue this research because the results might prove beneficial to elucidate the pathology of OSL and the measures to prevent the initiation and progression of the disease.
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- 2018
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42. Differential Rod Contouring is Essential for Improving Vertebral Rotation in Patients With Adolescent Idiopathic Scoliosis
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Hiroto Makino, Masato Nakano, Yasuhito Yahara, Shoji Seki, Tomoatsu Kimura, Yoshiharu Kawaguchi, Norikazu Hirano, and Peter O. Newton
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Male ,medicine.medical_specialty ,Adolescent ,Intraoperative Neurophysiological Monitoring ,Rotation ,genetic structures ,medicine.medical_treatment ,Idiopathic scoliosis ,Thoracic Vertebrae ,03 medical and health sciences ,0302 clinical medicine ,Vertebral rotation ,parasitic diseases ,medicine ,Humans ,Orthopedics and Sports Medicine ,In patient ,Reduction (orthopedic surgery) ,030222 orthopedics ,Contouring ,business.industry ,Scoliosis surgery ,Vertebral body ,Spinal Fusion ,Scoliosis ,Female ,Neurology (clinical) ,Radiology ,Intraoperative ct ,Tomography, X-Ray Computed ,business ,030217 neurology & neurosurgery - Abstract
A case series.We investigated the contributions of rod contouring and differential rod contouring (DRC) to the reduction of apical axial vertebral body rotation in patients with adolescent idiopathic scoliosis (AIS).DRC is used for posterior spinal correction and fusion. The contribution of DRC to vertebral body derotation is unclear.We analyzed the results of intraoperative computed tomography (CT) in 40 consecutive AIS patients with thoracic curves (Lenke type I or II, 35; type III or IV, 5). Rod contour before initial rod rotation was analyzed by x-ray. Periapical rod contour between concave and convex rod rotation (RR) were analyzed by cone-beam CT imaging. To analyze the reduction of vertebral body rotation with DRC, intraoperative cone-beam CT scans of the three apical vertebrae of the major curve of the scoliosis (120 vertebrae) were taken post-concave RR and post-convex DRC in all patients. The angle of vertebral body rotation was measured. In addition, the contribution of rod contouring to apical vertebral body derotation was analyzed. Rib hump indices (RHi) were measured by pre- and postoperative CT.The mean vertebral body rotation angles post-concave RR and post-convex DRC were 15.3° and 9.3°, respectively, for a mean reduction of vertebral rotation in convex DRC after concave RR of 6.0° for thoracic curves (P 0.001). The RHi was significantly improved by DRC (P 0.05). Improved apical vertebral rotation was significantly correlated with the difference of apical rod curvature between concave and convex. Vertebral derotation was significantly higher in curves with10° difference between concave and convex rod curvature than differences 10°.DRC contributed substantially to axial derotation and reducing rib hump in thoracic scoliosis. The degree of apical rod curvature correlated with the degree of apical vertebral derotation.4.
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- 2018
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43. Selection of posterior spinal osteotomies for more effective periapical segmental vertebral derotation in adolescent idiopathic scoliosis–An in vivo comparative analysis between Ponte osteotomy and inferior facetectomy alone
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Yasuhito Yahara, Yoshiharu Kawaguchi, Tomoatsu Kimura, Shoji Seki, and Hiroto Makino
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Male ,Adolescent ,Radiography ,medicine.medical_treatment ,Bone Screws ,Lumbar vertebrae ,Osteotomy ,Thoracic Vertebrae ,Zygapophyseal Joint ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,Range of Motion, Articular ,Orthodontics ,030222 orthopedics ,Lumbar Vertebrae ,business.industry ,Lumbar Curve ,Treatment Outcome ,medicine.anatomical_structure ,Scoliosis ,Spinal fusion ,Thoracic vertebrae ,Facetectomy ,Female ,Surgery ,Range of motion ,business ,030217 neurology & neurosurgery - Abstract
Ponte osteotomy is a useful method in posterior spinal release. However, it is unclear whether Ponte osteotomy itself contributes to vertebral derotation in surgery for adolescent idiopathic scoliosis (AIS) patients compared to inferior facetectomy alone. This study aimed to assess the effect of Ponte osteotomy on the magnitude of periapical vertebral body rotation compared to inferior facetectomy alone. This study was a prospective collected data.The study included 63 patients with AIS (Thoracic curve type, 35; thoracolumbar/lumbar curve type, 27), who underwent surgery between August 2011 and January 2015. All AIS patients underwent posterior spinal fusion with uniplanar screws and Ponte osteotomies on three periapical intervertebral segments. We measured and analyzed the flexibility of periapical intervertebral rotation pre- and post-bilateral inferior facetectomy, and post-Ponte osteotomy with our device (three times). The difference in intervertebral rotation between pre- and post-Ponte osteotomy was analyzed.The mean increase in angle was 5.6° for thoracic curves and 6.4° for thoracolumbar curves. The increase in angle for thoracolumbar curves was significantly larger than that for thoracic curves (P 0.05). The more an apical region of the scoliosis was located at caudal side of spine, the more the flexibility due to Ponte osteotomy increased (P 0.05). The significant differences of the increase in intervertebral flexibility between inferior facetectomies and Ponte osteotomies were recognized at middle thoracic and thoracolumbar regions (P 0.005).Our data suggest that Ponte osteotomy has a loosening effect on periapical scoliotic curvature compared to inferior facetectomy alone. Ponte osteotomy is likely to be associated with an increase in loosening of the middle thoracic and thoracolumbar regions.
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- 2018
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44. Distribution of ossified spinal lesions in patients with severe ossification of the posterior longitudinal ligament and prediction of ossification at each segment based on the cervical OP index classification: a multicenter study (JOSL CT study)
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Yukihiro Matsuyama, Tomohiko Hasegawa, Shiro Imagama, Soraya Nishimura, Masao Koda, Katsushi Takeshita, Masashi Yamazaki, Toshitaka Yoshii, Shunsuke Fujibayashi, Atsushi Kimura, Hiroyuki Katoh, Morio Matsumoto, Hiroshi Ozawa, Takeo Furuya, Shoji Seki, Masahiko Watanabe, Kei Ando, Masaya Nakamura, Narihito Nagoshi, Kazuhiro Takeuchi, Akio Iwanami, Haruo Kanno, Atsushi Okawa, Hirotaka Haro, Yoshiharu Kawaguchi, Shuta Ushio, Takashi Tsuji, Kanji Mori, Kanehiro Fujiyoshi, Takashi Hirai, Masahiko Abematsu, Kanichiro Wada, Mitsuru Furukawa, Tsuyoshi Yamada, Tetsuro Ohba, and Kei Watanabe
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Adult ,Male ,musculoskeletal diseases ,medicine.medical_specialty ,lcsh:Diseases of the musculoskeletal system ,Ossification predisposition ,Lumbar vertebrae ,Ossification of Posterior Longitudinal Ligament ,Severity of Illness Index ,Thoracic Vertebrae ,03 medical and health sciences ,Myelopathy ,0302 clinical medicine ,Lumbar ,Rheumatology ,Internal medicine ,medicine ,Prevalence ,Humans ,Whole spine ,Orthopedics and Sports Medicine ,OPLL ,Computed tomography ,Aged ,Aged, 80 and over ,030222 orthopedics ,Lumbar Vertebrae ,Ossification ,business.industry ,Intervertebral disc ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Orthopedic surgery ,Thoracic vertebrae ,Female ,Radiology ,medicine.symptom ,lcsh:RC925-935 ,business ,030217 neurology & neurosurgery ,Research Article - Abstract
Background In patients with ossification of the posterior longitudinal ligament (OPLL) in the cervical spine, it is well known that the thoracic ossified lesions often coexist with the cervical lesions and can cause severe myelopathy. However, the prevalence of OPLL at each level of the thoracic and lumbar spinal segments is unknown. The aims of this study were to investigate how often OPLL occurs at each level in the thoracolumbar spine in patients with a radiological diagnosis of cervical OPLL and to identify the spinal levels most likely to develop ossification. Methods Data were collected from 20 institutions in Japan. Three hundred and twenty-two patients with a diagnosis of cervical OPLL were included. The OPLL index (OP index), defined as the sum of the vertebral body and intervertebral disc levels where OPLL is present, was used to determine disease severity. An OP index ≥20 was defined as severe OPLL. The prevalence of OPLL at each level of the thoracic and lumbar spinal segments was calculated. Results Women were more likely to have ossified lesions in the thoracolumbar spine than men. Severe OPLL was significantly more common in women than in men (20% vs. 4.5%). For thoracic vertebral OPLL, the most frequently affected was the T1 segment in both men and women, followed by the T1/2 and T3/4 intervertebral levels in men and women, respectively. Ossified lesions were frequently seen at the intervertebral and vertebral levels around the cervicothoracic and thoracolumbar junctions in men with severe OPLL, whereas OPLL was more diffusely distributed in the thoracic spine in women with severe OPLL. Conclusion Thoracolumbar OPLL occurred most often at T1 in men and at T3/4 in women. In severe OPLL cases, although ossified lesions were frequently seen at the intervertebral and vertebral levels around the cervicothoracic and thoracolumbar junctions in men, OPLL could be observed more diffusely in the thoracic spine in women.
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- 2018
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45. Genetic background of degenerative disc disease in the lumbar spine
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Yoshiharu Kawaguchi
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medicine.medical_specialty ,Lumbar disc degeneration ,lcsh:Surgery ,SNP ,Review Article ,Bioinformatics ,Degenerative disc disease ,lumbar disc herniation ,polymorphism ,03 medical and health sciences ,Lumbar disc ,0302 clinical medicine ,Epidemiology ,Medicine ,Orthopedics and Sports Medicine ,genetics ,gene ,030203 arthritis & rheumatology ,business.industry ,lumbar spine ,lumbar disc diseases ,lcsh:RD1-811 ,medicine.disease ,Low back pain ,Review article ,Surgery ,Lumbar spine ,Neurology (clinical) ,Lumbar disc herniation ,medicine.symptom ,business ,lumbar disc degeneration ,030217 neurology & neurosurgery ,discogenic low back pain - Abstract
This is a review paper on the topic of genetic background of degenerative disc diseases in the lumbar spine. Lumbar disc diseases (LDDs), such as lumbar disc degeneration and lumbar disc herniation, are the main cause of low back pain. There are a lot of studies that tried to identify the causes of LDDs. The causes have been categorized into environmental factors and genetic factors. Recent studies revealed that LDDs are mainly caused by genetic factors. Numerous studies have been carried out using the genetic approach for LDDs. The history of these studies is divided into three periods: (1) era of epidemiological research using familial background and twins, (2) era of genomic research using DNA polymorphisms to identify susceptible genes for LDDs, and (3) era of functional research to determine how the genes cause LDDs. This review article was undertaken to present the history of genetic approach to LDDs and to discuss the current issues and future perspectives.
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- 2018
46. Lumbar spine surgery in patients with rheumatoid arthritis (RA): what affects the outcomes?
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Kayo Suzuki, Yasuhito Yahara, Taketoshi Yasuda, Isao Matsushita, Yoshiharu Kawaguchi, Norikazu Hirano, Hiraku Motomura, Hiroto Makino, Masato Nakano, Kenta Watanabe, Shoji Seki, and Tomoatsu Kimura
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Adult ,Male ,musculoskeletal diseases ,medicine.medical_specialty ,Context (language use) ,Lumbar vertebrae ,Arthritis, Rheumatoid ,03 medical and health sciences ,Postoperative Complications ,Spinal Stenosis ,0302 clinical medicine ,Lumbar ,medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,030203 arthritis & rheumatology ,Lumbar Vertebrae ,business.industry ,Lumbar spinal stenosis ,Intervertebral disc ,Middle Aged ,Decompression, Surgical ,medicine.disease ,Spondylolisthesis ,Surgery ,Spinal Fusion ,medicine.anatomical_structure ,Spinal decompression ,Rheumatoid arthritis ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background Context Although the cervical spine is only occasionally involved in rheumatoid arthritis (RA), involvement of the lumbar spine is even less common. A few reports on lumbar spinal stenosis in patients with RA have appeared. Although disc space narrowing occurs in aging, postoperative adjacent segment disease (ASD) in patients with RA has not been subject to much analysis. Purpose The objective of this study was to investigate differences in ASD and clinical outcomes between lumbar spinal decompression with and without fusion in patients with RA. Study Design/Setting This is a retrospective comparative study. Patient Sample A total of 52 patients with RA who underwent surgery for lumbar spinal disorders were included. Twenty-seven patients underwent decompression surgery with fusion and 25 underwent decompression surgery alone. Outcome Measures Intervertebral disc space narrowing and spondylolisthesis of the segment immediately cranial to the surgical site were measured using a three-dimensional volume rendering software. Pre- and postoperative evaluation of RA activity and Japanese Orthopaedic Association (JOA) scores were conducted. Materials and Methods All patients had preoperative and annual postoperative lumbar radiographs and were followed up for a mean of 5.1 years (range 3.5–10.9 years). Pre- and postoperative (2 years after surgery) JOA scores were recorded and any postoperative complications were investigated. Degrees of intervertebral disc narrowing and spondylolisthesis at the adjacent levels were evaluated on radiographs and were compared between the two groups. Analysis was performed to look for any correlation between ASD and RA disease activities. Results Postoperative JOA scores were significantly improved in both groups. The rate of revision surgery was significantly higher in the fusion group than that in the non-fusion group. The rate of ASD was significantly greater in the fusion group than that in the non-fusion group at the final follow-up examination. Both matrix metalloproteinase 3 (MMP-3) and the 28-joint disease activity score incorporating C-reactive protein levels (DAS28-CRP) were significantly associated with the incidence and severity of ASD. Conclusions Adjacent segment disease and the need for revision surgery were significantly higher in the fusion group than those in the non-fusion group. A preoperative high MMP-3 and DAS28-CRP are likely to be associated with postoperative ASD.
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- 2018
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47. Sacroiliac Joint Variation in Patients With Ossification of the Posterior Longitudinal Ligament
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Shoji Seki, Yoshiharu Kawaguchi, Kenta Watanabe, Katsuhiko Kamei, Hiroto Makino, Kayo Suzuki, Yasuhito Yahara, Nguyen Tran Canh Tung, and Taketoshi Yasuda
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Sacroiliac joint ,Spinal ligament ossification ,business.industry ,Ossification of the posterior longitudinal ligament ,Retrospective cohort study ,Anatomy ,medicine.disease ,medicine.anatomical_structure ,Ligament ,medicine ,Orthopedics and Sports Medicine ,Surgery ,In patient ,Heterotopic ossification ,Neurology (clinical) ,business - Abstract
Study Design: Retrospective Cohort Study. Objectives: Ossification of the posterior longitudinal ligament (OPLL) reveals heterotopic ossification in the spinal ligament. OPLL also tends to ossify ligaments and entheses throughout the body. However, hallmarks of sacroiliac (SI) joint ossification and its variation in OPLL have not been clarified. Here, we investigated the morphological changes in SI joints in individuals with and without OPLL. Methods: We included 240 age- and sex-matched patients (OPLL+, 120; OPLL−, 120) in the study. SI joint variations were classified into 4 types: Type 1, normal or small peripheral bone irregularity; Type 2, subchondral bone sclerosis and osteophyte formation; Type 3, vacuum phenomenon; and Type 4, bridging osteophyte and bony fusion. Type 4 was further divided into 3 subgroups as previously described. Interactions between the ossified spinal region in OPLL and morphological changes in the SI joint were evaluated. Results: SI joint ankylosis occurs more frequently in patients with OPLL (51.7%) than in those without (non-OPLL) (33.3%). The SI joint vacuum phenomenon (49.2%) was the main finding in non-OPLL. SI joint ankylosis in OPLL was characterized by anterior bridging and intra-articular fusion. OPLL patients with multilevel ossification tend to develop degeneration and ankylosis of the SI joints. Conclusions: OPLL conferred a high risk of SI joint ossification compared with non-OPLL, and patients with extensive ossification had a higher rate of SI joint ankylosis. Understanding SI joint variation could help elucidate OPLL etiology and clarify the phenotypic differences in the SI joint between OPLL and other spinal disorders.
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- 2021
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48. Introduction to the Essence of Clinical Practice Guidelines for Ossification of Spinal Ligaments, 2019
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Yoshiharu Kawaguchi
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Clinical Practice ,Spinal ligaments ,Editorial ,RD1-811 ,Ossification ,business.industry ,medicine ,Orthopedics and Sports Medicine ,Surgery ,Neurology (clinical) ,Anatomy ,medicine.symptom ,business - Published
- 2021
49. Lumbar disc degeneration progression in young women in their 20's: A prospective ten-year follow up
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Hiroto Makino, Yoshiharu Kawaguchi, Shiro Ikegawa, Masato Nakano, Shoji Seki, Taketoshi Yasuda, Kayo Suzuki, and Tomoatsu Kimura
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Adult ,medicine.medical_specialty ,Time Factors ,Lumbar disc degeneration ,Intervertebral Disc Degeneration ,Degeneration (medical) ,Degenerative disc disease ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,030212 general & internal medicine ,Young adult ,Prospective cohort study ,Lumbar Vertebrae ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,medicine.disease ,Magnetic Resonance Imaging ,Low back pain ,Disease Progression ,Female ,Surgery ,Lumbar spine ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Background Lumbar disc degeneration (LDD) is known to be the main cause of low back pain, although it is unclear how or when LDD progresses. The purpose of this study was to clarify the process and features of LDD progression in young women. Methods We enrolled 480 nursing students and carried out a prospective cohort study in 84 nursing students. MRI of the lumbar spine was taken once during their time as a student and again at 9.8 years (7–14) after the first MRI when they were working as nurses. The grade of LDD was determined according to Schneiderman's grade. The progression of disc degeneration was evaluated by the change in the degenerative disc disease (DDD) score (the summation of DDD score at each disc level). The subjects were divided into two groups based on MRI findings: Group A, those without disc degeneration at the first MRI (n = 58) and Group B, those showing disc degeneration on the first MRI (n = 26). We evaluated the change in DDD score and assessed the particular disc levels that showed Schneiderman's grade worsening in each group. Results At the time of the 2nd MRI, the DDD score increased from 5.6 (5–9) to 6.3 (5–11). The L5/S disc was the most frequent level showing the progression of LDD. In Group A, 18 subjects (31.0%) and in Group B, 15 subjects (57.7%) had degeneration progression (p = 0.02). Conclusions This study revealed that 31% of the young adult subjects already had disc degeneration in 20's (time of first MRI) and the disc degeneration rapidly progressed in these subjects.
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- 2017
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50. Life expectancy after cervical laminoplasty-Causes of the fatal prognosis at the early stage (within 5 years)
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Masahiko Kanamori, Yoshiharu Kawaguchi, Yasuhito Yahara, Kayo Suzuki, Taketoshi Yasuda, Shoji Seki, Hiroto Makino, Masato Nakano, and Tomoatsu Kimura
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cervical laminoplasty ,medicine.medical_specialty ,medicine.medical_treatment ,lcsh:Surgery ,cervical spine ,cause of death ,ossification of the posterior longitudinal ligament ,operative treatment ,medicine ,Cervical spondylosis ,Orthopedics and Sports Medicine ,In patient ,Stage (cooking) ,Cause of death ,business.industry ,cervical spondylosis ,lcsh:RD1-811 ,Laminoplasty ,medicine.disease ,Surgery ,Pneumonia ,Cervical laminoplasty ,life expectancy ,Life expectancy ,Original Article ,Neurology (clinical) ,business - Abstract
Introduction In more than 20 years' follow-up after cervical laminoplasty, some patients died at an early stage, within 5 years postoperatively. The details remain unclear. This study was conducted to elucidate the clinical features in patients who died at an early stage after cervical laminoplasty to determine possible preventive measures against early death after surgery. Methods A total of 74 patients who died with the follow-up period were included. The patients were divided into two groups: patients with a short survival period (S group, died ≤5 years after surgery) and patients with a long survival period (L group, died >5 years after surgery). Diseases, gender, age, causes of the death, general complications before surgery, and the pre- and postoperative JOA scores were compared between the two groups. Results Eleven patients (15%) died within 5 years after laminoplasty. The average age at death in the S group was 68.7 years which was considerably younger than that in the L group (80.2 years). The ratio of pneumonia was higher in the S group, compared to that in the L group. Postoperative JOA score in the S group was lower than that in the L group. Conclusions 11 patients out of 74 patients (15%) died within 5 years after laminoplasty. The average age at the death in the S group was much younger than that in the L group. The postoperative JOA score in the S group was lower than that in the L group. As pneumonia was more prevalent in the S group, it might be reasonable to give the information for the protection of pneumonia after cervical laminoplasty.
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- 2017
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