Details of a Researcher - Watanabe, Koota

Papers - Watanabe, Koota

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Posterior and Anterior Fusion for Severe Cervical Kyphosis in a Patient with Chondrodysplasia Punctata: A Case Report

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

JBJS case connector (JBJS case connector) 11 ( 1 ) 2021.03

CASE: A 4-year-old girl with spastic gait and hand clumsiness who was diagnosed with cervical myelopathy caused by atlantoaxial dislocation and midcervical severe kyphosis associated with chondrodysplasia punctata (CDP). The patient underwent posterior instrumentation and anterior spinal fusion and successful correction with osseous fusion was obtained 8 months after surgery. In addition, the preoperative neurological symptoms were completely recovered. CONCLUSION: Owing to the characteristics of CDP, the treatment for the cervical lesion is extremely complicated. Successful stabilization and improvement of the neurological symptom were achieved by combining posterior and anterior fusion with instrumentation in this case.

Gorham-Stout Disease Resulting in Spinal Deformity Treated by Fusion Surgery Combined With Everolimus Therapy: A Case Report

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

JBJS case connector (JBJS case connector) 11 ( 1 ) 2021.03

CASE: Gorham-Stout disease (GSD) is a rare disorder characterized by progressive localized osteolysis and lymphatic malformation. A 26-year-old woman with GSD presented to our hospital with a Cobb angle of 100° and a kyphosis angle of 88°. Everolimus therapy was initiated to control the disease prior to surgery. After halo-gravity traction for 4 weeks, we performed anterior and posterior spinal fusion. Postoperative computed tomography revealed satisfactory bone union and no significant loss of correction 1 year post-surgery. CONCLUSION: This case suggests that anterior and posterior spinal fusion combined with everolimus therapy can be a therapeutic option for GSD.

Symptomatic postoperative spinal subdural hematoma following posterior lumbar spinous process-splitting decompression surgery for lumbar spinal canal stenosis: A case report

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

Spine Surgery and Related Research (Spine Surgery and Related Research) 5 ( 5 ) 117 - 119 2021.03

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Proximal junctional kyphosis and proximal junctional failure in the treatment for adult spinal deformity: Definitions and epidemiology

Watanabe K., Yagi M., Fujita N., Suzuki S., Tsuji O., Nagoshi N., Okada E., Nakamura M., Matumoto M.

Techniques in Orthopaedics (Techniques in Orthopaedics) 36 ( 1 ) 2 - 6 2021.03

ISSN 08859698

Proximal junctional failure (PJF) is considered to be one of the most serious complications after correction surgery with a long construct for adult spinal deformity. Proximal junctional kyphosis (PJK) was first defined as an angle between the lower endplate of the uppermost instrumented vertebra (UIV) and the upper endplate of UIV+2 of 10 degrees or greater, and at least 10 degrees greater than the preoperative measurement. Although PJK has been found to cause no significant clinical symptoms, PJF is regarded as a pathology associated with a fracture of UIV or UIV+1, posterior osseoligamentous disruption, or a pullout of instrumentation at the UIV, and may require revision surgery. The incidence of PJK or PJF is influenced by a variety of factors including the pathology of the deformity, surgical procedures and spinal construct, status of osteoporosis, prophylactic procedures, and the follow-up period. Therefore, the reported incidences of PJK vary widely, from 7.7% to 56%, whereas those of PJF vary widely, from 1.4% to 35%.

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Predictive Probability of the Global Alignment and Proportion Score for the Development of Mechanical Failure Following Adult Spinal Deformity Surgery in Asian Patients

Yagi M., Daimon K., Hosogane N., Okada E., Suzuki S., Tsuji O., Nagoshi N., Fujita N., Nakamura M., Matsumoto M., Watanabe K.

Spine (Spine) 46 ( 2 ) E80 - E86 2021.01

STUDY DESIGN: This is a multicenter retrospective review of 257 surgically treated consecutive ASD patients who had a minimum of five fused segments, completed a 2-year follow-up (53 ± 19 yrs, females: 236 [92%]). OBJECTIVE: This study aimed to validate the predictive probability of the GAP score in an Asian ASD patient cohort. SUMMARY OF BACKGROUND DATA: The GAP score is a recently established risk stratification model for MF following ASD surgery. However, the predictive ability of the GAP score is not well studied. This study aimed to validate the predictive probability of the GAP score in an Asian ASD patient cohort. METHODS: Comparisons of the immediate postoperative GAP scores between MF the and MF-free groups were performed. We evaluated the discriminative ability of the GAP score based on the area under the receiver operating characteristic curve (AUROC). The Cuzick test was performed to determine whether there is a trend between the GAP score and the incidence of MF or revision surgery. Univariate logistic regression analyses were performed to explore the associations between the GAP score and the incidence of MF or revision surgery. RESULTS: No difference was observed in the GAP score between the MF and MF-free groups (MF vs. MF-free; GAP: 5.9 ± 3.3 vs. 5.2 ± 2.7, P = 0.07). The Cuzick analysis showed no trend between the GAP score and the risk for MF or revision surgery. Likewise, the MF rate was not correlated with the GAP score, as shown by the ROC curve (AUC of 0.56 [95% CI 0.48-0.63], P = 0.124). Univariate logistic regression confirmed no associations between the GAP score and the incidence of MF or revision surgery (MF; moderately disproportioned [MD]: OR: 0.6 [95% CI: 0.3-1.2], P = 0.17, severely disproportioned [SD]: OR: 1.2 [95% CI: 0.6-2.3], P = 0.69, revision surgery; MD: OR: 0.8 [95% CI: 0.2-2.8], P = 0.71, SD: OR: 1.2 [95% CI: 0.9-8.7], P = 0.08). CONCLUSION: In this multicenter study, in an Asian ASD patient cohort, the GAP score was not associated with the incidence of MF or revision surgery. Additional studies on the predictive ability of the GAP score in different patient cohorts are warranted.Level of Evidence: 3.

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Limited cost benefit of lateral interbody fusion for adult spinal deformity surgery

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

Spine (Spine) 46 ( 1 ) 48 - 53 2021.01

ISSN 03622436

Study Design. Retrospective case series. Objective. The aim of this study was to compare the utility and cost-effectiveness of multilevel lateral interbody fusion (LIF) combined with posterior spinal fusion (PSF) (L group) and conventional PSF (with transforaminal lumbar interbody fusion) (P group) in adult spinal deformity (ASD) surgery. Summary of Background Data. The clinical and radiographic outcomes of multilevel LIF for ASD have been reported favorable; however, the cost benefit of LIF in conjunction with PSF is still controversial. Methods. Retrospective comparisons of 88 surgically treated ASD patients with minimum 2-year follow-up from a multicenter database (L group [n=39] and P group [n=49]) were performed. Demographic and radiographic data, health-related quality of life (HRQoL), and the direct hospitalization cost for the initial surgery and 2-year total hospitalization cost were analyzed. Results. Analyses of sagittal spinal alignment showed no significant difference between the two groups at baseline and 2 years post-operation. Surgical time was longer in the L group (L vs. P: 354 vs. 268 minutes, P<0.01), whereas the amount of blood loss was greater in the P group (494 vs. 678 mL, P=0.03). The HRQoL was improved similarly at 2 years post-operation (L vs. P: SRS-22 total score, 3.86 vs. 3.80, P=0.54), with comparable revision rates (L vs. P: 18% vs. 10%, P=0.29). The total direct cost of index surgery was significantly higher in the L group (65,937 vs. 49,849 USD, P<0.01), which was mainly due to the operating room cost, including implant cost (54,466 vs. 41,328 USD, P<0.01). In addition, the 2-year total hospitalization cost, including revision surgery, was also significantly higher in the L group (70,847 vs. 52,560 USD, P<0.01). Conclusion. LIF with PSF is a similarly effective surgery for ASD when compared with conventional PSF. However, due to the significantly higher cost, additional studies on the costeffectiveness of LIF in different ASD patient cohorts are warranted.

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K-line (−) in the neck-flexed position negatively affects surgical outcome of expansive open-door laminoplasty for cervical spondylotic myelopathy

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

Journal of Orthopaedic Science (Journal of Orthopaedic Science) 2021

ISSN 09492658

Background: The K-line in the neck-flexed position (FK-line) on radiography reflects dynamic factors and cervical alignment. Although the FK-line has been reported to affect the neurological recovery after muscle-preserving selective laminectomy for cervical spondylotic myelopathy (CSM), its influence on surgical outcomes after expansive open-door laminoplasty (ELAP) has not been investigated. Methods: We reviewed the surgical outcomes in 81 patients with multilevel CSM who underwent C4–C6 ELAP combined with C3 and C7 partial laminectomy using a laminoplasty plate and were followed up for at least 2 years. We defined the K-line (−) as some portion of a bony spur or the vertebral body crossing the FK-line, whereas the FK-line (+) was defined as that never crossing the FK-line. Patients were divided into the FK-line (+) (n = 61) and FK-line (−) groups (n = 20), and the surgical outcomes were compared between the groups. A multivariate analysis was performed to identify the factors that influenced the neurological outcomes. Results: The FK-line (−) group had a smaller C2–C7 angle, smaller C7 slope, greater postoperative increase in the C2–C7 sagittal vertical axis, greater kyphosis in cervical flexion and less lordosis in cervical extension, and higher incidence of postoperative residual spinal cord compression. The preoperative-to-postoperative changes in the Japanese Orthopedic Association (JOA) score and JOA score recovery rate (RR) were lower in the FK-line (−) group. The multiple linear regression analysis revealed that the K-line (−) (β = −0.327, P = 0.011) and high signal intensity (SI) changes on T2-weighted imaging (WI) combined with the low SI changes on T1-WI in the spinal cord (β = −0.320, P = 0.013) negatively affected the JOA score RR. Conclusions: The FK-line can be used for patients with CSM as a simple indicator of neurological outcomes after ELAP.

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Imaging Characteristics and Surgical Outcomes in Patients With Intraspinal Solitary Fibrous Tumor/Hemangiopericytoma: A Retrospective Cohort Study

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

Global Spine Journal (Global Spine Journal) 2021

ISSN 21925682

Study Design: Retrospective cohort study. Objectives: Intraspinal solitary fibrous tumor (SFT)/hemangiopericytoma (HPC) is often misdiagnosed preoperatively as schwannoma or meningioma because its imaging characteristics are not well understood. As postoperative prognosis differs among the 3 lesions, predicting the probability of SFT/HPC preoperatively is essential. Thus, this study investigates the imaging characteristics of SFT/HPC compared with those of schwannoma or meningioma and evaluates surgical outcomes. Methods: The preoperative imaging findings, tumor resection extent, recurrence and regrowth rates, and neurological improvement were compared between 10 patients with SFT/HPC and 42 patients with schwannoma or 40 patients with meningioma. Results: Most patients with SFT/HPC showed isointensity on both T1- and T2-weighted images compared with patients with schwannoma (P = 0.011 and 0.029, respectively) and no significant difference compared with patients with meningioma (P = 0.575 and 0.845, respectively). Almost all patients with SFT/HPC showed highly uniformizing enhancement patterns, similar to those with meningioma (P = 0.496). Compared with meningioma, SFT/HPC lacked the dural tail sign and intratumoral calcification and exhibited irregular shape. Of the 5 patients who underwent partial resection, 60% exhibited tumor recurrence and regrowth following surgery. Conclusions: Complete en bloc surgical resection should be attempted in patients with intraspinal SFT/HPC to prevent postoperative recurrence or regrowth. As this tumor is often preoperatively misdiagnosed, we recommend that the imaging findings exhibited in this study should be used to positively suspect SFT/HPC. This will enhance patient outcomes by enabling more appropriate preoperative surgical planning.

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Effectiveness of Duloxetine for Postsurgical Chronic Neuropathic Disorders after Spine and Spinal Cord Surgery

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

Asian Spine Journal (Asian Spine Journal) 15 ( 5 ) 650 - 658 2021

ISSN 19761902

Study Design: This is a retrospective observational study with an outpatient setting.Purpose: This study aimed to describe the effects of duloxetine (DLX) administration for postsurgical chronic neuropathic disorders(both pain and numbness) following spinal surgery in patients without depression.Overview of Literature: Although several reports indicated the potential of DLX to effectively treat postoperative symptoms as aperioperative intervention, there have been no reports of its positive effect on postsurgical chronic neuropathic disorders.Methods: A total of 24 patients with postsurgical chronic pain and/or numbness Numeric Rating Scale (NRS) scores of ≥4 wereenrolled. All patients underwent spine or spinal cord surgery at Keio University Hospital and received daily administration of DLX formore than 3 months. The mean postoperative period before the first administration of DLX was 35.5±57.0 months. DLX was administeredfor more than 3 months at a dose of 20, 40, or 60 mg/day, and the degree of pain and numbness was evaluated using the NRSbefore administration and 3 months after administration. Effectiveness was defined as more than a 2-point decrease in the NRS scorefollowing administration.Results: In terms of the type of symptoms, 15 patients experienced only numbness, eight experienced both pain and numbness, andone experienced only pain. Of the 24 patients, 19 achieved effective relief with DLX. DLX was effective for all patients with postsurgicalchronic pain (n=9), and it reduced postsurgical chronic numbness in 18 of 23 patients. No significant difference was observed inbackground spinal disorders. DLX was not effective for five patients who complained only of postsurgical chronic numbness.Conclusions: This study reports the effectiveness of DLX for postsurgical chronic neuropathic disorders. Although DLX reduced postsurgicalchronic pain (efficacy rate=100%) and numbness (78.3%) in certain patients, further investigation is needed to determine itsoptimal use

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Early-onset scoliosis associated with shprintzen-goldberg syndrome treated with growing rods and required multiple unplanned surgeries: A case report

Takahashi Y., Watanabe K., Yagi M., Suzuki S., Nori S., Tsuji O., Nagoshi N., Okada E., Fujit N., Nakamura M., Matsumoto M.

Spine Surgery and Related Research (Spine Surgery and Related Research) 5 ( 3 ) 214 - 217 2021

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Does Diabetes Affect the Surgical Outcomes in Cases With Cervical Ossification of the Posterior Longitudinal Ligament? A Multicenter Study From Asia Pacific Spine Study Group

Nagoshi N., Watanabe K., Nakamura M., Matsumoto M., Li N., Ma S., He D., Tian W., Jeon H., Lee J.J., Kim K.N., Ha Y., Hong Kwan K.Y., Po Cheung A.K.

Global Spine Journal (Global Spine Journal) 2021

ISSN 21925682

Study Design: Retrospective multicenter study. Objectives: To evaluate the surgical outcomes of cervical ossification of the posterior longitudinal ligament (OPLL) in diabetes mellitus (DM) patients. Methods: Approximately 253 cervical OPLL patients who underwent surgical decompression with or without fixation were registered at 4 institutions in 3 Asian countries. They were followed up for at least 2 years. Demographics, imaging, and surgical information were collected, and cervical Japanese Orthopaedic Association (JOA) scores and the visual analog scale (VAS) for the neck were used for evaluation. Results: Forty-seven patients had DM, showing higher hypertension and cardiovascular disease prevalence. Although they presented worse preoperative JOA scores than non-DM patients (10.5 ± 3.1 vs. 11.8 ± 3.2; P = 0.01), the former showed comparable neurologic recovery at the final follow-up (13.9 ± 2.9 vs. 14.2 ± 2.6; P = 0.41). No correlation was noted between the hemoglobin A1c level in the DM group and the pre- and postoperative JOA scores. No significant difference was noted in VAS scores between the groups at pre- and postsurgery. Regarding perioperative complications, DM patients presented a higher C5 palsy frequency (14.9% vs. 5.8%; P = 0.04). A similar trend was observed when surgical procedure was limited to laminoplasty. Conclusions: This is the first multicenter Asian study to evaluate the impact of DM on cervical OPLL patients. Surgical results were favorable even in DM cases, regardless of preoperative hemoglobin A1c levels or operative procedures. However, caution is warranted for the occurrence of C5 palsy after surgery.

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Comparable satisfaction and clinical outcomes after surgery for adolescent idiopathic scoliosis in the adult (AISA) between the US and Japan

Yagi M., Ames C.P., Hosogane N., Smith J.S., Shaffrey C.I., Schwab F.J., Lafage V., Bess S., Matsumoto M., Watanabe K.

Journal of Orthopaedic Science (Journal of Orthopaedic Science) 2021

ISSN 09492658

Background: The impact of ethnicity on the surgery outcomes of adolescent idiopathic scoliosis in the adult (AISA) is poorly understood. This study aimed to compare the surgery outcomes for AISA between the United States (US) and Japan (JP). Methods: 171 surgically treated AISA (20-40y) were consecutively collected from 2 separate multicenter databases. Patients were propensity-score matched for age, gender, curve type, levels fused, and 2y postop spinal alignment. Demographic and radiographic parameters were compared between the US and JP at baseline and 2y post-op. Results: A total of 108 patients were matched by propensity score (age; US vs. JP: 29 ± 6 vs. 29 ± 7y, females: 76 vs. 76%, curve type [Schwab-SRS TypeT; TypeD; TypeL; TypeN]: 35; 35; 30; 0 vs. 37; 33; 30; 0%)] levels fused: 10 ± 4 vs. 10 ± 4, 2y thoracic curve:17 ± 13 vs. 17 ± 12°, 2y CSVL: 10 ± 8 vs. 11 ± 9 mm). Similar clinical improvement was achieved between US and JP (function; 4.2 ± 0.9 vs 4.3 ± 0.6, p = 0.60, pain; 3.8 ± 0.9 vs 4.1 ± 0.8, p = 0.13, satisfaction; 4.3 ± 0.9 vs 4.2 ± 0.7, p = 0.61, total; 4.0 ± 0.8 vs 4.1 ± 0.5, p = 0.60). The correlation analyzes indicated that postoperative SRS-22 subdomains correlated differently with satisfaction (all subdomains moderately correlated with satisfaction in the US while only pain and mental health correlated moderately with satisfaction in JP ([function: r = 0.61 vs 0.29, pain: r =. 72 vs 0.54, self-image: r = 0.72 vs 0.37, mental health: r = 0.64 vs 0.55]). Conclusions: Surgery for AISA was similarly effective in the US and JP. Satisfaction for spinal surgery among patients in different countries may not be different unless the procedure limits an individual's unique lifestyle that the patient expected to resume.

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A rare case of dumbbell-shaped lymphoplasmacyte-rich meningioma arising at the upper cervical spinal cord

Fukui K., Tsuji O., Suzuki S., Nori S., Nagoshi N., Okada E., Yagi M., Okita H., Fujita N., Watanabe K., Nakamura M., Matsumoto M.

Journal of Orthopaedic Science (Journal of Orthopaedic Science) 2021

ISSN 09492658

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The characteristics of the young patients with cervical ossification of the posterior longitudinal ligament of the spine: A multicenter cross-sectional study

Mori K., Yoshii T., Hirai T., Maki S., Katsumi K., Nagoshi N., Nishimura S., Takeuchi K., Ushio S., Furuya T., Watanabe K., Nishida N., Watanabe K., Kaito T., Kato S., Nagashima K., Koda M., Ito K., Imagama S., Matsuoka Y., Wada K., Kimura A., Ohba T., Katoh H., Matsuyama Y., Ozawa H., Haro H., Takeshita K., Watanabe M., Matsumoto M., Nakamura M., Yamazaki M., Okawa A., Kawaguchi Y.

Journal of Orthopaedic Science (Journal of Orthopaedic Science) 2021

ISSN 09492658

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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The impact of diabetes mellitus on spinal fracture with diffuse idiopathic skeletal hyperostosis: A multicenter retrospective study

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

Journal of Orthopaedic Science (Journal of Orthopaedic Science) 2021

ISSN 09492658

Background: Patients with diffuse idiopathic skeletal hyperostosis (DISH) are susceptible to spinal column injuries with neurological deterioration. Previous studies indicated that the prevalence of diabetes mellitus (DM) in patients with DISH was higher than that in patients without DISH. This study investigates the impact of DM on surgical outcomes for spinal fractures in patients with DISH. Methods: We retrospectively evaluated 177 spinal fractures in patients with DISH (132 men and 45 women; mean age, 75 ± 10 years) who underwent surgery from a multicenter database. The subjects were classified into two groups according to the presence of DM. Perioperative complications, neurological status by Frankel grade, mortality rate, and status of surgical site infection (SSI) were compared between the two groups. Results: DM was present in 28.2% (50/177) of the patients. The proportion of men was significantly higher in the DM group (DM group: 86.0% vs. non-DM group: 70.1%) (p = 0.03). The overall complication rate was 22.0% in the DM group and 19.7% in the non-DM group (p = 0.60). Poisson regression model revealed that SSI was significantly associated with DM (DM group: 10.0% vs. non-DM group: 2.4%, Relative risk: 4.5) (p = 0.048). Change in neurological status, mortality rate, instrumentation failure, and nonunion were similar between both groups. HbA1c and fasting blood glucose level (SSI group: 7.2% ± 1.2%, 201 ± 67 mg/dL vs. non-SSI group: 6.6% ± 1.1%, 167 ± 47 mg/dL) tended to be higher in patients with SSI; however, there was no significant difference. Conclusions: In spinal fracture in patients with DISH, although DM was an associated factor for SSI with a relative risk of 4.5, DM did not negatively impact neurological recovery. Perioperative glycemic control may be useful for preventing SSI because fasting blood glucose level was high in patients with SSI.

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Upper End Vertebra of Proximal Thoracic Curve At T1 is a Novel Risk Factor of Postoperative Shoulder Imbalance in Lenke Type 2 Adolescent Idiopathic Scoliosis

Isogai N., Yagi M., Otomo N., Maeda Y., Suzuki S., Nori S., Tsuji O., Nagoshi N., Okada E., Fujita N., Nakamura M., Matsumoto M., Watanabe K.

Global Spine Journal (Global Spine Journal) 2021

ISSN 21925682

Study Design: Retrospective single-center study. Objective: We investigated the risk factors of postoperative shoulder imbalance (PSI) in patients with Lenke type 2 adolescent idiopathic scoliosis (AIS) including the position of preoperative upper end vertebra (UEV). Methods: Seventy-five patients with Lenke type 2 AIS who underwent posterior correction and fusion surgeries from 2008 to 2018 were included. We included only patients whose upper instrumented vertebrae were at T2. The patients were divided into 2 groups based on radiographic shoulder height (RSH) at final follow-up, namely PSI group and non-PSI group, and PSI was defined as RSH > 10 mm. UEV, RSH, Cobb angle, curve flexibility, T1 and T2 tilt, correction rate, Risser grade, Scoliosis Research Society-22 scores, and demographic data were compared between the groups using independent t-tests or chi-square tests. Variables with P value < 0.20 in univariate analysis were assessed in logistic regression analysis. Results: Thirty-four patients in the PSI group and 37 patients in the non-PSI group were analyzed. Univariate analysis revealed that there were more patients with UEV at T1 (PSI: 85%, non-PSI: 54%, P < 0.01) and Risser grade ≥ 3 (PSI: 88%, non-PSI: 62%; P < 0.05) in the PSI group than in the non-PSI group. Logistic regression analysis revealed that UEV at T1 (odds ratio [OR] = 4.1 [1.2–14.4], P < 0.05) and Risser grade ≥ 3 (OR = 3.9 [1.1–14.5], P < 0.05) are significantly associated with PSI. Conclusions: UEV at T1 and Risser grade ≥ 3 at the time of surgery are significant risk factors of PSI.

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Metabolic syndrome is a predisposing factor for diffuse idiopathic skeletal hyperostosis

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

Neurospine (Neurospine) 18 ( 1 ) 109 - 116 2021

ISSN 25866583

Objective: Diffuse idiopathic skeletal hyperostosis (DISH) causes spinal ankylosis, which can result in patients suffering specific spinal fractures that lead to a reduction in the activities of daily life in older patients. Currently, DISH is associated with diabetes mellitus and cardiovascular disease; however, the association between DISH and metabolic syndrome has not been established. The purpose of this study was to investigate a potential association between DISH and metabolic syndrome. Methods: We retrospectively reviewed clinical data from consecutive subjects undergoing the musculoskeletal health medical checkups, and enrolled 327 subjects (174 men and 153 women; mean, 63.4 ± 13.7-years). Subjects who had spinal ankylosis at least 4 contiguous vertebral bodies were classified as the DISH group (n = 39) while the others were part of the non-DISH group (n = 288). The definition of the metabolic syndrome comes from diagnostic criteria used by the Japanese Society for Internal Medicine. Age, sex, body max index (BMI), hematological evaluation, blood pressure, presence of metabolic syndrome, the visceral fat area on abdominal computed tomography, and spinal epidural lipomatosis (SEL) on magnetic resonance imaging were evaluated. Results: Compared to the non-DISH group, in the DISH group, mean age (DISH group, 74.3 years; non-DISH group, 1.9 years; p < 0.001), male prevalence were higher (DISH group, 82.1%; non-DISH group, 49.3%; p < 0.001), and BMI was greater (DISH group, 24.8; non-DISH group, 23.0; p = 0.006). the metabolic syndrome was more frequently observed in DISH group (28.9%) than in the non-DISH group (16.0%) (p = 0.045). The visceral fat area was significantly larger in the DISH group than in the non-DISH group (DISH group, 130.7 ± 58.2 cm2; Non-DISH group, 89.0 ± 48.1 cm2; p <0.001). The prevalence of SEL was similar between the 2 groups (10.3% in the DISH group vs. 8.7% in the non-DISH group; p = 0.464). Poisson regression analysis revealed that the metabolic syndrome was significantly associated with DISH with odds ratio of 2.0 (95% confidence interval, 1.0– 3.7; p = 0.004). Conclusion: Metabolic syndrome was significantly associated with DISH. Our data showed metabolic syndrome is potentially related to DISH.

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Spinous Process-Splitting Laminectomy Approach for Tumor Excision at Conus Medullaris or Cauda Equina Level Results in Satisfactory Clinical Outcomes Without Affecting Global Spinal Sagittal Alignment

Okubo T., Nagoshi N., Tsuji O., Nishimura S., Suzuki S., Nori S., Yagi M., Matsumoto M., Nakamura M., Watanabe K.

Global Spine Journal (Global Spine Journal) 2021

ISSN 21925682

Study design: Retrospective comparative study. Objectives: The present study investigated radiographical changes in global spinal sagittal alignment (GSSA) and clinical outcomes following tumor resection using spinous process-splitting laminectomy (SPSL) approach without fixation in patients with conus medullaris (CM) or cauda equina (CE) tumor. Methods: Forty-one patients with CM or CE tumor (19 males, 22 females, mean age at surgery of 52.9 ± 13.0 years) were included in this study. The variations of outcome variables were analyzed in various GSSA profiles using radiographic outcomes. The clinical outcomes were assessed using Japan Orthopaedic Association (JOA) score and JOA back pain evaluation questionnaire (JOABPEQ). Results: In all cases, the various GSSA parameters (sagittal vertical axis, C2–7 lordosis, T1 slope, thoracic kyphosis, T10–L2 kyphosis, lumbar lordosis [LL; upper, middle, and lower], sacral slope, pelvic incidence, and pelvic tilt) did not significantly change in the 2-years postoperative period. Moreover, age at surgery, the number of resected laminae, preoperative T12–L2 kyphosis, or LL did not affect the postoperative changes in T12–L2 kyphosis or LL, and had no statistically significant correlation among them. The scores of each postoperative JOA domain and the Visual Analogue Scale included in the JOABPEQ were significantly improved. There was no statistical significant group difference in each sagittal profile or clinical outcomes between CM and CE groups postoperatively. Conclusions: Tumor resection using SPSL approach did not affected the various GSSA parameters examined and resulted in satisfactory clinical outcomes, indicating that SPSL approach is a suitable surgical technique for patients with CM or CE tumor.

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Postoperative tongue deviation by hypoglossal nerve palsy and Tapia's syndrome after cervical laminoplasty: report of two cases

Ishihara H., Tsuji O., Okada E., Izawa Y., Kato J., Suzuki S., Takahashi Y., Nori S., Nagoshi N., Yagi M., Watanabe K., Nakamura M., Matsumoto M.

Journal of Orthopaedic Science (Journal of Orthopaedic Science) 2021

ISSN 09492658

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Myeloperoxidase-antineutrophil cytoplasmic antibody positive hypertrophic spinal pachymeningitis at the cervicothoracic junction: A case report

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

Spine Surgery and Related Research (Spine Surgery and Related Research) 5 ( 3 ) 211 - 213 2021

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