著者

Ryo Fukata Takeo Furuya Yuki Shiko Yohei Kawasaki Mayuko Kuwata Keita Takase Ryosuke Tadaki Tomoyo Akasaka Geundong Kim Yahiko Takeuchi Mitsuo Morita Atsushi Murata Seiji Ohtori

出版者

The Japanese Society for Spine Surgery and Related Research

雑誌

Spine Surgery and Related Research (ISSN:2432261X)

巻号頁・発行日

vol.7, no.5, pp.414-420, 2023-09-27 (Released:2023-09-27)

参考文献数

31

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Introduction: We investigated the effect of preoperative joint position sense in the big toe on the postoperative recovery of gait function after spinal tumor surgery.Methods: Seventy-three patients with spinal tumors who underwent surgery at our hospital between 2014 and 2019 and could be followed for at least 6 months after surgery were included. The patients were divided into the cervical spinal (41 cases) and thoracic spinal (32 cases) groups according to the localization of the tumor. These groups were further classified into an Impaired group (cervical spinal, 34 cases; thoracic spinal, 19 cases) and an Intact group (cervical spinal, 7 cases; thoracic spinal, 13 cases) according to the presence or absence of preoperative joint position sense in the big toe. The amount of change in ambulatory function from the preoperative period to 3 and 6 months postoperatively was compared between the Impaired and Intact groups within each tumor localization category.Results: Impaired preoperative joint position sense in the big toe in patients undergoing thoracic spinal tumor surgery delayed the recovery of gait function in the early postoperative period.Conclusions: In patients with thoracic spinal tumor surgery, the absence of preoperative joint position sense in the big toe delayed the recovery of postoperative gait function.

著者

Masanari Takami Yasuhiro Iwasaki Motohiro Okada Keiji Nagata Naoaki Shibata Seiya Kato Hiroshi Yamada

出版者

The Japanese Society for Spine Surgery and Related Research

雑誌

Spine Surgery and Related Research (ISSN:2432261X)

巻号頁・発行日

vol.6, no.5, pp.464-471, 2022-09-27 (Released:2022-09-27)

参考文献数

22

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Introduction: Massive hemothorax due to thoracic vertebral fractures (MHTVF) is a potentially lethal condition; however, its epidemiological and clinical data have been rarely described. Thus, in this study, we aimed to evaluate the incidence, predictive factors, and clinical features of MHTVF.Methods: This retrospective cohort study enrolled 202 consecutive patients (136 male and 66 female patients) with thoracic vertebral fractures treated at our institute between January 2009 and December 2019. Their mean age was 60.7 (range, 17-90) years. Unstable fractures accounted for 57.4% (n=116) of the total fractures. The patients were then divided into MHTVF and non-MHTVF groups. We assessed the following MHTVF-associated factors: sex, age, history of medical conditions, anticoagulation/antiplatelet drug use, injury severity score, anatomical distribution of levels of the vertebral fractures, fracture type, and presence or absence of diffuse idiopathic skeletal hyperostosis (DISH) fracture.Results: In total, eight patients (six men and two women) with a mean age of 68.9 years (range, 22-85 years) were determined to exhibit MHTVF. The incidence of MHTVF in patients with unstable thoracic spinal fractures was 6.9%, whereas none of those with stable spinal fractures exhibited MHTVF. Factors like type B (p=0.049) and DISH (p=0.017) fractures were noted to be significantly associated with the MHTVF. Three patients experienced shock upon arrival, whereas two exhibited delayed shock. Chest tube insertion and/or emergency thoracotomy was performed. The survival rate was 100.0%.Conclusions: MHTVF is not rare. Because type B and DISH fractures are identified as predictive factors of MHTVF, it must be carefully treated to avoid preventable death even after hospitalization in patients with these thoracic fractures.

著者

Mitsuru Yagi Nobuyuki Fujita Tomohiko Hasegawa Gen Inoue Yoshihisa Kotani Seiji Ohtori Sumihisa Orita Yasushi Oshima Daisuke Sakai Toshinori Sakai Hiroshi Taneichi Daisuke Togawa Kazuo Nakanishi Hiroaki Nakashima Toshitaka Yoshii Masaya Nakamura Motoki Iwasaki Masahiko Watanabe Hirotaka Haro Tokumi Kanemura Naobumi Hosogane New Technology Assessment Committee of The Japanese Society for Spine Surgery and Related Research

出版者

The Japanese Society for Spine Surgery and Related Research

雑誌

Spine Surgery and Related Research (ISSN:2432261X)

巻号頁・発行日

pp.2022-0194, (Released:2022-12-12)

被引用文献数

1

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IntroductionLateral lumbar interbody fusion (LLIF) has been introduced in Japan in 2013. Despite the effectiveness of this procedure, several considerable complications have been reported. This study reported the results of a nationwide survey performed by the Japanese Society for Spine Surgery and Related Research (JSSR) on the complications associated with LLIF performed in Japan.MethodsJSSR members conducted a web-based survey following LLIF between 2015 and 2020. Any complications meeting the following criteria were included: (1) major vessel, (2) urinary tract, (3) renal, (4) visceral organ, (5) lung, (6) vertebral, (7) nerve, and (8) anterior longitudinal ligament injury; (9) weakness of psoas; (10) motor and (11) sensory deficit; (12) surgical site infection; and (13) other complications. The complications were analyzed in all LLIF patients, and the differences in incidence and type of complications between the transpsoas (TP) and prepsoas (PP) approaches were compared.ResultsAmong the 13,245 LLIF patients (TP 6,198 patients [47%] and PP 7,047 patients [53%]), 389 complications occurred in 366 (2.76%) patients. The most common complication was sensory deficit (0.5%), followed by motor deficit (0.43%) and weakness of psoas muscle (0.22%). Among the patient cohort, 100 patients (0.74%) required revision surgery during the survey period. Almost half of the complications developed in patients with spinal deformity (183 patients [47.0%]). Four patients (0.03%) died from complications. Statistically more frequent complications occurred in the TP approach than in the PP approach (TP vs. PP, 220 patients [3.55%] vs. 169 patients [2.40%]; p < 0.001).ConclusionsThe overall complication rate was 2.76%, and 0.74% of the patients required revision surgery because of complications. Four patients died from complications. LLIF may be beneficial for degenerative lumbar conditions with acceptable complications; however, the indication for spinal deformity should be carefully determined by the experience of the surgeon and the extent of the deformity.

著者

Akihito Kawai Sachiko Kawasaki Tomoko Nishimura Hideki Shigematsu Masato Tanaka Yasuhito Tanaka

出版者

The Japanese Society for Spine Surgery and Related Research

雑誌

Spine Surgery and Related Research (ISSN:2432261X)

巻号頁・発行日

vol.6, no.6, pp.721-724, 2022-11-27 (Released:2022-11-27)

参考文献数

10

著者

William H. Waddell Benjamin M. Weisenthal Nicholas Golinvaux Abigail L. Henry Jacquelyn Pennings John P. Wanner Rishabh Gupta Toshitaka Yoshii Zhou Feifei Byron F. Stephens

出版者

The Japanese Society for Spine Surgery and Related Research

雑誌

Spine Surgery and Related Research (ISSN:2432261X)

巻号頁・発行日

vol.6, no.5, pp.460-463, 2022-09-27 (Released:2022-09-27)

参考文献数

27

被引用文献数

1

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Introduction: Laminoplasty is a well-established technique used to manage cervical myelopathy (CM). Nevertheless, the degree to which United States surgeons have adopted laminoplasty from Japan to treat CM is less clear. The purpose of this study was to compare operative management strategies for CM in the United States (US) with Japan.Methods: This study used a retrospective cohort of 16,084 patients from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database and 389,872 patients from the Japanese Diagnosis Procedure Combination (DPC) database from 2007 to 2015. Patients with the following diagnoses were collected: spondylosis with myelopathy (ICD-19; 721.1, ICD-10; M47.12) and disk herniation with myelopathy (ICD-9; 722.71, ICD-10; M50.00). The proportion of surgeries between Japan and the US was compared using a linear regression model controlling for year.Results: US surgeons utilized anterior procedures in 70% of cases compared to 9% in Japan (p<.001). In contrast, Japan had significantly more laminoplasties than the US (43% vs. 4%, respectively, p<.001). The percentage of laminoplasty in Japan (43%) relative to the percentage in the US (4%) was significantly different (p<.001). Accounting for increases in the number of total surgeries per year seen in the ACS-NSQIP and DPC databases, no specific surgery demonstrated a significant increase or decrease over the 8 years.Conclusions: Japanese surgeons employ laminoplasty to treat CM approximately ten times more frequently than US surgeons who prefer anterior procedures.

著者

Kazuo Nakanishi Yasukazu Hijikata Kazuya Uchino Seiya Watanabe Kosuke Misaki Hideaki Iba

出版者

The Japanese Society for Spine Surgery and Related Research

雑誌

Spine Surgery and Related Research (ISSN:2432261X)

巻号頁・発行日

vol.6, no.1, pp.26-30, 2022-01-27 (Released:2022-01-27)

参考文献数

22

被引用文献数

1

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Introduction: There is a growing momentum for the collaboration between multiple disciplines for the prevention and treatment of skeletal-related events (SREs) in patients with metastatic spinal tumors. However, the effectiveness of multidisciplinary approaches remains unclear. Hence, we conducted an exploratory study to examine the impact of liaison treatment for metastatic spinal tumor (LMST) on the prevention of SREs among patients with a metastatic spinal tumor.Methods: This study was an exploratory interrupted time series conducted in a single medical center. Overall, 1,043 patients with a metastatic spinal tumor diagnosed between January 2011 and December 2020 were included. The LMST was implemented in January 2014. The LMST team consisted of the orthopedic surgery, thoracic surgery, breast and thyroid surgery, clinical oncology, urology, and radiology departments. Monthly joint conferences were held for patients with spinal instability, and the incidence of SRE was measured at 6-month intervals.Results: Throughout the study period, we identified 66 SRE incidences. After the implementation of the LMST, a level change of −5.2% (95% confidence interval [CI]: −11.7 to 1.3, p = 0.11) was observed. Subsequently, a post-implementation trend change of −0.3% (95% CI: −2.0 to 1.5, p = 0.75) beyond the baseline was noted.Conclusions: We suggest both immediate and gradual effects of the introduction of the LMST on deterring the development of SREs. Our results support the global trend of introducing a multidisciplinary approach for the treatment of metastatic spinal tumors.

著者

Takashi Hirai Takuya Takahashi Tomoyuki Tanaka Takayuki Motoyoshi Yu Matsukura Masato Yuasa Hiroyuki Inose Toshitaka Yoshii Atsushi Okawa

出版者

The Japanese Society for Spine Surgery and Related Research

雑誌

Spine Surgery and Related Research (ISSN:2432261X)

巻号頁・発行日

vol.6, no.3, pp.252-260, 2022-05-27 (Released:2022-05-27)

参考文献数

21

被引用文献数

5

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Introduction: Chemonucleolysis with condoliase (chondroitin sulfate ABC endolyase) has been used to treat patients with lumbar disc herniation (LDH) in Japan since 2018. In this study, we retrospectively investigated clinical outcomes in patients who received an intradiscal condoliase injection for LDH and sought to identify significant predictors of good outcome.Methods: Indications for treatment were as follows: (1) unilateral leg pain with or without back pain, (2) nerve root compression caused by LDH confirmed on magnetic resonance imaging (MRI), and (3) leg pain resistant to at least 1 month of conservative treatment, including medication, nerve root block, or physical therapy. Patients with motor weakness or a history of severe allergy were excluded, as were those with the foraminal or sequestrated type of LDH. The injection was defined as effective if the numeric rating scale score for leg pain improved by ≥50% at 6 months post-treatment.Results: A total of 52 patients (mean age, 45.0 years) were enrolled and classified according to whether the injection was effective (E group, n=40, 76.9%) or less effective (L group, n=9, 17.3%). Three patients (5.8%) underwent herniotomy for residual pain within 6 months of the injection. There were no severe adverse events. Reduction of herniation was seen on MRI more often in the E group than in the L group. The effectiveness in patients with transligamentous LDH was similar to that in patients with subligamentous LDH. High-intensity signal change in the area of LDH on pretreatment T2-weighted MRI was a significant predictor of successful leg pain relief.Conclusions: An intradiscal condoliase injection was a safe and effective treatment for painful radiculopathy caused by LDH. Leg pain was more likely to improve in patients with high-intensity signal change in the area of LDH before treatment.

著者

Tetsuya Tamaki Muneharu Ando Yukihiro Nakagawa Hiroshi Iwasaki Shunji Tsutsui Masanari Takami Hiroshi Yamada

出版者

The Japanese Society for Spine Surgery and Related Research

雑誌

Spine Surgery and Related Research (ISSN:2432261X)

巻号頁・発行日

vol.5, no.3, pp.120-132, 2021-05-27 (Released:2021-05-27)

参考文献数

61

被引用文献数

6

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An intraoperative functional spinal cord monitoring system is a technology used by spine and spinal cord surgeons to perform a safe surgery and to gain further surgical proficiency. However, no existing clinical neurophysiological method used in the operating room can monitor all complex spinal cord functions. Therefore, by observing the activities of certain neural action potentials transferred via limited neural tissues, surgeons need to deductively estimate the function of the whole spinal cord. Thus, as the number of spinal cord functions that need to be observed increases, spinal cord monitoring can be more reliable. However, in some situations, critical decision-making is affected by the limited capability of these methods. Nevertheless, good teamwork enables sharing of seamless information within the team composed of a surgeon, anesthesiologist, monitoring technician and nurses greatly contributes to making quick and accurate decisions. The surgeon, who is the person in charge of the team, should communicate with multidisciplinary team members using common technical terms. For this reason, spine and spinal cord surgeons must have appropriate knowledge of the methods currently used, especially of their utility and limitations. To date, at least six electrophysiological methods are available for clinical utilization: three are used to monitor sensory-related tracts, and three are used to monitor motor-related spinal cord functions. If surgeons perform electrode setting, utilizing their expertise, then the range of available methods is broadened, and more meticulous intraoperative functional spinal cord monitoring can be carried out. Furthermore, if the team members share information effectively by utilizing a clinically feasible judicious checklist or tools, then spinal cord monitoring will be more reliable.

著者

Gen Inoue Takashi Kaito Yukihiro Matsuyama Toshihiko Yamashita Mamoru Kawakami Kazuhisa Takahashi Munehito Yoshida Shiro Imagama Seiji Ohtori Toshihiko Taguchi Hirotaka Haro Hiroshi Taneichi Masashi Yamazaki Kotaro Nishida Hiroshi Yamada Daijiro Kabata Ayumi Shintani Motoki Iwasaki Manabu Ito Naohisa Miyakoshi Hideki Murakami Kazuo Yonenobu Tomoyuki Takura Joji Mochida

出版者

The Japanese Society for Spine Surgery and Related Research

雑誌

Spine Surgery and Related Research (ISSN:2432261X)

巻号頁・発行日

pp.2020-0083, (Released:2020-11-20)

被引用文献数

2

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Introduction: Chronic low back pain (CLBP) is a leading cause of disability, yet there is limited high-quality evidence to identify the most suitable pharmacological therapy. The purpose of this Japanese nationwide, multicenter, prospective study was to compare the effectiveness of four representative drug therapies—acetaminophen, celecoxib, loxoprofen, and a tramadol and acetaminophen (T+A) combination drug—to establish evidence for a drug of choice for CLBP.Methods: Patients with CLBP (N = 471) received one of the four treatments and were evaluated, prospectively and comprehensively, once every month for six months using a visual analog scale (VAS) for LBP, the Japanese Orthopedic Association (JOA) score, the JOA Back Pain Evaluation Questionnaire (JOABPEQ), the Roland–Morris Disability Questionnaire (RDQ), the EuroQol five-dimensions three-levels (EQ-5D-3L), and the Short Form-8 item health survey (SF-8). We conducted multivariable linear regression analyses of the four drugs at 1 and 6 months after drug allocation. Differences with P < 0.05 were considered statistically significant.Results: Patients who received acetaminophen showed a significant improvement from baseline in the mental health subscale of the JOABPEQ at one month (P = 0.02) and the JOA score at six months (P < 0.01). None of the other outcome measures among the four drugs differed significantly. Across groups, all outcome measures, except the mental component summary (MCS) score of the SF-8, improved equivalently, although most measurements showed no obvious cumulative effect over six months. The MCS score of the SF-8 decreased gradually over six months in all groups.Conclusions: Most of the outcome measures among the treated groups were not significantly different, indicating similar treatment effects of the four drugs for CLBP. Our study indicated the limit of each outcome measure for evaluating the patient status, suggesting that a single outcome measure is insufficient to reflect treatment effectiveness.

著者

Hiroto Takenaka Tatsunori Ikemoto Junya Suzuki Masayuki Inoue Young-Chang Arai Takahiro Ushida Masataka Deie Mitsuhiro Kamiya

出版者

The Japanese Society for Spine Surgery and Related Research

雑誌

Spine Surgery and Related Research (ISSN:2432261X)

巻号頁・発行日

pp.2019-0083, (Released:2019-12-03)

被引用文献数

4

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BackgroundThe present study aimed to investigate the association between trunk muscle strength, lumbar spine bone mineral density (BMD), lumbar scoliosis angle (LSA), and appendicular skeletal muscle mass index (ASMI) and the severity locomotive syndrome (LS) using dual-energy X-ray absorptiometry (DXA) technology in elderly individuals.MethodsIn this cross-sectional study, we enrolled 168 individuals aged >60 years. We measured their trunk muscle strength (flexion and extension) and BMD, LSA, and ASMI using DXA. We defined degenerative lumbar scoliosis (DLS) as LSA ≥ 10° by the Cobb method using the DXA image. The locomotor function was evaluated using the timed up-and-go (TUG) test and the 25-question Geriatric Locomotive Function Scale (GLFS-25) score. Normal locomotor function, LS-1, and LS-2 were defined as a GLFS-25 score of <7, ≥7 and <16, and ≥16, respectively. We compared the three groups, analyzing the associations between all variables and the locomotor function using univariate and multivariate analyses.ResultsAlthough there was no significant difference in sex ratio, BMD, ASMI, and trunk-flexor strength, significant differences were observed in age (p < 0.01), the prevalence of DLS (p = 0.02), trunk-extensor strength (p < 0.01), and trunk-extensor/flexor strength ratio (p < 0.01) among the three groups. In multiple regression analyses, the significant risk factors of the TUG test were age (β = 0.26), body mass index (β = 0.36), LSA (β = 0.15), ASMI (β = −0.30), and trunk-extensor strength (β = −0.19), whereas the significant factor of the GLFS-25 score was trunk-extensor strength (β = −0.31).ConclusionsThe results indicate that it is clinically important for LS to pay careful attention not only to BMD but also to lumbar scoliosis when DXA examination of the lumbar spine is routinely conducted. Moreover, it is essential to note that trunk-extensor strength is more important than trunk-flexor strength in maintaining locomotor function in elderly individuals.

著者

Nozomu Inoue Alejandro A. Espinoza Orías Kazuyuki Segami

出版者

The Japanese Society for Spine Surgery and Related Research

雑誌

Spine Surgery and Related Research (ISSN:2432261X)

巻号頁・発行日

pp.2019-0017, (Released:2019-04-26)

被引用文献数

22

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Zygapophyseal, or facet, joints are complicated biomechanical structures in the spine, with a complex three-dimensional (3D) anatomy, variable mechanical functions in different spinal movements, and effects on the overall spine mechanical behavior. The 3D morphology of the facet joint is linked to its biomechanical function. Failure of the biomechanical function of the facet joint leads to osteoarthritic changes in it and is implicated in other spinal disorders such as degenerative spondylolisthesis. Facet joints and intervertebral discs are part of an entity called the spinal motion segment, the three-joint complex, or the articular triad. Functioning together, the structures in the spinal motion segments provide physiological spinal motion, while protecting the spine by preventing activities that can be injurious. Loss of intervertebral disk height associated with disk degeneration affects the mechanical behavior of facet joints. Axial compressive load transmission through the tip of the inferior articular process can occur in the extended position, especially with reduced disk height, which may cause capsular impingement and low back pain. The 3D curvature of the articular surfaces and capsular ligaments play important roles in different spinal positions. In this review article, we will summarize the anatomy of the lumbar facet joint relevant to its biomechanical function and biomechanical behavior under different loading conditions.

著者

Hiroto Takenaka Tatsunori Ikemoto Junya Suzuki Masayuki Inoue Young-Chang Arai Takahiro Ushida Masataka Deie Mitsuhiro Kamiya

出版者

The Japanese Society for Spine Surgery and Related Research

雑誌

Spine Surgery and Related Research (ISSN:2432261X)

巻号頁・発行日

vol.4, no.2, pp.164-170, 2020-04-27 (Released:2020-04-27)

参考文献数

46

被引用文献数

4

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Introduction: The present study aimed to investigate the association between trunk muscle strength, lumbar spine bone mineral density (BMD), lumbar scoliosis angle (LSA), and appendicular skeletal muscle mass index (ASMI) and the severity locomotive syndrome (LS) using dual-energy X-ray absorptiometry (DXA) technology in elderly individuals.Methods: In this cross-sectional study, we enrolled 168 individuals aged >60 years. We measured their trunk muscle strength (flexion and extension) and BMD, LSA, and ASMI using DXA. We defined degenerative lumbar scoliosis (DLS) as LSA ≥ 10° by the Cobb method using the DXA image. The locomotor function was evaluated using the timed up-and-go (TUG) test and the 25-question Geriatric Locomotive Function Scale (GLFS-25) score. Normal locomotor function, LS-1, and LS-2 were defined as a GLFS-25 score of <7, ≥7 and <16, and ≥16, respectively. We compared the three groups, analyzing the associations between all variables and the locomotor function using univariate and multivariate analyses.Results: Although there was no significant difference in sex ratio, BMD, ASMI, and trunk-flexor strength, significant differences were observed in age (p < 0.01), the prevalence of DLS (p = 0.02), trunk-extensor strength (p < 0.01), and trunk-extensor/flexor strength ratio (p < 0.01) among the three groups. In multiple regression analyses, the significant risk factors of the TUG test were age (β = 0.26), body mass index (β = 0.36), LSA (β = 0.15), ASMI (β = −0.30), and trunk-extensor strength (β = −0.19), whereas the significant factor of the GLFS-25 score was trunk-extensor strength (β = −0.31).Conclusions: The results indicate that it is clinically important for LS to pay careful attention not only to BMD but also to lumbar scoliosis when DXA examination of the lumbar spine is routinely conducted. Moreover, it is essential to note that trunk-extensor strength is more important than trunk-flexor strength in maintaining locomotor function in elderly individuals.

著者

Seiji Ohtori Masayuki Miyagi Gen Inoue

出版者

The Japanese Society for Spine Surgery and Related Research

雑誌

Spine Surgery and Related Research (ISSN:2432261X)

巻号頁・発行日

vol.2, no.1, pp.11-17, 2018-01-20 (Released:2018-01-27)

参考文献数

91

被引用文献数

41

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Introduction: Many patients suffer from discogenic low back pain. However, the mechanisms, diagnosistic strategy, and treatment of discogenic low back pain all remain controversial. The purpose of this paper was to review the pathological mechanisms of discogenic low back pain.Methods: Many authors have investigated the pathological mechanisms of discogenic low back pain using animal models and examining human patients. Central to most investigations is understanding the innervation and instabilities of diseased intervertebral discs and the role of inflammatory mediators. We discuss three pathological mechanisms of discogenic low back pain: innervation, inflammation, and mechanical hypermobility of the intervertebral disc.Results: Sensory nerve fibers include C-fibers and A delta-fibers, which relay pain signals from the innervated outer layers of the intervertebral disc under normal conditions. However, ingrowth of these sensory nerve fibers into the inner layers of intervertebral disc occurs under disease conditions. Levels of neurotrophic factors and some cytokines are significantly higher in diseased discs than in normal discs. Stablization of the segmental hypermobility, which can be induced by intervertebral disc degeneration, suppresses inflammation and prevents sensitization of sensory nerve fibers innervating the disc.Conclusions: Pathological mechanisms of discogenic low back pain include sensory nerve ingrowth into inner layers of the intervertebral disc, upregulation of neurotrophic factors and cytokines, and instability. Inhibition of these mechanisms is important in the treatment of discogenic low back pain.

著者

Ahmed Bakhsh Ali Hassan Aljuzair Hany Eldawoody

出版者

The Japanese Society for Spine Surgery and Related Research

雑誌

Spine Surgery and Related Research (ISSN:2432261X)

巻号頁・発行日

pp.2019-0118, (Released:2020-03-19)

被引用文献数

11

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Introduction:The World Report on Road Traffic Injury Prevention indicates that by 2020, road traffic injuries will be a major killer, accounting for half a million deaths and 15 million disability-adjusted life years. The Kingdom of Saudi Arabia (KSA) has one of the highest rates of spinal cord injuries in the world, with 62 people injured per 1 million, and the injuries are mostly due to traffic accidents.Materials and Methods: All polytrauma patients associated with spinal injuries admitted to Prince Mohammed bin Abdul Aziz Hospital (PMAH), Riyadh, from January 2017 to June 2018, were included in this study. Patients with old spinal injuries, any previous spinal surgery, spine infection, or concomitant diagnosed malignancies or osteoporotic collapse with or without falls were excluded. All patients underwent whole-spine computed tomography scan and, in selective cases, magnetic resonance imaging of the spine.Results: Of the 230 patients, 90.0% were male, and 60% were in the second and third decades. Motor vehicle accidents were responsible for 83% of the cases, of which 50% of the victims were the drivers, and 80% were passengers with no seatbelt on. Nearly 50% of the spinal injuries were associated with injuries in the other body parts. Cervical spine injury accounted for 44% of the cases, followed by the lumbar spine injury. Twenty five percent of the patients presented with fixed neurologic deficit in the form of quadriplegia or paraplegia (ASIA-A). The mortality rate was 1.3%.Conclusion: This study revealed that motor vehicle accidents are a major cause of spinal injuries in the KSA. One-fourth of the spinal Injuries are associated with complete spinal cord injuries. Therefore, in order to prevent lifelong disability in the young population, a nationwide program should be initiated to prevent road traffic accidents.

著者

Aakash Agarwal Amey Kelkar Ashish Garg Agarwal Daksh Jayaswal Arvind Jayaswal Vithal Shendge

出版者

The Japanese Society for Spine Surgery and Related Research

雑誌

Spine Surgery and Related Research (ISSN:2432261X)

巻号頁・発行日

pp.2019-0041, (Released:2019-10-20)

被引用文献数

19

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Introduction: Recent literature identifies similar failure rates such as anchor pull-out and rod breakage, but a higher unplanned revision surgery with MAGEC rods than with traditional growth rods. Besides known failure modes such as rod fracture, infection, etc., failure to noninvasively distract the rods was cited as the main cause of such unplanned surgeries. The source of these data ranges from multicenter cohort studies to singular case series. These studies included explanted implants that had undergone failure in distraction mechanism, rod fracture, or infection, or had reached their maximum length. Nevertheless, in addition to identifying the overall mode of failure, it is equally important to identify the large-scale incidence of exclusive failures in comparison with standard instrumentation failure modes in spine surgery.Method: The US Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) databases were searched for reports on MAGEC rods, and on standard instrumentation used for spinal fusion. The adverse events were recorded, tabulated, and analyzed.Results: A search of the US FDA MAUDE database yielded reports of 163 device-related adverse events. These included distraction mechanism failure (n=129), rod fracture (n=24), and minor voluntary reports of infection and tissue discoloration (n=10). For standard instrumentation usage in spine surgery, pedicle screw breakage post surgery (n=336), set screw damage during surgery (n=257), rod breakage post surgery (n=175), interbody cage breakage during surgery (n=118), and pedicle screw breakage during surgery (n=75) were identified as the top 5 failure modes.Conclusion: The study identified the distraction mechanism failure as the most common and growing complication associated with MAGEC rod usage in children with scoliosis, leading to unplanned invasive revision surgeries.

著者

Keiji Nagata Yuyu Ishimoto Shinichi Nakao Shoko Fujiwara Toshiko Matsuoka Tomoko Kitagawa Masafumi Nakagawa Masakazu Minetama Mamoru Kawakami

出版者

The Japanese Society for Spine Surgery and Related Research

雑誌

Spine Surgery and Related Research (ISSN:2432261X)

巻号頁・発行日

vol.2, no.3, pp.177-185, 2018-07-25 (Released:2018-07-27)

参考文献数

32

被引用文献数

5

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Introduction: The aims of the present study were 1) to examine the association between neck and shoulder pain (NSP) and lifestyle in the general population and 2) to examine if sagittal spino-pelvic malalignment is more prevalent in NSP.Methods: A total of 107 volunteers (mean age, 64.5 years) were recruited in this study from listings of resident registrations in Kihoku region, Wakayama, Japan. Feeling pain or stiffness in the neck or shoulders was defined as an NSP. The items studied were: 1) the existence or lack of NSP and their severity (using VAS scale), 2) Short Form-36 (SF-36), 3) Self-Rating Questionnaire for Depression (SRQ-D), 4) Pain Catastrophizing Scale (PCS), 5) a detailed history consisting of 5 domains as being relevant to the psychosocial situation of patients with chronic pain, 6) A VAS of pain and numbness to the arm, and from thoracic region to legs. The radiographic parameters evaluated were also measured. Participants with a VAS score of 40 mm or higher and less were divided into 2 groups. Association of SF-36, SRQ-D, and PCS with NSP were assessed using multiple regression analysis.Results: In terms of QoL, psychological assessment and a detailed history, bodily pain in SF-36, SRQ-D, and family stress were significantly associated with NSP. A VAS of pain and numbness to the arm, and from thoracic region to legs, was significantly associated with NSP. There were no statistical correlations between the VAS and radiographic parameters of the cervical spine. Among the whole spine sagittal measurements, multiple logistic regression analysis showed that sacral slope (SS) and sagittal vertical axis (SVA) were significantly associated with NSP.Conclusion: In this study, we showed the factors associated with NSP. Large SS and reduced SVA were significantly associated with NSP, while cervical spine measurements were not.

著者

Shoichiro Takei Masayuki Miyagi Wataru Saito Takayuki Imura Gen Inoue Toshiyuki Nakazawa Eiki Shirasawa Kentaro Uchida Tsutomu Akazawa Naonobu Takahira Masashi Takaso

出版者

The Japanese Society for Spine Surgery and Related Research

雑誌

Spine Surgery and Related Research (ISSN:2432261X)

巻号頁・発行日

vol.2, no.4, pp.294-298, 2018-10-26 (Released:2018-10-27)

参考文献数

22

被引用文献数

2 7

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Introduction: Patients with spinal muscular atrophy (SMA) usually have progressive scoliosis. Although fusion of the sacrum or pelvis has been recommended for correcting pelvic obliquity (PO), the procedure is invasive. This study determined as to whether performing instrumentation to the fifth lumbar vertebra (L5) is safe and effective for scoliosis in patients with SMA.Methods: Twelve patients with SMA underwent posterior spinal fusion and stopping instrumentation at the L5 level. We evaluated age at surgery, the duration of surgery, blood loss, complications, preoperative and postoperative Cobb angles, and PO.Results: The mean age at surgery was 11.4 years; the mean duration of surgery was 319 minutes, and the mean blood loss was 1170 mL. The Cobb angle improved from 97.3° to 39.1° at 1 month postoperatively (correction rate, 60.9%) and to 42.3° at the final follow-up. PO was corrected from 27.8° to 13.1° at 1 month postoperatively (correction rate, 51.7%) and to 19.8° at the final follow-up. No complications were reported. All patients showed improvement in low back pain, with reduced difficulty while sitting. However, >10% correction loss of PO was observed in 6 patients with high preoperative PO.Conclusions: The correction rate of scoliosis in SMA patients with posterior spinal fusion and instrumentation to the L5 level was acceptable, and no complications occurred. Scoliosis associated with SMA was more rigid and severer than scoliosis associated with Duchenne muscular dystrophy. Correction rates of the Cobb angle and PO in SMA patients with instrumentation to L5 were similar to those in SMA patients with instrumentation to the sacrum or pelvis. Correction loss of PO was greater in patients with high preoperative PO than in those with low preoperative PO. Instrumentation and fusion to L5 for scoliosis in patients with SMA seems safe and effective, except in cases of high preoperative PO.

著者

Costansia Bureta Hiroyuki Tominaga Takuya Yamamoto Ichiro Kawamura Masahiko Abematsu Kazunori Yone Setsuro Komiya

出版者

The Japanese Society for Spine Surgery and Related Research

雑誌

Spine Surgery and Related Research (ISSN:2432261X)

巻号頁・発行日

vol.2, no.3, pp.226-229, 2018-07-25 (Released:2018-07-27)

参考文献数

21

被引用文献数

12

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Introduction: One complication after scoliosis surgery is ileus; however, few reports have described the frequency of and risk factors for this complication. We conducted a retrospective clinical study with logistic regression analysis to confirm the frequency of and risk factors for ileus after scoliosis surgery.Methods: After a retrospective review of data from patients who underwent surgical correction of spinal deformity from 2009 to 2014, 110 cases (age range, 4-73 yr; median, 14 yr) were included in the study. We defined postoperative ileus (POI) as a surgical complication characterized by decreased intestinal peristalsis and the absence of stool for more than 3 days postoperatively. Various parameters were compared between patients with POI and those without POI. Logistic regression analysis was performed to assess the risk factors associated with ileus; a P value of <0.05 was considered statistically significant.Results: Fifteen of 110 (13.6%) cases developed POI. The median height, weight, operation time, and blood loss volume of the patients with versus without POI were 146 versus 152 cm, 39.0 versus 44.0 kg, 387 versus 359 min, and 1590 versus 1170 g, respectively. There were no significant differences between patients with versus without POI in the measured parameters, with the exception of patient height, bed rest period, and presence of neuromuscular scoliosis. Multiple logistic regression analysis revealed neuromuscular scoliosis as a significant risk factor for POI (odds ratio, 4.21; 95% CI, 1.23-14.40).Conclusions: Our findings indicate a high probability of POI after scoliosis surgery, with an incidence of 13.6%. Neurogenic scoliosis, but not lowest instrumented vertebra or correction rate, was a risk factor for POI after scoliosis surgery. Digestive symptoms should be carefully monitored after surgery, particularly in patients with neuromuscular scoliosis.