Research Achievements - Original paper -
-
Tsuchie H.
International Journal of Clinical Oncology ( International Journal of Clinical Oncology ) 23 ( 4 ) 775 - 782 2018.08
Research paper (journal)
-
Miyakoshi N.
BMC Surgery ( BMC Surgery ) 18 ( 1 ) 38 2018.06
Research paper (journal)
Background: Safe excision of spinal cord tumors depends on sufficient visualization of the tumor and surrounding structures. In patients with spinal cord tumor adjacent to a stenotic spinal canal, extensive bony decompression proximal and distal to the tumor should be considered for safer excision of the tumor. Extensive wide laminectomy is one choice for such cases, but postoperative problems such as kyphotic deformity remain a concern. Case presentation: A 76-year-old man and a 60-year-old woman presented with symptomatic intradural extramedullary spinal cord tumors in the cervical spine. Both patients showed a combination of spondylotic changes in the cervical spine and stenotic condition at the level of the tumor. Both tumors were successfully resected through open-door laminoplasty with hydroxyapatite (HA) spacers, with the tumor located on the side of the laminoplasty. Histological diagnosis was schwannoma for both tumors. HA spacers completely bonded to the host bone and did not interfere with postoperative magnetic resonance imaging (MRI) of the inside of the spinal canal. Cervical spine alignment was maintained at the final follow-up of 6 years in both cases. Conclusion: Laminoplasty with HA spacers enabled successful tumor extirpation, reliable MRI follow-up after surgery, and maintenance of normal cervical spine alignment. Laminoplasty with HA spacers represents a good option for the treatment of cervical spinal cord tumor in patients combined with spinal stenosis.
-
Kasukawa Y.
Pain Practice ( Pain Practice ) 18 ( 5 ) 625 - 630 2018.06
Research paper (journal)
Purpose: We aimed to evaluate the incidence of (and risk factors for) postoperative pregabalin and/or limaprost to treat persistent numbness and/or pain of the lower extremities after lumbar spinal stenosis (LSS) surgery. Methods: Medical records of 329 patients (168 men, 161 women
average age 70 years) were retrospectively reviewed for data on the duration of LSS diagnosis
LSS disease
preoperative medication (limaprost, pregabalin, or combined limaprost/pregabalin
duration)
symptoms
preoperative/postoperative intermittent claudication (IC)
operation type
and postoperative medication and period. Results: Limaprost, pregabalin, and combined limaprost/pregabalin were prescribed preoperatively for 43%, 7%, and 5% of patients, respectively. At an average of 21 months postoperatively, limaprost, pregabalin, and combined therapy were prescribed in 11%, 8%, 4% of patients, respectively. Medication requirement was significantly lower postoperatively than preoperatively (P <
0.0001). Significant risk factors for required postoperative medication were required preoperative medication (odds ratio [OR] 3.088, 95% confidence interval [CI] 1.679 to 5.681]
postoperative period (OR 1.063, 95% CI 1.031 to 1.096)
and postoperative IC (OR 3.868, 95% CI 1.481 to 10.103). A negative impact from postoperative medication was seen in patients who had undergone decompression surgery (OR 0.589, 95% CI 0.377 to 0.918). Conclusions: Overall, 23% of LSS patients required medication for pain and/or numbness at 21 months postoperatively. Significant factors portending required postoperative medication were preoperative medication, longer postoperative period, and postoperative IC. A negative influence from postoperative medication was seen in patients who had undergone decompression surgery without fusion. -
Reconstruction of a chronically ruptured Achilles tendon using an internal brace: A case report
Chida S.
Journal of Medical Case Reports ( Journal of Medical Case Reports ) 12 ( 1 ) 54 2018.03
Research paper (journal)
Background: We reconstructed a chronically ruptured Achilles tendon and the associated scar tissue using braided polyblend polyethylene sutures (FiberWire
Arthrex Inc.
Naples, FL, USA) and anchors. Case presentation: A 68-year-old Japanese man, who was being treated for right Achilles tendinosis, felt pain in his Achilles tendon when walking and started to find plantar flexion of his ankle joint difficult. As his symptoms persisted, he visited us after 4 weeks. Surgery and orthotic therapy were recommended, but he did not want to undergo these treatments. However, he began to find walking difficult and so underwent surgery 6 months after suffering the injury. The interior of the tendon was curetted, and the ruptured region was subjected to plication using the surrounding scar tissue. Using the percutaneous Achilles repair system (Arthrex Inc.), FiberWire sutures were inserted, and two skin incisions were made on the medial and lateral sides of his calcaneus in the region surrounding the Achilles tendon attachment. SutureLasso (Arthrex Inc.) was passed through, and the proximal FiberWire suture was relayed and fixed with 4.75-mm SwiveLock (Arthrex Inc.). After surgery, his foot was fixed in plaster at 20° plantar flexion of his ankle joint. The plaster was removed 1 week after surgery, and after-treatment was initiated with active dorsiflexion training. No orthosis was used after surgery. As of 16 postoperative months, no re-rupture had occurred. Conclusions: This method might allow post-treatment rehabilitation, and so on, to occur earlier, and, hence, could become an option for the reconstruction of chronically ruptured Achilles tendons. -
Kijima H.
HIP International ( HIP International ) 28 ( 2 ) 145 - 147 2018.03
Research paper (journal)
-
SAITO Hidetomo, SAITO Kimio, SHIMADA Yoichi, AKAGAWA Manabu, TSUKAMOTO Hiroaki, MIYAKOSHI Naohisa
Journal of the Eastern Japan Association of Orthopaedics and Traumatology ( The Eastern Japan Association of Orthopaedics and Traumatology ) 30 ( 2 ) 155 - 163 2018
Research paper (journal)
<p>Around knee osteotomy (AKO), Uni-compartmental Knee Arthroplasty (UKA) and Total Knee Arthroplasty (TKA) were well-established procedure to treat medial osteoarthritis. Physiological joint orientation was re-acquired by Double Level Osteotomy. Depressed medial tibial plateau could be reduced by Tibial Condylar Valgus Osteotomy. Thus, deformity created by medial knee osteoarthritis (OA) could be reduced if use of these procedures even if severely advanced knee OA. We compared the clinical results between TKA and AKO. The subjects were surveyed clinical scores (New KSS, KOOS, Oxford knee score, JOA score) at 36 knees (average age: 71.9 years, follow-up period: 22.4 months) and compared with AKO group (14 knees) and TKA (22 knees). In the New KSS, the AKO group was significantly higher in postoperative functional activity and advanced activity. The subscale pain of KOOS was significantly higher in the TKA group. AKO was supposed to be one of procedures to treat advanced knee OA.</p>
-
Analgesic effects of minodronate in a rat chronic pain model
Kasukawa Y.
Biomedical Research (Japan) ( Biomedical Research (Japan) ) 39 ( 5 ) 261 - 268 2018
Research paper (journal)
<p>We evaluated the analgesic effects of minodronate, alendronate and pregabalin on mechanical and thermal allodynia, as well as changes in bone mineral density and skeletal muscle volume caused by chronic constriction injury (CCI) in an ovariectomized rat. Ovariectomy was performed on four-week-old female Wistar rats. Thereafter, at 8-weeks of age, the left sciatic nerve was ligated to create the chronic pain model (CCI limb), and sham surgery was performed on the right hindlimb. In all rats, either minodronate (0.15 mg/kg/week), alendronate (0.15 mg/kg/week), pregabalin (10 mg/kg/week), or their vehicle was administered for 2 weeks starting on the 0th day of CCI. Behavioral evaluations, with von Frey testing and the hot plate test, were performed on days 0, 7 and 14. After 2 weeks, bilateral femurs and tibialis anterior muscles were harvested for bone mineral density and cross sectional area measurements, respectively. Two weeks treatment with minodronate significantly improved mechanical and thermal allodynia evaluated by the von Frey and hot plate tests in the CCI limb (<i>P</i> < 0.05). Minodronate and alendronate treatment for 2 weeks significantly increased total femoral bone mineral density in the CCI limb compared with pregabalin or vehicle treatment (<i>P</i> < 0.01). Cross sectional area of the CCI limb in the minodronate group was significantly larger than that of the alendronate group (<i>P</i> < 0.05) and pregabalin group (<i>P</i> < 0.05). Two-week treatment with minodronate, but not alendronate or pregabalin, improved mechanical and thermal allodynia caused by CCI in ovariectomized rats.</p>
-
Urayama Masakazu, Abe Hidekazu, Kamo Keiji, Sugimura Yusuke, Miyakoshi Naohisa, Shimada Yoichi, AORA (Akita Orthopedic group on Rheumatoid Arthritis), Aonuma Hiroshi, Kashiwagura Takeshi, Ito Hiroki, Kobayashi Moto, Sakuraba Tsutomu, Tani Takayuki, Aizawa Toshiaki, Kawano Tetuya
Clinical Rheumatology and Related Research ( The Japanese Society for Clinical Rheumatology and Related Research ) 30 ( 2 ) 114 - 119 2018
Research paper (journal)
<p>Objective: By assessing dropout of rheumatoid arthritis (RA) cases due to inadequate effect of Tocilizumab (TCZ) therapy in the Akita Orthopedic Group on Rheumatoid Arthritis registry, this study aimed to investigate more effective ways to use this drug.Subjects and methods: This study included 177 patients who were treated with TCZ, consisting of 95 treatment-naive patients (group N) and 82 patients switching to TCZ therapy (group S). We retrospectively collected data on patient characteristics, duration of treatment before discontinuation, treatment details after discontinuation, disease activity.Results: TCZ therapy was discontinued due to inadequate effect in 12 patients. Patient mean age was 58 years (range, 44-82 years). Mean disease duration was 120 months (range, 6-366 months). Group N included 4 patients, and group S included 8, all of whom switched from tumor necrosis factor (TNF) inhibitors. The mean duration of TCZ therapy before discontinuation was 30 months (range, 6-67 months). After discontinuation, TCZ was switched to other biopharmaceuticals in 10 patients, consisting of 2 patients who switched to TNF inhibitors and 8 who switched to abatacept (ABT). At the final evaluation, 3 patients switched to TNF inhibitors again. Clinical disease activity index (CDAI) was 20.3 ± 13.4 (mean ± standard deviation) at the start of therapy and 12.4 ± 8.1 at the time of discontinuation. Six patients achieved low disease activity (LDA). CDAI at the final evaluation was 9.5 ± 8.4. LDA was achieved in 8 patients.Conclusion: Dropout cases due to inadequate effect of TCZ for RA included many patients who switched from TNF inhibitors. TNF inhibitors and ABT can equally replace TCZ for dropout cases. TCZ can be more effectively and continuously used, based on comprehensive assessment of its effect.</p>
-
Comparison of Atypical and Osteoporotic Femoral Shaft Fractures in the Elderly: A Multicenter Study
Miura T.
Advances in Orthopedics ( Advances in Orthopedics ) 2018 1068053 2018
Research paper (journal)
Background. In atypical femoral fractures, owing to the high rates of complications and delayed healing that accompany the plate fixation, the most favorable treatment is intramedullary nailing. Although there is insufficient evidence, plate fixation is chosen due to anterolateral bowing of the femur. This study compared the bone healing time and rates of complications in atypical femoral shaft fractures and osteoporotic femoral shaft fractures. Methods. We searched the medical records of 3 institutions in Japan for patients with femoral shaft fractures who visited between 1 January 2010 and 31 December 2015. We identified 65 patients and excluded 37 among these due to high-energy injuries or being younger than 65 years. Among the remaining patients, we identified 17 and 11 women with atypical (AFF group) and osteoporotic femoral shaft fractures (OP group), respectively. Results. In surgical method, there were differences in intramedullary nailing (94.1% versus 27.2%) (p <
0.01). The mean bone healing time was 11.1 months versus 6.7 months in 2 groups (p <
0.01). Iatrogenic femoral fractures during intramedullary nail insertion were observed in both groups, and reoperation was only seen in atypical femoral fractures treated with a plate fixation, but there was no difference in the rate of complications (23.5% versus 9.1%). Conclusions. In the atypical femoral fracture group, intramedullary nailing was more chosen, but the bone healing time was delayed and plate fixation cases needed reoperation. There was no significant difference in the rate of complications between the 2 groups. -
Kimura Ryota, Shimada Yoichi, Matsunaga Toshiki, Iwami Takehiro, Kudo Daisuke, Saitoh Kimio, Hatakeyama Kazutoshi, Watanabe Motoyuki, Takahashi Yusuke, Miyakoshi Naohisa
Progress in Rehabilitation Medicine ( 公益社団法人 日本リハビリテーション医学会 ) 3 ( 0 ) 2018
Research paper (journal)
<p><b>Objective:</b> We developed a rehabilitation robot to assist hemiplegics with gait exercises. The robot was combined with functional electrical stimulation (FES) of the affected side and was controlled by a real-time-feedback system that attempted to replicate the lower extremity movements of the non-affected limb on the affected side. We measured the reproducibility of the non-affected limb movements on the affected side using FES in non-disabled individuals and evaluated the smoothness of the resulting motion. <b>Method:</b> Ten healthy men participated in this study. The left side was defined as the non-affected side. The measured hip and knee joint angles of the non-affected side were reproduced on the pseudo-paralytic side using the robot's motors. The right quadriceps was stimulated with FES. Joint angles were measured with a motion capture system. We assessed the reproducibility of the amplitude from the maximum angle of flexion to extension during the walking cycle. The smoothness of the motion was evaluated using the angular jerk cost (AJC). <b>Results:</b> The amplitude reproduction (%) was 87.9 ± 6.2 (mean ± standard deviation) and 71.5 ± 10.7 for the hip and knee joints, respectively. The walking cycle reproduction rate was 99.9 ± 0.1 and 99.8 ± 0.2 for the hip and knee joints, respectively. There were no statistically significant differences between results with FES versus those without FES. The AJC of the robot side was significantly smaller than that of the non-affected side. <b>Conclusions:</b> A master–slave gait rehabilitation system has not previously been attempted in hemiplegic patients. Our rehabilitation robot showed high reproducibility of motion on the affected side.</p>
-
AKAGAWA Manabu, SAITO Hidetomo, SAITO Kimio, SASAKI Kana, MIYAKOSHI Naohisa, SHIMADA Yoichi
Journal of the Eastern Japan Association of Orthopaedics and Traumatology ( The Eastern Japan Association of Orthopaedics and Traumatology ) 30 ( 1 ) 86 - 88 2018
Research paper (journal)
-
Kudo D.
Clinical Interventions in Aging ( Clinical Interventions in Aging ) 13 1633 - 1638 2018
Research paper (journal)
-
Pyogenic Spondylitis Caused by Methicillin-Resistant <i>Staphylococcus aureus</i> Associated with Tracheostomy followed by Resection of Ossification of the Anterior Longitudinal Ligament.
Hongo M, Miyakoshi N, Fujii M, Kasukawa Y, Ishikawa Y, Kudo D, Shimada Y
Case reports in orthopedics 2018 9076509 2018
Research paper (journal)
-
The relation between bone marrow lesions of knee osteoarthritis and bone strength parameters
FUJII Masashi, KIJIMA Hiroaki, SAITO Hidetomo, NOZAKA Koji, MIYAKOSHI Naohisa, SHIMADA Yoichi
Journal of the Eastern Japan Association of Orthopaedics and Traumatology ( The Eastern Japan Association of Orthopaedics and Traumatology ) 30 ( 1 ) 52 - 56 2018
Research paper (journal)
-
Cervical arachnoid cyst mimicking the cause of cervical radiculopathy: A case report
Kobayashi T.
Interdisciplinary Neurosurgery: Advanced Techniques and Case Management ( Interdisciplinary Neurosurgery: Advanced Techniques and Case Management ) 10 37 - 39 2017.12
Research paper (journal)
-
Kudo D.
European Spine Journal ( European Spine Journal ) 26 ( 12 ) 3156 - 3161 2017.12
Research paper (journal)
Malnutrition is one of the important risk factors for postoperative complications. Transferrin, prealbumin, and retinol-binding protein, so-called rapid turnover proteins (RTPs), may be the better indicators for early detection of nutritional deficits. However, few studies have described the impact of serum RTP levels on postoperative surgical site infection (SSI) in spine surgery. The purpose of this study was to investigate the relationship between preoperative serum RTPs and postoperative SSI.
The data of 105 patients (64 male, 41 female; average age 64.4 years; age range 20-88 years) who underwent spine surgery in a single institution between 2014 and 2015 were retrospectively analyzed. Preoperative total lymphocyte count, serum albumin, transferrin, prealbumin, retinol-binding protein, pre-and postopeartive C-reactive protein (CRP), white blood cell count (WBC), and total lymphocyte count were evaluated. Postoperative CRP, WBC, and total lymphocyte count were repeated two or three times/week until hospital discharge. A broad spectrum penicillin or second generation cephalosporin was administered as a prophylactic antibiotic to each patient. When repeated CRP elevation or lymphopenia (no more than 10% or 1000/mu L) after postoperative day 3 or 4 was observed, possible SSI was diagnosed. Variables between possible SSI group and non-SSI group were compared using Mann-Whitney U or Chi square test. All variables on univariate analysis were included in multiple logistic regression analysis to identify risk factors for possible postoperative SSI.
Thirty-five patients were diagnosed with possible SSI. The mean operative time of possible SSI group was significantly longer (p = 0.036), preoperative total lymphocyte count and serum prealbumin level of possible SSI group were significantly lower (p = 0.002, p = 0.048, respectively) than that of non-SSI group. On univariate analysis, operative time (p = 0.012), preoperative total lymphocyte count (p = 0.041), serum albumin level (p = 0.038), and serum prealbumin level (p = 0.044) were significant contributors to possible SSI, and multiple logistic regression analysis revealed that operative time was the significant contributor to possible SSI (odds ratio 1.008, 95% confidence interval (CI) 1.001-1.015, p = 0.024).
A low prealbumin level is a possible risk factor for early-stage SSI in spine surgery, though it was not statistically significant; operative time was the most important indicator of SSI on multivariate analysis. -
Miyakoshi N.
Asian Spine Journal ( Asian Spine Journal ) 11 ( 5 ) 756 - 762 2017.10
Research paper (journal)
Study Design: A retrospective comparative study. Purpose: To compare perioperative medical complications after posterior approach spinal instrumentation surgery for osteoporotic vertebral collapse (OVC) between patients with primary osteoporosis and those with secondary osteoporosis. Overview of Literature: With increased aging of society, the demand for instrumentation surgery for an osteoporotic spine has been increasing. However, no studies have compared the rates or severities of perioperative complications after spinal instrumentation surgery between patients with primary osteoporosis and those with secondary osteoporosis. Methods: Ninety-one patients with OVC aged =50 years (23 males and 68 females) who underwent posterior approach vertebral replacement with cages or posterior spinal fusion combined with vertebroplasty were divided into primary (n=56) and secondary (n=35) osteoporosis groups. Bone mineral density (BMD), osteoporosis treatment prior to OVC, operative invasiveness, and perioperative medical complications were compared. Results: Diabetes mellitus (51.4%) was the most common cause of secondary osteoporosis, followed by glucocorticoid use (22.9%). No significant differences were seen in terms of age, gender, BMD, osteoporosis treatment, or operative invasiveness, including the number of levels fused, estimated blood loss, and number of patients requiring transfusion. No significant difference in the incidence of perioperative complications were observed between the primary and secondary osteoporosis groups (16.1% vs. 22.9%). However, surgical site infection (SSI) was significantly more frequently seen in the secondary osteoporosis group (11.4%) than in the primary osteoporosis group (1.8%
p <
0.05). One patient in the secondary osteoporosis group developed methicillin-resistant Staphylococcus aureus infection that ultimately required instrument removal. Conclusions: The overall incidence of perioperative medical complications after posterior approach spinal instrumentation surgery for OVC was comparable between the primary and secondary osteoporosis groups under conditions of similar background characteristics and operative invasiveness. However, SSI (particularly more severe cases) occurred more frequently in patients with secondary osteoporosis. -
Sasaki K.
Asian Spine Journal ( Asian Spine Journal ) 11 ( 4 ) 562 - 569 2017.08
Research paper (journal)
Study Design: In vivo biomechanical study using a three-dimensional (3D) musculoskeletal model for elderly individuals with or without pelvic retroversion. Purpose: To evaluate the effect of pelvic retroversion on the sagittal alignment of the spine, pelvis, and lower limb in elderly females while standing and walking. Overview of Literature: Patients with hip-spine syndrome have concurrent hip-joint and spine diseases. However, the dynamic sagittal alignment between the hip joint and spine has rarely been investigated. We used a 3D musculoskeletal model to evaluate global spinopelvic parameters, including spinal inclination and pelvic tilt (PT). Methods: A total of 32 ambulant females (mean age=78 years) without assistance were enrolled in the study. On the basis of the radiographic measurement for PT, participants were divided into the pelvic retroversion group (R-group
PT=20°) and the normal group (N-group
PT <
20°). A 3D musculoskeletal motion analysis system was used to analyze the calculated value for the alignment of spine, pelvis, and lower limb, including calculated (C)-PT, sagittal vertical axis (C-SVA), pelvic incidence, lumbar lordosis, T1 pelvic angle (CTPA), as well as knee and hip flexion angles while standing and walking. Results: While standing, C-PT and C-TPA in the R-group were significantly larger than those in the N-group. Hip angle was significantly smaller in the R-group than in the N-group, unlike knee angle, which did not show difference. While walking, C-SVA and C-TPA were significantly increased, whereas C-PT decreased compared with those while standing. The maximum hip-flexion angle was significantly smaller in the R-group than in the N-group. There was a significant correlation between the radiographic and calculated parameters. Conclusions: The 3D musculoskeletal model was useful in evaluating the sagittal alignment of the spine, pelvis, and leg. Spinopelvic sagittal alignment showed deterioration while walking. C-PT was significantly decreased while walking in the R-group, indicating possible compensatory mechanisms attempting to increase coverage of the femoral head. The reduction in the hip flexion angle in the R-group was also considered as a compensatory mechanism.