Comprehensive Assessment of Indirect Decompression Through Lateral Lumbar Interbody Fusion for Degenerative Lumbar Spinal Stenosis: A Japanese Orthopedic Association Back Pain Evaluation Questionnaire-Based Analysis.

STUDY DESIGN: A retrospective study. OBJECTIVE: This study aimed to comprehensively evaluate the clinical outcomes of lateral lumbar interbody fusion (LLIF) as an indirect decompression technique for degenerative spondylolisthesis (DS) and concomitant degenerative lumbar spinal stenosis (DLSS) patients. We utilized the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) to assess treatment success and its impact on patient's quality of life (QOL). METHODS: We included 124 patients who underwent LLIF. Pre- and postoperative JOABPEQ evaluations indicated treatment success. Subgroup analysis categorized patients' perceptions of surgery as beneficial or non-beneficial. RESULTS: 89% of patients (110/124) reported satisfaction with LLIF. Lateral lumbar interbody fusion achieved successful indirect decompression, increasing canal diameter and central canal area. Significant improvements occurred across all JOABPEQ domains, notably for low back pain, lumbar function, walking ability, social life function, and mental health. Patients who perceived the surgery as beneficial experienced fewer postoperative complications, lower numeric rating scale scores for pain relief, and greater functional outcome improvements compared to non-beneficial patients. CONCLUSIONS: Our findings highlight the utility of JOABPEQ as a valuable and sensitive tool for assessing treatment effectiveness and patient-reported outcomes in DS and concomitant DLSS patients. Patients undergoing LLIF. The results affirm the favorable outcomes of LLIF as a surgical option for DLSS patients and emphasize the importance of considering patient perspectives when evaluating overall treatment success. The study provides valuable insights into the impact of indirect decompression on patients' QOL, supporting the effectiveness of LLIF as a minimally invasive technique for DLSS and DS management.

Early Radiological Assessment of Static and Expandable Cages in Lateral Single Position for Indirect Decompression- Lateral Lumbar Interbody Fusion.

OBJECTIVE: This study aimed to compare the postoperative alignment of static and expandable cages in lateral single-position (LSP) for indirect decompression in lateral lumbar interbody fusion (LLIF). METHODS: We included sixty-seven patients who underwent LSP-LLIF for lumbar degenerative disease. We performed radiological assessments preoperatively and two weeks postoperatively using computed tomography and magnetic resonance imaging. We divided the patients into the expandable cage group (23 patients) and the static cage group (44 patients). We measured disc height (DH), segmental lordosis (SL), and foraminal area (FA) from computed tomography images and the area of the dural sac from magnetic resonance imaging. We recorded surgical outcomes and complications. RESULTS: Both static and expandable cages demonstrated improvements in DH, SL, FA, and dural sac expansion. However, we found no statistically significant differences in the average change in DH (4.4 ± 2.1 mm vs. 4.2 ± 1.8 mm, P = 0.685), the average change in SL (1.0 ± 4.4° vs. 1.9 ± 3.6°, P = 0.310), or FA change (32.5 ± 31.7 mm2 vs. 34.9 ± 29.5 mm2, P = 0.966) between the expandable and static cage groups. We also found no statistically significant difference in dural sac enlargement between the two groups. We observed no significant differences in operation time, estimated blood loss, or length of hospital stay between the two groups. No severe adverse events or additional surgeries were reported. CONCLUSIONS: In LSP-LLIF without facet joint resection or other posterior techniques, static and expandable cages showed comparable effectiveness in achieving increased DH, SL, FA, and indirect decompression.

Comparison of properties determined using electromechanical assessment (Arthro-BST™) with macroscopic and histological properties in symptomatic human articular cartilage of the hip.

BACKGROUND: Cartilage degeneration is assessed using various methods. Although macroscopic evaluation can directly measure cartilage degeneration, it cannot accurately assess cartilage properties. Histological examination is one of the most accurate methods for evaluating cartilage degeneration. However, it is invasive and requires collection of cartilage tissue. In contrast, the Arthro-BST™ probe can assess cartilage properties noninvasively. This study aimed to evaluate the effectiveness of the Arthro-BST in assessing cartilage degeneration by comparing macroscopic (International Cartilage Repair Society [ICRS] classification) and histological evaluations (modified Mankin score and Osteoarthritis Research Society International [OARSI] histological grade). METHODS: Fourteen femoral heads were excised from 13 patients during surgery to treat hip osteoarthritis or femoral fracture. The ICRS score was used for macroscopic evaluation of cartilage degeneration. The Arthro-BST was applied at sites matching the areas of cartilage damage. The sites assessed using the ICRS classification and Arthro-BST were evaluated histologically (modified Mankin score and OARSI histological grade), and these were compared with the Arthro-BST results. RESULTS: The ICRS classification identified significant differences between grades 1 and 3 (p < 0.01), between grades 1 and 4 (p < 0.01), between grades 2 and 3 (p < 0.01), and between grades 2 and 4 (p < 0.01). Significant correlations were observed between the Arthro-BST results and the ICRS score, modified Mankin score (structure, cellularity, matrix staining, total score), and OARSI histological grade. CONCLUSIONS: In the assessment of hip osteoarthritis, the Arthro-BST results correlated with those of macroscopic and histological evaluations. The Arthro-BST is useful for assessing hip osteoarthritis and may be helpful for noninvasive assessment of cartilage degeneration.

Radiographs assessment of changes in the psoas muscle at L4-L5 level after single-level lateral lumbar interbody fusion in patients with postoperative motor weakness.

The purposes of this study were (1) to investigate postoperative changes in cross-sectional area (CSA) and signal intensity (SI) of the psoas muscle (PS) using magnetic resonance imaging (MRI) and (2) to compare the CSA and SI of the PS between patients with and without motor weakness after single-level lateral lumbar interbody fusion (LLIF) at level L4-L5. Sixty patients were divided into two groups-those with postoperative motor weakness and those without-and the two groups were compared. Baseline demographics and clinical characteristics, such as operation time and blood loss, length of hospital stay, and postoperative complications, were recorded. The CSA and SI of the PS were obtained from the MRI regions of interest defined by manual tracing. Patients who developed motor weakness after surgery were significantly older (p = 0.040). The operation time (p = 0.868), LLIF operative time (p = 0.476), and estimated bleeding loss (p = 0.168) did not differ significantly between groups. In both groups, the CSA and SI of the left and right PS increased after surgery. The change in the CSA of the left PS was significantly higher in patients with weakness (247.6 ± 155.2 mm2) than without weakness (152.2 ± 133.1 mm2) (p = 0.036). The change in SI of the left PS did not differ between the two groups (p = 0.530). To prevent postoperative motor weakness regardless of the operation time, surgeons should be aware of the potential for surgical invasive of the PS during LLIF in older people.

Quality assessment of cellular and tissue-based products using liquid chromatography-tandem mass spectrometry.

We are currently conducting clinical research on cell sheets for cartilage regeneration. One issue with the future use of chondrocyte sheets as cellular and tissue-based products is quality assessment. Currently, chondrocyte sheets are evaluated using invasive methods that cannot be performed on every sheet produced. We report here on our liquid chromatography-tandem mass spectrometry (LC-MS/MS) technique that allows the noninvasive assessment of every sheet using only 50 µl of culture medium. We found that LC-MS/MS could be used to confirm cell sheet viability through the measurement of glucose and glutamine uptake, to estimate extracellular matrix production by measuring serine consumption, to estimate cell kinetics by measuring cytidine and uracil concentrations, and to estimate melanoma inhibitory activity level by measuring pyridoxal concentration. LC-MS/MS may be useful for the noninvasive assessment of products to be used in regenerative medicine.

Assessment of the Safety of Chondrocyte Sheet Implantation for Cartilage Regeneration.

We have previously studied the effects of chondrocyte sheets on the repair and regeneration of articular cartilage by using temperature-responsive culture inserts. On the basis of this work, we succeeded in rapid fabrication of chondrocyte sheets with the use of a coculture method in which inserts were placed between synoviocytes and chondrocytes. Treatment of cartilage defects using layered chondrocyte sheets promotes repair and regeneration; this method is compatible with in vivo osteoarthritis models that reproduce partial-thickness defects. In human stem cell clinical research guidelines, the Ministry of Health, Labour and Welfare (MHLW) approved several applications related to this technology. Indeed, its translation to a clinical setting is already yielding favorable results. In this study, we evaluated the risk of tumorigenesis associated with this treatment and characterized the dynamics of biological processes associated with the posttransplantation cell sheets in vivo. Furthermore, we also confirmed the safety of the procedure by using array comparative genomic hybridization (array CGH) and G-band staining to screen for deleterious genetic aberrations during prolonged subculture of cells. The safety of chondrocytes that were cultured for longer than normal was confirmed by the array CGH and G-band staining results. In addition, tumorigenicity testing confirmed that culture chondrocyte sheets are not tumorigenic. Furthermore, from the evaluation of bioluminescence imaging following implantation of the cell sheets, it was confirmed that the transplanted chondrocytes and synoviocytes remained in the knee joint and did not transfer elsewhere over time. We believe that the technique used in this study is a highly useful method for evaluating the safety of not only chondrocytes but also extensive subculturing in general.

Evaluation of quality of life and neuropathic pain in patients with low back pain using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire.

PURPOSE: To examine the impact that neuropathic or nociceptive pain has on the quality of life (QOL) in patients with low back pain (LBP) using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and the Japanese version of the PainDETECT Questionnaire (PDQ-J). METHODS: Between June 2012 and December 2013, 650 new patients were treated at our institution for LBP. All patients between the ages of 20 and 79 were asked to complete a set of questionnaires including the PDQ-J, a pain visual analog scale (VAS), the JOABPEQ, and the Short Form 36 (SF-36). Based on the PDQ-J scores, participants were classified into three groups: a neuropathic pain group, a nociceptive pain group, and an intermediate mixed pain group. Among them, patients with clear neuropathic and nociceptive LBP were selected. To investigate the differences between neuropathic and nociceptive LBP, diagnosis of spinal disorder, prevalence, age, gender, duration of symptoms, VAS scores, and self-reported general health (SF-36 and JOABPEQ) were compared between the neuropathic and nociceptive pain groups. RESULTS: Of 650 patients with LBP, 331 completed the questionnaires and were enrolled in the study. There were 193 men (58.3 %) and 138 women (41.7 %) with a mean age of 54.5 years (range 20-79 years). From the PDQ-J survey, 49 patients (15 %) were classified as having neuropathic pain, and 190 (58 %) were categorized as having nociceptive pain. Patients in the neuropathic pain group had significantly higher VAS scores and lower SF-36 and JOABPEQ scores compared to the nociceptive pain group. CONCLUSION: We examined the impact of nociceptive or neuropathic LBP on QOL. A comparison of JOABPEQ scores between LBP patients assessed by PDQ-J as having neuropathic pain or nociceptive pain suggests that neuropathic pain affects the social and psychological well-being of LBP patients.

Assessment of expressions of heat shock protein (HSP 72) and apoptosis after ArF excimer laser ablation of the cornea.

We immunohistochemically studied expressions of inducible heat shock protein 70 (HSP 72) and apoptosis of corneas ablated with an ArF excimer laser. The temperature of corneal surfaces and laser-induced optical emission spectra were measured in real time as direct physical parameters related to the ablation mechanism. To the best of the authors' knowledge, there have been no experimental studies regarding the influence of physical parameters directly related to the ablation mechanism on corneal reactions at the cell level after laser ablation. The expression of HSP 72 was mainly localized in the regenerative epithelium, which was confirmed to be caused by laser ablation. The HSP 72 positive cell ratios had a correlation with thermal dose, which was derived from the measured time courses of temperature. Expressions of both HSP 72 and apoptosis depended on the thermal dose and elapsed time after ablation. HSP 72 and apoptosis could be seen up to a few hundred micrometers into the stroma, only at a fluence with an optical breakdown emission. This could have been caused by shock waves induced by the optical breakdown.