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1.
J Orthop Sci ; 28(1): 46-91, 2023 Jan.
Article in English | MEDLINE | ID: mdl-35597732

ABSTRACT

BACKGROUND: The Japanese Orthopaedic Association (JOA) guideline for the management of lumbar spinal stenosis (LSS) was first published in 2011. Since then, the medical care system for LSS has changed and many new articles regarding the epidemiology and diagnostics of LSS, conservative treatments such as new pharmacotherapy and physical therapy, and surgical treatments including minimally invasive surgery have been published. In addition, various issues need to be examined, such as verification of patient-reported outcome measures, and the economic effect of revised medical management of patients with lumbar spinal disorders. Accordingly, in 2019 the JOA clinical guidelines committee decided to update the guideline and consequently established a formulation committee. The purpose of this study was to describe the formulation we implemented for the revision of the guideline, incorporating the recent advances of evidence-based medicine. METHODS: The JOA LSS guideline formulation committee revised the previous guideline based on the method for preparing clinical guidelines in Japan proposed by the Medical Information Network Distribution Service in 2017. Background and clinical questions were determined followed by a literature search related to each question. Appropriate articles based on keywords were selected from all the searched literature. Using prepared structured abstracts, systematic reviews and meta-analyses were performed. The strength of evidence and recommendations for each clinical question was decided by the committee members. RESULTS: Eight background and 15 clinical questions were determined. Answers and explanations were described for the background questions. For each clinical question, the strength of evidence and the recommendation were both decided, and an explanation was provided. CONCLUSIONS: The 2021 clinical practice guideline for the management of LSS was completed according to the latest evidence-based medicine. We expect that this guideline will be useful for all medical providers as an index in daily medical care, as well as for patients with LSS.


Subject(s)
Practice Guidelines as Topic , Spinal Stenosis , Humans , Lumbar Vertebrae/surgery , Orthopedics , Spinal Stenosis/surgery , Japan , Societies, Medical
2.
J Bone Miner Metab ; 36(5): 596-604, 2018 Sep.
Article in English | MEDLINE | ID: mdl-29027045

ABSTRACT

Osteoporosis has become a worldwide public health problem, in part due to the fact that it increases the risk of fragility hip fractures (FHFs). The epidemiological assessment of FHFs is critical for their prevention; however, datasets for FHFs in Japan remain scarce. This was a multicenter, prospective, observational study in the northern district of Kyushu Island. Inclusion criteria were age > 60 years with a diagnosis of FHF and acquisition of clinical data by an electronic data capture system. Of 1294 registered patients, 1146 enrolled in the study. Nearly one third of patients (31.8%) had a history of previous fragility fractures. The percentage of patients receiving osteoporosis treatment on admission was 21.5%. Almost all patients underwent surgical treatment (99.1%), though fewer than 30% had surgery within 48 h after hospitalization. Bone mineral density (BMD) was evaluated during hospitalization in only 50.4% of patients. The rate of osteoporosis treatment increased from 21.5% on admission to 39.3% during hospitalization. The main reasons that prescribers did not administer osteoporosis treatment during hospitalization were forgetfulness (28.4%) and clinical judgment (13.6%). Age and female ratio were significantly higher in patients with previous FHFs than in those without. There was a significant difference in the rate of osteoporosis treatment or L-spine BMD values in patients with or without previous FHFs on admission. In conclusion, this study confirmed that the evaluation and treatment of osteoporosis and FHFs is still suboptimal in Japan, even in urban districts.


Subject(s)
Electronic Health Records , Hip Fractures/epidemiology , Osteoporosis/epidemiology , Registries , Aged, 80 and over , Bone Density , Female , Hip Fractures/physiopathology , Hospitalization , Humans , Japan/epidemiology , Male , Osteoporosis/drug therapy , Osteoporosis/physiopathology , Prospective Studies
3.
Skeletal Radiol ; 42(6): 849-51, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23447096

ABSTRACT

We report our experience in two cases of subchondral insufficiency fracture of the femoral head with a history of internal fixation of the femoral neck fracture. Both cases were young females (26 and 43 years old, respectively). Their hip pain occurred more than 2 years and 1 year after the primary surgical treatment, respectively. MRI revealed bone marrow edema pattern, as well as a low-intensity band on the T1-weighted images, which are commonly observed in osteonecrosis. However, the low-intensity bands were parallel to the subchondral bone end-plate, which are characteristic findings of subchondral insufficiency fracture. Both patients were administered anti-inflammatory drugs and/or bisphosphonate. One patient underwent a transtrochanteric curved varus osteotomy 1 year and 9 months after the onset, and the other healed without collapse of the femoral head. Our cases indicate that subchondral insufficiency fractures may need to be considered as one of the possible conditions after the internal fixation of a femoral neck fracture, in addition to posttraumatic osteonecrosis.


Subject(s)
Femoral Neck Fractures/diagnosis , Femoral Neck Fractures/surgery , Femur Head/injuries , Femur Head/pathology , Fracture Fixation, Internal/adverse effects , Fractures, Stress/diagnosis , Fractures, Stress/etiology , Adult , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging/methods , Treatment Outcome
5.
J Clin Neurosci ; 83: 68-70, 2021 Jan.
Article in English | MEDLINE | ID: mdl-33317879

ABSTRACT

Spinal meningioma is a common benign intradural spinal tumor. It has been reported that the local recurrence rate after surgical resection increases with longer follow-up duration. Simpson grade 1 resection could reduce the risk of recurrence, but this procedure needs dural reconstruction, which would cause cerebrospinal fluid (CSF) leakage or iatrogenic spinal cord injury. Saito et al. reported dura preservation technique to reduce the risk of CSF leakage, in which the meningioma together with the inner layer of the dura is removed and the outer layer is preserved for simple dural closure. The long-term outcomes with this technique have never been investigated. In this study, we retrospectively analyzed the data of 38 surgically treated patients (dura preservation technique, 12 patients; Simpson grade 2 resection, 26 patients) to assess the long-term recurrence rate (mean, 121.5 months; range, 60-228 months). The local recurrence rate in the dura preservation group was 8.3% (1 of 12 cases), which was similar to that in Simpson grade 2 resection group (2 of 26 cases [7.7%]). Although this case series did not indicate the significant difference in the recurrence rates between the dura preservation group and Simpson grade 2 group, we consider that this technique still has advantages for surgically less invasiveness in terms of dural reconstruction which is necessary for Simpson grade 1 and higher possibility of complete resection of tumors compared with Simpson grade 2 resection.


Subject(s)
Dura Mater/surgery , Meningeal Neoplasms/surgery , Meningioma/surgery , Neurosurgical Procedures/methods , Adult , Aged , Female , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/epidemiology , Retrospective Studies , Spinal Cord Neoplasms/surgery , Time
6.
Arch Osteoporos ; 16(1): 132, 2021 09 13.
Article in English | MEDLINE | ID: mdl-34515859

ABSTRACT

We examined osteoporosis medication use and factors affecting persistence in 497 patients with fragility hip fractures. Only 25.5% of patients received continuous medication for 3 years, and 44.1% of patients received no treatment. Low Barthel index at discharge was a risk factor for both non-treatment and non-persistence to osteoporosis medication. PURPOSE: Fragility hip fractures (FHF) caused by osteoporosis decrease the quality of life and worsen life expectancy. Use of osteoporosis medication may be an efficient method in the prevention of secondary FHF. However, previous studies have reported low rates of osteoporosis medication and persistence after FHF. This study aimed to evaluate osteoporosis medication use and factors affecting persistence in patients with FHF in the northern Kyushu area of Japan. METHODS: A total of 497 FHF patients aged ≥ 60 years with a 3-year follow-up were included. We prospectively collected data from questionnaires sent every 6 months regarding compliance with osteoporosis medication. We compared baseline characteristics among three groups: no treatment (NT), no persistence (NP), and persistence (P), and conducted multivariable regression models to determine covariates associated with non-treatment (NT vs. NP/P) and non-persistence (NP vs. P). RESULTS: There were 219 (44.1%), 151 (30.4%), and 127 (25.5%) patients in the NT, NP, and P groups, respectively. Factors associated with non-treatment were male sex, chronic kidney disease, no previous osteoporosis treatment, and low Barthel index (BI) at discharge. The only factor associated with non-persistence was a low BI at discharge. Factors associated with a low BI at discharge were male sex, older age, trochanteric fracture, and surgical delay. CONCLUSION: Low BI at discharge is a risk factor for both non-treatment and non-persistence to osteoporosis medication. Therefore, appropriate interventions to improve BI may result in persistence to osteoporosis medication.


Subject(s)
Bone Density Conservation Agents , Hip Fractures , Osteoporosis , Osteoporotic Fractures , Aged , Bone Density Conservation Agents/therapeutic use , Hip Fractures/epidemiology , Humans , Japan/epidemiology , Male , Osteoporosis/drug therapy , Osteoporosis/epidemiology , Osteoporotic Fractures/epidemiology , Osteoporotic Fractures/prevention & control , Patient Discharge , Prospective Studies , Quality of Life
7.
J Neurosurg Spine ; : 1-7, 2019 Dec 27.
Article in English | MEDLINE | ID: mdl-31881534

ABSTRACT

OBJECTIVE: Compression of the spinal cord by thoracic ossification of the posterior longitudinal ligament (T-OPLL) often causes severe thoracic myelopathy. Although surgery is the most effective treatment for T-OPLL, problems associated with surgical intervention require resolution because surgical outcomes are not always favorable, and a small number of patients experience deterioration of their neurological status after surgery. The aim of the present study was to examine the surgery-related risk factors contributing to poor clinical outcomes for myelopathy caused by T-OPLL. METHODS: Data were extracted from the records of 55 patients with thoracic myelopathy due to T-OPLL at institutions in the Fukuoka Spine Group. The mean follow-up period was 5.3 years. Surgical outcomes were assessed using the Japanese Orthopaedic Association (JOA) scale. To investigate the definitive factors associated with surgical outcomes, univariate and multivariate regression analyses were performed with several patient-related and surgery-related factors, including preoperative comorbidities, radiological findings, JOA score, surgical methods, surgical outcomes, and complications. RESULTS: Neurological status improved in 33 patients (60.0%) and deteriorated in 10 patients (18.2%) after surgery. The use of instrumentation was significantly associated with an improved outcome. In the comparison of surgical approaches, posterior decompression and fusion resulted in a significantly higher neurological recovery rate than did anterior decompression via a posterior approach and fusion or decompression alone. It was also found that postoperative neurological status was significantly poorer when there were fewer instrumented spinal levels than decompression levels. CSF leakage was a predictable risk factor for deterioration following surgery. CONCLUSIONS: It is important to identify preventable risk factors for poor surgical outcomes for T-OPLL. The findings of the present study suggest that intraoperative CSF leakage and a lower number of instrumented spinal fusion levels than decompression levels were exacerbating factors for the neurological improvement in T-OPLL surgery.

8.
J Orthop Surg (Hong Kong) ; 27(3): 2309499019866965, 2019.
Article in English | MEDLINE | ID: mdl-31466509

ABSTRACT

PURPOSE: Fragility hip fractures (FHFs) are associated with a high risk of mortality, but the relative contribution of various factors remains controversial. This study aimed to evaluate predictive factors of mortality at 1 year after discharge in Japan. METHODS: A total of 497 patients aged 60 years or older who sustained FHFs during follow-up were included in this study. Expected variables were finally assessed using multivariable Cox proportional hazards models. RESULTS: The 1-year mortality rate was 9.1% (95% confidence interval: 6.8-12.0%, n = 45). Log-rank test revealed that previous fractures (p = 0.003), Barthel index (BI) at discharge (p = 0.011), and place-to-discharge (p = 0.004) were significantly associated with mortality for male patients. Meanwhile, body mass index (BMI; p = 0.023), total Charlson comorbidity index (TCCI; p = 0.005), smoking (p = 0.007), length of hospital stay (LOS; p = 0.009), and BI (p = 0.004) were the counterparts for females. By multivariate analyses, previous vertebral fractures (hazard ratio (HR) 3.33; p = 0.044), and BI <30 (HR 5.42, p = 0.013) were the predictive variables of mortality for male patients. BMI <18.5 kg/m2 (HR 2.70, p = 0.023), TCCI ≥5 (HR 2.61, p = 0.032), smoking history (HR 3.59, p = 0.018), LOS <14 days (HR 13.9; p = 0.007), and BI <30 (HR 2.76; p = 0.049) were the counterparts for females. CONCLUSIONS: Previous vertebral fractures and BI <30 were the predictive variables of mortality for male patients, and BMI <18.5 kg/m2, TCCI ≥5, smoking history, LOS <14 days, and BI <30 were those for females. Decreased BI is one of the independent and preventable risk factors. A comprehensive therapeutic approach should be considered to prevent deterioration of activities of daily living and a higher risk of mortality.


Subject(s)
Activities of Daily Living , Frailty/mortality , Hip Fractures/mortality , Patient Discharge/statistics & numerical data , Aged, 80 and over , Comorbidity , Female , Follow-Up Studies , Hip Fractures/physiopathology , Humans , Japan/epidemiology , Length of Stay/trends , Male , Prognosis , Retrospective Studies , Risk Factors , Survival Rate/trends , Time Factors
9.
PLoS One ; 13(4): e0195946, 2018.
Article in English | MEDLINE | ID: mdl-29664923

ABSTRACT

OBJECTIVE: The aim of this study was to investigate the clinicopathologic features of lumbar disc herniation (LDH) with endplate degeneration and the association between cartilaginous fragments and inflammatory response to the herniated disc. SUMMARY OF BACKGROUND DATA: LDH often involves hyaline cartilage fragments pulled from the vertebral endplates. Modic changes are closely associated with LDH that contains hyaline cartilage, and cartilaginous endplates seem to affect resorption of the herniated disc. METHODS: A total of 78 patients who underwent microscopic discectomy between 9 and 16 weeks after an occurrence of LDH were reviewed. Modic changes, disc degeneration, high-intensity zone, and vertebral corner defect were evaluated using magnetic resonance imaging (MRI). Histopathological observations of cartilaginous endplates and inflamed granulation tissue in the herniated disc were made. In cases with inflamed granulation tissue, neovascularization and macrophage infiltration were also evaluated using immunohistochemical analysis. RESULTS: Modic changes were observed in approximately one-third of the patients (26 cases: type 1, 7; type 2, 17; and type 3, 2). Cartilaginous endplates were observed in 32 cases (41%) and in the majority of cases with Modic changes compared with cases without Modic changes (65%, p = 0.001). Although inflamed granulation tissue was observed in 60 cases (77%), no significant differences were detected in patient age and the composition of the herniated material. Immunohistochemical analysis showed that fewer CD34-positive capillaries and CD68-positive cells were found in cases with cartilaginous fragments compared with those without cartilaginous fragments (p < 0.001). In addition, a higher immunoreactivity to CD34 and CD68 was found in herniated discs <25% of whose area was occupied by cartilaginous endplates compared with discs whose area was occupied at 25% or more (p < 0.001). CONCLUSION: There is an association between LDH with endplate degeneration and cartilaginous herniation, with Modic type 2 predominating. Furthermore, neovascularization and macrophage infiltration, especially if the amount of cartilage is high, are likely to be less frequent in cartilaginous herniation, leading to failure in the spontaneous remission of clinical symptoms.


Subject(s)
Bone Resorption/pathology , Intervertebral Disc Degeneration/pathology , Intervertebral Disc Displacement/pathology , Intervertebral Disc/pathology , Lumbar Vertebrae/pathology , Adult , Aged , Biomarkers , Female , Granulation Tissue/pathology , Humans , Hyaline Cartilage , Immunohistochemistry , Intervertebral Disc Displacement/diagnostic imaging , Macrophages/metabolism , Macrophages/pathology , Magnetic Resonance Imaging/methods , Male , Middle Aged , Neovascularization, Pathologic/metabolism , Neovascularization, Pathologic/pathology
10.
Clin Calcium ; 15 Suppl 1: 92-6; discussion 96-7, 2005 Sep.
Article in Japanese | MEDLINE | ID: mdl-16272639

ABSTRACT

Postmenopausal women on maintenance haemodialysis (MHD) has considerably higher risk of bone fracture than general population with combination of postmenopausal osteoporosis and renal osteodystrophy. However, the treatment of osteoporosis on MHD has not been established. Evidence indicates raloxifene (RLX), a selective estrogen receptor modulator, is effective for a protection of bone fracture without increasing of breast cancer and endometrial cancer. We hereby report short-term use experience of RLX for the postmenopausal MHD patients. Fifteen postmenopausal MHD patients with less than 80% of YAM bone density in DEXA administrated 60 mg RLX on every HD days (3 days/week). Serum NTX level significantly decreased after 6 months (180 +/- 18 vs. 95 +/- 12 nmol/BCE/L, p< 0.05), however, i-PTH did not have the significant difference. (115 +/- 23 vs. 157 +/- 29 pg/mL). RLX is effective for bone biomarker improvement in postmenopausal MHD patients. Further evaluation for the effectiveness and safety of RLX is necessary in the long term.


Subject(s)
Fractures, Spontaneous/etiology , Fractures, Spontaneous/prevention & control , Osteoporosis, Postmenopausal/drug therapy , Raloxifene Hydrochloride/administration & dosage , Renal Dialysis/adverse effects , Selective Estrogen Receptor Modulators/administration & dosage , Aged , Aged, 80 and over , Biomarkers/blood , Bone Density , Collagen/blood , Collagen Type I , Drug Administration Schedule , Female , Humans , Middle Aged , Osteoporosis, Postmenopausal/complications , Osteoporosis, Postmenopausal/metabolism , Peptides/blood , Risk
12.
Spine (Phila Pa 1976) ; 31(3): 303-8, 2006 Feb 01.
Article in English | MEDLINE | ID: mdl-16449903

ABSTRACT

STUDY DESIGN: Clinical radiographic and outcomes investigation. OBJECTIVE: To investigate clinical and radiographic outcomes for lumbosacral fusion (in patients with spinal deformity) using a combination of bilateral sacral and iliac screws with a minimum 5-year follow-up. SUMMARY OF BACKGROUND DATA: To our knowledge, long-term results (>5 years of follow-up) of bilateral S1 screw/bilateral iliac screw fixation have never been published or presented. MATERIALS AND METHODS: A total of 67 patients (from an initial consecutive cohort of 81) undergoing lumbosacral fusion with bilateral sacral and iliac screws with a minimum follow-up of 5 years (range 5-10 + 5, average 6 + 3) were analyzed for radiographic outcome and clinical course by an outcome questionnaire (administered at ultimate follow-up) analysis. Patients were divided into 2 groups: group 1, 34 patients with mostly high-grade spondylolisthesis; and group 2, 33 with adult scoliosis fused mostly from the thoracic spine to the sacrum. A true anteroposterior pelvis film was obtained in all patients to assess for sacroiliac joint arthritis, as were standard spine radiographs. Patients were administered Oswestry and directed buttock pain questionnaires at latest follow-up. RESULTS: There were no cases of sacral screw failure (i.e., screw loosening, partial screw pullout, or fracture of the sacral screw). There were 5 cases of nonunion at L5-S1. Of the 5 cases, 3 did not have anterior column support at L5-S1. Four of the 5 cases were revised, and, subsequently, 3 achieved union. Iliac screws were removed electively on 1 or both sides in 23 of the patients after 2 years postoperatively because of prominence. There were 7 cases of iliac screw breakage. Iliac screw halos were observed in 29 patients. No sacroiliac osteoarthritis was observed on the true anteroposterior pelvis films. At ultimate follow-up, average visual analog painscale (0-10) score to assess buttock pain was 2.4, and average Oswestry score was 20.1. CONCLUSIONS: For high-grade spondylolisthesis and long adult deformity fusions to the sacrum, a montage of bilateral S1 screws and iliac screws were effective in protecting the sacral screws from failure. Pseudarthrosis at L5-S1 was manifested by rod breakage at that level. We saw no evidence of a long-term effect of the iliac screws predisposing the sacroiliac joints to degeneration at follow-up ranging from 5 to 10 years.


Subject(s)
Bone Screws , Ilium/surgery , Pelvic Bones/surgery , Sacrum/surgery , Spinal Diseases/surgery , Spinal Fusion/instrumentation , Adolescent , Adult , Aged , Child , Female , Follow-Up Studies , Humans , Ilium/diagnostic imaging , Internal Fixators , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/surgery , Male , Middle Aged , Pelvic Bones/diagnostic imaging , Radiography , Sacrum/diagnostic imaging , Spinal Diseases/diagnostic imaging , Spinal Fusion/methods
13.
Spine (Phila Pa 1976) ; 29(22): 2533-7, 2004 Nov 15.
Article in English | MEDLINE | ID: mdl-15543069

ABSTRACT

STUDY DESIGN: Retrospective clinical and laboratory data analyses were performed on hemodialysis (HD) patients with bacterial spondylodiscitis. OBJECTIVES: The purpose of this study was to investigate clinical characteristics and related problems for the diagnosis and treatment of spondylodiscitis in patients on maintenance HD. Possible factors for the development of spondylodiscitis were also discussed. SUMMARY OF BACKGROUND DATA: Although bacterial spondylodiscitis is one of most serious complications that can occur in HD patients, few reports are seen describing its clinical course and treatment in HD patients. METHODS: A total of 9 HD patients were diagnosed as having bacterial spondylodiscitis at our institute. The onset of infection, characteristics of clinical symptoms, and clinical course were reviewed retrospectively. RESULTS: Latent form occurrence was most frequent, and only 1 in 9 cases presented high-grade fever at the beginning of treatment. Many complications were encountered both in conservatively treated and operated cases. Three patients were operated on, 1 of whom died 2 days after operation. Two of six patients in the conservatively treated group also died during the treatment period. CONCLUSIONS: The presence of bacterial spondylodiscitis must be considered when treating back pain of HD patients even when they are afebrile. Careful observation of general status in addition to local conditions is essential. Indication of operation should be considered carefully because of the poor general status and bone quality of HD patients. MRI, in addition to plain radiographs, was necessary to differentiate destructive spondylarthropathy from bacterial spondylodiscitis.


Subject(s)
Discitis/diagnosis , Discitis/etiology , Renal Dialysis/adverse effects , Adult , Aged , Aged, 80 and over , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/microbiology , Discitis/microbiology , Female , Humans , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/microbiology , Male , Middle Aged , Radiography , Retrospective Studies , Thoracic Vertebrae/diagnostic imaging , Thoracic Vertebrae/microbiology
14.
Clin Orthop Relat Res ; (394): 236-42, 2002 Jan.
Article in English | MEDLINE | ID: mdl-11795739

ABSTRACT

Seven spontaneous ruptures of major tendons in five patients receiving long-term hemodialysis were reviewed between June 1990 and May 2000. The average age of the two men and the three women was 51.4 years. The average period of hemodialysis was 11 years. The etiology, pathologic focus, frequency, symptoms, problems, and operative indications were examined. Reconstruction using Leeds-Keio artificial tendons provided excellent results in all patients but one. Hyperparathyroidism existed in all patients. Local amyloid depositions were not found in any of the patients. In all patients, the ruptured site was not in the tendon but at the tendon attachment to the bone, which was smooth and completely free from tendon tissue. Thus, the most likely etiology of tendon ruptures in patients receiving hemodialysis was thought to be the fragility of the bone at the tendon attachment attributable to secondary hyperparathyroidism. To prevent this complication, control of hyperparathyroidism may be important, especially in active young patients.


Subject(s)
Plastic Surgery Procedures/methods , Renal Dialysis/adverse effects , Tendon Injuries/etiology , Adult , Aged , Female , Follow-Up Studies , Humans , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/therapy , Long-Term Care , Magnetic Resonance Imaging , Male , Middle Aged , Radiography , Recovery of Function , Renal Dialysis/methods , Retrospective Studies , Risk Assessment , Rupture, Spontaneous/diagnostic imaging , Rupture, Spontaneous/etiology , Rupture, Spontaneous/surgery , Tendon Injuries/diagnostic imaging , Tendon Injuries/surgery , Tendons/diagnostic imaging , Tendons/physiopathology , Tendons/surgery , Treatment Outcome
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