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1.
Eur Spine J ; 2020 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-32424638

RESUMO

PURPOSE: Percutaneous pedicle screw (PPS) fixation has been commonly used for various spine surgeries. Rigid PPS fixation is necessary to decrease the incidence of screw loosening in osteoporotic spine. Recently, we have reported biomechanical advantages of augmentation technique using hydroxyapatite (HA) granules for PPS fixation in synthetic bone. However, its biomechanical performance in augmenting PPS fixation for osteoporotic spine has not been fully elucidated. The aim of the present study is to perform a cadaveric biomechanical analysis of PPS fixation augmented with HA granules. METHODS: Thirty osteoporotic lumbar vertebrae (L1-L5) were obtained from 6 cadavers (3 men and 3 women; age 80 ± 9 years; bone mineral density 73 ± 9 mg/cm3). The maximal pullout strength and maximal insertion torque were compared between the screws inserted into the vertebrae with and without augmentation. In toggle testing, the number of craniocaudal toggle cycles and maximal load required to achieve the 2-mm screw head displacement were also compared. RESULTS: The maximal pullout strength in the screws augmented with HA granules was significantly greater compared to those without augmentation (p < 0.05). The augmentation significantly increased the maximal insertion torque of the screws (p < 0.05). Moreover, the number of toggle cycles and the maximal load required to reach 2 mm of displacement were significantly higher in the augmented screws (p < 0.05). CONCLUSION: The PPS fixation was significantly enhanced by the augmentation with HA granules in the osteoporotic lumbar spine. The PPS fixation augmented with HA granules might decrease the incidence of screw loosening and implant failure in patients with osteoporotic spine.

2.
J Neurotrauma ; 2020 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-32233738

RESUMO

Autophagy is the degradation process of dysfunctional intracellular components and has a crucial function in various human diseases. There are three different types of autophagy: macroautophagy, microautophagy, and chaperone-mediated autophagy (CMA). CMA is a major route for the elimination of cellular aberrant proteins and can provide a cytoprotective effect. The present study investigated the expression of lysosome-associated membrane protein type 2A (LAMP2A), which is the hallmark of CMA activity, in damaged neural tissue after spinal cord injury (SCI) in mice. The number of LAMP2A-expressing cells was significantly increased at the lesion following SCI. The increased number of LAMP2A-positive cells was observed from 24 h and peaked at 3 days after injury. A western blot analysis confirmed that the level of LAMP2A protein was significantly increased in the injured spinal cord compared with the uninjured cord. On double staining for LAMP2A and different neural cell type markers, the increased expression of LAMP2A was observed in neurons, astrocytes, oligodendrocytes, and microglia/macrophages following injury. An electron microscopic analysis showed that secondary lysosomes were increased in damaged neurons at the lesion site. Immunoelectron microscopy revealed that the gold particles with anti-LAMP2A antibody were frequently localized at the secondary lysosomes in the injured site. These findings indicated that CMA was clearly activated in damaged neural tissue after SCI. The activation of CMA may contribute to the elimination of intracellular aberrant proteins and exert a neuroprotective effect following SCI.

3.
Exp Neurol ; 328: 113251, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32087252

RESUMO

Low-energy extracorporeal shock wave therapy (ESWT) has been used to treat various human diseases. Previous studies have shown that low-energy ESWT promotes the release of various cell growth factors and trophic factors from the cells surrounding the target lesion. The aim of the current study was to determine whether the application of low-energy ESWT upregulates the expression of brain-derived neurotrophic factor (BDNF) and reduces neural tissue damage and functional impairment using a rat model of thoracic spinal cord contusion injury. We found that low-energy ESWT promoted BDNF expression in the damaged neural tissue. The expression of BDNF was increased in various neural cells at the lesion. Additionally, low-energy ESWT increased the area of spared white matter and the number of oligodendrocytes in the injured spinal cord compared with untreated control animals. There were more axonal fibers around the injured site after the application of low-energy ESWT than control. Importantly, low-energy ESWT improved the locomotor functions evaluated by both the BBB scale and ladder rung walking test in addition to the sensory function measured using a von Frey test. Moreover, the electrophysiological assessment confirmed that the conductivity of the central motor pathway in the injured spinal cord was restored by low-energy ESWT. These findings indicate that low-energy ESWT promotes BDNF expression at the lesion site and reduces the neural tissue damage and functional impairment following spinal cord injury. Our results support the potential application of low-energy ESWT as a novel therapeutic strategy for treating spinal cord injury.

4.
Cells ; 8(12)2019 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-31817643

RESUMO

The receptor-interacting protein kinase 3 (RIPK3) is a key regulator of necroptosis and is involved in various pathologies of human diseases. We previously reported that RIPK3 expression is upregulated in various neural cells at the lesions and necroptosis contributed to secondary neural tissue damage after spinal cord injury (SCI). Interestingly, recent studies have shown that the B-RAFV600E inhibitor dabrafenib has a function to selectively inhibit RIPK3 and prevents necroptosis in various disease models. In the present study, using a mouse model of thoracic spinal cord contusion injury, we demonstrate that dabrafenib administration in the acute phase significantly inhibites RIPK3-mediated necroptosis in the injured spinal cord. The administration of dabrafenib attenuated secondary neural tissue damage, such as demyelination, neuronal loss, and axonal damage, following SCI. Importantly, the neuroprotective effect of dabrafenib dramatically improved the recovery of locomotor and sensory functions after SCI. Furthermore, the electrophysiological assessment of the injured spinal cord objectively confirmed that the functional recovery was enhanced by dabrafenib. These findings suggest that the B-RAFV600E inhibitor dabrafenib attenuates RIPK3-mediated necroptosis to provide a neuroprotective effect and promotes functional recovery after SCI. The administration of dabrafenib may be a novel therapeutic strategy for treating patients with SCI in the future.

5.
J Orthop Sci ; 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31672380

RESUMO

BACKGROUND: Ossification of the posterior longitudinal ligament of the spine (OPLL) is characterized by heterotopic bone formation in the posterior longitudinal ligament of the spine. We know that the size and distribution of the ossified lesions in patients with OPLL are different in each case. However, the characteristics of the patients with radiologically severe cervical OPLL remain unknown. METHODS: The participants of our study were symptomatic patients with cervical OPLL who were diagnosed by standard radiographs of the cervical spine. Whole-spine CT data and demographic data such as age and sex were obtained from 20 institutions belonging to the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. According to the number of the levels involved by OPLL, we stratified the patients into two subgroups: severe group (S-group) and non-severe group (NS-group) to delineate the characteristics of radiologically severe patients with cervical OPLL. We also evaluated the most compressed level and the degree of occupying ratio of cervical spinal canal by OPLL at the most compressed level. RESULTS: A total of 234 patients with a mean age of 65 years were recruited. The S-group consisted of 48 patients (21%, 12 females and 36 males) and the NS-group consisted of 92 patients (79%, 22 females and 70 males). The mean age of males in the S-group (68 years old) was significantly higher than that of males in the NS-group (64 years old); however there was no significant difference in the mean age in females between the S-group (69 years old) and the NS-group (66 years old). No significant difference of body mass index, ossification of the nuchal ligament-positivity and presence of diabetes mellitus were found between the S- and the NS-group. CONCLUSIONS: It is likely that the manner of extension of cervical OPLL is different between male and female patients.

6.
Spine Surg Relat Res ; 3(4): 304-311, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31768449

RESUMO

Introduction: Laminoplasty is a common surgery for cervical myelopathy. Previous studies have analyzed the reoperation rates in posterior decompression surgeries of the cervical spine. However, few studies have solely focused on midline-splitting laminoplasty (MSL) using a large number of patients. This aims to analyze the reoperation rates after MSL using the survival function method. Methods: Between 1988 and 2013, 4,208 MSLs were performed as a primary operation for cervical myelopathy and enrolled in our spinal surgery registration system. The Kaplan-Meier survival function method was used to analyze the rates of reoperation. Results: Of 4,208 patients with primary MSL, 40 underwent reoperation for neurological complications. The overall reoperation rate was 0.26%, 0.64%, 0.83%, 0.93%, and 0.95% at 1, 5, 10, 20, and >20 years, respectively. The causes of reoperation were postoperative cervical radiculopathy in 10 patients, stenosis at an adjacent level in 8, stenosis due to failed "open-door" lamina in 6, instability of the cervical spine in 4, cervical disc herniation in 3, elongation of ossification of the posterior longitudinal ligament in 3, spinal cord injury in 1, fracture of the cervical spine in 1, postoperative scar formation in 1, ossification of anterior longitudinal ligament in 1, and unknown in 2. The number of patients with surgical site infection (SSI) who needed surgical debridement was 34 (0.81%). Conclusions: Excluding reoperations for SSI, the reoperation rate of MSL was approximately 1.0% at the maximum of 26 years after surgery. MSL was determined to be a reliable surgical procedure regarding postoperative complications requiring additional surgeries.

7.
PLoS One ; 14(9): e0223106, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31557234

RESUMO

INTRODUCTION: Percutaneous pedicle screw (PPS) can provide internal fixation of the thoracolumbar spine through a minimally invasive surgical procedure. PPS fixation has been widely used to treat various spinal diseases. Rigid fixation of PPS is essential for managing osteoporotic spine in order to prevent the risks of screw loosening and implant failure. We recently developed a novel augmentation method using hydroxyapatite (HA) granules for PPS fixation. The aim of this study was to evaluate the strength and stiffness of PPS fixation augmented with HA granules using an osteoporotic bone model. METHODS: Screws were inserted into uniform synthetic bone (sawbones) with and without augmentation. The uniaxial pullout strength and insertion torque of the screws were evaluated. In addition, each screw underwent cyclic toggling under incrementally increasing physiological loads until 2 mm of screwhead displacement occurred. The maximal pullout strength (N), maximal insertion torque (N·cm), number of toggle cycles and maximal load (N) required to achieve 2-mm screwhead displacement were compared between the screws with and without augmentation. RESULTS: The maximal pullout strength was significantly stronger for screws with augmentation than for those without augmentation (302 ± 19 N vs. 254 ± 17 N, p < 0.05). In addition, the maximal insertion torque was significantly increased in screws with augmentation compared to those without augmentation (48 ± 4 N·cm vs. 26 ± 5 N·cm, p < 0.05). Furthermore, the number of toggle cycles and the maximal load required to reach 2 mm of displacement were significantly greater in screws with augmentation than in those without augmentation (106 ± 9 vs. 52 ± 10 cycles; 152 ± 4 N vs. 124 ± 5 N, p < 0.05). CONCLUSIONS: Augmentation using HA granules significantly enhanced the rigidity of PPS fixation in the osteoporotic bone model. The present study suggested that novel augmentation with HA granules may be a useful technique for PPS fixation in patients with osteoporotic spine.

9.
World Neurosurg ; 129: e216-e223, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31125780

RESUMO

OBJECTIVE: Giant sacral schwannomas are rare and difficult to treat. Unexpected neurologic deficits after surgery and tumor recurrence should be considered when surgery is performed. We attempt to remove the tumors via piecemeal total or subtotal excision, leaving parts of the capsule adjacent to nerves to preserve the nerves. This study aimed to present the cases of giant sacral schwannoma at our institutions as well as review the relevant literature and to discuss surgical management. METHODS: This study included 11 patients (5 male and 6 female, mean age 53 years) with giant sacral schwannoma who were treated surgically. The clinical features, surgical details, and outcomes were investigated retrospectively. RESULTS: The tumors were intraosseous type in 4 cases, dumb-bell type in 3 cases, and retroperitoneal type in 4 cases. The surgeries were performed by a combined anterior and posterior approach in 4 cases, a posterior approach in 4 cases, and an anterior approach in 3 cases. The tumors were removed via piecemeal total or subtotal excision in 7 cases, partial excision in 3 cases, and enucleation in 1 case. After surgery, symptoms improved in all cases. The tumor recurred in 2 patients after partial excision. No patients receiving piecemeal total or subtotal excision showed recurrence. One patient developed motor weakness after piecemeal subtotal excision, but the symptoms resolved. CONCLUSIONS: Adopting an appropriate surgical approach based on the location of the tumor is important. Piecemeal total or subtotal excision, with parts of the capsule adjacent to nerves left behind may help achieve a good outcome, avoiding a postoperative neurologic deficit.


Assuntos
Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos , Sacro/cirurgia , Raízes Nervosas Espinhais/cirurgia , Adulto , Idoso , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Estudos Retrospectivos , Sacro/diagnóstico por imagem , Sacro/patologia , Raízes Nervosas Espinhais/diagnóstico por imagem , Raízes Nervosas Espinhais/patologia , Resultado do Tratamento
10.
Int Orthop ; 43(4): 917-922, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30607499

RESUMO

PURPOSE: To date, various minimally invasive surgeries for lumbar disc herniation (LDH) have been performed in many countries, including microendoscopic discectomy (MED) and percutaneous endoscopic discectomy (PED). We herein report the surgical indications, current concepts, and techniques of minimally invasive discectomy for LDH, including MED and PED. The postoperative outcomes and risks of complications compared with conventional discectomy are also discussed. METHODS: By reviewing past literatures, the current concepts, surgical techniques, and clinical outcomes were described. RESULTS: Minimally invasive discectomy is generally performed using a transmuscular approach with an endoscopic technique and can reduce muscle and soft tissue damage. The minimal invasiveness can also reduce the severity of postoperative pain and improve patient satisfaction compared with conventional open discectomy. Based on the data of previous systematic reviews and meta-analyses, minimally invasive lumbar discectomy, such as MED and PED, appears to be safe and effective alternatives to open discectomy for patients with symptomatic LDH. These minimally invasive surgeries can provide beneficial effects to shorten the hospital stay and time to return to work. However, minimally invasive discectomy has a demanding learning curve. Only a well-trained surgeon and support team should perform these less invasive procedures. CONCLUSIONS: Clinical evidence supporting the superiority of MED and PED is still limited. Well-designed prospective multicentered randomized controlled trials with large samples are therefore needed in order to draw a convincing conclusion.


Assuntos
Discotomia Percutânea , Discotomia , Procedimentos Cirúrgicos Minimamente Invasivos , Discotomia/métodos , Discotomia Percutânea/métodos , Endoscopia/métodos , Humanos , Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Tempo de Internação , Vértebras Lombares/cirurgia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Prospectivos
11.
J Orthop Sci ; 24(1): 35-41, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30243519

RESUMO

BACKGROUND: Previous studies have shown that patients with cervical ossification of the posterior longitudinal ligament (OPLL) often have co-existing ossification of the nuchal ligament (ONL). However, no studies have focused on ONL and its relevance to the severity of OPLL or ossification of other spinal ligaments, such as anterior longitudinal ligament (OALL), ligamentum flavum (OLF), and supraspinous/interspinous ligament (OSIL). METHODS: In this multicenter study, we investigated ossification of the spinal ligaments in the whole spine computed tomography (CT) images of 233 cervical OPLL patients. The severity of ossification was evaluated using ossification index for each spinal ligament, calculated as the sum of the level of ossification. We compared the severity of ossification in each spinal ligament between patients with ONL and those without ONL. Furthermore, we investigated how the number of segments, where ONL exists, affects the severity of ossification in each spinal ligament. RESULTS: One hundred thirty patients (55.8%) had co-existing ONL in the cervical OPLL patients included in this study. The ONL (+) group included more male and aged patients. The cervical ossification indexes of OPLL and OALL were higher in ONL (+) patients than in ONL (-) patients. The thoracolumbar ossification indexes of OALL and OSIL were also higher in ONL (+) patients. Logistic regression analysis revealed that age, gender and cervical OA-index were independent factors correlating to the existence of ONL. In the cervical spine, both the ossification indexes of OALL and OPLL increased as the levels of ONL increased. Similarly, in the thoracolumbar spine, both the ossification indexes of OALL and OSIL were increased as the levels of cervical ONL increased. In the multiple regression analysis, cervical OA-index and thoracolumbar OSI-index showed significant correlation with the number of ONL levels. CONCLUSIONS: Co-existence of ONL in cervical OPLL patients was associated with the severity of spinal hyperostosis especially in cervical OPLL, OALL, thoracolumbar OALL and OSIL.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Ligamentos Longitudinais/diagnóstico por imagem , Ossificação do Ligamento Longitudinal Posterior/complicações , Ossificação Heterotópica/complicações , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ossificação do Ligamento Longitudinal Posterior/diagnóstico , Ossificação Heterotópica/diagnóstico , Índice de Gravidade de Doença
12.
Int Orthop ; 43(4): 987-993, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30470865

RESUMO

PURPOSE: Adjacent segment degeneration (ASDeg) and disease (ASDis) have become major concerns after fusion surgery. However, there is no definitive data or knowledge about the incidence or risk factors. The review discusses the incidence and risk factors and prevention of ASDeg and ASDis in the relevant literature. METHODS: We performed a systematic review of meta-analyses, randomized control trials, and cohort studies published in English to provide evidence-based information about ASDeg and ASDis. RESULTS: According to a meta-analysis, the pooled incidence of ASDeg after lumbar and cervical fusion surgery was 26.6% and 32.8%, respectively. Approximately 1/4-1/3 of ASDeg progressed to ASDis. Risk factors after cervical fusion surgery were young age, pre-existing disc degeneration, short fusion segment, high T1 slope, disruption of adjacent soft tissue, and plate placement close to the adjacent disc. The risk factors of ASDeg and ASDis after lumbar fusion surgery were age, genetic factors, high body mass index, pre-existing adjacent segment degeneration, laminectomy at the adjacent level of fusion, excessive distraction of the fusion level, insufficient lumbar lordosis, multilevel fixation, floating fusion, coronal wedging of L5-S disc, pelvic tilt, and osteoporosis. Motion-preserving surgeries seem to have less risk of ASDeg and ASDis than conventional fusion surgery both in the lumbar and cervical spine. CONCLUSIONS: The existent literature points out variables involved in ASDeg and ASDis. High evidence-level studies should provide more relevant data to guide strategies for avoiding ASDeg and ASDis.


Assuntos
Degeneração do Disco Intervertebral , Vértebras Lombares , Fusão Vertebral , Humanos , Degeneração do Disco Intervertebral/etiologia , Degeneração do Disco Intervertebral/cirurgia , Laminectomia , Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Fusão Vertebral/efeitos adversos
13.
Clin Spine Surg ; 31(9): E460-E465, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30113323

RESUMO

STUDY DESIGN: This was a retrospective multicenter study. OBJECTIVE: To clarify the progression of diffuse idiopathic skeletal hyperostosis (DISH) using whole-spine computed tomography in patients with cervical ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA: DISH and cervical OPLL frequently coexist, and can cause ankylosing spinal fractures due to biomechanical changes and fragility of the affected vertebrae. The epidemiology and pathophysiology of DISH occurring with cervical OPLL are unclear. MATERIALS AND METHODS: We used whole-spine computed tomography to determine the prevalence of DISH in 234 patients with a diagnosis of cervical OPLL based on plain cervical radiographs. We established a novel system for grading the progression of DISH based on a cluster analysis of the DISH distribution along the spine. We calculated the correlation coefficient between this grading system and patient age. RESULTS: The prevalence of DISH in patients with cervical OPLL was 48.7%. Patients with DISH were significantly older than those who did not have DISH (67.3 vs. 63.4 y; P=0.005). Cluster analysis classified the DISH distribution into 6 regions, based on the levels affected: C2-C5, C3-T1, C6-T5, T3-10, T8-L2, and T12-S1. DISH was observed most frequently at T3-T10. We defined a system for grading DISH progression based on the number of regions involved, from grade 0 to 6. DISH was distributed at T3-T10 in >60% of the grade 1 patients, whereas most patients with DISH at the cervical or lumbar spine were grade 4 or 5. There was a weak but significant correlation between the DISH grade and patient age. CONCLUSIONS: DISH was present in nearly half of the patients with cervical OPLL. DISH was more common in older patients. DISH developed at the thoracic level and progressed into the cervical and/or lumbar spine with age. LEVEL OF EVIDENCE: Level III.


Assuntos
Hiperostose Esquelética Difusa Idiopática/diagnóstico por imagem , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Análise por Conglomerados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência
14.
Clin Spine Surg ; 31(7): E363-E367, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29863595

RESUMO

STUDY DESIGN: This is a prospective multicenter study. SUMMARY OF BACKGROUND DATA: Postoperative spinal cord swelling has been reported in patients with cervical spondylotic myelopathy. In the cases of the spinal cord swelling, the involvement in the intramedullary gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) enhancement on magnetic resonance imaging (MRI) was referred. OBJECTIVE: The prevalence and clinical relevance of postoperative spinal cord swelling and its relationship with intramedullary Gd-DTPA enhancement in patients with cervical spondylotic myelopathy were investigated. SUBJECTS AND METHODS: A total of 683 consecutive patients with cervical spondylotic myelopathy who underwent laminoplasty were examined. T1, T2, and Gd-DTPA-enhanced MRI were performed before surgery. Patients with intramedullary Gd-DTPA enhancement were allocated to the enhancement group. Fifty consecutive cases who did not exhibit intramedullary Gd-DTPA enhancement were allocated to the nonenhancement group. Both groups underwent MRI examinations at 1 month and 1 year after surgery. RESULTS: The prevalence of spinal cord swelling in the enhancement group (26%) was significantly higher than that in the nonenhancement group (4%) (P=0.0038). At 1 year after surgery, spinal cord swelling had resolved in all patients in the nonenhancement group, while it persisted in 3 of 13 patients (23%) in the enhancement group. On multiple regression analysis, intramedullary Gd-DTPA enhancement rather than the spinal cord swelling showed a significant influence in terms of recovery of the Japanese Orthopedic Association score. CONCLUSIONS: Surgical outcomes of patients with postoperative swelling should be evaluated separately according to the presence or absence of intramedullary Gd-DTPA enhancement on MRI. Spinal cord swelling associated with intramedullary Gd-DTPA enhancement was indicative of poor prognosis.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Gadolínio DTPA/química , Imagem por Ressonância Magnética , Medula Espinal/patologia , Medula Espinal/cirurgia , Espondilose/diagnóstico por imagem , Espondilose/cirurgia , Humanos , Modelos Lineares
15.
BMC Musculoskelet Disord ; 19(1): 107, 2018 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-29621987

RESUMO

BACKGROUND: In patients with ossification of the posterior longitudinal ligament (OPLL) in the cervical spine, it is well known that the thoracic ossified lesions often coexist with the cervical lesions and can cause severe myelopathy. However, the prevalence of OPLL at each level of the thoracic and lumbar spinal segments is unknown. The aims of this study were to investigate how often OPLL occurs at each level in the thoracolumbar spine in patients with a radiological diagnosis of cervical OPLL and to identify the spinal levels most likely to develop ossification. METHODS: Data were collected from 20 institutions in Japan. Three hundred and twenty-two patients with a diagnosis of cervical OPLL were included. The OPLL index (OP index), defined as the sum of the vertebral body and intervertebral disc levels where OPLL is present, was used to determine disease severity. An OP index ≥20 was defined as severe OPLL. The prevalence of OPLL at each level of the thoracic and lumbar spinal segments was calculated. RESULTS: Women were more likely to have ossified lesions in the thoracolumbar spine than men. Severe OPLL was significantly more common in women than in men (20% vs. 4.5%). For thoracic vertebral OPLL, the most frequently affected was the T1 segment in both men and women, followed by the T1/2 and T3/4 intervertebral levels in men and women, respectively. Ossified lesions were frequently seen at the intervertebral and vertebral levels around the cervicothoracic and thoracolumbar junctions in men with severe OPLL, whereas OPLL was more diffusely distributed in the thoracic spine in women with severe OPLL. CONCLUSION: Thoracolumbar OPLL occurred most often at T1 in men and at T3/4 in women. In severe OPLL cases, although ossified lesions were frequently seen at the intervertebral and vertebral levels around the cervicothoracic and thoracolumbar junctions in men, OPLL could be observed more diffusely in the thoracic spine in women.


Assuntos
Vértebras Lombares/patologia , Ossificação do Ligamento Longitudinal Posterior/patologia , Vértebras Torácicas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
16.
Clin Case Rep ; 6(1): 63-67, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29375839

RESUMO

Benign notochordal cell tumor is a benign intraosseous lesion, demonstrates characteristic imaging features. The lesion demonstrates low-signal intensity in T1-weighted images, high-signal intensity in T2-weighted images, and no enhancement with contrast medium in MRI and slight osteosclerosis in CT. If typical imaging findings are identified, biopsy is not necessary.

17.
J Neurosurg Sci ; 2018 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-29308631

RESUMO

BACKGROUND: Japan has had a rapidly aging population during the past 30 years. This study aimed to investigate longitudinal changes in the surgical rate for spinal disorders in Miyagi Prefecture (2.35 million inhabitants) with a similar population composition to Japan. METHODS: Data of spinal surgeries were collected using the spine registry by Tohoku University Spine Society. Data on the annual number of spinal surgeries between 1988 and 2014 of all populations, in those aged ≧65 years old, in those aged ≧75 years old, and for each pathology were collected. The annual surgical rate per 100,000 inhabitants was calculated. RESULTS: The surgical rate in 2010-2014 in total, at ≧65 years old, and at ≧75 years old showed 3.2-, 3.8- and 7.1-fold increases, respectively, compared with that in 1988-1989. Degenerative spinal disorders, spinal trauma and pyogenic spondylitis markedly increased, while metastatic spinal tumor and tuberculous spondylitis decreased over time. The surgical rate at ≧75 years with lumbar spinal stenosis showed a 12.6 times increase. CONCLUSIONS: During a rapid period of aging, the rate of spinal surgeries has markedly increased, particularly, that for degenerative disorders. This is the first report on the long-term longitudinal changes in the rate of spinal surgery.

18.
Eur Spine J ; 27(Suppl 3): 386-392, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-28993889

RESUMO

PURPOSE: Primary osseous hemangiopericytoma (HPC) of the spine is exceedingly rare. HPC has malignant potential and has the capacity for metastasis and local recurrence. We herein present the first case of recurrent primary osseous HPC in the thoracic spine that was successfully treated by total spondylectomy at three vertebral levels and spinal reconstruction. METHODS: We performed a two-stage operation for recurrent HPC using anterior and posterior approaches at the T5-T7 vertebrae. The preoperative embolization of the tumor was performed to prevent massive intraoperative bleeding. Then, total spondylectomy was performed (T5-T7) to resect the tumor. Anterior spinal reconstruction and posterior instrumentation were performed, with abundant bone autograft and allograft used to achieve sufficient boney fusion following the removal of the tumor. RESULTS: At 2 years after surgery, the patient had made a sufficient recovery from his symptoms. The bone union was complete without tumor recurrence or implant failure. CONCLUSIONS: Total spondylectomy and spinal reconstruction with instrumentation might be useful for performing the safe and adequate excision of recurrent HPC of the spine. However, patients should be closely monitored to detect local recurrence and the malignant degeneration of the tumor after surgery.


Assuntos
Hemangiopericitoma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Fusão Vertebral/métodos , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/patologia , Adulto , Embolização Terapêutica/métodos , Hemangiopericitoma/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias da Coluna Vertebral/patologia , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X
19.
Spine J ; 18(5): 726-733, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-28870841

RESUMO

BACKGROUND CONTEXT: Previous studies have shown that axial loading during magnetic resonance imaging (MRI) significantly reduces the size of the dural sac compared with conventional MRI in patients with degenerative lumbar disease. In our previous study, axial-loaded MRI showed a significantly larger degree of olisthesis than conventional MRI in patients with degenerative spondylolisthesis (DS). Furthermore, the degree of olisthesis on axial-loaded MRI correlated more strongly with that observed on X-ray in the upright position. However, no study has investigated whether or not the increase in the degree of olisthesis during axial loading correlates with the reduction in the dural sac size and affects the severity of clinical symptoms in patients with DS. PURPOSE: The objective of this study was to determine whether or not the increase in the degree of olisthesis correlates with the reduction of the dural sac cross-sectional area (DCSA) detected on axial-loaded MRI and worsens the severity of clinical symptoms in patients with DS. STUDY DESIGN/SETTING: This is an imaging cohort study. PATIENT SAMPLE: A total of 41 consecutive patients with DS were prospectively evaluated in this study. OUTCOME MEASURES: The outcome measures include the degree of olisthesis, the DCSA, the Pearson correlation coefficient, and the severity of clinical symptoms. MATERIALS AND METHODS: The differences in the degree of olisthesis and the DCSA between conventional and axial-loaded MRIs were determined. The Pearson correlation coefficient of the increase in the degree of olisthesis with the reduction in the DCSA during axial loading was calculated. The reduction in the DCSA and the severity of clinical symptoms in patients exhibiting a ≥2-mm increase in the degree of olisthesis were compared with those in patients exhibiting a <2-mm increase. RESULTS: The increase in the degree of olisthesis was significantly correlated with the reduction in the DCSA during axial loading (Pearson correlation coefficient=0.63, p<.001). The reduction in the DCSA during axial loading in patients with a ≥2-mm increase in the degree of olisthesis (26±3 mm2) was significantly greater than in those with a <2-mm increase (13±2 mm2) (p<.01). Clinical symptoms such as walking distance and activity of daily living evaluated using the Japanese Orthopaedic Association score were significantly worse in patients with a ≥2-mm increase in the degree of olisthesis (117±19 m and 6.7±0.5 points, respectively) than in those with a <2-mm increase (236±36 m and 8.4±0.4 points, respectively) (p<.05). CONCLUSIONS: The present study demonstrated that the increase in the degree of olisthesis was significantly correlated with the reduction in the dural sac size detected on axial-loaded MRI and worsened the severity of clinical symptoms in patients with DS. These results suggest that axial-loaded MRI may be a useful imaging study for detecting dynamic changes in the degree of olisthesis during axial loading to the lumbar spine related to the narrowing of the spinal canal and the severity of clinical symptoms in the assessment of patients with DS.


Assuntos
Imagem por Ressonância Magnética/métodos , Espondilolistese/diagnóstico por imagem , Idoso , Dura-Máter/diagnóstico por imagem , Feminino , Humanos , Região Lombossacral/diagnóstico por imagem , Imagem por Ressonância Magnética/normas , Masculino , Pessoa de Meia-Idade
20.
Eur Spine J ; 27(Suppl 3): 359-367, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-28840353

RESUMO

PURPOSE: Ossification of the ligamentum flavum (OLF) is a possible cause of thoracic myelopathy. We report two rare cases with recurrent thoracic myelopathy caused by OLF markedly re-extended at the same intervertebral level after the primary surgery. METHODS: Both patients had thoracic myelopathy caused by OLF and underwent decompressive laminectomy and resection of the OLF in the primary surgery. However, the neurological conditions gradually deteriorated following recovery after the primary surgery due to the recurrent OLF at the same intervertebral level. RESULTS: These patients were successfully treated by revision surgery via resection of the recurrent OLF and posterior spinal fusion with instrumentation. Two years after the second surgery, the neurological disturbance was resolved satisfactorily, and re-growth of the resected ossified lesion was not observed. CONCLUSIONS: The recurrence of OLF following resection of the ossified lesions is exceedingly rare but should be noted in patients treated surgically for thoracic myelopathy due to OLF.


Assuntos
Ligamento Amarelo/patologia , Ossificação Heterotópica/complicações , Doenças da Medula Espinal/etiologia , Fusão Vertebral/métodos , Feminino , Humanos , Laminectomia/efeitos adversos , Ligamento Amarelo/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/cirurgia , Recidiva , Reoperação/métodos , Doenças da Medula Espinal/cirurgia , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X
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