Publications by authors named "Fumihiko Eto"

28 Publications

  • Page 1 of 1

Factors affecting the waiting time from injury to surgery in elderly patients with cervical spine injury: A Japanese multicenter survey.

World Neurosurg 2022 Aug 1. Epub 2022 Aug 1.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan.

Objective: The management of cervical spine injuries in the elderly is often complicated by the presence of multiple medical comorbidities, and it is not uncommon for preoperative testing to reveal other conditions that require the postponement of surgery. However, the factors that affect the waiting time from injury to surgery have not been clarified. The purpose of this multicenter database study was to analyze the clinical features and identify the factors affecting the number of days waited between injury and surgery in elderly patients with cervical spine injury.

Methods: We retrospectively reviewed the case histories of 1512 Japanese patients with cervical spinal injury who were seen at among 33 institutions. After excluding patients not initially receiving surgery for cervical spinal injury, 694 patients were ultimately analyzed. Based on a multivariate mixed model, we determined the factors related to the number of days from injury to surgery.

Results: The mean time from injury to surgery was 12.3 days. Multivariate analysis revealed delays of 10.7 days for renal disorder, 7.3 days for anticoagulant use, and 15.2 days for non-surgical thoracolumbar fracture as factors prolonging wait time. In contrast, a C3 or lower spine injury was significantly associated with a shortening of 9.5 days to surgery.

Conclusions: This multicenter database study identified several factors influencing the time between injury and cervical spine surgery in elderly patients. While renal impairment, anticoagulant use, and non-surgical thoracolumbar fracture may increase the number of days to surgery, trauma to C3 or lower may expedite surgical treatment.
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http://dx.doi.org/10.1016/j.wneu.2022.07.104DOI Listing
August 2022

Evaluation of dynamic spinal alignment changes and compensation using three-dimensional gait motion analysis for dropped head syndrome.

Spine J 2022 Jul 22. Epub 2022 Jul 22.

Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.

Background Context: Dynamic kinematic evaluation of spino-pelvic alignment during gait using three-dimensional (3D) motion analysis has been proposed for adult spinal thoracolumbar deformity. That is because conventional full-spine radiographs cannot be used to evaluate dynamic factors. However, dynamic changes in spino-pelvic alignment during gait for dropped head syndrome (DHS) have not been studied using this approach.

Purpose: This study aimed to assess the dynamic changes in spinal-pelvic alignment during gait in patients with DHS using 3D motion analysis.

Study Design: Retrospective review of collected radiographic and kinematic data.

Patient Sample: Nineteen DHS patients with neck pain and/or anterior gaze disturbance.

Outcome Measures: Static spino-pelvic radiological alignment, dynamic spino-pelvic kinematic parameters and electromyogram (EMG) data.

Methods: Center of gravity of the head - C7 sagittal vertical axis (CGH-C7 SVA), C2-C7 SVA, T1 slope; cervical lordosis (CL), C7SVA, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT) and pelvic incidence (PI) were assessed using full-spine radiographs in a standing position to assess static spino-pelvic alignment. The 3D gait motion analysis was conducted during gait. Dynamic kinematic parameters were divided into spinal segments: cervical (C-), thoracic (T-), lumbar (L-) and pelvis (P-). Each spinal segment coronal angle to the pelvic angle, each spinal segment sagittal angle to the pelvic angle and pelvic sagittal angle to the horizontal axis were assessed as dynamic spino-pelvic kinematic parameters. Trunk and lower limb muscle activity during gait were assessed using wireless surface EMG analysis. Dynamic spino-pelvic kinematic variables and muscle activity were compared between the first walking lap and the final lap during gait analysis. The change in dynamic kinematic parameters was correlated with static radiological alignment and electromyographic muscular activity change.

Results: Cervical and thoracic anterior tilt increased significantly after an extended period of walking, indicating that dropped head worsened during gait. An increase of cervical anterior tilt during walking was significantly associated with decreased muscle activity in the cervical paraspinal muscles (r=-0.463, P<0.05) and latissimus dorsi (r=-0.763, p<0.01). Furthermore, significant correlations were found between a change in thoracic sagittal angle to pelvic angle and C7SVA (r=0.683, p<0.01) and LL (r=-0.475, p<0.05). This means that a larger C7SVA and smaller LL were associated with increased thoracic anterior tilt during gait.

Conclusions: The 3D motion analysis for DHS showed that cervical and thoracic anterior tilt significantly increased after extended walking, resulting in worsening of dropped head. Decreased muscle activity of the neck extensor muscles during gait suggests insufficient neck extensor muscle endurance, which was associated with increased cervical anterior tilt. A greater increase in the thoracic anterior tilt during gait was found in DHS patients with a larger C7SVA and smaller LL due to insufficient thoracolumbar compensation for the dropped head. Correction of the cervical spine alone would not be sufficient to improve dropped head in cases with increased thoracic anterior tilt during gait. The results suggest that C7SVA and LL are crucial parameters in the surgical strategy for DHS.
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http://dx.doi.org/10.1016/j.spinee.2022.07.096DOI Listing
July 2022

A Novel Technique for Occipitocervical Fusion with Triple Rod Connection to Prevent Implant Failure.

Cureus 2022 May 8;14(5):e24821. Epub 2022 May 8.

Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN.

Occipitocervical fusion is an effective surgical method for treating various upper cervical disorders. However, complications such as implant failure due to rod breakage have been reported. Therefore, we devised a surgical technique for occipitocervical fusion with a triple rod connection to prevent implant failure. Occipitocervical fusion with triple rod connection was performed in two cases with a high risk of instability such as athetoid cerebral palsy and rheumatoid arthritis. A multiaxial screw (diameter: 4.5 mm) was inserted into the screw hole in the middle of the occipital plate, and subsequently, an additional rod was attached. It was connected to the main rod using an offset connector at the caudal side. The connection of the additional rod was simple and did not interfere with the fusion bed for bone graft between the occipital bone and axis. The head of the screw was crimped to the occipital plate, and the plate was firmly fixed. Moreover, since the head of the screw did not protrude to the dorsal side, the tension of the soft tissue and skin did not increase. No complications occurred after surgery in both cases. In addition, no special instruments were required to connect the additional rod to the main rod in this procedure. Therefore, our technique may be useful as an option to prevent implant failure due to rod breakage at the craniocervical junction.
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http://dx.doi.org/10.7759/cureus.24821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9172811PMC
May 2022

Does surgery improve neurological outcomes in older individuals with cervical spinal cord injury without bone injury? A multicenter study.

Spinal Cord 2022 Jun 11. Epub 2022 Jun 11.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.

Study Design: Retrospective multicenter study.

Objectives: To investigate the neurological outcomes of older individuals treated with surgery versus conservative treatment for cervical spinal cord injury (CSCI) without bone injury.

Setting: Thirty-three medical institutions in Japan.

Methods: This study included 317 consecutive persons aged ≥65 years with CSCI without bone injury in participating institutes between 2010 and 2020. The participants were followed up for at least 6 months after the injury. Individuals were divided into surgery (n = 114) and conservative treatment (n = 203) groups. To compare neurological outcomes and complications between the groups, propensity score matching of the baseline factors (characteristics, comorbidities, and neurological function) was performed.

Results: After propensity score matching, the surgery and conservative treatment groups comprised 89 individuals each. Surgery was performed at a median of 9.0 (3-17) days after CSCI. Baseline factors were comparable between groups, and the standardized difference in the covariates in the matched cohort was <10%. The American Spinal Injury Association (ASIA) impairment scale grade and ASIA motor score (AMS) 6 months after injury and changes in the AMS from baseline to 6 months after injury were not significantly different between groups (P = 0.63, P = 0.24, and P = 0.75, respectively). Few participants who underwent surgery demonstrated perioperative complications such as dural tear (1.1%), surgical site infection (2.2%), and C5 palsy (5.6%).

Conclusion: Conservative treatment is suggested to be a more favorable option for older individuals with CSCI without bone injuries, but this finding requires further validation.
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http://dx.doi.org/10.1038/s41393-022-00818-6DOI Listing
June 2022

Prognostic Factors for Respiratory Dysfunction for Cervical Spinal Cord Injury and/or Cervical Fractures in Elderly Patients: A Multicenter Survey.

Global Spine J 2022 May 26:21925682221095470. Epub 2022 May 26.

Department of Orthopedic Surgery, Graduate School of Medical Sciences, 38305Kyushu University, Fukuoka, Japan.

Study Design: Retrospective Cohort Study.

Objective: The purpose of this study was to investigate the prognosis of respiratory function in elderly patients with cervical spinal cord injury (SCI) and to identify predictive factors.

Methods: We included 1353 cases of elderly cervical SCI patients collected from 78 institutions in Japan. Patients who required early tracheostomy and ventilator management and those who developed respiratory complications were defined as the respiratory disability group. Patients' background characteristics, injury mechanism, injury form, neurological disability, complications, and treatment methods were compared between the disability and non-disability groups. Multiple logistic regression analysis was used to examine the independent factors. Patients who required respiratory management for 6 months or longer after injury and those who died of respiratory complications were classified into the severe disability group and were compared with minor cases who were weaned off the respirator.

Results: A total of 104 patients (7.8%) had impaired respiratory function. Comparisons between the disabled and non-disabled groups and between the severe and mild injury groups yielded distinct trends. In multiple logistic regression analysis, age, blood glucose level, presence of ossification of posterior longitudinal ligament (OPLL), anterior vertebral hematoma, and critical paralysis were selected as independent risk factors.

Conclusion: Age, OPLL, severe paralysis, anterior vertebral hematoma, hypoalbuminemia, and blood glucose level at the time of injury were independent factors for respiratory failure. Hyperglycemia may have a negative effect on respiratory function in this condition.
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http://dx.doi.org/10.1177/21925682221095470DOI Listing
May 2022

Usefulness of the Round Endcap Expandable Cage Placed on the Vertebral Ring Apophysis in Anterior Spinal Reconstruction.

Cureus 2022 Mar 28;14(3):e23586. Epub 2022 Mar 28.

Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, JPN.

Rectangular endcap expandable cages are common in anterior thoracolumbar spine restoration. However, the cage is often too large to place in small, elderly women. In this study, we evaluated a method to place a round endcap expandable cage on the vertebral ring apophysis in elderly women. From April 2017 to August 2020, five women (mean age 75.8 years) underwent anterior-posterior spinal fusion with a round endcap expandable cage on the vertebral ring apophysis at the thoracolumbar junction. The local kyphotic angle, coronal Cobb angle, and intervertebral height were evaluated pre-and postoperatively. Cage subsidence and bone union were evaluated. The mean local kyphotic angle, coronal Cobb angle, and intervertebral height before surgery were 35.2°, 10.0°, and 65.3 mm, respectively. Immediately postoperatively, 1 week and 3 weeks after surgery, the kyphotic angle was 13.4°, 16.6°, and 18.5°; coronal Cobb angle was 2.8°, 2.2°, and 4.3°; and intervertebral height was 76.2 mm, 71.8 mm, and 70.6 mm. Cage subsidence was not observed and the bone union was achieved in all cases. An expandable cage with a round endcap was placed in small, elderly women by inserting the cage over the strong apophysis of the vertebral body. This technique may be useful to reduce the risk of postoperative subsidence and correction loss.
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http://dx.doi.org/10.7759/cureus.23586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9045845PMC
March 2022

Surgical Apgar Score and Controlling Nutritional Status Score are significant predictors of major complications after cervical spine surgery.

Sci Rep 2022 04 22;12(1):6605. Epub 2022 Apr 22.

Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.

Nutritional screening scores, including Controlling Nutritional Status (CONUT) Score and Surgical Apgar Score (SAS), which reflect intraoperative hemodynamics, have been reported to be useful for predicting major postoperative complications in various kinds of surgery. We assessed independent risk factors for major complications after cervical spine surgery using those scoring measurements. We retrospectively reviewed medical records of patients who underwent cervical spine surgery at our institution from 2014 to 2019. Baseline clinical information, including the CONUT Score, and surgical factors, including the SAS, were assessed as risk factors for major postoperative complications. We analyzed 261 patients. Major postoperative complications occurred in 40 cases (15.3%). In the multivariate analysis, SAS (odds ratio [OR], 0.42; P < 0.01), CONUT (OR, 1.39; P < 0.01), and operative time (OR, 1.42; P < 0.01) were significant independent risk factors of major complications. The area under the SAS curve was 0.852 in the receiver operating characteristic curve analysis. Postoperative hospitalization duration was significantly longer in major complications group. Evaluating preoperative nutritional condition and intraoperative hemodynamics with CONUT score and SAS was useful for predicting major postoperative complications of cervical spine surgery. In addition, both scoring measurements are easily calculated, objective evaluations. Perioperative management utilizing those scoring measurements may help prevent them.
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http://dx.doi.org/10.1038/s41598-022-10674-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9033867PMC
April 2022

Characteristics of recurrent cases after conservative therapy in adolescent lumbar spondylolysis.

Sci Rep 2022 03 7;12(1):4019. Epub 2022 Mar 7.

Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.

Occasionally lumbar spondylolysis in adolescents will recur after conservative treatment. The goal of this study was to retrospectively review the conditions in which recurrence transpired in a subset of adolescent patients diagnosed with acute lumbar spondylolysis. A retrospective survey was conducted in 141 patients who had been treated for spondylolysis and had obtained bone union. Twenty subjects were selected who had recurrent lumbar spondylolysis after returning to sports activity following the initial spondylolysis treatment. There were 18 males and two females with an average age at the time of initial visit of 13.3 years and 14.1 years at the time of recurrence. The average period of initial treatment was 101 days, and the average time to recurrence after healing was 149 days. There were three cases at L3, two cases at L4 and 15 cases at L5. At recurrence, 18 patients had unilateral involvement and two patients presented with bilateral occurrence. Four cases did not achieve bony union. In this study, the recurrence rate was 13.2%. Eighty percent of cases had recurrence within six months after healing. After recurrence, 20% of the cases reached pseudoarthrosis. It is useful to take regular MRI images to detect recurrence within six months after returning to sports.
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http://dx.doi.org/10.1038/s41598-022-07884-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8901666PMC
March 2022

Immediate effects of hybrid assistive limb gait training on lower limb function in a chronic myelopathy patient with postoperative late neurological deterioration.

BMC Res Notes 2022 Mar 4;15(1):89. Epub 2022 Mar 4.

Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.

Objective: The Hybrid Assistive Limb (HAL) has recently been used to treat movement disorders. Although studies have shown its effectiveness for chronic myelopathy, the immediate effects of HAL gait training on lower limb function have not been clarified. We conducted HAL gait training and examined its immediate effects on a 69-year-old man with re-deterioration of myelopathy in the chronic phase after surgery for compression myelopathy. The HAL intervention was performed every 4 weeks for 10 total sessions. Immediately before and after each session, we analyzed the patient's walking ability using the 10-m walk test. In the 4th HAL session, the gastrocnemius muscle activity was measured bilaterally using a synchronized motion capture-electromyogram system.

Results: The training effects became steady after the 2nd session. In sessions 2-10, the step length increased from 0.56 to 0.63 m (mean: 0.031 m) immediately after HAL training. The motion capture-electromyogram analyses showed that considerable amounts of gastrocnemius muscle activity were detected during the stance and swing phases before HAL training. During and immediately after HAL training, gastrocnemius activity during the swing phase was diminished. HAL gait training has an immediate effect for inducing a normal gait pattern with less spasticity in those with chronic myelopathy.
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http://dx.doi.org/10.1186/s13104-022-05979-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8896224PMC
March 2022

Functional magnetic resonance imaging of brain activity during hybrid assistive limb intervention in a chronic spinal cord injury patient with C4 quadriplegia.

J Clin Neurosci 2022 May 25;99:17-21. Epub 2022 Feb 25.

Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan. Electronic address:

Hybrid assistive limb (HAL) is a wearable robot, which has recently been used for the treatment of patients with movement disorders including spinal cord injury (SCI). Although several studies have indicated the effectiveness of HAL for SCI patients, changes in brain activity during the HAL intervention have not yet been fully characterized. A 19-year-old man with a chronic SCI resulting in complete C4 quadriplegia underwent five weeks of HAL training for a total of ten sessions. We evaluated his brain activity using task-induced functional MRI (fMRI) after the fourth, sixth and tenth HAL sessions. We also assessed the spasticity of this patient using the modified Ashworth scale (mAs). As controls for the task-induced fMRI, we examined the brain activity in two healthy subjects. The fMRI findings indicated an increased response to a motor imagery task in the patient's cerebral cortex compared to controls. In addition, the activation pattern in his cortex changed during the five weeks of HAL intervention. We observed increased cerebral lateralization in his primary motor cortex. We also found that the laterality index calculated for the precentral gyrus had a significant negative correlation with the total mAs score over the course of the HAL treatment. Our results indicate that the cerebral cortex of the present SCI patient was hyperactive during the imagery task, and the cortical activation was reduced with progression of the HAL treatment.
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http://dx.doi.org/10.1016/j.jocn.2022.02.027DOI Listing
May 2022

A Case of Postoperative Recurrent Lumbar Disc Herniation Conservatively Treated with Novel Intradiscal Condoliase Injection.

Case Rep Orthop 2022 15;2022:3656753. Epub 2022 Feb 15.

Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 3058575 Ibaraki, Japan.

Although postoperative recurrent lumbar disc herniation (rec-LDH) is uncommon, it is a challenging situation that requires revision surgery when conservative treatment fails. Recently, an agent inducing chemical dissolution of the nucleus pulposus using condoliase has been approved as a novel intradiscal treatment for LDH. To date, no evidence has been reported regarding its effectiveness in the treatment of postoperative rec-LDH. A 25-year-old man with a history of LDH in L4/5, who underwent transforaminal full endoscopic lumbar discectomy when he was 17 years old, complained of severe pain radiating to his left leg since 1 month. The straight leg-raising test was limited to 25° on the left side. Lumbar T2-weighted magnetic resonance imaging (MRI) showed intracanal, left-sided transligamentous disc herniation at L4/5 with high-signal intensity. Because the conservative treatment with oral analgesics and selective left L5 nerve root block failed, the patient requested intradiscal condoliase injection instead of revision surgery. There were no adverse events reported after the condoliase treatment, and the pain radiating to the left leg improved within 2 weeks. A lumbar MRI performed 2 months after treatment revealed that the disc herniation had significantly decreased in size. The straight leg-raising test examined 3 months after treatment was negative. In this case, the disc herniation was of the transligamentous type and showed a high-signal intensity on T2-weighted MRI which could be suitably treated by condoliase injection therapy. This case report is the first to suggest that intradiscal condoliase injection could be a useful and novel conservative treatment option to treat postoperative rec-LDH.
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http://dx.doi.org/10.1155/2022/3656753DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8863464PMC
February 2022

Prognostic Factors for Cervical Spinal Cord Injury without Major Bone Injury in Elderly Patients.

J Neurotrauma 2022 05 4;39(9-10):658-666. Epub 2022 Feb 4.

Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan.

In the current aging society, there has been a marked increase in the incidence of cervical spinal cord injury (CSCI) without major bone injury. This multi-center study aimed to identify predictors of neurological improvement in elderly patients with CSCI without major bone injury. The participants were 591 patients aged ≥65 years with CSCI without major bone injury and a minimum follow-up period of three months. Neurologic status was defined using the American Spinal Injury Association (ASIA) impairment scale (AIS). Univariate and multi-variate analyses were performed to identify prognostic factors for walking recovery in AIS A-C cases and full upper extremity motor recovery in AIS D cases. In AIS A-C cases, body mass index (odds ratio (OR): 1.112), magnetic resonance imaging signal change (OR: 0.240), AIS on admission (OR: 3.497), comorbidity of dementia/delirium (OR: 0.365), and post-injury pneumonia (OR: 0.194) were identified as independent prognostic factors for walking recovery. The prevalence of ossification of the posterior longitudinal ligament (OR: 0.494) was also found to be an independent prognostic factor in AIS B and C cases only. In AIS D cases, age (OR: 0.937), upper extremity ASIA motor score on admission (OR: 1.230 [per 5 scores]), and operation (OR: 0.519) were independent prognostic factors for full motor recovery. The severity of AIS at admission was the strongest predictor of functional outcomes. Promoting rehabilitation, however, through measures to reduce cognitive changes, post-injury pneumonia, and unhealthy body weight changes can contribute to greater neurological improvement in AIS A-C cases.
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http://dx.doi.org/10.1089/neu.2021.0351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9081051PMC
May 2022

Paravertebral foramen screw fixation for posterior cervical spine surgery: clinical case series.

J Neurosurg Spine 2021 Oct 22:1-8. Epub 2021 Oct 22.

Objective: The goal of this study was to clarify the clinical utility of paravertebral foramen screws (PVFSs) and to determine intraoperative indicators for appropriate screw placement during posterior cervical fusion surgery to improve its safety.

Methods: The authors included data from 46 patients (29 men and 17 women, mean age 61.7 years) who underwent posterior cervical spine surgery with 94 PVFSs. Of the 94 PVFSs, 77 were used in C6, 9 in C3, 5 in C4, and 3 in C5. According to the cervical lateral radiographic view, the authors divided the 94 PVFSs into 3 groups as follows: a longer group, in which the tip of PVFS was located anteriorly from the line of the posterior wall of the vertebral body (> +0 mm); an intermediate group, in which the screw tip was located up to 2 mm posteriorly to the posterior wall of the vertebral body (-2 to 0 mm); and a shorter group, in which the screw tip was located more than 2 mm posteriorly (< -2 mm). The accuracy of screw placement was assessed using CT imaging in the axial plane, and the proportion of screws penetrating a vertebral foramen or a transverse foramen was compared between the 3 groups. Screw loosening was defined as a lucent zone around the screw evaluated on cervical radiography at 1 year after surgery. Complications related to PVFS insertion and revision surgery related to PVFS were evaluated.

Results: The authors classified 25 PVFSs into the longer group, 43 into the intermediate group, and 26 into the shorter group. The proportion of screws penetrating a vertebral foramen was largest in the shorter group, and the proportion penetrating a transverse foramen was largest in the longer group. Screw loosening was confirmed for 3 of 94 PVFSs. One PVFS inserted in C6 unilaterally within a long construct from C2 to C7 showed loosening, but it did not cause clinical symptoms. Revision surgery was required for 2 PVFSs inserted in C3 bilaterally as the lower instrumented vertebra in occiput-cervical fusion because they pulled out. There was no neurovascular complication related to PVFS insertion.

Conclusions: PVFSs are useful for posterior cervical fusion surgery as alternative anchor screws, and the line of the posterior wall of the cervical body on lateral fluoroscopic images is a potential intraoperative reference to indicate an appropriate trajectory for PVFSs.
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http://dx.doi.org/10.3171/2021.6.SPINE21411DOI Listing
October 2021

Continuous local antibiotic perfusion for patients with surgical site infection after instrumented spinal surgery; a novel technique to retain the implants.

J Clin Neurosci 2021 Nov 13;93:70-74. Epub 2021 Sep 13.

Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba City, Ibaraki 305-8575, Japan.

Objectives: To describe the novel technique of continuous local antibiotic perfusion (CLAP) for a surgical site infection (SSI) after instrumented spinal surgery.

Methods: CLAP was applied to 4 continuous patients at our institution who developed SSI after instrumented spinal surgery.

Results: All 4 patients were successfully treated and the infection was controlled. The implant was retained in all patients. The duration of CLAP ranged from 2 to 3 weeks. The blood level of the antibiotic used (gentamicin) at 1 week after the initiation of CLAP did not increase in any patient. No other adverse events occurred in any patient. Dramatic improvements in laboratory parameters, including the white blood cell (WBC) counts and C-reactive protein (CRP) levels were seen in every patient at 1 week after the initiation of CLAP.

Conclusions: CLAP controlled the infection without severe adverse events in all 4 patients, and the implants were retained. Despite its cost and the discomfort of patients, CLAP may become an option for the treatment of SSIs after instrumented spinal surgery. A large number of case series are needed to verify the efficacy of CLAP for patients with SSIs after instrumented spinal surgery.
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http://dx.doi.org/10.1016/j.jocn.2021.09.001DOI Listing
November 2021

The fatty degeneration of the lumbar erector spinae muscles affects dynamic spinal compensation ability during gait in adult spinal deformity.

Sci Rep 2021 09 10;11(1):18088. Epub 2021 Sep 10.

Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.

This study aimed to investigate whether fat infiltration in lumbar paravertebral muscles assessed by magnetic resonance imaging (MRI) could be related to dynamic sagittal spino-pelvic balance during gait in adult spinal deformity (ASD). This is a retrospective analysis of 28 patients with ASD. The fat infiltration rate of lumbar erector spinae muscles, multifidus muscles and psoas major muscles was measured by T2 weighted axial MRI at L1-2 and L4-5. Dynamic sagittal spinal and pelvic angles during gait were evaluated using 3D motion analysis. The correlation between fat infiltration rate of those muscles with variations in dynamic kinematic variables while walking and static radiological parameters was analyzed. Spinal kyphosis and pelvic anteversion significantly increased during gait. Fat infiltration rate of erector spinae muscles at L1-2 was positively correlated with thoracic kyphosis (r = 0.392, p = 0.039) and pelvic tilt (r = 0.415, p = 0.028). Increase of spinal kyphosis during walking was positively correlated with fat infiltration rate of erector spinae muscles both at L1-2 (r = 0.394, p = 0.038) and L4-5 (r = 0.428, p = 0.023). Qualitative evaluation of lumbar erector spinae muscles assessed by fat infiltration rate has the potential to reflect dynamic spino-pelvic balance during gait.
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http://dx.doi.org/10.1038/s41598-021-97358-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8433155PMC
September 2021

What Trajectory Is Safe for Double Penetrating Endplate Screw Posterior Spinal Fusion Surgery in the Thoracolumbar Region?

World Neurosurg 2021 07 18;151:e972-e978. Epub 2021 May 18.

Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.

Background: The penetrating end plate screw (PES) technique improved the fixation strength of the pedicle screw by penetrating the end plate in posterior fusion. The "double" PES, which is a trajectory that penetrates both the upper end plate of the corresponding vertebra and the lower end plate of the upper adjacent vertebral body, provides a stronger tricortical fixation but requires a stricter trajectory. The purpose of this study was to measure the cephalad angles from T7-L5 that would allow a safe trajectory for "double" PES.

Methods: We analyzed 1078 pedicles of 539 vertebral bodies of 50 consecutive cases (27 males and 23 females, mean age, 63.3 years) who underwent computed tomography (CT) myelography for evaluation of spinal disorders. The mean cephalad angle to obtain the double PES trajectory of each vertebra was examined, except for cases in which the appropriate trajectory would perforate the pedicles.

Results: The cephalad angle for the appropriate trajectory of "double" PES ranged from 23.4 to 37.6 degrees in the thoracic spine and 34.8 to 40.8 degrees in the lumbar spine. The ratio of pedicle perforation was significantly higher at T7 (16%), L4 (26%), and L5 (52%).

Conclusions: It is important to measure the optimal cephalad angle by preoperative computed tomography imaging according to the vertebral level. In L4 and L5, "double" PES should be avoided because it is often unsafe.
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http://dx.doi.org/10.1016/j.wneu.2021.05.027DOI Listing
July 2021

Correlation between osteoarthritis of the atlantoaxial facet joint and a high-riding vertebral artery.

BMC Musculoskelet Disord 2021 May 3;22(1):406. Epub 2021 May 3.

Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan.

Background: A high-riding vertebral artery (HRVA) is an intraosseous anomaly that narrows the trajectory for C2 pedicle screws. The prevalence of a HRVA is high in patients who need surgery at the craniovertebral junction, but reports about HRVAs in subaxial cervical spine disorders are limited. We sought to determine the prevalence of HRVAs among patients with subaxial cervical spine disorders to elucidate the potential risk for VA injury in subaxial cervical spine surgery.

Methods: We included 215 patients, 94 were with a main lesion from C3 to C7 (subaxial group) and 121 were with a main lesion from T1 to L5 (thoracolumbar group). A HRVA was defined as a maximum C2 pedicle diameter of < 3.5 mm on axial CT. The sex, age of patients, body mass index (BMI), osteoarthritis of the atlantoaxial (C1-2) facet joints, and prevalence of a HRVA in the 2 groups were compared and logistic regression was used to identify the factors correlated with a HRVA.

Results: The patients in the subaxial group were younger than those in the thoracolumbar group, but their sex and BMI did not differ significantly between the 2 groups. The mean osteoarthritis grade of the C1-2 facet joints of patients in the subaxial group was significantly higher than that in those in the thoracolumbar group. A HRVA was found in 26 patients of 94 (27.7 %) in the subaxial group and in 19 of 121 (15.7 %) in the thoracolumbar group. The prevalence of a HRVA in the subaxial group was significantly higher and osteoarthritis of C1-2 facet joints correlated significantly with a HRVA.

Conclusions: The prevalence of a HRVA in patients with subaxial cervical spine disorders is higher than in those without and osteoarthritis of the C1-2 facet joints is correlated with a HRVA.
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http://dx.doi.org/10.1186/s12891-021-04275-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8091766PMC
May 2021

Features of sacral alar fatigue fractures in adolescent athletes with overuse.

Sci Rep 2021 04 19;11(1):8420. Epub 2021 Apr 19.

Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.

Three types of sacral alar fatigue fractures are elderly, postnatal, and sport-related. They are most prevalent in athletes during adulthood; there are few reports of sacral alar fatigue fractures in young athletes. The purpose of this study was to analyze sacral alar fatigue fractures in adolescent athletes. Of the 920 patients hospitalized with low back pain, 13 were diagnosed with sacral alar fatigue fractures with magnetic resonance imaging (MRI) abnormalities. We investigated age, sex, sports discipline, span from symptom onset to consultation, laterality, complication with spondylolysis, computed tomography (CT) findings, and treatment span. The average age was 14.5 years old (8-men and 5-women). The most frequent discipline was basketball. The span to consultation was 13.2 days. The number of right-side cases was 9. Seven cases were complicated by bilateral spondylolysis. MRI abnormalities were observed in all the cases. Only two patients showed abnormal findings on CT. Averagely 67 days after treatment, participants returned to their sports. Sacral alar fatigue fractures suggest that the span from onset to consultation is short. Fracture lines are often unclear on CT, and MRI is useful for diagnosis. More than half of the cases in this study were complicated by lumbar spondylolysis.
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http://dx.doi.org/10.1038/s41598-021-87752-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055686PMC
April 2021

Union evaluation of lumbar spondylolysis using MRI and CT in adolescents treated conservatively.

J Orthop Sci 2022 Mar 15;27(2):317-322. Epub 2021 Feb 15.

Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tuskuba, Ibaraki, Japan.

Background: This study evaluated the union rate of acute lumbar spondylolysis in patients treated conservatively, according to the protocol.

Methods: The subjects included high school students and younger patients who were diagnosed with lumbar spondylolysis presenting bone marrow edema. We investigated the union rate, the period until union, unilateral or bilateral, vertebral level, laterality (right or left), and pathological stage at the first visit. Some unilateral cases included bilateral spondylolysis with contralateral pseudarthrotic lesion; therefore, the union rate of the "true" unilateral case in which the contralateral side was normal was calculated. We excluded multi-level lesions.

Results: With conservative treatment for lumbar spondylolysis of 189 lesions in 142 cases, 144 healed and 45 were considered as nonunion. The average treatment period until union was 106 days. The union of "true" unilateral cases in which the contralateral side was normal was noted in 68/71 lesions, but that of bilateral cases was noted in 71/94 lesions. The union in L3, L4, and L5 vertebrae was noted in 15/17, 40/49, and 89/123 lesions, respectively. The union was observed in 63/87 on the right and 86/102 on the left. The union was noted in the pre-lysis, early, and progressive stages in 36/39, 81/97, and 27/53 lesions, respectively. Furthermore, the union was noted in stages 0, 1a, 1b, 1c, and 2 in 13/15, 47/52, 30/36, 34/42, and 20/44 lesions, respectively.

Conclusion: Accurate union evaluation using CT and MRI showed a union rate of 76% with conservative treatment for spondylolysis. The union rate of the "true" unilateral cases in which the contralateral side was normal was 96%, which was significantly higher than that of the bilateral cases. Moreover, the union rate of lesions in the axial progressive stage and sagittal stage 2 was significantly lower than that of lesions in other stages.

Study Design: clinical retrospective study.
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http://dx.doi.org/10.1016/j.jos.2021.01.002DOI Listing
March 2022

Characteristics of relief and residual low back pain after discectomy in patients with lumbar disc herniation: analysis using a detailed visual analog scale.

BMC Musculoskelet Disord 2021 Feb 11;22(1):167. Epub 2021 Feb 11.

Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan.

Background: Several authors have reported favorable results in low back pain (LBP) for patients with lumbar disc herniation (LDH) treated with discectomy. However, detailed changes over time in the characteristics and location of LBP before and after discectomy for LDH remain unclear. To clarify these points, we conducted an observational study to determine the detailed characteristics and location of LBP before and after discectomy for LDH, using a detailed visual analog scale (VAS) bilaterally.

Methods: We included 65 patients with LDH treated by discectomy in this study. A detailed VAS for LBP was administered with the patient under 3 different conditions: in motion, standing, and sitting. Bilateral VAS was also administered (affected versus opposite side) for LBP, lower extremity pain (LEP), and lower extremity numbness (LEN). The Oswestry Disability Index (ODI) was used to quantify clinical status. Changes over time in these VAS and ODI were investigated. Pfirrmann grading and Modic change as seen by magnetic resonance imaging (MRI) were reviewed before and 1 year after discectomy to determine disc and endplate condition.

Results: Before surgery, LBP on the affected side while the patients were in motion was significantly higher than LBP while they were sitting (p = 0.025). This increased LBP on the affected side in motion was improved significantly after discectomy (p < 0.001). By contrast, the residual LBP while sitting at 1 year after surgery was significantly higher than the LBP while they were in motion or standing (p = 0.015). At 1 year following discectomy, residual LBP while sitting was significantly greater in cases showing changes in Pfirrmann grade (p = 0.002) or Modic type (p = 0.025).

Conclusions: Improvement of LBP on the affected side while the patient is in motion suggests that radicular LBP is improved following discectomy by nerve root decompression. Furthermore, residual LBP may reflect increased load and pressure on the disc and endplate in the sitting position.
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http://dx.doi.org/10.1186/s12891-021-04015-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879619PMC
February 2021

A Case of Cardiac Arrest during C1 Laminectomy for Irreducible Atlantoaxial Subluxation.

Case Rep Orthop 2021 18;2021:6691426. Epub 2021 Jan 18.

Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.

We report a case of cardiac arrest, which occurred during C1 laminectomy for irreducible atlantoaxial subluxation, with return of spontaneous circulation (ROSC) upon interruption of the laminectomy. A 60-year-old woman with rheumatoid arthritis presented with neck pain, bilateral finger numbness, and bladder-rectal disturbance. Simple radiograph images showed that the atlantodental interval (ADI) was enlarged to 8 mm, and magnetic resonance imaging revealed severe spinal stenosis at C1. She was diagnosed with cervical spondylotic myelopathy due to atlantoaxial subluxation. Cardiac arrest occurred twice during the C1 laminectomy and occipito-cervical fusion (Occ-C3), and ROSC occurred without any treatment. There was no postoperative worsening of neurological symptoms, and the improvement of sensory and motor palsy was favorable. The pathogenic mechanism was presumed to be trigeminocardiac reflex. Cardiac arrest during upper cervical spine surgery is an important intraoperative complication of which operators should be made aware.
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http://dx.doi.org/10.1155/2021/6691426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834814PMC
January 2021

Factors associated with failure of bony union after conservative treatment of acute cases of unilateral lumbar spondylolysis.

BMC Musculoskelet Disord 2021 Jan 13;22(1):75. Epub 2021 Jan 13.

Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.

Background: If bone union is expected, conservative treatment is generally selected for lumbar spondylolysis. However, sometimes conservative treatments are unsuccessful. We sought to determine the factors associated with failure of bony union in acute unilateral lumbar spondylolysis with bone marrow edema including contralateral pseudarthrosis.

Methods: This study targeted unilateral lumbar spondylolysis treated conservatively in high school or younger students. Conservative therapy was continued until the bone marrow edema disappeared on MRI and bone union was investigated by CT. We conducted a univariate analysis of sex, age, pathological stage, lesion level complicating the contralateral bone defect, lesion level, and intercurrent spina bifida occulta, and variables with p < 0.1 were considered in a logistic regression analysis. An item with p < 0.05 was defined as a factor associated with failure of bony union.

Results: We found 92 cases of unilateral spondylolysis with bone marrow edema and 66 cases were successfully treated conservatively. Failure of bony union in unilateral lumbar spondylolysis with bone marrow edema was associated with progressive pathological stage (p = 0.004), contralateral pseudarthrosis (p < 0.001), and L5 lesion level (p = 0.002). The odds ratio was 20.0 (95% CI 3.0-193.9) for progressive pathological stage, 78.8 (95% CI 13-846) for contralateral pseudarthrosis, and 175 (95% CI 8.5-8192) for L5 lesion level.

Conclusions: Conservative therapy aiming at bony union is contraindicated in cases of acute unilateral spondylolysis when the pathological stage is progressive, the lesion level is L5, or there is contralateral pseudarthrotic spondylolysis.
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http://dx.doi.org/10.1186/s12891-020-03940-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807717PMC
January 2021

Bone Healing in Adolescents with Bilateral L5 Spondylolysis with and without Preexisting Contralateral Terminal Spondylolysis.

Asian Spine J 2021 Dec 28;15(6):747-752. Epub 2020 Dec 28.

Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.

Study Design: Retrospective cohort study.

Purpose: To examine bone healing with conservative treatment in cases of adolescent bilateral L5 spondylolysis.

Overview Of Literature: We classified bilateral L5 spondylolysis, which is the most affected spinal level, by fracture stage and aimed to compare the bone healing rate according to the fracture stage and evaluate the presence of a preexisting contralateral terminal fracture at the diagnosis of fresh spondylolysis.

Methods: We evaluated 48 patients (38 boys and 10 girls) with bilateral L5 spondylolysis diagnosed during or before high school. L5 spondylolysis was classified into two groups: fresh group (bilateral fresh spondylolysis cases), and terminal group (cases wherein one side had fresh spondylolysis and the contralateral side had terminal spondylolysis). We investigated the age of examination and bone healing rate in both groups. We investigated progressive-stage lesions and bone healing rate with or without progressive-stage lesions.

Results: The bone healing rate in the fresh group was significantly higher than that in the terminal group 72.0% vs. 26.1%, p=0.003). In both the groups, the bone healing rate was significantly higher in patients without progressive-stage lesions than in those with progressive-stage lesions.

Conclusions: Bone healing of progressive-stage fresh spondylolysis was not achieved by conservative treatment when contralateral terminal spondylolysis was present in adolescents with bilateral L5 spondylolysis. Our results suggest that bilateral L5 spondylolysis treatment strategies must be determined based on the combination of the stages present.
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http://dx.doi.org/10.31616/asj.2020.0309DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8696065PMC
December 2021

Comparison of clinical results of decompression/fusion surgery for paralysis caused by metastatic spinal tumors of unknown versus known origin.

J Rural Med 2020 Oct 1;15(4):189-193. Epub 2020 Oct 1.

Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan.

Whether or not emergent decompression/fusion surgery for paralysis caused by metastatic spinal tumors of unknown origin improves patient neurological outcome and survival remains unclear. This study aimed to evaluate the clinical outcomes of emergent decompression/fusion surgery for paralysis caused by spinal tumors of unknown or not previously diagnosed origin. Data from the medical records of 11 patients with spinal tumors of unknown origin (study group) were compared with those of 15 patients with metastatic spinal tumors of known origin (control group). The outcome measures were postoperative performance status, motor function evaluated with the Frankel grade, and actual survival after surgery as compared with the estimated survival calculated using the Tokuhashi score. χ analyses were performed to evaluate differences between the groups. The mean performance status was 3.6 preoperatively, which improved to 2.9 postoperatively (<0.05), in the unknown origin group and 3.6 preoperatively, which improved to 2.7 postoperatively (<0.05), in the control group. Seven patients (64%) in the unknown origin group showed improvement in paralysis by ≥1 Frankel grade. By contrast, only 4 patients (27%) in the control group showed improvement in paralysis. The unknown origin group tended to show better improvement (=0.05). All the patients in the unknown origin group underwent adjuvant therapy after definitive diagnosis following surgery. The unknown origin group showed a slight tendency toward better survival than toward the estimated survival. Emergent decompression/fusion surgery for patients with paralysis caused by metastatic tumors of unknown origin is potentially useful for diagnosing tumor origin and improving neurological outcomes and performance status, and thus for extending survival.
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http://dx.doi.org/10.2185/jrm.2020-031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7530598PMC
October 2020

Characteristics of adolescent lumbar spondylolysis with acute unilateral fatigue fracture and contralateral pseudoarthrosis.

J Rural Med 2020 Oct 1;15(4):170-177. Epub 2020 Oct 1.

Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center/Mito Kyodo General Hospital, Japan.

This study aimed to examine the characteristics of lumbar spondylolysis with acute lumbar spondylolysis on one side and pseudoarthrotic spondylolysis on the other, relative to acute lumbar spondylolysis on one side only. Short-tau inversion recovery images obtained through magnetic resonance imaging were used to diagnose 58 patients with acute lumbar spondylolysis with bone marrow edema on one side only. A total of 20 patients who had pars defects on the contralateral side (terminal-stage pseudoarthrotic spondylolysis) were included in the contralateral pseudoarthrosis group (P group). The remaining 38 patients with normal images for the contralateral pars interarticularis were included in the unilateral lesion group, in which the contralateral side was normal (U group). We investigated the union rate, age, sex, lesion laterality, vertebral level, pathological stage, and existing spina bifida occulta in both groups. The P group was characterized by a higher proportion of right-side cases, L5 lesions, more progressed pathological stage, and spina bifida occulta and a significantly lower union rate than the U group. The union rate in patients with lumbar spondylolysis with acute lumbar spondylolysis on one side and pseudoarthrotic spondylolysis on the opposite side was only 15%. We should inform patients with acute unilateral spondylolysis lesions and contralateral pseudoarthrosis about this poor union rate and urge them to choose their therapy accordingly.
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http://dx.doi.org/10.2185/jrm.2020-026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7530601PMC
October 2020

Clinical features of spontaneous spinal epidural hematoma.

J Rural Med 2019 Nov 20;14(2):206-210. Epub 2019 Nov 20.

Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education andTraining Center, Mito Kyodo General Hospital, Japan.

Spontaneous spinal epidural hematoma is rare and therefore difficult to diagnose. This study evaluated the clinical features of this condition in patients admitted to our hospital. We evaluated 12 patients with spontaneous spinal epidural hematoma who were treated at our hospital. We investigated the following variables in these patients: underlying diseases, medications used, initial symptoms, spinal level affected, whether transported to the hospital by ambulance, department where first evaluated, mass lesion on computed tomography with soft tissue window settings, time interval between symptom onset and diagnosis, treatment received, and Frankel classification on arrival and when last observed. Five patients reported the use of antiplatelet or anticoagulant drugs. All patients in this study reported acute onset of severe pain as the initial symptom, and 10 patients reported some degree of paralysis accompanying the pain. With respect to the morbidity level, the cervical region was the most common site of involvement (n=7). Ten patients were transported to the hospital at night via ambulance. Five patients first visited the Department of Internal Medicine. Seven patients presented with a mass lesion on computed tomography with soft tissue window settings. The time interval between symptom onset and diagnosis ranged from 2 hours to 6 days. Three and 9 patients received conservative and surgical treatments, respectively. No patient showed worsening of Frankel classification. Acute onset of severe pain was the most characteristic clinical symptom. Spontaneous spinal epidural hematoma should be included in the differential diagnosis. Computed tomography with soft tissue window settings may rule out cerebrovascular disease and cardiovascular disease, and specifically detect a hematoma. Subsequent magnetic resonance imaging can diagnose a spontaneous spinal epidural hematoma at an early stage.
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http://dx.doi.org/10.2185/jrm.3005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6877928PMC
November 2019

Prevalence of curable and pseudoarthrosis stages of adolescent lumbar spondylolysis.

J Rural Med 2018 Nov 29;13(2):105-109. Epub 2018 Nov 29.

Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Japan.

The aim of this study was to determine the prevalence of curable and pseudoarthrosis stages of adolescent lumbar spondylolysis under high school students complaining of and seeking medical consultation for low back pain. We analyzed age, sex, morbidity, presence of spina bifida occulta (SBO), and competitive sport discipline of patients with lumbar spondylolysis. We then stratified their pathological stage using a modified classification system via magnetic resonance imaging and computed tomography. Of 507 patients, 451 lesions in 268 patients were diagnosed with lumbar spondylolysis (average age, 14.7 years; sex ratio, 215:53 male/female). Morbidity levels were as follows: L1, 1 lesion in 1 patient; L2, 9 lesions in 5 patients; L3, 38 lesions in 25 patients; L4, 106 lesions in 74 patients; L5, 297 lesions in 189 patients, and SBO verified in 111 patients. A total of 264 patients played a specific sport: baseball, 93; soccer, 49; volleyball, 21; track and field, 21; basketball, 20; others, 164. The prevalence of curable- and pseudoarthrosis-stage lumbar spondylolysis was 206 lesions in 142 patients, and 141 lesions in 87 patients, respectively. With 59.3% of patients having curable-stage lumbar spondylolysis, adolescent athletes with low back pain are urged to seek consultation. Furthermore, clinicians should perform magnetic resonance imaging to avoid misdiagnosis.
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http://dx.doi.org/10.2185/jrm.2967DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6288723PMC
November 2018
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