Publications by authors named "Keitaro Minato"

4 Publications

  • Page 1 of 1

Minimally Invasive Spinal Stabilization with Denosumab before Total Spondylectomy for a Collapsing Lower Lumbar Spinal Giant Cell Tumor.

Acta Med Okayama 2021 Feb;75(1):95-101

Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences.

A 21-year-old man consulted our hospital for treatment of a spinal giant cell tumor (GCT) of Enneking stage III. Lower lumbar-spine tumors and severe spinal canal stenosis are associated with high risk for surgical mor-bidity. Stability was temporarily secured with a percutaneous pedicle screw fixation in combination with deno-sumab, which shrank the tumor. Total en bloc spondylectomy was then performed 6 months after initiation of denosumab, and the patient was followed for 3 years. There was no local recurrence, and bony fusion was obtained. Minimally invasive surgery and denosumab allowed safer and easier treatment of a collapsing lower lumbar extra-compartmental GCT.
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February 2021

Indication for drainage for a hematogenous iliopsoas abscess: Analysis of patients initially treated without drainage.

J Orthop Sci 2020 Dec 12. Epub 2020 Dec 12.

Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata city, Japan.

Background: This study aimed to determine the indications for drainage in extended haematogenous iliopsoas abscesses (IPAs), which include both primary and vertebral osteomyelitis-related IPAs.

Methods: Sixty-three IPA patients who were initially treated with only antibiotics and no drainage were enrolled. The success (S) group included patients who were cured without drainage, while the failure (F) group included those who required open or percutaneous drainage or died.

Results: Compared with patients in the S group, patients in the F group (n = 15) had a higher incidence of end-stage renal disease on hemodialysis, compromised immunity, vertebral osteomyelitis of the cervicothoracic spine, other musculoskeletal infections, and multilocular abscesses. The IPAs in the F group had larger transverse and longitudinal diameters. In receiver operating characteristic curve analyses for the diameter of IPAs, the most valuable cut-off points predicting the F group were a longitudinal diameter of 5.0 cm (sensitivity, 1.0; specificity, 0.67) and a transverse diameter of 2.3 cm (sensitivity, 0.73; specificity, 0.73). A combination of both diameter cut-offs had high specificity (sensitivity, 0.73; specificity, 0.90).

Conclusions: Drainage should be applied in case of a larger abscess with transverse diameter ≥ 2.3 cm and longitudinal diameter ≥ 5.0 cm. Conversely, IPAs with longitudinal diameter <5 cm do not require drainage. Haemodialysis, compromised immunity, vertebral osteomyelitis of the cervicothoracic spine, and musculoskeletal infections are risk factors of conservative treatment failure.
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December 2020

Health-Related Quality of Life in Nonoperated Patients With Adolescent Idiopathic Scoliosis in the Middle Years: A Mean 25-Year Follow-up Study.

Spine (Phila Pa 1976) 2020 Jan;45(2):E83-E89

Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan.

Study Design: A retrospective long-term follow-up study.

Objective: To investigate the health-related quality of life (HRQOL) status in middle-aged patients with adolescent idiopathic scoliosis (AIS) treated non-surgically.

Summary Of Background Data: The HRQOL status using various established questionnaires for non-operated AIS patients has not been fully investigated in long-term follow-up surveys.

Methods: Inclusion criteria were non-surgical treatment for AIS, more than or equl to 30° major scoliosis at skeletal maturity (Risser grade ≥4), and age more than or equl to 30 years at the time of the survey. A total of 107 AIS patients were included and divided into three groups (single main thoracic [MT] curve group; n = 50, single thoracolumbar/lumbar [TL/L] curve group; n = 19, and double-major [DM] curve group; n = 38) based on curve location at skeletal maturity. Age- and sex-matched volunteers were selected as the control group.

Results: There were no significant differences in age at survey, body mass index, bone mineral density of the femoral neck, and skeletal muscle mass index among the groups. In all groups, major scoliosis progressed by approximately 0.5°/yr from the time of skeletal maturity to the survey. The thoracolumbar (TL/L) and double-major (DM) groups showed significantly worse visual analog scale scores for low back pain compared with the main thoracice (MT) group (P < 0.05). The all-scoliosis groups showed significantly worse scores for self-image domain of the Scoliosis Research Society Outcome Instrument-22 (SRS-22) than the control group (P < 0.0001). The TL/L group showed significantly worse scores for walking ability and social function domains of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) (P < 0.05). There were no significant differences in Oswestory Disability Index and Short-Form-12 among the four groups.

Conclusion: AIS patients with single MT curve maintain equal HRQOL status compared with healthy controls. Patients with structural TL/L curves are likely to experience greater annual TL/L curve progression and have substantial low back pain or worse low back pain-specific HRQOL status during middle age.

Level Of Evidence: 4.
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January 2020

Rib Hyperostosis as a Risk Factor for Poor Prognosis in Cervical Spine Injury Patients With Diffuse Idiopathic Skeletal Hyperostosis.

Spine (Phila Pa 1976) 2020 Mar;45(5):300-308

Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan.

Study Design: Retrospective multi-center study.

Objective: To identify the morphological features of costovertebral joints and ribs in surgically managed cervical injury patients with diffuse idiopathic skeletal hyperostosis (DISH) and to examine its impact on their vital prognosis.

Summary Of Background Data: Several reports have indicated that DISH is an independent risk factor for mortality after spinal fracture. The reason for the high mortality in cervical injury patients with DISH is unclear, although some reports have suggested a possible association between pulmonary complications and mortality.

Methods: From 1999 to 2017, a total of 50 DISH patients (44 males) with cervical spine injuries who underwent spinal surgery were enrolled (average age 74 yrs). Prognosis and clinical risk factor data were collected; the morphological features of the patients' costovertebral joints and ribs were evaluated with computed tomography. The influence of each proposed risk factor and thoracic morphological feature on mortality was tested with univariate and multivariate analyses.

Results: The survival rate at 5 years after surgery was 52.3%. Nineteen (38%) patients died, and the most common cause of death was pneumonia (68%). Costovertebral bone excrescences and rib hyperostosis were found to be thoracic pathognomonic signs; their frequencies were 94% and 82%, respectively, and these conditions occurred in an average of 7.0 joints and 4.7 bones, respectively. The results of the log-rank test showed a significant difference in age, injury severity score (ISS), costovertebral bone excrescences, and rib hyperostosis. The results of age-adjusted multivariate analysis indicated that age (hazard ratio [HR] = 8.65, 95% confidence interval [CI] = 1.10-68.28, P = 0.041) and rib hyperostosis (HR = 3.82, 95% CI = 1.38-10.57, P = 0.010) were associated with mortality.

Conclusion: Reduced chest wall mobility associated with rib hyperostosis in cervical spine injury patients with DISH leads to a poor prognosis.

Level Of Evidence: 3.
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March 2020