Publications by authors named "Kota Watanabe"

362 Publications

Clinical outcomes and a therapeutic indication of intramedullary spinal cord astrocytoma.

Spinal Cord 2021 Jul 26. Epub 2021 Jul 26.

Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.

Study Design: Retrospective cohort study.

Objectives: Although intramedullary astrocytoma is associated with a high mortality rate, the optimal treatment has not reached a consensus. This study aimed at evaluating neurologic function and overall survival rate (OSR) in the treatment of this tumor.

Setting: The single institution in Japan.

Methods: This study enrolled 67 subjects who underwent surgical treatment for intramedullary astrocytoma. Demographic, imaging, and surgical information were collected from each participant. Tumors were histologically categorized using the World Health Organization classification, and subjects were divided into low-grade (I and II; n = 40) and high-grade (III and IV; n = 27) groups. Neurologic status was evaluated using the modified McCormick scale (MMS). OSR was assessed using Kaplan-Meier methods.

Results: The OSR decreased when the pathological grade increased (p < 0.01). Regarding the therapeutic efficacy for low-grade astrocytomas, subjects who underwent gross total resection (GTR) showed a higher OSR than those who did not (p = 0.02). GTR prevented worsening of MMS score, while non-GTR increased the MMS score (p < 0.01). In the high-grade group, 19 and 10 underwent radiation therapy and chemotherapy, respectively. However, both treatments did not improve OSR. Cordotomy was performed for subjects whose lesional area was at the thoracic level, but the OSR did not significantly increase.

Conclusions: The most beneficial therapeutic strategy for low-grade astrocytomas was GTR, whereas that for the high-grade tumors was unclear. Further studies with a larger sample size are warranted to validate the effective treatment for malignant astrocytomas.
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http://dx.doi.org/10.1038/s41393-021-00676-8DOI Listing
July 2021

Can Postoperative Distal Adding-On be Predicted in Lenke Type 1B and 1C Curves with Intraoperative Radiographs?

Spine (Phila Pa 1976) 2021 Jul 16. Epub 2021 Jul 16.

Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan Department of Environmental and Occupational Health, School of Medicine, Toho University. Tokyo, Japan.

Study Design: A retrospective study of consecutive collected data.

Objective: To investigate risk factors for postoperative distal adding-on (DA) in Lenke Type 1B and 1C curves using intraoperative radiographs.

Summary Of Background Data: In adolescent idiopathic scoliosis (AIS), DA radiographic complication can negatively affect postoperative clinical results. However, few studies have focused on assessing risk factors for DA using intraoperative radiographs.

Methods: We retrospectively evaluated 69 AIS patients with Lenke Type 1B or 1C curves who underwent posterior selective thoracic fusion. We divided patients into DA and non-DA groups based on radiograph data at 2-year follow-up using Wang et al. (Spine 2011) definition of DA. We compared coronal radiographic parameters, including relative positions of end vertebra (EV), stable vertebra (SV), neutral vertebra (NV), and last touching vertebra (LTV) to lowest instrumented vertebra (LIV), and intraoperative radiographic parameters, between the two groups.

Results: DA was present in 13 patients (18.8%) at 2-year follow-up. The mean LIV-EV, LIV-NV, LIV-SV, and LIV-LTV relative positions were significantly smaller in the DA group than in the non-DA group. Multivariate analysis showed that LIV-LTV was significantly associated with DA (DA:-0.2 ± 0.7, non-DA: 0.6 ± 0.7). Intraoperative radiographs showed that the mean angulation of the first disc below the LIV after final adjustment was significantly larger in the DA group (2.3° ± 1.1°) than in the non-DA group (0.9° ± 0.7°). Patients whose angulation of the first disc below the LIV was more than 3° were significantly associated with DA.

Conclusion: The LIV selected at more cranial to the LTV may be a risk factor for postoperative DA in Lenke Type 1B and 1C curves. Moreover, it was suggested that LIV extension might be considered when the first disc's angulation below the LIV is > 3° in intraoperative radiographs.Level of Evidence: 3.
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http://dx.doi.org/10.1097/BRS.0000000000004174DOI Listing
July 2021

Nano-Arthroscopic Ultrasound-Guided Excision of Unresolved Osgood-Schlatter Disease.

Arthrosc Tech 2021 Jun 24;10(6):e1581-e1587. Epub 2021 May 24.

Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.

The nano-arthroscopic ultrasound-guided ossicle excision technique is used in the management of an unresolved Osgood-Schlatter disease. The NanoScope is inserted slightly lateral to the proximal patella tendon and moved on between the ossicle and anterior surface of the proximal tibia under ultrasonographic guidance. The 5-mm skin incision is made as a working portal on the medial side of the proximal patella tendon. The proximal border of the ossicle is clearly identified after bursectomy. Then, the ossicles are removed piece by piece using a 2-mm arthroscopic punch. During the resection, the remaining ossicle is continuously confirmed by ultrasound. Finally, the complete excision of the ossicle is shown by the nano-arthroscopic view and ultrasound. The patient is allowed to have a full weight-bearing and an unrestricted range of motion on the day of surgery. Patients are permitted to resume their sports activities without any restriction after 6 weeks. This technique is recommended to athletes who suffer from painful unresolved Osgood-Schlatter disease because of the benefits of it being a minimally invasive surgery with an early postoperative recovery.
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http://dx.doi.org/10.1016/j.eats.2021.02.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252821PMC
June 2021

The impact of ossification spread on cervical spine function in patients with ossification of the posterior longitudinal ligament.

Sci Rep 2021 Jul 12;11(1):14337. Epub 2021 Jul 12.

Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo , Japan.

Ossification of the posterior longitudinal ligament (OPLL) is a progressive disease. The bridging of ossified lesions to the vertebral body gradually increases, thereby decreasing the mobility of the cervical spine; thus, cervical spine function may decrease over time. However, cervical spine function in patients with cervical OPLL has not been evaluated in large prospective studies. Therefore, we conducted a prospective multicenter study to clarify whether ossification spread can influence cervical spine function and quality of life (QOL) in patients with cervical OPLL. In total, 238 patients (162 men, 76 women; mean age, 63.9 years) were enrolled from 16 institutions. Each patient underwent whole spine computed tomography and was evaluated for cervical spine function and QOL using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). In the multivariate regression analysis, a higher neck VAS score and a larger number of bridge formations of OPLL in the whole spine were significant predictors of adverse outcomes related to cervical spine function. This is the first prospective multicenter study to reveal the impact of ossification spread on cervical spine function. These findings are important to understand the natural course of OPLL and can serve as controls when evaluating postoperative cervical spine function.
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http://dx.doi.org/10.1038/s41598-021-93602-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8275804PMC
July 2021

Lab-scale autothermal thermophilic aerobic digestion can maintain and remove nitrogen by controlling shear stress and oxygen supply system.

J Biosci Bioeng 2021 Jun 21. Epub 2021 Jun 21.

Laboratory of Soil and Environmental Microbiology, Division of Systems Bioengineering, Department of Bioscience and Biotechnology, Faculty of Agriculture, Graduate School of Bioresources and Bioenvironmental Sciences, Kyushu University, Fukuoka 819-0395, Japan; Laboratory of Microbial Environmental Protection, Tropical Microbiology Unit, Center for International Education and Research of Agriculture, Faculty of Agriculture, Kyushu University, Fukuoka 819-0395, Japan.

Autothermal thermophilic aerobic digestion (ATAD) is used to treat human excreta hygienically. We previously reported a unique full-scale ATAD, showing distinctive bacterial community transitions and producing high-nitrogen-content liquid fertilizer; nevertheless, the mechanism remains unclear. One hypothesis involves using a gas-inducing (GI) agitator. We designed a lab-scale GI system and compared it with a disk-turbine (DT) agitator system by mimicking the temperature shift of full-scale ATAD. The agitation system and its agitation speed greatly affected physicochemical properties and bacterial community structure. GI system at 1000 rpm (GI1000; high total carbon removal efficiency, 88.3%), with few nitrifying and denitrifying bacteria, maintained a high ammoniacal nitrogen concentration and had more shared operational taxonomic units related to Acinetobacter sp., Arcobacter sp., and Longimicrobium sp. with the full-scale ATAD compared with the GI system at 490 rpm and DT system at 1000 rpm (DT1000). Furthermore, DT1000, with a high abundance of nitrifying and denitrifying bacteria such as Alcaligenes aquatilis and Pseudomonas caeni, removed 94.7% total nitrogen with 71.9% total carbon removal efficiency. These results suggested that shear stress and oxygen supply system would change the bacterial community structure, thus affected ATAD performances. Consequently, it is possible that ATAD can be applied for not only production of highly nitrogen-containing liquid fertilizer but also extremely nitrogen removal of wastewater.
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http://dx.doi.org/10.1016/j.jbiosc.2021.05.008DOI Listing
June 2021

The impact of diabetes mellitus on spinal fracture with diffuse idiopathic skeletal hyperostosis: A multicenter retrospective study.

J Orthop Sci 2021 Jun 20. Epub 2021 Jun 20.

Dept. of Orthopaedic Surgery, Keio University, Tokyo, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan. Electronic address:

Background: Patients with diffuse idiopathic skeletal hyperostosis (DISH) are susceptible to spinal column injuries with neurological deterioration. Previous studies indicated that the prevalence of diabetes mellitus (DM) in patients with DISH was higher than that in patients without DISH. This study investigates the impact of DM on surgical outcomes for spinal fractures in patients with DISH.

Methods: We retrospectively evaluated 177 spinal fractures in patients with DISH (132 men and 45 women; mean age, 75 ± 10 years) who underwent surgery from a multicenter database. The subjects were classified into two groups according to the presence of DM. Perioperative complications, neurological status by Frankel grade, mortality rate, and status of surgical site infection (SSI) were compared between the two groups.

Results: DM was present in 28.2% (50/177) of the patients. The proportion of men was significantly higher in the DM group (DM group: 86.0% vs. non-DM group: 70.1%) (p = 0.03). The overall complication rate was 22.0% in the DM group and 19.7% in the non-DM group (p = 0.60). Poisson regression model revealed that SSI was significantly associated with DM (DM group: 10.0% vs. non-DM group: 2.4%, Relative risk: 4.5) (p = 0.048). Change in neurological status, mortality rate, instrumentation failure, and nonunion were similar between both groups. HbA1c and fasting blood glucose level (SSI group: 7.2% ± 1.2%, 201 ± 67 mg/dL vs. non-SSI group: 6.6% ± 1.1%, 167 ± 47 mg/dL) tended to be higher in patients with SSI; however, there was no significant difference.

Conclusions: In spinal fracture in patients with DISH, although DM was an associated factor for SSI with a relative risk of 4.5, DM did not negatively impact neurological recovery. Perioperative glycemic control may be useful for preventing SSI because fasting blood glucose level was high in patients with SSI.
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http://dx.doi.org/10.1016/j.jos.2021.03.021DOI Listing
June 2021

Polygenic Risk Score of Adolescent Idiopathic Scoliosis for Potential Clinical Use.

J Bone Miner Res 2021 Jun 22. Epub 2021 Jun 22.

Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.

Adolescent idiopathic scoliosis (AIS) is a common disease causing three-dimensional spinal deformity in as many as 3% of adolescents. Development of a method that can accurately predict the onset and progression of AIS is an immediate need for clinical practice. Because the heritability of AIS is estimated as high as 87.5% in twin studies, prediction of its onset and progression based on genetic data is a promising option. We show the usefulness of polygenic risk score (PRS) for the prediction of onset and progression of AIS. We used AIS genomewide association study (GWAS) data comprising 79,211 subjects in three cohorts and constructed a PRS based on association statistics in a discovery set including 31,999 female subjects. After calibration using a validation data set, we applied the PRS to a test data set. By integrating functional annotations showing heritability enrichment in the selection of variants, the PRS demonstrated an association with AIS susceptibility (p = 3.5 × 10 with area under the receiver-operating characteristic [AUROC] = 0.674, sensitivity = 0.644, and specificity = 0.622). The decile with the highest PRS showed an odds ratio of as high as 3.36 (p = 1.4 × 10 ) to develop AIS compared with the fifth in decile. The addition of a predictive model with only a single clinical parameter (body mass index) improved predictive ability for development of AIS (AUROC = 0.722, net reclassification improvement [NRI] 0.505 ± 0.054, p = 1.6 × 10 ), potentiating clinical use of the prediction model. Furthermore, we found the Cobb angle (CA), the severity measurement of AIS, to be a polygenic trait that showed a significant genetic correlation with AIS susceptibility (rg = 0.6, p = 3.0 × 10 ). The AIS PRS demonstrated a significant association with CA. These results indicate a shared polygenic architecture between onset and progression of AIS and the potential usefulness of PRS in clinical settings as a predictor to promote early intervention of AIS and avoid invasive surgery. © 2021 American Society for Bone and Mineral Research (ASBMR).
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http://dx.doi.org/10.1002/jbmr.4324DOI Listing
June 2021

Relationship Between Plantar Callosity and Foot Deformity in Hallux Valgus Using Weightbearing Computed Tomography.

J Foot Ankle Surg 2021 May 26. Epub 2021 May 26.

Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.

Plantar callosities under lesser metatarsals are often accompanied by the hallux valgus, and the cause of callosity is thought to be associated with the foot deformity, such as the metatarsal length discrepancy, the abnormal metatarsal head height, cavus, flat foot, and rheumatoid conditions. However, it is unclear which variable is most involved in the cause of callosity in hallux valgus deformity. To clarify the factors associated with the callosity with hallux valgus deformity, we conducted multiple image assessments based on weightbearing radiography and computed tomography. A retrospective review was performed based on the collection of clinical records from all patients with hallux valgus treated from 2010 to 2019 in our institution. We measured the hallux valgus angle, intermetatarsal angles, calcaneal pitch angles, talo-first metatarsal angles, metatarsal length, metatarsal head height, first metatarsal pronation angles, and sesamoid position with weightbearing radiography and computed tomography. We analyzed the relation between callosity formation and imaging assessments using univariate and multivariate logistic regression models. Fifty feet were retrospectively evaluated, and multiple logistic analyses by the stepwise method revealed that the first metatarsal-lateral-sesamoid distance was the only radiographical variable associated with callosity formation among all the tested variables (p < .001). As the grade of the callosity became more severe, the lateral shift of the lateral sesamoid increased. The position of the sesamoid bone appears to have a critical role in the assessment and choice of treatment protocols and further research needs to be conducted on the relationship with the position of sesamoid bone to elucidate the mechanism of callus formation.
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http://dx.doi.org/10.1053/j.jfas.2021.05.007DOI Listing
May 2021

Upper End Vertebra of Proximal Thoracic Curve At T1 is a Novel Risk Factor of Postoperative Shoulder Imbalance in Lenke Type 2 Adolescent Idiopathic Scoliosis.

Global Spine J 2021 Jun 14:21925682211023049. Epub 2021 Jun 14.

Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.

Study Design: Retrospective single-center study.

Objective: We investigated the risk factors of postoperative shoulder imbalance (PSI) in patients with Lenke type 2 adolescent idiopathic scoliosis (AIS) including the position of preoperative upper end vertebra (UEV).

Methods: Seventy-five patients with Lenke type 2 AIS who underwent posterior correction and fusion surgeries from 2008 to 2018 were included. We included only patients whose upper instrumented vertebrae were at T2. The patients were divided into 2 groups based on radiographic shoulder height (RSH) at final follow-up, namely PSI group and non-PSI group, and PSI was defined as RSH > 10 mm. UEV, RSH, Cobb angle, curve flexibility, T1 and T2 tilt, correction rate, Risser grade, Scoliosis Research Society-22 scores, and demographic data were compared between the groups using independent tests or chi-square tests. Variables with value < 0.20 in univariate analysis were assessed in logistic regression analysis.

Results: Thirty-four patients in the PSI group and 37 patients in the non-PSI group were analyzed. Univariate analysis revealed that there were more patients with UEV at T1 (PSI: 85%, non-PSI: 54%, < 0.01) and Risser grade ≥ 3 (PSI: 88%, non-PSI: 62%; < 0.05) in the PSI group than in the non-PSI group. Logistic regression analysis revealed that UEV at T1 (odds ratio [OR] = 4.1 [1.2-14.4], < 0.05) and Risser grade ≥ 3 (OR = 3.9 [1.1-14.5], < 0.05) are significantly associated with PSI.

Conclusions: UEV at T1 and Risser grade ≥ 3 at the time of surgery are significant risk factors of PSI.
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http://dx.doi.org/10.1177/21925682211023049DOI Listing
June 2021

Spontaneous Reduction of Chiari Malformation and Syringomyelia After Posterior Spinal Fusion for Scoliosis: A Case Report.

JBJS Case Connect 2021 06 11;11(2). Epub 2021 Jun 11.

Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.

Case: A 22-year-old skeletally mature man with scoliosis accompanied by syringomyelia associated with Chiari malformation type 1 was presented to our hospital. Because the maximal syrinx/cord ratio was small, and he had no neurological deficit, he underwent corrective surgery without the treatment of the syringomyelia.

Conclusion: The scoliosis was corrected without any neurological complications. Magnetic resonance imaging taken 8 days after the surgery showed the reduction of the size of the syringomyelia. The syringomyelia almost disappeared at the 8-year follow-up.
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http://dx.doi.org/10.2106/JBJS.CC.20.00779DOI Listing
June 2021

Neurological improvement is associated with neck pain attenuation after surgery for cervical ossification of the posterior longitudinal ligament.

Sci Rep 2021 Jun 7;11(1):11910. Epub 2021 Jun 7.

Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, Tochigi, 321-0293, Japan.

Although favourable surgical outcomes for myelopathy caused by cervical ossification of the posterior longitudinal ligament (OPLL) have been reported, factors significantly associated with post-operative neck pain attenuation still remain unclear. The primary aim of the present study was to determine factors significantly associated with post-operative neck pain attenuation in patients with cervical OPLL using a prospective multi-centre registry of surgically treated cervical OPLL. Significant postoperative neck pain reduction (50% reduction of neck pain) was achieved in 31.3% of patients. There was no significant difference in neck pain attenuation between surgical procedures. Statistical analyses with univariate analyses followed by stepwise logistic regression revealed neurological recovery as a factor having a significant positive association with post-operative neck pain attenuation (p = 0.04, odds ratio 5.68 (95% confidence interval: 1.27-22.2)). In conclusion, neurological recovery was an independent factor having a significant positive association with post-operative neck pain attenuation in patients with cervical myelopathy caused by OPLL who underwent cervical spine surgery.
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http://dx.doi.org/10.1038/s41598-021-91268-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184776PMC
June 2021

The characteristics of the young patients with cervical ossification of the posterior longitudinal ligament of the spine: A multicenter cross-sectional study.

J Orthop Sci 2021 Jun 3. Epub 2021 Jun 3.

Department of Orthopedic Surgery, Keio University, School of Medicine, Tokyo, Japan; Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan.

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. Although the patients with OPLL are more common in the 60s and 70s, we know that there are markedly young patients (e.g., early 40s). However, to the best of our knowledge, there is few reports characterize young patients with cervical OPLL in terms of the imaging features, subjective symptoms, and ADL problems.

Methods: This is the multicenter cross-sectional study. Two hundred and thirty-seven Japanese symptomatic patients with cervical OPLL confirmed by standard X-rays collected from 16 institutions belonging to the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament formed by the Japanese Ministry of Health, Labor and Welfare were recruited. Whole spine CT data as well as demographic data such as age, gender, patients-based evaluations, and the 36-item Short Form Health Survey (SF-36) were evaluated.

Results: Young group (≦ 45 years old) consisted of 23 patients (8 females and 15 males), accounting for 9.7% of the total. Their characteristics were high body mass index (BMI), significant involvement of trauma in the onset and deterioration of symptoms, and the predominance of thoracic OPLL. The patient-based evaluations did not show a significant difference between the young and non-young groups, or between the genders in the young group except for bodily pain (BP) of SF-36. Female patients in young group had significantly lower BP score of SF-36 than that of male in young group.

Conclusions: Characteristics of young patients with cervical OPLL were high BMI, significant involvement of trauma in the onset and deterioration of symptoms, lower BP score of SF-36 in female, and the predominance of thoracic OPLL.
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http://dx.doi.org/10.1016/j.jos.2021.04.010DOI Listing
June 2021

Surgical Predictors for Prevention of Postoperative Shoulder Imbalance in Lenke Type 2A Adolescent Idiopathic Scoliosis.

Spine (Phila Pa 1976) 2021 Jun 2. Epub 2021 Jun 2.

Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan Department of Orthopaedic Surgery, Sangubashi Spine Surgery Hospital, Tokyo, Japan Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY Department of Orthopaedic Surgery, Keio University, Tokyo, Japan Department of Orthopaedic Surgery, Kobe Medical Center Kobe, Japan Department of Orthopaedic Surgery, Gunma Spine Center, Takasaki, Japan Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan Department of Orthopaedic Surgery, Meijo Hospital, Nagoya, Japan Department of Orthopedic Surgery, JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan.

Study Design: Multicenter, retrospective cohort study.

Objective: The aim of this study was to investigate the occurrence and surgical predictors of postoperative shoulder imbalance (PSI) in Lenke type 2A adolescent idiopathic scoliosis (AIS).

Summary Of Background Data: Although several studies have investigated the factors influencing PSI in Lenke type 2 curves, no studies have analyzed PSI-related factors considering upper instrumented vertebra (UIV) and lumbar modifier type simultaneously.

Methods: Patients with Lenke Type 2A AIS treated by spinal fusion were retrospectively identified and their data were extracted from six spine centers in Japan. Inclusion criteria were age between 10 and 20 years at surgery, UIV = T2, major curve 40° to 90°, and follow-up for 24 to 30 months after surgery. We analyzed patient characteristics, surgical characteristics, and preoperative and immediate-postoperative radiographic parameters. We defined patients with lower instrumented vertebra (LIV) equal or proximal to the last touching vertebra (LTV) as selective thoracic fusion (STF-LTV) and patients with LIV distal to the LTV as non-STF-LTV. t Tests, Mann-Whitney U test, χ2 tests, Fisher exact tests, and multivariate logistic regression were used for statistical analyses.

Results: Among the 99 consecutive patients with a mean follow-up of 25.6 months, PSI was seen in 27 (27.3%) patients immediately after and in 17 (17.2%) patients at 24 to 30 months. The univariate analysis revealed that the significant risk factors of PSI were preoperative radiographical shoulder height, non-STF-LTV, and high main thoracic curve (MTC) correction (immediate-postoperative MTC correction rate: ≥70%), with PSI incidence of 40.0%. The multivariate logistic regression analysis indicated that interaction term of non-STF-LTV and high MTC correction was an independent risk factor for PSI (non-STF-LTV and high MTC correction, odds ratio: 5.167, 95% confidence interval: 1.470-18.159, P = 0.010).

Conclusion: To prevent PSI in Lenke Type 2A AIS patients, surgeons should avoid the combination of non-STF-LTV and high MTC correction in those surgeries with UIV as T2.Level of Evidence: 4.
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http://dx.doi.org/10.1097/BRS.0000000000004135DOI Listing
June 2021

Cervical intramedullary recurrent Ewing sarcoma after 10-year disease-free survival in an adult: a case report and review of literature.

Spinal Cord Ser Cases 2021 May 27;7(1):45. Epub 2021 May 27.

Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.

Introduction: Intramedullary metastasis of Ewing sarcoma is extremely rare. Here, we report an adult case of cervical intramedullary recurrent Ewing sarcoma after a 10-year disease-free survival after the initial surgery for a thoracic lesion.

Case Presentation: A 39-year-old man with a history of surgery and chemoradiotherapy for thoracic Ewing sarcoma ten years ago presented with neck pain and incomplete motor paralysis in the right upper extremity, which had suddenly appeared three months before. Cervical magnetic resonance imaging revealed a tear-drop-shaped intramedullary lesion at the C3 level accompanied by diffuse edematous change. Because of the rapid progression of his myelopathy, he underwent surgery for this intramedullary lesion. Intraoperatively, the tumor exhibited an orangish exophytic appearance. The unclearness of the tumor boundary compelled us to perform a partial resection. The histopathology showed the tumor comprised small round atypical cells with immunoreactivity for Nkx2.2 and CD99, diagnosing a metastatic Ewing sarcoma. Postoperatively, although his myelopathy improved transiently and adjuvant chemotherapy radiation was undergone, he died of cranial dissemination of the tumor two months and a half later.

Discussion: To our knowledge, 31 cases of primary and only 4 cases of recurrent intramedullary spinal Ewing sarcoma have been reported to date; however, this is the first case of recurrent intramedullary Ewing sarcoma with a 10-year disease-free survival. Sadly, the prognosis of the current case was extremely poor. There is no clear treatment guideline for recurrent intramedullary Ewing sarcoma because of its rarity, and further collection of similar cases would be required.
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http://dx.doi.org/10.1038/s41394-021-00406-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160263PMC
May 2021

Comparison of Surgical Outcomes After Open- and Double-Door Laminoplasties for Patients with Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Multicenter Study.

Spine (Phila Pa 1976) 2021 May 6. Epub 2021 May 6.

Department of Orthopaedic Surgery, School of Medicine, Keio University, Shinjuku Ward, Tokyo, Japan Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo Ward, Tokyo, Japan Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchishi, Saitama, Japan Department of Orthopedic Surgery, Kudanzaka Hospital, Chiyodaku, Japan Department of Orthopaedic Surgery, Wakayama Medical University Kihoku Hospital, Katsuragi-cho, Itogun, Wakayama, Japan Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan Department of Orthopedic Surgery, Niigata University Medicine and Dental General Hospital, Chuo Ward, Niigata, Niigata, Japan Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan Department of Orthopedics, Jichi Medical University, Shimotsuke, Tochigi, Japan Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chuo Ward, Chiba, Japan Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakaishi, Osaka, Japan Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine,, Showa Ward, Nagoya, Aichi, Japan Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, Japan Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, Eiheiji-cho, Yoshida-gun, Fukui, Japan Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan Department of Orthopedic Surgery, Imakiire General Hospital, Kagoshimashi, Japan Department of Orthopedic Surgery, Graduate School of Medicine, Osaka University, Suita-shi, Osaka, Japan Department of Orthopaedic Surgery, Kurume University School of Medicine, Kurume-shi, Fukuoka, Japan Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan Department of Orthopedic Surgery, University of Yamanashi, Chuo Ward, Yamanashi, Japan Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, Mibu-machi, Shimotsuga-gun, Tochigi, Japan Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan Department of Orthopaedic Surgery, Tohoku University School of Medicine, Aoba Ward, Sendai, Miyagi, Japan Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Toyama, Japan Japanese Multicenter Research Organization for Ossification of the Spinal Ligament.

Study Design: A prospective multicenter study.

Objective: To evaluate and compare the surgical outcomes after open-door (OD) and double-door (DD) laminoplasties in subjects with cervical ossification of the posterior longitudinal ligament (OPLL).

Summary Of Background Data: Although previous studies compared clinical results after OD and DD laminoplasties, they were performed at a single institution with a relatively small sample size targeting mixed pathologies, including cervical spondylotic myelopathy.

Methods: This study was performed by the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. A total of 478 patients with myelopathy caused by cervical OPLL from 28 institutions were prospectively registered from 2014 to 2017 and followed up for 2 years. Of these, 41 and 164 patients received OD and DD laminoplasties, respectively. Demographic information, medical history, and imaging findings were collected. Clinical outcomes were assessed using the cervical Japanese Orthopaedic Association (JOA), JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and visual analog scale (VAS) scores.

Results: Age, sex, symptom duration, and comorbidities were not significantly different between the groups. Segmental ossification was the most frequent in both groups. No significant differences in K-line type, canal occupying ratio, C2-C7 angles, and range of motion (ROM) were found. Both procedures reduced the cervical ROM postoperatively. A comparable frequency of perioperative complications was observed between the groups. The cervical JOA scores showed a similar improvement at 2 years postoperatively. The reduction in VAS score for neck pain was favorable in the OD group (P = 0.02), while other pain assessments did not show any significant differences between the groups. The functional outcomes assessed using the JOACMEQ presented equivalent effective rates.

Conclusion: The results demonstrated almost comparable surgical outcomes between OD and DD laminoplasties. Laminoplasty is a valuable technique as a therapeutic option for cervical OPLL.Level of Evidence: 5.
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http://dx.doi.org/10.1097/BRS.0000000000004094DOI Listing
May 2021

Coronal Plane Gap Increases Postoperative Pseudoarthrosis after Lateral Interbody Fusion for Adult Spinal Deformity.

Asian Spine J 2021 May 6. Epub 2021 May 6.

Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Japan.

Study Design: This is a retrospective study.

Purpose: This study aims to evaluate the risk factor associated with pseudoarthrosis after placement of lateral interbody fusion (LIF) cages for adult spinal deformity (ASD) treatment.

Overview Of Literature: LIF technique is widely used for ASD correction. Furthermore, pseudoarthrosis is a major complication of fusion surgery required for revision surgery.

Methods: This study included 42 patients with ASD (two men and 40 women; 112 segments; mean, 68.5±8.4 years; and mean follow-up, 31.6±17.0 months) who underwent LIF and posterior correction surgery. The concave slot of the LIF cage was filled with an autologous iliac crest bone graft (IBG), and the convex slot with a porous hydroxyapatite/collagen (HAp/Col) composite was soaked with bone marrow aspirate. Endplate injury, the gap between vertebral endplate and cage in the coronal or sagittal plane, and fusion status were evaluated using computed tomography multiplanar reconstruction at 12 months after surgery. Moreover, the associated risk factors for pseudoarthrosis were analyzed.

Results: Fusion at LIF segments were observed in 71.4% segments at 12 months after surgery. Fusion on the concave slot (autologous IBG side), convex slot (porous HAp/Col composite side), and both concave and convex slots were observed in 66.1%, 37.5%, and 36.6% of patients, respectively. Moreover, pseudoarthrosis was observed in 28.6% at 12 months after surgery. Consequently, logistic regression analysis of the fusion at the LIF segment revealed that the gap between the LIF cage and endplate in the coronal plane (p=0.030; odds ratio, 0.183; 95% confidence interval, 0.030-0.183) was significantly associated with pseudoarthrosis at the LIF segments.

Conclusions: ASD surgery fusion rate using LIF cages was 71.4% at 12 months after surgery. The fusion rate was higher on the concave slot filled with autologous IBG than on the convex slot filled with a porous HAp/Col composite. The gap in the coronal plane was a risk factor for pseudoarthrosis at the LIF segment.
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http://dx.doi.org/10.31616/asj.2020.0336DOI Listing
May 2021

K-line (-) in the neck-flexed position negatively affects surgical outcome of expansive open-door laminoplasty for cervical spondylotic myelopathy.

J Orthop Sci 2021 Apr 14. Epub 2021 Apr 14.

Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan. Electronic address:

Background: The K-line in the neck-flexed position (FK-line) on radiography reflects dynamic factors and cervical alignment. Although the FK-line has been reported to affect the neurological recovery after muscle-preserving selective laminectomy for cervical spondylotic myelopathy (CSM), its influence on surgical outcomes after expansive open-door laminoplasty (ELAP) has not been investigated.

Methods: We reviewed the surgical outcomes in 81 patients with multilevel CSM who underwent C4-C6 ELAP combined with C3 and C7 partial laminectomy using a laminoplasty plate and were followed up for at least 2 years. We defined the K-line (-) as some portion of a bony spur or the vertebral body crossing the FK-line, whereas the FK-line (+) was defined as that never crossing the FK-line. Patients were divided into the FK-line (+) (n = 61) and FK-line (-) groups (n = 20), and the surgical outcomes were compared between the groups. A multivariate analysis was performed to identify the factors that influenced the neurological outcomes.

Results: The FK-line (-) group had a smaller C2-C7 angle, smaller C7 slope, greater postoperative increase in the C2-C7 sagittal vertical axis, greater kyphosis in cervical flexion and less lordosis in cervical extension, and higher incidence of postoperative residual spinal cord compression. The preoperative-to-postoperative changes in the Japanese Orthopedic Association (JOA) score and JOA score recovery rate (RR) were lower in the FK-line (-) group. The multiple linear regression analysis revealed that the K-line (-) (β = -0.327, P = 0.011) and high signal intensity (SI) changes on T2-weighted imaging (WI) combined with the low SI changes on T1-WI in the spinal cord (β = -0.320, P = 0.013) negatively affected the JOA score RR.

Conclusions: The FK-line can be used for patients with CSM as a simple indicator of neurological outcomes after ELAP.
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http://dx.doi.org/10.1016/j.jos.2021.02.005DOI Listing
April 2021

Surgical resection of arteriovenous fistula at the cauda equina.

Spinal Cord Ser Cases 2021 Apr 13;7(1):29. Epub 2021 Apr 13.

Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.

Introduction: Although spinal arteriovenous fistula (AVF) has been reported widely, AVF at the cauda equina is quite rare. We described a case of AVF at the cauda equina that was fed by the distal radicular artery (DRA).

Case Presentation: A 50-year-old woman presented with sudden weakness of the lower extremities. Magnetic resonance imaging (MRI) revealed a lesion with a highly intense signal at the conus medullaris, which was surrounded by several low-intensity signals (flow voids). Digital subtraction angiography revealed AVF at the cauda equina and that it was fed by the DRA, which was directly fed by the L3 segmental artery. We performed surgical resection of the AVF while monitoring motor-evoked potentials. The patient's postoperative course was uneventful, and her neurological symptoms gradually resolved. MRI 2 years after surgery showed the disappearance of both intramedullary edema and the flow voids.

Discussion: For the AVF, located at the cauda equina and fed by the DRA in this case, surgical resection or endovascular embolization could have been selected. We performed open surgery to achieve complete obliteration of the AVF, which led to postoperative functional recovery without any adverse events. However, only a limited number of AVFs at the level of the cauda equina have been reported, and treatment standards have not been established. Further studies of AVFs at the cauda equina are necessary to clarify the epidemiological characteristics and clinical outcomes with an appropriate sample size.
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http://dx.doi.org/10.1038/s41394-021-00400-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8044232PMC
April 2021

Quantitative Evaluation of Ankle Instability Using a Capacitance-Type Strain Sensor.

Foot Ankle Int 2021 Mar 26:1071100721996714. Epub 2021 Mar 26.

Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.

Background: Manual evaluation is an important method for assessing ankle instability, but it is not quantitative. Capacitance-type sensors can be used to measure the distance on the basis of the capacitance value. We applied the sensor to the noninvasive device for measuring ankle instability and showed its utility.

Methods: First, 5 ankles embalmed by Thiel's method were used in an experiment using a cadaver. The capacitance-type sensor was fixed alongside the anterior talofibular ligament (ATFL) of a specially made brace, and the anterior drawer test was performed. The test had been performed for the intact ankle, with the ATFL transected and with both the ATFL and calcaneofibular ligament (CFL) transected. The anterior drawer distance was calculated by the sensor. Intra- and interinvestigator reliability were also analyzed.Next, as a clinical study, a brace with a sensor was fitted to 22 ankles of 20 patients with a history of ankle sprain. An anterior drawer test at a load of 150 N was conducted using a Telos stress device. The anterior drawer distances measured by the sensor and based on radiographic images were then compared.

Results: The mean anterior drawer distances were 3.7 ± 1.0 mm for the intact cadavers, 6.1 ± 1.6 mm with the ATFL transected ( < .001), and 7.9 ± 1.8 mm with the ATFL and CFL transected ( < .001). The intrainvestigator intraclass correlation coefficients (ICCs) were 0.862 to 0.939, and the interinvestigator ICC was 0.815. In the experiments on patients, the mean anterior drawer distance measured by the sensor was 2.9 ± 0.9 mm, and it was 2.7 ± 0.9 mm for the radiographic images. The correlation coefficient between the sensor and the radiographic images was 0.843.

Conclusion: We quantitatively evaluated anterior drawer laxity using a capacitance-type sensor and found it had high reproducibility and strongly correlated with stress radiography measurements in patients with ankle instability. Capacitance-type sensors can be used for the safe, simple, and accurate evaluation of ankle instability.
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http://dx.doi.org/10.1177/1071100721996714DOI Listing
March 2021

Posterior and Anterior Fusion for Severe Cervical Kyphosis in a Patient with Chondrodysplasia Punctata: A Case Report.

JBJS Case Connect 2021 03 16;11(1). Epub 2021 Mar 16.

Department of Orthopaedic Surgery, Keio University, Tokyo, Japan.

Case: A 4-year-old girl with spastic gait and hand clumsiness who was diagnosed with cervical myelopathy caused by atlantoaxial dislocation and midcervical severe kyphosis associated with chondrodysplasia punctata (CDP). The patient underwent posterior instrumentation and anterior spinal fusion and successful correction with osseous fusion was obtained 8 months after surgery. In addition, the preoperative neurological symptoms were completely recovered.

Conclusion: Owing to the characteristics of CDP, the treatment for the cervical lesion is extremely complicated. Successful stabilization and improvement of the neurological symptom were achieved by combining posterior and anterior fusion with instrumentation in this case.
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http://dx.doi.org/10.2106/JBJS.CC.20.00646DOI Listing
March 2021

Does Diabetes Affect the Surgical Outcomes in Cases With Cervical Ossification of the Posterior Longitudinal Ligament? A Multicenter Study From Asia Pacific Spine Study Group.

Global Spine J 2021 Mar 10:2192568221996300. Epub 2021 Mar 10.

Department of Orthopaedics and Traumatology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.

Study Design: Retrospective multicenter study.

Objectives: To evaluate the surgical outcomes of cervical ossification of the posterior longitudinal ligament (OPLL) in diabetes mellitus (DM) patients.

Methods: Approximately 253 cervical OPLL patients who underwent surgical decompression with or without fixation were registered at 4 institutions in 3 Asian countries. They were followed up for at least 2 years. Demographics, imaging, and surgical information were collected, and cervical Japanese Orthopaedic Association (JOA) scores and the visual analog scale (VAS) for the neck were used for evaluation.

Results: Forty-seven patients had DM, showing higher hypertension and cardiovascular disease prevalence. Although they presented worse preoperative JOA scores than non-DM patients (10.5 ± 3.1 vs. 11.8 ± 3.2; = 0.01), the former showed comparable neurologic recovery at the final follow-up (13.9 ± 2.9 vs. 14.2 ± 2.6; = 0.41). No correlation was noted between the hemoglobin A1c level in the DM group and the pre- and postoperative JOA scores. No significant difference was noted in VAS scores between the groups at pre- and postsurgery. Regarding perioperative complications, DM patients presented a higher C5 palsy frequency (14.9% vs. 5.8%; = 0.04). A similar trend was observed when surgical procedure was limited to laminoplasty.

Conclusions: This is the first multicenter Asian study to evaluate the impact of DM on cervical OPLL patients. Surgical results were favorable even in DM cases, regardless of preoperative hemoglobin A1c levels or operative procedures. However, caution is warranted for the occurrence of C5 palsy after surgery.
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March 2021

Predictors of neurologic outcome after surgery for cervical ossification of the posterior longitudinal ligament differ based on myelopathy severity: a multicenter study.

J Neurosurg Spine 2021 Mar 12:1-10. Epub 2021 Mar 12.

2Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul.

Objective: The purpose of this retrospective multicenter study was to compare prognostic factors for neurological recovery in patients undergoing surgery for cervical ossification of the posterior longitudinal ligament (OPLL) based on their presenting mild, moderate, or severe myelopathy.

Methods: The study included 372 consecutive patients with OPLL who underwent surgery for cervical myelopathy between 2006 and 2016 in East Asian countries with a high OPLL prevalence. Baseline and postoperative clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) myelopathy score and recovery ratio. Radiographic assessment included occupying ratio, cervical range of motion, and sagittal alignment parameters. Patient myelopathy was classified as mild, moderate, or severe based on the preoperative JOA score. Linear and multivariate regression analyses were performed to identify patient and surgical factors associated with neurological recovery stratified by baseline myelopathy severity.

Results: The mean follow-up period was 45.4 months (range 25-140 months). The mean preoperative and postoperative JOA scores and recovery ratios for the total cohort were 11.7 ± 3.0, 14.5 ± 2.7, and 55.2% ± 39.3%, respectively. In patients with mild myelopathy, only age and diabetes correlated with recovery. In patients with moderate to severe myelopathy, older age and preoperative increased signal intensity on T2-weighted imaging were significantly correlated with a lower likelihood of recovery, while female sex and anterior decompression with fusion (ADF) were associated with better recovery.

Conclusions: Various patient and surgical factors are correlated with likelihood of neurological recovery after surgical treatment for cervical OPLL, depending on the severity of presenting myelopathy. Older age, male sex, intramedullary high signal intensity, and posterior decompression are associated with less myelopathy improvement in patients with worse baseline function. Therefore, myelopathy-specific preoperative counseling regarding prognosis for postoperative long-term neurological improvement should include consideration of these individual and surgical factors.
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http://dx.doi.org/10.3171/2020.8.SPINE20504DOI Listing
March 2021

Imaging Characteristics and Surgical Outcomes in Patients With Intraspinal Solitary Fibrous Tumor/Hemangiopericytoma: A Retrospective Cohort Study.

Global Spine J 2021 Mar 11:2192568221994799. Epub 2021 Mar 11.

Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.

Study Design: Retrospective cohort study.

Objectives: Intraspinal solitary fibrous tumor (SFT)/hemangiopericytoma (HPC) is often misdiagnosed preoperatively as schwannoma or meningioma because its imaging characteristics are not well understood. As postoperative prognosis differs among the 3 lesions, predicting the probability of SFT/HPC preoperatively is essential. Thus, this study investigates the imaging characteristics of SFT/HPC compared with those of schwannoma or meningioma and evaluates surgical outcomes.

Methods: The preoperative imaging findings, tumor resection extent, recurrence and regrowth rates, and neurological improvement were compared between 10 patients with SFT/HPC and 42 patients with schwannoma or 40 patients with meningioma.

Results: Most patients with SFT/HPC showed isointensity on both T1- and T2-weighted images compared with patients with schwannoma ( = 0.011 and 0.029, respectively) and no significant difference compared with patients with meningioma ( = 0.575 and 0.845, respectively). Almost all patients with SFT/HPC showed highly uniformizing enhancement patterns, similar to those with meningioma ( = 0.496). Compared with meningioma, SFT/HPC lacked the dural tail sign and intratumoral calcification and exhibited irregular shape. Of the 5 patients who underwent partial resection, 60% exhibited tumor recurrence and regrowth following surgery.

Conclusions: Complete surgical resection should be attempted in patients with intraspinal SFT/HPC to prevent postoperative recurrence or regrowth. As this tumor is often preoperatively misdiagnosed, we recommend that the imaging findings exhibited in this study should be used to positively suspect SFT/HPC. This will enhance patient outcomes by enabling more appropriate preoperative surgical planning.
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http://dx.doi.org/10.1177/2192568221994799DOI Listing
March 2021

Gorham-Stout Disease Resulting in Spinal Deformity Treated by Fusion Surgery Combined With Everolimus Therapy: A Case Report.

JBJS Case Connect 2021 03 3;11(1). Epub 2021 Mar 3.

Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan.

Case: Gorham-Stout disease (GSD) is a rare disorder characterized by progressive localized osteolysis and lymphatic malformation. A 26-year-old woman with GSD presented to our hospital with a Cobb angle of 100° and a kyphosis angle of 88°. Everolimus therapy was initiated to control the disease prior to surgery. After halo-gravity traction for 4 weeks, we performed anterior and posterior spinal fusion. Postoperative computed tomography revealed satisfactory bone union and no significant loss of correction 1 year post-surgery.

Conclusion: This case suggests that anterior and posterior spinal fusion combined with everolimus therapy can be a therapeutic option for GSD.
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http://dx.doi.org/10.2106/JBJS.CC.20.00296DOI Listing
March 2021

Relationship between shear elastic modulus and passive force of the human rectus femoris at multiple sites: a Thiel soft-embalmed cadaver study.

J Med Ultrason (2001) 2021 Apr 12;48(2):115-121. Epub 2021 Feb 12.

Second Division of Physical Therapy, School of Health Sciences, Sapporo Medical University, West 17, South 1, Chuo-ku, Sapporo, Japan.

Purpose: Estimation of muscle passive force from elasticity using shear wave elastography (SWE) has been reported. However, the relationship between the elasticity and passive force of human muscles has not been elucidated. This study investigated the elastic modulus-passive force relationship in human skeletal muscles at multiple sites.

Methods: Four rectus femoris (RF) muscles were dissected from a human Thiel-embalmed cadaver. Calibration weights (0-600 g in 60-g increments) were applied to the distal tendon via a pulley system, and the shear elastic modulus as an index of elasticity was measured using SWE. The shear elastic modulus of the RF was measured at the proximal, central, and distal portions.

Results: The results demonstrated that the relationships between the elasticity in the longitudinal direction of the muscle and the passive force were nearly linear for all tested sites, with coefficients of determination ranging from 0.813 to 0.993.

Conclusion: Shear wave elastography may be used as an indirect method to measure the changing passive force at any site within human muscles.
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http://dx.doi.org/10.1007/s10396-020-01076-wDOI Listing
April 2021

Does Selective Posterior Correction and Fusion Surgery Influence Cervical Sagittal Alignment In Patient With Lenke Type 5 Adolescent Idiopathic Scoliosis? - A 5-Year Follow Up Retrospective Cohort Study.

Spine (Phila Pa 1976) 2021 Jan 25. Epub 2021 Jan 25.

Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan.

Study Design: A retrospective comparative study.

Objective: To examine the changes in cervical sagittal alignment (CSA) following surgical correction in a patient with Lenke type 5 adolescent idiopathic scoliosis (AIS) and evaluate any possible factors influencing postoperative CSA.

Summary Of Background Data: Few studies have assessed the association between CSA and thoracic or lumbar sagittal alignment in AIS patients with major thoracolumbar/lumbar curve who underwent posterior correction and fusion surgery.

Methods: 66 patients with Lenke type 5 AIS (2 males and 64 females, the mean age at surgery of 16.2 years) were included in this study. They were followed up for minimum 5 years after surgery. Multiple linear regression analysis was used to evaluate possible factors influencing the postoperative CSA. To determine the influence of upper end vertebra (UEV) level on postoperative CSA, the subjects were divided into two groups according to UEV level of ≥ T9 or ≤ T10. The outcome variables were compared between the two groups and analyzed for changes in various spinal sagittal profiles using radiographic outcomes.

Results: Multiple linear regression analysis revealed that preoperative T10-L2 kyphosis and LL were significantly correlated with postoperative C2-7 lordosis. However, CSA did not significantly change at 5 years after surgery. Sub-analysis of the cohort revealed that in the UEV ≥ T9 group, the mean thoracic kyphosis significantly increased from 20.3 ± 10.6° to 24.0 ± 8.9° and the mean C2-7 lordosis also significantly increased from -12.5 ± 8.3° to -4.3 ± 10.3° at 5-year postoperatively. SRS-22 outcomes were comparable between the groups.

Conclusion: We indicated that the CSA was not influenced by surgical correction in most Lenke type 5 AIS patients. However, in a patient whose UEV was located at T9 or higher levels, CSA was influenced through the changes in thoracic kyphosis following posterior correction surgery.Level of Evidence: 4.
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http://dx.doi.org/10.1097/BRS.0000000000003967DOI Listing
January 2021
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