TOGAWA Daisuke

    Kindai University Nara Hospital Professor/General Manager
Last Updated :2024/03/24

Researcher Information

Degree

  • Doctor (Medicine)(2000/03 Yokohama City University)

J-Global ID

Research Areas

  • Life sciences / Orthopedics

Published Papers

  • Shunki Iemura; Shigeshi Mori; Masato Kamiya; Kenji Yamazaki; Takaya Kobayashi; Masao Akagi; Daisuke Togawa
    Annals of Medicine and Surgery Elsevier BV 79 103882 - 103882 2049-0801 2022/07 
    INTRODUCTION AND IMPORTANCE: Iliopsoas and iliacus abscesses are caused by hematogenous and lymphatic infections and the spread of inflammation in neighboring organs. A small number of cases have been reported in which inflammation spread not only within the iliopsoas muscle but also to the thigh. Here we report a case of retroperitoneal infiltration and perforation of cecal cancer that caused extensive abscess formation from the iliacus muscle to the thigh. CASE PRESENTATION: An 80-year-old man who had undergone chemotherapy for cecal cancer had abdominal pain and right thigh pain without any particular attraction. CT images showed extensive abscess formation from the iliacus muscle to the subcutaneous part of the thigh due to retroperitoneal infiltration and perforation of cecal cancer. Ileocecal resection, colostomy, and retroperitoneal abscess drainage were performed for perforation of cecal cancer and pelvic abscess. Although the thigh was initially drained by a small incision, the infection did not heal. Extensive debridement and drainage were required for all of the contaminated areas, and after all the infection was completely cured. CLINICAL DISCUSSION: The optimal treatment for an abscess that has spread from the inguinal region to the thigh is unclear. In this case, active debridement and drainage of the infected area were effective and should have been done early. CONCLUSION: We believed that debridement and drainage should have been performed from the time of the first surgery not only by the small incision drainage but also for all of the contaminated areas when the infection had been widespread.
  • 戸川 大輔
    脊椎脊髄ジャーナル 三輪書店 34 (11) 701 - 708 0914-4412 2022/03
  • Hiroyuki Inose; Tsuyoshi Kato; Shoichi Ichimura; Hiroaki Nakamura; Masatoshi Hoshino; Shinji Takahashi; Daisuke Togawa; Toru Hirano; Yasuaki Tokuhashi; Tetsuro Ohba; Hirotaka Haro; Takashi Tsuji; Kimiaki Sato; Yutaka Sasao; Masahiko Takahata; Koji Otani; Suketaka Momoshima; Takashi Hirai; Toshitaka Yoshii; Atsushi Okawa
    Journal of clinical medicine 11 (6) 2022/03 
    Although osteoporotic vertebral fractures (OVFs) are the most common type of osteoporotic fracture, few reports have investigated the factors contributing to residual low back pain in the chronic phase after OVFs by using radiographic evaluation. We examined the contribution of nonunion, vertebral deformity, and thoracolumbar alignment to the severity of residual low back pain post-OVF. This post hoc analysis of a prospective randomized study included 195 patients with a 48-week follow-up period. We investigated the associations between radiographic variables with the visual analog scale (VAS) scores for low back pain at 48 weeks post-OVF using a multiple linear regression model. Univariate analysis revealed that analgesic use, the local angle on magnetic resonance imaging, anterior vertebral body compression percentage on X-ray, and nonunion showed a significant association with VAS scores for low back pain. Multiple regression analysis produced the following equation: VAS for low back pain at 48 weeks = 15.49 + 0.29 × VAS for low back pain at 0 weeks + (with analgesics: +8.84, without analgesics: -8.84) + (union: -5.72, nonunion: -5.72). Among local alignment, thoracolumbar alignment, and nonunion, nonunion independently contributed to residual low back pain at 48 weeks post-OVF. A treatment strategy that reduces the occurrence of nonunion is desirable.
  • Shigeshi Mori; Masao Akagi; Akihiro Moritake; Ichiro Tsukamoto; Kotaro Yamagishi; Shinji Inoue; Koichi Nakagawa; Daisuke Togawa
    The journal of knee surgery 36 (5) 555 - 561 2021/12 
    There has been no consensus about how to determine the individual posterior tibial slope (PTS) intraoperatively. The purpose of this study was to investigate whether the tibial plateau could be used as a reference for reproducing individual PTS during medial unicompartmental knee arthroplasty (UKA). Preoperative computed tomography (CT) data from 48 lower limbs for medial UKA were imported into a three-dimensional planning software. Digitally reconstructed radiographs were created from the CT data as the lateral knee plain radiographs and the radiographic PTS angle was measured. Then, the PTS angles on the medial one-quarter and the center of the MTP (¼ and ½ MTP, respectively), and that on the medial tibial eminence (TE) were measured on the sagittal multiplanar reconstruction image. Finally, 20 lateral knee radiographs with an arthroscopic probe placed on the ¼ and the ½ MTP were obtained intraoperatively, and the angle between the axis of the probe and the tangent line of the plateau was measured. The mean radiographic PTS angle was 7.9 ± 3.0 degrees (range: 1.7-13.6 degrees). The mean PTS angles on the ¼ MTP, the ½ MTP, and the TE were 8.1 ± 3.0 degrees (1.2-13.4 degrees), 9.1 ± 3.0 degrees (1.4-14.7 degrees), and 9.9 ± 3.1 degrees (3.1-15.7 degrees), respectively. The PTS angles on the ¼ MTP and the ½ MTP were strongly correlated with the radiographic PTS angle (r =0.87 and 0.80, respectively, p < 0.001). A statistically significant difference was observed between the mean angle of the radiographic PTS and the PTS on the TE (p < 0.01). The mean angle between the axis of the probe and the tangent line of the tibial plateau was -0.4 ± 0.9 degrees (-2.3-1.3 degrees) on the ¼ MTP and -0.1 ± 0.7 degrees (-1.5-1.2 degrees) on the ½ MTP, respectively. An area from the medial one-quarter to the center of the MTP could be used as an anatomical reference for the individual PTS.
  • 【脊椎の外科基本手技】骨粗鬆症 脆弱性椎体骨折に対する低侵襲外科治療
    戸川 大輔
    Orthopaedics (株)全日本病院出版会 34 (10) 202 - 207 0914-8124 2021/10 
    骨粗鬆症性椎体骨折を受傷する患者年齢層は幅広い。骨粗鬆症を背景として発症する脆弱性椎体骨折の治療選択において、患者年齢は重要な一要素である。近年は作用機序の異なる多彩な骨粗鬆症治療薬があるが、これらの選択も患者年齢によって考慮される。経皮的椎体形成術は、脆弱性椎体骨折に対する低侵襲手術治療である。現在、本邦で主に行われているのはballoon kyphoplasty(BKP)であるが、使用マテリアルは骨セメント(PMMA:polymethylmethacrylate)である。骨セメントの骨伝導能はcalcium phosphate cementやhydroxyapatiteと比較して低く、主な役割は骨折を安定化させるスペーサーである。余命が長い患者にPMMAを使用することで、将来の手術治療選択を困難とする場合もある。低侵襲手術治療を選択するうえでも患者年齢は重要な要素である。(著者抄録)
  • Hiroyuki Inose; Tsuyoshi Kato; Shoichi Ichimura; Hiroaki Nakamura; Masatoshi Hoshino; Daisuke Togawa; Toru Hirano; Yasuaki Tokuhashi; Tetsuro Ohba; Hirotaka Haro; Takashi Tsuji; Kimiaki Sato; Yutaka Sasao; Masahiko Takahata; Koji Otani; Suketaka Momoshima; Kunihiko Takahashi; Masato Yuasa; Takashi Hirai; Toshitaka Yoshii; Atsushi Okawa
    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 30 (9) 2698 - 2707 2021/09 
    PURPOSE: To investigate the incidence and characteristics of subsequent vertebral fracture after osteoporotic vertebral fractures (OVFs) and identify risk factors for subsequent vertebral fractures. METHODS: This post-hoc analysis from a prospective randomized multicenter trial included 225 patients with a 48-week follow-up period. Differences between the subsequent and non-subsequent fracture groups were analyzed. RESULTS: Of the 225 patients, 15 (6.7%) had a subsequent fracture during the 48-week follow-up. The annual incidence of subsequent vertebral fracture after fresh OVFs in women aged 65-85 years was 68.8 per 1000 person-years. Most patients (73.3%) experienced subsequent vertebral fractures within 6 months. At 48 weeks, European Quality of Life-5 Dimensions, the Japanese Orthopedic Association Back Pain Evaluation Questionnaire pain-related disorder, walking ability, social life function, and lumbar function scores were significantly lower, while the visual analog scale (VAS) for low back pain was higher in patients with subsequent fracture. Cox proportional hazards analysis showed that a VAS score ≥ 70 at 0 weeks was an independent predictor of subsequent vertebral fracture. After adjustment for history of previous fracture, there was a ~ 67% reduction in the risk of subsequent vertebral fracture at the rigid-brace treatment. CONCLUSION: Women with a fresh OVF were at higher risk for subsequent vertebral fracture within the next year. Severe low back pain and use of soft braces were associated with higher risk of subsequent vertebral fractures. Therefore, when treating patients after OVFs with these risk factors, more attention may be needed for the occurrence of subsequent vertebral fractures. LEVEL OF EVIDENCE: III.
  • 鳥海 賢介; 山崎 顕二; 戸川 大輔
    骨折 (一社)日本骨折治療学会 43 (4) 882 - 885 0287-2285 2021/08
  • AOYAMA Shingo
    Japanese Journal of Joint Diseases Japanese Society for Joint Diseases 40 (2) 74 - 81 1883-2873 2021/07 
    目的 : 膝単純X線前後像の正面性評価に, 大腿骨遠位顆部における膝蓋骨の中央性が用いられている。しかし, その根拠は明らかでない。一方で, 膝正面を指示する様々な解剖学的参照軸が人工膝関節全置換術 (TKA) で用いられているが, 膝単純X線像の正面性との関係は不明である。本研究では, 解剖学的参照軸により膝関節を正面化した場合の膝CTデータデジタル再構成による擬似的膝単純X線像 (DRR) 上での膝蓋骨位置を評価した。これにより, 膝単純X線前後像の正面性に根拠を与えることができると考えた。 方法 : 内側膝単顆置換術 (内側UKA) を施行した25膝 (OA Grade: 1〜2) のCTデータを術前計画ソフト (3Dテンプレート, 京セラ) に読み込み, 大腿骨側はWhiteside line, 臨床的上顆軸 (CEA), 外科的上顆軸 (SEA), 後顆軸 (PCA), 脛骨側はAkagi's line, PCL脛骨付着部中央と膝蓋腱付着部内縁1/3または1/2を結ぶラインを用いて膝を正面化した上で膝DRR前後像を得た。そして, 大腿骨遠位顆部中央線に対する膝蓋骨中央点の偏位距離 (patellar center offset: PCO) を計測した。また, 大腿骨遠位顆部の幅でPCOを除したcorrected PCO (cPCO), および, Ademolaらのpatellar centering ratio (PCR) を算出した。 結果 : Whiteside line, CEA, SEA, PCAおよびAkagi lineを参照した場合には, 膝蓋骨は大腿骨遠位顆部中央線に対して外側に偏位し, 膝蓋腱付着部内縁1/3と1/2を参照した場合には内側に偏位した。PCOは, Whiteside line, CEAおよびAkagi lineで小さく, それぞれ−0.5mm±1.5, −1.2mm±2.2および−2.7mm±2.7であった。cPCOは, Whiteside line, CEAおよびAkagi's lineで小さく, それぞれ−0.7%±3.0, −1.6%±4.2, −2.4%±4.6であった。PCRは, Whiteside line, CEA, およびAkagi's lineで小さく, それぞれ−2.1%±3.5, −1.6%±7.9, −4.2%±4.8であった。 考察および結論 : 大腿骨側ではWhiteside lineまたはCEAを参照軸とした場合, 概ね膝蓋骨は大腿骨顆部の中央に位置した。脛骨側ではAkagi's lineがWhiteside lineやCEAと似た傾向を示す参照軸であった。我々が通常正面性が良好であると考える膝単純X線前後像は, これらの解剖学的参照軸に対して並行または垂直に撮影されたものであり, 機能解剖学的な根拠があるものと考えられた。また, 膝X線写真撮影時にはCEAを皮膚上から触知して参照軸とすれば, 正面性の良い膝X線写真が得られるであろう。
  • Hideyuki Arima; Yu Yamato; Tomohiko Hasegawa; Daisuke Togawa; Go Yoshida; Tatsuya Yasuda; Tomohiro Banno; Shin Oe; Hiroki Ushirozako; Tomohiro Yamada; Yuh Watanabe; Koichiro Ide; Yukihiro Matsuyama
    Journal of neurosurgery. Spine 1 - 8 2021/06 
    OBJECTIVE: Extensive corrective fusion surgery was performed on elderly patients with adult spinal deformity (ASD) to improve abnormal posture. Varying improvements in postoperative walking function were expected owing to differences in muscular strength and bone quality between patients in their 40s and those over 75 years of age. The purpose of this study was to compare preoperative and postoperative gait posture and physical functionality in elderly patients with ASD who underwent extensive corrective fusion to the thoracic spine. METHODS: A prospectively maintained surgical database was reviewed for patients with ASD who underwent corrective fusion surgery (thoracic spine to pelvis) between 2011 and 2016. The cohort was divided into three age groups: nonelderly (40-64 years), young-old (65-74 years), and old-old (> 75 years). Patients underwent a 4-m walk test preoperatively and 2 years postoperatively to measure gait-trunk tilt angle and walking speed (meters per minute). RESULTS: Among 291 patients with ASD who underwent corrective fusion surgery, 56 patients (14 men and 42 women; mean age 68.8 years) were included. Mean preoperative gait-trunk tilt angle (12.9° vs 5.2°, p < 0.01) and walking speed (41.2 m/min vs 45.7 m/min, p < 0.01) significantly improved postoperatively. Intergroup analysis revealed that the mean preoperative gait-trunk tilt angles in the nonelderly (n = 13), young-old (n = 28), and old-old (n = 15) groups were 11.9°, 10.0°, and 19.3°, respectively; postoperatively, these improved to 4.5°, 4.5°, and 7.2°, respectively. Mean preoperative walking speeds of 47.9, 40.0, and 37.7 m/min improved to 52.4, 44.8, and 41.5 m/min postoperatively in the nonelderly, young-old, and old-old groups, respectively. There were no statistically significant differences in degree of improvement in gait-trunk tilt angle and walking speed among groups. CONCLUSIONS: Extensive corrective fusion surgery improved the postoperative walking posture of patients with ASD. Statistical analysis of gait measurements demonstrated intergroup equivalence, indicating comparable improvement in physical functionality in elderly and middle-aged patients after corrective fusion surgery.
  • Koichiro Ide; Tomohiro Banno; Yu Yamato; Tomohiko Hasegawa; Go Yoshida; Tatsuya Yasuda; Hideyuki Arima; Shin Oe; Yuki Mihara; Hiroki Ushirozako; Tomohiro Yamada; Yuh Watanabe; Keiichi Nakai; Kenta Kurosu; Hironobu Hoshino; Haruo Niwa; Daisuke Togawa; Yukihiro Matsuyama
    Geriatrics & gerontology international 21 (6) 458 - 464 2021/06 
    AIM: The relationship between locomotive syndrome (LS), frailty and sarcopenia is unclear. This cohort study investigates the epidemiology of the three conditions and examines the relationship between them. METHODS: The participants were 337 Japanese adults aged ≥60 years who had undergone a healthcare checkup. LS, frailty and sarcopenia were assessed using the Geriatric Locomotive Function Scale, the Kihon Checklist and the Asian Working Group for Sarcopenia criteria, respectively. The epidemiological investigation and correlations of the three concepts were examined. RESULTS: In total, 212 participants (63%) were women. The participants' mean age was 76 years (range 60-94 years). The average Geriatric Locomotive Function Scale total score was 11.4 ± 11.2, and Kihon Checklist was 4.72 ± 3.97. A total of 202 (59.9%) participants met one of the criteria; 190 (56.9%) were diagnosed with LS, 77 (22.6%) with frailty and 26 (7.7%) with sarcopenia; and 70 out of 77 (90.1%) of frailty patients and 21 out of 26 (80.1%) of sarcopenia patients were included in LS. The relationship between the total score, subcategorical scores and survey items for each was investigated. Activities of daily living, physical function and mental status showed a strong correlation with all concepts. However, nutrition of frailty patients and muscle mass of sarcopenia patients did not correlate with other factors. CONCLUSIONS: LS overlapped with frailty and sarcopenia. LS criteria might be useful as the best tool to screen older persons who would be at risk for requiring care in the near future. However, nutrition status could only be assessed by frailty and muscle mass by sarcopenia. Geriatr Gerontol Int 2021; 21: 458-464.
  • Koichiro Ide; Yu Yamato; Tomohiko Hasegawa; Go Yoshida; Tatsuya Yasuda; Tomohiro Banno; Hideyuki Arima; Shin Oe; Yuki Mihara; Hiroki Ushirozako; Tomohiro Yamada; Yuh Watanabe; Keiichi Nakai; Hironobu Hoshino; Haruo Niwa; Daisuke Togawa; Yukihiro Matsuyama
    Geriatrics & gerontology international 21 (6) 492 - 497 2021/06 
    AIM: The 25-question Geriatric Locomotive Function Scale (hereafter, "GLFS-25") is a simple screening tool to detect elderly individuals at high risk of locomotive syndrome and promote interventions. This cohort study aimed to clarify if it can predict the need for nursing care certification in the near future. METHODS: Participants were 531 Japanese adults aged ≥65 years who had undergone a healthcare checkup in 2012 and never received nursing care certification until 2012. We collected baseline information and conducted a physical examination in 2012. We investigated the presence of nursing care certification and care need level from 2013 to 2018. Relationships of these factors with nursing care certification after 6 years were assessed. A receiver operating characteristic curve for both the GLFS-25 and physical examination were used to determine optimal threshold value. RESULTS: From 2013 to 2018, 114 volunteers (21.4%) applied for nursing care certification and 29 volunteers died. The group with nursing care certification (over support level 1) had an average age of 79.9 years and a mean score of 17.8 on the scale. Those without nursing care certification had an average age of 74.1 years and a mean score of 8.7. When the GLFS-25 score was 12.5, sensitivity was 0.658 and specificity was 0.760. The area under the curve was 0.736 (95% confidence interval 0.682-0.789). CONCLUSIONS: The GLFS-25 has enabled early detection of individuals with locomotive syndrome who are more likely to need nursing care certification in the near future. We propose using a cutoff score of 13 for the scale. Geriatr Gerontol Int 2021; 21: 492-497.
  • Hiroyuki Inose; Tsuyoshi Kato; Shoichi Ichimura; Hiroaki Nakamura; Masatoshi Hoshino; Daisuke Togawa; Toru Hirano; Yasuaki Tokuhashi; Tetsuro Ohba; Hirotaka Haro; Takashi Tsuji; Kimiaki Sato; Yutaka Sasao; Masahiko Takahata; Koji Otani; Suketaka Momoshima; Masato Yuasa; Takashi Hirai; Toshitaka Yoshii; Atsushi Okawa
    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 26 (3) 453 - 458 2021/05 
    BACKGROUND: Studies on the clinical and radiographic risk factors for the residual low back pain beyond 6 months after osteoporotic vertebral fractures (OVFs) are lacking. Hence, this study aimed to characterize a patient population with residual low back pain 48 weeks after acute OVFs and to identify the risk factors associated with residual low back pain. METHODS: This prospective multicenter study included 166 female patients aged 65-85 years with acute one-level OVFs. We defined the residual low back pain as visual analog scale (VAS) for low back pain ≥3.5 at 48 weeks in this study, as VAS score ≥3.5 is used to describe moderate or severe pain. Thus, outcome and risk factor analyses were performed by comparing patients with VAS scores <3.5 and ≥ 3.5. In the radiographic analysis, the anterior vertebral body compression percentage was measured at 0, 12, and 48 weeks. Magnetic resonance imaging (MRI) was performed at enrollment and 48 weeks. RESULTS: Of the 166 patients analyzed, 58 complained of residual low back pain at 48 weeks after OVFs. At 0 weeks, the VAS score was significantly higher, and the JOABPEQ mental health score and anterior vertebral body compression percentage were significantly lower in patients with persistent pain 48 weeks after OVFs. The independent risk factors in the acute phase for persistent pain 48 weeks after OVFs were a high VAS score, MRI T2 fluid-intensity image pattern, and a lower anterior vertebral body compression percentage. CONCLUSIONS: Severe low back pain, MRI T2 fluid-intensity image pattern, and severe vertebral body collapse in the acute phase were significant risk factors for residual low back pain 48 weeks after OVFs. Patients with acute OVFs who have these risk factors should be carefully monitored for the possible development of residual chronic low back pain.
  • Akihiro Moritake; Shigeshi Mori; Masato Kamiya; Kenji Yamazaki; Shingo Aoyama; Masao Akagi; Daisuke Togawa
    Annals of medicine and surgery (2012) 65 102332 - 102332 2021/05 
    Introduction: Nontuberculous mycobacterial (NTM) infections of the musculoskeletal system are uncommon. Such infections are typically acquired by direct inoculation after penetrating trauma, surgical procedures, or needle injections. There are no reported cases of NTM infection after arthrocentesis for idiopathic hemarthrosis of the knee. Here we report a case of NTM infection in the knee that developed after arthrocentesis for idiopathic hemarthrosis of the knee. Presentation of case: The patient was an 85-year-old woman who experienced swelling of the left knee. An arthrocentesis was carried out, and hemarthrosis was found. The patient was referred to our hospital for repeated recurrence of hematoma of the knee. Significant swelling was observed in the suprapatellar sac. Magnetic resonance imaging examination revealed a mass at the suprapatellar sac. Laboratory data showed elevation of inflammatory markers. Debridement was performed under arthroscopy and samples were collected for culture. Although routine microbiological cultures were negative, the patient continued to experience knee swelling and laboratory data showed high C-reactive protein levels. Therefore, open debridement was carried out. At 4 weeks after the first surgical treatment, intraoperative cultures yielded Mycobacterium intracellulare. At this point, we diagnosed septic arthritis of the knee due to NTM infection. The patient showed an excellent prognosis with three-drug medical treatment for 1 year. Conclusion: Clinically, diagnosis of septic arthritis due to NTM infection is not easy. Because selection of examination depends on clinical suspicion, NTM infections should be considered for patients with elevation of inflammatory markers after episodes of surgical procedures, and/or needle injections.
  • Masao Koda; Hideki Hanaoka; Yasuhisa Fujii; Michiko Hanawa; Yohei Kawasaki; Yoshihito Ozawa; Tadami Fujiwara; Takeo Furuya; Yasushi Ijima; Junya Saito; Mitsuhiro Kitamura; Takuya Miyamoto; Seiji Ohtori; Yukei Matsumoto; Tetsuya Abe; Hiroshi Takahashi; Kei Watanabe; Toru Hirano; Masayuki Ohashi; Hirokazu Shoji; Tatsuki Mizouchi; Norio Kawahara; Masahito Kawaguchi; Yugo Orita; Takeshi Sasamoto; Masahito Yoshioka; Masafumi Fujii; Katsutaka Yonezawa; Daisuke Soma; Hiroshi Taneichi; Daisaku Takeuchi; Satoshi Inami; Hiroshi Moridaira; Haruki Ueda; Futoshi Asano; Yosuke Shibao; Ikuo Aita; Yosuke Takeuchi; Masaya Mimura; Jun Shimbo; Yukio Someya; Sumio Ikenoue; Hiroaki Sameda; Kan Takase; Yoshikazu Ikeda; Fumitake Nakajima; Mitsuhiro Hashimoto; Fumio Hasue; Takayuki Fujiyoshi; Koshiro Kamiya; Masahiko Watanabe; Hiroyuki Katoh; Yukihiro Matsuyama; Tomohiko Hasegawa; Go Yoshida; Hideyuki Arima; Yu Yamato; Shin Oe; Daisuke Togawa; Sho Kobayashi; Koji Akeda; Eiji Kawamoto; Hiroshi Imai; Toshihiko Sakakibara; Akihiro Sudo; Yasuo Ito; Takeshi Kikuchi; Tomoyuki Takigawa; Takuya Morita; Nobuhiro Tanaka; Kazuyoshi Nakanishi; Naosuke Kamei; Shinji Kotaka; Hideo Baba; Tsuyoshi Okudaira; Hiroaki Konishi; Takayuki Yamaguchi; Keigo Ito; Yoshito Katayama; Taro Matsumoto; Tomohiro Matsumoto; Haruo Kanno; Toshimi Aizawa; Ko Hashimoto; Toshimitsu Eto; Takehiro Sugaya; Michiharu Matsuda; Kazunari Fushimi; Satoshi Nozawa; Chizuo Iwai; Toshihiko Taguchi; Tsukasa Kanchiku; Hidenori Suzuki; Norihiro Nishida; Masahiro Funaba; Takashi Sakai; Yasuaki Imajo; Masashi Yamazaki
    Brain : a journal of neurology 144 (3) 789 - 799 2021/04 
    Attenuation of the secondary injury of spinal cord injury (SCI) can suppress the spread of spinal cord tissue damage, possibly resulting in spinal cord sparing that can improve functional prognoses. Granulocyte colony-stimulating factor (G-CSF) is a haematological cytokine commonly used to treat neutropenia. Previous reports have shown that G-CSF promotes functional recovery in rodent models of SCI. Based on preclinical results, we conducted early phase clinical trials, showing safety/feasibility and suggestive efficacy. These lines of evidence demonstrate that G-CSF might have therapeutic benefits for acute SCI in humans. To confirm this efficacy and to obtain strong evidence for pharmaceutical approval of G-CSF therapy for SCI, we conducted a phase 3 clinical trial designed as a prospective, randomized, double-blinded and placebo-controlled comparative trial. The current trial included cervical SCI [severity of American Spinal Injury Association (ASIA) Impairment Scale (AIS) B or C] within 48 h after injury. Patients are randomly assigned to G-CSF and placebo groups. The G-CSF group was administered 400 μg/m2/day × 5 days of G-CSF in normal saline via intravenous infusion for five consecutive days. The placebo group was similarly administered a placebo. Allocation was concealed between blinded evaluators of efficacy/safety and those for laboratory data, as G-CSF markedly increases white blood cell counts that can reveal patient treatment. Efficacy and safety were evaluated by blinded observer. Our primary end point was changes in ASIA motor scores from baseline to 3 months after drug administration. Each group includes 44 patients (88 total patients). Our protocol was approved by the Pharmaceuticals and Medical Device Agency in Japan and this trial is funded by the Center for Clinical Trials, Japan Medical Association. There was no significant difference in the primary end point between the G-CSF and the placebo control groups. In contrast, one of the secondary end points showed that the ASIA motor score 6 months (P = 0.062) and 1 year (P = 0.073) after drug administration tend to be higher in the G-CSF group compared with the placebo control group. Moreover, in patients aged over 65 years old, motor recovery 6 months after drug administration showed a strong trend towards a better recovery in the G-CSF treated group (P = 0.056) compared with the control group. The present trial failed to show a significant effect of G-CSF in primary end point although the subanalyses of the present trial suggested potential G-CSF benefits for specific population.
  • Hideyuki Arima; Tomohiko Hasegawa; Yu Yamato; Daisuke Togawa; Go Yoshida; Tatsuya Yasuda; Tomohiro Banno; Shin Oe; Yuki Mihara; Hiroki Ushirozako; Tomohiro Yamada; Yuh Watanabe; Koichiro Ide; Keiichi Nakai; Yukihiro Matsuyama
    Spine 46 (6) E384-E391  2021/03 
    STUDY DESIGN: Retrospective longitudinal cohort study. OBJECTIVE: This study aimed to elucidate factors affecting the likelihood of achieving minimum clinically important difference (MCID) to patient-reported outcomes defined by the Scoliosis Research Society-22r (SRS-22r) among patients with adult spinal deformity (ASD) who underwent extensive corrective fusion surgery from the thoracic spine to the pelvis. SUMMARY OF BACKGROUND DATA: Achieving MCID for SRS-22r parameters was a measure of surgical efficacy. Patient characteristics and surgical and radiographic factors that affect the likelihood of achieving MCID for SRS-22r parameters are unknown. METHODS: Data from patients with ASD who underwent extensive corrective fusion surgery from the thoracic spine to the pelvis during 2010 to 2016 were retrospectively reviewed. Data from a total of 167 patients with ≥2 years of follow-up were included. Multivariate analysis was used to investigate factors associated with the likelihood of achieving MCID for each of the SRS-22r domains (Function, Pain, Subtotal) 2 years after surgery. The following MCID values were used: 0.90 for Function, 0.85 for Pain, and 1.05 for the Subtotal. RESULTS: MCID achievement rate was 36.5% for Function, 46.1% for Pain, and 44.3% for the Subtotal domain. In multivariate analysis, preoperative SRS-22r Function (odds ratio [OR] = 0.204, 95% confidence interval [CI] 0.105-0.396) increased the likelihood of achieving MCID for SRS-22r Function. Preoperative SRS-22r Subtotal (OR = 0.211, 95% CI, 0.107-0.413), preoperative pelvic tilt (OR = 1.072, 95% CI, 1.012-1.136), preoperative pelvic incidence minus lumbar lordosis (OR = 0.965, 95% CI, 0.934-0.997), and postoperative sagittal vertical axis (OR = 0.985, 95% CI, 0.974-0.995) affected the likelihood of achieving MCID for the SRS-22r Subtotal. CONCLUSION: Patients with poor preoperative health-related quality of life were more likely to achieve improvement in SRS-22r parameters after extensive corrective fusion surgery for ASD. Achieving postoperative sagittal alignment increased the likelihood of achieving MCID for the SRS-22r Subtotal domain.Level of Evidence: 3.
  • Yagi Mitsuru; Ishii Ken; Iwasaki Motoki; Inoue Gen; Ohtori Seiji; Orita Sumihisa; Kanemura Tokumi; Kotani Toshiaki; Sairyo Koichi; Sakai Daisuke; Sudo Hideki; Takahashi Jun; Taneichi Hiroshi; Togawa Daisuke; Nakamura Masaya; Hasagawa Tomohiko; Fujibayashi Shunsuke; Yoshii Toshitaka; Wakao Norimitsu; Watanabe Masahiko; Hosogane Naobumi
    Journal of Spine Research The Japanese Society for Spine Surgery and Related Research 12 (1-2) 38 - 44 1884-7137 2021/01 
    Background: Recently, lateral lumbar interbody fusion (LIF) including eXtreme lateral lnterbody fusion (XLIF), direct lateral interbody fusion (DLIF), and oblique lateral interbody fusion (OLIF), has been introduced in Japan. Despite the effectiveness of this procedure, several complications have been reported. Since 2015, to identify the overall complication rate and type, the Japanese Society for Spine Surgery and Related Research (JSSR) has started a nationwide survey on the incidence and the type of complications related to LIF among all JSSR members. Purpose: To report the results of a nationwide survey performed by JSSR on complications in LIF performed in Japan in 2018 Methods: A web-based survey on the complications following LIF was performed by JSSR for all JSSR members. Any complications meeting the criteria listed below have been included: (1) major vessel injury, (2) urinary tract injury, (3) renal injury, (4) visceral organ injury, (5) lung injury, (6) weakness of psoas, (7) motor deficit, (8) sensory deficit, (9) vertebral injury, (10) nerve injury, (11) anterior longitudinal ligament injury, (12) surgical site infection (SSI), and (13) other complications. Incidence and type of complications were analyzed in all LIF cases, and the difference in incidence and the type of complications between XLIF and OLIF were also compared. Results: Among the 2,354 LIF cases (XLIF: 1,130 cases [48%], DLIF: 21 cases [0.9%], and OLIF: 1,230 cases [51%]), complications occurred in 54 (2.3%) cases. The most common complications were motor deficit (0.34%) and SSI (0.34%), followed by sensory deficit (0.25%) and major vessel injury (0.17%). Eighteen (30% of all complications and 0.8% of all cases) cases required revision surgery during the survey period. There were three (0.1%) cases of mortality cases due to complications of this surgery. There was no statistically significant difference in the frequency of complications between XLIF and OLIF (2.7% vs.1.7%, p = 0.10). Conclusion: We conducted a nationwide survey on complications following LIF surgery. The overall complication rate was 2.3%, and 0.8% of cases required revision surgery related to complications. Three mortality cases occurred due to complications. Future detailed studies are recommended to evaluate severe complications to mitigate the risk of mortality in this procedure.
  • TORIUMI Kensuke
    The Central Japan Journal of Orthopaedic Surgery & Traumatology THE CENTRAL JAPAN ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 64 (1) 145 - 146 0008-9443 2021/01 
    首下がり症候群(DHS)6例を対象に、治療フローチャートに基づいて、既往歴や内服歴を把握し、病因・病態を把握した上で、投薬量や種類の調整やリハビリテーション、手術治療を行い、愁訴の変化を調査した。平均年齢は74.0(45〜89)歳で、発症してから治療開始までの期間は平均10.2(2〜26)ヵ月であった。その結果、2例で薬剤性DHSが疑われ、うち1例は抗パーキンソン病薬を変更し、1例は抗精神病薬を減量することで首下がり症状が改善し、水平視が可能となった。残り4例は胸椎以下に強直した後彎があり、うち3例は座位姿勢矯正などの理学療法を、1例は下方注視時に頸椎黄色靱帯骨化による頸髄症を呈していたため、除圧術を施行し、4例とも首下がり症状が改善し、愁訴が軽減した。首下がりの治療は病態の把握と頸椎の可動性を基に治療戦略を立てることが重要と考えられた。
  • Hiroyuki Inose; Tsuyoshi Kato; Hiroaki Nakamura; Masatoshi Hoshino; Daisuke Togawa; Toru Hirano; Yasuaki Tokuhashi; Tetsuro Ohba; Hirotaka Haro; Takashi Tsuji; Kimiaki Sato; Yutaka Sasao; Masahiko Takahata; Koji Otani; Suketaka Momoshima; Kunihiko Takahashi; Masato Yuasa; Takashi Hirai; Toshitaka Yoshii; Atsushi Okawa
    Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation 30 (1) 129 - 135 2021/01 
    PURPOSE: No study has investigated the clinical and radiographic risk factors for the deterioration of quality of life (QOL) beyond 6 months after osteoporotic vertebral fractures (OVF). The purpose of this study was to identify the predictors associated with poor QOL improvement after OVF. METHODS: This post hoc analysis included 166 women aged 65-85 years with acute 1-level OVFs. For the patient-reported outcome measures, scores on the European Quality of Life-5 Dimensions (EQ-5D) scale, and visual analogue scale (VAS) for low back pain were used. Lateral radiography at 0, 12, and 48 weeks and magnetic resonance imaging (MRI) at enrollment and at 48 weeks were performed. The associations between baseline variables with change scores for EQ-5D were investigated using a multiple linear regression model. RESULTS: Univariate analysis showed that time since fracture, EQ-5D score, and VAS for low back pain at 0 week showed significant association with increased EQ-5D score from 0 to 48 weeks. According to the multiple regression analysis, the following equation was obtained: increased EQ-5D score from 0 to 48 weeks = 1.305 - 0.978 × EQ-5D at 0 week - 0.021 × VAS for low back pain at 0 week - 0.006 × age + (fluid-intensity T2-weighted MR image patterns: - 0.037, except for fluid-intensity T2-weighted MR image patterns: + 0.037). CONCLUSION: In conclusion, older patients with severe low back pain and fluid-intensity T2-weighted MR image patterns were more likely to have lower QOL improvements after OVFs and may therefore need extra support to improve QOL.
  • Sreenath Jakinapally; Yu Yamato; Tomohiko Hasegawa; Daisuke Togawa; Go Yoshida; Tomohiro Banno; Hideyuki Arima; Shin Oe; Tatsuya Yasuda; Hiroki Ushirozako; Tomohiro Yamada; Koichirou Ide; Yuh Watanabe; Yukihiro Matsuyama
    Spine deformity 8 (6) 1313 - 1323 2020/12 
    STUDY DESIGN: This was a retrospective analysis of a prospectively collected consecutive case series of patients with adult spinal deformity (ASD). OBJECTIVE: This study aimed to investigate the impact of the geometrical sagittal shape of the corrected spine on the development of proximal junctional kyphosis (PJK). Several studies have documented risk factors for PJK in ASD surgery. Geometrical assessment is vital for evaluating sagittal spinal deformity. It is essential to assess the postoperative geometrical shape of the spine and the location of the correction in the spine to decrease postoperative junctional stress and PJK. METHODS: Consecutive patients with ASD who underwent corrective fusion with long constructs to the pelvis were included. Patients with neuromuscular disease, congenital and adolescent scoliosis, infection, and spinal tumor were excluded. We investigated the spinopelvic and geometrical parameters of the whole spine. The locations of the thoracic and lumbar apical vertebrae and the inflection vertebrae (IV), where the curvature of the associated adjacent vertebral bodies changes from kyphosis to lordosis, were investigated. The subjects were divided into PJK included patients who underwent revision surgery for junctional failure or with a change in proximal junctional angle ≥ 20°, and non-PJK groups. RESULTS: A total of 139 patients (mean age, 69.6 years; range 18-82 years) were included. There were 47 and 92 patients in the PJK and non-PJK groups, respectively. The IV were located significantly cranial and posterior, the lumbar apex were located significantly posterior in the PJK group at the immediate postoperative time points. The significant risk factors for PJK on binary logistic regression were cranial IV and posterior lumbar apical vertebrae. The incidence of PJK in patients with IV at T12 or cranial tends PJK significantly higher (69%) than at L1 or caudal (26%). CONCLUSIONS: Geometrical spinal shape should be taken into account to reduce the rate of postoperative mechanical complications. LEVEL OF EVIDENCE: Level of evidence III.
  • 戸川 大輔
    整形外科看護 (株)メディカ出版 25 (11) 1100 - 1104 1342-4718 2020/11
  • 青木 保親; 市村 正一; 大鳥 精司; 戸川 大輔; 萩野 浩; 星野 雅俊; 宮腰 尚久; 日本整形外科学会骨粗鬆症委員会骨粗鬆症性椎体骨折診療マニュアルワーキンググループ
    日本整形外科学会雑誌 (公社)日本整形外科学会 94 (10) 882 - 906 0021-5325 2020/10
  • Tomohiro Yamada; Yu Yamato; Yoshihiro Sato; Daisuke Togawa; Tomohiko Hasegawa; Go Yoshida; Tatsuya Yasuda; Hideyuki Arima; Tomohiro Banno; Shin Oe; Hiroki Ushirozako; Koichiro Ide; Yuh Watanabe; Yukihiro Matsuyama
    Spine 45 (19) E1232-E1238  2020/10 
    STUDY DESIGN: Four-year, longitudinal cohort study. OBJECTIVE: The aim of this study was to investigate the effect of original spinal shape on incidental vertebral fractures (VFs) and to identify the influence of changes in pre- and post-fracture geometrical spinal shape. SUMMARY OF BACKGROUND DATA: Clinical evidence demonstrates that VFs cause spinal kyphosis, morbidities, and deteriorating quality of life in elderly people. However, knowledge of geometrical spinal shapes that affect incidental VFs is limited. METHODS: Three hundred seventeen volunteers underwent whole spine radiography as part of a health screening in both 2012 and 2016. We extracted volunteers with incidental VF in 2016. Sex- and age-matched volunteers without VF were enrolled as controls. Baseline demographic variables, geometrical spinal shape, and spinopelvic parameters were compared between the two groups. In volunteers with incidental VF, we investigated the association between baseline spinal shape and post-fracture shape. RESULTS: Twenty-seven volunteers (12 men; mean age 75.4 ± 5.4 and 15 women; mean age 71.6 ± 7.9) with VF were enrolled, and 175 volunteers (48 men, 127 women) without VF were selected as controls. In men with VF, the thoracic kyphosis apex was located significantly more posteriorly and caudally than in those without VF. In women with VF, the lordosis apex was located significantly more posteriorly and caudally than in those without VF. After fractures occurring above the inflexion vertebra, the low anterior apex spine (L5) changed its geometrical shape in that the posterior apex and the inflexion vertebra shifted significantly more posteriorly compared to the high anterior apex spine (L4/5). CONCLUSION: Original geometrical spinal shape affected the occurrence of VF, and post-fracture spinal shape depended on the positional relationship between the inflexion vertebra and fractured vertebra. Our study helps to understand the influence of geometrical spinal shape on the risks of VF. LEVEL OF EVIDENCE: 3.
  • Shin Oe; Yu Yamato; Tomohiko Hasegawa; Go Yoshida; Sho Kobayashi; Tatsuya Yasuda; Tomohiro Banno; Hideyuki Arima; Yuki Mihara; Hiroki Ushirozako; Tomohiro Yamada; Koichiro Ide; Yuh Watanabe; Daisuke Togawa; Haruo Niwa; Yukihiro Matsuyama
    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 29 (9) 2329 - 2339 2020/09 
    PURPOSE: There is controversy regarding age-related deterioration of spinal sagittal alignment in cross-sectional study. Although we reported that deterioration in spinal alignment originated at the cervical spine in males and the pelvis in females, others studies have indicated that the lumbar spine is initially implicated in both sexes. The purpose of this study was to clarify these differences in a longitudinal cohort study. METHODS: Our analysis was based on 237 individuals aged 60-89 years who participated in our health screening study in 2014 and 2018. They were classified into six groups by birth year and sex: 60-69 years (26 males, 49 females); 70-79 years (35 males, 88 females); and 80-89 years (19 males, 20 females). The following parameters were measured from standing radiographs: pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis, T1 slope, cervical lordosis, C7 sagittal vertical axis (C7 SVA), and C2-7 SVA. RESULTS: In males, the first significant change was an increase in the PT angle (19°, in 2014, to 21°, in 2018) in the 80-89 years age group (P < 0.05), with no significant deterioration in cervical parameters. In females, spinal deterioration included a change in the SS (32°-30°), PT (18°-20°), and SVA (- 8 to 6 mm) in the 60-69 years age group (P < 0.05), with no change in the LL. CONCLUSIONS: Contrary to prior studies, our longitudinal data indicated that deterioration in spinal alignment originates in the pelvis for both sex but develops earlier in females than males.
  • Shin Oe; Yu Yamato; Tomohiko Hasegawa; Go Yoshida; Sho Kobayashi; Tatsuya Yasuda; Tomohiro Banno; Hideyuki Arima; Yuki Mihara; Hiroki Ushirozako; Tomohiro Yamada; Koichiro Ide; Yuh Watanabe; Daisuke Togawa; Haruo Niwa; Yukihiro Matsuyama
    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 29 (8) 2107 - 2108 2020/08 
    Unfortunately, figure 3 was incorrectly published in the original publication. The complete correct figure 3 is given below.
  • Tatsuya Yasuda; Daisuke Togawa; Tomohiko Hasegawa; Yu Yamato; Sho Kobayashi; Go Yoshida; Tomohiro Banno; Hideyuki Arima; Shin Oe; Hironobu Hoshino; Hiroshi Koyama; Mitsuru Hanada; Takayuki Imada; Yukihiro Matsuyama
    Asian spine journal 14 (4) 495 - 501 2020/08 
    STUDY DESIGN: Large cohort study of volunteers. PURPOSE: The purpose of this study was to investigate the relationship between the severity of knee osteoarthritis, assessed using the Kellgren-Lawrence (KL) grading scale, and spinopelvic sagittal alignment in older adult volunteers. OVERVIEW OF LITERATURE: The relationship between spinopelvic alignment in the sagittal plane and knee osteoarthritis in the coronal plane is unclear. METHODS: Volunteers over 50 years of age underwent radiographic analysis. Radiographic parameters including pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), thoracic kyphosis, and sagittal vertical axis (SVA) were measured. The the three Scoliosis Research Society-Schwab sagittal modifiers (PT, SVA, PI-LL) were categorized and the KL grade was assessed. Differences in spinopelvic parameters and Oswestry Disability Index (ODI) scores among KL grades were evaluated. RESULTS: A total of 396 volunteers (160 men, 236 women; mean age, 74.4 years) were analyzed. PI-LL and PT in KL4 were significantly higher compared to that in the other KL grades. However, there were no significant group differences in SVA. In women, but not in men, higher frequencies of the worst modifier grade (++) were observed for PI-LL and PT in the KL3 and KL4 groups compared to those for the other KL grades. In women, the ODI score in KL4 was worse compared to that in the other KL grades. CONCLUSIONS: Individuals over 50 years of age with severe knee osteoarthritis had poor lumbo-pelvic sagittal alignment. Moreover, the progression severity of knee osteoarthritis had more impact onstronger relationship with lumbo-pelvic malalignment and disability-related low back pain in women than in men.
  • Go Yoshida; Hiroki Ushirozako; Tomohiko Hasegawa; Yu Yamato; Sho Kobayashi; Tatsuya Yasuda; Tomohiro Banno; Hideyuki Arima; Shin Oe; Yuki Mihara; Koichiro Ide; Yuh Watanabe; Tomohiro Yamada; Daisuke Togawa; Yukihiro Matsuyama
    Spine 45 (15) E950-E958  2020/08 
    STUDY DESIGN: Case-control study from a continuous series. OBJECTIVES: To study the impact of perioperative sitting radiographs in adult spinal deformity (ASD) patients and determine whether proximal junctional kyphosis (PJK) can be prevented using preoperative sitting radiograph. SUMMARY OF BACKGROUND DATA: Radiographic analysis of ASD comprises standing whole-spine radiography which cannot evaluate the relaxed posture without head-to-foot compensation. METHODS: Preoperative and postoperative whole-spine standing and sitting radiographs and proximal mechanical complications in surgically treated spinal disorders with a minimum of 1-year follow-up were studied. Whole-spinal alignment was defined by cervical lordosis (CL), sagittal vertical axis (SVA), T1 slope (T1S), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and level of kyphotic apex (KA). Proximal mechanical complication was described as a PJK (proximal junctional angle >20°) or reoperation due to proximal junctional failure. RESULTS: Surgically treated 113 patients were prospectively investigated. Patients were divided into either the ASD (thoracic to ilium posterior corrective fusion), or non-ASD groups. In the ASD group, 10 patients had postoperative PJK, and three revision surgeries were carried out due to PJF with neurological deficit. Comparing standing with sitting positions, CL, TK, and PT became larger, SVA became frontal, LL and SS became smaller, and KA became caudal particularly in the ASD group. Logistic regression analysis demonstrated that the most influenced plumb line for PJK was the upper instrumented vertebra (UIV) to C2 plumb line distance, with a cutoff value of 115 mm for predicting PJK. CONCLUSION: Our findings highlight the usefulness of sitting spinal alignment evaluation, particularly in ASD patients, with maximum effort of thoracic spine and lower extremity compensation at standing. Mechanical complications such as PJK could be predicted using the distance from the planned UIV to the C2 plumb line in preoperative sitting radiographs. LEVEL OF EVIDENCE: 3.
  • Yu Yamato; Yoshihiro Sato; Daisuke Togawa; Tomohiko Hasegawa; Go Yoshida; Tatsuya Yasuda; Tomohiro Banno; Hideyuki Arima; Shin Oe; Yuki Mihara; Hiroki Ushirozako; Tomohiro Yamada; Yukihiro Matsuyama
    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 25 (4) 557 - 564 2020/07 
    BACKGROUND: Several studies indicated the influence of age and sex on spinal alignment using spino-pelvic radiographic parameters. However, information regarding the geometrical assessment of the sagittal spinal plane in the elderly population remains limited. This study aimed to determine the apices of lumbar lordosis and thoracic kyphosis, and spinal inflection point in elderly individuals and clarify the effect of age, sex, and pelvic incidence (PI) on sagittal geometry. METHODS: In total, 440 volunteers (193 men; 247 women) were enrolled. The spino-pelvic radiographic parameters were measured. The apices of thoracic kyphosis and lumbar lordosis, and the inflection point where the vertebral curvature changes from kyphosis to lordosis were investigated. We analyzed the differences in the sagittal curve shape according to the sex, age, and PI magnitude. RESULTS: On average, the apices of thoracic kyphosis and lumbar lordosis, and the inflection point were located at the levels of the T8/9 intervertebral disc, L3/4 disc, and L1 vertebra, respectively. Significant differences between men and women were observed with respect to the spino-pelvic parameters; however, the positions of the apices were significantly different only with respect to the lumbar apex offsets among individuals in their 70s. The inflectional point and apex of thoracic kyphosis among individuals aged >80 years were located significantly anteriorly and caudally in comparison to those among individuals aged <69 years. The apex of lumbar lordosis and the inflection point in individuals with high PI were located significantly anteriorly and cranially in comparison to those in individuals with low PI. CONCLUSIONS: The apices of thoracic kyphosis and lumbar lordosis, and the inflection point were located at the T8/9 intervertebral disc, L3/4 disc, and L1 vertebra, respectively. The shape of the sagittal spinal curve varied according to age and the magnitude of PI, and these findings cannot be evaluated using the conventional spino-pelvic parameters. Knowledge of standard geometrical spine shape could be useful for spinal deformity treatment in elderly patients.
  • Hiroyuki Inose; Tsuyoshi Kato; Shoichi Ichimura; Hiroaki Nakamura; Masatoshi Hoshino; Daisuke Togawa; Toru Hirano; Yasuaki Tokuhashi; Tetsuro Ohba; Hirotaka Haro; Takashi Tsuji; Kimiaki Sato; Yutaka Sasao; Masahiko Takahata; Koji Otani; Suketaka Momoshima; Masato Yuasa; Takashi Hirai; Toshitaka Yoshii; Atsushi Okawa
    Spine 45 (13) 895 - 902 2020/07 
    STUDY DESIGN: Prospective cohort study. OBJECTIVE: To characterize a patient population with nonunion after acute osteoporotic vertebral fractures (OVFs) and compare the union and nonunion groups to identify risk factors for nonunion. SUMMARY OF BACKGROUND DATA: While OVFs are the most common type of osteoporotic fracture, the predictive value of a clinical assessment for nonunion at 48 weeks after OVF has not been extensively studied. METHODS: This prospective multicenter cohort study included female patients aged 65 to 85 years with acute one-level osteoporotic compression fractures. In the radiographic analysis, the anterior vertebral body compression percentage was measured at 0, 12, and 48 weeks. Magnetic resonance imaging (MRI) was performed at enrollment and at 48 weeks to confirm the diagnosis and union status. The patient-reported outcome measures included scores on the European Quality of Life-5 Dimensions (EQ-5D), a visual analogue scale for low back pain, and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) at 0, 12, and 48 weeks. RESULTS: In total, 166 patients completed the 12-month follow-up, 29 of whom had nonunion. Patients with nonunion at 48 weeks after OVF had lower EQ-5D and JOABPEQ walking ability, social life function, mental health, and lumbar function scores than those with union at 48 weeks after injury. The independent risk factors for nonunion after OVF in the acute phase were a diffuse low type pattern on T1-weighted MRI and diffuse low and fluid type patterns on T2-weighted MRI. The anterior vertebral body compression percentage and JOABPEQ social life function scores were independent risk factors at 12 weeks. CONCLUSION: A diffuse low type pattern on T1-weighted MRI and diffuse low and fluid type patterns on T2-weighted MRI were independent risk factors for nonunion in the acute phase. Patients who have acute OVFs with these risk factors should be carefully monitored for nonunion. LEVEL OF EVIDENCE: 2.
  • Yu Yamato; Tomohiko Hasegawa; Daisuke Togawa; Go Yoshida; Tomohiro Banno; Hideyuki Arima; Shin Oe; Yuki Mihara; Hiroki Ushirozako; Tatsuya Yasuda; Yukihiro Matsuyama
    Spine deformity 8 (3) 481 - 490 2020/06 
    STUDY DESIGN: A retrospective analysis of a prospectively collected consecutive case series of patients with adult spinal deformity who underwent 3-column osteotomy (3-CO) with pelvic fixation. OBJECTIVES: The objectives were to verify the effect of additional rods and determine the optimal type of additional rod for preventing rod fracture (RF). RF is a frequent complication following 3-CO surgery in patients with adult spinal deformity. Two types of additional rod constructs were utilized to prevent RF. METHODS: We evaluated data retrieved from a prospectively collected single-center database. Patients were classified into two groups depending on rod constructs: conventional 2-rod and 2-rod constructs with additional rods. The additional rod constructs were also stratified into two groups according to the location that they covered: only osteotomy site (short additional rod) or osteotomy site and lumbosacral junction (long additional rod). RESULTS: A total of 48 patients (average age 67.6 years; follow-up rate: 90.6%; 2-rod: 25 cases and additional rod: 23 cases) were included. No significant difference was observed in age, fusion level, operation time, blood loss, and rod composition. The incidence of RF in the additional rods (36%) was significantly lower than that in the 2-rod constructs (68%). Comparing the additional rod constructs, RF occurred in 7 cases (64%) in short additional rod and 2 cases (17%) in long additional rod. RF occurred at the level below the additional rod construct in 6 of 7 RF cases with short additional rod. CONCLUSIONS: Additional rods covering the osteotomy site and lumbosacral junction reduced the incidence of RF following 3-CO surgery with pelvic fixation in short term. LEVEL OF EVIDENCE: 3.
  • 戸川 大輔
    脊椎脊髄ジャーナル (株)三輪書店 33 (4) 490 - 493 0914-4412 2020/04 
    <文献概要>はじめに 骨粗鬆症性椎体骨折の評価は,胸腰椎の側面X線像を用いて行われる.椎体骨折の既往の有無(既存骨折)を診断することは,骨粗鬆症の診断において重要である.また,骨粗鬆症の薬物治療効果の評価では,新たな骨折の発生(新規骨折)を診断することが頻繁に行われる.これらの椎体骨折評価法には定量的評価法(Quantitative Measurement:QM法)と半定量的評価法(Semi-quantitative Method:SQ法)があり,これらの方法は骨粗鬆症治療薬の臨床試験,治療効果判定に用いられている.本稿ではQM法,SQ法それぞれの方法,特徴と注意点について述べる.
  • Tomohiko Hasegawa; Hiroki Ushirozako; Yu Yamato; Daisuke Togawa; Go Yoshida; Sho Kobayashi; Tatsuya Yasuda; Tomohiro Banno; Hideyuki Arima; Shin Oe; Tomohiro Yamada; Koichiro Ide; Yuh Watanabe; Yukihiro Matsuyama
    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 29 (4) 860 - 869 2020/04 
    PURPOSE: Gastroesophageal reflux disease (GERD) is reported as one of the symptoms of adult spinal deformity (ASD). Little is known about the mid- to long-term improvement in GERD symptoms after ASD surgery. Therefore, this retrospective study from prospectively collected database aimed to investigate GERD symptoms in patients for a minimum of 2 years after ASD corrective surgery. METHODS: Records from 230 patients (mean age: 64 years) who underwent ASD surgery were examined using the frequency scale for the symptoms of GERD (FSSG) questionnaires for the diagnosis of GERD. FSSG scores and radiographic parameters were investigated preoperatively and postoperatively at 6 months and 1, 2, and 5 years. RESULTS: In total, 90 (39%) patients were preoperatively diagnosed with GERD defined by FSSG score ≥ 8 points. Radiographic results showed that the corrective surgeries improved local and global alignments. In the GERD patients, preoperative FSSG scores (16.1 ± 7.3 points) significantly improved to 7.7 ± 7.4 points within 6 months postoperatively (p < 0.001), and postoperative FSSG scores maintained at 1 year (9.9 ± 8.2 points, p = 0.061), 2 years (9.7 ± 8.2 points, p = 0.086), and 5 years (9.4 ± 8.0 points, p = 0.177). Among the GERD group, 62 patients (69%; improvement cases) showed improvement in GERD symptoms defined by FSSG score < 8 points within 6 months postoperatively. CONCLUSIONS: Among ASD patients, 39% were diagnosed with GERD. In 69% of these patients, GERD symptoms improved within 6 months of corrective surgery and maintained up to 5 years postoperatively. These slides can be retrieved under Electronic Supplementary Material.
  • TORIUMI Kensuke
    The Central Japan Journal of Orthopaedic Surgery & Traumatology THE CENTRAL JAPAN ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 63 (2) 313 - 314 0008-9443 2020/03 
    74歳男。自宅内で左肩を壁に強打して左鎖骨遠位端骨折を負い、8日後にclavicle hook plateを用いて内固定術を行った。術後3週時、明らかな外傷起点なく鎖骨遠位部の疼痛を自覚し、肩峰背側の皮下に突起物が触れるとのことで受診した。画像検査で肩峰骨折を伴うフックのカットアウトを認め、術後5週時に再手術を行う方針となった。骨折部の骨癒合はまだ得られていないと考えられたため再手術の方法として抜釘は選択せず、ロッキングプレートの入れ替えも骨折部の安定が得られないと考えられたため施行せず、フックプレート先端の切除のみ行った。結果、術直後に疼痛は消失し、13週後のX線検査で仮骨形成が認められ、肩関節JOAスコアは93点と良好な経過が得られた。
  • Yu Yamato; Tomohiko Hasegawa; Daisuke Togawa; Go Yoshida; Tatsuya Yasuda; Tomohiro Banno; Shin Oe; Hideyuki Arima; Yuki Mihara; Hiroki Ushirozako; Sho Kobayashi; Yukihiro Matsuyama
    Spine 45 (4) E217-E226  2020/02 
    STUDY DESIGN: A retrospective case series. OBJECTIVE: To clarify the mid-term results of extensive spinal fusion surgery in patients with Parkinson disease (PD) or atypical Parkinsonism, especially with respect to their activities of daily living (ADL) over time SUMMARY OF BACKGROUND DATA.: Postural disorders associated with PD lead to spinal imbalance and deformity, resulting in significant disabilities. Clinical outcomes of extensive fusion surgeries in patients with PD over a medium-term follow-up period are currently unknown. METHODS: Patients with PD who underwent extensive fusion surgery more than 5 years prior were included. The patients' backgrounds, surgical and radiographic parameters, perioperative and mechanical complications, and indoor ADL over time were assessed. To assess the activities of severely disabled patients, indoor ADL was classified into four stages: independent; or cane, walker, and wheelchair use. RESULTS: Twenty-two patients (mean age, 70.6 yrs) were included. The mean blood loss, duration of surgery, and fusion levels were 2039 mL, 424 minutes, and 11.9 levels, respectively. Sagittal vertical axis improved from 220 mm preoperatively to 95 mm postoperatively. Perioperative complications were observed in 17 cases (77%). Before surgery, 1, 5, 12, and four cases were independent in ADL, T-cane, walker, and wheelchair use, respectively, which improved to seven, four, six, and four, respectively in 1 year. Revision surgeries were performed in eight patients (36%) within 3 years of surgery. In the 3 to 5 years after the surgery, the ADL of nine patients worsened due to deterioration of PD. Fifteen cases were followed up over 5 years, at which one, two, four, and seven cases were independent in ADL, cane, walker, and wheelchair use, respectively. CONCLUSION: Surgical intervention in PD patients with spinal deformities leads to good short-term outcomes; however, the patients' conditions deteriorated because of complications within 3 years and worsening of PD over 3 years after the surgery. LEVEL OF EVIDENCE: 4.
  • 戸川 大輔
    整形・災害外科 金原出版(株) 63 (2) 165 - 171 0387-4095 2020/02 
    <文献概要>超高齢社会で多くの高齢者を抱える本邦では,骨粗鬆症性椎体骨折の診療体制が議論されている。近年はADL維持の重要性が認識され,速やかな疼痛緩和と良好な健康関連QOL獲得に治療の重点がおかれる。経皮的椎体形成術のように安全かつ有効な低侵襲手術が可能となり,椎体骨折の整復固定,さらには体動時痛軽減による日常生活動作の早期回復を目指すことができるようになったため,従来の治療体系を変えて対応することも多くなっている。骨粗鬆症性椎体骨折を受傷する患者は広い年齢層で存在する。50〜60歳代では背景である病態(骨粗鬆症)の治療や脊柱アライメントに留意して治療する必要があるが,90歳代の超高齢者ではできる限り早く診断し,ADLの再獲得のために必要であれば早期手術治療介入を考慮することが重要である。
  • 成人脊柱変形矯正術中脊髄モニタリングのfalse positive発生におけるanesthetic fadeの検討
    後迫 宏紀; 吉田 剛; 長谷川 智彦; 大和 雄; 安田 達也; 坂野 友啓; 有馬 秀幸; 大江 慎; 三原 唯暉; 山田 智裕; 戸川 大輔; 松山 幸弘
    脊髄機能診断学 エーザイ(株) 40 (1) 76 - 79 2020/02 
    成人脊柱変形矯正手術において脊髄モニタリングのfalse positive(FP)を生じる機序や麻酔の影響について検討した。成人脊柱変形矯正手術に対し、multi-channel Br(E)-MsEP(以下、MEP)による術中脊髄モニタリングを行った282例(男性55例、女性227例、平均60.8歳)を対象とした。True positive 16例、FP 62例(20.8%)、True negative(TN)191例、False negative 1例であり、感度94%、特異度75%であった。FP群の手術時間/出血量は404分/1670ml、TN群は334分/1120mlであり、FP群では手術時間が長く出血量が多かった。FP群ではTN群と比較して術中平均体温が有意に高く、術中体温変化が大きかった。FP群の術中プロポフォール平均総使用量は1890mg、TN群は1520mgであり、FP群にてプロポフォール総使用量が多かった。Propofol使用量、長時間手術、出血量は成人脊柱変形矯正手術中のMEPモニタリングにおけるFP発生に影響しており、anesthetic fadeの可能性を考慮する必要があると考えられた。
  • 胸椎後縦靱帯骨化症に対する術中脊髄モニタリングと脊髄循環不全
    吉田 剛; 後迫 宏紀; 長谷川 智彦; 大和 雄; 小林 祥; 坂野 友啓; 大江 慎; 有馬 秀幸; 安田 達也; 山田 智裕; 三原 唯暉; 戸川 大輔; 松山 幸弘
    脊髄機能診断学 エーザイ(株) 40 (1) 130 - 134 2020/02 
    高度脊髄圧迫を伴った4例(男性1例、女性3例、平均53.8歳)の胸椎後縦靱帯骨化症の術中脊髄モニタリングと術前脊髄血管造影、術中血流ドップラーエコーによる所見を対比させ、胸椎OPLLにおける脊髄循環不全麻痺に関連した可能性について検討した。術前血管造影では4例のAdamkiewicz arteryはT7からL2高位より分岐し、上向する前脊髄動脈が一部確認されたが、全例とも靱帯骨化病巣部に一致した椎体高位で前脊髄動脈が消失し狭窄または途絶が疑われた。術中脊髄モニタリングでは4例中3例で狭窄部除圧の際にMEPアラームを生じ、うち1例で術後麻痺の悪化を認めた。術中にドップラーエコーで前脊髄動脈の導出を試みたところ、血管造影で前脊髄動脈が描出できる領域ではドップラーエコーでも前脊髄動脈の描出が可能であったが、血管造影で前脊髄動脈が途絶している領域ではドップラーエコーでも前脊髄動脈の確認を行うことはできなかった。
  • Yuh Watanabe; Go Yoshida; Tomohiko Hasegawa; Yu Yamato; Daisuke Togawa; Tomohiro Banno; Shin Oe; Hideyuki Arima; Hiroki Ushirozako; Tomohiro Yamada; Hideyuki Murata; Yukihiro Matsuyama
    Spine 45 (2) E76-E82  2020/01 
    STUDY DESIGN: A retrospective study. OBJECTIVE: We aimed to evaluate the impact of mental status on the clinical outcomes of patients with adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA: Limited information is currently available on how preoperative mental status affects postoperative health-related quality of life (HRQOL) in patients with ASD. METHODS: We enrolled 165 patients with ASD who underwent corrective surgery at a single university hospital between March 2010 and September 2015. We compared Scoliosis Research Society-22r (SRS-22r) and Oswestry Disability Index (ODI) scores using various x-ray parameters at these time points: preoperative period and postoperative 2 years. Additionally, to determine the associations between perioperative complications and mental health disorders, we examined these x-ray parameters: lumbar lordosis, thoracic kyphosis, sacral slope, pelvic incidence, pelvic tilt, sagittal vertical axis (SVA), and T1 pelvic angle (TPA). RESULTS: We found correlations between the preoperative SRS-22r total score and preoperative ODI (r = -0.692, P < 0.01) and postoperative ODI (r = -0.443, P < 0.01). Preoperative SRS-22r mental domain correlated with preoperative ODI (r = -0.561, P ≤ 0.01) and postoperative ODI (r = -0.315, P ≤ 0.01). Perioperative (preoperative and postoperative) SRS-22r mental domain did not correlate with the postoperative x-ray parameters except for SVA and TPA. Postoperative mental health correlated with early infection (P < 0.05), hematoma (P < 0.05), deep vein thrombosis (P < 0.05), and delirium (P < 0.05). Regression analysis revealed that preoperative SRS-22r mental health score correlated with preoperative ODI (P < 0.001) and postoperative ODI (P < 0.001). The regression coefficient number between preoperative SRS-22r mental health score and perioperative (preoperative and postoperative) ODI improved from -17.3 to -10.2 from preoperative to postoperative periods. CONCLUSION: Diminished preoperative mental health worsened postoperative HRQOL. Perioperative complications influence postoperative mental status and HRQOL; hence, screening preoperative mental health is important. LEVEL OF EVIDENCE: 3.
  • Yagi Mitsuru; Fujibayashi Shunsuke; Nakamura Masaya; Taneichi Hiroshi; Ohtori Seiji; Sairyo Koichi; Ishii Ken; Yoshii Toshitaka; Togawa Daisuke; Sakai Daisuke; Watanabe Masahiko; Iwasaki Motoki
    Journal of Spine Research The Japanese Society for Spine Surgery and Related Research 11 (1) 2 - 7 1884-7137 2020/01 
    Introduction: Recently, lateral lumbar interbody fusion (LIF), including extreme lateral interbody fusion (XLIF), direct lateral interbody fusion (DLIF), and oblique lateral interbody fusion (OLIF), has been introduced in Japan. Despite the effectiveness of the procedure, several complications related to this procedure have been reported. Since 2015, to identify the overall complication rate and type of LIF, the Japanese Society for Spine Surgery and Related Research (JSSR) has started a nationwide survey on the incidence and type of complications related to LIF among all JSSR members. We report on the results of the nationwide survey conducted by JSSR on the complications associated with LIF performed in Japan in 2017. Methods: A web-based nationwide survey on the complications following LIF was conducted by JSSR for all JSSR members. Any complications meeting the following criteria were included: 1. major vessel injury, 2. urinary tract injury, 3. renal injury, 4. visceral organ injury, 5. lung injury, 6. weakness of psoas, 7. motor deficit, 8. sensory deficit, 9. vertebral injury, 10. nerve injury, 11. anterior longitudinal ligament injury, 12. surgical site infection (SSI), and 13. other complications. The incidence and type of LIF were analyzed among all patients who underwent LIF, and the differences in the incidence and type of complications between XLIF and OLIF were compared. Results: Among 2,311 patients who underwent LIF [XLIF: 906 cases (39.2%), DLIF: 50 cases (2.2%), and OLIF: 1,355 cases (58.6%) ], complications were observed in 72 patients (3.1%). The most common complication was sensory deficit (0.74%), followed by motor deficit (0.35%), SSI (0.30%), weakness of psoas (0.22%), nerve injury (0.22%), and major vessel injury (0.09%). Ten patients (0.4%) required revision surgery during the survey period. There was no statistically significant difference in the frequency of resultant complications between XLIF and OLIF (3.8% vs. 3.0%, p = 0.34). Conclusions: We conducted a nationwide survey on the complications that occur following LIF. The overall complication rate was 3.1%, and 0.4% patients required revision surgery for the complications. Major vessel injury occurred in 0.09%, nerve injury occurred in 0.22%, and SSI occurred in 0.30% patients.
  • Dung Huu Tran; Hironobu Hoshino; Daisuke Togawa; Yukihiro Matsuyama
    Aging clinical and experimental research 32 (1) 67 - 76 2020/01 
    BACKGROUND: Knee osteoarthritis is one of the most common orthopedic diseases. However, few studies have reported the morphometric characteristics of the lower leg related to the progression of knee osteoarthritis in regional populations. This study aimed to determine the radiographic morphometries of the lower leg in subjects who showed progression of osteoarthritis of the knee in the TOEI cohort. METHODS: Data were collected from the TOEI study cohort, during the period from 2014 to 2016, to assess osteoarthritis of the knee and radiographic morphometries of the lower leg. The joints were divided into three groups according to osteoarthritis progression over 2 years. There were 323 legs of females and 163 legs of males. Knees which did not exhibit osteoarthritis were in group 1; knees with osteoarthritis that remained stable for 2 years were in group 2; knees that worsened osteoarthritis over 2 years were in group 3. Morphometric parameters in the lower leg were measured by radiographs taken in 2014. RESULTS: In female subjects, group 2 had higher age, lower lever arm ratio and lower hip-knee-ankle angle, and higher height of the hip center compared with group (1). Group 3 had higher age compared with group 1 and lower height of the hip center compared with group (2). In male subjects, group 2 had lower height of the hip center and lower hip-knee-ankle angle compared with group 1. Group 3 had higher patellar shift index compared with group 1, higher height of the hip center and higher femoral neck length compared with group 2. CONCLUSIONS: Higher age was the risk of osteoarthritis progression of the knee in female subjects but not significant risk in male subjects. Hip morphometries such as height of the hip center and femoral neck length in which showed a sex difference might be associated with the progression of knee osteoarthritis.
  • Hiroki Ushirozako; Go Yoshida; Tomohiko Hasegawa; Yu Yamato; Tatsuya Yasuda; Tomohiro Banno; Hideyuki Arima; Shin Oe; Yuki Mihara; Tomohiro Yamada; Toshiyuki Ojima; Daisuke Togawa; Yukihiro Matsuyama
    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 25 (1) 82 - 88 2020/01 
    BACKGROUND: Degenerative lumbar scoliosis (DLS) is one of the most frequent spinal deformities of the aging spine. The purpose of our study was to clarify the independent predictors of pre-existing DLS progression and their influence on the health related quality of life (HRQOL). METHODS: This study included 356 volunteers (127 men and 229 women; mean age, 72.2 years; follow-up period, 4 years) who underwent musculoskeletal screening. Standing whole-spine radiographic measurements included the Cobb angle of DLS and C7-center sacral vertical line (C7-CSVL; shift to the concave side of the DLS curve indicated a positive value). A baseline Cobb angle ≥10° indicated pre-existing DLS, and Cobb angle deterioration of ≥4° was considered DLS progression. For HRQOL assessment, the Oswestry Disability Index (ODI) was used. Pre-existing DLS cases were divided into progression and non-progression groups. RESULTS: Among 93 cases (26.1%) with pre-existing DLS at baseline, 23 cases (pre-existing DLS progression group) showed DLS progression. The mean C7-CSVLs were 10.5 and -3.1 mm in the pre-existing progression and non-progression groups, respectively (p < 0.01). The optimal cutoff C7-CSVL length was 5 mm, with high sensitivity and specificity. Multivariate logistic regression analysis showed that a C7-CSVL ≥5 mm (odds ratio, 3.8; 95% CI: 1.42-10.34; p < 0.01) was independently associated with pre-existing DLS progression. ODI scores deteriorated significantly more in the pre-existing progression group than the non-progression group (+9.8% versus +3.9%; p < 0.05). CONCLUSIONS: Pre-existing DLS progression is associated with a shift to the concave side of C7-CSVL and influences HRQOL deterioration. It is important to assess coronal global alignment for prediction of a DLS progression.
  • Tomohiro Yamada; Tomohiko Hasegawa; Yu Yamato; Go Yoshida; Sho Kobayashi; Tatsuya Yasuda; Tomohiro Banno; Hideyuki Arima; Shin Oe; Yuki Mihara; Hiroki Ushirozako; Daisuke Togawa; Yukihiro Matsuyama
    Spine surgery and related research 4 (1) 81 - 83 2020
  • 戸川 大輔; 松山 幸弘
    関節外科 (株)メジカルビュー社 38 (12) 1260 - 1269 0286-5394 2019/12 
    近年,高齢者の姿勢異常(成人脊柱変形)に注目が集まっている。加齢とともに起こる矢状面アライメントの悪化が健康関連QOL(health related quality of life;HRQOL)の悪化と相関することが知られている。姿勢異常(脊柱アライメント異常)において,性別による特徴,加齢によるアライメント異常の進行の程度などが運動器検診の結果から分析できる。姿勢異常が悪化すると,男性より女性で特にHRQOLを低下させる腰背部痛が出やすくなる。(著者抄録)
  • トガワ ダイスケ
    整形外科看護 (株)メディカ出版 24 (11) 1065 - 1074 1342-4718 2019/11
  • バンノ トモヒロ; ヤマト ユウ; ハセガワ トモヒコ; トガワ ダイスケ; ヨシダ ゴウ; アリマ ヒデユキ; オオエ シン; マツヤマ ユキヒロ
    Journal of Spine Research (一社)日本脊椎脊髄病学会 10 (11) 1498 - 1503 1884-7137 2019/11 
    腰椎カーブが主体のadolescent idiopathic scoliosis患者19例(男性2例、女性17例、平均年齢14歳)を対象とし、固定下位端(LIV)直下の椎間板角を計測した。術直後と1年時の推移から増加群(9例)と減少群(10例)に分け、比較検討した。増加群でflexibilityが大きく、術後lumbo-sacral take-off angleが大きかった。C7-central sacral vertical lineは増加群で術後に悪化し、術後1年では差はなくなった。術後LIV直下の椎間板角増大が自家矯正に関与していた。(著者抄録)
  • トガワ ダイスケ
    Bone Joint Nerve (株)アークメディア 9 (4) 521 - 527 2186-1110 2019/10
  • Shin Oe; Daisuke Togawa; Tomohiko Hasegawa; Yu Yamato; Go Yoshida; Sho Kobayashi; Tatsuya Yasuda; Tomohiro Banno; Hideyuki Arima; Yuki Mihara; Hiroki Ushirozako; Yukihiro Matsuyama
    Spine deformity 7 (5) 759 - 770 2019/09 
    STUDY DESIGN: A retrospective study of surgical outcomes. OBJECTIVE: This study aimed to investigate the preoperative risk factors for proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA: The cause of PJK is still unclear, although some risk factors have been reported in ASD surgery. METHODS: A total of 185 patients who were followed up for more than two years and underwent ASD surgery were recruited. PJK was defined as a proximal junctional angle ≥20° or reoperation due to PJK within two years after surgery. These patients were divided into PJK and non-PJK groups. Whole-spine standing radiography was performed before and immediately, one year, and two years after the surgery. RESULTS: The PJK and non-PJK groups comprised 58 and 127 cases, respectively. The incidence of PJK demonstrated significant differences according to preoperative thoracic kyphosis (TK): 37% (TK ≤19°), 33% (TK 20°-29°), 9% (TK 30°-39°), 32% (TK 40°-49°), and 41% (TK ≥50°) (p < .05). Logistic regression analysis suggested that the amount of change in TK before and just after the surgery (ΔTK) was a significant risk factor for PJK (p < .001; odds ratio 1.062, 95% confidence interval 1.029-1.097). CONCLUSION: ΔTK was less in the TK group of 30°-39° because the TK of patients who underwent ASD surgery converged to 34.5° just after surgery. Consequently, a lower or higher TK was likely to result in a large ΔTK just after surgery. Therefore, patients who had an optimal TK (30°-39°) had a lower risk of PJK. LEVEL OF EVIDENCE: Level IV.
  • Hideyuki Arima; Daisuke Togawa; Tomohiko Hasegawa; Yu Yamato; Go Yoshida; Sho Kobayashi; Tatsuya Yasuda; Tomohiro Banno; Shin Oe; Yuki Mihara; Hiroki Ushirozako; Hironobu Hoshino; Yukihiro Matsuyama
    Asian spine journal 895 - 903 2019/07 
    Study Design: Cross-sectional cohort study. Purpose: This study aimed to investigate the relationship between hypertension and spino-pelvic sagittal alignment in middle-aged and elderly individuals. Overview of the Literature: Positive global sagittal alignment is associated with poor health-related quality of life. Hypertension is associated with tissue microcirculation disorders of the skeletal muscle. We hypothesized that hypertension may be involved in positive global sagittal alignment. Methods: In this institutional review board-approved study, 655 participants (262 men and 393 women; mean age, 72.9 years; range, 50-92 years) who underwent musculoskeletal screening in Toei town, Aichi, Japan were included. Whole spine and pelvic radiographs were taken, and radiographic parameters (thoracic kyphosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and sagittal vertical axis [SVA]) were measured using an image-analysis software. Hypertension was assessed using the standard criteria. The study participants were divided into three subgroups as per age (50-64 years, 65-74 years, and ≥75 years). We examined the differences in the radiographic parameters of those with and without hypertension in each age subgroup. Results: In each age subgroup, there was no significant difference in the age and sex of those with and without hypertension. SVA was significantly shifted forward in the hypertension group than in the non-hypertension group in those aged 50-64 years old (32.4 mm vs. 16.0 mm, p=0.018) and in those aged 65-74 years old (42.7 mm vs. 30.6 mm, p=0.012). There was no significant difference between the hypertension and non-hypertension groups in terms of the alignment of the lumbar and thoracic spine in all the subgroups. In multivariate analysis, hypertension was a significant independent factor of forward-shifted SVA (standardized beta 0.093, p=0.015). Conclusions: This study showed that hypertension was associated with forward-shifted global sagittal alignment.
  • Yuki Mihara; Daisuke Togawa; Tomohiko Hasegawa; Yu Yamato; Go Yoshida; Sho Kobayashi; Tatsuya Yasuda; Tomohiro Banno; Hideyuki Arima; Shin Oe; Hiroki Ushirozako; Yukihiro Matsuyama
    Spine deformity 7 (4) 602 - 609 2019/07 
    STUDY DESIGN: Large cohort study. OBJECTIVE: To investigate the role of lumbar retrolisthesis in spinopelvic alignment and health-related quality of life (HRQOL) among volunteers aged >50 years. SUMMARY OF BACKGROUND DATA: Lumbar retrolisthesis pathology has not been sufficiently elucidated. METHODS: We included 639 volunteers (257 men, average age 73 [50-92] years). Sagittal vertical axis (SVA), maximum thoracic kyphosis (maxTK), lumbar lordosis (LL), pelvic incidence (PI), and pelvic tilt (PT) were measured using whole-spine and pelvic radiographs taken in standing position. MaxTK was measured from the upper to the lower end vertebrae of spinal kyphosis in the sagittal plane using Cobb's method. HRQOL was evaluated using the Oswestry Disability Index (ODI). Subjects with ≥3 mm posterior lumbar vertebral slip and those with multiple retrolisthesis were included in R(+) and multiple groups, respectively. In single lumbar retrolisthesis subjects, those above L3-L4 were defined as the superior group and below L4-L5 as the inferior group. RESULTS: The R(+) group had 259 (41%) subjects. Of the posterior slipped vertebrae, 235 (91%) were consistent with the lower end vertebra of the maxTK or its adjacent one. The R(+) group had significantly more males; subjects were older than those in the R(-) group. They also had significantly greater SVA, TK, maxTK, and PI-LL and smaller LL and PI. Multivariate analysis revealed that sex, maxTK, and LL were independent predictors of lumbar retrolisthesis. The inferior group had a significantly greater SVA, PT and PI-LL, and smaller LL and PI than the R(-), superior, and multiple groups. The inferior group also had significantly worse ODI than the R(-) group. CONCLUSIONS: Subjects with lumbar retrolisthesis showed greater spinal kyphosis and worse spinopelvic alignments. Subjects with lower-generated lumbar retrolisthesis showed worse spinopelvic alignment and HRQOL than subjects with upper-generated lumbar retrolisthesis and multiple ones and those without it. LEVEL OF EVIDENCE: Level IV.
  • Yu Yamato; Tomohiko Hasegawa; Daisuke Togawa; Go Yoshida; Tomohiro Banno; Hideyuki Arima; Shin Oe; Yuki Mihara; Hiroki Ushirozako; Sho Kobayashi; Tatsuya Yasuda; Yukihiro Matsuyama
    Spine deformity 7 (4) 610 - 618 2019/07 
    STUDY DESIGN: Retrospective analysis of a prospectively collected consecutive case series. OBJECTIVES: To determine the effect of spinopelvic correction on clinical outcomes and discuss the approach to target alignment in elderly or extremely elderly spinal deformity patients. SUMMARY OF BACKGROUND DATA: Age-dependent target alignment during corrective fusion surgery in elderly patients remains controversial. Age-related target spinal alignment should be examined based on the outcomes data of patients with fused, nonphysiological spines. METHODS: Consecutive adult spinal deformity (ASD) patients aged 45 years or older who underwent thoracolumbar corrective fusion of at least five levels were included. Spinopelvic radiographic parameters, health-related quality of life (Oswestry Disability Index [ODI]), and the scores on a numeric rating scale of low back pain were investigated before and after the operation. The patients were stratified into three groups according to age as follows: Middle-Age, 45-64 years; Elderly, 65-74 years; and Extremely Elderly, ≥75 years. We also stratified the patients into three groups according to lumber lordosis (LL) as follows: ideal (within ±5° of ideal LL), moderate (between -5° and -20° of ideal LL), and under (under ideal LL by -20°). RESULTS: A total of 149 patients (Middle-Age, 38; Elderly, 68; and Extremely Elderly, 43) were included in this study. No significant difference was observed in any of the radiographic parameters in each age group. The ODI and numeric rating scale scores of the ideal-correction group at two years after surgery were significantly better than those of the undercorrection group across all ages. A significant correlation with ODI was observed between sagittal spinopelvic parameters in the Elderly and Extremely Elderly groups. A stronger correlation was observed in the Extremely Elderly group compared with the Elderly group. CONCLUSIONS: Rigorous realignment of sagittal vertical axis is correlated with ODI outcomes, especially in very elderly patients. LEVEL OF EVIDENCE: Level 4.
  • Hideyuki Arima; Leah Y Carreon; Steven D Glassman; Yu Yamato; Tomohiko Hasegawa; Daisuke Togawa; Sho Kobayashi; Go Yoshida; Tatsuya Yasuda; Tomohiro Banno; Shin Oe; Yuki Mihara; Hiroki Ushirozako; Yukihiro Matsuyama
    Spine deformity 7 (4) 627 - 632 2019/07 
    STUDY DESIGN: Longitudinal cohort. OBJECTIVE: To calculate the minimum clinically important difference (MCID) threshold values for the Scoliosis Research Society-22R (SRS-22R) in Japanese patients with adult spinal deformity (ASD) and to compare the results with previously reported values in a North American population. SUMMARY OF BACKGROUND DATA: The SRS-22R has been shown to be reliable, valid, and responsive to change in patients with ASD undergoing surgery. The MCID quantifies a threshold value of improvement that is clinically relevant to the patient. We hypothesize that MCID threshold values of SRS-22R differ between different cultural groups. METHODS: We identified ASD patients who completed the SRS-22R preoperatively and the SRS-30 at minimum two years after surgery. Answers to the last seven questions of the SRS-30 were used as anchors to determine the MCID for the SRS-22R Activity, Pain, Appearance, Mental domains, and Total score using receiver operating characteristic (ROC) curve analysis. RESULTS: A total of 122 (16 male, 106 female) patients were included in the analysis. There was a statistically significant improvement in all domain scores from preoperation to two years postoperation. There was a statistically significant difference in change in domain score among the responses to the anchors (p < .05). The ROC curve analysis yielded MCID values of 0.90 for Activity (area under the curve [AUC] = 0.766), 0.85 for Pain (AUC = 0.637), 1.05 for Appearance (AUC = 0.764), and 0.70 for Mental (AUC = 0.641) domain, 1.05 for Total score (AUC = 0.670). Except for Appearance, these MCID thresholds were higher compared with values reported in patients from North America (Activity = 0.60, Pain = 0.40, Appearance = 1.23, Total = 0.71). CONCLUSIONS: Results of this study showed that cultural variations exist for MCID threshold values for SRS-22 Activity, Pain, Mental domains, and Total score after surgical treatment of ASD.
  • トガワ ダイスケ; ニワ ハルオ; ハセガワ トモヒコ; ヤマト ユウ; ヨシダ ゴウ; ヤスダ タツヤ; バンノ トモヒロ; アリマ ヒデユキ; オオエ シン; ウシロザコ ヒロキ; ヤマダ トモヒロ; ナツメ イクコ; ホシノ ヒロノブ; マツヤマ ユキヒロ
    Journal of Spine Research (一社)日本脊椎脊髄病学会 10 (6) 970 - 975 1884-7137 2019/06 [Refereed]
     
    高齢運動器検診受診者63名(男性24名、女性39名、平均年齢78歳)を対象として6ヵ月間、整形外科医が外来形式でロコモティブシンドロームの予防と改善のために体操指導を行った。内容は大腿四頭筋訓練、片脚起立訓練、スクワット、ヒップアップ訓練とし、日記形式でモニタリングをしながら行った。対象者全体および男女別の検討において1、3、6ヵ月後の再診外来で大腿四頭筋筋力、歩行速度は経時的に増加した。この傾向は脊柱グローバルアライメント不良例においても同様であった。(著者抄録)
  • Tomohiro Banno; Tomohiko Hasegawa; Yu Yamato; Daisuke Togawa; Go Yoshida; Sho Kobayashi; Tatsuya Yasuda; Hideyuki Arima; Shin Oe; Yuki Mihara; Hiroki Ushirozako; Yukihiro Matsuyama
    Asian spine journal 13 (3) 500 - 510 2019/06 
    STUDY DESIGN: A retrospective study. PURPOSE: To investigate the incidence of iliac screw loosening with a two-rod vs. multi-rod construct and the effect on clinical and radiographic outcomes after surgery for adult spinal deformity (ASD). OVERVIEW OF LITERATURE: Multi-rod construct is useful for preventing rod fracture in ASD surgery. However, limited information is available regarding the incidence of iliac screw loosening after corrective fusion surgery using a multi-rod construct. METHODS: Total 106 patients with ASD (24 men and 82 women; mean age, 68 years) who underwent corrective fusion surgery using bilateral iliac screws and were followed up for at least 1 year were reviewed. The following variables were compared between patients who underwent surgery with a two-rod and multi-rod construct: age, sex, bone mineral density (BMD), fusion level, high-grade osteotomy, L5/S interbody fusion, screw loosening (upper instrumented vertebra [UIV], S1, and iliac), rod fracture, proximal junctional kyphosis, spinopelvic parameters, and Oswestry Disability Index (ODI) score. We also compared patients with and without iliac screw loosening in the multi-rod construct group. RESULTS: Of the 106 patients, 55 underwent surgery with a conventional two-rod construct and 51 with a multi-rod construct (three rods in 16, four rods in 35). Iliac and UIV screw loosening was observed in 24 patients (21%) and 35 patients (33%), respectively. The multi-rod group showed significantly higher incidence of iliac and UIV screw loosening and lower incidence of rod fracture. Patients with iliac screw loosening had a lower BMD than those without screw loosening; however, no significant differences were observed in the spinopelvic parameters or the ODI score. CONCLUSIONS: The use of multi-rod constructs led to a higher incidence of junctional screw loosening than the use of conventional two-rod constructs, especially in patients with osteoporosis. Iliac screw loosening did not affect sagittal alignment or clinical outcome in the short term.
  • イデ コウイチロウ; トガワ ダイスケ; ハセガワ トモヒコ; ヤマト ユウ; ヨシダ ゴウ; バンノ トモヒロ; アリマ ヒデユキ; オオエ シン; ウシロザコ ヒロキ; ホシノ ヒロノブ; マツヤマ ユキヒロ
    Journal of Spine Research (一社)日本脊椎脊髄病学会 10 (5) 869 - 872 1884-7137 2019/05 
    60歳以上の高齢者に対して運動器検診を4年間にわたって3度行い、半定量評価法でGenant Grade I以上の椎体骨折罹患とロコモティブシンドローム(ロコモ)との関連について調査した。経年的な椎体骨折の連鎖により、歩行機能の中でも急ぎ足での歩行が困難となり、立ち上がりに支障がでることでロコモが悪化していた。形態学的な椎体骨折の存在であってもロコモ発症の契機となり、その連鎖はロコモ重症化を助長する可能性がある。(著者抄録)
  • Shin Oe; Daisuke Togawa; Yu Yamato; Go Yoshida; Tomohiko Hasegawa; Sho Kobayashi; Tatsuya Yasuda; Tomohiro Banno; Hideyuki Arima; Yuki Mihara; Hiroki Ushirozako; Yukihiro Matsuyama
    Spine 44 (8) 579 - 587 2019/04 
    STUDY DESIGN: Retrospective study of postoperative outcomes of adult spinal deformity (ASD) surgery. OBJECTIVE: To clarify the differences in postoperative outcomes depending on the presence or absence of thoracic compensatory changes among patients with a T1 slope (TS) more than 40°. SUMMARY OF BACKGROUND DATA: Loss correction after ASD surgery is more likely to occur when preoperative TS is more than 40°. When preoperative TS is more than 40°, some cases involve compensatory changes in the thoracic spine and decreased thoracic kyphosis (TK); others involve increased TK without compensatory changes. METHODS: Seventy-nine patients with TS more than 40° who underwent ASD surgery were enrolled and separated into compensated and noncompensated groups (group C: TK <40°; group NC: TK ≥40°). Radiographic parameters obtained by whole-spine standing x-ray, the Oswestry Disability Index (ODI), and Scoliosis Research Society-22 (SRS-22) questionnaire were assessed. RESULTS: There were 41 patients in group C and 38 patients in group NC. Preoperative significant differences in TS did not disappear after surgery (preoperative TS: group C and group NC = 46° and 55°, P < 0.001; just after surgery: group C and group NC = 27° and 40°, P < 0.001; 2 years later: group C and group NC = 34° and 47°, P < 0.001). There were no significant differences in ODI and all domains of the SRS-22 before surgery. However, 2 years after the surgery, ODI (38%), pain (3.5), self-image (3.0), and total (3.2) values of the SRS-22 for group NC were significantly worse than those (28%, 4.0, 3.4, and 3.5, respectively) for group C (P < 0.05). CONCLUSION: Changes in the thoracic spine (TS and TK >40°) result in poor postoperative outcomes. Extending the upper instrumented vertebra (UIV) to the upper thoracic spine must be considered. Even when TS is more than 40°, TK less than 40°, and upper instrumented vertebra set to the lower thoracic level result in good postoperative outcomes. LEVEL OF EVIDENCE: 3.
  • アリマ ヒデユキ; ハセガワ トモヒコ; クロダ リョウ; ホソイ ヤスシ; トガワ ダイスケ; ヤマト ユウ; ヨシダ ゴウ; バンノ トモヒロ; オオエ シン; ウシロザコ ヒロキ; ミヤジマ ヒロアキ; マツヤマ ユキヒロ
    Journal of Spine Research (一社)日本脊椎脊髄病学会 10 (4) 788 - 792 1884-7137 2019/04 
    症例は78歳、女性。既往に気管支喘息あり。2〜3週間前からの腰痛、両下肢痛、両下肢脱力を主訴に来院。両膝下以遠のしびれと著明な疼痛に加え、両側下肢遠位筋優位にMMT0〜1の筋力低下があった。単純X線、MRI上L1新鮮椎体骨折があったが、脊柱管狭窄はなかった。血液検査では好酸球優位の著明な白血球増加があり、好酸球性多発血管炎性肉芽腫症と診断。ステロイド加療にて両下肢痛は改善したが、両下腿以下の麻痺は残存した。(著者抄録)
  • バンノ トモヒロ; ハセガワ トモヒコ; ヤマト ユウ; トガワ ダイスケ; ヨシダ ゴウ; アリマ ヒデユキ; オオエ シン; ウシロザコ ヒロキ; マツヤマ ユキヒロ
    Journal of Spine Research (一社)日本脊椎脊髄病学会 10 (4) 797 - 801 1884-7137 2019/04 
    症例1は38歳男性、C1/2高位の上衣腫に対して腫瘍摘出術施行。術中腫瘍摘出時に最高血圧200以上の異常高血圧を来した。症例2は35歳男性、C1高位の異型性髄膜腫に対して腫瘍切除術施行。術中腫瘍摘出時に心停止を来した。2症例とも腫瘍剥離操作中に異常循環動態を来し、手術操作を止めることで自然に回復した。延髄には血管運動中枢があるため、上位頸椎部の腫瘍摘出の際には術中の異常循環動態に十分な注意を要する。(著者抄録)
  • 長谷川 智彦; 大和 雄; 戸川 大輔; 吉田 剛; 松山 幸弘
    整形・災害外科 金原出版(株) 62 (5) 643 - 649 0387-4095 2019/04 
    <文献概要>成人脊柱変形手術患者291例について,青壮年群,中年群,高齢群の3群に分け,病態の特徴,ODIの術後変化,GERD(胃食道逆流)症状の変化,合併症,再手術について検討した。青壮年群では特発性側彎症または遺残が8割以上を占め,中年群では変性後(側)彎症が6割を占めた。高齢群では変性後(側)彎症が6割に加え,椎体骨折後後彎症,パーキンソン病の割合が高かった。術前のアライメント,特に腰椎骨盤パラメータとODIは青壮年群で比較的保たれているのに対し,中年群,高齢群においては不良であった。しかし,術後改善し,2年まで良好な回復が維持された。GERDの合併は38%と高率であったが,3群の間に罹患率の差はなかった。GERD症状は7割を超える患者で改善維持された。手術合併症については,晩期を含め30%を超える合併症発生があり,周術期では神経障害と血腫,深部感染が,晩期には固定ロッドの破損が多数を占めていた。
  • 大江 慎; 戸川 大輔; 大和 雄; 長谷川 智彦; 吉田 剛; 松山 幸弘
    脊椎脊髄ジャーナル (株)三輪書店 32 (4) 307 - 312 0914-4412 2019/04 
    TOEI study 2012と2016の全脊柱立位単純X線撮影で脊柱変形が進行した216例(進行群:男性70例、女性146例)と、進行しなかった128例(進行なし群:男性52例、女性76例)を比較し、脊柱変形が進行する要因について検討した。その結果、男性で進行なし群と進行群の間に有意差を認めた背景は年齢、開眼片足立ち、握力、運動習慣の有無であり、2012年時のX線パラメータでは唯一SVAのみであった。一方、女性では運動習慣の有無のみ有意差が認められ、2012年時のX線パラメータではSS、CL、TS-CL、SVAに有意差がみられた。ロジスティック回帰分析では、男性はSVAと握力、女性はSSと運動習慣の有無が有意な危険因子として挙げられた。以上より、男女ともにSVAが高い場合、女性では更にSS低下がみられる場合、脊柱変形が進行する可能性が高く、運動習慣をもつことが脊柱変形進行の予防に重要であることが示唆された。
  • Shin Oe; Daisuke Togawa; Yu Yamato; Tomohiko Hasegawa; Go Yoshida; Sho Kobayashi; Tatsuya Yasuda; Tomohiro Banno; Hideyuki Arima; Yuki Mihara; Hiroki Ushirozako; Tomohiro Yamada; Yukihiro Matsuyama
    Spine 44 (7) 472 - 478 2019/04 
    STUDY DESIGN: A retrospective study of postoperative delirium after adult spinal deformity (ASD) surgery. OBJECTIVE: To identify the risk factors of post-ASD surgery delirium, including nutritional state before surgery. SUMMARY OF BACKGROUND DATA: Recently, malnutrition was reported as one of the risk factors of delirium. The prognostic nutritional index (PNI) and controlling nutritional status index (CONUT) scores are simple methods of nutritional evaluation. However, there are no reports that verify that delirium is related to the PNI and CONUT score in patients who have undergone ASD surgery. METHODS: A consecutive 319 patients who underwent ASD surgery were divided into a delirium group (group D) or nondelirium group (group ND). Preoperative risk factors, including PNI, were assessed. RESULTS: Group D consisted of 30 patients and group ND consisted of 289 patients. There was significant difference in age (group D:group ND = 73:62, P = 0.000), serum albumin (4.2:4.3, P = 0.028), operative time (422:395 min, P = 0.029), PNI score (49:52, P = 0.011), and CONUT score (1.7:1.1, P = 0.046). Using multiple logistic regression analysis, we found significant risk factors for delirium to be age (P = 0.006, odds ratio = 1.11, 95% confidence interval = 1.03-1.19) and PNI (P = 0.003, odds ratio = 0.87, 95% confidence interval = 0.79-0.96). A receiver operating characteristic curve showed that the cut-off value of PNI and age for delirium were 49.7 and 68.5 years, respectively. CONCLUSION: The risk factors of postoperative delirium after ASD surgery were PNI less than 49.7 and age more than 68.5 years. Patients who undergo ASD surgery beyond these preoperative cut-off values should be cautioned about delirium and be required to provide adequate informed consent. LEVEL OF EVIDENCE: 3.
  • Hiroki Ushirozako; Go Yoshida; Sho Kobayashi; Tomohiko Hasegawa; Yu Yamato; Tatsuya Yasuda; Tomohiro Banno; Hideyuki Arima; Shin Oe; Yuki Mihara; Daisuke Togawa; Yukihiro Matsuyama
    Journal of neurosurgery. Spine 1 - 9 2019/02 
    OBJECTIVEIntraoperative neuromonitoring may be valuable for predicting postoperative neurological complications, and transcranial motor evoked potentials (TcMEPs) are the most reliable monitoring modality with high sensitivity. One of the most frequent problems of TcMEP monitoring is the high rate of false-positive alerts, also called "anesthetic fade." The purpose of this study was to clarify the risk factors for false-positive TcMEP alerts and to find ways to reduce false-positive rates.METHODSThe authors analyzed 703 patients who underwent TcMEP monitoring under total intravenous anesthesia during spinal surgery within a 7-year interval. They defined an alert point as final TcMEP amplitudes ≤ 30% of the baseline. Variations in body temperature (maximum - minimum body temperature during surgery) were measured. Patients with false-positive alerts were classified into 2 groups: a global group with alerts observed in 2 or more muscles of the upper and lower extremities, and a focal group with alerts observed in 1 muscle.RESULTSFalse-positive alerts occurred in 100 cases (14%), comprising 60 cases with global and 40 cases with focal alerts. Compared with the 545 true-negative cases, in the false-positive cases the patients had received a significantly higher total propofol dose (1915 mg vs 1380 mg; p < 0.001). In the false-positive cases with global alerts, the patients had also received a higher mean propofol dose than those with focal alerts (4.5 mg/kg/hr vs 4.2 mg/kg/hr; p = 0.087). The cutoff value of the total propofol dose for predicting false-positive alerts, with the best sensitivity and specificity, was 1550 mg. Multivariate logistic analysis revealed that a total propofol dose > 1550 mg (OR 4.583; 95% CI 2.785-7.539; p < 0.001), variation in body temperature (1°C difference; OR 1.691; 95% CI 1.060-2.465; p < 0.01), and estimated blood loss (500-ml difference; OR 1.309; 95% CI 1.155-1.484; p < 0.001) were independently associated with false-positive alerts.CONCLUSIONSIntraoperative total propofol dose > 1550 mg, larger variation in body temperature, and greater blood loss are independently associated with false-positive alerts during spinal surgery. The authors believe that these factors may contribute to the false-positive global alerts that characterize anesthetic fade. As it is necessary to consider multiple confounding factors to distinguish false-positive alerts from true-positive alerts, including variation in body temperature or ischemic condition, the authors argue the importance of a team approach that includes surgeons, anesthesiologists, and medical engineers.
  • Tsuyoshi Kato; Hiroyuki Inose; Shoichi Ichimura; Yasuaki Tokuhashi; Hiroaki Nakamura; Masatoshi Hoshino; Daisuke Togawa; Toru Hirano; Hirotaka Haro; Tetsuro Ohba; Takashi Tsuji; Kimiaki Sato; Yutaka Sasao; Masahiko Takahata; Koji Otani; Suketaka Momoshima; Ukihide Tateishi; Makoto Tomita; Ryuichi Takemasa; Masato Yuasa; Takashi Hirai; Toshitaka Yoshii; Atsushi Okawa
    Journal of clinical medicine 8 (2) 2019/02 
    While bracing is the standard conservative treatment for acute osteoporotic compression fracture, the efficacy of different brace treatments has not been extensively studied. We aimed to clarify and compare the preventive effect of the different brace treatments on the deformity of the vertebral body and other clinical results in this patient cohort. This multicenter nationwide prospective randomized study included female patients aged 65⁻85 years with acute one-level osteoporotic compression fractures. We assigned patients within four weeks of injury to either a rigid-brace treatment or a soft-brace treatment. The main outcome measure was the anterior vertebral body compression percentage at 48 weeks. Secondary outcome measures included scores on the European Quality of Life-5 Dimensions (EQ-5D), visual analog scale (VAS) for lower back pain, and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). A total of 141 patients were assigned to the rigid-brace group, whereas 143 patients were assigned to the soft-brace group. There were no statistically significant differences in the primary outcome and secondary outcome measures between groups. In conclusion, among patients with fresh vertebral compression fractures, the 12-week rigid-brace treatment did not result in a statistically greater prevention of spinal deformity, better quality of life, or lesser back pain than soft-brace.
  • 術中脊髄モニタリングのfalse positive発生におけるanesthetic fadeの検討
    後迫 宏紀; 吉田 剛; 長谷川 智彦; 大和 雄; 坂野 友啓; 有馬 秀幸; 三原 唯暉; 大江 慎; 戸川 大輔; 松山 幸弘
    脊髄機能診断学 エーザイ(株) 39 (1) 99 - 102 2019/02 
    長時間手術で術中脊髄モニタリングのfalse positive(FP)を生じる機序や麻酔の影響について検討した。当科で脊椎手術に対し、multi-channel MEPによる術中脊髄モニタリングを行った930例(男性323例、女性607例、平均53.0歳)を対象とした。True positive 39例、FP 79例(85%)、True negative(TN)808例、False negative 4例であり、感度91%、特異度91%であった。年齢、性別、身長、体重、BMI、ASA分類ではFP症例とTN症例の間に有意差はなかった。FP症例の術中最終波形の振幅低下率は平均8.7%であった。手術データを2群間で比較したところ、手術時間、麻酔時間、術中出血量、吸入麻酔併用の有無、フェンタニル総使用量、プロポフォール濃度には有意差はなかった。術中のアラーム時に麻酔薬使用量を評価することで、MEPの精度向上に貢献できる可能性があると考えられた。
  • 側彎症手術においてMEPのfalse positiveに波形導出部位と振幅が与える影響
    鈴木 勘太; 後迫 宏紀; 吉田 剛; 長谷川 智彦; 大和 雄; 坂野 友啓; 有馬 秀幸; 大江 慎; 三原 唯暉; 長末 鉄平; 鈴木 咲子; 森田 耕司; 戸川 大輔; 松山 幸弘
    脊髄機能診断学 エーザイ(株) 39 (1) 118 - 121 2019/02 
    術中脊髄モニタリングBr(E)-MsEP(以下、MEP)の偽陽性(FP)症例のコントロール波形データについて検討した。側彎症に対して矯正固定術を行い、術中脊髄モニタリングMEPでFPを呈した36例(男性10例、女性26例、平均48.7歳)を対象とした。下肢導出筋である大腿四頭筋、ハムストリング、前脛骨筋、腓腹筋に着目して解析を行い、術中最終波形が両側下肢2筋以上で低下した全体低下群、それ以外の下肢近位筋のみが低下した近位筋低下群、下肢遠位筋のみが低下した遠位筋低下群の3群に群分けした。近位筋低下群15例(42%)、遠位筋低下群6例(17%)、全体低下群18例(50%)であり、近位筋に多くFPが発生していた。近位筋低下群のコントロール波形平均振幅は307μV、True negative(TN)近位筋群は484μVであり有意差はなかったが、遠位筋低下群は288μV、TN遠位筋群は660μVであり、遠位筋低下群のコントロール波形振幅がTN群と比して有意に小さかった。FPアラートの局所発生例は近位筋に多く発生していた。
  • 術中脊髄モニタリングBr(E)-MsEP頭蓋刺激電極の位置が波形振幅に与える影響
    長末 鉄平; 吉田 剛; 後迫 宏紀; 長谷川 智彦; 大和 雄; 戸川 大輔; 坂野 友啓; 有馬 秀幸; 大江 慎; 三原 唯暉; 鈴木 勘太; 鈴木 咲子; 森田 耕司; 松山 幸弘
    脊髄機能診断学 エーザイ(株) 39 (1) 144 - 148 2019/02 
    刺激電極の位置がBr(E)-MsEP波形振幅に与える影響について検討した。2017年10月〜12月に当院で行われた脊椎手術10例(設定群)に対しては、外後頭隆起-鼻根点の中点と両耳介径の交差点から、耳介径の1/10を中心から左右に移動させた点に刺激電極を設置した。また、2016年1月〜2017年3月に手術を施行した13例(従来群)ではCzから左右7cm、前方2cmに電極を設置した。電位振幅では上肢導出筋、下肢導出筋において従来群、設定群の2群間に有意差はなかった。下肢遠位筋である前脛骨筋(TA)、腓腹筋(Gc)の波形振幅を上肢遠位筋である小指外転筋(ADM)の波形振幅で除し、下肢遠位筋の上肢遠位筋に対する波形振幅比を算出したところ、波形振幅比は従来群が大きく、両側TA/ADM、左Gc/ADMで有意に高値を示していた。従来群と比較して設定群では中心側への刺激電極設置を行ったが、下肢電位の増幅はみられなかった。
  • Go Yoshida; Tomohiko Hasegawa; Yu Yamato; Sho Kobayashi; Oe Shin; Tomohiro Banno; Yuuki Mihara; Hideyuki Arima; Hiroki Ushirozako; Tatsuya Yasuda; Daisuke Togawa; Yukihiro Matsuyama
    Asian spine journal 13 (1) 35 - 44 2019/02 
    STUDY DESIGN: Retrospective study. PURPOSE: To calculate the minimum clinically important difference (MCID) for total and individual domains of the Oswestry Disability Index (ODI) and assess score distribution and changes over time in surgically treated adult spinal deformity (ASD) patients. OVERVIEW OF LITERATURE: Despite the common use of ODI for assessing ASD, there are no robust studies defining MCID values for this index. METHODS: This study included 240 consecutive ASD patients with a minimum of 2 years of follow-up. We calculated MCID values for total and individual ODI domains using all or part of the Scoliosis Research Society-22R questionnaire as anchors. Using current MCID values, we measured the acquisition rates in patients who acquired MCID at follow-up in both total and individual ODI domains. Differences in pathology, age, and locations of the upper and lower instrumented vertebrae were analyzed. RESULTS: MCID of the total ODI score was 11%, with an area under the curve of 0.737. Each domain ranged from 0 to 2, with 1 being the most common value. In the pain and standing domains, >60% of the patients acquired MCID, although acquisition rates of the personal care, lifting, sleep, and sexual activity domains were relatively low (20%-35%). Patients with MCID had more radiographic improvement in lumbar lordosis, sagittal vertical axis, and T1 pelvic angle than those without MCID (p<0.05). CONCLUSIONS: To our knowledge, this is the first study to describe MCID of ODI (11%) after ASD surgery. In the pain and standing domains, most patients acquired MCID although the rates of acquisition of MCID in the personal care, lifting, sleep, and sexual activity domains were low. Spine surgeons should counsel their patients regarding the benefits and setbacks of ASD surgery.
  • YAMADA Tomohiro
    The Central Japan Journal of Orthopaedic Surgery & Traumatology THE CENTRAL JAPAN ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 62 (1) 111 - 112 0008-9443 2019/01 
    地域住民運動器検診を受診した456名(男性171名、女性285名、平均年齢76.5歳)を対象とし、立位全脊柱X線にて評価した脊椎アライメントと転倒リスクとの関連について検討した。対象を転倒リスクあり群となし群に分け比較を行った。その結果、転倒リスクあり群は119名(26%)で、なし群と比較して年齢、脊椎矢状面アライメント(SVA)が有意に大きかった。ロジスティック解析では、転倒リスクの危険因子として年齢、SVAが抽出された。
  • Tomohiro Banno; Hideyuki Arima; Tomohiko Hasegawa; Yu Yamato; Daisuke Togawa; Go Yoshida; Tatsuya Yasuda; Shin Oe; Yuki Mihara; Hiroki Ushirozako; Yukihiro Matsuyama
    Spine deformity 7 (1) 125 - 131 2019/01 
    OBJECTIVE: We investigated the relationship between cross-sectional area (CSA) of paravertebral muscle and trunk tilt at standing and walking in adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA: Although the importance of back muscles for the development of spinal kyphosis was well described, the influence on maintaining the sagittal balance was unclear. METHODS: Forty-five female patients (mean age, 68.8 years) with ASD were studied. We measured sagittal vertical axis [SVA], pelvic tilt [PT], and pelvic incidence-lumbar lordosis [PI-LL]) by lateral spine radiograph. For the assessment of trunk tilt standing-trunk tilt angle (STA) by lateral standing radiograph, gait-trunk tilt angle (GTA) by lateral gait images, and the increasing trunk tilt angle (ITA) by subtracting the STA from the GTA were calculated. Using L1/2 and L4/5 axial MRI, the CSAs of bilateral multifidus muscles (MF) and elector spinae (ES) removed fat by Image J software were calculated. We examined the correlation between trunk tilt angle (STA, GTA, and ITA) and spinopelvic parameters (SVA, PT, and PI minus LL) and also the correlation among muscle CSA, trunk tilt angle (STA, GTA, and ITA), and Oswestry Disability Index (ODI). RESULTS: The mean STA, GTA, and ITA were 4.2°, 13.0°, and 8.8°, respectively. The CSAs of back muscles were 278 mm2 at L1/2 MF, 1,687 mm2 at L1/2 ES, 636 mm2 at L4/5 MF, and 1,355 mm2 at L4/5 ES, respectively. Trunk tilt angle had significant relations with spinopelvic parameters. Concerning about muscle CSA, significant correlations were observed between STA and L4/5 MF (r = -0.517), GTA and L1/2 ES (r = -0.461) and L4/5 MF (r = -0.476), and ITA and L1/2 ES(r = -0.429). ODI showed significant correlation with STA and GTA. CONCLUSIONS: Paravertebral muscles were crucial to keep upright posture during walking as well as standing.
  • Go Yoshida; Hiroki Ushirozako; Sho Kobayashi; Tomohiko Hasegawa; Yu Yamato; Tomohiro Banno; Shin Oe; Hideyuki Arima; Yuki Mihara; Tatsuya Yasuda; Daisuke Togawa; Yukihiro Matsuyama
    Spine deformity 7 (1) 132 - 140 2019/01 
    STUDY DESIGN: Retrospective study. OBJECTIVES: To analyze intraoperative neuromonitoring (IONM) alerts in various surgical procedures and clarify incidences and causes of IONM alarms in consecutive adult spinal deformity (ASD) surgeries. SUMMARY OF BACKGROUND DATA: ASD surgery has a high neurologic complication rate. IONM may play a role in identifying and preventing neurologic complications. METHODS: This study included 275 consecutive ASD patients treated by posterior corrective fusion who had been followed up for more than two years. We divided the patients into 1) the PCO group: multiple posterior column osteotomies; and 2) the 3CO group: three-column osteotomy including pedicle subtraction osteotomy and vertebral column resection. We set a 70% amplitude reduction as the alarm point for transcranial electrical stimulation motor-evoked potentials (Tc-MEPs) using 32-channel IONM. RESULTS: The PCO and 3CO groups included 162 and 113 cases, respectively. IONM revealed 32 cases (11.6%) of Tc-MEP alerts, 10.4% in the PCO group, and 13.2% in the 3CO group. Postoperative follow-ups revealed 15 cases (5.5%) of new neurologic deficits, 4.9% in the PCO group, and 6.2% in the 3CO group. Most IONM alarms in the PCO group appeared at the time of rod rotation maneuvers, and 88.9% of alarms were selective for MEP decrease. In contrast, IONM alarms in the 3CO group appeared at the time of spinal shortening, and 80% were global MEP decreases. Immediately after the alarm, neurologic deficits might be rescued by foraminal decompression after rod rotation and by adjusting the length of spinal shortening. Overall, more than 50% of cases with IONM alerts were rescued by intraoperative additional management. CONCLUSION: IONM reduced the incidence of neurologic complications in ASD surgery. Spinal surgeons should recognize the type of muscle derivation and respond to such alerts by performing appropriate corrections reflecting the mechanism underlying the neural damage. LEVEL OF EVIDENCE: Level IV.
  • Hiroki Ushirozako; Go Yoshida; Daisuke Togawa; Takao Omura; Tomohiko Hasegawa; Yu Yamato; Tomohiro Banno; Hideyuki Arima; Shin Oe; Yuki Mihara; Tomohiro Yamada; Takahiro Natsume; Shinya Ogawa; Yuji Awaga; Hiroyuki Takamatsu; Yukihiro Matsuyama
    Spine surgery and related research 3 (4) 368 - 376 2019 
    Introduction: There is currently a lack of translatable, preclinical models of low back pain (LBP). Chymopapain, a proteolytic enzyme used to treat lumbar intervertebral disc (IVD) herniation, could induce discogenic LBP. The current study developed a behavioral model of discogenic LBP in nonhuman primates. Significant brain activation is observed in clinical LBP. Thus, the current study also sought to define brain activation over time in a macaque with discogenic LBP. Methods: Responses to pressure applied to the back at L4/L5 were measured in eight adult male Macaca fasciculata using a pressure algometer. The nucleus pulpous of the IVD between L4 and L5 was aspirated and chymopapain (1 mg/mL) was injected under fluoroscopic guidance (n = 2). In two macaques, the nucleus pulpous was only aspirated. Brain activation in response to pressure applied to the lower back was assessed using a 3.0T magnetic resonance imaging scanner in four macaques before and 1, 3, 9, and 14 days after treatment. Results: The mean (±SD) response pressure before treatment was 1.4 ± 0.1 kg. One day after chymopapain treatment, the response pressure decreased to 0.6 ± 0.05 kg (P < 0.01), suggestive of pressure hypersensitivity. Over time, the pressure thresholds following chymopapain treatment gradually returned to normal. Following aspiration only, the response pressure was 1.4 ± 0.05 kg, which was not significantly different from the uninjured controls. There was activation of the secondary somatosensory cortex and insular cortex one and three days after chymopapain treatment; there was no activation following aspiration only. Conclusions: Enzymatic treatment of the nucleus pulpous leads to acute LBP and pressure-evoked activation in pain-related brain areas. The current model of discogenic LBP parallels clinical LBP and could be used to further elaborate the mechanism of acute LBP.
  • 高齢者の骨粗鬆症性椎体骨折・溶骨性脊椎腫瘍に対する経皮的椎体形成術の有用性
    戸川 大輔
    Medical Science Digest (株)ニュー・サイエンス社 44 (13) 715 - 716 1347-4340 2018/11
  • Tatsuya Yasuda; Tomohiko Hasegawa; Yu Yamato; Daisuke Togawa; Sho Kobayashi; Go Yoshida; Tomohiro Banno; Hideyuki Arima; Shin Oe; Yukihiro Matsuyama
    Journal of neurosurgery. Spine 29 (5) 530 - 534 2018/11 
    OBJECTIVEThe purpose of this study was to evaluate the effect of position on lumbar lordosis (LL) in adult spinal deformity (ASD) patients.METHODSThe authors evaluated the radiographic data of ASD patients who underwent posterior corrective fusion surgery from the thoracic spine to L5, S1, or the ilium for the treatment of ASD of the lumbar spine. The spinopelvic parameters were measured in the standing position preoperatively. LL was also evaluated in the supine position preoperatively and in the prone position on the surgical frame. Changes in LL were compared between groups.RESULTSEighty-five patients were included. The average LL in standing, supine, and prone positions was 11.8°, 24.3°, and 24.0°, respectively. LL increased significantly from standing to supine or prone position (p < 0.001). In 80 patients (94.1%), the difference between supine LL and prone LL was within 5°. Change in LL from standing to prone position was significantly higher in the severe deformity group.CONCLUSIONSThe lordotic effect of intraoperative prone positioning was remarkable in patients with severe deformities. LL in the supine position was approximately the same as that in the prone position. Therefore, assessing preoperative supine lateral lumbar radiographs enables one to plan corrective spinal surgeries in ASD patients.
  • Tomohiro Banno; Daisuke Togawa; Tomohiko Hasegawa; Yu Yamato; Go Yoshida; Sho Kobayashi; Tatsuya Yasuda; Hideyuki Arima; Shin Oe; Yuki Mihara; Hiroki Ushirozako; Yukihiro Matsuyama
    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 23 (6) 929 - 934 2018/11 
    BACKGROUND: Diffuse idiopathic skeletal hyperostosis (DISH) is associated with increasing age, obesity, and diabetes mellitus. However, little is known about the clinical impacts of DISH on physical function and spinal deformity in elderly populations. The purpose of this study was to elucidate the influence of DISH on physical function, spinal deformity, and health-related quality of life (HRQOL) in elderly populations. METHODS: We enrolled 504 volunteers (203 men and 301 women, mean age 74.0 years). Height, weight, body mass index (BMI), blood pressure, grip strength, one-leg standing time, sit-and-reach, functional reach, and bone mineral density (BMD) were measured. Using whole spine standing X-rays, the prevalence, location, and numbers of fused vertebra of DISH and spinopelvic parameters were measured. HRQOL measures, including the Oswestry Disability Index and the EuroQuol-5D were also obtained. We compared DISH subjects with control subjects of age and sex matching. We compared DISH subjects in the thoracic spine (T-DISH) to those in the thoraco-lumbar spine (TL-DISH). RESULTS: DISH occurred more frequently in men (14.3%) than in women (4.3%). The mean age was significantly higher of subjects with DISH than of those without DISH. The mean number of fused vertebra by DISH was 5.5 ± 1.5, and T-DISH was observed in 57% cases. DISH group showed greater body weights, BMIs, blood pressures, and BMD in the lumbar spine compared to the control group. No inter-group differences were observed in physical function, HRQOL and spinopelvic parameters. Subjects with TL-DISH had significantly lower values of sit-and-reach and functional reach than those with T-DISH. CONCLUSIONS: Subjects with DISH showed greater body weights, BMIs, blood pressures, and BMD compared to age- and sex-matched controls, while physical function, spinal alignment, and HRQOL were comparable between groups.
  • Tatsuya Yasuda; Tomohiko Hasegawa; Yu Yamato; Daisuke Togawa; Sho Kobayashi; Go Yoshida; Tomohiro Banno; Hideyuki Arima; Shin Oe; Yukihiro Matsuyama
    Spine surgery and related research 2 (4) 283 - 289 2018/10 
    Introduction: Correction of lumbar lordosis is the primary goal of surgical treatment of adult spinal deformity. However, only limited research has evaluated the effects of this correction on the adaptive curvature of the thoracic spine. The purpose of this study is to evaluate the change in thoracic curvature after corrective surgery to restore lumbar lordosis in patients with adult spinal deformity. Methods: We completed a retrospective analysis of the radiological data of 65 patients, ≥50 years old, who underwent corrective surgery of lumbar spine lordosis from any level below T8 to the ilium. Patients with insufficient correction, defined by a pelvic incidence minus lumbar lordosis angle (PI-LL) > 10°, were excluded, with the data of 43 patients included in the analysis. The following radiological measures of spinal alignment were measured at three time points, preoperatively, on the first day of standing postoperatively and at 2 years post-surgery: sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), and PI-LL. Results: Postoperative change in TK was correlated to preoperative TK and age. The increase in TK was larger for patients <75 years of age, increasing from 23.1° to 38.0° after surgery and to 46.7° at 2-years postoperatively. In contrast, for patients >75 years, TK remained largely unchanged at 37.8° just after surgery but increased substantively to 50.1° at the 2-year follow-up. The postoperative change in TK immediately after surgery was determined using equation "predict change in TK = -0.21 × age - 0.6 × preoperative TK + 41.8" by multiple regression analysis. Conclusions: Reciprocal change in TK after lumbar spine correction is correlated to preoperative TK and age.
  • 三原 唯暉; 戸川 大輔; 長谷川 智彦; 大和 雄; 吉田 剛; 松山 幸弘
    別冊整形外科 (株)南江堂 1 (74) 128 - 131 0287-1645 2018/10 
    著者等は一般住民健診における腰椎後方すべり(後方すべり)例での脊柱骨盤パラメータの関与を分析し報告している。その報告のポイントの一つとして、脊柱後彎の大きい症例では後彎の下位終椎に後方すべりが発生しやすいことが挙げられる。そこで後方すべりには姿勢異常が伴うのではないかという仮説が生まれた。今回この仮説について、Itoiらの姿勢異常分類(正常・円背・凹円背・全後彎・亀背)を用いて検証した。対象は、50歳以上の一般健診受診者で立位全脊椎・骨盤単純X線を撮影できた548例とした。X線像に基づく姿勢異常分類の内訳は、正常242例、円背132例、凹円背99例、全後彎64例、亀背11例であった。後方すべりは240例(44%)に認め、姿勢分類別にみた後方すべりの頻度は正常群13%、円背群62%、凹円背群64%、全後彎群83%、亀背群100%であり、正常群に比べて他の4群は有意に高かった。後方すべりの発生高位を姿勢分類別で比較したところ、全後彎群と亀背群は他の3群に比べて下位腰椎(尾側)を発生高位とする割合が有意に高かった。
  • 大江 慎; 戸川 大輔; 大和 雄; 長谷川 智彦; 吉田 剛; 小林 祥; 安田 達也; 坂野 友啓; 有馬 秀幸; 三原 唯暉; 後迫 宏紀; 山田 智裕; 松山 幸弘
    臨床整形外科 (株)医学書院 53 (9) 841 - 845 0557-0433 2018/09 
    <文献概要>低カリウム血症に伴う首下がり症候群を発症した1例を経験したので報告する.症例は69歳男性で,頸部の伸展困難を主訴に来院した.後頸部の筋群のみ脱力を認め,その他,神経学的異常は認められなかった.血清カリウム値は1.9mEq/Lと著明に低下していた.血清カリウム値の補正を行ったところ,頸部の伸展もできるようになり首下がりは改善した.首下がり症候群の原因は多岐にわたるが,低カリウム血症も鑑別疾患の1つとして重要である.
  • Hiroki Ushirozako; Go Yoshida; Sho Kobayashi; Tomohiko Hasegawa; Yu Yamato; Tatsuya Yasuda; Tomohiro Banno; Hideyuki Arima; Shin Oe; Yuki Mihara; Daisuke Togawa; Yukihiro Matsuyama
    Asian spine journal 12 (4) 639 - 647 2018/08 
    STUDY DESIGN: Retrospective study. PURPOSE: We aimed to determine the utility of transcranial motor evoked potential (TcMEP) monitoring for the detection of intraoperative nerve root injury. OVERVIEW OF LITERATURE: Intraoperative neuromonitoring is important for the prediction of neurological injuries or postoperative paralysis. Nerve root injury can develop as a complication of adult spinal deformity (ASD) surgery. METHODS: We analyzed 295 patients who underwent ASD surgery using multi-channel TcMEP monitoring between 2010 and 2016 (58 men, 237 women; median age, 68 years; follow-up period ≥1 year). We defined the alarm point as a TcMEP amplitude <30% of that at baseline, and nerve root injury as meeting the focal TcMEP alerts shortly following surgical procedures with the presence of postoperative motor deficits in the selected muscles. Patients were classified into two groups, as those with nerve root injury and those with true-negatives. RESULTS: Seven patients (2.4%) exhibited neurological events related to nerve root injury, comprising six true-positive and one falsenegative cases. TcMEP monitoring from multiple myotomes was effective in detecting nerve root injury. Compared to the 248 truenegative cases, the seven cases of nerve root injury were associated with significantly different preoperative pelvic tilt (PT) values, sacral slope values, and degree of change in PT. The cutoff for the degree of change in PT for predicting nerve root injury, with the best sensitivity and specificity, was 17.5°. Multivariate logistic analyses revealed that a change of >17.5° in PT (odds ratio, 17.5; 95% confidence interval, 1.994-153.560; p =0.010) was independently associated with intraoperative nerve root injury. CONCLUSIONS: Multi-channel TcMEP monitoring may be useful for detecting nerve root injuries. A change in PT of >17.5° may be a significant risk factor for neurological events related to intraoperative nerve root injury.
  • Daisuke Togawa; Tomohiko Hasegawa; Yu Yamato; Go Yoshida; Sho Kobayashi; Tatsuya Yasuda; Shin Oe; Tomohiro Banno; Hideyuki Arima; Yuki Mihara; Hiroki Ushirozako; Yukihiro Matsuyama
    Spine 43 (14) E804-E812  2018/07 
    STUDY DESIGN: A prospective case series analysis. OBJECTIVE: The purpose of this study was to investigate the degree of difficulty in daily activities of adult spinal deformity (ASD) patients after corrective long fusion to the pelvis, with an emphasis on bend forward activities. SUMMARY OF BACKGROUND DATA: No prospective studies have been reported regarding the postoperative impairments and their time course after long fusion in ASD patients. METHODS: One-hundred three patients [26 men, 77 women; mean age 68 (50-82) years] who underwent corrective long fusion from the thoracic spine to the pelvis were included. As a control group, 578 volunteers [213 men, 365 women; mean age 72 (50-84)] who underwent musculoskeletal examination were included. Seven daily activities were assessed using Disability Scores (DS10), which ask patients to rate the difficulty of actions from 1 (very easy) to 10 (very difficult). The activities selected were a) gait, b) ability to trim toe nails, c) lie supine, d) perform personal hygiene, e) put on pants, f) pick up an item from the floor, and g) get down on all fours. Each of these activities were rated by all volunteers and patients at five assessment points in 2 years. Questionnaires (ODI, SRS-22, and DS10) were administered preoperatively, at discharge, 6 months, 1 year, and 2 years postoperatively. Radiographic parameters and clinical results of the control group were compared with those of the ASD patients and the patients with different upper instrumented vertebrae. RESULTS: Although successful clinical results and deformity corrections were achieved, the ASD patients reported significant difficulty in b), d), e), f), and g) after the surgery (all P < 0.0001), regardless of the fusion length. The difficulty gradually improved toward 2 years but did not reach preoperative status. CONCLUSION: Activities requiring patients to bend forward were more difficult for elderly ASD patients postoperatively. LEVEL OF EVIDENCE: 3.
  • USHIROZAKO Hiroki
    The Central Japan Journal of Orthopaedic Surgery & Traumatology THE CENTRAL JAPAN ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 61 (4) 747 - 748 0008-9443 2018/07 
    50歳以上の運動器検診者624例(男性247例、女性377例、平均年齢72.8歳)を対象に、立位全脊椎矢状面アライメントにおける代償機構が健康関連QOLに与える影響について検討した。全脊椎立位単純X線側面像でpelvic tilt(PT)、T1 pelvic angle(TPA)、大腿屈曲(膝屈曲の代用)FIA、C7 plumb lineの大腿骨頭中心からの位置を測定し、oswestry disability index(ODI)を評価し男女で比較した。その結果、体幹前方移動と膝屈曲はODIが有意に高値で、女性は男性と比較して骨盤を後傾して代償していた。膝屈曲は健康関連QOLへの影響が強く、下肢矢状面アライメント評価は必須であり、性差を考慮した代償機構の検討が必要があると考えられた。
  • MIHARA Yuki
    The Central Japan Journal of Orthopaedic Surgery & Traumatology THE CENTRAL JAPAN ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 61 (4) 749 - 750 0008-9443 2018/07 
    半年間に、運動器検診を行った50歳以上の333名(男性136名、女性197名、平均年齢70歳)を対象に、全脊椎立位単純X線所見からItoi姿勢分類で評価困難な脊柱後彎の少ない例Flat back type(FB群)を抽出し、脊柱骨盤パラメーターおよびhealth-related quality of life(HRQOL)について検討した。FB群はSVA40mm未満26名(FB-群)、40mm以上95mm未満41名(FB+)群、95mm以上24名(FB++)群に分類し比較した。その結果、FB-群はNormal type(N群)に比してPI-LLが有意に大きかった。FB+、FB++群はN群、FB-群と比較してSVA、PT、PI-LLが有意に大きく、ODIは有意に不良であった。以上より、Itoi分類で評価困難なFBは、脊椎骨盤アライメントおよびHRQOLに幅があり、脊柱グローバルアライメントがHRQOLと最も強く相関していた。また、脊柱グローバルアライメントが不良になるに伴ってHRQOLが悪化する傾向を認めた。
  • ウシロザコ ヒロキ; ヨシダ ゴウ; ハセガワ トモヒコ; ヤマト ユウ; トガワ ダイスケ; マツヤマ ユキヒロ
    Journal of Spine Research (一社)日本脊椎脊髄病学会 9 (7) 1213 - 1216 1884-7137 2018/07 
    高齢者における脊柱側彎進行と健康関連QOL(HRQOL)との関係を調査した。2012年および2016年に高齢者運動器検診に参加した337名の側彎Cobb角を計測し、Oswestry Disability index(ODI)との相関について検討した。側彎Cobb角が5度以上進行した症例は有意にODIが高値であった。高齢者においては矢状面アライメントがQOLに影響を与えると報告されているが、脊柱側彎の進行もHRQOLに影響を及ぼす可能性が示唆された。(著者抄録)
  • Yu Yamato; Tomohiko Hasegawa; Sho Kobayashi; Tatsuya Yasuda; Daisuke Togawa; Go Yoshida; Tomohiro Banno; Shin Oe; Yuki Mihara; Yukihiro Matsuyama
    Journal of neurosurgery. Spine 29 (1) 59 - 67 2018/07 
    OBJECTIVE Despite the significant incidence of rod fractures (RFs) following long-segment corrective fusion surgery, little is known about the optimal treatment strategy. The objectives of this study were to investigate the time course of clinical symptoms and treatments in patients with RFs following adult spinal deformity (ASD) surgery and to establish treatment recommendations. METHODS This study was a retrospective case series of patients with RFs whose data were retrieved from a prospectively collected single-center database. The authors reviewed the cases of 304 patients (mean age 62.9 years) who underwent ASD surgery. Primary symptoms, time course of symptoms, and treatments were investigated by reviewing medical records. Standing whole-spine radiographs obtained before and after RF development and at last follow-up were evaluated. Osseous union was assessed using CT scans and intraoperative findings. RESULTS There were 54 RFs in 53 patients (mean age 68.5 years [range 41-84 years]) occurring at a mean of 21 months (range 6-47 months) after surgery. In 1 patient RF occurred twice, with each case at a different time and level, and the symptoms and treatments for these 2 RFs were analyzed separately (1 case of revision surgery and 1 case of nonoperative treatment). The overall rate of RF observed on radiographs after a minimum follow-up of 1 year was 18.0% (54 of 300 cases). The clinical symptoms at the time of RF were pain in 77.8% (42 of 54 cases) and no onset of new symptoms in 20.5% (11 of 54 cases). The pain was temporary and had subsided in 19 of 42 cases (45%) within 2 weeks. In 36 of the 54 cases (66.7%) (including the first RF in the patient with 2 RFs), patients underwent revision surgery at a mean of 116 days (range 5-888 days) after diagnosis. In 18 cases patients received only nonoperative treatment as of the last follow-up, including 17 cases in which the patients experienced no pain and no remarkable progression of deformity (mean 18.5 months after RF development). CONCLUSIONS This analysis of 54 RFs in 53 patients following corrective fusion surgery for ASD demonstrates a relationship between symptoms and alignment change. Revision surgeries were performed in a total of 36 cases. Nonoperative care was offered in 18 (33.3%) of 54 cases at the last follow-up, with no additional symptoms in 17 of the 18 cases. These data offer useful information regarding informed decision making for patients in whom an RF occurs after ASD surgery.
  • 小山 博史; 花田 充; 今田 貴章; 戸川 大輔; 星野 裕信; 松山 幸弘
    整形・災害外科 金原出版(株) 61 (7) 815 - 821 0387-4095 2018/06 
    <文献概要>変形性膝関節症(膝OA)が脊椎アライメントに与える影響について,運動器検診データを用いて調査した。217名の被検診者(男性88名,女性129名,平均74歳)を対象とした。51%に腰痛,43%に膝痛があり,47%にX線像でKellgren-Lawrence(KL)grade 2以上の膝OAがあった。KL grade 2以上では,骨盤が後傾し,sagittal vertical axisが大きく(C7垂線が前方移動),膝が屈曲していた。KL grade 2以上において膝痛がある人は,腰痛の合併があり,胸椎の後彎が減少していた。加齢により脊椎の彎曲が減少し骨盤が後傾するが,手術を考慮するほどでない程度の膝痛がある膝OA患者では,胸椎の後彎を減じて立位姿勢を保持していると考えた。一方,膝の上下の疼痛の有無で比較すると,矢状面アライメントに関連はなく,膝の上下に疼痛がある人は下肢の内反が大きかったため,膝OAによる関節炎が影響したと考えた。
  • フルハシ ヒロキ; コヤマ ヒロシ
    整形・災害外科 金原出版(株) 61 (7) 829 - 836 0387-4095 2018/06 
    <文献概要>脊柱変形矯正固定とTHAの合併例は合併症が多いことが知られている。THA後に脊柱変形矯正固定術を行う際,骨盤の前傾,脊椎-骨盤の可動性低下のため,THA後方脱臼のリスクが高くなる。当院でTHA後に脊柱変形矯正固定を行った10例13股のうち5股(38%)に後方脱臼がみられた。脱臼の有無で比較すると,脊椎手術による仙骨傾斜角の矯正量や脊椎術後のTHAインプラントアライメントに差はなく,脱臼の危険因子を同定することは困難であった。THA後の脊柱変形矯正固定では,インプラントだけでなく骨も含めたインピンジメントシミュレーションを行い,矯正量や術式の調整を検討することが重要である。
  • Shin Oe; Daisuke Togawa; Go Yoshida; Tomohiko Hasegawa; Yu Yamato; Tatsuya Yasuda; Tomohiro Banno; Hideyuki Arima; Yuki Mihara; Hiroki Ushirozako; Yukihiro Matsuyama
    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 27 (6) 1423 - 1431 2018/06 
    PURPOSE: The Neck Disability Index (NDI) is used to evaluate patients with cervical spine disease. However, few reports have defined the cut-off values of the NDI. The purpose of this study was to identify the cut-off values of and factors with a negative impact on NDI. METHODS: A total of 487 volunteers were divided into three groups based on disability: none, mild, and disabled. The cut-off values of the NDI were determined using receiver-operating characteristic curves. After these groups were divided based on sex and age adjustment was performed, the factors with a negative impact on NDI were investigated using multiple logistic regression analysis. RESULTS: Groups none, mild, and disabled included 207, 186, and 94 volunteers, respectively. The cut-off values of the NDI in each group were 0-5, 6-17, and ≥ 18%, respectively. After adjusting for age, groups none, mild, and disabled had 65, 56, and 23 males, respectively, and 92, 103, and 56 females, respectively. In multiple logistic regression analysis, the factors with a negative impact on NDI in males were manual work (odds ratio [OR] 1.924), higher T1 slope minus cervical lordosis (OR 1.043), and higher C2-7 sagittal vertical axis (OR 1.029, P < 0.05). Among females, the factors were hand-grip strength (OR 0.936), body fat percentage (OR 0.942), and sporting activity (OR 0.456, P < 0.05). CONCLUSION: Deterioration in NDI was associated with cervical spinal malalignment and manual labor in males and lack of physical activity and sarcopenia in females. These slides can be retrieved under Electronic Supplementary Material.
  • Bao Nt Nguyen; Hironobu Hoshino; Daisuke Togawa; Yukihiro Matsuyama
    Clinics in orthopedic surgery 10 (2) 149 - 156 2018/06 
    Background: Bone mineral density (BMD) is the indicator of bone quality in at-risk individuals. Along with the fracture risk assessment tool (FRAX), a quick assessment of BMD from routine radiographs may be useful in the case of lacking X-ray absorptiometry data. This study aimed to investigate the correlation of cortical thickness index (CTI) and canal flare index (CFI) with BMD and FRAX and to evaluate their ability to predict femoral neck BMD (nBMD) and FRAX in the general elderly population. Methods: A total of 560 volunteers (age ≥ 50 years) who underwent hip-spine X-ray, BMD scanning and FRAX calculation were retrospectively reviewed. CTI and CFI were measured on anteroposterior radiographs and analyzed for their correlation with BMD and FRAX and for their ability to predict nBMD. The ability of CTI to predict osteoporosis status (OPS) and fracture risk status (FRS) was also investigated and the threshold values were calculated. All the analyses were performed separately on male and female subjects. Results: Significant differences in CTI, CFI, nBMD and FRAX between males and females were observed. CTI and CFI demonstrated significant positive correlation with nBMD and FRAX (all p < 0.001) in both males and females. CTI, height, and weight significantly predicted nBMD. CTI statistically predicted OPS and FRS, and the values of 0.56 and 0.62 were computed as CTI thresholds for males and females, respectively. Conclusions: CTI was significantly correlated with nBMD and it predicted nBMD at good prediction levels. Therefore, CTI may be used as a supportive tool in the assessment of OPS and FRS besides BMD and FRAX in clinical practice.
  • Masao Koda; Hideki Hanaoka; Takatoshi Sato; Yasuhisa Fujii; Michiko Hanawa; Sho Takahashi; Takeo Furuya; Yasushi Ijima; Junya Saito; Mitsuhiro Kitamura; Seiji Ohtori; Yukei Matsumoto; Tetsuya Abe; Kei Watanabe; Toru Hirano; Masayuki Ohashi; Hirokazu Shoji; Tatsuki Mizouchi; Ikuko Takahashi; Norio Kawahara; Masahito Kawaguchi; Yugo Orita; Takeshi Sasamoto; Masahito Yoshioka; Masafumi Fujii; Katsutaka Yonezawa; Daisuke Soma; Hiroshi Taneichi; Daisaku Takeuchi; Satoshi Inami; Hiroshi Moridaira; Haruki Ueda; Futoshi Asano; Yosuke Shibao; Ikuo Aita; Yosuke Takeuchi; Masaya Mimura; Jun Shimbo; Yukio Someya; Sumio Ikenoue; Hiroaki Sameda; Kan Takase; Yoshikazu Ikeda; Fumitake Nakajima; Mitsuhiro Hashimoto; Tomoyuki Ozawa; Fumio Hasue; Takayuki Fujiyoshi; Koshiro Kamiya; Masahiko Watanabe; Hiroyuki Katoh; Yukihiro Matsuyama; Yu Yamamoto; Daisuke Togawa; Tomohiko Hasegawa; Sho Kobayashi; Go Yoshida; Shin Oe; Tomohiro Banno; Hideyuki Arima; Koji Akeda; Eiji Kawamoto; Hiroshi Imai; Toshihiko Sakakibara; Akihiro Sudo; Yasuo Ito; Tsuyoshi Kikuchi; Shuhei Osaki; Nobuhiro Tanaka; Kazuyoshi Nakanishi; Naosuke Kamei; Shinji Kotaka; Hideo Baba; Tsuyoshi Okudaira; Hiroaki Konishi; Takayuki Yamaguchi; Keigo Ito; Yoshito Katayama; Taro Matsumoto; Tomohiro Matsumoto; Masaru Idota; Haruo Kanno; Toshimi Aizawa; Ko Hashimoto; Toshimitsu Eto; Takehiro Sugaya; Michiharu Matsuda; Kazunari Fushimi; Satoshi Nozawa; Chizuo Iwai; Toshihiko Taguchi; Tsukasa Kanchiku; Hidenori Suzuki; Norihiro Nishida; Masahiro Funaba; Masashi Yamazaki
    BMJ open 8 (5) e019083  2018/05 
    INTRODUCTION: Granulocyte colony-stimulating factor (G-CSF) is generally used for neutropaenia. Previous experimental studies revealed that G-CSF promoted neurological recovery after spinal cord injury (SCI). Next, we moved to early phase of clinical trials. In a phase I/IIa trial, no adverse events were observed. Next, we conducted a non-randomised, non-blinded, comparative trial, which suggested the efficacy of G-CSF for promoting neurological recovery. Based on those results, we are now performing a phase III trial. METHODS AND ANALYSIS: The objective of this study is to evaluate the efficacy of G-CSF for acute SCI. The study design is a prospective, multicentre, randomised, double-blinded, placebo-controlled comparative study. The current trial includes cervical SCI (severity of American Spinal Injury Association (ASIA) Impairment Scale B/C) within 48 hours after injury. Patients are randomly assigned to G-CSF and placebo groups. The G-CSF group is administered 400 µg/m2/day×5 days of G-CSF in normal saline via intravenous infusion for 5 consecutive days. The placebo group is similarly administered a placebo. Our primary endpoint is changes in ASIA motor scores from baseline to 3 months. Each group includes 44 patients (88 total patients). ETHICS AND DISSEMINATION: The study will be conducted according to the principles of the World Medical Association Declaration of Helsinki and in accordance with the Japanese Medical Research Involving Human Subjects Act and other guidelines, regulations and Acts. Results of the clinical study will be submitted to the head of the respective clinical study site as a report after conclusion of the clinical study by the sponsor-investigator. Even if the results are not favourable despite conducting the clinical study properly, the data will be published as a paper. TRIAL REGISTRATION NUMBER: UMIN000018752.
  • Go Yoshida; Tomohiko Hasegawa; Yu Yamato; Sho Kobayashi; Shin Oe; Tomohiro Banno; Yuuki Mihara; Hideyuki Arima; Hiroki Ushirozako; Tatsuya Yasuda; Daisuke Togawa; Yukihiro Matsuyama
    Spine 43 (8) 562 - 570 2018/04 
    STUDY DESIGN: A retrospective database study. OBJECTIVE: The aim of this study was to develop and validate a sliding scale for predicting perioperative complications associated with adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA: ASD surgery can have high perioperative complication rates, which is associated with increased morbidity and mortality. METHODS: Data on consecutive ASD patients undergoing posterior corrective surgery over a 6-year interval were collected from a prospective database. The patients' preoperative general condition, surgical status, and perioperative complications occurring within 30 days of surgery were analyzed and independent predictors were determined using multivariable logistic regression analysis. We made the sliding scale using cut-off values from receiver operating curve analysis and validated the performance of this model. RESULTS: Three hundred four patients were included with a mean age of 62.9 years. One hundred eight patients (35.5%) were affected by at least one perioperative complication with a total of 195 perioperative complications, including neurological (12.8%), excessive blood loss (11.2%), delirium (11.2%), and infection (3.6%). Total independent predictors were age [odds ratio (OR): 1.042], operation time (OPT) (OR: 2.015), and estimated blood loss (EBL) (OR: 4.885) with cut-off values of approximately 70 years, 6 hours, and 2000 mL, respectively. Fusion of ≥10 segments (OR: 2.262), three-column osteotomy (OR: 1.860), current use of antihypertensive (OR: 2.595) and anticoagulant (OR: 7.013), and body mass index (OR: 1.160) were risk factors for neurological complications, infection, and deep vein thrombosis/pulmonary thrombosis. Our proposed sliding scale had a sensitivity of 91%, specificity of 58.1%, and the incidence of perioperative complication in the validation dataset was smaller than that without this scale (P ≤ 0.05). CONCLUSION: Patients' age, current medication, and degenerative pathology might be independent preoperative as well as operative predictors. An age and comorbidities based sliding scale with classifications of OPT and EBL may be useful for risk prediction in ASD surgery. LEVEL OF EVIDENCE: 3.
  • バンノ トモヒロ; ハセガワ トモヒコ; ヤマト ユウ; コバヤシ ショウ; トガワ ダイスケ; オオエ シン; マツヤマ ユキヒロ
    Journal of Spine Research (一社)日本脊椎脊髄病学会 9 (4) 858 - 861 1884-7137 2018/04 
    矢状面アライメント不良を呈する成人脊柱変形手術患者34例(男性5例、女性29例、平均年齢71歳)を対象に、術前腰椎MRIを用いて脊柱起立筋、多裂筋の断面積を計測した。術後2年間でTPA変化量≦5°をG群(18例)、>5°をP群(16例)として比較検討した。P群で有意に脊柱起立筋、多裂筋断面積が小さかった(p<0.05)。術前の背筋量が術後矢状面アライメントの維持に影響することが示唆された。(著者抄録)
  • Tomohiro Banno; Tomohiko Hasegawa; Yu Yamato; Sho Kobayashi; Daisuke Togawa; Go Yoshida; Tatsuya Yasuda; Shin Oe; Yuki Mihara; Hiroki Ushirozako; Yukihiro Matsuyama
    Spine 43 (4) 262 - 269 2018/02 
    STUDY DESIGN: Retrospective study. OBJECTIVE: To determine the prevalence of loss in fixed segment alignment after surgical correction of adult spinal deformity (ASD) and identify associated risk factors. SUMMARY OF BACKGROUND DATA: Altered fixed segment alignment influences global spinal alignment; however, associated risk factors have not been determined. METHODS: Data of 63 patients with ASD (55 females; mean age, 68.0 yrs), who underwent corrective fusion from the lower thoracic spine to the pelvis and completed the 2-year follow up, were retrospectively analyzed. Change in alignment early postoperatively and at 2 years postoperatively was evaluated using the fixed segmental angle (FSA) and fixed vertebral angle (FVA). The predictive value of the following parameters was evaluated: age, sex, body mass index (BMI), high grade osteotomy, rod material, screw loosening, spinopelvic parameters [T1 pelvic angle (TPA), sagittal vertical axis (SVA), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), and proximal junctional kyphosis (PJA), and Oswestry Disability Index (ODI) scores]. RESULTS: Change of 2.4° in FSA and -3.1° in FVA were identified 2 years postoperatively, with higher intrarater and interrater reliability for FSA. Based on minimal detectable change in FSA, patients were classified into two groups: (+) loss (ΔFSA >3°) and (-) loss (ΔFSA ≤3°). Correction loss occurred in 17 patients; these patients had a greater BMI, higher rate of high-grade osteotomies, commercially pure titanium (CP) rods implanted, screw loosening, higher preoperative and postoperative TPA, and higher TPA, SVA, and PT after 2 years, than patients without correction loss. CONCLUSION: The loss of sagittal fixed segment alignment was relatively high at 27%. Greater BMI, high-grade osteotomies, CP rod use, and sagittal malalignment were associated with correction loss after ASD surgery. LEVEL OF EVIDENCE: 4.
  • 術中神経根障害に対する脊髄モニタリング(Br(E)-MsEP)の有用性
    後迫 宏紀; 小林 祥; 長谷川 智彦; 大和 雄; 吉田 剛; 戸川 大輔; 安田 達也; 坂野 友啓; 三原 唯暉; 大江 慎; 松山 幸弘
    脊髄機能診断学 エーザイ(株) 38 (1) 146 - 149 2018/02
  • Shin Oe; Daisuke Togawa; Go Yoshida; Tomohiko Hasegawa; Yu Yamato; Tatsuya Yasuda; Tomohiro Banno; Hideyuki Arima; Yuki Mihara; Hiroki Ushirozako; Yukihiro Matsuyama
    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 27 (2) 442 - 447 2018/02 
    PURPOSE: The line of sight when whole-spine radiographs are taken has not been defined. In our 2012 health screening study (TOEI study), whole-spine radiographs were taken with the volunteers in the most relaxed position and with a horizontal gaze. However, in the TOEI 2014 study, a mirror was placed in front of their faces to unify their line of sight. To our knowledge, there are no reports on how the sagittal alignment changes when radiographs are taken using a mirror. The purpose of this study was to investigate how mirror placement impacted sagittal spinal alignment in whole-spine radiographs taken while standing. METHODS: Volunteers who participated in both the TOEI 2012 and 2014 studies were recruited. Pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), cervical lordosis (CL), slope of McGregor's line (McGS), and C7 sagittal vertical axis (C7 SVA) were examined using software. RESULTS: Three hundred fifty-four volunteers (142 males, 212 females, average age in 2012: 72 years) whose radiographs were evaluated in both previous studies were enrolled. The average parameters of 2012 and 2014 were: PT: 18° and 21° (P < 0.01), LL: 40° and 40°, TK: 34° and 34°, CL: 13° and 23° (P < 0.01), McGS: 2° ± 11° and - 9° ± 8° (P < 0.01), and C7 SVA: 46 and 23 mm (P < 0.01), respectively. In the Levene test, the McGS variation in 2014 [95% confidence interval (CI) 0.9-3.4] was significantly smaller than that in 2012 (95% CI - 9.7 to - 8.0, P < 0.01). CONCLUSION: The smaller McGS variation in the TOEI 2014 study suggested that mirror placement could standardize the head's position. These results showed that the mirror placement retroflexed cervical alignment and caused the head to lean backward. It is important that a mirror is placed to unify the line of sight.
  • TOGAWA Daisuke
    The Central Japan Journal of Orthopaedic Surgery & Traumatology THE CENTRAL JAPAN ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 61 (1) 173 - 174 0008-9443 2018/01 
    高齢運動器検診者において、運動習慣の有無が運動能力、健康関連quality of life(QOL)に与える影響を、4年間の縦断研究によって検討した。健康診断問診票調査に基づく運動習慣あり群45名、運動習慣なし群159名を対象とした。運動能力に関して、運動習慣あり群と運動習慣なし群との間に有意差は認めなかった。2012年健康関連QOLのベースラインは運動習慣あり群で有意に良好であった。また、2016年に調査した健康関連QOLに関して、全体および男性で統計学的有意差を認め、運動習慣がない群では4年の間に健康関連QOLが悪化したのに比較して、運動習慣のある群ではQOLが維持されていた。3年以上の運動習慣があると4年間で健康関連QOLに明らかな差が出ることが示され、ロコモティブシンドロームの予防のために運動習慣をもつことが重要であることが明らかとなった。
  • Hideyuki Arima; Leah Y Carreon; Steven D Glassman; Yu Yamato; Tomohiko Hasegawa; Daisuke Togawa; Sho Kobayashi; Go Yoshida; Tatsuya Yasuda; Tomohiro Banno; Shin Oe; Yuki Mihara; Yukihiro Matsuyama
    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 23 (1) 20 - 25 2018/01 
    BACKGROUND: The Scoliosis Research Society-22r (SRS-22r) has been shown to be reliable, valid and responsive to change in patients with adult spinal deformity (ASD) undergoing surgery. The minimum clinically important difference (MCID) quantifies a threshold value of improvement that is clinically relevant to the patient. Health-related quality of life scores depend on age. The purpose of this study was to assess MCID threshold values stratified by age for SRS-22r domains in patients with ASD undergoing surgical correction. METHODS: We identified a consecutive series of 184 Japanese ASD patients who completed the SRS-22r and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) preoperatively and 1 year postoperatively. Effectiveness as measured on the JOABPEQ was used as the anchor to determine MCID for the Function, Pain, and Mental health domains using receiver-operating-characteristic (ROC) curve analysis. We performed MCID analysis stratified by age (<70 or ≥70). RESULTS: Mean preoperative SRS-22r Function score was 2.69 improving to 3.23 at postoperatively (p < 0.001). Mean preoperative SRS-22r Pain score was 3.04 improving to 3.78 at postoperatively (p < 0.001). Mean preoperative SRS-22r Mental health score was 2.72 improving to 3.25 at postoperatively (p < 0.001). There was a statistically difference in change in domain score between "not effective" and "effective" (p < 0.001). The ROC curve analysis methods yielded MCID values of 0.58 for Function, 0.55 for Pain, and 0.70 for Mental health domains. There was difference of MCID value for Function and Mental health domain between aged <70 and ≥70; 0.78 and 0.55 for Function; 0.70 and 0.48 for Mental health. CONCLUSION: Results of this study showed that MCID threshold values for SRS-22 Function and Mental health domains in older than 70 was lower than in younger than 70, potentially implying that older patients have lower expectation.
  • トガワ ダイスケ; フルハシ ヒロキ; コヤマ ヒロシ; マツヤマ ユキヒロ
    整形外科最小侵襲手術ジャーナル (株)全日本病院出版会 (85) 20 - 26 1342-3991 2017/12 
    人工股関節置換術後に骨盤アライメントが変化すると、人工股関節の脱臼が発生するリスクが増大することが報告されている。特に女性では、男性と比較して加齢による腰椎前彎減少、骨盤後傾が起こりやすい。そのため、カップ前捻が過度に大きいとTHA術後経過観察中に骨頭とカップとの関係性に変化をもたらし、前方脱臼を発生する可能性が高まる。また近年、成人脊柱変形に対する広範囲脊柱骨盤矯正固定術が一般的に行われるようになってきた。特に高齢者では脊椎から骨盤までの固定術が行われる際、骨盤後傾を前傾方向に矯正することが健康関連QOL改善のために重要であるとされている。このことにより、人工股関節の既往のある患者では、カップ傾斜が後捻し、ネックとカップ前方のインピンジメントが起こりやすくなり、後方脱臼のリスクが増大する。本稿では、人工股関節置換術の既往のある成人脊柱変形患者に行った脊柱骨盤矯正固定術後、人工股関節の脱臼を繰り返した症例を紹介しつつ、その脱臼機序と予防対策について考察する。(著者抄録)
  • Hideyuki Arima; Yoshiji Suzuki; Daisuke Togawa; Yuki Mihara; Hideyuki Murata; Yukihiro Matsuyama
    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 26 (12) 3122 - 3128 2017/12 
    PURPOSE: This study aimed to investigate the treatment effects of low-intensity pulsed ultrasound (LIPUS) on progressive-stage spondylolysis. Spondylolysis is a stress fracture of the pars interarticularis. Based on the results of computed tomography, spondylolysis was classified into three categories: early, progressive, and terminal. Bone healing was prolonged or not obtained in progressive-stage spondylolysis. The progression of spondylolysis to nonunion has been associated with an increased incidence of spondylolisthesis. To prevent these clinical conditions, achieving bony healing of the spondylolysis site should be the goal of treatment. METHODS: 15 consecutive pediatric patients with progressive-stage spondylolysis (defects) with MRI high-signal change were analyzed. Nine patients were treated conservative treatment including avoidance of any sport activity and the use of a brace during treatment (conventional). Six patients were treated using LIPUS everyday during treatment in addition to conservative treatment. Approximately every 1.5 months, bone healing was evaluated via CT. Cases that retained defects after 4.5 months were defined as nonunion. RESULTS: Two patients dropped out during the study period. A total of 13 patients (mean 14.6 ± 2.5 years) from the database met with 19 interarticularis defects. The bone union rate in LIPUS group was significantly higher than that in conventional group (66.7 vs. 10.0%, p = 0.020). The treatment period to bone union was 3.8 months and 2.7 ± 0.3 months in conventional and LIPUS groups. CONCLUSIONS: This study revealed that LIPUS treatment might be effective for bone union in patients with progressive-stage spondylolysis with MRI high-signal change. LEVEL OF EVIDENCE: 4.
  • Shin Oe; Daisuke Togawa; Go Yoshida; Tomohiko Hasegawa; Yu Yamato; Sho Kobayashi; Tatsuya Yasuda; Tomohiro Banno; Yuki Mihara; Yukihiro Matsuyama
    Asian spine journal 11 (6) 959 - 967 2017/12 
    Study Design: Large cohort study. Purpose: To clarify spinal sagittal alignment and health-related quality of life (HRQOL) according to sex in volunteers aged >50 years with cervical deformity (CD). Overview of Literature: Adult spinal deformities, especially those associated with lumbosacral lesions, are more frequent in females; however, CD is observed to a greater extent in males. Methods: We divided 656 volunteers (263 males, 393 females; age, 50-89 years [mean, 73 years]) as follows: males with CD (CDM; 82 patients); males without CD (NCDM, 181); females with CD (CDF, 36); and females without CD (NCDF, 357). CD was defined as C2-7 sagittal vertical axis (SVA) ≥40 mm. We measured pelvic tilt (PT), pelvic incidence minus lumbar lordosis (PI-LL), thoracic kyphosis, T1 slope, cervical lordosis, C7 SVA, and C2-7 SVA. HRQOL was evaluated using EuroQOL five dimensions questionnaire (EQ-5D). Results: In CDM, NCDM, CDF, and NCDF groups, the respective parameters were as follows: PT: 15°, 14°, 26°, and 21°; PI-LL: 7°, 5°, 16°, and 10°; C2-7 SVA: 49, 24, 46, and 20 mm; C7 SVA: 61, 40, 75, and 47 mm; and EQ-5D: 0.82, 0.88, 0.78, and 0.81. PT and PI-LL were significantly greater in the CDF group than in the NCDF group (p<0.05) but were not significantly different between CDM and NCDM groups. The CDF group already showed deterioration of spinopelvic alignment, although it was maintained in the CDM group. EQ-5D in showed significantly greater deterioration the CDM group than in the NCDM group; deterioration of lumbopelvic parameters had less influence in males (p<0.05). Conclusions: Sagittal spinal deformity may have different mechanisms in males and females. The deterioration of spinal sagittal alignment in males may originate from the cervical spine, and CD may be associated with HRQOL.
  • ヤスダ タツヤ; ハセガワ トモヒコ; ヤマト ユウ; コバヤシ ショウ; トガワ ダイスケ; オオエ シン; マツヤマ ユキヒロ
    Journal of Spine Research (一社)日本脊椎脊髄病学会 8 (10) 1646 - 1649 1884-7137 2017/10 
    成人脊柱変形手術で上位固定端をT9もしくはT10とし下位固定端を腸骨とした矯正固定術において、十分な腰椎前彎が獲得できた症例での術前後胸椎の変化を調査した。術後胸椎変化は術前胸椎後彎角と負の相関があり、30〜40°付近に収束していく傾向があった。術後胸椎後彎はpelvic incidenceと負の相関があったが、カーブの変曲点の影響が考えられた。(著者抄録)
  • 大江 慎; 戸川 大輔; 長谷川 智彦; 大和 雄; 吉田 剛; 坂野 友啓; 有馬 秀幸; 安田 達也; 松山 幸弘
    別冊整形外科 (株)南江堂 1 (72) 111 - 114 0287-1645 2017/10 
    2016年の住民健診で立位単純全脊椎X線像を評価した489例(男184例、女305例、平均年齢74.2歳)を対象に、成人脊椎変形(ASD)と頸椎アライメント異常(CD)の有病率を調査した。ASD(-)CD(-)は169例(35%)、ASD(+)CD(-)は242例(49%)、ASD(-)CD(+)は25例(5%)、ASD(+)CD(+)は53例(11%)であった。ASD(-)CD(-)は75歳未満では125例(55%)であったが75歳以上では44例(17%)であった。一方、ASD(+)CD(+)は75歳未満では14例(6%)であったが75歳以上では39例(15%)であり、75歳以上は有意に有病率が高かった。ASD(-)CD(-)は75歳未満では男23%、女13%で、両方アライメント異常を持つ可能性は男性で有意に低く、ASD(+)CD(-)は75以上・75歳未満ともに有病率は女性が有意に高かった。両アライメント異常を合併した場合、どちらの治療を優先するかは保存的治療効果により判断可能であると考えられた。
  • Hideyuki Arima; Yu Yamato; Tomohiko Hasegawa; Sho Kobayashi; Go Yoshida; Tatsuya Yasuda; Tomohiro Banno; Shin Oe; Yuki Mihara; Daisuke Togawa; Yukihiro Matsuyama
    Spine 42 (19) 1456 - 1463 2017/10 
    STUDY DESIGN: Longitudinal cohort. OBJECTIVE: The present study aimed to document changes in posture and lower extremity kinematics during gait in patients with adult spinal deformity (ASD) after extensive corrective surgery. SUMMARY OF BACKGROUND DATA: Standing radiographic parameters are typically used to evaluate patients with ASD. Previously, preoperative walking and standing posture discrepancy were reported in patients with ASD. We did not include comparison between before and after surgery. Therefore, we thought that pre- and postoperative evaluations for patients with ASD should include gait analysis. METHODS: Thirty-nine patients with ASD (5 men, 34 women; mean age, 71.0 ± 6.1) who underwent posterior corrective fixation surgeries from the thoracic spine to the pelvis were included. A 4-m walk was recorded and analyzed. Sagittal balance while walking was calculated as the angle between the plumb line on the side and the line connecting the greater trochanter and pinna while walking (i.e., the gait-trunk tilt angle [GTA]). We measured maximum knee extension angle during one gait cycle, step length (cm), and walking speed (m/min). Radiographic parameters were also measured. RESULTS: The mean GTA and the mean maximum knee extension angle significantly improved from 13.4° to 6.4°, and -13.3° to -9.4°(P < 0.001 and P = 0.006), respectively. The mean step length improved from 40.4 to 43.1 cm (P = 0.049), but there was no significant change in walking speed (38.4 to 41.5 m/min, P = 0.105). Postoperative GTA, maximum knee extension angle and step length correlated with postoperative pelvic incidence minus lumbar lordosis (r = 0.324, P = 0.044; r = -0.317, P = 0.049; r = -0.416, P = 0.008, respectively). CONCLUSION: Our results suggest that postoperative posture, maximum knee extension angle, and step length during gait in patients with ASD improved corresponding to how much correction of the sagittal spinal deformity was achieved. LEVEL OF EVIDENCE: 3.
  • オオエ シン; ヤマト ユウ; トガワ ダイスケ; ハセガワ トモヒコ; ヨシダ ゴウ; コバヤシ ショウ; ヤスダ タツヤ; クロス ケンタ; マツヤマ ユキヒロ
    Journal of Spine Research (一社)日本脊椎脊髄病学会 8 (9) 1448 - 1454 1884-7137 2017/09 
    成人脊柱変形患者88例の術後2年時の手術成績をT1 slope 40°以上の群と40°未満の群に分けて評価した。T1 slope 40°以上の症例におけるC7 Sagittal vertical axisは術直後には良好に矯正されるが、2年の経過で次第に矯正損失を起こした。これは非固定椎である頸胸椎アライメントの悪化が原因と考えられた。(著者抄録)
  • コバヤシ ショウ; ハセガワ トモヒコ; ヤマト ユウ; トガワ ダイスケ; オオエ シン; バンノ トモヒロ; クロス ケンタ; ヨシダ ゴウ; マツヤマ ユキヒロ
    Journal of Spine Research (一社)日本脊椎脊髄病学会 8 (9) 1472 - 1476 1884-7137 2017/09 
    成人の脊柱アライメント研究では、脊柱骨盤矢状面アライメントが健康関連QOLや運動機能障害によく相関することが知られている。さらに腰背部痛も矢状面アライメントに関連するとされる。一般的に高齢者は腰背部痛の頻度が高いとされるが、なかには疼痛のまったくない例もある。そのような疼痛を訴えない高齢者を含めた脊柱変形の疫学研究では、腰背部痛とは無関係に、運動機能障害が高率に発生していた。高齢者の脊柱変形例におけるロコモティブシンドロームの重症化過程においても運動機能低下と疼痛の訴えに有意な関連はなかった。(著者抄録)
  • トガワ ダイスケ; ハセガワ トモヒコ; ヤマト ユウ; コバヤシ ショウ; バンノ トモヒロ; オオエ シン; クロス ケンタ; マツヤマ ユキヒロ
    Journal of Spine Research (一社)日本脊椎脊髄病学会 8 (9) 1488 - 1492 1884-7137 2017/09 
    どのような全脊柱アライメント異常があるときに、どの高位に腰椎後方すべりが発生するのか、またどのようにHRQOLへ関与するのかを50歳以上を対象とした運動器検診で調査した。腰椎後方すべりは検診者の41%で発生し、PIが小さい例で起こりやすく、84%が脊柱後彎の下位終椎もしくはその下位隣接椎体に発生していた。腰椎後方すべり例は脊柱が後彎、前傾する傾向があり、下位発生例ほど腰椎前彎が減少する傾向があった。(著者抄録)
  • Tomohiro Banno; Tomohiko Hasegawa; Yu Yamato; Sho Kobayashi; Daisuke Togawa; Shin Oe; Yuki Mihara; Yukihiro Matsuyama
    Spine 42 (17) E1024-E1030  2017/09 
    STUDY DESIGN: A retrospective study. OBJECTIVE: We investigated the prevalence of iliac screw loosening and determined risk factors after adult spinal deformity surgery. SUMMARY OF BACKGROUND DATA: Lumbosacral fixation is crucial to maintain optimal sagittal alignment. Iliac screws are commonly placed to provide protection for sacral pedicle screws. Radiolucent areas around the screws indicate fixation loss and pseudarthrosis. METHODS: Seventy-two patients with adult spinal deformity (13 men, 59 women; mean age, 69.0 yr) who underwent spinal deformity surgeries using bilateral iliac screws with at least 2 years follow-up were studied. Iliac and S1 screw loosening were assessed by postoperative radiograph. The period of loosening appearance and the relations between loosening and the following items were investigated: (1) upper instrumented vertebra, (2) L5/S interbody fusion, (3) iliac screw placement, (4) spinopelvic parameters (T1 pelvic angle, sagittal vertical axis, pelvic tilt, pelvic incidence-lumbar lordosis [LL]). Oswestry Disability Index scores were obtained preoperatively and 2 years postoperatively. RESULTS: Iliac and S1 screw loosening was found in 20 (27.8%) and 7 patients (9.7%), respectively. Iliac screw loosening appeared at 5.2 months (range, 3-12) on average. Compared with nonloosening, loosening had significantly higher upper thoracic fusion rates (above T6), lower L5/S interbody fusion rate, higher misplacement rate, and higher insufficient correction rate (PI-LL >10°). Oswestry Disability Index significantly improved in nonloosening, whereas no significant difference was observed in loosening. Multiple regression analysis showed that misplacement (odds ratio = 10.8) and insufficient correction (odds ratio = 7.5) affected loosening. CONCLUSION: Iliac screw loosening indicated instability of the lumbosacral junction, resulting in sagittal malalignment and poor outcomes. Accurate screw insertion and restoration of optimal LL were necessary to prevent complications. LEVEL OF EVIDENCE: 4.
  • Ryo Kondo; Yu Yamato; Tetsuyuki Nagafusa; Takashi Mizushima; Tomohiko Hasegawa; Sho Kobayashi; Daisuke Togawa; Shin Oe; Kenta Kurosu; Yukihiro Matsuyama
    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 26 (8) 2138 - 2145 2017/08 
    PURPOSE: To identify the effects of corrective long spinal fusion to the ilium on physical function in patients with adult spinal deformity (ASD). METHODS: Thirty patients who underwent corrective long spinal fusion to the ilium were prospectively analysed. Patients were divided into the ++ group [sagittal vertical axis (SVA) ≥ 95 mm and pelvic tilt (PT) ≥ 30°, 14 patients] and 0+ group (SVA <95 mm or PT <30°, 16 patients). Subjects' low back pain [visual analogue scale (VAS) (pain with motion)], muscle strength (knee extensors and hip flexors), balance [timed up and go (TUG)], gait performance [10-metre walking test (10MWT, maximum speed), and 6-minute walk test (6MWT)] were assessed before surgery, at discharge, and 6 and 12 months after the surgery. RESULTS: All study patients had a significant improvement in the VAS score between baseline and at discharge, 6 months postoperatively, and 12 months postoperatively. The values of the TUG and 6MWT significantly improved 12 months postoperatively. The values of the TUG, 10MWT, and 6MWT improved significantly more in the ++ group than in the 0+ group at 12 months. CONCLUSION: Corrective long spinal fusion contributed to improving back pain at discharge and gait ability at 12 months in patients with ASD.
  • Tomohiro Banno; Yu Yamato; Tomohiko Hasegawa; Sho Kobayashi; Daisuke Togawa; Shin Oe; Yuki Mihara; Kenta Kurosu; Naoto Yamamoto; Yukihiro Matsuyama
    Clinical spine surgery 30 (7) E968-E973  2017/08 
    STUDY DESIGN: This is a case-control study. OBJECTIVE: The present study aimed to compare the cross-sectional areas of the psoas major and multifidus muscles between elderly patients with adult spinal deformity (ASD) and age-matched and body weight-matched controls, and to evaluate the associations between the cross-sectional areas of these muscles and the severity of spinal deformity. SUMMARY OF BACKGROUND DATA: The study included 49 female kyphosis patients with mild scoliosis (Cobb angle <20 degrees; mean age, 70.9 y, group D). The control group (group C) included age-matched and body weight-matched female patients who underwent abdominal surgery (n=98; mean age, 71.7 y). MATERIALS AND METHODS: The cross-sectional areas of the bilateral psoas majors and multifidus muscles were calculated using preoperative L4/L5 axial computed tomography images. In group D, the following spinopelvic parameters were assessed: sagittal vertical axis, pelvic tilt, pelvic incidence, lumbar lordosis, and thoracic kyphosis. The relationships between the muscle cross-sectional areas and spinopelvic parameters were evaluated. RESULTS: The cross-sectional area of the multifidus muscle was lower in group D than in group C. However, the cross-sectional area of the psoas major muscle was not different between the 2 groups. In multiple regression analysis, the cross-sectional area of the multifidus muscle was significantly associated with all spinopelvic parameters. CONCLUSIONS: The cross-sectional area of the multifidus muscle might be lower in elderly patients with ASD than in controls. In the elderly population, the severity of sagittal spinal deformity might be correlated with the cross-sectional area of the multifidus muscle. Therefore, muscle imbalances between the flexors and extensors of the spine could participate in the pathology of ASD.
  • オオエ シン; トガワ ダイスケ; ヤマト ユウ; ハセガワ トモヒコ; ヨシダ ゴウ; コバヤシ ショウ; ヤスダ タツヤ; マツヤマ ユキヒロ
    Journal of Spine Research (一社)日本脊椎脊髄病学会 8 (6) 1122 - 1126 1884-7137 2017/06 
    住民検診に参加した416例を非高齢者、前期高齢者、後期高齢者に分け健康関連と骨密度を男女別に調査した。骨密度と健康関連QOL悪化の年代には男女差が認められた。これらの対策は男性では少なくとも前期高齢者から、女性は非高齢者(特に50歳代)から行うべきである。(著者抄録)
  • Tatsuya Yasuda; Tomohiko Hasegawa; Yu Yamato; Sho Kobayashi; Daisuke Togawa; Shin Oe; Yukihiro Matsuyama
    Journal of spine surgery (Hong Kong) 3 (2) 204 - 211 2017/06 
    BACKGROUND: Proximal junctional kyphosis (PJK) is a common complication after corrective long spinal fusion for adult spinal deformity. Although some reports evaluated PJK after corrective long spinal fusion, there is no report about analysis of PJK cases in the same fusion area. The purpose of this study to investigated the incidence of and risk factors for PJK in adults undergoing long spinal fusion from the distal thoracic vertebrae (T9/T10) to the ilium. METHODS: We enrolled 56 adult patients (>40 years of age) who underwent posterior corrective surgery with same fusion area from T9 or T10 to the ilium for spinal deformity. Pre- and postoperative radiographic measurements included the sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), and pelvic incidence minus LL (PI-LL). The Oswestry disability index (ODI) was used to evaluate patient outcomes preoperatively and one year after surgery. We analyzed the incidence for PJK and compared PJK and non-PJK cases. RESULTS: PJK at the final follow-up occurred in 19 of 56 (33.9%) patients. The mean age and ODI were not significantly different between the PJK and non-PJK groups. Both two groups had good spinopelvic sagittal alignment after surgery in terms of SVA and PI-LL. Only three cases required revision surgery for symptomatic PJK. Three cases had history of rheumatoid arthritis and/or total hip arthroplasty surgery. CONCLUSIONS: The incidence of PJK was 33.9%, and ODI was not significantly different between the PJK and non-PJK groups. Symptomatic PJK was only three cases and all of them had lower extremity joint disorders. We should pay attention also lower extremity joint to prevent symptomatic PJK at the lower thoracic level.
  • コバヤシ ショウ; ハセガワ トモヒコ; ヤマト ユウ; トガワ ダイスケ; オオエ シン; バンノ トモヒロ; クロス ケンタ; ヨシダ ゴウ; マツヤマ ユキヒロ
    Journal of Spine Research (一社)日本脊椎脊髄病学会 8 (5) 1080 - 1086 1884-7137 2017/05 
    成人脊柱変形に対する矯正骨切り手術が発展し、良好なアライメントの獲得が可能となった。一方で局所の強い矯正により、神経合併症の発生が危惧される。どの程度の矯正量が神経合併症をきたすか、過去の報告から脊柱骨切り手術の矯正量と術後の神経脱落所見との関係を調査した。成人脊柱変形に対する脊柱骨切り症例の神経合併症率は10〜22%であり、特に1椎間当たりの12mm以上の短縮、55度以上の局所後彎矯正を行った場合には、神経合併症の頻度が高かった。成人脊柱変形骨切り手術において過大な矢状面矯正は、神経合併症リスクが高くなることを示した。(著者抄録)
  • Hiroki Furuhashi; Daisuke Togawa; Hiroshi Koyama; Hironobu Hoshino; Tatsuya Yasuda; Yukihiro Matsuyama
    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 26 (Suppl 1) 100 - 106 2017/05 
    PURPOSE: Several reports have indicated that anterior dislocation of total hip arthroplasty (THA) can be caused by spinal degenerative changes with excessive pelvic retroversion. However, no reports have indicated that posterior dislocation can be caused by fixed pelvic anteversion after corrective spine surgery. We describe a rare case experiencing repeated posterior THA dislocation that occurred at 5 months after corrective spinal long fusion with pelvic fixation. METHODS: A 64-year-old woman had undergone bilateral THA at 13 years before presenting to our institution. She had been diagnosed with kyphoscoliosis and underwent three subsequent spinal surgeries after the THA. We finally performed spinal corrective long fusion from T5 to ilium with pelvic fixation (with iliac screws). Five months later, she experienced severe hip pain when she tried to stand up from the toilet, and was unable to move, due to posterior THA dislocation. Therefore, we performed closed reduction under sedation, and her left hip was easily reduced. After the reduction, she started to walk with a hip abduction brace. However, she had experienced 5 subsequent dislocations. RESULTS: Based on our findings and previous reports, we have hypothesized that posterior dislocation could be occurred after spinal corrective long fusion with pelvic fixation due to three mechanisms: (1) a change in the THA cup alignment before and after spinal corrective long fusion surgery, (2) decreased and fixed pelvic posterior tilt in the sitting position, or (3) the trunk's forward tilting during standing-up motion after spinopelvic fixation. CONCLUSIONS: Spinal long fusion with pelvic fixation could be a risk factor for posterior THA dislocation.
  • Tomohiro Banno; Tsuyoshi Ohishi; Tomohiko Hasegawa; Yu Yamato; Sho Kobayashi; Daisuke Togawa; Tatsuya Yasuda; Yukihiro Matsuyama
    Clinical spine surgery 30 (4) E407-E411  2017/05 
    STUDY DESIGN: Retrospective study. OBJECTIVE: To investigate the accuracy of freehand iliac screw insertion and to determine how this can be performed safely. BACKGROUND AND METHODS: Seventy-seven adult scoliosis patients with an average age of 70.1 years who underwent spinal deformity surgery with spinopelvic fixation using bilateral iliac screws were enrolled. Penetration of the iliac table was assessed using postoperative computed tomography. Screw penetration of the iliac table or screw insertion from the sacroiliac joint was considered misplacement. Screw positioning was classified as the screw being in the proper position (group C), the screw penetrating the outer table (group O), and the screw penetrating the inner table (group I). The iliac opening angle and the distance between the posterior superior iliac spines (PSISs) were measured using preoperative computed tomography. The angle between the sacral slope and the iliac screw, termed as the sagittal screw angle, was measured using postoperative lateral lumbar radiography. RESULTS: Of the 154 iliac screws in 77 patients, 14 screws in 12 patients penetrated the outer table and 12 screws in 11 patients penetrated the inner table. The total proportion of misplacement was 18.8%, although there were no major complications. With regard to iliac morphology, the iliac opening angle was 24.2±4.3 degrees and the distance between the PSISs was 90.6±7.7 mm. The distance between the PSISs correlated negatively with the iliac opening angle. The iliac opening angle was smaller in group O than in group C (P<0.05). The sagittal screw angle in group I was smaller than that in group C (P<0.01). CONCLUSIONS: Screw penetration of the outer iliac table possibly occurred in patients with a narrow iliac opening angle. Screw penetration of the inner table occurred when the screw was inserted more cranially than the sacral slope. Therefore, the iliac screw should be inserted approximately parallel to the sacral slope.
  • 大江 慎; 戸川 大輔; 長谷川 智彦; 大和 雄; 小林 祥; 松山 幸弘
    脊椎脊髄ジャーナル (株)三輪書店 30 (4) 271 - 276 0914-4412 2017/04
  • バンノ トモヒロ; ハセガワ トモヒコ; ヤマト ユウ; コバヤシ ショウ; トガワ ダイスケ; オオエ シン; マツヤマ ユキヒロ
    Journal of Spine Research (一社)日本脊椎脊髄病学会 8 (4) 984 - 988 1884-7137 2017/04 
    成人脊柱変形患者52名(男性6名、女性46名、平均年齢70.0歳)を対象に、術前立位・臥位全脊柱X線像から、ΔTPAを計測した。術前、術直後、1年時のTPA、SVA、PT、PI-LL、TK、術前および1年時のODI、SRS-22を調査した。ΔTPAは1年時のPTと相関した。一方で、術直後のパラメータやODI、SRS-22との相関はみられなかった。また、ΔTPAはTPA、PTの術後変化量と相関を認めた。体位によるアライメント変化を評価することは術後予後予測に有用と考えられた。(著者抄録)
  • 亜急性期の重度の自律神経障害管理に難渋した脊髄損傷患者の1例
    黒須 健太; 長谷川 智彦; 吉田 剛; 安田 達也; 戸川 大輔; 大和 雄; 小林 祥; 大江 慎; 松山 幸弘
    東海脊椎外科 東海脊椎脊髄病研究会 31 19 - 21 0913-476X 2017/04 
    29歳男性。飲酒後、体動困難となっているところを発見され、当院へ救急搬送となった。単純X線、CT、MRI所見より、C5、C6椎体骨折を伴うC5頸髄損傷(Frankel A)と診断され、頸椎後方固定術を施行した。術後7日目より離床訓練を開始したが、頭位上昇により著明な低血圧を生じた。その後も自立神経障害による起立性低血圧のため離床に難渋したが、ミドドリンの内服や理学療法により術後3ヵ月で、1日40分程度の座位が可能となった。
  • 成人脊柱変形矯正手術により大動脈弁下狭窄が消失した1例
    三原 唯暉; 長谷川 智彦; 大和 雄; 戸川 大輔; 吉田 剛; 小林 祥; 坂野 友啓; 大江 慎; 黒須 健太; 松山 幸弘; 齊藤 岳児
    東海脊椎外科 東海脊椎脊髄病研究会 31 31 - 35 0913-476X 2017/04 
    68歳男性。背部痛を主訴に近医を受診、精査の結果、第9胸椎椎体骨折と診断された。保存的加療を受けるも脊柱後彎変形が進行し、背部痛も遷延したため当科へ紹介となった。既往歴に第12胸椎椎体骨折があった。単純X線ではT9およびT12椎体の楔状変形を認め、変形は胸椎後彎角が50°のrigidなround backタイプであった。心エコーではS字状中隔心に伴う大動脈弁下狭窄がみられた。T9、T12椎体骨折後の後彎変形に対し骨切りを伴う後方矯正固定術を施行したところ、後彎変形の改善に加え、S字状中隔心に伴う大動脈弁下狭窄は術後2週で消失した。本症例では脊柱変形が大動脈弁下狭窄の原因になっていたことが考えられた。
  • Go Yoshida; Kenta Kurosu; Yu Yamato; Tomohiko Hasegawa; Tatsuya Yasuda; Daisuke Togawa; Yukihiro Matsuyama
    Asian spine journal 11 (2) 190 - 197 2017/04 
    STUDY DESIGN: Prospective physical measurement of the sagittal vertical axis (SVA). PURPOSE: To evaluate a simple method for measuring SVA by analyzing its relationship with radiographic measurements and clinical appearance. OVERVIEW OF LITERATURE: No studies have examined physical measurements using the cranial center of gravity (CCG) in a relaxed standing position. METHODS: The physical measurement of the horizontal distance between CCG and spina iliaca posterior superior (CCG-SIPS) was measured using a straight ruler in 252 healthy volunteers and 56 patients with adult spinal deformity. Health-related quality of life (HRQOL) was evaluated using the Oswestry disability index (ODI), and clinical symptoms were assessed according to standing status and the presence of gastroesophageal reflux disease (GERD). RESULTS: CCG-SIPS increased with age in the volunteer group and strongly correlated with radiographic SVA in the patient group (r=0.984). Differences increased between CCG-SIPS in patients in the relaxed position and radiographic SVA with an increase in sagittal malalignment (r=0.692, p<0.001). ODI with high sagittal malalignment (CCG-SIPS>120 mm) was significantly larger in the patient group than in the group with low sagittal malalignment (59.9±18.8 vs. 45.1±17.0; p=0.004); these patients (CCG-SIPS>120 mm) needed crutches or walkers for standing. The patient group with GERD had significantly larger sagittal malalignment than the group without GERD (160.3 mm vs. 81.0 mm). CONCLUSIONS: The CCG-SIPS correlated with age and strongly reflected radiographic SVA and HRQOL in the patients. Moreover, it reflects a relaxed posture without a backward shift in the radiographic position even in patients with severe sagittal malalignment. The critical limit of CCG-SIPS can be relevant to clinical appearance, including standing assistance (>120 mm) and the existence of GERD (>150 mm). Thus, it will be a useful predictor of true SVA in clinical practice before radiographic evaluation.
  • 近藤 亮; 永房 鉄之; 美津島 隆; 野嶋 治; 戸川 大輔; 大和 雄; 松山 幸弘
    理学療法学Supplement 公益社団法人 日本理学療法士協会 2016 201 - 201 2017 

    【はじめに】

    成人脊柱変形に対する脊椎固定術にて多くの愁訴は改善し健康関連QOLは改善する。しかし,多椎間に行われた矯正固定術で脊柱は柔軟性を失い,術後体幹屈曲を主とする日常生活動作(ADL)については困難を認める。そこで我々は,成人脊柱変形に対する矯正固定術後の困難となり得る「動作困難感」について調査し,術後の爪切りやかがみ動作など前屈動作は術前より困難であった。それらの「動作困難感」は,徐々に改善傾向を認めると報告したが,「しているADL」については明らかでない。

    【目的】

    成人脊柱変形患者に対する後方矯正固定術後の日常生活動作への影響を明らかにし,理学療法介入を探ること。

    【方法】

    対象は2013年8月から2014年9月に当院整形外科にて,手術予定の成人脊柱変形患者47名のうち測定が可能であった30名(女性28名,男性2名,平均年齢65.9歳,身長147.1cm,体重48.9kg,BMI22.5kg/m2)とした。術後6ヶ月までは硬性コルセット,術後12ヶ月までは軟性コルセットを装着し,骨癒合が得られるまで過度な体幹前屈・回旋動作は制限している。評価項目はADLはFunctional Independence Measure(FIM)の各運動項目の術前,退院時,術後6ヶ月,術後12ヶ月とし,健康関連QOLはOswestry Disability Index(ODI)とScoliosis Research Society-22(SRS-22)の術前,術後6ヶ月,術後12ヶ月とした。統計解析はFIMの各運動項目,ODI,SRS-22の推移の検討にはWilcoxonの符号付き順位検定を用いて分析した。解析にはSPSS,Statistics21を使用し,有意水準を5%未満とした。

    【結果】

    健康関連QOLは術前と比べて術後6ヶ月,術後12ヶ月に有意な改善を認めた(ODI 40.2→30.1→27.7,SRS-22は2.5→3.4→3.3(p<0.01))。FIM運動項目で,術前と比べて退院時,術後6ヶ月,術後12ヶ月に有意に低下を認めた項目は清拭(7.0→5.5→6.2→6.6(p<0.05)),更衣下衣(6.9→4.7→6.0→6.2(p<0.001)),移乗浴槽(6.8→5.9→6.1→6.4(p<0.05))であった。一方,術前と比べて術後6ヶ月,術後12ヶ月に有意に改善を認めた項目は歩行(6.5→6.2→6.7→6.8(p<0.05))であった。

    【結論】

    成人脊柱変形患者に対する矯正固定術にて健康関連QOLや歩行は改善した。一方,清拭や更衣下衣などの前屈を伴う動作や,浴槽へ沈み込んだり上がったりする浴槽動作は,術後12ヶ月においても低下していることが明らかとなった。術後12ヶ月以降は,軟性コルセットを外した生活動作が可能となる為,今後更なる調査が必要である。骨癒合や体幹前屈動作の可否を医師と確認しながら,経過時期に合わせた動作指導が必要である。

  • 術後麻痺例におけるDouble-Train刺激法によるBr(E)-MsEP波形変化
    中村 元春; 小林 祥; 大江 慎; 長谷川 智彦; 戸川 大輔; 大和 雄; 黒須 健太; 瀧山 弘也; 田仲 飛鳥; 森田 耕司; 松山 幸弘
    脊髄機能診断学 エーザイ(株) 37 (1) 103 - 106 2017/01 
    術中脊髄機能モニタリングを行った症例のうち、術後麻痺が生じた脊椎・脊髄手術例12例を対象に、両下肢筋電位における術中のBr(E)-MsEP波形の変化について、Single-Train刺激法(ST法)とDouble-Train刺激法(DT法)で波形振幅を比較した。また、麻痺の生じた筋を抽出し、ST法、DT法の振幅低下率、麻痺の有無を検討した。その結果、術後麻痺が生じたのは12例27筋であった。術後麻痺例の術中最終波形の振幅を計測すると、DT法とST法の術中波形の低下は同様であった。12例27筋のうち2例2筋は、最終波形の振幅低下が50%程度で術後麻痺を生じた。他の25筋はST法、DT法とも70%以下の振幅低下があった。全12例のうち、神経根障害と考えられたのは7例、脊髄障害は4例、馬尾障害は1例であった。振幅50%以下で術後麻痺を生じた2筋は、選択的な脊髄障害例であった。以上より、DT法における術中波形の低下は、ST法と同様に術後麻痺を予見できると考えられた。
  • 術中Br(E)-MsEP波形とDouble train波形の解離した症例の検討
    黒須 健太; 小林 祥; 長谷川 智彦; 戸川 大輔; 大江 慎; 松山 幸弘
    脊髄機能診断学 エーザイ(株) 37 (1) 107 - 111 2017/01 
    脊椎手術の際にBr(E)-MsEPとDouble train刺激(DTS)によるモニタリングが施行された678例について検討した。Br(E)-MsEP、DTSのアラームポイントをコントロール波形と比較して70%振幅低下したものと定義し、Br(E)-MsEPとDTSの判定に解離があったものを抽出した。手術に関するパラメーター(出血量、時間)と臨床症状(術前と比較しMMT1レベル以上の低下)との相関性を検討した。その結果、6例がinclusion criteriaに合致し、うち1例が術後筋力低下を呈した。出血量と手術時間は筋力低下例で多かったが、有意差はなかった。なお、DTSはBr(E)-MsEPと比較して偽陽性例が少なかった。以上、Br(E)-MsEPで波形が不安定な場合はDTSを併せてモニターすることが有用であると考えられた。
  • 長時間手術例における術中Br(E)-MsEPモニタリングの波形減衰
    瀧山 弘也; 小林 祥; 大江 慎; 長谷川 智彦; 戸川 大輔; 大和 雄; 黒須 健太; 田仲 飛鳥; 森田 耕司; 松山 幸弘
    脊髄機能診断学 エーザイ(株) 37 (1) 112 - 115 2017/01 
    術中脊髄機能モニタリング下の成人脊柱変形手術100例を対象に、手術時間とBr(E)-MsEP波形の減衰との関係を検討した。また、Single-train刺激法(STS)とDouble-train刺激法(DTS)の波形減衰を比較検討した。手術時間は5時間未満が50例(A群)、5時間以上が50例(B群)であった。波形低下した筋電位の最終波形とコントロール波形の振幅比は、手術時間と強い相関はなかった。最終波形とコントロール波形で振幅比が僅かでも減衰した筋電位数の割合では、A群のSTSの振幅比は60%、DTSの振幅比は57%の筋電位に波形は減衰した。B群のSTSの振幅比は80%、DTSの振幅比68%の筋電位に波形は減衰した。最終波形とコントロール波形で振幅がアラームポイントである3割まで低下した筋電位の割合は、A群ではSTSの振幅比が12%、DTSの振幅比は17%まで波形減衰が生じた。B群ではSTSの振幅比は30%低下、DTSの振幅比15%まで波形は減衰した。B群のSTSとDTSでは、約15%、2倍もの差があった。DTSを用いることでMEP波形減衰の発生を半減させることが可能であった。
  • Hideyuki Arima; Yu Yamato; Tomohiko Hasegawa; Daisuke Togawa; Sho Kobayashi; Tatsuya Yasuda; Tomohiro Banno; Shin Oe; Yukihiro Matsuyama
    Spine 42 (1) E25-E30  2017/01 
    STUDY DESIGN: Retrospective case series. OBJECTIVE: The present study aimed to determine the characteristics of patients with adult spinal deformity (ASD) with a discrepancy between standing and walking postures. SUMMARY OF BACKGROUND DATA: Standing radiographic parameters are typically used to evaluate patients with ASD. Patients with ASD with relatively good sagittal alignment on standing radiography have, however, been reported to walk with a forward trunk tilt. METHODS: Patients with ASD (n = 93; 13 men, 80 women; mean age, 65.0 yr) who underwent corrective surgery and preoperative gait analysis at our hospital between 2011 and 2013 were included. Spine radiographs and gait analysis data were acquired preoperatively. Standing-trunk tilt angle (STA) on lateral standing x-ray, gait-trunk tilt angle (GTA) from lateral gait images, and radiographic parameters of the spine and pelvis (lumbar lordosis [LL], pelvic tilt, and sagittal vertical axis) were measured. We calculated the increasing trunk tilt angle (ITA), by subtracting the STA from the GTA, for use as an index of discrepancy between standing posture and sagittal balance during walking. We examined the relation between radiographic parameters and ITA. RESULTS: The mean preoperative STA and GTA were 3.5° and 11.1°, respectively. The mean preoperative ITA, which represents the degree of discrepancy between standing posture and sagittal balance during walking, was 7.6°. The mean preoperative sagittal vertical axis, LL, pelvic incidence (PI), pelvic tilt, and PI minus LL were 102.6 mm, 20.3°, 52.9°, 32.1°, and 32.6°, respectively. The PI minus LL mismatch was positively correlated with the ITA (R = 0.237, P = 0.023). In particular, patients with ASD with a PI minus LL mismatch of more than 40° had a significantly greater ITA. CONCLUSION: Gait analysis revealed that a preoperative standing-walking discrepancy is associated with severe PI - LL mismatch. LEVEL OF EVIDENCE: 4.
  • 成人脊柱変形に対しlong fusionを施行した後のロッド折損
    安田 達也; 長谷川 智彦; 大和 雄; 小林 祥; 戸川 大輔; 大江 慎; 松山 幸弘
    浜松医療センター学術誌 浜松医療センター 10 (1) 104 - 106 2186-4608 2016/12 
    成人脊柱変形に対し、long fusionによる矯正固定術が増加している。術後にロッド折損が起こる例が散見されたためその特徴の調査を行った。脊椎のアライメントや術式とは関連がなく、純チタン性のロッドではロッド折損の発生率が低かった。(著者抄録)
  • ウシロザコ ヒロキ; コバヤシ ショウ; ハセガワ トモヒコ; ヤマト ユウ; トガワ ダイスケ; ヤスダ タツヤ; バンノ トモヒロ; オオエ シン; マツヤマ ユキヒロ
    Journal of Spine Research (一社)日本脊椎脊髄病学会 7 (11) 1590 - 1593 1884-7137 2016/11 
    高齢者における脊柱側彎と健康関連QOLとの関係を調査した。高齢者運動器検診に参加した654名の側彎Cobb角を計測し、Oswestry Disability index(ODI)との相関について検討した。側彎Cobb角20°以上の群は有意にODIが高かった。高齢者においては矢状面アライメントがQOLに影響を与えると報告されているが、冠状面アライメントもCobb角20°以上ではQOLに影響を及ぼしていた。(著者抄録)
  • Tomohiro Banno; Daisuke Togawa; Hideyuki Arima; Tomohiko Hasegawa; Yu Yamato; Sho Kobayashi; Tatsuya Yasuda; Shin Oe; Hironobu Hoshino; Yukihiro Matsuyama
    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 25 (11) 3687 - 3693 2016/11 
    PURPOSE: T1 pelvic angle (TPA) and global tilt (GT) are spinopelvic parameters that account for trunk anteversion and pelvic retroversion. To investigate spinopelvic parameters, especially TPA and GT, in Japanese adults and determine norms for each parameter related to health-related quality of life (HRQOL). MATERIALS AND METHODS: Six hundred and fifty-six volunteers (262 men and 394 women) aged 50-92 years (mean, 72.8 years) were enrolled in this study. The incidence of vertebral fracture, spondylolisthesis and coronal malalignment were measured. Five spinopelvic parameters (TPA, GT, sagittal vertical axis [SVA], pelvic tilt [PT], and pelvic incidence-lumbar lordosis [PI-LL]) were measured using whole spine standing radiographs. The mean values for each parameter were estimated by sex and decade of life. HRQOL measures, including the Oswestry Disability Index (ODI) and EuroQuol-5D (EQ-5D), were also obtained. Pearson's correlation coefficients were determined between each parameter and HRQOL measure. Moreover, the factors contributing to the QOL score were calculated using logistic regression with age, sex, the existence of vertebral fracture and spondylolisthesis, coronal malalignment (coronal curve >30°) and sagittal malalignment (SVA >95 mm) as explanatory variables and the presence of disability (ODI >40) as a free variable. RESULTS: The mean values for the spinopelvic parameters were as follows: TPA, 17.9°; GT, 23.2°; SVA, 50.2 mm; PT, 18.6°; and PI-LL, 7.5°. TPA and GT strongly correlated with each other (r = 0.990) and with the other spinopelvic parameters. TPA and GT correlated with ODI (r = 0.339, r = 0.348, respectively) and EQ-5D (r = -0.285, r = -0.288, respectively), similar to those for SVA. TPA, GT, PT, and PI-LL were significantly higher in women than in men. PT and PI-LL gradually increased with age, while TPA, GT, and SVA tended to deteriorate after the 7th decade. Based on a logistic regression analysis, the deterioration of ODI was mostly affected by the sagittal malalignment. The TPA and GT cut-off values for severe disability (ODI >40) based on linear regression modeling were 26.0° and 33.7°, respectively. CONCLUSIONS: We determined reference values for spinopelvic parameters in elderly volunteers. Similar to SVA, TPA and GT correlated with HRQOL. TPA, GT, PT, and PI-LL were worse in women and progressed with age.
  • Tomohiro Banno; Tomohiko Hasegawa; Yu Yamato; Sho Kobayashi; Daisuke Togawa; Shin Oe; Yuki Mihara; Yukihiro Matsuyama
    Spine 41 (21) 1641 - 1648 2016/11 
    STUDY DESIGN: Retrospective review. OBJECTIVE: We investigated validity of T1 pelvic angle (TPA) for postoperative assessment and determined its target value for corrective scoliosis surgery. SUMMARY OF BACKGROUND DATA: TPA is a novel spinopelvic parameter accounting for both pelvic retroversion and trunk anteversion. As an angle, it is less affected by posture and correlates well with health-related quality of life in adult spinal deformity patients. According to our study in elderly volunteers, the threshold TPA value for disability (Oswestry Disability Index [ODI] score >20) was approximately 20°. METHODS: Seventy adult scoliosis patients (5 men and 65 women; mean age, 67.8 yr) who underwent spinal deformity surgeries and were followed up for at least 2 years postoperatively were studied. The following parameters based on whole-spine and pelvic radiography were assessed preoperatively, soon after operation, and 2 years postoperatively: C7-central sacral vertical line, TPA, sagittal vertical axis (SVA), pelvic tilt, and pelvic incidence minus lumbar lordosis. ODI and Scoliosis Research Society-22 scores were obtained preoperatively and 2 years postoperatively. Based on postoperative TPA, patients were divided into two groups: ≤20° (group G) and greater than 20° (group P). RESULTS: TPA and SVA correlated with health-related quality of life. Two years postoperatively, TPA best correlated with ODI and Scoliosis Research Society-22 scores, although all parameters correlated with them, and TPA soon after operation best correlated with ODI scores 2 years postoperatively. Two years postoperatively, each parameter and ODI scores in group G were better than those in group P. CONCLUSION: The correlation results showed that TPA appropriately assessed clinical outcomes following spinal deformity surgery. TPA assessed soon after operation correlated with ODI score 2 years postoperatively, and thus predicted prognosis. Because patients whose postoperative corrected TPA was 20° or lesser had better spinopelvic parameters and ODI scores 2 years postoperatively, TPA 20° or lesser was the proper target value for corrective surgery. LEVEL OF EVIDENCE: 4.
  • Shin Oe; Yu Yamato; Daisuke Togawa; Kenta Kurosu; Yuki Mihara; Tomohiro Banno; Tatsuya Yasuda; Sho Kobayashi; Tomohiko Hasegawa; Yukihiro Matsuyama
    Spine 41 (19) E1168-E1176  2016/10 
    STUDY DESIGN: A retrospective study of surgical outcomes of adult spinal deformity (ASD) cases. OBJECTIVE: The aim of the study was to investigate the effects of high T1 slope (T1S) on surgical outcomes in patients with ASD. SUMMARY OF BACKGROUND DATA: Few studies have evaluated the surgical outcomes of patients with ASD with cervical deformities. METHODS: Eighty-eight patients with ASD who underwent posterior spinal corrective fusion were assigned to either group A (T1S <40°) or group B (T1S ≥40°). Whole-spine standing radiographs of both groups were preoperatively assessed: at first standing after the surgery and at 1 and 2 years postoperatively. RESULTS: There were 56 patients in group A and 32 in group B. The preoperative C7 sagittal vertical axis (SVA) improved from 61 to 41 mm in group A and from 161 to 64 mm in group B at first standing after the surgery. C7 SVA at 2 years after the surgery was, however, 57 mm in group A and 98 mm in group B because of correction loss (P = 0.003). T1S measurements before and immediately after the surgery and 2 years after the surgery were, however, 25°, 23°, and 27° in group A and 53°, 36°, and 41° in group B, respectively. There were no significant differences among measurements in group A. Those in group B were, however, significantly improved in the first standing, but T1S of 40° or higher deteriorated toward 2 years after the surgery. CONCLUSION: Among patients with T1S of 40° or higher, C7 SVA improved immediately after the surgery but worsened at 2 years after the surgery. These results suggested that cervicothoracic parameters were important predictors of correction loss. LEVEL OF EVIDENCE: 4.
  • ハセガワ トモヒコ; ヤマト ユウ; コバヤシ ショウ; トガワ ダイスケ; ヤスダ タツヤ; オオエ シン; ヤマダ トモヒロ; ナカイ ケイイチ; バンノ トモヒロ; ミハラ ユウキ; マツヤマ ユキヒロ
    日本整形外科学会雑誌 (公社)日本整形外科学会 90 (9) 595 - 599 0021-5325 2016/09
  • YAMATO Yu
    The Central Japan Journal of Orthopaedic Surgery & Traumatology THE CENTRAL JAPAN ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 59 (5) 959 - 960 0008-9443 2016/09 
    2014年4月〜2015年8月の間に成人脊柱変形に対してlateral lumbar interbody fusion(LLIF)を併用した二期的矯正固定術を施行した33例を対象にLLIFの局所矯正角度をCT再構成像にて調査検討した。その結果、脊柱変形に対する矯正固定術において、LLIFで1椎間あたり平均2.6°の前彎が獲得されていた。脊柱変形のカーブタイプの違いは変形の病態の違いを反映しているとともに、矯正効果が異なることが示唆された。
  • ヤマト ユウ; ハセガワ トモヒコ; コバヤシ ショウ; ヤスダ タツヤ; トガワ ダイスケ; オオエ シン; バンノ トモヒロ; ミハラ ユウキ; クロス ケンタ; マツヤマ ユキヒロ
    Journal of Spine Research (一社)日本脊椎脊髄病学会 7 (9) 1352 - 1355 1884-7137 2016/09 
    成人脊柱変形術後の矯正アライメントが1年後の健康関連quality of life(QOL)に与える影響を調査し、手術時に目標とすべきアライメントを検討した。骨盤を健常者から計測した至適位置まで前傾した骨盤前傾群でOswestry disability indexの平均値がminimum clinically important differenceを満たす改善が得られていた。成人脊柱変形手術時には十分な腰椎前彎を獲得し骨盤を前傾することの重要性が示された。(著者抄録)
  • Tatsuya Yasuda; Tomohiko Hasegawa; Yu Yamato; Sho Kobayashi; Daisuke Togawa; Tomohiro Banno; Hideyuki Arima; Shin Oe; Yukihiro Matsuyama
    Spine deformity 4 (5) 378 - 384 2016/09 
    STUDY DESIGN: A retrospective study. OBJECT: To investigate the rate of lumbosacral junction complication after long corrective spinal fusion for degenerative kyphoscoliosis cases with different lower instrumented vertebra (LIV) of L5, S1 (non-iliac group), and ilium (iliac group). SUMMARY OF BACKGROUND DATA: In long spinal fusion, high mechanical stress is concentrated at the fusion ends, especially at the lumbosacral junction. There are conflicting views regarding the selection of lower instrumented vertebra in long spinal fusion for adult spinal deformity. METHODS: This study included 53 adult patients who underwent posterior long corrective fusion (more than five levels) for their spinal kyphoscoliosis with a minimum 2 years' follow-up. The patients were divided into two groups: distal fusion level was L5, S1 (non-iliac group), or ilium (iliac group). We investigated the complication status (L5/S1 instability, pseudoarthrosis, screw loosening, sacral fracture, and rod fracture) in the lumbosacral junction. RESULTS: There were 25 patients (L5:6 cases, S1:19 cases) in the non-iliac group and 28 in the iliac group. There was no significant deference in age and preoperative radiographic parameters between the 2 groups. In the non-iliac group, revision surgery was performed in 6 of the 25 cases (24%, LIV L5: 1 case, S: 5 cases). Lumbosacral failure was observed in 3 of 6 cases with LIV at L5 and a radiolucent sign around S1 pedicle screws were observed in 15 of 19 cases in LIV at S. In the iliac group, revision surgery was required because of rod fractures in 2 of 28 cases (7.1%). There was no other major complication in iliac group. CONCLUSION: This study showed that a high complication rate at the lumbosacral junction was observed when the L5 or S1 was selected as the distal fusion end in long corrective fusion. On the other hand, the lumbosacral complication rate was low when using iliac screw as the lower fusion end. Thus, we recommend spinopelvic fixation using iliac screw as the lower fusion end of long corrective fusion for the adult spinal deformity surgery, with the high rate of failure in our patients with long fusions stopped at L5 and S1.
  • 骨粗鬆症性椎体骨折の予防、診断、治療 Update 骨粗鬆症性椎体骨折診療におけるballoon kyphoplastyの適応範囲
    戸川 大輔
    日本骨粗鬆症学会雑誌 (一社)日本骨粗鬆症学会 2 (3) 286 - 287 2189-8383 2016/08
  • Go Yoshida; Koji Sato; Tokumi Kanemura; Toshiki Iwase; Daisuke Togawa; Yukihiro Matsuyama
    Asian spine journal 10 (4) 630 - 8 2016/08 
    STUDY DESIGN: Retrospective. PURPOSE: This study aims to investigate the accuracy of the oblique fluoroscopic view, based on preoperative computed tomography (CT) images for accurate placement of lumbosacral percutaneous pedicle screws (PPS). OVERVIEW OF LITERATURE: Although PPS misplacement has been reported as one of the main complications in minimally invasive spine surgery, there is no comparative data on the misplacement rate among different fluoroscopic techniques, or comparing such techniques with open procedures. METHODS: We retrospectively selected 230 consecutive patients who underwent posterior spinal fusion with a pedicle screw construct for degenerative lumbar disease, and divided them into 3 groups, those who had undergone: minimally invasive percutaneous procedure using biplane (lateral and anterior-posterior views using a single C-arm) fluoroscope views (group M-1), minimally invasive percutaneous procedure using the oblique fluoroscopic view based on preoperative CT (group M-2), and conventional open procedure using a lateral fluoroscopic view (group O: controls). The relative position of the screw to the pedicle was graded for the pedicle breach as no breach, <2 mm, 2-4 mm, or >4 mm. Inaccuracy was calculated and assessed according to the spinal level, direction and neurological deficit. Inter-group radiation exposure was estimated using fluoroscopy time. RESULTS: Inaccuracy involved an incline toward L5, causing medial or lateral perforation of pedicles in group M-1, but it was distributed relatively equally throughout multiple levels in groups M-2 and controls. The mean fluoroscopy time/case ranged from 1.6 to 3.9 minutes. CONCLUSIONS: Minimally invasive lumbosacral PPS placement using the conventional fluoroscopic technique carries an increased risk of inaccurate screw placement and resultant neurological deficits, compared with that of the open procedure. Inaccuracy tended to be distributed between medial and lateral perforations of the L5 pedicle, as a result of pedicle morphology and the PPS pathway. Oblique fluoroscopic views, based on CT measurement, may allow accurate PPS insertion with a shorter fluoroscopy time.
  • 長谷川 智彦; 大和 雄; 戸川 大輔; 小林 祥; 大江 慎; 松山 幸弘
    整形・災害外科 金原出版(株) 59 (7) 949 - 955 0387-4095 2016/06
  • 井出 浩一郎; 戸川 大輔; 星野 裕信; 松山 幸弘
    整形・災害外科 金原出版(株) 59 (7) 891 - 894 0387-4095 2016/06 
    中山間地域に住む50歳以上の運動器検診受診者を対象に、脊柱アライメントほか、椎体骨折とロコモティブシンドローム(ロコモ)との関連について調査した。その結果、1)椎体骨折はロコモ25と強い相関を認めなかったが、矢状アライメント、特にSVAと強い相関が認められた。2)質問項目ごとにSVAとの相関を検討すると、SVAは歩行の質問項目と有意な相関が認められた。また、Schwab分類のModifierごとに評価すると矢状アライメントが不良になるほどロコモ25の悪化が示された。3)2012年と2014年の結果を比較すると、新規椎体骨折群に比べ既存骨折群はロコモ25が悪く、経年的な悪化がみられた。
  • 【低侵襲脊椎手術の合併症とRevision Surgery】Balloon Kyphoplasty(BKP)の合併症と対策
    戸川 大輔
    整形外科最小侵襲手術ジャーナル (株)全日本病院出版会 (79) 91 - 98 1342-3991 2016/05 
    Balloon Kyphoplasty(BKP)は骨粗鬆症性椎体骨折遷延治癒、癒合不全、偽関節、または溶骨性椎体腫瘍に対して行う低侵襲な経皮的椎体形成術の一術式である。2011年1月の保険収載以降、BKPは本邦でも広く行われるようになった。疼痛緩和に関しては概ね良好な成績が報告される一方で、術後の合併症も散見される。最も頻度が高いのはBKP後の続発性骨折で、骨セメント漏洩がそれに続く。また頻度は少ないが骨セメント塊の脱転、血腫、感染、術後神経合併症などの合併症も散見される。対象が高齢者であることが多いため、これら合併症が患者に与える影響は時に重篤ともなり得る。特に頻度の高い続発性骨折については、術後の装具療法の併用、PTH製剤の併用、患者への術前からの十分な説明などによって全般的に頻度が抑えられてきている。本稿ではBalloon Kyphoplastyの合併症とその対策の現状について述べる。(著者抄録)
  • 戸川 大輔; 有馬 秀幸; 松山 幸弘
    整形外科Surgical Technique (株)メディカ出版 6 (2) 228 - 230 2185-7733 2016/04
  • 坂野 友啓; 戸川 大輔
    脊椎脊髄ジャーナル (株)三輪書店 29 (4) 414 - 419 0914-4412 2016/04
  • ヤスダ タツヤ; ハセガワ トモヒコ; ヤマト ユウ; コバヤシ ショウ; トガワ ダイスケ; バンノ トモヒロ; オオエ シン; ミハラ ユウキ; マツヤマ ユキヒロ
    Journal of Spine Research (一社)日本脊椎脊髄病学会 7 (4) 834 - 836 1884-7137 2016/04 
    成人脊柱変形患者における体位変化による腰椎前彎角(LL)について検討した。平均は立位LL10.4°、仰臥位LI22.5°、腹臥位LI22.0°であった。立位では有意にLLは減少していたが、仰臥位と腹臥位ではLLはほぼ近似しており、最も差が大きい症例でも8°の違いしかなかった。術中腹臥位LLは仰臥位LLで代用できる可能性が示される結果であった。(著者抄録)
  • バンノ トモヒロ; ハセガワ トモヒコ; ヤマト ユウ; コバヤシ ショウ; トガワ ダイスケ; オオエ シン; ミハラ ユウキ; マツヤマ ユキヒロ
    Journal of Spine Research (一社)日本脊椎脊髄病学会 7 (4) 837 - 840 1884-7137 2016/04 
    脊柱後彎症患者57例(男性8例、女性49例、平均年齢71.3歳)を対象にタイプ別に円背、亀背、全後彎に分け、術前CTを用いて大腰筋と多裂筋の面積、脊柱パラメータ(SVA、PT、LL)を計測し、群間比較した。円背19例、亀背18例、全後彎20例で各群間に年齢、性別、体重差はなかった。大腰筋面積は各群で差はなかったが、多裂筋面積は全後彎で他群より有意に小さかった。SVA、PT、LLも全後彎で他群より有意に悪かった。(著者抄録)
  • Tatsuya Yasuda; Tomohiko Hasegawa; Yu Yamato; Sho Kobayashi; Daisuke Togawa; Tomohiro Banno; Hideyuki Arima; Shin Oe; Yukihiro Matsuyama
    Asian spine journal 10 (2) 309 - 13 2016/04 
    STUDY DESIGN: Retrospective case series. PURPOSE: To investigate the relationship between tumor location and clinical characteristics. OVERVIEW OF LITERATURE: Hemangioblastoma is a rare disease that develops in the central nervous system. Magnetic resonance imaging (MRI) is useful to evaluate hemangioblastomas. Hemangioblastoma's location is designated as intramedullary, intramedullary+extramedullary, or extramedullary by MRI. METHODS: We analyzed 11 patients who underwent surgery for spinal hemangioblastoma. Using T1 contrast axial MRI data, the cases were divided into three groups (intramedullary, intramedullary+extramedullary, and extramedullary). Patient demographics, MRI findings, and preoperative neurological status were analyzed and compared for each group. RESULTS: The average age of patients with intramedullary, intramedullary+extramedullary, and extramedullary hemangioblastoma was 34.0, 64.4, and 67.5 years, respectively. Patients in the intramedullary hemangioblastoma group were younger than the other groups. Extramedullary cases had a smaller syrinx compared to the other groups. CONCLUSIONS: Age may play an important role in the hemangioblastoma tumor location and the subsequent diagnosis by an MRI.
  • 戸川 大輔; 佐藤 義弘; 松山 幸弘
    日本整形外科学会雑誌 (公社)日本整形外科学会 90 (2) S97 - S97 0021-5325 2016/03
  • 戸川 大輔
    Loco Cure (株)先端医学社 2 (1) 60 - 64 2189-4221 2016/02 
    Balloon Kyphoplasty(BKP)は低侵襲手術である。保存療法抵抗性の椎体骨折遷延治癒、癒合不全、偽関節を対象とする。骨折椎体内部からバルーンを加圧して骨折を整復できる。術中に骨折椎体を固定できるため後療法が即開始できる。神経障害、重度の椎体圧潰のBKP適応には検討を要する。(著者抄録)
  • Yu Yamato; Tomohiko Hasegawa; Sho Kobayashi; Tatsuya Yasuda; Daisuke Togawa; Hideyuki Arima; Shin Oe; Takahiro Iida; Akira Matsumura; Naobumi Hosogane; Morio Matsumoto; Yukihiro Matsuyama
    Spine 41 (4) E211-7  2016/02 
    STUDY DESIGN: This investigation consisted of a cross-sectional study and a retrospective multicenter case series. OBJECTIVE: This investigation sought to identify the ideal lumbar lordosis (LL) angle for restoring an optimal pelvic tilt (PT) in patients with adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA: To achieve successful corrective fusion in ASD patients with sagittal imbalance, it is essential to correct the sagittal spinal alignment and obtain a suitable pelvic inclination. We determined the LL angle that would restore the optimal PT following ASD surgery. METHODS: The cross-sectional study included 184 elderly volunteers (mean age 64 years) with an Oswestry Disability Index score less than 20%. The relationship between PT or LL and the pelvic incidence (PI) in normal individuals was investigated. The second study included 116 ASD patients (mean age 66 years) who underwent thoracolumbar corrective fusion at 1 of 4 spine centers. The postoperative PT values were calculated using the parameters measured. On the basis of these studies, an ideal LL angle was determined. RESULTS: In the cross-sectional study, the linear regression equation for the optimal PT as a function of PI was "optimal PT = 0.47 × PI - 7.5." In the second study, the postoperative PT was determined as a function of PI and corrected LL, using the equation "postoperative PT = 0.7 × PI - 0.5 × corrected LL + 8.1." The target LL angle was determined by mathematically equalizing the PTs of these 2 equations: "target LL = 0.45 × PI + 31.8." CONCLUSION: The ideal LL angle can be determined using the equation "LL = 0.45 × PI + 31.8," which can be used as a reference during surgical planning in ASD cases. LEVEL OF EVIDENCE: 4.
  • 市川 美智華; 小林 祥; 大江 慎; 安田 達也; 長谷川 智彦; 戸川 大輔; 大和 雄; 田仲 飛鳥; 鈴木 咲子; 森田 耕司; 松山 幸弘
    脊髄機能診断学 エーザイ(株) 36 (1) 105 - 108 2016/01 
    Double-train経頭蓋電気刺激による術中脊髄モニタリング(Br(E)-MsEP)波形について従来法と比較検討した。脊柱変形86例、脊椎脊髄腫瘍23例、後縦靱帯骨化症(OPLL)14例を対象とした。平均振幅は多数回刺激法(MPS)で654.1μV、Double-train経頭蓋電気刺激法(DTS)で922.1μVであった。約141%MPSに対してDTSが有意に増強した。振幅が5μV以下の筋電位を導出困難とした時、MPSの1311/1409筋(93%)が導出可能で、98/1409筋(7%)が導出困難であった。DTSでは、1336/1409筋(95%)が導出可能で、73/1409筋(5%)が導出困難であった。
  • 田仲 飛鳥; 長谷川 智彦; 小林 祥; 大和 雄; 安田 達也; 有馬 秀幸; 戸川 大輔; 山田 智裕; 中井 慶一; 鈴木 咲子; 市川 美智華; 森田 耕司; 松山 幸弘
    脊髄機能診断学 エーザイ(株) 36 (1) 146 - 149 2016/01 
    術中経頭蓋電気刺激に伴う舌咬傷を3例経験した。症例1(舌尖部の潰瘍形成)は64歳女性で、経口挿管に伴い、硬質なバイトブロックを使用した。口腔内に挿管チューブがあった為、舌の咬傷はなかったが、舌尖部が挿管チューブと接触することにより、潰瘍を形成した。症例2(舌尖部の血腫形成)は40歳男性で、経鼻挿管と硬質なバイトブロック使用下にて脊髄腫瘍摘出術を施行した。術後、口腔内ガーゼ除去時に舌が腫れているのを発見したが、出血もなく創部不明であった為、経過観察となった。症例3(舌の裂傷)は79歳女性で、経鼻挿管と口腔内ガーゼによるパッキングにて側彎症手術を施行した。術後、ガーゼ除去時に出血があり、舌咬傷を発見した。舌の左側に3cm程度の裂傷を認め、縫合止血を行った。
  • 鈴木 咲子; 小林 祥; 安田 達也; 戸川 大輔; 大和 雄; 長谷川 智彦; 市川 美智華; 田仲 飛鳥; 森田 耕司; 松山 幸弘
    脊髄機能診断学 エーザイ(株) 36 (1) 157 - 160 2016/01 
    腰椎変性側彎症に対する矯正固定術において術後麻痺が回避できた2例を経験した。症例1は82歳女性で、腰椎変形側彎症に対し、L2/3、3/4の前方椎体間固定術を施行し、二期的にT10から腸骨の後方矯正固定術と、L4/5、5/Sの腰椎椎体間固定術を施行した。後方矯正固定術において、右前脛骨筋のみBr(E)-MsEP波形が一次的に導出不良を来たした。右のL5神経根がtetheringされていたため、椎弓根部の除圧追加と、神経根と椎間孔部の剥離を行った。直後より右前脛骨筋のBr(E)-MsEP波形回復を認めた。症例2は66歳女性で、成人後側彎症に対し、L2/3、3/4の前方椎体間固定術を施行し、二期的にT10から腸骨の後方矯正固定術と、L4/5、5/Sの腰椎椎体間固定術を施行した。後方矯正術において、左大腿四頭筋のみBr(E)-MsEP波形が一時的に導出不良をきたした。左のL4神経根がtetheringされていたため、椎弓根部の除圧追加と、神経根と椎間孔部の剥離を行った。直後より左大腿四頭筋のBr(E)-MsEP波形回復を認めた。
  • Mitsushige Sugimoto; Tomohiko Hasegawa; Masafumi Nishino; Shu Sahara; Takahiro Uotani; Hitomi Ichikawa; Takuma Kagami; Ken Sugimoto; Yu Yamato; Daisuke Togawa; Sho Kobayashi; Hironobu Hoshino; Yukihiro Matsuyama; Takahisa Furuta
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 28 (1) 50 - 8 2016/01 
    BACKGROUND AND AIM: Spinal kyphotic deformity occasionally results in gastroesophageal reflux disease (GERD). The effects of acid reflux on the esophagus in kyphotic patients are unclear, however, and it is unknown whether acid reflux, endoscopic GERD, and reflux-related symptoms improve following surgical spinal correction in these patients. Herein, we investigated the characteristics of GERD in kyphotic patients and the improvement in GERD following surgical correction. METHODS: In 48 patients with severe kyphotic deformity scheduled for surgical spinal correction, we conducted esophagogastroduodenoscopy, 24-h pH monitoring and three questionnaire surveys, including the frequency scale for the symptoms of GERD (FSSG). We repeated these measurements after surgical correction and compared pre- and post-surgery values. RESULTS: Of 48 patients, 70.8% [95% CI: 55.9-83.0%, 34/48] had endoscopically evaluated esophageal mucosal injury. Regarding pH before surgery, 64.9% (CI: 47.5-79.8%, 24/37) had abnormal acid reflux (intraesophageal pH < 4 more than 5% of the time). FSSG score was significantly associated with the severity of GERD, and the positive rate was 52.6% (CI: 35.8-69.0%, 20/38). Following surgical correction, esophageal mucosal injury improved endoscopically in 90% of patients, and median total FSSG score significantly decreased from 8 (0-30) to 5 (0-19) (P = 0.005). Regarding pH after surgery, prevalence of abnormal acid reflux decreased from 66.7% (95% CI: 41.0-86.7%) to 33.3% (95% CI: 13.3-59.0%) (P = 0.045). CONCLUSION: Surgical spinal correction in kyphosis patients improves not only kyphotic deformity-related disorders but also esophageal mucosal injury, abnormal acid reflux, and reflux-related symptoms.
  • 戸川 大輔
    Geriatric Medicine (株)ライフ・サイエンス 53 (12) 1269 - 1275 0387-1088 2015/12 
    腰背部痛の程度が軽い骨粗鬆症性椎体骨折は、初診で診断されずに経過することがある。多くの椎体骨折は骨癒合を得て良好な臨床経過をたどるが、骨癒合が得られず、遷延治癒、癒合不全、偽関節となって圧潰すると、神経障害へと進行したり、楔状化して後彎変形の原因となり脊柱変形へ進行することもある。Balloon Kyphoplasty(BKP)は低侵襲で骨折椎体の整復固定を特徴とした手術手技であり、骨粗鬆症性椎体骨折治療の中で大きな役割を担う治療となってきている。(著者抄録)
  • Tatsuya Yasuda; Tomohiko Hasegawa; Yu Yamato; Sho Kobayashi; Daisuke Togawa; Yukihiro Matsuyama
    Asian spine journal 9 (6) 923 - 7 2015/12 
    STUDY DESIGN: Case series. PURPOSE: The objective of this study was to investigate the change in pulmonary function in adult patients with a spinal deformity who underwent spinal corrective surgery. OVERVIEW OF LITERATURE: Degenerative lumbar and/or thoraco-lumbar deformities are is often prominent in adult spinal deformity cases, whereas a thoracic deformity involving the chest wall is inconspicuous. A lumbar spine deformity could affect the pulmonary function; however, few reports have investigated pulmonary function in adult patients with a spinal deformity. METHODS: This study included 14 adult patients with a spinal deformity who underwent posterior corrective fusion (3 males, 11 females; mean age, 67.4 years). We measured percent vital capacity (%VC) and percent forced expiratory volume in 1 second (%FEV1) before surgery and six months after surgery. We investigated the change in pulmonary function after corrective surgery and the correlation between radiographic parameters and pulmonary function. RESULTS: Mean preoperative %VC and %FEV1 values were 99.9% and 79.3%, respectively. Two cases were diagnosed with restrictive impairment, and two cases were diagnosed with obstructive impairment before surgery. %VC improved in the restrictive impairment cases six months after surgery. However, %FEV1 did not improve significantly after surgery in the obstructive impairment cases. CONCLUSIONS: Restrictive impairment was improved in adult patients with a spinal deformity by corrective spinal surgery. However, spinal surgery did not improve obstructive impairment.
  • 戸川 大輔; 星野 裕信; 松山 幸弘
    臨床整形外科 (株)医学書院 50 (11) 1047 - 1052 0557-0433 2015/11 
    近年,脊椎外科の領域で成人脊柱変形とQOLとの関連性が熱心に議論されている.本邦では欧米より高齢の患者が脊柱変形治療の対象となっている.われわれは,愛知県北設楽郡東栄町において50歳以上の高齢者に運動器検診を行っている.高齢検診者の立位脊柱骨盤X線における矢状面アライメントは,高齢群ほど悪く,矢状面アライメントが悪いほど健康関連QOLが悪いことを示した.しかし日本人高齢者では,矢状面の中等度の脊柱変形(PI-LL20°,SVA91mm,PT24°)までは健康関連QOLを悪化させずに許容していた.(著者抄録)
  • 小林 祥; 長谷川 智彦; 大和 雄; 安田 達也; 有馬 秀幸; 坂野 友啓; 大江 慎; 山田 智裕; 中井 慶一; 戸川 大輔; 松山 幸弘
    Journal of Spine Research (一社)日本脊椎脊髄病学会 6 (11) 1614 - 1617 1884-7137 2015/11 
    思春期特発性側彎症の腰椎カーブ(Lenke type 5、6)に対するDirect vertebral rotation(DVR)の矯正効果を検討した。対象は21例で、DVRを行わなかった症例をN-DVR群、DVRを行った症例をDVR群とし、2群に分けて後ろ向き比較研究を行った。術前Apical vertebral rotation(AVR)や術前後の冠状面、矢状面パラメータについては、有意差はなかったが、術後平均AVRはDVR群:19.3度、N-DVR群:11.3度、術後Upasani分類の平均値は、DVR群0.4とN-DVR群1.2であり、DVR群では有意に回旋矯正が得られた。また術後SRS-22 Self image、SatisfactionはそれぞれDVR群:4.38点、4.31点、N-DVR群:3.47点、3.67点と、DVR群が有意に高得点であった。腰椎DVRは腰椎側彎の回旋矯正を可能とし、優れた容姿の獲得と手術満足度の向上に貢献することができたため、有用な矯正手技と考えた。(著者抄録)
  • Shin Oe; Daisuke Togawa; Keiichi Nakai; Tomohiro Yamada; Hideyuki Arima; Tomohiro Banno; Tatsuya Yasuda; Sho Kobayasi; Yu Yamato; Tomohiko Hasegawa; Go Yoshida; Yukihiro Matsuyama
    Spine 40 (19) 1487 - 94 2015/10 
    STUDY DESIGN: Large cohort study of volunteers aged over 50. OBJECTIVE: To investigate influence of age and sex on cervical sagittal alignment among volunteers aged over 50. SUMMARY OF BACKGROUND DATA: Few large-scale studies have described normative values in cervical spine alignment regarding age and sex among volunteers aged over 50. METHODS: The study cohort included 656 volunteers aged 50 to 89 years. Pelvic tilt, sacral slope, pelvic incidence, lumbar lordosis, pelvic incidence-lumbar lordosis, thoracic kyphosis, T1 slope (T1S), cervical lordosis (CL), C7 sagittal vertical axis (C7 SVA), C2-C7 SVA, and T1S-CL were measured using whole spine and pelvic radiographs taken in the standing position. Health-related quality of life was assessed using the EuroQOL (EQ-5D) standardized instrument for measurement of health outcome and Oswestry Disability Index. RESULTS: There were 36 subjects aged 50 to 59 years, 174 aged 60 to 69 years, 311 aged 70 to 79 years, and 135 aged 80 to 89 years. Average T1S for each decade was 32°, 31°, 33°, and 36° for males, and 28°, 29°, 32°, and 37° for females, respectively. Average C2-C7 SVA was 25, 28, 34, and 35 mm for males, and 20, 21, 22, and 28 mm for females, respectively. C2-C7 SVA 40 mm or more, T1S 40° or more, and T1S-CL 20° or more pertaining to EQ-5D were significantly worse in other cases. CONCLUSION: C2-C7 SVA was significantly greater in males among all age groups, particularly among those with C2-C7 SVA of 40 mm or more [males, 69% (82/118) vs. females, 33% (36/118)]. Sagittal parameters of cervical spine were significantly worse in males than females. C2-C7 SVA, T1S, and T1S-CL negatively influenced EQ-5D. These results help to explain the greater prevalence of cervical spondylotic myelopathy among elderly males. LEVEL OF EVIDENCE: 3.
  • Tatsuya Yasuda; Daisuke Togawa; Tomohiko Hasegawa; Yu Yamato; Sho Kobayashi; Hideyuki Arima; Yukihiro Matsuyama
    Asian spine journal 9 (4) 660 - 660 2015/08
  • 井出 浩一郎; 大和 雄; 小林 祥; 長谷川 智彦; 戸川 大輔; 安田 達也; 坂野 友啓; 有馬 秀幸; 大江 慎; 山田 智裕; 中井 慶一; 松山 幸弘
    Journal of Spine Research (一社)日本脊椎脊髄病学会 6 (7) 1182 - 1185 1884-7137 2015/07 
    脊椎インストゥルメンテーション術後の深部感染は非常に深刻な合併症である。われわれは持続陰圧吸引療法(NPWT)をもちいた治療ストラテジーで、深部感染症例でほぼすべてのインストゥルメントを温存し治療することができた。当科で用いている簡易NPWTを含めた当科の治療法を詳述する。早期発見、早期治療が肝要であり、感染早期の徹底的なデブリードマンとNPWTを用いることでインストゥルメントの温存は可能である。(著者抄録)
  • 坂野 友啓; 長谷川 智彦; 大和 雄; 小林 祥; 戸川 大輔; 安田 達也; 大江 慎; 有馬 秀幸; 松山 幸弘
    Journal of Spine Research (一社)日本脊椎脊髄病学会 6 (7) 1206 - 1210 1884-7137 2015/07 
    腸骨スクリューを併用した脊柱変形手術患者97例194本につき2011〜2012(前期群)51例と2013以降(後期群)46例の刺入精度を比較した。また術前CTを用いて腸骨開大角を、術後X線写真を用いて腸骨スクリュー矢状面角を計測した。刺入精度は前期群で77.5%、後期群90.2%と後期群で有意に高かった。腸骨開大角の小さな症例で外側逸脱が、仙骨傾斜に対して頭側を向いて刺入された例で内側逸脱が多かった。(著者抄録)
  • Tatsuya Yasuda; Tomohiko Hasegawa; Yu Yamato; Sho Kobayashi; Daisuke Togawa; Hideyuki Arima; Yukihiro Matsuyama
    Asian spine journal 9 (3) 423 - 6 2015/06 
    STUDY DESIGN: A prospective, randomized, controlled study. PURPOSE: The objective of this study was to evaluate the effectiveness of two techniques of skin preparation with povidone-iodine. OVERVIEW OF LITERATURE: Preoperative skin preparation is important for preventing surgical site infection by reducing the bacteria in the surgical area. Povidone-iodine is a commonly used agent for preoperative skin preparation, and further decrease in surgical site infections can be expected by understanding how to apply it more effectively. METHODS: Eighty-nine spine surgery patients were randomly allocated to two groups. In group A, povidone-iodine was applied to the surgical site just before starting the operation; in group B, povidone-iodine was applied several minutes prior to starting the operation and was allowed to dry. We collected samples from the wound edge before suturing, and we compared the rates of positive culture between the two groups. RESULTS: The rate of positive culture was 30.2% (13 out of 43 patients) in group A, and 6.5% (3 out of 46 patients) in group B. This indicates that there was a significant difference in postoperative infection rates between group A and group B. CONCLUSIONS: Because bacteria on the skin appeared significantly reduced by allowing povidone-iodine to dry for several minutes prior to surgery, we recommend this approach to reduce the incidence of postoperative infections.
  • 戸川 大輔
    脊椎脊髄ジャーナル (株)三輪書店 28 (5) 505 - 509 0914-4412 2015/05
  • 長谷川 智彦; 大和 雄; 小林 祥; 戸川 大輔; 安田 達也; 有馬 秀幸; 坂野 友啓; 松山 幸弘
    Journal of Spine Research (一社)日本脊椎脊髄病学会 6 (4) 844 - 848 1884-7137 2015/04 
    成人脊柱変形矯正手術後にロッド折損を来し、入れ替え術を施行した5例の患者において、ロッド破断面の形態を調査することにより、ロッドにかかる負荷を推定した。破断は術後1年以降に発生し、椎体骨切り部またはL5/S1高位に生じた。破断面の形状からは、腰椎前彎を減じる1方向負荷がロッド背側よりロッドに加わっていることが推察された。また、破断はロッドbendingの際に形成されたnotchより生じていた。(著者抄録)
  • 骨粗鬆症性椎体骨折診療とBalloon Kyphoplasty(BKP)
    戸川 大輔
    東海脊椎外科 東海脊椎脊髄病研究会 29 6 - 11 0913-476X 2015/04
  • Tatsuya Yasuda; Daisuke Togawa; Tomohiko Hasegawa; Yu Yamato; Sho Kobayashi; Hideyuki Arima; Yukihiro Matsuyama
    Asian spine journal 9 (2) 295 - 8 2015/04 
    A recurrent laryngeal nerve injury is known as a complication referring to an anterior cervical spine surgery. However, hypoglossal nerve injury is not well known yet. Herein we report a rare case of a 39-years-old male with a hypoglossal nerve injury after C3/4 osteophyte resection with Smith-Robinson approach. In this case there appeared difficulties of articulation and tongue movement with deviation of the tongue to the left side after the surgery and we diagnosed a hypoglossal nerve injury due to retraction against the nerve during the operation. During the operative approach to the upper cervical spine we had to retract the internal carotid artery and the soft tissue to reach the vertebrae. This retract was the cause of the hypoglossal nerve injury. A gently traction and intermittent release is important to avoid a hypoglossal nerve damage.
  • トガワ ダイスケ
    Bone Joint Nerve (株)アークメディア 5 (2) 287 - 292 2186-1110 2015/03
  • 骨粗鬆症性椎体骨折後後彎症(OPK)の病態と治療戦略 骨粗鬆症性椎体骨折後後彎症(OPK)の病態と治療
    長谷川 智彦; 大和 雄; 小林 祥; 戸川 大輔; 安田 達也; 坂野 友啓; 有馬 秀幸; 大江 慎; 山田 智裕; 中井 慶一; 松山 幸弘
    日本整形外科学会雑誌 (公社)日本整形外科学会 89 (2) S46 - S46 0021-5325 2015/03
  • 戸川 大輔; 安田 達也; 大和 雄; 小林 祥; 大江 慎; 坂野 友啓; 有馬 秀幸; 山田 智裕; 渡邊 悠; 井出 浩一郎; 中井 慶一; 長谷川 智彦; 星野 裕信; 松山 幸弘
    Orthopaedics (株)全日本病院出版会 28 (2) 7 - 14 0914-8124 2015/02 
    近年、脊椎外科の領域で成人脊柱変形とQOLとの相関が熱心に議論されている。海外においても同様の傾向がみられるが、本邦ではより高齢の患者が脊柱変形治療の対象となっている。我々は、愛知県北設楽郡東栄町において50歳以上の高齢者に運動器検診を行ってきた。656名の高齢検診者(平均73歳)の立位脊柱骨盤X線における矢状面アライメントは、高齢群ほど悪く、矢状面アライメントが悪いほど健康関連QOLが悪いことを明確に示した。SRS-Schwab分類のsagittal modifierの正常はPI-LL10°未満、sagittal vertical axis(SVA)は40mm未満、pelvic tilt(PT)は20°未満であるが、本研究対象でODI40%をQOL障害の境界閾値とするとPI-LL20°、SVA91mm、PT24°となり、日本人高齢者では、矢状面の中等度の脊柱変形を許容していた。(著者抄録)
  • 長谷川 智彦; 大和 雄; 戸川 大輔; 小林 祥; 安田 達也; 松山 幸弘
    Orthopaedics (株)全日本病院出版会 28 (2) 69 - 75 0914-8124 2015/02 
    腰椎変性後側彎症の矯正手術では、2つの治療方針を軸に治療を行う。1つ目は、矯正の目標設定であり、冠状面変形よりも矢状面変形、特に腰椎前彎、骨盤傾斜、全脊柱の矢状面アライメントを改善するように努める。そこで当科では、骨盤傾斜(PT:pelvic tilt)を改善させることを最終目標に、患者ごとのpelvic incidenceに応じた腰椎前彎獲得formula(目標LL=0.45×PI+31.8°)を策定し使用している。2つ目は、症状と変形形態に応じた矯正手技の選択法の策定である。我々は、(1)神経症状、(2)腰痛、(3)不安定性、(4)SVA≧50mm、(5)Cobb角≧30°、(6)硬いがスムーズな形態の後彎形態、(7)シャープな後彎変形、という7つのパラメータにより成人脊柱変形を5つのlevelに分け、矯正術式適応を決定するstrategyを作製し、これに従い矯正手術を行っている。(著者抄録)
  • 安田 達也; 小林 祥; 長谷川 智彦; 大和 雄; 戸川 大輔; 鴨下 方彦; 田仲 飛鳥; 松山 幸弘
    脊髄機能診断学 エーザイ(株) 35 (1) 152 - 155 2015/01 
    症例は47歳女性で、両下肢の痺れを主訴とした。画像所見でC5/6に分節性後縦靱帯骨化症(OPLL)、T1-5に連続性OPLL、T4/5、T5/6に黄色靱帯骨化、T12-L2に連続性OPLLを認め、脊髄は圧迫されていた。胸椎レベルでのOPLLによる狭窄と考えたが、頸椎OPLLの関与も否定できず、手術侵襲を考え二期的手術を計画した。まずBr(E)-MsEPによる脊髄モニタリング下に頸椎椎弓形成術を施行し、術後筋力低下はなく、両下肢痺れは半減した。予定通り3週後に胸椎手術を行い、仰臥位モニタリングでは両上下肢とも良好なMEP波形が得られた。腹臥位に変換したところ、下肢のMEP波形が消失し、仰臥位に戻すと回復したが腹臥位では再度消失したため、手術は危険と判断し中止した。ハローベスト固定で神経症状悪化がないことを確認し、この状態で手術を施行した。腹臥位で上下肢とも良好なMEP波形が得られ、除圧固定術により下肢症状は消失した。
  • 田仲 飛鳥; 長谷川 智彦; 小林 祥; 大和 雄; 安田 達也; 有馬 秀幸; 戸川 大輔; 市川 美智華; 木村 竜希; 鴨下 方彦; 松山 幸弘
    脊髄機能診断学 エーザイ(株) 35 (1) 171 - 174 2015/01 
    手術を施行した成人側彎症25例(男2例、女23例、平均73.2歳)を対象に、神経根微弱電流直接刺激による電気的運動神経支配分布の調査を行った。術中所見で各神経根に形態異常のないことを確認し、直視下に125対計250根への刺激を行った。1筋のみで導出が得られたのはL2で32根、L3で45根、L4で42根、L5で41根、S1で44根、次点振幅筋まではそれぞれ27根、32根、32根、31根、35根であった。各神経根の反応は、最大振幅筋がL2、L3、L4で大腿四頭筋(Qd)がそれぞれ66%、62%、33%、L5では前脛骨筋(TA)が44%、S1では腓腹筋(Gc)が43%であった。次点筋はL2でハムストリング(Ham)が57%、L3では内転筋(AL)が42%、L4ではQdとHamがそれぞれ25%、L5ではTAが38%、S1ではGcが37%であった。上位2筋ではL2、L3、L4でQdがそれぞれ45%、48%、30%を占め、L5ではTAが42%、S1ではGcが41%であった。
  • 鴨下 方彦; 有馬 秀幸; 市川 美智華; 木村 竜希; 田仲 飛鳥; 峯田 周幸; 小林 祥; 長谷川 智彦; 大和 雄; 戸川 大輔; 安田 達也; 松山 幸弘
    脊髄機能診断学 エーザイ(株) 35 (1) 192 - 195 2015/01 
    脊髄髄内腫瘍摘出術を施行した25例(男15例、女10例、平均49歳)を対象に、術中体性感覚誘発電位(SSEP)の変化と術後疼痛との関連を調査した。再現性のあるSSEPが得られたのは13例で、50%以上の振幅低下があったのは5例(A群)、不変が8例(B群)であった。潜時が10%以上延長した症例はなかった。B群の組織型は血管芽腫5例、上衣腫1例、星細胞腫1例、海綿状血管腫1例、A群はそれぞれ2例、1例、2例、0例であった。術前の疼痛Visual Analog ScaleはA群平均67.5mm、B群48.75mmと有意差はなく、術後はそれぞれ70.0mm、28.75mmと有意差を認めた。術中SSEP振幅低下を認めた症例は、術後疼痛が強いことが示された。
  • 【骨粗鬆症性椎体骨折治療のコツとpitfall】骨粗鬆症性椎体骨折診断治療に役立つ組織解剖・病理学的知識
    戸川 大輔
    整形外科最小侵襲手術ジャーナル (株)全日本病院出版会 (73) 2 - 8 1342-3991 2014/12 
    骨粗鬆症性椎体骨折は軽微な外傷でも受傷するので、ときに疼痛発症時期が明確ではなく、医療機関受診や診断が遅れる場合がある。骨折椎体内の組織像は受傷からの時期により異なるが、多くの症例では線維性組織のみならず、断片化した壊死骨周囲に仮骨形成、軟骨内骨化や骨髄様組織などが認められることから骨折治癒能力が存在していることがわかる。また、骨粗鬆症性椎体骨折に対する椎体形成術ではPolymethylmethacrylate(PMMA)、Calcium Phosphate Cement(CPC)、Hydroxyapatite(HA)など、様々な生体材料が用いられている。骨移植材料、バイオマテリアルを使用する部位においては、周囲の組織との反応、力学的負荷の影響などをよく認識し、母床の環境をよく理解したうえで、使用すべきである。(著者抄録)
  • H Arima; T Hasegawa; D Togawa; Y Yamato; S Kobayashi; T Yasuda; Y Matsuyama
    Spinal Cord Springer Science and Business Media LLC 52 (10) 769 - 773 1362-4393 2014/10
  • 小林 祥; 長谷川 智彦; 大和 雄; 安田 達也; 有馬 秀幸; 戸川 大輔; 松山 幸弘
    Journal of Spine Research (一社)日本脊椎脊髄病学会 5 (10) 1433 - 1437 1884-7137 2014/10 
    Sagittal vertical axis(SVA)は、脊柱矢状面バランスのパラメーターとして広く用いられ健康関連QOL(health related quality of life:HRQOL)とよく相関することが知られているが、骨盤や下肢により代償されるという問題がある。しかし、骨盤や下肢の代償により、HRQOLがどう変化するか検討した報告は少ない。そこで、骨盤下肢アライメントも成人脊柱変形患者の手術成績を左右するかどうか、骨盤下肢アライメントを含めた矢状面脊柱バランスとHRQOLの関係を検討した。成人脊柱変形手術を行った127例のうち、術前と術後1年時にLumbar lordosis(LL)、Pelvic tilt(PT)、SVA、大腿屈曲角(Angle of Femoral Obliquity:FOA)を立位全脊柱X線像より計測し、Oswestry Disability Index(ODI)とJOABPEQ、SRS22を評価した60例を対象とした。矢状面脊柱バランスは、C7垂線が大腿骨頭中心から仙椎の間にあり、PT<22°、FOA<10°を満たす症例をideal balance(A群)とし、C7垂線が骨頭中心より前方にあるが、PT<22°、FOA<10°を満たした症例をeconomy balance(B群)、PT>22°、FOA<10°であった症例をcompensated balance(C群)、PT>22°、FOA>10°であった症例をpoor balance(D群)として4群に分け、それぞれ術後1年での健康関連QOLを比較検討した。術前後ODI、JOABPEQとSRS22各ドメインは、矢状面バランスが不良で代償が大きければ有意に悪化した。術前後のHRQOLは、骨盤下肢アライメントを包括した矢状面バランス分類と良く相似し、骨盤や下肢の代償があればQOLは低下していた。SVAが正常であるのみならず、骨盤や下肢の代償が起こらない脊柱バランスを獲得することが、手術では良好な成績につながった。(著者抄録)
  • 小林 祥; 長谷川 智彦; 大和 雄; 安田 達也; 有馬 秀幸; 戸川 大輔; 松山 幸弘
    Journal of Spine Research (一社)日本脊椎脊髄病学会 5 (7) 1039 - 1042 1884-7137 2014/07 
    成人脊柱変形に対する脊柱骨切り手術による、神経合併症について検討した。当科にてポンテ骨切り術、Pedicle subtraction osteotomy、Vertebral column resectionを行った109例を対象とした。術中脊髄モニタリングの閉創時の最終波形変化は12例(11%)、術後麻痺は7例(6.4%)に出現した。6例(5.5%)ではモニタリング波形変化があったが、閉創までに回復した。感度は100%、特異度は92%であった。術後麻痺を予知し、およそ半数の症例で術後麻痺を回避でき、モニタリングは有用と考えた。(著者抄録)
  • 有馬 秀幸; 長谷川 智彦; 大和 雄; 戸川 大輔; 小林 祥; 安田 達也; 松山 幸弘
    Journal of Spine Research (一社)日本脊椎脊髄病学会 5 (7) 1070 - 1076 1884-7137 2014/07 
    顕微鏡下に摘出術を施行した脊髄髄内血管芽腫8例における術前後の疼痛変化を調査した。全例脊髄モニタリング下に施行した。術後に2例で疼痛が改善し、3例で不変、3例で悪化した。腫瘍の局在では、頸椎の髄内型で術後の疼痛悪化例が多かった。また、腫瘍がDorsal root entry zoneの軟膜下に発生し、術中に同部位を処置した6例中3例で疼痛が悪化しており腫瘍の局在が術後の疼痛に関連していると考えられた。(著者抄録)
  • 大和 雄; 松山 幸弘; 長谷川 智彦; 戸川 大輔; 小林 祥; 安田 達也; 有馬 秀幸
    日本臨床整形外科学会雑誌 (一社)日本臨床整形外科学会 39 (2) 247 - 251 1881-7149 2014/07 
    慢性腰痛を主訴に整形外科診療所を受診した症例の腰椎骨盤の矢状面アライメントとquality of life(以下QOL)との関連について、多施設で横断的に調査し検討した。対象は、静岡県臨床整形外科医会会員の33施設を慢性腰痛のために受診した405例(平均年齢71.5歳、男性121例、女性284例)である。脊柱矢状面アライメントの評価のために、立位での腰椎および骨盤のX線写真側面像を撮影した。またvisual analogue scale(VAS)による腰痛の評価と、QOLおよび胃食道逆流症(gastroesophageal reflux disease、以下GERD)の評価のためのアンケートを行った。結果、脊柱骨盤矢状面アライメントとQOLや疼痛との間に、軽度の関連性がみられた。GERDの頻度と脊柱アライメントとの間には、関連性はなかった。成人脊柱変形は、多様な病態、多彩な症状を呈する疾患である。また、高齢者が多く、脊柱変形以外の要素がQOLに影響していたと考えられた。本研究は、大学病院と診療所で連携した共同多施設調査の試みであり、今後も継続していきたい。(著者抄録)
  • HOSHINO Hironobu
    The Central Japan Journal of Orthopaedic Surgery & Traumatology THE CENTRAL JAPAN ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 57 (4) 807 - 808 0008-9443 2014/07 
    住民検診で運動器検診および全脊椎・下肢全長単純X線写真を撮影した50歳以上の691名(男273名、女418名)を対象に、ロコモ25の自己記入式アンケートとEQ5Dを用いた自己記入式アンケートを行い、脊椎と下肢の運動器疾患の有無がロコモティブシンドロームとQOLに及ぼす影響を調査した。男性は正常群65例・脊椎疾患群84例・下肢疾患群31例・脊椎・下肢両疾患群93例であり、女性では正常群59例・脊椎疾患群77例・下肢疾患群66例・両疾患群214例であった。男女とも両疾患群が正常群と脊椎疾患群と比較して有意に高齢であった。各群間で年齢の影響を除外して検討すると、ロコモ25は男性では正常群と脊椎疾患群と比較して両疾患群が有意に高値であり、女性では正常群と比較して両疾患群が有意に高値であった。EQ5Dは男性では正常群と脊椎疾患群と比較して両疾患群が有意に低値であり、女性では正常群と比較して両疾患群が有意に低値であった。
  • Go Yoshida; Tatsuya Yasuda; Daisuke Togawa; Tomohiko Hasegawa; Yu Yamato; Sho Kobayashi; Hideyuki Arima; Hironobu Hoshino; Yukihiro Matsuyama
    Spine 39 (14) 1121 - 7 2014/06 
    STUDY DESIGN: Prospective radiographical analysis using the cranial center of gravity (CCG) of sagittal vertical axis (SVA) in elderly asymptomatic individuals. OBJECTIVE: To determine sex differences and age-related correlations of CCG and relationships between CCG and other spinopelvic parameters/health-related quality of life (HRQOL) measures. SUMMARY OF BACKGROUND DATA: Few studies have investigated CCG in a relatively large sample of elderly asymptomatic individuals. METHODS: Six hundred seventy-one healthy participants older than 50 years (mean age, 72.9 yr; range, 50-92 yr) were enrolled. Whole-spine standing radiographs were obtained. The following radiographical measurements were obtained: (1) CCG-C7 SVA, (2) C7-SVA, (3) CCG-SVA, (4) C2-C7 lordosis angle, (5) thoracic kyphosis, (6) lumbar lordosis, (7) pelvic incidence, and (8) sacral slope. HRQOL measures included the EuroQol-5D and Oswestry Disability Index. Pearson product-moment correlation coefficients were calculated between pairs of radiographical measures and HRQOL. RESULTS: Sex differences were observed in CCG-C7 SVA, CCG-SVA, C2-C7 Cobb angle, thoracic kyphosis, and pelvic incidence. Three SVA parameters (CCG-C7 SVA, C7-SVA, CCG-SVA) rapidly increased between seventh and ninth decades and were approximately 40, 80, and 120 mm, respectively, in the ninth decade. Age-related correlations were observed for all parameters without pelvic incidence, and the CCG measurement correlated the most with age. Furthermore, CCG-SVA correlated with other spinopelvic measurements and HRQOL. CONCLUSION: Age-related changes and sex difference in craniopelvic alignment were analyzed. Craniopelvic alignment became rapidly positive with age, particularly in the eighth decade. The CCG measurement correlated the most with age and may be a useful index marker of global spinal balance in decision making for surgical treatment of adult deformity involving cervical and thoracolumbar lesions. LEVEL OF EVIDENCE: 4.
  • H. Arima; M. Hanada; T. Hayasaka; N. Masaki; T. Omura; D. Xu; T. Hasegawa; D. Togawa; Y. Yamato; S. Kobayashi; T. Yasuda; Y. Matsuyama; M. Setou
    Neuroscience Elsevier BV 269 1 - 10 0306-4522 2014/06
  • 大和 雄; 長谷川 智彦; 小林 祥; 安田 達也; 戸川 大輔; 松山 幸弘
    Journal of Spine Research (一社)日本脊椎脊髄病学会 5 (6) 905 - 908 1884-7137 2014/06 
    骨粗鬆症性椎体骨折を伴う脊柱変形24例の、脊柱骨盤矢状面パラメータと健康関連quality of life(QOL)を、脊柱変形型別に検討した。円背は胸椎の後彎を腰椎で代償しており、QOLも他の変形に比べ良好だった。亀背は局所後彎変形を胸椎および骨盤で代償していたがややグローバルアライメントは不良であった。全後彎は変形が代償されておらずグローバルアライメントが不良であり、QOLが最も低下していた。(著者抄録)
  • 安田 達也; 長谷川 智彦; 大和 雄; 小林 祥; 戸川 大輔; 松山 幸弘
    Journal of Spine Research (一社)日本脊椎脊髄病学会 5 (6) 914 - 916 1884-7137 2014/06 
    成人脊柱変形患者の愁訴につきSRS-22の各ドメインでの評価を年齢を3群に分けて行った。高齢者のほうがより機能的に障害が強く、疼痛も強い傾向であった。しかしながら整容面や精神面でのスコアでは年齢間に差はなく高齢者であっても自らの容姿に対するコンプレックスがあり精神的にもダメージを受けているため手術を希望しているとの結果であった。(著者抄録)
  • 用語解説 骨粗鬆症性椎体骨折編 新鮮骨折と陳旧性骨折
    戸川 大輔
    脊椎脊髄ジャーナル (株)三輪書店 27 (5) 557 - 559 0914-4412 2014/05
  • ARIMA Hideyuki
    The Central Japan Journal of Orthopaedic Surgery & Traumatology THE CENTRAL JAPAN ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 57 (3) 551 - 552 0008-9443 2014/05 
    手術加療を行った成人脊柱変形症22例(男性3例、女性19例、平均71歳)を対象に、術後の歩行姿勢の改善が及ぼす社会生活機能について検討した。術前と術後1年時の4m歩行での1サイクル(片足踵接地から次の踵接地まで)中におけるC7棘突起と大転子の水平距離を連続的に測定し、その平均値(C7PGD)を歩行時矢状面パラメータとした。C7PGDは術前で-90〜210mmと前傾例が散見され、術後1年時で-60〜90mmと体幹バランスは改善していた。C7PGD≦0の歩行姿勢良好群(C群)は8例、C7PGD>0の歩行姿勢前傾群(N群)は14例であった。両群の患者背景ではC群の方が手術時年齢が有意に若かった(65歳vs72歳)。SRS-22スコアは術後1年で全例が全項目とも改善した。術前のSRS-22スコアは全項目でC群が高値を示し、特にメンタルヘルスの項目で有意に高値であった。術後1年時のSRS-22スコアは両群とも全項目で改善し、C群ではN群に比べ全項目で高値を示した。
  • 仙骨部perineural cystに対してcyst-subarachnoidシャントを施行した1例
    大和 雄; 長谷川 智彦; 小林 祥; 安田 達也; 戸川 大輔; 有馬 秀幸; 松山 幸弘
    東海脊椎外科 東海脊椎脊髄病研究会 28 39 - 42 0913-476X 2014/04 
    42歳女。立位や座位をとると右臀部痛が出現し、徐々に右大腿後面まで疼痛が広がった。さらに立位や座位を続けていると右下腿の後面にしびれ感が出現し、5分以上の立位や座位の保持は不能であった。単純X線像では第2仙椎の椎体後壁にscallopingを認め、右S2神経根造影およびブロックを施行すると、一時的に症状の改善を認めた。以上の所見から、右S2神経根に発生したperineural cystと診断し、嚢腫内からクモ膜下腔へのシャント術(cyst-subarachnoid shunt)を施行した。術後、臀部痛と下肢痛は速やかに軽快し、立位と座位の保持が可能となった。術後6ヵ月が経過したが、症状の再発は認めていない。
  • HOSHINO Hironobu
    The Central Japan Journal of Orthopaedic Surgery & Traumatology THE CENTRAL JAPAN ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 57 (1) 41 - 42 0008-9443 2014/01 
    中山間地域(愛知県東栄町)の50歳以降の住民検診で運動器検診を行い、立位下肢全長単純X線写真が撮影された691例を対象に下肢変形性関節症の頻度を調査した。股関節の評価はCE角20°未満の臼蓋形成不全または関節裂隙の狭小化のある初期股関節症以上のものを変形性股関節症ありとし、膝関節の評価はKellgren and Lawrenceのgrade II以上を変形性膝関節症ありとした。その結果、変形性膝関節症の頻度は加齢と共に増加する傾向があった。各疾患で正常群・片側群・両側群に分けて年齢の影響を調べたところ、変形性膝関節症では男女とも正常群に比べ両側群で有意に高齢であった。また、BMIの影響を調べたところ、変形性股関節症では女性において正常群に比べ両側群で有意にBMIが低く、変形性膝関節症では女性において両側群で有意にBMIが高かった。以上より、女性では両側変形性股関節症が痩せと関連し、変形性膝関節症は男性では加齢、女性では加齢と肥満が関連すると考えられた。
  • 有馬 秀幸; 大和 雄; 長谷川 智彦; 戸川 大輔; 小林 祥; 安田 達也; 松山 幸弘
    Journal of Spine Research (一社)日本脊椎脊髄病学会 4 (11) 1703 - 1708 1884-7137 2013/11 
    脊柱矯正固定術を施行した成人脊柱変形患者11例の術前と術後1年の歩行解析を行った。5例で術前に立位矢状面バランスと歩行時矢状面バランスに乖離があった。また、矯正術後1年時には、立位矢状面バランスと歩行時矢状面バランスはともに改善し、両者の間には乖離する症例はなかった。矯正手術により脊椎と骨盤のアライメントが改善した事がこの結果に寄与している可能性がある。(著者抄録)
  • You-Qiang Song; Tatsuki Karasugi; Kenneth M C Cheung; Kazuhiro Chiba; Daniel W H Ho; Atsushi Miyake; Patrick Y P Kao; Kit Ling Sze; Anita Yee; Atsushi Takahashi; Yoshiharu Kawaguchi; Yasuo Mikami; Morio Matsumoto; Daisuke Togawa; Masahiro Kanayama; Dongquan Shi; Jin Dai; Qing Jiang; Chengai Wu; Wei Tian; Na Wang; John C Y Leong; Keith D K Luk; Shea-ping Yip; Stacey S Cherny; Junwen Wang; Stefan Mundlos; Anthi Kelempisioti; Pasi J Eskola; Minna Männikkö; Pirkka Mäkelä; Jaro Karppinen; Marjo-Riitta Järvelin; Paul F O'Reilly; Michiaki Kubo; Tomoatsu Kimura; Toshikazu Kubo; Yoshiaki Toyama; Hiroshi Mizuta; Kathryn S E Cheah; Tatsuhiko Tsunoda; Pak-Chung Sham; Shiro Ikegawa; Danny Chan
    The Journal of clinical investigation 123 (11) 4909 - 17 2013/11 
    Lumbar disc degeneration (LDD) is associated with both genetic and environmental factors and affects many people worldwide. A hallmark of LDD is loss of proteoglycan and water content in the nucleus pulposus of intervertebral discs. While some genetic determinants have been reported, the etiology of LDD is largely unknown. Here we report the findings from linkage and association studies on a total of 32,642 subjects consisting of 4,043 LDD cases and 28,599 control subjects. We identified carbohydrate sulfotransferase 3 (CHST3), an enzyme that catalyzes proteoglycan sulfation, as a susceptibility gene for LDD. The strongest genome-wide linkage peak encompassed CHST3 from a Southern Chinese family–based data set, while a genome-wide association was observed at rs4148941 in the gene in a meta-analysis using multiethnic population cohorts. rs4148941 lies within a potential microRNA-513a-5p (miR-513a-5p) binding site. Interaction between miR-513a-5p and mRNA transcribed from the susceptibility allele (A allele) of rs4148941 was enhanced in vitro compared with transcripts from other alleles. Additionally, expression of CHST3 mRNA was significantly reduced in the intervertebral disc cells of human subjects carrying the A allele of rs4148941. Together, our data provide new insights into the etiology of LDD, implicating an interplay between genetic risk factors and miRNA.
  • 戸川 大輔
    整形外科Surgical Technique (株)メディカ出版 3 (5) 515 - 526 2185-7733 2013/10
  • 小林 祥; 長谷川 智彦; 大和 雄; 安田 達也; 有馬 秀幸; 戸川 大輔; 松山 幸弘
    別冊整形外科 (株)南江堂 1 (64) 43 - 48 0287-1645 2013/10 
    後方矯正固定術を行った特発性思春期側彎症27例を対象に、術中X線像と術後肩バランスを比較検討した。その結果、術後肩バランスは矯正X線像のTh1 tiltと有意な相関を示し、術中ならびに術後Th1 tiltは肩バランスの指標として有用であることが示唆された。また、Th1 tilt 7°以上では有意に術後の肩バランスが不良であり、術中はTh1 tiltを目安にして矯正を行う必要があると考えられた。
  • 小林 祥; 長谷川 智彦; 大和 雄; 安田 達也; 戸川 大輔; 松山 幸弘
    Journal of Spine Research (一社)日本脊椎脊髄病学会 4 (10) 1471 - 1475 1884-7137 2013/10 
    成人脊柱変形患者に対して矯正固定術を行った78例を対象とし、術前後の矢状面下肢アライメントを検討した。術後、下肢アライメントは有意に改善し、またODIやJOABPEQ歩行機能障害も改善した。成人脊柱変形に対する矯正固定術により矢状面下肢アライメントが改善し、QOLの向上が得られた。(著者抄録)
  • 安田 達也; 長谷川 智彦; 大和 雄; 小林 祥; 戸川 大輔; 有馬 秀幸; 松山 幸弘
    Journal of Spine Research (一社)日本脊椎脊髄病学会 4 (9) 1360 - 1362 1884-7137 2013/09 
    成人脊柱変形手術における腰椎前彎の獲得は重要である。腰椎前彎を獲得した際に胸椎がどのような変化をするのかを調査した。36例の手術例で検討したところ、術前の胸椎後彎角が少ないほど術後大きく後彎を獲得するという結果であり、術後の胸椎後彎角はある一定の値に収束していくと考えられた。胸椎は腰椎の前彎を獲得することにより至適な後彎角度が獲得できている可能性があるが、更なる検討が必要である。(著者抄録)
  • ARIMA Hideyuki
    The Central Japan Journal of Orthopaedic Surgery & Traumatology THE CENTRAL JAPAN ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 56 (5) 1291 - 1292 0008-9443 2013/09 
    成人脊柱変形症の12例(全例女性、手術時平均年齢65歳)を対象として、矯正固定術前後の歩行解析結果とJOABPEQ歩行機能障害スコアの関連について検討した。術式は中下位胸椎から下位腰椎もしくは骨盤までの後方矯正固定術で、術前と術後1年時にホームビデオを用いて簡易的に歩行解析を行った。その結果、歩行時矢状面パラメータであるC7PGDは術前平均23mmで、体幹の前傾例も後傾例もみられていた。術後1年時には、前傾例も後傾倒も共に歩行時体幹バランスは改善していた。立位矢状面X線パラメータであるsagittal vertical axisは、術前平均86mmが術後1年時には平均30mmへと改善となった。JOABPEQ歩行機能障害スコアでは、術前平均35ポイントから術後平均64ポイントへと有意に改善し、11例中8例では歩行機能障害スコアが術後に20ポイント以上改善となり、歩行機能障害スコアが改善しなかった3例においては、C7PGDに改善が認められた。
  • 戸川 大輔; 松山 幸弘
    関節外科 (株)メジカルビュー社 32 (7) 816 - 820 0286-5394 2013/07
  • 大和 雄; 長谷川 智彦; 小林 祥; 安田 達也; 戸川 大輔; 松山 幸弘
    Journal of Spine Research (一社)日本脊椎脊髄病学会 4 (7) 1102 - 1106 1884-7137 2013/07 
    パーキンソン病に伴う重度のrigidな脊柱変形を生じている5例に対して、椎体骨切りを併用した後方広範囲矯正固定術を施行した。術前後のX線像パラメータ、術中出血、手術時間、合併症について検討した。手術侵襲は大きかったが術後全例でADLの改善が得られ、合併症も重篤なものはなく経過良好であった。(著者抄録)
  • YAMATO Yu
    The Central Japan Journal of Orthopaedic Surgery & Traumatology THE CENTRAL JAPAN ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 56 (4) 959 - 960 0008-9443 2013/07 
    成人脊柱変形の矯正固定術を施行した症例のうち、50歳以下で神経筋疾患、歩行不能例、股関節疾患合併例を除いた50症例を対象に調査検討した。歩行時常に大腿が垂線より屈曲している症例を大腿屈曲群(FF群)、一時期でも大腿が伸展している症例を大腿伸展群(FE群)とした。FF群は16例、FE群は34例で、平均年齢はFF群68歳、FE群72歳であった。X線パラメータであるsagittal vertical axis、pelvic incidence、pelvictilt(PT)のそれぞれの平均値はFF群(154mm、58°、40°)、FE群(81mm、51°、29°)とFF群で有意に大きかった。また、健康関連QOLではOswestry disability indexの平均はFF群50%、FE群42%で、FF群で大きい傾向にあった。JOABPEQは平均FF群で(15、34)、FE群で(39、52)であり、FF群で有意に低値であった。
  • トガワ ダイスケ
    整形・災害外科 金原出版(株) 56 (7) 821 - 830 0387-4095 2013/06
  • 【加齢と姿勢異常】成人脊柱変形の脊柱骨盤矢状面アライメントと矯正術
    大和 雄; 松山 幸弘; 長谷川 智彦; 戸川 大輔; 小林 祥; 安田 達也
    脊椎脊髄ジャーナル (株)三輪書店 26 (6) 653 - 658 0914-4412 2013/06
  • 有馬 秀幸; 長谷川 智彦; 大和 雄; 戸川 大輔; 小林 祥; 安田 達也; 松山 幸弘; 三原 唯暉; 鈴木 義司; 村田 英之
    静岡整形外科医学雑誌 静岡県整形外科医会 6 (1) 19 - 22 1882-3998 2013/05 
    本研究では成長期の腰痛症患者における腰椎分離症新鮮例のMRIによる発生頻度を調査した。18歳以下の主訴が腰痛である患者133例を対象とした。MRIの脂肪抑制T2強調像を撮像し、椎弓根にHigh Signal Changeを認める症例を腰椎分離症新鮮例と診断した。結果は133例中60例(45%)が腰椎分離症新鮮例であった。年齢別には14歳から15歳にそのピークがあった。罹患高位では第4、5腰椎が多く、第5腰椎分離症例は39例48椎弓で、全体の65%であった。両側第5腰椎分離症は9例(15%)、対側椎弓偽関節の片側例は11例(18%)であった。腰椎分離症新鮮例の発生頻度は過去の報告とほぼ同程度であった。(著者抄録)
  • 三原 唯暉; 山下 大輔; 鈴木 隆辰; 鈴木 義司; 村田 英之; 安田 達也; 有馬 秀幸; 小林 祥; 大和 雄; 戸川 大輔; 長谷川 智彦; 松山 幸弘
    静岡整形外科医学雑誌 静岡県整形外科医会 6 (1) 23 - 26 1882-3998 2013/05 
    近年、腰椎後彎症の矯正術であるpedicle subtraction osteotomyについて多くの報告がされるようになってきている。しかし、それに伴って短縮椎体の偽関節やそれに伴うrodの折損例なども報告されてきている。短縮椎体の偽関節は短縮椎体がfree bodyとなることが原因であると我々は考えている。そこで当科におけるPSOでは局所後彎が最も強い椎体でLehmerの骨切りに準じて短縮椎体の骨切りを施行した上、さらに短縮椎体の上下に椎体間固定を施行している。この方法により短縮椎体が偽関節となることが予防できると考える。(著者抄録)
  • Satoshi Mori; Satoshi Soen; Hiroshi Hagino; Tetsuo Nakano; Masako Ito; Saeko Fujiwara; Yoshiharu Kato; Yasuaki Tokuhashi; Daisuke Togawa; Naoto Endo; Takeshi Sawaguchi
    Journal of bone and mineral metabolism Springer Science and Business Media LLC 31 (3) 258 - 261 0914-8779 2013/05 
    Justification Criteria for Vertebral Fractures 2012 version was made based on new clinical findings. Major differences in this version compared to the 1996 version are inclusion of the semiquantitative method (SQ), statements to improve considerations during radiographic analysis, and the need for more detailed evaluation by MRI.
  • 戸川 大輔; 松山 幸弘
    日本臨床 (株)日本臨床社 71 (増刊2 最新の骨粗鬆症学) 484 - 487 0047-1852 2013/04
  • パーキンソン病に伴うrigidな脊椎後彎変形に対して椎体骨切りを併用した広範囲後方固定術を施行した1例
    大和 雄; 長谷川 智彦; 小林 祥; 安田 達也; 戸川 大輔; 有馬 秀幸; 松山 幸弘
    東海脊椎外科 東海脊椎脊髄病研究会 27 14 - 17 0913-476X 2013/04 
    症例はパーキンソン病の既往を有する75歳女性で、腰背部痛、腹部の圧迫感、歩行障害を主訴に当科を受診した。受診時、体幹バランス不良のため独歩困難であった。立位全脊柱単純X線、CT所見より、Th12の圧迫骨折を伴う重度の脊柱後彎変形と診断し、保存療法が無効であったため、Th12の椎体亜全摘を併用したTh7〜S1の広範囲後方矯正固定術を行った。術後、脊柱変形は著明に改善し、術後1年の時点でT字杖歩行可能であり、Oswestry disability indexは術前58%が術後44%に改善した。
  • 戸川 大輔; 松山 幸弘
    Orthopaedics (株)全日本病院出版会 26 (3) 23 - 29 0914-8124 2013/03 
    超高齢社会である日本では、今後さらに骨粗鬆症患者が増加すると想定される。骨折予防効果のある薬物が多数存在するにも関わらず、現段階ではその投薬率は低い。骨粗鬆症患者において椎体骨折は最も高頻度に発生する骨折である。したがって骨粗鬆症性椎体骨折に対する治療、およびその臨床成績が注目されている。Balloon kyphoplasty(以下、BKP)は骨粗鬆症性椎体骨折、溶骨性脊椎腫瘍に対して行う経皮的椎体形成術の一手術手技であり、2011年1月に本邦での保険診療が可能となった。約8割の椎体骨折は2〜3ヵ月の適切な保存療法にて骨癒合が得られ、QOLを再獲得できるが、約2割の椎体骨折は遷延治癒、偽関節と進行し著明な体動時痛のためにQOLが障害される。本稿では骨粗鬆症性椎体骨折に対するBKPの手術適応とその介入時期、手技、治療効果、QOLへの影響、および合併症とその対策について述べる。(著者抄録)
  • 小林 祥; 長谷川 智彦; 安田 達也; 大和 雄; 戸川 大輔; 木村 竜希; 田仲 飛鳥; 川村 茂之; 松山 幸弘
    脊髄機能診断学 エーザイ(株) 34 (1) 90 - 93 2013/02 
    600V前後でパルス間隔(IPI)2ミリ秒(ms)の5連発刺激、0.9Hzにて平均加算5〜20回で記録した25名(MPS群)、200mAでIPI 2msの5連発刺激をsingle-train刺激(STS)とした25名(STS群)、double-train刺激としてSTSをトレイン間隔20msで繰り返し刺激した147名(DTS群)を対象に、筋誘発電位を記録し比較検討した。導出率はMPS群で87%、STS群で92.3%、DTS群で96.2%であった。術前筋力と導出率との関係では、MMT(徒手筋力テスト)3、4ではDTS群において有意に導出率が高かった。感度は100%、特異度はMPS群78%、STS群86%、DTS群92%と、DTSで比較的よい特異度が得られた。DTSは脊椎脊髄手術を安全かつ迅速に行うために有用なモニタリング法であると考えられた。
  • 木村 竜希; 小林 祥; 安田 達也; 大和 雄; 戸川 大輔; 長谷川 智彦; 田仲 飛鳥; 川村 茂之; 松山 幸弘
    脊髄機能診断学 エーザイ(株) 34 (1) 94 - 97 2013/02 
    術中脊髄機能モニタリングを行った50名(男23名、女27名、平均54歳)を対象に検討した。刺激時間間隔(ISI)2ミリ秒(ms)、5連発刺激をsingle train刺激(ST)、ISI 2ms、5連発刺激をトレイン間隔(ITI)20msで2回行う刺激をshort interval-double train刺激(S-DT)、ISI 2ms、5連発刺激をITI 200msで2回行う刺激をlong interval-double train刺激(L-DT)とし、筋誘発電位を記録した。全導出波形の平均振幅はSTで520μV、S-DTで990μV、L-DTで781μVであった。STで導出困難であったのは16%で、その半数以上はS-DTで大きな振幅が得られた。S-DTはST、L-DTに比べ平均振幅が有意に高く、波形増強効果がある有用な刺激方法である。
  • 田仲 飛鳥; 小林 祥; 長谷川 智彦; 大和 雄; 安田 達也; 木村 竜希; 川村 茂之; 戸川 大輔; 松山 幸弘
    脊髄機能診断学 エーザイ(株) 34 (1) 204 - 208 2013/02 
    神経合併症の頻度が高いとされている脊髄円錐部腫瘍の摘出術において、肛門括約筋電極を用いた術中脊髄モニタリングを行った。術中モニタリングにて電位の低下(コントロール波形より振幅70%低下)が認められたのは2名で、1名は腫瘍摘出の際に電位が低下、次第に回復が認められたfalse positive、1名は摘出後に電位消失し、回復が認められなかったtrue positiveであった。術中に肛門括約筋電位の変動が認められることにより、術後膀胱直腸障害の予見ができ、手術操作の中断やステロイド投与などの神経合併症回避のための対策をとることができた。
  • 有馬 秀幸; 村田 英之; 長谷川 智彦; 戸川 大輔; 大和 雄; 小林 祥; 安田 達也; 坂野 友啓; 松山 幸弘
    臨床整形外科 (株)医学書院 48 (1) 81 - 85 0557-0433 2013/01 
    軸椎歯突起後方偽腫瘍(以下,偽腫瘍)は,環軸椎不安定性に起因する非腫瘍性腫瘤と考えられている.5例を経験し治療法を検討した.環軸椎に不安定性のない2例に対し後方除圧術を施行し,そのうち1例に術後腫瘤の増大があり後頭頸椎後方除圧固定術を施行した.環軸椎に不安定性のある3例に対しては後方固定術を施行した.後頭頸椎後方固定を施行した1例で術後速やかに腫瘤が縮小した.偽腫瘍は環軸椎関節への機械的刺激により反応性に形成されるため,固定術を行うことが望ましい.神経症状が急速に悪化している場合に後頭頸椎後方除圧固定術は有効であった.(著者抄録)
  • 森 諭史; 宗圓 聰; 萩野 浩; 中野 哲雄; 伊東 昌子; 藤原 佐枝子; 加藤 義治; 徳橋 泰明; 戸川 大輔; 遠藤 直人; 澤口 毅; 椎体骨折評価委員会
    Osteoporosis Japan ライフサイエンス出版(株) 21 (1) 25 - 32 0919-6307 2013/01
  • 大和 雄; 長谷川 智彦; 戸川 大輔; 小林 祥; 安田 達也; 松山 幸弘
    静岡整形外科医学雑誌 静岡県整形外科医会 5 (2) 77 - 81 1882-3998 2012/11 
    成人で脊柱変形を有する患者の中には強い腰背部痛を訴えることがあり、慢性難治性腰痛として治療されている症例もある。オピオイドにて鎮痛治療がされていた脊柱変形を伴う慢性腰痛症例2例に対して胸腰椎後方矯正固定術を施行し、経過良好であったので報告する。症例1:80歳男性。腰痛、臀部痛、腰痛性間欠跛行を主訴とした。塩酸モルヒネにて疼痛コントロールがされていた。腰椎前彎が減少し、矢状面バランスの高度不良を認めたため、脊柱変形による症状と考えT8から骨盤までの矯正固定術を施行した。術後疼痛は軽減し退院時にはオピオイド離脱も可能となった。症例2:65歳女性。腰痛、臀部痛のために塩酸モルヒネで疼痛がコントロールされていた。胸腰椎の後側彎変形が強く矢状面、冠状面ともにバランスが不良であった。胸腰椎矯正固定術を施行し、症状は軽快した。慢性難治性の腰痛は社会心理的な要素もあり、診断治療に難渋することがある。慢性腰痛患者に脊柱矢状面でのバランス不良を認めた際には脊柱変形による腰痛も念頭に置く必要がある。(著者抄録)
  • 小林 祥; 長谷川 智彦; 大和 雄; 安田 達也; 有馬 秀幸; 戸川 大輔; 松山 幸弘
    別冊整形外科 (株)南江堂 1 (62) 124 - 129 0287-1645 2012/10 
    腰部脊柱管狭窄症に伴うL5神経根椎間孔部・孔外部障害6例に斜位MRI(神経根の走行に沿った斜位像の撮影)を行い、その有用性について検討した。その結果、メタルアーティファクトの1例を除いて神経根障害の部位を詳細に把握でき、術中所見と一致する圧迫所見が認められた。代表例2例を提示した。
  • 骨粗鬆症性圧迫骨折患者の早期離床によるADLの拡大について Balloon Kyphoplastyの効果
    佐藤 智彦; 酒井 亜希子; 谷藤 典子; 藤原 祐美子; 村本 智代; 宇田 聡子; 戸川 大輔
    函館中央病院医誌 函館中央病院 (14) 43 - 45 1341-9056 2012/10
  • 長谷川 智彦; 大和 雄; 小林 祥; 戸川 大輔; 安田 達也; 松山 幸弘
    臨床整形外科 (株)医学書院 47 (9) 857 - 864 0557-0433 2012/09 
    成人側彎症の特徴と,手術治療について思春期特発性側彎症との相違点を提示し,成人側彎症手術の特性について言及した.また,成人側彎症の矯正固定手術における安全性を高めるために,当科で行っている方策のうち,多数筋モニターによる脊髄,神経根モニタリングと術中2D,3Dイメージ取得可能なO-armイメージ下でのナビゲーションを用いた矯正固定手術について,参考症例を提示し,その有用性について述べた.また術中,術後の出血低減のために行っている7つの方法,注意点について述べた.(著者抄録)
  • 【骨粗鬆症性椎体骨折に対する最小侵襲手術】骨粗鬆症性椎体骨折に対するBalloon Kyphoplasty
    戸川 大輔; 松山 幸弘
    整形外科最小侵襲手術ジャーナル (株)全日本病院出版会 (64) 59 - 66 1342-3991 2012/09 
    Balloon Kyphoplasty(以下、BKP)は骨粗鬆症性椎体骨折、溶骨性脊椎腫瘍に対して行う経皮的椎体形成術の一手術手技である。この手術は1998年にアメリカで始められた、従来の経皮的椎体形成術(percutaneous vertebroplasty)の改良型である。本邦では保存療法が無効であった原発性骨粗鬆症性椎体骨折の遷延治癒に対する治療としてBKPの多施設共同試験が2005年8月から行われた。術後2年の臨床成績は良好な疼痛緩和と安全性を示した。この手術手技は2010年2月に薬事承認され、さらに2011年1月に、BKP専用のトレーニングを受けた医師の治療に対する保険適応が許可された。さらに2012年4月には新たな診療報酬コード(K142-4)が付けられた。本稿では骨粗鬆症性椎体骨折に対するBKPの適応、手技、治療効果、QOLへの影響、および合併症とその対策について述べる。(著者抄録)
  • 【運動器の10年-ロコモティブシンドロームと骨折】原発性骨粗鬆症性椎体骨折に対するBalloon Kyphoplasty
    戸川 大輔
    クリニシアン エーザイ(株) 59 (7) 680 - 685 0387-1541 2012/07
  • 戸川 大輔; 松山 幸弘
    Orthopaedics (株)全日本病院出版会 25 (7) 55 - 60 0914-8124 2012/06 
    65歳以上が約23%を占める超高齢社会の日本では、今後も益々高齢者率が増加し続け、男女ともに有訴者率の高い腰背部痛に対する医療対策が急務となっている。骨粗鬆症の患者は高頻度に腰背部痛を訴えることから、骨粗鬆症の病態が高齢者の腰背部痛に関与していると考えられており、骨粗鬆症の病態による疼痛発症の詳細なメカニズムが多方面から検討されている。骨粗鬆症患者の腰背部痛には一般に薬物治療、運動療法などが効果的である。骨粗鬆症を背景として最も頻繁に発生する脆弱性骨折は脊椎椎体骨折であり、この骨折に対してまず施行される保存療法の臨床成績は一般に良好である。しかし一定率(約10〜20%)で発症する遷延治癒、椎体偽関節に対しては、これを放置することなく治療する必要がある。低侵襲な椎体形成術はその選択肢のひとつであり、早期に腰背部痛を緩和し、高齢者のQOLの再獲得に有効である。(著者抄録)
  • 戸川 大輔
    日本医事新報 (株)日本医事新報社 (4589) 50 - 51 0385-9215 2012/04
  • 戸川 大輔; 松山 幸弘
    整形外科Surgical Technique (株)メディカ出版 2 (2) 204 - 207 2185-7733 2012/04
  • 徳橋 泰明; 森 諭史; 宗圓 聰; 萩野 浩; 中野 哲雄; 伊東 昌子; 藤原 佐枝子; 加藤 義治; 戸川 大輔; 遠藤 直人; 椎体骨折評価委員会
    日本整形外科学会雑誌 (公社)日本整形外科学会 86 (4) 196 - 199 0021-5325 2012/04
  • 【椎体形成とkyphoplastyの最新情報】Balloon kyphoplastyの手技と日本における現状
    戸川 大輔; 松山 幸弘
    脊椎脊髄ジャーナル (株)三輪書店 25 (3) 183 - 188 0914-4412 2012/03
  • 戸川 大輔; 金山 雅弘; 重信 恵一; 大羽 文博; 長濱 賢; 橋本 友幸; 仲村 真実; 宇美 由美; 宇田 聡子; 田中 静子
    日本整形外科学会雑誌 (公社)日本整形外科学会 85 (12) 928 - 933 0021-5325 2011/12 
    原発性骨粗鬆症性圧迫骨折の患者について、骨折発生または疼痛発症から3ヵ月後(12週後)の偽関節率、QOL障害、およびそれらの相関性について検討した。原発性骨粗鬆症性新鮮圧迫骨折患者57例69骨折を対象とした。骨折椎体内に大、小に関わらずcleftを認めたのは69骨折中28骨折で、偽関節と評価されたのは69骨折中10骨折であった。これら偽関節10骨折の3ヵ月保存療法後のCTで、明らかな椎体後壁損傷、不安定性は認めず、脊髄障害や神経根障害を呈した症例はなかった。EQ-5D平均効用値は、受傷前(推定値)が0.9067、入院時(骨折後)が0.48、退院時が0.759、3ヵ月後が0.85であった。57例に処方された装具は、硬性装具44例、ダーメンコルセット8例、軟性コルセット3例、処方なし2例であった。偽関節となった10例10骨折はすべて腋窩から腸骨翼までの硬性装具を処方された。
  • 胸椎脱臼骨折の手術後に発生した両側乳糜胸の1例
    重信 恵一; 橋本 友幸; 金山 雅弘; 大羽 文博; 戸川 大輔; 山田 勝久; 本橋 雅寿; 斉藤 達志
    函館中央病院医誌 函館中央病院 (13) 5 - 7 1341-9056 2011/12 
    80歳男。室内で転倒し、受傷した。腰背部痛のため体動困難で、両下肢は脱力のため車イス歩行の状態であった。神経学的には下肢の深部腱反射は低下し、両腸腰筋以下の軽度の筋力低下と両膝以下のしびれを認めた。転倒時の過伸展による胸椎脱臼骨折と診断し、手術加療を目的に入院した。第8胸椎から第2腰椎まで脊椎インストルメンテーションを併用した後方固定術と骨移植術を施行した。術後は出血による貧血と低アルブミン血症があり、大量輸血と低アルブミン血症の補正を行った。CTで胸腔内には胸水が貯留し、胸腔ドレナージを施行した。臨床経過と併せて乳糜胸を疑い、絶食にて中心静脈栄養で高タンパク高カロリー輸液による管理とした。術後2週前後で胸腔ドレナージは両側とも抜去可能となった。ベッド上でのリハビリテーションや下肢筋力訓練した。術後1年で一本杖歩行まで可能となったが、術後2年6ヵ月に合併症である心不全のため死亡した。
  • トガワ ダイスケ
    Journal of Spine Research (一社)日本脊椎脊髄病学会 2 (9) 1485 - 1493 1884-7137 2011/09 
    受傷後8週間以上の保存療法により疼痛緩和、骨折治癒が得られない原発性骨粗鬆症性圧迫骨折患者を対象に多施設共同研究でballoon kyphoplastyを施行した。解析対象となった81症例の臨床成績では、手術後に有意な疼痛緩和が得られ、椎体高復元率の平均値は術直後で39.8%であった。SF-36はgeneral health以外の7項目で術前と比較して有意に改善し、その改善は術後12ヵ月まで保たれた。(著者抄録)
  • 【最近のInterventional Radiologyの話題(Part 2)】Kyphoplasty 本邦の現状
    戸川 大輔
    Rad Fan (株)メディカルアイ 9 (10) 58 - 60 1348-3498 2011/08
  • 戸川 大輔
    整形外科 (株)南江堂 62 (8) 721 - 729 0030-5901 2011/07
  • 戸川 大輔
    Journal of Musculoskeletal Pain Research (一社)日本運動器疼痛学会 3 (1) 14 - 20 2186-2796 2011/07 
    Balloon Kyphoplasty(BKP)は、骨粗鬆症性脊椎圧迫骨折、溶骨性脊椎腫瘍に対する経皮的椎体形成術の一術式である。BKPの特徴、疼痛抑制機序、適応、日本での臨床試験結果、手術のポイントと注意点、更に今後の課題を述べた。日本で初めてのBKPによる原発性骨粗鬆症性圧迫骨折の治療成績では、良好な疼痛緩和と有効な椎体高の回復が得られた。また、術中・術後の神経障害や感染、心肺合併症や血管合併症は認めなかった。
  • 【疼痛性疾患に対する治療の新展開】骨粗鬆症性脊椎圧迫骨折に対する経皮的椎体形成術の効果
    戸川 大輔
    リウマチ科 (有)科学評論社 45 (6) 603 - 611 0915-227X 2011/06
  • Ken Nagahama; Masahiro Kanayama; Daisuke Togawa; Tomoyuki Hashimoto; Akio Minami
    Journal of neurosurgery. Spine 14 (4) 500 - 7 2011/04 
    OBJECT: Bisphosphonate medications are widely used for the treatment of osteoporosis, but they might disturb the healing process of spinal fusion. The object of this prospective randomized controlled study was to evaluate the effect of bisphosphonate medication on spinal fusion through radiographic, clinical, and biological assessments. METHODS: A total of 40 patients with osteoporosis who were candidates for single-level posterior lumbar interbody fusion were randomly assigned to the alendronate group (alendronate sodium 35 mg/week) or the control group (vitamin D, alfacalcidol 1 μg/day). Pedicle screw fixation and carbon polyetheretherketone cages were used for all the patients. Bone graft material was prepared as a mixture of local bone and β-tricalcium phosphate in a ratio of 2:1. Functional radiography and CT scans were used to evaluate fusion status and cage subsidence. The incidence of vertebral compression fractures (VCFs) occurring after surgery (subsequent VCFs) was assessed by means of MR imaging. Bridging bone formation was graded into 3 categories: Grade A (bridging bone through bilateral cages), Grade B (bridging bone through a unilateral cage), or Grade C (incomplete bony bridging). A solid fusion was defined as less than 5° of angular motion in flexion-extension radiographs and the presence of bridging bone through the cage (Grade A or B). Clinical outcome was evaluated by means of the Oswestry Disability Index. Bone metabolic markers (serum bone alkaline phosphatase, serum and urine Type I collagen cross-linked N-telopeptides) were measured to investigate the biological effects of alendronate on spinal fusion. RESULTS: Bridging bone formation (Grade A or B) was more frequently observed in the alendronate group at all postoperative assessment periods. At 1-year postoperative follow-up, a solid fusion was achieved in 95% of the patients in the alendronate group and 65% of those in the control group. Cage subsidence (> 2 mm) was observed in 5% of the alendronate group and 29% of the control group. No vertebral fractures were observed in the alendronate group, whereas 24% of patients in the control group showed subsequent VCFs. There was no statistically significant between-groups difference in clinical outcomes, but poor clinical results in the control group were associated with pseudarthrosis and subsequent VCFs. Biochemical analysis of bone turnover demonstrated that alendronate inhibited bone resorption from the early phase of the fusion process and also suppressed bone formation after 6 months postoperatively. CONCLUSIONS: Favorable mechanical circumstances provided by alendronate overcame its detrimental biological effect on the healing process of spinal fusion. The authors recommend that osteoporosis patients undergoing spinal fusion take bisphosphonates throughout the postoperative period.
  • 戸川 大輔
    北海道整形災害外科学会雑誌 北海道整形災害外科学会 52 (2) 203 - 208 1343-3873 2011/03
  • 徳橋 泰明; 森 諭史; 宗圓 聡; 萩野 浩; 中野 哲雄; 加藤 義治; 戸川 大輔
    日本整形外科学会雑誌 (公社)日本整形外科学会 85 (2) S255 - S255 0021-5325 2011/02
  • 戸川 大輔
    整形・災害外科 金原出版(株) 54 (1) 55 - 60 0387-4095 2011/01
  • 戸川 大輔
    整形外科 (株)南江堂 61 (11) 1231 - 1238 0030-5901 2010/10
  • Masahiro Kanayama; Fumihiro Oha; Daisuke Togawa; Keiichi Shigenobu; Tomoyuki Hashimoto
    Clinical orthopaedics and related research 468 (10) 2690 - 4 2010/10 
    BACKGROUND: Closed-suction drainage is commonly used for prevention of postoperative hematoma and associated neurologic compromise after lumbar decompression, but it remains unclear whether suction drainage reduces postoperative complications. QUESTIONS/PURPOSES: We evaluated the efficacy of closed-suction drainage in single-level lumbar decompression surgery. PATIENTS AND METHODS: We retrospectively reviewed 560 patients who underwent single-level lumbar decompression or discectomy. We routinely used closed-suction drainage in all spinal surgeries until July 2003, and thereafter, we did not use drains in single-level lumbar decompression surgery. These two groups (298 patients in the group that received drains, 262 in the group that did not receive drains) were compared for rates of wound infection and epidural hematoma. RESULTS: Mean operating time (55 versus 56 minutes) and intraoperative blood loss (64 versus 57 mL) were not different between the two groups. None of 560 patients had a wound infection requiring surgical intervention. The rate of postoperative hematoma was 0.7% in the group that received drains (two of 298 patients) and 0% in the group that did not receive drains (zero of 262 patients). CONCLUSIONS: In this study, the risk of wound infection and hematomas in single-level lumbar decompression surgery was not influenced by use of a drain. The use of postoperative wound drainage in patients with potential risk for epidural bleeding in situations such as multiple-level decompression, instrumentation surgery, anticoagulant therapy, trauma, and tumors or metastases needs additional study. LEVEL OF EVIDENCE: Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
  • 頸髄損傷による四肢麻痺患者の自宅退院への取り組み 残存機能を活かした援助とQOLの向上
    小野 絵梨子; 手塚 八代恵; 住吉 奈央子; 井戸 亜紀; 熊谷 幸美; 山谷 美貴; 加藤 なぎさ; 伊早坂 唯; 浅野 文子; 坂本 里美; 宇田 聡子; 戸川 大輔
    函館中央病院医誌 函館中央病院 (12) 52 - 54 1341-9056 2010/06 
    30代男。C4/5脱臼骨折による脊髄損傷でC5以下の完全四肢麻痺の状態となり、膀胱瘻造設、人工肛門造設された。患者は当初、「自分に出来る事は無いから看護師に任せるしかない」など落ち込んだ発言がみられ、食事・清拭・体位変換・リハビリの時間以外はテレビなどを見ることもなく過ごしていたが、練習によりタッチペンによるゲームやパソコンの操作が出来るようになるにつれ表情が明るくなり、笑顔がみられるようになった。また、患者・家族は自宅退院を希望していたため、早期より医師・看護師・コメディカルが患者・家族参加型のカンファレンスを月2回行い、自宅での生活ができるよう準備した。電動車イスと移動用リフトを導入し、食事については全介助であったが支援ロボット「マイスプーン」を導入し、患者のQOLを向上させることができた。妻に対しては、体位変換の方法と褥瘡好発部位についてパンフレットを作成して説明しながら実際に行ってもらい、人工肛門やストマパックの交換については認定看護師が説明し、いずれも問題なく出来るようになった。家の改修工事が終わった後、自宅退院となった。
  • Masahiro Kanayama; Michiko Horio; Yumi Umi; Ai Yamaguchi; Junichi Omata; Daisuke Togawa; Tomoyuki Hashimoto
    Spine 35 (6) 647 - 51 2010/03 
    STUDY DESIGN: A retrospective survey using privacy-conscious questionnaires. OBJECTIVE: To determine the quality and frequency of sexual activities in patients with lumbar disc herniation before and after surgery. SUMMARY OF BACKGROUND DATA: Patients and health care professionals often hesitate to talk about the effects of disease, illness, or surgery on sexuality, but it is imperative that sexuality issues be addressed. METHODS: Of 90 consecutive patients, 64 who had surgically-treated lumbar disc herniation participated in this survey after informed consent. There were 43 males and 21 females with mean age of 36 years. Duration of symptom was averaged 42 weeks. The patients were asked to complete questionnaires concerning sexual desire, activity, adjustment, and satisfaction. About 83% of the patients had sexual desire, and 89% achieved satisfaction during sexual activities in presick period. RESULTS: Lumbar disc herniation decreased sexual desire in 50% and frequency of sexual activity in 59% of the patients. About 67% of males and 81% of females felt discomfort during sexual activity; satisfaction decreased in 28% of male and 41% of females. Adjustment in sexual position was required in 54% of males and 86% of females. Surgery improved sexual desire, frequency of sexual activity, and satisfaction in 85%, 88%, and 94%, respectively. However, 31% of females did not regain sexual desire and 46% still felt discomfort during sexual activity (the rates were 7% and 17% in males, respectively). Sexual activity was resumed within 2 postoperative weeks in 23% (27% in males and 14% in females), and 4 weeks in 53%. Males resumed sexual activity earlier than females. CONCLUSION: Lumbar disc herniation largely impacted sexual desire, activity, and satisfaction. Adjustment in sexual position was required in large number of patients to avoid discomfort during sexual activities. Surgical treatment improved quality of sexual activities, but more females did not regain sexual desire, felt sexual discomfort, and thereby resumed sexual activities later than males after surgery.
  • Masahiro Kanayama; Takashi Ishida; Tomoyuki Hashimoto; Keiichi Shigenobu; Daisuke Togawa; Fumihiro Oha; Kiyoshi Kaneda
    Journal of spinal disorders & techniques 23 (1) 53 - 6 2010/02 
    STUDY DESIGN: A retrospective study. OBJECTIVES: To investigate the clinical and radiographic results of spinal reconstruction using Kaneda anterior spinal instrumentation for osteoporotic vertebral collapse. SUMMARY OF BACKGROUND DATA: Recent advances in osteoporotic vertebral fracture treatment including kyphoplasty changes the role of major surgery for these pathologies. However, osteoporotic vertebral collapse with neurologic compromise remains requiring surgical decompression and reconstruction. METHODS: Thirty-one consecutive patients who underwent anterior spinal reconstruction for osteoporotic vertebral collapse with neurologic deficits were reviewed retrospectively. Twenty-six patients had single vertebral collapse and 5 had multiple lesions. They were 10 males and 21 females with mean age of 71 years. Mean follow-up period was 57 months. For anterior column support, iliac bone graft was used in 1 patient, cylindrical titanium cages in 12, and bioactive ceramic spacers in 18 patients. Kaneda anterior instrumentation was used in all the patients. Radiographic and clinical assessments were performed preoperatively and at the final follow-up. RESULTS: All the patients showed neurologic recovery. Visual analog scales (0 to 10) of low back pain and sciatic pain were 5.8 and 4.2 before surgery, and 2.1 and 0.6 at the final follow-up, respectively. Mean kyphosis of operative levels was 31 degrees before surgery, and improved to 13 degrees immediately after surgery and 21 degrees at the final follow-up. Posterior reinforcement was required in 6 patients (19%), who had severe osteoporosis and/or underwent multilevel corpectomies. Solid fusion was achieved in all patients at the final follow-up. CONCLUSIONS: The current study demonstrated the advantages of anterior spinal reconstruction in osteoporotic vertebral collapse: (1) safe and reliable decompression could be performed, and (2) 80% of patients were successfully treated with anterior spinal reconstruction alone. However, patients with multilevel corpectomies and/or severe osteoporosis highly required posterior reinforcement.
  • TOGAWA Daisuke; KANAYAMA Masahiro; SHIGENOBU Keiichi; OHA Fumihiro; NAGAHAMA Ken; HASHIMOTO Tomoyuki
    Spine Surgery and Related Research 20 (3) 666 - 672 1346-4876 2009/11
  • Masahiro Kanayama; Daisuke Togawa; Chihiro Takahashi; Tomoya Terai; Tomoyuki Hashimoto
    Journal of neurosurgery. Spine 11 (4) 501 - 7 2009/10 
    OBJECT: The current cross-sectional observational MR imaging study aimed to investigate the prevalence and risk factors of lumbar disc degeneration in a healthy population and to establish the baseline data for a prospective longitudinal study. METHODS: Two hundred healthy volunteers participated in this study after providing informed consent. The status of lumbar disc degeneration was assessed by 3 independent observers, who used sagittal T2-weighted MR imaging. Demographic data collected included age, sex, body mass index, episode(s) of low-back pain, smoking status, hours of standing and sitting, and Roland-Morris Disability Questionnaire scores. There were 68 men and 132 women whose mean age was 39.7 years (range 30-55 years). Eighty-two individuals (41%) were smokers, and the Roland-Morris Disability Questionnaire scores were averaged to 0.6/24. RESULTS: The prevalence of disc degeneration was 7.0% in L1-2, 12.0% in L2-3, 15.5% in L3-4, 49.5% in L4-5, and 53.0% in L5-S1. A herniated disc was observed at the corresponding levels in 0.5, 3.5, 6.5, 25.0, and 35.0% of cases respectively. Spondylolisthesis was observed in < 3% of this population. Multiple logistic regression analysis demonstrated that age and hours sitting were significantly related to L4-5 disc herniation. Episode of low-back pain, smoking status, body mass index, and hours standing did not affect the prevalence of disc degeneration. CONCLUSIONS: The current study established the baseline data of lumbar disc degeneration in a 30- to 55-year-old healthy population for a prospective longitudinal study. Hours spent sitting significantly increased the prevalence of disc herniation, but episode of low-back pain, smoking status, obesity, and standing hours were not significant risk factors.
  • Masahiro Kanayama; Daisuke Togawa; Tomoyuki Hashimoto; Keiichi Shigenobu; Fumihiro Oha
    Journal of spinal disorders & techniques 22 (7) 463 - 7 2009/10 
    STUDY DESIGN: A retrospective study. OBJECTIVES: This study aims to determine the prevalence and nature of adjacent-segment deterioration after posterior ligamentoplasty, posterolateral lumbar fusion (PLF) versus posterior lumbar interbody fusion (PLIF). SUMMARY OF BACKGROUND: Motion-preserving technologies including disc arthroplasty and ligamentoplasty were gaining interest to reduce the risk of adjacent-segment morbidity. However, few clinical studies have reported the prevalence of adjacent-segment disease in motion-preserving surgeries. METHODS: Two-hundred and eighteen consecutive patients who had undergone single-level posterior L4-L5 pedicle-screw-instrumented fusion or ligamentoplasty were reviewed at minimum 2-year follow-up. They were 91 males and 127 females with mean age of 62 years. Follow-up period was averaged 41 months and follow-up rate was 97.3%. There were 78 cases of PLIF, 75 of PLF, and 65 of ligamentoplasty. Demographics were not statistically different among the 3 groups. Prevalence of adjacent-segment morbidity (radiculopathy associated with newly developed pathologies at neighboring levels) and required additional surgery were investigated. RESULTS: Prevalence of adjacent-segment morbidity was 14.1% in PLIF, 13.3% in PLF, and 9.2% in ligamentoplasty; the time to represent symptom was averaged 25.2, 39.3, and 51.8 postoperative months, respectively. Additional surgeries for adjacent-segment pathologies were required for 7.6% in PLIF, 6.7% in PLF, and 1.5% in ligamentoplasty. Although all PLF cases needed only decompression surgeries, 66.7% of reoperations in the PLIF group required fusion owing to progression of adjacent-segment instability. CONCLUSIONS: Prevalence of adjacent-segment disease and reoperation rate seemed to be lower in ligamentoplasty than fusion surgeries, but the difference was not significant. Ligamentoplasty circumvented adjacent-segment disease for longer period than fusion surgeries. Although the rates of additional surgeries in PLIF and PLF were comparable, PLIF developed adjacent-level instability and required fusion surgery more frequently than PLF.
  • 紺野 愼一; 戸川 大輔; 鎌江 伊三夫; 井上 幸恵; 菊地 臣一
    整形外科 (株)南江堂 60 (10) 1033 - 1038 0030-5901 2009/09 
    日常診療において脊椎圧迫骨折(VCF)の保存的治療を中心的に行っている整形外科医に対してアンケートを実施し、期待医療費の推計を試みた。アンケートは全国83施設に依頼し、最終的に65施設から得られた結果を集計した。その結果、医療機関を受診し、保存的治療を受けた骨粗鬆症性VCF患者における1治療あたりの医療費は平均37.1万円と推計された。また、入院のみの治療方針における推計結果は、状態1(腰背部痛あり、ADL支障なし、神経症状なし)の場合で入院期間が36.3日で66.6万円、状態2(腰背部痛あり、ADL支障あり、神経症状なし)では39.6日で72.1万円、状態3(腰背部痛あり、ADL支障あり、神経症状あり)では48.9日で89.3万円となった。本分析で推計した1治療あたりの平均医療費をもとにして、全国規模の骨粗鬆症性VCF保存的治療による年間疾病負担額の推計を試みた結果、年間1089億円と推計された。
  • 宮城島 一史; 伊藤 俊一; 隈元 庸夫; 小俣 純一; 湯浅 敦智; 戸川 大輔; 金山 雅弘
    北海道理学療法 (公社)北海道理学療法士会 26 36 - 39 0912-1455 2009/07 
    本報告の目的は,トルクマシーンであるProxomed社製Tergumed Plus Rotation.(以下,Tergumed)を用いて等尺性体幹回旋運動時の筋電図学的検討を行い,体幹回旋運動の特性を明らかにすることである.Tergumedによる体幹回旋筋力の測定は高い再現性を示し,体幹回旋筋力には左右差を認めなかった.筋活動量は,非回旋側外腹斜筋,回旋側腰部脊柱起立筋が有意に高かった.また,多裂筋の筋活動量には左右差を認めなかった.Tergumedは体幹筋の高い筋活動量が得られることから,体幹回旋運動の筋力トレーニング機器として有用と考える.腹斜筋群のみならず脊柱起立筋や多裂筋が働くことから,TergumedのトレーニングはADL上重要とされる体幹回旋運動での背筋強化,同時収縮運動につながる可能性が示唆された.(著者抄録)
  • 強直性脊椎骨増殖症を有する患者に生じた胸椎過伸展型骨折に対する治療経験
    長濱 賢; 重信 恵一; 戸川 大輔; 大羽 文博; 金山 雅弘; 橋本 友幸
    函館中央病院医誌 函館中央病院 (11) 1 - 3 1341-9056 2009/05 
    強直性脊椎骨増殖症(ASH)は、前縦靱帯を中心に骨化を示す疾患であり、多椎体に骨癒合が生じる。また、脊椎周囲の靱帯などの支持組織も硬化するため、脊椎骨折後は不安定性が生じやすい。今回、ASHに胸椎過伸展型骨折を合併し手術加療を要した症例を経験したので報告した。患者は80歳男性で、歩行中に転倒し、その後背部痛が出現したため近医受診しX線検査を受けたが、骨折などの異常は指摘されなかった。4日後頃から痛みが徐々に増強し、体動困難となり、同時に下肢の脱力感も出現したため救急車で当院へ来院した。X線所見は脊椎全域にわたる前縦靱帯骨化が著明であり、CT検査でTh11・12の骨折を認め、MRI検査ではTh11/12の椎間板・棘突起間の軟部組織に損傷が認められた。これらの所見から、基礎疾患としてASHを有し、転倒時の胸椎過伸展によりTh11・12骨折を生じたものと診断した。治療はTh9からL2までの後方椎体固定術を行い、良好な結果が得られた。
  • 脊椎手術創に対するカラヤヘッシブの使用経験
    吉住 典子; 飯田 恵美; 田中 静子; 戸川 大輔; 金山 雅弘; 大羽 文博; 重信 恵一; 橋本 友幸
    函館中央病院医誌 函館中央病院 (11) 43 - 46 1341-9056 2009/05 
    2006年4月から腰椎後方手術後の創傷被覆材としてカラヤヘッシブを使用している。今回、これまでに使用した22例の成績を報告するとともに、当院で以前使用していた創傷被覆材(ダーマボンド)を比較対照としてカラヤヘッシブの長所・短所について検討した。カラヤヘッシブの使用成績は、手術創の癒合不全を認めた症例は1例もなく、全例で良好な創傷治癒が得られた。カラヤヘッシブの張替えを要したものが7例(32%)あり、張替えの原因は血腫が4例、融解変性2例、白濁化1例であった。カラヤヘッシブの長所としては「創部塗布から乾燥までの時間が短い」「剥がし残しが少なく皮膚トラブルが少ない」「低コスト」といったことが考えられ、短所としては「融解・変性・べたつきが強い」「張替えに手間がかかる」「創の観察がやや困難である」ことなどが考えられた。
  • 【骨粗鬆症性脊椎骨折 診断、治療の最前線】Balloon Kyphoplasty 日本の臨床治験と今後の課題
    戸川 大輔
    脊椎脊髄ジャーナル (株)三輪書店 22 (3) 267 - 273 0914-4412 2009/03
  • 重信 恵一; 橋本 友幸; 金山 雅弘; 大羽 文博; 戸川 大輔; 寺井 智也; 長濱 賢; 山根 繁
    北海道整形災害外科学会雑誌 北海道整形災害外科学会 50 (1) 38 - 42 1343-3873 2008/08 
    男性骨粗鬆症の臨床像について調査した。1年間に治療を行った男性骨粗鬆症患者76例(平均70歳)を対象とした。受傷契機は骨折が54例(71%)を占め、高回転型の症例を多く認めた。血清リン(P)は平均3.1mg/dlで、低P血症を2例に認めた。28例(37%)に骨量に影響する基礎疾患の合併を認め、続発性骨粗鬆症が疑われた。治療の原則は予防であり、一般的にはカルシウムとビタミンDの補給が先行されるが、重症例ではビスフォスフォネート製剤が有効な症例もあった。また、1年以内に治療から脱落した症例は24例(32%)で、治療中止となった症例の平均治療期間は4.4ヵ月であった。問題点には男性の骨粗鬆症スクリーニング率・治療参加率が低いことが挙げられ、大腿骨頸部骨折の危険因子(BMI低値、50歳以降の骨折歴、大腿骨頸部骨折の家族歴、喫煙、3ヵ月以上のステロイド服用、過度のアルコール摂取、関節リウマチ、血清テストステロン低値)を有する男性に対する骨粗鬆症の啓蒙が必要だと思われた。
  • Michael J Voor; Robin Madsen; Arthur Malkani; Daisuke Togawa; Thomas W Bauer
    Orthopedics 31 (5) 443 - 443 2008/05 
    To determine whether washing morselized cancellous bone allograft in impaction grafting for revision hip arthroplasty would improve mechanical and biologic performance, left hip hemiarthroplasty with a collarless stem cemented into impacted morselized cancellous bone was performed in 22 goats. Washed allograft was used in the experimental group, and standard allograft was used in the control group. One of 11 experimental and 4 of 11 control implants were observed to be loose at 8 weeks. Washing allowed significantly more morselized cancellous bone to be placed in the experimental group compared to the control group (7.7+/-1.9 and 6.2+/-2.0 g, respectively, P<.05). Significantly less in vivo subsidence over the 8-week study period also was demonstrated in the experimental group compared to the control group (0.4+/-0.4 and 2.2+/-2.3 mm, respectively, P<.05). Angular motion during cyclic +/-1.5 Nm loading demonstrated significant differences between the 2 groups at time zero (2.67 degrees +/-1.02 degrees for the control group and 1.98 degrees +/-0.47 degrees for the experimental group, P<.05) and at 8 weeks (2.40 degrees +/-0.38 degrees for the control group and 1.74 degrees +/-0.55 degrees for the experimental group, P<.05). Histology showed little difference between the 2 groups, but there was a trend toward less inflammation in the experimental group.
  • Lisa A Ferrara; Ilya Gordon; Richard Schlenk; Madeline Coquillette; Aaron J Fleischman; Shuvo Roy; Daisuke Togawa; Thomas W Bauer; Edward C Benzel
    SAS journal 2 (1) 1 - 8 2008 
    BACKGROUND: In this preliminary study we used a goat model to quantify pressure at an interbody bone graft interface. Although the study was designed to assess fusion status, the concept behind the technology could lead to early detection of implant failure and potential hazardous complications related to motion-preservation devices. The purpose of this study was to investigate the feasibility of in vivo pressure monitoring as a strategy to determine fusion status. METHODS: Telemetric pressure transducers were implanted, and pressure at the bone graft interfaces of cervical interbody fusion autografts placed into living goats (Groups A and B) was evaluated. Group A constituted the 4-month survival group and Group B the 6-month survival group. One goat served as the study control (Group C) and was not implanted with a pressure transducer. An additional six cadaveric goat cervical spines (Group D) were obtained from a local slaughterhouse and implanted with bone grafts and ventral plates and used for in vitro biomechanical comparison to the specimens from Groups A and B. RESULTS: All goats demonstrated an increase in interface pressure within the first 10 days postoperatively, with the largest relative change in pressure occurring between the sixth and ninth days. The goats from Groups A and B had a 200% to 400% increase in relative pressure. CONCLUSIONS: Although this was a pilot study to assess pressure as an indicator for a fusion or pseudarthrosis, the preliminary data suggest that early bone healing is detectable by an increase in pressure. Thus, pressure may serve as an indicator of fusion status by detecting altered biomechanical parameters.
  • Hidetake Takigami; Ken Kumagai; Larry Latson; Daisuke Togawa; Thomas Bauer; Kimerly Powell; Robert S Butler; George F Muschler
    Journal of orthopaedic research : official publication of the Orthopaedic Research Society 25 (10) 1333 - 42 0736-0266 2007/10 
    Osteogenic Protein-1 (OP-1, BMP-7) acts locally on connective tissue progenitors (CTPs) to induce bone formation. The response to OP-1 and similar agents is potentially limited by the number of local CTPs. This study tested the hypothesis that supplementing local CTPs using autogenous bone marrow will enhance bone formation at an OP-1 implant. Four 1.0-cm diameter unicortical cylindrical defects in the left proximal femur were grafted in each of seven dogs. Radial ingrowth of new bone formation was assessed at 4 weeks using micro CT. The OP-1 (3.5 mg rhOP-1 in 1 g bovine collagen I matrix) was implanted in each site combined with either clotted blood or aspirated bone marrow (BM). Bone formation was increased in the group augmented with transplanted marrow. These data suggest that increasing the local population of cells and CTPs using aspirated bone marrow can enhance the performance of OP-1, but may not eliminate the effects of site variation on the response to OP-1 and similar agents. The canine multiple femoral defect model defined in this study is well suited to quantitatively evaluate strategies for augmenting bone repair using local cell targeting and cell transplantation strategies.
  • Masahiro Kanayama; Tomoyuki Hashimoto; Keiichi Shigenobu; Daisuke Togawa; Fumihiro Oha
    Spine 32 (18) 1992 - 6 2007/08 
    STUDY DESIGN: A retrospective long-term follow-up study. OBJECTIVES: To report minimum 10-year follow-up results of posterior dynamic stabilization using Graf artificial ligament and to evaluate the role and limitations of this procedure in the treatment of degenerative lumbar disorders. SUMMARY OF BACKGROUND: Motion-preserving surgeries, including artificial disc replacement and ligamentoplasty, are increasingly gaining interest to avoid adverse effects of spinal fusion, but literature addressing long-term results is sparse. METHODS: A total of 56 consecutive patients who underwent Graf ligamentoplasty were reviewed at a minimum 10-year follow-up. Forty-three patients in the original cohort had sufficient clinical and radiographic follow-up for analysis. The pathologies included degenerative spondylolisthesis in 23 patients, disc herniation with flexion instability in 13 patients, spinal stenosis with flexion instability in 4 patients, and degenerative scoliosis in 3 patients. Single-level procedures were performed in 36 patients; multilevel procedures were performed in 7 patients. Radiographic and clinical assessments were performed before surgery and at the final follow-up. RESULTS: Disability due to low back pain and/or sciatic symptoms was significantly improved in the patients with degenerative spondylolisthesis or flexion instability. However, degenerative scoliosis and/or laterolisthesis were associated with poor clinical improvement. In radiographic assessment, segmental lordosis was maintained in 10.9 degrees, and flexion-extension motion was averaged 3.6 degrees at the final follow-up. Facet arthrodesis eventually occurred in 14 patients (32.6%) at an average of 82 months after surgery. Additional surgeries were required in 3 patients (7.0%) for adjacent segment pathologies. CONCLUSION: The long-term results showed that Graf ligamentoplasty is an effective treatment option for low-grade degenerative spondylolisthesis and flexion instability. However, this procedure has limitations to correct spinal deformity, and is not advocated for the treatment of degenerative scoliosis and laterolisthesis.
  • 小俣 純一; 伊藤 俊一; 金山 雅弘; 戸川 大輔; 橋本 友幸
    北海道理学療法 (公社)北海道理学療法士会 24 77 - 80 0912-1455 2007/07 
    慢性腰痛症患者の体幹回旋筋力を測定し、腰痛症の体幹回旋筋力の特性を検討した。器質的な脊椎疾患及び著明な神経症状を有さない慢性腰痛症20例を対象とした。体幹回旋筋力をTergumed Plus Rotationを用いて測定し、疼痛側への回旋筋力と非疼痛側への回旋筋力に分けて左右差を比較した。さらにOswestry Disability IndexにおいてADLを評価してADLの制限に影響する要因について検討した。非疼痛側への回旋筋力は疼痛側への回旋筋力に比べて弱く、ADLにおいて体幹回旋筋力の左右差がより影響を及ぼした。体幹回旋筋力のImbalanceが存在し、腰痛症者のADLにおいて体幹回旋筋力は重要な役割を果たしていることが示唆された。
  • Naomi Kobayashi; Kevin Ong; Marta Villarraga; Jeffrey Schwardt; Robert Wenz; Daisuke Togawa; Takaaki Fujishiro; A Simon Turner; Howard B Seim 3rd; Thomas W Bauer
    Journal of biomedical materials research. Part A 81 (4) 838 - 46 1549-3296 2007/06 
    We investigated the histological and compressive properties of three different calcium phosphate cements (CPCs) using a sheep vertebral bone void model. One of the CPCs contained barium sulfate to enhance its radiopacity. Bone voids were surgically created in the lumbar region of 23 ovine spines - L3, L4, and L5 (n = 69 total vertebral bodies) - and the voids were filled with one of the three CPCs. A fourth group consisted of whole intact vertebrae. Histologic evaluation was performed for 30 of the 69 vertebrae 2 or 4 months after surgery along with radiographic evaluation. Compressive testing was performed on 39 vertebrae 4 months after surgery along with micro-CT analysis. All three CPCs were biocompatible and extremely osteoconductive. Osteoclasts associated with adjacent bone formation suggest that each cement can undergo slow resorption and replacement by bone and bone marrow. Compressive testing did not reveal a significant difference in the ultimate strength, ultimate strain, and structural modulus, among the three CPCs and intact whole vertebrae. Micro-CT analysis revealed good osseointegration between all three CPCs and adjacent bone. The barium sulfate did not affect the CPCs biocompatibility or mechanical properties. These results suggest that CPC might be a good alternative to polymethylmethacrylate for selected indications.
  • 重信 恵一; 橋本 友幸; 大越 康充; 多田 博; 山本 一樹; 金山 雅弘; 江端 済; 長崎 晋矢; 大羽 文博; 戸川 大輔; 今淵 隆誠; 亀田 敏明; 加藤 琢磨; 山根 繁; 宮澤 政義; 斉藤 恒夫; 加藤 秀昭
    Osteoporosis Japan ライフサイエンス出版(株) 15 (2) 229 - 233 0919-6307 2007/04 
    76歳女。腰痛を主訴に受診した。第4腰椎の圧迫骨折および骨粗鬆症と診断し、体幹コルセット装着後に経口ビスホスホネート製剤(BP)の投与を開始した。投与6ヵ月目に腰痛は消失し、X線検査でも椎体の良好な骨硬化が認められ、骨密度も増加した。投与21ヵ月目に歯科で齲蝕の抜歯処置を受けたが、BPの内服は継続していた。抜歯の5ヵ月後に左頬部に腫脹・鈍痛が出現し、上顎骨骨髄炎と診断された。保存的治療では改善せず、腐骨切除+掻爬術を施行された。病理診断は「骨壊死に併発した骨髄炎」であった。
  • Masahiro Kanayama; Tomoyuki Hashimoto; Keiichi Shigenobu; Fumihiro Oha; Daisuke Togawa
    Journal of neurosurgery. Spine 6 (4) 327 - 9 1547-5654 2007/04 
    OBJECT: Antimicrobial prophylaxis (AMP) reduces the rate of surgical site infection (SSI) in lumbar spine surgery, but a great deal of variation exists regarding the timing and duration of AMP. The authors had previously used prophylactic antibiotics for 5 to 7 postoperative days. Based on the Centers for Disease Control and Prevention (CDC) guideline, the AMP period was changed to the day of surgery only. In the current study, the authors compared the rate of SSI in lumbar spine surgeries between two different protocols of AMP. METHODS: Data from 1597 consecutive uninfected patients who had undergone lumbar spine surgery between January 1999 and September 2004 were reviewed. The pathophysiologies among these patients included disc herniation in 686, degenerative spondylolisthesis in 340, spinal stenosis in 259, failed lumbar surgeries in 73, degenerative scoliosis in 52, isthmic spondylolisthesis in 48, spinal trauma in 34, foraminal stenosis in 27, spinal tumor in 27, and miscellaneous in 51 patients. The rate of SSI was compared between the two AMP groups. There were 1133 patients in the multiple-dose group, and 464 patients in the single-dose group. The rate of instrumentation surgery was not statistically different between the multiple-dose group (43%) and the single-dose group (39%). The overall rate of SSI was 0.7%. The SSI rate was 0.8% in the multiple-dose group and 0.4% in the single-dose group; the difference between the two was not significant. Regarding the organisms of SSI, resistant strains of bacteria were cultured in five (83.3%) of six patients in the multiple-dose group, whereas none was cultured in the single-dose group. CONCLUSIONS: Data in the current study did not demonstrate a difference in the rate of SSI between the two different AMP protocols. Based on the CDC guideline, a single dose of AMP was proven to be efficacious for the prevention of SSI in lumbar spine surgeries. A shorter duration of first-generation cephalosporin use may effectively prevent the emergence of antibiotic-resistant bacterial infection.
  • Daisuke Togawa; Mark M Kayanja; Mary K Reinhardt; Moshe Shoham; Alin Balter; Alon Friedlander; Nachshon Knoller; Edward C Benzel; Isador H Lieberman
    Neurosurgery 60 (2 Suppl 1) ONS129-39; discussion ONS139  2007/02 
    OBJECTIVE: To evaluate the accuracy of a novel bone-mounted miniature robotic system for percutaneous placement of pedicle and translaminar facet screws. METHODS: Thirty-five spinal levels in 10 cadavers were instrumented. Each cadaver's entire torso was scanned before the procedure. Surgeons planned optimal entry points and trajectories for screws on reconstructed three-dimensional virtual x-rays of each vertebra. Either a clamp or a minimally invasive external frame was attached to the bony anatomy. Anteroposterior and lateral fluoroscopic images using targeting devices were obtained and automatically registered with the virtual x-rays of each vertebra generated from the computed tomographic scan obtained before the procedure. A miniature robot was mounted onto the clamp and external frame and the system controlled the robot's motions to align the cannulated drill guide along the planned trajectory. A drill bit was introduced through the cannulated guide and a hole was drilled through the cortex. Then, K-wires were introduced and advanced through the same cannulated guide and left inside the cadaver. The cadavers were scanned with computed tomography after the procedure and the system's accuracy was evaluated in three planes, comparing K-wire positions with the preoperative plan. A total of fifty-five procedures were evaluated. RESULTS: Twenty-nine of 32 K-wires and all four screws were placed with less than 1.5 mm of deviation; average deviation was 0.87 +/- 0.63 mm (range, 0-1.7 mm) from the preoperative plan in this group. Sixteen of 19 K-wires were placed with less than 1.5 mm of deviation. There was one broken and one bent K-wire. Another K-wire was misplaced because of collision with the previously placed wire on the contralateral side of the same vertebra because of a mistake in planning, resulting in a 6.5-mm deviation. When this case was excluded, average deviation was 0.82 +/- 0.65 mm (range, 0-1.5 mm). CONCLUSION: These results verify the system's accuracy and support its use for minimally invasive spine surgery in selected patients.
  • M. Shoham; I. H. Lieberman; E. C. Benzel; D. Togawa; E. Zehavi; B. Zilberstein; M. Roffman; A. Bruskin; A. Fridlander; L. Joskowicz; S. Brink-Danan; N. Knoller
    Computer Aided Surgery Informa UK Limited 12 (2) 105 - 115 1092-9088 2007/01
  • Naomi Kobayashi; Thomas W Bauer; Hiroshige Sakai; Daisuke Togawa; Isador H Lieberman; Takaaki Fujishiro; Gary W Procop
    Joint bone spine 73 (6) 745 - 7 2006/12 
    We report a case of a culture-negative osteomyelitis in which our newly developed real-time polymerase chain reaction (PCR) could differentiate Staphylococcus aureus from Staphylococcus epidermidis. This is the first report that described the application of this novel assay to an orthopedics clinical sample. This assay may be useful for other clinical culture-negative cases in a combination with a broad-spectrum assay as a rapid microorganism identification method.
  • Isador H Lieberman; Daisuke Togawa; Mark M Kayanja; Mary K Reinhardt; Alon Friedlander; Nachshon Knoller; Edward C Benzel
    Neurosurgery 59 (3) 641 - 50 2006/09 
    OBJECTIVE: To introduce a new miniature robot (SpineAssist; MAZOR Surgical Technologies, Caesarea, Israel) that has been developed and tested as a surgical assistant for accurate percutaneous placement of pedicle screws and translaminar facet screws. METHODS: Virtual projections in three planes-axial, lateral, and anteroposterior-are reconstructed for each vertebra from a preoperative computed tomographic (CT) scan. On a specially designed graphic user interface with proprietary software, the surgeon plans the trajectory of the screws. Intraoperative fluoroscopic x-rays with targeting devices are then matched with the CT-based virtual images, as well as the surgeon's plan. A clamp is attached to the spinous process or a minimally invasive frame (Hover-T frame; MAZOR Surgical Technologies) is mounted to the iliac crest and one spinous process. The miniature robot is then attached to the clamp and/or frame. On the basis of combined CT scan and fluoroscopic data, the robot aligns itself to the desired entry point and trajectory, as dictated by the surgeon's preoperative plan. RESULTS: A test case in a cadaver lumbar spine was performed in which four screws and two rods were inserted, using a minimally invasive technique, combining the SpineAssist system and Hover-T frame in conjunction with the PathFinder system (Spinal Concept Inc., Austin, TX). The discrepancy between the planned and actual screw trajectories was measured by means of postprocedural CT scan. Overall, the four screws were implanted with an average deviation of 1.02 +/- 0.56 mm (range, 0-1.5 mm) from the surgeon's plan. CONCLUSION: These preliminary results confirm the system's accuracy and support its use in minimally invasive spine surgery applications.
  • Naomi Kobayashi; Thomas W Bauer; Marion J Tuohy; Isador H Lieberman; Viktor Krebs; Daisuke Togawa; Takaaki Fujishiro; Gary W Procop
    Journal of orthopaedic research : official publication of the Orthopaedic Research Society 24 (8) 1641 - 9 0736-0266 2006/08 
    We have developed a combined real-time PCR and pyrosequencing assay that successfully differentiated the vast majority of gram-positive and gram-negative bacteria when bacterial isolates were tested. The purpose of this study was to evaluate this assay on clinical specimens obtained from orthopedic surgeries, and to prospectively compare the results of "molecular Gram stain" with culture and conventional direct Gram stain. Forty-five surgical specimens were obtained from patients who underwent orthopedic surgery procedures. The DNA was extracted and a set of broad-range PCR primers that targeted a part of the 16S rDNA gene was used for pan-bacterial PCR. The amplicons were submitted for pyrosequencing and the resulting molecular Gram stain characteristics were recorded. Culture and direct Gram staining were performed using standard methods for all cases. Surgical specimens were reviewed histologically for all cases that had a discrepancy between culture and molecular results. There was an 86.7% (39/45) agreement between the traditional and molecular methods. In 12/14 (85.7%) culture-proven cases of bacterial infection, molecular Gram stain characteristics were in agreement with the culture results, while the conventional Gram stain result was in agreement only for five cases (35.7%). In the 31 culture negative cases, 27 cases were also PCR negative, whereas 4 were PCR positive. Three of these were characterized as gram negative and one as gram positive by this molecular method. Molecular determination of the Gram stain characteristics of bacteria that cause orthopedic infections may be achieved, in most instances, by this method. Further studies are necessary to understand the clinical importance of PCR-positive/culture-negative results.
  • Daniel Shedid; Daisuke Togawa; Isador H Lieberman
    Clinics in geriatric medicine 22 (3) 535 - 44 0749-0690 2006/08 
    Osteoporosis has devastating consequences for individuals and society in terms of suffering, disability, and increased health care expenses. Early diagnosis and treatment of compression fractures with kyphoplasty allow restoration of normal anatomy as much as possible. Vertebral augmentations by kyphoplasty are efficacious treatments for osteoporotic compression fractures. Kyphoplasty minimizes the risk for cement leakage by compacting the cancellous bone to the periphery, sealing off the fracture clefts,and creating a cavity into which cement is poured. This technique may prevent propagation of further fractures by reducing the col-lapsed vertebral bodies toward its native height, normalizing the sagittal spinal alignment and the force transmission along the spine.
  • A. Jay Khanna; Mary Kay Reinhardt; Daisuke Togawa; Isador H Lieberman
    Osteoporosis International Springer Science and Business Media LLC 17 (6) 817 - 826 0937-941X 2006/05
  • Masahiro Kanayama; Tomoyuki Hashimoto; Keiichi Shigenobu; Shigeru Yamane; Thomas W Bauer; Daisuke Togawa
    Spine 31 (10) 1067 - 74 2006/05 
    STUDY DESIGN: A prospective, randomized and controlled study. OBJECTIVES: To evaluate the osteoinductive property of Osteogenic Protein-1 (OP-1 or BMP-7) and fusion rate in human instrumented posterolateral lumbar fusion through radiographic examination, surgical exploration, and histologic assessment. SUMMARY OF BACKGROUND DATA: The use of osteoinductive agents is a current topic in spinal fusion. Numerous preclinical investigations have demonstrated efficacy of osteoinductive proteins in spinal fusion, but few human clinical studies have been reported. METHODS: Nineteen patients with L3-L4 or L4-L5 degenerative spondylolisthesis underwent posterolateral lumbar fusion using pedicle screw instrumentation. The patients were randomized to receive either OP-1 Putty (3.5 mg OP-1/g of collagen matrix per side) alone (n = 9), or local autograft with HA-TCP granules (n = 10). Fusion status was evaluated using plain radiography and CT scan. Radiographic fusion criteria included less than 5 degrees of angular motion, less than 2 mm of translation, and evidence of bridging bone in the posterolateral lumbar area in which the graft materials were placed following decortication. After a minimum 1-year follow-up, the patients who showed radiographic evidence of fusion underwent instrumentation removal and surgical exploration of the fusion site. Biopsy specimens were taken from the fusion mass and evaluated histologically. RESULTS: Radiographic fusion rate was 7 of 9 OP-1 patients and 9 of 10 control patients. Based on surgical exploration of these 16 patients, new bone formation was macroscopically observed in the posterolateral lumbar region in all cases; however, solid fusion was observed in 4 of 7OP-1 and 7 of 9 HA-TCP/autograft patients. Histologic assessment demonstrated viable bone in 6 of 7 OP-1 patients. All the control (HA-TCP/autograft) specimens contained viable bone and fibrous tissue surrounding ceramic granules, suggesting slow incorporation of the graft material. CONCLUSIONS: In a human posterolateral lumbar spine trial, OP-1 reliably induced viable amounts of new bone formation, but the fusion success rate evaluated by surgical exploration was only 4 of 7.
  • Mark Makumbi Kayanja; Richard Schlenk; Daisuke Togawa; Lisa Ferrara; Isador Lieberman
    Spine 31 (7) 769 - 74 2006/04 
    STUDY DESIGN: Experimental biomechanics of multilevel segments with 0, 1, 2, and 3 vertebral levels of polymethylmethacrylate augmentation. OBJECTIVE: To compare multilevel spinal segments with different numbers (0, 1, 2, and 3) of vertebral levels augmented with polymethylmethacrylate. SUMMARY OF BACKGROUND DATA: The stiffness and strength of single-level polymethylmethacrylate augmentations in individual and multilevel vertebrae treated by kyphoplasty and vertebroplasty have been studied, but the biomechanics of multilevel segments with more than 1 vertebral level augmented with polymethylmethacrylate are lacking, yet this is clinically relevant in multilevel compression fracture treatment. MATERIALS AND METHODS: A total of 48 multilevel segments (T3-T5, T6-T8, T9-T11, T12-L2, and L3-L5) from 12 spines with known bone mineral density (BMD) were allocated into 6 groups based on the number of vertebral levels augmented: 0 levels (n = 13), control group; 1 level (n = 7), group 2; 2 levels, groups 3, 4, and 5 (n = 7 in each); and 3 levels (n = 7), group 6. They were compressed to failure, disarticulated into individual vertebrae, and retested. Stiffness and strength were statistically analyzed using a univariate analysis of variance comparing the main effects, using least significant difference comparisons with 0.05 probability level. RESULTS: Strength was dependent on BMD (P < 0.001 multilevel segments, P < 0.001 individual vertebrae), with no differences among the 6 different augmentation groups, and no significant differences between augmented and nonaugmented individual vertebrae. Stiffness was dependent on BMD (P = 0.009 multilevel segments, P < 0.004 individual vertebrae), with no significant differences among the 6 different augmentation groups, and no significant differences between augmented and nonaugmented individual vertebrae. CONCLUSIONS: Multilevel segment biomechanics are dependent on BMD and not the pattern of augmentation, so the augmentation of fractured vertebrae can be extended to adjacent levels at risk for fracture to maintain stiffness and strength, thus preventing further fractures.
  • KANAYAMA Masahiro; HASHIMOTO Tomoyuki; SHIGENOBU Keiichi; OHA Fumihiro; TOGAWA Daisuke; YAMANE Shigeru
    東日本整形災害外科学会雑誌 東日本整形災害外科学会 18 (1) 33 - 36 1342-7784 2006/03 
    腰椎変性疾患に対してGraf制動術を施行し10年以上経過した37例中,追跡調査しえた28例を対象に長期成績を調査した.X線学的には,長期にわたり制動椎間は前彎位が保持されており,約6割の症例で椎間可動性が温存されていた.Graf制動術は,変性すべり症やflexion instabilityの症例では長期的にも良好な成績が約束されるが,変性後側彎症など変形矯正が必要な症例では成績が不良だった(著者抄録)
  • Daisuke Togawa; Jeffrey J Kovacic; Thomas W Bauer; Mary Kay Reinhardt; Darrel S Brodke; Isador H Lieberman
    Spine 31 (1) E4-10  2006/01 
    STUDY DESIGN: Animal study. OBJECTIVES: To investigate the gross behavior and the histologic effect(s) of polymethylmethacrylate (PMMA) in primate vertebral bodies after percutaneous vertebroplasty and kyphoplasty. SUMMARY OF BACKGROUND DATA: PMMA is known to induce thermal osteonecrosis in exposed bone during tumor surgery and total joint arthroplasty, and barium sulfate as well as PMMA are known to induce a foreign body reaction, but the effects of PMMA on vertebral cancellous bone have not been well documented. Furthermore, little is known about the mechanisms of cement extravasation that occasionally occur during these procedures. Lastly, it is not known if differences exist between vertebroplasty and kyphoplasty with regards to the above occurrences. METHODS: Six living, elderly, female baboons were used in this study. Seven vertebrae from T12 to L6 were investigated in each animal. Two levels underwent vertebroplasty, two underwent kyphoplasty, and one underwent cavity creation only without cement augmentation in each animal. Three animals were killed at 24 hours and three at 26 weeks after surgery. The specimens were examined macroscopically for cement migration, and histologically for evidence of thermal necrosis, foreign body reaction, cement migration, and intravascular extravasation. RESULTS: Small zones of osteonecrosis were observed histologically at the bone-cement interface in only two kyphoplasty (2 of 6) and two vertebroplasty specimens (2 of 5) at 26 weeks after surgery. All of these necrotic segments of bone were associated with new bone formation. Foreign body reactions were observed in all specimens at 26 weeks after surgery, yet none of them was associated with bone resorption. The incidence of cement leak into the spinal canal and adjacent soft tissues was 6 of 11 and 4 of 11 in vertebroplasty specimens and 5 of 12 and 3 of 12 in kyphoplasty specimens, respectively. There was no statistical difference in the incidence of cement leakage into the spinal canal (P = 0.54) and adjacent soft tissues (P = 0.55) between vertebroplasty and kyphoplasty specimens. The incidence of intravascular cement was significantly greater in vertebroplasty (11 of 12, 91%) than in kyphoplasty (5 of 12, 42%) (P = 0.013). CONCLUSIONS: PMMA caused relatively little necrotic exothermal effect. The presence of PMMA with barium sulfate induces a mild foreign body reaction. The use of a balloon tamp creates a void by displacing pieces of bone, which may result in a lower incidence of intravascular cement leak.
  • Isador H. Lieberman; Daisuke Togawa; Mark M. Kayanja
    The Spine Journal Elsevier BV 5 (6) S305 - S316 1529-9430 2005/11
  • Naomi Kobayashi; Daisuke Togawa; Takaaki Fujishiro; Kimberly A Powell; A Simon Turner; Howard B Seim 3rd; Thomas W Bauer
    Journal of biomedical materials research. Part A 75 (1) 123 - 7 1549-3296 2005/10 
    Percutaneous vertebral augmentation with PMMA has been widely performed and usually provides good pain relief and stabilization of fractured vertebrae. Adequate visualization of PMMA during injection is desirable to minimize cement extravasation, so contrast agents such as barium sulfate are commonly added to the PMMA. The aim of this study was to evaluate the differences of histology and radiographic visualization when different concentrations of barium sulfate are mixed with PMMA. Six sheep were utilized in this study. Three vertebrae of each animal were exposed via retroperitoneal approach, and a cavity was created and then filled with either 10% or 30% BaSO4/PMMA, or left empty. Vertebrae were harvested and analyzed radiographically and histologically 12 and 90 days after surgery. Average CT value of the 30% BaSO4/PMMA group was 2.4-fold higher than that of the 10% BaSO4/PMMA group. Foreign-body giant cells were recognized around BaSO4particles at 90 days in the 30% BaSO4 group, whereas few particles were recognized in the 10% group at 90 days, or in either group at 12 days. A very mild giant-cell reaction is induced by a higher concentration of BaSO4 in PMMA, but the marked improvement in cement visualization by increased BaSO4 may be important to minimize more serious complications of cement extravasation during PMMA injection.
  • A Jay Khanna; Phillip Neubauer; Daisuke Togawa; Mary Kay Reinhardt; Isador H Lieberman
    Supportive cancer therapy 3 (1) 21 - 5 2005/10 
    Advances in the detection and treatment of many cancers have led to prolonged life and improved quality of life for patients with localized and metastatic cancer; however, the improved survival of patients with osseous lesions, coupled with the destructive nature of metastatic disease and the medications to treat these lesions, has increased the likelihood of vertebral body collapse. Conventional surgical techniques are often poorly tolerated by this patient population, whereas nonoperative management can lead to continued pain and diminished function in the terminal years of life. Vertebroplasty and kyphoplasty are minimally invasive vertebral augmentation techniques used to treat pain in such patients while maintaining a positive safety profile. Vertebroplasty and kyphoplasty are tools in a spectrum of treatments for vertebral compression fractures secondary to osteoporosis and metastatic disease and are not mutually exclusive. Additional research in this area in large cohorts of patients is needed to establish these techniques as safe and clinically cost-effective methods of treating patients with vertebral compression fractures secondary to spinal metastases.
  • 戸川 大輔; Lieberman Isador H.; Khanna A.Jay; Reinhardt Mary Kay
    臨床整形外科 (株)医学書院 40 (9) 1004 - 1013 0557-0433 2005/09
  • Daisuke Togawa; Richard Schlenk; Isador H Lieberman
    AJR. American journal of roentgenology 185 (1) 277; author reply 277  0361-803X 2005/07
  • Naomi Kobayashi; Thomas W Bauer; Daisuke Togawa; Isador H Lieberman; Hiroshige Sakai; Takaaki Fujishiro; Marion J Tuohy; Gary W Procop
    Diagnostic molecular pathology : the American journal of surgical pathology, part B 14 (2) 83 - 9 1052-9551 2005/06 
    The bacteria associated with orthopaedic infections are usually common gram-positive and gram-negative bacteria. This fundamental grouping of bacteria is a necessary first step in the selection of appropriate antibiotics. Since polymerase chain reaction (PCR) is more rapid and may be more sensitive than culture, we developed a postamplification pyrosequencing method to subcategorize bacteria based on a few nucleotide polymorphisms in the 16S rRNA gene. We validated this method using well-characterized strains of bacteria and applied it to specimens from spinal surgery cases with suspected infections. Lysates of 114 bacteria including 75 species were created following standard cultivation to obtain DNA. The DNA was amplified by a broad-range real-time PCR. The amplicons were evaluated by pyrosequencing and were classified as gram-positive, gram-negative, or acid-fast bacilli based on the first three to five nucleotides sequenced. In addition, clinical cases of suspected infection were obtained from spinal surgery. The results of the "molecular Gram stain" were compared with the results of traditional Gram stain and culture. The lysates of 107 (93.9%) of the bacteria extracts tested were appropriately categorized as gram-positive and gram-negative or as acid-fast bacilli on the basis of this assay. The sensitivity and specificity of this assay were 100% and 97.4% for gram-positive and 88.3% and 100% for gram-negative isolates. All of the five clinical samples were appropriately categorized as containing gram-positive or gram-negative bacteria with this assay. This study demonstrates that high sensitivity and specificity of a molecular gram stain may be achieved using broad-range real-time PCR and pyrosequencing.
  • Kai-Uwe Lewandrowski; Daisuke Togawa; Thomas W Bauer; Robert F McLain
    The Journal of bone and joint surgery. American volume 87 (6) 1348 - 53 0021-9355 2005/06
  • Daisuke Togawa; Isador H Lieberman; Thomas W Bauer; Mary Kay Reinhardt; Mark M Kayanja
    Spine 30 (7) 781 - 6 2005/04 
    STUDY DESIGN: A histological evaluation of biopsies obtained from presumed osteoporotic vertebral compression fractures (VCF) to confirm possible osteomalacia after tetracycline labeling. OBJECTIVE: To describe the results of a series of biopsies obtained at the time of vertebral augmentation in presumed osteoporotic VCF, with special reference to the presence of unmineralized bone (osteomalacia) and occult or unconfirmed plasma cell dyscrasia. SUMMARY OF BACKGROUND DATA: Vertebral augmentation is now widely performed as a method to treat osteoporotic or osteolytic VCF. However, the influence of underlying pathology on the effect of treatment is unclear. METHODS: As of October 2003, 178 biopsies were obtained from 142 patients with VCF during 246 kyphoplasty procedures. There were 110 one-level, 28 two-level, and 4 three-level biopsies. Patients included 41 men and 101 women, with an average age of 72 years (range 40-90). The patients consented to this procedure, and 25 received tetracycline (1g/day, in 2 doses separated by 6 days). Vertebral body biopsies were taken using a trephine just before the kyphoplasty procedure. The biopsies were fixed, embedded, and stained with toluidine blue and hematoxylin eosin, and were viewed with transmitted light. Unstained sections were viewed under fluorescent light to detect tetracycline labels. RESULTS: The 178 biopsy levels included: T4 (3), T5 (1), T6 (4), T7 (13), T8 (12), T9 (8), T10 (11), T11 (17), T12 (28), L1 (25), L2 (14), L3 (13), L4 (17), and L5 (12). All specimens showed fragmented bone with variable amounts of unmineralized bone (osteoid), suggesting bone remodeling and/or fracture healing. Woven bone and cartilaginous tissue were often present, representing fracture callus formation. The biopsies obtained from 30 patients (21%), including 4 who received tetracycline, showed significantly increased osteoid, suggesting either increased bone remodeling activity or mineralization defect (osteomalacia). One sample from these 4 patients who received tetracycline showed no tetracycline labels, essentially diagnostic of osteomalacia. The biopsies also provided definitive diagnoses for one case of unsuspected and 3 cases of unconfirmed plasma cell dyscrasia. CONCLUSIONS: The majority of biopsies from this series of patients revealed findings consistent with various stages of fracture healing. Osteoid seams were increased in 30 patients, representing either increased bone remodeling or osteomalacia. More cases with tetracycline labeling will help elucidate the true incidence of osteomalacia in this population. As we confirmed 4 cases of plasma cell dyscrasia, we advocate a biopsy during each first-time vertebral augmentation procedure.
  • Naoya Taki; Joscelyn M Tatro; Jennifer L Nalepka; Daisuke Togawa; Victor M Goldberg; Clare M Rimnac; Edward M Greenfield
    Journal of orthopaedic research : official publication of the Orthopaedic Research Society 23 (2) 376 - 83 0736-0266 2005/03 
    Periprosthetic osteolysis is a major clinical problem that limits the long-term survival of total joint arthroplasties. Osteolysis is induced by implant-derived wear particles, primarily from the polyethylene bearing surfaces. This study examined two hypotheses. First, that similar mechanisms are responsible for osteolysis induced by polyethylene and titanium particles. Second, that lymphocytes do not play a major role in particle-induced osteolysis. To test these hypotheses, we used the murine calvarial model that we have previously used to examine titanium-induced osteolysis. Polyethylene particles rapidly induced osteolysis in the murine calvaria 5-7 days after implantation. The polyethylene-induced osteolysis was associated with large numbers of osteoclasts as well as the formation of a thick periosteal fibrous tissue layer with numerous macrophages containing phagocytosed polyethylene particles. Polyethylene-induced osteolysis was rapidly repaired and was undetectable by day 21 after implantation. Lymphocytes were noted in the fibrous layer of wild-type mice. However, the amount of osteolysis and cytokine production induced by polyethylene particles was not substantially affected by the lack of lymphocytes in Pfp/Rag2 double knock out mice. All of these findings are similar to our observations of osteolysis induced by titanium particles. These results provide strong support for both of our hypotheses: that similar mechanisms are responsible for osteolysis induced by polyethylene and titanium particles and that lymphocytes do not play a major role in particle-induced osteolysis.
  • Mark M. Kayanja; Daisuke Togawa; Isador H. Lieberman
    The Spine Journal Elsevier BV 5 (1) 55 - 63 1529-9430 2005/01
  • H. Sakai; G. W. Procop; N. Kobayashi; D. Togawa; D. A. Wilson; L. Borden; V. Krebs; T. W. Bauer
    Journal of Clinical Microbiology American Society for Microbiology 42 (12) 5739 - 5744 0095-1137 2004/12 
    ABSTRACT A real-time PCR assay that uses two fluorescence resonance energy transfer probe sets and targets the tuf gene of staphylococci is described here. One probe set detects the Staphylococcus genus, whereas the other probe set is specific for Staphylococcus aureus . One hundred thirty-eight cultured isolates, which contained 41 isolates of staphylococci representing at least nine species, and 100 positive blood cultures that contained gram-positive cocci in clusters were tested. This assay was 100% sensitive and 100% specific for the detection of the Staphylococcus genus and of S. aureus .
  • Isador H Lieberman; Frank M Phillips; Daisuke Togawa; Michael Modic; Thomas Masaryk; Nancy Obuchowski; Curtis W Slipman
    Journal of vascular and interventional radiology : JVIR 15 (11) 1193 - 6 1051-0443 2004/11
  • UESUGI Masaaki
    日本小児整形外科学会雑誌 (一社)日本小児整形外科学会 13 (2) 135 - 137 0917-6950 2004/06 
    21歳女.19歳時に特発性側彎症に対し第5胸椎から第3胸椎までCotrel-Dubousette法による後方矯正固定術を施行した.術後6ヵ月で第3胸椎にかかっていたラミナフックが脱転したため,そのフックとロッドを一部切除し,術後1年10ヵ月でインプラントを全部抜去した.抜釘後6ヵ月で腰部の創部皮下に腫瘤を触知し,急速増大した.生検を行い,病理診断はデスモイドであったため,広範切除術を施行した.切除術後5年で再発はない
  • イエサカ カズホ; トガワ ダイスケ
    バイオマテリアル-生体材料- 日本バイオマテリアル学会 22 (3) 168 - 173 1347-7080 2004/05
  • Daisuke Togawa; Thomas W Bauer; Isador H Lieberman; Hiroshige Sakai
    The Journal of bone and joint surgery. American volume 86 (1) 70 - 9 0021-9355 2004/01 
    BACKGROUND: Although interbody cages are widely used, there is little histological documentation of the tissue within cages in the human spine. The purpose of this study was to describe the contents of retrieved, clinically failed, interbody cages from human patients, with special reference to the influence of graft type on the viability of bone in the cages. METHODS: Seventy-eight cages that had been retrieved from forty-eight patients were analyzed. There were eight carbon-fiber cages and seventy threaded metal cages. Of the sixty-seven cages for which information about grafting was available, fifty-six had been packed with autograft only, six had local autograft mixed with demineralized bone matrix, four had allograft, and one had demineralized bone matrix only. The indications for cage retrieval included a failed fusion, malposition or migration of the cage, trauma (a compression fracture at the fusion site), low-back pain, progressive spondylosis, nerve-root impingement, and/or infection. The cages had been in situ for an average of twenty-two months. Undecalcified sections through the center of each plastic embedded cage were reviewed, and the approximate areas occupied by viable bone, necrotic bone, fibrocartilage, hyaline cartilage, fibrous tissue, and graft substitute were visually estimated. Debris particles were estimated by a semiquantitative scoring system. RESULTS: Seventy-one of the seventy-eight cages showed evidence of vascular ingrowth and areas of histologically viable bone, representing incorporating bone graft. The average area occupied by viable bone was 44% (range, 0% to 80%). In some cages, relatively large fragments of cortical bone graft were associated with only minimal new-bone formation. Fibrocartilage occupied up to 50% of the available area in these failed cages. Some cages also contained small fibrocartilage seams connecting segments of bone in a pattern that suggested motion in vivo. In thirty-one of the seventy-eight cages, > or = 5% of the available area was occupied by hyaline cartilage, probably from vertebral end plates or facet joints. CONCLUSIONS: While this study was not designed to test the efficacy of cages or of bone graft, the prevalence of hyaline and fibrocartilage in these failed cages illustrates the importance of graft and graft-site preparation to maximize bone-graft incorporation. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.
  • 戸川 大輔; Bauer Thomas W.; 齋藤 知行
    骨・関節・靱帯 (株)アークメディア 16 (9) 1177 - 1182 0915-1125 2003/09
  • Thomas W Bauer; Daisuke Togawa
    Orthopedics 26 (9) 925 - 6 0147-7447 2003/09
  • Daisuke Togawa; Thomas W Bauer; Isador H Lieberman; Satoshi Takikawa
    Spine 28 (14) 1521 - 7 2003/07 
    STUDY DESIGN: Histologic documentation of vertebral bodies retrieved from human patients. OBJECTIVES: The purpose of this study is to illustrate the histologic findings of two cases in which vertebroplasty and/or kyphoplasty had been performed. SUMMARY OF BACKGROUND DATA: There are a number of controversies to vertebral augmentation, including the use of inflatable bone tamps, use of nonstandardized polymethylmethacrylate (PMMA) preparations, the extent and significance of thermal necrosis, any foreign body reaction, and cement extravasation. METHODS: Four vertebral bodies from two cases ranging from 1 month to 2 years after surgery were analyzed histologically. Microscope slides of retrieved vertebral bodies were reviewed with special reference for evidence of thermal necrosis, foreign body reaction, migration of cement, cement voids and fractures, and for the influence of the bone tamp on adjacent bone. RESULTS: The cancellous bone around the cement of the kyphoplasty specimen showed good density, suggesting that the tamping had displaced bone, essentially autografting the space around the cement. Bone immediately around the cement did not show extensive necrosis, but there were a few spicules of necrotic bone associated with creeping substitution, suggesting either thermal effect, the original fracture, or displacement of bone by the procedure. Foreign body giant cells and macrophages were identified in the fibrous membrane around the PMMA in all segments. These cells contained material consistent with cement particles and/or barium sulfate. Particles were also present within vascular spaces. CONCLUSIONS: To our knowledge, these cases are among the first published reports of human histology after vertebral cement augmentation and have implications concerning the nature of the surgical procedures as well as the material used for injection.
  • Satoshi Takikawa; Thomas W Bauer; Helen Kambic; Daisuke Togawa
    Journal of biomedical materials research. Part A 65 (1) 37 - 42 1549-3296 2003/04 
    In the United States, demineralized bone matrix (DBM) is considered a transplantable tissue and therefore is regulated primarily by the American Association of Tissue Banks. Even though DBM is not subjected to the same regulations relative to performance claims as medical devices are, one would expect different processing methods might yield DBM preparations of different osteoinductive potential. The purpose of this study was to use an established athymic rat model to compare the osteoinductive properties of two commercially available human DBMs prepared using different methods but having essentially identical product claims. Sixteen female athymic rats were used to test equivalent volumes of two lots each of Grafton Putty (Osteotech, Inc., Eatontown, NJ), Osteofil (Regeneration Technologies, Inc., Alachua, FL), and rat DBM. At 28 days after implantation, qualitative and semiquantitative microscopy showed no significant differences in bone formation between the two lots from each source, but rat DBM produced significantly more bone than Grafton, which produced significantly more bone than Osteofil. Our results suggest that methods of graft processing may represent a greater source of variability than do differences among individual donors. Whether these differences relate to methods of demineralization, carrier, dose of DBM per volume, or to some other factor remains to be determined.
  • Daisuke Togawa; Thomas W Bauer; Isador H Lieberman; Gary L Lowery; Satoshi Takikawa
    Spine 28 (3) 246 - 53 2003/02 
    STUDY DESIGN: Histologic documentation of contents within retrieved, failed human titanium mesh cages. OBJECTIVES: The purpose of this study is to describe the contents of a series of retrieved, clinically failed titanium mesh cages from human patients. SUMMARY OF BACKGROUND DATA: The use of interbody fusion cages is gaining rapid acceptance, but there is little histologic documentation of tissue within retrieved cages. METHODS: Eleven Titanium Surgical Mesh Cages (Harms; DePuy AcroMed, Raynham, MA) retrieved from 10 patients were histologically analyzed. Indications for cage retrieval included failed fusion or failed fusion with instrumentation failure. The cages had been in situ from 2 to 47 months. Histologic sections were reviewed qualitatively, and the approximate percent of area in the cage occupied by viable bone, necrotic bone, fibrocartilage, hyaline cartilage, fibrous tissue, and bone graft substitute was visually estimated. Particles of metal debris were estimated by a semiquantitative scoring system. RESULTS: All cages except one showed evidence of vascular ingrowth and areas of histologically viable bone, representing incorporating bone graft. At least a few particles of debris were present in 9 of 11 cages. Fibrocartilage of probable intervertebral disc origin ranged from 0% to 70% of the available area. Several cages contained small seams of fibrocartilage connecting segments of bone in a pattern that suggested a response to motion. CONCLUSIONS: Mean viable bone area within 11 retrieved, human titanium mesh cages was approximately 31%. Seams of fibrocartilage within the cages may represent tissue differentiation in response to bending or compressive load.
  • TOGAWA Daisuke; BAUER Thomas W.; BRANTIGAN John W.; LOWERY Gary L.
    Spine 26 (24) 2744 - 2750 0362-2436 2001/12
  • ORITO Keisuke; YASODA Takahisa; HIRAKAWA Kazuo; TOGAWA Daisuke; MITSUKI Naoto; KOSHINO Tomihisa
    関東整形災害外科学会雑誌 関東整形災害外科学会 31 (3) 258 - 262 0389-7087 2000/05 
    71歳女,PCA型人工股関節置換術後,カップ再置換術を行った症例を経験した.1)大腿骨近位部及び臼蓋側の骨溶解を認めた.2)偽関節包には組織学的にポリエチレンの磨耗粉が多数認められた.3)大腿側骨溶解部では巨細胞を認めた.また周囲に泡沫細胞が多数存在した
  • Daisuke Togawa; Tomihisa Koshino; Tomoyuki Saito; Toshitaka Takagi; Jiro Machida
    Cancer Letters Elsevier BV 146 (1) 25 - 33 0304-3835 1999/11
  • TOGAWA Daisuke; KOSHINO Tomihisa; SAITO Tomoyuki; YASODA Takahisa
    関東整形災害外科学会雑誌 関東整形災害外科学会 30 (4) 330 - 334 0389-7087 1999/08 
    58歳女に放射線療法及び脊髄損傷予防の為の後方固定術を施行した.術後1年の現在,頸部痛は消失し,神経学的異常の出現もなく経過良好である
  • OKAZAKI Atsushi; OKAMOTO Renzo; WADA Jiro; SAKANO Hiroaki; HAYASHI Takeshi; TOGAWA Daisuke; SAKURAI Shin-ichi; KOSHINO Tomihisa
    関東整形災害外科学会雑誌 関東整形災害外科学会 29 (6) 622 - 627 0389-7087 1998/12 
    55歳女.TKAを施行し,術後腓骨神経麻痺が発生した.腓骨頭切除術及び腓骨神経剥離術にて腓骨神経麻痺は改善した.TKA後約2年では歩行能力は改善した
  • TOGAWA Daisuke; KOSHINO Tomihisa; MACHIDA Jiro; NAKAZAWA Akihiro
    関東整形災害外科学会雑誌 関東整形災害外科学会 29 (6) 628 - 631 0389-7087 1998/12

Books etc

Conference Activities & Talks

  • 胸骨骨折に多発胸椎椎体圧潰を合併し後彎変形が進行した1例
    山崎 顕二; 小林 敬也; 家村 駿輝; 森 成志; 神谷 正人; 戸川 大輔
    第138回中部日本整形外科災害外科学会・学術集会  2022/04  (一社)中部日本整形外科災害外科学会
  • 骨原発性悪性リンパ腫による病的大腿骨骨幹部骨折の一例
    小林 敬也; 山崎 顕二; 家村 駿輝; 森 成志; 神谷 正人; 戸川 大輔
    第138回中部日本整形外科災害外科学会・学術集会  2022/04  (一社)中部日本整形外科災害外科学会
  • 中井 慶一; 大和 雄; 長谷川 智彦; 戸川 大輔; 吉田 剛; 坂野 友啓; 有馬 秀幸; 三原 唯暉; 大江 慎; 松山 幸弘
    Journal of Spine Research  2022/03  (一社)日本脊椎脊髄病学会
  • UKA と TKA の術式選択-膝関節症治療全体の成績向上のために-
    森 成志; 家村 駿輝; 小林 敬也; 山崎 顕二; 神谷 正人; 戸川 大輔; 井上 紳司; 青山 真吾; 墳本 一郎; 赤木 將男
    第52回日本人工関節学会  2022/02
  • Vertebral Augmentation for Osteoporotic and Osteolytic Vertebral Fractures
    Daisuke Togawa
    7th World Congress of Minimally Invasive Spine Surgery & Techniques  2021/11
  • 溶骨性脊椎腫瘍に対するBalloon Kyphoplasty
    戸川大輔
    第27回日本最小侵襲整形外科学会  2021/11
  • Balloon Kyphoplasty (BKP) -超高齢者に対する治療コンセプト
    戸川大輔
    第11回最小侵襲脊椎治療学会  2021/10
  • がんロコモに対する当院の取り組み ―骨転移外来設置と手術治療の実際
    戸川大輔
    第29回日本腰痛学会  2021/10
  • 骨粗鬆症性椎体骨折の診断と治療の実際~骨粗鬆症性椎体骨折診療マニュアルより~
    戸川大輔
    Medical Tribune Web講演(全国講演)  2021/10
  • 骨粗鬆症性椎体骨折診療マニュアル(日本整形外科学会骨粗鬆症委員会WG策定) ~診断と治療選択のポイント~
    戸川大輔
    第39回日本骨代謝学会学術集会  2021/10
  • Surgical treatment for osteoporotic vertebral fractures
    Daisuke Togawa
    The 28th Annual meeting of Japanese Society for the study of surgical technique for spine and spinal nerve, Tea time seminar  2021/09
  • To Establish Clearer Evidence in Vertebral Augmentation - Biomaterial and Timing of Surgical Indication Considering Patient's Age
    Daisuke Togawa
    The 21st Annual Meeting of the Pacific and Asian Society of Minimally Invasive Spine Surgery  2021/07
  • 骨粗鬆症性椎体骨折に対する経皮的椎体形成術(Balloon Kyphoplasty) ー年代別治療体系
    戸川大輔
    第22回日本骨粗鬆症学会  2020/10
  • Age-dependent surgical strategy for the patinets with vertebral fractures - spinal alignment first? or ADL first?
    Daisuke Togawa
    The 49th Annual Meeting of the Japanese Society for Spine Surgery and Related Research  2020/09
  • Vertebral augmentation in Japan - History of balloon kyphoplasty 10 years
    Daisuke Togawa
    The 49th Annual Meeting of the Japanese Society for Spine Surgery and Related Research  2020/09
  • 骨粗鬆症性脆弱性骨折を伴う成人後側弯変形ー手術治療について
    戸川 大輔
    第10回最小侵襲脊椎治療学会  2020/02
  • 骨粗鬆症性椎体骨折に対する経皮的椎体形成術の適応と成績
    戸川大輔
    第27回日本腰痛学会  2019/09
  • 骨粗鬆症性椎体骨折に対する Balloon Kyphoplasty -早期適応症例における留意すべき点
    戸川大輔
    第48回日本脊椎脊髄病学会学術集会  2019/04
  • Balloon Kyphoplastyの安全性と有効性 ―適応時期の推移―
    戸川大輔
    第21回日本低侵襲脊椎外科学会  2018/11
  • Balloon Kyphoplasty(BKP)の実際
    戸川大輔
    第24回日本最小侵襲整形外科学会  2018/11
  • パーキンソン病および関連疾患に伴う脊柱変形に対する長範囲矯正固定術-長期フォローで矯正固定手術は満足できる結果か?-
    大和 雄; 長谷川智彦; 戸川大輔; 吉田剛; 坂野友啓; 有馬秀幸; 大江慎; 三原唯暉; 後迫宏紀; 山田智裕; 松山幸弘
    第52回日本側彎症学会学術集会  2018/11
  • カニクイザル椎間板障害モデルにおける痛みの可視化:椎間板性疼痛は二次体性感覚野および島皮質の活動を増加させる—
    後迫宏紀; 吉田 剛; 長谷川智彦; 大和 雄; 戸川大輔; 夏目貴弘; 小川真弥; 阿波賀祐治; Hama A; 髙松宏幸; 松山幸弘
    第26回日本腰痛学会  2018/10
  • ハンズオンセッションⅡ(看護師対象)
    戸川大輔
    若手医師と看護師のための脊椎インストゥルメンテーションセミナー・ハンズオンセッション(第27回日本脊椎インストゥルメンテーション学会併設)  2018/09
  • ハンズオンセッションⅠ(若手医師対象)
    戸川大輔
    若手医師と看護師のための脊椎インストゥルメンテーションセミナー・ハンズオンセッション(第27回日本脊椎インストゥルメンテーション学会併設)  2018/09
  • 最新インストゥルメントの紹介
    戸川大輔
    若手医師と看護師のための脊椎インストゥルメンテーションセミナー・ハンズオンセッション(第27回日本脊椎インストゥルメンテーション学会併設)  2018/09
  • 成人脊柱変形患者の治療では腰仙以降部、股関節に要注意
    長谷川智彦; 大和 雄; 戸川大輔; 吉田 剛; 小林 祥; 安田達也; 坂野友啓; 有馬秀幸; 大江 慎; 三原唯暉; 後迫宏起; 山田智裕; 松山幸弘
    第27回日本イントゥルメンテーション学会  2018/09
  • Sagittal Spinal Alignment versus Health Related Quality of Life Investigated by Longitudinal Cohort in the Japanese Elderly Volunteers (“TOEI study”)
    Daisuke Togawa
    2018 Sino - Japan (Shenzhen) Spine Summit for Adult Spinal Deformity  2018/08
  • Vertebroplasty, Kyphoplasty, Spinejack and Others
    Daisuke Togawa
    Asia Pacific Spine Society Annual meeting 2018  2018/06
  • How to get your manuscript published and why participate in the peer review process?
    Daisuke Togawa
    第91回日本整形外科学会学術集会  2018/05
  • 脊柱変形手術患者の立位歩行時の体幹下肢の関連
    大和 雄; 有馬秀幸; 長谷川智彦; 戸川大輔; 吉田 剛; 坂野友啓; 大江 慎; 小林 祥; 安田達也; 三原唯暉; 後迫宏紀; 松山幸弘
    第45回日本関節病学会  2017/11
  • ハンズオンセッションⅡ(看護師対象)
    戸川大輔
    若手医師と看護師のための脊椎インストゥルメンテーションセミナー・ハンズオンセッション(第26回日本脊椎インストゥルメンテーション学会併設)  2017/10
  • ハンズオンセッションⅠ(若手医師対象)
    戸川大輔
    若手医師と看護師のための脊椎インストゥルメンテーションセミナー・ハンズオンセッション(第26回日本脊椎インストゥルメンテーション学会併設)  2017/10
  • 最新インストゥルメントの紹介
    戸川大輔
    若手医師と看護師のための脊椎インストゥルメンテーションセミナー・ハンズオンセッション(第26回日本脊椎インストゥルメンテーション学会併設)  2017/10
  • 成人脊柱変形手術における周術期合併症対策-スライディングスケールの開発-
    吉田 剛; 長谷川智彦; 大和 雄; 大江 慎; 坂野友啓; 有馬幸秀; 三原唯暉; 安田達也; 戸川大輔; 松山幸弘
    第51回日本側弯症学会学術集会  2017/08
  • TOEI study - Age and Gender Differences in Spinopelvic Sagittal Alignment and Health Related Quality of Life of Elderly Volunteers longitudinal Cohort (2012~2016)
    Daisuke Togawa
    第14回日仏整形外科合同会議  2017/05
  • 一般住民における脊椎矢状面アライメントの評価と臨床応用
    大和 雄; 戸川大輔; 長谷川智彦; 小林 祥; 安田達也; 吉田 剛; 坂野友啓; 大江 慎; 三原唯暉; 松山幸弘
    第46回日本脊椎脊髄病学会学術集会  2017/04
  • 成人脊柱変形手術後の再手術-年代、原因別の検討-
    戸川大輔; 長谷川智彦; 大和 雄; 吉田 剛; 小林 祥; 安田達也; 大江 慎; 坂野友啓; 三原唯暉; 松山幸弘
    第7回日本成人脊柱変形学会  2017/03
  • 成人脊柱変形手術後ロッド折損例の症候と治療経過
    戸川大輔; 長谷川智彦; 大和 雄; 吉田 剛; 小林 祥; 安田達也; 大江 慎; 坂野友啓; 三原唯暉; 松山幸弘
    第7回日本成人脊柱変形学会  2017/03
  • 最新インストゥルメントの紹介
    戸川大輔
    若手医師と看護師のための脊椎インストゥルメンテーションセミナー・ハンズオンセッション(第25回日本イントゥルメンテーション学会併設)  2016/10
  • 多発性骨髄腫に対する経皮的椎体形成術
    戸川大輔
    第41回日本骨髄腫学会学術総会  2016/05
  • 骨粗鬆症性椎体骨折診療におけるBalloon Kyphoplastyの適応範囲
    戸川大輔; 佐藤義弘; 松山幸弘
    第89回日本整形外科学会学術総会  2016/05
  • 椎体骨折と高齢者の全脊椎矢状面アライメントを考える-保存療法/BKP/脊柱再建-
    戸川大輔
    第89回日本整形外科学会学術総会  2016/05
  • 成人脊柱変形手術に対する骨切り矯正量の安全域
    小林 祥; 長谷川智彦; 大和雄; 戸川大輔; 大江慎; 坂野友啓; 三原唯暉; 黒須健太; 松山幸弘
    第45回日本脊椎脊髄病学会  2016/04
  • Balloon Kyphoplastyを考える―骨粗鬆症性椎体骨折治療の問題点
    戸川大輔
    第45回日本脊椎脊髄病学会  2016/04
  • How to publish your manuscript in JBJS?
    Daisuke Togawa
    Asia Pacific Orthopaedic Association 2016  2016/03
  • 成人脊柱変形に対するLLIFを併用した矯正固定術で低侵襲かつ十分な矯正が得られるか
    大和 雄; 長谷川智彦; 小林 祥; 戸川大輔; 大江 慎; 松山幸弘
    第18回日本低侵襲脊椎外科学会  2015/11
  • TOEI Study-高齢運動器検診者の性別からみた骨粗鬆症と腰痛の関連性
    戸川大輔
    第23回日本腰痛学会  2015/11
  • 成人脊柱変形手術において大きい矯正は危険か? 骨切り矯正量と神経合併症の検討
    小林 祥; 長谷川智彦; 大和 雄; 安田達也; 戸川大輔; 松山幸弘
    第24回日本脊椎インストゥルメンテーション学会  2015/11
  • 高齢運動器検診者における脊柱骨盤パラメータ悪化とQOLの悪化の相関性
    戸川大輔; 坂野友啓; 長谷川智彦; 大和 雄; 小林 祥; 安田達也; 大江 慎; 松山幸弘
    第49回日本側弯症学会各術集会  2015/11
  • 骨粗鬆症性椎体骨折後後弯症(OPK)の病態と治療
    長谷川智彦; 大和 雄; 小林 祥; 戸川大輔; 安田達也; 坂野友啓; 有馬秀幸; 大江 慎; 山田智裕; 中井慶一; 松山幸弘
    第88回日本整形外科学会学術集会  2015/05
  • Sagittal alignment in the elderly. Should we adjust sagittal alignment goals by age?
    Daisuke Togawa
    Eurospine-SRS Joint 2015 Spring Meeting  2015
  • 骨粗鬆症性椎体骨折診断の諸問題-予防・診断・治療体系の整備-
    戸川大輔
    第44回日本脊椎脊髄病学会学術集会  2015/04
  • 成人脊柱変形-目標とすべきアライメントとは?
    大和 雄; 長谷川智彦; 小林 祥; 安田達也; 戸川大輔; 有馬秀幸; 坂野友啓; 大江 慎; 松山幸弘
    第48回日本側彎症学会学術集会  2014/11
  • 椎体骨折による脊柱変形に対する脊柱再建術
    長谷川智彦; 大和 雄; 小林 祥; 戸川大輔; 安田達也; 坂野友啓; 大江 慎; 山田智裕; 中井慶一; 松山幸弘
    第49回日本脊髄障害医学会  2014/09
  • 脊椎外科とデバイスラグ
    戸川大輔
    第87回日本整形外科学会学術総会  2014/05
  • Balloon Kyphoplasty: 骨粗鬆症性椎体骨折研究会 全国調査結果
    戸川大輔; 蜂谷裕道; 骨粗鬆症性椎体骨折研究会
    第43回日本脊椎脊髄病学会学術集会  2014/04
  • 脊椎固定術の功罪 成人脊柱変形術後1年のアライメントとQOL調査-術後よりよいQOLを得られるアライメントは
    大和 雄; 長谷川智彦; 小林 祥; 安田達也; 戸川大輔; 有馬秀幸; 松山幸弘
    第43回日本脊椎脊髄病学会学術集会  2014/04
  • 骨粗鬆症性腰痛(骨傷あり・なし)の治療戦略 骨粗鬆症性椎体骨折による脊柱変形の矢状面パラメータとQOL
    大和 雄; 長谷川智彦; 小林 祥; 安田達也; 戸川大輔; 有馬秀幸; 松山幸弘
    第21回日本腰痛学会  2013/11
  • 成人脊柱変形の術式選択
    長谷川智彦; 大和 雄; 小林 祥; 戸川大輔; 安田達也; 有馬秀幸; 松山幸弘
    第20回記念 日本脊椎・脊髄神経手術手技学会  2013/09
  • 成人脊柱変形症矢状面formulaの検討
    大和 雄; 長谷川智彦; 戸川大輔; 小林 祥; 安田達也; 有馬秀幸; 松山幸弘
    第20回記念 日本脊椎・脊髄神経手術手技学会  2013/09
  • 骨粗鬆症性椎体骨折の治療戦略
    戸川大輔
    日本IVR学会第11回夏季学術セミナー  2013/08
  • 成人脊柱変形QOL調査-静岡県臨床整形外科医会診療所での横断的検討-
    大和 雄; 長谷川智彦; 小林 祥; 安田達也; 戸川大輔; 松山幸弘
    第26回日本臨床整形外科学会学術大会 富士山学会・静岡  2013/07
  • 成人脊柱変形の手術
    長谷川智彦; 大和 雄; 小林 祥; 戸川大輔; 安田達也; 松山幸弘
    第26回日本臨床整形外科学会学術大会 富士山学会・静岡  2013/07
  • 骨粗鬆症と椎体骨折の診断と治療:薬物治療の意義と整形外科医への啓蒙
    戸川大輔
    第26回日本臨床整形外科学会学術大会 富士山学会・静岡  2013/07
  • BKPの適応と限界
    戸川大輔
    第86回日本整形外科学会総会  2013/05
  • Balloon Kyphoplastyの適応と合併症対策
    戸川大輔
    第42回日本IVR学会総会  2013/05
  • 骨粗鬆症性椎体骨折に対する多種椎体形成術間での術後続発性骨折発生に関する比較検討
    加藤 剛; 大川 淳; 德橋泰明; 中村博亮; 武政龍一; 戸川大輔; 四宮謙一
    第20回日本腰痛学会  2012/11
  • 成人脊柱変形に対する矯正固定術は矢状面下肢アライメントも変えるか?
    小林 祥; 長谷川智彦; 大和 雄; 安田達也; 有馬秀幸; 戸川大輔; 松山幸弘
    第21回日本脊椎インストゥルメンテーション学会  2012/11
  • Balloon Kyphoplasty – Tips and Tricks
    Daisuke Togawa
    19th Japan Society for the Study of Surgical Technique for Spine and Spinal Nerves  2012/09
  • Posterior surgical treatment of kyphotic deformity with compression fracture
    Hasegawa T; Togawa D; Yamato Y; Kobayashi S; Yasuda T; Matsuyama Y
    2012 Spine Across the Sea  2012/07
  • 骨粗鬆症性椎体骨折に対する椎体形成術
    戸川大輔
    第10回脊椎脊髄病研修コース(日本脊椎脊髄病学会 )  2012/04
  • 骨粗鬆症と椎体骨折の治療指針
    戸川大輔
    第41回日本脊椎脊髄病学会  2012/04
  • 骨粗鬆症性椎体骨折に対する椎体形成術からみた診断の問題点
    戸川大輔
    第41回日本脊椎脊髄病学会  2012
  • Balloon Kyphoplasty
    Daisuke Togawa
    JPSTSS-IGASS(International Group for Advancement in Spine Science) Joint Meeting.(JPSTSS Pre-Meeting)  2011/09
  • 椎体骨折判定-脊椎外科医の立場から
    戸川大輔
    第29回日本骨代謝学会学術集会  2011/07
  • 椎体骨折評価-脊椎外科医の立場から
    戸川大輔
    第31回日本骨形態計測学会  2011/05
  • 腰椎インストゥルメンテーション手術後感染に対する治療指針-インプラント抜去を判断するMRI所見-
    金山雅弘; 戸川大輔; 橋本友幸; 重信恵一; 大羽文博; 山田勝久
    第84回日本整形外科学会学術集会  2011/05
  • 経皮的椎体形成術を行うための椎体骨折画像診断
    戸川大輔
    第40回日本脊椎脊髄病学会  2011/04
  • 骨粗鬆症性椎体骨折の治療体系 -Balloon Kyphoplastyの適応範囲-
    戸川大輔
    第40回日本脊椎脊髄病学会  2011/04
  • Balloon Kyphoplasty – 日本での治験成績と今後の課題
    戸川大輔
    第83回日本整形外科学会学術総会  2010/05
  • 骨粗鬆症性圧迫骨折の保存治療過程における骨折治癒とEuroQOL (EQ-5D)効用値の相関性
    戸川大輔; 金山雅弘; 重信恵一; 大羽文博; 長濱賢; 橋本友幸; 仲村真実; 宇美由美; 宇田聡子; 田中静子
    第83回日本整形外科学会学術総会  2010/05
  • 原発性骨粗鬆症性圧迫骨折に対するBalloon Kyphoplasty – 日本の臨床試験成績
    戸川大輔
    第39回日本脊椎脊髄病学会  2010/04
  • 骨粗鬆症性胸腰椎骨折後椎体圧潰による不安定性後弯と遅発性神経麻痺の病態と治療
    金田清志; 伊藤学; 金山雅弘; 橋本友幸; 戸川大輔; 須田浩太; 楫野知道
    第39回日本脊椎脊髄病学会  2010/04
  • 腰椎変性側彎に対するshort segment fusionの問題点ー脊柱変形の進行と体幹バランス悪化についてー
    金山雅弘; 戸川大輔; 橋本友幸; 重信恵一; 大羽文博; 長濱賢
    第39回日本脊椎脊髄病学会  2010/04
  • 骨粗鬆症性圧迫骨折、骨髄腫、溶骨性転移性椎体腫瘍に対するBalloon Kyphoplastyの治療成績
    戸川大輔; Lieberman IH
    第43回日本側彎症学会  2009/11
  • 骨粗鬆症性圧迫骨折に対するBalloon Kyphoplastyでの椎体高回復ー術中体位と手術手技による椎体高回復の分析
    戸川大輔; Lieberman IH; Shlenk R; Reinhardt MK; Glaser JA; Merritt J; Odell J; Wildstein M
    第43回日本側彎症学会  2009/11
  • Balloon Kyphoplasty – 骨粗鬆症性圧迫骨折に対する低侵襲手術手技としての長所と短所
    戸川大輔
    第17回日本腰痛学会  2009/11
  • Balloon Kyphoplasty - 手術手技、適応、日本における臨床治験成績
    戸川大輔
    第35回日本骨折治療学会  2009/07
  • Kyphoplasty – Height Restoration. International Meeting of Advanced Spine Techniques
    Daisuke Togawa
    12th IMAST  2005/07

MISC

Research Grants & Projects

  • Japan Society for the Promotion of Science:Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)
    Date (from‐to) : 2017/04 -2020/03 
    Author : TOGAWA Daisuke
     
    Effect of exercise intervention for elderly volunteers on Locomotive syndrome has been investigated. Sixty-four patients (25 males, 39 females, average age: 78) were investigated. They were educated about quadriceps, one-leg standing, half squat, and hip-up trainings at out-patient clinic, and performed them at home for 3 months. After 3 months, their average grip power, muscle volume, muscle power (quadriceps), and gait speed were changed from 24.6 to 25.5 kg, 6.7 to 6.6 kg/m2, 229 to 322 N, 1.2 to 1.3 m/s, respectively. Grip power, muscle power (quadriceps), and gait speed were significantly increased (P= <0.001, <0.001, =0.03). Sarcopenia was observed in 4 cases (6%) at the first investigation, however, it was decreased to 2 cases 3 months after the intervention.

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