Toshinori Sakai and Shinsuke Katoh : 経椎体的椎間板ヘルニア切除術, May 2012.
23.
Toshinori Sakai, Koichi Sairyo and NN Bhatia : Management of Thoracolumbar Fractures., 2012.
24.
Toshinori Sakai, Koichi Sairyo and Bhatia B. Nitin : Spondylolysis and Spondylolisthesis., 2010.
25.
Koichi Sairyo, Goel K. Vijay, Biyani Ashok, Ebraheim A. Nabil, Toshinori Sakai and Togawa Disuke : Endscopic decompression for lumbar spondylolysis: clinical and biomechanical observations., 2007.
Academic Paper (Judged Full Paper):
1.
Kazuya Kishima, Kiyoshi Yagi, Kazuta Yamashita, Fumitake Tezuka, Masatoshi Morimoto, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Transforaminal full-endoscopic ventral facetectomy: mid-term results and factors associated with poor surgical outcomes., Journal of Neurological Surgery. Part A, Central European Neurosurgery, Vol.85, No.2, 155-163, 2024.
(Summary)
Full-endoscopic spine surgery (FESS) is a well-established procedure for herniated nucleus pulposus. It is a minimally invasive surgery that can be performed under local anesthesia through only an 8-mm skin incision. With improvements in surgical equipment such as high-speed drills, the indications for FESS have expanded to include lumbar spinal stenosis (LSS). We perform transforaminal full-endoscopic ventral facetectomy (TF-FEVF) for unilateral nerve root-type lateral recess stenosis (LRS) using a transforaminal approach under local anesthesia. PURPOSE The aim of this study was to examine the postoperative results of TF-FEVF for LRS and to identify factors associated with poor surgical outcomes. STUDY DESIGN Retrospective study. PATIENT SAMPLE 85 patients who underwent TF-FEVF for LRS under local anesthesia. OUTCOME MEASURES Clinical outcomes were determined by visual analogue scale (VAS) and the modified MacNab criteria. Evaluation was performed using magnetic resonance imaging (MRI), computed tomography (CT), and flexion-extension radiographs. METHODS This study involved 85 patients (47 male, 38 female) who underwent TF-FEVF for LRS. The mean age was 70.5 years and the mean follow-up duration was 14.8 months. Data were collected on sex, age, level of operation, diagnosis, history of spine surgery at the same level, and duration of follow-up. The diagnosis was categorized as lumbar spinal stenosis with or without disc bulging. Clinical evaluation was performed using the VAS and modified MacNab criteria. MRI was used to evaluate the degree of disc degeneration, vertebral endplate degeneration, disc height, thickening of the ligamentum flavum, and stenosis. Bony stenosis was evaluated using CT. Sagittal translation and sagittal angulation were also measured by flexion-extension radiographs, and Cobb angle was measured using a standing front view radiograph. All variables were compared between patients with excellent/good outcomes (E/G group) and those with fair/poor outcomes (F/P group) using the modified MacNab criteria. Results Postoperative VAS showed that leg pain decreased from 59.0±28.6 preoperatively to 17.9±27.2 at final follow up (P<0.01), and that lower back pain also decreased from 60.7±26.6 preoperatively to 27.3±28.6 at final follow up (P<0.01). According to the modified MacNab criteria, the results during the final follow-up were excellent in 39 cases, good in 21 cases, fair in 13 cases, and poor in 12 cases. There were no significant differences in sex, age, diagnosis, history of spine surgery, and duration of follow-up periods between the 60 cases (70.6%) in the E/G group and the 25 cases (29.4%) in the F/P group. Imaging evaluation revealed statistically significant differences between the E/G group and the F/P group in intervertebral angle flexion (3.2° vs 0.4°, P<0.05), sagittal angulation (4.3° vs 8.1°, P<0.05), slip in flexion (0.9mm vs 2.8mm, P<0.05), sagittal translation (0.7mm vs 1.6mm, P<0.05), and Cobb angle (-0.5° vs -1.9°, P<0.05). Conclusion Mid-term results of TF-FEVF were generally favorable; factors contributing to good or poor TF-FEVF outcomes were large sagittal angulation, large sagittal translation, and concave side.
Hiroaki Manabe, Masatoshi Morimoto, Kosuke Sugiura, Makoto Takeuchi, Fumitake Tezuka, Kazuta Yamashita, Toshinori Sakai and Koichi Sairyo : Morphological Evaluation of Lumbar Facet Joints in Professional Baseball Players., Orthopaedic Journal of Sports Medicine, Vol.12, No.1, 2024.
(Summary)
The facet joints of professional baseball players were enlarged asymmetrically, with different tendencies observed between pitchers and fielders. Although pitching and batting are movements that transmit the rotation from the lower limbs to the upper limbs, the effects of rotation and lateral flexion were associated significantly with facet joint hypertrophy.
Yoshihiro Ishihama, Fumitake Tezuka, Hiroaki Manabe, Masatoshi Morimoto, Kazuta Yamashita, Toshinori Sakai and Koichi Sairyo : Facet Joint Morphology and Tropism in Adolescents: Association with Lumbar Disc Herniation and Spondylolysis., Spine, 2023.
(Summary)
Facet tropism in adolescents is similar in the axial and sagittal planes. Facet tropism and specific morphology may be related to lumbar disc herniation and spondylolysis in this age group.
Ryo Okada, Toshinori Sakai, Toshihiko Nishisho, Akihiro Nitta, Shigeyuki Takahara, Koichi Oba and Koichi Sairyo : Preoperative Planning Using Three-dimensional Printing for Full-endoscopic Spine Surgery: A Technical Note., NMC Case Report Journal, Vol.9, 249-253, 2022.
(Summary)
Transforaminal full-endoscopic spine surgery (TF-FESS) is a novel minimally invasive spine surgery that requires only an 8-mm skin incision and causes minimal damage to the paravertebral muscles. To perform TF-FESS safely and efficiently, preoperative planning is quite important as the intervention requires anatomical understanding and high technical skills. Recently, three-dimensional (3D) printing has become a useful tool in various surgeries, and several studies have addressed its efficacy; however, there are no reports on the application of 3D printing to FESS. In this study, we present two cases of severe lumbar deformities for which preoperative 3D printing was useful. The 3D printing enabled the surgeons to visualize and plan the drilling of the superior articular process for a successful foraminoplasty at a low cost. The manufacturing equipment cost about USD 900 and is able to produce an actual-size model at a cost of less than USD 10 per patient. In conclusion, preoperative planning using 3D printing should be adopted to safely perform FESS.
Kiyoshi Yagi, Kazuya Kishima, Fumitake Tezuka, Masatoshi Morimoto, Kazuta Yamashita, Yoichiro Takata, Toshinori Sakai, Toru Maeda, Junzo Fujitani and Koichi Sairyo : A Technical Pitfall of Decompression with Direct Repair of a Ragged Edge Using the Smiley-Face Rod Method : A Case Report., The Journal of Medical Investigation : JMI, Vol.69, No.3.4, 308-311, 2022.
(Summary)
The smiley-face rod method has been reported to be a successful technique for reducing slippage and repairing pars defects in lumbar spondylolisthesis. However, we encountered a patient who developed right L5 radiculopathy with muscle weakness after use of the smiley-face rod method. The patient was a 19-year-old female judo player who had undergone direct repair surgery using the smiley-face rod method for terminal-stage lumbar spondylolysis. Postoperatively, she developed paresthesia on the lateral side of the right thigh with weakness of the right tibialis anterior and extensor hallucis longus. Computed tomography showed right foraminal stenosis at L5 with the floating lamina shifted ventrally and apophyseal ring fracture. In this case, the spondylolysis fracture angle differed between the left and right sides, with the fracture line on the right side running more sagittally. As a result, the floating lamina was shifted ventrally on the right side by compression and the right L5 intervertebral foraminal space was narrowed due to the ventral shift in the floating lamina and the apophyseal ring bone fragment. The shape of the fracture line should be examined carefully before surgery to avoid this technical pitfall. J. Med. Invest. 69 : 308-311, August, 2022.
Yoshihiro Ishihama, Masatoshi Morimoto, Fumitake Tezuka, Kazuta Yamashita, Hiroaki Manabe, Kosuke Sugiura, Makoto Takeuchi, Yoichiro Takata, Toshinori Sakai, Toru Maeda, Akihiro Nagamachi and Koichi Sairyo : Full-Endoscopic Trans-Kambin Triangle Lumbar Interbody Fusion: Surgical Technique and Nomenclature., Journal of Neurological Surgery. Part A, Central European Neurosurgery, Vol.83, No.4, 308-313, 2022.
(Summary)
Kambin's triangle lies immediately behind the psoas major. Therefore, we consider KLIF as a lateral LIF procedure comparable with oblique or extreme LIF. However, unlike oblique or extreme LIF, there are no major vessels and organs in the surgical field; therefore, KLIF is the safest type of lateral LIF. Furthermore, using the endoscope, we can perform decompression directly using the facetectomy technique.
Kiyoshi Yagi, Kazuya Kishima, Fumitake Tezuka, Masatoshi Morimoto, Kazuta Yamashita, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Advantages of revision transforaminal full-endoscopic spine surgery in patients who have previously undergone posterior spine surgery., Journal of Neurological Surgery. Part A, Central European Neurosurgery, 2022.
(Summary)
Revision lumbar spine surgery via a posterior approach is more challenging than primary surgery because of epidural or perineural scar tissue. It demands more extensive removal of the posterior structures to confirm intact bony landmarks and could cause iatrogenic instability postoperatively; therefore, fusion surgery is often selected. However, adjacent segment disease after fusion surgery could be a problem, and further exposure of the posterior muscles could result in multiple operated back syndrome. To address these problems, we now perform transforaminal full-endoscopic spine surgery (TF-FES) as revision surgery in patients who have previously undergone posterior lumbar surgery. There have been several reports on the advantages of TF-FES, which include feasibility of local anesthesia, minimal invasiveness to posterior structures, and less scar tissue with fewer adhesions. To assess the clinical outcomes of revision TF-FES and outline its advantages. Forty-eight consecutive patients who underwent revision TF-FES (at 60 levels) under local anesthesia. Clinical outcomes of TF-FES performed as revision surgery in patients with a history of posterior lumbar spine surgery. Intraoperative blood loss, operating time, and complication rate were evaluated. Postoperative outcomes were assessed using the modified Macnab criteria and visual analog scale (VAS) scores for leg pain, back pain, and leg numbness. We also compared the outcome of revision FES with that of primary FES. Mean operating time was 70.5±14.4 (52-106) min. Blood loss was unmeasurable. The clinical outcomes were rated as excellent at 16 levels (26.7%), good at 28 (46.7%), fair in 10 (16.7%), and poor at 6 (10.0%). The mean preoperative VAS score was 6.0±2.6 for back pain, 6.8±2.4 for leg pain, and 6.3±2.8 for leg numbness. At the final follow-up, the mean postoperative VAS scores for were 4.3±2.5, 3.8±2.6, and 4.6±3.2, respectively. VAS scores for all three parameters were significantly improved (p<0.05). There was no significant difference in operating time, intraoperative blood loss, or the complication rate between revision FES and primary FES. Clinical outcomes of revision TF-FES in patients with a history of posterior lumbar spine surgery were acceptable (excellent and good in 73.4% of cases). TF-FES can preserve the posterior structures and avoid scar tissue and adhesions. Therefore, TF-FES could be an effective procedure for patients who have previously undergone posterior lumbar spine surgery.
Yugen Fujii, Toshihiko Nishisho, Fumitake Tezuka, Akio Iwanami, Kazuta Yamashita, Shun-ichi Toki, Masatoshi Morimoto, Kosuke Sugiura, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Hemangioblastoma of the Cauda Equina : A Case Report and Review of the Literature., The Journal of Medical Investigation : JMI, Vol.69, No.3.4, 312-315, 2022.
(Summary)
Introduction : Hemangioblastoma in the spine mainly occurs at the cervical and thoracic levels and is often associated with von Hippel-Lindau (VHL) syndrome. Here, we reported a quite rare case of spinal sporadic hemangioblastoma arising from the cauda equina. Case presentation : A 66-year-old woman presented with a 5-year history of low back and leg pain. Imaging revealed a hypervascular intradural extramedullary tumor in the lumbar region. Preoperative angiography helped to identify the feeding arteries and draining vein, and so facilitated subsequent tumor resection. The pain was dramatically improved but weakness of the left tibialis anterior and left extensor hallucis longus muscles persisted. Discussion : We reported a rare case of spinal hemangioblastoma arising from the cauda equina. Preoperative angiography may be useful for diagnosis and understanding of the anatomy of feeding veins. J. Med. Invest. 69 : 312-315, August, 2022.
Ayaka Hashimoto, Fumitake Tezuka, Kazuta Yamashita, Masatoshi Morimoto, Kosuke Sugiura, Makoto Takeuchi, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Planned Four-stage Transforaminal Full-endoscopic Lumbar Decompression under Local Anesthesia in a Patient with Severe Comorbidity., NMC Case Report Journal, Vol.8, No.1, 221-227, 2021.
(Summary)
A 74-year-old man presented with symptoms of intermittent claudication. A diagnosis of lumbar spinal canal stenosis (LSS) at L3/4 and L4/5 was made based on the clinical and radiological findings. Bilateral lateral recess stenosis was detected at both these levels on magnetic resonance imaging (MRI) and on computed tomography (CT) scans obtained after myelography. Four nerve roots were impinged bilaterally at L4 and L5. The initial plan was to perform conventional laminectomy at L3/4 and L4/5 under general anesthesia. However, the neurologists pointed out that the patient had comorbidities of parkinsonism and severe carotid artery stenosis, meaning that an increase or decrease in blood pressure during general anesthesia could cause a stroke. Therefore, we changed the surgical plan to four-stage full-endoscopic ventral facetectomy at L3/4 and L4/5 bilaterally under local anesthesia. There were no surgery-related complications after any of the four operations. The patient's symptoms improved after the final operation and the modified MacNab criteria indicated a good clinical outcome. Full-endoscopic lumbar decompression surgery under local anesthesia may be effective in elderly patients who are in poor general health.
Nobutoshi Takamatsu, Kazuta Yamashita, Kosuke Sugiura, Hiroaki Manabe, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Successful Full Endoscopic Surgery for L5 Radiculopathy Due to L4-5 Discal Cyst and Disc Herniation in a Professional Baseball Player., NMC Case Report Journal, Vol.8, No.1, 189-194, 2021.
(Summary)
Discal cysts are rare intraspinal extradural cysts that communicate with the corresponding intervertebral discs, and the diagnosis is difficult to distinguish from other causes of low back pain and radiculopathy. Optimal management for this type of cyst has not been determined because of its rarity. Here, we report successful treatment of a discal cyst and lumbar disc herniation using full endoscopic surgery in a professional baseball player with a chief complaint of weakness in his left lower leg. He had been treated conservatively but symptoms did not improve. Discography helped us to differentially diagnose discal cyst from other cystic lesions. Conventional surgical treatment would have resulted in considerable loss of baseball playing time for the patient. We opted to perform minimally invasive transforaminal full endoscopic surgery under local anesthesia to treat the discal cyst and lumbar disc herniation simultaneously without resection of bone and ligament handling. We removed the discal cyst and disc herniation, which released tension on the left nerve root at the L5 level, and then performed thermal annuloplasty to avoid recurrence. Postoperative course was good and he returned to play baseball at his original competitive level 3 months later. To our knowledge, there have been no previous reports of successful full endoscopic surgery for discal cyst and lumbar disc herniation performed simultaneously in a professional baseball player. It can be difficult to decide on the proper treatment for discal cysts, but full endoscopic surgery for symptomatic discal cyst might be one good option especially for elite athletes.
Kosuke Sugiura, Kazuta Yamashita, Hiroaki Manabe, Yoshihiro Ishihama, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Prompt Return to Work after Bilateral Transforaminal Full-endoscopic Lateral Recess Decompression under Local Anesthesia: A Case Report., Journal of Neurological Surgery. Part A, Central European Neurosurgery, Vol.82, No.3, 289-293, 2021.
(Summary)
Transforaminal full-endoscopic lumbar diskectomy became established early in the 21st century. It can be performed under local anesthesia and requires only an 8-mm skin incision, making it the least invasive disk surgery method available. The full-endoscopic technique has recently been used to treat lumbar spinal canal stenosis. Here, we describe the outcome of simultaneous bilateral decompression of lumbar lateral recess stenosis via a transforaminal approach under local anesthesia in a 60-year-old man. The patient presented with a complaint of bilateral leg pain that was preventing him from standing and walking, and he had been able to continue his work as a dentist by treating patients while seated. Imaging studies revealed bilateral lumbar lateral recess stenosis with central herniated nucleus pulposus at L4/5. We performed simultaneous bilateral transforaminal full-endoscopic lumbar lateral recess decompression (TE-LRD) under local anesthesia. Both decompression and diskectomy were successfully completed without complications. Five days after TE-LRD, he was able to return to work, and 3 months after the surgery, he resumed playing golf. Full-endoscopic surgery under local anesthesia can be very effective in patients who need to return to work as soon as possible after surgery.
Seiji Yamaya, Fumitake Tezuka, Kosuke Sugiura, Makoto Takeuchi, Hiroaki Manabe, Masatoshi Morimoto, Kazuta Yamashita, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Risk Factor for Additional Intravenous Medication during Transforaminal Full-endoscopic Lumbar Discectomy under Local Anesthesia., Neurologia Medico-Chirurgica, Vol.61, No.3, 236-242, 2021.
(Summary)
Transforaminal full-endoscopic lumbar discectomy (TELD) can be performed under local anesthesia. However, there have been no reports on risk factors for a change in vital signs or the need for additional medications to maintain adequate analgesia during this procedure. The purpose of this study was to identify risk factors for additional intravenous medication during TELD under local anesthesia. The following factors were retrospectively evaluated in 113 consecutive patients who underwent TELD under local anesthesia at our institution: demographic characteristics, radiological features at the intervertebral disc level, distance between the superior articular process and the exiting nerve root, height of the intervertebral disc, height of the bulging disc, height of the intervertebral foramen, and distance from the insertion site to the spinous process on magnetic resonance imaging (MRI) and computed tomography (CT) scans of the lumbar spine. Logistic regression analysis was performed to determine factors associated with the need for additional drugs. In all, 23 cases (20.4%) required additional intraoperative medications because of hypertension, hypotension, bradycardia, or pain. Logistic regression analysis revealed that age (partial regression coefficient 0.05, p = 0.02) and bulging disc height (partial regression coefficient -0.7, p = 0.003) influenced the need for additional drugs. There were significant associations of need for additional intravenous medication with older age (>62 years) and a smaller bulging disc height (<8.2 mm). Patients with these factors require close monitoring for changes in vital signs or increasing pain when performing TELD under local anesthesia and may need additional intravenous medication.
Hiroaki Manabe, Kazuta Yamashita, Kosaku Higashino, Masatoshi Morimoto, Kosuke Sugiura, Yoshihiro Ishihama, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai and Koichi Sairyo : Bone Formation During Correction of Vertebral Rounding Deformity in a Rat Model of Pediatric Spondylolisthesis., Spine, Vol.46, No.5, E294-E302, 2021.
(Summary)
Correction of vertebral rounding deformity was associated with improvement of chondrocyte differentiation; furthermore, there is possible involvement of a third mechanism, namely transchondroid bone ossification.Level of Evidence: N/A.
Makoto Takeuchi, Kazuta Yamashita, Ayaka Hashimoto, Nobutoshi Takamatsu, Kosuke Sugiura, Hiroaki Manabe, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Return to the Original Work Activity Following the Full-endoscopic Lumbar Surgery under the Local Anesthesia., Neurologia Medico-Chirurgica, Vol.61, No.2, 144-151, 2021.
(Summary)
Transforaminal full-endoscopic spine (TF-FES) surgery is minimally invasive and can be performed under local anesthesia. Thus, it is expected that the patient can return to work (RTW) quickly. However, information in the literature regarding this is sparse. The purpose of this study is to review the timing of RTW after TF-FES surgery. This study involved 50 patients (14 women, 36 men; mean age 44.5 years, age range: 20-65 years) who underwent TF-FES surgery between January 2016 and April 2018. All the patients were active workers. Occupations varied widely (e.g., physician, nurse, helper, clerk, construction worker, chef, and schoolteacher). There were no surgery-related complications. Median time to RTW was 21 days. More than half of the patients could RTW within 21 days. In all, 12 cases (24%) could have RTW within 7 days. Occupations of 12 patients who achieved RTW within 7 days included physician, company owner, and restaurant owner, with 11 in the Light work, 1 was in the Medium work, and none in the Heavy work. All 12 had a quick RTW because their work was Light and they could not take prolonged sick leave. Prompt RTW is possible with TF-FES surgery. The biggest merit of TF-FES surgery is minimal invasiveness to the muscles of the back. Also, it can be performed under local anesthesia. Our findings reveal quicker RTW after surgery, depending on occupational type.
Toshinori Sakai, Hiroaki Manabe, Tsuyoshi Goto, Kosuke Sugiura, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata and Koichi Sairyo : Extraosseous Signal Changes on Magnetic Resonance Imaging in Pediatric Patients with Early-Stage Lumbar Spondylolysis., The Journal of Medical Investigation : JMI, Vol.68, No.1.2, 136-139, 2021.
(Summary)
Purpose : To analyze extraosseous signal changes (ESCs) on magnetic resonance imaging (MRI) in pediatric patients with stress fractures occurring in the lamina. Methods : This study was a retrospective review of 69 consecutive pediatric patients with stress fractures occurring in the lamina. We analyzed MRI scans obtained at the first presentation. Results : We used mainly axial short tau inversion recovery images acquired through the pedicle of these 84 fracture sites to identify the ESCs. These were then divided into three groups: "invisible" when no ESC was detected, "periosteal" for ESC seen on only the dorsal side of the lamina, and "perimuscular" for ESC distinctly spread around / in the paravertebral muscles. In total, 78 (92.9%) fracture sites showed ESCs on the dorsal side of the lamina among which 72 ESCs were located on only the "dorsal" side, while 6 ESCs were on the ventral side against the transverse process. Conclusion : ESCs on MRI were detected in more than 90% of patients before stress fracture became apparent in the lamina, which was considered similar to findings of periosteal thickening / edema detected at the onset of stress fracture in long bone. J. Med. Invest. 68 : 136-139, February, 2021.
Koichi Sairyo, Toru Maeda, Kazuta Yamashita, Fumitake Tezuka, Masatoshi Morimoto, Kiyoshi Yagi, Kazuya Kishima, Kosuke Sugiura, Makoto Takeuchi, Yuji Yamada, Yoichiro Takata and Toshinori Sakai : A new surgical strategy for the intractable chronic low back pain due to type 1 Modic change using transforaminal full-endoscopic disc cleaning (FEDC) surgery under the local anesthesia : A case report and literature review., The Journal of Medical Investigation : JMI, Vol.68, No.1.2, 1-5, 2021.
(Summary)
It has been reported that Modic change of the lumbar spine endplate includes three types: i.e. . edema or inflammation for type 1, fatty marrow change for type 2 and sclerotic change for type 3. Basically, type 1 Modic change may be related to the chronic low back pain. There are two kinds of the treatment for the type 1 Modic change to heal the pain : the anti-inflammatory drugs, and intra-discal injection of steroid. When the inflammatory change would be intractable, surgical intervention is needed. The gold standard for the surgical intervention is the segmental fusion of the affected level. The fusion surgery may cause the adjacent degeneration ; thus, motion preservation surgery is better, if possible. Our department started the motion preservation full-endoscopic intradiscal debridement surgery for this pathology, since some of the type 1 Modic change may be chronic discitis by P. Acnes. In this paper, we describe the first patient of type 1 Modic change who was successfully treated by the full-endoscopic intra-discal debridement and drainage under the local anesthesia. We named this procedure as transforaminal full-endoscopic disc cleaning surgery (FEDC). Finally, pathology, conservative and surgical intervention of Modic change was discussed. J. Med. Invest. 68 : 1-5, February, 2021.
Seiji Yamaya, Yuki Okada, Kousaku Higashino, Toshinori Sakai, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Akihiro Nagamachi, Takashi Chikawa and Koichi Sairyo : Early outcomes of transforaminal percutaneous endoscopic lumbar discectomy for high school athletes with herniated nucleus pulposus of the lumbar spine., Journal of Pediatric Orthopaedics. Part B, Vol.29, No.6, 599-606, 2020.
(Summary)
There are no reports in the literature on the clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) for high school athletes suffering from herniated nucleus pulposus (HNP) of the lumbar spine. PELD is a minimally invasive surgical procedure that can be performed under local anesthesia via an 8-mm skin incision. This study examined the outcomes of transforaminal PELD in high school athletes suffering from HNP. Subjects were 18 patients [14 males and four females; mean age 17 (15-18) years] who underwent PELD at our institutions. The events in which the patients competed were baseball (n = 6), softball (n = 2), rugby (n = 2), basketball (n = 2), table tennis (n = 2), American football (n = 1), wrestling (n = 1), track and field (n = 1), and dance (n = 1). All patients underwent PELD under local anesthesia. Back pain was assessed using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and a visual analog scale (VAS) before and after surgery. Time to return to competitive sport, complications, and rate of recurrence of herniation were examined. All factors assessed by the JOABPEQ were significantly improved after surgery. VAS score was also improved after surgery. Time to return to competitive sport was 7 weeks on average. The rate of return to play was 94.4%. There were no complications, such as dural tear, exiting nerve root injury, or hematoma. One patient had recurrence of HNP. PELD is a promising minimally invasive and effective procedure for high school athletes with HNP.
Mitsuhiro Kamada, Hiroaki Manabe, Kazuta Yamashita, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Full-endoscopic Decompression of Foraminal Stenosis Caused by Facet Hypertrophy Contralateral to the Dominant Hand in a Baseball Pitcher: A Case Report., NMC Case Report Journal, Vol.7, No.4, 173-177, 2020.
(Summary)
Back pain and lower extremity pain have various causes and occasionally occur simultaneously, creating diagnostic difficulties. In addition, athletes require special consideration in terms of treatment. Here, we report a case of foraminal stenosis as a result of lumbar disc prolapse combined with facet hypertrophy contralateral to the dominant hand in a baseball pitcher that was successfully treated by minimally invasive full-endoscopic surgery. A 31-year-old left-handed male baseball pitcher presented with complaints of low back pain and right buttock pain while pitching. A diagnosis of foraminal stenosis caused by a disc bulge combined with facet hypertrophy contralateral to the dominant hand was made on the basis of physical and radiological findings. His symptoms improved immediately after transforaminal full-endoscopic lumbar discectomy and foraminoplasty under local anesthesia. He returned to play 3 months after surgery. Foraminal stenosis due to facet hypertrophy may occur in the side contralateral to the throwing arm in pitchers. Minimally invasive decompression using a full-endoscopic procedure is required for high-level athletes at this position.
Hiroaki Manabe, Toshinori Sakai, Kosuke Sugiura, Yoshihiro Ishihama, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Toru Maeda and Koichi Sairyo : Spontaneous Laminar Fracture during Successful Conservative Treatment of Lumbar Spondylolysis at the Adjacent Spinal Level: A Case Report., NMC Case Report Journal, Vol.7, No.4, 179-182, 2020.
(Summary)
Although lumbar spondylolysis (LS) is regarded as a stress fracture, the underlying pathomechanism has yet to be fully elucidated. Here, we present a case that casts doubt on the notion that LS is truly a stress fracture. An 11-year-old female basketball player was brought to our clinic with a 2-week history of persistent low back pain. Magnetic resonance imaging with short TI inversion recovery (STIR-MRI) showed high signal intensity changes at the L4 pedicles bilaterally. Computed tomography (CT) revealed a faint fracture line at the left pars interarticularis. We made a diagnosis of stress fracture and recommended conservative treatment, including cessation of sports activities and wearing of a hard brace. Compliance with treatment was excellent. As expected, the STIR-MRI findings at L4 gradually resolved and bone healing was achieved. However, a follow-up STIR-MRI scan 10 weeks later revealed high signal intensity at the left L5 pedicle. Conservative treatment was continued for the findings at L5, which were considered to indicate a stress fracture (spondylolysis). Five weeks later, CT revealed a bony defect in the lamina at L5 on the left and bone union at L4. Although LS is generally considered to be a stress fracture, there have been several reports of familial occurrence and genetic predisposition. This patient's mother had also been treated for spondylolysis at L5. These observations suggest an underlying genetic etiology in this case.
Shun-ichi Toki, Kousaku Higashino, Hiroaki Manabe, Masatoshi Morimoto, Kosuke Sugiura, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Toru Maeda, Toshinori Sakai, Natsuo Yasui and Koichi Sairyo : Morphometric Analysis of Subaxial Cervical Spine with Myelopathy: A Comparison with the Normal Population., Spine Surgery and Related Research, Vol.5, No.1, 34-40, 2020.
(Summary)
The morphometry of the sagittal diameter of the spinal canal, sagittal-transverse ratio, and canal-body ratio on axial reconstructive CT images appears useful for distinguishing cervical spinal canal stenosis involving myelopathy.
Yusaku Nakayama, Kazuta Yamashita, Kosuke Sugiura, Makoto Takeuchi, Masatoshi Morimoto, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Surgical management of stress fracture of the contralateral pedicle in a baseball player with unilateral lumbar spondylolysis : A case report., The Journal of Medical Investigation : JMI, Vol.67, No.3.4, 382-385, 2020.
(Summary)
We describe successful surgical treatment in a case of L5 unilateral spondylolysis with contralateral pedicle stress fracture that was not resolved by conservative treatment in a high-performing college baseball player. The 20-year-old man presented with left low back pain that stopped his sports activities. Over the previous year, he had experienced a couple of episodes of pain that subsided with cessation of sports but reappeared after a return to sports. Computed tomography and magnetic resonance imaging revealed a right terminal stage pars fracture and a left pedicle stress fracture at L5. The pain originated from the left pedicle fracture, with no pain from the right unilateral spondylolysis. Given that conservative treatment for 1 year had not been effective, we decided on surgical treatment. Bilateral pedicle screws and the smiley face rod method were applied, and both fractures subsequently healed. In the 2 years since the surgery, the patient has returned to sports and has the potential to become a professional player. J. Med. Invest. 67 : 382-385, August, 2020.
Yoshihiro Ishihama, Toshinori Sakai, Hiroaki Manabe, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Toru Maeda and Koichi Sairyo : Debridement for Infectious Spondylodiscitis in a 9-year-old Girl Using Full-Endoscopic Discectomy System : a Case Report and literature review., The Journal of Medical Investigation : JMI, Vol.67, No.3.4, 351-344, 2020.
(Summary)
Objective : Infectious spondylodiscitis (IS) is rarely seen in healthy elementary school age children. Conservative treatment with antibiotics is usually preferable but sometimes fails because of the low identification rate of the pathogen by percutaneous needle biopsy. When surgical treatment is indicated, selecting the appropriate procedure is crucial in terms of invasiveness for such young children. Case report : We present the case of a 9-year-old otherwise healthy girl with IS who successfully underwent debridement and identification of the causative pathogen using full endoscopic discectomy (FED) system. Methicillin-susceptible Staphylococcus aureus was identified on several cultures of samples. Immediately after the surgery, the LBP was significantly decreased and the remittent fever resolved dramatically. At the 1-year follow-up, she had no symptoms and plain radiographs showed bony fusion. Conclusion : This is the first report on IS in elementary school-age children treated with the FED system. Debridement using this system could provide minimally invasive and effective curettage of the infected disc space and can be helpful in identifying the pathogen even for small children. J. Med. Invest. 67 : 351-354, August, 2020.
Daiki Nakajima, Kazuta Yamashita, Fumitake Tezuka, Kosuke Sugiura, Yoshihiro Ishihama, Hiroaki Manabe, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Successful full-endoscopic decompression surgery under local anesthesia for L5 radiculopathy caused by L5-Sforaminal stenosis and L4-5 lateral recess stenosis : A case report., The Journal of Medical Investigation : JMI, Vol.67, No.1.2, 192-196, 2020.
(Summary)
In this report, we presented a 65 year-old male case having right leg pain due to L5 radiculopathy. Based on the radiological examination including CT, MRI and radiculography, double crash impingement of L5 nerve root due to L4-5 lateral recess and L5-S foraminal stenosis was diagnosed. Because of the strong pain, he could not work anymore. His job was a general manager of big hospital, he needed to return to job as soon as possible. We decided to conduct the full-endoscopic decompression surgery of ventral facetectomy (FEVF) for L4-5 lateral recess stenosis and foraminoplasty (FELF) for L5-S foraminal stenosis. The technique can be done under the local anesthesia with only 8 mm skin incision; thus, it must be the least invasive spine surgery. Soon after the surgery, he could return to the original job as a general manager. In conclusion, the full-endoscopic decompression surgery for the spinal canal stenosis such as FELF and FEVF would be minimally invasive procedure and it enable patients the quick return to the original activity. J. Med. Invest. 67 : 192-196, February, 2020.
Fumitake Tezuka, Toshinori Sakai, Toshihiko Nishisho, Kosuke Sugiura, Yoshihiro Ishihama, Hiroaki Manabe, Kazuta Yamashita, Yoichiro Takata, Toru Maeda and Koichi Sairyo : Distribution of the Spinal Arteries in Adult Patients with Lumbar Spondylolysis., The Journal of Medical Investigation : JMI, Vol.67, No.1.2, 62-66, 2020.
(Summary)
INTRODUCTION : The pathology of lumbar spondylolysis is generally thought to begin with a stress fracture in adolescence. Stress fractures of the lower extremities occur in watershed areas with a poor vascular supply because of an inability to respond to stress and heal. This pathology has not been well researched in the lumbar spine. The aim of this study was to evaluate the distribution of the spinal arteries in patients with lumbar spondylolysis. METHODS : The extraosseous distribution of the arteries around the pars interarticularis was retrospectively investigated in 14 patients with colon cancer who underwent abdominal contrast-enhanced computed tomography (CE-CT) as part of a preoperative assessment at our hospital and were found to have spondylolysis at L5. RESULTS : All patients were found to have terminal-stage spondylolysis at L5 (1 unilateral, 13 bilateral). L5 segmental artery was absent in all cases. However, separate spinal arteries supplying the pars interarticularis at L5 were found above and below the transverse process at this level. CONCLUSION : All the patients had two separate arteries originating from the cranial and caudal sides that distributed to the superior and inferior articular processes, suggesting that the pars interarticularis is a posterior element containing a vascular watershed area. J. Med. Invest. 67 : 62-66, February, 2020.
Hiroaki Manabe, Fumitake Tezuka, Kazuta Yamashita, Kosuke Sugiura, Yoshihiro Ishihama, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Operating Costs of Full-endoscopic Lumbar Spine Surgery in Japan., Neurologia Medico-Chirurgica, Vol.60, No.1, 26-29, 2020.
(Summary)
For full-endoscopic lumbar discectomy, operating costs are also important because expensive equipment are necessary. We surveyed the operating costs of surgical equipment necessary for full-endoscopic surgery together with surgical procedure reimbursement fees. A total of 295 cases of full-endoscopic surgery via a transforaminal approach were retrospectively analyzed. We calculated the frequency of damage and the unit purchase price of devices such as endoscopes, and surgical instruments such as grasping forceps for nucleotomy, high-speed drill bar, and bipolar forceps, and examined the operating costs in Japanese yen against the procedure fee per case. Endoscope breakage occurred seven times, and a payment of ¥760,000 was necessary for trade-in and purchase of a new endoscope. The total breakage number of grasping forceps was 58, and the purchase price per unit was ¥116,000. Therefore, a total of ¥12,020,000 was required for the 295 cases, and the calculated operating cost that accompanies equipment breakage was ¥40,000 per case. In addition, about ¥118,000 was required for disposable bipolar forceps and high-speed drill bar to be used intraoperatively for each case. Thus, for one case it is calculated that total ¥158,000 is utilized for equipment from the surgical reimbursement fee per case specified by the Japanese Ministry of Health being ¥303,900. Minimally invasive procedures provide great benefit to patients; however, the eventual contribution to hospital profits is small and may not be sufficient. To resolve this issue, the cost of surgical equipment should be lowered and/or the surgical reimbursement fee of the full-endoscopic surgery should be raised.
Yugen Fujii, Kazuta Yamashita, Kosuke Sugiura, Yoshihiro Ishihama, Hiroaki Manabe, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Early return to activity after minimally invasive full endoscopic decompression surgery in medical doctors., Journal of Spine Surgery, Vol.6, No.Suppl 1, S294-S299, 2020.
(Summary)
Full endoscopic surgery including discectomy (FED) and ventral facetectomy (FEVF) is a minimally invasive lumbar decompression surgery that only requires an 8 mm skin incision and can be done under the local anesthesia and sedation. Six male medical doctors underwent the endoscopic decompression (FED/FEVF) for common degenerative lumbar spine problems. Their age ranged from 27 to 63 years of age with a mean of 40 years. Five doctors underwent FED surgery for herniated nucleus pulposus (HNP), and the remaining one physician had FEVF for lumbar lateral recess stenosis. There were no surgery related complications. Postoperatively, 5 out of the 6 physician patients returned the original job within a week because they had clinical duties. The shortest duration to return to work was reported by a 63-year-old orthopedic surgeon resumed working in his clinic 2 days after the FEVF surgery. The longest duration to return to work occurred in general medicine resident who took almost 2 weeks for the sick leave because he did not have clinical duties. The mean duration for the returning to work was 5.8 days after the surgery. At final follow-up ranging from 6 to 30 months, all physician patients were working without any residual pain. In the hands of the authors, the full endoscopic transforaminal decompression surgery is the preferred surgical option and allowed early return to work-an observation that is not the norm in Japan.
Shota Shigekiyo, Toshihiko Nishisho, Yoichiro Takata, Shun-ichi Toki, Kosuke Sugiura, Yoshihiro Ishihama, Hiroaki Manabe, Fumitake Tezuka, Kazuta Yamashita, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Intracanalicular Osteochondroma in the Lumbar Spine., NMC Case Report Journal, Vol.7, No.1, 11-15, 2020.
(Summary)
resection of the osteochondroma with the ligamentum flavum relieved the symptoms. Spinal osteochondroma occurs relatively frequently in elderly individuals compared with peripheral lesions and mimics a degenerative spinal disorder. Careful physical examination and imaging evaluation can reveal this tumor and surgery is effective for relieving the symptoms.
Hiroaki Manabe, Kosuke Sugiura, Yoshihiro Ishihama, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Imaging Features of Non-Isthmic Spondylolysis: A Case Report., Spine Surgery and Related Research, Vol.4, No.2, 187-189, 2019.
Yosuke Fujimoto, Toshinori Sakai and Koichi Sairyo : What Type of Orthosis is Optimal for Conservative Treatment of Lumbar Spondylolysis?: A Biomechanical Analysis., Spine Surgery and Related Research, Vol.4, No.1, 74-80, 2019.
(Summary)
HO showed high restriction in all directions. RS showed higher restriction in extension than NB and less restriction in flexion and side bending than other custom-made LSOs. DC was the only soft LSO showing higher restriction than NB in flexion.
Haruhiko Yoshinari, Fumitake Tezuka, Kazuta Yamashita, Hiroaki Manabe, Fumio Hayashi, Yoshihiro Ishihama, Kosuke Sugiura, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Transforaminal full-endoscopic lumbar discectomy under local anesthesia in awake and aware conditions: the inside-out and outside-in techniques., Current Reviews in Musculoskeletal Medicine, Vol.12, No.3, 311-317, 2019.
(Summary)
Initially, TELD was performed as the "inside-out" technique but was associated with reports of postoperative dysesthesia due to exiting nerve injury. Recently, the "outside-in" technique after foraminoplasty was proposed for safer insertion of the cannula into the disc. Foraminoplasty can widen the narrow foramen, thereby allowing the 8-mm cannula to pass through easily and safely, and thus injury to the exiting nerve root can be theoretically avoided. We described two types of the TELD in this review. Surgeons should be familiar with the inside-out and outside-in techniques for TELD; therefore, we can select appropriate technique for each case.
Yuhei Yamasaki, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Multiple Loose Bodies in the Lumbar Facet Joint: Case Report., NMC Case Report Journal, Vol.6, No.3, 79-81, 2019.
(Summary)
We describe here a patient diagnosed with multiple loose bodies in the lumbar facet joint. The patient was a 52-year-old woman who presented with left sciatic pain. Neurological findings indicated L5 radiculopathy. Radiological findings revealed lateral recess stenosis at the L4-L5 level, and loose bodies in the left L4-L5 facet joint were noted that compressed the left L5 nerve root. We performed laminotomy at the left L4-L5 level, and removed five loose bodies located on the dorsal side of the ligamentum flavum. Following removal of the loose bodies and flavectomy, the L5 nerve root was decompressed. Postoperatively, the patient's symptoms improved markedly. Symptomatic multiple loose bodies in the lumbar facet joint are very rare, and can cause lumbar radiculopathy. It is important for spine surgeons to recognize this pathology.
Kaori Momota, Toshihiko Nishisho, Ryo Miyagi, Shun-ichi Toki, Kazuta Yamashita, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Akihiro Nagamachi, Toru Maeda and Koichi Sairyo : A Rare Case of Acute-Onset Spastic Quadriparesis Caused by a Chondroma of the Cervical Spine., Case Reports in Orthopedics, Vol.2019, 2019.
(Summary)
Chondromas are benign cartilaginous tumors that occur very rarely in the spine. Moreover, chondromas of the extraskeletal origin are also very rare. In this case report, we describe an extremely rare case of chondroma arising from the ligamentum flavum in the cervical spine. A 67-year-old man presented to our clinic with acute-onset spastic quadriparesis. We performed emergent magnetic resonance imaging and found an epidural mass in the right ligamentum flavum at C4-C5. The acute-onset presentation was suspicious for intraligamentous hematoma in the ligamentum flavum at this level. We performed emergency decompression surgery and en bloc removal of the epidural mass with the right C4 and C5 lamina. The lesion had the appearance of cartilaginous tissue rather than hematoma. Based on the histological investigation, the final diagnosis was intraligamentous chondroma of the cervical spine. The quadriparesis improved postoperatively, as did the results of manual muscle testing in the affected area, and he was able to resume walking independently with a cane. At the one-year follow-up, the manual muscle testing results were almost normal. Surgeons should keep in mind the possibility of benign tumors including chondroma of the cervical spine when a patient presents with acute-onset quadriparesis.
Kazuta Yamashita, Toshinori Sakai, Yoichiro Takata, Fumitake Tezuka, Hiroaki Manabe, Masatoshi Morimoto, Yutaka Kinoshita, Hiroshi Yonezu, Takashi Chikawa, Yasuyoshi Mase and Koichi Sairyo : Low Back Pain in Adolescent Athletes: Comparison of Diagnoses Made by General Orthopedic Surgeons and Spine Surgeons., International Journal of Spine Surgery, Vol.13, No.2, 178-185, 2019.
(Summary)
In adolescent athletes, the rate of NSLBP diagnosed by general orthopedic surgeons decreased markedly when the diagnosis was made by spine surgeons. A thorough medical interview, careful physical examination, appropriate diagnostic imaging, and selective nerve block examination can effectively identify the cause of low back pain.
Hiroaki Manabe, Toshinori Sakai, Ryo Miyagi, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata and Koichi Sairyo : Identification of abnormalities in the lumbar nerve tract using diffusion-weighted magnetic resonance neurography., European Spine Journal, Vol.28, No.4, 849-854, 2019.
(Summary)
Abnormalities of the lumbar nerve tract caused by congenital variations or high nerve root take-off angles are difficult to visualize. Diffusion-weighted magnetic resonance neurography (DW-MRN) has recently been introduced for imaging of the lumbosacral region. The aims of this study were to identify lumbar nerve tract abnormalities caused by congenital variation or a high nerve root take-off angle using DW-MRN and to assess the diagnostic value of this imaging modality.
Hiroaki Manabe, Kazuta Yamashita, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Thermal Annuloplasty Using Percutaneous Endoscopic Discectomy for Elite Athletes with Discogenic Low Back Pain., Neurologia Medico-Chirurgica, Vol.59, No.2, 48-53, 2019.
(Summary)
The purpose of this study was to assess the usefulness of radiofrequency thermal annuloplasty (TA) using percutaneous endoscopic discectomy/TA (PED/TA) in elite athletes with discogenic low back pain. Twelve patients (11 men, 1 woman; mean age 27.9 years) underwent PED/TA under local anesthesia. Clinical data for these patients (17 affected intervertebral discs), including type of sport played, average duration of low back pain, disc level affected, presence or absence of a high signal intensity zone on magnetic resonance imaging, and whether the patient returned to playing competitive sport, were retrospectively reviewed. The most common sport played by the patient was baseball (n = 8), followed by cycling (n = 2), tennis (n = 1), and hammer throw (n = 1). The average duration of low back pain was 24.3 months. The intervertebral disc levels affected were L4/5 (n = 11) and L5/S1 (n = 6). A high signal intensity zone was detected in nine discs. Although two patients required additional surgery, all patients were able to return to their original competitive level of play. Duration for the return to play was 2.8 months after surgery except the two revision cases. PED/TA for discogenic pain enables an early return to competitive sports, and so is particularly useful for elite athletes.
Masatoshi Morimoto, Kousaku Higashino, Hiroaki Manabe, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Shoichiro Takao, Toshinori Sakai, Takashi Chikawa, Akihiro Nagamachi and Koichi Sairyo : Age-related changes in axial and sagittal orientation of the facet joints: Comparison with changes in degenerative spondylolisthesis., Journal of Orthopaedic Science, Vol.24, No.1, 50-56, 2019.
(Summary)
Despite facet joints being three-dimensional structures, previous computed tomography and magnetic resonance imaging studies have evaluated facet joint orientation in only the axial plane. Facet joint orientation in the sagittal plane has rarely been studied using these imaging techniques. The aim of this study was to elucidate facet joint orientation in both the axial and sagittal planes on computed tomography. A total of 568 patients (343 men, 225 women) (excluding orthopedic outpatients) for whom abdominal and pelvic computed tomography scans were obtained at our hospital between September 2010 and October 2012 were included. Mean age was 63 (range 21-90) years. Patients were divided into a degenerative spondylolisthesis group (67 patients; 30 men, 37 women) and a control group (313 patients; 313 men, 188 women). Facet joint orientation was evaluated in the control group according to patient age (≤50, 51-60, 61-70, or ≥71 years). The findings in the control group were then compared with those in the degenerative spondylolisthesis group. The orientation of the lumbar facet joints at each level was measured in the axial and sagittal planes on computed tomography images. Facet joint angles decreased with age at L4/5 and L5/S1 in women in the axial plane and at L4/5 in men and L3/4 and L4/5 in women in the sagittal plane. The variation in facet joint angle was greatest at L4/5 in women. Patients with degenerative spondylolisthesis showed more sagittally and horizontally oriented facet joints in the axial and sagittal planes; facet tropism showed an association with degenerative spondylolisthesis in the axial plane. The axial and sagittal orientation of facet joints in the lower lumbar vertebra, especially L4/5, was negatively correlated with age. This finding could help to explain why older people are more prone to degenerative spondylolisthesis.
(Keyword)
Adult / Age Factors / Aged / Aged, 80 and over / aging / female / Humans / Lumbar Vertebrae / magnetic resonance imaging / male / Middle Aged / ROC Curve / Spondylolisthesis / Tomography, X-Ray Computed / Young Adult / Zygapophyseal Joint
Kenichiro Kita, Toshinori Sakai, Kazuta Yamashita, Akihiro Nagamachi and Koichi Sairyo : Spontaneous lumbar spinal subdural hematoma: a case report., British Journal of Neurosurgery, Vol.33, No.3, 264-268, 2019.
(Summary)
Spinal subdural hematoma (SSDH) is an uncommon disease causing acute onset of spinal disorder. Several causes of SSDH have been reported, but reports of spontaneous occurrence of SSDH are limited.
Yuto Sugimine, Kentaro Sakaeda, Kazuta Yamashita, Hiroaki Manabe, Kosuke Sugiura, Fumio Hayashi, Yoshihiro Ishihama, Yoichiro Takata, Toshinori Sakai, Toru Maeda, Tomohiko Tateishi and Koichi Sairyo : Surgical Treatment of Lumbar Herniated Nucleus Pulposus Combined with Residual Bony Fragment of Apophyseal Ring Fracture in High-Level Athletes : A Report of Two Cases., The Journal of Medical Investigation : JMI, Vol.66, No.3.4, 358-361, 2019.
(Summary)
In this paper, we present 2 cases of herniated nucleus pulposus (HNP) combined with the residual bony fragment of apophyseal ring fracture. HNP typically exists at the narrow lateral recess formed by the bony fragment, and so it has been reported that symptoms may persist. Case 1 was a 22-year-old man, a high-level javelin thrower and Paralympic athlete. He had a history of persistent pain for 4 years due to HNP, and so we performed surgical removal. Case 2 was a 23-year-old male professional baseball player. He was referred to us only 17 days after the onset of pain and presented with muscle weakness, a feature which may prolong the clinical course in addition other features such as pain. Thus, we performed a comparatively quick intervention of surgical removal. In both cases, we had excellent clinical outcomes and better function and performance. In conclusion, in cases with HNP and apophyseal ring separation, surgical intervention in the comparatively early phase can be recommended, particularly if the patients desire quick return to their original level of activity. J. Med. Invest. 66 : 358-361, August, 2019.
Yoshihiro Ishihama, Fumitake Tezuka, Hiroaki Manabe, Kazuta Yamashita, Yoichiro Takata, Toshinori Sakai, Takashi Chikawa and Koichi Sairyo : Minimally invasive cervical micro-endoscopic foraminotomy for C6 radiculopathy with overlooked scapular winging - A case report., The Journal of Medical Investigation : JMI, Vol.66, No.3.4, 340-343, 2019.
(Summary)
A 73-year-old woman complained of right medial side of scapular pain associated with winged scapula to miss without observing the back in minute detail. Additional treatment was required due to overlooking caused by insufficient examination. We performed micro-endoscopic foraminotomy that provided the disappearance of scapular pain and improvement of winged scapula in relatively early. It was commonly said that winged scapula is an extremely rare condition that causes dysfunction of the upper extremities. We suggest that there are the meaning of winged scapula in diagnosis and the importance of physical examination. Further studies should be required to research the morbidity of winged scapula associated with cervical disease. By sharing our experience of this attention arousing case, we provide information not to repeat the same mistakes. J. Med. Invest. 66 : 340-343, August, 2019.
Tsuyoshi Goto, Toshinori Sakai, Kosuke Sugiura, Hiroaki Manabe, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Shinsuke Katoh and Koichi Sairyo : A semi-rigid thoracolumbar orthosis fitted immediately after spinal surgery : stabilizing effects and patient satisfaction., The Journal of Medical Investigation : JMI, Vol.66, No.3.4, 275-279, 2019.
(Summary)
Purpose : To evaluate the stabilizing effects of a Fit Cure-Spine® semi-rigid thoracolumbar orthosis and wearer satisfaction after lumbar surgery. Methods : In study 1, the spinal angle, spinal motion angle, and distribution of load were measured in 8 adult male volunteers when the orthosis was worn (1) with no custom-made stay (CMS), (2) with a CMS in the prone position (P-CMS), and (3) with a CMS in the prone position and decreased lordosis (DP-CMS). In study 2, pain scale scores and responses to a questionnaire were recorded in 40 consecutive patients who underwent lumbar spinal surgery in our hospital. Results : In study 1, the mean lumbar lordosis when standing was similar to that in the prone position. When the trunk was bent forward, loads on the back support in P-CMS and DP-CMS were concentrated at the center of the CMS, unlike those for No-CMS. In study 2, there was a significant decrease in postoperative wound pain after wearing the Fit Cure-Spine orthosis for 2 weeks. Most patients who wore the orthosis were satisfied with their pain outcome. Conclusion : Adjustment to lumbar lordosis and the prone position was restricted in volunteers wearing the Fit Cure-Spine with a CMS. J. Med. Invest. 66 : 275-279, August, 2019.
Kazuta Yamashita, Kosuke Sugiura, Hiroaki Manabe, Yoshihiro Ishihama, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Accurate diagnosis of low back pain in adult elite athletes., The Journal of Medical Investigation : JMI, Vol.66, No.3.4, 252-257, 2019.
(Summary)
Background : There is few reports evaluated accurately the pain generator of low back pain in elite athletes. The purpose of this report was to show case series and to investigate the cause of unidentified low back pain of elite athletes. Methods : Twenty-three adult elite athletes consulted our sports spine clinic to seek a second opinion for low back pain between April 2013 and March 2016. Their cause of low back pain had not been identified by nearby doctor. Spine surgeons had diagnosed using diagnostic injection and STIR-MRI and the final diagnosis made by the spine surgeon were collected. Results : The mean age of 23 patients (16 male, 7 female) was 30.4 years. The most common sport played was baseball. The final diagnosis made by a spine surgeon was as follows : disc related low back pain (n = 12), facet joint arthritis (n = 5), vertebral endplate injury (n = 4), early-stage lumbar spondylolysis (n = 1), supraspinous ligament injury (n = 1). Conclusions : A thorough medical interview, careful physical examination, appropriate diagnostic imaging, and injection block examination can effectively identify the cause of low back pain. J. Med. Invest. 66 : 252-257, August, 2019.
Koichi Sairyo, Kazuta Yamashita, Hiroaki Manabe, Yoshihiro Ishihama, Kosuke Sugiura, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Yasuyuki Omichi, Nobutoshi Takamatsu, Ayaka Hashimoto and Toru Maeda : A novel surgical concept of transforaminal full-endoscopic lumbar undercutting laminectomy (TE-LUL) for central canal stenosis of the lumbar spine with local anesthesia : A case report and literature review., The Journal of Medical Investigation : JMI, Vol.66, No.3.4, 224-229, 2019.
(Summary)
Full-endoscopic spinal surgery was first developed for the lumbar herniated nucleus pulposus. Mainly, there are two types in the full-endoscopic lumbar surgery : i.e., transforaminal (TF) and interlaminar approach. The surgery can be done under the local anesthesia for the TF approach ; therefore, we need to further develop the TF approach to variety of the spinal disorders. Recently, the TF full-endoscopic surgery has been applied for the spinal canal stenosis. First, transforaminal full-endoscopic lumbar foraminoplasty for the foraminal stenosis ; then, transforaminal lumbar lateral recess decompression for the lateral recess stenosis has been developed. Finally, we have developed the surgical technique to decompress the central stenosis via TF approach under the local anesthesia. Prior to initiate the clinical case, we have attempted the lumbar undercutting laminectomy using a fresh cadaveric spine. After we technically confirmed that the transforaminal full-endoscopic lumbar undercutting laminectomy (TE-LUL) is possible, we applied the technique to the patient whose lung capacity did not allow general anesthesia. The 72 years old female patient with central canal stenosis could be improved her left leg pain and muscle weakness after TE-LUL under the local anesthesia. In this paper, we introduce the surgical technique of the TE-LUL and discuss of the efficacy of the TE-LUL. J. Med. Invest. 66 : 224-229, August, 2019.
Hiroaki Manabe, Toshinori Sakai, Masatoshi Morimoto, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata and Koichi Sairyo : Radiological Outcomes of Posterior Lumbar Interbody Fusion Using a Titanium-coated PEEK Cage., The Journal of Medical Investigation : JMI, Vol.66, No.1.2, 119-122, 2019.
(Summary)
INTRODUCTION Titanium (Ti) coated polyether ether ketone (PEEK) interbody cages (IBCs) have been introduced to overcome any disadvantages. The purpose of this study was to investigate the radiological outcomes of lumbar interbody fusion (LIF) surgery using the Ti-coated PEEK IBC with a minimum of 1-year of follow-up. METHODS A total of 26 intervertebral spaces in consecutive 21 patients who underwent posterior/transforaminal LIF using the Ti-coated PEEK IBC were evaluated. Rates of bone union, screw loosening, cage subsidence and bone cyst formation around the endplate were evaluated on computed tomography scans acquired at least 1 year postoperatively. RESULTS AND DISCUSSION At the 1-year follow-up, bone fusion was achieved in 23 (88.4%) of 26 intervertebral spaces. Cagesubsidence was found in 5 intervertebral spaces ; however,bone fusion was achieved in all these spaces. Bone cysts formed in 4 intervertebral spaces and 4 of 94 screws were found to be loosened. Three of the loosened screws were found in vertebral bodies adjacent to intervertebral spaces with nonunion. However, there was no association between these events. Although more scientific evidence is required to determine the advantages of Ti-coated PEEK IBCs, we believe the clinical outcomes achieved were favorable at the 1 year minimum follow-up. J. Med. Invest. 66 : 119-122, February, 2019.
Tsuyoshi Goto, Toshinori Sakai, Nori Sato, Shinsuke Katoh and Koichi Sairyo : An Adolescent Athlete with Low Back Pain Associated with Spina Bifida Occulta at the Thoracolumbar Junction : A Case Report., The Journal of Medical Investigation : JMI, Vol.66, No.1.2, 199-200, 2019.
(Summary)
These results suggest that evaluation of the coordination of the muscles and skeletal structures has an important role in the treatment of cases with an anatomical abnormality such as SBO. J.Med.Invest.66:199-200, February, 2019.
Kazuta Yamashita, Fumitake Tezuka, Hiroaki Manabe, Masatoshi Morimoto, Fumio Hayashi, Yoichiro Takata, Toshinori Sakai, Hiroshi Yonezu, Kousaku Higashino, Takashi Chikawa, Akihiro Nagamachi and Koichi Sairyo : Successful Endoscopic Surgery for L5 Radiculopathy Caused by Far-Lateral Disc Herniation at L5-S1 and L5 Isthmic Grade 2 Spondylolisthesis in a Professional Baseball Player., International Journal of Spine Surgery, Vol.12, No.5, 624-628, 2018.
(Summary)
Minimally invasive endoscopic surgery is an option for radiculopathy in very active patients who need an early return to their previous level of physical activity.
Tsuyoshi Goto, Toshinori Sakai, Kosuke Sugiura, Hiroaki Manabe, Masatoshi Morimoto, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Takashi Chikawa, Shinsuke Katoh and Koichi Sairyo : Dash-Associated Spondylolysis Hypothesis., Spine Surgery and Related Research, Vol.3, No.2, 146-150, 2018.
(Summary)
Kinematically and kinetically, the spinopelvic angles in Dash were considered similar to those in Shoot. Dash could cause mechanical stress at the pars interarticularis of the lumbar spine, similar to that caused by Shoot, thus leading to spondylolysis.
Toshinori Sakai, Tsuyoshi Goto, Kosuke Sugiura, Hiroaki Manabe, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Takashi Chikawa and Koichi Sairyo : Bony Healing of Discontinuous Laminar Stress Fractures Due to Contralateral Pars Defect or Spina Bifida Occulta., Spine Surgery and Related Research, Vol.3, No.1, 67-70, 2018.
(Summary)
Contralateral pars defect remains an unfavorable factor for bony healing discontinuous laminar stress fractures.
Toshinori Sakai, 橋本 拓也, Keizo Wada, Ryo Miyagi and Koichi Sairyo : A New Method of Image Evaluation for Diagnosis of Pain : Clinical Application of Diffusion-weighted Imaging, Journal of Spine Research, Vol.9, No.6, 1005-1011, 2018.
Norio Yamamoto, Hirofumi Kosaka, Kousaku Higashino, Masatoshi Morimoto, Kazuta Yamashita, Fumitake Tezuka, Fumio Hayashi, Yoichiro Takata, Toshinori Sakai, Akihiro Nagamachi and Koichi Sairyo : Vertebral Lateral Notch as Optimal Entry Point for Lateral Mass Screwing Using Modified Roy-Camille Technique., Asian Spine Journal, Vol.12, No.2, 272-276, 2018.
(Summary)
The vertebral lateral notch of the cervical spine was an effective landmark to determine the entry point for lateral mass screwing. The modified Roy-Camille technique proposed here may prevent surgical complications and poor outcomes.
Koichi Iwaki, Toshinori Sakai, Daisuke Hamada, Yohei Hayashi, Nanae Inoue, Miyuki Mitsumoto, Yusuke Hattori, Tsuyoshi Goto, Koichi Sairyo and Shuichiro Tsuji : Physical features of pediatric patients with lumbar spondylolysis and effectiveness of rehabilitation., The Journal of Medical Investigation : JMI, Vol.65, No.3.4, 177-183, 2018.
(Summary)
The purpose of this study was to evaluate the physical features of pediatric patients with lumbar spondylolysis (LS), factors that increase the load during compensatory movements at the lumbar spine, and the outcomes of rehabilitation. Twenty patients were included. Fifteen items were used:fingertip-to-floor distance (FFD), straight leg raising (SLR), heel-to-buttock distance (HBD), tightness of the rectus femoris, the lateral and medial rotator muscles, iliopsoas, tensor fascia lata, adductor muscles, soleus muscle, and latissimus dorsi, and trunk rotation, sit-ups and endurance of the abdominal and back muscles. Initial findings were judged as positive or negative using previously reported cut-off values and were re-evaluated 2 or 3 months later. Positive tests were found for HBD and tightness of the rectus femoris in 85% of the patients, for endurance of the abdominal muscles in 75%, SLR and sit-ups in 70%, and FFD and tightness of the external rotator muscles in 60%. The physical features varied according to the type of sport played, and some patients were refractory to rehabilitation. Only 17.6%, 33.3%, and 40.0% of patients with initially positive findings for HBD, tightness of the external rotator muscles, and endurance of the abdominal muscles, respectively, achieved improvements after rehabilitation. J. Med. Invest. 65:177-183, August, 2018.
Nori Sato, Kousaku Higashino, Toshinori Sakai, Tomoya Terai, K Vijay Goel, Ashok Biyani, Nabil Ebraheim, Yoichiro Takata, Fumio Hayashi, Kazuta Yamashita, Masatoshi Morimoto, Hiroaki Manabe and Koichi Sairyo : Role of Epiligament in Ligamentum Flavum Hypertrophy in Patients with Lumbar Spinal Canal Stenosis:a Pilot Study., The Journal of Medical Investigation : JMI, Vol.65, No.1.2, 85-89, 2018.
(Summary)
Ligamentum flavum (LF) hypertrophy is one of the main factors of lumbar spinal canal stenosis (LSCS). The primary object of this study is to clarify the existence of epiligament in the LF and its role in hypertrophy, and to develop an LF hypertrophy animal model. A cadaveric spine from a 30-year-old man was used to investigate the existence of epiligament in LF. Five LF samples from LSCS patients were obtained to evaluate hypertrophied LF. To create a rat model, we destabilized the lumbar spine. Each LF was sagittally cut for histological evaluation. The epiligament was clearly evident in normal LF specimens, which stained pink on Elastica van Gieson and green on Masson Trichrome. One layer was observed on the dural side and another on the dorsal side of the LF. LSCS patients had an enlarged dorsal epiligament, at around 30 times that of the regular thin epiligament on the dural side. The destabilized rat model showed an enlarged dorsal epiligament, with a mean thickness 8-fold that of the control. LF hypertrophy may be due to enlargement of the dorsal epiligament. Mechanical loading of the LF is an important factor for inducing hypertrophy in the rat model. J. Med. Invest. 65:85-89, February, 2018.
Kazuta Yamashita, Toshinori Sakai, Yoichiro Takata, Fumio Hayashi, Fumitake Tezuka, Masatoshi Morimoto, Yutaka Kinoshita, Akihiro Nagamachi, Takashi Chikawa, Hiroshi Yonezu, Kousaku Higashino, Tadanori Sakamaki and Koichi Sairyo : Utility of STIR-MRI in Detecting the Pain Generator in Asymmetric Bilateral Pars Fracture: A Report of 5 Cases., Neurologia Medico-Chirurgica, Vol.58, No.2, 91-95, 2017.
(Summary)
Lumbar spondylolysis usually occurs as a stress fracture in the pars interarticularis of the vertebra. It is a prevalent sports-related disorder and a common cause of low back pain. We encountered five athletes (4 males, 1 female) with severe low back pain. Mean age was 14.5 years. All five patients were found to have bilateral pars fracture. In all cases, staging based on the findings from computed tomography scan of the right and left pars fracture was different. On short tau inversion recovery magnetic resonance imaging (STIR-MRI) of the comparatively newer more recently injured side, high signal intensity changes were obvious and dominant at the intra- and extraosseous area, which would indicate tissue edema and/or bleeding. Furthermore, the imaging findings corresponded to the side of the low back pain. In conclusion, STIR-MRI can effectively distinguish between painful pars fracture and painless pars fracture.
Kenji Yokoyama, Kenji Endo, Yoichiro Takata, Fumitake Tezuka, Hiroaki Manabe, Kazuta Yamashita, Toshinori Sakai, Takashi Chikawa, Akihiro Nagamachi and Koichi Sairyo : Bone Bruise of the Thoracic Spine Caused by Mild Physical Activity in Children., Case Reports in Orthopedics, 2017.
(Summary)
Vertebral bone bruise (VBB) in children commonly occurs following a fall from a height, and more than one vertebral body may be affected. We encountered 6 children each with a single VBB caused by mild physical activity. All the children had tenderness on the corresponding spinous process with no neurologic findings. Magnetic resonance imaging (MRI) showed typical findings of VBB in all cases. The children were treated conservatively with a soft thoracolumbar brace and instructed to rest with no physical activity for a month. At follow-up 1 month later, the back pain had diminished, and the signal changes seen on MRI had disappeared in all cases. We conclude that mild physical activity may be a cause of VBB in children and good clinical results can be achieved by using a soft thoracolumbar brace and rest.
Hideyuki Uraoka, Kousaku Higashino, Masatoshi Morimoto, Kazuta Yamashita, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Akihiro Nagamachi, Masaaki Murase and Koichi Sairyo : Study of lesions of the lumbar endplate based on the stage of maturation of the lumbar vertebral body: the relationship between skeletal maturity and chronological age., European Journal of Orthopaedic Surgery & Traumatology, Vol.28, No.2, 183-187, 2017.
(Summary)
The lesion of the lumbar endplate is sometimes identified in the vertebrae of children and adolescents. The purpose of this study is to compare between skeletal maturity and chronological age. The second purpose of this study is to clarify the lesions of the lumbar endplate based on the maturation of the lumbar vertebral body. Six hundred and thirty-two (485 men and 147 women) consecutive patients were included. The mean age at the first medical examination was 13.8 years. Their skeletal maturity was evaluated based on the appearances of the secondary ossification center of L3. The area of the endplate lesions was classified into five types. The apophyseal stage was observed from 10 years old to 18 years old, and the apophyseal stage was shown the peak at 14 years old. The appearance of the apophyseal ring was observed earlier in female patients than in male patients. For the concave type, the lesion at upper level vertebra was more prevalent. The anterior and middle type of the lesion at upper level vertebra was more prevalent. For the posterior type, the lesion of the inferior rim of L4 and the lesion of the rim of L5 were more prevalent. This study emerged after comparing skeletal maturity based on the maturation of the lumbar vertebral body with the chronological age of a large number of patients and examining the lesions of the lumbar endplate based on the stage of maturation of the lumbar vertebral body.
Shingo Hama, Ichiro Tonogai, Toshinori Sakai, Yuichiro Goda, Fumitake Tezuka, Tetsuya Matsuura, Naoto Suzue, Rui Takahashi, Tomoya Terai, Kousaku Higashino, Shoji Fukuta, Akihiro Nagamachi and Koichi Sairyo : Pediatric isthmic spondylolisthesis showing radiologic evidence of slippage after physis injury., Journal of Pediatric Orthopaedics. Part B, Vol.26, No.4, 388-392, 2017.
(Summary)
The pathogenesis of slippage in pediatric spondylolisthesis is still unclear, although epiphyseal injury may account for many cases based on preclinical studies. However, no reports have described a pediatric case of isthmic spondylolisthesis showing radiologic evidence of epiphyseal injury. We report such evidence in a 13-year-old boy with low-back pain. Radiography revealed rounding of the S1 surface, a fracture line below the S1 endplate surface, and a bone marrow lesion in addition to slippage. Slippage and the rounding deformity were partially reversed (from 20 to 14% and from 42 to 27%, respectively) with conservative treatment and natural bone remodeling.
Fumitake Tezuka, Toshinori Sakai, Mitsunobu Abe, Kazuta Yamashita, Yoichiro Takata, Kousaku Higashino, Takashi Chikawa, Akihiro Nagamachi and Koichi Sairyo : Anatomical considerations of the iliac crest on percutaneous endoscopic discectomy using a transforaminal approach., The Spine Journal, Vol.17, No.12, 1875-1880, 2017.
(Summary)
From the results of this study, the trajectory of TF-PED can be limited by the surrounding anatomical structures. The maximum inclination angle indicated that treatment for the central type of LDH at the L5-S1 disc level was considered more difficult than that at the L4-L5 disc level because of the iliac crest. In the clinical setting, such anatomical particularities can be overcome by using a more perpendicular approach (hand-down technique) with the possible addition of a foraminoplasty. Moreover, we found that we must consider the laterality of the trajectory of TF-PED in terms of the patients' age or sex.
Toshinori Sakai, Fumitake Tezuka, Mitsunobu Abe, Kazuta Yamashita, Yoichiro Takata, Kousaku Higashino, Akihiro Nagamachi and Koichi Sairyo : Pediatric Patient with Incidental Os Odontoideum Safely Treated with Posterior Fixation Using Rod-Hook System and Preoperative Planning Using 3D Printer: A Case Report., Journal of Neurological Surgery. Part A, Central European Neurosurgery, Vol.78, No.3, 306-309, 2017.
(Summary)
Os odontoideum is often found incidentally. Surgical treatment is recommended for patients with atlantoaxial instability or neurologic deficits. Although various techniques have been used for C1-C2 fusion in adults, the use of these procedures in children is not widely accepted. We present a 12-year-old boy with incidental os odontoideum and obvious C1-C2 instability, in which bony union was achieved safely and successfully by posterior fixation using a rod-hook system and perioperative planning using a three-dimensional printer. At the 2-year follow-up, bone formation around the gap of the dens, which has been generally considered as pseudoarthrosis, was obtained after union of the posterior element of C1-C2.
Toshinori Sakai and Koichi Sairyo : Answer to the Letter to the Editor of C. Birkenmaier concerning "Rehydration of a degenerated disc on MRI synchronized with transition of Modic changes following stand-alone XLIF" by K. Kita, T. Sakai, M. Abe, Y. Takata and K. Sairyo (Eur Spine J; 2017). doi:10.1007/s00586-017-4945-6., European Spine Journal, Vol.26, No.6, 1790-1791, 2017.
Fumitake Tezuka, Koichi Sairyo, Toshinori Sakai and Akira Dezawa : Etiology of Adult-onset Stress Fracture in the Lumbar Spine., Clinical Spine Surgery, Vol.30, No.3, E233-E238, 2017.
(Summary)
Although lumbar spondylolysis is generally recognized to occur in childhood or adolescence, fresh lumbar spondylolysis should be included in the differential diagnosis of adult low back pain when patients are high-level athletes. Conservative treatment should be attempted for adult patients.
Kazuta Yamashita, Hisanori Ikuma, Takuya Tokashiki, Takashi Maehara, Akihiro Nagamachi, Yoichiro Takata, Toshinori Sakai, Kousaku Higashino and Koichi Sairyo : Radiation Exposure to the Hand of a Spinal Interventionalist during Fluoroscopically Guided Procedures., Asian Spine Journal, Vol.11, No.1, 75-81, 2017.
(Summary)
Our findings indicated that the cumulative radiation dose measured at the dominant hand may exceed the annual dose limit specified by the International Commission on Radiological Protection. Spinal interventionalists should take special care to limit the duration of fluoroscopy and radiation exposure.
Kenichiro Kita, Yoichiro Takata, Kousaku Higashino, Kazuta Yamashita, Fumitake Tezuka, Toshinori Sakai, Akihiro Nagamachi and Koichi Sairyo : Surgical Removal of Circumferentially Leaked Polymethyl Methacrylate in the Epidural Space of the Thoracic Spine after Percutaneous Vertebroplasty., The Surgery Journal, Vol.3, No.1, e1-e5, 2017.
(Summary)
Background The major complication of percutaneous vertebroplasty (PVP) using polymethyl methacrylate (PMMA) is epidural leakage of PMMA that damages the spinal cord. Methods This is a case report. Result A 77-year-old man presented to our institution with a 6-month history of muscle weakness and an intolerable burning sensation of both lower limbs after PVP with PMMA for thoracic compression fracture at T7 at another hospital. His past medical history was significant for hypertension. He had no history of smoking and alcohol. Computed tomography revealed massive leakage of PMMA into the T6 and T7 spinal canal circumferentially surrounding the spinal cord that caused marked encroachment of the thecal sac. Magnetic resonance images revealed cord compression and intramedullary signal change from T6 to T7 level. After we verified that the leaked PMMA could be easily detached from the dura mater in the cadaveric lumbar spine, surgical decompression and removal of epidural PMMA was performed. The leaked PMMA was carefully thinned down with a high-speed diamond burr. Eight pieces of PMMA were detached from the dura mater easily without causing a dural tear. No neurologic deterioration was observed in the postoperative period. The burning sensation resolved, but the muscle weakness remained unchanged. One and a half years postoperatively, the muscle weakness has improved to ⅘ on the manual muscle strength test, but he could not walk without an aid because of spasticity. Conclusion This report demonstrates the catastrophic epidural extrusion of PMMA following PVP. Extravasated PMMA can be removed through a working space created by means of laminectomy and subtraction of the affected pedicle. Spine surgeons should recognize the possible neurologic complications of PVP and be prepared to treat them using suitable approaches.
Kenichiro Kita, Toshinori Sakai, Mitsunobu Abe, Yoichiro Takata and Koichi Sairyo : Rehydration of a degenerated disc on MRI synchronized with transition of Modic changes following stand-alone XLIF., European Spine Journal, Vol.26, No.3, 626-631, 2017.
(Summary)
Lumbar intervertebral disc degeneration (LDD) is known to be associated with low back pain (LBP) and leads to degenerative lumbar disease. LDD is considered to be irreversible, and no truly effective treatment that suppresses LDD or regenerates the degenerated disc has been established thus far. Here, we report the case of a 42-year-old woman with a 10-year history of persistent LBP. Magnetic resonance imaging (MRI) demonstrated degenerative changes (Pfirrmann classification: grade IV) in the L4-5 intervertebral disc with type I and III mixed Modic changes adjacent to the disc. Conservative treatments were not effective, so we opted for stand-alone extreme lateral interbody fusion (XLIF). One year after the operation, the LBP had almost disappeared. Follow-up MRI revealed transition of the Modic changes from type I to type III. In addition, rehydration of the degenerated disc behind the XLIF cage was evident (Pfirrmann classification changed from grade IV to grade II). To our knowledge, this is the first report of a change in LDD. Several factors are likely responsible for the regenerative response, including curettage of the hyaline cartilaginous endplates and auto-iliac cancellous bone grafting, which were considered to have affected nucleus pulposus cells in the residual disc.
Tsuyoshi Goto, Toshinori Sakai, Tetsuya Enishi, Nori Sato, Koji Komatsu, Koichi Sairyo and Shinsuke Katoh : Changes of posture and muscle activities in the trunk and legs during walking in patients with lumbar spinal stenosis after decompression surgery. A preliminary report., Gait & Posture, Vol.51, 149-152, 2017.
(Summary)
Neurogenic intermittent claudication is a main symptom in lumbar spinal stenosis (LSS), and postural change is often observed during walking. This study aimed to identify the changes in posture and muscle activity in the trunk and legs during walking in patients with LSS by examining 6 patients who had undergone decompression surgery. None of them had significant paralysis. Gait analysis using Vicon motion capture system(®) with electromyographic recordings of the paravertebral muscles (PVM) and vastus lateralis muscle (VL) was performed preoperatively and 2 weeks postoperatively. Results showed that the thorax angle indicating the degree of trunk flexion after walking decreased significantly and the pelvic angle tended to decrease after surgery. However, there were no difference in the spine angle, which is a measure of the motion of the thoraco-lumbar spine among the evaluations. The knee angle increased significantly after surgery both at the beginning and at the end of walking, but the angles of the hip and ankle did not change significantly after surgery. Knee torques increased significantly after surgery both at the beginning and at the end of walking. The activity of the PVM decreased and that of the VL increased after surgery. The results indicate that patients with LSS walk in a forward-bending position without flexing the spine, which can be one of the neurologic symptoms. Increases in knee torque and VL activity seemed to reflect the increase of walking speed, and the decrease of PVM activity appeared to be caused by postural improvement after surgery.
Kenichiro Kita, Kazuta Yamashita, Mitsunobu Abe, Yoichiro Takata, Toshinori Sakai, Kousaku Higashino, Akihiro Nagamachi and Koichi Sairyo : Eight-year follow-up findings of surgical treatment for severe dystrophic changes in the cervical spine associated with neurofibromatosis type I: a case report., Journal of Pediatric Orthopaedics. Part B, Vol.26, No.1, 91-94, 2017.
(Summary)
Long-term follow-up findings for dystrophic changes in the cervical spine caused by neurofibromatosis type 1 have been rarely reported. A 13-year-old boy with severe dural ectasia in the cervical spine underwent cervical posterior fusion from C1 to C5 for prevention of cervical spine fracture and spinal injury. We followed him up for 8 years after surgery. We measured the progression of the destruction on yearly MRI. The dural ectasia gradually progressed until 3 years postoperatively. Subsequently, no further enlargement of the dural sac occurred. At the 8-year follow-up examination, the patient had no limitations in the activities of daily life.
Kousaku Higashino, Kazuta Yamashita, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai and Koichi Sairyo : 非特異的腰痛診断に陥りやすい椎間板性腰痛, Japanese Journal of Orthopaedic Sports Medicine, Vol.37, No.1, 2-6, 2017.
72.
Kosuke Sugiura, Toshinori Sakai, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Kousaku Higashino, Akihiro Nagamachi and Koichi Sairyo : Signal intensity changes of the posterior elements of the lumbar spine in symptomatic adults., Spine Surgery and Related Research, Vol.1, No.3, 140-145, 2017.
Kazuta Yamashita, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Fumio Hayashi, Fumitake Tezuka, Masatoshi Morimoto, Akihiro Nagamachi and Koichi Sairyo : The reduction and direct repair of isthmic spondylolisthesis using the smiley face rod method in adolescent athlete: Technical note., The Journal of Medical Investigation : JMI, Vol.64, No.1.2, 168-172, 2017.
(Summary)
Presently, lumbar spondylolisthesis did not have the indication of direct repair surgery because of the difficulty to reduce the slippage. In this report, we presented a case and described a minimally invasive direct repair surgery to reduce and repair the pars interarticularis defects of lumbar spondylolisthesis. First, curettage and removal of the synovium of the pars interarticularis and decompression of nerve root are conducted. Next, cancellous bone is harvested from the iliac crest. And then the Percutaneous Pedicle Screws are inserted bilaterally. A rod is bended and placed just caudal to the spinous process. We can make reposition of slipped vertebra and stabilize the loose lamina more firmly using a reduction tool and a rod pusher. Finally, bone grafts are implanted onto the pars defects. The Smiley face rod method is very useful to reduce the slippage and repair the pars defects in the lumbar spondylolisthesis especially in adolescent athletes. J. Med. Invest. 64: 168-172, February, 2017.
(Keyword)
Adolescent / Baseball / Bone Nails / Humans / Lumbar Vertebrae / Male / Minimally Invasive Surgical Procedures / Orthopedic Procedures / Pedicle Screws / Spondylolisthesis
Kazuta Yamashita, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Akihiro Nagamachi and Koichi Sairyo : Natural Correction and Adaptation of a Severely Deformed Sacral Dome in an Adolescent with Isthmic Spondylolisthesis: A Case Report., JBJS Case Connector, Vol.7, No.2, e26, 2017.
(Summary)
Vertebral deformity in children can be reversible. Orthopaedic surgeons should be aware that pediatric patients with a severe deformity of the sacral dome and vertebral slippage can be managed nonoperatively.
Kenji Yokoyama, Kazuta Yamashita, Masatoshi Morimoto, Fumitake Tezuka, Fumio Hayashi, Yoichiro Takata, Toshinori Sakai, Kousaku Higashino, Takashi Chikawa, Hiroshi Yonezu, Akihiro Nagamachi and Koichi Sairyo : Accurate diagnosis of chronic low back pain in a high-level college athlete: a case report., The Journal of Medical Investigation : JMI, Vol.64, No.3.4, 313-316, 2017.
(Summary)
A 21-year-old woman who was high-level college softball player presented with a 6-month history of low back pain that had been treated unsuccessfully by medication at local clinics. There was tenderness in the left paravertebral muscle at the lower lumbar level. X-ray and computed tomography revealed congenital scoliosis and an L6 hemivertebra. Short tau inversion recovery magnetic resonance imaging showed a fluid collection at the left L6-S1 facet joint. We performed a diagnostic facet injection, consisting of 1% lidocaine and steroids, that was infiltrated into the left facet joint at L6-S1. Her persistent low back pain disappeared immediately after the facet block. We diagnosed left-sided facet arthritis at L6-S1. Due to her multiple congenital anomalies, excessive loading occurred at the facet joint. Therefore, we opted for conservative management, including mobilization of the thoracic spine and stretching of hamstrings and quadriceps. This case report underscores the importance of accurate diagnosis of low back pain and of the diagnostic utility of short tau inversion recovery magnetic resonance imaging and lumbar facet block in young athletes with chronic spinal pain. J. Med. Invest. 64: 313-316, August, 2017.
Kazuta Yamashita, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Fumio Hayashi, Fumitake Tezuka, Masatoshi Morimoto, Takashi Chikawa, Akihiro Nagamachi and Koichi Sairyo : Percutaneous full endoscopic lumbar foraminoplasty for adjacent level foraminal stenosis following vertebral intersegmental fusion in an awake and aware patient under local anesthesia: A case report., The Journal of Medical Investigation : JMI, Vol.64, No.3.4, 291-295, 2017.
(Summary)
Percutaneous endoscopic surgery for the lumbar spine has become established in the last decade. It requires only an 8 mm skin incision, causes minimal damage to the paravertebral muscles, and can be performed under local anesthesia. With the advent of improved equipment, in particular the high-speed surgical drill, the indications for percutaneous endoscopic surgery have expanded to include lumbar spinal canal stenosis. Transforaminal percutaneous endoscopic discectomy has been used to treat intervertebral stenosis. However, it has been reported that adjacent level disc degeneration and foraminal stenosis can occur following intervertebral segmental fusion. When this adjacent level pathology becomes symptomatic, additional fusion surgery is often needed. We performed minimally invasive percutaneous full endoscopic lumbar foraminoplasty in an awake and aware 50-year-old woman under local anesthesia. The procedure was successful with no complications. Her radiculopathy, including muscle weakness and leg pain due to impingement of the exiting nerve, improved after the surgery. J. Med. Invest. 64: 291-295, August, 2017.
Akihiro Nagamachi, Mitsuhiko Takahashi, Noriaki Mima, Keisuke Adachi, Kazumasa Inoue, C Subash Jha, Akihiro Nitta, Masatoshi Morimoto, Tomoya Takasago, Toshiyuki Iwame, Keizo Wada, Fumitake Tezuka, Kazuta Yamashita, Fumio Hayashi, Ryo Miyagi, Toshihiko Nishisho, Ichiro Tonogai, Tomohiro Goto, Yoichiro Takata, Toshinori Sakai, Kousaku Higashino, Takashi Chikawa and Koichi Sairyo : Radiographic changes of cervical destructive spondyloarthropathy in long-term hemodialysis patients: A 9-year longitudinal observational study., The Journal of Medical Investigation : JMI, Vol.64, No.1.2, 68-73, 2017.
(Summary)
Analyses of radiographic changes and clinical symptom of destructive spondyloarthropathy (DSA) on consecutive 42 patients managed with long-term hemodialysis were performed to elucidate radiographic changes of DSA and the factors that influence to the destructive changes. Patients underwent plain radiographs of the cervical spine with 9 years interval. Grading of radiological feature from lateral view was classified into grade 0 to grade 3. Clinical symptom was evaluated using modified Japanese Orthopaedic Association scoring system for cervical myelopathy (mJOA score). Destructive changes were observed in 3 patients at the first examination, and those were observed in 15 patients 9 years after the first examination. There is no statistically significant difference between the duration of hemodialysis and the grade. The mean age at the onset of hemodialysis, however, was significantly higher in patients of grade 2 and 3 than those of grade 1. Older patients with long-term hemodialysis had destructive changes. Destructive changes commonly observed in lower cervical spine. The average numbers of the involved disc level were 1.6 in grade 2 and 1.0 in grade 3. Clinical symptoms were varied in each grade and there was no statistically significant difference in total mJOA score among these grades. J. Med. Invest. 64: 68-73, February, 2017.
C Subash Jha, Yoichiro Takata, Mitsunobu Abe, Kazuta Yamashita, Fumitake Tezuka, Toshinori Sakai, Kousaku Higashino, Akihiro Nagamachi and Koichi Sairyo : High intensity zone in lumbar spine and its correlation with disc degeneration., The Journal of Medical Investigation : JMI, Vol.64, No.1.2, 39-42, 2017.
(Summary)
Purpose; To investigate the prevalence, clinical significance of high intensity zone (HIZ), and associated disc degeneration. Materials and methods; We undertook retrospective analysis of 228 patients, aged from 15 to 55 years, who had undergone magnetic resonance (MR) imaging of lumbar spine in outpatient clinic from 2013 to 2014. HIZ was defined as a presence of high intensity signal in the annulus on T2-weighted images. All HIZ positive discs were classified according to Pfirrmann grading system for presence of disc degeneration. Results; Forty-three patients (18.8%) with 53 intervertebral discs demonstrated HIZ. There was no significant predominance about age and gender for the presence of HIZ. HIZ occurred mainly at L4-5 (43.3%) and L5-S1 (30.2%) levels, infrequently at L3-4 (17%) and rarely at upper levels. The prevalence of disc degenerations with Pfirrmann grade 3, 4, and 5 were significantly higher in HIZ positive patients than in randomly selected 35 HIZ negative patients (64% vs. 46%, respectively). Conclusion; In this study we identified that the presence of HIZ was directly proportional to increased incidence of disc degeneration in remaining lumbar discs. The prevalence of significant degeneration was significantly higher in HIZ positive patient at lower three lumbar levels. J. Med. Invest. 64: 39-42, February, 2017.
Koichi Sairyo, Kousaku Higashino, Kazuta Yamashita, Fumio Hayashi, Keizo Wada, Toshinori Sakai, Yoichiro Takata, Fumitake Tezuka, Masatoshi Morimoto, Tomoya Terai, Takashi Chikawa, Hiroshi Yonezu, Akihiro Nagamachi and Yoshihiro Fukui : A new concept of transforaminal ventral facetectomy including simultaneous decompression of foraminal and lateral recess stenosis: Technical considerations in a fresh cadaver model and a literature review., The Journal of Medical Investigation : JMI, Vol.64, No.1.2, 1-6, 2017.
(Summary)
Percutaneous endoscopic surgery for the lumbar spine, which was established in the last decade, requires only an 8-mm skin incision and causes minimal damage to the paravertebral muscles; thus, it is considered to be a minimally invasive technique for spinal surgery. It has been used to perform percutaneous endoscopic discectomy via two main approaches: the TF approach is a posterolateral one through the intervertebral foramen and can be done under local anesthesia; the IL approach is a more traditional one through the interlaminar space and is difficult to perform under local anesthesia. Recently, these techniques have been applied for lumbar spinal stenosis (LSS), the TF method for foraminal stenosis under local anesthesia, and the IL method for central and lateral recess stenosis under general anesthesia. In this study, using a fresh human cadaver model, we performed simultaneous decompression of the lateral recess and foraminal stenosis at L4-5 using the TF approach. Computed tomography confirmed enlargement of the lateral recess and intervertebral foramen. This technique, which can be performed under local anesthesia, should benefit elderly patients with LSS and poor general condition due to multiple comorbidities. Finally, we introduce the concept of percutaneous transforaminal ventral facetectomy using a spinal percutaneous endoscope. J. Med. Invest. 64: 1-6, February, 2017.
Keizo Wada, Takuya Hashimoto, Ryo Miyagi, Toshinori Sakai and Koichi Sairyo : Diffusion tensor imaging and tractography of the sciatic nerve: assessment of fractional anisotropy and apparent diffusion coefficient values relative to the piriformis muscle, a preliminary study., Skeletal Radiology, Vol.46, No.3, 309-314, 2016.
(Summary)
Piriformis muscle syndrome (PMS) is underdiagnosed. To evaluate the potential of diffusion tensor imaging and diffusion tensor tractography as innovative tools for the diagnosis of PMS by functional assessment of the sciatic nerve, the aims of this study are to assess the reproducibility and to evaluate the changes in the parameters at levels proximal and distal to the piriformis. Fractional anisotropy (FA) and the apparent diffusion coefficient (ADC) of the sciatic nerve at three levels were quantified twice each by two examiners using the fiber-tracking method. In the first part of the study, laterality and reproducibility were evaluated using intraclass correlation coefficients (ICC) in ten healthy volunteers. In the second part of the study, the healthy side and symptomatic side were assessed in ten consecutive patients with sciatica. There were three patients with no findings on lumbar magnetic resonance imaging (MRI). There was no laterality in either FA or ADC values in asymptomatic patients at any level. The mean intra-rater ICC was 0.90 and the mean inter-rater ICC was 0.87. FA was significantly lower and ADC significantly higher on the symptomatic side at each level in patients with sciatica. In the three sciatica patients with no findings on lumbar MRI, FA was significantly lower and ADC was significantly higher only at levels distal to the piriformis. These patients experienced full pain relief after ultrasound-guided injection of local anesthesia. Diffusion tensor imaging and diffusion tensor tractography might be innovative tools for the diagnosis of PMS.
(Keyword)
Adult / Aged / Aged, 80 and over / anisotropy / Diffusion Tensor Imaging / Female / Humans / Image Interpretation, Computer-Assisted / Male / Middle Aged / Piriformis Muscle Syndrome / Reproducibility of Results / Sciatic Neuropathy
Nori Sato, Takako Taniguchi, Yuichiro Goda, Hirofumi Kosaka, Kosaku Higashino, Toshinori Sakai, Shinsuke Katoh, Natsuo Yasui, Koichi Sairyo and Hisaaki Taniguchi : Proteomic Analysis of Human Tendon and Ligament: Solubilization and Analysis of Insoluble Extracellular Matrix in Connective Tissues., Journal of Proteome Research, Vol.15, No.12, 4709-4721, 2016.
(Summary)
Connective tissues such as tendon, ligament and cartilage are mostly composed of extracellular matrix (ECM). These tissues are insoluble, mainly due to the highly cross-linked ECM proteins such as collagens. Difficulties obtaining suitable samples for mass spectrometric analysis render the application of modern proteomic technologies difficult. Complete solubilization of them would not only elucidate protein composition of normal tissues but also reveal pathophysiology of pathological tissues. Here we report complete solubilization of human Achilles tendon and yellow ligament, which is achieved by chemical digestion combined with successive protease treatment including elastase. The digestion mixture was subjected to liquid chromatography-mass spectrometry. The low specificity of elastase was overcome by accurate mass analysis achieved using FT-ICR-MS. In addition to the detailed proteome of both tissues, we also quantitatively determine the major protein composition of samples, by measuring peak area of some characteristic peptides detected in tissue samples and in purified proteins. As a result, differences between human Achilles tendon and yellow ligament were elucidated at molecular level.
Masatoshi Morimoto, Kousaku Higashino, Shinsuke Katoh, Fumitake Tezuka, Kazuta Yamashita, Fumio Hayashi, Yoichiro Takata, Toshinori Sakai, Akihiro Nagamachi and Koichi Sairyo : A Rare Case of Progressive Palsy of the Lower Leg Caused by a Huge Lumbar Posterior Endplate Lesion after Recurrent Disc Herniation., Case Reports in Orthopedics, Vol.2016, 2016.
(Summary)
A lesion of the lumbar posterior endplate is sometimes identified in the spinal canal of children and adolescents; it causes symptoms similar to those of a herniated disc. However, the pathology of the endplate lesion and the pathology of the herniated disc are different. We present a rare case of a 23-year-old woman who developed progressive palsy of the lower leg caused by huge lumbar posterior endplate lesion after recurrent disc herniation.
Yoichiro Takata, Kousaku Higashino, Masatoshi Morimoto, Toshinori Sakai, Kazuta Yamashita, Mitusnobu Abe, Akihiro Nagamachi and Koichi Sairyo : Vacuum Phenomenon of the Sacroiliac Joint: Correlation with Sacropelvic Morphology., Asian Spine Journal, Vol.10, No.4, 762-766, 2016.
(Summary)
These data suggest that differences in sacropelvic morphology can influence the biomechanical environment and contribute to SJVP in men. Presence of SJVP did not affect JOA or RDQ scores.
Kazuta Yamashita, Kousaku Higashino, Keizo Wada, Masatoshi Morimoto, Mitsunobu Abe, Yoichiro Takata, Toshinori Sakai, Yoshihiro Fukui and Koichi Sairyo : Radiation Exposure to the Surgeon and Patient During a Fluoroscopic Procedure: How High is the Exposure Dose? A Cadaveric Study., Spine, Vol.41, No.15, 1254-1260, 2016.
Shunsuke Tamaki, Kazuta Yamashita, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata and Koichi Sairyo : Lumbar Posterior Apophyseal Ring Fracture Combined with Spondylolysis in Pediatric Athletes: A Report of Three Cases., JBJS Case Connector, Vol.6, No.3, e64, 2016.
(Summary)
In patients with severe low back and radicular pain in whom spondylolysis is suspected, it is important to perform not only magnetic resonance imaging and radiography but also computed tomography for identifying posterior apophyseal ring fractures.
Tetsuya Kimura, Toshinori Sakai, Fumitake Tezuka, Mitsunobu Abe, Kazuta Yamashita, Yoichiro Takata, Kousaku Higashino and Koichi Sairyo : Compression Myelopathy due to Proliferative Changes around C2 Pars Defects without Instability., Asian Spine Journal, Vol.10, No.3, 565-569, 2016.
(Summary)
We report a case with compression myelopathy due to proliferative changes around the C2 pars defects without instability. A 69-year-old man presented with progressive clumsy hands and spastic gait. Plain radiographs showed bilateral spondylolysis (pars defects) at C2 and fusion between C2 and C3 spinous processes. Dynamic views revealed mobility through the pars defects, but there was no apparent instability. Computed tomography showed proliferative changes at the pars defects, which protruded into spinal canal. On magnetic resonance imaging, the spinal cord was compressed and intramedullary high signal change was found. A diagnosis of compression myelopathy due to proliferative changes around the C2 pars defects was made. We performed posterior decompression. Postoperatively, symptoms have been alleviated and images revealed sufficient decompression and no apparent instability. In patients with the cervical spondylolysis, myelopathy caused by instability or slippage have been periodically reported. The present case involving C2 spondylolysis is extremely rare.
Akihiro Nitta, Toshinori Sakai, Yuichiro Goda, Yoichiro Takata, Kousaku Higashino, Tadanori Sakamaki and Koichi Sairyo : Prevalence of Symptomatic Lumbar Spondylolysis in Pediatric Patients., Orthopedics, Vol.39, No.3, e434-437, 2016.
(Summary)
Lumbar spondylolysis, a stress fracture of the pars interarticularis, is prevalent in adolescent athletes. Recent advances in diagnostic tools and techniques enable early diagnosis before these fractures progress to complete fractures through the pars. However, because patients often consult family physicians for primary care of low back pain and these physicians may not have access to diagnostic modalities such as magnetic resonance imaging (MRI) and computed tomography, stress fractures can be missed. This study surveyed the prevalence of symptomatic spondylolysis in pediatric patients who consulted an orthopedic clinic for primary care and investigated whether such acute stress fractures may be overlooked without MRI. The prospective study investigated 264 patients who were younger than 19 years and had low back pain. Of the 153 patients (58.0%) with low back pain persisting for longer than 2 weeks, 136 who agreed to undergo MRI were included in the study. This group included 11 elementary school students, 71 junior high school students, and 54 high school students. The overall prevalence of lumbar spondylolysis was 39.7% (54 of 136) and was 9.3% in elementary school students (5 of 11, 45.5%), 59.3% in junior high school students (32 of 71, 45.1%), and 31.5% in high school students (17 of 54, 31.5%). All 54 patients with spondylolysis had a history of athletic activity. Primary care physicians should recognize that approximately 40% of pediatric patients presenting with low back pain persisting for longer than 2 weeks may have spondylolysis and should consider MRI in those with a history of athletic activity. Because the spine is immature in this age group, almost half of affected elementary school and junior high school students may have lumbar spondylolysis. [Orthopedics.].
Shingo Hama, Yoichiro Takata, Toshinori Sakai, Kousaku Higashino, Mitsunobu Abe, Akihiro Nagamachi and Koichi Sairyo : Sacral fatigue fractures in children with sacral spina bifida occulta., Journal of Pediatric Orthopaedics. Part B, Vol.25, No.3, 278-282, 2016.
(Summary)
In this report, we present two cases of 9-year-old children with spina bifida occulta (SBO) of the sacrum, who were diagnosed with sacral fatigue fractures. In both patients, MRI showed a linear signal void and high signal in sacral ala on the short tau inversion recovery sequence. Sacral SBO at the same level of the sacral fracture was observed in each patient on computed tomography images. These lesions healed with rest. This is the first literature reporting cases with sacral stress fractures who had SBO at the same level of fracture.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0/.
Toshinori Sakai, Yuichiro Goda, Fumitake Tezuka, Mitsunobu Abe, Kazuta Yamashita, Yoichiro Takata, Kousaku Higashino, Akihiro Nagamachi and Koichi Sairyo : Clinical features of patients with pars defects identified in adulthood., European Journal of Orthopaedic Surgery & Traumatology, Vol.26, No.3, 259-262, 2016.
(Summary)
Lumbar spondylolysis is considered a stress fracture of the pars interarticularis that occurs during growth. However, it is sometimes insidious and identified in adults as pseudoarthrosis, the terminal-stage of spondylolysis. The purpose of this study was to identify the clinical features of patients with terminal-stage spondylolysis that first manifested during adulthood.
C Subash Jha, Ichiro Tonogai, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Yuichiro Goda, Mitsunobu Abe, Akihiro Nagamachi, Shoji Fukuta and Koichi Sairyo : Postoperative discal cyst: An unusual complication after microendoscopic discectomy in teenagers., Asian Journal of Endoscopic Surgery, Vol.9, No.1, 89-92, 2016.
(Summary)
Various complications after microendoscopic discectomy (MED) are well known, but postoperative discal cyst is a unique and relatively unknown complication. Here, we report on two teenage patients who presented with postoperative discal cyst after MED for herniated nucleus pulposus (HNP), which resolved after conservative treatment. The patients were diagnosed with HNP at L4-5 and L5-S1 based on MRI and then treated by MED. Postoperative discal cyst was diagnosed on MRI after recurrence of symptoms. Both patients were managed conservatively. T2-weighted MRI demonstrated hyperintense collections adjacent to the operated intervertebral disc level, which were communicating with the corresponding disc annulus. Because the clinical symptoms were relatively mild, the patients were managed conservatively; both made a complete clinical recovery with radiological evidence of improvement. Postoperative discal cyst is a relatively unknown complication after MED for HNP. Surgeons should be aware of this postoperative complication when operating on young individuals with HNP.
Toshinori Sakai, Yuichiro Goda, Fumitake Tezuka, Yoichiro Takata, Kousaku Higashino, Masahiro Sato, Yasuyoshi Mase, Akihiro Nagamachi and Koichi Sairyo : Characteristics of lumbar spondylolysis in elementary school age children., European Spine Journal, Vol.25, No.2, 602-606, 2016.
(Summary)
Lumbar spondylolysis in elementary school age children was commonly a terminal-stage bone defect at L5, which was not necessarily related to history of athletic activity and was sometimes asymptomatic. It was often associated with SBO, indicating a possible congenital predisposition. These findings may provide further insight into the pathogenesis of lumbar spondylolysis.
Toshihiko Nishisho, Toshinori Sakai, Fumitake Tezuka, Kosaku Higashino, Shoichiro Takao, Yoichiro Takata, Ryo Miyagi, Shunichi Toki, Mitsunobu Abe, Kazuta Yamashita, Akihiro Nagamachi and Koichi Sairyo : Delayed Diagnosis of Primary Bone and Soft Tissue Tumors Initially Treated as Degenerative Spinal Disorders., The Journal of Medical Investigation : JMI, Vol.63, No.3-4, 274-277, 2016.
(Summary)
Background Symptoms of primary bone and soft tissue tumors located in the trunk mimic those of degenerative spinal disorders such as low back pain or pain or numbness of the legs. Due to their rarity, especially in sarcoma located in the trunk, diagnosis is sometimes delayed. Methods A retrospective review was performed of the records of 383 patients with primary bone and soft tissue tumors who visit our out patient clinic from 2011 to 2013 at a single institution. Patients with delayed diagnosis of primary bone and soft tissue tumors initially treated as degenerative spinal disorders for more than 2 months were identified. Results Of the 383 patients, 5 (1.3%) were initially diagnosed as having degenerative spinal disorders. All 5 patients had bone or soft tissue tumors in the lumbar spine or pelvis. Three patients had a malignant tumor (osteosarcoma, chondrosarcoma, or small round cell sarcoma) at the progressive stage, and 1 died of lung metastasis. Two patients had a benign tumor (aneurysmal bone cyst or simple bone cyst). Conclusions Our findings suggest that when low back pain and leg pain are refractory to conservative treatment, further radiological examination should be conducted. J. Med. Invest. 63: 274-277, August, 2016.
Kosuke Sugiura, Toshinori Sakai, Keisuke Adachi, Kazumasa Inoue, Satoshi Endo, Yasuaki Tamaki, Koichi Sairyo and Akihiro Nagamachi : Complete Fracture-Dislocation of the Thoracolumbar Spine with No Critical Neurological Deficit: A Case Report., The Journal of Medical Investigation : JMI, Vol.63, No.1-2, 122-126, 2016.
(Summary)
Fractures at the thoracolumbar junction are the most common spinal column fractures. Among type C fractures in the Arbeitsgemeinschaft für Osteosynthesefragen Spine Classification, cases with complete fracture-dislocations of the spinal column often result in a critical neurological deficit despite surgical treatment. We present a case of an 18-year-old man who had a complete fracture-dislocation of the T12 vertebral body and multiple injuries following high-energy trauma but no critical neurological deficits. Because of active bleeding in the left thoracic cavity, the patient underwent open reduction of the T12 vertebral body and anterior spinal fusion of the T11-L1 vertebral bodies via an anterior approach between the T9 and T10 ribs within 24 h of the accident. Four months postoperatively, the patient could ambulate independently, with a slight disturbance of light touch. At 6 months postoperatively, plain computed tomography scans showed bony union of the T12 vertebral body. We postulated two reasons for the absence of critical neurological dysfunction: (1) spontaneous spinal canal sparing because of the fracture of the right superior articular process in the L1 vertebral body and (2) fracture morphology, that is, a rotational fracture with mild to moderately strong shearing stress to the dura mater. J. Med. Invest. 63: 122-126, February, 2016.
Kazuta Yamashita, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Mitsunobu Abe, Masatoshi Morimoto, Akihiro Nagamachi and Koichi Sairyo : Revision percutaneous endoscopic lumbar discectomy under the local anesthesia for the recurrent lumbar herniated nucleus pulposus in a high class athlete: A case Report., The Journal of Medical Investigation : JMI, Vol.63, No.1-2, 135-139, 2016.
(Summary)
Percutaneous endoscopic discectomy (PED) is a minimally invasive spinal technique and has several advantages compared with open surgery. We describe repeat PED surgery for recurrent herniated nucleus pulposus (HNP). The patient was a 33-year-old handball high level player. Previously, he underwent transforaminal PED under local anesthesia for intracanalicular HNP at L4-5 level about 2 years ago. He could return to his original competitive level. Two years later, he felt low back and right leg pain again when he was playing handball. Magnetic resonance imaging revealed the recurrence of HNP at the same level. We conducted transforaminal PED again using the exact same route as the previous surgery. Although there was a little adhesion around the L5 nerve root, we could easily identify and remove the herniated mass using endoscopic forceps. Immediately after the surgery, the low back and leg pain disappeared. Repeat PED surgery for recurrence of lumbar disc herniation is effective especially for athletes because of the benefits of PED, including surgery under local anesthesia, preservation of normal posterior structures, less postoperative pain, early discharge, and faster return to sports. J. Med. Invest. 63: 135-139, February, 2016.
Subash Jha C, Shoji Fukuta, Keizo Wada, Kousaku Higashino, Rui Amari-Kita, Takahiko Tsutsui, Tomohiro Goto, Daisuke Hamada, Naoto Suzue, Tetsuya Matsuura, Toshihiko Nishisho, Mitsunobu Abe, Yoichiro Takata, Toshinori Sakai, Akihiro Nagamachi and Koichi Sairyo : Optimizing baseplate position in reverse total shoulder arthroplasty in small-sized Japanese females: technical notes and literature review., The Journal of Medical Investigation : JMI, Vol.63, No.1-2, 8-14, 2016.
(Summary)
The management of cuff tear arthropathy (CTA) has always been a challenge for shoulder surgeons. Introduction of reverse total shoulder arthroplasty (RTSA) helped in providing pain relief and improved shoulder function in patients with CTA. In this study, we aimed to evaluate the short-term clinical results and some clinical details regarding the types of available prosthesis, positioning, and size of the components for RTSA in a population of short-stature female Japanese. In our seven cases, the average glenoid size was 23.9 mm in width and 34.2 mm in height. The average width was smaller than the size of all available baseplates. We implanted reverse shoulder prostheses with baseplate that measured 28 mm in diameter and two locking screws. The center of the baseplate was shifted to allow slight anterior overhang relative to the anatomical center to avoid breakage of the posterior cortex and to achieve firm fixation. One case of humeral shaft fracture occurred while inserting the humeral stem and required encircling wiring. In our experience, the short term clinical results of RTSA were excellent, but a new prosthesis that is designed to fit the short stature of Asians with smaller glenoid and humerus should be considered. J. Med. Invest. 63: 8-14, February, 2016.
Subash Jha C, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Mitsunobu Abe, Kazuta Yamashita, Masatoshi Morimoto, Shoji Fukuta, Akihiro Nagamachi and Koichi Sairyo : Clinical Significance of High-intensity Zone for Discogenic Low Back Pain: A Review., The Journal of Medical Investigation : JMI, Vol.63, No.1-2, 1-7, 2016.
(Summary)
High-intensity zone (HIZ) was originally described as a high-intensity signal on T2-weighted magnetic resonance (MR) images, located in the posterior annulus fibrosus, clearly separated from the nucleus pulposus. Among symptomatic patients with low back pain, HIZ is present in 28-59% of cases. In morphologically abnormal discs, high sensitivity and specificity of 81% and 79%, respectively, were reported for HIZs and concordant pain during discography. In contrast, another report indicated low rates. Although most papers reported high sensitivity and specificity for this relationship, it remains controversial. Regarding the pathology of HIZs, inflammatory granulation tissues are found at sites showing HIZs. Such inflammatory tissues produce pro-inflammatory cytokines and mediators, which sensitize the nociceptors within the disc and cause pain. An effective treatment for this condition is yet to be established. Recently, minimally invasive surgery using percutaneous endoscopic discectomy (PED) under local anesthesia was introduced. After removal of the degenerated disc material, the HIZ is identified with the endoscope and then coagulated and modulated with a bipolar radio pulse. This technique is called thermal annuloplasty. In conclusion, HIZs is an important sign of painful intervertebral disc disruption, if identified precisely based on factors such as location and intensity. J. Med. Invest. 63: 1-7, February, 2016.
Subash Jha C, Toshinori Sakai, Mika Hangai, Akiko Toyota, Shoji Fukuta, Akihiro Nagamachi and Koichi Sairyo : Stress fracture of the thoracic spine in an elite rhythmic gymnast: A case report., The Journal of Medical Investigation : JMI, Vol.63, No.1-2, 119-121, 2016.
(Summary)
Spondylolysis, a defect or stress fracture of the vertebral pars interarticularis, occurs most frequently in the lower lumbar spine and occasionally in the cervical spine, but is extremely rare in the thoracic spine. We report the case of a 17 year-old girl, an elite rhythmic gymnast, who reported with early-stage thoracic spondylolysis at T10 and T11 levels. Physicians should be aware that performance of unusual athletic movements, such as those by gymnasts, may lead to spondylolysis in rare locations. J. Med. Invest. 63: 119-121, February, 2016.
Tadahiro Higuchi, Ichiro Tonogai, Toshinori Sakai, Yoichiro Takata, Yuichiro Goda, Mitsunobu Abe, C Subash Jha, Shoji Fukuta, Kousaku Higashino, Akihiro Nagamachi and Koichi Sairyo : Hysterical conversion paralysis in an adolescent boy with lumbar spondylolysis., Journal of Pediatric Orthopaedics. Part B, Vol.25, No.3, 271-274, 2016.
(Summary)
We describe a case of recurrent hysterical paralysis triggered by low back pain because of lumbar spondylolysis. A 16-year-old male soccer player was referred to our institution with five previous episodes of acute paralysis triggered by severe low back pain. We performed direct surgical repair of the terminal-stage bilateral spondylolysis at L4 using a hook-rod system. His chronic low back pain was completely resolved, and no further episodes of hysterical paralysis have occurred after surgery. Spine surgeons should be aware of possible hysterical conversion paralysis when there is discrepancy between radiological and neurological findings.
Yasuaki Tamaki, Toshinori Sakai, Ryo Miyagi, Takefumi Nakagawa, Tateaki Shimakawa, Koichi Sairyo and Takashi Chikawa : Intradural lumbar disc herniation after percutaneous endoscopic lumbar discectomy: case report., Journal of Neurosurgery. Spine, Vol.23, No.3, 336-394, 2015.
(Summary)
A 64-year-old man was referred to the authors with low-back pain (LBP) and right leg pain with a history of previously diagnosed lumbar disc herniation (LDH) at L4-5. He had undergone 2 percutaneous endoscopic lumbar discectomies (PELDs) for the herniation at another institution, and according to the surgical record of the second surgery, a dural tear occurred intraoperatively but was not repaired. Postoperative conservative treatments such as an epidural block and blood patch had not relieved his persistent LBP or right leg pain. Upon referral to the authors, MRI and myelography revealed an intradural LDH. The herniated mass was removed by durotomy, and posterior lumbar interbody fusion was performed. His symptoms were partially improved after surgery. Primary suture is technically difficult when a dural tear occurs during PELD. Therefore, close attention should be paid to avoiding such tears, and surgeons should increase their awareness of intradural LDH as a possible postoperative complication of PELD.
C Subash Jha, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Mitsunobu Abe, Akihiro Nagamachi, Shoji Fukuta and Koichi Sairyo : Percutaneous Endoscopic Discectomy via Transforaminal Route for Discal Cyst., Case Reports in Orthopedics, 2015.
(Summary)
Background. Discal cyst has been identified as a rare cause of low back pain and radiating leg pain. The pathogenesis and management of this condition are still debated. The largest number of reported cases had undergone microsurgery while very few cases have been treated with percutaneous endoscopic discectomy (PED). Methods. An 18-year-old boy complained of low back pain radiating to right leg after a minor road traffic accident. Diagnosis of a discal cyst at L4-L5 level was made based on magnetic resonance imaging (MRI). Despite conservative management for 6 months, the low back pain and radiating leg pain persisted so surgical treatment by PED was performed under local anesthesia. As the patient was a very active baseball player, his physician recommended a minimally invasive procedure to avoid damage to the back muscles. Results. The patient's low back pain and leg pain disappeared immediately after surgery and he made a rapid recovery. He resumed mild exercise and sports practice 4 weeks after surgery. Complete regression of the cystic lesion was demonstrated on the 2-month postoperative MRI. Conclusion. A minimal invasive procedure like PED can be an effective surgical treatment for discal cyst, especially in active individuals who play sports.
Ryo Miyagi, Toshinori Sakai, Eiko Yamabe and Hiroshi Yoshioka : Consecutive assessment of FA and ADC values of normal lumbar nerve roots from the junction of the dura mater., BMC Musculoskeletal Disorders, Vol.16, 2015.
(Summary)
Our study demonstrated that ADC and FA values of each L4, 5, and S1 at the proximal portion from the junction of the dura matter changed linearly. It would be useful to know the normal profile of DTI values by location of each nerve root so that we can detect subtle abnormalities in each nerve root.
(Keyword)
Adult / Diffusion Magnetic Resonance Imaging / Dura Mater / Healthy Volunteers / Humans / Image Interpretation, Computer-Assisted / Lumbosacral Plexus / Male / Predictive Value of Tests / Spinal Nerve Roots
Koichi Sairyo, Akihiro Nagamachi, Tetsuya Matsuura, Kousaku Higashino, Toshinori Sakai, Naoto Suzue, Daisuke Hamada, Yoichiro Takata, Tomohiro Goto, Toshihiko Nishisho, Yuichiro Goda, Takahiko Tsutsui, Ichiro Tonogai, Ryo Miyagi, Mitsunobu Abe, Masatoshi Morimoto, Kazuaki Mineta, Tetsuya Kimura, Akihiro Nitta, Tadahiro Higuchi, Shingo Hama, Jha C. Subash, Rui Takahashi and Shoji Fukuta : A review of the pathomechanism of forward slippage in pediatric spondylolysis : The Tokushima theory of growth plate slippage, The Journal of Medical Investigation : JMI, Vol.62, No.1,2, 11-18, 2015.
(Summary)
Spondylolysis is a stress fracture of the pars interarticularis, which in some cases progresses to spondylolisthesis (forward slippage of the vertebral body). This slip progression is prevalent in children and occurs very rarely after spinal maturation. The pathomechanism and predilection for children remains controversial despite considerable clinical and basic research into the disorder over the last three decades. Here we review the pathomechanism of spondylolytic spondylolisthesis in children and adolescents, and specifically the Tokushima theory of growth plate slippage developed from our extensive research findings. Clinically, we have observed the slippage site near the growth plate on MRI; then, using fresh cadaveric spines, we found the weakest link against forward shear loading was the growth plate. We subsequently developed an immature rat model showing forward slippage after growth plate injury. Moreover, finite element analysis of the pediatric spine clearly showed increased mechanical stress at the growth plate in the spondylolytic pediatric spine model compared with the intact pediatric spine. Thus, spondylolysis progresses to spondylolisthesis (forward slippage) in children and adolescents with the growth plate as the site of the slippage. Repetitive mechanical loading on to the growth plate may serve to separate the growth plate and subsequently progress to spondylolisthesis.
Jha C. Subash, Ichiro Tonogai, Yoichiro Takata, Toshinori Sakai, Kousaku Higashino, Tetsuya Matsuura, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Toshihiko Nishisho, Takahiko Tsutsui, Yuichiro Goda, Mitsunobu Abe, Kazuaki Mineta, Tetsuya Kimura, Akihiro Nitta, Shingo Hama, Tadahiro Higuchi, Shoji Fukuta and Koichi Sairyo : Percutaneous Endoscopic Lumbar Discectomy for a Huge Herniated Disc Causing Acute Cauda Equina Syndrome : A Case Report, The Journal of Medical Investigation : JMI, Vol.62, No.1,2, 100-102, 2015.
(Summary)
Microsurgery for lumbar disc herniation that requires surgical intervention has been well described. The methods vary from traditional open discectomy to minimally invasive techniques. All need adequate preanesthetic preparation of patients as general anesthesia is required for the procedure, and nerve monitoring is necessary to prevent iatrogenic nerve injury. Conventional surgical techniques sometimes require the removal of the corresponding lamina to assess the nerve root and herniated disc, and this may increase the risk for posterior instability of the vertebral body. Should this occur, fusion surgery may be needed, further increasing morbidity and cost. We present here a case of lumbar herniated disc fragments causing acute cauda equina syndrome that were endoscopically resected through a transforaminal approach in an awake patient under local anesthesia. Percutaneous endoscopic discectomy under local anesthesia proved to be a better alternative to open back surgery as it made immediate intervention possible, was associated with fewer perioperative complications and morbidity, minimized soft tissue damage, and allowed early rehabilitation with a better outcome and greater patient satisfaction. In addition to these advantages, percutaneous endoscopic discectomy protects other approaches that may be needed in subsequent surgeries, whether open or minimally invasive.
Toshihiko Nishisho, Naoyoshi Hanaoka, Ryo Miyagi, Toshinori Sakai, Shunichi Toki, Mitsuhiko Takahashi, Kenji Endo, Natsuo Yasui and Koichi Sairyo : Local administration of zoledronic Acid for giant cell tumor of bone., Orthopedics, Vol.38, No.1, e25-30, 2015.
(Summary)
Giant cell tumor of bone is a locally aggressive tumor with a high local recurrence rate. Several adjuvant therapies have been employed to reduce the recurrence rate, but their effectiveness remains controversial. The authors attempted local administration of zoledronic acid, a nitrogen-containing bisphosphonate that strongly inhibits bone resorption, as an adjuvant treatment for histologically proven giant cell tumor of bone in 5 patients at their institution. After biopsy, 4 patients were treated with local administration of zoledronic acid with artificial bone and 1 was treated with zoledronic acid without artificial bone. Histologic response to the treatment was evaluated with surgically resected specimens. The 4 patients treated with artificial bone showed local control, with histologic tumor necrosis rates of 90%, 90%, 50%, and 10%. Magnetic resonance imaging showed poor gadolinium enhancement, and histologic examination after local zoledronic acid treatment showed tumor necrosis. One patient without artificial bone showed no histologic tumor necrosis and had local recurrence in soft tissue 18 months after tumor resection. A 3-week waiting period between biopsy and zoledronic acid treatment appears reasonable from the histological study. Complication of this therapy was delayed wound healing and it occurred in 2 cases. Taken together, this case series suggests that local administration of zoledronic acid with artificial bone is a potential adjuvant therapy for giant cell tumor of bone. On the other hand, effective local administration of zoledronic acid requires some bone matrix, including artificial bone. Campanacci's grading is important for predicting the effect of local administration of zoledronic acid. [Orthopedics. 2015; 38(1):e25-e30.].
Athletes sometimes experience overuse injuries. To diagnose these injuries, ultrasonography is often more useful than plain radiography, computed tomography (CT), or magnetic resonance imaging (MRI). Ultrasonography can show both bone and soft tissue from various angles as needed, providing great detail in many cases. In conditions such as osteochondrosis or enthesopathies such as Osgood-Schlatter disease, Sinding-Larsen-Johansson disease, bipartite patella, osteochondritis dissecans of the knee, painful accessory navicular,and jumper's knee, ultrasonography can reveal certain types of bony irregularities or neovascularization of the surrounding tissue. In patients of enthesopathy, ultrasonography can show the degenerative changes at the insertion of the tendon. Given its usefulness in treatment, ultrasonography is expected to become essential in the management of overuse injuries affecting the lower limb in athletes. J. Med. Invest. 62: 109-113, August, 2015.
Mitsunobu Abe, Yoichiro Takata, Kousaku Higashino, Toshinori Sakai, Tetsuya Matsuura, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Toshihiko Nishisho, Yuichiro Goda, Takahiko Tsutsui, Ichiro Tonogai, Ryo Miyagi, Masatoshi Morimoto, Kazuaki Mineta, Tetsuya Kimura, Akihiro Nitta, Shingo Hama, Tadahiro Higuchi, Subash Jha C, Rui Takahashi, Shoji Fukuta and Koichi Sairyo : Foraminoplastic transforaminal percutaneous endoscopic discectomy at the lumbosacral junction under local anesthesia in an elite rugby player., The Journal of Medical Investigation : JMI, Vol.62, No.3-4, 238-241, 2015.
(Summary)
Percutaneous endoscopic discectomy (PED) is the least invasive disc surgery available at present. The procedure can be performed under local anesthesia and requires only an 8 mm skin incision. Furthermore, damage to the back muscle is considered minimal, which is particularly important for disc surgery in athletes. However, employing the transforaminal (TF) PED approach at the lumbosacral junction can be challenging due to anatomical constraints imposed by the iliac crest. In such cases, foraminoplasty is required in addition to the standard TF procedure. A 28-year-old man who was a very active rugby player visited us complaining of lower back and left leg pain. His visual analog scale (VAS) score for pain was 8/10 and 3/10, respectively. MRI revealed a herniated nucleus pulposus at L5-S level. TF-PED was planned; however, the anatomy of the iliac crest was later found to prevent access to the herniated mass. Foraminoplasty was therefore performed to enlarge the foramen, thereby allowing a cannula to be passed through the foramen into the canal without causing exiting nerve injury. The herniated mass was then successfully removed via the TF-PED procedure. Pain resolved after surgery, and his VAS score decreased to 0/10 for both back and leg pain. The patient returned to full rugby activity 8 weeks after surgery. In conclusion, even with an intracanalicular herniated mass at the lumbosacral junction, a TF-PED procedure is possible if additional foraminoplasty is adequately performed to enlarge the foramen. J. Med. Invest. 62: 238-241, August, 2015.
Yoichiro Takata, Toshinori Sakai, Kousaku Higashino, Tetsuya Matsuura, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Toshihiko Nishisho, Takahiko Tsutsui, Yuichiro Goda, Masatoshi Morimoto, Mitsunobu Abe, Kazuaki Mineta, Tetsuya Kimura, Akihiro Nitta, Shingo Hama, Tadahiro Higuchi, Subash Jha C, Rui Takahashi, Shoji Fukuta and Koichi Sairyo : State of the art: Intraoperative neuromonitoring in spinal deformity surgery., The Journal of Medical Investigation : JMI, Vol.62, No.3-4, 103-108, 2015.
(Summary)
Application of deformity correction spinal surgery has increased substantially over the past three decades in parallel with improvements in surgical techniques. Intraoperative neuromonitoring (IOM) techniques,including somatosensory evoked potentials (SEPs), muscle evoked potentials (MEPs), and spontaneous electromyography (free-run EMG), have also improved surgical outcome by reducing the risk of iatrogenic neural injury. In this article, we review IOM techniques and their applications in spinal deformity surgery. We also summarize results of selected studies including hundreds of spinal correction surgeries. These studies indicate that multimodal IOM of both motor and sensory responses is superior to either modality alone for reducing the incidence of neural injury during surgery. J. Med. Invest. 62: 103-108, August, 2015.
Kazuaki Mineta, Kousaku Higashino, Toshinori Sakai, Yoshihiro Fukui and Koichi Sairyo : Recurrence of type I Modic inflammatory changes in the lumbar spine: effectiveness of intradiscal therapy., Skeletal Radiology, Vol.43, No.11, 1645-1649, 2014.
(Summary)
Here we report a case of recurrence of Modic type I inflammatory changes in the lumbar spine. A 49-year-old man was referred to our department with a history of chronic low back pain of at least 20 years. At the first consultation, he complained of low back pain only and had no other symptoms such as leg pain, numbness, or weakness. Although his pain was typically mild, he experienced one or two episodes of severe and incapacitating low back pain a year. After two intradiscal steroid injections, his pain disappeared immediately and completely. After 6 months of conservative treatment, Modic type I change switched to Modic type II change. However, 12 months after the first treatment, he once again experienced severe low back pain. Follow-up magnetic resonance imaging (MRI) indicated recurrence of Modic type I change that was stronger than the first occurrence. Two intradiscal injections relieved the pain. Six months after the second episode, follow-up MRI showed another switch of Modic type I change to Modic type II change. Switches of Modic change have been controversial, with mixed findings on pain, natural history, and degenerative changes. The present case reinforces the notion that Modic type I change corresponds to reversible local inflammation.
Fumitake Tezuka, Toshinori Sakai, Ryo Miyagi, Yoichiro Takata, Kousaku Higashino, Shinsuke Katoh, Koichi Sairyo and Natsuo Yasui : Complete resolution of a case of calcific tendinitis of the longus colli with conservative treatment., Asian Spine Journal, Vol.8, No.5, 675-679, 2014.
(Summary)
Acute calcific tendinitis of the longuscolli is a self-limiting inflammatory condition caused by calcium hydroxyapatite deposition in the longuscolli tendon. Although several case reports have described its radiological presentation, few reports provide detailed chronological accounts through symptomatic and radiologic resolution. A 59-year-old woman presented with severe neck pain and stiffness of a few days duration as well as moderate discomfort when swallowing. Lateral radiographs revealed a large calcium deposit anterior to the C1.C2 joint and swelling of the prevertebral soft tissue from C1 to C5. CT and magnetic resonance imaging showed fluid in the retropharyngeal gap.A soft collar and non-steroidal anti-inflammatory drug were prescribed, without antibiotics. At 4 months after presentation, the calcium deposit and all symptoms had resolved completely. Although this disease is comparatively rare, physicians should keep it in mind when a patient presents with acute severe neck pain.
Yuichiro Goda, Toshinori Sakai, Tadanori Sakamaki, Yoichiro Takata, Kousaku Higashino and Koichi Sairyo : Analysis of MRI signal changes in the adjacent pedicle of adolescent patients with fresh lumbar spondylolysis., European Spine Journal, Vol.23, No.9, 1892-1895, 2014.
(Summary)
MRI revealed a higher prevalence of L3 or L4 spondylolysis than observed with CT.
Yoichiro Takata, Toshinori Sakai, Kousaku Higashino, Yuichiro Goda, Kazuaki Mineta, Kosuke Sugiura and Koichi Sairyo : Minimally Invasive Microendoscopic Resection of the Transverse Process for Treatment of Low Back Pain with Bertolotti's Syndrome., Case Reports in Orthopedics, Vol.2014, 613971, 2014.
(Summary)
Bertolotti's syndrome is characterized by anomalous enlargement of the transverse process of the most caudal lumbar segment, causing chronic and persistent low back pain or sciatica. We describe the case of a 45-year-old woman who presented with left sciatic pain and low back pain due to a recurrent lumbar disc herniation at L4-5 with Bertolotti's syndrome. Selective L5 nerve root block and local injection of lidocaine into the articulation between the transverse process and sacral ala temporarily relieved the left sciatic pain and low back pain, respectively. To confirm the effect of local injection on low back pain, we gave a second local injection, which once again relieved the low back pain. Microendoscopic resection of the pseudoarticulation region and discectomy successfully relieved all symptoms. This report illustrates the effectiveness of minimally invasive resection of the transverse process for the treatment of low back pain with Bertolotti's syndrome.
Yoichiro Takata, Toshinori Sakai, Kousaku Higashino, Yuichiro Goda, Fumitake Tezuka and Koichi Sairyo : Intradural extramedullary capillary hemangioma in the upper thoracic spine: a review of the literature., Case Reports in Orthopedics, Vol.2014, 604131, 2014.
(Summary)
Capillary hemangiomas are benign tumors found in the skin and soft tissues in younger people. They occur in the central nervous system only rarely, and intradural occurrence is extremely rare. We report here a 60-year-old man presenting with thoracic girdle pain and progressive gait disturbance. Magnetic resonance images of the thoracic spine showed a 12 × 8 × 20 mm, well-defined intradural mass at the T2 level, compressing the spinal cord laterally. Relative to the spinal cord, the mass was hypo- to isointense on T1-weighted images and relatively hyperintense on T2-weighted images, with strong enhancement on contrast-enhanced T1-weighted images. The patient underwent T1-2 hemilaminectomy with resection of the intradural extramedullary tumor, which showed characteristics of a capillary hemangioma on histologic examination. The patient's symptoms improved following the surgery and no clinical or radiological evidence of recurrence was noted at the 2-year follow-up. We present this case with a review of the literature, highlighting features for differential diagnosis.
Kosuke Sugiura, Ichiro Tonogai, Tetsuya Matsuura, Kousaku Higashino, Toshinori Sakai, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Yoichiro Takata, Toshihiko Nishisho, Yuichiro Goda, Ryosuke Sato, Kenji Kondo, Fumitake Tezuka, Kazuaki Mineta, Makoto Takeuchi, Mitsuhiko Takahashi, Hiroshi Egawa and Koichi Sairyo : Discoscopic findings of high signal intensity zones on magnetic resonance imaging of lumbar intervertebral discs., Case Reports in Orthopedics, Vol.2014, 245952, 2014.
(Summary)
A 32-year-old man underwent radiofrequency thermal annuloplasty (TA) with percutaneous endoscopic discectomy (PED) under local anesthesia for chronic low back pain. His diagnosis was discogenic pain with a high signal intensity zone (HIZ) in the posterior corner of the L4-5 disc. Flexion pain was sporadic, and steroid injection was given twice for severe pain. After the third episode of strong pain, PED and TA were conducted. The discoscope was inserted into the posterior annulus and revealed a migrated white nucleus pulposus which was stained blue. Then, after moving the discoscope to the site of the HIZ, a migrated slightly red nucleus pulposus was found, suggesting inflammation and/or new vessels penetrating the mass. After removing the fragment, the HIZ site was ablated by TA. To our knowledge, this is the first report of the discoscopic findings of HIZ of the lumbar intervertebral disc.
Mitsuhiko Takahashi, Toshinori Sakai, Koichi Sairyo, Shoichiro Takao, S Mima and Natsuo Yasui : Magnetic resonance imaging in adolescent symptomatic navicular tuberosity., The Journal of Medical Investigation : JMI, Vol.61, No.1-2, 22-27, 2014.
(Summary)
The accessory navicular bone is one of the most common accessory ossicles, which sometimes become symptomatic. Abnormalities in magnetic resonance (MR) image, e. g. edema-like bone marrow pattern, have been reported for symptomatic accessory navicular. However, it has not been completely understood the edema-like bone marrow pattern correlates to the symptom of navicular tuberosity. We investigated the edema-like bone marrow pattern in correlation with alleviation of the symptom and the presence of accessory navicular bone. Ten adolescents with pain localized to the navicular tuberosity were recruited and seven cases were further examined with consecutive MR images. Edema-like bone marrow pattern was found in all symptomatic navicular but not in asymptomatic navicular. Intensity of the pattern diminished with alleviation of the symptom. Moreover, this correlation was recognized even in the patients who had no accessory navicular bones. MR images could be used not only for diagnosis but for monitor of healing in adolescent symptomatic navicular. There may be different pathologic mechanism for adolescent symptomatic navicular tuberosity, such as an osteitis, in adolescents.
(Keyword)
accessory navicular / magnetic resonance image / edema-like bone marrow pattern / adolescents
Toshinori Sakai, Ryo Miyagi, Eiko Yamabe, Yasunari Fujinaga, Nitin Bhatia N and Hiroshi Yoshioka : Diffusion-weighted imaging and diffusion tensor imaging of asymptomatic lumbar disc herniation., The Journal of Medical Investigation : JMI, Vol.61, No.1-2, 197-203, 2014.
(Summary)
Diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) were performed on a healthy 31-year-old man with asymptomatic lumbar disc herniation. Although the left S1 nerve root was obviously entrapped by a herniated mass, neither DWI nor DTI showed any significant findings for the nerve root. Decreased apparent diffusion coefficient (ADC) values and increased fractional anisotropy (FA) values were found. These results are contrary to those in previously published studies of symptomatic patients, in which a combination of increased ADC and decreased FA seem to have a relationship with nerve injury and subsequent symptoms, such as leg pain or palsy. Our results seen in an asymptomatic subject suggest that the compressed nerve with no injury, such as edema, demyelination, or persistent axonal injury, may be indicated by a combination of decreased ADC and increased FA. ADC and FA could therefore be potential tools to elucidate the pathomechanism of radiculopathy.
Yoichiro Takata, Toshinori Sakai, F Tezuka, Yuichiro Goda, Kousaku Higashino and Koichi Sairyo : Clinical Outcome of Minimally Invasive Repair of Pars Defect Using Percutaneous Pedicle Screws and Hook-Rod System in Adults with Lumbar Spondylolysis., Ann Orthop Rheumatol, Vol.2, No.2, 1013, 2014.
121.
Fumitake Tezuka, Toshinori Sakai, Yoichiro Takata, Kousaku Higashino and Koichi Sairyo : Multi-level spondylolisthesis required transdiscal screws due to the rare vertebral deformities.A case report., Ann Orthop Rheumatol, Vol.2, No.1, 1012, 2014.
122.
K Mineta, Yuichiro Goda, Toshinori Sakai, Yoichiro Takata, Kousaku Higashino, Shinsuke Katoh, H Uraoka, M Takahashi and Koichi Sairyo : Late-onset Non-dysraphic Intradural Spinal Cord Lipoma: A Case Report and Literature Review., Ann Orthop Rheumatol, Vol.2, No.1, 1008, 2014.
123.
Koichi Sairyo, Hiroshi Egawa, Tetsuya Matsuura, Mitsuhiko Takahashi, Kousaku Higashino, Toshinori Sakai, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Yoichiro Takata, Toshihiko Nishisho, Yuichiro Goda, Ryosuke Sato, Takahiko Tsutsui, Ichiro Tonogai, Kenji Kondo, Fumitake Tezuka, Kazuaki Mineta, Kosuke Sugiura, Makoto Takeuchi and Akira Dezawa : State of the Art: Transforaminal Approach for Percutaneous Endoscopic Lumbar Discectomy under Local Anesthesia., The Journal of Medical Investigation : JMI, Vol.61, No.3-4, 217-225, 2014.
(Summary)
Minimally invasive percutaneous endoscopic discectomy (PED) with a transforaminal approach under local anesthesia was started in the late 20th century. As the procedure requires a skin incision of only 8 mm, it is the least invasive disc surgery procedure at present, and owing to advances in instruments and optics, the use of this technique has gradually spread. In Japan, Dr. Dezawa from Teikyo University Mizonokuchi Hospital introduced this technique in 2003. Thanks to his efforts, the number of surgeons who can perform PED has increased, although the number of active PED surgeons is still only around 20. The first author (K.S.) started PED in 2010. In this review article, we explain the state-of-the-art PED transforaminal technique for minimally invasive disc surgery and present three successful cases. J. Med. Invest. 61: 217-225, August, 2014.
Tomohiro Goto, Daisuke Hamada, Kazuaki Mineta, Ichiro Tonogai, Hiroshi Egawa, Tetsuya Matsuura, Mitsuhiko Takahashi, Kousaku Higashino, Toshinori Sakai, Naoto Suzue, Yoichiro Takata, Toshihiko Nishisho, Yuichiro Goda, Ryosuke Sato, Fumitake Tezuka, Kenji Kondo, Makoto Takeuchi, Kousuke Sugiura and Koichi Sairyo : The state of the art in arthroscopic hip surgery., The Journal of Medical Investigation : JMI, Vol.61, No.3-4, 226-232, 2014.
(Summary)
Hip arthroscopy is among the most rapidly evolving arthroscopic techniques in the last decade and offers the benefits of being both a minimally invasive procedure and an excellent diagnostic tool. Improvements in instrumentation and surgical skills have advanced our ability to accurately diagnose and treat various conditions of the hip joint, and hip arthroscopy has elucidated several pathologies that cause disabling symptoms. Many of these conditions were previously unrecognized and left untreated. The indications for hip arthroscopy include the management of early osteoarthritis, synovial disorders (e. g., synovial osteochondromatosis), labral tears, chondral lesions, and femoroacetabular impingement (FAI), which is increasingly recognized as a disorder that can lead to the development of early cartilage and labral injury. A better understanding of hip arthroscopy, including the anatomy, improved surgical techniques, indications, and complications of the procedure, is essential for its success. This review article discusses the state of the art of arthroscopic hip surgery. J. Med. Invest. 61: 226-232, August, 2014.
Tetsuya Matsuura, Hiroshi Egawa, Mitsuhiko Takahashi, Kousaku Higashino, Toshinori Sakai, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Yoichiro Takata, Toshihiko Nishisho, Yuichiro Goda, Ryosuke Sato, Ichiro Tonogai, Kenji Kondo, Fumitake Tezuka, Kazuaki Mineta, Kosuke Sugiura, Makoto Takeuchi and Koichi Sairyo : State of the art: elbow arthroscopy: review of the literature and application for osteochondritis dissecans of the capitellum., The Journal of Medical Investigation : JMI, Vol.61, No.3-4, 233-240, 2014.
(Summary)
Elbow arthroscopy has become a safe and effective treatment option for a number of elbow disorders. The most rewarding and successful indication is the removal of loose bodies. Loose bodies are often a result of osteochondritis dissecans (OCD) of the capitellum, and arthroscopy in this case is useful for performing debridement, thereby eliminating the need for a more extensive open procedure associated with complications. In this review, we describe our arthroscopic technique for OCD of the capitellum. We usually conduct arthroscopy in the supine position, and use 2.9-mm arthroscopes of 30° and 70°. The 70° arthroscope provides a greater operative field than the 30° arthroscope. Arthroscopic treatment for OCD may require 2 anterior and 2 posterior portals. Loose bodies are commonly found in the radial fossa, coronoid fossa, and in the olecranon fossa. Once the loose bodies are removed, all unstable cartilage of the capitellum lesion is removed to create a stable bed. If any sclerotic changes to the lesion bed are observed, we create microfractures in the lesion bed. The most significant complication in arthroplasty is neurovascular injury. However, we have never experienced this devastating complication, which can be avoided by paying careful attention to detail. J. Med. Invest. 61: 233-240, August, 2014.
Koichi Sairyo, Tetsuya Matsuura, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Yuichiro Goda, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Toshihiko Nishisho, Ryosuke Sato, Takahiko Tsutsui, Ichiro Tonogai and Kazuaki Mineta : Surgery Related Complications in Percutaneous Endoscopic Lumbar Discectomy under Local Anesthesia., The Journal of Medical Investigation : JMI, Vol.61, No.3-4, 264-269, 2014.
(Summary)
The minimally invasive percutaneous endoscopic discectomy (PED) as the postero-lateral approach with the local anesthesia was started in the late 20th century. The procedure only requires 8 mm of skin incision; thus, it is the least invasive disc surgery presently. The surgery related complications were reviewed in the initial 100 cases from the single surgeon (K. S., first author). Two cases showed exiting nerve irritation, and complained of leg paresthetic pain for 6 to 12 weeks after the surgery (2.0%). The symptoms got better with medicines. One showed post-surgical epidural hematoma, and required surgical removal of the mass (1.0%). Two cases complained neck pain during surgery (2.0%). Surgeons would be aware of the specific complications for the postero-lateral approach of PED procedure. J. Med. Invest. 61: 264-269, August, 2014.
Yoichiro Takata, Tetsuya Matsuura, Kousaku Higashino, Toshinori Sakai, Takuya Mishiro, Naoto Suzue, Hirofumi Kosaka, Daisuke Hamada, Tomohiro Goto, Toshihiko Nishisho, Yuichiro Goda, Ryosuke Sato, Takahiko Tsutsui, Ichiro Tonogai, Fumitake Tezuka, Kazuaki Mineta, Tetsuya Kimura, Akihiro Nitta, Tadahiro Higuchi, Shingo Hama and Koichi Sairyo : Hybrid technique of cortical bone trajectory and pedicle screwing for minimally invasive spine reconstruction surgery: A technical note., The Journal of Medical Investigation : JMI, Vol.61, No.3-4, 388-392, 2014.
(Summary)
The pedicle screw (PS) system is widely used for spinal reconstruction. Recently, screw insertion using the cortical bone trajectory (CBT) technique has been reported to provide increased holding strength of the vertebra, even in an osteoporotic spine. CBT is also beneficial due to its low invasiveness. We have been performing hybrid reconstruction with CBT at the cranial level and PS at the caudal level based on the concept of minimal invasiveness. We applied this hybrid technique to 6 cases of degenerative spondylolisthesis. Surgery was completed with a small skin incision of around 5-6 cm, which is shorter than that of the conventional PS procedure. The mean percent slippage before surgery was 19.8%, and this was reduced to 3.9% after surgery and almost maintained 3 months after surgery. Furthermore, no major surgical complications were observed. Here, we introduce the minimally invasive hybrid technique of CBT-PS. Surgeons should be aware of the procedure as an option for minimally invasive lumbar spine reconstructive surgery. J. Med. Invest. 61: 388-392, August, 2014.
Makoto Takeuchi, Naoto Suzue, Tetsuya Matsuura, Kousaku Higashino, Toshinori Sakai, Daisuke Hamada, Tomohiro Goto, Yoichiro Takata, Toshihiko Nishisho, Yuichiro Goda, Ryosuke Sato, Ichiro Tonogai, Kazuaki Mineta and Koichi Sairyo : Reconstruction of chronic Achilles tendon rupture using the semitendinosus tendon: a case report., The Journal of Medical Investigation : JMI, Vol.61, No.3-4, 417-420, 2014.
(Summary)
Achilles tendon rupture is a common trauma requiring surgical management. For chronic Achilles tendon rupture in particular, reconstructive surgery is desirable and several methods have been described. Here we present a case of chronic Achilles tendon rupture reconstructed using the semitendinosus tendon because of the difficulty in pulling down the proximal stump to reach the distal stump and due to an insufficient margin for hooking a suture to the distal stump. Postoperatively, the patient had a fully functional tendon and resumed his normal activities of daily living. Using this surgical technique, we expect favorable outcomes in cases of Achilles tendon rupture. J. Med. Invest. 61: 417-420, August, 2014.
Ichiro Tonogai, Toshinori Sakai, Fumitake Tezuka, Yuichiro Goda, Yoichiro Takata, Kousaku Higashino and Koichi Sairyo : Spontaneous rupture and hemorrhage of myxopapillary ependymoma of the filum terminale: a case report and literature review., The Journal of Medical Investigation : JMI, Vol.61, No.3-4, 430-435, 2014.
(Summary)
We present a rare case of acute onset cauda equina syndrome caused by a ruptured myxopapillary ependymoma with accompanying hemorrhage. A 26-year-old healthy woman developed muscle weakness and sensory disturbances in her bilateral lower extremities. Magnetic resonance imaging showed a huge mass from the L1 body to the L2-3 disc level. She was able to ambulate with crutches after the tumor was successfully removed. To prevent recurrence, she received whole brain and spinal cord radiation. No sing of recurrence were detected at the 8 month follow up. J. Med. Invest. 61: 430-435, August, 2014.
Kazuaki Mineta, Tomohiro Goto, Daisuke Hamada, Takahiko Tsutsui, Ichiro Tonogai, Naoto Suzue, Tetsuya Matsuura, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Toshihiko Nishisho, Ryousuke Sato, Yuichiro Goda, Tadahiro Higuchi, Shingo Hama, Tetsuya Kimura, Akihiro Nitta and Koichi Sairyo : Efficacy of hip arthroscopy in the diagnosis and treatment of synovial osteochondromatosis: a case report and literature review., The Journal of Medical Investigation : JMI, Vol.61, No.3-4, 436-441, 2014.
(Summary)
Here we report a rare case of synovial osteochondromatosis of the hip and provide a brief review of the literature. A 37-year-old woman was referred to our department with a 3-year history of right hip pain. At initial consultation, she complained of pain upon standing and when sitting down, occasional pain at rest and nocturnal pain in the right hip, and worsening of the pain at premenstruum. The range of motion of the affected hip was totally limited by pain. Plain radiography revealed a slightly calcified (or ossified) lesion at the acetabular fossa of the right hip. Computed tomography showed clusters of loose bodies filling the acetabular fossa. Synovial osteochondromatosis was suspected and she underwent hip arthroscopic surgery. Complete resection was performed using the lateral and anterior portals. Postoperatively, her symptoms disappeared entirely and she was discharged 4 days after surgery. The patient regained full range of motion of the right hip and follow-up CT revealed no remaining loose bodies in the right hip. Hip arthroscopy is considered to be effective for the diagnosis and treatment of synovial osteochondromatosis of the hip and is minimally invasive. J. Med. Invest. 61: 436-441, August, 2014.
Ryo Miyagi, Koichi Sairyo, Toshinori Sakai, Fumitake Tezuka, Yasuhiro Kitagawa and Akira Dezawa : Persistent tight hamstrings following conservative treatment for apophyseal ring fracture in adolescent athletes: critical appraisal., The Journal of Medical Investigation : JMI, Vol.61, No.3-4, 446-451, 2014.
(Summary)
Apophyseal ring fracture is a unique disease in children and adolescents. Its clinical features include low back pain, sciatica, paravertebral muscle spasm and tenderness, restricted back motion, neurological symptoms, and tight hamstrings. For all athletes, body flexibility is one of the most important factors for better performance. Therefore, persistent tight hamstrings has a negative influence on athletic performance. In this report, we present two adolescent athletes with apophyseal ring fracture treated successfully by conservative treatment for severe low back pain (LBP) and leg pain, despite having persistent tight hamstrings for more than one year. Unlike herniated nucleus pulposus, bony fragments in the spinal canal never disappear. Although conservative treatment can alleviate LBP and leg pain, surgical removal of fragments is considered when symptoms such as tight hamstrings and restricted lumbar motion due to canal stenosis are found, particularly in athletes. J. Med. Invest. 61: 446-451, August, 2014.
J Hopkins, Toshinori Sakai, Koichi Sairyo, J Mefford, NN Bhatia, Ichiro Tonogai, Akira Dezawa and Natsuo Yasui : Endoscope Assisted Excision of a Juxtafacet Cyst in an Adolescent Athlete: A Case Report., Journal of Neurological Surgery. Part A, Central European Neurosurgery, Vol.74, No.Suppl 1, e66-e69, 2013.
(Summary)
Juxtafacet cysts (JFCs) are a cause of back and radicular pain that can be treated conservatively and operatively. Such strategies include lumbosacral brace, epidural injection, open surgery, and minimally invasive surgery; although surgical treatment is usually reserved for unsuccessful conservative treatment. The role of minimally invasive surgery in athletic youth with JFCs has yet to be determined. The patient is a 16-year-old basketball player with a JFC. We performed endoscope-assisted cystectomy. Endoscope-assisted JFC excision immediately and completely resolved the patient's lower back and leg pain with no recurrence of symptoms 4 years after surgery. We suggest that JFCs of the lumbar spine be a part of the differential diagnosis in young patients with back and radicular pain. Furthermore, we recommend that endoscope-assisted surgery be employed in the treatment of JFCs in young athletes.
(Keyword)
Adolescent / Basketball / Cystectomy / Cysts / Endoscopy / Humans / Low Back Pain / Magnetic Resonance Imaging / Male / Pain / Recovery of Function / Surgical Procedures, Minimally Invasive / Treatment Outcome / Zygapophyseal Joint
Eiko Yamabe, Arash Anavim, Toshinori Sakai, Ryo Miyagi, Toshiyasu Nakamura, Dave Hitt and Hiroshi Yoshioka : Comparison between high-resolution isotropic three-dimensional and high-resolution conventional two-dimensional FSE MR images of the wrist at 3 tesla: a pilot study., Journal of Magnetic Resonance Imaging : JMRI, Vol.40, No.3, 603-608, 2013.
(Summary)
With regard to clinical applications, 3D MRI of the wrist has almost equal potential to 2D MRI.
Yasunari Fujinaga, Hiroshi Yoshioka, Toshinori Sakai, Yoko Sakai, Felipe Souza and Philipp Lang : Quantitative measurement of femoral condyle cartilage in the knee by MRI: validation study by multireaders., Journal of Magnetic Resonance Imaging : JMRI, Vol.39, No.4, 972-977, 2013.
(Summary)
Inter- and intraobserver reproducibility of cartilage segmentation using semiautomated software was validated. Although there was no statistical significance, there was a tendency of under- or overestimating CV by each sequence.
(Keyword)
Aged / Aged, 80 and over / Cartilage, Articular / Female / Femur / Humans / Image Enhancement / Image Interpretation, Computer-Assisted / Knee Joint / Magnetic Resonance Imaging / Male / Middle Aged / Observer Variation / Osteoarthritis, Knee / Pattern Recognition, Automated / Reproducibility of Results / Sensitivity and Specificity
Atsuhisa Yamada, Koichi Sairyo, Isao Shibuya, Ko Kato, Akira Dezawa and Toshinori Sakai : Lumbar spondylolysis in juveniles from the same family: a report of three cases and a review of the literature., Case Reports in Orthopedics, 2013.
(Summary)
Spondylolysis is reported as a stress fracture of the pars interarticularis with a strong hereditary basis. Three cases of lumbar spondylolysis in juveniles from the same family are reported, and the genetics of the condition are reviewed. The first boy, a 13-year-old soccer player, was diagnosed with terminal stage L5 bilateral spondylolysis with grade 1 slippage. The second boy, a 10-year-old baseball player, had terminal stage right side unilateral spondylolysis. The third boy, also a 10-year-old baseball player, was diagnosed with early stage bilateral L5 spondylolysis. The second and third boys are identical twins, and all three cases exhibited concomitant spina bifida occulta. Lumbar spondylolysis has a strong hereditary basis and is reported to be an autosomal dominant condition.
Koichi Sairyo, Takeshi Kawamura, Yasuyoshi Mase, Yasushi Hada, Toshinori Sakai, Kiyotaka Hasebe and Akira Dezawa : Jack-knife stretching promotes flexibility of tight hamstrings after 4 weeks: a pilot study., European Journal of Orthopaedic Surgery & Traumatology, Vol.23, No.6, 657-663, 2013.
(Summary)
Tight hamstrings are reported to be one of the causes of low back pain. However, there have been few reports on effective stretching procedures for the tight hamstrings. The so-called jack-knife stretch, an active-static type of stretching, can efficiently increase the flexibility of tight hamstrings. To evaluate hamstring tightness before and after the 4-week stretching protocol in healthy volunteer adults and patients aged under 18 years with low back pain. For understanding the hamstrings tightness, we measured two parameters including (1) finger to floor distance (FFD) and (2) pelvis forward inclination angle (PFIA). Eight healthy adult volunteers who had no lumbar or hip problems participated in this study (mean age: 26.8 years). All lacked flexibility and their FFD were positive before the experiment. Subjects performed 2 sets of the jack-knife stretch every day for 4 weeks. One set consisted of 5 repetitions, each held for 5 s. Before and during the 4-week experiment, the FFD and PFIA of toe-touching tests were measured weekly. For 17 of the sports players aged under 18, only FFD was measured. In adult volunteers, FFD was 14.1 ± 6.1 cm before the experiment and decreased to -8.1 ± 3.7 cm by the end of week 4, indicating a gain in flexibility of 22.2 cm. PFIA was 50.6 ± 8.2 before the experiment and 83.8 ± 5.8 degrees after. Before and after the experiment, the differences were significant (p < 0.05). For those aged under 18, FFD was 8.1 ± 8.0 and -9.6 ± 6.8, before and after the stretching, respectively. This difference was significant (p < 0.05). The jack-knife stretch is a useful active-static stretching technique to efficiently increase flexibility of tight hamstrings.
Takashi Chikawa, Toshinori Sakai, N Nitin Bhatia, Ryo Miyagi, Koichi Sairyo, Yuichiro Goda, Masaru Nakamura, Shunji Nakano, Takeaki Shimakawa and Akira Minato : Clinical outcomes of spinal surgery in patients treated with hemodialysis., Journal of Spinal Disorders & Techniques, Vol.26, No.6, 321-324, 2013.
(Summary)
Even in patients treated with long-term HD, spinal surgeries reliably obtain neurological and functional improvement if surgeons judge the preoperative inclusion criteria correctly. However, if surgeries are necessary for these patients, surgeons should consider the patients' comorbidity-related survival rate after the spinal surgeries.
Toshinori Sakai, Koichi Sairyo, Yasuyoshi Mase and Akira Dezawa : Synchronic multiple stress fractures of L5 left hemilamina:a case of an unusual type of lumbar spondylolysis, European Journal of Orthopaedic Surgery & Traumatology, Vol.22 (Suppl 1), S41-S43, 2012.
Ryou Miyagi, Koichi Sairyo, Toshinori Sakai, H Yoshioka and Natsuo Yasui : Two types of laminolysis in adolescent athletes., Journal of Orthopaedics and Traumatology, Vol.13, No.4, 225-228, 2012.
(Summary)
Bony defects in the spine are divided into three main types: spondylolysis, pediculolysis, and laminolysis. Lumbar spondylolysis is a well-known stress fracture that occurs frequently in adolescent athletes. Pediculolysis means stress fracture of the pedicle, which sometimes occurs subsequent to unilateral spondylolysis. Laminolysis is a rarely reported stress fracture similar to spondylolysis and pediculolysis that sometimes causes low back pain (LBP). However, its pathomechanism has not been elucidated. Recently, we encountered four adolescent athletes with symptomatic laminolysis. Mean age was 15.8 (range 15-17) years. All subjects reported severe LBP exacerbated by extension of the lumbar spine, and radiology revealed two types of laminolysis: hemilaminar type and intralaminar type. To elucidate the mechanisms of each type, we reviewed a biomechanical study, and found that the hemilaminar type was thought to be subsequent to contralateral spondylolysis, while the intralaminar type might be a result of a stress fracture due to repetitive extension loading.
Ramez N. Eskander, Leslie M. Randall, Toshinori Sakai, Yi Guo, Bang Hoang and Xiaolin Zi : Flavokawain B, a novel, naturally occurring chalcone, exhibits robust apoptotic effects and induces G2/M arrest of a uterine leiomyosarcoma cell line., The Journal of Obstetrics and Gynaecology Research, Vol.38, No.8, 1086-1094, 2012.
(Summary)
To examine the effects of flavokawain B (FKB), a novel kava chalcone, on the growth of uterine leiomyosarcoma (LMS) cells and investigated its utility in the treatment of uterine LMS. Uterine leiomyosarcoma (SK-LMS-1), endometrial adenocarcinoma (ECC-1) and the non-malignant, human endometrium fibroblast-like (T-HESC) cell lines were cultured and treated with different concentrations of FKB. Cell viability was determined by MTT assays and the IC(50) was estimated. Fluorescent-activated cell sorting (FACS) analysis of apoptosis and cell cycle was performed. Real-time reverse-transcription polymerase chain reaction and western blot analysis were utilized to evaluate differences in the expression of apoptotic markers. FKB preferentially inhibited the growth of SK-LMS-1 and ECC-1 cells compared to T-HESC control cells. FKB significantly increased both early and late apoptosis in SK-LMS-1 and ECC-1 cells relative to control. Cell cycle analysis illustrated an increase in the G2/M fraction in treated cell lines relative to control. Furthermore, FKB induced the expression of pro-apoptotic death receptor 5 (DR5), Bim, and Puma, and decreased expression of an inhibitor of apoptosis, survivin. FKB also acted synergistically when combined with docetaxel and gemcitabine (combination index = 0.260). FKB treatment results in cell cycle arrest and a robust induction of apoptosis in SK-LMS-1 and ECC-1 cell lines. This natural product deserved further investigation as a potential therapeutic agent in the treatment of uterine LMS.
Koichi Sairyo, Toshinori Sakai, Natsuo Yasui and Dezawa Akira : Conservative treatment for pediatric lumbar spondylolysis to achieve bone healing using a hard brace: what type and how long?, Journal of Neurosurgery. Spine, Vol.16, No.6, 610-614, 2012.
(Summary)
Various kinds of trunk braces have been used to achieve bone healing in cases of pediatric lumbar spondylolysis. However, the optimal brace for achieving bone healing is unclear. The purpose of the present study was to determine in what types of spondylolysis bone healing can be achieved and how long it takes. In this prospective study, 63 pars interarticularis defects (spondylolysis) among 37 patients who were younger than 18 years (mean 13.5 ± 2.7 years) were treated using a hard brace. The youngest patient was 8 years old. Based on the results of CT scanning, the lyses were classified into 3 categories: early, progressive, and terminal defects. Progressive defects were further divided into 2 types according to STIR MRI findings: those with high signal intensity at the adjacent pedicle and those with low signal intensity (that is, a normal appearance). A hard brace, such as a molded plastic thoracolumbosacral orthosis, was used to immobilize the trunk. Approximately every 3 months, CT scanning was performed to evaluate bone healing until approximately 6 months. The union rates were 94%, 64%, 27%, and 0% for the early, progressive with high signal intensity, progressive with low signal intensity, and terminal defects, respectively. It was noted that no terminal defect was healed using conservative treatment. The mean time to healing among the defects that showed bone healing was 3.2, 5.4, and 5.7 months for the early, progressive with high signal intensity, and progressive with low signal intensity groups, respectively. Patients with early-stage defects are the best candidates for conservative treatment with a hard brace because more than 90% of such cases can be healed in 3 months.
Toshinori Sakai, Koichi Sairyo, Bhatia N. Nitin, Miyagi Ryo, Tamura Tatsuya, Shinsuke Katoh and Natsuo Yasui : MRI Changes of the Spinal Subdural Space after Lumbar Spine Surgeries: Report of Two Cases., Asian Spine Journal, Vol.5, No.4, 262-266, 2011.
(Summary)
Although magnetic resonance imaging (MRI) is frequently used to assess the lumbar spine, there are few reports in the medical literature that have evaluated using MRI immediately following spinal surgery. Furthermore, descriptions of the subdural changes after lumbar spine surgery are also infrequent. In this paper, we present two cases with subdural change seen on MRI immediately after lumbar surgery. Both the patients had mild symptoms that resolved spontaneously, and the follow-up MRI scans showed resolution of the subdural changes. Subdural changes should be considered as one of the possible causes of unexpected symptoms in patients following lumbar spinal surgery.
Chikawa Takashi, Toshinori Sakai, Bhatia N. Nitin, Koichi Sairyo, Utsunomiya Risa, Nakamura Masaru, Shunji Nakano, Shimakawa Takeaki and Minato Akira : Retrospective Study of Deep Surgical Site Infections Following Spinal Surgery and the Effectiveness of Continuous Irrigation., British Journal of Neurosurgery, Vol.25, No.5, 621-624, 2011.
(Summary)
Surgical site infection (SSI) is an unfortunate and unpreventable complication of any surgical intervention including spinal surgery. Early deep SSI (EDSSI) after instrumented spinal fusion are particularly difficult to manage due to the implanted, and possibly infected, instrumentation. The purpose of this study is to retrospectively review patients who underwent spinal surgery, investigate the rate of EDSSI, identify patient-related and surgery-related risk factors and to assess the effectiveness of continuous indwelling irrigation on the eradication of these infections. A total of 814 patients (319 women and 495 men) who underwent spinal surgery were enrolled. Mean age at the initial surgery was 57.4 years old. Infections that penetrated the deep fascia within 1 month after the initial operation were considered as EDSSI. The rate of EDSSI, causal organisms, infection management and resolution were studied. Furthermore, we examined the patient-related and the operation-related risk factors. An overall incidence of EDSSI of 1.1% was found. In 177 patients with diabetes mellitus (DM), two patients (1.1%) developed EDSSI. In 28 patients receiving chronic haemodialysis (HD), two patients with infections (7.1%) were identified, which was statistically significantly greater than the other patient populations. Both operative time and intraoperative blood loss were significantly greater in patients with EDSSI than in non-infected patients. Furthermore, the rate of EDSSI in patients undergoing instrumented spinal fusion (3.8%) was significantly higher than that in the other patients. In the nine patients who developed EDSSI, the causal organisms were identified and treated by surgical debridement, antibiotic therapy and continuous indwelling surgical site irrigation. All infections resolved, and no recurrence has been observed at final follow-up. Removal of the instrumentation was required in only one patient. Based on our results, we believe that continuous surgical site irrigation is an effective adjunct in the surgical treatment for early SSI following spinal surgery.
Ryo Miyagi, Koichi Sairyo, Toshinori Sakai and Akira Dezawa : A remarkable case of hypertrophic pseudoarthrosis of the pars interarticularis in a young American football professional player., European Journal of Orthopaedic Surgery & Traumatology, Vol.22 Suppl 1, 1-3, 2011.
(Summary)
Lumbar spondylolysis is a defect of the pars interarticularis regarded as a stress fracture. The bone stump around the pars defect usually appears atrophic and is fibrously united or filled with fibro cartilaginous mass, similar to long bone pseudoarthrosis. Lumbar spondylolysis sometimes causes bone growth resembling that of an osteophyte in osteoarthritis, and in elderly patients, the ragged edges result in radiculopathy around the defect. However, lumbar spondylolysis is rarely reported to cause hypertrophic changes resulting in spinal canal stenosis in young patients. In this report, we present an unprecedented radiological finding of distinctive hypertrophic change around the pars defect, which occurred in a young professional football player.
Risa Utsunomiya, Toshinori Sakai, Keizo Wada, Koichi Sairyo, Hirofumi Kosaka, Shinsuke Katoh and Natsuo Yasui : Hemorrhagic Facet Cyst in the Lumbar Spine Causing Contralateral Leg Symptoms: A Case Report, Asian Spine Journal, Vol.5, No.3, 196-200, 2011.
(Summary)
Here we present a case of hemorrhagic lumbar facet cyst presenting with progressive radiculopathy only on the contralateral side. If a patient has previous back pain or neuropathy for several months and then suddenly deteriorates, hemorrhagic facet cyst of the lumbar spine should be part of the differential diagnosis. However, as in the present case, we should be aware that there is a possibility of a contralateral lesion.
Koichi Sairyo, Toshinori Sakai, Mase Yasuyoshi, Kon Tamiyo, Shibuya Isao, Kanamori Yasuo, Kosugi Tatsuo and Dezawa Akira : Painful lumbar spondylolysis among pediatric sports players: a pilot MRI study., Archives of Orthopaedic and Trauma Surgery, Vol.131, No.11, 1485-1489, 2011.
(Summary)
For children and adolescents who are very active athletes, fresh lumbar spondylolysis is the main pathologic cause of lower back pain (LBP). However, regarding the terminal-stage spondylolysis (pars defect), there have been few studies to clarify the pathomechanism of LBP. The purpose of this study is to clarify the cause of LBP associated with pars defects in athletes. This is the first report showing a possible pathomechanism of LBP in active athletes with painful pars defect. Six pediatric athletes (5 boys and 1 girl) below 18 years old with painful bilateral lumbar spondylolysis were evaluated. In all cases, spondylolysis was identified as terminal stage (pseudoarthrosis) on CT scan. To evaluate the inflammation around the pars defects, short time inversion recovery (STIR) MRI was performed along with the sagittal section. Fluid collection, which is an indicator of inflammatory events, was evaluated in 12 pars defects as well as in 12 cranial and caudal adjoining facet joints. Inflammation (i.e., fluid collection) was observed in all 12 pars defects in six subjects at the pseudoarthrotic pars defects. In terms of facet joints, 7 of 12 (58%) pars defects showed fluid collection at the cranial and/or caudal adjoining joints on STIR MRI. The present study showed that inflammation was always present at the pars defects and in some cases at the adjoining facet joints. Thus, it is not difficult to understand how, during sports activity, inflammation may first occur at the pseudoarthrotic site and then spread to the adjoining facet joints. This mechanism could cause LBP associated with terminal-stage (pseudoarthrotics) spondylolysis in athletes.
(Keyword)
Adolescent / Child / Female / Humans / Low Back Pain / Lumbar Vertebrae / Magnetic Resonance Imaging / Male / Pilot Projects / Prospective Studies / Spondylolysis / Sports
Jason Mefford, Koichi Sairyo, Toshinori Sakai, Justin Hopkins, Madoka Inoue, Rui Amari, Nitin N Bhatia, Akira Dezawa and Natsuo Yasui : Modic Type 1 Change in Lumbar Spine in Golfers., Skeletal Radiology, Vol.40, No.4, 467-473, 2011.
(Summary)
Low back pain (LBP) is the most prevalent musculoskeletal complaint among professional and amateur golfers; however, associated radiological changes in golf-related LBP have not been examined in the literature. We suspect that Modic Type 1 changes in the lumbar spine are linked to golf-related LBP. In this retrospective case series, four middle-aged golfers (one professional and three high-level amateurs) presented to our clinic with LBP. Inflammation of the right side of endplates in the lumbar spine was suspected based on Modic Type 1 changes detected by magnetic resonance imaging (MRI) in each patient. All four cases were diagnosed with right-sided endplate inflammation and administered intradiscal steroid injections with a non-steroidal anti-inflammatory drug (NSAID). Treatment swiftly alleviated LBP and diminished Modic Type 1 changes on follow-up MRI 3-6 months later in all four patients. We suggest that Modic Type 1 changes play a significant role in the diagnosis and treatment of golf-related LBP.
(Keyword)
Golf / Humans / Low Back Pain / Lumbar Vertebrae / Magnetic Resonance Imaging / Male / Middle Aged
Miyagi Ryo, Toshinori Sakai, Bhatia N. Nitin, Koichi Sairyo, Shinsuke Katoh and Chikawa Takashi : Anterior Thoracolumbar Reconstruction Surgery for Late Collapse Following Vertebroplasty: Report of Three Cases., The Journal of Medical Investigation : JMI, Vol.58, No.1-2, 148-153, 2011.
(Summary)
Although vertebroplasty (VP) using polymethylmethacrylate (PMMA) is thought to be an effective procedure for osteoporotic vertebral compression fractures, several complications have been reported. In this paper, we present three patients who developed local kyphotic deformity as a result of late collapse of the cemented vertebrae. In all patients we safely removed the PMMA block through an anterior approach and anterior reconstruction was performed successfully. In only one patient who had a three column unstable injury with fractured posterior elements was additional posterior spinal fixation needed. In conclusion, VP is thought to be an effective and minimal invasive technique to treat osteoporotic compression fractures in older patients. Once collapse or nonunion of the treated vertebral body occurs, however, removal of the cement and anterior reconstruction may be required to realign of the affected segments and reconstruct the spine.
Terai Tomoya, Koichi Sairyo, Goel K. Vijay, Ebraheim A. Nabil, Biyani Ashok, Faizan Ahmad, Kiapour Ali, Higashino Kosaku, Toshinori Sakai and Natsuo Yasui : Biomechanical rationale of sacral rounding deformity in pediatric spondylolisthesis: a clinical and biomechanical study., Archives of Orthopaedic and Trauma Surgery, Vol.131, No.9, 1187-1194, 2011.
(Summary)
Rounding surface of the sacral dome and wedging deformity of the vertebral body are commonly observed in patients with isthmic spondylolisthesis. Recently, an animal study showed that the deformity can be caused by the growth plate involvement in the immature pediatric vertebral body after biomechanical alteration due to the pars defects. However, the pathomechanism and biomechanics of these deformities have yet to be clarified. To demonstrate that the sacral rounding deformity observed in pediatric patients with spondylolisthesis can be reversed, and to understand the pathomechanism of the deformity from the biomechanical standpoint by analyzing changes of stress around the growth plate of the vertebral body due to spondylolysis. Three-dimensional finite element pediatric lumbar models of the L3-L5 segment were utilized. Unlike the adult model, this pediatric model had growth plates and apophyseal rings. We analyzed stress distribution in response to 351°N axial compression and 10 N m moment in flexion, extension, lateral bending, and axial rotation. Bilateral spondylolysis was created in the model at the L4 level. The stress in the bilateral defect model was compared to the intact model predictions and the results obtained in the pediatric patients with sacral rounding deformity. Two patients presented rounding deformity of the anterior upper corner at S1 at the initial visit. They were asked to stop sports activities and use a soft trunk brace. Twelve months later, no rounding deformity was observed on the radiographs indicating that this deformity was reversible in pediatric cases. The biomechanical study indicated that in the pediatric spondylolytic spine, mechanical stress increased at the anterior upper corner during lumbar motion. In the presence of spondylolysis, mechanical stress increases in the growth plate at the anterior upper corner. Repetitive increases of mechanical stress may cause rounding deformity of the sacral dome mediated by growth plate involvement. When mechanical stress at the growth plate is reduced by wearing a brace, the proper functioning of the growth plate can help to remodel the sacral dome to its normal shape.
Shinji Yoshioka, Koichi Sairyo, Toshinori Sakai, Tatsuya Tamura, Hirofumi Kosaka and Natsuo Yasui : Osseous erosion by herniated nucleus pulposus mimicking intraspinal tumor: a case report., Journal of Orthopaedics and Traumatology, Vol.11, No.4, 257-261, 2010.
(Summary)
Erosion of spinal osseous structure, so-called scalloping, has been rarely reported associated with herniated nucleus pulposus (HNP). We report a rare case of HNP causing erosion of the spinal osseous structure (including lamina). The patient was an 81-year-old woman with 3-year history of low-back pain and left leg radiating pain. Muscle weakness of the left leg was also apparent. Computed tomography following myelography showed severe compression of the dural sac at the level of L3-L4; furthermore, erosion of the lamina, pedicle, and vertebral body was noted, indicating that the space-occupying mass was most probably a tumorous lesion. The mass also showed calcification inside. During the surgery, the mass was confirmed to be an HNP with calcification. Following resection, the pain disappeared. Surgeons should be aware of the possibility of scalloping of the vertebrae caused by HNP mimicking a tumorous lesion.
Toshinori Sakai, Koichi Sairyo, Shoichiro Takao, Hirofumi Kosaka and Natsuo Yasui : Adolescents with symptomatic laminolysis. -Report of two cases-., Journal of Orthopaedics and Traumatology, Vol.11, No.3, 189-193, 2010.
(Summary)
Retroisthmic cleft refers to a cleft in the lamina and is rarely reported. It was first described by Brocher, and later Wick et al. proposed the term "laminolysis" to describe the retroisthmic cleft by analogy with the nomenclature of the applied stress fracture of the pars interarticularis (spondylolysis) and the pedicle (pediculolysis). In this paper, we describe two adolescent sports players with symptomatic lumbar laminolysis. Both improved significantly after adequate conservative treatment. Knowledge of laminolysis in adolescent patients with low back pain is necessary to avoid overlooking it and late diagnosis. For correct diagnosis, multidetector three-dimensional computed tomography (CT) is suggested. In addition, magnetic resonance imaging (MRI) also allows detection of inflammation in the defects.
(Keyword)
Adolescent / Follow-Up Studies / Humans / Image Interpretation, Computer-Assisted / Immobilization / Injections, Intra-Articular / Lidocaine / Low Back Pain / Lumbar Vertebrae / Magnetic Resonance Imaging / Male / Pain Measurement / Recovery of Function / Severity of Illness Index / Spondylolysis / Steroids / Tomography, X-Ray Computed / Treatment Outcome
Tomoya Terai, Koichi Sairyo, VK Goel, N Ebraheim, A Biyani, A Faizan, Toshinori Sakai and Natsuo Yasui : Spondylolysis originates in the ventral aspect of the pars interarticularis: a clinical and biomechanical study., The Journal of Bone and Joint Surgery. British Volume, Vol.92, No.8, 1123-1127, 2010.
(Summary)
Lumbar spondylolysis is a stress fracture of the pars interarticularis. We have evaluated the site of origin of the fracture clinically and biomechanically. Ten adolescents with incomplete stress fractures of the pars (four bilateral) were included in our study. There were seven boys and three girls aged between 11 and 17 years. The site of the fracture was confirmed by axial and sagittal reconstructed CT. The maximum principal tensile stresses and their locations in the L5 pars during lumbar movement were calculated using a three-dimensional finite-element model of the L3-S1 segment. In all ten patients the fracture line was seen only at the caudal-ventral aspect of the pars and did not spread completely to the craniodorsal aspect. According to the finite-element analysis, the higher stresses were found at the caudal-ventral aspect in all loading modes. In extension, the stress was twofold higher in the ventral than in the dorsal aspect. Our radiological and biomechanical results were in agreement with our clinical observations.
Koichi Sairyo, Toshinori Sakai, Kousaku Higashino, M Inoue, Natsuo Yasui and A Dezawa : Complications of endoscopic lumbar decompression surgery., Minimally Invasive Neurosurgery : MIN, Vol.53, No.4, 175-178, 2010.
(Summary)
Endoscopic lumbar decompression is useful for the treatment of various spinal conditions and is being performed in an increasing number of patients worldwide. We reviewed the surgery-related complications in patients who underwent endoscopic surgery and discuss the learning curve for this procedure. Since the first case in August 2000, a total of 138 patients have undergone endoscopic posterior decompression surgery. Of these, there were 74 patients with Herniated Nucleus Pulposus (HNP), 57 with Lumbar Canal Stenosis (LCS), and 7 with other conditions. From 2003 to 2005, the senior surgeon took a sabbatical, and no endoscopic surgery was conducted. We divided the cases based on the date of surgery: there were 62 patients in the early (E) group (before September 2003), and 76 in the late (L) group (from January 2006 to April 2008). We compared the incidence of surgery-related complications between 2 disease types as well as between the E and L groups. We encountered 11 complications, which included 6 dural tears, 2 post-surgical hematomas, 2 neural complications and 1 fracture of the inferior articular process. The incidence of surgery-related complications was 8.6%. The incidences of complications were 8.1% and 9.3% for HNP and LCS, respectively, and 11.3%, and 5.3% in the E and L groups, respectively. The incidence was particularly high (16.7%) in the E group with LCS. There is a steep learning curve for endoscopic surgery. Based on the data, surgeons should start performing endoscopic techniques for LCS after gaining enough experience of endoscopic surgery for HNP.
Shinji Yoshioka, Koichi Sairyo, Toshinori Sakai and Natsuo Yasui : Congenital absence of lumbosacral articular facet joint associated with conjoined nerve root., Journal of Orthopaedics and Traumatology, Vol.11, No.3, 183-187, 2010.
(Summary)
We report a rare case of congenital absence of the L5-S1 facet joint, which was associated with a conjoined nerve root. Combination of these two anomalies has been quite rarely reported in the literature. A 39-year-old man presented with acute low back pain and right leg radiating pain. Muscle weakness and sensory disturbance of the right leg were also apparent in the region innervated by L5 and S1 nerve roots. Preoperative multidetector three-dimensional computed tomography (3D-CT) showed complete absence of the right S1 superior articular process. Magnetic resonance (MR) images showed lumbar disc herniation at right L5-S1 level that migrated cranially. Intraoperative findings revealed that the right L5 nerve root and S1 nerve root were conjoined, and the conjoined nerve root was compressed by L5-S1 disc herniation, which led to impairment of the conjoined nerve root by a single-level lumbar disc herniation. After removal of the disc herniation, his right leg pain immediately subsided, however muscle weakness and sensory disturbance persisted. Surgeons should be aware of this nerve root anomaly when examining a patient who shows an unusual clinical presentation and/or congenital osseous anomaly.
Toshinori Sakai, Koichi Sairyo, Naoto Suzue, Hirofumi Kosaka and Natsuo Yasui : Incidence and etiology of lumbar spondylolysis: review of the literature., Journal of Orthopaedic Science, Vol.15, No.3, 281-288, 2010.
(Summary)
Lumbar spondylolysis is a defect of the pars interarticularis known to occur as a stress fracture. Its incidence varies considerably depending on ethnicity, sex, and sports activity. However, there are few literature reviews describing its incidence in different ethnic groups or in people who engage in different sports. We reviewed the most relevant articles on spondylolysis published in scientific journals. First, we focused on its incidence in various ethnic groups distributed by sex, the familial occurrence, and in patients with relevant diseases. Second, we focused on the incidence of spondylolysis in relation to the sports practiced by the patients. Although placing special emphasis on the incidence of lumbar spondylolysis in the general population in Japan, we also reviewed the Japanese and English literature to investigate its incidence among those who engage in different sports. The incidence of lumbar spondylolysis in the general Japanese population was 5.9%. Most studies report that the incidence in higher in male subjects than in female subjects. We found that Japanese rugby and judo players were prone to suffer lumbar spondylolysis, at an incidence of about 20%. However, the incidence for Japanese professional soccer and baseball players was much higher, at 30%, which was more than five times the incidence in the general Japanese population. The incidence of lumbar spondylolysis varies depending on ethnicity, sex, family history, relevant disease, and sports activity.
(Keyword)
African Americans / Athletic Injuries / European Continental Ancestry Group / Female / Fractures, Stress / Humans / Incidence / Japan / Lumbar Vertebrae / Male / Spondylolysis / United States
Toshinori Sakai, Koichi Sairyo, Seiichi Mima and Natsuo Yasui : Significance of magnetic resonance imaging signal change in the pedicle in the management of pediatric lumbar spondylolysis., Spine, Vol.35, No.14, E641-645, 2010.
(Summary)
Prospective study. To investigate the time course of signal changes in the adjacent pedicle in fresh pediatric lumbar spondylolysis. A recent study reported that high signal change (HSC) on T2-magnetic resonance image (MRI) in the pedicle adjacent to the pars interarticularis could be an indicator of early spondylolysis. In addition, the HSC-positive pars defects showed significant better bony healing than the HSC-negative pars defects. However, there has been no report on the time course and the duration of HSC. We prospectively investigated 10 boys and 5 girls with fresh lumbar spondylolysis showing HSC in the adjacent pedicle. Their mean age was 15.1 years, ranging from 10 to 17 years. Two patients had multilevel unilateral spondylolysis. Among 15 patients, HSC was found in 22 (12 unilateral and 5 bilateral) pedicles. At the first presentation, the diagnosis of spondylolysis was made based on the plain radiograph findings, multidetector computed tomograms (CTs), and MRI. Every month from the first presentation, follow-up MRIs were taken. When HSC disappeared, multidetector CT was taken to confirm bony healing of the pars defect. Bony healing of the pars was obtained in 21 out of 22 defects. The bony healing rate was 95.6%. In 19 pedicles of 12 patients, HSC gradually diminished by every month until it disappeared 3 months later, and radiologic osseous healing was confirmed by CT in all but 1 patient. In the 3 remaining pedicles of 3 patients, HSC took more than 4 months to disappear. In this study, HSC disappeared in most pedicles on the 3-month follow-up MRI. In patients who did not comply with treatment, HSC tended to last longer. These results led us to hypothesize that MRI at the third month during follow-up can indicate whether the conservative treatment is being successful or not.
Madoka Inoue, Koichi Sairyo, Toshinori Sakai and Natsuo Yasui : Significance of surgical treatment for severe dystrophic changes in the cervical spine associated with neurofibromatosis type I: a case report., Journal of Pediatric Orthopaedics. Part B, Vol.19, No.3, 270-275, 2010.
(Summary)
There have been several reports about the treatments for dystrophic changes in the thoracic or lumbar spines owing to neurofibromatosis type-1. However, dystrophic changes in the cervical spine have been rarely reported. In this study, we present the case of a 13-year-old boy with severe dystrophic changes (dural ectasia) in the cervical spine owing to neurofibromatosis type-1. Although he had no neurological deficit, imaging studies revealed cervical kyphotic deformity and osteolysis of vertebral bodies. Thinning of vertebral bodies and laminae from C2 to C5 was remarkable, suggesting that the patient was at risk of suffering a spinal injury. The patient underwent cervical posterior fusion. At the 2-year follow-up examination, there was complete posterior bony fusion and no obvious progression.
Keizo Wada, Koichi Sairyo, Toshinori Sakai and Natsuo Yasui : Minimally invasive endoscopic bilateral decompression with a unilateral approach (endo-BiDUA) for elderly patients with lumbar spinal canal stenosis., Minimally Invasive Neurosurgery : MIN, Vol.53, No.2, 65-68, 2010.
(Summary)
Endoscopic spinal surgery has become increasingly common year for year because it is a minimally invasive procedure. In our hospital, we introduced endoscopic bilateral decompression with a unilateral approach (endo-BiDUA) in 2006. In this paper, we review clinically and radiographically the elderly patients who underwent the endo-BiDUA. Fifteen patients aged over 65 years were included in this review. They had undergone endo-BiDUA between January 2006 and July 2008. Operation time, blood loss, complications, clinical outcome using the Japanese Orthopedic Association (JOA) score, and enlargement ratio of the dural tube on magnetic resonance imaging (MRI), were evaluated. The mean operation time per level of endo-BiDUA was 144 min. Blood loss was about 60.2 mL. One patient had a post-surgical hematoma and required an additional laminectomy and removal of the hematoma 2 days after the surgery. No other complications such as dural tear, nerve root injury, or infection were encountered. All patients but one, who had a post-surgical hematoma, could start walking within 2 days following the surgery. Before surgery, the mean JOA score was 17.0 and it improved to about 23.3 after the surgery. The area of the dural tube increased to 408.0% after the surgery (range: 211-774%). Endo-BiDUA facilitated the return of elderly patients with lumbar spinal canal stenosis to their original daily activities.
(Keyword)
Aged / Aged, 80 and over / Decompression, Surgical / Endoscopy / Female / Humans / Lumbar Vertebrae / Magnetic Resonance Imaging / Male / Spinal Stenosis / Treatment Outcome
An ossified arachnoid membrane combined with cystic formation is rarely reported as a cause of spinal cord compression. We report the case of a 60-year-old man who presented with diffuse ossification of the arachnoid membrane (arachnoid ossification) and multiple cystic changes (arachnoid cyst) at the thoracic and lumbar spine. The lesions were surgically removed and progressive deterioration was prevented, although no marked improvement of neurological symptoms was attained.
Tatsuya Tamura, Toshinori Sakai, Koichi Sairyo, Shoichiro Takao, Seiko Kagawa, Shinsuke Katoh and Natsuo Yasui : Hematoma in the Cervical Ligamentum Flavum. Report of a Case and Review of the Literature., Skeletal Radiology, Vol.39, No.3, 289-293, 2010.
(Summary)
Hematoma of the cervical ligamentum flavum is very rare, and its pathogenesis is unknown. We describe a case of ligamentum flavum hematoma in the cervical spine causing severe myelopathy. Postoperative histological examination suggested it was the result of the rupture of a hemangioma or of an arteriovenous malformation in the ligamentum flavum. After removal of the lesion, the patient's condition immediately improved. Review of all three reported cases, including this one, showed that complete resection of the mass resulted in immediate relief of symptoms of incomplete paraplegia. The findings of magnetic resonance imaging (MRI) of the hematoma may vary with time, and they may show no characteristic intensity. However, MRI of this case revealed that the tissues surrounding the mass were enhanced with gadolinium diethylene triamine penta-acetic acid, and an area of homogeneous iso-intensity was clearly surrounded by a low-intensity area (flavum) on T2-weighed short-tau inversion recovery images. These findings could be characteristic of the ligamentum flavum hematoma and might help in the differentiation from a cervical epidural hematoma.
Koichi Sairyo, Toshinori Sakai, Rui Amari and Natsuo Yasui : Causes of radiculopathy in young athletes with spondylolysis., The American Journal of Sports Medicine, Vol.38, No.2, 357-362, 2010.
(Summary)
The main clinical symptom of lumbar spondylolysis is lower back pain. Radiculopathy rarely occurs without vertebral slippage. Hypothesis Spondylolysis in young athletes can cause lumbar radiculopathy. Case series; Level of evidence, 4. Ten patients (7 males and 3 females) were included in this study. The age of the patients ranged from 12 to 27 years. We employed plain radiography, computed tomography, magnetic resonance imaging, and selective radiculography if needed. The pathomechanism was classified into nonspondylolytic radiculopathy (3 cases) and spondylolytic radiculopathy (7 cases). In the nonspondylolytic group, 1 patient had a juxta-facet cyst at L4-5 and 2 patients had a herniated nucleus pulposus. In the other group, spondylolytic-related factors caused radiculopathy, and spondylolysis was in the early or progressive stage in all 7 patients. Radiologic findings indicated that radiculopathy was caused by extraosseous hematoma or edema in the vicinity of the fracture site. The radiculopathy disappeared within a month of nonoperative management, and radiologic abnormalities disappeared 3 to 6 months later. Radiculopathy can occur together with lumbar spondylolysis without slippage in young athletes. We propose extra-osseous hematoma or edema at the site of spondylolysis as the unique pathomechanism causing radiculopathy in young athletes. Radiculopathy is rare in athletes with spondylolysis. Magnetic resonance imaging is a useful tool to clarify the pathologic changes that induce the radiculopathy for both spondylolytic and nonspondylolytic factors.
(Keyword)
Adolescent / Adult / Athletes / Child / Female / Humans / Low Back Pain / Magnetic Resonance Imaging / Male / Radiculopathy / Spondylolysis / Tomography, X-Ray Computed / Young Adult
Shoichiro Takao, Toshinori Sakai, Koichi Sairyo, Tadashi Kondo, Junji Ueno, Natsuo Yasui and Hiromu Nishitani : Radiographic comparison between male and female patients with lumbar spondylolysis., The Journal of Medical Investigation : JMI, Vol.57, No.1-2, 133-137, 2010.
(Summary)
We studied the lumbar spines of 117 adults (39 women and 78 men) with spondylolysis unrelated to low back pain using multidetector computed tomography (CT). Of the 117 subjects with spondylolysis, including five with multiple-level spondylolysis, there were 124 vertebrae with spondylolysis. In adult lumbar spines with unilateral spondylolysis, there was no significant difference between the incidence of spondylolisthesis in female and male subjects. However, in those with bilateral spondylolysis, there was a significantly higher incidence of spondylolisthesis in female subjects (90.9%) than in males (66.2%). Furthermore, females with bilateral spondylolysis had significant more slippage than males. Lumbar index and lumbar lordosis were not significantly different between male and female subjects, and did not significantly correlate with slippage. In conclusion, to treat acute spondylolysis in adolescents, it is important to obtain bony union at least unilaterally, especially in female subjects, to prevent further slippage.
(Keyword)
Adult / Aged / Aged, 80 and over / Female / Humans / Incidence / Lumbar Vertebrae / Male / Middle Aged / Sex Characteristics / Spondylolisthesis / Spondylolysis / Tomography, X-Ray Computed
Toshinori Sakai, Koichi Sairyo, Shoichiro Takao, Hiromu Nishitani and Natsuo Yasui : Incidence of lumbar spondylolysis in the general population in Japan based on multidetector computed tomography scans from two thousand subjects., Spine, Vol.34, No.21, 2346-2350, 2009.
(Summary)
Epidemiological analysis using CTs. To investigate the true incidence of lumbar spondylolysis in the general population in Japan. Although there have been several reports on the incidence of lumbar spondylolysis, they had some weakness. One of them concerns the subjects investigated, because the incidence of lumbar spondylolysis varies considerably, and some patients are asymptomatic. In addition, most of the past studies used plain radiograph films or skeletal investigation. Therefore, the past reported incidence may not correspond to that of the general population. We reviewed the computed tomography (CT) scans of 2000 subjects (age: 20-92 years) who had undergone abdominal and pelvic CT on a single multidetector CT scanner for reasons unrelated to low back pain. We reviewed them for spondylolysis, spondylolytic spondylolisthesis, and spina bifida occulta (SBO) in the lumbosacral region. The grade (I-IV) of spondylolisthesis was measured using midsagittal reconstructions. Lumbar spondylolysis was found in 117 subjects (5.9%). Their male-female ratio was 2:1. Multiple-level spondylolysis was found in 5 subjects (0.3%). Among these 117 subjects, there were 124 vertebrae with spondylolysis. Of them, 112 (90.3%) corresponded to L5, and 26 (21.0%) had unilateral spondylolysis.SBO was found in 154 subjects. Of them, 25 had spondylolysis (16.2%), whereas, in 1846 subjects without SBO, 92 had spondylolysis (5.0%). The incidence of spondylolysis among the patients with SBO was significantly higher than that in subjects without SBO (Odd ratio was 3.7-fold).Of 124 vertebrae with spondylolysis, 75 (60.5%) showed low-grade (Meyerding grade I or II) spondylolisthesis, and no subject presented high-grade spondylolisthesis. Spondylolisthesis was found in 74.5% of the subjects with bilateral spondylolysis, and in 7.7% of those with unilateral spondylolysis. The incidence of lumbar spondylolysis in the Japanese general population was 5.9% (males: 7.9%, females: 3.9%).
(Keyword)
Adult / Aged / Aged, 80 and over / Female / Humans / Incidence / Japan / Lumbar Vertebrae / Male / Middle Aged / Spina Bifida Occulta / Spondylolisthesis / Spondylolysis / Tomography, X-Ray Computed / Young Adult
Toshinori Sakai, Shinsuke Katoh, Koichi Sairyo, Tatsuya Tamura, Nori Hirohashi, Kousaku Higashino and Natsuo Yasui : Anterior transvertebral herniotomy for cervical disc herniation: a long-term follow-up study, Journal of Spinal Disorders & Techniques, Vol.22, No.6, 408-412, 2009.
(Summary)
Retrospective study. To investigate the efficacy and radiologic changes after anterior transvertebral herniotomy (ATH), in patients followed for at least 10 years after the surgery. The theoretical idea of ATH is to remove an extruded herniated mass while preserving disc motion. To our knowledge, no report has been published on the long-term outcome of this procedure. Twenty patients underwent single-level ATH at our institution between 1989 and 1995. Clinical outcome was evaluated by visual analog scale for neck and arm pain according to Japanese Orthopaedic Association (JOA) score, and range of motion (ROM) of the cervical spine. Radiologic outcome was evaluated by measuring disc height and range of intervertebral motion of the site on plain radiographs. We also evaluated the operated and the adjacent segments by magnetic resonance imaging (MRI) for degenerative changes. Fifteen of the 20 patients were evaluated. One patient required additional surgery, 3 patients were lost to follow-up, and 1 patient had died by the time of the evaluation. Therefore, we evaluated the clinical outcome of 15 patients. Both the plain radiographs and MRI were available from 10 patients, and for 3 patients only the plain radiographs were available. Two patients refused x-ray examination at the final follow-up. Regarding clinical outcome, no patient had suffered from neck pain or arm pain. The average visual analog scale was 7.8/100 (%) for neck pain, and 7.0/100 (%) for arm pain. JOA scores improved and remained at a good level. The improvement rate was 88.5%. The average ROM of the cervical spine was 42.7 degrees in flexion, 52.3 degrees in extension, 58.6 degrees in axial rotation, and 25.0 degrees in lateral bending. Although ROM in axial rotation and lateral bending was symmetric, the range was smaller than that in the healthy segments. On plain radiographs, although the disc height in the operated segment was not significantly decreased compared with the other segments, loss of intervertebral motion was noticed on the follow-up roentgenograms in most cases. Only 2 patients had mobility of the operated intervertebral levels (>10 degrees). There was no collapse of the drilled vertebral body in any patient. Four of the 10 patients who underwent MRI showed protrusion of intervertebral discs, including those adjacent to the affected discs. No recurrence of disk herniation at the involved level was seen on the follow-up MRI. In conclusion, ATH provided a good clinical outcome that was maintained for a long time. Although intervertebral motion at the operated level decreased to some extent, degenerative changes at the adjacent levels were not enhanced.
(Keyword)
Activities of Daily Living / Cervical Vertebrae / Diskectomy / Female / Follow-Up Studies / Humans / Intervertebral Disc / Intervertebral Disc Displacement / magnetic resonance imaging / Male / Middle Aged / Neck Pain / Patient Satisfaction / Postoperative Complications / Range of Motion, Articular / Retrospective Studies / Spinal Cord Compression / Spondylosis / time / Treatment Outcome
Koichi Sairyo, Toshinori Sakai and Natsuo Yasui : Minimally invasive technique for direct repair of pars interarticularis defects in adults using a percutaneous pedicle screw and hook-rod system., Journal of Neurosurgery. Spine, Vol.10, No.5, 492-495, 2009.
(Summary)
In this report, the authors described a new minimally invasive technique to repair pars interarticularis defects in adults. The well-established technique using the pedicle screw (PS) and hook-rod system was modified. First, bilateral PSs were inserted percutaneuosly using the Sextant system. Then, through a small skin incision (3-4 cm), an illuminated tubular retractor (Quadrant system; Medtronic Sofamore Danek) was inserted into the pars defect. When this system is used, it is not necessary to detach all the back muscles to access the lytic part. The bursa and fibrocartilaginous mass near the defects were removed. After decortication of the pseudarthrosis at the spondylolytic level, bone grafts were implanted. Finally, the hook part of a hook-rod system was attached to the lamina and the rod was secured at the tulip head of the PSs. The authors performed this procedure in 2 adult patients, 32 and 24 years of age. Immediately after surgery both patients' low-back pain disappeared, and by 3 months postoperatively both had returned to their original work or sports activities.
(Keyword)
Bone Screws / Humans / Lumbar Vertebrae / Male / Pseudarthrosis / Spondylolysis / Surgical Procedures, Minimally Invasive / Young Adult
Fumio Hayashi, Toshinori Sakai, Koichi Sairyo, Nori Hirohashi, Kousaku Higashino, Shinsuke Katoh and Natsuo Yasui : Intramedullary schwannoma with calcification of the epiconus., The Spine Journal, Vol.9, No.5, e19-e23, 2009.
(Summary)
There have been few reports on intramedullary ancient schwannoma. Schwann cells are generally present in the nerve root, not in the spinal cord. Thus, intramedullary schwannomas are rare, and in most cases there is cyst formation without calcification. To report a patient with intramedullary ancient schwannoma at the epiconus together with a review of the previously published cases. Case report. A 78-year-old woman. Retrospective case review. DESCRIPTION OF THE CASE: A 78-year-old woman had presented with severe weakness of the lower extremities, increased patellar reflex, and sensory disturbance of the entire lower extremities. Magnetic resonance imaging showed a tumorous mass in the intramedullary region of epiconus at T11-L1, and computed tomography revealed calcification in the tumor. She underwent total resection of the tumor. Histopathological findings were consistent with the diagnosis of ancient schwannoma. After the operation, although lower extremities weakness and sensory disturbance deteriorated transiently, lower leg pain disappeared. At the final follow-up of 10 months after the operation, lower leg pain did not relapse. We reported a rare case presenting epiconus syndrome due to intramedullary ancient schwannoma, which should be considered for the differential diagnosis of a tumor that shows calcification.
Rui Amari, Toshinori Sakai, Shinsuke Katoh, Koichi Sairyo, Kosaku Higashino, Keizo Tachibana and Natsuo Yasui : Fresh stress fractures of lumbar pedicles in an adolescent male ballet dancer: case report and literature review., Archives of Orthopaedic and Trauma Surgery, Vol.129, No.3, 397-401, 2009.
(Summary)
Stress fracture in the pars interarticularis is a common cause of low back pain in young athletes. Pedicle stress fractures have also been reported in adolescent sport players, and most of them were associated with contralateral spondylolysis. Only a few cases with bilateral pedicle stress fractures have been reported. We report a 14-year-old ballet dancer with fresh bilateral pedicle fractures treated conservatively, together with a review of the literature.
(Keyword)
Adolescent / Dancing / Fractures, Stress / Humans / Low Back Pain / Lumbar Vertebrae / Male / Spinal Fractures
Koichi Sairyo, Toshinori Sakai and Natsuo Yasui : Conservative treatment of lumbar spondylolysis in childhood and adolescence: the radiological signs which predict healing., The Journal of Bone and Joint Surgery. British Volume, Vol.91, No.2, 206-209, 2009.
(Summary)
It has been noted that bony union of a pars defect can be achieved in children if they wear a trunk brace. Our aim was to evaluate how the stage of the defect on CT and the presence or absence of high signal change in the adjacent pedicle on T2-weighted MRI were related to bony healing. We treated 23 children conservatively for at least three months. There were 19 boys and four girls with a mean age of 13.5 years (7 to 17). They were asked to refrain from sporting activity and to wear a Damen soft thoracolumbosacral type brace. There were 41 pars defects in 23 patients. These were classified as an early, progressive or terminal stage on CT. The early-stage lesions had a hairline crack in the pars interarticularis, which became a gap in the progressive stage. A terminal-stage defect was equivalent to a pseudarthrosis. On the T2-weighted MR scan the presence or absence of high signal change in the adjacent pedicle was assessed and on this basis the defects were divided into high signal change-positive or -negative. Healing of the defect was assessed by CT. In all, 13 (87%) of the 15 early defects healed. Of 19 progressive defects, only six (32%) healed. None of the seven terminal defects healed. Of the 26 high signal change-positive defects 20 (77%) healed after conservative treatment whereas none of the high signal change-negative defects did so. We concluded that an early-stage defect on CT and high signal change in the adjacent pedicle on a T2-weighted MR scan are useful predictors of bony healing of a pars defect in children after conservative treatment.
Koichi Sairyo, Toshinori Sakai, Kousaku Higashino, Tatsuya Tamura, Shinsuke Katoh and Natsuo Yasui : Cervical and upper thoracic screwing for spinal fusion: strategy for its safe insertion to avoid major complications., Archives of Orthopaedic and Trauma Surgery, Vol.129, No.11, 1447-1452, 2009.
(Summary)
There are several screwing techniques to attain cervical fusion such as pedicle screw, lateral mass screw, facet screw, transarticular and laminar screw. Each screwing technique has advantages and disadvantages. In this study, we introduce our strategy for safe screwing and its clinical results. Our strategy is as follows: lateral mass screw for C1, 3, 4, 5, 6 and pedicle screw for C2, 7, and thoracic level. When the C2 pedicle is thinner than 3.5 mm, we use C2 laminar screws. We do not use Magerl transarticular screw or facet screw; 146 screws were inserted in 17 patients. There were no major complications such as spinal cord and nerve root injury. We did not observe vertebral arterial injury either. Of the 146 screws, 141 (97.0%) were accurately inserted. As for lateral mass screwing by Roy-Camille's technique and C2 laminar screwing, all screws were inserted in the appropriate site (100%) without any complications. Five pedicle screws were misplaced. Of the 57 pedicle screws, 5 showed a minor tear of the wall at C7, Th1 and Th3, the success rate for all pedicle screws was 91%. All showed solid fusion. For cervical screwing the most important aspect should be safety to avoid severe morbidity. Our strategy, which consists in the combined use of pedicle, lateral mass and laminar screwing, is safe and reliable.
Takahiro Sasa, Yusuke Yoshizumi, Koichi Imada, Masato Aoki, Tomoya Terai, Tomofumi Koizumi, Vijay K. Goel, Ahmad Faizan, Ashok Biyani, Toshinori Sakai and Koichi Sairyo : Cervical spondylolysis in a judo player. A case report and biomechanical analysis., Archives of Orthopaedic and Trauma Surgery, Vol.129, No.4, 559-567, 2009.
(Summary)
A case report and a biomechanical study using a finite element method. To report a case with the cervical spondylolysis and to understand the biomechanics of the cervical spine with spondylolysis at C6. Cervical spondylolysis, although not a common spinal disorder, can occur in athletes. Presently, the exact pathology, natural history and biomechanics are not known. Thus, treatment strategies for this disorder in athletes are in controversy. To treat and/or advise patients with cervical spondylolysis, the cervical spine biomechanics regarding this disorder should be understood. A case of a 12-year-old male judo player is presented. The patient presented with occipital and upper neck pain. Plain radiographs, reconstructed CT scan and MRIs of this patient were reviewed. Biomechanically, stress distributions were analyzed in response to 73.6 N axial compression and 1.5-Nm moment in flexion, extension, lateral bending, and axial rotation using a FE model of the intact ligamentous C3 to C7 segment. Bilateral spondylolysis was created in the model at C6. The stress results from the bilateral defect model were compared to the intact model predictions. Plain radiographs showed bilateral C6 spondylolysis, and grade I spondylolisthesis. MRI showed mild disc degeneration at C6/7. With conservative treatment, the symptoms disappeared. In the spondylolysis model, the maximum Von Mises Stresses at C6/7 increased in all cervical spine motions, as compared to the intact case. Specifically, in axial rotation, the stress increase was 3.7-fold as compared to the intact model. The range of motion at C6/7 increased in the spondylolysis model as well. Again, during axial rotation, the increase in motion was 2.3-fold when compared to the intact model. Cervical spondylolysis can cause biomechanical alterations, especially in axial rotation, leading to increased disc stresses and range of motion. The increased stresses in the disc and the hypermobility would be a dangerous condition for athletes participating in contact sports such as judo. Thus, we recommended that judo players with cervical spondylolysis should change to non-contact sports, such as jogging.
(Keyword)
Biomechanics / Cervical Vertebrae / Child / Finite Element Analysis / Humans / Male / Martial Arts / Range of Motion, Articular / Spondylosis / Tomography, X-Ray Computed
Koichi Sairyo, Toshinori Sakai, Natsuo Yasui, Ali Kiapour, Ashok Biyani, Nabil Ebraheim and K Vijay Goel : Newly occurred L4 spondylolysis in the lumbar spine with pre-existence L5 spondylolysis among sports players: case reports and biomechanical analysis., Archives of Orthopaedic and Trauma Surgery, Vol.129, No.10, 1433-1439, 2009.
(Summary)
STUDY DESIGN: Case series and a biomechanical study using a finite element (FE) analysis. OBJECTIVES: To report three cases with multi-level spondylolysis and to understand the mechanism biomechanically. BACKGROUND: Multi-level spondylolysis is a very rare condition. There have been few reports in the literature on multi-level spondylolysis among sports players. METHODS: We reviewed three cases of the condition, clinically. These patients were very active young sports players and had newly developed fresh L4 spondylolysis and pre-existing L5 terminal stage spondylolysis. Thus, we assumed that L5 spondylolysis may have increased the pars stress at the cranial adjacent levels, leading to newly developed spondylolysis at these levels. Biomechanically, we investigated pars stress at L4 with or without spondylolysis at L5 using the finite element technique. RESULTS: L4 pars stress decreased in the presence of L5 spondylolysis, which does not support our first hypothesis. CONCLUSIONS: It seems that multi-level spondylolysis may occur due to genetic and not biomechanical reasons.
Kousaku Higashino, Shinsuke Katoh, Koichi Sairyo, Yuichiro Goda, Toshinori Sakai, Takashi Kitaichi, Tetsuya Kitagawa and Natsuo Yasui : Pseudoaneurysm of the thoracoabdominal aorta caused by the severe migration of an anterior spinal device. A case report., The Spine Journal, Vol.8, No.4, 696-699, 2008.
(Summary)
Case report. To describe the case of pseudoaneurysm of the thoracoabdominal aorta caused by the severe migration of an anterior spinal device 5 years after surgery. Case report. A 70-year-old woman was referred to us because of migrated anterior spinal devices and a pseudoaneurysm of the thoracoabdominal aorta. This patient had undergone anterior corpectomy and spinal fusion from Th12 to L2 because of delayed palsy after a burst fracture using a smooth rod Kaneda device (SRK) with bioactive ceramic (apatite-wollastonite containing glass ceramic) at a local hospital. She had persistent low back pain after the surgery. Five years after the initial surgery, the patient was referred to us because of increasing of her low back pain and the migrated SRK devices shown on plain X-ray films. An enhanced computed tomography scan taken in our hospital clearly showed a pseudoaneurysm of the thoracoabdominal aorta surrounding the SRK devices. The pseudoaneurysm was resected, the aortic defect was repaired with an artificial patch, and the migrated SRK devices were removed. The pseudoaneurysm of the aorta can occur secondary to a migrated anterior spinal fixation device and can be successfully treated by revision anterior surgery with vascular repair and implant removal.
Koichi Sairyo, Toshinori Sakai, Kousaku Higashino, Bunji Hirao, Shinsuke Katoh and Natsuo Yasui : Minimally invasive excision of lumbar epidural lipomatosis using a spinal endoscope., Minimally Invasive Neurosurgery : MIN, Vol.51, No.1, 43-46, 2008.
(Summary)
In this report, we describe the case of a patient with a long-term radiculopathy due to epidural lipomatosis at the L3-4 intervertebral disc level. The fatty tissue was located on the dorsal side of the dural sac in the spinal canal and compressed the dural sac. The fatty tissue was removed endoscopically. After surgery, the symptoms disappeared, and neurological deficits normalized. We would like to state that epidural lipomatosis is a good candidate for minimally invasive endoscopic surgery because of its anatomic location.
(Keyword)
Aged / Cauda Equina / Decompression, Surgical / Dura Mater / Endoscopy / Epidural Space / Humans / Lipomatosis / Low Back Pain / Lumbar Vertebrae / Magnetic Resonance Imaging / Male / Polyradiculopathy / Spinal Canal / Surgical Procedures, Minimally Invasive / Treatment Outcome
Ichiro Tonogai, Toshinori Sakai, Shinsuke Katoh, Kousaku Higashino, Koichi Sairyo, Nori Hirohashi and Natsuo Yasui : Myelopathy in a 6-year-old girl caused by neurofibromatosis Type 1: a case report, The Spine Journal, Vol.8, No.5, 836-840, 2008.
(Summary)
Even when there is radiological evidence of spinal involvement, young patients with neurofibromatosis Type 1 (NF-1) seldom have symptoms. We report the case of a child who developed rapidly progressive myelopathy. To describe a technique used to prevent postoperative spinal deformity and instability, after removal of a dumbbell-shaped tumor in a 6-year-old child. Case report. A 6-year-old female. Retrospective case review. The patient underwent a resection of the cervical dumbbell tumor using an osteoplastic laminectomy technique to prevent postoperative spinal deformity. At 2-year follow-up, there was no clinical or radiographic evidence of complications or spinal kyphotic deformity. The case of a 6-year-old girl with cervical myelopathy caused by NF-1 was reported. The tumor was removed after osteoplastic laminectomy, which could prevent postoperative kyphotic deformity.
Toshinori Sakai, Koichi Sairyo, Daisuke Hamada, Kousaku Higashino, Shinsuke Katoh, Yoichiro Takata, F Shinomiya and Natsuo Yasui : Radiological features of lumbar spinal lesions in patients with rheumatoid arthritis with special reference to the changes around intervertebral discs., The Spine Journal, Vol.8, No.4, 605-611, 2008.
(Summary)
Compared with the cervical spine, little attention has been paid to rheumatoid arthritis (RA)-related lumbar disorders. Only a few articles have described the status of the lumbar spine affected by RA based on plain X-ray films and magnetic resonance imaging (MRI). To describe the features and prevalence of radiological changes of the lumbar spine of patients with RA and to clarify the correlations of such features with disease activity. Transverse radiological study. We radiographically examined 104 patients with RA whose age ranged from 21 to 78 years (mean, 51.0). In each, the duration of RA exceeded 10 years (mean, 17.7 years). Clinical outcomes included Ochi's classification, Lansbury index, C-reactive protein (CRP) (mg/dL), rheumatoid factor (RF) (U/mL), and platelet (count/mm). Radiological outcomes included radiography and MRI. One hundred four RA patients were included in this study regardless of the presence/absence of low back pain. We examined discs from L1-2 to L5-S, including endplates, in each patient on plain X-ray films and magnetic resonance images and used a comprehensive grading system to evaluate each feature of the lumbar spine affected by RA based on the present findings and published reports. The correlations of these radiological features with RA activity and Ochi's classification were examined. To quantify disease activity, we determined the Lansbury index, serum CRP (mg/dL), RF (U/mL), and platelet count (count/mm) at the time of radiological examinations. Of the 104 patients, 47 (45.2%) exhibited a lumbar lesion. There were two types of lumbar disc lesions related to RA: disc narrowing and disc ballooning. The Lansbury index of patients with the most severe lesions was significantly higher than that of patients with less severe lesions (p<.01). The frequency of lumbar involvement also increased as the number of affected peripheral joints increased, and Ochi's classification appeared to be useful in predicting the occurrence of lumbar lesions. Of 104 patients, 47 (45.2%) exhibited abnormalities on X-ray films and MRI. There were two types of disorders, disc narrowing and disc ballooning. Both the Lansbury index and Ochi's classification reflected the severity of lumbar lesions in RA patients.
(Keyword)
Adult / Aged / Arthritis, Rheumatoid / Female / Humans / Intervertebral Disc / Lumbar Vertebrae / Magnetic Resonance Imaging / Male / Middle Aged / Severity of Illness Index / Spinal Stenosis
Kousaku Higashino, Koichi Sairyo, Tadanori Sakamaki, Shinnji Komatsubara, Kiminori Yukata, Naohito Hibino, hirofumi Kosaka, Toshinori Sakai, Shinsuke Katoh, Toshiaki Sano and Natsuo Yasui : Vertebral rounding deformity in pediatric spondylolisthesis occurs due to deficient of endochondral ossification of the growth plate: radiological, histological and immunohistochemical analysis of a rat spondylolisthesis model., Spine, Vol.32, No.25, 2839-2845, 2007.
(Summary)
A study using rat spondylolisthesis models. To clarify pathomechanism of vertebral rounding deformity in pediatric spondylolisthesis. For high-grade slippage, rounding of sacrum surface associated with L5 spondylolisthesis is reported to be the most responsible risk factor. However, the exact pathomechanism of the rounding deformity is yet to be clarified. Spondylolisthesis rat model (4-week-old) was used. Radiographs were taken weekly for 5 weeks after the surgery. The lumbar spines were harvested for histology. Hematoxylin and eosin, alcian blue staining, and tartrate-resistant acid phosphatase staining were used. Immunohistochemically, the growth plate cartilage was studied for type II and X collagen. A modified bone histomorphometric analysis was also performed. Radiographs showed slippage 1 week after surgery. Rounding deformity was obvious 2 weeks after surgery. The rounding deformity progressed with time. Three weeks after surgery, the specific columns of growth plate were unclear at the anterior corner, which corresponded to the rounding surface observed on radiographs. Instead, a huge mass of cartilage was observed at that site. Tartrate-resistant acid phosphatase-positive cells were observed in the vicinity of the growth plate except in relation with the anterior corner. The growth plate and cartilage mass at the anterior corner stained positive for type II collagen. Chondrocytes in the hypertrophied layer stained positively for type X collagen; however, staining was faint at the anterior corner. The results suggested that the chondrocytes at the anterior did not form, morphologically and functionally, the normal growth plate. From histomorphometrical analysis, the normal posterior growth plate made endochondral bone growth in 510 +/- 20 microm for a week, whereas the anterior corner in 200 +/- 15 microm. Deficient endochondral ossification of the growth plate in the anterior upper corner of the vertebra could be the pathomechanism of the rounding deformity of the sacrum.
(Keyword)
Acid Phosphatase / Age Factors / Animals / Cartilage / Chondrocytes / Collagen Type II / Collagen Type X / Disease Models, Animal / Female / Growth Plate / Immunohistochemistry / Isoenzymes / Lumbar Vertebrae / Ossification, Heterotopic / Rats / Rats, Wistar / Spondylolisthesis / Time Factors
Hirofumi Kosaka, Koichi Sairyo, Ashok Biyani, Douglas Leaman, Richard Yeasting, Kousaku Higashino, Toshinori Sakai, Shinsuke Katoh, Toshiaki Sano, Vijay K. Goel and Natsuo Yasui : Pathomechanism of loss of elasticity and hypertrophy of lumbar ligamentum flavum in elderly patients with lumbar spinal canal stenosis., Spine, Vol.32, No.25, 2805-2811, 2007.
(Summary)
A histologic, biologic, and immunohistochemical assessment using human samples of lumbar ligamentum flavum. To clarify the pathomechanism of loss of elasticity and hypertrophy of the lumbar ligamentum flavum (LF) in the elderly population. The most common spinal disorder in elderly patients is lumbar spinal canal stenosis, causing low back and leg pain, and paresis. Canal narrowing, in part, results from hypertrophy of the LF. Although histologic and biologic literature on this topic is available, the pathomechanism of loss of elasticity and hypertrophy of the LF is still unknown. One fetus, 5 young, and 5 elderly LF were obtained for histologic study. Hematoxylin and eosin, Alcian blue, Masson Trichrome, and Elastica Van Gieson stains were performed for each LF. Nine LF were collected and were used for biologic study of real time RT-PCR to quantitatively measure mRNA expression of Type I collagen and elastin in each LF. In the LF of the fetus, elastic fibers accounted for about 75% of the entire area. In the dural aspect of the LF in the young and elderly group, the ratio was also around 75%; however, the ratio of the dorsal aspect decreased with age. Almost half of the area showing loss of elastic fibers was shown to be converted to cartilaginous tissue producing Type II collagen and proteoglycan by Alcian blue and Type II collagen immunohistochemistry. The area, which did not stain black with EV nor blue with AB stain, was positively stained blue with T stain, indicating scarring. The area of the normal dural layer was 18.0 +/- 2.3 and 33.8 +/- 4.3 (mm2), for young and elderly group, respectively. Accordingly, it was 3.2 +/- 0.8 and 18.0 +/- 10.2 (mm2), for the dorsal abnormal layer. Elastin mRNA showed a relatively strong correlation (r = 0.44) with age; however, the slope was very gentle. Type I collagen mRNA showed a very strong correlation (r = 0.80) with age. The slope was steeper, and the value reached at 1000% (10-fold) around 65 years old when compared with the LF from younger patient. Elastin mRNA showed a weak correlation (r = 0.36) with thickness, and the slope was gentle. Type I collagen mRNA showed relatively strong correlation (r = 0.52) with thickness. The slope was steeper, and the line reached at 1000% (10-fold) around 6.5 (mm) when compared with a thin LF. Decreased elasticity of LF in the elderly is due to the loss of elastic fibers and a concomitant increase of collagenous fibers in the dorsal aspect. LF hypertrophy could be due to the thickening of the normal elastic layer as well as of the abnormal collagenous layer.
(Keyword)
Adult / Age Factors / aging / Collagen Type I / Collagen Type II / elasticity / Elastin / fetus / Humans / Hypertrophy / Ligamentum Flavum / Lumbar Vertebrae / Middle Aged / RNA, Messenger / Spinal Stenosis
Nori Hirohashi, Toshinori Sakai, Koichi Sairyo, Koichi Oba, Kousaku Higashino, Shinsuke Katoh and Natsuo Yasui : Lumbar radiculopathy caused by extradural rheumatoid nodules. A case report., Journal of Neurosurgery. Spine, Vol.7, No.3, 352-356, 2007.
(Summary)
The authors report on a 51-year-old woman with a 9-year history of rheumatoid arthritis (RA) who presented with symptomatic rheumatoid nodules in the lumbar extradural region with compression on the L-5 nerve roots bilaterally. She had also suffered from dysesthesia in the right lower leg and intermittent claudication. Magnetic resonance imaging revealed masses compressing the dural sac, and on lumbar myelography and computed tomography myelography a filling defect at L4-5 was revealed, which was compressing the dural sac posterolaterally on both sides. The masses were surgically removed. On histological examination the typical characteristics of rheumatoid nodules were found. Soon after the operation all of the patient's symptoms disappeared. There have been few reports on extradural rheumatoid nodules. Patients with RA usually complain of articular symptoms, and in fact the patient in the present study had been referred to the authors' institution for total hip arthroplasty. However, various symptoms other than those arising from articular lesions were found clinically. The authors believe that if patients with RA are also examined for extraarticular lesions, it is likely that these will be more frequently detected.
Ichiro Tonogai, Koichi Sairyo, Kousaku Higashino, Toshinori Sakai, Shinsuke Katoh and Natsuo Yasui : Minimally invasive endoscopic removal of herniated nucleus pulposus that had migrated to the S1 nerve root foramen., Minimally Invasive Neurosurgery : MIN, Vol.50, No.3, 173-177, 2007.
(Summary)
In this report, we described an adult case with a lumbar herniated nucleus pulposus that had migrated to the S1 nerve root foramen from L5-S1 disc space. Endoscopically, the migrated mass was successfully removed after laminectomy at the S1 with a small skin incision of 20 mm in length. Unlike the other levels, the intraforaminally migrated mass along the S1 root can be excised without any removal of the facet joints; therefore, additional spinal fusion is not necessary. Thus, an S1 foraminal migrated mass can be a good surgical candidate for minimally invasive endoscopic surgery.
Kousaku Higashino, Koichi Sairyo, Shinsuke Katoh, Toshinori Sakai, Hirofumi Kosaka and Natsuo Yasui : Minimally invasive technique for direct repair of the pars defects in young adults using a spinal endoscope. A technical note., Minimally Invasive Neurosurgery : MIN, Vol.50, No.3, 186-190, 2007.
(Summary)
Pars defect (spondylolysis) of the lumbar spine can cause chronic low back pain, and it sometimes requires surgical intervention. Direct repair is selected for the surgery if young adult patients do not present significant disc degeneration and lumbar instability. In order to lessen damages of back muscles during surgery, we added the use of a spinal endoscope to the "Buck's screwing procedure" the direct repair. There are four steps in this procedure: 1) identification of the defect, 2) curettage (refresh) of the defect, 3) percutaneous insertion of the annulated screws and 4) cancellous bone grafting. All these steps can be done endoscopically. We treated 3 young adults--a baseball player, a professional cycle-racer and a sculptor--using this endoscopic procedure. There were no complications during or after the operation. Union was obtained in all defects within 3 months, and they returned to their previous activities within 6 months after the surgery.
Kousaku Higashino, Yoshito Matsui, Syoji Yagi, Yoichiro Takata, Tomohiro Goto, Toshinori Sakai, Shinsuke Katoh and Natsuo Yasui : The alpha2 type IX collagen tryptophan polymorphism is associated with the severity of disc degeneration in younger patients with herniated nucleus pulposus of the lumbar spine., International Orthopaedics, Vol.31, No.1, 107-111, 2007.
(Summary)
Tryptophan alleles in COL9A2 (Trp2) and COL9A3 (Trp3) have been linked to lumbar disc diseases in the Finnish population. Although such diseases consist of various pathogenetically different conditions, detailed analysis of each has not been well documented. The aim of this study was to clarify whether the collagen IX tryptophan alleles influence the symptomatic degeneration of the lumbar disc in Japanese patients with herniated nucleus pulposus. We performed a prospective study of 84 patients who underwent lumbar discectomy. The degree of disc degeneration was evaluated by magnetic resonance images in relation to the collagen IX genotype. Twenty patients (21.4%) had the Trp2 allele and no patients had the Trp3 allele. Patients under 40 years with the Trp2 allele showed more severe disc degeneration at the surgical level than did those without the Trp2 allele (odds ratio 6.00, P=0.043). In contrast, patients aged 40 years or over did not show significant association between disc degeneration and collagen IX genotype. Our results suggest that the Trp2 allele is an age-dependent risk factor for the severity of disc degeneration in younger patients with symptomatic herniated nucleus pulposus of the lumbar spine.
(Keyword)
Adult / Collagen Type IX / Female / Genetic Predisposition to Disease / Humans / Intervertebral Disc / Intervertebral Disc Displacement / Lumbar Vertebrae / Magnetic Resonance Imaging / Male / Odds Ratio / Polymorphism, Genetic / Prospective Studies / Risk Factors
Toshinori Sakai, Shinsuke Katoh, Koichi Sairyo, Kousaku Higashino, Nori Hirohashi and Natsuo Yasui : Extension of contained rupture of an abdominal aortic aneurysm into a lumbar intervertebral disc. Case report., Journal of Neurosurgery. Spine, Vol.7, No.2, 221-226, 2007.
(Summary)
Chronic contained rupture of an abdominal aortic aneurysm (AAA) is a rare event, making its diagnosis difficult. A delayed diagnosis and delayed surgical repair compromise the outcome. In this paper the authors report the case of a chronic contained rupture of an AAA causing spinal destruction, in which diagnosis was difficult because the lesion produced symptoms mimicking those of pyogenic spondylitis.
Koichi Sairyo, Goel K. Vijay, S Vadapalli, Vishnubhotra Lakshmi Sri, Biyani Ashok, Ebraheim A. Nabil, Terai Tomoya and Toshinori Sakai : Biomechanical comparison of lumbar spine with or without spina bifida occulta. A finite element analysis., Spinal Cord, Vol.44, No.7, 440-444, 2006.
(Summary)
Biomechanical study using finite element model (FEM) of lumbar spine. Very high coincidence of spina bifida occulta (SBO) has been reported more than in 60% of lumbar spondylolysis. The altered biomechanics due to SBO is one considerable factor for this coincidence. Thus, in this study, the biomechanical changes in the lumbar spine due to the presence of SBO were evaluated. United States of America (USA). An experimentally validated three-dimensional nonlinear FEM of the intact ligamentous L3-S1 segment was used and modified to simulate two kinds of SBO at L5. One model had SBO with no change in the length of the spinous process and the other had a small dysplastic spinous process. Von Mises stresses at pars interarticularis were analyzed in the six degrees of lumbar motion with 400 N axial compression, which simulates the standing position. The range of motion at L4/5 and L5/S1 were also calculated. It was observed that the stresses in all the models were similar, and there was no change in the highest stress value when compared to the intact model. The range of motion was also similar in all the models. The lumbar kinematics of SBO was thus shown to be similar to the intact model. SBO does not alter lumbar biomechanics with respect to stress and range of motion. The high coincidence of spondylolysis in spines with SBO may not be due to the mechanical factors.
Naoyoshi Hanaoka, Yoshiteru Kawasaki, Toshinori Sakai, Taro Nakamura, Kazuhisa Nanamori, Eijiro Nakamura, Ken Uchida and Hidehiro Yamada : Percutaneous drainage and continuous irrigation in patients with severe pyogenic spondylitis, abscess formation, and marked bone destruction., Journal of Neurosurgery. Spine, Vol.4, No.5, 374-379, 2006.
(Summary)
The use of percutaneous suction aspiration has recently become viewed as an effective management strategy for pyogenic spondylitis unresponsive to conservative treatment. What remains unclear is whether it can be effective for severe pyogenic spondylitis in which abscess formation or marked bone destruction is present. The authors undertook a study to clarify answers to this question. The authors evaluated clinical and radiographic/neuroimaging data obtained in five patients with severe pyogenic spondylitis, extensive abscesses, and marked bone destruction. These patients had undergone percutaneous drainage and continuous irrigation because open surgery was considered contraindicated in light of their poor general health. The mean period during which continuous irrigation was applied was 9 days (range 7-11 days), and the mean period during which the drainage tube was in place was 19 days (range 13-38 days). All patients suffered from back pain, which was relieved by the percutaneous technique in four patients after a mean of 8 days. The abscesses and inflammation resolved in all patients. Progressive osseous destruction was not observed, and open surgery was performed in only one patient in whom back pain persisted as a result of spinal instability. After an unsuccessful course of conservative treatment, severe pyogenic spondylitis with abscess formation or marked bone destruction was successfully treated using percutaneous drainage and continuous irrigation. Based on their results, the authors believe that this procedure can be used in patients with severe pyogenic spondylitis that was unresponsive to conservative treatment, particularly in those whose general health is poor.
Terai Tomoya, Henmi Tatsuhiko, Kanematsu Yoshiji, Fujii Koji, Mishiro Takuya, Toshinori Sakai and Koichi Sairyo : Adult onset tethered cord syndrome associated with intradural dermoid cyst. A case report., Spinal Cord, Vol.44, No.4, 260-262, 2006.
(Summary)
A case report and a review of literature. To describe a rare case of adult onset tethered cord syndrome associated with intradural dermoid cyst. General Orthopedics, Japan. A 50-year-old woman was referred to us because of right leg pain and pollakiuria. Neurological examinations and radiological assessments including myelography, computerized tomography scan and Magnetic resonance image were carried out. We diagnosed it as the adult onset tethered cord syndrome associated with an intradural cystic lesion. The cystic lesion was totally removed following laminectomy from L5 through S4. Histologically, the tumor was diagnosed as a dermoid cyst. Intradural dermoid could produce adult onset tethered cord syndrome, but it was not reported in the English literatures to our knowledge.
Toshinori Sakai, Yamada Hidehiro, Nakamura Taro, Nanamori Kazuhisa, Yoshiteru Kawasaki, Hanaoka Naoyoshi, Nakamura Eijiro, Uchida Ken, Goel K. Vijay, Vishnubhotra Lakshmi Sri and Koichi Sairyo : Lumbar spinal disorders in patients with athetoid cerebral palsy. A clinical and biomechanical study., Spine, Vol.31, No.3, E66-E70, 2006.
(Summary)
Radiologic study for patients with athetoid cerebral palsy (CP), and a biomechanical study using the finite-element model (FEM). To understand the lumbar disorders of athetoid CP patients and the etiology based on the results from the FEM study. Cervical spondylotic myelopathy is a well-identified spinal disorder associated with cerebral palsy, especially in athetoid type. One can rationalize that the athetoid involuntary trunk movement may induce stress-related lumbar disorders. Until now, very few investigations have been conducted on lumbar disorders that could occur in patients with CP. Sixty-one cases with athetoid cerebral palsy were clinically reviewed. Radiographs of the lumbar spine in 30 cases with low back pain were taken. From these radiographs, the incidence of lumbar spondylolysis and endplate lesion was analyzed. The biomechanical study was conducted using a three-dimensional FEM of the ligamentous lumbar spine. Axial compression of 400 N was applied to simulate preload on the spine during the standing position followed with 10.6 Nm moment to simulate extension and axial rotation. The combined motion of extension and axial rotation was also simulated. During supine position, pure extension and rotation were simulated, and no preload was applied. The von Mises stresses were computed at the pars interarticularis at the each level and compared for different motions. Among the 61 patients, 41 complained of symptoms such as low back and leg pain. Thirty of these 41 patients gave their consents to undergo radiographic evaluation. Twenty-eight of the 30 patients (93.3%) showed stress-related disorders such as the spondylolysis and/or vertebral endplate lesions. Spondylolysis was found in 18 of the 30 patients (60.0%). Spondylolysis was observed at the multiple levels in 4 patients involving two levels in 2 cases and three levels in the other 2 cases. Vertebral endplate lesions (deformity) were seen in 26 (86.7%) of the 30 patients. Overall, the lesions (deformity) were found in 109 of 330 endplates (33.0%) out of all lumbar endplates in the 30 patients. The FEM based results showed that stresses at pars interarticularis of L5 were the highest of all levels in all loading modes, with or without preload. However, compared with the extension or axial rotation alone modes, the combined motion of extension and rotation showed higher stresses at the pars interarticularis. The athetoid involuntary movements in CP patients may cause stress-related lumbar disorders. Especially, combined extension and rotation due to the involuntary trunk motion may contribute to the high incidence of spondylolysis.
Ami Inui, Koichi Sairyo, Shinsuke Katoh, Kousaku Higashino, Toshinori Sakai, M Shiiba and Natsuo Yasui : Extruded lumbar osseous endplate causing long-term radiculopathy in an adult: an endoscopic excision., Minimally Invasive Neurosurgery : MIN, Vol.49, No.1, 55-57, 2006.
(Summary)
In this report, we described an adult case that had a long-term radiculopathy due to an extruded osseous endplate of the lumbar spine at the L5-S1 intervertebral disc level. The osseous material inside the extruded material was not absorbed, and it had continued compressing the nerve root for one year. Endoscopically, the bony fragment was successfully removed. After the surgery, the patient's symptom disappeared, and neurological deficits became normalized. In conclusion, we propose that surgical intervention should be taken into account for the treatment of HNP, when the extruded material contains bony fragment such as osseous endplate.
Kousaku Higashino, Shinsuke Katoh, Koichi Sairyo, Toshinori Sakai, Hirofumi Kosaka and Natsuo Yasui : Preservation of C7 spinous process does not influence the long-term outcome after laminoplasty for cervical spondylotic myelopathy., International Orthopaedics, Vol.30, No.5, 362-365, 2006.
(Summary)
Axial pain is one of the major complications after laminoplasty, and preservation of C7 spinous process during the procedure can reduce the axial pain. However, it has not been elucidated whether laminoplasty preserving the C7 spinous process can maintain neurological improvement for a long time. The purpose of our retrospective study was to investigate the long-term neurological outcome after open-door laminoplasty preserving the C7 spinous process for cervical spondylotic myelopathy (CSM). Clinical and radiological outcomes were analysed in 42 patients who underwent open-door laminoplasty preserving C7 spinous process and followed up for more than 5 years. Neurological function was evaluated by means of the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. Axial pain was assessed using a visual analog scale (VAS) at the last examination. Alignment and motion of the cervical spine were measured from radiographs, and magnetic resonance imaging (MRI) was used to evaluate postoperative compression at C7. The mean JOA score was 9.4 before surgery and 12.0 at the latest follow-up. The mean VAS score in 26 patients score was 9.7/100. No compression of the spinal cord was observed in any MRI at the latest follow-up. Preservation of the C7 spinous process does not influence the long-term outcome of CSM after laminoplasty. Although we did not have a comparative group, the procedure described here should be considered as the solution.
We report the case of a 42-year-old Japanese woman with unusual diaphyseal dysplasia of bilateral femora. Radiographs showed thickening and sclerosis of the cortex with resultant enlargement of the diaphysis, unclear demarcation of the surface of the cortex, and no periosteal reaction. These changes were found on the left femur at the first presentation, and those on the right femur developed within several years. Although this patient partly presented characteristics of Ribbing disease and Camurati-Engelmann disease, the focal involvement of bilateral femora suggested an unknown pathogenesis.
Fujii Koji, Henmi Tatsuhiko, Kanematsu Yoshiji, Mishiro Takuya and Toshinori Sakai : Surgical treatment of lumbar disc herniation in elderly patients., The Journal of Bone and Joint Surgery. British Volume, Vol.85, No.8, 1146-1150, 2003.
(Summary)
Between 1995 and 1999, 12 patients aged 65 years or more (mean 70.2) with lumbar disc herniation, underwent partial laminectomy and nucleotomy. The results were compared with those of 25 younger patients aged between 20 and 40 years (mean 30.1), who underwent the same surgical procedure. The Japanese Orthopedic Association (JOA) score was used to assess the clinical outcome. The minimum follow-up was 12 months. The pre- and post-operative total JOA scores and the rate of improvement of the JOA score were not significantly different between the elderly (11.1, 24.3 points, and 74.1%), and the younger group (11.6, 26.4 points and 84.5%). The results of this study indicate that the outcome of lumbar discectomy in elderly patients is as good as in younger patients.
(Keyword)
Activities of Daily Living / Adult / Age Factors / Aged / Diskectomy / Female / Follow-Up Studies / Humans / Intervertebral Disc Displacement / Lumbar Vertebrae / Male / Severity of Illness Index / Statistics, Nonparametric / Treatment Outcome
Terai Tomoya, Henmi Tatsuhiko, Kanematsu Yoshiji, Fujii Koji, Mishiro Takuya and Toshinori Sakai : Clinical evaluation of aged patients who underwent surgery for femoral neck fractures: comparative study of clinical results according to age., Journal of Orthopaedic Surgery (Hong Kong), Vol.10, No.1, 23-28, 2002.
(Summary)
The objective was to assess mortality and ambulatory ability for elderly patients over 90 years of age with femoral neck fractures treated surgically. From January 1998 to March 1999, 60 patients aged over 80 years were chosen for the study. The patients had a mean age of 87.1 years. The mean follow-up period was 12.9 months. The patients were classified into three groups according to age: group A (80-84 years old), group B (85-89 years old) and group C (over 90 years old). The rates of recovered postoperative walking ability were 72.2% (13/18) of group A, 65.2% (15/23) of group B and 84.2% (16/19) of group C. These patients were followed up until death or for at least one year. The overall mortality rates were 11.1% (2/18) of group A, 17.4% (4/23) of group B and 10.5% (2/19) of group C.
(Keyword)
Aged / Aged, 80 and over / Arthroplasty / Female / Femoral Neck Fractures / Fracture Fixation, Internal / Humans / Male / Recovery of Function / Treatment Outcome / Walking
Fujii Koji, Henmi Tatsuhiko, Kanematsu Yoshiji, Mishiro Takuya, Toshinori Sakai and Terai Tomoya : Fractures of the distal end of radius in elderly patients: a comparative study of anatomical and functional results., Journal of Orthopaedic Surgery (Hong Kong), Vol.10, No.1, 9-15, 2002.
(Summary)
The functional and anatomical results of distal end of radius fractures with severe displacement in 22 elderly patients are reviewed in this retrospective study. The mean age of the patients was 69.4 years (range, 60-88 years) and the mean follow-up period was 24 months (range, 12-53 months). According to the sum of demerit points (Saito, 1983), the latest follow-up functional end results were excellent in 64% of fractures and good in 36%. As for the anatomical results at follow-up, the average radial tilt was 20.7 degrees, ulnar variance was 4.0 mm, and palmar tilt was -2.7 degrees respectively. Though most of the patients had satisfactory outcome and the functional results did not correlate with the radiographic evidence of minor deformities, the functional results of the patients with radial shortening of 6 mm or over were poor. Furthermore, the grip power was the most significant factor related to subjective evaluation and did not improve significantly in patients with the non-dominant hand injured.
(Keyword)
Aged / Aged, 80 and over / Colles' Fracture / Female / Fracture Healing / Humans / Male / Middle Aged / Orthopedic Procedures / Recovery of Function / Retrospective Studies / Severity of Illness Index / Treatment Outcome
Koichi Sairyo, Shinsuke Katoh, Toshinori Sakai, Mishiro Takuya and Ikata Takaaki : Characteristics of velocity-controlled knee movement in patients with cervical compression myelopathy: what is the optimal rehabilitation exercise for spastic gait?, Spine (Phila Pa 1976)., Vol.26, No.23, E535-E538, 2001.
Toshinori Sakai and Koichi Sairyo : Decompression and direct repair of lumbar spondylolysis in adults, Orthopedic surgery, Vol.62, No.8, 730-734, Jul. 2011.
Kosuke Sugiura, Masatoshi Morimoto, Fumitake Tezuka, Kazuta Yamashita, Toshinori Sakai and Koichi Sairyo : Early return to work after minimally invasive full endoscopic decompression surgery in medical doctors: a case series., The 21st Annual Meeting of the Pacific and Asian Society of Minimally Invasive Spine Surgery (PASMISS), Jul. 2021.
2.
Nori Sato, Nakahara Keiko, Yoshihiro Ishihama, Toshinori Sakai, Takashi Chikawa, Koichi Sairyo and Shinsuke Katoh : Three-Dimensional Finger Motion Analysis in a Patient with Cervical Myelopathy, 2019 Annual Meeting of the Orthopaedic Research Society, Austin, TX, USA, Feb. 2019, 2019.
3.
Ishihama Yoshihiro, Toshinori Sakai, Hiroaki Manabe, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Takashi Chikawa and Koichi Sairyo : Abdominal free air on postoperative CT scans following XLIF, 2nd SOLAS Japan region meeting(November 10,2018), Nagoya, Nov. 2018.
4.
Kazuta Yamashita, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Fumitake Tezuka, Akihiro Nagamachi and Koichi Sairyo : Percutaneous endoscopic lumbar discectomy(PED)for top athletes, The 16th Japan-Korea Combined Meeting of Orthopaedic Sports Medicine(September 8,2018), Tokushima, Sep. 2018.
5.
Kazuta Yamashita, Higashino Kosaku, Hiroaki Manabe, Toshinori Sakai, Yoichiro Takata, Fumitake Tezuka, Takashi Chikawa and Koichi Sairyo : Reducing mechanical stress in immature pediatric spondylolisthesis can make modification of sacral dome: a study of spondylolisthesis rat model, The 16th Japan-Korea Combined Meeting of Orthopaedic Sports Medicine(September 8,2018), Tokushima, Sep. 2018.
6.
Hiroaki Manabe, Toshinori Sakai, Ryo Miyagi, Morimoto Masatoshi, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Takashi Chikawa and Koichi Sairyo : MORPHOLOGICAL EVALUATION OF LUMBAR NERVE ROOT USING USING DIFFUSION-WEIGHTED MR NEUROGRAPHY, Spine Across the Sea 2018(July 29-August 2,2018), Hawaii, Jul. 2018.
7.
Hiroaki Manabe, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Takashi Chikawa, Toshinori Sakai and Koichi Sairyo : Percutaneous endscopic surgery via transforaminal approach for L5/S intra-canal disc herniation- Relation between bone resection volume and pelvic height-, The 18th Annual Meeting of the Pacific and Asian Society of Minimally Inbasive Spine Surgery(PASMISS 2018)(July 19-21,2018), Taiwan, Jul. 2018.
8.
Hiroaki Manabe, Kazuta Yamashita, Kousaku Higashino, Morimoto Masatoshi, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Takashi Chikawa and Koichi Sairyo : Reducing mechanical stress in immature pediatric spondylolisthesis can make remodeling of sacral dome: a study of spondylolisthesis rat model, The 18th Annual Meeting of the Pacific and Asian Society of Minimally Inbasive Spine Surgery(PASMISS 2018)(July 19-21,2018), Taiwan, Jul. 2018.
9.
Fumio Hayashi, Kousaku Higashino, Morimoto Masatoshi, Yuichiro Goda, Toshinori Sakai, Nori Sato, Morimoto Yuki, Yoichiro Takata, Fumitake Tezuka and Koichi Sairyo : Association between hypertrophy of ligamentum flavum in lumbar spinal canal stenosis and increased myofibroblasts in dorsal layer of ligament, The 18th Annual Meeting of the Pacific and Asian Society of Minimally Inbasive Spine Surgery(PASMISS 2018)(July 19-21,2018), Taiwan, Jul. 2018.
10.
Ishihama Yoshihiro, Hiroaki Manabe, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Takashi Chikawa and Koichi Sairyo : Percutaneous endoscopic true transforaminal lumbar intervertebral fusion(PE-TLIF)- surgical technique and the short-term results, The 18th Annual Meeting of the Pacific and Asian Society of Minimally Inbasive Spine Surgery(PASMISS 2018)(July 19-21,2018), Taiwan, Jul. 2018.
11.
Fumitake Tezuka, Futatsugi Toshimasa, Sugiura Kosuke, Ishihama Yoshihiro, Hiroaki Manabe, Fumio Hayashi, Kazuta Yamashita, Yoichiro Takata, Toshinori Sakai, Takashi Chikawa and Sairyo Koichi and : Transforaminal percutaneous endoscopic lumbar decompression surgery as the revision surgery, The 18th Annual Meeting of the Pacific and Asian Society of Minimally Inbasive Spine Surgery(PASMISS 2018)(July 19-21,2018), Taiwan, Jul. 2018.
12.
Fumitake Tezuka, Sugiura Kosuke, Ishihama Yoshihiro, Hiroaki Manabe, Fumio Hayashi, Kazuta Yamashita, Yoichiro Takata, Toshinori Sakai, Takashi Chikawa and Koichi Sairyo : Transforaminal percutaneous endoscopic lumbar discectomy using foraminoplastic outside-in technique under local anesthesia, The 18th Annual Meeting of the Pacific and Asian Society of Minimally Inbasive Spine Surgery(PASMISS 2018)(July 19-21,2018), Taiwan, Jul. 2018.
13.
Fumitake Tezuka, Sugiura Kosuke, Yoshihiro Ishihama, Hiroaki Manabe, Fumio Hayashi, Kazuta Yamashita, Yoichiro Takata, Toshinori Sakai, Takashi Chikawa and Koichi Sairyo : Percutaneous endoscopic lumbar discectomy for the high school athletes, The 18th Annual Meeting of the Pacific and Asian Society of Minimally Inbasive Spine Surgery(PASMISS 2018)(July 19-21,2018), Taiwan, Jul. 2018.
14.
重清 昌太, Fumitake Tezuka, Hiroaki Manabe, Yoichiro Takata, Toshinori Sakai, Takashi Chikawa and Koichi Sairyo : Osteochondroma of the lumbar lesion: report of two cases, The 28th Japanese-Korean Combined Orthopaedic Symposium, Jun. 2018.
15.
加納 将嗣, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Takashi Chikawa and Koichi Sairyo : Adult-onset Stress Fracture in the Lumbar Spine of High-level Athletes:Case Series, The 28th Japanese-Korean Combined Orthopaedic Symposium, Jun. 2018.
16.
Hiroaki Manabe, Kazuta Yamashita, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Takashi Chikawa and Koichi Sairyo : Accurate diagnosis of low back pain in adult elite athletes, The 28th Japan Korea Conbined Orthopaedic Symposium(June 14-15,2018), Gifu, Jun. 2018.
17.
Fumitake Tezuka, Hiroaki Manabe, Yoichiro Takata, Toshinori Sakai, Takashi Chikawa and Koichi Sairyo : The effectiveness and safety of transforaminal percutaneous endoscopic lumbar decompression surgery for the lumbar spinal canal stenosis under local anesthesia, The 28th Japan Korea Conbined Orthopaedic Symposium(June 14-15,2018), Gifu, Jun. 2018.
18.
Hiroaki Manabe, Toshinori Sakai, Ryo Miyagi, Morimoto Masatoshi, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Takashi Chikawa and Koichi Sairyo : MORPHOLOGICAL EVALUATION OF LUMBAR NERVE ROOT USING USING DIFFUSION-WEIGHTED MR NEUROGRAPHY, 49th International Society for the Study of the Lumbar Spine Annual Meeting(May 14-18,2018), Banff, May 2018.
19.
Hiroaki Manabe, Toshinori Sakai, Morimoto Masatoshi, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Takashi Chikawa and Koichi Sairyo : RADIOLOGICAL OUTCOMES OF LUMBAR INTERBODY FUSION USING TITANIUM-COATED PEEK CAGE, 48th International Society for the Study of the Lumbar Spine Annual Meeting(May 14-18,2018), Banff, May 2018.
20.
Toshinori Sakai, Sugiura Kosuke, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Takashi Chikawa and Koichi Sairyo : Signal intensity changes of the posterior elements of the lumbar spine in symptomatic adults., 47th International Society for the Study of the Lumbar Spine Annual Meeting(May 14-18,2018), Banff,Canada, May 2018.
21.
Toshinori Sakai, Goto Tsuyoshi, Sugiura Kosuke, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Takashi Chikawa and Koichi Sairyo : Bony healing rate of stress fracture occurred in discontinuous lamina due to pars defect or spina bifida occulta., 45th International Society for the Study of the Lumbar Spine Annual Meeting(May 14-18,2018), Banff, May 2018.
22.
Kazuta Yamashita, Kousaku Higashino, Hiroaki Hayashi, Toshinori Sakai, Yoichiro Takata, Fumio Hayashi, Fumitake Tezuka, Hiroaki Manabe, Takashi Chikawa, Yoshihiro Fukui and Koichi Sairyo : A cadaveric study for estimating the dose reduction when using pulsed and collimated x-ray beams in procedures, 45th International Society for the Study of the Lumbar Spine Annual Meeting(May 14-18,2018), Banff, May 2018.
23.
Kazuta Yamashita, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Fumio Hayashi, Fumitake Tezuka, Hiroaki Manabe, Takashi Chikawa and Koichi Sairyo : Remodeling of the dome deformity in the immature rat lumbar spondylolisthesis model, 45th International Society for the Study of the Lumbar Spine Annual Meeting(May 14-18,2018), Banff, May 2018.
24.
Fumio Hayashi, Kousaku Higashino, Morimoto Masatoshi, Yuichiro Goda, Toshinori Sakai, Yoichiro Takata, Fumitake Tezuka and Koichi Sairyo : Histochemical analysis of ligamentum flavum on various collagens and myofibroblasts compared dorsal with dural side, 2018 Orthopaedic Research Society Annual Meeting (March 10-13,2018), New Orleans, Mar. 2018.
25.
Toshinori Sakai, Yoichiro Takata, Fumitake Tezuka, Takashi Chikawa and Koichi Sairyo : Assessment of cage subsidence at 1year follow-up after stand-alone XLIF, 1st SOLAS Japan Regional Meeting, Tokyo, Dec. 2017.
26.
Toshinori Sakai, Yoichiro Takata, Fumitake Tezuka, Takashi Chikawa and Koichi Sairyo : Risk management for avoidance of major vascular/lumbar segmental artery injury during lateral transpsoas approach, 1st SOLAS Japan Regional Meeting, Tokyo, Dec. 2017.
27.
Akihiro Nagamachi, Masatoshi Morimoto, Fumitake Tezuka, Fumio Hayashi, Kazuta Yamashita, Yoichiro Takata, Toshinori Sakai, Kousaku Higashino and Koichi Sairyo : Medical Economic Efficiency of Percutaneous Endoscopic Lumbar Discectomy in Japan., 17th Annual meeting of the Pacific and Asian Society of the Minimally Invasive Spine Surgery(July 27-29, 2017), Sapporo, Jul. 2017.
28.
山屋 誠司, Toshinori Sakai, Fumitake Tezuka, 山﨑 悠平, Kazuta Yamashita, Yoichiro Takata, Kousaku Higashino, Takashi Chikawa, Akihiro Nagamachi and Koichi Sairyo : Endoscopic Decompression Surgery via a Transforaminal Approach under Local Anesthesia for Lateral Recess Stenosis Due to Lumbar Degenerative Disease., 17th Annual meeting of the Pacific and Asian Society of the Minimally Invasive Spine Surgery(July 27-29, 2017), Sapporo, Jul. 2017.
29.
山屋 誠司, Toshinori Sakai, Fumitake Tezuka, 山﨑 悠平, Kazuta Yamashita, Yoichiro Takata, Kousaku Higashino, Takashi Chikawa, Akihiro Nagamachi and Koichi Sairyo : The Usefulness of Surgical Techniques and The Management of Local Anesthesia to Avoid Exiting Nerve Root Injury During Percutaneous Endoscopic Lumbar Discectomy., 17th Annual meeting of the Pacific and Asian Society of the Minimally Invasive Spine Surgery(July 27-29, 2017), Sapporo, Jul. 2017.
30.
Fumitake Tezuka, Hiroaki Manabe, Masatoshi Morimoto, Fumio Hayashi, Kazuta Yamashita, Yoichiro Takata, Toshinori Sakai, Akihiro Nagamachi and Koichi Sairyo : Risk Assessment of Abdominal and Retroperitoneal Organ Injuries Performing Transforaminal Percutaneous Endoscopic Lumbar Discectomy., 17th Annual meeting of the Pacific and Asian Society of the Minimally Invasive Spine Surgery(July 27-29, 2017), Sapporo, Jul. 2017.
31.
Kazuta Yamashita, Yoichiro Takata, Toshinori Sakai, Kousaku Higashino and Koichi Sairyo : Long term results of arthroscopic debridement of osteochondritis dissecans in adolescent athletes, American Orthopaedic Society for Sports Medicine Annual Meeting 2017(July 20-23, 2017), Toronto, Jul. 2017.
32.
Masatoshi Morimoto, Fumitake Tezuka, Fumio Hayashi, Kazuta Yamashita, Yoichiro Takata, Toshinori Sakai, Kousaku Higashino, Akihiro Nagamachi, Koichi Sairyo, Ryosuke Sato, Masato Miyake and Seiichi Oyadomari : ER STRESS AGGRAVATES THE HYPERTROPHY OF THE LIGAMNTUM FLAVUM, International Society for the Study of Lumbar Spine(ISSLS) 2017( May 29June 2, 2017), Athens, May 2017.
33.
Yoichiro Takata, Fumitake Tezuka, Kazuta Yamashita, Toshinori Sakai, Kousaku Higashino, Akihiro Nagamachi and Koichi Sairyo : The correlation between spinal alignments with clinical outcome after lumbar decompression/fusion surgery in patients with lumbar spinal canal stenosis, International Society for the Study of Lumbar Spine(ISSLS) 2017( May 29June 2, 2017), Athens, May 2017.
34.
Kazuta Yamashita, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Fumitake Tezuka, Yasuyoshi Mase, Akihiro Nagamachi and Koichi Sairyo : Low back pain of the adolescent athletes -The pathology falls into unidentified non-specific low back pain-, The International Society for the Advancement of Spine Surgery (April 12-14,2017), Bocs Raton ,FL, Apr. 2017.
35.
Kazuta Yamashita, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Fumitake Tezuka, Akihiro Nagamachi and Koichi Sairyo : Percutaneous endoscopic lumbar discectomy(PED) for top athletes, The International Society for the Advancement of Spine Surgery (April 12-14,2017), Bocs Raton ,FL, Apr. 2017.
36.
Toshinori Sakai, Fumitake Tezuka, Kazuta Yamashita, Yoichiro Takata, Kousaku Higashino, Akihiro Nagamachi and Koichi Sairyo : Conservative Treatment for Bony Healing in Pediatric Lumbar Spondylolysis., AAOS 2017 Annual meeting(March 14-18, 2017), San Diego, Mar. 2017.
37.
Tetsuya Matsuura, Naoto Suzue, Toshiyuki Iwame, Toshinori Sakai, Kousaku Higashino, Yoichiro Takata, Yuichiro Goda and Koichi Sairyo : Prevalence of osteochondritis dissevcans of the capitellum in young baseball players on ultrasonographic findings, The 12th Korean-Japan Joint meeting of Orthopedic Sports Medicine, Sep. 2014.
38.
Yuichiro Goda, Nori Sato, Takako Taniguchi, Yoichiro Takata, Hirofumi Kosaka, Toshinori Sakai, Kousaku Higashino, Koichi Sairyo, Shinsuke Katoh, Hisaaki Taniguchi and Natsuo Yasui : Proteomic analysis of ligamentum flavum, 52nd International Spinal Cord Society (ISCoS), Oct. 2013.
39.
Yuichiro Goda, Nori Sato, Takako Taniguchi, Yoichiro Takata, Hirofumi Kosaka, Toshinori Sakai, Kousaku Higashino, Koichi Sairyo, Shinsuke Katoh, Hisaaki Taniguchi and Natsuo Yasui : Proteomic analysis of ligamentum flavum from lumbar spinal canal stenosis, International Society for Study of the Lumbar Spine (ISSLS) 2013, May 2013.
40.
Eiko Yamabe, Toshinori Sakai, Ryo Miyagi, Toshiyasu Nakamura and Hiroshi Yoshioka : Diffusion-weighted MR nerve imaging of the median nerve at the carpal tunnel., 2013 Annual meeting of the Orthopaedic Research Society,January 26-29, 2013 (Poster Presentation ), San Antonio, TX, Jan. 2013.
41.
Yuichiro Goda, Nori Sato, Takako Taniguchi, Yoichiro Takata, Hirofumi Kosaka, Toshinori Sakai, Kousaku Higashino, Koichi Sairyo, Shinsuke Katoh, Hisaaki Taniguchi and Natsuo Yasui : Proteomic Analysis of Ligamentum Flavum from Lumbar Spinal Canal Stenosis., 2013 Annual meeting of the Orthopaedic Research Society, January 26-29, 2013 (Poster Presentation ), San Antonio, TX, Jan. 2013.
42.
Yuichiro Goda, Tadanori Sakamaki, Toshinori Sakai, Natsuo Yasui and Koichi Sairyo : Analysis of adolescent patients with MRI signal changes in the adjacent pedicle in fresh lumbar spondylolysis., The 35nd Annual meeting of ISSLS, SPINEWEEK 2012,May 28- June 1,2012 (E-poster), Geneva, May 2012.
43.
Ryo Miyagi, Koichi Sairyo, Toshinori Sakai, Natsuo Yasui and Akira Dezawa : Symptomatic laminolysis in adolescent athletes., The 35nd Annual meeting of ISSLS, SPINEWEEK 2012,May 28- June 1,2012 (E-poster), Geneva, May 2012.
44.
Toshinori Sakai, Shoichiro Takao, Koichi Sairyo, Hiromu Nishitani and Natsuo Yasui : Gender differences of radiographic findings in patients with lumbar spondylolysis., The 35nd Annual meeting of ISSLS, SPINEWEEK 2012,May 28- June 1,2012 (Special E-poster), Geneva, May 2012.
45.
Nori Sato, Takako Taniguchi, Yuichiro Goda, Hirofumi Kosaka, Kousaku Higashino, Toshinori Sakai, Koichi Sairyo, Shinsuke Katoh, Hisaaki Taniguchi and Natsuo Yasui : Quantitative proteomic analysis of human tendon and ligament, 2012 Annual Meeting of the Orthopaedic Research Society, Feb. 2012.
46.
Toshinori Sakai, Kim Jung Kap, Guo Yi, Eskander N. Ramez, Hopkins Justin, Mefford Jason, Pourmorady Jonathan, Bhatia N Nitin, Zi Xiaolin and Hoang H. Bang : A novel chemopreventive strategy for synovial sarcoma using Flavokawain B, a natural compound from Kava extract., The Connective Tissue Oncology Society, CTOS 2011 meeting, Chicago, IL, Oct. 2011.
47.
Eskander N Ramez, Randall M. Leslie, Toshinori Sakai, Guo Yi, Hoang Bang and Zi. Xiaolin : Flavokawain B, a novel naturally occurring chalcone, exhibits robust apoptotic effects and induces G2/M arrest of a uterine leiomyosarcoma cell line., The Connective Tissue Oncology Society, CTOS 2011 meeting, Chicago, IL, Oct. 2011.
48.
Kim Jung Kap, Guo Yi, Toshinori Sakai, Eskander N Ramez, McQueen Peter, Ghaffar Samia, Rooney Kevin, Christ Alexander, Zi Xiaolin and Hoang H. Bang : Targeting Neuropilin, a VEGF receptor, to control angiogenesis and tumor growth in osteosarcoma., he Connective Tissue Oncology Society, CTOS 2011 meeting, Chicago, IL, Oct. 2011.
49.
Miyagi Ryo, Koichi Sairyo, Toshinori Sakai, Bhatia N. Nitin, Yoshioka Hiroshi, Natsuo Yasui and Dezawa Akira : Symtopmatic Laminolysis in Adolescents Sports Players., The International Skeletal Society, San Diego, California, Sep. 2011.
50.
Shoichiro Takao, Toshinori Sakai, Koichi Sairyo, Junji Ueno, Natsuo Yasui and Hiromu Nishitani : Lumbar spondylolysis: clinical significance of gender difference., The International Skeletal Society, San Diego, California, Sep. 2011.
51.
Fujinaga Yasunari, Toshinori Sakai, Takahara Tato, Hitt Davis, Anavim Arash, Bhatia N. Nitin and Yoshioka Hiroshi : Optimization and initial clinical experience of single-shot diffusion-weighted lumbosacral plexus MR imaging., The International Skeletal Society, San Diego, California, Sep. 2011.
52.
Fujinaga Yasunari, Yoshioka Hiroshi, Toshinori Sakai, Sakai Yoko, Souza Felipe and Lang K Philipp : Quantitative measurement of the knee cartilage by magnetic resonance imaging validation study by multi-readers., The International Skeletal Society, San Diego, California, Sep. 2011.
53.
Guo Yi, Ghaffar Samia, Christ Alexander, Rooney Kevin, Eskander Ramez, Toshinori Sakai, Zi Xiaolin and Hoang H Bang : Wnt antagonist suppresses angiogenesis in osteosarcoma by down-regulating neuropilin-1 (NRP-1) expression., Wnt 2011, Los Angeles, California, Jun. 2011.
54.
Sakamaki Tadanori, Koichi Sairyo and Toshinori Sakai : MRI based diagnostic strategy increased the prevalence of the spondylolysis in children and adolescents with chronic low back pain., The 37th Annual meeting of ISSLS, Gothenburg, Sweden, Jun. 2011.
55.
Guo Yi, Rubin Elyssa, Pourmorady Jonathan, Christ Alexander, Rooney Kevin, Eskander Ramez, Toshinori Sakai, Bhatia N. Nitin, Zi Xiaolin and Hoang H. Bang : DKK3, a secreted Wnt antagonist, suppress tumorigenic potential and lung metastasis of osteosarcoma., American Association for Cancer Research 102nd Annual Meeting, Orlando, Florida, Apr. 2011.
56.
Toshinori Sakai, Guo Yi, Ramez Eskander, Mefford Jason, Hopkins Justin, Zi Xiaolin, Bhatia N. Nitin and Hoang H. Bang : Flavokawain B, a kava chalcone, induces apoptosis in synovial sarcoma cell lines., American Association for Cancer Research 102nd Annual Meeting, Orlando, Florida, Apr. 2011.
57.
Nori Sato, T Taniguchi, Yuichiro Goda, Hirofumi Kosaka, Kousaku Higashino, Toshinori Sakai, Koichi Sairyo, Shinsuke Katoh, H Taniguchi and Natsuo Yasui : Establishment of a Method for Proteomic Analysis of Human Achilles Tendon, 2011Annual Meeting of the Orthopaedic Research Society(2011.1.13-16), Long Beach Conbention Center (Long Beach,California), Jan. 2011.
58.
Nori Sato, Takako Taniguchi, Yuichiro Goda, Hirofumi Kosaka, Kosaku Higashino, Toshinori Sakai, Koichi Sairyo, Shinsuke Katoh, Hisaaki Taniguchi and Natsuo Yasui : Establishment of a Method for Proteomic Analysis of Human Achilles Tendon., 2011 Annual meeting of the Orthopaedic Research Society, Long Beach, California, Long Beach, California, Jan. 2011.
59.
Nori Sato, Taniguchi Takako, Goda Yuichiro, Kosaka Hirofumi, Higashino Kosaku, Toshinori Sakai, Koichi Sairyo, Shinsuke Katoh, Hisaaki Taniguchi and Natsuo Yasui : Development of a Method for Proteomic Analysis of Human Yellow Ligament., 2011 Annual meeting of the Orthopaedic Research Society, Long Beach, California, Long Beach, California, Jan. 2011.
60.
Toshinori Sakai, Shinsuke Katoh, Koichi Sairyo, Chisato Tanaka, Rumi Katashima, Katsuhiko Yoshimoto and Mitsuo Itakura : An SNP in the 3region of the Collagen11 Alpha 2 Gene is Associated with Susceptibility to OPLL., 47th Annual Meeting of Orthopaedic Research Society, San Francisco, Feb. 2001.
Nori Sato, Toshinori Sakai, 梅村 公子, 森脇 好乃美, 森脇 笙, 西良 浩一 and 加藤 真介 : 手指の三次元動作解析におけるマーカー貼付簡素化の検討, The Japanese Journal of Rehabilitation Medicine, Vol.56, 2-P1-3-5, May 2019.
Fumio Hayashi, Kousaku Higashino, Masatoshi Morimoto, Yuichiro Goda, Toshinori Sakai, Nori Sato, Yoichiro Takata, Fumitake Tezuka and Koichi Sairyo : 黄色靱帯肥厚メカニズムの解明 筋線維芽細胞に着目して, The Journal of the Japanese Orthopaedic Association, Vol.92, No.3, S655, Mar. 2018.
Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Yuichiro Goda, Koichi Sairyo and Yoshihiro Fukui : Evaluation of PED procedure between surgery for patients and training using fresh cadavers, 第120回日本解剖学会全国学術集会,第92回日本生理学会, Mar. 2015.
Toshinori Sakai, Ramez Eskander, Yi Guo, Kap Jung Kim, Jason Mefford, Justin Hopkins, Nitin Bhatia, Xiaolin Zi and Bang Hoang : Flavokawain Bは滑膜肉腫細胞株のapoptosisを誘導する, 第27回日本整形外科学会基礎学術集会(2012.10.26-27)(Poster presentation), Oct. 2012.