This study compared the 1-year clinical outcomes and disc degeneration rates after transforaminal full-endoscopic lumbar discectomy (TF-FED), condoliase injection, open discectomy (OD), and microendoscopic discectomy (MED) for lumbar disc herniation (LDH). In total, 279 patients with LDH were divided into four treatment groups: TF-FED, OD, MED, and condoliase injection. Outcomes were evaluated on the basis of the complication rate, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), visual analog scale (VAS) scores, and the modified MacNab criteria. Surgical and hospital costs were assessed. Disc degeneration and endplate bone marrow edema were evaluated using magnetic resonance images. The mean postoperative JOABPEQ, VAS, or modified MacNab scores among the four groups had no significant differences. Additionally, the nerve injury or reoperation rate among the TF-FED, OD, and MED groups had no significant difference. However, the reoperation rate with condoliase injection was high because of residual disc herniation. Surgical and hospital costs were lower with condoliase injection and higher with OD and MED than those with TF-FED. With TF-FED and condoliase injection, the Pfirrmann grade progressed, and the disc height was significantly smaller than that with OD and MED. Endplate bone marrow edema was more common with condoliase injection and TF-FED. All groups had good outcomes. TF-FED and condoliase injection may reduce the burden of surgery because they can be performed under local anesthesia with little blood loss and low medical costs but tend to be associated with disc degeneration and endplate bone marrow edema. A randomized controlled study with a larger sample is needed.
Junzo Fujitani, Fumitake Tezuka, Takahiro Ogawa, Shunsuke Tamaki, Kosuke Sugiura, Makoto Takeuchi, Masatoshi Morimoto, Kazuta Yamashita and Koichi Sairyo : Mismatch between Augmented Reality Navigation Images and Actual Location of a Cauda Equina Tumor:A Case Report., 2024.
(Summary)
Combined use of intraoperative ultrasound and augmented reality navigation seems advisable in such cases. J. Med. Invest. 71 : 174-176, February, 2024.
Kazuta Yamashita and Koichi Sairyo : PPS:腰椎分離症修復術 Smiley face Rod Method, MEDICAL VIEW CO., LTD., May 2017.
Academic Paper (Judged Full Paper):
1.
Yasukazu Hijikata, Kazuta Yamashita, Natsuko Hatsusaka, Tatsuo Nagata, Hiroko Kitamura, Koichi Morota, Satoru Matsuzaki, Koichi Nakagami, Go Hitomi, Tomoko Kuriyama, Munehiko Kowatari, Koichi Chida, Hiroshi Sasaki and Takashi Moritake : Prevalence of Cataractous Changes in the Eyes and Chronic Inflammatory Changes in the Hands Among Spine Surgeons., The Journal of Bone and Joint Surgery. American Volume, 107, 7, 2025.
(Summary)
The impact of radiation exposure on cataracts and hand skin cancer in orthopaedic and spine surgeons remains understudied. This study aimed to investigate the prevalence of cataracts and chronic hand inflammation in orthopaedic and spine surgeons and to assess their association with radiation exposure.A cross-sectional analysis was conducted on orthopaedic and spine surgeons attending the 38th Annual Meeting of the Neurospinal Society of Japan or the 31st Annual Meeting of the Japanese Society for the Study of Low Back Pain. Cataractous changes were categorized into none, lens micro-opacity, or cataracts and were detailed alongside the prevalence of chronic hand inflammation, which included longitudinal melanonychia and hand eczema. Participants were divided into quartiles according to hand-exposure opportunities in the operating and fluoroscopy rooms in 2022. Prevalence ratios and 95% confidence intervals (CIs) of chronic hand inflammation in the upper quartiles relative to the first quartile were calculated using modified Poisson regression adjusted for potential confounders.The median work experience of the 162 participants was 23 years, and the median number of hand-exposure opportunities was 70 (interquartile range [IQR], 20 to 123) in the operating room and 20 (IQR, 0 to 60) in the fluoroscopy room. The prevalence of cataracts was 20% (32 participants), and the prevalence of cataractous changes, including lens micro-opacity, was 40% (64 participants). Chronic hand inflammation was present in 62 participants (38%), of whom 52 had longitudinal melanonychia and 23 had hand eczema. The adjusted prevalence ratios of chronic hand inflammation relative to the lowest quartile of hand-exposure opportunities in the operating room were 0.91 (0.50, 1.66) for quartile 2, 0.72 (0.41, 1.25) for quartile 3, and 1.56 (0.97, 2.50) for quartile 4. For fluoroscopy room exposure, the adjusted prevalence ratios were 2.31 (1.16, 4.58) for quartile 2, 2.03 (1.00, 4.09) for quartile 3, and 2.94 (1.51, 5.75) for quartile 4.This study highlighted substantial cataractous and chronic hand inflammatory changes in spine surgeons, indicating indirect and direct radiation exposure effects. Therefore, radiation safety and protective measures must be emphasized. Comparative studies with other populations and longitudinal observations are required to better understand the effects of radiation on health.Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
Yutaro Kanda, Kozaburo Mizutani, Masashi Kumon, Saori Soeda, Kosuke Sugiura, Masatoshi Morimoto, Fumitake Tezuka, Kazuta Yamashita and Koichi Sairyo : Pitfalls in the Diagnosis and Treatment of Low Back Pain in an Elite Para-athlete Successfully Treated by Transforaminal Full-endoscopic Discectomy with Thermal Annuloplasty: A Case Reports., NMC Case Report Journal, 12, 7-13, 2025.
(Summary)
We report a rare case of an elite para-athlete with lumbar disk herniation whose pain generator was difficult to diagnose and treat. A 28-year-old woman with paraplegia below the T10 level felt pain in her low back and left leg during a match. Magnetic resonance imaging revealed a lateral lumbar disk herniation and a high-intensity zone on the left side at the L5-L6 level. Because the pain disappeared following L5 selective nerve block, we performed transforaminal full-endoscopic discectomy alone. Despite the disappearance of leg pain after surgery, her low back pain persisted. We performed thermal annuloplasty because reproducible pain and subsequent temporary pain relief by discography and discoblock after the initial surgery indicated discogenic pain. Her suffering from back pain gradually reduced. She returned to competition 2 months after the second surgery without intensive rehabilitation due to difficulty in performing core exercises for abdominal muscles. During the return match, she experienced a relapse of pain in the low back and left leg, which was caused by a recurrence of disk herniation. We performed a full-endoscopic discectomy with thermal annuloplasty again. Her clinical symptoms were immediately relieved. We enhanced her thoracic spine flexibility to prevent subsequent recurrence. Finally, she returned to international competition 2 months after the third surgery. Close attention to para-athletes is required to achieve an accurate diagnosis of pain generators and prevent recurrence due to their distinctive disorders. Thermal annuloplasty and rehabilitating thoracic movement can be an excellent option for para-athletes with discogenic low back pain.
Takahiro Ogawa, Masatoshi Morimoto, Shutaro Fujimoto, Masaru Tominaga, Yasuyuki Ohmichi, Kosuke Sugiura, Fumitake Tezuka, Kazuta Yamashita and Koichi Sairyo : Development of New Surgical Training for Full Endoscopic Surgery Using 3D-Printed Models., Spine Surgery and Related Research, 8, 6, 591-599, 2024.
(Summary)
Full endoscopic spine surgery continues to spread worldwide but has a long learning curve. Conventional endoscopy training uses live pigs or human cadavers, which has disadvantages such as high costs and limited availability. Therefore, this study aimed to develop and evaluate three-dimensional (3D)-printed models for endoscopy training.Models for 3D printing were generated using raw imaging data from 1.0-mm slices of computed tomography scans, and each part was printed using a different colored material. The combined model was used for training as part of the full endoscopy training kit.This approach offers several advantages. First, it enables the creation of accurate disease models, such as lumbar disc herniation and other abnormalities, which are useful for both surgical training and preoperative simulations. Second, it is useful for learning surgical orientation. During surgical training, the surgical field can be viewed directly through an endoscope or with the naked eye. By using various colors, it becomes easier to recognize the orientation. Third, the amount of drilling resection can be easily confirmed, facilitating feedback. Finally, training for various surgical techniques is possible, including endoscopic holding techniques and using the endoscope's outer sheath to retract nerves. However, this approach also has some disadvantages, such as the lack of bleeding, inability to reproduce tissue hardness, and difficulty in faithfully recreating soft tissue, such as connective tissue, blood vessels, and fat. Therefore, it is difficult to reproduce the hardness of the calcified disc or disc herniation with apophyseal ring fracture. Moreover, 3D-printed models are not suitable for surgical training using the interlaminal approach because it is difficult to perform separation between the ligamentum flavum and dural matter or between the dural matter and intervertebral disc.3D-printed models are a useful complement to live pigs and human cadavers in surgical training and can reduce the time required to acquire endoscopic skills.
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, 85, 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.
Daisuke Yamashita, Kazuta Yamashita, Kosuke Sugiura, Masatoshi Morimoto, Hiroaki Manabe, Fumitake Tezuka and Koichi Sairyo : Robotic-assisted minimally invasive repair surgery for progressive spondylolysis in a young athlete: a technical note., Journal of Surgical Case Reports, 2024, 2, 2024.
(Summary)
Presently, the invasiveness of direct repair surgery for lumbar spondylolysis is relatively high. Thus, high school and junior high school students who play sports often cannot return to sports before graduation because of the invasiveness. The use of a robotic system enabled an accurate and minimally invasive procedure. Robotic-assisted minimally invasive direct pars repair surgery is useful for young patients with progressive spondylolysis.
Shutaro Fujimoto, Takashi Inokuchi, Shunsuke Tamaki, Kosuke Sugiura, Makoto Takeuchi, Masatoshi Morimoto, Fumitake Tezuka, Kazuta Yamashita, Junzo Fujitani and Koichi Sairyo : Return-to-play outcomes after full-endoscopic spine surgery under local anesthesia in professional baseball players: Comparison by timing of surgery., Journal of Orthopaedic Science, 2024.
(Summary)
TF-FESS is a good technique for achieving a quick return to play in professional baseball players. In particular, surgery performed during the post-season could allow players to return to play after adequate rehabilitation with no game loss.
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, 12, 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.
Kazuya Kishima, Kiyoshi Yagi, Kazuta Yamashita, Fumitake Tezuka, Masatoshi Morimoto, Yoichiro Takata, Toshinori Sakai, Toru Maeda and Koichi Sairyo : Full-endoscopic spine surgery in oldest old patients aged over 90 years:A case report., The Journal of Medical Investigation : JMI, 71, 1.2, 169-173, 2024.
(Summary)
FESS is a good surgical procedure for elderly patients who are in a poor general condition because it is minimally invasive and can be performed under local anesthesia with early mobilization. J. Med. Invest. 71 : 169-173, February, 2024.
(Keyword)
Humans / Aged, 80 and over / female / female / Endoscopy / Lumbar Vertebrae
Yasuaki Tamaki, Kazuta Yamashita, Daiki Nakajima, Yasuyuki Ohmichi, Yoshinori Takahashi, Michihiro Takai, Shunsuke Tamaki, Tomohiro Goto, Hiroaki Hayashi, Kousaku Higashino, Yoshihiro Tsuruo and Koichi Sairyo : Radiation exposure doses to the surgical team during hip surgery is significantly higher during lateral imaging than posteroanterior imaging: a cadaveric simulation study., Journal of Occupational Medicine and Toxicology, 18, 1, 27, 2023.
(Summary)
Radiation exposure dose was significantly higher during lateral imaging up to 19.8 times comparing to the posteroanterior imaging. It is effective to reduce the lateral imaging time for reducing the intraoperative radiation exposure. In addition, appropriate distance from fluoroscopy resulted in very low exposure for nurses and anesthesiologists. Surgeon should pay attention that surgical staff do not get closer than necessary to the irradiation field.
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, 84, 6, 528-535, 2023.
(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.
Masatoshi Morimoto, Keizo Wada, Shunsuke Tamaki, Saori Soeda, Kosuke Sugiura, Hiroaki Manabe, Fumitake Tezuka, Kazuta Yamashita and Koichi Sairyo : Clinical Outcome of Full Endoscopic Trans Kambin's Triangle Lumbar Interbody Fusion: A Systematic Review., World Neurosurgery, 178, 317-329, 2023.
(Summary)
Full-endoscopic (FE) lumbar interbody fusion (LIF) is now a widely used type of minimally invasive surgery (MIS). Although FE-LIF includes LIF with foraminoplasty via a Kambin's triangle approach (FE-KLIF) and LIF with foraminotomy via an interlaminar approach, these techniques are rarely discussed separately. This review evaluates the outcomes and complications of FE-KLIF reported in the literature. The PubMed, Medline, Embase, Web of Science, and Cochrane Library databases were searched for studies reporting the outcomes of FE-KLIF. Of 464 publications assessed, 11 met our inclusion criteria. Although the most frequently treated level was L4/5, L5/S1 was also treated. FE-KLIF was performed under local anesthesia and sedation or under epidural anesthesia without general anesthesia. Visual analog scale and Oswestry Disability Index scores were improved postoperatively in all uncontrolled studies; however, there was no significant difference in these scores in studies that compared FE-KLIF with posterior LIF (PLIF) or MIS-transforaminal LIF (TLIF). There was also no significant difference in the fusion rate between FE-KLIF and PLIF or MIS-TLIF. In terms of complications, although there were no reports of hematoma, dural tear and surgical site infection were reported in 1 paper each, with transient nerve disorders reported in 5 studies (frequency, 1.8%-23.5%). This review indicates that FE-KLIF is a feasible and viable surgical option for lumbar degenerative disease. However, the amount and level of evidence is low for the studies included in this review, and the data on long-term outcomes remain limited.
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.
Various approaches to lumbar interbody fusion have been described. The usefulness of full-endoscopic trans-Kambin's triangle lumbar interbody fusion has recently been reported. This technique has several advantages in patients with degenerative spondylolisthesis, including the ability to improve symptoms without decompression surgery. Moreover, given that the entire procedure is performed percutaneously, it can be performed without increasing the operation time or surgical invasiveness, even in obese patients. In this article, we discuss these advantages and illustrate them with representative cases.
Junzo Fujitani, Kazuta Yamashita, Fumitake Tezuka, Kosuke Sugiura and Koichi Sairyo : Effects of Pilates Exercise on Age-related Kyphosis, EC Orthopaedics, 14, 2, 15-21, 2023.
(Summary)
This report describes a case in which Pilates exercise was used successfully to treat age-related kyphosis. The patient was a 72-year-old woman who presented to us complaining of abnormal posture and being unable to stand for more than 3 min without using a walker or cane. A standing lateral plain radiograph showed kyphotic deformity of the thoracic spine and a C7 sagittal vertical axis to be 185 mm. We recommended thoracic to iliac spinal correction and fusion surgery. However, the patient opted for conservative treatment, so was referred for rehabilitation. Her kyphosis was flexible, with a decrease in the thoracic kyphosis angle from about 50 degrees in the standing position to about 10 degrees in the lying position. The basic concept when using Pilates exercise for rehabilitation in patients with kyphosis is stretching of the ventral aspect of the body and strengthening exercises for the dorsal aspect of the spine. After 4 weeks of rehabilitation, the patient's posture became more upright and she could stand without support for more than 10 min. Even though we have had only one such case, our experience is that Pilates exercise can be a useful rehabilitation tool for patients with age-related kyphosis.
Kazuta Yamashita, Yasuaki Tamaki, Daiki Nakajima, Yasuyuki Omichi, Yoshinori Takahashi, Michihiro Takai, Tomohiro Goto, Hiroaki Hayashi, Kousaku Higashino, Yoshihiro Tsuruo and Koichi Sairyo : A Cadaveric Simulation Study of Radiation Exposure to the Surgical Team during Fluoroscopic Spinal Surgery: How Much Are We Exposed?, Spine Surgery and Related Research, 7, 4, 341-349, 2023.
(Summary)
The occupational radiation exposure dose to surgical team members during C-arm fluoroscopy-guided lumbar spinal procedures varies according to the X-ray source position. Our findings would help surgical team members to know the risk of radiation exposure during various fluoroscopic procedures. Surgeons in particular need to reduce their radiation exposure by using appropriate shielding and technique.
Masatoshi Morimoto, Ryo Okada, Kosuke Sugiura, Hiroaki Manabe, Takashi Inokuchi, Fumitake Tezuka, Kazuta Yamashita, Shoichiro Takao, Junzo Fujitani and Koichi Sairyo : Low Back Pain and Lumbar Degeneration in Japanese Professional Baseball Players., Orthopaedic Journal of Sports Medicine, 10, 10, 2022.
(Summary)
Among professional baseball players in their 20s, lumbar degeneration was less common, and they most frequently developed diseases less related to degeneration, such as LDH. However, among players in their 30s, lumbar degeneration was more advanced, and degenerative diseases such as discogenic pain occurred more frequently. Research on training methods could lead to the prevention of LBP. Our data may be applicable to other professional athletes and will contribute to diagnosis and treatment.
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, 69, 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.
Takashi Inokuchi, Fumitake Tezuka, Kazuta Yamashita, Masatoshi Morimoto, Kosuke Sugiura, Junzo Fujitani and Koichi Sairyo : Transforaminal Full-endoscopic Discectomy for Gas-containing Herniated Nucleus Pulposus at L5-S1 Under Local Anesthesia : A Case Report., The Journal of Medical Investigation : JMI, 69, 3.4, 328-331, 2022.
(Summary)
The vacuum phenomenon is often observed in degenerative disc disease, whereas gas-containing disc herniation is relatively rare. Full-endoscopic discectomy at the lumbar spine level via a transforaminal approach, which was established and subsequently refined over the last two decades, requires only an 8-mm skin incision and causes minimal damage to the paravertebral muscles. Foraminoplasty, performed with a high-speed drill, is a useful technique to enlarge the foramen, especially when applied at the L5-S1 level, where the trajectory is limited because of anatomical structures such as the iliac crest. Here, we report a case of gas-containing lumbar disc herniation at L5-S1 that was successfully treated by transforaminal full-endoscopic discectomy. The patient was a 62-year-old man with low back pain and pain in the plantar aspect of the right great toe. Magnetic resonance and computed tomography scans demonstrated gas-containing lumbar disc herniation at L5-S1 on the right. Following foraminoplasty, transforaminal full-endoscopic lumbar discectomy was successfully performed under local anesthesia. The patient's symptoms improved immediately after the surgery. Transforaminal full-endoscopic surgery can be effective and minimally invasive even when performed for gas-containing disc herniation. J. Med. Invest. 69 : 328-331, 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, 83, 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.
Masatoshi Morimoto, Kosuke Sugiura, Kousaku Higashino, Hiroaki Manabe, Fumitake Tezuka, Keizo Wada, Kazuta Yamashita, Shoichiro Takao and Koichi Sairyo : Association of spinal anomalies with spondylolysis and spina bifida occulta, European Spine Journal, 31, 4, 858-864, 2022.
(Summary)
To investigate the association of spinal anomalies with lumbar spondylolysis and spina bifida occulta (SBO). A total of 1190 patients with thoracic, abdominal, and pelvic computed tomography scans available were categorized according to the number of presacral (thoracic and lumbar) mobile vertebrae and the presence or absence of lumbosacral transitional vertebrae (LSTV). The prevalence of spondylolysis and SBO and the association of spinal anomalies with these disorders were evaluated. Normal morphology (17 mobile vertebra with no LSTV) was found in 607 men (86.5%) and 419 women (85.9%) and about 14% of patients had anomalies. Spondylolysis was found in 74 patients (6.2%), comprising 54 men (7.7%) and 20 women (4.1%). SBO involving the lumbar spine was found in 9 men (1.3%) and 2 women (0.4%). Spondylolysis was significantly more common in men with 18 vertebrae without LSTV (21.1%) than in those with 17 vertebrae without LSTV (7.2%) (p = 0.002). The prevalence of spinal anomalies was 55.6% in men and 50.0% in women with SBO that included a lumbar level was significantly higher than in both men (13.5%, p < 0.001) and women (4.8%, p = 0.003) without SBO. These findings indicate that there is a relationship between spinal anomalies and both spondylolysis and SBO, which may lead to elucidation of the mechanism of onset of spondylolysis and improve its treatment and prognosis. Awareness that patients with SBO involving the lumbar spine have an increased likelihood of a spinal anomaly may help to prevent level errors during spinal 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, 69, 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.
Fumio Hayashi, Masatoshi Morimoto, Kousaku Higashino, Yuichiro Goda, Nori Sato, Fumitake Tezuka, Kazuta Yamashita and Koichi Sairyo : Myofibroblasts are increased in the dorsal layer of the hypertrophic ligamentum flavum in lumbar spinal canal stenosis., The Spine Journal, 22, 4, 697-704, 2021.
(Summary)
The results of this study partially elucidate the molecular mechanisms of LF hypertrophy and suggest that myofibroblasts may be involved in age-related degeneration of the LF.
Daiki Nakajima, Kazuta Yamashita, Makoto Takeuchi, Kosuke Sugiura, Masatoshi Morimoto, Fumitake Tezuka, Kiyoshi Yagi, Kazuya Kishima and Koichi Sairyo : Full-endoscopic Spine Surgery for Discogenic Low Back Pain with High-intensity Zones and Modic Type 1 Change in a Professional Baseball Player., NMC Case Report Journal, 8, 1, 587-593, 2021.
(Summary)
Non-specific low back pain in athletes can be caused by discogenic back pain, Modic type 1 change, and facet joint arthritis. In this report, we describe a full-endoscopic surgical strategy that we have used to treat a patient with both discogenic pain and Modic type 1 change. The patient was a 32-year-old professional baseball player who played an infield position and had a 2-year history of low back pain. Three years earlier, he had undergone micro-endoscopic discectomy for left herniated nucleus pulposus at L5/S1. His leg symptoms resolved postoperatively, and he returned to playing baseball the following season. However, his low back pain gradually increased. Two years after the initial surgery, he was experiencing low back pain in daily life and found it very difficult to play baseball. Short T1 inversion recovery (STIR) magnetic resonance imaging (MRI) revealed Modic type 1 change and high-signal intensity zones in degenerated discs at L4/5 and L5/S1. Injection of xylocaine 1% reduced the pain temporarily, confirming that the pain generator was at L4/5 and L5/S1. The pathological diagnosis was discogenic pain with Modic type 1 change. We performed full-endoscopic disc cleaning (FEDC) surgery for the Modic type 1 change and thermal annuloplasty (TA) for the discogenic pain at these levels. The patient's low back pain decreased steadily thereafter. Six months after surgery, he returned to baseball, playing for a full season without pain. We have successfully treated a professional baseball player with discogenic pain and Modic type 1 change by full-endoscopic surgery.
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, 8, 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, 8, 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, 82, 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, 61, 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.
Kazuta Yamashita, Kousaku Higashino, Hiroaki Hayashi, Kazuki Takegami, Fumio Hayashi, Yoshihiro Tsuruo and Koichi Sairyo : Direct measurement of radiation exposure dose to individual organs during diagnostic computed tomography examination., Scientific Reports, 11, 1, 2021.
(Summary)
Ionizing radiation from Computed tomography (CT) examinations and the associated health risks are growing concerns. The purpose of this study was to directly measure individual organ doses during routine clinical CT scanning protocols and to evaluate how these measurements vary with scanning conditions. Optically stimulated luminescence (OSL) dosimeters were surgically implanted into individual organs of fresh non-embalmed whole-body cadavers. Whole-body, head, chest, and abdomen CT scans were taken of 6 cadavers by simulating common clinical methods. The dosimeters were extracted and the radiation exposure doses for each organ were calculated. Average values were used for analysis. Measured individual organ doses for whole-body routine CT protocol were less than 20 mGy for all organs. The measured doses of surface/shallow organs were higher than those of deep organs under the same irradiation conditions. At the same tube voltage and tube current, all internal organ doses were significantly higher for whole-body scans compared with abdominal scans. This study could provide valuable information on individual organ doses and their trends under various scanning conditions. These data could be referenced and used when considering CT examination in daily clinical situations.
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, 46, 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, 61, 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, 68, 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, 68, 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, 29, 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, 7, 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, 7, 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, 5, 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, 67, 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, 67, 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, 67, 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, 67, 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, 60, 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, 6, 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, 7, 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, 4, 2, 187-189, 2019.
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, 12, 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, 6, 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, 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, 13, 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, 28, 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, 59, 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, 24, 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, 33, 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, 66, 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, 66, 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, 66, 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, 66, 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, 66, 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, 66, 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.
Kazuta Yamashita and Koichi Sairyo : Ⅱ．成長期スポーツ外傷・障害について -部位別の特徴と種目- 腰椎外傷の特徴と種目関連性, Monthly Book MEDICAL REHABILITATION, 228, 48-55, 2018.
66.
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, 12, 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, 3, 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, 3, 1, 67-70, 2018.
(Summary)
Contralateral pars defect remains an unfavorable factor for bony healing discontinuous laminar stress fractures.
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, 12, 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.
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, 65, 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, 58, 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, 28, 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.
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, 17, 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, 78, 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.
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, 11, 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, 3, 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, 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, 26, 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, 37, 1, 2-6, 2017.
84.
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, 1, 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, 64, 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, 7, 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, 64, 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, 64, 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, 64, 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, 64, 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, 64, 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.
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, 6, 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.
Fumitake Tezuka, Masatoshi Morimoto, Kazuta Yamashita, Yoichiro Takata and Koichi Sairyo : Discogenic pain with radiological findings of high intensity zone and toxic annular tear, Orthopeadics and Traumatology, 63, 11, 1469-1473, Oct. 2020.
(Keyword)
High intensity zone / Toxic annular tear / Discogenic pain
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.
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.
3.
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.
4.
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.
5.
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.
6.
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.
7.
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.
8.
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.
9.
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.
10.
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.
11.
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.
12.
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.
13.
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.
14.
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.
15.
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.
16.
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.
17.
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.
18.
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.
19.
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.
20.
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.
21.
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.
22.
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.
23.
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.
24.
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.
25.
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.
26.
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.
27.
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.
Fumitake Tezuka, Takuma Abe, Kosuke Sugiura, INOKUCHI Takashi, Masatoshi Morimoto, Kazuta Yamashita and Koichi Sairyo : 拡張現実顕微鏡(AR顕微鏡)を用いた脊椎手術の展望および使用経験, 第16回日本CAOS研究会【開催期間:2022年3月17日-18日】, Mar. 2022.
59.
Kosuke Sugiura, Masatoshi Morimoto, Inoguchi Tkashi, Fumitake Tezuka, Kazuta Yamashita and Koichi Sairyo : Effectiveness of the new training system of full endoscopic spine surgeries using NIPRO Bone Model., 第264回徳島医学会学術集会(on line), Feb. 2022.
Development of quantitative analysis technology for objects using photon-counting X-ray radiography and derivation of quantitative indicators of bone strength (Project/Area Number: 24K03306 )