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.
Yutaka Kinoshita, Toshinori Sakai, Kosuke Sugiura, Takahisa Kurosaki, Jiro Kobayashi, Saori Soeda, Yasuaki Tamaki, Masatoshi Morimoto, Hiroaki Manabe, Fumitake Tezuka, Kazuta Yamashita and Koichi Sairyo : Can MRI Replace CT in the Diagnosis and Staging of Lumbar Spondylolysis in Pediatric Patients? A Validation Study Using MR Bone Imaging, Journal of Pediatric Orthopedics, 2025.
(Summary)
Magnetic resonance (MR) bone imaging may reduce radiation exposure compared with computed tomography (CT) in staging lumbar spondylolysis. This study aimed to validate the consistency between MR bone imaging and CT. We retrospectively investigated short tau inversion recovery (STIR), MR bone imaging, and CT scans of patients diagnosed with lumbar spondylolysis who underwent MRI and CT scans within 2 weeks between November 2021 and March 2023.We identified 190 fractures in 968 pars interarticularis of 105 patients. MR bone imaging was based on Siemens 3 Tesla T1-weighted volumetric interpolated breath-hold imaging (T1 VIBE). The CT-based staging and T1 VIBE-based staging were matched [incomplete fracture, complete fracture, gap of ≥2 mm (gap)]. For fracture detection with CT as a reference, the respective sensitivity, specificity, and accuracy were 94%, 99%, and 99% for incomplete fracture, 74%, 100%, and 98% for complete fracture, 81%, 99%, and 99% for gap, and 97%, 100%, and 100% for any fracture. When we assessed 62 pars with complete fracture or a gap, the rates were 91%, 100%, and 99%, respectively. In staging 190 fractures with CT as a reference, the respective sensitivity, specificity, and accuracy were 94%, 91%, and 93% for incomplete fracture, 74%, 96%, and 91% for complete fracture, 81%, 96%, and 95% for gap, and 97%, 100%, and 97% for any fracture. The respective values were 91%, 98%, and 96% for complete fracture combined with gap. Of 153 pedicles with high signal change on STIR, 10 showed no fracture line, 110 showed incomplete fracture lines, 30 showed complete fracture lines, and 3 showed a gap on T1 VIBE, compared with 5, 109, 39, and 0, respectively, on CT. The T1 VIBE sequence is highly accurate, although it has some limitations in fracture detection. T1 VIBE can be used clinically in conjunction with STIR and may replace CT in determining the treatment strategy for lumbar spondylolysis, resulting in reduced medical radiation exposure to pediatric patients. Level III diagnostic study.
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.
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, 30, 1, 39-43, 2025.
(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.
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.
Masatoshi Morimoto, Sudharshan Tripathi, Manoj Kodigudla, Emi Motohashi, Junzo Fujitani, K Vijay Goel and Koichi Sairyo : Biomechanical Effects of Thoracic Flexibility and Stiffness on Lumbar Spine Loading: A Finite Element Analysis Study., World Neurosurgery, 184, e282-e290, 2024.
(Summary)
Biomechanically, disc stress and pars interarticularis stress decrease in the flexible thoracic spine. Flexibility of the thoracic spine reduces lumbar spine loading and could help to prevent stress-related disorders.
(Keyword)
Humans / Finite Element Analysis / Lumbar Vertebrae / Laminectomy / Intervertebral Disc / Range of Motion, Articular / Biomechanical Phenomena
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.
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.
Yasuyuki Ohmichi, Noriaki Mima, Keizo Wada, Ryo Okada, Yasuaki Tamaki, Daisuke Hamada, Tomohiro Goto, Masatoshi Morimoto, Tsutomu Enomoto, Hiroki Hayashi and Koichi Sairyo : Can TBS reference values be a valid indicator for clinical vertebral fracture? A cross-sectional study., Journal of Bone and Mineral Metabolism, 42, 1, 60-68, 2024.
(Summary)
Trabecular bone score (TBS) is partially independent of fracture risk. Reference values for TBS have not been established in official guidelines, and thus clinicians often have difficulty interpreting TBS results. This study aimed to investigate whether reference values for TBS could be a valid indicator for clinical vertebral fracture (CVF).
(Keyword)
Humans / Female / Spinal Fractures / Cross-Sectional Studies / Reference Values / Cancellous Bone / Osteoporosis / Bone Density / Absorptiometry, Photon / Lumbar Vertebrae / Osteoporotic Fractures
Yu Otake, Fumitake Tezuka, Kazuta Yamashita, Masatoshi Morimoto, Kosuke Sugiura, Makoto Takeuchi, Shunsuke Tamaki, Junzo Fujitani, Hiroshi Kageyama and Koichi Sairyo : Full-Endoscopic Foraminal Decompression for Foraminal Stenosis Following Osteoporotic Vertebral Fracture in an Elderly Woman Under Local Anesthesia:A Case Report., The Journal of Medical Investigation : JMI, 71, 1.2, 179-183, 2024.
(Summary)
Osteoporotic vertebral fracture (OVF) is common in the elderly population. In this report, we describe a case with radiculopathy due to foraminal stenosis caused by OVF in a very elderly patient that was treated successfully by full-endoscopic foraminotomy under local anesthesia. The patient was an 89-year-old woman who presented with a chief complaint of left leg pain for 5 years. She visited a couple of hospitals and finally consulted us to determine the exact cause of the pain. Computed tomography scans were obtained and selective nerve root block at L3 was performed. The diagnosis was radiculopathy at L3 due to foraminal stenosis following OVF. The patient had severe heart disease, so we decided to avoid surgery under general anesthesia and planned full-endoscopic spine surgery under local anesthesia. We performed transforaminal full-endoscopic lumbar foraminotomy at L3-L4 to decompress the L3 nerve root. The leg pain disappeared completely immediately after surgery. Postoperative computed tomography confirmed appropriate bone resection. The leg pain did not recur during a year of postoperative follow-up. OVF may cause lumbar radiculopathy as a result of foraminal stenosis, and transforaminal full-endoscopic lumbar foraminotomy under local anesthesia would be the best option in an elderly patient with poor general condition. J. Med. Invest. 71 : 179-183, February, 2024.
(Keyword)
Humans / Female / Aged, 80 and over / Anesthesia, Local / Spinal Fractures / Spinal Stenosis / Decompression, Surgical / Endoscopy / Osteoporotic Fractures / Lumbar Vertebrae / Radiculopathy
Takahiro Ogawa, Masatoshi Morimoto, Fumitake Tezuka, Kazuta Yamashita, Kosuke Sugiura, Shutaro Fujimoto, Michael Castro, Junzo Fujitani and Koichi Sairyo : Cardiac arrest as an unusual complication in transforaminal full-endoscopic spine surgery under local anesthesia:a case report., The Journal of Medical Investigation : JMI, 71, 3.4, 314-319, 2024.
(Summary)
Transforaminal full-endoscopic surgery can be performed under local anesthesia, which is safer than general anesthesia, especially in the elderly. However, emergencies can still occur under local anesthesia. We describe a case of cardiac arrest at the start of full-endoscopic spine surgery under local anesthesia.The patient was an 80-year-old woman with right lower leg pain caused by two-level lumbar spinal canal stenosis. Two-stage full-endoscopic spine surgery under local anesthesia was planned. The first surgery was completed uneventfully. However, during the second surgery, cardiac arrest occurred because of Mobitz type II atrioventricular block. Percutaneous pacing was started immediately, followed by insertion of a temporary pacemaker via the femoral artery as a life-saving measure. Four days later, a permanent pacemaker was implanted. One month later, the second-stage decompression was completed without complications.Elderly patients require careful intraoperative monitoring for emergencies during surgery under local anesthesia as under general anesthesia. J. Med. Invest. 71 : 314-319, August, 2024.
(Keyword)
Humans / Female / Aged, 80 and over / Anesthesia, Local / Heart Arrest / Endoscopy / Spinal Stenosis / Lumbar Vertebrae / Intraoperative Complications
Kosuke Sugiura, Toshinori Sakai, Masatoshi Morimoto, Hiroaki Manabe, Fumitake Tezuka, Kazuta Yamashita and Koichi Sairyo : Five Years of Follow-up after Posterior Cervical Fusion Surgery for Hirayama Disease:A Case Report., The Journal of Medical Investigation : JMI, 71, 3.4, 298-302, 2024.
(Summary)
Hirayama disease (HD) is characterized by slow progression of muscle atrophy without sensory disturbance in a single upper extremity in adolescent boys. HD can be treated using both conservative measures and surgery. However, the optimal treatment remains controversial.We have encountered an 18-year-old man with HD who presented to us with a 2-year history of progressive muscle atrophy and weakness of the left upper extremity. He underwent posterior cervical fusion surgery in the extended position without decompression. As of 5 years postoperatively, there has been no deterioration of his muscular atrophy and weakness and his condition has mildly improved. He was able to return to daily life and work with no difficulty.Although cervical fusion surgery has several risks, including adjacent segment disease, posterior spinal fusion surgery without decompression in the short segment can be considered as a surgical option for HD. J. Med. Invest. 71 : 298-302, August, 2024.
(Keyword)
Humans / Spinal Muscular Atrophies of Childhood / Male / Spinal Fusion / Adolescent / Cervical Vertebrae / Follow-Up Studies
Koichi Sairyo, Yutaro Kanda, Kozaburo Mizutani, Masashi Kumon, Saori Soeda, Fumiaki Makiyama, Ryota Mio, Masatoshi Morimoto, Shunsuke Tamaki, Keisuke Nishidono, Kosuke Sugiura, Makoto Takeuchi, Hiroaki Manabe, Fumitake Tezuka, Kazuta Yamashita, Hiroshi Kageyama and Junzo Fujitani : Transforaminal full-endoscopic decompression under local anesthesia for foraminal stenosis due to stable L5 isthmic spondylolisthesis, a technical note and review:Pars crisscross decompression., The Journal of Medical Investigation : JMI, 71, 3.4, 191-196, 2024.
(Summary)
Foraminal stenosis is one of the types of lumbar spinal stenosis. The pathology can be treated minimally invasively by full-endoscopic spine surgery (FESS). The final challenge in transforaminal FESS is foraminal stenosis in patients with stable isthmic spondylolisthesis at L5. This article provides a step-by-step explanation of how to achieve complete decompression. A cannula of 8 mm in diameter is docked at the base of the superior articular process of the sacrum. The pars crisscross that consists of the superior articular process at S1, the floating lamina, the inferior articular process at L4, and the pars ragged edge is then clearly seen endoscopically. Visualization of the pars crisscross is key to successful decompression. Starting with the superior articular process at S1, followed by partial removal of the floating lamina. Next, the tip of the inferior articular process at L4 is removed. The pars ragged edge is then carefully shaved. Finally, decompression of the exiting nerve root at L5 is confirmed. This report provides the first step-by step description of full-endoscopic decompression of foraminal stenosis under local anesthesia in patients with stable L5 isthmic spondylolisthesis, which we have named "full-endoscopic pars crisscross decompression". J. Med. Invest. 71 : 191-196, August, 2024.
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
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.
Yasuyuki Ohmichi, Noriaki Mima, Ryo Okada, Keizo Wada, Masatoshi Morimoto and Koichi Sairyo : Identifying vertebral fractures in the Japanese population using the trabecular bone score: a cross-sectional study., BMC Musculoskeletal Disorders, 23, 1, 976, 2022.
(Summary)
TBS was a significant indicator of vertebral fractures in the Japanese population and might contribute to identifying patients with vertebral fractures, particularly those with osteopenia who need pharmacologic therapy.
(Keyword)
Humans / Female / Spinal Fractures / Cancellous Bone / Cross-Sectional Studies / Japan / Absorptiometry, Photon / Bone Density / Osteoporosis / Lumbar Vertebrae / Bone Diseases, Metabolic / Fractures, Bone / Osteoporotic Fractures
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.
Masatoshi Morimoto, Shogo Tomiyama, Makoto Takeuchi, Yuji Yamada, Masahiro Kashima, Naoyuki Yoshida, Hirofumi Takami, Koichi Sairyo and Toru Maeda : Anterior Longitudinal Ligament Avulsion Fracture when Changing the Patient's Position from Lateral to Prone during Extreme Lateral Interbody Fusion: A Case Report., Spine Surgery and Related Research, 7, 1, 103-105, 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.
Kosuke Sugiura, Masatoshi Morimoto, Kousaku Higashino, Makoto Takeuchi, Hiroaki Manabe, Shoichiro Takao, Toru Maeda and Koichi Sairyo : Transitional vertebrae and numerical variants of the spine : prevalence and relationship to low back pain or degenerative spondylolisthesis., The Bone & Joint Journal, 103-B, 7, 1301-1308, 2021.
(Summary)
Overall, 24% of subjects had anomalies in the thoracolumbar region: the type of anomaly differed between males and females, which could have significant implications for spinal surgery. A decreased number of vertebrae was associated with DS: numerical variants may potentially be a clinical problem. Cite this article:
(Keyword)
Aged / Aged, 80 and over / Disability Evaluation / Female / Humans / Japan / Low Back Pain / Lumbar Vertebrae / Male / Middle Aged / Prevalence / Retrospective Studies / Spondylolisthesis / Thoracic Vertebrae / Tomography, X-Ray Computed
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.
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.
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.
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.
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.
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.
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.
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.
56.
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.
Fumio Hayashi, Kousaku Higashino, Masatoshi Morimoto, Yuichiro Goda, Toshinori Sakai, Nori Sato, Yoichiro Takata, Fumitake Tezuka and Koichi Sairyo : 黄色靱帯肥厚メカニズムの解明 筋線維芽細胞に着目して, The Journal of the Japanese Orthopaedic Association, 92, 3, S655, Mar. 2018.