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.
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
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.
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.
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.
In recent years, exercise therapy using Pilates(= motor control)has been attracting attention. In the human skeleton, stability joints and mobility joints are arranged alternately(Joint by Joint Theory). The aim of Pilates exercise therapy is to improve the stability of the cervical and lumbar spine, which tend to be over-mobile, and to improve the mobility of the thoracic spine and hip joints, which tend to be under-mobile, in order to achieve and maintain a neutral position(physiological kyphosis)of the spinal column. Dynamic and static control of the spine through Pilates, with an awareness of axial elongation(AE)and spine articulation(SA), can be used to stabilize the affected area and increase the mobility of adjacent body parts. In addition, the use of specialized Pilates equipments can be introduced to rehabilitation at a relatively early stage because it can assist in multiple levels of movement. It can easily simplify and complicate posture ; thus, it can be expected to improve performance in a wide range of activities from daily life to sports.
Junzo Fujitani and Koichi Sairyo : Outside-in Technique for Transforaminal Full-Endoscopic Lumbar Discectomy Under Local Anesthesia: A Review Article, EC Orthopaedics, 12, 10, 40-48, 2021.
(Summary)
Transforaminal full-endoscopic lumbar discectomy (TF-FELD) was first introduced more than 20 years ago, followed by interlaminar full-endoscopic lumbar discectomy (IL-FELD). Both TF-FELD and IL-FELD require only an 8-mm skin incision and damage to the back muscles is minimal. Thus, these methods are the least invasive disc surgery at present. However, unlike the interlaminar method, the transforaminal method can be performed under the local anesthesia, which is its biggest advantage. Although an inside-out approach after foraminoplasty was initially recommended, an outside-in approach has recently been proposed for safety reasons. This technique is less invasive and allows an early return to the original level of activity. TF-FELD has also been used in athletes because of its minimal invasiveness. It was initially thought that the transforaminal approach would be difficult to perform at L5/S1, so the interlaminar approach was recommended. However, with the advent of foraminoplasty, TF-FELD is now possible even at L5/S1. This review article explains the TF-FELD technique in detail.
The effect of long-term strenuous resistance training on glucose effectiveness (SG) was examined by comparing 11 strength-trained and 20 sedentary males by a minimal model approach. Lean body mass (LBM) was measured by hydrostatic weighing. The LBM in strength-trained subjects (65.7 +/- 3.1 kg) was significantly larger than in sedentary subjects (56.6 +/- 1.2 kg, P < .01). The glucose disappearance constant ([KG] 3.07% +/- 0.45% min(-1)) and insulin sensitivity ([SI] 17.5 +/- 2.0 x 10(-5) x min(-1) x pmol/L(-1)) in strength-trained subjects were significantly higher than in sedentary subjects (2.06% +/- 0.14% x min(-1) and 10.3 +/- 1.2 x 10(-5) x min(-1) x pmol/L(-1), P < .05). SG in strength-trained subjects (0.024 +/- 0.003 min(-1)) was significantly higher than in sedentary subjects (0.018 +/- 0.001 min(-1), P < .05). These results thus suggest that the improved glucose tolerance in strength-trained subjects was due to increased SG and SI.
(Keyword)
Adult / Blood Glucose / Body Composition / Exercise Test / Glucose Tolerance Test / Humans / insulin / male / Models, Biological / oxygen consumption / Physical Endurance / Physical Fitness / Weight Lifting
Kentaro Doi, Ataru Taniguchi, Yoshikatsu Nakai, Hitomi Kawamura, Yasuki Higaki, Hideki Yokoi, Hiroaki Tanaka, Junzo Fujitani, Masashige Suzuki, Kumpei Tokuyama, Masahiko Sakai and Mitsuo Fukushima : Decreased glucose effectiveness but not insulin resistance in glucose-tolerant offspring of Japanese non-insulin-dependent diabetic patients: a minimal-model analysis., Metabolism: Clinical and Experimental, 46, 8, 880-883, 1997.
(Summary)
The aim of the study was to estimate insulin sensitivity (SI), insulin secretion, and glucose effectiveness (SG) in 10 subjects with normal glucose tolerance (eight men and two women) with a family history of non-insulin-dependent diabetes mellitus (NIDDM offspring). Ten glucose-tolerant subjects (eight men and two women) without a family history of NIDDM served as control subjects. All subjects were Japanese. They underwent a modified frequently sampled intravenous glucose tolerance test (FSIGT): glucose (300 mg/kg body weight) was administered, and insulin (20 mU/kg over 5 minutes) was infused from 20 to 25 minutes after glucose. SI and SG were estimated by Bergman's minimal-model method. No significant difference was observed in body mass index (22.6 +/- 1.5 v 21.5 +/- 0.6 kg/m2) and fasting glucose (5.1 +/- 0.1 v 5.2 +/- 0.1 mol/L) and insulin (40.7 +/- 6.3 v 42.6 +/- 6.7 pmol/L). SI was not different between the two groups (0.83 +/- 0.11 v 0.94 +/- 0.15 x 10(-1).min-1.pmol/ L-1, P > .05). The acute insulin response to glucose (AIRglucose) estimated by intravenous glucose tolerance testing was significantly lower in the offspring than in the normal controls (2,139 +/- 265 v 3,438 +/- 318 pmol/L.min, P < .05). The glucose disappearance rate (KG) and SG were significantly diminished in the offspring versus normal controls (KG, 1.50 +/- 0.22 v 2.10 +/- 0.15 min-1, P < .05; SG, 0.016 +/- 0.003 v 0.023 +/- 0.002 min-1, P < .05). Thus, glucose-tolerant Japanese NIDDM offspring with normal insulin sensitivity are characterized by a reduced AIRglucose and diminished SG. This is the first report that glucose resistance but not insulin resistance already exists in glucose-tolerant Japanese NIDDM offspring.
(Keyword)
Blood Glucose / Case-Control Studies / Diabetes Mellitus, Type 2 / female / Glucose Tolerance Test / Humans / insulin resistance / Japan / male / Time Factors
Y Higaki, T Kagawa, Junzo Fujitani, A Kiyonaga, M Shindo, A Taniguchi, Y Nakai, K Tokuyama, M Suzuki and H Tanaka : Effects of a single bout of exercise on glucose effectiveness., Journal of Applied Physiology, 80, 3, 754-759, 1996.
(Summary)
The effects of a single bout of exercise on glucose effectiveness (SG) and insulin sensitivity (SI) in 22 sedentary subjects were estimated with a minimal model approach. The intravenous glucose tolerance test (IVGTT) was performed 1) 11 h after an exercise bout on a cycle ergometer at the lactate threshold level (mild exercise) for 60 min, 2) 11 h after an exercise bout at the 4 mM lactate level (hard exercise) for 36 +/- 1 min, 3) 11 h after an exhaustive-exercise bout (exhaustive exercise) for 96 +/- 7 min, or 4) without any prior exercise (control). Only the exhaustive exercise increased the glucose disappearance constant (2.69 +/- 0.28 vs. 2.05 +/- 0.13%/min; P < 0.05) and SI (15.0 +/- 2.0 vs. 10.3 +/- 0.9 x 10(-5) min/pM: P < 0.05) in comparison with the control condition. The SG and SG at zero insulin (GEZI) were not affected by any exercise condition. However, a marked individual difference in GEZI emerged after the exhaustive exercise and could be divided into two subgroups: one decreased in GEZI (0.014 +/- 0.001 vs. 0.007 +/- 0.001 min-1) and the other increased in GEZI (0.014 +/- 0.001 vs. 0.021 +/- 0.003 min-1). The former subgroup was accompanied by elevated levels of plasma creatine kinase (100 +/- 16 vs. 598 +/- 315 IU/l; P < 0.05) and myoglobin (Mb; 46 +/- 4 vs. 126 +/- 47 ng/ml; P < 0.05), whereas the latter subgroup showed no significant change in creatinine kinase (99 +/- 10 vs. 128 +/- 9 IU/l; P > 0.05) and Mb (50 +/- 7 vs. 51 +/- 4 ng/ml; P > 0.05). In both subgroups, SI was similarly increased after the exhaustive exercise. These results thus suggest that a single bout of exercise that results in muscle damage or changes in muscle permeability, as reflected in the increased creatine kinase and Mb levels, decreases GEZI, whereas exhaustive exercise without such alterations increases GEZI.
(Keyword)
Adult / Blood Glucose / Creatine Kinase / Exercise / Humans / insulin / male / Time Factors
Ataru Taniguchi, Yoshikatu Nakai, Kentaro Doi, Hiroaki Fukuzawa, Mitsuo Fukushima, Hitomi Kawamura, Kumpei Tokuyama, Masashige Suzuki, Junzo Fujitani, Hiroaki Tanaka and Itaru Nagata : Insulin sensitivity, insulin secretion, and glucose effectiveness in obese subjects: a minimal model analysis., Metabolism: Clinical and Experimental, 44, 11, 1397-1400, 1995.
(Summary)
The aim of the present study was to estimate insulin sensitivity (SI), insulin secretion, and glucose effectiveness in 14 obese subjects who were further divided into two groups: one with normal glucose tolerance and the other with impaired glucose tolerance (IGT). Glucose tolerance was determined by criteria of the World Health Organization. All subjects were Japanese. They underwent a modified frequently sampled intravenous glucose tolerance test: glucose (300 mg/kg body weight) was administered, and insulin (20 mU/kg body weight given over 5 minutes) was infused from 20 to 25 minutes after administration of glucose. SI and glucose effectiveness at basal insulin (SG) were estimated by Bergman's minimal model method. Body mass index (33.0 +/- 1.8 v 30.9 +/- 1.5 kg/m2, P > .05) and fasting insulin level (127.9 +/- 30.0 v 107.4 +/- 14.4 pmol/L, P > .05) were higher in obese IGT subjects than in normal obese subjects, but were not statistically significant. With regard to fasting glucose level, obese subjects with IGT (5.9 +/- 0.3 mmol/L) had significantly higher levels than those with normal glucose tolerance (5.1 +/- 0.2 mmol/L, P < .01). There was no significant difference in SI between the two groups (0.53 +/- 0.10 v 0.56 +/- 0.13 x 10(-4).min-1.pmol/L-1, P > .05). Pancreatic insulin secretion expressed as the integrated area of plasma insulin above the basal level during the first 19 minutes was significantly lower in obese subjects with IGT (3,366 +/- 1,495 pmol/L.min) than in those with normal glucose tolerance (16,400 +/- 4,509 pmol/L.min, P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)
(Keyword)
Adult / Body Mass Index / Computer Simulation / female / glucose / Glucose Tolerance Test / Humans / insulin / insulin resistance / Insulin Secretion / Islets of Langerhans / Japan / male / Middle Aged / Models, Biological / obesity / World Health Organization
K. Tokuyama, Y. Higaki, Junzo Fujitani, A. Kiyonaga, H. Tanaka, M. Shindo, M. Fukushima, Y. Nakai, H. Imura, I. Nagata and A. Taniguchi : Intravenous glucose tolerance test-derived glucose effectiveness in physically trained humans, American Journal of Physiology, Endocrinology and Metabolism, 265, E298-E303, 1993.
Junzo Fujitani, Y. Higaki, T. Kagawa, A. Kiyonaga, M. Shindo, K. Tokuyama and H. Tanaka : Intravenous glucose tolerance test-derived glucose effectiveness in physically trained humans, 4th International Symposium on Minimal Modelling: Current and Future Developments., Copenhagen, Jul. 1997.
2.
Junzo Fujitani, Y. Higaki, T. Kagawa, A. Kiyonaga, M. Shindo, M. Fukushima, Y. Nakai, H. Imura, A. Taniguchi, I. Nagata, K. Tokuyama and H. Tanaka : The relationship between physical fitness and glucose effectiveness, 40th American College of Sports Medicine, USA, Jun. 1994.
Proceeding of Domestic Conference:
1.
Junzo Fujitani, Nori Sato, Tetsuya Matsuura and Koichi Sairyo : ピラティスによる運動器リハビリテーションネットワークシステムの構築∼徳島大学モデル∼, 第8回四国脊椎外科研究会, Apr. 2023.
2.
Junzo Fujitani, Nori Sato, Tetsuya Matsuura and Koichi Sairyo : ピラティスによる運動器リハビリテーションネットワークシステムの構築∼徳島大学モデル∼, 第140回中部日本整形外科災害外科学会, Apr. 2023.
3.
Junzo Fujitani, Nori Sato, 友成 健 and Koichi Sairyo : 腰椎椎間板ヘルニア・全内視鏡術後リハビリテーションにおけるピラティスの導入, 第33回日本臨床スポーツ医学会, Nov. 2022.
4.
Junzo Fujitani, Nori Sato, 友成 健, Tsuyoshi Gotoh and Koichi Sairyo : 腰椎椎間板ヘルニア・全内視鏡術後リハビリテーションにおけるピラティスの導入, 第30回日本腰痛学会【開催期間:2022年10月21日-22日】, Oct. 2022.
Junzo Fujitani, Koichi Sairyo, Nori Sato and 友成 健 : 腰椎椎間板ヘルニア・全内視鏡術後リハビリテーションにおけるピラティスの導入, Japanese Journal of Clinical Sports Medicine, 30, 4, S267, Oct. 2022.