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.
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.