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.
Jun Kawamata, Shoji Fukuta, Yusuke Fukuta and Koichi Sairyo : Learning curve for intraoperative computer navigation in reverse total shoulder arthroplasty by the cumulative sum method, Seminars in Arthroplasty Jses, 35, 2, 254-262, 2025.
(Keyword)
Computer-assisted surgery / Glenoid component / Learning curve / Level IV / Navigation system / Operation time / Retrospective Case Series / Reverse total shoulder arthroplasty
Yasuko Ichihara, Hiroyasu Mori, Motomu Kamada, Tetsuya Matsuura, Koichi Sairyo, Mizusa Hyodo, Rie Tsutsumi, Hiroshi Sakaue, Ken-ichi Aihara, Makoto Funaki, Akio Kuroda and Munehide Matsuhisa : Effects of high-intensity interval walking training on muscle strength, walking ability, and health-related quality of life in people with diabetes accompanied by lower extremity weakness: A randomized controlled trial., Journal of Diabetes Investigation, 16, 4, 646-655, 2025.
(Summary)
The present study showed that IWT for people with diabetes accompanied by lower extremity weakness did not improve knee extension muscle strength compared to CWT but did improve walking ability and physical QOL.
Yasuyuki Ohmichi, Tomohiro Goto, Yukako Nishiyama, Gakuto Yoshida, Kaori Momota, Michihiro Takai, Ryosuke Sato, Tetsuya Enishi, Shunji Nakano and Koichi Sairyo : Detecting soft-tissue interposition in proximal tibial physeal injury based on fast field echo resembling a computed tomography using restricted echo-spacing (FRACTURE): a case report, Pediatric Radiology, 55, 6, 1319-1325, 2025.
(Summary)
Fast field echo resembling a computed tomography using restricted echo-spacing (FRACTURE) is a method of magnetic resonance bone imaging that provides computed tomography-like image contrast based on a high-resolution three-dimensional gradient sequence. This is the first report on the application of FRACTURE in the detection of soft-tissue interposition. We present a case of Ogden type IV proximal tibial physeal injury in an 11-year-old boy. FRACTURE revealed soft-tissue interposition into the displaced physis as high signal. Intraoperatively, the ruptured periosteum was entrapped into the displaced physis. In addition to the benefit of radiation-free imaging, FRACTURE is useful for assisting in the detection of interposition for many radiologists and orthopedic surgeons, and it may be useful in determining the treatment strategy for proximal tibial physeal injury.
Yasuyuki Ohmichi, Tomohiro Goto, Kaori Momota, Ryosuke Sato, Koichi Sairyo and Shunji Nakano : Simultaneous bilateral total knee arthroplasty has higher risk of asymptomatic deep vein thrombosis in patients in their 80s compared with unilateral total knee arthroplasty: a propensity score-matched comparative study across different age groups., Archives of Orthopaedic and Trauma Surgery, 145, 1, 2025.
(Summary)
This study compared complications and clinical outcomes between simultaneous bilateral total knee arthroplasty (SBTKA) and unilateral total knee arthroplasty (UTKA) across different age groups.This retrospective single-center study included 939 consecutive patients aged 60-89 years who underwent primary total knee arthroplasty between 2019 and 2023. After applying propensity score matching for preoperative deep vein thrombosis (DVT), American Society of Anesthesiologists (ASA) classification, and preoperative functional activity according to the Knee Society Score 2011 (KSS) to 223 patients who underwent SBTKA and 716 patients who underwent UTKA, SBTKA and UTKA were compared in the following age groups: 60s (28 vs. 28), 70s (110 vs. 110), and 80s (60 vs. 60). Perioperative complications and clinical outcomes at 1 year after surgery were compared between SBTKA and UTKA. Lower limb Doppler ultrasound was performed to screen for asymptomatic DVT preoperatively and on postoperative day 7.Average ASA classification ranged from 2.0 to 2.2 across all age groups, with no difference between SBTKA and UTKA. Compared with UTKA, the decrease in hemoglobin was significantly greater after SBTKA in patients in their 70s and 80s (both p < 0.001). The proportion of blood transfusion showed no significant difference across all age groups. Asymptomatic DVT was more frequent after SBTKA than after UTKA in patients in their 80s (58.3% vs. 40.0%, p < 0.045), but not those in their 60s (42.9% vs. 32.1%) or 70s (50.9% vs. 46.3%). Clinical outcomes (knee symptoms, patient satisfaction, patient expectations, functional activity according to the KSS) were comparable between SBTKA and UTKA across all age groups at 1 year postoperatively.SBTKA had higher risk of asymptomatic DVT in patients in their 80s. With evaluation of risk factors and careful patient selection, SBTKA is a valid option in terms of safety and clinical outcomes in elderly patients with ASA 2.
(Keyword)
Humans / Arthroplasty, Replacement, Knee / Aged / Venous Thrombosis / Middle Aged / Propensity Score / Retrospective Studies / Aged, 80 and over / male / female / Age Factors / Postoperative Complications / Risk Factors
Yasuyuki Omichi, Tomohiro Goto, Kaori Momota, Ryosuke Sato, Koichi Sairyo and Shunji Nakano : Simultaneous bilateral total knee arthroplasty has higher risk of asymptomatic deep vein thrombosis in patients in their 80s compared with unilateral total knee arthroplasty: a propensity score-matched comparative study across different age groups, Archives of Orthopaedic and Trauma Surgery, 145, 1, 196, 2025.
(Summary)
This study compared complications and clinical outcomes between simultaneous bilateral total knee arthroplasty (SBTKA) and unilateral total knee arthroplasty (UTKA) across different age groups. This retrospective single-center study included 939 consecutive patients aged 60-89 years who underwent primary total knee arthroplasty between 2019 and 2023. After applying propensity score matching for preoperative deep vein thrombosis (DVT), American Society of Anesthesiologists (ASA) classification, and preoperative functional activity according to the Knee Society Score 2011 (KSS) to 223 patients who underwent SBTKA and 716 patients who underwent UTKA, SBTKA and UTKA were compared in the following age groups: 60s (28 vs. 28), 70s (110 vs. 110), and 80s (60 vs. 60). Perioperative complications and clinical outcomes at 1 year after surgery were compared between SBTKA and UTKA. Lower limb Doppler ultrasound was performed to screen for asymptomatic DVT preoperatively and on postoperative day 7. Average ASA classification ranged from 2.0 to 2.2 across all age groups, with no difference between SBTKA and UTKA. Compared with UTKA, the decrease in hemoglobin was significantly greater after SBTKA in patients in their 70s and 80s (both p < 0.001). The proportion of blood transfusion showed no significant difference across all age groups. Asymptomatic DVT was more frequent after SBTKA than after UTKA in patients in their 80s (58.3% vs. 40.0%, p < 0.045), but not those in their 60s (42.9% vs. 32.1%) or 70s (50.9% vs. 46.3%). Clinical outcomes (knee symptoms, patient satisfaction, patient expectations, functional activity according to the KSS) were comparable between SBTKA and UTKA across all age groups at 1 year postoperatively. SBTKA had higher risk of asymptomatic DVT in patients in their 80s. With evaluation of risk factors and careful patient selection, SBTKA is a valid option in terms of safety and clinical outcomes in elderly patients with ASA 2.
(Keyword)
Asymptomatic deep vein thrombosis / Clinical outcomes / Different age groups / Simultaneous bilateral total knee arthroplasty / Unilateral total knee arthroplasty
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.
Kazuaki Mineta, Toshihiko Nishisho, Masahiko Okada, Mitsuhiro Kamada and Koichi Sairyo : Real-world safety and effectiveness of romosozumab following daily or weekly administration of teriparatide in primary and secondary osteoporosis., Bone, 193, 2025.
(Summary)
Romosozumab is an anti-sclerostin antibody that increases bone formation and decreases bone resorption, and it became available for patients at high risk of osteoporotic fractures in Japan in 2019. The aim of this study was to clarify the clinical effects, safety, and predictors of the effectiveness of 12 months of romosozumab therapy following daily or weekly administration of teriparatide. The study had an observational pre-post design and included 171 female patients. Romosozumab was administered at a dose of 210 mg subcutaneously every 4 weeks for 12 months following daily or weekly administration of teriparatide. The incidence of new fractures, safety, and changes in bone mineral density (BMD) and bone turnover markers were recorded. New fractures occurred in 3 cases (2.2 %). Four patients (2.3 %) with secondary osteoporosis experienced cardiovascular events, which were fatal in 1 patient (0.6 %). The percent changes in BMD at the spine and total hip at 12 months from baseline were + 7.9 % and + 2.4 %, respectively. The percent change in spine BMD did not significantly differ according to whether daily or weekly teriparatide was given as previous treatment. Romosozumab following teriparatide showed greater effectiveness in patients with primary osteoporosis, high P1NP level at 1 month, and low percent changes in TRACP-5b after 12 months of treatment. Romosozumab after treatment with daily or weekly teriparatide was relatively safe and more effective in patients with primary osteoporosis than in those with secondary osteoporosis.
(Keyword)
Aged / Aged, 80 and over / female / Humans / Middle Aged / Antibodies, Monoclonal / Bone Density / Bone Density Conservation Agents / Drug Administration Schedule / osteoporosis / Teriparatide / Treatment Outcome
Daisuke Nakai, Shoji Fukuta, Jun Kawamata, Hiroshi Yonezu, Toru Maeda and Koichi Sairyo : Pathological formation of subcoracoid bursa effusion on magnetic resonance imaging studies., Journal of Shoulder and Elbow Surgery, 34, 6, e340-e347, 2024.
(Summary)
The subcoracoid space includes the subcoracoid bursa (SCB) and subscapular bursa (SSB). We aimed to clarify the relationship between the presence or amount of SCB effusion and other structures around the SCB on magnetic resonance imaging (MRI) and to discuss the pathological formation of SCB effusion.Medical records and MR images of patients who had undergone MRI examinations for shoulder pain were retrospectively reviewed. The presence or absence of SCB, SSB, and subacromial-subdeltoid bursa (SASDB) effusion was evaluated. If SCB effusion was present, the largest diameter of the effusion was measured on sagittal images to represent the amount of SCB effusion. The presence or absence of communication between the SCB and SASDB or SSB effusion were also evaluated on sagittal and axial MRI.Eighty shoulders in 70 patients were analyzed. The mean age was 70.4 ± 10.4 (range, 50-87) years. Thirty-three of the 80 shoulders (41.3%) showed SCB effusion on MRI. The clinical diagnoses of these 33 shoulders were rotator cuff tear (RCT), n = 23; frozen shoulder, n = 6; subacromial impingement, n = 3; and calcific tendinopathy, n = 1. Multivariate logistic regression analysis showed that RCT (P = .015) and SSB effusion (P = .036) were significantly associated with the presence of SCB effusion, but SASDB effusion was not. In shoulders with RCT, the SCB communicated with the SASDB in 65.2%, and with the SSB in 4.3%. In other shoulders, the SCB communicated with the SASDB in 60.0%, and with the SSB in 40.0%. The rate of SCB-SSB communication was significantly higher in shoulders without RCT than in shoulders with RCT (P = .021). The largest diameter of SCB effusion was normally distributed in 33 shoulders (4.7-34.8 mm), and mean was 19.6 ± 7.4 mm. The largest diameter of SCB effusion was 21.9 ± 6.3 mm in 23 shoulders with RCT, and 13.5 ± 6.8 mm in 10 other shoulders (P < .05). Multiple regression analysis showed that RCT (P = .002) and SSB effusion (P = .029) were significantly associated with the largest diameter of SCB effusion, but SASDB effusion was not.SCB effusion can be recognized and extended by inflow from SASDB effusion in RCT. Without RCT, SCB effusion may occasionally be visible due to inflow from SSB effusion.
(Keyword)
Humans / magnetic resonance imaging / Middle Aged / male / Aged / female / Retrospective Studies / Shoulder Joint / Bursa, Synovial / Aged, 80 and over / Shoulder Pain / Rotator Cuff Injuries / Bursitis
Yasuyuki Ohmichi, Tomohiro Goto, Kaori Momota, Michihiro Takai, Ryosuke Sato, Tetsuya Enishi, Shunji Nakano and Koichi Sairyo : Acute avulsion fracture of the ischial tuberosity in an adolescent athlete treated by suture anchor fixation using the suture bridge technique: a case report., Journal of Surgical Case Reports, 2024, 11, 2024.
(Summary)
This is the first report of acute avulsion fracture of the ischial tuberosity (AFIT) treated by suture anchor fixation using the suture bridge technique. A 13-year-old boy developed sudden, severe right hip pain while running a short distance. Pelvic images revealed the avulsion fracture of the right ischial tuberosity with displacement of the avulsed fragment by 35 mm. We performed open reduction and reconstruction fixation 5 days after the injury using the subgluteal approach with longitudinal skin incision. Four suture anchors were set at the ischial tuberosity, and the avulsed fragment was repositioned and fixed using the suture bridge technique. At 1 year postoperatively, the avulsion fracture was bony fused, and he had returned to his preinjury competitive level. Use of multiple suture anchors increases the strength of fixation, which overcomes the problem of anchor loosening and makes open reduction and reconstruction fixation an effective treatment for acute avulsion fracture of the ischial tuberosity.
Daisuke Yoshimura, Jun Kawamata, Shoji Fukuta, Yuka Shimasaki, Daisuke Kita and Koichi Sairyo : Minimal clinically important difference in the Japanese Orthopedic Association Score and shoulder 36 after arthroscopic rotator cuff repair in a Japanese population: A retrospective cohort study., Journal of Orthopaedic Science, 30, 4, 597-604, 2024.
(Summary)
In Japan, the Japanese Orthopedic Association (JOA) score is widely used as a clinician-reported outcome after shoulder surgery. However, Shoulder36 is positioned as a general patient-reported outcome measure. This study aimed to determine the correlations between the JOA score and scores in the domains of the Shoulder36 and their minimal clinically important differences (MCIDs) and cutoff values for the patient-acceptable symptom state (PASS) after unilateral arthroscopic rotator cuff repair (ARCR).We evaluated 145 patients using the JOA score and Shoulder36 before and 1 year after surgery. The MCID and PASS cutoff values were determined by patients' responses to the following anchor item: A, none ("no good at all"); B, poor ("some effect but unsatisfactory"); C, good ("satisfactory effect with occasional episodes of pain or stiffness"); D, excellent ("ideal response, virtually pain-free"). The correlations between the JOA score and the domains of the Shoulder36 were statistically calculated. The border between B and C was defined as the threshold for PASS.There were significant correlations between the JOA score and the Shoulder36 domains. The responses to the anchor item were as follows: A (n = 0), B (n = 21), C (n = 76), and D (n = 48). The MCID for the JOA score was 19.5 points and the MCIDs for Shoulder36 were 0.5 points for pain, 0.667 for range of motion, 0.67 for muscle strength, 0.3 for general health, 0.571 for activities of daily living, and 1.0 for sports ability. The PASS cutoff value was 89.0 points for the JOA score and 3.8 points for pain, 3.667 for range of motion, 3.0 for muscle strength, 3.7 for general health, 3.7 for activities of daily living, and 3.0 for sports ability in the Shoulder36.The MCID and cutoff PASS values for the JOA score and Shoulder36 identified in this study will help to determine the effectiveness of multidisciplinary management after ARCR.
(Keyword)
Humans / Male / Female / Retrospective Studies / Arthroscopy / Minimal Clinically Important Difference / Middle Aged / Japan / Rotator Cuff Injuries / Aged / Patient Reported Outcome Measures / Range of Motion, Articular / Adult / Treatment Outcome / Pain Measurement / East Asian People
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
Yasuaki Tamaki, Tomohiro Goto, Keizo Wada, Yasuyuki Ohmichi, Daisuke Hamada and Koichi Sairyo : Robotic arm-assisted total hip arthroplasty via a minimally invasive anterolateral approach in the supine position improves the precision of cup placement in patients with developmental dysplasia of the hip., Journal of Orthopaedic Science, 29, 2, 559-565, 2024.
(Summary)
Robotic arm-assisted THA using a minimally invasive technique via an anterolateral approach in the supine position allows accurate cup placement in patients with DDH.
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.
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
Tetsuya Matsuura, Naoto Suzue, Toshiyuki Iwame, Jyoji Iwase, Kenji Yokoyama, Shoichiro Takao and Koichi Sairyo : Prevalence of osteochondritis dissecans of the capitellum in elementary school baseball players based on ultrasonographic screening: a 15-year overview in Tokushima, Japan., JSES International, 8, 3, 661-666, 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
Yasuyuki Ohmichi, Daisuke Hamada, Keizo Wada, Yasuaki Tamaki, Shota Shigekiyo and Koichi Sairyo : Robotic-assisted total knee arthroplasty improved component alignment in the coronal plane compared with navigation-assisted total knee arthroplasty: a comparative study., Journal of Robotic Surgery, 17, 6, 2831-2839, 2023.
(Summary)
The purpose of this study was to directly compare implant placement accuracy and postoperative limb alignment between robotic-assisted total knee arthroplasty and navigation-assisted total knee arthroplasty. This retrospective case-control study included a consecutive series of 182 knees (robotic-assisted group, n = 103 knees; navigation-assisted group, n = 79). An image-free handheld robotic system (NAVIO) or an image-free navigation system (Precision N) was used. Component and limb alignment were evaluated on three-dimensional computed tomography scans and full-length standing anterior-posterior radiographs. We compared the errors between the final intraoperative plan and the postoperative coronal and sagittal alignment of the components and the hip-knee-ankle angle between the two groups. The orientation of the femoral and tibial components in the coronal plane were more accurate in the robotic-assisted group than in the navigation-assisted group (p < 0.05). There was no significant difference in the orientation of the femoral and tibial component in the sagittal plane between the two groups. There were fewer outliers in the tibial coronal plane in the robotic-assisted group (p < 0.05). There was also no significant difference in the frequency of outlying values for coronal or sagittal alignment of the femoral component or sagittal alignment of the tibial component or the hip-knee-ankle angle between the two groups. Robotic-assisted total knee arthroplasty using a handheld image-free system improved component alignment in the coronal plane compared with total knee arthroplasty using an image-free navigation system. Robotic surgery helps surgeons to achieve personalised alignment that may result in better clinical outcomes.
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.
Yasuaki Tamaki, Tomohiro Goto, Keizo Wada, Yasuyuki Ohmichi, Daisuke Hamada and Koichi Sairyo : Increased hip flexion angle and protrusion of the anterior acetabular component can predict symptomatic iliopsoas impingement after total hip arthroplasty: a retrospective study., Hip International, 33, 6, 985-991, 2023.
(Summary)
Symptomatic IPI had an incidence of 11.0% and a predilection for hips with osteonecrosis. Pre- and postoperative hip flexion angles were significantly greater in hips with symptomatic IPI (
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.
Yutaro Sasaki, Masayuki Takahashi, Keito Shiozaki, Katsuhito Hori, Fumiya Kadoriku, Kei Daizumoto, Ryotaro Tomida, Yoshiteru Ueno, Yoshito Kusuhara, Tomoya Fukawa, Kunihisa Yamaguchi, Yasuyo Yamamoto, Koichi Tomita, Koichi Sairyo and Hiroomi Kanayama : The importance of laparoscopic surgery for young urologists remains unwavering even in the era of robot assisted surgery, Asian Journal of Endoscopic Surgery, 17, 1, e13254, 2023.
(Summary)
Robot-assisted surgery (RAS) cannot be achieved without the performance of laparoscopic surgical techniques by a patient-side surgeon (PSS). In many medical institutions in Japan, young urologists often take on the role of a PSS. Participating in RAS as a PSS provides a good opportunity to acquire not only the knowledge necessary for surgery, but also skills in laparoscopic surgical techniques. Learning laparoscopic surgery as a PSS may contribute to improving the quality of RAS. Furthermore, it will lead to skill improvement as an operator in laparoscopic surgery. However, notably, opportunities for young urologists to perform laparoscopic surgery are decreasing in the current era of RAS. Under these circumstances, we believe that cadaver surgical training will become increasingly important in the future. We believe that performance of cadaver surgical training will contribute to increased motivation, enhance the understanding of surgical procedures, and facilitate the acquisition of surgical techniques.
Yutaro Sasaki, Masayuki Takahashi, Keito Shiozaki, Katsuhito Hori, Fumiya Kadoriku, Kei Daizumoto, Ryotaro Tomida, Yoshiteru Ueno, Yoshito Kusuhara, Tomoya Fukawa, Kunihisa Yamaguchi, Yasuyo Yamamoto, Koichi Tomita, Koichi Sairyo and Hiroomi Kanayama : The importance of laparoscopic surgery for young urologists remains unwavering even in the era of robot assisted surgery, Asian Journal of Endoscopic Surgery, 17, 1, e13254, 2023.
(Summary)
Robot-assisted surgery (RAS) cannot be achieved without the performance of laparoscopic surgical techniques by a patient-side surgeon (PSS). In many medical institutions in Japan, young urologists often take on the role of a PSS. Participating in RAS as a PSS provides a good opportunity to acquire not only the knowledge necessary for surgery, but also skills in laparoscopic surgical techniques. Learning laparoscopic surgery as a PSS may contribute to improving the quality of RAS. Furthermore, it will lead to skill improvement as an operator in laparoscopic surgery. However, notably, opportunities for young urologists to perform laparoscopic surgery are decreasing in the current era of RAS. Under these circumstances, we believe that cadaver surgical training will become increasingly important in the future. We believe that performance of cadaver surgical training will contribute to increased motivation, enhance the understanding of surgical procedures, and facilitate the acquisition of surgical techniques.
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.
Ichiro Tonogai, Yuhei Yamasaki, Toshihiko Nishisho and Koichi Sairyo : Republication of "Mucous Cyst at the Interphalangeal Joint of the First Toe Caused by Contact Pressure With the Second Toe due to Hallux Valgus: A Case Report"., Foot & Ankle Orthopaedics, 8, 3, 2023.
(Summary)
A 77-year-old woman presented with a mucous cyst on the lateral aspect of the interphalangeal joint of the first toe caused by contact pressure with the second toe from hallux valgus. She complained of discomfort and discharge from the left first toe for approximately 4 months. Physical examination showed the second toe pressing strongly against the first toe due to hallux valgus and discharge from the skin on the lateral aspect of the interphalangeal joint of the first toe. Magnetic resonance imaging showed a cystic lesion at the same level. The patient underwent a modified scarf osteotomy of the first metatarsal for hallux valgus to resolve the contact pressure between the toes-considered the cause of the mucous cyst-and resection of mucous cyst. Forefoot weight bearing was allowed 6 weeks after surgery. As of 1 year after surgery, she has had no recurrence of the cyst. The score on the Japanese Society for Surgery of the Foot hallux metatarsophalangeal-interphalangeal scale improved from 59/100 points to 92/100. This outcome suggests that hallux valgus correction should be considered when a mucous cyst is associated with contact pressure due to a hallux valgus deformity. To the best of our knowledge, there are no previous reports of a mucous cyst caused by contact pressure between the first toe and second toe due to hallux valgus.
Ichiro Tonogai, Daiki Nakajima, Ryo Miyagi and Koichi Sairyo : Republication of "Gelatinous Transformation of Bone Marrow in the Calcaneus, Diagnosed by Open Bone Biopsy in a Patient With Anorexia Nervosa: A Case Report"., Foot & Ankle Orthopaedics, 8, 3, 2023.
(Summary)
He was able to return to work and had no left heel pain. This case indicates that foot and ankle surgeons need to be aware of this rare pathology, although it might be difficult to diagnose without biopsy. To our knowledge, very few descriptions of GTBM in the calcaneus have been reported to date.
Yuto Sugimine, Shunji Nakano, Hitoshi Goto, Ryosuke Sato, Tetsuya Enishi, Tomohiro Goto and Koichi Sairyo : Middle-term outcome and complications after primary total hip arthroplasty using a contemporary titanium tapered wedge cementless femoral stem., The Journal of Medical Investigation : JMI, 70, 3.4, 471-475, 2023.
(Summary)
The purpose of this study is to evaluate the results and intraoperative or postoperative complications of primary total hip arthroplasty (THA) using a contemporary tapered wedge titanium femoral component. A total of 213 THAs in 187 patients were followed up more than 5 years (mean, 102 months ; range, 60-150). The mean age at surgery was 64.2 years (range, 20?89 years). These patients were clinically evaluated using the JOA scoring system and radiographically host bone reactions around the implants, as well as femoral loosening. The mean JOA score improved from 49 (range, 21?75) to 92 (range, 59?100). All 12 patients with poor results (JOA < 75) coexisted with cerebral, spinal, joint, and musculoskeletal disorders. At the final follow-up, implant survival was 100%. Complications occurred in 23 hips. They consisted of 12 hips with intra-operative fractures, 2 hips with sciatic nerve palsy, one hip with infections, 3 hips with recurrent dislocations, and 8 hips with aseptic cup loosening. In conclusion, we have shown excellent survival rate of the contemporary tapered wedge stem in primary THA ; however, patients with coexisting diseases could not acquire sufficient improvement in hip function and ambulatory ability. J. Med. Invest. 70 : 471-475, August, 2023.
(Keyword)
Humans / Young Adult / Adult / Arthroplasty, Replacement, Hip / Hip Prosthesis / Titanium / Follow-Up Studies / Prosthesis Design / Reoperation / Treatment Outcome / Retrospective Studies
Yasuyuki Ohmichi, Shun-ichi Toki, Toshihiko Nishisho, Takeshi Harada, Nori Sato and Koichi Sairyo : Atypical femoral fracture in a multiple myeloma patient undergoing treatment with denosumab: A case report and literature review., International Journal of Surgery Case Reports, 108, 2023.
(Summary)
Atypical femoral fracture may occur in patients with multiple myeloma who receive denosumab, even for a short period. Attending physicians should be cognizant of the early symptoms and signs of this fracture.
Yasuyuki Ohmichi, Daisuke Hamada, Ryo Okada, Keizo Wada, Yasuaki Tamaki, Shinichiro Yamada, Tomohiro Goto and Koichi Sairyo : Hematogenous prosthetic knee joint infection with Klebsiella pneumoniae caused by asymptomatic gallbladder abscess: a case report and literature review, Journal of Surgical Case Reports, 2023, 6, 2023.
(Summary)
, other sources of infection should be suspected and investigated regardless of whether they are symptomatic.
Yasuaki Tamaki, Daisuke Hamada, Keizo Wada, Tomoya Takasago, Akihiro Nitta, Yasuyuki Ohmichi, Tomohiro Goto, Yoshihiro Tsuruo and Koichi Sairyo : Kinematic comparison between the knee after bicruciate stabilized total knee arthroplasty and the native knee: A cadaveric study., The Knee, 42, 289-296, 2023.
(Summary)
Kinematics of BCS-TKA is close to that of the native knee. However, there is a statistically significant difference in AP position of the femur during mid flexion and initial rotational position of the tibia between the BCS-TKA knee and the native knee.
Vit Kotheeranurak, Wongthawat Liawrungrueang, Javier Quillo-Olvera, J Christoph Siepe, Zhou Zhen Li, V Pramod Lokhande, Gun Choi, Yong Ahn, Chien-Min Chen, Kyung-Chul Choi, Facundo Isseldyk Van, Vincent Hagel, Koichi Sairyo, P Christoph Hofstetter, David Curto Del, Yue Zhou, Chen Bolai, Seok Jun Bae, Muhammed Assous, Guang-Xun Lin, Khanathip Jitpakdee, Yanting Liu and Jin-Sung Kim : Full-Endoscopic Lumbar Discectomy Approach Selection: A Systematic Review and Proposed Algorithm., Spine, 48, 8, 534-544, 2023.
(Summary)
The proposed algorithm suggests a TELD for LDH located in the foraminal or extraforaminal zones at upper and lower levels and for central and subarticular discs at the upper levels considering the anatomic foraminal features and the craniocaudal pathology location. An IELD is preferred for LDH in the central or subarticular zones at L4/L5 and L5/S1, especially if a high iliac crest or high-grade migration is found.
Yasuyuki Ohmichi, Tomohiro Goto, Keizo Wada, Yasuaki Tamaki, Daisuke Hamada and Koichi Sairyo : Impact of the hip-spine relationship and patient-perceived leg length discrepancy after total hip arthroplasty: A retrospective study., Journal of Orthopaedic Science, 2023.
(Summary)
Patient-perceived leg length discrepancy (PLLD) is one of the major postoperative complications of total hip arthroplasty (THA). This study aimed to identify factors that cause PLLD following THA.
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.
Akihiro Nitta, Keizo Wada, Daisuke Hamada, Koichi Oba, Hiroshi Mikami and Koichi Sairyo : Insertion of a spacer block translates the tibia anteriorly during evaluation of soft tissue balance in cruciate-retaining total knee arthroplasty., The Knee, 42, 125-129, 2023.
(Summary)
Assessment of soft tissue balance using a spacer block in CR TKA during knee flexion changes the location of the tibia. Surgeons should be aware of the potential for overestimating the postoperative flexion gap in CR TKA when using a spacer block to assess the flexion gap.
Yasuaki Tamaki, Tomohiro Goto, Jyoji Iwase, Keizo Wada, Yasuyuki Ohmichi, Daisuke Hamada, Yoshihiro Tsuruo and Koichi Sairyo : Relationship between iliopsoas muscle surface pressure and implant alignment after total hip arthroplasty: a cadaveric study., Scientific Reports, 13, 1, 2023.
(Summary)
Iliopsoas impingement after total hip arthroplasty is caused by the implant irritating the iliopsoas muscle, but changes in the iliopsoas muscle have not been quantitatively evaluated. This study assessed changes in the surface pressure of the iliopsoas muscle when the implant alignment was varied. Total hip arthroplasty was performed in 10 fresh-frozen cadaveric hips. We evaluated the maximum and mean surface pressure of the iliopsoas muscle with the hip in 20° and 10° extension, the neutral position, and 10° flexion when the anterior cup protrusion length (ACPL), stem version, and stem offset were varied. When the ACPL was changed to 0, 3, and 6 mm in 20° extension, the maximum surface pressure was significantly increased for ACPL of 6 mm compared with 0 mm. Decreased stem anteversion resulted in a significant reduction in both the maximum and mean surface pressure compared with native anteversion from 20° extension to the neutral position. Increased stem offset resulted in significant increases in the maximum and mean surface pressure of the iliopsoas muscle compared with decreased stem offset in 20° extension. Not only large ACPL but also changes in stem version and offset affected the maximum surface pressure of the iliopsoas muscle.
(Keyword)
Humans / Arthroplasty, Replacement, Hip / Prostheses and Implants / Plastic Surgery Procedures / Cadaver / Muscles
Shinji Kawaguchi, Shoji Fukuta, Masashi Kano and Koichi Sairyo : Reduction of perioperative blood loss and operating time for arthroscopic rotator cuff repair by intravenous administration of tranexamic acid., Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology, 31, 6-10, 2023.
(Summary)
Administration of a single intravenous dose of TXA improved visual clarity in arthroscopic RCR, decreased the total operating time, and reduced hemoglobin loss on postoperative day 7.
Makoto Takeuchi, Toshihiko Nishisho, Shun-ichi Toki, Shinji Kawaguchi, Shunsuke Tamaki, Takeshi Oya, Yoshihiro Uto, Toyomasa Katagiri and Koichi Sairyo : Blue light induces apoptosis and autophagy by promoting ROS-mediated mitochondrial dysfunction in synovial sarcoma., Cancer Medicine, 12, 8, 9668-9683, 2023.
(Summary)
Taken together, our results revealed that BL induced apoptosis via the ROS-mitochondrial signaling pathway, and autophagy was activated in response to the production of ROS, which protected SS cells from apoptosis. Therefore, BL is a promising candidate for the development of an antitumor therapeutic strategy targeting SS.
Tetsuya Okahisa, Tetsuya Matsuura, Ken Tomonari, Kouji Komatsu, Kenji Yokoyama, Jyoji Iwase, Megumi Yamada and Koichi Sairyo : Between-day reliability and minimum detectable change of the Conventional Gait Model 2 and Plug-in Gait Model during running., Gait & Posture, 100, 171-178, 2023.
(Summary)
The between-day reliability of CGM2 was mostly good to excellent for lower limb kinematics and kinetics during running. We believe that CGM2 can more accurately assess kinematic differences between the coronal and transverse planes than the PiG.
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.
Hyeun-Sung Kim, Koichi Sairyo, Yukoh Ohara and Chien-Min Chen : Evidence-Based Endoscopic Spinal Surgery Special Section., World Neurosurgery, 168, 323, 2022.
Ichiro Tonogai, Yoshihiro Tsuruo and Koichi Sairyo : Relationship Between the Lateral Plantar Artery and the Retrograde Intramedullary Nail During Tibiotalar and Subtalar Arthrodesis: A Fresh Cadaveric Study., Foot & Ankle Specialist, 15, 6, 551-555, 2022.
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
Shun-ichi Toki, Toshihiko Nishisho, Ryo Miyagi, Yoshimi Bando, Mika Sakaki, Yusuke Demizu, Tomoaki Okimoto and Koichi Sairyo : Combination chemotherapy of doxorubicin and ifosfamide with proton beam therapy for myoepithelial carcinoma originating in the paraspinal region: A case report and literature review., Molecular and Clinical Oncology, 17, 6, 2022.
(Summary)
Soft tissue myoepithelial carcinoma (MEC) is an extremely rare mesenchymal tumor that has a poor prognosis unless complete surgical resection is achieved. The present study reported a case of a 38-year-old woman with a tumor in the left paraspinal region at L2 to L3 with vertebral destruction. MEC was diagnosed based on molecular pathological examination of a biopsy specimen. Because curative surgery was expected to be difficult, a combination of chemotherapy with doxorubicin and ifosfamide and proton beam therapy as local therapy was performed, resulting in long-term survival for at least 7.8 years. To the best of our knowledge, this is the first case of soft tissue MEC for which classical cytotoxic chemotherapy and proton beam therapy were effective. Although surgical resection with negative margins is the mainstay of treatment for MEC, adequate doxorubicin-based systemic therapy and high-dose radiation therapy may be a feasible alternative in patients with unresectable or advanced MEC. Future studies on the relationship between molecular pathological features, including biomarkers, and the selection of therapeutic agents are warranted.
Yohei Takahashi, Takashi Kaji, Toshiyuki Yasui, Atsuko Yoshida, Naoto Yonetani, Naoto Suzue, Shinsuke Katoh, Kazuhisa Maeda, Koichi Sairyo, Minoru Irahara and Takeshi Iwasa : Ultrasonographic changes in quadriceps femoris thickness in women with normal pregnancy and women on bed rest for threatened preterm labor., Scientific Reports, 12, 1, 17506, 2022.
(Summary)
This study aimed to evaluate the changes in quadriceps femoris muscle thickness during the pregnancy and postpartum periods and to elucidate the effect of bed rest for threatened preterm labor on muscle thickness. In 26 women with normal pregnancy, quadriceps femoris thickness was measured at 11-13, 26, 30, and 35 weeks' gestation, and at 3-5 days and 1 month postpartum using ultrasonography. In 15 pregnant women treated with bed rest for threatened premature labor, quadriceps femoris thickness was measured at 30 and 35 weeks' gestation and postpartum. In women with normal pregnancy, quadriceps femoris thickness increased, peaking at 35 weeks' gestation, followed by a postpartum decrease. In women on bed rest, quadriceps femoris thickness showed no significant change during the pregnancy and postpartum periods, and the muscle was significantly thinner at 35 weeks' gestation than that in women with normal pregnancy. In conclusion, a significant increase in quadriceps femoris muscle thickness during normal pregnancy was found using ultrasonography. Meanwhile, in pregnant women on bed rest treatment, the quadriceps femoris was significantly thinner in the late third trimester than that in normal pregnant women. Prolonged bed rest can affect normal changes in the quadriceps femoris muscle thickness during the pregnancy and postpartum periods.
(Keyword)
Infant, Newborn / Humans / Female / Pregnancy / Bed Rest / Quadriceps Muscle / Obstetric Labor, Premature / Gestational Age / Pregnancy Trimester, Third
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.
Ichiro Tonogai, Yoshihiro Tsuruo and Koichi Sairyo : Examination of Safe Zone to Avoid Injury of the Lateral Plantar Artery During Calcaneal Osteotomy: A Fresh Cadaveric Study., Foot & Ankle Specialist, 15, 5, 432-437, 2022.
Hiroaki Nishimoto, Shoji Fukuta, Naoshi Fukui, Koichi Sairyo and Tetsuo Yamaguchi : Characteristics of gene expression in frozen shoulder, BMC Musculoskeletal Disorders, 23, 1, 811, 2022.
(Summary)
Severe frozen shoulder (FS) is often resistant to treatment and can thus result in long-term functional impairment. However, its etiology remains unknown. We hypothesized that gene expression of FS would vary by synovial location. The synovial tissues of patients with FS were collected prospectively and analyzed for the expression of 19 genes. Synovial tissues from patients with rotator cuff tear (RCT) or shoulder instability (SI) were also analyzed as controls. A total of 10 samples were analyzed from each group. The specimens were arthroscopically taken from three different locations: rotator interval (RI), axillary recess (AX), and subacromial bursa (SAB). Total RNA was extracted from the collected tissues and was analyzed by real-time polymerase chain reaction for the following genes: matrix metalloproteinases (MMPs); tissue inhibitors of metalloproteinases (TIMPs); inflammatory cytokines (IL1B, TNF, and IL6); type I and II procollagen (COL1A1 and COL2A1); growth factors (IGF1 and TGFB1); neural factors (NGF and NGFR); SOX9; and ACTA2. Site-specific analysis showed that MMP13, IL-6, SOX9, and COL1A1 were increased in all three sites. Four genes (MMP3, MMP9, COL2A1, and NGFR) were increased in the AX, MMP3 in the RI, and NGFR in the SAB were increased in the FS group than in the RCT and SI groups. In the FS group, there was a correlation between the expression of genes related to chondrogenesis (MMP2, IGF1, SOX9, COL2A1, NGF, and NGFR) or fibrosis (MMP9, TGFB1, and COL1A1). The expression levels of numerous MMPs, pro-inflammatory cytokines, and collagen-related genes were increased in the FS group, suggesting that catabolic and anabolic changes have simultaneously occurred. In addition, genes related to chondrogenesis or fibrosis were highly expressed in the FS group, which might have affected the range of motion limitation of the shoulder. Compared to RI and SAB, the AX was the most common site of increased expression in FS. Analyzing the lower region of the shoulder joint may lead to the elucidation of the pathogenesis of FS.
Ryo Okada, Toshinori Sakai, Toshihiko Nishisho, Akihiro Nitta, Shigeyuki Takahara, Koichi Oba and Koichi Sairyo : Preoperative Planning Using Three-dimensional Printing for Full-endoscopic Spine Surgery: A Technical Note., NMC Case Report Journal, 9, 249-253, 2022.
(Summary)
Transforaminal full-endoscopic spine surgery (TF-FESS) is a novel minimally invasive spine surgery that requires only an 8-mm skin incision and causes minimal damage to the paravertebral muscles. To perform TF-FESS safely and efficiently, preoperative planning is quite important as the intervention requires anatomical understanding and high technical skills. Recently, three-dimensional (3D) printing has become a useful tool in various surgeries, and several studies have addressed its efficacy; however, there are no reports on the application of 3D printing to FESS. In this study, we present two cases of severe lumbar deformities for which preoperative 3D printing was useful. The 3D printing enabled the surgeons to visualize and plan the drilling of the superior articular process for a successful foraminoplasty at a low cost. The manufacturing equipment cost about USD 900 and is able to produce an actual-size model at a cost of less than USD 10 per patient. In conclusion, preoperative planning using 3D printing should be adopted to safely perform FESS.
Kiyoshi Yagi, Kazuya Kishima, Fumitake Tezuka, Masatoshi Morimoto, Kazuta Yamashita, Yoichiro Takata, Toshinori Sakai, Toru Maeda, Junzo Fujitani and Koichi Sairyo : A Technical Pitfall of Decompression with Direct Repair of a Ragged Edge Using the Smiley-Face Rod Method : A Case Report., The Journal of Medical Investigation : JMI, 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.
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.
Nori Sato, 友成 健 and Koichi Sairyo : 骨粗鬆症からみたロコモの予防, Shikoku Acta Medica, 78, 1, 2, 21-26, 2022.
(Summary)
Osteoporosis is one of the causes of locomotive syndrome. If osteoporosis is left untreated, fractures can occur, making it difficult to move and, in some cases, rendering the patient bedridden. Fractures have been reported to increase mortality. Prevention and treatment of osteoporosis is essential to extend healthy life expectancy. In addition to pharmacological treatment, osteoporosis control requires attention to diet, exercise and fall prevention in daily life. In this report, the treatment of osteoporosis and prevention of locomotive syndrome are described.
(Keyword)
osteoporosis / locomotive syndrome / fracture / healthy life expectancy
Masaru Nakamura, Shunji Nakano, Ryosuke Sato, Kenji Kondo, Hitoshi Goto, Haruhiko Yoshinari, Tateaki Shimakawa, Tetsuya Enishi, Shinji Yoshioka and Koichi Sairyo : Efficacy of preoperative autologous blood storage in one-stage bilateral total knee arthroplasty., Journal of Orthopaedic Science, 27, 3, 648-651, 2022.
(Summary)
Preoperative autologous blood storage can help increase the likelihood of avoiding allogeneic blood transfusion in patients undergoing one-stage bilateral TKA.
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.
Ichiro Tonogai, Yoshihiro Tsuruo and Koichi Sairyo : Implications of dorsalis pedis artery anatomical variants for dorsal midfoot surgery, Foot & Ankle International, 43, 7, 942-947, 2022.
(Summary)
The dorsalis pedis artery (DPA) usually branches into the arcuate artery (AA) from its lateral side which in turn crosses the bases of the lateral four metatarsals. The DPA then passes into the first interosseous space, where it divides into the first metatarsal artery and the deep plantar artery. In this study, we aimed to determine the extent of variation in the DPA and the distance between the AA and the tarsometatarsal (TMT) joint with the aim of reducing the risk of vascular complications arising from dorsal midfoot surgery. In 29 fresh cadaveric feet, we examined the course of the DPA and the distance between the AA and the TMT joint on computed tomography images with barium sulfate contrast. The DPA was observed to have a standard course in 11 of the 29 cases (37.9%) but did not give rise to the AA and lateral tarsal artery or branches of the plantar arterial arch supplying to the second to fourth metatarsal spaces in 10 of 29 cases (34.5%). The mean closest distance from the TMT joint to the AA at the second, third, and fourth metatarsal level in the sagittal plane was 11.4, 14.6, and 17.1 mm, respectively. We found substantial variation in the arterial anatomy of the DPA system across the dorsal midfoot. The risk of pseudoaneurysm and frank arterial disruption may be mitigated if the surgeon is aware of the variations of the course of the DPA when performing dorsal midfoot surgery.
Takuya Kasamasu, Yuko Ishida, Masahiro Sato, Yasuyoshi Mase and Koichi Sairyo : Rates of Return to Sports and Recurrence in Pediatric Athletes after Conservative Treatment for Lumbar Spondylolysis., Spine Surgery and Related Research, 6, 5, 540-544, 2022.
(Summary)
1.8 months) because of the time required for bone healing. There were several cases of recurrence after RTS. Strategies to prevent recurrence of lumbar spondylolysis in pediatric athletes are discussed.
Yasuaki Tamaki, Tomohiro Goto, Jyoji Iwase, Keizo Wada, Daisuke Hamada, Yoshihiro Tsuruo and Koichi Sairyo : Contributions of the ischiofemoral ligament, iliofemoral ligament, and conjoined tendon to hip stability after total hip arthroplasty : a cadaveric study, Journal of Orthopaedic Research, 40, 12, 2885-2893, 2022.
(Summary)
An adequate soft tissue balance is important in total hip arthroplasty (THA). This study assessed the contribution of the iliofemoral ligament, ischiofemoral ligament, and conjoined tendon to the range of hip rotation after THA and hip stability in response to axial traction. THA was performed in eight fresh-frozen cadaveric specimens via an anterolateral approach using a navigation system. The ischiofemoral ligament, the medial arm of the iliofemoral ligament, and the conjoined tendon were resected in that order. The ranges of external and internal rotation and the amount of movement of the femoral head in response to axial traction were measured with the hip in 10° of extension, the neutral position, and in 10°, 30°, and 60° of flexion. Resection of the medial arm of the iliofemoral ligament significantly increased the range of external rotation in 10° of extension, the neutral position, and in 10°, 30°, and 60° of flexion. The conjoined tendon was the most important inhibitor of internal rotation from 10° of extension to 30° of flexion. Although each single element had a minor role in stabilizing the hip when axial traction was applied, resection of two or more elements significantly affected joint stability. The iliofemoral ligament and conjoined tendon are the main inhibitors of external rotation and internal rotation, respectively, when THA is performed using an anterior or anterolateral approach. Resection of two or more elements could greatly affect hip stability when axial traction is applied.
(Keyword)
Humans / Arthroplasty, Replacement, Hip / Biomechanical Phenomena / Cadaver / Ligaments, Articular / Range of Motion, Articular / Tendons
Toshiyuki Iwame, Tetsuya Matsuura, Naoto Suzue, Sakurako Katsuura-Kamano, Shoichiro Takao, Jyoji Iwase and Koichi Sairyo : One-year follow-up ultrasonographic study of the subchondral bone surface of the distal femoral epiphysis in children aged 9-11 years., Journal of Pediatric Orthopaedics. Part B, 31, 2, e174-e179, 2022.
(Summary)
Subchondral bone surface irregularity of the distal femoral epiphysis was more common on US in growing children aged 9-11 years, and transition from an irregular to a smooth outline accelerated after age 10 years. US is a reliable method for assessing the morphology of the distal femoral epiphysis and could be a useful screening tool for detecting OCD.
Nobutoshi Takamatsu, Hiroaki Manabe, Kazuma Wada, Tetsuya Hirano, Takashi Chikawa and Koichi Sairyo : Successful treatment of intractable pseudomeningocele with FXIII deficiency by surgery and FXIII replacement therapy: A case report., International Journal of Surgery Case Reports, 92, 2022.
(Summary)
Pseudomeningocele is an extradural cystic collection of cerebrospinal fluid (CSF) and is rare and typically asymptomatic. However, pseudomeningocele is sometimes associated with symptoms. Whether symptomatic pseudomeningocele is best treated conservatively or surgically remains controversial. Factor XIII (FXIII) is a blood coagulation factor that also promotes fibroblast proliferation during wound healing. Although treatment of postsurgical CSF leakage with FXIII has been reported, there have been no reports on surgical treatment and FXIII replacement therapy of pseudomeningocele with FXIII deficiency. We report a case of pseudomeningocele with FXIII deficiency that was successfully treated by surgery and FXIII replacement therapy. The patient presented with symptoms of intracranial hypotension syndrome that had started a few months after laminectomy for thoracic ossification of the ligamentum flavum 2 years earlier. Magnetic resonance imaging and delayed computed tomography myelography confirmed a diagnosis of pseudomeningocele. Epidural blood patch treatment was performed twice but did not result in improvement. Furthermore, the FXIII level decreased to 56%, so the patient was also diagnosed as having acquired FXIII deficiency. We elected to treat the patient by surgery with FXIII replacement therapy. The dural injury was repaired using an artificial dura mater patch, fibrin glue, and polyglycolic acid sheets. The FXIII level was 74%-135% during the perioperative period. The patient had a good postoperative course. Postoperative magnetic resonance images showed resolution of the pseudomeningocele. There was no recurrence during 6 months of follow-up. Perioperative FXIII replacement may be a useful treatment for pseudomeningocele with FXIII deficiency.
Masaru Nakamura, Tateaki Shimakawa, Shunji Nakano, Ryosuke Sato, Kenji Kondo, Hitoshi Goto, Yuto Sugimine, Tetsuya Enishi and Koichi Sairyo : Effectiveness of Primary Total Hip Arthroplasty Combined with Intra-articular and Intravenous Tranexamic Acid: A Retrospective Analysis of Number of Doses and Dose Strength., Indian Journal of Orthopaedics, 56, 7, 1234-1239, 2022.
(Summary)
Reducing perioperative bleeding decreases the invasiveness of surgery, which is important from the perspective of medical safety.
Yasuaki Tamaki, Tomohiro Goto, Tomoya Takasago, Keizo Wada, Daisuke Hamada and Koichi Sairyo : Clinical and radiological outcomes of total hip arthroplasty using a highly porous titanium cup or a conventional hydroxyapatite-coated titanium cup: A retrospective study in Japanese patients., Journal of Orthopaedic Science, 27, 1, 163-168, 2022.
(Summary)
Despite excellent clinical outcomes in both study groups, the incidence of RLLs was higher in the OsseoTi group than in the Trident group. Although none of our cases with RLL have required revision surgery for aseptic loosening so far, these patients require careful follow-up.
Nobutoshi Takamatsu, Hiroaki Manabe, Yuki Yokoo, Kazuma Wada, Tetsuya Hirano, Naohito Hibino, Tatsuhiko Henmi, Takashi Chikawa and Koichi Sairyo : Comparison between O-arm Navigation and Conventional Fluoroscopic Guidance in Corrective Posterior Fixation for Cervical Spinal Injury., The Journal of Medical Investigation : JMI, 69, 3.4, 273-277, 2022.
(Summary)
Purpose : To compare the effectiveness of O-arm navigation with that of conventional fluoroscopic guidance in corrective posterior fixation for cervical spinal injury. Methods : This retrospective comparative study involved 11 consecutive patients who underwent corrective posterior fixation using O-arm navigation or conventional fluoroscopy for cervical spinal injury between February 2016 and May 2021. Patient-specific characteristics (age and sex), number of screws, number of pedicle screws, accuracy of pedicle screw insertion, number of vertebral bodies fixed, operating time, and length of hospital stay were analyzed using the t-test. A P-value < 0.05 was considered statistically significant. Results : Corrective posterior fixation was performed under O-arm navigation in 5 patients and under conventional fluoroscopic guidance in 6. A significantly greater number of pedicle screws was used in the O-arm group (6.4 vs 2.7, P = 0.046). According to the Neo classification for pedicle screw placement, there were no grade 2 or 3 breaches. No other items showed a significant difference between the groups (P > 0.05). Conclusion : O-arm navigation can improve the accuracy of cervical pedicle screw insertion. Its introduction could expand the indications for use of pedicle screws in posterior fixation of cervical spinal injury beyond those that are possible using conventional fluoroscopy. J. Med. Invest. 69 : 273-277, August, 2022.
Katsutoshi Miyatake, Shoji Fukuta, Ichiro Tonogai, Keizo Wada, Kousaku Higashino, Hiroshi Mikami, Hiroshi Yonezu, Koichi Sairyo and Yoshihiro Tsuruo : Influence of the glenoid baseplate position on the direction and length of the superior and inferior locking screws., The Journal of Medical Investigation : JMI, 69, 3.4, 185-190, 2022.
(Summary)
Introduction : Superior screw insertion in reverse shoulder arthroplasty (RSA) carries the potential risk of suprascapular injury. The purpose of this study was to evaluate how the baseplate position affects the superior screw position and length in RSA. Methods : Three-dimensional (3D) computer simulation models of RSA were established using computed tomography data of baseplates with superior and inferior screws and 3D scapular models from 10 fresh cadavers. Superior screw position, the distance from the superior screw hole to the suprascapular notch, and the screw lengths were measured and compared among various baseplate positions with two inferior tilts (0 and 10 degrees) and three rotational patterns (11-5, 12-6, and 1-7 o'clock in the right shoulder). Results : For the 1-7 o'clock / inferior tilt 0 degrees baseplate, the superior screw located anterior to the SS notch in all shoulders, the distance to the SS notch was the longest (12.8 mm), and the inferior screw length was the shortest (23.1 mm). Conclusion : Although there is a concern of a short inferior screw length, initial fixation using a baseplate with 1-7 o'clock rotation and an inferior tilt of 0 degrees appears preferable for SS nerve injury prevention during superior screw insertion. J. Med. Invest. 69 : 185-190, August, 2022.
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.
Yuya Ikezumi, Yasushi Matsuura, Teruhiro Morishita, Noriko Ide, Isao Kitada, Takafumi Katayama, Rie Tsutsumi, Hiroshi Sakaue, Yutaka Taketani, Koichi Sairyo and Eiji Takeda : Necessity of daily 1000-IU vitamin D supplementation for maintaining a sufficient vitamin D status., The Journal of Medical Investigation : JMI, 69, 1.2, 135-140, 2022.
(Summary)
The changes in the serum 25-hydroxyvitamin D (25(OH)D) concentrations after daily 1000-IU vitamin D intake for 3 months (3-month-VD), 6 months (6-month-VD) and then 6-month cessation of vitamin D in-take (6-month-VD cessation) were examined. The serum 25(OH)D levels in 11 male and 16 female subjects were 12.1±3.5 ng/mL at baseline, increased to 27.1±4.7 ng/mL at 3-month-VD, 28.5±5.1 ng/mL at 6-month-VD and decreased to 16.4±4.0 ng/mL at 6-month-VD cessation. The present study suggested that a vitamin D intake of 1000 IU/day is required to maintain the 25(OH) D concentration at 30 ng/mL or higher without vitamin D intoxication. J. Med. Invest. 69 : 135-140, February, 2022.
(Keyword)
Dietary Supplements / female / Humans / male / Nutritional Status / vitamin D / Vitamin D Deficiency / Vitamins
Sung Hyeun Kim, Hung Pang Wu, Koichi Sairyo and Il-Tae Jang : A Narrative Review of Uniportal Endoscopic Lumbar Interbody Fusion: Comparison of Uniportal Facet-Preserving Trans-Kambin Endoscopic Fusion and Uniportal Facet-Sacrificing Posterolateral Transforaminal Lumbar Interbody Fusion., International Journal of Spine Surgery, 15, suppl 3, S72-S83, 2021.
(Summary)
Uniportal endoscopic lumbar interbody fusion aims to achieve the bony union of 2 lumbar segments through cage insertion using full spinal endoscopy. Endoscopic fusion can adjust foraminal height and disc height, improve alignment, and minimize collateral soft tissue damage during the insertion of an interbody cage. The surgery is performed under constant irrigation with normal saline and an optical endoscopic lens close to the targeted disc segment. Two main subtypes of uniportal endoscopic fusion are currently described in the literature. We broadly classify them into facet-preserving and facet-sacrificing endoscopic lumbar interbody fusions. We have termed them uniportal facet-preserving trans-Kambin endoscopic fusion and uniportal facet-sacrificing posterolateral transforaminal lumbar interbody fusion. In this article, we review the current literature and discuss the history, indications, contraindications, technical differences, clinical outcomes, and complications of uniportal endoscopic interbody fusion surgery.
Ichiro Tonogai and Koichi Sairyo : One-stage tibial deformity correction and ankle arthrodesis for ankle osteoarthritis and tibial malalignment after low tibial osteotomy., International Journal of Surgery Case Reports, 89, 2021.
(Summary)
We reported a rare case of ankle osteoarthritis and tibial malalignment that was successfully treated with one-stage corrective tibial opening wedge osteotomy and ankle arthrodesis using an anterolateral plate via a transfibular approach.
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.
Shun-ichi Toki, Tetsuro Yoshimaru, Yosuke Matsushita, Hitoshi Aibara, Masaya Ono, Koichi Tsuneyama, Koichi Sairyo and Toyomasa Katagiri : The survival and proliferation of osteosarcoma cells are dependent on the mitochondrial BIG3-PHB2 complex formation., Cancer Science, 112, 10, 4208-4219, 2021.
(Summary)
Previous studies reported the critical role of the brefeldin A-inhibited guanine nucleotide exchange protein 3-prohibitin 2 (BIG3-PHB2) complex in modulating estrogen signaling activation in breast cancer cells, yet its pathophysiological roles in osteosarcoma (OS) cells remain elusive. Here, we report a novel function of BIG3-PHB2 in OS malignancy. BIG3-PHB2 complexes were localized mainly in mitochondria in OS cells, unlike in estrogen-dependent breast cancer cells. Depletion of endogenous BIG3 expression by small interfering RNA (siRNA) treatment led to significant inhibition of OS cell growth. Disruption of BIG3-PHB2 complex formation by treatment with specific peptide inhibitor also resulted in significant dose-dependent suppression of OS cell growth, migration, and invasion resulting from G2/M-phase arrest and in PARP cleavage, ultimately leading to PARP-1/apoptosis-inducing factor (AIF) pathway activation-dependent apoptosis in OS cells. Subsequent proteomic and bioinformatic pathway analyses revealed that disruption of the BIG3-PHB2 complex might lead to downregulation of inner mitochondrial membrane protein complex activity. Our findings indicate that the mitochondrial BIG3-PHB2 complex might regulate PARP-1/AIF pathway-dependent apoptosis during OS cell proliferation and progression and that disruption of this complex may be a promising therapeutic strategy for OS.
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.
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.
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.
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.
Ichiro Tonogai and Koichi Sairyo : Temporary Kirschner wire fixation of the first metatarsophalangeal joint before osteotomy for hallux valgus., International Journal of Surgery Case Reports, 84, 2021.
(Summary)
We have developed a modified Mitchell osteotomy with the novel TeKFiM method (Tonogai method) before osteotomy for hallux valgus to avoid incongruency and overcorrection. This method also provides a landmark to correct pronation and plantarward shifting.
Tomoya Takasago, Tomohiro Goto, Keizo Wada, Daisuke Hamada and Koichi Sairyo : Postoperative radiographic evaluation and simulation study for optimal cup placement in high-hip centre total hip arthroplasty., Hip International, 31, 3, 335-341, 2021.
(Summary)
We retrospectively reviewed 214 patients who underwent primary total hip arthroplasty (THA) and identified 30 hips with Crowe II (
Tomoya Terai, Takashi Chikawa, Tatsuhiko Henmi and Koichi Sairyo : Magnetic Resonance Imaging Findings and Clinical Outcomes in the Early Postoperative Period after Full Endoscopic Diskectomy for Lumbar Disk Herniation., Journal of Neurological Surgery. Part A, Central European Neurosurgery, 83, 1, 13-19, 2021.
(Summary)
Postoperative MRI findings within 1 week of FED showed grade C or D residual disk material in 24 of 33 patients (73%). Clinical symptoms improved in the early postoperative period, even though residual disk bulging was present. Persisting residual bulging in the early stage following surgery may not correlate with clinical symptoms.
Yutaka Kinoshita, Shunji Nakano, Shinji Yoshioka, Masaru Nakamura, Tomohiro Goto, Daisuke Hamada and Koichi Sairyo : A Rare Case of Extremely Severe Heterotopic Ossification after Primary Total Hip Arthroplasty due to Persistent Mild Periprosthetic Joint Infection., Case Reports in Orthopedics, 2021, 2021.
(Summary)
infection in a 78-year-old male patient. The patient had poorly controlled diabetes mellitus with no diabetic complications. The patient had no previous history of hip surgery, hip injury, or systemic bacterial infection. Immediately after the initial THA, he developed intermittent low-grade fever (37°C), which persisted for 3 months; consequently, he also reported mild hip pain during walking. He experienced a gradual decrease in hip range of motion within 5 years after the surgery, with progressive gait impairment. Two revision surgeries were required for the successful treatment of this difficult case. The patient's hip function improved, and the PJI was controlled following the second revision surgery. Based on the clinical course, CNS-caused PJI may lead to severe HO. This possibility warrants verification from an accumulated number of cases.
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.
Ichiro Tonogai and Koichi Sairyo : Posterior ankle arthroscopy for posterior ankle synovitis with an enlarged posterior talar process caused by a cat bite or scratch: A case report., International Journal of Surgery Case Reports, 81, 105761, 2021.
(Summary)
We report a rare case of posterior ankle synovitis with an enlarged posterior talar process caused by a cat bite or scratch which was treated successfully by posterior ankle arthroscopic debridement.
Tetsuya Matsuura, Yuki Takata, Toshiyuki Iwame, Jyoji Iwase, Kenji Yokoyama, Shoichiro Takao, Susumu Nishio, Kokichi Arisawa and Koichi Sairyo : Limiting the Pitch Count in Youth Baseball Pitchers Decreases Elbow Pain., Orthopaedic Journal of Sports Medicine, 9, 3, 2021.
(Summary)
A pitch count limit of 70 pitches per day for baseball pitchers 12 years could be more protective against elbow pain and reduced flexion than a limit of 7 innings per day, but it may not be effective for reducing the risk of capitellar OCD.
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.
Ichiro Tonogai and Koichi Sairyo : A case of ankle osteoarthritis associated with lateral premalleolar bursitis caused by chronic ankle instability., International Journal of Surgery Case Reports, 80, 2021.
(Summary)
We report a case of arthroscopic arthrodesis for osteoarthritis of the ankle associated with lateral premalleolar bursitis caused by the check valve mechanism of chronic ankle instability after old ankle sprain.
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.
Takayoshi Shinya, Otomi Yoichi, Toshihiko Nishisho, B Beuthien-Baumann, Saho Irahara, Michiko Kubo, Hideki Otsuka, Yoshimi Bando, Koichi Sairyo and Masafumi Harada : Clinical application of dynamic 18F-fluorodeoxyglucose positron-emission tomography / computed tomography in the differential diagnoses of musculoskeletal lesions, The Journal of Medical Investigation : JMI, 68, 1. 2, 96-104, 2021.
(Summary)
<p>We aimed to assess the differential diagnostic efficacy of dynamic F-18 fluorodeoxyglucose (FDG) positron emission tomography / computed tomography (PET / CT) and to evaluate the appropriate scan timings for diagnosis of musculoskeletal lesions (MSLs). Dynamic scans (5-15 [phase 1], 15-25 [phase 2], and 25-35 [phase 3] min after F-18 FDG injection) and dual-time-point scans (1 and 2 h after injection) were acquired for 23 MSLs [4 benign MSLs (BMSLs). 10 primary malignant musculoskeletal tumors (PMMSTs), and 9 metastatic musculoskeletal tumors (MMSTs)]. We compared the maximum standardized uptake values (SUVmax) and corresponding retention indices for dynamic (RI-SUVdyn) and dual-time-point (RI-SUVdual) scans and evaluated diagnostic efficacy using receiver operating characteristic (ROC) curve analyses. The SUVmax gradually decreased or was almost identical with minimal fluctuation in 3 BMSLs and 1 PMMST. SUVmax increased over time after phase 2 in 18 malignant MSLs (MMSLs). There were significant differences in SUVmax (for all time phases) and RI-SUV dual between BMSLs and MMSLs and between PMMSTs and MMSTs. In the ROC analyses, the areas under the curve for SUV in phases 2 and 3 were highest for differentiating BMSLs from MMSLs and PMMSTs from MMSTs, respectively. Dynamic F-18 FDG PET / CT is valuable for diagnosis of musculoskeletal lesions. J. Med. Invest. 68 : 96-104, February, 2021</p>
(Keyword)
bone and soft tissue tumors / dynamic scan / musculoskeletal lesion / positron emission tomography computed tomography / sarcoma
Shoji Fukuta, Keizo Wada, Kousaku Higashino, Koichi Sairyo and Yoshihiro Tsuruo : Optimal baseplate position in reverse shoulder arthroplasty in small-stature Japanese women : a cadaveric study., The Journal of Medical Investigation : JMI, 68, 1.2, 175-180, 2021.
(Summary)
The purpose of this study was to determine the optimal position of the baseplate on the small glenoid of female Japanese. Two sets of 3D scapular models were made according to the CT data of 7 female cadavers. We set two scenarios of the baseplate placement : A and B. In scenario A, the baseplate was placed on the glenoid face centrally in the anteroposterior direction. In scenario B, the baseplate was implanted at the point where the baseplate post was contained within the glenoid vault. Whether or not the baseplate post perforated the scapular neck was recorded. In scenario A, the central post penetrated the scapular neck posteriorly in 5 scapulae. In scenario B, the average distances from the guide pin position to the anterior glenoid rim was 9.7 ± 1.7 mm and the optimal position of the guide pin was 1.9 ± 1.7 mm anterior from the glenoid center. The central post was contained within the scapula without breakage of the cortex. This study demonstrated that shifting the center of the baseplate slightly anterior to the anatomic center is necessary to avoid perforation of the scapular neck in small female Japanese. J. Med. Invest. 68 : 175-180, February, 2021.
Teruhiro Morishita, Michiko Sato, Takafumi Katayama, Nami Sumida, Hiroshi Omae, Shigeko Satomura, Masae Sakuma, Hidekazu Arai, Akihiko Kawaura, Eiji Takeda, Shinsuke Katoh and Koichi Sairyo : Cut-off values for skeletal muscle strength and physical functions in Japanese elderly with walking difficulty., The Journal of Medical Investigation : JMI, 68, 1.2, 48-52, 2021.
(Summary)
Age-related changes in muscle strength and physical functions, and the association between vitamin D status and skeletal muscle functions were investigated in 36 men (21-90 years old) and 52 women (21-104 years old). Significant ageing-related decreases in several skeletal muscle functions and serum 25-hydroxyvitamin D [25(OH)D] levels were observed in both men and women. Cut-off values for the Timed up and go (TUG) test, walking speed, handgrip strength and Barthel Index (BI) detecting walking difficulties in the receiver operating characteristic (ROC) analysis were 11.1 sec, 0.60 m / sec, 17.0 kg, and 90.0 in males, and 28.6 sec, 0.43 m / sec, 13.9 kg, and 67.5 in females, respectively. By comparing personal present data of muscle strength with these cut-off values, people can easily understand their process to walking difficulty. Therefore, these results are important and useful to avoid or to delay a handicapped and dependent status by improving the vitamin D level, rehabilitation and nursing care. J. Med. Invest. 68 : 48-52, February, 2021.
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.
Tomoya Takasago, Daisuke Hamada, Keizo Wada, Akihiro Nitta, Yasuaki Tamaki, Tomohiro Goto, Yoshihiro Tsuruo and Koichi Sairyo : Insufficient lateral joint laxity after bicruciate-retaining total knee arthroplasty potentially influences kinematics during flexion: A biomechanical cadaveric study., The Knee, 28, 311-318, 2021.
(Summary)
Restoring optimal joint laxity was not always straightforward in BCR TKA if the 4 ligaments were preserved. Lateral joint laxity was potentially decreased in BCR TKA and may result in kinematic conflict during flexion. Surgeons should be aware of the need to achieve sufficient lateral joint laxity in this type of BCR TKA.
Toshiyuki Iwame, Tetsuya Matsuura, T Okahisa, S Katsuura-Kamano, Keizo Wada, Jyoji Iwase and Koichi Sairyo : Quadriceps strength to body weight ratio is a significant indicator for initiating jogging after anterior cruciate ligament reconstruction., The Knee, 28, 240-246, 2021.
(Summary)
Quadriceps strength recovery after anterior cruciate ligament (ACL) reconstruction is an important criterion for progress in rehabilitation and return to sports. The purpose of this study was to determine whether quadriceps strength to body weight ratio (QS/BW) is a significant indicator for initiating jogging after ACL reconstruction.
Ken TOMONARI, Tsuyoshi GOTO, Nori Sato, Toshifumi OSAWA, Tomohiro Goto, Koichi Sairyo and Shinsuke Katoh : Dynamic Spinal Alignment in Patients with Osteoarthritis of the Hip, Physical Therapy Japan, 48, 1, 72-78, 2021.
Yasushi Matsuura, Teruhiro Morishita, Michiko Sato, Nami Sumida, Takafumi Katayama, Rie Tsutsumi, Hiroshi Sakaue, Yutaka Taketani, Koichi Sairyo, Akihiko Kawaura and Eiji Takeda : Effects of daily 1,000-IU vitamin D-fortified milk intake on skeletal muscle mass, power, physical function and nutrition status in Japanese., The Journal of Medical Investigation : JMI, 68, 3.4, 249-255, 2021.
(Summary)
An intervention study was conducted to investigate the effects of daily 1,000-IU vitamin D-fortified milk intake on skeletal muscle mass, power, physical function and nutrition status in 26 healthy people and 8 older adults living in a nursing home. The serum 25-hydroxyvitamin D [25(OH)D] level was 13.4 ± 0.8 ng / mL and it markedly increased to 29.6 ± 0.9 ng / mL after daily 1000-IU vitamin D-fortified milk intake for 6 months. Handgrip strength (kg) also significantly increased in the 21-50 years and total groups, and male subjects, and the timed up and go test significantly improved in the 21-50 years and total groups, and female subjects after 6-month vitamin D intake. However, there were no significant differences between baseline and post-treatment in the Barthel Index (BI), walking speed (m / sec) or skeletal muscle mass (kg, % of BW, kg / m2). Therefore, the present study suggested that vitamin D-fortified milk intake is effective at improving muscle strength and physical function in Japanese, although further studies are needed, particularly for older adults. J. Med. Invest. 68 : 249-255, August, 2021.
(Keyword)
Aged / Animals / female / Hand Strength / Humans / Japan / male / Milk / Muscle Strength / Muscle, Skeletal / Nutritional Status / Postural Balance / Time and Motion Studies / vitamin D
Shoji Fukuta, Shinji Kawaguchi and Koichi Sairyo : Partial thickness tear of the supraspinatus at the musculotendinous junction in a softball catcher., The Journal of Medical Investigation : JMI, 68, 3.4, 386-388, 2021.
(Summary)
We report a rare case of a partial thickness tear of the supraspinatus at the musculotendinous junction in a softball catcher. Preoperative magnetic resonance images of the shoulder showed high signal intensity areas at the musculotendinous junction, along with discontinuity of the articular side of the supraspinatus. Arthroscopic examination revealed articular-side partial tear at the musculotendinous junction. The patient was able to return to playing softball 20 weeks after arthroscopic side-to-side repair. J. Med. Invest. 68 : 386-388, August, 2021.
Yanting Liu, Jin-Sung Kim, Chien-Min Chen, Gun Choi, Sang Ho Lee, Sebastian Ruetten, Xifeng Zhang and Koichi Sairyo : A Review of Full-endoscopic Interlaminar Discectomy for Lumbar Disc Disease: A Historical and Technical Overview., Journal of Minimally Invasive Spine Surgery and Technique, 6, suppl1, s109-s116, 2021.
Koji Matsumoto, Anoli Shah, Amey Kelkar, Dikshya Parajuli, Sushil Sudershan, K Vijay Goel and Koichi Sairyo : Biomechanical evaluation of a novel decompression surgery: Transforaminal full-endoscopic lateral recess decompression (TE-LRD)., North American Spine Society Journal, 5, 2020.
(Summary)
50% TE-LRD was the decompression surgical technique with the least effect on spinal instability. 100% TE-LRD showed to be effective for cases with degenerative discs. 50% TE-LRD may decrease the risk of postoperative intervertebral disc and facet joint degeneration.
Yasuaki Tamaki, Tomohiro Goto, Keizo Wada, Daisuke Hamada, Yoshihiro Tsuruo and Koichi Sairyo : Anatomic evaluation of the insertional footprints of the iliofemoral and ischiofemoral ligaments: a cadaveric study., BMC Musculoskeletal Disorders, 21, 1, 828, 2020.
(Summary)
Understanding the size and location of each capsular ligament footprint in relation to an osseous landmark may help surgeons to manage the hip capsule intraoperatively even under a narrow surgical view. The findings of this study underscore the importance of recognizing that the distal ISFL footprint is located relatively forward and very close to the distal lateral arm footprint.
Ichiro Tonogai and Koichi Sairyo : Arthrodesis for chronic lateral subtalar joint dislocation caused by posterior tibial tendon dysfunction: A case report., International Journal of Surgery Case Reports, 78, 21-25, 2020.
(Summary)
We report a rare case of chronic lateral subtalar dislocation caused by PTTD that was treated by fusion of the talonavicular and talocalcaneal joints.
板東 真由, Soushi Ishida, Keisuke Kashiwagi, 戸田 皓大, Kunihisa Yamaguchi, Yoshiaki Kubo, Koichi Sairyo and Ichiro Hashimoto : A Case of Giant Basal Cell Carcinoma of the Penis with False-positive Metastasis on PET/CT, Japanese Journal of Plastic Surgery, 63, 12, 1578-1585, 2020.
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.
Keizo Wada, 三上 浩, Shun-ichi Toki, 甘利 留衣, Michihiro Takai and Koichi Sairyo : Intra- and inter-rater reliability of a three-dimensional classification system for intertrochanteric fracture using computed tomography, Injury, 51, 11, 2682-2685, 2020.
(Summary)
Intertrochanteric fractures are common fragility fractures in elderly patients. The importance of a reliable classification system for these fractures has been increasingly recognized. The aim of this study was to test the hypothesis that three-dimensional classification by CT has better intra- and inter-observer reliability than conventional two-dimensional classification. Two hundred and three consecutive patients (39 male, 164 female; mean age 84.5 years) with intertrochanteric fracture were included in the study. In each case, the fracture was classified using the two-dimensional Evans-Jensen and AO/OTA systems that rely on plain radiographs and using a three-dimensional fragment-based CT system. The second evaluation was performed 1 month after the first evaluation by the same examiner to determine intra-observer reliability. Another blinded examiner also classified each case to assess inter-observer reliability. The kappa coefficient was used for determination of intra- and inter-observer reliability. The kappa values for the two-dimensional Evans-Jensen and AO/OTA classification systems showed moderate intra-observer reliability (κ=0.65 and κ=0.61, respectively) and slight inter-observer reliability (κ=0.20 and κ=0.19). The intra-observer kappa value for the three-dimensional classification system was 0.88, indicating almost perfect reliability; the inter-observer kappa value was 0.70, indicating substantial reliability. The findings of this study confirm that the fragment-based classification system has high reliability. Surgeons should be aware that the three-dimensional fragment-based CT system for classification of intertrochanteric fractures has better intra-observer and inter-observer reliability than the conventional two-dimensional systems.
Ichiro Tonogai and Koichi Sairyo : A case of osteophyte excision and arthroscopic arthrodesis for tarsal tunnel syndrome with traumatic osteoarthritis of the ankle., International Journal of Surgery Case Reports, 76, 510-516, 2020.
(Summary)
We report here successful treatment of a rare case of tarsal tunnel syndrome (TTS) accompanied with traumatic osteoarthritis of the ankle, treated with osteophyte excision for the TTS and arthroscopic for the osteoarthritis.
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.
Makoto Takeuchi, Takashi Chikawa, Naohito Hibino, Yoshinori Takahashi, Yuhei Yamasaki, Kaori Momota, Tatsuhiko Henmi, Toru Maeda and Koichi Sairyo : An Elite Triathlete with High-grade Isthmic Spondylolisthesis Treated by Lumbar Decompression Surgery without Fusion., NMC Case Report Journal, 7, 4, 167-171, 2020.
(Summary)
The patient was a 48-year-old female recreational triathlete who had been experiencing mild low back pain since high school. She had recently developed right leg pain and had gradually worsening difficulty in running. She preferred to undergo spinal surgery without fusion so that she could return to triathlons as soon as possible, and she was referred to our hospital. Plain radiographs showed Meyerding grade 3 isthmic spondylolisthesis at L5 and a slipped L5 vertebral body. Selective nerve root block at L5 relieved the right leg pain temporarily. The final diagnosis was right L5 radiculopathy due to compression by the ragged edge of the L5 pars defect from the posterior side and by the upside-down foraminal stenosis at L5-S1. An L4-L5 partial laminectomy was performed with resection of the ragged edge and one-third of the caudal pedicle at L5. Adequate decompression was achieved by exposing the L5 spinal nerve root from the branch portion to the outside of the L5 pedicle. The right leg pain disappeared postoperatively and she returned to participating in triathlons. One year after surgery, there was slight radiographic progression of the slip in 5 mm; however, there had been no recurrence of the right leg pain. Several studies have reported excellent outcomes after decompression surgery in patients with isthmic spondylolisthesis. To our knowledge, this is the first report of successful lumbar decompression surgery without fusion for high-grade isthmic spondylolisthesis in a triathlete, although in short-term results.
Ichiro Tonogai and Koichi Sairyo : A case of arthroscopic ankle arthrodesis for hemophilic arthropathy of the bilateral ankles., International Journal of Surgery Case Reports, 74, 251-256, 2020.
(Summary)
We report successful treatment with arthroscopic arthrodesis in a case of hemophilic arthropathy in both ankles.
Takayoshi Shinya, Youichi Otomi, Toshihiko Nishisho, Bettina Beuthien-Baumann, Michiko Kubo, Hideki Otsuka, Yoshimi Bando, Hiroaki Yanagawa, Koichi Sairyo and Masafumi Harada : Preliminary clinical assessment of dynamic carbon-11 methionine positron-emission tomography/computed tomography for the diagnosis of the pathologies in patients with musculoskeletal lesions: a prospective study., European Journal of Hybrid Imaging, 26, 4, 15, 2020.
(Summary)
Dynamic C-11 MET PET scans have the potential to be good predictors of discriminating MSLs in patients with primary unknown MSLs in clinical practice.
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.
Ichiro Tonogai and Koichi Sairyo : Posterior Ankle Arthroscopy for Osteochondromatosis of the Posterior Ankle Extra-Articular Space with a Longitudinal Tear of Flexor Hallucis Longus., Case Reports in Orthopedics, 2020, 2020.
(Summary)
We report a rare case of osteochondromatosis of the posterior ankle extra-articular space with a longitudinal tear of flexor hallucis longus (FHL). A 77-year-old woman was referred to our hospital with an approximately 4-year history of pain and swelling in the right posterior ankle joint without obvious trauma. The pain had worsened in the previous 2 years. On presentation, she had tenderness at the posteromedial and posterolateral ankle. Imaging revealed several ossified loose bodies in the posterior ankle extra-articular space. We removed the loose bodies, performed tenosynovectomy around the FHL, and released the FHL tendon using a posterior arthroscopic technique via standard posterolateral and posteromedial portals. A longitudinal tear and fibrillation were detected in the FHL. The patient was able to return to her daily activities approximately 3 weeks after surgery. At the 1-year follow-up visit, she continued to have minor discomfort and slight swelling on the posteromedial aspect of the right ankle but had no recurrence of the ossified loose bodies. To our knowledge, this is the first report of osteochondromatosis of the posterior ankle extra-articular space with a longitudinal tear of the FHL that was treated by removal of loose bodies, tenosynovectomy around the FHL, and release of the FHL tendon via posterior ankle arthroscopy.
P Christoph Hofstetter, Yong Ahn, Gun Choi, A J N Gibson, S Ruetten, Yue Zhou, Zhou Zhen Li, J Christoph Siepe, Ralf Wagner, Jun-Ho Lee, Koichi Sairyo, Chul Kyung Choi, Chien-Min Chen, E A Telfeian, Xifeng Zhang, Arun Banhot, V Pramod Lokhande, N Prada, Jian Shen, C F Cortinas, P N Brooks, Peter Daele Van, Vit Kotheeranurak, Saqib Hasan, Gun Keorochana, Mohammed Assous, Roger Härtl and Jin-Sung Kim : AOSpine Consensus Paper on Nomenclature for Working-Channel Endoscopic Spinal Procedures., Global Spine Journal, 10, 2 Suppl, 111S-121S, 2020.
(Summary)
We believe that it is critical to delineate a consensus nomenclature to facilitate uniformity of working-channel endoscopic procedures within academic scholarship. This will hopefully facilitate development, standardization of procedures, teaching, and widespread acceptance of full-endoscopic spinal procedures.
Tetsuya Matsuura, Toshiyuki Iwame, Naoto Suzue, Shinji Kashiwaguchi, Takenobu Iwase, Daisuke Hamada and Koichi Sairyo : Long-term Outcomes of Arthroscopic Debridement With or Without Drilling for Osteochondritis Dissecans of the Capitellum in Adolescent Baseball Players: A 10-year Follow-up Study., Arthroscopy : the Journal of Arthroscopic & Related Surgery, 36, 5, 1273-1280, 2020.
(Summary)
Arthroscopic debridement with or without drilling allowed return to play in adolescent baseball players for positions other than pitchers. Long-term outcomes are likely durable regardless of lesion size.
Keizo Wada, Daisuke Hamada, Tomoya Takasago, Akihiro Nitta, Tomohiro Goto, Ichiro Tonogai, Yoshihiro Tsuruo and Koichi Sairyo : Joint distraction force changes the three-dimensional articulation of the femur and tibia in total knee arthroplasty: a cadaveric study., Knee Surgery, Sports Traumatology, Arthroscopy, 28, 5, 1488-1496, 2020.
(Summary)
Joint distraction force changed three-dimensional articulation regardless of PCL preservation. PCL function was revealed as a factor restraining both tibial posterior translation and internal rotation. Surgeons should recognize that joint gap evaluation using a tensor device is subject to three-dimensional changes depending on the magnitude of the joint distraction force.
Ichiro Tonogai and Koichi Sairyo : Posterior Arthroscopic Treatment of a Massive Effusion in the Flexor Hallucis Longus Tendon Sheath Associated with Stenosing Tenosynovitis and Os Trigonum., Case Reports in Orthopedics, 2020, 2020.
(Summary)
We report a rare case of massive accumulation of fluid in the flexor hallucis longus tendon sheath with stenosing tenosynovitis and os trigonum. A 34-year-old woman presented to our hospital with pain and swelling in the posteromedial aspect of the left ankle joint after an ankle sprain approximately 8 months earlier. There was tenderness at the posteromedial aspect of the ankle, and the pain worsened on dorsiflexion of the left great toe. Magnetic resonance imaging revealed massive accumulation of fluid around the flexor hallucis longus tendon. We removed the os trigonum, performed tenosynovectomy around the flexor hallucis longus, and released the flexor hallucis longus tendon via posterior arthroscopy using standard posterolateral and posteromedial portals. At 1 week postoperatively, the patient was asymptomatic and able to resume her daily activities. There has been no recurrence of the massive accumulation of fluid around the flexor hallucis longus tendon as of 1 year after the surgery. To our knowledge, this is a rare case report of extreme massive effusion in the flexor hallucis longus tendon sheath with stenosing tenosynovitis and os trigonum treated successfully by removal of the os trigonum, tenosynovectomy around the flexor hallucis longus, and release of the flexor hallucis longus tendon via posterior ankle arthroscopy.
Tetsuya Matsuura, Toshiyuki Iwame, Jyoji Iwase and Koichi Sairyo : Osteochondritis Dissecans of the Capitellum :Review of the Literature., The Journal of Medical Investigation : JMI, 67, 3.4, 217-221, 2020.
(Summary)
Osteochondritis dissecans (OCD) of the capitellum is a leading cause of elbow disability in adolescent baseball players. Previous studies have not found an association of player position with capitellar OCD. Elbow pain and a longer playing history might be related to progression of capitellar OCD but do not in themselves increase the risk of development of the condition. The cause of capitellar OCD is likely to include a combination of repetitive microtrauma and internal factors, such as ischemia and genetic predisposition. A combination of radiography, computed tomography, magnetic resonance imaging, and ultrasonography have aided our understanding of the pathology of capitellar OCD. Screening using ultrasonography enables early detection and provides an opportunity for successful conservative treatment. Treatment has conventionally included both operative and nonoperative measures based on the stage and size of the lesion, skeletal maturity, subjective symptoms, and structural integrity of the cartilage. Early-stage lesions respond better to nonoperative treatment than those in more advanced stages. Operative indications include persistent symptoms despite nonoperative treatment, symptomatic loose bodies, and displacement or detachment of fragments. J. Med. Invest. 67 : 217-221, August, 2020.
Chandra Subash Jha and Koichi Sairyo : The role of Propionibacterium acnes in and Modic type 1 changes : A literature review., The Journal of Medical Investigation : JMI, 67, 1.2, 21-26, 2020.
(Summary)
Propionibacterium acnes (P. acnes) is part of the normal flora of human skin, oral cavity, intestinal tract and external ear canal. However, breach in the mucosa as well as ruptured annulus fibrosus provide favorable pathway for P. acnes to nucleus pulposus where it can proliferate under anaerobic condition. In past two decades many authors have identified P. acnes in routine culture of discs. There studies showed that almost 50% of discs cultured were positive for various organism, and in vast majority of culture positive disc, P. acnes was the primary organism isolated. However, there are few studies that refute the hypothesis that P. acnes has a role in pathogenesis of Modic type 1 changes. Identification of P. acnes in culture indicates the infective patho-mechanism in the pathogenesis of Modic type 1 changes, which may be ameable to antibiotic treatment. However, it is still difficult to identify which subset of these patients (patients with low back pain with type 1 Modic change) are infective in nature. Further investigation and more clinical trails will be required for clear identification of the infective subgroup among low back patient in general. J. Med. Invest. 67 : 21-26, February, 2020.
Michiko Sato, Teruhiro Morishita, Takafumi Katayama, Shigeko Satomura, Hiroko Okuno, Nami Sumida, Masae Sakuma, Hidekazu Arai, Shinsuke Katoh, Koichi Sairyo, Akihiko Kawaura and Eiji Takeda : Relationship between age-related decreases in serum 25-hydroxyvitamin D levels and skeletal muscle mass in Japanese women., The Journal of Medical Investigation : JMI, 67, 1.2, 151-157, 2020.
(Summary)
A clearer understanding of skeletal muscle mass (SMM) in middle-aged and elderly individuals is important for maintaining functionality. In the present study, age-related changes in SMM, the threshold of SMM with walking difficulty, intestinal nutrient absorption rate, and various serum factors were examined in Japanese populations of different ages. We used 24-h creatinine excretion as a measure of total body SMM. Age-related decreases in SMM, intestinal nutrient absorption rates, and serum 25-hydroxyvitamin D [25(OH)D] concentrations were significantly higher in women than in men. The cut-off values for SMM (kg), its percentage of total body weight (BW), the SMM index [SMMI] (Kg / m2), and creatinine height index (CHI) (%) in elderly individuals with walking difficulty were approximately 8-10 kg, 17-20% of BW, 3.9-4.6 kg / m2, and 44%, respectively. Serum 25(OH)D concentrations were closely associated with SMM (kg, % of BW, kg / m2) and CHI (%) as well as the intestinal absorption rates of nitrogen (%) and phosphorus (%) in women, but not in men. The present results demonstrate that vitamin D is an important metabolic factor in skeletal muscle, and contributes to the optimal management of skeletal muscle and the prevention of sarcopenia. J. Med. Invest. 67 : 151-157, February, 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.
Makoto Takeuchi, Fumitake Tezuka, Takashi Chikawa, Naohito Hibino, Yoshinori Takahashi, Yuhei Yamasaki, Kaori Momota, Tatsuhiko Henmi, Toru Maeda and Koichi Sairyo : Consecutive double-level lumbar spondylolysis successfully treated with the double "smiley face" rod method., The Journal of Medical Investigation : JMI, 67, 1.2, 202-206, 2020.
(Summary)
We report a case of double-level lumbar spondylolysis at L4 and L5 that was successfully treated with the double "smiley face" rod method. A healthy 29-year-old man who presented with a 6-year history of chronic low back pain was referred to us for surgical treatment. Plain radiographs and computed tomography of the lumbar spine revealed bilateral pars defects at L4 and L5 without slip or scoliosis. The patient underwent direct repair of the pars defects using the double smiley face rod method at L4 and L5. There were no intraoperative or postoperative complications, and the patient had improved clinically by 1 year after surgery. The low back pain was completely disappeared and visual analog scale was 0. He restarted tennis again as the recreational level. While several techniques for direct repair of lumbar spondylolysis have been described, this is the first report of the double smiley face rod method being used to repair the consecutive double-level lumbar spondylolysis. J. Med. Invest. 67 : 202-206, 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.
Yasuaki Tamaki, Tomohiro Goto, Tomoya Takasago, Keizo Wada, Daisuke Hamada and Koichi Sairyo : Proximal Femoral Rotational Osteotomy for Symptomatic Femoral Retroversion : A Case Report, The Journal of Medical Investigation : JMI, 67, 1.2, 214-216, 2020.
(Summary)
The Rotational osteotomy for femoral retroversion has been extremely rare despite the known association between femoral neck retroversion, hip pain, and osteoarthritis. Here, we describe a case of femoral neck retroversion for which proximal femoral rotation osteotomy. A 16-year-old boy with a past history of developmental dysplasia of the both hip treated conservatively presented with a complaint of pain in left hips. On physical examination, flexion of the left hip was limited to 90° with terminal pain. Internal rotation was also limited to 10°. Computed tomography (CT) showed -7.1° anteversion of the left femur. We performed rotational osteotomy to increase femoral anteversion because conservative treatment was not effective. The postoperative course was uneventful. At 12 postoperative months, his left hip pain was completely disappeared and femoral anteversion was 34° on CT scans. Retroversion of the femur is a distinct dynamic factor that should be considered in the evaluation of mechanical causes of hip pain. Restoring the normal rotational alignment of the hip resulted in cure of the impingement due to femoral retroversion. J. Med. Invest. 67 : 214-216, February, 2020.
Toshiyuki Iwame, Tetsuya Matsuura, Tetsuya Okahisa, Jyoji Iwase, Hirokazu Uemura and Koichi Sairyo : Factors correlating with recovery of quadriceps strength after double-bundle anterior cruciate ligament reconstruction with hamstring tendon autografts., European Journal of Orthopaedic Surgery & Traumatology, 30, 2, 307-312, 2020.
(Summary)
Recovery of quadriceps strength after anterior cruciate ligament (ACL) reconstruction is one of the criteria used to promote rehabilitation and return to play. The purpose of this study was to investigate the factors associated with recovery of quadriceps strength after ACL reconstruction with hamstring tendon autografts.
Ichiro Tonogai, Fumio Hayashi, Yoshihiro Tsuruo and Koichi Sairyo : The Origin of the Anterior Lateral Malleolar Artery From the Anterior Tibial Artery: A Fresh Cadaveric Study., Foot & Ankle Specialist, 13, 1, 69-73, 2020.
(Summary)
The anterior lateral malleolar artery (ALMA), which usually originates from the anterior tibial artery (ATA), courses transversely and laterally, passing under the extensor digitorum longus and peroneus tertius tendons. Variations in the origin of the ALMA from the ATA can occur. Branches of the ATA, such as the ALMA, are prone to pseudoaneurysm. This study reviewed the origin of the ALMA from the ATA and aimed to identify problems in anterior ankle arthroscopy that might cause injury to the ALMA. Enhanced computed tomography scans of 24 feet of 24 fresh cadavers (13 males, 11 females; average age 78.1 years) were assessed. The limb was injected with barium sulfate suspension through the external iliac artery; the origin of the ALMA from the ATA on the sagittal plane was recorded. The origin was at the ankle joint level in 4 specimens and below the ankle joint in 17 specimens. The distance from the ankle joint to the branching point of the ALMA on the sagittal plane was 5.2 mm distal to the joint. The level of origin of the ALMA from the ATA was established. Instruments should not be inserted from the distal direction when placing anterolateral portals. Levels of Evidence: Level IV, cadaveric study.
Toru Maeda, Kousaku Higashino, Satoshi Hattori and Koichi Sairyo : A Rare Case of Delayed Onset Tunneling Disc Herniation in the Lumbar Spine., Spine Surgery and Related Research, 4, 3, 280-283, 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.
Koichi Sairyo and Toru Maeda : Safety of Interlaminar Full-Endoscopic Lumbar Decompression, EC Orthopaedics, 11, 10, 18-22, 2020.
148.
Toshiyuki Iwame, Tetsuya Matsuura, Naoto Suzue, Jyoji Iwase, Hirokazu Uemura and Koichi Sairyo : Factors Associated With Knee Pain and Heel Pain in Youth Soccer Players Aged 8 to 12 Years., Orthopaedic Journal of Sports Medicine, 7, 11, 2019.
(Summary)
In this study of youth soccer players, knee pain was associated with older age and more years of play, but heel pain was not significantly associated with any factor.
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.
Yasuaki Tamaki, Daisuke Hamada, Tadashi Mitsuhashi, Tokio Kasai, Takuya Mishiro, Takahiko Tsutsui, Kenichiro Kita and Koichi Sairyo : Intraligamentous Hematoma of the Anterior Cruciate Ligament., Case Reports in Orthopedics, 2019, 2019.
(Summary)
Lesions of the anterior cruciate ligament (ACL) are rare entities in clinical practice. Here, we present the case of an intraligamentous hematoma of the ACL. A 20-year-old man (height 173 cm, weight 62.9 kg, body mass index 21) with no significant past medical history developed progressively worsening pain and limitation of range of motion in the left knee due to minor trauma. No abnormality was found on plain radiography; however, magnetic resonance imaging revealed a cystic lesion in the intercondylar fossa that was hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging. We performed knee arthroscopy, made a longitudinal incision in the anterior aspect of the ACL, and identified a hematoma. The patient's postoperative course was uneventful. There is no evidence of recurrence at one year after surgery. Although the ACL is a relatively hypovascular structure, it does contain microscopic blood vessels. In this case, we speculate that the intraligamentous hematoma was the result of rupture of these very small blood vessels in response to a minor injury.
Yosuke Fujimoto, Toshinori Sakai and Koichi Sairyo : What Type of Orthosis is Optimal for Conservative Treatment of Lumbar Spondylolysis?: A Biomechanical Analysis., Spine Surgery and Related Research, 4, 1, 74-80, 2019.
(Summary)
HO showed high restriction in all directions. RS showed higher restriction in extension than NB and less restriction in flexion and side bending than other custom-made LSOs. DC was the only soft LSO showing higher restriction than NB in flexion.
Keizo Wada, Daisuke Hamada, Tomoya Takasago, Tomohiro Goto, Ichiro Tonogai, Yoshihiro Tsuruo and Koichi Sairyo : Rotational and varus-valgus laxity affects kinematics of the normal knee: A cadaveric study., Journal of Orthopaedic Surgery (Hong Kong), 27, 3, 2309499019873726, 2019.
(Summary)
The present study revealed that the rotation angle of the tibia was correlated to the intermediate angle of IE laxity at 0°, 30°, 60°, and 90° of knee flexion and the coronal alignment of the lower limb also correlated to the intermediate angle of VV laxity. These findings provide important reference data on soft tissue laxity and kinematics of the normal knee.
Koichi Sairyo and Toru Maeda : Fullendo-KLIF for the Anatomical Nomenclature of the Full-Endoscope Guided Lumbar Interbody Fusion through the Kambin Triangle: PELIF, PETLIF, FELIF, FE-TLIF or KLIF?, EC Orthopaedics, 10, 9, 743-745, 2019.
154.
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.
This study shows that the rotational kinematics of the native knee is reproduced after BCR TKA with the medial constrained insert. Surgeons and implant designers should be aware that constraint of the medial side in BCR TKA is a crucial factor for restoration of native kinematics which may lead to better clinical outcome.
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.
Ichiro Tonogai, Fumio Hayashi, Yoshihiro Tsuruo and Koichi Sairyo : Examination of the Origin and Branching Direction of the Anterior Medial Malleolar Artery From the Anterior Tibial Artery: A Cadaveric Study., Foot & Ankle Specialist, 12, 2, 167-171, 2019.
Ichiro Tonogai, Fumio Hayashi, Yoshihiro Tsuruo and Koichi Sairyo : Direction and location of the nutrient artery to the fifth metatarsal at risk in osteotomy for bunionette., Foot and Ankle Surgery, 25, 2, 193-197, 2019.
(Summary)
This report revealed direction and location of the nutrient artery entering the fifth metatarsal.
Shoji Fukuta, Katsutoshli Miyatake, Tetsuya Matsuura and Koichi Sairyo : Two Cases of Spontaneous Recurrent Hemarthrosis of the Shoulder with Acromial Erosion Associated with Impingement Syndrome., Case Reports in Orthopedics, 2019, 2019.
(Summary)
Spontaneous recurrent hemarthrosis of the shoulder is rare. Most previously reported cases were associated with massive rotator cuff tear and degenerative glenohumeral arthritis. We described two cases of recurrent hemarthrosis without osteoarthritis of the shoulder. Both cases had bony erosion of the acromion, which was confirmed arthroscopically as the origin of bleeding. Arthroscopic coagulation, acromioplasty, and drainage were successful and there was no recurrence of hemorrhage.
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.
Keizo Wada, Daisuke Hamada, Tomoya Takasago, Mitsuhiro Kamada, Tomohiro Goto, Yoshihiro Tsuruo and Koichi Sairyo : Intraoperative analysis of the kinematics of the native knee including two-dimensional translation of the femur using a navigation system : a cadaveric study., The Journal of Medical Investigation : JMI, 66, 3.4, 367-371, 2019.
(Summary)
The aim of this cadaveric study was to evaluate the intraoperative kinematics of the native knee including two-dimensional translation of the femur using a navigation system. Eight native knees of 4 fresh-frozen whole-body cadavers were used for the study. The kinematics of each knee were analyzed intraoperatively using the navigation system. Although anterior-posterior translation could not be assessed directly, it could be calculated using a formula derived from the parameters in the navigation system. The native knee showed external rotation of the femur in early knee flexion, transient internal rotation in mid flexion, and gradual external rotation in late flexion. There was no marked change in the coronal rotation angle of the mechanical axis during knee flexion. The femoral center moved anteriorly in early knee flexion and posteriorly in late flexion. The distance moved in the medial-lateral direction was relatively smaller than that in the anterior-posterior direction. Two-dimensional translation of the surgical epicondylar axis showed a medial pivot-like motion. In this cadaveric study, the kinematics of the native knee, including two-dimensional translation of the femur, could be satisfactorily assessed intraoperatively using a navigation system. The intraoperative kinematics of the knee can be analyzed in more detail using this methodology. J. Med. Invest. 66 : 367-371, August, 2019.
Keizo Wada, Hiroshi Mikami, Rui Amari, Shun-ichi Toki, Michihiro Takai and Koichi Sairyo : A novel three-dimensional classification system for intertrochanteric fractures based on computed tomography findings., The Journal of Medical Investigation : JMI, 66, 3.4, 362-366, 2019.
(Summary)
A novel three-dimensional fragment-based classification system based on computed tomography findings was established to characterize femoral intertrochanteric fractures. The intertrochanteric bone fragments were defined as follows : neck, posterior portion of the greater trochanter, anterior portion of the greater trochanter, lesser trochanter, and shaft. Each type of fracture was classified as 2-, 3-, 4-, or 5-fragment according to the number of floating bone fragments. Following the description of the fracture type, each floating bone fragment was appended, with the exception of a fragment involving the shaft. Ninety-five intertrochanteric fractures were classified by the same surgeon. The fractures occurred in 14 men and 81 women with a mean age of 84.7 years. The frequency of each type of fracture was investigated. Thirty-one fractures (32.6%) were 2-fragment and 64 (67.4%) were ≥ 3-fragment. A fragment of the anterior portion of the greater trochanter, which cannot be classified using conventional systems, was included in 29 cases (30.5%). A 5-fragment fracture was detected in two cases (2.1%). Using this fragment-based classification system, intertrochanteric fractures can be evaluated in more detail than is possible using conventional classification systems. J. Med. Invest. 66 : 362-366, August, 2019.
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.
Yuta Uemura, Yoko Sakai, Yasuo Tsutsumi, Nami Kakuta, Chiaki Murakami, Shiho Satomi, Takuro Oyama, Naohiro Ohshita, Tomoya Takasago, Daisuke Hamada, Koichi Sairyo and Katsuya Tanaka : Postoperative nausea and vomiting following lower limb surgery :a comparison between single-injection intraarticular anesthesia and continuous epidural anesthesia., The Journal of Medical Investigation : JMI, 66, 3.4, 303-307, 2019.
(Summary)
Study Objective : the incidence of postoperative nausea and vomiting (PONV) following single-injection intraarticular anesthesia was compared to that following continuous epidural anesthesia. Design : Prospective, double-blind, randomized study. Setting : University-affiliated teaching hospital. Patients : Forty-eight patients finally participated in this study, and each group contained twenty-four patients. Interventions : Patients scheduled to undergo lower limb surgery under general anesthesia were randomly allocated into two groups, to receive either single-injection intraarticular or continuous epidural anesthesia for postoperative analgesia. Measurements : The incidence and severity of PONV, complete response rates (i.e., no vomiting or rescue antiemetic use), and pain scores were recorded 2, 24, and 48 h postoperatively. Main results : No significant differences between groups were observed in the incidence and severity of PONV, rescue antiemetic use, or complete response rate at any of the time points, but only the use of rescue analgesics was significantly less in continuous epidural anesthesia group during the 2-24h postoperative period (P=0.04). Conclusion : While the use of single-injection intraarticular anesthesia following lower limb surgery did not prevent PONV more than continuous epidural anesthesia in this study, the intraarticular technique still provides greater simplicity, safety, and cost-effectiveness. J. Med. Invest. 66 : 303-307, 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.
Tsuyoshi Goto, Toshinori Sakai, Nori Sato, Shinsuke Katoh and Koichi Sairyo : An Adolescent Athlete with Low Back Pain Associated with Spina Bifida Occulta at the Thoracolumbar Junction : A Case Report., The Journal of Medical Investigation : JMI, 66, 1.2, 199-200, 2019.
(Summary)
These results suggest that evaluation of the coordination of the muscles and skeletal structures has an important role in the treatment of cases with an anatomical abnormality such as SBO. J.Med.Invest.66:199-200, February, 2019.
Masashi Kano, Toshihiko Nishisho, Ryo Miyagi, Fumio Chikugo, Eiji Kudo, Shoichiro Takao, Seiji Iwamoto, Shun-ichi Toki and Koichi Sairyo : Intimal sarcoma arising from the common iliac artery presenting with artery occlusion : a case report and literature review., The Journal of Medical Investigation : JMI, 66, 1.2, 205-208, 2019.
(Summary)
We present a rare case of intimal sarcoma arising from the common iliac artery in an 82-year-old man who presented with intermittent claudication. He had undergone endovascular therapy with self-expanding stents to both iliac arteries that had occluded soon after placement. After salvage bypass grafting, a diagnosis of intimal sarcoma with angiosarcoma phenotype from the iliac artery was made. Further bypass graft surgery relieved symptoms temporarily. However, the tumor progressed and the left limb became ischemic. The chemotherapy of eribulin did not prevent tumor progression. The patient died of the disease 20 months after the first surgery. J. Med. Invest. 66 : 205-208, February, 2019.
Toshiyuki Iwame, Tetsuya Matsuura, Joji Iwase, Shoichiro Takao, Hiroshi Egawa and Koichi Sairyo : Two Years of Follow-up Magnetic Resonance Imaging for Osteochondral Injury of the Lateral Femoral Condyle in an Adolescent Basketball Player., The Journal of Medical Investigation : JMI, 66, 1.2, 213-217, 2019.
(Summary)
Chondral and osteochondral injuries of the femoral condyle are rare, and relatively few cases have been reported. Therefore, the mechanism, treatment, and findings on follow-up of these injuries are not well described. Here, we report the case of an adolescent basketball player who sustained a sports-related traumatic osteochondral injury of the lateral femoral condyle. He was treated with open reduction and internal fixation with the pull-out suture technique. Two years later, he was able to resume sporting activities at his pre-injury level with no symptoms. Magnetic resonance imaging (MRI) confirmed survival of the fixed osteochondral fragment and restoration of the congruity of the articular cartilage with no sign of delamination. This report describes the clinical outcome of this osteochondral injury of the lateral femoral condyle as seen on MRI at the 2-year follow-up and discuss the mechanism and treatment of this injury. J. Med. Invest. 66 : 213-217, February, 2019.
Ichiro Tonogai, Eiki Fujimoto and Koichi Sairyo : Pseudoaneurysm of the Perforating Peroneal Artery following Ankle Arthroscopy., Case Reports in Orthopedics, 2018.
(Summary)
The use of standard anterolateral and anteromedial portals in ankle arthroscopy results in reduced risk of vascular complications. Anatomical variations of the arterial network of the foot and ankle might render the vessels more susceptible to injury during procedures involving the anterior ankle joint. The literature, to our knowledge, reports only one case of a pseudoaneurysm involving the peroneal artery after ankle arthroscopy. Here, we report the unusual case of a 48-year-old man in general good health with the absence of the anterior tibial artery and posterior tibial artery. The patient presented with a pseudoaneurysm of the perforating peroneal artery following ankle arthroscopy for traumatic osteoarthritis associated with nonunion of the medial malleolus. The perforating peroneal artery injury was repaired by performing end-to-end anastomosis. The perforating peroneal artery is at higher risk for iatrogenic injury during ankle arthroscopy in the presence of abnormal arterial variations of the foot and ankle, particularly the absence of the anterior tibial artery and posterior tibial artery. Before ankle arthroscopy, surgeons should therefore carefully observe the course of the perforating peroneal artery on enhanced 3-dimensional computed tomography, especially in patients with a history of trauma to the ankle joint.
Ichiro Tonogai, Hiroki Arase, Yutaka Kawabata and Koichi Sairyo : Septic True Aneurysm of the Posterior Tibial Artery Diagnosed after Anterior Arthroscopic Debridement of a Septic Ankle following Infective Endocarditis: A Case Report., Journal of Orthopaedic Case Reports, 8, 6, 68-73, 2018.
(Summary)
Magnetic resonance imaging should be performed before arthroscopic surgery to rule outaneurysm, especially in a patient with a septic ankle and/ora history of infective endocarditis.
Shinji Yoshioka, Shunji Nakano, Yutaka Kinoshita, Masaru Nakamura, Tomohiro Goto, Daisuke Hamada and Koichi Sairyo : Comparison of a highly porous titanium cup (Tritanium) and a conventional hydroxyapatite-coated porous titanium cup: A retrospective analysis of clinical and radiological outcomes in hip arthroplasty among Japanese patients., Journal of Orthopaedic Science, 23, 6, 967-972, 2018.
(Summary)
Both groups showed successful clinical results over short-term follow-up; however, the Tritanium group had a significantly higher rate of radiolucent line occurrence around the cups than did the Trident group. Thus, radiolucent lines can occur when using highly porous titanium cups; these lines indicate the possibility of future cup loosening. Longer follow-up and assessment of the results of using this implant are necessary.
Daisuke Hamada, Keizo Wada, Tomoya Takasago, Tomohiro Goto, Akihiro Nitta, Kousaku Higashino, Yoshihiro Fukui and Koichi Sairyo : Native rotational knee kinematics are lost in bicruciate-retaining total knee arthroplasty when the tibial component is replaced., Knee Surgery, Sports Traumatology, Arthroscopy, 26, 11, 3249-3256, 2018.
(Summary)
The rotational kinematics of the native knee are not always preserved after BCR TKA. Native rotational kinematics are preserved after meniscectomy and femoral replacement, but are lost after tibial replacement in BCR TKA. Surgeons should pay close attention to maintain the anteroposterior stabilizing function of the ACL in BCR TKA, rather than to restore the native rotational kinematics.
Ichiro Tonogai, Fumio Hayashi, Yoshihiro Tsuruo and Koichi Sairyo : Distances from the deep plantar arch to the lesser metatarsals at risk during osteotomy: a fresh cadaveric study., Journal of Foot and Ankle Research, 11, 57, 2018.
(Summary)
Enhanced computed tomography scans of 20 fresh cadaveric feet (male,
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.
186.
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.
Keizo Wada, Daisuke Hamada, Tomoya Takasago, Akihiro Nitta, Tomohiro Goto, Ichiro Tonogai, Yoshihiro Tsuruo and Koichi Sairyo : Native rotational knee kinematics is restored after lateral UKA but not after medial UKA., Knee Surgery, Sports Traumatology, Arthroscopy, 26, 11, 3438-3443, 2018.
(Summary)
The rotational kinematics of the native knee was not restored after medial UKA but was preserved after lateral UKA. There were no significant differences in the varus/valgus kinematics after either medial or lateral UKA when compared with those of the native knees. Thus, the geometry of the medial tibial articular surface is a determinant of the ability to restore the rotational kinematics of the native knee. Surgeons and implant designers should be aware that the anatomical medial articular geometry is an important factor in restoration of the native knee kinematics after knee arthroplasty.
Ichiro Tonogai, Keizo Wada, Kousaku Higashino, Yoshihiro Fukui and Koichi Sairyo : Location and direction of the nutrient artery to the first metatarsal at risk in osteotomy for hallux valgus., Foot and Ankle Surgery, 24, 5, 460-465, 2018.
(Summary)
Location and direction of the first metatarsal nutrient artery was established.
Keizo Wada, Tomohiro Goto, Tomoya Takasago, Takahiko Tsutsui and Koichi Sairyo : Acetabular Reconstruction Using a Trabecular Metal Cup with a Novel Pelvic Osteotomy Technique for Severe Acetabular Bone Defect., Case Reports in Orthopedics, 2018.
(Summary)
The advantages of this technique are twofold, namely, stable fixation of the cup sandwiched between the anterior and posterior walls and reconstruction of the anterior wall using living bone, which allows bone ingrowth into the cup.
Ichiro Tonogai, Toshihiko Nishisho, Shoichiro Takao, Ryo Miyagi, Kenji Yokoyama, Shunichi Toki and Koichi Sairyo : Symptomatic Os Intercuneiform: A Case Report., The Journal of Foot and Ankle Surgery, 57, 5, 997-999, 2018.
(Summary)
We encountered a case of an accessory bone in the foot in the distal portion of the tarsal navicular and the proximal portion of the intermediate cuneiform, namely an os intercuneiform. The patient presented with a history of pain on the dorsal aspect of the left foot, with tenderness and swelling. Perioperative findings revealed a synfibrotic connection between the accessory bone and the navicular and intermediate cuneiform. After unsuccessful conservative treatment, the accessory bone was excised, leading to postoperative symptomatic relief.
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.
Ichiro Tonogai, Fumio Hayashi, Yoshihiro Tsuruo and Koichi Sairyo : Entry points of nutrient arteries at risk during osteotomy of the lesser metatarsals: a fresh cadaveric study., Journal of Foot and Ankle Research, 11, 46, 2018.
(Summary)
Distal metatarsal osteotomies might be safer than shaft or proximal osteotomy to avoid disruption of the nutrient artery, leading to delayed consolidation of the osteotomy and nonunion.
(Keyword)
Aged / Aged, 80 and over / Arteries / Cadaver / Computed Tomography Angiography / Female / Humans / Image Enhancement / Male / Metatarsal Bones / Middle Aged / Organs at Risk / Osteotomy
Ichiro Tonogai, Daiki Nakajima, Ryo Miyagi and Koichi Sairyo : Gelatinous transformation of bone marrow in the calcaneus, diagnosed by open bone biopsy in a patient with anorexia nervosa: A case report., Foot & Ankle Orthopaedics, 3, 3, FirstPublished, 2018.
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.
Toshinori Sakai, 橋本 拓也, Keizo Wada, Ryo Miyagi and Koichi Sairyo : A New Method of Image Evaluation for Diagnosis of Pain : Clinical Application of Diffusion-weighted Imaging, Journal of Spine Research, 9, 6, 1005-1011, 2018.
Ichiro Tonogai and Koichi Sairyo : Psychogenic Equinovarus Caused by Dislocation of the Chopart Joint Complex., Case Reports in Orthopedics, 2018, 2018.
(Summary)
Patients with conversion disorder (CD) present with weakness or unexplained movement disorder that may evolve from inciting psychological events, but presentation with rigid deformity is rare. Only one case of CD presenting as foot deformity with atraumatic rigid psychogenic equinovarus has been reported previously. Here we describe a rare case of psychogenic equinovarus in a physically healthy 10-year-old boy. He had noticed left equinovarus deformity upon waking abruptly but had no history of preceding trauma and no relevant medical history. Computed tomography (CT) images revealed dislocation of the left Chopart joint complex, but clinical examination did not suggest an organic neurologic disorder. On further history taking, he reported that he was under psychological stress because of being required to play baseball against his will. When he was given permission to withdraw from this stressful situation, the equinovarus improved without the need for surgical invention. This report highlights the importance of early and accurate diagnosis of psychogenic equinovarus, so that unnecessary surgery can be avoided. This is the first report of psychogenic equinovarus caused by dislocation of the Chopart joint complex that was confirmed with CT.
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.
Ichiro Tonogai, Fumio Hayashi, Yoshihiro Tsuruo and Koichi Sairyo : Anatomic Study of Anterior and Posterior Ankle Portal Sites for Ankle Arthroscopy in Plantarflexion and Dorsiflexion: A Cadaveric Study in the Japanese Population., The Journal of Foot and Ankle Surgery, 57, 3, 537-542, 2018.
(Summary)
Arthroscopy is an important and minimally invasive diagnostic and therapeutic tool. However, the risk of injury to the neurovascular structures around the portals exists during arthroscopy of the ankle. In the present study, we measured the distance between each portal and the adjacent neurovascular structures with the foot in plantarflexion and dorsiflexion in the Japanese population. Standard anterolateral (AL), anteromedial, posterolateral (PL), and posteromedial portal positions were identified in 6 fresh adult cadaveric feet. The skin was dissected from the underlying tissue to visualize the adjacent neurovascular structures as noninvasively as possible. The superficial peroneal nerve was the structure closest to an anterior (i.e., AL) portal (3.2 ± 4.2 and 8.3 ± 3.9 mm in plantarflexion and 5.2 ± 4.3 and 10.8 ± 4.1 mm in dorsiflexion), followed by the saphenous nerve and great saphenous vein (SpV). The distance from the superficial peroneal nerve to the AL portal and from the saphenous nerve and great SpV to the anteromedial portal increased significantly with dorsiflexion and decreased significantly with plantarflexion. The sural nerve was the structure closest to the posterior (i.e., PL) portal (10.4 ± 4.8 mm in plantarflexion and 8.5 ± 3.9 mm in dorsiflexion), followed by the lesser SpV. The distance from the sural nerve, saphenous nerve, and lesser SpV to the PL portal and from flexor hallucis longus, posterior tibial artery, and tibial nerve to the posteromedial portal increased significantly in plantarflexion and decreased significantly in dorsiflexion. These findings could help to prevent damage to the neurovascular structures during ankle arthroscopy.
Tatsuhiko Henmi, Tomoya Terai, Akihiro Nagamachi and Koichi Sairyo : Morphometric Changes of the Lumbar Intervertebral Foramen after Percutaneous Endoscopic Foraminoplasty under Local Anesthesia., Journal of Neurological Surgery. Part A, Central European Neurosurgery, 79, 1, 19-24, 2018.
(Summary)
Background Percutaneous endoscopic diskectomy (PED) for the lumbar spine is a relatively new technique that is becoming more common due to its relatively less invasive nature. However, one possible serious complication is an exiting nerve injury when the cannula of the endoscope is inserted into the neural canal through the intervertebral foramen. A technique to enlarge the intervertebral foramen, called foraminoplasty, was recently established to insert the cannula safely into an appropriate position in the neural canal. Methods In this study we performed foraminoplasty during PED under local anesthesia on 15 patients. Using computed tomography scans before and after surgery, the morphometric changes of the intervertebral foramen were evaluated. Surgery-related complications were reviewed. Results There were 13 men and 2 women, 21 to 86 years of age (mean: 47.1 years). Disk levels were 13 cases at L4-L5, one case at L3-L4, and one case at L5-S1. In 50% of the cases, the mean foraminal area significantly increased from 58.6 mm(2) before surgery to 88.4 mm(2) after surgery (p < 0.05 by paired t test). The diameter of the foramen was increased at all three points: the lower end plate of the superior vertebrae, the disk, and the upper end plate of the inferior vertebrae. The area increased ∼ 1.5 times, especially at the upper end plate of the inferior vertebrae. In all cases, no exiting nerve injury was encountered during PED. Conclusion Foraminoplasty was an effective method for avoiding exiting nerve root injury during transforaminal PED.
Koichi Iwaki, Toshinori Sakai, Daisuke Hamada, Yohei Hayashi, Nanae Inoue, Miyuki Mitsumoto, Yusuke Hattori, Tsuyoshi Goto, Koichi Sairyo and Shuichiro Tsuji : Physical features of pediatric patients with lumbar spondylolysis and effectiveness of rehabilitation., The Journal of Medical Investigation : JMI, 65, 3.4, 177-183, 2018.
(Summary)
The purpose of this study was to evaluate the physical features of pediatric patients with lumbar spondylolysis (LS), factors that increase the load during compensatory movements at the lumbar spine, and the outcomes of rehabilitation. Twenty patients were included. Fifteen items were used:fingertip-to-floor distance (FFD), straight leg raising (SLR), heel-to-buttock distance (HBD), tightness of the rectus femoris, the lateral and medial rotator muscles, iliopsoas, tensor fascia lata, adductor muscles, soleus muscle, and latissimus dorsi, and trunk rotation, sit-ups and endurance of the abdominal and back muscles. Initial findings were judged as positive or negative using previously reported cut-off values and were re-evaluated 2 or 3 months later. Positive tests were found for HBD and tightness of the rectus femoris in 85% of the patients, for endurance of the abdominal muscles in 75%, SLR and sit-ups in 70%, and FFD and tightness of the external rotator muscles in 60%. The physical features varied according to the type of sport played, and some patients were refractory to rehabilitation. Only 17.6%, 33.3%, and 40.0% of patients with initially positive findings for HBD, tightness of the external rotator muscles, and endurance of the abdominal muscles, respectively, achieved improvements after rehabilitation. J. Med. Invest. 65:177-183, August, 2018.
Nori Sato, Kousaku Higashino, Toshinori Sakai, Tomoya Terai, K Vijay Goel, Ashok Biyani, Nabil Ebraheim, Yoichiro Takata, Fumio Hayashi, Kazuta Yamashita, Masatoshi Morimoto, Hiroaki Manabe and Koichi Sairyo : Role of Epiligament in Ligamentum Flavum Hypertrophy in Patients with Lumbar Spinal Canal Stenosis:a Pilot Study., The Journal of Medical Investigation : JMI, 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.
Nori Sato, Naomi Hase, Akemi Osaka, Koichi Sairyo and Shinsuke Katoh : Falls among Hospitalized Patients in an Acute Care Hospital: Analyses of Incident Reports., The Journal of Medical Investigation : JMI, 65, 1.2, 81-84, 2018.
(Summary)
Falls cause injuries such as fractures, skin lacerations, bleeding, and head injury, and could result in more severe medical conditions in hospitalized patients. We retrospectively investigated the incidence and characteristics of falls among hospitalized patients in an acute care hospital from incident reports by hospital staff between January and June 2013. There were 154 falls in 135 patients, 2 of which resulted in fracture. The average age of patients who fell was 63.9 (range 0 to 91) years. Many falls occurred at the bedside (68.2%). Approximately half of all falls were related to elimination (46.6%). The most common time of discovery of falls was 2:00-2:59 AM (14/154;9.1%), followed by early in the morning when patients would actively move. Fall rates in our hospital were 1.39 falls per 1,000 patient days. The department of respiratory medicine and rheumatology had the highest fall rate (3.08 falls per 1,000 patient days), followed by the departments of neurosurgery and neurology (2.98 falls per 1,000 patient days). This study revealed the characteristics of falls in an acute care hospital, and suggests that their notification in the hospital might help reduce the incidence of falls in hospitalized patients. J. Med. Invest. 65:81-84, February, 2018.
Teruhiro Morishita, Michiko Sato, Hiroko Kume, Masae Sakuma, Hidekazu Arai, Takahumi Katayama, Shinsuke Katoh, Koichi Sairyo and Eiji Takeda : Skeletal muscle mass of old Japanese women suffering from walking difficulty in nursing home., The Journal of Medical Investigation : JMI, 65, 1.2, 122-130, 2018.
(Summary)
By using 24 hour urinary creatinine levels, skeletal muscle mass (kg), its rate (%) of body weight and creatinine height index (%) were determined in old Japanese women suffering from walking difficulty in nursing home and compare with those of young university students. Those of old subjects showed approximately 30-50%, 36-44% and 44-46% of young subjects, respectively. It is suggested that these values are important and useful biomarkers for the planning and the achievement of rehabilitation program for the maintaining and restoring skeletal muscle mass and for the careful support by registered care workers to aged persons. J. Med. Invest. 65:122-125, 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.
Koichi Sairyo, Takashi Chikawa and Akihiro Nagamachi : State-of-the-art transforaminal percutaneous endoscopic lumbar surgery under local anesthesia: Discectomy, foraminoplasty, and ventral facetectomy., Journal of Orthopaedic Science, 23, 2, 229-236, 2017.
(Summary)
Transforaminal (TF) percutaneous endoscopic surgery for the lumbar spine under the local anesthesia was initiated in 2003 in Japan. Since it requires only an 8-mm skin incision and damage of the paravertebral muscles would be minimum, it would be the least invasive spinal surgery at present. At the beginning, the technique was used for discectomy; thus, the procedure was called PELD (percutaneous endoscopic lumbar discectomy). TF approach can be done under the local anesthesia, there are great benefits. During the surgery patients would be in awake and aware condition; thus, severe nerve root damage can be avoided. Furthermore, the procedure is possible for the elderly patients with poor general condition, which does not allow the general anesthesia. Historically, the technique was first applied for the herniated nucleus pulposus. Then, foraminoplasty, which is the enlargement surgery of the narrow foramen, became possible thanks to the development of the high speed drill. It was called the percutaneous endoscopic lumbar foraminoplasty (PELF). More recently, this technique was applied to decompress the lateral recess stenosis, and the technique was named percutaneous endoscopic ventral facetectomy (PEVF). In this review article, we explain in detail the development of the surgical technique of with time with showing our typical cases.
Ryosuke Sato, Yoshitaka Hamada, Naohito Hibino, Toshihiko Nishisho, Ichiro Tonogai, Kenji Endo and Koichi Sairyo : Restoration of the Active Forearm Rotation Using Vascularized Free Fibular Graft and Radial Head Arthroplasty for a Wide Defect of the Proximal Radius., The Journal of Hand Surgery, Asian-Pacific Volume, 22, 4, 531-534, 2017.
(Summary)
In this report we present a case of re-stabilization of the proximal radius using vascularized free fibular graft combined with anconeus arthroplasty to stabilize the transplanted fibula in a patient with large loss of the proximal radius due to Ewing's sarcoma. A 20-year-old woman had Ewing's sarcoma in the proximal three-fourths of the radius. The resection of large part of the radius containing radial head were necessary for removal of the sarcoma. Reconstruction of the proximal radius was performed using vascularized free fibular graft and the transplanted fibula was stabilized by attaching the anconeus to the proximal edge of the fibula. 2 years after surgery, she had neither recurrence nor metastasis, and achieved functional recovery. The combination anconeus arthroplasty with vascularized free fibular graft can be a good technique for re-stabilization of the elbow and recovery of the forearm function.
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.
Fumitake Tezuka and Koichi Sairyo : 腰椎分離症, パーフェクト疲労骨折, 179-182, 2017.
213.
Fumitake Tezuka and Koichi Sairyo : 棘突起疲労骨折, パーフェクト疲労骨折, 129-131, 2017.
214.
Toshiyuki Iwame and Koichi Sairyo : 鎖骨疲労骨折, パーフェクト疲労骨折, 134-136, 2017.
215.
Ichiro Tonogai, Daisuke Hamada and Koichi Sairyo : Morphology of the Incisura Fibularis at the Distal Tibiofibular Syndesmosis in the Japanese Population., The Journal of Foot and Ankle Surgery, 56, 6, 1147-1150, 2017.
(Summary)
The morphology of the distal tibiofibular syndesmosis can determine the pathology and mechanism of syndesmotic injury. The present study assessed measurements obtained from computed tomography (CT) images of the normal distal tibiofibular syndesmosis in Japanese subjects. CT scans of 120 right feet with a normal distal tibiofibular syndesmosis obtained from January 2009 to December 2016 were retrospectively assessed at the level 10 mm proximal to the tibial plafond. The incisura fibularis was considered concave when its depth was ≥4 mm and shallow when its depth was <4 mm. The depth of the incisura fibularis, anterior tibiofibular distance (TFD), posterior TFD, and longitudinal/transverse length of the distal fibula were measured. The incisura fibularis was concave in 64.2% of the feet and shallow in 35.8%. The mean anterior TFD was 2.2 ± 0.8 mm (2.4 ± 0.8 mm in males; 2.1 ± 0.8 mm in females; 2.1 ± 0.8 mm for concave; 2.2 ± 0.9 mm for shallow). The mean posterior TFD was 5.9 ± 1.6 mm (6.7 ± 2.1 in males; 5.7 ± 1.3 mm in females; 5.5 ± 1.3 mm for concave; 6.5 ± 1.9 mm for shallow). The mean longitudinal/transverse length of the distal fibula at the level of the syndesmosis was 1.2 mm (1.3 mm in males; 1.2 mm in females; 1.1 mm for concave; 1.3 mm for shallow). The mean posterior TFD was significantly greater than the mean anterior TFD and was also significantly greater in males than in females. Significant differences were found in the body mass index, posterior TFD, and longitudinal/transverse length of the distal fibula according to whether the incisura fibularis was concave or shallow. The present study has provided measurements of the normal tibiofibular syndesmosis in the Japanese population. These data suggest that the morphology of the syndesmosis varies, especially with respect to whether the incisura fibularis is concave or shallow.
Toshiyuki Iwame, Tetsuya Matsuura, Naoto Suzue, Shunsuke Tamaki, Kenji Yokoyama and Koichi Sairyo : Two-year follow-up study of subchondral surface irregularities of the capitellum on ultrasonography in baseball players under the age of 10 years, Skeletal Radiology, 46, 11, 1499-1505, 2017.
(Summary)
To determine whether subchondral surface irregularities of the capitellum on ultrasonography in baseball players under the age of 10 years are indicative of early osteochondritis dissecans (OCD) of the capitellum. A total of 321 players aged 6-9 years underwent ultrasonographic examination, and the findings for the subchondral bone of the capitellum on the throwing side were graded as 0, 1a, 1b, 2, or 3. Subjects classified as grade 1a or 1b showed irregularities of the subchondral bone surface and were investigated radiographically for OCD. All players continued to throw and were re-examined by ultrasonography after 1 and 2 years. At the first examination, 11/321 (3.4%) had irregularities at the subchondral surface of the capitellum [grade 1a in 7/321 (2.2%); grade 1b in 4/321 (1.2%)]. The seven players with grade 1a showed no evidence of OCD or Panner's disease on radiography and were reclassified as grade 0 at the 2-year follow-up. All four players with grade 1b were reclassified as grade 0 at follow-up 1 and 2 years later. Subchondral bone surface irregularities of the capitellum on ultrasonography in children under the age of 10 years may not be indicative of disease, but rather represent variation of ossification during normal development.
Ichiro Tonogai, Fumio Hayashi, Yoshihiro Tsuruo and Koichi Sairyo : Distance Between the Anterior Distal Tibial Edge and the Anterior Tibial Artery in Distraction and Nondistraction During Anterior Ankle Arthroscopy: A Cadaveric Study., Foot & Ankle International, 39, 1, 113-118, 2017.
(Summary)
The anatomic relationship of the ATA to its surrounding structures may be at more risk without saline injection or with distraction during anterior ankle arthroscopy.
Yasuaki Tamaki, Tomohiro Goto, Takahiko Tsutsui, Tomoya Takasago, Keizo Wada and Koichi Sairyo : Compression of the Femoral Vessels by a Pseudotumor after Metal-on-Metal Total Hip Arthroplasty., Case Reports in Orthopedics, 2017.
(Summary)
Here we present a case of pseudotumor following total hip arthroplasty (THA) that resulted in a circulatory disturbance caused by compression of the femoral vasculature. A 63-year-old man presented with pain, swelling, and redness of the left leg 5 years after primary metal-on-metal THA using the AML-Plus stem, Pinnacle® acetabular cup, and 36 mm diameter Ultamet metal head system (DePuy Orthopaedics, Warsaw, IN). Enhanced computed tomography and magnetic resonance imaging revealed a large cystic lesion extending from the left hip anteriorly to the intrapelvic region and compressing the left femoral vessels. Percutaneous puncture of the lesion yielded a dark red aspirate and the patient was diagnosed to have a pseudotumor causing compression of the femoral vessels. We performed revision surgery to replace the metal head and metal liner with a smaller ceramic head and polyethylene liner without removal of the stem. Corrosion of the head-neck junction was identified intraoperatively with no obvious wear on the bearing surfaces. The left leg swelling and redness improved immediately postoperatively. A large pseudotumor should be kept in mind as a cause of vascular compression with unilateral leg edema in a patient who has undergone metal-on-metal THA.
Shunsuke Fujibayashi, Noriaki Kawakami, Takashi Asazuma, Manabu Ito, Jun Mizutani, Hideki Nagashima, Masaya Nakamura, Koichi Sairyo, Ryuichi Takemasa and Motoki Iwasaki : Complications Associated with Lateral Interbody Fusion: Nationwide Survey of 2998 Cases During the First Two Years of Its Use in Japan., Spine, 42, 19, 1478-1484, 2017.
Keizo Wada, Tomohiro Goto, Tomoya Takasago, Daisuke Hamada and Koichi Sairyo : Piriformis muscle syndrome with assessment of sciatic nerve using diffusion tensor imaging and tractography: a case report., Skeletal Radiology, 46, 10, 1399-1404, 2017.
(Summary)
Piriformis muscle syndrome (PMS) is difficult to diagnose by objective evaluation of sciatic nerve injury. Here we report a case of PMS diagnosed by diffusion tensor imaging (DTI) and tractography of the sciatic nerve, which can assess and visualize the extent of nerve injury. The patient was a 53-year-old man with a 2-year history of continuous pain and numbness in the left leg. His symptoms worsened when sitting. Physical examination, including sensorimotor neurologic tests, the deep tendon reflex test, and the straight leg raise test, revealed no specific findings. The hip flexion adduction and internal rotation test and resisted contraction maneuvers for the piriformis muscle were positive. There were no abnormal findings on magnetic resonance imaging (MRI) of the lumbar spine. The transverse diameter of piriformis muscle was slightly thicker in affected side on MRI of the pelvis. A single DTI sequence was performed during MRI of the pelvis. Fractional anisotropy (FA) and the apparent diffusion coefficient (ADC) of the sciatic nerve were quantified at three levels using the fiber-tracking method. FA values were significantly lower and ADC values were significantly higher distal to the piriformis muscle. We performed endoscopic-assisted resection of the piriformis tendon. Intraoperatively, the motor-evoked potentials in the left gastrocnemius were improved by resection of the piriformis tendon. The patient's symptoms improved immediately after surgery. There was no significant difference in FA or ADC at any level between the affected side and the unaffected side 3 months postoperatively. MRI-DTI may aid the diagnosis of PMS.
Toshihiko Nishisho, Mika Sakaki, Ryo Miyagi, Shoichiro Takao and Koichi Sairyo : Burned-out seminoma revealed by solitary rib bone metastasis., Skeletal Radiology, 46, 10, 1415-1420, 2017.
(Summary)
Burned-out tumor is a rare phenomenon in which a testicular tumor regresses in the primary lesion and progresses in a metastatic lesion. We report the case of a 30-year-old male with burned-out seminoma revealed by open biopsy of solitary 10th rib bone metastasis. He underwent inguinal orchiectomy, which revealed hyalinization, indicating a spontaneously regressed testicular tumor. Chemotherapy for seminoma was administered in three cycles of bleomycin + etoposide + cisplatin therapy. The chemotherapy was effective, and wide resection of the rib was subsequently performed. No postoperative chemotherapy was performed, and there has been no evidence of recurrence for 3 years postoperatively.
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.
Takahiko Tsutsui, Tomohiro Goto, Keizo Wada, Tomoya Takasago, Daisuke Hamada and Koichi Sairyo : Efficacy of a computed tomography-based navigation system for placement of the acetabular component in total hip arthroplasty for developmental dysplasia of the hip., Journal of Orthopaedic Surgery (Hong Kong), 25, 3, 2017.
(Summary)
THA using a CT-based navigation system achieved quite high accuracy of cup alignment angles and spatial cup positioning in primary THA for patients with DDH.
Yasuaki Tamaki, Akihiro Nagamachi, Kazumasa Inoue, Makoto Takeuchi, Kosuke Sugiura, Yasuyuki Omichi, Shunsuke Tamaki, Takashi Chikawa, Koichi Sairyo and Keisuke Adachi : Incidence and clinical features of sacral insufficiency fracture in the emergency department., The American Journal of Emergency Medicine, 35, 9, 1314-1316, 2017.
(Summary)
This study demonstrates that accurate diagnosis of SIF may be delayed because of difficulties in detecting this type of fracture on plain X-ray and the non-specific nature of the presenting complaints. Emergency physicians should keep SIF in mind when investigating patients who complain of low back pain or gluteal pain. Findings at the second sacral segment on MRI targeting the lumbar spine may aid early diagnosis of this type of pelvic fracture.
Mitsuhiko Takahashi, Ryosuke Sato, Kenji Kondo and Koichi Sairyo : Morphological alterations of the tendon and pulley on ultrasound after intrasynovial injection of betamethasone for trigger digit., Ultrasonography, 37, 2, 134-139, 2017.
(Summary)
The injection of a single dose of betamethasone improved clinical symptoms by reducing the volume of both the tendon and pulley, which may be related to the fact that tendon and pulley ruptures are delayed by corticosteroid injections.
Ichiro Tonogai, Toshihiko Nishisho, Ryo Miyagi and Koichi Sairyo : Total calcanectomy for metastasis of renal cell carcinoma in the calcaneus: A case report., Foot and Ankle Surgery, 24, 1, e7-e12, 2017.
(Summary)
We present a rare case of metastasis of renal cell carcinoma to the calcaneus in a 59-year-old man who presented with pain and inability to bear weight on the left foot 3 years after right nephrectomy for renal cell carcinoma. He successfully underwent en bloc resection of his right calcaneus with a limb salvage procedure, total calcanectomy without bony reconstruction. Histological findings identified the lesion as a metastasis originating from a renal cell carcinoma. Recent follow-up examination showed no recurrence. To the best of our knowledge, this is the first reported case to be treated with total calcanectomy for renal cell carcinoma metastasis.
Tetsuya Matsuura, Keizo Wada, Naoto Suzue, Toshiyuki Iwame, Shoji Fukuta and Koichi Sairyo : Bilateral osteochondritis dissecans of the capitellum in fraternal twins: A case report, JBJS Case Connector, 7, 3, e44, 2017.
(Summary)
We report the cases of 15-year-old male fraternal twins with bilateral osteochondritis dissecans (OCD) of the capitellum in the absence of syndromic features. At the time of presentation, they had been actively engaged in competitive rhythmic gymnastics for 3 years. Both patients had chronic symptoms in the right elbow, and both underwent arthroscopic evaluation and management. The cases of these 2 patients provide evidence to support the theory that the etiology of OCD may have a genetic background.
Masaru Nakamura, Tateaki Shimakawa, Shunji Nakano, Takashi Chikawa, Shinji Yoshioka, Masahiro Kashima, Shunichi Toki and Koichi Sairyo : Screening for nasal carriage of Staphylococcus aureus among patients scheduled to undergo orthopedic surgery: Incidence of surgical site infection by nasal carriage., Journal of Orthopaedic Science, 22, 4, 778-782, 2017.
(Summary)
Subjects were 4148 patients who underwent preoperative screening for nasal carrier and subsequently underwent orthopedic surgery during a 7-year period between April 2007 and March 2014. The incidence of SSI among patients who were operated in our department was investigated, and the rates were compared between patients with and without nasal carriage to reveal the effect of preoperative nasal carriage on SSI.
Shingo Hama, Ichiro Tonogai, Toshinori Sakai, Yuichiro Goda, Fumitake Tezuka, Tetsuya Matsuura, Naoto Suzue, Rui Takahashi, Tomoya Terai, Kousaku Higashino, Shoji Fukuta, Akihiro Nagamachi and Koichi Sairyo : Pediatric isthmic spondylolisthesis showing radiologic evidence of slippage after physis injury., Journal of Pediatric Orthopaedics. Part B, 26, 4, 388-392, 2017.
(Summary)
The pathogenesis of slippage in pediatric spondylolisthesis is still unclear, although epiphyseal injury may account for many cases based on preclinical studies. However, no reports have described a pediatric case of isthmic spondylolisthesis showing radiologic evidence of epiphyseal injury. We report such evidence in a 13-year-old boy with low-back pain. Radiography revealed rounding of the S1 surface, a fracture line below the S1 endplate surface, and a bone marrow lesion in addition to slippage. Slippage and the rounding deformity were partially reversed (from 20 to 14% and from 42 to 27%, respectively) with conservative treatment and natural bone remodeling.
Fumitake Tezuka, Toshinori Sakai, Mitsunobu Abe, Kazuta Yamashita, Yoichiro Takata, Kousaku Higashino, Takashi Chikawa, Akihiro Nagamachi and Koichi Sairyo : Anatomical considerations of the iliac crest on percutaneous endoscopic discectomy using a transforaminal approach., The Spine Journal, 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.
Ichiro Tonogai, Daisuke Hamada, Yuhei Yamasaki, Keizo Wada, Tomoya Takasago, Takahiko Tsutsui, Tomohiro Goto and Koichi Sairyo : Custom-Made Alumina Ceramic Total Talar Prosthesis for Idiopathic Aseptic Necrosis of the Talus: Report of Two Cases., Case Reports in Orthopedics, 2017.
(Summary)
Two women aged 65 years and 78 years presented to our center with idiopathic necrosis of the talus. In both cases, imaging examinations showed collapse and sclerotic changes of the talar body caused by the necrosis. Both women underwent resection and placement of a third-generation custom-made alumina ceramic total talar prosthesis. Immobilization of the ankle in a short-leg cast for 3 weeks was followed by early rehabilitation. One year and 6 months after surgery, both women were able to walk without pain. Their Japanese Society for Surgery of the Foot ankle-hindfoot scale scores improved from 22 and 29/100 points to 90 and 95/100 points, respectively. To the best of our knowledge, the successful treatments of these two rare cases of idiopathic necrosis of the talus are among only a few reported cases of using a third-generation alumina ceramic prosthesis.
Ichiro Tonogai, Tetsuya Matsuura, Toshiyuki Iwame, Keizo Wada, Tomoya Takasago, Tomohiro Goto, Daisuke Hamada, Yohei Kawatani, Eiki Fujimoto, Tetsuya Kitagawa, Shoichiro Takao, Seiji Iwamoto, Moriaki Yamanaka, Masafumi Harada and Koichi Sairyo : Pseudoaneurysm of the Anterior Tibial Artery following Ankle Arthroscopy in a Soccer Player., Case Reports in Orthopedics, 2017.
(Summary)
Ankle arthroscopy carries a lower risk of vascular complications when standard anterolateral and anteromedial portals are used. However, the thickness of the fat pad at the anterior ankle affords little protection for the thin-walled anterior tibial artery, rendering it susceptible to indirect damage during procedures performed on the anterior ankle joint. To our knowledge, only 11 cases of pseudoaneurysm involving the anterior tibial artery after ankle arthroscopy have been described in the literature. Here we reported a rare case of a 19-year-old soccer player who presented with pseudoaneurysm of the anterior tibial artery following ankle arthroscopy using an ankle distraction method and underwent anastomosis for the anterior tibial artery injury. Excessive distraction of the ankle puts the neurovascular structures at greater risk for iatrogenic injury of the anterior tibial artery during ankle arthroscopy. Surgeons should look carefully for postoperative ankle swelling and pain after ankle arthroscopy.
Kazuaki Mineta, Masahiko Okada, Soshi Matsumoto, Daisuke Hamada, Tomohiro Goto and Koichi Sairyo : Fracture of the Tibial Baseplate 16 Years after Miller-Galante II Total Knee Arthroplasty., Case Reports in Orthopedics, 2017.
(Summary)
We report a rare case of tibial baseplate fracture of Miller-Galante II (MG II) prosthesis. We examine the factors that may cause such late fracture and review the literature on radiographic analysis and retrieval studies. A 76-year-old woman, who had undergone bilateral MG II total knee arthroplasty due to rheumatoid arthritis 16 years earlier, presented to our department with a 3-month history of left knee pain. Plain radiographs revealed severe distortion of the medial tibial component. During revision knee arthroplasty, we observed severe metallosis in the knee joint, polyethylene insert deformation, and posteromedial coronal baseplate fracture. After removal of the fractured tray, a bone deficit due to osteolysis was noted. The revision prosthesis (LCCK, Zimmer-Biomet) was implanted uneventfully. Four months after revision surgery, the patient was ambulating and had no complications. The implants on the right side had survived without complications for 17 years. We speculate that the primary causative factor of the fatigue fracture of the base plate due to loss of bony support most likely secondary to osteolysis was varus malalignment at primary implantation. This case highlights the importance of paying close attention to the correct alignment of each component at primary implantation.
Ryosuke Sato, Naohito Hibino, Yoshitaka Hamada and Koichi Sairyo : Ulnolunate Ligament Avulsion Fracture of the Lunate: A Case Report., Journal of Wrist Surgery, 6, 2, 148-151, 2017.
(Summary)
Traumatic lunate fractures are very rare and those treatments require an understanding of anatomical features. We present a case of an ulnolunate ligament avulsion fracture of the lunate that was successfully repaired by surgical fixation with open reduction and internal fixation. We believe that restoration of ulnolunate ligament function is important to prevent further deterioration of wrist function after this injury.
Tetsuya Matsuura, Toshiyuki Iwame, Naoto Suzue, Kokichi Arisawa and Koichi Sairyo : Risk factors for shoulder and elbow pain in youth baseball players., The Physician and Sportsmedicine, 45, 2, 140-144, 2017.
(Summary)
This study sought to quantify the 1-year cumulative incidence of shoulder and elbow pain among youth baseball players and identify risk factors associated with the occurrence of shoulder and elbow pain. In total, 900 youth baseball players (aged 7-11 years) were enrolled in a 1-year prospective follow-up study. One year later, the players were asked whether they had experienced episodes of shoulder or elbow pain and the following risk factors for such pain were investigated: age, position, length of baseball experience, training hours per week, and history of shoulder or elbow pain. Data for the groups with and without shoulder or elbow pain were analyzed using multivariate logistic regression models. Episodes of shoulder pain were reported by 18.3% of players and episodes of elbow pain were reported by 35.2% of players. Multivariate analysis showed that shoulder pain was associated with pitcher position, catcher position, longer training hours per week, and history of shoulder and elbow pain, and that elbow pain was associated with age, pitcher position, catcher position, longer training hours per week, and history of elbow pain. Length of baseball experience was not associated with shoulder or elbow pain. History of elbow pain, pitcher position, catcher position, and longer training hours per week were associated with both types of pain. History of shoulder pain was associated with shoulder pain but not elbow pain. Age was associated with elbow pain but not shoulder pain.
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.
Toshinori Sakai and Koichi Sairyo : Answer to the Letter to the Editor of C. Birkenmaier concerning "Rehydration of a degenerated disc on MRI synchronized with transition of Modic changes following stand-alone XLIF" by K. Kita, T. Sakai, M. Abe, Y. Takata and K. Sairyo (Eur Spine J; 2017). doi:10.1007/s00586-017-4945-6., European Spine Journal, 26, 6, 1790-1791, 2017.
Masatoshi Morimoto, Yoshinori Takahashi, Takahiro Kubo, Kosuke Sugiura, Yasuaki Tamaki, Shunichi Toki, Katsuyoshi Suganuma, Kazumasa Inoue, Keisuke Adachi, Takashi Chikawa, Koichi Sairyo and Akihiro Nagamachi : Prognostic value of dynamic MRI positive enhancement integral color mapping in osteosynthesis of undisplaced femoral neck fractures., Journal of Orthopaedic Science, 22, 4, 722-725, 2017.
(Summary)
PEICM precisely detected femoral head perfusion. Primary prosthetic replacement should be considered for older patients with Type C to minimize the chances of revision surgery, even in undisplaced femoral neck fractures.
Fumitake Tezuka, Koichi Sairyo, Toshinori Sakai and Akira Dezawa : Etiology of Adult-onset Stress Fracture in the Lumbar Spine., Clinical Spine Surgery, 30, 3, E233-E238, 2017.
(Summary)
Although lumbar spondylolysis is generally recognized to occur in childhood or adolescence, fresh lumbar spondylolysis should be included in the differential diagnosis of adult low back pain when patients are high-level athletes. Conservative treatment should be attempted for adult patients.
Kazuta Yamashita, Hisanori Ikuma, Takuya Tokashiki, Takashi Maehara, Akihiro Nagamachi, Yoichiro Takata, Toshinori Sakai, Kousaku Higashino and Koichi Sairyo : Radiation Exposure to the Hand of a Spinal Interventionalist during Fluoroscopically Guided Procedures., Asian Spine Journal, 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, Toshinori Sakai, Mitsunobu Abe, Yoichiro Takata and Koichi Sairyo : Rehydration of a degenerated disc on MRI synchronized with transition of Modic changes following stand-alone XLIF., European Spine Journal, 26, 3, 626-631, 2017.
(Summary)
Lumbar intervertebral disc degeneration (LDD) is known to be associated with low back pain (LBP) and leads to degenerative lumbar disease. LDD is considered to be irreversible, and no truly effective treatment that suppresses LDD or regenerates the degenerated disc has been established thus far. Here, we report the case of a 42-year-old woman with a 10-year history of persistent LBP. Magnetic resonance imaging (MRI) demonstrated degenerative changes (Pfirrmann classification: grade IV) in the L4-5 intervertebral disc with type I and III mixed Modic changes adjacent to the disc. Conservative treatments were not effective, so we opted for stand-alone extreme lateral interbody fusion (XLIF). One year after the operation, the LBP had almost disappeared. Follow-up MRI revealed transition of the Modic changes from type I to type III. In addition, rehydration of the degenerated disc behind the XLIF cage was evident (Pfirrmann classification changed from grade IV to grade II). To our knowledge, this is the first report of a change in LDD. Several factors are likely responsible for the regenerative response, including curettage of the hyaline cartilaginous endplates and auto-iliac cancellous bone grafting, which were considered to have affected nucleus pulposus cells in the residual disc.
Keizo Wada, Hiroshi Mikami, Koichi Oba, Hiroshi Yonezu and Koichi Sairyo : Cementless calcar-replacement stem with integrated greater trochanter plate for unstable intertrochanteric fracture in very elderly patients., Journal of Orthopaedic Surgery (Hong Kong), 25, 1, 2309499016684749, 2017.
(Summary)
Hemiarthroplasty using the MOD-Centaur stem for unstable intertrochanteric fracture in very elderly patients offers favorable outcomes. These findings encourage early walking without any loading limitations, despite severe osteoporosis, and emphasize the importance of greater trochanteric fixation, which reconstructs the mechanism of the gluteus medius muscle.
Tsuyoshi Goto, Toshinori Sakai, Tetsuya Enishi, Nori Sato, Koji Komatsu, Koichi Sairyo and Shinsuke Katoh : Changes of posture and muscle activities in the trunk and legs during walking in patients with lumbar spinal stenosis after decompression surgery. A preliminary report., Gait & Posture, 51, 149-152, 2017.
(Summary)
Neurogenic intermittent claudication is a main symptom in lumbar spinal stenosis (LSS), and postural change is often observed during walking. This study aimed to identify the changes in posture and muscle activity in the trunk and legs during walking in patients with LSS by examining 6 patients who had undergone decompression surgery. None of them had significant paralysis. Gait analysis using Vicon motion capture system(®) with electromyographic recordings of the paravertebral muscles (PVM) and vastus lateralis muscle (VL) was performed preoperatively and 2 weeks postoperatively. Results showed that the thorax angle indicating the degree of trunk flexion after walking decreased significantly and the pelvic angle tended to decrease after surgery. However, there were no difference in the spine angle, which is a measure of the motion of the thoraco-lumbar spine among the evaluations. The knee angle increased significantly after surgery both at the beginning and at the end of walking, but the angles of the hip and ankle did not change significantly after surgery. Knee torques increased significantly after surgery both at the beginning and at the end of walking. The activity of the PVM decreased and that of the VL increased after surgery. The results indicate that patients with LSS walk in a forward-bending position without flexing the spine, which can be one of the neurologic symptoms. Increases in knee torque and VL activity seemed to reflect the increase of walking speed, and the decrease of PVM activity appeared to be caused by postural improvement after surgery.
Kenichiro Kita, Kazuta Yamashita, Mitsunobu Abe, Yoichiro Takata, Toshinori Sakai, Kousaku Higashino, Akihiro Nagamachi and Koichi Sairyo : Eight-year follow-up findings of surgical treatment for severe dystrophic changes in the cervical spine associated with neurofibromatosis type I: a case report., Journal of Pediatric Orthopaedics. Part B, 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.
252.
Ichiro Tonogai, Daisuke Hamada and Koichi Sairyo : Radiographic changes in coronal alignment of the ankle joint immediately after primary total knee arthroplasty for varus knee osteoarthritis., The Foot and Ankle Online Journal, 10, 2, 2, 2017.
253.
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.
Keizo Wada, Hiroshi Mikami, Daisuke Hamada, Takaharu Yamazaki, Tetsuya Tomita and Koichi Sairyo : Can intraoperative kinematic analysis predict postoperative kinematics following total knee arthroplasty? A preliminary., The Journal of Medical Investigation : JMI, 65, 1.2, 21-26, 2017.
(Summary)
The preliminary study analyzed the relationship between intraoperative navigation-based kinematics and postoperative 2-dimensional/3-dimensional (2D/3D) image registration-based kinematics in total knee arthroplasty (TKA). Six knees in 5 patients were analyzed. All TKA procedures were performed using an image-free knee navigation system. Tibial internal rotation was assessed by intraoperative knee kinematics. At 1 year after surgery, tibial internal rotation was evaluated using a 2D/3D image registration technique under loaded and unloaded conditions. The correlation between intraoperative and postoperative data for the tibial internal rotation angle at 10 increments of knee flexion was then assessed. Difference in the knee flexion angle between the intraoperative and postoperative evaluations was adjusted to account for the sagittal cutting angle of the distal femur and proximal tibia. A correlation was found between the intraoperative and postoperative data for loaded knee flexion with this adjustment (Pearson's r = 0.725, p = 0.012). However, intraoperative kinematics was not significantly correlated with postoperative kinematics in the absence of loading. Larger adequately powered prospective studies are now needed to confirm our preliminary finding that postoperative loaded kinematics can be predicted by intraoperative evaluation. J. Med. Invest. 65:21-26, February, 2018.
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.
Daisuke Hamada, Keizo Wada, Hiroshi Mikami, Shunichi Toki, Tomohiro Goto, Takahiko Tsutsui, Tomoya Takasago, Akihiro Nagamachi and Koichi Sairyo : The Posterior Condylar Cartilage Affects Rotational Alignment of the Femoral Component in Varus Knee Osteoarthritis., The Journal of Medical Investigation : JMI, 64, 1.2, 24-29, 2017.
(Summary)
Rotational alignment of the femoral component in total knee arthroplasty (TKA) is important for patellar tracking and ligament balance. Preoperative planning based on radiography might have a potential risk for over-rotation because these X-ray based measurements can not detect asymmetric cartilage wear on posterior condyle. The purpose of this study is to evaluate the effect of the posterior condylar cartilage of varus osteoarthritic knee on rotational alignment of the femoral component in TKA. We established two different condylar twist angles (CTA) from intraoperative multiplanar reconstruction (MPR) images and intraoperative information of navigation system. The CTA measured by a navigation system that includes the cartilage (4.8±2.0°) was smaller than those measured by MPR images, which does not include the cartilage (6.6±2.1°) (p<0.05). The difference between these two angles that corresponds to the remaining posterior condylar cartilage was 1.7±1.2°. This result demonstrated that the posterior condylar cartilage might lead to over-rotational of the femoral component in varus osteoarthritic knee. Therefore, when determining rotational alignment of the femoral component, surgeons should consider the effect of the remaining posterior condylar cartilage to avoid the over-rotation of the femoral component, especially in severe varus knees. J. Med. Invest. 64: 24-29, February, 2016.
Shunichi Toki, Toshihiko Nishisho, Shoichiro Takao, Ryo Miyagi, Fumitake Tezuka, Akihiro Nagamachi and Koichi Sairyo : Fibroma of tendon sheath on the medial side of the knee: a case report., The Journal of Medical Investigation : JMI, 64, 1.2, 173-176, 2017.
(Summary)
Fibroma of tendon sheath, which is a benign soft tissue tumor, primarily affects the finger, hand, or wrist. It rarely involves the knee and only a few cases appear in the literature. Here, we report a case of fibroma of tendon sheath on the medial side of the knee, in a previously hardly reported location, and provide detailed imaging and histological findings. A 54-year-old man presented with his right knee pain and a palpable mass that had developed 3 months earlier. Magnetic resonance imaging showed isointensity in the soft tissue tumor on T1-weighted images, variable intensity on T2-weighted images, and contrast enhancement. The specimen obtained by needle biopsy showed no histological findings of malignancy. Marginal resection was performed and the microscopic diagnosis was fibroma of tendon sheath. Since fibroma of tendon sheath is relatively rare, the radiological feature is not specific, and a rate of local recurrence following excision is high, careful diagnosis, surgical treatment and long-term follow-up are necessary. J. Med. Invest. 64: 173-176, February, 2017.
Masahiro Sato, Yasuyoshi Mase and Koichi Sairyo : Active stretching for lower extremity muscle tightness in pediatric patients with lumbar spondylolysis., The Journal of Medical Investigation : JMI, 64, 1.2, 136-139, 2017.
(Summary)
Home-based active stretching was effective for relieving muscle tightness in the leg in a pediatric population. Adolescent athletes should perform such exercise to maintain flexibility and prevent lumbar disorders. J. Med. Invest. 64: 136-139, 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.
Keizo Wada, Takuya Hashimoto, Ryo Miyagi, Toshinori Sakai and Koichi Sairyo : Diffusion tensor imaging and tractography of the sciatic nerve: assessment of fractional anisotropy and apparent diffusion coefficient values relative to the piriformis muscle, a preliminary study., Skeletal Radiology, 46, 3, 309-314, 2016.
(Summary)
Piriformis muscle syndrome (PMS) is underdiagnosed. To evaluate the potential of diffusion tensor imaging and diffusion tensor tractography as innovative tools for the diagnosis of PMS by functional assessment of the sciatic nerve, the aims of this study are to assess the reproducibility and to evaluate the changes in the parameters at levels proximal and distal to the piriformis. Fractional anisotropy (FA) and the apparent diffusion coefficient (ADC) of the sciatic nerve at three levels were quantified twice each by two examiners using the fiber-tracking method. In the first part of the study, laterality and reproducibility were evaluated using intraclass correlation coefficients (ICC) in ten healthy volunteers. In the second part of the study, the healthy side and symptomatic side were assessed in ten consecutive patients with sciatica. There were three patients with no findings on lumbar magnetic resonance imaging (MRI). There was no laterality in either FA or ADC values in asymptomatic patients at any level. The mean intra-rater ICC was 0.90 and the mean inter-rater ICC was 0.87. FA was significantly lower and ADC significantly higher on the symptomatic side at each level in patients with sciatica. In the three sciatica patients with no findings on lumbar MRI, FA was significantly lower and ADC was significantly higher only at levels distal to the piriformis. These patients experienced full pain relief after ultrasound-guided injection of local anesthesia. Diffusion tensor imaging and diffusion tensor tractography might be innovative tools for the diagnosis of PMS.
(Keyword)
Adult / Aged / Aged, 80 and over / anisotropy / Diffusion Tensor Imaging / Female / Humans / Image Interpretation, Computer-Assisted / Male / Middle Aged / Piriformis Muscle Syndrome / Reproducibility of Results / Sciatic Neuropathy
Chandra Subash Jha, Toshihiko Nishisho, Tetsuya Matsuura, Makoto Takeuchi, Ryo Miyagi, Shoichiro Takao, Naoto Suzue, Shunichi Toki, Akihiro Nagamachi and Koichi Sairyo : Pigmented villonodular synovitis of the knee joint in a 5-year-old girl treated with combined open and arthroscopic surgery: a case report., Journal of Pediatric Orthopaedics. Part B, 25, 6, 564-569, 2016.
(Summary)
Pigmented villonodular synovitis is an extremely rare disease in skeletally immature patients. Erosive destruction of the involved joint leads to early arthritis, and its high recurrence rate makes treatment challenging. Multiple surgical approaches exist, but it is unclear as to which among them achieves the lowest possible recurrence rate and morbidity. We report the case of a 5-year-old girl with left knee pain and swelling who was diagnosed with diffuse pigmented villonodular synovitis of the left knee based on MRI findings. Combined open and arthroscopic surgery was performed to completely remove the tumor. Postoperative histopathological examination confirmed the diagnosis of diffuse pigmented villonodular synovitis. The postoperative course was uneventful, with a gradual improvement in symptoms. There were no signs of recurrence on postoperative MRI performed at the 8-month follow-up, with neither knee pain nor limitation of range of motion. The favorable outcome in this case suggests that combined open and arthroscopic surgery may be an effective method for treating pigmented villonodular synovitis in skeletally immature patients.
Nori Sato, Takako Taniguchi, Yuichiro Goda, Hirofumi Kosaka, Kosaku Higashino, Toshinori Sakai, Shinsuke Katoh, Natsuo Yasui, Koichi Sairyo and Hisaaki Taniguchi : Proteomic Analysis of Human Tendon and Ligament: Solubilization and Analysis of Insoluble Extracellular Matrix in Connective Tissues., Journal of Proteome Research, 15, 12, 4709-4721, 2016.
(Summary)
Connective tissues such as tendon, ligament and cartilage are mostly composed of extracellular matrix (ECM). These tissues are insoluble, mainly due to the highly cross-linked ECM proteins such as collagens. Difficulties obtaining suitable samples for mass spectrometric analysis render the application of modern proteomic technologies difficult. Complete solubilization of them would not only elucidate protein composition of normal tissues but also reveal pathophysiology of pathological tissues. Here we report complete solubilization of human Achilles tendon and yellow ligament, which is achieved by chemical digestion combined with successive protease treatment including elastase. The digestion mixture was subjected to liquid chromatography-mass spectrometry. The low specificity of elastase was overcome by accurate mass analysis achieved using FT-ICR-MS. In addition to the detailed proteome of both tissues, we also quantitatively determine the major protein composition of samples, by measuring peak area of some characteristic peptides detected in tissue samples and in purified proteins. As a result, differences between human Achilles tendon and yellow ligament were elucidated at molecular level.
Kazuaki Mineta, Tomohiro Goto, Keizou Wada, Yasuaki Tamaki, Daisuke Hamada, Ichiro Tonogai, Kousaku Higashino and Koichi Sairyo : CT-based morphological assessment of the hip joint in Japanese patients: association with radiographic predictors of femoroacetabular impingement., The Bone & Joint Journal, 98-B, 9, 1167-1174, 2016.
(Summary)
The prevalence of radiographic FAI was common in Japanese patients who are generally considered to have dysplastic hips. Cite this article: Bone Joint J 2016;98-B:1167-74.
(Keyword)
Acetabulum / Adult / Age Distribution / Aged / Aged, 80 and over / Femoracetabular Impingement / Femur Head / Hip Dislocation / Humans / Imaging, Three-Dimensional / Japan / Middle Aged / Observer Variation / Predictive Value of Tests / Prevalence / Range of Motion, Articular / Retrospective Studies / Severity of Illness Index / Sex Distribution / Tomography, X-Ray Computed / Young Adult
Masaru Nakamura, Tateaki Shimakawa, Shunji Nakano, Takashi Chikawa, Shinji Yoshioka, Masahiro Kashima, Shunichi Toki, Hidehisa Horiguchi and Koichi Sairyo : Failure rates of Asian-type anatomic medullary locking stemmed metal-on-metal total hip replacement: A cause for adverse tissue reactions to metal debris (ARMD)., Journal of Orthopaedic Science, 21, 6, 779-785, 2016.
(Summary)
We conclude that the major cause of failure of Asian-type AML stemmed MoM THR is likely the breakage of the fixation between the taper neck and metal head at the head-neck junction.
Masatoshi Morimoto, Kousaku Higashino, Shinsuke Katoh, Fumitake Tezuka, Kazuta Yamashita, Fumio Hayashi, Yoichiro Takata, Toshinori Sakai, Akihiro Nagamachi and Koichi Sairyo : A Rare Case of Progressive Palsy of the Lower Leg Caused by a Huge Lumbar Posterior Endplate Lesion after Recurrent Disc Herniation., Case Reports in Orthopedics, 2016, 2016.
(Summary)
A lesion of the lumbar posterior endplate is sometimes identified in the spinal canal of children and adolescents; it causes symptoms similar to those of a herniated disc. However, the pathology of the endplate lesion and the pathology of the herniated disc are different. We present a rare case of a 23-year-old woman who developed progressive palsy of the lower leg caused by huge lumbar posterior endplate lesion after recurrent disc herniation.
Tomoya Takasago, Tomohiro Goto, Keizo Wada, Daisuke Hamada, Toshiyuki Iwame, Tetsuya Matsuura, Akihiro Nagamachi and Koichi Sairyo : Metallosis after Exchange of the Femoral Head and Liner following Ceramic Acetabular Liner Dissociation in Total Hip Arthroplasty with a Modular Layered Acetabular Component., Case Reports in Orthopedics, 2016, 2016.
(Summary)
The type of bearing material that should be used in revision surgery after the failure of ceramic-on-ceramic total hip arthroplasty (THA) remains controversial. In the case of ceramic fracture, the residual ceramic particles can cause consequent metallosis when metal implants are used for revision THA. On the other hand, in the case of THA failure without ceramic fracture, revision THA with a metal femoral head provides satisfactory results. We report an unusual case of progressive osteolysis due to metallosis that developed after revision THA for ceramic liner dissociation without a liner fracture performed using a metal femoral head and polyethylene liner. The residual metal debris and abnormal pumping motion of the polyethylene liner due to the breakage of the locking system or the aspherical metal shell being abraded by the ceramic head seemed to be the cause of the progressive osteolysis.
Yoichiro Takata, Kousaku Higashino, Masatoshi Morimoto, Toshinori Sakai, Kazuta Yamashita, Mitusnobu Abe, Akihiro Nagamachi and Koichi Sairyo : Vacuum Phenomenon of the Sacroiliac Joint: Correlation with Sacropelvic Morphology., Asian Spine Journal, 10, 4, 762-766, 2016.
(Summary)
These data suggest that differences in sacropelvic morphology can influence the biomechanical environment and contribute to SJVP in men. Presence of SJVP did not affect JOA or RDQ scores.
Keizo Wada, Tomohiro Goto, Fumitake Tezuka, Shunsuke Tamaki, Daisuke Hamada, Takahiko Tsutsui and Koichi Sairyo : Variations in the obturator artery around the obturator foramen assessed by three-dimensional computed tomographic angiography and prevention of vascular-related complications in rotational acetabular osteotomy., International Orthopaedics, 41, 1, 133-139, 2016.
(Summary)
Extensive care should be taken during rotational acetabular osteotomy in patients showing variations of the obturator artery with corona mortis.
Kazuaki Mineta, Tomohiro Goto, Keizo Wada, Yasuaki Tamaki, Daisuke Hamada, Kousaku Higashino and Koichi Sairyo : Comparison of femoroacetabular impingement-related radiographic features in a convenience sample of Japanese patients with and without herniation pits., Skeletal Radiology, 45, 8, 1079-1088, 2016.
(Summary)
We revealed the prevalence of HPs and showed it has a predilection for men in this Japanese cohort. Femoral head asphericity or small head-neck offset was more common in subjects with HPs than those without HPs.
Kazuta Yamashita, Kousaku Higashino, Keizo Wada, Masatoshi Morimoto, Mitsunobu Abe, Yoichiro Takata, Toshinori Sakai, Yoshihiro Fukui and Koichi Sairyo : Radiation Exposure to the Surgeon and Patient During a Fluoroscopic Procedure: How High is the Exposure Dose? A Cadaveric Study., Spine, 41, 15, 1254-1260, 2016.
Tomohiro Goto, Kazuaki Mineta, Keizo Wada, Yasuaki Tamaki, Daisuke Hamada, Tomoya Takasago, Kousaku Higashino and Koichi Sairyo : Correlation between coxa profunda and morphological parameters of acetabular coverage in a Japanese cohort: A CT study., Journal of Orthopaedic Science, 21, 5, 667-672, 2016.
(Summary)
Coxa profunda is a common radiographic feature in Japanese patients, especially in women. Coxa profunda may be less useful for diagnosing acetabular overcoverage because of its common occurrence with various hip morphologies and its poor specificity for detecting acetabular overcoverage. However, men with coxa profunda have greater acetabular coverage, so coxa profunda may contribute to acetabular coverage in men. We should take into account that coxa profunda may have different implications between the sexes.
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.
Shoji Fukuta, Takahiko Tsutsui, Rui Amari, Keizo Wada and Koichi Sairyo : Tendon retraction with rotator cuff tear causes a decrease in cross-sectional area of the supraspinatus muscle on magnetic resonance imaging., Journal of Shoulder and Elbow Surgery, 25, 7, 1069-1075, 2016.
(Summary)
To avoid the influence of retraction of the supraspinatus tendon, sufficient medial slices from the musculotendinous junction should be used for evaluation of muscle atrophy.
Keizo Wada, Daisuke Hamada, Shunsuke Tamaki, Kousaku Higashino, Yoshihiro Fukui and Koichi Sairyo : Influence of Medial collateral ligament release for internal rotation of tibia in posterior stabilized total knee arthroplasty: a cadaveric study, The Journal of Arthroplasty, 32, 1, 270-273, 2016.
(Summary)
Previous studies suggested that changes in kinematics in total knee arthroplasty (TKA) affected satisfaction level. The aim of this cadaveric study was to evaluate the effect of medial collateral ligament (MCL) release by multiple needle puncture on knee rotational kinematics in posterior-stabilized TKA. Six fresh, frozen cadaveric knees were included in this study. All TKA procedures were performed with an image-free navigation system using a 10-mm polyethylene insert. Tibial internal rotation was assessed to evaluate intraoperative knee kinematics. Multiple needle puncturing was performed 5, 10, and 15 times for the hard portion of the MCL at 90° knee flexion. Kinematic analysis was performed after every 5 punctures. After performing 15 punctures, a 14-mm polyethylene insert was inserted, and kinematic analysis was performed. The tibial internal rotation angle at maximum knee flexion without multiple needle puncturing was significantly larger (9.42°) than that after 15 punctures (3°). Negative correlation (Pearson r = -0.715, P < .001) between tibial internal rotation angle at maximum knee flexion and frequency of puncture was observed. The tibial internal rotation angle with a 14-mm insert was significantly larger (7.25°) compared with the angle after 15 punctures. Tibial internal rotation during knee flexion was reduced by extensive MCL release using multiple needle puncturing and was recovered by increasing of medial tightness. From the point of view of knee kinematics, medial tightness should be allowed to maintain the internal rotation angle of the tibia during knee flexion which might lead to patient satisfaction.
Tetsuya Kimura, Toshinori Sakai, Fumitake Tezuka, Mitsunobu Abe, Kazuta Yamashita, Yoichiro Takata, Kousaku Higashino and Koichi Sairyo : Compression Myelopathy due to Proliferative Changes around C2 Pars Defects without Instability., Asian Spine Journal, 10, 3, 565-569, 2016.
(Summary)
We report a case with compression myelopathy due to proliferative changes around the C2 pars defects without instability. A 69-year-old man presented with progressive clumsy hands and spastic gait. Plain radiographs showed bilateral spondylolysis (pars defects) at C2 and fusion between C2 and C3 spinous processes. Dynamic views revealed mobility through the pars defects, but there was no apparent instability. Computed tomography showed proliferative changes at the pars defects, which protruded into spinal canal. On magnetic resonance imaging, the spinal cord was compressed and intramedullary high signal change was found. A diagnosis of compression myelopathy due to proliferative changes around the C2 pars defects was made. We performed posterior decompression. Postoperatively, symptoms have been alleviated and images revealed sufficient decompression and no apparent instability. In patients with the cervical spondylolysis, myelopathy caused by instability or slippage have been periodically reported. The present case involving C2 spondylolysis is extremely rare.
Tetsuya Kimura, Tomohiro Goto, Daisuke Hamada, Takahiko Tsutsui, Keizo Wada, Shoji Fukuta, Akihiro Nagamachi and Koichi Sairyo : Subchondral insufficiency fracture of the femoral head caused by excessive lateralizatioin of the acetabular rim, Case Reports in Orthopedics, 2016.
(Summary)
We present a case of a 53-year-old woman with subchondral insufficiency fracture (SIF) of the femoral head without history of severe osteoporosis or overexertion. Plain radiographs showed acetabular overcoverage with excessive lateralization of the acetabular rim. A diagnosis of SIF was made by typical MRI findings of SIF. The lesion occurred at the antipodes of the extended rim. Increased mechanical stress over the femoral head due to impingement against the excess bone was suspected as a cause of SIF. The distinct femoral head deformity is consistent with this hypothesis. This is the first report of SIF associated with acetabular overcoverage.
Akihiro Nitta, Toshinori Sakai, Yuichiro Goda, Yoichiro Takata, Kousaku Higashino, Tadanori Sakamaki and Koichi Sairyo : Prevalence of Symptomatic Lumbar Spondylolysis in Pediatric Patients., Orthopedics, 39, 3, e434-437, 2016.
(Summary)
Lumbar spondylolysis, a stress fracture of the pars interarticularis, is prevalent in adolescent athletes. Recent advances in diagnostic tools and techniques enable early diagnosis before these fractures progress to complete fractures through the pars. However, because patients often consult family physicians for primary care of low back pain and these physicians may not have access to diagnostic modalities such as magnetic resonance imaging (MRI) and computed tomography, stress fractures can be missed. This study surveyed the prevalence of symptomatic spondylolysis in pediatric patients who consulted an orthopedic clinic for primary care and investigated whether such acute stress fractures may be overlooked without MRI. The prospective study investigated 264 patients who were younger than 19 years and had low back pain. Of the 153 patients (58.0%) with low back pain persisting for longer than 2 weeks, 136 who agreed to undergo MRI were included in the study. This group included 11 elementary school students, 71 junior high school students, and 54 high school students. The overall prevalence of lumbar spondylolysis was 39.7% (54 of 136) and was 9.3% in elementary school students (5 of 11, 45.5%), 59.3% in junior high school students (32 of 71, 45.1%), and 31.5% in high school students (17 of 54, 31.5%). All 54 patients with spondylolysis had a history of athletic activity. Primary care physicians should recognize that approximately 40% of pediatric patients presenting with low back pain persisting for longer than 2 weeks may have spondylolysis and should consider MRI in those with a history of athletic activity. Because the spine is immature in this age group, almost half of affected elementary school and junior high school students may have lumbar spondylolysis. [Orthopedics.].
Koichi Sairyo and Akihiro Nagamachi : State-of-the-art management of low back pain in athletes: Instructional lecture., Journal of Orthopaedic Science, 21, 3, 263-272, 2016.
(Summary)
In this paper, we describe "state of the art" on the diagnosis and treatment for low back pain in athletes. Lumbar motion that induces specific pain would be a clue to the exact diagnosis. In the flexion pain group, lumbar herniated nucleus pulposus is the most common disorder. Discogenic pain and type 1 Modic endplate inflammation may also cause flexion pain; however, the diagnosis is sometimes difficult. In children and adolescents, apophyseal ring fracture is prevalent. In the extension pain group, lumbar spondylolysis is very common, especially in pediatric athletes. In adults, facet pain due to overloading would be the pathology, while low back pain with trunk rotation is not common. However, throwing athletes, such as pitchers and hammer throwers, may experience this kind of pain; facet arthritis contralateral to the throwing arm would be the origin of the pain. Low back pain on lumbar lateral bending is rare, but we experienced some cases in golfers in whom type 1 Modic change at the lateral corner was the source of pain. In this article, we explained strategies for state-of-the-art diagnosis and minimally invasive treatment.
Shingo Hama, Yoichiro Takata, Toshinori Sakai, Kousaku Higashino, Mitsunobu Abe, Akihiro Nagamachi and Koichi Sairyo : Sacral fatigue fractures in children with sacral spina bifida occulta., Journal of Pediatric Orthopaedics. Part B, 25, 3, 278-282, 2016.
(Summary)
In this report, we present two cases of 9-year-old children with spina bifida occulta (SBO) of the sacrum, who were diagnosed with sacral fatigue fractures. In both patients, MRI showed a linear signal void and high signal in sacral ala on the short tau inversion recovery sequence. Sacral SBO at the same level of the sacral fracture was observed in each patient on computed tomography images. These lesions healed with rest. This is the first literature reporting cases with sacral stress fractures who had SBO at the same level of fracture.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0/.
Toshinori Sakai, Yuichiro Goda, Fumitake Tezuka, Mitsunobu Abe, Kazuta Yamashita, Yoichiro Takata, Kousaku Higashino, Akihiro Nagamachi and Koichi Sairyo : Clinical features of patients with pars defects identified in adulthood., European Journal of Orthopaedic Surgery & Traumatology, 26, 3, 259-262, 2016.
(Summary)
Lumbar spondylolysis is considered a stress fracture of the pars interarticularis that occurs during growth. However, it is sometimes insidious and identified in adults as pseudoarthrosis, the terminal-stage of spondylolysis. The purpose of this study was to identify the clinical features of patients with terminal-stage spondylolysis that first manifested during adulthood.
Tetsuya Matsuura, Naoto Suzue, Toshiyuki Iwame, Kokichi Arisawa, Shoji Fukuta and Koichi Sairyo : Epidemiology of shoulder and elbow pain in youth baseball players., The Physician and Sportsmedicine, 44, 2, 97-100, 2016.
(Summary)
There are relatively few published epidemiological studies examining the differences in the risk of shoulder and elbow pain in young baseball players. The purpose of this study was to investigate risk factors for shoulder and elbow pain in child and adolescent baseball players.
Tetsuya Kimura, Hiroaki Takai, Tatsuo Azuma and Koichi Sairyo : Motion Analysis of the Trapeziometacarpal Joint Using Three-dimensional Computed Tomography, The Journal of Hand Surgery, Asian-Pacific Volume, 21, 1, 78-84, 2016.
(Summary)
Zancolli theorized that the first metacarpal bone axially rotates on the semispheroidal part of the trapezium, which is controlled by ligaments. This study used three-dimensional computed tomography (3D-CT) to describe the motion of the first metacarpal bone on the trapezium. 3D-CT images were taken of the left hand of 30 healthy volunteers (mean age [Formula: see text] years, 15 men and 15 women). They were divided into five groups: radial abduction, retroposition, adduction, palmar abduction, and opposition. The range of motion of radial abduction and palmar abduction of the trapeziometacarpal joint was measured from the first metacarpal bone to the second metacarpal bone. The range of motion of pronation was measured following Cheema's method. The main contacts of the joint surface of trapezium and the first metacarpal bone were determined on the 3D-CT images. Pronation of the trapeziometacarpal joint was [Formula: see text] in radial abduction, [Formula: see text] in retroposition, [Formula: see text] in adduction, [Formula: see text] in palmar abduction, and [Formula: see text] in opposition. Radial abduction was [Formula: see text] in radial abduction, [Formula: see text] in retroposition, [Formula: see text] in adduction, [Formula: see text] in palmar abduction, and [Formula: see text] in opposition. Palmar abduction was [Formula: see text] in radial abduction, [Formula: see text] in retroposition, [Formula: see text] in adduction, [Formula: see text] in palmar abduction, and [Formula: see text] in opposition. The contact surfaces of the trapezium and the first metacarpal bone were dorsal and ulnar in radial abduction, radial and ulnar in retroposition, and volar-ulnar and volarradial in opposition, respectively, while they were both central in adduction and both radial in palmar abduction. The range of motion of the trapeziometacarpal joint was 44° for radial abduction/adduction, 48° for palmar abduction/adduction, and 57° for pronation/supination. The varying contact surfaces of the trapezium and the first metacarpal bone enabled a wide range of motion.
C Subash Jha, Ichiro Tonogai, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Yuichiro Goda, Mitsunobu Abe, Akihiro Nagamachi, Shoji Fukuta and Koichi Sairyo : Postoperative discal cyst: An unusual complication after microendoscopic discectomy in teenagers., Asian Journal of Endoscopic Surgery, 9, 1, 89-92, 2016.
(Summary)
Various complications after microendoscopic discectomy (MED) are well known, but postoperative discal cyst is a unique and relatively unknown complication. Here, we report on two teenage patients who presented with postoperative discal cyst after MED for herniated nucleus pulposus (HNP), which resolved after conservative treatment. The patients were diagnosed with HNP at L4-5 and L5-S1 based on MRI and then treated by MED. Postoperative discal cyst was diagnosed on MRI after recurrence of symptoms. Both patients were managed conservatively. T2-weighted MRI demonstrated hyperintense collections adjacent to the operated intervertebral disc level, which were communicating with the corresponding disc annulus. Because the clinical symptoms were relatively mild, the patients were managed conservatively; both made a complete clinical recovery with radiological evidence of improvement. Postoperative discal cyst is a relatively unknown complication after MED for HNP. Surgeons should be aware of this postoperative complication when operating on young individuals with HNP.
Percutaneous endoscopic discectomy (PED) is a minimally invasive disc surgery that can be performed under local anesthesia and requires only an 8-mm skin incision. For transligamentous extruded nucleus pulposus with foraminal stenosis, it is very hard to remove the migrated mass with a simple transforaminal approach. For such difficult cases, foraminoplasty and an epiduroscopic technique is useful. A 29-year-old man visited the authors' hospital, complaining of low-back and right leg pain. MRI revealed a massive herniated nucleus pulposus with foraminal stenosis. A transforaminal PED was planned to remove the herniated mass. Through the inside-out technique, the base of the herniated mass was removed. Following the foraminoplasty, the cannula was moved into the epidural space. With epidural observation just beneath the nerve root, the extruded transligamentous fragment was confirmed and removed en bloc. Immediately after the surgery, the patient's symptoms resolved. The combination of foraminoplasty and epiduroscopic observation during the transforaminal approach for PED is a useful and reliable technique to remove extruded transligamentous disc fragments.
Toshinori Sakai, Yuichiro Goda, Fumitake Tezuka, Yoichiro Takata, Kousaku Higashino, Masahiro Sato, Yasuyoshi Mase, Akihiro Nagamachi and Koichi Sairyo : Characteristics of lumbar spondylolysis in elementary school age children., European Spine Journal, 25, 2, 602-606, 2016.
(Summary)
Lumbar spondylolysis in elementary school age children was commonly a terminal-stage bone defect at L5, which was not necessarily related to history of athletic activity and was sometimes asymptomatic. It was often associated with SBO, indicating a possible congenital predisposition. These findings may provide further insight into the pathogenesis of lumbar spondylolysis.
Keizo Wada, Hiroshi Mikami, Daisuke Hamada, Hiroshi Yonezu, Koichi Oba and Koichi Sairyo : Measurement of rotational and coronal alignment in total knee arthroplasty using a navigation system is reproducible., Archives of Orthopaedic and Trauma Surgery, 136, 2, 271-276, 2016.
(Summary)
Manual intraoperative kinematic analysis using a navigation system in TKA showed excellent reproducibility. This result may encourage further studies about intraoperative kinematic analysis using a navigation system in TKA.
Toshiyuki Iwame, Tetsuya Matsuura, Naoto Suzue, Shinji Kashiwaguchi, Takenobu Iwase, Shoji Fukuta, Daisuke Hamada, Tomohiro Goto, Takahiko Tsutsui, Keizo Wada, Hiroshi Egawa, Akihiro Nagamachi and Koichi Sairyo : Outcome of an elbow check-up system for child and adolescent baseball players., The Journal of Medical Investigation : JMI, 63, 3-4, 171-174, 2016.
(Summary)
About 30% of youth baseball players had episodes of elbow pain, and 64.1% of players with elbow pain had abnormal findings on physical examination. Furthermore, 85.2% of subjects who underwent radiographic examination exhibited radiographic abnormalities. About 4% of young baseball players had an abnormal finding on initial ultrasonography screening, and nearly 50% of them had OCD of the capitellum on radiographs. J. Med. Invest. 63: 171-174, August, 2016.
Toshihiko Nishisho, Toshinori Sakai, Fumitake Tezuka, Kosaku Higashino, Shoichiro Takao, Yoichiro Takata, Ryo Miyagi, Shunichi Toki, Mitsunobu Abe, Kazuta Yamashita, Akihiro Nagamachi and Koichi Sairyo : Delayed Diagnosis of Primary Bone and Soft Tissue Tumors Initially Treated as Degenerative Spinal Disorders., The Journal of Medical Investigation : JMI, 63, 3-4, 274-277, 2016.
(Summary)
Background Symptoms of primary bone and soft tissue tumors located in the trunk mimic those of degenerative spinal disorders such as low back pain or pain or numbness of the legs. Due to their rarity, especially in sarcoma located in the trunk, diagnosis is sometimes delayed. Methods A retrospective review was performed of the records of 383 patients with primary bone and soft tissue tumors who visit our out patient clinic from 2011 to 2013 at a single institution. Patients with delayed diagnosis of primary bone and soft tissue tumors initially treated as degenerative spinal disorders for more than 2 months were identified. Results Of the 383 patients, 5 (1.3%) were initially diagnosed as having degenerative spinal disorders. All 5 patients had bone or soft tissue tumors in the lumbar spine or pelvis. Three patients had a malignant tumor (osteosarcoma, chondrosarcoma, or small round cell sarcoma) at the progressive stage, and 1 died of lung metastasis. Two patients had a benign tumor (aneurysmal bone cyst or simple bone cyst). Conclusions Our findings suggest that when low back pain and leg pain are refractory to conservative treatment, further radiological examination should be conducted. J. Med. Invest. 63: 274-277, August, 2016.
Kazuaki Mineta, Naoto Suzue, Tetsuya Matsuura and Koichi Sairyo : Efficacy of Achilles Suture Bridge Technique for Insertional Achilles Tendinosis in an Obese and Athletic Patient., The Journal of Medical Investigation : JMI, 63, 3-4, 310-314, 2016.
(Summary)
Here, we report the efficacy of the suture bridge technique for treating insertional Achilles tendinosis in an obese and athletic patient. A 48-year-old man presented to our department with a 6-month history of left posterior heel pain. The patient was an athlete (triathlon) and appeared obese (height: 197 cm, body weight: 120 kg, body mass index: 30.9). A diagnosis of insertional Achilles tendinosis was made. Because 6 months of conservative treatments had failed, we performed open resection of the calcaneal exostosis and Haglund's deformity along with debridement of the degenerative tissue of the tendon. Wide detachment of the insertion of the Achilles tendon was necessary, and reattachment of the tendon was performed using the Arthrex SpeedBridge(TM) system (Arthrex, Inc., Naples, FL). Six weeks postoperatively, this patient was allowed to walk with full weight bearing. Twelve weeks after surgery, this patient started jogging with neither pain nor evidence of Achilles tendon rupture. The suture bridge technique was effective for the reconstruction of the Achilles tendon in an obese and athletic patient. J. Med. Invest. 63: 310-314, August, 2016.
Toshihiko Nishisho, Shoichiro Takao, Ryo Miyagi, Shunichi Toki, Akihiro Nagamachi and Koichi Sairyo : Complete spontaneous regression of a subpubic cartilaginous cyst: a case report., The Journal of Medical Investigation : JMI, 63, 3-4, 319-322, 2016.
(Summary)
Subpubic cartilaginous cyst was recently reported as a rare degenerative mass on the pubic symphysis. We report here a 59-year-old woman who presented with a vulvar mass that showed complete spontaneous regression 48 months after the initial visit. Treatment was only wearing brace. This is the first report of complete spontaneous regression of a subpubic cartilaginous cyst. In the case of small subpubic cyst, observation and follow-up alone may be sufficient. J. Med. Invest. 63: 319-322, August, 2016.
Kiyotaka Hasebe, Yu Okubo, Koji Kaneoka, Kohei Takada, Daisuke Suzuki and Koichi Sairyo : The effect of dynamic stretching on hamstrings flexibility with respect to the spino-pelvic rhythm., The Journal of Medical Investigation : JMI, 63, 1-2, 85-90, 2016.
(Summary)
Dynamic stretching could change the spino-pelvic rhythm to a pelvis-dominant motion, indicating that flexible hamstrings are important for preventing low back pain. J. Med. Invest. 63: 85-90, February, 2016.
Kosuke Sugiura, Toshinori Sakai, Keisuke Adachi, Kazumasa Inoue, Satoshi Endo, Yasuaki Tamaki, Koichi Sairyo and Akihiro Nagamachi : Complete Fracture-Dislocation of the Thoracolumbar Spine with No Critical Neurological Deficit: A Case Report., The Journal of Medical Investigation : JMI, 63, 1-2, 122-126, 2016.
(Summary)
Fractures at the thoracolumbar junction are the most common spinal column fractures. Among type C fractures in the Arbeitsgemeinschaft für Osteosynthesefragen Spine Classification, cases with complete fracture-dislocations of the spinal column often result in a critical neurological deficit despite surgical treatment. We present a case of an 18-year-old man who had a complete fracture-dislocation of the T12 vertebral body and multiple injuries following high-energy trauma but no critical neurological deficits. Because of active bleeding in the left thoracic cavity, the patient underwent open reduction of the T12 vertebral body and anterior spinal fusion of the T11-L1 vertebral bodies via an anterior approach between the T9 and T10 ribs within 24 h of the accident. Four months postoperatively, the patient could ambulate independently, with a slight disturbance of light touch. At 6 months postoperatively, plain computed tomography scans showed bony union of the T12 vertebral body. We postulated two reasons for the absence of critical neurological dysfunction: (1) spontaneous spinal canal sparing because of the fracture of the right superior articular process in the L1 vertebral body and (2) fracture morphology, that is, a rotational fracture with mild to moderately strong shearing stress to the dura mater. J. Med. Invest. 63: 122-126, February, 2016.
Shinji Kawaguchi, Shoji Fukuta, Takahiko Tsutsui, Tetsuya Matsuura, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Ryo Miyagi, Keizo Wada, Kenichiro Kita, Shunsuke Tamaki, Toshihiko Matsumura, Akihiro Nagamachi and Koichi Sairyo : Arthroscopic excision of unstable os acromiale associated with impingement syndrome: a case report., The Journal of Medical Investigation : JMI, 63, 1-2, 131-134, 2016.
(Summary)
Os acromiale is a rare anatomical variant that is caused by failure of fusion of the acromial apophysis and is usually asymptomatic. We report a case of impingement syndrome of the left shoulder secondary to unstable os acromiale, which was initially overlooked and confirmed only during arthroscopic examination. Arthroscopic excision of the unstable fragment was successful without residual dysfunction of the deltoid muscle. J. Med. Invest. 63: 131-134, February, 2016.
Kazuta Yamashita, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Mitsunobu Abe, Masatoshi Morimoto, Akihiro Nagamachi and Koichi Sairyo : Revision percutaneous endoscopic lumbar discectomy under the local anesthesia for the recurrent lumbar herniated nucleus pulposus in a high class athlete: A case Report., The Journal of Medical Investigation : JMI, 63, 1-2, 135-139, 2016.
(Summary)
Percutaneous endoscopic discectomy (PED) is a minimally invasive spinal technique and has several advantages compared with open surgery. We describe repeat PED surgery for recurrent herniated nucleus pulposus (HNP). The patient was a 33-year-old handball high level player. Previously, he underwent transforaminal PED under local anesthesia for intracanalicular HNP at L4-5 level about 2 years ago. He could return to his original competitive level. Two years later, he felt low back and right leg pain again when he was playing handball. Magnetic resonance imaging revealed the recurrence of HNP at the same level. We conducted transforaminal PED again using the exact same route as the previous surgery. Although there was a little adhesion around the L5 nerve root, we could easily identify and remove the herniated mass using endoscopic forceps. Immediately after the surgery, the low back and leg pain disappeared. Repeat PED surgery for recurrence of lumbar disc herniation is effective especially for athletes because of the benefits of PED, including surgery under local anesthesia, preservation of normal posterior structures, less postoperative pain, early discharge, and faster return to sports. J. Med. Invest. 63: 135-139, February, 2016.
Subash Jha C, Shoji Fukuta, Keizo Wada, Kousaku Higashino, Rui Amari-Kita, Takahiko Tsutsui, Tomohiro Goto, Daisuke Hamada, Naoto Suzue, Tetsuya Matsuura, Toshihiko Nishisho, Mitsunobu Abe, Yoichiro Takata, Toshinori Sakai, Akihiro Nagamachi and Koichi Sairyo : Optimizing baseplate position in reverse total shoulder arthroplasty in small-sized Japanese females: technical notes and literature review., The Journal of Medical Investigation : JMI, 63, 1-2, 8-14, 2016.
(Summary)
The management of cuff tear arthropathy (CTA) has always been a challenge for shoulder surgeons. Introduction of reverse total shoulder arthroplasty (RTSA) helped in providing pain relief and improved shoulder function in patients with CTA. In this study, we aimed to evaluate the short-term clinical results and some clinical details regarding the types of available prosthesis, positioning, and size of the components for RTSA in a population of short-stature female Japanese. In our seven cases, the average glenoid size was 23.9 mm in width and 34.2 mm in height. The average width was smaller than the size of all available baseplates. We implanted reverse shoulder prostheses with baseplate that measured 28 mm in diameter and two locking screws. The center of the baseplate was shifted to allow slight anterior overhang relative to the anatomical center to avoid breakage of the posterior cortex and to achieve firm fixation. One case of humeral shaft fracture occurred while inserting the humeral stem and required encircling wiring. In our experience, the short term clinical results of RTSA were excellent, but a new prosthesis that is designed to fit the short stature of Asians with smaller glenoid and humerus should be considered. J. Med. Invest. 63: 8-14, February, 2016.
Subash Jha C, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Mitsunobu Abe, Kazuta Yamashita, Masatoshi Morimoto, Shoji Fukuta, Akihiro Nagamachi and Koichi Sairyo : Clinical Significance of High-intensity Zone for Discogenic Low Back Pain: A Review., The Journal of Medical Investigation : JMI, 63, 1-2, 1-7, 2016.
(Summary)
High-intensity zone (HIZ) was originally described as a high-intensity signal on T2-weighted magnetic resonance (MR) images, located in the posterior annulus fibrosus, clearly separated from the nucleus pulposus. Among symptomatic patients with low back pain, HIZ is present in 28-59% of cases. In morphologically abnormal discs, high sensitivity and specificity of 81% and 79%, respectively, were reported for HIZs and concordant pain during discography. In contrast, another report indicated low rates. Although most papers reported high sensitivity and specificity for this relationship, it remains controversial. Regarding the pathology of HIZs, inflammatory granulation tissues are found at sites showing HIZs. Such inflammatory tissues produce pro-inflammatory cytokines and mediators, which sensitize the nociceptors within the disc and cause pain. An effective treatment for this condition is yet to be established. Recently, minimally invasive surgery using percutaneous endoscopic discectomy (PED) under local anesthesia was introduced. After removal of the degenerated disc material, the HIZ is identified with the endoscope and then coagulated and modulated with a bipolar radio pulse. This technique is called thermal annuloplasty. In conclusion, HIZs is an important sign of painful intervertebral disc disruption, if identified precisely based on factors such as location and intensity. J. Med. Invest. 63: 1-7, February, 2016.
Subash Jha C, Toshinori Sakai, Mika Hangai, Akiko Toyota, Shoji Fukuta, Akihiro Nagamachi and Koichi Sairyo : Stress fracture of the thoracic spine in an elite rhythmic gymnast: A case report., The Journal of Medical Investigation : JMI, 63, 1-2, 119-121, 2016.
(Summary)
Spondylolysis, a defect or stress fracture of the vertebral pars interarticularis, occurs most frequently in the lower lumbar spine and occasionally in the cervical spine, but is extremely rare in the thoracic spine. We report the case of a 17 year-old girl, an elite rhythmic gymnast, who reported with early-stage thoracic spondylolysis at T10 and T11 levels. Physicians should be aware that performance of unusual athletic movements, such as those by gymnasts, may lead to spondylolysis in rare locations. J. Med. Invest. 63: 119-121, February, 2016.
Tadahiro Higuchi, Ichiro Tonogai, Toshinori Sakai, Yoichiro Takata, Yuichiro Goda, Mitsunobu Abe, C Subash Jha, Shoji Fukuta, Kousaku Higashino, Akihiro Nagamachi and Koichi Sairyo : Hysterical conversion paralysis in an adolescent boy with lumbar spondylolysis., Journal of Pediatric Orthopaedics. Part B, 25, 3, 271-274, 2016.
(Summary)
We describe a case of recurrent hysterical paralysis triggered by low back pain because of lumbar spondylolysis. A 16-year-old male soccer player was referred to our institution with five previous episodes of acute paralysis triggered by severe low back pain. We performed direct surgical repair of the terminal-stage bilateral spondylolysis at L4 using a hook-rod system. His chronic low back pain was completely resolved, and no further episodes of hysterical paralysis have occurred after surgery. Spine surgeons should be aware of possible hysterical conversion paralysis when there is discrepancy between radiological and neurological findings.
Daisuke Hamada, Tetsuya Matsuura, Kosuke Sugiura, Tadahiro Higuchi, Naoto Suzue, Tomohiro Goto, Takahiko Tsutsui, Keizo Wada, Shoji Fukuta and Koichi Sairyo : An Unusual Cause of Posterior Elbow Impingement: Detachment of a Hypertrophied Posterior Fat Pad., Case Reports in Orthopedics, 2015, 2015.
(Summary)
We report a case of a 47-year-old woman who developed posterior impingement of the elbow due to detachment of a hypertrophied posterior fat pad. She reported acute left elbow pain after leaning back onto a hard object with her hand and subsequently experienced a "catching" sensation. Comparison with the magnetic resonance images of a normal elbow revealed a hypertrophied posterior fat pad interposed between the olecranon and olecranon fossa in both elbows, with the fat pad in the left elbow located more inferiorly than that in the right elbow. Elbow arthroscopy showed the olecranon fossa covered by the fat pad, a portion of which was detached from the rest of the pad. Debridement of the detached portion was performed until no impingement was evident. Postoperatively, full extension of the elbow did not elicit pain. Clinicians should include this pathology among the differential diagnoses for posterior elbow pain.
Kiminori Yukata, Sho Nakai, Tomohiro Goto, Yuichi Ikeda, Yasunori Shimaoka, Issei Yamanaka, Koichi Sairyo and Jun-Ichi Hamawaki : Cystic lesion around the hip joint., World Journal of Orthopedics, 6, 9, 688-704, 2015.
(Summary)
This article presents a narrative review of cystic lesions around the hip and primarily consists of 5 sections: Radiological examination, prevalence, pathogenesis, symptoms, and treatment. Cystic lesions around the hip are usually asymptomatic but may be observed incidentally on imaging examinations, such as computed tomography and magnetic resonance imaging. Some cysts may enlarge because of various pathological factors, such as trauma, osteoarthritis, rheumatoid arthritis, or total hip arthroplasty (THA), and may become symptomatic because of compression of surrounding structures, including the femoral, obturator, or sciatic nerves, external iliac or common femoral artery, femoral or external iliac vein, sigmoid colon, cecum, small bowel, ureters, and bladder. Treatment for symptomatic cystic lesions around the hip joint includes rest, nonsteroidal anti-inflammatory drug administration, needle aspiration, and surgical excision. Furthermore, when these cysts are associated with osteoarthritis, rheumatoid arthritis, and THA, primary or revision THA surgery will be necessary concurrent with cyst excision. Knowledge of the characteristic clinical appearance of cystic masses around the hip will be useful for determining specific diagnoses and treatments.
Shoji Fukuta, Takahiko Tsutsui, Tetsuya Matsuura, Naoto Suzue, Daisuke Hamada, Tomohiro Goto and Koichi Sairyo : Detached Anterior Horn of the Medial Meniscus Mimicking a Parameniscal Cyst., Case Reports in Orthopedics, 2015, 2015.
(Summary)
We report a case of a detached anterior horn of the medial meniscus with anterior knee pain. Preoperative magnetic resonance images of the knee were initially interpreted as a parameniscal cyst. Arthroscopic examination revealed subluxation of the anterior horn of the medial meniscus due to detachment from its anterior tibial insertion. Arthroscopic fixation with a suture anchor was successful and the cystic lesion was no longer visible on postoperative images.
Tomoya Takasago, Tomohiro Goto, Takahiko Tsutsui, Kenji Kondo, Daisuke Hamada, Ichiro Tonogai, Keizo Wada and Koichi Sairyo : A Huge Capital Drop with Compression of Femoral Vessels Associated with Hip Osteoarthritis., Case Reports in Orthopedics, 2015, 2015.
(Summary)
A capital drop is a type of osteophyte at the inferomedial portion of the femoral head commonly observed in hip osteoarthritis (OA), secondary to developmental dysplasia. Capital drop itself is typically asymptomatic; however, symptoms can appear secondary to impinge against the acetabulum or to irritation of the surrounding tissues, such as nerves, vessels, and tendons. We present here a case of unilateral leg edema in a patient with hip OA, caused by a huge bone mass occurring at the inferomedial portion of the femoral head that compressed the femoral vessels. We diagnosed this bone mass as a capital drop secondary to hip OA after confirming that the mass occurred at least after the age of 63 years based on a previous X-ray. We performed early resection and total hip arthroplasty since the patient's hip pain was due to both advanced hip OA and compression of the femoral vessels; moreover, we aimed to prevent venous thrombosis secondary to vascular compression considering the advanced age and the potent risk of thrombosis in the patient. A large capital drop should be considered as a cause of vascular compression in cases of unilateral leg edema in OA patients.
Yasuaki Tamaki, Toshinori Sakai, Ryo Miyagi, Takefumi Nakagawa, Tateaki Shimakawa, Koichi Sairyo and Takashi Chikawa : Intradural lumbar disc herniation after percutaneous endoscopic lumbar discectomy: case report., Journal of Neurosurgery. Spine, 23, 3, 336-394, 2015.
(Summary)
A 64-year-old man was referred to the authors with low-back pain (LBP) and right leg pain with a history of previously diagnosed lumbar disc herniation (LDH) at L4-5. He had undergone 2 percutaneous endoscopic lumbar discectomies (PELDs) for the herniation at another institution, and according to the surgical record of the second surgery, a dural tear occurred intraoperatively but was not repaired. Postoperative conservative treatments such as an epidural block and blood patch had not relieved his persistent LBP or right leg pain. Upon referral to the authors, MRI and myelography revealed an intradural LDH. The herniated mass was removed by durotomy, and posterior lumbar interbody fusion was performed. His symptoms were partially improved after surgery. Primary suture is technically difficult when a dural tear occurs during PELD. Therefore, close attention should be paid to avoiding such tears, and surgeons should increase their awareness of intradural LDH as a possible postoperative complication of PELD.
C Subash Jha, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Mitsunobu Abe, Akihiro Nagamachi, Shoji Fukuta and Koichi Sairyo : Percutaneous Endoscopic Discectomy via Transforaminal Route for Discal Cyst., Case Reports in Orthopedics, 2015.
(Summary)
Background. Discal cyst has been identified as a rare cause of low back pain and radiating leg pain. The pathogenesis and management of this condition are still debated. The largest number of reported cases had undergone microsurgery while very few cases have been treated with percutaneous endoscopic discectomy (PED). Methods. An 18-year-old boy complained of low back pain radiating to right leg after a minor road traffic accident. Diagnosis of a discal cyst at L4-L5 level was made based on magnetic resonance imaging (MRI). Despite conservative management for 6 months, the low back pain and radiating leg pain persisted so surgical treatment by PED was performed under local anesthesia. As the patient was a very active baseball player, his physician recommended a minimally invasive procedure to avoid damage to the back muscles. Results. The patient's low back pain and leg pain disappeared immediately after surgery and he made a rapid recovery. He resumed mild exercise and sports practice 4 weeks after surgery. Complete regression of the cystic lesion was demonstrated on the 2-month postoperative MRI. Conclusion. A minimal invasive procedure like PED can be an effective surgical treatment for discal cyst, especially in active individuals who play sports.
Naohito Hibino, Keizou Wada and Koichi Sairyo : Collateral ligament repair augmented by an A2 pulley flap for chronic ligament rupture of the finger metacarpophalangeal joint., The Journal of Hand Surgery, European Volume, 2015.
Tomohiro Goto, Kazuaki Mineta, Tomoya Takasago, Daisuke Hamada and Koichi Sairyo : Pseudotumor associated with cemented bipolar hemiarthroplasty: an unusual presentation as a granulomatous thigh mass., Skeletal Radiology, 44, 10, 1541-1545, 2015.
(Summary)
Although polyethylene wear-induced osteolysis is a common complication of hip arthroplasty, extensile osteolysis developing into a large granulomatous thigh mass at a site distant from the joint is rare. We report a case of a thigh pseudotumor 25 years after cemented bipolar hemiarthroplasty, in which x-rays revealed a radiolucent line around the stem at the proximal site only, not at the diaphysis of the femur. We initially suspected a real tumor because it had a unique appearance, as if the mass resorbed the posterior cortex of the femur, and it was located at a site distant from the proximal osteolytic lesions. We clearly showed the existence of a connection between the thigh mass and the joint space by performing intra-articular injection of contrast medium with continuous pressure. It seemed that polyethylene wear particles were transported distally along the stem-cement interface by fluid pressure, and an osteolytic reaction against polyethylene wear particles had occurred at the posterior middle third of the stem where the cement mantle was nonuniform and polyethylene particles first came into contact with the bone. Our findings suggest that nonuniform cemented prosthesis with osteolysis, even if it is low grade in a limited area, carries the risk of extensile osteolysis with asymptomatic development of an extra-articular granulomatous mass.
Naohito Hibino, Yoshitaka Hamada, Shyunichi Toki, Shinji Yoshioka, Masahiro Yamano and Koichi Sairyo : Irreducible Palmar Dislocation of the Distal Interphalangeal Joint Due to Closed Degloving of the Distal Phalanx of the Little Finger., Hand Surgery, 20, 2, 304-306, 2015.
(Summary)
Since irreducible dislocation of the distal interphalangeal joint (DIP joint) is dorsal dislocation, irreducible palmar dislocation of the DIP Joint is very rare. This case was associated with a closed degloving injury of the distal phalanx of the little finger and required operative treatment.
Yoshitaka Hamada, Koichi Sairyo and Ryosuke Sato : An adjustable device to keep the thumb in opposition and prevent adduction contracture after surgery or injury., The Journal of Hand Surgery, European Volume, 40, 4, 416-417, 2015.
Yoshitaka Hamada, Koichi Sairyo, Naohito Hibino, Anna Kobayashi and Ryosuke Sato : Effect of preservation of corticoperiosteal attachment on bone healing at osteotomy sites after ulna-shortening osteotomy., Hand (New York, N.Y.), 10, 1, 105-110, 2015.
(Summary)
Preservation of the corticoperiosteal attachment significantly shortened the endosteal union time. Our results indicate that preservation of the periosteum may accelerate bone healing after ulna-shortening osteotomy.
Ichiro Tonogai, Mitsuhiko Takahashi, Kiminori Yukata, Ryosuke Sato, Takeshi Nikawa, Natsuo Yasui and Koichi Sairyo : Osteoactivin attenuates skeletal muscle fibrosis after distraction osteogenesis by promoting extracellular matrix degradation/remodeling., Journal of Pediatric Orthopaedics. Part B, 24, 2, 162-169, 2015.
(Summary)
The aim of this study was to determine whether osteoactivin attenuated skeletal muscle fibrosis caused by distraction osteogenesis. Tibial osteotomies were performed on wild-type and osteoactivin-transgenic (OA-Tg) mice, and tibiae were distracted for 2 weeks. Ankle plantar flexion torque and the gastrocnemius muscles were analyzed. The amount and area of collagenous tissue and the passive torque were reduced in the OA-Tg group at 8 weeks after osteotomy. Transcript levels of matrix metalloprotease (mmp)-3 and MMP-9 were upregulated, and MMP-3 and MMP-9 proteins were increased in the OA-Tg group. Osteoactivin-mediated increase in MMPs may attenuate skeletal muscle fibrosis.
Yoshitaka Hamada, Anna Kobayashi, Koichi Sairyo, Ryosuke Sato and Naohito Hibino : Correction of a Hyperextension Deformity at the Metacarpophalangeal Joint by Arthroplasty for Osteoarthritis of the Thumb Carpometacarpal Joint Followed by External Fixator: A Case Series: Modified Ilizarov Method for Correction of a Collapsed Thumb Deformity Due to Carpometacarpal Osteoarthritis., Journal of Hand and Microsurgery, 7, 1, 67-72, 2015.
(Summary)
A hyperextension deformity in the advanced stages of carpometacarpal (CMC) arthritis of the thumb could affect the outcomes of thumb CMC joint arthroplasty. We introduce the interesting approach for treating severely collapsed thumb deformities with gradual distraction and coordinated correction of the MCP and CMC joints by means of external fixators. We divided 8 cases into 3 groups according to the angle of passive flexion of the hyperextended MCP joint: group 1, 10-20°, group 2a, 20-40°, and group 2b, >40°, retrospectively. We first performed CMC arthroplasty with trapezium excision. In group 1, we corrected the MCP hyperextension deformity by manual passive flexion and fixed the joint with an extension block Kirshner wire (K-wire) for 2 months. However, deformities recurred in 2 of 5 cases after removing the K-wire. These patients received corrective percutaneous osteotomy with external fixators at the metacarpal neck. In groups 2a and 2b, we performed CMC arthroplasty and set external fixators at the same time. All cases in groups 1 and 2a have been without recurrence for more than 2 years, while a deformity recurred in group 2b. The results of this small case series encouraged us to propose an interesting approach for collapsed zigzag thumb deformity. Good outcomes with excellent maintenance of active MCP movement and no recurrence are highly anticipated if the hyperextended thumb has no obvious degenerative changes and can be corrected by <40° of passive flexion. Our results also indicate a risk of recurrence associated with extension block by K-wire.
Mitsuhiko Takahashi, Natsuo Yasui, Tetsuya Enishi, Nori Sato, Takatoshi Mizobuchi, Yukako Homma and Koichi Sairyo : Diverse muscle architecture adaptations in a rabbit tibial lengthening model., Muscles, Ligaments and Tendons Journal, 4, 4, 433-437, 2015.
(Summary)
this study demonstrated that muscle belly length largely adapted to the lengthening. The increase in sarcomere number did not match the increase in muscle belly length. We estimated that elongation of the intramuscular aponeuroses is another mechanism of the adaptation in addition to the increase in sarcomere number.
Tetsuya Enishi, Hirokazu Uemura, Shinsuke Katoh, Masanori Inatsugi, Sho Minato, Kei Inatsugi, Mikiko Inatsugi, Nori Sato and Koichi Sairyo : Transient severe hypotension with once-weekly subcutaneous injection of teriparatide in osteoporotic patient : a case report and insight for the drug interaction between hypotensive agents and teriparatide, The Journal of Medical Investigation : JMI, 62, 1,2, 93-96, 2015.
(Summary)
Teriparatide, a recombinant form of parathyroid hormone, were well recognized as a useful option for the treatment of the osteoporosis. Although some side effects of teriparatide include headache, nausea, dizziness, and limb pain were reported. Here we present a 80-year-old woman of transient asymptomatic hypotension with once-weekly subcutaneous injection of teriparatide for the treatment of osteoporosis with hypertension disease as acute-phase reactions. Systolic blood pressure decreased in both 30 min and 60 min after injection compared with before injection. Heart rate increased with passage of time. Statistically significant were observed among before, 30 min, 60 min after injection of teriparatide. Slight nausea was seen as subjective symptoms with the first and second injection after 30 min. This case indicates careful attention, at least 1 hr, was recommended with weekly subcutaneous injections of teriparatide in the treatment for osoteoproteic patient with hypertension decreases. This is a first report, to the best of our knowledge, to demonstrate the transient asymptomatic hypotension after once-weekly injection of teriparatide with hypertension disease. Transient hypotension occurred after injection of teriparatide during the treatment period and was asymptomatic except for the first 2 injections.
Koichi Sairyo, Akihiro Nagamachi, Tetsuya Matsuura, Kousaku Higashino, Toshinori Sakai, Naoto Suzue, Daisuke Hamada, Yoichiro Takata, Tomohiro Goto, Toshihiko Nishisho, Yuichiro Goda, Takahiko Tsutsui, Ichiro Tonogai, Ryo Miyagi, Mitsunobu Abe, Masatoshi Morimoto, Kazuaki Mineta, Tetsuya Kimura, Akihiro Nitta, Tadahiro Higuchi, Shingo Hama, Jha C. Subash, Rui Takahashi and Shoji Fukuta : A review of the pathomechanism of forward slippage in pediatric spondylolysis : The Tokushima theory of growth plate slippage, The Journal of Medical Investigation : JMI, 62, 1,2, 11-18, 2015.
(Summary)
Spondylolysis is a stress fracture of the pars interarticularis, which in some cases progresses to spondylolisthesis (forward slippage of the vertebral body). This slip progression is prevalent in children and occurs very rarely after spinal maturation. The pathomechanism and predilection for children remains controversial despite considerable clinical and basic research into the disorder over the last three decades. Here we review the pathomechanism of spondylolytic spondylolisthesis in children and adolescents, and specifically the Tokushima theory of growth plate slippage developed from our extensive research findings. Clinically, we have observed the slippage site near the growth plate on MRI; then, using fresh cadaveric spines, we found the weakest link against forward shear loading was the growth plate. We subsequently developed an immature rat model showing forward slippage after growth plate injury. Moreover, finite element analysis of the pediatric spine clearly showed increased mechanical stress at the growth plate in the spondylolytic pediatric spine model compared with the intact pediatric spine. Thus, spondylolysis progresses to spondylolisthesis (forward slippage) in children and adolescents with the growth plate as the site of the slippage. Repetitive mechanical loading on to the growth plate may serve to separate the growth plate and subsequently progress to spondylolisthesis.
Ichiro Tonogai, Yoshitaka Hamada, Naohito Hibino, Ryosuke Sato, Tatsuhiko Henmi and Koichi Sairyo : Salmonella osteomyelitis of the distal radius in a healthy young adult patient : Report of a rare case and literature review, The Journal of Medical Investigation : JMI, 62, 1,2, 97-99, 2015.
(Summary)
Salmonella osteomyelitis of the radius in a healthy individual is very rare. We present such a case involving the distal radius of a healthy 23-year-old man without underlying disease or possible episode. He had right wrist pain for approximately 3 years, and osteolytic lesion was seen in the right distal radius. He underwent surgical treatment, and salmonella was isolated from pus in the lesion. Postoperative antibiotics successfully treated his infection. He had no sign of recurrence, but the point of entry for infection remains unknown.
Jha C. Subash, Ichiro Tonogai, Yoichiro Takata, Toshinori Sakai, Kousaku Higashino, Tetsuya Matsuura, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Toshihiko Nishisho, Takahiko Tsutsui, Yuichiro Goda, Mitsunobu Abe, Kazuaki Mineta, Tetsuya Kimura, Akihiro Nitta, Shingo Hama, Tadahiro Higuchi, Shoji Fukuta and Koichi Sairyo : Percutaneous Endoscopic Lumbar Discectomy for a Huge Herniated Disc Causing Acute Cauda Equina Syndrome : A Case Report, The Journal of Medical Investigation : JMI, 62, 1,2, 100-102, 2015.
(Summary)
Microsurgery for lumbar disc herniation that requires surgical intervention has been well described. The methods vary from traditional open discectomy to minimally invasive techniques. All need adequate preanesthetic preparation of patients as general anesthesia is required for the procedure, and nerve monitoring is necessary to prevent iatrogenic nerve injury. Conventional surgical techniques sometimes require the removal of the corresponding lamina to assess the nerve root and herniated disc, and this may increase the risk for posterior instability of the vertebral body. Should this occur, fusion surgery may be needed, further increasing morbidity and cost. We present here a case of lumbar herniated disc fragments causing acute cauda equina syndrome that were endoscopically resected through a transforaminal approach in an awake patient under local anesthesia. Percutaneous endoscopic discectomy under local anesthesia proved to be a better alternative to open back surgery as it made immediate intervention possible, was associated with fewer perioperative complications and morbidity, minimized soft tissue damage, and allowed early rehabilitation with a better outcome and greater patient satisfaction. In addition to these advantages, percutaneous endoscopic discectomy protects other approaches that may be needed in subsequent surgeries, whether open or minimally invasive.
Toshihiko Nishisho, Naoyoshi Hanaoka, Ryo Miyagi, Toshinori Sakai, Shunichi Toki, Mitsuhiko Takahashi, Kenji Endo, Natsuo Yasui and Koichi Sairyo : Local administration of zoledronic Acid for giant cell tumor of bone., Orthopedics, 38, 1, e25-30, 2015.
(Summary)
Giant cell tumor of bone is a locally aggressive tumor with a high local recurrence rate. Several adjuvant therapies have been employed to reduce the recurrence rate, but their effectiveness remains controversial. The authors attempted local administration of zoledronic acid, a nitrogen-containing bisphosphonate that strongly inhibits bone resorption, as an adjuvant treatment for histologically proven giant cell tumor of bone in 5 patients at their institution. After biopsy, 4 patients were treated with local administration of zoledronic acid with artificial bone and 1 was treated with zoledronic acid without artificial bone. Histologic response to the treatment was evaluated with surgically resected specimens. The 4 patients treated with artificial bone showed local control, with histologic tumor necrosis rates of 90%, 90%, 50%, and 10%. Magnetic resonance imaging showed poor gadolinium enhancement, and histologic examination after local zoledronic acid treatment showed tumor necrosis. One patient without artificial bone showed no histologic tumor necrosis and had local recurrence in soft tissue 18 months after tumor resection. A 3-week waiting period between biopsy and zoledronic acid treatment appears reasonable from the histological study. Complication of this therapy was delayed wound healing and it occurred in 2 cases. Taken together, this case series suggests that local administration of zoledronic acid with artificial bone is a potential adjuvant therapy for giant cell tumor of bone. On the other hand, effective local administration of zoledronic acid requires some bone matrix, including artificial bone. Campanacci's grading is important for predicting the effect of local administration of zoledronic acid. [Orthopedics. 2015; 38(1):e25-e30.].
Yoshiji Kanematsu, Tetsuya Matsuura, Shinji Kashiwaguchi, Takenobu Iwase, Naoto Suzue, Toshiyuki Iwame and Koichi Sairyo : Radiographic follow-up study of Little Leaguer's shoulder., Skeletal Radiology, 44, 1, 73-76, 2015.
(Summary)
Little Leaguer's shoulder is a syndrome involving the proximal humeral epiphyseal plate. Conservative treatment usually resolves the symptoms. However, there are no reports of a radiographic follow-up study of this disease. The purpose of this study was to show the radiographic healing process of Little Leaguer's shoulder.
Tetsuya Enishi, Tetsuya Matsuura, Naoto Suzue and Koichi Sairyo : Fracture of a persistent olecranon physis in an adult, Trauma Case Reports, 1, 1,2, 9-12, 2015.
Athletes sometimes experience overuse injuries. To diagnose these injuries, ultrasonography is often more useful than plain radiography, computed tomography (CT), or magnetic resonance imaging (MRI). Ultrasonography can show both bone and soft tissue from various angles as needed, providing great detail in many cases. In conditions such as osteochondrosis or enthesopathies such as Osgood-Schlatter disease, Sinding-Larsen-Johansson disease, bipartite patella, osteochondritis dissecans of the knee, painful accessory navicular,and jumper's knee, ultrasonography can reveal certain types of bony irregularities or neovascularization of the surrounding tissue. In patients of enthesopathy, ultrasonography can show the degenerative changes at the insertion of the tendon. Given its usefulness in treatment, ultrasonography is expected to become essential in the management of overuse injuries affecting the lower limb in athletes. J. Med. Invest. 62: 109-113, August, 2015.
Yoshiji Kanematsu, Tetsuya Matsuura, Shinji Kashiwaguchi, Takenobu Iwase, Naoto Suzue, Toshiyuki Iwame, Shoji Fukuta, Daisuke Hamada, Tomohiro Goto and Koichi Sairyo : Epidemiology of shoulder injuries in young baseball players and grading of radiologic findings of Little Leaguer's shoulder., The Journal of Medical Investigation : JMI, 62, 3-4, 123-125, 2015.
(Summary)
Relatively few epidemiological studies have examined shoulder injuries. This study aimed to investigate the epidemiology of such injuries in young baseball players. A total of 2,055 players aged 9-12 years who participated in a regional championship between 1983 and 1985 were the subjects of this investigation. They were assessed by questionnaire and radiographic examination. Prevalence of shoulder pain was determined according to position, years of baseball playing experience, and training hours per week. Radiographic examination was recommended to all players who complained of shoulder pain. Of the 2,055 subjects, 275 (13.4%) reported episodes of pain in the throwing shoulder. Years of baseball experience, but not player position or training hours per week, was significantly associated with shoulder pain. Forty-one of the 275 subjects reporting shoulder pain agreed to undergo radiography and 15 exhibited findings of Little Leaguer's shoulder. Their lesions could be classified into three distinct grades based on radiographic findings: grade I, widening of the epiphyseal plate in the lateral area (n=9); grade II, widening at all areas of the epiphyseal plate and demineralization of the metaphysis (n=5); and grade III, a slipped epiphysis (n=1). J. Med. Invest. 62: 123-125, August, 2015.
Ichiro Tonogai, Mitsuhiko Takahashi, Takahiko Tsutsui, Tomohiro Goto, Daisuke Hamada, Naoto Suzue, Tetsuya Matsuura, Natsuo Yasui and Koichi Sairyo : Forearm lengthening by distraction osteogenesis: A report on 5 limbs in 3 cases., The Journal of Medical Investigation : JMI, 62, 3-4, 219-222, 2015.
(Summary)
Radioulnar length discrepancy causes pain and decreases function of the wrist, forearm, and elbow. Limb lengthening, which has been used in the treatment of various deformities of the forearm, is necessary to restore balance between the ulna and radius. We treated 5 limbs in 3 patients (2 boys, 1 girl; mean age 9.3 years old) with radioulnar length discrepancy by distraction osteogenesis of either the ulna or radius using external fixators. We dissected the interosseous membrane between the ulna and radius in 3 limbs in 2 cases and did not do so in 2 limbs of 1 case. These cases include 2 cases with hereditary multiple exostoses, and 1 case with multiple epiphyseal dysplasia. The results were investigated and evaluated in this study, using appropriate clinical and radiographic parameters, noting the state of the interosseous membrane, which has an important role in forearm stability. The mean fixation period was 113 days. The mean distraction distance was 22.8 mm. The mean follow-up period was 637.7 days. The mean ulnar shortening and radial articular angle respectively improved from 7.4 mm and 30.2° preoperatively to -0.1 mm and 34.8° postoperatively. Balance between the ulna and radius was restored, and the results showed significant improvements in range of motion of the joints. However, 2 unintended radial head subluxations occurred in 2 limbs without dissection of the interosseous membrane. In addition, a keloid remained in 1 limb due to pin site infection. Forearm lengthening by distraction osteogenesis was useful in our cases. It is important to recognize the function of the interosseous membrane when lengthening is performed by osteotomy of the proximal ulna by gradual distraction with an external fixator. J. Med. Invest. 62: 219-222, August, 2015.
Mitsunobu Abe, Yoichiro Takata, Kousaku Higashino, Toshinori Sakai, Tetsuya Matsuura, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Toshihiko Nishisho, Yuichiro Goda, Takahiko Tsutsui, Ichiro Tonogai, Ryo Miyagi, Masatoshi Morimoto, Kazuaki Mineta, Tetsuya Kimura, Akihiro Nitta, Shingo Hama, Tadahiro Higuchi, Subash Jha C, Rui Takahashi, Shoji Fukuta and Koichi Sairyo : Foraminoplastic transforaminal percutaneous endoscopic discectomy at the lumbosacral junction under local anesthesia in an elite rugby player., The Journal of Medical Investigation : JMI, 62, 3-4, 238-241, 2015.
(Summary)
Percutaneous endoscopic discectomy (PED) is the least invasive disc surgery available at present. The procedure can be performed under local anesthesia and requires only an 8 mm skin incision. Furthermore, damage to the back muscle is considered minimal, which is particularly important for disc surgery in athletes. However, employing the transforaminal (TF) PED approach at the lumbosacral junction can be challenging due to anatomical constraints imposed by the iliac crest. In such cases, foraminoplasty is required in addition to the standard TF procedure. A 28-year-old man who was a very active rugby player visited us complaining of lower back and left leg pain. His visual analog scale (VAS) score for pain was 8/10 and 3/10, respectively. MRI revealed a herniated nucleus pulposus at L5-S level. TF-PED was planned; however, the anatomy of the iliac crest was later found to prevent access to the herniated mass. Foraminoplasty was therefore performed to enlarge the foramen, thereby allowing a cannula to be passed through the foramen into the canal without causing exiting nerve injury. The herniated mass was then successfully removed via the TF-PED procedure. Pain resolved after surgery, and his VAS score decreased to 0/10 for both back and leg pain. The patient returned to full rugby activity 8 weeks after surgery. In conclusion, even with an intracanalicular herniated mass at the lumbosacral junction, a TF-PED procedure is possible if additional foraminoplasty is adequately performed to enlarge the foramen. J. Med. Invest. 62: 238-241, August, 2015.
Takahiko Tsutsui, Tomohiro Goto, Daisuke Hamada, Ichiro Tonogai, Kazuaki Mineta, Mitsunobu Abe, Tetsuya Matsuura, Naoto Suzue, Shoji Fukuta and Koichi Sairyo : Successful Outcomes Using Interlocking Prostheses for Periprosthetic Fractures with Loose Femoral Components., The Journal of Medical Investigation : JMI, 62, 3-4, 242-244, 2015.
(Summary)
Periprosthetic femoral fractures with implant loosening are difficult to treat, especially when accompanied by severe bone loss. We report here the treatment outcomes of 4 patients (1 man, 3 women; age range 69-86 years) with periprosthetic femoral fractures and implant loosening after bipolar hemiarthroplasty. Fractures were classified according to the Vancouver classification as type B2 and B3, with adequate or compromised bone stock, respectively. One patient was initially treated conservatively but symptoms due to implant loosening persisted and revision surgery was required. All patients underwent revision using a long-stem cementless implant with interlocking screws as well as a cancellous allograft to augment the bone stock. At final follow-up (mean, 25 months), all patients had stable implant fixation, bony union of the fracture, and marked recovery of the proximal femoral bone stock through allograft use. This revision procedure achieved implant fixation and fracture healing with reconstitution of the femur even in the short term and even in cases with severe bone deficiency. J. Med. Invest. 62: 242-244, August, 2015.
Kosuke Sugiura, Naoto Suzue, Tetsuya Matsuura, Daisuke Hamada, Tomohiro Goto, Yoichiro Takata and Koichi Sairyo : Ganglion cyst arising from the infrapatellar fat pad in a child., The Journal of Medical Investigation : JMI, 62, 3-4, 245-247, 2015.
(Summary)
A ganglion cyst is a cystic lesion containing myxoid matrix and lined by a pseudomembrane. A ganglion cyst arising from the infrapatellar fat pad is very rare, with only a few reports appearing in the literature, and the present case is the first report of this lesion in a child. A 10-year-old boy presented with right knee pain that showed no improvement despite resting from sports activity for 1 month. Magnetic resonance imaging revealed a multilobular mass between the infrapatellar fat pad and anterior cruciate ligament. Arthroscopic excision of the mass was performed. The mass was noted to arise from the infrapatellar fat pad and was filled with myxoid matrix. The histological diagnosis was a ganglion cyst. In active pediatric patients with pain or limited range of motion in the knee, physicians should consider the possibility of a ganglion cyst from the infrapatellar fat pad, despite its rarity. J. Med. Invest. 62: 245-247, August, 2015.
Yasuyuki Omichi, Ichiro Tonogai, Shinsuke Kaji, Teruaki Sangawa and Koichi Sairyo : Meralgia paresthetica caused by entrapment of the lateral femoral subcutaneous nerve at the fascia lata of the thigh: a case report and literature review., The Journal of Medical Investigation : JMI, 62, 3-4, 248-250, 2015.
(Summary)
Meralgia paresthetica (MP) causes tingling, stinging or a burning sensation in the anterolateral part of the thigh, usually as a result of entrapment of the lateral femoral cutaneous nerve (LFCN) at the inguinal ligament (IL) due to mechanical or iatrogenic injury. However, there are few reports on MP caused by entrapment of the LFCN at a more distal site from the IL. We report here a rare case of MP caused by entrapment of the LFCN at the fascia lata of the thigh level. A 23-year-old man felt numbness and sharp pain at the anterolateral aspects of both thighs soon after direct repair surgery for L5 isthmic spondylolisthesis. Although his symptoms were relieved a few days later, numbness and sharp pain in the right thigh recurred 6 months after the surgery. A diagnosis of MP was made, and decompression of the LFCN was performed because conservative treatment for MP was inadequate. Intraoperatively, it was noted that the LFCN was entrapped underneath the fascia lata of the thigh, not at the IL level. His symptoms disappeared after LFCN was released. This case demonstrates that it is necessary to consider the possibility of entrapment of the LFCN at the fascia lata at the thigh level in MP. J. Med. Invest. 62: 248-250, August, 2015.
Kazuma Wada, Naohito Hibino, Kenji Kondo, Shinji Yoshioka, Tomoya Terai, Tatsuhiko Henmi and Koichi Sairyo : Open dislocation of the proximal interphalangeal joint of the little finger subsequent to chronic radial collateral ligament injury: a case report of primary ligament reconstruction with a half-slip of the flexor digitorum superficialis: Case Report., The Journal of Medical Investigation : JMI, 62, 3-4, 258-260, 2015.
(Summary)
Open dislocation of the proximal interphalangeal (PIP) joint is relatively rare. We report a case of a 32-year-old man who had open dislocation of the PIP joint of the little finger while playing American football. He had a history of chronic radial collateral ligament injury. We reconstructed the radial collateral ligament with a half-slip of the flexor digitorum superficialis tendon. J. Med. Invest. 62: 258-260, August, 2015.
Shingo Hama, Daisuke Hamada, Tomohiro Goto, Takahiko Tsutsui, Ichiro Tonogai, Naoto Suzue, Tetsuya Matsuura and Koichi Sairyo : Revision total knee arthroplasty for unexplained pain after unicompartmental knee arthroplasty: a case report., The Journal of Medical Investigation : JMI, 62, 3-4, 261-263, 2015.
(Summary)
In this report, we present a case of a 64-year-old woman who underwent revision of knee arthroplasty after failed unicompartmental knee arthroplasty (UKA). She underwent UKA (Biomet Oxford Phase 3) for right localized medial knee pain at the age of 53 and the postoperative course had been uneventful. Eight years after UKA, she had right knee pain that gradually worsened. Tenderness was present over the medial femorotibial and patellofemoral (PF) joints. Plain radiograph showed small osteophytes on the intercondylar eminence and in the lateral compartment. However, these findings were not severe. Although several causes of knee pain after UKA have been reported, none of those causes were found in this case, so the diagnosis of unexplained pain was made. We performed knee arthroscopy and it revealed severe osteoarthritis of the PF joint, bone attrition and exposure of subchondral bone of the medial part of the lateral condyle together with severe synovitis. Revision surgery was performed in the same operation. The postoperative course was excellent and the severe knee pain resolved after surgery. Several registries revealed that revision for unexplained pain was more common after UKA than after total knee arthroplasty. We pointed out the possible causes of unexplained pain including pathological conditions, which were present in our case. Revision surgery may be unsuccessful if the cause of failure is not adequately considered. J. Med. Invest. 62: 261-263, August, 2015.
Yoichiro Takata, Toshinori Sakai, Kousaku Higashino, Tetsuya Matsuura, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Toshihiko Nishisho, Takahiko Tsutsui, Yuichiro Goda, Masatoshi Morimoto, Mitsunobu Abe, Kazuaki Mineta, Tetsuya Kimura, Akihiro Nitta, Shingo Hama, Tadahiro Higuchi, Subash Jha C, Rui Takahashi, Shoji Fukuta and Koichi Sairyo : State of the art: Intraoperative neuromonitoring in spinal deformity surgery., The Journal of Medical Investigation : JMI, 62, 3-4, 103-108, 2015.
(Summary)
Application of deformity correction spinal surgery has increased substantially over the past three decades in parallel with improvements in surgical techniques. Intraoperative neuromonitoring (IOM) techniques,including somatosensory evoked potentials (SEPs), muscle evoked potentials (MEPs), and spontaneous electromyography (free-run EMG), have also improved surgical outcome by reducing the risk of iatrogenic neural injury. In this article, we review IOM techniques and their applications in spinal deformity surgery. We also summarize results of selected studies including hundreds of spinal correction surgeries. These studies indicate that multimodal IOM of both motor and sensory responses is superior to either modality alone for reducing the incidence of neural injury during surgery. J. Med. Invest. 62: 103-108, August, 2015.
Tomoya Takasago, Tomohiro Goto, Shunichi Toki, Daisuke Hamada, Shinji Yoshioka, Ichiro Tonogai, Takahiko Tsutsui, Yasuaki Tamaki, Keizo Wada and Koichi Sairyo : Intrapelvic migration of the lag screw in intramedullary nailing., Case Reports in Orthopedics, 2014, 519045, 2014.
(Summary)
Internal fixation with intramedullary devices has gained popularity for the treatment of intertrochanteric femoral fractures, which are common injuries in the elderly. The most common complications are lag screw cut out from the femoral head and femoral fracture at the distal tip of the nail. We report here a rare complication of postoperative lag screw migration into the pelvis with no trauma. The patient was subsequently treated with lag screw removal and revision surgery with total hip arthroplasty. This case demonstrated that optimal fracture reduction and positioning of the lag screw are the most important surgical steps for decreasing the risk of medial migration of the lag screw. Furthermore, to prevent complications, careful attention should be paid to subsequent steps such as precise insertion of the set screw.
Tetsuya Enishi, Tetsuya Matsuura, Naoto Suzue, Yoshinori Takahashi and Koichi Sairyo : Cartilage degeneration at symptomatic persistent olecranon physis in adolescent baseball players., Advances in Orthopedics, 2014, 545438, 2014.
(Summary)
Background. Elbow overuse injuries are common in adolescent baseball players, but symptomatic persistent olecranon physis is rare, and its pathogenesis remains unclear. Purpose. To examine the histopathological and imaging findings of advanced persistent olecranon physis. Methods. The olecranon physes of 2 baseball pitchers, aged 14 and 15 years, were examined by preoperative magnetic resonance imaging (MRI), and surgical specimens were examined histologically. Results. T2-weighted MRI revealed alterations in the intrachondral signal intensity possibly related to collagen degeneration and increased free water content. Histological findings of specimens stained with hematoxylin-eosin showed complete disorganization of the cartilage structure, hypocellularity, chondrocyte cluster formation, and moderately reduced staining. All these findings are hallmarks of osteoarthritis and are suggestive of cartilage degeneration. Conclusion. Growth plate degeneration was evident in advanced cases of symptomatic persistent olecranon physis. These findings contribute to understanding the pathogenesis of this disease.
Kousaku Higashino and Koichi Sairyo : Discogenic pain,HIZ(high signal intensity zone)とModic type Ⅰchangeの診断と治療, Monthly Book Orthopaedics, 27, 13, 49-54, 2014.
347.
Ichiro Tonogai, Daisuke Hamada, Tomohiro Goto, Tomoya Takasago, Takahiko Tsutsui, Naoto Suzue, Tetsuya Matsuura and Koichi Sairyo : Retrograde intramedullary nailing with a blocking pin technique for reduction of periprosthetic supracondylar femoral fracture after total knee arthroplasty: technical note with a compatibility chart of the nail to femoral component., Case Reports in Orthopedics, 2014, 856853, 2014.
(Summary)
Periprosthetic fractures after total knee arthroplasty (TKA) present a clear management challenge, and retrograde intramedullary nails have recently gained widespread acceptance in treatment of these fractures. In two cases, we found a blocking screw technique, first reported by Krettek et al., was useful in the reduction of the fractures. Both patients attained preinjury mobility after intramedullary nailing. Moreover, we present a chart summarizing the notch designs of various femoral components because some prosthetic knee designs are not amenable to retrograde nailing. We hope this will be helpful in determining indications for retrograde nailing in periprosthetic fractures after TKA.
Kazuaki Mineta, Kousaku Higashino, Toshinori Sakai, Yoshihiro Fukui and Koichi Sairyo : Recurrence of type I Modic inflammatory changes in the lumbar spine: effectiveness of intradiscal therapy., Skeletal Radiology, 43, 11, 1645-1649, 2014.
(Summary)
Here we report a case of recurrence of Modic type I inflammatory changes in the lumbar spine. A 49-year-old man was referred to our department with a history of chronic low back pain of at least 20 years. At the first consultation, he complained of low back pain only and had no other symptoms such as leg pain, numbness, or weakness. Although his pain was typically mild, he experienced one or two episodes of severe and incapacitating low back pain a year. After two intradiscal steroid injections, his pain disappeared immediately and completely. After 6 months of conservative treatment, Modic type I change switched to Modic type II change. However, 12 months after the first treatment, he once again experienced severe low back pain. Follow-up magnetic resonance imaging (MRI) indicated recurrence of Modic type I change that was stronger than the first occurrence. Two intradiscal injections relieved the pain. Six months after the second episode, follow-up MRI showed another switch of Modic type I change to Modic type II change. Switches of Modic change have been controversial, with mixed findings on pain, natural history, and degenerative changes. The present case reinforces the notion that Modic type I change corresponds to reversible local inflammation.
Fumitake Tezuka, Toshinori Sakai, Ryo Miyagi, Yoichiro Takata, Kousaku Higashino, Shinsuke Katoh, Koichi Sairyo and Natsuo Yasui : Complete resolution of a case of calcific tendinitis of the longus colli with conservative treatment., Asian Spine Journal, 8, 5, 675-679, 2014.
(Summary)
Acute calcific tendinitis of the longuscolli is a self-limiting inflammatory condition caused by calcium hydroxyapatite deposition in the longuscolli tendon. Although several case reports have described its radiological presentation, few reports provide detailed chronological accounts through symptomatic and radiologic resolution. A 59-year-old woman presented with severe neck pain and stiffness of a few days duration as well as moderate discomfort when swallowing. Lateral radiographs revealed a large calcium deposit anterior to the C1.C2 joint and swelling of the prevertebral soft tissue from C1 to C5. CT and magnetic resonance imaging showed fluid in the retropharyngeal gap.A soft collar and non-steroidal anti-inflammatory drug were prescribed, without antibiotics. At 4 months after presentation, the calcium deposit and all symptoms had resolved completely. Although this disease is comparatively rare, physicians should keep it in mind when a patient presents with acute severe neck pain.
Yamamoto Norio, Shinsuke Katoh, Kousaku Higashino and Koichi Sairyo : Idiopathic spinal cord herniation with duplicated dura mater and dorsal subarachnoid septum. Report of a case and review of the literature, International Journal of Spine Surgery, 8, 2014.
(Summary)
Idiopathic spinal cord herniation (ISCH) is a rare condition and its pathogenesis remains unclear. The purpose of this case report is to present an ISCH case with dorsal subarachnoid septum suggesting the pathogenesis of ISCH being adhesions from preexisting inflammation. Single case report. A 60-year-old woman presented with Brown-Séquard syndrome below the level of T6. Magnetic resonance imaging revealed the thoracic spinal cord was displaced ventrally, and the dorsal subarachnoid space was enlarged and had a septum between the spinal cord and dura mater. Intraoperatively, the dorsal dura mater was seen to be adherent and the subarachnoid septum was identified after durotomy. The inner layer defect of the duplicated dura mater was found in the ventral dura mater, through which the spinal cord had herniated. After releasing the septum, the adhesions around the dura mater, and the hiatus, the spinal cord was reduced. The present case indicates that adhesions around the dura mater can be the pathogenesis of ISCH.
Yuichiro Goda, Toshinori Sakai, Tadanori Sakamaki, Yoichiro Takata, Kousaku Higashino and Koichi Sairyo : Analysis of MRI signal changes in the adjacent pedicle of adolescent patients with fresh lumbar spondylolysis., European Spine Journal, 23, 9, 1892-1895, 2014.
(Summary)
MRI revealed a higher prevalence of L3 or L4 spondylolysis than observed with CT.
Takeuchi Makoto, Tomohiro Goto, Kiminori Yukata, Naoto Suzue, Daisuke Hamada, Toshihiko Nishisho, Ichiro Tonogai, Tetsuya Matsuura and Koichi Sairyo : Nonunion of the First Sternocostal Synchondrosis Accompanied by Sternoclavicular Joint Synovitis, Case Reports in Orthopedics, 2014, 798329, 2014.
(Summary)
Injury to the sternocostal synchondrosis of the first rib is quite rare. We report one such case in a 50-year-old man with nonunion of the first sternocostal synchondrosis accompanied by synovitis of the sternoclavicular joint. He first underwent arthroscopic surgery of the left sternoclavicular joint. Postoperatively, the patient's symptoms decreased by half, but another pain and crepitus at the inferior lateral portion of the sternoclavicular joint developed. Since MRI and functional CT reexaminations revealed nonunion of the first sternocostal synchondrosis, resection arthroplasty of the first sternocostal joint was performed. This resulted in immediate resolution of the symptoms. At 2-year follow-up, his symptoms disappeared entirely with no limited range of motion of the shoulder.
Shunichi Toki, Naohito Hibino, Koichi Sairyo, Mitsuhiko Takahashi, Shinji Yoshioka, Masahiro Yamano and Tatsuhiko Henmi : Osteomyelitis Caused by Candida glabrata in the Distal Phalanx., Case Reports in Orthopedics, 2014, 962575, 2014.
(Summary)
Osteomyelitis caused by Candida glabrata is rare and its optimal treatment is unknown. Here we report a case of osteomyelitis caused by C. glabrata in the distal phalanx in a 54-year-old woman. Despite partial resection of the nail and administering a 1-month course of antibiotics for paronychia, the local swelling remained and an osteolytic lesion was found. C. glabrata osteomyelitis of the distal phalanx was later diagnosed after curettage. Thereafter, the patient was treated with antifungal agents for 3 months. The infection eventually resolved, and radiological healing of the osteolytic lesion was achieved. Antifungal susceptibility testing should be performed in the case of osteomyelitis caused by nonalbicans Candida species, due to their resistance to fluconazole.
Tetsuya Enishi, Kiminori Yukata, Mitsuhiko Takahashi, Ryosuke Sato, Koichi Sairyo and Natsuo Yasui : Hypertrophic chondrocytes in the rabbit growth plate can proliferate and differentiate into osteogenic cells when capillary invasion is interposed by a membrane filter., PLoS ONE, 9, 8, e104638, 2014.
(Summary)
The fate of hypertrophic chondrocytes during endochondral ossification remains controversial. It has long been thought that the calcified cartilage is invaded by blood vessels and that new bone is deposited on the surface of the eroded cartilage by newly arrived cells. The present study was designed to determine whether hypertrophic chondrocytes were destined to die or could survive to participate in new bone formation. In a rabbit experiment, a membrane filter with a pore size of 1 µm was inserted in the middle of the hypertrophic zone of the distal growth plate of ulna. In 33 of 37 animals, vascular invasion was successfully interposed by the membrane filter. During 8 days, the cartilage growth plate was enlarged, making the thickness 3-fold greater than that of the nonoperated control side. Histological examination demonstrated that the hypertrophic zone was exclusively elongated. At the terminal end of the growth plate, hypertrophic chondrocytes extruded from their territorial matrix into the open cavity on the surface of the membrane filter. The progenies of hypertrophic chondrocytes (PHCs) were PCNA positive and caspase-3 negative. In situ hybridization studies demonstrated that PHCs did not express cartilage matrix proteins anymore but expressed bone matrix proteins. Immunohistochemical studies also demonstrated that the new matrix produced by PHCs contained type I collagen, osteonectin, and osteocalcin. Based on these results, we concluded that hypertrophic chondrocytes switched into bone-forming cells after vascular invasion was interposed in the normal growth plate.
Tetsuya Matsuura, Naoto Suzue, Toshiyuki Iwame, Susumu Nishio and Koichi Sairyo : Prevalence of Osteochondritis Dissecans of the Capitellum in Young Baseball Players: Results Based on Ultrasonographic Findings., Orthopaedic Journal of Sports Medicine, 2, 8, 2014.
(Summary)
The prevalence of OCD of the capitellum was 2.1% in 1000 baseball players aged 10 to 12 years, with no differences in prevalence according to age or player position.
Kiyotaka Hasebe, Koichi Sairyo, Yasushi Hada, Akira Dezawa, Yu Okubo, Koji Kaneoka and Yoshio Nakamura : Spino-pelvic-rhythm with forward trunk bending in normal subjects without low back pain., European Journal of Orthopaedic Surgery & Traumatology, 24, Suppl1, S193-199, 2014.
(Summary)
A strong correlation between low back pain and tight hamstrings has been reported. However, the effect of tight hamstrings on spinal biomechanics remains unclear. The purpose of the study was to investigate spino-pelvic-rhythm during forward bending of the trunk and to clarify the rhythm features with regard to hamstrings tightness. Eighteen healthy male adults with no history of low back pain volunteered to participate. First, we measured the finger-to-floor distance (FFD) in the upright position and set this parameter to 100 %. Using a spinal mouse, spinal alignment was measured in the following four positions: (1) upright posture-100 % FFD; (2) forward bending-50 % FFD; (3) forward bending-25 % FFD; and (4) forward bending-0 % FFD (fingers in contact with the floor). Changes of the angle of the thoracic and lumbar spine as well as the pelvis were calculated. As an indicator of tight hamstrings, we measured straight leg raising (SLR) angle. From positions 1-2 (phase I), the entire spino-pelvic angle moved in 104°. During this phase, the lumbar spine mainly moved. In the second phase (positions 2-3), it moved in 16°. Interestingly, all but 2 subjects showed a negative angle in the thoracic motion, meaning that the thoracic spine extended 4° during trunk flexion, thus exhibiting paradoxical motion. During this phase, lumbopelvic rhythm showed 2 patterns. In 7 subjects, pelvic motion was greater than lumbar motion, while the remaining subjects showed the opposite. In subjects without tight hamstrings, 83 % showed a pelvis-dominant pattern. Only 7 subjects were capable of position 4. During this phase, only slight motion was noted in the spine, and the majority of the motion occurred in the pelvis. Lumbar and pelvic motion correlated negatively in all phases. SLR angle and pelvic motion correlated strongly during phase III, indicating dominant pelvic movement in flexible subjects. The lumbo-pelvic-rhythm comprises 2 patterns-lumbar dominant and pelvis dominant. In flexible subjects, pelvis movement was dominant. In conclusion, improving tight hamstrings may reduce lumbar loading thereby reducing low back pain.
Ichiro Tonogai, Tomohiro Goto, Daisuke Hamada, Toshiyuki Iwame, Shinji Yoshioka, Takahiko Tsutsui, Yuichiro Goda, Hiroshi Egawa and Koichi Sairyo : Bilateral atypical femoral fractures in a patient with multiple myeloma treated with intravenous bisphosphonate therapy., Case Reports in Orthopedics, 2014, 452418, 2014.
(Summary)
Bisphosphonates are currently the standard approach to managing bone disease in multiple myeloma. Bisphosphonates have high bone affinity that inhibits osteoclastic activity and additionally reduces the growth factors released from malignant or osteoblastic cells, thereby impairing abnormal bone remodeling which leads to osteolysis. However, patients of multiple myeloma may be at a higher risk of atypical femoral fractures because the treatment for malignant myeloma requires notably higher cumulative doses of bisphosphonates. Here we present a patient with bilateral atypical femoral fractures and multiple myeloma treated with intravenous bisphosphonate therapy.
Mitsuhiko Takahashi, Tokio Kasai, Toshihiko Nishisho, Michihiro Takai, Hideko Endo, Takanori Hirose and Koichi Sairyo : Reverse adipofascial flap after resection of a malignant perineurioma of the forearm., Orthopedics, 37, 7, e661-4, 2014.
(Summary)
The authors describe a patient with recurrent perineurioma arising in the subcutaneous tissue of the dorsal forearm and extending along the forearm fascia. Soft tissue perineurioma is a rare, originally benign peripheral nerve sheath neoplasm arising from the perineurium, a protective cell barrier surrounding the individual fascicles in peripheral nerves. Perineurioma has only recently been recognized as an entity distinct from other nerve sheath tumors, such as schwannoma and neurofibroma, with unique morphologic, ultrastructural, and immunoreactive features. The recurrent tumor had converted into malignant perineurioma, defined as increased nuclear pleomorphism and cellularity. The ill-marginate feature extending along the fascia required wide resection, leaving a substantial defect on the distal forearm. Surgical repair of large forearm skin defects is challenging because of limited skin extensibility for flap creation, the prominence of the site in terms of aesthetic outcome, and the risk of damage to extrinsic muscles that control delicate hand movements. The reverse forearm adipofascial flap, which was based on distal perforators of the radial artery, was suitable for the current case to cover the exposed myotendinous junctions of the forearm extensor muscles. This flap did not sacrifice skin, a major vessel, or skeletal muscles, and preserved function at both the donor and the recipient sites. The texture of the graft was similar to that of the surrounding skin. The clinical and histopathologic features of this rare tumor are also described to aid in the differential diagnosis and as a reference for surgeons who treat soft tissue neoplasms and may encounter this type of soft tumor.
Yasuaki Tamaki, Tomohiro Goto, Daisuke Hamada, Toshihiko Nishisho, Kiminori Yukata, Naoto Suzue, Hiroshi Egawa and Koichi Sairyo : Massive femoral osteolysis secondary to loosening of a cemented roughened long stem: a case report., Case Reports in Orthopedics, 2014, 840267, 2014.
(Summary)
The surface finish of a femoral stem plays an important role in the longevity of cemented total hip arthroplasty. In efforts to decrease the rate of aseptic loosening, some prostheses have been designed to have a roughened surface that enhances bonding between the prosthesis and cement, but clinical outcomes remain controversial. We present a rare case of massive osteolysis with extreme femoral expansion that developed after cemented revision total hip arthroplasty. The destructive changes in the femur were attributable to abnormal motion of the stem and were aggravated by the roughened precoated surface of the long femoral component. Revision surgery using a total femur prosthesis was performed because there was insufficient remaining bone to fix the new prosthesis. The surgical technique involved wrapping polypropylene meshes around the prosthesis to create an insertion for the soft tissue, which proved useful for preventing muscular weakness and subsequent dislocation of the hip.
Yoichiro Takata, Toshinori Sakai, Kousaku Higashino, Yuichiro Goda, Kazuaki Mineta, Kosuke Sugiura and Koichi Sairyo : Minimally Invasive Microendoscopic Resection of the Transverse Process for Treatment of Low Back Pain with Bertolotti's Syndrome., Case Reports in Orthopedics, 2014, 613971, 2014.
(Summary)
Bertolotti's syndrome is characterized by anomalous enlargement of the transverse process of the most caudal lumbar segment, causing chronic and persistent low back pain or sciatica. We describe the case of a 45-year-old woman who presented with left sciatic pain and low back pain due to a recurrent lumbar disc herniation at L4-5 with Bertolotti's syndrome. Selective L5 nerve root block and local injection of lidocaine into the articulation between the transverse process and sacral ala temporarily relieved the left sciatic pain and low back pain, respectively. To confirm the effect of local injection on low back pain, we gave a second local injection, which once again relieved the low back pain. Microendoscopic resection of the pseudoarticulation region and discectomy successfully relieved all symptoms. This report illustrates the effectiveness of minimally invasive resection of the transverse process for the treatment of low back pain with Bertolotti's syndrome.
Yoichiro Takata, Toshinori Sakai, Kousaku Higashino, Yuichiro Goda, Fumitake Tezuka and Koichi Sairyo : Intradural extramedullary capillary hemangioma in the upper thoracic spine: a review of the literature., Case Reports in Orthopedics, 2014, 604131, 2014.
(Summary)
Capillary hemangiomas are benign tumors found in the skin and soft tissues in younger people. They occur in the central nervous system only rarely, and intradural occurrence is extremely rare. We report here a 60-year-old man presenting with thoracic girdle pain and progressive gait disturbance. Magnetic resonance images of the thoracic spine showed a 12 × 8 × 20 mm, well-defined intradural mass at the T2 level, compressing the spinal cord laterally. Relative to the spinal cord, the mass was hypo- to isointense on T1-weighted images and relatively hyperintense on T2-weighted images, with strong enhancement on contrast-enhanced T1-weighted images. The patient underwent T1-2 hemilaminectomy with resection of the intradural extramedullary tumor, which showed characteristics of a capillary hemangioma on histologic examination. The patient's symptoms improved following the surgery and no clinical or radiological evidence of recurrence was noted at the 2-year follow-up. We present this case with a review of the literature, highlighting features for differential diagnosis.
Kosuke Sugiura, Ichiro Tonogai, Tetsuya Matsuura, Kousaku Higashino, Toshinori Sakai, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Yoichiro Takata, Toshihiko Nishisho, Yuichiro Goda, Ryosuke Sato, Kenji Kondo, Fumitake Tezuka, Kazuaki Mineta, Makoto Takeuchi, Mitsuhiko Takahashi, Hiroshi Egawa and Koichi Sairyo : Discoscopic findings of high signal intensity zones on magnetic resonance imaging of lumbar intervertebral discs., Case Reports in Orthopedics, 2014, 245952, 2014.
(Summary)
A 32-year-old man underwent radiofrequency thermal annuloplasty (TA) with percutaneous endoscopic discectomy (PED) under local anesthesia for chronic low back pain. His diagnosis was discogenic pain with a high signal intensity zone (HIZ) in the posterior corner of the L4-5 disc. Flexion pain was sporadic, and steroid injection was given twice for severe pain. After the third episode of strong pain, PED and TA were conducted. The discoscope was inserted into the posterior annulus and revealed a migrated white nucleus pulposus which was stained blue. Then, after moving the discoscope to the site of the HIZ, a migrated slightly red nucleus pulposus was found, suggesting inflammation and/or new vessels penetrating the mass. After removing the fragment, the HIZ site was ablated by TA. To our knowledge, this is the first report of the discoscopic findings of HIZ of the lumbar intervertebral disc.
Yoshitaka Hamada, Koichi Sairyo, Naohito Hibino and Anna Kobayashi : Correction of Severe Contracture of Intrinsic Plus Hand with a Modified Ilizarov Mini-Fixator: Correction with an Ilizarov Mini-Fixator for Severe Hand Contracture., Journal of Hand and Microsurgery, 7, 1, 161-165, 2014.
A Dezawa and Koichi Sairyo : Comparison of organic electroluminescence and liquid crystal displays for clinical utility in orthopedic endoscopic surgery., Asian Journal of Endoscopic Surgery, 7, 2, 152-159, 2014.
(Summary)
Organic electroluminescence displays (OELD) use organic materials that self-emit light with the passage of an electric current. OELD provide high contrast, excellent color reproducibility at low brightness, excellent video images, and less restricted viewing angles. OELD are thus promising for medical use. This study compared the utility of an OELD with conventional liquid crystal displays (LCD) for imaging in orthopedic endoscopic surgery. One OELD and two conventional LCD that were indistinguishable in external appearance were used in this study. Images from 18 patients were displayed simultaneously on three monitors and evaluated by six orthopedic surgeons with extensive surgical experience. Images were shown for 2 min, repeated twice, and viewed from the front and side (diagonally). Surgeon rated both clinical utility (12 parameters) and image quality (11 parameters) for each image on a 5-point scale: 1, very good; 2, good; 3, average; 4, poor; and 5, very poor. For clinical utility in 16 percutaneous endoscopic discectomy cases, mean scores for all 12 parameters were significantly better on the OELD than on the LCD, including organ distinguishability (2.1 vs 3.2, respectively), lesion identification (2.2 vs 3.1), and overall viewing impression (2.1 vs 3.1). For image quality, all 11 parameters were better on the OELD than on LCD. Significant differences were identified in six parameters, including contrast (1.8 vs 2.9), color reproducibility in dark areas (1.8 vs 2.9), and viewing angle (2.2 vs 2.9). The high contrast and excellent color reproducibility of the OELD reduced the constraints of imaging under endoscopy, in which securing a field of view may be difficult. Distinguishability of organs was good, including ligaments, dura mater, nerves, and adipose tissue, contributing to good stereoscopic images of the surgical field. These findings suggest the utility of OELD for excellent display of surgical images and for enabling safe and highly accurate endoscopic surgery.
Tomoya Terai, Hiroyuki Yamada, Katsunori Asano, Atsushi Nawata, Tetsuji Iwasaki, Tatsuhiko Henmi and Koichi Sairyo : Effectiveness of three types of lumbar orthosis for restricting extension motion., European Journal of Orthopaedic Surgery & Traumatology, 24 Suppl 1, S239-43, 2014.
(Summary)
Spinal orthoses are implemented to restrict lumbar motion. Several studies have compared the effectiveness of various types of lumbar orthoses on restricting motion, but none have compared the effect of different back supports on restricting extension. This study sought to evaluate the effectiveness of three types of lumbar orthosis in regard to their ability to restrict motion during extension. Range of motion was quantified using the Spinal Mouse system to measure flexion and extension, and the load distribution of the back support was measured using a pressure sensor. Ten subjects (8 men, 2 women) were assessed under the following five experimental conditions: custom-made stay (CMS), aluminum stay (AS), plastic stay (PS), corset only, and no brace. None of the stays changed the flexion angle, and none of the supports prevented flexion bending. The mean extension angle after immobilization with the CMS, AS, PS, corset only, and no brace was 27.5° ± 8.5°, 33.4° ± 11.0°, 34.3° ± 9.4°, 37.8° ± 10.7°, and 42.6° ± 10.5°, respectively. The load in the CMS was concentrated at the vertical ends of the stay, with a mean load of 11.5 ± 2.4 N at the top and 8.9 ± 2.4 N at the bottom. The loads at the top and bottom of the support were 7.2 ± 4.3 and 5.3 ± 3.1 N with the AS and 5.8 ± 2.3 and 4.4 ± 1.7 N with the PS, respectively. All supports allowed similar flexion motion. Although the CMS, AS, and PS all restricted extension compared with no brace, the CMS was the most effective for restricting trunk extension motion.
Shinsuke Katoh, Tetsuya Enishi, Nori Sato and Koichi Sairyo : High incidence of acute traumatic spinal cord injury in a rural population in Japan in 2011 and 2012: an epidemiological study., Spinal Cord, 52, 4, 264-267, 2014.
(Summary)
Study design:Retrospective questionnaire-based epidemiological study.Background:Physicians treating acute traumatic spinal cord injury (SCI) in Japan noticed an increased occurrence of cervical SCI without skeletal injury.Objective:To elucidate the precise epidemiology of acute cervical SCI with the aim of planning a prevention program.Methods:Questionnaires were posted to all hospitals in Tokushima prefecture (around 780 000 inhabitants) to investigate the annual incidence of SCI in 2011 and 2012.Results:The response rate was 79% in 2011 and 64% in 2012. The returned questionnaires reported on 95 patients in 2011 and 91 patients in 2012, with a mean age of 67.6 and 64.3 years and an annual incidence (per million population) of 121.4 and 117.1, respectively. More than two-thirds of the cases suffered cervical SCI without skeletal injury, and 61% of these were categorized as Frankel D neurological deficits due to low-energy impact as the main cause.Conclusion:The incidence of incomplete cervical SCI does appear to be increasing, and significant regional differences in the incidence of cervical SCI exist across Japan. We speculate that factors other than age are contributing to this increase.Spinal Cord advance online publication, 11 February 2014; doi:10.1038/sc.2014.13.
Mitsuhiko Takahashi, Toshinori Sakai, Koichi Sairyo, Shoichiro Takao, S Mima and Natsuo Yasui : Magnetic resonance imaging in adolescent symptomatic navicular tuberosity., The Journal of Medical Investigation : JMI, 61, 1-2, 22-27, 2014.
(Summary)
The accessory navicular bone is one of the most common accessory ossicles, which sometimes become symptomatic. Abnormalities in magnetic resonance (MR) image, e. g. edema-like bone marrow pattern, have been reported for symptomatic accessory navicular. However, it has not been completely understood the edema-like bone marrow pattern correlates to the symptom of navicular tuberosity. We investigated the edema-like bone marrow pattern in correlation with alleviation of the symptom and the presence of accessory navicular bone. Ten adolescents with pain localized to the navicular tuberosity were recruited and seven cases were further examined with consecutive MR images. Edema-like bone marrow pattern was found in all symptomatic navicular but not in asymptomatic navicular. Intensity of the pattern diminished with alleviation of the symptom. Moreover, this correlation was recognized even in the patients who had no accessory navicular bones. MR images could be used not only for diagnosis but for monitor of healing in adolescent symptomatic navicular. There may be different pathologic mechanism for adolescent symptomatic navicular tuberosity, such as an osteitis, in adolescents.
(Keyword)
accessory navicular / magnetic resonance image / edema-like bone marrow pattern / adolescents
Yoichiro Takata, Toshinori Sakai, F Tezuka, Yuichiro Goda, Kousaku Higashino and Koichi Sairyo : Clinical Outcome of Minimally Invasive Repair of Pars Defect Using Percutaneous Pedicle Screws and Hook-Rod System in Adults with Lumbar Spondylolysis., Ann Orthop Rheumatol, 2, 2, 1013, 2014.
370.
Fumitake Tezuka, Toshinori Sakai, Yoichiro Takata, Kousaku Higashino and Koichi Sairyo : Multi-level spondylolisthesis required transdiscal screws due to the rare vertebral deformities.A case report., Ann Orthop Rheumatol, 2, 1, 1012, 2014.
371.
K Mineta, Yuichiro Goda, Toshinori Sakai, Yoichiro Takata, Kousaku Higashino, Shinsuke Katoh, H Uraoka, M Takahashi and Koichi Sairyo : Late-onset Non-dysraphic Intradural Spinal Cord Lipoma: A Case Report and Literature Review., Ann Orthop Rheumatol, 2, 1, 1008, 2014.
372.
Koichi Sairyo, Hiroshi Egawa, Tetsuya Matsuura, Mitsuhiko Takahashi, Kousaku Higashino, Toshinori Sakai, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Yoichiro Takata, Toshihiko Nishisho, Yuichiro Goda, Ryosuke Sato, Takahiko Tsutsui, Ichiro Tonogai, Kenji Kondo, Fumitake Tezuka, Kazuaki Mineta, Kosuke Sugiura, Makoto Takeuchi and Akira Dezawa : State of the Art: Transforaminal Approach for Percutaneous Endoscopic Lumbar Discectomy under Local Anesthesia., The Journal of Medical Investigation : JMI, 61, 3-4, 217-225, 2014.
(Summary)
Minimally invasive percutaneous endoscopic discectomy (PED) with a transforaminal approach under local anesthesia was started in the late 20th century. As the procedure requires a skin incision of only 8 mm, it is the least invasive disc surgery procedure at present, and owing to advances in instruments and optics, the use of this technique has gradually spread. In Japan, Dr. Dezawa from Teikyo University Mizonokuchi Hospital introduced this technique in 2003. Thanks to his efforts, the number of surgeons who can perform PED has increased, although the number of active PED surgeons is still only around 20. The first author (K.S.) started PED in 2010. In this review article, we explain the state-of-the-art PED transforaminal technique for minimally invasive disc surgery and present three successful cases. J. Med. Invest. 61: 217-225, August, 2014.
Tomohiro Goto, Daisuke Hamada, Kazuaki Mineta, Ichiro Tonogai, Hiroshi Egawa, Tetsuya Matsuura, Mitsuhiko Takahashi, Kousaku Higashino, Toshinori Sakai, Naoto Suzue, Yoichiro Takata, Toshihiko Nishisho, Yuichiro Goda, Ryosuke Sato, Fumitake Tezuka, Kenji Kondo, Makoto Takeuchi, Kousuke Sugiura and Koichi Sairyo : The state of the art in arthroscopic hip surgery., The Journal of Medical Investigation : JMI, 61, 3-4, 226-232, 2014.
(Summary)
Hip arthroscopy is among the most rapidly evolving arthroscopic techniques in the last decade and offers the benefits of being both a minimally invasive procedure and an excellent diagnostic tool. Improvements in instrumentation and surgical skills have advanced our ability to accurately diagnose and treat various conditions of the hip joint, and hip arthroscopy has elucidated several pathologies that cause disabling symptoms. Many of these conditions were previously unrecognized and left untreated. The indications for hip arthroscopy include the management of early osteoarthritis, synovial disorders (e. g., synovial osteochondromatosis), labral tears, chondral lesions, and femoroacetabular impingement (FAI), which is increasingly recognized as a disorder that can lead to the development of early cartilage and labral injury. A better understanding of hip arthroscopy, including the anatomy, improved surgical techniques, indications, and complications of the procedure, is essential for its success. This review article discusses the state of the art of arthroscopic hip surgery. J. Med. Invest. 61: 226-232, August, 2014.
Tetsuya Matsuura, Hiroshi Egawa, Mitsuhiko Takahashi, Kousaku Higashino, Toshinori Sakai, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Yoichiro Takata, Toshihiko Nishisho, Yuichiro Goda, Ryosuke Sato, Ichiro Tonogai, Kenji Kondo, Fumitake Tezuka, Kazuaki Mineta, Kosuke Sugiura, Makoto Takeuchi and Koichi Sairyo : State of the art: elbow arthroscopy: review of the literature and application for osteochondritis dissecans of the capitellum., The Journal of Medical Investigation : JMI, 61, 3-4, 233-240, 2014.
(Summary)
Elbow arthroscopy has become a safe and effective treatment option for a number of elbow disorders. The most rewarding and successful indication is the removal of loose bodies. Loose bodies are often a result of osteochondritis dissecans (OCD) of the capitellum, and arthroscopy in this case is useful for performing debridement, thereby eliminating the need for a more extensive open procedure associated with complications. In this review, we describe our arthroscopic technique for OCD of the capitellum. We usually conduct arthroscopy in the supine position, and use 2.9-mm arthroscopes of 30° and 70°. The 70° arthroscope provides a greater operative field than the 30° arthroscope. Arthroscopic treatment for OCD may require 2 anterior and 2 posterior portals. Loose bodies are commonly found in the radial fossa, coronoid fossa, and in the olecranon fossa. Once the loose bodies are removed, all unstable cartilage of the capitellum lesion is removed to create a stable bed. If any sclerotic changes to the lesion bed are observed, we create microfractures in the lesion bed. The most significant complication in arthroplasty is neurovascular injury. However, we have never experienced this devastating complication, which can be avoided by paying careful attention to detail. J. Med. Invest. 61: 233-240, August, 2014.
Koichi Sairyo, Tetsuya Matsuura, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Yuichiro Goda, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Toshihiko Nishisho, Ryosuke Sato, Takahiko Tsutsui, Ichiro Tonogai and Kazuaki Mineta : Surgery Related Complications in Percutaneous Endoscopic Lumbar Discectomy under Local Anesthesia., The Journal of Medical Investigation : JMI, 61, 3-4, 264-269, 2014.
(Summary)
The minimally invasive percutaneous endoscopic discectomy (PED) as the postero-lateral approach with the local anesthesia was started in the late 20th century. The procedure only requires 8 mm of skin incision; thus, it is the least invasive disc surgery presently. The surgery related complications were reviewed in the initial 100 cases from the single surgeon (K. S., first author). Two cases showed exiting nerve irritation, and complained of leg paresthetic pain for 6 to 12 weeks after the surgery (2.0%). The symptoms got better with medicines. One showed post-surgical epidural hematoma, and required surgical removal of the mass (1.0%). Two cases complained neck pain during surgery (2.0%). Surgeons would be aware of the specific complications for the postero-lateral approach of PED procedure. J. Med. Invest. 61: 264-269, August, 2014.
Naoto Suzue, Tetsuya Matsuura, Toshiyuki Iwame, Daisuke Hamada, Tomohiro Goto, Yoichiro Takata, Takenobu Iwase and Koichi Sairyo : Prevalence of childhood and adolescent soccer-related overuse injuries., The Journal of Medical Investigation : JMI, 61, 3-4, 369-373, 2014.
(Summary)
The majority of players who had experienced pain and were found to have osteochondrosis had severe injuries such as osteochondritis dissecans or lumbar spondylolysis. We suggest many of the players involved in this study receive further radiographic or ultrasonic examination. J. Med. Invest. 61: 369-373, August, 2014.
Yoichiro Takata, Tetsuya Matsuura, Kousaku Higashino, Toshinori Sakai, Takuya Mishiro, Naoto Suzue, Hirofumi Kosaka, Daisuke Hamada, Tomohiro Goto, Toshihiko Nishisho, Yuichiro Goda, Ryosuke Sato, Takahiko Tsutsui, Ichiro Tonogai, Fumitake Tezuka, Kazuaki Mineta, Tetsuya Kimura, Akihiro Nitta, Tadahiro Higuchi, Shingo Hama and Koichi Sairyo : Hybrid technique of cortical bone trajectory and pedicle screwing for minimally invasive spine reconstruction surgery: A technical note., The Journal of Medical Investigation : JMI, 61, 3-4, 388-392, 2014.
(Summary)
The pedicle screw (PS) system is widely used for spinal reconstruction. Recently, screw insertion using the cortical bone trajectory (CBT) technique has been reported to provide increased holding strength of the vertebra, even in an osteoporotic spine. CBT is also beneficial due to its low invasiveness. We have been performing hybrid reconstruction with CBT at the cranial level and PS at the caudal level based on the concept of minimal invasiveness. We applied this hybrid technique to 6 cases of degenerative spondylolisthesis. Surgery was completed with a small skin incision of around 5-6 cm, which is shorter than that of the conventional PS procedure. The mean percent slippage before surgery was 19.8%, and this was reduced to 3.9% after surgery and almost maintained 3 months after surgery. Furthermore, no major surgical complications were observed. Here, we introduce the minimally invasive hybrid technique of CBT-PS. Surgeons should be aware of the procedure as an option for minimally invasive lumbar spine reconstructive surgery. J. Med. Invest. 61: 388-392, August, 2014.
Takuya Mishiro, Koichi Sairyo, Akira Shinohara, Takashi Chikawa, Hirofumi Kosaka and Akira Dezawa : Assessment of maximal insertional torque of cervical and thoracic screws during posterior spinal surgery., The Journal of Medical Investigation : JMI, 61, 3-4, 393-398, 2014.
(Summary)
Intraoperative insertional torque could be a good indicator to evaluate the purchase and help guide decisions on screw type and insertion technique. Further postoperative assessments with sequential X-rays are needed to reveal the significance of MIT during posterior spinal fusion. J. Med. Invest. 61: 393-398, August, 2014.
Tomohiro Goto, Daisuke Hamada, Toshiyuki Iwame, Naoto Suzue, Makoto Takeuchi, Hiroshi Egawa and Koichi Sairyo : Medial Patellofemoral Ligament Reconstruction for Patellar Dislocation due to Rupture of the Medial Structures after Total Knee Arthroplasty: A Case Report and Review of the Literature., The Journal of Medical Investigation : JMI, 61, 3-4, 409-412, 2014.
(Summary)
Patellar dislocation is a well-recognized major complication after total knee arthroplasty (TKA). Treatment of this injury is determined according to the cause of the dislocation. In particular, proximal realignment, distal realignment, and lateral retinaculum release are options if patellar instability is not caused by prosthetic malposition. Here we report a case of patellar dislocation following TKA due to rupture of the medial structures that was treated by medial patellofemoral ligament reconstruction and lateral retinacular release. In addition, we provide a brief review of the related literature. J. Med. Invest. 61: 409-412, August, 2014.
Naoto Suzue, Toshiyuki Iwame, Kenji Kato, Shoichiro Takao, Tomohiko Tateishi, Yoshitsugu Takeda, Daisuke Hamada, Tomohiro Goto, Yoichiro Takata, Tetsuya Matsuura and Koichi Sairyo : Plantar fascia rupture in a professional soccer player., The Journal of Medical Investigation : JMI, 61, 3-4, 413-416, 2014.
(Summary)
We report the case of a 29-year-old male professional soccer player who presented with symptoms of plantar fasciitis. His symptoms occurred with no remarkable triggers and gradually worsened despite conservative treatments including taping, use of insoles, and physical therapy. Local corticosteroid injection was given twice as a further intervention, but his plantar fascia partially ruptured 49 days after the second injection. He was treated conservatively with platelet-rich plasma, and magnetic resonance imaging showed regenerative change of the ruptured fascia. Five months after the rupture, he returned to his original level of training. If professional athletes find it difficult to refrain from athletic activity, as in the present case, the risk of rupture due to corticosteroid injection should not be overlooked. J. Med. Invest. 61: 413-416, August, 2014.
Makoto Takeuchi, Naoto Suzue, Tetsuya Matsuura, Kousaku Higashino, Toshinori Sakai, Daisuke Hamada, Tomohiro Goto, Yoichiro Takata, Toshihiko Nishisho, Yuichiro Goda, Ryosuke Sato, Ichiro Tonogai, Kazuaki Mineta and Koichi Sairyo : Reconstruction of chronic Achilles tendon rupture using the semitendinosus tendon: a case report., The Journal of Medical Investigation : JMI, 61, 3-4, 417-420, 2014.
(Summary)
Achilles tendon rupture is a common trauma requiring surgical management. For chronic Achilles tendon rupture in particular, reconstructive surgery is desirable and several methods have been described. Here we present a case of chronic Achilles tendon rupture reconstructed using the semitendinosus tendon because of the difficulty in pulling down the proximal stump to reach the distal stump and due to an insufficient margin for hooking a suture to the distal stump. Postoperatively, the patient had a fully functional tendon and resumed his normal activities of daily living. Using this surgical technique, we expect favorable outcomes in cases of Achilles tendon rupture. J. Med. Invest. 61: 417-420, August, 2014.
Ichiro Tonogai, Toshinori Sakai, Fumitake Tezuka, Yuichiro Goda, Yoichiro Takata, Kousaku Higashino and Koichi Sairyo : Spontaneous rupture and hemorrhage of myxopapillary ependymoma of the filum terminale: a case report and literature review., The Journal of Medical Investigation : JMI, 61, 3-4, 430-435, 2014.
(Summary)
We present a rare case of acute onset cauda equina syndrome caused by a ruptured myxopapillary ependymoma with accompanying hemorrhage. A 26-year-old healthy woman developed muscle weakness and sensory disturbances in her bilateral lower extremities. Magnetic resonance imaging showed a huge mass from the L1 body to the L2-3 disc level. She was able to ambulate with crutches after the tumor was successfully removed. To prevent recurrence, she received whole brain and spinal cord radiation. No sing of recurrence were detected at the 8 month follow up. J. Med. Invest. 61: 430-435, August, 2014.
Kazuaki Mineta, Tomohiro Goto, Daisuke Hamada, Takahiko Tsutsui, Ichiro Tonogai, Naoto Suzue, Tetsuya Matsuura, Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Toshihiko Nishisho, Ryousuke Sato, Yuichiro Goda, Tadahiro Higuchi, Shingo Hama, Tetsuya Kimura, Akihiro Nitta and Koichi Sairyo : Efficacy of hip arthroscopy in the diagnosis and treatment of synovial osteochondromatosis: a case report and literature review., The Journal of Medical Investigation : JMI, 61, 3-4, 436-441, 2014.
(Summary)
Here we report a rare case of synovial osteochondromatosis of the hip and provide a brief review of the literature. A 37-year-old woman was referred to our department with a 3-year history of right hip pain. At initial consultation, she complained of pain upon standing and when sitting down, occasional pain at rest and nocturnal pain in the right hip, and worsening of the pain at premenstruum. The range of motion of the affected hip was totally limited by pain. Plain radiography revealed a slightly calcified (or ossified) lesion at the acetabular fossa of the right hip. Computed tomography showed clusters of loose bodies filling the acetabular fossa. Synovial osteochondromatosis was suspected and she underwent hip arthroscopic surgery. Complete resection was performed using the lateral and anterior portals. Postoperatively, her symptoms disappeared entirely and she was discharged 4 days after surgery. The patient regained full range of motion of the right hip and follow-up CT revealed no remaining loose bodies in the right hip. Hip arthroscopy is considered to be effective for the diagnosis and treatment of synovial osteochondromatosis of the hip and is minimally invasive. J. Med. Invest. 61: 436-441, August, 2014.
Ryo Miyagi, Koichi Sairyo, Toshinori Sakai, Fumitake Tezuka, Yasuhiro Kitagawa and Akira Dezawa : Persistent tight hamstrings following conservative treatment for apophyseal ring fracture in adolescent athletes: critical appraisal., The Journal of Medical Investigation : JMI, 61, 3-4, 446-451, 2014.
(Summary)
Apophyseal ring fracture is a unique disease in children and adolescents. Its clinical features include low back pain, sciatica, paravertebral muscle spasm and tenderness, restricted back motion, neurological symptoms, and tight hamstrings. For all athletes, body flexibility is one of the most important factors for better performance. Therefore, persistent tight hamstrings has a negative influence on athletic performance. In this report, we present two adolescent athletes with apophyseal ring fracture treated successfully by conservative treatment for severe low back pain (LBP) and leg pain, despite having persistent tight hamstrings for more than one year. Unlike herniated nucleus pulposus, bony fragments in the spinal canal never disappear. Although conservative treatment can alleviate LBP and leg pain, surgical removal of fragments is considered when symptoms such as tight hamstrings and restricted lumbar motion due to canal stenosis are found, particularly in athletes. J. Med. Invest. 61: 446-451, August, 2014.
Mitsuhiko Takahashi, Ichiro Tonogai and Koichi Sairyo : Treatment of extra-articular distal radial malunion with percutaneous osteotomy and an intramedullary implant., Hand Surgery, 19, 2, 217-222, 2014.
(Summary)
Distal radius malunion is often seen after distal radius fracture. We performed a less invasive but secure corrective surgery using an intramedullary implant combined with percutaneous osteotomy. The purpose of this study was to evaluate the results of this surgical technique. Three patients with malunion of a distal radius fracture were included. We assessed the wrist joint disability scores pre-operatively and at the final follow-up an average of 21 months after surgery. We also performed radiological assessments of volar tilt, radial inclination, and ulnar variance. All three patients achieved excellent clinical results with an average joint disability score of 93.3 at the final follow-up. The radiological parameters improved without any post-operative correction loss. Intramedullary implant combined with percutaneous osteotomy provides sufficient stability after correction of distal radius malunion and avoids the complications associated with the use of a volar plate.
J Hopkins, Toshinori Sakai, Koichi Sairyo, J Mefford, NN Bhatia, Ichiro Tonogai, Akira Dezawa and Natsuo Yasui : Endoscope Assisted Excision of a Juxtafacet Cyst in an Adolescent Athlete: A Case Report., Journal of Neurological Surgery. Part A, Central European Neurosurgery, 74, Suppl 1, e66-e69, 2013.
(Summary)
Juxtafacet cysts (JFCs) are a cause of back and radicular pain that can be treated conservatively and operatively. Such strategies include lumbosacral brace, epidural injection, open surgery, and minimally invasive surgery; although surgical treatment is usually reserved for unsuccessful conservative treatment. The role of minimally invasive surgery in athletic youth with JFCs has yet to be determined. The patient is a 16-year-old basketball player with a JFC. We performed endoscope-assisted cystectomy. Endoscope-assisted JFC excision immediately and completely resolved the patient's lower back and leg pain with no recurrence of symptoms 4 years after surgery. We suggest that JFCs of the lumbar spine be a part of the differential diagnosis in young patients with back and radicular pain. Furthermore, we recommend that endoscope-assisted surgery be employed in the treatment of JFCs in young athletes.
(Keyword)
Adolescent / Basketball / Cystectomy / Cysts / Endoscopy / Humans / Low Back Pain / Magnetic Resonance Imaging / Male / Pain / Recovery of Function / Surgical Procedures, Minimally Invasive / Treatment Outcome / Zygapophyseal Joint
Atsuhisa Yamada, Koichi Sairyo, Isao Shibuya, Ko Kato, Akira Dezawa and Toshinori Sakai : Lumbar spondylolysis in juveniles from the same family: a report of three cases and a review of the literature., Case Reports in Orthopedics, 2013.
(Summary)
Spondylolysis is reported as a stress fracture of the pars interarticularis with a strong hereditary basis. Three cases of lumbar spondylolysis in juveniles from the same family are reported, and the genetics of the condition are reviewed. The first boy, a 13-year-old soccer player, was diagnosed with terminal stage L5 bilateral spondylolysis with grade 1 slippage. The second boy, a 10-year-old baseball player, had terminal stage right side unilateral spondylolysis. The third boy, also a 10-year-old baseball player, was diagnosed with early stage bilateral L5 spondylolysis. The second and third boys are identical twins, and all three cases exhibited concomitant spina bifida occulta. Lumbar spondylolysis has a strong hereditary basis and is reported to be an autosomal dominant condition.
Koichi Sairyo, Takeshi Kawamura, Yasuyoshi Mase, Yasushi Hada, Toshinori Sakai, Kiyotaka Hasebe and Akira Dezawa : Jack-knife stretching promotes flexibility of tight hamstrings after 4 weeks: a pilot study., European Journal of Orthopaedic Surgery & Traumatology, 23, 6, 657-663, 2013.
(Summary)
Tight hamstrings are reported to be one of the causes of low back pain. However, there have been few reports on effective stretching procedures for the tight hamstrings. The so-called jack-knife stretch, an active-static type of stretching, can efficiently increase the flexibility of tight hamstrings. To evaluate hamstring tightness before and after the 4-week stretching protocol in healthy volunteer adults and patients aged under 18 years with low back pain. For understanding the hamstrings tightness, we measured two parameters including (1) finger to floor distance (FFD) and (2) pelvis forward inclination angle (PFIA). Eight healthy adult volunteers who had no lumbar or hip problems participated in this study (mean age: 26.8 years). All lacked flexibility and their FFD were positive before the experiment. Subjects performed 2 sets of the jack-knife stretch every day for 4 weeks. One set consisted of 5 repetitions, each held for 5 s. Before and during the 4-week experiment, the FFD and PFIA of toe-touching tests were measured weekly. For 17 of the sports players aged under 18, only FFD was measured. In adult volunteers, FFD was 14.1 ± 6.1 cm before the experiment and decreased to -8.1 ± 3.7 cm by the end of week 4, indicating a gain in flexibility of 22.2 cm. PFIA was 50.6 ± 8.2 before the experiment and 83.8 ± 5.8 degrees after. Before and after the experiment, the differences were significant (p < 0.05). For those aged under 18, FFD was 8.1 ± 8.0 and -9.6 ± 6.8, before and after the stretching, respectively. This difference was significant (p < 0.05). The jack-knife stretch is a useful active-static stretching technique to efficiently increase flexibility of tight hamstrings.
Koichi Sairyo, Yasuhiro Kitagawa and Akira Dezawa : Percutaneous endoscopic discectomy and thermal annuloplasty for professional athletes., Asian Journal of Endoscopic Surgery, 6, 4, 292-297, 2013.
(Summary)
PED/TA is a minimally invasive and effective procedure for discogenic low back pain, especially in athletes.
Takashi Chikawa, Toshinori Sakai, N Nitin Bhatia, Ryo Miyagi, Koichi Sairyo, Yuichiro Goda, Masaru Nakamura, Shunji Nakano, Takeaki Shimakawa and Akira Minato : Clinical outcomes of spinal surgery in patients treated with hemodialysis., Journal of Spinal Disorders & Techniques, 26, 6, 321-324, 2013.
(Summary)
Even in patients treated with long-term HD, spinal surgeries reliably obtain neurological and functional improvement if surgeons judge the preoperative inclusion criteria correctly. However, if surgeries are necessary for these patients, surgeons should consider the patients' comorbidity-related survival rate after the spinal surgeries.
Isao Shibuya, Koichi Sairyo, Yasuo Kanamori and Akira Dezawa : Four-rod stabilization of severely destabilized lumbar spine caused by metastatic tumor., Case Reports in Orthopedics, 2013.
(Summary)
We report a case of a 67-year-old female with severely destabilized lumbar spine caused by metastatic malignant tumor. The primary lesion was a thyroid follicular adenocarcinoma. Complete destruction of the L3, L4, and L5 vertebrae had resulted in severe instability, which left the patient with severe back pain and bed-ridden. Since the vertebrae were so severely damaged at 3 levels, 4 rods were used to stabilize the spine. Following stabilization, the pain was alleviated and the patient's quality of life improved. We introduce here the 4-rod technique to stabilize the spine over 3 vertebral levels following severe destruction by metastatic tumor.
Takayuki Sumita, Koichi Sairyo, Isao Shibuya, Yoshihiro Kitahama, Yasuo Kanamori, Hironori Matsumoto, Soichi Koga, Yasuhiro Kitagawa and Akira Dezawa : V-rod technique for direct repair surgery of pediatric lumbar spondylolysis combined with posterior apophyseal ring fracture., Asian Spine Journal, 7, 2, 115-118, 2013.
(Summary)
We report a pediatric baseball player having both a fracture of the posterior ring apophysis and spondylolysis. He was presented to a primary care physician complaining of back pain and leg pain. Despite conservative treatment for 3 months, the pain did not subside. He was referred to our clinic, and surgical intervention was carried out. First, a bony fragment of the caudal L5 apophyseal ring was removed following fenestration at the L5-S interlaminal space, bilaterally: and decompression of the bilateral S1 nerve roots was confirmed. Next, pseudoarthrosis of the L5 pars was refreshed and pedicle screws were inserted bilaterally. A v-shaped rod was inserted beneath the L5 spinous process, which stabilized the pars defects. After the surgery, back pain and leg pain completely disappeared. In conclusion, the v-rod technique is appropriate for the spondylolysis direct repair surgery, especially, in case the loose lamina would have a partial laminotomy.
Yoshihiro Kitahama, Koichi Sairyo and Akira Dezawa : Percutaneous endoscopic transforaminal approach to decompress the lateral recess in an elderly patient with spinal canal stenosis, herniated nucleus pulposus and pulmonary comorbidities., Asian Journal of Endoscopic Surgery, 6, 2, 130-133, 2013.
(Summary)
A 70-year-old man with severe pulmonary comorbidities was referred to our institution for treatment of a right L5 nerve impingement. He had suffered from spinal canal stenosis and herniated nucleus pulposus (HNP) at the level of L4-L5 for more than a year and had been treated conservatively. However, the pain could not be alleviated, and his primary care physician scheduled posterior decompression surgery. During this procedure, the anesthesiologist refused to induce general anesthesia because of the patient's very poor pulmonary condition. Subsequently, the patient was referred to us. We used a transforaminal approach with percutaneous endoscopic discectomy, with the patient under local anesthesia. First, herniated nucleus pulposus fragments at the disc level were removed. With a trephine drill, the upper part of the L5 pedicle was removed, which allowed for the extraction of dorsally migrated fragments. Following complete removal of the herniated nucleus pulposus fragments, osseous decompression was performed. The osseous endplate of L5 (anterior part of the lateral recess) was removed to enlarge the lateral recess so that decompression of the L5 nerve root was possible. The patient's lower back pain and right leg pain subsided following surgery. Percutaneous endoscopic discectomy is useful for patients with severe comorbidities as it can be done with local anesthesia.
Tetsu Arai, Koichi Sairyo, Isao Shibuya, Ko Kato and Akira Dezawa : Multilevel direct repair surgery for three-level lumbar spondylolysis., Case Reports in Orthopedics, 2013.
(Summary)
A 45-year-old man presented to our clinic requesting evaluation for surgical treatment of chronic low back pain of more than 20 years duration. He was diagnosed with 3-level lumbar spondylolysis at L3-5. Direct repair using the pedicle screw and hook-rod system was conducted for all three levels. After the surgery, his low back pain completely disappeared. Six months later, he felt discomfort and heard a metallic sound as he twisted his trunk. Computed tomography and radiography indicated that the hook head for L3 and the screw head for L4 were interfering with each other, causing the sound. We confirmed bony union at L3 and removed the L3 system. Surgeons should be aware of such complications if direct repair using a pedicle screw and hook-rod system is conducted for multilevel spondylolysis.
Ryosuke Sato, Mitsuhiko Takahashi, Toshihiko Nishisho, Kenji Endo and Koichi Sairyo : An undifferentiated Pleomorphic Sarcoma with Massive Intratumoral Hematoma: A Case Report and Literature Review., Ann Orthop Rheumatol, 1, 1, 1006, 2013.
397.
Toshinori Sakai, Koichi Sairyo, Yasuyoshi Mase and Akira Dezawa : Synchronic multiple stress fractures of L5 left hemilamina:a case of an unusual type of lumbar spondylolysis, European Journal of Orthopaedic Surgery & Traumatology, 22 (Suppl 1), S41-S43, 2012.
Ryou Miyagi, Koichi Sairyo, Toshinori Sakai, H Yoshioka and Natsuo Yasui : Two types of laminolysis in adolescent athletes., Journal of Orthopaedics and Traumatology, 13, 4, 225-228, 2012.
(Summary)
Bony defects in the spine are divided into three main types: spondylolysis, pediculolysis, and laminolysis. Lumbar spondylolysis is a well-known stress fracture that occurs frequently in adolescent athletes. Pediculolysis means stress fracture of the pedicle, which sometimes occurs subsequent to unilateral spondylolysis. Laminolysis is a rarely reported stress fracture similar to spondylolysis and pediculolysis that sometimes causes low back pain (LBP). However, its pathomechanism has not been elucidated. Recently, we encountered four adolescent athletes with symptomatic laminolysis. Mean age was 15.8 (range 15-17) years. All subjects reported severe LBP exacerbated by extension of the lumbar spine, and radiology revealed two types of laminolysis: hemilaminar type and intralaminar type. To elucidate the mechanisms of each type, we reviewed a biomechanical study, and found that the hemilaminar type was thought to be subsequent to contralateral spondylolysis, while the intralaminar type might be a result of a stress fracture due to repetitive extension loading.
Kousaku Higashino, Koichi Sairyo, Shinsuke Katoh, Shoichiro Takao, Hirofumi Kosaka and Natsuo Yasui : Long-term outcomes of lumbar posterior apophyseal end-plate lesions in children and adolescents., The Journal of Bone and Joint Surgery. American Volume, 94, 11, e74(1)-(7), 2012.
(Summary)
A lesion of the lumbar posterior apophyseal end plate in children and adolescents causes symptoms similar to those associated with a herniated disc. However, the end-plate lesion and the herniated disc differ in terms of pathology. The purpose of this study was to clarify the long-term clinical and radiographic outcomes in children and adolescents who were treated either surgically or conservatively for a lumbar posterior apophyseal end-plate lesion. We identified twenty-four consecutive patients who had been treated in the sports clinic of our hospital. The mean age at the first medical examination was 14.5 years. The mean follow-up time was 13.8 years. The mean age at the time of final follow-up was 28.4 years. All twenty-four patients had symptomatic low back pain with sciatica. All but two were active in sports. Sixteen patients were treated conservatively, and eight patients underwent surgical intervention. Skeletal maturity was evaluated on the basis of the appearance of the secondary ossification center of L3. The apophyseal stage ("A" stage), which was assigned when the secondary ossification center of the vertebral body was visible on radiographs, was seen most frequently. Both the surgically treated group and the conservatively treated group demonstrated progressive disc degeneration at the involved level. The average Roland-Morris Disability Questionnaire (RDQ) score was 1.3 for the patients treated conservatively and 1.8 for those treated surgically, a nonsignificant difference. One patient developed spinal stenosis after twelve years of conservative treatment. One patient treated surgically demonstrated severe lumbar instability. There were no significant associations between the magnetic resonance imaging (MRI) findings and RDQ scores. Histological examination of surgical specimens showed irregular alignment of the anulus fibrosus, with degenerative matrix and chondrocytes without a nucleus. The long-term outcome for patients with a posterior end-plate lesion is favorable, regardless of whether it is treated surgically or nonsurgically.
(Keyword)
Adolescent / Adult / Age Factors / Cohort Studies / Disease Progression / female / Follow-Up Studies / Growth Plate / Humans / Intervertebral Disc / Low Back Pain / Lumbar Vertebrae / magnetic resonance imaging / male / Manipulation, Orthopedic / Orthopedic Procedures / Pain Measurement / Recovery of Function / Risk Assessment / Severity of Illness Index / Sex Factors / Spinal Diseases / Spinal Stenosis / Statistics, Nonparametric / Time Factors / Tomography, X-Ray Computed / Treatment Outcome / Young Adult
Koichi Sairyo, Toshinori Sakai, Natsuo Yasui and Dezawa Akira : Conservative treatment for pediatric lumbar spondylolysis to achieve bone healing using a hard brace: what type and how long?, Journal of Neurosurgery. Spine, 16, 6, 610-614, 2012.
(Summary)
Various kinds of trunk braces have been used to achieve bone healing in cases of pediatric lumbar spondylolysis. However, the optimal brace for achieving bone healing is unclear. The purpose of the present study was to determine in what types of spondylolysis bone healing can be achieved and how long it takes. In this prospective study, 63 pars interarticularis defects (spondylolysis) among 37 patients who were younger than 18 years (mean 13.5 ± 2.7 years) were treated using a hard brace. The youngest patient was 8 years old. Based on the results of CT scanning, the lyses were classified into 3 categories: early, progressive, and terminal defects. Progressive defects were further divided into 2 types according to STIR MRI findings: those with high signal intensity at the adjacent pedicle and those with low signal intensity (that is, a normal appearance). A hard brace, such as a molded plastic thoracolumbosacral orthosis, was used to immobilize the trunk. Approximately every 3 months, CT scanning was performed to evaluate bone healing until approximately 6 months. The union rates were 94%, 64%, 27%, and 0% for the early, progressive with high signal intensity, progressive with low signal intensity, and terminal defects, respectively. It was noted that no terminal defect was healed using conservative treatment. The mean time to healing among the defects that showed bone healing was 3.2, 5.4, and 5.7 months for the early, progressive with high signal intensity, and progressive with low signal intensity groups, respectively. Patients with early-stage defects are the best candidates for conservative treatment with a hard brace because more than 90% of such cases can be healed in 3 months.
Toshinori Sakai, Koichi Sairyo, Bhatia N. Nitin, Miyagi Ryo, Tamura Tatsuya, Shinsuke Katoh and Natsuo Yasui : MRI Changes of the Spinal Subdural Space after Lumbar Spine Surgeries: Report of Two Cases., Asian Spine Journal, 5, 4, 262-266, 2011.
(Summary)
Although magnetic resonance imaging (MRI) is frequently used to assess the lumbar spine, there are few reports in the medical literature that have evaluated using MRI immediately following spinal surgery. Furthermore, descriptions of the subdural changes after lumbar spine surgery are also infrequent. In this paper, we present two cases with subdural change seen on MRI immediately after lumbar surgery. Both the patients had mild symptoms that resolved spontaneously, and the follow-up MRI scans showed resolution of the subdural changes. Subdural changes should be considered as one of the possible causes of unexpected symptoms in patients following lumbar spinal surgery.
Chikawa Takashi, Toshinori Sakai, Bhatia N. Nitin, Koichi Sairyo, Utsunomiya Risa, Nakamura Masaru, Shunji Nakano, Shimakawa Takeaki and Minato Akira : Retrospective Study of Deep Surgical Site Infections Following Spinal Surgery and the Effectiveness of Continuous Irrigation., British Journal of Neurosurgery, 25, 5, 621-624, 2011.
(Summary)
Surgical site infection (SSI) is an unfortunate and unpreventable complication of any surgical intervention including spinal surgery. Early deep SSI (EDSSI) after instrumented spinal fusion are particularly difficult to manage due to the implanted, and possibly infected, instrumentation. The purpose of this study is to retrospectively review patients who underwent spinal surgery, investigate the rate of EDSSI, identify patient-related and surgery-related risk factors and to assess the effectiveness of continuous indwelling irrigation on the eradication of these infections. A total of 814 patients (319 women and 495 men) who underwent spinal surgery were enrolled. Mean age at the initial surgery was 57.4 years old. Infections that penetrated the deep fascia within 1 month after the initial operation were considered as EDSSI. The rate of EDSSI, causal organisms, infection management and resolution were studied. Furthermore, we examined the patient-related and the operation-related risk factors. An overall incidence of EDSSI of 1.1% was found. In 177 patients with diabetes mellitus (DM), two patients (1.1%) developed EDSSI. In 28 patients receiving chronic haemodialysis (HD), two patients with infections (7.1%) were identified, which was statistically significantly greater than the other patient populations. Both operative time and intraoperative blood loss were significantly greater in patients with EDSSI than in non-infected patients. Furthermore, the rate of EDSSI in patients undergoing instrumented spinal fusion (3.8%) was significantly higher than that in the other patients. In the nine patients who developed EDSSI, the causal organisms were identified and treated by surgical debridement, antibiotic therapy and continuous indwelling surgical site irrigation. All infections resolved, and no recurrence has been observed at final follow-up. Removal of the instrumentation was required in only one patient. Based on our results, we believe that continuous surgical site irrigation is an effective adjunct in the surgical treatment for early SSI following spinal surgery.
Ryo Miyagi, Koichi Sairyo, Toshinori Sakai and Akira Dezawa : A remarkable case of hypertrophic pseudoarthrosis of the pars interarticularis in a young American football professional player., European Journal of Orthopaedic Surgery & Traumatology, 22 Suppl 1, 1-3, 2011.
(Summary)
Lumbar spondylolysis is a defect of the pars interarticularis regarded as a stress fracture. The bone stump around the pars defect usually appears atrophic and is fibrously united or filled with fibro cartilaginous mass, similar to long bone pseudoarthrosis. Lumbar spondylolysis sometimes causes bone growth resembling that of an osteophyte in osteoarthritis, and in elderly patients, the ragged edges result in radiculopathy around the defect. However, lumbar spondylolysis is rarely reported to cause hypertrophic changes resulting in spinal canal stenosis in young patients. In this report, we present an unprecedented radiological finding of distinctive hypertrophic change around the pars defect, which occurred in a young professional football player.
Risa Utsunomiya, Toshinori Sakai, Keizo Wada, Koichi Sairyo, Hirofumi Kosaka, Shinsuke Katoh and Natsuo Yasui : Hemorrhagic Facet Cyst in the Lumbar Spine Causing Contralateral Leg Symptoms: A Case Report, Asian Spine Journal, 5, 3, 196-200, 2011.
(Summary)
Here we present a case of hemorrhagic lumbar facet cyst presenting with progressive radiculopathy only on the contralateral side. If a patient has previous back pain or neuropathy for several months and then suddenly deteriorates, hemorrhagic facet cyst of the lumbar spine should be part of the differential diagnosis. However, as in the present case, we should be aware that there is a possibility of a contralateral lesion.
Koichi Sairyo, Toshinori Sakai, Mase Yasuyoshi, Kon Tamiyo, Shibuya Isao, Kanamori Yasuo, Kosugi Tatsuo and Dezawa Akira : Painful lumbar spondylolysis among pediatric sports players: a pilot MRI study., Archives of Orthopaedic and Trauma Surgery, 131, 11, 1485-1489, 2011.
(Summary)
For children and adolescents who are very active athletes, fresh lumbar spondylolysis is the main pathologic cause of lower back pain (LBP). However, regarding the terminal-stage spondylolysis (pars defect), there have been few studies to clarify the pathomechanism of LBP. The purpose of this study is to clarify the cause of LBP associated with pars defects in athletes. This is the first report showing a possible pathomechanism of LBP in active athletes with painful pars defect. Six pediatric athletes (5 boys and 1 girl) below 18 years old with painful bilateral lumbar spondylolysis were evaluated. In all cases, spondylolysis was identified as terminal stage (pseudoarthrosis) on CT scan. To evaluate the inflammation around the pars defects, short time inversion recovery (STIR) MRI was performed along with the sagittal section. Fluid collection, which is an indicator of inflammatory events, was evaluated in 12 pars defects as well as in 12 cranial and caudal adjoining facet joints. Inflammation (i.e., fluid collection) was observed in all 12 pars defects in six subjects at the pseudoarthrotic pars defects. In terms of facet joints, 7 of 12 (58%) pars defects showed fluid collection at the cranial and/or caudal adjoining joints on STIR MRI. The present study showed that inflammation was always present at the pars defects and in some cases at the adjoining facet joints. Thus, it is not difficult to understand how, during sports activity, inflammation may first occur at the pseudoarthrotic site and then spread to the adjoining facet joints. This mechanism could cause LBP associated with terminal-stage (pseudoarthrotics) spondylolysis in athletes.
(Keyword)
Adolescent / Child / Female / Humans / Low Back Pain / Lumbar Vertebrae / Magnetic Resonance Imaging / Male / Pilot Projects / Prospective Studies / Spondylolysis / Sports
Jason Mefford, Koichi Sairyo, Toshinori Sakai, Justin Hopkins, Madoka Inoue, Rui Amari, Nitin N Bhatia, Akira Dezawa and Natsuo Yasui : Modic Type 1 Change in Lumbar Spine in Golfers., Skeletal Radiology, 40, 4, 467-473, 2011.
(Summary)
Low back pain (LBP) is the most prevalent musculoskeletal complaint among professional and amateur golfers; however, associated radiological changes in golf-related LBP have not been examined in the literature. We suspect that Modic Type 1 changes in the lumbar spine are linked to golf-related LBP. In this retrospective case series, four middle-aged golfers (one professional and three high-level amateurs) presented to our clinic with LBP. Inflammation of the right side of endplates in the lumbar spine was suspected based on Modic Type 1 changes detected by magnetic resonance imaging (MRI) in each patient. All four cases were diagnosed with right-sided endplate inflammation and administered intradiscal steroid injections with a non-steroidal anti-inflammatory drug (NSAID). Treatment swiftly alleviated LBP and diminished Modic Type 1 changes on follow-up MRI 3-6 months later in all four patients. We suggest that Modic Type 1 changes play a significant role in the diagnosis and treatment of golf-related LBP.
(Keyword)
Golf / Humans / Low Back Pain / Lumbar Vertebrae / Magnetic Resonance Imaging / Male / Middle Aged
Miyagi Ryo, Toshinori Sakai, Bhatia N. Nitin, Koichi Sairyo, Shinsuke Katoh and Chikawa Takashi : Anterior Thoracolumbar Reconstruction Surgery for Late Collapse Following Vertebroplasty: Report of Three Cases., The Journal of Medical Investigation : JMI, 58, 1-2, 148-153, 2011.
(Summary)
Although vertebroplasty (VP) using polymethylmethacrylate (PMMA) is thought to be an effective procedure for osteoporotic vertebral compression fractures, several complications have been reported. In this paper, we present three patients who developed local kyphotic deformity as a result of late collapse of the cemented vertebrae. In all patients we safely removed the PMMA block through an anterior approach and anterior reconstruction was performed successfully. In only one patient who had a three column unstable injury with fractured posterior elements was additional posterior spinal fixation needed. In conclusion, VP is thought to be an effective and minimal invasive technique to treat osteoporotic compression fractures in older patients. Once collapse or nonunion of the treated vertebral body occurs, however, removal of the cement and anterior reconstruction may be required to realign of the affected segments and reconstruct the spine.
Terai Tomoya, Koichi Sairyo, Goel K. Vijay, Ebraheim A. Nabil, Biyani Ashok, Faizan Ahmad, Kiapour Ali, Higashino Kosaku, Toshinori Sakai and Natsuo Yasui : Biomechanical rationale of sacral rounding deformity in pediatric spondylolisthesis: a clinical and biomechanical study., Archives of Orthopaedic and Trauma Surgery, 131, 9, 1187-1194, 2011.
(Summary)
Rounding surface of the sacral dome and wedging deformity of the vertebral body are commonly observed in patients with isthmic spondylolisthesis. Recently, an animal study showed that the deformity can be caused by the growth plate involvement in the immature pediatric vertebral body after biomechanical alteration due to the pars defects. However, the pathomechanism and biomechanics of these deformities have yet to be clarified. To demonstrate that the sacral rounding deformity observed in pediatric patients with spondylolisthesis can be reversed, and to understand the pathomechanism of the deformity from the biomechanical standpoint by analyzing changes of stress around the growth plate of the vertebral body due to spondylolysis. Three-dimensional finite element pediatric lumbar models of the L3-L5 segment were utilized. Unlike the adult model, this pediatric model had growth plates and apophyseal rings. We analyzed stress distribution in response to 351°N axial compression and 10 N m moment in flexion, extension, lateral bending, and axial rotation. Bilateral spondylolysis was created in the model at the L4 level. The stress in the bilateral defect model was compared to the intact model predictions and the results obtained in the pediatric patients with sacral rounding deformity. Two patients presented rounding deformity of the anterior upper corner at S1 at the initial visit. They were asked to stop sports activities and use a soft trunk brace. Twelve months later, no rounding deformity was observed on the radiographs indicating that this deformity was reversible in pediatric cases. The biomechanical study indicated that in the pediatric spondylolytic spine, mechanical stress increased at the anterior upper corner during lumbar motion. In the presence of spondylolysis, mechanical stress increases in the growth plate at the anterior upper corner. Repetitive increases of mechanical stress may cause rounding deformity of the sacral dome mediated by growth plate involvement. When mechanical stress at the growth plate is reduced by wearing a brace, the proper functioning of the growth plate can help to remodel the sacral dome to its normal shape.
Shinji Yoshioka, Koichi Sairyo, Toshinori Sakai, Tatsuya Tamura, Hirofumi Kosaka and Natsuo Yasui : Osseous erosion by herniated nucleus pulposus mimicking intraspinal tumor: a case report., Journal of Orthopaedics and Traumatology, 11, 4, 257-261, 2010.
(Summary)
Erosion of spinal osseous structure, so-called scalloping, has been rarely reported associated with herniated nucleus pulposus (HNP). We report a rare case of HNP causing erosion of the spinal osseous structure (including lamina). The patient was an 81-year-old woman with 3-year history of low-back pain and left leg radiating pain. Muscle weakness of the left leg was also apparent. Computed tomography following myelography showed severe compression of the dural sac at the level of L3-L4; furthermore, erosion of the lamina, pedicle, and vertebral body was noted, indicating that the space-occupying mass was most probably a tumorous lesion. The mass also showed calcification inside. During the surgery, the mass was confirmed to be an HNP with calcification. Following resection, the pain disappeared. Surgeons should be aware of the possibility of scalloping of the vertebrae caused by HNP mimicking a tumorous lesion.
Toshinori Sakai, Koichi Sairyo, Shoichiro Takao, Hirofumi Kosaka and Natsuo Yasui : Adolescents with symptomatic laminolysis. -Report of two cases-., Journal of Orthopaedics and Traumatology, 11, 3, 189-193, 2010.
(Summary)
Retroisthmic cleft refers to a cleft in the lamina and is rarely reported. It was first described by Brocher, and later Wick et al. proposed the term "laminolysis" to describe the retroisthmic cleft by analogy with the nomenclature of the applied stress fracture of the pars interarticularis (spondylolysis) and the pedicle (pediculolysis). In this paper, we describe two adolescent sports players with symptomatic lumbar laminolysis. Both improved significantly after adequate conservative treatment. Knowledge of laminolysis in adolescent patients with low back pain is necessary to avoid overlooking it and late diagnosis. For correct diagnosis, multidetector three-dimensional computed tomography (CT) is suggested. In addition, magnetic resonance imaging (MRI) also allows detection of inflammation in the defects.
(Keyword)
Adolescent / Follow-Up Studies / Humans / Image Interpretation, Computer-Assisted / Immobilization / Injections, Intra-Articular / Lidocaine / Low Back Pain / Lumbar Vertebrae / Magnetic Resonance Imaging / Male / Pain Measurement / Recovery of Function / Severity of Illness Index / Spondylolysis / Steroids / Tomography, X-Ray Computed / Treatment Outcome
Tomoya Terai, Koichi Sairyo, VK Goel, N Ebraheim, A Biyani, A Faizan, Toshinori Sakai and Natsuo Yasui : Spondylolysis originates in the ventral aspect of the pars interarticularis: a clinical and biomechanical study., The Journal of Bone and Joint Surgery. British Volume, 92, 8, 1123-1127, 2010.
(Summary)
Lumbar spondylolysis is a stress fracture of the pars interarticularis. We have evaluated the site of origin of the fracture clinically and biomechanically. Ten adolescents with incomplete stress fractures of the pars (four bilateral) were included in our study. There were seven boys and three girls aged between 11 and 17 years. The site of the fracture was confirmed by axial and sagittal reconstructed CT. The maximum principal tensile stresses and their locations in the L5 pars during lumbar movement were calculated using a three-dimensional finite-element model of the L3-S1 segment. In all ten patients the fracture line was seen only at the caudal-ventral aspect of the pars and did not spread completely to the craniodorsal aspect. According to the finite-element analysis, the higher stresses were found at the caudal-ventral aspect in all loading modes. In extension, the stress was twofold higher in the ventral than in the dorsal aspect. Our radiological and biomechanical results were in agreement with our clinical observations.
Koichi Sairyo, Toshinori Sakai, Kousaku Higashino, M Inoue, Natsuo Yasui and A Dezawa : Complications of endoscopic lumbar decompression surgery., Minimally Invasive Neurosurgery : MIN, 53, 4, 175-178, 2010.
(Summary)
Endoscopic lumbar decompression is useful for the treatment of various spinal conditions and is being performed in an increasing number of patients worldwide. We reviewed the surgery-related complications in patients who underwent endoscopic surgery and discuss the learning curve for this procedure. Since the first case in August 2000, a total of 138 patients have undergone endoscopic posterior decompression surgery. Of these, there were 74 patients with Herniated Nucleus Pulposus (HNP), 57 with Lumbar Canal Stenosis (LCS), and 7 with other conditions. From 2003 to 2005, the senior surgeon took a sabbatical, and no endoscopic surgery was conducted. We divided the cases based on the date of surgery: there were 62 patients in the early (E) group (before September 2003), and 76 in the late (L) group (from January 2006 to April 2008). We compared the incidence of surgery-related complications between 2 disease types as well as between the E and L groups. We encountered 11 complications, which included 6 dural tears, 2 post-surgical hematomas, 2 neural complications and 1 fracture of the inferior articular process. The incidence of surgery-related complications was 8.6%. The incidences of complications were 8.1% and 9.3% for HNP and LCS, respectively, and 11.3%, and 5.3% in the E and L groups, respectively. The incidence was particularly high (16.7%) in the E group with LCS. There is a steep learning curve for endoscopic surgery. Based on the data, surgeons should start performing endoscopic techniques for LCS after gaining enough experience of endoscopic surgery for HNP.
Shinji Yoshioka, Koichi Sairyo, Toshinori Sakai and Natsuo Yasui : Congenital absence of lumbosacral articular facet joint associated with conjoined nerve root., Journal of Orthopaedics and Traumatology, 11, 3, 183-187, 2010.
(Summary)
We report a rare case of congenital absence of the L5-S1 facet joint, which was associated with a conjoined nerve root. Combination of these two anomalies has been quite rarely reported in the literature. A 39-year-old man presented with acute low back pain and right leg radiating pain. Muscle weakness and sensory disturbance of the right leg were also apparent in the region innervated by L5 and S1 nerve roots. Preoperative multidetector three-dimensional computed tomography (3D-CT) showed complete absence of the right S1 superior articular process. Magnetic resonance (MR) images showed lumbar disc herniation at right L5-S1 level that migrated cranially. Intraoperative findings revealed that the right L5 nerve root and S1 nerve root were conjoined, and the conjoined nerve root was compressed by L5-S1 disc herniation, which led to impairment of the conjoined nerve root by a single-level lumbar disc herniation. After removal of the disc herniation, his right leg pain immediately subsided, however muscle weakness and sensory disturbance persisted. Surgeons should be aware of this nerve root anomaly when examining a patient who shows an unusual clinical presentation and/or congenital osseous anomaly.
Toshinori Sakai, Koichi Sairyo, Naoto Suzue, Hirofumi Kosaka and Natsuo Yasui : Incidence and etiology of lumbar spondylolysis: review of the literature., Journal of Orthopaedic Science, 15, 3, 281-288, 2010.
(Summary)
Lumbar spondylolysis is a defect of the pars interarticularis known to occur as a stress fracture. Its incidence varies considerably depending on ethnicity, sex, and sports activity. However, there are few literature reviews describing its incidence in different ethnic groups or in people who engage in different sports. We reviewed the most relevant articles on spondylolysis published in scientific journals. First, we focused on its incidence in various ethnic groups distributed by sex, the familial occurrence, and in patients with relevant diseases. Second, we focused on the incidence of spondylolysis in relation to the sports practiced by the patients. Although placing special emphasis on the incidence of lumbar spondylolysis in the general population in Japan, we also reviewed the Japanese and English literature to investigate its incidence among those who engage in different sports. The incidence of lumbar spondylolysis in the general Japanese population was 5.9%. Most studies report that the incidence in higher in male subjects than in female subjects. We found that Japanese rugby and judo players were prone to suffer lumbar spondylolysis, at an incidence of about 20%. However, the incidence for Japanese professional soccer and baseball players was much higher, at 30%, which was more than five times the incidence in the general Japanese population. The incidence of lumbar spondylolysis varies depending on ethnicity, sex, family history, relevant disease, and sports activity.
(Keyword)
African Americans / Athletic Injuries / European Continental Ancestry Group / Female / Fractures, Stress / Humans / Incidence / Japan / Lumbar Vertebrae / Male / Spondylolysis / United States
Toshinori Sakai, Koichi Sairyo, Seiichi Mima and Natsuo Yasui : Significance of magnetic resonance imaging signal change in the pedicle in the management of pediatric lumbar spondylolysis., Spine, 35, 14, E641-645, 2010.
(Summary)
Prospective study. To investigate the time course of signal changes in the adjacent pedicle in fresh pediatric lumbar spondylolysis. A recent study reported that high signal change (HSC) on T2-magnetic resonance image (MRI) in the pedicle adjacent to the pars interarticularis could be an indicator of early spondylolysis. In addition, the HSC-positive pars defects showed significant better bony healing than the HSC-negative pars defects. However, there has been no report on the time course and the duration of HSC. We prospectively investigated 10 boys and 5 girls with fresh lumbar spondylolysis showing HSC in the adjacent pedicle. Their mean age was 15.1 years, ranging from 10 to 17 years. Two patients had multilevel unilateral spondylolysis. Among 15 patients, HSC was found in 22 (12 unilateral and 5 bilateral) pedicles. At the first presentation, the diagnosis of spondylolysis was made based on the plain radiograph findings, multidetector computed tomograms (CTs), and MRI. Every month from the first presentation, follow-up MRIs were taken. When HSC disappeared, multidetector CT was taken to confirm bony healing of the pars defect. Bony healing of the pars was obtained in 21 out of 22 defects. The bony healing rate was 95.6%. In 19 pedicles of 12 patients, HSC gradually diminished by every month until it disappeared 3 months later, and radiologic osseous healing was confirmed by CT in all but 1 patient. In the 3 remaining pedicles of 3 patients, HSC took more than 4 months to disappear. In this study, HSC disappeared in most pedicles on the 3-month follow-up MRI. In patients who did not comply with treatment, HSC tended to last longer. These results led us to hypothesize that MRI at the third month during follow-up can indicate whether the conservative treatment is being successful or not.
Madoka Inoue, Koichi Sairyo, Toshinori Sakai and Natsuo Yasui : Significance of surgical treatment for severe dystrophic changes in the cervical spine associated with neurofibromatosis type I: a case report., Journal of Pediatric Orthopaedics. Part B, 19, 3, 270-275, 2010.
(Summary)
There have been several reports about the treatments for dystrophic changes in the thoracic or lumbar spines owing to neurofibromatosis type-1. However, dystrophic changes in the cervical spine have been rarely reported. In this study, we present the case of a 13-year-old boy with severe dystrophic changes (dural ectasia) in the cervical spine owing to neurofibromatosis type-1. Although he had no neurological deficit, imaging studies revealed cervical kyphotic deformity and osteolysis of vertebral bodies. Thinning of vertebral bodies and laminae from C2 to C5 was remarkable, suggesting that the patient was at risk of suffering a spinal injury. The patient underwent cervical posterior fusion. At the 2-year follow-up examination, there was complete posterior bony fusion and no obvious progression.
Keizo Wada, Koichi Sairyo, Toshinori Sakai and Natsuo Yasui : Minimally invasive endoscopic bilateral decompression with a unilateral approach (endo-BiDUA) for elderly patients with lumbar spinal canal stenosis., Minimally Invasive Neurosurgery : MIN, 53, 2, 65-68, 2010.
(Summary)
Endoscopic spinal surgery has become increasingly common year for year because it is a minimally invasive procedure. In our hospital, we introduced endoscopic bilateral decompression with a unilateral approach (endo-BiDUA) in 2006. In this paper, we review clinically and radiographically the elderly patients who underwent the endo-BiDUA. Fifteen patients aged over 65 years were included in this review. They had undergone endo-BiDUA between January 2006 and July 2008. Operation time, blood loss, complications, clinical outcome using the Japanese Orthopedic Association (JOA) score, and enlargement ratio of the dural tube on magnetic resonance imaging (MRI), were evaluated. The mean operation time per level of endo-BiDUA was 144 min. Blood loss was about 60.2 mL. One patient had a post-surgical hematoma and required an additional laminectomy and removal of the hematoma 2 days after the surgery. No other complications such as dural tear, nerve root injury, or infection were encountered. All patients but one, who had a post-surgical hematoma, could start walking within 2 days following the surgery. Before surgery, the mean JOA score was 17.0 and it improved to about 23.3 after the surgery. The area of the dural tube increased to 408.0% after the surgery (range: 211-774%). Endo-BiDUA facilitated the return of elderly patients with lumbar spinal canal stenosis to their original daily activities.
(Keyword)
Aged / Aged, 80 and over / Decompression, Surgical / Endoscopy / Female / Humans / Lumbar Vertebrae / Magnetic Resonance Imaging / Male / Spinal Stenosis / Treatment Outcome
An ossified arachnoid membrane combined with cystic formation is rarely reported as a cause of spinal cord compression. We report the case of a 60-year-old man who presented with diffuse ossification of the arachnoid membrane (arachnoid ossification) and multiple cystic changes (arachnoid cyst) at the thoracic and lumbar spine. The lesions were surgically removed and progressive deterioration was prevented, although no marked improvement of neurological symptoms was attained.
Tatsuya Tamura, Toshinori Sakai, Koichi Sairyo, Shoichiro Takao, Seiko Kagawa, Shinsuke Katoh and Natsuo Yasui : Hematoma in the Cervical Ligamentum Flavum. Report of a Case and Review of the Literature., Skeletal Radiology, 39, 3, 289-293, 2010.
(Summary)
Hematoma of the cervical ligamentum flavum is very rare, and its pathogenesis is unknown. We describe a case of ligamentum flavum hematoma in the cervical spine causing severe myelopathy. Postoperative histological examination suggested it was the result of the rupture of a hemangioma or of an arteriovenous malformation in the ligamentum flavum. After removal of the lesion, the patient's condition immediately improved. Review of all three reported cases, including this one, showed that complete resection of the mass resulted in immediate relief of symptoms of incomplete paraplegia. The findings of magnetic resonance imaging (MRI) of the hematoma may vary with time, and they may show no characteristic intensity. However, MRI of this case revealed that the tissues surrounding the mass were enhanced with gadolinium diethylene triamine penta-acetic acid, and an area of homogeneous iso-intensity was clearly surrounded by a low-intensity area (flavum) on T2-weighed short-tau inversion recovery images. These findings could be characteristic of the ligamentum flavum hematoma and might help in the differentiation from a cervical epidural hematoma.
Koichi Sairyo, Toshinori Sakai, Rui Amari and Natsuo Yasui : Causes of radiculopathy in young athletes with spondylolysis., The American Journal of Sports Medicine, 38, 2, 357-362, 2010.
(Summary)
The main clinical symptom of lumbar spondylolysis is lower back pain. Radiculopathy rarely occurs without vertebral slippage. Hypothesis Spondylolysis in young athletes can cause lumbar radiculopathy. Case series; Level of evidence, 4. Ten patients (7 males and 3 females) were included in this study. The age of the patients ranged from 12 to 27 years. We employed plain radiography, computed tomography, magnetic resonance imaging, and selective radiculography if needed. The pathomechanism was classified into nonspondylolytic radiculopathy (3 cases) and spondylolytic radiculopathy (7 cases). In the nonspondylolytic group, 1 patient had a juxta-facet cyst at L4-5 and 2 patients had a herniated nucleus pulposus. In the other group, spondylolytic-related factors caused radiculopathy, and spondylolysis was in the early or progressive stage in all 7 patients. Radiologic findings indicated that radiculopathy was caused by extraosseous hematoma or edema in the vicinity of the fracture site. The radiculopathy disappeared within a month of nonoperative management, and radiologic abnormalities disappeared 3 to 6 months later. Radiculopathy can occur together with lumbar spondylolysis without slippage in young athletes. We propose extra-osseous hematoma or edema at the site of spondylolysis as the unique pathomechanism causing radiculopathy in young athletes. Radiculopathy is rare in athletes with spondylolysis. Magnetic resonance imaging is a useful tool to clarify the pathologic changes that induce the radiculopathy for both spondylolytic and nonspondylolytic factors.
(Keyword)
Adolescent / Adult / Athletes / Child / Female / Humans / Low Back Pain / Magnetic Resonance Imaging / Male / Radiculopathy / Spondylolysis / Tomography, X-Ray Computed / Young Adult
Shoichiro Takao, Toshinori Sakai, Koichi Sairyo, Tadashi Kondo, Junji Ueno, Natsuo Yasui and Hiromu Nishitani : Radiographic comparison between male and female patients with lumbar spondylolysis., The Journal of Medical Investigation : JMI, 57, 1-2, 133-137, 2010.
(Summary)
We studied the lumbar spines of 117 adults (39 women and 78 men) with spondylolysis unrelated to low back pain using multidetector computed tomography (CT). Of the 117 subjects with spondylolysis, including five with multiple-level spondylolysis, there were 124 vertebrae with spondylolysis. In adult lumbar spines with unilateral spondylolysis, there was no significant difference between the incidence of spondylolisthesis in female and male subjects. However, in those with bilateral spondylolysis, there was a significantly higher incidence of spondylolisthesis in female subjects (90.9%) than in males (66.2%). Furthermore, females with bilateral spondylolysis had significant more slippage than males. Lumbar index and lumbar lordosis were not significantly different between male and female subjects, and did not significantly correlate with slippage. In conclusion, to treat acute spondylolysis in adolescents, it is important to obtain bony union at least unilaterally, especially in female subjects, to prevent further slippage.
(Keyword)
Adult / Aged / Aged, 80 and over / Female / Humans / Incidence / Lumbar Vertebrae / Male / Middle Aged / Sex Characteristics / Spondylolisthesis / Spondylolysis / Tomography, X-Ray Computed
Toshinori Sakai, Koichi Sairyo, Shoichiro Takao, Hiromu Nishitani and Natsuo Yasui : Incidence of lumbar spondylolysis in the general population in Japan based on multidetector computed tomography scans from two thousand subjects., Spine, 34, 21, 2346-2350, 2009.
(Summary)
Epidemiological analysis using CTs. To investigate the true incidence of lumbar spondylolysis in the general population in Japan. Although there have been several reports on the incidence of lumbar spondylolysis, they had some weakness. One of them concerns the subjects investigated, because the incidence of lumbar spondylolysis varies considerably, and some patients are asymptomatic. In addition, most of the past studies used plain radiograph films or skeletal investigation. Therefore, the past reported incidence may not correspond to that of the general population. We reviewed the computed tomography (CT) scans of 2000 subjects (age: 20-92 years) who had undergone abdominal and pelvic CT on a single multidetector CT scanner for reasons unrelated to low back pain. We reviewed them for spondylolysis, spondylolytic spondylolisthesis, and spina bifida occulta (SBO) in the lumbosacral region. The grade (I-IV) of spondylolisthesis was measured using midsagittal reconstructions. Lumbar spondylolysis was found in 117 subjects (5.9%). Their male-female ratio was 2:1. Multiple-level spondylolysis was found in 5 subjects (0.3%). Among these 117 subjects, there were 124 vertebrae with spondylolysis. Of them, 112 (90.3%) corresponded to L5, and 26 (21.0%) had unilateral spondylolysis.SBO was found in 154 subjects. Of them, 25 had spondylolysis (16.2%), whereas, in 1846 subjects without SBO, 92 had spondylolysis (5.0%). The incidence of spondylolysis among the patients with SBO was significantly higher than that in subjects without SBO (Odd ratio was 3.7-fold).Of 124 vertebrae with spondylolysis, 75 (60.5%) showed low-grade (Meyerding grade I or II) spondylolisthesis, and no subject presented high-grade spondylolisthesis. Spondylolisthesis was found in 74.5% of the subjects with bilateral spondylolysis, and in 7.7% of those with unilateral spondylolysis. The incidence of lumbar spondylolysis in the Japanese general population was 5.9% (males: 7.9%, females: 3.9%).
(Keyword)
Adult / Aged / Aged, 80 and over / Female / Humans / Incidence / Japan / Lumbar Vertebrae / Male / Middle Aged / Spina Bifida Occulta / Spondylolisthesis / Spondylolysis / Tomography, X-Ray Computed / Young Adult
Toshinori Sakai, Shinsuke Katoh, Koichi Sairyo, Tatsuya Tamura, Nori Hirohashi, Kousaku Higashino and Natsuo Yasui : Anterior transvertebral herniotomy for cervical disc herniation: a long-term follow-up study, Journal of Spinal Disorders & Techniques, 22, 6, 408-412, 2009.
(Summary)
Retrospective study. To investigate the efficacy and radiologic changes after anterior transvertebral herniotomy (ATH), in patients followed for at least 10 years after the surgery. The theoretical idea of ATH is to remove an extruded herniated mass while preserving disc motion. To our knowledge, no report has been published on the long-term outcome of this procedure. Twenty patients underwent single-level ATH at our institution between 1989 and 1995. Clinical outcome was evaluated by visual analog scale for neck and arm pain according to Japanese Orthopaedic Association (JOA) score, and range of motion (ROM) of the cervical spine. Radiologic outcome was evaluated by measuring disc height and range of intervertebral motion of the site on plain radiographs. We also evaluated the operated and the adjacent segments by magnetic resonance imaging (MRI) for degenerative changes. Fifteen of the 20 patients were evaluated. One patient required additional surgery, 3 patients were lost to follow-up, and 1 patient had died by the time of the evaluation. Therefore, we evaluated the clinical outcome of 15 patients. Both the plain radiographs and MRI were available from 10 patients, and for 3 patients only the plain radiographs were available. Two patients refused x-ray examination at the final follow-up. Regarding clinical outcome, no patient had suffered from neck pain or arm pain. The average visual analog scale was 7.8/100 (%) for neck pain, and 7.0/100 (%) for arm pain. JOA scores improved and remained at a good level. The improvement rate was 88.5%. The average ROM of the cervical spine was 42.7 degrees in flexion, 52.3 degrees in extension, 58.6 degrees in axial rotation, and 25.0 degrees in lateral bending. Although ROM in axial rotation and lateral bending was symmetric, the range was smaller than that in the healthy segments. On plain radiographs, although the disc height in the operated segment was not significantly decreased compared with the other segments, loss of intervertebral motion was noticed on the follow-up roentgenograms in most cases. Only 2 patients had mobility of the operated intervertebral levels (>10 degrees). There was no collapse of the drilled vertebral body in any patient. Four of the 10 patients who underwent MRI showed protrusion of intervertebral discs, including those adjacent to the affected discs. No recurrence of disk herniation at the involved level was seen on the follow-up MRI. In conclusion, ATH provided a good clinical outcome that was maintained for a long time. Although intervertebral motion at the operated level decreased to some extent, degenerative changes at the adjacent levels were not enhanced.
(Keyword)
Activities of Daily Living / Cervical Vertebrae / Diskectomy / Female / Follow-Up Studies / Humans / Intervertebral Disc / Intervertebral Disc Displacement / magnetic resonance imaging / Male / Middle Aged / Neck Pain / Patient Satisfaction / Postoperative Complications / Range of Motion, Articular / Retrospective Studies / Spinal Cord Compression / Spondylosis / time / Treatment Outcome
Kousaku Higashino, Koichi Sairyo, Shinsuke Katoh, Shunji Nakano, Tetsuya Enishi and Natsuo Yasui : The effect of rheumatoid arthritis on the anatomy of the female cervical spine: a radiological study., The Journal of Bone and Joint Surgery. British Volume, 91, 8, 1058-1063, 2009.
(Summary)
The effect of rheumatoid arthritis on the anatomy of the cervical spine has not been clearly documented. We studied 129 female patients, 90 with rheumatoid arthritis and 39 with other pathologies (the control group). There were 21 patients in the control group with a diagnosis of cervical spondylotic myelopathy, and 18 with ossification of the posterior longitudinal ligament. All had plain lateral radiographs taken of the cervical spine as well as a reconstructed CT scan. The axial diameter of the width of the pedicle, the thickness of the lateral mass, the height of the isthmus and internal height were measured. The transverse diameter of the transverse foramen (d1) and that of the spinal canal (d2) were measured, and the ratio d1/d2 calculated. The width of the pedicles and the thickness of the lateral masses were significantly less in patients with rheumatoid arthritis than in those with other pathologies. The area of the transverse foramina in patients with rheumatoid arthritis was significantly greater than that in the other patients. The ratio of d1 to d2 was not significantly different. A high-riding vertebral artery was noted in 33.9% of the patients with rheumatoid arthritis and in 7.7% of those with other pathologies. This difference was statistically significant. In the rheumatoid group there was a significant correlation between isthmus height and vertical subluxation and between internal height and vertical subluxation.
(Keyword)
Adult / Aged / Aged, 80 and over / Arthritis, Rheumatoid / Cervical Vertebrae / Disease Progression / Female / Humans / Internal Fixators / Middle Aged / Predictive Value of Tests / Vertebral Artery / Young Adult
Abbaspour Aziz, Mitsuhiko Takahashi, Koichi Sairyo, Shinjiro Takata, Kiminori Yukata, Ami Inui and Natsuo Yasui : Optimal increase in bone mass by continuous local infusion of alendronate during distraction osteogenesis in rabbits, Bone, 44, 5, 917-923, 2009.
(Summary)
Several methods have been used to increase bone mass in distraction osteogenesis. Since bone resorption as well as regeneration is stimulated in the distracted segment, bisphosphonate can be a beneficial agent for distraction osteogenesis. Here, we examined the effects of bisphosphonate injected continuously into the regenerate on bone volume, and architectural and mechanical properties of distraction osteogenesis. The left tibia of Japanese White rabbits (n=66) was subjected to slow distraction using an external fixator. At the beginning of the consolidation phase, alendronate (7 microg/kg/day) was infused directly into the lengthened segment for 14 days using an osmotic pump. Control rabbits were infused with phosphate buffered saline (PBS). The tibiae were monitored weekly by soft X-ray and dual-energy X-ray absorptiometry (DXA). The animals were sacrificed at 4, 6, and 8 weeks after operation to examine bone mineral density (BMD) and cortical bone thickness (CBT) by peripheral quantitative computerized tomography (pQCT), while the mechanical property of the lengthened tibia was measured by three-point bending test. In PBS-infused control animals, bone mineral content around the lengthened segment began to decrease after the first week of consolidation phase, forming a tubular bone structure with thin cortex. Infusion of alendronate increased peak bone mineral content around the lengthened segment. At the end of the experiment, volumetric BMD, CBT and mechanical strength of the lengthened segment of the treatment group were approximately twice those of the control animals. Alendronate infused in this manner significantly prevented the osteopenia that critically began early in the consolidation phase, though the dose used in this study was relatively low and no adverse events were noted.
(Keyword)
Absorptiometry, Photon / Alendronate / Animals / Biomechanical Phenomena / Bone Density / Male / Osteogenesis, Distraction / Rabbits / Tibia / Tomography, X-Ray Computed
Koichi Sairyo, Toshinori Sakai and Natsuo Yasui : Minimally invasive technique for direct repair of pars interarticularis defects in adults using a percutaneous pedicle screw and hook-rod system., Journal of Neurosurgery. Spine, 10, 5, 492-495, 2009.
(Summary)
In this report, the authors described a new minimally invasive technique to repair pars interarticularis defects in adults. The well-established technique using the pedicle screw (PS) and hook-rod system was modified. First, bilateral PSs were inserted percutaneuosly using the Sextant system. Then, through a small skin incision (3-4 cm), an illuminated tubular retractor (Quadrant system; Medtronic Sofamore Danek) was inserted into the pars defect. When this system is used, it is not necessary to detach all the back muscles to access the lytic part. The bursa and fibrocartilaginous mass near the defects were removed. After decortication of the pseudarthrosis at the spondylolytic level, bone grafts were implanted. Finally, the hook part of a hook-rod system was attached to the lamina and the rod was secured at the tulip head of the PSs. The authors performed this procedure in 2 adult patients, 32 and 24 years of age. Immediately after surgery both patients' low-back pain disappeared, and by 3 months postoperatively both had returned to their original work or sports activities.
(Keyword)
Bone Screws / Humans / Lumbar Vertebrae / Male / Pseudarthrosis / Spondylolysis / Surgical Procedures, Minimally Invasive / Young Adult
Fumio Hayashi, Toshinori Sakai, Koichi Sairyo, Nori Hirohashi, Kousaku Higashino, Shinsuke Katoh and Natsuo Yasui : Intramedullary schwannoma with calcification of the epiconus., The Spine Journal, 9, 5, e19-e23, 2009.
(Summary)
There have been few reports on intramedullary ancient schwannoma. Schwann cells are generally present in the nerve root, not in the spinal cord. Thus, intramedullary schwannomas are rare, and in most cases there is cyst formation without calcification. To report a patient with intramedullary ancient schwannoma at the epiconus together with a review of the previously published cases. Case report. A 78-year-old woman. Retrospective case review. DESCRIPTION OF THE CASE: A 78-year-old woman had presented with severe weakness of the lower extremities, increased patellar reflex, and sensory disturbance of the entire lower extremities. Magnetic resonance imaging showed a tumorous mass in the intramedullary region of epiconus at T11-L1, and computed tomography revealed calcification in the tumor. She underwent total resection of the tumor. Histopathological findings were consistent with the diagnosis of ancient schwannoma. After the operation, although lower extremities weakness and sensory disturbance deteriorated transiently, lower leg pain disappeared. At the final follow-up of 10 months after the operation, lower leg pain did not relapse. We reported a rare case presenting epiconus syndrome due to intramedullary ancient schwannoma, which should be considered for the differential diagnosis of a tumor that shows calcification.
Rui Amari, Toshinori Sakai, Shinsuke Katoh, Koichi Sairyo, Kosaku Higashino, Keizo Tachibana and Natsuo Yasui : Fresh stress fractures of lumbar pedicles in an adolescent male ballet dancer: case report and literature review., Archives of Orthopaedic and Trauma Surgery, 129, 3, 397-401, 2009.
(Summary)
Stress fracture in the pars interarticularis is a common cause of low back pain in young athletes. Pedicle stress fractures have also been reported in adolescent sport players, and most of them were associated with contralateral spondylolysis. Only a few cases with bilateral pedicle stress fractures have been reported. We report a 14-year-old ballet dancer with fresh bilateral pedicle fractures treated conservatively, together with a review of the literature.
(Keyword)
Adolescent / Dancing / Fractures, Stress / Humans / Low Back Pain / Lumbar Vertebrae / Male / Spinal Fractures
Koichi Sairyo, Toshinori Sakai and Natsuo Yasui : Conservative treatment of lumbar spondylolysis in childhood and adolescence: the radiological signs which predict healing., The Journal of Bone and Joint Surgery. British Volume, 91, 2, 206-209, 2009.
(Summary)
It has been noted that bony union of a pars defect can be achieved in children if they wear a trunk brace. Our aim was to evaluate how the stage of the defect on CT and the presence or absence of high signal change in the adjacent pedicle on T2-weighted MRI were related to bony healing. We treated 23 children conservatively for at least three months. There were 19 boys and four girls with a mean age of 13.5 years (7 to 17). They were asked to refrain from sporting activity and to wear a Damen soft thoracolumbosacral type brace. There were 41 pars defects in 23 patients. These were classified as an early, progressive or terminal stage on CT. The early-stage lesions had a hairline crack in the pars interarticularis, which became a gap in the progressive stage. A terminal-stage defect was equivalent to a pseudarthrosis. On the T2-weighted MR scan the presence or absence of high signal change in the adjacent pedicle was assessed and on this basis the defects were divided into high signal change-positive or -negative. Healing of the defect was assessed by CT. In all, 13 (87%) of the 15 early defects healed. Of 19 progressive defects, only six (32%) healed. None of the seven terminal defects healed. Of the 26 high signal change-positive defects 20 (77%) healed after conservative treatment whereas none of the high signal change-negative defects did so. We concluded that an early-stage defect on CT and high signal change in the adjacent pedicle on a T2-weighted MR scan are useful predictors of bony healing of a pars defect in children after conservative treatment.
Koichi Sairyo, Toshinori Sakai, Kousaku Higashino, Tatsuya Tamura, Shinsuke Katoh and Natsuo Yasui : Cervical and upper thoracic screwing for spinal fusion: strategy for its safe insertion to avoid major complications., Archives of Orthopaedic and Trauma Surgery, 129, 11, 1447-1452, 2009.
(Summary)
There are several screwing techniques to attain cervical fusion such as pedicle screw, lateral mass screw, facet screw, transarticular and laminar screw. Each screwing technique has advantages and disadvantages. In this study, we introduce our strategy for safe screwing and its clinical results. Our strategy is as follows: lateral mass screw for C1, 3, 4, 5, 6 and pedicle screw for C2, 7, and thoracic level. When the C2 pedicle is thinner than 3.5 mm, we use C2 laminar screws. We do not use Magerl transarticular screw or facet screw; 146 screws were inserted in 17 patients. There were no major complications such as spinal cord and nerve root injury. We did not observe vertebral arterial injury either. Of the 146 screws, 141 (97.0%) were accurately inserted. As for lateral mass screwing by Roy-Camille's technique and C2 laminar screwing, all screws were inserted in the appropriate site (100%) without any complications. Five pedicle screws were misplaced. Of the 57 pedicle screws, 5 showed a minor tear of the wall at C7, Th1 and Th3, the success rate for all pedicle screws was 91%. All showed solid fusion. For cervical screwing the most important aspect should be safety to avoid severe morbidity. Our strategy, which consists in the combined use of pedicle, lateral mass and laminar screwing, is safe and reliable.
Takahiro Sasa, Yusuke Yoshizumi, Koichi Imada, Masato Aoki, Tomoya Terai, Tomofumi Koizumi, Vijay K. Goel, Ahmad Faizan, Ashok Biyani, Toshinori Sakai and Koichi Sairyo : Cervical spondylolysis in a judo player. A case report and biomechanical analysis., Archives of Orthopaedic and Trauma Surgery, 129, 4, 559-567, 2009.
(Summary)
A case report and a biomechanical study using a finite element method. To report a case with the cervical spondylolysis and to understand the biomechanics of the cervical spine with spondylolysis at C6. Cervical spondylolysis, although not a common spinal disorder, can occur in athletes. Presently, the exact pathology, natural history and biomechanics are not known. Thus, treatment strategies for this disorder in athletes are in controversy. To treat and/or advise patients with cervical spondylolysis, the cervical spine biomechanics regarding this disorder should be understood. A case of a 12-year-old male judo player is presented. The patient presented with occipital and upper neck pain. Plain radiographs, reconstructed CT scan and MRIs of this patient were reviewed. Biomechanically, stress distributions were analyzed in response to 73.6 N axial compression and 1.5-Nm moment in flexion, extension, lateral bending, and axial rotation using a FE model of the intact ligamentous C3 to C7 segment. Bilateral spondylolysis was created in the model at C6. The stress results from the bilateral defect model were compared to the intact model predictions. Plain radiographs showed bilateral C6 spondylolysis, and grade I spondylolisthesis. MRI showed mild disc degeneration at C6/7. With conservative treatment, the symptoms disappeared. In the spondylolysis model, the maximum Von Mises Stresses at C6/7 increased in all cervical spine motions, as compared to the intact case. Specifically, in axial rotation, the stress increase was 3.7-fold as compared to the intact model. The range of motion at C6/7 increased in the spondylolysis model as well. Again, during axial rotation, the increase in motion was 2.3-fold when compared to the intact model. Cervical spondylolysis can cause biomechanical alterations, especially in axial rotation, leading to increased disc stresses and range of motion. The increased stresses in the disc and the hypermobility would be a dangerous condition for athletes participating in contact sports such as judo. Thus, we recommended that judo players with cervical spondylolysis should change to non-contact sports, such as jogging.
(Keyword)
Biomechanics / Cervical Vertebrae / Child / Finite Element Analysis / Humans / Male / Martial Arts / Range of Motion, Articular / Spondylosis / Tomography, X-Ray Computed
Koichi Sairyo, Toshinori Sakai, Natsuo Yasui, Ali Kiapour, Ashok Biyani, Nabil Ebraheim and K Vijay Goel : Newly occurred L4 spondylolysis in the lumbar spine with pre-existence L5 spondylolysis among sports players: case reports and biomechanical analysis., Archives of Orthopaedic and Trauma Surgery, 129, 10, 1433-1439, 2009.
(Summary)
STUDY DESIGN: Case series and a biomechanical study using a finite element (FE) analysis. OBJECTIVES: To report three cases with multi-level spondylolysis and to understand the mechanism biomechanically. BACKGROUND: Multi-level spondylolysis is a very rare condition. There have been few reports in the literature on multi-level spondylolysis among sports players. METHODS: We reviewed three cases of the condition, clinically. These patients were very active young sports players and had newly developed fresh L4 spondylolysis and pre-existing L5 terminal stage spondylolysis. Thus, we assumed that L5 spondylolysis may have increased the pars stress at the cranial adjacent levels, leading to newly developed spondylolysis at these levels. Biomechanically, we investigated pars stress at L4 with or without spondylolysis at L5 using the finite element technique. RESULTS: L4 pars stress decreased in the presence of L5 spondylolysis, which does not support our first hypothesis. CONCLUSIONS: It seems that multi-level spondylolysis may occur due to genetic and not biomechanical reasons.
Kousaku Higashino, Shinsuke Katoh, Koichi Sairyo, Yuichiro Goda, Toshinori Sakai, Takashi Kitaichi, Tetsuya Kitagawa and Natsuo Yasui : Pseudoaneurysm of the thoracoabdominal aorta caused by the severe migration of an anterior spinal device. A case report., The Spine Journal, 8, 4, 696-699, 2008.
(Summary)
Case report. To describe the case of pseudoaneurysm of the thoracoabdominal aorta caused by the severe migration of an anterior spinal device 5 years after surgery. Case report. A 70-year-old woman was referred to us because of migrated anterior spinal devices and a pseudoaneurysm of the thoracoabdominal aorta. This patient had undergone anterior corpectomy and spinal fusion from Th12 to L2 because of delayed palsy after a burst fracture using a smooth rod Kaneda device (SRK) with bioactive ceramic (apatite-wollastonite containing glass ceramic) at a local hospital. She had persistent low back pain after the surgery. Five years after the initial surgery, the patient was referred to us because of increasing of her low back pain and the migrated SRK devices shown on plain X-ray films. An enhanced computed tomography scan taken in our hospital clearly showed a pseudoaneurysm of the thoracoabdominal aorta surrounding the SRK devices. The pseudoaneurysm was resected, the aortic defect was repaired with an artificial patch, and the migrated SRK devices were removed. The pseudoaneurysm of the aorta can occur secondary to a migrated anterior spinal fixation device and can be successfully treated by revision anterior surgery with vascular repair and implant removal.
Kiminori Yukata, Shinsuke Katoh, Koichi Sairyo, Yoshito Matsui, Yoshitaka Hamada and Natsuo Yasui : Os odontoideum in achondroplasia: a case report., Journal of Pediatric Orthopaedics. Part B, 17, 2, 103-105, 2008.
(Summary)
The neurological complication in achondroplasia has been focused on the foramen magnum stenosis. We report the combination of os odontoideum in a patient with achondroplasia.
Koichi Sairyo, Toshinori Sakai, Kousaku Higashino, Bunji Hirao, Shinsuke Katoh and Natsuo Yasui : Minimally invasive excision of lumbar epidural lipomatosis using a spinal endoscope., Minimally Invasive Neurosurgery : MIN, 51, 1, 43-46, 2008.
(Summary)
In this report, we describe the case of a patient with a long-term radiculopathy due to epidural lipomatosis at the L3-4 intervertebral disc level. The fatty tissue was located on the dorsal side of the dural sac in the spinal canal and compressed the dural sac. The fatty tissue was removed endoscopically. After surgery, the symptoms disappeared, and neurological deficits normalized. We would like to state that epidural lipomatosis is a good candidate for minimally invasive endoscopic surgery because of its anatomic location.
(Keyword)
Aged / Cauda Equina / Decompression, Surgical / Dura Mater / Endoscopy / Epidural Space / Humans / Lipomatosis / Low Back Pain / Lumbar Vertebrae / Magnetic Resonance Imaging / Male / Polyradiculopathy / Spinal Canal / Surgical Procedures, Minimally Invasive / Treatment Outcome
Ichiro Tonogai, Toshinori Sakai, Shinsuke Katoh, Kousaku Higashino, Koichi Sairyo, Nori Hirohashi and Natsuo Yasui : Myelopathy in a 6-year-old girl caused by neurofibromatosis Type 1: a case report, The Spine Journal, 8, 5, 836-840, 2008.
(Summary)
Even when there is radiological evidence of spinal involvement, young patients with neurofibromatosis Type 1 (NF-1) seldom have symptoms. We report the case of a child who developed rapidly progressive myelopathy. To describe a technique used to prevent postoperative spinal deformity and instability, after removal of a dumbbell-shaped tumor in a 6-year-old child. Case report. A 6-year-old female. Retrospective case review. The patient underwent a resection of the cervical dumbbell tumor using an osteoplastic laminectomy technique to prevent postoperative spinal deformity. At 2-year follow-up, there was no clinical or radiographic evidence of complications or spinal kyphotic deformity. The case of a 6-year-old girl with cervical myelopathy caused by NF-1 was reported. The tumor was removed after osteoplastic laminectomy, which could prevent postoperative kyphotic deformity.
Aziz Abbaspour, Shinjiro Takata, Koichi Sairyo, Shinsuke Katoh, Kiminori Yukata and Natsuo Yasui : Continuous local infusion of fibroblast growth factor-2 enhances consolidation of the bone segment lengthened by distraction osteogenesis in rabbit experiment., Bone, 42, 1, 98-106, 2008.
(Summary)
Experimental tibial lengthening was achieved in 61 rabbits to examine the effect of continuous local infusion of recombinant human fibroblast growth factor-2 (rhFGF-2) on bone healing of the lengthened segment. The tibial diaphysis was separated by osteotomy and was subjected to slow progressive distraction (rate: 0.35 mm/12 h) using a monolateral external fixator. There were a lag phase for 1 week, a distraction phase for 2 weeks, and a consolidation phase for 5 weeks in this experiment. At various stages of distraction, rhFGF-2 was infused continuously for 2 weeks into the lengthened segment (rate: 14.28 microg/60 microl/day) using an osmotic pump implanted under the skin. Bone healing was significantly accelerated when rhFGF-2 was infused in the beginning of consolidation phase, but not in the distraction phase or in the lag phase. Infusion of normal saline (N/S) using the same osmotic pump had no effect. Dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computerized tomography (pQCT) studies demonstrated that rhFGF-2-treated tibia had increased bone mineral density (BMD), bone mineral content (BMC) and cortical bone thickness (CBT) when compared with N/S-treated tibia. Three-point bending test demonstrated that rhFGF-2-treated bone had significantly stronger mechanical properties than N/S-treated bone. Finally, distribution of the infused materials was checked by using Indian ink or radio-opaque. The dyes distributed widely but exclusively in the lengthened segment. Based on these results, we conclude that direct delivery of rhFGF-2 into the lengthened segment can shorten the consolidation phase of limb lengthening and the method is applicable to the clinical treatment.
(Keyword)
Absorptiometry, Photon / Animals / Bone Density / Disease Models, Animal / Fibroblast Growth Factor 2 / Fractures, Bone / Injections, Intralesional / Male / Osteogenesis / Osteogenesis, Distraction / Rabbits / Tomography, X-Ray Computed
Toshinori Sakai, Koichi Sairyo, Daisuke Hamada, Kousaku Higashino, Shinsuke Katoh, Yoichiro Takata, F Shinomiya and Natsuo Yasui : Radiological features of lumbar spinal lesions in patients with rheumatoid arthritis with special reference to the changes around intervertebral discs., The Spine Journal, 8, 4, 605-611, 2008.
(Summary)
Compared with the cervical spine, little attention has been paid to rheumatoid arthritis (RA)-related lumbar disorders. Only a few articles have described the status of the lumbar spine affected by RA based on plain X-ray films and magnetic resonance imaging (MRI). To describe the features and prevalence of radiological changes of the lumbar spine of patients with RA and to clarify the correlations of such features with disease activity. Transverse radiological study. We radiographically examined 104 patients with RA whose age ranged from 21 to 78 years (mean, 51.0). In each, the duration of RA exceeded 10 years (mean, 17.7 years). Clinical outcomes included Ochi's classification, Lansbury index, C-reactive protein (CRP) (mg/dL), rheumatoid factor (RF) (U/mL), and platelet (count/mm). Radiological outcomes included radiography and MRI. One hundred four RA patients were included in this study regardless of the presence/absence of low back pain. We examined discs from L1-2 to L5-S, including endplates, in each patient on plain X-ray films and magnetic resonance images and used a comprehensive grading system to evaluate each feature of the lumbar spine affected by RA based on the present findings and published reports. The correlations of these radiological features with RA activity and Ochi's classification were examined. To quantify disease activity, we determined the Lansbury index, serum CRP (mg/dL), RF (U/mL), and platelet count (count/mm) at the time of radiological examinations. Of the 104 patients, 47 (45.2%) exhibited a lumbar lesion. There were two types of lumbar disc lesions related to RA: disc narrowing and disc ballooning. The Lansbury index of patients with the most severe lesions was significantly higher than that of patients with less severe lesions (p<.01). The frequency of lumbar involvement also increased as the number of affected peripheral joints increased, and Ochi's classification appeared to be useful in predicting the occurrence of lumbar lesions. Of 104 patients, 47 (45.2%) exhibited abnormalities on X-ray films and MRI. There were two types of disorders, disc narrowing and disc ballooning. Both the Lansbury index and Ochi's classification reflected the severity of lumbar lesions in RA patients.
(Keyword)
Adult / Aged / Arthritis, Rheumatoid / Female / Humans / Intervertebral Disc / Lumbar Vertebrae / Magnetic Resonance Imaging / Male / Middle Aged / Severity of Illness Index / Spinal Stenosis
Kousaku Higashino, Koichi Sairyo, Tadanori Sakamaki, Shinnji Komatsubara, Kiminori Yukata, Naohito Hibino, hirofumi Kosaka, Toshinori Sakai, Shinsuke Katoh, Toshiaki Sano and Natsuo Yasui : Vertebral rounding deformity in pediatric spondylolisthesis occurs due to deficient of endochondral ossification of the growth plate: radiological, histological and immunohistochemical analysis of a rat spondylolisthesis model., Spine, 32, 25, 2839-2845, 2007.
(Summary)
A study using rat spondylolisthesis models. To clarify pathomechanism of vertebral rounding deformity in pediatric spondylolisthesis. For high-grade slippage, rounding of sacrum surface associated with L5 spondylolisthesis is reported to be the most responsible risk factor. However, the exact pathomechanism of the rounding deformity is yet to be clarified. Spondylolisthesis rat model (4-week-old) was used. Radiographs were taken weekly for 5 weeks after the surgery. The lumbar spines were harvested for histology. Hematoxylin and eosin, alcian blue staining, and tartrate-resistant acid phosphatase staining were used. Immunohistochemically, the growth plate cartilage was studied for type II and X collagen. A modified bone histomorphometric analysis was also performed. Radiographs showed slippage 1 week after surgery. Rounding deformity was obvious 2 weeks after surgery. The rounding deformity progressed with time. Three weeks after surgery, the specific columns of growth plate were unclear at the anterior corner, which corresponded to the rounding surface observed on radiographs. Instead, a huge mass of cartilage was observed at that site. Tartrate-resistant acid phosphatase-positive cells were observed in the vicinity of the growth plate except in relation with the anterior corner. The growth plate and cartilage mass at the anterior corner stained positive for type II collagen. Chondrocytes in the hypertrophied layer stained positively for type X collagen; however, staining was faint at the anterior corner. The results suggested that the chondrocytes at the anterior did not form, morphologically and functionally, the normal growth plate. From histomorphometrical analysis, the normal posterior growth plate made endochondral bone growth in 510 +/- 20 microm for a week, whereas the anterior corner in 200 +/- 15 microm. Deficient endochondral ossification of the growth plate in the anterior upper corner of the vertebra could be the pathomechanism of the rounding deformity of the sacrum.
(Keyword)
Acid Phosphatase / Age Factors / Animals / Cartilage / Chondrocytes / Collagen Type II / Collagen Type X / Disease Models, Animal / Female / Growth Plate / Immunohistochemistry / Isoenzymes / Lumbar Vertebrae / Ossification, Heterotopic / Rats / Rats, Wistar / Spondylolisthesis / Time Factors
Hirofumi Kosaka, Koichi Sairyo, Ashok Biyani, Douglas Leaman, Richard Yeasting, Kousaku Higashino, Toshinori Sakai, Shinsuke Katoh, Toshiaki Sano, Vijay K. Goel and Natsuo Yasui : Pathomechanism of loss of elasticity and hypertrophy of lumbar ligamentum flavum in elderly patients with lumbar spinal canal stenosis., Spine, 32, 25, 2805-2811, 2007.
(Summary)
A histologic, biologic, and immunohistochemical assessment using human samples of lumbar ligamentum flavum. To clarify the pathomechanism of loss of elasticity and hypertrophy of the lumbar ligamentum flavum (LF) in the elderly population. The most common spinal disorder in elderly patients is lumbar spinal canal stenosis, causing low back and leg pain, and paresis. Canal narrowing, in part, results from hypertrophy of the LF. Although histologic and biologic literature on this topic is available, the pathomechanism of loss of elasticity and hypertrophy of the LF is still unknown. One fetus, 5 young, and 5 elderly LF were obtained for histologic study. Hematoxylin and eosin, Alcian blue, Masson Trichrome, and Elastica Van Gieson stains were performed for each LF. Nine LF were collected and were used for biologic study of real time RT-PCR to quantitatively measure mRNA expression of Type I collagen and elastin in each LF. In the LF of the fetus, elastic fibers accounted for about 75% of the entire area. In the dural aspect of the LF in the young and elderly group, the ratio was also around 75%; however, the ratio of the dorsal aspect decreased with age. Almost half of the area showing loss of elastic fibers was shown to be converted to cartilaginous tissue producing Type II collagen and proteoglycan by Alcian blue and Type II collagen immunohistochemistry. The area, which did not stain black with EV nor blue with AB stain, was positively stained blue with T stain, indicating scarring. The area of the normal dural layer was 18.0 +/- 2.3 and 33.8 +/- 4.3 (mm2), for young and elderly group, respectively. Accordingly, it was 3.2 +/- 0.8 and 18.0 +/- 10.2 (mm2), for the dorsal abnormal layer. Elastin mRNA showed a relatively strong correlation (r = 0.44) with age; however, the slope was very gentle. Type I collagen mRNA showed a very strong correlation (r = 0.80) with age. The slope was steeper, and the value reached at 1000% (10-fold) around 65 years old when compared with the LF from younger patient. Elastin mRNA showed a weak correlation (r = 0.36) with thickness, and the slope was gentle. Type I collagen mRNA showed relatively strong correlation (r = 0.52) with thickness. The slope was steeper, and the line reached at 1000% (10-fold) around 6.5 (mm) when compared with a thin LF. Decreased elasticity of LF in the elderly is due to the loss of elastic fibers and a concomitant increase of collagenous fibers in the dorsal aspect. LF hypertrophy could be due to the thickening of the normal elastic layer as well as of the abnormal collagenous layer.
(Keyword)
Adult / Age Factors / aging / Collagen Type I / Collagen Type II / elasticity / Elastin / fetus / Humans / Hypertrophy / Ligamentum Flavum / Lumbar Vertebrae / Middle Aged / RNA, Messenger / Spinal Stenosis
Yoshitaka Hamada, Koichi Sairyo, Natsuo Yasui and Tokio Kasai : Intraneural heterotopic ossification of a digital nerve., The Journal of Hand Surgery, European Volume, 32, 6, 715, 2007.
Naohito Hibino, Yoshitaka Hamada, Koichi Sairyo, Kiminori Yukata, Toshiaki Sano and Natsuo Yasui : Callus formation during healing of the repaired tendon-bone junction. A rat experimental model., The Journal of Bone and Joint Surgery. British Volume, 89, 11, 1539-1544, 2007.
(Summary)
This study was undertaken to elucidate the mechanism of biological repair at the tendon-bone junction in a rat model. The stump of the toe flexor tendon was sutured to a drilled hole in the tibia (tendon suture group, n = 23) to investigate healing of the tendon-bone junction both radiologically and histologically. Radiological and histological findings were compared with those observed in a sham control group where the bone alone was drilled (n = 19). The biomechanical strength of the repaired junction was confirmed by pull-out testing six weeks after surgery in four rats in the tendon suture group. Callus formation was observed at the site of repair in the tendon suture group, whereas in the sham group callus formation was minimal. During the pull-out test, the repaired tendon-bone junction did not fail because the musculotendinous junction always disrupted first. In order to understand the factors that influenced callus formation at the site of repair, four further groups were evaluated. The nature of the sutured tendon itself was investigated by analysing healing of a tendon stump after necrosis had been induced with liquid nitrogen in 16 cases. A proximal suture group (n = 16) and a partial tenotomy group (n = 16) were prepared to investigate the effects of biomechanical loading on the site of repair. Finally, a group where the periosteum had been excised at the site of repair (n = 16) was examined to study the role of the periosteum. These four groups showed less callus formation radiologically and histologically than did the tendon suture group. In conclusion, the sutured tendon-bone junction healed and achieved mechanical strength at six weeks after suturing, showing good local callus formation. The viability of the tendon stump, mechanical loading and intact periosteum were all found to be important factors for better callus formation at a repaired tendon-bone junction.
Yoshitaka Hamada, Koichi Sairyo and Natsuo Yasui : Locking of the metacarpophalangeal joint as a result of the shape of the metacarpal head in achondroplasia., The Journal of Hand Surgery, European Volume, 32, 5, 588-590, 2007.
(Summary)
A 21 year-old woman with achondroplasia exhibited locking of the metacarpophalangeal joint of the right index finger which required surgery to release the joint. Locking was confirmed to be due to entrapment of the fan-like part of the radial collateral ligament on a metacarpal head prominence arising from epiphysial thickening.
Nori Hirohashi, Toshinori Sakai, Koichi Sairyo, Koichi Oba, Kousaku Higashino, Shinsuke Katoh and Natsuo Yasui : Lumbar radiculopathy caused by extradural rheumatoid nodules. A case report., Journal of Neurosurgery. Spine, 7, 3, 352-356, 2007.
(Summary)
The authors report on a 51-year-old woman with a 9-year history of rheumatoid arthritis (RA) who presented with symptomatic rheumatoid nodules in the lumbar extradural region with compression on the L-5 nerve roots bilaterally. She had also suffered from dysesthesia in the right lower leg and intermittent claudication. Magnetic resonance imaging revealed masses compressing the dural sac, and on lumbar myelography and computed tomography myelography a filling defect at L4-5 was revealed, which was compressing the dural sac posterolaterally on both sides. The masses were surgically removed. On histological examination the typical characteristics of rheumatoid nodules were found. Soon after the operation all of the patient's symptoms disappeared. There have been few reports on extradural rheumatoid nodules. Patients with RA usually complain of articular symptoms, and in fact the patient in the present study had been referred to the authors' institution for total hip arthroplasty. However, various symptoms other than those arising from articular lesions were found clinically. The authors believe that if patients with RA are also examined for extraarticular lesions, it is likely that these will be more frequently detected.
Ichiro Tonogai, Koichi Sairyo, Kousaku Higashino, Toshinori Sakai, Shinsuke Katoh and Natsuo Yasui : Minimally invasive endoscopic removal of herniated nucleus pulposus that had migrated to the S1 nerve root foramen., Minimally Invasive Neurosurgery : MIN, 50, 3, 173-177, 2007.
(Summary)
In this report, we described an adult case with a lumbar herniated nucleus pulposus that had migrated to the S1 nerve root foramen from L5-S1 disc space. Endoscopically, the migrated mass was successfully removed after laminectomy at the S1 with a small skin incision of 20 mm in length. Unlike the other levels, the intraforaminally migrated mass along the S1 root can be excised without any removal of the facet joints; therefore, additional spinal fusion is not necessary. Thus, an S1 foraminal migrated mass can be a good surgical candidate for minimally invasive endoscopic surgery.
A Ivanov, A Faizan, Koichi Sairyo, N Ebraheim, A Biyani and VK. Goel : Minimally invasive decompression for lumbar spinal canal stenosis in younger age patients could lead to higher stresses in remaining neural arch ? A Finite Element Investigation., Minimally Invasive Neurosurgery : MIN, 50, 1, 18-22, 2007.
(Summary)
A young patient group with the symptoms of acquired spinal stenosis has been identified recently in the literature. The patients between 25-50 years of age were found to have signs of lumbar spinal stenosis because of degenerative spinal changes. Some of them were operated on using the same limited decompression approaches as the older patients. However, this group differs from the geriatric population due to the scarcity of remodeling degenerative signs at the spine. Therefore, the possible ligamentous laxity, facet joint degeneration or only the removal of some spinal structures could lead to the increased stresses in the remaining spinal arch and could have an unfavorable course of events after the procedure. A biomechanical study has been done using an experimentally validated finite element model (FEM) of the intact L3-S1 lumbar spine to elucidate the influence of the limited decompression on range of motion (ROM) and stress distribution on the neural arch in this patient group. We simulated unilateral laminotomy L4 and medial facetectomy L4-5, medial facetectomy L4-5 and lateral fenestration of L5 pars interarticularis, combined transarticular lateral and medial approach with partial facetectomy L4-5, "port-hole" decompression at the L4 level, and hemilaminectomy L4 with medial facetectomy L4-5. The ROM and maximum von Mises stresses were analyzed in flexion, extension, lateral bending, and axial rotation in response to a 10.6 Nm moment with 400 N axial compression. The data were compared with the intact spine and hemilaminectomy L4 with medial facetectomy L4-5 models. The investigation revealed almost the same ROM after simulation but a considerable increase in stresses at both the pars interarticularis and the inferior facet after limited decompressions, especially in extension and rotation to the contralateral side. Stresses at the contralateral L4 pedicle were highest after L4 hemilaminectomy and medial facetectomy L4-5. Due to the observed increases in stresses, the surgeon should be aware of the possibilities of stress-fractures in this patient group.
Kousaku Higashino, Koichi Sairyo, Shinsuke Katoh, Toshinori Sakai, Hirofumi Kosaka and Natsuo Yasui : Minimally invasive technique for direct repair of the pars defects in young adults using a spinal endoscope. A technical note., Minimally Invasive Neurosurgery : MIN, 50, 3, 186-190, 2007.
(Summary)
Pars defect (spondylolysis) of the lumbar spine can cause chronic low back pain, and it sometimes requires surgical intervention. Direct repair is selected for the surgery if young adult patients do not present significant disc degeneration and lumbar instability. In order to lessen damages of back muscles during surgery, we added the use of a spinal endoscope to the "Buck's screwing procedure" the direct repair. There are four steps in this procedure: 1) identification of the defect, 2) curettage (refresh) of the defect, 3) percutaneous insertion of the annulated screws and 4) cancellous bone grafting. All these steps can be done endoscopically. We treated 3 young adults--a baseball player, a professional cycle-racer and a sculptor--using this endoscopic procedure. There were no complications during or after the operation. Union was obtained in all defects within 3 months, and they returned to their previous activities within 6 months after the surgery.
Toshinori Sakai, Shinsuke Katoh, Koichi Sairyo, Kousaku Higashino, Nori Hirohashi and Natsuo Yasui : Extension of contained rupture of an abdominal aortic aneurysm into a lumbar intervertebral disc. Case report., Journal of Neurosurgery. Spine, 7, 2, 221-226, 2007.
(Summary)
Chronic contained rupture of an abdominal aortic aneurysm (AAA) is a rare event, making its diagnosis difficult. A delayed diagnosis and delayed surgical repair compromise the outcome. In this paper the authors report the case of a chronic contained rupture of an AAA causing spinal destruction, in which diagnosis was difficult because the lesion produced symptoms mimicking those of pyogenic spondylitis.
S Vadapalli, Koichi Sairyo, VK Goel, M Robon, A Biyani, A Khandha and NA. Ebraheim : Biomechanical rationale for using peek spacers for lumbar interbody fusion - a finite element study., Spine, 31, 26, 992-998, 2006.
(Summary)
To determine the effect of cage/spacer stiffness on the stresses in the bone graft and cage subsidence. To investigate the effect of cage stiffness on the biomechanics of the fused segment in the lumbar region using finite element analysis. There are a wide variety of cage/spacer designs available for lumbar interbody fusion surgery. These range from circular, tapered, rectangular with and without curvature, and were initially manufactured using titanium alloy. Recent advances in the medical implant industry have resulted in using medical grade polyetheretherketone (PEEK). The biomechanical advantages of using different cage material in terms of stability, subsidence, and stresses in bone graft are not fully understood. A previously validated 3-dimensional, nonlinear finite element model of an intact L3-L5 segment was modified to simulate posterior interbody fusion spacers made of PEEK ("E" = 3.6 GPa) and titanium ("E" = 110 GPa) at the L4/5 disc with posterior instrumentation. Bone graft ("E" = 12 GPa) packed between the spacers in the intervertebral space was also simulated. The posterior lumbar interbody fusion spacer with instrumentation and graft represent a simulation of the condition present immediately after surgery. The peak centroidal Von Mises stresses in the graft bone increased by at least 9-fold with PEEK spacers as compared to titanium spacer. The peak centroidal Von Mises stresses in the endplates increased by at least 2.4-fold with titanium spacers over the PEEK spacers. These stresses were concentrated at places where the spacer interfaced with the endplate. The stiffness of the spacer did not affect the relative motion (stability) across the instrumented (L4/5) segment. Spacers less stiff than the graft will: (1) provide stability similar to titanium cages in the presence of posterior instrumentation, (2) reduce the stresses in endplates adjacent to the spacers, and (3) increase the load transfer through the graft, as evident from the increase in stresses in graft.
Koichi Sairyo, VK Goel, A Faizan, S Vadapalli, S Biyani and N Ebraheim : Buck's Direct Repair of Lumbar Spondylolysis Restores Disc Stresses at the Involved and Adjacent Levels., Clinical Biomechanics, 21, 10, 1020-1026, 2006.
(Summary)
Lumbar spondylolysis was reported to cause disc degeneration at both caudal and cranial adjacent level. However, basic disc biomechanics in the spondylolytic spine is not fully understood. Purpose of this study was to analyze the disc stresses at cranial and caudal adjacent level of lumbar spondylolysis. Also, the biomechanical effects of Buck's technique on disc stresses at these two segments were evaluated. An experimentally validated three-dimensional non-linear finite element model of the intact ligamentous L3-S1 segment was used. Bilateral lumbar spondylolysis was simulated by creating bilateral pars defects with 1.0 mm gap at L5. Buck's direct repair model was simulated with 4.0 mm cannulated Titanium screws, placed bilaterally across the defect. Von Mises stresses in the annulus fibrosus and nucleus pulposus at L4/5 (cranial adjacent) and L5/S (caudal adjacent) disc levels were analyzed in flexion, extension, lateral bending and axial rotation in response to 400 N of axial compression and 10.6 Nm moment. The highest values were compared among the three models, intact, spondylolysis and Buck's technique. After spondylolysis occurred at L5, annulus fibrosus and nucleus pulposus stresses at L4/5 increased to 111% and 120%, respectively. After the Buck's technique it recovered to 102% and 105%, correspondingly. On the other hand, at L5/S, annulus fibrosus stress increased to 168%, and nucleus pulposus, 155%, which was much higher when compared to the stresses at L4/5. After the Buck's technique the stresses were decreased to 125% and 120%, correspondingly. During rotation motion, especially, the operation normalized the disc stress completely. Spondylolysis increases disc stresses at the affected as well as cranial adjacent level, and it may lead to disc degeneration at both levels. However, the increase in stresses is higher at the affected caudal level, when compared to the cranial level. Buck's technique may restore the disc stresses back to normal at both disc levels. Thus, this technique may be beneficial from a biomechanical perspective as well.
N Jonathan Grauer, Ashok Biyani, Ahmad Faizan, Ali Kiapour, Koichi Sairyo, Alex Ivanov, A Nabil Ebraheim, H Serhan, Ch Tushar Patel and K Vijay Goel : Biomechanics of two level Charite artificial disc placement in comparison to fusion plus single level disc placement combination, The Spine Journal, 6, 6, 659-666, 2006.
(Summary)
Biomechanical studies of artificial discs that quantify parameters such as load sharing and stresses have been reported in literature for single-level disc placements. However, literature on the effects of using the Charité artificial disc (ChD) at two levels (2LChD) as compared with one-level fusion (using a cage [CG] and a pedicle screw system) plus one-level artificial disc combination (CGChD) is sparse. To determine the effects of the 2LChD and CGChD across the implanted and adjacent segments. A finite element model of a L3-S1 segment was used to compare the biomechanical effects of the ChD placed at two lower levels (2LChD model) with L5-S1 fusion (using a CG and a pedicle screw system) plus L4-L5 level ChD placement combination (CGChD model). We used our recently published and experimentally validated L3-S1 finite element model for the present study. The intact model was subjected to 400 N axial compression and 10.6 Nm of flexion/extension moments. The experimental constructs described above were then subjected to 400 N axial compression and a moment that produced overall motion equal to the intact model predictions (hybrid testing protocol). Resultant motion, loads across facets, and other parameters were analyzed at the experimental and adjacent levels. In flexion, the bending moments for the CGChD and 2LChD models were 15.4 Nm (fusion effect) and 7.3 Nm (increase in flexibility effect), respectively in comparison to 10.6 Nm for the intact model. The corresponding values in the extension mode were 11.2 Nm and 7.2 Nm. The predicted flexion rotations across the L5-S1 segment for the CGChD decreased by 76% (fusion effect), and increased at the L4-L5 and the L3-L4 levels by 68.5% and 28%, respectively. In the extension mode, motion across the L5-S1 segment decreased by 96.4% whereas it increased 74.6% and 18.2% across the L4-L5 and L3-L4 levels, respectively. For the 2LChD model, the flexion rotation across the L5-S1 segment increased by 28.2%. The motions across the L4-L5 and L3-L4 segments decreased by 12% and 24%, respectively. In extension, the corresponding changes were 10% increase, 10% increase, and 21% decrease at the L5-S1, L4-L5, and L3-L4 levels, respectively. The facet loads were in line with the changes in motion, except for the 2LChD case. The changes at L3-L4 level for both of the cases were of similar magnitude (approximately 25%), although in the CGChD model it increased and in the 2LChD model it decreased. The changes in motion at the L4-L5 level were large for the CGChD model as compared with the 2LChD model predictions (approximately 70% increase vs. 10% increase). It is difficult to speculate if an increase in motion across a segment, as compared with the intact case, is more harmful than a decrease in motion.
(Keyword)
Biomechanical Phenomena / finite element analysis / Humans / Intervertebral Disc / Lumbar Vertebrae / Models, Neurological / Range of Motion, Articular / Spinal Fusion
Sasidhar Vadapalli, Matt Robon, Ashok Biyani, Koichi Sairyo, K Vijay Goel, Ashutosh Khandha and M Malak : Effect of lumbar interbody cage geometry on construct stability: a cadaveric study., Spine, 31, 19, 2189-2194, 2006.
(Summary)
Biomechanical study to investigate three-dimensional motion behavior of cadaveric spines in various surgical simulations. To determine the effect of cage geometry on the construct stability. There is a wide variety of cage/spacer designs available for lumbar interbody fusion surgery. These range from circular, tapered, and rectangular with and without curvature. However, the effectiveness of cages with different designs and materials to stabilize a decompressed intervertebral space has not been fully studied. Six fresh ligamentous lumbar spine specimens (L1-S2) were subjected to pure moments in the six loading directions. The resulting spatial orientations of the vertebrae were recorded using Optotrak Motion Measurement System. Measurements were made sequentially for intact, bilateral spacer placements across L4-L5 using a posterior approach, supplemented with pedicle screw-rod system fixation, and after the cyclic loading in flexion-extension mode. The stability tended to decrease after the bilateral cage placement as compared with the intact for all loading cases except flexion. In flexion, the angular displacement decreased to 80% of the intact. However, there was no significant statistical difference seen in stability between intact and after bilateral spacer placement. Following the addition of posterior fixation using pedicle screw-rod system, the stability significantly increased in all directions. Cyclic loading did not have any significant effect on the stability. Stand-alone cages restore motion to near-intact levels at best, and supplement instrumentation is essential for significantly increasing the stability of the decompressed segment. The effects of cage geometry and Young's modulus of the cage material do not seem to influence the stability, as compared with the other cagedesigns, especially after supplemental fixation with a posterior system.
(Keyword)
Aged / Aged, 80 and over / Biomechanics / Cadaver / Equipment Design / Female / Humans / Internal Fixators / Joint Instability / Lumbar Vertebrae / Male / Middle Aged / Range of Motion, Articular / Spinal Fusion
Shinji Komatsubara, Koichi Sairyo, Shinsuke Katoh, Tadanori Sakamaki, Kousaku Higashino and Natsuo Yasui : High-grade slippage of the lumbar spine in a rat model of spondylolisthesis: effects of cyclooxygenase-2 inhibitor on its deformity., Spine, 31, 16, 528-534, 2006.
(Summary)
Radiographic and histologic evaluation of spondylolisthesis in a rat model. To investigate the effects of etodolac, a cox-2 inhibitor, on the severity of spondylolisthesis in a 4-week-old rat model. Spondylolisthesis occurs associated with spondylolysis in some pediatric patients. In such patients, the percent of forward slippage varies individually ranging between 0% and 100%. The factors determining the severity of forward slippage have not been clarified as yet. In earlier studies, we found that growth plate stress fracture was the basic lesion and that slippage was a consequence of the stress fracture. Hence, we hypothesized that the capacity of bone healing might be an important determinant of the degree of forward slippage. A lumbar spine slippage model was prepared in 4-week-old rats with vertebral physis fracture. To disrupt the fracture healing, the cyclooxygenase-2 (cox-2) inhibitor etodolac was used, and its effects on slippage and deformity were evaluated radiologically and histologically. In the etodolac group, forward slip significantly increased (P < 0.05) to the Meyerding Grade III while in the control rats it was Grade I or II. Bone remodeling of the vertebral body was suppressed by etodolac. Histologically, epiphyseal separation with slippage was observed in all the control and etodolac-treated rats. However, in the etodolac-treated group, the epiphyseal plate was greatly separated and did not present periosteal thickening at the physis fracture site. Vertebral forward slippage occurred in young rats after epiphyseal separation. In the etodolac group, slippage increased as deterioration of the bone healing capacity increased. Poor bony healing is suggested as one of the determinants of high-grade spondylolisthesis in children and adolescents.
(Keyword)
Animals / Bone Remodeling / Cyclooxygenase 2 Inhibitors / Dose-Response Relationship, Drug / Etodolac / Female / Growth Plate / Lumbar Vertebrae / Rats / Rats, Wistar / Severity of Illness Index / Spinal Fractures / Spondylolisthesis / Wound Healing
Koichi Sairyo, Goel K. Vijay, S Vadapalli, Vishnubhotra Lakshmi Sri, Biyani Ashok, Ebraheim A. Nabil, Terai Tomoya and Toshinori Sakai : Biomechanical comparison of lumbar spine with or without spina bifida occulta. A finite element analysis., Spinal Cord, 44, 7, 440-444, 2006.
(Summary)
Biomechanical study using finite element model (FEM) of lumbar spine. Very high coincidence of spina bifida occulta (SBO) has been reported more than in 60% of lumbar spondylolysis. The altered biomechanics due to SBO is one considerable factor for this coincidence. Thus, in this study, the biomechanical changes in the lumbar spine due to the presence of SBO were evaluated. United States of America (USA). An experimentally validated three-dimensional nonlinear FEM of the intact ligamentous L3-S1 segment was used and modified to simulate two kinds of SBO at L5. One model had SBO with no change in the length of the spinous process and the other had a small dysplastic spinous process. Von Mises stresses at pars interarticularis were analyzed in the six degrees of lumbar motion with 400 N axial compression, which simulates the standing position. The range of motion at L4/5 and L5/S1 were also calculated. It was observed that the stresses in all the models were similar, and there was no change in the highest stress value when compared to the intact model. The range of motion was also similar in all the models. The lumbar kinematics of SBO was thus shown to be similar to the intact model. SBO does not alter lumbar biomechanics with respect to stress and range of motion. The high coincidence of spondylolysis in spines with SBO may not be due to the mechanical factors.
Jiayong Liu, Nabil Ebraheim, Steven P Haman, Chris H Sanford, Koichi Sairyo, Ahmad Faizan, Lee Woldenberg and Vijay K Goel : How the increase of the cervical disc space height affects the facet joint - an anatomy study., Spine, 31, 12, 350-354, 2006.
(Summary)
In vitro study on the effect of increasing the height of the cervical disc space on the facet joint. To demonstrate how facet joint articulation is affected by increasing the cervical disc space height. A surgeon attempts to increase the disc space and inserts a larger artificial disc than normal in order to keep the intervertebral foramen open and the prosthesis stable. However, it is hypothesized by the current authors that this procedure could have an adverse effect on the facet joints. Computerized tomography images passing through the disc space and the center of the C4-C7 facet joints (sagittal plane) were obtained from 15 cadaveric cervical spine specimens. A 1-mm incremental increase to a total 5 mm in disc space height was performed to simulate the changes seen in disc replacement. The change in the facet joint articulation overlap and space in the sagittal plane at normal and each displacement was measured. Each 1-mm incremental increase in disc space at C4-C5 translated to a decrease in the facet joint articulation overlap in the sagittal plane by approximately 8%. The mean facet joint space increased approximately 0.8 mm. At the C5-C6 and the C6-C7 levels, the articulation overlap decreased by approximately 7% and the facet joint space increased approximately 0.8 mm. There is a significant decrease of the facet joint articulation overlap in the sagittal plane and an increase in the facet joint space following an increase in the cervical disc space. The inappropriate increase of the disc space height may result in facet joint subluxation and could lead to the accelerated failure of the artificial disc.
Koichi Sairyo, Vijay K Goel, Akiyoshi Masuda, Srilakshmi Vishnubhotla, Ahmad Faizan, Ashok Biyani, Nabil Ebraheim, Daisuke Yonekura, Riichi Murakami and Tomoya Terai : Three dimensional finite element analysis of the pediatric lumbar spine. Part II: biomechanical change as the initiating factor for pediatric isthmic spondylolisthesis at the growth plate., European Spine Journal, 15, 6, 930-935, 2006.
(Summary)
A non-linear 3-dimensional finite element pediatric lumbar spine model with vertebral growth plate and apophyseal bony ring was developed. Lumbar spondylolysis was simulated in the model. The Von Mises stresses in the structures surrounding the vertebral growth plate, including apophyseal bony ring and osseous endplate were calculated in various loading modes. Instantaneous axis of rotation (IAR) path from flexion to extension was also analyzed. The results were compared with those of the intact model and the literature. The IAR path was at the posterior disc-endplate space of the lower vertebra in the intact spine, and moved cranially towards the upper-posterior disc space in the lytic spine. This was in agreement with in vivo radiological data by Sakamaki et al. [19]. During various loading modes, stresses in the spondylolytic pediatric model were higher than that of the intact model; ranging from 1.1 to 6.0 times, with the highest value in extension at the growth plate. In conclusion, FE models indicate that stress concentrations in the lytic model increase at the growth plate which may lead to physis stress fracture leading to spondylolisthesis.
Koichi Sairyo, Vijay K Goel, Akiyoshi Masuda, Srilakshmi Vishnubhotla, Ahmad Faizan, Ashok Biyani, Nabil Ebraheim, Daisuke Yonekura, Riichi Murakami and Tomoya Terai : Three-dimensional finite element analysis of the pediatric lumbar spine. Part I: pathomechanism of apophyseal bony ring fracture., European Spine Journal, 15, 6, 923-929, 2006.
(Summary)
The purpose of this study was to (1) develop a three-dimensional, nonlinear pediatric lumbar spine finite element model (FEM), and (2) identify the mechanical reasons for the posterior apophyseal bony ring fracture in the pediatric patients. The pediatric spine FE model was created from an experimentally validated three-dimensional adult lumbar spine FEM. The size of the FEM was reduced to 96% taking into account of the ratio of the sitting height of an average 14-years-old children to that of an adult. The pediatric spine was created with anatomically specific features like the growth plate and the apophyseal bony ring. For the stress analyses, a 10-N m moment was applied in all the six directions of motion for the lumbar spine. A preload of 351 N was applied which corresponds to the mean body weight of the 14-years-old group. The stresses at the apophyseal bony ring, growth plate and endplate were calculated. The results indicate that the structures surrounding the growth plate including apophyseal bony ring and osseous endplate were highly stressed, as compared to other structures. Furthermore, posterior structures in extension were in compression whereas in flexion they were in tension, with magnitude of stresses higher in extension than in flexion. Over time, the higher compression stresses along with tension stresses in flexion may contribute to the apophyseal ring fracture (fatigue phenomena).
Terai Tomoya, Henmi Tatsuhiko, Kanematsu Yoshiji, Fujii Koji, Mishiro Takuya, Toshinori Sakai and Koichi Sairyo : Adult onset tethered cord syndrome associated with intradural dermoid cyst. A case report., Spinal Cord, 44, 4, 260-262, 2006.
(Summary)
A case report and a review of literature. To describe a rare case of adult onset tethered cord syndrome associated with intradural dermoid cyst. General Orthopedics, Japan. A 50-year-old woman was referred to us because of right leg pain and pollakiuria. Neurological examinations and radiological assessments including myelography, computerized tomography scan and Magnetic resonance image were carried out. We diagnosed it as the adult onset tethered cord syndrome associated with an intradural cystic lesion. The cystic lesion was totally removed following laminectomy from L5 through S4. Histologically, the tumor was diagnosed as a dermoid cyst. Intradural dermoid could produce adult onset tethered cord syndrome, but it was not reported in the English literatures to our knowledge.
Toshinori Sakai, Yamada Hidehiro, Nakamura Taro, Nanamori Kazuhisa, Yoshiteru Kawasaki, Hanaoka Naoyoshi, Nakamura Eijiro, Uchida Ken, Goel K. Vijay, Vishnubhotra Lakshmi Sri and Koichi Sairyo : Lumbar spinal disorders in patients with athetoid cerebral palsy. A clinical and biomechanical study., Spine, 31, 3, E66-E70, 2006.
(Summary)
Radiologic study for patients with athetoid cerebral palsy (CP), and a biomechanical study using the finite-element model (FEM). To understand the lumbar disorders of athetoid CP patients and the etiology based on the results from the FEM study. Cervical spondylotic myelopathy is a well-identified spinal disorder associated with cerebral palsy, especially in athetoid type. One can rationalize that the athetoid involuntary trunk movement may induce stress-related lumbar disorders. Until now, very few investigations have been conducted on lumbar disorders that could occur in patients with CP. Sixty-one cases with athetoid cerebral palsy were clinically reviewed. Radiographs of the lumbar spine in 30 cases with low back pain were taken. From these radiographs, the incidence of lumbar spondylolysis and endplate lesion was analyzed. The biomechanical study was conducted using a three-dimensional FEM of the ligamentous lumbar spine. Axial compression of 400 N was applied to simulate preload on the spine during the standing position followed with 10.6 Nm moment to simulate extension and axial rotation. The combined motion of extension and axial rotation was also simulated. During supine position, pure extension and rotation were simulated, and no preload was applied. The von Mises stresses were computed at the pars interarticularis at the each level and compared for different motions. Among the 61 patients, 41 complained of symptoms such as low back and leg pain. Thirty of these 41 patients gave their consents to undergo radiographic evaluation. Twenty-eight of the 30 patients (93.3%) showed stress-related disorders such as the spondylolysis and/or vertebral endplate lesions. Spondylolysis was found in 18 of the 30 patients (60.0%). Spondylolysis was observed at the multiple levels in 4 patients involving two levels in 2 cases and three levels in the other 2 cases. Vertebral endplate lesions (deformity) were seen in 26 (86.7%) of the 30 patients. Overall, the lesions (deformity) were found in 109 of 330 endplates (33.0%) out of all lumbar endplates in the 30 patients. The FEM based results showed that stresses at pars interarticularis of L5 were the highest of all levels in all loading modes, with or without preload. However, compared with the extension or axial rotation alone modes, the combined motion of extension and rotation showed higher stresses at the pars interarticularis. The athetoid involuntary movements in CP patients may cause stress-related lumbar disorders. Especially, combined extension and rotation due to the involuntary trunk motion may contribute to the high incidence of spondylolysis.
Ami Inui, Koichi Sairyo, Shinsuke Katoh, Kousaku Higashino, Toshinori Sakai, M Shiiba and Natsuo Yasui : Extruded lumbar osseous endplate causing long-term radiculopathy in an adult: an endoscopic excision., Minimally Invasive Neurosurgery : MIN, 49, 1, 55-57, 2006.
(Summary)
In this report, we described an adult case that had a long-term radiculopathy due to an extruded osseous endplate of the lumbar spine at the L5-S1 intervertebral disc level. The osseous material inside the extruded material was not absorbed, and it had continued compressing the nerve root for one year. Endoscopically, the bony fragment was successfully removed. After the surgery, the patient's symptom disappeared, and neurological deficits became normalized. In conclusion, we propose that surgical intervention should be taken into account for the treatment of HNP, when the extruded material contains bony fragment such as osseous endplate.
Koichi Sairyo, Shinsuke Katoh, Yoichiro Takata, Tomoya Terai, Natsuo Yasui, K Vijay Goel, Akiyoshi Masuda, Sasidhar Vadapalli, Ashok Biyani and Nabil Ebraheim : MRI signal changes of the pedicle as an indicator for early diagnosis of spondylolysis in children and adolescents. A clinical and biomechanical study., Spine, 31, 2, 206-211, 2006.
(Summary)
Clinical review of pediatric patients with lumbar spondylolysis and biomechanical analysis using finite-element lumbar spine model. To evaluate the usefulness of the signal changes observed on MR images of the pedicle for the early diagnosis of spondylolysis, and to investigate the pathomechanism of the signal changes based on the stresses in pedicles, as predicted using finite-element analyses. Furthermore, to evaluate the usefulness of the signal change to predict the bony healing following conservative treatment. Since early-stage spondylolysis can achieve osseous healing conservatively, it is important to diagnose this disorder as early as possible. Presently, there is no well-established, noninvasive, and reliable diagnostic tool for the early diagnosis. Thirty-seven pediatric patients with spondylolysis were included. Sixty-eight defects were examined and their stages as revealed on CT scans were recorded. High signal changes (HSC) of the pedicles on axial T2-weighted MRI were compared with the CT-based stages of the defect. Among them, 16 patients, including 15 boys and 1 girl, were treated conservatively for at least a 3-month period. Bony healing of the fracture site was evaluated on CT, and the results were compared between two groups with or without HSC at the initial consultation. Using a three-dimensional nonlinear finite-element model of the L3-L5 segment, stress distributions in the pars and pedicle regions were analyzed in response to 400 N compression and 10.6 Nm moment. Based on CTs, 68 pars defects were classified as follows: 8 very early, 24 late-early, 16 progressive, and 20 terminal stages. All defects in very early and late-early stages (100%) showed HSC on T2-weighted MRI at the ipsilateral pedicle. Among 16 progressive stages, eight (50%) showed HSC, while no defects of the terminal stage (0%) were found to have HSC. In total, 29 pars defects were treated conservatively out of 16 patients. In 19 of the HSC positive defects, 15 (79%) showed bony healing after the conservative treatment, whereas none of the 10 HSC negative defects (0%) showed any healing. The results were statistically significant at P < 0.05 (chi). Stress results from the finite-element model indicated that pars interarticularis showed the highest value in all loading modes, and the pedicle showed the second highest. The correlation between the high stresses in the pedicle and the corresponding HSC suggest that signal changes in MRI could be used as an indicator for early diagnosis of spondylolysis. The HSC of the pedicle provided useful information to diagnose early stage spondylolysis. Furthermore, the HSC may be a good indicator as to whether a bony union will result from conservative treatment.
(Keyword)
Adolescent / biomechanics / Child / Early Diagnosis / Female / Follow-Up Studies / Humans / Lumbar Vertebrae / magnetic resonance imaging / Male / Retrospective Studies / Spondylolysis
Koichi Sairyo, Vijay K Goel, Ashok Biyani, Nabil Ebraheim, Akiyoshi Masuda and Jinjiau Liu : Decompression surgery for lumbar spondylolysis without fusion: A review article., The Internet Journal of Spine Surgery, 2, 2, 2006.
Kousaku Higashino, Shinsuke Katoh, Koichi Sairyo, Toshinori Sakai, Hirofumi Kosaka and Natsuo Yasui : Preservation of C7 spinous process does not influence the long-term outcome after laminoplasty for cervical spondylotic myelopathy., International Orthopaedics, 30, 5, 362-365, 2006.
(Summary)
Axial pain is one of the major complications after laminoplasty, and preservation of C7 spinous process during the procedure can reduce the axial pain. However, it has not been elucidated whether laminoplasty preserving the C7 spinous process can maintain neurological improvement for a long time. The purpose of our retrospective study was to investigate the long-term neurological outcome after open-door laminoplasty preserving the C7 spinous process for cervical spondylotic myelopathy (CSM). Clinical and radiological outcomes were analysed in 42 patients who underwent open-door laminoplasty preserving C7 spinous process and followed up for more than 5 years. Neurological function was evaluated by means of the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. Axial pain was assessed using a visual analog scale (VAS) at the last examination. Alignment and motion of the cervical spine were measured from radiographs, and magnetic resonance imaging (MRI) was used to evaluate postoperative compression at C7. The mean JOA score was 9.4 before surgery and 12.0 at the latest follow-up. The mean VAS score in 26 patients score was 9.7/100. No compression of the spinal cord was observed in any MRI at the latest follow-up. Preservation of the C7 spinous process does not influence the long-term outcome of CSM after laminoplasty. Although we did not have a comparative group, the procedure described here should be considered as the solution.
Takayuki Ogawa, Takeshi Nikawa, Harumi Furochi, Miki Kosyoji, Katsuya Hirasaka, Naoto Suzue, Koichi Sairyo, Shunji Nakano, Takashi Yamaoka, Mitsuo Itakura, Kyoichi Kishi and Natsuo Yasui : Osteoactivin upregulates expression of MMP-3 and MMP-9 in fibroblasts infiltrated into denervated skeletal muscle in mice, American Journal of Physiology, Cell Physiology, 289, 3, C697-C707, 2005.
(Summary)
In this study, we examined pathophysiological roles of osteoactivin, a functionally unknown type I membrane glycoprotein, in mouse skeletal muscle atrophied by denervation (sciatic neurectomy). Denervation increased the amounts of osteoactivin, vimentin, matrix metalloproteinase-3 (MMP-3), and MMP-9 in mouse gastrocnemius muscle. Interestingly, immunohistochemical analysis revealed that vimentin, MMP-3, and MMP-9 were mainly present in fibroblast-like cells infiltrated into denervated mouse gastrocnemius muscle, whereas osteoactivin was expressed in the sarcolemma of myofibers adjacent to the fibroblast-like cells. On the basis of these findings, we reasoned that osteoactivin in myocytes was involved in activation of the infiltrated fibroblasts. To address this issue, we examined effects of osteoactivin on expression of MMPs in fibroblasts in vitro and in vivo. Overexpression of osteoactivin in NIH-3T3 fibroblasts induced expression of MMP-3, but not in mouse C(2)C(12) myoblasts, indicating that osteoactivin might functionally target fibroblasts. Treatment with recombinant mouse osteoactivin increased the amounts of collagen type I, MMP-3, and MMP-9 in mouse NIH-3T3 fibroblasts. The upregulated expression of these fibroblast marker proteins was significantly inhibited by heparin, but not by an integrin inhibitor, indicating that a heparin-binding motif in the extracellular domain might be an active site of osteoactivin. In osteoactivin-transgenic mice, denervation further enhanced expression of MMP-3 and MMP-9 in fibroblasts infiltrated into gastrocnemius muscle, compared with wild-type mice. Our present results suggest that osteoactivin might function as an activator for fibroblasts infiltrated into denervated skeletal muscles and play an important role in regulating degeneration/regeneration of extracellular matrix.
Cyclooxigenase-2 (COX-2) inhibitors have been reported to delay fracture healing. To investigate the major inhibitory period of COX-2 inhibitors in fracture healing, we administrated etodolac, a COX-2-specific inhibitor, to a rat fracture model by altering the period of administration from early to late. After closed fractures had been created at the middle of the femoral shafts in 12-week-old Wister rats, a standardized dose of etodolac was administrated in three ways: group I received it for 3 weeks, group II for just the first week after operation, and group III for just the third (final) week. Group IV was the vehicle control group. Bone maturation was estimated by radiographic scoring system, and mechanically by a three-point bending test. In both the radiographic and mechanical studies, groups I and II showed lower scores than group IV, indicating that even a short period of administration of a COX-2-specific inhibitor in the early phase of fracture healing creates a risk of delayed healing. blacksquare, square, filled.
Koichi Sairyo, Shinsuke Katoh, Takahiro Sasa, Natsuo Yasui, K Vijay Goel, Sasidhar Vadapalli, Akiyoshi Masuda, Ashok Biyani and Nabil Ebraheim : Athletes With Unilateral Spondylolysis Are at Risk of Stress Fracture at the Contralateral Pedicle and Pars Interarticularis, --- A Clinical and Biomechanical Study ---, The American Journal of Sports Medicine, 33, 4, 583-590, 2005.
(Summary)
Unilateral spondylolysis is common in youths; its clinical and biomechanical features, especially effects on the contralateral side, are not fully understood. Unilateral spondylolysis predisposes the contralateral side to stress fracture, especially in athletes actively engaged in sporting activities involving torsion of the trunk. Case series and descriptive laboratory study. Thirteen athletes younger than age 20 with unilateral spondylolysis were included. The contralateral pedicle and pars of spondylolytic vertebrae were examined using computed tomography and magnetic resonance imaging. Using a finite element model of the intact ligamentous L3-S1 segment, stress distributions were analyzed in response to 400-N axial compression and 10.6-N.m moment in flexion, extension, lateral bending, and axial rotation. Unilateral spondylolysis was created in the model at L5. The stress results from the unilateral defect model were compared to the intact model predictions and correlated to the contralateral defects seen in patients. Among 13 patients, there were 6 early-, 2 progressive-, and 5 terminal-stage defects. Three (23.1%) showed contralateral stress fracture. Among them, 2 belonged to the progressive-stage and 1 to the terminal-stage spondylolysis group. The remaining 4 patients in the terminal defect group showed stress reactions, such as sclerosis at the contralateral pedicle. In the finite element analysis model with an L5 left spondylolysis, the stresses at the contralateral and pars interarticularis were found to increase in all loading modes, with increases as high as 12.6-fold compared to the intact spine. Unilateral spondylolysis could lead to stress fracture or sclerosis at the contralateral side due to an increase in stresses in the region. Surgeons should be aware of possibility of contralateral stress fractures in cases in which patients, especially athletes engaged in active sports, show unilateral spondylolysis and persistent low back pain complaints.
V Goel, J Grauer, T Patel, A Biyani, Koichi Sairyo, S Vishnubhotla, A Matyas, I Cowgill, M Shaw, R Long, D Dick, M Panjabi and H Serhan : Effects of Charite artificial disc on the implanted and adjacent spinal segments mechanics using a hybrid testing protocol., Spine, 30, 24, 2755-2764, 2005.
(Summary)
Finite element model of L3-S1 segment and confirmatory cadaveric testing were used to investigate the biomechanical effects of a mobile core type artificial disc (Charité artificial disc; DePuy Spine, Raynham, MA) on the lumbar spine. To determine the effects of the Charité artificial disc across the implanted and adjacent segments. Biomechanical studies of artificial discs that quantify parameters, like the load sharing and stresses, are sparse in the literature, especially for mobile-type core artificial disc designs. In addition, there is no standard protocol for studying the adjacent segmental effects of such implants. Human osteo-ligamentous spines (L1-S1) were tested before and after L5-S1 Charité artificial disc placement. The data were used to validate further an intact 3-dimensional (3-D) nonlinear L3-S1 finite element model. The model was subjected to 400-N axial compression and 10.6 Nm of flexion/extension pure moments (load control) or pure moments that produced the overall rotation of the L3-S1 Charité model equal to the intact case (hybrid approach). Resultant motion, load, and stress parameters were analyzed at the experimental and adjacent levels. Finite element model validation was achieved only with the load-controlled experiments. The hybrid approach, believed to be more clinically relevant, revealed that Charité artificial disc leads to motion increases in flexion (19%) and extension (44%) at the L5-S1 level. At the instrumented level, the decrease in the facet loads was less than at the adjacent levels; the corresponding decrease being 26% at L3-L4, 25% at L4-L5, and 13.4% at L5-S1 when compared to the intact. Intradiscal pressure changes in the L4-L5 and L3-L4 segments were minimal. Shear stresses at the Charité artificial disc-L5 endplate interface were higher than those at S1 interface. However, in the load control mode, the increase in facet loads in extension was approximately 14%, as compared to the intact case. The hybrid testing protocol is advocated because it better reproduces clinical observations in terms of motion following surgery, using pure moments. Using this approach, we found that the Charité artificial disc placement slightly increases motion at the implanted level, with a resultant increase in facet loading when compared to the adjacent segments, while the motions and loads decrease at the adjacent levels. However, in the load control mode that we believe is not that clinically relevant, there was a large increase in motion and a corresponding increase in facet loads, as compared to the intact.
A Biyani, Koichi Sairyo, J Liljenquist and VK Goel : Ipsilateral pedicle screw fixation and contralateral translaminar facet screw placement in conjunction with TLIF: Technical Note., The Internet Journal of Spine Surgery, 2, 2, 2005.
Koichi Sairyo, Ashok Biyani, K Vijay Goel, Douglas Leaman, Robert Booth, Jean Thomas, Daniel Gehning, S Vishnubhotla and Nabil Ebraheim : Pathomechanism of ligamentum flavum hypertrophy: a multidisciplinary investigation based on clinical, biomechanical, histologic, and biologic assessments., Spine, 30, 23, 2649-2656, 2005.
(Summary)
A multidisciplinary study involving clinical, histologic, biomechanical, biologic, and immunohistologic approaches. OBJECTIVE.: To clarify the pathomechanism of hypertrophy of the ligamentum flavum. The most common spinal disorder in elderly patients is lumbar spinal canal stenosis, causing low back and leg pain, and paresis. Canal narrowing, in part, results from hypertrophy of the ligamentum flavum. Although histologic and biologic literature on this topic is available, the pathomechanism of ligamentum flavum hypertrophy is still unknown. The thickness of 308 ligamenta flava at L2/3, L3/4, L4/5, and L5/S1 levels of 77 patients was measured using magnetic resonance imaging. The relationships between thickness, age, and level were evaluated. Histologic evaluation was performed on 20 ligamentum flavum samples, which were collected during surgery. Trichrome and Verhoeff-van Gieson elastic stains were performed for each ligamentum flavum to understand the degree of fibrosis and elastic fiber status, respectively. To understand the mechanical stresses in various layers of ligamentum flavum, a 3-dimensional finite element model was used. Von Mises stresses were computed, and values between dural and dorsal layers were compared. There were 10 ligamenta flava collected for biologic assessment. Using real-time reverse transcriptase polymerase chain reaction, transforming growth factor (TGF)-beta messenger ribonucleic acid expression was quantitatively measured. The cellular location of TGF-beta was also confirmed from 18 ligamenta flava using immunohistologic techniques. The ligamentum flavum thickness increased with age, however, the increment at L4/5 and L3/4 levels was larger than at L2/3 and L5/S1 levels. Histology showed that as the ligamentum flavum thickness increased, fibrosis increased and elastic fibers decreased. This tendency was more predominant along the dorsal side. Von Misses stresses revealed that the dorsal fibers of ligamentum flavum were subjected to higher stress than the dural fibers. This was most remarkably observed at L4/5. The largest increase in ratio observed between the dorsal and dural layer was approximately 5-fold in flexion at L4/5 in flexion. Expression of TGF-beta was observed in all ligamenta flava, however, the expression decreased as the ligamentum flavum thickness increased. Immunohistochemistry showed that TGF-beta was released by the endothelial cells, not by fibroblasts. Fibrosis is the main cause of ligamentum flavum hypertrophy, and fibrosis is caused by the accumulation of mechanical stress with the aging process, especially along the dorsal aspect of the ligamentum flavum. TGF-beta released by the endothelial cells may stimulate fibrosis, especially during the early phase of hypertrophy.
Tadanori Sakamaki, Hiroshi Mikami, Yuji Okada, Tetsuya Tamura, Kazuhito Shinohara, Takuya Mishiro and Koichi Sairyo : Signal intensity of cerebrospinal fluid on MR images can indicate the severity of lumbar spinal canal stenosis., The Internet Journal of Spine Surgery, 1, 2, 2005.
Koichi Sairyo, Shinsuke Katoh, Shinji Komatsubara, Ttomoya Terai, Natsuo Yasui, K Vijay Goel, Sasidhar Vadapalli, Ashok Biyani and Nabil Ebraheim : Spondylolysis fracture angle in children and adolescents on CT indicates the facture producing force vector A biomechanical rationale., The Internet Journal of Spine Surgery, 1, 2, 2005.
Koichi Sairyo, VK Goel, A Masuda, A Biyani, N Ebraheim, Takuya Mishiro and Tomoya Terai : Biomechanical Rationale of Endoscopic Decompression for Lumbar Spondylolysis As An Effective Minimally Invasive Procedure - A study based on the Finite Element Analysis., Minimally Invasive Neurosurgery : MIN, 48, 2, 119-122, 2005.
(Summary)
We evaluated the biomechanical behavior of the endoscopic decompression for lumbar spondylolysis using the finite element technique. An experimentally validated, 3-dimensional, non-linear finite element model of the intact L3 - 5 segment was modified to create the L4 bilateral spondylolysis and left-sided endoscopic decompression. The model of Gill's laminectomy (conventional decompression surgery of the spondylolysis) was also created. The stress distributions in the disc and endplate regions were analyzed in response to 400 N compression and 10.6 Nm moment in clinically relevant modes. The results were compared among three models. During the flexion motion, the pressure in the L4/5 nucleus pulposus was 0.09, 0.09 and 0.16 (MPa) for spondylolysis, endoscopic decompression and Gill's procedure, respectively. The corresponding stresses in the annulus fibrosus were 0.65, 0.65 and 1.25 (MPa), respectively. The stress at the adjoining endplates showed an about 2-fold increase in the Gill's procedure compared to the other two models. The stress values for the endoscopic and spondylolysis models were of similar magnitudes. In the other motions, i. e., extension, lateral bending, or axial rotation, the results were similar among all of the models. These results indicate that the Gill's procedure may lead to an increase in intradiscal pressure (IDP) and other biomechanical parameters after the surgery during flexion, whereas the endoscopic decompression did not change the segment mechanics after the surgery, as compared to the spondylolysis alone case. In conclusion, endoscopic decompression of the spondylolysis, as a minimally invasive surgery, does not alert mechanical stability by itself.
Takahiro Sasa, Koichi Sairyo, Naoyuki Yoshida, Mari Fukunaga, Keiko Koga, Makoto Ishikawa and Natsuo Yasui : Continuous muscle stretch prevents disuse muscle atrophy and deterioration of its oxidative capacity in rat tail-suspension models, American Journal of Physical Medicine & Rehabilitation, 83, 11, 851-856, 2004.
(Summary)
The purpose of this study was to evaluate the effect of continuous muscle stretch on disuse-atrophied muscles. Sprague-Dawley rats were used and divided into five groups: control group, hind limb suspended for 3 and 7 days, and hind-limb suspension plus strenuous continuous muscle stretch for 3 and 7 days. In the hind-limb suspension plus strenuous continuous muscle stretch groups, the gastrocnemius-plantaris-soleus muscles were stretched using a plastic plate that immobilized the ankle joint at the maximum dorsal flexed position during the hind-limb suspension period. The intracellular energy metabolism of the working muscle during electric stimulation was evaluated by phosphorus-31 magnetic resonance spectroscopy in vivo. Changes in phosphocreatine, inorganic phosphate, and the intracellular pH were monitored to evaluate intramuscular oxidative capacity. Maximum tension and muscle wet mass were also measured. The oxidative capacity, muscle wet weight, and maximum tension decreased after hind-limb suspension. The muscle oxidative capacity at control levels was maintained during the first 3 days in muscles subjected to continuous strenuous stretch. It was also effective to prevent the decrease in muscle mass and maximum twitch tension during the initial 3 days. However, the effects did not persist. Continuous strenuous stretch was effective to prevent disuse muscle atrophy and its functional deterioration; however, its effects did not last long.
Koichi Sairyo, Shinsuke Katoh, Tadanori Sakamaki, Megumi Inoue, Shinji Komatsubara, Takayuki Ogawa, Toshiaki Sano, K. Vijay Goel and Natsuo Yasui : Vertebral forward slippage in immature lumbar spine occurs following epiphyseal separation and its occurence is unrelated to disc degeneration. Is the pediatric spondylolisthesis a physis stress fracture of vertebral body?, Spine, 29, 5, 524-527, 2004.
(Summary)
Radiographic and histologic evaluation of a rat model of lumbar spine slippage. To clarify the pathomechanism of slippage in the immature spine. There are controversial hypotheses regarding the pathogenesis of slippage of the pediatric spine with pars defects. Some studies supported that disc degeneration was its cause, while others indicated the growth plate injury was the cause. An immature lumbar spine slippage model in 4-week-old rats was used. Following posterior destabilizing surgery, the lumbar spine was radiographically and histologically examined at 1, 3, 5, and 7 days after surgery. Radiographically, slippage occurred about 7% in the % slip on day 7, and no slippage was observed before day 5. Histologically, epiphyseal separation also appeared on day 7; before day 5, the growth plate showed no abnormalities. Within 7 days after the operation, the anulus fibrosus did not show any sign indicating degeneration. The nucleus pulposus was also normal up to day 7. The findings of this study support the hypothesis that vertebral forward slippage of the immature spine occurs following epiphyseal separation and its occurrence is unrelated to disc degeneration.
K Fujii, Shinsuke Katoh, Koichi Sairyo, T Ikata and Natsuo Yasui : Union of defects in the pars interarticularis of the lumbar spine in children and adolescents. Radiological outcome after conservative treatment., The Journal of Bone and Joint Surgery. British Volume, 86, 2, 225-231, 2004.
(Summary)
Lumbar spondylolysis can heal with conservative treatment, but few attempts have been made to identify factors which may affect union of the defects in the pars. We have evaluated, retrospectively, the effects of prognostic variables on bony union of pars defects in 134 young patients less than 18 years of age with 239 defects of the pars who had been treated conservatively. All patients were evaluated by CT scans when first seen and more than six months later at follow-up. The results showed that the spinal level and the stage of the defects were the predominant factors. The site of the defects in the pars, the presence or development of spondylolisthesis, the condition of the contralateral pars, the degree of lumbar lordosis and the degree of lumbar inclination all significantly affected union.
Takahiro Sasa, Koichi Sairyo, Naoyuki Yoshida, Makoto Ishikawa, Mari Fukunaga and Natsuo Yasui : Muscular oxidative capacity in ovariectomized rats discussion on the endurance performance of female athletes with sports-related-amenorrhea, Journal of Sports Science & Medicine, 3, 15-22, 2004.
Koichi Sairyo, Shinsuke Katoh, T Sakamki, S. Komatsubara and Natsuo Yasui : Three successive stress fractures at the same vertebral level in an adolescent baseball player, The American Journal of Sports Medicine, 31, 4, 606-610, 2003.
(Keyword)
Adolescent / Baseball / Bone Transplantation / Fractures, Stress / Humans / Low Back Pain / Lumbar Vertebrae / magnetic resonance imaging / Male / Physical Examination / Spinal Fractures / Tomography, X-Ray Computed / Treatment Outcome
(Link to Search Site for Scientific Articles)
● PubMed @ National Institutes of Health, US National Library of Medicine (PMID): 12860553
Tadanori Sakamaki, Koichi Sairyo, Shinsuke Katoh, Hideko Endo, Shinji Komatsubara, Toshiaki Sano and Natsuo Yasui : The Pathogenesis of Slippage and Deformity in the Pediatric Lumbar Spine, --- A Radiographic and Histologic Study using a New Rat In Vivo Model ---, Spine, 28, 7, 645-651, 2003.
Koichi Sairyo, Shinsuke Katoh, Tadanori Sakamaki, Shinji Komatsubara and Natsuo Yasui : A new endoscopic technique to decompress lumbar nerve roots affected by spondylolysis. Technical note, Journal of Neurosurgery, 98, 3 Suppl, 290-293, 2003.
(Summary)
The authors describe a new endoscopic technique to decompress lumbar nerve roots affected by spondylolysis. Short-term clinical outcome was evaluated. Surgery-related indications were: 1) radiculopathy without low-back pain; 2) no spinal instability demonstrated on dynamic radiographs; and 3) age older than 40 years. Seven patients, four men and three women, fulfilled these criteria and underwent endoscopic decompressive surgery. Their mean age was 60.9 years (range 42-70 years). No subluxation was present in four patients, whereas Meyerding Grade I slippage was demonstrated in three. For endoscopic decompression, a skin incision of 16 to 18 mm in length was made, and fenestration was performed to identify the affected nerve root. The proximal stump of the ragged edge of the spondylotic lesion, and the fibrocartilaginous mass compressing the nerve root were removed. The follow-up period ranged from 6 to 22 months (mean 11.7 months). Clinical outcome was evaluated using Gill criteria; in three patients the outcome was excellent, and in four it was good. This new endoscopic technique was useful in the decompression of nerve roots affected by spondylolysis, the technique was minimally invasive, and the clinical results were acceptable.
Naoyuki Yoshida, Koichi Sairyo, Takahiro Sasa, Mari Fukunaga, Keiko Koga, Takaaki Ikata and Natsuo Yasui : Electrical Stimulation Prevents Deterioration of the Oxidative Capacity of Disuse-Atrophied Muscles in Rats, Aviation, Space, and Environmental Medicine, 74, 3, 207-211, 2003.
(Summary)
The purpose of this study was to evaluate the effects of electrical stimulation on disuse-atrophied muscles. Sprague-Dawley rats were used and divided into three groups: control (C), hind-limb suspended for 7 d (HS), and HS plus transcutaneous electrical stimulation for 7 d (ES). In the ES group, transcutaneous electrical stimulation was induced at 1 Hz for 1 h every day to condition the gastrocnemius-plantaris-soleus muscles. Muscle oxidative capacity was evaluated by 31P-MRS in vivo. Maximum tension and muscle wet mass were also measured. Muscle oxidative capacity decreased within 1 wk in HS; however, it was maintained when electric stimulation was applied to the suspended limb. The maximum twitch tension in HS was significantly smaller than that in C (p < 0.05), while in ES it did not differ from that in C. The muscle mass was significantly smaller in the HS and ES groups compared to C (p < 0.05). These data indicated that twitch electrical stimulation was effective in preventing deterioration of muscle functions, such as maximum tension and oxidative capacity, induced by 1 wk of disuse.
(Keyword)
disuse / muscle / oxidative / capacity / 31P-MRS
(Link to Search Site for Scientific Articles)
● PubMed @ National Institutes of Health, US National Library of Medicine (PMID): 12650266
Tadanori Sakamaki, Koichi Sairyo and Shinsuke Katoh : Comparison of spine movements between normal pediatric spine and spondylolytic spine with reference to instantaneous axis of rotation, Spine, 27, 2, 141-145, 2002.
(Summary)
A radiologic study of lumbar kinematics in the pediatric spine was conducted. To clarify the kinematic alteration in the pediatric spine with pars defects by measuring the location of the instantaneous axis of rotation. Vertebral slippage and deformities such as wedging of L5 are observed frequently in pediatric patients with spondylolysis. However, the kinematics of pediatric lumbar spine with pars defects has not yet been well documented. Radiographs of 70 pediatric patients (57 boys and 13 girls) with low back pain were examined. The control group (without spondylolysis) consisted of 22 patients (15 boys and 7 girls; mean age, 14.6 years; range, 10-18 years), and the lysis group (with spondylolysis at L5) consisted of 48 patients (42 boys and 6 girls; mean age, 14.5 years; range, 11-18 years). The lysis group was further divided into four subgroups according to the stage of defects and existence of slippage: Group 1 (early stage defect), Group 2 (progressive stage defect), Group 3 (terminal stage defect without slippage), and Group 4 (terminal stage defect with slippage of more than 5%; olisthesis). The instantaneous axis of rotation at L4-L5 and L5-S1 from the extended to the flexed position was measured on lateral dynamic radiograms taken in with the subject in the recumbent position. The relation between lumbar index and the site of instantaneous axis of rotation at L5-S1 also was analyzed. The site of instantaneous axis of rotation at L5-S1 and L4-L5 in the control group was not located in the rotating cranial vertebra. In 1 of the 11 patients in the early-stage subgroup, the instantaneous axis of rotation at L5-S1 was found in the cranial vertebra. In 4 of the 11 patients in the progressive stage, 11 of the 16 patients in the terminal stage, and in 7 of the 10 patients in the olisthesis subgroup, the instantaneous axis of rotation was located in the cranial vertebra. Cranial deviation in the instantaneous axis of rotation was observed more frequently in the vertebra with severe deformity less than 80% of the lumbar index than in the vertebra with milder deformity. The instantaneous axis of rotation deviated cranially as the stage of pars defects advanced, and as the wedge deformity increased. Kinematic alteration of the lumbar spine in pediatric patients with spondylolysis may affect chondrocytes of the endplate, perhaps contributing to the consequent spine deformities occurring secondarily to spondylolysis.
Koichi Sairyo, Shinsuke Katoh, Toshinori Sakai, Mishiro Takuya and Ikata Takaaki : Characteristics of velocity-controlled knee movement in patients with cervical compression myelopathy: what is the optimal rehabilitation exercise for spastic gait?, Spine, 26, 23, E535-E538, 2001.
(Summary)
The isokinetic strength of knee extensors and flexors was measured at various controlled velocities in patients with spastic paraparesis caused by cervical compression myelopathy. To evaluate leg function objectively in patients with myelopathy. Cervical compression myelopathy causes varying degrees of spastic paresis in the legs and affects the activities of patients. However, the leg function characteristics of the patients have not been fully elucidated. Velocity-controlled voluntary knee movements were studied in 39 patients (25 men and 14 women) with compression myelopathy. Their mean age was 60.2 years (range, 44-77 years). The patients were divided into Group A (ambulation without aid, n = 22) and Group AA (ambulation with aid, n = 17). Isometric peak torque values were measured in knee flexor and extensor muscles at 60 degrees of knee flexion, and isokinetic peak torque values were determined in maximal voluntary concentric movements of these muscles at constant angle velocities of 40 degrees, 80 degrees, 120 degrees, 160 degrees, and 180 degrees per second. The relative strength (percentage of isometric peak torque value) of the isokinetic motion was calculated at each velocity. In both groups, the relative strength decreased as the velocity increased, and the degree of reduced strength in the flexors at the high velocities of 160 degrees and 180 degrees per second was significantly greater in Group AA than in Group A (P < 0.05), whereas no significant difference was found in the extensors between the groups. The results indicate that isokinetic strength at a high velocity may reflect the severity of spastic paresis in the legs resulting from compression myelopathy.
(Keyword)
Aged / Cervical Vertebrae / Exercise Therapy / Female / Gait / Humans / Knee / Leg / Male / Middle Aged / Movement / Muscle, Skeletal / Paraparesis, Spastic / Severity of Illness Index / Spinal Cord Compression / Time Factors / Walking
Koichi Sairyo, Shinsuke Katoh, Toshinori Sakai, Takuya Mishiro and Takaaki Ikata : Evaluation of leg motor function affected by cervical compression myelopathy, SPINE, 26, 23, E535-E538, 2001.
485.
Kiyoshi Kajiura, Shinsuke Katoh, Koichi Sairyo, Takaaki Ikata, Vijay K. Goel and Ri-ichi Murakami : Slippage mechanism of pediatric spondylolysis:biomechanical study using immature calf spines, --- Discussion based on a biomechanical study using immature calf spines ---, Spine, 26, 20, 2208-2213, 2001.
(Summary)
This study analyzed the skeletal-age-dependent strength of the lumbar growth plate to resist anterior shearing forces using the MTS system in the immature calf spine with pars defects. To clarify the pathomechanism of the skeletal-age-dependent incidence of slippage in pediatric patients with pars defects by comparing the strength of the lumbar growth plate among three skeletal age groups. Isthmic spondylolisthesis occurs and progresses more frequently during the growth period, whereas it is rare afterward. However, little evidence has been demonstrated to elucidate the etiology. For this study, 15 lumbar functional spine units were divided into three groups according to their skeletal ages. Five were from neonates (Group 1), five from calves approximately 2 months old (Group 2), and five from calves about 24 months old (Group 3). An anterior shearing force was applied to each specimen until failure, after bilateral pars defects were created. Failure load (newtons) and displacement at failure (millimeters) were calculated from the load-displacement curve. The site of failure was confirmed by plain radiograph. All 15 functional spine units failed at the growth plate. The failure load was 242.79 +/- 46.05 N in Group 1, 986.40 +/- 124.16 N in Group 2, and 2024.54 +/- 245.53 N in Group 3. Statistically significant differences were found among the three groups (P < 0.05). The displacement at failure was 7.52 +/- 1.84 mm in Group 1, 11.10 +/- 2.30 mm in Group 2, and 8.15 +/- 2.66 mm in Group 3. There were no significant differences among the groups. The results indicate that the strength of the growth plate, the weakest link in this model, against anterior shearing forces depends on the skeletal maturity, and that the biomechanical weakness of the growth plate plays an important role in the slippage mechanism.
Naoyuki Yoshida, Takaaki Ikata, Koichi Sairyo, Tetsuya Matsuura, Takahiro Sasa, Keiko Koga and Mari Fukunaga : Evaluation of Disuse Atrophy of Rat Skeletal Muscle Based on Muscle Energy Metabolism Assessed by 31P-MRS, Journal of Physiological Anthropology and Applied Human Science, 20, 4, 247-252, 2001.
(Summary)
The purpose of this study was to evaluate disuse atrophy of skeletal muscle using a hind-limb suspension model, with special reference to energy metabolism. Twenty-four Sprague-Dawley rats were divided into four groups: control group (C), hind-limb suspended for 3 days (HS-3), for 7 days (HS-7) and for 14 days (HS-14). The gastrocnemius-plantaris-soleus (GPS) muscles in each group were subjected to the following measurements. After a 2-min rest, contraction of the GPS muscles was induced by electrical stimulation of the sciatic nerve at 0.25 Hz for 10 min, then the frequency was increased to 0.5 and 1.0 Hz every 10 min. During the stimulation, twitch forces were recorded by a strain gauge, and 31P-MRS was performed simultaneously. Maximum tension was measured at the muscle contraction induced at 0.25 Hz; the wet weight of the whole and each muscle in the GPS muscles was also measured. From the 31P-MR spectra during muscle contraction, the oxidative capacity was calculated and compared among the groups. The weights of the whole GPS muscles in C, HS-3, HS-7 and HS-14, were 2.66 +/- 0.09, 2.39 +/- 0.21, 2.34 +/- 0.21 and 2.18 +/- 0.14 (g) respectively. Thus, the muscle mass significantly decreased with time (p < 0.05). Among the GPS muscles, the decrease in weight of the soleus muscle was especially remarkable; in the HS-14 group its weight decreased to 60% of that in the C group. We evaluated maximum tension and oxidative capacity as the muscle function. The maximum tensions in C, HS-3, HS-7 and HS-14 were 519 +/- 43, 446 +/- 66, 450 +/- 23 and 465 +/- 29 (g), respectively. This was significantly greater in the C group than in any other groups, however there were no significant differences among the three HS groups. The oxidative capacity during muscle contraction in the C group was higher than in any HS group and it did not further decrease even if the suspension of the limbs was prolonged beyond 3 days. The present study showed that in disuse atrophy, muscle mass and muscle function did not change simultaneously. Thus, it is necessary to develop countermeasures to prevent muscle atrophy and muscle function deterioration independently.
(Keyword)
Animals / Atrophy / Electric Stimulation / Energy Metabolism / Hindlimb / Magnetic Resonance Spectroscopy / Male / Muscle Contraction / Muscle, Skeletal / Oxygen Consumption / Phosphorus Isotopes / Rats / Rats, Sprague-Dawley
Koichi Sairyo, Shinsuke Katoh, Takaaki Ikata, Koji Fujii and K Kajiura : Development of spondylolytic olisthesis in adolescents, The Spine Journal, 1, 3, 171-175, 2001.
(Summary)
Although it has been well documented that slippage in patients with spondylolysis is most prevalent during the growth period, the exact time when slippage initiates and halts during the growth period is still unknown. Moreover, the contribution of spinal deformities, such as wedging of the vertebral body to the slippage, remains controversial. To clarify when slippage in pediatric spondylolysis initiates and halts. Retrospective study. We radiographically examined 46 athletes under 18 years of age with spondylolysis at the fifth lumbar vertebra (L5). The mean age at the first consultation was 13.3 years. The average follow-up period was 6.0 years. Longitudinal observation of slippage at L5 on radiogram in correlation with the maturity of the lumbar spine. From a lateral radiogram of each patient, percent slippage, lumbar index (LI), and skeletal age of the affected vertebra were measured. Changes in the percent slippage over time were investigated, and the correlation between the percent slippage and LI was analyzed. From the cartilaginous stage to the apophyseal stage, the slippage increased in 80.0% of the patients (16 of 20). From the cartilaginous stage to the epiphyseal stage, slippage increased in 11.1% of the patients (3 of 27). None of the patients (0 of 22) showed an increase after the epiphyseal stage. In 20 patients in whom slippage increased during the follow-up period, the percent slippage at the final consultation and the LI at the first consultation showed no significant correlation; however, the percent slippage and the LI at the final consultation were significantly (p<.01) correlated. In conclusion, slippage was more prevalent in individuals of a younger skeletal age whose lumbar spine was immature, and it halted during the epiphyseal stage when the growth period was over and the vertebra matured. Furthermore, the results suggest that wedge deformity of an affected vertebra might be the result rather than the cause of slippage.
(Keyword)
Adolescent / Age Distribution / children / Disease Progression / Female / Follow-Up Studies / Humans / Lumbar Vertebrae / Male / probability / Retrospective Studies / Risk Assessment / Severity of Illness Index / Sex Distribution / Spondylolisthesis / Spondylolysis / Time Factors
Y Kato, Takaaki Ikata, Hiroaki Takai, Shinjiro Takata, Koichi Sairyo and K Iwanaga : Effects of specific warm-up at various intensities on energy metabolism during subsequent exercise, The Journal of Sports Medicine and Physical Fitness, 40, 2, 126-130, 2000.
(Summary)
To investigate the effects of specific warm-up at various intensities on energy metabolism during subsequent intense exercise. specific warm-up was consisted of 3 sets of wrist flexions for 5 min, with each set followed by a 3-min rest. The intensity of specific warm-up was set at 20%, 30% or 40% of maximal voluntary contraction (MVC). The subjects then performed a set of wrist flexions at 60% MVC for 4 min as the criterion exercise. For the control experiment, criterion exercise was done without specific warm-up. Five healthy volunteers. using phosphorus-31 magnetic resonance spectroscopy, spectra were obtained from the wrist flexor muscles to determine the ratio of inorganic phosphate to phosphocreatine (Pi/PCr) and intracellular pH. The Pi/PCr during the criterion exercise after specific warm-up at any intensity was not significantly different from that without specific warm-up. The intracellular pH during the criterion exercise after specific warm-up at 30% or 40% MVC was significantly higher than that without specific warm-up. These results indicate that mild warm-up exercise could inhibit the development of intracellular acidosis during subsequent intense exercise.
(Keyword)
Adult / Energy Metabolism / Exercise / Humans / Magnetic Resonance Spectroscopy / Male / Muscle, Skeletal / Phosphates / Phosphocreatine / Phosphorus Radioisotopes
(Link to Search Site for Scientific Articles)
● PubMed @ National Institutes of Health, US National Library of Medicine (PMID): 11034432
Koichi Sairyo : 特集 腰椎分離症のパラダイムシフト-理論を知り，理論を超える-【特集編集:西良浩一】巻頭言, The Journal of Clinical Sports Medicine, 40, 5, 2023.
16.
Ryosuke Sato, Naohito Hibino, Masahiro Yamano, Shinji Yoshioka, Tomoya Terai, Kenichiro Kita, Shingo Hama, Yoshitaka Hamada, Ichiro Tonogai and Koichi Sairyo : One-Stage Reconstruction for Re-rupture of Achilles Tendon with Soft Tissue Infection: Using an Anterolateral Thigh Flap Incorporating a Vascularized Muscle Flap and a Strip of Iliotibial Tract., Journal of Hand and Microsurgery, 10, 2, 105-108, 2018.
(Summary)
Reconstruction is challenging in a patient with loss of a segment of Achilles tendon and infection in the overlying soft tissue. Here the authors describe one-stage tendon reconstruction, using an anterolateral thigh free flap incorporating a vascularized muscle flap and a strip of iliotibial tract in a patient with re-rupture of an Achilles tendon and soft tissue infection. Postoperative immobilization of the affected ankle using an external fixator enabled us to observe the flap directly and reduce pressure on the flap. The patient had a successful outcome, with no difficulty in walking, running, or climbing stairs and no limitation of range of motion at the ankle joint postoperatively. This is a promising technique for reconstruction of the Achilles tendon and treatment of infection as a one-step procedure.
Kenji Takagishi, Tetsuya Matsuura and Koichi Sairyo : Shoulder and elbow pain in elementary school baseball players: The results from a nation-wide survey in Japan, Journal of Orthopaedic Science, 22, 4, 682-686, 2017.
(Summary)
Despite recommendations on how to prevent baseball injuries in youths by the Japanese Society of Clinical Sports Medicine, shoulder and elbow pain still frequently occurs in young baseball players. We conducted a questionnaire survey among baseball players at elementary schools across the country to understand the practice conditions of players, examining the risk factors of shoulder and elbow pain in baseball players. The questionnaire survey was conducted among elementary school baseball players as members of the Baseball Federation of Japan in September 2015. A total of 8354 players belonging to 412 teams (average age: 8.9) responded to the survey. Among 7894 players who did not have any shoulder and/or elbow pain in September 2014, elbow pain was experienced in 12.3% of them, shoulder pain in 8.0% and shoulder and/or elbow pain in 17.4% during the previous one year. A total of 2835 (39.9% of the total) practiced four days or more per week and 97.6% practiced 3 h or more per day on Saturdays and Sundays. The risk factors associated shoulder and elbow pain included a male sex, older age, pitchers and catchers, and players throwing more than 50 balls per day. It has been revealed that Japanese elementary school baseball players train too much. Coaches should pay attention to older players, male players, pitchers and catchers in order to prevent shoulder and elbow pain. Furthermore, elementary school baseball players should not be allowed to throw more than 50 balls per day. Retrospective cohort study.
室伏 由佳 and Koichi Sairyo : 総論 スポーツの価値を護るアンチ・ドーピングにむけた取り組みと対策, The Journal of Clinical Sports Medicine, 37, 12, 1358-1363, Dec. 2020.
3.
Koichi Sairyo and 室伏 由佳 : 特集 2021年からのアンチ・ドーピング-Code改定と未来のスポーツを考える- 特集編集:西良浩一，室伏由佳, The Journal of Clinical Sports Medicine, 37, 12, Dec. 2020.
4.
Koichi Sairyo : Specific and non-specific low back pain in athletes : minimally invasive treatment based on the pathology of pain generators, The Journal of the Japanese Orthopaedic Association, 94, 11, 1049-1056, Nov. 2020.
(Keyword)
Athlete / Non-specific low back pain / Full-endoscopic surgery
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
Fumitake Tezuka, Yoichiro Takata and Koichi Sairyo : High signal intensity zone と Toxic annular tear, The Journal of Clinical Sports Medicine, 37, 9, 1002-1006, Sep. 2020.
Kousaku Higashino and Koichi Sairyo : ゴルフにおける腰痛の治療, The Journal of Clinical Sports Medicine, 33, 3, 252-255, Mar. 2016.
28.
寺井 智也 and Koichi Sairyo : 腰椎分離症とバイオメカニクス, The Journal of Clinical Sports Medicine, 33, 1, 40-45, Jan. 2016.
29.
Mitsuhiko Takahashi, Natsuo Yasui, Koichi Sairyo, Shinsuke Katoh, 三代 卓哉 and 三橋 雅 : 軟骨無形成症に対する四肢骨延長術の合併症, The Central Japan Journal of Orthopaedic Surgery & Traumatology, 58, 4, 759-760, Jul. 2015.
Low back pain is commonly occurred among athletes. There are some pathologies causing the pain, and most of the pathology would be based on the overuse of the spine during the sports performance. Thus, the clue to obtain the exact diagnosis of the back pain is the lumbar motion causing the pain. Roughly, the pathology is classified into two ; i.e., flexion pain and extension pain. In flexion, anterior component of the spine such as intervertebral disc and endplate is loaded. Thus, disorders causing flexion pain would be disc herniation, discogenic pain, type 1 Modic endplate inflammation and so on. During the lumbar extension motion, posterior element including the facet joints and lamina is loaded. Based on this phenomenon, the lumbar spondylolysis and facet joint arthritis would be the main pathology causing the extension pain. Once the exact diagnosis can be obtained, pin-point intervention is possible including the block therapy and endoscopic surgery. The state of the art minimally invasive disc surgery is the endoscopic surgery. The technique is called the percutaneous endoscopic discectomy (PED). It only requires 8 mm for the skin incision, and it can be done under the local anesthesia. With utilizing the PED system, we have been treating the athletes with disc herniation and discogenic pain minimally invasively.
Koichi Sairyo, Shinsuke Katoh and Natsuo Yasui : 腰痛, NEW MOOK 整形外科 小児整形外科, 15, 53-67, 2004.
48.
Shinsuke Katoh, Koichi Sairyo and Natsuo Yasui : 発育期腰椎終板の成長軟骨障害に関する最近の知見, Orthopeadics and Traumatology, 46, 5, 543-550, 2003.
49.
Koichi Sairyo, Shinsuke Katoh and Natsuo Yasui : 発育期腰椎分離症・分離すべり症, Monthly Book Orthopaedics, 15, 12, 38-45, 2002.
50.
Koichi Sairyo, Shinsuke Katoh and Natsuo Yasui : スポーツ選手のための腰椎装具の実際 発育期腰部疾患における装具療法の位置づけ, The Journal of Clinical Sports Medicine, 19, 10, 1189-1194, 2002.
Proceeding of International Conference:
1.
Koichi Sairyo : Full-endoscopic spine surgery for the sports related lumbar disord, The 2nd International Spine Symposium(Center for Trauma-Orthopedics, Can Tho Central General), Viet Nam, Nov. 2023.
2.
Koichi Sairyo : Full-endoscopic trans-Kambin triangle lumbar interbody fusion for spondylolisthesis, The 2nd International Spine Symposium(Center for Trauma-Orthopedics, Can Tho Central General), Viet Nam, Nov. 2023.
3.
Koichi Sairyo : Full-endoscopic spine surgery under the local anesthesia: discectomy and decompression, The 2nd International Spine Symposium(Center for Trauma-Orthopedics, Can Tho Central General), Viet Nam, Nov. 2023.
4.
Koichi Sairyo : Endoscopic surgery for low back pain in athletes, 台湾 国際スポーツ医学会, Taiwan, Nov. 2023.
5.
Koichi Sairyo : Full-endoscopic Trans-kambin Lumbar Interbody Fusion for Spondylolisthesis., 2nd International conference on Spine and Neurosurgery Neuro Spine 2023(自宅)【国際ウエビナー:フランス】, 自宅, Aug. 2023.
Koichi Sairyo : History of Minimally Invasive Spine Surgery in Japan., PASMISS 2023&TSESS 6th Annual Meeting(Plenary Lecture)(Formosa Hotel-International Banquet Hall), Taiwan, Jul. 2023.
8.
Koichi Sairyo : What is behind the victory of Samurai Japan at WBC 2023 endoscopic surgery for low back pain in athletes., Special Lecture(高雄医学大学で講義), Taiwan, Jul. 2023.
9.
Kenji Yokoyama, Tetsuya Matsuura, Jyoji Iwase, Toshiyuki Iwame and Koichi Sairyo : CT Sagittal Image Evaluation for Osteochondritis Dissecans of the Elbow Correlates with Clinical Outcomes of Arthroscopic Debridement in Adolescent Baseball Players., 2023 International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, Jun. 2023.
Koichi Sairyo : The Secrets of Full-Endoscopic Spine Surgery for Athletes: What is behind the victory of the National Team ``Samurai Japan'' at the World Baseball Classic, Spine Week 2023(Melbourne Convention Exhibition Center:Australia), Australia, May 2023.
12.
Koichi Sairyo : The Secrets of the Full-Endoscopic Transforaminal Approach: Tips and Tricks from Transforaminal Endoscopy Expert, Spine Week 2023(Melbourne Convention Exhibition Center:Australia), Australia, May 2023.
13.
Koichi Sairyo : Perfect return to play after full-endoscopic lumbar spine surgery in professional athletes., 【国際ウエビナー(インド)】(自宅), 自宅, Mar. 2023.
14.
Yasuaki Tamaki, Tomohiro Goto, Jyoji Iwase, Daisuke Hamada, Keizo Wada and Koichi Sairyo : Contributions of the ischiofemoral ligament, iliofemoral ligament, and conjoined tendon to hip stability after total hip arthroplasty: a cadaveric study, ORS2023, Feb. 2023.
15.
Koichi Sairyo : Full-endoscopic Decompression Surgery for Lumbar Spinal Stenosis in Elderly Patients with Poor General Condition., 2022 Annual Meeting of Taiwan Society for Endoscopic Spine Surgery【国際ウェビナー:台湾】自宅からWEB, Tokushima, Dec. 2022.
16.
Toshihiko Nishisho, Shun-ichi Toki, Ryo Miyagi and Koichi Sairyo : ASSESSMENT OF SURGICAL MARGIN CLASSIFICATION FOR SOFT TISSUE SARCOMA: DEFINITIONS OF ADEQUATE MARGINS SYSTEM FOR PLANNING AND EVALUATION, The Connective Tissue Oncology Society 2022 annual meeting, Vancouver, Nov. 2022.
17.
Koichi Sairyo : Is endoscopic surgery replacing open and MIS surgery for lumbar discectomy, What does the evidences say?, Himalayan Spine Symposium【国際ウェビナー:ネパール】自宅からWEB, 徳島市, Nov. 2022.
Koichi Sairyo : Full-endoscopic trans-Kambin Lumbar Interbody Fusion Fullendo-KLIF for Spondylolisthesis., 3rd World Congress on MIS & Endoscopic Spine Surgery【国際ウェビナー:インド】自宅からWEB, Tokushima, Sep. 2022.
20.
Koichi Sairyo : Full-Endoscopic intradiscal surgery for low back pain in professional baseball players, Thermal Annuloplasty & Disc Cleaning., 3rd World Congress on MIS & Endoscopic Spine Surgery【国際ウェビナー:インド】自宅からWEB, Tokushima, Sep. 2022.
21.
Koichi Sairyo : Full-endoscopic trans-Kambin Lumbar Interbody Fusion without decompression for spondylolisthesis., 7th ASEAN MISST【国際ウェビナー:タイ】自宅からWEB, 徳島市, Jul. 2022.
Koichi Sairyo : Full-Endoscopic surgery for professional athletes: Discectomy, Foraminotomy, paThermal Annuloplasty & Disc Cleaning., 1st ISMISS Asia Japan【国際ウェビナー:愛知】自宅からWEB, Tokushima, Mar. 2022.
25.
Koichi Sairyo : Transforaminal Full-endoscopic Decompression Surgery Under Local Anesthesia: Awake & Aware Condition., French Endoscopic Spine Surgery Course【国際ウェビナー:パリ】自宅からWEB, Tokushima, Jan. 2022.
26.
Koichi Sairyo : Full-endoscopic surgery for professional athletes:discectomy,foraminotomy,thermal annuloplasty and disc cleaning., The 4th Annual Meeting of Taiwan society of endoscopic spine surgery 2021(TSESS), 自宅, Dec. 2021.
27.
Koichi Sairyo : Endoscopic Ventral Facetectomy (TE-LF with TE-LRD) for The Lumbar Spinal Canal Stenosis., Davos Course AO Spine Virtual Weekend-Endoscopy, 自宅, Dec. 2021.
Tetsuya Matsuura, Toshiyuki Iwame, Jyoji Iwase, Kenji Yokoyama and Koichi Sairyo : Long-term outcomes of arthroscopic debridement with or without drilling for osteochondritis dissecans of the capitellum in adolescent baseball players: a 10-year follow-up study, ISAKOS, Nov. 2021.
30.
Koichi Sairyo : Transforaminal Full Endoscopic lumbar Spine Surgery under Local Anesthesia:Future Perspective., Annual International Meeting SPINE ACROSS THE SEA(HAWAII), 自宅, Jul. 2021.
31.
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.
Koichi Sairyo : Full-endoscopic trans-Kambin lumbar interbody fusion (fullendo KLIF) for degenerative spinal conditions., 13th Combined meeting of Asia Pacific Spine Society & Asia Pacific Paediatric Orthopaedic Society.(APSS-APPOS 2021), Kobe, Jun. 2021.
34.
Toshihiko Nishisho, Shun-ichi Toki, Ryo Miyagi and Koichi Sairyo : ACIDIC MICROENVIRONMENTS IN SOFT TISSUE SARCOMA PROMOTES FOXM1 EXPRESSION AND TUMORIGENESIS., The Connective Tissue Oncology Society Annual Meeting, Nov. 2020.
35.
Toshihiko Nishisho, Shun-ichi Toki, Ryo Miyagi and Koichi Sairyo : SOFT-TISSUE SARCOMA IN ELDERLY PATIENTS: PATTERNS OF CARE AND SURVIVAL, The Connective Tissue Oncology Society Annual Meeting, November 18-21, 2020., Nov. 2020.
Koichi Sairyo : Full-Endoscopic Lateral Access Interbody Fusion through The Kambin's Triangle, 1st MIS Spine Week of Thailand combined with 3rd ISESS International Society of Endoscopic Spine Surgery, Chiang Mai, Thailand, Nov. 2019.
39.
Koichi Sairyo : Full-Endoscopic Transforaminal Thermal Annuloplasty for Chronic Discogenic Low Back Pain in Athletes, 1st MIS Spine Week of Thailand combined with 3rd ISESS International Society of Endoscopic Spine Surgery, Chiang Mai, Thailand, Nov. 2019.
40.
Koichi Sairyo : Discogenic Low Back Pain in the Japanese Elite Athlete and Full-endoscopic Thermal Annuloplasty., The 7th ACMISST & 18th KOMISS 2019, Seoul Kore(Grand Hilton Hotel), May 2019.
41.
Koichi Sairyo : Lateral Recess Decompression via Transforaminal Approach:Application of Full Endoscopic Surgery., The 7th ACMISST & 18th KOMISS 2019, Seoul Kore(Grand Hilton Hotel), May 2019.
42.
Nori Sato, Nakahara Keiko, Yoshihiro Ishihama, Toshinori Sakai, Takashi Chikawa, Koichi Sairyo and Shinsuke Katoh : Three-Dimensional Finger Motion Analysis in a Patient with Cervical Myelopathy, 2019 Annual Meeting of the Orthopaedic Research Society, Austin, TX, USA, Feb. 2019, 2019.
43.
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.
44.
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.
45.
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.
46.
Ichiro Tonogai, Fumio Hayashi, Yoshihiro Tsuruo and Koichi Sairyo : Fresh cadaveric study of the origin and branching direction of the anterior medial malleolar artery from the anterior tibial artery., 44th Annual meeting of the Japanese Orthopaedic Society for Sports Medicine(September 7-September 9,2018), Tokushima, Sep. 2018.
47.
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.
48.
Koichi Sairyo : Application of the percutaneous endscopic discectomy(PED)procedure to decompress the lateral recess stenosis in the elderly:percutaneous endscopic ventral facetectomy(PEVF)., The 18th Annual Meeting of the Pacific and Asian Society of Minimally Inbasive Spine Surgery (PASMISS 2018), Kaohsiung, Jul. 2018.
49.
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.
50.
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.
51.
Fumio Hayashi, Kousaku Higashino, Morimoto Masatoshi, Yuichiro Goda, Toshinori Sakai, Nori Sato, Morimoto Yuki, Yoichiro Takata, Fumitake Tezuka and Koichi Sairyo : Association between hypertrophy of ligamentum flavum in lumbar spinal canal stenosis and increased myofibroblasts in dorsal layer of ligament, The 18th Annual Meeting of the Pacific and Asian Society of Minimally Inbasive Spine Surgery(PASMISS 2018)(July 19-21,2018), Taiwan, Jul. 2018.
52.
Ishihama Yoshihiro, Hiroaki Manabe, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Takashi Chikawa and Koichi Sairyo : Percutaneous endoscopic true transforaminal lumbar intervertebral fusion(PE-TLIF)- surgical technique and the short-term results, The 18th Annual Meeting of the Pacific and Asian Society of Minimally Inbasive Spine Surgery(PASMISS 2018)(July 19-21,2018), Taiwan, Jul. 2018.
53.
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.
54.
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.
55.
Ichiro Tonogai, Fumio Hayashi, Yoshihiro Tsuruo and Koichi Sairyo : Cadaveric anatomical study of anterior and posterior ankle arthroscopic portals in ankle plantarflexion and dorsiflexion positions., 2018 American Orthopaedic Foot & Ankle Society Annual meeting(July 11-14,2018), Boston, Jul. 2018.
56.
Toshiyuki Iwame, Tetsuya Matsuura and Koichi Sairyo : Exceeding pitch count recommendations in youth baseball increases the elbow injuries, American Orthopaedic Society for Sports Medicine 2018(July 5-8,2018), San Diego, Jul. 2018.
57.
重清 昌太, Fumitake Tezuka, Hiroaki Manabe, Yoichiro Takata, Toshinori Sakai, Takashi Chikawa and Koichi Sairyo : Osteochondroma of the lumbar lesion: report of two cases, The 28th Japanese-Korean Combined Orthopaedic Symposium, Jun. 2018.
58.
加納 将嗣, Fumitake Tezuka, Yoichiro Takata, Toshinori Sakai, Takashi Chikawa and Koichi Sairyo : Adult-onset Stress Fracture in the Lumbar Spine of High-level Athletes:Case Series, The 28th Japanese-Korean Combined Orthopaedic Symposium, Jun. 2018.
59.
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.
60.
Fumitake Tezuka, Hiroaki Manabe, Yoichiro Takata, Toshinori Sakai, Takashi Chikawa and Koichi Sairyo : The effectiveness and safety of transforaminal percutaneous endoscopic lumbar decompression surgery for the lumbar spinal canal stenosis under local anesthesia, The 28th Japan Korea Conbined Orthopaedic Symposium(June 14-15,2018), Gifu, Jun. 2018.
61.
Tomohiro Goto, Keizo Wada, Tomoya Takasago and Koichi Sairyo : The Influence Of Posterior Pelvic Tilt On Three Dimensional Radiographic Acetabular Coverage In The Patients With Borderline Acetabular Dysplasia Of The Hip, The 19th European Federation of National Associations of Orthopaedics and Traumatology(May 30-June 1,2018), Barcelona, May 2018.
62.
Keizo Wada, Daisuke Hamada, Tomoya Takasago, Tomohiro Goto, Ichiro Tonogai, Yoshihiro Tsuruo and Koichi Sairyo : Joint Distraction Force Changes the Three-Dimensional Position of the Femur and the Tibia in Total Knee Arthroplasty: a Cadaveric Study, The 19th European Federation of National Associations of Orthopaedics and Traumatology(May 30-June 1,2018), Barcelona, May 2018.
63.
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.
64.
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.
65.
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.
66.
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.
67.
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.
68.
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.
69.
Tomoya Takasago, Daisuke Hamada, Keizo Wada, Tomohiro Goto, Akihiro Nitta, Ichiro Tonogai, Yoshihiro Tsuruo and Koichi Sairyo : Retention of the anterior cruciate ligament increase the joint stability in anterior, external rotation and varus directions in TKA, A biomechanical cadaveric study, 18th ESSKA congress(May 9-12,2018), Glasgow, May 2018.
70.
Keizo Wada, Daisuke Hamada, Tomoya Takasago, Ichiro Tonogai, Yoshihiro Tsuruo and Koichi Sairyo : Knee kinematics after lateral UKA are closer to native knee kinematics compared to those after medial UKA, a cadaveric study, 18th ESSKA congress(May 9-12,2018), Glasgow, May 2018.
71.
Daisuke Hamada, Keizo Wada, Tomoya Takasago, Akihiro Nitta, Tomohiro Goto, Ichiro Tonogai, Yoshihiro Tsuruo and Koichi Sairyo : Native rotational kinematics are lost in bicruciate-retaining total knee arthroplasty when the tibial component is replaced: an in vitro study, 18th ESSKA congress(May 9-12,2018), Glasgow, May 2018.
72.
Fumio Hayashi, Kousaku Higashino, Morimoto Masatoshi, Yuichiro Goda, Toshinori Sakai, Yoichiro Takata, Fumitake Tezuka and Koichi Sairyo : Histochemical analysis of ligamentum flavum on various collagens and myofibroblasts compared dorsal with dural side, 2018 Orthopaedic Research Society Annual Meeting (March 10-13,2018), New Orleans, Mar. 2018.
73.
Ichiro Tonogai, Fumio Hayashi, Yoshihiro Tsuruo and Koichi Sairyo : Direction and location of the nutrient artery to the fifth metatarsal at risk in osteotomy for bunionette: enhanced computed tomographic study in fresh cadavers., 2018 Orthopaedic Research Society Annual Meeting (March 10-13,2018), New Orleans, Mar. 2018.
74.
Tetsuya Matsuura, Toshiyuki Iwame and Koichi Sairyo : Exceeding Pitch Count Recommendatios in Youth Baseball Increase the Elbow Injuries, American Academy of Orthopaedic Surgeons 2018 Annual Meeting (March 6-March 10,2018), New Orleans, Mar. 2018.
75.
Koichi Sairyo : Management of acute and chronic pars fractures in the elite athlete., AAOS 2018 Annual Meeting, New Orleans, 2018.
76.
Koichi Sairyo : Application of the transforaminal percutaneous spinal endoscope to the lumbar spinal canal stenosis: foraminoplasty (PELF) and ventral facetectomy., The 3rd Cross-Strait and International Summit Conference of Endscopic Spine Surgery, 台湾, Dec. 2017.
77.
Toshinori Sakai, Yoichiro Takata, Fumitake Tezuka, Takashi Chikawa and Koichi Sairyo : Assessment of cage subsidence at 1year follow-up after stand-alone XLIF, 1st SOLAS Japan Regional Meeting, Tokyo, Dec. 2017.
78.
Toshinori Sakai, Yoichiro Takata, Fumitake Tezuka, Takashi Chikawa and Koichi Sairyo : Risk management for avoidance of major vascular/lumbar segmental artery injury during lateral transpsoas approach, 1st SOLAS Japan Regional Meeting, Tokyo, Dec. 2017.
79.
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.
80.
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.
81.
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.
82.
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.
83.
Tetsuya Matsuura, Toshiyuki Iwame, Naoto Suzue and Koichi Sairyo : Long term results of arthroscopic debridement of osteochondritis dissecans in adolescent athletes, American Orthopaedic Society for Sports Medicine Annual Meeting 2017, 5(7 suppl6), Jul. 2017.
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.
85.
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.
86.
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.
87.
Ryo Miyagi, Toshihiko Nishisho, Shunichi Toki and Koichi Sairyo : Multiple primary malignancys in the patients with bone and soft tissue sarcoma, The 19th International Society of Limb Salvage (ISOLS) General Meeting(May 10-12, 2017), May 2017.
88.
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.
89.
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.
90.
Tetsuya Matsuura, Toshiyuki Iwame, Naoto Suzue and Koichi Sairyo : Outcome of Asymptomatic Osteochondritis Dissecans of the Capitellum in Adolescent Baseball Players : A 2year Followup Study, American Orthopaedic Society for Sports Medicine 2017 Specialty Day, San Diego, Mar. 2017.
91.
Tetsuya Matsuura, Toshiyuki Iwame, Naoto Suzue and Koichi Sairyo : Outcome of Asymptomatic Osteochondritis Dissecans of the Capitellum in Adolescent Baseball Players: A 2-year Follow-up Study, American Orthopaedic Society for Sports Medicine 2017 Specialty Day, Mar. 2017.
92.
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.
93.
Hiroaki Hayashi, Kazuki Takegami, Kenji Yamada, Yoshiki Mihara, Natsumi Kimoto, Yuki Kanazawa, Kousaku Higashino, Yamashita Kazuta, Fumio Hayashi, Yoshihiro Fukui, Koichi Sairyo, Tohru Okazaki, Takuya Hashizume and Ikuo Kobayashi : Convenient measurement method using small-type OSL dosimeters for evaluation of doses in CT scans: uncertainty evaluation, entrance-skin dose of phantom, and organ dose of cadaver, Radiological Society of North America (RSNA), Chicago, Dec. 2016.
(Summary)
(1)Aims Because the OSL dosimeter used in this research is small in size, when the dosimeters are attached to the patients, it should be considered that certain dosimeters are directly irradiated by the collimated X-ray beam and others are not. (2)Experiments First, we investigated the precision and accuracy of the OSL dosimeters as functions of ``number of detectors (rows)'' and ``pitch factor'' using a CT scanner. In this experiment, the true entrance skin doses (ESDs) and its distribution of a water phantom was measured with Gafchromic film. (3)Results & Discussion We estimated that OSL dosimeters can measure doses within an uncertainty of 25% for most irradiation conditions. Additionally, we demonstrated the application of dose measurements using the OSL dosimeters; 1) ESDs of a body phantom were measured, and 2) organ doses of a cadaver were directly determined for the first time. These data are valuable for the education of dose reductions. Our method using the OSL dosimeter is convenient, therefore everyone can share our results for improvement of clinical CT examinations.
94.
Koichi Sairyo : How to access the L5/S1 transforaminally under local anaesthesia, The Hong Kong Orthopaedic Association The 36th Annual Congress Hong Kong, Hong Kong, Nov. 2016.
95.
Toshiyuki Iwame, Tetsuya Matsuura, Naoto Suzue and Koichi Sairyo : Cumulative Incidence of Osteochondritis Dissecans of the Capitellum in Child and Adolescent Baseball Players, American Orthopaedic Society for Sports Medicine Annual Meeting 2016, Jul. 2016.
96.
Tetsuya Matsuura, Naoto Suzue, Toshiyuki Iwame and Koichi Sairyo : Risk factors for osteochondritis dissecans of the capitellum in young baseball players, The 13th International Congress of Shoulder and Elbow Surgery, PP6-5, May 2016.
97.
Ryo Miyagi, Toshihiko Nishisho, Shuichi Toki and Koichi Sairyo : The role of the vacuolar type H+-ATPase in the liposarcoma., 2016 Annual meeting of the Orthopaedic Research Society, Orland, USA, Mar. 2016.
98.
K.Hsu Wellington and Koichi Sairyo : Management and Treatment of Sports-related Spine Injuries., Spine Across The Sea, Hawaii, Jul. 2015.
99.
Koichi Sairyo : Finite element modeling of spondylolisthesis., 42nd ISSLS annual Meeting, San Francisco, Jun. 2015.
100.
Tetsuya Matsuura, Naoto Suzue, Toshiyuki Iwame and Koichi Sairyo : Prevalence of osteochondritis dissecans of the capitellum in young baseball players based on ultrasonographic findings, American Orthopaedic Society for Sports Medicine 2015 Specialty Day, 3, 3, Mar. 2015.
Daisuke Hamada, Tomohiro Goto and Koichi Sairyo : The effect of posterior condylar cartilage on the rotational alignment of the femoral component in knee osteoarthritis and rheumatoid arthritis, ISTA 2014 Annual Meeting (September 25-27, Kyoto, Japan), Kyoto, Sep. 2014.
102.
Tetsuya Matsuura, Naoto Suzue, Toshiyuki Iwame, Toshinori Sakai, Kousaku Higashino, Yoichiro Takata, Yuichiro Goda and Koichi Sairyo : Prevalence of osteochondritis dissevcans of the capitellum in young baseball players on ultrasonographic findings, The 12th Korean-Japan Joint meeting of Orthopedic Sports Medicine, Sep. 2014.
103.
Yuichiro Goda, Nori Sato, Takako Taniguchi, Yoichiro Takata, Hirofumi Kosaka, Toshinori Sakai, Kousaku Higashino, Koichi Sairyo, Shinsuke Katoh, Hisaaki Taniguchi and Natsuo Yasui : Proteomic analysis of ligamentum flavum, 52nd International Spinal Cord Society (ISCoS), Oct. 2013.
104.
Yuichiro Goda, Nori Sato, Takako Taniguchi, Yoichiro Takata, Hirofumi Kosaka, Toshinori Sakai, Kousaku Higashino, Koichi Sairyo, Shinsuke Katoh, Hisaaki Taniguchi and Natsuo Yasui : Proteomic analysis of ligamentum flavum from lumbar spinal canal stenosis, International Society for Study of the Lumbar Spine (ISSLS) 2013, May 2013.
105.
Yuichiro Goda, Nori Sato, Takako Taniguchi, Yoichiro Takata, Hirofumi Kosaka, Toshinori Sakai, Kousaku Higashino, Koichi Sairyo, Shinsuke Katoh, Hisaaki Taniguchi and Natsuo Yasui : Proteomic Analysis of Ligamentum Flavum from Lumbar Spinal Canal Stenosis., 2013 Annual meeting of the Orthopaedic Research Society, January 26-29, 2013 (Poster Presentation ), San Antonio, TX, Jan. 2013.
106.
Yuichiro Goda, Tadanori Sakamaki, Toshinori Sakai, Natsuo Yasui and Koichi Sairyo : Analysis of adolescent patients with MRI signal changes in the adjacent pedicle in fresh lumbar spondylolysis., The 35nd Annual meeting of ISSLS, SPINEWEEK 2012,May 28- June 1,2012 (E-poster), Geneva, May 2012.
107.
Ryo Miyagi, Koichi Sairyo, Toshinori Sakai, Natsuo Yasui and Akira Dezawa : Symptomatic laminolysis in adolescent athletes., The 35nd Annual meeting of ISSLS, SPINEWEEK 2012,May 28- June 1,2012 (E-poster), Geneva, May 2012.
108.
Toshinori Sakai, Shoichiro Takao, Koichi Sairyo, Hiromu Nishitani and Natsuo Yasui : Gender differences of radiographic findings in patients with lumbar spondylolysis., The 35nd Annual meeting of ISSLS, SPINEWEEK 2012,May 28- June 1,2012 (Special E-poster), Geneva, May 2012.
109.
Nori Sato, Takako Taniguchi, Yuichiro Goda, Hirofumi Kosaka, Kousaku Higashino, Toshinori Sakai, Koichi Sairyo, Shinsuke Katoh, Hisaaki Taniguchi and Natsuo Yasui : Quantitative proteomic analysis of human tendon and ligament, 2012 Annual Meeting of the Orthopaedic Research Society, Feb. 2012.
110.
Shoichiro Takao, Koichi Sairyo, Tadashi Kondo, Junji Ueno, Natsuo Yasui and Hiromu Nishitani : Lumbar spondylolysis: clinical significance of gender difference, International Skeletal Society 2011 Annual Meeting, San Diego, Sep. 2011.
111.
Miyagi Ryo, Koichi Sairyo, Toshinori Sakai, Bhatia N. Nitin, Yoshioka Hiroshi, Natsuo Yasui and Dezawa Akira : Symtopmatic Laminolysis in Adolescents Sports Players., The International Skeletal Society, San Diego, California, Sep. 2011.
112.
Shoichiro Takao, Toshinori Sakai, Koichi Sairyo, Junji Ueno, Natsuo Yasui and Hiromu Nishitani : Lumbar spondylolysis: clinical significance of gender difference., The International Skeletal Society, San Diego, California, Sep. 2011.
113.
Sakamaki Tadanori, Koichi Sairyo and Toshinori Sakai : MRI based diagnostic strategy increased the prevalence of the spondylolysis in children and adolescents with chronic low back pain., The 37th Annual meeting of ISSLS, Gothenburg, Sweden, Jun. 2011.
114.
Nori Sato, T Taniguchi, Yuichiro Goda, Hirofumi Kosaka, Kousaku Higashino, Toshinori Sakai, Koichi Sairyo, Shinsuke Katoh, H Taniguchi and Natsuo Yasui : Establishment of a Method for Proteomic Analysis of Human Achilles Tendon, 2011Annual Meeting of the Orthopaedic Research Society(2011.1.13-16), Long Beach Conbention Center (Long Beach,California), Jan. 2011.
115.
Nori Sato, Takako Taniguchi, Yuichiro Goda, Hirofumi Kosaka, Kosaku Higashino, Toshinori Sakai, Koichi Sairyo, Shinsuke Katoh, Hisaaki Taniguchi and Natsuo Yasui : Establishment of a Method for Proteomic Analysis of Human Achilles Tendon., 2011 Annual meeting of the Orthopaedic Research Society, Long Beach, California, Long Beach, California, Jan. 2011.
116.
Nori Sato, Taniguchi Takako, Goda Yuichiro, Kosaka Hirofumi, Higashino Kosaku, Toshinori Sakai, Koichi Sairyo, Shinsuke Katoh, Hisaaki Taniguchi and Natsuo Yasui : Development of a Method for Proteomic Analysis of Human Yellow Ligament., 2011 Annual meeting of the Orthopaedic Research Society, Long Beach, California, Long Beach, California, Jan. 2011.
117.
Natsuo Yasui, Mitsuhiko Takahashi, Kiminori Yukata, Aziz Abbaspour, Shinjiro Takata and Koichi Sairyo : Enhanced bone healing by local infusion of FGF-2 and bisphosphonate during distraction osteogenesis, 6th Meeting of the A.S.A.M.I International & 3rd World Congress on External Fixation(Hesperia Tower Hotel & Convention Center Gran Via (Barcelona)), Oct. 2010.
118.
Toshinori Sakai, Shinsuke Katoh, Koichi Sairyo, Chisato Tanaka, Rumi Katashima, Katsuhiko Yoshimoto and Mitsuo Itakura : An SNP in the 3region of the Collagen11 Alpha 2 Gene is Associated with Susceptibility to OPLL., 47th Annual Meeting of Orthopaedic Research Society, San Francisco, Feb. 2001.
Koichi Sairyo : 神経障害性疼痛を運動療法で攻略, 第4回地域連携セミナー∼神経障害性疼痛と治療について考える∼(稲次病院 会議室), Mar. 2024.
9.
Koichi Sairyo : 腰痛治療, 小松島市医師会在宅医療・介護連携推進事業 市民公開講座(サウンドハウスホール), Mar. 2024.
10.
Koichi Sairyo : Be professional of the Kinematic Control Rehabilitation after MIS Spine Surgery., The 6th ISMISS combined with The 16th MISS Summit Forum(米国フロリダ州からライブ講演), Mar. 2024.
11.
Koichi Sairyo : 非特異的腰痛の謎を解明する, 第34回骨軟部放射線研究会(あわぎんホール), Mar. 2024.
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.
140.
Koichi Sairyo : Full-endoscopic Transforaminal Decompression for Lumbar Spinal Canal Stenosis Under Local Anesthesia., 3rd World Congress on MIS & Endoscopic Spine Surgery【国際ウェビナー:インド】自宅からWEB, Sep. 2022.
Koichi Sairyo : 脊椎全内視鏡手術がもたらす疼痛治療の次世代スタンダード, 脊椎疾患 Up to Date (第一三共徳島営業所から配信:WEB), Sep. 2022.
145.
Kenji Yokoyama, Tetsuya Matsuura, Jyoji Iwase and Koichi Sairyo : CTによる肘離断性骨軟骨炎の病巣評価と，鏡視下郭清術後の肘関節可動域の関連, The Journal of the Japanese Orthopaedic Association, 96, 8, S1808, Sep. 2022.
146.
Fumitake Tezuka, FUJIMOTO Shutaro, 小川 貴大, Kosuke Sugiura, Masatoshi Morimoto, Kazuta Yamashita and Koichi Sairyo : AR顕微鏡を用いた脊髄腫瘍手術の有用性とピットフォールについて, 第34回徳大脊椎外科カンファレンス(ホテルクレメント徳島), Aug. 2022.
Kenji Yokoyama, Tetsuya Matsuura, Jyoji Iwase, Toshiyuki Iwame and Koichi Sairyo : Computed Tomography is More Useful for Accurate Measuring Osteochondral Defects of Osteochondritis Dissecans of the Elbow than Radiography., JOSKAS-JOSSM 2022【開催期間:2022年6月16日-18日】, Jun. 2022.
Yasuyuki Ohmichi, Toshihiko Nishisho, Shun-ichi Toki and Koichi Sairyo : 大腿骨骨転移の病的骨折危険予測は複数の方法を組み合わせることで精度を高めることができるか, 第95回日本整形外科学会学術総会【開催期間:2022年5月19日- 22日】, May 2022.
204.
Toshihiko Nishisho, Shun-ichi Toki, Ryo Miyagi and Koichi Sairyo : 軟部肉腫局所制御予測に最適な切除縁評価法の検討, 第95回日本整形外科学会学術総会【開催期間:2022年5月19日- 22日】, May 2022.
205.
Tetsuya Matsuura, Toshiyuki Iwame, Jyoji Iwase, Kenji Yokoyama and Koichi Sairyo : 肘離断性骨軟骨炎に対する体外衝撃波治療の経験, The Journal of the Japanese Orthopaedic Association, May 2022.
206.
Tetsuya Matsuura, Nori Sato, Shinsuke Katoh and Koichi Sairyo : 肘離断性骨軟骨炎に対する集束型体外衝撃波治療, The Japanese Journal of Rehabilitation Medicine, 1881-3526, S121, May 2022.
207.
Nori Sato, 梅村 公子, 松田 拓, Tetsuya Matsuura, Shinsuke Katoh and Koichi Sairyo : 急性期病院入院患者の転倒・転落のうちインシデント影響度分類レベル3b以上の検討 8年間の分析, The Japanese Journal of Rehabilitation Medicine, S182, May 2022.
大前 博司, 近藤 心, 松田 拓, 梅村 公子, Nori Sato and Koichi Sairyo : 脳梗塞発症後2週以内に測定したPhase angleが退院時のmodified Rankin Scaleに及ぼす影響, The Japanese Journal of Rehabilitation Medicine, S604, May 2022.
斎藤 貴, Nori Sato, 松本 健, 大西 宏和, 藤井 康光, 田中 雄悟, Koichi Sairyo and 酒井 良忠 : 肺がん患者における術前6分間歩行距離の決定因子 探索的研究, The Japanese Journal of Rehabilitation Medicine, S640, May 2022.
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.
Koichi Sairyo : Full-endoscopic lumbar spine surgery:beyond the gold standard., 7th World Congress of Minimally Inbasive Spine Surgery&Techniques, Nov. 2021.
Koichi Sairyo : Efficacy of Full Endoscopic Ventral Facetectomy for The Lumbar Spinal Canal Stenosis., World Spine Congress 2021【国際ウエビナー:パリ】, Nov. 2021.
Koichi Sairyo : Full-endoscopic trans-kambin lumbar interbody fusion (fullendo KLIF) The state of the Art Technical Advances., SMISS-Asia Pacific 【国際ウエビナー:韓国】, Oct. 2021.
Tetsuya Matsuura, Nori Sato, 梅村 公子, Shinsuke Katoh and Koichi Sairyo : 少年野球検診で発見した肘離断性骨軟骨炎の経過, The Japanese Journal of Rehabilitation Medicine, Jun. 2021.
292.
Koichi Sairyo : 脊椎内視鏡手術のSDGs (Sustainable Development Goals), 写真向け勉強会及び第2回KLIFを語る会(オンライン配信), May 2021.
293.
Koichi Sairyo : 一般整形外科医が知っておくべきスポーツ関連腰痛の診断と治療, 第94回日本整形外科学会学術総会, May 2021.
294.
Koichi Sairyo : 全内視鏡脊椎手術(full-endoscopic spine surgery)の進化, 第94回日本整形外科学会学術総会, May 2021.
295.
Koichi Sairyo : 全内視鏡下trans-Kambin interbody fusion(Fullendo-KLIF)-手術手技と臨床成績-, 第94回日本整形外科学会学術総会, May 2021.
296.
Tetsuya Matsuura, Toshiyuki Iwame, Jyoji Iwase, Kenji Yokoyama, Shinji Kashiwaguchi, 岩瀬 毅信 and Koichi Sairyo : 少年野球肘検診の過去，現在，未来, The Journal of the Japanese Orthopaedic Association, May 2021.
297.
Koichi Sairyo : 腰痛治療の最前線:Beyond the Tokyo∼この技術を徳島から全国へ∼, 公益社団法人日本薬剤学会(招待講演) 第36年会【オンデマンド形式】2021年5月13日-15日, May 2021.
298.
Koichi Sairyo : アスリートの腰痛:診断と内視鏡下手術, 第10回日本テニス・スポーツ医学研究会, May 2021.
299.
Nori Sato, Koichi Sairyo, 松田 拓, 梅村 公子 and Shinsuke Katoh : リハビリテーション医学とバイオメカニズム 頸髄症患者における手指巧緻運動障害の三次元動作解析, The Japanese Journal of Rehabilitation Medicine, 58, JSY07-2, May 2021.
Nori Sato, 梅村 公子, 松田 拓, Koichi Sairyo and Shinsuke Katoh : 急性期病院入院患者におけるリハビリテーション中の転倒・転落の分析, The Japanese Journal of Rehabilitation Medicine, 58, 1-14-8-2, May 2021.
Koichi Sairyo : Transforaminal full-endoscopic decompression for lumbar spinal canal stenosis:Awake and aware condition., Kyiv Endoscopic Spine Surgery Course【国際ウエビナー:ウクライナ】, Apr. 2021.
308.
Koichi Sairyo : Transforaminal full-endoscopic decompression for lumbar spinal stenosis under local anesthesia:aware&awake condition., Kyiv Endoscopic Spine Surgery Course International Society of Unilateral Biportal Endoscopy (ISUBE) 2021Webinar,ukraine, Apr. 2021.
309.
Koichi Sairyo : Challenge against the gold standard using spine full-endoscope., Kyiv Endoscopic Spine Surgery Course International Society of Unilateral Biportal Endoscopy (ISUBE) 2021Webinar,ukraine, Apr. 2021.
310.
Koichi Sairyo : Transforaminal full endoscopic intradiscal surgery for discogenic pain & type Modic change., Endovision presents: International Minimally Invasive and Endoscopic Spine Surgery Webinar, Apr. 2021.
Koichi Sairyo : アスリートの腰痛と神経障害性疼痛∼pain generator の同定が完治を導く∼, 第216回北陸整形外科集談会 日本整形外科学会教育研修講演, Mar. 2021.
313.
Koichi Sairyo : Efficacy of Radiofrequency Bipolar for Full-endoscopic Intradiscal Surgery:Thermal Annuloplasty (Discogenic Pain) &Disc Cleaning (Type 1 Modic Change)., The 3rd ISMISS Asia-Japan Meeting, Mar. 2021.
314.
Koichi Sairyo : Efficacy of Radiofrequency Bipolar for Full-endpscopic Intradiscal Surgery:Thermal Annuloplasty & Disc Cleaning., The 3rd ISMISS Asia-Japan Meeting【オンデマンド配信】, Mar. 2021.
315.
古本 太希, Daisuke Hamada, Keizo Wada, Yasuaki Tamaki, Nori Sato, Tomohiro Goto, Shinsuke Katoh and Koichi Sairyo : 両十字靱帯温存型の人工膝関節全置換術後では歩行時に正常な膝関節運動力学動態を再現できていない, The Journal of the Japanese Orthopaedic Association, 95, 3, S790, Mar. 2021.
Koichi Sairyo : Lecture of ISMISS ASIA president Sustainable Development Goals(SDGs)of Full-Endoscopic Spine Surgery., The 3rd. ISMISS Asia-Japan combined with The13th.MISS Summit Forum【オンデマンド配信】, Mar. 2021.
Nori Sato, 梅村 公子, 松田 拓, Koichi Sairyo and Shinsuke Katoh : 転倒・転落アセスメントシートを用いた入院患者の転倒・転落の背景因子の検討 多変量解析による検討, The Japanese Journal of Rehabilitation Medicine, 57, 3-14-4-6, Jul. 2020.
(Keyword)
危険因子 *転倒・転落 *リハビリテーション リスク評価 ヒト
350.
Koichi Sairyo : Full-Endoscopic Decompression:When to say NO., AOSAP 1st virtual Conference【WEB】, Jun. 2020.
Koichi Sairyo : 局所麻酔・腰痛全内視鏡手術の進化-経椎間孔の世界がこれまでの概念を変える-(教育研修講演67), 第93回日本整形外科学会学術総会【WEB】, May 2020.
353.
Koichi Sairyo, Kosuke Sugiura, Takayuki Uchida and Takeshi Nikawa : ミトコンドリア-小胞体接触領域(MAM)は廃用性筋委縮を制御する(一般演題 基礎:筋・腱・滑膜 ), 第93回日本整形外科学会学術総会【WEB】, May 2020.
354.
Koichi Sairyo, Kousaku Higashino, Tomohiro Goto, Yasuaki Tamaki and Yoshihiro Tsuruo : 全内視鏡下脊椎手術のカダバートレーニング(シンポジウム67), 第93回日本整形外科学会学術総会【WEB】, May 2020.
355.
Koichi Sairyo, Hiroaki Manabe and 半谷 美夏 : 女子新体操選手の脊柱障害特殊性(シンポジウム11), 第93回日本整形外科学会学術総会【WEB】, May 2020.
356.
Koichi Sairyo : 非特異的腰痛のpain generator -トップアスリートからの解析-(シンポジウム3), 第93回日本整形外科学会学術総会【WEB】, May 2020.
357.
古本 太希, Daisuke Hamada, Tomoya Takasago, Keizo Wada, Yasuaki Tamaki, Nori Sato, Tomohiro Goto, Shinsuke Katoh and Koichi Sairyo : 人工膝関節全置換術後6ヵ月での1足1段様式による段階降段のための大腿四頭筋力のカットオフ値, The Journal of the Japanese Orthopaedic Association, 94, 3, S1261, Mar. 2020.
(Keyword)
基準値 *膝関節置換術(リハビリテーション) *大腿四頭筋 *階段昇降 ヒト
358.
Koichi Sairyo : アスリートの非特異的腰痛を攻略:The Leading Edge Technology, 淡青運動器セミナー2020(御茶ノ水ソラシティカンファレンスセンター), Feb. 2020.
359.
Koichi Sairyo : 腰部脊柱管狭窄症における全内視鏡手術∼除圧からposterior to psoas LIFまで∼, 第6回JALAS(御茶ノ水ソラシティカンファレンスセンター), Jan. 2020.
Nori Sato, Koichi Sairyo, 森脇 好乃美, 森脇 笙 and Shinsuke Katoh : 術前術後に手指三次元動作解析が可能であった頸髄症患者の一例, The Japanese Journal of Rehabilitation Medicine, 55, S350, Oct. 2018.
Koichi Sairyo : Percutaneous Endoscopic Transforaminal Spine Surgery for the Lumbar Spinal Canal Stenosis: Decompression (PELF/PEVF) and Fusion (PETLIF/PEDLIF), 第2回ISESS 第2回ISMISS Asia-Japan 第11回MISS Summit Forum 3大会 合同開催, Sep. 2018.
401.
Nori Sato, Hiroshi Yonezu, Fumio Hayashi, Shinsuke Katoh and Koichi Sairyo : 骨粗鬆症外来における女性患者の筋量と大腿骨骨質の相関について, The Journal of Japan Osteoporosis Society, 4, Suppl.1, 289, Sep. 2018.
(Keyword)
*筋骨格系生理学的現象 *骨粗鬆症 *大腿骨 *身体組成 *骨質 *筋量 ヒト 女
402.
Nori Sato, 酒井 紀典, Fumitake Tezuka, Yoichiro Takata, Takashi Chikawa, Koichi Sairyo and Shinsuke Katoh : 頸髄症患者における手指三次元動作解析, The Journal of the Japanese Orthopaedic Association, 92, 8, S1746, Aug. 2018.
(Keyword)
*手指 *動作 *頸椎症性脊髄症 *動作分析 ヒト 高齢者(65∼79) 男 女
403.
岡久 哲也, Tetsuya Matsuura, Toshiyuki Iwame, Nori Sato, Shinsuke Katoh and Koichi Sairyo : 前十字靱帯再建術後6ヵ月における膝伸展筋力及び膝屈曲筋力とSingle Leg Hopの距離，恐怖感及び疼痛の関係, Japanese Journal of Orthopaedic Sports Medicine, 38, 4, 429, Aug. 2018.
Yamada Yoshiko, Yada Keigo, Hiroyuki Nodera, Koichi Sairyo, Masashi Akaike and Akiyoshi Nishimura : Effectiveness of the medical English course taught by an all-Japanese clinician team, 第21回日本医学英語教育学会, Jul. 2018.
Koichi Sairyo : 腰椎分離症の最新の知見, 第91回日本整形外科学会学術総会 シンポジウム60, May 2018.
412.
Toshinori Sakai, 後藤 強, 杉浦 宏祐, Fumitake Tezuka, Yoichiro Takata, Takashi Chikawa and Koichi Sairyo : 骨性連続性が途絶えた椎弓に発生した新規腰椎疲労骨折の骨癒合率について, 第91回日本整形外科学会学術総会, May 2018.
413.
Koichi Sairyo : アスリートにおける特異的腰痛と非特異的腰痛∼pain generator の同定で完治を導く∼, 第28回中国四国ペインクリニック学会 教育講演, May 2018.
414.
Tetsuya Matsuura, Toshiyuki Iwame and Koichi Sairyo : 小児の肘離断性骨軟骨炎に対する鏡視下郭清術, 日本関節鏡・膝・スポーツ整形外科学会雑誌, 43, 4, 507, May 2018.
415.
百田 佳織, Nori Sato, Koichi Sairyo and Shinsuke Katoh : 腸腰筋筋力の簡易定量化の確立 験者内信頼性および験者間信頼性の検討, The Japanese Journal of Rehabilitation Medicine, 55, 2-6-7-5, May 2018.
(Keyword)
*腸腰筋 観察者による差 結果再現性 *筋力 ヒト 成人(19∼44) 男
416.
Nori Sato, 百田 佳織, Koichi Sairyo and Shinsuke Katoh : 手指の三次元動作解析における動作課題の検討, The Japanese Journal of Rehabilitation Medicine, 55, 2-10-1-5, May 2018.
(Keyword)
*手指 *動作 *動作分析 ヒト 男
417.
Keizo Wada, Tomohiro Goto, Tomoya Takasago, Daisuke Hamada and Koichi Sairyo : 骨盤傾斜が骨頭被覆率に与える影響についての検討, 第91回日本整形外科学会学術総会, May 2018.
Tetsuya Matsuura, Toshiyuki Iwame, Naoto Suzue, 横山 賢二 and Koichi Sairyo : 検診で早期発見されたのちに手術に至った肘離断性骨軟骨炎の検討, The Journal of the Japanese Orthopaedic Association, 92, 3, S636, Mar. 2018.
423.
Tetsuya Matsuura, Toshiyuki Iwame, 横山 賢二, Naoto Suzue, Shinji Kashiwaguchi, 岩瀬 毅信 and Koichi Sairyo : 肘離断性骨軟骨炎の診断と保存療法, The Journal of the Japanese Orthopaedic Association, 92, 2, S476, Mar. 2018.
424.
Tetsuya Matsuura, Toshiyuki Iwame, 横山 賢二, Naoto Suzue, Shinji Kashiwaguchi, 岩瀬 毅信 and Koichi Sairyo : 少年野球肘の予防と対策, The Journal of the Japanese Orthopaedic Association, 92, 2, S359, Mar. 2018.
425.
Koichi Sairyo : スポーツ障害と腰痛:ストレッチで腰痛予防, 市民公開講座 徳島大学病院フォーラム2014春, Mar. 2018.
426.
Koichi Sairyo : 非特異的腰痛の背景とアスリートにおける実際, 第29回腰痛シンポジウム, Mar. 2018.
427.
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.
Koichi Sairyo : ロコモと腰痛, 第2回Clinical Conference in KURAMOTO, Jun. 2017.
462.
Koichi Sairyo : 局所麻酔下経皮的内視鏡脊椎手術の最前線-PED,PELF,thermal annuloplasty-, 第90回日本整形外科学会学術総会, May 2017.
463.
Tetsuya Matsuura, Toshiyuki Iwame, Naoto Suzue, Shinji Kashiwaguchi, 岩瀬 毅信 and Koichi Sairyo : 少年野球選手における肘離断性骨軟骨炎に対する保存療法, 第90回日本整形外科学会学術総会, May 2017.
464.
Koichi Sairyo : トップアスリートの慢性腰痛におけるHIZの意義と低侵襲内視鏡治:Thermal annuloplasty, 第90回日本整形外科学会学術総会, May 2017.
465.
Nori Sato, Yuichiro Goda, Kousaku Higashino, Toshinori Sakai, Shinsuke Katoh and Koichi Sairyo : 腰部脊柱管狭窄症患者における肥厚黄色靭帯の完全可溶化とプロテオーム解析の確立, 第128回中部日本整形外科災害外科学会・学術集会, Apr. 2017.
466.
Koichi Sairyo : Percutanes endoscopic transforaminal surgery under the local anesthesia: state of the art technique for discectomy, foraminoplasty and ventral facetectomy., The 1st ISMISS Asia-Japan combined with the 10th memorial MISS Summit Forum, Mar. 2017.
467.
Koichi Sairyo : アスリートの腰痛∼確定診断に基づく低侵襲手術の最前線∼, 東北大学整形外科談論会, Mar. 2017.
468.
Koichi Sairyo : アスリートの腰痛∼非特異的腰痛の病態と内視鏡治療∼, 第2回整形外科医とオピオイドを語る会, Mar. 2017.
469.
Koichi Sairyo : アスリートの腰痛∼早期復帰を可能にする方程式∼, 第56回獨整会公開学術講演会, Mar. 2017.
470.
Koichi Sairyo : ロコモティブシンドロームと腰痛, 小松島市医師会学術講演会, Mar. 2017.
Kousaku Higashino, Keizo Wada, Tomohiro Goto, Daisuke Hamada, Koichi Sairyo and Yoshihiro Fukui : 閉鎖動脈の分岐，骨髄内血行の研究, 第121回日本解剖学会総会・全国学術集会, Mar. 2016.
518.
Koichi Sairyo : アスリートの腰痛管理∼診断と内視鏡治療の最前線∼, 京都整形外科医会3月例会, Mar. 2016.
519.
Koichi Sairyo : アスリートの腰痛∼確定診断への方程式∼, 第6回川崎医科大学マカオンセミナー, Mar. 2016.
520.
Tetsuya Matsuura, Naoto Suzue, Toshiyuki Iwame and Koichi Sairyo : 少年野球検診で発見された肘離断性骨軟骨炎の臨床経過, The Journal of the Japanese Orthopaedic Association, 90, 3, S583, Mar. 2016.
521.
Tetsuya Matsuura, Naoto Suzue, Toshiyuki Iwame and Koichi Sairyo : 徳島県における肘離断性骨軟骨炎の早期発見を目的とした少年野球検診, The Journal of the Japanese Orthopaedic Association, 90, 2, S358, Mar. 2016.
Kousaku Higashino, Toshinori Sakai, Yoichiro Takata, Yuichiro Goda, Koichi Sairyo and Yoshihiro Fukui : Evaluation of PED procedure between surgery for patients and training using fresh cadavers, 第120回日本解剖学会全国学術集会,第92回日本生理学会, Mar. 2015.
568.
Koichi Sairyo : アスリートの腰痛∼確定診断への方程式∼, 第23回信州脊椎脊髄疾患研究会, Mar. 2015.
569.
Koichi Sairyo : スポーツと腰部障害謎の腰痛を解き明かす, 第38回日本脳神経外傷学会, Mar. 2015.
570.
Koichi Sairyo : 腰椎分離症の診断と治療におけるバイオメカニクスの役割, 第10回大阪バイオメカニクス研究会, Mar. 2015.
Koichi Sairyo : 局所麻酔後外側刺入PED法(Transforaminal and far-lateral法)の合併症, 第43回日本脊椎脊髄病学会学術集会, Apr. 2014.
643.
Koichi Sairyo : 脊椎内視鏡手術の進化~局所麻酔・潅流無血野へのパラダイムシフト~, 第1回徳島整形外科登竜門医会∼Resident Research Day∼, Apr. 2014.
644.
Koichi Sairyo : 脊椎内視鏡手術の進歩~PEDとthermal annuloplastyを中心に~, 「二金会」学術講演会, Mar. 2014.
645.
Koichi Sairyo : ゴルファー特有の腰痛∼腰痛診断のバイオメカニクス∼, Sports Forum 21 The Golf, Mar. 2014.
646.
Koichi Sairyo : 「アスリートの腰痛」∼確実な診断に基づく，低侵襲手術∼, 18回四国スポーツセラピー研究会, Mar. 2014.
647.
Koichi Sairyo : スポーツ選手の腰痛管理∼低侵襲治療でフィールド復帰を可能にする∼, 第27回SUMS骨・関節懇話会, Mar. 2014.
648.
Koichi Sairyo : 国民病としての腰痛~診断，最少侵襲手術，そして予防~, 平成25年度第2回徳島県臨床内科医会講演会, Mar. 2014.
649.
Koichi Sairyo : 腰痛の診断と低侵襲手術の最前線, 第25回徳島女性医学研究会, Mar. 2014.
650.
Koichi Sairyo : 学部∼スポーツ医学のメッカを目指して∼, 徳島大学医学部白衣授与・Student Doctor認定証授与式, Mar. 2014.
651.
Koichi Sairyo : アスリートの腰痛管理∼確実な診断と低侵襲治療でフィールド復帰を可能とする∼, 西良浩一 平成25年度神奈川県医師会健康スポーツ医部会, Mar. 2014.
652.
Koichi Sairyo : Minimally invasive treatment of chrornic low back pain in athletes: Percutaneous endoscopic surgery and thermal annuloplasty, The 7th MISS Summit Forum Luncheon Seminar, Mar. 2014.
Natsuo Yasui, Koichi Sairyo, Takeshi Nikawa and Kyoichi Kishi : Osteoactivin : A novel glycoprotein inhibiting adhesion of osteoblastic cells to bone matrix, ラット宇宙実験サンプルシェア研究, 2002.