Koichi Sairyo : OS NEXUS 高齢者上肢骨折に対する手術, MEDICAL VIEW CO., LTD., Feb. 2018.
16.
Koichi Sairyo : OS NEXUS 股関節の再建法 成功への準備とコツ, MEDICAL VIEW CO., LTD., Nov. 2017.
17.
Koichi Sairyo : OS NEXUS スポーツ復帰のための手術 肩・肘, MEDICAL VIEW CO., LTD., Aug. 2017.
18.
Koichi Sairyo : OS NEXUS 脊椎固定術 匠のワザ, MEDICAL VIEW CO., LTD., May 2017.
19.
Kazuta Yamashita and Koichi Sairyo : PPS:腰椎分離症修復術 Smiley face Rod Method, MEDICAL VIEW CO., LTD., May 2017.
20.
岩目 敏幸, Tetsuya Matsuura, Naoto Suzue and Koichi Sairyo : Ⅱ.こどものスポーツ傷害の早期発見・予防 3.サッカー検診の実際と障害予防への取り組み, 株式会社 全日本病院出版会, May 2015.
21.
酒巻 忠範 and Koichi Sairyo : Ⅳ.部位別-こどものスポーツ傷害の治療と予防 3.腰部のスポーツ障害;公式をもちいた腰椎分離症治療のストラテジー, 株式会社 全日本病院出版会, May 2015.
22.
北浜 義博 and Koichi Sairyo : 7)低侵襲腰椎分離部修復術-フックロッド法とスマイリーフェイスロッド法, Apr. 2015.
23.
Toshinori Sakai and Koichi Sairyo : 脊椎分離症，脊椎分離すべり症, エルゼビア・ジャパン株式会社, Mar. 2013.
24.
Toshinori Sakai and Koichi Sairyo : 今日の臨床サポート, エルゼビア・ジャパン株式会社, Mar. 2013.
25.
Koichi Sairyo : 脊椎の疾患「腰椎分離症」, 2013.
26.
Toshinori Sakai, Koichi Sairyo and NN Bhatia : Management of Thoracolumbar Fractures., 2012.
27.
Toshinori Sakai, Koichi Sairyo and Bhatia B. Nitin : Spondylolysis and Spondylolisthesis., 2010.
28.
Koichi Sairyo, Goel K. Vijay, Biyani Ashok, Ebraheim A. Nabil, Toshinori Sakai and Togawa Disuke : Endscopic decompression for lumbar spondylolysis: clinical and biomechanical observations., 2007.
Academic Paper (Judged Full Paper):
1.
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), Vol.27, No.3,
(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.
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, 2019.
(Summary)
We retrospectively reviewed 214 patients who underwent primary total hip arthroplasty (THA) and identified 30 hips with Crowe II (
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, 2019.
(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.
Toshiyuki Iwame, Tetsuya Matsuura, Tetsuya Okahisa, Joji 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, 2019.
(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.
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, Vol.10, No.9, 743-745, 2019.
7.
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, 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.
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, 2019.
(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.
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, Vol.6, No.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, Vol.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, Vol.13, No.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, Vol.28, No.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 : Direction and location of the nutrient artery to the fifth metatarsal at risk in osteotomy for bunionette., Foot and Ankle Surgery, Vol.25, No.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, Vol.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, Vol.59, No.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.
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, 2019.
(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.
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, Vol.24, No.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
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, Vol.66, No.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, Vol.66, No.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, Vol.66, No.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, Vol.66, No.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, Vol.66, No.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, Vol.66, No.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, Vol.66, No.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, Vol.66, No.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, Vol.66, No.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, Vol.66, No.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, Vol.66, No.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, Vol.66, No.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, Vol.8, No.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, Vol.23, No.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, Vol.26, No.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, Vol.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, No.228, 48-55, 2018.
38.
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, Vol.12, No.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, Vol.26, No.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, Vol.24, No.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, Vol.57, No.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, Vol.3, No.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, Vol.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
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, Vol.3, No.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, Vol.9, No.6, 1005-1011, 2018.
Ichiro Tonogai and Koichi Sairyo : Psychogenic Equinovarus Caused by Dislocation of the Chopart Joint Complex., Case Reports in Orthopedics, Vol.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, Vol.12, No.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 : Examination of the Origin and Branching Direction of the Anterior Medial Malleolar Artery From the Anterior Tibial Artery: A Cadaveric Study., Foot & Ankle Specialist, Vol.12, No.2, 167-171, 2018.
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, Vol.57, No.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, Vol.79, No.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, Vol.65, No.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, Vol.65, No.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, Vol.65, No.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, Vol.65, No.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, Vol.58, No.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, Vol.23, No.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.
Kazuta Yamashita and Koichi Sairyo : 運動器の痛み 2.発育期(こども)における腰痛とそのマネジメント, The Medical Frontline, Vol.72, No.12, 106-113, 2017.
62.
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, Vol.22, No.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.
65.
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.
66.
Toshiyuki Iwame and Koichi Sairyo : 鎖骨疲労骨折, パーフェクト疲労骨折, 134-136, 2017.
67.
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, Vol.56, No.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, Vol.46, No.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, Vol.39, No.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, Vol.42, No.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, Vol.46, No.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, Vol.46, No.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, Vol.28, No.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), Vol.25, No.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, Vol.35, No.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, Vol.37, No.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, Vol.24, No.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, Vol.7, No.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, Vol.22, No.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, Vol.26, No.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, Vol.17, No.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.
Kenichiro Kita, Toshinori Sakai, Kazuta Yamashita, Akihiro Nagamachi and Koichi Sairyo : Spontaneous lumbar spinal subdural hematoma: a case report., British Journal of Neurosurgery, Vol.13, 1-5, 2017.
(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.
Ryosuke Sato, Naohito Hibino, Yoshitaka Hamada and Koichi Sairyo : Ulnolunate Ligament Avulsion Fracture of the Lunate: A Case Report., Journal of Wrist Surgery, Vol.6, No.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, Vol.45, No.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, Vol.78, No.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, Vol.26, No.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, Vol.22, No.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, Vol.30, No.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, Vol.11, No.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, Vol.3, No.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, Vol.26, No.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), Vol.25, No.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, Vol.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, Vol.26, No.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, Vol.37, No.1, 2-6, 2017.
105.
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, Vol.10, No.2, 2, 2017.
106.
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, Vol.1, No.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, Vol.65, No.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, Vol.64, No.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, Vol.7, No.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, Vol.64, No.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, Vol.64, No.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, Vol.64, No.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, Vol.64, No.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, Vol.64, No.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, Vol.64, No.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, Vol.64, No.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, Vol.64, No.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, Vol.46, No.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, Vol.25, No.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, Vol.15, No.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, Vol.98-B, No.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, Vol.21, No.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, Vol.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, Vol.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, Vol.10, No.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, Vol.41, No.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, Vol.45, No.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, Vol.41, No.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, Vol.21, No.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, Vol.6, No.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, Vol.25, No.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, Vol.32, No.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, Vol.10, No.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, Vol.39, No.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, Vol.21, No.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, Vol.25, No.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, Vol.26, No.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, Vol.44, No.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, Vol.21, No.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, Vol.9, No.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, Vol.25, No.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, Vol.136, No.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, Vol.63, No.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, Vol.63, No.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, Vol.63, No.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, Vol.63, No.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, Vol.63, No.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, Vol.63, No.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, Vol.63, No.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, Vol.63, No.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, Vol.63, No.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, Vol.63, No.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, Vol.63, No.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, Vol.25, No.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, Vol.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, Vol.6, No.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, Vol.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, Vol.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, Vol.23, No.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, Vol.44, No.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, Vol.20, No.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, Vol.40, No.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.), Vol.10, No.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, Vol.24, No.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, Vol.7, No.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, Vol.4, No.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.
(Link to Search Site for Scientific Articles)
● PubMed @ National Institutes of Health, US National Library of Medicine (PMID): 25767780
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, Vol.62, No.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, Vol.62, No.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, Vol.62, No.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, Vol.62, No.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, Vol.38, No.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, Vol.44, No.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, Vol.1, No.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, Vol.62, No.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, Vol.62, No.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, Vol.62, No.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, Vol.62, No.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, Vol.62, No.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, Vol.62, No.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, Vol.62, No.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, Vol.62, No.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, Vol.62, No.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, Vol.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, Vol.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, Vol.27, No.13, 49-54, 2014.
200.
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, Vol.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, Vol.43, No.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, Vol.8, No.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, Vol.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, Vol.23, No.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, Vol.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, Vol.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, Vol.9, No.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, Vol.2, No.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, Vol.24, No.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, Vol.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, Vol.37, No.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, Vol.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, Vol.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, Vol.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, Vol.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, Vol.7, No.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, Vol.7, No.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, Vol.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, Vol.52, No.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, Vol.61, No.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, Vol.2, No.2, 1013, 2014.
223.
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, Vol.2, No.1, 1012, 2014.
224.
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, Vol.2, No.1, 1008, 2014.
225.
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, Vol.61, No.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, Vol.61, No.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, Vol.61, No.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, Vol.61, No.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, Vol.61, No.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, Vol.61, No.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, Vol.61, No.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, Vol.61, No.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, Vol.61, No.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, Vol.61, No.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, Vol.61, No.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, Vol.61, No.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, Vol.61, No.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, Vol.19, No.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, Vol.74, No.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, Vol.23, No.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, Vol.6, No.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, Vol.26, No.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, Vol.7, No.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, Vol.6, No.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, Vol.1, No.1, 1006, 2013.
250.
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, Vol.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, Vol.13, No.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, Vol.94, No.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, Vol.16, No.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, Vol.5, No.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, Vol.25, No.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, Vol.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, Vol.5, No.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, Vol.131, No.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, Vol.40, No.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, Vol.58, No.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, Vol.131, No.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, Vol.11, No.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, Vol.11, No.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, Vol.92, No.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, Vol.53, No.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, Vol.11, No.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, Vol.15, No.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, Vol.35, No.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, Vol.19, No.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, Vol.53, No.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, Vol.39, No.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, Vol.38, No.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, Vol.57, No.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, Vol.34, No.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, Vol.22, No.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, Vol.91, No.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, Vol.44, No.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, Vol.10, No.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, Vol.9, No.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, Vol.129, No.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, Vol.91, No.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, Vol.129, No.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, Vol.129, No.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, Vol.129, No.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, Vol.8, No.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, Vol.17, No.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, Vol.51, No.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, Vol.8, No.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, Vol.42, No.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, Vol.8, No.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, Vol.32, No.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, A Biyani, D Leaman, R Yeasting, Kousaku Higashino, Toshinori Sakai, Shinsuke Katoh, Toshiaki Sano, VK Goel and Natsuo Yasui : Pathomechanism of loss of elasticity and hypertrophy of lumbar ligamentum flavum in elderly patients with lumbar spinal canal stenosis., Spine, Vol.32, No.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, Vol.32, No.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, Vol.89, No.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, Vol.32, No.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, Vol.7, No.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, Vol.50, No.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, Vol.50, No.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, Vol.50, No.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, Vol.7, No.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, Vol.31, No.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, Vol.21, No.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, Vol.6, No.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 compar