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Microendoscopic Excision of Osteoid Osteoma in the Pedicle of the Third Lumbar Vertebra
Katsuhito Yoshioka,Eizo Matsuda,Hideki Murakami,Hiroyuki Tsuchiya 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.6
We present a rare case of a patient who underwent complete microendoscopic excision of an osteoid osteoma, which induced radiculopathy without nerve root compression. A 20-year-old man presented severe right groin pain that was temporarily relieved by nonsteroidal anti-inflammatory drugs. A computed tomography (CT) scan showed typical features of a nidus located in the inferior cortex of the right L3 pedicle. We performed surgery using a posterior microendoscopic approach. We drilled vertically along the line of the cortex of the caudal pedicle using a high-speed drill. After identifying the tumor, en bloc resection of the nidus was achieved. Immediately after surgery, pain in the right groin disappeared. A CT scan showed that most of the right L3 pedicle remained. This minimally invasive technique preserves spinal structures, including the facet and pedicle, and is a viable option for the treatment of spinal osteoid osteomas located close to vital structures.
Kazuya Shinmura,Hideki Murakami,Satoru Demura,Satoshi Kato,Katsuhito Yoshioka,Hiroyuki Hayashi,Noriaki Yokogawa,Takashi Igarashi,Moriyuki Fujii,Noritaka Yonezawa,Hiroyuki Tsuchiya 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.6
Study Design: A retrospective study. Purpose: To evaluate the immunity-enhancing effect of implantation of a liquid nitrogen-treated tumor. Overview of Literature: We have developed a new technique of implanting a tumor frozen in liquid nitrogen after posterior decompression and stabilization, with the aim of enhancing antitumor immunity in order to prolong the survival period of the patient. In the current study, the immunity-enhancing effect of this new technique has been evaluated. Methods: The subjects were 19 patients in whom we had earlier performed decompression and stabilization between April 2011 and September 2013. The 19 subjects were divided into two groups, namely a frozen autologous tumor tissue implantation group (n=15; “implantation group”), which consisted of patients, who underwent implantation with autologous tumor tissue frozen in liquid nitrogen, and a control group (n=4), which consisted of patients, who did not undergo autologous cancer transplantation. To evaluate the immunity-enhancing effect of the protocol, plasma cytokines (interferon [IFN]-γ and interleukin [IL]-12) were analyzed before surgery and a month after surgery. Results: The mean rate of increase in IFN-γ was significantly higher in the implantation group (p =0.03). Regarding IL-12, no significant difference was observed between the groups, although the implantation group exhibited increased levels of IL-12 (p =0.22). Conclusions: Decompression and stabilization combined with autologous frozen tumor cell implantation can enhance cancer immunity in metastatic spinal tumor patients. It is hypothesized that this procedure might prevent local recurrence and prolong survival period.
Kyoichi Ogawa,Tamon Kabata,Toru Maeda,Yoshitomo Kajino,Hiroyuki Tsuchiya 대한정형외과학회 2014 Clinics in Orthopedic Surgery Vol.6 No.2
Background: Several studies have shown that better placement of the acetabular cup and femoral stem can be achieved in total hip arthroplasty (THA) by using the computer navigation system rather than the free-hand alignment methods. However, there have been no comparisons of the relevant clinical advantages in using the computer navigation as opposed to the manual intraoperative measurement devices. The purpose of this study is to determine whether the use of computer navigation can improve postoperative leg length discrepancy (LLD) compared to the use of the measurement device. Methods: We performed a retrospective study comparing 30 computer-assisted THAs with 40 THAs performed using a simple manual measurement device. Results: The postoperative LLD was 3.0 mm (range, 0 to 8 mm) in the computer-assisted group and 2.9 mm (range, 0 to 10 mm) in the device group. Statistically significant difference was not seen between the two groups. Conclusions: The results showed good equalization of the leg lengths using both computed tomography-based navigation and the simple manual measurement device.
Satoshi Kato,Satoru Demura,Yuki Kurokawa,Naoki Takahashi,Kazuya Shinmura,Noriaki Yokogawa,Noritaka Yonezawa,Takaki Shimizu,Ryo Kitagawa,Hiroyuki Tsuchiya 대한재활의학회 2020 Annals of Rehabilitation Medicine Vol.44 No.3
Objective To examine the efficacy and safety of an innovative, device-driven abdominal trunk muscle strengthening program, with the ability to measure muscle strength, to treat chronic low back pain (LBP) in elderly participants. Methods Seven women with non-specific chronic LBP, lasting at least 3 months, were enrolled and treated with the prescribed exercise regimen. Patients participated in a 12-week device-driven exercise program which included abdominal trunk muscle strengthening and 4 types of stretches for the trunk and lower extremities. Primary outcomes were adverse events associated with the exercise program, improvement in abdominal trunk muscle strength, as measured by the device, and improvement in the numerical rating scale (NRS) scores of LBP with the exercise. Secondary outcomes were improvement in the Roland-Morris Disability Questionnaire (RDQ) score and the results of the locomotive syndrome risk test, including the stand-up and two-step tests. Results There were no reports of increased back pain or new-onset abdominal pain or discomfort during or after the device-driven exercise program. The mean abdominal trunk muscle strength, NRS, RDQ scores, and the stand-up and two-step test scores were significantly improved at the end of the trial compared to baseline. Conclusion No participants experienced adverse events during the 12-week strengthening program, which involved the use of our device and stretching, indicating the program was safe. Further, the program significantly improved various measures of LBP and physical function in elderly participants.
Invasiveness Reduction of Recent Total En Bloc Spondylectomy: Assessment of the Learning Curve
Takayoshi Ishii,Hideki Murakami,Satoru Demura,Satoshi Kato,Katsuhito Yoshioka,Moriyuki Fujii,Takashi Igarashi,Hiroyuki Tsuchiya 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.3
Study Design: Case-control study. Purpose: To evaluate the surgical magnitude and learning curve of “second-generation” total en bloc spondylectomy (TES). Overview of Literature: In June 2010, we developed second-generation TES combined with tumor-induced cryoimmunology, which does not require autograft harvesting. Methods: TES was performed in 63 patients between June 2010 and September 2013. Three groups of patients were evaluated: 20 undergoing surgery in the first year of development of second-generation TES (group I), 20 in the second year (group II), and 23 in the third year (group III). Patient backgrounds showed no remarkable differences. Operating time, intraoperative blood loss, blood transfusion, and postoperative C-reactive protein and creatine phosphokinase were compared among the groups. Results: Mean±standard deviation operating time was 486±130 minutes in group I, 441±85 minutes in group II, and 396±75 minutes in group III. The time was significantly shorter in group III than in group I (p <0.05). Intraoperative blood loss was 901±646 mL in group I, 433±177 mL in group II, and 411±167 mL in group III. Blood loss was significantly lower in groups II and III than in group I (p <0.01). Transfusion was not required in 20 of 23 patients in group III, and mean C-reactive protein levels on postoperative day 3 were significantly lower in this group than in group I (6.12 mg/L vs. 10.07 mg/L; p <0.05). Postoperative creatine phosphokinase levels did not differ among the groups. Conclusions: TES is associated with a significant learning curve. Thus, second-generation TES can no longer be considered highly invasive.
Katsuhiro Hayashi,Tetsutaro Yahata,Ryota Muramoto,Norio Yamamoto,Akihiko Takeuchi,Shinji Miwa,Takashi Higuchi,Kensaku Abe,Yuta Taniguchi,Hisaki Aiba,Yoshihiro Araki,Hiroyuki Tsuchiya 대한재활의학회 2018 Annals of Rehabilitation Medicine Vol.42 No.3
Objective To analyze patient characteristics of cancer rehabilitation and outcomes at our hospital.Methods This retrospective study analyzed 580 patients, who underwent cancer rehabilitation at our hospital and rehabilitation outcome after therapy were investigated. The relationship between the initial Barthel index and discharge outcomes was investigated, with a special focus on cancer patients with bone metastasis. The Barthel index and performance status (Eastern Cooperative Oncology Group) before and after rehabilitation were analyzed, and threshold value of home discharge was calculated from a receiver operating characteristic curve (ROC). General criteria for home discharge from our hospital included independence in performing basic activities of daily living such as bathing, feeding, and toileting or availability of home support from a family member/caregiver.Results The outcomes after rehabilitation among all the patients were as follows: discharge home 59%, death 13%, and others 27%. Statistical differences were observed between the initial and final values of the Barthel index in patients with bone metastasis, who could be discharged home (p=0.012). ROC analysis of the initial Barthel index for predicting home discharge revealed a threshold value of 60, sensitivity of 0.76, and specificity of 0.72.Conclusion The patients with bone metastasis had a lower rate of home discharge and a higher rate of mortality than all the study patients who underwent cancer rehabilitation at our hospital. It is proposed that at the time of initiation of rehabilitation for patients with bone metastasis, an initial Barthel index lower than 60 might predict a worse outcome than home discharge.