Impact of Spinal Correction Surgeries with Osteotomy and Pelvic Fixation in Patients with Kyphosis Due to Osteoporotic Vertebral Fractures

Hasegawa Tomohiko,Ushirozako Hiroki,Yamato Yu,Yoshida Go,Yasuda Tatsuya,Banno Tomohiro,Arima Hideyuki,Oe Shin,Yamada Tomohiro,Ide Koichiro,Watanabe Yuh,Matsuyama Yukihiro 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.4

Study DesignCombination of retrospective and prospective study.PurposeWe aimed to compare the clinical outcomes between local fixation surgery and spinopelvic fixation surgery for the treatment of kyphosis secondary to osteoporotic vertebral fractures with spinopelvic malalignment.Overview of LiteratureThe clinical characteristics of patients with rigid kyphosis due to osteoporotic vertebral fracture differ from that of middle-aged patients with vertebral fractures in terms of bone fragility and presence of spinopelvic malalignment. Little is known about the surgical strategies for these deformities, most especially the extent of fusion of vertebra involved.MethodsWe analyzed 24 patients with vertebral osteotomy at the level of the fracture and spinal fixation without pelvic fixation (local group), and 22 patients with vertebral osteotomy and pelvic fixation (pelvic group). Radiographic parameters, the incidence of proximal junctional kyphosis (PJK), distal junctional kyphosis (DJK), rod fractures, and the Oswestry Disability Index (ODI) were compared between the two groups over a 2-year follow-up period.ResultsIn the pelvic group, postoperative spinopelvic parameters significantly improved, with the improvements maintained. No remarkable changes in spinopelvic parameters were seen in the local group. The mean ODI scores 2 years after surgery were 45.3 and 33.0 in the local and pelvic group, respectively (p-value <0.05). There was no significant difference in the incidence of PJK in the local and pelvic groups, but there was a higher rate of DJK (41.7%) in the local group. In contrast, rod fractures were more common in the pelvic group (45.5%). Patients with DJK had higher ODI scores 2 years after surgery (52.0 in DJK patients vs. 34.8 in non-DJK patients; p-value <0.05).ConclusionsFor patients with rigid kyphosis due to osteoporotic vertebral fractures, better spinopelvic alignment and health-related quality of life can be achieved through extensive corrective surgery with pelvic fixation.

Physical properties of near-Earth asteroids with a low delta-<i>v</i>: Survey of target candidates for the Hayabusa2 mission

Hasegawa, Sunao,Kuroda, Daisuke,Kitazato, Kohei,Kasuga, Toshihiro,Sekiguchi, Tomohiko,Takato, Naruhisa,Aoki, Kentaro,Arai, Akira,Choi, Young-Jun,Fuse, Tetsuharu,Hanayama, Hidekazu,Hattori, Takashi,Hsi Astronomical Society of Japan 2018 Publications of the Astronomical Society of Japan Vol.70 No.6

Relationship between Spinal Hemangioblastoma Location and Age

Tatsuya Yasuda,Tomohiko Hasegawa,Yu Yamato,Sho Kobayashi,Daisuke Togawa,Tomohiro Banno,Hideyuki Arima,Shin Oe,Yukihiro Matsuyama 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.2

Study Design: Retrospective case series. Purpose: To investigate the relationship between tumor location and clinical characteristics. Overview of Literature: Hemangioblastoma is a rare disease that develops in the central nervous system. Magnetic resonance imaging (MRI) is useful to evaluate hemangioblastomas. Hemangioblastoma’s location is designated as intramedullary, intramedullary+extramedullary, or extramedullary by MRI. Methods: We analyzed 11 patients who underwent surgery for spinal hemangioblastoma. Using T1 contrast axial MRI data, the cases were divided into three groups (intramedullary, intramedullary+extramedullary, and extramedullary). Patient demographics, MRI findings, and preoperative neurological status were analyzed and compared for each group. Results: The average age of patients with intramedullary, intramedullary+extramedullary, and extramedullary hemangioblastoma was 34.0, 64.4, and 67.5 years, respectively. Patients in the intramedullary hemangioblastoma group were younger than the other groups. Extramedullary cases had a smaller syrinx compared to the other groups. Conclusions: Age may play an important role in the hemangioblastoma tumor location and the subsequent diagnosis by an MRI.

Multi-Rod Constructs Can Increase the Incidence of Iliac Screw Loosening after Surgery for Adult Spinal Deformity

Tomohiro Banno,Tomohiko Hasegawa,Yu Yamato,Daisuke Togawa,Go Yoshida,Sho Kobayashi,Tatsuya Yasuda,Hideyuki Arima,Shin Oe,Yuki Mihara,Hiroki Ushirozako,Yukihiro Matsuyama 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.3

Study Design: A retrospective study. Purpose: To investigate the incidence of iliac screw loosening with a two-rod vs. multi-rod construct and the effect on clinical and radiographic outcomes after surgery for adult spinal deformity (ASD). Overview of Literature: Multi-rod construct is useful for preventing rod fracture in ASD surgery. However, limited information is available regarding the incidence of iliac screw loosening after corrective fusion surgery using a multi-rod construct. Methods: Total 106 patients with ASD (24 men and 82 women; mean age, 68 years) who underwent corrective fusion surgery using bilateral iliac screws and were followed up for at least 1 year were reviewed. The following variables were compared between patients who underwent surgery with a two-rod and multi-rod construct: age, sex, bone mineral density (BMD), fusion level, high-grade osteotomy, L5/S interbody fusion, screw loosening (upper instrumented vertebra [UIV], S1, and iliac), rod fracture, proximal junctional kyphosis, spinopelvic parameters, and Oswestry Disability Index (ODI) score. We also compared patients with and without iliac screw loosening in the multi-rod construct group. Results: Of the 106 patients, 55 underwent surgery with a conventional two-rod construct and 51 with a multi-rod construct (three rods in 16, four rods in 35). Iliac and UIV screw loosening was observed in 24 patients (21%) and 35 patients (33%), respectively. The multi-rod group showed significantly higher incidence of iliac and UIV screw loosening and lower incidence of rod fracture. Patients with iliac screw loosening had a lower BMD than those without screw loosening; however, no significant differences were observed in the spinopelvic parameters or the ODI score. Conclusions: The use of multi-rod constructs led to a higher incidence of junctional screw loosening than the use of conventional two-rod constructs, especially in patients with osteoporosis. Iliac screw loosening did not affect sagittal alignment or clinical outcome in the short term.

Preoperative and Postoperative Pulmonary Function in Elderly Patients with Thoracolumbar Kyphoscoliosis

Tatsuya Yasuda,Tomohiko Hasegawa,Yu Yamato,Sho Kobayashi,Daisuke Togawa,Yukihiro Matsuyama 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.6

Study Design: Case series. Purpose: The objective of this study was to investigate the change in pulmonary function in adult patients with a spinal deformity who underwent spinal corrective surgery. Overview of Literature: Degenerative lumbar and/or thoraco-lumbar deformities are is often prominent in adult spinal deformity cases, whereas a thoracic deformity involving the chest wall is inconspicuous. A lumbar spine deformity could affect the pulmonary function; however, few reports have investigated pulmonary function in adult patients with a spinal deformity. Methods: This study included 14 adult patients with a spinal deformity who underwent posterior corrective fusion (3 males, 11 females; mean age, 67.4 years). We measured percent vital capacity (%VC) and percent forced expiratory volume in 1 second (%FEV1) before surgery and six months after surgery. We investigated the change in pulmonary function after corrective surgery and the correlation between radiographic parameters and pulmonary function. Results: Mean preoperative %VC and %FEV1 values were 99.9% and 79.3%, respectively. Two cases were diagnosed with restrictive impairment, and two cases were diagnosed with obstructive impairment before surgery. %VC improved in the restrictive impairment cases six months after surgery. However, %FEV1 did not improve significantly after surgery in the obstructive impairment cases. Conclusions: Restrictive impairment was improved in adult patients with a spinal deformity by corrective spinal surgery. However, spinal surgery did not improve obstructive impairment.

Optimal Timing of Preoperative Skin Preparation with Povidone-Iodine for Spine Surgery: A Prospective, Randomized Controlled Study

Tatsuya Yasuda,Tomohiko Hasegawa,Yu Yamato,Sho Kobayashi,Daisuke Togawa,Hideyuki Arima,Yukihiro Matsuyama 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.3

Study Design: A prospective, randomized, controlled study. Purpose: The objective of this study was to evaluate the effectiveness of two techniques of skin preparation with povidone-iodine. Overview of Literature: Preoperative skin preparation is important for preventing surgical site infection by reducing the bacteria in the surgical area. Povidone-iodine is a commonly used agent for preoperative skin preparation, and further decrease in surgical site infections can be expected by understanding how to apply it more effectively. Methods: Eighty-nine spine surgery patients were randomly allocated to two groups. In group A, povidone-iodine was applied to the surgical site just before starting the operation; in group B, povidone-iodine was applied several minutes prior to starting the operation and was allowed to dry. We collected samples from the wound edge before suturing, and we compared the rates of positive culture between the two groups. Results: The rate of positive culture was 30.2% (13 out of 43 patients) in group A, and 6.5% (3 out of 46 patients) in group B. This indicates that there was a significant difference in postoperative infection rates between group A and group B. Conclusions: Because bacteria on the skin appeared significantly reduced by allowing povidone-iodine to dry for several minutes prior to surgery, we recommend this approach to reduce the incidence of postoperative infections.

Minimum Clinically Important Differences in Oswestry Disability Index Domains and Their Impact on Adult Spinal Deformity Surgery

Go Yoshida,Tomohiko Hasegawa,Yu Yamato,,Sho Kobayashi,Oe Shin,Tomohiro Banno,Yuuki Mihara,Hideyuki Arima,Hiroki Ushirozako,Tatsuya Yasuda,Daisuke Togawa,Yukihiro Matsuyama 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.1

Study Design: Retrospective study. Purpose: To calculate the minimum clinically important difference (MCID) for total and individual domains of the Oswestry Disability Index (ODI) and assess score distribution and changes over time in surgically treated adult spinal deformity (ASD) patients. Overview of Literature: Despite the common use of ODI for assessing ASD, there are no robust studies defining MCID values for this index. Methods: This study included 240 consecutive ASD patients with a minimum of 2 years of follow-up. We calculated MCID values for total and individual ODI domains using all or part of the Scoliosis Research Society-22R questionnaire as anchors. Using current MCID values, we measured the acquisition rates in patients who acquired MCID at follow-up in both total and individual ODI domains. Differences in pathology, age, and locations of the upper and lower instrumented vertebrae were analyzed. Results: MCID of the total ODI score was 11%, with an area under the curve of 0.737. Each domain ranged from 0 to 2, with 1 being the most common value. In the pain and standing domains, >60% of the patients acquired MCID, although acquisition rates of the personal care, lifting, sleep, and sexual activity domains were relatively low (20%–35%). Patients with MCID had more radiographic improvement in lumbar lordosis, sagittal vertical axis, and T1 pelvic angle than those without MCID (p <0.05). Conclusions: To our knowledge, this is the first study to describe MCID of ODI (11%) after ASD surgery. In the pain and standing domains, most patients acquired MCID although the rates of acquisition of MCID in the personal care, lifting, sleep, and sexual activity domains were low. Spine surgeons should counsel their patients regarding the benefits and setbacks of ASD surgery.

Revision Surgery for a Rod Fracture with Multirod Constructs Using a Posterior-Only Approach Following Surgery for Adult Spinal Deformity

Yamato Yu,Hasegawa Tomohiko,Yoshida Go,Banno Tomohiro,Oe Shin,Arima Hideyuki,Mihara Yuki,Ushirozako Hiroki,Yamada Tomohiro,Watanabe Yuh,Ide Koichiro,Nakai Keiichi,Kurosu Kenta,Matsuyama Yukihiro 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.5

Study Design: Single-center retrospective case series.Purpose: We aimed to evaluate the clinical results of revision surgery for a rod fracture using a posterior-only approach and determine the best procedure to prevent refracture in patients with adult spinal deformity (ASD).Overview of Literature: ASD affects the thoracolumbar spine and often requires surgical correction. However, surgery for extensive spinal fusion causes rod fracture, a major mechanical complication. Few studies have described the treatment methods for rod fractures. Furthermore, the clinical outcomes of revision surgery for rod fractures in patients with ASD are currently unclear.Methods: We retrospectively reviewed the medical records of 404 patients who underwent corrective fusion surgery for ASD with a minimum 2-year follow-up. We studied cases of reoperation for postoperative rod fractures and investigated surgical procedure, intraoperative findings, clinical course, and rod refracture following revision surgery.Results: Rod fracture was observed in 88 patients (21.8%). Fifty-three patients (average age, 68.3 years; average blood loss, 502.2 mL [% estimated blood volume=16.4%]; and operation time, 203.3 minutes) who suffered from a rod fracture at an average of 28.3 months after the primary operation underwent reoperation. Surgical invasiveness had no significant differences in total or partial rod replacement; however, the procedures with and without an anterior bone graft significantly differed. The replaced rod refractured at an average of 35.3 months after the revision surgery of five patients. The rod also refractured at a level outside multiple rods in two patients and with traumatic episodes in three patients. Three patients had bone grafts in the anterior column.Conclusions: Revision surgery involving a multirod with a posterior-only approach for a rod fracture that occurred after ASD was performed successfully. Bone grafting in the anterior column is unnecessary for patients without massive bone defects.

Hypertension Is Related to Positive Global Sagittal Alignment: A Cross-Sectional Cohort Study

Hideyuki Arima,Daisuke Togawa,Tomohiko Hasegawa,Yu Yamato,Go Yoshida,Sho Kobayashi,Tatsuya Yasuda,Tomohiro Banno,Shin Oe,Yuki Mihara,Hiroki Ushirozako,Hironobu Hoshino,Yukihiro Matsuyama 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.6

Study Design: Cross-sectional cohort study. Purpose: This study aimed to investigate the relationship between hypertension and spino-pelvic sagittal alignment in middle-aged and elderly individuals. Overview of Literature: Positive global sagittal alignment is associated with poor health-related quality of life. Hypertension is associated with tissue microcirculation disorders of the skeletal muscle. We hypothesized that hypertension may be involved in positive global sagittal alignment. Methods: In this institutional review board-approved study, 655 participants (262 men and 393 women; mean age, 72.9 years; range, 50–92 years) who underwent musculoskeletal screening in Toei town, Aichi, Japan were included. Whole spine and pelvic radiographs were taken, and radiographic parameters (thoracic kyphosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and sagittal vertical axis [SVA]) were measured using an image-analysis software. Hypertension was assessed using the standard criteria. The study participants were divided into three subgroups as per age (50–64 years, 65–74 years, and ≥75 years). We examined the differences in the radiographic parameters of those with and without hypertension in each age subgroup. Results: In each age subgroup, there was no significant difference in the age and sex of those with and without hypertension. SVA was significantly shifted forward in the hypertension group than in the non-hypertension group in those aged 50–64 years old (32.4 mm vs. 16.0 mm, p=0.018) and in those aged 65–74 years old (42.7 mm vs. 30.6 mm, p=0.012). There was no significant difference between the hypertension and non-hypertension groups in terms of the alignment of the lumbar and thoracic spine in all the subgroups. In multivariate analysis, hypertension was a significant independent factor of forward-shifted SVA (standardized beta 0.093, p=0.015). Conclusions: This study showed that hypertension was associated with forward-shifted global sagittal alignment.

Spinal Sagittal Alignment, Hospital Anxiety and Depression Scale Scores, and Patient-Reported Outcome among People with Sporting Activity

Oe Shin,Yamato Yu,Hasegawa Tomohiko,Yoshida Go,Kobayashi Sho,Yasuda Tatsuya,Banno Tomohiro,Arima Hideyuki,Mihara Yuki,Ushirozako Hiroki,Yamada Tomohiro,Ide Koichiro,Watanabe Yuh,Haruo Niwa,Matsuyama Y 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.3

Study Design: Retrospective cohort study.Purpose: This study aimed to investigate how participation in sporting activity affects patient-reported outcome (PRO), including Neck Disability Index (NDI), in males and females.Overview of Literature: Previously, our study reported that factors with a negative influence on the NDI in females were a lack of sporting activities. However, it was still unclear why it affected poor scores of NDI.Methods: The subjects were 473 volunteers. They were divided into two groups (activity and non-activity) according to participation or non-participation in sporting activities using a self-filled questionnaire. The evaluation items were height, weight, grip strength, bone density, Hospital Anxiety and Depression Scale (HADS) score, standing radiographic parameters, PRO (evaluated by EuroQol-5 dimension [EQ-5D], Oswestry Disability Index [ODI]), and NDI.Results: There were 101 males in the non-activity group and 69 in the activity group and 178 females in the non-activity group and 125 in the activity group. For the males, the evaluation items with significant influence were cervical lordosis (non-activity group:activity group, 17°:22°) and T1 slope minus cervical lordosis (10°:6°, <i>p</i> <0.05). For the females, the evaluation items with significant influence were sagittal vertical axis (28:14 mm), HADS (10.4:8.4), EQ-5D (0.79:0.86), ODI (17:12), and NDI (12:9, <i>p</i> <0.01). HADS and PRO in the females were significantly correlated with the EQ-5D (−0.40), ODI (0.43), and NDI (0.55).Conclusions: Males who participated in sporting activities had better cervical spine alignment but no effect on PRO. Females with sporting activities had better spinal global alignment and less mental stress. It is suggested that sporting activity in females might be associated with PRO because HADS highly correlates with PRO.