Remnant Tumor Margin as Predictive Factor for Its Growth After Incomplete Resection of Cervical Dumbbell-Shaped Schwannomas

Kazuya Kitamura,Narihito Nagoshi,Osahiko Tsuji,Satoshi Suzuki,Satoshi Nori,Eijiro Okada,Mitsuru Yagi,Morio Matsumoto,Masaya Nakamura,Kota Watanabe 대한척추신경외과학회 2022 Neurospine Vol.19 No.1

Objective: The purpose of our study was to investigate the risk factors of remnant tumor growth after incomplete resection (IR) of cervical dumbbell-shaped schwannomas (DS). Methods: Twenty-one patients with IR of cervical DS with at least 2 years of follow-up were included and were divided into 2 groups: the remnant tumor growth (G) (n = 10) and no growth (NG) (n = 11) groups. The tumor location in the axial plane according to Toyama classification, the location of the remnant tumor margin, and the tumor growth rate (MIB1 index) index were compared. Results: No significant differences in Toyama classification and MIB-1 index were found. Age was significantly higher in the G group (61.4 years vs. 47.6 years; p = 0.030), but univariate logistic regression analysis revealed little correlation to the growth (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.001–1.166; p = 0.047). Seventeen patients (9 in the G and 8 in the NG group) underwent the posterior one-way approach, and significant differences in the location of the remnant tumor margin were confirmed: within the spinal canal in 1 and 0 case, at the entrance of the intervertebral foramen in 7 and 1 cases, and in the foramen distal from the entrance in 1 and 7 cases, in the G and NG groups, respectively (p = 0.007). The proximal margin was identified as a significant predictor of the growth (OR, 56.0; 95% CI, 2.93–1,072; p = 0.008). Conclusion: Remnant tumors with margins distally away from the entrance of the foramen were less likely to grow after IR of cervical DS.

A Design of Prototype Low Energy Processor by Variable Stages Pipeline Technique

Yuji ICHIKAWA,Takahiro SASAKI,Tetsuo HIRONAKA,Kazuya TANIGAWA,Toshiaki KITAMURA,Toshio KONDO 대한전자공학회 2005 ITC-CSCC :International Technical Conference on Ci Vol.2005 No.2

Disc Height Narrowing Could Not Stabilize the Mobility at the Level of Cervical Spondylolisthesis: A Retrospective Study of 83 Patients with Cervical Single-Level Spondylolisthesis

Aoyama Ryoma,Yamane Junichi,Ninomiya Ken,Takahashi Yuichiro,Kitamura Kazuya,Nori Satoshi,Suzuki Satoshi,Shiraishi Tateru 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.1

Study Design: A retrospective study at a single academic institution.Purpose: We aimed to understand the pathogenesis of cervical spondylolisthesis by analyzing whether narrowing of the disc height stabilizes the slipped disc level according to the degenerative cascade.Overview of Literature: According to Kirkaldy-Willis’ degenerative cascade, the narrowing of the disc height at slipped level contributes to intervertebral stability in lumbar spondylolisthesis. Conversely, the pathogenesis of cervical spondylolisthesis is unknown due to a scarcity of reports on the condition.Methods: The images of 83 patients with cervical single-level spondylolisthesis were studied. We looked at 52 slipped levels for anterior slippage and 31 for posterior slippage. The imaging parameters included slippage in the neutral, flexed, and extended positions, axial facet joint orientation, sagittal facet slope, global cervical alignment, C2–C7 angle, C2–C7 sagittal vertical axis, range of motion (ROM), and slipped disc angle ROM.Results: With the narrowing of the intervertebral disc height, slippage in the flexed position of both anterior and posterior spondylolisthesis increased. However, in both anterior and posterior spondylolisthesis, disc height narrowing did not show stability. The narrowing of the intervertebral disc height was found to be a risk factor for a translation of slippage of 1.8 mm or more in flexionextension motion in anterior spondylolisthesis in multivariate regression analysis.Conclusions: Narrowing the intervertebral disc height did not stabilize the translation of slippage in flexion-extension motion in cervical spondylolisthesis. Instead, narrowing of the disc height was associated with a translation of slippage of 1.8 mm or more in flexion-extension motion in cases of anterior slippage. Therefore, we discovered that degenerative cascade stabilization for cervical spondylolisthesis was difficult to achieve.

Cervical Spinous Process and Its Attached Muscles Maintain Lower Disk Lordosis: A Retrospective Study of 155 Patients Who Underwent Muscle-Preserving Double Laminectomies

Aoyama Ryoma,Yamane Junichi,Ninomiya Ken,Takahashi Yuichiro,Kitamura Kazuya,Nori Satoshi,Suzuki Satoshi,Shiraishi Tateru 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.5

Study Design: A retrospective study conducted at a single academic institution.Purpose: This study compared the postoperative alignment of consecutive double laminectomies according to their decompression levels and investigated the influence of the extension unit of the spinous process and its attached muscles on postoperative alignment.Overview of Literature: Many reports have investigated bony and soft tissue factors as the causes of postoperative cervical alignment disorders. To-this-date, no other article has clarified the importance of the attached muscles between the spinous processes of C3 and C6 to maintain local cervical alignment.Methods: In total, 155 consecutive patients who underwent muscle-preserving consecutive double laminectomies for cervical spondylotic myelopathy from 2005 to 2013 were included in this study. The imaging parameters included the C2–C7 angle, range of motion, C2–C7 sagittal vertical axis (SVA), C7 slope, C2–C5 angle, C5-C7 angle, local disk angle caudal to the decompression level, and the disk height between C2/C3 and C7/Th1.Results: The caudal disk angle of the decompression level decreased after consecutive double laminectomies, thus suggesting that the extension unit maintained the local lordosis at the lower disk of the decompression level. Postoperatively, in the C3–4 decompression cases, the C2–C7 angle decreased by 7.3°, and the C2–C7 SVA increased by 8.6 mm, thus indicating the appearance of an alignment disorder. Multivariate logistic regression analysis showed that cephalad laminectomy was a risk factor for C2–C7 angle decreases >10°. However, the postoperative recovery rate of Japanese Orthopedic Association scores after consecutive double laminectomies was reasonable, and the overall cervical alignment was well maintained in all decompression levels except C3–C4.Conclusions: The cervical extension unit maintained lordosis at the disk caudal to it. The extension unit was found to contribute more to the maintenance of lordosis of the entire cervical spine at the cephalad side.

Necessity of pharyngeal anesthesia during transoral gastrointestinal endoscopy: a randomized clinical trial

Tomoyuki Hayashi,Yoshiro Asahina,Yasuhito Takeda,Masaki Miyazawa,Hajime Takatori,Hidenori Kido,Jun Seishima,Noriho Iida,Kazuya Kitamura,Takeshi Terashima,Sakae Miyagi,Tadashi Toyama,Eishiro Mizukoshi 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.5

Background/Aims: The necessity for pharyngeal anesthesia during upper gastrointestinal endoscopy is controversial. This study aimedto compare the observation ability with and without pharyngeal anesthesia under midazolam sedation. Methods: This prospective, single-blinded, randomized study included 500 patients who underwent transoral upper gastrointestinalendoscopy under intravenous midazolam sedation. Patients were randomly allocated to pharyngeal anesthesia: PA+ or PA– groups (250patients/group). The endoscopists obtained 10 images of the oropharynx and hypopharynx. The primary outcome was the non-inferiorityof the PA- group in terms of the pharyngeal observation success rate. Results: The pharyngeal observation success rates in the pharyngeal anesthesia with and without (PA+ and PA–) groups were 84.0%and 72.0%, respectively. The PA– group was inferior (p=0.707, non-inferiority) to the PA+ group in terms of observable parts (8.33 vs. 8.86, p=0.006), time (67.2 vs. 58.2 seconds, p=0.001), and pain (1.21±2.37 vs. 0.68±1.78, p=0.004, 0–10 point visual analog scale). Suitablequality images of the posterior wall of the oropharynx, vocal fold, and pyriform sinus were inferior in the PA– group. Subgroupanalysis showed a higher sedation level (Ramsay score ≥5) with almost no differences in the pharyngeal observation success rate betweenthe groups. Conclusions: Non-pharyngeal anesthesia showed no non-inferiority in pharyngeal observation ability. Pharyngeal anesthesia may improvepharyngeal observation ability in the hypopharynx and reduce pain. However, deeper anesthesia may reduce this difference.