Conservative and Surgical Treatment Improves Pain and Ankle-Brachial Index in Patients with Lumbar Spinal Stenosis

Seiji Ohtori,Masaomi Yamashita,Yasuaki Murata,Yawara Eguchi,Yasuchika Aoki,Hiromi Ataka,Jiro Hirayama,Tomoyuki Ozawa,Tatsuo Morinaga,Hajime Arai,Masaya Mimura,Hiroto Kamoda,Sumihisa Orita,Masayuki Miy 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.4

Purpose: The pathological mechanism of lumbar spinal stenosis is reduced blood flow in nerve roots and degeneration of nerve roots. Exercise and prostaglandin E1 is used for patients with peripheral arterial disease to increase capillary flow around the main artery and improve symptoms; however, the ankle-brachial index (ABI), an estimation of blood flow in the main artery in the leg, does not change after treatment. Lumbar spinal nerve roots contain somatosensory, somatomotor, and unmyelinated autonomic nerves. Improved blood flow by medication with prostaglandin E1 and decompression surgery in these spinal nerve roots may improve the function of nerve fibers innervating muscle, capillary, and main vessels in the lower leg, resulting in an increased ABI. The purpose of the study was to examine whether these treatments can improve ABI. Materials and Methods: One hundred and seven patients who received conservative treatment such as exercise and medication (n=56) or surgical treatment (n=51) were included. Low back pain and leg pain scores, walking distance, and ABI were measured before treatment and after 3 months of conservative treatment alone or surgical treatment followed by conservative treatment. Results: Low back pain, leg pain, and walking distance significantly improved after both treatments (p<0.05). ABI significantly increased in each group (p<0.05). Conclusion: This is the first investigation of changes in ABI after treatment in patients with lumbar spinal stenosis. Improvement of the spinal nerve roots by medication and decompression surgery may improve the supply of blood flow to the lower leg in patients with lumbar spinal stenosis.

Incidence of Nocturnal Leg Cramps in Patients with Lumbar Spinal Stenosis before and after Conservative and Surgical Treatment

Seiji Ohtori,Masaomi Yamashita,Yasuaki Murata,Yawara Eguchi,Yasuchika Aoki,Hiromi Ataka,Jiro Hirayama,Tomoyuki Ozawa,Tatsuo Morinaga,Hajime Arai,Masaya Mimura,Hiroto Kamoda,Sumihisa Orita,Masayuki Miy 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.3

Purpose: To examine the effects of conservative and surgical treatments for nocturnalleg cramps in patients with lumbar spinal stenosis (LSS). Nocturnal leg cramps is frequently observed in patients with peripheral neuropathy. However, there have been few reports on the relationship between nocturnal leg cramps and LSS, and it remains unknown whether conservative or surgical intervention has an impact on leg cramps in patients with LSS. Materials and Methods: The subjects were 130 LSS patients with low back and leg pain. Conservative treatment such as exercise, medication, and epidural block was used in 66 patients and surgical treatmentsuch as decompression or decompression and fusion was performed in 64 patients. Pain scores and frequency of nocturnal leg cramps were evaluated based on self-reported questionnaires completed before and 3 months after treatment. Results: The severity of low back and leg pain was higher and the incidence of nocturnal leg cramps was significantly higher before treatment in the surgically treated group compared with the conservatively treated group. Pain scores improvedin both groups after the intervention. The incidence of nocturnal leg cramps was significantly improved by surgical treatment (p=0.027), but not by conservative treatment (p=0.122). Conclusion: The findings of this prospective study indicate that the prevalence of nocturnal leg cramps is associated with LSS and severity of symptoms. Pain symptoms were improved by conservative or surgicaltreatment, but only surgery improved nocturnal leg cramps in patients with LSS. Thus, these results indicate that the prevalence of nocturnal leg cramps is associatedwith spinal nerve compression by LSS.

Lower SMI is a risk factor for dysphagia in Japanese hospitalized patients with osteoporotic vertebral and hip fracture: A retrospective study

Kaoru Suseki,Masaomi Yamashita,Yoshiaki Kojima,Yojiro Minegishi,Koichiro Komiya,Masashi Takaso 대한골다공증학회 2022 Osteoporosis and Sarcopenia Vol.8 No.4

Objectives: Many patients with osteoporotic fragile fracture often suffer from dysphagia that results in malnutrition, further deterioration of physical strength, and rehabilitation difficulties. This study aims to investigate the risk factors for dysphagia in hospitalized patients with osteoporotic vertebral and/or hip fractures. Methods: Between January 2020 and December 2021, 569 inpatients were managed for osteoporotic vertebral or hip fractures. Of these, 503 patients were analyzed and 66 were excluded as the required data could not be obtained or dysphagia with causative diseases such as cerebrovascular disease. The patients were divided into 2 groups: patients with dysphagia (P-group) and patients without dysphagia (N-group). We investigated gender, fracture site, age, systemic skeletal muscle mass index (SMI), bone mineral density (BMD), and body mass index (BMI) in early stage of hospitalization and studied their relationship with dysphagia. Results: There were no significant differences in gender and fracture site between the 2 groups. A significant difference was observed in age, SMI, BMD, and BMI (P < 0.01). We performed a logistic regression analysis with the P-group as the objective variable and age, SMI, BMD, and BMI as explanatory variables. We divided objective groups into all patients, patients with vertebral fracture, patients with hip fracture, men, and women. SMI was an independent risk factor in all groups. Conclusions: Lower SMI was a risk factor for dysphagia in hospitalized patients with osteoporotic vertebral and hip fractures. We carefully observed swallowing function of patients with decreased SMI to maintain the nutritional status and prevent rehabilitation difficulties.

Existence of a Neuropathic Pain Component in Patients with Osteoarthritis of the Knee

Seiji Ohtori,Sumihisa Orita,Masaomi Yamashita,Tetsuhiro Ishikawa,Toshinori Ito,Tomonori Shigemura,Hideki Nishiyama,Shin Konno,Hideyuki Ohta,Masashi Takaso,Gen Inoue,Yawara Eguchi,Nobuyasu Ochiai,Shunj 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.4

Purpose: Pain from osteoarthritis (OA) is generally classified as nociceptive (inflammatory). Animal models of knee OA have shown that sensory nerve fibers innervating the knee are significantly damaged with destruction of subchondral bone junction, and induce neuropathic pain (NP). Our objective was to examine NP in the knees of OA patients using painDETECT (an NP questionnaire) and to evaluate the relationship between NP, pain intensity, and stage of OA. Materials and Methods:Ninety-two knee OA patients were evaluated in this study. Pain scores using Visual Analogue Scales (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), painDETECT, duration of symptoms, severity of OA using the Kellgren-Lawrence (KL) system, and amount of joint fluid were evaluated and compared using a Spearman’s correlation coefficient by rank test. Results: Our study identified at least 5.4% of our knee OA patients as likely to have NP and 15.2% as possibly having NP. The painDETECT score was significantly correlated with the VAS and WOMAC pain severity. Compared with the painDETECT score, there was a tendency for positive correlation with the KL grade, and tendency for negative correlation with the existence and amount of joint fluid, but these correlations were not significant. Conclusion: PainDETECT scores classified 5.4% of pain from knee OA as NP. NP tended to be seen in patients with less joint fluid and increased KL grade, both of which corresponded to late stages of OA. It is important to consider the existence of NP in the treatment of knee OA pain.

Correlation Between Walking Ability and Monthly Care Costs in Elderly Patients After Surgical Treatments for Hip Fractures

Koki Abe,Kazuhide Inage,Keishi Yamashita,Masaomi Yamashita,Akiyoshi Yamamaoka,Masaki Norimoto,Yoshinori Nakata,Takeshi Mitsuka,Kaoru Suseki,Sumihisa Orita,Kazuki Fujimoto,Yasuhiro Shiga,Hirohito Kanam 대한재활의학회 2018 Annals of Rehabilitation Medicine Vol.42 No.4

Objective To validate the relationship between residual walking ability and monthly care cost as well as long-term care insurance (LTCI) certification level in elderly patients after surgical treatment for hip fractures in Japan. ethods Elderly patients aged >75 years who underwent surgical treatment for hip fractures in our hospital were included. The pre- and post-surgical (6-month) walking ability and LTCI certification and the presence or absence of dementia was determined from medical records and questionnaires. Walking ability was classified into 6 levels used in our daily medical practice. Based on these data, we correlated the relationship between walking ability and the LTCI certification level. Further, based on the official statistics pertaining to the average monthly costs per person at each LTCI certification level, we evaluated the relationship between walking ability and monthly care cost. Results A total of 105 cases (mean age, 80.2 years; 16 men; 39 patients with dementia) were included. The correlation between walking ability and average monthly cost per person as well as LTCI certification level at 6 months postoperatively (r=0.58) was demonstrated. The correlation was found in both groups with and without dementia. Conclusion The ability to walk reduced the cost of care in elderly patients who experienced hip fracture, regardless of the presence of dementia.

Ajoy Prasad Shetty

Go Kubota,Hiroto Kamoda,Sumihisa Orita,Kazuhidee Inage,Michihiro Ito,Masaomi Yamashita,Takeo Furuya,Tsutomu Akazawa,Yasuhiro Shiga,Seiji Ohtori 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.1

Study Design: Retrospective case series. Purpose: To examine the efficacy of platelet-rich plasma (PRP) for bone fusion in transforaminal lumbar interbody fusion (TLIF) using local bone grafting. Overview of Literature: Several authors have reported the efficacy of PRP for bone union in animal models. However, the use of PRP for bone fusion in TLIF surgery has not been fully explored. Methods: Twenty patients underwent single-level TLIF surgery because of L4 spondylolisthesis. An interbody fusion cage and local bone were used in nine patients (control group) and an interbody fusion cage, local bone, and PRP were used in 11 patients (PRP group). PRP was prepared from the patients’ blood samples (400 mL) immediately before surgery. The duration of bone union and postoperative bone fusion rate were assessed using plain radiography at every 3 months postoperatively and computed tomography at 12 or 24 months postoperatively, respectively. Lower back pain, leg pain, and leg numbness were evaluated using the visual analog scale preoperatively and at 3, 6, 12, and 24 months postoperatively. Results: The platelet count was 8.7 times higher in PRP than in blood. The bone union rate was significantly superior in the PRP group than in the control group (91% and 77%, respectively; p =0.035), whereas the average duration of bone union was not significantly different between the groups (7.7±0.74 and 10.0±2.00 months, respectively; p =0.131). There was no significant difference in lower back pain, leg pain, and leg numbness in both groups during follow-up (p >0.05). Conclusions Our study suggests that the use of PRP in TLIF surgery increases bone fusion rate.

Freeze-Dried Human Platelet-Rich Plasma Retains Activation and Growth Factor Expression after an Eight-Week Preservation Period

Yasuhiro Shiga,Go Kubota,Sumihisa Orita,Kazuhide Inage,Hiroto Kamoda,Masaomi Yamashita,Toru Iseki,Michihiro Ito,Kazuyo Yamauchi,Yawara Eguchi,Takeshi Sainoh,Jun Sato,Kazuki Fujimoto,Koki Abe,Hirohito 대한척추외과학회 2017 Asian Spine Journal Vol.11 No.3

Study Design: Controlled laboratory study. Purpose: This study aimed to evaluate the efficacy of platelet-rich plasma (PRP) stored at room temperature (RT), frozen, or after freeze-drying. Overview of Literature: PRP enriches tissue repair and regeneration, and is a novel treatment option for musculoskeletal pathologies. However, whether biological activity is preserved during PRP storage remains uncertain. Methods: PRP was prepared from blood of 12 healthy human volunteers (200 mL/person) and stored using three methods: PRP was stored at RT with shaking, PRP was frozen and stored at –80°C, or PRP was freeze-dried and stored at RT. Platelet counts and growth factor content were examined immediately after preparation, as well as 2, 4, and 8 weeks after storage. Platelet activation rate was quantified by flow cytometry. Results: Platelet counts were impossible to determine in many RT samples after 2 weeks, but they remained at constant levels in frozen and freeze-dried samples, even after 8 weeks of storage. Flow cytometry showed approximately 80% activation of the platelets regardless of storage conditions. Almost no growth factors were detected in the RT samples after 8 weeks, while low but significant expression was detected in the frozen and freeze-dried PRP. Over time, the mean relative concentrations of various growth factors decreased significantly or disappeared in the RT group. In the frozen group, levels were maintained for 4 weeks, but decreased significantly by 8 weeks (p <0.05). The freeze-dried group maintained baseline levels of growth factors for the entire 8-week duration. Conclusions: Freeze-drying enables PRP storage while maintaining bioactivity and efficacy for extended periods.