Compensatory Pelvic Retro-Rotation Associated with a Decreased Quality of Life in Patients with Normal Sagittal Balance

Shimokawa Tetsuya,Miyamoto Kei,Hioki Akira,Masuda Takahiro,Fushimi Kazunari,Ogawa Hiroyasu,Ohnishi Kazuichiro,Akiyama Haruhiko 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.2

Study Design: Cross-sectional observational study. Purpose: To examine whether pelvic rotation as a compensatory mechanism for sagittal imbalance is related to quality of life (QOL). Overview of Literature: Poor sagittal alignment is associated with compensatory pelvic retroversion and decreased QOL. Whether the compensatory pelvic tilt (PT) influences QOL is unclear. Methods: Overall, 134 subjects aged ≥20 years with lower back pain were included (104 females; mean age, 70±9.8 years). Sagittal vertical alignment (SVA) and PT were analyzed radiographically. Patients were stratified into three groups based on SVA values: good alignment (group G), intermediate alignment (group I), and poor sagittal alignment (group P). Patients in group I were further categorized into two groups: low PT and high PT. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) was used for clinical assessment, and the scores were compared between groups. Results: As SVA increased, PT and lumbar lordosis (LL) increased and decreased, respectively. PT and LL differed significantly between groups G and P (p<0.01 for each comparison). Within group I, there was no significant difference in SVA between the high PT and low PT groups, suggesting that the high PT group had acquired a compensated sagittal balance. Importantly, all domains in the JOABPEQ (except for lower back pain) were significantly lower in the high PT group than in the low PT group (p<0.05 for every comparison). Conclusions: This study showed that focusing solely on SVA as a single indicator can cause important losses in QOL to be overlooked in patients with lumbar disorders. Although pelvic retroversion can compensate for sagittal balance, it is associated with a significant decrease in QOL. To improve the assessment of patients with lumbar disorders, PT should be considered besides SVA.

Cervical Symmetric Dumbbell Ganglioneuromas Causing Severe Paresis

Akira Hioki,Kei Miyamoto,Yoshinobu Hirose,Yusuke Kito,Kazunari Fushimi,Katsuji Shimizu 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.1

We report an extremely rare case with bilateral and symmetric dumbbell ganglioneuromas of the cervical spine in an elderly patient. A 72-year-old man came by ambulance to our hospital due to progressive incomplete paraplegia. Magnetic resonance imaging demonstrated bilateral symmetric dumbbell tumors at the C1/2 level. We performed total resection of the intracanalar tumor, aiming at complete decompression of the spinal cord, and partial and subtotal resection of foraminal outside portions. Histopathological examination of the surgical specimen indicated the tumor cells to be spindle cells with the presence of ganglion cells and no cellular pleomorphism, suggesting a diagnosis of ganglioneuroma. Although the surgery was not curative, the postoperative course was uneventful and provided a satisfactory outcome. This is the fourth known case of cervical ganglioneuromas of the bilateral symmetric dumbbell type.

Clinical Outcomes of Surgical Treatments for Traumatic Spinal Injuries due to Snowboarding

Takahiro Masuda,Kei Miyamoto,Kazuhiko Wakahara,Kazu Matsumoto,Akira Hioki,Tetsuya Shimokawa,Katsuji Shimizu,Shinji Ogura,Haruhiko Akiyama 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.1

Study Design: Retrospective study. Purpose: To assess treatment outcomes of snowboarding-related spinal and spinal cord injuries. Overview of Literature: Snowboarding-related spinal or spinal cord injury have a great impact on social and sporting activities. Methods: A retrospective review of 19 cases of surgically treated snowboard-related injury was done. Analyzed parameters included site of injury, type of fracture, peri- and postoperative complications, pre- and postoperative neurological status, activities of daily living, and participation in sports activities at the final follow-up. Results: The major site of injury was the thoracolumbar junction caused by fracture-dislocation (13/19 cases). The remaining 6 cases had cervical spine injuries. Over 60% of the patients had Frankel A and B paralysis. All patients were surgically treated by posterior fusion with instrumentation. Five underwent additional anterior fusion. Surgical outcome was restoration of ambulatory capacity in 12 patients (63.2%). Ultimately, 15 patients (78.9%) could return to work. Patients with complete paralysis upon admission showed reduced ambulatory capacity compared to those with incomplete paralysis. None of the patients again participated in any sports activities, including snowboarding. Conclusions: Snowboarding-related spinal or spinal cord injury has a great impact on social as well as sports activities. It is necessary to enhance promotion of injury prevention emphasizing the snowboarders’ responsibility code.

Comparison of Magnetic Resonance Imaging and Computed Tomography-Myelography for Quantitative Evaluation of Lumbar Intracanalar Cross-Section

Hiroyasu Ogura,Kei Miyamoto,Shoji Fukuta,Toshitaka Naganawa,Katsuji Shimizu 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.1

Purpose: A comparison of MRI and computed tomography-myelography (CTM) for lumbar intracanalar dimensions. To compare the capability and reproducibility of MRI and CTM in measuring the cross-sectional morphology of intracanalar lesions of the lumbar spine. Materials and Methods: MRI and CTM of lumbar disc levels from 61 subjects with various lumbar spinal diseases were studied. Dural area, dural anteroposterior (AP) diameter, dural right-left diameter, and thickness of the ligamentum flavum were measured by two orthopedic surgeons. Each section was graded by degree of stenosis. Absolute value and intra- and inter-observer correlation coefficients (ICC) of these measurements and the associations between MRI and CTM values were determined. Results: Except for MRI determination of ligament flavum thickness, CTM and MRI and intra- and ICC suggested sufficient reproducibility. When measurements of dural area, dural AP diameter, and RL diameter were compared, values in CTM were significantly (p = 0.01-0.004) larger than those in MRI (CTM/MRI ratios, 119%, 111%, and 105%, respectively). As spinal stenosis became more severe, discrepancies between CTM and MRI in measurements of the dural sac became larger. Conclusion:Both CTM and MRI provided reproducible measurements of lumbar intracanalar dimensions. However, flavum thickness may be more accurately measured by CTM. Because the differences in the measurements between CTM and MRI are very slight and there is very little data to suggest that the precise degree of stenosis is related to symptoms or treatment outcome, the usefulness of the CTM over MRI needs to be confirmed in future studies.

Hemilaminectomy for Removal of Extramedullary or Extradural Spinal Cord Tumors: Medium to Long-Term Clinical Outcomes

Toshitaka Naganawa,Kei Miyamoto,Hideo Hosoe,Naoki Suzuki,Katsuji Shimizu 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.1

Purpose: Laminectomy is generally the treatment of choice for removal of spinal tumors. However, it has been shown that laminectomy may cause instability due to damage of posterior elements of the spinal column, which may induce subsequent kyphosis in the future. Therefore, to reduce the risk of deformity and spinal instability after laminectomy, hemilaminectomy has been used. However, the medium to long-term effects of hemilaminectomy on spinal sagittal alignment is not well understood. The present study was performed to evaluate the clinical outcomes, including spinal sagittal alignment of patients, associated with spinal cord tumors treated by surgical excision using hemilaminectomy. Materials and Methods: Twenty hemilaminectomy operations at our institute for extramedullary or extradural spinal cord tumors in 19 patients were evaluated retrospectively with an average follow-up of 85 months (range, 40-131 months). Neurological condition was evaluated using the improvement ratio of the Japanese Orthopaedic Association Score (JOA score) for cervical, thoracic myelopathy, or back pain, and sagittal alignment by sagittal Cobb angle of the hemilaminectomied area. Results: The mean improvement ratio of neurological results was 56.7% in the cervical spine (p < 0.01, n = 10), 26.3% in the thoracic spine (not significant, n = 5), and 48.6% in the lumbar spine (NS, n = 5). The sagittal Cobb angle was 4.3 ± 18.0° in the preoperative period and 5.4 ± 17.6° at the latest follow-up, indicating no significant deterioration. Conclusion: Hemilaminectomy is useful for extramedullary or extradural spinal cord tumors in providing fair neurological status and restoration of spinal sagittal alignment in medium to long-term follow-up.

EFG법에 의한 ${\gamma}-6Bi_2O_3{\cdot}GeO_2$

김호건,유건종,Kei-Miyamoto 한국결정성장학회 1991 韓國結晶成長學會誌 Vol.1 No.2

The fundamental conditions for growing $r-6Bi_2O_3{\cdot}GeO_2$ (BGO) single crystal plates by EFG (Edge -defined Film-fed Growth) method, were investigated and the characterization, quality test were carried out for obtained BGO single crystal plates. The optimum growing conditions determined in this study were as follows: ${\cdot}$ temperature gradient: 22^{\circ}C/cm 광기능소자로 응용성이 넓은 전기광학결정 $r-6Bi_2O_3{\cdot}GeO_2$(이하 BGO로 약칭)을 EFG(Edge-defined Film-fed Growth)법에 의하여 판상단결정으로 육성하는 기초적 조건을 조사하였고 얻어진 판상단결정의 characterization 및 평가를 행하였다. 본 연구에서 얻어진 최적성장조건은 온도구배가 $22^{\circ}C$/cm 이었고 인상속도는 2.0mm/h이었다. 결정성장 최적조건에서 육성된 BGO결정은 제 2상의 석출이 없고 grain boundary가 존재하지 않으며 X선분석으로도 단결정임이 확인되었다. 육성된 판상단결정의 판면은 (100)면이었고 결정성장 방위는 <110>이었다. 육성된 판상단결정은 편광현미경하에서는 pore, void, inclusion, striation등의 성장결함이 없는 양질의 단결정이었으나 미세결함인 전위(dislocation)의 존재가 확인되었고 전위밀도는 $7.0{\times}105/cm^2$이었다.

Cantilever Transforaminal Lumbar Interbody Fusion for Upper Lumbar Degenerative Diseases (Minimum 2 Years Follow Up)

Akira Hioki,Kei Miyamoto,Hideo Hosoe,Seiichi Sugiyama,Naoki Suzuki,Katsuji Shimizu 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.2

Purpose: To evaluate the clinical outcomes of cantilever transforaminal lumbar interbody fusion (c-TLIF) for upper lumbar diseases. Materials and Methods: Seventeen patients (11 males, 6 females; mean ± SD age: 62 ± 14 years) who underwent c-TLIF using kidney type spacers between 2002 and 2008 were retrospectively evaluated,at a mean follow-up of 44.1 ± 12.3 months (2 year minimum). The primary diseases studied were disc herniation, ossification of posterior longitudinal ligament (OPLL), degenerative scoliosis, lumbar spinal canal stenosis, spondylolisthesis, and degeneration of adjacent disc after operation. Fusion areas were L1-L2 (5 patients), L2-L3 (9 patients), L1-L3 (1 patient), and L2-L4 (2 patients). Operation time, blood loss, complications, Japanese Orthopaedic Association (JOA) score for back pain, bone union, sagittal alignment change of fusion level, and degeneration of adjacent disc were evaluated. Results: JOA score improved significantly after surgery, from 12 ± 2 to 23 ± 3 points (p < 0.01). We also observed significant improvement in sagittal alignment of the fusion levels, from - 1.0 ± 7.4 to 5.2 ± 6.1 degrees (p < 0.01). Bony fusion was obtained in all cases. One patient experienced a subcutaneous infection, which was cured by irrigation. At the final follow-up, three patients showed degenerative changes in adjacent discs, and one showed corrective loss of fusion level. Conclusion: c-TLIF is a safe procedure, providing satisfactory results for patients with upper lumbar degenerative diseases.

Sagittal Alignment of a Strut Graft Affects Graft Subsidence and Clinical Outcomes of Anterior Cervical Corpectomy and Fusion

Koun Yamauchi,Kazunari Fushimi,Kei Miyamoto,Akira Hioki,Katsuji Shimizu,Haruhiko Akiyama 대한척추외과학회 2017 Asian Spine Journal Vol.11 No.5

Study Design: Retrospective study. Purpose: The purpose of this study was to investigate the influence of sagittal alignment of the strut graft on graft subsidence and clinical outcomes after anterior cervical corpectomy and fusion (ACCF). Overview of Literature: ACCF is a common technique for the treatment of various cervical pathologies. Although graft subsidence sometimes occurs after ACCF, it is one cause for poor clinical results. Malalignment of the strut graft is probably one of the factors associated with graft subsidence. However, to the best of our knowledge, no prior reports have demonstrated correlations between the alignment of the strut graft and clinical outcomes. Methods: We evaluated 56 patients (33 men and 23 women; mean age, 59 years; range, 33–84 years; 45 with cervical spondylotic myelopathy and 11 with ossification of the posterior longitudinal ligament) who underwent one- or two-level ACCF with an autogenous fibular strut graft and anterior plating. The Japanese Orthopaedic Association (JOA) score recovery ratio for cervical spondylotic myelopathy was used to evaluate clinical outcomes. The JOA score and lateral radiograms were evaluated 1 week and 1 year postoperatively. Patients were divided into two groups (a straight group [group I] and an oblique group [group Z]) based on radiographic assessment of the sagittal alignment of the strut graft. Results: Group I showed a significantly greater JOA score recovery ratio (p <0.05) and a significantly lower graft subsidence than group Z (p <0.01). Conclusions: Our findings suggest that a straight alignment of the strut graft provides better clinical outcomes and lower incidence of graft subsidence after ACCF. In contrast, an oblique strut graft can lead to significantly increased strut graft subsidence and poor clinical results.

Endoscopic Ultrasonography-Guided Gallbladder Drainage as a Treatment Option for Acute Cholecystitis after Metal Stent Placement in Malignant Biliary Strictures

Fumisato Kozakai,Yoshihide Kanno,Kei Ito,Shinsuke Koshita,Takahisa Ogawa,Hiroaki Kusunose,Kaori Masu,Toshitaka Sakai,Toji Murabayashi,Keisuke Yonamine,Yujiro Kawakami,Yuki Fujii,Kazuaki Miyamoto,Yutak 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.3

Background/Aims: It is often diffcult to manage acute cholecystitis after metal stent (MS) placement in unresectable malignant biliarystrictures. The aim of this study was to evaluate the feasibility of endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD)for acute cholecystitis. Methods: The clinical outcomes of 10 patients who underwent EUS-GBD for acute cholecystitis after MS placement between January2011 and August 2018 were retrospectively evaluated. The procedural outcomes of percutaneous transhepatic gallbladder drainage(PTGBD) with tube placement (n=11 cases) and aspiration (PTGBA) (n=27 cases) during the study period were evaluated as a reference. Results: The technical success and clinical effectiveness rates of EUS-GBD were 90% (9/10) and 89% (8/9), respectively. Severe bileleakage that required surgical treatment occurred in one case. Acute cholecystitis recurred after stent dislocation in 38% (3/8) of thecases. Both PTGBD and PTGBA were technically successful in all cases without severe adverse events and clinically effective in 91% and63% of the cases, respectively. Conclusions: EUS-GBD after MS placement was a feasible option for treating acute cholecystitis. However, it was a rescue techniquefollowing the established percutaneous intervention in the current setting because of the immature technical methodology, includingdedicated devices, which need further development.

Inside Plastic Stents versus Metal Stents for Treating Unresectable Malignant Perihilar Biliary Obstructions: A Retrospective Comparative Study

Yoshihide Kanno,Shinsuke Koshita,Takahisa Ogawa,Hiroaki Kusunose,Kaori Masu,Toshitaka Sakai,Keisuke Yonamine,Kazuaki Miyamoto,Toji Murabayashi,Fumisato Kozakai,Jun Horaguchi,Yutaka Noda,Kei Ito 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.6

Background/Aims: The aim of this study was to evaluate outcomes of inside plastic stents (iPSs) versus those of metal stents (MSs) for treating unresectable perihilar malignant obstructions. Methods: For all patients who underwent endoscopic suprapapillary placement of iPS(s) or MS(s) as the first permanent biliary drainage for unresectable malignant perihilar obstructions between January 2014 and August 2019, clinical outcomes using iPSs (n=20) and MSs (n=85), including clinical efficacy, adverse events, and time to recurrence of biliary obstruction (RBO), were retrospectively evaluated. Results: There were no differences in clinical effectiveness (95% for the iPS group vs. 92% for the MS group, p=1.00). Procedure-related adverse events, including pancreatitis, acute cholangitis, acute cholecystitis, and death, were observed for 8% of the MS group, although no patient in the iPS group developed such adverse events. The median time to RBO was 561 days (95% confidence interval, 0–1,186 days) for iPSs and 209 days (127–291 days) for MSs, showing a significant difference (p=0.008). Conclusions: Time to RBO after iPS placement was significantly longer than that after MS placement. IPSs, which are removable, unlike MSs, were an acceptable option.