Commentary on “The Incidence of Adding-On or Distal Junctional Kyphosis in Adolescent Idiopathic Scoliosis Treated by Anterior Spinal Fusion to L3 Was Significantly Higher Than by Posterior Spinal Fusion to L3”

Morio Matsumoto 대한척추신경외과학회 2021 Neurospine Vol.18 No.3

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Sacropelvic Parameters and L5 Spondylolysis: Computed Tomography Analysis

Matsumoto Morio 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.1

Study Design: Retrospective analysis of computed tomography scans.Purpose: This study aims to determine the association of sagittal sacropelvic parameters with L5 spondylolysis.Overview of Literature: The association of increased pelvic incidence (PI) and decreased sacral table angle (STA) with spondylolysis has been reported, but no study has simultaneously analyzed multiple sacropelvic variables to compare their association.Methods: In this study, computed tomography scans obtained to assess major trauma in patients aged >16 years were analyzed. Scans meeting one of the following criteria were excluded: abnormal anatomy, previous spine or hip/pelvis surgery, or spinal pathology, including deformity, infection, tumor, or trauma. sacral anatomic orientation (SAO), PI, pelvic thickness (PTH), femoro-sacral posterior angle (FSPA), STA, and sacral kyphosis (SK) were measured.Results: Overall, 202 scans were analyzed: 25 with L5 spondylolysis and 177 normal. Among the groups, a significant difference was observed in SAO (43.3° vs. 51.6°), PI (61.7° vs. 49.8°), STA (95.4° vs. 101.8°), and SK (31.0° vs. 23.7°). Based on the logistic regression analysis, only PI (odds ratio [OR], 1.074; 95% CI, 1.026–1.124) and STA (OR, 0.822; 95% CI, 0.734–0.920) remained significant predictors for the presence of spondylolysis. In the spondylolysis group, PI correlated significantly with PTH (r=−0.589), FSPA (r=0.880), and SK (r=0.576), whereas in the normal group, PI correlated significantly with FSPA (r=0.781) and SK (r=0.728).Conclusions: By simultaneously assessing multiple sacropelvic parameters, we associated increasing PI with L5 spondylolysis. Decreasing STA, which likely represents a chronic remodeling secondary to spondylolysis, was also associated with increased risk. Back pain in an adolescent or young adult with high PI or low STA should raise suspicion of a possible occult spondylolysis.

An Application of Artificial Intelligence to Diagnostic Imaging of Spine Disease: Estimating Spinal Alignment From Moiré Images

Kota Watanabe,Yoshimitsu Aoki,Morio Matsumoto 대한척추신경외과학회 2019 Neurospine Vol.16 No.4

The use of artificial intelligence (AI) as a tool supporting the diagnosis and treatment of spinal diseases is eagerly anticipated. In the field of diagnostic imaging, the possible application of AI includes diagnostic support for diseases requiring highly specialized expertise, such as trauma in children, scoliosis, symptomatic diseases, and spinal cord tumors. Moiré topography, which describes the 3-dimensional surface of the trunk with band patterns, has been used to screen students for scoliosis, but the interpretation of the band patterns can be ambiguous. Thus, we created a scoliosis screening system that estimates spinal alignment, the Cobb angle, and vertebral rotation from moiré images. In our system, a convolutional neural network (CNN) estimates the positions of 12 thoracic and 5 lumbar vertebrae, 17 spinous processes, and the vertebral rotation angle of each vertebra. We used this information to estimate the Cobb angle. The mean absolute error (MAE) of the estimated vertebral positions was 3.6 pixels (~5.4 mm) per person. T1 and L5 had smaller MAEs than the other levels. The MAE per person between the Cobb angle measured by doctors and the estimated Cobb angle was 3.42°. The MAE was 4.38° in normal spines, 3.13° in spines with a slight deformity, and 2.74° in spines with a mild to severe deformity. The MAE of the angle of vertebral rotation was 2.9°±1.4°, and was smaller when the deformity was milder. The proposed method of estimating the Cobb angle and AVR from moiré images using a CNN is expected to enhance the accuracy of scoliosis screening.

Association of Continuous Vertebral Bone Bridges and Bone Mineral Density with the Fracture Risk in Patients with Diffuse Idiopathic Skeletal Hyperostosis

Furukawa Mitsuru,Okuyama Kunimasa,Ninomiya Ken,Yato Yoshiyuki,Miyamoto Takeshi,Nakamura Masaya,Matsumoto Morio 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.1

Study Design: Cross-sectional study.Purpose: To examine whether the number of continuous vertebral bone bridges and bone mineral density (BMD) influence the fracture risk in diffuse idiopathic skeletal hyperostosis (DISH) patients.Overview of Literature: Bone bridges connecting through the intervertebral body in DISH create long lever arms that can increase the risk of fractures from minor trauma. DISH patients have a BMD that is higher than or comparable to those of age-matched healthy subjects.Methods: We examined the computed tomography scans from the thoracic vertebra to the sacrum used to diagnose DISH in 140 patients (98 men and 42 women; average age, 78.6 years). We compared patients who did (n=52) and did not have (n=88) fractures at the continuous vertebral bodies fused by bone bridges. The relationship between the vertebral fractures and the maximum number of vertebrae that are bony cross-linked with contiguous adjacent vertebrae (max VB) from the thoracic vertebra to the sacrum or from the lumbar vertebra to the sacrum and proximal femur BMD were analyzed using a logistic regression model.Results: We found that after adjusting for the confounding factors, higher max VB, both from the thoracic vertebrae to the sacrum and the lumbar vertebrae to the sacrum, was associated with a higher risk of vertebral fractures. This difference was statistically significant. The risk was higher when only the lumbar vertebrae to the sacrum was considered (thoracic vertebrae to the sacrum: odds ratio, 1.21; p<0.05; lumbar vertebrae to the sacrum: odds ratio, 2.78; p<0.01). Moreover, low proximal femur BMD in DISH patients raises the fracture risk (odds ratio, 0.47; p<0.01).Conclusions: Many continuous vertebral bone bridges, especially those that extend to the lumbar spine and low proximal femur BMD, are risk factors for fracture in DISH patients.

Atlantoaxial Stabilization Using C1 and C2 Laminar Screw Fixation

Takashi Tsuji,Kazuhiro Chiba,Yosuke Horiuchi,Tadahisa Urabe,Shota Fujita,Morio Matsumoto 대한척추외과학회 2017 Asian Spine Journal Vol.11 No.2

We describe the use of a C1 laminar screw in combination with a C2 laminar screw as a salvage technique to treat two patients, one with persistent first intersegmental artery and the other with vertebral artery occlusion after cervical spine fracture. The combined use of C1 and C2 laminar screws allows for good fixation of the atlantoaxial joint with a lower risk of vertebral artery injury; therefore, it can be an alternative surgical procedure for patients with congenital or traumatic anomalous vertebral artery.

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.

Coronal Plane Gap Increases Postoperative Pseudoarthrosis after Lateral Interbody Fusion for Adult Spinal Deformity

Okada Eijiro,Yagi Mitsuru,Yamamoto Yusuke,Suzuki Satoshi,Nori Satoshi,Tsuji Osahiko,Nagoshi Narihito,Fujita Nobuyuki,Nakamura Masaya,Matsumoto Morio,Watanabe Kota 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.3

Study Design: This is a retrospective study.Purpose: This study aims to evaluate the risk factor associated with pseudoarthrosis after placement of lateral interbody fusion (LIF) cages for adult spinal deformity (ASD) treatment. Overview of Literature: LIF technique is widely used for ASD correction. Furthermore, pseudoarthrosis is a major complication of fusion surgery required for revision surgery.Methods: This study included 42 patients with ASD (two men and 40 women; 112 segments; mean, 68.5±8.4 years; and mean follow-up, 31.6±17.0 months) who underwent LIF and posterior correction surgery. The concave slot of the LIF cage was filled with an autologous iliac crest bone graft (IBG), and the convex slot with a porous hydroxyapatite/collagen (HAp/Col) composite was soaked with bone marrow aspirate. Endplate injury, the gap between vertebral endplate and cage in the coronal or sagittal plane, and fusion status were evaluated using computed tomography multiplanar reconstruction at 12 months after surgery. Moreover, the associated risk factors for pseudoarthrosis were analyzed.Results: Fusion at LIF segments were observed in 71.4% segments at 12 months after surgery. Fusion on the concave slot (autologous IBG side), convex slot (porous HAp/Col composite side), and both concave and convex slots were observed in 66.1%, 37.5%, and 36.6% of patients, respectively. Moreover, pseudoarthrosis was observed in 28.6% at 12 months after surgery. Consequently, logistic regression analysis of the fusion at the LIF segment revealed that the gap between the LIF cage and endplate in the coronal plane (p=0.030; odds ratio, 0.183; 95% confidence interval, 0.030–0.183) was significantly associated with pseudoarthrosis at the LIF segments.Conclusions: ASD surgery fusion rate using LIF cages was 71.4% at 12 months after surgery. The fusion rate was higher on the concave slot filled with autologous IBG than on the convex slot filled with a porous HAp/Col composite. The gap in the coronal plane was a risk factor for pseudoarthrosis at the LIF segment.

Sagittal Spinopelvic Malalignment in Parkinson Disease: Prevalence and Associations With Disease Severity

Oh, Jae Keun,Smith, Justin S.,Shaffrey, Christopher I.,Lafage, Virginie,Schwab, Frank,Ames, Christopher P.,Matsumoto, Morio,Baik, Jong Sam,Ha, Yoon by Lippincott Williams Wilkins 2014 1528-1159) Vol.39 No.14

STUDY DESIGN.: Prospective study. OBJECTIVE.: Our objectives were to evaluate the prevalence of sagittal spinopelvic malalignment in a consecutive series of patients with Parkinson disease (PD) and to identify factors associated with sagittal spinopelvic deformity in this population. SUMMARY OF BACKGROUND DATA.: PD is a degenerative neurological condition characterized by tremor, rigidity, bradykinesia, and loss of postural reflexes. The prevalence of spinal deformity in PD is higher than that of age-matched adults without PD. METHODS.: This study was a prospective assessment of consecutive patients with PD presenting to a neurology clinic during 12 months. Inclusion criteria included age more than 21 years and diagnosis of PD. Age- and sex-matched control group was selected from patients with cervical spondylosis. Clinical and demographic factors were collected including Unified Parkinson Disease Rating Scale score and Hoehn and Yahr stage. Full-length standing spine radiographs were assessed. Patients were grouped into either low C7 sagittal vertical axis (SVA) (<5 cm) or high C7 SVA (≥5 cm) and into matched (≤10°) or mismatched (>10°) pelvic incidence (PI)-lumbar lordosis. RESULTS.: Eighty-nine patients met criteria (41 males/48 females), including 52 with low C7 SVA and 37 with high C7 SVA. Significantly higher prevalence of high C7 SVA was found in PD (41.6 vs. 16.8%; P < 0.001). The high C7 SVA group was significantly older (72.4 vs. 65.1 yr; P < 0.001) and had a higher proportion of females (68% vs. 44%; P = 0.034), greater severity of PD based on Hoehn and Yahr stage (1.89 vs. 1.37; P < 0.001) and Unified Parkinson Disease Rating Scale (30.5 vs. 17.2; P = 0.002. Unified Parkinson Disease Rating Scale significantly correlated with C7 SVA (r = 0.474). Compared with the matched (≤10°) PI-lumbar lordosis group, the mismatch PI-lumbar lordosis group had higher C7 SVA, higher PI, higher pelvic tilt, lower lumbar lordosis, and lower thoracic kyphosis (P ≤ 0.003). CONCLUSION.: Patients with PD have a high prevalence of sagittal spinopelvic malalignment than control group patients. Greater severity of PD is associated with sagittal spinopelvic malalignment.Level of Evidence: 3

Poor Prognostic Factors for Surgical Treatment of Spinal Intramedullary Ependymoma (World Health Organization Grade II)

Tsuji Osahiko,Nagoshi Narihito,Ishii Ryota,Nori Satoshi,Suzuki Satoshi,Okada Eijiro,Fujita Nobuyuki,Yagi Mitsuru,Matsumoto Morio,Nakamura Masaya,Watanabe Kota 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.6

Study Design: Single-center retrospective study.Purpose: We aimed to explore the postoperative prognostic factors for spinal intramedullary ependymoma.Overview of Literature: Ependymoma (World Health Organization grade II) is the most frequent intramedullary spinal tumor and is treated by total resection. However, postoperative deterioration of motor function occasionally occurs.Methods: Eighty patients who underwent surgical resection at Keio University and Fujita Health University in Tokyo, Japan between 2003 and 2015 with more than 2 years of follow-up were enrolled. A good surgical result was defined as an improvement in the modified McCormick Scale score by one grade or more or having the same clinical grade as was observed preoperatively. Meanwhile, a poor result was defined as a reduction in the McCormick Scale score of one grade or more or remaining in grade IV or V at final follow-up. Univariate and multivariate logistic regression analyses of the following factors were performed in the two groups: sex, age, preoperative Visual Analog Scale (VAS), tumor location, the extent of tumor resection, hemosiderin caps, cavity length, and tumor length on magnetic resonance imaging.Results: At final follow-up, 15 patients were included in the poor results group and 65 in the good results group. In the univariate analysis, the factors related to poor results were as follows: higher age, preoperative McCormick Scale score severity, higher preoperative VAS, thoracic location, hemosiderin capped, and non-gross total resection (GTR). A multiple logistic regression analysis was conducted and showed that age, worse preoperative McCormick Scale score, and non-GTR were significant factors for poor prognosis.Conclusions: The independent risk factors for motor deterioration after ependymoma resection were age, worse preoperative McCormick Scale score, and non-GTR. Early surgery for patients with even mild neurological disorders could facilitate functional outcomes. These results may contribute to determining the optimal timing of surgery for spinal intramedullary ependymoma.

Surgical and Functional Outcomes of Expansive Open-Door Laminoplasty for Patients With Mild Kyphotic Cervical Alignment

Narihito Nagoshi,Satoshi Nori,Osahiko Tsuji,Satoshi Suzuki,Eijiro Okada,Mitsuru Yagi,Masaya Nakamura,Morio Matsumoto,Kota Watanabe 대한척추신경외과학회 2021 Neurospine Vol.18 No.4

Objective: To evaluate the cervical dynamics, neurological function, pain, and quality of life in patients with mild cervical kyphotic alignment who underwent expansive unilateral open-door laminoplasty (ELAP). Methods: In this retrospective single-center study, we reviewed the surgical outcomes of 80 patients with cervical spondylotic myelopathy who were followed for at least 2 years. The patients were categorized into the preoperative kyphotic group (C2–7 angle <0°) and nonkyphotic group (angle ≥0°). We compared clinical information, radiographic parameters, Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) scores, and cervical Japanese Orthopaedic Association (JOA) scores between the groups. Results: The kyphotic and nonkyphotic groups comprised 17 and 63 patients, respectively. The preoperative C2–7 angles were -3.7° in the kyphotic group and 15.4° in the nonkyphotic group (p<0.01). In the kyphotic group, kyphotic alignment improved to lordosis at the final follow-up (2.6°, p=0.01). The preoperative (16.4° vs. 24.1°, p<0.01) and final-follow-up (17.8° vs. 24.5°, p<0.01) C7 slopes were significantly smaller in the kyphotic group. ELAP reduced pain in the arms or hands (p=0.02) and improved the JOA scores (p<0.01) in the kyphotic group. Patient-reported outcomes assessed using the JOACMEQ showed comparable effective rates in both groups. Conclusion: Patients with mild cervical kyphosis showed smaller C7 slopes as a compensatory mechanism. Kyphotic angles significantly improved to lordosis after ELAP, resulting in favorable clinical outcomes. ELAP is a useful surgical option for patients even if they present mild kyphotic cervical angles.