Short-Term Results of Transforaminal Lumbar Interbody Fusion Using Pedicle Screw with Cortical Bone Trajectory Compared with Conventional Trajectory

Yuji Kasukawa,Naohisa Miyakoshi,Michio Hongo,Yoshinori Ishikawa,Daisuke Kudo,Yoichi Shimada 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.3

Study Design: Case-control study. Purpose: To evaluate clinical and radiological results of transforaminal lumbar interbody fusion (TLIF) performed with cortical bone trajectory (CBT) pedicle screw insertion with those of TLIF using ‘conventional’ or percutaneous pedicle screw insertion. Overview of Literature: CBT is a new trajectory for pedicle screw insertion in the lumbar spine; clinical and radiological results of TLIF using pedicle screws inserted with CBT are unclear. Methods: In total, 26 patients (11 males, 15 females) were enrolled in this retrospective study and divided into three groups: TLIF with pedicle screw insertion by conventional minimally invasive methods via the Wiltse approach (M-TLIF, n=10), TLIF with percutaneous pedicle screw insertion (P-TLIF, n=6), and TLIF with pedicle screw insertion with CBT (CBT-TLIF, n=10). Surgical results and preand postoperative radiological findings were evaluated and compared. Results: Intraoperative blood loss was significantly less with CBT-TLIF (p =0.03) than with M-TLIF. Postoperative lordotic angles did not differ significantly among the three groups. Complete fusions were obtained in 10 of 12 levels (83%) with M-TLIF, in seven levels (100%) with P-TLIF, and in 10 of 11 levels (91%) with CBT-TLIF. On postoperative computed tomography, correct positioning was seen in 84.1% of M-TLIF screws, 88.5% of P-TLIF screws, and 90% of CBT-TLIF screws. Conclusions: CBT-TLIF resulted in less blood loss and a shorter operative duration than M-TLIF or P-TLIF. Postoperative rates of bone union, maintenance of lordotic angles, and accuracy of pedicle screw positions were similar among the three groups.

Surgical Results of Patients with Myelopathy due to Ossification of the Ligamentum Flavum with Ossification of the Posterior Longitudinal Ligament or a Vertebral Fracture at the Same Level of the Thoracic Spine: A Retrospective Comparative Study

Yuji Kasukawa,Naohisa Miyakoshi,Michio Hongo,Yoshinori Ishikawa,Daisuke Kudo,Ryota Kimura,Yuichi Ono,Jumpei Iida,Chiaki Sato,Yoichi Shimada 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.5

Study Design: Retrospective and comparative study. Purpose: We assessed surgical treatment outcomes in patients with thoracic myelopathy due to ossification of the ligamentum flavum (OLF), and OLF combined with ossification of the posterior longitudinal ligament (OPLL) or vertebral fracture (VF) at the same level. Overview of Literature: OLF and OPLL cause severe thoracic myelopathy. Osteoporotic VF commonly occurs at the thoracolumbar junction. There have been no investigations of thoracic myelopathy due to OLF and VF. Methods: Forty patients were divided among three groups: the OLF group (n=23): myelopathy due to OLF, the OLF+OPLL group (n=12): myelopathy due to OLF and OPLL, and the OLF+VF group (n=5): myelopathy due to OLF and VF. We recorded OLF, OPLL, and VF sites and operative procedures. Each patient’s neurological status, according to the Japanese Orthopaedic Association (JOA) score, and walking ability were evaluated pre- and postoperatively. Results: Patients in the OLF+OPLL group were significantly younger than those in the other two groups. The preoperative JOA score was significantly lower in the OLF+VF than OLF group. The final JOA score was significantly lower in the OLF+VF than OLF and OLF+OPLL groups. The JOA score recovery rate was significantly lower in the OLF+VF than OLF group. Final walking ability was significantly worse in the OLF+OPLL and OLF+VF groups than in the OLF group and significantly worse in the OLF+VF than OLF+OPLL group. Conclusions: Thoracic myelopathy due to OLF+VF occurs primarily in older females, who also exhibit worse preoperative and postoperative neurological status, and worse walking ability, than patients with thoracic myelopathy due to OLF or OLF+OPLL.

Teriparatide and etelcalcetide improve bone, fibrosis, and fat parameters in chronic kidney disease model rats

Shun Igarashi,Yuji Kasukawa,Koji Nozaka,Hiroyuki Tsuchie,Kazunobu Abe,Hikaru Saito,Ryo Shoji,Fumihito Kasama,Shuntaro Harata,Kento Okamoto,Keita Oya,Naohisa Miyakoshi 대한골다공증학회 2023 Osteoporosis and Sarcopenia Vol.9 No.4

Objectives: Chronic kidney disease (CKD) complicated by secondary hyperparathyroidism (SHPT) is associated with an increased risk of fragility fractures. Etelcalcetide (EC) is a treatment for SHPT that reduces serum parathyroid hormone (PTH) levels. However, the effects of combined treatment with osteoporosis drugs such as teriparatide (TPTD) remain unclear. This study investigates the combined effects of EC and TPTD on bone in CKD model rats. Methods: The CKD model was established in 8-week-old male Wistar rats by feeding them a 0.75% adenine diet for 4 weeks. At 20 weeks of age, the rats were divided into 4 groups (n = 9–10 in each group): CKD group (vehicle administration), TPTD group (30 μg/kg, 3 times/week), EC group (0.6 mg/kg, daily), and Comb group (TPTD and EC combined). EC was injected for 12 weeks starting at 20 weeks of age, and TPTD was injected for 8 weeks starting at 24 weeks of age. After treatment, the followings were evaluated: bone mineral density, bone strength, biochemical tests, bone and fat histomorphometry, and micro-computed tomography. Results: In CKD model rats, the combination of EC and TPTD was more effective in increasing cortical bone thickness and bone strength and inhibiting porosity. In addition, the combined treatment decreased bone marrow adiposity and fibrosis, and it increased bone mass and improved bone microstructure in trabecular bone. Conclusions: With the observed benefits such as improved bone mass, bone strength, structural properties, and bone marrow adiposity, combination therapy may be a potential way to improve bone fragility in CKD.

Combined treatment with minodronate and vitamin C increases bone mineral density and strength in vitamin C-deficient rats

Toyohito Segawa,Naohisa Miyakoshi,Yuji Kasukawa,Hiroshi Aonuma,Hiroyuki Tsuchie,Yoichi Shimada 대한골다공증학회 2016 Osteoporosis and Sarcopenia Vol.2 No.1

Objectives: Reduced bone quality caused by vitamin C deficiency in older persons may lead to incidental fragility fractures during bisphosphonate treatment, although bisphosphonate increases bone mineral density (BMD). This study aimed to evaluate the effects of minodronate and ascorbic acid (Aa) on BMD, bone quality, and bone strength in Aa-deficient osteogenic disorder Shionogi (ODS) rats. Methods: Six-month-old ODS rats were divided into four groups (n ¼ 20 per group): (1) Aa supplementation (Aa þ ); (2) Aa-deficient (Aa ? ); (3) Aa supplementation and minodronate administration (Aaþ þ Mino); and (4) Aa-deficient and minodronate administration (Aa? þ Mino). BMD, bone strength, bone histomorphometry, and bone quality determined using Fourier transform infrared spectroscopy imaging (FTIRI) were evaluated after 4 and 8 weeks. Results: BMD was significantly higher in the Aaþ þ Mino group than in the Aa? group ( p < 0.05). Bone strength was significantly higher in the Aaþ and Aaþ þ Mino groups than in the Aa? group ( p < 0.05). Furthermore, bone strength was significantly higher in the Aaþ þ Mino group than in the Aa? þ Mino group ( p < 0.05). Minodronate treatment irrespective of Aa supplementation significantly decreased bone resorption compared with the Aaþ and Aa? groups ( p < 0.05). No significant differences in the parameters evaluated by FTIRI were observed between the groups. Conclusions: Aa supplementation improved bone strength in ODS rats. Combined treatment with minodronate and Aa, but not minodronate alone, improved bone strength and increased BMD. Aa is required for bone health because it is essential for osteoblast differentiation. © 2016 The Korean Society of Osteoporosis. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Occurrence of vertebral fracture more closely associated with decreased anteroposterior than lateral lumbar bone mineral density

Hiroyuki Tsuchie,Naohisa Miyakoshi,Yuji Kasukawa,Tomio Nishi,Hidekazu Abe,Toyohito Segawa,Yoichi Shimada 대한골다공증학회 2016 Osteoporosis and Sarcopenia Vol.2 No.1

Objectives: While it has been pointed out that an anteroposterior (AP) view of the lumbar spine may lead to overestimation of the bone mineral density (BMD), a lateral view is expected lead to the early detection of BMD loss on scanning cancellous bone. Vertebral fracture is often seen in aged osteoporotic patients, and it is important to prevent this fracture. Therefore, we aimed to identify the optimal site for BMD measurement to assess the risk of vertebral fracture. Methods: Forty-seven female patients with fresh osteoporotic vertebral fracture and BMD measurements were included in this study (Fracture group). As a non-fractured control group, 218 female patients with BMD measurements were enrolled (Control group). We compared BMD values based on AP and lateral views of the lumbar spine from L2 to L4 and the femoral neck. With a lateral view of the lumbar spine, we measured both the total vertebral body and vertebral body center, mainly composed of cancellous bone. Results: BMD of the AP lumbar spine in the Fracture group was significantly lower than in the Control group (P < 0.05). In the subanalyses for comparisons between age-matched fracture and control groups, BMD of only the AP lumbar spine in the Fracture group was significantly lower than in the Control group (P < 0.01). Conclusions: AP lumbar spine BMD is optimal for assessing vertebral fracture occurrence. © 2016 The Korean Society of Osteoporosis. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Evaluation of bone mineral density and bone strength in autochthonous transgenic model mice for diabetes mellitus (Akita mice)

Kentaro Ohuchi,Naohisa Miyakoshi,Yuji Kasukawa,Toyohito Segawa,Hayato Kinoshita,Yoichi Shimada 대한골다공증학회 2015 Osteoporosis and Sarcopenia Vol.1 No.2

Objectives: Diabetes mellitus (DM) causes secondary osteoporosis, which reduces bone mineral density (BMD) and bone strength. Akita mice (AM) are DM model mice used to evaluate glucose metabolism. However, bone metabolism in AM remains unclear. The purpose of this study was to evaluate BMD, bone strength, and serum sclerostin levels in AM. Methods: Female AM and control mice (C57/BL/6NCrSlc; CM) were divided into four groups: (1) a CM group sacrificed at 14 (CM-14w; n ¼ 8) or (2) 18 weeks of age (CM-18w; n ¼ 6); and (3) an AM group sacrificed at 14 (AM-14w; n ¼ 9) or (4) 18 weeks of age (AM-18w; n ¼ 6). Blood glucose level, serum sclerostin level, total tibial BMD, and femoral shaft bone strength were evaluated at each time point. Results: Blood glucose levels were significantly higher in AM than in CM (p < 0.001). Serum sclerostin levels were significantly lower in AM- 18w than in CM-18w (p < 0.001). BMD was significantly lower in AM-14w than in CM-14w (p ¼ 0.004). Stiffness of the femoral shaft was significantly lower in AM-18w than in CM-14w (p ¼ 0.04). Body weight (r ¼ 0.608, p < 0.01) and maximum load (r ¼ 0.438, p < 0.05) were significantly positively correlated with serum sclerostin levels, while blood glucose levels showed a significant negative correlation (r¼?0.708, p < 0.01). Conclusions: AM showed decreased BMD and bone strength with lower levels of serum sclerostin than CM. © 2015 The Korean Society of Osteoporosis. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Effects of eldecalcitol and ibandronate on secondary osteoporosis and muscle wasting in rats with adjuvant-induced arthritis

Yuichi Ono,Naohisa Miyakoshi,Yuji Kasukawa,Hiroyuki Nagasawa,Hiroyuki Tsuchie,Manabu Akagawa,Itsuki Nagahata,Yusuke Yuasa,Chiaki Sato,Yoichi Shimada 대한골다공증학회 2018 Osteoporosis and Sarcopenia Vol.4 No.4

Objectives: Rheumatoid arthritis (RA) is characterized by chronic inflammation of the synovium, progressive erosion of the articular cartilage, and joint destruction. RA also causes secondary osteoporosis and muscle wasting. We investigated the effects of ibandronate (IBN), a bisphosphonate; eldecalcitol (ELD), an active vitamin D3 derivative; and combination treatment with both agents on secondary osteoporosis and muscle wasting using adjuvant-induced arthritis rats. Methods: Arthritis was induced in 8-week-old male Lewis rats. Rats were randomized into 4 treatment groups and an untreated normal control group: IBN (subcutaneously, once every 2 weeks,10 mg/kg), ELD (orally, once daily, 30 ng/kg/day), IBN þ ELD, vehicle, and control. Paw thickness measurements were performed for evaluation of arthritis. The femur was scanned using dual-energy X-ray absorptiometry. Cross-sectional areas of left tibialis and anterior muscle fibers and the expression of MuRF1, atrogin-1, MyoD, and myogenin in the gastrocnemius muscle were measured to evaluate muscle wasting. Results: IBN and/or ELD increased bone mineral density (BMD) in the femur. In addition, there was an additiveeffect of combination treatment compared with single treatments for BMD. However, IBNand/or ELD did not inhibit muscle wasting in adjuvant-induced arthritis rats. Conclusions: Combination treatment with IBN and ELD may be effective for secondary osteoporosis associated with RA. Other treatments are necessary for muscle wasting associated with RA. Studies in humans are needed to confirm these findings.

Effects of teriparatide on bone in autochthonous transgenic model mice for diabetes mellitus (Akita mice)

Kentaro Ohuchi,Naohisa Miyakoshi,Yuji Kasukawa,Toyohito Segawa,Hayato Kinoshita,Chie Sato,Masashi Fujii,Yoichi Shimada 대한골다공증학회 2019 Osteoporosis and Sarcopenia Vol.5 No.4

Objectives: The purpose of this study is to evaluate the effects of teriparatide (TPTD) on bone mineral density (BMD), bone strength, and bone quality in Akita mouse models of diabetes mellitus. Methods: Twelve-week-old female Akita mice and control mice (C57/BL/6NCrSlc) were divided into 4 groups: control mice treated with vehicle (n ¼ 7) or TPTD (n ¼ 6); and Akita mice treated with vehicle (n ¼ 6) or TPTD (n ¼ 7). TPTD or vehicle was administered subcutaneously 3 times a week for 8 weeks. Blood glucose, serum sclerostin, total tibial BMD, femoral shaft bone strength, and bone quality using Fourier-transform infrared spectroscopy imaging were evaluated. Results: No significant differences in serum sclerostin levels were evident among these groups after 8 weeks of treatment. TPTD significantly increased BMD in control mice (þ12.7%, P ¼ 0.02) and Akita mice (þ29.2%, P ¼ 0.001) compared with vehicle. Maximum load and stiffness were significantly higher in Akita mice treated with TPTD than in Akita mice treated with vehicle (þ56.6%, P ¼ 0.03 and þ 90.5%, P ¼ 0.02, respectively). On Fourier-transform infrared spectroscopy imaging, the mineral/matrix ratio was significantly lower in Akita mice treated with vehicle than in control mice (12.2%, P ¼ 0.02), and TPTD treatment significantly increased the mineral/matrix ratio (P ¼ 0.003). Conclusions: TPTD thus improved BMD and bone strength in both control mice and Akita mice, with improvements in the mineral/matrix ratio among Akita mice.

Effects of combined therapy of alendronate and low-intensity pulsed ultrasound on metaphyseal bone repair after osteotomy in the proximal tibia of glucocorticoid-induced osteopenia rats

Tetsuya Kawano,Naohisa Miyakoshi,Yuji Kasukawa,Michio Hongo,Hiroyuki Tsuchie,Chie Sato,Masashi Fujii,Masazumi Suzuki,Manabu Akagawa,Yuichi Ono,Yusuke Yuasa,Itsuki Nagahata,Yoichi Shimada 대한골다공증학회 2017 Osteoporosis and Sarcopenia Vol.3 No.4

Objectives: Glucocorticoid (GC) treatment inhibits activation of runt-related transcription factor 2 (Runx2), which is essential for osteoblast differentiation from stem cells. As a result, GC treatment results in bone loss, GC-induced osteoporosis (GIO), elevated fracture risk, and delayed bone healing. Bisphosphonates such as alendronate (ALN) are recommended for treating or preventing GIO, and lowintensity pulsed ultrasound (LIPUS) facilitates fracture healing and maturation of regenerated bone. Combined therapy with ALN and LIPUS may stimulate cancellous bone healing in GIO rats. Here, we examined the effect of ALN and LIPUS on cancellous bone osteotomy repair in the proximal tibia of GIO rats. Methods: Prednisolone (10 mg/kg body weight/day) was administered for 4 weeks to induce GIO in 6- month-old female Sprague-Dawley rats. Tibial osteotomy was then performed and daily subcutaneous injection of ALN (1-mg/kg body weight) was subsequently administered alone or in combination with LIPUS (20 min/day) for 2 or 4 weeks. Results: ALN significantly increased bone mineral density (BMD) at 2 and 4 weeks, and ALN þ LIPUS significantly increased BMD at 4 weeks. Bone union rates were significantly increased after 2 and 4 weeks ALN and ALN þ LIPUS treatment. Lastly, ALN and ALN þ LIPUS significantly increased the proportion of Runx2 positive cells at 4 weeks. Conclusions: ALN monotherapy and combined ALN and LUPUS treatment augmented BMD and stimulated cancellous bone repair with increased Runx2 expression at the osteotomy site in GIO rats. However, the combined treatment had no additional effect on cancellous bone healing compared to ALN monotherapy. © 2017 The Korean Society of Osteoporosis. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Analysis of bone in adenine-induced chronic kidney disease model rats

Hikaru Saito,Naohisa Miyakoshi,Yuji Kasukawa,Koji Nozaka,Hiroyuki Tsuchie,Chiaki Sato,Kazunobu Abe,Ryo Shoji,Yoichi Shimada 대한골다공증학회 2021 Osteoporosis and Sarcopenia Vol.7 No.4

Objectives: The purpose of this study is to investigate the stage of chronic kidney disease (CKD) in adenine-induced CKD model rats by serum analyses, and to examine bone mineral density (BMD), bone strength, and microstructure of trabecular and cortical bone in these rats. Methods: Eight-week-old, male Wistar rats (n ¼ 42) were divided into 2 groups: those fed a 0.75% adenine diet for 4 weeks until 12 weeks of age to generate CKD model rats (CKD group); and sham rats. The CKD and sham groups were sacrificed at 12, 16, and 20 weeks of age (n ¼ 7 in each group and at 12, 16, and 20 weeks), and various parameters were evaluated, including body weight, renal wet weight, muscle wet weight, renal histology, biochemical tests, BMD, biomechanical testing, and micro-computed tomography (CT). The parameters were compared between the 2 groups at the various time points. Results: In the CKD model rats, at 20 weeks of age, serum creatinine, phosphorus, and intact-PTH levels were elevated, and serum calcium levels were normal, indicating that the CKD was stage IV and associated with secondary hyperparathyroidism. Decreased BMDs of the whole body and the femur were observed as bone changes, and micro-CT analysis showed deterioration of bone microstructure of the cortical bone that resulted in decreased bone strength in the cortical and trabecular bone. Conclusions: These CKD model rats showed stage IV CKD and appear appropriate for evaluating the effects of several treatments for CKD-related osteoporosis and mineral bone disorder.