Preoperative Less Right Shoulder Elevation Had a Higher Risk of Postoperative Shoulder Imbalance When Main Thoracic Curve Shows Higher Correction Regardless of the Upper Instrumented Vertebra Level for Patients with Adolescent Idiopathic Scoliosis Lenke

Banno Tomohiro,Yamato Yu,Hasegawa Tomohiko,Yoshida Go,Arima Hideyuki,Oe Shin,Mihara Yuki,Ide Koichiro,Watanabe Yuh,Kurosu Kenta,Nakai Keiichi,Matsuyama Yukihiro 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.1

Study Design: This is a retrospective study.Purpose: This study aimed to investigate the incidence of and risk factors for postoperative shoulder imbalance (PSI) in patients with Lenke type 1.Overview of Literature: PSI is a complication resulting in poor self-image and satisfaction in adolescent idiopathic scoliosis (AIS) patients.Methods: We examined the data of AIS patients with Lenke type 1 curves who underwent posterior fusion surgery in a retrospective manner. PSI was defined as a 2-year postoperative absolute radiographic shoulder height (RSH) of ≥2 cm. Patients were divided into two groups based on the presence of PSI and the level of their upper instrumented vertebra (UIV) (UIV at T2 or T3 [U-UIV] or UIV below T3 [L-UIV]). The radiographic parameters and clinical outcomes were compared, and the cutoff values of risk factors were identified by multivariate analysis.Results: Of 104 patients, 21 (20.2%) had left shoulder elevation PSI. The PSI group had a significantly greater preoperative RSH (−5.1 mm vs. −14.3 mm) and main thoracic (MT) curve correction rate (77.3% vs. 69.1%) than the non-PSI group. The PSI incidence did not differ between the U-UIV and L-UIV groups. Multivariate analysis identified preoperative RSH and the MT curve correction rate as independent risk factors for PSI. The receiver operating characteristic curve analysis identified the preoperative RSH cutoff value as −6.5 mm and MT curve correction rate cutoff value as 76.9%.Conclusions: Even in AIS patients with Lenke type 1 curves, the incidence of PSI was relatively high (20.2%). Patients with preoperative lower right shoulder elevation (i.e., RSH >−6.5 mm) had a higher risk of PSI regardless of UIV level when the MT curve showed a higher correction rate (i.e., correction rate >76.9%).

Multi-Rod Constructs Can Increase the Incidence of Iliac Screw Loosening after Surgery for Adult Spinal Deformity

Tomohiro Banno,Tomohiko Hasegawa,Yu Yamato,Daisuke Togawa,Go Yoshida,Sho Kobayashi,Tatsuya Yasuda,Hideyuki Arima,Shin Oe,Yuki Mihara,Hiroki Ushirozako,Yukihiro Matsuyama 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.3

Study Design: A retrospective study. Purpose: To investigate the incidence of iliac screw loosening with a two-rod vs. multi-rod construct and the effect on clinical and radiographic outcomes after surgery for adult spinal deformity (ASD). Overview of Literature: Multi-rod construct is useful for preventing rod fracture in ASD surgery. However, limited information is available regarding the incidence of iliac screw loosening after corrective fusion surgery using a multi-rod construct. Methods: Total 106 patients with ASD (24 men and 82 women; mean age, 68 years) who underwent corrective fusion surgery using bilateral iliac screws and were followed up for at least 1 year were reviewed. The following variables were compared between patients who underwent surgery with a two-rod and multi-rod construct: age, sex, bone mineral density (BMD), fusion level, high-grade osteotomy, L5/S interbody fusion, screw loosening (upper instrumented vertebra [UIV], S1, and iliac), rod fracture, proximal junctional kyphosis, spinopelvic parameters, and Oswestry Disability Index (ODI) score. We also compared patients with and without iliac screw loosening in the multi-rod construct group. Results: Of the 106 patients, 55 underwent surgery with a conventional two-rod construct and 51 with a multi-rod construct (three rods in 16, four rods in 35). Iliac and UIV screw loosening was observed in 24 patients (21%) and 35 patients (33%), respectively. The multi-rod group showed significantly higher incidence of iliac and UIV screw loosening and lower incidence of rod fracture. Patients with iliac screw loosening had a lower BMD than those without screw loosening; however, no significant differences were observed in the spinopelvic parameters or the ODI score. Conclusions: The use of multi-rod constructs led to a higher incidence of junctional screw loosening than the use of conventional two-rod constructs, especially in patients with osteoporosis. Iliac screw loosening did not affect sagittal alignment or clinical outcome in the short term.

Fatigue Strength Improvement and Fatigue Crack Closure by Portable Pneumatic Needle-Peening Treatment on Welded Joints

Koji Kinoshita,Yuki Banno,Yuki Ono,Shohey Yamada,Mitsuru Handa 한국강구조학회 2019 International Journal of Steel Structures Vol.19 No.3

This study experimentally investigates eff ect of fatigue strength improvement of the Portable Pneumatic Needle-Peening treatment (PPP treatment) as a needle peening on out-of-plane gusset welded joints by using plate bending fatigue tests. This study also examined eff ect of the travel speed and the number of treatment passes of the PPP treatment with regards to its fatigue strength improvement. After the fatigue tests, the observation of the fracture surface with Scanning Electron Microscope was carried out in order to clarify the crack initiation. From those test results, it may be concluded that the eff ect of fatigue strength improvement might be governed by treatment passes with suffi cient travel speed. In addition, this study carried out additional fatigue tests that focus on fatigue crack closer by using the PPP treatment. As a result of additional fatigue tests for fatigue crack closure, it might be said that the eff ect of fatigue crack closure is eff ective when the distance between fatigue cracks and treatment area is less than 2.0 mm.

Fatigue Strength Improvement of Welded Joints of Existing Steel Bridges by Shot-Peening

Koji Kinoshita,Yuki Banno,Yuki Ono,Shohey Yamada,Mitsuru Handa 한국강구조학회 2019 International Journal of Steel Structures Vol.19 No.2

Shot-peening recently can be applied to existing steel bridges due to the development of new vacuuming techniques of shots after peening in the construction site. This study experimentally investigates eff ects of fatigue strength improvement of shot-peening on welded joints. Bending fatigue tests using out-of-plane gusset welded joints specimens were carried out and three type specimens were compared: as-welded, grit-blasted, and shot-peened. In addition, this paper examines diff erences of fatigue strength improvement eff ects in case of applying shot-peening to inside of scallop where shots might be diffi cult to hit perpendicularly to weld toe of welded joints because of narrow space, and the residual stress measurement in order to clarify introducing compressive residual stress were carried out. As a result, it may be concluded that shot-peening can improve fatigue strength of welded joints and its mechanism was identifi ed as extension of crack initiation life and delay crack propagation due to benefi cial compressive residual stress in the vicinity of surface layer.

Significance of PD-L1 expression in carbon-ion radiotherapy for uterine cervical adeno/adenosquamous carcinoma

Moito Iijima,Noriyuki Okonogi,Nakako Izumi Nakajima,Yukie Morokoshi,Hiroaki Kanda,Taiju Yamada,Yusuke Kobayashi,Kouji Banno,Masaru Wakatsuki,Shigeru Yamada,Tadashi Kamada,Daisuke Aoki,Sumitaka Hasegaw 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.2

Objective: Programmed cell death-ligand 1 (PD-L1) is expressed in tumor cells and has been shown to predict clinical outcomes of several types of malignancies. The aim of this study was to investigate the effects of carbon-ion (C-ion) beam irradiation on PD-L1 expression in human uterine cervical adeno/adenosquamous carcinoma (UCAA) cells and clinical samples and to identify the prognostic factors for outcomes after C-ion radiotherapy (CIRT). Methods: The effects of C-ion irradiation on PD-L1 expression in human UCAA and cervical squamous cell carcinoma cells were examined by flow cytometry. We examined PD-L1 expression in UCAA biopsy specimens from 33 patients before CIRT started (pre-CIRT) and after 12 Gy (relative biological effectiveness [RBE]) irradiation (post-12Gy-C) in 4 fractions of CIRT to investigate the correlation between PD-L1 status and clinical outcomes. Results: The PD-L1 expression was upregulated by C-ion beam in a dose-dependent manner in HeLa and SiHa cells through phosphorylated Chk1. The overall frequencies of pre-CIRT and post-12Gy-C PD-L1 positivity were 45% (15/33) and 67% (22/33), respectively. The post-12Gy-C PD-L1 expression was significantly elevated compared to the pre-CIRT PD-L1 expression. There was no significant relationship between the pre-CIRT PD-L1 status and clinical outcomes, such as local control (LC), progression-free survival (PFS), and overall survival (OS). However, the post-12Gy-C PD-L1 expression had better correlation with PFS, but not with LC and OS. Conclusion: CIRT can induce PD-L1 expression in UCAA and we propose that PD-L1 expression after starting CIRT may become as a predictive prognostic marker in CIRT for UCAA.

Revision Surgery for a Rod Fracture with Multirod Constructs Using a Posterior-Only Approach Following Surgery for Adult Spinal Deformity

Yamato Yu,Hasegawa Tomohiko,Yoshida Go,Banno Tomohiro,Oe Shin,Arima Hideyuki,Mihara Yuki,Ushirozako Hiroki,Yamada Tomohiro,Watanabe Yuh,Ide Koichiro,Nakai Keiichi,Kurosu Kenta,Matsuyama Yukihiro 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.5

Study Design: Single-center retrospective case series.Purpose: We aimed to evaluate the clinical results of revision surgery for a rod fracture using a posterior-only approach and determine the best procedure to prevent refracture in patients with adult spinal deformity (ASD).Overview of Literature: ASD affects the thoracolumbar spine and often requires surgical correction. However, surgery for extensive spinal fusion causes rod fracture, a major mechanical complication. Few studies have described the treatment methods for rod fractures. Furthermore, the clinical outcomes of revision surgery for rod fractures in patients with ASD are currently unclear.Methods: We retrospectively reviewed the medical records of 404 patients who underwent corrective fusion surgery for ASD with a minimum 2-year follow-up. We studied cases of reoperation for postoperative rod fractures and investigated surgical procedure, intraoperative findings, clinical course, and rod refracture following revision surgery.Results: Rod fracture was observed in 88 patients (21.8%). Fifty-three patients (average age, 68.3 years; average blood loss, 502.2 mL [% estimated blood volume=16.4%]; and operation time, 203.3 minutes) who suffered from a rod fracture at an average of 28.3 months after the primary operation underwent reoperation. Surgical invasiveness had no significant differences in total or partial rod replacement; however, the procedures with and without an anterior bone graft significantly differed. The replaced rod refractured at an average of 35.3 months after the revision surgery of five patients. The rod also refractured at a level outside multiple rods in two patients and with traumatic episodes in three patients. Three patients had bone grafts in the anterior column.Conclusions: Revision surgery involving a multirod with a posterior-only approach for a rod fracture that occurred after ASD was performed successfully. Bone grafting in the anterior column is unnecessary for patients without massive bone defects.

Change in Line of Sight after Corrective Surgery of Adult Spinal Deformity Patients: A 2-Year Follow-up

Magcalas Ken Jeffrey,Oe Shin,Yamato Yu,Hasegawa Tomohiko,Yoshida Go,Banno Tomohiro,Arima Hideyuki,Mihara Yuki,Ushirozako Hiroki,Yamada Tomohiro,Ide Koichiro,Watanabe Yuh,Matsuyama Yukihiro 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.2

Study Design: Cohort study.Purpose: There is currently no published study that focuses on the spinal corrective surgery effects with cranial parameters in adult spinal deformity (ASD) patients. It is an important factor to measure since it plays a critical role in maintaining the line of sight. The objective is to determine the change in cranial parameters using the slope of McGregor’s line (McGS) after ASD surgery after 2 years of follow-up.Overview of Literature: A study concluded that cervical spine alignment (C2–C7 lordosis) is strongly affected by thoracic kyphosis (TK). Another study showed that patients with ascending gaze had significantly more thoracolumbar malalignment.Methods: This retrospective study includes 295 corrective surgery patients with ASD. Subjects were divided into two groups after propensity age matching analysis: cranial malalignment (McGS <−8 or >13) and normal cranial alignment (−8≤ McGS ≤13). Lumbar lordosis (LL), pelvic tilt (PT), TK, cervical lordosis (CL), and sagittal vertical axis (SVA) were evaluated between the two groups.Results: SVA (95–56 mm) and PT (34°–25°) decreased and LL (19°–41°) increased 2 years after surgery (p <0.05), but McGS (−1.1° to −0.5°) and CL (21°–19°) did not change. Conversely, in the group with cranial malalignment, SVA (120–64 mm), PT (35°–26°), and LL (12°–41°) showed similar results to the normal cranial parameter group 2 years after surgery, but in contrast, McGS (−13° to −2°) and CL (24°–18°) improved significantly.Conclusions: Severe ASD adversely affects to maintain horizontal gaze but can be improved by spinal corrective surgery.

Association between Pelvic Parameters and Vaginal Delivery

Yamada Tomohiro,Yamato Yu,Hasegawa Tomohiko,Yoshida Go,Yasuda Tatsuya,Banno Tomohiro,Arima Hideyuki,Oe Shin,Mihara Yuki,Ushirozako Hiroki,Ide Koichiro,Watanabe Yuh,Hosino Hironobu,Matsuyama Yukihiro 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.2

Study Design: Cross-sectional study. Purpose: To investigate the association between vaginal delivery and pelvic parameters and clarify the effect of parity on parameter fluctuations. Overview of Literature: During vaginal delivery, the sacroiliac joint widens and the sacrum nutates (nods). However, the association between these pelvic parameters and parity is unknown. Methods: As part of a 2016 health screening, 320 female volunteers underwent whole-spine radiographs. Age-matched healthy women were grouped according to the number of vaginal deliveries (0, 1–2, or ≥3). Demographic variables and spinopelvic parameters were compared among the three groups. Results: Of the 320 volunteers, 213 were enrolled (mean age, 71.1±7.2 years). The mean number of vaginal deliveries was 2.2. The average pelvic incidence (PI) was 55.6°±11.1° and was significantly higher in the 90 women with three or more vaginal deliveries than in the other two groups (p<0.001). The average sacral slope was 33.4°±11.1° and was significantly higher in the women with three or more vaginal deliveries than in the 18 who did not deliver vaginally (p<0.001). The 105 women with one or two vaginal deliveries had significantly higher PIs and sacral slopes than did those who did not deliver vaginally (p<0.001). Conclusions: This is the first study documenting an association between vaginal delivery and pelvic parameters. Bony birth canal realignment during vaginal delivery can affect postnatal PI. Our study helps in understanding the PI changes over a woman’s life span.

How Is Degenerative Lumbar Scoliosis Associated with Spinopelvic and Lower-Extremity Alignments in the Elderly

Wang Jili,Ushirozako Hiroki,Yamato Yu,Ide Koichiro,Hasegawa Tomohiko,Yoshida Go,Banno Tomohiro,Oe Shin,Arima Hideyuki,Mihara Yuki,Watanabe Yuh,Nakai Keiichi,Kurosu Kenta,Hoshino Hironobu,Matsuyama Yuk 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.2

Study Design: A retrospective cohort study.Purpose: Our aim is to investigate the relationship between degenerative lumbar scoliosis (DLS), and whole-body alignment, including spinopelvic and lower extremity alignments. Overview of Literature: DLS is a deformity commonly associated with aging. However, the correlation between whole-body alignment and DLS remains controversial.Methods: Adult volunteers aged over 50 years were included in the study after participating in the screening program. Characteristic data and standing radiographic parameters were assessed. A propensity score model was established with adjustments for age and sex after a preliminary analysis, and cases were divided into DLS (Cobb angle >10°) and non-DLS (Cobb angle ≤10°) groups.Results: There were significant differences in age, sex, C2 sagittal vertical axis (C2-SVA), C7-SVA, T1 pelvic angle (TPA), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), PI minus LL (PI–LL), knee angle, ankle angle, pelvic shift, C7-center sacral vertical line, L4 tilt, femur-tibia angle, and hip-knee-ankle angle (all p <0.05) using a preliminary analysis of 261 cases (75 DLS and 186 non-DLS). A one-to-one propensity score-matched analysis was used after 70 pairs of cases were selected. There were no significant differences in the characteristic data for lower extremity parameters. There were still significantly higher values of C2-SVA, TPA, PI, PT, and PI–LL in DLS group than in non-DLS group (all p <0.05).Conclusions: This study showed an important relationship between DLS and sagittal spinal deformity. However, DLS was not associated with the sagittal and coronal lower extremity alignments.

Spinal Sagittal Alignment, Hospital Anxiety and Depression Scale Scores, and Patient-Reported Outcome among People with Sporting Activity

Oe Shin,Yamato Yu,Hasegawa Tomohiko,Yoshida Go,Kobayashi Sho,Yasuda Tatsuya,Banno Tomohiro,Arima Hideyuki,Mihara Yuki,Ushirozako Hiroki,Yamada Tomohiro,Ide Koichiro,Watanabe Yuh,Haruo Niwa,Matsuyama Y 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.3

Study Design: Retrospective cohort study.Purpose: This study aimed to investigate how participation in sporting activity affects patient-reported outcome (PRO), including Neck Disability Index (NDI), in males and females.Overview of Literature: Previously, our study reported that factors with a negative influence on the NDI in females were a lack of sporting activities. However, it was still unclear why it affected poor scores of NDI.Methods: The subjects were 473 volunteers. They were divided into two groups (activity and non-activity) according to participation or non-participation in sporting activities using a self-filled questionnaire. The evaluation items were height, weight, grip strength, bone density, Hospital Anxiety and Depression Scale (HADS) score, standing radiographic parameters, PRO (evaluated by EuroQol-5 dimension [EQ-5D], Oswestry Disability Index [ODI]), and NDI.Results: There were 101 males in the non-activity group and 69 in the activity group and 178 females in the non-activity group and 125 in the activity group. For the males, the evaluation items with significant influence were cervical lordosis (non-activity group:activity group, 17°:22°) and T1 slope minus cervical lordosis (10°:6°, <i>p</i> <0.05). For the females, the evaluation items with significant influence were sagittal vertical axis (28:14 mm), HADS (10.4:8.4), EQ-5D (0.79:0.86), ODI (17:12), and NDI (12:9, <i>p</i> <0.01). HADS and PRO in the females were significantly correlated with the EQ-5D (−0.40), ODI (0.43), and NDI (0.55).Conclusions: Males who participated in sporting activities had better cervical spine alignment but no effect on PRO. Females with sporting activities had better spinal global alignment and less mental stress. It is suggested that sporting activity in females might be associated with PRO because HADS highly correlates with PRO.