Changes in Sagittal Alignment Following Short-Level Lumbar Interbody Fusion: Comparison between Posterior and Lateral Lumbar Interbody Fusions

Hiroaki Nakashima,Tokumi Kanemura,Kotaro Satake,Yoshimoto Ishikawa,Jun Ouchida,Naoki Segi,Hidetoshi Yamaguchi,Shiro Imagama 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.6

Study Design: Retrospective case-control study. Purpose: We aimed to compare radiologic outcomes between posterior (PLIF) and lateral lumbar interbody fusion (LLIF) in short-level spinal fusion surgeries. Overview of Literature: Although LLIF enables surgeons to insert large lordotic cages, it is unknown whether LLIF more effectively corrects local and global sagittal alignments compared with PLIF in short-level spinal fusion surgeries. Methods: Radiographic data acquired from patients with lumbar interbody fusion (≤3 levels) using PLIF or LLIF for degenerative lumbar diseases were analyzed. The following radiographic parameters were evaluated preoperatively and at 2 years postoperatively: segmental lordotic angle, disk height, lumbar lordosis (LL), pelvic tilt (PT), C7 sagittal vertical axis, and thoracic kyphosis (TK). Results: In total, 144 patients with PLIF (193 fused levels) and 101 with LLIF (159 fused levels) were included. Patients’ backgrounds and preoperative radiographic parameters for any level of fusion did not differ significantly between PLIF and LLIF procedures. The LLIF group exhibited significantly greater changes at 1-level fusion compared to the PLIF group in the parameters of segmental lordotic angle (5.1°±5.8° vs. 2.1°±5.0°, p<0.001), disk height (4.2±2.3 mm vs. 2.2±2.0 mm, p<0.001), LL (7.8°±7.6° vs. 3.9°±8.6°, p=0.004), and PI–LL (−6.9°±6.8° vs. −3.6°±10.1°, p=0.03). While, a similar trend was observed regarding 2-level fusion, significantly greater changes were only observed in LL (12.1°±11.1° vs. 4.2°±9.1°, p=0.047) and PI–LL (−11.2°±11.3° vs. −3.0°±9.3°, p=0.043), PT (−6.4°±4.9° vs. −2.5°±5.3°, p=0.049) and TK (7.8°±11.8° vs. −0.3°±9.7°, p=0.047) in the LLIF group at 3-level fusion. Conclusions: LLIF provides significantly better local sagittal alignment than PLIF in 1- or 2-level fusion cases and improves spinopelvic alignment and local alignment for 3-level fusion cases. Thus, LLIF was demonstrated to be a useful lumbar interbody fusion technique, constituting a powerful tool for achieving sagittal realignment with minimal surgical invasiveness.

Factors Affecting Postoperative Sagittal Alignment after Lateral Lumbar Interbody Fusion in Adult Spinal Deformity: Posterior Osteotomy, Anterior Longitudinal Ligament Rupture, and Endplate Injury

Hiroaki Nakashima,Tokumi Kanemura,Kotaro Satake,Yoshimoto Ishikawa,Jun Ouchida,Naoki Segi,Hidetoshi Yamaguchi,Shiro Imagama 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.5

Study Design: Prospective cohort study. Purpose: To identify factors that affect sagittal alignment correction in lateral lumbar interbody fusion (LIF) surgery for adult spinal deformity (ASD) and to investigate the degree of correction in each condition. Overview of Literature: LIF is a useful procedure for ASD, but the degree of correction can be affected by posterior osteotomy, intraoperative endplate injury, or anterior longitudinal ligament (ALL) rupture. Methods: Radiographical data for 30 patients who underwent LIF for ASD were examined prospectively. All underwent two-stage surgery (LIF followed by posterior fixation). Radiographical parameters were measured preoperatively, after LIF, and after posterior fixation; these included the segmental lordotic angle, lumbar lordosis (LL), and other sagittal alignment factors. Results: LL was corrected from 16.5°±16.7° preoperatively to 33.4°±13.8° after LIF (p<0.001) and then to 52.1°±7.9° following posterior fixation (p<0.001). At levels where Schwab grade 2 osteotomy was performed, the acquired segmental lordotic angles from the preoperative value to after posterior fixation and from after LIF to after posterior fixation were 19.5°±9.2° and 9.9°±3.9°, respectively. On average, 12.4° more was added than in cases without osteotomy. Endplate injury was identified at 21 levels (19.4%) after LIF, with a mean loss of 3.4° in the acquired segmental lordotic angle (5.3°±8.4° and 1.9°±5.9° without and with endplate injury, respectively). ALL rupture was identified at seven levels (6.5%), and on average 19.3° more was added in these cases between the preoperative and postoperative values than in cases without ALL rupture. Conclusions: LIF provides adequate sagittal alignment restoration for ASD, but the degree of correction is affected by grade 2 osteotomy, intraoperative endplate injury, and ALL rupture.

Unplanned Second-Stage Decompression for Neurological Deterioration Caused by Central Canal Stenosis after Indirect Lumbar Decompression Surgery

Hiroaki Nakashima,Tokumi Kanemura,Kotaro Satake,Yoshimoto Ishikawa,Jun Ouchida,Naoki Segi,Hidetoshi Yamaguchi,Shiro Imagama 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.4

Study Design: Prospective cohort study. Purpose: This study aimed to identify risk factors for unplanned second-stage decompression for postoperative neurological deficit after indirect decompression using lateral lumbar interbody fusion (LLIF) with posterior fixation. Overview of Literature: Indirect lumbar decompression with LLIF has been used as a minimally invasive alternative to direct decompression to treat degenerative lumbar diseases requiring neural decompression. However, evidence on the prevalence of neurological deficits caused by spinal canal stenosis after indirect decompression is limited. Methods: This study included 158 patients (mean age, 71.13±7.98 years; male/female ratio, 67/91) who underwent indirect decompression with LLIF and posterior fixation. Indirect decompression was performed at 271 levels (mean level, 1.71±0.97). Logistic regression analysis was used to identify the risk factors for postoperative neurological deficits. The variables included were age, sex, body mass index, presence of primary diseases, diabetes mellitus, preoperative motor deficit, levels operated on, preoperative severity of lumbar stenosis, and preoperative Japanese Orthopedic Association (JOA) score. Results: Postoperative neurological deficit due to spinal canal stenosis occurred in three patients (1.9%). Spinal stenosis due to hemodialysis (p<0.001), ligament ossification (p<0.001), presence of preoperative motor paralysis (p<0.001), low JOA score (p=0.004), and severe canal stenosis (p=0.02) were significantly more frequent in the paralysis group. Conclusions: Severe preoperative canal stenosis and neurological deficit were identified as risk factors for postoperative neurological deterioration caused by spinal canal stenosis. Additionally, uncommon diseases, such as spinal stenosis due to hemodialysis and ligament ossification, increased the risk of postoperative neurological deficit; therefore, in such cases, indirect decompression is contraindicated.

Comparative Radiographic Outcomes of Lateral and Posterior Lumbar Interbody Fusion in the Treatment of Degenerative Lumbar Kyphosis

Hiroaki Nakashima,Tokumi Kanemura,Kotaro Satake,Yoshimoto Ishikawa,Jun Ouchida,Naoki Segi,Hidetoshi Yamaguchi,Shiro Imagama 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.3

Study Design: Retrospective case–control study. Purpose: To compare surgical invasiveness and radiological outcomes between posterior lumbar interbody fusion (PLIF) and lateral lumbar interbody fusion (LLIF) for degenerative lumbar kyphosis. Overview of Literature: LLIF is a minimally invasive interbody fusion technique; however, few reports compared the clinical outcomes of conventional PLIF and LLIF for degenerative lumbar kyphosis. Methods: Radiographic data for patients who have undergone lumbar interbody fusion (≥3 levels) using PLIF or LLIF for degenerative lumbar kyphosis (lumbar lordosis [LL] <20°) were retrospectively examined. The following radiographic parameters were retrospectively evaluated preoperatively and 2 years postoperatively: segmental lordotic angle, LL, pelvic tilt (PT), pelvic incidence (PI), C7 sagittal vertical axis, and T1 pelvic angle. Results: Nineteen consecutive cases with PLIF and 27 cases with LLIF were included. There were no significant differences in patients’ backgrounds or preoperative radiographic parameters between the PLIF and the LLIF groups. The mean fusion level was 5.5±2.5 levels and 5.8±2.5 levels in the PLIF and LLIF groups, respectively (p=0.69). Although there was no significant difference in surgical times (p=0.58), the estimated blood loss was significantly greater in the PLIF group (p<0.001). Two years postoperatively, comparing the PLIF and LLIF groups, the segmental lordotic angle achieved (7.4°±7.6° and 10.6°±9.4°, respectively; p=0.03), LL (27.8°±13.9° and 39.2°±12.7°, respectively; p=0.006), PI–LL (19.8°±14.8° and 3.1°±17.5°, respectively; p=0.002), and PT (22.6°±7.1° and 14.2°±13.9°, respectively; p=0.02) were significantly better in the LLIF group. Conclusions: LLIF provided significantly better sagittal alignment restoration in the context of degenerative lumbar kyphosis, with less blood loss.

The Prevalence and Risk Factors for S2 Alar-Iliac Screw Loosening with a Minimum 2-Year Follow-up

Hiroaki Nakashima,Tokumi Kanemura,Kotaro Satake,Kenyu Ito,Yoshimoto Ishikawa,Jun Ouchida,Naoki Segi,Hidetoshi Yamaguchi,Shiro Imagama 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.2

Study Design: A retrospective cohort study. Purpose: The purpose of this study was to investigate the prevalence and risk factors for S2 alar-iliac (SAI) screw loosening following lumbosacral fixation, with a minimum 2-year follow-up. Overview of Literature: Although SAI screws allow surgeons to perform lumbosacral fixation with a low profile and enhanced biomechanical strength, screw loosening following surgery can occur in some cases. However, few studies have investigated the prevalence and risk factors for SAI screw loosening. Methods: This retrospective study included 35 patients (mean age, 72.8±8.0 years; male, 10; female, 25) who underwent lumbosacral fixation using SAI screws with at least 2 years of follow-up. SAI screw loosening and L5–S bony fusion were assessed using computed tomography. The period for which the screws appeared loose and the risk factors for SAI screw loosening were investigated 2 years after surgery. Results: A total of 70 SAI screws and 70 S1 pedicle screws were inserted. Loosening was observed 0.5, 1, and 2 years after surgery in 17 (24.3%), 35 (50.0%), and 35 (50.0%) SAI screws, respectively. Bony fusion rate at L5–S was significantly lower in patients with SAI screw loosening than in those without screw loosening (65.0% vs. 93.3%, p=0.048). The score for SAI screw contact with the iliac cortical bone and the bony fusion rate at L5–S were significantly lower in the loosening group than in the non-loosening group (1.8±0.5 vs. 2.2±0.3, p<0.001, respectively). Postoperative pelvic incidence–lumbar lordosis was significantly higher in the loosening group than in the non-loosening group (7.9°±15.4° vs. 0.5°±8.7°, p=0.02, respectively). Conclusions: SAI screw loosening is closely correlated with pseudoarthrosis at L5–S. Appropriate screw insertion and optimal lumbar lordosis restoration are important to prevent postoperative complications related to SAI screws.

Indirect Decompression Using Lateral Lumbar Interbody Fusion for Restenosis after an Initial Decompression Surgery

Nakashima Hiroaki,Kanemura Tokumi,Satake Kotaro,Ito Kenyu,Ishikawa Yoshimoto,Ouchida Jun,Segi Naoki,Yamaguchi Hidetoshi,Imagama Shiro 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.3

Study Design: Retrospective comparative study.Purpose: We compared clinical and radiographical outcomes after lumbar decompression revision surgery for restenosis by lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF).Overview of Literature: Indirect lumbar decompression with LLIF was used to treat degenerative lumbar diseases requiring neural decompression. However, only a few studies have focused on the effectiveness of this technique for restenosis after lumbar decompression.Methods: We retrospectively investigated 52 cases involving lumbar interbody fusions for restenosis with spondylolisthesis after lumbar decompressions; these cases consisted of 15 patients who underwent indirect decompression with LLIF and posterior fixation and 37 patients who underwent the same procedure with PLIF. We compared Japanese Orthopaedic Association (JOA) scores and perioperative complications between groups. The cross-sectional areas of the thecal sac on magnetic resonance imaging were measured before, immediately after, and 2 years after surgery. We conducted statistical analyses using unpaired t -test and Fisher’s exact tests, and a <i>p</i> -value <0.05 was considered statistically significant.Results: The operative time was significantly shorter in the LLIF group than in the PLIF group (115.3±33.6 min vs. 186.2±34.2 min, respectively; <i>p</i> <0.001). In addition, the intraoperative blood loss was significantly lower in the LLIF group than in the PLIF group (58.2±32.7 mL vs. 303.2±140.1 mL, respectively; <i>p</i> <0.001). We found two cases of transient lateral thigh weakness (13.3%) in the LLIF group and five cases of incidental durotomy, one case of deep infection, and one case of neurological deterioration in the PLIF group—resulting in a higher complication incidence (18.9%), although it did not reach (<i>p</i> =0.63). The JOA scores improved significantly in both groups.Conclusions: Indirect decompression using LLIF provided acceptable clinical and radiographical outcomes in patients with restenosis with spondylolisthesis after lumbar decompression; no revision-surgery-specific complications were found. Our results suggest that LLIF is a safe and minimally invasive procedure for revision surgery.

Characteristic for Growth and Fruit Body Polysaccharide of Caterpillar Fungi, Cordyceps sobolifera(Hill.) Berk. et Br.

Ohga, Shoji,Yoshimoto, Hiroaki,Pokhrel, Chandra,Yang, Bai-Song,Miyazawa, Noriko,Meng, Tianxiao,Hosoda, Shun,Mae, Masuo,Sun, Zhu Institute of Agricultural Science 2008 Korean Journal of Agricultural Science Vol.35 No.2

Mycelial expansion and fruit body development of caterpillar fungi, Cordyceps sobolifera(Hill.) Berk. et Br. was examined on various carbon and nitrogen sources, some substrates with various supplements. Best temperature for the mycelial expansion was $25^{\circ}C$, while optimal pH was 7. Glucose and polypeptone were the best sources of carbon and nitrogen, respectively, as well as 1:1 was the best ratio of carbon and nitrogen. The unpolish rice and bean curd lees were used as core substrates combined individually with five various supplements. In substrates based, all the supplements with all combinations were found to exhibit the mycelial growth and fruit body formation. Likewise, yolk was found as a superior supplement and also clarified quite high polysaccharide content in the fruit body.

Dynamic Channel Assignment with a Channel Framework for Mobile Stations Running on Expressways in a Two-dimensional Service Area

Kazunori Okada,Hiroaki Takahashi,Shigetoshi Yoshimoto,Shoji Shinoda 대한전자공학회 1996 대한전자공학회 워크샵 Vol.1996 No.-

Characteristic for Growth and Fruit Body Polysaccharide of Caterpillar Fungi, Cordyceps sobolifera(Hill.) Berk. et Br.

Shoji Ohga,Hiroaki Yoshimoto,Chandra Pokhrel,Yang, Baisong,Noriko Miyazawa,Tianxiao Meng,Shun Hosoda,Masuo Mae,Zhu Sun 충남대학교 농업과학연구소 2008 농업과학연구 Vol.35 No.2

Mycelial expansion and fruit body development of caterpillar fungi, Cordyceps sobolifera(Hill.) Berk. et Br. was examined on various carbon and nitrogen sources, some substrates with various supplements. Best temperature for the mycelial expansion was 25℃, while optimal pH was 7. Glucose and polypeptone were the best sources of carbon and nitrogen, respectively, as well as 1:1 was the best ratio of carbon and nitrogen. The unpolish rice and bean curd lees were used as core substrates combined individually with five various supplements. In substrates based, all the supplements with all combinations were found to exhibit the mycelial growth and fruit body formation. Likewise, yolk was found as a superior supplement and also clarified quite high polysaccharide content in the fruit body.

Ingestion of mushroom chitosan ameliorates genetic lipidosis

Fumio Eguchi,Akiko Kakinuma,Hiroaki Yoshimoto 한국버섯학회 2010 한국버섯학회지 Vol.8 No.4

[Introduction] Mushroom constituents have been found to be highly effective in the prevention and treatment of lifestyle diseases such as lipidosis, high blood pressure, and diabetes, which are closely linked to eating habits, and several varieties of functional foods have been developed from these constituents. As a result, doctors of Western medicine in particular, who in the past have been dismissive of herbal or Oriental medicine, are now tending to take a more proactive stance toward adopting the better aspects of alternative, complementary or traditional medicine. Natural remedies and folk medicines have been incorporated into the treatment of cancer, for example, and in the same way it has become common to incorporate mushrooms into treatment regimes before and after surgical interventions and alongside therapies such as chemotherapy, radiation therapy, and hormone therapy. Mushroom chitosan, which is investigated in this study, is a novel functional ingredient made from the mushroom Flammulina velutipes (Curt.:Fr.) Sing., which is the most common edible mushroom to be artificially cultivated in Japan and has long been part of the Japanese diet. Unlike chitosans of crustacean origin, mushroom chitosan is rich in the main structural component β-glucan, and this dietary fiber is expected to have positive functions within the body. In particular, there are hopes that mushroom chitosan will inhibit cholesterol and fat absorption in the small intestine, and suppress total cholesterol and neutral fat levels in the serum. Previous human trials have confirmed the anti-metabolic syndrome efficacy of supplements containing mushroom chitosan. Here we report the ameliorative effects of mushroom chitosan in an animal model of genetic obesity and lipidosis. [Methods] Mushroom chitosan (RSK2, Ricom Corporation) was administered at different doses to Crj:(ZUC)-fa/fa rats an animal model of obesity and hyperlipidemia continuously for 10 weeks. The rats were kept at a temperature of 22±1ºC and humidity of 60±10%, and illuminated with fluorescent lamps for 12 h/day (07:00~19:00). Body weight, food consumption, body condition, and hematological and blood biochemical blood parameters were measured, and pathological examination (pathological analysis of hepatic lipid droplets) was performed using HE staining. [Results and discussion] Mushroom chitosan (RSK2) showed high efficacy in suppressing weight gain in Crj:(ZUC)-fa/fa rats presenting obesity due to genetic lipidosis. The smallest effective dose was 3 mg/kg. In addition, values for neutral fat, β-lipoproteins and total lipid due to ingestion improved to the normal values. Moreover, the pathological study of the liver revealed a decrease in lipid droplets appearing in the central zone of the hepatic lobule and a decrease in fat deposition in the liver in the group that ingested mushroom chitosan. The results also suggested that serum lipid levels were improved through egestion of excess fat with the feces. Mushroom chitosan (RSK2) was shown to be effective in controlling increase in serum lipids as it has lipase-inhibiting activity, and was shown to control fat deposition in internal organs through egestion of excess blood lipids with the feces. Mushroom chitosan is thus a functional food that is effective in preventing and treating contemporary lifestyle diseases.