2Department of Orthopaedic Surgery, Myungeun Hospital, Busan, Korea

Takato Aihara,Tomoaki Toyone,Yasuaki Murata,Kazuhide Inage,Makoto Urushibara,Juntaro Ouchi 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.1

Study Design: Retrospective review of prospectively collected outcome data. Purpose: To compare 5-year outcomes following decompression with fusion (FU) and microendoscopic decompression (MED) in patients with degenerative lumbar spondylolisthesis (DLS) and to define surgical indication limitations regarding the use of MED for this condition. Overview of Literature: There have been no comparative studies on mid- or long-term outcomes following FU and MED for patients with DLS. Methods: Forty-one consecutive patients with DLS were surgically treated. Sixteen patients first underwent FU (FU group), and 25 then underwent MED (MED group). The 5-year clinical outcomes following the two surgical methods were compared using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. Results: The degree of improvement (DOI) for social life function was significantly greater in the MED group than in the FU group. Although not statistically significant, DOIs for the other four functional scores were also greater in the MED group than in the FU group. However, patients with a large percentage of slippage in the neutral position might experience limited improvement in low back pain, those with a large percentage of slippage at maximal extension might experience limited improvement in three functional scores, and those with a small intervertebral angle at maximal flexion might have limited improvement in three functional scores after MED for DLS. Therefore, we statistically compared the DOIs between the FU and MED groups regarding the preoperative percentage of slippage in the neutral position among patients with greater than 20% slippage, the preoperative percentage of slippage at maximal extension among patients with greater than 15% slippage, and the intervertebral angle at flexion among patients with angles lesser than −5°; however, there were no statistically significant differences between the two groups. Conclusions: MED is a useful minimally invasive surgical procedure that possibly offers better clinical outcomes than FU for DLS.

Modified Open-Door Laminoplasty Using a Ceramic Spacer and Suture Fixation for Cervical Myelopathy

Tomoyuki Ozawa,Tomoaki Toyone,Ryutaro Shiboi,Kunimasa Inada,Yasuhiro Oikawa,Kazuhisa Takahashi,Seiji Ohtori,Gen Inoue,Masayuki Miyagi,Tetsuhiro Ishikawa,Toshiyuki Shirahata,Yoshifumi Kudo,Katsunori In 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.6

Purpose: To introduce a new simple technique using suture anchors and ceramic spacers to stabilize the elevated laminae in open-door cervical laminoplasty. Although ceramic spacers were placed in the opened laminae and fixed with nylon threads in this series, it was occasionally difficult to fix the nylon threads to the lateral mass. Materials and Methods: Study 1: A preliminary study was conducted using a suture anchor system. Sixteen consecutive patients who underwent surgery for cervical myelopathy were prospectively examined. Study 2: The second study was performed prospectivelyto evaluate the feasibility of this new technique based on the result of the preliminary study. Clinical outcomes were examined in 45 consecutive patients [cervical spondylotic myelopathy (CSM)] and 43 consecutive patients (OPLL). The Japanese Orthopedic Association scoring system (JOA score), axial neck pain, and radiological findings were analyzed. Results: 1) In one case, re-operation was necessary due to dislodgement of the ceramic spacer following rupture of the thread. 2) In all patients, postoperative CT scans showed that the anchors were securely inserted into the bone. In the CSM group, the average JOA score improved from 9.5 points preoperatively to 13.3 at follow-up (recovery 51%). In the OPLL group, the average JOA score improvedfrom 10.1 (5–14) points preoperatively to 14.4 (11–16) at follow-up (recovery 62%). There were no serious complications. Conclusion: The use of the suture anchor system made it unnecessary to create a hole in the lateral mass and enabled reliable and faster fixation of the HA spacers in open-door laminoplasty.

Efficacy of the Thoracolumbar Interfascial Plane Block for Lumbar Laminoplasty: A Retrospective Study

Hironobu Ueshima,Tomoyuki Ozawa,Tomoaki Toyone,Hiroshi Otake 대한척추외과학회 2017 Asian Spine Journal Vol.11 No.5

Study Design: This paper was a single center-based retrospective study with prospective data collection. Purpose: Compared with other surgeries, limited options are available for perioperative pain management in spinal surgery. Therefore, we aimed to identify new pain management in this study. Overview of Literature: The thoracolumbar interfascial plane (TLIP) block has been reported to provide effective regional analgesia in the lumbar region. This study investigated the efficacy of the TLIP block for pain management in lumbar laminoplasty. Methods: We investigated patients who underwent lumbar laminoplasty for the treatment of lumbar spinal canal stenosis from April to October 2015. Patients with secondary surgery or surgery involving more than four intervertebral spaces were excluded. The primary outcome measure was the pain scale score within 48 hours after the surgery. The secondary outcomes were the number of additional analgesic drugs used and the number of patients complaining of complications, such as nausea and vomiting, within 24 hours after the surgery. Results: We retrospectively assessed the data of 44 patients who underwent lumbar laminoplasty. Of these, 25 patients received only general anesthesia (G group), whereas 19 patients received the TLIP block along with general anesthesia (T group). Compared with the G group, the T group reported lower pain scores for pain at 1, 2, 4, and 24 hours postoperatively. Moreover, the number of patients who received the additional analgesic pentazocine was lower in the T group than in the G group. The two groups showed no significant differences in the incidence of complications. Conclusions: The TLIP block provides effective analgesia for 24 hours postoperatively in patients undergoing lumbar laminoplasty.

Efficacy of the Erector Spinae Plane Block for Lumbar Spinal Surgery: A Retrospective Study

Hironobu Ueshima,Mayumi Inagaki,Tomoaki Toyone,Hiroshi Otake 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.2

Study Design: A retrospective study. Purpose: The first research on the erector spinae plane (ESP) block was published in 2016. To our knowledge, no cohort studies or randomized controlled trials of the ESP block were performed in 2016 and 2017. Overview of the Literature: This study retrospectively investigated the efficacy of the ESP block in pain management after lumbar spinal surgery. Methods: Patients who underwent lumbar spinal surgery in 2017 were enrolled in the study. Those who underwent secondary surgery with local anesthesia other than the ESP block were excluded. The primary outcome was the Numerical Rating Scale (NRS) pain score at various time points until the morning of postoperative day 2. The secondary outcomes were the amount of intravenous fentanyl administered during the first 24 hours following the surgery and the number of patients with complaints of complications such as nausea and vomiting until the morning of postoperative day 2. Results: The data of 41 patients undergoing lumbar spinal surgery were retrospectively analyzed. Of these, 23 received only general anesthesia (G group), whereas the other 18 patients received the ESP block in addition to general anesthesia (E group). The NRS pain scores and the amount of fentanyl administered were lower in the G group than in the E group at all measured time points (all data were less than p<0.05). There was no significant difference in the incidence of complications between the two groups (p=0.11). Conclusions: The ESP block provides effective postoperative analgesic effect for 24 hours in patients undergoing lumbar spinal surgery.