Analysis of Rod Fracture at the Lumbosacral Junction Following Surgery for Adult Spinal Deformity

Sakuma Tsuyoshi,Kotani Toshiaki,Iijima Yasushi,Akazawa Tsutomu,Ohtori Seiji,Minami Shohei 대한척추외과학회 2024 Asian Spine Journal Vol.18 No.1

Study Design: Retrospective study.Purpose: This study aimed to investigate the differences in the characteristics of patients with rod fracture (RF) at the lumbosacral junction from those without RF following adult spinal deformity (ASD) surgery.Overview of Literature: RF is a major complication following ASD surgery and may require reoperation because of pain and correction loss. The lumbosacral junction is a common RF site. However, risk factors for RFs at the lumbosacral junction remain unknown.Methods: The study included data from 100 patients who underwent ASD surgery between 2012 and 2020. Fifteen of these patients presented with RFs. Patient demographics, clinical outcomes, and radiographic parameters were evaluated in each group.Results: RFs were significantly more frequent in patients with a medical history of total hip arthroplasty (THA; <i>p</i>=0.01) or severe obesity (<i>p</i>=0.04). However, no significant differences in clinical outcomes, preoperative or postoperative measurements, or changes were found between pre- and postoperative radiographic parameters within the groups. Both pre- (<i>p</i>=0.01) and postoperative (<i>p</i>=0.02) anterior disc heights were significantly greater in the RF group than in the non-RF group. In the RF group, the postoperative lordotic angles of the lumbosacral junction significantly decreased compared with preoperative angles (<i>p</i>=0.02). Multiple logistic regression analysis demonstrated that a THA history (odds ratio, 34.2), severe obesity (odds ratio, 14.0), and preoperative anterior disc height (odds ratio, 1.2) were significant risk factors for RFs.Conclusions: In this study, the greatest risk factors for postoperative lumbosacral RF after ASD surgery were THA history, severe obesity, and postoperative anterior disc height of ≥10. For patients at higher risk, the use of multirods is considered necessary.

INTERSPECIES VARIATION OF CYTOCHROME P-45Q - ESTAULlSHMENT OF CELL LINES CARRYING HUMAN ENZYMES AND APPLICATION TO TOXICOLOGY TESTING

(Tetsuya Kamataki),(Tsuyoshi Yokoi),(Minoru Sawada),(Tsutomu Sakuma) 한국응용약물학회 1994 학술대회 Vol.1994 No.1

Risk Factors for Loosening of S2 Alar Iliac Screw: Surgical Outcomes of Adult Spinal Deformity

Iijima Yasushi,Kotani Toshiaki,Sakuma Tsuyoshi,Nakayama Keita,Akazawa Tsutomu,Kishida Shunji,Muramatsu Yuta,Sasaki Yu,Ueno Keisuke,Asada Tomoyuki,Sato Kosuke,Minami Shohei,Ohtori Seiji 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.6

Study Design: Retrospective study.Purpose: To determine the risk factors for S2 alar iliac (S2AI) screw loosening and its association with lumbosacral fusion in patients with adult spinal deformity (ASD).Overview of Literature: S2AI screws have been widely used for ASD surgery in recent years. However, no studies have analyzed the risk factors for loosening of S2AI screws and its association with lumbosacral fusion.Methods: Cases of 50 patients with ASD who underwent long spinal fusion (>9 levels) with S2AI screws were retrospectively reviewed. Loosening of S2AI screws and S1 pedicle screws and bone fusion at the level of L5–S1 at 2 years after surgery were investigated using computed tomography. In addition, risk factors for loosening of S2AI screws were determined in patients with ASD. Results: At 2 years after surgery, 33 cases (66%) of S2AI screw loosening and six cases (12%) of S1 pedicle screw loosening were observed. In 40 of 47 cases (85%), bone fusion at L5–S1 was found. Pseudarthrosis at L5–S1 was not significantly associated with S2AI screw loosening (19.3% vs. 6.3%, <i>p</i>=0.23), but significantly higher in patients with S1 screw loosening (83.3% vs. 4.9%, <i>p</i><0.001). On multivariate logistic regression analyses, high upper instrumented vertebra (UIV) level (T5 or above) (odds ratio [OR], 4.4; 95% confidence interval [CI], 1.0–18.6; <i>p</i>=0.045) and obesity (OR, 11.4; 95% CI, 1.2–107.2; <i>p</i>=0.033) were independent risk factors for S2AI screw loosening.Conclusions: High UIV level (T5 or above) and obesity were independent risk factors for S2AI screw loosening in patients with lumbosacral fixation in surgery for ASD. The incidence of lumbosacral fusion is associated with S1 screw loosening, but not S2AI screw loosening.

Effects of Incentive Spirometry on Respiratory Motion in Healthy Subjects Using Cine Breathing Magnetic Resonance Imaging

Toshiaki Kotani,Tsutomu Akazawa,Tsuyoshi Sakuma,Shigeyuki Nagaya,Masaru Sonoda,Yuji Tanaka,Takehide Katogi,Tetsuharu Nemoto,Shohei Minami 대한재활의학회 2015 Annals of Rehabilitation Medicine Vol.39 No.3

Objective To investigate the effectiveness of incentive spirometry on respiratory motion in healthy subjects using cine breathing magnetic resonance imaging (MRI).Methods Ten non-smoking healthy subjects without any history of respiratory disease were studied. Subjects were asked to perform pulmonary training using incentive spirometry every day for two weeks. To assess the effectiveness of this training, pulmonary function tests and cine breathing MRI were performed before starting pulmonary training and two weeks after its completion.Results After training, there were significant improvements in vital capacity (VC) from 3.58±0.8 L to 3.74±0.8 L and in %VC from 107.4±10.8 to 112.1±8.2. Significant changes were observed in the right diaphragm motion, right chest wall motion, and left chest wall motion, which were increased from 55.7±9.6 mm to 63.4±10.2 mm, from 15.6±6.1 mm to 23.4±10.4 mm, and from 16.3±7.6 mm to 22.0±9.8 mm, respectively.Conclusion Two weeks of training using incentive spirometry provided improvements in pulmonary function and respiratory motion, which suggested that incentive spirometry may be a useful preoperative modality for improving pulmonary function during the perioperative period.

Accuracy of Pedicle Screw Placement in Scoliosis Surgery: A Comparison between Conventional Computed Tomography-Based and O-Arm-Based Navigation Techniques

Toshiaki Kotani,Tsutomu Akazawa,Tsuyoshi Sakuma,Kayo Koyama,Tetsuharu Nemoto,Kento Nawata,Atsuro Yamazaki,Shohei Minami 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.3

Study Design: Retrospective study. Purpose: We compared the accuracy of O-arm-based navigation with computed tomography (CT)-based navigation in scoliotic surgery. Overview of Literature: No previous reports comparing the results of O-arm-based navigation with conventional CT-based navigation in scoliotic surgery have been published. Methods: A total of 222 pedicle screws were implanted in 29 patients using CT-based navigation (group C) and 416 screws were implanted in 32 patients using O-arm-based navigation (group O). Postoperative CT was performed to assess the screw accuracy, using the established Neo classification (grade 0: no perforation, grade 1: perforation <2 mm, grade 2: perforation ≥2 and <4, and grade 3: perforation ≥4 mm). Results: In group C, 188 (84.7%) of the 222 pedicle screw placements were categorized as grade 0, 23 (10.4%) were grade 1, 11 (5.0%) were grade 2, and 0 were grade 3. In group O, 351 (84.4%) of the 416 pedicle screw placements were categorized as grade 0, 52 (12.5%) were grade 1, 13 (3.1%) were grade 2, and 0 were grade 3. Statistical analysis showed no significant difference in the prevalence of grade 2–3 perforations between groups C and O. The time to position one screw, including registration, was 10.9±3.2 minutes in group C, but was significantly decreased to 5.4±1.1 minutes in group O. Conclusions: O-arm-based navigation facilitates pedicle screw insertion as accurately as conventional CT-based navigation. The use of O-arm-based navigation successfully reduced the time, demonstrating advantages in the safety and accuracy of pedicle screw placement for scoliotic surgery.

Bone Mineral Density and Physical Performance of Female Patients 27 Years or Longer after Surgery for Adolescent Idiopathic Scoliosis

Tsutomu Akazawa,Toshiaki Kotani,Tsuyoshi Sakuma,Takehide Katogi,Shohei Minami,Hisateru Niki,Yoshiaki Torii,Shigeta Morioka,Sumihisa Orita,Kazuhide Inage,Kazuki Fujimoto,Yasuhiro Shiga,Kazuhisa Takahas 대한척추외과학회 2017 Asian Spine Journal Vol.11 No.5

Study Design: Retrospective cohort study. Purpose: To assess bone mineral density (BMD) and bone metabolism ≥27 years after surgery in female patients who underwent spinal fusion for adolescent idiopathic scoliosis (AIS) during adolescence and to determine their associations with physical performance. Overview of Literature: There are no studies investigating postsurgical BMD in middle-aged AIS patients. Methods: This study included 23 patients who provided informed consent among 229 female patients with AIS who underwent spinal fusion from 1968 until 1988. Average age at the time of observation was 48.8 years. BMD was measured at the left femoral neck, and the levels of two bone metabolism markers– procollagen type 1 N-terminal propeptide (P1NP) and tartrate-resistant acid phosphatase 5b (TRACP-5b)–were measured from blood samples. Physical performance was measured using grip strength, sit-ups, sit-andreach, side step, and standing long jump. Results: Mean BMD was 0.784 g/cm2. According to the World Health Organization diagnostic criteria, one subject (4.3%) had osteoporosis, whereas nine subjects (39.1%) had osteopenia. In patients with osteoporosis or osteopenia, P1NP and TRACP-5b levels were high, and BMD loss was because of high metabolic turnover. All calculated standard scores for physical performance were lower in the study cohort than in healthy individuals. There was a positive correlation between BMD and the standard score for grip strength, whereas there were weak positive correlations between BMD and the standard scores for side step and standing long jump. Conclusions: In female AIS patients who underwent spinal fusion in adolescence, 4.3% and 39.1% had osteoporosis and osteopenia, respectively, ≥27 years after surgery. Exercise performance of these patients was poor compared with the national standards. In these patients, increased physical activity should be encouraged to prevent BMD loss in middle age.

Hooks at the Upper Instrumented Vertebra Can Adjust Postoperative Shoulder Balance in Patients with Adolescent Idiopathic Scoliosis: 5 Years or More of Follow-up

Shingo Kuroya,Tsutomu Akazawa,Toshiaki Kotani,Tsuyoshi Sakuma,Shohei Minami,Yoshiaki Torii,Tasuku Umehara,Masahiro Iinuma,Kenichi Murakami,Sumihisa Orita,Kazuhide Inage,Yawara Eguchi,Kazuki Fujimoto,Y 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.5

Study Design: A retrospective cohort study. Purpose: This study aims to investigate postoperative shoulder imbalance (PSI) ≥5 years postoperatively in patients who underwent posterior spinal fusion using hooks at the upper instrumented vertebra (UIV) for Lenke type 1 adolescent idiopathic scoliosis (AIS). Overview of Literature: Studies have reported PSI due to excessive correction of the main thoracic curve. Methods: We examined 56 patients with AIS who underwent a posterior spinal fusion with hooks at the UIV from 2004 to 2010. Of these, we enrolled 14 patients who underwent surgery, at least, 5 years ago. X-rays and Scoliosis Research Society-22 (SRS-22) questionnaire were administered. To evaluate the shoulder balance, T1 vertebral tilt angle (T1 tilt), clavicle angle, and radiographic shoulder height (RSH) were measured. PSI was considered as the absolute value of the postoperative RSH being ≥20 mm. Based on radiographs obtained immediately postoperatively, we divided patients into two groups as follows: the balanced group (absolute value of RSH <20 mm) and imbalanced group (absolute value of RSH ≥20 mm). Results: The frequency of PSI was 28.6% immediately postoperatively, 0% 2 years postoperatively, and 7.1% at the last follow-up. In the balanced group, PSI did not occur even at 2 years postoperatively or at the last follow-up. In the imbalanced group, PSI was improved in all patients 2 years postoperatively and all patients, except one patient, at the last follow-up. No significant differences were noted in the frequency of distal adding-on at 2 years postoperatively or the last follow-up between the balanced group and the imbalanced group. We observed moderate negative correlations between the absolute value of T1 tilt and the SRS-22 pain and satisfaction at the last follow-up. Conclusions: Hooks at the UIV could adjust the shoulder balance to avoid long-term PSI in patients with AIS.

Assessment of the Initial Diagnostic Accuracy of a Fragility Fracture of the Sacrum: A Study of 56 Patients

Umeda Ryo,Iijima Yasushi,Yamakawa Nanako,Kotani Toshiaki,Sakuma Tsuyoshi,Kishida Shunji,Ueno Keisuke,Kajiwara Daisuke,Akazawa Tsutomu,Shiga Yasuhiro,Minami Shohei,Ohtori Seiji,Nakagawa Koichi 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.6

Study Design: Retrospective study.Purpose: To investigate the clinical manifestations of a fragility fracture of the sacrum (FFS) and the factors that may contribute to a misdiagnosis.Overview of Literature: The number of patients diagnosed with FFS has increased because of extended life expectancy and osteoporosis. Patients with FFS may report nonspecific symptoms, such as back, buttock, groin, and/or leg pain, leading to a misdiagnosis and a delay in definitive diagnosis.Methods: Fifty-six patients (13 males and 43 females) with an average age of 80.2±9.2 years admitted to the hospital for FFS between 2006 and 2021 were analyzed retrospectively. The following patient data were collected using medical records: pain regions, a history of trauma, initial diagnoses, and rates of fracture detection using radiography, computed tomography (CT), and magnetic resonance imaging (MRI).Results: Forty-one patients presented with low back and/or buttock pain, nine presented with groin pain, and 17 presented with thigh or leg pain. There was no history of trauma in 18 patients (32%). At the initial visit, 27 patients (48%) were diagnosed with sacral or pelvic fragility fractures. In contrast, 29 patients (52%) were initially misdiagnosed with lumbar spine disease (23 patients), hip joint diseases (three patients), and buttock bruises (three patients). Fracture detection rates for FFS were 2% using radiography, 71% using CT, and 93% using MRI. FFS was diagnosed definitively using an MRI with a coronal short tau inversion recovery (STIR) sequence.Conclusions: Some patients with FFS have leg pain with no history of trauma and are initially misdiagnosed as having lumbar spine disease, hip joint disease, or simple bruises. When these clinical symptoms are reported, we recommend considering FFS as one of the differential diagnoses and performing lumbar or pelvic MRIs, particularly coronal STIR images, to rule out FFS.