Clinical Relationship of Degenerative Changes between the Cervical and Lumbar Spine

Yuichiro Morishita,Zorica Buser,Anthony D’Oro,Keiichiro Shiba,Jeffrey C. Wang 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.2

Study Design: Retrospective, observational, case series. Purpose: To elucidate the prevalence of degenerative changes in the cervical and lumbar spine and estimate the degenerative changes in the cervical spine based on the degeneration of lumbar disc through a retrospective review of magnetic resonance (MR) images. Overview of Literature: Over 50% of middle-aged adults show evidence of spinal degeneration. However, the relationship between degenerative changes in the cervical and lumbar spine has yet to be elucidated. Methods: A retrospective review of positional MR images of 152 patients with symptoms related to cervical and lumbar spondylosis with or without a neurogenic component was conducted. The degree of intervertebral disc degeneration (IDD) was assessed on a grade of 1–5 for each segment of the cervical and lumbar spine using MR T2-weighted sagittal images. The grades across all segments were summed to produce the degenerative disc score (DDS) for the cervical and lumbar spine. The patients were divided into two groups based on the IDD grade for each lumbar segment: normal (grades 1 and 2) and degenerative (grades 3–5). Results: DDSs for the cervical and lumbar spine were positively correlated. Significant differences in cervical DDSs between the groups were observed in all lumbar segments. Although there were no significant differences in cervical DDSs among the degenerative lumbar segment, cervical DDSs at the L1–2 and L2–3 segments tended to be higher than those at the L3–4, L4–5, and L5–S degenerative segments. Conclusions: Our study shows that participants with degenerative changes in the upper lumbar segments are more likely to have a certain amount of cervical spondylosis. This information could be used to lower the incidence of a missed diagnosis of cervical spine disorders in patients presenting with lumbar spine symptomology.

Changes in urinary potassium excretion in patients with chronic kidney disease

( Yuichiro Ueda ),( Susumu Ookawara ),( Kiyonori Ito ),( Haruhisa Miyazawa ),( Yoshio Kaku ),( Taro Hoshino ),( Kaoru Tabei ),( Yoshiyuki Morishita ) 대한신장학회 2016 Kidney Research and Clinical Practice Vol.35 No.2

Background: Hyperkalemia is one of the more serious complications of chronic kidney disease (CKD), and the cause of potassium retention is a reduction in urinary potassium excretion. However, few studies have examined the extent of the decrease of urinary potassium excretion in detail with respect to decreased renal function. Methods: Nine hundred eighty-nine patients with CKD (CKD stages G1 and G2 combined: 135; G3a: 107; G3b: 170; G4: 289; and G5: 288) were evaluated retrospectively. Values for urinary potassium excretion were compared between CKD stages, and the associations between urinary potassium excretion and clinical parameters, including diabetes mellitus status and use of renineangiotensinealdosterone system inhibitors, were analyzed using a multivariable linear regression analysis. Results: Urinary potassium excretion gradually decreased with worsening of CKD (G5: 24.8 ± 0.8 mEq/d, P < 0.001 vs. earlier CKD stages). In contrast, the value of fractional excretion of potassium at CKD G5 was significantly higher than that at the other stages (30.63 ± 0.93%, P < 0.001). Multivariable linear regression analysis revealed that urinary potassium excretion was independently associated with urinary sodium excretion (standardized coefficient, 0.499), the estimated glomerular filtration rate (0.281), and serum chloride concentration (e0.086). Conclusion: This study demonstrated that urinary potassium excretion decreased with reductions in renal function. Furthermore, urinary potassium excretion was mainly affected by urinary sodium excretion and estimated glomerular filtration rate in patients with CKD, whereas the presence of diabetes mellitus and use of renineangiotensinealdosterone system inhibitors were not associated with urinary potassium excretion in this study.

Diastematomyelia: A Surgical Case with Long-Term Follow-Up

Hirofumi Bekki,Yuichiro Morishita,Osamu Kawano,Keiichiro Shiba,Yukihide Iwamoto 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.1

Few reports have described the involvement of syringomyelia associated with diastematomyelia in the etiology of neurological deficits. We reported a case with syringomyelia associated with diastematomyelia. A female patient with diastematomyelia was followed up clinically over 14 years. At the age of 8, she developed clubfoot deformity with neurological deterioration. Motor function of the right peroneus demonstrated grade 2 in manual muscle tests. Continuous intracanial bony septum and double cords with independent double dura were observed at upper thoracic spine. Magnetic resonance imaging revealed a tethering of the spinal cord and syringomyelia distal to the level of diastematomyelia. Extirpation of the osseum septum and duralplasty were performed surgically. She grew without neurological deterioration during 7 years postoperatively. A long-term followed up case with syringomyelia that was possibly secondary to the tethering of the spinal cord associated with diastematomyelia, and effective treatment with extirpation of the osseum septum and duralplasty was described.

Clinical Influence of Cervical Spinal Canal Stenosis on Neurological Outcome after Traumatic Cervical Spinal Cord Injury without Major Fracture or Dislocation

Tsuneaki Takao,Seiji Okada,Yuichiro Morishita,Takeshi Maeda,Kensuke Kubota,Ryosuke Ideta,Eiji Mori,Itaru Yugue,Osamu Kawano,Hiroaki Sakai,Takayoshi Ueta,Keiichiro Shiba 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.3

Study Design: Retrospective case series. Purpose: To clarify the influence of cervical spinal canal stenosis (CSCS) on neurological functional recovery after traumatic cervical spinal cord injury (CSCI) without major fracture or dislocation Overview of Literature: The biomechanical etiology of traumatic CSCI remains under discussion and its relationship with CSCS is one of the most controversial issues in the clinical management of traumatic CSCI. Methods: To obtain a relatively uniform background, patients non-surgically treated for an acute C3–4 level CSCI without major fracture or dislocation were selected. We analyzed 58 subjects with traumatic CSCI using T2-weighted mid-sagittal magnetic resonance imaging. The sagittal diameter of the cerebrospinal fluid (CSF) column, degree of canal stenosis, and neurologic outcomes in motor function, including improvement rate, were assessed. Results: There were no significant relationships between sagittal diameter of the CSF column at the C3–4 segment and their American Spinal Injury Association motor scores at both admission and discharge. Moreover, no significant relationships were observed between the sagittal diameter of the CSF column at the C3-4 segment and their neurological recovery during the following period. Conclusions: No relationships between pre-existing CSCS and neurological outcomes were evident after traumatic CSCI. These results suggest that decompression surgery might not be recommended for traumatic CSCI without major fracture or dislocation despite pre-existing CSCS.

Radiological Outcome of Short Segment Posterior Instrumentation and Fusion for Thoracolumbar Burst Fractures

Truc Tam Vu,Yuichiro Morishita,Itaru Yugue,Tetsuo Hayashi,Takeshi Maeda,Keiichiro Shiba 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.3

Study Design: Retrospective study. Purpose: To evaluate the radiological outcome of the surgical treatment of thoracolumbar burst fractures by using short segment posterior instrumentation (SSPI) and fusion. Overview of Literature: The optimal surgical treatment of thoracolumbar burst fractures remains a matter of debate. SSPI is one of a number of possible choices, yet some studies have revealed high rates of poor radiological outcome for this SSPI. Methods: Patients treated using the short segment instrumentation and fusion technique at the Spinal Injuries Center (Iizuka, Fukuoka, Japan) from January 1, 2006 to July 31, 2012 were selected for this study. Radiographic parameters such as local sagittal angle, regional sagittal angle, disc angle, anterior or posterior height of the vertebral body at admission, postoperation and final observation were collected for radiological outcome evaluation. Results: There were 31 patients who met the inclusion criteria with a mean follow-up duration of 22.7 months (range, 12–48 months). The mean age of this group was 47.9 years (range, 15–77 years). The mean local sagittal angles at the time of admission, post-operation and final observation were 13.1°, 7.8° and 14.8°, respectively. There were 71% good cases and 29% poor cases based on our criteria for the radiological outcome evaluation. The correction loss has a strong correlation with the load sharing classification score (Spearman rho=0.64, p <0.001). Conclusions: The loss of kyphotic correction following the surgical treatment of thoracolumbar burst fracture by short segment instrumentation is common and has a close correlation with the degree of comminution of the vertebral body. Patients with high load sharing scores are more susceptible to correction loss and postoperative kyphotic deformity than those with low scores.

Bilateral comparison of the absorbed dose to water in high energy X-ray beams between the KRISS and the NMIJ

김인중,김병철,이철영,Shimizu Morihito,Morishita Yuichiro,Saito Norio 한국원자력학회 2020 Nuclear Engineering and Technology Vol.52 No.7

The Korea Research Institute of Standards and Science (KRISS) established a new standard of the absorbed dose to water in LINAC X-ray beams. To confirm the equivalence of the new standard with other national metrology institutes (NMIs), a bilateral comparison study of the absorbed dose to water in high energy X-ray beams was performed between the KRISS and the National Metrology Institute of Japan (NMIJ). The comparison was made in-directly. Three transfer chambers were calibrated in the high energy X-ray beams by both laboratories and the calibration coefficients were compared. The average ratios of the calibration coefficients of the three transfer chambers obtained by the KRISS to those obtained by the NMIJ were 1.004, 1.006, 1.006, 1.007 for 6, 10, 15 and 18 MV X-ray beams, respectively. The calibration coefficients obtained at the KRISS were higher than those at the NMIJ but they were in good agreement within the expanded uncertainty of 1.0% (k ¼ 2). The results of this study will be used as the evidence for the KRISS standard being comparable with those of other NMIs, temporarily, in the interim period up to finalizing a key comparison study, BIPM.RI(I)eK6 managed by the Consultative Committee for Ionizing Radiation