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  • 1
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    Online Resource
    Risk Factors for Poor Outcome after Palliative Surgery for Metastatic Spinal Tumors
    MDPI AG ; 2023
    In:  Journal of Clinical Medicine Vol. 12, No. 10 ( 2023-05-13), p. 3442-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 12, No. 10 ( 2023-05-13), p. 3442-
    Abstract: Palliative surgery is performed to improve the quality of life of patients with spinal metastases. However, it is sometimes difficult to achieve the expected results because the patient’s condition, and risk factors related to poor outcomes have not been well elucidated. This study aimed to evaluate the functional outcomes and investigate the risk factors for poor outcomes after palliative surgery for spinal metastasis. We retrospectively reviewed the records of 117 consecutive patients who underwent palliative surgery for spinal metastases. Neurological and ambulatory statuses were evaluated pre- and post-operatively. Poor outcomes were defined as no improvement or deterioration in functional status or early mortality, and the related risk factors were analyzed using multivariate logistic regression analysis. The results showed neurological improvement in 48% and ambulatory improvement in 70% of the patients with preoperative impairment, whereas 18% of the patients showed poor outcomes. In the multivariate analysis, low hemoglobin levels and low revised Tokuhashi scores were identified as risk factors for poor outcomes. The present results suggest that anemia and low revised Tokuhashi scores are related not only to life expectancy but also to functional recovery after surgery. Treatment options should be carefully selected for the patients with these factors.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm12103442
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2662592-1
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  • 2
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    Long-term, Time-course Evaluation of Ligamentum Flavum Hypertrophy Induced by Mechanical Stress : An Experimental Animal Study
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Spine Vol. 46, No. 9 ( 2021-05-1), p. E520-E527
    Details
    In: Spine, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. 9 ( 2021-05-1), p. E520-E527
    Abstract: Experimental animal study. Objective. The aim of this study was to clarify chronological effects of mechanical stress on ligamentum flavum (LF) using a long-term fusion rabbit model. Summary of Background Data. LF hypertrophy is a major pathology of lumbar spinal stenosis (LSS), but its mechanism remains unclear. We previously demonstrated mechanical-stress-induced LF hypertrophy with a rabbit model. However, we only investigated LFs at a single time point in the short-term; the effects of long-term mechanical stress have not been elucidated. Methods. Eighteen-week-old male New Zealand White rabbits were randomly divided into two groups: the mechanical stress group underwent L2–3 and L4–5 posterolateral fusion and resection of the L3–4 supraspinal muscle, whereas the control group underwent only surgical exposure. Rabbits were sacrificed 16 and 52 weeks after the procedure. Axial specimens of LFs at L3–4 were evaluated histologically. Immunohistochemistry for alpha-smooth muscle actin (α-SMA) was performed to assess the numbers of vessels and myofibroblasts. Results. In the mechanical stress group, LFs at the L3–4 level exhibited hypertrophy with elastic fiber disruption and cartilage matrix production at 16 and 52 weeks. A trend test indicated that mechanical stress induced LF hypertrophy, elastic fiber disruption, and cartilage matrix production in a time-dependent manner, with the lowest levels before treatment and the highest at 52 weeks. Immunostaining for α-SMA showed similar numbers of vessels in both groups, whereas the percentage of myofibroblasts was significantly larger at 16 and 52 weeks in the mechanical stress group than in the control group. Conclusion. We demonstrated that long-term mechanical stress caused LF hypertrophy with progressive elastic fiber disruption and cartilage matrix production accompanied by enhanced myofibroblasts. In addition, the reported rabbit model could be extended to elucidate the mechanism of LF hypertrophy and to develop new therapeutic strategies for LSS by preventing LF hypertrophy. Level of Evidence: SSSSS
    Type of Medium: Online Resource
    ISSN: 0362-2436 , 1528-1159
    URL: Article
    DOI: 10.1097/BRS.0000000000003832
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2002195-1
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  • 3
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    The Severity of Cervical Disc Degeneration Does Not Impact 2-year Postoperative Outcomes in Patients With Cervical Spondylotic Myelopathy Who Underwent Laminoplasty
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Spine Vol. 45, No. 18 ( 2020-09-15), p. E1142-E1149
    Details
    In: Spine, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 18 ( 2020-09-15), p. E1142-E1149
    Type of Medium: Online Resource
    ISSN: 0362-2436 , 1528-1159
    URL: Article
    DOI: 10.1097/BRS.0000000000003528
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2002195-1
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  • 4
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    Biglycan expression and its function in human ligamentum flavum
    Springer Science and Business Media LLC ; 2021
    In:  Scientific Reports Vol. 11, No. 1 ( 2021-03-01)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 11, No. 1 ( 2021-03-01)
    Abstract: Hypertrophy of the ligamentum flavum (LF) is a major cause of lumbar spinal stenosis (LSS), and the pathology involves disruption of elastic fibers, fibrosis with increased cellularity and collagens, and/or calcification. Previous studies have implicated the increased expression of the proteoglycan family in hypertrophied LF. Furthermore, the gene expression profile in a rabbit experimental model of LF hypertrophy revealed that biglycan (BGN) is upregulated in hypertrophied LF by mechanical stress. However, the expression and function of BGN in human LF has not been well elucidated. To investigate the involvement of BGN in the pathomechanism of human ligamentum hypertrophy, first we confirmed increased expression of BGN by immunohistochemistry in the extracellular matrix of hypertrophied LF of LSS patients compared to LF without hypertrophy. Experiments using primary cell cultures revealed that BGN promoted cell proliferation. Furthermore, BGN induces changes in cell morphology and promotes myofibroblastic differentiation and cell migration. These effects are observed for both cells from hypertrophied and non-hypertrophied LF. The present study revealed hyper-expression of BGN in hypertrophied LF and function of increased proteoglycan in LF cells. BGN may play a crucial role in the pathophysiology of LF hypertrophy through cell proliferation, myofibroblastic differentiation, and cell migration.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/s41598-021-84363-x
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2615211-3
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  • 5
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    Muscle strength rather than appendicular skeletal muscle mass might affect spinal sagittal alignment, low back pain, and health-related quality of life
    Springer Science and Business Media LLC ; 2023
    In:  Scientific Reports Vol. 13, No. 1 ( 2023-06-19)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2023-06-19)
    Abstract: Sarcopenia is defined as decreasing in muscle strength and mass, and dynapenia is defined as decreasing in muscle strength and maintained muscle mass. This study elucidated the prevalence and characteristics of sarcopenia and dynapenia and evaluate in elderly spinal disorders patients. 1039 spinal disorders patients aged ≥ 65 years were included. We measured age, grip strength, muscle mass, spinal sagittal alignment parameters, low back pain (LBP) scores and health-related quality of life (HR-QoL) scores. Based on the previous reports, patients were categorised into normal group: NG, pre-sarcopenia group: PG, dynapenia group: DG, and sarcopenia group: SG. Pre-sarcopenia, dynapenia, and sarcopenia were found in 101 (9.7%), 249 (19.2%), and 91 (8.8%) patients, respectively. The spinal sagittal alignment parameters, trunk muscle mass, LBP, and HR-QoL scores were significantly worse in DG and SG compared with those in PG and NG. Spinal alignment, trunk muscle mass, and clinical outcomes, including LBP and HR-QoL scores, were maintained in the PG and poor in the DG and SG. Thus, intervention for muscle strength may be a treatment option for changes of spinal sagittal alignment and low back pain.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/s41598-023-37125-w
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2615211-3
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  • 6
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    Clinical outcomes of laminoplasty for patients with lysosomal storage disease including mucopolysaccharidosis and mucolipidoses: a retrospective cohort study
    Springer Science and Business Media LLC ; 2021
    In:  Orphanet Journal of Rare Diseases Vol. 16, No. 1 ( 2021-12)
    Details
    In: Orphanet Journal of Rare Diseases, Springer Science and Business Media LLC, Vol. 16, No. 1 ( 2021-12)
    Abstract: Although the clinical efficacy of laminoplasty in adult cervical spondylotic myelopathy or ossification of posterior longitudinal ligament has been frequently reported, there are only few reports of laminoplasty for patients with lysosome storage diseases (LSDs). Therefore, this study aimed to report the midterm clinical and radiological outcomes of patients with LSDs after cervical laminoplasty. Methods Six patients with LSD who underwent laminoplasty with/without C1 laminectomy for cervical myelopathy were enrolled. Clinical evaluations, including the cervical Japanese Orthopedic Association (cJOA) score and visual analog scale (VAS) scores for upper extremity numbness, and radiographic parameters, including C2–C7 lordotic angle, atlanto-dens interval (ADI), and ⊿ADI, were evaluated preoperatively, at 2 years postoperatively, and at the final follow-up. Results Five patients had mucopolysaccharidoses (type I: n = 1, II: n = 3, VII: n = 1) and one patient had mucolipidoses type III. The mean age of patients at surgery was 27.5 years, and the mean postoperative follow-up period was 61 months. All mucopolysaccharidoses cases required C1 posterior arch resection with C2–C7 laminoplasty. No critical complications were observed postoperatively. There were no significant differences in C2–C7 angle (p = 0.724) and ⊿ADI (p = 0.592) between the preoperative and final follow-ups. The cJOA score and VAS for numbness significantly improved at the final follow-up (p = 0.004 and p = 0.007, respectively). Conclusions The cervical myelopathy in patients with LSD could be safely and effectively treated with laminoplasty with/without C1 posterior arch resection after excluding patients with atlantoaxial instability. Atlantoaxial stability and symptom improvement could be maintained at an average of 5 years postoperatively.
    Type of Medium: Online Resource
    ISSN: 1750-1172
    URL: Article
    DOI: 10.1186/s13023-021-02031-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2225857-7
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  • 7
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    The effect of minimally invasive lumbar decompression surgery on sagittal spinopelvic alignment in patients with lumbar spinal stenosis: a 5-year follow-up study
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2021
    In:  Journal of Neurosurgery: Spine ( 2021-06), p. 1-8
    Details
    In: Journal of Neurosurgery: Spine, Journal of Neurosurgery Publishing Group (JNSPG), ( 2021-06), p. 1-8
    Abstract: Several studies have examined the relationship between sagittal spinopelvic alignment and clinical outcomes after spinal surgery. However, the long-term reciprocal changes in sagittal spinopelvic alignment in patients with lumbar spinal stenosis after decompression surgery remain unclear. The aim of this study was to investigate radiographic changes in sagittal spinopelvic alignment and clinical outcomes at the 2-year and 5-year follow-ups after minimally invasive lumbar decompression surgery. METHODS The authors retrospectively studied the medical records of 110 patients who underwent bilateral decompression via a unilateral approach for lumbar spinal stenosis. Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores for low-back pain (LBP), leg pain, leg numbness, and spinopelvic parameters were evaluated before surgery and at the 2-year and 5-year follow-ups. Sagittal malalignment was defined as a sagittal vertical axis (SVA) ≥ 50 mm. RESULTS Compared with baseline, lumbar lordosis significantly increased after decompression surgery at the 2-year (30.2° vs 38.5°, respectively; p 〈 0.001) and 5-year (30.2° vs 35.7°, respectively; p 〈 0.001) follow-ups. SVA significantly decreased at the 2-year follow-up compared with baseline (36.1 mm vs 51.5 mm, respectively; p 〈 0.001). However, there was no difference in SVA at the 5-year follow-up compared with baseline (50.6 mm vs 51.5 mm, respectively; p = 0.812). At the 5-year follow-up, 82.5% of patients with preoperative normal alignment maintained normal alignment, whereas 42.6% of patients with preoperative malalignment developed normal alignment. Preoperative sagittal malalignment was associated with the VAS score for LBP at baseline and 2-year and 5-year follow-ups and the JOA score at the 5-year follow-up. Postoperative sagittal malalignment was associated with the VAS score for LBP at the 2-year and 5-year follow-ups and the VAS score for leg pain at the 5-year follow-up. There was a trend toward deterioration in clinical outcomes in patients with persistent postural malalignment compared with other patients. CONCLUSIONS After minimally invasive surgery, spinal sagittal malalignment can convert to normal alignment at both short-term and long-term follow-ups. Sagittal malalignment has a negative impact on the VAS score for LBP and a weakly negative impact on the JOA score after decompression surgery.
    Type of Medium: Online Resource
    ISSN: 1547-5654
    URL: Article
    DOI: 10.3171/2020.11.SPINE201552
    RVK:
    XA 55270.1
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2021
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  • 8
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    Mid-term changes in spinopelvic sagittal alignment in lumbar spinal stenosis with coexisting degenerative spondylolisthesis or scoliosis after minimally invasive lumbar decompression surgery: minimum five-year follow-up
    Elsevier BV ; 2022
    In:  The Spine Journal Vol. 22, No. 5 ( 2022-05), p. 819-826
    Details
    In: The Spine Journal, Elsevier BV, Vol. 22, No. 5 ( 2022-05), p. 819-826
    Type of Medium: Online Resource
    ISSN: 1529-9430
    URL: Article
    DOI: 10.1016/j.spinee.2021.11.012
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2057875-1
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  • 9
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    Residual numbness of the upper extremity after cervical surgery in patients with cervical spondylotic myelopathy
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2020
    In:  Journal of Neurosurgery: Spine Vol. 33, No. 6 ( 2020-12), p. 734-741
    Details
    In: Journal of Neurosurgery: Spine, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 33, No. 6 ( 2020-12), p. 734-741
    Abstract: Although numbness is one of the chief complaints of patients with cervical spondylotic myelopathy (CSM), preoperative factors relating to residual numbness of the upper extremity (UE) and impact of the outcomes on cervical surgery are not well established. The authors hypothesized that severe preoperative UE numbness could be a risk factor for residual UE numbness after surgery and that the residual UE numbness could have a negative impact on postoperative outcomes. Therefore, this study aimed to identify the preoperative factors that are predictive of residual UE numbness after cervical surgery and demonstrate the effects of residual UE numbness on clinical scores and radiographic parameters. METHODS The study design was a retrospective cohort study. The authors analyzed data of 103 patients who underwent cervical laminoplasty from January 2012 to December 2014 and were followed up for more than 2 years postoperatively. The patients were divided into two groups: the severe residual-numbness group (postoperative visual analog scale [VAS] score for UE numbness 〉 40 mm) and the no/mild residual-numbness group (VAS score ≤ 40 mm). The outcome measures were VAS score, Japanese Orthopaedic Association scores for cervical myelopathy, physical and mental component summaries of the 36-Item Short-Form Health Survey (SF-36), radiographic film parameters (C2–7 sagittal vertical axis, range of motion, C2–7 lordotic angle, and C7 slope), and MRI findings (severity of cervical canal stenosis, snake-eye appearance, severity of foraminal stenosis). Following univariate analysis, which compared the preoperative factors between groups, the variables with p values 〈 0.1 were included in the multivariate linear regression analysis. Additionally, the changes in clinical scores and radiographic parameters after 2 years of surgery were compared using a mixed-effects model. RESULTS Among 103 patients, 42 (40.8%) had residual UE numbness. In the multivariate analysis, sex and preoperative UE pain were found to be independent variables correlating with residual UE numbness (p = 0.017 and 0.046, respectively). The severity of preoperative UE numbness did not relate to the residual UE numbness (p = 0.153). The improvement in neck pain VAS score and physical component summary of the SF-36 was significantly low in the severe residual-numbness group (p 〈 0.001 and 0.040, respectively). CONCLUSIONS Forty-one percent of the CSM patients experienced residual UE numbness for at least 2 years after cervical posterior decompression surgery. Female sex and preoperative severe UE pain were the predictive factors for residual UE numbness. The patients with residual UE numbness showed less improvement of neck pain and lower physical status compared to the patients without numbness.
    Type of Medium: Online Resource
    ISSN: 1547-5654
    URL: Article
    DOI: 10.3171/2020.4.SPINE191566
    RVK:
    XA 55270.1
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2020
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  • 10
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    Clinical Impact of Cervical Imbalance on Surgical Outcomes of Laminoplasty : A Propensity Score–Matching Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Clinical Spine Surgery: A Spine Publication Vol. 33, No. 1 ( 2020-02), p. E1-E7
    Details
    In: Clinical Spine Surgery: A Spine Publication, Ovid Technologies (Wolters Kluwer Health), Vol. 33, No. 1 ( 2020-02), p. E1-E7
    Abstract: This is a retrospective cohort study. Objective: The objective of this study was to identify the impact of preoperative cervical sagittal balance on the 2-year surgical outcomes of laminoplasty. Summary of Background Data: The cervical imbalance is considered associated with poor health-related quality of life and poor outcomes for cervical deformity surgery. However, the influences of cervical imbalance on the clinical outcomes of laminoplasty for cervical spondylotic myelopathy (CSM) patients are unclear. Materials and Methods: A total of 277 consecutive CSM patients who underwent laminoplasty were analyzed. From the last consecutive 136 patients, matched control group [cervical sagittal vertical axis (cSVA) 〈 40 mm, n=30] and matched imbalance group (≥40 mm, n=30) were selected based on their propensity score adjusted for age, sex, cervical alignment, and preoperative Japanese Orthopaedic Association (JOA) score. Change in clinical outcomes and radiographic parameters at 2 years postoperatively were compared between the 2 matched groups using mixed-effects model. For the validation of the primary results, factors that correlated with the recovery rate of JOA score of another 141 patients were analyzed using multiple linear regression analysis. Results: There was no significant interaction between the 2 matched groups in all clinical outcomes, including the severity of myelopathy, patient-oriented health-related quality of life score, physical and mental status, physical functions, and pain score. Regarding the radiographic evaluation, change in cSVA showed significant differences ( P =0.038); cSVA was kept stable in the matched control group, whereas its value significantly decreased in the matched imbalance group. Multiple linear regression models demonstrated that preoperative cSVA is not significantly related to the recovery rate of JOA score at 2 years postoperatively ( P =0.114). Conclusions: Preoperative cervical imbalance did not significantly affect the 2-year surgical outcomes of laminoplasty. Furthermore, cervical imbalance improved after surgery. These results can suggest physicians consider laminoplasty as a treatment for CSM patients regardless of their cervical balance. Level of Evidence: Level III—treatment benefits: nonrandomized controlled cohort/follow-up study.
    Type of Medium: Online Resource
    ISSN: 2380-0186
    URL: Article
    DOI: 10.1097/BSD.0000000000000849
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2849652-8
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