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ABSTRACT: PURPOSE: Curved peri-acetabular osteotomy (CPO) produces excellent clinical results, but the surgical procedure is technically demanding, and severe complications related to the osteotomy have been reported. To provide a safe, accurate surgical procedure, we have developed a novel method for setting the cutting line and direction. We have designed and made a custom cutting guide for individual patients. The purpose of the study was to evaluate the efficacy of this new method and cutting guide. METHODS: The cutting line was designed on a full-scale three-dimensional plaster model made from computed tomography (CT) data for each case. The surface of each plaster model was colour-coded according to the distance from the centre of the femoral head. A custom cutting guide was designed based on this cutting line on the workstation. A titanium custom cutting guide was fabricated using rapid prototyping technology. The cutting guide directed the cutting direction of the osteotome. We evaluated the outcomes for seven consecutive hips in seven patients who underwent CPO using the system between April and December 2011. All peri-operative complications were recorded. The accuracy of the cutting line was evaluated using CT data obtained two weeks after the operation. RESULTS: There were no major complications related to the osteotomy such as posterior column fracture or intra-articular osteotomy. The actual cutting line corresponded almost exactly to the planned cutting line in all cases. CONCLUSIONS: The colour-coded plaster model and the custom cutting guide were effective for avoiding severe complications associated with a CPO.
International Orthopaedics 04/2013; · 2.03 Impact Factor
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Toshiyuki Kawai,
Mitsuru Takemoto, Shunsuke Fujibayashi,
Haruhiko Akiyama,
Seiji Yamaguchi,
Deepak K Pattanayak,
Kenji Doi,
Tomiharu Matsushita,
Takashi Nakamura,
Tadashi Kokubo,
Shuichi Matsuda
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ABSTRACT: Bone ingrowth into porous Ti metal is important for stable fixation of Ti metal implants to surrounding bone. However, without surface treatment this is limited to only a thin region of the outer surface of the Ti metal. In the present study, a porous Ti metal with a porosity of ~60 % and interpore connections of 70-200 micrometers in diameter was investigated in terms of its chemical and heat treatments, by implanting it into rabbit femur for periods varying from 3 to 12 weeks. The porous Ti metal subjected to heat treatment at 600 °C after H2SO4/HCl mixed acid treatment showed the largest bone ingrowth in comparison with those subjected to no treatment, only acid treatment, and only heat treatment even at an early stage after implantation, and remained as such even 12 weeks after implantation. Their bone ingrowths were well interpreted in terms of apatite-forming abilities of the Ti metals in body environment. Their apatite-forming abilities did not depend upon their surface roughness nor type of crystalline phase, but upon the positive surface charge.
Journal of Materials Science Materials in Medicine 03/2013; · 2.32 Impact Factor
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Masanori Izeki,
Masashi Neo,
Hiromu Ito,
Koutatsu Nagai,
Tatsuro Ishizaki,
Takeshi Okamoto, Shunsuke Fujibayashi,
Mitsuru Takemoto,
Hiroyuki Yoshitomi,
Tomoki Aoyama,
Shuichi Matsuda
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ABSTRACT: Study Design. A cross-sectional study.Objective. The purpose of this study was to investigate the effect of reduction of anterior atlantoaxial subluxation (AAS) on the oropharyngeal airway space.Summary of Background Data. Our previous studies have shown that reduction of the occipito-C2 angle (O-C2A) makes the mandible shift posteriorly, resulting in oropharyngeal airway stenosis, which occasionally causes postoperative dysphagia after occipito-cervical fusion. Based on this background, we hypothesized that reduction of AAS would also cause oropharyngeal airway stenosis independent of the O-C2A, because it also shifts the mandible posteriorly. To our knowledge, there are no data demonstrating an association between reduction of AAS and the oropharyngeal airway space.Methods. The authors prospectively evaluated 64 patients with rheumatoid arthritis. We analyzed lateral cervical plain X-rays of five different positions (neutral, flexion, extension, retraction, and protrusion), and measured the O-C2A, C2-C6 angle, anterior atlantodental interval (AADI), anteroposterior distance of the narrowest oropharyngeal airway space (nPAS), and so on. The subjects were classified into two groups: group R comprised patients with a "reducible AAS" in dynamic cervical movement, and group N comprised "non-AAS" patients.Results. In the multiple regression analysis, the change in the O-C2A (dOC2A) was the only significant independent variable related to the percentage change in the nPAS from the neutral position (%dnPAS) in group N. On the contrary, the change in the AADI and dOC2A were significantly related to the%dnPAS in group R. No cases in group N and 7 cases (28%) in group R showed a paradoxical decrease in the nPAS in extension, in which the O-C2A is largest and reduction of AAS is obtained.Conclusions. Reduction of AAS has a negative effect on the oropharyngeal airway space. Therefore, reduction of AAS during occipito-cervical fusion may cause postoperative dysphagia despite maintenance of the O-C2A.
Spine 02/2013; · 2.08 Impact Factor
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ABSTRACT: The effects of surface treatment on the bone-bonding properties of Ti metal were examined by both mechanical detaching test and histological observation after implantation into rabbit tibiae for various periods ranging from 4 to 26 weeks. The bone-bonding ability of Ti metal, which is extremely low as it is abraded, was hardly increased by simple heat treatment at 600 °C or treatment with H(2)SO(4)/HCl mixed acid alone, but was markedly increased by the heat treatment after the acid treatment. Even Ti metal that had been previously subjected to NaOH treatment showed considerably high bone-bonding ability after acid and heat treatments. Such high bonding abilities were attributed to their high apatite-forming ability in the body environment. Their high apatite-forming abilities were attributed to a high positive surface charge, and not to the type of crystalline phase or specific roughness of their surfaces. The present study has demonstrated that acid and subsequent heat treatments are effective for conferring stable fixation properties on Ti metal implants.
Journal of Materials Science Materials in Medicine 09/2012; · 2.32 Impact Factor
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ABSTRACT: A retrospective study was conducted to investigate the impact of vertebral endplate cyst formation on union status after lumbar interbody fusion.
To assess the impact of cyst formation at the vertebral endplate in the early detection of nonunion after lumbar interbody fusion. The relationship between vertebral endplate cyst formation and subsequent union status was evaluated retrospectively using dynamic x-ray and computed tomography (CT) and multiplanar reconstruction.
Although many studies have reported on the assessment of bony union after lumbar interbody fusion, no study has reported on the radiological risk factors for nonunion in the early postoperative period. The meaning and importance of vertebral endplate cyst formation have not been reported and should be clarified.
Radiological vertebral endplate changes at 93 levels were assessed in 76 patients after transforaminal lumbar interbody fusion, using a titanium cage with pedicle screw fixation. Computed tomographic findings for the vertebral endplate at 3 months were compared between nonunion and union cases. The relationship between vertebral endplate cyst formation and union status was tested statistically.
Fifty-nine union cases were compared with 17 nonunion cases. The overall union rate was 75.2% at 1 year and 82.8% at 2 years. At 1 year, the sensitivity of cyst formation for subsequent nonunion was 69.6%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 90.9%. Multivariate logistic regression analysis showed that a multioperated back was a significant predictor of cyst formation (odds ratio [OR]: 3.8; 95% confidence interval [CI]: 1.1-13.1) and that cyst formation and multioperated back were significant predictors of nonunion (OR: 12.3; 95% CI: 1.8-133 and OR: 116; 95% CI: 22.4-infinity, respectively).
These findings show a relationship between vertebral endplate cyst formation in the early postoperative period and nonunion after lumbar interbody fusion. Endplate cyst formation is a useful early predictor of subsequent nonunion.
Spine 05/2012; 37(19):E1197-202. · 2.08 Impact Factor
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ABSTRACT: The aim of this study was to determine whether the recent refinement and downsizing of the implants for posterior cervical fusion increase the occurrence of implant failure.
One hundred forty-two consecutive cases of cervical fusion, using either cannulated Magerl screws or a multiaxial pedicle screw-rod system, were reviewed retrospectively after an average follow-up period of more than 3 years, and the rate and characteristics of the failure of these implants were evaluated.
Implant failure occurred in six (4.2%) patients: five with rheumatoid arthritis and one with athetoid cerebral palsy. Occipital plate fracture occurred in two patients, Magerl screw breakage in one patient, cervical pedicle screw fracture in two patients, and disassembly of the pedicle screw and rod in two patients (one with an occipital plate fracture). There was no rod fracture. The implant failures were asymptomatic, except in one patient. Disassembly of the pedicle screw and rod was observed immediately after another surgical procedure under general anesthesia in two patients.
The failure rate of 4.2% was similar to the rates reported in the literature for posterior lumbar spinal fusion, confirming the reliability of the recent cervical screw-rod system.
European Spine Journal 02/2012; 21(2):328-34. · 1.97 Impact Factor
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ABSTRACT: There is no established consensus on the indications for surgery in patients with considerable cord compression but only slight myelopathy. The purpose of this study is to stimulate discussion about the indications for surgery in these patients.
The records of consecutive patients who underwent cervical laminoplasty (CLP) during 3.5 years were reviewed. Those patients whose pre-operative Japanese Orthopaedic Association score (JOA score, maximum 17) for cervical myelopathy was 16 points or more, indicating that they had very slight myelopathy, were selected. The postoperative JOA scores of these patients were checked via a chart review, and they were sent a survey asking about their degree of satisfaction with the results of surgery.
Of 143 patients who underwent CLP, 14 presented with a preoperative JOA score of 16 or more. No patients showed a postoperative deterioration in JOA score. Nine patients complained of pre-operative hand numbness and this symptom disappeared postoperatively in seven cases. Most patients were satisfied with the results of the surgery: "very satisfied" in 11 cases and none selected "slightly dissatisfied" or "very dissatisfied".
We believe that surgery can rescue well-informed and deliberately selected patients with only slight myelopathy, because their symptoms improve and they are freed from persistent anxiety.
European Spine Journal 02/2012; 21(2):340-6. · 1.97 Impact Factor
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Skeletal Radiology 09/2011; 40(12):1629-32. · 1.54 Impact Factor
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ABSTRACT: The objective of this study was to establish the efficacy and safety of porous bioactive titanium metal for use in a spinal fusion device, based on a prospective human clinical trial. A high-strength spinal interbody fusion device was manufactured from porous titanium metal. A bioactive surface was produced by simple chemical and thermal treatment. Five patients with unstable lumbar spine disease were treated surgically using this device in a clinical trial approved by our Ethics Review Committee and the University Hospital Medical Information Network. Clinical and radiological results were reported at the minimum follow-up period of 1 year. The optimal mechanical strength and interconnected structure of the porous titanium metal were adjusted for the device. The whole surface of porous titanium metal was treated uniformly and its bioactive ability was confirmed before clinical use. Successful bony union was achieved in all cases within 6 months without the need for autologous iliac crest bone grafting. Two specific findings including an anchoring effect and gap filling were evident radiologically. All clinical parameters improved significantly after the operation and no adverse effects were encountered during the follow-up period. Although a larger and longer-term follow-up clinical study is mandatory to reach any firm conclusions, the study results show that this porous bioactive titanium metal is promising material for a spinal fusion device.
European Spine Journal 03/2011; 20(9):1486-95. · 1.97 Impact Factor
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ABSTRACT: Material-induced osteoinduction is reported in comparatively large animals such as dogs and pigs; however, it does not often occur in small animals such as rodents. In this study, we implanted porous calcium-deficient hydroxyapatite (CDHA) in the dorsal muscles of dogs and rats and compared the two species, with emphasis on multinucleated cells, by using hematoxylin and eosin (HE) staining, tartrate-resistant acid phosphatase (TRAP) staining, transmission electron microscope (TEM) observation, and reverse transcription-polymerase chain reaction (RT-PCR). In CDHA extracted from dogs, numerous TRAP-positive multinucleated cells were detected after 2 weeks and new bone formation was observed after 4 weeks. In contrast, in rats, only a small number of TRAP-positive cells were detected and no bone formation was observed within 6 weeks. CDHA was more degraded in dogs than in rats. TEM observation of the multinucleated cells in CDHA extracted from dogs after 3 weeks revealed osteoclast-like features such as ruffled borders. However, CDHA extracted from rats did not exhibit osteoclast-like features. RT-PCR evaluation showed that the expression of cathepsin K was higher in dogs than in rats. These results indicate that TRAP-positive cells might be one of the main factors responsible for the cross-species difference in material-induced osteoinduction.
Journal of Biomedical Materials Research Part A 02/2011; 96(2):402-12. · 2.63 Impact Factor
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ABSTRACT: Radiographic analysis using normal patients.
To analyze the relationship between the cervical alignment and the oropharyngeal space.
Few clinical studies stress the effect of the occipito-C2 (O-C2) alignment on the oropharyngeal space. A previous study showed dysphagia and/or dyspnea after occipitocervical fusion was caused by oropharyngeal stenosis resulting from O-C2 fixation in a flexed position. Other independent researchers showed that development or improvement of obstructive sleep apnea in rheumatoid arthritis patients was related to the O-C2 alignment. However, there are limited basic data demonstrating the relationship between the O-C2 alignment and the oropharyngeal space.
Plain lateral cervical radiographs in five tested positions--neutral, flexion, extension, protrusion, and retraction--of 40 asymptomatic volunteers were collected. The O-C2 angle, the C2-C6 angle, and the anterior-posterior distance of the narrowest oropharyngeal airway space (nPAS) were measured, and the changes in value from the neutral to the other four positions were calculated for each patient.
According to the multiple regression analysis, there was an extremely strong linear correlation of the change in the O-C2 angle with the percentage change in the nPAS. Referring to the multiple regression analysis, a decrease of 10° in the O-C2 angle caused a 37% reduction in the nPAS in the neutral position. In contrast, no significant correlation was found between the change in the C2-C6 angle and the percentage change in the nPAS.
Our results show the impact of the O-C2 angle on the oropharyngeal space. This knowledge will be useful for the diagnosis and treatment of the upper cervical lesion combined with the upper airway stenosis, and for the determination of the optimal fixation angle in occipitocervical fusion.
Spine 01/2011; 36(11):E720-6. · 2.08 Impact Factor
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ABSTRACT: Experimental animal study.
To investigate the osteogenic properties of a particulate uncalcined, unsintered hydroxyapatite/polydllactide (u-HA/PdlLA) composite scaffold loaded with bone marrow aspirate (BMA).
Because of the high morbidity associated with bone graft harvesting, current research in spine surgery has largely focused on bone graft alternatives involving a combination of scaffolds and osteogenic substances. BMA is obtained by a simple and relatively noninvasive method and can easily be clinically applied as an osteogenic material. However, few studies have reported successful posterolateral spinal fusion (PLF) with BMA-loaded synthetic materials.
Porous u-HA/PdlLA composites loaded with BMA were used as bone graft substitutes. In experiment 1, porous u-HA/PdlLA cylinders containing or lacking BMA were implanted in rabbit muscles. They were retrieved 4, 8, and 12 weeks after implantation, and ectopic bone formation was histologically evaluated. In experiment 2, 48 rabbits underwent PLF with 1 of 4 bone grafts: autogenous bone (group 1); single-strip u-HA/PdlLA alone (group 2); morselized u-HA/PdlLA + BMA (group 3); or single-strip u-HA/PdlLA + BMA (group 4). After 12 weeks, fusion was assessed by manual palpation, microcomputed tomography, mechanical tests, and histologic examination.
In experiment 1, ectopic bone formation was observed in BMA-loaded u-HA/PdlLA, and the new bone area increased until 12 weeks after implantation. In experiment 2, the fusion rates in groups 1, 2, 3, and 4 were 58.3%, 16.7%, 66.7%, and 91.7%, respectively, as determined by manual palpation, and 66.7%, 16.7%, 75.0%, and 91.7%, respectively, as determined by microcomputed tomography. The mechanical strength was significantly greater in group 4 than in the other groups (P < 0.05).
Conclusion. Our results indicate that BMA-loaded porous μ-HA/PdlLA is an effective alternative to autogenous bone grafts. The structure and composition of porous u-HA/PdlLA render it an effective scaffold for BMA.
Spine 11/2010; 36(6):441-7. · 2.08 Impact Factor
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Toshihiko Saito,
Mitsuru Takemoto,
Akinobu Fukuda,
Yutaka Kuroda, Shunsuke Fujibayashi,
Masashi Neo,
Daisuke Honjoh,
Tsuneo Hiraide,
Takashi Kizuki,
Tadashi Kokubo,
Takashi Nakamura
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ABSTRACT: Organic polymers can be uniformly surface-modified with bioactive TiO(2) by using a sol-gel method. Titania-based surface-modified polyethylene terephthalate (TiPET) plates and fabric have shown apatite-forming ability in simulated body fluid. Here, we first investigated the bone-bonding ability and mechanical bonding strength between the surface-modified layer and the base material (PET) of TiPET plates in vivo. For clinical applicability, we also examined the bone-bonding ability of TiPET fabric and the effect of titania-based surface modification on peri-implant tissue reactions (e.g. connective tissue capsule formation) in bone in vivo. Solid PET plates and PET fabric were prepared. Test plates and fabric were surface-modified with titania solution by using a sol-gel method. Histological examinations of the plates implanted into rabbit tibiae revealed direct contact between the TiPET plate and the bone. After the detaching test, a considerable amount of bone residue was observed on the surface of the TiPET plate. This result suggests that the mechanical bond strength between surface-modified layer and the base material is stronger than that between newly generated bone and tibia, and indirectly ensures the mechanical stability of the surface-modified layer. Pulling tests and histological examinations of the TiPET fabric revealed its excellent bone-bonding ability and micro-computed tomographic images showed excellent osteoconductive ability of TiPET fabric. The connective tissue capsule was much thinner, with less inflammatory tissue around the TiPET implants than around the control samples. These results indicate that TiPET fabric possesses a mechanically stable surface-modified layer, excellent bone-bonding ability, osteoconductive ability, and biocompatibility in bone.
Acta biomaterialia 11/2010; 7(4):1558-69. · 3.98 Impact Factor
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ABSTRACT: Foraminal stenosis is a common cause of lumbar radicular symptoms. Recognition of the dynamic pathology, as well as the static anatomical changes, is important to achieving successful surgical outcomes. Excessive facet and anulus removal leads to subsequent disc space narrowing and/or segmental instability, which can cause poor results after decompressive surgery. The objective of this study was to evaluate the efficacy of the paraspinal-approach transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar foraminal stenosis.
Twenty levels of lumbar foraminal stenosis in 16 patients were treated using an instrumented paraspinal-approach TLIF. There were 12 single-level and 4 two-level cases. Pathologies included foraminal stenosis at 13 levels and lateral disc herniation with disc space narrowing at 7.
In all patients, preoperative radicular symptoms and mechanical low-back pain were resolved immediately after the operation and leg weakness improved gradually. The recovery rate using the Japanese Orthopaedic Association score was 89.1%. Bony union was achieved within 6 months after the operation in all cases. Postoperative MR imaging showed minimal changes in the paraspinal muscles in the single-level cases.
The paraspinal-approach TLIF is a minimally invasive, safe, and secure procedure for treating lumbar foraminal lesions. Direct visualization and decompression for the foraminal lesion, distraction of the collapsed disc space, and stabilization of the unstable segments can be achieved simultaneously through the paraspinal approach, which produces successful clinical and radiological results.
Journal of neurosurgery. Spine 10/2010; 13(4):500-8. · 1.61 Impact Factor
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ABSTRACT: Study Design. A report of 4 cases of spinal osteotomy performed under the guidance of a computer-assisted navigation system and a technical note about the use of the navigation system for spinal osteotomy.
Objective. To document the surgical technique and usefulness of computer-assisted surgery for spinal osteotomy.
Summary of Background Data. A computer-assisted navigation system provides accurate 3-dimensional (3D) real-time surgical information during the operation. Although there are many reports on the accuracy and usefulness of a navigation system for pedicle screw placement, there are few reports on the application for spinal osteotomy.
Methods. We report on 4 complex cases including 3 solitary malignant spinal tumors and 1 spinal kyphotic deformity of ankylosing spondylitis, which were treated surgically using a computer-assisted spinal osteotomy. The surgical technique and postoperative clinical and radiologic results are presented.
Results. 3D spinal osteotomy under the guidance of a computer-assisted navigation system was performed successfully in 4 patients. All malignant tumors were resected en bloc, and the spinal deformity was corrected precisely according to the preoperative plan. Pathologic analysis confirmed the en bloc resection without tumor exposure in the 3 patients with a spinal tumor.
Conclusion. The use of a computer-assisted navigation system will help ensure the safety and efficacy of a complex 3D spinal osteotomy.
Spine 08/2010; 35(18):E895-E903. · 2.08 Impact Factor
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ABSTRACT: A report of 4 cases of spinal osteotomy performed under the guidance of a computer-assisted navigation system and a technical note about the use of the navigation system for spinal osteotomy.
To document the surgical technique and usefulness of computer-assisted surgery for spinal osteotomy.
A computer-assisted navigation system provides accurate 3-dimensional (3D) real-time surgical information during the operation. Although there are many reports on the accuracy and usefulness of a navigation system for pedicle screw placement, there are few reports on the application for spinal osteotomy.
We report on 4 complex cases including 3 solitary malignant spinal tumors and 1 spinal kyphotic deformity of ankylosing spondylitis, which were treated surgically using a computer-assisted spinal osteotomy. The surgical technique and postoperative clinical and radiologic results are presented.
3D spinal osteotomy under the guidance of a computer-assisted navigation system was performed successfully in 4 patients. All malignant tumors were resected en bloc, and the spinal deformity was corrected precisely according to the preoperative plan. Pathologic analysis confirmed the en bloc resection without tumor exposure in the 3 patients with a spinal tumor.
The use of a computer-assisted navigation system will help ensure the safety and efficacy of a complex 3D spinal osteotomy.
Spine 08/2010; 35(18):E895-903. · 2.08 Impact Factor
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ABSTRACT: A retrospective comparative study of the S1 pedicle screw (S1PS) position obtained using 2 surgical approaches.
To determine whether the paraspinal approach leads to more medially oriented placement of the S1PS compared with the midline approach.
To obtain a stronger as well as safer fixation of the S1PS, medially oriented screw placement is very important. However, no study has recommended a surgical approach to achieve this object.
The positions of 32 screws placed by the midline approach and 34 screws placed by the paraspinal approach were compared using postoperative computed tomography. The location of the bilateral common iliac veins (CIV) in relation to the S1PS tips was also analyzed to evaluate their safety.
There was no statistical difference in screw insertion point regardless of the approach employed. However, in the paraspinal group the S1PS were placed with significantly greater medial direction and with longer screws. In addition, they pierced the anterior sacral cortex closer to the midline compared with the midline approach. Four left screws in the midline approach group made contact with the left CIV, whereas no screw in the paraspinal approach group lay adjacent to the CIV.
Our results demonstrate that the paraspinal approach for S1PS placement may be superior to the midline approach in terms of the medially oriented screw placement that is biomechanically stronger and less risky for the CIV.
Spine 05/2010; 35(11):E452-7. · 2.08 Impact Factor
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ABSTRACT: A prospective study to investigate serial changes in neck muscle strength before and after cervical laminoplasty.
To examine the correlation between neck muscle strength and axial symptoms, and to clarify the risk factors for axial symptoms.
Axial symptoms are common complications after posterior cervical spinal surgery. Although several technical considerations have reduced axial symptoms, the causes of axial symptoms are still largely unknown. Previous studies have indicated that neck muscle strength is reduced in patients with neck pain.
Nineteen consecutive patients underwent cervical expansive laminoplasty for cervical spondylotic myelopathy. Age, sex, operative time, blood loss, clinical results, cervical curvature, range of motion, visual analog scale (VAS) for axial symptoms, and manual muscle strengths were examined before and after surgery. At 3 and 12 months, these factors were compared statistically between the no pain (NP) group (VAS <3) and the pain (P) group (VAS >or=3). The correlation between VAS and neck muscle strength, and the reduction in neck muscle strength in extension were analyzed statistically.
Six patients (31.5%) complained of axial symptoms at 3 months, and the symptoms continued in 3 patients (15.8%) at 12 months. At 3 months, cervical lordosis was 15.7 degrees in the NP group and 5.0 degrees in the P group, and neck strength in extension was 104.9% and 61.8%, respectively. At 12 months, neck strength in extension was 124.3% and 62.2%, respectively. These differences were statistically significant. The correlation between neck pain VAS and neck muscle strength, and the reduction in neck muscle strength in extension were statistically significant.
Neck muscle strength recovered to the preoperative value by 3 months and increased to 120% by 12 months in the NP group, whereas in the P group, neck muscle strength remained reduced by 60% and did not recover. Neck muscle strength and axial symptoms were strongly correlated.
Journal of spinal disorders & techniques 05/2010; 23(3):197-202. · 1.21 Impact Factor
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ABSTRACT: A highly bioactive bone-bonding Ti metal was obtained when Ti metal was simply heat-treated after a common acid treatment. This bone-bonding property was ascribed to the formation of apatite on the Ti metal in a body environment. The formation of apatite on the Ti metal was induced neither by its surface roughness nor by the rutile phase precipitated on its surface, but by its positively charged surface. The surface of the Ti metal was positively charged because acid groups were adsorbed on titanium hydride formed on the Ti metal by the acid treatment, and remained even after the titanium hydride was transformed into titanium oxide by the subsequent heat treatment. These results provide a new principle based on a positively charged surface for obtaining bioactive materials.
Journal of The Royal Society Interface 05/2010; 7 Suppl 5:S503-13. · 4.40 Impact Factor
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Akiko Fukuhara,
Katsuhiro Masago,
Masashi Neo, Shunsuke Fujibayashi,
Shiro Fujita,
Yukimasa Hatachi,
Kaoru Irisa,
Yuichi Sakamori,
Yosuke Togashi,
Young Hak Kim,
Tadashi Mio,
Michiaki Mishima
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ABSTRACT: BACKGROUND: Spinal metastases of patients with advanced stage lung cancer are an important target for palliative therapy, because their incidence is high, and they often cause severe symptoms and worsen the quality of life. Surgery is one of the most effective treatment options, but the indication of surgery is unclear as the procedure is invasive and patients with spinal metastasis have a rather short life expectancy. Furthermore, there have been few studies that have focused on lung cancer with poor prognosis. METHODS: We reviewed all of the cases of lung cancer from January 1999 to July 2007 in the Department of Respiratory Medicine, Kyoto University Hospital, Japan. Thirteen patients with metastatic spinal tumor of lung cancer underwent surgery, and all of them had a poor performance status score (3 or 4). RESULTS: Neurological improvement by at least 1 Frankel grade was seen in 10 of 14 cases (71%). Improvement of the movement capacity was noted in 9 of 14 cases (64%), and pain improvement was noted in 12 of 14 (86%). Median postoperative survival was 5 months (1-25 months). In particular, the group with a good postoperative performance status score (0-2) was shown to have a better median postoperative survival of 13 months. CONCLUSIONS: Surgical treatment for symptomatic metastatic spinal tumor of lung cancer can improve quality of life in a substantially high percentage of patients. Surgery should be considered even if preoperative performance status is poor.
Case Reports in Oncology 01/2010; 3(1):63-71.
