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Ikuyo Kou,
Yohei Takahashi,
Todd A Johnson,
Atsushi Takahashi,
Long Guo,
Jin Dai,
Xusheng Qiu,
Swarkar Sharma,
Aki Takimoto,
Yoji Ogura, [......],
Qing Jiang,
Yuji Hiraki,
Michiaki Kubo,
Yoshiaki Toyama,
Tatsuhiko Tsunoda,
Carol A Wise,
Yong Qiu,
Chisa Shukunami,
Morio Matsumoto,
Shiro Ikegawa
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ABSTRACT: Adolescent idiopathic scoliosis (AIS) is the most common pediatric skeletal disease. We previously reported a locus on chromosome 10q24.31 associated with AIS susceptibility in Japanese using a genome-wide association study (GWAS) consisting of 1,033 cases and 1,473 controls. To identify additional AIS-associated loci, we expanded the study by adding X-chromosome SNPs in the GWAS and increasing the size of the replication cohorts. Through a stepwise association study including 1,819 cases and 25,939 controls, we identified a new susceptibility locus on chromosome 6q24.1 in Japanese (P = 2.25 × 10(-10); odds ratio (OR) = 1.28). The most significantly associated SNP, rs6570507, was in GPR126 (encoding G protein-coupled receptor 126). Its association was replicated in Han Chinese and European-ancestry populations (combined P = 1.27 × 10(-14); OR = 1.27). GPR126 was highly expressed in cartilage, and the knockdown of gpr126 in zebrafish caused delayed ossification of the developing spine. Our results should provide insights into the etiology and pathogenesis of AIS.
Nature Genetics 05/2013; · 35.53 Impact Factor
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Ikuyo Kou,
Yohei Takahashi,
Todd A Johnson,
Atsushi Takahashi,
Long Guo,
Jin Dai,
Xusheng Qiu, Swarkar Sharma,
Aki Takimoto,
Yoji Ogura, [......],
Qing Jiang,
Yuji Hiraki,
Michiaki Kubo,
Yoshiaki Toyama,
Tatsuhiko Tsunoda,
Carol A Wise,
Yong Qiu,
Chisa Shukunami,
Morio Matsumoto,
Shiro Ikegawa
[show abstract]
[hide abstract]
ABSTRACT: Adolescent idiopathic scoliosis (AIS) is the most common pediatric skeletal disease1. We previously reported a locus on chromosome 10q24.31 associated with AIS susceptibility in Japanese using a genome-wide association study (GWAS) consisting of 1,033 cases and 1,473 controls2. To identify additional AIS-associated loci, we expanded the study by adding X-chromosome SNPs in the GWAS and increasing the size of the replication cohorts. Through a stepwise association study including 1,819 cases and 25,939 controls, we identified a new susceptibility locus on chromosome 6q24.1 in Japanese (P = 2.25 × 10−10; odds ratio (OR) = 1.28). The most significantly associated SNP, rs6570507, was in GPR126 (encoding G protein–coupled receptor 126). Its association was replicated in Han Chinese and European-ancestry populations (combined P = 1.27 × 10−14; OR = 1.27). GPR126 was highly expressed in cartilage, and the knockdown of gpr126 in zebrafish caused delayed ossification of the developing spine. Our results should provide insights into the etiology and pathogenesis of AIS.
Nature Genetics 05/2013; · 35.53 Impact Factor
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ABSTRACT: Anterior spinal fusion with instrumentation is used for the treatment of thoracolumbar/lumbar scoliosis. The aim of this long-term, retrospective, hospital-based cohort study was to determine the outcomes of anterior dual-rod instrumentation in a consecutive series of patients with thoracolumbar/lumbar adolescent idiopathic scoliosis managed by a single surgeon at a single institution.
A consecutive series of thirty-two patients with Lenke type-5C thoracolumbar/lumbar adolescent idiopathic scoliosis were included. Outcome measures included patient demographics, radiographic measurements, adjacent-segment degeneration, pulmonary function, and Scoliosis Research Society outcome instrument (SRS-30) scores. Perioperative and postoperative complications were recorded.
Thirty patients were followed for a mean of 17.2 years (range, twelve to twenty-three years). The mean thoracolumbar/lumbar Cobb angle correction rate and correction loss at the time of the latest follow-up were 79.8% and 3.4°, respectively. The average percent-predicted forced vital capacity and forced expiratory volume in one second were 91.8% and 81.8%, respectively. The average total SRS-30 score was 4.2. Mild degeneration below the fusion mass was observed in 23% of the patients. No instrumentation failure, pseudarthrosis, surgical site infection, or clinically relevant neurovascular complications were observed. Two patients required surgical revision with posterior spinal instrumentation, one because of subjacent disc wedging and the other because of progression of the thoracic curve deformity.
Radiographic findings, pulmonary function, and clinical measures were satisfactory at the time of follow-up, at a minimum of twelve years. Anterior dual-rod instrumentation remains a useful surgical treatment for Lenke type-5C thoracolumbar/lumbar adolescent idiopathic scoliosis.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Journal of Bone and Joint Surgery 04/2013; 95(8):e491-8. · 3.27 Impact Factor
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Yoji Ogura,
Yohei Takahashi,
Ikuyo Kou,
Masahiro Nakajima,
Katsuki Kono,
Noriaki Kawakami,
Koki Uno,
Manabu Ito,
Shohei Minami,
Haruhisa Yanagida, [......],
Ikuho Yonezawa,
Taichi Tsuji,
Teppei Suzuki, Hideki Sudo,
Toshiaki Kotani,
Kota Watanabe,
Kazuhiro Chiba,
Yoshiaki Toyama,
Morio Matsumoto,
Shiro Ikegawa
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ABSTRACT: Study Design. A genetic association study of single nucleotide polymorphisms (SNPs) previously reported to be associated with curve progression of adolescent idiopathic scoliosis (AIS).Objective. To determine whether the association of 53 SNPs with curve progression reported in Caucasian AIS are replicated in Japanese AIS.Summary of Background Data. Predicting curve progression is important in clinical practice of AIS. The progression of AIS is reported to be associated with a number of genes. Associations with 53 SNPs have been reported, and the SNPs are used for a progression test in Caucasian AIS; however, there has been no replication study for their association.Methods. We recruited 2,117 AIS patients with ≧ 10° (Cobb angle) of scoliosis curves. They were divided into progression and non-progression groups according to their Cobb angle. We defined the progression of the curve as Cobb angle > 50° for skeletally mature subjects, > 40° for immature ones, and postoperative ones. We defined the non-progression of the curve as Cobb angle ≦50° only for skeletally mature subjects. 1,714 of 2,117 AIS patients were allocated to either the progression or non-progression group. We evaluated the association of 53 SNPs with curve progression by comparing risk allele frequencies between the two groups.Results. We evaluated the progression (N = 600) and non-progression (N = 1,114) subjects, and their risk allele frequencies were not different significantly. We found no replication of the association on AIS curve progression in any of the SNPs.Conclusion. The associations of the 53 SNPs with progression of AIS curve are not definite. Large-scale association studies based on appropriate criteria for progression would be necessary to identify SNPs associated with the curve progression.
Spine 04/2013; · 2.08 Impact Factor
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ABSTRACT: Background Fungal infection in the spine is rare and its treatment is challenging. Conservative treatment with antifungal drugs often fails, with the result that surgical intervention is required in many cases. Since the general conditions of patients with fungal infections is bad due to their comorbid medical problems, surgical invasiveness should be minimized. We have reported the effectiveness of posterolateral endoscopic surgery in treating pyogenic and tuberculous spondylodiscitis. This study reports the clinical results of posterolateral endoscopic surgery in treating fungal spinal infection.Methods Between 2001 and 2009 we used posterolateral endoscopic surgery to treat four patients with fungal spinal infection. All were males, three in their 50s, and one in his 70s. The levels of infection were L2/3 and L5/S1 in one patient each, and L3/4 in two patients. As for the Griffiths classification, there was one patient in class 1, two in class 2, and one in class 3. Postoperative follow-up periods ranged from 26 to 92 months. Treatment history before surgery, species of causative fungus, selection of antifungal drugs and their duration, blood examinations, subsidence of infection, radiographic changes of the spine, and various complications were all investigated.Results All patients had been treated with broad-spectrum antibiotics followed by anti-methicillin-resistant Staphylococcus aureus drugs for more than several months by previous doctors. From cultures of the tissues taken during endoscopic surgery, Candida species were detected in three patients and Paecilomyces species in one. After endoscopic surgery, the patients were administered antifungal drugs for 3 months, except for one patient who had a side effect. All patients showed successful subsidence of infection at the final follow-up.Conclusion Fungal spinal infection occurred in patients with a lengthy use of broad-spectrum antibiotics and anti-methicillin-resistant Staphylococcus aureus drugs. Posterolateral endoscopic debridement and irrigation surgery successfully treated fungal spinal infection. This procedure is effective in treatment of fungal spinal infection with minimal invasiveness.
Journal of neurological surgery. Part A, Central European neurosurgery. 03/2013;
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ABSTRACT: OBJECTIVE: This two case report describes the circumferential osteotomy of anterior-posterior-anterior surgical sequence, and the efficacy of this technique using cervical pedicle screw fixation for severe fixed cervical kyphosis. SUMMARY OF BACKGROUND DATA: Surgical treatment for severe circumferentially fixed cervical kyphosis has been challenging. Both anterior and posterior releases are necessary to provide the cervical mobility necessary for fusion in a corrected position. CASE DESCRIPTION: Etiology of fixed cervical kyphosis was unknown in one patient and neurofibromatosis in one patient. Both patients had severe fixed cervical kyphosis based on cervical radiographs and underwent circumferential osteotomy and fixation, using an anterior-posterior-anterior surgical sequence and correction of kyphosis by pedicle screw fixation. CONCLUSION: Severe fixed cervical kyphosis was treated successfully using circumferential osteotomy and pedicle screw fixation. The surgical sequence described in this report is a reasonable approach for severe circumferentially fixed cervical kyphosis and short segment fixation can be achieved using pedicle screws.
World Neurosurgery 01/2013; · 0.68 Impact Factor
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ABSTRACT: BACKGROUND: Intervertebral disc degeneration is a significant cause of degenerative spinal diseases. Nucleus pulposus (NP) cells reportedly fail to survive in large degenerated discs with limited nutrient availability. Therefore, understanding the regulatory mechanism of the molecular response of NP cells to nutrient deprivation may reveal a new strategy to treat disc degeneration. This study aimed to identify genes related to nutrient deprivation in NP cells on a global scale in an experimental nutrient deprivation model. METHODOLOGYPRINCIPAL FINDINGS: Rat NP cells were subjected to serum starvation. Global gene expression was profiled by microarray analysis. Confirmation of the selected genes was obtained by real-time polymerase chain reaction array analysis. Western blotting was used to confirm the expression of selected genes. Functional interactions between p21(Cip1) and caspase 3 were examined. Finally, flow cytometric analyses of NP cells were performed. Microarray analysis revealed 2922 differentially expressed probe sets with ≥1.5-fold changes in expression. Serum starvation of NP cells significantly affected the expression of several genes involved in DNA damage checkpoints of the cell cycle, including Atm, Brca1, Cdc25, Gadd45, Hus1, Ppm1D, Rad 9, Tp53, and Cyclin D1. Both p27(Kip1) and p53 protein expression was upregulated in serum-starved cells. p21(Cip1) expression remained in NP cells transfected with short interfering RNA targeting caspase 3 (caspase 3 siRNA). Both G1 arrest and apoptosis induced by serum starvation were inhibited in cells transfected with caspase 3 siRNA. CONCLUSIONSSIGNIFICANCE: Nutrient deprivation in NP cells results in the activation of a signaling response including DNA damage checkpoint genes regulating the cell cycle. These results provide novel possibilities to improve the success of intervertebral disc regenerative techniques.
PLoS ONE 01/2013; 8(3):e58806. · 4.09 Impact Factor
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ABSTRACT: BACKGROUND CONTEXT: In the cervical spine, the combination of ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL) is rarely seen. There have been only four cases reported in the English literature. PURPOSE: We describe two more cases that exhibited cervical myelopathy resulting from the combination of cervical OLF and OPLL and required surgery. A literature review with a comparative analysis between previous reports and present cases was also performed. STUDY DESIGN: Case report and literature review. PATIENT SAMPLE: Two patients with combined OLF and OPLL. OUTCOME MEASURES: Preoperative computed tomography, magnetic resonance imaging, and pathological findings from operative specimens were used to confirm the diagnoses. METHODS: A 76-year-old man (Case 1) presented with disturbance of gait and fine finger movement. Magnetic resonance imaging showed severe spinal canal stenosis and cord compression at the C3-C4 level. Computed tomography showed OPLL at the C2-C6 levels (segmental type) and OLF at the left C3-C4 level. The patient underwent posterior decompression and OLF resection. A 75-year-old man (Case 2) presented with sensory disturbance and muscle weakness in his bilateral upper extremities and disturbance in fine finger movements. Magnetic resonance imaging showed severe spinal canal stenosis and cord compression at the C2-C3 and C3 levels. Computed tomography showed OPLL at the C3-C7 levels (mixed type) and OLF at the left C2-C3 and C3 levels. The patient also underwent posterior decompression and OLF resection. RESULTS: In both cases, histological examination of the surgical specimens showed osseous tissue and enchondral ossification within the ligamentum flavum, and the diagnosis in each case was OLF. After surgery, both patients' symptoms immediately improved, and no recurrence was observed at 2 years after surgery. CONCLUSIONS: We experienced two cases of cervical myelopathy resulting from the combination of OLF and OPLL in the cervical spine. The symptoms of myelopathy were treated successfully by laminectomy and laminoplasty with OLF resection in both cases. The literature review including the present two cases revealed that cervical OLF tended to occur adjacent or close to the margin of cervical OPLL, suggesting that the increased mechanical stress at the junction of OPLL may be a causative factor.
The spine journal: official journal of the North American Spine Society 12/2012; · 2.90 Impact Factor
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ABSTRACT: STRUCTURED ABSTRACT: Study Design: Retrospective review.Objective: To assess the long-term outcomes of anterior spinal fusion (ASF) for treating thoracic adolescent idiopathic scoliosis (AIS).Summary of Background Data: Although ASF is reported to provide good coronal and sagittal correction of the main thoracic (MT) AIS curves, the long-term outcomes of ASF is unknown.Methods: A consecutive series of 25 patients with Lenke 1 MT AIS were included. Outcome measures comprised radiographic measurements, pulmonary function, and Scoliosis Research Society outcome instrument (SRS-30) scores (preoperative SRS-30 scores were not documented). Postoperative surgical revisions and complications were recorded.Results: Twenty-five patients were followed-up for 12-18 years (average, 15.2 years). The average MT Cobb angle correction rate and the correction loss at the final follow-up were 56.7% and 9.2°, respectively. The average preoperative instrumented level of kyphosis was 8.3°, which significantly improved to 18.6° (p = 0.0003) at the final follow-up. The average percent-predicted forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were significantly decreased during long-term follow-up measurements (73% and 69%; p = 0.0004 and 0.0016, respectively). However, no patient had complaints related to pulmonary function. The average total SRS-30 score was 4.0. Implant breakage was not observed. All patients, except 1 who required revision surgery, demonstrated solid fusion. Late instrumentation-related bronchial problems were observed in 1 patient who required implant removal and bronchial tube repair 13 years after the initial surgery.Conclusion: Overall radiographic findings and patient outcome measures of ASF for Lenke 1 MT AIS were satisfactory at an average follow-up of 15 years. ASF provides significant sagittal correction of the main thoracic curve with long-term maintenance of sagittal profiles. Percent-predicted values of FVC and FEV1 were decreased in this cohort; however, no patient had complaints related to pulmonary function.
Spine 11/2012; · 2.08 Impact Factor
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Yoji Ogura,
Yohei Takahashi,
Ikuyo Kou,
Masahiro Nakajima,
Katsuki Kono,
Noriaki Kawakami,
Koki Uno,
Manabu Ito,
Shohei Minami,
Haruhisa Yanagida, [......],
Ikuho Yonezawa,
Taichi Tsuji,
Teppei Suzuki, Hideki Sudo,
Toshiaki Kotani,
Kota Watanabe,
Kazuhiro Chiba,
Yoshiaki Toyama,
Morio Matsumoto,
Shiro Ikegawa
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ABSTRACT: Study Design. A genetic association study of single nucleotide polymorphisms (SNPs) previously reported to be associated with curve progression of adolescent idiopathic scoliosis (AIS).Objective. To determine whether the association of five SNPs with curve progression reported in Chinese AIS are replicated in Japanese AIS.Summary of Background Data. AIS is a common spinal deformity and has a strong genetic predisposition. Predicting curve progression is important in clinical practice. The progression of AIS is reported to be associated with a number of genes. Associations with neurotrophin 3 (NTF3), G protein-coupled estrogen receptor 1 (GPER), and tissue inhibitor of metalloproteinase 2 (TIMP2) have been reported in Han Chinese AIS; however, there has been no replication study for them.Methods. We recruited 2,117 AIS patients with ≧ 10° (Cobb angle) of scoliosis curves. They were divided into progression and non-progression groups according to their scoliosis curves. Patients who had ≧40°of the curve were included into the progression group, and those who had ≦30°of the curve and reached skeletally maturation into the non-progression group. We evaluated the association of five SNPs (rs11063714 in NTF3, rs3808351, rs10269151 and rs4266553 in GPER, and rs8179090 in TIMP2) with curve progression by comparing risk allele frequencies between the two groups and the mean Cobb angle for each genotype.Results. We evaluated the progression (N = 880) and non-progression (N = 492) subjects, and their risk allele frequencies were not different significantly. The mean Cobb angle for each genotype also did not have statistical difference. We found no replication of the association on AIS curve progression in any of the SNPs.Conclusion. The associations of the five SNPs with progression of AIS curve are not definite. Large-scale association studies based on appropriate criteria for progression would be necessary to identify SNPs associated with the curve progression.
Spine 10/2012; · 2.08 Impact Factor
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The spine journal: official journal of the North American Spine Society 07/2012; 12(8):714-5. · 2.90 Impact Factor
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ABSTRACT: To evaluate the effectiveness of posterior occipitocervical reconstruction using the anchors of cervical pedicle screws and plate-rod systems for patients with congenital osseous anomalies at the craniocervical junction.
Twenty patients with congenital osseous lesions who underwent posterior occipitocervical fusion using the anchors of cervical pedicle screws and plate-rod systems for reduction and fixation from 1996 to 2009 were reviewed. The lesions included os odontoideum, occipitalization of the atlas, congenital C2-3 fusion, congenital atlantoaxial subluxation, congenital basilar invagination and combined anomalies. The clinical assessment and the measurements of the images were performed preoperatively, postoperatively and at most recent follow-up.
The combined deformity of flexion of the occipitoatlantoaxial complex and invagination of the odontoid process associated with congenital osseous lesions at the craniocervical junction was corrected by application of combined forces of extension and distraction between the occiput and the cervical pedicle screws. Preoperative myelopathy improved in 94.7% patients. The mean Ranawat value, Redlund-Johnnell value, atlantodental distance, occiput (O)-C2 angle, and C2-C7 lordosis angle improved postoperatively and was sustained at most recent follow-up. The mean cervicomedullary angle improved from 129.3° preoperatively to 153.3° postoperatively. The mean range of motion at the lower adjacent motion segment remained unchanged at most recent follow-up. The fusion rate was 95%.
The results of the present study indicate that posterior occipitocervical reconstruction using the anchors of cervical pedicle screws and plate-rod systems is an effective technique for treatment of deformities and/or instability caused by congenital osseous anomalies at the craniocervical junction.
European Spine Journal 05/2012; 21(8):1580-9. · 1.97 Impact Factor
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ABSTRACT: There have been some reports describing hematoma in the thoracic and lumbar ligamentum flavum, but there have been only three reports of hematoma in the cervical ligamentum flavum.
We describe another case of the ligamentum flavum hematoma in the cervical spine with a different feature of occurrence that required surgical treatment.
Case report.
Patient with ligamentum flavum hematoma in the cervical spine.
Preoperative magnetic resonance imaging and pathologic finding from operative specimen confirmed the diagnosis.
A 69-year-old man insidiously presented with pain in his left upper arm and difficulty in left shoulder abduction. Neurologic examination demonstrated a cervical myelopathy with diffuse muscle weakness of left upper extremity and sensory disturbance. Imaging studies revealed a mass of high intense on T1-weighted images and isointense on T2-weighted images posterior to the dura at C4 lower end level. The patient underwent C4-C5 hemilaminectomy and the removal of the mass. The mass existed within the ligamentum flavum and was connected toward the pedicle like the beads of a rosary.
Histopathologic examination of the surgical specimen showed that the hematoma was present within the ligamentum flavum and contained macrophages that had phagocytosed red blood cells and hemosiderin. After surgery, the patients' symptoms immediately improved, and no recurrence was observed at 2 years postoperatively.
We reported a very rare case of hematoma in the ligamentum flavum of the cervical spine that required surgery. Because the patient was without the history of trauma, it was suggested that the use of antiplatelet drugs was responsible for the occurrence of the disease.
The spine journal: official journal of the North American Spine Society 04/2012; 12(4):e18-21. · 2.90 Impact Factor
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ABSTRACT: This study aimed to compare patients undergoing deep extensor muscle-preserving laminoplasty and conventional open-door laminoplasty for the treatment of cervical spondylotic myelopathy (CSM). We specifically assessed axial pain, cervical spine function, and quality of life (QOL) with a minimum follow-up period of 3 years.
Ninety patients were divided into two groups and underwent either conventional open-door laminoplasty (CL group) or laminoplasty using the deep extensor muscle-preserving approach (MP group). The latter approach was undertaken by preserving the multifidus and semispinalis cervicis attachments followed by open-door laminoplasty and resuturing of the bisected spinous processes at each decompression level. The mean follow-up period was 7.7 years (range, 36-128 months). Preoperative and follow-up evaluations included the Japanese Orthopaedic Association (JOA) score, a tentative version of the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) including cervical spine function and QOL, and a visual analog scale (VAS) for axial pain. Radiological analyses included cervical lordosis and flexion-extension range of motion (C2-7), as well as deep extensor muscle areas on axial magnetic resonance imaging (MRI).
The mean number of decompressed laminae was 3.9 and 3.3 in CL and MP groups, respectively, which was statistically equivalent. Japanese Orthopaedic Association recovery was statistically equivalent between the two groups. The MP group demonstrated a superior QOL score (57 vs. 46%) compared with the CL group at final follow-up (p < 0.05). Mean VAS scores at final follow-up were 2.2 and 4.3 in MP and CL groups, respectively (p < 0.05). Cervical lordosis and flexion-extension range of motion were statistically equivalent. The percentage deep muscle area on MRI was significantly lesser in the CL group compared with the MP group (58 vs. 102%; p < 0.01).
We demonstrated the superiority of deep extensor muscle-preserving laminoplasty in terms of postoperative axial pain, QOL, and prevention of atrophy of the deep extensor muscles over conventional open-door laminoplasty for the treatment of CSM.
European Spine Journal 03/2012; 21(8):1536-44. · 1.97 Impact Factor
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ABSTRACT: Review article.
To review the indications, detailed techniques, and complications of cervical pedicle screw fixation procedure.
Although screw insertion into the cervical pedicles has been considered too risky for the neurovascular structures except C2 and C7, biomechanical studies revealed a superior stabilizing effect of pedicle screw fixation in the cervical spine to other fixation procedures including lateral mass screw fixation. In addition, several investigators reported superior reconstructive results of unstable cervical spine.
A literature review and review of the authors' experience in the treatment of the patients with unstable cervical spine and/or cervical spinal deformities using cervical pedicle screw fixation procedure.
Pedicle screw fixation is biomechanically most reliable for reconstruction of the cervical spine in various kinds of disorders. Previously reported articles revealed that pedicle screw fixation is useful for reconstruction of unstable cervical spine and correction of cervical deformities. Neurovascular complication by this procedure cannot be completely eliminated; however, it can be minimized by sufficient preoperative imaging studies and strict control of screw placement during surgery. Modern technology of computer navigation system and newly developing aiming devices can be expected to increase the accuracy of screw placement.
Pedicle screw provides excellent 3-dimensional fixations and is a useful procedure for reconstruction of the cervical spine in various kinds of disorders. Possible neurovascular complication can be minimized by sufficient preoperative imaging studies and strict control of screw placement during surgery.
Spine 03/2012; 37(5):E349-56. · 2.08 Impact Factor
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ABSTRACT: In order to minimize perioperative invasiveness and improve the patients' functional capacity of daily living, we have performed minimally invasive lumbar decompression and posterolateral fusion (MIS-PLF) with percutaneous pedicle screw fixation for degenerative spondylolisthesis with spinal stenosis. Although several minimally invasive fusion procedures have been reported, no study has yet demonstrated the efficacy of MIS-PLF in degenerative spondylolisthesis of the lumbar spine. This study prospectively compared the mid-term clinical outcome of MIS-PLF with those of conventional PLF (open-PLF) focusing on perioperative invasiveness and patients' functional capacity of daily living.
A total of 80 patients received single-level PLF for lumbar degenerative spondylolisthesis with spinal stenosis. There were 43 cases of MIS-PLF and 37 cases of open-PLF. The surgical technique of MIS-PLF included making a main incision (4 cm), and neural decompression followed by percutaneous pedicle screwing and rod insertion. The posterolateral gutter including the medial transverse process was decorticated and iliac bone graft was performed. The parameters analyzed up to a 2-year period included the operation time, intra and postoperative blood loss, Oswestry-Disability Index (ODI), Roland-Morris Questionnaire (RMQ), the Japanese Orthopaedic Association score, and the visual analogue scale of low back pain. The fusion rate and complications were also reviewed.
The average operation time was statistically equivalent between the two groups. The intraoperative blood loss was significantly less in the MIS-PLF group (181 ml) when compared to the open-PLF group (453 ml). The postoperative bleeding on day 1 was also less in the MIS-PLF group (210 ml) when compared to the open-PLF group (406 ml). The ODI and RMQ scores rapidly decreased during the initial postoperative 2 weeks in the MIS-PLF group, and consistently maintained lower values than those in the open-PLF group at 3, 6, 12, and 24 months postoperatively. The fusion rate was statistically equivalent between the two groups (98 vs. 100%), and no major complications occurred.
The MIS-PLF utilizing a percutaneous pedicle screw system is less invasive compared to conventional open-PLF. The reduction in postoperative pain led to an increase in activity of daily living (ADL), demonstrating rapid improvement of several functional parameters. This superiority in the MIS-PLF group was maintained until 2 years postoperatively, suggesting that less invasive PLF offers better mid-term results in terms of reducing low back pain and improving patients' functional capacity of daily living. The MIS-PLF utilizing percutaneous pedicle screw fixation serves as an alternative technique, eliminating the need for conventional open approach.
European Spine Journal 12/2011; 21(6):1171-7. · 1.97 Impact Factor
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Yohei Takahashi,
Ikuyo Kou,
Atsushi Takahashi,
Todd A Johnson,
Katsuki Kono,
Noriaki Kawakami,
Koki Uno,
Manabu Ito,
Shohei Minami,
Haruhisa Yanagida, [......],
Toshiaki Kotani,
Kota Watanabe,
Kazuhiro Chiba,
Naoya Hosono,
Naoyuki Kamatani,
Tatsuhiko Tsunoda,
Yoshiaki Toyama,
Michiaki Kubo,
Morio Matsumoto,
Shiro Ikegawa
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ABSTRACT: Adolescent idiopathic scoliosis is a pediatric spinal deformity affecting 2-3% of school-age children worldwide(1). Genetic factors have been implicated in its etiology(2). Through a genome-wide association study (GWAS) and replication study involving a total of 1,376 Japanese females with adolescent idiopathic scoliosis and 11,297 female controls, we identified a locus at chromosome 10q24.31 associated with adolescent idiopathic scoliosis susceptibility. The most significant SNP (rs11190870; combined P = 1.24 × 10(-19); odds ratio (OR) = 1.56) is located near LBX1 (encoding ladybird homeobox 1). The identification of this susceptibility locus provides new insights into the pathogenesis of adolescent idiopathic scoliosis.
Nature Genetics 12/2011; 43(12):1237-40. · 35.53 Impact Factor
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ABSTRACT: Use of computer-assisted spine surgery (CASS) technologies, such as navigation systems, to improve the accuracy of pedicle screw (PS) placement is increasingly popular. Despite of their benefits, previous CASS systems are too expensive to be ubiquitously employed, and more affordable and portable systems are desirable. The aim of this study was to introduce a novel and affordable computer-assisted technique that 3-dimensionally visualizes anatomical features of the pedicles and assists in PS insertion. The authors have termed this the 3D-visual guidance technique for inserting pedicle screws (3D-VG TIPS).
The 3D-VG technique for placing PSs requires only a consumer-class computer with an inexpensive 3D DICOM viewer; other special equipment is unnecessary. Preoperative CT data of the spine were collected for each patient using the 3D-VG TIPS. In this technique, the anatomical axis of each pedicle can be analyzed by volume-rendered 3D models, as with existing navigation systems, and both the ideal entry point and the trajectory of each PS can be visualized on the surface of 3D-rendered images. Intraoperative guidance slides are made from these images and displayed on a TV monitor in the operating room. The surgeon can insert PSs according to these guidance slides. The authors enrolled 30 patients with adolescent idiopathic scoliosis (AIS) who underwent posterior fusion with segmental screw fixation for validation of this technique.
The novel technique allowed surgeons, from office or home, to evaluate the precise anatomy of each pedicle and the risks of screw misplacement, and to perform 3D preoperative planning for screw placement on their own computer. Looking at both 3D guidance images on a TV monitor and the bony structures of the posterior elements in each patient in the operating theater, surgeons were able to determine the best entry point for each PS with ease and confidence. Using the current technique, the screw malposition rate was 4.5% in the thoracic region in corrective surgery for AIS.
The authors found that 3D-VG TIPS worked on a consumer-class computer and easily visualized the ideal entry point and trajectory of PSs in any operating theater without costly special equipment. This new technique is suitable for preoperative planning and intraoperative guidance when performing reconstructive surgery with PSs.
Journal of neurosurgery. Spine 07/2011; 15(5):479-85. · 1.61 Impact Factor
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Yohei Takahashi,
Morio Matsumoto,
Tatsuki Karasugi,
Kota Watanabe,
Kazuhiro Chiba,
Noriaki Kawakami,
Taichi Tsuji,
Koki Uno,
Teppei Suzuki,
Manabu Ito, Hideki Sudo,
Shohei Minami,
Toshiaki Kotani,
Katsuki Kono,
Haruhisa Yanagida,
Hiroshi Taneichi,
Atsushi Takahashi,
Yoshiaki Toyama,
Shiro Ikegawa
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ABSTRACT: Adolescent idiopathic scoliosis (AIS) is a common disorder with a strong genetic predisposition. Associations between AIS and common single nucleotide polymorphisms (SNPs) in estrogen receptor genes have been reported. rs9340799 in the gene for estrogen receptor α (ESR1) is reported to be associated with curve severity in Japanese and with AIS predisposition and curve severity in Chinese. In addition, rs1256120 in the gene for estrogen receptor β (ESR2) is reported to be associated with AIS predisposition and curve severity in Chinese. However, the sample sizes of these previous studies were small, and the associations of these SNPs have not been replicated. To examine the association between AIS and estrogen receptor genes, we investigated the association of rs9340799 and rs1256120 with AIS predisposition and curve severity using a large Japanese population, consisting of 798 AIS patients and 637 sex-matched controls. We found no association of either SNP with AIS predisposition or curve severity in the Japanese population. Considering the statistical power of the present study and the limitations of the previous reports, we conclude that the associations of rs9340799 and rs1256120 with AIS predisposition and curve severity are negative.
Journal of Orthopaedic Research 06/2011; 29(6):834-7. · 2.81 Impact Factor
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Yohei Takahashi,
Morio Matsumoto,
Tatsuki Karasugi,
Kota Watanabe,
Kazuhiro Chiba,
Noriaki Kawakami,
Taichi Tsuji,
Koki Uno,
Teppei Suzuki,
Manabu Ito, Hideki Sudo,
Shohei Minami,
Toshiaki Kotani,
Katsuki Kono,
Haruhisa Yanagida,
Hiroshi Taneichi,
Atsushi Takahashi,
Yoshiaki Toyama,
Shiro Ikegawa
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ABSTRACT: Adolescent idiopathic scoliosis (AIS) is a spinal deformity most commonly arising in apparently healthy girls around puberty. AIS has a strong genetic predisposition. Several genetic associations between AIS and single nucleotide polymorphisms (SNPs) have been reported; common SNPs in the genes for matrilin 1 (MATN1), melatonin receptor 1B (MTNR1B), tryptophan hydroxylase 1 (TPH1), and insulin-like growth factor 1 (IGF1) are reported to be associated with AIS in Chinese. However, these associations have not been replicated so far. To confirm the associations, we compared these SNPs with AIS predisposition and curve severity in a population of Japanese females consisting of 798 AIS patients and 1,239 controls. All the subjects were genotyped using the PCR-based Invader assay. We found no association of any of the SNPs with AIS predisposition or curve severity. Considering the statistical power and sample size of the present study, we concluded that these SNPs are not associated with either AIS predisposition or curve severity in Japanese.
Journal of Orthopaedic Research 02/2011; 29(7):1055-8. · 2.81 Impact Factor
