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ABSTRACT: Prospective trial of virtual endoscopy in spinal surgery.
To investigate the utility of virtual endoscopy of the spine in conjunction with spinal surgery.
Several studies have described clinical applications of virtual endoscopy to visualize the inside of the bronchi, paranasal sinus, stomach, small intestine, pancreatic duct, and bile duct, but, to date, no study has described the use of virtual endoscopy in the spine.
Virtual endoscopy is a realistic 3-dimensional intraluminal simulation of tubular structures that is generated by postprocessing of computed tomographic data sets. Five patients with spinal disease were selected: 2 patients with degenerative disease, 2 patients with spinal deformity, and 1 patient with spinal injury.
Virtual endoscopy software allows an observer to explore the spinal canal with a mouse, using multislice computed tomographic data. Our study found that virtual endoscopy of the spine has advantages compared with standard imaging methods because surgeons can noninvasively explore the spinal canal in all directions.
Virtual endoscopy of the spine may be useful to surgeons for diagnosis, preoperative planning, and postoperative assessment by obviating the need to mentally construct a 3-dimensional picture of the spinal canal from 2-dimensional computed tomographic scans.
Spine 05/2012; 37(12):E752-6. · 2.08 Impact Factor
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ABSTRACT: STUDY DESIGN.: A case-control study. OBJECTIVE.: To compare health-related quality of life and low back pain of healthy subjects with those of patients with nonidiopathic scoliosis (non-IS) and idiopathic scoliosis (IS) 21 years or more after surgery. SUMMARY OF BACKGROUND DATA.: There have been a very small number of reports on long-term results of surgery for non-IS. There have not been any reports that compare non-IS, IS, and healthy subjects. METHODS.: The subjects with scoliosis were 602 patients who had undergone surgery between 1968 and 1988. The Scoliosis Research Society Patient Questionnaire (SRS-22), Roland-Morris Disability Questionnaire (RDQ), and our institution's original questionnaire were used for evaluating long-term clinical outcomes. The 136 respondents consisted of 56 patients with non-IS (non-IS group) and 80 patients with IS (IS group). The control group (CTR group) consisted of 80 healthy volunteers who were age- and body mass index-matched to the scoliosis groups. RESULTS.: In the SRS-22, the 3 groups had no significant differences in pain and mental health. For function and self-image, the non-IS group and the IS group had a significantly lower score than the CTR group. In the RDQ, the non-IS group had significantly more severe low back pain than the CTR group. There was no significant difference in low back pain between the non-IS group and IS group or between the IS group and CTR group. The non-IS group had a significantly lower marriage rate than the IS and CTR groups. CONCLUSION.: The patients with non-IS and IS had similar health-related quality of life and low back pain. The patients with non-IS were found to have lower function and self-image in the SRS-22 questionnaire and more severe low back pain in the RDQ than healthy subjects. The patients with non-IS had a significantly lower marriage rate than the other 2 groups.
Spine 04/2012; 37(22):1899-903. · 2.08 Impact Factor
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ABSTRACT: A case control study.
To determine the clinical outcome of middle-aged patients surgically treated for adolescent idiopathic scoliosis and to compare their outcomes with assessments of age- and sex-matched healthy controls.
Several long-term follow-up studies have been published on the clinical outcomes of surgical treatment for adolescent idiopathic scoliosis in patients who have reached their 20s or 30s. However, clinical outcomes in patients who have reached middle age remain unknown.
This study included 256 patients surgically treated for adolescent idiopathic scoliosis (AIS) between 1968 and 1988. The Scoliosis Research Society Patient Questionnaire (SRS-22) and Roland-Morris Disability Questionnaire (RDQ) were used for evaluating long-term clinical outcomes. Sixty-six (25.8%; 62 females, 4 males; mean age, 46.0 years [range 34-56]) of the 256 patients responded to the questionnaires. The mean follow-up period was 31.5 (range 21-41) years. Seventy-six healthy age- and sex-matched individuals with neither a history of spinal surgery nor scoliosis were selected as a control (CTR) group.
On the basis of the SRS-22 responses, AIS patients had significantly decreased function (AIS: 4.3 ± 0.6, CTR: 4.7 ± 0.5, P < 0.01) and decreased self-image (AIS: 3.0 ± 0.8, CTR: 3.7 ± 0.5, P < 0.01) in comparison with the controls, but the 2 groups were similar with respect to pain (AIS: 4.3 ± 0.6, CTR: 4.2 ± 0.5, P = 0.14) and mental health (AIS: 3.9 ± 0.9, CTR: 3.7 ± 0.7, P = 0.14). The RDQ responses indicated that low back pain was not significantly increased in the AIS group compared with the CTR group (AIS: 1.8 ± 3.5, CTR: 1.4 ± 3.1, P = 0.36).
Surgery had no demonstrable adverse effects on pain or mental health in these middle-aged AIS patients 21-41 years after surgery, although the AIS patients did have significantly lower function and lower self-image than the controls.
Spine 03/2012; 37(5):402-5. · 2.08 Impact Factor
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Sumihisa Orita, Takana Koshi,
Takeshi Mitsuka,
Masayuki Miyagi,
Gen Inoue,
Gen Arai,
Tetsuhiro Ishikawa,
Eiji Hanaoka,
Keishi Yamashita,
Masaomi Yamashita,
Yawara Eguchi,
Tomoaki Toyone,
Kazuhisa Takahashi,
Seiji Ohtori
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ABSTRACT: One of the sources of knee pain in osteoarthritis (OA) is believed to be related to local chronic inflammation of the knee joints, which involves the production of inflammatory cytokines such as tumor necrosis factor alpha (TNFα), interleukin (IL)-6, and nerve growth factor (NGF) in the synovial membrane, and these cytokines are believed to promote pathological OA. In the present study, correlations between proinflammatory cytokines in knee synovial fluid and radiographic changes and functional scores and pain scores among OA patients were examined.
Synovial fluid was harvested from the knees of 47 consecutive OA patients, and the levels of TNFα, IL-6, and NGF were measured using enzyme-linked immunosorbent assays. Osteoarthritic knees were classified using Kellgren-Lawrence (KL) grading (1-4). The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) was used to assess self-reported physical function, pain, and stiffness.
TNFα and IL-6 were detectable in knee synovial, whereas NGF was not. TNFα was not correlated with the KL grade, whereas IL-6 had a significantly negative correlation. We observed differences in the correlations between TNFα and IL-6 with WOMAC scores and their subscales (pain, stiffness, and physical function). TNFα exhibited a significant correlation with the total score and its 3 subscales, whereas IL-6 exhibited a moderately significant negative correlation only with the subscale of stiffness.
The present study demonstrated that the concentrations of proinflammatory cytokines are correlated with KL grades and WOMAC scores in patients with knee OA. Although TNFα did not have a significant correlation with the radiographic grading, it was significantly associated with the WOMAC score. IL-6 had a significant negative correlation with the KL grading, whereas it had only a weakly significant correlation with the subscore of stiffness. The results suggest that these cytokines play a role in the pathogenesis of synovitis in osteoarthritic knees in different ways: TNFα is correlated with pain, whereas IL-6 is correlated with joint function.
BMC Musculoskeletal Disorders 06/2011; 12:144. · 1.58 Impact Factor
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Seiji Ohtori, Takana Koshi,
Masaomi Yamashita,
Masashi Takaso,
Kazuyo Yamauchi,
Gen Inoue,
Munetaka Suzuki,
Sumihisa Orita,
Yawara Eguchi,
Nobuyasu Ochiai, [......],
Tetsuhiro Ishikawa,
Gen Arai,
Masayuki Miyagi,
Hiroto Kamoda,
Miyako Suzuki,
Junichi Nakamura,
Takeo Furuya,
Tomoaki Toyone,
Masatsune Yamagata,
Kazuhisa Takahashi
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ABSTRACT: Surgery for lumbar spondylolisthesis is widely performed. However, there have been no reports comparing posterolateral and anterior interbody fusion prospectively. We compared instrumented posterolateral fusion with anterior interbody fusion for L4 spondylolisthesis in a prospective study.
Forty-six patients diagnosed with L4 degenerated spondylolisthesis were divided into two groups. Twenty-two consecutive patients underwent non-instrumented anterior interbody fusion using an iliac bone graft (ALIF; L4-L5 level), and 24 consecutive patients underwent instrumented posterolateral fusion with local bone (PLF; L4-L5 level). The rates of bone union, visual analog scale (VAS) score, Japanese Orthopedic Association (JOA) score, Oswestry Disability Index (ODI), surgical invasion, and complications were evaluated before and 2 years after surgery.
Age, VAS score, JOA score, and ODI were not significantly different between the two groups before surgery (P > 0.05). Success of bone union between the two groups was not significantly different (P > 0.05). Blood loss during surgery was significantly less; however, periods of bed rest and hospital stay were significantly longer in the ALIF group (P < 0.05). Overall patient satisfaction, and low back and leg pain in both groups were significantly improved after surgery; however, low back pain showed greater improvement in the ALIF group compared with the PLF group (P < 0.05). Complications such as donor site pain (4 patients in the ALIF group) and dural tearing (3 patients in the PLF group) were observed.
If single level fusion for L4 spondylolisthesis is performed, both anterior and posterior methods reduce patients' low back and leg pain. Improvement of low back pain was significantly greater after ALIF; however, periods of hospital stay and of bed rest were significantly longer.
Journal of Orthopaedic Science 05/2011; 16(4):352-8. · 0.84 Impact Factor
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Seiji Ohtori, Takana Koshi,
Munetaka Suzuki,
Masashi Takaso,
Masaomi Yamashita,
Kazuyo Yamauchi,
Gen Inoue,
Sumihisa Orita,
Yawara Eguchi,
Nobuyasu Ochiai, [......],
Yasuchika Aoki,
Junichi Nakamura,
Tetsuhiro Ishikawa,
Gen Arai,
Masayuki Miyagi,
Hiroto Kamoda,
Miyako Suzuki,
Takeo Furuya,
Tomoaki Toyone,
Kazuhisa Takahashi
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ABSTRACT: Prospective trial.
To examine the bone union and clinical results after unilateral or bilateral instrumented posterolateral fusion surgery using a local bone graft.
The iliac crest bone graft technique for lumbar posterolateral fusion surgery is widely used; however, donor site problems such as pain and sensory disturbance have been reported. Local bone has been used for bilateral multisegment fusion surgery; however, outcomes have been poor because of insufficient amounts of local bone used. This study evaluated unilateral and bilateral posterolateral fusion at 3 levels using a local bone graft.
Sixty-two patients diagnosed with degenerated spondylolisthesis at 3 levels were divided into 2 groups. All underwent decompression and bilateral instrumented posterolateral fusion. However, a unilateral local bone graft was used in 32 patients and bilateral local bone graft was used in 30 patients. The amount of bone grafting, proportion of patients with bone union, duration of bone union, visual analog scale score, Japanese Orthopedic Association score, and Oswestry Disability Index were evaluated before and 2 years after surgery.
Visual analog scale score, Japanese Orthopedic Association score, and Oswestry Disability Index were not significantly different between the 2 groups before and after surgery (P > 0.05). The amount of local bone graft used for each segment was significantly less in the bilateral group (P < 0.05). The proportion of patients with rates of bone union and instability were 86% and 9%, respectively, in the unilateral group, but significantly poorer at 60% and 34% in the bilateral group.
If multisegment fusion (3-level fusion) is performed, bilateral local bone grafting results in a poor rate of bone union because of an insufficiency of local bone. Unilateral bone grafting is recommended because better rates of bone union and stability are achieved.
Spine 05/2011; 36(26):E1744-8. · 2.08 Impact Factor
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Seiji Ohtori, Takana Koshi,
Masaomi Yamashita,
Kazuyo Yamauchi,
Gen Inoue,
Munetaka Suzuki,
Sumihisa Orita,
Yawara Eguchi,
Nobuyasu Ochiai,
Shunji Kishida, [......],
Kazuki Kuniyoshi,
Yasuchika Aoki,
Tetsuhiro Ishikawa,
Gen Arai,
Masayuki Miyagi,
Hiroto Kamoda,
Miyako Suzuki,
Junichi Nakamura,
Tomoaki Toyone,
Kazuhisa Takahashi
Spine 03/2011; 36(5):347-54. · 2.08 Impact Factor
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Kazuhide Inage,
Seiji Ohtori, Takana Koshi,
Munetaka Suzuki,
Masashi Takaso,
Masaomi Yamashita,
Kazuyo Yamauchi,
Gen Inoue,
Sumihisa Orita,
Yawara Eguchi, [......],
Kazuki Kuniyoshi,
Yasuchika Aoki,
Junichi Nakamura,
Tetsuhiro Ishikawa,
Gen Arai,
Masayuki Miyagi,
Hiroto Kamoda,
Takane Suzuki,
Tomoaki Toyone,
Kazuhisa Takahashi
[show abstract]
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ABSTRACT: Prospective trial.
To examine the difference in bone union and clinical results after one-, two-, and three-level instrumented posterolateral fusion surgery using a local bone graft.
The iliac crest bone graft technique for lumbar posterolateral fusion surgery is widely used; however, donor site problems such as pain and sensory disturbance have been reported. Local bone has been used for fusion surgery; however, its reliability as a graft for multiple segments has not been fully reported.
One hundred twenty-two patients diagnosed with degenerated spondylolisthesis were divided into three groups [spondylolisthesis at 1 level (n = 42), at 2 levels (n = 40), and at 3 levels (n = 40)]. All patients underwent decompression and instrumented posterolateral fusion with a local bone graft. The amount of bone graft, proportion of patients with (rate) and duration of bone union, Visual Analog Scale (VAS) score, Japanese Orthopedic Association Score (JOAS), and Oswestry Disability Index (ODI) were evaluated before and 2 years after therapy.
VAS score, JOA score, and ODI were not significantly different among the three groups before and after surgery (P > 0.05). Average amount of local bone graft used for one segment significantly decreased in proportion to the number of fusion levels (P < 0.05). The rate of bone union was 88% in the one-level group, 85% in the two-level group, and 62.5% in the three-level group, which was significantly lower than that in the one- and two-level groups (P < 0.05).
If one- and two-level posterolateral fusion were performed, the local bone graft technique provides a good and uniform bone union rate; however, for three-level fusion poor results were obtained because of an insufficient amount of local bone.
Spine 01/2011; 36(17):1392-6. · 2.08 Impact Factor
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Yasuhiro Oikawa,
Seiji Ohtori, Takana Koshi,
Masashi Takaso,
Gen Inoue,
Sumihisa Orita,
Yawara Eguchi,
Nobuyasu Ochiai,
Shunji Kishida,
Kazuki Kuniyoshi,
Junichi Nakamura,
Yasuchika Aoki,
Tetsuhiro Ishikawa,
Masayuki Miyagi,
Gen Arai,
Hiroto Kamoda,
Miyako Suzuki,
Takeshi Sainoh,
Tomoaki Toyone,
Kazuhisa Takahashi
[show abstract]
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ABSTRACT: Prospective study of 212 patients with groin pain but without low back pain.
To evaluate discogenic groin pain without low back pain or radicular pain.
Patients feel low back pain originating from discogenic disease. It has been reported that the rat lower lumbar discs are innervated mainly by L2 dorsal root ganglion neurons. Thus, it is possible that patients feel referred groin pain corresponding to the L2 dermatome originating from intervertebral discs; however, the referred pain has not been fully clarified in humans.
We selected 5 patients with groin pain alone for investigation. The patients suffered from groin pain and showed disc degeneration only at 1 level (L4-L5 or L5-S1) on magnetic resonance imaging. Patients did not show any hip joint abnormality on radiography or magnetic resonance imaging. To prove that their groin pain originated in degenerated intervertebral discs, we evaluated changes in groin pain after infiltration of lidocaine into hip joints and examined pain provocation on discography, pain relief by anesthetic discoblock, and finally anterior lumbar interbody fusion surgery.
All patients were negative for hip joint block, positive for pain provocation on discography, and positive for pain relief by anesthetic discoblock. Furthermore, bony union was achieved 1 year after anterior interbody fusion surgery in all patients, and visual analogue scale score of groin pain was significantly improved at 1 year after surgery in all patients (P < 0.05).
In the current study, we diagnosed discogenic groin pain, using magnetic resonance imaging, infiltration of lidocaine into the hip joint, pain provocation on discography, pain relief by anesthetic discoblock, and lumbar surgery. It is important to consider the existence of discogenic groin pain if patients do not show low back pain.
Spine 01/2011; 37(2):114-8. · 2.08 Impact Factor
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Seiji Ohtori,
Miyako Suzuki, Takana Koshi,
Masashi Takaso,
Masaomi Yamashita,
Kazuyo Yamauchi,
Gen Inoue,
Munetaka Suzuki,
Sumihisa Orita,
Yawara Eguchi, [......],
Shunji Kishida,
Kazuki Kuniyoshi,
Junichi Nakamura,
Yasuchika Aoki,
Tetsuhiro Ishikawa,
Gen Arai,
Masayuki Miyagi,
Hiroto Kamoda,
Tomoaki Toyone,
Kazuhisa Takahashi
[show abstract]
[hide abstract]
ABSTRACT: The iliac crest bone grafting (ICBG) technique for lumbar posterolateral fusion surgery is widely used; however, donor site problems such as pain and sensory disturbance have been reported. Local bone is available for fusion surgery, but its reliability as a graft has not been fully reported. In the current study, we examined single-level instrumented posterolateral fusion with a local bone graft versus an ICBG in a prospective randomized study. Eighty-two patients diagnosed with L4 degenerated spondylolisthesis were divided into two groups at random. Forty-two patients underwent instrumented posterolateral fusion with a local bone graft (L4-L5 level), and 40 patients underwent instrumented posterolateral fusion with an ICBG (L4-L5 level). Rate and duration of bone union, visual analog scale (VAS) score, Japanese orthopedic association score (JOAS), Oswestry Disability Index (ODI), and complications were evaluated before and 2 years after therapy. VAS score, JOAS, and ODI were not significantly different between the two groups before and after surgery (P > 0.05). Rate and average duration of bone union were 90% and 8.5 months in the local bone graft group, and 85% and 7.7 months in the ICBG group, but without significant difference (P > 0.05). Prolonged surgical time and complications such as donor site pain (8 patients) and sensory disturbance (6 patients) were observed in the ICBG group. If single-level posterolateral fusion was performed, local bone graft technique has the same bone union rate compared with ICBG, requires less surgical time, and has fewer complications.
European Spine Journal 12/2010; 20(4):635-9. · 1.97 Impact Factor
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Seiji Ohtori,
Munetaka Suzuki, Takana Koshi,
Masaomi Yamashita,
Kazuyo Yamauchi,
Gen Inoue,
Sumihisa Orita,
Yawara Eguchi,
Kazuki Kuniyoshi,
Nobuyasu Ochiai, [......],
Masashi Takaso,
Yasuchika Aoki,
Tetsuhiro Ishikawa,
Gen Arai,
Masayuki Miyagi,
Hiroto Kamoda,
Miyako Suzuki,
Junichi Nakamura,
Tomoaki Toyone,
Kazuhisa Takahashi
[show abstract]
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ABSTRACT: Prospective cohort study.
To examine the utility of 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) to diagnose pyogenic spondylitis in patients showing Modic change.
Vertebral bone marrow infection may appear as Modic type 1 signal on magnetic resonance imaging, so it is difficult to distinguish between common Modic change and infection. In the current study, we aimed to examine the utility of 18F-FDG-PET to diagnose pyogenic spondylitis in patients showing Modic change.
In a prospective assessment of 312 patients showing low back pain, 18 patients were suspected of having pyogenic vertebral osteomyelitis because of their symptoms, biopsy results, blood analysis, x-ray examination, magnetic resonance imaging, and FDG-PET during a 1-year follow-up.
Observers ultimately diagnosed 11 patients with pyogenic spondylitis (group 1 observers). FDG-PET evaluation by 2 radiologists (group 2 observers) showed isotope accumulation in the lumbar spine in 11 patients, and no accumulation in 7 patients. The evaluation by group 1 observers, who did not see the FDG-PET findings, was compared with the evaluation by group 2 observers. No patients were evaluated differently by group 1 and group 2 observers.
In conclusion, the rate of detecting spondylodiscitis infection was very high if FDG-PET was additionally used. FDG-PET is recommended to distinguish between common Modic change and spinal infection.
Spine 12/2010; 35(26):E1599-603. · 2.08 Impact Factor
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Seiji Ohtori,
Shinichiro Nakamura, Takana Koshi,
Masaomi Yamashita,
Kazuyo Yamauchi,
Gen Inoue,
Sumihisa Orita,
Yawara Eguchi,
Munetaka Suzuki,
Nobuyasu Ochiai, [......],
Junichi Nakamura,
Tetsuhiro Ishikawa,
Gen Arai,
Masayuki Miyagi,
Hiroto Kamoda,
Miyako Suzuki,
Yuzuru Takahashi,
Tomoaki Toyone,
Masatsune Yamagata,
Kazuhisa Takahashi
[show abstract]
[hide abstract]
ABSTRACT: It has been reported that rat L5/6 lumbar discs are innervated mainly by L2 dorsal root ganglion neurons. We previously reported that L2 spinal nerve infiltration was effective for discogenic low back pain (DLBP) patients, although the diagnosis was based only on the results of physical examination, plain films, and magnetic resonance imaging (MRI). The purpose of the current study was to evaluate L2 spinal nerve block for DLBP patients retrospectively based on MRI findings and surgical results.
A total of 62 patients with only LBP and no accompanying radicular pain were investigated. Patients had only one level of disc degeneration on MRI. When pain was provoked during discography, we performed surgery at the next stage (40 patients). In all, 22 patients were excluded owing to negative discography results. Of the 40 patients, we evaluated 25 strictly selected patients suffering from DLBP. DLBP was diagnosed when the patient experienced pain relief at least 2 years after anterior lumbar interbody fusion. Fifteen patients who did not show pain relief after surgery were used for the non-DLBP group. L2 spinal nerve infiltration using 1.5 ml of lidocaine was performed in all 40 patients before surgery. The visual analogue scale (VAS) score after L2 spinal nerve infiltration was recorded, and an association of L2 spinal nerve infiltration and DLBP was explored.
Low back pain scores assessed using the VAS score, the Japanese Orthopedic Association score, and the Oswestry Disability Index score in the two groups were not significantly different. L 2 spinal nerve infiltration was effective for 27 patients but not effective for 13 patients; the VAS score after 15 min and 2 h improved in the DLBP group compared with that of the non-DLBP group (P < 0. 05). L2 spinal nerve infiltration was more effective in DLBP patients (21 patients, 84%) than in the non-DLBP group (6 patients, 40%) (P < 0.05).
In the current study, L2 spinal nerve infiltration was effective in 84% of selected DLBP patients and is thought to be a useful tool for diagnosing DLBP. However, we should take into consideration that the L2 spinal nerve infiltration was effective in 40% of non-DLBP patients as well.
Journal of Orthopaedic Science 11/2010; 15(6):731-6. · 0.84 Impact Factor
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Seiji Ohtori,
Munetaka Suzuki, Takana Koshi,
Masashi Takaso,
Masaomi Yamashita,
Gen Inoue,
Kazuyo Yamauchi,
Sumihisa Orita,
Yawara Eguchi,
Kazuki Kuniyoshi, [......],
Shunji Kishida,
Junichi Nakamura,
Yasuchika Aoki,
Tetsuhiro Ishikawa,
Gen Arai,
Masayuki Miyagi,
Hiroto Kamoda,
Miyako Suzuki,
Tomoaki Toyone,
Kazuhisa Takahashi
[show abstract]
[hide abstract]
ABSTRACT: In pathologic radicular pain of lumbar spinal stenosis, cytokines such as tumor necrosis factor-alpha (TNF-α) and interleukins (ILs) play a crucial role in the pathogenesis of nerve degeneration and pain. We investigated TNF-α and IL-6 levels in the cerebrospinal fluid (CSF) of patients with radicular pain caused by lumbar spinal stenosis (LSS). A total of 30 LSS patients and 10 age-matched controls were examined. CSF samples were obtained adjacent to the level of stenosis in 30 LSS patients, and at the L4-L5 level in the 10 control patients. TNF-α and IL-6 levels in the samples were analyzed using enzyme-linked immunosorbent assays (ELISA). We compared the amounts of TNF-α and IL-6 with severity of pain (low back and leg pain), walking ability, and severity of stenosis (cross-sectional area of dural space). The concentration of IL-6 was significantly higher in LSS patients than in controls, but TNF-α levels were beneath the limit of detection. There was no correlation between IL-6 levels and severity of pain or walking ability (p > 0.05). However, there was a significant correlation between IL-6 levels and severity of stenosis (p < 0.05). The current study showed that the increased CSF IL-6 levels in LSS patients with radicular pain were not correlated with pain severity; although not proven in this study, the increase in CSF IL-6 concentration could indicate pathological nerve damage or degeneration of lumbar radiculopathy represented by the severity of stenosis.
European Spine Journal 10/2010; 20(6):942-6. · 1.97 Impact Factor
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Sumihisa Orita,
Seiji Ohtori, Takana Koshi,
Masaomi Yamashita,
Kazuyo Yamauchi,
Gen Inoue,
Munetaka Suzuki,
Yawara Eguchi,
Hiroto Kamoda,
Gen Arai,
Tetsuhiro Ishikawa,
Masayuki Miyagi,
Nobuyasu Ochiai,
Shunji Kishida,
Masashi Takaso,
Yasuchika Aoki,
Tomoaki Toyone,
Kazuhisa Takahashi
[show abstract]
[hide abstract]
ABSTRACT: Investigation of sensory innervation of rat osteoporotic lumbar vertebrae using in vitro and in vivo models.
To investigate (1) sensory innervation of osteoporotic rat vertebrae, (2) effects of risedronate on sensory neurons, (3) effects of osteoporosis treatment on bone mineral densities (BMDs) and the sensory innervation.
Osteoporotic patients without fractures sometimes experience vague low back pain of unknown origin. The mechanisms of osteoporosis treatments against the pain are unclear.
(1) The expression of calcitonin gene-related peptide (CGRP) immunoreactive (-ir) or transient receptor potential vanilloid 1 (TRPV1)-ir nerve fibers in vertebrae and dorsal root ganglions (DRG) innervating L3 vertebrae of Sprague Dawley rats labeled with neurotracer were examined in control, sham, and ovariectomized (OVX) rats. (2) Cultured rat neonate DRG neurons in media containing different concentrations of risedronate were immunostained for CGRP, and we measured its activity using axonal length and proportion of CGRP-ir neurons. (3) BMDs and CGRP expression in DRG neurons innervating L3 vertebrae were examined in the following 5 groups: sham (treated with saline), OVX (saline), OVX+EXE (treadmill exercise), OVX+RIS (risedronate), and OVX+RIS+EXE (risedronate and exercise).
(1) A few CGRP-ir or TRPV1-ir nerve fibers were observed in the bone marrow. CGRP or TRPV1 expression in DRG was elevated in the OVX group (P < 0.05). (2) The axonal length and proportion of CGRP-ir neurons were dose-dependently suppressed (P < 0.05). (3) BMDs improved and the CGRP expression decreased in the risedronate-treated groups (P < 0.05), especially in the OVX+RIS+EXE group.
Sensory innervation of osteoporotic rat vertebrae showed increased expression of CGRP and TRPV1 in DRG neurons. Risedronate suppressed activity of CGRP-ir neurons in vitro, improved BMD, and decreased CGRP expression, especially together with exercise in vivo.
Spine 10/2010; 35(22):1974-82. · 2.08 Impact Factor
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Seiji Ohtori,
Masaomi Yamashita,
Kazuyo Yamauchi,
Gen Inoue, Takana Koshi,
Munetaka Suzuki,
Sumihisa Orita,
Yawara Eguchi,
Nobuyasu Ochiai,
Shunji Kishida,
Masashi Takaso,
Yasuchika Aoki,
Tetsuhiro Ishikawa,
Gen Arai,
Masayuki Miyagi,
Hiroto Kamoda,
Junichi Nakamura,
Kazuhisa Takahashi
[show abstract]
[hide abstract]
ABSTRACT: Prospective cohort study.
To examine the relationship between low back pain after discectomy for disc herniation and Modic type 1 change.
Lumbar vertebral bone marrow change is divided into Modic types. Some reports indicate that Modic type 1 is related to low back pain, but the reliability of this assertion is unclear. The current study examines changes in low back pain in patients with lumbar disc herniation and Modic type 1 change after lumbar discectomy without fusion surgery.
Forty-five patients with lumbar disc herniation showing normal or Modic type 1 signals in their bone marrow were selected (mean age 35 years). All patients suffered low back and leg pain because of lumbar disc herniation, and underwent a discectomy without fusion. We evaluated change in low back pain [Visual analogue scale (VAS) score, Japanese Orthopedic Association score (JOAS), and Oswestry Disability Index (ODI)] before, 12 and 24 months after surgery.
Twenty-three patients showed Modic type 1 signals and 22 patients showed normal intensity before surgery. VAS score, JOAS, and ODI were not significantly different between the normal and Modic type 1 groups. VAS score, JOAS, and ODI improved after surgery in both groups (P>0.05). Low back pain after surgery evaluated from the 3 scores was not significantly different in the 2 groups 12 or 24 months after surgery (P>0.05).
Discectomy improved low back pain in patients suffering from lumbar disc herniation. Patients with or without Modic type 1 change showed a similar improvement of low back pain score. Low back pain in patients with disc herniation appears to mainly originate from disc or nerve root compression, and decompression surgery without fusion is an option for these patients, even those with Modic type 1 changes.
Spine 06/2010; 35(13):E596-600. · 2.08 Impact Factor
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Seiji Ohtori, Takana Koshi,
Masaomi Yamashita,
Kazuyo Yamauchi,
Gen Inoue,
Munetaka Suzuki,
Masashi Takaso,
Sumihisa Orita,
Yawara Eguchi,
Nobuyasu Ochiai,
Shunji Kishida,
Kazuki Kuniyoshi,
Junichi Nakamura,
Yasuchika Aoki,
Tetsuhiro Ishikawa,
Gen Arai,
Masayuki Miyagi,
Hiroto Kamoda,
Kazuhisa Takahashi
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ABSTRACT: The relationship of Modic change to pain and inflammation remains to be unclear. Recently, some authors have reported that Modic type 1 signals are closely related to infection. However, if the patients do not have severe back pain, fever, or an abnormal blood profile, it is difficult to distinguish between common Modic change and infection. The purpose of this study was to examine the prevalence of pyogenic spondylitis in patients who showed Modic type 1 change without other signs of infection. Seventy-one patients with Modic type 1 change were evaluated (average age 55, 32 males and 39 females). X-ray and magnetic resonance imaging (MRI) were performed to investigate low-back pain and leg pain. Body temperature was measured and blood analysis (including white blood cell count and level of C-reactive protein) was conducted for all patents. All 71 patients with Modic type 1 change, but without other signs of infection were followed for 2 years. Low-back pain, X-ray, and blood analyses were performed every 3 months; and MRI was performed every year. Severe low-back pain or abnormal signs developed in four patients during the follow-up. Pyogenic spondylitis was diagnosed in three patients by symptoms, blood results, and imaging, and confirmed by biopsy. Two of the three patients were diabetic. A total of 4.2% of patients with Modic type 1 change, but without other signs of infection were diagnosed as having pyogenic spondylitis during the 2-year follow-up, therefore, it is important to consider this before treating Modic type 1 change.
European Spine Journal 03/2010; 19(7):1200-5. · 1.97 Impact Factor
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Seiji Ohtori,
Masaomi Yamashita,
Kazuyo Yamauchi,
Gen Inoue, Takana Koshi,
Munetaka Suzuki,
Sumihisa Orita,
Yawara Eguchi,
Nobuyasu Ochiai,
Shunji Kishida,
Masashi Takaso,
Kazuki Kuniyoshi,
Tetsuhiro Ishikawa,
Gen Arai,
Masayuki Miyagi,
Hiroto Kamoda,
Junichi Nakamura,
Yasuchika Aoki,
Kazuhisa Takahashi
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ABSTRACT: Prospective cohort study.
To examine the change of Modic Type 1 to Type 2 after posterolateral fusion surgery.
Lumbar vertebral bone marrow change is divided into Modic types. Magnetic resonance imaging reveals Modic Type 1 and 2 signals. Some reports indicate that with time, Type 1 signals (intervertebral instability) change to Type 2 (restabilization), but the reliability of this assertion is unclear. The current study examines the change of Modic Type 1 signals to Type 2 after posterolateral fusion surgery.
Patients with Modic Type 1 and 2 signals were selected (mean age, 65 years). All patients suffered low back pain and leg pain due to lumbar spinal canal stenosis, and underwent decompression and posterolateral fusion surgery. We evaluated change in Modic signal and severity of low back pain (Visual analogue scale score, Japanese Orthopedic Association score, and Oswestry Disability Index before and 24 months after surgery.
Of 21 patients with Modic Type 1 signals before surgery, 2 cases changed to normal bone marrow, 9 to Type 2, and 12 remained Type 1. Of 12 patients with Type 2 signals, none changed to Type 1, 2 changed to normal bone marrow, and 10 remained Type 2. Visual analogue scale score, Japanese Orthopedic Association score, and Oswestry Disability Index improved after surgery; however, low back pain was not significantly associated with signal change after surgery (P > 0.05).
In the current study, Modic Type 1 signals changed to Type 2; however, Type 2 did not change to Type 1, suggesting that Type 2 signals indicate a stabilized stage. For Modic Type 1 and 2 signals, there were changes to normal bone marrow signals in 4 cases. Therefore, degenerated bone marrow may be able to regenerate after surgical stabilization. We did not show a significant difference between low back pain and signal type.
Spine 02/2010; 35(12):1231-5. · 2.08 Impact Factor
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Seiji Ohtori,
Masaomi Yamashita,
Gen Inoue,
Kazuyo Yamauchi, Takana Koshi,
Munetaka Suzuki,
Masashi Takaso,
Sumihisa Orita,
Yawara Eguchi,
Nobuyasu Ochiai, [......],
Masaya Mimura,
Noriyuki Yanagawa,
Tetsuhiro Ishikawa,
Gen Arai,
Masayuki Miyagi,
Hiroto Kamoda,
Yasuchika Aoki,
Kazuki Kuniyoshi,
Junichi Nakamura,
Kazuhisa Takahashi
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ABSTRACT: The number of patients showing lumbar degenerative scoliosis, including disc wedging, has increased, and examination of the mechanism of spinal nerve compression due to lateral and rotational mobility of the lumbar spine is necessary. Thirty-two patients with L4-L5 disc wedging but without antero- or retrospondylolisthesis and ten age-matched controls were examined. The angle of disc wedging and change in the angle between left and right bending were evaluated by anterior-posterior X-ray images of patients while they were in a standing position. The degree of disc degeneration and existence of vacuum phenomena were evaluated at the L4-L5 discs. Rotational mobility between maximal right and left rotation was examined by computed tomography (CT). Rotational mobility was measured using the spinal transverse processes of L4 and L5. The relationship between these factors was statistically evaluated using multivariate analysis and Spearman's correlation test. There was a significant increase in the average rotational mobility of the L4-L5 disc-wedging group. In the L4-L5 disc-wedging group, the increased angle of disc wedging and change in the angle between left and right bending correlated with increased rotational mobility. The degree of disc degeneration did not affect rotational mobility. However, existence of vacuum phenomena increased the rotational mobility of the L4-L5 disc-wedging group. This is the first study to evaluate the rotational hypermobility of L4-L5 disc wedging in patients without antero- or retrospondylolisthesis using kinematic CT. Increases in the wedging angle and abnormal instability of lateral bending correlated with increased rotational mobility. For surgical planning of degenerative L4-L5 disc wedging, it is important to consider rotational hypermobility using kinematic CT or X-ray imaging findings of lateral bending.
European Spine Journal 02/2010; 19(6):989-94. · 1.97 Impact Factor
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Seiji Ohtori,
Toshinori Ito,
Masaomi Yamashita,
Yasuaki Murata,
Tatsuo Morinaga,
Jiro Hirayama,
Tomoaki Kinoshita,
Hiromi Ataka, Takana Koshi,
Toshihiko Sekikawa, [......],
Kaoru Suseki,
Hajime Arai,
Masahiro Kurokawa,
Yawara Eguchi,
Miyako Suzuki,
Yuzuru Okamoto,
Jin Miyagi,
Masatsune Yamagata,
Tomoaki Toyone,
Kazuhisa Takahashi
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ABSTRACT: The Japanese Orthopaedic Association (JOA) has investigated the JOA Back Pain Evaluation Questionnaire (JOABPEQ) to evaluate several aspects of low back pain in patients. The score includes five categories (25 items) selected from the Roland Morris Disability Questionnaire and Short Form 36, and a visual analogue scale. Japanese physicians have recently used these scores to evaluate back pain; however, the efficacy has not been fully explored in large-scale studies. In the current study, we used the JOABPEQ to evaluate lumbar spinal disease in 555 patients (with lumbar disc herniation, lumbar spinal stenosis, and lumbar disc degeneration/spondylosis) in multiple spine centers and compared the results based on age, sex, and type of disease.
A total of 555 patients who had low back or leg pain were selected in 22 hospitals in Chiba Prefecture. Spine surgeons diagnosed their disease type based on symptoms, physical examination, radiography images, and magnetic resonance imaging. In all, 486 patients were diagnosed with spinal stenosis (239 patients), disc degeneration/spondylosis (143 patients), or disc herniation (104 patients). The other 69 patients were diagnosed with spondylolysis (16 patients) or other diseases (53 patients). The pain score in all patients was evaluated using the JOABPEQ (from 0 to 100, with 0 indicating the worst pain).
The age of the patients was 56.1 +/- 13.3 years (mean +/- SD); the age of patients in the disc herniation and disc degeneration/spondylosis group was significantly lower than that in the spinal stenosis group. The average JOABPEQ scores in all patients were, for low back pain, 47.1; lumbar function, 53.6; walking ability, 54.8; social life function, 48.7; and mental health, 48.3. The low back pain score in men was significantly worse than that in women. In contrast, the mental health score in women was significantly higher than that in men. The low back pain score in patients <40 years old and the walking ability score in patients >65 years old were significantly lower than those scores in other patients. Based on the disease type, low back pain, lumbar function, social life function, and mental health scores for patients with disc herniation were significantly worse than for those with spinal stenosis.
JOABPEQ scores were evaluated for several lumbar diseases. The average of five categories of JOABPEQ scores in all patients was similarly distributed. However, the average scores in the five categories were significantly different depending on age, sex, and type of disease. Compared with prior mass data (baseline data on the observational cohort of the Spine Patient Outcomes Research Trial in the United States), many data were similar based on the type of disease in the current study. Furthermore, the JOABPEQ is easy to use compared with the SF-36. Hence, we concluded that the JOABPEQ could be used worldwide as a tool for evaluating low back pain.
Journal of Orthopaedic Science 01/2010; 15(1):86-91. · 0.84 Impact Factor
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ABSTRACT: Degeneration of lumbar intervertebral discs is thought to be a cause of low back pain. Studies have found that a cause of discogenic low back pain is intervertebral disc inflammation and axonal growth of afferent fibers innervating the disc. Lumbar spine fusion for chronic discogenic low back pain is considered an effective procedure. However, no study has investigated the mechanism of pain relief. We did this by applying Fluoro-Gold (FG) to the ventral aspect of the L4-L5 intervertebral discs of 40 rats. We exposed the nucleus pulposus to the annulus fibrosus in a disc punctured model. Rats were divided into 4 groups. Group A: Punctured intervertebral disc with sham posterolateral fusion (PLF) (n = 10), Group B: Punctured intervertebral disc with PLF (n = 15), Group C: Normal intervertebral disc (no puncture) with PLF (n = 10), and Group D: Normal disc (no disc puncture) with sham PLF (n = 5). Four weeks after surgery, bilateral L1-L5 dorsal root ganglia (DRGs) were stained with growth-associated protein 43 (GAP43), a marker of axonal growth, and calcitonin gene-related peptide (CGRP), a neuropeptide marker of pain. Bone union was evaluated using X-ray imaging. Of the FG-labeled neurons, the proportions of GAP43- and CGRP-immunoreactive (IR) neurons in Group A were significantly higher than in Group D (P < 0.05). The proportions of GAP43- and CGRP-IR neurons in bone union rats in Group B were significantly lower than in nonunion rats in Group B and in the rats in Group A (P < 0.05). No significant differences in GAP43- and CGRP-IR neurons were observed between bone union and nonunion rats in Group C and the rats in Group D (P > 0.05). PLF is strongly related to the downregulation of GAP43 and CGRP expression. Therefore, PLF may suppress the increase of inflammatory neuropeptides and the process of axonal growth. Moreover, these results may explain, in part, the mechanism of pain relief following lumbar spinal fusion for chronic discogenic low back pain in humans.
European Spine Journal 12/2009; 19(4):593-600. · 1.97 Impact Factor
