基本情報
研究キーワード
30研究分野
1経歴
1-
2013年 - 2014年
論文
76-
JOURNAL OF NEUROLOGICAL SURGERY PART A-CENTRAL EUROPEAN NEUROSURGERY 75(6) 474-478 2014年11月 査読有りIntroductionMicroendoscopic techniques through a unilateral paramedian approach or muscle-preserving techniques using a microscope have been reported as minimally invasive spinal decompression procedures for the cervical spine. In this study, we developed a novel technique, cervical microendoscopic interlaminar decompression (CMID) through a midline approach, for treating cervical compression myelopathy. MethodsA total of 29 consecutive patients with single- or two-level cervical compression myelopathy were reviewed. For the single-level cases (e.g., C5-C6), a midline skin incision, approximate to 2 cm in length, was made at the spinal level to be decompressed (C5-C6) under fluoroscopic guidance. The nuchal ligament was longitudinally cut, and tips of the spinous processes (C5 and C6) were exposed. A 16-mm tubular retractor was inserted between the tips of the C5 and C6 spinous processes. A dome-like laminectomy of C5, partial laminectomy of the upper part of C6, and flavectomy were performed. For the two-level cases (e.g., C4-C5 and C5-C6), the decompression procedure was completed by splitting the spinous process (C5). Pre- and postoperative neurologic status was evaluated using the Japanese Orthopedic Association (JOA) score. Neck and arm pain was also evaluated using a numerical rating scale (NRS). ResultsOverall, 10 patients underwent single-level decompression, and 19 patients underwent two-level decompression. The average age was 67 years (range: 40-83 years), and the mean follow-up period was 11 months (range: 4-14 months). The average pre- and postoperative JOA scores were 10.2 and 13.5, with a mean recovery rate of 49%. The mean preoperative and postoperative NRS scores were 3.5 and 1.5 for neck pain and 4.6 and 2.9 for arm pain, respectively. One patient showed transient mild weakness of the leg that recovered neurologically within a few weeks. No other postoperative complications were observed. ConclusionThis procedure revealed good short-term surgical results. This technique has advantages including (1) a symmetrical orientation of the surgical field, (2) an intermuscular incision that minimizes blood loss and muscle trauma, and (3) the ability to safely complete the decompression procedure without retracting the cervical spinal cord compared with the unilateral approach. Although long-term surgical results are required, this technique is not only safe but also minimally invasive as a treatment for cervical compression myelopathy.
-
SPINE JOURNAL 14(10) 2275-2280 2014年10月 査読有りBACKGROUND CONTEXT: The incidence and relevant risk of ischemic stroke after cervical spine trauma remain unknown. PURPOSE: To examine the incidence of ischemic stroke during hospitalization in patients with cervical spine injury, and analyze the impact of different types of cervical spine injuries on the occurrence of ischemic stroke. STUDY DESIGN: Retrospective analysis of data abstracted from the Diagnosis Procedure Combination database, a nationally representative database in Japan. PATIENT SAMPLE: We included all patients hospitalized for any of the following traumas: fracture of cervical spine (International Classification of Diseases, 10th Revision codes: S120, S121, S122, S127, S129); dislocation of cervical spine (S131, S133); and cervical spinal cord injury (SCI) (S141). OUTCOME MEASURES: Outcome measures included all-cause in-hospital mortality and incidence of ischemic stroke (I63) during hospitalization. METHODS: We analyzed the effects of age, sex, comorbidities, smoking status, spinal surgery, consciousness level at admission, and type of cervical spine injury on outcomes. RESULTS: We identified 11,005 patients with cervical spine injury (8,031 men, 2,974 women; mean [standard deviation] age, 63.5 [18] years). According to the types of cervical spine injury, we stratified the patients into three groups: cervical fracture and/or dislocation without SCI (2,363 patients); cervical fracture and/or dislocation associated with SCI (1,283 patients); and cervical SCI without fracture and/or dislocation (7,359 patients). Overall, ischemic stroke occurred in 115 (1.0%) patients during hospitalization (median length of stay, 26 days). In-hospital death occurred in 456 (4.1%) patients. Multivariate analyses showed that ischemic stroke after cervical spine injury was significantly associated with age, diabetes, and consciousness level at admission. The highest in-hospital mortality was observed in patients with cervical fracture and/or dislocation associated with SCI (7.6%), followed by cervical SCI without fracture and/or dislocation (4.0%), and cervical fracture and/or dislocation without SCI (2.6%). Unlike mortality, risks of stroke did not vary significantly among the three groups. CONCLUSIONS: This analysis revealed that ischemic stroke after cervical spine injury was not uncommon and was associated with increased mortality and morbidity. Occurrence of ischemic stroke was significantly associated with age, comorbidities such as diabetes, and consciousness level at admission, but not with the type of spine injury. (C) 2014 Elsevier Inc. All rights reserved.
-
SPINE 39(8) E508-E513 2014年4月 査読有りStudy Design. A retrospective study. Objective. To investigate the morphology of the cervical spine in patients with athetoid cerebral palsy (CP), and to evaluate its relationship with the breach of cervical pedicle screws. Summary of Background Data. Cervical pedicle screws have been increasingly used in surgery for patients with CP, but screw misplacement is not uncommon. Although the altered morphology of the cervical spine in patients with CP may result in this high breach rate, few studies have examined the cervical pedicle profile. Methods. We retrospectively analyzed 31 patients with cervical myelopathy with CP, as well as 30 patients with cervical spondylotic myelopathy (CSM), who underwent posterior decompression surgery. The pedicle outer diameter, inner diameter, transverse angle and lateral mass deformity were investigated by obtaining preoperative computed tomographic scans. The accuracy of the placement of 56 pedicle screws used in fusion surgery for 12 patients with CP was also analyzed using postoperative computed tomographic scans. Results. The outer diameter of the pedicle in CP was in the range from 3.3 to 9.6 mm, and was larger than that in CSM at all cervical levels except for C7. Pedicle sclerosis was more frequently observed in CP than in CSM (23% vs. 7.3%, P < 0.001). The transverse angle at C3 and C4 was larger, and lateral mass deformity was more frequently observed in CP than in CSM. The critical breach of pedicle screws in CP was found in 29%. A multivariate analysis revealed that pedicle sclerosis was associated with an increased risk of breach (odds ratio: 6.3; 95% confidence interval: 1.03-39.0; P = 0.047). Conclusion. The pedicle diameter in patients with CP was relatively large, but pedicle sclerosis, a wide transverse angle and lateral mass deformity were frequently observed. Sclerotic pedicles were associated with a higher risk of critical breach.
-
EMERGENCY MEDICINE JOURNAL 31(3) 201-206 2014年3月 査読有りObjective To examine the magnitude of the adverse impact of high-dose methylprednisolone treatment in patients with acute cervical spinal cord injury (SCI). Methods We examined the abstracted data from the Japanese Diagnosis Procedure Combination database, and included patients with ICD-10 code S141 who were admitted on an emergency basis between 1 July and 31 December in 2007-2009. The investigation evaluated the patients' sex, age, comorbidities, Japan Coma Scale, hospital volume and the amount of methylprednisolone administered. One-to-one propensity-score matching between high-dose methylprednisolone group (>5000 mg) and control group was performed to compare the rates of in-hospital death and major complications (sepsis; pneumonia; urinary tract infection; gastrointestinal ulcer/bleeding; and pulmonary embolism). Results We identified 3508 cervical SCI patients (2652 men and 856 women; mean age, 60.8 +/- 18.7 years) including 824 (23.5%) patients who received high-dose methylprednisolone. A propensity-matched analysis with 824 pairs of patients showed a significant increase in the occurrence of gastrointestinal ulcer/bleeding (68/812 vs 31/812; p<0.001) in the high-dose methylprednisolone group. Overall, the high-dose methylprednisolone group demonstrated a significantly higher risk of complications (144/812 vs 96/812; OR, 1.66; 95% CI 1.23 to 2.24; p=0.001) than the control group. There was no significant difference in in-hospital mortality between the high-dose methylprednisolone group and the control group (p=0.884). Conclusions Patients receiving high-dose methylprednisolone had a significantly increased risk of major complications, in particular, gastrointestinal ulcer/bleeding. However, high-dose methylprednisolone treatment was not associated with any increase in mortality.
-
JOURNAL OF ORTHOPAEDIC SCIENCE 19(2) 218-222 2014年3月 査読有りClumsiness and numbness of the upper extremity is one of the most common complaints of patients with cervical myelopathy. However, most previous evaluations after cervical laminoplasty have only been based on physicians' points of view. We used Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) self-report questionnaire, which was designed to measure physical function and symptoms in people with upper-limb disorders to evaluate functional outcomes after laminoplasty. Ninety-four patients who underwent laminoplasty for cervical myelopathy and replied to the questionnaire were included in this study. The average age was 62 years, and mean follow-up period was 61 months. The Japanese Orthopedic Association (JOA) score, Neck Disability Index (NDI), Short-Form Health Questionnaire of 36 questions (physical component score, PCS), upper-extremity pain (Numerical Rating Scale), and QuickDASH (0-100, 0 being least severe) were used to evaluate surgical outcomes. Satisfaction with treatment was also investigated, and internal consistency and criterion-related validity were evaluated. The QuickDASH cutoff value for patient satisfaction was determined by receiver operating characteristic curve (ROC) analysis. The mean total JOA scores were 10 before and 13 after surgery, and average postoperative QuickDASH score was 30. Cronbach alpha of the QuickDASH was 0.94. QuickDASH was significantly correlated with JOA score for upper-extremity motor and sensation, NDI, PCS, and pain. Cutoff value of the QuickDASH was 34.0 by ROC analysis. Significantly better QuickDASH scores were found for patients who were satisfied with treatment than for those who were not, whereas JOA score for upper-extremity motor function did not show a significant difference. QuickDASH had significant correlations with disease-specific JOA scores and other generic outcome measures. Moreover, QuickDASH significantly reflected patients' satisfaction with treatment, whereas the JOA score for upper-extremity motor function did not. QuickDASH was useful in evaluating upper-extremity functional outcomes after cervical laminoplasty.
MISC
146-
日本整形外科学会雑誌 87(2) S49 2013年3月5日
-
Prog Med 33(1) 57-59 2013年1月10日
-
日本脊椎脊髄病学会雑誌 = The journal of the Japan Spine Research Society 20(4) 823-833 2009年12月25日
-
脊柱変形 : 日本側彎症研究会会誌 = Spinal deformity : the journal of Japanese Scoliosis Society 24(1) 61-64 2009年12月20日
-
日本脊椎脊髄病学会雑誌 = The journal of the Japan Spine Research Society 19(1) 2-2 2008年3月20日
-
日本脊椎脊髄病学会雑誌 = The journal of the Japan Spine Research Society 19(2) 286-286 2008年3月20日
-
日本脊椎脊髄病学会雑誌 = The journal of the Japan Spine Research Society 19(2) 390-390 2008年3月20日
-
日本脊椎脊髄病学会雑誌 = The journal of the Japan Spine Research Society 19(2) 395-395 2008年3月20日
-
日本脊椎脊髄病学会雑誌 = The journal of the Japan Spine Research Society 19(2) 440-440 2008年3月20日
-
脊柱変形 : 日本側彎症研究会会誌 = Spinal deformity : the journal of Japanese Scoliosis Society 22(1) 157-161 2007年12月20日
-
日本整形外科學會雜誌 = The Journal of the Japanese Orthopaedic Association 81(9) 725-725 2007年9月25日
-
日本整形外科學會雜誌 = The Journal of the Japanese Orthopaedic Association 81(7) 595-595 2007年7月25日
-
日本整形外科學會雜誌 = The Journal of the Japanese Orthopaedic Association 81(7) 596-596 2007年7月25日
-
東日本整形災害外科学会雑誌 = Journal of the Eastern Japan Association of Orthopaedics and Traumatology 18(4) 426-428 2006年12月25日
-
脊柱変形 : 日本側彎症研究会会誌 = Spinal deformity : the journal of Japanese Scoliosis Society 21(1) 116-119 2006年12月20日
-
日本脊椎脊髄病学会雑誌 = The journal of the Japan Spine Research Society 17(1) 51-52 2006年3月20日
-
日本脊椎脊髄病学会雑誌 = The journal of the Japan Spine Research Society 17(1) 60-60 2006年3月20日
-
日本脊椎脊髄病学会雑誌 = The journal of the Japan Spine Research Society 17(1) 85-85 2006年3月20日
-
日本脊椎脊髄病学会雑誌 = The journal of the Japan Spine Research Society 17(1) 109-109 2006年3月20日
-
日本脊椎脊髄病学会雑誌 = The journal of the Japan Spine Research Society 17(1) 112-112 2006年3月20日
-
日本整形外科學會雜誌 = The Journal of the Japanese Orthopaedic Association 80(1) 66-68 2006年1月25日
-
東日本整形災害外科学会雑誌 = Journal of the Eastern Japan Association of Orthopaedics and Traumatology 17(4) 623-627 2005年12月25日
-
脊柱変形 : 日本側彎症研究会会誌 = Spinal deformity : the journal of Japanese Scoliosis Society 20(1) 16-19 2005年12月20日
-
脊柱変形 : 日本側彎症研究会会誌 = Spinal deformity : the journal of Japanese Scoliosis Society 20(1) 69-73 2005年12月20日
-
脊柱変形 : 日本側彎症研究会会誌 = Spinal deformity : the journal of Japanese Scoliosis Society 20(1) 88-90 2005年12月20日
-
日本整形外科學會雜誌 = The Journal of the Japanese Orthopaedic Association 79(9) 612-612 2005年9月25日
-
リハビリテーション医学 : 日本リハビリテーション医学会誌 41(9) 625-627 2004年9月18日本研究の目的は10秒テストと30mテストによる運動機能評価が脊椎疾患患者において適応可能かどうかをJOA上下肢運動機能スコアとの相関の程度を調べることで検証することである.対象は頸髄症41例(男性28例,女性13例)で平均年齢は64±9歳であった.10秒テストでは10秒間できるだけ全手指を開閉させる回数,30mテストでは平地15mの往復にかかる歩行時間および歩数を測定した.10秒テストでは患側で14.5,30mテストでは歩行時間が25.1秒,歩数は51.7歩であった.上下肢JOAスコアはそれぞれ2.4,2.3であった.10秒テストは上肢JOAスコアと,30mテストの歩行時間・歩数の逆数は下肢JOAスコアとそれぞれ有意に相関した(0.37,0.41,0.45 : Spearman).10秒テストと30mテストによる運動機能評価法は脊椎疾患の治療効果判定に使用できる可能性がある.
-
東日本整形災害外科学会雑誌 = Journal of the Eastern Japan Association of Orthopaedics and Traumatology 16(2) 235-238 2004年6月30日
-
日本脊椎脊髄病学会雑誌 = The journal of the Japan Spine Research Society 15(1) 16-16 2004年5月20日
-
日本脊椎脊髄病学会雑誌 = The journal of the Japan Spine Research Society 15(1) 153-153 2004年5月20日
-
日本脊椎脊髄病学会雑誌 = The journal of the Japan Spine Research Society 15(1) 178-178 2004年5月20日