JaLCDOI 10.18926/AMO/54980
FullText URL 71_2_119.pdf
Author Oda, Yoshiaki| Takigawa, Tomoyuki| Sugimoto, Yoshihisa| Tanaka, Masato| Akazawa, Hirofumi| Ozaki, Toshifumi|
Abstract Patients with cerebral palsy (CP) frequently present with scoliosis; however, the pattern of curve progression is difficult to predict. We aimed to clarify the natural course of the progression of scoliosis and to identify scoliosis predictors. This was a retrospective, single-center, observational study. Total of 92 CP patients from Asahikawasou Ryouiku Iryou Center in Okayama, Japan were retrospectively analyzed. Cobb angle, presence of hip dislocation and pelvic obliquity, and Gross Motor Function Classification System (GMFCS) were investigated. Severe CP was defined as GMFCS level IV or V. The mean observation period was 10.7 years. Thirtyfour severe CP patients presented with scoliosis and were divided into 3 groups based on their clinical courses: severe, moderate and mild. The mean Cobb angles at the final follow-up were 129°, 53°, and 13° in the severe, moderate, and mild groups, respectively. The average progressions from 18 to 25 years were 2.7°/year, 0.7°/year, and 0.1°/year in the severe, moderate, and mild curve groups, respectively. We observed the natural course of scoliosis and identified 3 courses based on the Cobb angle at 15 and 18 years of age. This method of classification may help clinicians predict the patients’ disease progression.
Keywords severe cerebral palsy scoliosis natural course Cobb angle progression
Amo Type Original Article
Published Date 2017-04
Publication Title Acta Medica Okayama
Volume volume71
Issue issue2
Publisher Okayama University Medical School
Start Page 119
End Page 126
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2017 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 28420893
JaLCDOI 10.18926/AMO/54807
FullText URL 70_6_449.pdf
Author Watanabe, Noriyuki| Sugimoto, Yoshihisa| Tanaka, Masato| Mazaki, Tetsuro| Arataki, Shinya| Takigawa, Tomoyuki| Kataoka, Masaki| Kunisada, Toshiyuki| Ozaki, Toshifumi|
Abstract Metastatic epidural spinal cord compression (MESCC) is a common complication in patients with a malignant tumor, but it is difficult to decide the proper time to perform the necessary surgery. Here we analyzed the prognostic factors for postoperative walking ability. We retrospectively reviewed the cases of 112 MESCC patients treated surgically at our institute and divided them into ambulatory (n= 88) and non-ambulatory (n=24) groups based on their American Spinal Injury Association (ASIA) Impairment Scale grades at the final follow-up. We also classified the patients preoperatively using the revised Tokuhashi score. We assessed the correlation between preoperative or intraoperative factors and postoperative walking ability in both groups. Of the 10 patients classified preoperatively as grade A or B, 2 (20 ) were ambulatory at the final follow-up. Of the 102 patients classified preoperatively as grade C, D or E, 86 (84 ) were ambulatory at the final follow-up (p<0.001). There were no significant differences between the groups in the average total Tokuhashi score. Our analysis revealed that the severity of paralysis significantly affects neurological recovery in patients with MESCC. Patients with MESCC should receive surgery before the preoperative ASIA Impairment Scale grade falls below grade C.
Keywords metastatic epidural spinal cord compression American Spinal Injury Association Impairment Scale Tokuhashi score walking ability prognostic factor
Amo Type Original Article
Published Date 2016-12
Publication Title Acta Medica Okayama
Volume volume70
Issue issue6
Publisher Okayama University Medical School
Start Page 449
End Page 453
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2016 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 28003669
Author Mazaki, Tetsuro| Shiozaki, Yasuyuki| Yamane, Kentaro| Yoshida, Aki| Nakamura, Mariko| Yoshida, Yasuhiro| Zhou, Di| Kitajima, Takashi| Tanaka, Masato| Ito, Yoshihiro| Ozaki, Toshifumi| Matsukawa, Akihiro|
Published Date 2014-03-25
Publication Title Scientific Reports
Volume volume4
Content Type Journal Article
JaLCDOI 10.18926/AMO/52901
FullText URL 68_5_313.pdf
Author Yamane, Kentaro| Tanaka, Masato| Sugimoto, Yoshihisa| Ichimura, Kouichi| Ozaki, Toshifumi|
Abstract Ossified meningioma is classified histologically as a phenotype of metaplastic meningioma, and it is extremely rare. There are only 12 cases involving ossified spinal meningiomas in the literature. We present the case of a 61-year-old female with a primary tumor within the ventral spinal canal at T12. Although we performed a total tumor excision using an ultrasonic bone aspirator, a temporary deterioration of motor evoked potentials (MEPs) was observed during curettage with a Kerrison rongeur. The neurologic findings worsened immediately after surgery. Histologically, the tumor was diagnosed as a metaplastic meningioma with osseous differentiation. In order to avoid spinal cord injury, great care must be taken when removing an ossified meningioma located on the ventral spinal cord.
Keywords spinal metaplastic meningioma osseous differentiation ossified meningioma ultrasonic bone aspirator post-operative course
Amo Type Case Report
Published Date 2014-10
Publication Title Acta Medica Okayama
Volume volume68
Issue issue5
Publisher Okayama University Medical School
Start Page 313
End Page 316
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2014 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 25338489
Web of Sience KeyUT 000343269300009
JaLCDOI 10.18926/AMO/52899
FullText URL 68_5_303.pdf
Author Tanaka, Masato| Sugimoto, Yoshihisa| Arataki, Shinya| Takigawa, Tomoyuki| Ozaki, Toshifumi|
Abstract Spinal deformity is an important clinical manifestation of Chiari I malformation (CM-I) and syringomyelia. Here we report the result of an 8-year follow-up of a 13-year-old girl with severe scoliosis associated with Chiari malformation and a large syringomyelia. The patient presented at our hospital at the age of 13 with a 68° scoliosis. Magnetic resonance imaging showed Chiari malformation and a large syringomyelia. Neurosurgical treatment involved foramen magnum decompression and partial C1 laminectomy, but the scoliosis still progressed. We present the first case report of a rare course of scoliosis in a patient with CM-I and a large syringomyelia.
Keywords Chiari I malformation syringomyelia scoliosis
Amo Type Case Report
Published Date 2014-10
Publication Title Acta Medica Okayama
Volume volume68
Issue issue5
Publisher Okayama University Medical School
Start Page 303
End Page 306
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2014 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 25338487
Web of Sience KeyUT 000343269300007
Author Shiozaki, Yasuyuki| Kitajima, Takashi| Mazaki, Tetsuro| Yoshida, Aki| Tanaka, Masato| Umezawa, Akihiro| Nakamura, Mariko| Yoshida, Yasuhiro| Ito, Yoshihiro| Ozaki, Toshifumi| Matsukawa, Akihiro|
Published Date 2013-04
Publication Title International Journal of Nanomedicine
Volume volume8
Issue issue1
Content Type Journal Article
JaLCDOI 10.18926/AMO/52012
FullText URL 67_6_385.pdf
Author Tanaka, Masato| Arataki, Shinya| Sugimoto, Yoshihisa| Takigawa, Tomoyuki| Tetsunaga, Tomoko| Ozaki, Toshifumi|
Abstract Craniometaphyseal dysplasia is a rare genetic condition characterized by progressive thickening of bones in the skull and metaphyseal abnormalities in the long bones. This disorder often causes progressively symptomatic cranial nerve compression, but in rare cases foramen magnum stenosis may lead to quadriplegia. Chiari I malformation with craniometaphyseal dysplasia is extremely rare. The authors report on a 25-year-old woman with myelopathy due to Chiari I malformation along with craniometaphyseal dysplasia. There are only four previous case reports of this condition. The authors present here the fifth case report of this rare condition and summarize its characteristics.
Keywords craniometaphyseal dysplasia Chiari malformation cervicomedullary compression
Amo Type Case Report
Published Date 2013-12
Publication Title Acta Medica Okayama
Volume volume67
Issue issue6
Publisher Okayama University Medical School
Start Page 385
End Page 389
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2013 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 24356723
Web of Sience KeyUT 000328915700007
JaLCDOI 10.18926/AMO/52007
FullText URL 67_6_343.pdf
Author Yamane, Kentaro| Takigawa, Tomoyuki| Tanaka, Masato| Osaki, Syuhei| Sugimoto, Yoshihisa| Ozaki, Toshifumi|
Abstract Cervical spinal schwannoma is benign, and outcomes after surgical resection are generally excellent. A surgical dilemma sometimes arises as to whether to perform total tumor removal, which carries a risk of sacrificing the nerve root, or subtotal removal, where the risk can be tumor recurrence. The purpose of this study was to identify factors with the potential to predict clinical impairment after surgery for cervical spinal schwannomas. Thirty cases of cervical schwannomas treated surgically in our institute were retrospectively reviewed;initial symptoms, tumor location, Eden classification, surgical method, functional outcome, and tumor recurrence were investigated. All permanent motor deficits were the result of resecting functionally relevant nerve roots (i.e., C5-8). The rate of permanent sensory deficit was 11% after C1-4 nerve root resection, and 67% after C5-8 nerve root resection. Permanent neurological deficits occurred in 14% of patients younger than 40 years and 38% of those older than 40. Dumbbell tumors were associated with the need for total or ventral nerve root transection, as well as with a high incidence of tumor recurrence. The incidence of permanent neurological deficit was significantly higher in patients undergoing C5-8 nerve root resection, and tended to be higher in those over 40.
Keywords cervical spinal schwannoma neurological deficit nerve root resection tumor resection tumor recurrence
Amo Type Original Article
Published Date 2013-12
Publication Title Acta Medica Okayama
Volume volume67
Issue issue6
Publisher Okayama University Medical School
Start Page 343
End Page 349
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2013 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 24356718
Web of Sience KeyUT 000328915700002
JaLCDOI 10.18926/AMO/49670
FullText URL 67_2_113.pdf
Author Sugimoto, Yoshihisa| Tanaka, Masato| Gobara, Hideo| Misawa, Haruo| Kunisada, Toshiyuki| Ozaki, Toshifumi|
Abstract We report on 2 patients who experienced injury to one of their lumbar arteries related to pedicle screw misplacement. In this report, the lumbar pedicle screw holes were made laterally with resultant injury to the lumbar artery. During surgery, arterial bleeding was controlled with pressure and gauze; however, the patients experienced vital shock after surgery. Vital shock ensued and they were rescued by catheter embolization. If patients receiving lumbar instrumentation surgery experience severe anemia or vital shock postoperatively, the surgeon should assume lumbar artery injury as a differential diagnosis.
Keywords catheter embolization complication lumbar artery injury pedicle screw
Amo Type Case Report
Published Date 2013-04
Publication Title Acta Medica Okayama
Volume volume67
Issue issue2
Publisher Okayama University Medical School
Start Page 113
End Page 116
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2013 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 23603928
Web of Sience KeyUT 000317801700006
JaLCDOI 10.18926/AMO/49047
FullText URL 66_6_499.pdf
Author Sugimoto, Yoshihisa| Tanaka, Masato| Nakahara, Ryuichi| Misawa, Haruo| Kunisada, Toshiyuki| Ozaki, Toshifumi|
Abstract An 11 year-old girl had 66 degrees of kyphosis in the thoracolumbar junction. For the purpose of planning for kyphosis correction, we created a 3-D, full-scale model of the spine and consulted spinal navigation. Three-dimensional models are generally used as tactile guides to verify the surgical approach and portray the anatomic relations specific to a given patient. We performed posterior fusion from Th10 to L3, and vertebral column resection of Th12 and L1. Screw entry points, directions, lengths and diameters were determined by reference to navigation. Both tools were useful in the bone resection. We could easily detect the posterior element to be resected using the 3D model. During the anterior bony resection, navigation helped us to check the disc level and anterior wall of the vertebrae, which were otherwise difficult to detect due to their depth in the surgical field. Thus, the combination of navigation and 3D models helped us to safely perform surgery for a patient with complex spinal deformity.
Keywords congenital scoliosis kyphosis navigation 3-dimensional models
Amo Type Case Report
Published Date 2012-12
Publication Title Acta Medica Okayama
Volume volume66
Issue issue6
Publisher Okayama University Medical School
Start Page 499
End Page 502
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2012 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 23254585
Web of Sience KeyUT 000312966100010
JaLCDOI 10.18926/AMO/49043
FullText URL 66_6_469.pdf
Author Shiozaki, Yasuyuki| Ito, Yasuo| Sugimoto, Yoshihisa| Tomioka, Masao| Shimokawa, Tetsuya| Mazaki, Tetsuro| Koshimune, Koichiro| Tanaka, Masato| Ozaki, Toshifumi|
Abstract In this study, we studied the relationship between fracture patterns and motor function recovery in 70 consecutive patients with cervical spinal cord injury. Fractures were categorized into 6 fracture types and subdivided into stages according to the Allen-Ferguson classification system:compressive flexion (CF), distractive flexion (DF), compressive extension (CE), distractive extension (DE), vertical compression (VC) and lateral flexion (LF). Paralysis was evaluated using the American Spinal Injury Association (ASIA) impairment scale at the time of injury and 3 months afterwards. The residual rate of complete motor palsy (ASIA grade A or B) at the final examination was higher in those patients with DE fractures than those with CF, DF or CE. The final outcomes were as follows. Of the 14 patients who were classified with CF fractures, residual palsy was frequently seen in patients who had stage 5 injury. Of the 27 patients with DF fractures, residual palsy occurred in about half of the patients who had stage 4 or 5 injury. Of the 18 patients with CE fractures, residual palsy occurred in half of the patients with stage 3 injury or higher. Finally, of the 7 patients with DE fractures, the rate of residual palsy was high even for the stage 1 and 2 cases;indeed, all DE patients who had complete motor palsy at the first examination had residual palsy at the final examination. Accordingly, we conclude that motor recovery may be related to fracture pattern.
Keywords cervical spinal cord injury motor function recovery fracture patterns
Amo Type Original Article
Published Date 2012-12
Publication Title Acta Medica Okayama
Volume volume66
Issue issue6
Publisher Okayama University Medical School
Start Page 469
End Page 473
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2012 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 23254581
Web of Sience KeyUT 000312966100006
JaLCDOI 10.18926/AMO/48692
FullText URL 66_4_363.pdf
Author Tanaka, Masato| Sugimoto, Yoshihiro| Misawa, Haruo| Takigawa, Tomoyuki| Kunisada, Toshiyuki| Ozaki, Toshifumi|
Abstract Spinal deformity is an important clinical manifestation after surgery for spinal cord tumors. One-third of patients who receive laminectomies and irradiation of the spinal column develop scoliosis, kyphosis, or kyphoscoliosis. Recent reports indicate good results after scoliosis surgery using segmental pedicle screws and a navigation system, but these reported studies have not included surgery for post-laminectomy kyphosis. Hooks and wires are ineffective in such patients who undergo laminectomy, and there are also high perioperative risks with insertion of pedicle screws because landmarks have been lost. Here, we report on the 5-year follow-up of a 13-year-old male patient with post-laminectomy and post-irradiation thoracic kyphoscoliosis after surgical treatment of spinal astrocytoma. Posterior segmental pedicle screw fixation was performed safely using a computer-assisted technique. The authors present the first case report for treatment of this condition using a navigation system.
Keywords astrocytoma scoliosis kyphoscoliosis navigation segmental pedicle screw fixation
Amo Type Case Report
Published Date 2012-08
Publication Title Acta Medica Okayama
Volume volume66
Issue issue4
Publisher Okayama University Medical School
Start Page 363
End Page 368
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2012 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 22918210
Web of Sience KeyUT 000307918900010
JaLCDOI 10.18926/AMO/48560
FullText URL 66_3_213.pdf
Author Kataoka, Masaki| Kunisada, Toshiyuki| Tanaka, Masato| Takeda, Ken| Itani, Satoru| Sugimoto, Yoshihisa| Misawa, Haruo| Senda, Masuo| Nakahara, Shinnosuke| Ozaki, Toshifumi|
Abstract There are a variety of treatment options for patients with spinal metastasis, and predicting prognosis is essential for selecting the proper treatment. The purpose of the present study was to identify the significant prognostic factors for the survival of patients with spinal metastasis. We retrospectively reviewed 143 patients with spinal metastasis. The median age was 61 years. Eleven factors reported previously were analyzed using the Cox proportional hazards model:gender, age, performance status, neurological deficits, pain, type of primary tumor, metastasis to major organs, previous chemotherapy, disease-free interval before spinal metastasis, multiple spinal metastases, and extra-spinal bone metastasis. The average survival of study patients after the first visit to our clinic was 22 months. Multivariate survival analysis demonstrated that type of primary tumor (hazard ratio [HR]=6.80, p<0.001), metastasis to major organs (HR=2.01, p=0.005), disease-free interval before spinal metastasis (HR=1.77, p=0.028), and extra-spinal bone metastasis (HR=1.75, p=0.017) were significant prognostic factors. Type of primary tumor was the most powerful prognostic factor. Other prognostic factors may differ among the types of primary tumor and may also be closely associated with primary disease activity. Further analysis of factors predicting prognosis should be conducted with respect to each type of primary tumor to help accurately predict prognosis.
Keywords spine metastasis survival prognostic factor cancer
Amo Type Original Article
Published Date 2012-06
Publication Title Acta Medica Okayama
Volume volume66
Issue issue3
Publisher Okayama University Medical School
Start Page 213
End Page 219
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2012 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 22729101
Web of Sience KeyUT 000305669700004
JaLCDOI 10.18926/AMO/48085
FullText URL 66_1_77.pdf
Author Zhang, Wei| Tanaka, Masato| Sugimoto, Yoshihisa| Ikuma, Hisanori| Nakanishi, Kazuo| Misawa, Haruo|
Abstract Many authors have reported on iatrogenic vertebral artery (VA) injury, but, to our knowledge, this is the first report of a dominant VA injury with compensatory blood flow from the hypoplastic VA. A 23-year-old woman with juvenile rheumatoid arthritis and atlantoaxial subluxation sustained injury to her dominant VA after occipitocervical fusion using transarticular screws. This did not result in lethal consequences due to compensation from her hypoplastic contralateral VA. Postoperative angiography, however, illustrated occlusion of the dominant left side, while the hypoplastic VA of the right side was enlarged. The patient experienced vertigo and loss of consciousness several times during rehabilitation. At the 4-year follow-up exam, bony fusion was observed, with no neurological deficits or correction loss. She had had no episodes of unconsciousness and no recurrence of any symptoms over the previous 3 years.
Keywords atlantoaxial subluxation vertebral artery injury transarticular screw rheumatoid arthritis
Amo Type Case Report
Published Date 2012-02
Publication Title Acta Medica Okayama
Volume volume66
Issue issue1
Publisher Okayama University Medical School
Start Page 77
End Page 81
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2012 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 22358143
Web of Sience KeyUT 000300800700011
JaLCDOI 10.18926/AMO/47262
FullText URL 65_6_369.pdf
Author Terada, Chuji| Yoshida, Aki| Nasu, Yoshihisa| Mori, Shuji| Tomono, Yasuko| Tanaka, Masato| Takahashi, Hideo K.| Nishibori, Masahiro| Ozaki, Toshifumi| Nishida, Keiichiro|
Abstract We investigated the expression and localization of high-mobility group box chromosomal protein-1 (HMGB-1) in human osteoarthritic (OA) cartilage in relation to the histopathological grade of cartilage destruction, and examined the role of HMGB-1 in the regulation of proinflammatory cytokine expression in chondrocytes. An immunohistochemical study demonstrated that total HMGB-1-positive cell ratios increase as the Osteoarthritis Research Society International (OARSI) histological grade increased. The population of cytoplasmic HMGB-1-positive chondrocytes was especially increased in the deep layers of higher-grade cartilage. The ratios and localization of receptors for advanced glycation end products (RAGE) expression by chondrocytes in Grade 2, 3, and 4 were significantly higher than those in Grade 1. In vitro stimulation with IL-1β, but not TNFα, significantly upregulated the expression of HMGB-1 mRNA by human OA chondrocytes. Both IL-1β and TNFα promoted the translocation of HMGB-1 from nuclei to cytoplasm. IL-1β and TNFα secretions were stimulated at higher levels of HMGB-1. The results of our study suggest the involvement of HMGB-1 in the pathogenesis of cartilage destruction in OA.
Keywords HMGB-1 RAGE chondrocyte osteoarthritis cartilage
Amo Type Original Article
Published Date 2011-12
Publication Title Acta Medica Okayama
Volume volume65
Issue issue6
Publisher Okayama University Medical School
Start Page 369
End Page 377
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2011 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 22189477
Web of Sience KeyUT 000298516900003
JaLCDOI 10.18926/AMO/46634
FullText URL 65_3_211.pdf
Author Nakanishi, Kazuo| Yamane, Kentarou| Tanaka, Masato| Misawa, Haruo| Saiga, Kenta| Ozaki, Toshifumi|
Abstract Here we report a case of surgery for kyphosis of the thoracolumbar spine in an elderly patient, in whom surgery was performed because the patient had developed intractable digestive symptoms. The case was that of a 76-year-old female with complaints of back pain and dysphagia. When videofluoroscopic examination (VF) of swallowing was performed in the cardia of the stomach, images that indicated stagnation and the reflux of food were observed. It was easier for the patient to swallow food in the extension position. We performed corrective fusion of the posterior spine. After the surgery, the kyphosis angle was improved to 27°, the patient's back pain was alleviated, and it became easier for the patient to swallow food. VF also showed that the patient's difficulties with the passage of food had improved. We believe that surgery is a good treatment option for cases of kyphosis with digestive symptoms and deteriorating activities of daily living (ADL), even in the absence of pain and paralysis. VF is also useful for performing evaluations before and after surgery.
Keywords kyphosis dysphagia videofluoroscopic examination of swallowing (VF) fusion
Amo Type Case Report
Published Date 2011-06
Publication Title Acta Medica Okayama
Volume volume65
Issue issue3
Publisher Okayama University Medical School
Start Page 211
End Page 214
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2011 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 21709720
Web of Sience KeyUT 000292017500009
JaLCDOI 10.18926/AMO/40504
FullText URL 64_5_293.pdf
Author Sugimoto, Yoshihisa| Ito, Yasuo| Tomioka, Masao| Shimokawa, Tetsuya| Shiozaki, Yasuyuki| Mazaki, Tetsuro| Tanaka, Masato|
Abstract We used a navigation system to insert 128 pedicle screws into 69 vertebrae (L1 to L3) of 49 consecutive patients. We assessed the pedicle isthmic width and the permission angle for pedicle screw insertion. The permission angle is the angle defined by the greatest medial and lateral trajectories allowable when placing the screw through the center of the pedicle. The rate of narrow-width pedicles (isthmic width less than 5mm) was 5 of 60 pedicles (8%) at L1, 4 of 60 pedicles (7%) at L2, and none (0%) at L3, L4 and L5. The rate of narrow-angle pedicles (a permission angle less than 15 degrees) was 21 of 60 pedicles (35%) at L1, 7 of 60 (12%) at L2, 3 of 60 (5%) at L3, and none (0%) at L4 and L5. Of 128 pedicle screws inserted into 69 vertebrae from L1 to L3, 125 (97.7%) were classified as Grade 1 (no pedicle perforation). In general, the upper lumbar vertebrae have more narrow-width and -angle pedicles. However, we could reduce the rate of pedicle screw misplacement in upper lumbar vertebra using a three-dimensional fluoroscopy and navigation system.
Keywords upper lumbar navigation pedicle screw anatomy misplacement
Amo Type Original Article
Published Date 2010-10
Publication Title Acta Medica Okayama
Volume volume64
Issue issue5
Publisher Okayama University Medical School
Start Page 293
End Page 297
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2010 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 20975762
Web of Sience KeyUT 000283563300004
JaLCDOI 10.18926/AMO/40014
FullText URL fulltext.pdf
Author Sugimoto, Yoshihisa| Ito, Yasuo| Tomioka, Masao| Shimokawa, Tetsuya| Shiozaki, Yasuyuki| Mazaki, Tetsuro| Tanaka, Masato|
Abstract Correct screw placement is especially difficult in the upper thoracic vertebrae. At the cervicothoracic junction (C7-T2), problems can arise because of the narrowness of the pedicle and the difficulty of using a lateral image intensifier there. Other upper thoracic vertebrae (T3-6) pose a problem for screw insertion also because of the narrower pedicle. We inserted 154 pedicle screws into 78 vertebrae (C7 to T6) in 38 patients. Screws were placed using intraoperative data acquisition by an isocentric C-arm fluoroscope (Siremobile Iso-C3D) and computer navigation. Out of 90 pedicle screws inserted into 45 vertebrae between C7 and T2, 87 of the 90 (96.7%) screws were classified as grade 1 (no perforation). Of 64 pedicle screws inserted into 33 vertebrae between T3 and T6, 61 of 64 (95.3%) screws were classified as grade 1. In this study, we reduced pedicle screw misplacement at the level of the C7 and upper thoracic (T1-6) vertebrae using the three-dimensional fluoroscopy navigation system.
Keywords Iso-C3D three-dimensional fluoroscopy navigation upper thoracic pedicle screw
Amo Type Original Article
Published Date 2010-06
Publication Title Acta Medica Okayama
Volume volume64
Issue issue3
Publisher Okayama University Medical School
Start Page 209
End Page 212
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 20596133
Web of Sience KeyUT 000279094300008
JaLCDOI 10.18926/AMO/32889
FullText URL fulltext.pdf
Author Nakanishi, Kazuo| Tanaka, Masato| Sugimoto, Yoshihisa| Ozaki, Toshifumi|
Abstract <p>We performed fixation using laminar screws in 2 patients in whom lateral mass screws, pedicle screws or transarticular screws could not be inserted. One was a 56-year-old woman who had anterior atlantoaxial subluxation (AAS). When a guide wire was inserted using an imaging guide, the hole bled massively. We thought the re-insertion of a guide wire or screw would thus increase the risk of vascular injury, so we used laminar screws. The other case was an 18-year-old man who had a hangman fracture. Preoperative magnetic resonance angiography showed occlusion of the left vertebral artery. A laminar screw was inserted into the patent side (i.e., the right side of C2). Cervical pedicle screws are the most biomechanically stable screws. However, their use carries a high risk of neurovascular complications during screw insertion, because the cervical pedicle is small and is adjacent laterally to the vertebral artery, medially to the spinal cord, and vertically to the nerve roots. Lateral mass screws are also reported to involve a risk of neurovascular injuries. The laminar screw method was thus thought to be useful, since arterial injuries could thus be avoided and it could also be used as a salvage modality for the previous misinsertion.</p>
Keywords laminar screw neurovascular complications lateral mass screw pedicle screw transarticular
Amo Type Case Report
Published Date 2007-04
Publication Title Acta Medica Okayama
Volume volume61
Issue issue2
Publisher Okayama University Medical School
Start Page 115
End Page 119
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
File Version publisher
Refereed True
PubMed ID 17471313
Web of Sience KeyUT 000245875600010
JaLCDOI 10.18926/AMO/31849
FullText URL fulltext.pdf
Author Tanaka, Masato| Nakahara, Shinnosuke| Ito, Yasuo| Kunisada, Toshiyuki| Misawa, Haruo| Koshimune, Koichiro| Ozaki, Toshifumi|
Abstract <p>Surgical treatment of metastatic spinal cord compression is controversial. The purpose of this study was to investigate the effectiveness of our current surgical treatments and the use of spinal instrumentation. In this retrospective study covering the years between 1990 and 2006, 100 patients with spinal metastases which were secondary to various cancers underwent posterior and/or anterior decompression with spinal stabilization for the purposes of reduction of pain, and/or to help correct or improve neurological deficits. The group was made up of 60 men and 40 women whose ages ranged from 16 to 83 years (average of 60 years), and the average follow-up period was 14 months. The effect of treatment upon pain relief and neural deficits was assessed, and the cumulative survival rate was calculated by the Kaplan-Meier method. The average surgical time was 185min. This was calculated based on the following times, listed here with the surgery type:178min for posterior surgery;245min for anterior surgery;465 min for combined surgery;and 475min for total en bloc spondylectomy. Average blood loss during surgery was 1,630 ml for posterior surgery, 1,760 ml for anterior surgery, 1,930 ml for combined surgery, and 3,640 ml for total en bloc spondylectomy. Preoperative pain and paralysis were improved by 88% and 53%, respectively. In regards to surgical complications, postoperative epidural hematoma was observed in 2 patients, and instrumentation-related infection was observed in 1. Only 2 patients died within 2 months of surgery. In conclusion, posterior and/or anterior decompression with spinal stabilization is a safe and effective treatment for patients with spinal metastases, and can improve their quality of life.</p>
Keywords spinal metastasis spinal surgery instrumentation
Amo Type Original Article
Published Date 2009-06
Publication Title Acta Medica Okayama
Volume volume63
Issue issue3
Publisher Okayama University Medical School
Start Page 145
End Page 150
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
File Version publisher
Refereed True
PubMed ID 19571901
Web of Sience KeyUT 000267388200004