Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：Trauma Case Reports  

Background: Acupuncture has become one of the most popular alternative medical treatments in the world. However, if the needle is inserted incorrectly into the body, various adverse events can occur and, in such cases, the needle should be removed. Acupuncture needles are very thin and fragile, making them difficult to detect and to confirm breakage or residual needle fragments during surgery. We report a case of a patient's self-placed acupuncture needle migrating into the cervical spinal canal and its surgical removal. We used cone-beam computed tomography in the hybrid operating room to confirm that the needle was removed in its entirety. Case presentation: A 37-year-old man presented with neck pain and gait disturbance. While he was self-acupuncturing, an acupuncture needle accidentally broke, and the remaining part of the needle penetrated and made contact with the cervical spinal cord. Cervical spine radiographs showed a metallic foreign body between the C1 and C2 spinous processes in the direction of the anterior cervical spine. Computed tomography images revealed that the acupuncture needle was penetrating the spinal canal and was in contact with the cervical cord. The acupuncture needle was removed under general anesthesia. The use of cone-beam computed tomography in the hybrid operating room allowed intraoperative confirmation that there was no breakage during needle removal, and no needle fragments were left behind. His symptoms disappeared without any complications after the operation. Conclusion: To the best of our knowledge, this is the first report of the removal of an acupuncture needle that migrated into the cervical spinal canal using cone-beam computed tomography in a hybrid operating room. Intraoperative cone-beam computed tomography is useful in patients with small, fragile foreign bodies for confirmation of the location of the object and to check for the presence of residual fragments.

DOI： 10.1016/j.tcr.2023.100772

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PubMed

Language：Japanese   Publisher：The Japanese Society for Spine Surgery and Related Research  

<p><b>Introduction: </b>In adolescent idiopathic scoliosis of Lenke type 1A, L4 is subdivided into right tilted 1A-R and left tilted 1A-L, with 1A-R considered to have a high risk of distal adding-on (DA). In this study, we investigated factors related to DA in 1A-R, especially vertebral body rotation.</p><p><b>Methods: </b>Included in this analysis were 15 consecutive cases with surgical treatment for Lenke 1A-R. Thirteen cases with both preoperative and 2-year postoperative data were analysed, while two cases were excluded due to an image defect or a lack of follow-up. Patients with and without DA were compared for background, SRS-22, preoperative, immediate postoperative, radiographic parameters 2 years after surgery, and vertebral body rotation using CT.</p><p><b>Results: </b>Four cases with postoperative DA were observed (DA+group). In this group, UIV rotation at the first standing tended to be left rotation (p=0.07), and the UIV rotation had resolved 2 years after surgery. Right rotation and wedging occurred in the lower intervertebral space of the LIV vertebral body (p=0.02). This suggests the DA may have been caused by a compensatory mechanism of right rotation and lateral flexion of the LIV to resolve the remnants of UIV rotation. Of note, Lenke type 1A-R has a long C-curve and the vertebral body rotation within the main curve tends to be unidirectional. Since there is no inflection point for vertebral body rotation within the fixed range, this may be a compensatory phenomenon to balance body axis rotation.</p><p><b>Conclusion: </b>Our results suggest that DA might occur by lateral rotation around LIV to compensate for convolution in the UIV.</p>

DOI： 10.34371/jspineres.2022-1210

CiNii Research

Language：English   Publisher：Journal of Neurosurgery Spine  

OBJECTIVE Various complications have been reported in the treatment of pediatric spinal deformities. Among these, instrument-related complications could be critical concerns and risks of reoperation. This study aimed to identify the incidence and causes of complications after primary definitive fusion for pediatric spine deformities. METHODS The authors retrospectively collected data from 14 institutions about patients who underwent primary definitive fusion between 2015 and 2017. There were 1490 eligible patients (1184 female and 306 male), with a mean age of 13.9 years. The incidence, causes, and reoperation rates were analyzed according to 4 etiologies of pediatric spine deformity (congenital, neuromuscular, syndromic, idiopathic). The complications were also categorized as screw-, hook-, or rod-related complications, implant loosening or backout, and junctional problems. RESULTS The incidence of overall instrument-related complications was 5.6% (84 cases). Regarding etiology, the incidence rates were 4.3% (idiopathic), 6.8% (syndromic), 7.9% (congenital), and 10.4% (neuromuscular) (p < 0.05). The most common causes were pedicle screw malposition (60.7%), followed by implant backout or loosening (15.4%), junctional problems (13.1%), rod breakage (4.8%), and other complications (6.0%). Univariate analysis showed that etiology, type of deformity (kyphosis), surgical procedure, operation time, and estimated blood loss were significant factors. Multivariate analysis revealed that etiology (neuromuscular), surgical procedure (combined approach), and operation time (> 5 hours) remained as significant risk factors. Among all patients with instrument-related complications, 45% (38/84) required revision surgery. Of these cases, > 50% were related to pedicle screw malposition. Medial breach was the most common complication regardless of location, from upper thoracic to lumbar spine. CONCLUSIONS Pedicle screw malposition was the primary cause of overall complications and subsequent reoperation. In addition to more precise screw insertion techniques, meticulous confirmation of pedicle screw placement, especially of medial breach, may reduce the overall instrument-related complications and revision rates.

DOI： 10.3171/2022.8.SPINE22729

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PubMed

Authorship：Lead author,　Corresponding author   Language：English  

Language：English   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publisher：Archives of Osteoporosis  

Summary : This study investigated how walking speed affects survival in patients with clinical osteoporotic vertebral fractures. A walking speed below 0.71 m/sec was associated with increased mortality. Walking speed may serve as a simple yet powerful prognostic indicator, highlighting the importance of mobility preservation in fracture management. Purpose: The number of patients with fractures caused by osteoporosis has increased with the increasing proportion of aging adults in recent years. Osteoporotic vertebral fractures (OVFs) are associated with poor prognosis. Although several reports on the life expectancy of patients with OVFs exist, it is unclear how walking speed affects the life expectancy of patients with clinical OVFs. This study investigated the relationship between walking speed and life expectancy after injury in patients with clinical OVFs. Methods: A total of 104 patients with new clinical OVFs were conservatively treated with a trunk cast from 2015 to 2017. Lumbar spine and femur bone mineral density (BMD), the Geriatric Nutritional Risk Index (GNRI), walking speed, and spinopelvic parameters were measured. We compared the deceased and survival groups and examined the risk factors influencing survival. Results: Among the 104 patients included in the study, 67 were women; the median age was 82 years, and the median observation period was 1168 days. Thirty-two patients died during the observation period. The deceased group had a lower GNRI and a slower walking speed at discharge. In addition, imaging revealed more local kyphosis and more calcification of vessels in the deceased group. The risk of death increased when the walking speed after the OVF was less than 0.71 m/sec. Conclusion: A walking speed of 0.71 m/sec or slower was associated with poor prognosis after clinical vertebral fracture. Nutritional management, kyphotic deformity prevention, and walking speed maintenance are essential for vertebral fracture treatment.

DOI： 10.1007/s11657-026-01686-w

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PubMed

Language：Japanese   Publisher：Spine Journal  

Background Context: Spinal metastasis affects the activities of daily living (ADL) of patients, and spinal surgery is aimed at improving or maintaining ADL. The Eastern Cooperative Oncology Group Performance status (ECOG-PS) is a measure of ADL, and its change after surgery can influence decisions regarding cancer treatment options. However, few detailed, large-scale studies have examined changes in ECOG-PS after surgery for spinal metastases. Purpose: (1) To investigate the effects of spinal surgery for metastatic spinal tumors on ECOG-PS, and (2) To identify the risk factors for poor postoperative improvement. Study Design: Prospective multicenter cohort study. Patient Sample: A total of 404 symptomatic patients who underwent surgical treatment for metastatic spinal tumors. Outcome Measures: ECOG-PS was designated as the primary outcome and Barthel Index (BI) as the secondary outcome. Both were assessed preoperatively and at 1 and 6 months postsurgery. Methods: Changes in ECOG-PS and BI were analyzed using the Friedman test or a general mixed-effect model. Poor outcomes were defined as a ECOG-PS score of 3, 4, or death. Preoperative factors associated with poor outcomes were analyzed using multivariate logistic regression analyses with complete or multiple imputed datasets. Results: Preoperative ECOG-PS and BI scores improved at 1 and 6 months postoperatively. Patients with a ECOG-PS score of ≤2 at 1 month had significantly higher rates of receiving systemic therapy than those with a ECOG-PS score of ≥3. No use of bone-modifying agents, Frankel grade ≥C, ECOG-PS score of ≥3, or a high C-reactive protein/albumin ratio (CAR) were the preoperative factors associated with poor PS at 1 month, whereas history of systemic therapy, ECOG-PS score of ≥3, primary tumor type, anemia, and high CAR were the preoperative factors associated with poor ECOG-PS at 6 months. Conclusion: Spinal surgery can improve ADL in patients with spinal metastases; however, not all patients experience favorable outcomes. The present findings indicate that the preoperative severity of paralysis and ADL impairment, laboratory data, and treatment history are important for predicting ADL after surgery for spinal metastasis.

DOI： 10.1016/j.spinee.2025.10.028

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PubMed

Language：Japanese   Publisher：Spine  

Study Design. – Retrospective analysis of data collected across multiple centers. Objective. – To develop machine learning models for predicting neurological outcomes 1 month postoperatively in patients with metastatic spinal tumors undergoing surgery, and to identify key factors influencing neurological recovery. Background. – The increasing prevalence of spinal metastases has led to a growing need for surgical intervention to address mechanical instability and neurological deficits. Predicting postoperative neurological status, as assessed by the Frankel classification, can provide valuable insights for surgical planning and patient counseling. Traditional prognostic models have shown limitations in capturing the complexity of neurological recovery patterns. Patients and Methods. – We analyzed data from 244 patients who underwent spinal surgery for metastatic disease across 38 institutions. The primary outcome was functional ambulation, defined as Frankel grades D or E at 1 month postoperatively. Four machine learning algorithms (random forest, XGBoost, LightGBM, and CatBoost) were used to build predictive models. Feature selection employed the Boruta algorithm and variance inflation factor analysis to reduce multicollinearity. Results. – Among the 244 patients, the proportion of ambulatory patients (Frankel grades D or E) increased from 36.8% preoperatively to 63.1% at 1 month postoperatively. The random forest model achieved the highest area under the receiver operating characteristic curve of 0.8516, followed by XGBoost (0.8351), CatBoost (0.8331), and LightGBM (0.8098). SHapley Additive exPlanations analysis identified preoperative Frankel classification, transfer ability, inflammatory markers (C-reactive protein and white blood cell-lymphocyte), and surgical timing as the most important predictors of postoperative outcomes. Conclusions. – Machine learning models showed strong predictive performance in assessing postoperative neurological status of patients with metastatic spinal tumors. Key factors, including preoperative neurological function, functional ability, and inflammation markers, significantly influenced outcomes. These findings could inform surgical decision-making and help set realistic postoperative expectations while potentially improving patient care through more accurate outcome prediction.

DOI： 10.1097/BRS.0000000000005322

Scopus

PubMed

Language：Japanese   Publisher：Spine  

Study Design. – Large multicenter prospective study. Objective. – We aimed to develop and validate a novel machine learning-based prognostic scoring system for spinal metastases. Summary of Background Data. – Spinal metastases, common complications in patients with advanced cancer, significantly affect neurological function, pain, and quality of life. Although surgery plays a crucial role in selected cases, the accurate prediction of patient prognosis remains challenging. Traditional scoring systems, developed for older treatment paradigms, do not fully reflect the impact of modern oncologic therapies. Methods. – This multicenter prospective study, conducted by the Japan Association of Spine Surgeons with Ambition, included 401 patients who underwent surgery for spinal metastases at 35 medical centers between 2018 and 2021. Patient demographics, tumor burden, performance status, and treatment history data were collected. Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression was used to identify significant predictors of one-year survival, followed by stepwise variable selection. The model performance was assessed using the area under the receiver operating characteristic curve (AUROC) and calibration plots. Results. – Among the 401 patients, 67.1% survived for one year, whereas 32.9% did not. Survivors had better performance status, lower tumor burden, and lower opioid use than non-survivors. LASSO regression identified five key predictors of one-year survival: age ≥75 years, poor performance status (≥3), presence of other bone metastases, preoperative opioid use, and lower preoperative Vitality Index. The final model demonstrated a strong predictive performance (AUROC=0.762). Based on the key prognostic factors, a simplified risk stratification system was developed to classify patients into low- (one-year survival 82.2%), intermediate- (67.2%), and high-risk (34.2%) groups. Conclusion. – We developed a clinically applicable prognostic scoring system for patients with spinal metastases using machine learning techniques to enhance predictive accuracy. This model provides a practical risk assessment tool to aid surgical decision-making and optimize postoperative management. Level of Evidence. – 2

DOI： 10.1097/BRS.0000000000005603

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PubMed

Language：Japanese   Publisher：Spine  

Study Design. – Prospective multicenter study. Objective. – To investigate risk factors for 3-month postoperative mortality in metastatic spinal tumor surgery, focusing on nutritional biomarkers and prognostic scores alongside clinical indicators. Summary of Background Data. – Metastatic spinal tumors affect patient morbidity and mortality. Although prognostic tools exist, they have limitations, particularly in emergency situations requiring rapid assessment. Nutritional biomarkers and prognostic scores may influence outcomes, but their role in predicting early postoperative mortality after spinal tumor surgery, particularly in prospective, multicenter studies, warrants investigation. Materials and Methods. – Data from 336 patients undergoing palliative surgery for metastatic spinal tumors were collected from 35 centers. The primary outcome was three-month postoperative mortality. Univariate and multivariate logistic regression analyses with bootstrapping were performed to identify predictors of early mortality, including demographics, prognostic scores [revised Tokuhashi, Tomita, modified Glasgow Prognostic Score (mGPS), and the New England Spinal Metastasis Score (NESMS)], and nutritional biomarkers. The discriminative ability of these factors was evaluated using the receiver operating characteristic curve analysis. Results. – The three-month postoperative mortality rate was 15.5%, with primary cancer progression accounting for 54% of the deaths. Multivariate analysis revealed that high mGPS (OR=1.989, P=0.008) and low preoperative performance status (PS) (OR=1.412, P=0.034) were significant independent predictors of early mortality, the Tomita score showed a trend toward significance (OR=1.234, P=0.050). The mGPS demonstrated a high discriminative ability, with an area under the curve of 0.716. Conclusion. – High mGPS and low preoperative PS are significant predictors of three-month postoperative mortality in patients undergoing surgery for metastatic spinal tumors. Incorporating the mGPS, which reflects nutritional and inflammatory status, into preoperative risk stratification is crucial for optimizing surgical decision-making. Level of Evidence. – Level II.

DOI： 10.1097/BRS.0000000000005359

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PubMed

Language：Japanese   Publisher：European Spine Journal  

Purpose: We aimed to develop and internally validate prediction models for one-month postoperative performance status (PS) after surgery for spinal metastases and to identify patients likely to achieve PS 0–2 at one month. Methods: We performed a retrospective analysis of a prospectively collected spine surgery registry. We compared three tree-based models (Random Forest, XGBoost, and CatBoost) with two regularized logistic regression models (ridge-regularized logistic regression and a sparse elastic-net logistic regression model constrained to ≤ 15 predictors). Model development and hyperparameter tuning were performed using nested cross-validation. Missing data were handled using model-specific strategies within the cross-validation pipeline, and a sensitivity analysis excluded the predictor with the highest missingness. Performance was assessed using discrimination and calibration metrics, including the area under the receiver operating characteristic curve (AUC-ROC), accuracy, precision, recall, F1 score, Brier score, calibration intercept, and calibration slope. Results: The primary analysis included 375 patients with available one-month PS out of 413 enrolled patients. Random Forest achieved the highest discrimination (AUC-ROC 0.811 ± 0.079) and showed calibration measures closest to the ideal among the evaluated models (Brier score 0.168; calibration intercept − 0.024; slope 1.121). The sparse elastic-net model showed good discrimination (AUC-ROC 0.796 ± 0.081) with a limited set of predictors, although its calibration metrics suggested less reliable absolute probability estimates (Brier score 0.217; intercept 0.612; slope 3.228). Excluding the predictor with the highest missingness yielded similar performance for the main models. Conclusion: Tree-based models, particularly Random Forest, provided the most favorable overall predictive performance for one-month postoperative PS after surgery for spinal metastases, whereas a sparse elastic-net logistic regression model preserved reasonable discrimination with a small predictor set and coefficient-based interpretability. These findings support clinically oriented prediction of early postoperative functional status while highlighting the need to assess calibration before clinical implementation.

DOI： 10.1007/s00586-026-09957-3

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PubMed

Language：Japanese   Publisher：Journal of Orthopaedic Science  

Background: The incidence of cancer and related deaths has increased substantially, with bone commonly serving as a metastatic site. Metastatic spinal tumors severely impair quality of life and activities of daily living. Prognostic scoring systems such as the revised Tokuhashi and Tomita scores are widely used in surgical decision-making for these tumors. However, their accuracy for recent cancer cases is unclear due to advances in cancer therapy. Methods: This multicenter, prospective study by the Japan Association of Spine Surgeons with Ambition analyzed 413 surgical cases for metastatic spinal tumors from October 2018 to March 2021. Of these, 272 cases with complete data were included. The Kaplan–Meier method, log-rank test, and statistical analysis were used to assess the association between survival and prognostic scores. Results: Both the revised Tokuhashi and Tomita scores significantly stratified patients by survival (P < 0.01). The revised Tokuhashi score accurately predicted survival in 60.3 % of patients, underestimated it in 33.1 %, and overestimated it in 6.6 %. Significant score differences were found among groups with different survival durations. However, differentiating between <6-month and 6–12-month survival periods was difficult. Conclusions: The revised Tokuhashi and Tomita scores remain valid tools for predicting prognosis in patients undergoing surgery for metastatic spinal tumors. Nonetheless, these systems tend to underestimate survival in recent cases, particularly in short-term prognoses. Updating the scoring criteria may be necessary to reflect advancements in cancer therapy and extended patient survival.

DOI： 10.1016/j.jos.2026.01.003

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PubMed

Language：Japanese   Publisher：Scientific Reports  

The usefulness of spine stabilization for treating metastatic spinal tumors with tumor-induced instability has been reported. However, no reports have prospectively evaluated the effectiveness of adding posterior decompression to stabilization surgery for improving symptoms. This multicenter prospective study aimed to determine whether adding posterior decompression to spine stabilization surgery for metastatic spinal tumors affects postoperative outcomes and complications. A total of 263 patients who underwent spine stabilization with (n = 189) or without (n = 74) decompression were analyzed. Patient demographics, the Spinal Instability Neoplastic Score (SINS), and the Epidural Spinal Cord Compression (ESCC) score were recorded. The outcomes were assessed preoperatively and at 1 and 6 months postoperatively in terms of neurological status, the Barthel Index, the EQ-5D-5 L, and the visual analog scale (VAS). Decompression was primarily performed in patients with severe neurological deficits and high-grade ESCC. Both groups showed postoperative improvement. Propensity score matching was applied to adjust for baseline differences. After matching, there were no significant differences in functional improvement between the decompression and nondecompression groups, and the complication rates were comparable. In matched patients presenting primarily with spinal instability and pain, the addition of decompression did not appear to confer a significant functional benefit within 6 months postoperatively.

DOI： 10.1038/s41598-025-12485-7

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PubMed

Language：Japanese   Publisher：Spine  

Study Design. – A multicenter prospective study. Objective. – To evaluate the effect of preoperative nutritional status, assessed using the prognostic nutritional index (PNI), on clinical outcomes, including survival prognosis, postoperative complications, hospitalization duration, and functional prognosis, in patients with metastatic spinal tumors undergoing surgery. Summary of Background Data. – Malnutrition is common in patients with cancer and is associated with poor clinical outcomes. However, data on the role of nutritional status in metastatic spinal tumors are limited. Methods. – We included 309 patients who underwent surgery for metastatic spinal tumors between October 2018 and March 2021. Patients were divided into two groups: normal nutrition (PNI ≥40) and malnutrition (PNI <40). Clinical outcomes, including 1-year mortality, postoperative complications, and functional improvements (performance status, Frankel grade, Barthel index, vitality index, and EuroQol 5-dimension 5-level), were compared using propensity score matching to adjust for confounding factors, such as age, sex, preoperative chemotherapy, performance status, primary tumor type, and visceral metastases. Results. – Thirty-six percent of patients were malnourished. After propensity score matching, the malnutrition group had a significantly higher mortality rate within 1 year than the normal nutrition group (55% vs. 31%, P<0.001) and showed limited physical improvement, including neurological recovery, one month postoperatively. However, improvements in motivation and quality of life (QOL) were comparable between the groups, and physical function recovery at six months was similar. No significant differences in postoperative complications or length of hospital stay were observed between the groups. Conclusions. – Preoperative malnutrition was observed in 36% of patients with metastatic spinal tumors who underwent surgery and was associated with a poor postoperative survival prognosis and delayed physical recovery. However, surgical treatment improved motivation, QOL, and physical function six months after surgery. These findings highlight the importance of assessing the nutritional status preoperatively and considering both survival and functional prognoses when selecting surgical treatment for patients with malnutrition.

DOI： 10.1097/BRS.0000000000005487

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PubMed

Language：Japanese   Publisher：Spine  

Study Design. – A prospective multicenter cohort study. Objective. – To develop and validate machine learning models for predicting health-related quality of life (HRQoL) improvements in patients after one month and six months of surgery for spinal metastases. Summary of Background Data. – The prediction of postoperative HRQoL of spinal metastases surgery remains understudied compared with studies of survival outcomes. Methods. – We analyzed data from 413 patients who underwent surgery for spinal metastases at 40 participating institutions in Japan. The primary outcome was HRQoL improvement, defined as an increase in the EuroQol 5-Dimension 5-Level (EQ-5D) utility value of ≥0.32 from baseline. We developed two models for 1-month (n=360) and 6-month (n=189) outcomes using various machine learning algorithms. Missing values were imputed, and feature selection was performed using recursive feature elimination with cross-validation. We split the data into training (80%) and test (20%) sets for each model. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, precision, and F1-score. SHapley Additive exPlanations (SHAP) analysis was used to interpret feature importance. Results. – The 6-month model outperformed the 1-month model across all metrics. For 1-month predictions, Logistic Regression achieved an AUC of 0.8136 and an accuracy of 0.7639 on the test set. For 6-month predictions, Naive Bayes demonstrated an AUC of 0.8928 and an accuracy of 0.8684. The 1-month model used 12 features, while the 6-month model required seven. SHAP analysis revealed that EQ-5D Mobility was the most influential feature in both models. Conclusions. – Our models demonstrate high predictive accuracy for HRQoL improvements following spinal metastases surgery, with superior performance of the 6-month model. These models could enhance clinical decision-making and patient counseling by providing personalized predictions of postoperative QoL. Future research should focus on external validation and integration of these models into clinical practice.

DOI： 10.1097/BRS.0000000000005367

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PubMed

Language：English  

DOI： 10.7759/cureus.90749

PubMed

Language：Japanese   Publisher：Journal of Orthopaedic Science  

Objective: This study aimed to elucidate postoperative outcomes in patients with spinal metastases of prostate cancer, with a focus on patient-oriented assessments. Methods: This was a prospective multicenter registry study involving 35 centers. A total of 413 patients enrolled in the Japanese Association for Spine Surgery and Oncology Multicenter Prospective Study of Surgery for Metastatic Spinal Tumors were evaluated for inclusion. The eligible patients were followed for at least 1 year after surgery. The Frankel Classification, Eastern Cooperative Oncology Group Performance Status, visual analog scale for pain, face scale, Barthel Index, vitality index, indications for oral pain medication, and the EQ-5D-5L questionnaire were used for evaluating functional status, activities of daily living, and patient motivation. Results: Of the 413 eligible patients, 41 with primary prostate cancer were included in the study. The patient-oriented assessments indicated that the patients experienced postoperative improvements in quality of life and motivation in most items, with the improvements extending for up to 6 months. More than half of the patients with Frankel classifications B or C showed improved neurological function at 1 month after surgery, and most patients presented maintained or improved their classification at 6 months. Conclusion: Surgical intervention for spinal metastases of prostate cancer significantly improved neurological function, quality of life, and motivation of the patients. Consequently, our results support the validity of surgical intervention for improving the neurological function and overall well-being of patients with spinal metastases of prostate cancer.

DOI： 10.1016/j.jos.2024.07.012

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Language：Japanese   Publisher：Global Spine Journal  

Study Design: Prospective multicenter study. Objectives: Palliative surgery is crucial for maintaining the quality of life (QOL) in patients with spinal metastases. This study aimed to compare the short-term outcomes of QOL after palliative surgery between patients with metastatic spinal tumors at different segments. Methods: We prospectively compared the data of 203 patients with spinal metastases at 2-3 consecutive segments who were divided into the following three groups: cervical, patients with cervical spine lesions; thoracic, patients with upper–middle thoracic spine lesions; and TL/L/S, patients with lesions at the thoracolumbar junction and lumbar and sacral regions. Preoperative and postoperative EuroQol 5-dimension (EQ5D) 5-level were compared. Results: All groups exhibited improvement in the Frankel grade, performance status, pain, Barthel index, EQ5D health state utility value (HSUV), and EQ5D visual analog scale (VAS) postoperatively. Although preoperative EQ5D HSUVs did not significantly differ between the groups (cervical, 0.461 ± 0.291; thoracic, 0.321 ± 0.292; and TL/L/S, 0.376 ± 0.272), the thoracic group exhibited significantly lower postoperative EQ5D HSUVs than the other two groups (cervical, 0.653 ± 0.233; thoracic, 0.513 ± 0.252; and TL/L/S, 0.624 ± 0.232). However, postoperative EQ5D VAS was not significantly different between the groups (cervical, 63.4 ± 25.8; thoracic, 54.7 ± 24.5; and TL/L/S, 61.7 ± 21.9). Conclusions: Palliative surgery for metastatic spinal tumors provided comparable QOL improvement, irrespective of the spinal segment involved. Patients with upper and middle thoracic spinal metastases had poorer QOL outcomes than those with metastases in other segments; however, sufficient QOL improvement was achieved.

DOI： 10.1177/21925682241297948

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PubMed

Language：Japanese   Publisher：Journal of Neurosurgery Spine  

OBJECTIVE Instrumentation surgery in combination with radiotherapy (RT) is one of the key management strategies for patients with spinal metastases. However, the use of materials can affect the RT dose delivered to the tumor site and surrounding tissues, as well as hinder optimal postoperative tumor evaluation. The association of the preoperative Spine Instability Neoplastic Score (SINS) with the need for spinal stabilization and life expectancy are unclear. This multicenter prospective study aimed to investigate the current situation and make recommendations regarding the choice of surgical procedure based on the preoperative SINS and prospectively collected postoperative patient-reported outcomes (PROs). METHODS The study prospectively included 317 patients with spinal metastases who underwent palliative surgery and had a minimum follow-up period of 6 months. The survey items included SINS, patient background, and clinical data including surgical procedure, history of RT, prognosis, and PROs (i.e., the visual analog scale score, Faces Scale, Barthel Index, Vitality Index, and 5-level EQ-5D health survey) at baseline, and at 1 and 6 months after surgery. The association of preoperative SINS with life expectancy, PROs, and surgical procedures was examined using statistical analysis. RESULTS Preoperative SINS (three categories) had no association with life expectancy. All PROs evaluated in the study improved up to 6 months after surgery. Pain categories (visual analog scale score and/or Faces Scale) at baseline were correlated with preoperative SINS. As many as 90.9% of enrolled patients underwent fusion surgery, and even in SINS 0–6 cases, implants were used in 64.3% of patients. Postoperative RT was performed in 42.9% of the patients. However, prospective assessments of PROs showed no significant difference between surgical procedures (with and without fusion) in patients with SINS 0–9. In addition, no cases required conversion from noninstrumentation surgery to fusion surgery. CONCLUSIONS Although the choice of surgical procedure should be made on a case-by-case basis on the NOMS (neurological, oncological, mechanical, and systemic) framework, careful consideration is required to determine whether spinal stabilization is needed in patients with SINS ≤ 9, considering the patient’s background and the plan for postoperative adjuvant therapy.

DOI： 10.3171/2024.7.SPINE24340

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PubMed

Language：Japanese   Publisher：BMC Musculoskeletal Disorders  

Background: Instrumentation failure (IF) is a major complication associated with growth-sparing surgery for pediatric spinal deformities; however, studies focusing on IF following each surgical procedure are lacking. We aimed to evaluate the incidence, timing, and rates of unplanned return to the operating room (UPROR) associated with IF following each surgical procedure in growth-sparing surgeries using traditional growing rods (TGRs) and vertical expandable prosthetic titanium ribs (VEPTRs). Methods: We reviewed 1,139 surgical procedures documented in a Japanese multicenter database from 2015 to 2017. Of these, 544 TGR and 455 VEPTR procedures were included for evaluation on a per-surgery basis. IF was defined as the occurrence of an implant-related complication requiring revision surgery. Results: The surgery-based incidences of IF requiring revision surgery in the TGR and VEPTR groups were 4.3% and 4.0%, respectively, with no significant intergroup difference. Remarkably, there was a negative correlation between IF incidence per surgical procedure and the number of lengthening surgeries in both groups. In addition, rod breakage in the TGR group and anchor-related complications in the VEPTR group tended to occur relatively early in the treatment course. The surgery-based rates of UPROR due to IF in the TGR and VEPTR groups were 2.0% and 1.5%, respectively, showing no statistically significant difference. Conclusions: We found that IF, such as anchor related-complications and rod breakage, occurs more frequently earlier in the course of lengthening surgeries. This finding may help in patient counseling and highlights the importance of close postoperative follow-up to detect IF and improve outcomes.

DOI： 10.1186/s12891-024-07211-9

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PubMed

Language：Japanese   Publisher：Spine  

Study Design. Multicenter, prospective registry study. Objective. To clarify minimal clinically important differences (MCIDs) for surgical interventions for spinal metastases, thereby enhancing patient care by integrating quality of life assessments with clinical outcomes. Background. Despite its proven usefulness in degenerative spinal diseases and deformities, the MCID remains unexplored regarding surgery for spinal metastases. Patients and Methods. This study included 171 (out of 413) patients from the multicenter "Prospective Registration Study on Surgery for Metastatic Spinal Tumors"by the Japan Association of Spine Surgeons. These were evaluated preoperatively and at 6 months postoperatively using the Face Scale, EuroQol-5 Dimensions-5 Levels (EQ-5D-5L), including the Visual Analog Scale, and performance status. The MCIDs were calculated using an anchor-based method, classifying participants into the improved, unchanged, and deteriorated groups based on the Face Scale scores. Focusing on the improved and unchanged groups, the change in the EQ-5D-5L values from before to after treatment was analyzed, and the cutoff value with the highest sensitivity and specificity was determined as the MCID through receiver operating characteristic curve analysis. The validity of the MCIDs was evaluated using a distribution-based calculation method for patient-reported outcomes. Results. The improved, unchanged, and deteriorated groups comprised 121, 28, and 22 participants, respectively. The anchor-based MCIDs for the EQ-5D-5L index, EQ-Visual Analog Scale, and domains of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression were 0.21, 15.50, 1.50, 0.50, 0.50, 0.50, and 0.50, respectively; the corresponding distribution-based MCIDs were 0.17, 15,99, 0.77, 0.80, 0.78, 0.60, and 0.70, respectively. Conclusion. We identified MCIDs for surgical treatment of spinal metastases, providing benchmarks for future clinical research. By retrospectively examining whether the MCIDs are achieved, factors favoring their achievement and risks affecting them can be explored. This could aid in decisions on surgical candidacy and patient counseling.

DOI： 10.1097/BRS.0000000000005062

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PubMed

Language：Japanese   Publisher：Medicine United States  

While biological disease-modifying anti-rheumatic drugs (bDMARDs) are considered beneficial for preventing osteoporosis and bone fracture, it is unclear whether bone loss is involved in the development of vertebral fracture, and few reports have examined the factors related to vertebral fracture in rheumatoid arthritis (RA) patients using bDMARDs. This study aims to identify factors influencing vertebral fracture in RA patients treated with bDMARDs. We retrospectively examined the records of 129 RA patients treated with bDMARDs for over 5 years. The lumbar spine and femoral bone mineral density, Disease Activity Score-28-C-Reactive Protein (DAS28-CRP) value, Simplified Disease Activity Index (SDAI), and modified Health Assessment Questionnaire (mHAQ) score were evaluated. The frequency of new vertebral fracture during the study and their risk factors were investigated. A comparison between the fracture group and the nonfracture group was performed. Multivariate analysis was performed using logistic regression analysis to detect risk factors for new vertebral fracture. The number of patients with new vertebral fracture during follow-up was 15 (11.6%) of the 129 patients in the study. Age and mHAQ score were significantly higher and lumbar spine and femoral neck bone mineral density were significantly lower in the fracture group than the nonfracture group. The risk factors for new vertebral fracture during the disease course were older age and higher mHAQ score indicating no remission over the 5 years of follow-up. In this study, there was no significant difference in disease indices such as the DAS28-CRP value and the SDAI between the fracture and nonfracture groups, suggesting an effective control of RA with bDMARDs. However, age and the mHAQ score, an index of RA dysfunction, were significantly higher in the fracture group. These results suggest that improving functional impairment may be important to prevent vertebral fracture in patients using bDMARDs.

DOI： 10.1097/MD.0000000000038740

Scopus

PubMed

Language：English   Publisher：The Japanese Society for Spine Surgery and Related Research  

<p>Introduction: The incidence of hyponatremia after orthopedic surgery is high. Hyponatremia may prolong hospitalization and increase mortality, but few reports have identified risk factors for hyponatremia after spinal surgery. This study aims to determine the incidence and risk factors for hyponatremia after spinal surgery.</p><p>Methods: A total of 200 patients aged 20 years or older who underwent spinal surgery at our hospital from 2020-2021 were recruited. Data on age, sex, height, weight, body mass index, operation duration, blood loss, albumin level, the geriatric nutritional risk index (GNRI), potassium level, the estimated glomerular filtration rate (eGFR), sodium level, length of hospital stay, history of hypertension, dialysis status, the occurrence of delirium during hospital stay, and oral medication use were collected. Comparisons between the postoperative hyponatremia group and the postoperative normonatremia group were conducted to evaluate the impact of hyponatremia on clinical outcomes.</p><p>Results: Postoperative hyponatremia was observed in 56 (28%) of the 200 patients after spinal surgery. Comparison between the postoperative hyponatremia group with the postoperative normonatremia group revealed that the patients in the postoperative hyponatremia group were significantly older (72 versus 68.5 years, p<0.01). Postoperative hyponatremia was significantly associated with low GNRI values (100.8 versus 109.3, p<0.01), low eGFR values (59.2 versus 70.8 mL/min/1.73 m², p<0.01), preoperative hyponatremia (138.5 vs. 141 mEq/L, p<0.01), and a high incidence of delirium (12.5% versus 2.7%, p=0.01). Older age (odds ratio=1.04, p=0.01) and preoperative hyponatremia (odds ratio=0.66, p value<0.01) were risk factors for postoperative hyponatremia.</p><p>Conclusions: In addition to older age and preoperative hyponatremia, the study identified new risk factors for postoperative hyponatremia, which are preoperative undernutrition and impaired renal function. The incidence of delirium was significantly higher in the postoperative hyponatremia group, suggesting that correcting preoperative hyponatremia and ensuring good nutrition may prevent delirium and thereby shorten hospital stays.</p>

DOI： 10.22603/ssrr.2023-0158

Scopus

PubMed

CiNii Research

Language：Japanese   Publisher：World Neurosurgery X  

Objective: Idiopathic normal-pressure hydrocephalus (iNPH) is characterized by symptoms of dementia, urinary incontinence, and gait disturbance; however, gait disturbance tends to persist after shunt surgery. Gait disturbance and urinary dysfunction are also major symptoms of lumbar spinal stenosis (LSS). Currently, the epidemiology of the complications of LSS in iNPH is unclear. Here, we evaluated the coexistence rate of LSS in iNPH cases. Methods: This was a retrospective case–control study. Between 2011 and 2017, 224 patients with a median age of 78 years, including 119 males, were diagnosed with iNPH and underwent lumboperitoneal shunts or ventriculoperitoneal shunts. LSS was diagnosed with magnetic resonance imaging by two spine surgeons. Age, sex, body mass index (BMI), Timed Up and Go (TUG) test, Mini Mental State Examination (MMSE) score, and urinary dysfunction were examined. We compared the changes in these variables in the group of patients with iNPH without LSS versus those with both iNPH and LSS. Results: Seventy-three iNPH patients (32.6%) with LSS had significantly higher age and BMI. The existence of LSS did not alter the postoperative improvement rates of MMSE and urinary dysfunction; however, TUG improvement was significantly impaired in the LSS-positive group. Conclusions: LSS affects improvements in gait disturbance of iNPH patients after shunt operation. Because our results revealed that one-third of iNPH patients were associated with LSS, gait disturbance observed in iNPH patients should be considered a potential complication of LSS.

DOI： 10.1016/j.wnsx.2023.100236

Scopus

PubMed

Language：Japanese   Publisher：(一社)日本小児整形外科学会  

Language：Japanese   Publisher：Scientific Reports  

Most spinal meningiomas arise from the thoracic dura in middle-aged and elderly women. Simpson grade 1 resection is recommended to avoid recurrence. For ventral and ventrolateral tumors, reconstruction after total dural resection is difficult, and spinal fluid leakage is likely. To overcome this concern, Saito et al. developed the technique of resecting the tumor with the inner dural layer, preserving the outer dural layer. Although meningioma rarely recurs, the recurrence period is approximately 8 years postoperatively. No studies have evaluated long-term (> 10-year) outcomes of the Saito method. Here, we report 10 cases of the Saito method with > 10-year follow-up and compare outcomes with those of other standard approaches. Twenty-nine pathology-confirmed meningioma patients underwent surgery in our department, ten with the Saito method. We investigated resection method (dura mater treatment), pathological type, and recurrence and compared pre- and postoperative clinical findings. The median follow-up was 132 months. Recurrence occurred after Simpson grades 3 and 4 resection. Simpson grades 1, 2, and the Saito method resulted in no recurrence. Neurological symptoms improved in all patients at final follow-up. This is the first report of long-term outcomes of the Saito method. The method achieved good neurological improvement with no recurrence in > 10-year follow-up.

DOI： 10.1038/s41598-021-83712-0

Scopus

PubMed

Language：Japanese   Publisher：西日本整形・災害外科学会  

【目的】びまん性特発性骨増殖症(DISH)や強直脊椎炎(AS)のような強直脊椎骨折に大動脈損傷を合併した症例を2例経験したので報告する.【症例】症例は2例(DISH 1例,AS 1例),受傷機転は交通事故と階段からの転落であった.2例とも造影CTを施行され,脊椎骨折と大動脈損傷(仮性動脈瘤1例,大動脈解離1例)の合併を認めた.ステントグラフト内挿術を優先したのちに,脊椎固定術を施行した.【考察】強直脊椎骨折は,診断が遅れる可能性や遅発性神経麻痺のリスクが高く,骨折に伴う様々な合併症が報告されている.大動脈損傷の合併率は1.3%と少ないが,死亡率は60%と非常に高い.転機に多大な影響をもたらすため,強直脊椎骨折では造影CTによる血管評価が必要である.(著者抄録)

Language：Japanese   Publisher：Journal of Biological Chemistry  

DOI： 10.1016/j.jbc.2021.100994

Scopus

PubMed

Language：Japanese   Publisher：Spine  

Study Design.A retrospective multicenter cohort study.Objective.The aim of this study was to identify the incidence and risk factors for UPROR within minimum 2-year follow-up in primary definitive fusion for pediatric spinal deformity.Summary of Background Data.Several previous reports have elucidated the incidence of complications after pediatric scoliosis surgery; however, there has been no study that described the incidence and risk factors for unplanned return to the operating room (UPROR) with long-term follow-up in surgery for pediatric scoliosis with every etiology.Methods.We retrospectively extracted data of patients aged <19 years, from 14 institutes in Japan, who underwent primary definitive fusion surgery for spinal deformity between January 1, 2015 and December 31, 2017. The primary outcomes were the incidence of UPROR within the minimum 2-year follow-up period for any reason. Univariate and multivariate logistical analyses were conducted to identify potential risk factors associated with UPROR.Results.We identified 1417 eligible patients (287 males and 1130 females) with a mean age of 13.9 years. UPROR for any reason within minimum 2-year follow-up was identified in 68 patients (4.8%). The most frequent cause for UPROR was implant failure found in 29 patients, followed by surgical site infection in 14 patients, junctional problems in 10 patients, and neurological complications in six patients. The multivariate logistic regression analysis revealed that a diagnosis of kyphosis (odds ratio [OR], 2.65; 95% confidence interval [CI] 1.16-6.04), etiology of congenital or structural type (OR 2.21; 95% CI 1.08-4.53), etiology of syndromic type (OR 2.67; 95% CI 1.27-5.64), and increased operation time of ≥300 minutes (OR 1.81; 95% CI 1.07-3.07) were the risk factors for the incidence of UPROR.Conclusion.The present multicenter study identified for the first time the incidence and risk factors for UPROR with minimum 2-year follow-up after primary definitive fusion surgery for pediatric spinal deformity with every etiology.Level of Evidence: 3.

DOI： 10.1097/BRS.0000000000003822

Scopus

PubMed

Language：Japanese   Publisher：西日本整形・災害外科学会  

【背景】頸椎前縦靱帯骨化はびまん性脊椎骨増殖症の頸椎病変として知られているが本症によって気道狭窄を生じた報告は稀である.【症例】64歳の男性.当院受診1年前より嚥下障害を自覚.3週前より特に誘因なく喘鳴,呼吸困難認め,増悪したため,当院救急部受診となる.同日気管内挿管施行後,上気道狭窄の診断にて気管切開施行.当初上咽頭腫瘍疑われ,耳鼻咽喉科にて精査するも,喉咽頭領域の腫瘍性病変やクループ等の病変は認めなかった.CTで頸椎前縦靱帯骨化による気道狭窄,嚥下造影にて著明な気管内への造影剤流入認めたため,頸椎前方アプローチによる骨化巣切除施行.手術4日後に気管カニューレ抜去,経口摂取可能となり,その後も呼吸苦,嚥下困難も消失し,自宅退院可能となった.【まとめ】有症状の本疾患に対し,手術療法は有用な治療である.本疾患は稀な病態であるが,上気道狭窄を来した疾患においての鑑別疾患の1つとすべきである.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

上位胸椎癒合椎を起点とした胸腰椎側彎症の成人進行例の1例を報告する.症例は61歳の女性.40歳代時に右肋骨隆起,右肩高位を自覚.53歳時に腰痛認め,前医受診.50歳後半より立位保持時の腰痛を自覚し症状増悪するため,前医受診し,当科紹介となる.T3-4に前後一致の癒合椎,胸椎主カーブ:40度,L3/4に椎間のwedgingを呈し,8年の経過で脊柱変形の進行と腰痛の進行認め,手術を施行した.癒合椎下の8年前の主カーブは軽度であったが,60歳前で40度台まで進行している.癒合椎部を主とした変形進行ではなく,また,いわゆるde novo側彎としては非典型的なカーブであり,経過画像からはT3-4の癒合椎以下の側彎が進行し構築され,腰椎代償が破綻したと考えられる.比較的進行が緩徐な上位胸椎癒合椎であっても,加齢変性が加わり代償性カーブの構築化,破綻する症例はあるため,経過フォローが必要である.(著者抄録)

Publisher：西日本整形・災害外科学会  

<p>【背景】頸椎前縦靭帯骨化はびまん性脊椎骨増殖症の頸椎病変として知られているが本症によって気道狭窄を生じた報告は稀である．【症例】64歳の男性．当院受診1年前より嚥下障害を自覚．3週前より特に誘因なく喘鳴，呼吸困難認め，増悪したため，当院救急部受診となる．同日気管内挿管施行後，上気道狭窄の診断にて気管切開施行．当初上咽頭腫瘍疑われ，耳鼻咽喉科にて精査するも，喉咽頭領域の腫瘍性病変やクループ等の病変は認めなかった．CTで頸椎前縦靭帯骨化による気道狭窄，嚥下造影にて著明な気管内への造影剤流入認めたため，頸椎前方アプローチによる骨化巣切除施行．手術4日後に気管カニューレ抜去，経口摂取可能となり，その後も呼吸苦，嚥下困難も消失し，自宅退院可能となった．【まとめ】有症状の本疾患に対し，手術療法は有用な治療である．本疾患は稀な病態であるが，上気道狭窄を来した疾患においての鑑別疾患の1つとすべきである．</p>

DOI： 10.5035/nishiseisai.70.284

CiNii Research

Language：Japanese   Publisher：西日本整形・災害外科学会  

<p>上位胸椎癒合椎を起点とした胸腰椎側弯症の成人進行例の1例を報告する．症例は61歳の女性．40歳台時に右肋骨隆起，右肩高位を自覚．53歳時に腰痛認め，前医受診．50歳後半より立位保持時の腰痛を自覚し症状増悪するため，前医受診し，当科紹介となる．T3－4に前後一致の癒合椎，胸椎主カーブ：40度，L3/4に椎間のwedgingを呈し，8年の経過で脊柱変形の進行と腰痛の進行認め，手術を施行した．癒合椎下の8年前の主カーブは軽度であったが，60歳前で40度台まで進行している．癒合椎部を主とした変形進行ではなく，また，いわゆるde novo側弯としては非典型的なカーブであり，経過画像からはT3－4の癒合椎以下の側弯が進行し構築され，腰椎代償が破綻したと考えられる．比較的進行が緩徐な上位胸椎癒合椎であっても，加齢変性が加わり代償性カーブの構築化，破綻する症例はあるため，経過フォローが必要である．</p>

DOI： 10.5035/nishiseisai.70.176

CiNii Research

Publisher：(株)三輪書店  

2012〜2015年に標記疾患に対し手術を施行した4例(S群)と経過観察した5例(NS群)の計9例(平均年齢66.4歳)を対象に、Eating Assessment Tool-10(EAT-10)と頸椎パラメータを後方視的に検討した。S群術後経過観察期間は平均21ヵ月であった。EAT-10はS群術前27.3点、NS群3.0点とS群で嚥下障害は高度であったが、術後は0.8点と有意に低下した。S群の手術前後、S群とNS群との頸椎パラメータ比較では、ともにC2-7角とC2-6a角において有意差を認め、S群術前で頸椎屈曲制限を認めた。

Publisher：西日本整形・災害外科学会  

早期発症側弯症に対する成長温存手術は、growth spurt前の脊柱変形に対する手術として、近年選択されている。今回低身長を合併した先天性前側弯症に対し、Shilla法に準じた成長温存手術を行った症例を報告する。10歳女児。117cm(-3SD)24kg(-2SD)初潮未。低身長に対し、成長ホルモン投与中。9歳時の学校検診で脊柱変形を指摘され当科受診。初診時に分節異常による脊柱変形(Cobb角:49度)による先天性前側弯と診断。Growing rodでは前弯のコントロールが困難と考えられ、当初Final fusionを検討したが、低身長もあるため、Shilla法に準じた成長温存手術を選択した。Shilla法に準じた成長温存手術はgrowing rodに比べ、多数回手術が回避できる利点に加え、頂椎カーブを扱うため、矢状面バランスも獲得しやすい利点もある。長期成績やメタローシスなどの問題点もあるが、成長温存手術を検討する際の選択肢となり得る。(著者抄録)

Authorship：Lead author   Language：Japanese  

Authorship：Lead author   Language：Japanese  

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