顔写真

アイザワ トシミ
相澤 俊峰
Toshimi Aizawa
所属
大学院医学系研究科 医科学専攻 外科病態学講座(整形外科学分野)
職名
教授
学位
  • 博士(医学)(東北大学)

委員歴 4

  • 日本整形外科学会 代議員

    2017年5月 ~ 継続中

  • 東日本整形災害外科学会 評議員

    2015年9月 ~ 継続中

  • 日本脊椎脊髄病学会 評議員

    2011年4月 ~ 継続中

  • 東北整形災害外科学会 事務局長

    2004年1月 ~ 2011年12月

所属学協会 3

  • 日本脊椎脊髄病学会(2010/04-2014/04 評議員)

  • 日本整形外科学会(2008/07- 脊椎内視鏡下手術医療安全対策小委員会委員)

  • 日本整形外科学会(2006/05-2008/05 脊椎内視鏡下手術インシデントワーキンググループメンバー)

研究キーワード 4

  • 脊椎手術

  • 胸椎後縦靱帯骨化症

  • 軟骨細胞

  • 成長軟骨板

研究分野 1

  • ライフサイエンス / 整形外科学 / 脊椎手術

論文 296

  1. Reliability of Conventional Two-Dimensional Magnetic Resonance Imaging for Diagnosing Extraforaminal Stenosis in Lumbosacral Transition.

    Kohei Takahashi, Myo Min Latt, Takumi Tsubakino, Manabu Suzuki, Takeshi Nakamura, Takeshi Hoshikawa, Tomowaki Nakagawa, Ko Hashimoto, Takahiro Onoki, Toshimi Aizawa, Yasuhisa Tanaka

    Spine surgery and related research 7 (6) 526-532 2023年11月27日

    DOI: 10.22603/ssrr.2023-0110  

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    INTRODUCTION: Three-dimensional (3D) magnetic resonance imaging (MRI) is reportedly superior to two-dimensional (2D) MRI for diagnosing lumbar foraminal stenosis at L5-S1. In this study, we strictly distinguished the intra- and extraforaminal regions and compared the diagnostic reliability and accuracy of 2D and 3D MRI in each region. METHODS: A total of 92 surgical cases of unilateral L5 radiculopathy were selected for imaging analysis, including 46 of foraminal stenosis at L5-S1 (Group F) and 46 of intraspinal canal stenosis at L4-5 (Group C) (48 men, 44 women; mean age, 66 years). The 2D and 3D MRI sets were assessed twice by two examiners. They were informed only of the laterality of the lesion in each case and asked to select among the following for each modality: "absence of foraminal stenosis," "intraforaminal stenosis," "extraforaminal stenosis," and "coincident intraforaminal and extraforaminal stenosis." The intra- and interobserver reliabilities were evaluated using kappa (κ) statistics for the intra- and extraforaminal regions and compared between 2D and 3D MRI. For each case, disagreements between examiners were resolved through discussion to obtain a diagnostic judgment for each modality. Subsequently, the final diagnosis of intra- and/or extraforaminal stenosis in Group F was made using multiple modalities and intraoperative findings. A comparison between 2D and 3D MRI in terms of diagnostic accuracy was performed for the intra- and extraforaminal regions. RESULTS: No significant difference was observed in the κ statistics between 2D and 3D MRI for the intraforaminal region, whereas 3D MRI had significantly larger κ statistic than 2D MRI for the extraforaminal region. Ultimately, 3D MRI perfectly judged the extraforaminal region, whereas 2D MRI detected only 44.8% of the cases of extraforaminal stenosis. CONCLUSIONS: More than half of extraforaminal stenosis was overlooked by 2D MRI, suggesting that it is unreliable for diagnosing extraforaminal stenosis at L5-S1.

  2. Are T1-Weighted Three-Dimensional Magnetic Resonance Images Inferior to T2-Weighted Images for Diagnosing Lumbar Foraminal Stenosis in the Fifth Lumbar Nerve Root? A Prospective, Comparative Study in Identical Patients.

    Ko Hashimoto, Yasuhisa Tanaka, Takumi Tsubakino, Takeshi Hoshikawa, Chikashi Kawahara, Tomowaki Nakagawa, Satoshi Tateda, Kohei Takahashi, Manabu Suzuki, Takahiro Onoki, Haruo Kanno, Naoki Morozumi, Yutaka Koizumi, Masahito Honda, Takashi Kusakabe, Masaru Suda, Shoichi Kokubun, Toshimi Aizawa

    Spine surgery and related research 7 (5) 436-442 2023年9月27日

    DOI: 10.22603/ssrr.2023-0026  

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    INTRODUCTION: Imaging analysis of foraminal stenosis in the fifth lumbar (L5) nerve root remains to be a challenge because of the anatomical complexity of the lumbosacral transition. T2-weighted three-dimensional (3D) magnetic resonance images (MRI) have been dominantly used for diagnosis of lumbar foraminal stenosis, while the reliability of T1-weighted images (WI) has also been proven. In this study, we aim to compare the reliability and reproducibility of T1- and T2-weighted 3D MRI in diagnosing lumbar foraminal stenosis (LFS) of the L5 nerve root. METHODS: In this study, 39 patients with unilateral L5 radiculopathy (20 had L4-L5 intracanal stenosis; 19 had L5-S foraminal stenosis) were enrolled, prospectively. T1- and T2-weighted 3D lumbar MRI were obtained from each patient. T1WI and T2WI were blinded and then separately reviewed twice by four examiners randomly. The examiners were instructed to answer the side of LFS or absence of LFS. The correct answer rate, sensitivity, specificity, and area under the curve were analyzed and compared between T1WI and T2WI. Also, intra- and interobserver agreements were calculated using kappa (κ)-statistics and compared in the same manner. RESULTS: The average correct answer rate, sensitivity, specificity, and area under the curve of the T1WI/T2WI were 84.6%/80.1%, 82.9%/80.3%, 86.3%/81.3%, and 0.846/0.801, respectively. The intraobserver κ-values of the four examiners ranged from 0.692 to 0.916 (average: 0.762) and from 0.669 to 0.801 (average: 0.720) for T1WI and T2WI, respectively. The interobserver κ-values calculated in a round-robin manner (24 combinations in total) ranged from 0.544 to 0.790 (average: 0.657) and from 0.524 to 0.828 (average: 0.652), respectively. CONCLUSIONS: As per our findings, T1- and T2-weighted 3D MRI were determined to have nearly equivalent reliability and reproducibility in terms of diagnosing LFS of the L5 nerve root.

  3. Radical decompression without fusion for L5 radiculopathy due to foraminal stenosis. 国際誌

    Kohei Takahashi, Ajay Yadav, Takumi Tsubakino, Takeshi Hoshikawa, Tomowaki Nakagawa, Ko Hashimoto, Manabu Suzuki, Toshimi Aizawa, Yasuhisa Tanaka

    Journal of spine surgery (Hong Kong) 9 (3) 278-287 2023年9月22日

    DOI: 10.21037/jss-23-62  

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    BACKGROUND: The highest incidence of lumbar foraminal stenosis (LFS) occurs in the L5-S1 segment and its anatomical features differ from those of other segments. Few previous reports have exhaustively assessed surgical outcomes after decompression surgery, limiting the materials to patients with LFS at the L5-S1 segment. We aimed to prospectively investigate instability and neurological improvement following our novel surgical technique for LFS at L5-S1, named "radical decompression" of the nerve root. METHODS: Patients with foraminal stenosis at L5-S1 who underwent surgery using our technique were prospectively evaluated two years postoperatively. The Japanese Orthopaedic Association (JOA) score and the JOA Back Pain Evaluation Questionnaire (JOABPEQ) were evaluated preoperatively and two years postoperatively. The following radiological parameters at L5-S1 were measured: lateral translation, sagittal translation, the difference in sagittal translation (DST) between flexion and extension, disc wedging angle, lordotic angle, the difference in lordotic angle (DLA) between flexion and extension, and disc height. Pre- and postoperative data were compared using paired t-tests. In addition, the patients were classified into a disc group (Group D) and a non-disc group (Group ND) according to whether a discectomy was performed intraoperatively. Changes in each parameter before and after surgery were compared between the groups. RESULTS: Twenty-eight patients were included in this analysis. The JOA scores improved in all patients. The mean preoperative and two-year postoperative JOA scores were 14.5±3.2 (range, 8-21) and 24.3±3.3 (range, 18-29), respectively (P<0.01). All JOABPEQ categories improved two years postoperatively (P<0.05). None of the patients underwent revision surgery. No significant changes were observed in any of the radiological parameters. No significant differences in the changes in each parameter before and after surgery were found between groups D and ND. CONCLUSIONS: Our surgical technique resulted in good neurological recovery and was associated with a low risk of postoperative segmental instability, regardless of additional discectomy.

  4. 鏡視下上方関節包再建術後の外旋改善は三角筋後部線維による

    有野 敦司, 山本 宣幸, 佐々木 一真, 木村 礼, 川上 純, 永元 英明, 相澤 俊峰, 井樋 栄二

    日本肩関節学会学術集会・日本肩の運動機能研究会学術集会抄録集 50回・20回 189-189 2023年9月

    出版者・発行元:(一社)日本肩関節学会

  5. MR画像を用いた軌跡外損傷評価の改善

    木村 礼, 山本 宣幸, 有野 敦司, 川上 純, 永元 英明, 相澤 俊峰, 井樋 栄二

    日本肩関節学会学術集会・日本肩の運動機能研究会学術集会抄録集 50回・20回 293-293 2023年9月

    出版者・発行元:(一社)日本肩関節学会

  6. Primary Malignant Lymphoma of the Cauda Equina Diagnosed after Decompression for Lumbar Spinal Stenosis: A Case Report.

    Manabu Suzuki, Kohei Takahashi, Mika Watanabe, Ko Hashimoto, Takahiro Onoki, Kyoichi Handa, Toshimi Aizawa

    The Tohoku journal of experimental medicine 260 (4) 341-346 2023年8月23日

    DOI: 10.1620/tjem.2023.J047  

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    Primary malignant lymphoma confinement to the cauda equina is rare. Only 14 cases of primary malignant lymphoma in the cauda equina have been reported. In these cases, the clinical features were similar to those of lumbar spinal canal stenosis (LSCS). This report describes a case of diffuse large B-cell lymphoma of the cauda equina that was diagnosed after decompression surgery for LSCS. An 80-year-old man presented with gait disturbance due to progressive muscle weakness in the lower extremities over the previous two months. He was diagnosed with LSCS, and decompression surgery was performed. However, the muscle weakness worsened after surgery; therefore, he was referred to our department. Plain magnetic resonance imaging (MRI) revealed swelling of the cauda equina. It demonstrated marked homogenous enhancement by gadolinium-diethylenetriamine pentaacetic acid. 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) revealed diffuse accumulation of 18F-FDG in the cauda equina. These imaging findings were consistent with those of cauda equina lymphomas. To confirm the diagnosis, we performed an open biopsy of the cauda equina. Histological examination indicated diffuse large B-cell lymphoma. Considering the patient's age and activities of daily living, further treatment was not performed. The patient died four months after the first surgery. Rapid progression of muscle weakness, which cannot be prevented by decompression surgery, and swollen cauda equina on MRI may be signs of this disorder. Gadolinium-enhanced MRI, 18F-FDG PET, and histological investigation of the cauda equina should be performed for diagnosing primary malignant lymphoma of the cauda equina.

  7. 人工股関節全置換術前の口腔ケアは全例で必要か? 口腔ケアが必要な感染高リスク症例の抽出法の検討

    馬塲 一慈, 千葉 大介, 森 優, 金淵 龍一, 栗山 恭明, 栗島 宏明, 鈴木 貴之, 濱田 壮志, 相澤 俊峰

    Hip Joint 49 (1) 57-59 2023年8月

    出版者・発行元:日本股関節学会

    ISSN:0389-3634

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    当院整形外科では2018年からTHA患者には手術前に当院歯科を受診してもらい、歯科治療が必要であればTHA前に治療を行う「口腔ケア」を導入し、2020年以降は再置換術例も含むTHA全例に口腔ケアを実施しているが、全例のケアは患者・医療者とも負担がかかる。そこで、口腔ケアが必要な感染高リスク症例を術前に選定できれば負担を軽減できると考え、選定するツールとして、2018年に報告された「人工関節置換術前に関節周囲感染の発生を予測するスコアリングシステム」が有用であるか検討した。口腔ケア導入前の2017年度のTHA患者50例と、口腔ケアを全例に実施した2020年度の患者68例のデータをもとに検討した結果、口腔ケアが必要な患者の選定に同スコアリングシステムは有用でないことが示唆された。

  8. 腱板断裂患者における脂肪化と筋萎縮 平均6年の前向き調査

    有野 敦司, 山本 宣幸, 川上 純, 木村 礼, 藍澤 一穂, 永元 英明, 佐野 博高, 相澤 俊峰, 井樋 栄二

    東日本整形災害外科学会雑誌 35 (3) 335-335 2023年8月

    出版者・発行元:東日本整形災害外科学会

    ISSN:1342-7784

    eISSN:2433-569X

  9. 脊椎後彎症患者の変形矯正術前後で股関節の運動学的特性はどう変化するか? 三次元動作解析装置を用いた歩行解析による検討

    藤田 涼, 高橋 康平, 関口 雄介, 鎌田 久美, 馬場 一慈, 秋 貴史, 橋本 功, 出江 紳一, 小澤 浩司, 相澤 俊峰

    日本整形外科学会雑誌 97 (8) S1841-S1841 2023年8月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  10. TiNbSn stems with gradient changes of Young’s modulus and stiffness reduce stress shielding compared to the standard fit-and-fill stems

    Kazuyoshi Baba, Yu Mori, Daisuke Chiba, Yoshiyuki Kuwahara, Hiroaki Kurishima, Hidetatsu Tanaka, Atsushi Kogure, Masayuki Kamimura, Norikazu Yamada, Susumu Ohtsu, Masamizu Oyama, Naoya Masahashi, Shuji Hanada, Eiji Itoi, Toshimi Aizawa

    European Journal of Medical Research 28 (1) 2023年7月3日

    出版者・発行元:Springer Science and Business Media LLC

    DOI: 10.1186/s40001-023-01199-z  

    eISSN:2047-783X

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    Abstract Background The difference between Young’s moduli of the femur and the stem causes stress shielding (SS). TiNbSn (TNS) stem has a low Young’s modulus and strength with gradient functional properties during the change in elastic modulus with heat treatment. The aim of this study was to investigate the inhibitory effect of TNS stems on SS and their clinical outcomes compared to conventional stems. Methods This study was a clinical trial. Primary THA was performed using a TNS stem from April 2016 to September 2017 for patients in the TNS group. Unilateral THA was performed using a Ti6Al4V alloy stem from January 2007 to February 2011 for patients in the control group. The TNS and Ti6Al4V stems were matched in shape. Radiographs were obtained at the 1- and 3-year follow-ups. Two surgeons independently checked the SS grade and appearance of cortical hypertrophy (CH). The Japanese Orthopaedic Association (JOA) scores before and 1 year after surgery were assessed as clinical scores. Results None of the patients in the TNS group had grade 3 or 4 SS. In contrast, in the control group, 24% and 40% of patients had grade 3 and 4 SS at the 1- and 3-year follow-ups, respectively. The SS grade was lower in the TNS group than in the control group at the 1- and 3-year follow-ups (p &lt; 0.001). The frequencies of CH in both groups were no significant difference at the 1- and 3-year follow-ups. The JOA scores of the TNS group significantly improved at 1 year after surgery and were comparable to control group. Conclusion The TNS stem reduced SS at 1 and 3 years after THA compared to the proximal-engaging cementless stem, although the shapes of the stems matched. The TNS stem could reduce SS, stem loosening, and periprosthetic fractures. Trial registration: Current Controlled Trials. ISRCTN21241251. https://www.isrctn.com/search?q=21241251. The date of registration was October 26, 2021. Retrospectively registered.

  11. THREE-COLUMN OSTEOTOMY WITH COMBINATION OF COMPRESSION HOOK AND PEDICLE SCREW FIXATION FOR ADULT SPINAL DEFORMITY IN PATIENTS WITH PARKINSON’S DISEASE

    Haruo Kanno, Ko Hashimoto, Kohei Takahashi, Kyoichi Handa, Toshimi Aizawa, Hiroshi Ozawa

    Journal of Musculoskeletal Research 26 (02) 2023年6月30日

    出版者・発行元:World Scientific Pub Co Pte Ltd

    DOI: 10.1142/s0218957723400055  

    ISSN:0218-9577

    eISSN:1793-6497

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    Purpose: Surgical treatment for adult spinal deformity (ASD) in patients with Parkinson’s disease (PD) is challenging and is associated with a significant risk of postoperative mechanical complications, such as rod breakage, pseudoarthrosis and proximal junctional failure. We herein report the surgical results of three-column osteotomy with pedicle screw fixation combined with compression hook for ASD associated with PD. Methods: We retrospectively investigated four patients with ASD due to PD who underwent three-column osteotomy with posterior instrumentation. The compression hook system placed on the laminae was used for closure of the osteotomy site during surgery and reinforcement of pedicle screw fixation. Surgical outcomes and radiographical parameters were analyzed. Results: Lumbar lordosis was improved from [Formula: see text] preoperatively to [Formula: see text] postoperatively, and [Formula: see text] at the final follow-up examination. The sagittal vertical axis was restored from 297 ± 104 mm preoperatively to 41 ± 13 mm postoperatively, and 72 ± 23 mm at the final follow-up examination. The preoperative VAS (88 ± 14 mm) for low back pain was significantly improved at the final follow-up examination (14 ± 28 mm). Walking disturbance due to low back pain was improved in all patients. No patients had mechanical failure (e.g. rod fracture, pseudarthrosis, or junctional failure) after surgery. Conclusion: The use of compression hooks to supplement pedicle screw fixation is beneficial for performing safe osteotomy closure during surgery and preventing postoperative mechanical failures, and may be a useful option when performing three-column osteotomy for ASD associated with PD.

  12. PJI 人工関節周囲感染診断におけるalpha-defensin検査の有用性について

    森 優, 千葉 大介, 上村 雅之, 金淵 龍一, 馬場 一慈, 相澤 俊峰

    日本骨・関節感染症学会プログラム・抄録集 46回 108-108 2023年6月

    出版者・発行元:(一社)日本骨・関節感染症学会

  13. 関節鏡視下に切除を行った上腕骨頭発生類骨骨腫の一例

    有野 敦司, 吉田 新一郎, 岩津 潤, 綿貫 宗則, 山本 宣幸, 相澤 俊峰, 常陸 真, 渡邉 みか

    東北整形災害外科学会雑誌 66 (1) 166-167 2023年6月

    出版者・発行元:東北整形災害外科学会

    ISSN:1348-8694

  14. Long-term results of Chiari pelvic osteotomy on the preservation of hip function with mean follow-up of more than 30 years and its prognostic factors

    Hiroaki Kurishima, Daisuke Chiba, Kazuyoshi Baba, Soshi Hamada, Takayuki Suzuki, Ryuichi Kanabuchi, Genji Fujii, Masamizu Oyama, Tatsuhiro Ochiai, Yu Mori, Toshimi Aizawa

    Journal of Orthopaedic Science 2023年6月

    出版者・発行元:Elsevier BV

    DOI: 10.1016/j.jos.2023.05.013  

    ISSN:0949-2658

  15. 【人工関節における進歩】バイオマテリアル 金属素材と表面加工 チタン合金・低弾性チタン合金 低弾性チタン合金,チタン-ニオブ-スズ合金で開発した人工股関節ステムの成績と今後の展望

    千葉 大介, 山田 則一, 森 優, 馬場 一慈, 大津 進, 大山 正瑞, 井樋 栄二, 相澤 俊峰

    別冊整形外科 (83) 9-12 2023年4月

    出版者・発行元:(株)南江堂

    ISSN:0287-1645

    eISSN:2433-4316

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    セメントレスステムの問題点の一つに応力遮蔽がある。現在もっともよく使用されているセメントレスステムはTi-6Al-4V合金で作られており、同合金は生体適合性がよく、耐食性にも優れている一方、Young率が110GPaと高く、これが応力遮蔽の原因の一つと考えられている。本学金属材料研究所で開発されたチタン-ニオブ-スズ合金(以下TNS合金)は、熱を加えることで強度やYoung率を変化させることのできる画期的な新合金であり、生体材料としての安全性と有用性については基礎実験で確認されている。今回、TNS合金の臨床応用を始めて術後平均3年が経過したので、その成績を報告した。対象は40例40関節で、放射線学的評価の方法は、術後3ヵ月・6ヵ月・1年・3年時に股関節X線撮影を行い、Engh分類に従って応力遮蔽の評価を行った。臨床学的評価は術前と術後6週・3ヵ月・6ヵ月・1年時にJOAスコアとJHEQによる評価を行った。放射線学的評価の結果、術後3年で応力遮断を26関節(65%)に認めたが、その程度はgrade 1が16関節、grade 2が10関節であり、grade 3以上はなかった。臨床学的評価の結果、JOAスコアは術前平均47.4±9.6点が術後1年時84.9±8.6点に改善し、JHEQスコアは術前平均18.1±9.5点が術後1年時57.5±11.7点に改善した。

  16. 【人工関節における進歩】バイオマテリアル 金属素材と表面加工 チタン合金・低弾性チタン合金 低弾性チタン合金,チタン-ニオブ-スズ合金で開発した人工股関節ステムの成績と今後の展望

    千葉 大介, 山田 則一, 森 優, 馬場 一慈, 大津 進, 大山 正瑞, 井樋 栄二, 相澤 俊峰

    別冊整形外科 (83) 9-12 2023年4月

    出版者・発行元:(株)南江堂

    ISSN:0287-1645

    eISSN:2433-4316

  17. Genome-Wide Association Study and Transcriptome of Japanese Patients with Developmental Dysplasia of the Hip Demonstrates an Association with the Ferroptosis Signaling Pathway

    Yu Mori, Kazuko Ueno, Daisuke Chiba, Ko Hashimoto, Yosuke Kawai, Kazuyoshi Baba, Hidetatsu Tanaka, Takashi Aki, Masanori Ogasawara, Naoto Shibasaki, Katsushi Tokunaga, Toshimi Aizawa, Masao Nagasaki

    International Journal of Molecular Sciences 24 (5) 5019-5019 2023年3月6日

    出版者・発行元:MDPI AG

    DOI: 10.3390/ijms24055019  

    eISSN:1422-0067

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    This study examined the association between developmental dysplasia of the hip (DDH) and disease-associated loci in a Japanese cohort. A genome-wide association study (GWAS) of 238 Japanese patients with DDH and 2044 healthy individuals was performed. As a replicate, GWAS was also conducted on the UK Biobank data with 3315 cases and matched 74,038 controls. Gene set enrichment analyses (GSEAs) of both the genetics and transcriptome of DDH were performed. Transcriptome analysis of cartilage specimens from DDH-associated osteoarthritis and femoral neck fractures was performed as a control. Most of the lead variants were very low-frequency ones in the UK, and variants in the Japanese GWAS could not be replicated with the UK GWAS. We assigned DDH-related candidate variants to 42 and 81 genes from the Japanese and UK GWASs, respectively, using functional mapping and annotation. GSEA of gene ontology, disease ontology, and canonical pathways identified the most enriched pathway to be the ferroptosis signaling pathway, both in the Japanese gene set as well as the Japanese and UK merged set. Transcriptome GSEA also identified significant downregulation of genes in the ferroptosis signaling pathway. Thus, the ferroptosis signaling pathway may be associated with the pathogenic mechanism of DDH.

  18. 日本人股関節形成不全患者の発症機序におけるフェロトーシスシグナルの関連

    森 優, 千葉 大介, 橋本 功, 馬場 一慈, 田中 秀達, 植野 和子, 長崎 正朗, 相澤 俊峰

    日本整形外科学会雑誌 97 (2) S115-S115 2023年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  19. SAPHO症候群の放射線学的特徴と臨床的多様性の検討

    森 優, 泉山 拓也, 綿貫 宗則, 吉田 新一郎, 森 菜緒子, 相澤 俊峰

    日本整形外科学会雑誌 97 (3) S888-S888 2023年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  20. 新規に開発した同一stem内で剛性が変化するstem(TiNbSn stem)のstress shielding予防効果

    馬場 一慈, 千葉 大介, 森 優, 田中 秀達, 小暮 敦史, 桑原 功行, 山田 則一, 大津 進, 大山 正瑞, 井樋 栄二, 相澤 俊峰

    日本整形外科学会雑誌 97 (3) S1114-S1114 2023年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  21. 腱板断裂患者における脂肪化と筋萎縮 平均6年の前向き調査

    有野 敦司, 山本 宣幸, 木村 礼, 藍澤 一穂, 川上 純, 永元 英明, 佐野 博高, 相澤 俊峰, 井樋 栄二

    日本整形外科学会雑誌 97 (2) S147-S147 2023年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  22. 肩関節外科に必要な解剖学 関節唇および関節包靱帯の解剖および機能

    山本 宣幸, 有野 敦司, 藍澤 一穂, 川上 純, 永元 英明, 相澤 俊峰, 井樋 栄二

    日本整形外科学会雑誌 97 (2) S515-S515 2023年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  23. 症候性腱板断裂患者の関節軟骨の変化 平均6年の前向き研究

    川上 純, 山本 宣幸, 有野 敦司, 木村 礼, 藍澤 一穂, 佐野 博高, 永元 英明, 常陸 真, 相澤 俊峰, 井樋 栄二

    日本整形外科学会雑誌 97 (3) S816-S816 2023年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  24. 関節窩骨欠損とHill-Sachs損傷の大きさの関係

    高橋 忠久, 山本 宣幸, 有野 敦司, 藍澤 一穂, 川上 純, 永元 英明, 相澤 俊峰, 井樋 栄二

    日本整形外科学会雑誌 97 (3) S1051-S1051 2023年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  25. TiNbSn合金で開発した人工股関節ステムの5年以上経過例の中期成績

    千葉 大介, 山田 則一, 大山 正瑞, 大津 進, 桑原 功行, 馬場 一慈, 田中 秀達, 花田 修治, 井樋 栄二, 相澤 俊峰

    日本整形外科学会雑誌 97 (2) S219-S219 2023年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  26. 若年スポーツ選手における腰痛の頻度 競技種目ごとの検討

    矢部 裕, 萩原 嘉廣, 大野木 孝嘉, 石川 圭佑, 相澤 俊峰

    日本整形外科学会雑誌 97 (2) S73-S73 2023年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  27. 網羅的なタンパク解析による黄色靱帯肥厚の病態解明

    矢部 裕, 萩原 嘉廣, 大野木 孝嘉, 石川 圭佑, 相澤 俊峰

    日本整形外科学会雑誌 97 (2) S318-S318 2023年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  28. 脊椎後彎症患者の立位静止時および歩行時の体幹前傾と股関節肢位の関係 3D動作解析装置とX線計測による検討

    石川 圭佑, 高橋 康平, 関口 雄介, 鎌田 久美, 大野木 孝嘉, 馬場 一慈, 秋 貴史, 橋本 功, 出江 紳一, 小澤 浩司, 相澤 俊峰

    日本整形外科学会雑誌 97 (3) S794-S794 2023年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  29. 日本人股関節形成不全患者の発症機序におけるフェロトーシスシグナルの関連

    森 優, 千葉 大介, 橋本 功, 馬場 一慈, 田中 秀達, 植野 和子, 長崎 正朗, 相澤 俊峰

    日本整形外科学会雑誌 97 (2) S115-S115 2023年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  30. SAPHO症候群の放射線学的特徴と臨床的多様性の検討

    森 優, 泉山 拓也, 綿貫 宗則, 吉田 新一郎, 森 菜緒子, 相澤 俊峰

    日本整形外科学会雑誌 97 (3) S888-S888 2023年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  31. 新規に開発した同一stem内で剛性が変化するstem(TiNbSn stem)のstress shielding予防効果

    馬場 一慈, 千葉 大介, 森 優, 田中 秀達, 小暮 敦史, 桑原 功行, 山田 則一, 大津 進, 大山 正瑞, 井樋 栄二, 相澤 俊峰

    日本整形外科学会雑誌 97 (3) S1114-S1114 2023年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  32. Two-stage revision knee arthroplasty for metallosis in a patient with rheumatoid arthritis: A case report

    Tomoki Koyama, Yu Mori, Masayuki Kamimura, Takashi Aki, Takuya Izumiyama, Naoko Mori, Daisuke Chiba, Ko Hashimoto, Nobuyuki Yamamoto, Toshimi Aizawa

    SAGE Open Medical Case Reports 2023年1月

    DOI: 10.1177/2050313X231177752  

  33. Anterior shift of the ventral dura mater: A novel concept of the posterior surgery for ossification of the posterior longitudinal ligament in thoracic spine. 国際誌

    Kohei Takahashi, Ko Hashimoto, Takahiro Onoki, Haruo Kanno, Hiroshi Ozawa, Toshimi Aizawa

    Frontiers in surgery 10 1120069-1120069 2023年

    DOI: 10.3389/fsurg.2023.1120069  

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    BACKGROUND: Thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) remains one of the most difficult disorders to treat. The Ohtsuka procedure, extirpation, or anterior floating of the OPLL through a posterior approach, has shown great surgical outcomes after several modifications. However, these procedures are technically demanding and pose a significant risk of neurological deterioration. We have developed a novel modified Ohtsuka procedure in which removal or minimization of the OPLL mass is unnecessary; instead, the ventral dura mater is shifted anteriorly with the posterior part of the vertebral bodies and targeted OPLL. SURGICAL PROCEDURE: First, pedicle screws were inserted at more than three spinal levels above and below the spinal level where pediculectomies were performed. After laminectomies and total pediculectomies, partial osteotomy of the posterior vertebra adjacent to the targeted OPLL was performed by using a curved air drill. Then, the PLL is completely resected at the cranial and caudal sites of the OPLL using special rongeurs or a threadwire saw with a diameter of 0.36 mm. The nerve roots were not resected during surgery. METHODS: Eighteen patients (follow-up ≥1 year) treated with our modified Ohtsuka procedure were assessed clinically, including the Japanese Orthopaedic Association (JOA) score for thoracic myelopathy and radiographically. RESULTS: The average follow-up period was 3.2 years (range, 1.3-6.1 years). The preoperative JOA score was 2.7 ± 1.7, which improved to 8.2 ± 1.8 at 1 year postoperatively; therefore, the recovery rate was 65.8 ± 19.8%. The CT scan at 1 year after surgery revealed the anterior shift of the OPLL averaged 3.1 ± 1.7 mm and the ossification-kyphosis angle of the anterior decompression site decreased at an average of 7.2 ± 6.8 degrees. Three patients demonstrated temporary neurological deterioration, all of whom completely recovered within 4 weeks postoperatively. DISCUSSION: The concept of our modified Ohtsuka procedure is 1) not OPLL extirpation or minimization but only the creation of space between the OPLL and spinal cord by an anterior shift of the ventral dura mater, which is achieved by complete resection of the PLL at the cranial and caudal sites of the OPLL; and 2) no nerve roots are sacrificed to prevent ischemic spinal cord injury. This procedure is not technically demanding and safe and provides secure decompression for thoracic OPLL. The anterior shift of the OPLL was smaller than expected, but it resulted in a relatively good surgical outcome with a recovery rate ≥65%. CONCLUSION: Our modified Ohtsuka procedure is quite secure and is not technically demanding, with a recovery rate of 65.8%.

  34. A modified minimally invasive surgery for thoracic pyogenic spondylitis: Percutaneous pedicle screw fixation in combination with a vertebral debridement in a separate posterolateral approach—A case report

    Yuki Sato, Ko Hashimoto, Michiharu Matsuda, Takahiro Onoki, Masayuki Kamimura, Kohei Takahashi, Yoshito Onoda, Daisuke Chiba, Yu Mori, Haruo Kanno, Nobuyuki Yamamoto, Toshimi Aizawa

    Clinical Case Reports 10 (12) 2022年12月

    出版者・発行元:Wiley

    DOI: 10.1002/ccr3.6710  

    ISSN:2050-0904

    eISSN:2050-0904

  35. Impacts of external rotators and the ischiofemoral ligament on preventing excessive internal hip rotation: a cadaveric study

    Kazuyoshi Baba, Daisuke Chiba, Yu Mori, Yoshiyuki Kuwahara, Atsushi Kogure, Takehiro Sugaya, Kumi Kamata, Itsuki Oizumi, Takayuki Suzuki, Hiroaki Kurishima, Soshi Hamada, Eiji Itoi, Toshimi Aizawa

    Journal of Orthopaedic Surgery and Research 17 (1) 2022年12月

    出版者・発行元:Springer Science and Business Media {LLC}

    DOI: 10.1186/s13018-021-02873-w  

    ISSN:1749-799X

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    <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>This study examined the biomechanics of preventing excessive internal hip joint rotation related to the hip flexion angle.</jats:p> </jats:sec><jats:sec> <jats:title>Method</jats:title> <jats:p>An intramedullary nail with a circular plate equipped with a protractor was installed in the femur of nine normal hips. The circular plate was pulled by 3.15 Nm of force in the internal rotation direction. The external rotators were individually resected, finally cutting the ischiofemoral ligament. The cutting order of the external rotators differed on each side to individually determine the internal rotation resistance. The external rotators were resected from the piriformis to the obturator externus in the right hips and the reverse order in the left hips. Traction was performed after excising each muscle and ischiofemoral ligament. Measurements were taken at 0°, 30°, and 60° of hip flexion, and the differences from baseline were calculated.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>For the right hip measurements, the piriformis and ischiofemoral ligament resection significantly differed at 0° of flexion (p = 0.02), each external rotator and the ischiofemoral ligament resections significantly differed at 30° of flexion (p &lt; 0.01), and the ischiofemoral ligament and piriformis and inferior gemellus resections significantly differed at 60° of flexion (p = 0.04 and p = 0.02, respectively). In the left hips, the ischiofemoral ligament and obturator externus, inferior gemellus, and obturator internus resections significantly differed at 0° of flexion (p &lt; 0.01, p &lt; 0.01, and p = 0.01, respectively), as did each external rotator and the ischiofemoral ligament resections at 30° of flexion (p &lt; 0.01).</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>The ischiofemoral ligament primarily restricted the internal rotation of the hip joint. The piriformis and obturator internus may restrict internal rotation at 0° and 60° of flexion.</jats:p> </jats:sec>

  36. How much force is acting on the shoulder joint to create a Hill-Sachs Lesion or reverse Hill-Sachs Lesion?

    Toshimitsu Etoh, Nobuyuki Yamamoto, Jun Kawakami, Masayuki Kamimura, Daisuke Chiba, Yu Mori, Ko Hashimoto, Toshimi Aizawa, Eiji Itoi

    Journal of Orthopaedic Science 2022年10月

    出版者・発行元:Elsevier BV

    DOI: 10.1016/j.jos.2022.09.016  

    ISSN:0949-2658

  37. 関節窩骨欠損とHill-Sachs損傷の大きさの関係

    高橋 忠久, 山本 宣幸, 有野 敦司, 藍澤 一穂, 川上 純, 永元 英明, 相澤 俊峰, 井樋 栄二

    日本肩関節学会学術集会・日本肩の運動機能研究会学術集会抄録集 49回・19回 135-135 2022年9月

    出版者・発行元:(一社)日本肩関節学会

  38. Latarjet法術後の移植骨の形態変化 骨欠損の大小による比較

    山本 宣幸, 有野 敦司, 藍澤 一穂, 高橋 忠久, 川上 純, 永元 英明, 相澤 俊峰, 井樋 栄二

    日本肩関節学会学術集会・日本肩の運動機能研究会学術集会抄録集 49回・19回 140-140 2022年9月

    出版者・発行元:(一社)日本肩関節学会

  39. 症候性腱板断裂患者の関節軟骨の変化 平均6年の前向き研究

    川上 純, 山本 宣幸, 有野 敦司, 木村 礼, 藍澤 一穂, 永元 英明, 佐野 博高, 常陸 真, 相澤 俊峰, 井樋 栄二

    日本肩関節学会学術集会・日本肩の運動機能研究会学術集会抄録集 49回・19回 149-149 2022年9月

    出版者・発行元:(一社)日本肩関節学会

  40. 腱板断裂患者における脂肪化と筋萎縮 平均6年の前向き調査

    有野 敦司, 山本 宣幸, 川上 純, 木村 礼, 藍澤 一穂, 永元 英明, 佐野 博高, 相澤 俊峰, 井樋 栄二

    日本肩関節学会学術集会・日本肩の運動機能研究会学術集会抄録集 49回・19回 150-150 2022年9月

    出版者・発行元:(一社)日本肩関節学会

  41. 早期腱板断裂性関節症の調査 MRIによる軟骨の厚さの評価

    木村 礼, 山本 宣幸, 有野 敦司, 藍澤 一穂, 川上 純, 永元 英明, 相澤 俊峰, 井樋 栄二

    日本肩関節学会学術集会・日本肩の運動機能研究会学術集会抄録集 49回・19回 163-163 2022年9月

    出版者・発行元:(一社)日本肩関節学会

  42. β-type TiNbSn Alloy Plates with Low Young Modulus Accelerates Osteosynthesis in Rabbit Tibiae

    Kentaro Ito, Yu Mori, Masayuki Kamimura, Masashi Koguchi, Hiroaki Kurishima, Tomoki Koyama, Naoko Mori, Naoya Masahashi, Shuji Hanada, Eiji Itoi, Toshimi Aizawa

    Clinical Orthopaedics and Related Research 480 (9) 1817-1832 2022年9月1日

    DOI: 10.1097/CORR.0000000000002240  

    ISSN:0009-921X

    eISSN:1528-1132

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    Background Ti6Al4V alloy, which is commonly used for biomedical applications, has a Young modulus (110 GPa) that is higher than that of human cortical bone (11 to 20 GPa). Using an implant with a material with a low Young modulus that enhances load sharing by the bone even more than those made of Ti6Al4V could be beneficial for bone healing and further reduce the potential for stress shielding. A new β-type TiNbSn alloy has a low Young modulus of approximately 40 to 49 GPa. However, whether the new titanium alloy with a lower Young modulus is advantageous in terms of fracture healing has not been assessed, and a small-animal model seems a reasonable first step in its assessment. Questions/purposesTo assess the impact of a TiNbSn alloy plate with a lower Young modulus compared with a Ti6Al4V alloy plate on fracture healing, we evaluated: (1) bony bridging and callus volume, (2) new bone formation and remaining cartilage tissue, (3) osteoblast activity in the callus, and (4) mechanical strength and stiffness of the callus in bending. Methods Fracture plates manufactured from TiNbSn and Ti6Al4V alloys, which have Young moduli of 49 GPa and 110 GPa, respectively, were compared. The main reason for using rabbits was the high reliability of the three-point bending mechanical test of the rabbit tibia. Forty-two male Japanese white rabbits weighing 2.8 to 3.4 kg were anesthetized. A 5-cm skin incision was made on the medial side in the mid-diaphysis of the right tibia. Eight-hole plates were used, which were 42 mm long, 5 mm wide, and 1.2 mm thick. Plate fixation was performed using three proximal and three distal screws. After the plate was installed, an osteotomy was performed using a 1-mm-wide wire saw to create a standardized tibial transverse osteotomy model with a 1-mm gap. Bone healing was quantitatively assessed by two nonblinded observers using micro-CT (bony bridging and callus volume), histomorphometry (new bone formation and remaining cartilage tissue), immunohistochemistry (osteoblast activity), and mechanical testing (mechanical strength and stiffness in bending). Measurements on nondemineralized specimens were descriptive statistics due to their small number. Four weeks after osteotomy and fixation, 30 rabbits were euthanized to undergo micro-CT and subsequent mechanical testing (n = 12), histomorphometry and immunohistochemistry with demineralized specimens (n = 12), and histomorphometry with a nondemineralized specimen (n = 6). Eight weeks postoperatively, 12 rabbits were euthanized for micro-CT and subsequent mechanical testing. Results Intramedullary fracture calluses treated with TiNbSn alloy plates had larger bone volumes and more numerous bridging structures than those treated with Ti6Al4V alloy plates at 4 weeks after osteotomy (Ti6Al4V alloy versus TiNbSn alloy: 30 ± 7 mm3versus 52 ± 14 mm3, mean difference 22 [95% CI 9 to 37]; p = 0.005; ICC 0.98 [95% CI 0.95 to 0.99]). Histologic assessments demonstrated there was greater new bone formation (total callus: Ti6Al4V versus TiNbSn: 16 ± 4 mm2versus 24 ± 7 mm2, mean difference 8 [95% CI 1 to 16]; p = 0.04; ICC 0.98 [95% CI 0.93 to 0.99]; intramedullary callus: Ti6Al4V versus TiNbSn: 6 ± 4 mm2versus 13 ± 5 mm2, mean difference 7 [95% CI 1 to 13]; p = 0.02; ICC 0.98 [95% CI 0.95 to 0.99]) and a higher number of osteocalcin-positive cells (Ti6Al4V alloy versus TiNbSn alloy: 1397 ± 197 cells/mm2versus 2044 ± 183 cells/mm2, mean difference 647 [95% CI 402 to 892]; p < 0.001; ICC 0.98 [95% CI 0.95 to 0.99]) in the TiNbSn alloy group than in the Ti6Al4V alloy group. At 4 weeks after osteotomy, both bone strength and stiffness of the healed bone in the TiNbSn alloy group were higher than those in the Ti6Al4V alloy group (maximum load: Ti6Al4V alloy versus TiNbSn alloy: 83 ± 30 N versus 127 ± 26 N; mean difference 44 [95% CI 8 to 80]; p = 0.02; stiffness: Ti6Al4V alloy versus TiNbSn alloy: 92 ± 43 N/mm versus 165 ± 63 N/mm; mean difference 73 [95% CI 4 to 143]; p = 0.047). Eight weeks after osteotomy, no between-group differences were observed in the strength and stiffness of the healed bone. Conclusion The results of this study indicate that TiNbSn alloy plate with a lower Young modulus resulted in improved bone formation and stiffer callus during the early phase (4 weeks after surgery) but not the later phase (8 weeks after surgery) of bone healing. Clinical Relevance An overly stiff plate may impair callus formation and bone healing. The TiNbSn alloy plate with a low Young modulus improves the early formation of new bone and stiff callus at the osteotomy site compared with the Ti6Al4V alloy plate in the healing process, which may promote bone repair. TiNbSn alloy may be a promising biomaterial for fracture treatment devices. Further research to address concerns about the strength of TiNbSn alloy plates, such as fatigue life and plate fracture, will be necessary for clinical applications, including mechanical tests to verify fatigue life and validation in larger animals with greater body weight.

  43. Extracorporeal shockwave therapy in an immobilized knee model in rats prevents progression of joint contracture. 国際誌

    Jun Iwatsu, Yutaka Yabe, Kenji Kanazawa, Nobuyuki Itaya, Yasuhito Sogi, Yoshihumi Saijo, Toshimi Aizawa, Yoshihiro Hagiwara

    Journal of orthopaedic research : official publication of the Orthopaedic Research Society 41 (5) 951-961 2022年8月28日

    DOI: 10.1002/jor.25433  

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    Joint immobilization, which ensures rest and accelerates tissue recovery in musculoskeletal disorders, often causes joint contracture, for which there is still no effective prevention. To address this, we investigated the effects of extracorporeal shockwave therapy (ESWT) in preventing joint contracture, in a unilaterally immobilized knee rat model. Under general anesthesia, ESWT (0.25 mJ/mm2 , 3000 shot, 4 Hz, 3 d/week) was administered from one day after immobilization up to 2, 4, and 6 weeks. The immobilized control group received general anesthesia without ESWT. We evaluated joint angle, tissue elasticity, and gene and protein expression related to fibrosis, inflammation, and angiogenesis in the joint capsule. Relative to the control, the ESWT group had greater joint angle at 4 and 6 weeks, and lower posterior-capsule elasticity at 6 weeks. In the ESWT group, at 6 weeks, gene expression of collagen type I (col1α1), connective tissue growth factor (CTGF), and α-smooth muscle actin (α-SMA) was significantly downregulated, whereas interleukin-6 (IL-6) and hypoxia inducible factor-1α (HIF-1α) gene expression was upregulated, relative to that in the control. Compared with that in the control, at 4 and 6 weeks, the ratio of CTGF+ cells were significantly lower in the ESWT group; at 4 weeks, the ESWT group had significantly fewer CD68+ cells in the adhesion area, and at 6 weeks, significantly more blood vessels. This article is protected by copyright. All rights reserved.

  44. Destructive Spondyloarthropathy due to Congenital Insensitivity to Pain with Anhidrosis: A Case Report of Long-Term Follow-Up.

    Ko Hashimoto, Kohei Takahashi, Takahiro Onoki, Haruo Kanno, Naoki Morozumi, Shin Yamazaki, Ken-Ichiro Yahata, Toshimi Aizawa

    The Tohoku journal of experimental medicine 258 (2) 91-95 2022年8月26日

    DOI: 10.1620/tjem.2022.J060  

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    Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal-recessive hereditary neuropathy causing congenital loss of pain sensation, thermoception, and perspiration. CIPA sometimes causes destructive spondyloarthropathy, the so-called Charcot spine, because of insensitivity to pain stimuli. Herein, we report a case of CIPA with severe spinal destruction treated by multiple spinal reconstructive surgeries and over 15 years of follow-up. A 15-year-old male patient who had been diagnosed with CIPA at the age of 17 months presented to his previous spine clinic with gait disturbance due to muscle weakness in his lower extremities. Imaging studies revealed that collapsed L3 and L4 vertebral bodies involved the spinal canal, and it was treated by L3-L4 instrumented posterior fusion. Fourteen years after surgery, the patient became unable to walk again due to spinal canal stenosis at the proximal fusion segment. An L2-L3 posterior interbody fusion alleviated his gait ability for 2 years; however, he became unable to stand again because of the collapsed fusion segment that caused severe lumbar kyphosis. Subsequently, a two-staged posterior and anterior fusion surgery from the lower thoracic spine to the pelvis was performed, and spinal fusion and neurological recovery were achieved 3 years after surgery. A kyphotic deformity in patients with CIPA-associated Charcot spine could be favorably treated by a long spinal fusion in combination with a reconstruction of an anterior spinal column. This case report provides a significant lesson for a treatment of CIPA-associated Charcot spine.

  45. 首下がり・腰曲がり治療の最前線-現状と今後の展望- 成人脊柱後彎症の病態における骨盤傾斜の重要性

    小澤 浩司, 鎌田 久美, 関口 雄介, 菅野 晴夫, 高橋 康平, 相澤 俊峰

    東日本整形災害外科学会雑誌 34 (3) 190-190 2022年8月

    出版者・発行元:東日本整形災害外科学会

    ISSN:1342-7784

    eISSN:2433-569X

  46. 外反型変形性膝関節症に対する遠位大腿骨骨切り術3例4膝の治療成績

    有野 敦司, 秋 貴史, 上村 雅之, 伊東 健太郎, 阿部 高久, 古口 昌志, 佐藤 宏陽, 藤盛 理子, 相澤 俊峰

    東北膝関節研究会会誌 30 27-31 2022年7月

    出版者・発行元:東北膝関節研究会

    ISSN:0917-5164

    eISSN:2433-5614

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    症例1は46歳男で、30歳頃から右膝の外反変形と疼痛を自覚し、徐々に左膝痛も自覚するようになった。今回、両膝の疼痛が増悪し、手術目的で当科に紹介された。単純X線で両膝ともKL分類grade 4の外反型OAを呈しており、%MAは105%/70%、FTAは160°/168°、mLDFAは81°/82°であった。手術は初めに右膝へDFOを行い、1年後に左膝へDFOを施行した。術後アライメントの矯正目標を%MA 50%とし、矯正角が右13°、左8°のMedial biplane closed wedge osteotomyを行った。右は術後4.5ヵ月で骨癒合が得られ、左は術後9.5ヵ月で骨癒合が得られた。最終観察時の%MAは33%/40%、FTAは180°/178°、mLDFAは92°/91°であった。症例2は69歳女で、53歳時から左膝痛を自覚し、近医で保存療法を受けていたが痛みは改善しないため手術目的で当科に紹介された。KL分類grade 4の外反型OAを認め、%MAは104%、FTAは156°、mLDFAは74°であった。矯正角度15°としてDFOを施行し、術後3ヵ月で骨癒合が得られ、最終観察時の%MAは38%、FTAは178°、mLDFAは89°であった。症例3は60歳女で、56歳時から右膝痛を自覚し、徐々に増悪したため手術目的で当科に紹介された。KL分類grade 3の外反型OAを認め、%MAは61%、FTAは168°、mLDFAは83°であった。矯正角度8°としてDFOを施行し、最終観察時の%MAは25%、FTAは180°、mLDFAは91°であった。

  47. Foraminal Stenosis at L5-S1 as an Overlooked Pathology of Bilateral Radiculopathy: A Case Series. 国際誌

    Kohei Takahashi, Ajay Kumar Yadav, Ko Hashimoto, Takumi Tsubakino, Toshimi Aizawa, Yasuhisa Tanaka

    Journal of orthopaedic case reports 12 (6) 13-18 2022年6月

    DOI: 10.13107/jocr.2022.v12.i06.2846  

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    INTRODUCTION: The classical symptom of foraminal stenosis is unilateral radiculopathy. Bilateral radiculopathy caused purely by foraminal stenosis is rare. Here, we report five cases of bilateral L5 radiculopathy caused purely by L5-S1 foraminal stenosis and describe the clinical and radiological features of these patients in detail. CASE PRESENTATION: Among the five patients, two were men and three were women with an average age of 69 years. Four patients had undergone surgeries at L4-5 level, previously. All the patients showed an improvement in symptoms in the post-operative period. After a certain period, the patients complained of bilateral leg pain and numbness. An additional surgery was performed in two patients; however, there was no improvement in symptoms. One patient, who did not undergo surgery, was treated conservatively for 3 years. All the patients had been suffering from bilateral leg symptoms before their first visit to our hospital. The neurological findings in these patients were consistent with bilateral L5 radiculopathy. The average pre-operative Japanese Orthopedic Association (JOA) score was 13 out of 29 points. Bilateral foraminal stenosis at L5-S1 level was confirmed using a three-dimensional magnetic resonance imaging or computed tomography. Posterior lumbar interbody fusion was performed in one patient and bilateral lateral fenestration using Wiltse's approach was performed in four patients. The neurological symptoms recovered immediately after surgery. The average JOA score at 2-year follow-up was 25 points. CONCLUSIONS: Spine surgeons may overlook the pathology of foraminal stenosis, particularly in patients with bilateral radiculopathy. Familiarity with the clinical and radiological features of symptomatic lumbar foraminal stenosis is necessary to properly diagnose bilateral foraminal stenosis at L5-S1 level.

  48. 「若年に見られる膝外傷後変形性膝関節症のマネジメント」 ACL再建術後に生じるOA変化の実態 KOACADを用いた定量評価

    秋 貴史, 上村 雅之, 伊東 健太郎, 阿部 高久, 古口 昌志, 佐藤 宏陽, 藤盛 理子, 井樋 栄二, 相澤 俊峰, 曽木 靖仁

    東北整形災害外科学会雑誌 65 (1) 173-174 2022年6月

    出版者・発行元:東北整形災害外科学会

    ISSN:1348-8694

  49. 硬膜内髄外腫瘍における神経鞘腫と髄膜腫のMRI鑑別アルゴリズムの有効性

    村上 大史, 半田 恭一, 大野木 孝嘉, 鈴木 学, 高橋 康平, 小野田 祥人, 矢部 裕, 橋本 功, 小澤 浩司, 相澤 俊峰

    東北整形災害外科学会雑誌 65 (1) 258-258 2022年6月

    出版者・発行元:東北整形災害外科学会

    ISSN:1348-8694

  50. Post-laminectomy cervical flexion myelopathy and its possible pathomechanism: A case report.

    Kohei Takahashi, Shinji Ogawa, Shuji Isefuku, Ko Hashimoto, Toshimi Aizawa

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2022年5月24日

    DOI: 10.1016/j.jos.2022.05.002  

  51. Innovation of Surgical Techniques for Screw Fixation in Patients with Osteoporotic Spine. 国際誌

    Haruo Kanno, Yoshito Onoda, Ko Hashimoto, Toshimi Aizawa, Hiroshi Ozawa

    Journal of clinical medicine 11 (9) 2022年5月4日

    DOI: 10.3390/jcm11092577  

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    Osteoporosis is a common disease in elderly populations and is a major public health problem worldwide. It is not uncommon for spine surgeons to perform spinal instrumented fusion surgeries for osteoporotic patients. However, in patients with severe osteoporosis, instrumented fusion may result in screw loosening, implant failure or nonunion because of a poor bone quality and decreased pedicle screw stability as well as increased graft subsidence risk. In addition, revision surgeries to correct failed instrumentation are becoming increasingly common in patients with osteoporosis. Therefore, techniques to enhance the fixation of pedicle screws are required in spinal surgeries for osteoporotic patients. To date, various instrumentation methods, such as a supplemental hook, sublaminar taping and sacral alar iliac screws, and modified screwing techniques have been available for reinforcing pedicle screw fixation. In addition, several materials, including polymethylmethacrylate and hydroxyapatite stick/granules, for insertion into prepared screw holes, can be used to enhance screw fixation. Many biomechanical tests support the effectiveness of these augmentation methods. We herein review the current therapeutic strategies for screw fixation and augmentation methods in the surgical treatment of patients with an osteoporotic spine.

  52. The psoas major muscle is essential for bipedal walking - An analysis using a novel upright bipedal-walking android model. 国際誌

    Kouji Sanaka, Ko Hashimoto, Daisuke Kurosawa, Eiichi Murakami, Hiroshi Ozawa, Kohei Takahashi, Takahiro Onoki, Toshimi Aizawa

    Gait & posture 94 15-18 2022年5月

    DOI: 10.1016/j.gaitpost.2022.02.018  

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    BACKGROUND: Bipedalism is a unique function in humans. Various investigations in bipedal walking have assessed the kinetic chain from the pelvis to the lower limbs. However, few studies have investigated the functions of the upper body including the psoas major muscles. In the present study, a bipedal-walking human full-body skeletal model, "the bipedal android model", was generated by attaching air cylinder devices to simulate the contraction and relaxation of various muscles required for bipedal walking, including the psoas major muscles. The bipedal-walking principle was discussed using the model. METHODS: Every part of a human full-body skeletal model was connected by wires or cables to retain the mobility of each joint. Then the psoas major (PM), gluteus minimus (GM), long head of biceps femoris (BF), quadriceps femoris (QF), and semimembranosus (SM) muscles were simulated in the skeletal model using air cylinders. The gait pattern was observed by synchronizing the contraction of PM, GM, QF and SM, and relaxation of BF of the ipsilateral side together with the reversed patterns in the contralateral side, and then switching the phase by every step. The gait pattern in dysfunction of PM or GM muscles was also observed by disconnecting the corresponding air cylinders. RESULTS: The synchronized contraction of PM, GM, QF and SM generates the force to tilt the upper body to ipsilateral side, followed by elevation of the lower limb together with the forward rotation of the pelvis in the contralateral side to swing the leg forward. The next step was generated by reversing the contraction phase at the landing of the swung leg. The dysfunction of PM muscle disabled effective gait in the model, while GM did not. SIGNIFICANCE: The bipedal android model indicated that the psoas major muscles play a crucial role in bipedal walking in human.

  53. Reinforcement of Percutaneous Pedicle Screw Fixation with Hydroxyapatite Granules in Patients with Osteoporotic Spine: Biomechanical Performance and Clinical Outcomes. 国際誌

    Haruo Kanno, Yoshito Onoda, Ko Hashimoto, Toshimi Aizawa, Hiroshi Ozawa

    Medicina (Kaunas, Lithuania) 58 (5) 2022年4月23日

    DOI: 10.3390/medicina58050579  

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    In percutaneous pedicle screw (PPS) fixation of the osteoporotic spine, rigid screw fixation obtaining strong stabilization is important for achieving successful treatment outcomes. However, in patients with severe osteoporosis, it is difficult to obtain PPS fixation with sufficient stability. PPS fixation has potential disadvantages with respect to maintaining secure stabilization in comparison to conventional pedicle screw fixation. In PPS fixation, bone grafting to achieve posterior spine fusion is generally not applicable and transverse connectors between the rods cannot be used to reinforce the fixation. Various augmentation methods, including additional hooks, sublaminar bands, and hydroxyapatite (HA) sticks, are available for conventional pedicle screw fixation. On the other hand, there has been no established augmentation method for PPS fixation. Recently, we developed a novel augmentation technique for PPS fixation using HA granules. This technique allows the percutaneous insertion of HA granules into the screw hole along the guidewire prior to insertion of the PPS. We have used this augmentation technique for PPS fixation in various spine surgeries in patients with osteoporosis. In our previous studies, biomechanical analyses demonstrated that PPS fixation was significantly enhanced by augmentation with HA granules in the osteoporotic lumbar spine. Furthermore, augmentation with HA granules was considered to decrease the incidence of screw loosening and implant failure following PPS fixation in patients with osteoporotic spine. In this article, we describe the surgical procedures of the augmentation method using HA granules and summarize our data from the biomechanical analysis of augmentation for PPS fixation. We also review the surgical outcomes of PPS fixation with augmentation using HA granules.

  54. Clinical outcome of porous hydroxyapatite/collagen graft on bone defects following curettage of bone tumors. 国際誌

    Jun Iwatsu, Munenori Watanuki, Shinichirou Yoshida, Shin Hitachi, Mika Watanabe, Toshimi Aizawa

    Journal of biomedical materials research. Part B, Applied biomaterials 110 (10) 2211-2216 2022年4月19日

    DOI: 10.1002/jbm.b.35070  

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    Hydroxyapatite/collagen (HAp/col) has been reported to be a highly useful bone-like nanocomposite. This study included 33 human patients to investigate the details of the clinical outcomes, which are (1) onset of timing of bone regeneration, (2) replacement by regenerated bone of HAp/col and (3) complications, in human cases grafting HAp/col in large bone defects, following curettage of bone tumors. Porous HAp/col initiated bone regeneration approximately 59 days following the surgery. In 15 cases (45%), complete replacement by newly formed bone was observed 12 months after surgery. On the other hand, incomplete replacement of HAp/col at the final follow-up was observed in 13 cases (39%). In these cases, HAp/col could not be detected in the transparent area of postoperative plain radiographs owing to quick absorption; moreover, it was difficult to distinguish whether the transparent area in plain radiographs was remaining HAp/col, recurrence, or remaining tumor. In addition, larger HAp/col implantation volume (≧15 cm3 ) was associated with poorer result of complete replacement (log-rank, p = .005). Further studies are warranted for the construction of a new artificial bone graft substitute that is more quickly and surely regenerated by newly formed bone in large bone defects.

  55. Chaperone-Mediated Autophagy in Neurodegenerative Diseases and Acute Neurological Insults in the Central Nervous System. 国際誌

    Haruo Kanno, Kyoichi Handa, Taishi Murakami, Toshimi Aizawa, Hiroshi Ozawa

    Cells 11 (7) 2022年4月2日

    DOI: 10.3390/cells11071205  

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    Autophagy is an important function that mediates the degradation of intracellular proteins and organelles. Chaperone-mediated autophagy (CMA) degrades selected proteins and has a crucial role in cellular proteostasis under various physiological and pathological conditions. CMA dysfunction leads to the accumulation of toxic protein aggregates in the central nervous system (CNS) and is involved in the pathogenic process of neurodegenerative diseases, including Parkinson's disease and Alzheimer's disease. Previous studies have suggested that the activation of CMA to degrade aberrant proteins can provide a neuroprotective effect in the CNS. Recent studies have shown that CMA activity is upregulated in damaged neural tissue following acute neurological insults, such as cerebral infarction, traumatic brain injury, and spinal cord injury. It has been also suggested that various protein degradation mechanisms are important for removing toxic aberrant proteins associated with secondary damage after acute neurological insults in the CNS. Therefore, enhancing the CMA pathway may induce neuroprotective effects not only in neurogenerative diseases but also in acute neurological insults. We herein review current knowledge concerning the biological mechanisms involved in CMA and highlight the role of CMA in neurodegenerative diseases and acute neurological insults. We also discuss the possibility of developing CMA-targeted therapeutic strategies for effective treatments.

  56. Lumbar radiculopathy due to Bertolotti's syndrome: Alternative method to reveal the "hidden zone" - A report of two cases and review of literature.

    Shigeaki Kojo, Kohei Takahashi, Takumi Tsubakino, Ko Hashimoto, Toshimi Aizawa, Yasuhisa Tanaka

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2022年3月16日

    DOI: 10.1016/j.jos.2022.02.004  

  57. 人工股関節置換術の術中関節可動域と術後の靴下の着脱・爪切り動作の満足度についての検討

    田中 秀達, 山田 則一, 栗島 宏明, 坂本 敬, 森 優, 大沼 正宏, 大山 正瑞, 相澤 俊峰, 北 純

    日本整形外科学会雑誌 96 (3) S565-S565 2022年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  58. 反復性肩関節前方脱臼に合併する関節窩骨欠損 各骨欠損型の特徴

    藍澤 一穂, 山本 宣幸, 川上 純, 木村 礼, 品川 清嗣, 永元 英明, 井樋 栄二, 相澤 俊峰

    日本整形外科学会雑誌 96 (2) S243-S243 2022年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  59. 股関節内旋制動における外旋筋や後方関節包の機能が、股関節屈曲角度で異なるか Cadaverを用いた研究

    馬場 一慈, 千葉 大介, 森 優, 桑原 功行, 小暮 敦史, 菅谷 岳広, 鈴木 貴之, 栗島 宏明, 浜田 壮志, 井樋 栄二, 相澤 俊峰

    日本整形外科学会雑誌 96 (3) S805-S805 2022年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  60. 脊椎後彎症患者の歩行時と立位時の股関節肢位 三次元動作解析装置を用いた歩行解析とX線計測による検討

    石川 圭佑, 高橋 康平, 関口 雄介, 鎌田 久美, 大野木 孝嘉, 馬場 一慈, 秋 貴史, 橋本 功, 出江 紳一, 小澤 浩司, 相澤 俊峰

    日本整形外科学会雑誌 96 (3) S754-S754 2022年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  61. 脊椎矢状面アライメントと股関節矢状面アライメントの関係

    馬場 一慈, 高橋 康平, 石川 圭佑, 藤田 涼, 秋 貴史, 大野木 孝嘉, 橋本 功, 関口 雄介, 出江 紳一, 小澤 浩司, 相澤 俊峰

    日本整形外科学会雑誌 96 (2) S193-S193 2022年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  62. 脊椎後彎症患者の歩行時と立位時の股関節肢位 三次元動作解析装置を用いた歩行解析とX線計測による検討

    石川 圭佑, 高橋 康平, 関口 雄介, 鎌田 久美, 大野木 孝嘉, 馬場 一慈, 秋 貴史, 橋本 功, 出江 紳一, 小澤 浩司, 相澤 俊峰

    日本整形外科学会雑誌 96 (3) S754-S754 2022年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  63. 前額断MRIによる腰椎椎間孔部狭窄の診断の信頼性と再現性 T1・T2強調画像の信頼性・再現性の比較

    橋本 功, 田中 靖久, 椿野 巧, 中川 智刀, 舘田 聡, 高橋 康平, 鈴木 学, 大野木 孝嘉, 古泉 豊, 国分 正一, 相澤 俊峰

    日本整形外科学会雑誌 96 (3) S762-S762 2022年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  64. 胸椎後縦靱帯骨化症に対する後方進入前方除圧術の除圧効果に関連する因子の検討

    高橋 康平, 橋本 功, 大野木 孝嘉, 菅野 晴夫, 小澤 浩司, 相澤 俊峰

    日本整形外科学会雑誌 96 (3) S1046-S1046 2022年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  65. 術前MRIによるEden分類2型と3型の脊髄砂時計腫の鑑別

    木村 礼, 橋本 功, 大野木 孝嘉, 高橋 康平, 相澤 俊峰

    日本整形外科学会雑誌 96 (3) S1135-S1135 2022年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  66. 視距離と頭部傾斜角による脊柱矢状面アライメントの推定 情報端末作業時のメガネ装着型姿勢モニタリング装置開発にむけて

    橋本 功, 高橋 佑生, 高橋 康平, 大野木 孝嘉, 相澤 俊峰

    日本整形外科学会雑誌 96 (3) S1183-S1183 2022年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  67. メタローシスに対して二期的に人工膝関節再置換術を行った関節リウマチの一例

    古山 和樹, 森 優, 上村 雅之, 相澤 俊峰

    日本リウマチ学会北海道・東北支部学術集会抄録集 31回 56-56 2022年1月

    出版者・発行元:(一社)日本リウマチ学会-北海道・東北支部

  68. Evaluation of the usefulness of the Synovasure alpha-defensin lateral flow test kit for the diagnosis of periprosthetic joint infection in Japanese patients

    Yu Mori, Ryuichi Kanabuchi, Kazayoshi Baba, Daisuke Chiba, Masayuki Kamimura, Naoko Mori, Toshimi Aizawa

    Journal of Orthopaedic Science 27 (4) 935-938 2022年

    DOI: 10.1016/j.jos.2022.05.001  

    ISSN:0949-2658

    eISSN:1436-2023

  69. Adolescent-onset Local Kyphosis with Anterior Column Hypoplasia and Subluxation of the Facet Joints of the Lumbar Spine: A Case Report. 国際誌

    Kohei Takahashi, Ko Hashimoto, Takahiro Onoki, Kyoichi Handa, Haruo Kanno, Toshimi Aizawa

    Journal of orthopaedic case reports 12 (1) 50-53 2022年1月

    DOI: 10.13107/jocr.2022.v12.i01.2614  

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    Introduction: Hypoplasia of the anterior portion of the vertebral body is a relatively rare subtype of juvenile vertebral deformity. The common manifestations of this type of deformity are scoliosis and kyphoscoliosis, while kyphosis without scoliosis is rare. Here, we present a very rare case of adolescent-onset local kyphosis with anterior column hypoplasia and subluxation of the facet joints of the lumbar spine, as demonstrated by dynamic lateral radiograms, which was successfully treated by spine-shortening osteotomy. Case Report: A 16-year-old male adolescent presented with low back pain with progressive protrusion of the lumbar spinous process 3 years before the first visit. The protrusion was not found in his back until the age of 13 years. His chief complaint was lower back pain and a protruding spinous process in the upper lumbar spine. The anteroposterior radiogram of the whole spine revealed no obvious scoliosis. The lateral radiogram showed hypoplasia of the anterior portion of the L2 vertebral body with local kyphosis at L1-3 of 23°. The global alignment was posteriorly shifted, with hypokyphosis of the thoracic spine and hyperlordosis of the lower lumbar spine. In the dynamic lateral radiograms, the facet joints at the L2-3 spinal level were subluxated in the flexed position. Computed tomography showed symmetrical hypoplasia of the anterior portion of the vertebral body of L2. Spine-shortening osteotomy at L2 and L1-3 posterior fusion was performed for local stabilization and correction of sagittal malalignment. The lateral radiogram at the 2-year post-operative follow-up demonstrated that the global alignment was normal, with local kyphosis at L1-3 of -2°. The improvement of hypokyphosis of the thoracic spine and hyperlordosis of the lower lumbar spine was achieved. Conclusions: Adolescent-onset local lumbar kyphosis with anterior column hypoplasia and segmental subluxation of the facet joints is very rare. Local correction by spine-shortening osteotomy with short fusion can also improve the global alignment.

  70. Imaging diagnosis of lumbar foraminal stenosis in the fifth lumbar nerve root: reliability and reproducibility of T1-weighted three-dimensional lumbar MRI. 国際誌

    Ko Hashimoto, Yasuhisa Tanaka, Takumi Tsubakino, Takeshi Hoshikawa, Tomowaki Nakagawa, Takashi Inawashiro, Kohei Takahashi, Masaru Suda, Toshimi Aizawa

    Journal of spine surgery (Hong Kong) 7 (4) 502-509 2021年12月

    DOI: 10.21037/jss-21-63  

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    BACKGROUND: Various magnetic resonance imaging (MRI) techniques have been reported in detection of lumbar foraminal stenosis (LFS), especially for T2-weighted three-dimensional MRI (3D-MRI) describing the shape of nerve roots. The detection of LFS in the fifth lumbar nerve root (L5 root), however, is still less reliable compared to other lumbar nerve roots. Then we have been using T1-weighted 3D-MRI aiming to depict the shape of, and also pathology affecting the L5 root. The aim of this study is to evaluate our T1-weighted 3D-MRI in diagnosing LFS of the L5 root. METHODS: This retrospective study included 24 patients with intracanal stenosis (ICS) at L4-5, and 30 patients with LFS at L5-S causing unilateral L5 root lesion. The pre-operative T1-weighted 3D-MRI aiming bilateral L5 nerve roots of each patient were blinded and reviewed twice by five spine surgeons, independently. The image evaluation was performed in two conditions: (I) the symptomatic side was judged in 30 patients of LFS patients, and (II) the symptomatic side or the absence of LFS was judged in images of all the 54 patients including LFS and ICS patients. The correct-answer-rate, sensitivity and specificity of the imaging study were calculated. Also, the intra- and interobserver agreement of the imaging study by five spine surgeons were evaluated by the kappa (κ) statistics. RESULTS: For conditions (I) and (II) above, the mean correct-answer-rate was 92.3% and 69.8%, respectively. The sensitivity and specificity of the imaging study was 72.6% and 66.3%, respectively. The average of intraobserver κ-value of five examiners was 0.874 and 0.708, and the average of interobserver κ-value was 0.837 and 0.578, respectively. CONCLUSIONS: As well as previously reported T2-weighted 3D-MRI, our T1-weighted 3D-MRI was found to be reliable in diagnosing LFS of the L5 root.

  71. Anterior decompression through a posterior approach for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: a novel concept in anterior decompression and technical notes with the preliminary outcomes. 国際誌

    Haruo Kanno, Toshimi Aizawa, Ko Hashimoto, Eiji Itoi, Hiroshi Ozawa

    Journal of neurosurgery. Spine 1-11 2021年9月24日

    DOI: 10.3171/2021.4.SPINE213  

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    OBJECTIVE: Various surgical procedures are used to manage thoracic myelopathy due to ossification of the posterior longitudinal ligament (OPLL). However, the outcomes of surgery for thoracic OPLL are generally unfavorable in comparison to surgery for cervical OPLL. Previous studies have shown a significant risk of perioperative complications in surgery for thoracic OPLL. Thus, a safe and secure surgical method to ensure better neurological recovery with less perioperative complications is needed. The authors report a novel concept of anterior decompression through a posterior approach aimed at anterior shift of the OPLL during surgery rather than extirpation or size reduction of the OPLL. This surgical technique can securely achieve anterior shift of the OPLL using a curved drill, threadwire saw, and curved rongeur. The preliminary outcomes were investigated to evaluate the safety and efficacy of this technique. METHODS: This study included 10 consecutive patients who underwent surgery for thoracic OPLL. Surgical outcomes, including the ambulatory status, Japanese Orthopaedic Association (JOA) score, and perioperative complications, were investigated retrospectively. In this surgery, pedicle screws are introduced at least three levels above and below the corresponding levels. The laminae, facet joints, transverse processes, and pedicles are then removed bilaterally at levels wherein subsequent anterior decompression is performed. For anterior decompression, the OPLL and posterior portion of the vertebral bodies are partially resected using a high-speed drill with a curved burr, enabling the removal of osseous tissues just ventral to the spinal cord without retracting the dural sac. To securely shift the OPLL anteriorly, the intact PLL and posterior portion of the vertebral bodies cranial and caudal to the lesion are completely resected using a threadwire saw and/or curved rongeur. Rods are connected to the screws, and bone grafting is performed for posterolateral fusion. RESULTS: Five patients were nonambulatory before surgery, but all were able to walk at the final follow-up. The average JOA score before surgery and at the final follow-up was 3.2 and 8.8 points, respectively. Notably, the mean recovery rate of JOA score was 72%. Furthermore, no patients showed neurological deterioration postoperatively. CONCLUSIONS: The surgical technique is a useful alternative for safely achieving sufficient anterior decompression through a posterior approach and may consequently reduce the risk of postoperative neurological deterioration and improve surgical outcomes in patients with thoracic OPLL.

  72. ビスフォスフォネートから治療変更したデノスマブの抗CCP抗体陽性関節リウマチ症例における骨関節破壊の抑制効果の検討

    森 優, 泉山 拓也, 井樋 栄二, 相澤 俊峰

    日本骨粗鬆症学会雑誌 7 (Suppl.1) 339-339 2021年9月

    出版者・発行元:(一社)日本骨粗鬆症学会

    ISSN:2189-8383

  73. 反復性肩関節前方脱臼に合併する関節窩骨欠損 各骨欠損型の特徴

    藍澤 一穂, 山本 宣幸, 川上 純, 井樋 栄二, 木村 礼, 品川 清嗣, 永元 英明, 相澤 俊峰

    東日本整形災害外科学会雑誌 33 (3) 454-454 2021年8月

    出版者・発行元:東日本整形災害外科学会

    ISSN:1342-7784

    eISSN:2433-569X

  74. 低弾性率チタン合金製プレートによるウサギ脛骨骨切り部の骨癒合促進効果

    伊東 健太郎, 森 優, 國井 知典, 栗島 宏明, 古口 昌志, 藤盛 理子, 正橋 直哉, 花田 修治, 井樋 栄二, 相澤 俊峰

    日本整形外科学会雑誌 95 (8) S1813-S1813 2021年8月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  75. 筋・筋膜痛における好中球細胞外トラップの関与

    鈴木 一瑛, 土谷 昌広, 神崎 展, 吉田 新一郎, 綿貫 宗則, 矢部 裕, 藤田 涼, 高橋 忠久, 萩原 嘉廣, 井樋 栄二, 相澤 俊峰

    日本整形外科学会雑誌 95 (8) S1778-S1778 2021年8月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  76. 胸腰椎緊急手術器械セットによる術前待機時間の短縮化

    小野田 祥人, 久志本 成樹, 矢部 裕, 橋本 功, 相澤 俊峰, 井樋 栄二, 菅野 晴夫

    東北整形災害外科学会雑誌 64 (1) 189-189 2021年6月

    出版者・発行元:東北整形災害外科学会

    ISSN:1348-8694

  77. 胸椎OPLLに対する彎曲型ドリルとT-sawを用いた新たな後方進入前方除圧 安全・確実な除圧による手術成績の向上

    菅野 晴夫, 小澤 浩司, 相澤 俊峰, 橋本 功, 高橋 康平, 半田 恭一, 井樋 栄二

    東北整形災害外科学会雑誌 64 (1) 193-193 2021年6月

    出版者・発行元:東北整形災害外科学会

    ISSN:1348-8694

  78. Mid- to Long-Term Outcomes After Resection of Thoracic Dumbbell Tumors Managed by Laminectomy and Unilateral Total Facetectomy Without Instrumented Fusion. 国際誌

    Yuya Ishikawa, Masayuki Ohashi, Toru Hirano, Michiharu Matsuda, Takeru Akabane, Haruo Kanno, Ko Hashimoto, Kyoichi Handa, Toshimi Aizawa, Tomoto Suzuki, Yukihide Shimamura, Kei Watanabe

    Global spine journal 21925682211008836-21925682211008836 2021年5月11日

    DOI: 10.1177/21925682211008836  

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    STUDY DESIGN: Retrospective multicenter study. OBJECTIVE: To evaluate mid- to long-term surgical outcomes of thoracic dumbbell tumors managed by laminectomy and unilateral total facetectomy without instrumented fusion. METHODS: A total of 15 patients with thoracic dumbbell tumors who underwent primary resection by laminectomy and unilateral total facetectomy without spinal instrumented fusion between 2000 and 2015 were reviewed. Patient characteristics, surgical outcomes (including spinal alignment and stability), disc degeneration, pain, disability, and health-related quality of life were evaluated. Additionally, to analyze the impact of the affected levels on these outcomes, we divided the patients into 2 groups: a middle thoracic group and a thoracolumbar group. RESULTS: The mean duration of follow-up was 100.5 months (range, 36-190 months). The affected level was T3-T4 or below in all patients. Although the local kyphosis angle (8.1° to 12.7°), thoracic kyphosis angle (25.6° to 33.9°), and coronal Cobb angle (6.6° to 9.5°) significantly increased from preoperative to the final visit (P ≤ .02), no patient demonstrated spinal instability. From magnetic resonance imaging, no patient had a worse grade of disc degeneration in the affected level than those in the adjacent levels. The percentage of patients who presented with an Oswestry disability index ≤ 22% was 80%. Moreover, the surgical region did not adversely affect the outcomes. No patient required additional surgery due to spinal instability or deformity. CONCLUSIONS: Unilateral total facetectomy without fusion to resect thoracic dumbbell tumors caused neither spinal deformity nor instability requiring additional surgery at the mid- to long-term follow-up.

  79. Randomized trial of granulocyte colony-stimulating factor for spinal cord injury. 国際誌

    Masao Koda, Hideki Hanaoka, Yasuhisa Fujii, Michiko Hanawa, Yohei Kawasaki, Yoshihito Ozawa, Tadami Fujiwara, Takeo Furuya, Yasushi Ijima, Junya Saito, Mitsuhiro Kitamura, Takuya Miyamoto, Seiji Ohtori, Yukei Matsumoto, Tetsuya Abe, Hiroshi Takahashi, Kei Watanabe, Toru Hirano, Masayuki Ohashi, Hirokazu Shoji, Tatsuki Mizouchi, Norio Kawahara, Masahito Kawaguchi, Yugo Orita, Takeshi Sasamoto, Masahito Yoshioka, Masafumi Fujii, Katsutaka Yonezawa, Daisuke Soma, Hiroshi Taneichi, Daisaku Takeuchi, Satoshi Inami, Hiroshi Moridaira, Haruki Ueda, Futoshi Asano, Yosuke Shibao, Ikuo Aita, Yosuke Takeuchi, Masaya Mimura, Jun Shimbo, Yukio Someya, Sumio Ikenoue, Hiroaki Sameda, Kan Takase, Yoshikazu Ikeda, Fumitake Nakajima, Mitsuhiro Hashimoto, Fumio Hasue, Takayuki Fujiyoshi, Koshiro Kamiya, Masahiko Watanabe, Hiroyuki Katoh, Yukihiro Matsuyama, Tomohiko Hasegawa, Go Yoshida, Hideyuki Arima, Yu Yamato, Shin Oe, Daisuke Togawa, Sho Kobayashi, Koji Akeda, Eiji Kawamoto, Hiroshi Imai, Toshihiko Sakakibara, Akihiro Sudo, Yasuo Ito, Takeshi Kikuchi, Tomoyuki Takigawa, Takuya Morita, Nobuhiro Tanaka, Kazuyoshi Nakanishi, Naosuke Kamei, Shinji Kotaka, Hideo Baba, Tsuyoshi Okudaira, Hiroaki Konishi, Takayuki Yamaguchi, Keigo Ito, Yoshito Katayama, Taro Matsumoto, Tomohiro Matsumoto, Haruo Kanno, Toshimi Aizawa, Ko Hashimoto, Toshimitsu Eto, Takehiro Sugaya, Michiharu Matsuda, Kazunari Fushimi, Satoshi Nozawa, Chizuo Iwai, Toshihiko Taguchi, Tsukasa Kanchiku, Hidenori Suzuki, Norihiro Nishida, Masahiro Funaba, Takashi Sakai, Yasuaki Imajo, Masashi Yamazaki

    Brain : a journal of neurology 144 (3) 789-799 2021年4月12日

    DOI: 10.1093/brain/awaa466  

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    Attenuation of the secondary injury of spinal cord injury (SCI) can suppress the spread of spinal cord tissue damage, possibly resulting in spinal cord sparing that can improve functional prognoses. Granulocyte colony-stimulating factor (G-CSF) is a haematological cytokine commonly used to treat neutropenia. Previous reports have shown that G-CSF promotes functional recovery in rodent models of SCI. Based on preclinical results, we conducted early phase clinical trials, showing safety/feasibility and suggestive efficacy. These lines of evidence demonstrate that G-CSF might have therapeutic benefits for acute SCI in humans. To confirm this efficacy and to obtain strong evidence for pharmaceutical approval of G-CSF therapy for SCI, we conducted a phase 3 clinical trial designed as a prospective, randomized, double-blinded and placebo-controlled comparative trial. The current trial included cervical SCI [severity of American Spinal Injury Association (ASIA) Impairment Scale (AIS) B or C] within 48 h after injury. Patients are randomly assigned to G-CSF and placebo groups. The G-CSF group was administered 400 μg/m2/day × 5 days of G-CSF in normal saline via intravenous infusion for five consecutive days. The placebo group was similarly administered a placebo. Allocation was concealed between blinded evaluators of efficacy/safety and those for laboratory data, as G-CSF markedly increases white blood cell counts that can reveal patient treatment. Efficacy and safety were evaluated by blinded observer. Our primary end point was changes in ASIA motor scores from baseline to 3 months after drug administration. Each group includes 44 patients (88 total patients). Our protocol was approved by the Pharmaceuticals and Medical Device Agency in Japan and this trial is funded by the Center for Clinical Trials, Japan Medical Association. There was no significant difference in the primary end point between the G-CSF and the placebo control groups. In contrast, one of the secondary end points showed that the ASIA motor score 6 months (P = 0.062) and 1 year (P = 0.073) after drug administration tend to be higher in the G-CSF group compared with the placebo control group. Moreover, in patients aged over 65 years old, motor recovery 6 months after drug administration showed a strong trend towards a better recovery in the G-CSF treated group (P = 0.056) compared with the control group. The present trial failed to show a significant effect of G-CSF in primary end point although the subanalyses of the present trial suggested potential G-CSF benefits for specific population.

  80. A Right Angle Guide for Distal Tuberosity Osteotomy With Medial Open Wedge High Tibial Osteotomy for Varus Knee Osteoarthritis. 国際誌

    Akira Sasaki, Takehiko Sugita, Nobuyuki Itaya, Toshimi Aizawa, Naohisa Miyatake, Seiya Miyamoto, Ikuo Maeda, Masayuki Kamimura, Atsushi Takahashi, Hideaki Nagamoto

    Arthroscopy techniques 10 (4) e1007-e1016 2021年4月

    DOI: 10.1016/j.eats.2020.11.017  

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    Medial open wedge high tibial osteotomy (OWHTO) is usually performed with proximal tuberosity osteotomy or setting the osteotomy line proximal to the tuberosity. However, OWHTO can result in patellofemoral complications due to postoperative patella infera. A new OWHTO technique, biplanar osteotomy with a distal tuberosity osteotomy, was reported in 2004 to prevent postoperative patella infera. To ensure that the 2 osteotomy lines maintain perpendicular, we describe the OWHTO procedure with a distal tuberosity osteotomy technique using a TriS Medial HTO Plate System (Olympus Terumo Biomaterials Corp., Tokyo, Japan) and a right angle guide we developed. In this Technical Note, we describe the procedure and advantages, risks, and limitations, as well as the pearls and pitfalls based on our experience.

  81. 胸椎後縦靱帯骨化症に対する後方進入前方除圧術(大塚変法)の手術成績とCTによる除圧の検証

    高橋 康平, 相澤 俊峰, 橋本 功, 小野田 祥人, 半田 恭一, 大野木 孝嘉, 菅野 晴夫, 小澤 浩司

    Journal of Spine Research 12 (3) 96-96 2021年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  82. 胸椎OPLLに対する彎曲型ドリルとT-sawを用いた新たな後方進入前方除圧 安全・確実な除圧が術後の麻痺悪化を回避し早期離床を可能にする

    菅野 晴夫, 相澤 俊峰, 橋本 功, 高橋 康平, 半田 恭一, 井樋 栄二, 小澤 浩司

    Journal of Spine Research 12 (3) 179-179 2021年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  83. 前額断MRIによる腰椎椎間孔部狭窄の診断 T1・T2強調画像の信頼性・再現性と読影傾向の比較検証

    橋本 功, 田中 靖久, 相澤 俊峰, 椿野 巧, 中川 智刀, 舘田 聡, 高橋 康平, 鈴木 学, 大野木 孝嘉, 両角 直樹, 古泉 豊, 佐藤 哲朗, 小澤 浩司, 菅野 晴夫, 国分 正一, 井樋 栄二

    Journal of Spine Research 12 (3) 359-359 2021年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  84. 成人脊柱変形に対するdynamic compression hookを併用した脊柱短縮骨切り術 変形矯正効果とロッド折損予防の検討

    菅野 晴夫, 相澤 俊峰, 橋本 功, 小澤 浩司

    Journal of Spine Research 12 (3) 394-394 2021年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  85. 脊髄神経鞘腫摘出術における神経根切離後の神経脱落症状の検討

    半田 恭一, 相澤 俊峰, 村上 大史, 大野木 孝嘉, 高橋 康平, 橋本 功, 小澤 浩司, 井樋 栄二

    Journal of Spine Research 12 (3) 429-429 2021年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  86. 硬膜内髄外腫瘍における神経鞘腫と髄膜腫のMRI鑑別アルゴリズムの有効性

    村上 大史, 相澤 俊峰, 半田 恭一, 大野木 孝嘉, 鈴木 学, 高橋 康平, 小野田 祥人, 橋本 功, 小澤 浩司, 井樋 栄二

    Journal of Spine Research 12 (3) 433-433 2021年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  87. 胸椎後縦靱帯骨化症に対する後方進入前方除圧術の成績 後方除圧固定術との比較

    相澤 俊峰, 橋本 功, 高橋 康平, 大野木 孝嘉, 半田 恭一, 菅野 晴夫, 小澤 浩司

    Journal of Spine Research 12 (3) 592-592 2021年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  88. 脊椎手術における温風式加温装置の術中使用はSSI発生リスクか 傾向スコアマッチング法を用いた検討

    半田 恭一, 菅野 晴夫, 松谷 重恒, 大野木 孝嘉, 高橋 康平, 橋本 功, 相澤 俊峰, 井樋 栄二

    日本整形外科学会雑誌 95 (3) S705-S705 2021年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  89. 前額断MRIによる腰椎椎間孔部狭窄の診断 T1・T2強調画像の信頼性・再現性と読影傾向の比較検証

    橋本 功, 田中 靖久, 相澤 俊峰, 椿野 巧, 中川 智刀, 舘田 聡, 高橋 康平, 鈴木 学, 大野木 孝嘉, 両角 直樹, 古泉 豊, 佐藤 哲朗, 小澤 浩司, 菅野 晴夫, 国分 正一, 井樋 栄二

    Journal of Spine Research 12 (3) 359-359 2021年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  90. Retrospective comparison of the surgical results for patients with thoracic myelopathy caused by ossification of the posterior longitudinal ligament: Posterior decompression with instrumented spinal fusion versus modified anterior decompression through a posterior approach.

    Toshimi Aizawa, Ko Hashimoto, Haruo Kanno, Kyoichi Handa, Kohei Takahashi, Takahiro Onoki, Eiji Itoi, Hiroshi Ozawa

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 27 (2) 323-329 2021年2月7日

    DOI: 10.1016/j.jos.2021.01.001  

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    BACKGROUND: In Japan, approximately 75% of patients with thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) are treated by posterior decompression with instrumented spinal fusion (PDF) because of its efficacy and safety. To achieve more effective decompression of the spinal cord using a posterior approach, anterior decompression through a posterior approach was developed. However, this technique has a high risk of postoperative paralysis. We have added a couple of ingenuities to this procedure (modified Ohtsuka procedure). This study was performed to report the surgical results of our modified Ohtsuka procedure and to compare them with the results of PDF. METHODS: This was a retrospective case series. From 2008 to 2018, we surgically treated 32 patients: 20 patients treated by PDF (PDF group) and 12 patients by our modified Ohtsuka procedure (modified Ohtsuka group) as the initial surgery. All patients were followed up for at least 12 months. The degree of surgical invasion and patients' neurological condition were assessed. RESULTS: The operative duration and intraoperative blood loss indicated no significant differences (PDF vs. Ohtuska: 507 ± 103 vs. 534 ± 99 min, 1022 ± 675 vs. 1160 ± 685 ml, respectively). The preoperative Japanese Orthopaedic Association (JOA) score was 4.5 ± 2.0 in the PDF group and 3.3 ± 1.4 in the modified Ohtsuka group (p < 0.05). However, the latest JOA score and recovery rate were significantly better in the modified Ohtsuka group than in the PDF group (8.9 ± 1.2 vs. 7.4 ± 2.5 and 70.8 ± 17.6% vs. 44.5 ± 40.2%, respectively). Postoperative paralysis did not occur in the modified Ohtsuka group while four patients had it in the PDF group. CONCLUSIONS: The present study clearly indicated the modified Ohtsuka group showed significantly better surgical outcomes than the PDF group with the recovery rate ≥70%.

  91. Novel augmentation technique of percutaneous pedicle screw fixation using hydroxyapatite granules in the osteoporotic lumbar spine: a cadaveric biomechanical analysis. 国際誌

    Haruo Kanno, Toshimi Aizawa, Ko Hashimoto, Eiji Itoi

    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 30 (1) 71-78 2021年1月

    DOI: 10.1007/s00586-020-06451-2  

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    PURPOSE: Percutaneous pedicle screw (PPS) fixation has been commonly used for various spine surgeries. Rigid PPS fixation is necessary to decrease the incidence of screw loosening in osteoporotic spine. Recently, we have reported biomechanical advantages of augmentation technique using hydroxyapatite (HA) granules for PPS fixation in synthetic bone. However, its biomechanical performance in augmenting PPS fixation for osteoporotic spine has not been fully elucidated. The aim of the present study is to perform a cadaveric biomechanical analysis of PPS fixation augmented with HA granules. METHODS: Thirty osteoporotic lumbar vertebrae (L1-L5) were obtained from 6 cadavers (3 men and 3 women; age 80 ± 9 years; bone mineral density 73 ± 9 mg/cm3). The maximal pullout strength and maximal insertion torque were compared between the screws inserted into the vertebrae with and without augmentation. In toggle testing, the number of craniocaudal toggle cycles and maximal load required to achieve the 2-mm screw head displacement were also compared. RESULTS: The maximal pullout strength in the screws augmented with HA granules was significantly greater compared to those without augmentation (p < 0.05). The augmentation significantly increased the maximal insertion torque of the screws (p < 0.05). Moreover, the number of toggle cycles and the maximal load required to reach 2 mm of displacement were significantly higher in the augmented screws (p < 0.05). CONCLUSION: The PPS fixation was significantly enhanced by the augmentation with HA granules in the osteoporotic lumbar spine. The PPS fixation augmented with HA granules might decrease the incidence of screw loosening and implant failure in patients with osteoporotic spine.

  92. Surgical results of nonambulatory patients caused by ossification of the posterior longitudinal ligaments in the thoracic spine: retrospective comparative study between posterior decompression and instrumented spinal fusion versus anterior decompression through a posterior approach. 国際誌

    Toshimi Aizawa, Toshimitsu Eto, Ko Hashimoto, Haruo Kanno, Eiji Itoi, Hiroshi Ozawa

    Journal of neurosurgery. Spine 34 (3) 1-6 2020年12月11日

    DOI: 10.3171/2020.7.SPINE20411  

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    OBJECTIVE: Thoracic myelopathy caused by ossification of the posterior longitudinal ligament (OPLL) remains one of the most difficult-to-treat disorders for spine surgeons. In Japan, approximately 75% of patients with this condition are treated using posterior decompression with instrumented spinal fusion (PDF). In contrast, anterior decompression is the most effective method for relieving spinal cord compression. The authors treated nonambulatory patients with thoracic OPLL by either PDF or by their technique using anterior decompression through a posterior approach. In this study the surgical results of these procedures are compared. METHODS: This was a retrospective case series. From 2008 to 2018, 9 patients with thoracic OPLL who could not walk preoperatively were treated surgically. Three patients were treated by PDF (the PDF group) and 6 patients were treated by anterior decompression through a posterior approach (the modified Ohtsuka group). The degree of surgical invasion and the neurological conditions of the patients were assessed. RESULTS: The PDF group had a shorter operative duration (mean 477 ± 122 vs 569 ± 92 minutes) and less intraoperative blood loss (mean 613 ± 380 vs 1180 ± 614 ml), although the differences were not statistically significant. The preoperative Japanese Orthopaedic Association (JOA) score was almost identical between the two groups; however, the latest JOA score and the recovery rate were significantly better in the modified Ohtsuka group than in the PDF group (8.8 ± 1.5 vs 5.0 ± 1.7 and 71.3% ± 23.7% vs 28.3% ± 5.7%, respectively). The walking ability was evaluated using the modified Frankel scale. According to this scale, 3 patients showed three grade improvements, 2 patients showed two grade improvements, and 1 patient showed one grade improvement in the modified Ohtsuka group. Three patients in the modified Ohtsuka group could walk without any support at the final follow-up. CONCLUSIONS: The present study clearly indicated that the surgical outcomes of the authors' modified Ohtsuka procedure were significantly better than those of PDF for patients who could not walk preoperatively.

  93. Rate of spinal surgery in a rapidly aging society: the 27-year changes in Miyagi prefecture, Japan. 国際誌

    Toshimi Aizawa, Shoichi Kokubun, Takashi Kusakabe, Hiroshi Ozawa, Yasuhisa Tanaka, Takeshi Hoshikawa, Ko Hashimoto, Haruo Kanno, Naoki Morozumi, Yutaka Koizumi, Chikashi Kawahara, Tetsuro Sato, Hironori Hyodo, Shinji Ogawa, Eiichi Murakami, Eiji Itoi

    Journal of neurosurgical sciences 64 (6) 525-530 2020年12月

    DOI: 10.23736/S0390-5616.18.04251-0  

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    BACKGROUND: Japan has had a rapidly aging population during the past 30 years. This study aimed to investigate longitudinal changes in the surgical rate for spinal disorders in Miyagi Prefecture (2.35 million inhabitants) with a similar population composition to Japan. METHODS: Data of spinal surgeries were collected using the spine registry by Tohoku University Spine Society. Data on the annual number of spinal surgeries between 1988 and 2014 of all populations, in those aged ≥65 years old, in those aged ≥75 years old, and for each pathology were collected. The annual surgical rate per 100,000 inhabitants was calculated. RESULTS: The surgical rate in 2010-2014 in total, at ≥65 years old, and at ≥75 years old showed 3.2-, 3.8- and 7.1-fold increases, respectively, compared with that in 1988-1989. Degenerative spinal disorders, spinal trauma and pyogenic spondylitis markedly increased, while metastatic spinal tumor and tuberculous spondylitis decreased over time. The surgical rate at ≥75 years with lumbar spinal stenosis showed a 12.6-time increase. CONCLUSIONS: During a rapid period of aging, the rate of spinal surgeries has markedly increased, particularly, that for degenerative disorders. This is the first report on the long-term longitudinal changes in the rate of spinal surgery.

  94. Anterior Decompression and Fusion Versus Laminoplasty for Cervical Myelopathy Caused by Soft Disk Herniation: A Long-term Prospective Multicenter Study. 国際誌

    Tomoaki Koakutsu, Toshimi Aizawa, Morichika Sasaki, Akira Sekiguchi, Naoki Morozumi, Yushin Ishii, Shoichi Kokubun, Ko Hashimoto, Fumio Kasama, Yasuhisa Tanaka, Tetsuro Sato, Eiji Itoi, Shin Yamazaki

    Clinical spine surgery 33 (10) E478-E485 2020年12月

    DOI: 10.1097/BSD.0000000000000986  

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    STUDY DESIGN: A prospective multicenter study. OBJECTIVE: The purpose of this study was to determine whether laminoplasty (LP) is comparable for myelopathy caused by cervical disk herniation (CDH). SUMMARY OF BACKGROUND DATA: Anterior decompression and fusion (ADF) has conventionally been used for myelopathy caused by CDH with stable outcomes. However, recurrence of myelopathy due to adjacent segment degeneration are its drawbacks. The efficacy of LP without discectomy has been sporadically reported, but no long-term prospective study has been conducted to verify it. MATERIALS AND METHODS: Patients with cervical myelopathy caused by CDH were studied. The first 30 patients and the next 30 patients were treated with ADF and LP, respectively. The outcomes were compared between the 22 ADF patients and the 20 LP patients who had completed the follow-up examination scheduled 10 years after surgery. RESULTS: There was no statistically significant difference in the postoperative severity or recovery rate of myelopathy between the 2 groups 10 years after surgery. One patient in the ADF group underwent LP for secondary myelopathy due to adjacent segment degeneration 2 years after the surgery. Reoperation was not required for patients in the LP group. Postoperative neck pain was significantly more severe in the LP group than in the ADF group. CONCLUSIONS: ADF and LP for cervical myelopathy caused by CDH achieve similarly favorable outcomes. Recurrence of myelopathy caused by adjacent segment degeneration is a disadvantage of ADF while residual neck pain is a disadvantage of LP.

  95. Obesity is a risk factor for osteoarthritis progression and spontaneous osteoporosis is a risk for the development of spontaneous osteonecrosis in patients with medial meniscus posterior root tear.

    Atsushi Takahashi, Jutaro Umehara, Masayuki Kamimura, Toshimi Aizawa, Eiji Itoi

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2020年10月5日

    DOI: 10.1016/j.jos.2020.09.001  

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    BACKGROUND: Obesity is a representative risk factor for osteoarthritis (OA). The relationship between osteoporosis and executed osteonecrosis has been reported. The primary aim of this study was to determine the influence of obesity and osteoporosis on disease progression in patients with medial meniscus posterior root tear (MMPRT). METHODS: We included 41 knees with MMPRT in this study. MMPRT was diagnosed based on the presence of both a meniscus ghost sign and a vertical linear defect on MRI. OA progression and development of osteonecrosis were evaluated using plain radiographs obtained at the initial visit and the final follow-up. The follow-up period for all knees was 30 ± 8 (mean ± standard deviation) months. Patients' physical attributes were assessed at initial visits; these attributes included body mass index (BMI) and the clinical risk for osteoporotic fracture, as determined by the World Health Organization fracture risk assessment tool (FRAX). Patients with a BMI ≥25 kg/m2 were classified in the obesity group and those with a BMI <25 kg/m2 in the control group. Patients with a FRAX score of ≥10% were classified in the high FRAX group and those with a FRAX score of <10% in the low FRAX group. RESULTS: OA progression evaluated by Kellgren-Lawrence grading scale was observed in 75% patients in the obesity group (1 grade in 38%, 2 grades in 31%, and 3 grades in 6%) and 58% in the control group (1 grade in 58%). Patients in the obesity group showed significantly greater OA progression. Spontaneous osteonecrosis was observed in no knees at the initial visit and six knees at the final follow-up. All six lesions were observed in the high FRAX group, which was statistically significant. CONCLUSIONS: OA progression and development of osteonecrosis were the two representative deterioration patterns in patients with MMPRT. High BMI was related with OA progression, and FRAX score of ≥10% with the development of osteonecrosis.

  96. 化膿性脊椎炎術後に非閉塞性腸管虚血症を発症した1例

    佐藤 宏陽, 相澤 俊峰, 橋本 功, 菅野 晴夫, 衛藤 俊光, 半田 恭一, 井樋 栄二

    臨床整形外科 55 (10) 1177-1180 2020年10月

    出版者・発行元:(株)医学書院

    ISSN:0557-0433

    eISSN:1882-1286

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    <文献概要>背景:非閉塞性腸管虚血症(non-occlusive mesenteric ischemia:NOMI)は術後合併症として生じ得る急性腸管虚血症の1つで致死率が高い.救命には早期診断が必須だが,整形外科領域では報告例が少なく,一般には認識されていない.目的:症例報告症例:糖尿病がある66歳女性の腰椎化膿性脊椎炎に対し,前方病巣掻爬および骨移植を行った.術後6時間で血圧が低下し,腹部膨満感などを訴えた.術後18時間の造影CTでNOMIと診断したが,救命し得ず術後42時間で死亡した.考察:心不全,透析,糖尿病,感染症などの危険因子を有する患者では,術後に血圧低下や循環血漿量減少が重なるとNOMIを発症する可能性があるので注意を要する.

  97. Criteria for Identifying Technically Difficult Cases when Performing Sacroiliac Intraarticular Injections Based on the Grade of Sacroiliac Arthrogram. 国際誌

    Daisuke Kurosawa, Eiichi Murakami, Toshimi Aizawa, Takashi Watanabe, Yutaka Yabe

    Pain medicine (Malden, Mass.) 21 (10) 2105-2110 2020年10月1日

    DOI: 10.1093/pm/pnaa120  

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    OBJECTIVE: An intraarticular sacroiliac joint (SIJ) injection cannot always be performed successfully. Based on the patterns of the sacroiliac arthrogram, we explored possible indicators of technically difficult and technically easy injections into the SIJ including demographic features and anatomical features evident on preprocedural imaging. DESIGN: Observational study. METHODS: We evaluated 76 patients with painful SIJ (total 108 joints) diagnosed by SIJ injections. The sacroiliac arthrogram was graded as follows: Grade (G) 0 = the margin of the joint was partially outlined; G1 = the margin was completely outlined; G2 = intraarticular space was substantially outlined; and G3 = intraarticular space was fully outlined. Two multivariable ordered logistic regression analyses were performed to test the relationships between gender, age, and Grade, as well as between computed tomography (CT) findings and grade. RESULTS: In men, the totals by Grade were G0 = 8 (joints); G1 = 33; G2 = 3; and G3 = 0. In women, these were G0 = 4; G1 = 28; G2 = 22; and G3 = 10. The Grade was significantly higher in women and was also higher with age (P < 0.05). Regarding morphological features in CT, minor osteophytes increased the odds in favor of better Grades of arthrogram (odds ratio = 3.50). Substantial vacuum phenomena strongly increased the odds of better arthrograms (20.52). CONCLUSIONS: Outlining the SIJ cavity fully is significantly more difficult in male patients of any age than in aged female patients. The presence of minor osteophytes and substantial vacuum phenomena on preprocedure CT scans can be reasonably reassuring to the practitioner that they are unlikely to encounter difficulties during injection.

  98. 腰痛のない健常中高年者229名における腰椎不安定性

    鈴木 学, 田中 靖久, 橋本 功, 相澤 俊峰, 椿野 巧, 星川 健, 高橋 康平, 三宅 公太, 小城 繁明, 金城 英傑, 井樋 栄二

    日本整形外科学会雑誌 94 (8) S1910-S1910 2020年9月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  99. 自然縮小した胸椎部砂時計腫の1例

    鈴木 学, 相澤 俊峰, 橋本 功, 菅野 晴夫, 小野田 祥人, 井樋 栄二

    東日本整形災害外科学会雑誌 32 (2) 198-201 2020年6月

    出版者・発行元:東日本整形災害外科学会

    ISSN:1342-7784

    eISSN:2433-569X

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    砂時計腫の約7割は神経鞘腫で、徐々に増大することが多い。13年の経過で縮小した砂時計腫を報告する。症例は57歳女性で、内科疾患の精査で胸部異常影を指摘された。MRIで脊柱管内から椎間孔、胸腔内に広がる砂時計腫が見られた。無症候性のため経過観察を行った。初診7年後のMRIで腫瘍内部に出血を示唆する所見が見られた後に縮小し、初診13年後に終診とした。腫瘍内出血が見られる場合は、自然縮小の可能性がある。(著者抄録)

  100. 胸椎後縦靱帯骨化症に対する後方進入前方除圧術の手術成績

    相澤 俊峰, 橋本 功, 菅野 晴夫, 半田 恭一, 小野田 祥人, 井樋 栄二, 小澤 浩司

    Journal of Spine Research 11 (3) 217-217 2020年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  101. 胸椎後縦靱帯骨化症に対する後方進入前方除圧術の新たな工夫 彎曲型ドリルとT-sawによる安全・確実な前方除圧

    菅野 晴夫, 相澤 俊峰, 橋本 功, 衛藤 俊光, 井樋 栄二

    Journal of Spine Research 11 (3) 219-219 2020年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  102. 固定術を併用しない胸椎砂時計腫摘出術の中長期成績 多施設研究

    石川 裕也, 大橋 正幸, 平野 徹, 松田 倫治, 赤羽 武, 菅野 晴夫, 橋本 功, 半田 恭一, 相澤 俊峰, 鈴木 智人, 嶋村 之秀, 渡辺 慶

    Journal of Spine Research 11 (3) 517-517 2020年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  103. 腰椎不安定性と腰痛の関連 189例の健常者による前向き研究

    鈴木 学, 田中 靖久, 橋本 功, 相澤 俊峰, 椿野 巧, 星川 健, 高橋 康平, 三宅 公太, 小城 繁明, 金城 英傑, 井樋 栄二

    日本整形外科学会雑誌 94 (2) S118-S118 2020年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  104. 胸椎後縦靱帯骨化症の手術成績 後方除圧固定術と後方進入前方除圧術の比較

    相澤 俊峰, 橋本 功, 菅野 晴夫, 衛藤 俊光, 小澤 浩司, 井樋 栄二

    日本整形外科学会雑誌 94 (3) S936-S936 2020年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  105. Spontaneous Resorption of Intradural Lumbar Disc Herniation: A Rare Case Report.

    Naoki Morozumi, Toshimi Aizawa, Morichika Sasaki, Yutaka Koizumi, Shoichi Kokubun

    Spine surgery and related research 4 (3) 277-279 2020年

    DOI: 10.22603/ssrr.2019-0074  

  106. Accurate and Minimally Invasive Cervical Pedicle Screw Insertion Procedure Using the Bone Biopsy Needle as Drill Guide.

    Tomoaki Koakutsu, Toshimi Aizawa, Eiji Itoi

    Spine surgery and related research 4 (4) 358-364 2020年

    DOI: 10.22603/ssrr.2019-0114  

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    Introduction: Cervical pedicle screw (CPS) fixation provides the strongest mechanical stability. It needs, however, wide soft tissue detachment to expose the entry point and carries the potential risk of iatrogenic damage to neurovascular structures. Malposition of the CPS cannot be completely avoided even using the navigation system. Technical Note: Using the bone biopsy needle as drill guide, we developed a novel accurate CPS insertion technique. (1) The entry point of CPS was exposed using Southwick's technique for anterior fixation or Tokioka's technique for posterior fixation. (2) A 13G bone biopsy needle was inserted from the entry point established by the fluoroscopy-assisted pedicle axis view technique described by Yukawa et al. to within a few millimeters of the pedicle. (3) The external sleeve of the bone biopsy needle was left in place as a drill guide, and the 1.25 mm guidewire for a 4.0 mm cannulated screw was then inserted into the pedicle cavity. (4) The external sleeve of the bone biopsy needle was removed, and the screw trajectory was created by a 2.7 mm cannulated drill bit over the guidewire. (5) Tapping was conducted prior to CPS insertion. Using this method, 29 CPSs in nine patients were inserted. Postoperative computed tomography scans revealed that all the CPSs were placed accurately. Conclusions: Utilizing the bone biopsy needle as drill guide, our procedure enables accurate positioning of CPS without expensive instruments.

  107. Quality of life after staged bilateral total knee arthroplasty: a minimum five-year follow-up study of seventy-eight patients. 国際誌 査読有り

    Takehiko Sugita, Naohisa Miyatake, Toshimi Aizawa, Akira Sasaki, Masayuki Kamimura, Atsushi Takahashi

    International orthopaedics 43 (10) 2309-2314 2019年10月

    DOI: 10.1007/s00264-018-4196-0  

    ISSN:0341-2695

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    PURPOSE: Although many studies have been performed to evaluate the quality of life (QOL) and patient satisfaction after total knee arthroplasty (TKA), almost all evaluations were performed in patients after unilateral TKA or in patients after mixed unilateral and bilateral TKA. Accordingly, this study aimed to evaluate QOL after staged bilateral TKA. METHODS: A total of 78 patients who underwent staged bilateral TKA for varus knee osteoarthritis were included in this study. All patients had longitudinal follow-up evaluations for at least five years. QOL was assessed by the Japanese Knee Osteoarthritis Measure (JKOM), a disease-specific and patient-derived QOL measure for Japanese patients. Conventional objective outcome scales, including the Knee Society Score and the Timed Up and Go test, were also assessed. In addition, QOL and objective outcomes were compared between the younger (≤ 80 years, average 75.8 years) and older (> 80 years, average 84.7 years) age groups at the final follow-up. RESULTS: Improvements in both JKOM and objective outcomes reached a plateau one year after staged bilateral TKA. Improvements were prolonged for more than five years. There were no statistically significant differences in JKOM or objective outcomes between the younger and older age groups, despite an 8.9-year difference in the average age. CONCLUSIONS: This was the first longitudinal study to evaluate QOL and objective outcomes after staged bilateral TKA for a period of at least five years. Improvements in QOL and objective outcomes reached a plateau one year after staged bilateral TKA and were prolonged for more than five years. No significant differences were observed in outcome scores between the younger and older age groups.

  108. Several pathologies cause delayed postoperative paralysis following posterior decompression and spinal fusion for thoracic myelopathy caused by ossification of the posterior longitudinal ligament. 査読有り

    Toshimitsu Eto, Toshimi Aizawa, Haruo Kanno, Ko Hashimoto, Eiji Itoi, Hiroshi Ozawa

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 27 (3) 725-733 2019年9月12日

    DOI: 10.1016/j.jos.2019.08.004  

    ISSN:0949-2658

  109. Spino-pelvic- lower extremity balance during walking in elderly patients with spinal kyphosis. 査読有り

    Kumi Kamata, Hiroshi Ozawa, Yusuke Sekiguchi, Toshimi Aizawa, Shinichi Izumi, Eiji Itoi

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 24 (5) 793-797 2019年9月

    DOI: 10.1016/j.jos.2019.01.005  

    ISSN:0949-2658

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    BACK GROUND: Patients with spinal kyphosis were radiographically evaluated while standing. However, the spino-pelvic alignment during walking is different. This study examined the spino-pelvic-lower extremity alignment during walking by a three-dimensional (3D) motion analysis. METHODS: Twenty-six patients with a sagittal vertical axis of ≥4 cm (male: female, 5:21; average age, 66 years) were evaluated. Using a 3D motion capture system, the trunk and pelvic anterior inclination angles, hip and knee joint angles were measured during a 3-min walk. The correlation coefficient between the change of the trunk anterior inclination angle and each parameter at the beginning of walking was calculated, and those parameters were compared with radiographic measurements. RESULTS: The patients were divided into two groups according to the change of the trunk anterior inclination angle: the large change group included 14 patients with an increase of ≥5° between the beginning and end of the 3-min walk; the small change group included 12 patients with an increase of <5°. The pelvic anterior inclination angle showed a significant difference between the two groups at the first gait cycles. The pelvic anterior inclination angle and the hip joint angle in the large change group showed a significant difference between the first and last cycles. The correlation coefficient revealed a significant association between the change in the trunk anterior inclination angle and the pelvic anterior inclination angle at the beginning of walking. There were no significant differences between the two groups in any radiographic spino-pelvic parameters. CONCLUSIONS: There were two types of patients with spinal kyphosis: patients with a small pelvic anterior inclination angle at the beginning of walking showed slight progression in their trunk anterior inclination, whereas those with a large pelvic angle showed a large degree of progression in their pelvic and trunk inclination during walking.

  110. Surgical Management of Giant Sacral Schwannoma: A Case Series and Literature Review. 国際誌 査読有り

    Kyoichi Handa, Hiroshi Ozawa, Toshimi Aizawa, Ko Hashimoto, Haruo Kanno, Satoshi Tateda, Eiji Itoi

    World neurosurgery 129 e216-e223-e223 2019年9月

    DOI: 10.1016/j.wneu.2019.05.113  

    ISSN:1878-8750

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    OBJECTIVE: Giant sacral schwannomas are rare and difficult to treat. Unexpected neurologic deficits after surgery and tumor recurrence should be considered when surgery is performed. We attempt to remove the tumors via piecemeal total or subtotal excision, leaving parts of the capsule adjacent to nerves to preserve the nerves. This study aimed to present the cases of giant sacral schwannoma at our institutions as well as review the relevant literature and to discuss surgical management. METHODS: This study included 11 patients (5 male and 6 female, mean age 53 years) with giant sacral schwannoma who were treated surgically. The clinical features, surgical details, and outcomes were investigated retrospectively. RESULTS: The tumors were intraosseous type in 4 cases, dumb-bell type in 3 cases, and retroperitoneal type in 4 cases. The surgeries were performed by a combined anterior and posterior approach in 4 cases, a posterior approach in 4 cases, and an anterior approach in 3 cases. The tumors were removed via piecemeal total or subtotal excision in 7 cases, partial excision in 3 cases, and enucleation in 1 case. After surgery, symptoms improved in all cases. The tumor recurred in 2 patients after partial excision. No patients receiving piecemeal total or subtotal excision showed recurrence. One patient developed motor weakness after piecemeal subtotal excision, but the symptoms resolved. CONCLUSIONS: Adopting an appropriate surgical approach based on the location of the tumor is important. Piecemeal total or subtotal excision, with parts of the capsule adjacent to nerves left behind may help achieve a good outcome, avoiding a postoperative neurologic deficit.

  111. 自然縮小傾向を示した胸椎部砂時計腫の1例

    鈴木 学, 相澤 俊峰, 橋本 功, 菅野 晴夫, 小野田 祥人, 衛藤 俊光, 半田 恭一, 大野木 孝嘉, 井樋 栄二

    東日本整形災害外科学会雑誌 31 (3) 371-371 2019年8月

    出版者・発行元:東日本整形災害外科学会

    ISSN:1342-7784

    eISSN:2433-569X

  112. Destructive discovertebral degenerative diseaseの1例

    松田 倫治, 相澤 俊峰, 橋本 功, 菅野 晴夫, 山屋 誠司, 衛藤 俊光, 半田 恭一, 井樋 栄二

    東北整形災害外科学会雑誌 62 (1) 154-154 2019年6月

    出版者・発行元:東北整形災害外科学会

    ISSN:1348-8694

  113. 東北大学脊椎外科懇話会手術登録

    相澤 俊峰, 国分 正一, 佐藤 哲朗, 田中 靖久, 笠間 史夫, 村上 栄一, 小澤 浩司, 兵藤 弘訓, 古泉 豊, 両角 直樹, 星川 健, 川原 央, 小川 真司, 日下部 隆, 中川 智刀, 橋本 功, 菅野 晴夫, 東北大学脊椎外科懇話会

    東北整形災害外科学会雑誌 62 (1) 201-201 2019年6月

    出版者・発行元:東北整形災害外科学会

    ISSN:1348-8694

  114. Adjacent segment degeneration after fusion spinal surgery-a systematic review. 国際誌 査読有り

    Ko Hashimoto, Toshimi Aizawa, Haruo Kanno, Eiji Itoi

    International orthopaedics 43 (4) 987-993 2019年4月

    DOI: 10.1007/s00264-018-4241-z  

    ISSN:0341-2695

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    PURPOSE: Adjacent segment degeneration (ASDeg) and disease (ASDis) have become major concerns after fusion surgery. However, there is no definitive data or knowledge about the incidence or risk factors. The review discusses the incidence and risk factors and prevention of ASDeg and ASDis in the relevant literature. METHODS: We performed a systematic review of meta-analyses, randomized control trials, and cohort studies published in English to provide evidence-based information about ASDeg and ASDis. RESULTS: According to a meta-analysis, the pooled incidence of ASDeg after lumbar and cervical fusion surgery was 26.6% and 32.8%, respectively. Approximately 1/4-1/3 of ASDeg progressed to ASDis. Risk factors after cervical fusion surgery were young age, pre-existing disc degeneration, short fusion segment, high T1 slope, disruption of adjacent soft tissue, and plate placement close to the adjacent disc. The risk factors of ASDeg and ASDis after lumbar fusion surgery were age, genetic factors, high body mass index, pre-existing adjacent segment degeneration, laminectomy at the adjacent level of fusion, excessive distraction of the fusion level, insufficient lumbar lordosis, multilevel fixation, floating fusion, coronal wedging of L5-S disc, pelvic tilt, and osteoporosis. Motion-preserving surgeries seem to have less risk of ASDeg and ASDis than conventional fusion surgery both in the lumbar and cervical spine. CONCLUSIONS: The existent literature points out variables involved in ASDeg and ASDis. High evidence-level studies should provide more relevant data to guide strategies for avoiding ASDeg and ASDis.

  115. Minimally invasive discectomy for lumbar disc herniation: current concepts, surgical techniques, and outcomes. 国際誌 査読有り

    Haruo Kanno, Toshimi Aizawa, Ko Hahimoto, Eiji Itoi

    International orthopaedics 43 (4) 917-922 2019年4月

    DOI: 10.1007/s00264-018-4256-5  

    ISSN:0341-2695

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    PURPOSE: To date, various minimally invasive surgeries for lumbar disc herniation (LDH) have been performed in many countries, including microendoscopic discectomy (MED) and percutaneous endoscopic discectomy (PED). We herein report the surgical indications, current concepts, and techniques of minimally invasive discectomy for LDH, including MED and PED. The postoperative outcomes and risks of complications compared with conventional discectomy are also discussed. METHODS: By reviewing past literatures, the current concepts, surgical techniques, and clinical outcomes were described. RESULTS: Minimally invasive discectomy is generally performed using a transmuscular approach with an endoscopic technique and can reduce muscle and soft tissue damage. The minimal invasiveness can also reduce the severity of postoperative pain and improve patient satisfaction compared with conventional open discectomy. Based on the data of previous systematic reviews and meta-analyses, minimally invasive lumbar discectomy, such as MED and PED, appears to be safe and effective alternatives to open discectomy for patients with symptomatic LDH. These minimally invasive surgeries can provide beneficial effects to shorten the hospital stay and time to return to work. However, minimally invasive discectomy has a demanding learning curve. Only a well-trained surgeon and support team should perform these less invasive procedures. CONCLUSIONS: Clinical evidence supporting the superiority of MED and PED is still limited. Well-designed prospective multicentered randomized controlled trials with large samples are therefore needed in order to draw a convincing conclusion.

  116. 脊椎・脊髄外科手術に関係した遠隔脳出血の発生頻度 11年間の前向き研究

    相澤 俊峰, 小澤 浩司, 菅野 晴夫, 橋本 功, 小野田 祥人, 松田 倫治, 井樋 栄二

    日本整形外科学会雑誌 93 (3) S873-S873 2019年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  117. Pitfalls during Sacroiliac Joint Arthrodesis for Patients with Severe Sacroiliac Joint Pain: Report of Three Cases with Sacral Dysmorphism Induced by Lumbosacral Transitional Vertebrae. 国際誌

    Daisuke Kurosawa, Eiichi Murakami, Toshimi Aizawa, Takashi Watanabe, Hiroshi Ozawa

    Journal of orthopaedic case reports 10 (1) 54-57 2019年

    DOI: 10.13107/jocr.2019.v10.i01.1634  

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    Introduction: Lumbosacral transitional vertebrae (LSTV) can cause sacral dysmorphism. Sacroiliac joint (SIJ) arthrodesis has been widely performed as the last resort for severe SIJ pain. We report three kinds of technical pitfalls identified in the surgical records of SIJ arthrodesis for the patients with sacral dysmorphism induced by LSTV. Case Report: For the cases of a 34-year-old man with LSTV Castellvi's Type IV, anterior SIJ arthrodesis using a plate and screws was performed. The most cranial sacral foramen was larger and irregularly round, and the nerve root ran to the lateral side from the deformed foramen more than usual. A firm medial traction of the nerve root together with the psoas major muscle for the purpose of attaching a plate and inserting screws on the sacrum side could cause the temporary radiculopathy. For a 26-year-old woman with a thin sacral alar due to IIIb, SIJ arthrodesis using multi screws with the posterolateral approach was performed. The most cranial screw penetrated the anterior margin of the sacrum and caused nerve root injury. For a 35-year-old man with Ib, posterior SIJ arthrodesis was attempted using screws and cylinder cages. The insertion of the implants using the posterior approach was technically challenging due to the small size of the sacrum. Conclusions: Pre-surgical planning for SIJ arthrodesis, including a surgical approach, is particularly important when we see patients with sacral dysmorphism induced by each type of LSTV. The presented surgical pitfalls will be valuable when surgeons perform SIJ arthrodesis for patients with LSTV.

  118. Reoperation Rates after Laminoplasty for Cervical Disorders: A 26-Year Period Survival Function Method Analysis.

    Ko Hashimoto, Toshimi Aizawa, Hiroshi Ozawa, Yasuhisa Tanaka, Takashi Kusakabe, Naoki Morozumi, Yutaka Koizumi, Tetsuro Sato, Hironori Hyodo, Tomowaki Nakagawa, Eiji Takahashi, Takeshi Hoshikawa, Hideki Imaizumi, Shinji Ogawa, Fumio Kasama, Haruo Kanno, Eiji Itoi, Shoichi Kokubun

    Spine surgery and related research 3 (4) 304-311 2019年

    DOI: 10.22603/ssrr.2019-0028  

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    Introduction: Laminoplasty is a common surgery for cervical myelopathy. Previous studies have analyzed the reoperation rates in posterior decompression surgeries of the cervical spine. However, few studies have solely focused on midline-splitting laminoplasty (MSL) using a large number of patients. This aims to analyze the reoperation rates after MSL using the survival function method. Methods: Between 1988 and 2013, 4,208 MSLs were performed as a primary operation for cervical myelopathy and enrolled in our spinal surgery registration system. The Kaplan-Meier survival function method was used to analyze the rates of reoperation. Results: Of 4,208 patients with primary MSL, 40 underwent reoperation for neurological complications. The overall reoperation rate was 0.26%, 0.64%, 0.83%, 0.93%, and 0.95% at 1, 5, 10, 20, and >20 years, respectively. The causes of reoperation were postoperative cervical radiculopathy in 10 patients, stenosis at an adjacent level in 8, stenosis due to failed "open-door" lamina in 6, instability of the cervical spine in 4, cervical disc herniation in 3, elongation of ossification of the posterior longitudinal ligament in 3, spinal cord injury in 1, fracture of the cervical spine in 1, postoperative scar formation in 1, ossification of anterior longitudinal ligament in 1, and unknown in 2. The number of patients with surgical site infection (SSI) who needed surgical debridement was 34 (0.81%). Conclusions: Excluding reoperations for SSI, the reoperation rate of MSL was approximately 1.0% at the maximum of 26 years after surgery. MSL was determined to be a reliable surgical procedure regarding postoperative complications requiring additional surgeries.

  119. Enhancing percutaneous pedicle screw fixation with hydroxyapatite granules: A biomechanical study using an osteoporotic bone model. 国際誌 査読有り

    Haruo Kanno, Toshimi Aizawa, Ko Hashimoto, Eiji Itoi

    PloS one 14 (9) e0223106 2019年

    DOI: 10.1371/journal.pone.0223106  

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    INTRODUCTION: Percutaneous pedicle screw (PPS) can provide internal fixation of the thoracolumbar spine through a minimally invasive surgical procedure. PPS fixation has been widely used to treat various spinal diseases. Rigid fixation of PPS is essential for managing osteoporotic spine in order to prevent the risks of screw loosening and implant failure. We recently developed a novel augmentation method using hydroxyapatite (HA) granules for PPS fixation. The aim of this study was to evaluate the strength and stiffness of PPS fixation augmented with HA granules using an osteoporotic bone model. METHODS: Screws were inserted into uniform synthetic bone (sawbones) with and without augmentation. The uniaxial pullout strength and insertion torque of the screws were evaluated. In addition, each screw underwent cyclic toggling under incrementally increasing physiological loads until 2 mm of screwhead displacement occurred. The maximal pullout strength (N), maximal insertion torque (N·cm), number of toggle cycles and maximal load (N) required to achieve 2-mm screwhead displacement were compared between the screws with and without augmentation. RESULTS: The maximal pullout strength was significantly stronger for screws with augmentation than for those without augmentation (302 ± 19 N vs. 254 ± 17 N, p < 0.05). In addition, the maximal insertion torque was significantly increased in screws with augmentation compared to those without augmentation (48 ± 4 N·cm vs. 26 ± 5 N·cm, p < 0.05). Furthermore, the number of toggle cycles and the maximal load required to reach 2 mm of displacement were significantly greater in screws with augmentation than in those without augmentation (106 ± 9 vs. 52 ± 10 cycles; 152 ± 4 N vs. 124 ± 5 N, p < 0.05). CONCLUSIONS: Augmentation using HA granules significantly enhanced the rigidity of PPS fixation in the osteoporotic bone model. The present study suggested that novel augmentation with HA granules may be a useful technique for PPS fixation in patients with osteoporotic spine.

  120. Perioperative Complications After Surgery for Thoracic Ossification of Posterior Longitudinal Ligament: A Nationwide Multicenter Prospective Study. 国際誌

    Shiro Imagama, Kei Ando, Kazuhiro Takeuchi, Satoshi Kato, Hideki Murakami, Toshimi Aizawa, Hiroshi Ozawa, Tomohiko Hasegawa, Yukihiro Matsuyama, Masao Koda, Masashi Yamazaki, Hirotaka Chikuda, Shigeo Shindo, Yukihiro Nakagawa, Atsushi Kimura, Katsushi Takeshita, Kanichiro Wada, Hiroyuki Katoh, Masahiko Watanabe, Kei Yamada, Takeo Furuya, Takashi Tsuji, Shunsuke Fujibayashi, Kanji Mori, Yoshiharu Kawaguchi, Kota Watanabe, Morio Matsumoto, Toshitaka Yoshii, Atsushi Okawa

    Spine 43 (23) E1389-E1397 2018年12月1日

    DOI: 10.1097/BRS.0000000000002703  

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    STUDY DESIGN: Prospective, multicenter, nationwide study. OBJECTIVE: To investigate perioperative complications and risk factors in surgery for thoracic ossification of the posterior longitudinal ligament (T-OPLL) using data from the registry of the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament. SUMMARY OF BACKGROUND DATA: There is no prospective multicenter study of surgical complications and risk factors for T-OPLL, and previous multicenter retrospective studies have lacked details. METHODS: Surgical methods, preoperative radiographic findings, pre- and postoperative thoracic myelopathy (Japanese Orthopaedic Association [JOA] score), prone and supine position test (PST), intraoperative ultrasonography, and intraoperative neurophysiological monitoring (IONM) were investigated prospectively in 115 cases (males: 55, females: 60, average age 53.1 y). Factors related to perioperative complications and risk factors for postoperative motor palsy were identified. RESULTS: Posterior decompression and fusion with instrumentation with or without dekyphosis was performed in 85 cases (74%). The JOA recovery rate at 1 year after surgery in all cases was 55%. Motor palsy occurred postoperatively in 37 cases (32.2%), with a mean recovery period of 2.7 months. A long recovery period for postoperative motor palsy was significantly associated with a high number of T-OPLL levels (P < 0.0001), lower preoperative JOA score (P < 0.05), and greater estimated blood loss (P < 0.05). Perioperative complications or postoperative motor palsy were significantly related to a higher number of T-OPLL levels, comorbid ossification of ligamentum flavum rate, lower preoperative JOA score, higher preoperative positive PST rate, more surgical invasiveness, a lower rate of intraoperative spinal cord floating in ultrasonography, and higher rate of deterioration of IONM. CONCLUSION: This study firstly demonstrated the perioperative complications with high postoperative motor palsy rate in a nationwide multicenter prospective study. Surgical outcomes for T-OPLL should be improved by identifying and preventing perioperative complications with significant risk factors. LEVEL OF EVIDENCE: 3.

  121. Sacroiliac joint arthrodesis for chronic sacroiliac joint pain: an anterior approach and clinical outcomes with a minimum 5-year follow-up. 国際誌 査読有り

    Eiichi Murakami, Daisuke Kurosawa, Toshimi Aizawa

    Journal of neurosurgery. Spine 29 (3) 279-285 2018年9月

    DOI: 10.3171/2018.1.SPINE17115  

    ISSN:1547-5654

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    OBJECTIVE The authors evaluated the outcomes of sacroiliac joint (SIJ) arthrodesis via an original anterior approach to the upper anterior surface of the SIJ in patients with a minimum of 5 years' follow-up. METHODS The authors performed anterior SIJ arthrodesis in 45 patients between 2001 and 2015. Of these patients, 27 (11 men and 16 women; mean age at surgery 49 [24-86] years) were followed up for a minimum of 5 years (average 113 months, range 61-157 months). In the 14 patients in the earlier period of this study, the authors used an anterior approach to expose the SIJ by separating the iliac muscle from the iliac bone and performed internal fixation. In the 13 patients later in the study, the authors changed to a pararectal approach, which involved an incision along the lateral border of the rectus abdominal muscle. Then, extraperitoneally, the upper anterior surface of the SIJ was exposed between the psoas major muscle and the iliac muscle. RESULTS Among the 27 patients, 21 had unilateral anterior arthrodesis alone, 4 required additional posterior arthrodesis, and 2 required pelvic ring arthrodesis because of later pain on the opposite side. In the 21 patients with a unilateral anterior arthrodesis, outcome according to the modified Macnab criteria was excellent in 7, good in 11, and fair in 3. Outcomes were excellent, good, fair, and poor in 1 patient each among the 4 with additional posterior fusion. Outcomes were good and poor for 1 patient each among those with pelvic ring arthrodesis. All 27 patients demonstrated bone union of the SIJ on CT. Lateral femoral cutaneous neuralgia developed in 7 of the 27 patients; 6 patients had undergone the initial anterior method and 1 the later method. CONCLUSIONS Anterior SIJ arthrodesis was effective in most patients with severe SIJ pain resistant to conservative therapy. This approach has the advantage of direct curettage and bone graft into the wide area of the SIJ, which result in good bone union. In particular, the authors' current pararectal approach could decrease the potential risk of lateral cutaneous injury.

  122. The effect of morphine added to periarticular multimodal drug injection or spinal anesthesia on pain management and functional recovery after total knee arthroplasty. 査読有り

    Seiya Miyamoto, Takehiko Sugita, Toshimi Aizawa, Naohisa Miyatake, Akira Sasaki, Ikuo Maeda, Masayuki Kamimura, Atsushi Takahashi

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 23 (5) 801-806 2018年9月

    DOI: 10.1016/j.jos.2018.04.013  

    ISSN:0949-2658

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    BACKGROUND: The efficacy of morphine added to periarticular multimodal drug injection (PMDI) for pain management after total knee arthroplasty (TKA) is controversial. Adding morphine to spinal anesthesia has reportedly improved pain relief for the first 24 h. We examined the effect of morphine added to PMDI or spinal anesthesia on pain management and functional recovery after TKA. METHODS: A total of 97 patients were randomized into three groups: in Group A (34 patients), 10 mg morphine was added to PMDI; Group B (31 patients), 0.1 mg morphine was added to spinal anesthesia; and Group C (32 patients), morphine was added to neither the PMDI nor spinal anesthetic. To evaluate the efficacy of added morphine for pain management, we assessed rest pain, the number of times analgesics were used, and the time period until the first analgesic use. The adverse effects of morphine were assessed by counting the numbers of times vomiting occurred and antiemetics were used. Functional recovery was evaluated by recording the range of motion of the knee and the date of ability to walk. RESULTS: Rest pain was the least in Group B at 6 and 12 h after operation. The number of times analgesics were used was the least in Group B. The time period until the first analgesic use was the longest in Group B. The number of vomiting episodes was the least in Group C. The number of times antiemetics were used was higher in Group A than in Group C. There were no significant differences in the range of motion and date of ability to walk among the three groups. CONCLUSIONS: The efficacy of morphine added to PMDI was limited, and that of morphine added to spinal anesthesia disappeared within 20 h postoperatively. Adding morphine to PMDI or spinal anesthesia did not improve functional recovery and caused some adverse effects.

  123. Spinal Cord Swelling After Surgery in Cervical Spondylotic Myelopathy: Relationship With Intramedullary Gd-DTPA Enhancement on MRI. 国際誌 査読有り

    Hiroshi Ozawa, Toshimi Aizawa, Satoshi Tateda, Ko Hashimoto, Haruo Kanno, Masato Ishizuka

    Clinical spine surgery 31 (7) E363-E367-E367 2018年8月

    DOI: 10.1097/BSD.0000000000000664  

    ISSN:2380-0186

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    STUDY DESIGN: This is a prospective multicenter study. SUMMARY OF BACKGROUND DATA: Postoperative spinal cord swelling has been reported in patients with cervical spondylotic myelopathy. In the cases of the spinal cord swelling, the involvement in the intramedullary gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) enhancement on magnetic resonance imaging (MRI) was referred. OBJECTIVE: The prevalence and clinical relevance of postoperative spinal cord swelling and its relationship with intramedullary Gd-DTPA enhancement in patients with cervical spondylotic myelopathy were investigated. SUBJECTS AND METHODS: A total of 683 consecutive patients with cervical spondylotic myelopathy who underwent laminoplasty were examined. T1, T2, and Gd-DTPA-enhanced MRI were performed before surgery. Patients with intramedullary Gd-DTPA enhancement were allocated to the enhancement group. Fifty consecutive cases who did not exhibit intramedullary Gd-DTPA enhancement were allocated to the nonenhancement group. Both groups underwent MRI examinations at 1 month and 1 year after surgery. RESULTS: The prevalence of spinal cord swelling in the enhancement group (26%) was significantly higher than that in the nonenhancement group (4%) (P=0.0038). At 1 year after surgery, spinal cord swelling had resolved in all patients in the nonenhancement group, while it persisted in 3 of 13 patients (23%) in the enhancement group. On multiple regression analysis, intramedullary Gd-DTPA enhancement rather than the spinal cord swelling showed a significant influence in terms of recovery of the Japanese Orthopedic Association score. CONCLUSIONS: Surgical outcomes of patients with postoperative swelling should be evaluated separately according to the presence or absence of intramedullary Gd-DTPA enhancement on MRI. Spinal cord swelling associated with intramedullary Gd-DTPA enhancement was indicative of poor prognosis.

  124. Recurrence of ossification of ligamentum flavum at the same intervertebral level in the thoracic spine: a report of two cases and review of the literature. 国際誌 査読有り

    Haruo Kanno, Tadahisa Takahashi, Toshimi Aizawa, Ko Hashimoto, Eiji Itoi, Hiroshi Ozawa

    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 27 (Suppl 3) 359-367 2018年7月

    DOI: 10.1007/s00586-017-5281-6  

    ISSN:0940-6719

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    PURPOSE: Ossification of the ligamentum flavum (OLF) is a possible cause of thoracic myelopathy. We report two rare cases with recurrent thoracic myelopathy caused by OLF markedly re-extended at the same intervertebral level after the primary surgery. METHODS: Both patients had thoracic myelopathy caused by OLF and underwent decompressive laminectomy and resection of the OLF in the primary surgery. However, the neurological conditions gradually deteriorated following recovery after the primary surgery due to the recurrent OLF at the same intervertebral level. RESULTS: These patients were successfully treated by revision surgery via resection of the recurrent OLF and posterior spinal fusion with instrumentation. Two years after the second surgery, the neurological disturbance was resolved satisfactorily, and re-growth of the resected ossified lesion was not observed. CONCLUSIONS: The recurrence of OLF following resection of the ossified lesions is exceedingly rare but should be noted in patients treated surgically for thoracic myelopathy due to OLF.

  125. Recurrent primary osseous hemangiopericytoma in the thoracic spine: a case report and literature review. 国際誌 査読有り

    Takahiro Onoki, Haruo Kanno, Toshimi Aizawa, Ko Hashimoto, Eiji Itoi, Hiroshi Ozawa

    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 27 (Suppl 3) 386-392 2018年7月

    DOI: 10.1007/s00586-017-5322-1  

    ISSN:0940-6719

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    PURPOSE: Primary osseous hemangiopericytoma (HPC) of the spine is exceedingly rare. HPC has malignant potential and has the capacity for metastasis and local recurrence. We herein present the first case of recurrent primary osseous HPC in the thoracic spine that was successfully treated by total spondylectomy at three vertebral levels and spinal reconstruction. METHODS: We performed a two-stage operation for recurrent HPC using anterior and posterior approaches at the T5-T7 vertebrae. The preoperative embolization of the tumor was performed to prevent massive intraoperative bleeding. Then, total spondylectomy was performed (T5-T7) to resect the tumor. Anterior spinal reconstruction and posterior instrumentation were performed, with abundant bone autograft and allograft used to achieve sufficient boney fusion following the removal of the tumor. RESULTS: At 2 years after surgery, the patient had made a sufficient recovery from his symptoms. The bone union was complete without tumor recurrence or implant failure. CONCLUSIONS: Total spondylectomy and spinal reconstruction with instrumentation might be useful for performing the safe and adequate excision of recurrent HPC of the spine. However, patients should be closely monitored to detect local recurrence and the malignant degeneration of the tumor after surgery.

  126. 再発した硬膜内髄外血管腫の2例

    半田 恭一, 相澤 俊峰, 橋本 功, 菅野 晴夫, 山屋 誠司, 松田 倫治, 衛藤 俊光, 小澤 浩司

    東北整形災害外科学会雑誌 61 (1) 234-234 2018年6月

    出版者・発行元:東北整形災害外科学会

    ISSN:1348-8694

  127. Study protocol for the G-SPIRIT trial: a randomised, placebo-controlled, double-blinded phase III trial of granulocyte colony-stimulating factor-mediated neuroprotection for acute spinal cord injury. 国際誌

    Masao Koda, Hideki Hanaoka, Takatoshi Sato, Yasuhisa Fujii, Michiko Hanawa, Sho Takahashi, Takeo Furuya, Yasushi Ijima, Junya Saito, Mitsuhiro Kitamura, Seiji Ohtori, Yukei Matsumoto, Tetsuya Abe, Kei Watanabe, Toru Hirano, Masayuki Ohashi, Hirokazu Shoji, Tatsuki Mizouchi, Ikuko Takahashi, Norio Kawahara, Masahito Kawaguchi, Yugo Orita, Takeshi Sasamoto, Masahito Yoshioka, Masafumi Fujii, Katsutaka Yonezawa, Daisuke Soma, Hiroshi Taneichi, Daisaku Takeuchi, Satoshi Inami, Hiroshi Moridaira, Haruki Ueda, Futoshi Asano, Yosuke Shibao, Ikuo Aita, Yosuke Takeuchi, Masaya Mimura, Jun Shimbo, Yukio Someya, Sumio Ikenoue, Hiroaki Sameda, Kan Takase, Yoshikazu Ikeda, Fumitake Nakajima, Mitsuhiro Hashimoto, Tomoyuki Ozawa, Fumio Hasue, Takayuki Fujiyoshi, Koshiro Kamiya, Masahiko Watanabe, Hiroyuki Katoh, Yukihiro Matsuyama, Yu Yamamoto, Daisuke Togawa, Tomohiko Hasegawa, Sho Kobayashi, Go Yoshida, Shin Oe, Tomohiro Banno, Hideyuki Arima, Koji Akeda, Eiji Kawamoto, Hiroshi Imai, Toshihiko Sakakibara, Akihiro Sudo, Yasuo Ito, Tsuyoshi Kikuchi, Shuhei Osaki, Nobuhiro Tanaka, Kazuyoshi Nakanishi, Naosuke Kamei, Shinji Kotaka, Hideo Baba, Tsuyoshi Okudaira, Hiroaki Konishi, Takayuki Yamaguchi, Keigo Ito, Yoshito Katayama, Taro Matsumoto, Tomohiro Matsumoto, Masaru Idota, Haruo Kanno, Toshimi Aizawa, Ko Hashimoto, Toshimitsu Eto, Takehiro Sugaya, Michiharu Matsuda, Kazunari Fushimi, Satoshi Nozawa, Chizuo Iwai, Toshihiko Taguchi, Tsukasa Kanchiku, Hidenori Suzuki, Norihiro Nishida, Masahiro Funaba, Masashi Yamazaki

    BMJ open 8 (5) e019083 2018年5月5日

    DOI: 10.1136/bmjopen-2017-019083  

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    INTRODUCTION: Granulocyte colony-stimulating factor (G-CSF) is generally used for neutropaenia. Previous experimental studies revealed that G-CSF promoted neurological recovery after spinal cord injury (SCI). Next, we moved to early phase of clinical trials. In a phase I/IIa trial, no adverse events were observed. Next, we conducted a non-randomised, non-blinded, comparative trial, which suggested the efficacy of G-CSF for promoting neurological recovery. Based on those results, we are now performing a phase III trial. METHODS AND ANALYSIS: The objective of this study is to evaluate the efficacy of G-CSF for acute SCI. The study design is a prospective, multicentre, randomised, double-blinded, placebo-controlled comparative study. The current trial includes cervical SCI (severity of American Spinal Injury Association (ASIA) Impairment Scale B/C) within 48 hours after injury. Patients are randomly assigned to G-CSF and placebo groups. The G-CSF group is administered 400 µg/m2/day×5 days of G-CSF in normal saline via intravenous infusion for 5 consecutive days. The placebo group is similarly administered a placebo. Our primary endpoint is changes in ASIA motor scores from baseline to 3 months. Each group includes 44 patients (88 total patients). ETHICS AND DISSEMINATION: The study will be conducted according to the principles of the World Medical Association Declaration of Helsinki and in accordance with the Japanese Medical Research Involving Human Subjects Act and other guidelines, regulations and Acts. Results of the clinical study will be submitted to the head of the respective clinical study site as a report after conclusion of the clinical study by the sponsor-investigator. Even if the results are not favourable despite conducting the clinical study properly, the data will be published as a paper. TRIAL REGISTRATION NUMBER: UMIN000018752.

  128. An increase in the degree of olisthesis during axial loading reduces the dural sac size and worsens clinical symptoms in patients with degenerative spondylolisthesis. 国際誌 査読有り

    Haruo Kanno, Toshimi Aizawa, Hiroshi Ozawa, Yutaka Koizumi, Naoki Morozumi, Eiji Itoi

    The spine journal : official journal of the North American Spine Society 18 (5) 726-733 2018年5月

    DOI: 10.1016/j.spinee.2017.08.251  

    ISSN:1529-9430

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    BACKGROUND CONTEXT: Previous studies have shown that axial loading during magnetic resonance imaging (MRI) significantly reduces the size of the dural sac compared with conventional MRI in patients with degenerative lumbar disease. In our previous study, axial-loaded MRI showed a significantly larger degree of olisthesis than conventional MRI in patients with degenerative spondylolisthesis (DS). Furthermore, the degree of olisthesis on axial-loaded MRI correlated more strongly with that observed on X-ray in the upright position. However, no study has investigated whether or not the increase in the degree of olisthesis during axial loading correlates with the reduction in the dural sac size and affects the severity of clinical symptoms in patients with DS. PURPOSE: The objective of this study was to determine whether or not the increase in the degree of olisthesis correlates with the reduction of the dural sac cross-sectional area (DCSA) detected on axial-loaded MRI and worsens the severity of clinical symptoms in patients with DS. STUDY DESIGN/SETTING: This is an imaging cohort study. PATIENT SAMPLE: A total of 41 consecutive patients with DS were prospectively evaluated in this study. OUTCOME MEASURES: The outcome measures include the degree of olisthesis, the DCSA, the Pearson correlation coefficient, and the severity of clinical symptoms. MATERIALS AND METHODS: The differences in the degree of olisthesis and the DCSA between conventional and axial-loaded MRIs were determined. The Pearson correlation coefficient of the increase in the degree of olisthesis with the reduction in the DCSA during axial loading was calculated. The reduction in the DCSA and the severity of clinical symptoms in patients exhibiting a ≥2-mm increase in the degree of olisthesis were compared with those in patients exhibiting a <2-mm increase. RESULTS: The increase in the degree of olisthesis was significantly correlated with the reduction in the DCSA during axial loading (Pearson correlation coefficient=0.63, p<.001). The reduction in the DCSA during axial loading in patients with a ≥2-mm increase in the degree of olisthesis (26±3 mm2) was significantly greater than in those with a <2-mm increase (13±2 mm2) (p<.01). Clinical symptoms such as walking distance and activity of daily living evaluated using the Japanese Orthopaedic Association score were significantly worse in patients with a ≥2-mm increase in the degree of olisthesis (117±19 m and 6.7±0.5 points, respectively) than in those with a <2-mm increase (236±36 m and 8.4±0.4 points, respectively) (p<.05). CONCLUSIONS: The present study demonstrated that the increase in the degree of olisthesis was significantly correlated with the reduction in the dural sac size detected on axial-loaded MRI and worsened the severity of clinical symptoms in patients with DS. These results suggest that axial-loaded MRI may be a useful imaging study for detecting dynamic changes in the degree of olisthesis during axial loading to the lumbar spine related to the narrowing of the spinal canal and the severity of clinical symptoms in the assessment of patients with DS.

  129. HA顆粒による経皮的椎弓根スクリューの新たな補強法の検討 生体力学的解析による骨粗鬆症脊椎への有効性の解析

    菅野 晴夫, 相澤 俊峰, 橋本 功, 山屋 誠司, 井樋 栄二

    日本整形外科学会雑誌 92 (2) S43-S43 2018年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  130. 仙椎部巨大神経鞘腫の治療成績

    半田 恭一, 小澤 浩司, 相澤 俊峰, 橋本 功, 菅野 晴夫, 舘田 聡, 井樋 栄二

    日本整形外科学会雑誌 92 (3) S791-S791 2018年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  131. 腰椎MRIのnerve root sedimentation signとredundant nerve rootの有無による脊柱管狭窄・臨床症状の比較

    菅野 晴夫, 相澤 俊峰, 橋本 功, 山屋 誠司, 井樋 栄二

    日本整形外科学会雑誌 92 (3) S1069-S1069 2018年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  132. 3D fusion imagingを応用した頸椎内視鏡下後方除圧術の3次元手術シミュレーションの有用性と課題

    山屋 誠司, 野村 和教, 中村 陽介, 中尾 慎一, 中尾 裕次, 綿貫 匡則, 綿貫 昭則, 菅野 晴夫, 橋本 功, 相澤 俊峰, 井樋 栄二, 山田 宏, 吉田 宗人

    Journal of Spine Research 9 (3) 236-236 2018年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  133. HA顆粒を用いた経皮的椎弓根スクリュー固定の補強法 骨粗鬆症脊椎への有効性の生体力学的解析

    菅野 晴夫, 相澤 俊峰, 橋本 功, 山屋 誠司, 井樋 栄二

    Journal of Spine Research 9 (3) 383-383 2018年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  134. 片側椎弓切除による脊髄腫瘍摘出術の検証 脊髄腫瘍約900手術症例の解析

    橋本 功, 相澤 俊峰, 菅野 晴夫, 山屋 誠司, 小澤 浩司, 国分 正一

    Journal of Spine Research 9 (3) 554-554 2018年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  135. 腰椎MRIにおけるnerve root sedimentation signとredundant nerve rootの検討 脊柱管狭窄・臨床症状との関連

    菅野 晴夫, 相澤 俊峰, 橋本 功, 山屋 誠司, 井樋 栄二

    Journal of Spine Research 9 (3) 577-577 2018年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  136. 超高齢化に伴う脊椎外科手術数の変化

    相澤 俊峰, 田中 靖久, 日下部 隆, 橋本 功, 菅野 晴夫, 両角 直樹, 古泉 豊, 小川 真司, 星川 健, 兵藤 弘訓, 村上 栄一, 笠間 忠夫, 佐藤 哲朗, 小澤 浩司, 国分 正一

    Journal of Spine Research 9 (2) 125-130 2018年2月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

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    東北大学脊椎外科懇話会脊椎外科手術登録と宮城県の国勢調査のデータをもとに、1988年から2014年の県民の人口当たりの脊椎外科手術件数を算出した。この27年間に人口10万人当たりの脊椎外科手術は年間24.1件から3.6倍の85.7件に増加した。年齢層別に見ると、65歳以上の高齢者は4.3倍に、75歳以上の後期高齢者は8.8倍に著増していた。頸部脊髄症と腰部脊柱管狭窄症に着目すると、前者は全体では27年間で2.8倍、高齢者では2.1倍、後期高齢者では3.8倍に、後者では全体で8.5倍、高齢者で8.9倍、後期高齢者では18.2倍に大きく増えていた。(著者抄録)

  137. Treatment strategy for sacroiliac joint-related pain at or around the posterior superior iliac spine. 国際誌 査読有り

    Eiichi Murakami, Daisuke Kurosawa, Toshimi Aizawa

    Clinical neurology and neurosurgery 165 43-46 2018年2月

    出版者・発行元:Elsevier B.V.

    DOI: 10.1016/j.clineuro.2017.12.017  

    ISSN:1872-6968 0303-8467

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    OBJECTIVE: Pain at or around the posterior superior iliac spine (PSIS) is characteristic of sacroiliac joint (SIJ) -related pain. This pain can be treated by either a peri- or intra-articular injection into the joint, with the former being much easier to perform. We investigated whether peri- or intra-articular injections were more frequently effective in patients with SIJ-related pain, and aimed to create an efficient treatment strategy for SIJ-related pain at or around the PSIS. DESIGN: Prospective case-control study. PATIENTS AND METHODS: We evaluated 85 patients with pain at or around the posterior superior iliac spine as indicated by the one finger test. First, we performed a peri-articular sacroiliac joint injection. If it was ineffective, an intra-articular injection was later given. Groin pain, sitting pain, sacroiliac joint shear test results, and posterior superior iliac spine and sacro-tuberous ligament tenderness were also compared between patients for whom a peri- or intra-articular injection was effective. RESULTS: Seventy-two (85%) of 85 patients had an effective injection. Out of these 72 patients, 58 (81%) had a positive peri-articular injection and 14 (19%) had a positive intra-articular injection. Four items, excluding tenderness of the sacro-tuberous ligament had no significant difference between these two injection types. CONCLUSION: To treat sacroiliac joint-related pain at or around the posterior superior iliac spine, a peri-articular injection should be performed first, and only if it is not effective should an intra-articular injection be administered. Using this strategy, we expect that most patients with sacroiliac joint-related pain will be efficiently diagnosed and treated.

  138. Diagnosis of benign notochordal cell tumor of the spine: is a biopsy necessary? 国際誌

    Satoshi Tateda, Ko Hashimoto, Toshimi Aizawa, Haruo Kanno, Shin Hitachi, Eiji Itoi, Hiroshi Ozawa

    Clinical case reports 6 (1) 63-67 2018年1月

    DOI: 10.1002/ccr3.1287  

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    Benign notochordal cell tumor is a benign intraosseous lesion, demonstrates characteristic imaging features. The lesion demonstrates low-signal intensity in T1-weighted images, high-signal intensity in T2-weighted images, and no enhancement with contrast medium in MRI and slight osteosclerosis in CT. If typical imaging findings are identified, biopsy is not necessary.

  139. Femoral footprint of the popliteus tendon may be at the risk of damage during total knee arthroplasty. 国際誌 査読有り

    Takashi Aki, Takehiko Sugita, Atsushi Takahashi, Toshimi Aizawa, Masayuki Kamimura, Akira Sasaki, Naohisa Miyatake, Eiji Itoi

    Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 25 (12) 3718-3722 2017年12月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s00167-016-4177-z  

    ISSN:0942-2056

    eISSN:1433-7347

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    PURPOSE: The present study focused on the prevalence of incidental excision of the femoral footprint of the popliteus tendon during total knee arthroplasty and its associated risk factors. METHODS: A total of 275 knee arthroplasties were performed for 226 patients with varus knee osteoarthritis. The status of the femoral footprint of the popliteus tendon was intraoperatively evaluated and classified into three groups (preserved, partially excised, and completely excised), and the prevalence of the excision was identified. Femoral component size, the thickness of the resected distal femoral condyle, and preoperative patient demographic data were compared for the three groups. Ordinal logistic regression analysis was performed to reveal risk factors associated with the excision. RESULTS: The femoral footprint of the popliteus tendon was preserved in 132 knees (48.0 %), partially excised in 94 knees (34.2 %) and completely excised in 49 knees (17.8 %). The ordinal logistic regression analysis revealed thicker resection of the distal femoral condyle (p < 0.0001) and shorter body height (p = 0.0266) to be the independent risk factors for the excision. CONCLUSIONS: The incidental partial or complete excision of the femoral footprint of the popliteus tendon was identified in approximately half of the evaluated knees. Thicker resection of the distal femoral condyle and shorter body height were the most significant risk factors for the excision. LEVEL OF EVIDENCE: Case-control study, Level III.

  140. Groin pain associated with sacroiliac joint dysfunction and lumbar disorders. 国際誌 査読有り

    Daisuke Kurosawa, Eiichi Murakami, Toshimi Aizawa

    Clinical neurology and neurosurgery 161 104-109 2017年10月

    出版者・発行元:Elsevier B.V.

    DOI: 10.1016/j.clineuro.2017.08.018  

    ISSN:1872-6968 0303-8467

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    OBJECTIVE: We investigated the prevalence of groin pain in patients with sacroiliac joint (SIJ) dysfunction, lumbar spinal canal stenosis (LSS), and lumbar disc herniation (LDH) who did not have hip disorders, and evaluated the clinical features that distinguished SIJ dysfunction from LSS and LDH. PATIENT AND METHODS: We evaluated 127 patients (57 men, 70 women, average age 55 years) with SIJ dysfunction, 146 (98 men, 48 women, average age 71 years) with LSS, and 124 (83 men, 41 women, average age 50 years) with LDH. The following data were retrospectively collected from the patients' medical charts: (1) the prevalence of groin pain for each pathology; (2) corresponding spinal level of LSS and LDH in the patients with groin pain; (3) the pain areas in the buttocks and back; pain increase while in positions such as sitting, lying supine, and side-lying; an SIJ shear test; and four tender points composed of the posterior superior iliac spine (PSIS), long posterior sacroiliac ligament (LPSL), sacrotuberous ligament (STL), and iliac muscle. RESULTS: Fifty-nine (46.5%) patients with SIJ dysfunction, 10 (6.8%) with LSS, and 10 (8.1%) with LDH reported groin pain. Of the 10 patients with LSS, five presented with cauda equina symptoms, two had stenosis of L2-L3, and three had stenosis below L3-L4. The other five presented with radiculopathy: the corresponding nerve root was L2, L3, and L4 in one patient each, and L5 in two. Of the 10 patients with LDH, eight presented with radiculopathy: the corresponding nerve root was L2 and L4 in three patients each, and L5 in two. Two patients presented with L4-L5 discogenic pain without radiculopathy. In patients with groin pain, pain provoked by the SIJ shear test and the tenderness of the PSIS and LPSL were significant physical signs that differentiated SIJ dysfunction from LSS and LDH. (Fisher's exact test, P<0.05) CONCLUSION: The prevalence of groin pain in patients with SIJ dysfunction was higher than in those with LSS or LDH. When patients who do not have hip disorders complain of groin and lumbogluteal pain, not only lumbar disorders but also SIJ dysfunction should be considered.

  141. HA顆粒を用いた経皮的椎弓根スクリュー固定に対する新たなaugmentation法 生体力学的解析による骨粗鬆症脊椎への有効性の解析

    菅野 晴夫, 相澤 俊峰, 橋本 功, 井樋 栄二

    日本整形外科学会雑誌 91 (8) S1638-S1638 2017年8月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  142. Body Mass Index 35kg/m2以上の患者の脊椎手術における問題点

    八幡 健一郎, 相澤 俊峰, 橋本 功, 菅野 晴夫, 舘田 聡, 井樋 栄二, 小澤 浩司

    東北整形災害外科学会雑誌 60 (1) 191-191 2017年6月

    出版者・発行元:東北整形災害外科学会

    ISSN:1348-8694

  143. 同一椎間に再発した胸椎黄色靱帯骨化症の2例

    高橋 忠久, 菅野 晴夫, 相澤 俊峰, 橋本 功, 井樋 栄二, 小澤 浩司

    東北整形災害外科学会雑誌 60 (1) 101-105 2017年6月

    出版者・発行元:東北整形災害外科学会

    ISSN:1348-8694

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    症例1(58歳女性)。前医にて黄色靱帯骨化症(OLF)による胸髄症に対し、T9-12椎弓およびOLFの切除が施行されたが、術後11年で両下肢の脱力としびれが再燃したため紹介となった。精査の結果、同一椎間に再発したOLFによる胸髄症と診断され、再発OLF切除およびT8-L2後方固定術を施行した。術後は両下肢のしびれ、筋力が改善し、術後2年でJOAスコアは5/11点まで改善した。症例2(58歳男性)。前医にてOLFによる胸髄症と腰部脊柱管狭窄症に対し、T9-11椎弓切除とL1-5の椎弓切除・後方固定術を施行されたが、術後4年目に両下肢の脱力としびれが再燃し、歩行障害が出現したため紹介となった。精査の結果、OLFの再発とOPLLの増大による胸髄症と診断され、T10/11のOLF切除と大塚法によるOPLL切除、T9-L1後方固定術を行った。術後は症状が改善し、術後1年でJOAスコアは10/11点まで改善した。

  144. Leg symptoms associated with sacroiliac joint disorder and related pain. 国際誌 査読有り

    Eiichi Murakami, Toshimi Aizawa, Daisuke Kurosawa, Kyoko Noguchi

    Clinical neurology and neurosurgery 157 55-58 2017年6月

    出版者・発行元:Elsevier B.V.

    DOI: 10.1016/j.clineuro.2017.03.020  

    ISSN:1872-6968 0303-8467

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    OBJECTIVE: The symptoms of sacroiliac joint (SIJ) disorders are usually detected in the buttock and groin, and occasionally referred to the thigh and leg. However, lumbar disorders also cause symptoms in these same body regions. The presence of a characteristic, symptomatic pattern in the legs would be useful for diagnosing SIJ disorders. This study aimed to identify specific leg symptoms in patients with SIJ pain originating from the posterior sacroiliac ligament and determine the rate of occurrence of these symptoms. PATIENTS AND METHODS: The source population consisted of 365 consecutive patients from February 2005 to December 2007. One hundred patients were diagnosed with SIJ pain by a periarticular SIJ injection (42 males and 58 females, average age 46 years, age range, 18-75 years). A leg symptom map was made by subtracting the symptoms after a periarticular SIJ injection from the initial symptoms, and evaluating the rate of each individual symptom by area. RESULTS: Ninety-four patients reported pain at or around the posterior-superior iliac spine (PSIS). Leg symptoms comprised pain and a numbness/tingling sensation; ≥60% of the patients had these symptoms. Pain was mainly detected in the back, buttock, groin, and thigh areas, while numbness/tingling was mainly detected in the lateral to posterior thigh and back of the calf. CONCLUSIONS: Leg symptoms associated with SIJ pain originating from the posterior sacroiliac ligament include both pain and numbness, which do not usually correspond to the dermatome. These leg symptoms in addition to pain around the PSIS may indicate SIJ disorders.

  145. Preliminary results of managing large medial tibial defects in primary total knee arthroplasty: autogenous morcellised bone graft. 国際誌 査読有り

    Takehiko Sugita, Toshimi Aizawa, Naohisa Miyatake, Akira Sasaki, Masayuki Kamimura, Atsushi Takahashi

    International orthopaedics 41 (5) 931-937 2017年5月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s00264-016-3339-4  

    ISSN:0341-2695

    eISSN:1432-5195

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    PURPOSE: This study reports a case series of 44 primary total knee arthroplasties (TKAs) using autogenous morcellised bone grafting for large (≥10-mm-deep) medial tibial defects, which are generally repaired using metal augmentation. The bone-grafting technique is described in detail and the radiological outcomes are presented. METHODS: A total of 44 TKAs were followed up for a mean period of 58 months (range 24-139 months). Multiple drill holes were made in the sclerotic floor of the defect, followed by the impaction of morcellised cancellous bone grafts to fill the defects. Tibial components were fixed using the cemented or noncemented technique and no internal fixation devices were used. Stem extension of the tibial component was only used in one TKA. RESULTS: Radiograms revealed that the grafted bone was completely incorporated into the host bone within one year post-operatively. No grafted bone absorption or collapse was detected. A clear zone between the tibial component and grafted bone was observed in six knees, but it did not become enlarged thereafter. CONCLUSIONS: The presented technique provided favourable radiological outcomes and had several advantages: (1) it enables preservation of as much bone as possible for future revision surgery; (2) it is cost effective and simple because metal augments, internal fixation devices and stem extension are not needed; (3) it can be used in the same manner any defect to a depth ≥3 mm. Thus, this is an acceptable and reproducible alternative technique.

  146. Successful Management of Gorham-Stout Disease in the Cervical Spine by Combined Conservative and Surgical Treatments: A Case Report. 査読有り

    Satoshi Tateda, Toshimi Aizawa, Ko Hashimoto, Haruo Kanno, Susumu Ohtsu, Eiji Itoi, Hiroshi Ozawa

    The Tohoku journal of experimental medicine 241 (4) 249-254 2017年4月

    出版者・発行元:TOHOKU UNIV MEDICAL PRESS

    DOI: 10.1620/tjem.241.249  

    ISSN:0040-8727

    eISSN:1349-3329

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    Gorham-Stout disease (GSD) is a rare condition characterized by intraosseous proliferation of endothelial-lined vessels and progressive osteolysis. The precise etiology and pathophysiology of the disease remain poorly understood. Current therapeutic options for GSD include chemotherapy, radiotherapy, and surgical resection, but the surgical treatment of GSD is difficult, especially in the spinal lesion. The indication of wide-margined resection was limited because of anatomical features. Herein, we report a case of GSD of the cervical spine in which the lesions were successfully stabilized with combined conservative and surgical treatments. A 15-year-old male patient was admitted because of severe neck pain. The patient presented no neurological deficiency. However, the radiological findings revealed osteolytic lesions on the laminae and vertebrae between C1 to C5. An open biopsy confirmed an irregular, thin-walled vessel formation in the bone trabeculae, which was diagnosed as GSD. Conservative treatment was initiated with chemotherapy and radiotherapy. After one and a half year, the osteolytic condition had regressed. Spinal fusion surgery was then performed from C2 to C5 to prevent for progression of the cervical kyphotic changes, and spinal fusion was confirmed 7 months after the surgery. The patient showed no recurrence of GSD in the 5-year follow-up period after surgery. We were able to provide successful treatment by giving priority to the combined conservative treatments. If a patient has no severe deformity or progressive neurologic deficits, it might be better to prioritize conservative treatments and to perform the surgery after the osteolytic changes have stopped.

  147. 脊椎手術後の遠隔脳出血発生頻度の前向き研究

    相澤 俊峰, 小澤 浩司, 橋本 功, 菅野 晴夫, 井樋 栄二

    日本整形外科学会雑誌 91 (2) S40-S40 2017年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  148. 片側椎弓切除による脊髄腫瘍摘出術の検証

    橋本 功, 相澤 俊峰, 菅野 晴夫, 小澤 浩司, 国分 正一

    日本整形外科学会雑誌 91 (3) S662-S662 2017年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  149. 腰部脊柱管狭窄症におけるnerve root sedimentation signと臨床症状の重症度の関連

    菅野 晴夫, 相澤 俊峰, 橋本 功, 井樋 栄二

    日本整形外科学会雑誌 91 (3) S742-S742 2017年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  150. 腰椎椎間孔内・外狭窄病変に対して3D fusion imagingを用いた内視鏡下手術シミュレーションの有用性

    山屋 誠司, 菅野 晴夫, 中村 聡, 高橋 伸光, 橋本 功, 相澤 俊峰, 小澤 浩司, 井樋 栄二

    日本整形外科学会雑誌 91 (3) S829-S829 2017年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  151. 経皮的椎弓根スクリュー固定に対するHA顆粒を用いた新たなaugmentation法

    菅野 晴夫, 相澤 俊峰, 橋本 功, 小澤 浩司, 井樋 栄二

    日本整形外科学会雑誌 91 (3) S837-S837 2017年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  152. 小児脊髄腫瘍に対する片側椎弓切除による腫瘍摘出後脊柱変形

    松田 倫治, 相澤 俊峰, 橋本 功, 菅野 晴夫, 衛藤 俊光, 井樋 栄二

    Journal of Spine Research 8 (3) 366-366 2017年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  153. 経皮的内視鏡下椎間板摘出術に対する3D fusion imagingを用いた新しい3次元術前計画 exiting nerve injuryを防ぐためのシミュレーション手術

    山屋 誠司, 菅野 晴夫, 中村 聡, 高橋 伸光, 橋本 功, 相澤 俊峰, 井樋 栄二

    Journal of Spine Research 8 (3) 491-491 2017年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  154. 超高齢社会に伴う脊椎疾患の手術数の変化

    相澤 俊峰, 国分 正一, 橋本 功, 菅野 晴夫, 小澤 浩司, 田中 靖久, 日下部 隆, 両角 直樹, 古泉 豊, 井樋 栄二

    Journal of Spine Research 8 (3) 749-749 2017年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  155. 腰部脊柱管狭窄症におけるnerve root sedimentation sign 脊柱管狭窄の程度・臨床症状の重症度との関連

    菅野 晴夫, 相澤 俊峰, 橋本 功, 衛藤 俊光, 井樋 栄二, 小澤 浩司

    Journal of Spine Research 8 (3) 759-759 2017年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  156. 高齢者脊椎手術(80歳以上)の疫学 東北大学脊椎外科懇話会・27年間の脊椎手術登録から

    橋本 功, 相澤 俊峰, 菅野 晴夫, 佐藤 哲朗, 田中 靖久, 両角 直樹, 古泉 豊, 日下部 隆, 小澤 浩司, 兵藤 弘訓, 井樋 栄二, 国分 正一

    Journal of Spine Research 8 (3) 775-775 2017年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  157. 術後創傷感染症と手術侵襲による炎症反応はどう違うのか ダメージ関連分子パターンに着目した検討 査読有り

    小圷 知明, 山田 充啓, 相澤 俊峰, 橋本 功, 井樋 栄二, 久志本 成樹

    日本整形外科学会雑誌 91 (2) S77-S77 2017年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  158. 脊椎外科周術期におけるダメージ関連分子パターンの動態 術後創傷感染症と手術侵襲による炎症反応はどう違うのか? 査読有り

    小圷 知明, 山田 充啓, 相澤 俊峰, 橋本 功, 井樋 栄二, 久志本 成樹

    Journal of Spine Research 8 (3) 560-560 2017年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  159. Evaluation of the size and position of the insertion of the anterior medial meniscus root in varus osteoarthritic knees. 国際誌 査読有り

    Akira Sasaki, Takehiko Sugita, Toshimi Aizawa, Naohisa Miyatake, Masayuki Kamimura, Hirokazu Fujisawa, Atsushi Takahashi

    Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 25 (2) 362-367 2017年2月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s00167-015-3963-3  

    ISSN:0942-2056

    eISSN:1433-7347

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    PURPOSE: Recent studies have suggested radial displacement of the medial meniscus as a cause of varus knee osteoarthritis (OA). Two anatomical studies reported that such displacement may be associated with anterior insertion of the medial meniscus anterior horn. It was aimed to evaluate the location and area of this insertion in patients with advanced knee OA. METHODS: Medial meniscus anterior horn insertions were classified into four types, as described in a previously reported classification during 225 total knee arthroplasty (TKA) in 184 patients. The incidence rates of insertion type were compared with previously reported rates in nearly normal or non-arthritic knees. The insertion surface area was also measured during 158 TKAs. RESULTS: Of the 225 knees, 82 (36.4 %), 93 (41.3 %), 35 (15.6 %), and 15 (6.7 %) were classified as I, II, III, and IV, respectively. An anteriorly inserted anterior horn was not more frequent in advanced varus OA knees than in previously reported nearly normal or non-arthritic knees. The insertion surface areas were 57.5 ± 18.9, 56.1 ± 16.0, and 56.4 ± 14.4 mm2 for types I, II, and III, respectively; these areas did not differ significantly. CONCLUSION: Since the incidence of an anteriorly inserted medial meniscus anterior horn was not higher in advanced varus OA knees than in normal or non-arthritic knees, an anteriorly inserted anterior horn may have little or no effect on the aetiology of varus OA knees. This study provides some information for clarifying the aetiology of knee OA. LEVEL OF EVIDENCE: IV.

  160. Comparison of intraoperative anthropometric measurements of the proximal tibia and tibial component in total knee arthroplasty. 査読有り

    Naohisa Miyatake, Takehiko Sugita, Toshimi Aizawa, Akira Sasaki, Ikuo Maeda, Masayuki Kamimura, Hirokazu Fujisawa, Atsushi Takahashi

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 21 (5) 635-9 2016年9月

    出版者・発行元:SPRINGER JAPAN KK

    DOI: 10.1016/j.jos.2016.06.003  

    ISSN:0949-2658

    eISSN:1436-2023

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    BACKGROUND: Precise matching of the tibial component and resected bony surfaces and proper rotational implanting of the tibial component are crucial for successful total knee arthroplasty. We aimed to analyze the exact anthropometric proximal tibial data of Japanese patients undergoing total knee arthroplasty and correlate the measurements with the dimensions of current total knee arthroplasty systems. METHODS: A total of 703 knees in 566 Japanese patients who underwent total knee arthroplasty for osteoarthritis were included. The bone resection in the proximal tibia was performed perpendicular to the tibial axis in the frontal plane. Measurements of the proximal tibia were intraoperatively obtained after proximal tibial preparation. RESULTS: There were significant positive correlations between the lateral anteroposterior and medial anteroposterior and mediolateral dimensions. A progressive decrease in the mediolateral/lateral anteroposterior ratio with an increasing lateral anteroposterior dimension or the mediolateral/anteroposterior ratio with an increasing anteroposterior dimension was observed. The lateral anteroposterior dimension was smaller than the medial anteroposterior dimension by a mean of 4.8 ± 2.0 mm. The proximal tibia exhibited asymmetry between the lateral and medial plateaus. A comparison of the morphological data and dimensions of the implants, one of which was a symmetric tibial component (NexGen) and the others were asymmetric (Genesis II and Persona), indicated that an asymmetric tibial component could be beneficial to maximize tibial plateau coverage. CONCLUSIONS: This study provided important reference data for designing a proper tibial component for Japanese people. The proximal tibial cut surface was asymmetric. There was wide dispersion in the lateral anteroposterior, medial anteroposterior, and mediolateral dimensions depending on the patient. Our data showed that the tibial components of the Genesis II and Persona rather than that of the NexGen may be preferable for Japanese people because of their asymmetric design.

  161. New Diagnostic Support Tool for Patients with Leg Symptoms Caused by  Lumbar Spinal Stenosis and Lumbar Intervertebral Disc Herniation:  a Self-administered, Self-reported history questionnaire

    Aizawa T, Tanaka Y, Yokoyama T, Shimada Y, Yamazaki K, Takei H, Konno S, Kawahara C, Itoi E, Kokubun S

    Journal of Orthopaedic Science 21 (5) 579-85 2016年9月

    DOI: 10.1016/j.jos.2016.07.012  

  162. 治療に成功した頸椎Gorham病の一例

    舘田 聡, 相澤 俊峰, 橋本 功, 菅野 晴夫, 井樋 栄二, 小澤 浩司

    東日本整形災害外科学会雑誌 28 (3) 401-401 2016年8月

    出版者・発行元:東日本整形災害外科学会

    ISSN:1342-7784

    eISSN:2433-569X

  163. 骨粗鬆症脊椎に対する経皮的椎弓根スクリューの固定性の生体力学的研究 HA顆粒を用いた新たなaugmentation法の開発と有効性の検討

    菅野 晴夫, 相澤 俊峰, 橋本 功, 衛藤 俊光, 井樋 栄二

    日本整形外科学会雑誌 90 (8) S1710-S1710 2016年8月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  164. 当院におけるBenign notochordal cell tumorの経験

    舘田 聡, 相澤 俊峰, 小澤 浩司, 橋本 功, 菅野 晴夫, 八幡 健一郎, 常陸 真

    東北整形災害外科学会雑誌 59 (1) 235-235 2016年6月

    出版者・発行元:東北整形災害外科学会

    ISSN:1348-8694

  165. 良性脊索細胞腫(benign notochordal cell tumor)の臨床的画像的特徴

    舘田 聡, 小澤 浩司, 相澤 俊峰, 橋本 功, 菅野 晴夫, 八幡 健一郎, 井樋 栄二, 常陸 真

    日本整形外科学会雑誌 90 (6) S1397-S1397 2016年6月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  166. Comparative study of treatment for distal radius fractures with two different palmar locking plates. 査読有り

    Tanaka H, Hatta T, Sasajima K, Itoi E, Aizawa T

    The Journal of hand surgery, European volume 41 (5) 536-542 2016年6月

    DOI: 10.1177/1753193415625830  

    ISSN:1753-1934

  167. 腰部脊柱管狭窄症の保存療法 2年以上手術しなかった症例の検討 査読有り

    相澤 俊峰, 小澤, 浩司, 日下部, 隆, 橋本 功, 菅野, 晴夫, 両角, 直樹, 古泉, 豊, 佐藤, 哲朗, 兵藤, 弘訓, 小川, 真司, 笠間, 史夫, 星川, 健, 国分, 正一, 舘田, 聡 八幡, 健一郎, 谷, 正太郎, 井樋 栄二

    東北整形災害外科学会雑誌 59 (1) 20-23 2016年6月

    出版者・発行元:東北整形災害外科学会

    ISSN:1348-8694

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    東北大学および関連病院で腰部脊柱管狭窄症(LSS)と診断され、2年以上手術せずに保存療法を施行された32例(男性19例、女性13例、初診時平均71歳(49〜89歳))を対象に、保存療法の実際を調査した。平均観察期間は4.5年(2〜13年)で、これらの症例の責任高位、症状分類、MRIでの狭窄程度、併存症、初診時間欠跛行、治療法、最終経過観察時間欠跛行、治療成績、手術に至らなかった理由を後方視的に検討した。責任高位はL4/5が27例と最多を占め、L3/4が3例、L2/3が2例、L5/Sが1例であった。症状は馬尾型と神経根型が14例、15例と約半数を占め、混合型が3例であった。MRI狭窄率は重度4例、中等度20例、軽度8例であった。併存症は24例75%で、高血圧6例、糖尿病と気管支喘息や睡眠時無呼吸症候群などの呼吸器疾患各5例、狭心症や心不全などの循環器疾患や腎不全など、腎疾患が各4例、癌3例などであった。全例に薬物療法が行われていた。使用された薬剤は非ステロイド性消炎鎮痛剤17例、プロスタグランジンE1が16例、ビタミンB12が13例、プレガバリン12例であった。間欠跛行距離は初診時100m以下12例、100〜500m 9例、500m以上11例が、最終経過観察時は100m以下7例、100〜500m 21例と多くが改善していた。治療成績は改善あるいはやや改善が75%と多くの症状が改善していた。手術に至らなかった理由として症状の他、全身合併症や社会的な問題、医師側の判断などがあった。

  168. Increased facet fluid predicts dynamic changes in the dural sac size on Axial-loaded MRi in patients with lumbar spinal canal stenosis 査読有り

    H. Kanno, H. Ozawa, Y. Koizumi, N. Morozumi, T. Aizawa, E. Itoi

    American Journal of Neuroradiology 37 (4) 730-735 2016年4月1日

    出版者・発行元:American Society of Neuroradiology

    DOI: 10.3174/ajnr.A4582  

    ISSN:1936-959X 0195-6108

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    BACKGROUND AND PURPOSE: Axial-loaded MR imaging, which simulates the spinal canal in a standing position, demonstrates reductions of the dural sac cross-sectional area in patients with lumbar spinal canal stenosis. However, there has been no useful conventional MRimagingfinding for predicting a reduction in the dural sac cross-sectional area on axial-loaded MR imaging. Previous studies have shown that increased facet fluid is associated with the spinal instability detected during positional changes. The purpose of this study was to analyze the correlations between facet fluid and dynamic changes in the dural sac cross-sectional area on axial-loaded MR imaging. MATERIALS AND METHODS: In 93 patients with lumbar spinal canal stenosis, the dural sac cross-sectional area was measured by using axial images of conventional and axial-loaded MR imaging. Changes in the dural sac cross-sectional area induced by axial loading were calculated. The correlation between the facet fluid width measured on conventional MR imaging and the change in dural sac crosssectional area was analyzed. The change in the dural sac cross-sectional area was compared between the intervertebral levels with and without the facet fluid width that was over the cutoff value determined in this study. RESULTS: The dural sac cross-sectional area was significantly smaller on axial-loaded MR imaging than on conventional MR imaging. The facet fluid width significantly correlated with the change in the dural sac cross-sectional area (r = 0.73, P &lt .001). The change in the dural sac cross-sectional area at the intervertebral level with the facet fluid width over the cutoff value was significantly greater than that at the other level. CONCLUSIONS: The increased facet fluid on conventional MR imaging is highly predictive of the dynamic reduction of dural sac cross-sectional area detected on axial-loaded MR imaging in the clinical assessment of lumbar spinal canal stenosis.

  169. 脊椎外科周術期におけるプレセプシンの動態―術後創傷感染症早期診断における有用性―

    小圷知明, 佐藤哲哉, 桑原功行, 工藤大介, 相澤俊峰, 橋本功, 井樋栄二, 久志本成樹

    Journal of Spine Research 7 (3) 409 2016年3月25日

    ISSN:1884-7137

  170. 腰部脊柱管狭窄症におけるnerve root sedimentation signと臨床症状の関係

    菅野 晴夫, 小澤 浩司, 相澤 俊峰, 橋本 功, 井樋 栄二

    日本整形外科学会雑誌 90 (2) S201-S201 2016年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  171. 腰部脊柱管狭窄症におけるnerve root sedimentation signと臨床症状の関係

    菅野 晴夫, 小澤 浩司, 相澤 俊峰, 橋本 功, 井樋 栄二

    Journal of Spine Research 7 (3) 550-550 2016年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  172. 脊椎手術後の遠隔小脳出血 後ろ向き研究と前向き研究

    相澤 俊峰, 芦名 善博, 橋本 功, 菅野 晴夫, 井樋 栄二, 小澤 浩司

    Journal of Spine Research 7 (3) 581-581 2016年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  173. 頸椎前方除圧固定術と椎弓形成術の再手術率 生存分析を用いた最長26年間の検討

    橋本 功, 小澤 浩司, 相澤 俊峰, 菅野 晴夫, 舘田 聡, 八幡 健一郎, 井樋 栄二, 国分 正一

    Journal of Spine Research 7 (3) 730-730 2016年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  174. Increasing Incidence of Degenerative Spinal Diseases in Japan during 25 Years: The Registration System of Spinal Surgery in Tohoku University Spine Society. 査読有り

    Toshimi Aizawa, Shoichi Kokubun, Hiroshi Ozawa, Takashi Kusakabe, Yasuhisa Tanaka, Takeshi Hoshikawa, Ko Hashimoto, Haruo Kanno, Naoki Morozumi, Yutaka Koizumi, Tetsuro Sato, Hironori Hyodo, Fumio Kasama, Shinji Ogawa, Eiichi Murakami, Chikashi Kawahara, Jun-Ichiro Yahata, Yushin Ishii, Eiji Itoi

    The Tohoku journal of experimental medicine 238 (2) 153-63 2016年2月

    出版者・発行元:TOHOKU UNIV MEDICAL PRESS

    DOI: 10.1620/tjem.238.153  

    ISSN:0040-8727

    eISSN:1349-3329

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    Spinal disorders affect mainly older people and cause pain, paralysis and/or deformities of the trunk and/or extremities, which could eventually disturb locomotive functions. For ensuring safe and high-quality treatment of spinal disorders, in 1987, the Tohoku University Spine Society (TUSS) was established by orthopedic departments in Tohoku University School of Medicine and its affiliated hospitals in and around Miyagi Prefecture. All spine surgeries have been enrolled in the TUSS Spine Registry since 1988. Using the data from this registration system between 1988 and 2012, we demonstrate here the longitudinal changes in surgical trends for spinal disorders in Japan that has rushed into the most advanced "aging society" in the world. In total, data on 56,744 surgeries were retrieved. The number of spinal surgeries has annually increased approximately 4-fold. There was a particular increase among patients aged ≥ 70 years and those aged ≥ 80 years, with a 20- to 90-fold increase. Nearly 90% of the spinal operations were performed for degenerative disorders, with their number increasing approximately 5-fold from 705 to 3,448. The most common disease for surgery was lumbar spinal stenosis (LSS) (35.9%), followed by lumbar disc herniation (27.7%) and cervical myelopathy (19.8%). In 2012, approximately half of the patients with LSS and cervical myelopathy were ≥ 70 years of age. In conclusion, the number of spinal operations markedly increased during the 25-year period, particularly among older patients. As Japan has a notably aged population, the present study could provide a near-future model for countries with aging population.

  175. Potential risk of excising the femoral insertion of the popliteus tendon during primary total knee arthroplasty: a biometric study. 査読有り

    Atsushi Takahashi, Takehiko Sugita, Toshimi Aizawa, Daisuke Chiba, Masayuki Kamimura, Takashi Aki, Eiji Itoi

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 20 (6) 1030-5 2015年11月

    出版者・発行元:SPRINGER JAPAN KK

    DOI: 10.1007/s00776-015-0773-x  

    ISSN:0949-2658

    eISSN:1436-2023

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    BACKGROUND: During total knee arthroplasty (TKA), excision of the popliteus tendon leads to extensive static gaps and reduced mobility. The purpose of this study was to determine the positional relationship between the femoral insertion of the popliteus tendon and the bone cutting lines of various TKA systems. METHODS: This study included 21 cadaveric right femurs presenting no macroscopic deformity. The lateral image of the femur and the template of the femoral component were overlaid to determine the preservation/excision of the popliteus tendon insertion. TKA systems used were Genesis II, NexGen, low contact stress (LCS), PFC Σ, Scorpio, and Vanguard. The knees in which the insertion was preserved in all implants or excised in at least one implant were classified into intact or the high-risk groups, respectively. RESULTS: The popliteus tendon was preserved in all specimens with the LCS system. In contrast, the popliteus tendon insertion was excised in ≥1/3 of the specimens with the other systems. The anteroposterior diameter was significantly larger in the intact group than that in the high-risk group (58.1 ± 4.5 mm vs. 53.7 ± 2.7 mm; p = 0.018). The high-risk group included more knees from female cadavers than the intact group (70 vs. 9 %; p = 0.008). CONCLUSION: During primary TKA, the femoral insertion of the popliteus tendon could be inevitably excised, regardless of technical problems. We demonstrate that the unique design of the LCS system preserves the popliteus tendon insertion. In addition, small knees and females may be risk factors for excision of the insertion.

  176. 高齢者の転倒と認知機能障害 大腿骨近位部骨折患者の予備的検討

    葛西 真理, 目黒 謙一, 小澤 浩司, 相澤 俊峰, 熊居 慶一, 今泉 秀樹, 大泉 晶, 峯岸 英絵, 山口 智, 井樋 栄二

    Dementia Japan 29 (3) 410-410 2015年9月

    出版者・発行元:(一社)日本認知症学会

    ISSN:1342-646X

  177. Autologous morselised bone grafting for medial tibial defects in total knee arthroplasty. 国際誌 査読有り

    Takehiko Sugita, Toshimi Aizawa, Akira Sasaki, Naohisa Miyatake, Hirokazu Fujisawa, Masayuki Kamimura

    Journal of orthopaedic surgery (Hong Kong) 23 (2) 185-9 2015年8月

    出版者・発行元:HONG KONG ACAD MEDICINE PRESS

    DOI: 10.1177/230949901502300214  

    ISSN:1022-5536

    eISSN:2309-4990

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    PURPOSE: To evaluate the outcome of autologous morselised bone grafting for a medial tibial defect of ≥10 mm deep in 45 total knee arthroplasties (TKAs). METHODS: 38 patients aged 46 to 85 (mean, 73) years underwent 45 TKAs and autologous morselised bone grafting for a medial tibial defect of ≥10 (range, 10-25) mm in depth by a single surgeon. In the first 19 TKAs, 2 resected subchondral bone plates from the lateral tibial plateau were driven into 2 gutters made on the floor of the medial tibial defect as bony support posts. Morselised cancellous bone grafts were then impacted around these posts. In the remaining 26 TKAs, multiple drill holes were made on the floor of the defect to decrease the remodelling time. Morselised cancellous bone grafts were impacted to fill the defects. The tibial components were fixed with cemented (n=34) or non-cemented (n=11) technique. Internal fixation devices were not used; stem extension was used in only 2 TKAs (in a patient with Charcot joint and a patient undergoing revision TKA). RESULTS: After a mean follow-up duration of 65 (range, 24-174) months, no patient showed gait disturbance. The mean knee flexion angle was 113.8º (range, 90º-130º). No absorption or collapse of the grafted bone, or component loosening were noted on radiographs. The grafted bone completely incorporated into the host bone, with bony trabeculae crossing the interface within 2 years in the first 19 TKAs and within one year in the latter 26 TKAs. The margin of the grafted area resembled bony cortex in 30 TKAs. CONCLUSION: Autologous morselised bone grafting is a viable option for most medial tibial defects during TKA.

  178. Tumor-induced osteomalacia caused by phosphaturic mesenchymal tumor of the cervical spine. 査読有り

    Takeshi Nakamura, Toshimi Aizawa, Takeshi Hoshikawa, Hiroshi Ozawa, Nobuaki Ito, Seiji Fukumoto, Eiji Itoi, Shoichi Kokubun

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 20 (4) 765-71 2015年7月

    DOI: 10.1007/s00776-014-0540-4  

    ISSN:0949-2658

  179. 緊急手術を要した胸椎から仙骨にわたる広範囲の術後胸腰椎硬膜下膿瘍の1例

    八幡 健一郎, 小澤 浩司, 相澤 俊峰, 橋本 功, 菅野 晴夫, 舘田 聡, 井樋 栄二, 高橋 良正, 佐藤 哲朗

    東北整形災害外科学会雑誌 58 (1) 196-196 2015年6月

    出版者・発行元:東北整形災害外科学会

    ISSN:1348-8694

  180. Changes in lumbar spondylolisthesis on axial-loaded MRI: do they reproduce the positional changes in the degree of olisthesis observed on X-ray images in the standing position? 国際誌 査読有り

    Haruo Kanno, Hiroshi Ozawa, Yutaka Koizumi, Naoki Morozumi, Toshimi Aizawa, Yushin Ishii, Eiji Itoi

    The spine journal : official journal of the North American Spine Society 15 (6) 1255-62 2015年6月1日

    出版者・発行元:ELSEVIER SCIENCE INC

    DOI: 10.1016/j.spinee.2015.02.016  

    ISSN:1529-9430

    eISSN:1878-1632

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    BACKGROUND CONTEXT: Axial-loaded magnetic resonance imaging (MRI) can partially simulate the lumbar spine in patients in a standing position and potentially provides additional imaging findings that cannot be obtained with conventional MRI in the clinical assessment of patients with degenerative lumbar disease. Previous studies have shown that axial-loaded MRI demonstrates a significant reduction in the size of the dural sac compared with conventional MRI. However, there has been no study to compare the degree of olisthesis among conventional MRI, axial-loaded MRI, and upright X-ray imaging in patients with degenerative spondylolisthesis (DS). PURPOSE: The purpose of the study is to determine whether axial-loaded MRI can demonstrate similar positional changes in lumbar olisthesis as those detected on upright lateral X-ray in patients with DS. STUDY DESIGN: This is an imaging cohort study. PATIENT SAMPLE: A total of 43 consecutive patients with DS exhibiting olisthesis of 3 mm or more on X-ray images in the standing position were prospectively evaluated in this study. OUTCOME MEASURES: The degree of olisthesis, intraclass correlation coefficient (ICC), and percentage of patients exhibiting olisthesis of 3 mm or more on MRI. METHODS: The degree of olisthesis was measured on conventional MRI, axial-loaded MRI, and lateral X-ray imaging performed in the upright position. The degree of olisthesis was compared among the three imaging techniques. The ICC values for the measurements of olisthesis between X-ray studies and conventional and axial-loaded MRI were calculated and compared. The percentage of patients exhibiting olisthesis of 3 mm or more was compared between conventional MRI and axial-loaded MRI. RESULTS: The degree of olisthesis on axial-loaded MRI (5.9±2.5 mm) was significantly greater than that observed on conventional MRI (4.4±2.4 mm) (p<.05) although the degrees on conventional and axial-loaded MRI were significantly smaller than that on upright X-ray images (7.1±2.8 mm) (p<.05). The ICC between axial-loaded MRI and X-ray imaging (0.75, 95% confidence interval: 0.58-0.85) was considerably greater than that observed between conventional MRI and X-ray imaging (0.40, 95% confidence interval: 0.11-0.62). The percentage of patients exhibiting olisthesis of 3 mm or more was significantly higher on axial-loaded MRI (91%) than on conventional MRI (63%) (p<.01). CONCLUSIONS: Axial-loaded MRI demonstrates a significantly larger degree of olisthesis than conventional MRI. In addition, the degree of olisthesis on axial-loaded MRI was found to be more strongly correlated with that observed on X-ray studies in the upright position. Furthermore, the use of axial-loaded MRI significantly reduced the misdiagnosis of olisthesis of 3 mm or more that was detected on X-ray imaging. These results suggest that axial-loaded MRI may be superior to identify the olisthesis of the lumbar spine and show the degrees of olisthesis correlated to those detected on upright X-ray imaging. Further studies should be needed to clarify the actual value of these findings on axial-loaded MRI and provide the evidence to support its clinical significance in the assessment of patients with DS.

  181. 頸髄症におけるMRI髄内T2高輝度領域のパターンと病理像の関係について

    小澤 浩司, 相澤 俊峰, 橋本 功, 菅野 晴夫, 井樋 栄二

    日本整形外科学会雑誌 89 (2) S107-S107 2015年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  182. 荷重MRIによる腰椎変性すべりの動的変化の検討 荷重によるすべりの増大と臨床症状の関係

    菅野 晴夫, 小澤 浩司, 相澤 俊峰, 橋本 功, 井樋 栄二

    Journal of Spine Research 6 (3) 553-553 2015年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  183. 荷重MRIにおける腰部脊柱管狭窄の検討 荷重による動的狭窄のリスク因子の解析

    菅野 晴夫, 小澤 浩司, 相澤 俊峰, 橋本 功, 井樋 栄二

    日本整形外科学会雑誌 89 (3) S638-S638 2015年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  184. Referred pain location depends on the affected section of the sacroiliac joint. 国際誌 査読有り

    Daisuke Kurosawa, Eiichi Murakami, Toshimi Aizawa

    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 24 (3) 521-7 2015年3月

    出版者・発行元:Springer Verlag

    DOI: 10.1007/s00586-014-3604-4  

    ISSN:1432-0932 0940-6719

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    PURPOSE: Pain referred from the sacroiliac joint (SIJ) may originate in the joint's posterior ligamentous region. The site of referred pain may depend on which SIJ section is affected. This study aimed to determine the exact origin of pain referred from four SIJ sections. METHODS: The study included 50 patients with SIJ dysfunction, confirmed by more than 70 % pain relief after periarticular injection of local anesthetic into the SIJ. The posterior SIJ was divided into four sections-upper, middle, lower, and other (cranial portion of the ilium outside the SIJ)-designated sections 1, 2, 3, and 0, respectively. We then inserted a needle into the periarticular SIJ under fluoroscopy. After the patient identified the area(s) in which the needle insertion produced referred pain, we injected a mixture of 2 % lidocaine and contrast medium into the corresponding SIJ section. RESULTS: Referred pain from SIJ section 0 was mainly located in the upper buttock along the iliac crest; pain from section 1, around the posterosuperior iliac spine; pain from section 2, in the middle buttock area; pain from section 3, in the lower buttock. In all, 22 (44.0 %) patients complained of groin pain, which was slightly relieved by lidocaine injection into SIJ sections 1 and 0. CONCLUSIONS: Dysfunctional upper sections of the SIJ are associated with pain in the upper buttock and lower sections with pain in the lower buttock. Groin pain might be referred from the upper SIJ sections.

  185. 胸椎砂時計腫の手術成績 脊椎固定は必要か? 査読有り

    相澤 俊峰, 小澤, 浩司, 橋本, 功, 菅野, 晴夫, 舘田, 聡, 矢部, 裕, 八幡, 健一郎, 井樋 栄二

    Journal of Spine Research 6 (3) 528-528 2015年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  186. 腰椎2大疾患の再手術率 脊柱管狭窄症と椎間板ヘルニア再手術率の生存分析 査読有り

    相澤 俊峰, 小澤, 浩司, 橋本, 功, 菅野, 晴夫, 日下部, 隆, 関口, 玲, 佐藤, 哲朗, 高橋, 永次, 両角, 直樹, 国分, 正一, 井樋 栄二

    日本整形外科学会雑誌 89 (2) S61-S61 2015年3月

  187. Reoperation rates after fenestration for lumbar spinal canal stenosis: a 20-year period survival function method analysis. 国際誌 査読有り

    Toshimi Aizawa, Hiroshi Ozawa, Takashi Kusakabe, Yasuhisa Tanaka, Akira Sekiguchi, Ko Hashimoto, Haruo Kanno, Naoki Morozumi, Yushin Ishii, Tetsuro Sato, Eiji Takahashi, Shoichi Kokubun, Eiji Itoi

    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 24 (2) 381-7 2015年2月

    出版者・発行元:Maik Nauka-Interperiodica Publishing

    DOI: 10.1007/s00586-014-3479-4  

    ISSN:1555-6174 0031-0301

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    PURPOSE: Fenestration is the gold standard surgery for lumbar spinal canal stenosis in Japan. Several previous studies have analyzed the reoperation rates in large numbers of patients undergoing several surgical procedures such as laminectomy with or without instrumented spinal fusion; however, there have been few studies focusing solely on fenestration. The purpose of this study was to calculate the reoperation rates after fenestration using the survival function method. METHODS: Form 1988-2007, 6,998 surgeries for lumbar spinal canal stenosis occurred in Miyagi prefecture, Japan, and these patients were enrolled by the spinal surgery registration system of the Department of Orthopaedic Surgery, Tohoku University. Among these, 5,835 surgeries involved fenestration as a primary surgery and for those who underwent ≥2 lumbar surgeries we analyzed the reoperation rates using the Kaplan-Meier method. RESULTS: Among the 5,835 patients undergoing primary fenestration, 215 patients underwent 221 revisions; 112 included the same spinal levels and 103 were revised only at other levels as primary fenestration. The overall reoperation rates were 0.8% at 1 year, 2.9% at 5 years, 5.2% at 10 years, 7.5% at 15 years and 8.6% at >17.7 years. Reoperation rates for those at the same spinal levels were 0.6% at 1 year, 1.7% at 5 years, 2.7% at 10 years, 3.8% at 15 years, and 4.1% at >17.0 years. CONCLUSIONS: Fenestration can be performed at low cost using standard spinal surgery equipments. The reoperation rates of this procedure were lower than previously reported for several other surgical procedures.

  188. Reoperation rates after fenestration for lumbar spinal canal stenosis: a 20-year period survival function method analysis 査読有り

    Toshimi Aizawa, Hiroshi Ozawa, Takashi Kusakabe, Yasuhisa Tanaka, Akira Sekiguchi, Ko Hashimoto, Haruo Kanno, Naoki Morozumi, Yushin Ishii, Tetsuro Sato, Eiji Takahashi, Shoichi Kokubun, Eiji Itoi

    EUROPEAN SPINE JOURNAL 24 (2) 381-387 2015年2月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s00586-014-3479-4  

    ISSN:0940-6719

    eISSN:1432-0932

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    Fenestration is the gold standard surgery for lumbar spinal canal stenosis in Japan. Several previous studies have analyzed the reoperation rates in large numbers of patients undergoing several surgical procedures such as laminectomy with or without instrumented spinal fusion; however, there have been few studies focusing solely on fenestration. The purpose of this study was to calculate the reoperation rates after fenestration using the survival function method. Form 1988-2007, 6,998 surgeries for lumbar spinal canal stenosis occurred in Miyagi prefecture, Japan, and these patients were enrolled by the spinal surgery registration system of the Department of Orthopaedic Surgery, Tohoku University. Among these, 5,835 surgeries involved fenestration as a primary surgery and for those who underwent a parts per thousand yen2 lumbar surgeries we analyzed the reoperation rates using the Kaplan-Meier method. Among the 5,835 patients undergoing primary fenestration, 215 patients underwent 221 revisions; 112 included the same spinal levels and 103 were revised only at other levels as primary fenestration. The overall reoperation rates were 0.8 % at 1 year, 2.9 % at 5 years, 5.2 % at 10 years, 7.5 % at 15 years and 8.6 % at &gt; 17.7 years. Reoperation rates for those at the same spinal levels were 0.6 % at 1 year, 1.7 % at 5 years, 2.7 % at 10 years, 3.8 % at 15 years, and 4.1 % at &gt; 17.0 years. Fenestration can be performed at low cost using standard spinal surgery equipments. The reoperation rates of this procedure were lower than previously reported for several other surgical procedures.

  189. Quality of life after bilateral total knee arthroplasty determined by a 3-year longitudinal evaluation using the Japanese knee osteoarthritis measure. 査読有り

    Takehiko Sugita, Yasuhiro Kikuchi, Toshimi Aizawa, Akira Sasaki, Naohisa Miyatake, Ikuo Maeda

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 20 (1) 137-42 2015年1月

    出版者・発行元:SPRINGER JAPAN KK

    DOI: 10.1007/s00776-014-0645-9  

    ISSN:0949-2658

    eISSN:1436-2023

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    BACKGROUND: Recently, the Japanese knee osteoarthritis measure (JKOM), a new disease-specific and patient-derived quality of life (QOL) measure, has been developed. The objectives of this study were to longitudinally evaluate QOL assessed by JKOM and objective outcomes including knee society score (KSS), range of motion (ROM), and timed up and go test (TUG) of patients who underwent bilateral total knee arthroplasties (TKAs) for osteoarthritis; to evaluate correlations between JKOM and those objective outcomes; and to test our hypothesis that increased maximum flexion leads to better JKOM. METHODS: Forty patients with bilateral TKAs and ≥ 3-year follow-up were included. There were 35 female and 5 male patients with a mean patient age of 74 years. They were evaluated preoperatively (Pre), 5-29 months after unilateral TKA (after U), 12-21 months after bilateral TKAs (1 year after B), 24-34 months after bilateral TKAs (2 years after B), and 36-46 months after bilateral TKAs (3 years after B) using JKOM, KSS, TUG, and ROM. RESULTS: Improvements in JKOM and TUG were statistically significant between "Pre" and "after U", and between the "after U" and "1 year after B". Improvements in the KSS function score were statistically significant between "after U" and "1 year after B" but not between "Pre" and "after U". The improvements in the JKOM scores, the KSS function score, and TUG did not increase after the 1-year follow-up but was maintained at "3 years after B". The maximum flexion value did not change among the evaluation time points. There were statistically significant correlations between JKOM with KSS and TUG but not with ROM. CONCLUSIONS: There were statistically significant correlations between JKOM with KSS and TUG but not with ROM. Therefore, our hypothesis was false even in a Japanese population.

  190. Medial meniscus tear morphology and related clinical symptoms in patients with medial knee osteoarthritis. 国際誌 査読有り

    Masayuki Kamimura, Jutaro Umehara, Atsushi Takahashi, Toshimi Aizawa, Eiji Itoi

    Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 23 (1) 158-63 2015年1月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s00167-014-2939-z  

    ISSN:0942-2056

    eISSN:1433-7347

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    PURPOSE: The objective of this study was to examine the association between clinical symptoms and arthroscopic meniscal findings in patients with early to moderate medial knee osteoarthritis. METHODS: One hundred and four patients (110 knees) were selected from a group of 132 patients (140 knees) aged ≥50 years who underwent arthroscopic surgery for medial meniscal tears. Inclusion criteria were as follows: (a) medial knee osteoarthritis and (b) simple medial meniscal tears extending to ≥1/4 of the meniscal margin. Subjective symptoms, location and nature of the pain, as well as the physical findings observed during initial assessment were evaluated using a standardized assessment chart. The relationship between arthroscopic meniscal findings and clinical symptoms was then analysed. RESULTS: Isolated meniscal tears were classified into four types: radial tear of the middle segment; posterior root tear; horizontal tear of the posterior segment; and flap tear. The following symptoms were reported at significantly higher frequencies: pain on standing and a catching sensation in patients with flap tears; pain on walking and nocturnal pain on rolling over in bed in patients with radial tears of the middle segment; and popliteal pain in patients with posterior root tears. CONCLUSIONS: This study demonstrates a relationship between the type of medial meniscal tear and characteristic clinical symptoms reported by patients with medial knee osteoarthritis. These results suggest that clinical symptoms in patients with osteoarthritis of the knee may be caused by meniscal tears. This evidence may help to better inform patients and surgeons regarding choice of treatment. LEVEL OF EVIDENCE: Case control study, Level III.

  191. 硬膜内髄外腫瘍との鑑別が問題となるidiopathic hypertrophic pachymeningitisの1例

    品川 清嗣, 小澤 浩司, 相澤 俊峰, 橋本 功, 菅野 晴夫, 園淵 和明, 井樋 栄二

    東日本整形災害外科学会雑誌 26 (3) 408-408 2014年8月

    出版者・発行元:東日本整形災害外科学会

    ISSN:1342-7784

    eISSN:2433-569X

  192. 脊柱後彎症に対する新しい股装具の開発

    小澤 浩司, 相澤 俊峰, 橋本 功, 菅野 晴夫, 井樋 栄二

    運動器リハビリテーション 25 (2) 187-187 2014年6月

    出版者・発行元:日本運動器科学会

    ISSN:2187-8420

  193. 腰椎変性すべり症に対する開窓術の限界 同一椎間再手術例の検討

    相澤 俊峰, 小澤 浩司, 橋本 功, 菅野 晴夫, 両角 直樹, 日下部 隆, 川原 央, 高橋 永次, 佐藤 哲朗, 国分 正一, 井樋 栄二

    日本整形外科学会雑誌 88 (2) S181-S181 2014年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  194. 荷重MRIによる腰部脊柱管狭窄の画像診断 立位の脊髄造影像における狭窄椎間の同定

    菅野 晴夫, 小澤 浩司, 相澤 俊峰, 古泉 豊, 両角 直樹, 橋本 功, 石井 祐信, 井樋 栄二

    日本整形外科学会雑誌 88 (2) S202-S202 2014年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  195. 頸髄症における術後脊髄腫脹の出現と画像の特徴について

    小澤 浩司, 佐藤 哲朗, 相澤 俊峰, 菅野 晴夫, 橋本 功, 井樋 栄二, 国分 正一

    日本整形外科学会雑誌 88 (3) S976-S976 2014年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  196. 荷重MRIによる腰部脊柱管狭窄症の画像診断 脊髄造影像における狭窄をどこまで捉えるか

    菅野 晴夫, 小澤 浩司, 相澤 俊峰, 橋本 功, 井樋 栄二

    Journal of Spine Research 5 (3) 436-436 2014年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

    eISSN:2435-1563

  197. Atypical findings on magnetic resonance imaging in the patients with active pyogenic spondylitis in Japanese university hospitals. 査読有り

    Toshimi Aizawa, Hiroshi Ozawa, Tomoaki Koakutsu, Takeshi Nakamura, Haruo Kanno, Toru Hirano, Atsuki Sano, Takui Ito, Eiji Itoi

    The Tohoku journal of experimental medicine 231 (1) 13-9 2013年9月

    出版者・発行元:TOHOKU UNIV MEDICAL PRESS

    DOI: 10.1620/tjem.231.13  

    ISSN:0040-8727

    eISSN:1349-3329

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    Recently, aging population and immuno-compromised patients have been rising in Japan. Accordingly, patients with pyogenic spondylitis have been increasing and may present atypical clinical features. University hospitals treat many elderly patients and patients with poor general condition. Therefore, patients with pyogenic spondylitis treated at two university hospitals were retrospectively investigated to clarify the recent clinical and radiologic characteristics of this infection. There were 30 patients (average age: 68 years) treated in two university hospitals between 2009 and 2010. The onset was acute or subacute in 15 patients, insidious in 7 and unclassified in 8. Culture tests were performed in 25 patients, and the causative microorganisms were identified in 20 patients with the identification rate of 80%, including 4 patients infected by methicillin-resistant staphylococci. Classically, active pyogenic spondylitis is characterized by typical findings on magnetic resonance imaging (MRI): obvious signal decrease in T1-weighted image (WI) and increase in T2WI with contrast enhancement found in most of the bodies of two adjacent vertebrae and the intervening intervertebral disc. Among 29 patients with active pyogenic spondylitis, whose lesions were not in the healing stage, 16 patients demonstrated at least one of the atypical MRI findings; 9 patients showed involvement ≥ 3 vertebrae or only 1 vertebra, 5 showed the signal changes of the lesions involving small, spotty, or faint areas, and 3 showed small vertebral lesions but larger epidural or paraspinal abscesses. In conclusion, currently, about half of the patients with pyogenic spondylitis demonstrate atypical MRI findings in the university hospitals in Japan.

  198. Bone formation within the articular cartilage of the lateral compartment of varus osteoarthritic knees. 査読有り

    Takehiko Sugita, Toshimi Aizawa, Tomomaro Kawamata, Akira Sasaki, Mitsuhiro Kashiwaba, Atsushi Takahashi

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 18 (4) 543-6 2013年7月

    出版者・発行元:SPRINGER JAPAN KK

    DOI: 10.1007/s00776-013-0396-z  

    ISSN:0949-2658

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    BACKGROUND: One of the causes of failure after unicompartmental knee arthroplasty (UKA) for varus osteoarthritis is the progression of osteoarthritis in the lateral compartment. Bone formation within the articular cartilage has been reported as a possible cause of the deterioration of the osteoarthritis. However, its prevalence and histology are still uncertain. The purpose of the current study is to investigate bone pieces obtained from the lateral compartment of the knee during total knee arthroplasty (TKA) radiographically and histopathologically, and to examine the bone formation within the articular cartilage in detail. METHODS: Thirty-four consecutive patients, who underwent TKA for varus osteoarthritis of the knee, were included in this study. There were 6 males and 28 females and the mean age at the surgery was 74 years (range 63-85 years). Fifty-seven and 99 sagittal slabs were acquired from the resected bone pieces of the distal lateral femoral condyle and lateral tibial plateau, respectively. These slabs were investigated by soft X-ray radiographs and histopathological analyses stained with hematoxylin-eosin and elastica-Masson. RESULTS: On soft X-ray radiographs, bone formation (in which bone trabeculae were clearly detected) within the articular cartilage was observed in 8 (14.0%) of 57 femoral slabs and 7 (7.1%) of 99 tibial slabs. Histopathological analyses revealed that the bone which had formed comprised normal trabeculae and fatty marrow. There was rich vascularity in the cartilage around the formed bone. CONCLUSIONS: The current study is the first to describe the prevalence, location, and histopathological findings of bone formation within the articular cartilage of the lateral compartment of varus osteoarthritic knees. Since the thickness of the cartilage covering the bone formation is less than that without it, it may result in the deterioration of the lateral compartment after UKA.

  199. Effect of medial tibial torsion on the sagittal alignment of lower legs in patients with medial knee osteoarthritis. 国際誌 査読有り

    Atsushi Takahashi, Toshimi Aizawa, Takashi Aki, Mitsuhiro Kashiwaba, Masayuki Kamimura, Shin Hitachi, Eiji Itoi

    Surgical and radiologic anatomy : SRA 35 (3) 205-10 2013年4月

    DOI: 10.1007/s00276-012-1011-2  

    ISSN:0930-1038 1279-8517

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    PURPOSE: The fibular axis (FA) and anterior tibial cortex (ATC) are good determinants of the sagittal mechanical axis (MA) of lower legs during total knee arthroplasty (TKA).When compared with healthy subjects, a significant medial tibial torsion has been reported in patients with medial knee osteoarthritis; this should affect the alignment of lower legs. The purpose of this study was to clarify the effect of the medial torsion on relationship between sagittal MA and intraoperative references (FA and ATC). METHODS: Fifty knees of 50 patients with medial knee osteoarthritis who underwent primary TKA were included in this study. Using preoperative computed tomographic data, the tibial torsion angle was measured in the axial plane. The angle between FA and MA, and the angle between ATC and MA were also measured in the sagittal plane. RESULTS: The tibial torsion angle was 7.9° ± 7.2° (range -11.3° to -24.3°). The angle between MA and FA was -1.8° ± 0.8° (range -0.1° to -4.3°), and the angle between MA and ATC was 4.6° ± 0.5° (range 3.1° to 5.5°). The population variance was significantly larger for the angle between MA and FA than that between MA and ATC (P = 0.0160). There was a significant positive correlation between the tibial torsion angle and the angle between MA and FA (R (2) = 0.5111, P < 0.0001). CONCLUSION: The angle between FA and MA in the sagittal plane increased in patients with large medial tibial torsion.

  200. X線診断Q&A 招待有り

    相澤俊峰

    整形外科 64 73-74 2013年4月1日

  201. Visualization of torn anterior cruciate ligament using 3-dimensional computed tomography. 国際誌 査読有り

    Hiroaki Uozumi, Toshimi Aizawa, Takehiko Sugita, Tomonori Kunii, Shun Abe, Eiji Itoi

    Orthopedic reviews 5 (3) e22-102 2013年

    DOI: 10.4081/or.2013.e22  

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    Recently, a remnant-preserving anterior cruciate ligament (ACL) reconstruction technique has been developed. However, the preoperative condition of remnant ACL is occasionally difficult to evaluate by magnetic resonance imaging. The purpose of this study is to evaluate the accuracy of pre-operative visualization of remnant ACL using three-dimensional computed tomography (3D-CT). The remnant ACL in 25 patients was examined by 3DCT before ACL reconstruction surgery. Findings on 3D-CT images and arthroscopy were compared. The 3D-CT images were classified into 4 groups: Group A, remnant fibers attached to the posterior cruciate ligament (PCL); Group B, those located between the PCL and the lateral wall; Group C, those attached to the lateral wall; and Group D, no identifiable remnant fibers on the tibial side. These groups were made up of 4, 3, 9 and 9 patients, respectively. Findings on 3D-CT images were identical to those during arthroscopy in 20 of 25 cases (80%). Remnant ACL can be accurately evaluated using 3D-CT in 80% of cases of torn ACL. This novel method is a useful technique for pre-operative assessment of remnant ACL.

  202. Epidemiology of surgically treated primary spinal cord tumors in Miyagi, Japan. 国際誌 査読有り

    Hiroshi Ozawa, Toshimi Aizawa, Haruo Kanno, Hirotaka Sano, Eiji Itoi

    Neuroepidemiology 41 (3-4) 156-60 2013年

    DOI: 10.1159/000353561  

    ISSN:0251-5350 1423-0208

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    BACKGROUND: Data for spinal cord tumors have not been collected in the past on a population-based level in Japan. The objective of the study was to provide detailed estimates of the population-based incidence of surgically treated primary spinal cord tumors in Japan. METHODS: Incidence of primary spinal cord tumors was estimated from patients treated surgically between 2008 and 2010 in Miyagi Prefecture. The overall incidence of spinal cord tumors was calculated, as well as the individual incidence rates according to age group, gender, pathology and tumor location. RESULTS: Of the primary spinal cord tumors identified (n = 112), 98% were nonmalignant. The overall incidence of spinal cord tumors was 1.60/100,000 person-years with an incidence of 1.77/100,000 in males and 1.45/100,000 in females. The incidence rate was highest in the age group of 60-64 years (3.04/100,000). Schwannoma accounted for 56% and meningioma accounted for 13% of the tumors. The histological type with the highest incidence was schwannoma (0.90/100,000), followed by meningioma (0.20/100,000). CONCLUSIONS: Due to the high incidence of schwannomas, the overall incidence of spinal cord tumors is higher in Japan than in Western countries, and Japanese males have a higher incidence than females, different from that observed in Western countries.

  203. Tumors at the lateral portion of the C1-2 interlaminar space compressing the spinal cord by rotation of the atlantoaxial joint: new aspects of spinal cord compression. 国際誌 査読有り

    Hiroshi Ozawa, Takashi Kusakabe, Toshimi Aizawa, Takeshi Nakamura, Yushin Ishii, Eiji Itoi

    Journal of neurosurgery. Spine 17 (6) 552-5 2012年12月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2012.9.SPINE12562  

    ISSN:1547-5654

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    The authors describe 2 patients with C-2 nerve root tumors in whom the lesions were located bilaterally in the lateral portions of the C1-2 interlaminar space and compressed the spinal cord when the atlantoaxial joint was rotated. The patients were adult men with neurofibromatosis. Each presented with clumsiness of both hands and motor weakness of the extremities accompanied by spastic gait. Magnetic resonance imaging of the cervical spine performed with the neck in the neutral position showed tumors at the bilateral lateral portion of the C1-2 interlaminar space without direct compression of the spinal cord. The spinal cord exhibited an I-shaped deformity at the same level as the tumors in one case and a trapezoidal deformity at the same level as the tumors in the other case. Computed tomography myelography and MRI on rotation of the cervical spine revealed bilateral intracanal protrusion of the tumors compressing the spinal cord from the lateral side. The tumors were successfully excised and occipitocervical fusion was performed. The tumors were pushed out into the spinal canal from the bilateral lateral portion of the interlaminar spaces due to rotation of the atlantoaxial joint. This was caused by a combination of posteromedial displacement of the lateral mass on the rotational side of the atlas and narrowing of the lateral portion of the interlaminar space on the contralateral side due to the coupling motion of the lateral bending and extension of the atlas. The spinal cord underwent compression from both lateral sides in a one-way rotation. Without sustained spinal cord compression, intermittent long-term dynamic spinal cord compression from both lateral sides should induce a pathognomonic spinal cord deformity and the onset of paralysis. To the authors' knowledge, there have been no reports of the present conditions-that is, the bilateral protrusion of tumors from the bilateral lateral portion of the C1-2 interlaminar spaces into the spinal canal due to atlantoaxial rotation.

  204. Natural history of intradural-extramedullary spinal cord tumors. 国際誌 査読有り

    Hiroshi Ozawa, Yoshito Onoda, Toshimi Aizawa, Takeshi Nakamura, Tomoaki Koakutsu, Eiji Itoi

    Acta neurologica Belgica 112 (3) 265-70 2012年9月

    出版者・発行元:SPRINGER HEIDELBERG

    DOI: 10.1007/s13760-012-0048-7  

    ISSN:0300-9009

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    The objective of the present study was to investigate the natural history of intradural-extramedullary spinal cord tumors. Nine cases of intradural-extramedullary tumors were observed over the 2 years. The physical and magnetic resonance imaging (MRI) examination were performed in the first examination and every other year. Tumors were classified as the schwannoma type and the meningioma type based on the MRI findings. The tumor volume was calculated by the craniocaudal length on a sagittal image and maximum transverse diameter on an axial image of MRI, every year. The annual growth rate, which was defined as the change in the volume each year compared to the volume of the previous year, was examined. There were six cases in the schwannoma type and three cases in the meningioma type. The schwannoma type tumors presented several growth patterns: unchanging, continuous slight growth, and initial slight growth followed by rapid growth during the observation period (6.7 ± 2.7 years), while the meningioma type tumors presented the continuous growth pattern during the observation period (4.3 ± 2.5 years). The average annual growth rate was 2.3 ± 5.5% in the schwannoma type and 7.0 ± 8.5% in the meningioma type. Schwannoma type tumors showed relatively less change in their size and would be observed for a longer time.

  205. Neuroprotective therapy using granulocyte colony-stimulating factor for patients with worsening symptoms of thoracic myelopathy: a multicenter prospective controlled trial. 国際誌

    Tsuyoshi Sakuma, Masashi Yamazaki, Akihiko Okawa, Hiroshi Takahashi, Kei Kato, Mitsuhiro Hashimoto, Koichi Hayashi, Takeo Furuya, Takayuki Fujiyoshi, Junko Kawabe, Chikato Mannoji, Tomohiro Miyashita, Ryo Kadota, Yukio Someya, Osamu Ikeda, Tomonori Yamauchi, Masayuki Hashimoto, Toshimi Aizawa, Atsushi Ono, Shiro Imagama, Tokumi Kanemura, Hideki Hanaoka, Kazuhisa Takahashi, Masao Koda

    Spine 37 (17) 1475-8 2012年8月1日

    eISSN:1528-1159

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    STUDY DESIGN: An open-labeled multicenter prospective controlled clinical trial. OBJECTIVE: To confirm the feasibility of granulocyte colony-stimulating factor (G-CSF) administration for patients with thoracic myelopathy. SUMMARY OF BACKGROUND DATA: Although G-CSF is best known as an important cytokine commonly used to treat neutropenia, it also has nonhematopoietic functions. Previous experimental studies have shown that G-CSF can enhance tissue regeneration of several organs, such as the heart and the brain. We previously reported that G-CSF promotes functional recovery after spinal cord injury in rodents. On the basis of those findings, we started a clinical trial of neuroprotective therapy, using G-CSF for patients with worsening symptoms of thoracic myelopathy. METHODS: Patients whose Japanese Orthopaedic Association (JOA) score for thoracic myelopathy had decreased 2 points or more during a recent 1-month period were eligible for entry. After giving informed consent, patients were assigned to G-CSF and control groups. The G-CSF group (n = 10) received G-CSF 10 μg/kg per day intravenously for 5 consecutive days. The control group (n = 14) received similar treatments as the G-CSF group except for G-CSF administration. The primary outcome was JOA recovery rate at 1 month after G-CSF administration or initial treatment. RESULTS: There was greater improvement in neurological functioning between baseline and 1-month follow-up in the G-CSF group (JOA recovery rate: 29.1 ± 20.5%) than in the control group (JOA recovery rate: 1.1 ± 4.2%) (P < 0.01). No serious adverse events occurred during or after the G-CSF administration. CONCLUSION: The results provide evidence that G-CSF administration caused neurological recovery in patients with worsening symptoms of thoracic compression myelopathy.

  206. Response to the editorial comments by Dr. Vincent C. Traynelis on the article entitled “Spine-Shortening Osteotomy for Patients with Tethered Cord Syndrome Caused by Lipomyelomeningocele.” 査読有り

    Kokubun S Aizawa T

    J Neurosurg Spine 15 19-20 2012年7月

  207. Prevalence of reoperation for perioperative complications in lumbar spinal surgery. 招待有り 査読有り

    Aizawa T Ozawa, H, Kusakabe, T, Nakamura T, Sekiguchi A, Koakutsu, T, Takahashi, K Morozumi, N, Koizumi Y, Itoi E

    J Spine Res 3 149-153 2012年7月

  208. Dynamic changes in the dural Sac cross-sectional area on axial loaded MR imaging: Is there a difference between degenerative spondylolisthesis and spinal stenosis? 査読有り

    H. Ozawa, Haruo Kanno, Y. Koizumi, N. Morozumi, T. Aizawa, T. Kusakabe, Y. Ishii, E. Itoi

    American Journal of Neuroradiology 33 (6) 1191-1197 2012年6月

    DOI: 10.3174/ajnr.A2920  

    ISSN:0195-6108 1936-959X

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    BACKGROUND AND PURPOSE: Axial loaded MR imaging, which can simulate the spinal canal of patients in a standing position, demonstrates a significant reduction of the DCSA compared with conventional MR imaging and provides valuable imaging findings in the assessment of the lumbar spinal canal. The purpose of this study was to compare the DCSA on axial loaded MR imaging between patients with DS and SpS. MATERIALS AND METHODS: Eighty-eight consecutive patients were divided into DS and SpS groups. DCSA on conventional MR imaging and axial loaded MR imaging and changes in the DCSA induced by axial loading were compared between DS and SpS groups. The prevalence of a significant change (&gt 15 mm2) in the DCSA was compared between the 2 groups. RESULTS: Axial loaded MR imaging demonstrated significantly smaller DCSA in the DS group (35 ± 22 mm2) than in the SpS group (50 ± 31 mm2), though conventional MR imaging did not show any differences between the 2 groups. The change in the DCSA induced by axial loading was significantly larger in the DS group (17 ± 12 mm2) compared with the SpS group (8 ± 8 mm2). The prevalence of a &gt 15-mm2 change in the DCSA was significantly higher in the DS group (62.5%) than in the SpS group (16.7%) (odds ratio, 8.33 95% confidence interval, 3.09-22.50). CONCLUSIONS: Axial loaded MR imaging demonstrated significantly larger changes in the DCSA in patients with DS compared those with SpS. A significant change in the DCSA was more frequently observed in patients with DS. Axial loaded MR imaging may therefore be a more useful tool to decrease the risk of underestimating the spinal canal narrowing in patients with DS than in those with SpS.

  209. Osteochondritis dissecans of the knee in identical twins: a report of two cases. 国際誌 査読有り

    Satsuki Onoda, Takehiko Sugita, Toshimi Aizawa, Masahiro Ohnuma, Atsushi Takahashi

    Journal of orthopaedic surgery (Hong Kong) 20 (1) 108-10 2012年4月

    出版者・発行元:HONG KONG ACAD MEDICINE PRESS

    ISSN:1022-5536

    eISSN:2309-4990

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    We report the second case of osteochondritis dissecans (OCD) of the knee in identical twins (bilaterally in one and unilaterally in the other). Fixations with bio-absorbable pins, cylindrical osteochondral graft, and osteochondral mosaicplasty were all successful and bone union was achieved. We considered that genetic factors remain essential even if other factors (particularly repetitive trauma) are mainly responsible for the occurrence of OCD.

  210. Reoperation for recurrent lumbar disc herniation: a study over a 20-year period in a Japanese population. 査読有り

    Toshimi Aizawa, Hiroshi Ozawa, Takashi Kusakabe, Takeshi Nakamura, Akira Sekiguchi, Atsushi Takahashi, Tatsuro Sasaji, Shigeyuki Tokunaga, Tomonori Chiba, Naoki Morozumi, Yutaka Koizumi, Eiji Itoi

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 17 (2) 107-13 2012年3月

    出版者・発行元:SPRINGER TOKYO

    DOI: 10.1007/s00776-011-0184-6  

    ISSN:0949-2658

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    BACKGROUND: Many studies have been reported on recurrent lumbar disc herniations covering several pathological conditions. In those studies, reoperation rate of revised disc excisions was calculated by simple division between the number of reoperations and that of the total primary disc excisions. To determine the real reoperation rate, strict definition of pathologies, a large number of patients, a long observation period, and survival function method are necessary. METHODS: Between 1988 and 2007, 5,626 patients with disc excision were enrolled by the spine registration system of the Department of Orthopaedic Surgery, Tohoku University, Japan. Among them, 192 had revised disc surgery, and we obtained data of 186 patients whose clinical features were assessed and reoperation rates analyzed using the Kaplan-Meier method. RESULTS: In total, 205 disc herniations were excised in the revision surgery (including contralateral herniation at the same level and new herniation at a different level), and 101 were real recurrent herniations (recurrence at the same level and side as the primary herniation). The kappa coefficient of the spinal level and side between the primary and revision surgeries was 0.41, indicting moderate correlations. Real recurrent herniations showed shorter intervals between primary and revision surgeries. Male patients with surgery at a younger age carried a higher risk of reoperation. In the revision surgery, transligamentous extrusion was significantly more common than other types of herniation. On Kaplan-Meier analysis, the reoperation rate of overall revised excisions was 0.62% at 1 year, 2.4% at 5 years, 4.4% at 10 years, and 5.9% after 17 years. That of real recurrent herniations was 0.5%, 1.4%, and 2.1%, respectively, and 2.8% after 15.7 years. CONCLUSION: Reoperation rate of real recurrent herniations calculated using survival function method gradually increased year by year, from 0.5% at 1 year after primary surgery to 2.8% at 15.7 years.

  211. Dynamic change of dural sac cross-sectional area in axial loaded magnetic resonance imaging correlates with the severity of clinical symptoms in patients with lumbar spinal canal stenosis. 国際誌 査読有り

    Haruo Kanno, Hiroshi Ozawa, Yutaka Koizumi, Naoki Morozumi, Toshimi Aizawa, Takashi Kusakabe, Yushin Ishii, Eiji Itoi

    Spine 37 (3) 207-13 2012年2月1日

    出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS

    DOI: 10.1097/BRS.0b013e3182134e73  

    ISSN:0362-2436

    eISSN:1528-1159

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    STUDY DESIGN: Cross-sectional registry and imaging cohort study. OBJECTIVE.: To examine whether the dural sac cross-sectional area (DCSA) in axial loaded magnetic resonance imaging (MRI) correlates with the severity of clinical symptoms in patients with lumbar spinal canal stenosis (LSCS). SUMMARY OF BACKGROUND DATA: Many studies have analyzed the relationship between DCSA on conventional MRI and the severity of symptoms in LSCS, but the link is still uncertain. Recently, axial loaded MRI, which can stimulate the spinal canal of patients in the upright position, has been developed. Axial loaded MRI demonstrates significant reduction of DCSA and provides valuable radiologic findings in the assessment of LSCS. However, there has been no study of the correlation between DCSA in axial loaded MRI and the severity of symptoms in LSCS. METHODS: In 88 patients with LSCS, DCSA in conventional MRI, axial loaded MRI, and changes in the DCSA were determined at the single most constricted intervertebral level. The severity of symptoms was evaluated on the basis of the duration of symptoms, walking distance, visual analogue scale of leg pain/numbness, and Japanese Orthopaedic Association score. Spearman correlations of the DCSA in conventional MRI, axial loaded MRI, and changes in the DCSA with the severity of symptoms were analyzed. In addition, the severity of symptoms and DCSA in conventional and axial loaded MRI were compared, respectively, between patients with and without significant (>15 mm) changes in the DCSA. RESULTS: The DCSA in axial loaded MRI had good correlations with walking distance and Japanese Orthopaedic Association score (rs = 0.46 and 0.45, respectively; P < 0.001). In addition, the change in the DCSA significantly correlated to walking distance, visual analogue scale of leg numbness, and Japanese Orthopaedic Association score (rs = 0.59, 0.44, and 0.54, respectively; P < 0.001). Furthermore, the symptoms were significantly worse in patients with more than 15 mm change in the DCSA (P < 0.001). Axial loaded MRI, but not conventional MRI, showed a significantly smaller DCSA in patients with more than 15 mm change in the DCSA (P < 0.05). CONCLUSION: DCSA in axial loaded MRI significantly correlated with the severity of symptoms. Axial loaded MRI demonstrated that changes in the DCSA significantly correlated with the severity of symptoms, which conventional MRI could not detect. Thus, MRI with axial loading provides more valuable information than the conventional MRI for assessing patients with LSCS.

  212. Fracture and contralateral dislocation of the twin facet joints of the lower cervical spine. 国際誌 査読有り

    Ly Minh Ngo, Toshimi Aizawa, Takeshi Hoshikawa, Yasuhisa Tanaka, Tetsuro Sato, Yushin Ishii, Shoichi Kokubun

    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 21 (2) 282-8 2012年2月

    出版者・発行元:SPRINGER

    DOI: 10.1007/s00586-011-1956-6  

    ISSN:0940-6719

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    PURPOSE: The combination of a facet fracture and a contralateral facet dislocation at the same intervertebral level of the cervical spine (a fracture and contralateral dislocation of the twin facet joints) has not been described in detail. The aims of this study are to report a series of 11 patients with this injury, to clarify the clinical features and to discuss its pathomechanism. METHODS: Among 251 patients with lower cervical spine fractures and/or dislocations surgically treated, 11 (9 males and 2 females, averaged age, 52 years) had this kind of injury. Medical charts and medical images were reviewed retrospectively. RESULTS: Injury levels were C4-5, C5-6 and C6-7 in 1, 4 and 6 patients, respectively. A fracture was found at the superior facet in 6, and at the inferior facet in 5. The anterior displacement of the vertebral body ranged from 7 to 19 mm. The unilateral horizontal facet appearance on an anteroposterior radiograph and the triple image on a CT composed of a separated fracture fragment, the base of the fractured facet, and the neighboring non-fractured facet were characteristic. All patients had neurological deficits from Frankel A to D, and were surgically treated by posterior fusion using wire or cable, or combined anterior and posterior spinal fusion. CONCLUSIONS: The fracture and contralateral dislocation of the twin facet joints can cause severe neurological deficits because of its gross anterior displacement. Its plausible pathomechanism is extension force exerted to the cervical spine when it is maximally bent laterally.

  213. Remodeling capacity of malunited odontoid process fractures in kyphotic angulation in infancy: an observation up to maturity in three patients. 国際誌 査読有り

    Shigeyuki Tokunaga, Yushin Ishii, Toshimi Aizawa, Yutaka Koizumi, Jun Kawai, Shoichi Kokubun

    Spine 36 (23) E1515-8-E1518 2011年11月1日

    出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS

    DOI: 10.1097/BRS.0b013e31820f6da6  

    ISSN:0362-2436

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    STUDY DESIGN: A retrospective case study. OBJECTIVE: To confirm the remodeling potential of the kyphotic malunited odontoid fracture in the pediatric spine. SUMMARY OF BACKGROUND DATA: Nonsurgical reduction and immobilization is the gold standard for the odontoid fracture in infancy. However, the reduction occasionally results in incomplete repositioning of the odontoid process. The cervical spine is subsequently immobilized until fusion in most cases in the hope of achieving remodeling with the growth of the remaining displacement and kyphotic angulation, although there are no precise data on the acceptable limit of the deformity. METHODS: Three patients (age at injury = 1 year 2 months to 3 years) with odontoid process fracture in infancy were treated conservatively and the fractures were observed on plain lateral radiographs until at least the age of 20 years. For evaluation of the angulated odontoid process, we used our original measurement method of the odontoid process tilting angle (OPTA). In addition, the OPTAs were also measured in 127 Japanese adult patients (57 male patients and 70 female patients; average age = 43 years) without a history of odontoid fracture, as normal controls. RESULTS: The OPTA in the normal controls was -21.4° ± 23.3°. The OPTAs ranged from 41° to 62° at the initial evaluation, from 12° to 30° at the time of bony union, and from -4° to -14° at the final follow-up at more than 20 years of age, which were all within one standard deviation of the mean in the normal adult controls. CONCLUSION: Angulated odontoid fractures with the OPTA around 30° at the time of bony union in infants younger than 3 years of age could have the capacity for remodeling to the normal morphology. No surgical reduction might be needed to recommend complete apposition of the odontoid process in the absence of severe or deteriorating neural impairment.

  214. Incidence of medial plica in 3,889 knee joints in the Japanese population. 国際誌 査読有り

    Akari Nakayama, Takehiko Sugita, Toshimi Aizawa, Atsushi Takahashi, Tetsuo Honma

    Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 27 (11) 1523-7 2011年11月

    出版者・発行元:W B SAUNDERS CO-ELSEVIER INC

    DOI: 10.1016/j.arthro.2011.06.022  

    ISSN:0749-8063

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    PURPOSE: This study aimed to document the incidence of medial plicae (plica synovialis mediopatellaris) in a large sample of the Japanese population and classify them in a type-dependent manner. METHODS: The incidence of medial plicae was investigated during arthroscopic surgery of 3,889 knee joints in 3,563 patients (mean age, 35 years); medial plicae were classified according to Sakakibara's classification (type A, a cord-like elevation in the synovial wall; type B, a shelf-like appearance; type C, a large shelf-like appearance covering the anterior surface of the medial femoral condyle; and type D, double insertions into the medial wall or having a central defect). Of all the knee joints examined, 2,006 knees belonged to male patients and 1,883 to female patients. Both knee joints were examined in 326 patients. From these data, the incidence of medial plicae was calculated. RESULTS: The overall incidence rate of medial plicae was 79.9%. The incidence of Sakakibara type A, B, C, and D medial plicae was 35.2%, 22.4%, 12.3%, and 10.0%, respectively. This pattern was reflected in all age groups in both genders, except in women aged 20 to 39 years. The κ coefficient was moderate, at 0.407, in the patients in whom both knee joints were examined. CONCLUSIONS: In a large cohort of Japanese patients undergoing arthroscopic knee surgery, the incidence of medial plica was 79.9%. The same pattern was seen in almost all age groups and in both genders (type A > type B > type C > type D). LEVEL OF EVIDENCE: Level IV, prognostic case series.

  215. 最近の知見、新たな疾患概念の画像所見―脊髄ヘルニア 招待有り

    相澤俊峰, 小澤浩司, 日下部隆, 中村豪, 井樋栄二

    脊椎脊髄 23 447-450 2011年10月

  216. 腰部脊柱管狭窄症の膀胱機能評価―JOAスコアと国際前立腺肥大症状スコア、尿流動態検査との比較. 査読有り

    高橋康平, 神尾一彦, 相澤俊峰, 佐藤信, 中川晴彦, 松下真史

    整形災害外科 53 179-185 2011年10月

  217. 環軸関節回旋により脊髄圧迫が生じたC2神経根腫瘍―2例報告 査読有り

    日下部隆, 小澤浩司, 相澤俊峰, 中村豪, 石井祐信, 井樋栄二

    東日本整災会誌 22 125-130 2011年10月

  218. 仙腸関節障害に伴う下肢症状 査読有り

    村上栄一, 野口京子, 黒澤大輔, 相澤俊峰

    臨床整形外科 45 711-714 2011年10月

    DOI: 10.11477/mf.1408101777  

  219. 腰部脊柱管狭窄症の膀胱機能評価―JOAスコアと国際前立腺肥大症状スコア、尿流動態検査との比較 査読有り

    高橋康平, 神尾一彦, 相澤俊峰, 佐藤信, 中川晴彦, 松下真史

    整形災害外科 53 179-185 2011年10月

  220. Can the fragment stability of osteochondritis dissecans be interpreted by arthroscopic findings alone? 国際誌 査読有り

    Takehiko Sugita, Toshimi Aizawa, Hiroaki Uozumi

    Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 27 (9) 1171-2 2011年9月

    出版者・発行元:W B SAUNDERS CO-ELSEVIER INC

    DOI: 10.1016/j.arthro.2011.06.039  

    ISSN:0749-8063

  221. Response 査読有り

    Shoichi Kokubun, Toshimi Aizawa

    Journal of Neurosurgery: Spine 15 (1) 20 2011年7月

    DOI: 10.3171/2010.12.SPINE10725  

    ISSN:1547-5654 1547-5646

  222. Spine-shortening osteotomy for patients with tethered cord syndrome caused by lipomyelomeningocele 査読有り

    Shoichi Kokubun, Hiroshi Ozawa, Toshimi Aizawa, Ngo Minh Ly, Yasuhisa Tanaka

    JOURNAL OF NEUROSURGERY-SPINE 15 (1) 21-27 2011年7月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2011.2.SPINE10114  

    ISSN:1547-5654

    eISSN:1547-5646

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    Object. Tethered cord syndrome (TCS) is a disorder involving an abnormal stretching of the tethered spinal cord caused by several pathological conditions and presents with a variety of neurological symptoms. Untethering (tethered cord release) is the gold standard treatment for TCS. However, untethering carries risks of spinal cord injury and postoperative retethering. To avoid these potential risks, the authors applied spine-shortening osteotomy to adult patients with TCS, and report on the surgical procedure and treatment outcomes. Methods. Eight patients with TCS caused by a lipomyelomeningocele were surgically treated by the authors' original procedure of spine-shortening osteotomy. Six patients were male and 2 were females; average age at the time of surgery was 31 years old. Spine-shortening osteotomy was performed at the level of L-1 in all but 2 patients, in whom it was performed at T-12, with spinal fusion between T-12 and L-2 or T-11 and L-1 using a pedicle screw rod system. The average follow-up period was 6.2 years and the patients' pre- and postoperative conditions were evaluated clinically and radiologically. Results. Preoperatively, all patients displayed severe neurological deficits such as motor disturbance, muscle atrophy, and bladder dysfunction. Several months before surgery, all showed progressive symptoms. Those symptoms showed initial improvement in 6 patients and stabilized in 2 postoperatively, but the improved symptoms worsened again in 4 of the 6 patients. The osteotomized vertebrae were shortened by 21 mm on average, and all spines showed complete bone union without loss of correction. At the final follow-up evaluations, 6 patients showed stabilization as per the modified Japanese Orthopaedic Association score for thoracic myelopathy. Conclusions. Spine-shortening osteotomy successfully helps reduce the spinal cord tension without causing direct neural damage. At minimum, it stabilized the patients' symptoms and/or helped delay neurological deterioration for a period of time. Spine-shortening osteotomy might be a feasible mode of treatment for adult TCS caused by a spinal lipoma. (DOI: 10.3171/2011.2.SPINE10114)

  223. Response to the editorial comments by Dr. Vincent C. Traynelis on the article entitled “Spine-Shortening Osteotomy for Patients with Tethered Cord Syndrome Caused by Lipomyelomeningocele.” 査読有り

    Kokubun S Aizawa T

    J Neurosurg Spine 15 19-20 2011年7月

  224. 骨組織球症―臨床・画像上の特徴と悪性腫瘍との鑑別― 査読有り

    保坂正美, 羽鳥正仁, 常陸真, 綿貫宗則, 相澤俊峰, 井樋栄二

    整形災害外科 54 1159-1170 2011年7月

  225. Spine-shortening osteotomy for patients with tethered cord syndrome caused by lipomyelomeningocele. 国際誌 査読有り

    Shoichi Kokubun, Hiroshi Ozawa, Toshimi Aizawa, Ngo Minh Ly, Yasuhisa Tanaka

    Journal of neurosurgery. Spine 15 (1) 21-7 2011年7月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/2011.2.SPINE10114  

    ISSN:1547-5654

    eISSN:1547-5646

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    OBJECTIVE: Tethered cord syndrome (TCS) is a disorder involving an abnormal stretching of the tethered spinal cord caused by several pathological conditions and presents with a variety of neurological symptoms. Untethering (tethered cord release) is the gold standard treatment for TCS. However, untethering carries risks of spinal cord injury and postoperative retethering. To avoid these potential risks, the authors applied spine-shortening osteotomy to adult patients with TCS, and report on the surgical procedure and treatment outcomes. METHODS: Eight patients with TCS caused by a lipomyelomeningocele were surgically treated by the authors' original procedure of spine-shortening osteotomy. Six patients were male and 2 were females; average age at the time of surgery was 31 years old. Spine-shortening osteotomy was performed at the level of L-1 in all but 2 patients, in whom it was performed at T-12, with spinal fusion between T-12 and L-2 or T-11 and L-1 using a pedicle screw-rod system. The average follow-up period was 6.2 years and the patients' pre- and postoperative conditions were evaluated clinically and radiologically. RESULTS: Preoperatively, all patients displayed severe neurological deficits such as motor disturbance, muscle atrophy, and bladder dysfunction. Several months before surgery, all showed progressive symptoms. Those symptoms showed initial improvement in 6 patients and stabilized in 2 postoperatively, but the improved symptoms worsened again in 4 of the 6 patients. The osteotomized vertebrae were shortened by 21 mm on average, and all spines showed complete bone union without loss of correction. At the final follow-up evaluations, 6 patients showed stabilization as per the modified Japanese Orthopaedic Association score for thoracic myelopathy. CONCLUSIONS: Spine-shortening osteotomy successfully helps reduce the spinal cord tension without causing direct neural damage. At minimum, it stabilized the patients' symptoms and/or helped delay neurological deterioration for a period of time. Spine-shortening osteotomy might be a feasible mode of treatment for adult TCS caused by a spinal lipoma.

  226. Bony island within the articular cartilage of the knee in a child: a rare condition for early osteoarthritis. 国際誌 査読有り

    Taku Hatta, Takehiko Sugita, Toshimi Aizawa, Masahiro Ohnuma, Atsushi Takahashi, Eiji Itoi

    Orthopedic reviews 3 (1) e7-29 2011年3月17日

    DOI: 10.4081/or.2011.e7  

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    Articular cartilage is a specific type of connective tissue composed of hydrated proteoglycans within a matrix of collagen fibrils. In the elderly population, it shows degenerative changes that may results in osteoarthritis. The more severe form of osteoarthritis occasionally demonstrates bone formation within the cartilage, which is designated as a bony protuberance, however, such lesions are rare in children. This report presents the case of a 10-year-old boy with a bony protuberance within the articular cartilage of the knee. The patient initially complained of knee pain and he subsequently developed flexion contracture. Radiological and arthroscopic examinations revealed a bony protuberance in the articular cartilage and degenerative changes of the cartilage above it. He was successfully treated by the removal of the bony protuberance and osteochondral grafting. The bony protuberance may have caused cartilage degradation since the thickness of the cartilage above it was thinner than that around the lesion. The bony protuberance within the articular cartilage formed in the younger population may be a possible cause of osteoarthritis. This case is a noteworthy with regard to the pathogenesis of osteoarthritis.

  227. 腰部脊柱管狭窄症の膀胱機能評価―JOAスコアと国際前立腺肥大症状スコア、尿流動態検査との比較 査読有り

    高橋康平, 神尾一彦, 相澤俊峰, 佐藤信, 中川晴彦, 松下真史

    整形災害外科 53 179-185 2010年11月

  228. 環軸関節回旋により脊髄圧迫が生じたC2神経根腫瘍―2例報告 査読有り

    日下部隆, 小澤浩司, 相澤俊峰, 中村豪, 石井祐信, 井樋栄二

    東日本整災会誌 22 125-130 2010年10月

  229. 仙腸関節障害に伴う下肢症状 査読有り

    村上栄一, 野口京子, 黒澤大輔, 相澤俊峰

    臨床整形外科 45 711-714 2010年10月

    DOI: 10.11477/mf.1408101777  

  230. 脊椎巨細胞腫12例の検討 査読有り

    関口玲, 小澤浩司, 相澤俊峰, 日下部隆, 中村豪, 保坂正美, 井樋栄二

    東日本整形災害外科学会雑誌 22 (3) 466-466 2010年8月

  231. 原発性脊椎腫瘍の手術成績 査読有り

    山屋誠司, 小澤浩司, 相澤俊峰, 日下部隆, 中村豪, 関口玲, 保坂正美, 井樋栄二

    東日本整形災害外科学会雑誌 22 (3) 465-465 2010年8月

  232. 傍脊柱筋・大腰筋における脊柱支持機能の比較 査読有り

    富谷明人, リチャード・リーバー, 相澤俊峰, 井樋栄二

    日本整形外科スポーツ医学会雑誌 30 (4) 387-387 2010年8月

  233. C1/2 facet cyst revealed by facet joint arthrography. 査読有り

    Toshimi Aizawa, Hiroshi Ozawa, Takashi Kusakabe, Takeshi Nakamura, Pongsthorn Chanplakorn, Eiji Itoi

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 15 (4) 603-7 2010年7月

    出版者・発行元:SPRINGER TOKYO

    DOI: 10.1007/s00776-009-1472-2  

    ISSN:0949-2658

  234. 最近の知見、新たな疾患概念の画像所見―脊髄ヘルニア 招待有り

    相澤俊峰, 小澤浩司, 日下部隆, 中村豪, 井樋栄二

    脊椎脊髄 23 447-450 2010年6月

  235. Clinical significance of intramedullary Gd-DTPA enhancement in cervical myelopathy. 査読有り

    Ozawa H, Sato T, Hyodo H, Ishii Y, Morozumi N, Koizumi Y, Matsumoto F, Kasama F, Aizawa T, Itoi E, Kokubun S

    Spinal Cord 48 (5) 415-422 2010年5月

    DOI: 10.1038/sc.2009.152  

  236. Giant sacral schwannoma: a report of six cases. 国際誌 査読有り

    Chanplakorn Pongsthorn, Hiroshi Ozawa, Toshimi Aizawa, Takashi Kusakabe, Takeshi Nakamura, Eiji Itoi

    Upsala journal of medical sciences 115 (2) 146-52 2010年5月

    出版者・発行元:INFORMA HEALTHCARE

    DOI: 10.3109/03009730903359674  

    ISSN:0300-9734

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    Sacral and presacral schwannomas are often found incidentally, because they present with vague symptoms or symptomless. Schwannoma occurring in this area occasionally presents with enormous dimensions, known as a giant schwannoma. The tumor removal is a surgical challenge due to the difficult approach and abundant vascularity. The aim of this study is to review cases of giant sacral schwannomas focusing the surgical management and outcome. Six patients with sacral and presacral schwannoma were treated surgically. The patients included two males and four females, and the mean age was 47.8 years. All patients experienced pain at the time of presentation. The tumors were classified as intraosseous type in one case, dumb-bell type in four cases, and retroperitoneal type in one case. The tumors were removed with a piecemeal subtotal excision in three patients, a partial excision in two patients, and enucleation in one patient. The surgeries were performed by the combination of an anterior and posterior approach in three patients, a posterior approach in two patients, and an anterior approach in one patient. The mean surgical time was 7.8 hrs, and the mean blood loss was 2572 g. The tumor recurred in one patient after the partial excision and was removed completely in a second surgery. No patient, including the patient who underwent the second surgery, presented with pain and obvious neurological deficit at the final follow-up. The surgical treatment of the giant sacral schwannoma with a piecemeal subtotal excision can achieve a good outcome, avoiding unnecessary neurological deficit.

  237. Incidence of complications associated with spinal endoscopic surgery: nationwide survey in 2007 by the Committee on Spinal Endoscopic Surgical Skill Qualification of Japanese Orthopaedic Association. 招待有り 査読有り

    Morio Matsumoto, Toru Hasegawa, Manabu Ito, Toshimi Aizawa, Shinichi Konno, Masatsune Yamagata, Sohei Ebara, Yudo Hachiya, Hiroaki Nakamura, Shoji Yagi, Kimiaki Sato, Akira Dezawa, Muneto Yoshida, Kenichi Shinomiya, Yoshiaki Toyama, Katsuji Shimizu, Kensei Nagata

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 15 (1) 92-6 2010年1月

    出版者・発行元:SPRINGER TOKYO

    DOI: 10.1007/s00776-009-1428-6  

    ISSN:0949-2658

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    BACKGROUND: This report was conducted to elucidate the current status of spinal endoscopic surgery and relevant incidents through analysis of the results of a questionnaire survey conducted in 2007 by the Committee on Spinal Endoscopic Surgical Skill Qualification of the Japanese Orthopaedic Association (JOA). METHODS: Questionnaire forms were sent to 2011 training facilities nationwide certified by the JOA, and 1082 of these facilities returned the filled questionnaires (response rate 53.8%). Of these facilities, 257 (23.8% of the responding facilities) undertook spinal endoscopic surgery in 2007. These institutions were asked to fill in the survey form with the details of the operations and relevant incidents as well as the incident levels. RESULTS: In total, the 257 facilities performed 6239 spinal endoscopic surgeries during 2007. Posterior spinal endoscopic surgery constituted most of the operations (6217 cases, 98.2%) including 4336 cases of microendoscopic discectomy (MED), 1273 cases of microendoscopic laminectomy or fenestration, and 379 cases of transforaminal or posterior lumbar interbody fusion. The total number of incidents was 133 (2.13%). The numbers of incidents by operative method were 75 (56.4%) during MED, 57 (42.9%) during microendoscopic laminectomy or fenestration, and 1 (0.8%) during interbody fusion. Of 133 incidents, dural tear occurred in 99 (74.4%), injury of the cauda equina or a nerve root in 7 (5.3%), facet fracture in 7 (5.3%), hematoma and wrong level in 6 each (4.5%), and wrong side and bedsore in 1 each (0.8%). The incident level was level 1 in 6, level 2 in 24, level 3a in 82, level 3b in 16, level 4 in 5, and level 5 (fatal) in 0. CONCLUSIONS: The results of this survey revealed an increasing trend of spinal endoscopic surgery and a decreasing trend of the complication rates. The complication rates of spinal endoscopic surgery were not higher than those of conventional surgery, indicating the safety of this surgical method.

  238. Comparison of cervical spinal canal diameter between younger and elder generations of Japanese. 査読有り

    Shin-ichi Goto, Jutaro Umehara, Toshimi Aizawa, Shoichi Kokubun

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 15 (1) 97-103 2010年1月

    出版者・発行元:SPRINGER TOKYO

    DOI: 10.1007/s00776-009-1427-7  

    ISSN:0949-2658

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    BACKGROUND: Cervical myelopathy is more common among Japanese than Westerners. The shorter anteroposterior diameter of the cervical spinal canals (AP diameter) is its probable cause. In recent years, builds of younger Japanese have become larger and been approaching those of Westerners. The purpose of this study was to investigate whether the cervical spinal canal had enlarged in the younger Japanese as well as any cross-sectional improvement in their builds. METHODS: The subjects included 300 men and 300 women who were healthy and without symptoms related to the cervical spine. They were divided into six age groups at 10-year intervals from the twenties to the seventies. Height, body weight, and arm span were measured as physical factors. Using lateral dynamic radiographs of the cervical spine, the AP diameter from C3 to C6 in the neutral position and Penning's jaw diameter in extension (jaw diameter) from C2/3 to C5/6 were measured. The number of trapezoid-shaped vertebral bodies with a thickened posterior margin were also counted as such thickening might be one of the causes of spinal canal narrowing. Statistical analysis was performed for the following associations in both sexes: (1) age and physical factors; (2) age and the AP diameter; (3) age and jaw diameter; and (4) the difference of the AP diameter of the canal within and outside the trapezoid-shaped deformity of the vertebral body. RESULTS: In both men and women, the younger generations statistically had a larger height, arm span, and AP diameter. Older generations showed a significantly narrower jaw diameter at all measured spinal levels in both sexes. Trapezoid-shaped vertebral bodies were found in 3.5% of the men and in 1.3% of the women in their fifties, sixties, and seventies, which statistically had no effect on the AP diameter being wider in the younger generations. CONCLUSIONS: Younger generations had larger builds and a wider canal of the cervical spine. A narrow spinal canal is a fundamental risk factor for cervical myelopathy. Therefore, cervical myelopathy might be expected to decrease in Japan in the near future when the present younger generations have aged.

  239. Histologic findings and possible causes of osteochondritis dissecans of the knee. 国際誌 査読有り

    Hiroaki Uozumi, Takehiko Sugita, Toshimi Aizawa, Atsushi Takahashi, Masahiro Ohnuma, Eiji Itoi

    The American journal of sports medicine 37 (10) 2003-8 2009年10月

    出版者・発行元:SAGE PUBLICATIONS INC

    DOI: 10.1177/0363546509346542  

    ISSN:0363-5465

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    BACKGROUND: The histologic findings of osteochondritis dissecans of the knee vary widely, leading to differences in the interpretation of its origins. Hypothesis The differences in the histologic findings of osteochondritis dissecans might represent a course of pathologic progression. STUDY DESIGN: Descriptive laboratory study. METHODS: Twelve knees in 11 patients (average age, 16 years) with osteochondritis dissecans of the medial femoral condyle were treated by biological internal fixation. During the surgery, cylinder osteochondral plugs were taken from the center of the osteochondritis dissecans lesion and examined with light microscopy. RESULTS: A complete or partial cleft separated the specimens into 2 parts: basal and fragment sides. The surface of the basal side was covered with dense fibrous or cartilaginous tissue and active bone remodeling was found beneath the surface. In the fragment side, the deep surface was also covered with dense fibrous or cartilaginous tissue and the articular surface consisted of normal articular cartilage. The area between these 2 surfaces could be classified into 3 types: (1) necrotic subchondral trabeculae, (2) viable subchondral trabeculae, and (3) cartilage without bone trabeculae. CONCLUSION: Based on the histologic findings of this study, the following origins and the pathologic progression of osteochondritis dissecans might be assumed: the initial change in the subchondral area is bone necrosis or subchondral fracture; the necrotic bone is then absorbed and replaced either by viable subchondral trabeculae or cartilage without bone trabeculae. CLINICAL RELEVANCE: The results of this histologic study provide readers with several insights about the causes and treatment options of osteochondritis dissecans.

  240. 脊椎内視鏡下手術の現状ー2007年1月〜12月手術施行状況調査・インシデント報告集計結果ー. 査読有り

    松本守雄, 長谷川徹, 相澤俊峰, 猪川輪哉, 伊東学, 江原宗平, 岡治道, 加藤圭彦, 川上守, 川原範夫, 古賀公明, 紺野慎一, 西良浩一, 坂本直俊, 佐藤公治, 佐藤公昭, 高野裕一, 高橋誠, 田中雅人, 出沢明, 中野恵介, 中村博亮, 夏山元伸, 長谷川和宏, 蜂谷裕道, 平泉裕, 藤本吉範, 前川慎吾, 前田健, 松本守雄, 三上靖夫, 望月眞人, 八木省次, 山縣正庸, 山元拓哉, 湯澤洋平, 清水克時, 四宮謙一, 戸山芳昭, 吉田宗人

    日本整形外科学会雑誌 83 56-61 2009年10月

  241. 胸部脊髄症の現況 招待有り

    佐藤哲朗, 相澤俊峰

    脊椎脊髄ジャーナル 22 136-141 2009年10月

  242. 脊椎内視鏡下手術の現状-2008年1月〜12月手術施行状況調査・インシデント報告集計結果- 査読有り

    松本守雄, 長谷川徹, 伊藤学, 相澤俊峰, 紺野慎一, 山縣正庸, 江原宗平, 蜂谷裕道, 中村博亮, 八木省次, 佐藤公昭, 出沢明, 吉田宗人, 戸山芳昭, 清水克時, 永田見生

    日本整形外科学会雑誌 83 1022-1027 2009年10月

  243. 離断性骨軟骨炎に対する組織学的検討 査読有り

    高橋敦, 相澤俊峰, 大沼正宏, 井樋栄二, 杉田健彦, 魚住弘明, 田代茂義

    東北膝関節研究会会誌 19 53-57 2009年10月

  244. Facet cyst hematoma in the lumbar spine: hematoma produced by bleeding into a pre-existing juxtafacet cyst. 査読有り

    Miyatake N Aizawa T, Hyodo, H, Sasaki H, Kusakabe, T, Sato T

    J Orthop Surg 17 80-84 2009年4月1日

  245. T1 radiculopathy caused by intervertebral disc herniation: symptomatic and neurological features. 査読有り

    Haruo Kanno, Toshimi Aizawa, Yasuhisa Tanaka, Takeshi Hoshikawa, Hiroshi Ozawa, Eiji Itoi, Shoichi Kokubun

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 14 (1) 103-6 2009年1月

    出版者・発行元:SPRINGER TOKYO

    DOI: 10.1007/s00776-008-1276-9  

    ISSN:0949-2658

  246. Severe facet joint arthrosis caused c7/t1 myelopathy: a case report. 国際誌 査読有り

    Toshimi Aizawa, Hiroshi Ozawa, Takeshi Hoshikawa, Takashi Kusakabe, Eiji Itoi

    Case reports in medicine 2009 481459-481459 2009年

    DOI: 10.1155/2009/481459  

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    Cervical myelopathy is caused by degenerative processes of the spine including intervertebral disc herniation and posterior spur usually developing at C3/4 to C5/6. C7/T1 single level myelopathy is very rare because of the anatomical characteristics. Facet joint arthrosis can be a cause of cervical myelopathy but only a few cases have been reported. The authors report an extremely rare case of C7/T1 myelopathy caused by facet joint arthrosis. A 58-year-old male presented with hand and gait clumsiness. The radiological examinations revealed severe C7/T1 facet joint arthrosis with bony spur extending into the spinal canal, which compressed the spinal cord laterally. The T1 spinous process indicated nonunion of a "clay-shoveler's" fracture, which suggested that his cervico-thoracic spine had been frequently moved, and thus severe arthrosis had occurred in the facet joints. A right hemilaminectomy of C7 and C7/T1 facetectomy with single level spinal fusion led to complete neurological improvement.

  247. Diagram specific to sacroiliac joint pain site indicated by one-finger test. 査読有り

    Eiichi Murakami, Toshimi Aizawa, Kyoko Noguchi, Haruo Kanno, Hiroshi Okuno, Hiroaki Uozumi

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 13 (6) 492-7 2008年11月

    出版者・発行元:Springer Japan

    DOI: 10.1007/s00776-008-1280-0  

    ISSN:0949-2658

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    BACKGROUND: The sacroiliac joint (SIJ) can be a source of low back and lower limb pain. The SIJ pain can originate not only from the joint space but also from the ligaments supporting the joint. Its diagnosis has been difficult because the physical and radiological examinations have proved less than satisfactory. Thus, to know the specific sites of SIJ pain, if these exist, could be very useful for making the diagnosis. The purpose of the present study was to identify the main site of SIJ pain according to the patient's pointing with one finger and to confirm the site by a pain-provocation test and periarticular lidocaine injection. METHODS: Forty-six of 247 consecutive patients with low back pain at our outpatient clinic, who could indicate with one finger the main site of the pain, which presented at only one site and was reproducible, were the subjects of this study. The main site of pain was anatomically confirmed by fluoroscopy. Then, a periarticular SIJ injection was performed. The patients were blindly assessed and a diagram of the main site of the SIJ pain was made. RESULTS: There were 19 males and 27 females and the age averaged 50 years. Eight patients showed a positive placebo response and were excluded from this study. Twenty-five of the remaining 38 patients indicated the main site of pain at the posterior-superior iliac spine (PSIS) or within 2 cm of the PSIS, and 18 of these patients showed a positive effect with periarticular SIJ block. The other 13 patients, including 2 patients with a positive response to the periarticular block, did not show the PSIS as the main site of pain. CONCLUSIONS: Our study clearly indicated that when patients point to the PSIS or within 2 cm of it as the main site of low back pain, using one finger, the SIJ should be considered as the origin of their low back pain.

  248. 黄色靭帯骨化による胸部脊髄症 招待有り

    相澤俊峰

    整形外科 59 1277-1280 2008年9月

  249. Spine-shortening vertebral osteotomy in a patient with tethered cord syndrome and a vertebral fracture. Case report. 国際誌 査読有り

    Haruo Kanno, Toshimi Aizawa, Hiroshi Ozawa, Takeshi Hoshikawa, Eiji Itoi, Shoichi Kokubun

    Journal of neurosurgery. Spine 9 (1) 62-6 2008年7月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/SPI/2008/9/7/062  

    ISSN:1547-5654

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    The authors report a rare case of tethered cord syndrome with low-placed conus medullaris complicated by a vertebral fracture that was successfully treated by a spine-shortening vertebral osteotomy. The patient was a 57-year-old woman whose neurological condition worsened after a T-12 vertebral fracture because a fracture fragment and the associated local kyphotic deformity directly compressed the tethered spinal cord. An osteotomy of the T-12 vertebra was performed in order to correct the kyphosis, remove the fracture fragment, and reduce the tension on the spinal cord. Postoperative radiographs showed the spine to be shortened by 22 mm, and the kyphosis between T-11 and L-1 improved from 23 degrees to 0 degrees . Two years after the surgery, the patient's neurological symptoms were resolved. The bone union was complete with no loss of correction.

  250. Sagittal alignment changes after thoracic laminectomy in adults. 国際誌 査読有り

    Toshimi Aizawa, Tetsuro Sato, Hiroshi Ozawa, Naoki Morozumi, Fujio Matsumoto, Hirotoshi Sasaki, Takeshi Hoshikawa, Chikashi Kawahara, Shoichi Kokubun, Eiji Itoi

    Journal of neurosurgery. Spine 8 (6) 510-6 2008年6月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/SPI/2008/8/6/510  

    ISSN:1547-5654

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    OBJECT: The increased kyphosis after thoracic laminectomy in adult patients was retrospectively evaluated and various factors affecting this spinal deformity were analyzed. METHODS: The authors conducted a retrospective study of 58 cases in which laminectomy was performed and more than half of the facet joints were left intact. The study group included 44 men (mean age 59 years) and 14 women (mean age 61 years) with thoracic myelopathy due to ossifications of the ligamentum flavum and/or the posterior longitudinal ligament or due to posterior bone spurs. Patients were followed up for a minimum of 2 years. Their neurological condition was evaluated using the Japanese Orthopaedic Association (JOA) scale (a full score is 11), and the magnitude of local kyphosis in the laminectomized area was determined using the Cobb angle method. RESULTS: The mean preoperative JOA score was 5.4; the mean postoperative score was 8.3. No relationship was found between postoperative JOA score and increased kyphotic angle. The mean preoperative kyphotic angle was 7.0 degrees . The mean postoperative kyphotic angle was 10.8 degrees . Thus local kyphosis in the treated area increased by only 3.8 degrees . The mean increase in kyphosis per spinal segment, calculated by dividing the kyphotic angle of the surgically decompressed area by the number of resected laminae, was 1.9 degrees . Female patients with >or= 3-level laminectomies showed a significant increase of kyphosis in both the laminectomized area and each spinal segment. CONCLUSIONS: The increase in kyphosis after thoracic laminectomy is not large and thus spinal fusion is usually not necessary. In cases involving female patients who undergo long-segment laminectomies, however, careful radiographic follow-up is recommended.

  251. Normal bone growth requires optimal estrogen levels: negative effects of both high and low dose estrogen on the number of growth plate chondrocytes. 査読有り

    Hiroyuki Takano, Toshimi Aizawa, Taichi Irie, Eiji Itoi, Shoichi Kokubun, Helmtrud I Roach

    The Tohoku journal of experimental medicine 214 (3) 269-80 2008年3月

    出版者・発行元:TOHOKU UNIV MEDICAL PRESS

    DOI: 10.1620/tjem.214.269  

    ISSN:0040-8727

    eISSN:1349-3329

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    Endochondral bone formation at epiphyseal growth plate consists of the synchronized processes of chondrogenesis and cartilage ossification. Estrogen, the major female sex hormone, plays an important role in this process, particularly during the pubertal growth spurt. However, its effects on the growth plate are not completely understood. The aims of this study were to clarify the effects of estrogen on the kinetics of chondrocytes in the growth plates of 10- to 25-week-old female rabbits by studying the effects of ovariectomy or high-dose administration of estrogen on the balance between cell proliferation and death. Forty-eight Japanese white rabbits were divided into three groups: sham operated, ovariectomized, or ovariectomized with subsequent weekly injection of high dose estrogen from 10 weeks. The chondrocyte kinetics was investigated by histomorphometry and immunohistochemistry, using antibodies for caspase-3, a marker of apoptosis, and for proliferating cell nuclear antigen. Both ovariectomized and estrogen-injected rabbits showed a declination of the chondrocyte number although the latter animals indicated a more dramatic effect. Estrogen-injected rabbits showed a decrease in the cell proliferating ability together with an increase in chondrocytes undergoing apoptosis while ovariectomy mainly reduced the cell proliferating ability. Given the known importance of estrogen for bone growth, one would expect that ovariectomy and high-dose administration of estrogen would have opposite effects. However, the present study indicated that both low and high concentration had a similar effect: a decrease in the chondrocyte number compared with control, suggesting that estrogen has to be maintained within a narrow range for optimal bone growth.

  252. 腰部脊柱管狭窄症における荷重MRIの検討. 査読有り

    菅野晴夫, 小澤浩司, 相澤俊峰, 星川 健, 川原 央, 井樋栄二

    東日本整災誌 20 (1) 60-64 2008年

    ISSN:1342-7784

  253. Response to the letter from Dr. Kong and Wang. 査読有り

    Aizawa T, Sato T, J Neurosurg

    J Neurosurg (spine) 6 377-378 2007年12月

  254. Crowned Dens syndrome. 国際誌 査読有り

    Shinichi Goto, Jutaro Umehara, Toshimi Aizawa, Shoichi Kokubun

    The Journal of bone and joint surgery. American volume 89 (12) 2732-6 2007年12月

    出版者・発行元:JOURNAL BONE JOINT SURGERY INC

    DOI: 10.2106/JBJS.F01322  

    ISSN:0021-9355

    eISSN:1535-1386

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    BACKGROUND: Patients with crowned dens syndrome typically present with severe neck pain and have calcium deposits around the odontoid process of the axis on radiographs. To our knowledge, the cases of only thirty-five patients have been reported in the English-language literature and the clinical features remain unclear. The purposes of this study were to examine the clinical features of crowned dens syndrome, determine treatment outcomes, and propose diagnostic criteria. METHODS: Forty patients with severe neck pain had calcium deposition around the odontoid process on computed tomography scans, and they were thus diagnosed as having crowned dens syndrome. Data were collected in relation to these patients, including the date of onset of neck pain, the presence of inflammatory indicators (increased body temperature, C-reactive protein levels, and white blood-cell count), and treatment outcomes. RESULTS: The male-to-female ratio was 0.6, and two-thirds of the patients were more than seventy years of age. All patients had markedly restricted neck motion, particularly in rotation, and all had one or more positive inflammatory indicators. Calcium deposition was detected in all areas around the odontoid process, but chiefly behind the process. Pain was typically relieved by nonsteroidal anti-inflammatory drugs, prednisolone, or both. A combination of both appeared to be the most effective. CONCLUSIONS: We believe that crowned dens syndrome is more common than previously recognized, especially in elderly patients. It is diagnosed on the basis of acute and severe neck pain; marked restriction of neck motion, particularly in rotation; the presence of inflammatory indicators, such as an elevated C-reactive protein level; calcium deposition around the odontoid process detected by computed tomography; no history of trauma; and the exclusion of other inflammatory diseases and tumors. Prednisolone and nonsteroidal anti-inflammatory drugs in combination are the recommended treatment for symptom relief.

  255. Spinal dumbbell tumors: an analysis of a series of 118 cases. 国際誌 査読有り

    Hiroshi Ozawa, Shoichi Kokubun, Toshimi Aizawa, Takeshi Hoshikawa, Chikashi Kawahara

    Journal of neurosurgery. Spine 7 (6) 587-93 2007年12月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/SPI-07/12/587  

    ISSN:1547-5654

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    OBJECT: The authors analyzed a series of 118 cases of spinal dumbbell tumors to elucidate the feature of the tumors. METHODS: Of 674 cases of spinal cord tumors, the incidence of dumbbell tumors was studied. The tumors were analyzed, and the authors focus on the distribution of age and sex, the pathological diagnoses, their locations, Eden classification, and the surgical methods used. RESULTS: The incidence of dumbbell tumors was 18%. The mean patient age was 43 years, which was younger than that for all spinal cord tumors (mean 50 years). There were 11 patients younger than 10 years of age. The rate of dumbbell tumors in the cervical spine was significantly higher than that of all spinal cord tumors. Fifteen (18%) of the 81 schwannomas were observed in the C-2 nerve root, thus having a higher incidence than those in the other nerve roots. In 99 cases (84%), the tumors were removed through a hemilaminectomy with or without a facetectomy and posterior fusion. Of 118 cases, 69% of the tumors were schwannomas, and malignant tumors were found in 10 cases (8.5%). Seven (64%) of 11 patients younger than 10 years of age had malignant tumors. Three patients older than 10 years of age had malignant tumors, thus accounting for 2.8% of the 107 older patients. CONCLUSIONS: The incidence of dumbbell tumors was 18%, and they are not uncommon. Malignant dumbbell tumors were more common in children younger than 10 years of age than in older patients.

  256. 慢性仙腸関節性疼痛に対する仙腸関節前方固定術 査読有り

    村上栄一, 菅野晴夫, 相澤俊峰, 奥野洋史, 野口京子

    日本腰痛会誌 13 (1) 197-203 2007年11月

    出版者・発行元:日本腰痛学会

    DOI: 10.3753/yotsu.13.197  

    ISSN:1345-9074

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    仙腸関節ブロックや骨盤ベルトなどの保存療法の効果が持続せず,日常生活や就労に著しい障害のある仙腸関節性疼痛例に対して仙腸関節前方固定術を行った.男6例,女9例の15例で,年齢は平均49歳(30~86歳),罹病期間は平均3.9年(1~7年),術後経過期間は平均2.3年(6カ月~5年)であった.片側前方固定術を14例に,両側固定術(骨盤輪固定術)を1例に施行した.これらの症例について,関節癒合をCTで,また臨床症状をJOAスコア,VASによる疼痛の変化,Roland-Morris disability questionnaire(RDQ)で評価した.関節癒合は15例全例で得られていた.JOAスコアが術前平均5.6点(4~9点)から術後平均18点(7~24点)に,VASが84(70~93)から40(10~75)に,RDQ得点が21.1(17~23)から6.9(1~14)に改善した.仙腸関節前方固定術の成績は良好であり,保存療法に抵抗する症例には有効な治療法と考えられる.

  257. 下垂手(drop finger)をきたす頚部神経根症. 査読有り

    田中靖久, 国分正一, 小澤浩司, 松本不二夫, 相澤俊峰, 星川健

    臨整外 39 475-480 2007年10月

  258. Results of surgical treatment for thoracic myelopathy: minimum 2-year follow-up study in 132 patients. 国際誌 査読有り

    Toshimi Aizawa, Tetsuro Sato, Hirotoshi Sasaki, Fujio Matsumoto, Naoki Morozumi, Takashi Kusakabe, Eiji Itoi, Shoichi Kokubun

    Journal of neurosurgery. Spine 7 (1) 13-20 2007年7月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/SPI-07/07/013  

    ISSN:1547-5654

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    OBJECT: Thoracic myelopathy is uncommon compared with cervical myelopathy. In this study, data obtained in patients with thoracic myelopathy caused by degenerative processes of the spine were retrospectively analyzed to clarify the surgical outcomes and to examine the various factors affecting the postoperative improvement. METHODS: Between 1988 and 2002, 132 patients with thoracic myelopathy underwent surgery and a minimum 2-year observation period. Clinical data were collected from medical and operative records, and sagittal alignment of the spine was measured on radiographs. The patients were evaluated pre- and postoperatively using the modified Japanese Orthopaedic Association (JOA) scale (maximum score 11). The relationships among various factors affecting the preoperative severity of myelopathy and postoperative improvement were also examined. RESULTS: The population consisted of 97 men (mean age at surgery was 58 years) and 35 women (mean age at surgery 62 years). Myelopathy was caused by ossification of the ligamentum flavum (OLF) in 73 patients, ossification of the posterior longitudinal ligament (OPLL) in 21, combined OLF-OPLL in 10, intervertebral disc herniation (IDH) in 15, posterior bone spur in 11, and OLF with IDH or posterior bone spur in one patient each. The surgical outcome was relatively good: a mean preoperative JOA score of 5.3 improved to a mean score of 7.8 at the last follow-up, 50 months on average after surgery. Thoracic myelopathy caused by OPLL, however, was associated with lower postoperative scores and recovery rates. In more than half of the patients the authors documented an increase of kyphosis of less than 2 degrees. CONCLUSIONS: Patients with a shorter preoperative duration of symptoms and milder myelopathy experienced significantly better postoperative neurological conditions, which indicated that those who present earlier with fewer disabilities should be recommended to undergo surgery in time, although the surgical treatment for OPLL still involves many problems.

  259. Estrogen deficiency leads to decrease in chondrocyte numbers in the rabbit growth plate. 査読有り

    Hiroyuki Takano, Toshimi Aizawa, Taichi Irie, Shoichi Kokubun, Eiji Itoi

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 12 (4) 366-74 2007年7月

    出版者・発行元:SPRINGER TOKYO

    DOI: 10.1007/s00776-007-1145-y  

    ISSN:0949-2658

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    BACKGROUND: In the pubertal growth plate, sex hormones play important roles in regulating the proliferation, differentiation, maturation, and programmed death of chondrocytes. Although many studies have been reported on the regulation of estrogen in long-bone growth, some of the mechanisms have remained unclear, including its role in cell kinetics in growth plate chondrocytes. The aim of this study was to clarify the effect of a deficiency of estrogen on growth plate chondrocytes. METHODS: We obtained growth plates of the femoral head from normal and ovariectomized Japanese white rabbits at 10, 15, 20, and 25 weeks of age. The effects of estrogen deficiency on the cell kinetics of growth plate chondrocytes were investigated immunohistochemically using antibodies for an apoptotic marker, caspase-3, and for proliferating cell nuclear antigen (PCNA). RESULTS: Both the length of the femur and the height of the growth plate in the ovariectomized rabbits tended to be larger than those in the normal rabbits. There were fewer chondrocytes in the ovariectomized rabbits than in the normal ones. Caspase-3-positive cells were detected mainly in the hypertrophic zone, whereas PCNA-positive cells were found in the proliferating to upper hypertrophic zones. The ovariectomized rabbits showed a higher caspase-3-positive rate at 20 weeks of age and a lower PCNA-positive ratio in all age groups than the normal rabbits. CONCLUSIONS: This study indicated that ovariectomy led to a decreased number of growth plate chondrocytes, which resulted from decreased cell-proliferating ability and probably acceleration of the number of chondrocytes undergoing apoptosis.

  260. Effect of periarticular and intraarticular lidocaine injections for sacroiliac joint pain: prospective comparative study. 査読有り

    Eiichi Murakami, Yasuhisa Tanaka, Toshimi Aizawa, Masato Ishizuka, Shoichi Kokubun

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 12 (3) 274-80 2007年5月

    出版者・発行元:SPRINGER TOKYO

    DOI: 10.1007/s00776-007-1126-1  

    ISSN:0949-2658

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    BACKGROUND: The sacroiliac joint (SIJ) can be a source of low back pain. Previous studies indicated that SIJ pain could originate from both the joint capsule and the posterior ligamentous tissues. It has not been clarified as to whether an intraarticular or periarticular injection procedure is more effective for this type of pain. The purpose of this study was to evaluate the effect of two injection procedures prospectively. METHODS: After a pain provocation test, an intraarticular injection of local anesthetic (2% lidocaine) was performed on the first 25 consecutive patients with SIJ pain and a periarticular injection on another 25. The periarticular injections were given to one or more sections of the posterior periarticular area of the SIJ and to another section in the extracranial portion. The effect of these injections was assessed using the "restriction of activities of daily life" scoring system from the Japanese Orthopaedic Association. RESULTS: The periarticular injection was effective in all patients, but the intraarticular one was effective in only 9 of 25 patients. An additional periarticular injection was performed in 16 patients who experienced no effect from the initial intraarticular injection and was considered effective in all of them. The injection into the middle of the periarticular area was more effective for SIJ pain. The improvement rate after the periarticular injection was 96%, which was significantly higher than that after the intraarticular injection, which was 62%. CONCLUSIONS: For patients with SIJ pain, periarticular injection is more effective and easier to perform than the intraarticular injection and should be tried initially.

  261. 医療費からみた内視鏡下腰椎椎間板ヘルニア摘出術の評価 査読有り

    相澤俊峰, 佐々木祐肇, 佐藤哲朗

    整形外科 58 217-219 2007年4月

  262. Ki-67標識率による脊髄神経鞘腫の増殖能の検討 査読有り

    小澤浩司, 渡辺みか, 菅野晴夫, 川原央, 星川健, 相澤俊峰

    日本脊椎脊髄病学会雑誌 18 (2) 559-559 2007年3月

  263. Effect of resting interval for muscle regeneration in mice. 国際誌 査読有り

    Aizawa Sasaki, Toshimi Aizawa, Akihito Tomiya, Yoshihiro Matsubara, Shoichi Kokubun, Eiji Itoi

    Upsala journal of medical sciences 112 (2) 175-81 2007年

    出版者・発行元:TAYLOR & FRANCIS AS

    ISSN:0300-9734

    eISSN:2000-1967

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    BACKGROUND: Muscle tissue has an exceptional ability to regenerate, however, unresting damage to the muscles by intense and frequent exercises occasionally causes prolonged muscle fatigue, soreness, and underperformance in sports. Taking rest is generally considered to be crucial for regular training to avoid the accumulation of muscle damage. We hypothesized that differences in the resting intervals between two periods of exercise may result in histological differences in muscle regeneration. METHOD: An eccentric contraction model of mouse gastrocnemius muscle was made using percutaneus electrical stimulation. The mice received eccentric exercises twice with resting intervals of 0, 12, 24 hours, 2, and 3 days. The authors investigated the ratio of myofibers with central nuclei to whole myofibers histologically (the centronuclear cell ratio; CNCR) at 14 days after the second exercise as an index of the muscle regeneration. RESULTS: The CNCR of the group that exercised one-time was 29.5%. In the groups exercised twice, it increased from 31.8% with an interval of 0 hours to a peak of 43.9% with 24 hours, then decreased to 32.8% with an interval of 3 days. The ratios of the groups with intervals of 12 and 24 hours were higher than those with one-time exercise and those with the intervals of 0 hours, 2 days, and 3 days. CONCLUSIONS: The resting interval between two periods of eccentric exercises affected the histology of muscle regeneration. The amount of muscle damage and/or the recovery process of damaged muscles should vary depending on the length of resting interval between strenuous exercises. An appropriate interval for rest must be necessary in order to avoid further muscle damage.

  264. Thoracic myelopathy caused by ossification of the ligamentum flavum: clinical features and surgical results in the Japanese population. 国際誌 査読有り

    Toshimi Aizawa, Tetsuro Sato, Hirotoshi Sasaki, Takashi Kusakabe, Naoki Morozumi, Shoichi Kokubun

    Journal of neurosurgery. Spine 5 (6) 514-9 2006年12月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    DOI: 10.3171/spi.2006.5.6.514  

    ISSN:1547-5654

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    OBJECT: Data obtained in patients with thoracic myelopathy caused by ossification of the ligamentum flavum (OLF) were retrospectively reviewed to clarify clinical features and surgical outcomes in the Japanese population. METHODS: Seventy-two patients who underwent surgery for OLF-induced myelopathy in the Miyagi Prefecture, Japan, between 1988 and 2002 were observed for at least 2 years. Clinical data were collected from medical and operative records. The patients were evaluated pre- and postoperatively using the modified Japanese Orthopaedic Association (JOA) scale (maximum score 11). The relationships among various factors (age, sex, and preoperative duration of symptoms) affecting the preoperative severity of myelopathy and postoperative improvement were also examined. CONCLUSIONS: In this series the surgical outcome was relatively good and depended on the severity of myelopathy; thus early and correct diagnosis is required to avoid poorer results. The male/female ratio was 3:2 and the mean patient age at surgery was 61 years for men and 68 for women. The patients commonly noticed numbness or pain in their lower legs or gait disturbances. In a total of 104 decompressed intervertebral disc levels, more than 80% of the ossified ligaments were at the T9-10 level or lower. The mean preoperative JOA score of 5.1 improved to 7.9 after an average of 46 months. The postoperative results statistically depended on the preoperative severity of myelopathy. Among studies of patients with OLF-related myelopathy, the present study had the largest sample size, which should help clarify the clinical features of OLF myelopathy.

  265. Facet cyst in the lumbar spine: radiological and histopathological findings and possible pathogenesis. 国際誌 査読有り

    Takashi Kusakabe, Fumio Kasama, Toshimi Aizawa, Tetsuro Sato, Shoichi Kokubun

    Journal of neurosurgery. Spine 5 (5) 398-403 2006年11月

    DOI: 10.3171/spi.2006.5.5.398  

    ISSN:1547-5654

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    OBJECT: The authors define facet cyst as a cyst located beside the facet joint and exhibiting a communication with the joint, as demonstrated on arthrography and subsequent computed tomography (CT) of the joint space. The purpose of this study was to determine the pathogenesis of facet cysts based on their radiological and histological features. METHODS: Forty-six juxtafacet cysts in 45 patients (26 men and 19 women, age range 41-82 years) were surgically treated after evaluation by arthrography and subsequent CT scanning. A communication channel between the cyst and the joint was confirmed in all cases and thus the lesions were designated facet cysts. In almost all patients the involved facet joint showed moderate to severe degeneration. After a thorough preoperative radiological evaluation, these cysts were excised en bloc by medial facetectomy with the entire ligamentum flavum. The specimens were cut axially at the maximum diameter and were histologically investigated. Morphologically, the cysts exhibited three shapes, appearing as: 1) a small protrusion, 2) a semicircular cyst, or 3) a round cyst. The cyst walls consisted of elastic and collagen fibers undergoing fibrinoid degeneration, but no synovial lining cells were detected. The cystic cavities were regularly filled with fibrinoids, and myxoid degeneration was found particularly in the larger cysts. CONCLUSIONS: Facet cysts are closely related to the degeneration of the neighboring facet joint. Analysis of the findings in this histological study suggests that there are several shapes of facet cysts. The authors propose that the shape could depend on the stage of the cyst's development.

  266. Thoracic myelopathy in Japan: epidemiological retrospective study in Miyagi Prefecture during 15 years. 査読有り

    Toshimi Aizawa, Tetsuro Sato, Yasuhisa Tanaka, Hiroshi Ozawa, Takeshi Hoshikawa, Yushin Ishii, Naoki Morozumi, Kentaro Ishibashi, Fumio Kasama, Hironori Hyodo, Eiichi Murakami, Takeshi Nishihira, Shoichi Kokubun

    The Tohoku journal of experimental medicine 210 (3) 199-208 2006年11月

    出版者・発行元:Tohoku University Medical Press

    DOI: 10.1620/tjem.210.199  

    ISSN:0040-8727

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    Thoracic myelopathy is defined as spinal cord compression in the thoracic region, leading to sensory and motor dysfunctions in the trunk and lower extremities, and can be caused by various degenerative processes of the spine. Thoracic myelopathy is rare, and there are many unsolved problems including its epidemiological and clinical features. We have established a registration system of spinal surgeries, which covered almost all surgeries in Miyagi Prefecture, and enrolled the data of 265 patients with thoracic myelopathy from 1988 to 2002. The annual rate of surgery gradually increased and averaged 0.9 per 100,000 inhabitants, which was less than 1/10 of that for cervical myelopathy. About 20 patients with thoracic myelopathy are operated on in Miyagi Prefecture each year. It frequently develops in middle-aged males. About half of the cases were caused by ossification of the ligamentum flavum, followed by ossification of the posterior longitudinal ligament, intervertebral disc herniation and posterior spur. Patients usually noticed numbness or pain in the legs and the preoperative duration was long, averaging 2 years. Its symptomatic similarities to lumbar disorders might cause difficulty in making a correct diagnosis. Since thoracic myelopathy can markedly restrict the activities of daily life, even general physicians should recognize this entity.

  267. One-stage lateral rhachotomy and posterior spinal fusion with compression hooks for Pott’s paralysis in the elderly. 査読有り

    Wang B Ozawa, H, Tanaka Y, Matsumoto, F Aizawa T, Kokubun S

    J Orthop Surg. 14 310-314 2006年10月

  268. 日本整形外科学会脊椎内視鏡下手術・技術認定制度委員会: 日本の内視鏡下手術技術認定制度と脊椎内視鏡下手術の現状. 査読有り

    谷川徹, 相澤俊峰, 猪川輪哉, 伊東学, 江原宗平, 岡治道, 加藤真介, 加藤圭彦, 川上守, 川原範夫, 古賀公明, 紺野慎一, 坂本直俊, 佐藤公治, 佐藤公昭, 高野裕一, 高橋誠, 田中雅人, 出沢明, 中野恵介, 中村博亮, 夏山元伸, 長谷川和宏, 蜂谷裕道, 平泉裕, 藤本吉範, 前川慎吾, 前田健, 松本守雄, 三上靖夫, 望月眞人, 八木省次, 山縣正庸, 山元拓哉, 湯澤洋平, 吉田宗人, 四宮謙一, 戸山芳昭

    日整会誌 80 754-761 2006年10月

  269. 脊髄ヘルニアと脊髄嚢腫性病変の治療戦略ー方針決定に必要な情報とその提供ー. 招待有り 査読有り

    相澤俊峰, 田中靖久, 星川健, 日下部隆, 中條悟, 国分正一

    脊椎脊髄ジャーナル 19 717-724 2006年10月

  270. Surgery for ossification of the ligamentum flavum 査読有り

    Yasuhisa Tanaka, Tetsuro Sato, Toshimi Aizawa

    OPLL: Ossification of the Posterior Longitudinal Ligament 265-269 2006年

    出版者・発行元:Springer Japan

    DOI: 10.1007/978-4-431-32563-5_37  

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    Introduction Ossification of the ligamentum fl avum (OLF) is one of the most common causes of compression myelopathy in degenerative processes of the thoracic spine [1]. When OLF is the sole compressive factor in a patient with thoracic myelopathy, posterior surgery is indicated because the myelopathy usually is not alleviated by conservative treatments but, rather, continues to deteriorate. OLF varies in range and shape depending on the patient. Although it has been fairly diffi cult to ascertain OLF correctly on conventional plain radiographs, nowadays OLF can be well depicted by computed tomography (CT). Posterior surgery for OLF consists basically of two procedures: laminectomy and fenestration. The procedure should be as minimally invasive as possible, but at the same time it is necessary to be safe enough to prevent surgical complications, which are not infrequent with thoracic spine surgery [2]. We describe in this chapter (1) the classifi cation of OLF using CT fi ndings, which is essential for choosing the appropriate procedure (2) the surgical techniques for each procedure and (3) the surgical results. © 2006 Springer.

  271. Lumbar discal cyst followed by intervertebral disc herniation: MRI findings of two cases. 査読有り

    Masako Tokunaga, Toshimi Aizawa, Hironori Hyodo, Hirotoshi Sasaki, Yasuhisa Tanaka, Tetsuro Sato

    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 11 (1) 81-4 2006年1月

    出版者・発行元:SPRINGER TOKYO

    DOI: 10.1007/s00776-005-0961-1  

    ISSN:0949-2658

  272. 筋性斜頚成長終了例と胸鎖乳突筋筋腹切離術. 査読有り

    星川健, 国分正一, 相澤俊峰, 田中靖久, 北純

    整形災害外科 48 233-239 2005年10月

  273. 脊髄係留症候群に対する脊柱短縮術. 査読有り

    田中靖久, 国分正一, 小澤浩司, 松本不二夫, 相澤俊峰, 星川健

    臨整外 40 633-637 2005年10月

    DOI: 10.11477/mf.1408100118  

  274. The role of sex hormones in the kinetics of chondrocytes in the growth plate - A study in the rabbit 査読有り

    T Irie, T Aizawa, S Kokubun

    JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME 87B (9) 1278-1284 2005年9月

    出版者・発行元:BRITISH EDITORIAL SOC BONE JOINT SURGERY

    DOI: 10.1302/0301-620X.87B9.15583  

    ISSN:0301-620X

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    Sex hormones play important roles in the regulation of the proliferation, maturation and death of chondrocytes in the epiphyseal growth plate. We have investigated the effects of male castration on the cell kinetics of chondrocytes as defined by the numbers of proliferating and dying cells. The growth plates of normal rabbits and animals castrated at eight weeks of age were obtained at 10, 15, 20 and 25 weeks of age. Our study suggested that castration led to an increase in apoptosis and a decrease in the proliferation of chondrocytes in the growth plate. In addition, the number of chondrocytes in the castrated rabbits was less than that of normal animals of the same age.

  275. Signal intensity changes on MRI during the healing process of spinal Langerhans cell granulomatosis: report of two cases. 国際誌 査読有り

    Toshimi Aizawa, Tetsuro Sato, Yasuhisa Tanaka, Shoichi Kokubun

    Journal of spinal disorders & techniques 18 (1) 98-101 2005年2月

    DOI: 10.1097/01.bsd.0000112040.70321.c1  

    ISSN:1536-0652

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    Two patients with spinal Langerhans cell granulomatosis were followed by magnetic resonance imaging, and the observed signal changes were detailed. Both patients had no neurologic abnormalities but back pain. They were treated by immobilization with a brace and bed rest. Their back pain disappeared after about a month. At the first visit, the tumorous lesions involving vertebrae showed mainly low signal intensity on T1-weighted imaging (T1WI) and high intensity on T2-weighted imaging (T2WI). They were clearly enhanced by gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA). Their original intensities changed to iso-intensities on both T1WI and T2WI without enhancement by Gd-DTPA after a year. These signal changes might indicate the healing stage of the involved vertebrae and recommend the removal of the spinal brace.

  276. Gorham disease of the spine: a case report and treatment strategies for this enigmatic bone disease. 査読有り

    Toshimi Aizawa, Tetsuro Sato, Shoichi Kokubun

    The Tohoku journal of experimental medicine 205 (2) 187-96 2005年2月

    DOI: 10.1620/tjem.205.187  

    ISSN:0040-8727

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    Gorham disease is an extremely rare condition of unknown etiology characterized by progressive osteolysis. Only 28 cases of its spinal involvement have been reported, and some of those cases showed kyphosis, kyphoscoliosis, subluxation or dislocation. No definite regimen of treatment has been established yet. A 10-year-old boy presented with a severe and progressive kyphosis over 90 degrees caused by Gorham disease from T3 to T12. In situ posterior fusion with a hook and rod system and iliac bone grafts were performed, but after surgery, he had complete paraplegia and its cause was uncertain. Based on the unfortunate consequence of the present case and the review of the literature, we propose the treatment strategies for spinal Gorham disease.

  277. 下垂手(drop finger)をきたす頚部神経根症. 査読有り

    田中靖久, 国分正一, 小澤浩司, 松本不二夫, 相澤俊峰, 星川健

    臨整外 39 475-480 2004年10月

    DOI: 10.11477/mf.1408100419  

  278. Kummell病に対する後方進入脊柱短縮術. 査読有り

    田中靖久, 国分正一, 小澤浩司, 松本不二夫, 相澤俊峰, 星川健

    日整会誌 78 265-269 2004年10月

  279. Myofibers express IL-6 after eccentric exercise 査読有り

    A Tomiya, T Aizawa, R Nagatomi, H Sensui, S Kokubun

    AMERICAN JOURNAL OF SPORTS MEDICINE 32 (2) 503-508 2004年3月

    出版者・発行元:AMER ORTHOPAEDIC SOC SPORT MED

    DOI: 10.1177/0095399703258788  

    ISSN:0363-5465

    詳細を見る 詳細を閉じる

    Background: Interleukin (IL)-6 is locally produced in skeletal muscles and shows a remarkable increase in plasma after eccentric exercises. Objective: To elucidate the cell types in the muscles responsible for IL-6 production after eccentric exercises. Study Design: Controlled laboratory study. Methods: An eccentric contraction model was made using electrical stimulation. The authors investigated the muscle damage and regeneration processes after eccentric exercises histologically, and the cell types expressing IL-6 and its subcellular compartimentalization with time immunohistochemically after eccentric exercises. Results: Swollen myofibers were detected from 8 hours to 3 days after exercises. Disrupted myofibers were detected from 24 hours to 7 days, with a peak of 3 days. IL-6 was detected only in the cytoplasm of myofibers until 12 hours; thereafter, it was found in the inflammatory cells and proliferating satellite cells as well. The swollen myofibers were negatively stained for IL-6. The positive ratios of IL-6 in myofibers; immediately increased after exercises, peaked in 12 hours, and then decreased. Conclusions: After eccentric exercises, IL-6 expression increased in myofibers preceding the disruption of myofibers. IL-6 might be closely related to muscle damage caused by strenuous exercises.

  280. Myofibers express IL-6 after eccentric exercise. 国際誌 査読有り

    Akihito Tomiya, Toshimi Aizawa, Ryoichi Nagatomi, Hiroomi Sensui, Shoichi Kokubun

    The American journal of sports medicine 32 (2) 503-8 2004年3月

    出版者・発行元:AMER ORTHOPAEDIC SOC SPORT MED

    DOI: 10.1177/0095399703258788  

    ISSN:0363-5465

    詳細を見る 詳細を閉じる

    BACKGROUND: Interleukin (IL)-6 is locally produced in skeletal muscles and shows a remarkable increase in plasma after eccentric exercises. OBJECTIVE: To elucidate the cell types in the muscles responsible for IL-6 production after eccentric exercises. STUDY DESIGN: Controlled laboratory study. METHODS: An eccentric contraction model was made using electrical stimulation. The authors investigated the muscle damage and regeneration processes after eccentric exercises histologically, and the cell types expressing IL-6 and its subcellular compartimentalization with time immunohistochemically after eccentric exercises. RESULTS: Swollen myofibers were detected from 8 hours to 3 days after exercises. Disrupted myofibers were detected from 24 hours to 7 days, with a peak of 3 days. IL-6 was detected only in the cytoplasm of myofibers until 12 hours; thereafter, it was found in the inflammatory cells and proliferating satellite cells as well. The swollen myofibers were negatively stained for IL-6. The positive ratios of IL-6 in myofibers immediately increased after exercises, peaked in 12 hours, and then decreased. CONCLUSIONS: After eccentric exercises, IL-6 expression increased in myofibers preceding the disruption of myofibers. IL-6 might be closely related to muscle damage caused by strenuous exercises.

  281. Impaired fracture healing in the absence of TNF-alpha signaling: The role of TNF-alpha in endochondral cartilage resorption 査読有り

    LC Gerstenfeld, TJ Cho, T Kon, T Aizawa, A Tsay, J Fitch, GL Barnes, DT Graves, TA Einhorn

    JOURNAL OF BONE AND MINERAL RESEARCH 18 (9) 1584-1592 2003年9月

    出版者・発行元:AMER SOC BONE & MINERAL RES

    DOI: 10.1359/jbmr.2003.18.9.1584  

    ISSN:0884-0431

    詳細を見る 詳細を閉じる

    Introduction: TNF-alpha is a major inflammatory factor that is induced as part of the innate immune response to injury, and it contributes to the normal regulatory processes of bone resorption. Methods: The role of TNF-alpha was examined in a model of simple closed fracture repair in wild-type and TNF-alpha receptor (p55(-/-)/p75(-/-))-deficient mice. Histomorphometric measurements of the cartilage and bone and apoptotic cell counts in hypertrophic cartilage were carried out at multiple time points over 28 days of fracture healing (n = 5 animals per time point). The expression of multiple mRNAs for various cellular functions including extracellular matrix formation, bone resorption, and apoptosis were assessed (triplicate polls of mRNAs). Results and Conclusions: In the absence of TNF-alpha signaling, chondrogenic differentiation was delayed by 2-4 days but subsequently proceeded at an elevated rate. Endochondral tissue resorption was delayed 2-3 weeks in the TNF-alpha receptor (p55(-/-)/p75(-/-))-deficient mice compared with the wild-type animals. Functional studies of the mechanisms underlying the delay in endochondral resorption indicated that TNF-alpha mediated both chondrocyte apoptosis and the expression of proresorptive cytokines that control endochondral tissue remodeling by osteoclasts. While the TNF-alpha receptor ablated animals show no overt developmental alterations of their skeletons, the results illustrate the primary roles that TNF-alpha function contributes to in promoting postnatal fracture repair as well as suggest that processes of skeletal tissue development and postnatal repair are controlled in part by differing mechanisms. In summary, these results show that TNF-alpha participates at several functional levels, including the recruitment of mesenchymal stem, apoptosis of hypertrophic chondrocytes, and the recruitment of osteoclasts function during the postnatal endochondral repair of fracture healing.

  282. Successful treatment for rhabdomyosarcoma by total spondylectomy in a child. 査読有り

    Takeshi Saito, Toshimi Aizawa, Osamu Kashimoto, Tetsuro Sato, Shoichi Kokubun

    The Tohoku journal of experimental medicine 198 (4) 251-8 2002年12月

    出版者・発行元:TOHOKU UNIV MEDICAL PRESS

    DOI: 10.1620/tjem.198.251  

    ISSN:0040-8727

    eISSN:1349-3329

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    A 7-year-old girl with a retroperitoneal rhabdomyosarcoma having invaded the L3 vertebra was treated by combination therapy consisting of chemotherapy, surgical resection and intraoperative radiation. Surgically, total spondylectomy was performed through a combined anterior and posterior procedures, and the spine was reconstructed with fibula bone grafts using a pedicle screw system made of titanium alloy. Transverse junction plates were not used at operation because of their bulkiness for the patient. Five days postoperatively, the rods dislodged from the screws and the grafted bones leaned. A Chance fracture-like transverse fracture of the L4 vertebra occurred during the revisional operation. Transverse plates and sublaminar wires were used to reduce the fracture and achieved stability. Six years postoperatively, the spine was completely fused and no local recurrence or metastasis is detected.

  283. 終糸発生傍神経節腫の一例 査読有り

    渡辺みか, 相澤俊峰, 森谷卓也, 笹野公伸

    日本内分泌学会雑誌 78 (2) 494-494 2002年9月

  284. Intramedullary plasma cell granuloma in the cervicothoracic spine. Case report. 国際誌 査読有り

    Toshimi Aizawa, Tetsuro Sato, Yasuhisa Tanaka, Koshi Kishimoto, Mika Watanabe, Shoichi Kokubun

    Journal of neurosurgery 97 (2 Suppl) 235-8 2002年9月

    出版者・発行元:AMER ASSOC NEUROLOGICAL SURGEONS

    ISSN:0022-3085

    詳細を見る 詳細を閉じる

    Intraspinal plasma cell granuloma, which is a nonneoplastic entity, is extremely rare. To date, only four cases have been documented in the spinal meninges. The authors report the first case of a C7-T1 intramedullary plasma cell granuloma. After excision of the lesion, the patient's gait and bladder dysfunction improved. This plasma cell granuloma initially showed no delineated mass on T1-weighted magnetic resonance (MR) images, low signal intensity on T2-weighted images, and was well enhanced after administration of gadolinium diethylenetriamine pentaacetic acid. The latter MR imaging modality should help to detect this tumorous lesion. Histologically, the granuloma needs to be distinguished from lymphoplasmacyte-rich meningioma and plasmacytoma.

  285. Medial superior cluneal nerve entrapment neuropathy in teenagers: a report of two cases. 査読有り

    Tarek A Aly, Yasuhisa Tanaka, Toshimi Aizawa, Hiroshi Ozawa, Shoichi Kokubun

    The Tohoku journal of experimental medicine 197 (4) 229-31 2002年8月

    出版者・発行元:TOHOKU UNIV MEDICAL PRESS

    DOI: 10.1620/tjem.197.229  

    ISSN:0040-8727

    eISSN:1349-3329

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    Medial superior cluneal nerve entrapment neuropathy causes pain radiating from the low back down to the posterior thigh. It tends to be misdiagnosed as a lumbar spine disorder. Patients in previous reports were in the middle or old age at the onset. Proposing simultaneous full flexion of the ipsilateral hip and knee joints as a provocation test, we present two cases of teenager females who spent long before diagnosis of their condition. Both of them had engaged in vigorous sports activities and completely recovered from the disability following local anaesthetic and corticosteroid injection at the trigger point.

  286. Idiopathic herniation of the thoracic spinal cord: report of three cases. 査読有り

    Aizawa T, Sato T, Tanaka Y, Kotajima S, Sekiya M, Kokubun S

    Spine 26 (20) E488-91 2001年10月15日

  287. Induction of apoptosis in chondrocytes by tumor necrosis factor-alpha 査読有り

    T Aizawa, T Kon, TA Einhorn, LC Gerstenfeld

    JOURNAL OF ORTHOPAEDIC RESEARCH 19 (5) 785-796 2001年9月

    出版者・発行元:WILEY-BLACKWELL

    DOI: 10.1016/S0736-0266(00)00078-4  

    ISSN:0736-0266

    詳細を見る 詳細を閉じる

    Tumor necrosis factor alpha (TNF-alpha) induces apoptosis in a number of cell types and plays an essential role in bone remodeling, both stimulating the proliferation of osteoblasts and activating osteoclasts. During endochondral ossification, apoptosis of chondrocytes occurs concurrently with new bone formation and the resorption and replacement of mineralized cartilage with woven bone. In the present study, the role of TNF-alpha in promoting chondrocyte apoptosis was examined. Chondrocyte cell populations, enriched in either hypertrophic or non-hypertrophic cells, were isolated from the cephalic and caudal portions of 17-day chick embryo sterna, respectively, and treated in vitro with 0.1-10 nM recombinant human TNF-alpha. As a positive control, apoptosis was also induced by Fas receptor antibody binding. Dye exclusion assays of the live/dead ratios of cells showed that TNF-alpha caused a dose-dependent 1.5- and 2.0-fold increase in the number of dead cells in both hypertrophic and non-hypertrophic chondrocytes. Induction of apoptosis was independently assayed by measurement of interleukin-1 beta -converting enzyme (ICE) activity, and analyzed by a semi-quantitative determination of DNA fragmentation. When compared to untreated cells, these analyses also showed dose-dependent increases in TNF-alpha induced apoptosis in both chondrocyte populations, with increases in the levels of ICE activity for all doses of TNF-alpha (from similar to5 to similar to 20 fold). Osteoblasts, however, were not affected by treatment with TNF-alpha or by Fas antibody/protein G induction. Immunostaining of chondrocytes for Fas receptor and caspase-2 protein expression showed that most of the chondrocytes expressed these two markers of apoptosis after treatment with TNF-alpha. Although cell killing and ICE induction were higher in the more hypertrophic cells, TNF-alpha induced apoptosis in both hypertrophic and non-hypertrophic chondrocyte populations, These results demonstrate that apoptosis may be induced in both hypertrophic and non-hypertrophic chondrocytes through both Fas and TNF-alpha receptor mediated signaling, and suggest that chondrocytes are more sensitive to apoptotic effects of TNF-alpha within the skeletal lineage than are osteoblasts. (C) 2001 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.

  288. 髄内形質細胞肉芽腫(Plasma cell granuloma)の1例 査読有り

    相澤俊峰, 佐藤哲朗, 田仲靖久, 国分正一, 渡辺みか

    東北整形災害外科紀要 45 (1) 150-150 2001年6月

  289. Expression of osteoprotegerin, receptor activator of NF-kappa B ligand (osteoprotegerin ligand) and related proinflammatory cytokines during fracture healing 査読有り

    T Kon, TJ Cho, T Aizawa, M Yamazaki, N Nooh, D Graves, LC Gerstenfeld, TA Einhorn

    JOURNAL OF BONE AND MINERAL RESEARCH 16 (6) 1004-1014 2001年6月

    出版者・発行元:WILEY-BLACKWELL

    ISSN:0884-0431

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    Fracture healing is a unique biological process regulated by a complex array of signaling molecules and proinflammatory cytokines, Recent evidence for the role of tumor necrosis family members in the coupling of cellular functions during skeletal homeostasis suggests that they also may be involved in the regulation of skeletal-repair. The expression of a number of cytokines and receptors that are of functional importance to bone remodeling (osteoprotegerin [OPG], macrophage colony-stimulating factor [M-CSF], and osteoprotegerin ligand [receptor activator of NF-kappaB ligand (RANKL)]), as well as inflammation (tumor necrosis factor alpha [TNF-alpha] and its receptors, and interleukin-1 alpha [IL-1 alpha] and -beta and their receptors) were analyzed over a 28-day period after the generation of simple transverse fractures in mouse tibias, OPG was expressed constitutively in unfractured bones and elevated levels of expression were detected throughout the repair process. It showed two distinct peaks of expression: the first occurring within 23 h after fracture and the second at the time of peak cartilage formation on day 7, In contrast, the expression of RANKL was nearly undetectable in unfractured bones but strongly induced throughout the period of fracture healing. The peak in expression of RANKL did not correlate with that of OPG, because maximal levels of expression were seen on day,3 and day 14, when OPG levels were decreasing. M-CSF expression followed the temporal profile of RANKL but was expressed at relatively high basal levels in unfractured bones. TNF-cy, lymphotoxin-P (LT-P), IL-1 alpha, and IL-1 beta showed peaks in expression within the first 24 h after fracture, depressed levels during the period of cartilage formation, and increased levels of expression on day 21 and day 28 when bone remodeling was initiated. Both TNF-alpha receptors (p55 and p75) and the IL-1RII receptor showed identical patterns of expression to their ligands, while the IL-1R1 was expressed only during the initial period of inflammation on day 1 and day 3 postfracture, Both TNF-alpha and IL-1 alpha expression were localized primarily in macrophages and inflammatory cells during the early periods of inflammation and seen in mesenchymal and osteoblastic cells later during healing. TNF-alpha expression also was detected at very high levels in hypertrophic chondrocytes, These data imply that the expression profiles for OPG, RANKL, and M-CSF are tightly coupled during fracture healing and involved in the regulation of both endochondral resorption and bone remodeling, TNF-a and IL-1 are expressed at both very early and late phases in the repair process, which suggests that these cytokines are important in the initiation of the repair process and play important functional roles in intramembraneous bone formation and trabecular bone remodeling.

  290. Impaired intramembranous bone formation during bone repair in the absence of tumor necrosis factor-alpha signaling 査読有り

    LC Gerstenfeld, TJ Cho, T Kon, T Aizawa, J Cruceta, BD Graves, TA Einhorn

    CELLS TISSUES ORGANS 169 (3) 285-294 2001年

    出版者・発行元:KARGER

    DOI: 10.1159/000047893  

    ISSN:1422-6405

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    Tumor necrosis factor-alpha (TNF-alpha) is known to mediate bone resorption; however, its role in osteogenesis has not been fully elucidated. In order to investigate the direct role of TNF-alpha signaling in the recruitment and differentiation of osteoblasts, two separate models of bone repair were used, marrow ablation and simple transverse fractures. These models were carried out in the tibiae of both wild-type and knock-out mice in which both TNF-alpha receptors (p55(-/-)/p75(-/-)) had been ablated. Marrow ablation is a unique model in which robust intramembranous bone formation is induced without an endochondral component, followed by remodeling and restoration of the original trabecular architecture of the bone marrow. In contrast, fracture repair proceeds concurrently through both endochondral and intramembranous processes of new bone tissue formation. In both models of bone repair, healing was delayed in the TNF-alpha receptor (p55(-/-)/p75(-/-)) deficient mice. In the marrow ablation model, young osteoblasts were recruited into the marrow space by day three in the wild-type mice, while the TNF-alpha (p55(-/-)/p75(-/-)) mice had only granulation tissue in the marrow cavity. Type I collagen and osteocalcin mRNA expressions were reduced similar to 30 and similar to 50%. respectively, of the control values in the TNF-alpha receptor ablated mice. In the fracture repair model there was almost a complete absence of the initial intramembranous bone formation on the periosteal surface in the TNF-alpha (p55(-/-)/p75(-/-)) mice. As healing progressed however, the callus tissues were greatly enlarged, and there was a delay in hypertrophy of the chondrocytes and the resorption of cartilage tissue. While during the initial period of fracture repair there was a marked reduction in the expression of both type I collagen and osteocalcin mRNAs in the TNF-alpha (p55(-/-)/p75(-/-)) mice, levels of these mRNAs were elevated by similar to 10-20% over the wild type at the later time points in the absence of endochondral resorption of the callus. The lack of inhibition of osteogenesis during endochondral resorption suggests that a different set of signals are involved in the recruitment of osteogenic cells during endochondral repair then during intramembranous bone formation. Go-culture of chondrocytes with a mesenchymal stem cell line was carried out to examine if chondrocytes themselves produced paracrine factors that promote osteogenic differentiation. These experiments demonstrated that chondrocytes do indeed produce factors that promoted osteogenic differentiation. In summary, the results presented here suggest that TNF-alpha plays a crucial role in promoting postnatal bone repair through the induction of osteoprogenitor cell recruitment or osteogenic cell activation in the context of intramembranous bone formation. These results further suggest that the signals that promote osteogenesis during endochondral bone formation are different from those involved in intramembranous bone formation. Copyright (C) 2001 S. Karger AG, Basel.

  291. c-Myc protein in the rabbit growth plate - Changes in immunolocalisation with age and possible roles from proliferation to apoptosis 査読有り

    T Aizawa, S Kokubun, T Kawamata, Y Tanaka, HI Roach

    JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME 81B (5) 921-925 1999年9月

    出版者・発行元:BRITISH EDITORIAL SOC BONE JOINT SURGERY

    DOI: 10.1302/0301-620X.81B5.9492  

    ISSN:0301-620X

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    Growth plates taken from five- to 20-week-old Japanese white rabbits were immunostained for c-Myc protein. This was localised both in the proliferating zone and upper hypertrophic zone at five weeks, whereas after ten weeks it was found mostly in the lower hypertrophic zone. The proliferating chondrocytes tended to show nuclear staining and the hypertrophic cells cytoplasmic staining, although the terminal hypertrophic chondrocytes sometimes expressed the protein in their nuclei. In the younger rabbits, c-Myc co-localised with proliferating cell nuclear antigen, whereas in the hypertrophic zone of older rabbits, it was present in some chondrocytes the nuclei of which also contained DNA breaks, Our study suggests that, in the rabbit growth plate, c-Myc is associated with different cellular processes, depending on the age and the developmental stage of the chondrocytes.

  292. 脊髄サルコイドーシスの1例 査読有り

    古泉 豊, 佐藤 哲朗, 相澤 俊峰, 国分 正一, 高橋 俊明

    東北整形災害外科紀要 42 (2) 277-277 1998年12月

    出版者・発行元:東北整形災害外科学会

    ISSN:0040-8751

  293. Changes in the expression of Fas, osteonectin and osteocalcin with age in the rabbit growth plate 査読有り

    T Aizawa, HI Roach, S Kokubun, Y Tanaka

    JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME 80B (5) 880-887 1998年9月

    出版者・発行元:BRITISH EDITORIAL SOC BONE JOINT SURGERY

    DOI: 10.1302/0301-620X.80B5.8430  

    ISSN:0301-620X

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    Chondrocytes of the growth plate are generally assumed to undergo apoptosis, but the mechanisms which induce this cell death are not known. The Fas receptor is a mediator of the apoptotic signal in some systems. We studied its expression in situ in growth plates of rabbits aged from five to 20 weeks. In addition, we investigated the immunolocalisation in the growth plates of the bone proteins, osteonectin nad osteocalcin, and the changes in their expression with age. The Fas-positive chondrocytes were found mostly in the hypertrophic zone, as were the osteonectin-positive adn osteocalcin-positive cells. The percentage of Fas-positive cells increased with age whereas little change was found in the number of osteonectin-positive and osteocalcin-positive chondrocytes. Many of the Fas-positive chondrocytes were also TUNEL-positive. This strongly suggests that apoptosis in the growth plate is mediated through the Fas system. Double immunostaining for osteocalcin and Fas showed that not all hypertrophic chondrocytes were of the same cell type. Some chondrocytes stained for osteocalcin only, others with Fas only, while some were positive for both.

  294. Paraparesis associated with mild congenital kyphoscoliosis in an adult 査読有り

    T Sato, S Kokubun, Y Tanaka, T Aizawa

    TOHOKU JOURNAL OF EXPERIMENTAL MEDICINE 183 (4) 303-308 1997年12月

    出版者・発行元:TOHOKU UNIV MEDICAL PRESS

    DOI: 10.1620/tjem.183.303  

    ISSN:0040-8727

    eISSN:1349-3329

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    A 48-year-old man suffering from paraparesis had congenital kyphoscoliosis due to fused wedged vertebrae between T2 and T4. The kyphoscoliosis consisted of left convex scoliosis measuring 26 degrees and kyphosis measuring 27 degrees. On CT-myelograms and axial MR images, the dura and spinal cord were deviated anterolaterally to the concave side of the curve around its apex. The spinal cord was stuck and flattened against the posterolateral margin of the vertebral body to the base of the pedicle with the posterior subarachnoid space preserved. Anterior decompression from the concave side through a transthoracic approach resulted in a remarkable neurological improvement. The paraparesis may have been caused by compression of the spinal cord through a tethering effect due to its developmental tightness around the apical vertebra and the additional tension created by motions of the neck. (C) 1997 Tohoku University Medical Press.

  295. Apoptosis and proliferation of growth plate chondrocytes in rabbits 査読有り

    T Aizawa, S Kokubun, Y Tanaka

    JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME 79B (3) 483-486 1997年5月

    出版者・発行元:BRITISH EDITORIAL SOC BONE JOINT SURGERY

    DOI: 10.1302/0301-620X.79B3.7221  

    ISSN:0301-620X

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    The growth plates of the femoral head of Japanese white rabbits aged 5, 10, 15 and 20 weeks were stained for apoptotic and proliferating chondrocytes using the TUNEL and PCNA antibody staining techniques, Both TUNEL- and PCNA-positive chondrocytes were detected in all of the specimens, The positive ratios of both stainings were calculated for the whole plate and for the resting, proliferating and hypertrophic zones, The highest ratios in both stainings occurred in the hypertrophic zone in all age groups, With growth, the TUNEL-positive ratio increased whereas the proliferating ratio decreased. We suggest that the increase in chondrocytic death by apoptosis and the decrease in cell proliferation potential led to closure of the growth plate.

  296. Extradural granulocytic sarcoma of the thoracic spine in acute myelogenous leukemia with 8;21 chromosome translocation 査読有り

    T Aizawa, S Kokubun, M Hatori, O Kashimoto, R Ichinohasama

    TOHOKU JOURNAL OF EXPERIMENTAL MEDICINE 178 (4) 431-436 1996年4月

    出版者・発行元:TOHOKU UNIV MEDICAL PRESS

    DOI: 10.1620/tjem.178.431  

    ISSN:0040-8727

    eISSN:1349-3329

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    We report a case of a 19-year-old male with an extradural granulocytic sarcoma at T5/6 to T7 demonstrated by MRI. He recovered from paraplegia that had progressed rapidly after excision of the tumor as an emergency operation. Histopathological studies disclosed granulocytic sarcoma. Both peripheral blood and bone marrow examinations revealed acute myelogenous leukemia. The karyotype of the bone marrow showed 45, X, -Y, t (8; 21) (q22; q22).

︎全件表示 ︎最初の5件までを表示

MISC 111

  1. TiNbSn合金で開発した人工股関節ステムの5年以上経過例の中期成績

    千葉大介, 山田則一, 大山正瑞, 大津進, 桑原功行, 馬場一慈, 田中秀達, 花田修治, 井樋栄二, 相澤俊峰

    日本整形外科学会雑誌 97 (2) 2023年

    ISSN:0021-5325

  2. 投球障害肩・肘を有する選手とdeep squat testとの関連性(The relationship between deep squat test and players with disabled throwing shoulder/elbow)

    Nagamoto Hideaki, Muraki Takayuki, Abe Masaya, Kimura Rei, Shinagawa Kiyotsugu, Yaguchi Haruki, Kurokawa Daisuke, Takahashi Hiroyuki, Yamamoto Nobuyuki, Aizawa Toshimi, Kumai Tsukasa

    日本整形外科学会雑誌 96 (3) S739-S739 2022年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  3. 投球肩および/あるいは投球肘に障害を有する選手は蹴り足のheel raise testで有意な陽性反応を示す(Players with disabled throwing shoulder and/or elbow show significant positive heel raise test of their kicking leg)

    Nagamoto Hideaki, Muraki Takayuki, Abe Masaya, Kimura Rei, Shinagawa Kiyotsugu, Yaguchi Haruki, Kurokawa Daisuke, Takahashi Hiroyuki, Yamamoto Nobuyuki, Aizawa Toshimi, Kumai Tsukasa

    日本整形外科学会雑誌 96 (3) S742-S742 2022年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  4. 局所麻酔・意識下,全内視鏡下腰椎手術と合併症回避の意義

    山屋誠司, 橋本功, 古泉豊, 鈴木学, 須田英明, 八幡健一郎, 川原央, 両角直樹, 国分正一, 相澤俊峰

    日本整形外科学会雑誌 96 (2) 2022年

    ISSN:0021-5325

  5. 全内視鏡除圧からKLIF固定まで:教育システムの提言

    山屋誠司, 橋本功, 古泉豊, 鈴木学, 須田英明, 八幡健一郎, 川原央, 両角直樹, 国分正一, 相澤俊峰

    日本整形外科学会雑誌 96 (2) 2022年

    ISSN:0021-5325

  6. アンドロイドモデルを用いた二足歩行時の仙腸関節面の荷重伝達部位とタイミング

    佐中孝二, 黒澤大輔, 村上栄一, 橋本功, 相澤俊峰

    整形外科 73 (3) 2022年

    ISSN:0030-5901

  7. 仙腸関節固定術後の仙結節靱帯部痛の頻度と経過

    黒澤大輔, 黒澤大輔, 佐々木健, 村上栄一, 村上栄一, 橋本功, 相澤俊峰

    日本整形外科学会雑誌 96 (3) 2022年

    ISSN:0021-5325

  8. Hip-sacroiliac syndrome(仮称)の検討(FAIS股関節鏡視下手術例)

    野口森幸, 村上栄一, 橋本功, 黒澤大輔, 相澤俊峰

    日本整形外科学会雑誌 96 (3) 2022年

    ISSN:0021-5325

  9. 前額断MRIによる腰椎椎間孔部狭窄の診断の信頼性と再現性-T1・T2強調画像の信頼性・再現性の比較-

    橋本功, 橋本功, 田中靖久, 椿野巧, 中川智刀, 舘田聡, 高橋康平, 高橋康平, 鈴木学, 大野木孝嘉, 古泉豊, 国分正一, 相澤俊峰

    日本整形外科学会雑誌 96 (3) 2022年

    ISSN:0021-5325

  10. 軽微な外傷で生じたアキレス腱部分断裂の一例

    佐藤 宏陽, 永元 英明, 藍澤 一穂, 品川 清嗣, 相澤 俊峰

    日本足の外科学会雑誌 42 (Suppl.) S246-S246 2021年10月

    出版者・発行元:(一社)日本足の外科学会

    ISSN:0916-7927

  11. 高校生アスリートに対する鏡視下足関節外側靱帯修復術の治療成績

    永元 英明, 木村 礼, 畠 英里, 相澤 俊峰, 熊井 司

    日本足の外科学会雑誌 42 (Suppl.) S346-S346 2021年10月

    出版者・発行元:(一社)日本足の外科学会

    ISSN:0916-7927

  12. TiNbSn合金で開発した人工股関節ステムの3年以上経過例の短期成績

    千葉大介, 山田則一, 大山正瑞, 大津進, 桑原功行, 馬場一慈, 田中秀達, 花田修治, 井樋栄二, 相澤俊峰

    日本股関節学会学術集会プログラム・抄録集 48th 2021年

  13. 馬尾に発生した悪性リンパ腫の1例

    鈴木学, 相澤俊峰, 橋本功, 高橋康平, 半田恭一, 井樋栄二

    東北整形災害外科学会プログラム・抄録集 118th 2021年

  14. 全身性疾患に伴う脊椎病変~腫瘍性疾患(脊椎転移など)と脊椎病変~

    大野木孝嘉, 高橋康平, 橋本功, 相澤俊峰

    東北整形災害外科学会プログラム・抄録集 118th 2021年

  15. 思春期に診断されたposterior hemivertebraに対して短縮骨切り術を施行した1例

    高橋康平, 半田恭一, 大野木孝嘉, 橋本功, 相澤俊峰

    東北整形災害外科学会プログラム・抄録集 118th 2021年

  16. MRIによるEden分類2型と3型の脊髄砂時計腫の鑑別

    木村礼, 橋本功, 高橋正樹, 半田恭一, 鈴木学, 高橋康平, 相澤俊峰

    東北整形災害外科学会プログラム・抄録集 118th 2021年

  17. 胸椎後縦靭帯骨化症に対する後方進入前方除圧術(大塚変法)の手術成績とCTによる除圧の検証

    高橋康平, 相澤俊峰, 橋本功, 小野田祥人, 半田恭一, 大野木孝嘉, 菅野晴夫, 小澤浩司

    Journal of Spine Research (Web) 12 (3) 2021年

    ISSN:2435-1563

  18. 成人脊柱変形に対するdynamic compression hookを併用した脊柱短縮骨切り術-変形矯正効果とロッド折損予防の検討-

    菅野晴夫, 菅野晴夫, 相澤俊峰, 橋本功, 小澤浩司

    Journal of Spine Research (Web) 12 (3) 2021年

    ISSN:2435-1563

  19. 胸椎後縦靱帯骨化症に対する後方進入前方除圧術の成績-後方除圧固定術との比較-

    相澤俊峰, 橋本功, 高橋康平, 大野木孝嘉, 半田恭一, 菅野晴夫, 小澤浩司

    Journal of Spine Research (Web) 12 (3) 2021年

    ISSN:2435-1563

  20. 脊髄神経鞘腫摘出術における神経根切離後の神経脱落症状の検討

    半田恭一, 相澤俊峰, 村上大史, 大野木孝嘉, 高橋康平, 橋本功, 小澤浩司, 井樋栄二

    Journal of Spine Research (Web) 12 (3) 2021年

    ISSN:2435-1563

  21. 硬膜内髄外腫瘍における神経鞘腫と髄膜腫のMRI鑑別アルゴリズムの有効性

    村上大史, 相澤俊峰, 半田恭一, 大野木孝嘉, 鈴木学, 高橋康平, 小野田祥人, 橋本功, 小澤浩司, 井樋栄二

    Journal of Spine Research (Web) 12 (3) 2021年

    ISSN:2435-1563

  22. 胸椎OPLLに対する弯曲型ドリルとT-sawを用いた新たな後方進入前方除圧-安全・確実な除圧が術後の麻痺悪化を回避し早期離床を可能にする-

    菅野晴夫, 菅野晴夫, 相澤俊峰, 橋本功, 高橋康平, 半田恭一, 井樋栄二, 小澤浩司

    Journal of Spine Research (Web) 12 (3) 2021年

    ISSN:2435-1563

  23. 胸椎OPLLに対する弯曲型ドリルとT-sawを用いた安全・確実な後方進入前方除圧-術後の麻痺悪化の回避と早期離床の促進-

    菅野晴夫, 相澤俊峰, 橋本功, 小澤浩司, 小澤浩司

    日本脊椎インストゥルメンテーション学会抄録集 30th 2021年

  24. 腰椎変性すべり症に対する全内視鏡下トランスカンビン腰椎椎体間固定術(KLIF)の有用性と課題

    山屋誠司, 橋本功, 古泉豊, 鈴木学, 須田英明, 八幡健一郎, 川原央, 両角直樹, 国分正一, 相澤俊峰

    日本内視鏡外科学会総会(Web) 34th 2021年

  25. 前額断MRIによる腰椎椎間孔部狭窄の診断-T1・T2強調画像の信頼性・再現性と読影傾向の比較検証-

    橋本功, 田中靖久, 相澤俊峰, 椿野巧, 中川智刀, 舘田聡, 高橋康平, 鈴木学, 大野木孝嘉, 両角直樹, 古泉豊, 佐藤哲朗, 小澤浩司, 菅野晴夫, 国分正一, 井樋栄二

    Journal of Spine Research (Web) 12 (3) 2021年

    ISSN:2435-1563

  26. 胸椎後縦靱帯骨化症に対する後方進入前方除圧術の手術成績

    相澤俊峰, 橋本功, 菅野晴夫, 半田恭一, 小野田祥人, 井樋栄二, 小澤浩司

    Journal of Spine Research (Web) 11 (3) 2020年

    ISSN:2435-1563

  27. 胸椎後縦靱帯骨化症に対する後方進入前方除圧術の新たな工夫-弯曲型ドリルとT-sawによる安全・確実な前方除圧-

    菅野晴夫, 相澤俊峰, 橋本功, 衛藤俊光, 井樋栄二

    Journal of Spine Research (Web) 11 (3) 2020年

    ISSN:2435-1563

  28. 片側椎間関節切除に固定術を併用しない胸椎砂時計腫摘出術の中長期成績:多施設研究

    石川裕也, 大橋正幸, 平野徹, 渡辺慶, 松田倫治, 菅野晴夫, 橋本功, 半田恭一, 相澤俊峰, 赤羽武, 鈴木智人, 嶋村之秀

    東北整形災害外科学会雑誌 63 (1) 2020年

    ISSN:1348-8694

  29. 自然縮小した胸椎部砂時計腫の1例

    鈴木学, 相澤俊峰, 橋本功, 菅野晴夫, 小野田祥人, 井樋栄二

    東日本整形災害外科学会雑誌(Web) 32 (2) 2020年

    ISSN:2433-569X

  30. Surgical Approach to Pigmented Villonodular Synovitis and Synovial Osteochondromatosis in Pathological Expansion of the Popliteus Bursa. 国際誌

    Takehiko Sugita, Nobuyuki Itaya, Toshimi Aizawa, Masayuki Kamimura, Atsushi Takahashi, Naohisa Miyatake

    Arthroscopy techniques 8 (12) e1495-e1499 2019年12月

    DOI: 10.1016/j.eats.2019.07.028  

    詳細を見る 詳細を閉じる

    We orthopaedic surgeons are not familiar with the popliteus bursa. It is defined as the expansion in the synovial membrane of the posterolateral part of the knee that lies between the lateral meniscus and the tendon of the popliteus muscle. The popliteus bursa extends approximately 1 cm distal to the joint line and has 4 borders; the medial border is the peripheral margin of the lateral meniscus, the lateral border is the popliteus tendon, and the superior and inferior borders are formed by 2 fascicles. We very rarely observe cystic lesions that expand more distally, such as pigmented villonodular synovitis (PVNS) and synovial osteochondromatosis. We consider the distally expanded bursa as the pathologic expansion of the popliteus bursa. When this expansion is involved with PVNS, it may be the cause of recurrence of PVNS in the knee joint. Synovial osteochondromatosis in this expansion may cause pain in the posterolateral corner of the knee and may become a source of free bodies in the knee joint. In such conditions, these lesions should be surgically excised. The purpose of this Technical Note is to describe a surgical approach to the pathologic expansion of the popliteus bursa.

  31. 不安定型骨盤輪骨折に対するDual‐SAI screwsを用いた整復固定術―Extended tab screwによるreduction technique―

    小野田祥人, 小野田祥人, 菅野晴夫, 相澤俊峰, 橋本功, 大柳琢, 大柳琢, 久志本成樹, 井樋栄二

    東日本整形災害外科学会雑誌 31 (3) 435-435 2019年8月5日

    出版者・発行元:東日本整形災害外科学会

    ISSN:1342-7784

    eISSN:2433-569X

  32. Destructive discovertebral degenerative diseaseの1例

    松田 倫治, 相澤 俊峰, 橋本 功, 菅野 晴夫, 山屋 誠司, 衛藤 俊光, 半田 恭一, 井樋 栄二

    東北整形災害外科学会雑誌 62 (1) 154-154 2019年6月

    出版者・発行元:東北整形災害外科学会

    ISSN:1348-8694

  33. 除圧固定術後に麻痺が増悪した胸椎OPLLの検討

    相澤俊峰, 衛藤俊光, 菅野晴夫, 小野田祥人, 橋本功, 半田恭一, 半田恭一, 小澤浩司

    Journal of Spine Research 10 (3) 2019年

    ISSN:1884-7137

  34. 脊柱靭帯骨化症に関する調査研究 胸椎OPLLに対する手術成績の検討-後方進入前方除圧術と後方除圧術の比較-

    小澤浩司, 衛藤俊光, 相澤俊峰, 菅野晴夫, 橋本功

    脊柱靭帯骨化症に関する調査研究 平成30年度 総括・分担研究報告書(Web) 2019年

  35. Postoperative Changes in Presepsin Level and Values Predictive of Surgical Site Infection After Spinal Surgery: A Single-Center, Prospective Observational Study. 国際誌

    Tomoaki Koakutsu, Tetsuya Sato, Toshimi Aizawa, Eiji Itoi, Shigeki Kushimoto

    Spine 43 (8) 578-584 2018年4月15日

    DOI: 10.1097/BRS.0000000000002376  

    ISSN:0362-2436

    詳細を見る 詳細を閉じる

    STUDY DESIGN: Single-institutional, prospective observational study. OBJECTIVE: To elucidate the perioperative kinetics of presepsin (PSEP) in patients undergoing spinal surgery, and to evaluate the possibility of PSEP in the early diagnosis of surgical site infection (SSI). SUMMARY OF BACKGROUND DATA: Early diagnosis of SSI after spinal surgery is important. Although several biomarkers have been used as early indicators of SSI, the specificity of these markers in SSI diagnosis was not high. PSEP was found as a novel diagnostic marker for bacterial sepsis in 2004. However, its kinetics after spinal surgery and its usefulness in early diagnosis of SSI have never been evaluated. METHODS: A total of 118 patients who underwent elective spinal surgery were enrolled. PSEP was measured before, immediately after, 1 day after, and 1 week after surgery. In patients without postoperative infection, perioperative kinetics of PSEP were analyzed. PSEP levels in patients with postoperative infection were also recorded separately, and their utility in SSI diagnosis was evaluated. RESULTS: In the 115 patients without postoperative infection, the median PSEP value was 126, 171, 194, and 147 pg/mL before, immediately after, 1 day after, and 1 week after surgery, respectively. Compared with the preoperative value, PSEP was significantly higher immediately after surgery and the next day, and return to the preoperative level 1 week after surgery. The estimated reference value for 95 percentile in patients without postoperative infection was 297 pg/mL 1 week after surgery. In three patients with postoperative infection, higher levels (>300 pg/mL) were observed 1 week after surgery. CONCLUSION: In patients after spinal surgery without infectious complications, blood levels of PSEP may immediately increase and return to preoperative levels 1 week after surgery. The PSEP value of 300 pg/mL 1 week after surgery might be used as a novel indicator for suspected SSI. LEVEL OF EVIDENCE: 4.

  36. 胸椎後縦靱帯骨化症手術の多施設前向き研究 術後運動麻痺リスク因子の解析

    今釜 史郎, 安藤 圭, 竹内 一裕, 加藤 仁志, 相澤 俊峰, 松山 幸弘, 渡邉 航太, 松本 守雄, 吉井 俊貴, 大川 淳

    日本整形外科学会雑誌 92 (2) S124-S124 2018年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  37. プレセプシンの整形外科周術期における動態と基準値策定の試み 単一施設前向き観察研究

    小圷 知明, 佐藤 哲哉, 相澤 俊峰, 井樋 栄二, 久志本 成樹

    日本整形外科学会雑誌 92 (3) S774-S774 2018年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  38. 悪性腫瘍との鑑別が問題となった胸壁熱傷の1例

    越智純子, 常陸真, 綿貫宗則, 保坂正美, 相澤俊峰, 渡辺みか

    Japanese Journal of Radiology 36 (Supplement) 14 2018年2月25日

    ISSN:1867-1071

  39. 脊髄係留症候群に対し一期的に脊髄係留解除術と脊柱短縮骨切り術を行った1例

    藤井駿, 菅野晴夫, 相澤俊峰, 橋本功, 井樋栄二, 小澤浩司

    東北整形災害外科学会プログラム・抄録集 115th 2018年

  40. 胸腰椎部meningeal cystの手術治療

    日下部隆, 中村豪, 関口玲, 衛藤俊光, 菅野晴夫, 橋本功, 相澤俊峰

    東北整形災害外科学会雑誌 61 (1) 2018年

    ISSN:1348-8694

  41. 術後評価 9)頚髄症における術後脊髄腫脹の検討-MRI Gd-DTPA増強効果との関係

    小澤浩司, 相澤俊峰, 舘田聡, 橋本功, 菅野晴夫, 佐藤哲朗

    整形外科 69 (6) 2018年

    ISSN:0030-5901

  42. Fluoroscopy-Guided Sacroiliac Intraarticular Injection via the Middle Portion of the Joint. 国際誌

    Daisuke Kurosawa, Eiichi Murakami, Toshimi Aizawa

    Pain medicine (Malden, Mass.) 18 (9) 1642-1648 2017年9月1日

    出版者・発行元:Oxford University Press

    DOI: 10.1093/pm/pnw297  

    ISSN:1526-4637 1526-2375

    詳細を見る 詳細を閉じる

    Objective: Sacroiliac intraarticular injection is necessary to confirm sacroiliac joint (SIJ) pain and is usually performed via the caudal one-third portion of the joint. However, this is occasionally impossible for anatomical reasons, and the success rate is low in clinical settings. We describe a technique via the middle portion of the joint. Design: Observational study. Subjects: Enrolled were 69 consecutive patients (27 men and 42 women, with an average age of 53 years) in whom the middle portion of 100 joints was targeted. Method: With the patient lying prone-oblique with the painful side down, a spinal needle was inserted into the middle portion of the joint. Subsequently, the fluoroscopy tube was angled at a caudal tilt of 25-30° to clearly detect the recess between the ilium and sacrum and the needle depth and direction. When the needle reached the posterior joint line, 2% lidocaine was injected after the contrast medium outlined the joint. Results: The success rate of the injection method was 80% (80/100). Among 80 successful cases, four were previously unsuccessful when the conventional method was used. Intraarticular injection using the new technique was unsuccessful in 20 joints; in three of these cases, the conventional method proved successful, and no techniques were successful in the other 17 cases. Conclusion: The injection technique via the middle portion of the joint can overcome some of the difficulties of the conventional injection method and can improve the chances of successful intraarticular injection.

  43. 成人脊柱変形の病態と治療 後彎症患者はなぜ歩行中に体幹が傾くのか? 3次元動作解析による体幹-骨盤-下肢アライメントの検討

    鎌田 久美, 相澤 俊峰, 井樋 栄二, 小澤 浩司, 関口 雄介, 出江 紳一

    東北整形災害外科学会雑誌 60 (1) 176-176 2017年6月

    出版者・発行元:東北整形災害外科学会

    ISSN:1348-8694

  44. 脊柱後弯症患者における歩行時の体幹前傾化の要因

    鎌田久美, 小澤浩司, 関口雄介, 相澤俊峰, 出江紳一, 井樋栄二

    日本整形外科学会雑誌 91 (2) S158 2017年3月13日

    ISSN:0021-5325

  45. 胸椎後縦靱帯骨化症手術における術後運動麻痺関連因子 多施設前向き研究

    今釜 史郎, 安藤 圭, 竹内 一裕, 加藤 仁志, 相澤 俊峰, 松山 幸弘, 渡邉 航太, 松本 守雄, 吉井 俊貴, 大川 淳, 厚労科研, AMED班研究胸椎AM, 手術多施設研究グループ

    日本整形外科学会雑誌 91 (3) S738-S738 2017年3月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  46. 脊柱靭帯骨化症に関する調査研究 強直性脊椎病変の画像所見に関する研究

    衛藤俊光, 相澤俊峰, 菅野晴夫, 橋本功, 小澤浩司

    脊柱靭帯骨化症に関する調査研究 平成28年度 総括研究報告書(Web) 2017年

  47. 整形外科周術期におけるmitochondrial DNAの動態

    小圷知明, 山田充啓, 工藤大介, 桑原功行, 橋本功, 相澤俊峰, 井樋栄二, 久志本成樹

    日本整形外科学会雑誌 90 (8) S1717 2016年8月31日

    ISSN:0021-5325

  48. 脊柱後彎症患者における歩行時の脊柱-骨盤-下肢関節アライメントの検討

    鎌田 久美, 小澤 浩司, 関口 雄介, 相澤 俊峰, 出江 紳一, 井樋 栄二

    日本整形外科学会雑誌 90 (8) S1505-S1505 2016年8月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  49. Lumbar artery injury from which the Adamkiewicz artery originated associated with lumbar spine injury: successfully treated by transcatheter arterial embolization. 国際誌

    Tomoaki Koakutsu, Toshimi Aizawa, Hironao Yuzawa, Eiji Itoi, Shigeki Kushimoto

    European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 25 Suppl 1 124-8 2016年5月

    DOI: 10.1007/s00586-015-4225-2  

    ISSN:0940-6719

    詳細を見る 詳細を閉じる

    PURPOSE: Lumbar artery injury associated with lumbar spine injury can be a cause of shock leading to life-threatening condition. The Adamkiewicz artery often bifurcates from a lumbar spine or an intercostal artery at the thoracolumbar junction, where spine injury most commonly occurs. However, in emergency transcatheter arterial embolization for lumbar artery injury, hemostasis has priority and blood supply to the Adamkiewicz artery is not frequently confirmed. The aim of this report is to present the case of lumbar spine injury with lumbar artery injury from which the Adamkiewicz artery bifurcated. METHODS: Retrospective description of a case. RESULTS: A 58-year-old man was pinned under about 300-kg steel container that fell on his back. He was transported to our hospital presented with hemorrhagic shock. Contrast-enhanced computed tomography demonstrated L1-2 flexion-distraction injury and the left psoas major muscle swelling with extravasation of contrast medium, which suspected lumbar artery injury. Emergency angiography demonstrated the bilateral 2nd lumbar artery injury. Likewise, the Adamkiewicz artery originated from the distal part of the left 2nd lumbar artery. Fortunately, selective angiography of the left 1st lumbar artery depicted collateral circulation to the Adamkiewicz artery. Embolization of the bilateral 2nd lumbar artery was performed and massive hemorrhage was controlled successfully without spinal cord ischemia. CONCLUSIONS: Close attention must be paid to lumbar artery injury in the management of patients with lumbar spine injury. Once lumbar artery injury is found, transcatheter arterial embolization can be the choice of the treatment with careful attention to the Adamkiewicz artery.

  50. 脊椎手術後のプレセプシン値の推移―術後創傷感染症早期診断における有用性―

    小圷知明, 佐藤哲哉, 桑原功行, 工藤大介, 相澤俊峰, 橋本功, 井樋栄二, 久志本成樹

    日本整形外科学会雑誌 90 (2) S86 2016年3月4日

    ISSN:0021-5325

  51. Benign thoracic dumbbell tumor can be removed through hemilaminectomy and facetectomy without spinal reconstruction. 国際誌

    Toshimi Aizawa, Hiroshi Ozawa, Ko Hashimoto, Haruo Kanno, Shoichi Kokubun, Eiji Itoi

    Journal of neurosurgical sciences 60 (1) 145-8 2016年3月

    出版者・発行元:EDIZIONI MINERVA MEDICA

    ISSN:0390-5616

    eISSN:1827-1855

  52. 腰部脊柱管狭窄症に対する内視鏡下椎弓切除術と棘突起縦割式椎弓切除術の前向き比較試験

    山屋誠司, 中村聡, 千田香織, 菅野晴夫, 橋本功, 相澤俊峰, 小澤浩司, 井樋栄二

    日本整形外科学会雑誌 90 (3) 2016年

    ISSN:0021-5325

  53. 脊柱後彎症における歩行時姿勢の検討

    鎌田 久美, 小澤 浩司, 関口 雄介, 相澤 俊峰, 出江 紳一, 井樋 栄二

    日本整形外科学会雑誌 89 (8) S1637-S1637 2015年9月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  54. T1神経根症とその特徴的症候

    田中靖久, 椿野巧, 星川健, 高橋康平, 鈴木学, 松田倫治, 橋本功, 菅野晴夫, 相澤俊峰

    Journal of Spine Research 6 (3) 2015年

    ISSN:1884-7137

  55. 中高齢者脊柱後弯症における歩行時姿勢の検討

    鎌田 久美, 小澤 浩司, 関口 雄介, 相澤 俊峰, 出江 紳一, 井樋 栄二

    運動器リハビリテーション = The journal of musculoskeletal medicine : 日本運動器科学会誌 26 (4) 414-418 2015年

    出版者・発行元:日本運動器科学会

    ISSN:2187-8420

  56. 動脈塞栓術が奏効した仙骨骨巨細胞腫の2例

    常陸 真, 高橋 昭喜, 綿貫 宗則, 保坂 正美, 相澤 俊峰, 小澤 浩司, 井樋 栄二

    日本整形外科学会雑誌 88 (6) S1280-S1280 2014年6月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  57. 最近10年間の当科におけるLuque SSI法の経験

    吉田 新一郎, 小澤 浩司, 相澤 俊峰, 中村 豪, 菅野 晴夫, 小圷 知明, 井樋 栄二

    東北整形災害外科学会雑誌 57 (1) 15-19 2014年6月

    出版者・発行元:東北整形災害外科学会

    ISSN:1348-8694

    詳細を見る 詳細を閉じる

    最近10年間に当科でLuque SSI法を行った12例について検討した。疾患の内訳は、転移性脊椎腫瘍が5例、頸胸椎脱臼骨折が3例、原発性脊椎腫瘍が2例、破裂骨折後の遅発性麻痺が2例であった。Luque SSI法を用いた理由は、椎弓根が細いためが5例、転移性脊椎腫瘍のためが4例、頸椎のためが3例であった。固定範囲はSegmental sublaminar wiringを頭尾側各3に椎弓を行った例が9例、頸椎で各2に椎弓を行った例が3例であった。11例で最終経過観察時まで良好な固定が維持された。術後合併症は、1例で術後一時的に麻痺の増悪を認めたが、術後1ヵ月以内に改善した。また、1例でワイヤーの折損による後彎変形を認め、再手術を要した。

  58. 自家骨移植により骨欠損部を再建し人工膝関節置換術を行ったCharcot関節の1例

    佐々木 毅志, 杉田 健彦, 佐々木 啓, 前田 郁雄, 本間 哲夫, 大沼 正宏, 相沢 俊峰, 柏葉 光宏, 高橋 敦, 藤澤 博一, 上村 雅之

    東北整形災害外科学会雑誌 57 (1) 133-136 2014年6月

    出版者・発行元:東北整形災害外科学会

    ISSN:1348-8694

    詳細を見る 詳細を閉じる

    症例は57歳女性で、50歳時よりCharcot膝関節の経過観察中であったが、56歳より左膝関節の内反変形、特に脛骨内側顆部の骨欠損が急速に進行した。今回、関節破壊の進行を懸念して、脛骨内側顆部に大きな骨欠損を伴ったCharcot左膝関節に対し自家骨移植を用いた人工膝関節置換術(TKA)を行った。術後1年で移植骨内側部に骨梁が確認され、術後3年で移植骨は周囲と同化し、経過良好であった。

  59. 頚椎椎間板ヘルニアに対する脊柱管拡大術の長期成績-多施設前向き研究による前方除圧固定術との比較-

    小圷知明, 佐々木盛力, 両角直樹, 石井祐信, 国分正一, 関口玲, 橋本功, 相澤俊峰, 井樋栄二, 笠間史夫, 田中靖久, 佐藤哲朗, 山崎伸

    Journal of Spine Research 5 (3) 2014年

    ISSN:1884-7137

  60. 脊柱後弯症に対する短期集中型のリハビリテーション訓練の効果について-介入の前後を比較した予備的研究-

    関口雄介, 関口雄介, 小澤浩司, 金子雅明, 相澤俊峰, 橋本功, 菅野晴夫, 出江紳一, 井樋栄二

    運動器リハビリテーション 25 (2) 2014年

    ISSN:2187-8420

  61. 腰部脊柱管狭窄症における荷重MRIと脊髄造影の比較

    菅野 晴夫, 遠藤 俊毅, 小澤 浩司, 相澤 俊峰, 古泉 豊, 両角 直樹, 石井 祐信, 井樋 栄二

    Journal of Spine Research 3 (3) 215-215 2012年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1884-7137

  62. 【炎症など悪性骨・軟部腫瘍と見まちがう疾患-診断のポイント】骨組織球症 臨床・画像上の特徴と悪性腫瘍との鑑別

    保坂 正美, 羽鳥 正仁, 常陸 真, 綿貫 宗則, 相沢 俊峰, 井樋 栄二

    整形・災害外科 54 (10) 1159-1170 2011年9月

    出版者・発行元:金原出版(株)

    ISSN:0387-4095

  63. 鎖骨骨幹部骨折に対する骨接合術における成績不良例の検討

    峯田 光能, 相澤 利武, 笹島 功一, 八田 卓久

    骨折 32 (1) 77-79 2010年2月25日

    ISSN:0287-2285

  64. 責任高位による胸部脊髄症の診断の問題点 上位と下位罹患例の診断過程の比較

    中村豪, 相澤俊峰, 小澤浩司, 日下部隆, 井樋栄二

    Journal of Spine Research 1 (4) 1014-1014 2010年

  65. 宮城県住民における腰椎椎間板ヘルニア手術の疫学調査

    日下部隆, 小澤浩司, 相澤俊峰, 小川真司, 松本不二夫, 村上栄一, 笠間史夫, 田中靖久, 石井祐信, 佐藤哲朗, 井樋栄二, 国分正一

    Journal of Spine Research 1 (4) 827-827 2010年

  66. 骨粗鬆性椎体骨折偽関節に対する椎弓根スクリューとフックを併用した脊柱短縮術

    小澤浩司, 田中靖久, 星川健, 相澤俊峰, 日下部隆, 中村豪, 井樋栄二, 国分正一

    Journal of Spine Research 1 (3) 290-290 2010年

  67. 脂肪髄膜瘤による脊髄係留症候群に対する脊柱短縮骨切り術の手術成績

    相澤俊峰, 小澤浩司, 日下部隆, 中村豪, 井樋栄二, 星川健, 田中靖久, 国分正一

    日本整形外科学会雑誌 84 (4) S671-S671 2010年

  68. 仙骨前面巨大神経鞘腫の治療

    小澤浩司, 相澤俊峰, 日下部隆, 中村豪, 井樋栄二

    日本整形外科学会雑誌 84 (4) S420-S420 2010年

  69. 脊髄髄膜腫の臨床症状、手術成績について 神経鞘腫との比較

    中村豪, 小澤浩司, 相澤俊峰, 日下部隆, 井樋栄二

    日本整形外科学会雑誌 84 (4) S418-S418 2010年

  70. 特発性胸髄硬膜外脂肪腫の1例

    篠崎 晋久, 小津 浩司, 相澤 俊峰, 星川 健, 川原 央, 千葉 大介, 井樋 栄二

    東北整形災害外科学会雑誌 53 (1) 188-189 2009年6月

    出版者・発行元:東北整形災害外科学会

    ISSN:1348-8694

  71. 両下肢麻痺で発症したdumbbell型ユーイング肉腫ファミリー腫瘍(ESFT)の1例

    森谷 邦彦, 熊谷 直憲, 松本 幸子, 新妻 秀剛, 小沼 正栄, 力石 健, 笹原 洋二, 久間木 悟, 土屋 滋, 相沢 俊峰, 保坂 正美

    日本小児科学会雑誌 113 (4) 751-751 2009年4月

    出版者・発行元:(公社)日本小児科学会

    ISSN:0001-6543

  72. 脊髄神経鞘腫の臨床症状、手術成績について

    小澤浩司, 相澤俊峰, 星川健, 日下部隆, 井樋栄二

    日本脊椎脊髄病学会雑誌 20 (2) 577-577 2009年

  73. 胸椎連続型OPLLに対する後方除圧術の限界

    小澤浩司, 武井寛, 伊藤拓緯, 相澤俊峰, 星川健, 日下部隆, 菅野晴夫, 石井祐信, 佐藤哲朗, 井樋栄二

    日本脊椎脊髄病学会雑誌 20 (2) 370-370 2009年

  74. 【変性腰椎の治療戦略】 変性腰椎(脊柱管狭窄症)の画像診断 腰部脊柱管狭窄症の荷重MRI

    菅野晴夫, 小澤浩司, 相澤俊峰, 星川健, 日下部隆, 井樋栄二, 石井祐信, 国分正一

    関節外科 28 (5) 580-587 2009年

  75. 原発性骨盤腫瘍に対し動脈塞栓術とビスフォスフォネート製剤を用いた治療経験

    保坂正美, 羽鳥正仁, 綿貫宗則, 星川健, 相澤俊峰, 日下部隆, 小澤浩司, 井樋栄二

    日本整形外科学会雑誌 83 (6) S864-S864 2009年

  76. 腰部脊柱管狭窄症における荷重MRIの検討

    菅野晴夫, 小澤浩司, 相澤俊峰, 星川健, 川原央, 井樋栄二

    東北整形災害外科学会雑誌 53 (1) 237-237 2009年

  77. 銃弾による胸髄損傷の1例

    星川健, 千葉大介, 菅野晴夫, 橋本功, 川原央, 相澤俊峰, 小澤浩司

    東北整形災害外科学会雑誌 53 (1) 232-232 2009年

  78. 環軸関節回旋により脊髄圧迫が生じた脊髄砂時計腫 2例報告

    日下部隆, 小澤浩司, 相澤俊峰, 星川健, 中村豪, 石井祐信, 井樋栄二

    東日本整形災害外科学会雑誌 21 (3) 386-386 2009年

  79. 前仙骨シュワン腫の外科的治療 5症例報告

    PongsthornChanplakorn, 小澤浩司, 相澤俊峰, 日下部隆, 中村豪, 井樋栄二

    東日本整形災害外科学会雑誌 21 (3) 282-282 2009年

  80. 頭痛を契機に発見されたC1/C2椎間関節嚢腫の1例

    中嶋 信人, 野本 達也, 水越 元気, 上田 雅之, 橋本 功, 相澤 俊峰, 小澤 浩司, 永山 寛, 山崎 峰雄, 片山 泰朗

    日本頭痛学会誌 35 (2) 79-79 2008年11月

    出版者・発行元:(一社)日本頭痛学会

    ISSN:1345-6547

  81. 両下肢麻痺で発症したdumbbell型ユーイング肉腫ファミリー腫瘍(ESFT)の1例

    森谷 邦彦, 熊谷 直憲, 松本 幸子, 新妻 秀剛, 小沼 正栄, 力石 健, 笹原 洋二, 久間木 悟, 土谷 滋, 相沢 俊峰, 保坂 正美

    小児がん 45 (プログラム・総会号) 318-318 2008年11月

    出版者・発行元:(NPO)日本小児がん学会

    ISSN:0389-4525

  82. 腰部脊柱管狭窄症における荷重MRI

    菅野 晴夫, 小澤 浩司, 相澤 俊峰, 星川 健, 川原 央, 井樋 栄二

    日本脊椎脊髄病学会雑誌 = The journal of the Japan Spine Research Society 19 (2) 415-415 2008年3月20日

    ISSN:1346-4876

  83. 頚髄症MRIにおける髄内増強病巣について

    小澤 浩司, 佐藤 哲朗, 兵藤 弘訓, 佐々木 祐筆, 両角 直樹, 小泉 豊, 松谷 重恒, 松本 不二夫, 中村 豪, 相澤 俊峰, 星川 健, 川原 央, 笠間 史夫, 田中 靖久, 石井 祐信, 国分 正一

    日本脊椎脊髄病学会雑誌 = The journal of the Japan Spine Research Society 19 (1) 26-26 2008年3月20日

    ISSN:1346-4876

  84. 脊椎内視鏡下手術の現状ー2006年1月〜12月手術施行状況調査・インシデント報告集計結果ー (日整会誌)

    長谷川徹, 相澤俊峰, 猪川輪哉, 伊東学, 江原宗平, 岡治道, 加藤真介, 加藤圭彦, 川上守, 川原範夫, 古賀公明, 紺野慎一, 坂本直俊, 佐藤公治, 佐藤公昭, 高野裕一, 高橋誠, 田中雅人, 出沢明, 中野恵介, 中村博亮, 夏山元伸, 長谷川和宏, 蜂谷裕道, 平泉裕, 藤本吉範, 前川慎吾, 前田健, 松本守雄, 三上靖夫, 望月眞人, 八木省次, 山縣正庸, 山元拓哉, 湯澤洋平, 吉田宗人, 四宮謙一, 戸山芳昭

    日整会誌 81 1072-1077 2007年12月

  85. エストロゲンの欠如は成長軟骨板軟骨細胞を減少させる

    高野 広之, 相澤 俊峰, 入江 太一, 国分 正一, 井樋 栄二

    日本整形外科學會雜誌 = The Journal of the Japanese Orthopaedic Association 81 (9) 732-732 2007年9月25日

    ISSN:0021-5325

  86. 仙腸関節性疼痛に対する関節内外ブロック療法の効果について

    村上 栄一, 田中 靖久, 相澤 俊峰, 石塚 正人, 国分 正一

    日本整形外科學會雜誌 = The Journal of the Japanese Orthopaedic Association 81 (7) 601-601 2007年7月25日

    ISSN:0021-5325

  87. 黄色靱帯骨化. (脊椎脊髄ジャーナル)

    相澤俊峰, 田中靖久, 星川健, 小澤浩司, 川原央, 井樋栄二

    脊椎脊髄ジャーナル 20 117-124 2007年5月

  88. 脊椎類骨骨腫に伴う側彎の本態 傍脊柱筋の筋融解

    川原 央, 小澤 浩司, 田中 靖久, 相沢 俊峰, 星川 健, 石井 祐信, 佐藤 哲朗, 国分 正一

    日本脊椎脊髄病学会雑誌 18 (1) 62-62 2007年3月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1346-4876

  89. 脊椎骨切り術による胸椎・肋骨近位部軟骨肉腫の治療

    小澤 浩司, 川原 央, 星川 健, 相澤 俊峰, 松本 不二夫, 田中 靖久, 国分 正一

    日本脊椎脊髄病学会雑誌 = The journal of the Japan Spine Research Society 17 (1) 243-243 2006年3月20日

    ISSN:1346-4876

  90. 特発性脊髄ヘルニアの神経症候. (脊椎脊髄 ジャーナル)

    相澤俊峰, 田中靖久, 国分正一

    脊椎脊髄 ジャーナル 18 535-539 2005年10月

  91. 頚椎前方除圧固定術(ASF)のクリティカルパス. (整形災害外科)

    相澤俊峰, 富谷明人, 国分正一, 菅野知恵, 小綿瑞恵

    整形災害外科 47 553-561 2004年10月

  92. 【内分泌病理学最近の進歩 2003】 終糸発生傍神経節腫の1例 (ホルモンと臨床)

    渡辺みか, 森谷卓也, 笹野公伸, 相澤俊峰

    ホルモンと臨床 51 (臨増) 158-161 2003年8月

  93. 脊椎好酸球性肉芽腫の MRI 所見の経時的変化

    相澤 俊峰, 田中 靖久, 小澤 浩司, 松本 不二夫, 星川 健, 国分 正一

    日本脊椎脊髄病学会雑誌 = The journal of the Japan Spine Research Society 14 (1) 390-390 2003年2月20日

    ISSN:1346-4876

  94. 下垂指(drop finger)をきたす頚部神経根症

    田中 靖久, 国分 正一, 小澤 浩司, 松本 不二夫, 相澤 俊峰, 星川 健

    日本脊椎脊髄病学会雑誌 = The journal of the Japan Spine Research Society 14 (1) 345-345 2003年2月20日

    ISSN:1346-4876

  95. 運動負荷と骨格筋細胞のIL-6

    富山 明人, 相澤 俊峰, 川又 朋麿, 国分 正一, 永富 良一, 泉水 宏臣

    日本整形外科学会雑誌 76 (8) S957-S957 2002年8月

    出版者・発行元:(公社)日本整形外科学会

    ISSN:0021-5325

  96. 第1肋骨に発生し脊椎に浸潤した骨巨細胞腫の1手術例

    樋口 和東, 田中 靖久, 星川 健, 相沢 俊峰, 両角 直樹, 後藤 均, 佐藤 哲朗, 国分 正一

    東北整形災害外科紀要 46 (1) 132-132 2002年6月

    出版者・発行元:東北整形災害外科学会

    ISSN:0040-8751

  97. 胸椎部特発性脊髄ヘルニア

    相澤 俊峰, 佐藤 哲朗, 田中 靖久, 松本 不二夫, 両角 直樹, 星川 健, 国分 正一

    日本脊椎脊髄病学会雑誌 = The journal of the Japan Spine Research Society 13 (1) 53-53 2002年4月26日

    ISSN:1346-4876

  98. 第1肋骨に発生し脊椎に浸潤した骨巨細胞腫の1手術例

    樋口 和東, 田中 靖久, 星川 健, 相沢 俊峰, 両角 直樹, 佐藤 哲朗, 国分 正一

    日本脊椎脊髄病学会雑誌 13 (1) 63-63 2002年4月

    出版者・発行元:(一社)日本脊椎脊髄病学会

    ISSN:1346-4876

  99. 遠心性運動負荷と骨格筋細胞のIL-6 : その発現と経時的変化について

    富谷 明人, 相澤 俊峰, 川又 朋麿, 国分 正一, 永富 良一, 泉水 宏臣, 上住 聡芳

    日本整形外科スポーツ医学会雑誌 = Japanese journal of orthopaedic sports medicine 22 (1) 86-86 2002年2月28日

    ISSN:1340-8577

  100. 【頸椎後彎症】 先天性頸椎後彎症

    国分正一, 田中靖久, 小澤浩司, 相澤俊峰, 佐藤哲朗, 石井祐信

    脊椎脊髄ジャーナル 14 (1) 16-21 2001年

  101. 【脊椎外科最近の進歩】 髄内腫瘍の診断と摘出術における課題

    佐藤哲朗, 田中靖久, 小澤浩司, 相澤俊峰, 国分正一

    臨床整形外科 36 (4) 379-385 2001年

    DOI: 10.11477/mf.1408903245  

  102. 【小児整形外科 最近の動向】 小児脊髄腫瘍と片側望椎弓切除による摘出術

    国分正一, 佐藤哲朗, 田中靖久, 小澤浩司, 相澤俊峰

    整形・災害外科 44 (9) 1101-1109 2001年

  103. 多数回手術を要した多発性脊柱靱帯骨化症の1例

    中條 悟, 佐藤 哲朗, 田中 靖久, 小澤 浩司, 後藤 均, 相沢 俊峰, 石塚 正人, 綿貫 宗則, 国分 正一

    東北整形災害外科紀要 44 (2) 259-259 2000年12月

    出版者・発行元:東北整形災害外科学会

    ISSN:0040-8751

  104. 骨折治癒過程の内軟骨骨化における軟骨細胞のアポトーシス

    相澤 俊峰, 川又 明麿, 国分 正一, 金 民世, GERSTENFELD LC., EINHORN TA.

    日本整形外科學會雜誌 74 (8) S1724 2000年8月25日

    ISSN:0021-5325

  105. 脊髄髄内腫瘍の診断と摘出術における課題

    佐藤 哲朗, 田中 靖久, 小澤 浩司, 相澤 俊峰, 中条 悟, 国分 正一

    日本脊椎外科学会雑誌 = The journal of the Japan Spine Research Society 11 (1) 3-3 2000年4月28日

    ISSN:0915-6496

  106. 腰部変性後弯症に対する後方侵入楔状骨切り術術式の開発と成績

    国分 正一, 佐藤 哲朗, 田中 靖久, 相沢 俊峰, 古泉 豊

    日本脊椎外科学会雑誌 = The journal of the Japan Spine Research Society 9 (1) 29-29 1998年5月22日

    ISSN:0915-6496

  107. 【黄色靱帯骨化症】胸椎部黄色靱帯骨化症の手術法と合併症

    佐藤 哲朗, 田中 靖久, 相沢 俊峰

    脊椎脊髄ジャーナル 11 (5) 505-510 1998年5月

    出版者・発行元:(株)三輪書店

    ISSN:0914-4412

  108. 成長軟骨板におけるアポトーシス関連蛋白の局在と役割

    相澤 俊峰, 国分 正一, 田中 靖久, ROACH H. I.

    日本整形外科學會雜誌 = The Journal of the Japanese Orthopaedic Association 71 (8) S1583 1997年8月25日

    ISSN:0021-5325

  109. 成長軟骨板における Fas 抗原と非コラーゲン蛋白の発現

    相澤 俊峰, 国分 正一, 田中 靖久

    日本整形外科學會雜誌 = The Journal of the Japanese Orthopaedic Association 70 (8) S1528 1996年8月25日

    ISSN:0021-5325

  110. 成長軟骨板におけるPCNAの発現とアポトーシス : 成長停止のメカニズムを考える

    相澤 俊峰, 国分 正一, 樫本 修, 高松 克哉, 松村 康弘, 田中 靖久

    日本整形外科學會雜誌 = The Journal of the Japanese Orthopaedic Association 69 (8) S1554 1995年8月25日

    ISSN:0021-5325

  111. 第6頸椎分離症の1例

    相沢 俊峰, 神尾 一彦, 鈴木 寛

    東北整形災害外科紀要 37 (1) 21-23 1993年5月

    出版者・発行元:東北整形災害外科学会

    ISSN:0040-8751

︎全件表示 ︎最初の5件までを表示

書籍等出版物 4

  1. スキル関節鏡下手術アトラス 脊椎内視鏡下手術.

    相澤俊峰

    2013年4月1日

  2. アトラス骨・関節画像診断. 5. 脊椎・脊髄

    山下敏彦, 相澤俊峰, 小澤浩司

    中外医学社 2011年7月

  3. 最新整形外科学大系 第1巻 運動器の生物学と生体力学

    越智隆弘, 相澤俊峰, 杉田健彦

    中山書店 2008年9月

  4. Ossification of the Posterior Longitudinal Ligament

    Tanaka Y, Sato, T, Aizawa T

    Springer 2006年10月

講演・口頭発表等 16

  1. 最近の大学病院における化膿性脊椎炎の臨床症状、画像所見の特徴

    日整会学術総会 2013年5月23日

  2. 腰部脊柱管狭窄症に対する開窓術後再手術例の検討

    日本脊椎脊髄病学会 2013年4月25日

  3. Thoracic myelopathy in Japan 国際会議

    Annual meeting of Taiwan Spine Society 2013年3月21日

  4. 生存解析を用いた腰椎椎間板ヘルニア再発手術率の検討.

    相澤俊峰ほか

    日本脊椎脊髄病学会 2012年4月19日

  5. 腰椎椎間板ヘルニア再発手術例の疫学的検討

    相澤俊峰ほか

    日本整形外科学会総会 2011年5月15日

  6. 合併症による腰椎再手術:東北大学脊椎外科懇話会手術登録14046手術の検討.

    相澤俊峰ほか

    日本脊椎脊髄病学会 2011年4月20日

  7. 脂肪髄膜瘤による脊髄係留症候群に対する脊柱短縮骨切り術の手術成績

    相澤俊峰, 小澤浩司, 日下部隆, 中村豪, 国分正一, 田中靖久, 井樋栄二

    日本整形外科学会総会 2010年5月17日

  8. 10. Spine-shortening Vertebral Osteotomy for the Patients with Tethered Cord Syndrome Caused by Spinal Lipoma. 国際会議

    Aizawa T, Kokubun S, Ozawa H, Kusakabe T, Itoi E

    European Federation of National Associations of Orthopaedics and Traumatology, 2009年6月3日

  9. 成人では胸髄症に対する椎弓切除術後に局所後弯がどれくらい進行するか

    相澤俊峰, 佐藤哲朗, 小澤浩司, 星川健, 松本不二夫, 国分正一

    第81回日整会学術総会 2008年5月22日

  10. 胸部脊髄症134例の手術成績の検討

    相澤俊峰, 佐藤哲朗, 佐々木祐肇, 松本不二夫, 両角直樹, 日下部隆, 川原央, 星川健, 小澤浩司, 田中靖久, 国分正一

    日本脊椎脊髄病学会 2007年4月26日

  11. Results of surgery for thoracic myelopathy 国際会議

    Aizawa T, Sato T

    American Academy of Orthopaedic Surgeons 2007年2月14日

  12. 脊柱靱帯骨化症による脊髄症手術症例の疫学的研究

    相澤俊峰, 田中靖久, 小澤浩司ほか

    日本整形外科学会総会 2006年4月20日

  13. Analysis of 139 patients with thoracic myelopathy caused by ossification of the ligamentum flavum. 国際会議

    Aizawa T, Sato T, Kokubun S, Kusakabe T, Morozumi K

    American Academy of Orthopaedic Surgeons 2006年3月22日

  14. 5. Analysis of 139 patients with thoracic myelopathy caused by ossification of the ligamentum flavum. 国際会議

    Aizawa T, Sato T

    American Academy of Orthopaedic Surgeons 2006年3月22日

  15. Ananysis of 139 patients with thoracic myelopathy caused by ossofocatoin of the ligamentum flavum 国際会議

    Aizawa T, Sato T

    American Academy of Orthopaedic Surgeons 2006年3月22日

  16. Analysis of 139 patients with thoracic myelopathy caused by ossification of the ligamentum flavum 国際会議

    Aizawa T, Sato T

    American Academy of Orthopaedic Surgeons 2006年3月22日

︎全件表示 ︎最初の5件までを表示

共同研究・競争的資金等の研究課題 2

  1. 成長軟骨板軟骨細胞に対する性ホルモンの影響

    山田 則一, 相澤 俊峰, 大沼 正宏, 川又 朋麿, 山田 則一

    提供機関:Japan Society for the Promotion of Science

    制度名:Grants-in-Aid for Scientific Research

    研究種目:Grant-in-Aid for Scientific Research (C)

    研究機関:Tohoku University

    2002年 ~ 2004年

    詳細を見る 詳細を閉じる

    ネンブタール静脈麻酔下に、8週齢の雄の日本白色家兎から精巣を摘出した。10,15,20,25週で安楽死させた。すなわち精巣摘出-屠殺時期で,8-10,8-15,8-20,8-25週群の4グループを作った。またコントロールとして、10,15,20,25週齢の正常なウサギのグループを作った。屠殺時に採血し、テストステロン濃度が、精巣摘出群では、検出閾値(0.1ng/ml)以下であることを確認した。大腿骨頚部の成長軟骨板を観察するため、脱灰、パラフィン包埋後、2.5μmの薄切スライドを作成し、HE染色、PCNA、Caspase-3、Osteopontinなどの免疫染色を行った。精巣摘出群では、成長軟骨板の高さが減少し、増殖細胞層の柱状構造が正常家兎より早く乱れ、また増殖細胞層の軟骨細胞の形状が肥大化する傾向がみられた。また、免疫染色からは精巣摘出によって軟骨細胞の増殖能の低下、細胞死が増加する傾向がみられた。 次いで、in vitroで軟骨細胞に対する性ホルモン負荷に対する影響を知るため、軟骨細胞の分離培養を行った.胎生17日の鶏の胸骨を摘出し、HE染色で頭側1/4が肥大細胞で、尾側1/2が非肥大細胞で構成されていることを確認した。胸骨の頭側5mm尾側8mmを採取し、Gerstenfeldらの方法に準じて培養した。培養した細胞からRNAを抽出し、reversetranscription-polymerase chain reaction(RT-PCR)法を行った。頭側の軟骨細胞ではX型コラーゲンを、尾側はII型コラーゲンを産生していた。すなわち、mRNAレベルで、前者が成熟した肥大細胞、後者が未熟な非肥大細胞であることが確認された。この培養系を用いて、性ホルモンの負荷実験を行った。テストステロン、エストロゲンを10-10,10-9,10-8,10-7,10-6mol/lの濃度勾配をつけ負荷した。APL活性、増殖能、細胞死、コラーゲンII、XなどのmRNA発現の変化を観察した。テストステロンでは、細胞増殖能の増加、エストロゲンでは、細胞死が増加する傾向がみられた

  2. 内軟骨骨化での軟骨細胞に対する腫瘍壊死因子(TNF)の働き

    相澤 俊峰, 大沼 正宏, 川又 朋麿, 川又 朋磨

    提供機関:Japan Society for the Promotion of Science

    制度名:Grants-in-Aid for Scientific Research

    研究種目:Grant-in-Aid for Scientific Research (C)

    研究機関:Tohoku University

    2000年 ~ 2001年

    詳細を見る 詳細を閉じる

    長管骨の伸長を司る成長軟骨板や、骨折治癒過程では内軟骨骨化がみられる。この骨化過程において軟骨細胞は増殖、成熟、肥大、そしてプログラム細胞死=アポトーシス細胞という連続した変化を示す。プログラム細胞死を惹起する因子はdeath factorと呼ばれ、腫瘍壊死因子(TNF)ファミリーに属するTNF-α、Fasリガンド、TRAILや酸化窒素(NO)などが知られる。本研究では骨折治癒過程におけるTNFの働きを、この軟骨細胞に対するアポトーシスの観点から捉えるとともに、他のdeath factorについても発現を観察した。 BALB/Cマウスの脛骨の横骨折モデルを用いた。術後1、2、3週でマウスを安楽死させ、RNase protection assay(RPA)で脛骨中のcaspase-8、TNF-αとその受容体であるp55、FasリガンドとFas受容体、TRAILのmRNAを同定した。また、これらの蛋白の発現を免疫染色により検討した。ボストン大字から提供されたTNF-α受容体のノックアウトマウス(TNF-α-KO)でも同様に骨折モデルを作製し、RPAで仮骨中のcaspase-8の発現を観察した。 BALB/Cマウスでは骨折後1週で骨折部付近では内軟骨骨化により作られた軟骨仮骨が骨折部を架橋していた。骨折後2週では軟骨細胞や軟骨性仮骨はまだ確認できたが、骨折後3週で骨折部はprimary spongiosaにより完全に癒合された。一方、TNF-α-KOでは、骨折後2週、3週で骨折仮骨が大量に残存し、骨折治癒過程が遅れる傾向にあった。 RPAでは、BALB/Cマウスでcaspase-8、TNF-αとp55、Fasリガンドと受容体、TRAILの発現が各群で認められた。これらの抗体を用いた免疫染色では、主に軟骨細胞で発現が認められた。またp55^-/p75^-マウスではcaspase-8のmRNAがほとんど同定できなかった。 本研究から骨折治癒過程にある軟骨細胞では、少なくとも3種傾の異なったdeath factor、TNF-α、Fasリガンド、TRAILが発現していた。軟骨仮骨が新生骨に変わるためには、軟骨細胞が除去されなければならない。この過程において軟骨細胞はこれらのdeath factorを発現し、オートクリン/パラクリン機序で"自殺"する可能性が考えられる。TNF-α受容体ノックアウトマウスでcaspase-8がほとんど発現していなかったことから、中でもTNF-αがその中心的な役割を担っている可能性が示唆された。

その他 2

  1. 急性脊髄損傷に対する顆粒球コロニー刺激因子を用いた神経保護療法

    詳細を見る 詳細を閉じる

    急性脊髄損傷に対する顆粒球コロニー刺激因子を用いた神経保護療法

  2. 大学病院における化膿性脊椎炎の最近の動向

    詳細を見る 詳細を閉じる

    大学病院における化膿性脊椎炎の最近の動向