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| 1.
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Shinmura, Kazuya ; Murakami, Hideki ; Demura, Satoru ; Kato, Satoshi ; Yoshioka, Katsuhito ; Hayashi, Hiroyuki ; Inoue, Kei ; Ota, Takashi ; Yokogawa, Noriaki ; Ishii, Takayoshi ; Igarashi, Takashi ; Tsuchiya, Hiroyuki ; 新村, 和也 ; 村上, 英樹 ; 出村, 諭 ; 加藤, 仁志 ; 土屋, 弘行
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金沢大学医薬保健研究域医学系<br />Our aim was to compare the process of bone formation after reconstruction of the vertebral body usin
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g a titanium cage with either a liquid nitrogen-treated (frozen) bone autograft or non-treated fresh bone autograft. Twelve canine beagles underwent anterior reconstruction of the 5th lumbar vertebrae using a titanium cage and bone autograft. Bone formation was compared across four experimental groups: fresh bone autograft groups, with animals sacrificed at either 8 or 16 weeks post-reconstruction, and liquid nitrogen-treated (frozen) bone autograft groups, with animals again sacrificed at either 8 or 16 weeks post-reconstruction. Bone formation was evaluated histologically by calculating the proportion of 'reaction' and 'mature bone' regions at the ends of the cage, its center, and ventral/dorsal sides. The reaction region contained osteocytes with a nucleus and osteoblasts accumulated on the surface of an osteoid, while a laminar structure was visible for mature bone regions. For fresh bone autografts, the reaction and mature bone regions significantly increased from 8 to 16 weeks post-reconstruction. By comparison, for frozen autografts, the reaction bone region did not significantly increase from 8 to 16 weeks post-reconstruction, while the mature bone region did increase over this time period. The proportion of reaction bone was higher at the ends and dorsal side of the cage at 8 weeks, for both graft types, with greater bone formation at the center of the cage at 16 weeks only for the fresh bone autograft. Therefore, bone formation in the anterior spinal reconstruction site tended to be delayed when using a frozen bone autograft compared to a fresh bone autograft. The bone formation process, however, was similar for both groups, beginning at the ends and dorsal side of the cage adjacent to the surrounding vertebral bone. © 2018 Shinmura et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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| 2.
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Yokogawa, Noriaki ; Murakami, Hideki ; Demura, Satoru ; Kato, Satoshi ; Yoshioka, Katsuhito ; Yamamoto, Miyuki ; Iseki, Shoichi ; Tsuchiya, Hiroyuki
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Purpose Spinal surgery in a previously irradiated field carries increased risk of perioperative complications, such as d
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elayed wound healing or wound infection. In addition, adhesion around the dura mater is often observed clinically. Therefore, similar to radiation-induced fibrosis- a major late-stage radiation injury in other tissue-epidural fibrosis is anticipated to occur after spinal radiation. In this study, we performed histopathologic assessment of postirradiation changes in the spinal dura mater and peridural tissue in mice. Materials and Methods The thoracolumbar transition of ddY mice was irradiated with a single dose of 10 or 20 Gy. After resection of the irradiated spine, occurrence of epidural fibrosis and expression of transforming growth factor beta 1 in the spinal dura mater were evaluated. In addition, microstructures in the spinal dura mater and peridural tissue were assessed using an electron microscope. Results In the 20-Gy irradiated mice, epidural fibrosis first occurred around 12 weeks postirradiation, and was observed in all cases from 16 weeks postirradiation. In contrast, epidural fibrosis was not observed in the nonirradiated mice. Compared with the nonirradiated mice, the 10- and 20-Gy irradiated mice had significantly more overexpression of transforming growth factor beta 1 at 1 week postirradiation and in the late stages after irradiation. In microstructural assessment, the arachnoid barrier cell layer was thinned at 12 and 24 weeks postirradiation compared with that in the nonirradiated mice. Conclusion In mice, spinal epidural fibrosis develops in the late stages after high-dose irradiation, and overexpression of transforming growth factor beta 1 occurs in a manner similar to that seen in radiation-induced fibrosis in other tissue. Additionally, thinning of the arachnoid barrier cell layer was observed in the late stages after irradiation. Thus, consideration should be given to the possibility that these phenomena can occur as radiation-induced injuries of the spine. Copyright © 2015 Yokogawa et al.
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| 3.
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Sasagawa, Takeshi ; Kawahara, Norio ; Murakami, Hideki ; Demura, Satoru ; Yoshioka, Katsuhito ; Yamaguchi, Takehiko ; Tsuchiya, Hiroyuki ; Tomita, Katsuro
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seikei@pop01.kanazawa-u.ac.jp<br />Background Each vertebra can be regarded as a compartment surrounded by several anato
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mically characterized barriers. However, in some cases tumorsextend beyond these barriers. The route of vertical extension to the adjacent vertebrae is unclear. The extent ofvertical extension of a metastatic spinal tumor is important in making the preoperative decision regarding the cranio-caudal surgical margin. The objective of this study was toinvestigate the route of vertical extension of metastatic vertebral tumors. Methods We examined 20 en bloc resected metastatic vertebral bodies in which the tumors had extendedoutside the vertebral body. Five to eight sagittal sections including the pedicle, and the lateral and central parts of the PLL were prepared from each resected specimen. The sections were stained with hematoxylin and eosin, and elastica van Gieson. Histological examination focused on the routes of the vertical extension of the tumor at each barrier tissue and the degree of tumor extension along each route. Results Vertical extension ofthe tumor was observed at the ALL in 6 cases, at the central part of the PLL in 14 cases, at the lateral part of the PLL in 20 cases, at the cartilaginous endplate in 3 cases, and at the periosteum on the lateral side of vertebral body in 7 cases. The tumor had extended the farthest at the lateral part of the PLL in 18 cases, at the lateral side of the vertebral body in 1 case, and through the disc in 1 case. Conclusions Metastatic vertebral tumors most commonly extend vertically at the lateral part of the PLL. The lateralpart of the PLL is raised by the tumor, which extends between the PLL and the posterior aspect of the disc. © The Japanese Orthopaedic Association 2011.
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| 4.
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Hayashi, Hiroyuki ; Murakami, Hideki ; Demura, Satoru ; Kato, Satoshi ; Yoshioka, Katsuhito ; Shinmura, Kazuya ; Yokogawa, Noriaki ; Ishii, Takayoshi ; Fang, Xiang ; Shirai, Toshiharu ; Tsuchiya, Hiroyuki
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Background context Surgical site infection (SSI) associated with instruments remains a serious and common complication in patients who undergo total en bloc spondylectomy (TES). It is very important that the risk factors for SSI are
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known to prevent it.Purpose The purpose of the study was to identify independent risk factors for SSI after TES and evaluate the positive effect of iodine-supported spinal instruments in the prevention of SSI after TES.Study design This is a retrospective clinical study.Patient sample One hundred twenty-five patients who underwent TES for vertebral tumor were evaluated.Outcome measures Incidence rate of SSI, risk factors for SSI after TES, and safety of iodine-supported spinal instruments were the outcome measures.Methods Risk factors for SSI were analyzed using logistic regression. In recent 69 patients with iodine-supported spinal instruments, the thyroid hormone levels in the blood were examined to confirm if iodine from the implant influenced thyroid function. Postoperative radiological evaluations were performed regularly.Results The rate of SSI was 6.4% (8/125 patients). By multivariate logistic regression, combined anterior and posterior approach and nonuse of iodine-supported spinal instruments were associated with an increased risk of SSI. The rate of SSI without iodine-supported spinal instruments was 12.5%, whereas the rate with iodine-supported spinal instruments was 1.4%. This difference was statistically significant. There were no detected abnormalities of thyroid gland function with the use of iodine-supported instruments. Among the 69 patients with iodine-supported spinal instruments, 2 patients required additional surgery because of instrument failure. However, there were no obvious involvements with the use of iodine-supported spinal instruments.Conclusions This study identified combined anterior and posterior approach and nonuse of iodine-supported spinal instruments to be independent risk factors for SSI after TES. Iodine-supported spinal instrument was extremely effective for prevention of SSI in patients with compromised status, and it had no detection of cytotoxic or adverse effects on the patients.
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| 5.
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Yokogawa, Noriaki ; Murakami, Hideki ; Demura, Satoru ; Kato, Satoshi ; Yoshioka, Katsuhito ; Hayashi, Hiroyuki ; Ishii, Takayoshi ; Fujii, Moriyuki ; Igarashi, Takashi ; Tsuchiya, Hiroyuki
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Background: In total en bloc spondylectomy (TES) of upper thoracic spine including the second thoracic (T2) vertebra, T2 nerve roots are usually transected. In this study, we examined the association between transection of
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the T2 nerve roots and upper-extremity motor function in patients with upper thoracic TES. Copyright:Methods: We assessed 16 patients who underwent upper thoracic TES with bilateral transection of the T2 nerve roots. Patients were divided into three groups: 3 patients without any processing of T1 and upper nerve roots (T2 group), 7 with extensive dissection of T1 nerve roots (T1-2 group), and 6 with extensive dissection of T1 and upper nerve roots (C-T2 group). Postoperative upper-extremity motor function was compared between the groups.Results: Postoperative deterioration of upper-extremity motor function was observed in 9 of the 16 patients (56.3%). Three of the 7 patients in the T1-2 group and all 6 patients in the C-T2 group showed deterioration of upper-extremity motor function, but there was no deterioration in the T2 group. In the T1-2 group, 3 patients showed mild deterioration that did not affect their activities of daily living and they achieved complete recovery at the latest follow-up examination. In contrast, severe dysfunction occurred frequently in the C-T2 group, without recovery at the latest follow-up.Conclusions: The transection of the T2 nerve roots alone did not result in upper-extremity motor dysfunction; rather, the dysfunction is caused by the extensive dissection of the T1 and upper nerve roots. Therefore, transection of the T2 nerve roots in upper thoracic TES seems to be an acceptable procedure with satisfactory outcomes.
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| 6.
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Sugita, Shurei ; Murakami, Hideki ; Demura, Satoru ; Kato, Satoshi ; Yoshioka, Katsuhito ; Yokogawa, Noriaki ; Tanaka, Sakae ; Tsuchiya, Hiroyuki
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Purpose: Total en bloc spondylectomy (TES) is accompanied by preoperative embolization of segmental arteries, which is l
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imited to three consecutive levels to avoid the risk of spinal cord ischemia. We retrospectively examined the efficacy and safety of repeated TES with embolization of more than three levels of segmental arteries. Methods: Seven patients underwent TES twice for spinal metastases at different levels. Every patient underwent embolization of the bilateral segmental arteries before each surgery. We assessed the total number of segmental arteries embolized, the existence of Adamkiewicz arteries during the embolization procedure, intraoperative blood loss, and the motor function of the lower limbs, using the American Spinal Injury Association (ASIA) motor score. Results: No patient experienced any motor deficit after embolization. During the embolization procedure, an Adamkiewicz artery was depicted in five patients, which precluded embolization at that level. The median number of segmental arteries embolized in total was 9 (9–11). Intraoperative blood loss (median, IQR) was 480 (420–630) ml during the first surgery and 520 (280–600) ml during the second surgery. The ASIA motor scores (median, IQR) were as follows; 100 (98–100) (first admission), 100 (100–100) (first discharge), 100 (98–100) (second admission), and 97 (94–100) (second discharge). No patients had developed statistically significant neurological deterioration, and there had been no local recurrence after a median follow-up of 17.8 months (range 1–51 months). Conclusion: Repeated TES procedures can be performed safely even if more than three levels of segmental arteries are embolized. © 2015 Springer-Verlag Berlin Heidelberg<br />Embargo Period 12 months
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Hayashi, Hiroyuki ; Murakami, Hideki ; Demura, Satoru ; Kato, Satoshi ; Kawahara, Norio ; Tsuchiya, Hiroyuki
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Background: Posterior lumbar interbody fusion (PLIF) has become the standard in the treatment for degenerative spondylol
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isthesis since improvement of spinal instrumentation However, few published studies have reported long term outcomes of PLIF using a same surgical procedure. The purpose of this study is to evaluate a long term outcome of PLIF using a same surgical procedure for L4-L5 degenerative spondylolisthesis. Materials and Methods: Out of 45 patients who underwent L4-L5 PLIF for degenerative spondylolisthesis between 1995 and 2003, 37 patients (16 males and 21 females) were evaluated in this study. Mean age was 61.8 years. The average followup period was 121 months. We evaluated % slip, lordosis at L4/L5, lumbar lordosis, Japanese Orthopedic Association's (JOA) score and adjacent segment degeneration. Results: The % slip significantly improved from an average of 17.0% before surgery to 9.7% at the last followup. Lordosis at L4/L5 averaged 3.6° before surgery, 8.2° after surgery and 6.9° at the last followup. Although patients experienced some loss of correction at last followup, their lordosis at L4/L5 at last followup still was significantly different from their lordosis at L4/L5 before surgery. Lumbar lordosis did not significantly change. Mean JOA score was 13.4 before surgery and 24.5 at the last followup; mean recovery ratio was 71.2%. Adjacent segment degeneration occurred in 40.5% of patients, almost all of which occurred in the cranial adjacent segment. Three patients (8.1%) required reoperation due to adjacent segment degeneration, at an average of 76 months after their initial surgery. Conclusions: With more than 10-year followup after L4-L5 PLIF for degenerative spondylolisthesis, the adjacent segment degeneration occurred in 40.5% and reoperation was required in 8.1%. © 2015, Medknow Publications Pvt Ltd. All rights reserved.
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| 8.
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Sugita, Shurei ; Murakami, Hideki ; Demura, Satoru ; Kato, Satoshi ; Yoshioka, Katsuhito ; Yokogawa, Noriaki ; Tanaka, Sakae ; Tsuchiya, Hiroyuki
概要:
Purpose: Total en bloc spondylectomy (TES) is accompanied by preoperative embolization of segmental arteries, which is l
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imited to three consecutive levels to avoid the risk of spinal cord ischemia. We retrospectively examined the efficacy and safety of repeated TES with embolization of more than three levels of segmental arteries. Methods: Seven patients underwent TES twice for spinal metastases at different levels. Every patient underwent embolization of the bilateral segmental arteries before each surgery. We assessed the total number of segmental arteries embolized, the existence of Adamkiewicz arteries during the embolization procedure, intraoperative blood loss, and the motor function of the lower limbs, using the American Spinal Injury Association (ASIA) motor score. Results: No patient experienced any motor deficit after embolization. During the embolization procedure, an Adamkiewicz artery was depicted in five patients, which precluded embolization at that level. The median number of segmental arteries embolized in total was 9 (9–11). Intraoperative blood loss (median, IQR) was 480 (420–630) ml during the first surgery and 520 (280–600) ml during the second surgery. The ASIA motor scores (median, IQR) were as follows; 100 (98–100) (first admission), 100 (100–100) (first discharge), 100 (98–100) (second admission), and 97 (94–100) (second discharge). No patients had developed statistically significant neurological deterioration, and there had been no local recurrence after a median follow-up of 17.8 months (range 1–51 months). Conclusion: Repeated TES procedures can be performed safely even if more than three levels of segmental arteries are embolized. © 2015, Springer-Verlag Berlin Heidelberg.<br />Embargo Period 12 months
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Demura, Satoru ; Kawahara, Norio ; Murakami, Hideki ; Akamaru, Tomoyuki ; Kato, Satoshi ; Oda, Makoto ; Tomita, Katsuro ; Tsuchiya, Hiroyuki
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This article describes a case of a giant cell tumor that expanded into the thoracic cavity and through the spinal canal into the vertebrae. A 36-year-old man presented with a 6-month history of back pain and dyspnea. Plain chest
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radiographs showed a huge mass accompanied by right pleural effusion. The mass involved the 12th thoracic spine, and the spinal cord was severely compressed. The tumor was resected with a 2-stage procedure. As a first stage to separate the tumor from the anterior vital structures under direct vision, thoracic surgeons performed a right thoracotomy with chest wall reconstruction from the 8th to 11th ribs. The right lung and inferior vena cava were gently retracted, and the tumor was carefully detached from these structures. We were not able to separate the tumor from the right diaphragm due to severe invasion; therefore, we performed partial resection of the right diaphragm with the tumor. After excision of the anterior part of the tumor, the thoracic wall was reconstructed with the right eighth rib and Marlex mesh. When the patient's general condition improved 2 weeks later, spondylectomy by posterior approach was performed. We achieved excision of a giant cell tumor that had expanded into the thoracic cavity and through the spinal canal into the vertebrae. The patient had achieved full rehabilitation with no neurological or respiratory abnormalities at 7 years postoperatively.
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10. Epidural inflammatory pseudotumor in the thoracic spine in a patient with polymyalgia rheumatica
Kato, Satoshi ; Murakami, Hideki ; Demura, Satoru ; Yoshioka, Katsuhito ; Okamoto, Yoshiyuki ; Hayashi, Hiroyuki ; Tsuchiya, Hiroyuki
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Background context: Only six previous cases of epidural inflammatory psedotumor in the spine have been reported. None of
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them were seen in the course of polymyalgia rheumatica (PMR). Purpose: To describe a rare case of epidural inflammatory pseudotumor in the thoracic spine in a patient with PMR. Study design: Case report. Methods: A 63-year-old man had a 6-year history of PMR treated with prednisone and cyclosporine. He presented with gait disturbance. Magnetic resonance imaging on the 12th day after the onset of the symptoms showed spinal cord compression caused by a posterior epidural mass at the T5-T6 level. Results: The patient underwent a T5-T6 laminectomy and a total excision of the mass, which involved the ligament flavum and epidural adipose tissue and firmly attached to the dura mater. Histopathologic examination revealed severe lymphoplasmacytic infiltration with fibrosis in the entire specimen and no evidence of hematomas or tumorous lesions. After surgery, the patient's neurologic symptoms disappeared immediately. Two years after surgery, the patient is neurologically normal and has not had a recurrence. Conclusions: This report identifies a rare case of epidural inflammatory pseudotumor in the thoracic spine in a patient with PMR. © 2012 Elsevier Inc. All rights reserved.
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