古矢 丈雄

PURPOSE: In this multicenter retrospective observational study, we examined the early effects of romosozumab in patients with severe osteoporosis in terms of time-course changes in bone metabolism marker, improvement in bone density, and adverse effects. MATERIALS AND METHODS: Patients with severe osteoporosis were included. We investigated the progress of TRACP 5b and P1NP before and 1-2 months after the administration of romosozumab. We also investigated the bone density of lumbar spine, femoral neck, and the entire femur, measured by the DXA method, before and 5-7 months after the administration of romosozumab. RESULTS: A total of 70 patients (7 males and 63 females, age 75.0±3.6 years) participated in this study. Significant improvements in TRACP 5b and P1NP levels were observed before and 1-2 months after romosozumab administration. The average bone density of lumbar spine, femoral neck, and the entire femur were measured before and 5-7 months after romosozumab administration; and a significant increase only observed in the lumbar spine. CONCLUSION: Consistent with the findings of previous clinical studies, romosozumab has both bone formation-enhancing and bone resorption effects (dual effect). In addition, romosozumab also demonstrated improvement in bone density from the early phase after the administration, though the result was only seen in the lumbar spine.

Nonsurgical treatment is the first option in patients with radiculopathy due to spinal metastasis. However, we have to consider surgical management for patients who are resistant to conservative treatment. There are few reports of surgical treatment for radiculopathy due to metastatic spine tumors. We present cases in three patients who underwent surgery for radiculopathy due to spinal metastasis. Case 1 was in an 82-year-old woman with lumbar foraminal stenosis at L5-S1 due to breast cancer metastasis to the right L5-S1 intervertebral foramen. She underwent subtotal tumor resection and posterior lumbosacral decompression and fusion. After the surgery, she was able to walk without pain. Case 2 was in a 70-year-old woman with C8 radiculopathy and amyotrophy due to breast cancer metastasis to the right C7-T1 intervertebral foramen. She underwent anterior cervical decompression and fixation from C6 to T1. After the surgery, the pain in her left upper limb was relieved, but the muscle weakness of her left finger extension remained. Case 3 was in a 72-year-old woman with C8 radiculopathy and amyotrophy due to rectal cancer metastasis to the right side of the C7 vertebral body and pedicle. She underwent tumor resection and left C7-T1 facetectomy. Muscle weakness of her right finger extension and pain improved postoperatively. Surgery for radiculopathy due to spinal metastasis can improve pain in afflicted patients. Postoperative improvement of motor weakness due to spinal metastasis varies depending on the case. Surgery for radiculopathy due to spinal metastasis is indicated when patients have conservative treatment-resistant radiculopathy or amyotrophy that affects their activities of daily living.

BACKGROUND: When treating cancer patients, the progression of symptoms is accompanied by the deterioration of systemic conditions and motor function. From a risk-benefit perspective, a certain level of physical function must be maintained to continue cancer treatment. Recently, outpatient cancer treatment has become more common. Motor function is important to determine the feasibility of continuing cancer treatment. The study aimed to evaluate the motor function of patients with visceral cancer using locomo tests established by Japanese Orthopaedic Association. METHODS: Locomo tests were performed, and the results were compared with data from non-cancer individuals. Background data were matched by propensity score matching. Data from 53 cancer patients (group C) were compared with that of 75 non-cancer patients (group N). RESULTS: The average score in the two-step test of group C was lower than that of group N (1.27: 1.37, p = 0.004). The average function in the stand-up test of group C was worse than that of group N (p = 0.001). The average score in the 25-question geriatric locomotive function scale (GLFS) of group C was significantly higher than that of group N (19.92: 5.29, SE 2.21, p < 0.001). Higher 25-question GLFS scores indicate reduced mobility. The proportion of the locomo stage 2 in group C was significantly higher than in group N (51%: 13%, p < 0.001). The results of the two field tests revealed a clinically minimal difference between the two groups, but a statistically significant difference. Locomo tests may be detect potential motor dysfunction in outpatient cancer patients with apparently maintained motor function. CONCLUSIONS: Even in cancer patients who attend outpatient clinics, their motor functions could be potentially impaired. Therapeutic interventions to maintain and enhance motor function for cancer patients could be useful for continuing cancer treatment, and furthermore, improving prognosis.

STUDY DESIGN: Prospective multicenter study. OBJECTIVES: The purpose of this study was to characterize a population of patients with degenerative cervical myelopathy (DCM) combined with a history of falling, and to identify the predictors associated with those falls. SUMMARY OF BACKGROUND DATA: Falls among patients with DCM are common and can lead to the worsening of neurological symptoms. However, there are no prospective studies that have investigated the risk factors for falls in these patients. METHODS: We prospectively enrolled patients scheduled for surgery for DCM and evaluated the significance of various preoperative measures for predicting falls. We then examined the correlation between the number of falls and the preoperative factors. Lastly, we performed stepwise logistic regression analysis to assess the concurrent effects of various factors on the occurrence of falls. RESULTS: Among the 135 patients analyzed, 64 experienced one or more falls from the time of enrollment to 1 year postoperatively. Univariate analysis showed that the preoperative potassium and albumin levels, handgrip strength, and the Japanese Orthopaedic Association score for the assessment of cervical myelopathy (C-JOA score) were lower and Nurick grade was higher in the fallers group. Serum potassium level, handgrip strength, C-JOA score, Nurick grade, European Quality of Life-5 Dimensions (EQ-5D) score, t1 pelvic angle, and sagittal vertical axis had weak correlations with the number of falls. The fallers group had a lower C-JOA and EQ-5D scores and a lower recovery rate at one year postoperatively. Stepwise multiple logistic regression analysis identified preoperative potassium level and handgrip strength as the independent preoperative predictors for falling. CONCLUSION: We identified preoperative lower serum potassium level and weaker handgrip strength as significant predictors of falls in patients with DCM. Therefore, DCM patients with these risk factors should be cautious about falls and might be candidates for immediate surgical intervention.Level of Evidence: 3.

Cutamesine, a sigma-1 receptor agonist, functions in both neuroprotection and neurite outgrowth. We assessed the therapeutic effects of cutamesine in a rodent spinal cord injury (SCI) model to demonstrate pre-clinical proof-of-concept. First of all, in order to determine optimal cutamesine dose, cutamesine was administered to normal rats and BDNF protein levels in the lumbar spinal cord were assessed by Western blot. Next, for the SCI model, spinal cords of adult female Sprague-Dawley rats were contused using an Infinite Horizon Impactor. Two weeks post-injury, rats were randomly assigned to receive daily subcutaneous injections of either cutamesine (3.0 mg/kg/day) or saline (as a control) for another two weeks. Immunohistochemistry for BDNF and 5-HT was assessed at four and twelve weeks post-injury in the lumbar spinal cord. Locomotor function was assessed weekly using the BBB locomotor scale until twelve weeks after SCI and CatWalk XT 10.5 gait analysis was conducted at twelve weeks after SCI. In normal rats, cutamesine treatment (3.0 mg/kg/day) significantly up-regulated BDNF expression in the lumbar spinal cord. In SCI rats, cutamesine treatment (3.0 mg/kg/day) significantly increased the fluorescence intensity of neuronal BDNF and serotonin boutons in the injured spinal cord compared to saline. However, cutamesine treatment did not promote significant locomotor recovery. Recent work indicates that cutamesine treatment alone did not promote locomotor recovery in spite of immunohistological changes. Future work will explore the influence of combining cutamesine with other treatment promoting plasticity (e.g. rehabilitative training) in SCI rats.

This study aimed to perform a comparative analysis of postoperative results between lumbar degenerative spondylolisthesis (LDS) treated with oblique lateral interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) from the Chiba spine surgery registry database. Sixty-five patients who underwent single-level OLIF (O group) for LDS with ≥ 3 years' follow-up were retrospectively reviewed. The control group comprised 78 patients who underwent single-level TLIF (T group). The analyzed variables included global alignment, radiological parameters of fused segments, asymptomatic and symptomatic ASD incidence, clinical outcomes at 3 years postoperatively using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire data, visual analogue scale scores for low back pain, lower extremity pain, and lower extremity numbness. There was no significant change in global alignment between the two groups. The rate of improvement in anterior intervertebral disc height was not significantly different between the groups at 1-month postoperatively. However, at the final evaluation, the anterior intervertebral disc height and incidence of asymptomatic ASD were significantly higher in the O group. There was no significant difference in symptomatic ASD, reoperation cases, or clinical results between groups. Thus, single-level OLIF can maintain the corrected disc height, but as it has no effect on global alignment, its benefit is limited.

Ossification of the posterior longitudinal ligament (OPLL) is commonly associated with diabetes mellitus (DM); however, the impact of DM on cervical spine surgery for OPLL remains unclear. This study was performed to evaluate the influence of diabetes DM on the outcomes following cervical spine surgery for OPLL. In total, 478 patients with cervical OPLL who underwent surgical treatment were prospectively recruited from April 2015 to July 2017. Functional measurements were conducted at baseline and at 6 months, 1 year, and 2 years after surgery using JOA and JOACMEQ scores. The incidence of postoperative complications was categorized into early (≤30 days) and late (>30 days), depending on the time from surgery. From the initial group of 478 patients, 402 completed the 2-year follow-up and were included in the analysis. Of the 402 patients, 127 (32%) had DM as a comorbid disease. The overall incidence of postoperative complications was significantly higher in patients with DM than in patients without DM in both the early and late postoperative periods. The patients with DM had a significantly lower JOA score and JOACMEQ scores in the domains of lower extremity function and quality of life than those without DM at the 2-year follow-up.

Ossification of the posterior longitudinal ligament (OPLL) is a progressive disease. The bridging of ossified lesions to the vertebral body gradually increases, thereby decreasing the mobility of the cervical spine; thus, cervical spine function may decrease over time. However, cervical spine function in patients with cervical OPLL has not been evaluated in large prospective studies. Therefore, we conducted a prospective multicenter study to clarify whether ossification spread can influence cervical spine function and quality of life (QOL) in patients with cervical OPLL. In total, 238 patients (162 men, 76 women; mean age, 63.9 years) were enrolled from 16 institutions. Each patient underwent whole spine computed tomography and was evaluated for cervical spine function and QOL using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). In the multivariate regression analysis, a higher neck VAS score and a larger number of bridge formations of OPLL in the whole spine were significant predictors of adverse outcomes related to cervical spine function. This is the first prospective multicenter study to reveal the impact of ossification spread on cervical spine function. These findings are important to understand the natural course of OPLL and can serve as controls when evaluating postoperative cervical spine function.

腕時計型のウエアラブル端末装置を用いて、腰痛患者の日常の活動量を計測・蓄積したデータを用い、日常および腰椎手術前後における活動量を客観的に評価することで腰痛患者の実態を評価し、患者立脚型アウトカムとの関連を調査した。ウエアラブル端末を用いた腰痛患者の客観的な活動量評価は、患者の記憶や主観に基づく従来型アンケート形式の評価と比較すると、より患者の実態に即した評価が得られると考えられる。

Horner's syndrome is caused by impairment of the sympathetic trunk, resulting in associated ptosis, miosis, and anhidrosis. The cervical sympathetic trunk is sometimes damaged during an anterior approach to the lower cervical spine. We report two cases of Horner's syndrome after anterior decompression and fusion for lower cervical spine pathologies. Case 1 was in a 58-year-old woman with a herniated C5-6 intervertebral disc presenting myelopathy who underwent anterior cervical discectomy and fusion of C5-6. After the operation, miosis and anhidrosis of the right face occurred, and the symptoms continued for more than 15 years. Case 2 was in a 40-year-old woman whose diagnosis was flexion myelopathy with kyphosis at C5-6 and canal stenosis, so she underwent anterior cervical C5-6 discectomy and fusion of C5-6. Immediately after surgery, ptosis and miosis occurred, which lasted for four months. Horner's syndrome tends to occur during anterior cervical spine procedures, especially at the lower level, and the syndrome may be transient or irreversible. During an anterior approach to the lower cervical spine, taking care not to damage the sympathetic trunk is important to avoid this complication.

Cervical ossification of the posterior longitudinal ligament (OPLL) is a contributing factor to spinal cord injury or trauma-induced myelopathy in the elderly. To reduce the incidence of these traumas, it is essential to diagnose OPLL at an early stage and to educate patients how to prevent falls. We thus evaluated the ability of our convolutional neural network (CNN) to differentially diagnose cervical spondylosis and cervical OPLL. We enrolled 250 patients with cervical spondylosis, 250 patients with cervical OPLL, and 180 radiographically normal controls. We evaluated the ability of our CNN model to distinguish cervical spondylosis, cervical OPLL, and controls, and the diagnostic accuracy was compared to that of 5 board-certified spine surgeons. The accuracy, average recall, precision, and F1 score of the CNN for classification of lateral cervical spine radiographs were 0.86, 0.86, 0.87, and 0.87, respectively. The accuracy was higher for CNN compared to any expert spine surgeon, and was statistically equal to 4 of the 5 experts and significantly higher than that of 1 expert. We demonstrated that the performance of the CNN was equal or superior to that of spine surgeons.

Although favourable surgical outcomes for myelopathy caused by cervical ossification of the posterior longitudinal ligament (OPLL) have been reported, factors significantly associated with post-operative neck pain attenuation still remain unclear. The primary aim of the present study was to determine factors significantly associated with post-operative neck pain attenuation in patients with cervical OPLL using a prospective multi-centre registry of surgically treated cervical OPLL. Significant postoperative neck pain reduction (50% reduction of neck pain) was achieved in 31.3% of patients. There was no significant difference in neck pain attenuation between surgical procedures. Statistical analyses with univariate analyses followed by stepwise logistic regression revealed neurological recovery as a factor having a significant positive association with post-operative neck pain attenuation (p = 0.04, odds ratio 5.68 (95% confidence interval: 1.27-22.2)). In conclusion, neurological recovery was an independent factor having a significant positive association with post-operative neck pain attenuation in patients with cervical myelopathy caused by OPLL who underwent cervical spine surgery.

BACKGROUND: Ossification of the posterior longitudinal ligament of the spine (OPLL) is characterized by heterotopic bone formation in the posterior longitudinal ligament of the spine. Although the patients with OPLL are more common in the 60s and 70s, we know that there are markedly young patients (e.g., early 40s). However, to the best of our knowledge, there is few reports characterize young patients with cervical OPLL in terms of the imaging features, subjective symptoms, and ADL problems. METHODS: This is the multicenter cross-sectional study. Two hundred and thirty-seven Japanese symptomatic patients with cervical OPLL confirmed by standard X-rays collected from 16 institutions belonging to the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament formed by the Japanese Ministry of Health, Labor and Welfare were recruited. Whole spine CT data as well as demographic data such as age, gender, patients-based evaluations, and the 36-item Short Form Health Survey (SF-36) were evaluated. RESULTS: Young group (≦ 45 years old) consisted of 23 patients (8 females and 15 males), accounting for 9.7% of the total. Their characteristics were high body mass index (BMI), significant involvement of trauma in the onset and deterioration of symptoms, and the predominance of thoracic OPLL. The patient-based evaluations did not show a significant difference between the young and non-young groups, or between the genders in the young group except for bodily pain (BP) of SF-36. Female patients in young group had significantly lower BP score of SF-36 than that of male in young group. CONCLUSIONS: Characteristics of young patients with cervical OPLL were high BMI, significant involvement of trauma in the onset and deterioration of symptoms, lower BP score of SF-36 in female, and the predominance of thoracic OPLL.

腰痛患者では複合的な疼痛要素が関与する可能性があり,下肢痛・臀部痛の存在が神経障害性疼痛の可能性を示唆する。2019年に発刊された腰痛診療ガイドライン改訂版では日常診療を反映した実践的ガイドラインとしての編纂がなされた。薬物治療の項では初版の急性・慢性腰痛に加えて坐骨神経痛が加味された。慢性腰痛を中心に有効性が述べられた運動療法は,近年広まりつつあるサルコペニアの概念とともに注目を浴びており,今後のさらなる研究が待たれる。(著者抄録)

Objective: In recent years, there has been an increase in research on the therapeutic effects of exergaming, but there have been few studies on these types of interventions for chronic low back pain. In this study, we hypothesized that the Nintendo Ring Fit Adventure (RFA) exergame would be effective for patients with chronic low back pain, and we conducted a randomized prospective longitudinal study.Materials and Methods: Patients with chronic low back pain were included in this study. Twenty randomly selected patients (9 males and 11 females, mean age 49.3 years) were included in the RFA group, and RFA exergaming was performed once a week for 40 minutes for 8 weeks. Twenty patients (12 males and 8 females, mean age 55.60 years) served as the control group and received oral treatment for 8 weeks. Pain and psychological scores (pain self-efficacy, pain catastrophizing, and kinesiophobia) were measured and analyzed before and after 8 weeks of treatment in both groups.Results: In the RFA group, low back pain, buttock pain, and pain self-efficacy were significantly improved after 8 weeks of RFA exergaming, but there was no significant improvement in lower limb numbness, pain catastrophizing, or kinesiophobia. In the control group, no significant improvement was observed after 8 weeks of oral treatment.Conclusion: RFA exergaming increased pain self-efficacy and reduced pain in patients with chronic low back pain. Future treatment protocols should be developed to improve pain self-efficacy.

BACKGROUND: Degenerative cervical myelopathy (DCM) can significantly impair a patient's quality of life (QOL). In this study, we aimed to identify predictors associated with QOL improvement after surgery for DCM. METHODS: This study included 148 patients who underwent surgery for DCM. The European QOL-5 Dimension (EQ-5D) score, the Japanese Orthopedic Association for the assessment of cervical myelopathy (C-JOA) score, and the Nurick grade were used as outcome measures. Radiographic examinations were performed at enrollment. The associations of baseline variables with changes in EQ-5D scores from preoperative to 1-year postoperative assessment were investigated using a multivariable linear regression model. RESULTS: The EQ-5D and C-JOA scores and the Nurick grade improved after surgery (P < 0.001, P < 0.001, and P < 0.001, respectively). Univariable analysis revealed that preoperative EQ-5D and C-JOA scores were significantly associated with increased EQ-5D scores from preoperative assessment to 1 year after surgery (P < 0.0001 and P = 0.045). Multivariable regression analysis showed that the independent preoperative predictors of change in QOL were lumbar lordosis (LL), sacral slope (SS), and T1 pelvic angle (TPA). According to the prediction model, the increased EQ-5D score from preoperatively to 1 year after surgery = 0.308 - 0.493 × EQ-5D + 0.006 × LL - 0.008 × SS + 0.004 × TPA. CONCLUSIONS: Preoperative LL, SS, and TPA significantly impacted the QOL of patients who underwent surgery for DCM. Less improvement in QOL after surgery was achieved in patients with smaller LL and TPA and larger SS values. Patients with these risk factors may therefore require additional support to experience adequate improvement in QOL.

The aim of this study was to determine whether advanced glycation end products (AGEs) revealed by skin autofluorescence (SAF), serum and urine pentosidine level, and serum homocysteine level can serve as a biomarker for sarcopenia in older women. The participants were 70 elderly women. The AGEs pentosidine, homocysteine, and SAF were measured as aging markers. This study shows that among the biomarkers for aging, serum pentosidine correlates with a loss of appendicular lean mass and can serve as a biomarker for sarcopenia. Moreover, SAF and homocysteine values exhibited a positive correlation with age and correlated with each other.Abbreviations: AGEs: advanced glycation end products; BIA: bioelectrical impedance analyzer; BMD: bone mineral density; DLS: degenerative lumbar scoliosis; DXA: dual-energy X-ray absorptiometry; ELISA: enzyme-linked immunoassay; HHcy: hyperhomocysteinemia; RIA: radioimmunoassay; SAF: skin autofluorescence; SMI: skeletal muscle mass index; T2DM: type 2 diabetes patients.

＜文献概要＞既存椎体骨折は将来の椎体骨折を4倍,またすべての骨折リスクを2倍に高めるとも報告されている。すなわち,骨粗鬆症性椎体骨折受傷直後から骨折の連鎖を止めるための薬物治療(二次骨折予防)を開始することが必須である。そこで本稿では,骨粗鬆症性椎体骨折に対する薬物療法について,(1)骨折の連鎖を止めるための薬物治療(二次骨折予防),(2)術前後の薬物治療(骨癒合促進)の2つの観点から概説する。

われわれ痛み診療に従事する医師にとって、骨粗鬆症と腰痛は非常に密接した病態であり、それらの機序を正確に理解することが診断および治療の観点から非常に重要である。骨粗鬆症患者が腰痛を訴える原因として、(1)骨折、(2)骨粗鬆化、(3)サルコペニア、(4)酸化ストレスの4つが注目されている。重要な点は、これらの原因は独立して存在するのではなく、お互いが重複して存在することが多いということである。このことを常に念頭に置き、腰痛のある骨粗鬆症患者を診察、治療していくことが重要であると考える。(著者抄録)

腰痛の予防においては、初発発生率の抑制、慢性化・悪化の防止、再発予防などが基本的な概念となる。健康的な生活を送るよう心がけることや理想体重の維持など生活習慣改善は腰痛予防に寄与し、運動療法は腰痛予防に有用である。運動療法による腰痛予防は「腰への負担をかけない姿勢や動作を取ること」や「筋力トレーニングやストレッチなどの体操を行うこと」を習慣づけ日常生活での姿勢改善と体幹筋筋力と筋持久力を回復することが重要である。また、腰痛予防や治療には日々新しいアイデアが創出され、昨今ではフィットネスゲームを腰痛改善を含む健康増進に役立てるexergamingも腰痛予防・治療の手段として報告されている。(著者抄録)

＜文献概要＞はじめに 後彎症は脊柱アライメント異常を呈する疾患であるが,加齢とともに増悪する傾向があり患者の生活の質(QOL)を著しく阻害することは周知の事実である.具体的には後彎変形による歩行能力低下に起因した日常生活動作(ADL)低下および持続的な慢性背筋疲労による難治性腰痛が臨床的な問題である.これらの症状は治療抵抗性(リハビリテーション介入や鎮痛薬を含めた薬剤介入など多くの保存的治療が無効)であることもよく知られている.一方で,近年ではこのような病態に対する手術的治療法の有効性が報告されているが,侵襲が大きすぎる点と高額の医療費がかかる点からスタンダードな治療法になるにはいたっていない.すなわち高齢社会を迎え患者数は年々増大しているが,その対策は後手に回っているといえる.そこで本稿では,高齢者後彎症の(1)病態メカニズム,(2)治療戦略に関する最新の知見について概説する.

We investigated the relationship between trunk muscle mass and spinal pathologies by gender. This multicenter cross-sectional study included patients aged ≥ 30 years who visited a spinal outpatient clinic. Trunk and appendicular muscle mass were measured using bioelectrical impedance analysis. The Oswestry Disability Index (ODI), visual analog scale (VAS) score for low back pain, sagittal vertical axis (SVA), and EuroQol 5 Dimension (EQ5D) score were investigated to evaluate spinal pathology. The association between trunk muscle mass and these parameters was analyzed by gender using a non-linear regression model adjusted for patients' demographics. We investigated the association between age and trunk muscle mass. We included 781 men and 957 women. Trunk muscle mass differed significantly between men and women, although it decreased with age after age 70 in both genders. Lower trunk muscle mass was significantly associated with ODI, SVA, and EQ5D score deterioration in both genders; its association with VAS was significant only in men. Most parameters deteriorated when trunk muscle mass was < 26 kg in men and < 19 kg in women. Lower trunk muscle mass was associated with lumbar disability, spinal imbalance, and poor quality of life in both genders, with significant difference in muscle mass.

畳み込みニューラルネットワーク(CNN)を用いてMRIによる神経鞘腫と髄膜腫の鑑別を行った。当院で腫瘍摘出術を受けた硬膜内髄外脊髄腫瘍患者(神経鞘腫50人、髄膜腫34人)を対象とした。T2強調像および造影T1強調像に基づくCNNのROC曲線のAUCはそれぞれ0.88および0.87であった。2人の放射線科医の感度はT2強調像と造影T1強調像の両方でCNNの感度よりも優れていた。特異度においては、CNNがT2強調像の2人の放射線科医よりも良好であり、造影T1強調線でも同様の傾向がみられたが有意差はなかった。CNNの正確度はT2強調像で放射線科医よりも優れている傾向にあったが、造影T1強調像では正確度は同等であった。本研究のCNNは経験豊富な放射線科医の鑑別能に匹敵する高い鑑別能で脊髄神経鞘腫と髄膜腫を識別することができた。

STUDY DESIGN: Retrospective observational study. PURPOSE: Lumbar spinal stenosis (LSS) has traditionally been evaluated morphologically, there is a paucity of literature on quantitative assessment of LSS. The purpose of this study was to investigate whether intraspinal diffusion tensor imaging (DTI) parameters such as apparent diffusion coefficient (ADC) and fractional anisotropy (FA) are useful for assessing LSS. OVERVIEW OF LITERATURE: Quantitative assessment of LSS is challenging. METHODS: Study participants comprised five healthy volunteers (mean age, 27.2 years) and 27 patients with LSS (mean age, 58.4 years) who were individually assessed using 3.0 Tesla magnetic resonance imaging. Intraspinal ADC and FA values of 10 intervertebral discs from healthy volunteers and 52 intervertebral discs from LSS patients were measured. Also, intraspinal canal area, Schizas classification (A: normal, B: mild stenosis, C: severe stenosis) and correlations with symptoms were investigated. Clinical symptoms were checked for the presence of low back pain (LBP), intermittent claudication (IMC), and bladder and bowel dysfunction (BBD). RESULTS: Compared to healthy individuals, LSS patients had significantly lower ADC (p<0.05) and significantly higher FA values (p<0.01). In Schizas classification, stenosis worsened from A to C. ADC values decreased significantly while FA values increased significantly in that order (p<0.05). A positive correlation was found between intraspinal canal area and ADC values (r=0.63, p<0.01) and a negative correlation between intraspinal canal area and FA values (p=-0.61, p<0.01). No correlations were noted between LBP and ADC or FA values. On the other hand, ADC values were significantly lower (p<0.05) and FA values were significantly higher (p<0.05) in patients with IMC or BBD. CONCLUSIONS: Intraspinal DTI parameters such as ADC and FA values were associated with the Schizas classification, intraspinal canal area, and clinical symptoms, suggesting that ADC and FA may be useful for quantitative assessment of LSS.

肺癌骨転移例で、主科(呼吸器内科または呼吸器外科)から当科に対して骨生検検体による遺伝子検索の依頼があった9例10検体の検索結果を報告した。検体採取部位の内訳は、腰椎椎弓根が4検体、腸骨3検体、胸椎椎弓根2検体、胸椎横突起1検体であった。病変の組織採取ができたのは9検体で、いずれも病理組織学的に癌細胞が確認された。病変組織を採取できなかった1検体は、骨修飾薬投与に伴う病変部の骨硬化が強いため生検針を病変に到達させることができなかった。遺伝子検査を実施した9検体中4検体にEGFR遺伝子変異が認められ、うち2例はT790Mが陽性であった。9例とも骨生検結果の報告後に主科で治療方針の検討が行われ、T790M陽性の2例はいずれも抗悪性腫瘍薬がゲフィチニブからオシメルチニブメシル酸塩へ変更となった。

This study examined the factors that inhibit the therapeutic effects of cognitive behavioral therapy (CBT) and clarify the adaptation judgment criteria of CBT. We included patients with chronic low back pain and allocated them to the adaptation (with visual analog scale [VAS] improvement) or non-adaptation group (without VAS improvement). The patients were analyzed using various psychological tests. CBT improved depressive symptoms and catastrophic thinking; however, they were not correlated with the VAS and did not directly affect low back pain improvement. The non-adaptation group showed an unexplainable/vague sense of anxiety; an excessive focus on searching for pain; a strong intimacy desire; a strong tendency of medical dependency; and fantasy or distortion of the actual experience, especially self-image. Moreover, the patients showed a low ability to objectively express or attribute meaning to pain due to poor language skills, attention-deficit hyperactivity disorder, and emotional value judgment. Individuals with the aforementioned characteristics of pre-CBT psychological tests should select a different treatment approach given the high poor-adaption possibility. Even patients with depressive or anxious symptoms are not necessarily adaptable for CBT. Therefore, pre-CBT tests for treatment suitability are necessary. Future studies should establish a protocol for psychotherapy suitable for the non-adaptation group.

BACKGROUND: Anterior decompression with fusion (ADF) has often been performed for degenerative cervical myelopathy (DCM) in patients with poor cervical spine alignment and/or anterior cord compression. We aimed to identify clinical and radiological predictors associated with neurological recovery after ADF. METHODS: This post-hoc analysis from a prospective multicenter study included patients who were scheduled for ADF for DCM. The patients who received other surgeries (laminoplasty, posterior decompression and fusion) were excluded. The associations between baseline clinical and radiographic variables (age, sex, body mass index, etiology, cervical lordosis, range of motion, C7 slope, C2-7 sagittal vertical axis [SVA], thoracic kyphosis [TK], lumbar lordosis, sacral slope, SVA, pelvic tilt, T1 pelvic angle [TPA], the Japanese Orthopedic Association score for the assessment of cervical myelopathy [C-JOA], European Quality of Life Five Dimensions Scale [EQ-5D], Neck Disability Index [NDI], Physical Component Summary of the SF-36 [PCS], and Mental Component Summary of the SF-36) and the recovery rates as the outcome variables were investigated in the univariate regression analysis. Then, the independent predictors for increased recovery rates were evaluated using a stepwise multiple regression analysis. RESULTS: In total, 37 patients completed the 1 year follow-up. The recovery rate was significantly correlated with SVA (p = 0.001) and TPA (p = 0.03). Univariate regression analyses showed that age (Regression coefficient = - 0.92, p = 0.049), SVA (Regression coefficient  = - 0.57, p = 0.004) and PCS (Regression coefficient = 0.80, p = 0.03) score were significantly associated with recovery rate. Then, a stepwise multiple regression analysis identified the independent predictors of recovery rate after ADF as TK (p = 0.01), PCS (p = 0.03), and SVA (p = 0.03). According to this prediction model, the following equation was obtained: recovery rate = - 8.26 + 1.17 × (TK) - 0.45 × (SVA) + 0.85 × (PCS) (p = 0.002, R2 = 0.44). CONCLUSION: Patients with lower TK, lower PCS score, and higher SVA were more likely to have poor neurological recovery after ADF. Therefore, patients with DCM and these predictors who undergo ADF should be warned about poor recovery and be required to provide adequate informed consent.

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 mu g/m(2)/day x 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.