稲毛 一秀

This study aimed to evaluate the time course of local changes during the acute phase of gastrocnemius muscle strain, in a rat model, using an in vivo imaging system. Thirty-eight, 8-week-old Sprague-Dawley male rats were used in our study. Experimental injury of the right gastrocnemius muscle was achieved using the drop-mass method. After inducing muscle injury, a liposomally formulated indocyanine green derivative (LP-iDOPE, 7 mg/kg) was injected intraperitoneally. We evaluated the muscle injuries using in vivo imaging, histological examinations, and enzyme-linked immunosorbent assays. The fluorescence peaked approximately 18 h after the injury, and decreased thereafter. Histological examinations revealed that repair of the injured tissue occurred between 18 and 24 h after injury. Quantitative analyses for various cytokines demonstrated significant elevations of interleukin-6 and tumor necrosis factor-α at 3 and 18 h post-injury, respectively. The time course of fluorescence intensity, measured using in vivo imaging, demonstrated that the changes in cytokine levels and histopathologic characteristics were consistent. Specifically, these changes reached peaked 18 h post-injury, followed by trends toward recovery.

PURPOSE: Surgery for lumbar spinal degeneration disease is widely performed. While posterior decompression and fusion are popular, anterior lumbar interbody fusion (ALIF) is also used for treatment. Extreme lateral interbody fusion (XLIF) is commonly used for noninvasive ALIF; however, several complications, such as spinal nerve and psoas muscle injury, have been reported. In the current study, we examined the clinical efficacy and complications of oblique lateral interbody fusion (OLIF) for lumbar spinal degeneration disease. MATERIALS AND METHODS: Thirty-five patients with degenerated spondylolisthesis, discogenic pain, and kyphoscoliosis were examined. All patients underwent OLIF surgery (using a cage and bone graft from the iliac crest) with or without posterior decompression, without real-time electromyography monitoring. Posterior screws were used in all patients. Visual analog scale (VAS) score and Oswestry Disability Index (ODI) were evaluated before and 6 months after surgery. Surgical complications were also evaluated. RESULTS: Pain scores significantly improved after surgery, compared to those before surgery (p<0.05). There was no patient who underwent revision surgery. There was no spinal nerve, major vessel, peritoneal, or urinary injury. Few patients showed symptoms from psoas invasion. CONCLUSION: OLIF surgery produced good surgical results without any major complication.

An 80-year-old woman presented with severe thoracolumbar kyphosis due to spinal tuberculosis with chronic low back pain and gait disturbance. Radiographs showed T9-L1 bony union in the anterior and posterior longitudinal ligaments. Rigid bony union of the L2 and L3 vertebral bodies, with trapezoid-shaped deformity, a sagittal vertical axis (SVA) of approximately 570 mm, and a severe pelvic posterior inclination, were also evident. No residual tuberculous disease was detected. The patient was treated with kyphoplasty, which included an L2 pedicle subtraction vertebral osteotomy (PSO), and T9-S1 fixation. The procedure yielded a 45° correction in the sagittal alignment and enhanced local stability, resulting in an SVA of 50 mm. Her post-operative lower back pain and the gait disturbance resolved. The osteotomy site showed sufficient bony union 8 months post-operatively. PSO yielded marked improvements and stability with no complications such as pseudoarthritis at the osteotomy site. Also her sagittal alignment was corrected to achieve adequate stability with sufficient activities of daily living and improved quality of life. Vertebral osteotomy on those with rigid deformity gives good and stable clinical outcome.

拡散テンソル画像は水分子の拡散の異方性をとらえる撮像法で定量的MRIとして脊髄神経の可視化・定量評価に応用された。脊柱管、椎間板へ応用することにより、椎間孔狭窄など従来の画像診断では評価困難な病変の可視化や脊髄神経の定量評価のみならず、脊柱管の狭窄や椎間板の変性について3次元的かつ定量的な評価が可能であった。拡散テンソル画像は腰痛疾患における新たな画像診断ツールとしての有用性について示された。(著者抄録)

若齢期の脊椎カリエスによる腰椎高度後彎症例に起因する慢性腰痛および歩行障害をきたしていた80歳女性に対して,骨切り術を用いた矯正固定術を行った。術前画像検査にてT9-L1椎体は靱帯骨化による癒合と脊椎カリエスによるL2-3椎体の変形癒合に伴う矢状面アライメントの高度不整による後彎変形を呈していた。脊椎矢状面アライメントの評価パラメータであるLL(Lumbar Lordosis:腰椎前彎角。正常35〜50°程度)は-24.1°,SVA(sagittal vertical axis:第7頸椎の垂線から仙骨後壁上縁までの距離。正常50mm以下)は570mmと大きく偏移していた。本患者に対してL2椎体に対し椎弓根切除を特徴とする骨切り術式であるpedicle subtraction osteotomy(PSO)による矯正固定術を行った。椎体の骨切りとT9-S1固定術を併用することにより約56.1°の矯正角を獲得,矢状面アライメントはLL32°,SVA56mmと改善した。その結果腰痛や歩行障害などの症状は消失,独歩にて自宅退院となりADLおよびQOLは著明な改善をきたした。高齢化社会の進行に伴い変性による脊柱後側彎の症例は増加傾向にあるが,特に本症例のような脊椎カリエスに伴う高度脊柱変形を伴う症例では,生理的自然経過を超越した高度変形に伴う矢状面アライメントの異常がもたらす脊髄や神経根の圧迫・狭窄による痛みやしびれ,麻痺などの神経症状に加えて体幹筋のバランス異常・負荷増加による疼痛や歩行異常を来すことが多い。このような症例では脊柱の可動性も極度に低下しているため通常の固定術・除圧術では十分な矯正が得られないことが多く,本症例のようにPSOをはじめとした骨切り矯正固定術を併用した術式が有効である。(著者抄録)

STUDY DESIGN: Retrospective study. PURPOSE: We conducted a study to investigate the time course changes in bone metabolic markers after the administration of the anti-receptor activator of nuclear factor-kappa B ligand (RANKL) antibody and to assess drug compliance among osteoporotic patients. OVERVIEW OF LITERATURE: The anti-RANKL antibody is expected to provide an improvement in those with a bone metabolism disorder. However there are only a few clinical reports available on the effect of treatment. METHODS: We included 40 post-menopausal osteoporotic patients who received the anti-RANKL antibody. To determine the time course changes in the bone metabolic markers, we measured the serum tartrate-resistant acid phosphatase 5b (TRACP 5b; a bone resorption marker) and the serum N-terminal propeptide of type 1 collagen (P1NP; a bone formation marker) levels prior to and 1 month after administrating the anti-RANKL antibody. To evaluable drug compliance, we assessed the dropout rate during treatment and at 6 months after treatment. RESULTS: The average TRACP 5b level significantly decreased from 574.8 mU/dL before treatment to 153.2 mU/dL 1 month after treatment (p<0.05). There was no significant difference in the average P1NP level, which was 56.9 µG/L and 35.1 µG/L before and 1 month after treatment, respectively (p>0.05). As for drug compliance, we did not have any dropouts during the treatment or after 6 months (dropout rate: 0%). CONCLUSIONS: Our study suggests that anti-RANKL antibody treatment suppresses bone resorption and maintains bone formation.

多血小板血漿(PRP)を用いた脊椎骨癒合促進について検討した。腰椎すべり症を伴う腰部脊柱管狭窄症39例を対象とし、インプラント+局所骨群(I群)、インプラント+局所骨+PRP群(II群)に分けた。PRPの血小板濃度は血液中の約8倍と有意に増加した。また、PRP中の骨形成に関与するPDGF-AA、AB、BB、TGF-βは血中濃度の50倍以上であった。骨癒合は全例で認め、骨癒合までの期間はI群9.8±0.53ヵ月、II群7.8±0.67ヵ月で、II群において有意に短縮した。VASによる疼痛評価は両群間で有意差はなかった。有害事象は、両群とも感染、発熱、臓器機能障害などはなかった。

BACKGROUND: Muscle injury is common and is thought to account for 10%-50% of all sports-related injuries. The use of rest, ice, compression, and elevation is common in clinical practice, but many treatments over a long period are required to produce a therapeutic effect. We evaluated the utility of photodynamic therapy as a new treatment option for the acute stage of muscle injury. METHODS: Twenty 8-week-old Sprague-Dawley male rats underwent experimental injury of the right gastrocnemius muscle with a drop-mass method. After muscle injury was induced, a liposomally formulated indocyanine green derivative (7 mg/kg) near-infrared laser irradiation was performed at 18 h after injury. Local time-dependent changes in the treatment (n = 14) and no treatment (n = 14) groups were evaluated with in vivo imaging, histologic examination, and enzyme-linked immunosorbent assay methods. RESULTS: In vivo imaging fluorescence values were significantly higher in the no treatment group, whereas interleukin-6 and tumor necrosis factor-α levels were significantly higher in the treatment group at 18 h after injury. Histologic examination results revealed that the treatment group had less bleeding and more degeneration repair processes than the no treatment group at 24 h and 1 week after muscle injury. CONCLUSIONS: These findings suggest that photodynamic therapy promotes a tissue-repairing effect during the early stage of muscle injury.

BACKGROUND: Corrective surgery for kyphoscoliosis patients tend to be highly invasive due to osteotomy. The present case introduce less invasive corrective surgery using anterior oblique lateral interbody fusion (OLIF) technique. CASE PRESENTATION: An 80-year-old Japanese man with a history of Parkinson's disease presented to our hospital because of severe kyphoscoliosis and gait disturbance. Considering the postsurgical complications due to osteotomy, we performed an anterior-posterior combined corrective fusion surgery: OLIF of Lumbar (L) 2-3, L3-4, and L4-5 (Medtronic Sofamor Danek, Memphis, TN, USA) followed by L5-Sacral (S) 1 anterior lumbar fusion via the OLIF approach using an anterior intervertebral cage, and posterior L3-4 and L4-5 facetectomy and posterior fusion using percutaneous pedicle screws from Thoracic (T) 10 to S1 with a T-9 hook system. The surgery was performed in a less invasive manner with no osteotomy, and it improved the sagittal alignments with moderate restoration, which improved the patient's posture and gait disturbance. The patient showed transient muscle weakness of proximal lower extremity contralateral side to the surgical site, which fully recovered by physical rehabilitation 3 months after the surgery. CONCLUSION: The surgical corrective procedure using the minimally invasive OLIF method including L5-S1 fusion showed a great advantage in treating degenerative kyphoscoliosis in a Parkinson's disease patient in its less-invasive approac.

脊椎疾患に伴う跛行で最も頻度が高いのが様々な要因による脊柱管狭窄症である。特に腰部脊柱管狭窄の認識は歴史的にはVerbiestが1949年に仏語で3例、そして1954年に英語で7例を報告したことに始まるとされている。我が国では若松が1970年に初めて本症の13例を考察し報告した。やがて1976年にArnoldiらが国際的な会議を経て国際分類を著した頃から、急速に疾患認識が高まったといえる。臨床症状として、(1)臀部から下肢の疼痛やしびれを有する、(2)臀部から下肢の疼痛やしびれは立位や歩行の持続によって出現あるいは増悪し、前屈や座位保持で軽快する、(3)MRIなどの画像で脊柱管の変性狭窄状態が確認され、臨床所見を説明できると考えられている。本稿では病態、診断、治療、鑑別診断について述べたい。(著者抄録)