牧 聡

PURPOSES: To analyze T2 relaxation times of the facet joint by MRI T2-mapping in patients with degenerative lumbar disorders (DLD), and to determine the correlation with lumbar instability in radiographs. METHODS: We conducted a T2-mapping of the lumbar facet joint using a 1.5 T MRI system. We classified patients with degenerative lumbar disorders scheduled to undergo decompression surgery into groups with stability and instability using radiographs, and compared the T2 relaxation times of the lumbar facet. Lumbar instability was defined as the presence of anterior translation ratio > 5% or disk range of motion (ROM) > 5° in the sagittal plane of SLFE radiographs. RESULTS: Inclusion criteria were met by 22 patients (45 levels, mean age 64.3 years). Facet effusions had high sensitivity (90%) but had low specificity (28%) for diagnosis of lumbar instability. Mean T2 relaxation times of right and left facet joints are significantly longer (98.4 ms) in the instability group than they are (87.6 ms) in the stability group (p < 0.001). Anterior translation ratio was positively correlated with mean T2 relaxation times of facet joint (R2 = 0.493, p < 0.05). From a ROC analysis, the cutoff value of T2 relaxation times for lumbar instability was 98.65 ms (sensitivity 60.0%, specificity 95.7%, AUC 0.763). CONCLUSIONS: The T2 relaxation times were positively correlated with lumbar instability. This new quantitative evaluation of lumbar facet joint using MRI T2-mapping might be useful to determine lumbar instability.

This study investigated the effect of romosozumab on bone union in a rat posterolateral lumbar fixation model. Posterolateral lumbar fixation was performed on 8-week-old male Sprague Dawley rats (n = 20). For bone grafting, autogenous bone (40 mg) was harvested from the spinous processes of the 10th thoracic vertebra until the 2nd lumbar vertebra and implanted between the intervertebral joints and transverse processes of the 4th and 5th lumbar vertebrae on both sides. Rats were matched by body weight and equally divided into two groups: R group (Evenity®, 25 mg/kg) and control (C) group (saline). Subcutaneous injections were administered twice a week until 8 weeks after surgery. Computed tomography was performed at surgery and week 8 after surgery. The area and percentage of bone trabeculae in the total area of bone fusion were calculated. Statistical analysis was performed using an unpaired t test (p < 0.05). We found that the R group rats had significantly higher mean bone union rate and volume than did the C group rats at all time courses starting week 4 after surgery. The R group had significantly higher increase rates than did the C group at weeks 4 and 6 after surgery. The percentage of bone trabeculae area in the R group was approximately 1.7 times larger than that in the C group. Thus, we demonstrated that romosozumab administration has stimulatory effects on bony outgrowth at bone graft sites. We attribute this to the modeling effect of romosozumab.

OBJECTIVE: It is unclear whether anterior cervical decompression and fusion (ADF) or laminoplasty (LMP) results in better outcomes for patients with K-line-positive (+) cervical ossification of the posterior longitudinal ligament (OPLL). The purpose of the study is to compare surgical outcomes and complications of ADF versus LMP in patients with K-line (+) OPLL. METHODS: The study included 478 patients enrolled in the Japanese Multicenter Research Organization for Ossification of the Spinal Ligament and who underwent surgical treatment for cervical OPLL. The patients who underwent anterior-posterior combined surgery or posterior decompression with instrumented fusion were excluded. The patients with a follow-up period of fewer than 2 years were also excluded, leaving 198 patients with K-line (+) OPLL. Propensity score matching was performed on 198 patients with K-line (+) OPLL who underwent ADF (44 patients) or LMP (154 patients), resulting in 39 pairs of patients based on the following predictors for surgical outcomes: age, preoperative Japanese Orthopaedic Association (JOA) score, C2-7 angle, and the occupying ratio of OPLL. Clinical outcomes were assessed 1 and 2 years after surgery using the recovery rate of the JOA score. Complications and reoperation rates were also investigated. RESULTS: The mean recovery rate of the JOA score 1 year after surgery was 55.3% for patients who underwent ADF and 42.3% (p = 0.06) for patients who underwent LMP. Two years after surgery, the recovery rate was 53.4% for those who underwent ADF and 38.7% for LMP (p = 0.07). Although both surgical procedures yielded good results, the mean recovery rate of JOA scores tended to be higher in the ADF group. The incidence of surgical complications, however, was higher following ADF (33%) than LMP (15%; p = 0.06). The reoperation rate was also higher in the ADF group (15%) than in the LMP group (0%; p = 0.01). CONCLUSIONS: Clinical outcomes were good for both ADF and LMP, indicating that ADF and LMP are appropriate procedures for patients with K-line (+) OPLL. Clinical outcomes of ADF 1 and 2 years after surgery tended to be better than LMP, but the analysis did not detect any significant difference in clinical outcomes between the groups. Conversely, patients who underwent ADF had a higher incidence of surgery-related complications. When considering indications for ADF or LMP, benefits and risks of the surgical procedures should be carefully weighed.

Introduction Advanced glycation end-products (AGEs) have the potential to serve as biomarkers of aging and metabolic diseases; however, how their expression relates to clinical symptoms is not well defined. In this study, we sought to determine whether the accumulation of pentosidine, one type of AGE, at the peripheral nerve is associated with cutaneous pain or hypersensitivity caused by ovariectomy (OVX). Methods We assigned 12-week-old female Sprague Dawley rats into either the OVX group (n = 6) or the sham group (n = 6). Cutaneous hindpaw sensitivity to mechanical stimuli was measured with von Frey filaments, using Chaplan's adapted method, and the 50% withdrawal threshold was calculated. Then, the accumulation of pentosidine, which represents AGEs, was measured in sciatic nerve fibers after staining with an anti-pentosidine antibody. Results OVX rats showed significantly increased plantar hypersensitivity to mechanical stimuli compared to sham rats 8 weeks after OVX (P = 0.017). Pentosidine-positive sciatic nerves were detected at a higher rate in OVX rats than in sham rats (P = 0.035). The pentosidine positivity rate in sciatic nerve fibers showed a negative correlation with withdrawal threshold (P < 0.001). Conclusions This study showed that higher levels of pentosidine in sciatic nerve fibers are associated with higher plantar hypersensitivity. Accumulation of pentosidine at the sciatic nerve, caused by OVX, may result in cutaneous hindpaw hypersensitivity.

In recent years, fracture image diagnosis using a convolutional neural network (CNN) has been reported. The purpose of the present study was to evaluate the ability of CNN to diagnose distal radius fractures (DRFs) using frontal and lateral wrist radiographs. We included 503 cases of DRF diagnosed by plain radiographs and 289 cases without fracture. We implemented the CNN model using Keras and Tensorflow. Frontal and lateral views of wrist radiographs were manually cropped and trained separately. Fine-tuning was performed using EfficientNets. The diagnostic ability of CNN was evaluated using 150 images with and without fractures from anteroposterior and lateral radiographs. The CNN model diagnosed DRF based on three views: frontal view, lateral view, and both frontal and lateral view. We determined the sensitivity, specificity, and accuracy of the CNN model, plotted a receiver operating characteristic (ROC) curve, and calculated the area under the ROC curve (AUC). We further compared performances between the CNN and three hand orthopedic surgeons. EfficientNet-B2 in the frontal view and EfficientNet-B4 in the lateral view showed highest accuracy on the validation dataset, and these models were used for combined views. The accuracy, sensitivity, and specificity of the CNN based on both anteroposterior and lateral radiographs were 99.3, 98.7, and 100, respectively. The accuracy of the CNN was equal to or better than that of three orthopedic surgeons. The AUC of the CNN on the combined views was 0.993. The CNN model exhibited high accuracy in the diagnosis of distal radius fracture with a plain radiograph.

STUDY DESIGN: Retrospective study of magnetic resonance imaging (MRI). OBJECTIVES: To assess the ability of a convolutional neural network (CNN) model to differentiate osteoporotic vertebral fractures (OVFs) and malignant vertebral compression fractures (MVFs) using short-TI inversion recovery (STIR) and T1-weighted images (T1WI) and to compare it to the performance of three spine surgeons. SUMMARY OF BACKGROUND DATA: Differentiating between OVFs and MVFs is crucial for appropriate clinical staging and treatment planning. However, an accurate diagnosis is sometimes difficult. Recently, CNN modeling-an artificial intelligence technique-has gained popularity in the radiology field. METHODS: We enrolled 50 patients with OVFs and 47 patients with MVFs who underwent thoracolumbar MRI. Sagittal STIR images and sagittal T1WI were used to train and validate the CNN models. To assess the performance of the CNN, the receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) was calculated. We also compared the accuracy, sensitivity, and specificity of the diagnosis made by the CNN and three spine surgeons. RESULTS: The AUC of ROC curves of the CNN based on STIR images and T1WI were 0.967 and 0.984, respectively. The CNN model based on STIR images showed a performance of 93.8% accuracy, 92.5% sensitivity, and 94.9% specificity. On the other hand, the CNN model based on T1WI showed a performance of 96.4% accuracy, 98.1% sensitivity, and 94.9% specificity. The accuracy and specificity of the CNN using both STIR and T1WI were statistically equal to or better than that of three spine surgeons. There were no significant differences in sensitivity based on both STIR images and T1WI between the CNN and spine surgeons. CONCLUSIONS: We successfully differentiated OVFs and MVFs based on MRI with high accuracy using the CNN model, which was statistically equal or superior to that of the spine surgeons.Level of Evidence: 4.

STUDY DESIGN: A retrospective observational study. PURPOSE: To compare two conservative treatments for acute osteoporotic vertebral fractures (OVFs). OVERVIEW OF LITERATURE: Several studies have reported conservative treatments for OVFs in terms of using a brace, rehabilitation, and bed rest. However, there is no consensus about the conservative treatment for OVFs. METHODS: We evaluated 68 patients with acute OVF treated in our hospital from 2007 to 2011. Thirty-four patients treated in prolonged bed rest (PBR) regimen underwent rehabilitation wearing a Jewett's brace after three weeks of bed rest. In contrast, the other 34 patients underwent rehabilitation wearing a Jewett's brace as soon as possible, which we called a stir-up (SU) regimen. We compared two treatment groups for medical costs, hospital length of stay (LOS), pain according to the numeric rating scale (NRS), the activities of daily living (ADL), and imaging studies. RESULTS: The average hospital LOS was significantly shorter in patients treated by the SU regimen, which resulted in the medical costs reduction. There was no significant difference in the NRS through 6 months between the two groups. Although many patients in both groups experienced at least one level reduction in ADL at 6 months after the injury, patients in the SU group tended to maintain their pre-injury ADL, which almost agrees with past reports. In terms of imaging studies, patients in the PBR group showed milder vertebral compression rate over time. Pseudoarthrosis occurred in 2 patients in the SU group, who presented with mild pain, which had little influence on their daily lives. CONCLUSION: We compared two conservative treatments for OVFs. Early rehabilitation was useful treatment for OVFs to minimize the risk for disuse syndrome, maintain pre-injury ADL status, and reduce the medical costs.

Although the functional and anatomical differences between the left and right eyelids are important in the evaluation of age-related changes in the eyelids, they have not been described clearly as indications for surgical treatments. This study aimed to investigate how laterality of the eyelids affects evaluation of age-related changes. Methods: Photographs of either one or both eyelids of 100 people were evaluated in four stages by 10 plastic surgeons. To investigate the consistency of the results between evaluations, surgeons evaluated the single-eyelid photographs (group U) or two-eyelid photographs (group B). It was investigated whether the difference in margin reflex distance 1, height of the upper eyelid crease, height of eyebrow, and levator contractile function were associated with mismatched evaluations. Results: The weighted kappa coefficient for groups B and U was 0.77 (substantial agreement). One-point difference in scores was observed in 23 cases. In the multiple logistic regression analysis, only the laterality the height of the eyelid crease was significantly different between patients whose evaluations were matched and those whose evaluations were mismatched (0.9 ± 0.1 mm versus 1.7 ± 0.2 mm; OR = 1.06, 95%CI: 1.01-1.10; P = 0.01). Conclusions: Besides the structure and function of each eyelid, the laterality of the height of the eyelid crease was important in the evaluation of the age-related changes in the eyelids. This factor may be important in evaluating the aesthetic and visual impressions of age-related changes in the eyelids.

Postoperative neck pain has been reported as an unsolved postoperative complication of surgery for cervical ossification of the posterior longitudinal ligament (OPLL). The aim of the present study was to elucidate factors having a significant association with postoperative deterioration of neck pain in cervical OPLL patients. We studied a cohort of patients in a prospective registry of 478 patients who had undergone cervical spine surgery for cervical OPLL. We excluded those without evaluation of preoperative neck pain. Therefore, 438 patients were included in the present study. Neck pain was evaluated with the visual analogue scale (VAS, 0-100 mm). Postoperative neck pain deterioration was defined as a ≥20 mm increase of VAS neck pain. Patient factors, neurological status, imaging factors and surgical factors were assessed. Univariate analyses followed by multivariate analysis using stepwise logistic regression was performed. Six months after surgery, 50 (11.6%) patients showed postoperative neck pain deterioration and 76 (17.4%) patients showed postoperative neck pain deterioration 2 years after surgery. Six months after surgery, the rate of neck pain deterioration was significantly higher in patients who had undergone posterior surgery. Two years after surgery, the number of levels fused was significantly correlated with neck pain deterioration.

BACKGROUND: Although diffuse idiopathic skeletal hyperostosis (DISH) is known to coexist with the ossification of spinal ligaments (OSLs), details of the radiographic relationship remain unclear. METHODS: We prospectively collected data of 239 patients with symptomatic cervical ossification of the posterior longitudinal ligament (OPLL) and analyzed the DISH severity on whole-spine computed tomography images, using the following grades: grade 0, no DISH; grade 1, DISH at T3-T10; grade 2, DISH at both T3-T10 and C6-T2 and/or T11-L2; and grade 3, DISH beyond C5 and/or L3. Ossification indices were calculated as the sum of vertebral and intervertebral levels with OSL for each patient. RESULTS: DISH was found in 107 patients (44.8%), 65 (60.7%) of whom had grade 2 DISH. We found significant associations of DISH grade with the indices for cervical OPLL (r = 0.45, p < 0.0001), thoracic ossification of the ligamentum flavum (OLF; r = 0.41, p < 0.0001) and thoracic ossification of the supra/interspinous ligaments (OSIL; r = 0.53, p < 0.0001). DISH grade was also correlated with the index for each OSL in the whole spine (OPLL: r = 0.29, p < 0.0001; OLF: r = 0.40, p < 0.0001; OSIL: r = 0.50, p < 0.0001). CONCLUSION: The DISH grade correlated with the indices of OSL at each high-prevalence level as well as the whole spine.

骨粗鬆症性椎体骨折に対して最も広く行われている低侵襲手術はballoon kyphoplasty(BKP)である。しかしながら不安定性が強い骨折や麻痺を伴う場合は除圧固定術の適応となる。除圧固定術には前方除圧固定、後方除圧固定、前後合併除圧固定の3つの方法がある。いずれもある程度の成績は得られているが、高齢である点、また基本に骨粗鬆症があり、アンカーとしてのスクリューの固定性が十分でないための合併症が存在する。本稿では、骨粗鬆症性椎体骨折の手術療法、成功させるためのコツ、さらには合併症などを記載したい。(著者抄録)

＜文献概要＞長期間にわたり緩徐に進行する外反母趾の治療では,早期診断のためのスクリーニングと定期的な進行のモニタリングが重要である。医療機関の受診を要し,また被曝を伴うX線に代わり,足の外観から外反母趾角を推定する方法が報告されている。われわれは,スマートフォン(デジタルカメラ)で自分の足を撮影した「自撮り」写真を用いて外反母趾角を計測する方法を考案した。「自撮り」による外反母趾角の計測は高い信頼性を持ち,またX線で計測した外反母趾角と高い相関があることを示した。さらに,人工知能を用いることにより計測を自動化することができた。スマートフォンアプリを用いた遠隔診療は,皮膚科や眼科領域では既に実用化されている。足部・足関節疾患の診療でも,外反母趾に限らず,外観から足部変形を評価することが多い。今後,スマートフォンを用いた遠隔診療の実用化が期待される。

＜文献概要＞はじめに 孤立性(孤在性)線維性腫瘍(solitary fibrous tumor:SFT)および孤立性(孤在性)線維性腫瘍/血管周皮腫(solitary fibrous tumor/hemangiopericytoma:SFT/HPC)は間葉系細胞由来の腫瘍である.胸部発生がもっとも多いが,ほかに腹部,骨盤内,四肢などさまざまな部位の軟部組織に発生する.中枢神経系では髄膜より発生することが知られている.SFTおよびSFT/HPCの多くは良性の経過をたどるが,局所再発や遠隔転移を起こす症例が存在する.また,再発や転移を繰り返すうちに悪性転化する症例が存在するとされる.SFTおよびSFT/HPCに対する治療は外科的完全摘出が第一選択とされている.本稿では脊椎脊髄領域に発生した自験例を示し,SFTおよびSFT/HPCの治療方針について考察する.

骨粗鬆症性椎体骨折に対して最も広く行われている低侵襲手術はballoon kyphoplasty(BKP)である。しかしながら不安定性が強い骨折や麻痺を伴う場合は除圧固定術の適応となる。除圧固定術には前方除圧固定、後方除圧固定、前後合併除圧固定の3つの方法がある。いずれもある程度の成績は得られているが、高齢である点、また基本に骨粗鬆症があり、アンカーとしてのスクリューの固定性が十分でないための合併症が存在する。本稿では、骨粗鬆症性椎体骨折の手術療法、成功させるためのコツ、さらには合併症などを記載したい。(著者抄録)

BACKGROUND: This study investigated how diffuse idiopathic skeletal hyperostosis (DISH) influences clinical characteristics in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Although DISH is considered unlikely to promote neurologic dysfunction, this relationship remains unclear. METHODS: Patient data were prospectively collected from 16 Japanese institutions. In total, 239 patients with cervical OPLL were enrolled who had whole-spine computed tomography images available. The primary outcomes were visual analog scale pain scores and the results of other self-reported clinical questionnaires. Correlations were sought between clinical symptoms and DISH using the following grading system: 1, DISH at T3-T10; 2, DISH at both T3-10 and C6-T2 and/or T11-L2; and 3, DISH beyond the C5 and/or L3 levels. RESULTS: DISH was absent in 132 cases, grade 1 in 23, grade 2 in 65, and grade 3 in 19. There were no significant correlations between DISH grade and clinical scores. However, there was a significant difference in the prevalence of neck pain (but not in back pain or low back pain) among the three grades. Interestingly, DISH localized in the thoracic spine (grade 1) may create overload at the cervical spine and lead to neck pain in patients with cervical OPLL. CONCLUSION: This study is the first prospective multicenter cross-sectional comparison of subjective outcomes in patients with cervical OPLL according to the presence or absence of DISH. The severity of DISH was partially associated with the prevalence of neck pain.

Osteoplastic laminectomy is a surgical procedure that enables a wide field during the surgery and enables preservation of the posterior vertebral column structure by refixing the lamina once separated. We performed an osteoplastic laminectomy for resection of a ganglioneuroma at the sacral spine, and improved previous lower limb pain. A 33-year-old woman complained of pain in the nerve root region of the left S1. Examination revealed an epidural tumor at the left S2 level and we planned to remove the tumor. By performing an osteoplastic laminectomy at the level of S1-S3, we could secure a wide view of the surgical site and reliably resect the tumor. Pathological examination revealed that the resected tumor was a ganglioneuroma that had a possibility of malignant conversion. The postoperative course of our patient was favorable and no complaint was heard about surgical site pain postoperatively. There has been no tumor recurrence for more than 2 years. Osteoplastic laminectomy is considered to be a useful technique for epidural tumors at the sacral 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.

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.

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.

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 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。