1.Spinopelvic Alignment and Low Back Pain after Total Hip Replacement Arthroplasty in Patients with Severe Hip Osteoarthritis
Yawara EGUCHI ; Satoshi IIDA ; Chiho SUZUKI ; Yoshiyuki SHINADA ; Tomoko SHOJI ; Kazuhisa TAKAHASHI ; Seiji OHTORI
Asian Spine Journal 2018;12(2):325-334
STUDY DESIGN: Retrospective observational study. PURPOSE: We examined change in lumbrosacral spine alignment and low back pain (LBP) following total hip arthroplasty (THA) in patients with severe hip osteoarthritis (OA). OVERVIEW OF LITERATURE: Severe hip osteoarthritis has been reported to cause spine alignment abnormalities and low back pain, and it has been reported that low back pain is improved following THA. METHODS: Our target population included 30 patients (29 female, mean age 63.5 years) with hip OA who underwent direct anterior approach THA. There were 12 cases with bilateral hip disease and 18 cases with unilateral osteoarthritis. Visual analogue scale (VAS) scores for LBP and coxalgia, the Roland-Morris Disability Questionnaire (RDQ), and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were assessed before and after surgery. Spinal alignment metrics were measured before and after surgery. RESULTS: VAS for LBP change from preoperative to final postoperative observation was significantly improved (p < 0.05), as was VAS for hip pain (p < 0.001). RDQ improved significantly (p < 0.01). All five domains of JOABPEQ were significantly improved (p < 0.05). In terms of coronal alignment, lumbar scoliosis change from preoperative to last observation was significantly reduced (p < 0.05). There were no significant changes in the sagittal alignment metrics. In addition, there was a correlation between before and after RDQ difference and before and after lumbar scoliosis difference (p < 0.05). VAS for LBP (p < 0.05) as well as RDQ (p < 0.05) were significantly improved only in unilateral OA. Lumbar scoliosis was significantly improved in cases of unilateral OA (p < 0.05), but alignment did not improve in cases of bilateral OA (p=0.29). CONCLUSIONS: The present study demonstrates improvements in VAS for LBP, RDQ, and all domains of JOABPEQ. There were also significant reductions in lumbar scoliosis and an observed correlation of RDQ improvement with lumbar scoliosis improvement. We were able to observe improvements in lumbar scoliosis and low back pain only in cases of unilateral OA. It has been suggested that the mechanism of low back pain improvement following THA is related to compensatory lumbar scoliosis improvement.
Arthroplasty
;
Arthroplasty, Replacement, Hip
;
Asian Continental Ancestry Group
;
Back Pain
;
Female
;
Health Services Needs and Demand
;
Hip
;
Humans
;
Low Back Pain
;
Observational Study
;
Osteoarthritis
;
Osteoarthritis, Hip
;
Retrospective Studies
;
Scoliosis
;
Spine
2.Response to Letter to the Editor: Spinopelvic Alignment and Low Back Pain after Total Hip Replacement Arthroplasty in Patients with Severe Hip Osteoarthritis
Yawara EGUCHI ; Satoshi IIDA ; Chiho SUZUKI ; Yoshiyuki SHINADA ; Tomoko SHOJI ; Kazuhisa TAKAHASHI ; Seiji OHTORI
Asian Spine Journal 2020;14(6):933-933
3.Baastrup's Disease Is Associated with Recurrent of Sciatica after Posterior Lumbar Spinal Decompressions Utilizing Floating Spinous Process Procedures.
Masao KODA ; Chikato MANNOJI ; Masazumi MURAKAMI ; Tomoaki KINOSHITA ; Jiro HIRAYAMA ; Tomohiro MIYASHITA ; Yawara EGUCHI ; Masashi YAMAZAKI ; Takane SUZUKI ; Masaaki ARAMOMI ; Mitsutoshi OTA ; Satoshi MAKI ; Kazuhisa TAKAHASHI ; Takeo FURUYA
Asian Spine Journal 2016;10(6):1085-1090
STUDY DESIGN: Retrospective case-control study. PURPOSE: To determine whether kissing spine is a risk factor for recurrence of sciatica after lumbar posterior decompression using a spinous process floating approach. OVERVIEW OF LITERATURE: Kissing spine is defined by apposition and sclerotic change of the facing spinous processes as shown in X-ray images, and is often accompanied by marked disc degeneration and decrement of disc height. If kissing spine significantly contributes to weight bearing and the stability of the lumbar spine, trauma to the spinous process might induce a breakdown of lumbar spine stability after posterior decompression surgery in cases of kissing spine. METHODS: The present study included 161 patients who had undergone posterior decompression surgery for lumbar canal stenosis using a spinous process floating approaches. We defined recurrence of sciatica as that resolved after initial surgery and then recurred. Kissing spine was defined as sclerotic change and the apposition of the spinous process in a plain radiogram. Preoperative foraminal stenosis was determined by the decrease of perineural fat intensity detected by parasagittal T1-weighted magnetic resonance imaging. Preoperative percentage slip, segmental range of motion, and segmental scoliosis were analyzed in preoperative radiographs. Univariate analysis followed by stepwise logistic regression analysis determined factors independently associated with recurrence of sciatica. RESULTS: Stepwise logistic regression revealed kissing spine (p=0.024; odds ratio, 3.80) and foraminal stenosis (p<0.01; odds ratio, 17.89) as independent risk factors for the recurrence of sciatica after posterior lumbar spinal decompression with spinous process floating procedures for lumbar spinal canal stenosis. CONCLUSIONS: When a patient shows kissing spine and concomitant subclinical foraminal stenosis at the affected level, we should sufficiently discuss the selection of an appropriate surgical procedure.
Case-Control Studies
;
Constriction, Pathologic
;
Decompression
;
Humans
;
Intervertebral Disc Degeneration
;
Logistic Models
;
Magnetic Resonance Imaging
;
Odds Ratio
;
Postoperative Complications
;
Range of Motion, Articular
;
Recurrence
;
Retrospective Studies
;
Risk Factors
;
Sciatica*
;
Scoliosis
;
Spinal Canal
;
Spine
;
Weight-Bearing
4.Elevated Levels of Serum Pentosidine Are Associated with Dropped Head Syndrome in Older Women
Yawara EGUCHI ; Toru TOYOGUCHI ; Kazuhide INAGE ; Sumihisa ORITA ; Kazuyo YAMAUCHI ; Miyako SUZUKI ; Hirohito KANAMOTO ; Koki ABE ; Masaki NORIMOTO ; Tomotaka UMIMURA ; Masao KODA ; Takeo FURUYA ; Yasuchika AOKI ; Kazuhisa TAKAHASHI ; Seiji OHTORI
Asian Spine Journal 2019;13(1):155-162
STUDY DESIGN: A retrospective observational study was performed. PURPOSE: We investigated the prevalence of sarcopenia in dropped head syndrome (DHS), and the relationship between biochemical markers, including major advanced glycation end products (AGEs), pentosidine, and DHS in older women. OVERVIEW OF LITERATURE: AGEs have been implicated in the pathogenesis of sarcopenia. METHODS: We studied 13 elderly women with idiopathic DHS (mean age, 77.2 years) and 20 healthy volunteers (mean age, 74.8 years). We used a bioelectrical impedance analyzer to analyze body composition, including appendicular skeletal muscle mass index (SMI; appendicular lean mass [kg]/[height (m)]2). Cervical sagittal plane alignment, including C2–C7 sagittal vertical axis (C2–C7SVA), C2–C7 angle, and C2 slope (C2S), was measured. Biochemical markers, such as serum and urinary pentosidine, serum homocysteine, 1, 25-dihydroxyvitamin D, and 25-hydroxyvitamin D, were measured. The level of each variable was compared between DHS and controls. The relationship between biochemical markers and DHS was examined. RESULTS: Sarcopenia (SMI < 5.75) was observed at a high prevalence in participants with DHS (77% compared to 22% of healthy controls). Height, weight, femoral bone mineral density, appendicular lean mass, total lean mass, and SMI all had significantly lower values in the DHS group. Serum and urinary pentosidine, and serum homocysteine were significantly higher in the DHS group compared to controls. Analysis of cervical alignment revealed a significant positive correlation of serum pentosidine with C2–C7SVA and C2S. CONCLUSIONS: Sarcopenia was involved in DHS, and high serum pentosidine levels are associated with severity of DHS in older women.
Aged
;
Biomarkers
;
Body Composition
;
Bone Density
;
Electric Impedance
;
Female
;
Glycosylation End Products, Advanced
;
Head
;
Healthy Volunteers
;
Homocysteine
;
Humans
;
Muscle, Skeletal
;
Neck Muscles
;
Observational Study
;
Prevalence
;
Retrospective Studies
;
Sarcopenia
5.Relationship between Skeletal Muscle Mass, Bone Mineral Density, and Trabecular Bone Score in Osteoporotic Vertebral Compression Fractures
Soichiro TOKESHI ; Yawara EGUCHI ; Munetaka SUZUKI ; Hajime YAMANAKA ; Hiroshi TAMAI ; Sumihisa ORITA ; Kazuhide INAGE ; Yasuhiro SHIGA ; Shigeo HAGIWARA ; Junichi NAKAMURA ; Tsutomu AKAZAWA ; Hiroshi TAKAHASHI ; Seiji OHTORI
Asian Spine Journal 2021;15(3):365-372
A retrospective observational study was performed. We investigated the relationships between skeletal muscle mass, bone mineral density (BMD), and trabecular bone score (TBS) in patients with osteoporotic vertebral compression fractures (VCFs). The TBS has attracted attention as a measurement of trabecular bone microarchitecture. It is derived from data obtained using dual-energy X-ray absorptiometry (DXA) and is a reported indicator of VCFs, and its addition to the Fracture Risk Assessment Tool increases the accuracy of fracture prediction. BMD, skeletal muscle mass, and TBS were measured in 142 patients who visited Shimoshizu National Hospital from April to August 2019. Patients were divided into a VCF group and a non-VCF group. Whole-body DXA scans were performed to analyze body composition, including appendicular skeletal muscle mass index (SMI; lean mass [kg]/height [m2]) and BMD. The diagnostic criteria for sarcopenia was an appendicular SMI <5.46 kg/m2. A logistic regression analysis was conducted to identify the risk factors for VCFs. The significant ( Patients with VCFs had low BMD, a low TBS, and low skeletal muscle mass. Lower femoral BMD and decreased leg muscle mass were identified as risk factors for VCFs independent of age, whereas the TBS was not identified as a risk factor for VCFs.
6.Relationship between Skeletal Muscle Mass, Bone Mineral Density, and Trabecular Bone Score in Osteoporotic Vertebral Compression Fractures
Soichiro TOKESHI ; Yawara EGUCHI ; Munetaka SUZUKI ; Hajime YAMANAKA ; Hiroshi TAMAI ; Sumihisa ORITA ; Kazuhide INAGE ; Yasuhiro SHIGA ; Shigeo HAGIWARA ; Junichi NAKAMURA ; Tsutomu AKAZAWA ; Hiroshi TAKAHASHI ; Seiji OHTORI
Asian Spine Journal 2021;15(3):365-372
A retrospective observational study was performed. We investigated the relationships between skeletal muscle mass, bone mineral density (BMD), and trabecular bone score (TBS) in patients with osteoporotic vertebral compression fractures (VCFs). The TBS has attracted attention as a measurement of trabecular bone microarchitecture. It is derived from data obtained using dual-energy X-ray absorptiometry (DXA) and is a reported indicator of VCFs, and its addition to the Fracture Risk Assessment Tool increases the accuracy of fracture prediction. BMD, skeletal muscle mass, and TBS were measured in 142 patients who visited Shimoshizu National Hospital from April to August 2019. Patients were divided into a VCF group and a non-VCF group. Whole-body DXA scans were performed to analyze body composition, including appendicular skeletal muscle mass index (SMI; lean mass [kg]/height [m2]) and BMD. The diagnostic criteria for sarcopenia was an appendicular SMI <5.46 kg/m2. A logistic regression analysis was conducted to identify the risk factors for VCFs. The significant ( Patients with VCFs had low BMD, a low TBS, and low skeletal muscle mass. Lower femoral BMD and decreased leg muscle mass were identified as risk factors for VCFs independent of age, whereas the TBS was not identified as a risk factor for VCFs.
7.Differences in Risk Factors for Decreased Cervical Lordosis after Multiple-Segment Laminoplasty for Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament: A Pilot Study
Takaki INOUE ; Satoshi MAKI ; Takeo FURUYA ; Sho OKIMATSU ; Atsushi YUNDE ; Masataka MIURA ; Yuki SHIRATANI ; Yuki NAGASHIMA ; Juntaro MARUYAMA ; Yasuhiro SHIGA ; Kazuhide INAGE ; Sumihisa ORITA ; Yawara EGUCHI ; Seiji OHTORI
Asian Spine Journal 2023;17(4):712-720
Methods:
This study included 50 patients with CSM and 39 with C-OPLL who underwent multi-segment laminoplasty. Decreased CL was defined as the difference between preoperative and 2-year postoperative neutral C2–7 Cobb angles. Radiographic parameters included preoperative neutral C2–7 Cobb angles, C2–7 sagittal vertical axis (SVA), T1 slope (T1S), dynamic extension reserve (DER), and range of motion. The radiographic risk factors were investigated for decreased CL in CSM and C-OPLL. Additionally, the Japanese Orthopedic Association (JOA) score was assessed preoperatively and 2 years postoperatively.
Results:
C2–7 SVA (p =0.018) and DER (p =0.002) were significantly correlated with decreased CL in CSM, while C2–7 Cobb angle (p =0.012) and C2–7 SVA (p =0.028) were correlated with decreased CL in C-OPLL. Multiple linear regression analysis revealed that greater C2–7 SVA (B =0.22, p =0.026) and small DER (B =−0.53, p =0.002) were significantly associated with decreased CL in CSM. By contrast, greater C2–7 SVA (B =0.36, p =0.031) was significantly associated with decreased CL in C-OPLL. The JOA score significantly improved in both CSM and C-OPLL (p <0.001).
Conclusions
C2–7 SVA was associated with a postoperative decreased CL in both CSM and C-OPLL, but DER was only associated with decreased CL in CSM. Risk factors for decreased CL slightly differed depending on the etiology of the condition.
8.Association between Osteoporosis and Skeletal Muscle Mass in Men
Masaya MIZUTANI ; Yawara EGUCHI ; Toru TOYOGUCHI ; Sumihisa ORITA ; Kazuhide INAGE ; Yasuhiro SHIGA ; Satoshi MAKI ; Junichi NAKAMURA ; Shigeo HAGIWARA ; Yasuchika AOKI ; Masahiro INOUE ; Masao KODA ; Hiroshi TAKAHASHI ; Tsutomu AKAZAWA ; Seiji OHTORI
Asian Spine Journal 2024;18(1):73-78
Methods:
This study included 99 men (mean age, 74.9 years; range, 28–93 years) who visited Qiball Clinic for BMD and body composition examinations. The osteoporosis group consisted of 24 patients (mean age, 72.5 years; range, 44–92 years), and the control group consisted of 75 individuals (mean age, 74.9 years; range, 28–93 years). Whole-body skeletal muscle mass was measured using a bioelectrical impedance analyzer. BMD was measured by dual X-ray absorptiometry. Skin autofluorescence (SAF), a marker of dermal AGE accumulation, was measured using a spectroscope. Osteoporosis was defined as a bone density T score of –2.5 or less. Physical findings, skeletal muscle mass, BMD, grip strength, and SAF were compared between the osteoporosis and control groups.
Results:
The osteoporosis group had significantly lower trunk muscle mass (23.1 kg vs. 24.9 kg), lower leg muscle mass (14.4 kg vs. 13.0 kg), and skeletal mass index (7.1 kg/m2 vs. 6.7 kg/m2) than the control group (all p<0.05). Lower limb muscle mass was identified as a risk factor for osteoporosis in men (odds ratio, 0.64; p=0.03).
Conclusions
Conservative treatment of osteoporosis in men will require an effective approach that facilitates the maintenance or strengthening of skeletal muscle mass, including exercise therapy with a focus on lower extremities and nutritional supplementation.
9.Diagnosis of Lumbar Foraminal Stenosis using Diffusion Tensor Imaging.
Yawara EGUCHI ; Seiji OHTORI ; Munetaka SUZUKI ; Yasuhiro OIKAWA ; Hajime YAMANAKA ; Hiroshi TAMAI ; Tatsuya KOBAYASHI ; Sumihisa ORITA ; Kazuyo YAMAUCHI ; Miyako SUZUKI ; Yasuchika AOKI ; Atsuya WATANABE ; Hirohito KANAMOTO ; Kazuhisa TAKAHASHI
Asian Spine Journal 2016;10(1):164-169
Diagnosis of lumbar foraminal stenosis remains difficult. Here, we report on a case in which bilateral lumbar foraminal stenosis was difficult to diagnose, and in which diffusion tensor imaging (DTI) was useful. The patient was a 52-year-old woman with low back pain and pain in both legs that was dominant on the right. Right lumbosacral nerve compression due to a massive uterine myoma was apparent, but the leg pain continued after a myomectomy was performed. No abnormalities were observed during nerve conduction studies. Computed tomography and magnetic resonance imaging indicated bilateral L5 lumbar foraminal stenosis. DTI imaging was done. The extraforaminal values were decreased and tractography was interrupted in the foraminal region. Bilateral L5 vertebral foraminal stenosis was treated by transforaminal lumbar interbody fusion and the pain in both legs disappeared. The case indicates the value of DTI for diagnosing vertebral foraminal stenosis.
Constriction, Pathologic*
;
Diagnosis*
;
Diffusion Tensor Imaging*
;
Diffusion*
;
Female
;
Humans
;
Leg
;
Leiomyoma
;
Low Back Pain
;
Magnetic Resonance Imaging
;
Middle Aged
;
Neural Conduction
10.Injection of Bupivacaine into Disc Space to Detect Painful Nonunion after Anterior Lumbar Interbody Fusion (ALIF) Surgery in Patients with Discogenic Low Back Pain.
Seiji KIMURA ; Seiji OHTORI ; Sumihisa ORITA ; Gen INOUE ; Yawara EGUCHI ; Masashi TAKASO ; Nobuyasu OCHIAI ; Kazuki KUNIYOSHI ; Yasuchika AOKI ; Tetsuhiro ISHIKAWA ; Masayuki MIYAGI ; Hiroto KAMODA ; Miyako SUZUKI ; Yoshihiro SAKUMA ; Gou KUBOTA ; Yasuhiro OIKAWA ; Kazuhide INAGE ; Takeshi SAINOH ; Kazuyo YAMAUCHI ; Tomoaki TOYONE ; Junichi NAKAMURA ; Shunji KISHIDA ; Jun SATO ; Kazuhisa TAKAHASHI
Yonsei Medical Journal 2014;55(2):487-492
PURPOSE: Bupivacaine is commonly used for the treatment of back pain and the diagnosis of its origin. Nonunion is sometimes observed after spinal fusion surgery; however, whether the nonunion causes pain is controversial. In the current study, we aimed to detect painful nonunion by injecting bupivacaine into the disc space of patients with nonunion after anterior lumbar interbody fusion (ALIF) surgery for discogenic low back pain. MATERIALS AND METHODS: From 52 patients with low back pain, we selected 42 who showed disc degeneration at only one level (L4-L5 or L5-S1) on magnetic resonance imaging and were diagnosed by pain provocation on discography and pain relief by discoblock (the injection of bupivacaine). They underwent ALIF surgery. If the patients showed low back pain and nonunion 2 years after surgery, we injected bupivacaine into the nonunion disc space. Patients showing pain relief after injection of bupivacaine underwent additional posterior fixation using pedicle screws. These patients were followed up 2 years after the revision surgery. RESULTS: Of the 42 patient subjects, 7 showed nonunion. Four of them did not show low back pain; whereas 3 showed moderate or severe low back pain. These 3 patients showed pain reduction after injection of bupivacaine into their nonunion disc space and underwent additional posterior fixation. They showed bony union and pain relief 2 years after the revision surgery. CONCLUSION: Injection of bupivacaine into the nonunion disc space after ALIF surgery for discogenic low back pain is useful for diagnosis of the origin of pain.
Back Pain
;
Bupivacaine*
;
Diagnosis
;
Humans
;
Intervertebral Disc
;
Intervertebral Disc Degeneration
;
Low Back Pain*
;
Magnetic Resonance Imaging
;
Methods
;
Spinal Fusion
;
Spine