Kagoshima-shi, Japan
Kagoshima-shi, Japan

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Kadooka M.,Kagoshima City Hospital | Kato H.,Nanpuh Hospital | Kato A.,Imakiire General Hospital | Ibara S.,Kagoshima City Hospital | And 2 more authors.
Early Human Development | Year: 2014

Background: Fetomaternal hemorrhage (FMH) can cause severe morbidity. However, perinatal risk factors for long-term poor outcome due to FMH have not been extensively studied. Aims: To determine which FMH infants are likely to have neurological sequelae. Study design: A single-center retrospective observational study. Perinatal factors, including demographic characteristics, Kleihauer-Betke test, blood gas analysis, and neonatal blood hemoglobin concentration ([Hb]), were analyzed in association with long-term outcomes. Subjects: All 18 neonates referred to a Neonatal Intensive Care Unit of Kagoshima City Hospital and diagnosed with FMH during a 15-year study period. All had a neonatal [Hb] <. 7.5. g/dL and 15 of 17 neonates tested had Kleihauer-Betke test result >. 4.0%. Outcome measures: Poor long-term outcome was defined as any of the following determined at 12. month old or more: cerebral palsy, mental retardation, attention deficit/hyperactivity disorder, and epilepsy. Results: Nine of the 18 neonates exhibited poor outcomes. Among demographic characteristics and blood variables compared between two groups with poor and favorable outcomes, significant differences were observed in [Hb] (3.6. ±. 1.4 vs. 5.4. ±. 1.1. g/dL, P=. 0.01), pH (7.09. ±. 0.11 vs. 7.25. ±. 0.13, P=. 0.02) and base deficits (17.5. ±. 5.4 vs. 10.4. ±. 6.0. mmol/L, P=. 0.02) in neonatal blood, and a number of infants with [Hb]. ≤. 4.5. g/dL (78%[7/9] vs. 22%[2/9], P=. 0.03), respectively. The base deficit in neonatal arterial blood increased significantly with decreasing neonatal [Hb]. Conclusions: Severe anemia causing severe base deficit is associated with neurological sequelae in FMH infants. © 2014 Elsevier Ltd.


Tofuku K.,Imakiire General Hospital | Koga H.,Imakiire General Hospital
European Spine Journal | Year: 2015

Purpose: We aimed to evaluate the value of single-photon emission computed tomography (SPECT)/computed tomography (CT) for the diagnosis of sacroiliac joint (SIJ) dysfunction. Methods: SPECT/CT was performed in 32 patients with severe SIJ dysfunction, who did not respond to 1-year conservative treatment and had a score of >4 points on a 10-cm visual analog scale. We investigated the relationship between the presence of severe SIJ dysfunction and tracer accumulation, as confirmed by SPECT/CT. In cases of bilateral SIJ dysfunction, we also compared the intensity of tracer accumulation on each side. Moreover, we examined the relationship between the intensity of tracer accumulation and the different treatments the patients subsequently received. Results: All 32 patients with severe SIJ dysfunction had tracer accumulation with a standardized uptake value (SUV) of >2.2 (mean SUV 4.7). In the 19 patients with lateralized symptom intensity, mean SUVs of the dominant side were significantly higher than those of the nondominant side. In 10 patients with no lateralization, the difference in the SUVs between sides was <0.6. Patients exhibiting higher levels of tracer accumulation required more advanced treatment. Conclusion: Patients with higher levels of tracer accumulation had greater symptom severity and also required more advanced treatment. Thus, we believe that SPECT/CT may be a suitable supplementary diagnostic modality for SIJ dysfunction as well as a useful technique for predicting the prognosis of this condition. © 2014, Springer-Verlag Berlin Heidelberg.


Matsunaga S.,Imakiire General Hospital | Komiya S.,Imakiire General Hospital | Toyama Y.,Imakiire General Hospital
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society | Year: 2015

PURPOSE: To clarify risk factors for the development of myelopathy in patients with cervical spondylotic cord compression.METHOD: The authors reviewed articles in which risk factors for the development of myelopathy in patients with cervical spondylotic cord compression were discussed. Ossification of the posterior longitudinal ligament (OPLL) was also reviewed as a disease which causes cervical cord compression to clarify pathomechanism of the development of myelopathy.RESULTS: Cervical motion segment disorders are considered to be multifactorial, and developmental size of the canal and foramina, pathological encroachment, biomechanical effects, and circulatory deficiencies are always present to some degree. Static and dynamic factors should be considered for the development of myelopathy. To clarify the pathomechanism of the development of myelopathy in patients with cervical spondylotic spinal cord compression, the exact natural history of CSM should be understood.CONCLUSION: Several predictable risk factors for the development of myelopathy have been proposed in CSM or OPLL studies, but they were not definitive. Further prospective population-based study is needed to clarify the mechanism.


Tofuku K.,Imakiire General Hospital | Koga H.,Imakiire General Hospital
European Spine Journal | Year: 2012

Purpose The purpose of this study was to describe a freehand pedicle screw insertion technique and to evaluate the accuracy of pedicle screw placement and validity of pedicle screw fixation in patients with subaxial cervical spine injuries. Methods We retrospectively reviewed 32 consecutive patients with subaxial cervical spine injuries who underwent posterior cervical fixation using our cervical pedicle screw (CPS) insertion technique. We also assessed the clinical and radiological outcomes and the accuracy of pedicle screw placement. Results The mean preoperative kyphosis was 4.0°, which was corrected to -5.2° after the operation, and the mean kyphosis angle was -4.4° at the final follow-up. The mean preoperative disc height ratio was 81.9%, and it improved to 105.4% after the operation, which was maintained until the final follow-up measurement of 103.4%. Bony union was achieved, and there were no instrumentation failures in any patient. Overall, 127 pedicle screws were inserted, of which 112 (88.1%) were classified as grade 1 (exact intrapedicular screw positioning), 10 (7.8%) as grade 2 (perforation<50% of the screw diameter), and 5 (3.9%) as grade 3 (perforation more than 50% of the screw diameter). Conclusion In our technique, a gutter is created using a high-speed burr at the transitional area between the lateral mass and lamina similar to the procedure in double-door laminoplasty to identify an entry point for CPS insertion. It is easy for general spine surgeons to identify a CPS insertion entry point using our technique. © 2011 Springer-Verlag.


Tofuku K.,Imakiire General Hospital | Koga H.,Imakiire General Hospital | Yanase M.,Yanase Orthopaedic Hospital | Komiya S.,Kagoshima Graduate
European Spine Journal | Year: 2012

Purpose The purpose of this study was to determine if the use of antibiotic-impregnated fibrin sealant (AFS) was effective in preventing surgical site infections (SSI) associated with spinal instrumentation. Methods In a preliminary study, five pieces of vancomycin-impregnated fibrin sealant, five nuts that were not treated with the sealant, and five nuts that were treated with the sealant were subjected to agar diffusion testing. In a clinical study, the rates of deep SSI were compared between 188 patients who underwent procedures involving spinal instrumentation without AFS (group 1) and 196 patients who underwent procedures involving spinal instrumentation with AFS (group 2). Results All five pieces of vancomycin-impregnated fibrin sealant and the five nuts treated with the sealant exhibited antimicrobial efficacy, while the five untreated nuts did not exhibit antimicrobial efficacy in the agar diffusion test. In the clinical study, 11 (5.8 %) of the 188 patients in group 1 acquired a deep SSI, while none (0 %) of the 196 patients in group 2 acquired a deep SSI. Conclusion The present study demonstrated that the application of AFS to spinal instrumentation yielded good clinical outcomes in terms of the prevention of postoperative spinal infections. It is hoped that limiting AFS use to patients requiring spinal instrumentation and those with risk factors for SSI will reduce the overall costs while preventing SSIs. © Springer-Verlag 2012.


Matsunaga S.,Imakiire General Hospital | Sakou T.,Imakiire General Hospital
Spine | Year: 2012

Study Design: Review article. Objective: To review the etiology, natural history, measurement tools, and image diagnosis of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine. Summary of Background Data: OPLL is a well-known disease that causes myelopathy. Genetic factors are very important for development of OPLL. However, the pathogenetic gene and natural history of OPLL have not been clarified. Methods: The authors reviewed studies about the etiology, natural history, measurement tools, and diagnosis of OPLL, which had been performed by the members of the Investigation Committee on the Ossification of the Spinal Ligaments of the Japanese Ministry of Health, Labour, and Welfare. Results: The prevalence of OPLL in the general Japanese population was reported to be 1.9% to 4.3% among people older than 30 years. Genetic factors are important for development of OPLL, and some candidate genes have been reported. Clinical course of OPLL has been clarified by a prospective long-term follow-up study. Some radiographic predictors for development of myelopathy were introduced. Image diagnosis of OPLL is easy by plain radiographs, but magnetic resonance imaging and computed tomography are useful to determine cord compression by OPLL. Conclusion: OPLL should be managed on the basis of the consideration of its natural history. Elucidation of pathogenetic genes of OPLL will introduce a new approach for management of OPLL. Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.


Matsunaga S.,Imakiire General Hospital | Komiya S.,Kagoshima University | Toyama Y.,Keio University
European Spine Journal | Year: 2013

Purpose: To clarify risk factors for the development of myelopathy in patients with cervical spondylotic cord compression. Method: The authors reviewed articles in which risk factors for the development of myelopathy in patients with cervical spondylotic cord compression were discussed. Ossification of the posterior longitudinal ligament (OPLL) was also reviewed as a disease which causes cervical cord compression to clarify pathomechanism of the development of myelopathy. Results: Cervical motion segment disorders are considered to be multifactorial, and developmental size of the canal and foramina, pathological encroachment, biomechanical effects, and circulatory deficiencies are always present to some degree. Static and dynamic factors should be considered for the development of myelopathy. To clarify the pathomechanism of the development of myelopathy in patients with cervical spondylotic spinal cord compression, the exact natural history of CSM should be understood. Conclusion: Several predictable risk factors for the development of myelopathy have been proposed in CSM or OPLL studies, but they were not definitive. Further prospective population-based study is needed to clarify the mechanism. © 2013 Springer-Verlag Berlin Heidelberg.


Koga H.,Imakiire General Hospital
Journal of NeuroInterventional Surgery | Year: 2012

An 84-year-old man experienced right buttock pain that radiated gradually to his right lower extremity over a few months before admission. MRI revealed a space occupying intraspinal lesion that was close to the right-sided L4-L5 facet joint and an extraspinal lesion posterior to the right-sided L5 lamina. The lesions appeared as hyperintense areas on T1 weighted images and heterogeneous areas on T2 weighted images. Facet arthrography under CT guidance revealed peripheral infiltration of the contrast medium only in the intraspinal lesion at early stages; subsequently, the contrast medium diffused into the extraspinal lesion, establishing a continuity of the right L4-L5 facet joint with both lesions, which were connected through the interlaminar space. A connection between the intraspinal and extraspinal lesions at the right-sided interlaminar space at the L4-L5 level was clearly noted during intraoperative examination. Histological examination revealed a hemorrhagic synovial cyst.


Tofuku K.,Imakiire General Hospital | Koga H.,Imakiire General Hospital
Journal of Clinical Neuroscience | Year: 2013

The purpose of this study was to compare the clinical and radiographic outcomes of patients with distractive flexion (DF) injuries of the subaxial cervical spine who had undergone a posterior procedure using cervical pedicle screw (CPS) fixation with those who had undergone a combined anterior and posterior procedure. Recommendations for the surgical treatment of DF injuries of the subaxial cervical spine remain controversial. There are few clinical reports of posterior CPS fixation for DF injuries. We retrospectively reviewed the clinical records and radiographs of 50 consecutive patients with DF injuries of the subaxial cervical spine treated at the Imakiire General Hospital. Group 1 consisted of 24 patients who underwent posterior wiring fixation and fusion with additional anterior decompression and fusion. Group 2 consisted of 26 patients who underwent posterior decompression and fusion with CPS fixation. Group 1 had a significantly longer operation time (295.4 minutes) than Group 2 (163.3 minutes). Group 1 had significantly higher blood loss (689.1 g) than Group 2 (313.7 g). No patient in Group 1 or 2 developed postoperative neurological worsening. The mean loss of kyphotic correction was 1.6° and 0.1° in Groups 1 and 2, respectively, and the loss of kyphotic correction in Group 2 was significantly less than that of Group 1. We suggest that posterior procedures with CPS fixation are reasonable for the management of cervical DF injuries. © 2012 Elsevier Ltd. All rights reserved.


Tofuku K.,Imakiire General Hospital | Koga H.,Imakiire General Hospital
Journal of Medical Case Reports | Year: 2012

Introduction: Although uncommon, selective cervical nerve root blocks can have serious complications. The most serious complications that have been reported include cerebral infarction, spinal cord infarction, transient quadriplegia and death. Case presentation: A 40-year-old Japanese woman with a history of severe right-sided cervical radicular pain was scheduled to undergo a right-sided C6 selective cervical nerve root block using a transforaminal approach under fluoroscopic guidance. An anterior oblique view of the C5-C6 intervertebral foramen was obtained, and a 23-gauge spinal needle, connected to the normal extension tube with a syringe filled with contrast medium, was introduced into the posterior-caudal aspect of the C5-C6 intervertebral foramen on the right side. In the anteroposterior view, the placement of the needle was considered satisfactory when it was placed no more medial than halfway across the width of the articular pillar. Although the spread of the contrast medium along the C6 nerve root was observed with right-sided C6 radiculography, the subdural flow of the contrast medium was not observed with real-time fluoroscopy. The extension tube used for the radiculography was removed from the spinal needle and a normal extension tube with a syringe filled with lidocaine connected in its place. We performed a negative aspiration test and then injected 1.5 mL of 1.0% lidocaine slowly around the C6 nerve root. Immediately after the injection of the local anesthetic, our patient developed acute flaccid paralysis, complained of breathing difficulties and became unresponsive; her respiratory pattern was uncoordinated. After 20 minutes, she regained consciousness and became alert, and her muscle strength in all four limbs returned to normal without any sensory deficits after receiving emergent cardiorespiratory support. Conclusions: We believe that confirming maintenance of the appropriate needle position in the anteroposterior view by injecting local anesthetic is important for preventing central needle movement. Because the potential risk of serious complications cannot be completely eliminated during the use of any established selective cervical nerve root block procedure, preparation for an emergency airway, ventilation and cardiovascular support is indispensable in cases of high spinal cord anesthesia. © 2012 Tofuku et al.; licensee BioMed Central Ltd.

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