Fukushima-shi, Japan
Fukushima-shi, Japan

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Nakagawa S.,Yukioka Hospital | Yoneda M.,Osaka Kosei nenkin Hospital | Mizuno N.,Yukioka Hospital | Hayashida K.,Osaka Police Hospital | And 2 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2013

Purpose: The role of posterior capsular tightness in throwing shoulder injury has not yet been clarified. Accordingly, the influence of posterior capsular tightness on the occurrence of throwing shoulder injury was investigated. Methods: Sixty-one shoulders with throwing injury were retrospectively reviewed, including 50 tight shoulders and 11 non-tight shoulders. Occurrence of long head of biceps (LHB) lesions, superior glenohumeral ligament (SGHL) and middle glenohumeral ligament (MGHL) injuries, type 2 SLAP lesions, and supraspinatus and subscapularis tendon injuries was compared between the tight and non-tight groups. Results: There were LHB lesions in 8 tight shoulders and 6 non-tight shoulders, SGHL injury in 14 and 8 shoulders, and subscapularis tendon injury in 6 and 5 shoulders, respectively, showing significant differences between tight and non-tight shoulders. In contrast, MGHL injury, type 2 SLAP lesions, and supraspinatus tendon injury showed no significant differences. The SLAP lesion was located anteriorly in 6 tight shoulders, posteriorly in 5, and combined in 4 versus 0, 3, and 0 for the non-tight shoulders, respectively, so anterior SLAP lesions only occurred in tight shoulders. Similarly, anterior supraspinatus tendon injuries had a higher incidence in tight shoulders than in non-tight shoulders (19 vs 3). Conclusions: Rotator interval lesions were frequent in non-tight shoulders, while anterior SLAP lesions and anterior supraspinatus tendon injuries were predominant in tight shoulders. The significance of posterior capsular tightness should be reconsidered. Level of evidence: Retrospective, Level IV. © 2012 Springer-Verlag.

Miyake J.,Osaka University | Shimada K.,Osaka Kosei nenkin Hospital | Masatomi T.,Yukioka Hospital
Journal of Shoulder and Elbow Surgery | Year: 2010

Hypothesis: Osteosynthesis for longstanding nonunion of the lateral humeral condyle in adults has a high rate of complications, including failure of bony union and restriction of elbow motion. We hypothesized that rigid fixation may contribute to higher union rate and the placement of the condyle fragment with proper tilting may minimize the reduction of elbow motion. Materials and methods: Ten patients were treated with osteosynthesis. Average age at operation was 38.6 years. Three patients had dysfunction of the ulnar nerve, 2 experienced pain, and 5 had both presentations. According to Toh et al's radiographic criteria, nonunion was categorized as Group 1 in 2 patients and Group 2 in 8 (J Bone Joint Surg Am 2002;84:593-598). We performed osteosynthesis with iliac bone graft and ulnar nerve anterior transposition, with efforts to fix the fragment rigidly and to manage the fragment position properly. Results: Osseous union was achieved in all 8 Group 2 patients, while 1 Group 1 case showed delayed union and the other did not achieve union. Pain resolved and ulnar nerve symptoms improved in all cases. In 9 patients with union, total arc of motion was reduced by an average of 20°. The preoperative mobility of the condyle fragment determined by maximum flexion and extension lateral radiographs had a correlation to the postoperative loss of motion (P = .047); however, loss of motion was less than that expected by radiographs. Conclusion: Osteosynthesis appears to be indicated for Group 2 nonunion with pain. Rigid fixation with care of the position of the fragment is important for the good outcomes. © 2010 Journal of Shoulder and Elbow Surgery Board of Trustees.

Akiyama K.,Osaka Kosei Nenkin Hospital | Sakai T.,Osaka University | Koyanagi J.,Osaka General Medical Center | Yoshikawa H.,Osaka University | Sugamoto K.,Osaka University
Journal of Orthopaedic Research | Year: 2013

Our objectives were to clarify the 3D articular contact areas of the in vivo normal hip joint and acetabular dysplasia during specific positions using magnetic resonance imaging (MRI), voxel-based registration, and proximity mapping. Forty-two normal and 24 dysplastic hips were examined. MRI was performed at four positions: neutral; 45°flexion; 15°extension; and the Patrick position. Femur and pelvis bone models were reconstructed at the neutral position and superimposed over the images of each different position using voxel-based registration. The inferred cartilage contact and bony impingement were investigated using proximity mapping. The femoral head translated in the anterior or posteroinferior, anterosuperior, and posteroinferior direction from neutral to 45°flexion, 15°extension, and the Patrick position, respectively. Multiple regression analyses showed age, femoral head sphericity, and acetabular sphericity to be associated with higher hip instability. The present technique using subject-specific models revealed the in vivo hip joint contact area in a population of healthy individuals and dysplastic patients without radioactive exposure. These results can be used for analyzing disease progression in the dysplastic hip and pathogenesis of acetabular labral tear. Copyright © 2013 Orthopaedic Research Society.

Mukai Y.,Osaka Kosei nenkin Hospital | Takenaka S.,Osaka Kosei nenkin Hospital | Hosono N.,Osaka Kosei nenkin Hospital | Miwa T.,Kansai Rosai Hospital | Fuji T.,Osaka Kosei nenkin Hospital
Journal of Neurosurgery: Spine | Year: 2013

Object. This randomized study was designed to elucidate the time course of the perioperative development of intramuscular multifidus muscle pressure after posterior lumbar interbody fusion (PLIF) and to investigate whether the route of pedicle screw insertion affects this pressure and resultant low-back pain. Although several studies have focused on intramuscular pressure associated with posterior lumbar surgery, those studies examined intramuscular pressure generated by the muscle retractors during surgery. No study has investigated the intramuscular pressure after PLIF. Methods. Forty patients with L4-5 degenerative spondylolisthesis were randomly assigned to undergo either the mini-open PLIF procedure with pedicle screw insertion between the multifidus and longissimus muscles (n = 20) or the conventional PLIF procedure via a midline approach only (n = 20). Intramuscular pressure was measured 5 times (at 30 minutes and at 6, 12, 24, and 48 hours after surgery) with an intraoperatively installed sensor. Concurrently, the FACES Pain Rating Scale score for low-back pain and the total dose of postoperative analgesics were recorded. Results. With the patients in the supine position, for both groups the mean pressure values were consistently 40-50 mm Hg, which exceeded the critical capillary pressure of the muscle. With the patients in the lateral decubitus position, the pressure decreased over time (from 14 to 9 mm Hg in the mini-open group and from 20 to 10 mm Hg in the conventional group). Among patients in the mini-open group, the pressure was lower, but the difference was not statistically significant. Postoperative pain and postoperative analgesic dosages were also lower . Conclusions. To the authors' knowledge, this is the first study to evaluate postoperative intramuscular pressure after PLIF. Although the results did not demonstrate a significant difference in the intramuscular pressure between the 2 types of PLIF, mini-open PLIF was associated with less pain after surgery. Clinical trial registration no.: UMIN000010069 (www.umin.ac.jp/ctr/index.htm). ©AANS, 2013.

Kaito T.,National Hospital Organization | Hosono N.,Osaka Kosei nenkin Hospital | Mukai Y.,Osaka Kosei nenkin Hospital | Makino T.,National Hospital Organization | And 2 more authors.
Journal of Neurosurgery: Spine | Year: 2010

Object. Spinal fusion at the L4-5 disc space alters the normal biomechanics of the spine, and the loss of motion at the fused level is compensated by increased motion and load at the other unfused segments. This may lead to deterioration of the adjacent segments of the lumbar spine, called adjacent-segment disease (ASD). In this study, the authors investigate the distracted disc height of the fused segment, caused by cage or bone insertion during surgery, as a novel risk factor for ASD after posterior lumbar interbody fusion (PLIF). Methods. Radiographic L3-4 ASD is defined by development of spondylolisthesis greater than 3 mm, a decrease in disc height of more than 3 mm, or intervertebral angle at flexion smaller than -5deg;. Symptomatic ASD is defined by a decrease of 4 points or more on the Japanese Orthopaedic Association scale. Eighty-five patients with L-4 spondylolisthesis treated by L4-5 PLIF underwent follow-up for more than 2 years (mean 38.8 ± 17.1 months). The patients were divided into 3 groups according to the final outcome. Group A comprised those patients without ASD (58), Group B patients had radiographic ASD (14), and Group C patients had symptomatic ASD (13). Results. The L4-5 disc space distraction by cage insertion was 3.1 mm in the group without ASD, 4.4 mm in the group with radiographic ASD, and 6.2 mm in the group with symptomatic ASD, as measured using lateral spinal radiographs just after surgery. Multivariate analysis showed that distraction was the most significant risk factor. Conclusions. The excessive distraction of the L4-5 disc space during PLIF surgery is a significant and potentially avoidable risk factor for the development of radiographic, symptomatic ASD.

Sakaura H.,Kansai Rosai Hospital | Hosono N.,Osaka Kosei Nenkin Hospital | Mukai Y.,Osaka Kosei Nenkin Hospital | Iwasaki M.,Osaka University | Yoshikawa H.,Osaka University
European Spine Journal | Year: 2011

C3-6 laminoplasty preserving muscle insertions into the C7 spinous process is reportedly associated with a significantly decreased frequency of postoperative axial neck pain. However, no prospective study has reported medium-term outcomes of C3-6 laminoplasty. The purpose of this study was to elucidate medium-term outcomes after C3-6 laminoplasty. Subjects comprised 31 patients with cervical myelopathy who underwent C3-6 laminoplasty preserving all bilateral muscles attached to the C2 and C7 spinous processes and were followed for C5 years. Clinical and radiological data were prospectively collected. Neurological status was assessed using Japanese Orthopaedic Association (JOA) score. Axial neck pain was graded as severe, moderate or mild. Sagittal alignment of the cervical spine and progression of ossification of the posterior longitudinal ligament (OPLL) were assessed by comparing serial lateral radiographs. Mean JOA score improved significantly from 10.6 before surgery to 14.7 at the time of maximum recovery, and slightly declined to 14.3 at final follow-up. In six patients who developed late deterioration, these conditions were unrelated to the cervical spine. As of final follow-up, only one patient (3.2%) had complained of axial neck pain persisting for 5 years. Although progression of OPLL was found in 63.6% of patients, none had experienced neurological deterioration due to this progression. At final follow-up, sagittal alignment of the cervical spine was more lordotic than before surgery. Medium-term outcomes of C3-6 laminoplasty were satisfactory. Frequencies of persistent axial neck pain and loss of cervical lordosis after surgery remained significantly decreased for C5 years postoperatively. © Springer-Verlag 2011.

Hosono N.,Osaka Kosei nenkin Hospital | Takenaka S.,Osaka Kosei nenkin Hospital | Mukai Y.,Osaka Kosei nenkin Hospital | Makino T.,National Hospital Organization | And 3 more authors.
Spine | Year: 2012

Study Design: A prospective follow-up study to detect the early neurological improvement after decompression surgery and to clarify its correlation with the late neurological outcome in patients with cervical compression myelopathy. Objective: To reveal the suitability of a simple performance, 15-second grip-and-release test for postoperative neurological recovery in patients with cervical myelopathy. Summary of Background Data: Although various parameters have been advocated as prognostic factors, there still remain arguments against them. Furthermore, neurological status after decompression surgery has been evaluated weekly or monthly in previous studies, but not hourly or daily. To follow the postoperative neurological recovery, we used our original performance test. Methods: Forty-eight patients who were admitted to undergo decompressive laminoplasty for cervical myelopathy were enrolled in the study. Twenty-five patients who were admitted for lumbar spine surgery were used as controls. Subjects were asked to fully grip and release with their right (or left) hand fingers as fast as possible for 15 seconds, which was recorded by a digital camera. And the number of grip-and-release cycles was counted (15-second test) in the recorded video files. Results: In the myelopathy group, the number of grip-and-release cycles before surgery and 4 hours, 24 hours, 48 hours, 1 week, and 2 weeks after surgery was 26.7 ± 10.0, 29.7 ± 9.9, 35.0 ± 11.3, 35.1 ± 9.8, 36.2 ± 9.6, and 37.2 ± 10.2, respectively. The number increased steeply after surgery until 24 hours, and the number was 94% after 24 hours of the number recorded 2 weeks after surgery. In the control group, the number of grip-and-release cycles at each time point was 37.9 ± 9.7, 34.7 ± 9.1, 39.2 ± 9.0, 38.5 ± 8.9, 38.9 ± 9.7, and 38.0 ± 9.3, respectively. There was a transient reduction 4 hours after surgery. Conclusion: Because the number recorded 24 hours after surgery was significantly correlated with both the maximum gain in the number on the 15-second test and the gain in the Japan Orthopaedic Association score, it could be used as a prognostic factor for neurological outcome in patients with cervical myelopathy. Copyright © 2012 Lippincott Williams & Wilkins.

Sakaura H.,Osaka University | Hosono N.,Osaka Kosei nenkin Hospital | Mukai Y.,Osaka Kosei nenkin Hospital | Fujimori T.,Osaka University | And 2 more authors.
Spine | Year: 2010

Study Design: Prospective study. Objective: To examine whether preservation of subaxial deep extensor muscles plays any significant role in reducing axial neck pain and unfavorable radiologic changes after cervical laminoplasty in patients with cervical spondylotic myelopathy and to confirm the benefits of preserving muscles attached to the C2 and C7 spinous processes. Summary of Background Data: Axial neck pain and unfavorable radiologic changes after cervical laminoplasty have been reported to mostly result from detachment of cervical extensor muscles, particularly muscles attached to the C2 and C7 spinous processes. Other surgeons have reported that preservation of subaxial deep extensor muscles reduces these adverse effects after cervical laminoplasty. Methods: Subjects comprised 36 patients with cervical spondylotic myelopathy who underwent C3-C6 open-door laminoplasty and were followed up for >24 months. Of these, 18 consecutive patients underwent our modified laminoplasty (muscles-preserved group) and the remaining 18 consecutive patients underwent the conventional procedure (muscles-disrupted group). Both procedures preserved all muscles attached to the C2 and C7 spinous processes. Subaxial deep extensor muscles on the hinged side were also preserved in the muscles-preserved group. Radiologic and clinical data were prospectively collected. Results: Both groups achieved equal neurologic improvement. Frequencies of axial neck pain showed no significant differences between groups. This value did not vary according to the side of preservation of subaxial deep extensor muscles or the side of muscle disruption. Postoperative loss of lordosis and range of motion of the cervical spine also demonstrated no significant difference between groups. Conclusion: These results indicate that preservation of subaxial deep extensor muscles plays no significant role in reducing axial neck pain and unfavorable radiologic changes after cervical laminoplasty, supporting the hypothesis that these adverse effects after laminoplasty largely result from detachment of muscles attached to the C2 and C7 spinous processes. © 2010, Lippincott Williams & Wilkins.

Ohata C.,Ikeda Municipal Hospital | Nakai C.,Osaka Kosei Nenkin Hospital | Kasugai T.,Osaka Kosei Nenkin Hospital | Katayama I.,Osaka University
Journal of Cutaneous Pathology | Year: 2012

Background: Consumption of the epidermis (hereafter, consumption), namely thinning of the epidermis with attenuation of basal and suprabasal layers and loss of rete ridges adjacent to collections of melanocytes, has been used to differentiate invasive melanoma from Spitz nevi. Evaluation of 213 invasive melanomas, including only two cases of acral lentiginous melanoma (ALM), showed that the frequency of consumption increases with increasing tumor thickness. Methods: We evaluated consumption in 52 acral melanomas relative to age, gender, Breslow depth, tumor thickness (based on the 2010 American Joint Commission on Cancer guidelines), Clark level, mitoses, ulceration, vertical-growth phase, regression, tumor-infiltrating lymphocytes and anatomical site. Results: Consumption was more frequent in ALM with increasing Breslow depth (p = 0.01), and in the presence of ulceration (p = 0.0078); in all cases with ulcer, consumption was found adjacent to the ulceration. There was no statistically significant difference in consumption in nail melanomas in comparison to melanomas of acral skin other than the nail. Conclusions: These results support the hypothesis that epidermal thinning in consumption represents an early phase of ulceration. No statistically significant difference in consumption was found between nail melanomas and melanomas of acral skin other than the nail, probably because of similar tumor thickness in both groups. Copyright © 2012 John Wiley & Sons A/S.

Takenaka S.,Osaka Kosei nenkin Hospital | Hosono N.,Osaka Kosei nenkin Hospital | Mukai Y.,Osaka Kosei nenkin Hospital | Miwa T.,Osaka Kosei nenkin Hospital | Fuji T.,Osaka Kosei nenkin Hospital
Journal of Neurosurgery: Spine | Year: 2013

Object. No previous hypothesis has attempted to fully account for the occurrence of upper-limb palsy (ULP) after cervical laminoplasty. The authors propose that friction-generated heat from a high-speed drill may cause thermal injury to the nerve roots close to the drilled bone, which may then lead to ULP. The authors investigated the effect of cooling the saline used for irrigation during the drilling on the incidence of upper-limb (C-5) palsy following cervical laminoplasty. Methods. The irrigation saline for drilling was used at room temperature (RT, average temperature of 25.6°C) in operations of 79 patients (the RT group) and cooled to an average of 12.1°C in operations of 80 patients (the low-temperature [LT] group). The authors used a hand-held dynamometer to precisely assess muscle strength presurgery and 2 weeks postsurgery. Results. There was a 7.6% and 1.9% decrease in the strength of the deltoid muscle, a 10.1% and 4.4% decrease in the strength of the biceps brachii, a 1.3% and 0.6% decrease in the strength of the triceps brachii, and a 7.6% and 3.1% decrease in grip strength in the RT and LT groups, respectively. Multivariate analysis revealed that a significant predictor for decreased deltoid muscle strength was the use of irrigation saline at RT. Conclusions. Using cooled irrigation saline during bone drilling significantly decreased the incidence of ULP and can thus be recommended as a simple method for the prevention of ULP.

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