JaLCDOI 10.18926/AMO/57949
FullText URL 74_1_27.pdf
Author Toda, Kazukiyo| Yagata, Yukihisa| Kikuchi, Takeshi| Takigawa, Tomoyuki| Ito, Yasuo|
Abstract Pelvic fractures occur with high-energy trauma, and the patient’s clinical status is unstable. Although a number of surgical methods for unstable pelvic fractures are available, none can achieve strong fixation with minimal invasiveness. We describe a surgical transiliac rod and screw fixation (TIF) procedure that provides minimally invasive fixation using a spinal implant for unstable pelvic ring fractures, and we retrospectively analyzed the procedure’s outcomes in 27 patients with type B or C1 fractures (based on the AO/ATO classification system). Small skin incisions are made above the posterior superior iliac spines on both sides. The ilium is partially resected, and two iliac screws are inserted on each side. The spinous process of the sacral spine is then shaved, and the iliac screws are connected to 2 rods, one placed caudal to the other. Corrective manipulation is performed at the fracture site, and the rods are connected with connectors. Favorable fracture reduction, defined as a rating of ‘excellent’ or ‘good,’ was achieved in 77.8% of the patients. Transiliac rod and screw fixation (TIF) will be a useful therapeutic option for unstable pelvic ring fractures.
Keywords pelvic ring fractures sacral fracture transiliac rod and screw fixation spinal fixation system minimally invasive surgery
Amo Type Original Article
Published Date 2020-02
Publication Title Acta Medica Okayama
Volume volume74
Issue issue1
Publisher Okayama University Medical School
Start Page 27
End Page 32
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2020 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 32099245
JaLCDOI 10.18926/AMO/56173
FullText URL 72_4_375.pdf
Author Morita, Takuya| Sugimoto, Yoshihisa| Takigawa, Tomoyuki| Misawa, Haruo| Ito, Yasuo| Ozaki, Toshifumi|
Abstract Venous thromboembolism (VTE) is a major complication in patients with acute spinal cord injury. There are few reports of VTE with acute thoracolumbar spinal cord injury (TLSCI). We assessed the incidence of VTE with acute TLSCI using color Doppler ultrasonography. We retrospectively assessed 75 patients with acute TLSCI (T1 to L1). All patients were surgically treated. VTE of the lower extremity and pelvis was assessed using color Doppler ultrasound regardless of whether symptoms were present. This retrospective study included patients who were assessed between 6 and 10 days (mean 8.1 days) after injury. VTE was detected in 27 of the 75 patients (35.7%) with or without paralysis. Of the 13 patients who had complete motor paralysis, 8 (62%) had VTE; of the 31 patients with incomplete motor paralysis, 10 (32%) had VTE, and of the 31 patients without motor paralysis, 9 (29%) had VTE. Among the patients with TLSCI, those with VTE had a significantly higher mean age than those without. The incidence of VTE in TLSCI patients is not related to the severity of paralysis in a Japanese population. The incidence appears to be related primarily to age.
Keywords venous thromboembolism thoracolumbar spinal cord injury paralysis, trauma complication
Amo Type Original Article
Published Date 2018-08
Publication Title Acta Medica Okayama
Volume volume72
Issue issue4
Publisher Okayama University Medical School
Start Page 375
End Page 378
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2018 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 30140085
JaLCDOI 10.18926/AMO/54188
FullText URL 70_2_97.pdf
Author Shinohara, Kensuke| Takigawa, Tomoyuki| Tanaka, Masato| Sugimoto, Yoshihisa| Arataki, Shinya| Ito, Yasuo| Ozaki, Toshifumi|
Abstract Vertical sacral fracture is one of the most difficult fractures to treat. Posterior fixation using spinal dual rods is a novel method for treating this fracture, but its biomechanical strength has not yet been reported. The aim of this study was to evaluate the biomechanical strength produced by posterior fixation using spinal instrumentation. Sacral fractures were created in eight pelvic bone models and classified into a posterior plate fixation group [P group, n=4] and a spinal instrumentation group [R group, n=4]. The biomechanical strength was tested by pushing down on the S1 vertebra from the top. The mean maximum loads were 1,057.4 N and 1,489.4 N in the P and R groups, respectively (p=0.014). The loads applied to the construct at displacements of 5mm and 7.5mm from the start of the universal testing machine loading were also significantly higher in the R group. The mean stiffness levels in the P and R groups were 88.3N/mm and 119.6N/mm, respectively (p=0.014). Posterior fixation using spinal instrumentation is biomechanically stronger than conventional posterior plate fixation. This procedure may be the optimal method for treating unstable sacral fracture fixation.
Keywords biomechanical comparison sacral fracture posterior fixation spinal instrumentation
Amo Type Original Article
Published Date 2016-04
Publication Title Acta Medica Okayama
Volume volume70
Issue issue2
Publisher Okayama University Medical School
Start Page 97
End Page 102
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2016 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 27094834
Web of Science KeyUT 000377626300004
JaLCDOI 10.18926/AMO/49043
FullText URL 66_6_469.pdf
Author Shiozaki, Yasuyuki| Ito, Yasuo| Sugimoto, Yoshihisa| Tomioka, Masao| Shimokawa, Tetsuya| Mazaki, Tetsuro| Koshimune, Koichiro| Tanaka, Masato| Ozaki, Toshifumi|
Abstract In this study, we studied the relationship between fracture patterns and motor function recovery in 70 consecutive patients with cervical spinal cord injury. Fractures were categorized into 6 fracture types and subdivided into stages according to the Allen-Ferguson classification system:compressive flexion (CF), distractive flexion (DF), compressive extension (CE), distractive extension (DE), vertical compression (VC) and lateral flexion (LF). Paralysis was evaluated using the American Spinal Injury Association (ASIA) impairment scale at the time of injury and 3 months afterwards. The residual rate of complete motor palsy (ASIA grade A or B) at the final examination was higher in those patients with DE fractures than those with CF, DF or CE. The final outcomes were as follows. Of the 14 patients who were classified with CF fractures, residual palsy was frequently seen in patients who had stage 5 injury. Of the 27 patients with DF fractures, residual palsy occurred in about half of the patients who had stage 4 or 5 injury. Of the 18 patients with CE fractures, residual palsy occurred in half of the patients with stage 3 injury or higher. Finally, of the 7 patients with DE fractures, the rate of residual palsy was high even for the stage 1 and 2 cases;indeed, all DE patients who had complete motor palsy at the first examination had residual palsy at the final examination. Accordingly, we conclude that motor recovery may be related to fracture pattern.
Keywords cervical spinal cord injury motor function recovery fracture patterns
Amo Type Original Article
Published Date 2012-12
Publication Title Acta Medica Okayama
Volume volume66
Issue issue6
Publisher Okayama University Medical School
Start Page 469
End Page 473
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2012 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 23254581
Web of Science KeyUT 000312966100006
JaLCDOI 10.18926/AMO/40504
FullText URL 64_5_293.pdf
Author Sugimoto, Yoshihisa| Ito, Yasuo| Tomioka, Masao| Shimokawa, Tetsuya| Shiozaki, Yasuyuki| Mazaki, Tetsuro| Tanaka, Masato|
Abstract We used a navigation system to insert 128 pedicle screws into 69 vertebrae (L1 to L3) of 49 consecutive patients. We assessed the pedicle isthmic width and the permission angle for pedicle screw insertion. The permission angle is the angle defined by the greatest medial and lateral trajectories allowable when placing the screw through the center of the pedicle. The rate of narrow-width pedicles (isthmic width less than 5mm) was 5 of 60 pedicles (8%) at L1, 4 of 60 pedicles (7%) at L2, and none (0%) at L3, L4 and L5. The rate of narrow-angle pedicles (a permission angle less than 15 degrees) was 21 of 60 pedicles (35%) at L1, 7 of 60 (12%) at L2, 3 of 60 (5%) at L3, and none (0%) at L4 and L5. Of 128 pedicle screws inserted into 69 vertebrae from L1 to L3, 125 (97.7%) were classified as Grade 1 (no pedicle perforation). In general, the upper lumbar vertebrae have more narrow-width and -angle pedicles. However, we could reduce the rate of pedicle screw misplacement in upper lumbar vertebra using a three-dimensional fluoroscopy and navigation system.
Keywords upper lumbar navigation pedicle screw anatomy misplacement
Amo Type Original Article
Published Date 2010-10
Publication Title Acta Medica Okayama
Volume volume64
Issue issue5
Publisher Okayama University Medical School
Start Page 293
End Page 297
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2010 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 20975762
Web of Sience KeyUT 000283563300004
JaLCDOI 10.18926/AMO/40014
FullText URL fulltext.pdf
Author Sugimoto, Yoshihisa| Ito, Yasuo| Tomioka, Masao| Shimokawa, Tetsuya| Shiozaki, Yasuyuki| Mazaki, Tetsuro| Tanaka, Masato|
Abstract Correct screw placement is especially difficult in the upper thoracic vertebrae. At the cervicothoracic junction (C7-T2), problems can arise because of the narrowness of the pedicle and the difficulty of using a lateral image intensifier there. Other upper thoracic vertebrae (T3-6) pose a problem for screw insertion also because of the narrower pedicle. We inserted 154 pedicle screws into 78 vertebrae (C7 to T6) in 38 patients. Screws were placed using intraoperative data acquisition by an isocentric C-arm fluoroscope (Siremobile Iso-C3D) and computer navigation. Out of 90 pedicle screws inserted into 45 vertebrae between C7 and T2, 87 of the 90 (96.7%) screws were classified as grade 1 (no perforation). Of 64 pedicle screws inserted into 33 vertebrae between T3 and T6, 61 of 64 (95.3%) screws were classified as grade 1. In this study, we reduced pedicle screw misplacement at the level of the C7 and upper thoracic (T1-6) vertebrae using the three-dimensional fluoroscopy navigation system.
Keywords Iso-C3D three-dimensional fluoroscopy navigation upper thoracic pedicle screw
Amo Type Original Article
Published Date 2010-06
Publication Title Acta Medica Okayama
Volume volume64
Issue issue3
Publisher Okayama University Medical School
Start Page 209
End Page 212
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 20596133
Web of Science KeyUT 000279094300008
JaLCDOI 10.18926/AMO/31849
FullText URL fulltext.pdf
Author Tanaka, Masato| Nakahara, Shinnosuke| Ito, Yasuo| Kunisada, Toshiyuki| Misawa, Haruo| Koshimune, Koichiro| Ozaki, Toshifumi|
Abstract <p>Surgical treatment of metastatic spinal cord compression is controversial. The purpose of this study was to investigate the effectiveness of our current surgical treatments and the use of spinal instrumentation. In this retrospective study covering the years between 1990 and 2006, 100 patients with spinal metastases which were secondary to various cancers underwent posterior and/or anterior decompression with spinal stabilization for the purposes of reduction of pain, and/or to help correct or improve neurological deficits. The group was made up of 60 men and 40 women whose ages ranged from 16 to 83 years (average of 60 years), and the average follow-up period was 14 months. The effect of treatment upon pain relief and neural deficits was assessed, and the cumulative survival rate was calculated by the Kaplan-Meier method. The average surgical time was 185min. This was calculated based on the following times, listed here with the surgery type:178min for posterior surgery;245min for anterior surgery;465 min for combined surgery;and 475min for total en bloc spondylectomy. Average blood loss during surgery was 1,630 ml for posterior surgery, 1,760 ml for anterior surgery, 1,930 ml for combined surgery, and 3,640 ml for total en bloc spondylectomy. Preoperative pain and paralysis were improved by 88% and 53%, respectively. In regards to surgical complications, postoperative epidural hematoma was observed in 2 patients, and instrumentation-related infection was observed in 1. Only 2 patients died within 2 months of surgery. In conclusion, posterior and/or anterior decompression with spinal stabilization is a safe and effective treatment for patients with spinal metastases, and can improve their quality of life.</p>
Keywords spinal metastasis spinal surgery instrumentation
Amo Type Original Article
Published Date 2009-06
Publication Title Acta Medica Okayama
Volume volume63
Issue issue3
Publisher Okayama University Medical School
Start Page 145
End Page 150
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
File Version publisher
Refereed True
PubMed ID 19571901
Web of Science KeyUT 000267388200004