Explore the vast range of titles available.

Study Design A retrospective comparative study. Objectives This study investigated radiographical changes in global spinal sagittal alignment (GSSA) and clinical outcomes after tumor resection without spinal fusion in patients with thoracic dumbbell tumors. Methods Thirty patients with thoracic dumbbell tumors who were followed up for at least 3 years were included in this study. Variations in the outcome variables were analyzed using individual GSSA parameters measured on radiography. Clinical outcomes were assessed using the modified McCormick scale (MMCS), Japan Orthopaedic Association (JOA) score, and visual analog scale (VAS). To assess the impact of the affected levels on these outcomes, we divided the patients into three groups according to the location of the tumor (upper [T1-4], middle [T5-8], or lower [T9-12] thoracic spine). Results The GSSA parameters (cervical lordosis, T1 slope, thoracic kyphosis [global, upper, middle, and lower], thoracolumbar kyphosis, lumbar lordosis, sacral slope, pelvic incidence, and pelvic tilt) of all the patients did not change significantly after surgery. Eleven of thirty patients had preoperative gait disturbances but they could walk without support (MMCS grade I or II) at the final follow-up. The JOA score and VAS showed significant postoperative improvements. No statistically significant differences were observed in each postoperative sagittal profile or clinical outcome between the upper, middle, and lower groups. Conclusions Tumor resection without spinal fusion did not affect the various GSSA parameters and resulted in satisfactory clinical outcomes, indicating that spinal fusion may not always be necessary when resecting thoracic dumbbell tumors.

Study designA retrospective observational study.ObjectivesTo elucidate predictive clinical factors associated with irreversible complete motor paralysis following traumatic cervical spinal cord injury (CSCI).SettingHokkaido Spinal Cord Injury Center, Japan.MethodsA consecutive series of 447 traumatic CSCI persons were eligible for this study. Individuals with complete motor paralysis at admission were selected and divided into two groups according to the motor functional outcomes at discharge. Initial findings in magnetic resonance imaging (MRI) and other clinical factors that could affect functional outcomes were compared between two groups of participants: those with and those without motor recovery below the level of injury at the time of discharge.ResultsOf the 73 consecutive participants with total motor paralysis at initial examination, 28 showed some recovery of motor function, whereas 45 remained complete motor paralysis at discharge, respectively. Multivariate logistic regression analysis showed that the presence of intramedullary hemorrhage manifested as a confined low intensity changes in diffuse high-intensity area and more than 50% of cord compression on MRI were significant predictors of irreversible complete motor paralysis (odds ratio [OR]: 8.4; 95% confidence interval [CI]: 1.2–58.2 and OR: 14.4; 95% CI: 2.5–82.8, respectively).ConclusionThe presence of intramedullary hemorrhage and/or severe cord compression on initial MRI were closely associated with irreversible paralysis in persons with motor complete paralysis following CSCI. Conversely, subjects with a negligible potential for recovery could be identified by referring to these negative findings.

Study Design Prospective multicenter cohort study. Objectives To determine the incidence and risk factors for postoperative complications following cervical spine surgery and to explore their association with long-term clinical outcomes. Methods A total of 1482 patients with degenerative cervical disorders who underwent surgery at 10 high-volume institutions in Japan were prospectively enrolled. Perioperative complications were defined as events occurring within 30 days postoperatively. Risk factors were analyzed using univariate and logistic regression analyses. Clinical outcomes were assessed using the cervical Japanese Orthopaedic Association (JOA) score and the Physical Component Summary (PCS) of the SF-36 at baseline and 2 years postoperatively. Results Perioperative complications occurred in 5.5% of patients: segmental motor paralysis (2.3%), neurological deficit (0.6%), dural tear (0.5%), CSF leakage (0.3%), epidural hematoma (0.9%), and surgical site infection (0.8%). Male sex (OR 3.049; 95% CI 1.045-8.929) and posterior fusion (OR 4.016; 95% CI, 1.518-10.620) were significant risk factors for segmental motor paralysis, while respiratory disease (OR 5.500; 95% CI, 1.462-20.694) was associated with surgical site infection. At 2 years, patients with complications showed variable neurological recovery, with many failing to reach the minimum clinically important difference. Conclusions Male sex, posterior fusion, and respiratory disease were identified as significant risk factors for major complications. Awareness of these factors may support improved surgical planning and perioperative management. However, interpretation of long-term outcomes should be made with caution because of the limited number of cases and potential selection bias associated with incomplete follow-up.

Human induced pluripotent stem cell-derived neural stem/progenitor cell (hiPSC-NS/PC)-based cell transplantation has emerged as a groundbreaking method for replacing damaged neural cells and stimulating functional recovery, but its efficacy is strongly influenced by the state of the injured spinal microenvironment. This study evaluates the impact of a dual therapeutic intervention utilizing hepatocyte growth factor (HGF) and hiPSC-NS/PC transplantation on motor function restoration following spinal cord injury (SCI).BACKGROUNDHuman induced pluripotent stem cell-derived neural stem/progenitor cell (hiPSC-NS/PC)-based cell transplantation has emerged as a groundbreaking method for replacing damaged neural cells and stimulating functional recovery, but its efficacy is strongly influenced by the state of the injured spinal microenvironment. This study evaluates the impact of a dual therapeutic intervention utilizing hepatocyte growth factor (HGF) and hiPSC-NS/PC transplantation on motor function restoration following spinal cord injury (SCI).Severe contusive SCI was induced in immunocompromised rats, followed by continuous administration of recombinant human HGF protein into the subarachnoid space immediately after SCI for two weeks. Acute-phase histological and RNA sequencing analyses were conducted. Nine days after the injury, hiPSC-NS/PCs were transplanted into the lesion epicenter of the injured spinal cord, and the functional and histological outcomes were determined.METHODSSevere contusive SCI was induced in immunocompromised rats, followed by continuous administration of recombinant human HGF protein into the subarachnoid space immediately after SCI for two weeks. Acute-phase histological and RNA sequencing analyses were conducted. Nine days after the injury, hiPSC-NS/PCs were transplanted into the lesion epicenter of the injured spinal cord, and the functional and histological outcomes were determined.The acute-phase HGF-treated group exhibited vascularization, diverse anti-inflammatory effects, and activation of endogenous neural stem cells after SCI, which collectively contributed to tissue preservation. Following cell transplantation into a favorable environment, the transplanted NS/PCs survived well, facilitating remyelination and neuronal regeneration in host tissues. These comprehensive effects led to substantial enhancements in motor function in the dual-therapy group compared to the single-treatment groups.RESULTSThe acute-phase HGF-treated group exhibited vascularization, diverse anti-inflammatory effects, and activation of endogenous neural stem cells after SCI, which collectively contributed to tissue preservation. Following cell transplantation into a favorable environment, the transplanted NS/PCs survived well, facilitating remyelination and neuronal regeneration in host tissues. These comprehensive effects led to substantial enhancements in motor function in the dual-therapy group compared to the single-treatment groups.We demonstrate that the combined therapeutic approach of HGF preconditioning and hiPSC-NS/PC transplantation enhances locomotor functional recovery post-SCI, highlighting a highly promising therapeutic strategy for acute to subacute SCI.CONCLUSIONSWe demonstrate that the combined therapeutic approach of HGF preconditioning and hiPSC-NS/PC transplantation enhances locomotor functional recovery post-SCI, highlighting a highly promising therapeutic strategy for acute to subacute SCI.

Study Design Retrospective Cohort Study. Objective Modic changes (MCs) have been associated with low back pain; however, their prognostic value in surgical outcomes—particularly in patients with lumbar spinal stenosis (LSS) treated with decompression alone—remains unclear. Few studies have investigated the progression and long-term clinical impact of MCs. This study aimed to evaluate the 10-year progression of MCs and their association with clinical outcomes following posterior decompression surgery for LSS. Methods This study included 62 patients who underwent posterior decompression for LSS and completed a 10-year follow-up with MRI and clinical assessments. MCs and disc degeneration were evaluated using standardized MRI criteria. Japanese Orthopaedic Association (JOA) scores and recovery rates were assessed preoperatively and at follow-up. Outcomes were compared between Modic-negative patients and those with preoperative Modic Type 1 or Type 2 changes. Analysis of covariance adjusted for confounding variables. Results The prevalence of MCs increased from 37.1% preoperatively to 74.2% at 10 years. Type 1 changes were dynamic, often progressing to Type 2 or 3. Type 2 changes were more stable and associated with significantly lower postoperative JOA scores and recovery rates compared to Modic-negative or Type 1 patients (P < 0.05), after adjustment for age, sex, sagittal alignment parameters, and disc degeneration. Type 2 MCs were also linked with minimal improvement in back pain. Conclusion Modic changes, particularly Type 2, are associated with inferior long-term outcomes. These findings suggest that Modic Type 2 may serve as a prognostic marker of advanced degeneration and may be associated with reduced recovery following decompression surgery.

Study Design Retrospective cohort study. Objective This study aimed to determine whether the outcomes of posterior correction and fusion surgery (PSF) in patients with residual adolescent idiopathic scoliosis (AIS) during adulthood (Lenke type 5 AdIS) are inferior to those in patients with AIS treated during adolescence. Methods We retrospectively evaluated 48 patients with type 5 AdIS who underwent PSF after 20 years old. As controls, we selected 67 patients with type 5 AIS who underwent PSF before 18 years old. Both groups were matched based on the preoperative thoracic and thoracolumbar/lumbar Cobb angles, resulting in 33 patients in each group. We compared preoperative and postoperative radiographic parameters and SRS-22 scores between the 2 groups. Results Preoperatively, the AdIS group had significantly lower flexibility index (59.0% ± 13.0% vs 66.6% ± 16.7%; P = 0.01). The preoperative SRS-22 scores for pain and mental health domain were significantly worse in the AdIS group (pain, 3.9 ± 0.8 vs 4.3 ± 0.7, P < 0.01; mental health, 3.6 ± 0.8 vs 4.2 ± 0.6, P < 0.01). The AdIS group had significantly more fused vertebrae and longer intraoperative time than the AIS group. Postoperatively, lumber Cobb angle (16.1° ± 5.6° vs 8.6° ± 4.0°, P < 0.01) and correction rate were both less favorable in the AdIS group. Both pain and mental health scores remained significantly worse in the AdIS group (pain: AdIS, 4.3 ± 0.6 vs AIS, 4.7 ± 0.3; P < 0.01; mental health: AdIS, 4.1 ± 0.7 vs AIS, 4.5 ± 0.5; P = 0.02). Conclusion Patients with type 5 AdIS had a similar correction of the major curve as those with AIS; however, the surgery was more invasive, with inferior postoperative clinical outcomes, than those with AIS. These findings suggest that the surgical timing should be carefully considered in patients with type 5 AIS to optimize outcomes.

Study Design Prospective multicenter cohort study. Objectives Although surgery for degenerative cervical myelopathy (DCM) often improves neurological function, predicting clinically meaningful recovery remains challenging. To identify preoperative predictors of achieving the minimum clinically important difference (MCID) in the Japanese Orthopaedic Association (JOA) score and to evaluate its association with patient-reported outcomes. Methods We prospectively analyzed 762 patients with moderate to severe DCM (defined by preoperative JOA score <15) who underwent surgery at 10 high-volume centers in Japan, with a 2-year follow-up. MCID was defined as a ≥2.5-point improvement in JOA score. Logistic regression identified independent predictors. Outcomes included JOA score, Visual Analog Scale (VAS), the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and the 36-Item Short Form Health Survey (SF-36). Results MCID was achieved in 63.0% of patients. Independent predictors included younger age (Odds ratio = 0.973 [95% confidence interval: 0.956-0.990]; P = 0.002), absence of cerebrovascular (0.466 [0.224-0.960]; P = 0.039) and cardiac disease (0.510 [0.285-0.912]; P = 0.023), greater cervical lordosis (1.021 [1.004-1.037]; P = 0.013), lower baseline JOA score (0.547 [0.485-0.617]; P < 0.001), and higher JOACMEQ scores for upper extremity function (1.011 [1.000-1.022]; P = 0.044) and QOL (1.021 [1.009-1.033]; P < 0.001). MCID achievement was associated with significantly greater improvements in VAS, most JOACMEQ domains, and all SF-36 subscales. Conclusions Younger age, absence of cerebrovascular and cardiac disease, greater cervical lordosis, lower baseline JOA score, and higher preoperative JOACMEQ scores for upper extremity function and QOL were associated with achieving MCID in JOA score.

Study Design Prospective multicenter cohort study. Objective To evaluate the impact of surgeon experience on surgical safety, radiographic outcomes, and patient-reported outcomes (PROMs) following anterior cervical discectomy and fusion (ACDF) in patients with cervical degenerative disc disease (CDDD). Methods This prospective cohort study was conducted at five spine-specialized institutions in Japan. A total of 208 patients with CDDD who underwent ACDF between 2019 and 2022 were enrolled. Procedures were performed by either board-certified spine (BCS) surgeons (n = 150) or non-BCS (NBCS) surgeons (n = 58) under direct BCS supervision. Demographics, surgical variables, radiographic outcomes, and clinical results were compared. Evaluations included surgical duration, estimated blood loss (EBL), complications, cervical alignment and range of motion (ROM), Japanese Orthopaedic Association (JOA) scores, Visual Analog Scale (VAS), JOACMEQ, and SF-36 scores. Results Surgical duration was comparable between groups, but EBL was significantly greater in the NBCS group (20.2 ± 35.0 mL vs 12.2 ± 13.7 mL, P = .020). Complication rates were low and similar. No major adverse events occurred in either group. Cervical alignment was maintained, and ROM slightly decreased postoperatively without intergroup differences. Both groups showed significant neurological improvement. Gains in JOA scores, reductions in VAS scores, and improvements in JOACMEQ and SF-36 scores were comparable. Conclusions ACDF performed by NBCS surgeons under BCS supervision achieved clinical outcomes equivalent to those by BCS surgeons. These findings underscore the effectiveness of structured supervision in ensuring surgical safety and fostering competency in spine surgery.

Study Design Retrospective multicenter study. Objectives To investigate surgical outcomes following posterior decompression for cervical ossification of the posterior longitudinal ligament (OPLL) when performed by board-certified spine (BCS) or non-BCS (NBCS) surgeons. Methods We included 203 patients with cervical OPLL who were followed for a minimum of 1 year after surgery. Demographic information, medical history, and imaging findings were collected. Clinical outcomes were assessed preoperatively and at the final follow-up using the Japanese Orthopedic Association (JOA) score and the visual analog scale (VAS) for the neck. We compared outcomes between BCS surgeons, who must meet several requirements, including experience in more than 300 spinal surgeries, and NBCS surgeons. Results BCS surgeons performed 124 out of 203 cases, while NBCS surgeons were primary in 79 cases, with 73.4% were directly supervised by a BCS surgeon. There was no statistically significant difference in surgical duration, estimated blood loss, and perioperative complication rates between the BCS and NBCS groups. Moreover, no statistically significant group differences were observed in each position of the C2-7 angle and cervical range of motion at preoperation and the final follow-up. Preoperative and final follow-up JOA scores, VAS for the neck, and JOA score recovery rate were comparable between the two groups. Conclusions Surgical outcomes, including functional recovery, complication rates, and cervical dynamics, were comparable between the BCS and NBCS groups. Consequently, posterior decompression for cervical OPLL is considered safe and effective when conducted by junior surgeons who have undergone training and supervision by experienced spine surgeons.