Updated on 2024/04/03

写真a

 
Oda Yoshiaki
 
Organization
Faculty of Medicine, Dentistry and Pharmaceutical Sciences Special-Appointment Assistant Professor
Position
Special-Appointment Assistant Professor
Contact information
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Degree

  • Doctor of Philosophy ( 2018.3   Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University )

 

Papers

  • New Spinal Shortening Technique for Tethered Cord Syndrome: A Technical Note. International journal

    Masato Tanaka, Sumeet Sonawane, Shinya Arataki, Yoshihiro Fujiwara, Takuya Taoka, Koji Uotani, Yoshiaki Oda, Kensuke Shinohara

    Medicina (Kaunas, Lithuania)   60 ( 1 )   2023.12

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    Background and Objectives: To present a new spinal shortening technique for tethered cord syndrome. Tethered cord syndrome (TCS) is a debilitating condition leading to progressive neurological decline. Surgical detethering for TCS is the gold standard of treatment. However, symptomatic retethering of TCS has been reported in 5%-50% of patients after initial release. To solve this problem, posterior spinal shortening osteotomy has been reported. This technique has risks of massive blood loss and neurological deterioration. The authors hereby report a new safe spinal shortening technique for tethered cord syndrome. Materials and Methods: A 31-year-old man with gait disturbance was referred to our hospital. After the delivery of treatment, he underwent surgical untethering of the spinal cord in another hospital. He had hyperreflexia of the Achilles tendon reflex and bilateral muscle weakness of the legs (MMT 3-4). He also had urinary and bowel incontinence, and total sensory loss below L5. An anteroposterior lumbar radiogram indicated partial laminectomy of L3 and L4. Lumbar MRI showed retethering of spinal cord. Results: The patient underwent a new spinal shortening technique for tethered cord syndrome under the guidance of O-arm navigation. First, from the anterior approach, disectomy from T12 to L3 was performed. Second, from the posterior approach, Ponte osteotomy was performed from T12 to L3, shortening the spinal column by 15 mm. The patient was successfully treated surgically. Postoperative lumbar MRI showed that the tension of the spinal cord was released. Manual muscle testing results and the sensory function of the left leg had recovered almost fully upon final follow-up at one year. Conclusions: A retethered spinal cord after initial untethering is difficult to treat. This new spinal shortening technique can represent another good option to release the tension of the spinal cord.

    DOI： 10.3390/medicina60010020

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  • Comparison of C-Arm-Free Oblique Lumbar Interbody Fusion L5-S1 (OLIF51) with Transforaminal Lumbar Interbody Fusion L5-S1 (TLIF51) for Adult Spinal Deformity. International journal

    Masato Tanaka, Sumeet Sonawane, Umesh Meena, Zhichao Lu, Yoshihiro Fujiwara, Takuya Taoka, Koji Uotani, Yoshiaki Oda, Tomoyoshi Sakaguchi, Shinya Arataki

    Medicina (Kaunas, Lithuania)   59 ( 5 )   2023.4

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    Background and Objectives: Adult spinal deformity (ASD) surgery, L5-S1 lordosis is very important factor. The main objective of the research is to retrospectively compare symptomatic presentation and radiological presentation in the sequelae of oblique lumbar inter-body spinal fusion at L5-S1 (OLIF51) and transforaminal lumbar interbody fusion (TLIF) for ASD. Materials and Methods: We retrospectively evaluated 54 patients who underwent corrective spinal fusion for ASD between October 2019 and January 2021. Thirteen patients underwent OLIF51 (average 74.6 years old, group O) and 41 patients underwent TLIF51 (average 70.5 years old, group T). Mean follow-up period was 23.9 months for group O and 28.9 months for group T, ranging from 12 to 43 months. Clinical and radiographic outcomes are assessed using values including visual analogue scale (VAS) for back pain and Oswestry disability index (ODI). Radiographic evaluation was also collected preoperatively and at 6, 12, and 24 months postoperatively. Results: Surgical time in group O was less than that in group T (356 min vs. 492 min, p = 0.003). However, intraoperative blood loss of both groups were not significantly different (1016 mL vs. 1252 mL, p = 0.274). Changes in VAS and ODI were similar in both groups. L5-S1 angle gain and L5-S1 height gain in group O were significantly better than those of group T (9.4° vs. 1.6°, p = 0.0001, 4.2 mm vs. 0.8 mm, p = 0.0002). Conclusions: Clinical outcomes were not significantly different in both groups, but surgical time in OLIF51 was significantly less than that in TLIF51. The radiographic outcomes showed that OLIF51 created more L5-S1 lordosis and L5-S1 disc height compared with TLIF 51.

    DOI： 10.3390/medicina59050838

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  • Posterolateral Floating Technique for the Thoracic Ossification of the Posterior Longitudinal Ligament with Navigation: A Technical Note.

    Masato Tanaka, Hardik Suthar, Dhvanit Desai, Taro Yamauchi, Shinya Arataki, Yoshihiro Fujiwara, Koji Uotani, Yoshiaki Oda, Haruo Misawa

    Acta medica Okayama   76 ( 6 )   743 - 748   2022.12

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    We describe a floating technique via a posterolateral approach with intraoperative O-arm navigation to facilitate decompression of the spinal cord in thoracic myelopathy due to severe ossification of the posterior longitudinal ligament (OPLL). A 62-year-old man with myelopathy due to thoracic OPLL had left-leg muscle weakness, urinary disturbance, and spastic gait. Bilateral leg pain and gait disturbance had persisted for 2 years. He was successfully treated by the posterolateral OPLL floating procedure and posterior pedicle fixation under O-arm navigation. At a 2-year follow-up, manual muscle testing results and sensory function of the left leg had recovered fully. His cervical Japanese Orthopedic Association score had improved from 5/12 to 11/12. The novel intraoperative O-arm navigation-guided posterolateral floating procedure for thoracic OPLL is effective for achieving precise decompression and strong fixation with a posterior approach only and can provide an excellent result for severe thoracic OPLL without the risk of adverse events from intraoperative radiation.

    DOI： 10.18926/AMO/64126

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  • Three-Dimensional Analysis of the Ideal Entry Point for Sacral Alar Iliac Screws. International journal

    Noriyuki Watanabe, Tomoyuki Takigawa, Koji Uotani, Yoshiaki Oda, Haruo Misawa, Masato Tanaka, Toshifumi Ozaki

    Asian spine journal   16 ( 6 )   874 - 881   2022.12

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    STUDY DESIGN: This is a virtual three-dimensional (3D) imaging study examining computed tomography (CT) data to investigate instrumentation placement. PURPOSE: In this study, we aim to clarify the ideal entry point and trajectory of the sacral alar iliac (SAI) screw in relationship to the dorsal foramen at S1 and the respective nerve root. OVERVIEW OF LITERATURE: To the best of our knowledge, there is yet no detailed 3D imaging study on the ideal entry point of the SAI screw. Despite the evidence suggesting that the dorsal foramen at S1 is a landmark on the sacrum, the S1 nerve root disruption is a general concern during the insertion of SAI screws. No other study has been published examining the nerve root location at the S1and SAI screw insertions. METHODS: Preoperative CT data from 26 patients pertaining to adult spinal deformities were investigated in this study. We applied a 3D image processing method for a detailed investigation. Virtual cylinders were used to mimic SAI screws. These were placed to penetrate the sacral iliac joint without violating the other cortex. We then assessed the trajectory of the longest SAI screw and the ideal entry point of SAI using a color mapping method on the surface of the sacrum. We measured the location of the nerve root at S1 in relation to the foramen at S1 and the sacral surface. RESULTS: As per the results of our color mapping, it was determined that areas that received high scores are located medially and caudally to the dorsal foramen of S1. The mean angle between a horizontal line and a line connecting the medial edge of the foramen and nerve root at S1 was 93.5°. The mean distances from the dorsal medial edge of the foramen and sacral surface to S1 nerve root were 21.8 mm and 13.9 mm, respectively. CONCLUSIONS: The ideal entry point of the SAI screw is located medially and caudally to the S1 dorsal foramen based on 3D digital mapping. It is also shown that this entry point spares the S1 nerve root from possible iatrogenic injuries.

    DOI： 10.31616/asj.2021.0268

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  • Factors influencing caregiver burden in chronic pain patients: A retrospective study. International journal

    Hironori Tsuji, Tomoko Tetsunaga, Tomonori Tetsunaga, Haruo Misawa, Yoshiaki Oda, Shinichiro Takao, Keiichiro Nishida, Toshifumi Ozaki

    Medicine   101 ( 39 )   e30802   2022.9

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    Chronic pain coexists with disability, anxiety, depression, and sleep disturbances, which are factors of pain chronicity in the fear-avoidance model. Self-efficacy for managing pain plays a protective role against pain chronicity. For chronic pain sufferers, social support from caregivers is important. However, such caregivers face enormous physical and mental burdens. This study aimed to assess how self-efficacy and factors related to the fear-avoidance model affect caregiver burden. Participants were 135 chronic pain patients and their caregivers who visited our outpatient pain special clinic. In clinical assessments, numeric rating scale (NRS), pain catastrophizing scale (PCS), hospital anxiety and depression scale (HADS), Athens insomnia scale (AIS), pain disability assessment scale (PDAS), pain self-efficacy questionnaire (PSEQ) for the patients and Zarit Burden Interview (ZBI) for their caregivers were evaluated. Participants were divided into 2 groups (L group ZBI < 24 points and H group ZBI ≥ 24 points) and compared. Regression analyses were conducted to identify factors correlated with the ZBI scores. Compared to L group, H group showed significantly higher NRS and HADs depression scores, and lower PSEQ scores. In univariate regression analysis, ZBI scores were significantly correlated with NRS, PCS, HADS anxiety, HADS depression, PDAS and PSEQ. Multiple linear regression analysis revealed that ZBI scores were significantly correlated with PSEQ. The caregivers who perceived high caregiver burden had significantly higher patients' pain intensity, depression, and lower self-efficacy than those who perceived low caregiver burden. Caregiver burden correlated with the pain intensity, pain catastrophizing, anxiety, depression, disability, and self-efficacy of chronic pain patients. Among these factors, self-efficacy was the most negatively correlated with caregiver burden. Treatments focused on increasing self-efficacy for managing pain have the potential to reduce caregiver burden.

    DOI： 10.1097/MD.0000000000030802

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  • C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position. International journal

    Masato Tanaka, Sameer Ruparel, Yoshiaki Oda, Yoshihiro Fujiwara, Sneha Shama, Koji Uotani, Shinya Arataki, Taro Yamauchi, Naveen Sake

    Journal of visualized experiments : JoVE   ( 187 )   2022.9

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    Oblique lumbar interbody fusion (OLIF) is an established technique for the indirect decompression of lumbar canal stenosis. However, OLIF at the L5-S1 level (OLIF51) is technically difficult because of the anatomical structures. We present a novel simultaneous technique of OLIF51 with percutaneous pedicle screw fixation without fluoroscopy. The patient is placed in a right lateral decubitus position. A percutaneous reference pin is inserted into the right sacroiliac joint. An O-arm scan is performed, and 3D reconstructed images are transmitted to the spinal navigation system. A 4 cm oblique skin incision is made under navigation guidance along the pelvis. The internal/external and transverse abdominal muscles are divided along the muscle fibers, protecting the iliohypogastric and ilioinguinal nerves. Using a retroperitoneal approach, the left common iliac vessels are identified. Special muscle retractors with illumination are used to expose the L5-S1 intervertebral disc. After disc preparation with navigated instruments, the disc space is distracted with navigated trials. Autogenous bone and demineralized bone material are then inserted into the cage hole. The OLIF51 cage is inserted into the disc space with the help of a mallet. Simultaneously, percutaneous pedicle screws are inserted by another surgeon without changing the lateral decubitus position of the patient. In conclusion, C-arm-free OLIF51 and simultaneous percutaneous pedicle screw fixation are performed in a lateral position under navigation guidance. This novel technique reduces surgical time and radiation hazards.

    DOI： 10.3791/63572

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  • Evaluation of SARC-F and SARC-CalF for sarcopenia screening in patients with chronic musculoskeletal pain: A prospective cross-sectional study. International journal

    Hironori Tsuji, Tomoko Tetsunaga, Tomonori Tetsunaga, Haruo Misawa, Yoshiaki Oda, Shinichiro Takao, Keiichiro Nishida, Toshifumi Ozaki

    Medicine   101 ( 29 )   e29568   2022.7

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    OBJECTIVES: Early sarcopenia detection using screening tools, such as SARC-F and SARC-CalF, has been proven reliable. However, the relationship between chronic musculoskeletal pain with sarcopenia is unknown. This study assessed sarcopenia morbidity as well as the reliability of sarcopenia screening with SARC-F and SARC-CalF in patients with chronic musculoskeletal pain. METHODS: Overall, 172 patients with chronic musculoskeletal pain were included in this cross-sectional study. All participants completed the SARC-F, SARC-CalF, numeric rating scale (NRS), and pain disability assessment scale (PDAS) assessments. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia criteria 2019. Correlations between SARC-F and SARC-CalF scores and each measured variable were evaluated using univariate and multiple linear regression analyses. A receiver operating characteristic curve analysis was conducted, and reliabilities of SARC-F and SARC-CalF scores for diagnosing sarcopenia were compared. RESULTS: Thirty-nine patients were diagnosed with sarcopenia. Among these, 10 patients were <65 years old, and 29 were >65 years old. Both SARC-F and SARC-CalF scores significantly correlated with grip power, gait speed, skeletal mass index, numeric rating scale score, and PDAS score. In multiple linear regression analysis, SALC-F and SALC-CalF scores significantly correlated with PDAS score, skeletal mass index, and gait speed. The area under the curve were 0.70 for SARC-F and 0.88 for SARC-CalF; SARC-CalF had a significantly higher area under the curve than SARC-F. DISCUSSION: Sarcopenia was diagnosed in patients aged <65 years with chronic musculoskeletal pain. SALC-F and SARC-CalF scores showed a significant correlation with disability due to pain and were reliable sarcopenia screening tools for chronic musculoskeletal pain. SARC-CalF was more reliable than SARC-F.

    DOI： 10.1097/MD.0000000000029568

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  • Surgical Management of Spinal Tuberculosis-The Past, Present, and Future. International journal

    Sameer Ruparel, Masato Tanaka, Rahul Mehta, Taro Yamauchi, Yoshiaki Oda, Sumeet Sonawane, Ram Chaddha

    Diagnostics (Basel, Switzerland)   12 ( 6 )   2022.5

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    Tuberculosis is endemic in many parts of the world. With increasing immigration, we can state that it is prevalent throughout the globe. Tuberculosis of the spine is the most common form of bone and joint tuberculosis; the principles of treatment are different; biology, mechanics, and neurology are affected. Management strategies have changed significantly over the years, from watchful observations to aggressive debridement, to selective surgical indications based on well-formed principles. This has been possible due to the development of various diagnostic tests for early detection of the disease, effective anti-tubercular therapy, and associated research, which have revolutionized treatment. This picture is rapidly changing with the advent of minimally invasive spine surgery and its application in treating spinal infections. This review article focuses on the past, present, and future principles of surgical management of tuberculosis of the spine.

    DOI： 10.3390/diagnostics12061307

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  • Mechanical Study of Various Pedicle Screw Systems including Percutaneous Pedicle Screw in Trauma Treatment. International journal

    Yoshiaki Oda, Tomoyuki Takigawa, Yasuo Ito, Haruo Misawa, Tomoko Tetsunaga, Koji Uotani, Toshifumi Ozaki

    Medicina (Kaunas, Lithuania)   58 ( 5 )   2022.4

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    Background and Objectives: Spine surgery using a percutaneous pedicle screw placement (PPSP) is widely implemented for spinal trauma. However, percutaneous systems have been reported to have weak screw-rod connections. In this study, conventional open and percutaneous systems were biomechanically evaluated and compared. Material and Methods: The experiments were performed in two stages: the first stage was a break test, whereas the second stage was a fatigue test. Four systems were used for the experiments. System 1 was intended for conventional open surgery (titanium rod with a 6.0 mm diameter, using a clamp connecting mechanism). System 2 was a percutaneous pedicle screw (PPS) system for trauma (titanium alloy rod with a 6.0 mm diameter, using ball ring connections). System 3 was a PPS system for trauma (cobalt-chromium alloy rod with a 6.0 mm diameter, using sagittal adjusting screw connections). System 4 was a general-purpose PPS system (titanium alloy rod with a 5.5 mm diameter, using a mechanism where the adapter in the head holds down the screw). Results: Stiffness values of 54.8 N/mm, 43.1 N/mm, 90.9 N/mm, and 39.3 N/mm were reported for systems 1, 2, 3, and 4, respectively. The average number of load cycles in the fatigue test was 134,393, 40,980, 1,550,389, and 147,724 for systems 1 to 4, respectively. At the end of the test, the displacements were 0.2 mm, 16.9 mm, 1.2 mm, and 8.6 mm, respectively. System 1, with a locking mechanism, showed the least displacement at the end of the test. Conclusion: A few PPS systems showed better results in terms on stiffness and life than the open system. The experiments showed that mechanical strength varies depending on the spinal implant. The experiments conducted are essential and significant to provide the mechanical strength required for surgical reconstruction.

    DOI： 10.3390/medicina58050565

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  • Comparison of Navigated Expandable Vertebral Cage with Conventional Expandable Vertebral Cage for Minimally Invasive Lumbar/Thoracolumbar Corpectomy. International journal

    Masato Tanaka, Mahendra Singh, Yoshihiro Fujiwara, Koji Uotani, Yoshiaki Oda, Shinya Arataki, Taro Yamauchi, Tomoyuki Takigawa, Yasuo Ito

    Medicina (Kaunas, Lithuania)   58 ( 3 )   2022.3

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    Background and Objectives: The thoracolumbar burst fracture is one of the most common spinal injuries. If the patient has severe symptoms, corpectomy is indicated. Currently, minimally invasive corpectomy with a navigated expandable vertebral cage is available thanks to spinal surgical technology. The aim of this study is to retrospectively compare clinical and radiographic outcomes of conventional and navigational minimally invasive corpectomy techniques. Materials and Methods: We retrospectively evaluated 21 patients who underwent thoracolumbar minimally invasive corpectomy between October 2016 and January 2021. Eleven patients had a navigated expandable cage (group N) and 10 patients had a conventional expandable cage (group C). Mean follow-up period was 31.9 months for group N and 34.7 months for group C, ranging from 12 to 42 months in both groups. Clinical and radiographic outcomes are assessed using values including visual analogue scale (VAS) for back pain and Oswestry disability index (ODI). This data was collected preoperatively and at 6, 12, and 24 months postoperatively. Results: Surgical time and intraoperative blood loss of both groups were not significantly different (234 min vs. 267 min, 656 mL vs. 786 mL). Changes in VAS and ODI were similar in both groups. However, lateral cage mal-position ratio in group N was lower than that of group C (relative risk 1.64, Odds ratio 4.5) and postoperative cage sinking was significantly lower in group N (p = 0.033). Conclusions: Clinical outcomes are not significantly different, but radiographic outcomes of lateral cage mal-position and postoperative cage sinking were significantly lower in the navigation group.

    DOI： 10.3390/medicina58030364

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  • Psoas muscle index predicts osteoporosis and fracture risk in individuals with degenerative spinal disease. International journal

    Yuya Kajiki, Hironori Tsuji, Haruo Misawa, Ryuichi Nakahara, Tomoko Tetsunaga, Kentaro Yamane, Yoshiaki Oda, Shinichiro Takao, Toshifumi Ozaki

    Nutrition (Burbank, Los Angeles County, Calif.)   93   111428 - 111428   2022.1

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    OBJECTIVES: Skeletal muscle loss and osteoporosis are major medical and socioeconomic concerns as the global population ages. Studies have reported that skeletal muscle mass correlates to bone mineral density (BMD). The psoas muscle index (PMI), measured as the L3 cross-sectional areas of the right and left psoas divided by the square of height, has a positive correlation with the total volume of skeletal muscle in the body. This study aimed to evaluate relationships between PMI and BMD and fracture risk estimated by the Fracture Risk Assessment Tool (FRAX). METHODS: Preoperatively acquired, plain computed tomography images at the L3 level were used to measure PMI in 87 people with degenerative spinal diseases. We evaluated the correlation between PMI and BMD and fracture risk estimated by FRAX. RESULTS: PMI was significantly correlated with BMD in the entire lumbar spine and femoral neck (r = 0.413 and 0.525, both P < 0.001). People with osteoporosis showed significantly lower PMI than those without (P < 0.05). PMI was also significantly correlated with FRAX score (r = -0.545, P < 0.001). Furthermore, based on the recommendation of osteoporosis treatment, participants were divided into two groups: FRAX ≥15% (R group) and FRAX <15% (C group). The R group showed significantly lower PMI than the C group (P < 0.001). Receiver operating characteristic curve analysis revealed that PMI has moderate accuracy in diagnosing osteoporosis and FRAX ≥15%. CONCLUSIONS: PMI was significantly associated with BMD and fracture risk. PMI measurement is straightforward and may increase the diagnosis rate of osteoporosis and fracture risk.

    DOI： 10.1016/j.nut.2021.111428

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  • Minimally Invasive L5 Corpectomy with Navigated Expandable Vertebral Cage: A Technical Note. International journal

    Taro Yamauchi, Ashish Jaiswal, Masato Tanaka, Yoshihiro Fujiwara, Yoshiaki Oda, Shinya Arataki, Haruo Misawa

    Brain sciences   11 ( 9 )   2021.9

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    BACKGROUND: Conventional L5 corpectomy requires a large incision and an extended period of intraoperative fluoroscopy. We describe herein a new L5 corpectomy technique. METHODS: A 79-year-old woman was referred to our hospital for leg pain and lower back pain due to an L5 vertebral fracture. Her daily life had been affected by severe lower back pain and sciatica for more than 2 months. We initially performed simple decompression surgery, but this proved effective for only 10 months. RESULTS: For revision surgery, the patient underwent minimally invasive L5 corpectomy with a navigated expandable cage without fluoroscopy. The second surgery took 215 min, and estimated blood loss was 750 mL. The revision surgery proved successful, and the patient could then walk using a cane. In terms of clinical outcomes, the Oswestry Disability Index improved from 66% to 24%, and the visual analog scale score for lower back pain improved from 84 to 31 mm at the 1-year follow-up. CONCLUSIONS: Minimally invasive L5 corpectomy with a navigated expandable vertebral cage is effective for reducing cage misplacement and surgical invasiveness. With this new technique, surgeons and operating room staff can avoid the risk of adverse events due to intraoperative radiation exposure.

    DOI： 10.3390/brainsci11091241

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  • Assessment of the Concordance Rate between Intraoperative Pathological Diagnosis and the Final Pathological Diagnosis of Spinal Cord Tumors.

    Sosuke Muraoka, Kentaro Yamane, Haruo Misawa, Tomoyuki Takigawa, Tomoko Tetsunaga, Yoshiaki Oda, Kazuo Nakanishi, Toshifumi Ozaki, Takehiro Tanaka

    Acta medica Okayama   75 ( 4 )   455 - 460   2021.8

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    The intraoperative pathological diagnosis (IPD) plays an important role in determining the optimal surgical treatment for spinal cord tumors. The final pathological diagnosis (FPD) is sometimes different from the IPD. Here, we sought to identify the accuracy of the IPD of spinal cord tumors compared to the FPD. We retrospec-tively analyzed the cases of 108 patients with spinal cord tumors treated surgically in our institute; the IPD, FPD, mismatched cases, and concordance rate between the IPD and FPD were investigated. Five cases involved a mismatch between the IPD and FPD. The overall concordance rate was 95.4%, with 90.9% for extra-dural lesions, 98.5% for intradural extramedullary lesions, 84.2% for intramedullary lesions, and 100% for dumbbell-type tumors. The concordance rate of intramedullary lesions tended to be lower than that of other lesions (p = 0.096). A lower concordance rate was revealed for intramedullary lesions compared to the other lesions. Despite the IPD clearly remaining a valuable tool during operative procedures, surgeons should recog-nize the limitations of IPDs and make comprehensive decisions about surgical treatments.

    DOI： 10.18926/AMO/62397

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  • A retro-odontoid pseudotumor treated with fixation and tumor resection by the lateral approach: illustrative case. International journal

    Yoshiaki Oda, Takamitsu Tokioka, Toshifumi Ozaki

    Journal of neurosurgery. Case lessons   1 ( 19 )   CASE20160   2021.5

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    BACKGROUND: A retro-odontoid pseudotumor is not a condition that requires resection. However, pathological diagnosis is required when a tumor such as a meningeal tumor or chordoma is suspected. The authors report a case of a large lesion treated with posterior fixation and tumor resection using a lateral approach. OBSERVATIONS: A 77-year-old man visited the authors' department complaining of neck pain and decreased dexterity of the upper extremities. Magnetic resonance imaging showed a large, beak-shaped lesion behind the dens and severe compression of the spinal cord. Surgery consisted of occipitocervical-C2 fixation, followed by tumor resection with a left lateral approach. The pathological diagnosis was consistent with a retro-odontoid pseudotumor. The tumor was resected to a relatively large extent and shrank over time, leading to complete disappearance. LESSONS: Pathological examination is also possible with a posterior approach if the tumor can be reached through the lateral edge of the dura. In that situation, the amount of resection is limited, and there is a risk of spinal cord compression. Intradural dissemination of tumors is a concern with the transdural approach. If tumor resection by the posterior approach is difficult, the lateral approach can facilitate tumor resection.

    DOI： 10.3171/CASE20160

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  • 慢性疼痛患者に対するロコモティブシンドローム診断における診断時の特徴及び注意点

    辻 寛謙, 三澤 治夫, 千田 益生, 西田 圭一郎, 濱田 全紀, 堅山 佳美, 鉄永 智紀, 小田 孔明, 伊勢 真人, 梶木 裕矢, 尾崎 敏文

    The Japanese Journal of Rehabilitation Medicine   58 ( 特別号 )   2 - 6   2021.5

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    Language：Japanese   Publisher：(公社)日本リハビリテーション医学会  

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  • 65歳以下の慢性疼痛患者におけるロコモティブシンドロームと体組成及び運動機能評価

    辻 寛謙, 三澤 治夫, 千田 益生, 西田 圭一郎, 濱田 全紀, 堅山 佳美, 鉄永 智紀, 小田 孔明, 伊勢 真人, 梶木 裕矢, 尾崎 敏文

    The Japanese Journal of Rehabilitation Medicine   58 ( 特別号 )   2 - 7   2021.5

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    Language：Japanese   Publisher：(公社)日本リハビリテーション医学会  

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  • Maximal Resection of Intramedullary Lipoma Using Intraoperative Ultrasonography: A Technical Note.

    Haruo Misawa, Yoshiaki Oda, Kentaro Yamane, Tomoko Tetsunaga, Toshifumi Ozaki

    Acta medica Okayama   75 ( 2 )   239 - 242   2021.4

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    One of the problems during surgery for intramedullary lipoma is the ambiguous boundary between the lipoma and the spinal cord, resulting in either incomplete resection or damage to the spinal cord. We report a case of intramedullary lipoma resection on a 61-year-old man in which the boundary between the tumor and spinal cord was repeatedly visualized with intraoperative ultrasonography. We focused on the distinctive features of fat as hyperechoic, in contrast to low-echo neural tissue. Subtotal resection of the tumor was achieved without any aggravation of neurological symptoms. Intraoperative ultrasonography may be useful for confirming tumor boundaries during intramedullary lipoma resection.

    DOI： 10.18926/AMO/61907

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  • Quantification of patellar tendon reflex using portable mechanomyography and electromyography devices. International journal

    Hironori Tsuji, Haruo Misawa, Tomoyuki Takigawa, Tomoko Tetsunaga, Kentaro Yamane, Yoshiaki Oda, Toshifumi Ozaki

    Scientific reports   11 ( 1 )   2284 - 2284   2021.1

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    Deep tendon reflexes are one of the main components of the clinical nervous system examinations. These assessments are inexpensive and quick. However, evaluation can be subjective and qualitative. This study aimed to objectively evaluate hyperreflexia of the patellar tendon reflex using portable mechanomyography (MMG) and electromyography (EMG) devices. This study included 10 preoperative patients (20 legs) who had a pathology that could cause bilateral patellar tendon hyperreflexia and 12 healthy volunteers (24 legs) with no prior history of neurological disorders. We attached MMG/EMG sensors onto the quadriceps and tapped the patellar tendon with maximal and constant force. Our results showed a significantly high amplitude of the root mean square (RMS) and low frequency of the mean power frequency (MPF) in the rectus femoris, vastus medialis, and vastus lateralis muscles in both EMG and MMG with both maximal and constant force. Especially in the patients with cervical and thoracic myelopathy, the receiver operating characteristic (ROC) curve for diagnosing hyperreflexia of the patellar tendon showed a moderate to very high area under the curve for all EMG-RMS, EMG-MPF, MMG-RMS, and MMG-MPF values. The use of EMG and MMG for objectively quantifying the patellar tendon reflex is simple and desirable for future clinical applications and could help diagnose neurological disorders.

    DOI： 10.1038/s41598-021-81874-5

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  • Minimally Invasive Cervical Pedicle Screw Fixation (MICEPS) via a Posterolateral Approach. International journal

    Takamitsu Tokioka, Yoshiaki Oda

    Clinical spine surgery   32 ( 7 )   279 - 284   2019.8

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    Cervical pedicle screw (PS) fixation provides great mechanical strength; however, it needs wide soft tissue detachment and has vertebral artery damage risk. Minimally invasive cervical pedicle screw (MICEPS) fixation, a new method for cervical PS fixation through a posterolateral approach, was developed to reduce soft tissue damage and avoid lateral misplacement of screws. Sixty-seven patients with cervical injury underwent MICEPS fixation. They were positioned prone on a radiolucent carbon table with a carbon Mayfield frame. A reference frame was attached to the spinous process through a small skin incision. One or 2 lateral incisions were made for screw insertion under navigation guidance. After the nuchal fascia was cut, the lateral mass was exposed with blunt dissection between the levator scapulae and splenius muscles. A self-retaining tubular retractor with illumination was applied between split muscle fibers. A 1.4-mm K-wire was inserted using an electric driver under navigation guidance. Drill and tap and cannulated PSs were sequentially inserted over the K-wire; facet fusion via bone grafting can be performed at this time. The rod was placed to the screw head. This technique can reduce intraoperative bleeding and screw deviation rate, with neither of the misplaced screws deviating laterally in the MICEPS group.

    DOI： 10.1097/BSD.0000000000000832

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  • Lateral Lumbar Interbody Fusion with Percutaneous Pedicle Screw in Combination with Microendoscopic Laminectomy in the Lateral Position for Lumbar Canal Stenosis.

    Yoshiaki Oda, Tarou Yamauchi, Masato Tanaka

    Acta medica Okayama   73 ( 4 )   373 - 377   2019.8

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    A minimally invasive surgical (MIS) procedure is an ideal surgical procedure. Many MIS techniques have been reported in spinal surgery. In clinical practice, we often encounter two-level canal stenosis cases, in which one level shows instability and the other does not. In such a case, fusion surgery for one level and decompression surgery for the other level is ideal. LLIF/OLIF approached from the lateral side has been reported effective. MIS decompression techniques in the lateral decubitus position have never been reported. We devised a surgical method that can accomplish both fixation and decompression in a consistent lateral decubitus position.

    DOI： 10.18926/AMO/56941

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  • An evaluation of anesthetic fade in motor evoked potential monitoring in spinal deformity surgeries. International journal

    Ryo Ugawa, Tomoyuki Takigawa, Hiroko Shimomiya, Takuma Ohnishi, Yuri Kurokawa, Yoshiaki Oda, Yasuyuki Shiozaki, Haruo Misawa, Masato Tanaka, Toshifumi Ozaki

    Journal of orthopaedic surgery and research   13 ( 1 )   227 - 227   2018.9

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    BACKGROUND: Intraoperative neuromonitoring using motor evoked potentials (MEP) satisfactorily detects motor tract integrity changes during spinal surgery. However, monitoring is affected by "anesthetic fade," in which the stimulation threshold increases because the waveform amplitude decreases with the accumulation of propofol. Therefore, the purpose of this study was to clarify the effect of anesthetic fade on transcranial MEPs by investigating the time-dependent changes of amplitude during spinal deformity surgeries. METHODS: We retrospectively reviewed medical records of 142 spinal deformity patients (66 patients with idiopathic scoliosis, 28 with adult spinal deformities, 19 with neuromuscular scoliosis, 17 with syndromic scoliosis, and 12 with congenital scoliosis). The average age was 28 years (range, 5 to 81 years). MEPs were recorded bilaterally from the abductor digiti minimi (ADM) and abductor hallucis (AH) muscles during spinal deformity surgeries. The Wilcoxon signed-rank test was used to investigate the time-dependent changes of amplitude after propofol infusion to evaluate anesthetic fade effects. RESULTS: The average time to baseline from initial propofol infusion was 113 min (range, 45 to 182 min). In the ADM, the amplitude was 52% at 1 h after initial propofol infusion, 102% at 2 h, 105% at 3 h, 101% at 4 h, 86% at 5 h, and 81% at 6 h. Compared to the 2-h time point, MEP decreased significantly by 16% at 5 h (P < 0.0005) and by 21% at 6 h (P < 0.05). In the AH, the amplitude was 49% at 1 h after initial infusion of propofol, 102% at 2 h, 102% at 3 h, 92% at 4 h, 71% at 5 h, and 63% at 6 h. Compared to the 2-h time point, MEP decreased significantly by 10% at 4 h (P < 0.005), by 31% at 5 h (P < 0.0000005), and by 39% at 6 h (P < 0.05). CONCLUSIONS: MEP amplitude significantly decreased in the upper limbs at 5 and 6 h and in the lower limbs at 4, 5, and 6 h after the initial infusion of propofol, respectively. The influence of anesthetic fade could influence false positive MEPs during long spinal surgeries.

    DOI： 10.1186/s13018-018-0934-7

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  • Relationship between Displacement of the Psoas Major Muscle and Spinal Alignment in Patients with Adult Spinal Deformity. International journal

    Yoshiaki Oda, Tomoyuki Takigawa, Ryo Ugawa, Yasuyuki Shiozaki, Haruo Misawa, Yoshihisa Sugimoto, Masato Tanaka, Toshifumi Ozaki

    Asian spine journal   12 ( 2 )   335 - 342   2018.4

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    STUDY DESIGN: Cross sectional study. PURPOSE: To clarify the difference in position of the psoas muscle between adult spinal deformity (ASD) and lumbar spinal stenosis (LSS). OVERVIEW OF LITERATURE: Although it is known that the psoas major muscle deviates in ASD patients, no report is available regarding the difference in comparison with LSS patients. METHODS: This study investigates 39 patients. For evaluating spinal alignment, pelvic tilt (PT), pelvic incidence (PI), sacral slope, lumbar lordosis (LL), PI-LL, Cobb angle, and the convex side, the lumbar curves were measured. For measuring the position of the psoas major at the L4/5 disk level, magnetic resonance imaging was used. The displacements of psoas major muscle were measured separately in the anterior-posterior and lateral directions. We examined the relationship between the radiographic parameters and anterior displacement (AD) and lateral displacement (LD) of the psoas major muscle. RESULTS: AD was demonstrated in 15 cases with ASD and nine cases with LSS (p>0.05). LD was observed in 13 cases with ASD and no cases with LSS (p<0.01). The Cobb angle was significantly greater in cases with AD than in those without AD (p=0.04). PT, LL, PI-LL, and Cobb angle were significantly greater in cases with LD (p<0.05). All cases with LD had AD, but no case without AD had LD (p<0.001). The side of greater displacement at L4/5 and the convex side of the lumbar curve were consistent in all cases. CONCLUSIONS: Despite AD being observed in LSS as well, LD was observed only in the ASD group. Radiographic parameters were worse when LD was seen, rather than AD.

    DOI： 10.4184/asj.2018.12.2.335

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  • Scoliosis in Patients with Severe Cerebral Palsy: Three Different Courses in Adolescents.

    Yoshiaki Oda, Tomoyuki Takigawa, Yoshihisa Sugimoto, Masato Tanaka, Hirofumi Akazawa, Toshifumi Ozaki

    Acta medica Okayama   71 ( 2 )   119 - 126   2017.4

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    Patients with cerebral palsy (CP) frequently present with scoliosis; however, the pattern of curve progression is difficult to predict. We aimed to clarify the natural course of the progression of scoliosis and to identify scoliosis predictors. This was a retrospective, single-center, observational study. Total of 92 CP patients from Asahikawasou Ryouiku Iryou Center in Okayama, Japan were retrospectively analyzed. Cobb angle, presence of hip dislocation and pelvic obliquity, and Gross Motor Function Classification System (GMFCS) were investigated. Severe CP was defined as GMFCS level IV or V. The mean observation period was 10.7 years. Thirtyfour severe CP patients presented with scoliosis and were divided into 3 groups based on their clinical courses: severe, moderate and mild. The mean Cobb angles at the final follow-up were 129°, 53°, and 13° in the severe, moderate, and mild groups, respectively. The average progressions from 18 to 25 years were 2.7°/year, 0.7°/year, and 0.1°/year in the severe, moderate, and mild curve groups, respectively. We observed the natural course of scoliosis and identified 3 courses based on the Cobb angle at 15 and 18 years of age. This method of classification may help clinicians predict the patients' disease progression.

    DOI： 10.18926/AMO/54980

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Research Projects

  • 有限要素法を用いた骨盤輪骨折に対する包括的な固定法評価

    Grant number：23K15743  2023.04 - 2026.03

    日本学術振興会  科学研究費助成事業  若手研究

    小田 孔明

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    Grant amount：\4550000 （ Direct expense: \3500000 、 Indirect expense：\1050000 ）

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  • 脊椎脊髄腫瘍に対する腫瘍融解ウイルス療法の確立

    Grant number：23K08589  2023.04 - 2026.03

    日本学術振興会  科学研究費助成事業  基盤研究(C)

    魚谷 弘二, 吉田 晶, 尾崎 敏文, 藤原 智洋, 田澤 大, 三澤 治夫, 小田 孔明

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    Grant amount：\4810000 （ Direct expense: \3700000 、 Indirect expense：\1110000 ）

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