Norimitsu Wakao

National Center for Geriatrics and Gerontology

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Shiro Imagama

Nagoya University

Naoki Ishiguro

Nagoya University

Yukihiro Matsuyama

Hamamatsu University School of Medicine

Mitsuhiro Kamiya

Asahi General Hospital

Zenya Ito

Wangjing Hospital of China Academy of Chinese Medical Sciences

Yoshihito Sakai

National Center for Geriatrics and Gerontology

Ken‐ichi Hirano

Osaka University

Kei Ando

Nagoya University

Mikinobu Takeuchi

Aichi Medical University

Atsuhiko Hirasawa

Aichi Medical University

Cooperative Institutions

Nagoya University

Northwestern University

Williams & Associates

Aichi Medical University

Nagoya University Hospital

National Center for Geriatrics and Gerontology

The University of Tokyo

Nagoya City University

Aichi Medical University Hospital

Research Organization of Information and Systems

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Open-Label Placebo Trial among Japanese Patients with Chronic Low Back Pain

Pain Research and Management (2020)

Tatsunori Ikemoto Takefumi Ueno Young‐Chang P. Arai Norimitsu Wakao Atsuhiko Hirasawa

Background. The aim of this study was to confirm the effectiveness of open-label placebo (OLP) in Japanese patients with chronic low back pain (CLBP), similar to previous reports, and to investigate its short- and medium-term effects in this study population. Methods. Fifty-two patients with CLBP were randomized into a treatment as usual (TAU) group (n = 26) or an OLP + TAU group (n = 26) for 12 weeks. The TAU included advice to remain active and exercise in conjunction with recent psychological education based on a self-management strategy. In contrast, participants in the OLP + TAU group were instructed to take two OLP capsules a day. Outcome measures were assessed at baseline and at weeks 3 and 12 using the Roland–Morris Disability Questionnaire (RMDQ), Numerical Rating Scale (NRS) for pain intensity, and the Timed-Up-and-Go (TUG) test. Difference in outcomes between the two groups was compared at the two follow-up points. Results. Although all participants completed the 3-week follow-up, four patients (two in each group) were lost to follow-up beyond week 3. There were no significant intergroup differences in changes in the RMDQ score (

p = 0.40

), pain-NRS score (

p = 0.19

), and TUG time (

p = 0.98

) at week 3. Two-way repeated measure analyses of covariance showed significant time-course effects but did not show group effects or any interactions between the time-course and group in terms of the RMDQ score. However, it did not show any effects in the pain-NRS score and TUG time at week 12. Conclusions. The OLP + TAU group showed no superior findings in comparison with the TAU group after 3 weeks and 12 weeks for Japanese patients with CLBP. Nonetheless, significant improvements in functional disability were observed in both groups.

10.1155/2020/6636979

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Citations (18)

Reliability of an Intraoperative Radiographic Anteroposterior View of the Spinal Midline for Detection of Pedicle Screws Breaching the Medial Pedicle Wall in the Thoracic, Lumbar, and Sacral Spine

World Neurosurgery (2019)

Ryuya Maejima Mikinobu Takeuchi Norimitsu Wakao Mitsuhiro Kamiya Masahiro Aoyama

Thoracic spine

Thoracic vertebrae

Spinal Surgery

10.1016/j.wneu.2019.01.058

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Citations (6)

CERVICAL INTRAMEDULLARY GLIOBLASTOMA WITH INTRACRANIAL DISSEMINATION: DESCRIPTION OF A RAPIDLY PROGRESSING CASE AND A LITERATURE REVIEW

Journal of Musculoskeletal Research (2010)

Kei Ando Yukihiro Matsuyama Yoshito Sakai Shiro Imagama Zenya Ito

We present a case of a 65-year-old female with glioblastoma of the spinal cord, which disseminated to an intracranial lesion. Magnetic resonance imaging revealed diffuse swelling at levels C1 to 4, which was pathologically consistent with glioblastoma, and right side pontine parenchyma mass. The patient died after seven weeks of hospitalization. The confirmed diagnosis of glioblastomas was obtained as a result of autopsy. Spinal glioblastomas are rare lesions of the central nervous system with a prognosis as poor as that of their intracranial counterpart. There have been only nine reports in English since 1990, including this case in Japan.

Parenchyma

Spinal Cord Neoplasm

10.1142/s0218957710002442

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Citations (1)

Surgical results in older patients with lumbar spinal stenosis according to gait speed in relation to the diagnosis for sarcopenia

Journal of orthopaedic surgery (2020)

Yoshihito Sakai Norimitsu Wakao Hiroki Matsui Keisuke Tomita Tsuyoshi Watanabe

The purpose of this study was to evaluate the implication of gait speed, which is a prerequisite for the diagnosis of sarcopenia in older patients with lumbar spinal stenosis (LSS).This study was conducted in a total of 235 patients with LSS who underwent surgical treatment. The state of sarcopenia and pre-sarcopenia, including gait speed, were evaluated before and after the operation.The proportion of patients with lower than at baseline levels of skeletal muscle mass index (SMI) and gait speed was 27.2% and 17.9%, respectively. Significant changes were observed in gait speed, whereas SMI showed no significant differences between the preoperative and postoperative periods. Sarcopenic patients presented lower levels of activities of daily living preoperatively than pre-sarcopenic patients. However, favorable surgical results were obtained postoperatively. Significant changes were observed in gait speed, whereas grip strength and SMI showed no significant differences between the preoperative and postoperative periods. The postoperative decrease in SMI was not significant.Postoperative gait speed was significantly improved, whereas muscle mass did not increase in the patients in this study. Therefore, low gait speed in patients with LSS seems to be derived from a neurologic disorder. The surgical results in low muscle mass patients without low gait speed were similar to those with low gait speed. Sarcopenia in elderly patients with locomotor disease should be evaluated using muscle mass alone without assessing physical performance.

10.1177/2309499020918422

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Citations (16)

The prevalence of diffuse idiopathic skeletal hyperostosis in Japan – the first report of measurement by CT and review of the literature

Journal of Orthopaedic Science (2016)

Atsuhiko Hirasawa Norimitsu Wakao Mitsuhiro Kamiya Mikinobu Takeuchi Katsuhisa Kawanami

Diffuse idiopathic skeletal hyperostosis (DISH) is prone to be accompanied by a spinal column fracture which is resistant to conservative therapy. This major characteristic of DISH is not recognized adequately by physicians, because the disease's detailed pathological condition has not yet been investigated. Therefore, the purposes of this study were to investigate the prevalence of DISH using computed tomography (CT), and to validate the reliability of CT interpretation.Subjects were 558 patients (300 male and 258 female) who underwent both CT of chest to pelvis and x-ray of chest and abdomen from August 2011 to July 2012 at any department other than orthopedic surgery in our institution. The definition of DISH based on x-ray as well as CT was the presence of consecutive fused vertebral bodies according to Resnick's criteria. The prevalence of DISH based on both modalities was calculated in all subjects. For 107 subjects extracted at random, intra- (Cohen kappa) and inter-observer error (Fleiss kappa) were calculated and the levels of fused segments were investigated.Ninety-eight of 558 subjects (17.6%) were diagnosed as DISH by x-ray, and 152 (27.2%) by CT. Among males, 70 of 300 subjects (23.3%) were diagnosed by x-ray, and 116 (38.7%) by CT. Among females, 28 of 258 subjects (10.9%) were diagnosed by x-ray and 36 (14.0%) by CT. The levels of fused segments were presented from thoracic spine to lumbar spine, especially the middle and lower thoracic spine. Cohen kappa of x-ray was 0.587, and that of CT was 0.825. Fleiss kappa of x-ray was 0.552, and that of CT was 0.643.The prevalence of DISH based on CT was 27.1%, which was higher than that of x-ray. In addition, intra- and inter-observer error by review of CT was less than that of x-ray. CT evaluation would be a better method for precise understanding of the state of DISH.

Hyperostosis

Kappa

Cohen's kappa

10.1016/j.jos.2016.02.001

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Citations (82)

The Essence of Clinical Practice Guidelines for Cervical Spondylotic Myelopathy, 2020

Spine Surgery and Related Research (2024)

Narihito Nagoshi Yasushi Fujiwara Yoichi Iizuka Hirotaka Chikuda Tsukasa Kanchiku

Cervical spondylotic myelopathy (CSM) is a general term for a disease-causing paralysis owing to spinal cord compression due to cervical spinal canal narrowing and age-related changes in the cervical spine combined with instability and trauma. CommentaryCSM is defined as follows.Symptoms When any of the following are observed.・Numbness in the four limbs (including the bilateral upper limbs only).・Manual dexterity impairment (such as difficulty using chopsticks and fastening buttons).・Gait impairment (such as trotting and difficulty descending stairs).・Bladder disturbance (such as frequent urination and urinary incontinence).Signs ・Reduced deep tendon reflex of the upper limbs at the level of impairment.・Accentuated tendon reflex below the level of impairment, the appearance of a pathological reflex, and myelopathic hand. Image Diagnosis・ On plain X-ray imaging, observation of intervertebral narrowing, posterior vertebral spur, and developmental spinal canal stenosis.・Findings of spinal cord compression on magnetic resonance imaging (MRI), computed tomography (CT), or myelography at the site of the lesion on plain X-ray imaging. Epidemiology SummaryCSM is common in men aged 50 years and older.It has been reported that the incidence of patients

Clinical Practice

10.22603/ssrr.2022-0229

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Citations (1)

[Cost-utility analysis of osteoporosis].

Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics (2005)

Atsushi Harada Yasumoto Matsui Marie Takemura Zenya Ito Norimitsu Wakao

老年病の需要増加に対する有限の医療・介護資源をいかに合理的に活用するかが問われている. 本稿では, 骨粗鬆症・骨折の疫学と費用を述べ, 次いで費用対効果の研究を介入法別に総説した. 骨粗鬆症性骨折による生命予後及び機能予後の悪化, 並びにQOL低下の存在は多くの研究から明らかで, 骨粗鬆症治療の効果はQOLを考慮した質調整生存年 (QALY) によって測定され, 費用・効用分析にて解析されるべきである. 従って, その費用対効果は, 単なる得られた生存年ではなく, 獲得されたQALY当たりの費用で評価されるのが適正で, QALYも得られ, 費用も節減が最も望ましいが, 妥当な費用閾値を越えなければ費用対効果は良好とされる.骨粗鬆症・骨折における治療の費用対効果は, 対象の有する骨粗鬆症性骨折リスクと介入法の効果及び費用に依存しており, 特に骨折リスクとしての年齢と介入費用の影響が強かった. 高価な治療であっても高齢であれば, 平均骨折リスクの女性では合理的費用対効果が認められ, 安価で効果のある治療なら, 閉経直後の正常女性でも合理的費用対効果が得られる. さらに介入効果として薬剤中止後の効果残存にも費用対効果は大きく左右され, 効果残存のない薬剤では, 最も安価でかつ最大の効果のある場合以外は, 費用対効果を得るのは困難とする報告もあった.介入法ごとの費用対効果を現時点の文献をもとに検討すると, HRTに関しては, 有益作用を有害作用が上回った最近の報告を元にした検討はまだ発表されていない. アレンドロネートは既存脊椎骨折のある高齢骨粗鬆症女性で十分な費用対効果が認められ, 効果は対象が高齢の方が優れており, 既存脊椎骨折を有する方が脊椎骨折のない場合より優れていた. リセドロネートも65歳以上の骨粗鬆症女性では既存骨折にかかわらず, 良好な費用対効果を示し, 既存骨折があれば70歳以上ですべて費用節減に至った. カルシウムとビタミンD併用は大腿骨頸部骨折リスクを減少し, 高齢女性で費用節減に到達した. ラロキシフェンは乳癌抑制作用も合わせると, 既存骨折の有無にかかわらず, 骨粗鬆症女性における費用対効果はどの年代でも良好であった. ヒッププロテクターは, 高齢者においては男女とも費用節減で, 特に高齢女性では大きい費用節減とQALY獲得が予測された.このように骨折リスクの高い高齢者にも費用対効果が十分期待できる介入法がいくつかあり, それらによる積極的な治療は医療経済的にも大いに有意義であると考えられる.

10.3143/geriatrics.42.596

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Citations (9)

Effect of an intensive conservative therapy with daily teriparatide administration and rehabilitation for osteoporotic delayed vertebral collapse and paralysis

Medicine (2018)

Norimitsu Wakao Mikinobu Takeuchi Daniel K. Riew Atsuhiko Hirasawa Shiro Imagama

Although patients with osteoporotic delayed vertebral collapse (ODVC) have frequently been treated surgically, the efficacy and limitation of conservative treatment for it have not yet been reported. The purpose of this study was to investigate the effectiveness and limitation of further intensive conservative treatment for patients with ODVC. Patients treated for ODVC from 2011 to 2014 with a follow-up period of more than 1 year were eligible. The fundamental treatment strategy consisted of surgical treatment following intensive conservative treatment with daily teriparatide and rehabilitation for 3 months. We conducted a surgical treatment for patients who could not keep standing position by themselves because of prolonged leg paralysis or intolerable back pain. We performed a logistic regression model in which surgical treatment was set as an objective variable, and other related factors including sex, age, the level of affected vertebrae, the quality of paralysis, changing rate (δ) of spinal canal encroachment, local kyphotic angle, mobility of collapsed vertebrae, EuroQol questionnaires (EQ5D), numerical rating scale (NRS), and Frankel grade as explanatory variables. We also plotted receiver operating curves (ROCs) to investigate the cutoff values of parameters at the baseline. Thirty patients (6 males and 24 females, mean age 76.7 years) were enrolled. Eventually 12 out of 30 patients avoided surgical treatment because their symptoms were improved. Logistic regression showed that δ of local kyphotic angle (odds ratio: 1.072), P = .01), mobility of collapsed vertebrae (1.063, 0.01), EQ5D (0.98, 0.04), and NRS (1.113, 0.01) were significantly correlated with the need for surgical treatments. Among the factors at baseline, only the mobility of collapsed vertebrae showed a significant value of area under a curve (AUC = 0.727, P = .008). The results that 40% of patients with ODVC did not need further surgical treatment after the intensive conservative treatment was of great significance. Patients with greater mobility of collapsed vertebrae might be treated surgically as quickly as possible.

10.1097/md.0000000000010906

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A double-blind randomized controlled trial of the local application of vancomycin versus ampicillin powder into the operative field for thoracic and/or lumbar fusions

Journal of Neurosurgery Spine (2018)

Mikinobu Takeuchi Norimitsu Wakao Mitsuhiro Kamiya Atsuhiko Hirasawa Kenta Murotani

OBJECTIVE Retrospective studies have reported that the local application of vancomycin (VCM) powder into the operative field decreases the incidence of surgical site infection (SSI) in thoracic and/or lumbar fusion. Authors of the present study prospectively evaluated the effects of VCM in patients undergoing thoracic and/or lumbar fusion. METHODS In this randomized double-blind trial, 230 patients undergoing thoracic and/or lumbar fusion were randomly assigned to the local administration of VCM (interventional group, 1 g) or ampicillin (AMP; control group, 1 g) into the surgical field. The primary outcome was SSI results within 1 year of surgery. RESULTS The trial was prematurely stopped according to predetermined rules. The results showed one superficial infection (0.9%, Staphylococcus aureus ) and one deep infection (0.9%, S. aureus ) in the VCM group and two superficial infections (1.8%, Staphylococcus epidermidis and culture negative) and one deep infection (0.9%, methicillin-resistant S. aureus ) in the AMP group. No significant differences in infection rates were observed between the groups (p = 0.8). CONCLUSIONS This double-blind randomized controlled trial demonstrated that the local application of VCM or AMP powder into the operative field in short thoracic and/or lumbar fusion procedures resulted in a similar incidence of SSI. ■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: randomized controlled trial; evidence: class III. Clinical trial registration no.: UMIN000009377 (umin.ac.jp/ctr)

10.3171/2018.3.spine171111

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Citations (30)

Proprioception and Geriatric Low Back Pain

Spine Surgery and Related Research (2022)

Yoshihito Sakai Tsuyoshi Watanabe Norimitsu Wakao Hiroki Matsui Naoaki Osada

Proprioception is a deep sensation that perceives the position of each part of the body, state of movement and muscle contraction, and resistance and mass applied to the body. Proprioceptive feedback influences movement and positional accuracy, resulting in key somatosensory functions for human postural control. Proprioception encompasses signals received from proprioceptors located in the skin, subcutaneous tissue, muscles, tendons, and joint capsules, commonly known as mechanoreceptors. The muscle spindle, a crucial proprioceptor, is stretched during eccentric contraction of muscle, thus generating an action potential on afferent fibers to convey a proprioceptive information to the sensorimotor cortex in the brain. For exercise therapy in patients with locomotor disease, proprioception serves an essential function for motor control; thus, this should be considered to obtain effective muscle output. As postural control is achieved by proprioceptive function according to the balance between the lower limb and trunk, relative proprioceptive weighting ratio can help clarify proprioceptive control using muscle response to mechanical vibration. The absence of proprioceptive information congruent with motor intention activates cortical center monitoring incongruence of sensation, leading to pathological pain. Therapeutic procedures may aim to restore the integrity of cortical information processing in musculoskeletal chronic pain. Poor proprioception is one of the main causes of decreased postural balance control in elderly patients with low back pain (LBP). It has been hypothesized that proprioception of the lower limbs deteriorates with age-related muscle mass loss (sarcopenia), which increases the proprioceptive burden on the lumbar spine. Accurate diagnosis of the proprioceptive function is important for establishing a treatment procedure for proprioceptive recovery, and further prospective research is required to clarify the relationship between proprioception and LBP improvement.

Proprioception

Muscle spindle

Sensation

Motor Control

10.22603/ssrr.2021-0269

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Citations (16)