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1.  The effects of surgery on locomotion in elderly patients with cervical spondylotic myelopathy 
European Spine Journal  2013;22(11):2545-2551.
This study aimed to evaluate the effects of surgery on locomotor ability in patients with cervical spondylotic myelopathy (CSM) and compare the results between elderly and younger patients.
A total of 369 consecutive patients who underwent expansive laminoplasty for CSM were prospectively analysed. Patients were divided into two age groups of ≥75 years (elderly group, 76 patients) and <75 years (younger group, 293 patients). Locomotor ability was estimated using part of the functional independence measure (FIM). The sum of gait and stairs items [functional independence measure (locomotion), FIM-L; possible scores, 2–14] and neurological status were estimated using the Japanese Orthopaedic Association (JOA) score (possible score, 0–17). Pre-operative neurological anamnesis was reviewed, and the surgical results of elderly patients with or without co-existing neurological history were evaluated to determine the origin of locomotor disability.
Peri-operative FIM-L and JOA scores were significantly lower in the elderly group than in the younger group, and the opposite was true for improved FIM score. Cerebral infarction and previous lumbar surgery were identified as neurological co-morbidities in the elderly group. However, there was no significant difference in surgical results between elderly patients with and without co-existing neurological disorders.
Decompression surgery can improve locomotor ability and decrease nursing care requirements among elderly patients with CSM. However, other neurological diseases can co-exist in elderly patients, making it difficult to diagnose the origin of locomotor disability. Therefore, detailed peri-operative work-up and timely decompression should be given priority to avoid progression towards fixed locomotor disability.
PMCID: PMC3886528  PMID: 23955371
Cervical spondylotic myelopathy; Laminoplasty; Locomotion; Functional independence measure; Elderly
2.  Rheumatoid vertical and subaxial subluxation can be prevented by atlantoaxial posterior screw fixation 
European Spine Journal  2012;21(12):2498-2505.
Literature has described a risk for subsequent vertical subluxation (VS) and subaxial subluxation (SAS) following atlantoaxial subluxation in rheumatoid patients; however, the interaction of each subluxation and the radiographic findings for atlantoaxial fixation has not been described. The purpose of this study was to evaluate the effects of two different posterior atlantoaxial screw fixation on the development of subluxation in patients with rheumatoid atlantoaxial subluxation.
Between 1996 and 2006, rheumatoid patients treated with transarticular fixation and posterior wiring (TA) or C1 lateral mass–C2 pedicle screw fixations (SR) in the Nagoya Spine Group hospitals, a multicenter cooperative study group, were included in this study. VS, SAS, craniocervical sagittal alignment, and range of motion (ROM) at the atlantoaxial adjacent segments were investigated to determine whether posterior atlantoaxial screw fixation is a prophylactic or a risk factor for the development of VS and SAS.
The mean follow-up was 7.2 years (4–12). No statistically significant difference was observed among the patients treated with either of the procedure during the follow-up period. Of 34 patients who underwent posterior atlantoaxial screw fixation, SAS was observed in 26.5 % during the follow-up period; however, VS was not observed. Postoperative C2–7 angle, and Oc–C1 and C2–3 ROM were significantly different between patients with and without postoperative SAS. The incidence of SAS was 38.9 % for TA and 12.5 % for SR; statistically significant differences were observed in the postoperative C1–2 and C2–7 angles, and C2–3 ROM.
Atlantoaxial posterior screw fixation may be an appropriate prophylactic intervention for VS and SAS if the atlantoaxial joint develops bony fusion following physiological alignment. Compared to TA, SR provided optimal atlantoaxial angle and prevented lower adjacent segment degeneration, thereby reducing SAS.
PMCID: PMC3508217  PMID: 22825632
Rheumatoid arthritis; Atlantoaxial subluxation; Vertical subluxation; Subaxial subluxation; Posterior screw fixation
3.  Li-Fraumeni syndrome with simultaneous osteosarcoma and liver cancer: Increased expression of a CD44 variant isoform after chemotherapy 
BMC Cancer  2012;12:444.
Li-Fraumeni syndrome (LFS) is a hereditary cancer predisposition syndrome that is commonly associated with a germline mutation in the tumor suppressor gene p53. Loss of p53 results in increased expression of CD44, a cancer stem cell (CSC) marker, which is involved in the scavenging of reactive oxygen species (ROS). Here, we report a change in the expression of a CD44 variant isoform (CD44v8-10) in an 8-year-old female LFS patient with osteosarcoma and atypical liver cancer after chemotherapy.
Case presentation
The patient visited a clinic with a chief complaint of chronic pain in a bruise on her right knee. Magnetic resonance imaging (MRI) raised the possibility of a bone malignancy. Biochemical testing also revealed significantly elevated levels of AFP, which strongly suggested the existence of a primary malignancy in the liver. MRI imaging showed the simultaneous development of osteosarcoma and liver cancer, both of which were confirmed upon biopsy. Combined therapy with surgical resection after chemotherapy was successful in this patient. Regardless of the absence of a familial history of hereditary cancer, a germline mutation in p53 was identified (a missense mutation defined as c.722 C>T, p.Ser241Phe). To better understand the cancer progression and response to treatment, immunohistochemical (IHC) analysis of biopsy specimens obtained before and after chemotherapy was performed using a specific antibody against CD44v8-10.
This case demonstrates the ectopic up-regulation of CD44v8-10 in a biopsy sample obtained after cytotoxic chemotherapy, which confers high levels of oxidative stress on cancer cells. Because the alternative splicing of CD44 is tightly regulated epigenetically, it is possible that micro-environmental stress resulting from chemotherapy caused the ectopic induction of CD44v8-10 in vivo.
PMCID: PMC3488581  PMID: 23031740
Li-Fraumeni syndrome (LFS); cancer stem cells (CSCs); CD44 variant isoforms
4.  Percutaneous Pedicle Screw Fixation of a Hangman's Fracture Using Intraoperative, Full Rotation, Three-dimensional Image (O-arm)-based Navigation: A Technical Case Report 
Asian Spine Journal  2012;6(3):194-198.
Surgical treatment of a hangman's fractures is technically demanding, even when using the standard open procedure. In this case report, a type II hangman's fracture was treated by percutaneous posterior screw fixation, without a midline incision, using intraoperative, full rotation, three-dimensional (3D) image (O-arm)-based navigation. A 48-year-old woman was injured in a motor vehicle accident and diagnosed with a unilateral hangman's fracture associated with subluxation of the C2 vertebral body on C3. After attaching the reference arc of the 3D-imaging system to the headholder, the cervical spine was screened using an O-arm without anatomical registration. Drilling and screw fixation were performed using a guide tube while referring to the reconstructed 3D-anatomical views. The operation was successfully completed without technical difficulties or neurovascular complications. This percutaneous procedure requires less dissection of normal tissue, which may allow earlier recovery. However, further validation of this procedure for its effectiveness and safety is required.
PMCID: PMC3429610  PMID: 22977699
Pedicle screw; Percutaneous; Minimally invasive; Hangman's fracture; Three-dimensional image-based navigation

Results 1-4 (4)