Noriaki Yokogawa

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Thoracic scoliosis is associated with pulmonary function impairment, yet the predictive value of thoracic deformity parameters remains unclear. This study aimed to evaluate whether 3-dimensional computed tomography (3D-CT) analysis predicts postoperative pulmonary function improvement in pediatric patients with thoracic scoliosis. This retrospective cohort study included 67 pediatric patients with thoracic scoliosis who underwent posterior spinal fusion. All patients completed preoperative and 2-year postoperative pulmonary function tests (PFTs), radiographs, and low-dose chest CT scans. 3D-CT was used to assess lung volume (LV), airway dimensions, and rib cage parameters. Patients were grouped into adolescent idiopathic scoliosis (AIS, n = 56) and non-AIS (n = 11) cohorts. Correlations were determined between anatomical deformities and changes in pulmonary function using Spearman's rank correlation coefficient. Surgical correction significantly improved thoracic Cobb angle and PFT values. Preoperative LV and bronchial cross-sectional area (CSA) correlated positively with postoperative FVC%. Rib cage deformity metrics-including apical rotation angle, vertebra-sternum angle, and spinal penetration index-were associated with greater FVC% improvement. Correction of thoracic hypokyphosis toward a more physiological kyphosis was also significantly linked to postoperative pulmonary function gains. Subgroup analysis indicated that non-AIS patients, although presenting with more severe deformities and poorer baseline function, achieved greater improvements postoperatively, yet still had inferior outcomes compared with AIS patients. This study showed that 3D low-dose CT imaging provides critical insights into the relationship between thoracic deformity and pulmonary function in pediatric scoliosis. Preoperative lung volume strongly predicted postoperative outcomes, and patients with more severe deformities had lower baseline function but greater improvement after surgery. Correction of thoracic hypokyphosis toward an acceptable kyphosis enhanced thoracic cavity configuration and pulmonary capacity. These results highlight the importance of detailed preoperative assessment and precise surgical planning. Incorporating 3D imaging may help tailor corrective strategies, particularly in non-idiopathic scoliosis with complex deformities and potential for greater functional recovery. Not applicable.

A retrospective multicenter study. To determine whether the extent of intramedullary hyperintensity on initi... Asian Spine Journal 2026;():-.

Objective: To examine back muscle activity and fatigue behavior in female patients with degenerative thoracolumbar kyphosis (DTK) using high-density surface electromyography (HDSEMG) and evaluate the effects of using a soft spinal orthosis.Methods: Seven female participants with DTK (mean age: 73.6 years) were assessed during static standing and a weighted holding task with and without a soft spinal orthosis. HDSEMG signals were obtained from the lumbar erector spinae using a 64-electrode array. Time to fatigue (TTF), spatial displacement, and directional consistency of muscle activation were analyzed using the spatial center of activity (SCoA) and circular variance (CV).Results: Orthosis use significantly reduced the sagittal vertical axis and low back pain. TTF was significantly prolonged during the weighted holding task with the orthosis (p=0.012), indicating delayed fatigue onset. SCoA displacement was significantly reduced in both tasks (p<0.001), whereas CV analysis demonstrated improved directional consistency of muscle activation.Conclusion: HD-SEMG revealed early fatigue onset and unstable muscle activation patterns in patients with DTK, particularly during load-bearing tasks performed without orthotic support. Orthosis used improved endurance and neuromuscular efficiency by reducing spatial and directional variability in muscle recruitment. These findings underscore the utility of HDSEMG for elucidating the neuromuscular pathophysiology of DTK and support the use of spinal orthoses as a conservative treatment approach.

Objective: To investigate the effects of social restrictions imposed during the coronavirus disease 2019 (COVID-19) pandemic on postoperative functional recovery in patients who underwent surgery for degenerative musculoskeletal disorders.Methods: This longitudinal prospective cohort study included 291 patients categorized into pre-pandemic (surgery in 2018), early pandemic (2019), and late-pandemic (2020) groups based on their 1-year recovery period. The primary outcome was improvement in locomotive syndrome (LS) status 1 year after surgery. We analyzed the association between social limitations and LS improvement using multivariate logistic and segmented regression analyses.Results: The late-pandemic group exhibited the lowest LS improvement rate (50.6%) and the highest prevalence of postoperative social contact limitations (61.0%). Multivariate analysis identified the absence of postoperative social contact limitation as a highly potent independent predictor of LS improvement (odds ratio, 10.01; 95% confidence interval, 5.40–19.34; p<0.01). Segmented regression analysis revealed a time lag: social contact limitations peaked in March 2020, whereas the decline in LS improvement rates began in October 2020.Conclusion: Prolonged social restrictions negatively impacted functional recovery, particularly during the late phase of the pandemic. Social participation, specifically direct social contact, could be a critical and independent component of postoperative rehabilitation. These findings underscore the need to integrate psychosocial assessments into standard postoperative care to optimize patient outcomes.

Background and objectives This study aimed to comprehensively assess degenerative changes in the intervertebral disc, facet joint, and paraspinal muscle after adolescent idiopathic scoliosis surgery and to evaluate clinical outcomes at a five-year follow-up using magnetic resonance imaging (MRI). We hypothesized that the pattern of degeneration would differ based on the distal level of fusion. Materials and methods We retrospectively reviewed patients with adolescent idiopathic scoliosis who underwent surgery between 2006 and 2015. The patients were divided into two groups based on the lowest instrumented vertebra (LIV): a proximal LIV group (L2 or above) and a distal LIV group (L3 or below). Degeneration was evaluated using MRI with the Pfirrmann and Fujiwara scoring systems. Fatty infiltration of paraspinal muscles was specifically assessed at the L5/S1 disc level, distal to the surgical field, using the Goutallier scoring system. Clinical outcomes were measured using the Scoliosis Research Society-22 (SRS-22) Patient Outcome Questionnaire. Statistical comparisons were performed using the Mann-Whitney U test and Wilcoxon signed-rank test. Results The proximal LIV group comprised 21 patients, while the distal LIV group had 19 patients. Postoperatively, six of 40 patients (15%) exhibited progression of disc degeneration in mobile segments, with no significant difference between groups. The proximal LIV group showed significant progression of facet joint degeneration up to three levels below the fusion, whereas the distal LIV group showed similar changes up to two levels. However, the distal LIV group demonstrated greater overall facet degeneration. Paraspinal muscle degeneration at the L5/S1 level was observed in 19 of 40 patients (47.5%), with a higher prevalence in the distal LIV group (73.7% vs. 23.8%). Clinical outcomes were satisfactory and did not differ significantly between the groups. Conclusions At the five-year mark, this study suggests an association between a more proximal LIV (L2 or above) and less facet joint and paraspinal muscle degeneration in patients undergoing fusion for adolescent idiopathic scoliosis. However, these preliminary radiological findings did not correlate with clinical symptoms, which remained satisfactory in both groups. These results should be interpreted with caution, and extended follow-up is necessary to determine the long-term clinical significance of these degenerative changes.

Background/Objectives: Massive intraoperative blood loss (IBL) is one of the major complications in metastatic spinal tumor surgery (MSTS), and understanding the predictors of this risk is essential. This study aimed to determine the impact of the intratumoral flow void (IFV) observed on standard magnetic resonance imaging (MRI) and its association with IBL in palliative surgery for metastatic spinal tumors. Methods: This retrospective analysis included 88 palliative excisional surgeries performed at a single hospital between 2010 and 2024. Factors such as age, sex, body mass index, tumor location, histological tumor type, spinal instability neoplastic score, revised Tokuhashi score, preoperative radiation, presence of IFV, and IFV diameter were assessed in addition to surgical details such as the number of resected and instrumented vertebrae and surgical duration. Results: Of the 88 patients, 71 (80.7%) exhibited IFV, with a mean IFV diameter of 1.8 ± 1.3 mm. The univariate analysis identified a significant association between IBL and several factors, including the presence of IFV, IFV diameter, hypervascular tumor type, number of instrumented vertebrae, and surgical duration. The multivariate analysis indicated that IFV diameter had the highest standardized coefficient among the examined variables, suggesting its strong potential as a predictor of IBL. Conclusions: This is the first study to identify the IFV diameter as a critical and independent predictor of IBL in MSTS. IFV diameter, which can be easily assessed using standard MRI, should be considered in surgical planning to effectively manage bleeding.

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Objectives: Respiration plays an important function in sustaining life. The diaphragm is the primary muscle involved in respiration, and plays an important role in trunk stabilization. Although it has been reported that respiratory function is important for trunk muscle stability, the correlation between respiratory function and abdominal trunk muscle strength remains undetermined. This study aimed to clarify this correlation among middle-aged and older patients. Methods: This observational study included 398 patients scheduled for surgery for degenerative conditions of the lower extremities. Respiratory function was evaluated using forced vital capacity and forced expiratory volume in 1 s measured using spirometry. Each patient underwent a physical function test before surgery, which included the assessment of the abdominal trunk muscle strength, grip power, knee extensor strength, one-leg standing time, and gait speed. Correlations between abdominal trunk muscle strength, respiratory function, and physical function were evaluated. Results: Abdominal trunk muscle strength was significantly correlated with forced vital capacity, forced expiratory volume in 1 s, grip power, knee extensor strength, one-leg standing time, and gait speed. Multiple linear regression analyses revealed that sex, forced vital capacity, forced expiratory volume in 1 s, and knee extensor strength were significant factors associated with abdominal trunk muscle strength. Conclusions: In middle-aged and older patients, abdominal trunk muscle strength including that of the diaphragm, is associated with forced vital capacity and forced expiratory volume in 1 s.