Low Back Pain and Lumbar Degeneration

Background: Baseball is one of the most popular sports in Asia. It is known that baseball can easily lead to back pain. However, there has been no survey of low back pain (LBP) and lumbar disc degeneration in Japanese professional baseball players to date. Purpose: To investigate the cause of LBP and lumbar degeneration in professional Japanese baseball players. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We retrospectively reviewed the medical records of Japanese professional baseball players with LBP who visited our hospital. Data were collected from July 2018 to April 2021. We also investigated whether the results differed between players in their 20s and 30s or between pitchers and fielders. Data analysis was performed using the chi-square test. Results: We surveyed 32 professional baseball players. The most frequent causes of LBP among players in their 20s (n = 21) were lumbar disc herniation (LDH; 57%) and spondylolysis (24%). Of the players with spondylolysis, 50% had adult-onset spondylolysis. Players in their 30s (n = 11) most commonly had discogenic pain (55%) as well as LDH and facet joint arthritis (each 18%). The incidence of lumbar intervertebral disc degeneration was significantly higher in players in their 30s (91%) than those in their 20s (14%), as was the incidence of Schmorl nodes and Modic type 1 changes. There was no significant difference in the cause of LBP or the incidence of lumbar intervertebral disc degeneration between pitchers and fielders (P = .59). Conclusion: Among professional baseball players in their 20s, lumbar degeneration was less common, and they most frequently developed diseases less related to degeneration, such as LDH. However, among players in their 30s, lumbar degeneration was more advanced, and degenerative diseases such as discogenic pain occurred more frequently. Research on training methods could lead to the prevention of LBP. Our data may be applicable to other professional athletes and will contribute to diagnosis and treatment

横断像と矢状断像における椎間関節角度の加齢性変化 : 変性すべり症症例との比較

Background: Despite facet joints being three-dimensional structures, previous computed tomography and magnetic resonance imaging studies have evaluated facet joint orientation in only the axial plane. Facet joint orientation in the sagittal plane has rarely been studied using these imaging techniques. The aim of this study was to elucidate facet joint orientation in both the axial and sagittal planes on computed tomography. Methods: A total of 568 patients (343 men, 225 women) (excluding orthopedic outpatients) for whom abdominal and pelvic computed tomography scans were obtained at our hospital between September 2010 and October 2012 were included. Mean age was 63 (range 21-90) years. Patients were divided into a degenerative spondylolisthesis group (67 patients; 30 men, 37 women) and a control group (313 patients; 313 men, 188 women). Facet joint orientation was evaluated in the control group according to patient age (≤50, 51-60, 61-70, or ≥71 years). The findings in the control group were then compared with those in the degenerative spondylolisthesis group. The orientation of the lumbar facet joints at each level was measured in the axial and sagittal planes on computed tomography images. Results: Facet joint angles decreased with age at L4/5 and L5/S1 in women in the axial plane and at L4/5 in men and L3/4 and L4/5 in women in the sagittal plane. The variation in facet joint angle was greatest at L4/5 in women. Patients with degenerative spondylolisthesis showed more sagittally and horizontally oriented facet joints in the axial and sagittal planes; facet tropism showed an association with degenerative spondylolisthesis in the axial plane. Conclusions: The axial and sagittal orientation of facet joints in the lower lumbar vertebra, especially L4/5, was negatively correlated with age. This finding could help to explain why older people are more prone to degenerative spondylolisthesis

Thrombolysis with Low-Dose Tissue Plasminogen Activator 3–4.5 h After Acute Ischemic Stroke in Five Hospital Groups in Japan

Clinical data from Japan on the safety and real-world outcomes of alteplase (tPA) thrombolysis in the extended therapeutic window are lacking. The aim of this study was to assess the safety and real-world outcomes of tPA administered within 3-4.5 h of stroke onset. The study comprised consecutive acute ischemic stroke patients (n = 177) admitted across five hospitals between September 2012 and August 2014. Patients received intravenous tPA within <3 or 3-4.5 h of stroke onset. Endovascular therapy was used for tPA-refractory patients. In the 3-4.5 h subgroup (31.6 % of patients), tPA was started 85 min later than the <3 h group (220 vs. 135 min, respectively). However, outcome measures were not significantly different between the <3 and 3-4.5 h subgroups for recanalization rate (67.8 vs. 57.1 %), symptomatic intracerebral hemorrhage (2.5 vs. 3.6 %), modified Rankin Scale score of 0-1 at 3 months (36.0 vs. 23.4 %), and mortality (6.9 vs. 8.3 %). We present data from 2005 to 2012 using a therapeutic window <3 h showing comparable results. tPA following endovascular therapy with recanalization might be superior to tPA only with recanalization (81.0 vs. 59.1 %). Compared with administration within 3 h of ischemic stroke onset, tPA administration within 3-4.5 h of ischemic stroke onset in real-world stroke emergency settings at multiple sites in Japan is as safe and has the same outcomes

Proximal Vertebral Body Fracture after 4-Level Fusion Using L1 as the Upper Instrumented Vertebra for Lumbar Degenerative Disease: Report of 2 Cases with Literature Review

Some cases with lumbar degenerative diseases require multi-level fusion surgeries. At our institute, 27 and 4 procedures of 3- and 4-level fusion were performed out of a total 672 posterior lumbar interfusions (PLIFs) on patients with lumbar degenerative disease from 2005 to 2010. We present 2 osteoporotic patients who developed proximal vertebral body fracture after 4-level fusion. Both cases presented with gait disability for leg pain by degenerative lumbar scoliosis and canal stenosis at the levels of L1/2-4/5. After 4-level fusion using L1 as the upper instrumented vertebra, proximal vertebral body fractures were found along with the right pedicle fractures of L1 in both cases. One of these patients, aged 82 years, was treated as an outpatient using a hard corset for 24 months, but the fractures were exacerbated over time. In the other patient, posterolateral fusion was extended from Th10 to L5. Both patients can walk alone and have been thoroughly followed up. In both cases, the fracture of the right L1 pedicle might be related to the subsequent fractures and fusion failure. In consideration of multi-level fusion, L1 should be avoided as an upper instrumented vertebra to prevent junctional kyphosis, especially in cases with osteoporosis and flat back posture

Clinicopathological features of advanced gastric cancer discovered after Helicobacter pylori eradication

　Helicobacter pylori infection is closely associated with gastric cancer, and its eradication is expected to prevent gastric cancer. However, gastric cancer is often detected discovered after eradication therapy for H. pylori infection. We aimed to investigate the endoscopic and clinical features of advanced gastric cancer after H. pylori eradication.　We retrospectively investigated tumor location, macroscopic and histological type, endoscopic gastric mucosal atrophy (using the Kimura-Takemoto classification), and the interval between eradication and detection of gastric cancer.　Nine patients (five males; mean age, 65.3 years [range, 44-79 years]), histologically diagnosed with advanced gastric cancer after successful H. pylori eradication between April 2003 and December 2018, were enrolled in this study.　In all cases, the cancer was located in the middle-to-upper portion of the stomach. With respect to macroscopic type, six cases were ulcerative, two were scirrhous, and one was polypoid. Histologically, all cancers were poorly or moderately differentiated adenocarcinomas. Endoscopic mucosal atrophy was mild in two cases, moderate in two cases, and severe in five cases. Two cases of scirrhous tumors developed from mild mucosal atrophy. Moreover, the tumor was detected within 36 months after H. pylori eradication in six patients (maximum: 120 months, mean: 38.7 months).　Our data demonstrated that post-eradicated advanced gastric cancers were located in the middle-to-upper portion of the stomach and were mainly ulcerative, poorly or moderately differentiated adenocarcinoma. More than half of the patients exhibited severe mucosal atrophy

Surgery in the Standing Position by a Surgeon with Achilles Tendon Rupture

Unexpected injuries can have a profound effect on a surgeonʼs performance and thus on patients and surgical departments. Here we describe a technique for performing surgery in the standing position, as done by a surgeon with an Achilles tendon rupture. During his prescribed 45-day non-weight-bearing period for the left ankle after surgery for an Achilles tendon rupture, the surgeon was able to participate in 15 surgeries as an operator or assistant, due to his use of a combination of injured-leg genuflection on a stool and a ʻSurgical Body Supportʼ device. Similarly injured surgeons may benefit from such support

A case of synchronous triple cancer of the esophagus, stomach, and colon detected by using gastrointestinal screening endoscopy

　In recent years, the detected number of multiple primary malignant tumors (MPMTs) in the gastrointestinal tract has been increasing with the advancement of gastrointestinal endoscopic equipment and the spread of endoscopic screening.　Here, we report a case of synchronous MPMTs of the esophagus, stomach, and colon detected by means of gastrointestinal screening endoscopy. The patient was a 67-year-old man who regularly visited the medical clinic for hypertension. He had a history of alcohol consumption (sake index: 250, with alcohol flushing syndrome) and smoking (Brinkman index: 800), and a family history of cancer (his father had gastric cancer).　At the medical clinic, he underwent gastrointestinal endoscopy for screening purposes. Prior observation with linked-color imaging (LCI), a type of image-enhanced endoscopy (IEE), revealed an irregular depressed lesion in the mid-esophagus. Simultaneously, an irregular, highly deformed depressed lesion and a small depressed lesion were detected on the incisura of the lesser curvature and the lesser curvature of the antrum, respectively. The esophageal lesion was identified as squamous cell carcinoma and both gastric lesions were identified as well-differentiated adenocarcinoma.　The patient was referred to our hospital for further examination and treatment for esophageal and gastric cancer. Subsequent colonoscopy revealed a well-defined, ulcerative tumor in the transverse colon. First, endoscopic submucosal dissection was performed for the esophageal lesion, followed by laparoscopy-assisted distal gastrectomy with D1+ lymph-node dissection and transverse colectomy with D2 lymph-node dissection for the gastric and colorectal lesions, respectively. Histopathologically, the main gastric and colonic tumors were in advanced stages; fortunately, the esophageal cancer was an early-stage lesion (7 × 5 mm, 0-IIc, pT1a-LPM, INFa, ly0, v0, pCurA), which has a much better prognosis than advanced esophageal cancer.　In patients with multiple cancer risk factors (alcohol consumption, smoking, and family history), it is important to consider the possibility of MPMTs. Furthermore, upper gastrointestinal observation combined with IEE, such as LCI, may be useful in the early detection of lesions