Conditions for Achieving Postoperative Pelvic Incidence-Lumbar Lordosis < 10° in Circumferential Minimally Invasive Surgery for Adult Spinal Deformity

This retrospective study aimed to evaluate the clinical outcomes of circumferential minimally invasive surgery (CMIS) using lateral lumbar interbody fusion (LLIF) and percutaneous pedicle screw (PPS) in adult spinal deformity (ASD) patients, and to clarify the conditions for achieving postoperative pelvic incidence-lumbar lordosis (PI-LL) < 10°. Demographics and other parameters of ASD patients who underwent CMIS and who were divided into groups G (achieved postoperative PI-LL < 10°) and P (PI-LL ≥ 10°) were compared. Of the 145 included ASD patients who underwent CMIS, the average fused level, bleeding volume, operative time, and number of intervertebral discs that underwent LLIF were 10.3 ± 0.5 segments, 723 ± 375 mL, 366 ± 70 min, and 4.0 segments, respectively. The rod material was titanium alloy in all the cases. The PI-LL significantly improved from 37.3 ± 17.9° to 1.2 ± 12.2° postoperatively. Pre- and postoperative PI, postoperative LL, preoperative PI-LL, PI-LL after LLIF, and postoperative PI-LL were significantly larger in group P. PI-LL after LLIF was identified as a significant risk factor of postoperative PI-LL < 10° by logistic regression, and the cut-off value on receiver operating characteristic curve analysis was 20°. Sufficient correction was achieved by CMIS. If PI-LL after LLIF was ≤20°, it was corrected to the ideal alignment by the PPS procedure

Analysis of measures against mechanical complications in circumferential minimally invasive surgery for adult spinal deformity

Aim: We evaluated the reduction of mechanical complications (MCs) in circumferential minimally invasive spinal surgery (c-MIS) to treat adult spinal deformity (ASD) using lateral lumbar interbody fusion and a percutaneous pedicle screw.Methods: Patients with ASD who underwent c-MIS with a follow-up period of > 24 months were enrolled. Groups were as follows: c-MIS using 5.5 mm rods (P group), c-MIS using a 5.5 mm single rod with cement augmentations in the upper instrumented vertebra (UIV)/UIV + 1 (B group), c-MIS using 6 mm rods (6P group), and multi-rod c-MIS (M group). Terminal rod contour was optimized to prevent proximal junctional kyphosis (PJK) in the P, 6P, and M groups. Patients were divided into an MC group, consisting of 68 patients with MCs, and a non-MC group, consisting of 78 patients without MCs. We examined various spinopelvic- and implant-related parameters between the groups.Results: Overall, 146 patients with ASD who underwent c-MIS were included. The incidence of PJK was significantly lower in the P and M groups than in the B group, and rod fracture was significantly lower in the M group than in the B and P groups. In the MC group, preoperative PT, postoperative PI-LL, and PSA were significantly larger than those in the non-MC group. Use of the 5.5 mm single rod and postoperative PI-LL were significant risk factors for MCs. Conclusion: The complication incidence decreased with improvements in surgical techniques and measures. Use of the 5.5 mm single rod and postoperative PI-LL were significant risk factors for MCs

First implementation of IHE-ITI EUA(Enterprise user authentication) and PSA(Patient synchronized application) in Japan - Evaluation of EUA and PSA functionality -

IHE ITI defined the 9 integration profiles. We planed to modify our PACS and Schedule management system for the CT, EUA and PSA integration profiles. We need to check the existing system carefully again prior to the implementation of the EUA and PSA. We define the programming interface of the web client and standalone program. In future, we will make disclosure of the programming interfaces and binary program. We are thinking that these IHE ITI functions are useful and will be widely implemented in hospitals.EuroPACS　200

Bone Fusion Morphology after Circumferential Minimally Invasive Spine Surgery Using Lateral Lumbar Interbody Fusion and Percutaneous Pedicle Screws without Bone Grafting in the Thoracic Spine: A Retrospective Study

Background and Objectives: This study aimed to investigate the process and morphology of thoracic and lumbosacral bone fusion in patients with adult spinal deformity (ASD) who underwent circumferential minimally invasive spine surgery (CMIS) by lateral lumbar interbody fusion (LLIF) and percutaneous pedicle screws (PPSs) without bone grafting in the thoracic spine and who have risk factors for bone fusion failure in the thoracic spine. Materials and Methods: This retrospective study included 61 patients with spinal deformities (46 women and 15 men) who underwent CMIS with LLIF and PPSs at our hospital after 2016 and completed a 3-year postoperative follow-up. The rate and morphology of bone fusion and rod fracture rate in the thoracic and lumbosacral vertebrae were evaluated. Patients were divided into the thoracic spine spontaneous bone fusion group and the bone fusion failure group. The data of various spinopelvic parameters and the incidence of complications were compared. The vertebral body conditions in the thoracic spine were classified as less degenerative (type N), osteophyte (type O), and diffuse idiopathic skeletal hyperostosis (DISH) (type D). Results: After three postoperative years, the bone fusion rates were 54%, 95%, and 89% for the thoracic, lumbar, and lumbosacral spine, respectively. Screw loosening in the thoracic vertebrae was significantly higher in the bone fusion failure group, while no significant differences were observed in the spinopelvic parameters, Oswestry Disability Index (ODI), and rate of proximal junctional kyphosis and rod fractures. Type N vertebral body condition and screw loosening were identified as risk factors for spontaneous bone fusion failure in the thoracic spine. Conclusion: This study indicated that spontaneous bone fusion is likely to be obtained without screw loosening, and even if bone fusion is not obtained, there is no effect on clinical results with the mid-term (3-year) results of CMIS without bone grafting in the thoracic spine

Development of Visual Integration Function in the multi-vender Hospital Information System -Evaluation of IHE IT-Infrastructure -

IHE ITI defined the 9 integration profiles. We planed to modify the PACS and the Schedule management system for the EUA and PSA integration profiles. We need to check the existing system carefully again prior to the implementation of the EUA and PSA. We define the programming interface of the web client and stand-alone program. In future, we will make disclosure of the programming interfaces and binary program. We are thinking that these IHE ITI functions are useful and will be widely implemented in hospitals.20th International Congress and Exhibition of Computer Assisted Radiology and Surgery (CARS2006

RBE values of carbon ions for three transplantables

HCPBM and ENLIGHT-200

Can We Rely on Prophylactic Two-Level Vertebral Cement Augmentation in Long-Segment Adult Spinal Deformity Surgery to Reduce the Incidence of Proximal Junctional Complications?

Background and Objectives: Proximal junctional kyphosis (PJK) and failure (PJF), the most prevalent complications following long-segment thoracolumbar fusions for adult spinal deformity (ASD), remain lacking in defined preventive measures. We studied whether one of the previously reported strategies with successful results—a prophylactic augmentation of the uppermost instrumented vertebra (UIV) and supra-adjacent vertebra to the UIV (UIV + 1) with polymethylmethacrylate (PMMA)—could also serve as a preventive measure of PJK/PJF in minimally invasive surgery (MIS). Materials and Methods: The study included 29 ASD patients who underwent a combination of minimally invasive lateral lumbar interbody fusion (MIS-LLIF) at L1-2 through L4-5, all-pedicle-screw instrumentation from the lower thoracic spine to the sacrum, S2-alar-iliac fixation, and two-level balloon-assisted PMMA vertebroplasty at the UIV and UIV + 1. Results: With a minimum 3-year follow-up, non-PJK/PJF group accounted for fifteen patients (52%), PJK for eight patients (28%), and PJF requiring surgical revision for six patients (21%). We had a total of seven patients with proximal junctional fracture, even though no patients showed implant/bone interface failure with screw pullout, probably through the effect of PMMA. In contrast to the PJK cohort, six PJF patients all had varying degrees of neurologic deficits from modified Frankel grade C to D3, which recovered to grades D3 and to grade D2 in three patients each, after a revision operation of proximal extension of instrumented fusion with or without neural decompression. None of the possible demographic and radiologic risk factors showed statistical differences between the non-PJK/PJF, PJK, and PJF groups. Conclusions: Compared with the traditional open surgical approach used in the previous studies with a positive result for the prophylactic two-level cement augmentation, the MIS procedures with substantial benefits to patients in terms of less access-related morbidity and less blood loss also provide a greater segmental stability, which, however, may have a negative effect on the development of PJK/PJF