|Division of Spine Surgery /
The Kobe University Orthopaedic Spine Surgery
division has three faculties, four graduate school students, and residents.
In our hospital, we treat severe complicated spinal diseases, including
tumors, scoliosis, and osteoporosis-associated spinal deformities,
working together with anesthesiologists, cardiologists, pediatricians,
radiologists, physiatrists, and co-medical staffs. We attempted to
find the best treatment strategy based on each patient's disease,
condition, and activity.
||▲Division of Spine
Recently, the number of our surgical cases is increasing up to approximately
300 cases/year, closely cooperating with neighboring hospitals. This
enables us to treat more patients surgically without long-period waiting.
We all continue to take on new challenges to rescue many patients
with spinal problems by optimal treatments.
The primary focus of our clinical studies is
to elucidate the natural course and prognosis of spinal diseases,
to clarify outcomes of surgical and non-surgical treatments, and
to develop new therapeutic devices and strategies.
We reported the natural course and predictive risk factors of cervical
spine instability in patients with rheumatoid arthritis, winning
a prestigious international award, the 2nd Clinical Research Paper
Award at the 43rd annual meeting of Cervical Spine Research Society
(San Diego, CA, 2015). We then performed a prospective follow-up
study of patients with spinal metastasis. Our reports describing
the outcomes and socioeconomic impacts of surgical treatment both
received the reputational Best Clinical Research Paper Award at
the 122nd and 125th meetings of the Central Japan Association of
Orthopaedic Surgery and Traumatology (Okayama, 2014 and Nagoya,
2015), respectively. In addition, our study regarding the efficacy
of an electronic conductivity device in severe syndromic scoliosis
surgery was selected as the Best Poster Award at the 49th annual
meeting of Japanese Scoliosis Society (Niigata, 2015). Furthermore,
we have multiple ongoing studies of spinal metastasis, intradural
tumors, and osteoporosis-induced vertebral fractures and kyphoscoliotic
For years, we are also developing a new, less-invasive treatment
device for lumbar spinal canal stenosis, a prototype of which was
previously reported internationally (Eur Spine J, 2012). After careful
basic trials of the device, we are ready to start the clinical trial
shortly. We continue clinical research to find the best practical
treatment for spinal diseases.
We are consistently conducting basic research for intervertebral
disc pathology. Our primary focus is to reveal the mechanism of
disc diseases and to provide insights into new biological therapy.
treatments of disc degeneration
The intervertebral disc a unique structure
consisting of the nucleus pulposus encapsulated by the annulus fibrosus
and endplates. The disc is the largest avascular organ in the body.
Therefore, additional nutrient deprivation associated with injury,
smoking, and/or aging is a suspected contributor to disc degeneration.
We studied biological agents, peptides, and proteins to reduce cellular
stress based on the anatomical characteristics and limited nutrition
of the disc-SIRT1 (Arthritis Res Ther, 2011, 2015), integrin antagonists
(Spine J, 2015), and adiponectin (J Orthop Surg Res, 2016). We are
testing these treatments in vivo for future clinical trials.
of disc degeneration
To study the disease mechanism and assess effects
of new biological treatments, the development of animal models is
essential. Mechanical loading is a major induction method to disc
degeneration. To mimic human spontaneous chronic disc degeneration,
we developed and reported a rat tail model of disc degeneration
induced by sustained static compression (J Orthop Res, 2010, 2011,
Arthritis Res Ther 2012, 2014). Furthermore, a modified version
of this model, better suited to observe earlier events of disc degeneration,
was also established (J Orthop Res 2014) and awarded the Best Basic
Research Paper Award at the 120th and meeting of the Central Japan
Association of Orthopaedic Surgery and Traumatology (Wakayama, 2013).
We have developed an ex-vivo dynamic compression model (Spine J,
2015) more recently in collaboration with Rush University (Chicago,
IL, USA), University of California San Diego (San Diego, CA, USA),
and Doshisha University (Kyoto, Japan). These animal models will
facilitate the future development of molecular treatments for disc
and immune privilege
We proposed the disc as an immune-privileged
site based on the anatomical feature and also the expression of
apoptosis-inducing Fas ligand in the nucleus pulposus (Spine [Phila
Pa 1976], 2002, 2004). We further clarified the interaction between
the nucleus pulposus and macrophages in an animal model of herniated
discs (Arthritis Rheum, 2012). Evidence regarding Fas ligand and
macrophage infiltration can provide useful information to understand
the pathophysiology of herniated disc disease. We are conducting
new studies to develop biological treatments.
|Division of Spine Surgery /
(1) Terashima Y, Kakutani K, Yurube T,
Takada T, Maeno K, Hirata H, Miyazaki S, Ito M, Kakiuchi Y, Takeoka
Y, Kuroda R, Nishida K. Expression of adiponectin receptors in human
and rat intervertebral disc cells and changes in receptor expression
during disc degeneration using a rat tail temporary static compression
model. J Orthop Surg Res 11(1):147, 2017.
Pohl PH, Lozito TP, Cuperman T, Yurube T, Moon HJ, Ngo K, Tuan RS,
Croix CS, Sowa GA, Rodrigues LM, Kang JD, Vo NV. Catabolic effects
of endothelial cell-derived microparticles on disc cells: Implications
in intervertebral disc neovascularization and degeneration. J Orthop
Res 34(8):1466-74, 2016.
(3) Miyazaki S, Kakutani K, Maeno K, Takada T, Yurube
T, Kurosaka M, Nishida K. Surgical debridement with retention of
spinal instrumentation and long-term antimicrobial therapy for multidrug-resistant
surgical site infections after spinal surgery: a case series. Int
Orthop 40(6):1171-7, 2016.
(4) Miyazaki S, Kakutani K, Yurube T, Maeno K, Takada
T, Zhang Z, Kurakawa T, Terashima Y, Ito M, Ueha T, Matsushita T,
Kuroda R, Kurosaka M, Nishida K. Recombinant human SIRT1 protects
against nutrient deprivation-induced mitochondrial apoptosis through
autophagy induction in human intervertebral disc nucleus pulposus
cells. Arthritis Res Ther 17:R253, 2015.
(5) Kurakawa T, Kakutani K, Morita Y, Kato Y, Yurube
T, Hirata H, Miyazaki S, Terashima Y, Maeno K, Takada T, Doita M,
Kurosaka M, Inoue N, Masuda K, Nishida K. Functional impact of integrin
α5β1 on the homeostasis of intervertebral discs: a study of mechanotransduction
pathways using a novel dynamic loading organ culture system. Spine
J 15(3):417-26, 2015.
(6) Hartman RA, Yurube T, Ngo K, Merzlak NE, Debski
RE, Brown BN, Kang JD, Sowa GA. Biological responses to flexion/extension
in spinal segments ex-vivo. J Orthop Res 33(8):1255-64, 2015.
(7) Pohl PHI, Tamaoki MJ, Rodrigues LM, Radcliff
KE, Yurube T, Kang JD, Belloti JC. Posterior surgical approach procedures
for cervical myelopathy (Protocol). Cochrane Database Syst Rev 2015
Issue 3, 2015.
(8) Yurube T, Sumi M, Nishida K, Miyamoto H, Kohyama
K, Matsubara T, Miura Y, Hirata H, Sugiyama D, Doita M. Accelerated
development of cervical spine instabilities in rheumatoid arthritis:
a prospective minimum 5-year cohort study. PLoS One 9(2):e88970,
(9) Yurube T, Hirata H, Kakutani K, Maeno K, Takada
T, Zhang Z, Takayama K, Matsushita T, Kuroda R, Kurosaka M, Nishida
K. Notochordal cell disappearance and modes of apoptotic cell death
in a rat tail static compression-induced disc degeneration model.
Arthritis Res Ther 16(1):R31, 2014.
(10) Moon HJ, Yurube T, Lozito TP, Pohl P, Hartman
RA, Sowa GA, Kang JD, Vo NV. Effects of secreted factors in culture
medium of annulus fibrosus cells on microvascular endothelial cells:
elucidating the possible pathomechanisms of matrix degradation and
nerve in-growth in disc degeneration. Osteoarthritis Cartilage 22(2):344-54,
(11) Hirata H, Yurube T, Kakutani K, Maeno K, Takada
T, Yamamoto J, Kurakawa T, Akisue T, Kuroda R, Kurosaka M, Nishida
K. A rat tail temporary static compression model reproduces different
stages of intervertebral disc degeneration with decreased notochordal
cell phenotype. J Orthop Res 32(3):455-63, 2014.
(12) Miyamoto H, Maeno K, Uno K, Kakutani K, Nishida
K, Sumi M. Outcomes of surgical intervention for cervical spondylotic
myelopathy accompanying local kyphosis (comparison between laminoplasty
alone and posterior reconstruction surgery using the screw-rod system).
Eur Spine J 23(2):341-46, 2014.
(13) Kakutani K, Doita M, Yoshikawa M, Okamoto K,
Maeno K, Yurube T, Sha N, Kurosaka M, Nishida K. C1 laminectomy
for retro-odontoid pseudotumor without atlantoaxial subluxation:
review of seven consecutive cases. Eur Spine J 22(5):1119-26, 2013.
(14) Nishida K, Kakutani K, Maeno K, Takada T, Yurube
T, Kuroda R, Kurosaka M. Efficacy of hemostasis for epidural venous
plexus and safety for neural structure using soft coagulation system
in spinal surgery: a laboratory investigation using a porcine model.
J Spinal Disord Tech 26(7):E281-5, 2013.
(15) Vo NV, Hartman RA, Yurube T, Jacobs LJ, Sowa
GA, Kang JD. Expression and regulation of metalloproteinases and
their inhibitors in intervertebral disc aging and degeneration.
Spine J 13(3):331-341, 2013.
(16) Yamamoto J, Maeno K, Takada T, Kakutani K,
Yurube T, Zhang Z, Hirata H, Kurakawa T, Sakai D, Mochida J, Doita
M, Kurosaka M, Nishida K. Fas ligand plays an important role for
the production of pro-inflammatory cytokines in intervertebral disc
nucleus pulposus cells. J Orthop Res 31(4):608-15, 2013.
(17) Fukuda K, Ozaki T, Tsumura N, Sengoku A, Nomi
M, Yanagiuchi A, Nishida K, Kuroda R, Iguchi T. Neurogenic bladder
associated with pure cervical spondylotic myelopathy: clinical characteristics
and recovery after surgery. Spine (Phila Pa 1976) 38(2):104-11,
(18) Yurube T, Sumi M, Nishida K, Miyamoto H, Kohyama
K, Matsubara T, Miura Y, Sugiyama D, Doita M. Incidence and aggravation
of cervical spine instabilities in rheumatoid arthritis: a prospective
minimum 5-year follow-up study of patients initially without cervical
involvement. Spine (Phila Pa 1976) 37(26):2136-2144, 2012.
(19) Iguchi T, Nishida K, Ozaki T, Kitagawa A, Tsumura
N, Kakutani K, Yurube T, Kuroda R. Grade three disc degeneration
is a critical stage for anterior spondylolisthesis in lumbar spine.
Eur Spine J 21(11):2134-2139, 2012.
(20) Yurube T, Takada T, Suzuki T, Kakutani K, Maeno
K, Doita M, Kurosaka M, Nishida K. Rat tail static compression model
mimics extracellular matrix metabolic imbalances of matrix metalloproteinases,
aggrecanases, and tissue inhibitors of metalloproteinases in intervertebral
disc degeneration. Arthritis Res Ther 14(2):R51, 2012.
(21) Takada T, Nishida K, Maeno K, Kakutani K, Yurube
T, Doita M, Kurosaka M. Intervertebral disc and macrophage interaction
induces mechanical hyperalgesia and cytokine production in a herniated
disc model in rats. Arthritis Rheum 64(8):2601-10, 2012.
(22) Nishida K, Doita M, Kakutani K, Maeno K, Yurube
T, Kurosaka M. Development of percutaneously insertable/removable
interspinous process spacer for treatment of posture-dependent lumbar
spinal-canal stenosis: preclinical feasibility study using porcine
model. Eur Spine J 21(6):1178-85, 2012.
(23) Hamamoto H, Miyamoto H, Doita M, Takada T,
Nishida K, Kurosaka M. Capability of nondegenerated and degenerated
discs in producing inflammatory agents with or without macrophage
interaction. Spine (Phila Pa 1976) 37(3):161-7, 2012.
(1) Kurosawa T, Yurube T, Kakutani K, Maeno K, Uno
K, Kurosaka M, Nishida K. Thoracic compression myelopathy due to
the progression of dystrophic scoliosis, the presence of a paraspinal
tumor, and high and excessive amplitude movement of the shoulder:
a case report of neurofibromatosis type 1. J Orthop Surg (Hong Kong)
(2) Takemori T, Kakutani K, Maeno K, Akisue T, Kurosaka
M, Nishida K. Symptomatic perineural cyst: report of two cases treated
with cyst-subarachnoid shunts. Eur Spine J 23(2):267-70, 2015.
(3) Tsutsumi N, Kojima Y, Nishida K, Maeno K, Kakutani
K, Kawakami F, Kanzawa M, Itoh T, Otsuki N, Nibu K. Surgical treatment
for recurrent solitary fibrous tumor invading atlas. Head Neck 36(11);E121-4,
(1) Kakutani K, Maeno K, Nishida K, Iwama
Y, Kurosaka M. Positron Emission Tomography Current Clinical and
Research Aspect, Durovic M(Ed.), ISBN; 978-953-307-824-3, 213-24,