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Dive into the research topics where Takahiko Tsutsui is active.

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Featured researches published by Takahiko Tsutsui.


The Journal of Medical Investigation | 2015

Foraminoplastic transforaminal percutaneous endoscopic discectomy at the lumbosacral junction under local anesthesia in an elite rugby player

Mitsunobu Abe; Yoichiro Takata; Kosaku Higashino; Toshinori Sakai; Tetsuya Matsuura; Naoto Suzue; Daisuke Hamada; Tomohiro Goto; Toshihiko Nishisho; Yuichiro Goda; Takahiko Tsutsui; Ichiro Tonogai; Ryo Miyagi; Masatoshi Morimoto; Kazuaki Mineta; Tetsuya Kimura; Shingo Hama; Tadahiro Higuchi; Subash C. Jha; Rui Takahashi; Shoji Fukuta; Koichi Sairyo

Percutaneous endoscopic discectomy (PED) is the least invasive disc surgery available at present. The procedure can be performed under local anesthesia and requires only an 8 mm skin incision. Furthermore, damage to the back muscle is considered minimal, which is particularly important for disc surgery in athletes. However, employing the transforaminal (TF) PED approach at the lumbosacral junction can be challenging due to anatomical constraints imposed by the iliac crest. In such cases, foraminoplasty is required in addition to the standard TF procedure. A 28-year-old man who was a very active rugby player visited us complaining of lower back and left leg pain. His visual analog scale (VAS) score for pain was 8/10 and 3/10, respectively. MRI revealed a herniated nucleus pulposus at L5-S level. TF-PED was planned; however, the anatomy of the iliac crest was later found to prevent access to the herniated mass. Foraminoplasty was therefore performed to enlarge the foramen, thereby allowing a cannula to be passed through the foramen into the canal without causing exiting nerve injury. The herniated mass was then successfully removed via the TF-PED procedure. Pain resolved after surgery, and his VAS score decreased to 0/10 for both back and leg pain. The patient returned to full rugby activity 8 weeks after surgery. In conclusion, even with an intracanalicular herniated mass at the lumbosacral junction, a TF-PED procedure is possible if additional foraminoplasty is adequately performed to enlarge the foramen.


The Journal of Medical Investigation | 2015

State-of-the-art ultrasonographic findings in lower extremity sports injuries

Naoto Suzue; Tetsuya Matsuura; Toshiyuki Iwame; Kosaku Higashino; Toshinori Sakai; Daisuke Hamada; Tomohiro Goto; Yoichiro Takata; Toshihiko Nishisho; Yuichiro Goda; Takahiko Tsutsui; Ichiro Tonogai; Ryo Miyagi; Mitsunobu Abe; Masatoshi Morimoto; Kazuaki Mineta; Tetsuya Kimura; Tadahiro Higuchi; Shingo Hama; Subash C. Jha; Rui Takahashi; Shoji Fukuta; Koichi Sairyo

Athletes sometimes experience overuse injuries. To diagnose these injuries, ultrasonography is often more useful than plain radiography, computed tomography (CT), or magnetic resonance imaging (MRI). Ultrasonography can show both bone and soft tissue from various angles as needed, providing great detail in many cases. In conditions such as osteochondrosis or enthesopathies such as Osgood-Schlatter disease, Sinding-Larsen-Johansson disease, bipartite patella, osteochondritis dissecans of the knee, painful accessory navicular,and jumpers knee, ultrasonography can reveal certain types of bony irregularities or neovascularization of the surrounding tissue. In patients of enthesopathy, ultrasonography can show the degenerative changes at the insertion of the tendon. Given its usefulness in treatment, ultrasonography is expected to become essential in the management of overuse injuries affecting the lower limb in athletes. J. Med. Invest. 62: 109-113, August, 2015.


Journal of Shoulder and Elbow Surgery | 2016

Tendon retraction with rotator cuff tear causes a decrease in cross-sectional area of the supraspinatus muscle on magnetic resonance imaging

Shoji Fukuta; Takahiko Tsutsui; Rui Amari; Keizo Wada; Koichi Sairyo

BACKGROUND Muscle atrophy and fatty degeneration of the rotator cuff muscles have been reported as negative prognostic indicators after rotator cuff repair. Although the Y-shaped view is widely used for measuring the cross-sectional area of the supraspinatus muscle, the contribution of retraction of the torn tendon as well as muscle atrophy must be considered. The purpose of this study was to clarify the relationship between cross-sectional area and tendon retraction or size of the tear. METHODS This study included 76 shoulders that were evaluated arthroscopically for the presence and size of tears. Cross-sectional areas of rotator cuff muscles were measured from the Y-shaped view to 3 more medial slices. The occupation ratio and tangent sign were evaluated on the Y-shaped view. The retraction of torn tendon was also measured on the oblique coronal images. RESULTS On the Y-shaped view, the cross-sectional area of the supraspinatus and the occupation ratio decreased in conjunction with the increase in tear size. A significant decrease in cross-sectional area was noted only in large and massive tears on more medial slices from the Y-shaped view. Significant decreases in the cross-sectional area of the infraspinatus were observed in large and massive tears on all images. A negative correlation was found between tendon retraction and cross-sectional area, which was strongest on the Y-shaped view. CONCLUSIONS To avoid the influence of retraction of the supraspinatus tendon, sufficient medial slices from the musculotendinous junction should be used for evaluation of muscle atrophy.


The Journal of Medical Investigation | 2015

Percutaneous Endoscopic Lumbar Discectomy for a Huge Herniated Disc Causing Acute Cauda Equina Syndrome: A Case Report

Subash C. Jha; Ichiro Tonogai; Yoichiro Takata; Toshinori Sakai; Kosaku Higashino; Tetsuya Matsuura; Naoto Suzue; Daisuke Hamada; Tomohiro Goto; Toshihiko Nishisho; Takahiko Tsutsui; Yuichiro Goda; Mitsunobu Abe; Kazuaki Mineta; Tetsuya Kimura; Shingo Hama; Tadahiro Higuchi; Shoji Fukuta; Koichi Sairyo

Microsurgery for lumbar disc herniation that requires surgical intervention has been well described. The methods vary from traditional open discectomy to minimally invasive techniques. All need adequate preanesthetic preparation of patients as general anesthesia is required for the procedure, and nerve monitoring is necessary to prevent iatrogenic nerve injury. Conventional surgical techniques sometimes require the removal of the corresponding lamina to assess the nerve root and herniated disc, and this may increase the risk for posterior instability of the vertebral body. Should this occur, fusion surgery may be needed, further increasing morbidity and cost. We present here a case of lumbar herniated disc fragments causing acute cauda equina syndrome that were endoscopically resected through a transforaminal approach in an awake patient under local anesthesia. Percutaneous endoscopic discectomy under local anesthesia proved to be a better alternative to open back surgery as it made immediate intervention possible, was associated with fewer perioperative complications and morbidity, minimized soft tissue damage, and allowed early rehabilitation with a better outcome and greater patient satisfaction. In addition to these advantages, percutaneous endoscopic discectomy protects other approaches that may be needed in subsequent surgeries, whether open or minimally invasive.


The Journal of Medical Investigation | 2015

State of the art: Intraoperative neuromonitoring in spinal deformity surgery

Yoichiro Takata; Toshinori Sakai; Kosaku Higashino; Tetsuya Matsuura; Naoto Suzue; Daisuke Hamada; Tomohiro Goto; Toshihiko Nishisho; Takahiko Tsutsui; Yuichiro Goda; Masatoshi Morimoto; Mitsunobu Abe; Kazuaki Mineta; Tetsuya Kimura; Shingo Hama; Tadahiro Higuchi; Subash C. Jha; Rui Takahashi; Shoji Fukuta; Koichi Sairyo

Application of deformity correction spinal surgery has increased substantially over the past three decades in parallel with improvements in surgical techniques. Intraoperative neuromonitoring (IOM) techniques,including somatosensory evoked potentials (SEPs), muscle evoked potentials (MEPs), and spontaneous electromyography (free-run EMG), have also improved surgical outcome by reducing the risk of iatrogenic neural injury. In this article, we review IOM techniques and their applications in spinal deformity surgery. We also summarize results of selected studies including hundreds of spinal correction surgeries. These studies indicate that multimodal IOM of both motor and sensory responses is superior to either modality alone for reducing the incidence of neural injury during surgery. J. Med. Invest. 62: 103-108, August, 2015.


Case reports in orthopedics | 2014

Retrograde intramedullary nailing with a blocking pin technique for reduction of periprosthetic supracondylar femoral fracture after total knee arthroplasty: technical note with a compatibility chart of the nail to femoral component.

Ichiro Tonogai; Daisuke Hamada; Tomohiro Goto; Tomoya Takasago; Takahiko Tsutsui; Naoto Suzue; Tetsuya Matsuura; Koichi Sairyo

Periprosthetic fractures after total knee arthroplasty (TKA) present a clear management challenge, and retrograde intramedullary nails have recently gained widespread acceptance in treatment of these fractures. In two cases, we found a blocking screw technique, first reported by Krettek et al., was useful in the reduction of the fractures. Both patients attained preinjury mobility after intramedullary nailing. Moreover, we present a chart summarizing the notch designs of various femoral components because some prosthetic knee designs are not amenable to retrograde nailing. We hope this will be helpful in determining indications for retrograde nailing in periprosthetic fractures after TKA.


Case reports in orthopedics | 2014

Intrapelvic Migration of the Lag Screw in Intramedullary Nailing

Tomoya Takasago; Tomohiro Goto; Shunichi Toki; Daisuke Hamada; Shinji Yoshioka; Ichiro Tonogai; Takahiko Tsutsui; Yasuaki Tamaki; Keizo Wada; Koichi Sairyo

Internal fixation with intramedullary devices has gained popularity for the treatment of intertrochanteric femoral fractures, which are common injuries in the elderly. The most common complications are lag screw cut out from the femoral head and femoral fracture at the distal tip of the nail. We report here a rare complication of postoperative lag screw migration into the pelvis with no trauma. The patient was subsequently treated with lag screw removal and revision surgery with total hip arthroplasty. This case demonstrated that optimal fracture reduction and positioning of the lag screw are the most important surgical steps for decreasing the risk of medial migration of the lag screw. Furthermore, to prevent complications, careful attention should be paid to subsequent steps such as precise insertion of the set screw.


The Journal of Medical Investigation | 2015

A review of the pathomechanism of forward slippage in pediatric spondylolysis : The Tokushima theory of growth plate slippage

Koichi Sairyo; Akihiro Nagamachi; Tetsuya Matsuura; Kosaku Higashino; Toshinori Sakai; Naoto Suzue; Daisuke Hamada; Yoichiro Takata; Tomohiro Goto; Toshihiko Nishisho; Yuichiro Goda; Takahiko Tsutsui; Ichiro Tonogai; Ryo Miyagi; Mitsunobu Abe; Masatoshi Morimoto; Kazuaki Mineta; Tetsuya Kimura; Tadahiro Higuchi; Shingo Hama; Subash C. Jha; Rui Takahashi; Shoji Fukuta

Spondylolysis is a stress fracture of the pars interarticularis, which in some cases progresses to spondylolisthesis (forward slippage of the vertebral body). This slip progression is prevalent in children and occurs very rarely after spinal maturation. The pathomechanism and predilection for children remains controversial despite considerable clinical and basic research into the disorder over the last three decades. Here we review the pathomechanism of spondylolytic spondylolisthesis in children and adolescents, and specifically the Tokushima theory of growth plate slippage developed from our extensive research findings. Clinically, we have observed the slippage site near the growth plate on MRI; then, using fresh cadaveric spines, we found the weakest link against forward shear loading was the growth plate. We subsequently developed an immature rat model showing forward slippage after growth plate injury. Moreover, finite element analysis of the pediatric spine clearly showed increased mechanical stress at the growth plate in the spondylolytic pediatric spine model compared with the intact pediatric spine. Thus, spondylolysis progresses to spondylolisthesis (forward slippage) in children and adolescents with the growth plate as the site of the slippage. Repetitive mechanical loading on to the growth plate may serve to separate the growth plate and subsequently progress to spondylolisthesis.


Journal of orthopaedic surgery | 2015

Double arthroscopic transtendon repair of partial-thickness articular surface tears of the rotator cuff: a surgical technique

Shoji Fukuta; Rui Amari; Takahiko Tsutsui

This study describes a technique of simultaneous arthroscopy and bursoscopy for transtendon repair of a partial-thickness articular surface rotator cuff tear. All procedures are under simultaneous visualisation from both the glenohumeral joint and the subacromial space to reduce the risk of intraoperative complications.


The Journal of Medical Investigation | 2016

Optimizing baseplate position in reverse total shoulder arthroplasty in small-sized Japanese females: technical notes and literature review

Subash C. Jha; Shoji Fukuta; Keizo Wada; Kosaku Higasino; Rui Amari-Kita; Takahiko Tsutsui; Tomohiro Goto; Daisuke Hamada; Naoto Suzue; Tetsuya Matsuura; Toshihiko Nishisho; Mitsunobu Abe; Yoichiro Takata; Toshinori Sakai; Akihiro Nagamachi; Koichi Sairyo

The management of cuff tear arthropathy (CTA) has always been a challenge for shoulder surgeons. Introduction of reverse total shoulder arthroplasty (RTSA) helped in providing pain relief and improved shoulder function in patients with CTA. In this study, we aimed to evaluate the short-term clinical results and some clinical details regarding the types of available prosthesis, positioning, and size of the components for RTSA in a population of short-stature female Japanese. In our seven cases, the average glenoid size was 23.9 mm in width and 34.2 mm in height. The average width was smaller than the size of all available baseplates. We implanted reverse shoulder prostheses with baseplate that measured 28 mm in diameter and two locking screws. The center of the baseplate was shifted to allow slight anterior overhang relative to the anatomical center to avoid breakage of the posterior cortex and to achieve firm fixation. One case of humeral shaft fracture occurred while inserting the humeral stem and required encircling wiring. In our experience, the short term clinical results of RTSA were excellent, but a new prosthesis that is designed to fit the short stature of Asians with smaller glenoid and humerus should be considered.

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Naoto Suzue

University of Tokushima

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Keizo Wada

University of Tokushima

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Shoji Fukuta

University of Tokushima

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