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1.
Global Spine J ; : 21925682231182333, 2023 Jun 09.
Artículo en Inglés | MEDLINE | ID: mdl-37293863

RESUMEN

STUDY DESIGN: Multicenter prospective study. OBJECTIVE: Patients with central sensitization (CS) are reported to be at high risk of poor outcomes after spinal surgery. However, the influence of CS on surgical outcomes for lumbar disc herniation (LDH) remains unknown. This study aimed to examine the association between preoperative CS and surgical outcomes in LDH patients. METHODS: A total of 100 consecutive patients with LDH (mean age 51.2) who underwent lumbar surgery were included in this study. The extent of CS was evaluated using the central sensitization inventory (CSI), a screening tool for CS-related symptoms. The patients completed the following CSI and clinical outcome assessments (COAs) preoperatively and 12 months postoperatively: the Japanese Orthopaedic Association (JOA) score for back pain, JOA back pain evaluation questionnaire (JOABPEQ), and Oswestry Disability Index (ODI). The association between preoperative CSI scores, and preoperative and postoperative COAs was analyzed, and the postoperative changes were statistically evaluated. RESULTS: The preoperative CSI score significantly decreased 12 months postoperatively. Preoperative CSI scores showed a significant correlation with most COAs; however, a significant correlation was only identified in the social function and mental health domains of JOABPEC postoperatively. Higher preoperative CSI showed worse preoperative COAs; however, all COAs significantly improved regardless of CSI severity. There were no significant differences in any COAs among the CSI severity groups 12 months postoperatively. CONCLUSIONS: The results of this study showed that lumbar surgeries significantly improved the COAs regardless of preoperative severity of CS in patients with LDH.

2.
Eur Spine J ; 32(12): 4200-4209, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37010610

RESUMEN

PURPOSE: The impact of central sensitization (CS) on neurological symptoms and surgical outcomes in patients with lumbar spinal stenosis (LSS) remains unknown. This study aimed to investigate the influence of preoperative CS on the surgical outcomes of patients with LSS. METHODS: A total of 197 consecutive patients with LSS (mean age 69.3) who underwent posterior decompression surgery with or without fusion were included in this study. The participants completed the CS inventory (CSI) scores and the following clinical outcome assessments (COAs) preoperatively and 12 months postoperatively: the Japanese Orthopaedic Association (JOA) score for back pain, JOA back pain evaluation questionnaire, and Oswestry Disability Index (ODI). The association between preoperative CSI scores and preoperative and postoperative COAs was analyzed, and postoperative changes were statistically evaluated. RESULTS: The preoperative CSI score significantly decreased at 12 months postoperatively and was significantly correlated with all COAs preoperatively and 12 months postoperatively. Higher preoperative CSI showed worse postoperative COAs and inferior postoperative improvement rates in the JOA score, VAS score for neurological symptoms, and ODI. Multiple regression analysis demonstrated that preoperative CSI was significantly associated with postoperative low back pain (LBP), mental health, quality of life (QOL), and neurological symptoms at 12 months postoperatively. CONCLUSIONS: Preoperative CS evaluated by CSI had a significantly worse impact on surgical outcomes, including neurological symptoms, disability, and QOL, especially related to LBP and psychological factors. CSI can be used clinically as a patient-reported measure for predicting postoperative outcomes in patients with LSS.


Asunto(s)
Dolor de la Región Lumbar , Estenosis Espinal , Humanos , Anciano , Resultado del Tratamiento , Estudios Prospectivos , Calidad de Vida , Descompresión Quirúrgica/efectos adversos , Estenosis Espinal/complicaciones , Estenosis Espinal/cirugía , Estenosis Espinal/diagnóstico , Sensibilización del Sistema Nervioso Central , Vértebras Lumbares/cirugía , Dolor de la Región Lumbar/cirugía , Dolor de la Región Lumbar/complicaciones
3.
Global Spine J ; 13(7): 1716-1727, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34672835

RESUMEN

STUDY DESIGN: This study is a retrospective review. OBJECTIVE: Central sensitization (CS) is a neurological phenomenon that involves hypersensitivity of the central nervous system. The central sensitization inventory (CSI) was developed as a screening tool to assess CS-related symptoms. The purpose of this study was to evaluate the association of preoperative CSI scores with patient-reported outcome measures (PROMs) including neurological symptoms for patients who underwent spine surgeries in a multicenter study. METHODS: A consecutive 673 patients who underwent spine surgery at 8 different institutions were included in this study. Preoperative CSI scores were assessed for all subjects. The participants completed the following PROMs: the Oswestry Disability Index (ODI), the Japanese Orthopaedic Association (JOA) back pain evaluation questionnaire (JOABPEQ) for lumbar spinal diseases, and the JOA cervical myelopathy evaluation questionnaire (JOACMEQ) for cervical spinal diseases. The association of CSI scores with PROMs was statistically evaluated. RESULTS: The average CSI score for the total subjects was 23.6 ± 13.5. The subjects with CS-related symptoms (CSI ≥ 40) were 13.2% (n = 89). The CSI score showed a significant and weak-to-moderate correlation with the PROMs including neurological symptoms that included all the domains of the JOACMEQ for cervical spinal diseases, and JOABPEQ and ODI for lumbar spinal diseases. Among these, psychological factors had the most influence on the correlation with CSI score. CONCLUSION: Central sensitization evaluated by the CSI is related to neurological symptoms and health-related quality of life in patients undergoing elective spine surgery.

4.
Global Spine J ; : 21925682221139813, 2022 Nov 09.
Artículo en Inglés | MEDLINE | ID: mdl-36350595

RESUMEN

STUDY DESIGN: Multicenter prospective study. OBJECTIVE: The influence of central sensitization (CS) on neurological symptoms and surgical outcomes in patients with degenerative cervical myelopathy (DCM) remains unknown. This study aimed to investigate the effects of preoperative CS on surgical outcomes of patients with DCM following posterior decompression surgery. METHODS: 77 consecutive patients with DCM (mean age 67.1) who received posterior decompression surgery were included in this study. The participants completed CS inventory (CSI) scores and the following patient-reported outcome measures (PROMs) preoperatively and 12 months postoperatively: the Japanese Orthopaedic Association (JOA) score for cervical myelopathy and JOA cervical myelopathy evaluation questionnaire (JOACMEQ) for cervical spinal diseases. The association of preoperative CSI scores with preoperative and postoperative PROMs was analyzed, and their changes were statistically evaluated. RESULTS: The preoperative CSI score was significantly decreased at 12 months postoperatively, and it was significantly associated with the JOA score and JOACMEQ preoperatively and at 12 months postoperatively. However, no significant association was observed between preoperative CSI and the postoperative change of any PROMs at 12 months. The posterior decompression surgery significantly improved the JOA scores and 'lower extremity function' and 'quality of life (QOL)' domains of the JOACMEQ, independent of the severity of preoperative CSI score. Multiple regression analysis demonstrated that preoperative CSI was significantly associated with the 'QOL' domain of JOACMEQ and original JOA score at 12 months postoperatively. CONCLUSION: The CSI score can be an auxiliary indicator of surgical outcomes of patients with DCM following posterior decompression surgery.

5.
J Med Case Rep ; 9: 52, 2015 Mar 06.
Artículo en Inglés | MEDLINE | ID: mdl-25889111

RESUMEN

INTRODUCTION: Intraosseous lipoma is a benign bone tumor, and the tumor occurs more frequently in the lower extremities. We present a very rare case of intraosseous lipoma occurring in the lumbar vertebral arch and spinous process. CASE PRESENTATION: A 54-year-old Japanese man presented with a three-month history of lumbar pain. Magnetic resonance imaging of the L3 vertebral arch and spinous process revealed high intensity on T1- and T2-weighted imaging, and it was suppressed on fat-suppression imaging and no enhancement showed on gadolinium contrast-enhanced imaging. Computed tomography imaging revealed an osteolytic change accompanied by marginal osteosclerosis in his third lumbar vertebral arch and spinous process, as well as a thinned and bulging bone cortex. An analgesic had been administered prior to his visit, but low back pain had persisted, so we performed curettage and filled the defect with hydroxyapatite bone. His low back pain was improved immediately after surgery, and no recurrence of tumor has been observed on computed tomography imaging as of three years postoperatively. CONCLUSIONS: Symptomatic intraosseous lipoma of spine is very rare, but the patient may be surgically well-treated by curettage and reconstruction of the benign tumor.


Asunto(s)
Lipoma/cirugía , Vértebras Lumbares/cirugía , Neoplasias de la Columna Vertebral/cirugía , Materiales Biocompatibles , Legrado/métodos , Durapatita , Humanos , Lipoma/diagnóstico , Vértebras Lumbares/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neoplasias de la Columna Vertebral/diagnóstico , Tomografía Computarizada por Rayos X
6.
Open Orthop J ; 6: 239-44, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22848336

RESUMEN

The internal fixing materials made from shape-memory alloys (SMAs) have recently been reported for long bone fracture. We present a new internal fixation technique using a cylindrical SMAs implant in a rat femoral fracture healing. The implant was designed in a shape to circumferentially fix the fractured bone using resilient SMA claws. To evaluate the fixing ability of the implant, three-point bending and rotation tests were performed. Fifteen female Wister rats were treated surgically as an experimental model. All rats were killed at 16 weeks postoperatively, and the radiological and histological evaluations were performed. In biomechanical test, the good fixation ability of the implant was demonstrated. In animal model, no cases of postoperative infection or death were encountered and postoperative gait was stable in all cases. Radiological examination at 16 weeks postoperatively demonstrated the implant firmly fixed to the fractured part, endosteal healing, and no callus formation in all cases. In Histological evaluation, bone union in all cases was characterized by endochondral ossification from within the medullary cavity. In conclusion, our cylindrical SMA implant provided good fixation in biomechanical tests, and achieved bone union in all 15 rats. If a larger size is designed in the future, our implant will be a clinically applicable, useful fixing material for fracture of the human long bones.

7.
J Orthop Surg (Hong Kong) ; 17(2): 187-9, 2009 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-19721149

RESUMEN

PURPOSE: To determine characteristics responsible for improvement of low back pain after cervical laminoplasty for cervical spondylotic myelopathy. METHODS: 18 men and 10 women aged 38 to 88 (mean, 71) years who had a low back pain visual analogue scale (VAS) score of 5 or more before cervical laminoplasty were included. In 12 patients the VAS score improved to 1 or <1 after surgery and remained so at 2 years, but in 16 it remained unimproved. Patient characteristics of the 2 groups were compared. RESULTS: Preoperatively, 11 of the 12 patients with improved VAS score had continuous low back pain all day, compared to 3 of the 16 who remained unimproved (p<0.01). CONCLUSION: In some patients, low back pain may be improved following cervical laminoplasty.


Asunto(s)
Vértebras Cervicales/cirugía , Laminectomía/métodos , Dolor de la Región Lumbar/cirugía , Espondilosis/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Dolor de la Región Lumbar/fisiopatología , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Espondilosis/fisiopatología , Resultado del Tratamiento
8.
Spine (Phila Pa 1976) ; 34(9): E337-41, 2009 Apr 20.
Artículo en Inglés | MEDLINE | ID: mdl-19531990

RESUMEN

STUDY DESIGN: A case of primary Ewing sarcoma of the lumbar spine is presented. OBJECTIVE: To present and review a rare case of primary Ewing sarcoma of the lumbar spine that required differentiation from spinal infection. SUMMARY OF BACKGROUND DATA: Primary Ewing sarcoma originating from the spinal column is very rare. Because Ewing sarcoma is one of the most aggressive bone tumors with high proliferative and invasive potential, its clinical symptoms and variety of imaging manifestations can mimic the pathologic findings of other diseases, including infectious diseases. METHODS: The clinical course, radiologic features, pathology and treatment outcome of a patient with primary Ewing sarcoma of the lumbar spine was documented. RESULTS: The magnetic resonance imaging findings showed an abnormal marrow signal at the L2 vertebra and significant enlargement of the unilateral iliopsoas muscle. Immunologic and molecular analysis of the surgical specimen provided a diagnosis of Ewing sarcoma. Laminotomy followed by multidisciplinary therapy including chemotherapy and radiation therapy was effective for treating this case. CONCLUSION: We report a case of Ewing sarcoma that mimicked a psoas abscess secondary to spinal infection. Abnormal magnetic resonance imaging images, as well as a confusing clinical course, made diagnosis difficult. When enlargement of the iliopsoas with a vertebral lesion is detected in a child with low back pain, Ewing sarcoma should be included in the differential diagnosis.


Asunto(s)
Absceso del Psoas/diagnóstico , Sarcoma de Ewing/diagnóstico , Enfermedades de la Columna Vertebral/diagnóstico , Neoplasias de la Columna Vertebral/diagnóstico , Niño , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Masculino , Absceso del Psoas/etiología , Enfermedades de la Columna Vertebral/complicaciones
9.
BMC Musculoskelet Disord ; 10: 4, 2009 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-19144120

RESUMEN

BACKGROUND: X-ray images of lumbar degenerative diseases often show not only claw osteophytes, but also pairs of osteophytes that form in a direction away from the adjacent disc. We have investigated the direction of the formation of anterior lumbar vertebral osteophytes across the lumbar vertebrae using a sufficient number of lumbar radiographs, because osteophytes images can provide essential information that will contribute to the understanding of the pathology and progress of lumbar spine degeneration. METHODS: The direction of the formation of 14,250 pairs of anterior lumbar vertebral osteophytes across the adjacent intervertebral discs in 2,850 patients who were all over 60 years old was investigated. Anterior lumbar vertebral osteophytes were distributed into six groups based on the direction of extension of each pair of osteophytes across the intervertebral disc space. RESULTS: In L1-L2 and L2-L3, the number of patients classified into groups B (the pair of osteophytes extended in the direction of the adjacent disc) and C (almost complete bone bridge formation by a pair of osteophytes across the intervertebral disc space) was larger than that classified into group D (the pair of osteophytes extended in a direction away from the adjacent disc). In L3-L4, L4-L5 and L5-S1, the number of patients in group D was greater than that of patients belonging to groups B and C. CONCLUSION: Our study showed that pairs of osteophytes frequently formed in the direction of the adjacent disc in the upper lumbar vertebrae (L1-L2 and L2-L3) and in the direction away from the adjacent disc in middle or lower lumbar vertebrae (L3-L4, L4-L5, and L5-S1).


Asunto(s)
Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/patología , Osteofito/diagnóstico por imagen , Osteofito/patología , Osteofitosis Vertebral/diagnóstico por imagen , Osteofitosis Vertebral/patología , Anciano , Anciano de 80 o más Años , Progresión de la Enfermedad , Femenino , Humanos , Disco Intervertebral/diagnóstico por imagen , Disco Intervertebral/patología , Disco Intervertebral/fisiopatología , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/patología , Desplazamiento del Disco Intervertebral/fisiopatología , Vértebras Lumbares/fisiopatología , Masculino , Persona de Mediana Edad , Osteofito/fisiopatología , Radiografía/métodos , Rango del Movimiento Articular/fisiología , Osteofitosis Vertebral/fisiopatología , Estenosis Espinal/complicaciones , Estenosis Espinal/patología , Estenosis Espinal/fisiopatología , Espondilosis/complicaciones , Espondilosis/patología , Espondilosis/fisiopatología
10.
Spine (Phila Pa 1976) ; 33(2): E62-5, 2008 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-18197093

RESUMEN

STUDY DESIGN: A case of thoracic myelopathy with alkaptonuria (ochronotic spondyloarthropathy) is presented. OBJECTIVE: To present and review the first reported case of an alkaptonuric patient with concomitant thoracic myelopathy. SUMMARY OF BACKGROUND DATA: Alkaptonuria, a rare hereditary metabolic disease, is characterized by accumulation of homogentistic acid, ochronosis, and destruction of connective tissue resulting in degenerative spondylosis and arthritis. Despite the high incidence of intervertebral disc diseases among patients with alkaptonuria, neurologic symptoms caused by spinal disease are rare. Thoracic myelopathy in a patient with alkaptonuria has not been previously reported. METHODS: The clinical course, radiologic features, pathology, and treatment outcome of an alkaptonuria patient with thoracic myelopathy was documented. RESULTS: Myelopathy of the patient was caused by rupture of a thoracic intervertebral disc. The neurologic symptoms of the patient were markedly improved after surgery. CONCLUSION: We have reported for the first time, that an alkaptonuria patient showed thoracic myelopathy caused by rupture of a thoracic intervertebral disc. Decompression followed by the instrumented fusion of the thoracic spine was effective for improving the neurologic symptoms.


Asunto(s)
Alcaptonuria/diagnóstico , Desplazamiento del Disco Intervertebral/patología , Disco Intervertebral/patología , Enfermedades de la Médula Espinal/diagnóstico , Vértebras Torácicas/patología , Anciano , Alcaptonuria/complicaciones , Alcaptonuria/terapia , Descompresión Quirúrgica , Humanos , Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/etiología , Desplazamiento del Disco Intervertebral/cirugía , Imagen por Resonancia Magnética , Masculino , Ocronosis/etiología , Ocronosis/patología , Médula Espinal/patología , Médula Espinal/cirugía , Enfermedades de la Médula Espinal/complicaciones , Enfermedades de la Médula Espinal/cirugía , Fusión Vertebral , Resultado del Tratamiento
11.
Phys Ther ; 86(12): 1661-7, 2006 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-17033040

RESUMEN

BACKGROUND AND PURPOSE: Although many studies have described clinical examination measures for the diagnosis of lumbar spinal instability, few of them have investigated the sensitivity and specificity of the measures that were used. The authors devised a passive lumbar extension (PLE) test for assessing lumbar spinal instability. The purpose of this study was to investigate the sensitivity, specificity, and positive likelihood ratio of this test. SUBJECTS AND METHODS: The PLE test as well as the instability catch sign, painful catch sign, and apprehension sign tests were done for 122 subjects with lumbar degenerative diseases. The subjects were divided into 2 groups-instability positive and instability negative-on the basis of findings on flexion-extension films of the lumbar spine. The sensitivity, specificity, predictive values, and positive likelihood ratio of each test were investigated. RESULTS: The sensitivity and specificity of the PLE test were 84.2% and 90.4%, respectively. These values were higher than those of other signs. The positive likelihood ratio of the PLE test was 8.84 (95% confidence interval=4.51-17.33). DISCUSSION AND CONCLUSION: The PLE test is an effective method for examining patients for lumbar spinal instability and can be performed easily in an outpatient clinic.


Asunto(s)
Vértebras Lumbares/diagnóstico por imagen , Estenosis Espinal/clasificación , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Sensibilidad y Especificidad , Estenosis Espinal/diagnóstico , Estenosis Espinal/diagnóstico por imagen
12.
Spine (Phila Pa 1976) ; 31(17): 1981-2, 2006 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-16924217

RESUMEN

STUDY DESIGN: A retrospective study. OBJECTIVE: To examine the frequency and current status of the incidence of deaths by suicide of patients with spinal diseases during hospitalization. SUMMARY OF BACKGROUND DATA: It was reported that most cases of deaths by suicide during hospitalization were patients admitted to the psychiatric ward. There were no reports to the incidence of death by suicide during hospitalization in patients with spinal diseases. METHODS: Of 69,861 patients admitted to the Department of Orthopedics of 28 affiliated hospitals of our university between September 1997 and August 2002, 14,987 patients with spinal diseases were targeted for this study. We examined the number of deaths by suicide during hospitalization. RESULTS: Of the 14,987 patients with spinal diseases, there were 5 deaths (0.03%) by suicide during hospitalization. There were no deaths by suicide in 54,874 patients with orthopedic diseases other than spinal diseases. CONCLUSION: In the treatment of patients with spinal diseases, it seemed important for spinal surgeons to provide comprehensive treatment for the whole patient by paying attention to the relationship between a patient and a physician, in particular, by carefully observing the psychologic status of a patient.


Asunto(s)
Hospitalización/estadística & datos numéricos , Enfermedades de la Columna Vertebral/psicología , Enfermedades de la Columna Vertebral/cirugía , Suicidio/estadística & datos numéricos , Adulto , Anciano , Antidepresivos/uso terapéutico , Ansiedad/etiología , Depresión/tratamiento farmacológico , Depresión/etiología , Miedo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/psicología , Estudios Retrospectivos
13.
Eur Spine J ; 15(7): 1103-7, 2006 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-16308723

RESUMEN

The purpose of the present study was to clarify changes in the psychological state of mothers of patients with idiopathic scoliosis, and to clarify relationships between the psychological states of the mothers and patients. The Maudsley personality inventory (MPI) was administered to 30 patients with idiopathic scoliosis who underwent surgery and their mothers preoperatively and at about 1 year postoperatively. We investigated the relationships between preoperative MPI scores and postoperative scores in patients and their mothers, respectively, and the relationships between MPI scores for patients and mothers. The results of the present study revealed that patients became more extroverted following surgery, while mothers displayed reduced neurotic tendencies. In conclusion, the mothers of patients who undergo corrective treatment for scoliosis may have experienced a substantial psychological burden before surgery, and doctors who treat patients with scoliosis should bear this point in mind.


Asunto(s)
Madres/psicología , Pruebas Psicológicas , Escoliosis/psicología , Escoliosis/cirugía , Adulto , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Periodo Posoperatorio , Cuidados Preoperatorios , Escoliosis/fisiopatología , Factores de Tiempo
14.
Orthopedics ; 28(8): 790-2, 2005 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-16119745

RESUMEN

We devised a new leg reposition test, to assess gait and balance in patients with spinal diseases. This study included 344 patients who were scheduled to undergo spine surgery; 14 (4.1%) patients showed positive results. These 14 patients had worse gait status than leg reposition test-negative patients both preoperatively and postoperatively. The leg reposition test is a simple procedure, and requires no specialized equipment. This study showed that the leg reposition test has a strong relation with gait status, and therefore a high clinical significance regarding the assessment of preoperative gait and balance and prediction of postoperative gait status.


Asunto(s)
Trastornos Neurológicos de la Marcha/diagnóstico , Marcha , Examen Físico/métodos , Equilibrio Postural , Enfermedades de la Columna Vertebral/cirugía , Adolescente , Adulto , Anciano , Niño , Femenino , Trastornos Neurológicos de la Marcha/etiología , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/efectos adversos , Cuidados Preoperatorios , Enfermedades de la Columna Vertebral/diagnóstico , Enfermedades de la Columna Vertebral/fisiopatología , Columna Vertebral/cirugía
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