Age-stratified analysis of temporomandibular joint osteoarthritis using cone-beam computed tomography.

Purpose: This study aimed to evaluate age-stratified radiographic features in temporomandibular joint osteoarthritis using cone-beam computed tomography. Materials and Methods: In total, 210 joints from 183 patients (144 females, 39 males, ranging from 12 to 88 years old with a mean age of 44.75±19.97 years) diagnosed with temporomandibular joint osteoarthritis were stratified by age. Mandibular condyle position and bony changes (flattening, erosion, osteophytes, subchondral sclerosis, and subchondral pseudocysts in both the condyle and articular eminence, thickening of the glenoid fossa, joint space narrowing, and joint loose bodies) were evaluated through cone-beam computed tomography. After adjusting for sex, the association between age groups and radiographic findings was analyzed using both a multiple regression model and a multinomial logistic regression model (α=0.05). Results: The prevalence of joint space narrowing and protruded condyle position in the glenoid fossa significantly increased with age (P<0.05). The risks of bony changes, including osteophytes and subchondral pseudocysts in the condyle; flattening, erosion, osteophyte, and subchondral sclerosis in the articular eminence; joint loose bodies; and thickening of the glenoid fossa, also significantly rose with increasing age (P<0.05). The number of radiographic findings increased with age; in particular, the increase was more pronounced in the temporal bone than in the mandibular condyle (P<0.05). Conclusion: Increasing age was associated with a higher frequency and greater diversity of bony changes in the temporal bone, as well as a protruded condyle position in the glenoid fossa, resulting in noticeable joint space narrowing in temporomandibular joint osteoarthritis.

Compensatory latency time delays during consecutive perturbations in older adults with and without kinesiophobia.

BACKGROUND: Fear of movement has been related to lower limb activation patterns in older adults. However, insight into consecutive perturbations on stepping strategy while considering fall-related confidence is unknown. RESEARCH QUESTION: Are there latency time delays following three consecutive slip perturbations between subjects with and without kinesiophobia when considering limb dominance and fall efficacy differences? METHODS: There were 15 older adults with kinesiophobia and 15 age- and body mass index (BMI)-matched control subjects. The subjects stood on the platform during three consecutive perturbations (250, 300, and 400 msec excursions), which were produced by a Bertec device. The subjects completed questionnaires to evaluate the psychological features of their fall-related fear (Tampa Scale for Kinesiophobia: TSK) as well as the modified fall efficacy scale (FES). The latency times (msec) measured the time it took for a subject to respond to a translation. RESULTS: Overall, the results of the FES demonstrated a moderate negative association with the TSK (r = -0.52, p = 0.004). There was a significant group difference for the FES (t = 2.78, p = 0.01). The FES demonstrated significant positive correlation coefficients (ranging from 0.40 to 0.51) and significant negative correlation coefficients (ranging from -0.41 to -0.61), except for the slow perturbations. The groups demonstrated a significant interaction on consecutive latency times and limb side (F = 5.84, p = 0.02). The latency time during the fast perturbations on the dominant limb (F = 5.53, p = 0.02) was significantly shorter in the kinesiophobia group. SIGNIFICANCE: The control group demonstrated confidence during fall-related activities, but the latency times were significantly different between groups when considering the dominant limb following repeated slip perturbations. The kinesiophobia group demonstrated shorter latency times on the dominant limb to protect against potential fall-risks from perturbations. The group interactions on limb side and consecutive perturbations need to be considered with fall-related confidence and improved standing balance in older adults with kinesiophobia.

Nationwide sample data analysis of additional surgery rate after anterior or posterior cervical spinal surgery.

Surgical outcomes of degenerative cervical spinal disease are dependent on the selection of surgical techniques. Although a standardized decision cannot be made in an actual clinical setting, continued education is provided to standardize the medical practice among surgeons. Therefore, it is necessary to supervise and regularly update overall surgical outcomes. This study aimed to compare the rate of additional surgery between anterior and posterior surgeries for degenerative cervical spinal disease using the National Health Insurance Service-National Sample Cohort (NHIS-NSC) nationwide patient database. The NHIS-NSC is a population-based cohort with about a million participants. This retrospective cohort study included 741 adult patients (> 18 years) who underwent their first cervical spinal surgery for degenerative cervical spinal disease. The median follow-up period was 7.3 years. An event was defined as the registration of any type of cervical spinal surgery during the follow-up period. Event-free survival analysis was used for outcome analysis, and the following factors were used as covariates for adjustment: location of disease, sex, age, type of insurance, disability, type of hospital, Charles comorbidity Index, and osteoporosis. Anterior cervical surgery was selected for 75.0% of the patients, and posterior cervical surgery for the remaining 25.0%. Cervical radiculopathy due to foraminal stenosis, hard disc, or soft disc was the primary diagnosis in 78.0% of the patients, and central spinal stenosis was the primary diagnosis in 22.0% of them. Additional surgery was performed for 5.0% of the patients after anterior cervical surgery and 6.5% of the patients after posterior cervical surgery (adjusted subhazard ratio, 0.83; 95% confidence interval, 0.40-1.74). The rates of additional surgery were not different between anterior and posterior cervical surgeries. The results would be helpful in evaluating current practice as a whole and adjusting the health insurance policy.

Quality Management System for an IoT Meteorological Sensor Network-Application to Smart Seoul Data of Things (S-DoT).

Meteorological data with a high horizontal resolution are essential for user-specific weather application services, such as flash floods, heat waves, strong winds, and road ice, in urban areas. National meteorological observation networks, such as the Automated Synoptic Observing System (ASOS) and Automated Weather System (AWS), provide accurate but low horizontal resolution data to address urban-scale weather phenomena. Many megacities are constructing their own Internet of Things (IoT) sensor networks to overcome this limitation. This study investigated the status of the smart Seoul data of things (S-DoT) network and the spatial distribution of temperature on heatwave and coldwave event days. The temperature at above 90% of S-DoT stations was higher than that at the ASOS station, mainly because of different surface covers and surrounding local climate zones. A quality management system for an S-DoT meteorological sensor network (QMS-SDM) comprising pre-processing, basic quality control, extended quality control, and data reconstruction using spatial gap-filling was developed. The upper threshold temperatures for the climate range test were set higher than those adopted by the ASOS. A 10-digit flag for each data point was defined to discriminate between normal, doubtful, and erroneous data. Missing data at a single station were imputed using the Stineman method, and the data with spatial outliers were filled with values at three stations within 2 km. Using QMS-SDM, irregular and diverse data formats were changed to regular and unit-format data. QMS-SDM application increased the amount of available data by 20-30%, and significantly improved data availability for urban meteorological information services.

Delayed response in rectus abdominis muscle following a step perturbation in subjects with and without recurrent low back pain.

BACKGROUND: Delayed trunk and lower limb muscle activation is associated with balance loss and fall injuries in subjects with recurrent low back pain (LBP). PURPOSE: This study was conducted to compare differences in the onset of muscle contractions of the trunk and lower limb muscles following a treadmill-induced step perturbation between subjects with and without LBP. METHODS: Eighty-three right limb dominant individuals (43 subjects with LBP and 40 control subjects) were exposed to the perturbation (0.31 m/s velocity for 0.2 m). The electromyography (EMG) reaction times were analyzed during the first step following the perturbation. The EMG electrodes were placed on both sides of the trunk and lower limbs, including the rectus abdominis (RA), erector spinae (ES), tibialis anterior (TA), and gastrocnemius (GA) muscles. RESULTS: The group x muscle interaction was statistically significant (F = 9.44, p = 0.003). The TA muscle activation was significantly delayed compared to the RA, ES, and GA. There was a significant interaction on side x muscle (F = 4.14, p = 0.04). The RA muscles were significantly delayed on the non-dominant (t = - 3.35, p = 0.001) and dominant (t = - 2.53, p = 0.01) sides in the LBP group. CONCLUSION: The LBP group demonstrated a delayed reaction time on the RA muscles, which indicated poor trunk control relative to the lower limbs. The delayed bilateral RA muscle might indicate possible coordination problems relative to the ES and lower limb muscles, which may lead to potential fall hazards.

Polygenic risk score for tumor aggressiveness and early-onset prostate cancer in Asians.

We attempted to assess the performance of an ethnic-specific polygenic risk score (PRS) designed from a Korean population to predict aggressive prostate cancer (PCa) and early-onset (age < 60). A PRS score comprised of 22 SNPs was computed in 3695 patients gathered from one of 4 tertiary centers in Korea. Males with biopsy or radical prostatectomy-proven PCa were included for analysis, collecting additional clinical parameters such as age, BMI, PSA, Gleason Group (GG), and staging. Patients were divided into 4 groups of PRS quartiles. Intergroup differences were assessed, as well as risk ratio and predictive performance based on GG using logistic regression analysis and AUC. No significant intergroup differences were observed for BMI, PSA, and rate of ≥ T3a tumors on pathology. Rate of GG ≥ 2, GG ≥ 3, and GG ≥ 4 showed a significant pattern of increase by PRS quartile (p < 0.001, < 0.001, and 0.039, respectively). With the lowest PRS quartile as reference, higher PRS groups showed sequentially escalating risk for GG ≥ 2 and GG ≥ 3 pathology, with a 4.6-fold rise in GG ≥ 2 (p < 0.001) and 2.0-fold rise in GG ≥ 3 (p < 0.001) for the highest PRS quartiles. Combining PRS with PSA improved prediction of early onset csPCa (AUC 0.759) compared to PRS (AUC 0.627) and PSA alone (AUC 0.736). To conclude, an ethnic-specific PRS was found to predict susceptibility of aggressive PCa in addition to improving detection of csPCa when combined with PSA in early onset populations. PRS may have a role as a risk-stratification model in actual practice. Large scale, multi-ethnic trials are required to validate our results.

The Effect of Cervical Fusion on Functional Sagittal Spinal Alignment Based on the Inflection Point: Case Series Study.

STUDY DESIGN: A retrospective radiologic study. OBJECTIVE: The inflection point is the disc space between a lordotic and kyphotic segment of spine. To our knowledge, there has been no study evaluating changes in functional sagittal alignment determined by inflection points after cervical fusion surgery. The purpose is to identify changes in functional sagittal alignment after cervical fusion as determined by functional segments between cervicothoracic and thoracolumbar inflection points. METHODS: Standing radiographs of the sagittal whole spine were taken in 62 patients who underwent cervical fusion procedures. We identified cervicothoracic and thoracolumbar inflection points in the sagittal plane and measured Cobb angles of resulting "functional" cervical, thoracic, and lumbar segments. We also measured the C2 and T1 sagittal vertical axis (SVA) distance to S1 and the anatomic cervical lordosis, thoracic kyphosis, lumbar lordosis, spinopelvic parameters, and T1 sagittal slope. We compared the pre- and post-op values. RESULTS: The functional cervical segment and T1 sagittal slope increased postoperatively. C2 and T1 SVA distance to S1 decreased postoperatively. In patients with a single level fusion or lower instrumented vertebra (LIV) proximal or equal to C6, functional cervical segment, and anatomic cervical lordosis increased postoperatively. In those with multiple level fusion or LIV distal or equal to C7, the C2 SVA distance to S1 decreased postoperatively. CONCLUSIONS: After cervical fusion surgery, functional cervical sagittal parameters determined by the inflection point improve without changes in the anatomic sagittal parameters. Postoperative changes in functional sagittal parameters were affected by the number of fused levels and LIV.

Spontaneous Hematomyelia Associated with the Use of Non-vitamin K Antagonist.

Vitamin K antagonists have been frequently prescribed as anticoagulants with the potential side effect of spontaneous hematomyelia with a poor prognosis. However, to our knowledge, there has been no report of spontaneous hematomyelia combined with the use of a non-vitamin K antagonist. A 63-year-old man presented with left leg weakness, impaired sensation, and urinary retention while taking rivaroxaban (non-vitamin K antagonist) for 4 months for atrial fibrillation. Anticoagulant agents were discontinued. Methylprednisolone pulse therapy was administered without surgical hematoma evacuation. Three months after the initial development of the hematomyelia, the symptoms improved to grade 5 for both lower extremities, and there was complete recovery in sensory and urinary functions. This might be the first description of a complete recovery of neurologic deficits without hematoma evacuation in spontaneous hematomyelia patients caused by non-vitamin K antagonist therapy.

Ankle reaction times with tray usage following a slip perturbation between subjects with and without chronic low back pain.

BACKGROUND: Abnormal stepping strategies have been associated with handheld tasks in subjects with chronic low back pain (LBP). However, the dominant ankle reactions of subjects with LBP remain unclear following a perturbation during handheld tasks. RESEARCH QUESTION: Are there differences in the reaction times of the ankle muscles during handheld tasks between subjects with and without LBP following a treadmill-induced slip perturbation? METHODS: Thirty-seven right limb dominant subjects with LBP and 37 subjects without LBP participated in the study. Each subject was introduced to a slip perturbation (1.37 m/sec velocity for 8.22 cm) with and without a handheld tray in random order. Subjects were allowed to recover by stepping forward for a 0.12 s duration while bilateral tibialis anterior (TA) and gastrocnemius (GA) muscle reaction times were measured by electromyography (EMG). RESULTS: The EMG results indicated that the groups demonstrated significant interactions on the limb sides and muscles (F = 4.86, p = 0.03). The dominant TA reaction time was significantly faster in the LBP group (t = 2.14, p = 0.03) while holding a tray. SIGNIFICANCE: The LBP group demonstrated faster reaction times on the dominant TA muscles during perturbations. Clinicians need to consider dominance-dependent compensatory ankle dorsiflexion strategies in LBP patients to help enhance dynamic balance and control.

Spatiotemporal variations in urban CO2 flux with land-use types in Seoul.

BACKGROUND: Cities are a major source of atmospheric CO2; however, understanding the surface CO2 exchange processes that determine the net CO2 flux emitted from each city is challenging owing to the high heterogeneity of urban land use. Therefore, this study investigates the spatiotemporal variations of urban CO2 flux over the Seoul Capital Area, South Korea from 2017 to 2018, using CO2 flux measurements at nine sites with different urban land-use types (baseline, residential, old town residential, commercial, and vegetation areas). RESULTS: Annual CO2 flux significantly varied from 1.09 kg C m- 2 year- 1 at the baseline site to 16.28 kg C m- 2 year- 1 at the old town residential site in the Seoul Capital Area. Monthly CO2 flux variations were closely correlated with the vegetation activity (r = - 0.61) at all sites; however, its correlation with building energy usage differed for each land-use type (r = 0.72 at residential sites and r = 0.34 at commercial sites). Diurnal CO2 flux variations were mostly correlated with traffic volume at all sites (r = 0.8); however, its correlation with the floating population was the opposite at residential (r = - 0.44) and commercial (r = 0.80) sites. Additionally, the hourly CO2 flux was highly related to temperature. At the vegetation site, as the temperature exceeded 24 ℃, the sensitivity of CO2 absorption to temperature increased 7.44-fold than that at the previous temperature. Conversely, the CO2 flux of non-vegetation sites increased when the temperature was less than or exceeded the 18 ℃ baseline, being three-times more sensitive to cold temperatures than hot ones. On average, non-vegetation urban sites emitted 0.45 g C m- 2 h- 1 of CO2 throughout the year, regardless of the temperature. CONCLUSIONS: Our results demonstrated that most urban areas acted as CO2 emission sources in all time zones; however, the CO2 flux characteristics varied extensively based on urban land-use types, even within cities. Therefore, multiple observations from various land-use types are essential for identifying the comprehensive CO2 cycle of each city to develop effective urban CO2 reduction policies.

The progression of the vertebral body bruise associated with a spinal fracture.

BACKGROUND: Advances in magnetic resonance imaging (MRI) have made it possible to find the vertebral body bruise (VBB), which was not found in computed tomography (CT) after trauma. There has been only one study with adult patients about whether traumatic VBB will cause a collapse of the vertebral body or not. The purpose is to elucidate the progression of VBB in non-osteoporotic adult patients and to identify the possible factors influencing the progression. METHOD: The VBB was defined on MRI as band-like or diffuse zones of high signal intensity on T2-weighted sequences without fracture of the cortex based on CT. The study population with traumatic VBB associated with non-osteoporotic spinal fracture was composed of 15 females and 21 males. The minimal follow-up period was 6 months. The ratio of anterior to posterior heights of the VBB, the ratio of anterior heights of the VBB to the average of those of cranial and caudal adjacent vertebral bodies, the anterior wedge angle of the VBB, and the focal angle around the VBB were compared between the initial and final visits. We evaluated the age of the patients, the C2 plumb line distance, the regional location of VBB, the etiology of VBB, and the treatment methods of the fractures as possible risk factors influencing the progression. RESULTS: There was no difference in the ratios and angles between the initial and final visits. The differences in the ratios and angles between the initial and final visits were not dependent on the possible risk factors. The anterior superior area is the most common in the distribution of VBB. CONCLUSIONS: Unlike compression fractures, the vertebral body with traumatic VBB found in adult patients with non-osteoporotic spinal fractures of AO classification A or B types did not develop collapse. In clinical practice, it is reasonable to diagnose it as a spinal fracture rather than a VBB if the collapse of a possible VBB occurs.

Asymmetrical thoracic-lumbar coordination during trunk rotation between adolescents with and without thoracic idiopathic scoliosis.

STUDY DESIGN: Cross-sectional comparative study. PURPOSE: To compare thoracic-lumbar kinematic changes and coordination based on coupling angles (CAs) in two different directions of trunk rotation between adolescents with idiopathic scoliosis (AIS) and control subjects. Altered three-dimensional (3D) deviations are often apparent in AIS groups during functional activities, such as gait. However, there is a lack of consistent evidence on coordinated motions during different directions of trunk rotation. METHODS: This study included 14 AIS and 17 age-matched control subjects who were all right limb dominant. A motion capture system was utilized to analyze the spinal segment motions. The outcome measures included range of motion (ROM) at the first thoracic (T1), seventh thoracic (T7), and first lumbar (L1) spinous processes as well as the sacral tubercle (S1). The CAs compared in-phase (rotation from right to left) and anti-phase (rotation from left to right) trunk rotations. RESULTS: Although there was no significant association with the spinal segments in the control group, the Cobb angle demonstrated significant positive correlations with anti-phase at T7 and L1 as well as in-phase at L1. Regarding the CAs, the groups demonstrated a significant interaction with both phases (F = 4.7, p = 0.04). The AIS group demonstrated positive correlations with ROM during in-phase at L1 and anti-phase at T7 and L1. CONCLUSION: The coordination based on the CAs of the lumbar spine relative to the thoracic spine significantly decreased during left to right trunk rotation in the AIS group. These results indicated that the AIS group demonstrated directional dissociation toward the dominant side of lumbar rotation. LEVEL OF EVIDENCE: III.

Direct medical costs after surgical or nonsurgical treatment for degenerative lumbar spinal disease: A nationwide matched cohort study with a 10-year follow-up.

OBJECTIVE: The demand for treating degenerative lumbar spinal disease has been increasing, leading to increased utilization of medical resources. Thus, we need to understand how the budget of insurance is currently used. The objective of the present study is to overview the utilization of the National Health Insurance Service (NHIS) by providing the direct insured cost between patients receiving surgery and patients receiving nonsurgical treatment for degenerative lumbar disease. METHODS: The NHIS-National Sample Cohort was utilized to select patients with lumbar disc herniation, spinal stenosis, spondylolisthesis or spondylolysis. A matched cohort study design was used to show direct medical costs of surgery (n = 2,698) and nonsurgical (n = 2,698) cohorts. Non-surgical treatment included medication, physiotherapy, injection, and chiropractic. The monthly costs of the surgery cohort and nonsurgical cohort were presented at initial treatment, posttreatment 1, 3, 6, 9, and 12 months and yearly thereafter for 10 years. RESULTS: The characteristics and matching factors were well-balanced between the matched cohorts. Overall, surgery cohort spent $50.84/patient/month, while the nonsurgical cohort spent $29.34/patient/month (p<0.01). Initially, surgery treatment led to more charge to NHIS ($2,762) than nonsurgical treatment ($180.4) (p<0.01). Compared with the non-surgical cohort, the surgery cohort charged $33/month more for the first 3 months, charged less at 12 months, and charged approximately the same over the course of 10 years. CONCLUSION: Surgical treatment initially led to more government reimbursement than nonsurgical treatment, but the charges during follow-up period were not different. The results of the present study should be interpreted in light of the costs of medical services, indirect costs, societal cost, quality of life and societal willingness to pay in each country. The monetary figures are implied to be actual economic costs but those in the reimbursement system instead reflect reimbursement charges from the government.

Reoperations after fusion surgeries for degenerative spinal diseases depending on cervical and lumbar regions: a national database study.

BACKGROUND: Reoperation is one of the key factors affecting postoperative clinical outcomes. The reoperation rates of cervical surgeries might be different from those of lumbar surgeries due to the anatomical and biomechanical differences. However, there has been no study to compare the reoperation rate between them. The purpose is to compare reoperation rates after fusion surgeries for degenerative spinal diseases depending on the anatomic region of cervical and lumbar spines. METHOD: We used the Korean Health Insurance Review & Assessment Service national database. Subjects were included if they had any of the primary procedures of fusion combined with the procedure of decompression procedures under the diagnosis of degenerative diseases (n = 42,060). We assigned the patients into two groups based on anatomical regions: cervical and lumbar fusion group (n = 11,784 vs 30,276). The primary endpoint of reoperation was the repeat of any aforementioned fusion procedures. Age, gender, presence of diabetes, associated comorbidities, and hospital types were considered potential confounding factors. RESULTS: The reoperation rate was higher in the patients who underwent lumbar fusion surgery than in the patients who underwent cervical fusion surgery during the entire follow up period (p = 0.0275). A similar pattern was found during the late period (p = 0.0468). However, in the early period, there was no difference in reoperation rates between the two groups. Associated comorbidities and hospital type were noted to be risk factors for reoperation. CONCLUSIONS: The incidence of reoperation was higher in the patients who underwent lumbar fusion surgery than those who underwent cervical fusion surgery for degenerative spinal diseases.

The reaction times and symmetry indices in the bilateral trunk and limb muscles in control subjects and subjects with low back pain that persisted two months or longer.

PURPOSE: This study was conducted to investigate the reaction times and symmetry index (SI) of the bilateral trunk and limb muscles between control subjects and subjects with low back pain (LBP) that persisted for two months or longer. METHODS: Fifty-seven right limb dominant subjects (31 healthy control subjects and 26 subjects with LBP) participated in this study. The subjects were exposed to a slip perturbation (0.24 m/sec velocity for 1.20 cm), which caused them to move forward for 0.10 s in standing while holding a tray. The electromyography (EMG) electrodes were placed on the bilateral erector spinae (ES), rectus abdominis (RA), rectus femoris, hamstring, tibialis anterior, gastrocnemius, biceps brachii (BB), and triceps brachii muscles. The reaction times were analyzed, and the SI was used to compare the bilateral trunk and limb muscles for the degree of asymmetry between groups. RESULTS: The ES reaction time was significantly delayed in the control group (0.33 ± 0.22 vs. 0.22 ± 0.17; t = 2.25, p = 0.03). The SI of reaction times was significantly different on the RA (t = -2.28, p = 0.03), ES (t = -2.36, p = 0.04), and BB (t = -2.15, p = 0.04) muscles between groups. CONCLUSION: The delayed non-dominant ES reaction time might indicate a freedom of pain recurrence in the control group. Although the asymmetry increased on the RA and BB muscles in the LBP group, it decreased on the ES muscle. The asymmetries on the trunk and BB muscles were evident in the LBP group. The asymmetrical reactions in the arm-trunk muscles need to be considered for rehabilitation strategies.

Changes in sleep disturbance in patients with cervical myelopathy: comparison between surgical treatment and conservative treatment.

BACKGROUND CONTEXT: The clinical symptoms of cervical myelopathy (CM) are closely associated with the risk factors of sleep disturbance, and its pathophysiological process is similar to that of spinal cord injury. Therefore, patients with CM are also expected to have sleep disturbance like patients with spinal cord injury, who typically have various types of sleep disorders. Fortunately, sleep disturbance in patients with CM is expected to respond well to treatment, and clinical studies are required to establish proper treatment strategies for CM patients with sleep disturbance. PURPOSE: To compare the effects of CM treatment on sleep quality between patients treated surgically and those managed conservatively and to identify predictors associated with sleep improvement. STUDY DESIGN/SETTING: Prospective cohort study. PATIENT SAMPLE: Patients diagnosed as having CM. OUTCOME MEASURES: Pittsburgh Sleep Quality Index (PSQI). METHODS: The effect of CM treatment on sleep improvement at the 6-month follow-up was evaluated using a multivariate logistic regression analysis of propensity score-matched patients. To investigate factors associated with significant sleep improvement, a subgroup analysis was performed. RESULTS: A total of 131 patients with CM and sleep disturbance were enrolled. Among these patients, 31 received surgical treatment and 100 received conservative treatment. Sleep quality improved rapidly and consistently after surgery, and significant sleep improvement was observed in most of the patients in the surgical group (26/31 patients, 83.9%) at the 6-month follow-up. However, sleep improvement only occurred in 27 (27%) of the 100 patients in the conservative group at the 6-month follow-up. The subgroup analysis revealed that the degree of CM determined by mJOA scores >13 was a significant predictor of sleep improvement after conservative treatment. CONCLUSIONS: Clinicians should closely monitor patients with CM with sleep disturbance, and proper treatment strategies should be considered according to the severity of the conditions.

Cervical Sagittal Imbalance after Cervical Laminoplasty in Elderly Patients.

PURPOSE: To determine the effect of age on sagittal cervical alignment after cervical laminoplasty procedure so as to identify the group with the greatest degree of variation. Study Setting. Single-center retrospective chart review in a tertiary referral hospital. Outcome Measures. The sagittal vertical axis (SVA) (C2-7), T1 slope, and cervical lordosis. METHODS: We included patients who underwent cervical laminoplasty between 2014 and 2018 and divided 60 consecutive patients into two groups using the cut-off age of 65 years. The Paired t-test and Mann-Whitney U test were used to compare changes between preoperative radiographic cervical sagittal parameters and those 1 year after surgery. RESULTS: Mean patient ages in the older and younger groups were 71 years and 52 years, respectively. The difference of C2-7 SVA was greater in the older group. CONCLUSION: Postoperative cervical balance can be worse when laminoplasty is performed in elderly patients.

Gender difference of hip-ankle compensations following a novel trip perturbation in young adults.

BACKGROUND: Women have an increased likelihood of sustaining a fall-related injury compared to men; however, little is known about fall prevention strategies between genders. The purpose of this study was to compare the gender differences in lower limb reactions and three-dimensional recovery patterns following a treadmill-induced trip perturbation. METHODS: Seventy-six participants who are right limb dominant enrolled in the study, which included 41 females (26.15 [9.92] years old) and 35 males (27.11 [9.15] years old). The outcome measures included a three-dimensional (3D) range of motion (ROM) analysis on the bilateral hip, knee, and ankle joints following the trip perturbation at a 0.89 m/s velocity for 0.12 m. This induced trip caused subjects to walk forward for a 0.26 s duration. FINDINGS: The female group demonstrated significantly increased frontal plane ROM in the right hip (t = 2.71, p = 0.01) and left ankle (t = 2.16, p = 0.03) as well as increased sagittal plane ROM in the right (t = 2.07, p = 0.04) and left (t = 2.36, p = 0.02) ankles. There was a significant gender interaction on 3D body region (F = 6.84, p = 0.01) following the perturbation. INTERPRETATION: There was a 3D gender difference on the lower limbs for balance control. The female group demonstrated increased sagittal motion in both ankles following a trip perturbation. In addition, their ROM increased on the dominant hip and non-dominant ankle in the frontal plane, which was compensated by step width for standing stability. Clinicians might want to consider the implications of gender differences on lower limb reaction patterns to help patients avoid potential injuries/falls.

Lumbar spine coordination during axial trunk rotation in adolescents with and without right thoracic idiopathic scoliosis.

Adolescent idiopathic scoliosis (AIS) is a complex deformity that often leads to loss of coordination and dynamic posture. However, there is a lack of understanding on inter-segmental coordination in AIS. The purpose of this study was to compare spinal range of motion (ROM), as well as the relations to coupling angles (CA) in the spinal region during trunk rotation, between AIS and control subjects. There were 14 subjects with right thoracic AIS and 18 control subjects who participated in the study. All subjects were asked to perform five repeated axial trunk rotations in standing while holding a bar. The outcome measures included ROM at the first thoracic spinous process (T1), the seventh thoracic spinous process (T7), the twelfth thoracic spinous process (T12), and the first sacrum spinous tubercle (S1) by the motion capture system. The CA in each spinal region (trunk, lumbar spine, and lower and upper thoraces) were analyzed while considering age and body mass index (BMI). The Cobb angle demonstrated positive moderate relationships with ROM at T7 (r = 0.62, p = 0.04) and the CA in the upper thorax (r = 0.69, p = 0.02) in the AIS group. There was no CA difference at the spinous processes between groups; however, the lumbar spine ROM significantly decreased in the AIS group (t = 2.40, p = 0.02). The BMI demonstrated moderate relationships on the lumbar spine (r = -0.67, p = 0.02) in the AIS group and the lower thorax (r = 0.59, p = 0.01) in the control group. The lumbar spine was significantly dissociated in the AIS group during trunk rotation, although the Cobb angle demonstrated positive relationships with ROM at T7. Collectively, the inter-segmental CA indicated that the AIS group compensated more independently to the right thoracic convexity. MINI ABSTRACT: The coordinated trunk rotations in the adolescent idiopathic scoliosis (AIS) group were compared with the control subjects. The lumbar spine motion was dissociated with the thorax in the AIS group and was negatively correlated with body mass index. Clinicians need to consider thorax convexity and dissociated lumbar motion for compensatory and rehabilitation strategies.

Hand grip strength as a surrogate marker for postoperative changes in spinopelvic alignment in patients with lumbar spinal stenosis.

There are a few studies on the postoperative changes in sagittal alignment and corresponding factors, including hand grip strength (HGS) and muscle performance tests for lumbar spinal stenosis (LSS). Thus, we aimed to determine whether HGS can be a surrogate marker for global sagittal alignment changes after decompression with fusion surgery for LSS. This retrospective observational study included 91 patients who underwent spine fusion surgery for LSS. Radiological spinopelvic parameters, including sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), global tilt (GT), and T1 pelvic angle (T1PA), were analyzed preoperatively and 1 year after posterior decompression and fusion surgery. To assess muscle performance, the 6-m walk (SMT), timed up and go (TUGT), and sit-to-stand (STS) tests were conducted. The relationship between HGS and postoperative SVA was examined through multiple linear regression analysis. Additionally, the relationship between HGS and preoperative/postoperative radiologic spinopelvic parameters and muscle performance test results was analyzed through Pearson's correlation. HGS was significantly correlated with age, preoperative and postoperative SVA, and the muscle performance tests. Furthermore, HGS was a factor that can significantly influence postoperative SVA changes in multiple linear regression analyses. Therefore, HGS may be a good predictor of postoperative SVA change.