Generalization of a clinical diagnosis support tool for lumbar spinal stenosis: Can the ankle brachial pressure index be replaced by palpation of the posterior tibial artery in the lumbar spinal stenosis diagnostic support tool? (DISTO project).

BACKGROUND: The Japanese Society for Spine Surgery and Related Research previously developed a diagnostic support tool for lumbar spinal stenosis (LSS-DST). Using the LSS-DST, general physicians can identify potential cases of LSS. However, in the LSS-DST, measurement of the ankle brachial pressure index (ABI) is required to exclude peripheral artery lesions in the lower limbs. We can expect further application of the LSS-DST if we can identify a simpler and easier method than ABI measurement. Therefore, in this large-scale, multicenter, cross-sectional study, we verified whether palpation of the posterior tibial (PT) artery could be used instead of ABI in the LSS-DST. METHODS: This survey was conducted at 2177 hospitals and included 28,883 participants. The sensitivity and specificity of the original LSS-DST method using the ABI and that of the LSS-DST ver2.0 with PT artery palpation were assessed to screen their ability for diagnosing LSS, using the physicians' final diagnosis based on the patients' history, physical examination and radiographic findings as the gold standard. RESULTS: The sensitivity and specificity [95%CI] of the LSS-DST were 88.2% [87.5, 88.8] and 83.9% [83.4, 84.5], respectively, whereas the sensitivity and specificity of the LSS-DST ver2.0 were 87.7% [87.0, 88.3] and 78.3% [77.7, 78.9], respectively, indicating that LSS-DST ver2.0 is a useful screening tool for LSS with good sensitivity. CONCLUSION: When the item of ABI in the LSS-DST is replaced by palpation of the PT artery (LSS-DST ver2.0), its sensitivity is maintained as a screening tool for LSS. LEVEL OF EVIDENCE: Level 3.

The role of the flexor pronator muscles as dynamic stabilizers against elbow valgus stress in patients with medial ulnar collateral ligament insufficiency.

BACKGROUND: The flexor pronator muscles (FPMs) have been reported to act as dynamic stabilizers against valgus forces in overhead-throwing athletes. Several studies have demonstrated the anatomic, biomechanical, and clinical effects of the FPMs. However, no studies have investigated the in vivo kinematics of the FPMs against the valgus forces on the elbow. This study aimed to clarify the clinical contribution of the FPMs as dynamic stabilizers in medial ulnar collateral ligament (MUCL) insufficiency. METHODS: Eighteen baseball players with MUCL injury participated in this study. The elbow was flexed to 90°, and the forearm was placed in the supinated position. Manual valgus stress was applied to the elbow joint until maximal shoulder external rotation was achieved. The width of the ulnohumeral joint space was measured using ultrasonography, and any changes in medial elbow pain were recorded before and after isometric forearm pronation. RESULTS: All the subjects had MUCL tenderness and felt medial elbow pain when elbow valgus stress was applied. The width of the medial joint space was significantly larger on the injured side than on the healthy side (5.1 ± 1.0 mm vs. 3.2 ± 1.0 mm) with elbow valgus stress. During isometric forearm pronation, the width of the medial joint space was significantly decreased (3.1 ± 0.9 mm vs. 2.6 ± 1.0 mm) and medial elbow pain had completely diminished. CONCLUSION: Isometric forearm pronation reduces valgus stress-induced widening of the medial joint space and medial elbow pain in patients with MUCL insufficiency.

Sagittal imbalance and symptoms of depression in adults: Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study (LOHAS).

PURPOSE: With spinal deformities, mental health can deteriorate due to sagittal imbalance of the spine. The purpose of this study was to clarify the relationship between sagittal imbalance and symptoms of depression among local residents in the community. METHODS: This study used data from the Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS) in 2010. The sagittal vertical axis (SVA) was identified as an indicator of sagittal imbalance. Symptoms of depression were assessed using the 5-item version of the Mental Health Inventory. Participants were classified into three categories based on the SVA balance as normal (< 40 mm), moderate imbalance (40-95 mm), and severe imbalance (> 95 mm). To evaluate the relationship between sagittal imbalance of the spine and symptoms of depression, the adjusted risk ratio (RR) and the 95% confidence interval (CI) were calculated using a generalized linear model with Poisson link. RESULTS: There were 786 participants included in the statistical analysis. Overall, the mean age was 68.1 y (standard deviation, 8.8 y), and 39.4% were men. The prevalence of symptoms of depression by SVA category was 18.6% for normal, 23.8% for moderate, and 40.6% for severe. On multivariate analysis, the RR of SVA for symptoms of depression compared to the normal category was 1.12 (95% CI 0.7-1.70) for the moderate category and 2.29 (95% CI 1.01-5.17) for the severe category. CONCLUSION: In local community residents, sagittal imbalance had a significant association with symptoms of depression.

The Change of Lumbar Spinal Stenosis Symptoms over a Six-Year Period in Community-Dwelling People.

Background and Objectives: The high prevalence of lumbar spinal stenosis (LSS) and its negative impact on quality of life in the elderly is well known. However, the longitudinal time course of LSS symptoms remains unclear. The purpose of this study was to clarify the longitudinal time course and associated factors of LSS symptoms over a period of six years in a community. Materials and Methods: This study was conducted with data prospectively collected in 2004 and 2010 under a retrospective design. In 2004, 1578 subjects (age range: 40 to 79 years) were interviewed on LSS symptoms using a specially designed and validated questionnaire. In 2010, a follow-up study was performed by mail, to which 789 subjects of the 2004 study population responded. Considering that the presence of osteoarthritis (OA) of the knee or hip may influence the participants' answers in the questionnaire, analysis was performed in all 789 subjects with and 513 subjects without either knee or hip OA. Changes in LSS symptoms between the initial and the 6-year survey were investigated. Multiple logistic regression analysis was used for detecting the risk factors for LSS symptom presence at the six-year follow-up. Results: 1. At the six-year follow-up, more than half of the subjects who showed LSS symptoms at the initial analysis became LSS-negative, and 12-15% of those who were LSS-negative became LSS-positive. 2. From the multiple logistic regression analysis, a lower Roland-Morris Disability Questionnaire (RDQ) score and a positive LSS symptom at the initial analysis were detected as predictive factors of the presence of LSS symptoms at the six-year follow-up in the total number of subjects, as well as just in those who did not have either knee or hip OA. Conclusions: More than half of the subjects who were LSS-positive at their initial assessment still experienced improvement in their symptoms even after 6 years. This means that both LSS symptoms and their time course vary from person to person. Predictive factors for the presence of LSS symptoms during the six-year follow-up period were RDQ score and positive LSS symptoms.

Level of Low Back Pain-Related Disability Is Associated with Risk of Subsequent Falls in an Older Population: Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS).

OBJECTIVES: To examine the longitudinal association between baseline disability due to low back pain (LBP) and future risk of falls, particularly significant falls requiring treatment, in a community-dwelling older population. METHODS: This was a prospective population-based cohort study using data from the Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS; 2008-2010). A total of 2,738 residents aged ≥60 years were enrolled. LBP was assessed using the Roland-Morris Disability Questionnaire (RMDQ), and the level of LBP-related disability was divided into three categories (none, low, and medium to high). Incidence of falls over the following year was determined using a self-reported questionnaire after the one-year follow-up period. The risk ratio (RR) for LBP-related disability associated with any fall and any fall requiring treatment was estimated using log binomial regression models. RESULTS: Data were analyzed for 1,358 subjects. The prevalence of LBP at baseline was 16.4%, whereas 122 (8.9%) participants reported a low level of LBP-related disability and 101 (7.4%) reported medium to high levels of LBP-related disability. Incidence of any fall and falls requiring treatment was reported by 22.1% and 4.6% of participants, respectively. Subjects with medium to high levels of disability were more likely to experience subsequent falls (adjusted RR = 1.53, 95% confidence interval [CI] = 1.21-1.95) and falls requiring treatment (adjusted RR = 2.55, 95% CI = 1.41-4.60) than those with no LBP-related disability. CONCLUSIONS: Level of LBP-related disability was associated with an increased risk of serious falls in a general population of community-living older adults. These findings can alert health care providers involved in fall prevention efforts to the important issue of activity-related disability due to LBP.

Sufficient duration of off-season decreases elbow disorders in elementary school-aged baseball players.

BACKGROUND: Several guidelines for the prevention of throwing injuries recommend a sufficiently long off-season; however, few studies providing scientific evidence to support these recommendations exist. Our study aimed to clarify the association between off-season duration and throwing elbow injuries among elementary school-aged baseball players. METHODS: This study enrolled 680 elementary school-aged baseball players who underwent medical checkups. The experience with elbow pain and the off-season duration were investigated via the administration of a self-completed questionnaire. Ultrasonographic assessment of the elbow joint was performed on the day of the medical checkup to assess for morphologic abnormalities. RESULTS: The prevalence of elbow pain and morphologic abnormalities of the medial epicondyle (medial epicondyle lesions) was significantly decreased when the subjects' off-season duration was longer. Multivariate analysis revealed that the risk of elbow pain was significantly lower in the group whose off-season lasted 1 to 2 months (odds ratio [OR], 0.32; 95% confidence interval [CI], 0.15-0.62; P = .0006) and in the group whose off-season lasted longer than 2 months (OR, 0.59; 95% CI, 0.37-0.95; P = .0316). The risk of medial epicondyle lesions was also significantly lower in the group whose off-season lasted 1 to 2 months (OR, 0.39; 95% CI, 0.22-0.67; P = .0005) and in the group whose off-season lasted longer than 2 months (OR, 0.36; 95% CI, 0.23-0.56; P < .0001). On the contrary, no significant correlation was found between capitellar osteochondritis dissecans and off-season duration. CONCLUSION: Off-season duration has a significant correlation with elbow pain and morphologic abnormalities of the medial elbow joint in elementary school-aged baseball players.

Reference values of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire in patients with lumbar spinal stenosis and characteristics of deterioration of QOL: Lumbar Spinal Stenosis Diagnosis Support Tool: DISTO project.

BACKGROUND: The reference values of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) in patients with lumbar spinal stenosis (LSS) are still unknown. This multicenter cross-sectional survey was performed to determine the reference values and disease-specific characteristics of deterioration of QOL caused by LSS itself, not by aging, through comparison of patients with and without LSS who had an outpatient visit for low back pain by age and sex groups. METHODS: The present study was performed at 564 medical centers and clinics. The JOABPEQ was measured for 8338 patients aged 20 years or over who came to an outpatient clinic for low back pain (LBP) and were examined for whether they had LSS using the LSS diagnosis support tool (LSS-DST). Scores in the five JOABPEQ domains were compared between the LSS group and the LBP without LSS group (LBP group) for each age and sex group. RESULTS: Scores for Pain-related disorder, Gait disturbance, Social life disturbance, and Psychological disorders were significantly lower in the LSS group than in the LBP group. CONCLUSION: The percentiles of JOABPEQ scores in patients with LSS were clarified and could be used as reference values. Deterioration of QOL caused by LSS itself, not by aging, are characterized by Pain-related disorder, Gait disturbance, Social life disturbance, and Psychological disorders.

The prevalence of scapular malalignment in elementally school aged baseball player and its association to shoulder disorder.

BACKGROUND: Various shoulder disorders have been reported to be associated with scapulothoracic joint dysfunction in adult overhead athletes. However, little is known about the prevalence of scapular malalignment and its relationship to shoulder injuries in skeletally immature baseball players. The purpose of the current study was to investigate the prevalence of scapular malalignment in elementary school-aged baseball players, as well as its association with shoulder disorder. METHODS: One hundred sixty-nine baseball players in higher elementary school grades (aged 11-12 years) were enrolled in this study. Shoulder pain experience pain over the previous one year, as well as other individual and environmental factors were surveyed by a self-completed questionnaire. Scapula malalignment was assessed using still images of both arms both at the side and in an elevated position. The relative position of the dominant scapula to the non-dominant side was assessed by two independent examiners. RESULTS: Scapular malalignment was observed in 126 subjects (74.6%), and the dominant scapula tended to deviate inferiorly and medially, as well as tilt anteriorly, compared with the non-dominant side. Forty-four of the 169 subjects (23.8%) experienced shoulder pain over the one year period. The prevalence of shoulder pain was significantly increased with the increasing scapular anterior tilt and the superior shift of the dominant scapula, whereas no significant correlation between shoulder pain and scapular horizontal shift or upward-downward rotation was observed. CONCLUSION: About three-quarters of the elementary school-aged baseball players in the current study presented with scapular malalignment, and those with anterior tilt and superior shift of the dominant scapula were at higher risk of shoulder pain.

Bowel/bladder dysfunction and numbness in the sole of the both feet in lumbar spinal stenosis - A multicenter cross-sectional study.

BACKGROUND: Numbness in the soles of both feet at rest or bowel/bladder dysfunction can occur in patients with lumbar spinal stenosis (LSS), especially in patients with cauda equina lesions. The purpose of this study was to clarify the relationship between cauda equina symptoms at rest and quality of life (QOL) in LSS patients using standardized questionnaires developed for the Japanese population. METHODS: A survey was conducted in 564 hospitals and general practice clinics nationwide from December 1, 2011 to December 31, 2012. All patients who visited hospital or clinic because of low back pain were included. Patients were diagnosed with LSS using the LSS-Diagnostic Support Tool (LSS-DST), and the severity of the disease was measured using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) for quality of life. Presence of both sole numbness and/or bowel/bladder dysfunction were determined by medical interview. 3647 patients were diagnosed with LSS according to the results of the LSS-DST. 1294 of these patients (35.5%) had symptoms at rest. Of these patients, 359 patients with sole numbness, 135 patients with bowel/bladder dysfunction, and 52 patients with both numbness and bowel/bladder dysfunction were compared to the patients without rest symptoms (n = 2182). Comparisons between groups with or without sole numbness and bowel/bladder dysfunction were performed using statistical analysis of JOABPEQ responses in the categories of pain-related disorder, lumbar spine disorder, gait disturbance, social life disturbance, and psychological disorder. RESULTS: All groups with sole numbness and/or bowel/bladder dysfunction had statistically lower (worse) scores in all categories of the JOABPEQ compared to the group without these symptoms at rest. CONCLUSION: LSS patients having numbness in the soles of both feet at rest or bowel/bladder dysfunction had lower measurements of QOL and activities of daily living than those patients without symptoms at rest. These symptoms appear to be related to QOL of LSS patients.

Osteochondroma of the Tibial Sesamoid: A Case Report and Review of the Literature.

Osteochondroma, one of the most common benign bone tumors, frequently occurs in the metaphysis of the long bones. We report an extremely rare case of osteochondroma that occurred in the tibial sesamoid. The patient was a 62-year-old Japanese male. He presented with a 1-year history of pain and a hard mass on the plantar aspect of the right forefoot sole. The osteochondroma protruded toward the sole from the tibial sesamoid, leading to pain on weightbearing. After tibial sesamoidectomy, the patient's symptoms were eliminated, and no pain or complications such as hallux valgus occurred after the surgery. Although a potential risk exists of postoperative hallux valgus deformity, tibial sesamoidectomy seems to be an appropriate surgical option for both osteochondroma and bizarre parosteal osteochondromatous proliferation to avoid residual pain or local recurrence.

Association between hand-grip strength and depressive symptoms: Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS).

BACKGROUND: no study has examined the longitudinal association between hand-grip strength and mental health, such as depressive symptoms. OBJECTIVE: we investigated the relationship between baseline hand-grip strength and the risk of depressive symptoms. DESIGN: a prospective cohort study. SETTING AND SUBJECTS: a prospective cohort study with a 1-year follow-up was conducted using 4,314 subjects from community-dwelling individuals aged 40-79 years in two Japanese municipalities, based on the Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS, 2008-10). METHODS: we assessed baseline hand-grip strength standardised using national representative data classified by age and gender, and depressive symptoms at baseline and after the follow-up using the five-item version of the Mental Health Inventory (MHI-5). RESULTS: the 4,314 subjects had a mean age of 66.3 years, 58.5% were women, and mean unadjusted hand-grip strength was 29.8 kg. Multivariable random-effect logistic regression analysis revealed that subjects with lower hand-grip strength (per 1SD decrease) had higher odds of having depressive symptoms at baseline [adjusted odds ratio (AOR) 1.15, 95% confidence interval (CI) 1.06-1.24; P = 0.001]. Further, lower hand-grip strength (per 1SD decrease) was associated with the longitudinal development of depressive symptoms after 1 year (AOR 1.13, 95% CI 1.01-1.27; P = 0.036). CONCLUSIONS: using a large population-based sample, our results suggest that lower hand-grip strength, standardised using age and gender, is both cross-sectionally and longitudinally associated with depressive symptoms.

Relationship between lumbar spinal stenosis and psychosocial factors: a multicenter cross-sectional study (DISTO project).

INTRODUCTION: Lumbar spinal stenosis (LSS) is a lumbar spinal disorder that causes leg symptoms and intermittent claudication. It is reported that the risk factors for low back pain include age, family history, smoking, obesity, work-related physical load, exercise, and depression. This was a multicenter, cross-sectional survey, and the aim of this study was to investigate the prevalence of LSS by age and the relationships between LSS and psychosocial factors and job satisfaction. METHODS: This study enrolled subjects aged 50 years and over from a survey of LSS in 2177 hospitals and general practices nationwide. The clinical characteristics of the LSS and non-LSS groups were compared using the χ2 test, and the multivariate logistic regression analysis was performed to examine associations between exercise, perceived stress, strenuous use of the low back or legs, job satisfaction, and LSS. RESULTS: In total, 18,642 patients (8338 males, 10,267 females) were analyzed. The rate of LSS was 38.3% and it increased with age. Regular exercise was less common among those in the LSS group than those in the non-LSS group (p<0.001). Satisfaction in all job-related items was less in the LSS group than in the non-LSS group (p<0.001). The odds for having LSS were higher in subjects having perceived stress and strenuous use of the low back or legs (p=0.001). The odds ratios of heart diseases and hypertension (p<0.001) were higher in the LSS group. CONCLUSION: This study investigated factors associated with LSS. The prevalence of LSS increased with age. Perceived stress and strenuous use of the low back or legs might be associated with LSS, and job satisfaction was lower with LSS.

Pain, quality of life and activity in aged evacuees living in temporary housing after the Great East Japan earthquake of 11 March 2011: a cross-sectional study in Minamisoma City, Fukushima prefecture.

BACKGROUND: The aim of this study was to clarify pain, quality of life and activity in the aged evacuees living in temporary housing after the Great East Japan Earthquake on 11 March 2011. METHODS: The study was a cross-sectional study performed in Minamisoma City, Fukushima Prefecture 1 year and 6 months after the disaster. Inclusion criteria were the ability to walk independently and consent to answer questionnaires. Seventy-one evacuees who met the inclusion criteria were included in this study. There were 16 men and 55 women with a mean age of 75.9 years. Sixty evacuees were surveyed when they gathered at the assembly hall in the temporary housing (Assembled group) and 11 evacuees were surveyed through individual visits to their residences (Individual group). Evacuees in the Individual group agreed to participate in this study, but refused to visit the assembly hall to engage in exercise and recreation. Pain, quality of life (QOL) and level of activity were assessed with the Numeric Rating Scale (NRS), the MOS Short-Form 36 item Health Survey (SF-36) and a pedometer, respectively. Student's t-test, Mann-Whitney U test, and Fisher's exact test were used for statistical analysis. RESULTS: Forty-four (62.0 %) residents had chronic pain with a mean NRS of 2.74. Twenty-one (29.6 %) of these residents had relatively severe pain rated 5 or above on the NRS. QOL was significantly lower for the subscales of "physical functioning," "role physical", "general health", "social functioning", "role emotional" and "mental health", when compared with the national standard values. Values were also visibly lower for "physical component summary" in the summary score. On comparing the Assembled group and the Individual group, "physical function", "role physical", "social functioning" and "physical component summary" were found to be significantly lower in the Individual group. The mean daily number of steps was 1,892 in the Individual group and 4,579 in the Assembled group. The Individual group thus significantly took less mean daily number of steps compared with the Assembled group. CONCLUSIONS: This study quantified the state of pain, QOL and activity of aged evacuees living in temporary housing after the Great East Japan Earthquake. The evacuees frequently had chronic pain and lower physical and mental QOL scores compared to the national standard values.

Glucose Uptake Is Decreased in Affected Lower Leg Muscles of Hemiparetic Persons during Level Walking.

Stroke patients suffer from gait disturbance due to altered leg muscle actions. Many kinesiological studies have investigated muscle actions, but the metabolic activity of muscles in stroke patients remains to be investigated. We therefore evaluated energy consumption in lower extremity muscles during level walking in hemiparetic individuals. Glucose uptake was measured by positron emission tomography (PET) using (18)F-fluorodeoxyglucose ((18)F-FDG) in eight hemiparetic (mean age: 56 years) and 11 healthy (mean age: 26 years) participants. Standardized uptake ratio (SUR) was computed in each muscle to express the (18)F-FDG-uptake level. SUR was compared across gluteal, thigh, and lower leg muscles and across individual muscles within each muscle group. For each muscle, SUR was compared among the paretic limb of hemiparetic participants, the non-paretic limb of hemiparetic participants, and the right limb of healthy participants. In paretic limbs, mean SUR did not differ between the three muscle groups, or between individual muscles within each muscle group. SURs of paretic lower leg muscles and gluteus minimus muscle were significantly smaller than those of non-paretic limb and healthy participants (p < 0.05). In the non-paretic limb of hemiparetic participants, SUR of the lower leg muscles was larger than that of the thigh muscles (p < 0.05). Unexpectedly, SURs of medial hamstring and posterior tibial muscles were larger in the non-paretic limb of hemiparetic participants, compared to the right limb of healthy participants (p < 0.05). (18)F-FDG PET is useful to evaluate energy consumption levels of lower extremity muscles during level walking in hemiparetic individuals.

Patient-reported disability in the general Japanese population was associated with medical care visits for low back pain, regardless of pain intensity.

BACKGROUND: Race/ethnicity is known to affect pain severity and the emotional aspects of pain, with medical care visits also reported to differ according to race/ethnicity. It has been hypothesized that there is an interactive relationship between pain intensity and patient-reported disability and that the interactive relationships are related to medical care visits. However, it remains unclear whether the association between patient-reported disability and medical care visits for low back pain (LBP) are dependent on the pain intensity. The aims of this study were to examine the prevalence of medical care visits among members of the Japanese general population and to analyze the association between patient-reported disability and medical care visits for LBP patients, regardless of the pain intensity. METHODS: From a random sample of the general Japanese population (n = 2962), we focused on those who experienced LBP within the past month. Subjects were asked about the number of medical care visits (medical clinic or complementary/alternative medical clinic) for LBP. Patient-reported disability was assessed using the Roland-Morris disability questionnaire (RDQ). Pain intensity of LBP was assessed by visual analog scale. To examine the association between RDQ and medical care visits among people with LBP, we used multiple logistic regression analysis and the trend analysis for the RDQ. RESULTS: Of 841 reporting LBP in the past month, 285 (33.9 %) visited a medical care facility. After adjusting for pain intensity and other confounding factors, the odds ratios for the RDQ categories 1-5, 6-10, 11-15, and ≥ 16 were compared with the RDQ categories 0, 1.13 (95 % CI 0.73-1.73), 2.05 (95 % CI 1.17-3.60), 2.21 (95 % CI 1.06-4.62), and 4.0 (95 % CI 1.60-9.98), respectively (p for trend <0.01). CONCLUSIONS: Patient-reported disability was associated with medical care visits for LBP, regardless of the pain intensity, with the results similar to those obtained for other races/ethnicities.

Computational psychological study of the Brief Scale for Psychiatric Problems in Orthopaedic Patients (BS-POP) for patients with chronic low back pain: verification of responsiveness.

BACKGROUND: We developed the Brief Scale for Psychiatric Problems in Orthopaedic Patients (BS-POP, physician and patient versions) and have previously shown that the BS-POP is reliable and has construct validity, criterion validity, and reproducibility. The present study aimed to proactively verify the responsiveness of the BS-POP with regard to chronic low back pain (LBP) patients. METHODS: The study subjects included 193 chronic LBP patients (81 males, 112 females; mean age 62 years) who had suffered from persistent LBP for ≥3 months. During the first test (before the treatment), the BS-POP, the Minnesota Multiphasic Personality Inventory (MMPI), the Profile of Mood States (POMS), the 36-item Short-form Health Survey version 2 (SF-36 v2), and the Roland-Morris Disability Questionnaire (RDQ) were conducted. The BS-POP, POMS, SF-36 v2, and RDQ for the third test were conducted (4-6 weeks after treatment) on all patients who had participated in the first test to determine the responsiveness of the BS-POP. The responsiveness of the BS-POP was investigated statistically. RESULTS: The total crude BS-POP scores were significantly lower for both physician and patient versions in the third test than in the first test. Moreover, the crude RDQ scores and SF-36 v2 items, physical functioning (PF), bodily pain (BP), MH, VT, and GH, and POMS items, tension-anxiety (T-A), D, F, and confusion (C) improved significantly, confirming responsiveness to treatment. DISCUSSION: The present findings indicate that the BS-POP possesses sufficient responsiveness from a computational psychology perspective. The BS-POP constitutes a tool enabling orthopaedists to easily identify psychiatric problems in orthopaedic patients.

Diagnostic accuracy of the Self-administered, Self-reported History Questionnaire for lumbar spinal stenosis patients in Japanese primary care settings: a multicenter cross-sectional study (DISTO-project).

BACKGROUND: Diagnostic support tools for lumbar spinal stenosis such as the Self-administered, Self-reported History Questionnaire have been developed in Japan, but no report has demonstrated the diagnostic accuracy of this questionnaire in Japanese primary care settings. This multicenter, cross-sectional survey was performed to evaluate and improve the diagnostic accuracy of this questionnaire for lumbar spinal stenosis patients in Japanese primary care settings. METHODS: The lumbar spinal stenosis diagnosis support tool project was conducted in 1657 hospitals to evaluate the diagnostic accuracy of the Self-administered, Self-reported History Questionnaire in Japan from 2011 to 2012. Consecutive adults (≥50 years old) from physicians, including non-orthopedic general practitioners and orthopedic general practitioners, were considered for enrollment. Consecutive adults (≥50 years old) with low back pain from hospital-based orthopedic surgeons were also considered for enrollment. The diagnostic accuracy of the Self-administered, Self-reported History Questionnaire with initial and several new cutoff points in classifying patients according to the presence of lumbar spinal stenosis was assessed in terms of sensitivity, specificity and negative predictive values. RESULTS: Among the 33,545 patients, 10,199 (30.4 %) were diagnosed with lumbar spinal stenosis by the physicians. The Self-administered, Self-reported History Questionnaire version 1.1 with a new cutoff point was more sensitive than the Self-administered, Self-reported History Questionnaire version 1.0 with the initial cutoff point (79.8 vs. 68.3 %) and less specific (68.8 vs. 75.1 %) for lumbar spinal stenosis diagnosis. The respective negative predictive values were 88.5 and 84.3 %. CONCLUSIONS: The Self-administered, Self-reported History Questionnaire version 1.1 with the new cutoff was more sensitive and had higher negative predictive value than version 1.0 with the initial cutoff. Therefore, the improved Self-administered, Self-reported History Questionnaire version 1.1 can be used for lumbar spinal stenosis screening, and its use may improve the quality of lumbar spinal stenosis diagnostic practice in Japanese primary care settings.

The effect of selective serotonin reuptake inhibitor (SSRI) on pain-related behavior in a rat model of neuropathic pain.

INTRODUCTION: Some antidepressants are effective for treating neuropathic pain independent of any effect on depression. Selective serotonin reuptake inhibitors (SSRIs) are one of the potential agents to treat neuropathic pain. The aims of this study were to compare the effects of SSRI and non-steroidal anti-inflammatory drugs (NSAIDs) on pain-related behavior and expression of cytokines in a rat model of neuropathic pain. MATERIALS AND METHODS: Spinal surgery was performed to apply nucleus pulposus (NP) to the dorsal root ganglion (DRG). NP animals were treated with saline (NP + S), meloxicam (NP + M), or low-dose or high-dose paroxetine (NP + PL and NP + PH), respectively. Behavioral testing was performed to investigate the mechanical withdrawal thresholds. The numbers of TNF-immunoreactive (IR) neurons in the DRG and of Iba1-IR microglia in the spinal cord (SC) were evaluated using immunohistochemistry. Expression of TNF in the DRG was examined using Western blots. RESULTS: The thresholds on days 14, 21, and 28 were higher in the drug-treated animals than in the NP + S group (p < 0.05). The number of TNF-IR neurons in DRGs from the NP + M group increased on day 2 and decreased on day 7, and TNF expression in DRGs was significantly higher in the NP + S group than in the NP + M group on days 7, 14. The number of Iba1-IR microglia in the SC was significantly higher in the NP + S group than in the NP + M, NP + PL, and NP + PH groups on days 7 and 14. CONCLUSION: An antidepressant might be a potential agent to treat lumbar disc herniation as well as NSAIDs.

Diagnostic value of the lumbar extension-loading test in patients with lumbar spinal stenosis: a cross-sectional study.

BACKGROUND: The gait-loading test is a well known, important test with which to assess the involved spinal level in patients with lumbar spinal stenosis. The lumbar extension-loading test also functions as a diagnostic loading test in patients with lumbar spinal stenosis; however, its efficacy remains uncertain. The purpose of this study was to compare the diagnostic value of the lumbar extension-loading test with that of the gait-loading test in patients with lumbar spinal stenosis. METHODS: A total of 116 consecutive patients (62 men and 54 women) diagnosed with lumbar spinal stenosis were included in this cross-sectional study of the lumbar extension-loading test. Subjective symptoms and objective neurological findings (motor, sensory, and reflex) were examined before and after the lumbar extension-loading and gait-loading tests. The efficacy of the lumbar extension-loading test for establishment of a correct diagnosis of the involved spinal level was assessed and compared with that of the gait-loading test. RESULTS: There were no significant differences between the lumbar extension-loading test and the gait-loading test in terms of subjective symptoms, objective neurological findings, or changes in the involved spinal level before and after each loading test. CONCLUSIONS: The lumbar extension-loading test is useful for assessment of lumbar spinal stenosis pathology and is capable of accurately determining the involved spinal level.

Does the fusion of a lumbar disk herniation improve the clinical outcome? an investigation with a minimum 10-year follow-up.

STUDY DESIGN: A retrospective long-term (minimum 10 y) follow-up and comparative study. OBJECTIVE: To compare the clinical outcome of surgically treated primary lumbar disk herniation (LDH) by conventional discectomy alone and discectomy with posterolateral fusion without instrumentation. SUMMARY OF BACKGROUND DATA: Primary LDH is usually treated by discectomy alone. The long-term outcome of discectomy alone is generally satisfactory. However, the superiority of a discectomy alone in comparison with a discectomy with fusion for primary LDH has yet to be determined. METHODS: Conventional discectomy without fusion was performed in 39 patients in hospital A (without-fusion group) and conventional discectomy with posterolateral fusion without instrumentation was performed in 109 patients in hospital B (with-fusion group). The subjective symptoms (analgesic use, continuing gait time, 4-grade modified outcome criteria, numerical rating scale of pain and satisfaction with the operation, and the Japanese version of the Roland-Morris Disability Questionnaire) and objective symptoms (straight leg raising test, manual muscle test, and sensory disturbance) were assessed. RESULTS: There were no differences detected in the subjective and objective symptoms between the without-fusion and with-fusion group. CONCLUSIONS: Routine fusion surgery for a primary LDH was therefore found to have no apparent benefit even in the long-term outcome.