Analysis of spinopelvic parameters in adult patients with lumbosacral transitional vertebrae.

PURPOSE: Spinopelvic sagittal alignment is crucial for assessing balance and determining treatment efficacy in patients with adult spinal deformity (ASD). Only a limited number of reports have addressed spinopelvic parameters and lumbosacral transitional vertebrae (LSTV). Our primary objective was to study spinopelvic sagittal parameter changes in patients with LSTV. A secondary objective was to investigate clinical symptoms and quality of life (QOL) in patients with LSTV. METHODS: In this study, we investigated 371 participants who had undergone medical check-ups for the spine. LSTV was evaluated using Castellvi's classification, and patients were divided into LSTV+ (type II-IV, L5 vertebra articulated or fused with the sacrum) and LSTV- groups. After propensity score matching for demographic data, we analyzed spinopelvic parameters, sacroiliac joint degeneration, clinical symptoms, and QOL for these two participant groups. Oswestry Disability Index (ODI) scores and EQ-5D (EuroQol 5 dimensions) indices were compared between the two groups. RESULTS: Forty-four patients each were analyzed in the LSTV + and LSTV- groups. The LSTV + group had significantly greater pelvic incidence (52.1 ± 11.2 vs. 47.8 ± 10.0 degrees, P = 0.031) and shorter pelvic thickness (10.2 ± 0.9 vs. 10.7 ± 0.8 cm, P = 0.018) compared to the LSTV- group. The "Sitting" domain of ODI (1.1 ± 0.9 vs. 0.6 ± 0.7, P = 0.011) and "Pain/Discomfort" domain of EQ-5D (2.0 ± 0.8 vs. 1.6 ± 0.7, P = 0.005) were larger in the LSTV + group. CONCLUSION: There was a robust association between LSTV and pelvic sagittal parameters. Clinical symptoms also differed between the two groups in some domains. Surgeons should be aware of the relationship between LSTV assessment, radiographic parameters and clinical symptoms.

Longitudinal impact of multi-segment spinal fixation surgery on mobility status and clinical outcomes in adult spinal deformity: a multicenter retrospective study.

PURPOSE: To investigate changes in postoperative mobility status in patients with ASD, and the determining factors that influence these changes and their impact on clinical outcomes, including the rate of home discharge and long-term mobility. METHODS: A total of 299 patients with ASD who underwent multi-segment posterior spinal fusion were registered in a multi-center database were investigated. Patient mobility status was assessed using walking aids and classified into five levels (1: independent, 2: cane, 3: walker, 4: assisted, and 5: wheelchair) preoperatively, at discharge, and after 2 years. We determined improvements or declines in the patient's mobility based on changes in the classification levels. The analysis focused on the factors contributing to the deterioration of postoperative mobility. RESULTS: Two years postoperatively, 87% of patients maintained or improved mobility. However, 27% showed decreased mobility status at discharge, associated with a lower rate of home discharge (49% vs. 80% in the maintained mobility group) and limited improvement in mobility status (35% vs. 5%) after 2 years. Notably, postoperative increases in thoracic kyphosis (7.0 ± 12.1 vs. 2.0 ± 12.4°, p = 0.002) and lower lumbar lordosis (4.2 ± 13.1 vs. 1.8 ± 12.6°, p = 0.050) were substantial factors in mobility decline. CONCLUSION: Postoperative mobility often temporarily decreases but generally improves after 2 years. However, an overcorrection in sagittal alignment, evidenced by increased TK, could detrimentally affect patients' mobility status. Transient mobility decline associated with overcorrection may require further rehabilitation or hospitalization. Further studies are required to determine the biomechanical effects of surgical correction on mobility.

Does global spinal alignment affect the use of walking aids after multi-segment spinal fixation for patients with ASD? A multicenter retrospective study.

PURPOSE: This study aimed to clarify the relation between global spinal alignment and the necessity of walking aid use in patients with adult spinal deformity (ASD) and to investigate the impact of spinal fixation on mobility status after surgery. METHODS: In total, 456 older patients with ASD who had multi-segment spinal fixation surgery and were registered in a multi-center database were investigated. Patients under 60 years of age and those unable to walk preoperatively were excluded. Patients were classified by their mobility status into the independent, cane, and walker groups. Comparison analysis was conducted using radiographic spinopelvic parameters and the previously reported global spine balance (GSB) classification. In addition, preoperative and 2 years postoperative mobility statuses were investigated. RESULTS: Of 261 patients analyzed, 66 used walking aids (canes, 46; walkers, 20). Analysis of preoperative radiographical parameters showed increased pelvic incidence and pelvic incidence-lumbar lordosis mismatch in the walker group and increased sagittal vertebral axis in the cane and walker groups versus the independent group. Analysis of GSB classification showed a higher percentage of walker use in those with severe imbalance (grade 3) in the sagittal classification but not in the coronal classification. While postoperative radiographical improvements were noted, there was no significant difference in the use of walking aids before and 2 years after surgery (P = 0.085). CONCLUSION: A significant correlation was found between "sagittal" spinal imbalance and increased reliance on walking aids, particularly walkers. However, the limitation of improvement in postoperative mobility status suggested that multiple factors influence the mobility ability of elderly patients with ASD.

An appropriate method for predicting the femoral angle on whole-body X-ray images from full-spine X-ray images.

INTRODUCTION: The importance of lower-limb compensation in patients with spinal malalignment due to spinal pathologies has been emphasized. The latest whole-body X-ray images (WBX) have enabled evaluations of whole-body alignment from head to toe. However, WBX is still not commonly available. Thus, the present study aimed to examine an alternative measurement method of the femoral angle on usual full-spine X-ray images (FSX) that approximates the femoral angle on WBX. METHODS: A total of 50 patients (age, 52.8 ± 25.3 years; female, n = 26; male, n = 24) underwent WBX and FSX. The following parameters were measured on lateral view X-rays: WBX and FSX femoral angle (angle between the femoral axis and a perpendicular line); FSX femoral distance (distance from the center of femoral head to the distal femur on FSX); WBX intersection length (length between the center of the femoral head and the intersection point [the point at which the line connecting the center of the femoral head and the midpoint of the femoral condyle intersects the center line of the femur] on WBX). RESULTS: The WBX femoral angle, and FSX femoral angle were 0.16 ± 4.2°, and -0.53 ± 4.1°, respectively. The FSX femoral distance was 102.7 ± 41.1 mm. An ROC curve analysis revealed that the cut-off value of the FSX femoral distance associated with minimal difference in the WBX and FSX femoral angles (<3°) was 73 mm (sensitivity 83.3%, specificity 87.5%, AUC 0.80). The WBX intersection length was 105.3 ± 27.3 mm. CONCLUSION: To calculate the femoral angle on FSX that approximates the WBX femoral angle, the femoral distance on FSX ≥73 mm is preferable. We suggest using the FSX femoral distance within the range of 80 mm-130 mm as a simple numerical value that meets all criteria.

The anatomical relationship between the celiac artery and the median arch ligament in degenerative spinal surgery.

BACKGROUND: This study aimed to characterize the anatomical relationship between the spine, the celiac artery (CA), and the median arcuate ligament using preoperative contrast-enhanced computed tomography (CT) images of patients with spinal deformity who underwent surgical correction. METHODS: This retrospective study included 81 consecutive patients (34 males, 47 females; average age: 70.2 years). The spinal level at which the CA originated, the diameter, extent of stenosis, and calcification were determined using CT sagittal images. Patients were divided into two groups: CA stenosis group and non-stenosis group. Factors associated with stenosis were examined. RESULTS: CA stenosis was observed in 17 (21%) patients. CA stenosis group had significantly higher body mass index (24.9 ± 3.9 vs. 22.7 ± 3.7, p = 0.03). In the CA stenosis group, J-type CA (upward angling of the course by more than 90° immediately after descending) was more frequently observed (64.7% vs. 18.8%, p < 0.001). The CA stenosis group had lower pelvic tilt (18.6 ± 6.7 vs. 25.1 ± 9.9, p = 0.02) than non-stenosis group. CONCLUSIONS: High BMI, J-type, and shorter distance between CA and MAL were risk factors for CA stenosis in this study. Patients with high BMI undergoing fixation of multiple intervertebral corrective fusions at the thoracolumbar junction should undergo preoperative CT evaluation of the anatomy of CA to assess the poteitial risk of celiac artery compression syndrome.

A nationwide multicenter study of the cost effectiveness of five leading drugs for pharmacological management of cervicobrachial symptoms.

BACKGROUND: Cervicobrachial pain frequently affects the quality of life (QOL) of the general public and has a significant economic impact on the health care systems of various countries. There are a number of treatment options for this disease, including widely-used drug therapy, but the effectiveness of each option is indeterminate, and there have been no published cost-effectiveness analysis studies so far. This prospective observational study aimed to examine the cost-effectiveness of drug treatment for cervicobrachial symptoms. METHODS: A 6-month medication regimen for each of five frequently-prescribed drugs for cervicobrachial symptoms was administered to 322 patients at 24 centers in Japan. Outcome measures, including of the EuroQol Group 5D, Short Form-8, and Visual Analog Scale (VAS), were investigated at baseline and every month thereafter. Incremental cost-effectiveness ratios (ICERs) of the drug cost to quality-adjusted life years (QALYs) were calculated. A stratified analysis of patient characteristics was also performed to identify baseline factors potentially affecting cost-effectiveness. RESULTS: The ICER of entire drug treatment for cervicobrachial symptoms was 7,491,640 yen. Compared with the reference willingness-to-pay, the ICER was assumed to not be cost-effective. A certain number of QALYs were gained during the first 3 months after the treatment intervention, but almost no QALYs were gained during the following 3 months. Stratified analysis showed that cost-effectiveness was extremely low for patients with high baseline VAS and high QOL. CONCLUSIONS: The available medications for cervicobrachial symptoms did not have excellent cost-effectiveness. Although a certain number of QALYs were gained during the first 3 months after medication, no QALYs were gained in the latter half of the study period, suggesting that it is not advisable to continue the medication needlessly. LEVEL OF EVIDENCE: II, prospective cohort study.

Meclozine ameliorates skeletal muscle pathology and increases muscle forces in mdx mice.

We screened pre-approved drugs for the survival of the Hu5/KD3 human myogenic progenitors. We found that meclozine, an anti-histamine drug that has long been used for motion sickness, promoted the proliferation and survival of Hu5/KD3 cells. Meclozine increased expression of MyoD, but reduced expression of myosin heavy chain and suppressed myotube formation. Withdrawal of meclozine, however, resumed the ability of Hu5/KD3 cells to differentiate into myotubes. We examined the effects of meclozine on mdx mouse carrying a nonsense mutation in the dystrophin gene and modeling for Duchenne muscular dystrophy. Intragastric administration of meclozine in mdx mouse increased the body weight, the muscle mass in the lower limbs, the cross-sectional area of the paravertebral muscle, and improved exercise performances. Previous reports show that inhibition of phosphorylation of ERK1/2 improves muscle functions in mouse models for Emery-Dreifuss muscular dystrophy and cancer cachexia, as well as in mdx mice. We and others previously showed that meclozine blocks the phosphorylation of ERK1/2 in cultured cells. We currently showed that meclozine decreased phosphorylation of ERK1/2 in muscles in mdx mice but not in wild-type mice. This was likely to be one of the underlying mechanisms of the effects of meclozine on mdx mice.

Impact of the hip joint mobility on whole-body sagittal alignment: prospective analysis in case with hip arthroplasty.

PURPOSE: To clarify the impact of restriction of hip extension on radiographic whole-body sagittal alignment with using postoperative changes of radiographical parameters for hip osteoarthritis. METHODS: We prospectively enrolled 68 patients with hip osteoarthritis scheduled for arthroplasty. Variables included manual examination of hip range of motion (H-ROM) and radiographic whole-body sagittal alignment parameters including sagittal vertical axis (SVA), center of acoustic meatus and femoral head offset (CAM-HA), thoracic kyphosis (TK), lumbar lordosis, sacral slope (SS), and knee flexion angle (KF). We divided patients with preoperative hip extension angle < 0 into the extension restriction (ER) + group and ≥ 0 into the ER- group. Differences in H-ROM, radiographic parameters between groups and postoperative changes were comparatively analyzed. RESULTS: Fifty-seven patients (The ER + group included 28 patients and the ER- group included 29 patients.) were available for the analysis. Pre-/postoperative H-ROM were 99.7 ± 24.9/118.1 ± 16.0 degrees (p < .01). Greater increases in SVA (5.4 ± 3.4 vs 3.4 ± 2.8 cm, p = .02) and in CAM-HA (3.9 ± 3.9 vs 2.8 ± 3.4 cm, p = 013) were found in the ER + group versus ER- group. Postoperatively, the ER + group showed an increase in TK (pre-/postoperative: 35.2 ± 9.7/37.4 ± 8.8 degrees, p = .04) and decreases in SS (36.5 ± 9.6/33.7 ± 9.9 degrees, p < .01) and KF (9.5 ± 7.0/6.9 ± 6.0 degrees, p = .02). Postoperative changes in radiographic parameters in the ER- group were not significant. CONCLUSION: Patients with restriction of hip extension showed global spine imbalance, and significant changes in TK, SS, and KF were observed after arthroplasty. The presence of hip joint disorder and H-ROM restriction must be considered when evaluating spinopelvic alignment and whole-body sagittal alignment.

The impact of diabetes mellitus on spinal fracture with diffuse idiopathic skeletal hyperostosis: A multicenter retrospective study.

BACKGROUND: Patients with diffuse idiopathic skeletal hyperostosis (DISH) are susceptible to spinal column injuries with neurological deterioration. Previous studies indicated that the prevalence of diabetes mellitus (DM) in patients with DISH was higher than that in patients without DISH. This study investigates the impact of DM on surgical outcomes for spinal fractures in patients with DISH. METHODS: We retrospectively evaluated 177 spinal fractures in patients with DISH (132 men and 45 women; mean age, 75 ± 10 years) who underwent surgery from a multicenter database. The subjects were classified into two groups according to the presence of DM. Perioperative complications, neurological status by Frankel grade, mortality rate, and status of surgical site infection (SSI) were compared between the two groups. RESULTS: DM was present in 28.2% (50/177) of the patients. The proportion of men was significantly higher in the DM group (DM group: 86.0% vs. non-DM group: 70.1%) (p = 0.03). The overall complication rate was 22.0% in the DM group and 19.7% in the non-DM group (p = 0.60). Poisson regression model revealed that SSI was significantly associated with DM (DM group: 10.0% vs. non-DM group: 2.4%, Relative risk: 4.5) (p = 0.048). Change in neurological status, mortality rate, instrumentation failure, and nonunion were similar between both groups. HbA1c and fasting blood glucose level (SSI group: 7.2% ± 1.2%, 201 ± 67 mg/dL vs. non-SSI group: 6.6% ± 1.1%, 167 ± 47 mg/dL) tended to be higher in patients with SSI; however, there was no significant difference. CONCLUSIONS: In spinal fracture in patients with DISH, although DM was an associated factor for SSI with a relative risk of 4.5, DM did not negatively impact neurological recovery. Perioperative glycemic control may be useful for preventing SSI because fasting blood glucose level was high in patients with SSI.

Risk factors for delayed diagnosis of spinal fracture associated with diffuse idiopathic skeletal hyperostosis: A nationwide multiinstitution survey.

BACKGROUND: Patients with DISH are susceptible to spinal fractures and subsequent neurological impairment, including after minor trauma. However, DISH is often asymptomatic and fractures may have minimal symptoms, which may lead to delayed diagnosis. The purpose of this study was to identify risk factors for delayed diagnosis of spinal fractures in patients with diffuse idiopathic skeletal hyperostosis (DISH). METHODS: The subjects were 285 patients with DISH surgically treated at 18 medical centers from 2005 to 2015. Cause of injury, imaging findings, neurological status at the times of injury and first hospital examination, and the time from injury to diagnosis were recorded. A delayed diagnosis was defined as that made >24 h after injury. RESULTS: Main causes of injury were minor trauma due to a fall from a standing or sitting position (51%) and high-energy trauma due to a fall from a high place (29%) or a traffic accident (12%). Delayed diagnosis occurred in 115 patients (40%; 35 females, 80 males; mean age 76.0 ± 10.4 years), while 170 (60%; 29 females, 141 males; mean age 74.6 ± 12.8 years) had early diagnosis. Delayed group had a significantly higher rate of minor trauma (n = 73, 63% vs. n = 73, 43%), significantly more Frankel grade E (intact neurological status) cases at the time of injury (n = 79, 69% vs. n = 73, 43%), and greater deterioration of Frankel grade from injury to diagnosis (34% vs. 8%, p < 0.01). In multivariate analysis, a minor trauma fall (OR 2.08; P < 0.05) and Frankel grade E at the time of injury (OR 2.29; P < 0.01) were significantly associated with delayed diagnosis. CONCLUSION: In patients with DISH, it is important to keep in mind the possibility of spinal fracture, even in a situation in which patient sustained only minor trauma and shows no neurological deficit. This is because delayed diagnosis of spinal fracture can cause subsequent neurological deterioration.

Weakness of grip strength reflects future locomotive syndrome and progression of locomotive risk stage: A 10-year longitudinal cohort study.

Objectives: Grip strength is a simple indicator of physical function. The goal of this retrospective study was to examine whether grip strength reflects locomotive syndrome and locomotive risk stage 10 years later.Methods: The participants were 88 Japanese adults aged >40 years who attended a health check-up in 2006. Relationships of baseline grip strength with physical performance and locomotive risk stage after 10 years were assessed in males and females.Results: The 88 subjects (31 males, 57 females; average age 61.6 in 2006) were followed for 10 years. Grip strength in 2006 had significant positive correlations with grip strength and back muscle strength, and negative correlations with 10 m-gait time and 3m Timed Up and Go (3m-TUG) test after 10 years (p < .05). Subjects with higher and lower grip strength in 2006 did not differ significantly in age, but had significant differences in physical performance, GLFS-25 (25-question Geriatric Locomotive Function Scale) scores and locomotive risk stage after 10 years (p < .05). Same result was also obtained in the examination by gender.Conclusion: Weak grip strength was significantly related to future physical status, and these findings were unaffected by age. Weak grip strength could be a risk factor for future locomotive syndrome and locomotive risk in community-dwelling people.

Characteristics of multi-channel Br(E)-MsEP waveforms for the lower extremity muscles in thoracic spine surgery: comparison based on preoperative motor status.

PURPOSE: To evaluate the characteristics of brain-evoked muscle action potential [Br(E)-MsEP] waveforms of lower limb muscles in thoracic spine surgery. METHODS: The subjects were 159 patients who underwent thoracic spine surgery with intraoperative Br(E)-MsEP monitoring from January 2009 to December 2015, using a total of 2226 muscles in the extremities. The waveform derivation rate for each lower extremity muscle was examined at baseline and intraoperatively. Data were interpreted based on the preoperative motor status. RESULTS: The preoperative ambulatory and non-ambulatory rates were 38% (60/159, McCormick grades I and II) and 62% (99/159, grades III-V), respectively. Eleven cases (all non-ambulatory) had undetectable baseline waveforms in all muscles, and in 19 cases (12%) a baseline waveform could only be derived from the abductor hallucis (AH). The waveform derivation rate in all lower limb muscles was significantly higher in ambulatory cases (p < 0.05), and the rates for the AH were the highest in both groups (p < 0.05). Postoperative paralysis occurred in 31 cases (19%). A decrease in intraoperative amplitude of ≥ 70% from baseline occurred in 54 cases and had sensitivity of 100% and specificity of 82% for prediction of postoperative motor deficit. CONCLUSIONS: This is the first study of Br(E)-MsEP waveforms for each lower limb muscle based on preoperative ambulatory status. Detection of waveforms from distal muscles was still possible in a case with preoperative motor deficit, and the AH had an especially high derivation rate, even in cases with preoperative muscle weakness. Collectively, the results support use of Br(E)-MsEP monitoring using the AH in the lower extremities.

Variety of preoperative MRI changes in spinal cord ependymoma of WHO grade II: a case series.

PURPOSE: To report a case series of surgically proven spinal ependymomas of WHO grade II in which there were changes in the preoperative MRI characteristics over time. METHODS: A total of 71 patients with spinal cord ependymoma of WHO grade II underwent surgery. There were ten cases in which surgery was performed at an average of 2.2 years after the tumor was found. Cystic components, syringomyelia, hemorrhage "cap sign," Gd enhancement pattern, characteristic changes in MRI, MIB-1 index, and neurological assessment during the preoperative period were examined. RESULTS: Cases with a huge cyst showed further enlargement of the cyst on the caudal and rostral sides with hemosiderin formation over time and changes in the pattern of Gd enhancement. In contrast, cases without initial cyst did not show cyst formation, and nodular homogeneous lesion remained without changes in Gd enhancement. Regarding neurological status, two cases with cyst enlargement and hemosiderin formation had worsened non-independent gait preoperatively. CONCLUSIONS: MRI in cases of spinal ependymomas of WHO grade II showed characteristics such as hemorrhage and cyst formation that varied over time. In particular, cases with cyst and hemosiderin showed tumor enlargement, including enlargement of lesions on the caudal and rostral sides and enlargement of Gd-enhanced lesions. These characteristics might influence gait ability during preoperative period. We emphasize that early surgery is still the standard of care for cervical intramedullary ependymoma, and our findings in this study should not be interpreted to indicate that such early surgery is not necessary in symptomatic cases. These slides can be retrieved under electronic supplementary material.

Increasing postural sway in balance test is related to locomotive syndrome risk: A cross-sectional study.

BACKGROUND: Locomotive syndrome risk level has been recently proposed to evaluate physical ability. Impaired balance control is one of the most important risk factors for falls. However, the relationship between locomotive syndrome risk and postural sway according to the balance test is unclear. This study aimed to investigate the relationship between locomotive syndrome risk and balance test results, including muscle mass and physical function, in a large-scale prospective general health checkup. METHODS: We enrolled 292 participants who underwent a basic health checkup and conducted a two-step test, stand-up test, evaluation using a 25-question geriatric locomotive function scale for the locomotive syndrome risk test, balance test, appendicular skeletal muscle mass measurement by bioelectrical impedance analysis, evaluation of physical function by the timed-up-and-go test, and back muscle and grip strength evaluation. A statistical comparative study was then conducted between normal and locomotive syndrome risk groups. Subsequently, significant factors for locomotive syndrome risk were investigated by multivariate analysis. RESULTS: The comparative study was conducted by adjusting age and sex using a generalized linear model. No significant difference in muscle mass existed, but postural sway in the balance test significantly increased in the people at locomotive syndrome risk. Among the four posturographic variables by balance test, increase in back-and-forth sway was the most remarkable variable associated with locomotive syndrome risk together with back muscle strength, body mass index, and the timed-up-and-go test by logistic regression analysis. This posturographic variable was significantly related to the timed-up-and-go test and leg skeletal muscle mass by multiple regression analysis. CONCLUSIONS: A relationship was recognized between locomotive syndrome risk and postural sway. In particular, increase in back-and-forth sway was an important factor for locomotive syndrome risk. If the balance test shows an increase in back-and-forth sway, attention should be paid to locomotive syndrome risk for possible intervention and early treatment.

Spinal fractures in patients with Diffuse idiopathic skeletal hyperostosis:A nationwide multi-institution survey.

BACKGROUND: Diffuse idiopathic skeletal hyperostosis (DISH) increases the spine's susceptibility to unstable fractures that can cause neurological deterioration. However, the detail of injury is still unclear. A nationwide multicenter retrospective study was conducted to assess the clinical characteristics and radiographic features of spinal fractures in patients with DISH. METHODS: Patients were eligible for this study if they 1) had DISH, defined as flowing ossification along the anterolateral aspect of at least four contiguous vertebral bodies, and 2) had an injury in the ankylosing spine. This study included 285 patients with DISH (221 males, 64 females; mean age 75.2 ± 9.5 years). RESULTS: The major cause of injury was falling from a standing or sitting position; this affected 146 patients (51.2%). Diagnosis of the fracture was delayed in 115 patients (40.4%). Later neurological deterioration by one or more Frankel grade was seen in 87 patients (30.5%). The following factors were significantly associated with neurological deficits: delayed diagnosis (p = 0.033), injury of the posterior column (p = 0.021), and the presence of ossification of the posterior longitudinal ligament (OPLL) (p < 0.001). The majority of patients (n = 241, 84.6%) were treated surgically, most commonly by conventional open posterior fixation (n = 199, 69.8%). Neurological improvement was seen in 20.0% of the conservatively treated patients, and in 47.0% of the patients treated surgically. CONCLUSIONS: Minor trauma could cause spinal fractures in DISH patients. Delayed diagnosis, injury of the posterior column, and the presence of OPLL were significantly associated with neurological deterioration. Patients with neurological deficits or unstable fractures should be treated by fixation surgery.

Relationship between locomotive syndrome and body composition among community-dwelling middle-age and elderly individuals in Japan: The Yakumo study.

OBJECTIVES: Locomotive syndrome (LS) is a condition requiring nursing care for musculoskeletal disorders. Our aim was to evaluate the correlation between body composition, measured by bioelectrical impedance analysis (BIA), and LS, measured using the 25-question Geriatric Locomotive Functional Scale (GLFS-25). METHODS: We enrolled 286 individuals who were undergoing regular health follow-up. All individuals completed the GLFS-25, body composition analysis by BIA, and five physical performance tests related to LS: timed up-and-go test, 10-m gait time, maximum stride length, back strength, and grip strength. Measured variables and demographic data were compared between individuals with and without LS. RESULTS: The extracellular water ratio, the extracellular water/total body water (ECW/TBW) ratio differentiated the LS and non-LS groups (p=.005), with all physical function measures being lower among individuals with a high, compared to low, ECW/TBW ratio. The risk ratio for LS among individuals with a high ECW/TBW ratio was 2.31, with an odds ratio of 2.67. CONCLUSION: The ECW/TBW ratio is predictive of LS. Based on our results, we propose that BIA should routinely be performed, with follow-up and intervention, as needed, for individuals with a high ECW/TBW ratio, as they are at risk for developing LS.

The decrease in phase angle measured by bioelectrical impedance analysis reflects the increased locomotive syndrome risk in community-dwelling people: The Yakumo study.

OBJECTIVES: The locomotive syndrome (LS) risk test has recently been advocated for the evaluation of physical ability. Phase angle measurement by bioelectrical impedance analysis (BIA) is an indicator of cellular health and muscle mass. We aimed to investigate how muscle mass and phase angle are related to LS risk stage. METHODS: A prospective cohort study was conducted in 311 patients who were undergoing a health checkup. All participants performed the two-step test, stand-up test, and 25-question geriatric locomotive function scale components of the LS risk test. Muscle mass and phase angle were measured using BIA. A comparison study was conducted among the three LS risk stages. RESULTS: In the trend test, phase angle decreased significantly as the LS risk stage progressed, whereas muscle mass did not show a significant difference. After adjusting for age and sex, phase angle showed a significant difference among all LS risk stages. Muscle mass did not show a significant difference between no risk and stage 1. CONCLUSION: Compared to muscle mass, phase angle more strongly reflects LS risk and becomes significantly reduced at later LS risk stages. Phase angle can be a useful screening tool for LS risk.

Predictors of locomotive syndrome in community-living people: A prospective five-year longitudinal study.

Objectives: Locomotive syndrome (LS) in middle-aged and elderly people has a high risk of a need for nursing care. The goal of the study was to examine predictors of LS in a prospective longitudinal study. Methods: The subjects were 205 people (87 males, 118 females) aged >40 years who underwent physical examinations and completed health questionnaires in health checkups in the Yakumo study in 2011 and 2016. LS was defined as ≥16 on the 25-Question Geriatric Locomotive Function Scale (GLFS-25). Subjects with LS in 2011 were excluded. Associations of all variables with the GLFS-25 score were analyzed using univariate and multivariate analyses. A receiver operating characteristic (ROC) curve for each physical measurement test was constructed to determine the best threshold value. Results: The subjects were divided into LS (n = 21) and non-LS (n = 184) groups, based on the 2016 checkup. In multivariate analysis, GLFS-25 (odds ratio [OR] = 1.437; p < 0.01), one-leg standing time (OR= 1.043, p < 0.05), and back muscle strength (OR =0.961, p <0.05) were significant predictors of LS. ROC analyses gave GLFS-25 scores of 6.2 and 6.8, one-leg standing times of 26.8 and 23.3 s, and back muscle strengths of 75.2 and 49.5 kg as thresholds for prediction of future LS in males and females, respectively. Conclusions: GLFS-25 score, one-leg standing time, and back muscle strength were identified as significant risk factors for LS in community-dwelling people, and threshold values were determined for these factors in a longitudinal study. For elderly people, these indicators could be predictors of locomotive syndrome, and may have validity for assessment of improvement of physical abilities through muscle training and body balance training.

Predictors of presarcopenia in community-dwelling older adults: A 5-year longitudinal study.

Objectives: Sarcopenia is an aging-induced decrease in muscle mass that increases frailty and fall in elderly people. Presarcopenia corresponds to the preliminary stage of sarcopenia. The purpose of this prospective study is to examine predictors of presarcopenia in health screening.Methods: The subjects were 124 community residents aged ≥60 years (55 males, 69 females, average age 70.2 years) who attended local government health checkups in 2010 and 2015, as part of the Yakumo study, and did not have presarcopenia in 2010. Body mass index (BMI), waist and hip circumferences, grip strength, bone mineral density (BMD), 10-m gait time, back muscle strength, and stride length were measured. Presarcopenia was defined using the appendicular skeletal muscle index (arm and leg skeletal muscle mass/height2).Results: The prevalences of presarcopenia in 2015 in males and females were 21.8% (12/55) and 30.4% (21/69), respectively. BMI, grip strength, BMD, back muscle strength, and osteoporosis deteriorated significantly more in the pre-sarcopenia group (n = 33) compared with controls (n = 91; no presarcopenia in 2015). In multivariate analysis, osteoporosis (OR 3.12, 95% CI 1.07-9.09; p < .05) was significantly associated with presarcopenia after 5 years.Conclusions: Establishment of risk factors for future pre-sarcopenia may allow development of evidence-based prevention strategies for this condition.

Surgical intervention for a pediatric isolated intramedullary spinal aneurysm.

PURPOSE: To report the case of a pediatric patient with intramedullary spinal aneurysm. METHODS: A 9-year-old boy presented with low back pain and subsequent gait disturbance. He had no history of trauma. After admission, MRI revealed an intramedullary spinal cord mass lesion surrounded by hemorrhage at the cervical-thoracic junction. Initial treatment was started with intravenous methylprednisolone and bed rest. Neurological deficit disappeared under careful observation for a few months. Surgical intervention was applied for diagnosis and resection of the mass lesion to prevent recurrent hemorrhage. RESULTS: Intraoperative ultrasound sonography helped to diagnose the lesion as a spinal cord aneurysm, prior to midline myelotomy. Monitoring of transcranial muscle evoked potentials helped to avoid spinal cord damage during surgery. There has been no evidence of spinal aneurysm on MRI for 3 years after surgery and no neurological deterioration. CONCLUSION: To our knowledge, this is a first report of an intramedullary spinal cord aneurysm at the cervical-thoracic junction in a pediatric patient. Careful observation after initial symptoms followed by surgical intervention was favorable in this case.