Amputation surgery associated with shortened survival in patients with localized soft tissue sarcoma.

BACKGROUND: The objectives of this study were to clarify whether localized extremity soft tissue sarcoma (STS) patients who underwent amputation surgery experienced worsened survival and to identify those patients for whom amputation surgery worsened survival. METHODS: Using the Surveillance, Epidemiology, and End Results database, we identified 8897 patients with localized extremity STS between 1983 and 2016. Of these 6431 patients, 733 patients underwent amputation surgery (Amputation group), and 5698 underwent limb-sparing surgery (Limb-sparing group). RESULTS: After adjusting for patient background by propensity score matching, a total of 1346 patients were included. Patients in the Amputation group showed worsened survival (cancer-specific survival (CSS): hazard ratio (HR) = 1.42, 95% confidence interval (CI) 1.15-1.75, overall survival (OS): HR = 1.41, 95%CI 1.20-1.65). In subclass analysis, patients with high-grade STS, spindle cell sarcoma and liposarcoma in the Amputation group showed shortened survival (high-grade-CSS: HR = 1.44, 95%CI 1.16-1.77, OS: HR = 1.38, 95%CI 1.18-1.62; spindle cell sarcoma-CSS: HR = 4.75, 95%CI 1.56-14.4, OS: HR = 2.32, 95%CI 1.45-3.70; liposarcoma-CSS: HR = 2.91, 95%CI 1.54-5.50, OS: HR = 2.32, 95%CI 1.45-3.70). CONCLUSIONS: Survival was shortened in localized extremity STS patients who received amputation surgery.

Comparison of difficulty in stair ascent and descent after total knee replacement.

[Purpose] Although many studies have shown that patients have difficulty in climbing or descending stairs after undergoing total knee replacement, no study so far has compared the difficulty of stair ascent and descent based on objective indicators. This study compared stair ascending and descending processes based on three indicators and clarified which was more difficult. [Participants and Methods] We defined 1) movement method, 2) the necessity for handrail use, and 3) speed as objective indicators. Seventy-eight patients who underwent total knee replacement participated in this study. Three months after the surgery, we examined 1) whether the patients could ascend or descend in a step-over-step or step-by-step manner, 2) whether the patients required handrail support, and measured 3) the time required to ascend and descend for four steps. [Results] The step-by-step movement and handrail requirement rates associated with stair descent were higher than the corresponding rates associated with stair ascent. In addition, the time required for stair descent was greater than that required for ascent. [Conclusion] We found that stair descent was more challenging than stair ascent in terms of all three objective indices: movement method, handrail use, and speed. The results indicate that rehabilitation after total knee replacement should focus more on stair descent than on stair ascent.

Posterolateral full-endoscopic debridement and irrigation is effective in treating thoraco-lumbar pyogenic spondylodiscitis, except in cases with large abscess cavities.

PURPOSE: To determine the efficacy and poor prognostic factors of posterolateral full-endoscopic debridement and irrigation (PEDI) surgery for thoraco-lumbar pyogenic spondylodiscitis. METHODS: We included 64 patients (46 men, 18 women; average age: 63.7 years) with thoracic/lumbar pyogenic spondylodiscitis who had undergone PEDI treatment and were followed up for more than 2 years. Clinical outcomes after PEDI surgery were retrospectively investigated to analyze the incidence and risk factors for prolonged and recurrent infection. RESULTS: Of 64 patients, 53 (82.8%) were cured of infection after PEDI surgery, and nine (17.2%) had prolonged or recurrent infection. Multivariate analysis demonstrated that significant risk factors for poor prognosis included a large intervertebral abscess cavity (P = 0.02) and multilevel intervertebral infections (P < 0.05). CONCLUSION: PEDI treatment is an effective, minimally invasive procedure for pyogenic spondylodiscitis. However, a large intervertebral abscess space could cause instability at the infected spinal column, leading to prolonged or recurrent infection after PEDI. In cases with a large abscess cavity with or without vertebral bone destruction, endoscopic drainage alone may have a poor prognosis, and spinal fixation surgery could be considered.

Real-world persistence of twice-weekly teriparatide and factors associated with the discontinuation in patients with osteoporosis.

INTRODUCTION: A 28.2 µg twice-weekly formulation of teriparatide (2/W-TPD) was developed to provide comparably high efficacy for osteoporosis to a 56.5 µg once-weekly formulation while improving the safety and persistence rate. In the current study, we aimed to elucidate the real-world persistence of 2/W-TPD and to identify the factors associated with the discontinuation of 2/W-TPD in patients with severe osteoporosis. MATERIALS AND METHODS: This retrospective study included 90 patients who were treated with 2/W-TPD at three hospitals in Japan. Patient information was collected, including age, sex, distance to the hospital, family structure, comorbidities, previous treatment for osteoporosis, timing of the injection, side effects and duration of 2/W-TPD treatment, barthel index (BI), and bone mineral density (BMD) of the lumbar spine and femoral neck. We examined the factors influencing 2/W-TPD discontinuation using the Cox proportional hazards model. RESULTS: The 12 month completion rate of 2/W-TPD therapy was 47.5%. The Cox hazard analysis identified side effects [Hazard Ratio (HR) = 14.59, P < 0.001], low BMD of the femoral neck (HR = 0.04, P = 0.002), and morning injection (HR = 3.29, P = 0.006) as risk factors influencing the discontinuation of 2/W-TPD. Other variables, including age, did not contribute to the continuation of 2/W-TPD. CONCLUSION: One year continuation rate of 2/W-TPD was higher than the previously reported value of the once-weekly formulation in real-world setting, probably due to the lower incidence of side effects. Introducing injection of 2/W-TPD may further improve the persistence of TPD therapy for osteoporosis.

Association between obesity and ossification of spinal ligaments in 622 asymptomatic subjects: a cross-sectional study.

INTRODUCTION: Previous studies on patients with symptoms of spinal ligament ossification, including ossification of the posterior longitudinal ligament (OPLL) and ligamentum flavum (OLF), have not clarified whether obesity is a cause or consequence of these diseases and were limited by selection bias. Thus, we investigated the association between obesity and the prevalence of spinal ligament ossification in randomly selected asymptomatic subjects. MATERIALS AND METHODS: Between April 2020 and March 2021, 622 asymptomatic Japanese subjects who underwent computed tomography of neck to pelvis for medical check-up purposes were included. All subjects were divided into the following three groups: normal weight (body mass index [BMI] < 25 kg/m2), obese I (25 ≤ BMI < 30 kg/m2), and obese II (BMI ≥ 30 kg/m2). The relationship between factors affecting the presence of each spinal ligament ossification was evaluated using multivariate logistic regression analysis. RESULTS: The proportion of subjects with thoracic OPLL was significantly higher in the obese II group than in the other two groups (vs. normal weight, P < 0.001; vs. obese I, P < 0.001). BMI was associated with the prevalence of OLF, cervical OPLL, thoracic OPLL, and ossification of the anterior longitudinal ligament (OALL). BMI was most significantly associated with the prevalence of thoracic OPLL (ß, 0.28; 95% confidence interval, 0.17-0.39). CONCLUSION: BMI was associated with the prevalence of OALL, cervical OPLL, thoracic OPLL, and OLF in asymptomatic subjects, suggesting that obesity is associated with the development of heterotopic ossification of the spinal ligaments.

Risk factors of multidrug-resistant pyogenic spondylitis in thoraco-lumbar spine: A retrospective study of 122 cases.

BACKGROUND: The number of spinal infections has been increasing in developed countries due to the increase of aged or immunosuppressed patients. Spondylitis caused by multidrug-resistant (MDR) bacterial infection often become intractable and require long-term antibiotic therapy and multiple surgeries. Therefore, it is of great importance to understand risk factors for MDR spinal infections. The aim of this study was to elucidate the risk factors for MDR bacterial spondylitis. METHODS: A total of 122 patients (82 men, 40 women; average age: 63.8 y) with thoracic/lumbar spondylitis who underwent posterolateral full-endoscopic debridement and irrigation were included. The organisms detected by this endoscopic procedure were investigated, and the incidence and risk factors for MDR bacterial infection were retrospectively analyzed. RESULTS: Cultures of specimens obtained by endoscopic procedures were positive in 78 patients (63.9%). Among 68 isolated bacteria, MDR bacteria accounted for 47.1%. Multivariate analysis showed that significant risk factors for MDR bacterial infection included autoimmune connective tissue disease (P = 0.03) and central venous catheter (P = 0.02). The incidence of MDR bacteria in patients who were administered a broad-spectrum antibiotic for more than 1 month preoperatively was 64.0%, which was significantly higher than in patients who were administered a broad-spectrum antibiotic for less than 1 month and patients who were administered a narrow-spectrum antibiotic (P < 0.01, P < 0.01, respectively). CONCLUSIONS: The significant risk factors for MDR bacterial spondylitis included immunosuppressed conditions, such as autoimmune connective tissue disease, presence of central venous catheter, and longer administration periods of a broad-spectrum antibiotic. In patients with pyogenic spondylitis who could not be controlled with previous antibiotics and whose result of culture was negative, administration of anti-MRSA antibiotics would be considered when they have the risk factors identified in this study.

Throwing distance and competitive performance of Boccia players.

[Purpose] This study aimed to clarify the relationship between throwing distance and competitive performance in Boccia players in order to establish a training program based on this evidence. [Participants and Methods] In total, 40 athletes, who competed in the Japan Boccia Championships and are certified players of the Japan Boccia Association, participated in the study. Participants threw the Boccia ball as far as possible, and throwing distances were compared between certified players (Group I, n=8), those who participated in the final round (Group II, n=9), and those who lost in the preliminary round (Group III, n=23). [Results] The maximum throwing distances were 16.38 ± 5.17 m (Group I), 10.67 ± 2.66 m (Group II), and 8.34 ± 2.73 m (Group III). Group I threw the ball significantly farther than Groups II and III. [Conclusion] Boccia is a target sport and throwing farther distances requires more effort. In addition, being able to throw at a longer distance means that Boccia players can throw a stronger ball and use this for various tactics. The results of this study suggest that long-distance throwing training would be effective in improving the competitive performance of Boccia players.

Increased risk of symptomatic progression of instability following decompression for lumbar canal stenosis in patients receiving chronic glucocorticoids therapy.

BACKGROUND: Lumbar decompression surgery is a commonly used treatment for degenerative lumbar spinal stenosis; however, some patients develop symptomatic spinal instability following decompression surgery. The objective of this study was to reveal risk factors for delayed instability following decompression surgery for lumbar spinal stenosis. METHODS: One hundred ten patients who underwent single-level lumbar decompression between 2008 and 2014 were retrospectively reviewed. Surgical indication for decompression surgery was symptomatic lumbar canal stenosis without spondylolisthesis or with minimum spondylolisthesis (less than 4 mm translation). Patients with gross segmental motion (>10° in disc angle, >2 mm translation) on flexion-extension lumbar radiographs were excluded. Age, sex, body mass index, smoking history, diabetes mellitus, autoimmune connective tissue diseases including rheumatoid arthritis, and the use of glucocorticoids were investigated. Radiographic measurements included disc angle, disc height, slippage, facet angle, segmental motion (flexion-extension), lumbar alignment, facet effusion, and disc degeneration. Data were analyzed using multivariate forward selection stepwise logistic regression, chi-square tests, and Student t-test. RESULTS: Six of 110 patients (5.5%) developed symptomatic spinal instability at the operative level and underwent spinal fusion surgery at an average of 2.1 years postoperatively. Autoimmune connective tissue disorders and chronic use of glucocorticoids were associated with the occurrence of symptomatic spinal instability requiring spine fusion surgery, while there was no significant difference in radiographic parameters and demographic factors excluding autoimmune connective tissue diseases between reoperation and non-reoperation groups. CONCLUSIONS: Patients with autoimmune connective tissue disorders receiving chronic glucocorticoid therapy are more likely to develop symptomatic spinal instability following decompression surgery for lumbar canal stenosis without or with minimal spondylolisthesis.

Different improvement trends in gait function and quadriceps strength early after total knee arthroplasty.

[Purpose] Improved quadriceps strength is a primary target of rehabilitation early after total knee arthroplasty. However, patients demonstrate varying improvement trends in gait function and quadriceps strength. This study evaluated the relationship between improvements in quadriceps strength and gait function. [Participants and Methods] The study included 49 patients who were scheduled to undergo unilateral total knee arthroplasty. Gait function, bilateral quadriceps strength, and pain were assessed in all patients. All assessments were performed preoperatively and at 2 and 3 weeks postoperatively. [Results] A significant correlation between gait function and the quadriceps strength on the operated side was observed preoperatively and 3 weeks postoperatively. The quadriceps strength on the non-operated side was significantly correlated with gait function at all time points. Multiple regression analysis showed that the quadriceps strength on the non-operated side was significantly associated with gait function, except the gait speed at 2 weeks. However, the quadriceps strength on the operated side was not observed to be an independent variable at all time points. [Conclusion] The quadriceps strength on the operated side is not an important determinant of gait function. It may be necessary to reconsider typical rehabilitation programs by focusing on the quadriceps strength on the operated side in patients undergoing total knee arthroplasty.

Peri-operative complications of lumbar spine surgery in patients over eighty five years of age: a retrospective cohort study.

PURPOSE: To compare peri-operative complication rates in ≥ 85-year-old patients who underwent decompression surgery with or without instrumented fusion for degenerative disorders. METHODS: This study involved 907 patients who underwent lumbar spine surgery for degenerative disorders between January 2006 and June 2012. Of these, 33 patients (3.6% of the entire population) were over 85 years of age (85-94 years). Decompression-alone and instrumentation groups were compared in terms of comorbidities, American Society of Anesthesiologists (ASA)-physical status (PS) class, peri-operative complications, and Japanese Orthopedic Association (JOA) scores. RESULTS: Thirty-three ≥ 85-year-old patients underwent surgery. All were ASA-PS class 2 (94%) or 3. The decompression-alone (n = 19) and instrumentation (n = 14) groups did not differ in comorbidity (95 vs. 100%, P = 0.383) or ASA-PS class (P = 0.561). Both exhibited improved JOA scores (decompression-alone: 13.4/29 to 22.7/29; instrumentation: 8.6/29 to 17.9/29; P = 0.9068) and had similar peri-operative complication rates (21.0 vs. 28.5%, P = 0.374). CONCLUSIONS: Although instrumentation is considered more invasive than decompression, we detected no statistically significant differences in peri-operative complication rates between these two types of surgery in ≥ 85-year-old patients. Surgeons should perform instrumentation even in the patients over 85 years with ASA class 3 or less.

[The consciousness survey and the effect of educational intervention of Advance Care Planning (ACP) including post-mortem to elderly residents living in old New Town of big city].

AIM: Awareness reform aims to enable survival in an aging society, and ultimately, improve healthcare. An ideal way to achieve this is by implementing Advance directive (Ad) and Advance Care Planning (ACP), which do not usually include postmortem events. This study aims to create opportunities for Ad and ACP to include the postmortem period as a trigger for this awareness reform. METHODS: We conducted an Ad/ACP enlightenment lecture, and a questionnaire survey pre- and post-lecture for the elderly in old New Town, which is known for its aging society. The questionnaire comprised 38 multiple-choice questions covering 6 themes assuming an advanced state of dementia. RESULTS: There were 35 participants (7 men and 22 women) aged 40-89 years. Several people left during the lecture, making it difficult to capture the precise transformation effect with regard to changing of mind. However, the effect of enlightenment was identified as a result of the consciousness survey. A statistically significant change in consciousness occurred in response to social contribution after death. Furthermore, notably more people wanted emergency transportation compared to those wanting resuscitation and extension of life. CONCLUSIONS: The medical treatment desired might vary over time. Even the desire for life extension may differ significantly among individuals. This survey indicated a divergent view between the general public and medical staff, regarding a series of medical actions. We must persistently promote opportunities for enlightenment in cooperation with the general public (i.e., the communities and families we serve).

Identification of selective inhibitors of sphingosine kinases 1 and 2 through a structure-activity relationship study of 4-epi-jaspine B.

We recently reported that 4-epi-jaspine B exhibits potent inhibitory activity towards sphingosine kinases (SphKs). In this study, we investigated the effects of modifying the 2-alkyl group, as well as the functional groups on the THF ring of 4-epi-jaspine B using a diversity-oriented synthesis approach based on a late-stage cross metathesis reaction. The introduction of a p-phenylene tether to the alkyl group was favored in most cases, whereas the replacement of a carbon atom with an oxygen atom led to a decrease in the inhibitory activity. Furthermore, the introduction of a bulky alkyl group at the terminus led to a slight increase in the inhibitory activity of this series towards SphKs compared with 4-epi-jaspine B (the Q values of compound 13 for SphK1 and SphK2 were 0.2 and 0.4, respectively). Based on this study, we identified two isoform selective inhibitors, including the m-phenylene derivative 4 [IC50 (SphK1) ≥30µM; IC50 (SphK2)=2.2µM] and the methyl ether derivative 22 [IC50 (SphK1)=4.0µM; IC50 (SphK2) ≥30µM].

Effect of teriparatide (rh-PTH 1-34) versus bisphosphonate on the healing of osteoporotic vertebral compression fracture: A retrospective comparative study.

BACKGROUND: Teriparatide (recombinant human parathyroid hormone 1-34) is increasingly used for the treatment of severe osteoporosis because it stimulates bone formation and may potentially enhance fracture healing. The objective of this study was to investigate the effects of teriparatide versus a bisphosphonate on radiographic outcomes in the treatment of osteoporotic vertebral compression fractures (OVCF). METHODS: A total of 98 patients undergoing non-operative treatment for recent single-level OVCF were reviewed retrospectively. Thirty-eight patients were treated by a once-daily subcutaneous injection of 20 micrograms of teriparatide (TPD group), whereas 60 patients received 35 mg of alendronate weekly (BP group). Except for these medications, the same treatment protocol was applied to both groups. The radiographic assessments included union status, vertebral kyphosis, and mid-vertebral body height. The rates of fracture site surgical intervention were also compared between the two groups. The mean follow-up period was 27 months (median 22.5, range 2 - 75 months). RESULTS: Cox regression analysis showed that TPD reduced the time-to-union (adjusted relative hazard ratio: 1.86, 95% C.I.: 1.21 - 2.83). The union rate at six months after treatment was 89% in the TPD group and 68% in the BP group; the surgical intervention rate was significantly higher in the TPD group (p = 0.026, adjusted odds ratio: 8.15, 95% C.I.: 2.02 - 43.33). The change in local kyphosis was 4.6° in the TPD group and 3.8° in the BP group (p = 0.495, paired t-test). The change of mid-vertebral body height was 4.4 mm in the TPD group and 3.4 mm in the BP group (p = 0.228, paired t-test). Fracture site surgical interventions were not required in the TPD group; however, two patients in the BP group eventually underwent surgical treatment for symptomatic non-union or vertebral collapse. CONCLUSIONS: This retrospective study suggests that teriparatide may enhance fracture healing and improve the union rate in OVCF.

Does spinopelvic alignment affect the union status in thoracolumbar osteoporotic vertebral compression fracture?

PURPOSE: In the healing of osteoporotic vertebral fracture, global spinal mal-alignment might increase the load sharing at the fracture site and deteriorate the fracture healing. This study aimed to evaluate the effect of spinopelvic alignment on the union status of thoracolumbar osteoporosis-related vertebral compression fracture (OVCF). METHODS: Consecutive 48 patients with a single-level thoracolumbar fresh OVCF were treated non-operatively. Union was judged by three independent observers at 6 months, and patients were divided into union group and non-union group. Spinopelvic alignment was measured using upright whole spine radiograph before treatment as follows: pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), sagittal vertical axis (SVA), and DSVA, defined as the distance from a plumb line dropped from the center of the C7 body to the center of fractured vertebral body. RESULT: Global spinal alignment was different in union group and non-union group: SVA (4.7 ± 0.7 cm in union group vs. 8.9 ± 1.3 cm in non-union group, P = 0.007), DSVA (4.2 ± 0.6 cm in union group vs. 9.5 ± 1.0 cm in non-union group, P < 0.001), and PI-LL (18.9° ± 2.2° in union group vs. 30.3° ± 3.9° in non-union group, P = 0.014). Over 5 cm of DSVA [P = 0.022, adjusted odds 7.9 (95 % CI 1.3-77.0)] and/or over 30° of PI-LL [P = 0.026, adjusted odds 6.6 (95 % CI 1.5-44.2)] showed the significant risk factors for non-union using multivariate logistic regression analysis in the other background status. CONCLUSIONS: Global spinal mal-alignment, showing over 5 cm of DSVA and/or over 30° of PI-LL, affected the union status of OVCF.

Immediate effects of quick trunk movement exercise on sit-to-stand movement in children with spastic cerebral palsy: a pilot study.

[Purpose] This pilot study examined the immediate effects of quick-seated trunk exercise on sit-to-stand movement in children with cerebral palsy. [Subjects and Methods] Five children with spastic cerebral palsy (hemiplegia, 3; diplegia, 2; age 6-17 years) performed five sessions of natural-seated trunk exercise at a self-selected speed (control). Following a 50-min rest period, five sessions of the quick-seated trunk exercise were conducted (experimental intervention) for each child. Each seated trunk exercise included 10 repetitions in the anterior-posterior and lateral directions. Sit-to-stand was assessed before and after each intervention using a motion analysis system. The total sit-to-stand task duration and sagittal, angular movements of the trunk, hip, knee, and ankle were calculated. [Results] There was a significant difference in the total duration of the sit-to-stand movement before and after natural-seated trunk exercise (2.40 ± 0.67 s vs. 2.24 ± 0.44 s) as well as quick seated trunk exercise (2.41 ± 0.54 s vs. 2.06 ± 0.45 s). However, the sit-to-stand duration increased after natural-seated trunk exercise in one participant while that after quick-seated trunk exercise decreased in all participants. [Conclusion] Performing a trunk exercise in a seated position resulted in immediate improvement of the temporal sit-to-stand parameters in children with spastic cerebral palsy.

A modified seated side tapping test in which the arms are crossed also reflects gait function in community-dwelling elderly.

[Purpose] Seated side tapping test (SST) performance is associated with mobility impairment in the elderly. Although this test was developed to assess trunk function, interpretation of its results may be confounded by the upper-limb movements in its protocol. Here, this study aimed to validate the association between trunk function and gait function by means of the Arms Crossed SST (AC-SST), a modified version of the SST in which the arms are crossed over the chest, to exclude the effects of the upper limbs. [Subjects and Methods] A total of 116 community-dwelling elderly people were enrolled in the study (mean age: 75.1 ± 5.5 yrs). Measurement categories were gait function (gait speed and TUG), lower extremity strength (knee extension and flexion strength), trunk muscle endurance (trunk extension and flexion endurance), and trunk function (SST and AC-SST). [Results] AC-SST performance significantly correlated with gait function items, as did SST performance. Moreover, AC-SST was one of the significant predictor variables of gait function selected in stepwise multiple regressions. [Conclusion] Gait function associated with performance on the AC-SST, a test of trunk function in which the effects of upper limb function were excluded, reinforcing the importance of trunk function to elderly mobility.

Genetic and antigenic characteristics of ApxIIA and ApxIIIA from Actinobacillus pleuropneumoniae serovars 2, 3, 4, 6, 8 and 15.

Apx toxins produced by Actinobacillus pleuropneumoniae are essential components of new generation vaccines. In this study, apxIIA and apxIIIA genes of serovars 2, 3, 4, 6, 8 and 15 were cloned and sequenced. Amino acid sequences of ApxIIA proteins of serovars 2, 3, 4, 6, 8 and 15 were almost identical to those of serovars 1, 5, 7, 9 and 11-13. Immunoblot analysis showed that rApxIIA from serovars 2 and 15 reacts strongly with sera from animals infected with various serovars. Sequence analysis revealed that ApxIIIA proteins has two variants, one in strains of serovar 2 and the other in strains of serovars 3, 4, 6, 8 and 15. A mouse cross-protection study showed that mice actively immunized with rApxIIIA/2 or rApxIIIA/15 are protected against challenge with A. pleuropneumoniae strains of serovars 3, 4, 6, 8, 15, and 2 expressing ApxIII/15 and ApxIII/2, respectively. Similarly, mice passively immunized with rabbit anti-rApxIIIA/2 or anti-rApxIIIA/15 sera were found to be protected against challenge with strains of serovars 2 and 15. Our study revealed antigenic and sequence similarities within ApxIIA and ApxIIIA proteins, which may help in the development of effective vaccines against disease caused by A. pleuropneumoniae.

Efficacy of ankle-brachial index as a preoperative screening in spine surgery.

PURPOSE: The aims of this study were to investigate the prevalence of peripheral arterial disease (PAD) and specify the patients who are necessary to measure ankle-brachial index (ABI) as a preoperative PAD screening in spine surgery. METHODS: A total of 1425 consecutive patients with non-emergency spine surgery underwent a PAD screening using ABI measurement. We reviewed their ABI data, age, smoking status, and co-morbidities including diabetes mellitus (DM), cerebrovascular disease (CVD) and ischemic heart disease (IHD). CT- or MR-angiography was used for a definitive diagnosis of PAD when the ABI was 0.9 or less. RESULTS: Of 1425 patients, 37 patients (2.5%) showed less than 0.9 in ABI; 24 patients (1.6%) were eventually diagnosed as PAD. Of 24 patients with PAD, 22 patients (91.6%) were over 65 years. The prevalence of DM was 58.3% in the PAD group versus 18.7% in the non-PAD group (P < 0.05). Patients with CVD or IHD were more likely to have PAD, but the differences were not significant. Smoking rate was 62.5% in the PAD group versus 42.4% in the non-PAD group (P < 0.05). CONCLUSIONS: The current preoperative PAD screening data showed that age over 65 years, DM and smoking habit were the risk factors for PAD development. Based on the current results, we advocate preoperative ABI measurement for over 50-year patients who had co-morbidities and/or smoking habit and all the patients aged 65 years or more.

Relationship between the duration and trunk inclination and hip angle during car transfer in individuals with tetraplegia.

[Purpose] The purpose of the present study was to investigate the relationship between the duration of the car transfer (CT) movement and trunk inclination and hip angles during this movement in individuals with tetraplegia. [Subjects and Methods] Eleven adult males with C6 tetraplegia participated in this study. The CT movement was recorded from the passenger side of the car using a digital video camera. From the video, the duration and trunk inclination and hip joint angle were recorded, and correlation coefficients were calculated. [Results] No correlation was found between the trunk inclination angle and the duration of the CT movement. However, a significant correlation was found between the hip angle and the duration of the CT movement: when the duration was short, the hip flexion angle was substantial. [Conclusion] The trunk inclination angle probably showed no effect on the duration of the CT movement because the movement was performed in a limited space and because the trunk muscles of the subjects were paralyzed. In contrast, C6 tetraplegia enabled smooth CT by allowing for control of trunk inclination, such as placing the lower extremities in the car, whereby the pelvis backward tilt angle increased.

Does balloon kyphoplasty improve the global spinal alignment in osteoporotic vertebral fracture?

PURPOSE: Balloon kyphoplasty (BKP) has been a well-accepted procedure in the treatment of osteoporotic vertebral compression fracture (OVCF), whereas it remains unclear whether or not this procedure has an impact on the global spinal alignment. The purpose of this study is to evaluate the effect of BKP on the global spinal alignment in OVCF. METHODS: Fifty-six consecutive patients who had undergone BKP for symptomatic OVCF were retrospectively reviewed with a mean follow-up of 32 months. They were seven males and 49 females with a mean age of 75 years. Radiographic assessment was performed using upright whole spine radiographs. The parameters included vertebral kyphosis, mid-vertebral body height and global sagittal spinal alignment (C7 plumb line deviation). Clinical outcomes were evaluated using visual analog scale of back pain. RESULTS: Fifty-one of 56 patients (91.1 %) achieved immediate pain relief. Vertebral kyphosis significantly decreased from 18 to 14 degrees, but 43 patients (76.8 %) still had more than 10 degrees of local kyphosis. Subsequent vertebral compression fractures were observed in seven patients (12.5 %). Anterior deviation of a C7 plumb line (C7PL) was 3.1 cm pre-operatively, 3.1 cm postoperatively, and significantly increased to 5.9 cm at the final follow-up. Consistent results were obtained in those with pre-operative sagittal imbalance (>5 cm anterior deviation of C7PL) and with pre-existing OVCFs. CONCLUSIONS: BKP contributed to immediate pain relief, but did not improve the global sagittal spinal alignment after OVCF. This procedure should be solely indicated for painful OVCF or non-union, and could not be expected to restore the global sagittal alignment.