The use of lateral lumbar interbody fusion for identifying adult patients with spinal deformities treatable by short corrective fusion in 2-stage surgery.

BACKGROUND: To investigate and compare the surgical outcomes of short and thoracopelvic corrective fusion with our two-stage technique using lateral lumbar interbody fusion (LLIF) and posterior open surgery. METHODS: Consecutive patients with adult spinal deformities who underwent a planned two-stage anterior-posterior surgery, using LLIF for the first stage and posterior open corrective fusion for the second stage, with a minimum of 2 years of follow-up were included. Patients who underwent lumbar or lumbosacral corrective fusion and thoracopelvic corrective fusion were categorized into the short group and thoracopelvic groups, respectively. We investigated the spinopelvic parameters and patient-reported outcome measurements. RESULTS: Seventy-four consecutive patients (8 men, 66 women; average age, 70.0 years) were included. Ten patients underwent short corrective fusion following significant improvements in the symptoms and radiographic parameters post-LLIF. Several preoperative spinopelvic parameters were better in the short group. Compared to the thoracopelvic group, those who underwent short fusion had a poorer alignment 2 years postoperatively but with comparable results and a significantly higher function score on the Scoliosis Research Society-22 r (SRS-22r) questionnaire. The mean Oswestry Disability Index and SRS-22r scores significantly improved during the 2-year postoperative follow-up in both the groups. CONCLUSIONS: Short corrective fusion can be considered in patients whose symptoms and radiographic parameters significantly improve following LLIF. Patients who undergo short fusion with LLIF application have poorer alignment than those who undergo thoracopelvic fusion 2 years postoperatively; however, the results are comparable, and the function score is significantly improved.

Deterioration of apatite orientation in the cholecystokinin B receptor gene (Cckbr)-deficient mouse femurs.

INTRODUCTION: The discrepancy between bone mineral density (BMD), the gold standard for bone assessment, and bone strength is a constraint in diagnosing bone function and determining treatment strategies for several bone diseases. Gastric hypochlorhydria induced by clinically used proton pump inhibitor (PPI) therapy indicates a discordance between changes in BMD and bone strength. Here, we used Cckbr-deficient mice with gastric hypochlorhydria to examine the effect of gastric hypochlorhydria on bone mass, BMD, and preferential orientation of the apatite crystallites, which is a strong indicator of bone strength. MATERIALS AND METHODS: Cckbr-deficient mice were created, and their femurs were analyzed for BMD and preferential orientation of the apatite c-axis along the femoral long axis. RESULTS: Cckbr-deficient mouse femurs displayed a slight osteoporotic bone loss at 18 weeks of age; however, BMD was comparable to that of wild-type mice. In contrast, apatite orientation in the femur mid-shaft significantly decreased from 9 to 18 weeks. To the best of our knowledge, this is the first report demonstrating the deterioration of apatite orientation in the bones of Cckbr-deficient mice. CONCLUSION: Lesions in Cckbr-deficient mice occurred earlier in apatite orientation than in bone mass. Hence, bone apatite orientation may be a promising method for detecting hypochlorhydria-induced osteoporosis caused by PPI treatment and warrants urgent clinical applications.

Perioperative lumbar subarachnoid drainage could not prevent postoperative CSF leakage after spinal cord tumor resection using an artificial dura mater.

BACKGROUND: Cerebrospinal fluid (CSF) leakage occurs in patients who undergo dural repair using artificial dura mater. This study aimed to determine if perioperative lumbar subarachnoid drainage could reduce the incidence of postoperative CSF leakage in cases of dural repair using artificial dura mater. METHODS: We retrospectively analyzed 84 patients (41 men, 43 women; mean age, 52.2 ± 20.1 years) who underwent intradural spinal cord tumor resection and dural repair using artificial dura mater. These patients were divided according to whether they underwent perioperative lumbar subarachnoid drainage (39 patients: D group) or had no drainage (45 patients: ND group). The incidence of radiographic and symptomatic CSF leakage as well as baseline characteristics and operative data were compared between the two groups. RESULTS: Radiographic CSF leakage was observed in 21 patients (25.0%), including 10 (25.6%) in the D group and 11 (24.4%) in the ND group. Symptomatic CSF leakage was observed in 12 patients (14.2%), including six (15,4%) in the D group and 11 (13.3%) in the ND group. There were no significant differences in the incidence of subcutaneous CSF accumulation and symptomatic CSF leakage between the two groups. In cases with symptomatic CSF leakage, the onset time of CSF leakage tended to be earlier (5.7 days vs 15.7 days), and the treatment period tended to be longer (5.8 weeks vs 2.8 weeks) in the ND group than in the D group. CONCLUSIONS: Perioperative lumbar subarachnoid drainage did not reduce the incidence of either radiographic or symptomatic CSF leakage. However, it might shorten the treatment period and reduce refractory CSF leakage, which requires multiple treatments over a long period.

Sex differences between the relationship of trunk muscle mass and whole body sagittal plane alignment in older adults.

BACKGROUND: This study aimed to clarify sex differences in the relationship between trunk muscle mass, aging, and whole-body sagittal alignment. METHODS: Subjects aged 60-89 years who underwent musculoskeletal screening in 2018 were included in the study. Subject demographics, trunk muscle mass (TMM) measured by bioelectrical impedance analysis (BIA), and spinopelvic and lower extremity alignment parameters measured from standing radiographic images were investigated. Additionally, TMM was corrected for BMI (TMM/BMI). The relationship between trunk muscle and whole-body sagittal alignment was analyzed for each age group (young-old group (60-74 years) and old-old group (>75 years)) and sex. RESULTS: A total of 281 (mean age 75.4 ± 6.7 years, 100 males and 181 females) were enrolled. The trunk muscle mass in both men and women significantly decreased with age. Regarding TMM/BMI, there was no significant difference in men, but there was a significant difference between females in the young-old and old-old groups (p < 0.001). TMM/BMI was significantly correlated with sagittal vertical axis (SVA) and knee flexion angle (KF) in both sexes. In females, TMM/BMI was significantly correlated with thoracic kyphosis in the young-old group, whereas in the old-old group, TMM/BMI was correlated with SVA, PI-LL, and KF. CONCLUSIONS: TMM was related to trunk anteverion and lower extremity alignment in both sexes. However, the relationship between TMM on alignment differs between sexes. Thoracic hyperkyphosis in young-old adults indicated a decrease in muscle mass, which may be a sign of future malalignment.

Characteristics of pedicle screw misplacement using freehand technique in degenerative scoliosis surgery.

PURPOSE: This study aimed to estimate the accuracy of pedicle screw (PS) placement in degenerative scoliosis surgery, characterize a patient population with PS misplacement, and analyze the association between misplaced PS vector and lumbar coronal curve. METHODS: In this study, 122 patients (average age 68.6 years), who underwent corrective and decompression surgery, were selected retrospectively. PS accuracy was evaluated in the thoracic to lumbar spine. We identified characteristics of misplacement in each patient. Screw positions were categorized into grade A, entirely in the pedicle; grade B, < 2 mm breach; grade C, 2-4 mm breach; and grade D, > 4 mm breach using postoperative computed tomography. RESULTS: The mean preoperative lumbar coronal curve was 32.3 ± 18.4°, and the number of fused vertebrae was 8.9 ± 2.8. A total of 2032 PS were categorized as follows: grade A, 1897 PS (93.3%); grade B, 67 (3.3%); grade C, 26 (1.3%); and grade D, 43 (2.1%). One PS (grade D), inserted at T5, needed surgery for removal due to neurological deficit. The misplacement group (grades C and D) had a significantly stronger lumbar coronal curve and apical vertebral rotation than the accuracy group (grades A and B). Misplaced PS vector (direction and degree) was significantly correlated with inserted vertebral rotation. Grade D misplacement was distributed mainly around the transitional vertebra of the lumbar curve. CONCLUSIONS: The accuracy of PS insertion in the thoracic to lumbar spine was high in DS surgery, but the need for care was highlighted in the transitional vertebra.

Disc degeneration could be recovered after chemonucleolysis with condoliase.-1 year clinical outcome of condoliase therapy.

BACKGROUND: Condoliase-induced chemonucleolysis is a less-invasive alternative treatment for lumbar disc herniation (LDH); however, its long-term clinical outcome is still unclear. This study aimed to investigate 1-year clinical outcomes and assess radiographs after chemonucleolysis with condoliase. METHODS: We enrolled patients with LDH who received condoliase injection with a follow-up period of >1 year. Sixty patients (37 men, 23 women; mean age, 44.5 ± 18.9 years; mean follow-up period, 22.0 ± 6.0 months) were analyzed. Changes in disc height and degeneration were evaluated using magnetic resonance imaging. Visual analog scale (VAS) scores for leg and back pain and the Oswestry disability index (ODI) were obtained. All data were assessed at baseline, 1-month, 3-month, and 1-year follow-up. RESULTS: Surgical treatment was subsequently required in 8 patients (12.5%) after condoliase therapy. Their ODI and VAS scores for leg pain and back pain significantly improved at 1 year, as in those who received condoliase therapy only. On MRI, progression of Pfirrmann grade was observed in 23 patients (44.2%) at 3 months; however, 8 patients recovered to baseline at 1 year. The mean disc height decreased at 3 months; however, it recovered at 1 year. Disc height recovery (disc recovery rate >50%) was observed in 30.8% of the patients. Patients with disc height recovery were significantly younger than those without. Patients with longer symptom duration (≥1 year) showed significantly lower rates of effectiveness compared with those with shorter symptom durations (<1 year). CONCLUSIONS: Chemonucleolysis with condoliase is a safe and minimally invasive treatment. Disc degeneration induced by chemonucleolysis could be recovered, particularly in younger patients. Prolonged symptom duration had adverse effects on outcome; thus, therapeutic intervention at the optimal time is needed.

Predictive factors for correction rate in severe idiopathic scoliosis (Cobb angle ≥ 90°): an analysis of 128 patients.

PURPOSE: Knowledge on the factors affecting the correction rate (CR) aids in the surgical planning among severe idiopathic scoliosis (IS) patients. This study aimed to investigate the independent factors affecting CR among patients with severe IS (Cobb angle ≥ 90°) who underwent single-staged posterior spinal fusion (PSF). METHODS: We retrospectively reviewed 128 severe IS patients who underwent single-staged PSF. Factors including age, height, weight, body mass index, Risser sign, Lenke subtypes, preoperative major Cobb angle, side bending major Cobb angle, side bending flexibility (SBF), motion segments of the major curve, AR curve, number of levels fused, screw density, operative time and postoperative major Cobb angle were analysed using linear regression analysis. RESULTS: The mean age was 15.5 ± 4.5 years with mean Risser sign of 3.1 ± 1.6. The mean preoperative Cobb, SBF, postoperative Cobb and CR were 102.8 ± 12.3°, 37.5 ± 13.7%, 44.4 ± 13.5° and 57.2 ± 10.8%, respectively. From stepwise multiple linear regression analysis, SBF, Risser sign and AR curve were the independent predictive factors for CR, with R2 value of 0.345 (p < 0.001). CR can be predicted using the formula: 47.21 + (0.34 × SBF)-(1.47 × Risser sign) + (3.69 × AR), where AR = 1 and non-AR = 0. CONCLUSION: The flexibility of the major curve, Risser sign and AR curve were the most important predictors for CR in a single-staged PSF among patients with severe IS.

Planned two-stage surgery using lateral lumbar interbody fusion and posterior corrective fusion: a retrospective study of perioperative complications.

PURPOSE: To determine the effect of planned two-stage surgery using lateral lumbar interbody fusion (LLIF) on the perioperative complication rate following corrective fusion surgery in patients with kyphoscoliosis. METHODS: Consecutive patients with degenerative scoliosis who underwent corrective fusion were divided into a control group that underwent single-stage posterior-only surgery and a group that underwent planned two-staged surgery with LLIF and posterior corrective fusion. We collected the patient background and surgical data and assessed the perioperative complication rates. We also investigated spinopelvic parameters and patient-reported outcome measurements (PROMs). RESULTS: One hundred and thirty-eight patients of mean age 69.8 (range, 50-84) years who met the study inclusion criteria were included. The two-stage group (n = 75) underwent a staged anterior-posterior surgical procedure, and the control group (n = 63) underwent single-stage surgery. There was no significant between-group difference in the incidence of perioperative complications, except for deep wound infection (reoperation is necessary for surgical site infection). Revision surgery within 3 months of the initial surgery was more common in the control group (n = 8, 12.7%) than in the two-stage group (n = 3, 4.0%). Spinopelvic parameters and PROMs were significantly better in the two-stage group at 2 years postoperatively. CONCLUSION: The complication rate for planned two-stage surgery was similar to that of previous posterior-only single-stage surgery. However, early reoperation was less common, and the degree of spinal correction and clinical results were significantly better after two-stage surgery.

Does preoperative prognostic nutrition index predict surgical site infection after spine surgery?

PURPOSE: Malnutrition is reported as one of the risk factors for surgical site infection (SSI). The prognostic nutritional index (PNI) is a simple method for nutritional evaluation. However, little is known about the relationship between SSI and the PNI in patients after spine surgery. We aimed to determine independent predictors of SSI after spine surgery. METHODS: We analyzed 1115 patients who underwent spine surgery (369 males, 746 females, mean age 56 years, follow-up period: at least 1 year). Patients were divided into SSI and non-SSI groups. Preoperative risk factors, including PNI (10 × serum albumin [g/dL] + 0.005 × total lymphocyte count [/µL]), were assessed. RESULTS: Postoperatively, 43 patients (3.9%) experienced SSI. Univariate analysis showed that preoperative PNI (48.5 vs 51.7; p < 0.01), revision status (p < 0.05), male sex (p < 0.01), body mass index (BMI) (p < 0.05), and usage of anticoagulant agents (p < 0.05) differed significantly between the SSI and non-SSI groups. Multivariate logistic regression analysis showed that preoperative PNI (odds ratio [OR], 0.94; 95% confidence interval [CI]: 0.90-0.98; p < 0.01), male sex (OR, 2.64; 95% CI: 1.40-4.99; p < 0.01), length of surgery ≥ 180 min (OR, 2.78; 95% CI: 1.30-5.96; p < 0.01), BMI ≥ 30 kg/m2 (OR, 2.89; 95% CI: 1.20-6.97; p < 0.05), and revision status (OR, 2.30; 95% CI: 1.07-4.98; p < 0.05) were independently associated with SSI postoperatively. CONCLUSION: Lower preoperative PNI was found to be a risk factor for SSI after spine surgery. Patients with lower preoperative PNI values should be cautioned about the risk of SSI and provide adequate informed consent.

Evaluation of the Central Sensitization Inventory Score in elderly adults with musculoskeletal examination.

OBJECTIVES: The present study aimed to conduct an epidemiological survey of Central Sensitization Inventory (CSI) scores in an older adult population and to investigate the association between the CSI scores, age, sex, pain intensity, site of pain, and health-related quality of life (QOL). METHODS: Participants were 373 Japanese adults aged ≥ 50 years who underwent a health checkup in 2018. We collected demographic data and clinical characteristics along with the CSI scores, QOL questionnaire, site of pain (neck, lower back, upper limb, and lower limb) and pain severity. We performed an epidemiological survey of the CSI scores and investigated the gender difference in CSI scores and the relationship between the CSI scores, site of pain, and QOL. RESULTS: The prevalence of low back pain was the highest (67.6%). The average CSI score was 14.2 points; 8% of volunteers had a high (> 30) CSI score. The CSI scores among women were significantly higher than those among men (p = .016). The CSI scores had a significantly moderate correlation with the numerical rating scale and QOL scores (all p < .001). Volunteers with neck pain showed the highest CSI scores (average 22.4 points). CONCLUSIONS: The CSI total score showed sex differences and had a significant correlation with pain severity and QOL. STUDY DESIGN: Cross-sectional study.

L5 pedicle subtraction osteotomy maintains good radiological and clinical outcomes in elderly patients with a rigid kyphosis deformity: a more than 2-year follow-up report.

PURPOSE: L5 pedicle subtraction osteotomy (PSO) is a demanding technique; thus, PSOs are usually performed at the L3/L4 level to correct the lack of lumbar lordosis. Mid- to long-term improvements in clinical outcomes after L5 PSO are unknown. We aimed to determine the efficacy and safety of L5 PSO for rigid kyphosis deformities. METHODS: We retrospectively reviewed the records of 57 patients with a rigid kyphosis deformity (mean age: 68 years) who underwent extensive corrective surgery incorporating PSO with a > 2-year follow-up. Radiographic parameters, postoperative complication rates, and the Oswestry Disability Index (ODI) scores were compared in the L5, L4, and L1-3 PSO groups preoperatively and at 1, 2, and 5 years postoperatively. RESULTS: There were 12, 25, and 20 patients in the L5, L4, and L1-3 PSO groups, respectively. Significant between-group differences were found in preoperative L4-S1 lordosis (L5:L4:L1-3 PSO groups = - 8.9°:8.9°:16.2°, P < 0.001). The surgeries improved the postoperative spinopelvic alignment (similar in all groups). There was no significant between-group difference in the postoperative complication rate; no irreversible complications occurred. In the L5 PSO group, there was one case of a common iliac vein injury. The ODI scores improved postoperatively in all groups; this was maintained for 5 years postoperatively. CONCLUSION: L5 PSO for L4-5/L5 kyphosis deformities resulted in adequate correction and ODI improvement, which were maintained up to 5 years postoperatively. The surgical invasiveness, complication rates, and long-term prognosis associated with L5 PSO were similar to those of PSOs performed at other levels.

Deterioration of sagittal spinal alignment with age originates from the pelvis not the lumbar spine: a 4-year longitudinal cohort study.

PURPOSE: There is controversy regarding age-related deterioration of spinal sagittal alignment in cross-sectional study. Although we reported that deterioration in spinal alignment originated at the cervical spine in males and the pelvis in females, others studies have indicated that the lumbar spine is initially implicated in both sexes. The purpose of this study was to clarify these differences in a longitudinal cohort study. METHODS: Our analysis was based on 237 individuals aged 60-89 years who participated in our health screening study in 2014 and 2018. They were classified into six groups by birth year and sex: 60-69 years (26 males, 49 females); 70-79 years (35 males, 88 females); and 80-89 years (19 males, 20 females). The following parameters were measured from standing radiographs: pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis, T1 slope, cervical lordosis, C7 sagittal vertical axis (C7 SVA), and C2-7 SVA. RESULTS: In males, the first significant change was an increase in the PT angle (19°, in 2014, to 21°, in 2018) in the 80-89 years age group (P < 0.05), with no significant deterioration in cervical parameters. In females, spinal deterioration included a change in the SS (32°-30°), PT (18°-20°), and SVA (- 8 to 6 mm) in the 60-69 years age group (P < 0.05), with no change in the LL. CONCLUSIONS: Contrary to prior studies, our longitudinal data indicated that deterioration in spinal alignment originates in the pelvis for both sex but develops earlier in females than males.

Correction to: Deterioration of sagittal spinal alignment with age originates from the pelvis not the lumbar spine: a 4-year longitudinal cohort study.

Unfortunately, figure 3 was incorrectly published in the original publication. The complete correct figure 3 is given below.

Impact of shift to the concave side of the C7-center sacral vertical line on de novo degenerative lumbar scoliosis progression in elderly volunteers.

BACKGROUND: Degenerative lumbar scoliosis (DLS) is one of the most frequent spinal deformities of the aging spine. The purpose of our study was to clarify the independent predictors of pre-existing DLS progression and their influence on the health related quality of life (HRQOL). METHODS: This study included 356 volunteers (127 men and 229 women; mean age, 72.2 years; follow-up period, 4 years) who underwent musculoskeletal screening. Standing whole-spine radiographic measurements included the Cobb angle of DLS and C7-center sacral vertical line (C7-CSVL; shift to the concave side of the DLS curve indicated a positive value). A baseline Cobb angle ≥10° indicated pre-existing DLS, and Cobb angle deterioration of ≥4° was considered DLS progression. For HRQOL assessment, the Oswestry Disability Index (ODI) was used. Pre-existing DLS cases were divided into progression and non-progression groups. RESULTS: Among 93 cases (26.1%) with pre-existing DLS at baseline, 23 cases (pre-existing DLS progression group) showed DLS progression. The mean C7-CSVLs were 10.5 and -3.1 mm in the pre-existing progression and non-progression groups, respectively (p < 0.01). The optimal cutoff C7-CSVL length was 5 mm, with high sensitivity and specificity. Multivariate logistic regression analysis showed that a C7-CSVL ≥5 mm (odds ratio, 3.8; 95% CI: 1.42-10.34; p < 0.01) was independently associated with pre-existing DLS progression. ODI scores deteriorated significantly more in the pre-existing progression group than the non-progression group (+9.8% versus +3.9%; p < 0.05). CONCLUSIONS: Pre-existing DLS progression is associated with a shift to the concave side of C7-CSVL and influences HRQOL deterioration. It is important to assess coronal global alignment for prediction of a DLS progression.

Differences in the geometrical spinal shape in the sagittal plane according to age and magnitude of pelvic incidence in healthy elderly individuals.

BACKGROUND: Several studies indicated the influence of age and sex on spinal alignment using spino-pelvic radiographic parameters. However, information regarding the geometrical assessment of the sagittal spinal plane in the elderly population remains limited. This study aimed to determine the apices of lumbar lordosis and thoracic kyphosis, and spinal inflection point in elderly individuals and clarify the effect of age, sex, and pelvic incidence (PI) on sagittal geometry. METHODS: In total, 440 volunteers (193 men; 247 women) were enrolled. The spino-pelvic radiographic parameters were measured. The apices of thoracic kyphosis and lumbar lordosis, and the inflection point where the vertebral curvature changes from kyphosis to lordosis were investigated. We analyzed the differences in the sagittal curve shape according to the sex, age, and PI magnitude. RESULTS: On average, the apices of thoracic kyphosis and lumbar lordosis, and the inflection point were located at the levels of the T8/9 intervertebral disc, L3/4 disc, and L1 vertebra, respectively. Significant differences between men and women were observed with respect to the spino-pelvic parameters; however, the positions of the apices were significantly different only with respect to the lumbar apex offsets among individuals in their 70s. The inflectional point and apex of thoracic kyphosis among individuals aged >80 years were located significantly anteriorly and caudally in comparison to those among individuals aged <69 years. The apex of lumbar lordosis and the inflection point in individuals with high PI were located significantly anteriorly and cranially in comparison to those in individuals with low PI. CONCLUSIONS: The apices of thoracic kyphosis and lumbar lordosis, and the inflection point were located at the T8/9 intervertebral disc, L3/4 disc, and L1 vertebra, respectively. The shape of the sagittal spinal curve varied according to age and the magnitude of PI, and these findings cannot be evaluated using the conventional spino-pelvic parameters. Knowledge of standard geometrical spine shape could be useful for spinal deformity treatment in elderly patients.

Cut-off values of and factors associated with a negative influence on Neck Disability Index.

PURPOSE: The Neck Disability Index (NDI) is used to evaluate patients with cervical spine disease. However, few reports have defined the cut-off values of the NDI. The purpose of this study was to identify the cut-off values of and factors with a negative impact on NDI. METHODS: A total of 487 volunteers were divided into three groups based on disability: none, mild, and disabled. The cut-off values of the NDI were determined using receiver-operating characteristic curves. After these groups were divided based on sex and age adjustment was performed, the factors with a negative impact on NDI were investigated using multiple logistic regression analysis. RESULTS: Groups none, mild, and disabled included 207, 186, and 94 volunteers, respectively. The cut-off values of the NDI in each group were 0-5, 6-17, and ≥ 18%, respectively. After adjusting for age, groups none, mild, and disabled had 65, 56, and 23 males, respectively, and 92, 103, and 56 females, respectively. In multiple logistic regression analysis, the factors with a negative impact on NDI in males were manual work (odds ratio [OR] 1.924), higher T1 slope minus cervical lordosis (OR 1.043), and higher C2-7 sagittal vertical axis (OR 1.029, P < 0.05). Among females, the factors were hand-grip strength (OR 0.936), body fat percentage (OR 0.942), and sporting activity (OR 0.456, P < 0.05). CONCLUSION: Deterioration in NDI was associated with cervical spinal malalignment and manual labor in males and lack of physical activity and sarcopenia in females. These slides can be retrieved under Electronic Supplementary Material.

Effects of mirror placement on sagittal alignment of the spine during acquisition of full-spine standing X-Rays.

PURPOSE: The line of sight when whole-spine radiographs are taken has not been defined. In our 2012 health screening study (TOEI study), whole-spine radiographs were taken with the volunteers in the most relaxed position and with a horizontal gaze. However, in the TOEI 2014 study, a mirror was placed in front of their faces to unify their line of sight. To our knowledge, there are no reports on how the sagittal alignment changes when radiographs are taken using a mirror. The purpose of this study was to investigate how mirror placement impacted sagittal spinal alignment in whole-spine radiographs taken while standing. METHODS: Volunteers who participated in both the TOEI 2012 and 2014 studies were recruited. Pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), cervical lordosis (CL), slope of McGregor's line (McGS), and C7 sagittal vertical axis (C7 SVA) were examined using software. RESULTS: Three hundred fifty-four volunteers (142 males, 212 females, average age in 2012: 72 years) whose radiographs were evaluated in both previous studies were enrolled. The average parameters of 2012 and 2014 were: PT: 18° and 21° (P < 0.01), LL: 40° and 40°, TK: 34° and 34°, CL: 13° and 23° (P < 0.01), McGS: 2° ± 11° and - 9° ± 8° (P < 0.01), and C7 SVA: 46 and 23 mm (P < 0.01), respectively. In the Levene test, the McGS variation in 2014 [95% confidence interval (CI) 0.9-3.4] was significantly smaller than that in 2012 (95% CI - 9.7 to - 8.0, P < 0.01). CONCLUSION: The smaller McGS variation in the TOEI 2014 study suggested that mirror placement could standardize the head's position. These results showed that the mirror placement retroflexed cervical alignment and caused the head to lean backward. It is important that a mirror is placed to unify the line of sight.

The controlled study of diffuse idiopathic skeletal hyperostosis for the assessment of physical function in elderly populations.

BACKGROUND: Diffuse idiopathic skeletal hyperostosis (DISH) is associated with increasing age, obesity, and diabetes mellitus. However, little is known about the clinical impacts of DISH on physical function and spinal deformity in elderly populations. The purpose of this study was to elucidate the influence of DISH on physical function, spinal deformity, and health-related quality of life (HRQOL) in elderly populations. METHODS: We enrolled 504 volunteers (203 men and 301 women, mean age 74.0 years). Height, weight, body mass index (BMI), blood pressure, grip strength, one-leg standing time, sit-and-reach, functional reach, and bone mineral density (BMD) were measured. Using whole spine standing X-rays, the prevalence, location, and numbers of fused vertebra of DISH and spinopelvic parameters were measured. HRQOL measures, including the Oswestry Disability Index and the EuroQuol-5D were also obtained. We compared DISH subjects with control subjects of age and sex matching. We compared DISH subjects in the thoracic spine (T-DISH) to those in the thoraco-lumbar spine (TL-DISH). RESULTS: DISH occurred more frequently in men (14.3%) than in women (4.3%). The mean age was significantly higher of subjects with DISH than of those without DISH. The mean number of fused vertebra by DISH was 5.5 ± 1.5, and T-DISH was observed in 57% cases. DISH group showed greater body weights, BMIs, blood pressures, and BMD in the lumbar spine compared to the control group. No inter-group differences were observed in physical function, HRQOL and spinopelvic parameters. Subjects with TL-DISH had significantly lower values of sit-and-reach and functional reach than those with T-DISH. CONCLUSIONS: Subjects with DISH showed greater body weights, BMIs, blood pressures, and BMD compared to age- and sex-matched controls, while physical function, spinal alignment, and HRQOL were comparable between groups.

Age variation in the minimum clinically important difference in SRS-22r after surgical treatment for adult spinal deformity - A single institution analysis in Japan.

BACKGROUND: The Scoliosis Research Society-22r (SRS-22r) has been shown to be reliable, valid and responsive to change in patients with adult spinal deformity (ASD) undergoing surgery. The minimum clinically important difference (MCID) quantifies a threshold value of improvement that is clinically relevant to the patient. Health-related quality of life scores depend on age. The purpose of this study was to assess MCID threshold values stratified by age for SRS-22r domains in patients with ASD undergoing surgical correction. METHODS: We identified a consecutive series of 184 Japanese ASD patients who completed the SRS-22r and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) preoperatively and 1 year postoperatively. Effectiveness as measured on the JOABPEQ was used as the anchor to determine MCID for the Function, Pain, and Mental health domains using receiver-operating-characteristic (ROC) curve analysis. We performed MCID analysis stratified by age (<70 or ≥70). RESULTS: Mean preoperative SRS-22r Function score was 2.69 improving to 3.23 at postoperatively (p < 0.001). Mean preoperative SRS-22r Pain score was 3.04 improving to 3.78 at postoperatively (p < 0.001). Mean preoperative SRS-22r Mental health score was 2.72 improving to 3.25 at postoperatively (p < 0.001). There was a statistically difference in change in domain score between "not effective" and "effective" (p < 0.001). The ROC curve analysis methods yielded MCID values of 0.58 for Function, 0.55 for Pain, and 0.70 for Mental health domains. There was difference of MCID value for Function and Mental health domain between aged <70 and ≥70; 0.78 and 0.55 for Function; 0.70 and 0.48 for Mental health. CONCLUSION: Results of this study showed that MCID threshold values for SRS-22 Function and Mental health domains in older than 70 was lower than in younger than 70, potentially implying that older patients have lower expectation.

Low-intensity pulsed ultrasound is effective for progressive-stage lumbar spondylolysis with MRI high-signal change.

PURPOSE: This study aimed to investigate the treatment effects of low-intensity pulsed ultrasound (LIPUS) on progressive-stage spondylolysis. Spondylolysis is a stress fracture of the pars interarticularis. Based on the results of computed tomography, spondylolysis was classified into three categories: early, progressive, and terminal. Bone healing was prolonged or not obtained in progressive-stage spondylolysis. The progression of spondylolysis to nonunion has been associated with an increased incidence of spondylolisthesis. To prevent these clinical conditions, achieving bony healing of the spondylolysis site should be the goal of treatment. METHODS: 15 consecutive pediatric patients with progressive-stage spondylolysis (defects) with MRI high-signal change were analyzed. Nine patients were treated conservative treatment including avoidance of any sport activity and the use of a brace during treatment (conventional). Six patients were treated using LIPUS everyday during treatment in addition to conservative treatment. Approximately every 1.5 months, bone healing was evaluated via CT. Cases that retained defects after 4.5 months were defined as nonunion. RESULTS: Two patients dropped out during the study period. A total of 13 patients (mean 14.6 ± 2.5 years) from the database met with 19 interarticularis defects. The bone union rate in LIPUS group was significantly higher than that in conventional group (66.7 vs. 10.0%, p = 0.020). The treatment period to bone union was 3.8 months and 2.7 ± 0.3 months in conventional and LIPUS groups. CONCLUSIONS: This study revealed that LIPUS treatment might be effective for bone union in patients with progressive-stage spondylolysis with MRI high-signal change. LEVEL OF EVIDENCE: 4.