The critical cutoff point of the Zurich Claudication Questionnaire and the Japanese Orthopaedic Association score indicating locomotive syndrome in patients with lumbar spinal canal stenosis.

BACKGROUND: Locomotive syndrome (LS) is a condition of decreased mobility caused by disorders of the locomotive organs. Lumbar spinal stenosis (LSS) is a LS disorder. The Japanese Orthopaedic Association score (JOA score) and the Zurich Claudication Questionnaire (ZCQ) are international evaluation tools for LSS. However, the relationship between LS and JOA score or ZCQ is unknown. This study aimed to clarify the correlations between LS progression and the values/parameters of the JOA score or ZCQ and to determine the critical cutoff point of the JOA score or ZCQ that indicates LS progression. METHODS: We recruited preoperative LSS patients (n = 82). Patients' mean age was 73.4 years. The study participants were evaluated using the 25-question Geriatric Locomotive Function Scale (GLFS), JOA score, and ZCQ (which consists of symptom severity and physical function), and the patients' health-related quality of life was assessed using EuroQoL-5 dimension (EQ-5D) utility values and the EuroQoL-visual analog scale (EQ-VAS). We investigated the correlations between the 25-question GLFS and each clinical variable and evaluated the critical cutoff point of each international evaluation tool to detect LS. RESULTS: There was a statistically significant correlation between 25-question GLFS and each clinical evaluation tool. LSS patients with LS showed significantly worse scores in the evaluation tools than LSS patients without LS. Moreover, we found that critical cutoff points of 17.5 on JOA score, 3.1 on ZCQ-symptom, and 2.3 on ZCQ-function could detect LS. CONCLUSIONS: A statistically significant correlation exists between the 25-question GLFS and the JOA score or ZCQ. It might be important to perform decompression surgery for LSS patients before they reach the cutoff values of the several clinical evaluation tools to avoid LS progression. STUDY DESIGN: Clinical prospective case-control study.

Sagittal alignment of cervical flexion and extension: lateral radiographic analysis.

STUDY DESIGN: An analysis of lateral radiographs in the upright, flexion-extension position. OBJECTIVES: To document and define the differences in cervical flexion-extension kinematics as they relate to changes of alignment in upright cervical lordosis. SUMMARY OF BACKGROUND DATA: No previous study has reported the association between sagittal plane cervical rotation kinematics and changes of alignment in upright cervical lordosis. METHODS: Lateral radiographs were classified into five groups (Group A, lordosis; Group B, straight; Group C, kyphosis; Group D, S-curve with lordotic upper cervical and kyphotic lower cervical spine; and Group E, S-curve with kyphotic upper cervical and lordotic lower cervical spine) by changes of alignment in upright position. Sagittal cervical rotation angles were measured by a computer-assisted method in the fully flexed and extended positions. RESULTS: Group A revealed the largest angle of lordosis at extension and the smallest angle of kyphosis at flexion, whereas Group C revealed the smallest angle of lordosis at extension and the largest angle of kyphosis at flexion. When Group D adopted the flexion-extension position, the curvature of the upper cervical spine was the same as Group A, whereas the lower cervical spine showed the same curve as Group C. Similarly, the cervical rotation kinematics in Group E were a combination of motion of upper cervical spine in Group C and that of lower spine in Group A. CONCLUSION: The results suggest that alterations in the static alignment of the cervical curvature cause alterations in the dynamic kinematics of the cervical spine during cervical flexion-extension. This information should aid in the interpretation of kinematic studies of the cervical spine.