＜Editors' Choice＞ Neck pain after cervical laminoplasty is associated with postoperative atrophy of the trapezius muscle.

Cervical laminoplasty is a safe and effective treatment for cervical myelopathy. However, it has a higher frequency of postoperative axial pain than other methods. A variety of causes of postoperative axial pain have been reported, but these have not been fully elucidated. This study aimed to investigate the association between postoperative axial pain and changes in the posterior neck muscles before and after surgery. The study included 93 patients with cervical myelopathy who underwent surgery at our institute between June 2010 and March 2013. The patients with greater preoperative and 1-year postoperative neck pain visual analog scale scores comprised the neck pain group. The cross-sectional area of the cervical posterior extensor muscles and the trapezius muscle were measured by magnetic resonance imaging before and 1 year after surgery at the C3/4, C4/5, and C5/6 levels to compare with neck pain. The total cross-sectional area atrophy rate (C3/C4, C4/C5, and C5/C6) of the trapezius muscle was significantly larger in patients with neck pain (12.8 ± 13.2) than in those without (6.2 ± 14.4; p<0.05). The cross-sectional area atrophy rate of the trapezius muscle at only the C5/6 level was significantly higher in patients with neck pain (16.7 ± 11.7) compared to those without (3.3 ± 14.4; p<0.001). No significant differences were found in the cross-sectional areas of the cervical posterior extensor muscles. Trapezius atrophy, especially at the lower cervical vertebrae, was associated with neck pain after cervical laminoplasty.

Association between Postoperative Neck Pain and Intraoperative Transcranial Motor-Evoked Potential Waveforms of the Trapezius Muscles in Patients with Cervical Myelopathy Who Underwent Cervical Laminoplasty.

STUDY DESIGN: Retrospective study. PURPOSE: Cervical laminoplasty is safe and effective for treating cervical myelopathy but has a higher frequency of postoperative axial pain compared to other methods. Several studies have reported on the causes of postoperative axial pain, but none have fully elucidated them. This study aimed to investigate the association between postoperative neck pain and intraoperative transcranial motor-evoked potential (MEP) waveforms of the trapezius muscles using transcranial MEPs. OVERVIEW OF LITERATURE: Few studies have investigated the association between postoperative neck pain and intraoperative transcranial MEP waveforms of the trapezius muscles in patients with cervical laminoplasty. METHODS: A total of 79 patients with cervical myelopathy who underwent cervical laminoplasty at our facility between June 2010 and March 2013 were included in this study. Intraoperative control and final waveform were evaluated based on the trapezius muscle MEPs by measuring the latency and amplitude. A neck pain group comprised patients with higher neck pain Visual Analog Scale scores from preoperative value to 1 year postoperatively. The cross-sectional areas of the trapezius muscles and the MEP latencies and amplitudes were compared between patients with and without neck pain. RESULTS: The latency and amplitude of the control waveforms were not significantly different between groups. The neck pain group had a significantly shorter final waveform latency (neck pain: 23.6±2.5, no neck pain: 25.8±4.5; p =0.019) and significantly larger amplitude (neck pain: 2,125±1,077, no neck pain: 1,630±966; p =0.041) than the no neck pain group. CONCLUSIONS: Postoperative neck pain was associated with the final waveform latency and amplitude of the trapezius muscle MEPs during cervical laminoplasty. Intraoperative electrophysiological trapezius muscle abnormalities could cause postoperative neck pain.

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.

Evaluation of the Association between Neck Pain and the Trapezius Muscles in Patients with Cervical Myelopathy Using Motor Evoked Potential: A Retrospective Study.

STUDY DESIGN: Retrospective study. PURPOSE: We aimed to use motor evoked potentials (MEPs) to examine the association of electrophysiological assessment of the trapezius muscle with neck pain. OVERVIEW OF LITERATURE: Previous reports on the association of neck pain with the trapezius muscle have focused on surface electromyograms and muscle oxygenation; however, to our knowledge, none of these studies included detailed data on MEPs. METHODS: The study included 100 patients with cervical myelopathy who underwent surgery at the National Center for Geriatrics and Gerontology in Obu, Japan from June 2010 to March 2013. Before the surgery, neck pain was evaluated using a Visual Analog Scale (a score ≥50 indicated neck pain and a score <50 indicated no neck pain). The preoperative cross-sectional areas of the trapezius muscles were measured with cervical magnetic resonance imaging sagittal T2-weighted images. Cranial stimulation under general anesthesia was used to derive the MEPs, enabling the measurement of latency and amplitude, using preoperative MEPs of the trapezius muscles. RESULTS: The MEP of the trapezius muscle in patients with neck pain had significantly shorter latencies than those in patients who did not have neck pain. However, there was no significant difference in the amplitude between patients with and without neck pain. However, this tended to be greater in patients with neck pain as compared to that in those without neck pain. The cross-sectional area of the trapezius muscle in patients with neck pain was significantly smaller than that in those who did not have neck pain. CONCLUSIONS: MEPs revealed electrophysiological abnormalities of the trapezius muscles in patients with neck pain, supporting a relationship of neck pain with the trapezius muscles.

Effect of race, age, and gender on lumbar muscle volume and fat infiltration in the degenerative spine.

BACKGROUND: The quantity and quality of spinal muscles in patients with degenerative spinal diseases and various backgrounds such as age, gender, or race is unclear. We quantitatively evaluated the cross-sectional area (CSA) and fatty degeneration of the muscles around the spine, using magnetic resonance imaging (MRI) in patients with degenerative spinal disease, and studied the effects of age, gender, and race in multicenter retrospective study. METHODS: The subjects were Caucasian and Asian patients with degenerative lumbar disease who underwent L4-5 single level spinal fusion surgery at centers in the United States and Japan. Using preoperative axial T2 MRI at the L4-5 disc level, the cross-sectional areas of the psoas and paraspinal muscles were measured. Fat infiltration was measured using the threshold method, and percent fat area (%FA) was calculated for each muscle. The muscle/disc area ratio (MDAR) was used to control for size differences per patient. T-test, Pearson's correlation coefficient, partial correlation, and multiple linear regression were used for statistical analysis. RESULTS: In total, 140 patients (53 men; 87 women; mean age, 69.2 years) were analyzed. Age was similar in Caucasians (n = 64) and Asians (n = 76). MDARs were larger in Caucasians for paraspinal and psoas muscles (p < 0.005). Percent FA of psoas was similar in Caucasians and Asians, but greater in the paraspinal muscles of Asians (p < 0.05). After controlling for race and gender, age was correlated negatively with MDAR (p < 0.001) and positively with %FA (p < 0.001). In the multiple linear regression analysis, age, gender, and race were independently affected by MDAR and %FA. CONCLUSIONS: Lumbar muscle mass and quality were affected by age, gender, and race, independently, in patients with degenerative lumbar disease.

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.

Utility of the Serum Cystatin C Level for Diagnosis of Osteoporosis among Middle-Aged and Elderly People.

PURPOSE: Osteoporosis is a common age-related disorder leading to increased bone fragility and risk of fracture. Early diagnosis of osteoporosis is a vital step in providing early therapeutic intervention. Serum cystatin C is a marker of early renal dysfunction, a predictor of cardiovascular and inflammatory diseases, and an inhibitor of the differentiation of osteoclast precursor cells. The purpose of this study was to evaluate the relationship between serum cystatin C and osteoporosis. METHODS: We enrolled 46 subjects who attended a health checkup and underwent measurement of bone status by quantitative ultrasound and determination of the level of serum cystatin C. A comparative study was conducted between those with and without osteoporosis for all subjects collectively and in two subgroups aged <65 and ≥65 years. RESULTS: Serum cystatin C levels were strongly correlated with age, creatinine, and bone status data, with significant negative correlations with stiffness, T-score, and percentage of young adult mean. Among patients with osteoporosis, serum cystatin C was significantly higher even after adjustment for age and sex, whereas no significant difference was noted in creatinine. For patients aged ≥ 65 years, serum cystatin C was significantly higher in subjects with osteoporosis, although there was no significant difference in age between normal subjects and those with osteoporosis. CONCLUSIONS: To the best of our knowledge, this is the first study to demonstrate an association between serum cystatin C and osteoporosis. Serum cystatin C is significantly higher in osteoporosis and in particular may be a useful marker for osteoporosis among middle and elderly people aged ≥ 65 years. Measurement of serum cystatin C can be carried out easily and may contribute to early diagnosis and treatment of osteoporosis.

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.

Electrophysiological Function of the Lumbar Multifidus and Erector Spinae Muscles in Elderly Patients With Chronic Low Back Pain.

STUDY DESIGN: This was a cross-sectional electrophysiological study. OBJECTIVE: The main objective of this study was to evaluate electrophysiological activation of lumbar multifidus (LM) and erector spinae (ES) in elderly patients with chronic low back pain (CLBP) classified by LBP developmental mechanisms. SUMMARY OF BACKGROUND DATA: Local and global muscles that function independently for stabilization and moment production, respectively, are crucial for stability and mobility of the lumbar spine. There is little research conducted on the electrophysiological functions of the LM as a local muscle and the ES as a global muscle in the lumbar spine, and their interrelation in patients with CLBP. MATERIALS AND METHODS: Elderly patients aged 65 years and above, with CLBP were assigned into motion-induced LBP (49 patients) or walking-induced LBP cohorts (57 patients), and compared with a control group (53 patients without LBP). Electrophysiological activation of the LM and ES was performed using surface electromyography (EMG) and mechanomyography (MMG) during lumbar extension and flexion. Electromechanical coupling efficiency (EMCE) was calculated using the ratio of MMG to EMG. RESULTS: EMG and MMG amplitudes in the LM tended to be lower in patients with LBP than in the control group. EMG and MMG amplitudes in the ES tended to be higher in patients with LBP than in the control group. EMCE was significantly higher in both the LM and ES during lumbar extension and flexion in the motion-induced LBP cohort than in the walking-induced LBP cohort; however, ES dominance was seen in the motion-induced LBP cohort, both in lumbar extension and flexion, according to the EMCE ratio. CONCLUSIONS: ES dominance was seen in the motion-induced LBP cohort, both in lumbar extension and flexion, according to the EMCE ratio. Subgrouping of patients according to the induction of LBP seems to be important for CLBP treatment, and the electrophysiological assessment for the deep and superficial back muscles may be beneficial to elderly patients.

＜Editors' Choice＞ Ultrasound measurement of thigh muscle thickness for assessment of sarcopenia.

Our aim of this study is to compare the thigh muscle thickness measurements obtained using ultrasound and bioelectrical impedance analysis (BIA) methods, and to investigate the validity and cutoff value of the ultrasonography. We analyzed a total of 201 participants (99 male and 102 female participants, mean age, 66.2 years) participated in the annual health checkup in the Yakumo Study, 2014. Thigh muscle thickness (TMT, sum of the rectus femoris and vastus intermedius muscle thickness) was measured using ultrasound at mid-thigh in the sitting position. Appendicular skeletal muscle mass (aSMI) was measured using BIA. Cutoff value of TMT was determined through the receiver operating characteristic analysis. We defined sarcopenia with the diagnostic algorithm of Asian Working Group for Sarcopenia. TMT was significantly reduced in subject with sarcopenia than in those without sarcopenia in both gender. Muscle measurements obtained using the BIA methods (aSMI) and ultrasound methods (TMT) showed a significant correlation, with a correlation coefficient of 0.38 (P < 0.001). Cutoff value, sensitivity, and specificity of TMT in diagnosis of muscle loss were 36 mm, 72.0%, and 73.9%, respectively, for the male participants, and 34 mm, 72.2%, and 72.4%, respectively, for the female participants. In conclusion, the ultrasonography for thigh muscle might be a simple diagnostic method for sarcopenia.

The Impact of Sarcopenia on Cervical Spine Sagittal Alignment After Cervical Laminoplasty.

STUDY DESIGN: This was a prospective follow-up study. OBJECTIVE: The main objective of this study was to evaluate the effects of sarcopenia on the sagittal alignment of the cervical spine after cervical laminoplasty in order to investigate the relationship between sarcopenia and spinal malalignment. SUMMARY OF BACKGROUND DATA: Sarcopenia, a progressive and all over loss of skeletal muscle mass and strength associated with aging, has been reported to be related to spinal malalignment. The causes of poor surgical outcome after cervical laminoplasty have been examined in recent years, including the sagittal malalignment of the cervical spine. However, there are few reports about the impact of sarcopenia on the sagittal alignment of the cervical spine. MATERIALS AND METHODS: A total of 171 patients who underwent cervical laminoplasty at our hospital between 2009 and 2015 were assigned to this study. The appendicular skeletal muscle mass [appendicular skeletal muscle index (SMI)] is commonly used to assess sarcopenia. Appendicular SMI (kg/m) was obtained from arm and leg muscle mass using dual-energy x-ray absorptiometry. Sanada and colleagues reference value for the Japanese appendicular SMI was used to diagnose sarcopenia. C2-C7 sagittal vertical axis (SVA), C2-C7 lordosis angle, and C2-C7 range of motion were measured for evaluation. The primary outcome was evaluated using the Japanese Orthopedic Association Score System for Cervical Myelopathy (JOA score) and the SF-36 Health Survey Physical Function (PF). RESULTS: Of the 171 patients, 48 were diagnosed with sarcopenia. Preoperative (P=0.001), postoperative (P=0.011), and 1-year follow-up (P=0.007) C2-C7 SVA were greater in the sarcopenia group. Preoperative (P=0.009), postoperative (P=0.018), and 1-year follow-up (P=0.023) SF-36 scores were higher in the nonsarcopenia group. Preoperative (P<0.001), postoperative (P<0.001), and 1-year follow-up (P=0.002) JOA scores were higher in the nonsarcopenia group. C2-C7 SVA and JOA scores were negatively correlated at 1-year follow-up (R=-0.213, P=0.005). C2-C7 SVA and SF-36 scores were not correlated at 1-year follow-up (R=-0.167, P=0.070). CONCLUSIONS: C2-C7 SVA was greater and postoperative outcome was worse after cervical laminoplasty in the sarcopenia group than in the nonsarcopenia group; thus, we believe it is necessary to evaluate sarcopenia before cervical laminoplasty, because sarcopenia may impact postoperative cervical alignment and postoperative outcome. LEVEL OF EVIDENCE: Level III.

A low phase angle measured with bioelectrical impedance analysis is associated with osteoporosis and is a risk factor for osteoporosis in community-dwelling people: the Yakumo study.

Although the phase angle has been reported to be related to predictive factors and therapeutic effects in various diseases, its relation with osteoporosis is unclear. In our large prospective survey of community-dwelling people, a low phase angle was related with osteoporosis, and it could be a predictor of osteoporosis. PURPOSE: The phase angle measured with bioelectrical impedance analysis (BIA) is one of the clinically important impedance parameters, and it is a predictor of prognosis and mortality for several diseases. The present cross-sectional study aimed to elucidate the association between osteoporosis and variables measured with BIA, including the phase angle. METHODS: The study included 307 participants from an annual health checkup. All participants underwent measurement of bone status by quantitative ultrasound and body composition by BIA. Osteoporosis was diagnosed according to the WHO classification, and statistical comparisons were conducted between normal individuals and osteoporosis patients. RESULTS: Age, proteins, minerals, and the phase angle were significantly different between normal individuals and osteoporosis patients (p < 0.001). Furthermore, after controlling for age and sex, proteins, minerals, and the phase angle were significantly lower in osteoporosis patients than those in normal individuals (p < 0.001). In multivariate logistic regression analysis, older age and a low phase angle were risk factors for osteoporosis. Additionally, multiple regression analysis showed that age, sex, proteins, minerals, and the appendicular skeletal muscle index were significantly related to the phase angle. CONCLUSIONS: The phase angle is a predictor of osteoporosis, which is unaffected by age and sex, and a lower phase angle is associated with greater probability of osteoporosis. The phase angle can be easily measured, and osteoporosis can be confirmed even at home. This may facilitate early diagnosis and treatment, which may be useful for preventing diseases related to osteoporosis.

Serum cystatin C level is associated with locomotive syndrome risk and can be an early predictor in community-living people: The Yakumo study.

OBJECTIVES: The locomotive syndrome (LS) risk has been recently proposed as a criterion for evaluating physical ability. Serum cystatin C level is an early renal function marker and a cardiovascular disease predictor. This study aimed to evaluate the relationship between serum cystatin C level and LS risk. METHODS: We enrolled 54 participants and conducted the two-step test, stand-up test, 25-question geriatric locomotive function scale, LS risk test, Timed Up and Go test, back muscle strength, grip strength, blood test and serum cystatin C level measurement. A comparative study was conducted in participants with and without LS risk and in subgroups aged <60 and ≥60 years. RESULTS: No significant difference was found in the serum cystatin C level in subgroups aged <60 years and without LS risk. However, it was significantly higher in subjects with LS risk and aged ≥60 years. The area under the curve of the serum cystatin C level for LS risk was 0.824. CONCLUSION: The serum cystatin C level is significantly related to LS risk and can be an early predictor. In middle-aged and elderly people with high serum cystatin C levels, it is strongly recommended to enforce LS risk test and intervention.

Sarcopenia and physical function are associated with inflammation and arteriosclerosis in community-dwelling people: The Yakumo study.

OBJECTIVES: Sarcopenia reduces physical function, while chronic inflammation causes arteriosclerosis and decreases skeletal muscle. We conducted a cross-sectional study to elucidate the associations among sarcopenia, physical function, arteriosclerosis, and inflammation in community-dwelling people. METHODS: We recruited 335 participants in an annual health checkup. We diagnosed sarcopenia based on appendicular skeletal muscle mass index (aSMI) assessed by bioelectrical impedance analysis. We measured several physical function tests, blood pressure, and serum levels of high-sensitivity C-reactive protein (hs-CRP), total cholesterol, and low-density lipoprotein cholesterol. RESULTS: After controlling for age, sex, and BMI, participants in the sarcopenia group showed lower performance in all measured physical tests than the normal group. Arteriosclerosis risk factors, including blood pressure, cholesterol levels, and hs-CRP, were significantly higher in the sarcopenia group than in the normal group. hs-CRP and total cholesterol levels were significant risk factors of sarcopenia. The aSMI, grip strength, and maximum stride length were negatively related to hs-CRP level. CONCLUSIONS: Community-dwelling people with sarcopenia had higher levels of hs-CRP and a higher risk for arteriosclerosis. The serum level of hs-CRP was an independent risk factor for sarcopenia and was associated with physical function. These findings indicate that chronic inflammation may relate arteriosclerosis and sarcopenia simultaneously.

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.

Sarcopenia affects conservative treatment of osteoporotic vertebral fracture.

OBJECTIVES: Sarcopenia and osteoporosis affects activities of daily living and quality of elderly people. However, little is known about its impact on elderly locomotor diseases, such as osteoporotic vertebral fracture (OVF). There is no report investigating the influence of both sarcopenia and osteoporosis on outcomes of OVF. This study aimed to evaluate the clinical outcomes of OVF in elderly patients from sarcopenic perspectives. METHODS: This prospective study was conducted with 396 patients, aged 65 years or more, hospitalized for the treatment of OVF (mean age, 81.9 ±â€¯7.1 years; 111 males, 285 females). The primary outcome was the Japanese Orthopaedic Association (JOA) score for lumbar disease (at first visit, hospital discharge, and 1 year after treatment) and Barthel index (at the same time and before hospitalization). The second outcome was living place after discharge. Susceptibility to sarcopenia and osteoporosis were evaluated and clinical results of conservative treatment were compared. RESULTS: Sarcopenia significantly affected Barthel index at first visit and discharge. Sarcopenia patients had significantly higher rate for discharge to nursing home and living in nursing home after 1 year than patients without sarcopenia. Osteoporosis significantly affected the JOA score at the first visit and the Barthel index before hospitalization, at the first visit, discharge, and after 1 year. Osteoporosis did not affect the living place at discharge and after 1 year. CONCLUSIONS: Sarcopenia and osteoporosis affected outcomes of conservative treatment for OVF; moreover, sarcopenia affected the living place of OVF patients at discharge and after 1 year.

Efficacy of Early Fusion With Local Bone Graft and Platelet-Rich Plasma in Lumbar Spinal Fusion Surgery Followed Over 10 Years.

STUDY DESIGN: Prospective clinical study. OBJECTIVE: Many oral surgeons use platelet-rich plasma (PRP) for bone defects, but the efficacy of PRP for spinal arthrodesis remains uncertain. The objective was to compare the efficacy of autologous local bone graft and PRP with local bone graft alone for promotion of bony union in posterolateral lumbar fusion (PLF) surgery, with investigation of the safety of PRP over 10 years. METHODS: A prospective study was conducted in 29 consecutive patients who underwent one-level PLF at L4/5 for degenerative lumbar disease. Local bone on the left (control) side and local bone with PRP on the right side were grafted. The fusion area and absorption of grafted bone at 58 regions were determined using computed tomography at 2 weeks and 3, 6, and 12 months after surgery. RESULTS: Average bone fusion areas on the PRP side were significantly wider at 3 and 6 months after surgery (P < .05). Average absorption values were significantly lower on the PRP side than on the control side at 3 and 6 months after surgery (P < .05). The PRP/control ratio was significantly different at 3 and 6 months compared to that at 2 weeks (P < .005). No adverse events related to PRP occurred with good clinical outcome over 10 years follow-up. CONCLUSIONS: Local application of PRP combined with autologous local bone graft has a positive impact on early fusion for lumbar arthrodesis with no adverse events over 10 years, and thus is a safe and low cost autologous option in spinal fusion.