Return-to-play outcomes after full-endoscopic spine surgery under local anesthesia in professional baseball players: Comparison by timing of surgery.

BACKGROUND: Full-endoscopic spine surgery via a transforaminal approach (TF-FESS) is minimally invasive and could help athletes quickly return to play. When treating professional athletes, we have to consider their season schedule. In this study, we investigated the characteristics of Japanese professional baseball players who underwent TF-FESS and examine how the timing of surgery influenced their postoperative course. METHODS: Ten players who underwent TF-FESS (discectomy, foraminoplasty, or thermal annuloplasty according to their diagnosis) under local anesthesia were analyzed. Multilevel surgeries were performed at the same time in patients with lesions at multiple levels. The patients were divided into three groups according to timing of surgery (pre/during/post-season). Time to complete return to play and duration of official game loss were compared between the three groups. RESULTS: All players (100 %) could return to their original level of professional play after FESS surgery. Seven of the 10 patients underwent two-level surgery. The mean time until complete return to play was 4.6 months (range, 2-8 months) and the mean duration of game loss was 1.5 months (range, 0-4 months). The mean duration of game loss was shorter in the post-season group than in the other groups (0.9 vs 2,4 months), and 4 of 6 patients in the post-season group did not miss any games. CONCLUSIONS: TF-FESS is a good technique for achieving a quick return to play in professional baseball players. In particular, surgery performed during the post-season could allow players to return to play after adequate rehabilitation with no game loss.

Transforaminal Full-endoscopic Discectomy for Gas-containing Herniated Nucleus Pulposus at L5-S1 Under Local Anesthesia†:†A Case Report.

The vacuum phenomenon is often observed in degenerative disc disease, whereas gas-containing disc herniation is relatively rare. Full-endoscopic discectomy at the lumbar spine level via a transforaminal approach, which was established and subsequently refined over the last two decades, requires only an 8-mm skin incision and causes minimal damage to the paravertebral muscles. Foraminoplasty, performed with a high-speed drill, is a useful technique to enlarge the foramen, especially when applied at the L5-S1 level, where the trajectory is limited because of anatomical structures such as the iliac crest. Here, we report a case of gas-containing lumbar disc herniation at L5-S1 that was successfully treated by transforaminal full-endoscopic discectomy. The patient was a 62-year-old man with low back pain and pain in the plantar aspect of the right great toe. Magnetic resonance and computed tomography scans demonstrated gas-containing lumbar disc herniation at L5-S1 on the right. Following foraminoplasty, transforaminal full-endoscopic lumbar discectomy was successfully performed under local anesthesia. The patient's symptoms improved immediately after the surgery. Transforaminal full-endoscopic surgery can be effective and minimally invasive even when performed for gas-containing disc herniation. J. Med. Invest. 69 : 328-331, August, 2022.

Low Back Pain and Lumbar Degeneration in Japanese Professional Baseball Players.

Background: Baseball is one of the most popular sports in Asia. It is known that baseball can easily lead to back pain. However, there has been no survey of low back pain (LBP) and lumbar disc degeneration in Japanese professional baseball players to date. Purpose: To investigate the cause of LBP and lumbar degeneration in professional Japanese baseball players. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We retrospectively reviewed the medical records of Japanese professional baseball players with LBP who visited our hospital. Data were collected from July 2018 to April 2021. We also investigated whether the results differed between players in their 20s and 30s or between pitchers and fielders. Data analysis was performed using the chi-square test. Results: We surveyed 32 professional baseball players. The most frequent causes of LBP among players in their 20s (n = 21) were lumbar disc herniation (LDH; 57%) and spondylolysis (24%). Of the players with spondylolysis, 50% had adult-onset spondylolysis. Players in their 30s (n = 11) most commonly had discogenic pain (55%) as well as LDH and facet joint arthritis (each 18%). The incidence of lumbar intervertebral disc degeneration was significantly higher in players in their 30s (91%) than those in their 20s (14%), as was the incidence of Schmorl nodes and Modic type 1 changes. There was no significant difference in the cause of LBP or the incidence of lumbar intervertebral disc degeneration between pitchers and fielders (P = .59). Conclusion: Among professional baseball players in their 20s, lumbar degeneration was less common, and they most frequently developed diseases less related to degeneration, such as LDH. However, among players in their 30s, lumbar degeneration was more advanced, and degenerative diseases such as discogenic pain occurred more frequently. Research on training methods could lead to the prevention of LBP. Our data may be applicable to other professional athletes and will contribute to diagnosis and treatment.

Hip fractures following intramedullary nailing fixation for femoral fractures.

INTRODUCTION: Proximal peri-implant femoral fractures occur following intramedullary nailing (IMN) fixation for trochanteric, femoral shaft, and distal femoral fractures. However, analyses of secondary hip fractures (SHFs) using large clinical samples are lacking. Therefore, we aimed to report the incidence and clinical outcomes of SHF after nailing fixation (IMN or cephalomedullary nailing [CMN]) for overall femoral fractures. In addition, we focused on IMN for femoral shaft fractures and investigated the risk factors for SHF. METHODS: This multicenter, retrospective, cohort study included 2,293 patients aged > 60 years who underwent nailing fixation for femoral fractures. The primary outcome was the incidence of SHF. In the assessment of clinical outcomes, we evaluated reoperation and the regaining of walking ability following SHF management. In addition, we conducted multivariable logistic regression analyses to examine the association between risk factors and SHF. RESULTS: Seventeen (0.7%) patients had SHFs, including 12 femoral neck fractures and 5 trochanteric fractures. Antegrade IMN was the most common type of nailing fixation. Multivariable analysis demonstrated that the absence of femoral head fixation was significantly associated with the incidence of SHF following IMN for femoral shaft fractures (odds ratio, 17.0; 95% confidence interval, 1.9-2265.7; p=0.006). In the assessment of clinical outcomes, there were two reoperations (16.7%) in the secondary femoral neck fracture group. Patients with secondary trochanteric fractures tended to have a lower probability of regaining walking ability than those with secondary femoral neck fractures (20% vs. 50%). CONCLUSIONS: In this multicenter study, the incidence of SHF after nail fixation for femoral fractures was 0.7%. The absence of femoral head fixation was significantly associated with SHF, and the clinical outcomes were poor. Therefore, femoral head fixation at the initial IMN fixation for femoral fractures may be a fixation option for surgeons to consider as an SHF prevention measure.

Circulating des-acyl ghrelin improves cardiovascular risk prediction in older hypertensive patients.

BACKGROUND: We aimed to assess the predictive value of circulating levels of des-acyl ghrelin, an abundant form of ghrelin in humans, for the risk of cardiovascular disease (CVD) in older hypertensive patients. We simultaneously evaluated other biomarkers, such as high-molecular-weight (HMW) adiponectin, high-sensitivity C-reactive protein (hs-CRP), and plasminogen activator inhibitor 1 (PAI-1), for their usefulness in risk prediction. METHODS: We enrolled 590 older hypertensive patients (mean age = 72.9 years; 41.0% men). The incidences of CVD, including coronary artery disease, stroke, congestive heart failure, and sudden death, were prospectively ascertained. RESULTS: During an average duration of 2.8 (SD = 0.7) years (1,653 person-years), there were 42 CVD events. Patients with CVD events had lower levels of des-acyl ghrelin at baseline than those without CVD events (median = 78.2 vs. 114.7 fmol/ml; P < 0.001). No difference was found among other biomarkers between the patients with CVD events and those without such events. The Cox proportional hazards model adjusted by covariables revealed that the hazard ratio for CVD events in patients with a 1-SD decrease of log des-acyl ghrelin was 1.8 (95% confidence interval = 1.3-2.4). Incorporation of des-acyl ghrelin in the risk model (including age, current smoking, 24-hour systolic blood pressure, preexisting CVD, and carotid intima-media thickness) improved the C statistics (from 0.683 to 0.721; P = 0.22) and resulted in a net reclassification improvement of 20.5% (P = 0.02). In contrast, HMW adiponectin, hs-CRP, and PAI-1 provided no improvement in risk prediction. CONCLUSIONS: Des-acyl ghrelin improved the prediction of CVD events in older hypertensive patients.

Association of cognitive dysfunction with cardiovascular disease events in elderly hypertensive patients.

OBJECTIVES: This study assesses whether presence of cognitive dysfunction can be a marker associated with the development of cardiovascular disease (CVD) events independent of ambulatory blood pressure (BP) or other indices of target organ damage (TOD) in elderly hypertensive patients. METHODS: We recruited 585 hypertensive patients (mean age, 73 years; 41% men) who were ambulatory, lived independently, and were without clinically overt dementia. Cognitive function was assessed by Mini-Mental State Examination (MMSE) at baseline, and CVD events (coronary artery disease, stroke, congestive heart failure, and sudden death) were prospectively ascertained. Cognitive dysfunction was defined as the lowest quartile of MMSE scores (n = 183, median 24 points). RESULTS: CVD events occurred in 42 people over an average of 2.8 years (1644 person-years). The prevalence of cognitive dysfunction was higher in patients with CVD events than those without (57 vs. 29%; both P <0.001) at baseline. Cognitive dysfunction was associated with CVD events, after adjustment for nocturnal SBP and evidence of TOD [i.e. albuminuria, cardiac hypertrophy, and carotid-artery intima-media thickness (IMT)], hazard ratio 2.5-2.9 (all P <0.01). Incorporation of MMSE in the risk model (including age, estimated glomerular filtration rate, and preexisting CVD) improved the C-statistics (from 0.691 to 0.741) and resulted in a net reclassification improvement of 17.6% (P = 0.02). In contrast, incorporation of albuminuria, cardiac hypertrophy, and high carotid-artery IMT added little further improvement in the risk prediction. CONCLUSION: Cognitive dysfunction is an independent marker associated with increased risk of CVD events in elderly hypertensive patients.

Regional differences in hypertensive cardiovascular remodeling between fishing and farming communities in Japan.

BACKGROUND: Effects of dietary n-3 polyunsaturated fatty acids (n-3 PUFA) intake on the cardiovascular system have been reported, and thus we hypothesized that the prevalence of hypertensive cardiovascular remodeling would be lower in a fishing than a farming community. METHODS: We recruited 263 essential hypertensives from a fishing and 333 from a farming village; all subjects were ≥40 years (mean 73 years; 42% men). They were cross-sectionally examined for serum eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), asymmetric dimethylarginine (ADMA) levels, left ventricular mass index (LVMI), and common-carotid artery (CCA) and internal-carotid artery (ICA) intima-media thickness (IMT). RESULTS: Compared to the patients in the farming village, those in the fishing village had higher serum EPA and DHA levels (63.3 vs.70.9 µg/ml, 137.2 vs.157.8 µg/ml) and lower ADMA levels (0.49 vs.0.47 nmol/ml; all P < 0.05). LVMI and both CCA-IMT and ICA-IMT levels were lower in the fishing than the farming village (113.2 vs.121.6 g/m(2), 0.88 vs.0.94 mm, 1.10 vs.1.17 mm: all P < 0.01) even after adjustment for age, sex, body mass index (BMI), duration of hypertensive medication, number of antihypertensive medications, and 24-h systolic blood pressure (SBP) level. The differences in LVMI and IMT levels between these communities also remained unchanged (all P < 0.01) after additional adjustment for the regional differences in EPA, DHA, and ADMA levels. A multivariable linear regression analysis showed that the difference in place of residence was independently associated with LVMI as well as with both CCA-IMT and ICA-IMT levels (all P < 0.01). CONCLUSION: The prevalence of cardiovascular remodeling was significantly lower in patients in the fishing community than in those in the farming community. Further investigations are required to explain the mechanisms underlying this association.

Association of poor physical function and cognitive dysfunction with high nocturnal blood pressure level in treated elderly hypertensive patients.

BACKGROUND: Our aim was to assess the association between poor physical function, cognitive dysfunction, and high nocturnal systolic blood pressure (SBP), all of which are markers of vulnerability or frailty in elderly persons. METHODS: In this cross-sectional study of 148 treated ambulatory elderly hypertensives (mean age: 75.5 years; 30% men), we evaluated 24-h BP levels, physical function (walking speed and timed up-and-go (TUG) tests), and mini-mental state examination (MMSE). Poor physical function or cognitive dysfunction was defined as a walking speed ≤1.5 m/s or MMSE score <27 points (below the geometric means for either examination). RESULTS: Both slower walking speed and lower MMSE scores were associated with high nocturnal SBP level, but not with daytime SBP level, even after adjustment for significant covariates (P = 0.05 and P < 0.01, respectively). Slower walking speed was significantly associated with the diminished nocturnal SBP dipping independent of the 24-h BP levels (P = 0.02). Compared with the patients who performed well on both physical and cognitive tests, or with those who had either poor physical function or cognitive dysfunction but not both, patients with both poor physical function and cognitive dysfunction had significantly higher nocturnal SBP levels (120 vs. 123 vs. 128 vs. 134 mm Hg; P = 0.008 for linear trend) and less marked nocturnal SBP dipping (-14.4 vs. -12.9 vs. -10.7 vs. -7.5%; P = 0.02 for linear trend) even after adjustment for significant covariates. CONCLUSION: Poor physical function and/or cognitive dysfunction could be valid markers likely to be associated with high nocturnal SBP, information which could help yield more refined prognosis for treated elderly hypertensives.

Association between morning blood pressure surge and cardiovascular remodeling in treated elderly hypertensive subjects.

BACKGROUND: It has remained unclear whether or not morning blood pressure (BP) surge (MS) is associated with cardiovascular remodeling in elderly (> or =60 years) hypertensive patients being treated by antihypertensive medications. METHODS: In this cross-sectional study (n = 197; mean 74.6 years; 37% men), we evaluated the association between MS, defined as the highest quartile of morning BP increase from sleep (> or =48 mm Hg; n = 49), and extent of cardiac hypertrophy and carotid artery intima-media thickness (IMT). RESULTS: Although there were no differences in 24-h BP levels and the number of prescribed antihypertensive medications between MS and non-MS group, the use of thiazide diuretics was more frequent in MS group than non-MS group (35% vs. 19%; P < 0.05). The MS group had significantly higher levels of left ventricular mass index (LVMI) and internal-carotid artery (ICA)-IMT than the non-MS group (both P < 0.01), independent of 24-h BP levels, daytime BP variability, the degree of nocturnal BP decline, the plasma low-density lipoprotein levels, and the use of diuretics. Even in subjects with a well-controlled 24-h BP level (<130/80 mm Hg; n = 75), these relationships were similar. A multiple logistic regression analysis showed that the presence of MS was an independent determinant of LV hypertrophy (LVH) (> or =125 g/m(2) in men and > or =110 g/m(2) in women) and assignment to the highest quartile of ICA-IMT (both P < 0.05). CONCLUSIONS: The MS in subjects being treated with antihypertensive medications was significantly associated with cardiovascular remodeling, independently of 24-h BP level, daytime BP variability, and nocturnal BP decline.

Plasma des-acyl ghrelin, but not plasma HMW adiponectin, is a useful cardiometabolic marker for predicting atherosclerosis in elderly hypertensive patients.

OBJECTIVE: The coming obesity epidemic in elderly persons necessitates the establishment of new and easy-to-use cardiometabolic markers to identify individuals most likely to develop atherosclerosis among hypertensives. METHODS: We measured plasma HMW adiponectin and des-acyl ghrelin levels, and carotid-artery intima-media thickness (cIMT) in 263 elderly hypertensives (mean 72.6 years; 37%men). Other cardiometabolic markers, including metabolites, inflammation, and hemostasis, were also measured. RESULTS AND CONCLUSION: Both HMW adiponectin and des-acyl ghrelin levels were inversely correlated with obesity. The HMW adiponectin level was favorably associated with glucose and lipid metabolites, PAI-1 (all P<0.05), and hs-CRP (P=0.07) after adjustment for age, sex, and BMI; however, it had no correlations with cIMT. In contrast, although there were no correlations between des-acyl ghrelin and cardiometabolic markers, except for a positive association with the nitrite/nitrate (NO(x)) level (P=0.002), des-acyl ghrelin had a significant inverse correlation with cIMT (P=0.003). A multivariable regression analysis showed that des-acyl ghrelin, but not HMW adiponectin, was significantly associated with cIMT after adjusting for age, obesity, sex, smoking, 24-h BP, and other cardiometabolic factors (beta=-0.178, P=0.001). Moreover, the increased risk of cIMT among those with abdominal obesity compared with non-obesity (0.833+/-0.185 mm vs. 0.782+/-0.163 mm, P=0.019) was explained by the elevated 24-h BP and reduced des-acyl ghrelin level, but not by other cardiometabolic parameters. These associations were unchanged after adding NO(x) to the model. In conclusion, the des-acyl ghrelin level is a useful cardiometabolic marker for predicting atherosclerosis in elderly hypertensives, and the pathologic pathway linking these factors is independent of its NO bioactivity.