Association between trunk extensor strength and gait-induced back pain in the elderly with adult spinal deformity: a cross-sectional study.

PURPOSE: The purpose of the present study was to investigate the association between quantitatively assessed trunk extensor strength and gait-induced back pain (GIBP) in patients with adult spinal deformity (ASD). METHODS: Ninety-five patients with ASD aged ≥ 50 years who were admitted to our hospital between April 2018 and March 2023 were included in the study. GIBP was evaluated through a 6-minute walking test (6MWT), with GIBP being defined as the occurrence of back pain during the evaluation and inability to complete the test. The patients were divided into three groups: difficulty completing the 6MWT (Group 1), ability to complete the 6MWT with breaks (Group 2), and ability to complete the 6MWT without taking a break (Group 3). The main independent variable was trunk extensor strength, which was measured using a hand-held dynamometer. Ordered logistic regression analysis was conducted to assess the association between GIBP and trunk extensor strength while adjusting for basic characteristics and radiographic parameters as covariates. RESULTS: The numbers of patients with ASD included in each group were; 27 in Group 1 (28.4%), 31 in Group 2 (32.6%), and 37 in Group 3 (39.0%). An ordered logistic regression analysis adjusted for basic characteristics and radiographic parameters, trunk extensor strength was significantly associated with GIBP (odds ratios, 1.128; 95% confidence intervals, 1.025-1.242). CONCLUSIONS: The results of the present study strongly indicate that trunk extensor strength is a valuable factor associated with GIBP in patients with ASD.

Novel assessment of physiotherapy outcomes in adults with structural spinal disorders.

PURPOSE: The aim is to investigate whether a simple prone posture assessment test (P-test) at baseline can be predict the effectiveness of at least 3 months of physiotherapy for adults with structural spinal disorders. METHODS: Seventy-six adults (age 71.0 ± 7.1 years) with structural spinal disorders who visited our outpatient clinic and underwent physiotherapy, which included muscle strength and range of motion training was provided once a week for a minimum of 3 months, and where the load was adjusted individually by the physiotherapist. The P-test is performed with the subject lying on the bed in a prone position and is positive if no low back pain is seen and the abdomen touches the bed. The Oswestry Disability Index (ODI) was used to assess disability. The minimum clinically important difference (MCID) was set at 10% improvement of the ODI score. Logistic regression analysis was performed to investigate the association between baseline P-test and achievement of ODI-MCID. RESULTS: The study population characteristics were: Sagittal vertical axis 138.1 ± 73.2 mm; Pelvic tilt, 36.9 ± 9.8 degrees; Pelvic incidence minus lumbar lordosis, 45.3 ± 22.1 degrees; and maximum coronal Cobb angle, 21.3 ± 19.7 degrees. Logistic regression analysis showed that being positive on the P-test was associated with the achievement of ODI-MCID (Odds ratio, 8.381; 95% confidence interval, 2.487-35.257). CONCLUSIONS: This study found that our developed P-test was a useful predictor of achieving the ODI-MCID in a cohort of adults with structural spinal disorders receiving at least 3 months of physiotherapy.

Influence of changes in pelvic anteversion during gait on walking ability and physical function in patients with adult spinal deformity: A cross-sectional study.

BACKGROUNDS: Evaluation of gait posture using a three-dimensional motion analysis system (3DMAS) revealed that elderly patients with adult spinal deformity (ASD) experience pelvic anteversion while walking. The purpose of this study was to investigate the influence of changes in pelvic anteversion during gait on walking ability and physical function in patients with ASD. METHODS: Fifty-four patients with ASD aged 50 years or older who were admitted to our hospital between March 2016 and December 2021 were included in the study. The 6-min walking distance (6MWD) was used to evaluate walking ability, and trunk and hip extensor strength were measured to evaluate physical function in the subjects. The 3DMAS was used to measure the subject's changes in pelvic anteversion during gait. After measuring the changes in pelvic anteversion, the median value of the study subjects was calculated, according to which the subjects were divided into two groups (small anteversion [S] group, large anteversion [L] group). Walking ability and physical function were compared between the two groups. RESULTS: The number of subjects in each group was 27. Comparisons of walking ability and physical function between the groups revealed significant differences in 6MWD (S group, 333.6 ± 111.2 m; L group, 238.0 ± 106.3 m) and hip extensor strength (S group, 15.8 ± 3.8 kgf; L group, 13.4 ± 4.4 kgf). No significant differences regarding trunk extensor strength were observed between the groups (S group, 15.2 ± 4.0 kgf; L group, 12.9 ± 4.8 kgf). CONCLUSION: The results of the present study revealed that ASD patients with greater pelvic anteversion associated with walking have lower walking ability and physical function. These results suggest the importance of evaluating the posture of ASD patients not only by using radiographic findings but also by assessing movement, such as gait posture.

Pregnancy and Lactation-Associated Osteoporosis Successfully Treated with Romosozumab: A Case Report.

Pregnancy- and lactation-associated osteoporosis (PLO) is a rare type of premenopausal osteoporosis that occurs mainly in the third trimester or immediately after delivery; one of its most common symptoms is back pain caused by a vertebral fracture. The pathogenesis of PLO is unclear, and there is no accepted consensus regarding the treatment of PLO. Although treatments with drugs such as bisphosphonate, strontium ranelate, denosumab, and teriparatide were reported, there is no report of a patient with PLO treated with romosozumab. We present the first case of a patient with PLO treated with romosozumab following 4-month teriparatide treatment. A 34-year-old primiparous and breastfeeding Japanese woman experienced severe low back pain 1 month postdelivery. She was diagnosed with PLO on the basis of low bone marrow density (BMD) and multiple vertebral fractures with no identified cause of secondary osteoporosis. She was treated with teriparatide injection for 4 months, but the treatment was discontinued because of the patient feeling severe nausea after every teriparatide injection and the appearance of new vertebral fractures. Thereafter, we used romosozumab for 12 months. After the romosozumab treatment, her BMD was increased from the baseline by 23.6% at L1-L4, 6.2% at the femoral neck, and 11.2% at the total hip. Treating PLO with 12-month romosozumab after 4 months of teriparatide injection remarkably increased the BMD of the lumbar spine, femoral neck, and total hip without subsequent fracture. Romosozumab has potential as a therapeutic option to improve the BMD and reduce the subsequent fracture risk of patients with PLO.

Dose-response relationship between spino-pelvic alignment determined by sagittal modifiers and back pain-specific quality of life.

PURPOSE: To determine whether abnormalities of the sagittal modifiers (SMs) of the Scoliosis Research Society (SRS)-Schwab classification truly reflect back pain (BP)-specific quality of life (QOL), it is necessary to examine their dose-response relationships and to determine clinically impactful thresholds for declines in BP-specific QOL. This study aimed to analyse the continuous dose-response relationship between each SM and BP-specific QOL. METHODS: This cross-sectional study, using data from a Japanese population-based cohort study, included 519 community-dwelling residents aged ≥ 50 years who participated in the annual health examination. The participants completed the Roland-Morris Disability Questionnaire (RDQ) on BP-specific QOL. Spino-pelvic alignment based on SMs was assessed by whole-spine X-ray examinations. We fitted general linear models with or without nonlinear terms to estimate the dose-response relationship between each SM and BP-specific QOL. RESULTS: Pelvic tilt, pelvic incidence minus lumbar lordosis (PI-LL), and sagittal vertical axis showed dose-response relationships with BP-specific QOL measured as the RDQ score. PI-LL was most likely to predict a minimally clinically important RDQ score when its value exceeded the 90th percentile. A nonlinear relationship between PI-LL and the BP-specific QOL score was found. RDQ increased when PI-LL exceeded 10°. CONCLUSION: PI-LL might be the most sensitive of the three modifiers of the SRS-Schwab classification for determining BP-specific QOL. Moreover, BP-specific QOL worsens rapidly when the compensatory mechanism against malalignment exceeds a critical value. Therefore, we suggest that traditional classifications and surgical strategies should be re-examined regarding the dose-dependent abnormalities of the SMs to develop a more reliable classification strategy.

Clinical outcomes of lumbar diseases specific test in patients who undergo endoscopy-assisted tubular surgery with lumbar herniated nucleus pulposus: an analysis using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ).

PURPOSE: This study was to evaluate clinical outcomes using a patient-oriented test that scores health-related quality of life (HRQOL) for patients after minimally invasive surgery using microendoscopic discectomy (MED) for lumbar disc hernia. Few studies regarding MED in terms of disease-specific quality of life measures using Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) have been published. METHODS: Retrospective analysis of the surgical and clinical outcomes with regard to reducing pain and improving the functional status for 31 patients who underwent MED for lumbar disc hernia was conducted. These patients were evaluated at 3-year follow-up. The evaluations were based on a visual analogue scale (VAS), the Japanese Orthopaedic Association (JOA) scoring system, and the JOABPEQ, which is an objective, patient-oriented test that assesses HRQOL in patients with lumbar disorders. RESULTS: A low rate of improvement was seen only in mental health until 1 year, the low rate of improvement in mental health and was independently correlated with body mass index (BMI), pre-operative scores on the Brief Scale for Psychiatric problems in Orthopaedic Patients (BS-POP), and scores on the BS-POP at 12 months post-operatively. CONCLUSIONS: All categories of VAS, JOA scores, and all domains of JOABPEQ were significantly higher over 3 years than those obtained pre-operatively. But only mental health domain showed mild improvement until 1 year. Moreover, BMI showed a negative correlation with improvements in the mental health domain post-operatively. As patients may be mentally exhausted from lumbar disc herniation, pre-operative mental health may be improved by surgical treatment.

Effect of Residual Pain After Posterior Fusion Surgery for Lumbar Degenerative Disorders on Health-Related Quality of Life: A Two-Year Follow-Up Using Patient-Reported Outcome Measures.

STUDY DESIGN: This is a prospective cohort study. PURPOSE: The present study aimed to investigate the effects of residual pain after fusion surgery for lumbar degenerative diseases on quality of life (QOL). OVERVIEW OF LITERATURE: Residual symptoms after spinal surgery often restrict patients' activities of daily living and reduce their QOL. However, few studies have comprehensively addressed physical, psychological, and social factors. METHODS: The study population included a cohort of 208 patients (mean age: 67.9 years) who had undergone posterior interbody fusion for lumbar degenerative disease between 2012 and 2019. We asked the patients to complete the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Short Form Health Survey (SF-36) preoperatively, as well as at six, 12, and 24 months postoperatively. The presence of residual postoperative pain (RPP) was determined using the low back pain score of the JOABPEQ at six months postoperatively, and patients with an improvement of < 20 points compared to preoperative assessment were classified as RPP+ based on a previous study. RESULTS: In all patients, there was a notable postoperative improvement in all JOABPEQ and SF-36 domains compared to preoperative scores. The RPP+ group comprised 60 patients (69.6 years), while the RPP- group comprised 148 patients (67.2 years). In the RPP+ group, the lumbar function in the JOABPEQ and general health in the SF-36 showed limited postoperative enhancement. The pace of improvement in the role-emotional, role-physical, social functioning, vitality, and mental health scores was slower in the RPP+ group compared to the RPP- group. CONCLUSIONS: In the current study, we found that the presence of residual pain at six months postoperatively affected QOL improvement up to 24 months after surgery. Lingering postoperative pain substantially impacted functional incapacity, social engagement, and psychological well-being. Notably, the lumbar function in the JOABPEQ and general health in the SF-36 showed distinct progression patterns in the RPP+ group.

Minimally Invasive Spinal Fusion Using Percutaneous Pedicle Screw Instrumentation Can Provide a Better Health-Related QOL in Early Stage Than Conventional Methods in the Treatment of Single-Level Degenerative Lumbar Spinal Diseases.

Purpose: To investigate whether the minimally invasive spinal fusion can provide the better outcome than conventional fusion surgery in the treatment of degenerative lumbar spinal diseases. Patients and Methods: One hundred and thirteen patients who had undergone single-level fusion surgery for degenerative lumbar spinal diseases were examined with a minimum of one-year follow-up. There were 56 men and 57 women with a median age of 70s ranging 47-88. The following three-types of fusion surgery were performed; minimally invasive transforaminal interbody fusion after microscopic decompression through a unilateral approach with percutaneous pedicle screwing (MTLIF), transforaminal interbody fusion after microscopic decompression through a unilateral approach (TLIF), and posterior lumbar interbody fusion with posterolateral fusion after open decompression through a bilateral approach (PLIF). The purpose for limiting on single level degenerative spinal disease was that it would be easy to compare the surgical outcomes among the three groups. Results: There were no statistically significant differences among three groups in terms of VAS scores, RDQ scores, and all of the domains in the JOABPEQ scores at the baseline. The JOABPEQ score for pain-related disorders at 6 months after surgery was statistically significantly higher in MTLIF group than the other two groups (P = 0.023). There were no statistically significant differences in the scores of the other outcome measures among three groups in whole follow-up period. Conclusion: The current study demonstrated that the JOABPEQ score for pain-related disorders at 6 months postoperatively was significantly better in MTLIF group than in the other groups. Since lumbar degenerative diseases mostly consisted in elderly patients, less invasive surgeries are desirable. MTLIF resulted in a better health-related QOL at 6 months after surgery, and its outcomes at the final follow-up were non-numerical inferiority. The results strongly indicate that MTLIF is desirable surgery especially for elderly patients with degenerative spinal diseases.

Delayed Pyogenic Spondylitis at the Same Level as Rod Fracture After Surgery for Adult Spinal Deformity: A Case Report.

CASE: Rod fracture (RF) occurred at L5-S level in a 79-year-old woman 7 months after spinal corrective surgery for adult spinal deformity (ASD). Four years after the surgery, pyogenic spondylitis occurred at the same level as RF. After the reinforcement of broken rods posteriorly, a transperitoneal approach was used for debridement and bone graft. However, prolonged infection, adhesive ileus, and small bowel perforation led to a total of 3 reoperations, resulting a colostomy. Three years after the reoperation, she was ambulatory with assistance. CONCLUSION: We need to follow-up postoperative ASD patients carefully because a single complication can lead to serious consequences.

Is dynamic spino-pelvic alignment during gait associated with lumbar function in patients with degenerative lumbar spinal stenosis?

INTRODUCTION: Static spine and pelvic posture has been reported to be associated with symptoms in patients with lumbar spinal stenosis (LSS), but it is unknown whether dynamic alignment of the spine and pelvis is associated with lumbar function in daily life. This study aims to investigate the relationship between dynamic alignment of the spine and pelvis during gait and lumbar function in daily life in patients with LSS. METHODS: We evaluated lumbar function in daily life using the Oswestry Disability Index (ODI), trunk and hip muscle strength as physical function, static spinal alignment, and dynamic spinal/pelvic alignment during gait. The relationship between the ODI score and physical function or static and dynamic alignment was examined. RESULTS: A total of 35 preoperative patients with LSS participated in this study. ODI score significantly correlated with trunk extension strength (r = -0.578, p = 0.000), hip extension strength (r = -0.472, p = 0.004), maximum spinal flexion angle during gait (r = -0.473, p = 0.004) and maximum pelvic anterior tilt angle (r = 0.510, p = 0.002). Multiple regression analysis showed that trunk extension strength (standardized ß; - 0.309), hip extension strength (standardized ß; -0.287), maximum spinal flexion angle (standardized ß; - 0.306) and maximum pelvic anterior tilt angle (standardized ß; 0.271) significantly affected the ODI score, with adjusted coefficient of determination of 0.529. CONCLUSION: The results of this study showed that the patients with LSS with weak hip or trunk extensor muscles, a greater angle of pelvic tilt or a less spinal flexion during gait had a lower lumbar function in daily life.

Cumulated ambulation score in hospitalized patients with osteoporotic vertebral fractures is an important predictor of returning home: a retrospective cohort study.

Osteoporotic vertebral fractures are recognized as a serious problem in the aging society. In this study, we found that the cumulated ambulation score predicts returning home in patients with osteoporotic vertebral fractures. The cumulated ambulation score is an important piece of information in determining the destination of patients with osteoporotic vertebral fractures. PURPOSE: Osteoporotic vertebral fractures are a serious problem affecting the health status of the elderly, and if they require inpatient treatment, they may have difficulty deciding where to discharge. The study's purpose is to investigate whether the cumulated ambulation scores predict returning home for hospitalized osteoporotic vertebral fractures patients. METHODS: The subjects were 120 osteoporotic vertebral fractures patients aged 65 years or older who were admitted to our hospital between April 2015 and March 2022. The cumulated ambulation scores for all subjects were measured in the 3-days right after admission. A multivariable analysis was performed with the dependent variable as whether the patient returned home and the independent variable as the cumulated ambulation score. Three models were created from the measured cumulated ambulation score, and each model was analyzed as an independent variable (model 1; score on the 1st day, model 2; total score on the 2-days, model 3; total score on the 3-days). RESULTS: The length of hospitalization for the osteoporotic vertebral fracture's patients were 11.8 ± 5.3 days, and 80 (66.7%) returned home. Multivariable analysis showed that cumulated ambulation score was a predictor of returning home (model 1, odds ratio: 3.151, 95% confidence interval: 2.074-5.203; model 2, odds ratio: 2.234, 95% confidence interval: 1.685-3.187; model 3, odds ratio: 1.929, 95% confidence interval: 1.535-2.599). CONCLUSION: The cumulated ambulation score of patients with osteoporotic vertebral fractures right after admission is a factor that affected returning home and is useful in determining where patients are discharged.

The association of dynamic spinal alignment on gait endurance of patients with adult spinal deformity: a cross-sectional study.

PURPOSE: The purpose of this study was to evaluate the gait posture of patients with adult spinal deformity (ASD) using a 3-dimensional motion analysis system (3DMAS) and to investigate whether it affects gait endurance. METHODS: Fifty-one patients with ASD aged 50 years or older who were admitted to our hospital between March 2016 and March 2018 were included in the study. The subjects completed the 6-min walking test, which is an indicator of gait endurance. Static standing posture was assessed by whole-spine x-ray examination (coronal cobb angle, CCA; sagittal vertical axis, SVA; pelvic tilt, PT; and pelvic incidence minus lumbar lordosis, PI-LL). In addition, the gait posture was evaluated by a 3DMAS (dynamic trunk tilt angle, DTA; and dynamic pelvic tilt angle, DPA). The relationship between standing and gait postures and gait endurance was investigated by multivariable analysis. RESULTS: In univariable analysis, SVA, PI-LL, and DTA were associated with gait endurance. Furthermore, in the multivariable analysis, DTA showed the strongest association among the static and dynamic parameters (R2 = 0.61, ß = - 0.35, P < 0.05). CONCLUSIONS: An association was found between gait posture and gait endurance in patients with ASD. These findings can be useful to health care providers treating patients with ASD. It is advisable to assess the gait posture of patients with ASD because they present postural abnormalities during gait.

Relationship between Lower Limb Pain Intensity and Dynamic Lumbopelvic-Hip Alignment in Patients with Degenerative Lumbar Spinal Canal Stenosis: A Cross-Sectional Study.

STUDY DESIGN: This cross-sectional study was conducted in a single hospital. PURPOSE: To clarify the relationship between lower limb pain intensity and dynamic lumbopelvic-hip alignment in patients with lumbar spinal canal stenosis (LSS), using a three-dimensional (3D) motion analysis system. OVERVIEW OF LITERATURE: Although it is well known that leg symptoms have a close relationship with posture in patients with LSS, the relationship under dynamic conditions, such as gait, remain unclear. METHODS: Thirty patients with LSS scheduled for spine surgery participated in this study. Lower limb pain was assessed using the Visual Analog Scale (VAS), and the patients were divided into two groups based on the mean scores (patients with scores above and below the mean were classified as the high-VAS and low-VAS groups, respectively). The kinematics of the spine, pelvis, and hip joints during gait were then measured using a 3D motion analysis system. Student paired t -tests were used to compare the angles of the spine, pelvis, and hip during gait between the two groups. RESULTS: Compared to those in the low-VAS group, the spine was significantly extended and bent toward the more painful lower limb side, and the pelvis was significantly anteriorly tilted among individuals in the high-VAS group. CONCLUSIONS: Patients with LSS experiencing severe pain in their lower limb tend to keep the spine in a more extended position, bend laterally toward the painful side, and have an anteriorly tilted pelvic posture. The dynamic spinal and pelvic alignment was closely related to the intensity of the lower limb pain.

Hip Extensor Strength Influences Dynamic Postural Changes during Gait in Patients with Adult Spinal Deformity: A Cross-Sectional Study Using Three-Dimensional Motion Analysis.

STUDY DESIGN: Single-hospital cross-sectional study. PURPOSE: The aim of the present study was to investigate the physical functions influencing dynamic postural change in patients with adult spinal deformity (ASD). OVERVIEW OF LITERATURE: Dynamic postural change leading to increased forward lean during gait is a problem in patients with ASD; however, the relationship between this change and trunk and hip extensor strength is unclear. METHODS: Thirty patients with ASD aged ≥50 years who were admitted to our hospital between July 2016 and September 2019 were included in this study. X-ray parameters (i.e., sagittal vertical axis, pelvic tilt, and pelvic incidence minus lumbar lordosis) were evaluated from the full-length standing radiographs of the subjects. Trunk and hip extensor strength was evaluated using a hand-held dynamometer. Dynamic postural changes (i.e., sagittal trunk shift during standing, sagittal trunk shift during gait, and delta sagittal trunk shift) were assessed using a three-dimensional motion analysis system. The relationships between dynamic postural change and various X-ray parameters, as well as trunk and hip extensor strength, were examined using multivariable analysis. RESULTS: Multivariable analysis showed that hip extensor strength is the factor most strongly associated with dynamic postural change among the X-ray parameters and physical functions assessed in this study (ß=-0.41, R2=0.12). CONCLUSIONS: We demonstrated the association between dynamic postural change and hip extensor strength in patients with ASD. Our results may be useful to healthcare providers treating patients with ASD. Interventions for dynamic postural change in patients with ASD should focus on hip extensor strength.

Maximum gait speed and lumbar spinal mobility can affect quality of life in elderly women with lumbar kyphosis.

Background: The site and angle of kyphosis are important factors that affect quality of life (QOL). Lumbar kyphosis, rather than thoracic kyphosis, is reported to affect the QOL in patients with kyphosis. Increased angle of kyphosis in elderly people is associated with a decline in motor and physical functions, and also correlates with reduced QOL. Investigation of how physical performance affects their QOL would be helpful in developing an effective physical therapy program for elderly patients with kyphosis. The aims of the current study were to evaluate the physical performance including back muscle strength, spinal range of motion, and walking ability in elderly patients with lumbar kyphosis, and to examine its association with back pain-specific QOL. Methods: The design of this study is a cross-sectional study in a single hospital. A total of 51 elderly women aged 65 years or older diagnosed with kyphosis were enrolled in the study. The items evaluated were back pain (visual analog scale [VAS]), back-pain specific QOL (the Oswestry Disability Index [ODI]), maximum gait speed, thoracic kyphosis angle, lumbar lordosis angle, sacral inclination, spinal inclination, trunk extension/flexion range of motion (ROM), thoracic spinal ROM, lumbar spinal ROM, and back muscle strength. Data were analyzed using bivariate analyses and multivariate regression analyses. Results: Significant positive correlations were observed between ODI and VAS (rs=0.506) or spinal inclination (rs=0.626). Significant negative correlations were observed between ODI and maximum gait speed (rs=-0.664), lumbar lordosis angle, (rs=-0.553), trunk extension ROM (rs=-0.571), lumbar spinal ROM (rs=-0.651), or back muscle strength (rs=-0.521). Multiple regression analysis demonstrated that maximum gait speed (standard partial regression coefficient; b=0.484) and lumbar spinal ROM (b=0.463) had a significant impact on ODI. The results of analysis of variance were significant with R2 of 0.622. Conclusions: The current study demonstrated that maximum gait speed and lumbar spinal ROM influenced back-pain specific QOL in the elderly women with lumbar kyphosis. Maximum gait speed and lumbar spinal ROM should be evaluated thoroughly to effectively perform non-operative treatment in elderly people with lumbar kyphosis.

Association between single limb standing test results and healthcare costs among community-dwelling older adults.

BACKGROUND AND OBJECTIVE: Identifying risks for older adults who will require healthcare resources is critical for the government, healthcare providers, and consumers. The objective of this study was to examine the relationship between the results of the single limb standing (SLS) test and healthcare costs among community-dwelling older adults. METHODS: We used data obtained from a population-based prospective cohort study of the residents of Tadami town in Fukushima Prefecture, Japan. The participants were above 60 years of age and had undergone annual health check-ups, and data on their healthcare costs over the two-year study period were available. A censored regression model adjusted for potential confounders was used to estimate the mean difference in total healthcare costs between participants who could remain standing on a single limb for at least 30 s and those who could not. RESULTS: Healthcare costs of participants who passed the SLS test were significantly lower than those who did not. The mean difference between the two groups' healthcare costs was 4064 USD (95 % confidence interval: 2661-5467 USD, p < 0.05). After adjusting for potential confounders, the mean difference between the two groups was smaller (1686 USD) but remained statistically significant (95 % confidence interval: 125-3246 USD, p < 0.05). CONCLUSIONS: Among community-dwelling older adults, limited static balance (SLS time <30 s) was found to be associated with high healthcare costs in the two years after the SLS test. The SLS test may help identify individuals at high risk of becoming frequent users of healthcare services in the future.

Recovery of paraplegia following postoperative epidural hematomas in lumbar canal stenosis surgery by closed kinetic chain (CKC) exercises: A case report.

RATIONALE: A postoperative spinal epidural hematoma (PSEH) is among the most devastating complications following spine and spinal cord surgery, and it should be considered before performing microendoscopic decompression as part of minimally invasive surgery, since early recovery is one of the advantages of this procedure. PATIENT CONCERNS: A 70-year-old woman with lumbar spinal stenosis at L4-5 underwent tubular surgery with the assistance of endoscopic laminectomy (MEL), but 2 days after the surgery, the patient noticed decreased lower limb sensation and power of the right leg, and she developed numbness from the level of L5 and weakness from the L4, 5 myotome distally. DIAGNOSES: An epidural hematoma at the L4-5 surgical site was found on magnetic resonance imaging of the lumbar spine and evacuated operatively. This rare complication appears to be the result of a PSEH. In the present case, complete neurological recovery was not achieved, despite rapid surgery. INTERVENTIONS: The patient's course and physical therapy, which focused on attitude maintenance practice and muscle-strengthening exercise of the closed kinetic change (CKC) type from the early stage of paraplegia, were specifically examined. OUTCOMES: The patient recovered complete motor function with attitude maintenance practice and muscle strengthening exercises after 3 months. CKC exercise in particular may contribute to improving caudal muscle weakness, including the L4, 5 innervated area (e.g., tibialis anterior [TA], extensor hallucis longus [EHL], flexor hallucis longus [FHL], gastrocnemius [GC], etc.). LESSONS: Prevention of PSEH is needed to not only avoid neurological deterioration, but also avoid delaying the patient's recovery. CKC exercise may contribute to improving the prolonged paralysis associated with a PSEH. Future studies should involve larger numbers of patients to evaluate the clinical features of PSEH and treatment by rehabilitation with more effective muscle exercises and stretches.

Postoperative neck symptoms of posterior approach for cervical compressive myelopathy: Expansive open-door laminoplasty vs. segmental partial laminectomy.

BACKGROUND: Laminoplasty is widely accepted as a standard treatment of cervical compressive myelopathy. However, due to the risk of postoperative complications such as neck symptoms, segmental partial laminectomy (SPL) is performed instead, which results in fewer postoperative symptoms. The aim of this study was to describe the difference in the incidence and severity of postoperative neck symptoms between traditional C3-C7 expansive open-door laminoplasty (ELAP) and SPL. METHODS: A retrospective and comparative study was performed regarding neck complications following the two surgical procedures. Twenty patients underwent SPL, and an additional 20 age- and gender-matched patients underwent traditional C3-C7 ELAP. Preoperative and postoperative JOA scores were measured, and postoperative neck symptoms in both groups were evaluated using a self-administered questionnaire, according to the Neck Pain and Disability Scale. RESULTS: The total incidence of postoperative neck symptoms in the SPL group was similar to that in the ELAP group; however, the severity of symptoms was remarkably lower in the SPL group than in the ELAP group. CONCLUSIONS: SPL seems to be a better procedure for reducing postoperative neck symptoms, when compared with C3-C7 ELAP.

Tubular surgery with the assistance of endoscopic surgery via a paramedian or midline approach for lumbar spinal canal stenosis at the L4/5 level.

BACKGROUND: Lumbar spinal canal stenosis surgery has recently improved with the use of minimally invasive techniques. Less invasive procedures have emerged, and microendoscopic decompression through smaller incisions is frequently performed. Tubular surgery with the assistance of endoscopic surgery procedures has led to particularly remarkable changes in surgery, with reduced tissue trauma and morbidity. PURPOSE: The purpose of this study was to compare the clinical outcomes of two different minimally invasive decompressive surgical techniques (microendoscopic bilateral decompression surgery using the unilateral approach [microendoscopic laminectomy (MEL)] and microendoscopy-assisted muscle-preserving interlaminar decompression (MILD; ME-MILD)) using spinal endoscopy for lumbar spinal canal stenosis measured using a visual analog scale (VAS), the Japanese Orthopedic Association (JOA) score, and the JOA Back Pain Evaluation Questionnaire (JOABPEQ), which is based on a patient-oriented scoring system. STUDY DESIGN: This study was a retrospective review of prospectively collected surgical data. METHODS: The study included 81 patients (MEL 39 patients, 20 men and 19 women, mean age 68.9 years; and ME-MILD 42 patients, 22 men and 20 women, mean age 73.1 years) with lumbar spinal stenosis (LSS). The indications for surgery were moderate-to-severe stenosis, persistent neurological symptoms, and failure of conservative treatment over 3 months, with a JOA score under 15 points or intermittent claudication at 100 m. This study included patients having LSS at a single vertebral level (L4/5). RESULTS: Low back pain, buttock-leg pain, and numbness were significantly improved in terms of the VAS score from 3 months with both MEL and ME-MILD. In all periods, JOA scores over 3 years of follow-up were significantly higher than those obtained before surgery with both MEL and ME-MILD, and there were improvements of low back pain and walking function. CONCLUSIONS: These observations demonstrate that ME-MILD is a safe and very effective minimally invasive technique for degenerative LSS, similar to MEL.

Acute calcific tendinitis of the thumb in a child: a case report.

Acute calcific tendinitis is rare in hand and digit, especially in children. We describe a rare case of acute calcific tendinitis of the thumb [extensor pollicis longus (EPL) tendon] in a 10-year-old boy. Plain radiographs showed a calcium deposit in the EPL tendon. Conservative therapy completely resolved all symptoms in 1 week. The calcium deposit shown on plain radiographs became smaller and completely disappeared within 6 weeks.