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1.
Medicina (Kaunas) ; 60(4)2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38674282

RESUMO

Background: In the diagnosis of lumbar spinal stenosis (LSS), finding stenosis with magnetic resonance imaging (MRI) does not always correlate with symptoms such as sciatica or intermittent claudication. We perform decompression surgery only for cases where the levels diagnosed from neurological findings are symptomatic, even if multiple stenoses are observed on MRI. The objective of this study was to examine the time course of asymptomatic stenosis in patients with LSS after they underwent decompression surgery for symptomatic stenosis. Materials and Methods: The participants in this study comprised 137 LSS patients who underwent single-level L4-5 decompression surgery from 2003 to 2013. The dural sac cross-sectional area at the L3-4 disc level was calculated based on preoperative MRI. A cross-sectional area less than 50 mm2 was defined as stenosis. The patients were grouped, according to additional spinal stenosis at the L3-4 level, into a double group (16 cases) with L3-4 stenosis, and a single group (121 cases) without L3-4 stenosis. Incidences of new-onset symptoms originating from L3-4 and additional L3-4-level surgery were examined. Results: Five years after surgery, 98 cases (72%) completed follow-up. During follow-up, 2 of 12 patients in the double group (16.7%) and 9 of 86 patients in the single group (10.5%) presented with new-onset symptoms originating from L3-4, showing no significant difference between groups. Additional L3-4 surgery was performed for one patient (8.3%) in the double group and three patients (3.5%) in the single group; again, no significant difference was shown. Conclusion: Patients with asymptomatic L3-4 stenosis on preoperative MRI were not prone to develop new symptoms or need additional L3-4-level surgery within 5 years after surgery when compared to patients without preoperative L3-4 stenosis. These results indicate that prophylactic decompression for asymptomatic levels is unnecessary.


Assuntos
Descompressão Cirúrgica , Vértebras Lombares , Imageamento por Ressonância Magnética , Estenose Espinal , Humanos , Estenose Espinal/cirurgia , Estenose Espinal/complicações , Estenose Espinal/diagnóstico por imagem , Masculino , Descompressão Cirúrgica/métodos , Feminino , Vértebras Lombares/cirurgia , Vértebras Lombares/diagnóstico por imagem , Idoso , Pessoa de Meia-Idade , Imageamento por Ressonância Magnética/métodos , Fatores de Tempo , Resultado do Tratamento , Estudos Retrospectivos , Idoso de 80 Anos ou mais
2.
Eur Spine J ; 32(2): 488-494, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-35962870

RESUMO

PURPOSE: It remains unclear whether musculoskeletal diseases are risk factors for dementia development. This prospective cohort study of community-dwelling residents aimed to clarify the impact of lumbar spinal stenosis (LSS) on dementia development. METHODS: We included participants aged ≥ 65 years from the Locomotive Syndrome and Health Outcomes in the Aizu cohort study. LSS was diagnosed using the validated LSS diagnostic support tool. Dementia development between 2008 and 2015 was investigated using official long-term care insurance certification data. We analysed the effects of LSS on dementia development after adjusting for potential confounders, like age, sex, diabetes, depressive symptoms, hip and knee joint osteoarthritis, daily activity, and smoking habit. RESULTS: We included 1220 patients in the final analysis. The incidence of dementia was significantly higher in the LSS group [48 of 444 (10.8%)] than in the control group [34 of 776 (4.4%)]. Multivariable analysis using multiple imputations revealed that the confidence interval for the adjusted odds ratio of LSS for dementia development was 1.87 (95% confidence interval; 1.14-3.07). CONCLUSION: We clarified that LSS is an independent risk factor for dementia development. Our findings suggest the importance of considering the risk of dementia in the decision-making process for the treatment of LSS.


Assuntos
Demência , Estenose Espinal , Humanos , Estudos de Coortes , Estudos Prospectivos , Estenose Espinal/epidemiologia , Estenose Espinal/diagnóstico , Vértebras Lombares , Fatores de Risco , Avaliação de Resultados em Cuidados de Saúde , Demência/epidemiologia , Demência/etiologia
3.
J Orthop Sci ; 28(3): 543-546, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-35305863

RESUMO

BACKGROUND: The Japanese Society for Spine Surgery and Related Research previously developed a diagnostic support tool for lumbar spinal stenosis (LSS-DST). Using the LSS-DST, general physicians can identify potential cases of LSS. However, in the LSS-DST, measurement of the ankle brachial pressure index (ABI) is required to exclude peripheral artery lesions in the lower limbs. We can expect further application of the LSS-DST if we can identify a simpler and easier method than ABI measurement. Therefore, in this large-scale, multicenter, cross-sectional study, we verified whether palpation of the posterior tibial (PT) artery could be used instead of ABI in the LSS-DST. METHODS: This survey was conducted at 2177 hospitals and included 28,883 participants. The sensitivity and specificity of the original LSS-DST method using the ABI and that of the LSS-DST ver2.0 with PT artery palpation were assessed to screen their ability for diagnosing LSS, using the physicians' final diagnosis based on the patients' history, physical examination and radiographic findings as the gold standard. RESULTS: The sensitivity and specificity [95%CI] of the LSS-DST were 88.2% [87.5, 88.8] and 83.9% [83.4, 84.5], respectively, whereas the sensitivity and specificity of the LSS-DST ver2.0 were 87.7% [87.0, 88.3] and 78.3% [77.7, 78.9], respectively, indicating that LSS-DST ver2.0 is a useful screening tool for LSS with good sensitivity. CONCLUSION: When the item of ABI in the LSS-DST is replaced by palpation of the PT artery (LSS-DST ver2.0), its sensitivity is maintained as a screening tool for LSS. LEVEL OF EVIDENCE: Level 3.


Assuntos
Estenose Espinal , Humanos , Estenose Espinal/diagnóstico , Estenose Espinal/patologia , Artérias da Tíbia , Estudos Transversais , Tornozelo , Vértebras Lombares/patologia , Palpação
4.
J Orthop Sci ; 2023 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-37838597

RESUMO

BACKGROUND: Psychosexual factors are one of the preoperative factors influencing acute postoperative pain. Because of gender differences in pain, the preoperative factors that influence acute postoperative pain may also differ between males and females. However, there have been no reports on such factors in patients with spinal disorders that focused on gender differences. Therefore, the purpose of this study was to examine the preoperative factors that influence acute postoperative pain, focusing on gender differences. METHODS: The subjects were 75 males and 60 females admitted for surgery for lumbar spinal disorders. Preoperatively, the following were assessed: low back pain using the Numeric Rating Scale (NRS); anxiety and depression using the Japanese version of the Hospital Anxiety and Depression Scale (HADS); catastrophic thinking using the Pain Catastrophizing Scale (PCS); psychiatric problems using the Brief Scale for Psychiatric Problems in Orthopaedic Patients (BS-POP); and neurological assessments. Acute postoperative pain was also assessed using the NRS within 48 h, postoperatively. Based on these data, we analyzed gender differences in preoperative factors affecting acute postoperative pain in patients with lumbar spinal disorders. RESULTS: Postoperative NRS and preoperative PCS scores were higher in females compared to males. In the males, the coefficient of determination of the multiple regression equation was 0.088, and PCS (ß = 0.323, p = 0.015) was extracted as a significant factor. In the females, the coefficient of determination of the multiple regression equation was 0.075, and BS-POP (ß = 0.300, p = 0.019) was extracted as a significant factor. CONCLUSION: Preoperative factors influencing acute postoperative pain for patients with lumbar spinal disorders vary by gender. It was suggested that males should be screened using PCS. In females, on the other hand, PCS alone is not sufficient for evaluation. It was suggested that evaluation using BS-POP should be considered in addition to PCS.

5.
Eur Spine J ; 30(9): 2450-2456, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33222004

RESUMO

PURPOSE: With spinal deformities, mental health can deteriorate due to sagittal imbalance of the spine. The purpose of this study was to clarify the relationship between sagittal imbalance and symptoms of depression among local residents in the community. METHODS: This study used data from the Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS) in 2010. The sagittal vertical axis (SVA) was identified as an indicator of sagittal imbalance. Symptoms of depression were assessed using the 5-item version of the Mental Health Inventory. Participants were classified into three categories based on the SVA balance as normal (< 40 mm), moderate imbalance (40-95 mm), and severe imbalance (> 95 mm). To evaluate the relationship between sagittal imbalance of the spine and symptoms of depression, the adjusted risk ratio (RR) and the 95% confidence interval (CI) were calculated using a generalized linear model with Poisson link. RESULTS: There were 786 participants included in the statistical analysis. Overall, the mean age was 68.1 y (standard deviation, 8.8 y), and 39.4% were men. The prevalence of symptoms of depression by SVA category was 18.6% for normal, 23.8% for moderate, and 40.6% for severe. On multivariate analysis, the RR of SVA for symptoms of depression compared to the normal category was 1.12 (95% CI 0.7-1.70) for the moderate category and 2.29 (95% CI 1.01-5.17) for the severe category. CONCLUSION: In local community residents, sagittal imbalance had a significant association with symptoms of depression.


Assuntos
Depressão , Coluna Vertebral , Adulto , Idoso , Estudos de Coortes , Depressão/epidemiologia , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Síndrome
6.
J Orthop Sci ; 26(6): 1124-1129, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33183936

RESUMO

BACKGROUND: Deterioration of quality of life in patients with chronic pain is difficult to treat. Chronic pain in patients with low quality of life may be "severe" and require multidisciplinary treatments. This study aimed to develop an objective severity discrimination scale based on quality of life measurements to identify patients with "severely disabling" chronic pain. METHODS: Subjects were 156 patients with chronic pain whose numerical rating pain score was ≥1 and who had pain for ≥3 months. Diseases associated with chronic pain included spinal diseases, joint diseases, concomitant diseases, complex regional pain syndromes, and other musculoskeletal diseases. Patients were divided into low, middle, and high groups based on physical quality of life summary scores on the Short Form-36. The mental component summary, painDETECT, Japanese version of the Pain Catastrophizing Scale, Brief Scale for Psychiatric Problems in Orthopaedic Patients, and factors related to degree/quality of pain during the past 4 weeks were analyzed to identify components in the low group. The score weighting factor for discriminating between the high and low groups was determined by discriminant analysis. RESULTS: Factor analysis identified 4 factors representing features of chronic pain patients with low QOL: enhanced perception of pain, pain catastrophic thoughts, depressive sleep disorder, and pain intensity. For discriminant analysis, patients were defined as those with low physical quality of life if each factor's total score multiplied by a factor plus a constant value of 2.6 was ≥0, and high quality of life if it was <0. The receiver operating characteristic curve area used to determine the cut-off value was 0.71, with 67.3% sensitivity and specificity. CONCLUSIONS: We developed a 33-question severity discrimination scale to define "severely disabling" chronic pain based on physical quality of life. "Severely disabling" patients identified on this scale could represent chronic pain patients needing focused multidisciplinary treatment.


Assuntos
Dor Crônica , Transtornos do Sono-Vigília , Dor Crônica/diagnóstico , Humanos , Medição da Dor , Qualidade de Vida , Sensibilidade e Especificidade
7.
Medicina (Kaunas) ; 57(10)2021 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-34684153

RESUMO

Background and Objectives: The high prevalence of lumbar spinal stenosis (LSS) and its negative impact on quality of life in the elderly is well known. However, the longitudinal time course of LSS symptoms remains unclear. The purpose of this study was to clarify the longitudinal time course and associated factors of LSS symptoms over a period of six years in a community. Materials and Methods: This study was conducted with data prospectively collected in 2004 and 2010 under a retrospective design. In 2004, 1578 subjects (age range: 40 to 79 years) were interviewed on LSS symptoms using a specially designed and validated questionnaire. In 2010, a follow-up study was performed by mail, to which 789 subjects of the 2004 study population responded. Considering that the presence of osteoarthritis (OA) of the knee or hip may influence the participants' answers in the questionnaire, analysis was performed in all 789 subjects with and 513 subjects without either knee or hip OA. Changes in LSS symptoms between the initial and the 6-year survey were investigated. Multiple logistic regression analysis was used for detecting the risk factors for LSS symptom presence at the six-year follow-up. Results: 1. At the six-year follow-up, more than half of the subjects who showed LSS symptoms at the initial analysis became LSS-negative, and 12-15% of those who were LSS-negative became LSS-positive. 2. From the multiple logistic regression analysis, a lower Roland-Morris Disability Questionnaire (RDQ) score and a positive LSS symptom at the initial analysis were detected as predictive factors of the presence of LSS symptoms at the six-year follow-up in the total number of subjects, as well as just in those who did not have either knee or hip OA. Conclusions: More than half of the subjects who were LSS-positive at their initial assessment still experienced improvement in their symptoms even after 6 years. This means that both LSS symptoms and their time course vary from person to person. Predictive factors for the presence of LSS symptoms during the six-year follow-up period were RDQ score and positive LSS symptoms.


Assuntos
Osteoartrite do Quadril , Estenose Espinal , Adulto , Idoso , Seguimentos , Humanos , Vida Independente , Vértebras Lombares , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Estenose Espinal/epidemiologia
8.
J Orthop Sci ; 24(4): 584-589, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30616940

RESUMO

BACKGROUND: The reference values of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) in patients with lumbar spinal stenosis (LSS) are still unknown. This multicenter cross-sectional survey was performed to determine the reference values and disease-specific characteristics of deterioration of QOL caused by LSS itself, not by aging, through comparison of patients with and without LSS who had an outpatient visit for low back pain by age and sex groups. METHODS: The present study was performed at 564 medical centers and clinics. The JOABPEQ was measured for 8338 patients aged 20 years or over who came to an outpatient clinic for low back pain (LBP) and were examined for whether they had LSS using the LSS diagnosis support tool (LSS-DST). Scores in the five JOABPEQ domains were compared between the LSS group and the LBP without LSS group (LBP group) for each age and sex group. RESULTS: Scores for Pain-related disorder, Gait disturbance, Social life disturbance, and Psychological disorders were significantly lower in the LSS group than in the LBP group. CONCLUSION: The percentiles of JOABPEQ scores in patients with LSS were clarified and could be used as reference values. Deterioration of QOL caused by LSS itself, not by aging, are characterized by Pain-related disorder, Gait disturbance, Social life disturbance, and Psychological disorders.


Assuntos
Técnicas de Apoio para a Decisão , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Vértebras Lombares , Qualidade de Vida , Estenose Espinal/complicações , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Medição da Dor , Valores de Referência , Inquéritos e Questionários , Avaliação de Sintomas , Adulto Jovem
9.
J Orthop Sci ; 23(3): 455-458, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29459084

RESUMO

BACKGROUND: Spinal extradural arachnoid cyst (SEDAC) is a cystic lesion that protrudes into the epidural space from a small dural defect. Early diagnosis of SEDAC is important because its expansion causes neurological damage. Two types of SEDAC, syndromic and sporadic, are present. Syndromic SEDAC is inherited as a part of lymphedema-distichiasis syndrome caused by mutations in the FOXC2 gene; however, it is often mistaken as sporadic because of low penetrance. It is not reasonable to conduct a genetic testing for all SEDAC patients and their family members. The aim of this study is to establish an effective screening method to distinguish syndromic SEDAC from sporadic SEDAC. METHODS: We performed a retrospective review of medical records and imaging studies of 29 subjects who were diagnosed with SEDAC. Clinical features, family history and magnetic resonance imaging (MRI) were analyzed. Mutations in FOXC2 were examined by Sanger-sequencing of the entire coding region of the genes. SEDAC having a mutation in FOXC2 gene was defined with syndromic SEDAC. RESULTS: Eleven subjects had a heterozygous mutation in FOXC2. They were all familial and hence syndromic SEDAC. Only one proband had known family history of SEDAC at diagnosis. MRI findings and physical examinations, especially eye and leg examinations, were quite useful to screen syndromic SEDAC. Physical examination often showed accompanying lymphedema and distichiasis in syndromic SEDAC. Syndromic SEDAC tended to have multiple cysts out of the thoracolumbar area. CONCLUSIONS: We established an effective screening method based on physical examinations and MRI findings.


Assuntos
Cistos Aracnóideos/diagnóstico , Cistos Aracnóideos/genética , Pestanas/anormalidades , Fatores de Transcrição Forkhead/genética , Linfedema/complicações , Mutação/genética , Adolescente , Adulto , Idoso , Criança , Diagnóstico Diferencial , Espaço Epidural , Humanos , Vértebras Lombares , Linfedema/diagnóstico , Linfedema/genética , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Exame Físico , Estudos Retrospectivos , Síndrome , Vértebras Torácicas
10.
J Orthop Sci ; 22(4): 647-651, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28551282

RESUMO

BACKGROUND: Numbness in the soles of both feet at rest or bowel/bladder dysfunction can occur in patients with lumbar spinal stenosis (LSS), especially in patients with cauda equina lesions. The purpose of this study was to clarify the relationship between cauda equina symptoms at rest and quality of life (QOL) in LSS patients using standardized questionnaires developed for the Japanese population. METHODS: A survey was conducted in 564 hospitals and general practice clinics nationwide from December 1, 2011 to December 31, 2012. All patients who visited hospital or clinic because of low back pain were included. Patients were diagnosed with LSS using the LSS-Diagnostic Support Tool (LSS-DST), and the severity of the disease was measured using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) for quality of life. Presence of both sole numbness and/or bowel/bladder dysfunction were determined by medical interview. 3647 patients were diagnosed with LSS according to the results of the LSS-DST. 1294 of these patients (35.5%) had symptoms at rest. Of these patients, 359 patients with sole numbness, 135 patients with bowel/bladder dysfunction, and 52 patients with both numbness and bowel/bladder dysfunction were compared to the patients without rest symptoms (n = 2182). Comparisons between groups with or without sole numbness and bowel/bladder dysfunction were performed using statistical analysis of JOABPEQ responses in the categories of pain-related disorder, lumbar spine disorder, gait disturbance, social life disturbance, and psychological disorder. RESULTS: All groups with sole numbness and/or bowel/bladder dysfunction had statistically lower (worse) scores in all categories of the JOABPEQ compared to the group without these symptoms at rest. CONCLUSION: LSS patients having numbness in the soles of both feet at rest or bowel/bladder dysfunction had lower measurements of QOL and activities of daily living than those patients without symptoms at rest. These symptoms appear to be related to QOL of LSS patients.


Assuntos
Hipestesia/etiologia , Enteropatias/etiologia , Vértebras Lombares , Estenose Espinal/complicações , Estenose Espinal/diagnóstico , Doenças da Bexiga Urinária/etiologia , Adulto , Idoso , Estudos Transversais , Feminino , , Humanos , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Descanso , Inquéritos e Questionários , Adulto Jovem
11.
J Foot Ankle Surg ; 56(3): 628-631, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28215361

RESUMO

Osteochondroma, one of the most common benign bone tumors, frequently occurs in the metaphysis of the long bones. We report an extremely rare case of osteochondroma that occurred in the tibial sesamoid. The patient was a 62-year-old Japanese male. He presented with a 1-year history of pain and a hard mass on the plantar aspect of the right forefoot sole. The osteochondroma protruded toward the sole from the tibial sesamoid, leading to pain on weightbearing. After tibial sesamoidectomy, the patient's symptoms were eliminated, and no pain or complications such as hallux valgus occurred after the surgery. Although a potential risk exists of postoperative hallux valgus deformity, tibial sesamoidectomy seems to be an appropriate surgical option for both osteochondroma and bizarre parosteal osteochondromatous proliferation to avoid residual pain or local recurrence.


Assuntos
Neoplasias Ósseas/patologia , Osteocondroma/patologia , Ossos Sesamoides/patologia , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteocondroma/diagnóstico por imagem , Osteocondroma/cirurgia , Ossos Sesamoides/diagnóstico por imagem , Ossos Sesamoides/cirurgia
12.
J Orthop Sci ; 21(2): 222-5, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26806332

RESUMO

BACKGROUND: The authors have developed a screening tool, the 25-Geriatric Locomotive Function Scale (GLFS-25), for the early detection of locomotive syndrome (LS). However, few studies have examined the prevalence of LS in the general population. This study estimated the prevalence of LS in Japan using the GLSF-25 and investigated age specific mean values for this scale. METHODS: A nationwide cross-sectional questionnaire survey was conducted to reveal standard values for the GLFS-25 and to estimate the total number of individuals with LS in Japan. Subjects were individuals selected from residents aged 40-79 years in Japan by a stratified, two-stage random sampling method in 2014. The survey period was from February to March 2014. A total of 9028 subjects were invited to participate. The GLFS-25 was used to estimate the prevalence of LS. We also investigated the degree of recognition of LS. RESULTS: Answers for the questionnaire were obtained from 5162 subjects (57.2%); 22.1% of responders had heard of LS. According to the GLSF-25, 614 subjects were regarded as having LS, representing a prevalence of 11.9%. When standardizing this value with the age distribution of the Japanese population, the total number of individuals with LS between the 40s and 70s in Japan was estimated to be approximately 7.5 million. Age specific standard values on the GLFS-25 were 4.4 in the 40s, 5.5 in the 50s, 7.1 in the 60s, and 12.7 in the 70s. The prevalence of LS increased with age and was particularly high in subjects aged 70-79. CONCLUSIONS: The degree of recognition of LS was 22%. This study demonstrated sex- and age specific standard values of the GLFS-25 and estimated the total number of individuals with LS in Japan based on a representative population.


Assuntos
Locomoção/fisiologia , Limitação da Mobilidade , Doenças Musculoesqueléticas/epidemiologia , Inquéritos e Questionários , Adulto , Distribuição por Idade , Idoso , Estudos Transversais , Feminino , Avaliação Geriátrica/métodos , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/fisiopatologia , Prevalência , Estudos Retrospectivos , Síndrome
13.
Eur Spine J ; 24(10): 2288-94, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25971357

RESUMO

INTRODUCTION: Lumbar spinal stenosis (LSS) is a lumbar spinal disorder that causes leg symptoms and intermittent claudication. It is reported that the risk factors for low back pain include age, family history, smoking, obesity, work-related physical load, exercise, and depression. This was a multicenter, cross-sectional survey, and the aim of this study was to investigate the prevalence of LSS by age and the relationships between LSS and psychosocial factors and job satisfaction. METHODS: This study enrolled subjects aged 50 years and over from a survey of LSS in 2177 hospitals and general practices nationwide. The clinical characteristics of the LSS and non-LSS groups were compared using the χ2 test, and the multivariate logistic regression analysis was performed to examine associations between exercise, perceived stress, strenuous use of the low back or legs, job satisfaction, and LSS. RESULTS: In total, 18,642 patients (8338 males, 10,267 females) were analyzed. The rate of LSS was 38.3% and it increased with age. Regular exercise was less common among those in the LSS group than those in the non-LSS group (p<0.001). Satisfaction in all job-related items was less in the LSS group than in the non-LSS group (p<0.001). The odds for having LSS were higher in subjects having perceived stress and strenuous use of the low back or legs (p=0.001). The odds ratios of heart diseases and hypertension (p<0.001) were higher in the LSS group. CONCLUSION: This study investigated factors associated with LSS. The prevalence of LSS increased with age. Perceived stress and strenuous use of the low back or legs might be associated with LSS, and job satisfaction was lower with LSS.


Assuntos
Vértebras Lombares/cirurgia , Estenose Espinal , Estudos Transversais , Feminino , Humanos , Masculino , Estenose Espinal/epidemiologia , Estenose Espinal/psicologia , Estenose Espinal/cirurgia
14.
BMC Musculoskelet Disord ; 16: 246, 2015 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-26359245

RESUMO

BACKGROUND: The aim of this study was to clarify pain, quality of life and activity in the aged evacuees living in temporary housing after the Great East Japan Earthquake on 11 March 2011. METHODS: The study was a cross-sectional study performed in Minamisoma City, Fukushima Prefecture 1 year and 6 months after the disaster. Inclusion criteria were the ability to walk independently and consent to answer questionnaires. Seventy-one evacuees who met the inclusion criteria were included in this study. There were 16 men and 55 women with a mean age of 75.9 years. Sixty evacuees were surveyed when they gathered at the assembly hall in the temporary housing (Assembled group) and 11 evacuees were surveyed through individual visits to their residences (Individual group). Evacuees in the Individual group agreed to participate in this study, but refused to visit the assembly hall to engage in exercise and recreation. Pain, quality of life (QOL) and level of activity were assessed with the Numeric Rating Scale (NRS), the MOS Short-Form 36 item Health Survey (SF-36) and a pedometer, respectively. Student's t-test, Mann-Whitney U test, and Fisher's exact test were used for statistical analysis. RESULTS: Forty-four (62.0 %) residents had chronic pain with a mean NRS of 2.74. Twenty-one (29.6 %) of these residents had relatively severe pain rated 5 or above on the NRS. QOL was significantly lower for the subscales of "physical functioning," "role physical", "general health", "social functioning", "role emotional" and "mental health", when compared with the national standard values. Values were also visibly lower for "physical component summary" in the summary score. On comparing the Assembled group and the Individual group, "physical function", "role physical", "social functioning" and "physical component summary" were found to be significantly lower in the Individual group. The mean daily number of steps was 1,892 in the Individual group and 4,579 in the Assembled group. The Individual group thus significantly took less mean daily number of steps compared with the Assembled group. CONCLUSIONS: This study quantified the state of pain, QOL and activity of aged evacuees living in temporary housing after the Great East Japan Earthquake. The evacuees frequently had chronic pain and lower physical and mental QOL scores compared to the national standard values.


Assuntos
Desastres , Terremotos , Habitação , Atividade Motora , Dor/psicologia , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Habitação/normas , Humanos , Japão/epidemiologia , Masculino , Atividade Motora/fisiologia , Dor/diagnóstico , Dor/epidemiologia , Inquéritos e Questionários
15.
J Orthop Sci ; 20(5): 805-10, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26092619

RESUMO

BACKGROUND: Diagnostic support tools for lumbar spinal stenosis such as the Self-administered, Self-reported History Questionnaire have been developed in Japan, but no report has demonstrated the diagnostic accuracy of this questionnaire in Japanese primary care settings. This multicenter, cross-sectional survey was performed to evaluate and improve the diagnostic accuracy of this questionnaire for lumbar spinal stenosis patients in Japanese primary care settings. METHODS: The lumbar spinal stenosis diagnosis support tool project was conducted in 1657 hospitals to evaluate the diagnostic accuracy of the Self-administered, Self-reported History Questionnaire in Japan from 2011 to 2012. Consecutive adults (≥50 years old) from physicians, including non-orthopedic general practitioners and orthopedic general practitioners, were considered for enrollment. Consecutive adults (≥50 years old) with low back pain from hospital-based orthopedic surgeons were also considered for enrollment. The diagnostic accuracy of the Self-administered, Self-reported History Questionnaire with initial and several new cutoff points in classifying patients according to the presence of lumbar spinal stenosis was assessed in terms of sensitivity, specificity and negative predictive values. RESULTS: Among the 33,545 patients, 10,199 (30.4 %) were diagnosed with lumbar spinal stenosis by the physicians. The Self-administered, Self-reported History Questionnaire version 1.1 with a new cutoff point was more sensitive than the Self-administered, Self-reported History Questionnaire version 1.0 with the initial cutoff point (79.8 vs. 68.3 %) and less specific (68.8 vs. 75.1 %) for lumbar spinal stenosis diagnosis. The respective negative predictive values were 88.5 and 84.3 %. CONCLUSIONS: The Self-administered, Self-reported History Questionnaire version 1.1 with the new cutoff was more sensitive and had higher negative predictive value than version 1.0 with the initial cutoff. Therefore, the improved Self-administered, Self-reported History Questionnaire version 1.1 can be used for lumbar spinal stenosis screening, and its use may improve the quality of lumbar spinal stenosis diagnostic practice in Japanese primary care settings.


Assuntos
Vértebras Lombares , Atenção Primária à Saúde/métodos , Autorrelato , Estenose Espinal/diagnóstico , Inquéritos e Questionários , Idoso , Estudos Transversais , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estenose Espinal/epidemiologia
16.
BMC Musculoskelet Disord ; 15: 259, 2014 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-25080292

RESUMO

BACKGROUND: The gait-loading test is a well known, important test with which to assess the involved spinal level in patients with lumbar spinal stenosis. The lumbar extension-loading test also functions as a diagnostic loading test in patients with lumbar spinal stenosis; however, its efficacy remains uncertain. The purpose of this study was to compare the diagnostic value of the lumbar extension-loading test with that of the gait-loading test in patients with lumbar spinal stenosis. METHODS: A total of 116 consecutive patients (62 men and 54 women) diagnosed with lumbar spinal stenosis were included in this cross-sectional study of the lumbar extension-loading test. Subjective symptoms and objective neurological findings (motor, sensory, and reflex) were examined before and after the lumbar extension-loading and gait-loading tests. The efficacy of the lumbar extension-loading test for establishment of a correct diagnosis of the involved spinal level was assessed and compared with that of the gait-loading test. RESULTS: There were no significant differences between the lumbar extension-loading test and the gait-loading test in terms of subjective symptoms, objective neurological findings, or changes in the involved spinal level before and after each loading test. CONCLUSIONS: The lumbar extension-loading test is useful for assessment of lumbar spinal stenosis pathology and is capable of accurately determining the involved spinal level.


Assuntos
Vértebras Lombares/fisiopatologia , Exame Físico/métodos , Estenose Espinal/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Estudos Transversais , Feminino , Marcha , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Limiar da Dor , Valor Preditivo dos Testes , Reflexo , Estenose Espinal/complicações , Estenose Espinal/fisiopatologia , Caminhada , Suporte de Carga
17.
J Spinal Disord Tech ; 27(4): 196-201, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22820279

RESUMO

STUDY DESIGN: A retrospective long-term (minimum 10 y) follow-up and comparative study. OBJECTIVE: To compare the clinical outcome of surgically treated primary lumbar disk herniation (LDH) by conventional discectomy alone and discectomy with posterolateral fusion without instrumentation. SUMMARY OF BACKGROUND DATA: Primary LDH is usually treated by discectomy alone. The long-term outcome of discectomy alone is generally satisfactory. However, the superiority of a discectomy alone in comparison with a discectomy with fusion for primary LDH has yet to be determined. METHODS: Conventional discectomy without fusion was performed in 39 patients in hospital A (without-fusion group) and conventional discectomy with posterolateral fusion without instrumentation was performed in 109 patients in hospital B (with-fusion group). The subjective symptoms (analgesic use, continuing gait time, 4-grade modified outcome criteria, numerical rating scale of pain and satisfaction with the operation, and the Japanese version of the Roland-Morris Disability Questionnaire) and objective symptoms (straight leg raising test, manual muscle test, and sensory disturbance) were assessed. RESULTS: There were no differences detected in the subjective and objective symptoms between the without-fusion and with-fusion group. CONCLUSIONS: Routine fusion surgery for a primary LDH was therefore found to have no apparent benefit even in the long-term outcome.


Assuntos
Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Dor/cirurgia , Satisfação do Paciente , Fusão Vertebral/efeitos adversos , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
18.
J Orthop Sci ; 19(5): 792-7, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25052870

RESUMO

BACKGROUND: The authors recently developed a screening tool, the 25-question Geriatric Locomotive Function Scale (GLFS-25), for the early detection of locomotive syndrome (LS). However, the nationwide prevalence of LS based on the GLFS-25 remains unknown. METHODS: A nationwide, cross-sectional Internet survey was conducted to estimate sex- and age-specific mean values of the GLFS-25 and the total number of individuals with LS in Japan. The distribution of the subjects' sex, age, geographical location, and population size was approximated by that observed in the national population census conducted in 2010. In total, 4,500 subjects who completed the GLFS-25 questionnaire on the Internet were included in the present study. RESULTS: The age-specific mean values for the GLFS25 were 5.8 in the 40s, 6.0 in the 50s, 5.9 in the 60s, and 8.8 in the 70s. The mean value for the GLFS-25 was significantly higher in the 70s than in the other age groups. The mean value for the GLFS-25 was significantly higher in females than in males. The prevalence of LS was 8.4% in the 40s and remained stable until the 60s, but increased rapidly in the 70s. The overall mean prevalence of LS was 10.2%. The total number of individuals between the 40s and 70s with LS in Japan was roughly estimated to be 6.5 million. CONCLUSIONS: This study determined sex- and age-specific estimates for the GLFS-25 using a nationwide, cross-sectional Internet survey. The current results highlight the magnitude of the problem associated with LS and encourage further large-scale population-based epidemiologic studies to determine the accurate prevalence of LS using stratified random sampling.


Assuntos
Locomoção/fisiologia , Limitação da Mobilidade , Doenças Musculoesqueléticas/epidemiologia , Atividades Cotidianas , Adulto , Idoso , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Internet , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/diagnóstico , Prevalência , Inquéritos e Questionários , Síndrome
19.
Fukushima J Med Sci ; 70(2): 99-102, 2024 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-38494732

RESUMO

BACKGROUND: In foot amputation, Chopart amputation is considered to have a high risk of deformity, and can result in poor function. We experienced a case in which Chopart amputation combined with tendon transfer and tendon lengthening was performed, and the patient was eventually able to walk independently with a foot prosthesis without experiencing deformity of the foot. We investigated walking speed and plantar pressure after Chopart amputation with and without a foot prosthesis. CASE: A 78-year-old man underwent Chopart amputation with tendon transfer and tendon lengthening. As a result, he was able to stand up and walk, both while bearing weight on the heel of the affected foot, but he was unable to push off the ground using that foot. When a foot prosthesis was introduced, the patient's walking speed increased from 0.6 m/s without the prosthesis to 0.8 m/s with the prosthesis, which was an increase of 33%. The plantar pressure at the stump decreased from 129.3 N/cm2 on average without the prosthesis to 51.6 N/cm2 with the prosthesis, which was a 59% decrease. Wearing a foot prosthesis improved the patient's walking speed and decreased plantar pressure at the amputation stump.


Assuntos
Amputação Cirúrgica , , Pressão , Velocidade de Caminhada , Humanos , Masculino , Idoso , Membros Artificiais , Caminhada
20.
Fukushima J Med Sci ; 70(2): 87-92, 2024 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-38494730

RESUMO

Diffuse idiopathic skeletal hyperostosis (DISH) frequently occurs in the spine, resulting in unstable fractures. Treating thoracolumbar fractures in patients with DISH is often difficult because the anterior opening of the vertebral body is exacerbated by dislocation in the prone position, making reduction difficult. In this study, we introduced a novel skull clamp-assisted positioning (SAP) technique. The patient is placed in a supine position with a skull clamp used in cervical spine surgery before surgery to prevent the progression of dislocation and to restore the patient's position. Using this method, the mean difference in local kyphosis angle improved from -2.9 (±8.4)° preoperatively to 10.9 (±7.7)° postoperatively. Furthermore, posterior displacement decreased from a preoperative mean of 5.5 (±4.3) mm to 0.3 (±0.7) mm postoperatively. Complications such as neurological sequelae, implant fracture, and surgical site infection were not observed through one year of postoperative follow-up. SAP may decrease invasiveness and complications. Longer-term studies and larger sample sizes are needed to establish long-term efficacy and benefits.


Assuntos
Hiperostose Esquelética Difusa Idiopática , Vértebras Lombares , Fraturas da Coluna Vertebral , Vértebras Torácicas , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Hiperostose Esquelética Difusa Idiopática/complicações , Hiperostose Esquelética Difusa Idiopática/cirurgia , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Posicionamento do Paciente/métodos , Crânio/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Fraturas da Coluna Vertebral/etiologia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia
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