Evaluation of locomotive syndrome in patients receiving surgical treatment for degenerative musculoskeletal diseases: A multicentre prospective study using the new criteria

Age diversity among older surgically treated patients with lumbar spinal stenosis: a retrospective comparative study of early and late older adults

BACKGROUND

At present, the threshold defining older adults is 65 years, and this classification has been widely accepted globally. However, with the extension of both life expectancy and healthy life expectancy, there is a need to reconsider this age-based definition. This study compared the characteristics and surgical outcomes of older patients with lumbar spinal stenosis (LSS) between the early and late stages to clarify age diversity in this population.

METHODS

Data collected from consecutive patients aged ≥ 65 years who underwent LSS surgery were retrospectively reviewed. All participants completed the Zurich Claudication Questionnaire, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and 25-Question Geriatric Locomotive Function Scale preoperatively as well as 6 and 12 months postoperatively. Frailty was evaluated using the 11-point modified frailty index. Polypharmacy was defined as the concomitant use of at least six drugs.

RESULTS

In total, 311 older patients with LSS were enrolled. Among them, 136 patients younger than 75 were categorized into the E group, and 175 patients aged 75 and older were categorized into the L group. Baseline characteristics, including frailty and polypharmacy, significantly differed between the groups. The frequency of effective case of surgical treatment on JOABPEQ was significantly lower for walking ability in the L group. At 1 year after surgery, the incidence of non-improvement in locomotive syndrome stages was higher in the L group than in the E group (relative risk = 1.38, 95% confidence interval [CI] = 1.08-1.78). In addition, when the L group was further divided into three subgroups based on age, the relative risk was 1.32 (95% CI = 0.99-1.76) for patients aged 75 to < 80, 1.42 (95% CI = 1.07-1.88) for those aged 80 to < 85 years, and 1.68 (95% CI = 1.16-2.45) for those aged ≥ 85.

CONCLUSIONS

Significant differences were observed in baseline characteristics and postoperative improvement of walking ability and locomotive syndrome based on age among older patients with LSS. Our findings underscore the significant age diversity among older adults, highlighting the necessity of considering each patient in a more nuanced age-specific manner rather than adopting a one-size-fits-all approach.

Preoperative Spinal Sagittal Alignment Affects Improvement of Locomotive Syndrome by Four Years After Total Hip Arthroplasty

Introduction Most patients with hip osteoarthritis requiring total hip arthroplasty suffer from locomotive syndrome stage 3, which indicates difficulty with mobility and social participation. Although total hip arthroplasty improves their locomotive syndrome stage, some patients remain at locomotive syndrome stage 3 after total hip arthroplasty, despite hip function improvement. Patients with severe hip osteoarthritis may have an abnormal spinal sagittal alignment. This study investigated the influence of preoperative spinopelvic parameters for locomotive syndrome improvement at four years after total hip arthroplasty. Methods This retrospective cohort study of a prospectively maintained database included 65 patients who had undergone total hip arthroplasty. Patients were divided into two groups based on whether they showed improvement from Locomotive Syndrome stage 3 at four years postoperatively: improved group (n = 51) and unchanged group (n = 14). Preoperative spinopelvic parameters were compared between the two groups and examined using logistic analysis to determine locomotive syndrome improvement. The cut-off values for preoperative key factors of locomotive syndrome improvement obtained using logistic analysis were determined using receiver operating characteristics analysis. Results Preoperative sagittal vertical axis was significantly larger and sacral slope was significantly smaller in the unchanged group than in the improved group. In the logistic regression analysis, preoperative sacral slope and the 25-question Geriatric Locomotive Function Scale (GLFS-25) were identified as factors associated with locomotive syndrome improvement. The receiver operating characteristic analysis showed that the cut-off values of preoperative sacral slope and GLFS-25 for locomotive syndrome improvement were 32.5° and 44.5, respectively. Conclusions Among hip osteoarthritis (OA) patients with locomotive syndrome stage 3, those who have small preoperative sacral slope and large preoperative GLFS-25 score may have difficulty improving their postoperative mobility. Therefore, it may be useful to suggest preoperatively that such patients should be prepared to use social services and other services after surgery to support their postoperative mobility.

Current status and risk determinants of locomotive syndrome in geriatric cancer survivors in China-a single-center cross-sectional survey

Objective

To assess the prevalence and risk determinants of locomotive syndrome (LS) in geriatric cancer survivors in China. To generate evidence-based insights for the clinical prevention and intervention strategies concerning LS in this vulnerable population, emphasizing the need for integrated public health initiatives focused on maintaining mobility among geriatric cancer survivors.

Methods

Six hundred geriatric cancer survivors were recruited at a hospital in China. A demographic questionnaire, the International Physical Activity Questionnaire-Short (IPAQ-S), and the Geriatric Locomotive Function Scale (GLFS-25) were administered. Survivors were stratified into three physical activity level (PAL) groups via IPAQ-S scores: low, medium, and high. LS was operationally defined via GLFS-25 scores, with cut-offs established for LS-1, LS-2, and LS-3. Elevated GLFS-25 scores signified deteriorated motor function (MF) and increased severity of LS. Data analysis was done to investigate the risk determinants to the occurrence and exacerbation of LS among geriatric cancer survivors.

Results

Of the 524 geriatric cancer survivors who completed the study, 292 (55.7%) were diagnosed with LS, including 152 (29%) categorized under LS-1, 52 (9.9%) under LS-2, and 88 (16.8%) under LS-3. Univariate analysis indicated that variations in exercise habits, prior occupational type, presence of tumor metastasis or recurrence, visual impairments, somatosensory abnormalities, and PAL were significantly associated with differing occurrences and severities of LS (p < 0.05). Ordinal logistic regression revealed that prior occupational type (OR = 0.466), tumor metastasis (OR = 0.404), tumor recurrence (OR = 0.341), and PAL (medium: OR = 7.178; high: OR = 1.984) were independent risk determinants modulating both the occurrence and severity of LS in cancer survivors (p < 0.05).

Conclusion

The occurrence of LS is notably elevated among geriatric cancer survivors in China, indicating a significant public health concern. Individuals who were previously engaged in non-physically demanding occupations and those with histories of tumor metastasis or recurrence, coupled with reduced PAL, demonstrate a heightened susceptibility and severities to LS. Early identification of these risk determinants is imperative for mitigating the onset and progression of LS. Comprehensive public health strategies, including regular screening programs, targeted physical rehabilitation initiatives, and community-based interventions, are essential to mitigate the onset and progression of LS in this vulnerable population, ultimately reducing its broader impact on aging-related health outcomes.

Assessment of Surgical Outcomes in Patients with Degenerative Cervical Myelopathy Using the 25-Question Geriatric Locomotive Function Scale: A Longitudinal Observational Study

Introduction

Locomotive syndrome caused by degenerative musculoskeletal diseases is reported to improve with surgical treatment. However, it is unclear whether surgical treatment is effective for the locomotive syndrome developing in patients with degenerative cervical myelopathy (DCM). Thus, this study primarily aimed to longitudinally assess the change in locomotive syndrome stage before and after cervical spinal surgery for patients with DCM using the 25-question geriatric locomotive function scale (GLFS-25). A secondary objective was to identify factors associated with the postoperative improvement in the locomotive syndrome stage.

Methods

We retrospectively reviewed clinical data of patients undergoing cervical spine surgery at our institution from April 2020 to May 2022 who had answered the Japanese Orthopaedic Association Cervical Myelopathy Assessment Questionnaire, visual analog scale, and GLFS-25 preoperatively and at 6 months and 1 year postoperatively. We collected demographic data, medical history, preoperative radiographic parameters, presence or absence of posterior longitudinal ligament ossification, and surgical data.

Results

We enrolled 115 patients (78 men and 37 women) in the present study. Preoperatively, using the GLFS-25, 73.9% of patients had stage 3, 10.4% had stage 2, 9.6% had stage 1, 6.1% had no locomotive syndrome. The stage distribution of locomotive syndrome improved significantly at 6-months and 1-year postoperatively. The multivariable Poisson regression analysis revealed that better preoperative lower extremity function (relative risk: 3.0; 95% confidence interval: 1.01-8.8) was significantly associated with postoperative improvement in the locomotive syndrome stage.

Conclusions

This is the first study to longitudinally assess the locomotive syndrome stage in patients with DCM using GLFS-25. Our results indicated that patients with DCM experienced significant improvement in the locomotive syndrome stage following cervical spine surgery. Particularly, the preoperative lower extremity function was significant in postoperative improvement in the locomotive syndrome stage.

Risk Factors that Hinder Locomotive Syndrome Improvement Following Surgery for Musculoskeletal Diseases in Older Patients: A Multicenter Prospective Study

OBJECTIVES

This study aimed to evaluate preoperative and postoperative locomotive syndrome (LS) in older adults undergoing surgical treatment for musculoskeletal diseases of the lumbar spine and lower extremities and identify risk factors that impede LS improvement after surgery.

METHODS

: The baseline evaluation included 471 patients 65 years or older (276 in the pre-old age [65-74 years] group; 195 in the old age [75 years or older] group) and examined the preoperative and postoperative LS data. The second evaluation performed to identify risk factors, including anthropometric measurements, comorbidity, and frailty, that hinder LS improvement after surgery included 378 patients with preoperative LS stage 3.

RESULTS

Preoperatively, 80% of the patients had LS stage 3; this rate decreased to 40% postoperatively. Half of the patients exhibited postoperative LS improvement. The LS improvement rate was higher in the pre-old age group than in the old age group. According to the multiple logistic regression analysis, old age, high body mass index, weak hand grip strength, and high 5-factor modified frailty index score were significant risk factors that hinder LS improvement after surgery.

CONCLUSIONS

Aging, obesity, weak muscle strength, and frailty can hinder LS improvement in older patients who undergo surgery.