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Tsujimura S, Michikawa T, Tsuzuki A, Kuroiwa T, Kawabata S, Kawano Y, Morita M, Hayakawa K, Kaneko S, Takechi H, Fujita N. Association between fractures and health status among independent older adults: insights from a suburban cohort in Japan. BMC Geriatr 2025; 25:243. [PMID: 40211178 PMCID: PMC11983925 DOI: 10.1186/s12877-025-05876-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2025] [Accepted: 03/21/2025] [Indexed: 04/12/2025] Open
Abstract
BACKGROUND Fractures are a significant health concern for older adults, affecting their activities of daily living (ADL), physical function, and mental well-being, and contributing to the need for long-term care. However, the factors associated with fractures among independent older adults remain unclear. This study aimed to examine the association between fractures and the health status of independent older adults in a representative suburban city in Japan using data from a survey of community-dwelling residents and to identify factors associated with fractures. METHODS A total of 15,853 survey questionnaires were mailed, and 11,346 valid responses were received, resulting in a response rate of 71.6%. The survey included questions on ADL, physical function, mental health, memory, medical conditions, and subjective complaints. For fractures, participants were asked the following question: "How many times have you experienced fractures since the age of 65?". Data were analyzed using Poisson regression models adjusted for age, sex, body mass index, family structure, and smoking history. RESULTS Among the respondents, 15% reported fractures after age of 65 years. A decline in ADL, physical function, mental health, and memory were significantly associated with increased fracture frequency. Under medical conditions, the prevalence of depression (p for trend = 0.042), respiratory diseases (p for trend = 0.001), and ophthalmologic conditions (p for trend = 0.002) increased significantly with fracture number. Most subjective complaints were significantly associated with fracture number, with dysphagia demonstrating the strongest association. CONCLUSIONS This study utilized a relatively large and highly representative sample of community-dwelling residents to identify factors associated with fractures in independent older adults. Even in independent older adults who were not certified as requiring long-term care, fractures were significantly associated with a decline in multiple health domains. These findings provide valuable insights that can inform efforts to promote healthy aging and reduce care dependency. CLINICAL TRIAL Not applicable.
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Affiliation(s)
- Shuzo Tsujimura
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - Akira Tsuzuki
- Faculty of Rehabilitation, School of Health Science, Fujita Health University, Aichi, Japan
| | - Takashi Kuroiwa
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Soya Kawabata
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Yusuke Kawano
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Mitsuhiro Morita
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Kazue Hayakawa
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Shinjiro Kaneko
- Department of Spine and Spinal Cord Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Hajime Takechi
- Department of Geriatrics and Cognitive Disorders, School of Medicine, Fujita Health University, Aichi, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan.
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Hirono T, Morita M, Michikawa T, Tobe R, Tobe T, Kato K, Kawabata S, Oya A, Kawano Y, Hayakawa K, Kaneko S, Matsumoto M, Nakamura M, Yamada S, Fujita N. Medication-based profiling of older orthopedic patients: a multicenter cross-sectional study. BMC Geriatr 2024; 24:672. [PMID: 39123123 PMCID: PMC11316294 DOI: 10.1186/s12877-024-05284-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 08/05/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Managing medication use in older orthopedic patients is imperative to extend their healthy life expectancy in an aging society. However, the actual situation regarding polypharmacy, the intake of potentially inappropriate medications (PIMs), and fall risk-increasing drugs (FRIDs) among older orthopedic patients is not well characterized. This study aimed to investigate the medication-based profiles of older orthopedic patients to highlight the critical points of concern. METHODS We retrospectively reviewed the clinical data of consecutive patients aged ≥ 65 years who underwent orthopedic surgery at two acute care hospitals between April 2020 and March 2021. The cutoff number of prescribed drugs for polypharmacy was set at 6. According to the specified guidelines, 19 categories of drugs were identified as PIMs, and 10 categories were classified as FRIDs. RESULTS A total of 995 older patients with orthopedic surgery were assessed, of which 57.4% were diagnosed with polypharmacy, 66.0% were receiving PIMs, and 41.7% were receiving FRIDs. The prevalence of FRID intake did not significantly differ among patients with degenerative spinal disease (n = 316), degenerative disease of extremities (n = 331), and fractures (n = 272). Compared with patients with degenerative disease of the extremities, the multivariable-adjusted prevalence ratios (PRs) of polypharmacy and PIM intake were significantly higher in patients with degenerative spinal disease (1.26 [confidence intervals (CI): 1.11-1.44] and 1.12 [CI: 1.00-1.25]), respectively. Use of antiemetic drugs (adjusted PR, 13.36; 95% CI: 3.14-56.81) and nonsteroidal anti-inflammatory drugs (adjusted PR, 1.37; 95% CI: 1.05-1.78) was significantly higher in patients with degenerative spinal disease. Among patients with degenerative spinal disease, the prevalence of antiemetic drug intake was 8.7% in lumbar spinal patients and 0% in cervical spinal patients. CONCLUSIONS More than half of the orthopedic patients in this study were affected by polypharmacy, and approximately two-thirds were prescribed some form of PIMs. Patients with degenerative spinal disease showed a significantly higher prevalence of polypharmacy and PIM use compared with other orthopedic diseases. Particular attention should be paid to the high frequency of antiemetic drugs and nonsteroidal anti-inflammatory drugs intake among patients with degenerative lumbar spine conditions.
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Affiliation(s)
- Takayuki Hirono
- Department of Orthopaedic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Aichi, Japan
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuhiro Morita
- Department of Orthopaedic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Aichi, Japan
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - Risa Tobe
- Department of Clinical Pharmacy, School of Medicine, Fujita Health University, Aichi, Japan
| | - Takao Tobe
- Department of Clinical Pharmacy, School of Medicine, Fujita Health University, Aichi, Japan
| | - Koki Kato
- Department of Clinical Pharmacy, School of Medicine, Fujita Health University, Aichi, Japan
| | - Soya Kawabata
- Department of Orthopaedic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Aichi, Japan
| | - Akihito Oya
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yusuke Kawano
- Department of Orthopaedic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Aichi, Japan
| | - Kazue Hayakawa
- Department of Orthopaedic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Aichi, Japan
| | - Shinjiro Kaneko
- Department of Spine and Spinal Cord Surgery, Fujita Health University, Aichi, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shigeki Yamada
- Department of Clinical Pharmacy, School of Medicine, Fujita Health University, Aichi, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Aichi, Japan.
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Ohba T, Goto G, Oda K, Tanaka N, Yokomichi H, Haro H. Comparative Study for Characteristics of Locomotive Syndrome in Patients with Lumbar Stenosis and Adult Spinal Deformity. J Clin Med 2023; 12:4345. [PMID: 37445379 DOI: 10.3390/jcm12134345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/09/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION The differential diagnoses of lumbar spinal stenosis (LSS) and adult spinal deformity (ASD) have been demonstrated primarily using sagittal radiographic spinopelvic parameters. However, it is more important to know the differences in the characteristic clinical symptoms to make accurate treatment decisions. Recently, the relationship between spinal disease and Locomotive Syndrome (LS) has been reported. Additionally, the Geriatric Locomotive Function Scale-25 (GLFS-25) was reported to be a useful scale to evaluate disease severity and characteristic clinical symptoms in spinal disease. METHODS Sixty-nine consecutive patients with ASD and 196 patients with LSS who underwent spinal surgery were included. Locomotive dysfunction was evaluated using the GLFS-25 questionnaire and physical performance tests including the two-step test and the stand-up test, measured preoperatively. The correlations between sagittal spinopelvic parameters of ASD and LS were examined. RESULTS All subjects with lumbar degenerative disease in the present study were diagnosed with LS preoperatively. The severity of LS in patients with LSS and ASD were statistically similar. GLFS-25 scores in the mobility and community domain were similarly poor in both groups. Several scores in the domestic life and self-care domains were significantly worse in the ASD group. Question 20 of the GLFS-25, related to load-bearing tasks and housework, was significantly associated with a large pelvic incidence in ASD patients. CONCLUSIONS Lumbar degenerative disease requiring surgery severely affects the LS of older people. ASD patients had more difficulty with load-bearing tasks and housework such as cleaning the yard, carrying heavy bedding, dressing, and bathing compared to LSS patients.
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Affiliation(s)
- Tetsuro Ohba
- Department of Orthopaedics, University of Yamanashi, Shimokato, Chuo 409-3898, Yamanashi, Japan
| | - Go Goto
- Department of Orthopaedics, University of Yamanashi, Shimokato, Chuo 409-3898, Yamanashi, Japan
| | - Kotaro Oda
- Department of Orthopaedics, University of Yamanashi, Shimokato, Chuo 409-3898, Yamanashi, Japan
| | - Nobuki Tanaka
- Department of Orthopaedics, University of Yamanashi, Shimokato, Chuo 409-3898, Yamanashi, Japan
| | - Hiroshi Yokomichi
- Department of Health Sciences, University of Yamanashi, Shimokato, Chuo 409-3898, Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopaedics, University of Yamanashi, Shimokato, Chuo 409-3898, Yamanashi, Japan
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Makizono T, Uchikado H, Ando T, Kikuchi J, Hattori G, Morioka M. A case of mid-thoracic osteoporotic vertebral fracture with the inability to belch syndrome. Surg Neurol Int 2022; 13:458. [DOI: 10.25259/sni_839_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 09/21/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Osteoporotic vertebral fractures (OVF) commonly occur at the thoracolumbar junction, but are less frequently encountered in the mid-thoracic region. Here, a 69-year-old female presented with back pain and the new onset of symptoms characterized by the inability to belch.
Case Description:
A 69-year-old female presented with back pain. 2 months later, she developed anorexia and difficulty belching. The thoracic magnetic resonance (MR) demonstrated a T7 OVF. As she ultimately underwent a balloon kyphoplasty (BKP), as conservative treatment was unsuccessful.
Conclusion:
OVF should be suspected in elderly females with the inability to belch accompanied by chest and back pain. The diagnosis is best established with a spinal MR imaging and should be followed by BKP.
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Affiliation(s)
- Takehiro Makizono
- Department of Neurosurgery, Social Insurance Tagawa Hospital, Kamihonmachi, Tagawa,
| | - Hisaaki Uchikado
- Department of Neurosurgery, Uchikado Neuro-Spine Clinic, Hakata-Ku Naka, Fukuoka,
| | - Takayasu Ando
- Department of Neurosurgery, Kurume University School of Medicine, Asahi-Machi, Kurume, Japan
| | - Jin Kikuchi
- Department of Neurosurgery, Kurume University School of Medicine, Asahi-Machi, Kurume, Japan
| | - Gohsuke Hattori
- Department of Neurosurgery, Kurume University School of Medicine, Asahi-Machi, Kurume, Japan
| | - Motohiro Morioka
- Department of Neurosurgery, Kurume University School of Medicine, Asahi-Machi, Kurume, Japan
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Ohba T, Koyama K, Oba H, Oda K, Tanaka N, Haro H. Clinical Importance, Incidence and Risk Factors for the Development of Postoperative Ileus Following Adult Spinal Deformity Surgery. Global Spine J 2022; 12:1135-1140. [PMID: 33334184 PMCID: PMC9210243 DOI: 10.1177/2192568220976562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective observational study of a cohort of consecutive patients. OBJECTIVES Postoperative ileus (POI) is associated with a variety of adverse effects. Although the incidence of and risk factors for POI following spinal surgery have been reported, the frequency and pathology of POI after spinal corrective surgery for adult spinal deformity (ASD) are still largely unknown. The study objectives were to: (1) clarify the prevalence and clinical significance of POI, (2) elucidate the risk factors for POI, (3) determine radiographically which preoperative and/or postoperative spinal parameters predominantly influence the risk of POI after spinal corrective surgery for ASD. METHODS We included data from 144 consecutive patients who underwent spinal corrective surgery. Perioperative medical complications and clinical information were extracted from patient electronic medical records. Preoperative radiographic parameters and changes in radiographic parameters after surgery were compared between patients with and without POI. Multivariate logistic regression analyses were performed to clarify potential risk factors for POI. RESULTS POI developed in 25/144 (17.4%) patients and was the most common complication in the present study. The frequencies of smoking, gastroesophageal reflux disease, and lateral lumbar interbody fusion (LLIF), as well as the duration of surgery were significantly greater in the group with POI versus the group without POI. Among radiographic parameters, only the change in thoracolumbar kyphosis (TLK) from before to after surgery was significantly larger in the group with POI. Multivariate logistic regression analysis showed that male sex, LLIF and large changes in TLK from before to after surgery were significantly associated with the development of POI. CONCLUSIONS These results suggested that LLIF and large corrections in TLK were independent risk factors for POI after ASD surgery. When patients with ASD have large TLK preoperatively, and it is determined that a large correction is needed, physicians must be aware of the potential for occurrence of POI.
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Affiliation(s)
- Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi, Kofu, Yamanashi, Japan,Tetsuro Ohba, MD, PhD, Department of Orthopaedics, University of Yamanashi, 1110, Shimokato, Chuo, Yamanashi 409-3898, Japan.
| | - Kensuke Koyama
- Department of Orthopaedic Surgery, University of Yamanashi, Kofu, Yamanashi, Japan
| | - Hiroki Oba
- Department of Orthopaedic Surgery, University of Yamanashi, Kofu, Yamanashi, Japan,Department of Orthopaedic Surgery, Shinshu University, School of Medicine, Matsumoto, Nagano, Japan
| | - Kotaro Oda
- Department of Orthopaedic Surgery, University of Yamanashi, Kofu, Yamanashi, Japan
| | - Nobuki Tanaka
- Department of Orthopaedic Surgery, University of Yamanashi, Kofu, Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, University of Yamanashi, Kofu, Yamanashi, Japan
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Preoperative Radiographic Evaluation of Thoracic Flexibility and Compensation for Adult Spinal Deformity Surgery. How to Select Optimal Upper Instrumented Vertebra to Prevent Proximal Junctional Kyphosis. Spine (Phila Pa 1976) 2022; 47:144-152. [PMID: 34027926 DOI: 10.1097/brs.0000000000004126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study of a cohort of consecutive patients. OBJECTIVE The aim of this study was to clarify the usefulness and value of the difference in thoracic kyphosis (ΔTK) angle in various positions by imaging the patient standing, prone, and supine to evaluate TK flexibility and compensation, and to establish optimal radiography to determine an appropriate thoracic level for upper instrumented vertebra (UIV) because a strategy to select an appropriate level to avoid proximal junctional kyphosis (PJK) remains elusive. SUMMARY OF BACKGROUND DATA Postoperative reciprocal progression of TK is a significant risk factor for PJK. However, how to predict and prevent postoperative reciprocal progression of TK remains unclear. We hypothesized that preoperative evaluation of both TK flexibility and compensation is essential to predict PJK and determine the UIV level. METHODS We included 144 consecutive patients with adult spinal deformity (ASD), ≥2 years' follow-up, and UIV Th9-11 in this retrospective cohort study. TK was measured from images with patients standing, prone, and supine. Supine ΔTK was calculated as standing TK- supine TK. Prone ΔTK was calculated as standing TK - prone TK. Receiver-operating characteristic (ROC) curves were analyzed to determine the thresholds of supine ΔTK and prone ΔTK for PJK occurrence. RESULTS PJK was observed in 64 of 144 (44%) patients 2 years postoperatively. Prone and supine ΔTKs were significantly larger in patients with PJK. A significant positive correlation between prone ΔTK and supine ΔTK was observed. When data from patients with and without PJK were plotted separately, a significantly higher proportion of patients with PJK had large prone and supine ΔTKs. The cutoff values of prone and supine ΔTKs for PJK risk were determined using ROC curve analysis. CONCLUSION Because of their significantly high risk for PJK, in patients with ASD and prone ΔTK >11.5° and supine ΔTK >18.5°, the upper-thoracic spine should be considered for UIV.Level of Evidence: 3.
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Abstract
STUDY DESIGN Retrospective observational study of consecutive patients. OBJECTIVE We sought to: (1) clarify the key factors predominantly associated with the insertional torque of pedicle screws; (2) compare the optimal factors for pedicle screw insertion to obtain rigid screw fixation in patients with adult spinal deformity (ASD) and in those with adolescent idiopathic scoliosis (AIS); (3) determine the optimal screw/pedicle ratio (S/P) to obtain rigid pedicle screw fixation. SUMMARY OF BACKGROUND DATA Rigid pedicle screw fixation is mandatory to perform corrections for spinal deformities properly and to allow successful fusion after surgery. The fixation depends mainly on screw position accuracy and patient bone quality. Traditionally, spinal surgeons have decided the screw size, trajectory, and tapping size based on their intuition. Insertional torque has been indicated as useful to predict screw fixation strength, and is correlated with screw pullout strength and frequency of postoperative screw loosening. METHODS We compared insertion torque at L1-L3 levels of 324 screws in 68 patients with ASD and 58 screws in 32 patients with AIS. We assessed the association between screw/pedicle ratio and insertion torque by constructing a spline curve. RESULTS Pedicle and screw diameter correlated positively with insertion torque in patients with either ASD or AIS. The optimal screw/pedicle ratio to obtain rigid pedicle screw fixation in patients with ASD was close to, but less than one, and, by contrast, was about 1 to 1.25 in patients with AIS. CONCLUSION We propose the concept of an optimal S/P ratio for obtaining rigid pedicle screw fixation during spinal corrective surgery, which is different for patients with ASD and patients with AIS. The S/P ratio is useful for deciding the appropriate diameter screw for each case in preoperative planning.Level of Evidence: 4.
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Locomotive syndrome: Prevalence, surgical outcomes, and physical performance of patients treated to correct adult spinal deformity. J Orthop Sci 2021; 26:678-683. [PMID: 32888792 DOI: 10.1016/j.jos.2020.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/11/2020] [Accepted: 06/24/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Locomotive syndrome (LS) was proposed by the Japanese Orthopedic Association and refers to a scenario in which imminent future nursing care services will be required by elderly adults to manage the functional deterioration of their locomotive organs. It is a social imperative to clarify the risk factors and treatment strategy for LS. However, the relationship between LS and adult spinal deformity (ASD) in those who are treated with spinal corrective surgery remains largely unknown. METHODS Forty consecutive patients who had ASD and underwent spinal surgery for their disorder were included in this study. Locomotive dysfunction was evaluated using the 25-item Geriatric Locomotive Function Scale-25 (GLFS-25) questionnaire and physical performance tests including the one-legged standing test, the two-step test, the stand-up test, the handgrip strength, and gait speed test which were measured preoperatively, 6 months after surgery, and 1 year after surgery. RESULTS Of the patients with ASD treated surgically, 95% of them had LS preoperatively and LS prevalence decreased significantly 1 year after surgery by 67.5% compared with the preoperative rate. Among physical performance tests, the walking stride and one-legged standing test improved significantly after spinal corrective surgery. The GLFS-25 items for the domains of pain, mobility, and domestic life improved overall postoperatively, whereas items in the self-care domain did not and the item for difficulty in putting on and taking off trousers and pants worsened. CONCLUSIONS Spinal corrective surgery significantly improved physical performance tests as well as the frequency and severity of LS in patients with ASD. However, some GLFS-25 items can worsen after surgery and require attention.
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Endo T, Ohba T, Oba H, Oda K, Tanaka N, Haro H. Prevalence and Key Radiographic Spinal Malalignment Parameters Associated with the Risk of Pulmonary Function Impairment in Patients Treated Surgically to Correct Adult Spinal Deformity. Spine Surg Relat Res 2020; 4:347-353. [PMID: 33195860 PMCID: PMC7661027 DOI: 10.22603/ssrr.2020-0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 03/14/2020] [Indexed: 01/16/2023] Open
Abstract
Introduction There is a significant relationship between pulmonary function and degree of spinal deformity, location of apical vertebrae, and coronal imbalance in patients with childhood spinal deformity. By contrast, the pathophysiology, epidemiology, and influence of deformity on respiratory dysfunction in patients with adult spinal deformity (ASD) remain largely unknown. We sought to clarify and compare the prevalence of pulmonary function impairment in patients with ASD with that in patients with lumbar spinal stenosis (LSS), to determine radiographically which spinal malalignment parameters are associated with a risk of respiratory dysfunction, and to determine the association of respiratory dysfunction with corrective surgery. Methods We conducted a prospective study of consecutive patients with a diagnosis of ASD or LSS who underwent spinal surgery. We included data from 122 consecutive patients with ASD and 121 consecutive patients with LSS. Parameters were obtained from full-length lateral radiographs taken with the patients standing and in supine and prone positions. We compared respiratory dysfunction between a group of patients with ASD and LSS and determined correlations between respiratory dysfunction and spinopelvic parameters. Results Preoperative % forced vital capacity (FVC) of patients with ASD was significantly lower than that of patients with LSS, and the frequency of restrictive ventilatory impairment was significantly higher in those with ASD (15.7%) than those with LSS (7.4%). Thoracolumbar kyphotic curvature (TK) while the patients were in supine position was significantly greater in the group with restrictive ventilatory impairment, and a significant negative correlation was found between %FVC and TK with the patients in supine position. We found no significant improvement of respiratory dysfunction 1 year after surgery. Conclusions Spinal deformity is a potential risk factor for restrictive ventilatory impairment in the elderly. We propose that radiographs obtained when patients are in supine position are valuable for evaluating the flexibility of the TK. Rigid TK might be an etiology of restrictive ventilatory impairment in patients with ASD.
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Affiliation(s)
- Tomoka Endo
- Department of Orthopaedic Surgery, University of Yamanashi, Chuou-city, Japan
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi, Chuou-city, Japan
| | - Hiroki Oba
- Department of Orthopaedic Surgery, Shinshu University, School of Medicine, Matsumoto city, Japan
| | - Kotaro Oda
- Department of Orthopaedic Surgery, University of Yamanashi, Chuou-city, Japan
| | - Nobuki Tanaka
- Department of Orthopaedic Surgery, University of Yamanashi, Chuou-city, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, University of Yamanashi, Chuou-city, Japan
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The Impact of Geometrical Spinal Shape on Fresh Vertebral Fractures in Elderly Volunteers: A Longitudinal Cohort Analysis. Spine (Phila Pa 1976) 2020; 45:E1232-E1238. [PMID: 32341306 DOI: 10.1097/brs.0000000000003534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Four-year, longitudinal cohort study. OBJECTIVE The aim of this study was to investigate the effect of original spinal shape on incidental vertebral fractures (VFs) and to identify the influence of changes in pre- and post-fracture geometrical spinal shape. SUMMARY OF BACKGROUND DATA Clinical evidence demonstrates that VFs cause spinal kyphosis, morbidities, and deteriorating quality of life in elderly people. However, knowledge of geometrical spinal shapes that affect incidental VFs is limited. METHODS Three hundred seventeen volunteers underwent whole spine radiography as part of a health screening in both 2012 and 2016. We extracted volunteers with incidental VF in 2016. Sex- and age-matched volunteers without VF were enrolled as controls. Baseline demographic variables, geometrical spinal shape, and spinopelvic parameters were compared between the two groups. In volunteers with incidental VF, we investigated the association between baseline spinal shape and post-fracture shape. RESULTS Twenty-seven volunteers (12 men; mean age 75.4 ± 5.4 and 15 women; mean age 71.6 ± 7.9) with VF were enrolled, and 175 volunteers (48 men, 127 women) without VF were selected as controls. In men with VF, the thoracic kyphosis apex was located significantly more posteriorly and caudally than in those without VF. In women with VF, the lordosis apex was located significantly more posteriorly and caudally than in those without VF. After fractures occurring above the inflexion vertebra, the low anterior apex spine (L5) changed its geometrical shape in that the posterior apex and the inflexion vertebra shifted significantly more posteriorly compared to the high anterior apex spine (L4/5). CONCLUSION Original geometrical spinal shape affected the occurrence of VF, and post-fracture spinal shape depended on the positional relationship between the inflexion vertebra and fractured vertebra. Our study helps to understand the influence of geometrical spinal shape on the risks of VF. LEVEL OF EVIDENCE 3.
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Scarpignato C, Hongo M, Wu JCY, Lottrup C, Lazarescu A, Stein E, Hunt RH. Pharmacologic treatment of GERD: Where we are now, and where are we going? Ann N Y Acad Sci 2020; 1482:193-212. [PMID: 32935346 DOI: 10.1111/nyas.14473] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/20/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023]
Abstract
The introduction of acid inhibition in clinical practice has revolutionized the management of acid-related diseases, leading to the virtual abolition of elective surgery for ulcer disease and relegating antireflux surgery to patients with gastroesophageal reflux disease (GERD) not adequately managed by medical therapy. Proton pump inhibitors (PPIs) are the antisecretory drugs of choice for the treatment of reflux disease. However, these drugs still leave some unmet clinical needs in GERD. PPI-refractoriness is common, and persistent symptoms are observed in up to 40-55% of daily PPI users. Potassium-competitive acid blockers (P-CABs) clearly overcome many of the drawbacks and limitations of PPIs, achieving rapid, potent, and prolonged acid suppression, offering the opportunity to address many of the unmet needs. In recent years, it has been increasingly recognized that impaired mucosal integrity is involved in the pathogenesis of GERD. As a consequence, esophageal mucosal protection has emerged as a new, promising therapeutic avenue. When P-CABS are used as add-on medications to standard treatment, a growing body of evidence suggests a significant additional benefit, especially in the relief of symptoms not responding to PPI therapy. On the contrary, reflux inhibitors are considered a promise unfulfilled, and prokinetic agents should only be used on a case-by-case basis.
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Affiliation(s)
- Carmelo Scarpignato
- Department of Health Sciences, United Campus of Malta, Msida, Malta.,Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Michio Hongo
- Department of Comprehensive Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Justin C Y Wu
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Christian Lottrup
- Department of Medicine, Aalborg University Hospital, Hobro, Denmark.,Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmak
| | - Adriana Lazarescu
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Ellen Stein
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland
| | - Richard H Hunt
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Karimian M, Nourmohammadi H, Salamati M, Hafezi Ahmadi MR, Kazemi F, Azami M. Epidemiology of gastroesophageal reflux disease in Iran: a systematic review and meta-analysis. BMC Gastroenterol 2020; 20:297. [PMID: 32928126 PMCID: PMC7488684 DOI: 10.1186/s12876-020-01417-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 08/07/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD), which leads to acid reflux into the esophagus, is a common gastrointestinal disorder. Several studies have shown the prevalence of GERD in Iranian population, but their evidence is contradictory. Therefore, the present study was conducted to investigate the epidemiology of GERD in Iran. METHODS The entire steps of this systematic review and meta-analysis were based on the MOOSE protocol, and the results were reported accordance with the PRISMA guideline. This review is registered on PROSPERO (registration number: CRD42020142861). To find potentially relevant published articles, comprehensive search was done on international online databases Scopus, Science Direct, EMBASE, PubMed/Medline, CINAHL, EBSCO, Cochrane Library, Web of Science, Iranian online databases and the Google Scholar search engine in June 2019. Cochran test and I2 index were used to assess the heterogeneity of the studies. Data were analyzed using Comprehensive Meta-Analysis software ver. 2. The significance level of the test was considered to be P < 0.05. RESULTS The daily, weekly, monthly, and overall prevalence of GERD symptoms in Iranian population was 5.64% (95%CI [confidence interval]: 3.77-8.35%; N = 66,398), 12.50% (95%CI: 9.63-16.08%; N = 110,388), 18.62% (95%CI: 12.90-26.12%; N = 70,749) and 43.07% (95%CI: 35.00-51.53%; N = 73,189), respectively. The daily, weekly, monthly, and overall prevalence of heartburn in Iranian population was 2.46% (95%CI: 0.93-6.39%; N = 18,774), 9.52% (95%CI: 6.16-14.41%; N = 54,125), 8.19% (95%CI: 2.42-24.30%; N = 19,363) and 23.20% (95%CI: 13.56-36.79%; N = 26,543), respectively. The daily, weekly, monthly, and overall prevalence of regurgitation in Iranian population was 4.00% (95%CI: 1.88-8.32%; N = 18,774), 9.79% (95%CI: 5.99-15.60%; N = 41,140), 13.76% (95%CI: 6.18-44.31%; N = 19,363) and 36.53% (95%CI: 19.30-58.08%; N = 21,174), respectively. The sensitivity analysis for prevalence of all types GERD, heartburn and regurgitation symptoms by removing a study showed that the overall estimate is still robust. CONCLUSION The present meta-analysis provides comprehensive and useful information on the epidemiology of GERD in Iran for policy-makers and health care providers. This study showed a high prevalence of GERD in Iran. Therefore, effective measures on GERD-related factors such as lifestyle can be among the health policies of Iran.
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Affiliation(s)
- Mohammad Karimian
- Department of General Surgery, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | | | - Majid Salamati
- Department of General Surgery, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | | | - Fatemeh Kazemi
- School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Milad Azami
- Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran.
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Predictors and Clinical Importance of Postoperative Coronal Malalignment After Surgery to Correct Adult Spinal Deformity. Clin Spine Surg 2020; 33:E337-E341. [PMID: 31996535 DOI: 10.1097/bsd.0000000000000947] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
STUDY DESIGN A retrospective observational study of a cohort of consecutive patients. OBJECTIVE The objective of this study was to determine the correlations between clinical outcomes of spinal surgery to correct adult spinal deformity (ASD) including mechanical complications and coronal malalignment and clarify the risk factors for postoperative coronal malalignment. SUMMARY OF BACKGROUND DATA Despite the coronal malalignment seen regularly in adult patients who have undergone spinal surgery to correct spinal deformity, the associations between coronal malalignment, and clinical outcomes including mechanical complications after the surgery have remained unclear until now. To understand the associations between coronal malalignment and outcomes of surgery to correct ASD, and risk factors for postoperative coronal malalignment has substantial clinical importance. MATERIALS AND METHODS We included data from 121 consecutive patients who had undergone spinal surgery to correct ASD and were followed up for a minimum of 2 years. Iliac screws were used for pelvic fixation in all cases. The coronal balance was defined as the horizontal distance between the midpoint of C7 and the center of the sacrum on the coronal plane, and coronal malalignment was defined as when the absolute coronal balance was >20 mm. Preoperative radiographic parameters, surgical features, and clinical outcomes including mechanical complications were compared between groups of patients with coronal balance and those with malalignment. Univariate and multivariate regression analysis were used to clarify risk factors for postoperative coronal malalignment. RESULTS Postoperative coronal malalignment had no significant association with the clinical outcome as evaluated by a Roland-Morris Disability Questionnaire and Oswestry Disability Index but had a significant association with the frequency of rod fracture. A large preoperative coronal imbalance (malalignment), L5 coronal tilt angle, and use of lateral lumbar interbody fusion were found as risk factors for postoperative coronal malalignment. CONCLUSION Postoperative coronal malalignment had no significant association with the clinical outcome as evaluated by the Oswestry Disability Index and Roland-Morris Disability Questionnaire but was significantly associated with the frequency of rod fracture. LEVEL OF EVIDENCE Level III.
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Ohba T, Ebata S, Oba H, Oda K, Tanaka N, Koyama K, Haro H. Key Radiographic Parameters That Influence the Improvement of Postoperative Gastroesophageal Reflux Disease in Patients Treated Surgically for Adult Spinal Deformity With a Minimum 2-Year Follow-up. Spine (Phila Pa 1976) 2020; 45:E943-E949. [PMID: 32675609 DOI: 10.1097/brs.0000000000003459] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVE The study objectives were to: (1) determine radiographically which spinal malalignment parameters predominantly influence the risk of gastroesophageal reflux disease (GERD); (2) evaluate the outcome of GERD 2 years after surgery for adult spinal deformity (ASD); and (3) clarify key factors that influence the improvement of postoperative GERD in ASD. SUMMARY OF BACKGROUND DATA Spinal deformity is reported to be involved in the pathology of GERD. Our previous study found that approximately 50% of patients treated surgically for ASD had GERD symptoms. However, the postoperative progress of GERD and the key factors that influence the improvement of postoperative GERD are largely unknown. METHODS Ninety-two patients with ASD treated with thoracolumbar corrective surgery and followed up for a minimum of 2 years were enrolled. All patients were asked to complete the Frequency Scale for Symptoms of GERD (FSSG) questionnaire preoperatively and at 1 and 2 years after surgery. GERD was diagnosed by FSSG score more than 8 points. Before, and at 1 and 2 years after surgery, full-length lateral radiographs were taken and radiographic parameters were obtained. RESULTS Patients were classified into two groups based on GERD symptoms, with 47 (51.1%) in the GERD+ group. Among parameters assessed, only thoracolumbar kyphosis (TLK) was significantly greater in the GERD+ group than in the GERD- group. The FSSG score improved significantly 1 year after surgery, but no significant difference was found between groups at 2 years. A significant correction loss of TLK was observed 2 years after surgery. There was a significant highly positive correlation between the FSSG score and TLK at 2 years after surgery. CONCLUSION GERD improved with correction of the spinal deformity but significant correction loss of the TLK even within the fusion presumably due to subsidence or proximal junctional kyphosis resulted in a cessation of that improvement over time. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi, Japan
| | - Shigeto Ebata
- Department of Orthopaedic Surgery, University of Yamanashi, Japan
| | - Hiroki Oba
- Department of Orthopaedic Surgery, School of Medicine, Shinshu University, Japan
| | - Kotaro Oda
- Department of Orthopaedic Surgery, University of Yamanashi, Japan
| | - Nobuki Tanaka
- Department of Orthopaedic Surgery, University of Yamanashi, Japan
| | - Kenuke Koyama
- Department of Orthopaedic Surgery, University of Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, University of Yamanashi, Japan
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Baba H, Okudaira T, Yamaguchi T, Hara S, Konishi H. Rollback Imaging as a Useful Tool in the Preoperative Evaluation of Osteoporotic Vertebral Fractures. Spine Surg Relat Res 2020; 4:142-147. [PMID: 32405560 PMCID: PMC7217669 DOI: 10.22603/ssrr.2019-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/12/2019] [Indexed: 11/15/2022] Open
Abstract
Introduction When surgery is performed for osteoporotic vertebral fractures, the extent to which kyphosis can be corrected by the intraoperative position of the body is often determined by preoperative radiography in the extension position. However, patients have difficulty adopting an adequate extension position due to the pain associated with their vertebral fracture. We place a pillow beneath the fractured vertebral body before surgery and take radiographs in the supine position to evaluate the extent to which the kyphosis can be corrected. This study aimed to examine the usefulness of this imaging method by comparing postoperative radiographs with preoperative radiographs taken with a pillow placed beneath the fractured vertebral body. Methods Lateral preoperative radiographs were taken of the patients in seated flexion and extension positions and the supine position. Lateral radiographs (rollback) were also taken 5 min after placing a firm pillow 20 cm in diameter beneath the fractured vertebral body. The kyphotic angle was compared between preoperative lateral radiographs of patients in the flexion, extension, and supine positions, rollback, and postoperative lateral radiographs in the supine position. Results The mean kyphotic angle was 33.3° in the flexion position, 28.3° in the extension position, 14.8° in the supine position, and 5.6° in rollback preoperatively and 6.4° postoperatively. The preoperative kyphotic angle differed from the postoperative kyphotic angle by ≥11° in 91% and 83% of participants in the flexion and extension positions, respectively; the difference was ≤ 5° in 30% and 61% of participants in the supine position and rollback, respectively. Differences in the postoperative angle were small in the order of rollback, supine position, extension position, and flexion position. Conclusions Compared with radiographs taken in the flexion, extension, and supine positions, rollback showed little difference from postoperative radiographs, which showed almost the same angle as the intraoperative kyphotic angle.
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Affiliation(s)
- Hideo Baba
- Department of Orthopaedic Surgery, Nagasaki Rosai Hospital, Sasebo, Japan
| | - Tsuyoshi Okudaira
- Department of Orthopaedic Surgery, Nagasaki Rosai Hospital, Sasebo, Japan
| | - Takayuki Yamaguchi
- Department of Orthopaedic Surgery, Nagasaki Rosai Hospital, Sasebo, Japan
| | - Shinichiro Hara
- Department of Orthopaedic Surgery, Nagasaki Rosai Hospital, Sasebo, Japan
| | - Hiroaki Konishi
- Department of Orthopaedic Surgery, Nagasaki Rosai Hospital, Sasebo, Japan
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Nakashima H, Kanemura T, Satake K, Ito K, Tanaka S, Segi N, Ouchida J, Ando K, Kobayashi K, Ishiguro N, Imagama S. Lateral approach corpectomy and reconstruction after anterior longitudinal ligament release in cases with fixed kyphosis: A technical note and a preliminary case series. J Clin Neurosci 2020; 78:164-169. [PMID: 32336631 DOI: 10.1016/j.jocn.2020.04.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/14/2020] [Indexed: 12/23/2022]
Abstract
Lateral approach corpectomy is a useful surgical technique for adult spinal deformity with vertebral deformity. However, in cases with anterior ankylosing over adjacent vertebrae, it is hard to achieve ideal correction without posterior column resection. To minimize surgical invasiveness, we have developed a method for lateral approach corpectomy and reconstruction after anterior longitudinal ligament release (LCRA) in such cases. The aim of the current study is to describe LCRA, and investigate surgical invasiveness, sagittal correction and perioperative complications in this surgery. The subjects were three patients (all female, average age 69.0 years old) with adult spinal deformity with severe fixed kyphosis who underwent LCRA and posterior fixation with pedicle screws. The primary disease was osteoporotic vertebral fracture in all patients. The operative levels were T12 in 2 cases and L2 in 1 case. The operative time and estimated blood loss were 442.3 ± 51.9 min and 875.7 ± 397.5 mL, respectively. Local kyphotic deformity was well corrected from 54.2 ± 4.3° preoperatively to 10.1 ± 3.7° in these surgeries (p < 0.001). There were surgical complications of dural tear and postoperative hemothorax in one case each. These outcomes suggest that LCRA gives good sagittal correction in cases with fixed kyphosis after osteoporotic vertebral fracture, and that this method is a viable surgical option for correction of fixed kyphosis.
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Affiliation(s)
- Hiroaki Nakashima
- Department of Orthopedic Surgery, Konan Kosei Hospital, Japan; Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konan Kosei Hospital, Japan
| | - Kotaro Satake
- Department of Orthopedic Surgery, Konan Kosei Hospital, Japan
| | - Kenyu Ito
- Department of Orthopedic Surgery, Konan Kosei Hospital, Japan
| | - Satoshi Tanaka
- Department of Orthopedic Surgery, Konan Kosei Hospital, Japan
| | - Naoki Segi
- Department of Orthopedic Surgery, Konan Kosei Hospital, Japan; Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Jun Ouchida
- Department of Orthopedic Surgery, Konan Kosei Hospital, Japan; Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Japan.
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Indications and limitations of minimally invasive lateral lumbar interbody fusion without osteotomy for adult spinal deformity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1362-1370. [DOI: 10.1007/s00586-020-06352-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 02/19/2020] [Indexed: 12/12/2022]
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Predictors of Poor Global Alignment and Proportion Score After Surgery for Adult Spinal Deformity. Spine (Phila Pa 1976) 2019; 44:E1136-E1143. [PMID: 31261271 DOI: 10.1097/brs.0000000000003086] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective observational study of a cohort of consecutive patients. OBJECTIVE To determine 1) the correlation between clinical and radiographic outcomes and Global Alignment and Proportion (GAP) score, and 2) which preoperative parameters predominantly influence the risk for poor GAP scores. SUMMARY OF BACKGROUND DATA Although numerous investigators have indicated their criteria for sagittal correction, it is still not unusual to observe poor outcome or complications even after ideal correction. The recently developed GAP score indicates spinopelvic alignment and setting surgical goals according to the score might decrease the prevalence of mechanical complications. However, there is no clear evidence of correlation between the GAP score and clinical outcomes, or which patient factors are preoperative predictors of poor postoperative GAP score. METHODS We included 128 consecutive patients treated with spinal correction surgery who had a minimum 2-year follow-up. The correlations between clinical outcomes, increased proximal junctional angle, and GAP score were determined. Univariate and multivariate logistic regression analyses were conducted to clarify potential preoperative risk factors for poor GAP score. RESULTS Based on total GAP score, 32 (25%) patients were grouped into proportioned, 50 (39.1%) into moderately disproportioned, and 44 (34.3%) into severely disproportioned spinopelvic alignment. Our present study showed a significantly positive correlation between Oswestry Disability Index, increased proximal junctional angle 2 years after surgery, and total GAP score. Uni and multivariate regression analysis showed a large global tilt was a risk factor for a poor GAP score and that the risk for a poor GAP score increased with ageing. CONCLUSIONS Because GAP score correlated with Oswestry Disability Index and increased proximal junctional angle 2 years after surgery, GAP score might define targets for sagittal spinopelvic alignment for favorable outcomes of corrective spinal surgery. A large preoperative global tilt is a potential predictor of poor postoperative GAP score. LEVEL OF EVIDENCE 3.
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Imagama S, Ando K, Kobayashi K, Machino M, Tanaka S, Morozumi M, Kanbara S, Ito S, Seki T, Hamada T, Ishizuka S, Nakashima H, Ishiguro N, Hasegawa Y. Increase in lumbar kyphosis and spinal inclination, declining back muscle strength, and sarcopenia are risk factors for onset of GERD: a 5-year prospective longitudinal cohort study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2619-2628. [PMID: 31506765 DOI: 10.1007/s00586-019-06139-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 08/27/2019] [Accepted: 09/03/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE The objective was to identify risk factors for new development of gastroesophageal reflux disease (GERD) 5 years later in a prospective longitudinal cohort study. METHODS A total of 178 subjects (male 72, female 106, mean age 68 years) without GERD in 2013 were examined for GERD in 2018. A Frequency Scale for Symptoms of GERD score ≥ 8 was used for diagnosis of GERD. Body mass index, spinal alignment, muscle strength, physical ability, number of oral drugs per day, sarcopenia, and frailty determined in 2013 and 2018 were compared between the GERD(+) and GERD(-) groups in 2018. Aggravation of lumbar kyphosis and spinal inclination from 2013 to 2018 was defined as a change of ≥ 5° or ≥ 10°, and weakening of back muscle strength as a change of ≥ 10 kg. QOL (SF-36) was also examined. RESULTS Of the 178 subjects, 38 (21%) were diagnosed as GERD(+) in 2018. Sarcopenia in 2018 was significantly related to a GERD(+) status (p < 0.05). The GERD(+) group had significantly higher rates of changes of lumbar kyphosis ≥ 5° (p < 0.005) and ≥ 10° (p < 0.0001), of spinal inclination ≥ 5° (p < 0.0001), and of decreased back muscle strength ≥ 10 kg (p < 0.05). SF-36 were also significantly worse in the GERD(+) group (p < 0.05). CONCLUSIONS This prospective longitudinal study firstly demonstrated that lumbar kyphotic change, aggravation of spinal inclination, decreased back muscle strength, and sarcopenia are significant risk factors for new development of GERD. Management and prevention of these factors may contribute to reduction of GERD symptoms and increased QOL in middle-aged and elderly people. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Masaaki Machino
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Satoshi Tanaka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Masayoshi Morozumi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Shunsuke Kanbara
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Sadayuki Ito
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Takashi Hamada
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Shinya Ishizuka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yukiharu Hasegawa
- Department of Rehabilitation, Kansai University of Welfare Sciences, 3-11-1, Asahigaoka, Kashiwara, Osaka, 582-0026, Japan
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