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Introduction: The revised Tokuhashi scoring system has been used to predict survival in patients with metastatic spinal tumors. Because of the rapid progress of cancer therapy, the original criteria of the revised Tokuhashi scoring system became in recent years unsuitable. The study aim was to evaluate the validity of the revised Tokuhashi scoring system in patients who underwent spinal surgery and to establish new prognostic criteria. Methods: The study enrolled 85 patients with metastatic spinal tumors who underwent spinal surgery. The patients' survival outcomes in October 2019 were as follows: 57 patients died; 10 were alive; and 18 had unknown prognoses. The study evaluated the validity of the Tokuhashi scoring system, and established and validated the new prognostic criteria. Results: The accuracies of the Tokuhashi scoring system were 66.7% in the short-term group, 60% in the midterm group, and 100% in the long-term group. Among the patients who died, the survival period and total score were significantly correlated. Total score cutoff point was six points in the patients whose predicted survival was

Introduction: The purpose of the present study was to determine, in a mid-term follow-up 5 years or more after surgery, the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and expiratory flow in patients with adolescent idiopathic scoliosis (AIS) who underwent posterior spinal fusion (PSF) with or without thoracoplasty. Methods: The subjects were 134 patients with AIS who underwent PSF between 2004 and 2013. Forty-five patients agreed to participate in the study. We divided the patients into two groups as follows: 24 patients who underwent PSF with thoracoplasty from 2004 to 2010 in the TP group and 21 patients who underwent PSF without thoracoplasty from 2011 to 2013 in the non-TP group. We evaluated whole spine X-ray imaging and pulmonary function tests (PFTs) in these patients. PFTs measured FVC, FEV1, peak expiratory flow (PEF), maximum expiratory flow at 50% FVC (V50), maximum expiratory flow at 25% FVC (V25), and the ratio of V50 to V25 (V50/V25). Results: The main thoracic curves were 53.6 ± 10.1° before surgery, 19.8 ± 7.6° 1 week after surgery, 22.3 ± 8.3° 2 years after surgery, and 23.3 ± 7.6° at the most recent observation. Compared with preoperative values, FVC, FEV1, and % FEV1 were improved significantly at the most recent observation. No significant difference was observed between % FVC before surgery and at the most recent observation. Compared with preoperative values, PEF, V50, and V25 were improved significantly at the most recent observation. V50/V25 did not change significantly. The changes in PFT values in the TP group and the non-TP group were compared. No significant differences were observed in FVC, % FVC, FEV1, % FEV1, PEF, V50, or V25. Conclusions: Regardless of whether thoracoplasty was performed or not, FVC, FEV1, and expiratory flow were improved 5 years or later after PSF.

Objective: The present study aims to describe fall-related self-efficacy as perceived by patients with chemotherapy-induced peripheral neuropathy (CIPN). The characteristics of patients associated with low perceived self-efficacy of preventing falls were investigated. Methods: A cross-sectional study of four hospitals in Japan. In this study, 100 outpatients who were receiving chemotherapy for cancer and experiencing CIPN were recruited. Participants completed an anonymous, self-administered questionnaire. Self-efficacy was measured with the falling self-efficacy (FSE) scale, and the severity and impact of CIPN was assessed with the Comprehensive Assessment Scale for CIPN in Survivors of Cancer (CAS-CIPN). Data about the demographic information of the patients, cancer diagnosis and treatment, pain and fatigue symptoms, and history of previous falls were collected. Logistic regression analysis was used to assess relationships between variables. Results: A total of 81 (81.0%) participants with CIPN completed the questionnaire. They reported experiencing fear of falling during their daily activities, which include the act of standing up, walking, and using the stairs. Small events, such as unstable postures and uncomfortable situations, affected their confidence of preventing falls. Logistic regression revealed that low FSE scores were significantly associated with female sex (P = 0.022), low body mass index (BMI;P= 0.026), and the CAS-CIPN score (P < 0.001). Conclusions: Female patients with CIPN and low BMI might have an increased need for enhanced fall-related self-efficacy. A comprehensive assessment of CIPN in patients at risk of low FSE scores is likely to be beneficial.

Introduction: Despite preserving lumbar disc mobility, spinal sagittal, and/or coronal alignment might ultimately impede surgical success. The purpose of this study was to elucidate the effects of spinal alignment on lumbar disc degeneration after 5 or more years in adolescent idiopathic scoliosis (AIS) patients who underwent spinal fusion. Methods: Subjects were 49 AIS patients who underwent posterior spinal fusion without lumbar curve fusion. The inclusion criteria were the following: 1) Lenke type 1A, 1B, 2A or 2B, 2) age 10 to 19 years at the time of operation, and 3) minimum 5-year follow-up. The exclusion criteria were the following: 1) diagnosed as other than AIS, 2) history of lumbar disc herniation and spondylolysis, 3) subsequent surgery, and 4) history of surgery before AIS surgery. Nineteen patients agreed to participate in this research. X-rays, lumbar MRI, and questionnaires were evaluated. Disc degeneration in non-fused segments was defined as Pfirrmann grade 3 or higher. Patients with disc degenerations at the final observation (DD[+] group) were compared to those without disc degenerations (DD[−] group). Results: There were no significant differences in the preoperative or postoperative 1-week X-ray parameters between both groups. The lumbar curve was significantly larger in the DD[+] group compared with the DD[−] group at the final observation (DD[+]: 16.8 degrees, DD[−]: 10.4 degrees, p = 0.035). The sagittal vertical axis (SVA) was significantly larger in the DD[+] group compared with the DD[−] group at the final observation (DD[+]: −4.4 mm, DD[−]: −34.3 mm, p = 0.006). SRS-22 function, self-image, and satisfaction scores were lower in the DD [+] group compared with the DD[−] group at the final observation. Conclusions: The patients with DD had significantly larger lumbar curve and SVA with lower SRS-22 function, self-image, and satisfaction scores at the final observation. Even though the non-fused segments were preserved, spinal alignments of non-fused lumbar curve affect the DDs.

There are no reports of pyogenic spinal infections secondary to an arterioenteric fistula in the literature. Herein, we report a case of recurrent pyogenic spinal infection caused by vascular graft penetration into the sigmoid colon. A 66-year-old man with a history of diabetes and abdominal aortic aneurysm surgery suffered from low back pain and fever. He visited his previous hospital, where a lumbar magnetic resonance imaging revealed a spinal infection. The patient received conservative therapy with antibiotics and underwent several surgeries. However, there was no improvement in his symptoms. The patient was referred to and hospitalized at our university hospital. Because intestinal bacteria were repeatedly detected in his blood cultures, a colonoscopy was performed, which revealed the exposure of a vascular graft in the sigmoid colon confirmed by contrast-enhanced computed tomography. We diagnosed the patient with recurrent pyogenic spinal infection caused by secondary arterioenteric fistula. He then underwent sigmoidectomy, resection of the infected vascular graft, and femoral–femoral artery bypass grafting. There was improvement in his symptoms after the surgery. Gastrointestinal examinations should be performed early when intestinal resident bacteria are detected in blood cultures in patients with pyogenic spinal infections.