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Abstract This study utilized a longitudinal survey in Japan to investigate whether higher Central Sensitization Inventory (CSI) scores, serving as a proxy for central sensitization-related symptoms, are associated with an increased risk of developing chronic low back pain (CLBP), focusing on the impact of the coronavirus disease (COVID-19) pandemic on these conditions. Healthy volunteers (n = 227; mean age: 68.5 ± 9.5 years) were surveyed at baseline (July 2019) and at follow-up (October 2020). The participants were categorized into four groups based on their CLBP status: None, De novo, Continued, and Improved. CLBP prevalence increased from 26% at baseline to 32% at follow-up. Higher baseline CSI scores (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02–1.09; p = 0.005) and older age (OR 1.06, 95% CI 1.02–1.11; p = 0.007) were identified as significant risk factors for developing CLBP. The mean CSI scores exhibited a slight non-significant increase from 16.9 ± 11.4 to 17.1 ± 11.7. Participants who adhered more strictly to the COVID-19 guidelines and engaged in reduced physical activity reported a higher CLBP prevalence. Our findings suggest that early identification and management of central sensitization are crucial for improving clinical outcomes, particularly during periods of external stress, such as the COVID-19 pandemic.

Abstract Some older adults with spinal deformity maintain standing posture via pelvic compensation when their center of gravity moves forward. Therefore, evaluations of global alignment should include both pelvic tilt (PT) and seventh cervical vertebra-sagittal vertical axis (C7-SVA). Here, we evaluate standing postures of older adults using C7-SVA with PT and investigate factors related to postural abnormality. This cross-sectional study used an established population-based cohort in Japan wherein 1121 participants underwent sagittal whole-spine radiography in a standing position and bioelectrical impedance analysis for muscle mass measurements. Presence of low back pain (LBP), visual analog scale (VAS) of LBP, and LBP-related disability (Oswestry Disability Index [ODI]) were evaluated. Based on the PT and C7-SVA, the participants were divided into four groups: normal, compensated, non-compensated, and decompensated. We defined the latter three categories as “malalignment” and examined group characteristics and factors. There were significant differences in ODI%, VAS and prevalence of LBP, and sarcopenia among the four groups, although these were non-significant between non-compensated and decompensated groups on stratified analysis. Moreover, the decompensated group was significantly associated with sarcopenia. Individuals with pelvic compensation are at increased risk for LBP and related disorders even with the C7-SVA maintained within normal range.

Abstract Kitchen elbow sign (KE-Sign) is a skin abnormality on the extensor side of the elbow and forearm that is often observed in patients with adult spinal deformity (ASD). The significance of KE-Sign in surgical cases was investigated. Overall, 114 patients with ASD treated with long spinal fusion were reviewed and divided into KE-Sign positive and negative groups. The preoperative and 1-year follow-up evaluations included radiographic parameters [C7 sagittal vertical axis (SVA), pelvic incidence (PI) and lumbar lordosis (LL)], the Oswestry Disability Index (ODI), visual analogue scales (VASs) for low back pain, leg pain, and satisfaction, and Short Form 36 questionnaire (SF-36). Multi-regression analysis was performed to identify patient satisfaction predictors and improvement in the ODI as dependent variables and preoperative background factors as independent variables. Preoperative characteristics showed no significant difference between both groups. Improvement in the ODI and VAS for satisfaction were significantly superior in the KE-Sign positive group. In multiple regression analysis, KE-Sign and preoperative ODI were significantly associated with improvement in the ODI; age, KE-Sign, preoperative low back pain VAS, and leg pain VAS were significantly associated with satisfaction. KE-Sign can be a predictor of better surgical outcomes in ASD patients.