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This study investigated the characteristics of physical activity according to sit-to-stand, standing, and stand-to-sit abilities in subacute stroke with walking difficulty.In this study, 29 participants with subacute stroke and walking difficulty were enrolled and classified into two groups: participants who successfully completed three items (i.e., sit-to-stand, standing, and stand-to-sit) of the Functional Balance Scale (independent group, n = 13) and those who showed incomplete scores on any of the three items (dependent group, n = 16). Light-intensity physical activity (LIPA) and moderate-to-vigorous physical activity (MVPA) were measured using an accelerometer at three periods (i.e. daytime, therapy time, and non-therapy time) for a week.Two-way analysis of variance (groups × physical activity intensity) demonstrated a significant interaction in each period. Post-hoc tests showed significantly more LIPAs and MVPAs in the independent group in all periods, except for MVPA in the non-therapy time. Particularly, LIPA showed significant between-group differences in each period.Among individuals with subacute stroke and walking difficulty, those who could completely perform sit-to-stand, standing, and stand-to-sit could perform more LIPAs. Increasing sit-to-stand, standing, and stand-to-sit abilities could be an important factor in increasing the opportunity to perform LIPAs.

[Purpose] To investigate reliability and discriminant validity of a single question about total lying time for assessing physical inactivity in community-dwelling older people. [Participants and Methods] The participants were 54 healthy older individuals (mean age, 72.5 years), who were asked to recall retrospectively their mean total lying and sleep times per day in the previous week (7 days). The total lying and sleep times per day in the forthcoming week (7 days) were also investigated prospectively after confirming the mean total lying and sleep times per day in the previous week, and their mean values per day were calculated. [Results] Intraclass reliability of total lying and sleep times per day in the forthcoming week were acceptable [ICC (1, 1) for total lying time=0.835, ICC (1, 1) for sleep time=0.707]. No significant difference in average total lying time between the previous (8.4 ± 2.0 hours/day) and forthcoming (8.7 ± 1.7 hours/day) weeks was seen. In the forthcoming week, average total lying time was significantly higher than average sleep time (7.1 ± 1.3 hours/day). There was low significant correlation between total lying time and sleep time. [Conclusion] Total lying time can be measured with acceptable reliability and discriminant validity, and is a different outcome than sleep time in community-dwelling older adults.

[Purpose] The purpose of this study was to examine the effectiveness of unsupervised low-intensity home exercises in improving physical activity and physical capacity for daily activities among the community-dwelling elderly. [Participants and Methods] We included 24 female older participants and divided them into two groups: 14 in the resistance training group and 10 in the fast walking group. The resistance training group performed shoulder joint flexion and abduction exercises using a resistance tube twice daily (in the morning and afternoon). Participants in the fast walking group walked fast for 3,000 steps once daily. Both groups continued the exercise intervention for 6 months. We measured the forced vital capacity, respiratory muscle strength, physical activity, walking distance in the 6-min walk test, grip strength, and knee extension strength before and after the intervention. [Results] The forced vital capacity significantly increased in the resistance training group, whereas the moderate-intensity physical activity time significantly increased in both groups and the vigorous-intensity physical activity time increased in the fast walking group only. We observed no intergroup differences in respiratory muscle strength, 6-min walking distance, grip strength, or knee extension strength. [Conclusion] The results of this study suggest that low-intensity home exercises can improve pulmonary function and physical activity and should be recommended for promoting health in the community-dwelling elderly.

Background: Little is known about the benefits of daytime physical activity on gait ability in subacute stroke.Objectives: We investigated association between daytime physical activity at hospital admission and improvement of gait independence 1 month later in subacute stroke.Methods: Thirty-four participants with subacute stroke who could not walk independently were assessed. An accelerometer (HJA 350-IT, OMRON) was used to record the mean duration of light-intensity physical activity (LIPA) and moderate-to-vigorous-intensity physical activity (MVPA). LIPA and MVPA were recorded for 12 h per day for 7 consecutive days, and at three different time periods (daytime, therapy time, non-therapy time) at rehabilitation hospital admission (baseline). Gait independence was assessed by the functional ambulation category (FAC) at baseline and 1 month later. Participants were categorized into two groups based on the change of gait independence, as follows: the improved group, in which the FAC increased by ≥1; the non-improved group, in which the FAC did not increase.Results: Compared with the non-improved group, the improved group demonstrated significantly higher values of all physical activity variables, except for non-therapy time MVPA (p < .05). Logistic regression analysis showed that higher daytime LIPA was significantly associated with FAC improvement (OR = 1.068, 95% CI 1.009 to 1.140). In particular, higher non-therapy time LIPA was closely associated with FAC improvement (OR = 1.253, 95% CI 1.002 to 1.568).Conclusions: To promote recovery of gait independence in first month from admission, increasing daytime physical activity, especially LIPA during daytime or non-therapy time, is an important treatment target in subacute stroke.

[Purpose] The purpose of this study was to evaluate the early effects of a knee-ankle-foot orthosis on static standing balance in people with subacute stroke. [Participants and Methods] Timed static standing balance in four standing conditions (feet apart with eyes open, feet apart with eyes closed, feet together with eyes open, and tandem stance with eyes open) was assessed in 29 inpatients (mean age: 67.3 ± 13.3 years) with subacute stroke with and without a knee-ankle-foot orthosis on the paretic lower limb. [Results] In the group of participants who were unable to stand without a knee-ankle-foot orthosis, the proportion of participants who were able to stand with a knee-ankle-foot orthosis was significantly increased in the following conditions: feet apart with eyes open and feet apart with eyes closed. In the group of participants who were able to stand without a knee-ankle-foot orthosis, the mean duration of time for which the participants with a knee-ankle-foot orthosis were able to stand was significantly longer than that for those without a knee-ankle-foot orthosis for all standing conditions. [Conclusion] A knee-ankle-foot orthosis may be a useful assistive device to support static standing balance for people with subacute stroke.

In older adults, social participation is an important component of rehabilitation and health promotion. Several studies have attempted to describe the definition and concepts of social participation, and there were many outcomes to measure social participation. This overview provides information about representative social participation and related concepts that have been defined in the literature. A standardized definition of social participation has not been developed; commonly, recognition for social participation was proposed as focused on involvement in social activities that provide interaction with others in a society or community. Many instruments assess the various aspects of social participation. Because of operational definition and diversity in social participation, performance in social participation was adopted as an aspect of assessment. Further discussions are needed to clarify the definition of social participation and evaluate the instruments used to assess social participation for it to be useful for rehabilitation and health promotion. In doing so, determining and developing assessment and intervention based on the purpose or perspective of social participation in older adults with and without disabilities is important.

[Purpose] To verify differences in independent mobility improvements between people with subacute stroke with knee-ankle-foot orthoses (KAFOs) and those with ankle-foot orthoses (AFOs) from admission to discharge, and to identify the relationship between mobility improvements and their characteristics. [Participants and Methods] This study included 381 hospitalized patients with subacute stroke who required complete mobility assistance at admission and for whom KAFOs (KAFO group) or AFOs (AFO group) were prescribed after admission. The functional independence measure (FIM) score at admission and discharge, FIM gain, age, Brunnstrom stage (BS) of the paretic lower limb at admission, and the period from admission to prescription for lower limb orthoses were investigated. [Results] Repeated-measures two-way analysis of variance revealed a significant group × time interaction in the walk/wheelchair and stair-climbing items of the FIM. Improvements in the scores in the KAFO group were significantly lower than those in the AFO group. Age, BS, FIM at admission, and period from admission to lower limb orthosis prescription significantly correlated with FIM gain in the walk/wheelchair and stair-climbing items. [Conclusion] A more effective intervention using lower limb orthoses with consideration of the influence of age, motor paralysis, and activities of daily living at admission is required to promote the improvements of people with subacute stroke prescribed KAFOs or AFOs.

[Purpose] This study aimed to assess the known-groups validity of the estimated metabolic equivalents during physical activities using accelerometer, Active Style Pro HJA 350-IT, in people with subacute stroke. [Subjects and Methods] Ten participants with subacute stroke and ten healthy people performed six activities (lying, sitting, standing, sitting with reaching task, standing with reaching task, and walking) and metabolic equivalents were estimated using the accelerometer during each activity. These estimated metabolic equivalents were compared with reported metabolic equivalents through compendiums or previous studies. Additionally, the estimated metabolic equivalents were compared between subacute stroke and healthy control participants. [Results] The estimated metabolic equivalents of both groups during maintaining posture showed significantly lower values in comparison with previous studies. There were no significant differences between the estimated metabolic equivalents during sitting with reaching tasks or standing with reaching tasks when compared with compendium metabolic equivalents across both groups. The estimated metabolic equivalents during walking were inevitable values significantly differed from previous study which conducted with stroke patients with lower gait abilities in both groups. [Conclusion] The estimated metabolic equivalents using accelerometer may be suitable to assess movement activity rather than motionless activity, and accelerometer demonstrated acceptable validity in people with subacute stroke.

Background Activity monitors are known to provide quantitative evaluation of physical activity in people with stroke. However, little evidence is available on the test-retest reliability and suitable measuring conditions for evaluating physical activity with an activity monitor in people with subacute stroke at a hospital setting. Objectives To evaluate reliability of physical activity measurement using an activity monitor in different measuring conditions in hospitalized people with subacute stroke according to gait ability. Methods Sixty-nine participants with subacute stroke were categorized based on their gait ability: group 1 (n = 22), could walk independently at sufficient gait speed (≥0.9 m/s); group 2 (n = 11), could walk independently with insufficient gait speed (0.9 m/s); group 3 (n = 36), required assistance in walking. Physical activity (sedentary behavior, light-intensity physical activity, moderate-to-vigorous physical activity) was measured using an activity monitor (OMRON, HJA350-IT) for seven consecutive days. All physical activity variables were calculated in five conditions defined according to measurement periods (3, 5, or 7 days with or without weekends). Results In groups 1 and 2, intraclass correlation coefficients were high across all measuring conditions in all physical activity variables (0.7). In group 3, intraclass correlation coefficients were high in all measuring conditions (0.7) except for three weekdays measuring condition (0.563-0.922). Conclusions In hospitalized people with subacute stroke, the central tendency of intensity-based physical activity could be assessed with good reliability using an activity monitor. For reliable measurement, more measurement days are needed in those with dependent walking compared to those with independent walking.

[Purpose] This study aimed to identify the preferential factor of activities of daily living disabilities for selecting between knee-ankle-foot orthosis and ankle-foot orthosis prescription in the early stage after admission. [Participants and Methods] This study included 442 inpatients who had a subacute stroke and received either knee-ankle-foot orthosis or ankle-foot orthosis after admission (mean age, 69 years). The functional independence measure was investigated within 1 week after admission. [Results] Inpatients who had a stroke and received knee-ankle-foot orthosis had significantly lower scores for all individual functional independence measure items than those who received ankle-foot orthosis. Logistic regression analysis revealed that functional independence measure transfer (bed, chair, and wheelchair) was closely associated with the difference in the prescribed lower limb orthosis after multivariate adjustment. [Conclusion] Compared with ankle-foot orthosis, knee-ankle-foot orthosis was prescribed to inpatients with more-severe disabilities, and the difference in the disability related to performing transfer activities was more noticeable than that in disability related to mobility between inpatients for whom knee-ankle-foot orthosis was prescribed and those for whom ankle-foot orthosis was prescribed. To provide effective rehabilitation for people who had a subacute stroke, for whom use of knee-ankle-foot orthosis or ankle-foot orthosis is recommended. The evaluation and intervention focused on standing performance related to performing transfer such as sit-to-stand, standing, moving while standing, and stepping might be a priority in the early stage after admission.

Objective: Gait ability may be related to the level of intensity-based physical activity in people who have experienced a stroke; however, this relationship has not been explored in previous studies. This study aimed to investigate the characteristics of intensity-based physical activity according to gait ability and to explore the factors related to different intensity physical activity. Method: Eighty hospitalized participants with subacute stroke were assigned to three groups based on their gait ability: group 1 (n = 28) could walk independently with a maximal gait speed (MGS) of more than 0.9 m/s; group 2 (n = 11) could walk independently with a MGS of less than 0.9 m/s; group 3 (n = 41) could not walk independently. Light-intensity physical activity (LIPA) and moderate-to-vigorous physical activity (MVPA) were measured for 12 hours using an accelerometer (OMRON, HJA350-IT) for 7 consecutive days and were calculated throughout three time periods (daytime, non-therapy time, or therapy time). Results: In each time period, a two-way ANOVA showed an interaction between the groups and intensity-based physical activity (p < 0.05). Bonferroni post hoc test showed a significantly higher LIPA in groups 1 and 2 compared with group 3 in daytime or non-therapy time. In contrast, group 1 showed a significantly higher MVPA compared with group 2 and 3 for each time period. Conclusion: During daytime and non-therapy time, the results suggested that gait independence is related to LIPA rather than gait speed, and gait speed and gait independence is related to MVPA.

Study Design Multicenter analysis of two groups of patients surgically treated for degenerative L4 unstable spondylolisthesis. Purpose To compare the clinical and radiographic outcomes of posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) for degenerative L4 unstable spondylolisthesis. Overview of Literature Surgery for lumbar degenerative spondylolisthesis is widely performed. However, few reports have compared the outcome of PLF to that of PLIF for degenerative L4 unstable spondylolisthesis. Methods Patients with L4 unstable spondylolisthesis with Meyerding grade II or more, slip of >10° or >4 mm upon maximum flexion and extension bending, and posterior opening of >5 degree upon flexion bending were studied. Patients were treated from January 2008 to January 2010. Patients who underwent PLF (n=12) and PLIF (n=19) were followed-up for >2 years. Radiographic findings and clinical outcomes evaluated by the Japanese Orthopaedic Association (JOA) score were compared between the two groups. Radiographic evaluation included slip angle, translation, slip angle and translation during maximum flexion and extension bending, intervertebral disc height, lumbar lordotic angle, and fusion rate. Results JOA scores of the PLF group before surgery and at final follow-up were 12.3±4.8 and 24.1±3.7, respectively; those of the PLIF group were 14.7±4.8 and 24.2±7.8, respectively, with no significant difference between the two groups. Correction of slip estimated from postoperative slip angle, translation, and maintenance of intervertebral disc height in the PLIF group was significantly (p

Background: The objectives of this study are to clarify the differences between the difficulties in daily life experienced by patients with both mild cognitive impairment (MCI) and chronic disease and those experienced by healthy elderly individuals. Methods: We assessed (a) cognitive function; (b) gait ability; (c) behavioral and psychological symptoms (observed at home); (d) activities of daily living (observed at home); (e) family caregiver burden, and (f) intention to continue family caregiving of 255 cognitively normal and 103 MCI subjects attending adult day care services covered by long-term care insurance, and compared the two groups. Results: Subjects with MCI display more behavioral and psychological symptoms than cognitively normal subjects, posing a heavy caregiver burden (p < 0.01). Behavioral and psychological symptoms most commonly observed in subjects with MCI are apathy, hallucinations, delusions, agitation, and aberrant motor behavior. Conclusion: Information regarding the behavioral and psychological symptoms displayed at home by patients with MCI can only be obtained from family caregivers living with the patients. To provide early-stage support for elderly patients with MCI, adult day care workers should collect information from family caregivers regarding behavioral and psychological symptoms observed at home.

Aim: The aim was to report a fenestration technique for gap reduction of acetabular depression fractures. Case presentation: A 76-year-old man suffered from severe left leg pain. The computed tomography scanning showed a displaced acetabular depression fracture, including a third fracture fragment in the center of the acetabular weight-bearing area. We performed a fenestration technique to fenestrate the outer plate of ilium to push down the dislocated fragment of the fracture. The patient was pain-free with good functional outcome of the hip joint at three years after operation. Conclusion: The fenestration technique is useful for displaced acetabular depression fractures. We performed open reduction in this particular case, but the technique may be done less invasively with the use of hip arthroscopy.

Study design A retrospective study. Purpose The present study aimed to evaluate mid-term results of cervical pedicle screw (CPS) fixation for cervical instability. Overview of literature CPS fixation has widely used in the treatment of cervical spinal instability from various causes; however, there are few reports on mid-term surgical results of CPS fixation. Methods Record of 19 patients who underwent cervical and/or upper thoracic (C2-T1) pedicle screw fixation for cervical instability was reviewed. The mean observation period was 90.2 months. Evaluated items included Japanese Orthopaedic Association (JOA) score and C2-7 lordotic angle before surgery and at 5 years after surgery. Postoperative computerized tomography was used to determine the accuracy of screw placement. Visual analog scale (VAS) for neck pain and radiological evidence of adjacent segment degeneration (ASD) at the 5-year follow-up were also evaluated. Results Mean JOA score was significantly improved from 9.0 points before surgery to 12.8 at 5 years after surgery (p=0.001). The C2-7 lordotic angle of the neutral position improved from 6.4° to 7.8° at 5 years after surgery, but this was not significant. The major perforation rate was 5.0%. There were no clinically significant complications such as vertebral artery injury, spinal cord injury, or nerve root injury caused by any screw perforation. Mean VAS for neck pain was 49.4 at 5 years after surgery. The rate of ASD was 21.1%. Conclusions Our mid-term results showed that CPS fixation was useful for treating cervical instability. Severe complications were prevented with the assistance of a computed tomography-based navigation system.

Study design Seventy-five patients who had been treated for lumbar spinal stenosis (LSS) were reviewed retrospectively. Purpose Invasion into the paravertebral muscle can cause major problems after laminectomy for LSS. To address these problems, we performed spinous process-splitting laminectomy. We present a comparative study of decompression of LSS using 2 approaches. Overview of literature There are no other study has investigated the lumbar spinal instability after spinous process-splitting laminectomy. Methods This study included 75 patients who underwent laminectomy for the treatment of LSS and who were observed through follow-ups for more than 2 years. Fifty-five patients underwent spinous process-splitting laminectomy (splitting group) and 20 patients underwent conventional laminectomy (conventional group). We evaluated the clinical and radiographic results of each surgical procedure. Results Japanese Orthopaedic Association score improved significantly in both groups two years postoperatively. The following values were all significantly lower, as shown with p-values, in the splitting group compared to the conventional group: average operating time (p=0.002), postoperative C-reactive protein level (p=0.006), the mean postoperative number of days until returning to normal body temperature (p=0.047), and the mean change in angulation 2 years postoperatively (p=0.007). The adjacent segment degeneration occurred in 6 patients (10.9%) in the splitting group and 11 patients (55.0%) in the conventional group. Conclusions In this study, the spinous process-splitting laminectomy was shown to be less invasive and more stable for patients with LSS, compared to the conventional laminectomy.

A cross-sectional study of the data retrospectively collected by chart review. This study aimed to clarify screw perforation features in 129 consecutive patients treated with computer-assisted cervical pedicle screw (CPS) insertion and to determine important considerations for computer-assisted CPS insertion. CPS fixation has been criticized for the potential risk of serious injury to neurovascular structures. To avoid such serious risks, computed tomography (CT)-based navigation has been used during CPS insertion, but screw perforation can occur even with the use of a navigation system. The records of 129 consecutive patients who underwent cervical (C2–C7) pedicle screw insertion using a CT-based navigation system from September 1997 to August 2013 were reviewed. Postoperative CT images were used to evaluate the accuracy of screw placement. The screw insertion status was classified as grade 1 (no perforation), indicating that the screw was accurately inserted in pedicle; grade 2 (minor perforation), indicating perforation of less than 50 % of the screw diameter; and grade 3 (major perforation), indicating perforation of 50 % or more of the screw diameter. We analyzed the direction and rate of screw perforation according to the vertebral level. The rate of grade 3 pedicle screw perforations was 6.7 % (39/579), whereas the combined rate of grades 2 and 3 perforations was 20.0 % (116/579). No clinically significant complications, such as vertebral artery injury, spinal cord injury, or nerve root injury, were caused by the screw perforations. Of the screws showing grade 3 perforation, 30.8 % screws were medially perforated and 69.2 % screws were laterally perforated. Of the screws showing grades 2 and 3 perforation, 21.6 % screws were medially perforated and 78.4 % screws were laterally perforated. Furthermore, we evaluated screw perforation rates according to the vertebral level. Grade 3 pedicle screw perforation occurred in 6.1 % of C2 screws; 7.5 % of C3 screws; 13.0 % of C4 screws; 6.5 % of C5 screws; 3.2 % of C6 screws; and 4.0 % of C7 screws. Grades 2 and 3 pedicle screw perforations occurred in 12.1 % of C2 screws, 22.6 % of C3 screws, 31.5 % of C4 screws, 22.2 % of C5 screws, 14.4 % of C6 screws, and 12.1 % of C7 screws. C3–5 screw perforation rate was significantly higher than C6–7 (p = 0.0024). Careful insertion of pedicle screws is necessary, especially at C3 to C5, even when using a CT-based navigation system. Pedicle screws tend to be laterally perforated.

PURPOSE This study aimed to develop a questionnaire to evaluate indoor life-space mobility and assess its validity in community-dwelling older adults certified as needing support or care. METHODS The participants included 37 community-dwelling older adults undergoing home-visit rehabilitation (mean age: 78.5±7.0 years). We developed a questionnaire to assess the degree of indoor life-space mobility (home-based life-space assessment (Hb-LSA)), evaluating the functional status (life-space assessment (LSA), time spent away from bed, functional independence measure (FIM), bedside mobility scale (BMS)), physical function (hand grip power (HGP), 30-second chair stand (CS-30), one-leg standing (OLS)) and cognitive status (mental status questionnaire (MSQ)). RESULTS The average Hb-LSA score was 56.3±24.3 (minimum 4 to maximum 102.5). The test-retest reliability was high (intraclass correlation coefficients: (1, 1)=0.986, (1, 2)=0.993). The Hb-LSA scores were significantly associated with the LSA (r=0.897), time spent away from bed (r=0.497), FIM (r=0.786), BMS (r=0.720), HGP (r=0.388), CS-30 (r=0.541) and OLS (r=0.455). There were no significant associations between the Hb-LSA scores and the FIM cognitive subscores (r=0.180) or MSQ scores (r=-0.240). The Hb-LSA scores were significantly higher among the participants able to move independently indoors (75.8±18.8 points) than in those who required help to move (45.7±20.2 points). CONCLUSIONS The Hb-LSA is a useful, reliable and valid tool for assessing the degree of indoor physical mobility in the life-space. The Hb-LSA score is related to the degree of independence of indoor mobility.

Study design A retrospective single-center study. Summary and background We routinely have used C1-C2 transarticular and cervical pedicle screw fixations to reconstruct highly destructed unstable rheumatoid arthritis (RA) cervical lesions. However, there is little data on midterm results of surgical reconstruction for rheumatoid cervical disorders, particularly, cervical pedicle screw fixation. Objectives The purpose of this study was to evaluate the mid-term surgical results of computer-assisted cervical reconstruction for such lesions. Methods Seventeen subjects (4 men, 13 women; mean age, 61 +/- 9 years) with RA cervical lesions who underwent C1-C2 transarticular screw fixation or occipitocervical fixation, with at least 5 years follow-up were studied. A frameless, stereotactic, optoelectronic, CT-based image-guidance system, was used for correct screw placement. Variables including the Japanese Orthopaedic Association (JOA) score, Ranawat class, EuroQol (EQ-5D), atlantodental interval, and Ranawat values before, and at 2 and 5 years after surgery, were evaluated. Furthermore, screw perforation rates were evaluated. Results The lesions included atlantoaxial subluxation (AAS, n = 6), AAS + vertical subluxation (VS, n = 7), and AAS + VS + subaxial subluxation (n = 4). There was significant neurological improvement at 2 years after surgery, as evidenced by the JOA scores, Ranawat class, and the EQ-5D utility weight. However, at 5 years after surgery, there was a deterioration of this improvement. The Ranawat values before, and at 2 and 5 years after surgery, were not significantly different. Major screw perforation rate was 2.1 %. No neural and vascular complications associated with screw insertion were observed. Conclusions Subjects with rheumatoid cervical lesions who underwent C1-C2 transarticular screw fixation or occipitocervical fixation using a pedicle screw had significantly improved clinical parameters at 2 years after surgery. However, there was a deterioration of this improvement at 5 years post surgery., Article, JOURNAL OF ORTHOPAEDIC SCIENCE. 18(6):916-925 (2013)

BACKGROUND CONTEXT: The EuroQol (EQ-5D) is a widely used comprehensive measure of health-related quality of life. There has been no study that has evaluated the health-related quality of life before and after the surgical reconstruction of rheumatoid arthritis (RA) cervical spine lesions using EQ-5D. PURPOSE: The present study aimed to evaluate the improvement of quality of life before and after surgical reconstruction of rheumatoid cervical spine using EQ-5D, and the surgical outcomes of cervical spine affected by RA. STUDY DESIGN: A retrospective study of the patients who underwent surgical reconstruction of cervical disorders in RA. PATIENT SAMPLE: Twenty-five patients (seven men, 18 women, mean age 62.2 years) who underwent surgical reconstruction of cervical disorders in RA were enrolled. OUTCOME MEASURES: Japanese Orthopaedic Association (JOA) score and EQ-5D. METHODS: Clinical symptoms were evaluated before surgery and at 2 years after surgery by measuring the JOA score. We also investigated health-related quality of life before surgery and outcome at 2 years after surgery using the EQ-5D questionnaire. RESULTS: Mean observation period was 46.3 months. Mean JOA score significantly improved from 9.1 +/- 4.5 points before surgery to 12.4 +/- 2.8 at the 2 years after surgery (p=.0001). All the EQ-5D data were improved at the 2 years after surgery, compared with the data before surgery; especially, pain (p=.005), usual activity (p=.005), mobility (p=.008), and anxiety/depression (p=.02) were significantly improved. Utility weight was 0.37 +/- 0.27 before surgery and 0.56 +/- 0.26 at the 2 years after surgery, showing significant improvement at the 2 years after surgery compared to before surgery (p=.002). CONCLUSIONS: The surgical reconstruction of rheumatoid cervical spine has been demonstrated to improve patients' health-related quality of life., Article, SPINE JOURNAL. 13(4):391-396 (2013)

Study design/setting Retrospective study. Objective The purpose of this study was to use multidimensional analysis with a computed tomography (CT)-based navigation system to measure the outer cortical diameter and the maximum screw trajectory length of the pedicle of the thoracic and lumbar regions of the spine in adolescent idiopathic scoliosis (AIS) patients. Another objective was to identify pedicles that require cautious insertion of screws. Summary of background data Pedicle diameter in AIS patients was narrower on the concave side of the scoliotic curve. Many researchers have measured pedicle diameter and length of AIS patients by using standard CT or magnetic resonance imaging (MRI), but only few have used 3-dimensional imaging, especially CT-based navigation. Methods Fifteen patients with right-side thoracic AIS who underwent pedicle screw fixation were studied. A CT-based navigation system was used to measure the pedicle diameter, defined as the widest outer cortical diameter at the narrowest part of the pedicle. Moreover, the maximum pedicle screw trajectory length was measured as the distance between the posterior cortical entry point of the pedicle screw and the anterior vertebral cortex in line with the axis of the pedicle between T1 and L5. In addition, the values of each parameter taken using the CT navigation system and the standard axial CT were compared. Results Pedicles on the concave side of the main thoracic curve apex and proximal thoracic curve tended to have the narrowest diameters. The mean length of the longest screw that could be fixed was longer on the right side, except for T8 and T9. Our data showed screw size feasibility as follows: 25 or 30 mm screws were feasible from T1 to T5; 30 or 35 mm screws, from T6 to T12; and 35 or 40 mm screws, from L1 to L5. Pedicle diameter measured by the CT navigation system was larger than that measured by standard axial CT. Left-side pedicle length measured by the CT navigation system was lesser than that measured by standard axial CT. Conclusions Pedicle diameter in patients with AIS is narrower on the concave side of the scoliotic curve, and therefore, caution should be exercised during screw insertion on the concave side.

Cervical pedicle screw (CPS) insertion is technically demanding and carries a risk of serious neurovascular complications when screws perforate. To avoid such serious risks, we currently perform CPS insertion using a computed tomography (CT)-guided navigation system. However, there remains a low probability of screw perforation during CPS insertion that is affected by factors such as CPS insertion angle and anatomical pedicle transverse angle (PTA).This study aimed to understand the perforation tendencies of CPS insertion angles in relation to anatomical PTA.This is a retrospective chart review.The study enrolled 151 consecutive patients (95 men and 56 women, with a mean age of 64.6 years).Anatomical PTA and CPS insertion angles were evaluated by axial CT images.The medical records of 151 consecutive patients who underwent CPS insertion using a CT-based navigation system were reviewed. We examined the relationships between PTA and CPS insertion angle on axial CT images according to vertebral level.The average preoperative PTA at each vertebral level was 32.1° for C2, 41.5° for C3, 41.0° for C4, 39.4° for C5, 34.4° for C6, and 27.3° for C7. Corresponding CT-determined pedicle screw insertion angles were 24.9°, 31.3°, 28.7°, 27.8°, 28.0°, and 26.0°, respectively. The CPS insertion angles at C2-C6 were significantly smaller than those for PTA (p.01). In evaluations of angle thresholds from C3 to C5 that predicted a higher risk of perforation, the receiver operating characteristic curve analysis determined CPS insertion angles of24.5° and36.5° for the identification of lateral and medial perforations, respectively.For CPS insertion into the C3-C5 pedicles using CT, there is an increased likelihood of lateral or medial perforation for insertion angles of24.5° or36.5°, respectively.

STUDY DESIGN: A retrospective study. PURPOSE: To evaluate the surgical results of computer-assisted C1-C2 transarticular screw fixation for atlantoaxial instability and the usefulness of the navigation system. OVERVIEW OF LITERATURE: We used a computed tomography (CT)-based computer navigation system in planning and screw insertion in Magerl's procedure, which provides the most rigid atlantoaxial fusion, to avoid risk of vertebral artery (VA) tear by avoiding high-riding VA during screw insertion. METHODS: Twenty patients who underwent atlantoaxial fusion under the CT-based navigation system were studied. The mean observation period was 33.5 months. The evaluated items included the existence of VA stenosis by preoperative magnetic resonance angiography, surgical time, blood loss volume, Japanese Orthopaedic Association (JOA) score and Ranawat's pain criteria before surgery and at final follow-up, postoperative screw position evaluated by CT, and bony fusion. RESULTS: The mean operation time was 205 minutes, with the mean blood loss volume of 242 ml. The mean JOA score was 11.6 points before surgery and 13.7 at final follow-up. Occipital and/or cervical pain presented before operation was remitted or resolved in all patients. Evaluation of screw insertion by CT revealed correct penetration to atlantoaxial joints, with a perforation rate of 2.6%. There was no complication, including VA tear, and all patients who were followed-up during one year or more after surgery achieved bony fusion. Some subjects who appeared inappropriate for surgery from CT images were assessed as eligible for surgery based on the evaluation results obtained using the navigation system. CONCLUSIONS: It was demonstrated that the CT-based navigation system is an effective support device for Magerl's procedure.

No studies have reported on osteotomies utilizing a navigation system in congenital scoliosis surgery. This study aimed to evaluate the surgical outcomes of eight patients with congenital scoliosis or kyphoscoliosis due to hemivertebrae treated by computer-assisted hemivertebral resection using only a posterior approach. Eight consecutive patients (two scoliotics and six kyphoscoliotics) managed by computer-assisted hemivertebral resection using only a posterior approach with transpedicular instrumentation were investigated retrospectively. A CT-based navigation system was used to confirm the positions of the vertebra, spinal cord and aorta in real-time when we inserted a pedicle screw and conducted the osteotomy. The mean patient age at surgery was 18 years (range 11-41 years). The mean follow-up was 46 months (range 18-84 months). Before surgery, the mean kyphotic curve was 55.8A degrees (range 26-83A degrees), and the mean scoliotic curve was 50.0A degrees (range 36-62A degrees). At the final follow-up period, the curves averaged 23.2A degrees (range 15-40A degrees) and 31.6A degrees (range 21-44A degrees), respectively, yielding kyphotic angle corrections of 32.7A degrees (range 11-58A degrees) and Cobb angle correction rates of 36.8% (range 24.1-48.3%). A total of 72 pedicle screws were inserted with the navigation system, and two screws revealed a perforating pedicle. No neurovascular complications occurred. The perforation rate was 2.8%. Hemivertebral resection via a single posterior approach is less invasive than combined anterior and posterior approaches; however, this procedure increases the risk of spinal cord and vascular injuries. Computer-assisted hemivertebral resection enables safe and accurate performance of a hemivertebral resection via a single posterior approach., Article, JOURNAL OF ORTHOPAEDIC SCIENCE. 16(5):503-509 (2011)

[Purpose] We conducted a noncontrolled intervention study in community-dwelling individuals with chronic stroke hemiplegia as subjects to examine the effectiveness of a 6 month low-frequency combined functional training program on enhancing factors related to physical performance, such as leg muscle strength, postural balance, and gait function. We also examined whether medium-term changes in physical performance correlated with time from stroke onset or degree of hemiplegia. [Subjects and Methods] Twenty-two individuals with chronic stroke hemiplegia who were using an adult day-care facility were enrolled in a combined functional training program consisting of stretching, muscle strengthening, postural balance training, and gait training once or twice a week for 6 months. The main outcomes measured were indices of physical performance - such as leg muscle strength (measured at about 1 repetition maximum [1RM] on a leg press machine), the functional reach test, the timed "up and go" test, comfortable gait speed, and maximum gait speed - and the Brunnstrom recovery stage (BRS). [Results] After 6 months of intervention, significant improvements were observed in all of the above-mentioned outcome measures of physical performance. No significant correlations were found between the percentage changes of physical performances after the intervention and time from stroke onset or BRS. [Conclusion] The 6 month low-frequency combined functional training program at an adult day-care facility results in medium-term improvements in leg muscle strength, postural balance and gait performance in community-dwelling individuals with chronic stroke hemiplegia.

[Purpose] The purpose of this study was to examine the reliability and clinical usefulness of a subjective risk rating of specific tasks (SRRST) for assessing risks of falls in frail elderly people. The participants were 30 elderly individuals who utilized day-care services. [Subjects and Methods] Participants were investigated the SRRST, grip strength, one repetition maximum of leg-press machine (1RM), one-leg standing time (OLS), functional reach, timed up and go test (TUG), and 10 m-walking speed, Barthel index, Tokyo Metropolitan Institute of Gerontology index, and history of falls in the previous year. The SRRST is comprised of 7 dichotomous questions screening of fall risk during activities of daily living such as walking, transferring, and wandering, and was scored twice a week by four raters. [Results] Intra-rater reliabilities of the SRRST were high (ICC (1,1) = 0.727 to 0.914, ICC (1,2) = 0.842 to 0.955), and inter-rater reliabilities of the SRRST were moderate to high (ICC (2,1) = 0.513, ICC (2,4) = 0.808). In comparison to the non-faller group, the faller group showed significantly lower 1RM and higher the SRRST. The SRRST showed moderate correlations with the OLS and TUG. [Conclusion] The SRRST showed moderate to high reliability and concurrent validity for assessing the fall risks in frail elderly people.

Background: The present study measured longitudinal changes in bone turnover markers in elderly patients with vertebral fracture and investigated the relationship among bone turnover markers, duration of bed rest and bone mineral density (BMD). Methods: Criteria for patient selection were 50 years in age and older, and presence of VF. Serum bone-specific alkaline phosphatase (BAP) was measured as a marker of bone formation. Urinary crosslinked N-terminal telopeptides of type I collagen (NTX) was measured as a marker of bone resorption. In principle, samples were collected just after injury, within 24 h, and 1, 2, 3, 5 and 8 weeks after. We also measured duration of bed rest and BMD. Results: The study population consisted of 42 cases. The average BMD of the lumbar vertebrae was 0.670 ± 0.174 g/cm2. Bed rest period was 17.9 ± 8.8 days. BAP showed significantly higher values at 2 and 3 weeks compared with the baseline value. Thereafter, BAP progressively decreased until 8 weeks. Urinary NTX was increased soon after the onset of pain with the same patterns in BAP. Urinary NTX values reached a peak at 3 weeks, and then they kept significantly higher values until 8 weeks. The peak value of serum BAP was affected by the duration of bed rest, although that of the urinary NTX was not. The peak values of serum BAP and urinary NTX showed negative correlations with the initial BMD values. Conclusions: Bone turnover markers remained higher at 8 weeks, even patients symptom was healed after VF. Bone turnover markers were affected on physical activity and BMD.

[Purpose] The purpose of this study was to examine the effects of low-frequency combined functional training over a 3-month period on lower extremity muscle strength and gait performance in community-dwelling people with chronic post-stroke hemiplegia. [Subjects] The subjects were 23 individuals with chronic post-stroke hemiplegia, utilizing the services of an adult day-care facility. [Methods] All subjects performed functional training programs consisting of stretching, strengthening, postural balance training, and gait training once or twice a week for 3 months. Leg muscle strength measured using a leg press machine at one repetition maximum (1RM), comfortable gait speed (CGS), maximal gait speed (MGS), and the difference between MGS and CGS (ΔGS) were assessed before and after intervention. [Results] Comparison of each outcome before and after intervention revealed significant increases in 1RM, CGS, MGS, and ΔGS. The change rate of ΔGS was correlated only with that of MGS. [Conclusion] Three-month combined functional training was effective at enhancing lower extremity muscle strength and gait performance, and ΔGS was increased by enhancement of MGS in community-dwelling people with chronic post-stroke hemiplegia.

Instability of the occipitocervical junction can present challenging surgical problems because of the unique anatomic and biomechanical characteristics of this region. The purpose of this study was to evaluate the long-term surgical results and usefulness of a computed tomography (CT)-based navigation system for the occipitocervical reconstruction.Twenty-three patients (10 men, 13 women; mean age at surgery 57.9 years; mean follow-up periods 52.9 months) with occipitocervical junction disorders were treated by occipitocervical reconstruction using pedicle screws, aided by a CT-based navigation system. Roentgenologic measurement and clinical evaluation were performed before surgery and at final follow-up. Postoperative CT and plane radiographs were used to determine the accuracy of screw placement.Mean atlantodental interval and Ranawat value were significantly improved (P.05), and mean clivoaxial angle was increased after surgery and maintained at final follow-up. Mean Japanese Orthopedic Association score before and at final follow-up was 7.1 ± 4.4 and 11.3 ± 3.5 points, showing significant improvement (P = .005). Fourteen patients (61%) improved more than one Ranawat grade. Six of nine patients (67%) in class IIIB were improved. On the other hand, nine patients (39 %) remained at the same class at final follow-up. A total of 88 pedicle screws were inserted into cervical and upper thoracic pedicles using the navigation system, and only one screw (1.1 %) showed major pedicle wall perforation. Solid union was achieved in all 23 patients.Occipitocervical reconstruction using pedicle screws provided a high fusion rate and maintained alignment in the occipitocervical region. The computer-assisted navigation system was a useful tool for accurate and safe pedicle screw insertion.

Background: Eel calcitonin (elcatonin) injection is widely used for elderly patients suffering from somatic pain in Japan. However, there have been few reports on the analgesic effects of elcatonin injection. The purpose of this study was to examine the analgesic effects of elcatonin injection in postmenopausal women with lower back pain. Methods: This study was designed as a double-blind, randomized, placebo-controlled study. Thirty-six women aged ≥50 years with acute lower back pain participated in this study. They were randomly divided into two treatment groups according to whether they received a placebo or a weekly trigger point injection of elcatonin (20 units). They were observed for 5 weeks and the extent of pain at motion and at rest according to the visual analog scale (VAS) was evaluated. The mean VAS scores for the elcatonin group were then compared with those of the placebo group. Results: There were no statistically significant differences in the mean VAS scores for pain at rest between the two groups during the 5-week treatment course. However, the mean VAS scores for motion pain in the elcatonin group were significantly lower than those in the placebo group at the third, fifth and sixth weeks. Conclusions: Elcatonin injection (20 units) significantly relieved motion pain in the lower back in postmenopausal women after three weeks of treatment. This analgesic effect continued for the subsequent 3 weeks.

Background: Different perforation rates for cervical pedicle screws by disease are expected in relation to bone quality and pedicle morphology; however, no report comparing pedicle screw perforation rate by disease had previously been published. This study investigated the perforation rates of pedicle screws inserted to cervical pedicle by disease and vertebral level using a CT-based navigation system. Materials/Methods: Fifty-three patients who underwent cervical pedicle screw insertion using CT based navigation system were studied. Diseases included rheumatoid arthritis (RA) (24 cases), destructive spondyloarthropathy (DSA) (10), cervical spondylotic myelopathy (CSM) (9), spine tumor (6), and cervical spondylotic myelopathy associated with athetoid cerebral palsy (CP) (4). Screw perforation rates for cervical pedicle screws were studied. Major perforation was defined as perforation 50% of screw diameter or more. Results: Major perforation rate by disease from C3 to C7 was as follows: spine tumor (0/24, 0%), RA (2/59, 3.4%), DSA (3/65, 4.6%), CP (2/20, 10.0%), and CSM (6/40, 15.0%). There were no clinically important complications such as vertebra arterial injury, spinal cord injury, or nerve root injury caused by any screw perforation. Major perforation rate by vertebral level was: C2(2/30, 6.7%), C3(4/49, 8.2%), C4(6/43, 14.0%), C5(1/32, 3.1%), C6(1/41, 2.4%), and C7(1/45, 2.2%), showing highest rate for C4, followed by C3. Conclusions: Cervical pedicle screw perforation rate by disease was higher in CSM compared to RA and DSA. The perforation rate by vertebral level was higher for C4 and C3, in this order.

〔目的〕高齢者における転倒の多くは滑りやつまずきといった外乱刺激が加わった時に生じており，既存の評価指標では明らかにすることのできない転倒リスク保因者を，外乱刺激を与えることで発見できる可能性がある。そこで本研究では，新たに開発した歩行時側方傾斜外乱刺激装置を用いて，高齢者と若年者の外乱負荷応答の違いを明らかにすることを目的とした。〔対象〕対象は，高齢者群13名（年齢77.9±3.9歳），若年者群15名（年齢20.1±3.1歳）であった。〔方法〕測定は重心動揺計を用い，至適歩行速度での歩行中，不意に与えられた側方傾斜外乱刺激に対する反応を計測し，反応動態を高齢者と若年者とで比較した。〔結果〕重心の座標推移から加速度を算出した結果，高齢者群は若年者群に比べ，外乱刺激に対して姿勢バランスを保持する二次的な負荷応答が有意に小さかった。〔結語〕この指標が外乱刺激に対する高齢者と若年者の反応動態の違いを反映している可能性が示唆された。

In Japan, spinal dual-energy X-ray absorptiometry (DXA) has been commonly performed for diagnosing osteoporosis but scanning the proximal femur is not done widely. The latest Japanese guidelines for prevention and treatment of osteoporosis, revised in 2006, recommend bone mineral density (BMD) measurement at both spine and hip for diagnosing osteoporosis, although there have been no reports that proved the necessity of those measurements. One thousand forty-one women and 485 men with clinical suspicion of osteoporosis were enrolled in this study, and DXA was performed at both spine and hip. The proportions of the patients who had inconsistency between diagnosis of osteoporosis from spinal DXA and that of hip were estimated. As a result, 22% of women and 15% of men had an inconsistency with the diagnosis of osteoporosis using DXA at each measurement site. There was inconsistency in diagnosing osteoporosis using DXA at the spine and proximal femur measurement sites. Because spine and femoral DXA measurements complement each other in the diagnosis of osteoporosis, BMD measurement at both spine and hip should be performed for all Japanese patients who are suspected osteoporosis, regardless of age and sex.

Background: Favorable surgical results had been reported in cervical posterior foraminotomy using endoscopy; however, the learning curve for the surgeon is steep. We therefore developed a procedure that can be performed more eas- ily and with small incision, called "Mini Open Foraminotomy (MOF)", using a tubular retractor (22mm diameter) under direct vision. The purpose of this study was to demonstrate the surgical procedure about MOF for cervical radiculopathy and assess a postoperative result of MOF. Materials/Methods: We performed MOF on 19 consecutive patients (15 males and 4 females) with cervical radiculopathy. Average age at time of operation was 48.9 years. Average follow-up period was 30.6 months. Spondylotic radiculopathy was diagnosed in 12 cases and disc herniation in seven cases. Skin incision was approximately 3 cm. Large (22mm diame- ter) METRx tube with illumination was fixed into paravertebral muscle. The lower articular process of the upper vertebra and the upper articular process of the lower vertebra were shaved with pneumatic drill and Kerrison rongeur to decom- press the nerve root under direct vision. Results: Mean operation time was 78±26 minutes. Mean hemorrhage weight was 50±46ml. All patients were able to stand and walk without neck collars on the first postoperative day, with dramatic reduction of radicular pain. Mean VAS of radicular pain showed significant improvement at final follow up compared with that before surgery (0.5±1.1 and 7.1±2.6, respectively; p

〔目的〕本研究では，地域在住高齢者を対象にLife-Space Assessment（LSA）を用いて活動量と身体機能およびIADLとの関連性を検証することを目的とした。〔対象〕対象は都市部に在住する地域在住高齢者411人（平均年齢76.7±5.3歳）であった。〔方法〕活動量の指標としてLSA，ならびにその下位項目であるIndependent Life-Space（LS-I），Life-Space using equipment（LS-E），Maximal Life-Space（LS-M）を調査した。また，質問紙調査として，要介護認定の有無とともに，健康状態，身体機能，IADLに関する項目について面接にて聴取した。〔結果〕LS-I，LS-E，LS-Mの値はいずれも約95％以上の者が5点満点を示し，LSAにおいても平均92.7点と高い値であった。LSAを5歳の年齢階級別に比較した結果，85歳以上の群におけるLSAは，65-69歳，70-74歳，75-79歳の各群に比べ，有意に低かった。また，健康状態，身体機能，IADLの状況によってLSAを比較した結果，「要介護認定あり」，「転倒恐怖感あり」，「健康感なし」，「3種以上の服薬あり」，「1 km歩行不可」，「5 m歩行時間が基準値以上」，「爪先立ち不可」，「握力が基準値以下」，「1人での外出が不可」，「趣味・稽古事なし」，「辞めた趣味あり」の各群においてLSAは有意に低い値を示した。〔結語〕以上の結果から，都市部に在住する高齢者は活動範囲が広く，活動量が高いものの，加齢によって低下することが示唆された。また，LSAは移動機能に必要な身体機能や健康状態，移動機能の必要性の高いIADLといった諸因子とより密接に関連し，高齢者における活動量の評価指標として有用であることが明らかになった。

The serum concentration of cross-linked telopeptide of type I collagen (ICTP) has been reported to be a useful marker and for both diagnosis and monitoring of bone metastasis. This study was performed to clarify the changes in various bone turnover markers, including ICTP, after bone fragility fracture.Seventy-six bone fragility fracture patients (14 men and 62 postmenopausal women; mean age, 77.0 years) were evaluated for bone resorption markers, including serum ICTP. We measured urinary N-terminal telopeptides of type I collagen (NTX) several times after fracture. Furthermore, serum ICTP, serum NTX, urinary deoxypyridinoline (DPD), and urinary C-telopeptide-cross-linked type I collagen (CTX) were measured at the times of both minimum and maximum urinary NTX.Urinary NTX was increased significantly from 86.4 +/- 57.9 to 214.3 +/- 137.2 nmol BCE/mmol Cr following fracture. Serum ICTP showed a similar significant increase from 7.6 +/- 4.7 to 10.4 +/- 5.5 ng/ml in bone fragility fracture patients. Furthermore, other markers also showed similar increases. The level of increase in urinary NTX (148.0%) was especially high compared with other bone resorption markers. On the other hand, the level of increase in serum ICTP (36.8%) was similar to that in serum NTX (39.8%). Serum ICTP levels were significantly correlated with other bone resorption markers, with an especially strong correlation between serum ICTP and serum NTX (r = 0.647, P0.001). The percentage of cases in which ICTP exceeded the cutoff value for suspected bone metastasis in postmenopausal women was 73.6%.The value of ICTP increases with bone fragility fracture and is correlated with other bone resorption markers, and ICTP obviously exceeded the reference value as compared with other bone resorption markers.

A 76-year-old woman presented history of left hip joint pain on walking, which occurred after she bent to move a planter. Plain radiographs showed no fracture. Bone scintigraphy revealed accumulation, and magnetic resonance imaging showed a low signal area on T1-weighted images. We diagnosed an insufficiency fracture and pain decreased naturally on conservative treatment. Insufficiency fracture of the acetabulum should be considered when elderly patients have hip joint pain. Magnetic resonance imaging and bone scintigraphy is most useful for the diagnosis.

Vertebral fractures, are a serious clinical problem for elderly osteoporotic patients, have been increasingly recognized and are now common. On the assumption that it is difficult to diagnose osteoporotic vertebral fractures on plain radiographs, we studied 78 consecutive patients aged over 50 years with severe back pain with or without minor trauma. All patients had been admitted to our department and had undergone radiographic examinations including plain radiography, magnetic resonance imaging (MRI) and bone scintigraphy. Surprisingly, 74 of the patients (94.9%) with severe back pain had vertebral fractures. Low intensity on T1-weighted MRI indicated that the severe back pain was a symptom of vertebral fracture. The patients were divided into two groups: those with total, and those with partial T1-weighted hypointensity of the vertebral body on MRI. Thirty-five of the vertebral fractures (47.3%) were not detectable on plain radiographs, and patients without trauma showed vertebral deformity more frequently than those with trauma. The patients were treated conservatively with bed rest until the severe back pain had subsided, after which they were evaluated clinically. The average period of bed rest was 22.3 days, which did not differ significantly in relation to the occurrence of trauma, the extent of the signal change in the vertebral body on MRI or the presence of vertebral deformity. Even without vertebral deformity or trauma, vertebral fractures required long periods of bed rest for pain relief and entailed serious clinical problems.

Biochemical bone metabolic markers are affected by fractures, and total alkaline phosphatase (ALP) is considered one of the bone formation markers. Only a few reports have dealt with changes in bone formation markers during the healing process of bone fragility hip fractures. Despite the difference in the amount of callus formation and bone fusion rate, no significant differences in longitudinal change of total ALP between femoral neck and trochanter fracture have been reported.A total of 69 osteoporotic patients with femoral neck or trochanter fracture whose serum concentrations of total ALP were examined at least four times at six periodic examination points (1, 2, 3, 4, 6, and 8 weeks after surgery) and whose state of bone union was obtained within 24 weeks after surgery were selected for this retrospective study. The characteristic longitudinal change of total ALP during the healing process was shown, and the possibility of total ALP as a predictive factor for the state of osteosynthesis of hip fractures is discussed.Changes in the total ALP level according to the healing process were similar for femoral neck and trochanter fractures. The concentration of total ALP rose to a maximum at 3 weeks after surgery and then gradually decreased for both fractures. However, the range of change was significantly greater for trochanter fractures than for femoral neck fractures. For trochanter fractures, total ALP decreased from 3 to 6 weeks after surgery in all but one patient.Increases in the concentration of total ALP after surgery and the subsequent decreases may reflect the normal healing process. A significant difference in the changes of total ALP after surgery between femoral trochanter and neck fractures was shown. Periodic measurement of total ALP might be useful for obtaining information on the osteosynthesis state.