Search

Introduction: For older adults, dysphagia is a serious problem that can occur after spinal cord injury (SCI), but its risk factors are unclear. This study aimed to identify risk factors for dysphagia in elderly patients (65 years) with cervical SCI. Methods: This multicenter study included 707 patients with cervical SCI (mean age 75.3 years). Univariate and multivariate analyses were conducted for patient characteristics and geriatric nutritional risk index (GNRI). Results: Dysphagia occurred in 69 patients (9.8%). The significant factors were as follows: male sex (odds ratio [OR] 3.43), GNRI

Abstract This retrospective cohort study established malnutrition’s impact on mortality and neurological recovery of older patients with cervical spinal cord injury (SCI). It included patients aged ≥ 65 years with traumatic cervical SCI treated conservatively or surgically. The Geriatric Nutritional Risk Index was calculated to assess nutritional-related risk. Overall, 789 patients (mean follow-up: 20.1 months) were examined and 47 had major nutritional-related risks on admission. One-year mortality rate, median survival time, neurological recovery, and activities of daily living (ADL) at 1 year post-injury were compared between patients with major nutrition-related risk and matched controls selected using 1:2 propensity score matching to adjust for age, pre-traumatic neurological impairment, and activity. In the Kaplan–Meier analysis, the median survival times were 44.9 and 76.5 months for patients with major nutrition-related risk and matched controls, respectively (p = 0.015). Matched controls had more individuals with a neurological improvement of American Spinal Injury Association Impairment Scale ≥ 1 grade (p = 0.039) and independence in ADL at 1 year post-injury than patients with major nutrition-related risk (p

Objectives To investigate potential knowledge gaps between neurologists and non-specialists and identify challenges in the current management of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), with a focus on ‘early diagnosis’ and ‘appropriate treatment’ for CIDP.Design A non-interventional, cross-sectional, web-based quantitative survey of physicians working in healthcare clinics or hospitals in Japan.Setting Participants were recruited from the Nikkei Business Publications panel from 18 August to 14 September 2022.Participants Responses from 360 physicians (120 each of internists, orthopaedists and neurologists) were collected.Outcome measures Responses relating to a CIDP hypothetical case and current understanding were assessed to determine awareness, collaboration preferences and diagnosis and treatment decisions.Results Understanding of CIDP was 90.8% among neurologists, 10.8% among orthopaedists and 13.3% among internists; >80% of orthopaedists and internists answered that neurologists are preferable for treatment. Diagnostic assessment using a hypothetical case showed 95.0% of neurologists, 74.2% of orthopaedists and 72.5% of internists suspected CIDP. Among orthopaedists and internists suspecting CIDP, >70% considered referring to neurology, while ~10% considered continuing treatment without a referral. Among neurologists, 69.4% chose intravenous immunoglobulin (IVIg) as first-line treatment and determined effectiveness to be ≤3 months.Conclusions Orthopaedists and internists had lower CIDP awareness compared with neurologists, which may lead to inadequate referrals to neurology. Evaluation of IVIg effectiveness for maintenance therapy occurred earlier than the guideline recommendations (6–12 months), risking premature discontinuation. Improving CIDP knowledge among orthopaedists and internists is critical for better diagnosis and collaboration with neurologists. Neurologists should consider slow and careful evaluation of IVIg maintenance therapy.Trial registration number UMIN000048516.

Abstract Although the incidence of cervical spinal cord injury (CSCI) with ossification of the posterior longitudinal ligament (OPLL) has increased in older adults, its etiology and neurological outcomes remain unknown. We identified OPLL characteristics and determined whether they influence neurological severity and improvement of CSCI in older patients. This multicenter retrospective cohort study identified 1512 patients aged ≥ 65 years diagnosed with CSCI on admission during 2010–2020. We analyzed CSCI etiology in OPLL patients. We performed propensity score-adjusted analyses to compare neurological outcomes between patients with and without OPLL. Cases were matched based on variables influencing neurological prognosis. The primary neurological outcome was rated according to the American Spine Injury Association (ASIA) impairment scale (AIS) and ASIA motor score (AMS). In 332 OPLL patients, the male-to-female ratio was approximately 4:1. Half of all patients displayed low-energy trauma-induced injury and one-third had CSCI without a bony injury. Propensity score matching created 279 pairs. There was no significant difference in the AIS grade and AMS between patients with and without OPLL during hospitalization, 6 months, and 12 months following injury. OPLL patients tended to exhibit worse neurological findings during injury; nevertheless, OPLL was not associated with poor neurological improvement in older CSCI patients.

Study Design An observational cohort study design was adopted in this study. Purpose This study was designed to investigate preoperative factors that predict poor outcomes following surgery in patients with proximal-type cervical spondylotic amyotrophy (PCSA) using radiological findings. Overview of Literature We evaluated the preoperative factors associated with poor outcomes using electrophysiological and neurological findings. However, the preoperative factors associated with poor outcomes remained unclear. Methods Sixty patients with PCSA who underwent surgical treatment of the cervical spine were enrolled. The radiological findings on plain radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) were evaluated. The cervical lordotic angles, C2–C7 sagittal vertical axis (SVA), and T1 slope were assessed on a lateral radiograph in the neutral position. CT was used to assess the width of the intervertebral foramen and the anterior protrusion of the superior articular process on the axial view. MRI was used to determine the number of levels of compression (NLC) and the presence of a high-intensity area in the spinal cord in the T2-weighted midsagittal view. The preoperative and postoperative strengths of the most atrophic muscles were evaluated using manual muscle testing. Improvements in strength were classified as excellent (five grades recovered), good (more than one grade recovered), fair (no improvement), or poor (worsened). Results The prevalence of C5 palsy was 17% (10/60). Patients with poor outcomes had higher NLC and Δ C2–C7 SVA than patients with excellent, good, and fair outcomes (p=0.015; odds ratio [OR], 5.758; 95% confidence interval [CI], 1.397–23.726 for a change of 10% and p=0.048; OR, 1.068; 95% CI, 0.992–1.141 for a change of 10%, respectively). Conclusions ΔC2–C7 SVA and NLC may be used as prognostic factors for achieving a poor outcome following surgery in patients with PCSA. More focus is needed on preventing the increase in ΔC2–C7 SVA.

Abstract Although traumatic cervical spine injuries in older adults are commonly caused by minor traumas, such as ground-level falls, their prognosis is often unfavorable. Studies examining the clinical characteristics of cervical spine injuries in older adults according to the external cause of injury are lacking. This study included 1512 patients of ≥ 65 years of age with traumatic cervical spine injuries registered in a Japanese nationwide multicenter database. The relationship between the external causes and clinical characteristics, as well as factors causing unfavorable outcomes at the ground-level falls, were retrospectively reviewed and examined. When fall-induced cervical spine injuries were categorized and compared based on fall height, the patients’ backgrounds and injury statuses differed significantly. Of note, patients injured from ground-level falls tended to have poorer pre-injury health conditions, such as medical comorbidities and frailty, compared with those who fell from higher heights. For ground-level falls, the mortality, walking independence, and home-discharge rates at 6 months post-injury were 9%, 67%, and 80%, respectively, with preexisting medical comorbidities and frailty associated with unfavorable outcomes, independent of age or severity of neurological impairment at the time of injury.

Abstract Background The 1-year mortality and functional prognoses of patients who received surgery for cervical trauma in the elderly remains unclear. The aim of this study is to investigate the rates of, and factors associated with mortality and the deterioration in walking capacity occurring 1 year after spinal fusion surgery for cervical fractures in patients 65 years of age or older. Methods Three hundred thirteen patients aged 65 years or more with a traumatic cervical fracture who received spinal fusion surgery were enrolled. The patients were divided into a survival group and a mortality group, or a maintained walking capacity group and a deteriorated walking capacity group. We compared patients’ backgrounds, trauma, and surgical parameters between the two groups. To identify factors associated with mortality or a deteriorated walking capacity 1 year postoperatively, a multivariate logistic regression analysis was conducted. Results One year postoperatively, the rate of mortality was 8%. A higher Charlson comorbidity index (CCI) score, a more severe the American Spinal Cord Injury Association impairment scale (AIS), and longer surgical time were identified as independent factors associated with an increase in 1-year mortality. The rate of deterioration in walking capacity between pre-trauma and 1 year postoperatively was 33%. A more severe AIS, lower albumin (Alb) and hemoglobin (Hb) values, and a larger number of fused segments were identified as independent factors associated with the increased risk of deteriorated walking capacity 1 year postoperatively. Conclusions The 1-year rate of mortality after spinal fusion surgery for cervical fracture in patients 65 years of age or older was 8%, and its associated factors were a higher CCI score, a more severe AIS, and a longer surgical time. The rate of deterioration in walking capacity was 33%, and its associated factors were a more severe AIS, lower Alb, lower Hb values, and a larger number of fused segments.

Introduction: In elderly patients with cervical spinal cord injury, comorbidities such as cardiovascular and cerebrovascular diseases are common, with frequent administration of antiplatelet/anticoagulant (APAC) drugs. Such patients may bleed easily or unexpectedly during surgery despite prior withdrawal of APAC medication. Few reports have examined the precise relationship between intraoperative blood loss and history of APAC use regarding surgery for cervical spine injury in the elderly. The present multicenter database survey aimed to answer the question of whether the use of APAC drugs affected the amount of intraoperative blood loss in elderly patients with cervical spinal cord trauma. Methods: The case histories of 1512 patients with cervical spine injury at 33 institutes were retrospectively reviewed. After excluding cases without spinal surgery or known blood loss volume, 797 patients were enrolled. Blood volume loss was the outcome of interest. We calculated propensity scores using the inverse probability of treatment weighting (IPTW) method. As an alternative sensitivity analysis, linear mixed model analyses were conducted as well. Results: Of the 776 patients (mean age: 75.1±6.4 years) eligible for IPTW calculation, 157 (20.2%) were taking APAC medications before the injury. After weighting, mean estimated blood loss was 204 mL for non-APAC patients and 215 mL for APAC patients. APAC use in elderly patients was not significantly associated with surgical blood loss according to the IPTW method with propensity scoring or linear mixed model analyses. Thus, it appeared possible to perform surgery expecting comparable blood loss in APAC and non-APAC cases. Conclusions: This multicenter study revealed no significant increase in surgical blood loss in elderly patients with cervical trauma taking APAC drugs. Surgeons may be able to prioritize patient background, complications, and preexisting conditions over APAC use before injury when examining the surgical indications for cervical spine trauma in the elderly.

Abstract The characteristic subcutaneous hemorrhage along the seat belt in motor vehicle accidents is called the seat belt sign (SBS). The risk of organ injuries is especially high when abdominal SBS is located above the anterior superior iliac spine (ASIS). The purpose of this study analyzed the physical and radiographic factors of healthy volunteers sit on car seat that affect initial position of abdominal seat belt, namely “lap belt”, related to the seat belt injury. This study was examined prospectively relation between physical characteristics of one hundred healthy volunteers and lap belt position sitting the car seat. Physical findings were clarified age, sex, height, body mass index (BMI), and waist circumference. Radiographical findings were measured lumber lordosis (LL), sacral slope (SS), and initial lap belt position by marking with lead tape for the center and ASIS of the lap belt installed on the driver’s car seat. In the lateral X-ray image, we measured the horizontal distance (X-value) and vertical distance (Z-value) from the ASIS to the central marker. The lap belt angle was determined to measure the angle between the horizontal line and the straight line connecting the upper edges of the markers. Statistical analysis of the relationships between physical characteristics and radiological findings was performed. X-value and Z-value were positively correlated with body weight, BMI, and waist circumference, while the lap belt angle was negatively correlated with body weight, BMI, and waist circumference. The relationship between physical characteristics and the initial position of seat belt was analyzed. Since the lap belt is positioned higher than the ASIS in occupants with a high BMI, it is likely to cause seat belt injury. This analysis can help to develop safer seat belts and to enlighten car occupants.

Abstract Background The spinal nerve ligation (SNL) rat is well known as the most common rodent model of neuropathic pain without motor deficit. Researchers have performed analyses using only the von Frey and thermal withdrawal tests to evaluate pain intensity in the rat experimental model. However, these test are completely different from the neurological examinations performed clinically. We think that several behavioral reactions must be observed following SNL because the patients with neuropathic pain usually have impaired coordination of the motions of the right–left limbs and right–left joint motion differences. In this study, we attempted to clarify the pain behavioral reactions in SNL rat model as in patients. We used the Kinema-Tracer system for 3D kinematics gait analysis to identify new characteristic parameters of each joint movement and gait pattern. Results The effect of SNL on mechanical allodynia was a 47 ± 6.1% decrease in the withdrawal threshold during 1–8 weeks post-operation. Sagittal trajectories of the hip, knee and ankle markers in SNL rats showed a large sagittal fluctuation of each joint while walking. Top minus bottom height of the left hip and knee that represents instability during walking was significantly larger in the SNL than sham rats. Both-foot contact time, which is one of the gait characteristics, was significantly longer in the SNL versus sham rats: 1.9 ± 0.15 s vs. 1.03 ± 0.15 s at 4 weeks post-operation (p = 0.003). We also examined the circular phase time to evaluate coordination of the right and left hind-limbs. The ratio of the right/left circular time was 1.0 ± 0.08 in the sham rats and 0.62 ± 0.15 in the SNL rats at 4 weeks post-operation. Conclusions We revealed new quantitative parameters in an SNL rat model that are directly relevant to the neurological symptoms in patients with neuropathic pain, in whom the von Frey and thermal withdrawal tests are not used at all clinically. This new 3D analysis system can contribute to the analysis of pain intensity of SNL rats in detail similar to human patients’ reactions following neuropathic pain.

In spinal cord injuries, external forces from various directions occur at various velocities. Therefore, it is important to physically evaluate whether the spinal cord is susceptible to damage and an increase in internal stress for external forces. We hypothesized that the spinal cord has mechanical features that vary under stress depending on the direction and velocity of injury. However, it is difficult to perform experiment because the spinal cord is very soft. There are no reports on the effects of multiple external forces. In this study, we used bovine spinal cord white matter to test and analyze the anisotropy and velocity dependence of the spinal cord. Tensile-vertical, tensile-parallel, shear-vertical, and shear-parallel tests were performed on the white matter in the fibrous direction (cranial to caudal). Strain rate in the experiment was 0.1, 1, 10, and 100/s. We calculated the Young's modulus of the spinal cord. Results of the tensile and shear tests revealed that stress tended to increase when external forces were applied parallel to the direction of axon fibers, such as in tensile-vertical and shear-vertical tests. However, external forces those tear against the fibrous direction and vertically, such as in tensile-parallel and shear-parallel tests, were less likely to increase stress even with increased velocity. We found that the spinal cord was prone to external forces, especially in the direction of the fibers, and to be under increased stress levels when the velocity of external forces increased. From these results, we confirmed that the spinal cord has velocity dependence and anisotropy. The Institutional Animal Care and Use Committee of Yamaguchi University waived the requirement for ethical approval.

The spinal cord is composed of gray matter and white matter. It is well known that the properties of these two tissues differ considerably. Spinal diseases often present with symptoms that are caused by spinal cord compression. Understanding the mechanical properties of gray and white matter would allow us to gain a deep understanding of the injuries caused to the spinal cord and provide information on the pathological changes to these distinct tissues in several disorders. Previous studies have reported on the physical properties of gray and white matter, however, these were focused on longitudinal tension tests. Little is known about the differences between gray and white matter in terms of their response to compression. We therefore performed mechanical compression test of the gray and white matter of spinal cords harvested from cows and analyzed the differences between them in response to compression. We conducted compression testing of gray matter and white matter to detect possible differences in the collapse rate. We found that increased compression (especially more than 50% compression) resulted in more severe injuries to both the gray and white matter. The present results on the mechanical differences between gray and white matter in response to compression will be useful when interpreting findings from medical imaging in patients with spinal conditions.

Chronic spinal cord injury (SCI) is a devastating condition that results in major neurological deficits and social burden. It continues to be managed symptomatically, and no real therapeutic strategies have been devised for its treatment. Neural stem/neural progenitor cells (NSCs/NPCs) being used for the treatment of chronic SCI in experimental SCI models can not only replace the lost cells and remyelinate axons in the injury site but also support their growth and provide neuroprotective factors. Currently, several clinical studies using NSCs/NPCs are underway worldwide. NSCs/NPCs also have the potential to differentiate into all three neuroglial lineages to regenerate neural circuits, demyelinate denuded axons, and provide trophic support to endogenous cells. This article explains the challenging pathophysiology of chronic SCI and discusses key NSC/NPC-based techniques having the greatest potential for translation over the next decade.

Spinal cord injury (SCI) is a catastrophic condition associated with significant neurological deficit and social and financial burdens. It is currently being managed symptomatically, with no real therapeutic strategies available. In recent years, a number of innovative regenerative strategies have emerged and have been continuously investigated in preclinical research and clinical trials. In the near future, several more are expected to come down the translational pipeline. Among ongoing and completed trials are those reporting the use of biomaterial scaffolds. The advancements in biomaterial technology, combined with stem cell therapy or other regenerative therapy, can now accelerate the progress of promising novel therapeutic strategies from bench to bedside. Various types of approaches to regeneration therapy for SCI have been combined with the use of supportive biomaterial scaffolds as a drug and cell delivery system to facilitate favorable cell–material interactions and the supportive effect of neuroprotection. In this review, we summarize some of the most recent insights of preclinical and clinical studies using biomaterial scaffolds in regenerative therapy for SCI and summarized the biomaterial strategies for treatment with simplified results data. One hundred and sixty-eight articles were selected in the present review, in which we focused on biomaterial scaffolds. We conducted our search of articles using PubMed and Medline, a medical database. We used a combination of “Spinal cord injury” and [“Biomaterial”, or “Scaffold”] as search terms and searched articles published up until 30 April 2022. Successful future therapies will require these biomaterial scaffolds and other synergistic approaches to address the persistent barriers to regeneration, including glial scarring, the loss of a structural framework, and biocompatibility. This database could serve as a benchmark to progress in future clinical trials for SCI using biomaterial scaffolds.

In recent years, several published articles have shown that quantitative sensory testing (QST) and pressure pain threshold (PPT) are useful in the analysis of neck/shoulder and low back pain. A valid reference for normal PPT values might be helpful for the clinical diagnosis of abnormal tenderness or muscle pain. However, there have been no reliable references for PPT values of neck/shoulder and back pain because the data vary depending on the devices used, the measurement units, and the area examined. In this article, we review previously published PPT articles on neck/shoulder and low back pain, discuss the measurement properties of PPT, and summarize the current data on PPT values in patients with chronic pain and healthy volunteers. We also reveal previous issues related to PPT evaluation and discuss the future of PPT assessment for widespread use in general clinics. We outline QST and PPT measurements and what kinds of perceptions can be quantified with the PPT. Ninety-seven articles were selected in the present review, in which we focused on the normative values and abnormal values in volunteers/patients with neck/shoulder and low back pain. We conducted our search of articles using PubMed and Medline, a medical database. We used a combination of “Pressure pain threshold” and “Neck shoulder pain” or “Back pain” as search terms and searched articles from 1 January 2000 to 1 June 2022. From the data extracted, we revealed the PPT values in healthy control subjects and patients with neck/shoulder and low back pain. This database could serve as a benchmark for future research with pressure algometers for the wide use of PPT assessment in clinics.

Analysis using human body models has been performed to reduce the impact of accidents; however, no analysis has shown a relationship between lumbar and pelvic/spine angle and seat belts in reducing human damage from accidents. Lumbar and pelvic/spine angles were measured in 75 individuals and the measurements were used to create three different angles for the Total Human Model for Safety model. In the present study, we focused on lumber lordosis (LL) and pelvic angle (PA). A normal distribution and histogram were used for analysis of PA (01, 10, and 50). The Total Human Model for Safety, including LL and PA, was corrected using finite element software. Simulations were conducted under the conditions of the Japan New Car Assessment Programme (JNCAP) 56 kph full lap frontal impact. Using the results of the FEM, the amount of lap-belt cranial sliding-up, anterior movement of the pelvis, posterior tilt of the pelvis, head injury criterion (HIC), second cervical vertebrae (C2) compressive load, C2 moment, chest deflectiou (upper, middle, and lower), left and right femur load, and shoulder belt force were measured. The lap-belt cranial sliding-up was 1.91 and 2.37 for PA10 and PA01, respectively, compared to PA50; the anterior movement of the pelvis was 1.08 and 1.12 for PA10 and PA01, respectively; and the posterior tilt of the pelvis was 1.1 and 1.18 for PA10 and PA01, respectively. HIC was 1.13 for PA10 and 1.58 for PA01; there was no difference in C2 compressive load by PA, but C2 moment increased to 1.59 for PA10 and 2.72 for PA01. It was found that as LL increases and the PA decreases, the seat belt becomes likely to catch the iliac bone, making it harder to cause injury. This study could help to reconsider the safe seat and seatbelt position in the future.

Low back pain (LBP) is the most common cause of chronic pain. Numerous clinical scales are available for evaluating pain, but their objective criteria in the management of LBP patients remain unclear. This study aimed to determine an objective cutoff value for a change in the Pain Intensity Numerical Rating Scale (ΔPI-NRS) three months after LBP treatment. Its utility was compared with changes in six commonly used clinical scales in LBP patients: Pain Disability Assessment Scale (PDAS), Pain Self-Efficacy Questionnaire (PSEC), Pain Catastrophizing Scale (PCS), Athens Insomnia Scale (AIS), EuroQoL 5 Dimension (EQ5D), and Locomo 25. We included 161 LBP patients treated in two representative pain management centers. Patients were partitioned into two groups based on patient's global impression of change (PGIC) three months after treatment: satisfied (PGIC = 1, 2) and unsatisfied (3-7). Multivariate logistic regression analysis was performed to explore relevant scales in distinguishing the two groups. We found ΔPI-NRS to be most closely associated with PGIC status regardless of pre-treatment pain intensity, followed by ΔEQ5D, ΔPDAS, ΔPSEC, and ΔPCS. The ΔPI-NRS cutoff value for distinguishing the PGIC status was determined by ROC analysis to be 1.3-1.8 depending on pre-treatment PI-NRS, which was rounded up to ΔPI-NRS = 2 for general use. Spearman's correlation coefficient revealed close relationships between ΔPI-NRS and the six other clinical scales. Therefore, we determined cutoff values of these scales in distinguishing the status of ΔPI-NRS≥2 vs. ΔPI-NRS

Patients with diffuse idiopathic skeletal hyperostosis (DISH) develop fractures of the vertebral bodies, even in minor trauma, because of the loss of flexibility, which causes difficulties in fusing vertebrae; therefore, the diagnosis of spine injuries may be delayed. We used the three-dimensional finite element method to add data on ossification to the healthy vertebral model in order to investigate how stress in intervertebral discs changes with bone shape and whether these changes present any risk factors. A healthy spine model and a DISH flat model (T8–sacrum) were generated from medical images. As an ossified hypertrophic model, T11–T12 was cross-linked with hypertrophic ossification, and hypertrophy was found to be 5 and 10 mm. An ossifying hypertrophic groove model (5 and 10 mm) was created at T11–T12 and T11–L1. A groove was created at the center of T12, and the radius of curvature of the groove was set to 1 and 2.5 mm. An extension force and flexion force were applied to the upper part of T8, assuming that external forces in the direction of flexion and extension were applied to the spine. Stresses were greater in the DISH flat model than in the healthy model. In the hypertrophic ossification model, the stress on the vertebral body was similar to greater ossification in extension and flexion. In the ossified hypertrophic groove model, the stress at the center of the groove increased. In DISH, vertebrae are more susceptible to stress. Furthermore, depending on the morphology of ossification, stresses on the vertebrae and intervertebral discs differed even with similar loads. An examination of ossification geometry may help surgeons decide the thoracolumbar spine’s stress elevated position in patients with DISH, thereby contributing to the understanding of the pathogenesis of pain.

Dysphagia is associated with poor quality of life, and pneumonia due to aspiration is life-threatening. Cervical ossification of the anterior longitudinal ligament (C-OALL) is one of the causes of dysphagia, and we report two cases in which dysphagia improved after surgery. Case 1: A 76-year-old man had C-OALL of greater than 16 mm and dysphagia and developed myelopathy. A fall resulted in upper and lower limb insufficiency paralysis, and posterior decompression fixation was performed. Pressure on the pharynx by C-OALL remained, but dysphagia improved. Improvement in this case was considered to be due to the loss of intervertebral mobility. Case 2: A 62-year-old man developed dysphagia 6 years ago. It gradually exacerbated, and the C-OALL increased. Laryngeal fiberscope and swallowing angiography revealed that the pharyngeal cavity was compressed and narrowed anteriorly due to ossification. Resection of the ossification was performed, and the patient’s symptoms improved. Direct decompression was successful in this case. Several evaluation methods for dysphagia have been reported, including screening tests, endoscopy, contrast studies, and radiological evaluation. In case 1, extensive ossification was improved by posterior fixation, albeit incidentally, whereas in case 2, a patient with extensive ossification exhibited symptoms. It is necessary to examine the cervical mobility, extent and morphology of ossification, and timing of surgery stenosis to determine the risk factors and treatment options, including rehabilitation.

Abstract Background The presence of vertebral fractures affect variations in the termination level of conus medullaris (TLCM) and alter neurological findings. However, few studies have examined association between vertebral fractures, TLCM, and neurological findings. Thus, we herein studied the number and severity of vertebral fractures, TLCM, and neurological findings to clarify the mechanism of neurological deterioration in patients with vertebral fractures. Methods A total of 411 patients who underwent computed tomographic myelography were classified into those with (group F, n = 73) and those without vertebral fractures (group C, n = 338). We assessed correlations between TLCM and age, height, and gender in group C, differences in TLCM between groups F and C, and correlations between TLCM, and the number and severity score of fractures. Neurological evaluations were performed for the patellar tendon reflex (PTR), muscle weakness, sensory disturbance, and bladder contraction disorders. Results TLCM was most commonly located at the L1 vertebral body in group C and did not significantly differ with age, height, or gender. TLCM was most commonly located at L2 vertebral body in group F. TLCM was more caudally located in group F (P

Introduction: Details of surgical and general complications for patients with cervical spondylotic myelopathy (CSM) are still uncertain. The purpose of this study was to describe surgeries and their complications among Japanese patients with CSM. Methods: The Japanese Society for Spine Surgery and Related Research performed a nationwide survey on spine surgery and complications in 2011. Data of patients with 2,961 CSM >40 years old were included. The clinicopathological variables were basic demographic and clinical information, surgical information, and surgical and general complications. To examine the influence of age, variables were compared among three age groups: patients 40-64 (n=1,123), 65-74 (n=966), and 75 (n=872) years of age. Results: The study included 1,970 males and 991 females and the mean age was 64.3 years old. There were 168 anterior (5.7%) and 2,770 posterior (94.2%) approach surgeries. The vast majority of patients with CSM were treated using the posterior approach, 89.4% of whom had decompression surgery only. Anterior surgeries were more common in the younger age group, but posterior surgeries were equally distributed. The incidence of total complications including surgical/general complications was similar for the anterior (16/168; 9.5%) and posterior (295/2,770; 10.6%) approaches. No patient died on the operating table, but four patients (0.1%) died within one month after surgery. No association was detected between complications and age, comorbidity, and other surgical factors. The incidence of complications was similar for the different age groups. However general complications were predominantly observed in the older group and those who had instrumented surgery. Conclusions: The results indicate that the indication and surgical performance for patients with CSM is favorable in Japan, despite the super-aging population. Few serious complications were reported in this study. However, more detailed informed consent about surgical and, in particular, general complications is necessary for the older patients with CSM.

The most common cause of lumbar spinal canal stenosis is age-related degenerative changes. The ligamentum flavum is said to become thicker and stiffer with age, based on several histological and cadaver studies. However, there are no studies determining the age-related changes of the mechanical properties of the ligamentum flavum in live patients. We examined the mechanical properties of the ligamentum flavum of live patients and evaluated the age-related changes. A total of 44 patients undergoing decompression surgery due to lumbar disease at our institute were included. The ligamentum flavum was harvested from the decompression site as a part of a necessary procedure for decompression. The tensile test was performed for the harvested ligamentum flavum within 24 h of harvest. Age-related changes in the stiffness of the ligamentum flavum were evaluated. Age was the only factor that showed a significant correlation with stiffness on multiple regression analysis. We demonstrated that the mechanical properties of the ligamentum flavum change with age.

Study DesignProspective study.PurposeWe evaluated the usefulness of diffusion tensor imaging (DTI) in diagnosing patients with cervical myelopathy by determining the accuracy of normal DTI parameter values.Overview of LiteratureDTI can visualize white matter tracts in vivo and quantify anisotropy. DTI is known to be more sensitive than conventional magnetic resonance imaging (MRI) in detecting subtle pathological changes of the spinal cord.MethodsA total of 31 normal subjects (13 men and 18 women; age, 23-87 years; mean age, 46.0 years) were included in this study. The patients had no symptoms of myelopathy or radiculopathy. A Philips Achieva 3-Tesla MRI with SE-type Single Shot EPI was used to obtain diffusion tensor images. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were measured as DTI parameters on axial sections of several cervical levels. Subjects were divided into two groups: >40 years (n=16) and ≤40 years (n=15). A paired t-test was used to compare significant differences between the groups. ADC and FA values were most stable on axial sections.ResultsFor all subjects, mean ADC and FA values were 1.06±0.09×10-3 mm2/sec and 0.68±0.05, respectively. ADC was significantly higher in subjects >40 years of age than in those ≤40 years. There was no significant difference in FA values between the two groups. The mean ADC value was significantly higher in normal subjects >40 years of age than in those ≤40 years.ConclusionsIt is important to consider age when evaluating cervical myelopathy by DTI.

Purpose: How to select operative methods for delayed paralysis after osteoporotic vertebral fracture remains a matter of debate. It is unclear which procedure provides better neurological and functional recovery. This study aimed to compare the various operative methods and investigate postoperative outcomes. Methods: The study included 42 delayed paralysis patients (mean age 73.7 years). The operative methods were posterior spinal shortening osteotomy with direct decompression and short or long fusion and posterior laminectomy and short fusion with vertebroplasty. All patients in the vertebroplasty group were fitted with hooks to prevent correction loss. We investigated postoperative complications, surgery time, intraoperative blood loss, and changes in walking ability and local kyphotic angle (LKA). Patients were divided into three groups: shortening with a peripheral fusion range of one intervertebral level (the SS group, n = 18), the same procedure with a peripheral fusion range of ≥2 intervertebral levels (the SL group, n = 12), and posterior laminectomy and short fusion with vertebroplasty (the VP group, n = 12). Results: Postoperative complications were observed in five patients, all of whom were in the SS and SL group. There were no significant differences between the SS and SL groups. The VP group experienced significantly shorter mean surgery times, significantly lower mean intraoperative blood loss, and an improvement in paralysis, walking ability, LKA, and correction loss. Overall, the VP group had significantly better outcomes. Conclusion: Posterior laminectomy and short fusion with vertebroplasty with the addition of hooks is useful in cases of delayed paralysis in elderly patients.

Study DesignMulticenter prospective study with a crossover design.PurposeThe objective of this study is to compare the efficacy of limaprost alfadex (LP) and elcatonin (EL) for lumbar spinal stenosis (LSS) patients with concurrent osteoporosis.Overview of LiteratureIt has been increasingly important to improve quality of life by establishing appropriate conservative treatments for LSS patients with concurrent osteoporosis who will presumably continue to increase due to the percentage of the aging elevations, however there is no prospective study.MethodsA total of 19 patients with LSS and concurrent osteoporosis were enrolled in this study. The patients were divided into two groups and compared using a crossover design. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and short-form (SF)-8 health survey scale were used for clinical evaluations.ResultsThere was a significant improvement of buttock-leg pain and numbness in the EL group. A significant improvement of impaired walking function was noted for the LP group according to the JOABPEQ while the rest of the items in the JOABPEQ showed no significant differences. The SF-8 health survey revealed that somatic pains and physical summary scores in the EL group and physical functioning and physical summary scores in the LP group tended to improve but not to any statistically significant extents.ConclusionsConcomitant uses of EL may be useful in patients who do not respond satisfactorily to the treatments of LP for 6-8 weeks.

Cross sectional data from the Yamaguchi low back pain study conducted in Yamaguchi prefecture, Japan, was used for this analysis.A total of 320 patients were recruited from walk-in orthopedic clinics in Yamaguchi Prefecture, Japan. Patients visited the clinics primarily for low back pain (LBP) and sought treatment between April and May 2015. A self-questionnaire was completed by patients, while radiographic testing and neurological and physical examination was performed by the orthopedist in each hospital. The cause and characters of LBP was determined following examination of the data, regional anesthesia and block injection.'Specific LBP' was diagnosed in 250 (78%) patients and non-diagnosable, 'non-specific LBP' in 70 (22%) patients. The VAS scores of patients were: LBP, 5.8±0.18; leg pain, 2.9±0.18 and the intensity of leg numbness was 1.9±0.16. Item scores for SF-8 were: general health, 46.6±0.40; physical function, 43.5±0.51; physical limitations, 42.8±0.53; body pain, 42.1±0.52; vitality, 48.4±0.37; social function, 46.9±0.53; emotional problems, 48.9±0.43; mental health, 46.9±0.43.The incidence of non-specific LBP in Japan was lower than previous reports from western countries, presumably because of variation in the diagnosis of LBP between different health care systems. In Japan, 78% of cases were classified as 'specific LBP' by orthopedists. Identification of the definitive cause of LBP should help to improve the quality of LBP treatment.