The efficacy of surgical treatment on locomotive syndrome and physical function in patients with lumbar spinal canal stenosis

Assessment of Surgical Outcomes in Patients with Degenerative Cervical Myelopathy Using the 25-Question Geriatric Locomotive Function Scale: A Longitudinal Observational Study

Introduction

Locomotive syndrome caused by degenerative musculoskeletal diseases is reported to improve with surgical treatment. However, it is unclear whether surgical treatment is effective for the locomotive syndrome developing in patients with degenerative cervical myelopathy (DCM). Thus, this study primarily aimed to longitudinally assess the change in locomotive syndrome stage before and after cervical spinal surgery for patients with DCM using the 25-question geriatric locomotive function scale (GLFS-25). A secondary objective was to identify factors associated with the postoperative improvement in the locomotive syndrome stage.

Methods

We retrospectively reviewed clinical data of patients undergoing cervical spine surgery at our institution from April 2020 to May 2022 who had answered the Japanese Orthopaedic Association Cervical Myelopathy Assessment Questionnaire, visual analog scale, and GLFS-25 preoperatively and at 6 months and 1 year postoperatively. We collected demographic data, medical history, preoperative radiographic parameters, presence or absence of posterior longitudinal ligament ossification, and surgical data.

Results

We enrolled 115 patients (78 men and 37 women) in the present study. Preoperatively, using the GLFS-25, 73.9% of patients had stage 3, 10.4% had stage 2, 9.6% had stage 1, 6.1% had no locomotive syndrome. The stage distribution of locomotive syndrome improved significantly at 6-months and 1-year postoperatively. The multivariable Poisson regression analysis revealed that better preoperative lower extremity function (relative risk: 3.0; 95% confidence interval: 1.01-8.8) was significantly associated with postoperative improvement in the locomotive syndrome stage.

Conclusions

This is the first study to longitudinally assess the locomotive syndrome stage in patients with DCM using GLFS-25. Our results indicated that patients with DCM experienced significant improvement in the locomotive syndrome stage following cervical spine surgery. Particularly, the preoperative lower extremity function was significant in postoperative improvement in the locomotive syndrome stage.

The Impact of Frailty on Surgical Outcome of Patients with Lumbar Spinal Canal Stenosis

Introduction

Frailty is an important factor in surgical outcomes. The current study aimed to evaluate the effect of preoperative frailty on postoperative outcomes in older patients with lumbar spinal canal stenosis (LSCS).

Methods

We retrospectively examined 209 patients aged ≥65 years who underwent surgery for LSCS. Health-related quality-of-life (HRQOL) tools, including the Roland-Morris Disability Questionnaire (RDQ), Zurich Claudication Questionnaire (ZCQ), and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), were used in the assessment conducted before surgery and at 6 months and 1 year after surgery. Frailty was categorized based on the 11-item modified frailty index (mFI-11). Patients with mFI-11 of 0, <0.21, and >0.21 were classified under the robust (R), pre-frailty (P), and frailty (F) groups, respectively.

Results

According to the mFI-11, 24, 138, and 47 patients were included in the R, P, and F groups, respectively. Regarding preoperative radiographic parameters, there was a remarkable increase in the sagittal vertical axis and a significant decrease in the development of lumbar lordosis with frailty progression. The preoperative scores of RDQ and ZCQ, and lumbar function, walking ability, social life, and psychological disorder domain scores of JOABPEQ differed significantly among these groups. The frequency of revision surgery was not higher in the F group than in the other groups. After adjustment for factors have shown different distributions among the three groups, the frequency of effective surgical cases did not show a clear trend among the three groups in all domains of the JOABPEQ.

Conclusions

The preoperative HRQOL scores and the radiographic parameters of patients with LSCS worsened with frailty severity. However, frailty did not affect the rate of revision surgery and surgical efficacy in patients with LSCS. Although this study has limitations, our findings indicated that even LSCS patients with frailty can be considered for surgery if they have an indication for LSCS surgery.

Association between frailty and locomotive syndrome in elderly patients with lumbar spinal stenosis: A retrospective longitudinal analysis

AIMS

With the aging society worldwide, lumbar spinal stenosis (LSS) has become common, and its incidence has been increasing worldwide. Frailty and locomotive syndrome significantly overlap as disorders in older people. The current study aimed to validate the association between frailty and locomotive syndrome in patients with LSS. In particular, the involvement of frailty in locomotive syndrome following surgery was examined.

METHODS

We retrospectively reviewed the time-course data of consecutive patients aged ≥65 years who underwent lumbar spinal surgery for LSS. The locomotive syndrome stages were determined using the 25-Question Geriatric Locomotive Function Scale: stage 0, score ≤6; stage 1, score ≥7; stage 2, score ≥16; and Stage 3, score ≥24. Robust, pre-frailty, and frailty were defined as a modified frailty index-11 score of 0, <0.21, and >0.21, respectively.

RESULTS

This study included 234 patients. All patients except one were diagnosed with locomotive syndrome preoperatively. Approximately 24.8% of participants were diagnosed with frailty. LSS surgery improved locomotive syndrome regardless of frailty severity. Meanwhile, multivariable analysis indicated that frailty could significantly inhibit improvement in locomotive syndrome after surgery in old patients with LSS (estimated relative risk: 0.6; 95% confidence interval: 0.4-0.9).

CONCLUSIONS

This study first assessed the association between locomotive syndrome and frailty in patients with LSS. Locomotive syndrome could be managed effectively with surgery regardless of frailty severity in old patients with LSS. However, our findings emphasize the need to screen for frailty preoperatively in this patient group. Geriatr Gerontol Int 2024; 24: 116-122.

Locomotive syndrome affects the acquisition of long-term care insurance system certification

BACKGROUND

Locomotive syndrome is closely related to the state of long-term care. This study aimed to longitudinally evaluate long-term care certification occurrence in locomotive syndrome using data from the Miyagawa study.

METHODS

The study included 470 individuals (168 males, 302 females; mean age, 70.7 years) with no long-term care certification at the time of participation in the study. Locomotive syndrome was classified into three stages (stages 1-3) according to the 25-question Geriatric Locomotive Function Scale. Analysis was performed with long-term care certification occurrence as the endpoint and locomotive syndrome stage as the explanatory variable.

RESULTS

The median observation period was 6.3 years, and long-term care certification occurred in 69 (34.2%) and 30 (11.2%) of the participants in the locomotive syndrome and no-locomotive syndrome groups, respectively. Independent risk factors of long-term care certification occurrence were locomotive syndrome stage-3 (hazard ratio: 2.27) in the total number of studies, and locomotive syndrome stages 2 (hazard ratio: 2.49) and 3 (hazard ratio: 2.79) in females. Locomotive syndrome stage-3 was an independent risk factor in long-term care certification occurrence due to musculoskeletal disorders (hazard ratio: 3.89).

CONCLUSIONS

The higher the locomotive syndrome stage, especially in females, the higher the risk of long-term care certification occurrence.

Impact of spinal surgery on locomotive syndrome in patients with lumbar spinal stenosis in clinical decision limit stage 3: a retrospective study

BACKGROUND

Locomotive syndrome (LS) is characterized by reduced mobility. Clinical decision limit (CDL) stage 3 in LS indicates physical frailty. Lumbar spinal canal stenosis (LSS) is one of the causes of LS, for which lumbar surgery is considered to improve the CDL stage. This study aimed to investigate the efficacy of lumbar surgery and independent factors for improving the CDL stage in patients with LSS.

METHODS

This retrospective study was conducted at the Department of Orthopaedic Surgery at our University Hospital. A total of 157 patients aged ≥ 65 years with LSS underwent lumbar surgery. The 25-Question Geriatric Locomotive Function scale (GLFS-25) was used to test for LS, and the Timed Up and Go test (TUG) was used to evaluate functional ability. Lower limb pain was evaluated using a visual analog scale. Patients with at least one improvement in the CDL stage following lumbar surgery were included in the improvement group. Differences in lower limb pain intensity between the groups were evaluated using the Wilcoxon rank-sum test. The Spearman's rank correlation coefficient was used to determine correlations between Δ lower limb pain and Δ GLFS-25. Logistic regression analysis was used to identify factors associated with improvement in LS.

RESULTS

The proportion of patients with improved CDL stage was 45.1% (improvement/non-improvement: 32/39). Δ Lower limb pain was significantly reduced in the improvement group compared with that in the non-improvement group (51.0 [36.3-71.0] vs 40.0 [4.0-53.5]; p = 0.0107). Δ GLFS-25 was significantly correlated with Δ lower limb pain (r = 0.3774, p = 0.0031). Multiple logistic regression analysis revealed that TUG and age were significantly associated with improvement in LS (odds ratio, 1.22; 95% confidence interval: 1.07-1.47).

CONCLUSIONS

Lumbar surgery effectively improved the CDL stage in patients with LSS. In addition, TUG was an independent factor associated with improvement in the CDL.

Risk Factors that Hinder Locomotive Syndrome Improvement Following Surgery for Musculoskeletal Diseases in Older Patients: A Multicenter Prospective Study

OBJECTIVES

This study aimed to evaluate preoperative and postoperative locomotive syndrome (LS) in older adults undergoing surgical treatment for musculoskeletal diseases of the lumbar spine and lower extremities and identify risk factors that impede LS improvement after surgery.

METHODS

: The baseline evaluation included 471 patients 65 years or older (276 in the pre-old age [65-74 years] group; 195 in the old age [75 years or older] group) and examined the preoperative and postoperative LS data. The second evaluation performed to identify risk factors, including anthropometric measurements, comorbidity, and frailty, that hinder LS improvement after surgery included 378 patients with preoperative LS stage 3.

RESULTS

Preoperatively, 80% of the patients had LS stage 3; this rate decreased to 40% postoperatively. Half of the patients exhibited postoperative LS improvement. The LS improvement rate was higher in the pre-old age group than in the old age group. According to the multiple logistic regression analysis, old age, high body mass index, weak hand grip strength, and high 5-factor modified frailty index score were significant risk factors that hinder LS improvement after surgery.

CONCLUSIONS

Aging, obesity, weak muscle strength, and frailty can hinder LS improvement in older patients who undergo surgery.

Locomotive Syndrome and Lumbar Spine Disease: A Systematic Review

Locomotive syndrome (LS) is defined based on the Loco-Check, 25-question Geriatric Locomotive Function Scale (GLFS-25), 5-question Geriatric Locomotive Function Scale (GLFS-5), Stand-Up Test, Two-Step Test, or a total assessment (i.e., positive for one or more of the GLFS-25, Stand-Up Test, and Two-Step Test). Lumbar spine disease has been reported to be one of the most common musculoskeletal disorders leading to LS. We therefore conducted a systematic review via PubMed, Google Scholar, Cochrane Library, Web of Science, and MEDLINE, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 26 studies were considered to be eligible for inclusion in this systematic review. The GLFS-25 showed an association with low back pain, sagittal spinopelvic malalignment, and lumbar spinal stenosis but not vertebral fracture. The GLFS-5 showed an association with low back pain and lumbar spinal stenosis. The Loco-Check and Two-Step Test showed an association with low back pain, sagittal spinopelvic malalignment, and lumbar spinal stenosis. The Stand-Up Test showed no association with lumbar spinal stenosis. The total assessment showed an association with low back pain and lumbar spinal stenosis. Furthermore, the GLFS-25, Two-Step Test, and total assessment were improved by spinal surgery for lumbar spinal stenosis. The current evidence concerning the relationship between LS and lumbar spine disease still seems insufficient, so further investigations are required on this topic.

Surgery Can Improve Locomotive Syndrome Due to Lumbar Spinal Canal Stenosis and Loco-Check Can Predict Best Timing of Surgery to Avoid Progress of Locomotive Syndrome

Introduction

Methods

Results

Conclusions

Evaluation of locomotive syndrome in patients receiving surgical treatment for degenerative musculoskeletal diseases: A multicentre prospective study using the new criteria

OBJECTIVES

This study aimed to evaluate the condition of patients with locomotive syndrome (LS) and their improvement after undergoing surgery for degenerative musculoskeletal diseases using the new criteria, including stage 3.

METHODS

In total, 435 patients aged ≥40 years (167 middle-aged and 268 older) were divided into four groups based on the disease location: the lumbar (n = 118), hip (n = 191), knee (n = 80), and foot and ankle (n = 46) groups. Patients were evaluated by pre- and 1 year postoperative LS risk tests, including the stand-up test, two-step test, and 25-Question Geriatric Locomotive Function Scale.

RESULTS

The pre- and postoperative prevalence of LS stage 3 were 78% and 29%, respectively. The postoperative LS stage improved in 62% of patients (77% and 53% in the middle-aged and older groups, respectively). Overall, the knee group showed the worst results, and the foot and ankle groups showed the best pre- and postoperative results. The pre- and postoperative prevalence of LS stage 3 according to the 25-Question Geriatric Locomotive Function Scale were comparable to those based on the total assessment.

CONCLUSIONS

The new LS stage criteria are appropriate, and the 25-Question Geriatric Locomotive Function Scale is a good option for evaluating patients requiring surgery.

Lumbar Spinal Canal Stenosis from the Perspective of Locomotive Syndrome and Metabolic Syndrome: A Narrative Review

Patients with lumbar spinal canal stenosis (LSS) have impaired activities of daily living because of pain or motor paralysis, but no effective preventive treatment is currently available. The number of patients with LSS is predicted to continually increase as the average age of the global population increases. To provide a conceptual framework for improving healthy life expectancy, the Japanese Orthopaedic Association introduced the concept of locomotive syndrome, to which LSS is related. Ours and other studies have shown that LSS exacerbates locomotive syndrome and that surgical treatment is one method for improving it. Furthermore, we propose that the two-step test, a locomotive syndrome risk test, is effective for assessing the risk for falls and severity of LSS. Meanwhile, lumbar spinal epidural lipomatosis (LSEL), which is a manifestation of LSS, has been shown to be related to metabolic syndrome. Previous studies have suggested that the whole LSS can be also associated with metabolic syndrome. Although locomotive syndrome is very different from metabolic syndrome, which involves lipid metabolism, these two syndromes overlap, such as in LSS. Conducting research on LSS from the perspectives of both locomotive syndrome and metabolic syndrome may lead to novel methods for prevention and treatment of LSS and, conversely, may yield clues for resolving symptoms of the two syndromes. This review provides an overview of LSS from the perspective of locomotive syndrome and metabolic syndrome, along with findings from our research group.