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Nakajima Y, Nagai S, Michikawa T, Hachiya K, Ito K, Takeda H, Kawabata S, Yoshioka A, Ikeda D, Kaneko S, Hachiya Y, Fujita N. Predictors of Patient Dissatisfaction after Lumbar Spinal Canal Stenosis Surgery: A Multicenter Retrospective Study. Spine Surg Relat Res 2024; 8:322-329. [PMID: 38868782 PMCID: PMC11165491 DOI: 10.22603/ssrr.2023-0256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/25/2023] [Indexed: 06/14/2024] Open
Abstract
Introduction Recently, patient satisfaction has gained prominence as a crucial measure for ensuring patient-centered care. Furthermore, patient satisfaction after lumbar spinal canal stenosis (LCS) surgery is an important metric for physician's decision of surgical indication and informed consent to patient. This study aimed to elucidate how patient satisfaction changed after LCS surgery to identify factors that predict patient dissatisfaction. Methods We retrospectively reviewed time-course data of patients aged ≥40 years who underwent LCS surgery at multiple hospitals. The participants completed the Zurich Claudication Questionnaire (ZCQ) and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) before surgery and then 6 months and 1 year postsurgery. Patient satisfaction was categorized according to the postoperative score of the satisfaction domain of the ZCQ: satisfied, score ≤2.0; moderately satisfied, 2.0< score ≤2.5; and dissatisfied, score >2.5. Results The study enrolled 241 patients. Our data indicated a satisfaction rate of around 70% at 6 months and then again 1 year after LCS surgery. Among those who were dissatisfied 6 months after LCS surgery, 47.6% were more satisfied 1 year postsurgery. Furthermore, 86.2% of those who were satisfied 6 months after LCS surgery remained satisfied at 1 year. Multivariable analysis revealed that age (relative risk, 0.5; 95% confidence interval, 0.2-0.8) and preoperative score of psychological disorders on the JOABPEQ (relative risk, 0.2; 95% confidence interval, 0.03-0.08) were significantly associated with LCS surgery dissatisfaction. In addition, the receiver operating characteristic curve analysis revealed that the cutoff value for the preoperative score of psychological disorder of the JOABPEQ was estimated at 40 for LCS surgery dissatisfaction. Conclusions Age and psychological disorders were identified as significant predictors of dissatisfaction, with a JOABPEQ cutoff value providing potential clinical applicability.
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Affiliation(s)
- Yukio Nakajima
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Sota Nagai
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - Kurenai Hachiya
- Department of Orthopaedic Surgery, Hachiya Orthopaedic Hospital, Nagoya, Japan
| | - Kei Ito
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Hiroki Takeda
- Department of Spine and Spinal Cord Surgery, Fujita Health University, Toyoake, Japan
| | - Soya Kawabata
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Atsushi Yoshioka
- Department of Orthopaedic Surgery, Hachiya Orthopaedic Hospital, Nagoya, Japan
| | - Daiki Ikeda
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Shinjiro Kaneko
- Department of Spine and Spinal Cord Surgery, Fujita Health University, Toyoake, Japan
| | - Yudo Hachiya
- Department of Orthopaedic Surgery, Hachiya Orthopaedic Hospital, Nagoya, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
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Sugimoto S, Nagai S, Ito K, Takeda H, Kawabata S, Michikawa T, Ikeda D, Kaneko S, Fujita N. The Impact of Frailty on Surgical Outcome of Patients with Lumbar Spinal Canal Stenosis. Spine Surg Relat Res 2024; 8:188-194. [PMID: 38618213 PMCID: PMC11007249 DOI: 10.22603/ssrr.2023-0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/13/2023] [Indexed: 04/16/2024] Open
Abstract
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.
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Affiliation(s)
- Saiki Sugimoto
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Sota Nagai
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Kei Ito
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Hiroki Takeda
- Department of Spine and Spinal Cord Surgery, Fujita Health University, Toyoake, Japan
| | - Soya Kawabata
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - Daiki Ikeda
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Shinjiro Kaneko
- Department of Spine and Spinal Cord Surgery, Fujita Health University, Toyoake, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
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Minetama M, Kawakami M, Teraguchi M, Nakagawa M, Yamamoto Y, Sakon N, Nakatani T, Matsuo S, Nakagawa Y. Minimal clinically important differences in walking capacity and physical activity after nonsurgical treatment in patients with lumbar spinal stenosis: a secondary analysis of a randomized controlled trial. Spine J 2024; 24:256-262. [PMID: 37871657 DOI: 10.1016/j.spinee.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/02/2023] [Accepted: 10/16/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND CONTEXT Little information is available about the minimal clinically important differences (MCIDs) for objective physical measurements in people with lumbar spinal stenosis (LSS). PURPOSE To use disorder-specific anchor and, multiple anchor-, and distribution-based approaches to determine the MCIDs for walking capacity and physical activity in patients with LSS receiving nonsurgical treatment. STUDY DESIGN/SETTING Secondary analysis of a randomized controlled trial. PATIENT SAMPLE Sixty-nine patients with neurogenic claudication caused by LSS receiving outpatient physical therapy. OUTCOME MEASURES Zurich claudication questionnaire (ZCQ), self-paced walking test (SPWT), and number of daily steps measured by pedometry. METHODS All patients completed the ZCQ, SPWT, and pedometry at the baseline and after 6 weeks. For the anchor-based approach, ZCQ symptom severity, physical function, and satisfaction subscales were used as the external anchors. Using the receiver-operating characteristic (ROC) curve, the MCIDs were determined based on the optimal cutoff points for changes in the SPWT or daily steps. For the distribution-based approach, the MCIDs were estimated from the standard deviations (SDs) of the baseline scores of the SPWT and daily steps. RESULTS In the anchor-based approach, only the ZCQ satisfaction subscale for the SPWT (0.73), and ZCQ symptom severity subscale for daily steps (0.71) exceeded the area under the ROC curve value of 0.7, which is considered acceptable. When using these subscales as anchors, the ROC curves and optimal cutoff points indicated MCIDs of 151 m for the SPWT and 1,149 steps for daily steps. The distribution-based approach estimated the MCIDs as 280 m for the SPWT and 1,274 steps for daily steps, and had a moderate effect size (0.5 SD). CONCLUSIONS The anchor-based approach had limited external responsiveness when the ZCQ was used as the anchor. However, this information may be helpful for interpreting walking capacity and physical activity in patients with LSS receiving nonsurgical treatment and for estimating power and sample size when planning new trials.
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Affiliation(s)
- Masakazu Minetama
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama 649-7113, Japan.
| | - Mamoru Kawakami
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama 649-7113, Japan; Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan, 45 Jyunibancho, Wakayama city, Wakayama, 640-8158, Japan
| | - Masatoshi Teraguchi
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama 649-7113, Japan
| | - Masafumi Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama 649-7113, Japan
| | - Yoshio Yamamoto
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama 649-7113, Japan
| | - Nana Sakon
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama 649-7113, Japan
| | - Tomohiro Nakatani
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama 649-7113, Japan
| | - Sachika Matsuo
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama 649-7113, Japan
| | - Yukihiro Nakagawa
- Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Ito-gun, Wakayama 649-7113, Japan
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Nagai S, Kawabata S, Michikawa T, Ito K, Takeda H, Ikeda D, Kaneko S, Fujita N. Association between frailty and locomotive syndrome in elderly patients with lumbar spinal stenosis: A retrospective longitudinal analysis. Geriatr Gerontol Int 2024; 24:116-122. [PMID: 38140947 DOI: 10.1111/ggi.14785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/23/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023]
Abstract
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.
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Affiliation(s)
- Sota Nagai
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Soya Kawabata
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - Kei Ito
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Hiroki Takeda
- Department of Spine and Spinal Cord Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Daiki Ikeda
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Shinjiro Kaneko
- Department of Spine and Spinal Cord Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan
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Sun C, Sun K, Wang S, Wang Y, Yuan P, Li Z, Yang S, Zhang J, Jia Y, Wang W, Qi B, Yang B, Liu J, Wei X, Zhu L. Effect of Baimai ointment on lumbar disc herniation: A multicentre, prospective, randomised, double-blind, placebo-controlled trial. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 122:155138. [PMID: 37922792 DOI: 10.1016/j.phymed.2023.155138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/21/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Baimai ointment is a traditional Tibetan topical ointment, which is widely used for various diseases related to the skeletal muscular system and neurological rehabilitation. It has demonstrated good clinical effectiveness. However, there is currently a lack of high-quality evidence regarding the clinical effectiveness of Baimai ointment in treating lumbar disc herniation (LDH). PURPOSE In this study, we conducted a prospective, multicenter, double-blind, randomized controlled trial at eight hospitals in China to investigate the clinical effectiveness of Baimai ointment in the treatment of LDH. METHODS Participants aged 18-65 years were diagnosed as LDH and were randomly assigned to receive either Baimai ointment or placebo. The treatment duration was 2 weeks, with 1-week follow-up after treatment. The primary outcome measures included VAS and JOA score. The secondary outcome measures included Likert scale, compliance with health education and the incidence of rescue therapy. The intervention effects on these outcomes were examined by generalized estimating equations (GEE) with baseline measurement as the covariates. All statistical analysis were performed using SPSS 25.0 and Python 3.11. RESULTS In total, 228 participants were screened from August 25, 2021 to January 31, 2022 at 8 Grade-A tertiary hospitals in China. Finally, 194 eligible participants were randomly assigned to the Baimai ointment group and placebo group in a 1:1 ratio. At the end of 2-week treatment (14th day) and 1-week follow-up after treatment (21st day), the decrease of VAS reached 39.57% (95% CI: 34.29, 44.86) and 36.85% (95% CI: 32.04, 41.66), the decrease in JOA score reached 27.74% (95% CI: 23.05, 32.43) and 26.25 % (95% CI: 20.82, 31.69) in Baimai ointment group. A significant group-by-time interaction indicated a difference for VAS between intervention over time (χ2 = 26.81, p = 0.020), but JOA score and Likert scale did not reach statistical significance. The adjusted net difference of VAS was statistically significant from 10th day of treatment (p < 0.05). After 2-week treatment, the relief rate of VAS was 30.85% (21.95, 41.34) in Baimai ointment group and 22.73% (14.75, 33.13) in placebo group (χ2 = 1.53, p = 0.217). It demonstrated Baimai ointment in improving VAS and JOA score was valuable from a clinical view by measuring MCID. Moreover, the Likert scale, the incidence of rescue therapy and compliance with health education did not reach statistical significance. There was no evidence showing that Baimai ointment could cause serious adverse reactions in treating patients with LDH. CONCLUSION Baimai ointment demonstrated significantly higher rates of symptom relief compared to the placebo for LDH patients, particularly in terms of relieving pain. Moreover, further high-quality randomized controlled trials were necessary to confirm these positive results. The study protocol is registered with the Clinical Trials Registry (registration number: ISRCTN11912818).
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Affiliation(s)
- Chuanrui Sun
- Wang Jing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, China
| | - Kai Sun
- Wang Jing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, China
| | - Shangquan Wang
- Wang Jing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, China
| | - Yanguo Wang
- Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300250, China
| | - Puwei Yuan
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, 712000, China
| | - Zhenhua Li
- Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, 130012, China
| | - Shaofeng Yang
- The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, 410007, China
| | - Jianhua Zhang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230031, China
| | - Yusong Jia
- Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Wei Wang
- Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Baoyu Qi
- Wang Jing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, China
| | - Bowen Yang
- Wang Jing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, China
| | - Jianping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Xu Wei
- Wang Jing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, China; Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Liguo Zhu
- Wang Jing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, China.
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Nakajima Y, Hachiya K, Michikawa T, Nagai S, Takeda H, Kawabata S, Yoshioka A, Kimata H, Ikeda D, Kaneko S, Ohno Y, Hachiya Y, Fujita N. Impact of surgical treatment on lipid metabolism in patients with lumbar spinal disorders: Prospective observational study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4153-4161. [PMID: 37837558 DOI: 10.1007/s00586-023-07976-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/02/2023] [Accepted: 09/26/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE It is still unclear how lumbar spinal surgery affects the lipid metabolism of patients with lumbar spinal disorders (LSDs) such as lumbar spinal canal stenosis and lumbar disk herniation. The present study aimed to assess the impact of lumbar spinal surgery on lipid metabolism in patients with LSDs and clarify the factors associated with changes in visceral fat (VF) accumulation before and after lumbar spinal surgery. METHODS Consecutive patients with lumbar spinal surgery for LSDs were prospectively included. Abdominal computed tomography images and blood examination of the participants were evaluated before surgery and at 6 months and 1 year after surgery. The cross-sectional VF area (VFA) was measured at the level of the navel using computed tomography images. Blood examination items included triglycerides and high-density lipoprotein (HDL). RESULTS The study enrolled a total of 138 patients. Female patients with LSDs had significantly increased VFA and serum triglyceride levels after lumbar spinal surgery. On multivariable analysis, the group with > 100 cm2 of preoperative VFA and a postoperative decrease in VFA had a significantly worse preoperative walking ability based on the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (relative risk 2.1; 95% confidence intervals 1.1-4.1). CONCLUSIONS The present study demonstrated that patients with LSDs did not necessarily improve their lipid metabolism after lumbar spinal surgery. Instead, female patients with LSDs had significantly deteriorated lipid metabolism after lumbar spinal surgery. Finally, a worse preoperative walking ability was associated with the improvement in excess VF accumulation after lumbar spinal surgery.
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Affiliation(s)
- Yukio Nakajima
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Kurenai Hachiya
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
- Department of Orthopaedic Surgery, Hachiya Orthopaedic Hospital, 2-4, Nagoya, Japan
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - Sota Nagai
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Hiroki Takeda
- Department of Spine and Spinal Cord Surgery, Fujita Health University, Toyoake, Japan
| | - Soya Kawabata
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Atsushi Yoshioka
- Department of Orthopaedic Surgery, Hachiya Orthopaedic Hospital, 2-4, Nagoya, Japan
| | | | - Daiki Ikeda
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Shinjiro Kaneko
- Department of Spine and Spinal Cord Surgery, Fujita Health University, Toyoake, Japan
| | - Yoshiharu Ohno
- Department of Radiology, School of Medicine, Fujita Health University, Toyoake, Japan
- Joint Research Laboratory of Advanced Medical Imaging, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yudo Hachiya
- Department of Orthopaedic Surgery, Hachiya Orthopaedic Hospital, 2-4, Nagoya, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan.
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Akeda K, Yamada J, Takegami N, Fujiwara T, Murata K, Kono T, Sudo T, Imanishi T, Kurata T, Kawakita E, Sakakibara T, Kondo T, Takegami K, Sato M, Sudo A. Central sensitization as a predictive factor for the surgical outcome in patients with lumbar spinal stenosis: a multicenter prospective study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4200-4209. [PMID: 37010610 DOI: 10.1007/s00586-023-07687-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/05/2023] [Accepted: 03/24/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE The impact of central sensitization (CS) on neurological symptoms and surgical outcomes in patients with lumbar spinal stenosis (LSS) remains unknown. This study aimed to investigate the influence of preoperative CS on the surgical outcomes of patients with LSS. METHODS A total of 197 consecutive patients with LSS (mean age 69.3) who underwent posterior decompression surgery with or without fusion were included in this study. The participants completed the CS inventory (CSI) scores and the following clinical outcome assessments (COAs) preoperatively and 12 months postoperatively: the Japanese Orthopaedic Association (JOA) score for back pain, JOA back pain evaluation questionnaire, and Oswestry Disability Index (ODI). The association between preoperative CSI scores and preoperative and postoperative COAs was analyzed, and postoperative changes were statistically evaluated. RESULTS The preoperative CSI score significantly decreased at 12 months postoperatively and was significantly correlated with all COAs preoperatively and 12 months postoperatively. Higher preoperative CSI showed worse postoperative COAs and inferior postoperative improvement rates in the JOA score, VAS score for neurological symptoms, and ODI. Multiple regression analysis demonstrated that preoperative CSI was significantly associated with postoperative low back pain (LBP), mental health, quality of life (QOL), and neurological symptoms at 12 months postoperatively. CONCLUSIONS Preoperative CS evaluated by CSI had a significantly worse impact on surgical outcomes, including neurological symptoms, disability, and QOL, especially related to LBP and psychological factors. CSI can be used clinically as a patient-reported measure for predicting postoperative outcomes in patients with LSS.
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Affiliation(s)
- Koji Akeda
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
- Department of Orthopedic Surgery, Iwasaki Hospital, Tsu, Japan.
| | - Junichi Yamada
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
- Department of Orthopedic Surgery, Iwasaki Hospital, Tsu, Japan
| | - Norihiko Takegami
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Tatsuhiko Fujiwara
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Koichiro Murata
- Department of Orthopedic Surgery, Tomidahama Hospital, Yokkaichi, Japan
| | - Toshibumi Kono
- Department of Orthopedic Surgery, Tomidahama Hospital, Yokkaichi, Japan
| | - Takao Sudo
- Department of Orthopedic Surgery, Murase Hospital, Suzuka, Japan
| | - Takao Imanishi
- Department of Orthopedic Surgery, Murase Hospital, Suzuka, Japan
| | - Tatsuya Kurata
- Department of Orthopedic Surgery, Takeuchi Hospital, Tsu, Japan
| | - Eiji Kawakita
- Department of Orthopedic Surgery, Saiseikai Matsusaka General Hospital, Matsusaka, Japan
| | | | - Tetsushi Kondo
- Department of Orthopedic Surgery, Murase Hospital, Suzuka, Japan
| | - Kenji Takegami
- Department of Orthopedic Surgery, Saiseikai Matsusaka General Hospital, Matsusaka, Japan
| | - Masayoshi Sato
- Department of Orthopedic Surgery, Iga City General Hospital, Iga, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
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8
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Akeda K, Hasegawa T, Togo Y, Watanabe K, Kawaguchi K, Yamada J, Takegami N, Fujiwara T, Sudo A. Quantitative Analysis of Lumbar Disc Bulging in Patients with Lumbar Spinal Stenosis: Implication for Surgical Outcomes of Decompression Surgery. J Clin Med 2023; 12:6172. [PMID: 37834816 PMCID: PMC10573634 DOI: 10.3390/jcm12196172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/16/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
This study aimed to quantitatively assess disc bulging using computed tomography (CT) in patients with lumbar spinal stenosis (LSS) and to examine whether disc bulging affects the surgical outcomes of patients with LSS after posterior decompression surgery. Sixty-three patients who underwent posterior decompression surgery for LSS were included. The extent of disc bulging was evaluated as the percentage of the extended area of the disc against the endplate area (%EAD) on axial CT images. The participants completed the following clinical outcome assessments (COAs) preoperatively and 12 months postoperatively: the JOA Back Pain Evaluation Questionnaire (JOABPEQ), Oswestry Disability Index (ODI), and Roland-Morris Disability Questionnaire (RDQ). The mean %EAD of 315 intervertebral discs was 18.9 ± 8.0. The %EAD was highest at L4/L5, followed by L3/L4, L2/L3, L1/L2, and L5/S1. The %EAD of the surgical level showed no significant correlation with all the preoperative COAs, but it had significant correlation with lumbar function, walking ability, social function domains of the JOABPEQ, ODI score, and RDQ score 12 months postoperatively. %EAD was significantly associated with the postoperative score in the walking ability domain of the JOABPEQ. %EAD affects postoperative clinical outcomes, including low back pain-related quality of life after decompression surgery.
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Affiliation(s)
- Koji Akeda
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Japan; (T.H.); (Y.T.); (K.W.); (K.K.); (J.Y.); (N.T.); (T.F.); (A.S.)
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9
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Inoue G. The Essence of Clinical Practice Guidelines for Lumbar Spinal Stenosis, 2021: 4. Surgical Treatment. Spine Surg Relat Res 2023; 7:308-313. [PMID: 37636139 PMCID: PMC10447186 DOI: 10.22603/ssrr.2022-0209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 08/29/2023] Open
Affiliation(s)
- Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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10
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Kawabata S, Akeda K, Yamada J, Takegami N, Fujiwara T, Fujita N, Sudo A. Advances in Platelet-Rich Plasma Treatment for Spinal Diseases: A Systematic Review. Int J Mol Sci 2023; 24:ijms24087677. [PMID: 37108837 PMCID: PMC10145581 DOI: 10.3390/ijms24087677] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
Spinal diseases are commonly associated with pain and neurological symptoms, which negatively impact patients' quality of life. Platelet-rich plasma (PRP) is an autologous source of multiple growth factors and cytokines, with the potential to promote tissue regeneration. Recently, PRP has been widely used for the treatment of musculoskeletal diseases, including spinal diseases, in clinics. Given the increasing popularity of PRP therapy, this article examines the current literature for basic research and emerging clinical applications of this therapy for treating spinal diseases. First, we review in vitro and in vivo studies, evaluating the potential of PRP in repairing intervertebral disc degeneration, promoting bone union in spinal fusion surgeries, and aiding in neurological recovery from spinal cord injury. Second, we address the clinical applications of PRP in treating degenerative spinal disease, including its analgesic effect on low back pain and radicular pain, as well as accelerating bone union during spinal fusion surgery. Basic research demonstrates the promising regenerative potential of PRP, and clinical studies have reported on the safety and efficacy of PRP therapy for treating several spinal diseases. Nevertheless, further high-quality randomized controlled trials would be required to establish clinical evidence of PRP therapy.
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Affiliation(s)
- Soya Kawabata
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan
| | - Koji Akeda
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Junichi Yamada
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Norihiko Takegami
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Tatsuhiko Fujiwara
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
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11
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Imai T, Nagai S, Michikawa T, Inagaki R, Kawabata S, Ito K, Hachiya K, Takeda H, Ikeda D, Yamada S, Fujita N, Kaneko S. Impact of Lumbar Surgery on Pharmacological Treatment for Patients with Lumbar Spinal Canal Stenosis: A Single-Center Retrospective Study. J Clin Med 2023; 12:jcm12062385. [PMID: 36983385 PMCID: PMC10056014 DOI: 10.3390/jcm12062385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/08/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Treatment for lumbar spinal canal stenosis (LSCS) is mainly classified into conservative and surgical therapies. Among conservative therapies, pharmacological treatment is commonly prescribed for LSCS. Meanwhile, surgical treatment is the last option for LSCS. This study aimed to examine the impact of lumbar surgery on pharmacological treatment for patients with LSCS. Consecutive patients aged ≥ 40 years who underwent lumbar surgery for LSCS were identified. A total of 142 patients were retrospectively reviewed for preoperative and 6-month and 1-year postoperative LSCS medications. The results showed that the number of LSCS medications significantly decreased after lumbar surgery. The proportion of the patients taking non-steroidal anti-inflammatory drugs, pregabalin/mirogabalin, opioids, prostaglandin E1 analogs, and neurotropin was significantly decreased after lumbar surgery, but that of the patients taking mecobalamin, acetaminophen, and serotonin-noradrenalin reuptake inhibitors was not significantly changed. Additionally, around 15% of the participants showed an increase in LSCS medications even after lumbar surgery. Multivariable analysis revealed that individuals without improvements in walking ability (RR: 2.7, 95% CI: 1.3-5.9) or social life (RR: 2.3, 95% CI: 1.1-5.0) had a greater risk of a postoperative increase in LSCS medications. The study results may provide physicians with beneficial information on treatment for LSCS.
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Affiliation(s)
- Takaya Imai
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
- Department of Spine and Spinal Cord Surgery, Fujita Health University, Toyoake 470-1192, Japan
| | - Sota Nagai
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo 143-8541, Japan
| | - Risa Inagaki
- Department of Clinical Pharmacy, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Soya Kawabata
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Kaori Ito
- Department of Clinical Pharmacy, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
- Department of Hematology, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Kurenai Hachiya
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Hiroki Takeda
- Department of Spine and Spinal Cord Surgery, Fujita Health University, Toyoake 470-1192, Japan
| | - Daiki Ikeda
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Shigeki Yamada
- Department of Clinical Pharmacy, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Shinjiro Kaneko
- Department of Spine and Spinal Cord Surgery, Fujita Health University, Toyoake 470-1192, Japan
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12
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Azizpour K, Birch NC, Peul WC. No need to add fusion to lumbar decompression for stenosis. Bone Joint J 2022; 104-B:1281-1283. [DOI: 10.1302/0301-620x.104b12.bjj-2022-1131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Kayoumars Azizpour
- Department of Neurosurgery, University Neurosurgical Center Holland, UMC
- HMC
- HAGA, Leiden & The Hague, the Netherlands
- Department of Orthopedics, Leiden University Medical Center, Leiden, the Netherlands
- Department of Orthopedics, Alrijne Hospital, Leiden, the Netherlands
| | - Nick C. Birch
- East Midlands Spine, Bragborough Hall Health and Wellbeing Centre, Daventry, UK
| | - Wilco C. Peul
- Department of Neurosurgery, University Neurosurgical Center Holland, UMC
- HMC
- HAGA, Leiden & The Hague, the Netherlands
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