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Takami M, Tsutsui S, Nagata K, Iwasaki H, Minamide A, Yukawa Y, Okada M, Taiji R, Murata S, Kozaki T, Hashizume H, Yamada H. Spinopelvic Parameters in the Elderly: Does Inadequate Correction Portend Worse Outcomes? Spine Surg Relat Res 2024; 8:439-447. [PMID: 39131407 PMCID: PMC11310528 DOI: 10.22603/ssrr.2023-0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/08/2024] [Indexed: 08/13/2024] Open
Abstract
Introduction This study aimed to compare the outcomes of corrective fusion for adult spinal deformity (ASD) in older people using two different sagittal correction goals: the conventional formula of "pelvic incidence (PI)-lumbar lordosis (LL) mismatch <10°" and an undercorrection strategy based on the range of 10°≤PI-LL≤20°. Methods A total of 102 consecutive patients (11 male and 91 female patients; mean age, 72.0 years) aged above 65 years with scoliosis >20° or LL<20° who had undergone long-segment fusion from the lower thoracic spine to the pelvis for ASD and had been followed-up for a minimum of two years at our institution since March 2013 were included in this retrospective study. After excluding patients with PI-LL≤-10° on postoperative standing radiographs, the remaining patients were divided into two groups: 31 patients with 10°≤PI-LL≤20° (U group) and 63 patients with -10° Results The incidence of proximal junctional kyphosis and mechanical failure was not significantly different between the groups (p=0.659 and 1.000, respectively). After excluding patients who underwent reoperation due to mechanical failure, there were no differences in the Oswestry Disability Index (ODI) and each domain of the Visual Analog Scale score, Scoliosis Research Society-22r patient questionnaire (SRS-22r), or the short form 36 health survey questionnaire at the final observation between the U (n=27) and M (n=57) groups. In addition, the non-inferiority and equivalence of the U group to the M group were demonstrated in all domains of the SRS-22r and ODI. Furthermore, the superiority of the U group was demonstrated by the functional domain of SRS-22r. Conclusions For the sagittal correction goal in corrective fusion surgery for ASD in the elderly, strict adherence to "PI-LL mismatch <10°" is not necessary and "PI-LL≤20°" may be acceptable.
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Affiliation(s)
- Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Keiji Nagata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Akihito Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
- Spine Center, Dokkyo Medical University Nikko Medical Center, Nikko, Japan
| | - Yasutsugu Yukawa
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
- Spine Center, Nagoya Kyoritsu Hospital, Nagoya, Japan
| | - Motohiro Okada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
- Department of Orthopaedic Surgery, Sumiya Orthopaedic Hospital, Wakayama, Japan
| | - Ryo Taiji
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Shizumasa Murata
- Department of Orthopaedic Surgery, Shingu Municipal Medical Center, Shingu, Japan
| | - Takuhei Kozaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
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Iwata S, Hashizume H, Yoshimura N, Oka H, Iwahashi H, Ishimoto Y, Nagata K, Teraguchi M, Kagotani R, Sasaki T, Tanaka S, Yoshida M, Yamada H. Osteoporosis, spinal degenerative disorders, and their association with low back pain, activities of daily living, and physical performance in a general population. Sci Rep 2024; 14:15860. [PMID: 38982114 PMCID: PMC11233640 DOI: 10.1038/s41598-024-64706-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 06/12/2024] [Indexed: 07/11/2024] Open
Abstract
Osteoporosis, vertebral fractures, and spinal degenerative diseases are common conditions that often coexist in older adults. This study aimed to determine the factors influencing low back pain and its impact on activities of daily living (ADL) and physical performance in older individuals with multiple comorbidities. This cross-sectional study was part of a large-scale population-based cohort study in Japan, involving 1009 participants who underwent spinal magnetic resonance imaging (MRI) to assess cervical cord compression, radiographic lumbar spinal stenosis, and lumbar disc degeneration. Vertebral fractures in the thoracolumbar spine were evaluated using sagittal MRI with a semi-quantitative method. Bone mineral density was measured using dual-energy X-ray absorptiometry. Low back pain, Oswestry Disability Index (ODI), and physical performance tests, such as one-leg standing time, five times chair-stand time, maximum walking speed, and maximum step length, were assessed. Using clinical conditions as objective variables and image evaluation parameters as explanatory variables, multiple regression analysis showed that vertebral fractures were significantly associated with low back pain and ODI. Vertebral fractures and osteoporosis significantly impacted physical performance, whereas osteoporosis alone did not affect low back pain or ODI. Our findings contribute to new insights into low back pain and its impact on ADL and physical performance.
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Affiliation(s)
- Shoei Iwata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
- Department of Orthopaedic Surgery, Wakayama Rosai Hospital, Wakayama City, Wakayama, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan.
- School of Health and Nursing Science, Wakayama Medical University, Wakayama City, Wakayama, Japan.
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, Faculty of Medicine, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Hiroyuki Oka
- Division of Musculoskeletal AI System Development, Graduate School of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Hiroki Iwahashi
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Yuyu Ishimoto
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Keiji Nagata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Masatoshi Teraguchi
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Ryohei Kagotani
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
- Department of Orthopaedic Surgery, Wakayama Rosai Hospital, Wakayama City, Wakayama, Japan
| | - Takahide Sasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Sakae Tanaka
- Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-Ku, Tokyo, Japan
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
- Department of Orthopedic Surgery, Sumiya Orthopedic Hospital, Wakayama City, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
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Tsutsui S, Hashizume H, Iwasaki H, Takami M, Ishimoto Y, Nagata K, Yamada H. Long-term Outcomes After Adult Spinal Deformity Surgery Using Lateral Interbody Fusion: Short Versus Long Fusion. Clin Spine Surg 2024:01933606-990000000-00262. [PMID: 38366331 DOI: 10.1097/bsd.0000000000001583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 01/22/2024] [Indexed: 02/18/2024]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To investigate long-term outcomes after short or long fusion for adult spinal deformity using lateral interbody fusion. SUMMARY OF BACKGROUND DATA Lateral interbody fusion is commonly used in adult spinal deformity surgery. Favorable short-term outcomes have been reported, but not long-term outcomes. Lateral interbody fusion with strong ability to correct deformity may allow the selection of short fusion techniques. MATERIALS AND METHODS We retrospectively reviewed adults who underwent this surgery with a minimum of 5 years of follow-up. Short fusion with the uppermost instrumented vertebra in the lumbar spine was performed in patients without degenerative changes at the thoracolumbar junction (S-group); others underwent long fusion with the uppermost instrumented vertebra in the thoracic spine (L-group). We assessed radiographic and clinical outcomes. RESULTS Short fusion was performed in 29 of 54 patients. One patient per group required revision surgery. Of the remainder, with similar preoperative characteristics and deformity correction between groups, correction loss (pelvic incidence-lumbar lordosis, P=0.003; pelvic tilt, P=0.005; sagittal vertical axis, P˂0.001) occurred within 2 years postoperatively in the S-group, and sagittal vertical axis continued to increase until the 5-year follow-up (P=0.021). Although there was a significant change in Oswestry disability index in the S-group (P=0.031) and self-image of Scoliosis Research Society 22r score in both groups (P=0.045 and 0.02) from 2- to 5-year follow-up, minimum clinically important differences were not reached. At 5-year follow-up, there was a significant difference in Oswestry Disability Index (P=0.013) and Scoliosis Research Society 22r scores (function: P=0.028; pain: P=0.003; subtotal: P=0.006) between the groups, but satisfaction scores were comparable and Oswestry Disability Index score (29.8%) in the S-group indicated moderate disability. CONCLUSIONS Health-related quality of life was maintained between 2- and 5-year follow-up in both groups. Short fusion may be an option for patients without degenerative changes at the thoracolumbar junction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Shunji Tsutsui
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
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Nagai T, Miyagami M, Okano I, Nakamura S, Okazaki Y, Sakamoto K, Kasai F, Kudo Y, Kawate N. Association of Spinal Alignment and Abdominal Circumference with Sarcopenia Status and Fall Risk in Patients with Osteoporosis: A Retrospective Study. Nutrients 2023; 15:nu15112571. [PMID: 37299534 DOI: 10.3390/nu15112571] [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: 04/08/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Since vertebral kyphosis and abdominal circumference are thought to influence sarcopenia and fall risk in osteoporosis, we evaluated sarcopenia and fall risk in patients with different measurements of abdominal circumference and sagittal longitudinal axis (SVA). In this post hoc study, 227 patients aged 65 years or more who visited an outpatient osteoporosis clinic were included in the analysis. Sarcopenia was determined from lean body mass, grip strength, and walking speed by dual energy X-ray absorptiometry; SVA (median 40 mm) and abdominal circumference (median 80 cm) were compared between the four groups, each divided into two groups. Nutritional management, falls, and fall anxiety scores were also examined. The incidence of sarcopenia was significantly increased in those with abdominal circumference < 80 cm in both the SVA < 40 mm and SVA ≥ 40 mm groups (p < 0.05). Nonetheless, the fall scores of those with SVA < 40 mm were lower than those of individuals with SVA ≥ 40 mm (p < 0.01). Based on the results of this study, SVA and abdominal circumference values may predict the risk of sarcopenia and falls. More research is needed before our results can be translated into clinical practice.
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Affiliation(s)
- Takashi Nagai
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo 142-866, Japan
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Makoto Miyagami
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Ichiro Okano
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Shota Nakamura
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Yuichiro Okazaki
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Keizo Sakamoto
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Fumihito Kasai
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Yoshifumi Kudo
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo 142-866, Japan
| | - Nobuyuki Kawate
- Department of Rehabilitation Medicine, Showa University School of Medicine, Tokyo 142-866, Japan
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Toivonen LA, Mäntymäki H, Häkkinen A, Kautiainen H, Neva MH. Postoperative Sagittal Balance Has Only a Limited Role in the Development of Adjacent Segment Disease After Lumbar Spine Fusion for Degenerative Lumbar Spine Disorders: A Subanalysis of the 10-year Follow-up Study. Spine (Phila Pa 1976) 2022; 47:1357-1361. [PMID: 35853095 PMCID: PMC9451944 DOI: 10.1097/brs.0000000000004400] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/01/2022] [Accepted: 03/14/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective additional analysis of a prospective follow-up study. OBJECTIVES We aimed to find out whether poor postoperative sagittal alignment increases revisions for adjacent segment disease (ASD) after lumbar spine fusion (LSF) performed for degenerative lumbar spine disease. SUMMARY OF BACKGROUND DATA Revisions for ASD accumulate over time after LSF for degenerative lumbar spine disease. The etiology of ASD is considered multifactorial. Yet, the role of postoperative sagittal balance in this process remains controversial. MATERIALS AND METHODS A total of 215 consecutive patients who had undergone an elective LSF surgery for spinal stenosis with (80%) or without (20%) spondylolisthesis were analyzed. Spinal reoperations were collected from the hospital records. Preoperative and postoperative sagittal alignment were evaluated from standing radiographs. The risk of revisions for ASD was evaluated by Cox proportional hazards regression models. RESULTS We did not find the poor postoperative balance [pelvic incidence-lumbar lordosis (LL) >9°] to significantly increase the risk of revisions for ASD: crude hazard ratio (HR)=1.5 [95% confidence interval (CI): 0.8-2.7], adjusted (by age, sex, pelvic incidence, fusion length, and the level of the caudal end of fusion): HR=1.7 (95% CI: 0.9-3.3). We found higher LL outside the fusion segment (LL-segmental lordosis) to decrease the risk of revisions for ASD: HR=0.9 (95% CI: 0.9-1.0). CONCLUSION Poor sagittal balance has only a limited role as a risk factor for the revisions for ASD among patients with degenerative spinal disease. However, the risk for ASD might be the greatest among patients with reduced spinal mobility.
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Affiliation(s)
- Leevi A. Toivonen
- Department of Orthopaedics and Trauma, Faculty of Medicine and Life Sciences and Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Heikki Mäntymäki
- Department of Orthopaedics and Trauma, Faculty of Medicine and Life Sciences and Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Arja Häkkinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Marko H. Neva
- Department of Orthopaedics and Trauma, Faculty of Medicine and Life Sciences and Tampere University Hospital, University of Tampere, Tampere, Finland
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