Stride length of elderly patients with lumbar spinal stenosis: Multi-center study using the Two-Step test

BackgroundShort stride length is one of clinical symptoms associated with lumbar spinal stenosis (LSS). Short stride is a risk factor for falls; therefore, identification of factors associated with short stride is critical for fall prevention in LSS patients. Although the Two-Step test can conveniently assess maximal stride length, it has not become widely used; therefore, its data are limited. We identified the potential factors associated with short stride of elderly LSS patients using Two-Step test.MethodsClinical data of patients aged >65 years who planned to undergo surgery for LSS were prospectively collected at multiple institutions. Patients were assessed with the Two-Step test and Timed Up-and-Go Test prior to surgery; 357 consecutive patients were enrolled. We determined the cut-off value of the Two-Step test score for short stride, referring to the Timed Up-and-Go Test score of 13.5 s, used to indicate high risk of falls in elderly individuals. Logistic regression model was constructed to identify factors associated with short stride.ResultsThe Two-Step test score showed moderate-to-strong inverse correlation with that of Timed Up-and-Go Test (r = ?0.65, p < 0.001). Using the tentative Two-Step test cut-off value (0.93) for short stride, multivariable analysis showed that age ≥80 years (OR = 2.3, 95% CI:1.1–4.8), a score of <60 for lumbar function in Japanese Orthopedic Association Back Pain Evaluation Questionnaire (OR = 2.7, 95% CI:1.5–4.7), motor deficit (OR = 2.7, 95% CI:1.2–6.1), and sagittal vertical axis ≥50 mm (OR = 2.1, 95% CI:1.2–3.5) were factors significantly associated with short stride in elderly patients with LSS.ConclusionsUsing the Two-Step test, we found that 80 years old and over, lumbar dysfunction, motor deficit of the lower extremities, and forward-bent posture were associated with short stride in LSS patients. Therefore, elderly LSS patients with these conditions may have a higher risk for falls.     

Presence of Modic type 1 change increases risk of postoperative pyogenic discitis following decompression surgery for lumbar canal stenosis

Study Design

Multicenter retrospective study.

CT-based morphological analysis of spinal fractures in patients with diffuse idiopathic skeletal hyperostosis

Purpose

To clarify correlations between spinal fracture and delayed paralysis in patients with diffuse idiopathic skeletal hyperostosis (DISH) using computed tomography (CT) with multiplanar reformatting (CT-MPR). DISH increases susceptibility to unstable spinal fractures, leading to neurological deterioration. The pathomechanism of the neurological injury is unclear.

Spinal fractures in patients with Diffuse idiopathic skeletal hyperostosis:A nationwide multi-institution survey

BackgroundDiffuse idiopathic skeletal hyperostosis (DISH) increases the spine's susceptibility to unstable fractures that can cause neurological deterioration. However, the detail of injury is still unclear. A nationwide multicenter retrospective study was conducted to assess the clinical characteristics and radiographic features of spinal fractures in patients with DISH.MethodsPatients were eligible for this study if they 1) had DISH, defined as flowing ossification along the anterolateral aspect of at least four contiguous vertebral bodies, and 2) had an injury in the ankylosing spine. This study included 285 patients with DISH (221 males, 64 females; mean age 75.2 ± 9.5 years).ResultsThe major cause of injury was falling from a standing or sitting position; this affected 146 patients (51.2%). Diagnosis of the fracture was delayed in 115 patients (40.4%). Later neurological deterioration by one or more Frankel grade was seen in 87 patients (30.5%). The following factors were significantly associated with neurological deficits: delayed diagnosis (p = 0.033), injury of the posterior column (p = 0.021), and the presence of ossification of the posterior longitudinal ligament (OPLL) (p < 0.001). The majority of patients (n = 241, 84.6%) were treated surgically, most commonly by conventional open posterior fixation (n = 199, 69.8%). Neurological improvement was seen in 20.0% of the conservatively treated patients, and in 47.0% of the patients treated surgically.ConclusionsMinor trauma could cause spinal fractures in DISH patients. Delayed diagnosis, injury of the posterior column, and the presence of OPLL were significantly associated with neurological deterioration. Patients with neurological deficits or unstable fractures should be treated by fixation surgery.     

A Report on the Positive Response to an Outdoor Nature Challenge of a Snow Camp for Young Liver Transplant Patients

Objectives

More than two decades have passed since the first living donor liver transplantation was performed in Japan in 1989. There are many reports about problems in adherence to taking medication and medical follow-ups in children who received liver transplants, because there is no transition strategy for those children and parents or guardians. The objective of this study is to measure the effect of nature and outdoor activity to improve children's medical adherence.

Clinical Results of Cardiopulmonary Bypass with Selective Cerebral Perfusion for Aneurysm of the Ascending Aorta and the Aortic Arch

The purpose of this report is to describe our experience using cardiopulmonary bypass with selective cerebral perfusion in 10 patients whose aneurysms required cross-clamping the aorta and brachiocephalic vessels. Cerebral perfusion was carried out with individual roller pumps. Flow rate was 11.2 ± 4.8 ml per kilogram of body weight per minute to the right axillary artery, 8.5 ± 1.0 to the right common carotid artery, 7.0 ± 2.0 to the left common carotid artery, and 3.9 to the left subclavian artery. All the patients came off bypass smoothly, and only 3 required small amounts of inotropic agents postoperatively. One patient with mycotic aneurysm died in the fourth postoperative week of massive bleeding due to disruption of the suture line. No cerebral complications were experienced. The operative results of this series suggest the usefulness of cardiopulmonary bypass with selective cerebral perfusion, and reasonably favorable outlook for patients with aneurysm involving the aortic arch and the ascending aorta.     

Prognostic factors associated with the surgical indication for lumbar spinal stenosis patients less responsive to conservative treatments: An investigator-initiated observational cohort study

Background

A few cohort studies have determined which patients with lumbar spinal stenosis are likely to need surgery because of the deterioration of symptoms. However, there are still insufficient data regarding the management of lumbar spinal stenosis due to lack of prognostic factors associated with the need for surgery. The purpose of this study was to identify the prognostic factors associated with the need for surgical treatment in patients with lumbar spinal stenosis.

Enhancing Survival of Human Hepatocytes by Neonatal Thymectomy and Partial Hepatectomy in Micro-miniature Pigs

Background

With the goal of in vivo cultivation of human hepatocytes that have not been sufficient in full differentiation in vitro, the advantage of neonatal thymectomy was verified on expansion of xenogeneic human hepatocyte in the micro-miniature pig (MMP).

Complications of spinal surgery for elderly patients with lumbar spinal stenosis in a super-aging country: An analysis of 8033 patients

Background

The Japanese Society for Spine Surgery and Related Research (JSSR) performed a third study on complications in spinal surgery in 2011. The purpose was to present information about surgery and complications in a large amount of elderly patients aged 65 years with lumbar spinal stenosis (LSS) without coexisting spondylolisthesis, spondylolysis, or scoliosis, and to compare patients aged ≥80 years to those aged 65–79 years.

Aneurysmal bone cyst of the sternum.

A very rare case of aneurysmal bone cyst of the sternum is described. Aneurysmal bone cyst is a tumorlike bone lesion occumng commonly in the metaphysis of long bones and in the vertebrae. This report is one of the very few cases in the literature of aneurysmal bone cyst of the sternum. Total resection of the tumor and reconstruction of the sternal defect using autogenous fibula are presented     

Loco-check presents a useful tool to determine health-related quality of life in elderly people with lumbar spinal stenosis

BackgroundLocomotive syndrome (LS) is a condition of decreased mobility caused by disorders of the locomotive organs. Lumbar spinal stenosis (LSS) is an LS disorder. The loco-check is a simple questionnaire comprising seven questions that can detect LS. The differences between the health-related quality of life (HRQoL) of elderly persons without LSS and those with LSS remain unclear. The primary aim of this study was to clarify these differences using the European quality of life (EuroQoL) scale. The secondary aim was to clarify the differences between the groups based on loco-check questionnaire responses.MethodsWe recruited patients aged ≥65 years. Our age- and sex-matched case/control cohorts included 28 elderly patients with LSS and 28 without LSS. The study participants were evaluated by the number of “yes” answers on the loco-check, the HRQoL using EuroQoL-5 dimension (EQ-5D) utility values, and the EuroQoL-visual analog scale (EQ-VAS). We compared differences between patients with and without LSS regarding HRQoL using EQ-5D utility values, EQ-VAS scores, the number of “yes” answers on the loco-check, and details of the loco-check.ResultsPatients with LSS had significantly lower EQ-5D utility values (p < 0.01) and more “yes” answers on the loco-check (p < 0.01) than those without LSS. There were no significant differences in EQ-VAS scores between groups (p = 0.09). There were statistically significant differences between groups in all questions except two: You often trip up or slip around the house and You can't make it across the road before the light turns red.ConclusionsElderly patients with LSS had lower EQ-5D utility values and more “yes” answers on the loco-check than elderly persons without LSS. Our results may clarify differentiating features of elderly patients with and without LSS.     

Increasing postural sway in balance test is related to locomotive syndrome risk: A cross-sectional study

BackgroundLocomotive syndrome risk level has been recently proposed to evaluate physical ability. Impaired balance control is one of the most important risk factors for falls. However, the relationship between locomotive syndrome risk and postural sway according to the balance test is unclear. This study aimed to investigate the relationship between locomotive syndrome risk and balance test results, including muscle mass and physical function, in a large-scale prospective general health checkup.MethodsWe enrolled 292 participants who underwent a basic health checkup and conducted a two-step test, stand-up test, evaluation using a 25-question geriatric locomotive function scale for the locomotive syndrome risk test, balance test, appendicular skeletal muscle mass measurement by bioelectrical impedance analysis, evaluation of physical function by the timed-up-and-go test, and back muscle and grip strength evaluation. A statistical comparative study was then conducted between normal and locomotive syndrome risk groups. Subsequently, significant factors for locomotive syndrome risk were investigated by multivariate analysis.ResultsThe comparative study was conducted by adjusting age and sex using a generalized linear model. No significant difference in muscle mass existed, but postural sway in the balance test significantly increased in the people at locomotive syndrome risk. Among the four posturographic variables by balance test, increase in back-and-forth sway was the most remarkable variable associated with locomotive syndrome risk together with back muscle strength, body mass index, and the timed-up-and-go test by logistic regression analysis. This posturographic variable was significantly related to the timed-up-and-go test and leg skeletal muscle mass by multiple regression analysis.ConclusionsA relationship was recognized between locomotive syndrome risk and postural sway. In particular, increase in back-and-forth sway was an important factor for locomotive syndrome risk. If the balance test shows an increase in back-and-forth sway, attention should be paid to locomotive syndrome risk for possible intervention and early treatment.     

Expression of the JAK/STAT signaling pathway in the ligamentum flavum of patients with lumbar spinal canal stenosis

Background

Ligamentum flavum (LF) hypertrophy is an important cause of lumbar spinal canal stenosis (LSS), one of the most common spinal disorders in the elderly. Although many cytokines are reported to be associated with LF hypertrophy, the intracellular signaling system is rarely discussed. The purpose of this study was to identify the JAK/STAT signaling pathway and to examine the role of the JAK/STAT systems in the hypertrophied LF.

Pulmonary blastoma in a child.

Pulmonary blastoma is a very rare type of lung tumor. In 1952 Barnard¹ described the first report of a rare pulmonary neoplasm which histologically resembled fetal lung tissue. He named it pulmonary embryoma. Spencer² reported four similar cases which he called pulmonary blastoma because they resembled the histologic pattern of nephroblastoma. Since then there have been 25 reported cases of this type of neoplasm but only two were in children.^3,4 We have recently treated a 10-yr-old girl with this neoplasm.     

Individualized fluid resuscitation based on haemodynamic monitoring in the management of extensive burns

An evaluation has been made on the effectiveness and feasibility of the individualized fluid replacement programme based on intensive haemodynamic monitoring using a Swan-Ganz catheter. Twenty-one extensively burned patients with an average burn of 60·8 per cent BSA were resuscitated with lactated Ringer's and colloid solutions. The rate of fluid administration was adjusted to maintain the optimal ranges of the various haemodynamic parameters including cardiac index and left ventricular stroke work index. Two patients failed to respond to fluid resuscitation possibly due to inadequate emergency procedures given before arrival at our institute. The remaining patients survived the shock phase, with the amount of fluid given to the 18 adult patients being (3·38 ±1·02 ml/kg) × (percentage burn) for the first 24 hours. A negative correlation existed between the amounts of lacated Ringer's solution and colloid solution used for the fluid resuscitation. Dopamine was effective in 4 out of 5 patients who showed depressed myocardial function. The individualized fluid programme was shown to be effective and reliable for the management of critically burned patients.