Purpose
To determine whether abnormalities of the sagittal modifiers (SMs) of the Scoliosis Research Society (SRS)-Schwab classification truly reflect back pain (BP)-specific quality of life (QOL), ...it is necessary to examine their dose–response relationships and to determine clinically impactful thresholds for declines in BP-specific QOL. This study aimed to analyse the continuous dose–response relationship between each SM and BP-specific QOL.
Methods
This cross-sectional study, using data from a Japanese population-based cohort study, included 519 community-dwelling residents aged ≥ 50 years who participated in the annual health examination. The participants completed the Roland–Morris Disability Questionnaire (RDQ) on BP-specific QOL. Spino-pelvic alignment based on SMs was assessed by whole-spine X-ray examinations. We fitted general linear models with or without nonlinear terms to estimate the dose–response relationship between each SM and BP-specific QOL.
Results
Pelvic tilt, pelvic incidence minus lumbar lordosis (PI-LL), and sagittal vertical axis showed dose–response relationships with BP-specific QOL measured as the RDQ score. PI-LL was most likely to predict a minimally clinically important RDQ score when its value exceeded the 90th percentile. A nonlinear relationship between PI-LL and the BP-specific QOL score was found. RDQ increased when PI-LL exceeded 10°.
Conclusion
PI-LL might be the most sensitive of the three modifiers of the SRS-Schwab classification for determining BP-specific QOL. Moreover, BP-specific QOL worsens rapidly when the compensatory mechanism against malalignment exceeds a critical value. Therefore, we suggest that traditional classifications and surgical strategies should be re-examined regarding the dose-dependent abnormalities of the SMs to develop a more reliable classification strategy.
Limited flexibility of the lower extremities, such as hamstring tightness, has long been suggested as a physical risk factor for low back pain among adolescent athletes. However, few prospective ...cohort studies have examined the direction of causality for this relationship. This prospective cohort study investigated the relationship between limited flexibility of the lower extremities and the occurrence of low back pain among high school baseball players.
Participants comprised 335 high school baseball players from 43 high school baseball teams who had undergone baseline medical evaluations (a self-completed questionnaire and physical examination). Occurrence of low back pain during a 1-year follow up, and associations with measurements of flexibility of the lower extremities such as straight-leg-raising angle (hamstring tightness), Thomas test (iliopsoas tightness), heel-buttock-distance (quadriceps tightness), and passive range of motion of the hip were investigated.
In total, 296 players (88.4%) participated in the 1-year follow-up survey, with 147 of the 296 players (49.7%) reporting the occurrence of low back pain during follow-up. The number of players with low back pain during follow-up peaked in November, then decreased and was lowest in June. After adjusting for factors associated with low back pain using logistic regression modeling, a significant association between hamstring tightness on the non-throwing arm side and low back pain (odds ratio 2.86, 95% confidence interval 1.17-6.94; P = 0.018) was found.
Hamstring tightness on the non-throwing arm side was identified as a potential risk factor for low back pain in high school baseball players. These results may provide guidance in the development of future prevention programs.
A cross-sectional multicenter observational study.
To identify associations between lumbar spinal stenosis (LSS) and lifestyle-related diseases.
Impaired blood flow as a result of arteriosclerosis ...facilitates degenerative changes in the spine. However, associations between LSS and lifestyle-related diseases (hypertension, diabetes, and dyslipidemia) remain unclear.
Participants comprised 526 patients diagnosed with LSS using the clinical diagnostic support tool and magnetic resonance imaging at 64 facilities. Data on 1218 males and 1636 females in the general population were selected from the 2006 National Health and Nutrition Survey as control data. We investigated the prevalence of lifestyle-related diseases (hypertension, diabetes, and dyslipidemia) and levels of hemoglobin A1c, total cholesterol, and high-density lipoprotein cholesterol. LSS and control groups were divided into 4 subgroups by age (nonelderly, <70 yr old; elderly, ≥ 70 yr) and sex. Statistical analyses were performed to compare patients with LSS and the control group using the χ test or Fisher exact text. Values of P < 0.05 were considered statistically significant.
Among nonelderly patients, proportions of patients with hypertension and diabetes mellitus were higher in patients with LSS than in controls (P < 0.01 each). The proportion of patients with hemoglobin A1c was 6.1% or greater and higher for female patients with LSS than for female controls (P < 0.05). No significant difference in the proportion of patients with dyslipidemia was apparent between the LSS and control groups.
After adjusting for age and sex, this study revealed a close association between diabetes and hypertension in 50- to 69-year-old patients with LSS. Physicians should consider the possibility of concomitant hypertension or diabetes mellitus when examining 50- to 69-year-old patients with LSS.
Purpose
The purpose of this study was to anatomically investigate the proximal origin of flexor–pronator muscles (FPMs) and clarify their contribution to dynamic stabilization of the elbow joint ...during valgus stress.
Methods
52 elbows from 26 donated formalin-fixed cadavers were examined. The pronator teres muscle (PT), flexor carpi radialis muscle (FCR), palmaris longus muscle (PL), flexor digitorum superficialis muscle (FDS), and flexor carpi ulnaris muscle (FCU) were identified, and their proximal origin and relationship to the anterior bundle of the medial ulna collateral ligament (AOL) were macroscopically and histologically investigated.
Results
The PT, FCR, PL, and FDS converged and formed a common tendon at their proximal origin (the anterior common tendon: ACT). The ACT was attached to the medial epicondyle and the joint capsule, just anterior and parallel to the AOL. The histological morphology of the ACT was quite similar to that of the AOL. The ulnar head of the PT was observed in 48 of 52 elbows (92.3 %), just behind the humeral head of PT. It mainly originated from the anterior edge of the sublime tubercle, while the upper part of ulnar head transitioned directly into the thickened joint capsule just anterior to the AOL.
Conclusion
The proximal attachment of the FPMs had a characteristic morphology. According to our results, the ACT and PT might assist the AOL by sharing static and dynamic traction forces applied to the medial elbow joint.
An experimental animal study.
To investigate the relationship between pain-related behavior and the expression of neurotrophic factors in the dorsal root ganglion (DRG) and spinal cord (SC) using a ...nucleus pulposus (NP) rat model.
Neurotrophic factors are released from activated glial cells and are associated with pain-related behavior. Nerve growth factor (NGF) is a neurotrophic factor that is induced by inflammation.
Rats were divided into an NP group (n = 94) and a sham-operated group (n = 46). NP harvested from the tail was applied to the left L5 DRG. Rats in the NP group were then divided into five subgroups: one non-treatment and four treatment groups. In the treatment groups, a dose of anti-NGF antibody or phosphate-buffered saline was administered into the DRG. Behavioral testing was performed to investigate the mechanical withdrawal threshold of the left hind paw for all groups. Immunohistochemical localization of NGF, phosphorylated p38 (p38), and brain-derived neurotrophic factor (BDNF) in the DRGs and SCs was performed, and the numbers of immunoreactive (IR) cells were counted.
The withdrawal threshold in the nontreatment NP group was significantly decreased for 35 days, and that of the middle- and high-dose treatment rats was significantly higher than the phosphate-buffered saline group values. In the DRG, NGF-IR, p38-IR, and BDNF-IR cells were increased for days 21. In the SC, BDNF-IR, and p38-IR cells were increased from days 7 to 21.
In the DRG, NGF expression increased, mechanical thresholds were reduced, and p38 and BDNF expression was increased in the NP group. p38 and BDNF expression was increased in SC neurons during the same period. Inhibition of NGF may be a potential treatment for neuropathic pain due to lumbar disc herniation.
5.
The incidence of lumbar spondylolysis is affected by sex, race, and congenital abnormalities. These differences suggest a genetic component to the etiology of spondylolysis. However, no definitive ...evidence has been presented regarding the inheritance of lumbar spondylolysis. We report familial cases of lumbar spondylolysis in 7- and 4-year-old brothers and their father, each of whom visited our clinic complaining of low back pain. Spondylolysis in the fifth lumbar vertebra (L5) was identified in both boys and their father from clinical, radiographic, computed tomographic, and magnetic resonance imaging examinations. Conservative treatment was provided for both boys. No bony union of any spondylolytic lesions was obtained, but they returned to sports activity without low back pain. Frequent development of spondylolysis, even at younger ages, in all male family members might indicate an underlying genetic etiology in lumbar spondylolysis, primarily in the form of autosomal dominant inheritance. However, information on patients and their parents should be considered carefully, as bony union with conservative therapy is not expected in such patients.
Controlled, interventional, animal study.
To investigate the spatial and temporal changes of μ-opioid receptor (MOR) expression in a rat lumbar disc herniation (LDH) model.
MORs widely express in the ...peripheral and central nervous systems, and opioid drugs produce an analgesic effect through their activation. However, the efficacy of opioid drugs is sometimes inadequate in several pathological conditions of pain. MORs in the brain as well as the spinal cord (SC) and dorsal root ganglion (DRG) are thought to be associated with pain-related behavior, but the underlying mechanisms are not completely understood.
In all, 91 adult female Sprague-Dawley rats were used. Autologous nucleus pulposus (NP) was applied onto the left L5 DRG in the NP group rats. Rats were divided into two surgical groups, the NP and the sham group. The von Frey test of left hind paw was performed before surgery, and 2, 7, 14, 21 and 28 days after surgery. Immunohistochemistry and immunoblotting in the DRG, SC, Caudate putamen, nucleus accumbens (NAc) and periaqueductal grey matter were performed before surgery, and 2, 7, 14, 21 and 28 days after surgery.
The thresholds in the NP group were significantly lower than those in the sham group from day 2 onwards. At days 7 and 14, MOR expression in the injured-side SC and DRG were significantly lower than those in the sham group. At day 21, MOR in the NAc was significantly decreased compared to that in the sham group.
Changes of MOR expression in the NAc, SC and DRG were associated with pain-related behavior. This result might show the underling pathogenesis of the resistance to MOR agonists in the patient with LDH.
N/A.
Abstract
Objectives
To examine the longitudinal association between baseline disability due to low back pain (LBP) and future risk of falls, particularly significant falls requiring treatment, in a ...community-dwelling older population.
Methods
This was a prospective population-based cohort study using data from the Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS; 2008–2010). A total of 2,738 residents aged ≥60 years were enrolled. LBP was assessed using the Roland-Morris Disability Questionnaire (RMDQ), and the level of LBP-related disability was divided into three categories (none, low, and medium to high). Incidence of falls over the following year was determined using a self-reported questionnaire after the one-year follow-up period. The risk ratio (RR) for LBP-related disability associated with any fall and any fall requiring treatment was estimated using log binomial regression models.
Results
Data were analyzed for 1,358 subjects. The prevalence of LBP at baseline was 16.4%, whereas 122 (8.9%) participants reported a low level of LBP-related disability and 101 (7.4%) reported medium to high levels of LBP-related disability. Incidence of any fall and falls requiring treatment was reported by 22.1% and 4.6% of participants, respectively. Subjects with medium to high levels of disability were more likely to experience subsequent falls (adjusted RR = 1.53, 95% confidence interval CI = 1.21–1.95) and falls requiring treatment (adjusted RR = 2.55, 95% CI = 1.41–4.60) than those with no LBP-related disability.
Conclusions
Level of LBP-related disability was associated with an increased risk of serious falls in a general population of community-living older adults. These findings can alert health care providers involved in fall prevention efforts to the important issue of activity-related disability due to LBP.
The Japanese Society for Spine Surgery and Related Research previously developed a diagnostic support tool for lumbar spinal stenosis (LSS-DST). Using the LSS-DST, general physicians can identify ...potential cases of LSS. However, in the LSS-DST, measurement of the ankle brachial pressure index (ABI) is required to exclude peripheral artery lesions in the lower limbs. We can expect further application of the LSS-DST if we can identify a simpler and easier method than ABI measurement. Therefore, in this large-scale, multicenter, cross-sectional study, we verified whether palpation of the posterior tibial (PT) artery could be used instead of ABI in the LSS-DST.
This survey was conducted at 2177 hospitals and included 28,883 participants. The sensitivity and specificity of the original LSS-DST method using the ABI and that of the LSS-DST ver2.0 with PT artery palpation were assessed to screen their ability for diagnosing LSS, using the physicians' final diagnosis based on the patients’ history, physical examination and radiographic findings as the gold standard.
The sensitivity and specificity 95%CI of the LSS-DST were 88.2% 87.5, 88.8 and 83.9% 83.4, 84.5, respectively, whereas the sensitivity and specificity of the LSS-DST ver2.0 were 87.7% 87.0, 88.3 and 78.3% 77.7, 78.9, respectively, indicating that LSS-DST ver2.0 is a useful screening tool for LSS with good sensitivity.
When the item of ABI in the LSS-DST is replaced by palpation of the PT artery (LSS-DST ver2.0), its sensitivity is maintained as a screening tool for LSS.
Level 3.
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