川端 走野

PURPOSE: To determine the prevalence and associated factors of dysphagia in older adults with degenerative cervical myelopathy (DCM), and to elucidate the longitudinal changes in swallowing function following subaxial posterior cervical spine surgery in this population. METHODS: This retrospective study reviewed clinical records of patients aged ≥ 65 years who underwent surgical treatment for DCM at a single center. Swallowing function was assessed preoperatively and at 6 months and 1 year postoperatively using the Eating Assessment Tool-10. Patient-reported outcomes were evaluated using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). For longitudinal analysis, only patients who underwent subaxial posterior cervical surgery were included. RESULTS: A total of 150 patients with DCM were analyzed. Preoperatively, 11.3% had dysphagia. The dysphagia group had a significantly smaller C7 slope and lower scores in the cervical spine function and quality of life domains of the JOACMEQ compared to the non-dysphagia group. Longitudinal analysis was conducted on 137 patients who underwent subaxial posterior cervical surgery. The prevalence of dysphagia increased from 9.5% preoperatively to 24.1% at 1 year postoperatively (p < 0.001). Patients with postoperative deterioration in swallowing function had higher body mass index and showed no significant improvement in any JOACMEQ domain, with some domains worsening postoperatively. CONCLUSION: Cervical sagittal imbalance may contribute to dysphagia in older patients with DCM. Postoperative dysphagia can develop even after subaxial posterior cervical surgery, particularly in older patients with limited improvement in cervical spine-related symptoms after surgery.

BACKGROUND: The 25-question Geriatric Locomotive Function Scale (GLFS-25) is a patient-reported outcome measure (PROM) for assessing locomotive syndrome, which reflects mobility limitations due to musculoskeletal decline in older adults. Although lumbar spinal stenosis (LSS) is a major contributor to locomotive syndrome, the utility of GLFS-25 in evaluating the clinical status of older patients with LSS remains unclear. This study aimed to evaluate the GLFS-25 as a disease-specific PROM for older adults with LSS by comparing it with established tools such as the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Zurich Claudication Questionnaire (ZCQ). METHODS: This retrospective cohort study included 206 patients aged ≥65 years who underwent surgery for LSS. GLFS-25, JOABPEQ, and ZCQ scores were collected preoperatively and at 6 months, 1 year, and 2 years postoperatively. Correlations between the GLFS-25 and other PROMs were analyzed. Locomotive syndrome stages were determined based on GLFS-25 scores. The predictive accuracy of ZCQ satisfaction scores for postoperative improvement in the locomotive syndrome stage was assessed using receiver operating characteristic analysis. RESULTS: GLFS-25 showed weak to moderate correlations with the five JOABPEQ domains and both ZCQ subscales. Patients with greater improvements in the locomotive syndrome stage also demonstrated higher proportions of treatment efficacy in the JOABPEQ domains. The ZCQ satisfaction score at 2 years postoperatively was a strong predictor of locomotive syndrome stage improvement, with an area under the curve of 0.858. The optimal satisfaction score cutoff for improvement in the locomotive syndrome stage was 1.917 (sensitivity: 80.0 %, specificity: 80.6 %). CONCLUSIONS: The GLFS-25 reflects clinical changes in older patients with LSS and correlates well with established PROMs. This tool may enable valid cross-sectional and longitudinal assessment of surgical outcomes for older patients with LSS. A ZCQ satisfaction score of approximately 1.9 indicates a meaningful improvement in the locomotive syndrome stage.

INTRODUCTION: Distal adding-on (DA) is a common radiographic complication following selective thoracic fusion for Lenke type 1A adolescent idiopathic scoliosis (AIS). This study aimed to investigate whether intraoperative radiographs can predict postoperative DA in Lenke type 1A AIS. METHODS: A total of 79 patients with AIS and Lenke type 1A (group A) who underwent posterior selective thoracic fusion were retrospectively evaluated. For comparison, another 79 patients with Lenke type 1B and 1C (group BC) were included. The occurrence and factors associated with DA at 2 years postoperatively were investigated using intraoperative radiographs. RESULTS: Of 158 total cases, eight patients (10%) in group A and 13 (16%) in group BC developed DA at two years postoperatively. Intraoperative radiographs in group A showed that the mean angulation of the first disc below the lowest instrumented vertebra (LIV) was significantly greater in the DA group (-2.3±2.3°) compared to the non-DA group (-0.6±1.7°). Patients with angulation of the first disc below the LIV greater than 3° were significantly associated with DA (odds ratio, 18.0; p<0.01) in group A, as well as in group BC (odds ratio, 22.0; p<0.01). In group A, the mean intraoperative LIV tilt angle was greater in the DA group (4.8±7.0°) than in the non-DA group (1.2±3.7°), with greater tilt observed in 1A-L (L4 tilted left) compared to type 1A-R (L4 tilted right). Multivariate analysis revealed that intraoperative LIV tilt was significantly associated with DA in group A, but not in group BC. CONCLUSIONS: Intraoperative radiographs showing angulation greater than 3° at the first disc below the LIV and larger LIV tilt angles were significantly associated with postoperative DA in Lenke type 1A. Surgeons should strive to achieve horizontalization of the LIV intraoperatively, especially in Lenke type 1A-L curves, to avoid postoperative DA.

BACKGROUND: The 25-item Geriatric Locomotive Function Scale (GLFS-25) is often used to assess locomotive syndrome stage in older adults with lumbar spinal stenosis (LSS). However, locomotive syndrome stage three encompasses a wide score range, potentially masking clinically meaningful improvements. This study aimed to establish the minimal clinically important difference (MCID) for the GLFS-25 and determine whether MCID-based assessment better reflects surgical outcomes than stage-based evaluation. METHODS: This study included 314 patients aged 65 years and older with LSS who were preoperatively classified as having locomotive syndrome stage three. Patient-reported outcome measures, including the GLFS-25, the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and Zurich Claudication Questionnaire (ZCQ), were administered before and at six months and 1 year after surgery. The MCID for the GLFS-25 was calculated using an anchor-based method, with the satisfaction item from the ZCQ at 1 year after surgery serving as the anchor. Patients were then categorized into four groups based on whether they achieved improvements in locomotive syndrome stage and/or the GLFS-25 MCID. RESULTS: A 19-point improvement in the GLFS-25 was determined to be the MCID, with an area under the receiver operating characteristic curve, sensitivity, and specificity of 0.80, 65.8%, and 90.2%, respectively. Based on postoperative changes, 129, 49, 33, and 103 patients achieved both stage and MCID improvement (group C), improvement in MCID alone (group M), improvement in stage alone (group S), and no improvement, respectively. Group C showed significantly better surgical effectiveness across all JOABPEQ domains. Group M showed significant improvements in four domains, whereas group S showed significant improvement in only one domain. CONCLUSIONS: The newly established 19-point MCID for the GLFS-25 more accurately represented clinically meaningful improvement than stage-based evaluation. The combined use of MCID and stage classification may enhance outcome assessment after LSS surgery in older adults.

BACKGROUND: Hip fractures in older adults require surgery and frequently result in prolonged hospital stays. Recently, the revision of Japan's medical reimbursement system introduced an acute care incentive to promote early surgery for hip fracture cases, highlighting the need for timely intervention and efficient inpatient management. In this context, the present study aimed to identify factors associated with prolonged hospital stay in older adults undergoing hip fracture surgery at two acute care hospitals in Japan. METHODS: A retrospective review was conducted on data from 1184 patients aged ≥65 years who underwent hip fracture surgery between April 2021 and March 2024. Patients were categorized into three groups based on their length of stay: ≤14 days (short group), 15-28 days (moderate group), and ≥29 days (long group). Multinomial logistic regression analysis was utilized to identify factors associated with prolonged hospital stays. Receiver operating characteristic curve analysis was conducted to determine the optimal cutoff for preoperative waiting time in predicting a prolonged hospital stay. RESULTS: The short group included 260 patients (22.0%), the moderate group 631 (53.3%), and the long group 293 (24.7%). Multivariable analysis revealed that extended preoperative waiting time and living with others were independently associated with prolonged hospital stay. The odds ratio for being in the long group was 3.62 (95% confidence interval: 2.40-5.46) for a preoperative waiting time of ≥3 days compared with ≤2 days. The optimal cutoff for preoperative waiting time to predict a hospital stay ≥29 days was 2.5 days (area under the curve: 0.68; sensitivity: 62.8%; specificity: 62.5%), highlighting a clear window for surgical intervention. CONCLUSION: The preoperative waiting time was crucial factor influencing the length of hospital stay after hip fracture surgery in older adults. Timely surgical intervention within 2 days of admission can enhance care efficiency and shorten the hospitalization period.