藤田 順之

OBJECTIVES: Whether to resurface the patella in total knee arthroplasty for patients with rheumatoid arthritis remains controversial. This study evaluated long-term clinical and radiographic outcomes after total knee arthroplasty without patellar resurfacing. METHODS: Of 100 knees in 74 patients who underwent total knee arthroplasty without patellar resurfacing, 64 knees in 49 patients were available for follow-up (mean, 13.6 years). Clinical evaluations included the presence of anterior knee pain at final follow-up, Knee Society Score, Knee Society Functional Score and Kujala score. Plain radiographic evaluations assessed patellar thinning and its relationship with clinical outcomes. We also compared outcomes between remission and non-remission groups based on Disease Activity Score in 28 joints using C-reactive protein at final follow-up. RESULTS: The incidence of anterior knee pain was 9.3%. At follow-up, Knee Society Scores and Functional Scores had improved significantly (p < 0.05). Although patellar thinning progressed, it did not appear to affect clinical outcomes or incidence of anterior knee pain. Disease activity did not differ significantly between groups or by presence of anterior knee pain. CONCLUSIONS: Long-term outcomes of total knee arthroplasty without patellar resurfacing in rheumatoid arthritis were favourable, indicating that this approach is acceptable.

OBJECTIVES: Patients with lumbar spinal stenosis (LSS) exhibit significantly different scoring patterns on the visual analogue scale (VAS) chart for low back pain (LP), buttock and lower limb pain (PL), and buttock and lower limb numbness (NL). This study investigated the usefulness of these preoperative scoring patterns on the VAS chart in predicting surgical outcomes in older adults undergoing LSS surgery. METHODS: Time-course data from patients aged ≥65 years who underwent LSS surgery at two institutions were retrospectively assessed. All participants completed the Zurich Claudication Questionnaire and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, which included the VAS chart, before surgery and at 6 months and 1 year postoperatively. RESULTS: In total, 334 participants were evaluated. Patients with equal preoperative scores across all three scales showed the highest average postoperative reduction in the three VAS scores. By contrast, those with the highest preoperative VAS scores for LP or NL had the lowest reductions. Based on the multivariable analysis, the highest preoperative VAS scores for LP (relative risk: 2.1) and NL (relative risk: 2.1) were significantly associated with poor surgical improvement in older adults with LSS. CONCLUSIONS: This study demonstrated the potential clinical utility of the preoperative VAS chart in predicting surgical improvement in older patients with LSS. Patients with equal preoperative VAS scores for LP, PL, and NL were more likely to have favorable surgical outcomes, while those with the highest preoperative scores for LP or NL were at higher risk for poor outcomes.

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CASE: We report a case of a 65-year-old man attempting suicide through anterior neck stabbing with an ice pick. Computed tomography showed spinal canal penetration at C4-5 near the midline, sparing the trachea, esophagus, and major vessels. The foreign body was removed under general anesthesia; cerebrospinal fluid leakage was noted, and the wound was tightly closed with a fibrin-based sealant. No motor or sensory deficits were present preoperatively or postoperatively. CONCLUSION: This case shows that penetrating cervical spinal canal injuries may occur without neurological impairment. Careful extraction under general anesthesia, ideally with neuromonitoring, is recommended to minimize complications.

INTRODUCTION: With ongoing societal aging, the demand for regenerative medicine has increased. Recently, reports demonstrating the efficacy of knee regenerative therapies have increased, although substantial proportions of these studies involved relatively younger populations. However, in Japan, where our hospital is located, it is common for patients well beyond the WHO-defined elderly age of 65 years to present with a desire for regenerative therapy. This retrospective cohort study investigated the utility of autologous protein solution (APS) knee joint injections by comparing their effects in patients aged 80 years and older and those younger than 80 years. METHODS: From July 2021 to August 2023, we administered single APS injections into the knee joints of patients diagnosed with osteoarthritis. Clinical assessment was conducted at baseline and at one and six months post-injection. Forty-one patients (44 knees) who completed all scheduled assessments were included in this analysis. Subjects were stratified into group E (≥80 years old) or group Y (<80 years old). Clinical evaluations included assessments of joint range of motion, inflammatory biomarkers (C-reactive protein), radiographic Kellgren-Lawrence classification, MRI findings including bone marrow edema, and standardized patient-reported outcome measures (Knee Injury and Osteoarthritis Outcome Score {KOOS} and Knee Society Score {KSS}), with KSS subdomain scores normalized to a 100-point scale. RESULTS: No distinct intergroup differences were observed for knee range of motion, blood test parameters, or MRI findings. Group E had the highest scores on the KOOS activities of daily living and quality of life subscales at one month post-APS administration; both subscale scores decreased at six months post-administration, whereas these subscale scores consistently increased over time in group Y. Compared with the findings in prior research reporting the minimum clinically important difference after platelet-rich plasma administration, the findings at six months after APS administration were superior for all KOOS subscales, excluding sports, in both groups. Concerning KSS scores, most subscale scores consistently increased throughout the follow-up period in both groups, whereas the expectation subscale score tended to decrease over time, likely reflecting the evolution of expectations after surgery. CONCLUSIONS: Intra-articular APS injections demonstrated clinical efficacy in patients aged 80 years and older. When the analysis was limited to those who continued follow‑up at both one and six months after treatment, a tendency toward a shorter duration of effect was still observed, indicating the need for careful patient selection.

STUDY DESIGN: Population-based cross-sectional study. OBJECTIVE: To examine the associations of sleep disturbance with low back pain (LBP) and pain-related disability in a community-based setting in Japan. SUMMARY OF BACKGROUND DATA: Sleep disturbance and LBP are highly prevalent and often overlap in ways that impair quality of life. Although their association has been reported, few population-based studies have simultaneously evaluated both LBP status and pain-related disability using validated assessment tools. METHODS: Data from 2,186 adults aged 20-90 years were analyzed. Sleep disturbance was assessed using the Athens Insomnia Scale (AIS; cutoff ≥6), and its association with LBP and pain-related disability (measured by the modified Oswestry Disability Index [mODI]) was examined. Psychological distress was assessed using the Kessler Psychological Distress Scale (K6). Multivariable logistic regression analyses were conducted to identify factors independently associated with sleep disturbance. Spearman's rank correlation coefficients were calculated to examine correlations between AIS scores and individual mODI items. RESULTS: The prevalence of LBP and sleep disturbance was 14.9% and 29.7%, respectively. Participants with sleep disturbance were more likely to report LBP and had significantly higher mODI and K6 scores. In regression models, chronic LBP was associated with sleep disturbance when mODI was not included; however, this association was no longer significant after inclusion of mODI, which itself remained robustly associated. Higher K6 scores were also independently related to sleep disturbance. Correlation analyses showed that among mODI items, "Pain intensity" (r=0.329, P<0.001) and "Sitting" (r=0.305, P<0.001) had the strongest correlations with AIS scores. CONCLUSION: Disability related to LBP, rather than pain itself, was significantly associated with sleep disturbance, and psychological distress was also independently associated with insomnia. LEVEL OF EVIDENCE: 2.

INTRODUCTION/AIMS: 3D magnetic resonance imaging (MRI) is a tool for visualizing and quantifying the volume of the median nerve; however, the diagnostic value of the volume of the median nerve for assessing CTS severity is unclear. This study aimed to evaluate the utility of 3T MRI combined with three-dimensional (3D) imaging to assess the cross-sectional volume (CSV) of the median nerve for diagnosing carpal tunnel syndrome (CTS) and determining its severity. METHODS: We used MRI to measure the CSV of the median nerve in 95 patients with CTS and 26 healthy controls. CTS severity was graded according to the Padua classification, and differences in CSV according to severity were analyzed. RESULTS: The mean CSVs for the severity groups were as follows: control, 22.4 mm3; minimal, 28.8 mm3; moderate, 34.4 mm3; severe, 53.6 mm3; and extreme, 48.3 mm3. CSV increased with CTS severity, with significantly higher values in the severe and extreme groups compared with the moderate, minimal, and control groups. DISCUSSION: This study showed that the CSV of the median nerve increased with disease severity, both visually and in three dimensions. This helps to visually understand the severity of CTS, and the association between morphology and disease severity may contribute to a better understanding of the pathophysiology of CTS.

AIMS: Polypharmacy, hyperpolypharmacy, and potentially inappropriate medication (PIM) in older adults are growing health concerns in the aging population. Older patients with degenerative cervical myelopathy (DCM) often have multiple comorbidities and are prescribed numerous medications. Thus, we investigated the current status of medication use among older patients with DCM, identified the characteristics of those with hyperpolypharmacy, and evaluated its impact on postoperative outcomes. METHODS: This retrospective study included 130 older patients with surgery for DCM. All participants completed the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) before and 1 year after surgery. RESULTS: Forty-two patients had hyperpolypharmacy (H group), and 88 had non-hyperpolypharmacy (N group). The commonly prescribed PIMs were antidiabetics (24.6%), nonsteroidal anti-inflammatory drugs (21.5%), and hypnotics (20.8%). Hypnotic use was significantly higher in the H group than in the N group (p < 0.001). The H group exhibited significantly more advanced frailty than the N group (p = 0.001). The preoperative JOACMEQ scores for upper extremity, lower extremity, and bladder function were significantly worse in the H group than in the N group (p = 0.020, 0.003, and 0.007, respectively) and remained significant following the multivariable model. Both groups had favorable surgical outcomes, but quality of life improvements were significant in the N group (p = 0.005) but not in the H group (p = 0.900). CONCLUSIONS: Older DCM patients with hyperpolypharmacy had more severe preoperative symptoms. Although surgery is a viable treatment option for this population, thorough preoperative informed consent regarding surgical outcomes is critically important.

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 occurrence of ALL rupture during posterior correction of adult spinal deformity (ASD) was rare before the introduction of lateral lumbar interbody fusion (LLIF) but has become more frequent recently. It remains unclear whether this phenomenon is unique to LLIF-combined procedures or primarily related to enhanced corrective ability. Methods: The research method used in this study is finite element analysis (FEA). Using preoperative computed tomography images, LLIF cage (L group) or posterior lumbar interbody fusion (PLIF) cage (P group) were placed in the disc space with identical lordotic angles and distances from the anterior vertebral body edge for the same patients' samples. Finite element simulations of corrective procedures were conducted. A spring simulating the ALL was introduced into the FEA, and the load on the ALL was evaluated with either LLIF or PLIF cage placement. Spring elongation directly measured the load on the ALL, while the location of the rotation center served as an indirect evaluation. Two different types of corrective procedures were created, one of which is mimicking ASD correction. For both procedures, the load to ALL was measured using abovementioned parameters when either LLIF cage (L group) or PLIF cage (P group) was used. The load to ALL was compared between L group and P group. Results: The degree of spring elongation during the simulation of a corrective procedure significantly decreased in the L group compared to the P group only in the model which is mimicking ASD correction (p = 0.006, Cohen's d = 2.33, Power (1-β) = 0.956). The rotation center was significantly more posteriorly located in the P group than that in the L group in both models. These differences were more obvious in the model mimicking ASD correction (p = 0.0013, Cohen's d = 2.00, Power (1-β) = 0.891). Conclusions: Our findings suggest that the use of a PLIF cage, which has a longer anterior-posterior cage length, caused the posterior edge of the cage to act as a pivot point. This configuration places greater leverage on the ALL, potentially leading to rupture during posterior correction procedures. This phenomenon, ALL rupture during posterior correction for ASD, is thought to be associated with increased corrective capabilities rather than being specific to the geometry of the LLIF cage.

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.

PURPOSE: Recently, a full-body upright computed tomography (CT) scanner has been developed, which when combined with myelography, is expected to provide valuable insights into the pathology of lumbar spine degenerative diseases (LSDD). This study aims to elucidate the distinctive features of upright CT myelography (CTM) in LSDD by comparing it with supine magnetic resonance imaging (MRI). METHODS: This study included 110 patients who underwent both supine MRI and upright CTM for LSDD. The anteroposterior diameter (APD), transverse diameter (TD), and area of the dural sac were measured from L1/2 to L5/S1. Lumbar lordosis (LL) was also measured in both modalities. RESULTS: The APD of the dural sac was significantly smaller at L2/3 and L4/5, while the TD was significantly larger at L1/2 and L2/3 on upright CTM compared to supine MRI. The dural sac area was significantly larger at L1/2 and smaller at L4/5 on upright CTM. Subgroup analysis divided patients into Group I (LL greater in upright CTM, n = 56) and Group D (LL smaller in upright CTM, n = 54). The dural sac area was significantly smaller at L3/4 and L4/5 in Group I and larger at L1/2 in Group D on upright CTM. CONCLUSIONS: Changes in the APD, TD and area of the dural sac during the transition from supine to standing were markedly dependent on the intervertebral level. These parameters were also influenced by patterns of change in LL between the two positions. Upright CTM revealed diverse position-related morphological changes in the lumbar dural sac in LSDD patients.

STUDY DESIGN: Retrospective multicenter study. OBJECTIVES: To identify predictors associated with failure of neurological improvement after posterior decompression surgery for degenerative cervical myelopathy (DCM). SETTING: 17 institutions in Japan. METHODS: Patients who underwent posterior decompression surgery and were followed up for >1 year were enrolled. The Japanese Orthopedic Association (JOA) recovery rate was determined, and patients were divided into three outcome groups based on the JOA recovery rate: fair (recovery rate, <22.2%: mean-1SD), moderate (22.3%-77.1%), and good (>77.2%: mean+1 SD) groups. Demographic information, postoperative complications, and radiographic parameters were assessed, and predictors of poor outcomes were identified using the multinominal logistic regression analysis. RESULTS: Of 868 patients enrolled, 140 (16.1%), 586 (67.5%), and 142 (16.3%) were assigned to the fair, moderate, and good groups, respectively, with mean JOA recovery rates of 6.2% ± 13.7%, 50.1% ± 15.0%, and 90.6% ± 8.3%. Although there were significant differences in the frequency of diabetes mellitus among the three groups in the univariate analysis (26.4% vs. 23.0% vs. 14.1%; p = 0.03), the multinominal regression analysis revealed that old age was a significant independent predictor of poor outcomes in the comparison between the fair and good groups (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.27-2.07; p < 0.01). Old age was also significantly associated with failure of neurological improvement between the fair and moderate groups (OR, 1.35; 95% CI 1.15-1.59; p < 0.01). CONCLUSIONS: Old age may be an independent predictor of failure of neurological improvement after posterior decompression surgery in patients with DCM.

BACKGROUND: The prevalence of degenerative spine diseases has continued to rise with the aging of the global population. Despite the availability of various aging indices, limited studies have comprehensively investigated degenerative spine diseases from the perspective of aging. This study aimed to evaluate degenerative cervical and lumbar diseases surgically treated using multiple clinical aging indices and elucidate the characteristics of each condition through comparative analysis. METHODS: Clinical data of consecutive patients aged ≥ 65 years who underwent surgery for degenerative cervical and lumbar diseases were retrospectively collected. Frailty was assessed using the 11-point modified frailty index. Locomotive syndrome stage was determined based on the 25-Question Geriatric Locomotive Function Scale. Functional decline was assessed according to the Kihon Checklist. Polypharmacy was defined based on a cutoff of six drugs. A total of 19 categories were considered potentially inappropriate medications. RESULTS: Among the included patients, 313 and 103 had degenerative lumbar (L group) and degenerative cervical (C group) diseases, respectively. The C group had significantly lower serum albumin levels (p = 0.03), a significantly higher frequency of functional decline in both physical function (p = 0.02) and activities of daily living (p = 0.046), and significantly more advanced frailty (p = 0.004) than the L group. Among potentially inappropriate medications, the frequency of diuretic use was significantly higher in the C group than in the L group (p = 0.04). Longitudinal observations showed significant postoperative improvements in locomotive syndrome stages in the L group but not the C group. Cross-sectional observations revealed no significant differences in locomotive syndrome stage distributions between both the groups before surgery (p = 0.402); however, the C group exhibited significantly more advanced locomotive syndrome stages than the L group at 6 months (p < 0.001) and 1 year after surgery (p < 0.001). CONCLUSIONS: Across various indices of aging, patients with degenerative cervical spine disease showed more significant progression than those with lumbar spine disease. Thorough understanding of these characteristics is essential when managing degenerative spine diseases, particularly in the selection of effective treatment approaches for the increasingly aging society in the future.

INTRODUCTION: Hallux hyperdorsiflexion and stiffness are typically associated with hallux rigidus. Although the underlying cause remains unclear, this case appears to have arisen in a patient undergoing treatment for schizophrenia, highlighting the importance of individualized and carefully tailored treatment approaches to achieve optimal patient outcomes and maintain high-quality care. CASE REPORT: A 71-year-old Asian woman undergoing treatment for schizophrenia presented with severe hyperdorsiflexion and stiffness of the right hallux, causing intense pain, which was particularly noticeable during gait and daily activities. Initially, the patient underwent rehabilitation to restore normal active motion of the right extensor hallucis longus (EHL). However, despite continuous rehabilitation, the stiffness persisted. Consequently, the patient underwent surgery involving dissection, lengthening of the distal EHL, and partial transposition of the proximal EHL. Postoperatively, the patient regained active hallux movement and showed significantly improved gait. CONCLUSION: Surgical treatment should be considered as an alternative option if symptoms persist for long in patients with hallux hyperdorsiflexion and stiffness. However, this approach is technically demanding and requires careful consideration of the strategy for successful recovery and optimal patient outcomes.

INTRODUCTION: One hypothesis of ossification of the posterior longitudinal ligament (OPLL) pathogenesis is that pluripotent mesenchymal stem/progenitor cells (MSCs) differentiate into chondrocytes and that heterotopic ossification occurs via endochondral ossification. However, studies on the origin and characteristics of these ectopically appearing chondrocytes are limited. The purpose of this study was to investigate the characteristics of chondrocytes in human OPLL tissue, with a particular focus on MSC markers. METHODS: OPLL samples were collected during surgery from four patients with cervical or lumbar OPLL. We investigated the expression of cell surface markers of MSC by reverse transcription-polymerase chain reaction (RT-PCR) and immunostaining. RESULTS: RT-PCR analysis revealed the expression of CD73, CD90, CD105, and platelet-derived growth factor receptor α (PDGFRα) in OPLL tissue. Immunostaining analysis also demonstrated that the chondrocytes in ossified tissue co-expressed CD73, CD90, CD105, and PDGFRα. CONCLUSIONS: Chondrocytes in the interstitium of the ossified tissue co-expressed MSC markers CD73, CD90, CD105, and PDGFRα, suggesting that ectopically appearing chondrocytes were derived from MSCs. These results indicated that MSCs are deeply involved in the pathogenesis of endochondral ossification in OPLL.

PURPOSE: Retro-odontoid pseudotumor (ROP) is a condition characterized by benign soft tissue proliferation at the odontoid process due to mechanical stress in the atlantoaxial joint, often represented by atlantoaxial subluxation (AAS). However, the pathogenesis of ROP remains unclear, as AAS can also occur without ROP. The purpose of this study is to clarify the pathogenesis of ROP in patients with AAS by analyzing imaging findings in patients without rheumatoid arthritis who underwent surgery for AAS and/or ROP. METHODS: A multicenter cross-sectional study was conducted. Patients without rheumatoid arthritis who underwent surgery for AAS and/or ROP at three university hospitals between 2010 and 2022 were enrolled in this study. Patients were divided into two groups: the ROP group, comprising patients with AAS and ROP, and the non-ROP group, comprising those with AAS without ROP. Patient demographics and preoperative imaging findings, including plain radiography, multidetector computed tomography, and magnetic resonance imaging, were compared between the two groups. RESULTS: The ROP group included 32 patients (age: 75.6 ± 7.7 years; 23 male and 9 female patients), while the non-ROP group comprised 18 patients (age: 70.5 ± 14.6 years; 9 male and 9 female patients). No significant differences were observed between the two groups in terms of age, sex, or history of cervical spine surgery. However, the O-C2 angle in the extension position and C2-C7 sagittal vertical axis were significantly larger in the ROP group than in the non-ROP group. Additionally, degeneration of the facet joints and intervertebral discs in the subaxial cervical spine was significantly more advanced in the ROP group than in the non-ROP group. CONCLUSION: In patients with AAS, the anterior translation of the cervical spine, as well as the progressive degeneration of the subaxial cervical facet joints and intervertebral discs, may increase mechanical stress on the atlantoaxial joint, contributing to the development of ROP.

PURPOSE: Low back pain (LBP) is a common occupational health problem. Chronotype, an individual's preferred timing of activity and sleep, has been linked to pain perception. Previous studies have found a potential association between chronotype and LBP, although the findings were limited by small sample sizes and restricted population types. We investigated the association between evening chronotype (eveningness) and LBP in a cohort comprising public servants of various ages. METHODS: We conducted a cross-sectional analysis of 4728 full-time public servants in Japan. LBP was assessed using a self-reported question. Individuals' chronotypes were determined using the reduced Morningness-Eveningness Questionnaire. The association between chronotype and LBP was analyzed using the chi-squared test and multiple logistic regression models adjusted for age, sex, occupation, overtime work, use of the internet/email, body mass index, smoking status, exercise habits, sedentary behavior, sleep duration, sleep medication use, and depressive symptoms. RESULTS: In total, 30% of the subjects reported LBP. The most common chronotype was intermediate type (51%), followed by morningness (38%) and eveningness (11%). A significant association between eveningness and LBP was observed. After adjusting for potential confounders, individuals with eveningness had a higher prevalence of LBP than those with morningness (36.2% vs. 28.7%; odds ratio: 1.46; 95% confidence interval: 1.16-1.83). CONCLUSION: Eveningness was statistically associated with LBP in a cohort of public servants. The present findings would strengthen the association's generalizability to more varied populations.

BACKGROUND: Hip fractures represent a significant public health issue in an aging society. Early surgical intervention for hip fractures in older adults is associated with fewer complications and higher survival rates, and recent reimbursement incentives in Japan have aimed to encourage surgery within 48 h of injury. However, information on the determinants of delayed surgery, including reimbursement incentives, remains limited. This study aimed to investigate the number of days from admission to surgery and identify factors associated with delayed surgery using data from two acute care hospitals in Japan. METHODS: We retrospectively analyzed data from 1,209 patients aged ≥ 65 years who underwent hip fracture surgery at two hospitals in Japan between April 2021 and March 2024. Patient- and healthcare system-related factors were compared between patients who underwent surgery within 2 days of admission (E group) and those who underwent surgery at later times (L group). Poisson regression was used to identify independent factors associated with delayed surgery. RESULTS: In total, 56% of patients underwent surgery within 2 days of admission. Multivariable analysis identified age ≥ 85 years (prevalence ratio [PR] = 0.81) and trochanteric fracture (PR = 0.81) as factors that reduced the prevalence of delayed surgery. Conversely, diabetes (PR = 1.18); cardiovascular disease (PR = 1.19); low serum albumin levels (PR = 2.08); admission in the pandemic period (PR = 1.26), university hospital (PR = 1.24); and admission on Thursday (PR = 1.69), Friday (PR = 2.99), or Saturday (PR = 2.60) were associated with delayed surgery. The in-hospital mortality rate was approximately 2%, with no significant difference observed between the E and L groups. CONCLUSIONS: Both patient- and healthcare system–related factors were associated with delayed surgery for hip fractures in older adults. Although a reimbursement incentive has been introduced to promote early surgery, real-world challenges, including preoperative risk factors and hospital resources, continue to affect surgical timing. These findings could help inform strategies to enhance timely surgical care for older patients with hip fractures in aging societies.

BACKGROUND: Patient satisfaction is an essential metric for evaluating treatment outcomes for LSS, both for patients and for their primary physicians. However, the Zurich Claudication Questionnaire (ZCQ) is the only representative patient-reported outcome measure that evaluates satisfaction. To develop a model using machine learning to predict postoperative satisfaction among older patients with lumbar spinal stenosis (LSS) based on preoperative and postoperative scores of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). METHODS: The training dataset was composed of time-course data of ZCQ and JOABPEQ scores from patients aged ≥65 years who underwent LSS surgery at a university hospital. The validation dataset included data from patients with LSS treated at a private orthopedic clinic. A linear support vector machine classifier was trained to predict achievement of a "Satisfied" state from preoperative and postoperative JOABPEQ scores. Internal validation was carried out via leave-one-out cross-validation, and external validation using a separate dataset to assess the accuracy, sensitivity, specificity, F1 score, and area under the receiver operating characteristics curve (AUROC). Variable importance was analyzed using model class reliance. RESULTS: A total of 232 and 66 individuals were included in the training and validation datasets, respectively. The machine-learning model exhibited an accuracy of 0.72, sensitivity of 0.75, specificity of 0.69, and AUROC of 0.82. Psychological disorder and walking ability were identified through permutation importance analysis as key factors for satisfaction. External validation on an independent dataset demonstrated comparable accuracy (0.76), sensitivity (0.83), and AUROC (0.75), although the specificity decreased (0.42). CONCLUSIONS: The machine learning model presented here can predict the postoperative satisfaction score on the ZCQ from preoperative and postoperative JOABPEQ scores, highlighting its potential for broader application in clinical settings.

BACKGROUND: Surgical outcomes for lumbar spinal stenosis (LSS) are generally favorable, even in older adults, and they effectively address locomotive syndrome. In older patients with LSS, support from family members during the postoperative recovery period is expected to be helpful, but the extent to which family structure influences surgical outcomes for LSS remains unclear. Herein, this study aimed to investigate the involvement of family structure in surgical outcomes for older patients with LSS. METHODS: This retrospective study included 350 consecutive patients aged ≥65 years who underwent LSS surgery between April 2020 and December 2023. Patients were categorized by family structure into the M (living with multiple family members) or S group (living with few or no family members). Postoperative outcomes were assessed using patient-reported outcomes, including the Roland-Morris Disability Questionnaire (RDQ), Geriatric Locomotive Function Scale (GLFS-25), and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. RESULTS: The M group consisted of 102 participants, while the S group comprised 248 participants. Preoperatively, there were no significant differences in the scores of all patient-reported outcomes between the groups. However, even after adjusting for baseline characteristics that significantly differed between the groups, the RDQ (p = 0.018) and GLFS-25 scores (p = 0.030) were significantly better in the M group than in the S group at 1 year postoperatively. Furthermore, the proportion of patients with postoperative improvement in the locomotive syndrome stage was significantly higher in the M group than in the S group at both 6 months (p = 0.027) and 1 year (p = 0.002) postoperatively. CONCLUSIONS: Family structure significantly affected postoperative outcomes in older adults with LSS, particularly concerning locomotive syndrome recovery. These findings highlight the potential value of involving families in healthcare planning, while recognizing that the availability and quality of support may vary across households.

Background: A pseudotumor adjacent to the odontoid has been reported to be a non-neoplastic mass that is mainly associated with atlantoaxial instability. Methods: Case report. Results: A 72-year-old woman presented to our clinic with a chief complaint of bilateral fine motor dysfunction and gait disturbance. She had rheumatoid arthritis as a comorbidity. Physical examination revealed bilateral hand fine motor dysfunction and signs of myelopathy, including hyperreflexia of the deep tendon reflexes in the lower extremities. Magnetic resonance imaging (MRI) showed a retro-odontoid pseudotumor. Surgery was proposed to the patient, but she did not wish to undergo surgery at this time. At a follow-up visit approximately one year after the initial visit, she complained of the progression of the bilateral hand fine motor dysfunction and gait disturbance. MRI demonstrated a pseudotumor in the space anterior to the odontoid process, indicating that the localization of the pseudotumor around the odontoid process changed from the posterior space to the anterior space in its natural course. Conclusions: The speculated sequential mechanism of the change in the location of the pseudotumor from the posterior space to anterior space to the odontoid process in the natural course is as follows: As the rheumatoid arthritis progressed, the C1-2 joint was immobilized in the dislocated position, and as a result, the retro-odontoid pseudotumor disappeared due to immobilization of the C1-2 joint. Following the disappearance of the retro-odontoid pseudotumor, the odontoid process shifted backward owing to rupture of the transverse annular ligament. Consequently, a new space appeared in front of the odontoid process. Subsequently, damage to the apical and alar ligaments resulted in pseudotumor formation in the new space. Considering our case, the formation of an antero-odontoid pseudotumor occurs only in limited cases, with extreme progression of the pathology. Most cases of retro-odontoid pseudotumors are treated by surgery before such a progression; therefore, we consider that such a case has not yet been reported in the literature.

BACKGROUND: The administration of potentially inappropriate medications (PIMs) as well as polypharmacy in older individuals has become a medical and socioeconomic issue. Meanwhile, given that lumbar spinal stenosis (LSS) is one of the most prevalent musculoskeletal conditions, significantly affecting mobility in older adults and becoming increasingly common in aging societies, its management in this population has emerged as a critical concern. We aimed to elucidate the prevalence of PIMs among older LSS patients and identify those potentially impacting surgical outcomes. METHODS: We retrospectively analyzed 296 consecutive patients aged 65 years or older who underwent LSS surgery. Based on available guidelines, 19 medication categories were considered PIMs. Pre- and postoperative health-related quality of life was assessed using the Roland-Morris Disability Questionnaire and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. RESULTS: The most frequently prescribed PIMs included hypnotics, steroids, antithrombotic drugs, antidiabetic drugs, laxatives, and nonsteroidal anti-inflammatory drugs in older LSS patients. Among these medications, antithrombotic drugs showed a significant association with surgical outcomes. When the subjects were divided into antithrombotic drug users (n = 57) and non-users (n = 239), no significant difference in the incidence of postoperative complications was observed between the two groups. However, 1 year after surgery, users had significantly worse walking ability than did nonusers (adjusted p value = 0.028), despite no significant differences before and 6 months after surgery. Furthermore, nonusers showed significant improvement in walking ability (p < 0.001) and social life scores (p = 0.014) from 6 months to 1 year after surgery, whereas users exhibited no significant improvements during this period. CONCLUSIONS: Among the PIMs, hypnotics, steroids, antithrombotic drugs, laxatives, antidiabetic drugs, and nonsteroidal anti-inflammatory drugs were commonly used by older LSS patients. Older LSS patients taking antithrombotic drugs are unlikely to have good surgical outcomes.

BACKGROUND: The management of elective surgeries during the COVID-19 pandemic was controversial, and the impact on lumbar spinal stenosis (LSS) surgery outcomes remains unclear. This study aimed to retrospectively analyze older adults who underwent LSS surgery during the pandemic and compare cases from its early and late phases. METHODS: Medical records of patients aged 65 and older who underwent LSS surgery between April 2020 and April 2023 were reviewed. The Zurich Claudication Questionnaire and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were administered preoperatively and at 6 months and 1 year postoperatively. RESULTS: The period from April 2020 to September 2021 was classified as the early phase, while October 2021 to April 2023 was classified as the late phase. This study evaluated a total of 267 older patients with LSS, with 138 undergoing surgery during the early phase and 129 during the late phase. There was one case of COVID-19 infection during hospitalization in the early phase and none in the late phase. Significant differences were found between the early and late phases in the distribution of American Society of Anesthesiologists physical status (ASA) and frequency of degenerative lumbar scoliosis (DLS). When the association between the COVID-19 pandemic phase and effective case of surgery treatment on JOABPEQ was examined, the multivariable adjusted relative risks of effective case in social life domain for the late-stage group were 0.7 (95 % CI = 0.5-0.9) at both 6 months and 1 year postoperatively using the early-phase group as the reference. No significant differences were found in the other four domains at either 6 months or 1 year postoperatively. CONCLUSIONS: Poorer social life outcomes in the late-phase patients with LSS surgery may be attributed to worse preoperative ASA scores and changes in social life during different pandemic phases.

BACKGROUND: Fractures are a significant health concern for older adults, affecting their activities of daily living (ADL), physical function, and mental well-being, and contributing to the need for long-term care. However, the factors associated with fractures among independent older adults remain unclear. This study aimed to examine the association between fractures and the health status of independent older adults in a representative suburban city in Japan using data from a survey of community-dwelling residents and to identify factors associated with fractures. METHODS: A total of 15,853 survey questionnaires were mailed, and 11,346 valid responses were received, resulting in a response rate of 71.6%. The survey included questions on ADL, physical function, mental health, memory, medical conditions, and subjective complaints. For fractures, participants were asked the following question: "How many times have you experienced fractures since the age of 65?". Data were analyzed using Poisson regression models adjusted for age, sex, body mass index, family structure, and smoking history. RESULTS: Among the respondents, 15% reported fractures after age of 65 years. A decline in ADL, physical function, mental health, and memory were significantly associated with increased fracture frequency. Under medical conditions, the prevalence of depression (p for trend = 0.042), respiratory diseases (p for trend = 0.001), and ophthalmologic conditions (p for trend = 0.002) increased significantly with fracture number. Most subjective complaints were significantly associated with fracture number, with dysphagia demonstrating the strongest association. CONCLUSIONS: This study utilized a relatively large and highly representative sample of community-dwelling residents to identify factors associated with fractures in independent older adults. Even in independent older adults who were not certified as requiring long-term care, fractures were significantly associated with a decline in multiple health domains. These findings provide valuable insights that can inform efforts to promote healthy aging and reduce care dependency. CLINICAL TRIAL: Not applicable.

OBJECTIVES: Symptomatic hand osteoarthritis (HOA) significantly affects daily activities and quality of life, but its associations with osteoarthritis (OA) in other joints and systemic factors remain unclear. This study aimed to comprehensively assess patients with symptomatic HOA by examining their laboratory findings and radiographic features across multiple joints. METHODS: This cross-sectional study enrolled 53 patients with symptomatic HOA who initially presented to the outpatient clinic with hand pain and were subsequently diagnosed. Radiographic assessments of the hands, knees, hips, and spine were performed using the grading system of Kellgren-Lawrence (KL). The sum of the KL scores for all joints in both hands was calculated as the hand KL score. RESULTS: In total, 79.2% of patients had coexistent knee OA. Elevated triglyceride levels and erythrocyte sedimentation rates were observed in >50% of the cohort. Hand KL scores displayed weak positive correlations with C-reactive protein levels (r=0.34) and knee KL scores (r=0.35). CONCLUSIONS: This study highlights the frequent coexistence of knee OA in patients with symptomatic HOA and suggests potential links between HOA, systemic inflammation, and lipid metabolism. These findings provide insights into the multifactorial nature of HOA and underscore the importance of comprehensive evaluation in clinical practice.

BACKGROUND: At present, the threshold defining older adults is 65 years, and this classification has been widely accepted globally. However, with the extension of both life expectancy and healthy life expectancy, there is a need to reconsider this age-based definition. This study compared the characteristics and surgical outcomes of older patients with lumbar spinal stenosis (LSS) between the early and late stages to clarify age diversity in this population. METHODS: Data collected from consecutive patients aged ≥ 65 years who underwent LSS surgery were retrospectively reviewed. All participants completed the Zurich Claudication Questionnaire, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and 25-Question Geriatric Locomotive Function Scale preoperatively as well as 6 and 12 months postoperatively. Frailty was evaluated using the 11-point modified frailty index. Polypharmacy was defined as the concomitant use of at least six drugs. RESULTS: In total, 311 older patients with LSS were enrolled. Among them, 136 patients younger than 75 were categorized into the E group, and 175 patients aged 75 and older were categorized into the L group. Baseline characteristics, including frailty and polypharmacy, significantly differed between the groups. The frequency of effective case of surgical treatment on JOABPEQ was significantly lower for walking ability in the L group. At 1 year after surgery, the incidence of non-improvement in locomotive syndrome stages was higher in the L group than in the E group (relative risk = 1.38, 95% confidence interval [CI] = 1.08-1.78). In addition, when the L group was further divided into three subgroups based on age, the relative risk was 1.32 (95% CI = 0.99-1.76) for patients aged 75 to < 80, 1.42 (95% CI = 1.07-1.88) for those aged 80 to < 85 years, and 1.68 (95% CI = 1.16-2.45) for those aged ≥ 85. CONCLUSIONS: Significant differences were observed in baseline characteristics and postoperative improvement of walking ability and locomotive syndrome based on age among older patients with LSS. Our findings underscore the significant age diversity among older adults, highlighting the necessity of considering each patient in a more nuanced age-specific manner rather than adopting a one-size-fits-all approach.

INTRODUCTION: Hip fractures, which result in a high rate of complications and mortality, are a major public health concern in aging societies. Physical restraint for older patients with hip fractures may be employed to ensure safety, continue medical treatment, and minimize the risk of harm to oneself or others. This study aimed to investigate the current practices of physical restraint use among hip fracture patients across 2 acute-care hospitals, as well as uncover factors associated with physical restraint in patients with hip fracture. METHODS: We retrospectively reviewed all patients aged ≥65 years who underwent surgery for hip fractures at two institutions. Physical restraint was applied in accordance with institutional guidelines, following thorough assessments by physicians and nurses and obtaining informed consent from the patient or their family. When we examined the independent associations of physical restraint during hospitalization, the Poisson regression models were used to estimate the relative risks (RRs) and 95% confidence intervals (CIs). RESULTS: In total, 463 older patients with hip fractures were assessed. Among the included patients, 118 (25.5%) were subjected to physical restraint. Multivariable analysis revealed that 85 years or older (RR, 1.8; CI: 1.1-3.0), a BMI below 18.5 (RR, 1.8; CI: 1.4-2.5), dementia (RR, 2.3; CI: 1.7-3.1), stroke (RR, 1.5; CI: 1.1-2.0), impairment in physical function (RR, 3.1; CI: 1.2-8.3), and administration of antipsychotics (RR, 1.6; CI: 1.0-2.4) were significantly associated with the implementation of physical restraint. CONCLUSIONS: This retrospective study provided real-world data regarding the use of physical restraint in older patients with hip fractures. Patients with older age, low BMI, dementia, stroke, impaired physical function, and administration of antipsychotics may be at high risk for the use of physical restraints. To minimize the use of physical restraints, future research for further data collection will be essential.

Low back pain (LBP) is a major public health issue, and lifestyle-related factors (LRFs) are increasingly recognized as key contributors to LBP. However, comprehensive studies using recent data concerning the association between LBP and LRFs remain limited. In this study, a nationally representative sample of Japanese adults were surveyed to evaluate the relationship between LRFs and LBP and to explore how these factors relate to both the severity and chronicity of LBP. A cross-sectional nationwide survey was conducted among 5000 randomly selected Japanese adults aged 20-90 years; valid responses were obtained from 2188. Participants were analyzed using three different methods: (1) those with or without current LBP, (2) those with no/mild or moderate/severe pain, and (3) those with or without chronic LBP. Key LRFs included body mass index, alcohol consumption, smoking, exercise habits, comorbidities (dyslipidemia, diabetes, and hypertension), and self-image regarding body shape. Multivariable logistic regression analysis revealed that current LBP was significantly associated with body mass index (odds ratio [OR]=1.04, 95% confidence interval [CI]: 1.00-1.07), alcohol consumption (OR=1.37, 95% CI: 1.04-1.80), smoking (OR=1.63, 95% CI: 1.21-2.20), and dyslipidemia (OR=1.51, 95% CI: 1.06-2.13), and the severity of LBP was associated with smoking (OR=1.77, 95% CI: 1.19-2.64), lack of exercise (OR=1.55, 95% CI: 1.10-2.15), and dyslipidemia (OR=1.64, 95% CI: 1.06-2.55). In addition, smoking was the only LRF significantly associated with chronic LBP (OR=1.70, 95% CI: 1.23-2.34). Multiple LRFs are associated with the prevalence of LBP. Stratified analysis provided deeper insight into specific risk factors for LBP. In particular, dyslipidemia is linked to pain severity, whereas smoking is associated with both severity and chronicity. Future longitudinal studies should focus on the influence of these key LRFs on onset, severity, and chronicity of LBP.

An absorbable adhesion barrier is a medical device that prevents postoperative adhesion and matches its biodegradation time with the regeneration period of its target tissues, which is important for antiadhesion effects. Physical hydrogels of Bombyx mori silk fibroin (SF) proteins are degradable in vivo. However, their biodegradation time is too long to exert antiadhesion effects. To shorten the biodegradation time of the SF hydrogels, we decreased the molecular weight (MW) of the SF proteins by alkaline treatment and prepared low-MW (LMW) SF hydrogels. The hydrogels contained less β-sheet crystalline and more amorphous structures than conventional, high-MW (HMW) SF hydrogels. Because of the potential loosened SF molecular structures in the hydrogel networks, the LMW SF hydrogels showed enhanced biodegradation (i.e., shorter in vitro enzymatic biodegradation time and faster in vivo biodegradation rate) as well as a lower affinity for plasma proteins and fibroblasts, which are involved in postoperative adhesion formation. An antiadhesion test using a rat abdominal adhesion model demonstrated that the LMW SF hydrogel applied to the abraded cecum was almost completely degraded within two weeks postimplantation, with a significantly lower adhesion severity score than that in the untreated model rat group. Conversely, the HMW SF hydrogel remained between the cecum and abdominal wall, with the same adhesion severity as that of the untreated model rat group. Therefore, we concluded that the antiadhesion effects of SF hydrogels were induced by enhanced biodegradation. The results of this study indicate the potential of LMW SF hydrogels as absorbable adhesion barriers.

PURPOSE: The purpose of this study was to determine the capability of proton density with fat fraction (PD-FFQ) imaging to help assess hematopoietic ability and diagnose aplastic anemia in adults. METHODS: Between January 2021 and March 2023, patients diagnosed with aplastic anemia (AA: n = 14) or myelodysplastic syndrome (MDS: n = 14) were examined by whole-body PD-FFQ imaging, and 14 of 126 age and gender matched patients who had undergone the same PD-FFQ imaging were selected as control group. All proton density fat fraction (PDFF) index evaluations were then performed by using regions of interest (ROIs). Pearson's correlation was used to determine the relationship between blood test results and each quantitative index, and ROC-based positive test and discrimination analyses to compare capability to differentiate the AA from the non-AA group. Finally, sensitivity, specificity and accuracy of all quantitative indexes were compared by means of McNemar's test. RESULTS: Mean PDFF, standard deviation (SD) and percentage of coefficient of variation (%CV) for vertebrae showed significant correlation with blood test results (-0.52 ≤ r ≤ -0.34, p < 0.05). Specificity (SP) and accuracy (AC) of %CV of PDFF in vertebrae were significantly higher than those of mean PDFF in vertebrae and the posterior superior iliac spine (SP: p = 0.0002, AC: p = 0.0001) and SD of PDFF in vertebrae (SP: p = 0.008, AC: p = 0.008). Moreover, AC of SD of PDFF in vertebrae was significantly higher than that of mean PDFF in vertebrae and the posterior superior iliac spine (p = 0.03). CONCLUSION: Whole-body PD-FFQ imaging is useful for hematopoietic ability assessment and diagnosis of aplastic anemia in adults.

INTRODUCTION AND IMPORTANCE: Synovial osteochondromatosis of the shoulder joint is predominantly primary, characterized by multiple osteochondral fragments, with reports of secondary synovial osteochondromatosis being rare. CASE PRESENTATION: The patient, a 48-year-old male, presented to our hospital with right shoulder pain persisting for several months. While there was no significant restriction in the range of motion, pain was noted during horizontal adduction and external rotation in the dependent position. Radiographs and CT scans revealed an osteochondral loose body in the glenohumeral joint and an osteophyte on the anterior margin of the glenoid cavity. A lidocaine test in the glenohumeral joint was positive, suggesting impingement by the loose body, leading to its surgical removal. Arthroscopically, the loose body was grasped and removed from the anterior aspect of the glenohumeral joint. The osteochondral fragment measured approximately 15 mm, with the total length including soft tissue being about 40 mm. Pathological findings indicated a layered arrangement of synovial cells, consistent with secondary synovial osteochondromatosis. Postoperatively, the shoulder pain improved rapidly, and follow-up was concluded six months after surgery. CLINICAL DISCUSSION: In this case, arthroscopy revealed a Hill-Sachs-like lesion and labral deficiency on the glenoid, suggesting past trauma. However, no bone defect matching the size of the loose body was observed. In secondary synovial osteochondromatosis, small osteochondral fragments can grow with nourishment from the synovium, suggesting the loose body in this case might have similarly enlarged post-trauma. CONCLUSION: The shoulder pain caused by a giant secondary synovial osteochondromatosis improved by removing the loose body arthroscopically.

AIM: Older patients with lumbar spinal stenosis (LSS) have a higher incidence of polypharmacy attributed to comorbidities and the use of pain relief medications. This study aimed to explore the effect of polypharmacy and hyperpolypharmacy on surgical outcomes in older patients with LSS based on health-related quality of life (HRQOL) and locomotive syndrome. METHODS: Consecutive patients aged ≥65 years who underwent lumbar spinal surgery for LSS were retrospectively reviewed. We assessed the preoperative and 1- and 2-year postoperative scores of three common HRQOL tools and the 25-question Geriatric Locomotive Function Scale. The patients were classified into the hyperpolypharmacy group (those taking ≥10 medications), polypharmacy group (those taking 6-9 medications) and non-polypharmacy group (those taking ≤5 medications). RESULTS: In total, 148 participants were evaluated. Among them, 35 were included in the non-polypharmacy group. There were no significant changes in the HRQOL and locomotive syndrome stage at baseline, even with polypharmacy progression. However, the HRQOL and locomotive syndrome stage worsened postoperatively with polypharmacy progression. When surgical efficacy was directly examined, results showed that the surgical outcomes were significantly associated with polypharmacy progression in older patients with LSS, even after adjusting for potential confounders. CONCLUSIONS: Polypharmacy, especially hyperpolypharmacy, had a negative impact on surgical outcomes in older patients with LSS. The number of prescription drugs should be taken into consideration before surgery in this patient group. Geriatr Gerontol Int 2024; ••: ••-••.

INTRODUCTION/AIMS: T2 magnetic resonance imaging (MRI) mapping has been applied to carpal tunnel syndrome (CTS) for quantitative assessment of the median nerve. However, quantitative changes in the median nerve before and after surgery using T2 MRI mapping remain unclear. We aimed to investigate whether pathological changes could be identified by pre- and postoperative T2 MRI mapping of the median nerve in CTS patients after open carpal tunnel release. METHODS: This was a prospective study that measured median nerve T2 and cross-sectional area (CSA) values at the distal carpal tunnel, hamate bone, proximal carpal tunnel, and forearm levels pre- and postoperatively. Associations between T2, CSA, and nerve conduction latency were also evaluated. RESULTS: A total of 36 patients with CTS (mean age, 64.5 ± 11.7 years) who underwent surgery were studied. The mean preoperative T2 values significantly decreased from 56.3 to 46.9 ms at the proximal carpal tunnel levels (p = .001), and from 52.4 to 48.7 ms at the hamate levels postoperatively (p = .04). Although there was a moderate association between preoperative T2 values at the distal carpal tunnel levels and distal motor latency values (r = -.46), other T2 values at all four carpal tunnel levels were not significantly associated with CSA or nerve conduction latency pre- or postoperatively. DISCUSSION: T2 MRI mapping of the carpal tunnel suggested a decrease in nerve edema after surgery. T2 MRI mapping provides quantitative information on the median nerve before and after surgery.

Hand osteoarthritis (HOA), characterized by an earlier onset age and reduced susceptibility to mechanical stress compared with knee and hip osteoarthritis, is considered a suitable disease for identifying predictive biomarkers of osteoarthritis. In particular, DNA methylation variants, expected to contribute to HOA susceptibility, hold potential as osteoarthritis biomarkers. In this study, leukocyte DNA methylation patterns were analyzed in blood samples from patients with HOA, aiming to identify disease-specific biomarkers for osteoarthritis. Using DNA methylation microarrays, we analyzed samples from three subjects with HOA and three age- and gender-matched healthy individuals. For validation, pyrosequencing analysis was conducted using samples from 16 to 9 subjects with and without HOA, respectively. From 735,026 probes in the DNA methylation array, the Top 100 CpG sites associated with HOA, based on low adjusted P-values, including those targeting bone morphogenetic protein 7 (BMP7), SBF2-AS1, PLOD2, ICOS, and CSF1R were identified. Validation analysis revealed significantly higher methylation levels in the BMP7-related site in the HOA group compared with the control group, even after adjusting for age, gender, and body mass index (p = 0.037). In contrast, no significant difference was observed in the other selected CpG sites between the HOA and control groups. This study highlights the significantly increased frequency of methylation at the specific BMP7 site in leukocytes of patients with HOA, suggesting its potential as a biomarker for HOA. Measurement of methylation levels at the CpG sites identified in this study offers a potential approach to prevent future osteoarthritis progression, providing valuable insights into disease management.

BACKGROUND: Managing medication use in older orthopedic patients is imperative to extend their healthy life expectancy in an aging society. However, the actual situation regarding polypharmacy, the intake of potentially inappropriate medications (PIMs), and fall risk-increasing drugs (FRIDs) among older orthopedic patients is not well characterized. This study aimed to investigate the medication-based profiles of older orthopedic patients to highlight the critical points of concern. METHODS: We retrospectively reviewed the clinical data of consecutive patients aged ≥ 65 years who underwent orthopedic surgery at two acute care hospitals between April 2020 and March 2021. The cutoff number of prescribed drugs for polypharmacy was set at 6. According to the specified guidelines, 19 categories of drugs were identified as PIMs, and 10 categories were classified as FRIDs. RESULTS: A total of 995 older patients with orthopedic surgery were assessed, of which 57.4% were diagnosed with polypharmacy, 66.0% were receiving PIMs, and 41.7% were receiving FRIDs. The prevalence of FRID intake did not significantly differ among patients with degenerative spinal disease (n = 316), degenerative disease of extremities (n = 331), and fractures (n = 272). Compared with patients with degenerative disease of the extremities, the multivariable-adjusted prevalence ratios (PRs) of polypharmacy and PIM intake were significantly higher in patients with degenerative spinal disease (1.26 [confidence intervals (CI): 1.11-1.44] and 1.12 [CI: 1.00-1.25]), respectively. Use of antiemetic drugs (adjusted PR, 13.36; 95% CI: 3.14-56.81) and nonsteroidal anti-inflammatory drugs (adjusted PR, 1.37; 95% CI: 1.05-1.78) was significantly higher in patients with degenerative spinal disease. Among patients with degenerative spinal disease, the prevalence of antiemetic drug intake was 8.7% in lumbar spinal patients and 0% in cervical spinal patients. CONCLUSIONS: More than half of the orthopedic patients in this study were affected by polypharmacy, and approximately two-thirds were prescribed some form of PIMs. Patients with degenerative spinal disease showed a significantly higher prevalence of polypharmacy and PIM use compared with other orthopedic diseases. Particular attention should be paid to the high frequency of antiemetic drugs and nonsteroidal anti-inflammatory drugs intake among patients with degenerative lumbar spine conditions.

BACKGROUND: In total knee arthroplasty (TKA), cementless fixation is initially weaker than cement fixation. This study aimed to examine whether filling the tibial peg holes with bone improves initial fixation strength in cementless TKA. METHODS: This prospective, comparative study examined 88 joints in 66 patients randomized to the bone filling (48 joints) or conventional group (no bone filling; 40 joints). All patients underwent TKA with the NexGen® trabecular metal modular tibial component. In the bone filling group, resected cancellous bone was filled into the peg holes before insertion of the tibial component. We performed clinical and plain radiographic evaluations after the operation and measured bone mineral density (BMD) at five sites below the component at 1, 3, 6, and 12 months postoperatively. RESULTS: Operative time and clinical evaluations were not significantly different. Plain radiography showed significant longitudinal thickening of the trabecula below the peg (P<0.05) and decreased occurrence of reactive lines (P=0.07) in the bone filling group compared with the conventional group. BMD was significantly higher in the bone filling group in the medial region below the peg at 1, 3, and 6 months and in the central region at 1 and 3 months (all P<0.05). CONCLUSIONS: When using the NexGen trabecular metal modular tibial component, concurrent peg hole bone filling increases the initial component fixation strength. Possible effects on long-term stabilization warrant further study.

BACKGROUND: The management of degenerative cervical myelopathy (DCM), which often impairs lower extremity function and increases the risk of falls, is gaining recognition for its importance in an aging society. Despite the significant overlap between frailty and locomotive syndrome (LS) in older adults, their interaction in older DCM patients remains unclear. We aimed to determine the characteristics of older DCM patients with frailty, focusing on the association between frailty and LS. METHODS: We retrospectively examined the clinical records and imaging data of consecutive patients aged 65 years and above who underwent surgery for DCM at a single facility. Frailty and LS stage were diagnosed using the modified frailty index-11 and the 25-question Geriatric Locomotive Function Scale (GLFS-25), respectively. RESULTS: A total of 114 subjects were analyzed, among whom approximately 30% were diagnosed with frailty. DCM patients with frailty had significantly worse Japanese Orthopaedic Association Cervical Myelopathy Assessment Questionnaire (JOACMEQ) and GLFS-25 scores at baseline than did those without frailty. Moreover, DCM patients with frailty had significantly more advanced LS stage at baseline than did those without frailty. Meanwhile, no significant difference in the improvement in JOACMEQ and GLFS-25 scores were observed between those with and without frailty after surgery. More precisely, DCM patients with frailty experienced better improvement in lower extremity function based on the JOACMEQ than did those without frailty. CONCLUSIONS: Our results demonstrated that older DCM patients had favorable outcomes following surgery regardless of frailty. Despite the significant association between frailty and LS in DCM patients, frailty did not negatively impact the improvement in LS in older DCM patients. These findings provide valuable information for both older DCM patients and their attending physicians that would help guide decisions about cervical spine surgery for DCM.

Bone fractures represent a common health problem, particularly in an increasingly aging population. Bioresorbable magnesium (Mg) alloy-based implants offer promising alternatives to traditional metallic implants for the treatment of bone fractures because they eliminate the need for implant removal after healing. The Mg-Y-rare-earth (RE)-Zr alloy WE43, designed for orthopedic implants, has received European Conformity mark approval. However, currently, WE43 is not clinically used in certain countries possibly because of concerns related to RE metals. In this study, we investigated the use of a RE-free alloy, namely, Mg-Zn-Zr alloy (ZK30), as an implant for bone fractures. Hydrofluoric acid (HF) treatment was performed to improve the corrosion resistance of ZK30. HF-treated ZK30 (HF-ZK30) exhibited lower corrosion rate and higher biocompatibility than those of WE43 in in vitro experiments. After implanting a rod of HF-ZK30 into the fractured femoral bones of mice, HF-ZK30 held the bones and healed the fracture without deformation. Treatment results of HF-ZK30 were comparable to those of WE43, indicating the potential of HF-ZK30 as a bioresorbable and safe implant for bone repair.

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.

INTRODUCTION: Locomotive syndrome caused by degenerative musculoskeletal diseases is reported to improve with surgical treatment. However, it is unclear whether surgical treatment is effective for the locomotive syndrome developing in patients with degenerative cervical myelopathy (DCM). Thus, this study primarily aimed to longitudinally assess the change in locomotive syndrome stage before and after cervical spinal surgery for patients with DCM using the 25-question geriatric locomotive function scale (GLFS-25). A secondary objective was to identify factors associated with the postoperative improvement in the locomotive syndrome stage. METHODS: We retrospectively reviewed clinical data of patients undergoing cervical spine surgery at our institution from April 2020 to May 2022 who had answered the Japanese Orthopaedic Association Cervical Myelopathy Assessment Questionnaire, visual analog scale, and GLFS-25 preoperatively and at 6 months and 1 year postoperatively. We collected demographic data, medical history, preoperative radiographic parameters, presence or absence of posterior longitudinal ligament ossification, and surgical data. RESULTS: We enrolled 115 patients (78 men and 37 women) in the present study. Preoperatively, using the GLFS-25, 73.9% of patients had stage 3, 10.4% had stage 2, 9.6% had stage 1, 6.1% had no locomotive syndrome. The stage distribution of locomotive syndrome improved significantly at 6-months and 1-year postoperatively. The multivariable Poisson regression analysis revealed that better preoperative lower extremity function (relative risk: 3.0; 95% confidence interval: 1.01-8.8) was significantly associated with postoperative improvement in the locomotive syndrome stage. CONCLUSIONS: This is the first study to longitudinally assess the locomotive syndrome stage in patients with DCM using GLFS-25. Our results indicated that patients with DCM experienced significant improvement in the locomotive syndrome stage following cervical spine surgery. Particularly, the preoperative lower extremity function was significant in postoperative improvement in the locomotive syndrome stage.

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.

BACKGROUND: Various treatments for chronic low back pain (LBP) have been reported; among them, platelet-rich plasma (PRP) as a regenerative medicine has attracted much attention. Although Modic type 1 change (MC1) is associated with LBP, no treatment has been established so far. In addition, no studies have administered PRP to intervertebral discs (IVDs) in patients with LBP, targeting MC1 only. Thus, the purpose of this study was to determine the safety and efficacy of PRP administration to the IVDs in patients with MC1 experiencing LBP. METHODS: PRP was injected intradiscally to 10 patients with MC1 experiencing LBP. Patients were followed prospectively for up to 24 weeks after primary administration. Physical condition, laboratory data, and lumbar x-ray images were evaluated for safety assessment. Furthermore, to evaluate the effectiveness of PRP, patient-reported outcomes were considered. In addition, changes in MC1 were assessed using magnetic resonance imaging (MRI). RESULTS: There were no adverse events in the laboratory data or lumbar X-ray images after administration. The mean visual analog scale, which was 70.0 ± 13.3 before the treatment, significantly decreased 1 week after PRP administration and was 39.0 ± 28.8 at the last observation. Oswestry disability index and Roland Morris disability questionnaire scores promptly improved after treatment, and both improved significantly 24 weeks after PRP administration. Follow-up MRI 24 weeks after treatment showed a significant decrease in the mean high-signal intensity of fat-suppressed T2-weighted imaging from 10.1 to 7.90 mm2 compared with that before PRP administration. CONCLUSIONS: The safety and efficacy of PRP administration to the IVDs of patients with MC1 experiencing LBP were identified. Post-treatment MRI suggested improvement in inflammation, speculating that PRP suppressed inflammation and consequently relieved the patient's symptoms. Despite the small number of patients, this treatment is promising for patients with MC1 experiencing LBP. The study protocol has been reviewed and approved by the Certified Committee for Regenerative Medicine and the Japanese Ministry of Health, Labor and Welfare (Japan Registry of Clinical Trials [jRCT] No. jRCTb042210159).