Influence of Diabetes Mellitus on Surgical Outcomes in Patients with Cervical Myelopathy: A Prospective, Multicenter Study

Shinji Tanishima,Tokumitsu Mihara,Atsushi Tanida,Chikako Takeda,Masaaki Murata,Toshiaki Takahashi,Koji Yamane,Tsugutake Morishita,Yasuo Morio,Hiroyuki Ishii,Satoru Fukata,Yoshiro Nanjo,Yuki Hamamoto,T 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.3

Study Design: Multicenter, prospective study. Purpose: To investigate the effects of diabetes mellitus (DM) on surgical outcomes in patients with cervical myelopathy. Overview of Literature: To date, few studies have investigated the influence of postoperative blood glucose or glycated hemoglobin (HbA1c) levels on surgical outcomes. Methods: The participants were patients who underwent surgery for the treatment of cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. The 61 cases were evaluated preoperatively and 1 year postoperatively using the Japanese Orthopaedic Association (JOA) scores and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). The study variables included fasting blood glucose and HbA1c levels measured preoperatively and at 1 week, 4 weeks, and 1 year postoperatively; the F-wave conduction velocity, latency, rate of occurrence, and M-wave latency in the ulnar and tibial nerves were measured preoperatively and at 1 year postoperatively. The patients were divided into a group without diabetes (N group, 42 patients) and a group with diabetes (DM group, 19 patients). We then assessed the associations between the surgical outcomes and each of the study variables. Results: JOA scores significantly improved in both groups; however, no significant between-group differences were found. There was no significant improvement in the JOACMEQ scores, which assessed cervical function, upper and lower limb function, and bladder function in both groups. We then subdivided the DM group into those with a good control of HbA1c after 1 year (DMG group, 12 patients) and those with HbA1c deterioration after 1 year (DMB group, seven patients), prior to comparing the surgical outcomes. The JOACMEQ scores for upper and lower limb function significantly improved in the DMG group (p<0.01). Compared with the DMB group, there were no significant increases in upper or lower limb function scores in the DMG group. Conclusions: Poor glycemic control might prevent postoperative functional recovery of the spinal cord.

Significance of Stabilometry for Assessing Postoperative Body Sway in Patients with Cervical Myelopathy

Shinji Tanishima,Hideki Nagashima,Hiroyuki Ishii,Satoru Fukata,Toshiyuki Dokai,Taiki Murakami,Yasuo Morio 대한척추외과학회 2017 Asian Spine Journal Vol.11 No.5

Study Design: Prospective study. Purpose: To examine the changes in body sway using stabilometry in patients who underwent cervical laminoplasty for cervical myelopathy. Overview of Literature: Although the patients of cervical myelopathy complain body sway there are few report to examine body sway objectively. Methods: Patients who received treatment for cervical myelopathy between October 2010 and February 2013 were included. Twentyone patients underwent cervical laminoplasty (myelopathy group). Body sway was assessed using stabilometry, wherein patients stood on a stabilometer with their eyes closed for 30 seconds. The Romberg ratio, outer peripheral area (OPA) with eyes closed (cm2), and total locus length per unit area (L/A) with eyes closed (/cm) were examined. Examinations were performed preoperatively (at baseline) and at 8 weeks postoperatively. Examination results of patients in the myelopathy group were compared with those of 17 healthy individuals (control group). Clinical symptoms were evaluated using the Japanese Orthopaedic Association scale score (JOA score) and the timed up and go (TUG) test. Results: In the myelopathy and control groups, the mean baseline Romberg ratio, OPA, and L/A were 2.3±1.2, 8.9±5.5 cm2, and 14.2±5.3/cm and 1.4±1.0, 4.3±2.8 cm2, and 23.7±10.1/cm, respectively. Eight weeks after laminoplasty, only L/A showed significant improvement from baseline in the myelopathy group (23.2±10.1 to 16.8±7.9; p =0.03). The Romberg ratio and OPA showed improvement in the myelopathy group, but the changes were not statistically significant. JOA scores and TUG test results in this group significantly improved from baseline to 8 weeks after laminoplasty (12.7 to 13.4 and 10.8 to 8.0 seconds, respectively; both p <0.05). Conclusions: L/A is a useful parameter for measuring body sway to assess the recovery of body sway after laminoplasty.

Evaluating the Reproducibility of the Walking Test for Intermittent Claudication Associated with Lumbar Spinal Stenosis

Tanishima Shinji,Weishi Li,Jianzhong Hu,Jie Zhao,Huilin Yang,Nagashima Hideki 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.3

Study Design: This is a multicenter, prospective study.Purpose: This study aimed to evaluate the reproducibility of the walking test for patients with lumbar spinal stenosis (LSS).Overview of Literature: Walking test is one of the useful procedures to investigate cauda equina syndrome with lumbar spinal stenosis. One the other hands, there were few studies to investigate the reproducibility of this test.Methods: In this study, we prospectively examined 70 LSS patients with intermittent claudication symptoms at a multicenter outpatient clinic. A walking test was administered at baseline and week 4 to assess patients’ walking distance and lower limb pain and numbness. Immediately after the walking test, patients were asked to use the Visual Analog Scale (VAS) to rate their pain and numbness in the front, back, outside, inside, and hip of the lower legs. The reproducibility of the walking test was evaluated using Cohen’s κ analysis and intraclass correlation coefficients (ICCs). Meanwhile, the Swiss Spinal Stenosis (SSS) Questionnaire was used to evaluate the severity of the stenosis.Results: The walking distance ICC at baseline and at week 4 remained unchanged at 0.7, with acceptable interobserver reliabilities for lower limb pain and numbness in both legs. The average VAS score for lower leg pain was 23.2±25.2 mm at baseline and 27.4±28.8 mm at week 4, while the corresponding average VAS score for numbness was 23.4±26.7 mm at baseline and 24.8±25.2 mm at week 4. The ICC score was 0.7 for leg pain and 0.7 for numbness. The mean SSS was 30.2±5.5 at baseline and 29.2±5.2 at week 4, and there was no significant difference in the severity.Conclusions: The walking test for LSS has acceptable reproducibility.

Relationship among Osteoporosis, Sarcopenia, Locomotive Syndrome, and Spinal Kyphosis in Older Individuals Living in a Local Mountain Area

Tanishima Shinji,Hagino Hiroshi,Matsumoto Hiromi,Tanimura Chika,Nagashima Hideki 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.6

Study Design: Cross-sectional cohort study.Purpose: This study investigated the relationship among osteoporosis, sarcopenia, locomotive syndrome, and spinal kyphosis in older individuals living in a mountain area.Overview of Literature: Kyphosis greatly reduces the quality of life of older individuals. Osteoporosis and sarcopenia are kyphosiscausing factors.Methods: This cross-sectional study included 361 individuals aged ≥65 years (mean age, 75.0 years) living in a local mountain area and underwent medical check-ups from 2014 to 2018. The survey items included kyphosis index, body mass index, back pain prevalence, back pain Visual Analog Scale score, Oswestry Disability Index, walking speed, grip strength, skeletal mass index, osteoporosis (% young adult mean [YAM]), LOCOMO 5 score, and presence of sarcopenia (Asian Working Group for Sarcopenia). The participants were divided into the N (kyphosis index: <12; n=229, 63.4%), M (kyphosis index: 12–15; n=99, 27.4%), and K (kyphosis index: ≥15; n=33, 9.2%) groups. <i>p</i> -values of <0.05 were considered statistically significant. An association factor of kyphosis (kyphosis index: ≥15) was investigated with logistic regression analysis.Results: Age and LOCOMO 5 scores were significantly higher (<i>p</i> <0.05) and %YAM and walking speed were significantly lower (<i>p</i> <0.05) in the K group than in the M and N groups. Other survey items showed significant differences. Only %YAM (odds ratio, 0.20; 95% confidence interval, 0.04–0.96) was an independent factor associated with a kyphosis index of ≥15.Conclusions: Decreased muscle mass and muscle strength would be related to kyphosis; however, no such relations were noted. Bone loss was significantly related to kyphosis. Osteoporosis-induced decrease in vertebral body height is present in the background. Sarcopenia and locomotive syndrome were not related to kyphosis, whereas decreased bone density was independently associated with kyphosis in older individuals living in a mountain area.

Relationship between sarcopenia and pain catastrophizing in patients with lumbar spinal stenosis: A cross-sectional study

Takashi Wada,Shinji Tanishima,Mari Osaki,Hideki Nagashima,Hiroshi Hagino 대한골다공증학회 2019 Osteoporosis and Sarcopenia Vol.5 No.4

Objectives: The purpose of this study is to clarify the psychological factors related to sarcopenia in patients with lumbar spinal stenosis (LSS). Methods: This cross-sectional study included 72 patients with LSS (38 males and 34 females; mean age, 70.4 ± 6.9 years). Demographic data, lower extremity pain, back pain, Japanese Orthopaedic Association score, Pain Catastrophizing Scale (PCS) score, Hospital Anxiety and Depression Scale (HADS) score, Fear- Avoidance Beliefs Questionnaire score, walking velocity, grip strength, walking distance, and appendicular muscle mass were assessed. Muscle mass was measured using bioelectrical impedance analysis. Patients were grouped based on sarcopenia status according to skeletal muscle mass index. Results: The prevalence of sarcopenia was 13.9% (10 of 72 patients). Sarcopenia was significantly more common in females. The incidence of dyslipidemia and cardiovascular disease were significantly higher in the sarcopenia group. The sarcopenia group had lower body weight, body mass index, grip strength, and walking distance than the control group. The sarcopenia group had higher PCS scores and HADSanxiety scores. Multivariate analysis identified body weight, dyslipidemia, walking distance, and PCS score as significantly related to sarcopenia. Conclusions: Pain catastrophizing might be the most relevant psychological factor in sarcopenia. Evaluation of both physical function and pain catastrophizing is needed when investigating sarcopenia in LSS.

Diagnosis of knee osteoarthritis and gait variability increases risk of falling for osteoporotic older adults: The GAINA study

Hiromi Matsumoto,Hiroshi Hagino,Hirofumi Sageshima,Mari Osaki,Shinji Tanishima,Chika Tanimura 대한골다공증학회 2015 Osteoporosis and Sarcopenia Vol.1 No.1

Objectives: To examine the relationship between history of falling, and musculoskeletal disease, bone mass, muscle strength, muscle mass, kyphosis, and gait speed and variability in osteoporotic older adults. Methods: The GAINA study, which began in 2014, is a population-based prospective study of subject cohorts from the town of Hino, Tottori Prefecture, Japan. Participants were recruited from among individuals who had an annual town-sponsored medical check-up in 2014, between May and June. A total 223 of residents were screened for our study. Inclusion criteria were osteoporotic older adults who had: (1) a ?70% young adult mean (YAM) bone mass as assessed using quantitative ultrasound (QUS) methods, (2) a prior hip fracture or vertebral fracture, (3) fragility fractures other than hip and vertebral fractures and <80% YAM of bone mass. From the total screened, 91 residents (mean age, 76.0 ± 8.0 years; 22 men and 69 women) met the eligibility criteria. History of falling, diagnosis of musculoskeletal disease, bone mass, grip strength, muscle mass, kyphosis, and gait speed were assessed. Gait variability analysis was based on acceleration in three directions: mediolateral (ML), vertical (VT), and anteroposterior (AP) using a wireless triaxial accelerometer. Subjects were classified as belonging to a nonfall group or fall group based on their history of falling. Results: During the previous 12 months, 26 falls were reported by 16 subjects (5 men and 11 women). Sixteen of the 91 included patients (17.6%) fell (22% men and 15% women), and 8 of the 16 subjects reported multiple falls. In a multivariable analysis, diagnosis of knee osteoarthritis and higher gait variability had a significant independent relationship with falling in these osteoporotic adults. Conclusions: Diagnosis of knee osteoarthritis and gait variability are associated with previous falls in osteoporotic older adults. Accelerometrybased gait analysis may be a useful tool with which to assess the risk of falling in this population.