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        The Relationship between the Occipitocervical Junction and Thoracic Kyphosis in Ankylosing Spondylitis: A Retrospective Cohort Study of 86 Cervical Fractures in Surgically Treated Patients

        Nodoka Manabe,Augusto Covaro,Lukas Bobinski,Takachika Shimizu,Claes Olerud,Yohan Robinson 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.1

        Study Design: Retrospective analysis of prospectively collected data. Purpose: To describe the radiological characteristics of the occipitocervical area in patients with ankylosing spondylitis (AS) using the novel measure X-angle and to describe the correlation between the ankylosed occipitoatlantoaxial (OAA) joint and thoracic kyphosis (TK). Overview of Literature: AS affects the axial skeleton, leading to progressive ankylosis of all vertebral segments. The effect of ankylosis on the upper cervical area of these patients is not well documented. Methods: All patients with complete ankylosis of the spinal column between C3 and T1, treated for cervical spinal fracture between 2007 and 2014, were eligible for inclusion in this study. The level of cervical fracture was identified. The T1–12 and T5–12 angles were measured using preoperative lateral radiography. The progressive degeneration of the C0-C1-C2 joints was evaluated via the new indicator X-angle, through the measurement of the angle of the C0-C1-C2 articulations in the coronal plane using computed tomography. Results: We included 86 consecutive patients with AS (67 males) aged 69±12 years. The patients were divided into two groups according to the degenerative change in the C0–C1 joint (62 patients with a mobile joint and 24 patients with an ankylosed joint). There was no significant difference between the two groups in terms of age (p =0.094) and level of fracture (p =0.949). The most commonly affected level was C6. There was no requirement for revision due to non-union in any of the patients. There was a statistically significant difference observed in the T1–12, T5–12, and X-angles (p =0.004, 0.001, and <0.001, respectively). TK was greater in the ankylosed joint group than in the mobile joint group. The X-angle was also greater in the ankylosed joint group because of the vertical destruction of the OAA joint. Conclusions: Thoracic hyperkyphosis resulted in degenerative changes in the C0-C1-C2 joint in patients with AS. The X-angle is a reliable method for measuring the integrity of the C0-C1-C2 joint in such patients.

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        The Association of Each Disability Based on the Three Sub-Categories of the Roland-Morris Disability Questionnaire during Hospitalization with Itself at 1 Year Postoperatively in Patients with Degenerative Lumbar Spinal Stenosis

        Daisuke Higuchi,Nodoka Manabe,Masatake Ino 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.1

        Study Design: A prospective study in a hospital. Purpose: To investigate whether each disability based on the three sub-categories of the Roland-Morris disability questionnaire (RDQ) during hospitalization is associated with itself at 1 year postoperatively in patients with degenerative lumbar spinal stenosis (LSS). Overview of Literature: Although the total score of the RDQ represents whole pain-related disabilities or health-related quality of life, it is a shortcoming that multi-dimensional changes in disabilities are difficult to understand when only using the RDQ. Methods: Fifty-seven patients with LSS (men, 28; women, 29; 63.0±12.1 years) were included. Disabilities, pain intensity and depressive feelings were assessed at preoperation, discharge and 1 year postoperatively. Results: The range of “mental and physical activities (MPA),” “functional movements on/around a bed (FM)” and “walking function (WF)” scores were 0 to 13 (median, 8), 0 to 6 (median, 6) and 0 to 4 (median, 3) at preoperation; 0 to 12 (median, 0), 0 to 6 (median, 0), and 0 to 4 (median, 0) at discharge; and 0 to 8 (median, 0), 0 to 5 (median, 0), and 0 to 4 (median, 0) at 1 year postoperatively, respectively. The following significant multiple regression equations were obtained: MPA at 1 year postoperatively=0.56 (MPA at discharge)- 0.10 (depression at discharge)+0.90 (adjusted r 2=0.41), FM at 1 year postoperatively=0.35 (MPA at discharge)-0.06 (depression at discharge)+0.40 (adjusted r 2=0.45) and WF at 1 year postoperatively=0.59 (WF at discharge)-0.08 (depression at discharge)+0.63 (adjusted r 2=0.29). Conclusions: In our LSS population, each disability based on MPA and WF at discharge is associated with itself in the future. Therefore, disabilities excluding functional movements are longitudinally independent.

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