Epidemiology of degenerative lumbar scoliosis: a community-based cohort study

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Clinical evaluation of surgery for osteophyte-associated dysphagia using the functional outcome swallowing scale.

PURPOSE:To investigate the surgical outcome of patients with osteophyte-associated dysphagia (OAD) using the functional outcome swallowing scale (FOSS). METHODS:A retrospective chart review of 10 surgical cases of OAD (9 male and 1 female patient; mean age of 65 years) from 1982 to 2017 was performed, and radiographic evaluations were conducted by video fluoroscopic swallow study (VFSS) and conventional radiography. All OAD cases were treated at a single institution, and osteophytes were surgically resected by the anterior approach under gentle retraction of the affected esophagus. FOSS (0 for normal, 5 for worst) was used for clinical evaluations, and surgical complications were recorded. RESULTS:VFSS evaluation of OAD showed that the affected osteophyte was located at C4/5 in four patients, followed by C3/4 in three patients. The mean FOSS showed significant improvement from 2.5 preoperatively to 0.3 postoperatively, and no major surgical complications were recorded. Comorbidities were diabetes mellitus in four patients, ossification of the posterior longitudinal ligament in three patients, and lumbar spinal stenosis (LSS) in three patients. CONCLUSION:Surgical treatment of OAD was promising, and all patients showed clinical recovery. Evaluation of dysphagia using FOSS was easy and reliable for OAD management, and FOSS 2 might be a good indication for surgical intervention

Lateral radiographs of patient no. 4 obtained 9 and 17 years after surgery (long-term follow-up).

<p>(A) Nine years after surgery, recurrent anterior osteophytes were observed at the C3/4 and C5/6 levels. (B) Seventeen years after surgery, the osteophytes were gradually enlarged at the C3/4 and C5/6 levels.</p

Clinical and demographic data and preoperative/postoperative FOSS scores.

<p>Clinical and demographic data and preoperative/postoperative FOSS scores.</p

Preoperative and postoperative lateral radiographs of patient no. 4.

<p>(A) Cervical osteophytes at C5/6 and OPLL at C2/3. (B) Preoperative VFSS showed that the contrast medium was obstructed at C5/6 level and the esophagus was compressed. (C) Postoperative VFSS contrast medium was not obstructed, and the osteophyte at C5/6 was excised completely.</p

北海道の整形外科外傷医療 旭川医科大学における外傷医療教育

著者最終原稿版1年間に救急搬送された患者のうち、頸椎捻挫を除いた整形外科外傷患者を対象に傷病名と頻度を調査した。142例の整形外科外傷患者が1年間に救急搬送された。大腿骨頸部骨折・大腿骨転子部骨折の症例が多く、これらの合計が外傷患者全体の約三分の一を占めた。上肢では手指の切断・不全切断、橈骨遠位端骨折、上腕骨頸部骨折、下肢では脛骨骨折、足関節骨折、膝関節周囲骨折、踵骨骨折が症例数としては多かった。これらの外傷に対する初期診療・評価・手術または保存的治療と後療法に習熟することが外傷治療を学ぶ上で重要であった。脊椎の外傷では神経学的所見と画像所見を正確に評価し、直ちに脊椎専門医に搬送するべきか保存的治療で経過観察するべきかの判断が重要と考えられた

Clinical, physical, and radiographic analyses of lumbar degenerative kyphosis and spondylolisthesis among community-based cohort.

PURPOSE: To investigate longitudinal radiographic changes, and physical characteristics of lumbar degenerative kyphosis (LDK) and spondylolisthesis (DS). METHODS: Two-hundred eighty nine community-based female subjects were recruited from population register and studied longitudinally for a mean 12.3 years. Upright entire spine radiographs were used to evaluate spinopelvic parameters, including lumbar lordosis (LL), pelvic incidence (PI), and vertebral slip (% slip). Physical measurements included lumbar range of motion (ROM), isometric trunk muscle strength, and photometric gait posture using change in trunk inclination angle (dTIA). RESULTS: Subjects' mean age (standard deviation: SD) was 56.9 (10.0) years at baseline and 68.5 (9.2) years at the final follow-up. Among 202 subjects who could perform instructed physical measurements, DS, defined as more than 5 % slip, was found in 50 subjects (24.8 %), and LDK, defined as LL of less than 1SD of mean value (<24.4°), was found in 24 subjects (11.9 %). DS subjects showed a significant weakness in trunk flexor strength (normal 282.5 ± 73.0 N vs. DS 245.5 ± 75.5 N, p = 0.0219), and LDK subjects showed significant differences in: trunk extensor strength (normal 493.4 ± 172.8 N vs. LDK 386.3 ± 167.6 N, p = 0.0066), ROM, and dTIA (normal 3.5° ± 2.7° vs. LDK 7.6° ± 4.8°, p < 0.0001). PI was significantly larger in DS and smaller in LDK than normal subjects (normal 53.8° ± 9.9° vs. DS 58.2° ± 10.6°, p = 0.0111; normal vs. LDK 48.4° ± 9.2°, p = 0.0191). CONCLUSIONS: Current study showed that DS was associated with reduced trunk flexor strength, which might increase pelvic anteversion, and LDK was associated with reduced extensor strength, ROM, and ambulatory kyphosis. Physical characteristics should be evaluated for the successful management of adult spinal deformity