Influence of lumbar kyphosis and back muscle strength on the symptoms of gastroesophageal reflux disease in middle-aged and elderly people

OBJECTIVE: The objectives of this study was to clarify the relationship between kyphosis and Gastroesophageal reflux disease (GERD) by evaluation of spinal alignment, obesity, osteoporosis, back muscle strength, intake of oral drugs, and smoking and alcohol history in screening of a community population to determine the factors related to GERD symptoms. SUMMARY OF BACKGROUND DATA: GERD increases with age and is estimated to occur in about 30% of people. Risk factors for GERD include aging, male gender, obesity, oral medicines, smoking, and alcohol intake. It has also been suggested that kyphosis may influence the frequency of GERD, but the relationship between kyphosis and GERD is unclear. SUBJECTS AND METHODS: We examined 245 subjects (100 males and 145 females; average age 66.7 years old) in a health checkup that included evaluation of sagittal balance and spinal mobility with SpinalMouse(®), GERD symptoms using the Frequency Scale for Symptoms of GERD (FSSG) questionnaire, body mass index, osteoporosis, back muscle strength, number of oral drugs taken per day, intake of nonsteroidal anti-inflammatory drugs (NSAIDs), intake of bisphosphonates, and smoking and alcohol intake. RESULTS: Multivariate logistic regression analysis including all the variables showed that lumbar lordosis angle, sagittal balance, number of oral drugs taken per day, and back muscle strength had significant effects on the presence of GERD (OR, 1.10, 1.11, 1.09 and 1.03; 95%CI, 1.03–1.17, 1.02–1.20, 1.01–1.18 and 1.01–1.04; p = 0.003, 0.015, 0.031 and 0.038, respectively). The other factors showed no association with GERD. CONCLUSION: This study is the first to show that lumbar kyphosis, poor sagittal balance; increased number of oral drugs taken per day, and decreased back muscle strength are important risk factors for the development of GERD symptoms. Thus, orthopedic surgeons and physicians should pay attention to GERD in elderly patients with spinal deformity

Analysis of hip geometry by clinical CT for the assessment of hip fracture risk in elderly Japanese women.

Two case-control studies were designed to investigate the contribution of the geometry and bone mineral density (BMD) of the proximal femur to bone strength in Japanese elderly women. We also investigated whether clinical CT is useful to assess the risk of hip fracture. Subjects in the neck fracture study included 20 Japanese women with neck fracture (age: mean+/-SD; 80.1+/-4.5 years old) and 20 age-matched control women (79.2+/-2.6 years old). Subjects in the trochanteric fracture study included 16 Japanese women with trochanteric fracture (82.6+/-5.0 years old) and 16 age-matched control women (80.8+/-3.8 years old). CT examination of the proximal femur was performed between the date of admission and the date of surgery. The CT scanners used were an Aquillion 16 (Toshiba) and Somatom 64 (Siemens); the scanning conditions including spatial resolution and scanning energy were adjusted, and the same type of reference phantom containing hydroxyapatite was used. QCT PRO software (Mindways) was used to analyze data for BMD, geometry, and biomechanical parameters. Both the neck and trochanteric fracture cases had significantly lower total and cortical BMD, a significantly smaller cortical cross-sectional area (CSA), and a larger trabecular CSA. Both had significantly thinner cortex and smaller distance to center of bone mass, and women with trochanteric fracture had a significantly smaller cortical perimeter in the cross-sectional femoral neck. Women with neck fracture had a longer hip axis length (HAL) and women with trochanteric fracture had a significantly larger neck-shaft angle (NSA). Both groups had significantly lower cross-sectional moment of inertia (CSMI), and only women with neck fracture had a significantly higher buckling ratio (BR) compared to their respective controls. According to the multiple logistic regression analysis, women with neck fracture had a significantly longer HAL, lower CSMI, and higher BR, and women with trochanteric fracture had a significantly smaller cortical CSA of the femoral neck. We conclude that clinical CT may be useful for the assessment of the risk of neck and trochanteric fracture

THE SURGICAL TREATMENT METHOD FOR AN ADULT POSTTRAUMATIC THORACOLUMBAR KYPHOSIS PATIENT WITH OSTEOGENESIS IMPERFECTA

Osteogenesis imperfecta (OI) is an inheritable bone disorder characterized by osseous fragility and ligamentous laxity. It is sometimes difficult to obtain bone union in patients with OI. The purpose of this report is to present a rare case of posttraumatic kyphosis due to a L1 burst fracture in a patient with OI, and to discuss how to treat it to achieve an adequate correction and circumferential fusion. The patient was a 29-year-old man with OI (Sillence type-IA) who had sustained an L1 fracture when he dived head first into a river. After 3 months of conservative therapy with a body cast, he showed disability at work because of his persistent low back pain and fatigue in his whole back. He showed no neurological disorder. Diagnostic imaging revealed localized kyphotic deformity at L1. Therefore, lumbar lordosis and thoracic kyphosis worsened. Anterior release and fusion, and posterior fusion were conducted. Three months after surgical treatment, circumferential fusion was obtained. His low back pain and fatigue in the whole back disappeared, and he could resume work without any difficulty. From the bone union standpoint, the surgical strategy for spinal correction in OI patients is still controversial because of the intractableness of bone union and fragility of the bone itself. The authors achieved circumferential union using anterior fusion and posterior fusion, in which wide bone bed is available owing to spared posterior elements of the spinal column

Two cases of pelvic sarcoma in the acetabulum with >10-year follow-ups after carbon ion radiotherapy.

There are many cases of bone and soft-tissue sarcoma in whichresection is difficult. This difficulty is typically related to the lesion\u27soriginal location or the possibility that resection could leadto a marked decline in the patient\u27s quality of life, based onpostoperative motor dysfunction or neurological damage [1].Moreover, even in cases where resection is possible, postoperativeirradiation is recommended for patients who experience incompleteresection or exhibit positive surgical margins. However,many kinds of bone and soft-tissue sarcomas are radio-resistanttumours, and it is can be difficult to control them using X-ray radiationtherapy.In the field of radiation oncology, heavy-ion beams are definedas radiation that is obtained by accelerating charged nuclei that areheavier than protons. Carbon ion radiotherapy is one type of heavyionradiotherapy having potential advantages over conventionalradiotherapy [2]. For example, carbon ions provide better physicaldose distribution, compared to conventional radiotherapy, becauseof the special characteristic of charged particle beams (the Braggpeak) [2,3]. Furthermore, they have a higher relative biologicaleffectiveness and a lower oxygen enhancement ratio. Some researchershave argued that protons represent a technicalimprovement for highly conformal therapy, and that heavier ionsmight even facilitate the treatment of cancers that are resistant toconventional X-ray therapy [4]. In Japan, the National Institute ofRadiological Science (NIRS) has treated patients using carbon ionradiotherapy since 1994, and over 8000 patients with various solidtumours have been treated using by carbon ion radiotherapy atNIRS [2].We informed two patients that there are not only advantages ofsurgery but also postoperative complications. In addition, we toldthem that carbon ion radiotherapy might be a safe and effectivemodality for patients who localized primary sarcoma who are unsuitablefor resection or for patients who refuse surgery includingamputation. As a result, both of them made a choose carbon iontherapy.In the present report, we describe two cases of pelvic sarcomaswith available oncological and functional results from prolongedfollow-ups (>10 years) after carbon ion radiotherapy without surgery.Informed consent has been obtained from these two patientsfor publication. This is the first report regarding delayed side effectsof carbon ion radiotherapy after a long-term follow-up