Effect of Different Types of Upper Instrumented Vertebrae Instruments on Proximal Junctional Kyphosis Following Adult Spinal Deformity Surgery: Pedicle Screw versus Transverse Process Hook

Study Design Retrospective comparative study. Purpose To compare the incidence of proximal junctional kyphosis (PJK) between transverse process hooks (TPHs) and pedicle screws (PSs) at the upper instrumented vertebrae (UIV) following adult spinal deformity (ASD) surgery. Overview of Literature The choice of UIV implant type may be important for avoiding PJK; however, few comparative clinical studies have evaluated the incidence of PJK according to the type of UIV implant used in ASD surgery. Methods We retrospectively reviewed 39 consecutive patients with ASD (mean age, 67 years; mean follow-up period, 41 months) who underwent corrective surgery between 2009 and 2013. TPH was used in 17 patients and PS in 22 patients. PJK was defined as the presence of a UIV or UIV±1 fracture, or a change in the proximal junctional angle (PJA) of >20°. Data of patients with TPH and PS were compared. Results The TPH group had a PJK incidence of 17.6% compared with 27.3% in the PS group (p =0.47). In the TPH group, PJK was a result of UIV fracture in one patient, UIV−1 fracture in one patient, and ligamentous failure in one patient. In the PS group, six patients developed PJK because of UIV fracture. No differences in radiographic parameters were found between the two groups. After analyzing the PJA data in the patients with PJK, the changes in PJA were significantly higher in the PS group than in the TPH group (19.0°/5.0°, p =0.04). Conclusions Our results show that using TPH as a UIV implant may not prevent PJK; however, using TPH as the UIV anchor may prevent vertebral collapse if cases of UIV fracture. The increased risk of UIV fracture collapse in the PS group may be a result of a higher mechanical load on UIV when using PS

Impact of the COVID-19 Pandemic on Elderly Patients with Spinal Disorders

During the ongoing coronavirus disease 2019 (COVID-19) pandemic, home-quarantine has been necessary, resulting in lifestyle changes that might negatively affect patients with spinal disorders, including a reduction in their quality of life (QoL) and activities of daily living (ADLs). However, studies on this impact are lacking. This study aimed to investigate the age-related changes in QoL and ADLs in patients with spinal disorders, and also identify factors associated with decline in ADLs. This multicenter cross-sectional study included patients who visited four private spine clinics for any symptoms. The study participants either had a clinic reservation, were first-time clinic visitors, or had a return visit to the clinic. The participants completed several questionnaires at two points: pre-pandemic and post-second wave. Changes in patient symptoms, exercise habits, ADLs, and health-related QoL were assessed. A logistic regression model was used to calculate the odds ratio (OR) of each variable for decline in ADLs. We included 606 patients; among them, 281 and 325 patients were aged 65 years were 1.7 (1.1–2.9), 2.4 (1.4–3.9), and 2.7 (1.6–4.4), respectively. In conclusion, there was a decline in the ADLs and QoL after the COVID-19 outbreak in patients with spinal disorders. Aging, reduction of exercise habits, and female sex were independent factors related to decline in ADLs

Prevalence of Restless Legs Syndrome and its Symptoms among Patients with Spinal Disorders

Restless legs syndrome (RLS) is a neurological disorder that causes uncomfortable sensations in the legs. The purpose of this study was to evaluate the symptoms of RLS in patients with spinal disorders and the impact of RLS on the clinical outcomes of lumbar spinal stenosis (LSS). The records of 278 patients (age range 65–92 years) with spinal disorders who visited our outpatient clinic were reviewed. We used a survey to identify subjects with RLS based on the International RLS Study Group diagnostic criteria. We further recorded patient characteristics, surgical outcomes, sleeping time, mental health condition, and the occurrence of leg cramps. Thirty-two patients (11.5%) met the criteria for RLS. The prevalence of anxiety (46.9% vs. 26.6%, p = 0.023) and leg cramps (90.6% vs. 73.2%, p = 0.030) was higher in patients with RLS than in those without. RLS was present in 12.3% of LSS patients. The visual analog scale score for lower back pain before surgery and at the final follow-up was significantly higher in LSS patients with RLS than in those without. However, the Japanese Orthopaedic Association (JOA) score, JOA score improvement ratio, and VAS score for leg numbness were not significantly different between the groups

Change in Physical and Mental Quality-of-Life between the Short- and Mid-Term Periods after Cervical Laminoplasty for Cervical Spondylotic Myelopathy: A Retrospective Cohort Study with Minimum 5 Years Follow-up

The mid-term surgical outcomes of cervical spondylotic myelopathy (CSM), evaluated using the cervical Japanese Orthopedic Association (cJOA) score, are reported to be satisfactory. However, there remains room for improvement in quality-of-life (QOL), especially after short-term follow-up. We aimed to demonstrate changes in mental and physical QOL between short- and mid-term follow-ups and determine the predictive factors for deterioration of QOL. In this retrospective cohort study, 80 consecutive patients underwent laminoplasty for CSM. The outcome measures were Short Form-36 Physical Component Summary (PCS), Mental Component Summary (MCS), and cJOA scores. PCS and MCS scores were compared at the 2- and 5-year postoperative time points. Additionally, a multivariate logistic regression model was used to identify the predictive factors for deterioration. Significant factors in the logistic regression analysis were analyzed using receiver-operating characteristic curves. The results showed that MCS scores did not deteriorate after 2 years postoperatively (p = 0.912). Meanwhile, PCS significantly declined between 2 and 5 years postoperatively (p = 0.008). cJOA scores at 2 years postoperatively were significantly associated with PCS deterioration at 2-year follow-up. In conclusion, only physical QOL might show deterioration after short-term follow-up. Such deterioration is likely in patients with a cJOA score <13.0 at 2 years postoperatively

Short-Term Risk Factors for Distal Junctional Kyphosis after Spinal Reconstruction Surgery in Patients with Osteoporotic Vertebrae

Study Design Level 3 retrospective cohort case-control study. Purpose This study aimed to investigate the risk factors for distal junctional kyphosis (DJK) caused by osteoporotic vertebral fractures following spinal reconstruction surgery, with a focus on the sagittal stable vertebra. Overview of Literature Despite the rarity of reports on DJK in this setting, DJK was reported to reduce when the lower instrumented vertebra (LIV) was extended to the sagittal stable vertebra in the posterior corrective fixation for Scheuermann’s disease. Methods This study included 46 patients who underwent spinal reconstruction surgery for thoracolumbar osteoporotic vertebral fractures and kyphosis and were followed up for 1 year postoperatively. DJK was defined as an advanced kyphosis angle >10° between the LIV and one lower vertebra. The patients were divided into groups with and without DJK. The risk factors of the two groups, such as patient background, surgery-related factors, radiographic parameters, and clinical outcomes, were analyzed. Results The DJK and non-DJK groups included 14 and 32 patients, respectively, without significant differences in patient background. Those with instability in the distal adjacent LIV disc had a significantly higher risk of DJK occurrence (28.6% vs. 3.2%, p=0.027). DJK occurrence significantly increased in those with the sagittal stable vertebra not included in the fixation range (57.1% vs. 18.8%, p=0.020). Other preoperative radiographic parameters were not significantly different. Instability in the distal adjacent LIV disc (adjusted odds ratio, 14.50; p=0.029) and the exclusion of the sagittal stable vertebra from the fixation range (adjusted odds ratio, 5.29; p=0.020) were significant risk factors for DJK occurrence. Conclusions Regarding spinal reconstruction surgery in patients with osteoporotic vertebral fractures, instability in the distal adjacent LIV disc and the exclusion of the sagittal stable vertebra from the fixation range were risk factors for DJK occurrence in the short term