The Influence of Posture on Instability Evaluation Using Flexion–Extension X-Ray Imaging in Lumbar Spondylolisthesis

Study DesignProspective clinical study.PurposeTo determine the optimal posture for instability evaluation using flexion–extension X-ray imaging in patients with lumbar spondylolisthesis.Overview of LiteratureCurrently, flexion–extension X-ray imaging is the most practical approach for the evaluation of lumbar instability. In flexion–extension X-ray imaging, achievement of the greatest segmental motion with flexion–extension movement is necessary. However, to our knowledge, currently, there is no standardized posture for determining lumbar instability.MethodsTwenty-three individuals with lumbar spondylosis related to the fourth vertebra underwent flexion–extension X-ray imaging in different postures (standing, sitting, and lateral decubitus positions), lumbar magnetic resonance imaging (MRI), and low back pain Visual Analog Scale (VAS) evaluation on the same day. Intervertebral angle, percent slippage, and intervertebral disc area ratio for different postures during flexion and extension were compared using Tukey’s method. The effect of low back pain and the association between MRI facet effusion and these measurements were investigated according to posture.ResultsThe percent slippage during extension (p=0.036), change in the percent slippage between flexion and extension (p=0.004), and change in the intervertebral angle (p=0.042) were significantly different between the sitting and lateral decubitus positions. There were also significant differences between the standing and lateral decubitus positions in the change in intervertebral angle (p=0.010). In patients with VAS score p=0.011) between the standing and lateral decubitus positions, percent slippage (p=0.048), and intervertebral disk ratio (p=0.008) between the sitting and lateral decubitus positions. We found no relationship between MRI facet effusion and posture in terms of instability.ConclusionsIn this study, intervertebral instability was best evaluated in the lateral decubitus position when using flexion–extension X-ray imaging for patients with fourth lumbar vertebral spondylolisthesis.

The Influence of Posture on Instability Evaluation Using Flexion–Extension X-Ray Imaging in Lumbar Spondylolisthesis

Study DesignProspective clinical study.PurposeTo determine the optimal posture for instability evaluation using flexion–extension X-ray imaging in patients with lumbar spondylolisthesis.Overview of LiteratureCurrently, flexion–extension X-ray imaging is the most practical approach for the evaluation of lumbar instability. In flexion–extension X-ray imaging, achievement of the greatest segmental motion with flexion–extension movement is necessary. However, to our knowledge, currently, there is no standardized posture for determining lumbar instability.MethodsTwenty-three individuals with lumbar spondylosis related to the fourth vertebra underwent flexion–extension X-ray imaging in different postures (standing, sitting, and lateral decubitus positions), lumbar magnetic resonance imaging (MRI), and low back pain Visual Analog Scale (VAS) evaluation on the same day. Intervertebral angle, percent slippage, and intervertebral disc area ratio for different postures during flexion and extension were compared using Tukey’s method. The effect of low back pain and the association between MRI facet effusion and these measurements were investigated according to posture.ResultsThe percent slippage during extension (p=0.036), change in the percent slippage between flexion and extension (p=0.004), and change in the intervertebral angle (p=0.042) were significantly different between the sitting and lateral decubitus positions. There were also significant differences between the standing and lateral decubitus positions in the change in intervertebral angle (p=0.010). In patients with VAS score p=0.011) between the standing and lateral decubitus positions, percent slippage (p=0.048), and intervertebral disk ratio (p=0.008) between the sitting and lateral decubitus positions. We found no relationship between MRI facet effusion and posture in terms of instability.ConclusionsIn this study, intervertebral instability was best evaluated in the lateral decubitus position when using flexion–extension X-ray imaging for patients with fourth lumbar vertebral spondylolisthesis.

Osteoporosis Associated with Chronic Obstructive Pulmonary Disease

Recent epidemiological studies have revealed that osteoporosis is closely associated with common chronic diseases including diabetes, hypertension, chronic kidney disorders, and chronic obstructive pulmonary disease (COPD). COPD is a chronic inflammatory airway disease but now well known to be associated with various systemic comorbidities including osteoporosis. Osteoporosis and osteoporotic fractures are extremely common in COPD patients, which have significant impacts on their quality of life (QOL), activities of daily life (ADL), respiratory function, and possibly their prognosis. COPD-associated osteoporosis is however extremely under-recognized, hence undertreated. Recent studies have suggested that both decreased bone mineral density (BMD) and impaired bone quality compromise bone strength causing fractures in COPD. In COPD patients, various general clinical risk factors for osteoporosis are present including smoking, older age, low body weight, and physical inactivity. In addition, disease-related risk factors such as decreased pulmonary function, inflammation, glucocorticoid use and vitamin D deficiency/insufficiency have been linked to the development of osteoporosis in COPD. Increased awareness of osteoporosis in COPD, especially that of high prevalence of vertebral fractures is called upon among general physicians as well as pulmonologists. Routine screening for osteoporosis and risk assessment of fractures will enable physicians to diagnose COPD patients with comorbid osteoporosis at an early stage. Timely prevention of developing osteoporosis together with appropriate treatment of established osteoporosis may improve QOL and ADL of the COPD patients, preserve their lung function and eventually result in better prognosis in these patients.

Prospective and Progress of Simulators in Medical Education / 医学教育

Simulations will be important in 21st-century medical education. However, several obstacles may prevent this teaching tool from being introduced to individual medical schools. Most medical schools cannot afford expensive full-scale simulators and do not have enough space for introducing simulation materials. Medical schools must also hire operators for extremely sophisticated computers. To solve these problems we propose to establish a medical simulation center in a large city. Trainees will come to the center from medical schools in Tokyo and learn fundamental techniques, such as intravenous injection and endotracheal intubation, with specialized partial simulators. In advanced courses, trainees can learn with fullscale simulations how to deal with serious situation. The establishment of a simulation center in a large city may popularize the use of expensive simulators and equipment. However, how to maintain the center financially remains a problem; raising funds from many sources is the key to success.