Comparisons on efficacy of elcatonin and limaprost alfadex in patients with lumbar spinal stenosis and concurrent osteoporosis: a preliminary study using a crossover design.

STUDY DESIGN: Multicenter prospective study with a crossover design. PURPOSE: The objective of this study is to compare the efficacy of limaprost alfadex (LP) and elcatonin (EL) for lumbar spinal stenosis (LSS) patients with concurrent osteoporosis. OVERVIEW OF LITERATURE: It has been increasingly important to improve quality of life by establishing appropriate conservative treatments for LSS patients with concurrent osteoporosis who will presumably continue to increase due to the percentage of the aging elevations, however there is no prospective study. METHODS: A total of 19 patients with LSS and concurrent osteoporosis were enrolled in this study. The patients were divided into two groups and compared using a crossover design. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and short-form (SF)-8 health survey scale were used for clinical evaluations. RESULTS: There was a significant improvement of buttock-leg pain and numbness in the EL group. A significant improvement of impaired walking function was noted for the LP group according to the JOABPEQ while the rest of the items in the JOABPEQ showed no significant differences. The SF-8 health survey revealed that somatic pains and physical summary scores in the EL group and physical functioning and physical summary scores in the LP group tended to improve but not to any statistically significant extents. CONCLUSIONS: Concomitant uses of EL may be useful in patients who do not respond satisfactorily to the treatments of LP for 6-8 weeks.

Validation study of a clinical diagnosis support tool for lumbar spinal stenosis.

BACKGROUND: A clinical diagnosis support tool for lumbar spinal stenosis was developed by the Japanese Society for Spine Surgery and Related Research. However, the use of this tool has not yet been validated. METHODS: Patients with symptoms in the lower extremities and who visited the Department of Orthopedics initially were recruited to the study. Orthopedic physicians who were not spine specialists completed the support tools. Spine specialists examined the patients, made a diagnosis, and completed the lumbar spine examination sheet made for the study. The support tool and lumbar spine examination sheet were sent to a central panel comprising four panelists who then decided on a final diagnosis. RESULTS: In total, 118 patients were evaluated, including 62 males and 56 females. Lumbar spinal stenosis was diagnosed in 58 and nonlumbar spinal stenosis in 60 patients. The mean score in the lumbar spinal stenosis group was 12.2 points (median 13 points). In the nonlumbar spinal stenosis group, the mean score was 7.5 points (median 7 points). Sensitivity was 0.948, and specificity was 0.40. CONCLUSIONS: Patients with lumbar spinal stenosis with a very low score were diagnosed with mild lumbar spinal stenosis, whereas nonlumbar spinal stenosis patients with a very high score were diagnosed as suffering from spine disease and needing special treatment by spine surgeons. Our results validate the use of the support tool for the diagnosis of lumbar spinal stenosis. Although the specificity observed in the present study was lower than that reported at development, we conclude that this support tool is useful for screening patients with lumbar spinal stenosis.

Dynamic contrast-enhanced magnetic resonance imaging of osteoporotic vertebral fracture.

STUDY DESIGN: This was a retrospective study of the relation between the blood perfusion of bone marrow in injured vertebrae and the degree of subsequent vertebral collapse in patients with osteoporotic vertebral fractures. OBJECTIVE: The objective was to evaluate blood perfusion of bone marrow in injured vertebrae using dynamic magnetic resonance imaging and study the possibility of predicting the progression of vertebral collapse. SUMMARY OF BACKGROUND DATA: Avascular necrosis of the vertebra is considered to be a cause of delayed vertebral collapse following osteoporotic vertebral fractures, but studies on the relation with the degree of progression of vertebral collapse by evaluation of vertebral blood perfusion have not been reported. METHODS: The subjects were 15 vertebrae in 14 patients with osteoporotic vertebral fractures, including 11 women and three men with a median age of 79 years. All patients underwent dynamic magnetic resonance imaging soon after the fracture and the area rate of the noncontrast region of the injured vertebrae in dynamic magnetic resonance imaging was measured. The correlation with the degree of progression of vertebral collapse obtained from plain radiograph imaging was studied. RESULTS: The vertebral collapse rate (percentage loss in vertebral body height) on initial examination was 17 +/- 10% (mean +/- SD) and that at the final examination was 33 +/- 19%, showing a progression of 16 +/- 11%. The noncontrast area rate in dynamic magnetic resonance imaging was 18 +/- 12%. A significant correlation was found between the degree of progression of vertebral collapse and the noncontrast area rate (Spearman r = 0.97, P < 0.001). CONCLUSIONS: The subsequent progression of vertebral collapse tended to increase the greater the noncontrast area in the injured vertebrae in dynamic magnetic resonance imaging. Dynamic magnetic resonance imaging appears to be useful in predicting the progression of collapse of fractured vertebrae.