Evaluation of a new apparatus combining a mobile device and hand-held roller for the detection of spinal deformities: association with the sum of the right and left angles of trunk inclination.

PURPOSE: To investigate the intra- and inter-observer reliabilities of the newly developed i-Scolioroller for scoliosis screening, and to determine the optimal i-Scolioroller measurement cutoff values for identifying adolescent scoliosis with a Cobb angle ≥ 20°. METHODS: The i-Scolioroller displays the right- and left-side maximum inclination angle (Rmax, Lmax) during the forward bending test (FBT), as well as the angle of trunk inclination (ATI, i.e., whether the Rmax or Lmax is greater). Sum-ATI is defined as the sum of Rmax and Lmax. Intra-class correlation coefficients (ICC) of the ATI and sum-ATI measurements were calculated to analyze the intra- and inter-observer reliabilities for 10 plaster torsos in FBT positions obtained from patients with idiopathic scoliosis. The optimal cutoff values for scoliosis were determined using receiver operating characteristic (ROC) analysis of i-Scolioroller measurements versus Cobb angles obtained from the upright whole-spine radiographs of 112 adolescent outpatients. RESULTS: The intra-observer ICCs for the ATI/sum-ATI for 3 observers were 0.851/0.856, 0.786/0.900, and 0.772/0.796, respectively, while the corresponding inter-observer ICCs for all participants were 0.733/0.745. On ROC analysis, an ATI of 8° was the optimal cutoff value for scoliosis (sensitivity and specificity: 79.2% and 70.0%, respectively). The optimal cutoff value for sum-ATI was 11° (sensitivity and specificity: 86.1% and 82.5%, respectively). The areas under the ROC curves were 0.859 for ATI and 0.908 for sum-ATI. CONCLUSION: The optimal cutoff values for identifying scoliosis using the i-Scolioroller were a combination of 11° for the sum-ATI and 8° for the ATI.

Classification of arm swing as a clinical marker of advancing spinal deformity among community-dwelling female volunteers 60 years or older.

The clinical characteristics of adult spinal deformity (ASD) include worsening of deformity during gait, which leads to unstable posture and propensity to fall. The purpose of this study was to classify arm swing and to analyse its clinical implications. Clinical and radiographic evaluations were performed with 168 community-dwelling female volunteers recruited from a population register in Hokkaido, Japan, with a mean age of 67.3 ± 4.7 years, and arm swing was classified into four groups according to maximum forward and backward arm swing distance: (1) predominantly forward swing with forward swing always larger than backward swing (FS, n = 138), (2) equal or equivocal swing (ES, n = 8), (3) predominantly backward swing with backward swing always larger than forward swing (BS, n = 20), and (4) thigh-hand type without arm swing with their hands placed on thighs (TH, n = 2). BS and FS showed significant differences in radiographic lumbar lordosis (BS 19.4 ± 18.1° vs. FS 40.6 ± 14.5°, P < 0.01 ANOVA), pelvic tilt (BS 40.0 ± 7.3° vs. FS 22.9 ± 8.9°, p < 0.01), number of vertebral fractures (BS 1.2 ± 1.4 vs. FS 0.3 ± 0.6, p < 0.01), and trunk extensor muscle strength (BS 374.9 ± 134.8 N vs. FS 478.1 ± 172.6 N, p < 0.05). Arm swing correlated with severity of radiographic ASD, osteoporotic changes, and back muscle weakness. The number of ASD patients, which includes patients with de novo/idiopathic scoliosis, degenerative/osteoporotic kyphosis, and other neuromuscular deformities, has been increasing, and further study should clarify the importance of dynamic evaluation of ASD among elderly patients.

Adult spinal deformity and its relationship with hip range of motion: a cohort study of community-dwelling females.

BACKGROUND CONTEXT: Adult spinal deformity affects lower extremity alignment with compensation in joint range of motion (ROM) and alignment of the hip. PURPOSE: To investigate the relationship between sagittal spinopelvic alignment and the ROM of the hip joint and the femoral oblique angle (FOA). STUDY DESIGN: Cross-sectional, observational cohort study of community-dwelling Japanese women. METHODS: The study group included 158 women, enrolled in our ongoing prospective cohort study, with upright spine radiographs and physical measurements obtained for all participants. Radiographic spinopelvic parameters included measurement of thoracic kyphosis, lumbar lordosis (LL), sagittal vertical axis (SVA), sacral slope, pelvic incidence, and pelvic tilt (PT). FOA parameters were measured on hip radiographs and hip ROM included external and internal rotation and extension. The association between spinopelvic parameters, the FOA, and hip joint ROM was evaluated using Spearman's correlation analysis. RESULTS: External rotation of the hip was correlated with LL (R=0.179, p=.024), PT (R=-0.273, p=.001) and SVA (R=-0.215, p=.007), with the FOA being correlated with the SVA (R=0.502, p<.001). CONCLUSIONS: The decrease in hip external rotation with adult spinal deformity might reflect a structural modification in spinopelvic alignment. An increase in FOA was associated with an increase in SVA, indicative of a sagittal malalignment in the decompensated phase of adult spinal deformity.

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.

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.

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

STUDY DESIGN: A 12-year prospective study of pre-existing and de novo degenerative lumbar scoliosis (DLS) among community-based female volunteers. OBJECTIVE: To investigate serial entire spine radiographs of healthy female volunteers and to clarify radiographical characteristics and predictors of pre-existing and de novo DLS. SUMMARY OF BACKGROUND DATA: DLS is among the most frequent spinal defomities in the aging spine; however, the onset or the natural course of this condition has not been elucidated. METHODS: A total of 144 female volunteers were recruited from population register. Radiographical measurements using entire spine radiographs included thoracic kyphosis (T4-12), lumbar lordosis (LL) (L1-5), sacral inclination angle, pelvic incidence, sagittal balance (C7 plumb), coronal L4 endplate angle (L4 tilt), and scoliotic angle by Cobb method. More than 10° of scoliosis was diagnosed as DLS. L4 vertebral size was measured (divided by body height) as well as lateral osteophyte formation and lateral disc wedge angle. RESULTS: Mean baseline age and follow-up period were 54.4 years and 12.1 years, respectively. Pre-existing DLS (pre-DLS) was found in 42 subjects (29.2%) at baseline. Among pre-DLS, 11 subjects (26%) showed more than 5° progression in scoliosis. De novo DLS has developed in 30 subjects (29.4%) among those without baseline scoliosis.Cox proportional hazards models revealed younger age, smaller L4 size, lower LL, greater DLS angle, and L4 tilt at baseline to be the risk factors of progression of pre-DLS and smaller L4 size, unilateral osteophyte formation, and lateral disc wedging to the risk of development of de novo DLS. CONCLUSION: This study indicated that younger age, smaller L4 size, lower LL, greater DLS angle, and L4 tilt at baseline should be evaluated as predictors of progression of pre-DLS. Early signs of asymmetric disc degeneration and smaller L4 size should also be evaluated as predictors of development of de novo DLS.

Radiographic analysis of newly developed degenerative spondylolisthesis in a mean twelve-year prospective study.

STUDY DESIGN: Prospective study of community-based female volunteers. OBJECTIVE: To investigate the incidence of newly developed degenerative spondylolisthesis (DS) among those without baseline deformity, and to clarify radiographic characteristics and predictors of DS. SUMMARY OF BACKGROUND DATA: There has been limited number of prospective studies of DS. Our on-going cohort study of healthy volunteers enabled long-term observation of highly susceptible perimenopause female subjects. METHODS: A final total of 142 female subjects without spondylolisthesis at baseline radiographs were included and followed up for more than 8 years. Standardized serial entire spine radiographs were used to measure spinopelvic alignment, including pelvic incidence (PI), vertebral inclination angle, disc height, vertebral size, and facet orientation. RESULTS: The incidence of newly developed DS was 12.7%. Comparison between DS and non-DS subjects demonstrated that DS subjects had significantly greater baseline lumbar lordosis, PI, vertebral inclination angle, and smaller vertebral size. Exaggerated lumbopelvic alignment was more prominent in L3-DS than in L4-DS, and L4-DS was associated with the decrease in L4/5 disc height. Multivariate analysis revealed that PI, L4 vertebral inclination, adjusted vertebral size, and facet sagittalization were independent predictors of the development of DS. CONCLUSION: This was the first study to confirm the relationship of PI and the development of DS in a long-term prospective observation. Proposed pathogenetic differences might explain the fact that L4-DS is far more prevalent than L3-DS. The development of DS could be predicted by baseline lumbopelvic morphology among the highly susceptible perimenopause women.

Effects of dry needling at tender points for neck pain (Japanese: katakori): near-infrared spectroscopy for monitoring muscular oxygenation of the trapezius.

BACKGROUND: Neck pain (katakori) is a common symptom in adult Japanese people. However, the pathophysiological aspect of this condition has not been well documented to date. The purpose of this study was to investigate the effects of tender point dry needling to the trapezius muscles and the resultant changes in muscular hemodynamics. METHODS: "Neck pain" patients were defined as those complaining of dull pain or discomfort mainly along the trapezius muscles without serious spinal or shoulder disorders. We used near-infrared spectroscopy to monitor the changes of oxyhemoglobin (oxyHb) and deoxyhemoglobin (deoxyHb) of the trapezius muscles and a Visual Analogue Scale (VAS) to assess subjective neck pain intensity. Experiment I: Nine subjects with "neck pain" and four control subjects were recruited. Total hemoglobin (Hb) and SdO2 [= oxyHb/(oxyHb + deoxyHb)] were measured before and immediately after needling for 15 min. We compared these parameters and VAS before and immediately after needling. Experiment II: Thirteen subjects with "neck pain" were instructed to perform isometric contraction of their trapezius muscles for 1 min; the half-recovery time of SdO2 (defined as T(R)) was measured. After that, all subjects underwent needling. On the next day, we repeated the measurements of T(R) after the same voluntary contraction of the trapezius muscle in the same patients. We compared T(R) and VAS before and on the day after needling. RESULTS: Experiment I: All subjects with "neck pain" reported significant pain relief (P = 0.0147) measured by VAS immediately after needling, but total Hb and SdO2 exhibited no significant change after needling. Experiment II: T(R) was shortened on the day after needling in 10 of 13 patients (P = 0.0043), and neck pain was decreased in 12 patients (P = 0.0158). CONCLUSIONS: After dry needling, total Hb and SdO2 did not change in real time, but T(R) was shortened on the next day. These results showed that the shortening of T(R) would provide a measure by which to assess the effectiveness of treatment for neck pain.