Central sensitization adversely affects quality of recovery following lumbar decompression surgery.

BACKGROUND: Central sensitization (CS) is defined as increased responsiveness of nociceptive neurons in the central nervous system to normal or subthreshold afferent input. The CS phenomenon is caused by continuous, intense nociceptor inputs triggering a prolonged but reversible increase in the excitability and synaptic efficacy of neurons in the central nociceptive pathway. Most patients undergoing surgery for lumbar spinal stenosis (LSS) experience symptoms for more than three months; therefore, it is possible that CS is associated with postoperative symptoms of LSS. The aim of this study was to clarify the influence of CS in patients who underwent surgery for LSS. METHODS: We used the Central Sensitization Inventory (CSI) to evaluate CS preoperatively. Clinical and neurological symptoms were assessed before surgery and three months after surgery using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOA-BPEQ) and the Oswestry Disability Index (ODI). To evaluate the correlation between the preoperative CSI score and each parameter of the JOA-BPEQ before and three months after surgery, a Pearson correlation coefficient was used. We also evaluated the correlation between preoperative CSI and improvement scores for each parameter of the JOA-BPEQ for surgery. Similarly, the ODI was assessed. RESULTS: This study included 118 patients. After surgery, the parameters of lumbar function disorder, social life function disorder, and mental health disorder revealed a statistically significant relationship (r = -0.289, -0.0354, and -0.493, respectively). There was no significant correlation between CSI and improvement scores of the JOA-BPEQ. The ODI assessment after surgery revealed a statistically significant relationship (r = 0.344). There was no significant correlation between the CSI and ODI improvement scores. CONCLUSION: This study showed that the severity of the CSI influenced the postoperative outcomes, and that surgical treatment improved the symptoms of LSS regardless of the occurrence of CS preoperatively.

Temporal Evolution of White Blood Cell Count and Differential: Reliable and Early Detection Markers for Surgical Site Infection Following Spinal Posterior Decompression Surgery.

Introduction: For early detection of surgical site infection (SSI) following spinal decompression surgery, we compared temporal changes in the values of laboratory markers that are not affected by operative parameters. Methods: The study included 302 patients, which were divided into an SSI group (patients who developed deep SSI) and a non-SSI group for analysis. We reviewed data on C-reactive protein level, total white blood cell (WBC) count, and WBC differential percentage and count before spinal decompression, on postoperative day 1, and on postoperative day 4. We identified laboratory markers that are not affected by operative parameters (operating time, intraoperative blood loss, and number of operative segments). Laboratory markers with a significant difference observed between the peak or nadir value and the value in the subsequent survey day were considered as an indicator of SSI. We examined the utility of each indicator by calculating sensitivity and specificity. Furthermore, we investigated the utility of the combination of all five indicators (wherein the recognition of one marker was considered positive). Results: Temporal changes in five laboratory markers were considered indicators of SSI. The changes from postoperative day 1 to postoperative day 4 were as follows: (1) increased WBC count (42% sensitivity, 88% specificity), (2) increased neutrophil percentage (25% sensitivity, 96% specificity), (3) increased neutrophil count (25% sensitivity, 94% specificity), (4) decreased lymphocyte percentage (25% sensitivity, 95% specificity), and (5) decreased lymphocyte count (25% sensitivity, 85% specificity). The combination of these five markers showed a 50% sensitivity, 81% specificity, and 0.65 AUC. Conclusions: Five markers were found to be reliable indicators of SSI following spinal decompression surgery because they were not affected by operative parameters. The combination of all five indicators had moderate sensitivity and high specificity. Therefore, this may be reliable and useful for the early detection of SSI.

Preliminary Screening Method for Low Bone Mineral Density Using a Self-Reported Questionnaire among Peri- and Postmenopausal Women.

STUDY DESIGN: Retrospective cohort study. PURPOSE: We propose a method for screening for low bone mineral density (BMD) among perimenopausal and postmenopausal women using a self-reported questionnaire. OVERVIEW OF LITERATURE: Osteoporosis is a major health problem worldwide. However, it is not cost-effective to evaluate BMD in all patients. Although several tools for predicting osteoporosis have been established, they do not focus much on low BMD prior to the development of osteoporosis. METHODS: We retrospectively reviewed the medical records of 198 women aged 40-70 years who underwent mass screening for osteoporosis at our hospital between 2016 and 2019. The BMD values and the following data were collected: age, body mass index, fracture history, lower back pain, height loss, kyphosis, history of fragility fracture, family history of vertebral or hip fracture, and menopause. The reliability of each data point for the young adult mean <80% was calculated using discriminant analysis. Variables with large weight coefficients were selected and scored. This scoring tool was examined, and a cutoff score for predicting the young adult mean <80% was determined. RESULTS: Sixty-four participants (32.3%) had a young adult mean <80%. According to the weight coefficients, the following five variables were scored as follows: age ≥60 years 3 points, body mass index <22 kg/m2 3 points, lower back pain 1 point, height loss (cm) 1 point, and menopause 1 point. The area under the receiver operating characteristic curve was 0.738 (95% confidence interval, 0.669-0.807). At cutoff scores of ≥5 and <5, the sensitivity was 82.8%, with specificity of 52.0%. CONCLUSIONS: The scoring tool performed well for predicting young adult mean <80% among perimenopausal and postmenopausal women in Japan. This tool may be useful to screen for low BMD.

Total Syntheses of Carazostatin, Hyellazole, and Carbazoquinocins B-F.

Total syntheses of carazostatin (1), hyellazole (2a), and carbazoquinocins B-F (3b-f) have been completed. The cross-coupling reaction between 3-iodoindole 8 and vinylstannane 11b gave the 3-alkenylindole 7. Treatment of 7 with ethynylmagnesium bromide, followed by etherification of the resulting alcohol 12 with MOMCl, yielded the 3-alkenyl-2-propargylindole 6. The compound 6 was treated with t-BuOK in t-BuOH at 90 degrees C to obtain the desired carbazoles 4 together with the N-deprotected carbazole 13 through an allene-mediated electrocyclic reaction. The carbazole 13a, derived from 4a or 4c, was converted into the triflate 24 in two steps. The triflate 24 was subjected to the Suzuki cross-coupling reaction with either 9-heptyl-9-BBN or phenylboronic acid in the presence of a palladium catalyst to produce the 1-heptylcarbazole 25a and the 1-phenylcarbazole 25b. Cleavage of the ether bond of 25a yielded carazostatin (1). Cleavage of the ether bond of 25b followed by O-methylation gave hyellazole (2a). Oxidation of carazostatin (1) with benzene seleninic anhydride afforded carbazoquinocin C (3c). In a similar way, carbazoquinocins B and D-F (3b,d-f) were synthesized, respectively.