Masabumi Miyamoto

JOA Back Pain Evaluation Questionnaire (JOABPEQ)/JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) The report on the development of revised versions April 16, 2007

1 Laboratory of Statistics, Osaka City University Faculty of Medicine, Osaka, Japan 2 Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan 3 Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan 4 Department of Orthopaedic Surgery, School of Medicine, Fukushima Medical University, Fukushima, Japan 5 Department of Orthopedic Surgery, Nippon Medical School, Tokyo, Japan 6 Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan 7 Department of Orthopaedic Surgery, Iwate Medical University School of Medicine, Morioka, Japan 8 Department of Orthopaedic Surgery, Saitama Medical School. Saitama, Japan 9 Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Yamaguchi, Japan 10 Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan 11 Department of Orthopaedics, Kochi Medical School, Kochi, Japan 12 Department of Orthopaedic Surgery, Hoshigaoka Koseinenkin Hospital, Osaka, Japan 13 National Hospital Organization, Osaka-Minami Medical Center, Osaka, Japan 14 Department of Internal Medicine, Houai Hospital, Osaka, Japan 15 Department of Public Health, Osaka City University Faculty of Medicine, Osaka, Japan

Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. Part 3. Validity study and establishment of the measurement scale

BackgroundThe Japanese Orthopaedic Association decided to revise the JOA score for low back pain and to develop a new outcome measure. In February 2002, the first survey was performed with a preliminary questionnaire consisting of 60 evaluation items. Based on findings of that survey, 25 items were selected for a draft of the JOA Back Pain Evaluation Questionnaire (JOABPEQ). The second survey was performed to confirm the reliability of the draft questionnaire. This article further evaluates the validity of this questionnaire and establishes a measurement scale.MethodsThe subjects of this study consisted of 355 patients with low back disorders of any type (201 men, 154 women; mean age 50.7 years). Each patient was asked to fill in a self-administered questionnaire. Superficial validity was checked in terms of the completion rate for filling out the entire questionnaire. Factor analysis was then performed to evaluate the validity of the questionnaire and establish a measurement scale.ResultsAs a result of the factor analysis, 25 items were categorized into five factors. The factors were named based on the commonality of the items: social function, mental health, lumbar function, walking ability, and low back pain. To establish a measurement scale for each factor, we determined the coefficient for each item so the difference between the maximum factor scores and minimum factor scores was approximately 100. We adjusted the formula so the maximum for each factor score was 100 and the minimum was 0.ConclusionsWe confirmed the validity of the JOA Back Pain Evaluation Questionnaire and est ablished a measurement scale.

JOA Back Pain Evaluation Questionnaire: initial report

BackgroundThere is no widely accepted objective evaluation for lumbar spine disorders. New outcome measures should be patient-oriented and should measure symptoms and self-reported functional status in multiple dimensions. The aim of this study was to identify items to be included in the disease-specific quality of life (QOL) questionnaire for the assessments of patients with lumbar spine disorders.MethodsThe draft of the QOL questionnaire that consisted of a total of 60 items, including 24 items derived from the Japanese version of the Roland Morris Disability Questionnaire (RDQ) and 36 items derived from the Japanese version of Short Form 36 (SF-36), were administered to patients and controls. After obtaining written informed consent, the following data were collected from the patient group (n = 328) and the control group (n = 213): (1) background characteristics, including age, diagnosis, Japanese Orthopaedic Association (JOA) score, and finger to floor distance; (2) responses to the questionnaire; (3) the identification rate by discrimination analysis to select the candidates for adoption and by adopting explanatory variables. The items to be excluded were determined by examining the explanatory variables, which were selected after the discrimination analysis, by setting the candidate to-be-excluded items as an objective variable.ResultsBased on the distribution of the responses, two items, RDQ-15 and RDQ-19, were excluded. From the results of the correlation coefficient calculation for each question in the patient group, 33 items were excluded and 27 candidate items were adopted. Based on the adoption explanatory variable used in the discrimination analysis, 25 of the 27 candidate items for adoption were accepted.ConclusionsThis study identified the 25 specific questionnaire items that should be included in the questionnaire to evaluate QOL of patients with various lumbar spine disorders.

JOA Back Pain Evaluation Questionnaire (JOABPEQ)/ JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) The report on the development of revised versions April 16, 2007: The Subcommittee of the Clinical Outcome Committee of the Japanese Orthopaedic Association on Low Back Pain and Cervical Myelopathy Evaluation

1 Laboratory of Statistics, Osaka City University Faculty of Medicine, Osaka, Japan 2 Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan 3 Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan 4 Department of Orthopaedic Surgery, School of Medicine, Fukushima Medical University, Fukushima, Japan 5 Department of Orthopedic Surgery, Nippon Medical School, Tokyo, Japan 6 Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan 7 Department of Orthopaedic Surgery, Iwate Medical University School of Medicine, Morioka, Japan 8 Department of Orthopaedic Surgery, Saitama Medical School. Saitama, Japan 9 Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Yamaguchi, Japan 10 Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan 11 Department of Orthopaedics, Kochi Medical School, Kochi, Japan 12 Department of Orthopaedic Surgery, Hoshigaoka Koseinenkin Hospital, Osaka, Japan 13 National Hospital Organization, Osaka-Minami Medical Center, Osaka, Japan 14 Department of Internal Medicine, Houai Hospital, Osaka, Japan 15 Department of Public Health, Osaka City University Faculty of Medicine, Osaka, Japan

Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ): part 4. Establishment of equations for severity scores

BackgroundTo establish a patient-oriented outcome measure for cervical myelopathy, a subcommittee of the Japanese Orthopaedic Association (JOA) developed a new scoring system to evaluate the overall clinical status of patients, which could be completed by patients themselves. The subcommittee completed three large-scale studies to select and modify questions derived from various preexisting outcome measures including Short Form-36, and then finalized and validated the questionnaire, which comprised 24 questions.MethodsThe finalized questionnaire was administered to 369 patients with cervical myelopathy due to disc herniation, spondylosis, or ossification of posterior longitudinal ligament by randomly selected board-certified spine surgeons. Patients with different severities of myelopathy were included to insure accuracy and responsiveness of this questionnaire against patients’ different neurological status.ResultsData of 236 patients were employed and were subjected to rigorous statistical analyses. There was no question that was difficult to answer and distribution of answers for each question was not concentrated to one choice, indicating the appropriateness of all 24 questions. Results of factor analysis suggested that the 24 questions could be divided into five different factors or functional domains. The factors were defined as follows: factor 1, lower extremity function; factor 2, quality of life; factor 3, cervical spine function; factor 4, bladder function; and factor 5, upper extremity function. Finally, equations that would yield scores for the five factors were assembled. The score to be used to represent the degree of patients’ disability or status in each domain can be calculated by multiplying prefixed numbers of selected answers to questions by preassigned coefficients. Coefficients were defined to make the minimum score 0 and the maximum score 100.ConclusionsWe have successfully established a questionnaire that is able to demonstrate the status of patients suffering cervical myelopathy from five different aspects represented by five intuitive numerical scores. The final issue to be confirmed is the responsiveness of this questionnaire to changes in patients’ status after various surgical and nonsurgical treatments.

Recurrence of fibrous hamartoma of infancy excised 14 years after the primary surgery

Fibrous hamartoma of infancy is a rare, benign, superficial soft-tissue mass. It usually occurs within the first 2 years of life at the axial regions, upper arms, and external genital areas. There have been some recurrences within the 1st year of the surgery, although no cases have been reported to recur after 1 year. The authors present a recurrent case of fibrous hamartoma of infancy 14 years after the primary surgery, and they show the clinical and histopathological findings.

Clinical usefulness of assessing lumbar somatosensory evoked potentials in lumbar spinal stenosis. Clinical article.

OBJECT The aim of this retrospective study was to evaluate the clinical usefulness of assessing lumbar somatosensory evoked potentials (SSEPs) in central lumbar spinal stenosis (LSS). METHODS The latencies of lumbar SSEPs were recorded in 40 patients with central LSS, including 16 men and 24 women. The mean age of the patients was 67.3 +/- 7.4 years. The diagnosis was LSS in 23 cases and LSS associated with degenerative spondylolisthesis in 17 cases. The average duration of symptoms was 43.8 +/- 51.2 months. Twenty-two cases had bilateral and 18 cases had unilateral leg symptoms. Thirty-seven cases were associated with neurogenic intermittent claudication and the mean walking distance of patients with this condition was 246.8 +/- 232.7 m. The mean Japanese Orthopedic Association scale score, as well as the visual analog scale (VAS) scores of low-back pain, leg pain, and numbness, were 16.5 +/- 3.5, 6.0 +/- 2.5, 6.9 +/- 2.1, and 7.8 +/- 2.2, respectively. The minimal cross-sectional area of the dural sac on MR imaging was 0.44 +/- 0.21 cm(2). Thirty-nine cases of cervical spondylotic myelopathy without lumbar and peripheral neuropathy were chosen as the control group. RESULTS The latencies of lumbar SSEPs in patients with LSS and in the control group were 23.0 +/- 2.0 ms and 21.6 +/- 1.9 ms, respectively. There was a statistically significant difference between the LSS and control groups (p < 0.05). The latency of lumbar SSEPs was significant correlated with the VAS score of leg numbness (p < 0.05). The latency of lumbar SSEPs in LSS was clearly delayed when the VAS score of leg numbness was > or = 8 (p < 0.05). CONCLUSIONS Lumbar SSEPs are able to detect neurological deficit in the lumbar area effectively, and they can reflect part of the subjective severity of sensory disturbance (numbness) in LSS. Both lumbar SSEPs and VAS scores of leg numbness may be useful for clinical evaluation in patients with LSS.

From the Japanese Orthopaedic AssociationJOA Back Pain Evaluation Questionnaire (JOABPEQ)/ JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) The report on the development of revised versions April 16, 2007: The Subcommittee of the Clinical Outcome Committee of the Japanese Orthopaedic Association on Low Back Pain and Cervical Myelopathy Evaluation

1 Laboratory of Statistics, Osaka City University Faculty of Medicine, Osaka, Japan 2 Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan 3 Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan 4 Department of Orthopaedic Surgery, School of Medicine, Fukushima Medical University, Fukushima, Japan 5 Department of Orthopedic Surgery, Nippon Medical School, Tokyo, Japan 6 Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan 7 Department of Orthopaedic Surgery, Iwate Medical University School of Medicine, Morioka, Japan 8 Department of Orthopaedic Surgery, Saitama Medical School. Saitama, Japan 9 Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Yamaguchi, Japan 10 Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan 11 Department of Orthopaedics, Kochi Medical School, Kochi, Japan 12 Department of Orthopaedic Surgery, Hoshigaoka Koseinenkin Hospital, Osaka, Japan 13 National Hospital Organization, Osaka-Minami Medical Center, Osaka, Japan 14 Department of Internal Medicine, Houai Hospital, Osaka, Japan 15 Department of Public Health, Osaka City University Faculty of Medicine, Osaka, Japan