Tae Sik Goh

Validation of the Korean version of the Scoliosis Research Society-22 questionnaire

IntroductionWe evaluated the reliability and validity of an adapted Korean version of the Scoliosis Research Society-22 (SRS-22) questionnaire.Materials and methodsTranslation/retranslation of the English version of SRS-22 was conducted, and all steps of the cross-cultural adaptation process were performed. The Korean version of the SRS-22 questionnaire and the previously validated Short Form-36 (SF-36) outcome instruments were mailed to 102 patients who had been treated surgically for idiopathic scoliosis. Eighty-two patients responded to the first mailing of questionnaires and 64 of the first-time responders returned their second survey. The average age of the 64 patients (56 females and 8 males) was 18.3xa0years. Reliability assessment was determined by estimating Cronbach’s α and intraclass correlation coefficient (ICC), respectively. Concurrent validity was evaluated by comparing SRS-22 domains with relevant domains in the SF-36 questionnaire using Pearson’s correlation coefficient.ResultsThe study demonstrated satisfactory internal consistency (Cronbach’s αxa0=xa00.80–0.89) for function/activity, pain and mental health, and good consistency (Cronbach’s αxa0=xa00.50–0.79) for the remaining domains. The ICC of all domains demonstrated excellent test/retest reproducibility. Considering concurrent validity, 3 domains showed excellent correlation, 9 domains good, 25 domains moderate, and 3 domains poor.ConclusionThe adapted Korean version of the SRS-22 questionnaire was successfully translated and showed acceptable measurement properties, and as such, is considered suitable for treatment outcome assessments in the Korean-speaking patients with idiopathic scoliosis.

Validation of the Korean version of the Roland–Morris Disability Questionnaire

We evaluated the reliability and validity of an adapted Korean version of the Roland–Morris Disability Questionnaire (RMDQ). Translation/retranslation of the English version of RMDQ was conducted, and all steps of the cross-cultural adaptation process were performed. The Korean version of the Visual Analog Scale (VAS) measure of pain, RMDQ, and the previously validated Oswestry Disability Index (ODI) were mailed to 100 consecutive patients with chronic lower back pain (LBP) of at least 3xa0months. Eighty-one patients responded to the first mailing of questionnaires and 63 of the first-time responder returned their second survey. The average age of the 63 patients (45 female, 18 male) was 47.8xa0years. Reliability assessment was determined by estimating kappa statistics of agreement for each item, the intraclass correlation coefficient (ICC), and Cronbach’s α. Concurrent validity was evaluated by comparing the responses of RMDQ with the results of VAS and responses of ODI by using Pearson’s correlation coefficient. The constructed Bland–Altman plot showed a good reliability. All items had a kappa statistics of agreement greater than 0.6. The RMDQ showed excellent test/re-test reliability as evidenced by the high ICC for 2 test occasions (ICCxa0=xa00.932, Pxa0<xa00.001). Internal consistency was found to be very good at both assessments with Cronbach’s α (0.942 and 0.951 at first and second assessments, respectively). The RMDQ was correlated with the VAS (rxa0=xa00.692; Pxa0=xa00.000 and rxa0=xa00.668; Pxa0=xa00.000 at first and second assessments, respectively), and with the ODI (rxa0=xa00.789; Pxa0=xa00.000 and rxa0=xa00.802; Pxa0=xa00.000, respectively). The adapted Korean version of the RMDQ was successfully translated and showed acceptable measurement properties, and as such, is considered suitable for outcome assessments in the Korean speaking patients with LBP.

Radiographic measurement reliability of lumbar lordosis in ankylosing spondylitis

IntroductionIntraobserver and interobserver reliabilities of the several different methods to measure lumbar lordosis have been reported. However, it has not been studied sofar in patients with ankylosing spondylitis (AS).Materials and methodsWe evaluated the inter and intraobserver reliabilities of six specific measures of global lumbar lordosis in patients with AS. Ninety-one consecutive patients with AS who met the most recently modified New York criteria were enrolled and underwent anteroposterior and lateral radiographs of whole spine. The radiographs were divided into non-ankylosis (no bony bridge in the lumbar spine), incomplete ankylosis (lumbar spines were partially connected by bony bridge) and complete ankylosis groups to evaluate the reliability of the Cobb L1–S1, Cobb L1–L5, centroid, posterior tangent L1–S1, posterior tangent L1–L5, and TRALL methods.ResultsThe radiographs were composed of 39 non-ankylosis, 27 incomplete ankylosis and 25 complete ankylosis. Intra- and inter-class correlation coefficients (ICCs) of all six methods were generally high. The ICCs were all ≥0.77 (excellent) for the six radiographic methods in the combined group. However, a comparison of the ICCs, 95xa0% confidence intervals and mean absolute difference (MAD) between groups with varying degrees of ankylosis showed that the reliability of the lordosis measurements decreased in proportion to the severity of ankylosis. The Cobb L1–S1, Cobb L1–L5 and posterior tangent L1–S1 method demonstrated higher ICCs for both inter and intraobserver comparisons and the other methods showed lower ICCs in all groups. The intraobserver MAD was similar in the Cobb L1–S1 and Cobb L1–L5 (2.7°–4.3°), but the other methods showed higher intraobserver MAD. Interobserver MAD of Cobb L1–L5 only showed low in all group.ConclusionThese results are the first to provide a reliability analysis of different global lumbar lordosis measurement methods in AS. The findings in this study demonstrated that the Cobb L1–L5 method is reliable for measuring the global lumbar lordosis in AS.

Validation of the Korean version of the Quebec Back Pain Disability Scale.

Study Design: Prospective study. Objective: To evaluate the reliability and validity of the adapted Korean version of the Quebec Back Pain Disability Scale (QDS). Summary of Background Data: The Korean version of the QDS has not been validated. Methods: Translation/retranslation of the English version of QDS was conducted, and all steps of the cross-cultural adaptation process were performed. The Korean version of the Visual Analog Scale (VAS) measure of pain, QDS and the previously validated Oswestry Disability Index (ODI) and Short Form-36 (SF-36) were mailed to 100 consecutive patients with chronic low back pain of at least 3 months duration. Eighty patients responded to the first mailing of questionnaires and 59 of the first time responder returned their second survey. The average age of the 59 patients (39 female, 20 male) was 48.0 years. Reliability assessment was determined by estimating &kgr; statistics of agreement for each item, the intraclass correlation coefficient (ICC) and the Cronbach &agr;. Concurrent and construct validity was evaluated by comparing the responses of QDS with the results of VAS and responses of ODI and SF-36 by using the Pearson correlation coefficient. Results: The constructed Bland Altman plot showed a good reliability. All items had a &kgr; statistics of agreement >0.6. The QDS showed excellent test/retest reliability as evidenced by the high ICC for both assessments (ICC=0.9094; P<0.001). Internal consistency was found to be very good at both assessments with the Cronbach &agr; (0.9172 and 0.9319 at first and second assessments, respectively). The QDS was correlated with the VAS (r=0.647; P<0.001 and r=0.609; P<0.001 at first and second assessments, respectively) and with the ODI (r=0.718; P<0.001 and r=0.690; P<0.001, respectively). The Korean version of the QDS showed a good significant correlation with functional scales of SF-36. Conclusions: The adapted Korean version of the QDS was successfully translated and showed acceptable measurement properties, and as such, is considered suitable for outcome assessments in the Korean-speaking patients with low back pain.

Validation of the Korean Version of the Neck Pain and Disability Scale

Study Design A prospective study. Purpose To evaluate the reliability and validity of the adapted Korean version of the Neck Pain and Disability Scale (NPDS). Overview of Literature The validity of Korean version of NPDS has not been completely demonstrated yet. Methods Translation/retranslation of the English version of NPDS was conducted, and all steps of the cross-cultural adaptation process were performed. The Korean version of the visual analog scale (VAS) measure of pain, NPDS and the previously validated Short Form-36 (SF-36) were mailed to 91 patients, who had been surgically treated for degenerative cervical disease. Eighty-one patients responded to the first mailing of questionnaires and 69 of the first time responder returned their second survey. Factor analysis and reliability assessment by kappa statistics of agreement for each item, the intraclass correlation coefficient and Cronbachs α were conducted. Concurrent and construct validity were also evaluated by comparing the responses of NPDS with the results of VAS and responses of SF-36. Results Factor analysis extracted 3 factors. All items had a kappa statistics of agreement greater than 0.6. The NPDS showed excellent test/re-test reliability. Internal consistency of Cronbachs α was found to be very good. The NPDS was correlated with the VAS. The Korean version of NPDS showed good significant correlation with SF-36 total score and with single SF-36 domains scores. Conclusions The adapted Korean version of the NPDS was successfully translated and is considered suitable for outcome assessments in the Korean-speaking patients with neck pain.

Association between estrogen receptor gene polymorphism and back pain intensity in female patients with degenerative lumbar spondylolisthesis.

Study Design: Prospective study. Objective: To examine the possible association of estrogen receptor &agr; (ER&agr;) polymorphisms and pain intensity in symptomatic female degenerative spondylolisthesis (DS) patients. Summary of Background Data: DS has been associated with a significant sex effect. Thus, several studies about the association between the ER gene and osteoarthritis have been reported. However, whether estrogen is associated with pain sensitivity is inconsistent in the existing literatures from both human and animal studies. Methods: The PvuII and XbaI polymorphisms, bone mineral density at the lumbar spine (LSBMD) and at the femoral neck (FNBMD), pain intensity at the leg and lower back, and radiologic and anthropometric findings were analyzed in 192 patients with DS. Results: There was a significant association between XbaI polymorphism and the visual analog scale score of back pain. The back pain visual analog scale in patients with a GG genotype was significantly higher than in patients with the AG (P<0.05) or the AA (P<0.05) genotypes. In addition, the presence of the CG haplotype was found to be associated with back pain intensity in the haplotype analysis of the PvuII and the XbaI polymorphisms of ER&agr;. Conclusions: These results suggest that the ER&agr; gene polymorphism using XbaI restriction enzyme influences the perception of back pain in patients with DS.

Analysis of sagittal balance of ankylosing spondylitis using spinopelvic parameters.

Study Design: Prospective study. Objective: To analyze sagittal spinopelvic parameters in ankylosing spondylitis (AS) patients. Summary of Background Data: There are little data on the relationship between the sagittal spinopelvic parameters and AS. Methods: The study and control groups comprised 90 AS patients and 40 controls. Participants were classified into 3 groups: normal (n=40), sagittal balance (n=58), and sagittal imbalance (n=32) groups. All underwent lateral radiograph of the whole spine including hip joints. The radiographic parameters were sacral slope, pelvic tilting, pelvic incidence, overhang of S1, thoracic kyphosis, lumbar lordosis, and C7 plumbline. Statistical analysis was performed to identify significant differences between the 2 groups. Correlations between radiological parameters and symptoms were sought. Results: AS patients and controls were found to be significantly different in terms of sagittal balance, sacral slope, pelvic tilt, pelvic incidence, S1 overhang, and lumbar lordosis. However, no significant difference was observed between these 2 groups for thoracic kyphosis (P>0.05). Of the 90 AS patients, 32 patients (5 women and 27 men) were assigned to the sagittal imbalance group and 58 (12 women and 46 men) to the sagittal balance group. There was a significant difference in all sagittal parameters and visual analogue scale (VAS) score between these 2 groups. Correlation analysis revealed significant relationships between sagittal parameters in AS. However, there was no association between sacral slope and S1 overhang, and between pelvic incidence and VAS score. Stepwise logistic regression analysis revealed that pelvic tilt contributed significantly to sagittal balance. Conclusions: AS patients and normal controls were found to be significantly different in terms of sagittal spinopelvic parameters. Significant relationships were found between sagittal spinopelvic parameters in AS patients. Pelvic tilt was a significant parameter in determination of sagittal balance in AS patient. Furthermore, VAS scores were significantly related to sagittal spinal parameters which were closely related with pelvic orientation in AS patients.

Outcome prediction with the revised American joint committee on cancer staging system and American thyroid association guidelines for thyroid cancer

BackgroundSeveral staging systems have been developed to predict the risk of mortality in patients with differentiated thyroid cancer (DTC). However, none of them have been shown to be clearly superior to the other.MethodsWe compared the patient outcome predictability of recently revised staging systems predictability of patient outcome using data from The Cancer Genome Atlas. To set a comparison among American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging 7th, 8th editions, American Thyroid Association guidelines 2009 and 2015, concordance index (c-index), Akaike information criterion (AIC), Bayesian information criterion (BIC), and Brier score were applied to quantify the predictive ability of a survival model, to select the statistical model, and to measure the accuracy of probabilistic predictions.ResultsA total of 457 patients with papillary thyroid cancer having a mean age of 45.9 years were included in this study (120 males, 337 females). Among these patients, 43 (9.4%) experienced recurrence/progression during the follow-up (591.2u2009±u2009833.5 months). Among the models used, the AJCC/UICC 8th edition, which showed the highest c-index and lowest AIC, BIC, and Brier score, was identified as the best among the models used.ConclusionAJCC/UICC 8th edition predicted patient outcome more accurately than the other staging systems.

Association of Estrogen Receptor Gene Polymorphism in Patients with Degenerative Lumbar Spondylolisthesise

OBJECTIVEnThe purpose of this study was to investigate the possible association of estrogen receptor alpha (ERα) gene polymorphisms in a cohort of degenerative spondylolisthesis (DS) patients.nnnMETHODSnAccordingly, the authors examined the association between DS and ERα gene polymorphisms in 174 patients diagnosed with DS. The Pvu II and Xba I polymorphisms, bone mineral density at the lumbar spine and femoral neck, and biochemical markers were analyzed and compared in the 174 patients with DS and 214 patients with spinal stenosis (SS).nnnRESULTSnA comparison of genotype frequencies in DS and SS patients revealed a significant difference for the Pvu II polymorphism only (p=0.0452). No significant difference was found between these two groups with respect to the Xba I polymorphism, BMD or biochemical markers. No significant association was found between the Pvu II polymorphism of ERα and BMD, vertebral slip or biochemical markers in patients with DS.nnnCONCLUSIONnThese results suggest that the ERα gene polymorphism using Pvu II restriction enzyme influences the prevalence of DS.

Posterior Decompression and Fusion in Patients with Multilevel Lumbar Foraminal Stenosis: A Comparison of Segmental Decompression and Wide Decompression

STUDY DESIGNnThis is a prospective study.nnnPURPOSEnWe compared the outcomes of segmental decompression and wide decompression in patients who had multilevel lumbar foraminal stenosis with back pain.nnnOVERVIEW OF LITERATUREnWide decompression and fusion in patients with multilevel lumbar foraminal stenosis may increase the risk of perioperative complications.nnnMETHODSnFrom March 2005 to December 2007, this study prospectively examined 87 patients with multilevel lumbar foraminal stenosis and who were treated by segmental or wide decompression along with posterior fusion using pedicle screw fixation, and these patients could be followed-up for a minimum of 2 years. Of the 87 patients, 45 and 42 patients were assigned to the segmental decompression group (group 1) and the wide decompression group (group 2), respectively. We compared the clinical and radiological outcomes of the patients in these two groups.nnnRESULTSnThere were no significant differences between groups 1 and 2 in terms of the levels of postoperative pain based on the visual analogue scale, the Oswestry Disability Score, the clinical results based on the Kirkaldy-Willis Criteria, the complication rate or the posterior fusion rate. On the other hand, the mean operating times in groups 1 and 2 were 153 ± 32 minutes and 187 ± 36 minutes, respectively (p < 0.05). The amount of blood loss during surgery and on the first postoperative day was 840 ± 236 ml and 1,040 ± 301 ml in groups 1 and 2, respectively (p < 0.05).nnnCONCLUSIONSnThese results suggest that segmental decompression offers promising and reproducible clinical and radiological results for patients suffering from multilevel lumbar foraminal stenosis.