Tetsuro Hida

High prevalence of sarcopenia and reduced leg muscle mass in Japanese patients immediately after a hip fracture.

Aim:  Sarcopenia‐related falls and fractures are becoming an emerging problem as a result of rapid aging worldwide. We aimed to investigate the prevalence of sarcopenia by estimating the muscle mass of the arms and legs of patients with and without hip fracture.

Analysis of hip geometry by clinical CT for the assessment of hip fracture risk in elderly Japanese women

Two case-control studies were designed to investigate the contribution of the geometry and bone mineral density (BMD) of the proximal femur to bone strength in Japanese elderly women. We also investigated whether clinical CT is useful to assess the risk of hip fracture. Subjects in the neck fracture study included 20 Japanese women with neck fracture (age: mean+/-SD; 80.1+/-4.5 years old) and 20 age-matched control women (79.2+/-2.6 years old). Subjects in the trochanteric fracture study included 16 Japanese women with trochanteric fracture (82.6+/-5.0 years old) and 16 age-matched control women (80.8+/-3.8 years old). CT examination of the proximal femur was performed between the date of admission and the date of surgery. The CT scanners used were an Aquillion 16 (Toshiba) and Somatom 64 (Siemens); the scanning conditions including spatial resolution and scanning energy were adjusted, and the same type of reference phantom containing hydroxyapatite was used. QCT PRO software (Mindways) was used to analyze data for BMD, geometry, and biomechanical parameters. Both the neck and trochanteric fracture cases had significantly lower total and cortical BMD, a significantly smaller cortical cross-sectional area (CSA), and a larger trabecular CSA. Both had significantly thinner cortex and smaller distance to center of bone mass, and women with trochanteric fracture had a significantly smaller cortical perimeter in the cross-sectional femoral neck. Women with neck fracture had a longer hip axis length (HAL) and women with trochanteric fracture had a significantly larger neck-shaft angle (NSA). Both groups had significantly lower cross-sectional moment of inertia (CSMI), and only women with neck fracture had a significantly higher buckling ratio (BR) compared to their respective controls. According to the multiple logistic regression analysis, women with neck fracture had a significantly longer HAL, lower CSMI, and higher BR, and women with trochanteric fracture had a significantly smaller cortical CSA of the femoral neck. We conclude that clinical CT may be useful for the assessment of the risk of neck and trochanteric fracture.

Cervical alignment and range of motion after laminoplasty: radiographical data from more than 500 cases with cervical spondylotic myelopathy and a review of the literature.

Study Design. A large-scale analysis of radiographical results of patients with cervical spondylotic myelopathy and a review of the literature. Objective. To identify changes in sagittal alignment and range of motion (ROM) after cervical laminoplasty. Summary of Background Data. Cervical laminoplasty is an effective procedure for decompressing multilevel spinal cord compression. It often induces postoperative complications such as loss of lordotic alignment and restriction of neck motion. Although numerous studies have reported the loss of flexion-extension ROM after laminoplasty, no large-scale study has been reported. Methods. Five hundred twenty consecutive patients with cervical spondylotic myelopathy (331 male and 189 female; mean age, 62.2 yr) who underwent modified double-door laminoplasty were enrolled. The average follow-up period was 33.3 months. All patients were allowed to sit up and walk on the first postoperative day using an orthosis, which could be removed within the first 2 weeks, even if long. Early cervical ROM exercises were performed as a part of the rehabilitation schedule. Radiography was performed before surgery and at the final follow-up. Cervical alignment in the neutral and flexion-extension view were measured by the Cobb method at C2–C7. The ROM was assessed by measuring the difference in alignment between flexion and extension. Results. The mean C2–C7 alignment in the neutral position was 11.9° lordotic preoperatively and 13.6° lordotic postoperatively; the alignment increased by 1.8° in lordosis. The mean total ROM decreased from a preoperative value of 40.1° to 33.5° at the final follow-up, showing a significant difference of 6.6°. The mean total ROM preservation after laminoplasty was 87.9%. Conclusion. Sagittal alignment was slightly changed, with only a 1.8° increase in lordosis. The ROM of the cervical spine was preserved by 87.9%. This preservation of alignment and ROM might be attributable to improvements including early removal of the cervical orthosis, postoperative neck exercises, and some surgical modifications.

Can Elderly Patients Recover Adequately After Laminoplasty? : A Comparative Study of 520 Patients With Cervical Spondylotic Myelopathy

Study Design. This was a prospective clinical comparative study of surgical outcomes for patients with cervical spondylotic myelopathy (CSM). Objective. The purpose of this study was to compare the surgical outcomes between nonelderly and elderly patients with CSM who underwent laminoplasty. Summary of Background Data. Age at the time of surgery influences the surgical outcome. We designed a large-scale study of the surgical outcome for CSM from a single operative procedure used exclusively in elderly patients. Methods. A total of 520 consecutive patients with CSM (331 men; 189 women) who underwent double-door laminoplasty were included. Mean age was 62 years (range, 23–93), and mean duration of disease was 20.1 ± 32.0 months. Average postoperative follow-up period was 33.3 ± 15.7 months. Patients were divided into 3 groups by age: nonelderly (<65 years), young-old (65–74 years), and old-old (≥75 years). The number of patients in each group was 287, 143, and 90. Pre- and postoperative neurological status was evaluated using the Japanese Orthopaedic Association scoring system for cervical myelopathy (JOA score). Results. Mean pre- and postoperative JOA scores in nonelderly, young-old, and old-old groups were 11.0 and 14.4, 10.2 and 13.2, and 8.7 and 11.8 points, respectively. The elderly group showed significantly low recovery rates of JOA scores compared with the nonelderly group (P < 0.0001). However, mean achieved JOA scores (postoperative JOA score − preoperative JOA score) were 3.4, 3.0, and 3.1 in nonelderly, young-old, and old-old groups, respectively, with no significant difference among these groups (P = 0.17). Conclusion. Pre- and postoperative JOA scores were low in elderly patients. However, the achieved JOA score was almost similar among the 3 groups. Thus, elderly patients could obtain reasonable recovery after cervical laminoplasty.

Managing Sarcopenia and Its Related-Fractures to Improve Quality of Life in Geriatric Populations

Sarcopenia, an aging-induced generalized decrease in muscle mass, strength, and function, is known to affect elderly individuals by decreasing mobile function and increasing frailty and imbalance that lead to falls and fragile fractures. Sarcopenia is a known risk factor for osteoporotic fractures, infections, and early death in some specific situations. The number of patients with sarcopenia is estimated to increase to 500 million people in the year 2050. Sarcopenia is believed to be caused by multiple factors such as disuse, malnutrition, age-related cellular changes, apoptosis, and genetic predisposition; however, this remains to be determined. Various methods have been developed, but no safe or effective treatment has been found to date. This paper is a review on the association between sarcopenia and its related-fractures and their diagnoses and management methods to prevent fractures.

Modified double-door laminoplasty in managing multilevel cervical spondylotic myelopathy: surgical outcome in 520 patients and technique description.

Study Design: This is a prospective study on surgical outcomes of double-door laminoplasty in patients with cervical spondylotic myelopathy (CSM). Objective: The purpose of this study was to report the efficacy and safety of modified double-door laminoplasty in a large series of patients with CSM. Summary of Background Data: Laminoplasty is an established procedure for the decompression of multisegmental CSM. However, no report has described the clinical outcomes of laminoplasty for a large number of patients with CSM (>500 patients). Methods: Between April 1995 and December 2006, 520 consecutive patients (331 male and 189 female) with CSM who underwent double-door laminoplasty and were followed-up for more than 1 year were enrolled in this study. The mean age was 62.2 years (23 to 93 y), and the mean duration of disease was 20.1±32.0 months. The severity of myelopathy before and after surgery was evaluated according to a scoring system proposed by the Japanese Orthopedic Association for cervical myelopathy (JOA score). Functional improvement was expressed by the recovery rate (RR) of the JOA score. Results: The average surgery time for laminoplasty was 75.2±23.3 minutes, and the average blood loss was 72.6±84.6 mL. The average follow-up period was 33.3±15.7 months. The mean JOA score was 10.4±2.8 points preoperatively and 13.6±2.5 points at final follow-up. The mean RR was 51.2±29.0%. On the basis of RR, we found that the conditions of 493 patients (94.8%) improved (RR, >1%), 20 patients (3.8%) showed no change (RR, 0%), and 7 patients (1.3%) in worse condition (RR, <0%). The 7 patients deteriorated for reasons (lumbar spinal canal stenosis and cerebral infarction) that were unrelated to CSM. Conclusions: Modified double-door laminoplasty is a safe, reliable, and effective procedure for patients with CSM.

The prevalence of pre- and postoperative symptoms in patients with cervical spondylotic myelopathy treated by cervical laminoplasty.

Study Design. A retrospective single-center study. Objective. To investigate the prevalence of symptoms before and after surgery in a large series of patients with cervical spondylotic myelopathy (CSM). Summary of Background Data. No study has elucidated the epidemiological data regarding the prevalence of pre- and postoperative symptoms in patients with CSM. Methods. Five hundred twenty consecutive patients with CSM (331 male and 189 female; mean age, 62.2 yr) treated by laminoplasty were enrolled. The average follow-up period was 33.3 months. Severity of myelopathy was evaluated according to a scoring system proposed by the Japanese Orthopedic Association for CSM, and prevalence was determined by the presence or absence of a full Japanese Orthopedic Association score for each function. The persistence rate (%) (postoperative prevalence/preoperative prevalence × 100) of each function impairment was also assessed after surgery. Results. The preoperative prevalence of motor function impairment in the upper and lower extremities was 77.7% and 80.4%, respectively, whereas that of sensory function impairment in the upper and lower extremities and trunk was 88.6%, 56.5%, and 48.3%, respectively. The preoperative prevalence of urinary bladder function impairment was 41.2%. The persistence rate of motor function impairment in the upper and lower extremities was 52.7% and 71.5%, respectively, whereas that of sensory function impairment in the upper and lower extremities and trunk was 72.0%, 56.8%, and 61.4%, respectively. The persistence rate of urinary bladder function impairment was 49.1%. Conclusion. The preoperative prevalence of motor function impairment in the upper and lower extremities and that of sensory function impairment in the upper extremity is higher than that of other function impairments, and impairments in lower extremity motor function and upper extremity sensory function often persist after surgery. These findings provide baseline data that may allow clinicians to accurately assess preoperative impairment and postoperative outcomes in patients with CSM.

Neuropathic Pain in Elderly Patients with Chronic Low Back Painand Effects of Pregabalin: A Preliminary Study

Study Design Preliminary study. Purpose To assess the association of neuropathic pain with chronic low back pain (LBP) and the effect of pregabalin on neuropathic pain in the elderly. Overview of Literature Of those with chronic LBP, 37% were predominantly presenting with neuropathic pain in young adults. Pregabalin is effective for pain in patients with diabetic neuropathy and peripheral neuralgia. No study has reported on the effects of pregabalin for chronic LBP in elderly patients yet. Methods Pregabalin was administered to 32 patients (age, ≥65 years) with chronic LBP for 4 weeks. Pain and activities of daily living were assessed using the Neuropathic Pain Screening Questionnaire (NePSQ), the pain DETECT questionnaire, visual analog scale, the Japanese Orthopedic Association score, the short form of the McGill Pain Questionnaire and the Roland Morris Disability Questionnaire. Modic change and spinal canal stenosis were investigated using magnetic resonance imaging. Results Altogether, 43.3% of patients had neuropathic pain according to the NePSQ and 15.6% patients had pain according to the pain DETECT. The efficacy rate of pregabalin was 73.3%. A significant effect was observed in patients with neuropathic pain after 4 weeks of administration. Conclusions Neuropathic pain was slightly less frequently associated with chronic LBP in the elderly. Pregabalin was effective in reducing pain in patients with chronic LBP accompanied with neuropathic pain. Lumbar spinal stenosis and lower limb symptoms were observed in patients with neuropathic pain. We recommend the use of pregabalin for patients after evaluating a screening score, clinical symptoms and magnetic resonance imaging studies.

Use of alfacalcidol in osteoporotic patients with low muscle mass might increase muscle mass: An investigation using a patient database

Sarcopenia causes a decline in physical performance and decreased quality of life. However, there is little evidence for effective treatments. Because of the similarities between osteoporosis and sarcopenia, alfacalcidol used for osteoporosis might be beneficial for low muscle mass. Therefore, we investigated the effect of alfacalcidol on muscle mass in patients with low muscle mass.

Staged decrease of physical ability on the locomotive syndrome risk test is related to neuropathic pain, nociceptive pain, shoulder complaints, and quality of life in middle-aged and elderly people – The utility of the locomotive syndrome risk test

Abstract Objectives: A locomotive syndrome (LS) risk test for evaluation of physical ability is recently proposed. The objective of this study is to evaluate the utility of this test by examining physical ability, neuropathic pain, nociceptive pain, shoulder complaints, and quality of life (QOL). Methods: A prospective cohort study was conducted in 523 subjects (240 males, 283 females; mean age: 63.3 years) at a health checkup. Data collected using visual analog scales (VAS) for shoulder pain, low back pain, sciatica, and knee pain, neuropathic pain, shoulder complaint, body mass index (BMI), osteoporosis, and SF-36 were compared among three LS risk stages. Results: Subjects in LS risk stage 1 (24%) had significantly more osteoporosis, slower gait speed, weaker muscle strength and higher VAS, with no difference in age and BMI compared to those with no LS risk (50%). Subjects in stage 2 (26%) had significantly poorer results for all items. Shoulder complaint, neuropathic pain and QOL differed significantly among all three groups and worsened with decline in mobility on the LS risk test. Conclusions: LS risk test is easy and useful screening tool for evaluation of mobility and for screening for pain and complaint associated with activity of daily living and QOL.