Yoshitaka Matsubayashi

Validity and Reliability of the Japanese Version of the painDETECT Questionnaire: A Multicenter Observational Study

Objectives The aim of this study was to evaluate the validity and reliability of the Japanese version of the painDETECT questionnaire (PDQ-J). Materials and Methods The translation of the original PDQ into Japanese was achieved according to the published guidelines. Subsequently, a multicenter observational study was performed to evaluate the validity and reliability of PDQ-J, including 113 Japanese patients suffering from pain. Results Factor analysis revealed that the main component of PDQ-J comprises two determinative factors, which account for 62% of the variance observed. Moreover, PDQ-J revealed statistically significant correlation with the intensity of pain (Numerical Rating Scale), Physical Component Score, and Mental Component Score of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The Cronbach alpha for the total score was 0.78 and for the main component was 0.80. In the analysis of test–retest method, the intraclass correlation coefficient between the two scores was 0.94. Conclusions We demonstrated the validity and reliability of PDQ-J. We encourage researchers and clinicians to use this tool for the assessment of patients who suffer suspected neuropathic pain.

Effect of Preoperative Sagittal Balance on Cervical Laminoplasty Outcomes.

Study Design. Retrospective case series. Objective. To clarify how preoperative global sagittal imbalance influences outcomes in patients with cervical compression myelopathy undergoing cervical laminoplasty. Summary of Background Data. The influence of sagittal balance on outcomes of cervical laminoplasty remains uncertain. Methods. The authors retrospectively reviewed data of 106 patients who underwent double-door cervical laminoplasty between 2004 and 2011 and investigated the influence of the C7 sagittal vertical axis (SVA) on outcome scores. Primary outcomes used were Japanese Orthopedic Association (JOA) scores, Numerical Rating Scale for neck or arm pain, the Short Form 36 Health Survey (physical and mental component summary scores ), and the Neck Disability Index (NDI). Results. Ninety-two patients with complete data were eligible for inclusion. The preoperative C7 SVA was ⩽5 cm in 64 patients (69.6%) and > 5 cm in 28 (30.4%). We compared each parameter by the magnitude of spinal sagittal balance (preoperative C7 SVA > 5 cm vs. C7 SVA ⩽ 5 cm) after adjusting for age via the least square mean analysis because the average age was significantly higher in patients with C7 SVA > 5 cm. As for the radiographic parameters, both C2–7 SVA and C7 SVA were larger in patients when the C7 SVA was > 5 cm. Numerical Rating Scale for postoperative arm pain, postoperative JOA scores, and both pre- and postoperative physical component summary and NDI were worse in patients with C7 SVA > 5 cm; however, the JOA score recovery rate and changes in physical component summary and NDI were not significantly different. Conclusion. Postoperative functional outcome scores were significantly lower in patients with C7 SVA > 5 cm, although the improvement after cervical laminoplasty was not greatly affected. The involvement of global sagittal balance and cervical regional alignment should be considered in evaluating surgical outcomes for patients undergoing cervical laminoplasty. Level of Evidence: 4

Extensive ossification of the paraspinal ligaments in a patient with vitamin D-resistant rickets: Case report with literature review

Highlights • This is the case of a 64-year-old woman with VDRR and extensive spinal ossification.• This case was followed up for over 30 years.• Imaging studies demonstrated fusion of the entire spine below the C2 vertebra.• Mobility at the craniovertebral junction caused C1-level spinal cord compression.• The pathology mimicked ankylosing spondylitis.

Cervical Anterolisthesis: A Predictor of Poor Neurological Outcomes in Cervical Spondylotic Myelopathy Patients After Cervical Laminoplasty.

Study Design. A retrospective cohort study. Objective. To clarify the influence of cervical spondylolisthesis on neurological outcomes in cervical spondylotic myelopathy (CSM) patients after cervical laminoplasty. Summary of Background Data. Studies focusing on the surgical outcomes in CSM patients with cervical spondylolisthesis are limited. Methods. We retrospectively reviewed 125 CSM patients after cervical laminoplasty. Neurological outcomes were evaluated by calculating the Japanese Orthopedic Association (JOA) recovery rate at 2 years after surgery. We defined anterolisthesis as a more than 3-mm anterior vertebral displacement in a flexion radiograph and retrolisthesis as a more than 3-mm posterior vertebral displacement in an extension radiograph. We further assessed potential risk factors for poor neurological outcomes after cervical laminoplasty, including cervical alignment, degree of spinal cord compression, duration of myelopathic symptoms, diabetes mellitus, and preoperative JOA score. Multivariate logistic regression analysis was performed to investigate the risk factors for poor outcomes (JOA recovery rate <50%) after cervical laminoplasty. Results. Our study included 86 men and 39 women with mean age of 64 (range, 30–89) years. Average JOA scores were 9.9 and 13.3 points before and at 2 years after surgery, respectively. Average recovery rate was 47.2% (range, −68% to 100%), with 62 patients having poor outcomes (JOA recovery rate <50%) at 2 years after surgery. Anterolisthesis and retrolisthesis were observed in 13 and 24 patients, respectively. Multivariate logistic regression analysis revealed that the anterolisthesis was a significant risk factor for poor outcomes (JOA recovery rate <50%) after cervical laminoplasty (P = 0.01), whereas retrolisthesis did not affect the neurological outcomes (P = 0.6). Conclusion. Anterolisthesis, but not retrolisthesis, is a significant risk factor for and predictor of poor neurological outcomes after cervical laminoplasty. Cervical laminoplasty should not be considered in CSM patients with anterolisthesis. Level of Evidence: 2

C7 sagittal vertical axis is the determinant of the C5–C7 angle in cervical sagittal alignment

BACKGROUND CONTEXT Previous studies have indicated that the T1 slope correlates with cervical lordosis. In contrast, the specific impact of the C7 sagittal vertical axis (C7SVA) on cervical lordosis remains unknown. PURPOSE This study aimed to investigate the specific role of C7SVA in cervical lordosis. STUDY DESIGN/SETTING This was a retrospective radiographic study. PATIENT SAMPLE Forty-eight consecutive patients who underwent lateral standing radiography of the entire spine were retrospectively reviewed. OUTCOME MEASURES Radiographic parameters included occipito (Oc)-C7, Oc-C2, C2-C7, C2-C4, and C5-C7 angles; T1 slope; C7SVA; T1 pelvic angle (TPA); pelvic incidence; pelvic tilt; and sacral slope. METHODS The radiographs of 96 consecutive patients who underwent lateral standing radiography of the entire spine in June 2015 in our hospital were retrospectively reviewed. Patients having cervical deformities, having undergone cervical fusion, and under 18 years of age were excluded. A total of 48 Asian patients (14 men and 34 women; mean age, 54.6 years) were eligible. Pathologies included scoliosis, myelopathy, thoracolumbar deformity, and spondylosis. Spearman rank correlation coefficients were used to examine correlations between the parameters. The relationship between C5-C7 lordosis and the radiographic parameters was calculated using the forward stepwise multivariate regression analysis. The authors do not have financial associations relevant to this article. RESULTS C7SVA correlated with the Oc-C7 (r=0.42) and C2-C7 (r=0.50) angles. However, the correlation coefficient was smaller than that between the T1 slope and Oc-C7 (r=0.83) or C2-C7 (r=0.76) angles. When the C2-C7 angle was divided into C2-C4 and C5-C7 angles, C7SVA correlated with the C5-C7 (r=0.63) angle but not with the C2-C4 angle. The correlation coefficient between the C5-C7 angle and C7SVA was higher than that between the C5-C7 angle and T1 slope (r=0.53) or the C5-C7 angle and TPA (r=0.60). Using radiographic parameters and age, multiple regression analysis revealed that only C7SVA affected the C5-C7 angle. CONCLUSIONS C7SVA was the only radiographic parameter that affected the C5-C7 angle. Both T1 slope and C7SVA are key to the shape of the cervical sagittal alignment. The results of this study can be a starting point to improve our understanding of cervical sagittal alignment.

Relationship between Neuropathic Pain and Obesity

Objectives. Overweight negatively affects musculoskeletal health; hence obesity is considered a risk factor for osteoarthritis and chronic low back pain. This was conducted to determine if obesity affects neuropathic pain, usually considered unrelated to the weight-load on the musculoskeletal system. Methods. Using a cut-off body mass index value of 25, 44 patients with neuropathic pain were grouped into a “high-BMI” group and a “normal-BMI” group. Results. The numeric rating scale of the high-BMI group was significantly higher than that of the normal-weight group (P < 0.05). The total NPSI scores were significantly higher (P < 0.01), and the paroxysmal pain and the negative symptoms were more serious in the high-BMI group than in the normal-BMI group. The high-BMI subjects also had significantly higher SF-MPQ scores (P < 0.05). However, both physical and mental health status on the SF-36 were comparable between the groups. Discussion. Neuropathic pain that did not arise from musculoskeletal damage was higher in the high-BMI patients. Paroxysmal pain was more severe, suggesting that neural damage might be aggravated by obesity-associated inflammation. These findings should have needed to be confirmed in future studies.

Correlations of Cervical Sagittal Alignment before and after Occipitocervical Fusion.

Study Design Retrospective radiographic study. Objective To investigate changes and correlations of cervical sagittal alignment including T1 slope before and after occipitocervical corrective surgery. We also investigated the relevance for preoperative planning. Methods We conducted a retrospective radiographic analysis of 27 patients who underwent surgery for occipitocervical deformity. There were 7 men and 20 women with a mean age of 56.0 years. Mean follow-up was 68.0 months (range 24 to 120). The radiographic parameters measured before surgery and at final follow-up included McGregor slope, T1 slope, occipito (O)–C2 angle, O–C7 angle, and C2–C7 angle. Pearson correlation coefficient was used to examine the correlation between the radiographic parameters. Results There was a stronger positive correlation between the T1 slope and the O–C7 angle both preoperatively and postoperatively (r = 0.72 and r = 0.83, respectively) than between the T1 slope and the C2–C7 angle (r = 0.60 and r = 0.76, respectively). The O–C2 angle and C2–C7 angle had inverse correlations to each other both pre- and postoperatively (r = − 0.50 and −0.45). McGregor slope and T1 slope did not significantly change postoperatively at final follow-up. Increase in O–C2 angle after surgery (mean change, 10.7 degrees) inversely correlated with decrease in postoperative C2–C7 angle (mean change, 12.2 degrees). As result of these complementary changes, O–C7 angle did not statistically change. Conclusions Our results suggest that the O–C7 angle is regulated by T1 slope and the corresponding O–C7 angle is divided into the O–C2 and C2–C7 angles, which have inverse correlation to each other and then maintain McGregor slope (horizontal gaze).

Psychometric Validation of the Japanese Version of the Neuropathic Pain Symptom Inventory

Objective This study aimed to evaluate the validity and reliability of the Japanese version of the Neuropathic Pain Symptom Inventory (NPSI-J). Design Cross-sectional study design. Subjects and Methods The original Neuropathic Pain Symptom Inventory (NPSI) was translated into Japanese according to published guidelines. Subsequently, an observational study of 60 Japanese patients suffering from neuropathic pain was performed to evaluate the validity and reliability of the NPSI-J. Results The NPSI-J exhibited a statistically significant correlation with pain intensity (Numerical Rating Scale). The Cronbach alpha value for Likert items was 0.86. Using the test–retest analysis method, the intraclass correlation coefficient between the two scores was 0.81. Factor analysis revealed that the main component of NPSI-J comprised three determinative factors. Conclusions The NPSI-J is a reliable and valid pain assessment tool.

Concurrent spinal schwannoma and meningioma mimicking a single cervical dumbbell-shaped tumor: case report.

Dumbbell-shaped tumors consisting of 2 different tumors are extremely rare. Herein, the authors present a case of concurrent spinal schwannoma and meningioma mimicking a single cervical dumbbell-shaped tumor. A 64-year-old man presented with a 5-year history of gradually exacerbating left occipital pain without clinical evidence of neurofibromatosis. Magnetic resonance imaging showed an extradural tumor along the left C-2 nerve root with a small intradural component. The tumor was approached via a C-1 hemilaminectomy. The intradural tumor was resected together with the extradural tumor after opening the dura mater. The intradural tumor was attached to the dura mater around the exit point of the C-2 nerve root. Intraoperative biopsy revealed that the extradural tumor was a schwannoma and that the intradural tumor was a meningioma. The dura mater adjacent to the tumor was then coagulated and resected. Postoperative pathological examination confirmed the same diagnoses with no evidence of continuity between the intra- and extradural components. The patients postoperative clinical course was uneventful. Clinicians should be aware that cervical dumbbell-shaped tumors can consist of 2 different tumors.

Hypoglossal Nerve Palsy due to Occipito-Cervical Kyphosis: A Case Report

Hypoglossal nerve palsy (HNP) is a potential cause of dysphagia. There have been few reports presenting with HNP associated with spinal diseases. Here, we report a case of HNP caused by postoperative upper cervical deformity. A 66-year-old man presented to our hospital with dysphasia and neck pain. One year prior to his first visit, he had been diagnosed with upper cervical tuberculosis and had undergone posterior C1-C2 fixation. These symptoms, however, further worsened nine months after the initial surgery. The physical examination led to the diagnosis of HNP. Radiographic examination revealed that the O-C kyphosis had been exacerbated and that this deformity was likely the primary cause of HNP. To restore the swallowing function, O-C fusion surgery was performed. Postoperatively, the patient showed immediate improvement of dysphasia with gradual recovery of hypoglossal nerve function. Our results indicate that the kyphosis in O-C junction would be a potential cause of HNP.