Objective: To develop a weighted disuse risk score rating. Design : Based on specified selection criteria, items of the disuse risk factor were chosen. Then, a conjoint questionnaire for physicians was created using orthogonal cards with ordinal disuse risk grade. Conjoint analysis (SPSS 15.0) was performed, weighting each item and making a formula for calculating the disuse risk score. Setting : The Rehabilitation Department of a University Hospital. Participants : Forty-one physician respondents and 129 consecutive inpatients referred to the rehabilitation department. Main outcome measures : Agreement of the rated disuse risk grade with the calculated disuse risk score, and the reliability of the calculated disuse risk score of the 129 inpatients. Results : Eleven disuse risk factor items were selected ; age, malignant tumor, heart impairment, respiratory impairment, kidney impairment, pain, gait disorder, psychiatric impairment, intellectual disability, dementia, and body mass index. Forty-one physicians completed and returned a postal questionnaire. Cronbach's a of the rated disuse risk grade was 0.948. The correlation coefficient of the average rated disuse risk grade to the calculated disuse risk score was 0.985 (p=0.000). Items of high overall importance (%) were gait disorder (14.0%), malignant tumor (11.5%), and respiratory impairment (11.0%). Those of low overall importance (%) were body mass index (6.8%), kidney impairment (6.6%), and psychiatric impairment (6.1%). For the 129 patients, the calculated disuse risk score of the 11-item was correlated to that of the 9-item weighted disuse risk factor (R=0.930, p=0.000). Conclusions : Both the 11-item disuse risk factor and the weighted disuse risk score rating were considered reliable and useful.

STUDY DESIGN: A retrospective comparative study. PURPOSE: To compare perioperative medical complications after posterior approach spinal instrumentation surgery for osteoporotic vertebral collapse (OVC) between patients with primary osteoporosis and those with secondary osteoporosis. OVERVIEW OF LITERATURE: With increased aging of society, the demand for instrumentation surgery for an osteoporotic spine has been increasing. However, no studies have compared the rates or severities of perioperative complications after spinal instrumentation surgery between patients with primary osteoporosis and those with secondary osteoporosis. METHODS: Ninety-one patients with OVC aged ≥50 years (23 males and 68 females) who underwent posterior approach vertebral replacement with cages or posterior spinal fusion combined with vertebroplasty were divided into primary (n=56) and secondary (n=35) osteoporosis groups. Bone mineral density (BMD), osteoporosis treatment prior to OVC, operative invasiveness, and perioperative medical complications were compared. RESULTS: Diabetes mellitus (51.4%) was the most common cause of secondary osteoporosis, followed by glucocorticoid use (22.9%). No significant differences were seen in terms of age, gender, BMD, osteoporosis treatment, or operative invasiveness, including the number of levels fused, estimated blood loss, and number of patients requiring transfusion. No significant difference in the incidence of perioperative complications were observed between the primary and secondary osteoporosis groups (16.1% vs. 22.9%). However, surgical site infection (SSI) was significantly more frequently seen in the secondary osteoporosis group (11.4%) than in the primary osteoporosis group (1.8%; p<0.05). One patient in the secondary osteoporosis group developed methicillin-resistant Staphylococcus aureus infection that ultimately required instrument removal. CONCLUSIONS: The overall incidence of perioperative medical complications after posterior approach spinal instrumentation surgery for OVC was comparable between the primary and secondary osteoporosis groups under conditions of similar background characteristics and operative invasiveness. However, SSI (particularly more severe cases) occurred more frequently in patients with secondary osteoporosis.
Aging ; Bone Density ; Diabetes Mellitus ; Humans ; Incidence ; Male ; Methicillin-Resistant Staphylococcus aureus ; Osteoporosis* ; Retrospective Studies ; Spinal Fusion ; Spine ; Surgical Wound Infection ; Vertebroplasty

STUDY DESIGN: A retrospective study. PURPOSE: To examine the efficacy and safety for a posterior-approach circumferential decompression and shortening reconstruction with a titanium mesh cage for lumbar burst fractures. OVERVIEW OF LITERATURE: Surgical decompression and reconstruction for severely unstable lumbar burst fractures requires an anterior or combined anteroposterior approach. Furthermore, anterior instrumentation for the lower lumbar is restricted through the presence of major vessels. METHODS: Three patients with an L1 burst fracture, one with an L3 and three with an L4 (5 men, 2 women; mean age, 65.0 years) who underwent circumferential decompression and shortening reconstruction with a titanium mesh cage through a posterior approach alone and a 4-year follow-up were evaluated regarding the clinical and radiological course. RESULTS: Mean operative time was 277 minutes. Mean blood loss was 471 ml. In 6 patients, the Frankel score improved more than one grade after surgery, and the remaining patient was at Frankel E both before and after surgery. Mean preoperative visual analogue scale was 7.0, improving to 0.7 postoperatively. Local kyphosis improved from 15.7degrees before surgery to -11.0degrees after surgery. In 3 cases regarding the mid to lower lumbar patients, local kyphosis increased more than 10degrees by 3 months following surgery, due to subsidence of the cages. One patient developed severe tilting and subsidence of the cage, requiring additional surgery. CONCLUSIONS: The results concerning this small series suggest the feasibility, efficacy, and safety of this treatment for unstable lumbar burst fractures. This technique from a posterior approach alone offers several advantages over traditional anterior or combined anteroposterior approaches.
Decompression ; Decompression, Surgical ; Follow-Up Studies ; Humans ; Kyphosis ; Male ; Operative Time ; Retrospective Studies ; Titanium

Objective：The Clinical Trunk Control Test (CTCT) is used to assess trunk function worldwide, particularly for patients with spinal cord injury (SCI), with good reliability and validity. In Japan, trunk function evaluation methods specialized for patients with SCI are scarce. The aim of the present study was to create a Japanese version of CTCT (CTCT-J) and verify its reliability.Methods：CTCT-J was created using the double-back translation format. The inter-rater reliability was calculated based on the total CTCT-J score and intraclass correlation coefficient (ICC) for each item. The weighted kappa coefficient was calculated for each subtest. To verify internal consistency, Cronbach's alpha coefficient was calculated for the CTCT-J total score and each item.Results：We enrolled 12 patients with SCI, including ten men and two women, with an average age of 51.9 ± 17.8 years. Nine and three patients had cervical and thoracic SCI, respectively. The ICC for inter-rater reliability ranged from 0.995 to 1.000 (p ＜0.05). The weighted kappa coefficient for each subtest ranged from 0.756 to 1.000 (p ＜0.05). In the internal consistency test, the Cronbach's alpha coefficient for all items was 0.995 (p ＜0.05).Conclusion：We created the CTCT-J with double back translation and verified its reliability. Good inter-rater reliability and internal consistency were observed, indicating its applicability in Japan.

Objective：The Clinical Trunk Control Test (CTCT) is used to assess trunk function worldwide, particularly for patients with spinal cord injury (SCI), with good reliability and validity. In Japan, trunk function evaluation methods specialized for patients with SCI are scarce. The aim of the present study was to create a Japanese version of CTCT (CTCT-J) and verify its reliability.Methods：CTCT-J was created using the double-back translation format. The inter-rater reliability was calculated based on the total CTCT-J score and intraclass correlation coefficient (ICC) for each item. The weighted kappa coefficient was calculated for each subtest. To verify internal consistency, Cronbach's alpha coefficient was calculated for the CTCT-J total score and each item.Results：We enrolled 12 patients with SCI, including ten men and two women, with an average age of 51.9 ± 17.8 years. Nine and three patients had cervical and thoracic SCI, respectively. The ICC for inter-rater reliability ranged from 0.995 to 1.000 (p ＜0.05). The weighted kappa coefficient for each subtest ranged from 0.756 to 1.000 (p ＜0.05). In the internal consistency test, the Cronbach's alpha coefficient for all items was 0.995 (p ＜0.05).Conclusion：We created the CTCT-J with double back translation and verified its reliability. Good inter-rater reliability and internal consistency were observed, indicating its applicability in Japan.