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Study design Prospective, randomized, controlled trial. Objective To investigate the effectiveness of home-based exercise on pain, dysfunction, and quality of life (QOL) in Japanese individuals with chronic low back pain (CLBP). Summary of background data Exercise therapy is a widely used treatment for CLBP in many countries. The studies on its effectiveness have been performed only in Western industrialized countries. The existence of cross-cultural differences and heterogeneity of patients in each country may influence the outcome of interventions for CLBP. Data that would enable researchers to compare the effectiveness of interventions between widely different societies is lacking. Methods A total of 201 patients with nonspecific CLBP were randomly assigned to either the control or exercise therapy group: 89 men and 112 women with a mean age of 42.2 years. The control group was treated with nonsteroidal anti-inflammatory drugs (NSAIDs), and the exercise group performed trunk muscle strengthening and stretching exercises. The primary outcome measures were pain intensity (visual analogue scale) and dysfunction level (Japan Low back pain Evaluation Questionnaire [JLEQ] and Roland-Morris Disability Questionnaire [RDQ]) over 12 months. The secondary outcome measure was FFD (Finger-floor distance). Statistical analysis was performed using Wilcoxon signed-ranks and Mann-Whitney U tests, and estimation of the median with 95% CI was calculated. Results In both groups, significant improvement was found at all points of follow-up assessment. However, JLEQ and RDQ were significantly more improved in the exercise group compared to the control group (P = 0.021 in JLEQ, P = 0.023 in RDQ). The 95% CI for the difference of medians of the change ratio between exercise and NSAID groups, [Exercise] - [NSAID], was -0.25 to -0.02 in JLEQ, -0.33 to 0.00 in RDQ, and -0.20 to 0.06 in visual analogue scale. Conclusion The home-based exercise prescribed and monitored by board-certified orthopedic surgeons was more effective than NSAIDs for Japanese patients with CLBP.

Study design Development of a nationwide patient-based outcome measure for patients with chronic low back pain (CLBP). Objective The purpose of this study was to develop and introduce a new means of measuring outcomes for Japanese individuals with CLBP (the Japan Low Back Pain Evaluation Questionnaire [JLEQ]), and to examine its validity and reliability by comparison with the Roland-Morris Disability Questionnaire (RDQ). Summary of background data CLBP is a serious problem affecting the health and welfare of workers, especially laborers. The severity and disability it causes vary depending on cultural background and the psycho-emotional aspect of the patients. Methods The following items were tested for the JLEQ and the RDQ using psychometric analyses: content validity, construct validity, criterion validity, internal-consistency reliability, and test and retest reliability. Results A total of 195 patients with CLBP participated in this study. There were no floor and ceiling effects in the JLEQ. Cronbach's alpha coefficient was 0.971 and 0.893 for the JLEQ and RDQ, respectively. The test-retest interclass correlation coefficient in the JLEQ was 0.886, indicating good test-retest reliability. Categorical principal component analysis showed that the construct structure consisted of 3 item clusters in the JLEQ. The factor loading patterns indicated that the JLEQ items were separated into 3 domains, i.e., a moderately loaded group, a less loaded group, and psychological conditions. The degree of correlation between the question items in the JLEQ and RDQ was evaluated using Akaike Information Criteria. Conclusion The JLEQ was shown to be a valid and reliable questionnaire scale for measurement of patient-based outcomes in CLBP patients.

Study Design. This in vitro analysis defines biomechanical properties of the Triumph Lumbar Disc (TLD) for posterolateral lumbar disc arthroplasty. Objectives. To quantify segmental kinematics afforded by the TLD, determine whether intervertebral positional changes of the device affect spinal kinematics, and compare kinematics following TLD reconstruction with historical CHARITE data. Summary of Background Data. As an alternative to arthrodesis, total disc arthroplasty serves to restore the biomechanical properties of the spine. However, there are kinematic and clinical concerns regarding posterior lumbar column destabilization and reconstruction using motion-preserving technology. Methods. Seven human lumbosacral spines were biomechanically evaluated under the following conditions: (1) Intact; (2) Unilateral facetectomy; (3) Facetectomy and discectomy; (4) TLD-posterior; (5) TLD-central; (6) TLD-anterior. Centers of intervertebral rotation (COR) and intradiscal pressures were compared at the operative/adjacent levels. Results. In axial rotation, L4-L5 range of motion (ROM) increased to 110% ± 15.3% following unilateral facetectomy and 134.3% ± 26.9% following facet/discectomy. Implanting the TLD in 3 positions—posterior, central, and anterior-demonstrated no significant differences in ROM (P > 0.05). Trends were similar in flexion/extension and lateral bending. The neutral zone increased under the facet/discectomy condition and TLD reconstructions compared to the intact condition (P < 0.05). CORs were dispersed at the operative level following destabilization. TLD in posterior and central positions restored loci to near the intact condition, whereas the anterior position produced more diffuse CORs. Adjacent level intradiscal pressures decreased in flexion-extension following destabilization and reconstruction. Conclusion. Axial rotation ROM following TLD reconstruction (central position) was 131.5% of intact, compared to historical controls for the CHARITE device (162.0%). This indicates that lumbar disc arthroplasty performed using a posterolateral approach may offer biomechanical advantages over the anterior approach. Moreover, this approach may minimize surgical complications and allow simultaneous decompression of the neural elements. Intervertebral positional changes of the TLD were not shown to affect spinal kinematics.

In order to clarify the pathomechanism of thoracolumbar burst fractures and to evaluate the influence of disc degeneration and bone mineral density, a biomechanical study was performed using cadaveric spines. Eleven motion segments of thoracolumbar spines from human cadavers were compressed vertically until a fracture occurred. In addition, bone mineral density and degree of disc degeneration were determined for each specimen. Compression of 7 of 11 specimens resulted in the typical burst fracture characterized by retropulsion of a bony fragment into the spinal canal and an increase of the interpedicular distance. All seven specimens showed disruptions of the middle end plate and disc materials in the vertebral body. The fracture line was located between the middle of the end plate and the middle of the posterior wall cortex. No burst fractures were seen in the specimens with severely degenerated discs and osteoporosis. In order to confirm the stress state in a vertebra that induces the burst fracture, finite element analysis of one motion segment was also carried out under the same mechanical conditions as the experiments in this study. As a result of calculation for the healthy disc, the highest stresses under axial compression were concentrated in the following areas: the middle of the end plate, the cancellous bone under the nucleus pulposus, and the middle of the posterior wall cortex. This implies that the above regions are more vulnerable to vertical compressive load. In the analysis of specimens with severely degenerated discs, stresses were very low at the end plate and cancellous bone under the nucleus.(ABSTRACT TRUNCATED AT 250 WORDS)

A case report and review of the literature are presented.To describe the clinical course and treatment of a patient with athetoid cerebral palsy who had quadriparesis due to an intraspinal cyst, following a failed occipitocervical fusion using sublaminar wires and rods.Intraspinal cyst as a cause of quadriparesis in a patient with athetoid cerebral palsy is extremely rare. To our knowledge, there have been no publications on this issue.A 60-year-old man with athetoid cerebral palsy and a history of posterior occipitocervical fusion presented with quadriparesis. Salvage surgery for cervical myelopathy and pseudarthrosis was performed with laminectomy and rearthrodesis using the pedicle screw system. An intraspinal cyst was identified as the main cause of the paraparesis.Solid bony fusion and the improvement of paraparesis were achieved 2 years and 1 month after the surgery. He is now able to feed himself and to walk with a cane, both without assistance.A physician managing patients with athetoid cerebral palsy should always be aware that an intraspinal cyst in the cervical spine may be the cause of cervical myelopathy.

Study Design. A prospective cohort study. Objectives. To introduce a novel back school for the treatment of patients with chronic low back pain (CLBP), and to report its clinical results. Summary of Background Data. Although back school is one of the treatment methods for patients with CLBP, its efficacy and appropriate style remain controversial. No studies have been published regarding the combined program of back school with a multidisciplinary team approach. Methods. A total of 182 patients with CLBP (74 men and 108 women; average age, 43.8 years) participated in this study. All patients were enrolled in the back school using a multidisciplinary team approach featuring quantitative functional evaluation and therapeutic exercises. The following outcome measures were evaluated at the baseline, and 6 and 12 months after the enrollment: the level of pain evaluated with a Visual Analog Scale (VAS). flexibility of trunk and hamstrings (finger-floor distance, straight leg raising), trunk muscle strength and endurance, frequency of therapeutic exercises, and self-reported patient satisfaction. Results. An averaged VAS score was 6.2 before enrollment in the program and 2.8 at follow-up. The pain improved in 141 patients (80.8%), did not change in 27 (15.4%), and was aggravated in 7 (3.8%). There was statistically significant improvement of finger-floor distance, trunk muscle strength, and endurance in the patients whose pain was relieved after enrollment in the program (P < 0.05). The compliance with the exercise program was significantly correlated with the clinical results (P < 0.05) Conclusions. We developed a novel back school using a multidisciplinary team approach, featuring quantitative functional evaluation and therapeutic exercises. The current study demonstrated that our program could provide a satisfactory result for the treatment of patients with CLBP. The quantitative functional evaluation was a worthwhile outcome measure when evaluating the efficacy of the treatment program. Teaching body mechanics and performing the therapeutic exercises through the multidisciplinary team approach are essential to managing CLBP in a general setting.

Histomorphometric and microradiographic studies were performed to investigate whether there are different rates of bone remodeling based on the intrinsic stability with anterior spinal instrumentation and to evaluate if biodegradable polymer could be used clinically as the material of choice for anterior spinal instrumentation. Twenty-one coon hounds underwent anterior and posterior spinal destabilizing procedures to produce a reproducible amount of spinal instability: corpectomy of L5, discectomies and partial facetectomies of L4-5 and L5-6, resections of L5 lamina, spinous process, supra- and interspinous ligament, and ligamentum flavum. Group 1 (N = 7) underwent anterior autogenous ulna strut graft alone at L4-6; group 2 (N = 7) underwent anterior biodegradable polymer strut alone at the same level; group 3 (N = 7) underwent same bone graft as in group 1, augmented by anterior Kaneda device. Six months after surgery quantitative histologic study showed that device-related osteopenia occurred in spines treated with Kaneda device. Within the L5 vertebral body the volumetric density of bone (mm3/cm3) was less for the group with Kaneda device (group 3) compared with that without instrumentation (group 1, P less than 0.05). In the spine treated with biodegradable polymer, no adverse host tissue responses were observed histologically. In addition, osteoconductive abilities of the polymer were suggested microscopically. Its mechanical property, however, was not rigid enough to stabilize the corpectomized spine.