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Study Design: A comparative study regarding the clinical outcome of the 2-different surgical procedures for patients with cervical spondylotic myelopathy (CSM). Objectives: To describe the anatomic basis of a segmental partial laminectomy (SPL) for the treatment of cervical spondylotic myelopathy and to compare the clinical outcome with traditional C3 to C7 expansive open-door laminoplasty (ELAP). Summary Of Background Data: Laminoplasty has been widely accepted for the treatment of CSM. However, some disadvantages have also been recognized. To resolve these problems, a SPL was performed. No previous studies have been reported regarding this surgical procedure. Methods: A total of 13 human cadavers were studied to analyze the spinal cord compression of cervical spondylosis. Twenty-six patients who underwent a SPL and 13 age- and gender-matched patients who underwent traditional C3-C7 ELAP were analyzed for their Japanese Orthopedic Association score, axial neck pain, and radiographic parameters (lordotic angle and ROM of cervical spine). Results: Based on cadaver studies, compression of the spinal cord was present in the articular segment, but not in the intraosseous segment. The removal of the ligamentum flavum and the superior edge of the lower lamina was sufficient for minimum posterior decompression of the cervical spinal cord.In comparison with the ELAP, the patients who underwent an SPL showed a similar recovery of the Japanese Orthopedic Association score, but the maintenance of the sagittal alignment and the range of motion were better after the SPL and postoperative neck and/or shoulder complaints also seemed to be reduced. Conclusion: A SPL, may therefore, be a useful and effective surgical procedure for cervical spondylotic myelopathy. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: A cross-sectional and epidemiologic study investigated low back pain. OBJECTIVE: To assess the correlation among outcome measures for low back pain, including sciatica, according to a proposed low back pain-related model. SUMMARY OF BACKGROUND DATA: Various outcome measures are used in low back pain research: pain, functional status, generic health status, and patient satisfaction. Correlation among these measures has been unclear. METHODS: For this study, 816 subjects (369 men and 447 women; average age, 62 years) who underwent an adult medical examination. The patients were interviewed concerning their personal background, severity of low back pain and sciatica, functional status, general health perception, social participation, subjective happiness, and patient satisfaction. The correlation among these measures was analyzed systematically using path analysis based on a low back pain-related model hypothesizing that low back pain and sciatica worsen functional status and general health perception and then affect social participation, subjective happiness, and patient satisfaction. RESULTS: Restriction of functional status was found to be the most closely correlated with severity of low back pain. A decrease in physical health was most closely correlated with restriction of function. Social participation, subjective happiness, and patient satisfaction were closely correlated with physical health status. There was a significant correlation among outcome measures concerning physical health, which was consistent with a low back pain-related model. CONCLUSIONS: The outcome measures concerning physical health in this study were found to be correlated significantly, consistent with the proposed low back pain-related model. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Cross-sectional survey. OBJECTIVE.: To investigate the relationship between low back pain (LBP) and metabolic syndrome (Mets) in community-based Japanese subjects. SUMMARY OF BACKGROUND DATA.: Relatively few reports have demonstrated a relationship between general pain and Mets, and none have addressed the relationship between LBP and Mets. METHODS: This study enrolled 2650 people from among residents aged 40 to 74 years in Tadami and Minamiaizu, Fukushima, Japan, who participated in health checkups conducted in 2008. LBP was defined as lower back pain continuing for more than 24 hours and severe enough to merit treatment, or it was based on clinical prediction rules from the clinical diagnosis support tool to identify patients with lumbar spinal stenosis. Mets was defined according to the Japanese criteria recommended by the Japanese Society of Internal Medicine. Prevalence of Mets was recorded for subjects with and without LBP. The relationship between LBP and Mets was investigated, using a generalized linear model. With LBP as the main explanatory variable and Mets as the outcome variable, risk ratios of Mets were calculated for men and women. RESULTS: In this study, we analyzed a total of 1395 subjects. In men, the prevalence of Mets was 21.2% in those without LBP and 24.7% in those with LBP. In women, the prevalence of Mets was 12.4% in those without LBP and 23.7% in those with LBP. After adjusting for factors such as age, body mass index, occupational status, SF-36 mental health, and physical activity level, no relationship was noted between LBP and Mets in men. However, in women, the risk ratio for Mets in subjects with LBP compared with those without LBP was 1.5 (95% confidence interval, 1.0-2.1). CONCLUSION: We observed a tendency toward higher prevalence of Mets among those with LBP than among those without it in women, but not in men. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Prospective study of assessment of surgical results using a new outcome measure for cervical myelopathy, the Japanese Orthopedic Association cervical myelopathy evaluation questionnaire (JOACMEQ). OBJECTIVE: To clarify correlations between pre- and postoperative JOACMEQ severity scores for cervical spine operations and grip strength and grip-and-release test, as objective evaluations, as well as correlations with the 8 subscales of the short form-36 (SF-36). METHODS: For pre- and postoperative evaluations, we examined 87 subjects who had undergone cervical spine operations and could be followed up for > or =6 months. JOACMEQ and the Japanese version of SF-36 were administered along with grip strength and grip-and-release tests, immediately preoperatively and 6 months postoperatively. Based on JOACMEQ severity scores pre- and postoperatively, treatment effectiveness was determined for cervical spine function, upper extremity function, lower extremity function, bladder function, and quality of life (QOL). We also clarified correlations between JOACMEQ scores and upper extremity function using grip strength and the grip-and-release test. In addition, correlations between the 5 JOACMEQ severity scores and the 8 subscales of SF-36 were analyzed. RESULTS: Effective rate of treatment was lower for upper extremity function than for other items (i.e., lower extremity function, bladder function, and QOL), and upper extremity function showed a different tendency for subjective improvement of symptoms following surgery compared to other items. JOACMEQ scores for upper extremity function, as subjective evaluations, may not necessarily improve even though improvements are seen in objective indicators such as grip strength and grip-and-release tests. CONCLUSION: JOACMEQ offers an effective method of evaluation from the perspective of patient evaluations of QOL. [ABSTRACT FROM AUTHOR]

STUDY DESIGN.: A cross-sectional study. OBJECTIVE.: To develop a reliable and valid instrument to measure quality of life (QOL) specifically targeting patients with lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA.: Studies on LSS have investigated the effectiveness of various types of treatments using health-related QOL. However, patients with LSS have various symptoms, and these symptoms change with posture, typical activities of daily living, etc. Thus, an LSS-specific scale to measure QOL is needed. METHODS.: We postulated 7 subdomains for LSS-specific QOL and accordingly, item pool was developed, focus group interviews of patients with LSS and qualitative analysis were conducted, resulting in preliminary version of QOL scale. Then, 189 patients with a diagnosis of LSS completed this preliminary version. Exploratory factor analysis was conducted to examine the factorial validity. Cronbach alpha coefficient and the test-retest method were used to assess the reliability. The criterion-based validity was determined using walking capacity, recommended treatment level judged by orthopedists, and LSS symptom scale scores. RESULTS.: Qualitative study confirmed the 7 domains but showed needs of addition and deletion of some items, resulting in 31 items. With factor analysis, after exclusion of 3 items, the remaining 28 items demonstrated strong unidimensionality. Cronbach alpha was 0.96. The coefficient of test-retest reliability was 0.86. Walking capacity, recommended treatment level, and LSS symptom scale scores were significantly correlated with the QOL scale scores. CONCLUSION.: A 28-item QOL scale specifically targeting patients with LSS was developed, and its reliability and validity were confirmed. [ABSTRACT FROM AUTHOR]