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Osteochondroma, one of the most common benign bone tumors, frequently occurs in the metaphysis of the long bones. We report an extremely rare case of osteochondroma that occurred in the tibial sesamoid. The patient was a 62-year-old Japanese male. He presented with a 1-year history of pain and a hard mass on the plantar aspect of the right forefoot sole. The osteochondroma protruded toward the sole from the tibial sesamoid, leading to pain on weightbearing. After tibial sesamoidectomy, the patient's symptoms were eliminated, and no pain or complications such as hallux valgus occurred after the surgery. Although a potential risk exists of postoperative hallux valgus deformity, tibial sesamoidectomy seems to be an appropriate surgical option for both osteochondroma and bizarre parosteal osteochondromatous proliferation to avoid residual pain or local recurrence. [ABSTRACT FROM AUTHOR]

Background: Few studies have examined the prevalence of lumbar spinal stenosis (LSS) in the general population. The purposes of this study were to estimate the prevalence of LSS and to investigate correlated factors for LSS in Japan. Methods: A questionnaire survey was performed on 4,400 subjects selected from residents aged 40–79 years in Japan by stratified two-stage random sampling in 2010. The question items consisted of lower-limb symptoms suggestive of LSS, the diagnostic support tool for LSS (LSS-DST), demographic and lifestyle characteristics, comorbidities, the Japanese Perceived Stress Scale (JPSS), and the Mental Health Index 5 (MHI-5). Using the LSS-DST, the presence of LSS was predicted to estimate the prevalence of LSS. Logistic regression analysis was performed to examine the relationship between LSS and correlated factors. Results: Questionnaires were obtained from 2,666 subjects (60.6 %), consisting of 1,264 males (47.4 %). The mean (standard deviation) age was 60.0 (10.9) years. According to the LSS-DST, 153 subjects were regarded as having LSS. The prevalence was estimated to be 5.7 %. When standardizing this value with the age distribution of the Japanese population, it was estimated that 3,650,000 Japanese subjects aged 40–79 years might have LSS using the LSS-DST. Prevalence increased with age and was particularly high in subjects aged 70–79 years, irrespective of gender. As correlated factors, an advanced age (60 years or older), diabetes mellitus, urological disorders, and osteoarthritis/fracture as comorbidities, and depressive symptoms, were associated with LSS. Conclusions: This study elucidated the prevalence of LSS and factors associated with LSS in Japan. This is the first report describing the estimated prevalence of LSS and associated factors using a strictly sampled representative population. [ABSTRACT FROM AUTHOR]

Background data: There is a considerable difference in pain perception among individuals. In patients with chronic pain, recent studies using fMRI, PET and SPECT have shown that functional changes mainly occurred in the anterior cingulate cortex (ACC), prefrontal cortex (PFC) and thalamus. Brain magnetic resonance spectroscopy (MRS) can evaluate brain chemistry by measuring metabolites such as N-acetyl aspartate (NAA). The purpose of this study was to analyze whether brain MRS could assess pain due to lumbar spine diseases. Methods: NAA levels were determined relative to the concentration of creatine/phosphocreatine complex (Cr) and choline (Cho), which is commonly used as an internal standard. The NAA/Cr and NAA/Cho ratios in the ACC, PFC and thalamus were compared between six patients with unilateral pain (left side) and six control patients without pain. Results: In the right thalamus (contralateral side to symptom), the NAA/Cr in the patients with pain was statistically significantly lower compared with the control patients ( p < 0.05). Also, in the right thalamus, the NAA/Cho in pain patients was significantly lower compared with controls ( p < 0.01). When considering just the right thalamus, there were statistically significant correlations between the numerical rating scale for pain (NRS) and NAA values. Conclusions: Lumbar pain can be assessed indirectly by analyzing the decrease in NAA concentration in the thalamus. [ABSTRACT FROM AUTHOR]

Abstract: Background: The purpose of the present study is to clarify the influence of acute and chronic interruption of blood flow from lumbar arteries as well as the influence of vascular reconstruction on low back pain, back muscles, and lumbar discs. Methods: Subjects were 34 patients with AAA in whom vascular reconstruction was performed. A second group was comprised of 9 patients with HAO. The presence of low back pain before surgery and at follow-up examination was retrospectively examined in the AAA group and the HAO group to investigate postoperative changes. The CSA and degeneration of the multifidus muscle and the lumbar discs on magnetic resonance imaging were assessed in the AAA group and control group. Results: Low back pain, significant atrophy, or degeneration of the multifidus muscle or degeneration of the lumbar disc did not newly develop after surgery in the AAA group. These results indicated that acute interruption of lumbar arteries did not induce the development or deterioration of low back pain and organic changes in the back muscles or lumbar discs. The frequency of low back pain before surgery was significantly higher in the HAO group than that in the AAA group. However, the frequency of low back pain after surgery did not differ significantly between the 2 groups because low back pain in the HAO group was improved after surgery. Conclusion: The finding that low back pain was improved by merely performing treatment for the vascular system might provide support for the presence of vascular backache. [Copyright &y& Elsevier]

A correction to the affiliation of an author of the article "Prevalence of lumbar spinal stenosis, using the diagnostic support tool, and correlated factors in Japan: A population-based study" that appeared in the October 29, 2013 online version of the "Journal of Orthopaedic Science" is presented.

The Japanese Society for Spine Surgery and Related Research previously developed a diagnostic support tool for lumbar spinal stenosis (LSS-DST). Using the LSS-DST, general physicians can identify potential cases of LSS. However, in the LSS-DST, measurement of the ankle brachial pressure index (ABI) is required to exclude peripheral artery lesions in the lower limbs. We can expect further application of the LSS-DST if we can identify a simpler and easier method than ABI measurement. Therefore, in this large-scale, multicenter, cross-sectional study, we verified whether palpation of the posterior tibial (PT) artery could be used instead of ABI in the LSS-DST. This survey was conducted at 2177 hospitals and included 28,883 participants. The sensitivity and specificity of the original LSS-DST method using the ABI and that of the LSS-DST ver2.0 with PT artery palpation were assessed to screen their ability for diagnosing LSS, using the physicians' final diagnosis based on the patients' history, physical examination and radiographic findings as the gold standard. The sensitivity and specificity [95%CI] of the LSS-DST were 88.2% [87.5, 88.8] and 83.9% [83.4, 84.5], respectively, whereas the sensitivity and specificity of the LSS-DST ver2.0 were 87.7% [87.0, 88.3] and 78.3% [77.7, 78.9], respectively, indicating that LSS-DST ver2.0 is a useful screening tool for LSS with good sensitivity. When the item of ABI in the LSS-DST is replaced by palpation of the PT artery (LSS-DST ver2.0), its sensitivity is maintained as a screening tool for LSS. Level 3. [ABSTRACT FROM AUTHOR]

The article describes the case of a 55-year-old man diagnosed with thoracic myelopathy as a result of alkaptonuric spondylosis and who underwent decompressive surgery. The patient was admitted for further evaluation of gait disturbances caused by progressive leg paralysis of 3 weeks' duration. He has a history of alkaptonuria and hypertension.

Background: Deterioration of quality of life in patients with chronic pain is difficult to treat. Chronic pain in patients with low quality of life may be "severe" and require multidisciplinary treatments. This study aimed to develop an objective severity discrimination scale based on quality of life measurements to identify patients with "severely disabling" chronic pain.Methods: Subjects were 156 patients with chronic pain whose numerical rating pain score was ≥1 and who had pain for ≥3 months. Diseases associated with chronic pain included spinal diseases, joint diseases, concomitant diseases, complex regional pain syndromes, and other musculoskeletal diseases. Patients were divided into low, middle, and high groups based on physical quality of life summary scores on the Short Form-36. The mental component summary, painDETECT, Japanese version of the Pain Catastrophizing Scale, Brief Scale for Psychiatric Problems in Orthopaedic Patients, and factors related to degree/quality of pain during the past 4 weeks were analyzed to identify components in the low group. The score weighting factor for discriminating between the high and low groups was determined by discriminant analysis.Results: Factor analysis identified 4 factors representing features of chronic pain patients with low QOL: enhanced perception of pain, pain catastrophic thoughts, depressive sleep disorder, and pain intensity. For discriminant analysis, patients were defined as those with low physical quality of life if each factor's total score multiplied by a factor plus a constant value of 2.6 was ≥0, and high quality of life if it was <0. The receiver operating characteristic curve area used to determine the cut-off value was 0.71, with 67.3% sensitivity and specificity.Conclusions: We developed a 33-question severity discrimination scale to define "severely disabling" chronic pain based on physical quality of life. "Severely disabling" patients identified on this scale could represent chronic pain patients needing focused multidisciplinary treatment. [ABSTRACT FROM AUTHOR]

Background: The reference values of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) in patients with lumbar spinal stenosis (LSS) are still unknown. This multicenter cross-sectional survey was performed to determine the reference values and disease-specific characteristics of deterioration of QOL caused by LSS itself, not by aging, through comparison of patients with and without LSS who had an outpatient visit for low back pain by age and sex groups.Methods: The present study was performed at 564 medical centers and clinics. The JOABPEQ was measured for 8338 patients aged 20 years or over who came to an outpatient clinic for low back pain (LBP) and were examined for whether they had LSS using the LSS diagnosis support tool (LSS-DST). Scores in the five JOABPEQ domains were compared between the LSS group and the LBP without LSS group (LBP group) for each age and sex group.Results: Scores for Pain-related disorder, Gait disturbance, Social life disturbance, and Psychological disorders were significantly lower in the LSS group than in the LBP group.Conclusion: The percentiles of JOABPEQ scores in patients with LSS were clarified and could be used as reference values. Deterioration of QOL caused by LSS itself, not by aging, are characterized by Pain-related disorder, Gait disturbance, Social life disturbance, and Psychological disorders. [ABSTRACT FROM AUTHOR]

Background: Spinal extradural arachnoid cyst (SEDAC) is a cystic lesion that protrudes into the epidural space from a small dural defect. Early diagnosis of SEDAC is important because its expansion causes neurological damage. Two types of SEDAC, syndromic and sporadic, are present. Syndromic SEDAC is inherited as a part of lymphedema-distichiasis syndrome caused by mutations in the FOXC2 gene; however, it is often mistaken as sporadic because of low penetrance. It is not reasonable to conduct a genetic testing for all SEDAC patients and their family members. The aim of this study is to establish an effective screening method to distinguish syndromic SEDAC from sporadic SEDAC.Methods: We performed a retrospective review of medical records and imaging studies of 29 subjects who were diagnosed with SEDAC. Clinical features, family history and magnetic resonance imaging (MRI) were analyzed. Mutations in FOXC2 were examined by Sanger-sequencing of the entire coding region of the genes. SEDAC having a mutation in FOXC2 gene was defined with syndromic SEDAC.Results: Eleven subjects had a heterozygous mutation in FOXC2. They were all familial and hence syndromic SEDAC. Only one proband had known family history of SEDAC at diagnosis. MRI findings and physical examinations, especially eye and leg examinations, were quite useful to screen syndromic SEDAC. Physical examination often showed accompanying lymphedema and distichiasis in syndromic SEDAC. Syndromic SEDAC tended to have multiple cysts out of the thoracolumbar area.Conclusions: We established an effective screening method based on physical examinations and MRI findings. [ABSTRACT FROM AUTHOR]

Background: Numbness in the soles of both feet at rest or bowel/bladder dysfunction can occur in patients with lumbar spinal stenosis (LSS), especially in patients with cauda equina lesions. The purpose of this study was to clarify the relationship between cauda equina symptoms at rest and quality of life (QOL) in LSS patients using standardized questionnaires developed for the Japanese population.Methods: A survey was conducted in 564 hospitals and general practice clinics nationwide from December 1, 2011 to December 31, 2012. All patients who visited hospital or clinic because of low back pain were included. Patients were diagnosed with LSS using the LSS-Diagnostic Support Tool (LSS-DST), and the severity of the disease was measured using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) for quality of life. Presence of both sole numbness and/or bowel/bladder dysfunction were determined by medical interview. 3647 patients were diagnosed with LSS according to the results of the LSS-DST. 1294 of these patients (35.5%) had symptoms at rest. Of these patients, 359 patients with sole numbness, 135 patients with bowel/bladder dysfunction, and 52 patients with both numbness and bowel/bladder dysfunction were compared to the patients without rest symptoms (n = 2182). Comparisons between groups with or without sole numbness and bowel/bladder dysfunction were performed using statistical analysis of JOABPEQ responses in the categories of pain-related disorder, lumbar spine disorder, gait disturbance, social life disturbance, and psychological disorder.Results: All groups with sole numbness and/or bowel/bladder dysfunction had statistically lower (worse) scores in all categories of the JOABPEQ compared to the group without these symptoms at rest.Conclusion: LSS patients having numbness in the soles of both feet at rest or bowel/bladder dysfunction had lower measurements of QOL and activities of daily living than those patients without symptoms at rest. These symptoms appear to be related to QOL of LSS patients. [ABSTRACT FROM AUTHOR]

Background: The authors have developed a screening tool, the 25-Geriatric Locomotive Function Scale (GLFS-25), for the early detection of locomotive syndrome (LS). However, few studies have examined the prevalence of LS in the general population. This study estimated the prevalence of LS in Japan using the GLSF-25 and investigated age specific mean values for this scale.Methods: A nationwide cross-sectional questionnaire survey was conducted to reveal standard values for the GLFS-25 and to estimate the total number of individuals with LS in Japan. Subjects were individuals selected from residents aged 40-79 years in Japan by a stratified, two-stage random sampling method in 2014. The survey period was from February to March 2014. A total of 9028 subjects were invited to participate. The GLFS-25 was used to estimate the prevalence of LS. We also investigated the degree of recognition of LS.Results: Answers for the questionnaire were obtained from 5162 subjects (57.2%); 22.1% of responders had heard of LS. According to the GLSF-25, 614 subjects were regarded as having LS, representing a prevalence of 11.9%. When standardizing this value with the age distribution of the Japanese population, the total number of individuals with LS between the 40s and 70s in Japan was estimated to be approximately 7.5 million. Age specific standard values on the GLFS-25 were 4.4 in the 40s, 5.5 in the 50s, 7.1 in the 60s, and 12.7 in the 70s. The prevalence of LS increased with age and was particularly high in subjects aged 70-79.Conclusions: The degree of recognition of LS was 22%. This study demonstrated sex- and age specific standard values of the GLFS-25 and estimated the total number of individuals with LS in Japan based on a representative population. [ABSTRACT FROM AUTHOR]

Background: Diagnostic support tools for lumbar spinal stenosis such as the Self-administered, Self-reported History Questionnaire have been developed in Japan, but no report has demonstrated the diagnostic accuracy of this questionnaire in Japanese primary care settings. This multicenter, cross-sectional survey was performed to evaluate and improve the diagnostic accuracy of this questionnaire for lumbar spinal stenosis patients in Japanese primary care settings.Methods: The lumbar spinal stenosis diagnosis support tool project was conducted in 1657 hospitals to evaluate the diagnostic accuracy of the Self-administered, Self-reported History Questionnaire in Japan from 2011 to 2012. Consecutive adults (≥50 years old) from physicians, including non-orthopedic general practitioners and orthopedic general practitioners, were considered for enrollment. Consecutive adults (≥50 years old) with low back pain from hospital-based orthopedic surgeons were also considered for enrollment. The diagnostic accuracy of the Self-administered, Self-reported History Questionnaire with initial and several new cutoff points in classifying patients according to the presence of lumbar spinal stenosis was assessed in terms of sensitivity, specificity and negative predictive values.Results: Among the 33,545 patients, 10,199 (30.4 %) were diagnosed with lumbar spinal stenosis by the physicians. The Self-administered, Self-reported History Questionnaire version 1.1 with a new cutoff point was more sensitive than the Self-administered, Self-reported History Questionnaire version 1.0 with the initial cutoff point (79.8 vs. 68.3 %) and less specific (68.8 vs. 75.1 %) for lumbar spinal stenosis diagnosis. The respective negative predictive values were 88.5 and 84.3 %.Conclusions: The Self-administered, Self-reported History Questionnaire version 1.1 with the new cutoff was more sensitive and had higher negative predictive value than version 1.0 with the initial cutoff. Therefore, the improved Self-administered, Self-reported History Questionnaire version 1.1 can be used for lumbar spinal stenosis screening, and its use may improve the quality of lumbar spinal stenosis diagnostic practice in Japanese primary care settings. [ABSTRACT FROM AUTHOR]

Background: The authors recently developed a screening tool, the 25-question Geriatric Locomotive Function Scale (GLFS-25), for the early detection of locomotive syndrome (LS). However, the nationwide prevalence of LS based on the GLFS-25 remains unknown. Methods: A nationwide, cross-sectional Internet survey was conducted to estimate sex- and age-specific mean values of the GLFS-25 and the total number of individuals with LS in Japan. The distribution of the subjects' sex, age, geographical location, and population size was approximated by that observed in the national population census conducted in 2010. In total, 4,500 subjects who completed the GLFS-25 questionnaire on the Internet were included in the present study. Results: The age-specific mean values for the GLFS25 were 5.8 in the 40s, 6.0 in the 50s, 5.9 in the 60s, and 8.8 in the 70s. The mean value for the GLFS-25 was significantly higher in the 70s than in the other age groups. The mean value for the GLFS-25 was significantly higher in females than in males. The prevalence of LS was 8.4 % in the 40s and remained stable until the 60s, but increased rapidly in the 70s. The overall mean prevalence of LS was 10.2 %. The total number of individuals between the 40s and 70s with LS in Japan was roughly estimated to be 6.5 million. Conclusions: This study determined sex- and age-specific estimates for the GLFS-25 using a nationwide, cross-sectional Internet survey. The current results highlight the magnitude of the problem associated with LS and encourage further large-scale population-based epidemiologic studies to determine the accurate prevalence of LS using stratified random sampling. [ABSTRACT FROM AUTHOR]