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Objective: To determine the prevalence of osteosarcopenia and its relationship with physical function in elderly people in Japan. Methods: The subjects were 427 healthy volunteers over 65 years old (205 males, 222 females, average age 71.4 years) who attended health checkups in 2016 and 2017. Body mass index (BMI), bone mineral density in the calcaneus (%YAM), physical parameters, and skeletal muscle mass were measured. The appendicular skeletal muscle index (aSMI) was calculated as arm and leg skeletal muscle mass/height 2 . Osteoporosis was defined as %YAM < 70%, sarcopenia as aSMI < 7.0 kg/m 2 (males) and <5.8 kg/m 2 (females), and osteosarcopenia as the presence of sarcopenia and osteoporosis. Results: Osteoporosis alone was diagnosed in 60 subjects (14%), sarcopenia alone in 55 (13%), and osteosarcopenia in 36 (8%). The prevalence of osteosarcopenia was 8% in all subjects, 12% in females, and 4% in males. BMI and back muscle strength were significantly lower in osteosarcopenia than in sarcopenia alone ( p  < .05); and weight, BMI, body fat, grip strength, and back muscle strength were significantly lower in osteosarcopenia than in osteoporosis alone ( p  < .05). Conclusion: Osteosarcopenia was significantly associated with muscle weakness. Further studies to identify other related factors are needed for prevention and treatment of osteosarcopenia.

Objectives: To investigate the severity and effect on quality of life (QOL) of various types of pain in healthy volunteers. Methods : A total of 384 subjects (male: 158, female: 226, average age: 63 years) were included in a prospective cohort study (Yakumo study). Shoulder pain, low back pain (LBP), sciatica, knee pain, and the American Shoulder and Elbow Surgeons (ASES) shoulder score were evaluated with SF-36. Results: The prevalence of shoulder pain, LBP, sciatica, and knee pain was 42%, 44%, 16%, and 48%, respectively, with similar severities of pain. Shoulder pain visual analogue scale (VAS) and ASES shoulder scores were significantly correlated with SF-36 domains. Subjects with poor physical QOL had significantly higher VAS scores for all pain types and a lower ASES shoulder score. Shoulder pain VAS was also significantly related to poor mental QOL. Multivariate regression analysis adjusted for age and gender showed that shoulder pain VAS (OR: 1.25, p  < .05) and 10-m gait speed (OR: 1.82, p  < .05) were significant independent risk factors for poor physical QOL. Conclusion: Only shoulder pain of similar severity to other pain and shoulder complaints impacted on both physical and mental QOL. The severity of shoulder pain was an independent risk factor for poor physical QOL.

Purpose: To examine effects of combined osteoporosis (P), knee osteoarthritis (K-OA), and lumbar spondylosis (L-OA) on quality of life (QOL), and identify risk factors for poor QOL. Methods: 1021 subjects (440 males, 581 females, mean age: 63.4 years) were prospectively included. Osteoporosis (%YAM ≤70%), K-OA (Kellgren-Lawrence grade ≥2), and L-OA (Nathan class ≥3) were defined. Subjects were divided into groups 0 to 3 based on the number of comorbid diseases, and into groups P, K, and L (one disease), PK, PL, and KL (two diseases), and PKL (three diseases). Clinical variables and QOL were compared, and risk factor analysis was conducted. Results: BMI, muscle strength, pain, and spinal inclination significantly increased and physical QOL worsened with more comorbidities. Though age did not differ among disease groups, BMI was significantly higher in groups K and L than in group P. Groups including subjects with L-OA had significantly lower lumbar lordosis and larger spinal inclination. In multivariate logistic regression analysis adjusted for age and gender, group KL, spinal inclination, gait speed, grip strength, and pain were risk factors for poor physical QOL. Conclusion: Increased comorbidity has a negative impact on physical QOL, and six risk factors for poor physical QOL were identified.

Objectives: Improvement of nutritional status, which may help prevent osteoporosis, can be assessed using the body cell mass (BCM) index, measured by the bioelectrical impedance analysis (BIA). However, the relationship between BCM and osteoporosis is not clear. This cross-sectional study investigated the association between osteoporosis and four components of body composition, including BCM. Methods: The study included 600 participants who underwent measurements of bone status by quantitative ultrasound and body composition by BIA at an annual health check-up. Normal and osteoporosis groups were compared. Results: There were 414 and 186 participants in the normal and osteoporosis groups, respectively. Significant differences between the two groups were observed in age, sex, height, weight, BCM, extracellular water (ECW) content, and minerals, even after adjusting for age and sex. In logistic regression analysis, BCM, age, and ECW were significant risk factors for osteoporosis. Furthermore, BCM and ECW in males and BCM and age in females were significant risk factors for osteoporosis. Conclusion: Of the four body composition components measured with BIA, reduction in BCM most reflected osteoporosis. BCM was a significant risk factor in both sexes for osteoporosis. BCM can be easily measured, and may be useful in the prevention and treatment of osteoporosis.

This study aims to establish radiographic parameters of lumbopelvic sagittal alignment, gender related differences, and age-related changes in a middle-aged community, to investigate whether age-related changes of lumbopelvic alignment reflect the risk of locomotive syndrome (LS). This study included 448 healthy Japanese volunteers who attended a basic health checkup supported by the local government. The subjects (184 males and 264 females, mean age: 62.7 years) were grouped according to their age by decade. Sagittal lumbopelvic parameters were collected by lateral spine radiographs including lumbar lordosis (L1-S1, LL), lower lumbar lordosis (L4-S1, LLL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). The three tests (stand-up test, two-step test, and 25-question geriatric locomotive function scale [GLFS-25]) composing the LS risk test were performed. LL was significantly lower in males than in the females. A significant decrease of LL and LLL was observed from 60 s to 70 s in the females. PI did not markedly change with aging in either gender but was lower in males. A remarkable increase of PT was seen from 60 s to 70 s in the females. SS did not markedly change with aging and was lower in males in all decades. The prevalence of LS risk in males and females increased gradually with age and was greater in females in any decade. 70 s females with LS risk had significantly lower LL and higher PT compared to them without LS risk. Radiographic parameters of lumbopelvic sagittal alignment were established in community-dwelling middle-age and elderly individuals., Competing Interests: Declaration of Competing Interest The authors report no conflict of interest except for the national grant., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: The objective of this study was to investigate the relationship between morphological changes in thoracic ossification of the posterior longitudinal ligament (T-OPLL) and postoperative neurological recovery after thoracic posterior fusion surgery. Changes of OPLL morphology and postoperative recovery in cases with T-OPLL have not been examined., Methods: In this prospective study, the authors evaluated data from 44 patients (23 male and 21 female) who underwent posterior decompression and fusion surgery with instrumentation for the treatment of T-OPLL at our hospital. The patients' mean age at surgery was 50.7 years (range 38-68 years). The minimum duration of follow-up was 2 years. The location of thoracic ossification of the ligamentum flavum (T-OLF), T-OLF at the OPLL level, OPLL morphology, fusion range, estimated blood loss, operative time, pre- and postoperative Japanese Orthopaedic Association (JOA) scores, and JOA recovery rate were investigated. Reconstructed sagittal multislice CT images were obtained before and at 3 and 6 months and 1 and 2 years after surgery. The basic fusion area was 3 vertebrae above and below the OPLL lesion. All parameters were compared between patients with and without continuity across the disc space at the OPLL at 3 and 6 months after surgery., Results: The preoperative morphology of OPLL was discontinuous across the disc space between the rostral and caudal ossification regions on sagittal CT images in all but one of the patients. Postoperatively, these segments became continuous in 42 patients (97.7%; occurring by 6.6 months on average) without progression of OPLL thickness. Patients with continuity at 3 months had significantly lower rates of diabetes mellitus (p < 0.05) and motor palsy in the lower extremities (p < 0.01). The group with continuity also had significantly higher mean postoperative JOA scores at 3 (p < 0.01) and 6 (p < 0.05) months and mean JOA recovery rates at 3 and 6 months (both p < 0.01) after surgery., Conclusions: Preoperatively, discontinuity of rostral and caudal ossified lesions was found on CT in all patients but one of this group of 44 patients who needed surgery for T-OPLL. Rigid fixation with instrumentation may have allowed these segments to connect at the OPLL. Such OPLL continuity at an early stage after surgery may accelerate spinal cord recovery.

Objectives: Br(E)-MsEP monitoring is widely used in spinal surgery for detection of spinal cord injury. However, Br(E)-MsEP waveform derivation requires high-intensity stimulation, and this raises a concern of adverse effects due to the immature corticospinal tract in pediatric patients. The purpose of this study is to determine the optimal stimulation intensity required for derivation of Br(E)-MsEP waveforms at baseline in pediatric spinal surgery., Patients and Methods: The subjects were 85 pediatric patients (4-15 years old, mean age at surgery: 11.1 years old) who were treated with spinal surgery using a posterior only approach under Br(E)-MsEP monitoring. The main diagnoses were adolescent idiopathic scoliosis (n = 44), syndromic and neuromuscular scoliosis (n = 23), and congenital scoliosis (n = 12). A total of 1513 muscles in the lower extremities were chosen for monitoring., Results: A baseline waveform was obtained in all 85 cases and baseline Br(E)-MsEP responses were obtained from 1437/1513 muscles (95%). The mean stimulation intensity for baseline waveform derivation was 156.4 mA (range: 100-200 mA), and the stimulation intensity was significantly correlated with age (p < 0.05). The mean stimulation intensities were 129 ± 12, 138 ± 20, and 167 ± 25 mA for children <5, 6 to 10, and 11 to 15 years old, respectively., Conclusion: There are no criteria for derivation of Br(E)-MsEP waveforms in pediatric patients undergoing spinal surgery. The stimulation intensity increased with age, and starting at a lower stimulation strength than that used in adults is appropriate for younger children., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Study Design: This was a cross-sectional electrophysiological study., Objective: The main objective of this study was to evaluate electrophysiological activation of lumbar multifidus (LM) and erector spinae (ES) in elderly patients with chronic low back pain (CLBP) classified by LBP developmental mechanisms., Summary of Background Data: Local and global muscles that function independently for stabilization and moment production, respectively, are crucial for stability and mobility of the lumbar spine. There is little research conducted on the electrophysiological functions of the LM as a local muscle and the ES as a global muscle in the lumbar spine, and their interrelation in patients with CLBP., Materials and Methods: Elderly patients aged 65 years and above, with CLBP were assigned into motion-induced LBP (49 patients) or walking-induced LBP cohorts (57 patients), and compared with a control group (53 patients without LBP). Electrophysiological activation of the LM and ES was performed using surface electromyography (EMG) and mechanomyography (MMG) during lumbar extension and flexion. Electromechanical coupling efficiency (EMCE) was calculated using the ratio of MMG to EMG., Results: EMG and MMG amplitudes in the LM tended to be lower in patients with LBP than in the control group. EMG and MMG amplitudes in the ES tended to be higher in patients with LBP than in the control group. EMCE was significantly higher in both the LM and ES during lumbar extension and flexion in the motion-induced LBP cohort than in the walking-induced LBP cohort; however, ES dominance was seen in the motion-induced LBP cohort, both in lumbar extension and flexion, according to the EMCE ratio., Conclusions: ES dominance was seen in the motion-induced LBP cohort, both in lumbar extension and flexion, according to the EMCE ratio. Subgrouping of patients according to the induction of LBP seems to be important for CLBP treatment, and the electrophysiological assessment for the deep and superficial back muscles may be beneficial to elderly patients.

Objectives: Sarcopenia and osteoporosis affects activities of daily living and quality of elderly people. However, little is known about its impact on elderly locomotor diseases, such as osteoporotic vertebral fracture (OVF). There is no report investigating the influence of both sarcopenia and osteoporosis on outcomes of OVF. This study aimed to evaluate the clinical outcomes of OVF in elderly patients from sarcopenic perspectives., Methods: This prospective study was conducted with 396 patients, aged 65 years or more, hospitalized for the treatment of OVF (mean age, 81.9 ± 7.1 years; 111 males, 285 females). The primary outcome was the Japanese Orthopaedic Association (JOA) score for lumbar disease (at first visit, hospital discharge, and 1 year after treatment) and Barthel index (at the same time and before hospitalization). The second outcome was living place after discharge. Susceptibility to sarcopenia and osteoporosis were evaluated and clinical results of conservative treatment were compared., Results: Sarcopenia significantly affected Barthel index at first visit and discharge. Sarcopenia patients had significantly higher rate for discharge to nursing home and living in nursing home after 1 year than patients without sarcopenia. Osteoporosis significantly affected the JOA score at the first visit and the Barthel index before hospitalization, at the first visit, discharge, and after 1 year. Osteoporosis did not affect the living place at discharge and after 1 year., Conclusions: Sarcopenia and osteoporosis affected outcomes of conservative treatment for OVF; moreover, sarcopenia affected the living place of OVF patients at discharge and after 1 year.

Decompressive laminoplasty with spinous process osteotomy (LSPO) was developed as a less invasive procedure for lumbar decompression by Weiner et al. There are few reports extensively highlighting the surgical outcomes of LSPO. The purpose of this study was to evaluate the surgical outcomes of LSPO for lumbar spinal stenosis (LSS). In total, 23 patients with LSS were studied. All patients were followed up for more than 2 years. The Japanese Orthopedic Association (JOA) scores, the recovery rate (RR) of JOA scores, Visual analog scale (VAS) scores, responses to the JOA Back Pain Evaluation Questionnaire (JOABPEQ), sagittal alignment and segmental motion following LSPO were assessed preoperatively and 2 years postoperatively. Postoperative paravertebral muscle atrophy and bone union rates between the spinous process and the residual laminae were assessed. Preoperative and 2-year postoperative JOA scores were 13.0 points and 24.7 points, respectively (p<0.001). With respect to JOABPEQ, significant improvements were observed in pain-related disorders (p<0.05), walking ability (p<0.01), social life function (p<0.05), and mental health (p<0.05) dimensions. There were no significant differences between preoperative and 2-year postoperative sagittal alignment and range of motion. The degree of the paravertebral muscle atrophy at 2 years postoperatively was 23.0 % at spread side and 9.6 % at nonspread side (p<0.01). The fusion rate of the spinous process with the arcus vertebrae was 87%. This result reveals that LSPO could acquire the reconstruction of posterior supporting structures. We demonstrated that LSPO could be a one of the surgical options for LSS.

Objectives: The prevalence of chronic low back pain (CLBP) increases with age and several mechanisms are involved in the development of CLBP, including osteoporosis; however, no associations with sarcopenia have yet been identified., Methods: In total, 100 patients with CLBP and 560 patients without CLBP (nCLBP) aged over 65 years were studied. Skeletal muscle mass index (SMI) and percentage of body fat were evaluated using whole-body dual-energy X-ray absorptiometry. Sarcopenia was diagnosed when the relative SMI was more than 2 standard deviations below the mean in young adults. Thus, the cutoff value for sarcopenia was defined according to Sanada's Japanese population data. Paraspinal muscle cross-sectional areas of the lumbar multifidus and the erector spinae muscles were calculated using magnetic resonance imaging., Results: Forty patients (40.0%) from the CLBP group and 149 (26.6%) from the nCLBP group met the criteria of sarcopenia. SMI was significantly lower and the body fat ratio was significantly higher in the CLBP group compared with the nCLBP group. Sarcopenic obesity was significantly observed in the CLBP group. Lumbar multifidus and the erector spinae muscle cross sectional area were significantly lower in the CLBP group., Conclusions: Elderly patients with CLBP have significantly lower skeletal muscle mass, and age-related mechanisms in sarcopenia are considered to be associated with chronic pain. Therapeutic procedures that are used to treat elderly aging muscle, including muscle strengthening and performance training, can possibly be a treatment for or used to prevent elderly CLBP.