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Abstract This study aims to investigate the influence of lumbar spine disorders on the development of asymmetric hallux valgus (HV). Data from the fifth survey of the Osteoarthritis/Osteoporosis Against Disability (ROAD) study, a nationwide prospective study in Japan, were analyzed. HV severity was categorized into 4 grades based on the radiographic HV angle, and asymmetric HV was defined as having at least one HV on either side, with a difference of two or more severity grades between the left and right. Controls were matched from both the Normal group (without HV on both sides) and the Symmetric group (HV on at least one side with a difference of one or less severity grades). Univariate analysis assessed lumbar conditions, and multinomial logistic regression analysis explored the association between lumbar spine disorders and asymmetric HV. Among 1997 participants, 27 had asymmetric HV. Univariate analysis revealed a higher incidence of L5 spondylolisthesis and scoliosis in the Asymmetric group. Multinomial logistic regression analysis revealed that scoliosis independently increased the likelihood of asymmetrical HV (Odds ratio [OR] = 3.586, 95%Confidence interval [CI] 1.111–11.582), but showed no significant impact on symmetrical HV (OR 0.910, 95% CI 0.355–2.334). Asymmetric HV is rare but may be associated with lumbar spine disorders, particularly scoliosis.

Objective: Considering the joint space width and osteophyte area (OPA) of the knee joints of Japanese adults, this study elucidated the ten-year trends in medial minimum joint space width (mJSW) and OPA using data of two independent cohorts from a population-based cohort study. Methods: The baseline survey of the Research on Osteoarthritis/Osteoporosis Against Disability study was conducted from 2005 to 2007; 2975 participants (1041 men, 1934 women) completed all knee osteoarthritis (OA) examinations. The fourth survey was performed from 2015 to 2016; distinct 2445 participants (764 men, 1681 women) completed identical examinations. The medial mJSW and medial tibial OPA were measured bilaterally using an automated system. Results: The mean medial mJSW (standard deviation) was 3.22 (0.96) mm and 2.65 (0.95) mm at baseline and 3.81 (1.20) mm and 3.13 (1.15) mm in the fourth survey for men and women, respectively. The mean medial mJSW in the fourth survey was significantly greater in both men and women in all age groups than at baseline (p ​

Abstract Femoroacetabular impingement has increasingly been recognized as a cause of primary hip osteoarthritis; however, its epidemiological indications remain unclear. We aimed to clarify the epidemiological indications and factors associated with cam deformity in a large-scale population-based cohort in Japan. Overall, 1480 participants (2960 hips) (491 men, 989 women; mean age, 65.3 years) analyzed in the third survey of the Research on Osteoarthritis/Osteoporosis Against Disability study were included. The α angle and spinopelvic parameters (lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence) were radiographically measured. Cam deformity was defined as α angle ≥ 60°. Overall, the cam deformity prevalence was 147/2960 (5.0%). Cam deformity prevalence tended to increase with age; in the univariate analysis, a higher percentage of men was observed in the group with cam deformity than in the group without it. No relationship was observed between cam deformity and hip pain. Factors associated with α angle were examined via multiple regression analysis for each gender; α angle was significantly associated with age and BMI in each gender. The α angle and PT were correlated in women. Thus, α angle and cam deformity prevalence increase with age in Japanese individuals. Accordingly, cam deformity can be considered a developmental disease.

Abstract The molecular pathophysiology underlying lumbar spondylosis development remains unclear. To identify genetic factors associated with lumbar spondylosis, we conducted a genome-wide association study using 83 severe lumbar spondylosis cases and 182 healthy controls and identified 65 candidate disease-associated single nucleotide polymorphisms (SNPs). Replication analysis in 510 case and 911 control subjects from five independent Japanese cohorts identified rs2054564, located in intron 7 of ADAMTS17, as a disease-associated SNP with a genome-wide significance threshold (P = 1.17 × 10–11, odds ratio = 1.92). This association was significant even after adjustment of age, sex, and body mass index (P = 7.52 × 10–11). A replication study in a Korean cohort, including 123 case and 319 control subjects, also verified the significant association of this SNP with severe lumbar spondylosis. Immunohistochemistry revealed that fibrillin-1 (FBN1) and ADAMTS17 were co-expressed in the annulus fibrosus of intervertebral discs (IVDs). ADAMTS17 overexpression in MG63 cells promoted extracellular microfibrils biogenesis, suggesting the potential role of ADAMTS17 in IVD function through interaction with fibrillin fibers. Finally, we provided evidence of FBN1 involvement in IVD function by showing that lumbar IVDs in patients with Marfan syndrome, caused by heterozygous FBN1 gene mutation, were significantly more degenerated. We identified a common SNP variant, located in ADAMTS17, associated with susceptibility to lumbar spondylosis and demonstrated the potential role of the ADAMTS17-fibrillin network in IVDs in lumbar spondylosis development.

Abstract The relationship between acetabular dysplasia and spino-pelvic alignment remains unclear. The aim of this study was to clarify the association between acetabular dysplasia and spino-pelvic alignment, based on a large-scale population-based cohort in Japan. From the third survey of the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study, 1,481 participants (491 men and 990 women; mean age, 65.3 years) were analyzed. Center-edge (CE) angle and spino-pelvic parameters (lumbar lordosis, LL; sacral slope, SS; pelvic tilt, PT; pelvic incidence, PI) were measured radiographically. Acetabular dysplasia was defined as a CE angle

Abstract Background There has been a paucity of literature revealing the discrepancy between self-recognition about hallux valgus (HV) and radiographically-evaluated foot configuration. Knowing this discrepancy will help to make a comparative review of the findings of previous literatures about epidemiological studies about the prevalence of HV. Questions/purposes (1) Is there a discrepancy between radiographically-assessed and self-recognized HV in the general population? (2) What factors affect the self-recognition of HV in the general population? Methods The fifth survey of the Research on Osteoarthritis/Osteoporosis against Disability study involved 1996 participants who had undergone anterior-posterior radiography of bilateral feet and answered a simple dichotomous questionnaire on self-recognition of HV. Measurements of the HV angle (HVA), interphalangeal angle of the hallux (IPA), and intermetatarsal angle between 1st and 2nd metatarsals (IMA) were performed using radiographs. Radiographic diagnosis of HV was done using the definition of hallux valgus angle of 20° or more. After univariate comparison of the participant backgrounds and radiographic measurements between participants with or without self-recognition of HV, multivariable logistic regression analysis was conducted in order to reveal independent factors affecting self-recognition. Results Significant difference was found between the prevalence of radiographically-assessed and self-recognized HV (29.8% vs. 16.5%, p

Abstract Studies have suggested a relationship between sagittal spinal malalignment and low back pain (LBP). The current study investigated the relationship of spinal alignment with LBP and physical performance in 1491 individuals who attended the second follow-up visit of the Wakayama Spine Study. The sagittal vertical axis at C7 (C7 SVA) was measured by a spine surgeon. The occurrence of LBP within one month, pain intensity, Oswestry Disability Index (ODI), and physical performance (grip strength, 6-m walking time, chair stand test, one-leg standing test) were also evaluated. LBP in the previous month was determined using ODI, and indicators of physical performance were measured. The mean C7 SVA was 11.0 ± 42.7 mm and was significantly greater in older participants (p

Objective: The trends in prevalence of hip osteoarthritis (OA) over a 10-year period among Japanese men and women were investigated using the data from the Research on Osteoarthritis/osteoporosis Against Disability study. Design: We analyzed the data of 2924 baseline survey participants (1026 men, 1898 women) aged 40–89 years (mean 70.7 years) residing in urban, mountainous, and coastal communities who were surveyed in 2005–2007. We compared these data with that of 2347 participants (726 men, 1621 women) aged 40–89 years (mean 69.2 years) from the fourth survey in 2015–2016. The fourth survey invited participants to attend follow-ups for baseline survey and recruited new participants. After scoring the radiographs using the Kellgren/Lawrence (K/L) grading system, hip OA was defined as a K/L score ≥2. Results: The prevalence of radiographic hip OA was 18.4% and 14.4% in the baseline survey, and 16.0% and 10.7% in the fourth survey among men and women, respectively. Among the participants aged 40–69 years, the prevalence of radiographic hip OA was significantly lower during the fourth survey than during the baseline survey. Whereas, among elderly men aged 70–79 years, radiographic hip OA was significantly less prevalent during the baseline survey than during the fourth survey. From the logistic regression analysis results, radiographic hip OA was significantly less prevalent during the fourth survey than during the baseline survey (odds ratio: 0.55, 95% confidence interval: 0.46–0.65). Conclusion: At a 10-year interval, the prevalence of radiographic hip OA shows an improving trend.

Abstract Background Walking speed is an important measure associated with health outcomes in older individuals, such as dependency and death. This study aimed to examine whether the walking speed of community-dwelling older adults varies between time periods within a day, as measured outdoors in daily life. We aimed to determine the types of walking speed variations and examine the factors associated with them. Methods Daily life outdoor walking speed was measured in 92 participants (average age 71.9 years±5.64) using a GPS smartphone app for 1 month. Average walking speeds for five time periods were analyzed with a linear mixed model. Intra-day walking speed variation patterns were classified by latent class analysis. Factors associated with the class were identified by logistic regression analysis. Results A statistically significant difference in average walking speed was found between early morning (1.33 m/s), and afternoon (1.27 m/s) and evening (1.26 m/s) (p

Abstract Pistol grip deformity (PGD) may be the main factor in femoroacetabular impingement development. This study aimed to clarify the epidemiological indices and factors related to PGD in Japanese people. This population-based cohort study included 1575 local Japanese residents. PGD, center edge angle, and joint space width were measured radiographically. We investigated the relationship between PGD and spino-pelvic parameters. Factors associated with PGD were examined using multiple logistic regression analysis, with the presence/absence of PGD as an objective variable, and sex, age, body mass index (BMI), and the presence/absence of hip pain or spino-pelvic parameters as explanatory variables. In the entire cohort, 4.9% (10.6% men, 2.1% women) had PGD on at least one side. A trend was observed between PGD and increasing age in both men and women (men: p

Daily consumption of eggplant powder containing 2.3 mg acetylcholine (ACh) is known to alleviate hypertension and improve mental status. However, eggplant powder used in clinical trials also contains the antihypertensive compound γ-aminobutyric acid (GABA). Although our previous study indicated that the main antihypertensive compound in eggplant is ACh, given that GABA amounts in eggplant do not reach the effective dosage, the effects of GABA on the antihypertensive effect of eggplant remain unclear. It is necessary to establish whether there is a synergistic effect between GABA and ACh and whether GABA in eggplant exerts antihypertensive effects. Consequently, here we sought to evaluate the effects of GABA on the antihypertensive effects of eggplant. We used a probability sum (q) test to investigate the combined effects of ACh and GABA and prepared eggplant powder with very low ACh content for oral administration in animals. ACh and GABA exhibited additive effects but the GABA content in eggplants was not sufficient to promote a hypotensive effect. In conclusion, ACh is the main component associated with the antihypertensive effects of eggplant but GABA within eggplants has a minimal effect in this regard. Thus, compared with GABA, ACh could be a more effective functional food constituent for lowering blood pressure.

Objectives This prospective study aimed to determine the association between radiographic lumbar spinal stenosis (LSS) and the quality of life (QOL) in the general Japanese population. Methods The severity of radiographic LSS was qualitatively graded on axial magnetic resonance images as follows: no stenosis, mild stenosis with ≤1/3 narrowing, moderate stenosis with a narrowing between 1/3 and 2/3, and severe stenosis with > 2/3 narrowing. Patients less than 40 years of age and those who had undergone previous lumbar spine surgery were excluded from the study. The Oswestry Disability Index (ODI), which includes 10 sections, was used to assess the QOL. One-way analysis of variance was performed to determine the statistical relationship between radiographic LSS and ODI. Further, logistic regression analysis adjusted for gender, age, and body mass index was performed to detect the relationship. Results Complete data were available for 907 patients (300 men and 607 women; mean age, 67.3±12.4 years). The prevalence of severe, moderate, and non-mild/non-radiographic were 30%, 48%, and 22%, respectively. In addition, the mean values of ODI in each group were 12.9%, 13.1%, and 11.7%, respectively, and there was no statistically significant difference between the three groups in logistic analysis (P = 0.55). In addition, no significant differences in any section of the ODI were observed among the groups. However, severe radiographic LSS was associated with low back pain in the "severe" group as determined by logistic analysis adjusted for gender, age, and body mass index (odds ratio: 1.53, confidence interval: 1.13–2.07) compared with the non-severe group. Conclusion In this general population study, severe radiographic LSS was associated with low back pain (LBP), but did not affect ODI.

We describe the effect of enzyme (protease M) addition on reducing turbidity and self-flocculating of solid particles (mainly starch) in the drainage water after boiling a type of wheat-flour noodle (DWBWN) without the addition of flocculants to decrease waste-water-treatment costs to reuse the content of such drainage water. Reduction in turbidity and flocculation/sedimentation of solid particles in DWBWN are highly dependent on enzyme addition/concentration and pH level. We conducted experiments to determine the effect of adding protease to DWBWN. A decrease in turbidity of over 90% was observed in protease-added DWBWN. A decrease in total carbon (TC) of approximately 40% in the clear upper portion of DWBNW was also observed after protease addition and sedimentation. This TC was almost the same as with the supernatant of stock DWBWN without protease addition after centrifuging. Adding protease to DWBWN decreased the protein content, strengthened the negative surface electron charge, and decreased the isoelectric point of the solid particles. To determine the dissociation of phosphate ions in relation to reduction in turbidity and flocculation/sedimentation of solid particles, these processes were observed at the same pH level of a specific dissociate form of phosphorylated (mono-ester phosphates) starch in solid particles. This suggest that the strong negative zeta-potential of solid particles formed in DWBWN reduce turbidity, and flocculation/sedimentation of solid particles depends on the electrostatic properties.

The authors wish to make a correction to the published version of their paper [...]

The authors wish to make a correction to the published version of their paper [...]

Abstract Background Mobility decrease is reportedly age-dependent in community dwelling elderly, and a major factor of disability in the geriatric population. The purpose of this study is to examine whether mobility decrease, as assessed using a set of tests, is similarly age-dependent in elderly adults who already have disability. Methods One hundred thirty-five community-dwelling elderly (54 men, 81 women) with disability and 1469 independent community dwellers (1009 men, 460 women) were analyzed. Disability was defined having a certified need for care under the long-term care insurance system in Japan. Lower extremity mobility decrease was quantified using the Locomotive Syndrome Risk Test, which comprises the two-step test, stand-up test, and 25-Question Geriatric Locomotive Function Scale (GLFS-25). Results Multivariable regression analyses indicated no age-related decrease in the three test scores among elderly with disability, whereas these scores all decreased with age among independent community dwellers. All the test scores decreased as care level increased. Conclusions Mobility decrease among elderly adults with disability is unrelated to age. However, the severity of care level is associated with mobility decrease.

Geniposidic acid (GEA), the main ingredient of several medicinal herbs, has pharmacological effects on hypertension, inflammation, diabetes, atherosclerosis, and cancer. The current study evaluated the mechanism underlying the hypotensive effects of a single oral administration of 100 mg GEA/kg in male spontaneously hypertensive rats. Blood pressure was significantly reduced at 6 h post GEA treatment, as compared with control rats. Plasma levels of atrial natriuretic peptide (ANP) were also upregulated by GEA, indicating that its anti-hypertensive activity involved enhanced ANP secretion from cardiomyocytes. This could reflect GEA-mediated activation of glucagon-like peptide-1 (GLP-1) receptors on atrial cardiomyocytes. Plasma GLP-1 levels were not significantly altered by GEA. This study is the first to report that orally administered GEA produces beneficial effects on heart tissue by increasing plasma ANP levels, although GEA is a known GLP-1 receptor agonist. These effects could underlie the broad physiological effects of medicinal herbs containing GEA.

Acetylcholine (ACh) is a novel antihypertensive food component. Here, we demonstrate the differential effects of oral ACh on high and normal blood pressure in rats. Spontaneously hypertensive rats (SHRs) and Wistar–Kyoto (WKY) rats were administered ACh orally. The blood pressure and heart rate of SHRs were significantly lowered with ACh doses of 10−5 and 10−3 mol/kg body weight (b.w.), and the urinary catecholamine levels were significantly decreased with 10−3 mol/kg b.w. In contrast, oral ACh administration had no effect on WKY rats. This difference was likely caused by differences in sympathetic nervous activity and the baroreflex between strains. Comparison of gene sequences between the two strains revealed Chga mutations, suggesting that changes in the expression of chromogranin A might be involved in the baroreflex in SHRs. Oral ACh had an antihypertensive effect under hypertension but not normotension, indicating that this may be used safely to prevent hypertension.

Eggplants are rich in acetylcholine (ACh), which can improve high blood pressure and negative psychological states. However, information on ACh content in individual parts of eggplant and the changes in ACh content during eggplant development is limited. Therefore, we investigated the ACh content in various parts of eggplant, namely, the leaf, root, bud, calyx, ovary, fruit, exocarp, mesocarp, partition, placenta, core, fruit base, fruit center, and fruit top in 26 eggplant varieties. Furthermore, the effect of heat treatment on ACh content was investigated. The ACh content significantly differed among the eggplant varieties. The difference between the varieties with the highest and lowest ACh content was 100-fold (Tosataka: 11 ± 0.61 mg/100 g fresh weight (FW) and Ryoma: 0.11 ± 0.046 mg/100 g FW, respectively). Eggplant fruit presented the highest ACh content (4.8 mg/100 g FW); it was three times higher than that in other parts combined (1.6 mg/100 g FW). The root contained the lowest ACh content among all parts. The ACh content increased with growth after flowering. The ACh content in the fruit 1.5 months after flowering was 400 times that in the ovary. ACh was uniformly distributed in eggplant flesh. Heat treatment did not cause ACh loss in eggplant. Thus, eggplant is an excellent raw material for functional foods.

Choline is an essential nutrient and choline esters are potential functional food ingredients. We aimed to analyze the choline compound content in 19 cultivated fruits and vegetables and identify those with high acetylcholine content. We utilized liquid chromatography with tandem mass spectrometry to quantify choline compounds according to the standard addition method. Choline compounds were extracted from lyophilized fruit/vegetable powders and passed through a weakly acidic cation exchange column, resulting in a concentrated solution of choline compounds. The compounds were separated on a pentafluorophenyl column and then analyzed using positive mode electrospray ionization. Results showed that acetylcholine and choline were the primary choline compounds in all agricultural products; propionylcholine and butyrylcholine were minor compounds in 17 and 12 agricultural products, respectively. The acetylcholine concentration was 2900-fold higher in eggplants (6.12 mg/100 g fresh weight [FW]) than in other agricultural products (average: 2.11 × 10−3 mg/100 g FW). The concentration of acetylcholine differed only 2-fold between eggplant cultivars with the highest (′Higomurasaki′: 5.53 mg/100 g FW) and lowest (′Onaga nasu′: 2.79 mg/100 g FW) concentrations. The half-life of acetylcholine in eggplants was approximately 16 days, which is longer the shelf life of eggplants. Thus, eggplants can be a good source of acetylcholine.

Eucommia ulmoides Oliv. leaf is a traditional Chinese antihypertensive and antidiabetic medicine. We examined the effects of chronic Eucommia leaf extract (ELE) administration on artery function and morphology in spontaneously hypertensive rats (SHRs). ELE was orally administered via normal diet ad libitum to six-week-old male SHRs at a concentration of 5% for seven weeks. Acetylcholine (ACh)-induced endothelium-dependent relaxation, sodium nitroprusside (SNP)-induced endothelium-independent relaxation, plasma nitric oxide (NO) levels, and media thickness were assessed. ELE significantly improved ACh-induced aortic endothelium-dependent relaxation but did not affect SNP-induced endothelium-independent relaxation in the SHRs, as compared to the animals receiving normal diet. Plasma NO levels and media thickness were significantly increased and decreased, respectively, in the ELE-treated SHRs. Therefore, long-term ELE administration may effectively improve vascular function by increasing plasma NO levels and bioavailability, and by preventing vascular hypertrophy in the SHR aorta.

This study aimed to establish sex- and age-dependent distributions of the cross sectional area and fatty infiltration ratio of paraspinal muscles, and to examine the correlation between paraspinal muscle degeneration and low back pain in the Japanese population.In this cross-sectional study, data from 796 participants (241 men, 555 women; mean age, 63.5 years) were analyzed. The measurement of the cross sectional area and fatty infiltration ratio of the erector spinae and multifidus from the level of T12/L1 to L4/5 and psoas major at the level of T12/L1 was performed using axial T2-weighted magnetic resonance imaging. Multivariate logistic regression analysis was used to estimate the association between fatty infiltration of the paraspinal muscles and the prevalence of low back pain.The cross sectional area was larger in men than women, and tended to decrease with age, with the exception of the erector spinae at T12/L1 and L1/2 in women. The fatty infiltration ratio was lower in men than women, except for multifidus at T12/L1 in 70-79 year-olds and psoas major in those less than 50 years-old, and tended to increase with age. Logistic regression analysis adjusted for age, sex, and body mass index showed that the fatty infiltration ratio of the erector spinae at L1/2 and L2/3 was significantly associated with low back pain (L1/2 level: odds ratio, 1.05; 95% confidence interval, 1.005-1.104; L2/3 level: odds ratio, 1.05; 95% confidence interval, 1.001-1.113).This study measured the cross sectional area and fatty infiltration ratio of paraspinal muscles in the Japanese population using magnetic resonance imaging, and demonstrated that the fatty infiltration ratio of the erector spinae in the upper lumbar spine was significantly associated with the presence of low back pain. The measurements could be used as reference values, which are important for future comparative studies.

To establish the normal values of spino-pelvic alignment and to clarify the effect of age-related changes using large, community-based cohorts.In this study, data from 1461 participants (466 men, 995 women) were analyzed. On lateral standing radiographs, the following parameters were measured: thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and C7 sagittal vertical axis (SVA). All values are expressed as the mean±standard deviation. The Spearman rank correlation coefficient was used to examine correlations between variables of spino-pelvic parameters. Finally, we analyzed the relationship between age and spino-pelvic parameters. Therefore, we entered values for the body mass index (BMI), SVA, TK, and PI-LL into a multiple regression model to adjust for potential confounding factors.The SVA, TK, and PT increased with age, and LL decreased with age. Regarding sex differences, the TK was statistically significantly larger in men than in women, and LL, PT, and PI were statistically significantly smaller in men than in women. Correlation coefficients between the SVA and TK, between the SVA and PI-LL, and between TK and PI-LL were none, strong, and weak, respectively. Results of multiple regression analysis between age and spino-pelvic parameters showed that the standardized partial regression coefficients for the SVA, TK, and PI-LL were 0.17, 0.30, and 0.23, respectively, in men and 0.29, 0.32, and 0.23, respectively, in women.We found that all parameters were significantly associated with age in men and women. The SVA, TK, and PT increased with age, and LL decreased with age. Results of multiple regression analysis also demonstrated that the SVA, TK, and PI-LL are related to age. Indeed, the PI-LL value increased with age. In this study, a more excessive PI-LL mismatch was shown, indicating an increased risk of spinal malalignment. Differences in the absolute values of spino-pelvic parameters in each sex were small yet statistically significant. Thus, further study should be performed to corroborate this finding.

A practical antihypertensive food, neo-fermented buckwheat sprouts (neo-FBS), was produced from buckwheat sprouts by lactic fermentation. The neo-FBS preparation gave a 12.7 times better yield and had a 10 times more potent blood-pressure-lowering (BPL) effect than conventionally prepared products. Neo-FBS decreased both systolic and diastolic blood pressure in spontaneously hypertensive rats (SHRs) at a dose of 0.010 mg/kg, an effect comparable to 1.0 mg/kg captopril, an anti-hypertensive drug. Orally administered neo-FBS (10 mg/kg) significantly decreased angiotensin I-converting enzyme (ACE) activity in the lung, thoracic aorta, heart, kidney, and liver of SHRs. Neo-FBS had a detectable relaxing effect on a phenylephrine-precontracted thoracic aorta in SHRs at 0.5 μg/mL and the EC50 value was 8.3 ± 1.4 μg/mL. The ACE inhibition and vasorelaxation activities were found to be responsible for the excellent BPL effect of neo-FBS. As SHR is a standard model for human hypertension, neo-FBS may also have BPL effects in human patients.

INTRODUCTION:High intensity zones (HIZ) of the lumbar spine are a phenotype of the intervertebral disc noted on MRI whose clinical relevance has been debated. Traditionally, T2-weighted (T2W) magnetic resonance imaging (MRI) has been utilized to identify HIZ of lumbar discs. However, controversy exists with regards to HIZ morphology, topography, and association with other MRI spinal phenotypes. Moreover, classification of HIZ has not been thoroughly defined in the past and the use of additional imaging parameters (e.g. T1W MRI) to assist in defining this phenotype has not been addressed. MATERIALS AND METHODS:A cross-sectional study of 814 (69.8% females) subjects with mean age of 63.6 years from a homogenous Japanese population was performed. T2W and T1W sagittal 1.5T MRI was obtained on all subjects to assess HIZ from L1-S1. We created a morphological and topographical HIZ classification based on disc level, shape type (round, fissure, vertical, rim, and enlarged), location within the disc (posterior, anterior), and signal type on T1W MRI (low, high and iso intensity) in comparison to the typical high intensity on T2W MRI. RESULTS:HIZ was noted in 38.0% of subjects. Of these, the prevalence of posterior, anterior, and both posterior/anterior HIZ in the overall lumbar spine were 47.3%, 42.4%, and 10.4%, respectively. Posterior HIZ was most common, occurring at L4/5 (32.5%) and L5/S1 (47.0%), whereas anterior HIZ was most common at L3/4 (41.8%). T1W iso-intensity type of HIZ was most prevalent (71.8%), followed by T1W high-intensity (21.4%) and T1W low-intensity (6.8%). Of all discs, round types were most prevalent (anterior: 3.6%, posterior: 3.7%) followed by vertical type (posterior: 1.6%). At all affected levels, there was a significant association between HIZ and disc degeneration, disc bulge/protrusion and Modic type II (p

OBJECTIVE:The purpose of this study was to evaluate the relations between the degree of encroachment, measured as the cross-sectional area of the dural sac, and low back pain in a large population. METHODS:In this cross-sectional study, data from 802 participants (247 men, 555 women; mean age, 63.5 years) were analyzed. The measurement of the cross-sectional area of the dural sac from the level of L1/2 to L4/5 was taken using axial T2-weighted images. The minimum cross-sectional area was defined as the cross-sectional area of the dural sac at the most constricted level in the examined spine. Participants were divided into three groups according to minimum cross-sectional area measurement quartiles (less than the first quartile, between the first and third quartiles, and greater than the third quartile). A multivariate logistic regression analysis was used to estimate the association between the minimum cross-sectional area and the prevalence of low back pain. RESULTS:The mean minimum cross-sectional area was 117.3 mm2 (men: 114.4 mm2; women: 118.6 mm2). A logistic regression analysis adjusted for age, sex, body mass index, and other confounding factors, including disc degeneration, showed that a narrow minimum cross-sectional area (smaller than the first quartile) was significantly associated with low back pain (odds ratio, 1.78; 95% confidence interval, 1.13-2.80 compared to the wide minimum cross-sectional area group: minimum cross-sectional area greater than the third quartile measured). CONCLUSION:This study showed that a narrow dural sac cross-sectional area was significantly associated with the presence of low back pain after adjustment for age, sex, and body mass index. Further investigations that include additional radiographic findings and psychological factors will continue to elucidate the causes of low back pain.

The Zurich Claudication Questionnaire (ZCQ) is a self-administered measure to evaluate symptom severity, physical function, and surgery satisfaction in lumbar spinal stenosis (LSS). The purpose of this study is to assess the psychometric properties of the Japanese ZCQ in LSS patients.LSS patients who are scheduled to undergo surgery were recruited from 12 facilities. Responses to several questionnaires, including the Japanese ZCQ; the visual analogue scale (VAS) to evaluate the degree of pain in the buttocks/legs, numbness in the buttocks/legs, and low back pain; the Oswestry Disability Index (ODI); and the SF-36v2, were collected before surgery and again 3 months after surgery (the post-surgery ZCQ was administered twice for test-retest reliability). For reliability, test-retest reliability was evaluated using the intra-class coefficient (ICC) and internal consistency was evaluated using Cronbach's alpha coefficient. Concurrent validity was assessed using Spearman's correlation coefficients between the Japanese ZCQ and other questionnaires. Effect size (ES) and standard response mean were calculated for responsiveness. All analyses were performed individually for the Japanese ZCQ symptom, function, and satisfaction domains.Data from 180 LSS patients were used in this analysis. The ICCs were 0.81, 0.89, and 0.88 and Cronbach's alpha coefficients were 0.78, 0.84, and 0.92 for the Japanese ZCQ symptom, function, and satisfaction domains, respectively. Regarding the concurrent validity, strong correlations (±0.5) were demonstrated between the Japanese ZCQ domains and the VAS leg pain, ODI, and SF-36v2 physical functioning or bodily pain, whereas correlations were approximately 0.3 in scales measuring other symptoms that are less related to symptom, function, or satisfaction domains. ESs showed high values for the ZCQ symptom and function domains (-1.73 for both).These psychometric assessments demonstrate that the Japanese ZCQ is a psychometrically reliable and valid measure in LSS. The Japanese ZCQ can evaluate both multi-dimensional aspects and the level of surgery satisfaction.

The objective of the present study was to examine the associations between metabolic syndrome (MS) components, such as overweight (OW), hypertension (HT), dyslipidemia (DL), and impaired glucose tolerance (IGT), and intervertebral disc degeneration (DD).The present study included 928 participants (308 men, 620 women) of the 1,011 participants in the Wakayama Spine Study. DD on magnetic resonance imaging was classified according to the Pfirrmann system. OW, HT, DL, and IGT were assessed using the criteria of the Examination Committee of Criteria for MS in Japan.Multivariable logistic regression analysis revealed that OW was significantly associated with cervical, thoracic, and lumbar DD (cervical: odds ratio [OR], 1.28; 95% confidence interval [CI], 0.92-1.78; thoracic: OR, 1.75; 95% CI, 1.24-2.51; lumbar: OR, 1.87; 95% CI, 1.06-3.48). HT and IGT were significantly associated with thoracic DD (HT: OR, 1.54; 95% CI, 1.09-2.18; IGT: OR, 1.65; 95% CI, 1.12-2.48). Furthermore, subjects with 1 or more MS components had a higher OR for thoracic DD compared with those without MS components (vs. no component; 1 component: OR, 1.58; 95% CI, 1.03-2.42; 2 components: OR, 2.60; 95% CI, 1.62-4.20; ≥3 components: OR, 2.62; 95% CI, 1.42-5.00).MS components were significantly associated with thoracic DD. Furthermore, accumulation of MS components significantly increased the OR for thoracic DD. These findings support the need for further studies of the effects of metabolic abnormality on DD.