Background: The Global Alignment and Proportion score has been validated in surgical cohorts as a predictor of mechanical complications in adult spine deformity, but its significance in the general population is poorly understood. We examined the association of the Global Alignment and Proportion score categories with locomotor syndrome and health-related quality of life in community-dwelling middle-aged and older adults to clarify the role of proportionality of sagittal alignment in musculoskeletal function and quality of life. Methods: Residents of Hokkaido, Japan, who underwent musculoskeletal health screening in 2019 were included in this retrospective cross-sectional study. Based on their Global Alignment and Proportion score classification, participants were divided into three groups: proportioned, moderately disproportioned (moderate), and severely disproportioned (severe). We compared participants' background, bone mineral density, exercise tests, pain levels, locomotor syndrome stage, and Short Form 36-Item Health Survey score data. Results: The mean age of the 217 participants was 64.0±9.5 years; 127 were female. The mean Global Alignment and Proportion score was 6.1±3.4 points, and the proportioned, moderate, and severe groups comprised 27, 106, and 84 participants, respectively. A statistically significant trend was observed in which the number of participants at high risk for locomotive syndrome increased as the Global Alignment and Proportion risk state worsened. In the Short Form 36 Health Survey domains of bodily pain and physical component summary scores, statistically significant trends toward lower scores were observed across groups with worsening Global Alignment and Proportion risk status. Conclusions: We identified an association between poorer Global Alignment and Proportion scores and the presence of locomotive syndrome, as well as lower health-related quality of life, among middle-aged and older adults. These findings suggest that the Global Alignment and Proportion score may be a useful indicator for characterizing musculoskeletal alignment in clinical and public health fields.
Introduction:Caregiver satisfaction after neuromuscular scoliosis (NMS) surgery is generally high; however, the relationship between task-specific caregiving burden and global treatment satisfaction remains unclear. This study aimed to identify patient- and caregiver-related determinants of transfer difficulty and global satisfaction in the long-term postoperative period. Methods:This cross-sectional follow-up study included individuals who underwent posterior spinal fusion for NMS between 2012 and 2020 and were ≥18 years at survey distribution. Caregivers completed a modified Bridwell questionnaire using 0-10 scales. Multivariate linear regression identified determinants of transfer difficulty and global satisfaction, with false discovery rate (FDR) correction applied. Results:Sixty-two caregivers responded (63% response rate). In the patient-related model, higher adult body weight (β=-0.14, p_FDR=0.077) and greater residual Cobb angle (β=-0.082, p_FDR=0.065) showed trends in transfer difficulty scores, though neither reached the p_FDR<0.05 threshold. Among caregiver-reported domains, difficulty with changing clothes (β=0.75, p_FDR=0.081) demonstrated a similar trend. Global satisfaction was significantly associated with better respiratory status (β=0.36, p_FDR=0.023) and improved swallowing (β=-0.16, p_FDR=0.047). Transfer difficulty showed no association with global satisfaction (β=-0.007, p_FDR=0.90). Conclusions:These findings represent exploratory associations observed at a single time point in adulthood and do not imply causal relationships. Transfer difficulty in adulthood appears to be primarily associated with body size and residual spinal deformity, whereas global satisfaction is primarily associated with improvements in respiratory and swallowing function. These findings indicate a dissociation between task-specific caregiving burden and global treatment satisfaction, suggesting that caregivers may affirm long-term treatment value despite ongoing physical challenges.
Introduction: Cervicobrachial symptoms are common causes of disability worldwide, yet the cost-effectiveness of combination therapy versus monotherapy remains unclear. In this nationwide multicenter study, we aimed to compare the economic value of multiple-drug therapy with that of monotherapy for cervicobrachial symptoms. Methods: This prospective observational study, conducted through the Japanese Society for Spine Surgery and Related Research, included 261 adults with cervicobrachial symptoms across 28 institutions (July 2020 to July 2022). Patients received monotherapy (n=112) or multiple-drug therapy (n=149) using five pre-specified agents: loxoprofen, celecoxib, acetaminophen, tramadol-acetaminophen, and pregabalin. The primary outcome was quality-adjusted life years (QALYs), calculated from monthly EuroQol 5-Dimension 5-Level assessments over six months. The secondary outcomes were drug costs and incremental cost-effectiveness ratios (ICERs), evaluated against Japan's reference threshold of 5,000,000 JPY per QALY. Results: Mean QALY gains were similar between the monotherapy (0.00267±0.00544) and multiple-drug therapy (0.00284±0.00774) groups, with no statistically significant difference (p>0.05). However, total drug costs were substantially higher with multiple-drug therapy (19,243 JPY vs. 8,275 JPY). ICERs were more favorable for monotherapy (3,093,957 JPY/QALY) than for multiple-drug therapy (6,781,101 JPY/QALY). Among agents used as monotherapy, loxoprofen (744,409 JPY/QALY) and acetaminophen (781,293 JPY/QALY) showed the most favorable cost-effectiveness profiles, whereas tramadol-acetaminophen (6,370,451 JPY/QALY) and pregabalin (10,995,651 JPY/QALY) had the least favorable cost-effectiveness. Most QALY gains occurred during the first three months in both groups. Conclusions: Multiple-drug therapy approximately doubled pharmaceutical costs without providing additional QALY gains over six months. Monotherapy, particularly with non-steroidal anti-inflammatory drugs or acetaminophen, offers superior cost-effectiveness and should be prioritized as first-line treatment. These findings underscore the need for restraint in polypharmacy and provide real-world evidence to guide clinical decision-making and national healthcare policy.
Background:Two-stage, anterior and posterior, cervical spine surgery is often utilized for complex spinal pathologies. The second stage may be performed on the same day or delayed to a separate day. A variety of considerations influence this decision, yet comprehensive and broad analyses examining predictors and outcomes of same-day versus delayed staging remain limited. Methods:A retrospective cohort study was conducted to investigate the effects of same-day versus delayed staging on complications and surgical outcomes. Adults undergoing two-stage cervical procedures were identified using the Quality Outcomes Database. The primary exposure was delaying the second-stage surgery to a separate day, termed the delayed second stage. Demographic, clinical, and preoperative data were analyzed. Outcomes included patient-reported outcome measures (PROMs) and reoperation rates at 3, 12, and 24 months, as well as the 30-day complication rate. Results:Among 394 patients (mean age 60.8±10.7, 52.0% male), 27.9% had delayed second-stage surgery, the majority had an anterior approach as the first stage (87.8%), and patients who had delayed second-stage surgery were less likely to have American Society of Anesthesiologists scores ≥3 (43.6% vs. 64.5%, p<0.001). Patients with delayed second-stage surgery had longer operative times (326±37.0 vs. 293±34.0 minutes, p=0.022) and longer hospital stays (4.4±0.79 vs. 3.1±0.54 days, p<0.001), with no significant differences in blood loss, reoperation rates, PROMs at 3, 12, and 24 months, or 30-day complication rates (all p>0.05). Conclusions:These results suggest that delaying the second stage may be more a question of resource utilization rather than concern for a negative impact on patient outcomes. Surgeons should acknowledge that either staging strategy, same-day or delayed, results in equivalent clinical outcomes with some differences in perioperative outcomes. The choice to delay second-stage surgery should be patient-centered and consider institutional factors.
Introduction:The prone position is generally regarded as the standard posture for back extensor strength testing. However, some older adults may have difficulty assuming this position, making alternative approaches more clinically feasible. It remains unclear whether measurements obtained in the sitting and semi-standing positions demonstrate sufficient validity compared with those in the prone position. This study aimed to evaluate the reliability and validity of isometric back extensor strength measurements using hand-held dynamometry (HHD) in the sitting position and the Biodex system in the semi-standing position. The results were compared with measurements in the prone position. Methods:Thirty-four healthy adults (10 males and 24 females; mean age, 23.8 years) participated. Back extensor strength was assessed using three methods: HHD in the prone, HHD in the sitting position, and the Biodex system in the semi-standing position. Test-retest reliability was evaluated using two sessions. Convergent validity of HHD in the sitting position and the Biodex in the semi-standing position was examined and compared with prone HHD, which served as a reference standard. Results:The semi-standing Biodex demonstrated excellent reliability and sufficient convergent validity compared with prone HHD, whereas HHD in the sitting position showed acceptable reliability but limited validity. Intraclass correlation coefficients (ICCs) indicated excellent reliability for prone HHD (ICC=0.95) and semi-standing Biodex (ICC=0.92), while sitting HHD showed acceptable reliability (ICC=0.76). Regarding convergent validity, the Biodex in the semi-standing position showed a moderate correlation with prone HHD (r=0.60), whereas sitting HHD showed a weaker correlation (r=0.45). Conclusions:The Biodex system in the semi-standing position demonstrated excellent reliability and sufficient validity for assessing back extensor strength. In contrast, HHD in the sitting position showed acceptable reliability but limited validity, which may be influenced by the measurement protocol used. Further studies are needed to improve measurement protocols, particularly for use in older adults and clinical populations.
