The first metatarsal bone can shorten after a distal chevron metatarsal osteotomy (DCMO). This shortening can result in a postoperative second metatarsal transfer lesion. The aim of the present study was to investigate the occurrence of second metatarsal transfer lesions after DCMO. This study involved 185 feet (138 patients), with hallux valgus (HV) deformity, treated with DCMO with Akin osteotomy. The mean patient age was 51.7 years (range, 21 to 74). Patients were followed for an average of 28 months, between June 2004 and June 2010. We measured the length of first metatarsal relative to second metatarsal preoperatively and postoperatively, using Morton’s and Hardy-Clapham’s methods. A second metatarsal transfer lesion was defined as a newly developed lesion, including metatarsalgia, a painful callosity, or a painless callosity, which was not present prior to the DCMO. The relation of the shortened first metatarsal after DCMO with the occurrence of second metatarsal transfer lesion was evaluated. Second metatarsal transfer lesions (painless callosity) developed in 5 feet (2.7%) of 185 feet. Twenty-four preoperative second metatarsal lesions were improved postoperatively. The median shortening of the first metatarsal bone after DCMO was 0.6 mm according to Morton’s method (range, –6.4 to 6.4), and 1.9 according to Hardy-Clapham’s method (range, –5.8 to 5.8). According to the extent of first metatarsal shortening after DCMO by Hardy-Clapham’s method and Morton’s method, there was no significant difference of the occurrence of second transfer metatarsal lesions (P = .259 and P = .176, respectively). In our study, second metatarsal transfer lesions developed in 2.7% of feet after DCMO. The occurrence of second metatarsal transfer lesions did not appear to be correlated with the degree of first metatarsal shortening in cases with less than 5.8 mm shortening. Level IV, retrospective case series.

Background/Objectives: Despite the increasing prevalence of both spinal stenosis and obesity, their association remains controversial. This study aimed to investigate the relationship between body mass index (BMI) and the risk of lumbar spinal stenosis in the Korean population using nationwide data. Methods: We analyzed data from 2,161,684 adults aged ≥40 years who underwent health examinations in 2009 using the Korean National Health Insurance System database. Participants were categorized by BMI into five groups: underweight (<18.5), normal weight (18.5–22.9), overweight (23.0–24.9), obesity class I (25.0–29.9), and obesity class II and above (≥30). Cox proportional hazards models were used to evaluate the association between BMI and lumbar spinal stenosis risk, adjusting for demographic characteristics, lifestyle factors, and comorbidities. Results: During the 10-year follow-up period, the incidence rate of lumbar spinal stenosis increased progressively with higher BMI categories, from 32.77 per 1000 person-years in the underweight group to 51.51 in the obesity class II and above group. In the fully adjusted model, compared to the normal weight group, the hazard ratios (95% confidence intervals) were 0.801 (0.787–0.815) for underweight, 1.132 (1.126–1.139) for overweight, 1.245 (1.238–1.252) for obesity class I, and 1.348 (1.331–1.366) for obesity class II and above. The association was stronger in females and participants aged <65 years. Conclusions: A higher BMI was independently associated with an increased risk of lumbar spinal stenosis in the Korean population. This association remained robust after adjusting for various confounding factors, suggesting BMI as a significant risk factor for spinal stenosis.

Background and Objectives: Lumbar spinal stenosis (LSS) is a leading cause of disability in older adults, but the role of cigarette smoking in its development remains unclear. This study aimed to clarify the association between smoking and the incidence of LSS, with a focus on dose–response relationships and subgroup variations by age and sex. Methods: We conducted a nationwide, population-based cohort study using the Korean National Health Insurance Service database. A total of 2,123,268 adults aged ≥ 40 years who underwent health screening in 2009 were followed until LSS diagnosis, death, or 2020. Smoking status, duration, daily consumption, and pack-years were assessed. Cox proportional hazards models with progressive adjustment for demographic, lifestyle, and clinical factors were applied. Results: Over a mean follow-up of 8.2 years (17.5 million person-years), 721,909 new cases of LSS were identified. Fully adjusted models showed higher risk in former (HR 1.047; 95% CI, 1.039–1.056) and current smokers (HR 1.052; 95% CI, 1.044–1.060) compared with never smokers. A clear dose–response pattern was observed, with the greatest risk in heavy smokers (≥40 pack-years; HR 1.207; 95% CI, 1.191–1.222). Subgroup analyses indicated stronger associations among adults aged ≥ 65 years and in women. Conclusions: Cigarette smoking was independently associated with an increased risk of LSS, with risk increasing according to lifetime exposure. The findings underscore the importance of smoking cessation strategies to reduce the burden of spinal degeneration, especially in older adults and women.

Heu JY, et al. Hip Pelvis. 2022 Sep;34(3):140-149. https://doi.org/10.5371/hp.2022.34.3.140