While bracing is the standard conservative treatment for acute osteoporotic compression fracture, the efficacy of different brace treatments has not been extensively studied. We aimed to clarify and compare the preventive effect of the different brace treatments on the deformity of the vertebral body and other clinical results in this patient cohort. This multicenter nationwide prospective randomized study included female patients aged 65–85 years with acute one-level osteoporotic compression fractures. We assigned patients within four weeks of injury to either a rigid-brace treatment or a soft-brace treatment. The main outcome measure was the anterior vertebral body compression percentage at 48 weeks. Secondary outcome measures included scores on the European Quality of Life-5 Dimensions (EQ-5D), visual analog scale (VAS) for lower back pain, and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). A total of 141 patients were assigned to the rigid-brace group, whereas 143 patients were assigned to the soft-brace group. There were no statistically significant differences in the primary outcome and secondary outcome measures between groups. In conclusion, among patients with fresh vertebral compression fractures, the 12-week rigid-brace treatment did not result in a statistically greater prevention of spinal deformity, better quality of life, or lesser back pain than soft-brace.

As the population ages, the number of lumbar spinal surgeries performed on sarcopenic patients will increase. The purpose of this study was to investigate the prevalence of sarcopenia and evaluated its impact on the results of lumbar spinal surgery. This study included 2 groups: One group consisted of patients who underwent whole-body dual-energy X-ray absorptiometry (DXA) scanning before the option of undergoing surgery for lumbar spinal disease (LSD group) and a second group consisted of patients underwent DXA scanning for osteoporosis screening under hospital watch at the geriatric medicine department (control group). In order to evaluate the impact of sarcopenia on the clinical outcome of lumbar spinal surgery, the Japanese Orthopedic Association (JOA) score, the recovery rate based on the JOA score, and visual analogue scale (VAS) scores for lower back pain, lower extremity pain, and lower extremity numbness were compared within the LSD group. The prevalence of sarcopenia showed no statistical difference between groups (control group, 50.7%; LSD group, 46.5%). In the LSD group, while the changes in VAS scores showed no statistical difference between the nonsarcopenia subgroup and sarcopenia subgroup, the sarcopenia subgroup demonstrated inferior JOA scores and recovery rates at the final follow-up when compared with the nonsarcopenia subgroup (P < 0.05). This study demonstrated a high prevalence of sarcopenia among the elderly populations in Japan and a negative impact of sarcopenia on clinical outcomes after lumbar spinal surgery.

Study Design.: Retrospective observational study. Objective.: To analyze a large consecutive cohort of patients who had undergone spinal instrumentation surgery, to characterize a patient population with surgical site infections (SSI), and to identify preoperative risk factors associated with SSI. Summary of Background Data.: Malnutrition is a risk factor for SSI in many health conditions; however, the evidence connecting preoperative malnutrition with SSI in spinal instrumentation surgery is limited because of the small number of retrospective studies. While the modified Glasgow prognostic score (mGPS), C-Reactive protein (CRP)–albumin ratio (CAR), controlling nutritional status index (CONUT), prognostic nutritional index (PNI), platelet–lymphocyte ratio (PLR), and neutrophil–lymphocyte ratio (NLR) are established methods for evaluating nutritious status, little has been reported on the predictive value of these indicators with respect to postoperative spinal infection. Methods.: We retrospectively investigated 384 patients who underwent spinal instrumentation surgery. We evaluated the significance of risk factors, including mGPS, CAR, CONUT, PNI, PLR, and NLR. We then performed stepwise logistic regression analysis to analyze the concurrent effects of various factors on the prevalence of SSI. Results.: Of the 384 patients analyzed, 14 were diagnosed with SSIs. Univariate analysis showed that preoperative BMI, lymphocyte count, albumin, erythrocyte sedimentation rate, CRP, CONUT, mGPS, CAR, and PNI were risk factors for SSI. Stepwise logistic regression analysis revealed that higher mGPS and lower BMI before surgery were independent risk factors for SSI. A receiver operating characteristic curve showed that the cut-off values of mGPS and BMI were 1 and 20.39, respectively. Conclusion.: The risk factors for SSI after spinal instrumentation surgery were mGPS more than or equal to 1 and BMI less than or equal to 20.39 kg/m². These findings could help to identify patients at higher risk of SSI after spinal instrumentation surgery. Level of Evidence: 4

A retrospective single-center study. To investigate how functional recovery is influenced by anterior compression of the spinal cord (ACS) and instability at the level of ACS after laminoplasty in patients with cervical spondylotic myelopathy. There have been many reports that patients whose spinal cord cannot be decompressed sufficiently after laminoplasty are likely to show unsatisfactory neurologic outcomes. Notably, postoperative ACS is well known to cause problems. Clinically, however, it remains unknown how functional recovery is inhibited by postoperative ACS. Sixty-four consecutive patients who underwent expansive laminoplasty for the treatment of myelopathy at our hospital between 1998 and 2005 were reviewed. All 64 patients were available for follow-up. The average follow-up period was 97 months (60–156 months). Patients were divided into 2 groups: the ACS(+) group comprised 16 patients who had ACS 3 years postoperatively, and the ACS(−) group comprised 48 patients with no ACS. Clinical outcome was compared in terms of the Japanese Orthopaedic Association score (mean total score, mean score of each item, and recovery rates). Demographics were similar between the 2 groups. Mean Japanese Orthopaedic Association score at final follow-up was 12.1 points (recovery rate 34.0%) in the ACS(+) group and 13.8 points (recovery rate 56.6%) in the ACS(−) group, and there was a significant difference in recovery rate between the groups (P < 0.05). Notably, a significant difference was found between the 2 groups in improvement of upper extremity motor function (P < 0.05). In addition, we found that not only the presence of ACS but also postoperative hypermobility of the intervertebral segment with ACS influenced clinical outcome negatively. These results demonstrate that ACS after laminoplasty could be a risk factor for clinical outcome and might prevent improvement in upper extremity motor function in patients with myelopathy.

A genome-wide association study (GWAS), which assessed multiple ethnicities, reported an association between single nucleotide polymorphisms in the 8q24 region and colorectal cancer risk. Although the association with the identified loci was strong, information on its impact in combination with lifestyle factors is limited. We conducted a case-control study in 481 patients with colorectal cancer (CRC) and 962 sex-age matched non-cancer controls. Data on lifestyle factors, including diet, were obtained by self-administered questionnaire. Two 8q24 loci, rs6983267 and rs10090154, were assessed by the TaqMan method. Associations were then assessed by multivariate logistic regression models that considered potential confounders. We found an increased risk of CRC with rs6983267 but not with rs10090154. An allelic OR was 1.22 (1.04-1.44, p for trend = 0.014), which remained significant after adjustment for confounders (OR = 1.25). No statistically significant interaction with potential confounding factors was observed. The polymorphism rs6983267 showed a significant association with CRC in a Japanese population. Further investigation of the biological mechanism of this association is warranted.