Introduction: Recently, lateral lumbar interbody fusion (LIF), including extreme lateral interbody fusion (XLIF), direct lateral interbody fusion (DLIF), and oblique lateral interbody fusion (OLIF), has been introduced in Japan. Despite the effectiveness of the procedure, several complications related to this procedure have been reported. Since 2015, to identify the overall complication rate and type of LIF, the Japanese Society for Spine Surgery and Related Research (JSSR) has started a nationwide survey on the incidence and type of complications related to LIF among all JSSR members. We report on the results of the nationwide survey conducted by JSSR on the complications associated with LIF performed in Japan in 2017.
Methods: A web-based nationwide survey on the complications following LIF was conducted by JSSR for all JSSR members. Any complications meeting the following criteria were included: 1. major vessel injury, 2. urinary tract injury, 3. renal injury, 4. visceral organ injury, 5. lung injury, 6. weakness of psoas, 7. motor deficit, 8. sensory deficit, 9. vertebral injury, 10. nerve injury, 11. anterior longitudinal ligament injury, 12. surgical site infection (SSI), and 13. other complications. The incidence and type of LIF were analyzed among all patients who underwent LIF, and the differences in the incidence and type of complications between XLIF and OLIF were compared.
Results: Among 2,311 patients who underwent LIF [XLIF: 906 cases (39.2%), DLIF: 50 cases (2.2%), and OLIF: 1,355 cases (58.6%) ], complications were observed in 72 patients (3.1%). The most common complication was sensory deficit (0.74%), followed by motor deficit (0.35%), SSI (0.30%), weakness of psoas (0.22%), nerve injury (0.22%), and major vessel injury (0.09%). Ten patients (0.4%) required revision surgery during the survey period. There was no statistically significant difference in the frequency of resultant complications between XLIF and OLIF (3.8% vs. 3.0%, p = 0.34).
Conclusions: We conducted a nationwide survey on the complications that occur following LIF. The overall complication rate was 3.1%, and 0.4% patients required revision surgery for the complications. Major vessel injury occurred in 0.09%, nerve injury occurred in 0.22%, and SSI occurred in 0.30% patients.
Introduction: Thoracolumbar fractures due to high-energy trauma occur frequently in patients with psychological disorders. The present study aimed to evaluate the features of thoracolumbar fractures in Japanese patients with psychological disorders using Injury Severity Score (ISS), for which, to the best of our knowledge, there is no report to date.
Methods: The present study included 111 patients who were hospitalized for the treatment of thoracolumbar fractures due to high-energy trauma between March 2009 and March 2019. The inclusion criterion was patients aged ≤65 years at the time of the trauma. The exclusion criterion was patients with osteoporotic or minor fractures (AO type A0). The patients' age, sex, injury mechanism, injury level, psychological disorder, ISS, Abbreviated Injury Scale (AIS) score for injured vertebrae, treatment (surgery or not), and timing of surgery were investigated.
Results: Among the 111 patients, 26 (23%) had psychological disorders: 8 had schizophrenia, 7 had adjustment disorders, 5 had depression, 5 had alcohol or drug dependence, and 1 had epilepsy. We divided the patients into two groups: the P group (n = 26) comprised patients with psychological disorders and the N group (n = 85) comprised patients without psychological disorders. The P group patients were significantly younger than the N group patients. There were no significant differences in sex between the groups. The P group patients injured themselves significantly more frequently by jumping (85%) than the N group patients. The proportion of severe trauma (ISS ≥ 16) was significantly higher in the P group patients (50%) than in the N group patients (11%). Furthermore, in patients with severely injured vertebrae (AIS score ≥ 3), the proportion of severe trauma (ISS ≥ 16) was significantly higher in the P group (55%) than in the N group (15%). By contrast, in patients with mildly injured vertebrae (AIS score = 2), there was no significant difference in the proportion of severe trauma between the groups. Similarly, there were no significant differences in the location of injured vertebrae, treatment, and timing of surgery between the groups.
Conclusions: The P group patients were significantly younger, jumped more frequently, and had a higher proportion of severe trauma than the N group patients. In patients with severely injured vertebrae, the proportion of severe trauma in the P group was significantly higher than that in the N group. Therefore, it is important to make treatment decisions for thoracolumbar fractures in patients with psychological disorders on the basis of the concept of "spine damage control."
Introduction: In recent years, it has been reported that psychosocial factors of patients with orthopedic disorders are involved in pain chronicity. Thus, it is effective to attend to psychosocial aspects as early as possible. The "Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF)" assessment tool collects patient-reported outcomes for 17 items, which can comprehensively evaluate multiple psychological factors. We developed the Japanese version of OSPRO-YF (OSPRO-YF-J) and verified its reliability and validity.
Methods: First, after obtaining permission to develop the Japanese version, we translated OSPRO-YF according to international guidelines. In the preliminary analysis (n = 21; average age, 49.1±20.4 years; 5 males and 16 females), we evaluated the cross-cultural understanding of item expressions and time required to complete the questionnaire. In addition, we verified its reliability. We statistically analyzed reliability in terms of reproducibility, internal consistency, and absolute reliability. We then verified the external validity of OSPRO-YF-J in a separate sample (n = 251; average age, 65.3±13.4 years; 70 males and 181 females). We summarized the obtained data descriptively and confirmed the presence of the ceiling and floor effects.
Results: The average time required to complete OSPRO-YF-J was 4.4±2.4 minutes, and the average score was 36.6±10.3 points. No ceiling or floor effect was observed. For reproducibility (Intraclass correlation coefficient = 0.86), Cronbach's α was 0.84, correlation coefficients for each item ranged from 0.4 to 0.7. Furthermore, in Bland-Altman analysis, no systematic errors (fixed or proportional errors) but only accidental errors were recognized in OSPRO-YF-J.
Conclusions: OSPRO-YF-J was confirmed to show good reliability and validity. OSPRO-YF-J is a comprehensive psychological evaluation scale and can be easily implemented in the clinical setting. Therefore, we think that it is a practical questionnaire for evaluating psychological factors.
Introduction: There are many reports on lumbar spondylolysis in adolescent baseball players, and a study has reported that 16.4% of college baseball players have spondylolysis. In addition, this study has reported that 44.1% of professional baseball players are affected with lumbar spondylolysis. In other words, spondylolysis is a common condition among baseball players. The occurrence of lumbar spondylolysis is thought to be related to stress concentration at the pars interarticularis due to lumbar extension and rotation. Especially during rotation, this stress is applied to the pars interarticularis opposite to the rotation direction. For this reason, it is thought that lumbar spondylolysis is often seen in unilateral cases in disciplines in which rotation in only one direction is repeated. In the present study, baseball players accounted for 35.2% of athletes diagnosed with lumbar spondylolysis at our hospital, and the majority of patients comprised those who were sportspersons. Also, in this report, bilateral cases accounted for 53.6% and unilateral cases accounted for 46.4% of athletes diagnosed with lumbar spondylolysis. The purpose of this study was to compare and evaluate the correlation between the laterality of spondylolysis and the throwing side or batting side, which are asymmetry behaviors in baseball players.
Methods: We investigated throwing side, batting side, and the laterality of spondylolysis for 93 lesions in 64 vertebrae of 57 players who belonged to a baseball club and were diagnosed with lumbar spondylolysis. In addition, we examined the fielding position ratio compared with that reported in a nationwide survey. Binomial test or Fisher exact test was used to determine a significant difference, i.e., p < 0.05.
Results: Statistics were obtained on the relationship with the laterality of spondylolysis during asymmetric movements in baseball players, and it was found that spondylolysis occurred on the side opposite to the throwing, but not batting, side. Furthermore, the occurrence of spondylolysis was significant in pitchers.
Conclusions: In this study, it was shown that lumbar spondylolysis in baseball players is strongly related to throwing and is likely to develop on the side opposite to the throwing side, especially in pitchers. In addition to throwing, fielders are involved in multiple actions such as batting and fielding.