The Oswestry Disability Index (ODI) is one of the most used assessment scales for patients with spine conditions, and translations into several languages have already been available. However, the scale's discriminative validity and responsiveness to the clinical change was somewhat understudied in these translated versions of the ODI. In this study, we independently developed a Japanese version of the ODI, and tested its discriminative and responsive performances among outpatients with various spinal conditions. We recruited 167 outpatients from seven participating clinics, and concurrently measured the translated ODI and MOS Short Form 36 (SF36) as a reference scale. We also obtained from medical records clinical information such as diagnoses, the past history of surgery, and existence of subjective symptoms and clinical signs. For testing discriminative validity, scores were compared by the number of symptoms and signs, with the trend test. Receiver operating characteristics (ROC) analysis was also conducted to compare ODI and SF36 in their performance to discriminate the existence of signs/symptoms, by chi-square test on the area under ROC curve (AUC). For 35 patients (17 clinically stable, 18 undergoing surgery and clinically significantly changed), the two scales were repeatedly administered after 3-6 months to compare responsiveness by using ROC analysis. The translated ODI and the SF36 Physical Function (PF) subscale showed a significant trend increase as the numbers of symptoms/signs increased. They also showed comparable performance in discriminating the existence of signs/symptoms (AUC=0.70-0.76 for ODI, 0.69-0.70 for SF36 PF, P=0.15-0.81), and clinical status change over time (AUC=0.82 for ODI, 0.72 for SF36 PF, P=0.31). Our results showed that the translated Japanese ODI showed fair discriminative validity and responsiveness as the original English scale showed.

Introduction:Degenerative lumbar kyphoscoliosis is a serious clinical condition that affects activities of daily living. This study aimed to investigate the age-related progression of nonoperative degenerative lumbar kyphoscoliosis, to clarify its final state in elderly people, and to identify factors associated with its progression.Methods: This retrospective longitudinal study included 115 nonoperative cases (mean age at first consultation, 70.9 years; range, 50-89 years). All were followed up for >6 years. The analysis included changes between initial and latest measurements in the coronal parameters (Cobb angle, L4 tilt angle, intervertebral angle, lateral spondylolisthesis, and C7-central sacral vertical line) and sagittal parameters (thoracic kyphosis, lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, sagittal vertical axis, and vertebral wedging rate). Factors in scoliosis progression were investigated by analyzing the correlations between the initial parameter values and the increase in Cobb angle. Results:Changes in the coronal parameters increased with age from 50s to 70s but decreased significantly in those aged 80s. Sagittal parameters increased by the age group, accelerating in those aged 80s, with the progression of vertebral wedging. In patients aged 50s-70s, the increase in Cobb angle correlated significantly with the initial Cobb angle, L4 tilt angle, and L4/L5 intervertebral angle.However, in the cases without initial scoliosis, the increase in Cobb angle correlated significantly only with the L4 tilt angle. There were no significant differences in any parameter according to the use of a trunk brace or medication for osteoporosis. Conclusions: L4 tilt angle is an important factor in the progression of degenerative scoliosis. The progression of scoliosis gradually ends after the age of 80 years with the decreasing variation of L4 tilt * * % *

Introduction: This study aimed to compare the clinical and radiological results of transforaminal lumbar interbody fusion (TLIF) with a boomerang-shaped cage and traditional posterior lumbar interbody fusion (PLIF) according to fused level and elucidate whether TLIF could replace PLIF at all lumbar levels. Methods: The study investigated 128 patients with lumbar spondylolisthesis who underwent a single-level TLIF or traditional PLIF. Intraoperative blood loss, operative time, and recovery rate were analyzed. Percent slip, disc height, and local lordosis at the fused level were measured using X-ray images from preoperation to the final follow-up. Results: No significant differences in recovery rate were observed at any level. The operative time and intraoperative blood loss were significantly less in the TLIF group at the L4/5 and L5/S1 levels. There were no significant differences in disc height or local lordosis at the L3/4 and L4/5 levels, and a satisfactory level of maintenance after the operation was achieved in both groups. However, at the L5/S1 level, postoperative maintenance after TLIF could not be achieved, and the obtained disc height and local lordosis in TLIF significantly decreased. Conclusions: Compared with traditional PLIF, TLIF was a less invasive procedure with a shorter operative time and lesser blood loss. TLIF could obtain similar local lordosis and disc height as PLIF at the L3/4 and L4/5 levels. At the L5/S1 level, the postoperative maintenance of local lordosis and disc height after TLIF was inferior to that after PLIF. On the basis of our results, we do not recommend performing TLIF at only the L5/S1 level.

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