The authors compared the utility of the International Prostate Symptom Score IPSS and Japan Orthopaedic Association JOA score for evaluating lower urinary tract symptoms LUTS associated with lumbar degenerative diseases. A total of 178 patients with lumbar degenerative diseases were assessed according to the IPSS and JOA score. These included 32 females F group , 80 males without urinary tract lesions Mn group , and 66 males with urinary tract lesions Mu group. Patients with 8 points on the IPSS and 3 points on the JOA score were classified as LUTS. Additionally, we investigated both storage and voiding symptoms using IPSS. Patients with 4 points from a possible maximum of 15 across 3 questions relating to storage and voiding symptoms on the IPSS were defined as symptom. Among all 178 patients, LUTS positivity was detected in 85 patients 48 by the IPSS and in 81 patients 46 by the JOA score. In the F group, 10 patients 31 were LUTS on both scoring systems. In the Mn group, 33 41 and 39 patients 49 were LUTS on the IPSS and JOA score, respectively. Thus, there was good statistical correlation between the IPSS and JOA score. However, a more detailed analysis of the findings revealed that the group defined as normal by JOA score had worse symptoms on the IPSS 25 of the 178 patients, including 14 in the F group and 22 in the Mn group. Moreover, IPSS clearly identified many cases with storage symptoms and many mixed cases with both voiding and storage symptoms associated with lumbar degenerative disease. In conclusion, IPSS was considered to be a more sensitive and useful scoring system than the JOA score for evaluating LUTS associated with lumbar degenerative diseases.
The authors compared the utility of the International Prostate Symptom Score IPSS and the Japan Orthopaedic Association JOA score for evaluating lower urinary tract symptoms LUTS associated with cervical degenerative myelopathy.A total of 128 patients with cervical degenerative myelopathy were assessed according to the IPSS and JOA score. These included 31 females F group , 61 males without urinary tract lesions Mn group , and 36 males with urinary tract lesions Mu group . Patients with 8 points on the IPSS and 2 points on the JOA score were classified as LUTS . Additionally, we investigated both storage and voiding symptoms using the IPSS. Patients with 4 points from a possible maximum of 15 across 3 questions relating to storage and voiding symptoms on the IPSS were defined as symptom . Among all 128 patients, LUTS positivity was detected in 58 patients 45by the IPSS and in 52 patients 41 by the JOA score. In the F group, 13 42 and 10 patients 32 were LUTS based on the IPSS and JOA score, respectively. In the Mn group, 23 38 and 20 patients 33 were LUTS based on the IPSS and JOA score, respectively. Thus, there was good correlation between the IPSS and JOA score.However, a more detailed analysis of the findings revealed that the group defined as normal by the JOA score had worse symptoms on the IPSS 24 of the 128 patients, including 24 in the F group and 22 in the Mn group. In addition, it was revealed that the group defined as slight by the JOA score had a wide range of symptoms from 2 to 27 on the IPSS. Moreover, a significant difference was not observed in IPSS between the slight group and severe groups according to the JOA score.Also from another viewpoint, IPSS clearly identified many cases with voiding symptoms and many mixed cases with both voiding and storage symptoms associated with cervical degenerative myelopathy.In conclusion, IPSS was considered to be a more sensitive and useful scoring system than the JOA score for evaluating LUTS associated with cervical degenerative myelopathy.Received April 12, 2013 accepted June 26, 2013Key words international prostate symptom score IPSS , neurogenic bladder, lower urinary tract symptoms LUTS , cervical degenerative myelopathy, spinal cord diseases Jpn J Neurosurg Tokyo 23 241 247, 2014
Vertebral compression fractures VCFs are the most common form of osteoporotic fracture with significant morbidity. Osteoporotic VCFs are a major health concern owing to the increasing population of elderly people. These fractures have traditionally been treated with conventional therapies such as analgesics, bed rest and bracing. In the last few decades, vertebroplasty, and subsequently kyphoplasty, have emerged as minimally invasive treatment options. Balloon kyphoplasty BKP is a recent modification of percutaneous vertebroplasty that can be considered in those patients who do not respond to initial treatment. Between February 2011 and July 2011, 7 patients with pain refractory to conservative therapy underwent single level kyphoplasty. We prospectively assessed the results of the kyphoplasties by clinical and radiological methods. We evaluated clinical outcome using the visual analog scale VAS , Japanese Orthopedic Association JOA and Oswestry Disability Index ODI scores. Radiological measurements included anterior, middle and posterior vertebral body height, local kyphotic angle and sagittal vertical axis SVA. All patients were female. The mean age was 77.7, with a range from 73 to 85. The fractures were located at the thoracolumbar junction, T12 5 cases, L1 2 cases, respectively. The length of conservative treatment ranged from 4 to 6 months mean 4.7 months. The mean VAS pain score decreased from 7.4 1.1 before surgery to 2.5 3.2 after surgery p 0.03. The mean JOA score increased from 11.8 5.8 before surgery to 17.8 4.2 after surgery p 0.007. The mean ODI score decreased from 34.0 9.0 before surgery to 21.4 12.2 after surgery p 0.007. The mean anterior height was 7.7 2.0 before treatment and 16.0 2.3 after treatment p 0.007. The mean middle height was 8.7 2.6 before treatment and 15.7 1.4 after treatment p 0.007. The mean posterior height was 25.0 2.1 before treatment and 25.8 2.6 after treatment p 0.18. The mean preoperative and postoperative local kyphotic angle at VCF were 21.2 4.6 and 12.4 3.7 , respectively p 0.007. The mean preoperative and postoperative SVA were 83.1 19.1 and 73.8 24.9, respectively p 0.15. BKP demonstrated rapid back pain relief in all patients associated with statistically significant restoration of vertebral body height and improvement of local kyphosis. However, the angular reduction attained at the level of VCF did not translate to similar correction of overall sagittal alignment. Cement extravasation was not observed, nor were complications such as pulmonary embolism or spinal compression. Only one patient developed subsequent vertebral body fracture adjacent to treated vertebra one month after the procedure. In our experience, kyphoplasty was found to be an effective and safe alternative in the treatment of osteoporotic VCFs.
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