Background Previous studies have indicated that trunk muscle strength decreases with chronic low back pain, and is associated with poor balance, poor functional performance, and falls in older adults. Strengthening exercises for chronic low back pain are considered the most effective intervention to improve functional outcomes. We developed an innovative exercise device for abdominal trunk muscles that also measures muscle strength. The correlation between muscle weakness, as measured by our device, the presence of chronic low back pain, and decreased physical ability associated with a risk of falling were evaluated in older women. Methods Thirty-eight elderly women, who could walk without support during daily activities and attended our outpatient clinic for treatment of chronic low back pain, knee or hip arthritis, or osteoporosis, were included in this study. Anthropometric measurements were performed. Grip power and one-leg standing time with eyes open were measured, and abdominal trunk muscle strength was measured using our device. History of falling in the previous 12 months was noted. Subjects with chronic low back pain (visual analog scale score ≥ 20 mm) for over 3 months were assigned to the low back pain group ( n = 21). The remaining subjects formed the non-low back pain group ( n = 17). Results Abdominal muscle strength of subjects in the low back pain group, and with history of falling, was significantly lower compared with that of subjects in the non-low back pain group, and in subjects without a history of falling, respectively. There was a moderate positive correlation between abdominal trunk muscle strength and one-leg standing time with eyes open. Conclusion We measured abdominal muscle strength in older women with chronic low back pain using our device, and it was significantly lower than that of those without chronic low back pain. Muscle weakness was associated with a history and risk of falling.

No abstract

The funder did not have any role in the design of the study and collection, analysis, and interpretation of data and writing of the manuscript.

Aims To evaluate the perioperative complications associated with total en bloc spondylectomy (TES) in patients with spinal tumours, based on the extent and level of tumour resection. Methods In total, 307 patients who underwent TES in a single centre were reviewed retrospectively. There were 164 male and 143 female patients with a mean age at the time of surgery of 52.9 years (SD 13.3). A total of 225 patients were operated on for spinal metastases, 34 for a malignant primary tumour, 41 for an aggressive benign tumour, and seven with a primary of unknown origin. The main lesion was located in the thoracic spine in 213, and in the lumbar spine in 94 patients. There were 97 patients who underwent TES for more than two consecutive vertebrae. Results Major and minor perioperative complications were observed in 122 (39.7%) and 84 (27.4%) patients respectively. The breakdown of complications was as follows: bleeding more than 2,000 ml in 60 (19.5%) patients, hardware failure in 82 (26.7%), neurological in 46 (15.0%), surgical site infection in 23 (7.5%), wound dehiscence in 16 (5.2%), cerebrospinal fluid leakage in 45 (14.7%), respiratory in 52 (16.9%), cardiovascular in 11 (3.6%), digestive in 19 (6.2%)/ The mortality within two months of surgery was four (1.3%). The total number of complications per operation were 1.01 (SD 1.0) in the single vertebral resection group and 1.56 (SD 1.2) in the group with more than two vertebral resections. Cardiovascular and respiratory complications, along with hardware failure were statistically higher in the group who had more than two vertebrae resected. Also, in this group the amount of bleeding in patients with a lumbar lesion or respiratory complication in patients with a thoracic lesion, were statistically higher. Multivariate analysis showed that using a combined anterior and posterior approach, when more than two vertebral resections were significant independent factors. Conclusion The characteristics of perioperative complications after TES were different depending on the extent and level of the tumour resection. In addition to preoperative clinical and pathological factors, it is therefore important to consider these factors in patients who undergo en bloc resection for spinal tumours. Cite this article: Bone Joint J 2021;103-B(5):976–983.

To the authors' knowledge, no comparative studies exist of venous thromboembolism (VTE) based on different pathologies, surgical procedures, or spinal levels after spinal surgery. The authors prospectively investigated VTE after elective spinal surgery. The study comprised 4 patient groups. Group 1 comprised 79 patients with lumbar spinal stenosis treated with posterior decompression without fusion; group 2 comprised 90 patients with lumbar or lower thoracic degenerative disease treated with instrumentation for spine fusion; group 3 comprised 89 patients with cervical degenerative disease treated with posterior decompression or instrumentation for fusion; and group 4 comprised 82 patients with spinal tumors treated with total spondylectomy or piecemeal excision with stabilization. Deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE) screening was performed for all 340 patients 7 to 10 days postoperatively. Binomial logistic regression analysis was used to assess the association of risk factors. The incidence of VTE was 15.2% in group 1, 13.3% in group 2, 4.5% in group 3, and 22.0% in group 4. The overall incidence of PTE was 2.9% (10/340 patients). Of the 10 cases of PTE, 2 were symptomatic and 8 were asymptomatic. No DVT occurred in 6 of 10 PTE-positive patients. Multivariate analysis showed that spinal tumors, neurologic deficits, and advanced age were risk factors for VTE. Spinal tumor surgery carries a high risk of critical VTE, whereas cervical spine surgery carries a low risk. No DVT occurred in 60% of PTE-positive patients. This result indicates that screening for PTE is also needed in patients who are at high risk for VTE.