Journal of Orthopaedic Science最新文献

{"title":"Does the upper line of the sacral ala approximate a horizontal line on pelvic radiographs of idiopathic scoliosis?","authors":"Masaki Ikejiri, Hideki Shigematsu, Sachiko Kawasaki, Yuma Suga, Takahiro Mui, Yasuhito Tanaka","doi":"10.1016/j.jos.2025.06.009","DOIUrl":"https://doi.org/10.1016/j.jos.2025.06.009","url":null,"abstract":"<p><strong>Background: </strong>Lower instrumented vertebra (LIV) in adolescent idiopathic scoliosis (AIS) corrective surgery is selected using the center sacral vertical line on supine side-bending radiographs. However, a horizontal line reference is not possible on supine radiographs. Therefore, we aimed to determine the pelvic reference line that best reflects the horizontal line, which can be used in determining the LIV on supine side-bending radiograph in patients with AIS.</p><p><strong>Methods: </strong>Patients with AIS (n = 258) were evaluated. On whole-spine standing anteroposterior radiographs, three lines were selected (the upper sacral line [USL], sacroiliac joint line [SIL], and upper iliac line [UIL]) and compared with the horizontal line to investigate tilt angles. Patients were allocated into thoracic (T; n = 90), lumbar (L; n = 61), and double (D; n = 107) curve groups based on thoracic and lumbar Cobb angles.</p><p><strong>Results: </strong>The mean USL; SIL; and UIL tilts were 2.3°, 4.7°, and 3.8°; 1.6°, 2.0°, and 2.0°; and 1.4°, 2.2°, and 1.8° in the T, L, and D groups, respectively. The USL was significantly tilted in all groups, without significant difference between the SIL and UIL tilts. The USL tilted significantly more from the horizontal line in the L and D groups than in the T group; the UIL tilted more in the L group compared with the T group. The SIL tilt was comparable between the groups. The Cobb angle on the thoracolumbar or lumbar curve significantly, albeit weakly, correlated with the USL and UIL tilt.</p><p><strong>Conclusions: </strong>On whole-spine standing anteroposterior radiographs, the USL had the greatest tilt (mean: 3.5°), whereas the SIL had the smallest tilt (mean: 1.8°) without significant variation across scoliosis types. Independent of Cobb angle and scoliosis type, the SIL was the most stable and reliable reference line for horizontal alignment, making it the preferred reference to LIV selection in patients undergoing AIS corrective surgery.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of decompression surgery and erythropoietin combination on a rat model of compressive myelopathy.","authors":"Yuki Shiratani, Takeo Furuya, Yuki Nagashima, Yasunori Toki, Masataka Miura, Sho Okimatsu, Juntaro Maruyama, Kyota Kitagawa, Takaki Inoue, Atsushi Yunde, Satoshi Maki, Seiji Ohtori","doi":"10.1016/j.jos.2025.06.013","DOIUrl":"https://doi.org/10.1016/j.jos.2025.06.013","url":null,"abstract":"<p><strong>Introduction: </strong>Cervical spondylotic myelopathy (CSM) is a degenerative condition caused by spinal cord compression, leading to significant neurological impairments. While decompression surgery is the gold standard for treating CSM, recovery is often incomplete, prompting the need for adjunct therapies. Erythropoietin (EPO), widely used for anemia treatment, has shown beneficial effects on the nervous system. This study evaluates the combined effects of decompression surgery and EPO administration in a rat model of compressive myelopathy.</p><p><strong>Methods: </strong>We developed a rat model of compressive myelopathy using a gradually expanding polymer sheet at C4-C5 levels. Rats were divided into three groups: Control (sham surgery, weekly saline injections), Decompression (decompression surgery, weekly saline injections), and Decompression + EPO (decompression surgery, weekly EPO injections). Motor function, myelination, and axonal integrity were evaluated over eight weeks using Basso, Beattie, and Bresnahan (BBB) scores, grid runway tests, and histological analyses.</p><p><strong>Results: </strong>The decompression + EPO group exhibited significantly better motor function, with higher BBB scores and fewer hindlimb drops in grid runway tests compared to the Control group. Histological analyses revealed enhanced myelination in the corticospinal tract, as shown by Luxol Fast Blue (LFB) staining and myelin basic protein (MBP) staining, along with increased axonal growth marked by growth-associated protein 43 (GAP-43) expression.</p><p><strong>Conclusion: </strong>Combining decompression surgery with EPO administration significantly improved motor recovery and promoted spinal cord myelination in a rat model of compressive myelopathy. These findings suggest EPO as a promising adjunct to surgical treatment in CSM, warranting further clinical investigation.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Locomotive syndrome clinical practice guide 2021.","authors":"Katsushi Takeshita, Kozo Nakamura, Hiromoto Ito, Yasumoto Matsui, Noriko Yoshimura, Yuichi Hoshino, Takashi Ohe, Atsushi Seichi, Shingo Muranaga, Takeshi Fuji, Keiko Yamada, Shigeyuki Muraki, Etsuo Chosa, Hideaki Ishibashi","doi":"10.1016/j.jos.2025.05.004","DOIUrl":"https://doi.org/10.1016/j.jos.2025.05.004","url":null,"abstract":"<p><strong>Background: </strong>\"Locomotive syndrome\" (LS), proposed by the Japanese Orthopaedic Association in 2007, refers to a condition where a person experiences a decline in mobility due to disorders of the locomotor system. Addressing LS is mandatory to extend healthy life expectancy, especially in any super aging society. In Japan, \"Locomotive Syndrome Clinical Guide 2010\" was published in 2010, followed by the standardization of English terms related to locomotive syndrome. To raise international awareness, the translation of this guide into English was planned.</p><p><strong>Methods: </strong>We followed the standardization of English terms related to locomotive syndrome. We used the figures and tables from the Japanese version in the English translation, and specifically selected key clinical questions for translation.</p><p><strong>Results: </strong>We selected 14 clinical questions, with nine tables and 25 figures.</p><p><strong>Conclusion: </strong>The abbreviated English version of \"Locomotive Syndrome Clinical Guide 2010\" is complete, and we hope this Clinical Guide are utilized for any people who care \"Locomotive syndrome\".</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic factors in patients with bone metastasis of renal cell carcinoma in the era of immune checkpoint inhibitors.","authors":"Yuki Ishibashi, Hiroshi Kobayashi, Koichi Okajima, Takahiro Oki, Yusuke Tsuda, Yusuke Shinoda, Ryoko Sawada, Sakae Tanaka","doi":"10.1016/j.jos.2025.06.008","DOIUrl":"https://doi.org/10.1016/j.jos.2025.06.008","url":null,"abstract":"<p><strong>Background: </strong>Patients with clear cell renal cell carcinoma (ccRCC) have a higher incidence of bone metastasis; however, the availability of immune checkpoint inhibitors (ICIs) is expected to improve their overall survival (OS). Hence, accurate data on the prognosis and survival of patients with bone metastases are necessary to recommend appropriate treatments. Therefore, we investigated the prognosis and prognostic factors of patients with ccRCC bone metastasis in the era of ICIs.</p><p><strong>Methods: </strong>This retrospective cohort study included 33 patients with ccRCC who were treated for bone metastases between 2016 and 2022. We evaluated the association between OS and clinical parameters, including serum biochemical concentrations, and blood cell count, using Kaplan-Meier curves and Cox proportional hazards models.</p><p><strong>Results: </strong>The median OS was 28 months (95 % confidence interval (CI): 8 months - not censored), and the 1-year survival rate was 64 %. Twenty-one patients were treated with ICIs after bone metastasis diagnosis. The multivariate analysis revealed that the use of ICIs after bone metastasis diagnosis was a good prognostic factor (hazard ratio, 0.32; 95 % CI: 0.11-0.89, p = 0.029). Patients in the Katagiri score 5-7 points group using ICIs had a significantly longer survival (p = 0.012) but similar OS compared to the 2-4 points group (p = 0.34).</p><p><strong>Conclusions: </strong>ICI use after the diagnosis of bone metastasis may be a favorable prognostic factor in patients with bone metastases due to ccRCC. The predictive power of the current scoring system could underestimate the prognoses in patients with ccRCC and bone metastasis not treated with ICIs, highlighting the need for a better predictive scoring system in the era of ICIs.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early surgery within 48 h for post-injury hip fractures improved clinical outcomes.","authors":"Tsunemasa Kita, Taro Funamoto, Haruki Mori, Hiroshi Ikejiri, Takuya Tajima, Etsuo Chosa, Naosuke Kamei","doi":"10.1016/j.jos.2025.05.008","DOIUrl":"https://doi.org/10.1016/j.jos.2025.05.008","url":null,"abstract":"<p><strong>Background: </strong>A medical fee incentive based on a 48-h target time for hip fracture surgery has been implemented in Japan since 2022. This study aimed to evaluate the clinical outcomes of early surgery within 48 h after hip fracture.</p><p><strong>Methods: </strong>This study was a retrospective, single-center study. Patients >60 years of age who underwent hip fracture surgery between 2021 and 2022 were eligible. They were divided into 2 groups: 2021 (before implementation of the system) and 2022 (after implementation of the system). The primary outcome was the surgical waiting time after injury. The secondary outcomes were clinical outcomes such as postoperative complication rate, mortality rate at 1 and 6 months after surgery, and length of stay in our institution. To assess the influence of early surgery on these outcomes, an additional analysis was performed in 2 groups: the early group (surgery within 48 h) and the delayed group (surgery beyond 48 h).</p><p><strong>Results: </strong>In total, 365 patients were included in this study. The surgical waiting time was significantly shortened after the implementation of the system (64.5 h in 2021 vs. 42.8 h in 2022, p < 0.001). There were significant differences between the 2021 and 2022 groups in the complication rate (17 % vs. 9 %, p = 0.03) and length of hospital stay (15 days vs. 13 days, p < 0.001). A multivariate analysis between the early and delayed group showed that early surgery was associated with a lower complication rate and shorter length of stay (p < 0.05).</p><p><strong>Conclusion: </strong>Efforts to perform early surgery within 48 h of injury following the new reimbursement scheme have contributed to improved clinical outcomes, including lower complication rates and shorter hospital stay in our institution.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medial meniscus tears in early-stage medial knee osteoarthritis: Prevalence and type in a Japanese cohort.","authors":"Ichiro Sekiya, Hisako Katano, Hideyuki Koga, Noriya Okanouchi, Makoto Tomita, Jun Masumoto, Nobutake Ozeki","doi":"10.1016/j.jos.2025.06.010","DOIUrl":"https://doi.org/10.1016/j.jos.2025.06.010","url":null,"abstract":"<p><strong>Background: </strong>Medial meniscus (MM) tears are closely associated with medial knee osteoarthritis (OA); however, their relationship in early-stage OA remains poorly understood. The purpose of this study was to elucidate the prevalence and types of MM tears in relation to age, gender, Kellgren-Lawrence (KL) grade, and MM extrusion among participants in the Kanagawa Knee Study, with the aim of potentially capturing the transition from healthy knees to early-stage medial knee OA.</p><p><strong>Methods: </strong>The study analyzed 469 subjects (227 women, 242 men) aged 30-79 years. MM morphology was classified into six types using 3 T magnetic resonance imaging (3 T MRI): signal, horizontal tear, longitudinal tear, radial tear, complex tear, and root tear. The KL grades were automatically evaluated using KOALA software. The MM extrusion was measured on coronal MRI images.</p><p><strong>Results: </strong>MM tears were present in 18.2 % of the subjects, with complex (7.9 %) and horizontal (7.7 %) tears being the most common. The prevalence of MM tears increased with age, with women in their sixties and seventies showing a significant increase compared to younger age groups. A marked gender difference was observed in patients in their sixties, with women showing a 45 % prevalence of MM tears compared to 19 % in men. The prevalence of MM tears increased with KL grade: 7 % in KL0, 14 % in KL1, 51 % in KL2, and 100 % in KL3-4. The prevalence was significantly higher in knees with MM extrusion ≥3 mm (90 %) than in those with MM extrusion <3 mm (11 %).</p><p><strong>Conclusions: </strong>MM tears become more prevalent with advancing age, higher KL grade, and increased MM extrusion. The risk of MM tears appears to be considerably higher in women in their sixties than in men of the same age group.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and internal validation of a Cox proportional hazards model for predicting 1-year mortality in patients conservatively managed for hip fracture.","authors":"Keisuke Nakamura, Yasushi Kurobe, Tomohiro Sasaki, Masayuki Shimizu","doi":"10.1016/j.jos.2025.06.002","DOIUrl":"https://doi.org/10.1016/j.jos.2025.06.002","url":null,"abstract":"<p><strong>Background: </strong>Hip fractures in older adults are associated with high mortality and functional decline, particularly in conservatively managed patients. However, prognostic models specific to conservatively managed patients remain scarce. We aimed to develop and internally validate a Cox proportional hazards (PH) model to predict 1-year mortality based on admission data.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study at a community hospital in Japan, including 76 patients aged ≥65 years who sustained femoral neck or trochanteric fractures and received conservative treatment between April 2018 and April 2020. The primary outcome was 1-year all-cause mortality. Variables included demographics, comorbidities, cognitive function, fracture type, and nutritional status. Missing data were imputed using a random forest algorithm. Univariable and multivariable Cox PH models were used. Internal validation was performed with bootstrap resampling (1000 iterations). Model discrimination was assessed using Harrell's C-index, and calibration was assessed using calibration plots.</p><p><strong>Results: </strong>The Cox PH regression analysis yielded: h (t∣age, body mass index [BMI], fracture type) = h₀(t) exp (0.005 × age - 0.274 × BMI - 1.870 × fracture type) (Fracture type: 0 = femoral neck, 1 = trochanteric). Lower BMI (hazard ratio [HR] = 0.760; 95 % confidence interval [CI]: 0.637-0.908; p = 0.002) and trochanteric fractures (HR = 0.154; 95 % CI: 0.058-0.411; p < 0.001) were significant predictors of increased mortality. The model demonstrated good discrimination (Harrell's C-index: 0.774; optimism-adjusted: 0.762). Calibration was poor at early timepoints (90-270 days); however, it improved at 365 days (slope = 1.03; C-statistic = 0.83). Decision curve analysis confirmed clinical utility at threshold probabilities above 10 %.</p><p><strong>Conclusions: </strong>We developed a Cox PH regression model with good discrimination and acceptable calibration at 1 year to predict mortality in patients with conservatively managed hip fractures. This model may assist clinicians in early risk stratification and individualized care planning.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative results of uncalcined hydroxyapatite/poly-L-lactic acid composite screw fixation and titanium screw fixation in the Mitchell osteotomy for moderate hallux valgus deformity.","authors":"Kazuya Sugimoto, Shinji Isomoto, Tomohiro Matsui, Kimio Miura, Sayaka Wakiyama, Yusuke Kobayashi, Norihiro Samoto, Akira Taniguchi, Yasuhito Tanaka","doi":"10.1016/j.jos.2025.06.016","DOIUrl":"https://doi.org/10.1016/j.jos.2025.06.016","url":null,"abstract":"<p><strong>Background: </strong>No study has reported on the use of bioabsorbable screws in modified Mitchell osteotomies. This study aimed to clarify the clinical and radiographic findings of modified Mitchell osteotomy using a bioabsorbable screw compared with the use of a titanium screw.</p><p><strong>Methods: </strong>Fifty-one feet from 43 patients with hallux valgus angles (HVAs) > 20° and <40° were included in the study. The osteotomy was fixed using an unsintered hydroxyapatite/poly-l-lactic acid (u-HA/PLLA) screw in 29 feet from 23 patients (group A) and by a titanium headless screw in 22 feet from 20 patients (group B). Patient sex, age, and body mass index (BMI) at surgery, and preoperative and postoperative Japanese Society for Surgery of the Foot (JSSF) hallux scale scores of the two groups were compared. The HVA, intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA) were measured on weight-bearing radiographs preoperatively and 1 year postoperatively. Postoperative dorsal displacement of the 1st metatarsal head (DD1MH) was also assessed.</p><p><strong>Results: </strong>No significant preoperative differences in these parameters were observed between the groups. The median JSSF scores improved from 75 to 95 in group A and from 64 to 95 in group B. Preoperatively and 1 year postoperatively, the HVAs were 27.5 and 11.0 in group A, 25.5 and 11.3 in group B; the IMAs were 14.3 and 9.4 in group A, 13.6 and 8.8 in group B; the DMAAs were 6.7 and -2.2 in group A, 7.9 and 4.5 in group B. The DD1MHs were 0.5 in group A and 0.0 in group B. No significant differences in the postoperative JSSF scale, HVA, IMA or DD1MH were noted between the groups.</p><p><strong>Conclusions: </strong>The results of Mitchell osteotomy with u-HA/PLLA screws did not significantly differ from those with titanium screws in clinical outcomes, HVA, IMA and DD1MH at 1 year postoperatively.</p><p><strong>Study design: </strong>Case control study; Level of evidence, 3.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of symptomatic factors of os subfibulare using ultrasonography.","authors":"Tomohiro Matsui, Kenji Honda, Tsukasa Kumai, Takeshi Sugimoto, Yasushi Shinohara, Yasuhito Tanaka","doi":"10.1016/j.jos.2025.06.004","DOIUrl":"https://doi.org/10.1016/j.jos.2025.06.004","url":null,"abstract":"<p><strong>Background: </strong>The os subfibulare is considered a fusion failure of the secondary ossification center or avulsion fracture at the lateral ankle ligament involving the anterior talofibular ligament alone or in combination with the calcaneofibular ligament. The os subfibulare causes symptomatic repetitive ankle sprains; however, asymptomatic forms exist. We aimed to identify the symptomatic factors of os subfibulare using ultrasonography (US).</p><p><strong>Methods: </strong>Twenty-one feet of patients who underwent operative treatment for symptomatic os subfibulare and 24 feet of those with asymptomatic os subfibulare were examined. US images were retrospectively evaluated, and the size of the ossicle, distance from the lateral malleolus to the ossicle, and instability of the ossicle during the anterior drawer stress ultrasonography test were assessed.</p><p><strong>Results: </strong>The size of the ossicle was mean 6.0 mm and 5.6 mm for the patient and control groups, respectively (p = 0.61). The distance in the rest position was mean 3.9 mm and 2.5 mm (p < 0.05) and median 1.4 mm and 0.0 mm during the stress test (p < 0.05) for the patient and control groups, respectively.</p><p><strong>Conclusion: </strong>US is a useful examination tool for predicting os subfibulare prognosis. Additionally, the distance from the lateral malleolus in the rest position and dynamic instability were predictive factors for symptomatic os subfibulare.</p><p><strong>Levels of evidence: </strong>Level Ⅲ, Case control study.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a machine-learning model for patient satisfaction prediction in lumbar spinal stenosis surgery: A multicenter study with ZCQ and JOABPEQ scores.","authors":"Soya Kawabata, Gen Miura, Yuki Akaike, Sota Nagai, Kurenai Hachiya, Takaya Imai, Hiroki Takeda, Atsushi Yoshioka, Shinjiro Kaneko, Yudo Hachiya, Nobuyuki Fujita, Takayuki Kannon, Junichiro Yoshimoto","doi":"10.1016/j.jos.2025.06.014","DOIUrl":"https://doi.org/10.1016/j.jos.2025.06.014","url":null,"abstract":"<p><strong>Background: </strong>Patient satisfaction is an essential metric for evaluating treatment outcomes for LSS, both for patients and for their primary physicians. However, the Zurich Claudication Questionnaire (ZCQ) is the only representative patient-reported outcome measure that evaluates satisfaction. To develop a model using machine learning to predict postoperative satisfaction among older patients with lumbar spinal stenosis (LSS) based on preoperative and postoperative scores of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ).</p><p><strong>Methods: </strong>The training dataset was composed of time-course data of ZCQ and JOABPEQ scores from patients aged ≥65 years who underwent LSS surgery at a university hospital. The validation dataset included data from patients with LSS treated at a private orthopedic clinic. A linear support vector machine classifier was trained to predict achievement of a \"Satisfied\" state from preoperative and postoperative JOABPEQ scores. Internal validation was carried out via leave-one-out cross-validation, and external validation using a separate dataset to assess the accuracy, sensitivity, specificity, F1 score, and area under the receiver operating characteristics curve (AUROC). Variable importance was analyzed using model class reliance.</p><p><strong>Results: </strong>A total of 232 and 66 individuals were included in the training and validation datasets, respectively. The machine-learning model exhibited an accuracy of 0.72, sensitivity of 0.75, specificity of 0.69, and AUROC of 0.82. Psychological disorder and walking ability were identified through permutation importance analysis as key factors for satisfaction. External validation on an independent dataset demonstrated comparable accuracy (0.76), sensitivity (0.83), and AUROC (0.75), although the specificity decreased (0.42).</p><p><strong>Conclusions: </strong>The machine learning model presented here can predict the postoperative satisfaction score on the ZCQ from preoperative and postoperative JOABPEQ scores, highlighting its potential for broader application in clinical settings.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}