Locomotive Syndrome: Prevalence, Surgical Outcomes, and Physical Performance of Patients Treated to Correct Adult Spinal Deformity
Journal of Spine Research
Locomotive syndrome (LS) was proposed by the Japanese Orthopedic Association and refers to a scenario in which imminent future nursing care services will be required by elderly adults to manage the functional deterioration of their locomotive organs. It is a social imperative to determine the risk factors and treatment strategy for LS; however, the relationship between LS and adult spinal deformity (ASD) in those who are treated with spinal corrective surgery remains largely unknown. To
... h the optimal surgical strategy for treating LS in patients with ASD, we sought to (1) determine the prevalence of LS in patients with ASD who were treated with spinal corrective surgery and (2) evaluate the improvement of LS after surgical spinal correction. Methods: Forty-seven consecutive patients who had ASD and underwent spinal surgery for their disorder were included in this study. Locomotive dysfunction was evaluated using the 25-item Geriatric Locomotive Function Scale-25 (GLFS-25) questionnaire and physical performance tests, including the one-legged standing test, two-step test, stand-up test, handgrip strength test, and gait speed test, which were conducted preoperatively, 1 year after surgery, and 2 years after surgery. Results: Among the patients with ASD who were treated surgically, 100% had LS preoperatively and 91% had grade 3 LS (LS3). Prevalence of LS3 significantly decreased 2 year after surgery by 55% compared with the preoperative rate. Among spinopelvic parameters, only the sagittal vertical axis (SVA) significantly correlated with the GLFS-25 values. The GLFS-25 items for the domains of pain, mobility, and domestic life improved overall postoperatively, whereas those in the self-care domain did not and the item for difficulty in putting on and taking off trousers and pants worsened. Conclusions: Spinal corrective surgery significantly improved physical performance as well as the frequency and severity of LS in patients with ASD. However, some GLFS-25 items can worsen after surgery and require attention.