title: Spinal sagittal balance substantially influences locomotive syndrome and physical performance in community-living middle-aged and elderly women.
abstract: OBJECTIVE
  Spinal sagittal imbalance has been well known risk factor of decreased quality of life in the field of adult spinal deformity. However, the impact of spinal sagittal balance on locomotive syndrome and physical performance in community-living elderly has not yet been clarified. The present study investigated the influence of spinal sagittal alignment on locomotive syndrome (LS) and physical performance in community-living middle-aged and elderly women.
  
  
  METHODS
  A total of 125 women between the age of 40-88 years (mean 66.2 ± 9.7 years) who completed the questionnaires, spinal mouse test, physical examination and physical performance tests in Yakumo study were enrolled in this study. Participants answered the 25-Question Geriatric Locomotive Function Scale (GLFS-25), the visual analog scale (VAS) for low back pain (LBP), knee pain. LS was defined as having a score of >16 points on the GLFS-25. Using spinal mouse, spinal inclination angle (SIA), thoracic kyphosis angle (TKA), lumbar lordosis angle (LLA), sacral slope angle (SSA), thoracic spinal range of motion (TSROM), lumbar spinal range of motion (LSROM) were measured. Timed-up-and-go test (TUG), one-leg standing time with eyes open (OLS), and maximum stride, back muscle strength were also measured. The relationship between spinal sagittal parameters and GLFS-25, VAS and physical performance tests were analyzed.
  
  
  RESULTS
  26 people were diagnosed as LS and 99 were diagnosed as non-LS. LBP and knee pain were greater, physical performance tests were poorer, SIA were greater, LLA were smaller in LS group compared to non-LS group even after adjustment by age. SIA significantly correlated with GLFS-25, TUG, OLS and maximum stride even after adjustment by age. The cutoff value of SIA for locomotive syndrome was 6°. People with a SIA of 6° or greater were grouped as "Inclined" and people with a SIA of less than 6° were grouped as "Non-inclined". 21 people were "Inclined" and 104 were "Non-inclined". Odds ratio to fall in LS of Inclined group compared to Non-inclined group is 5.0. GLFS-25 were significantly higher, VAS for LBP were greater, TUG, OLS and maximum stride were poorer in Inclined group compared to Non-inclined group even after adjustment by age.
  
  
  CONCLUSIONS
  The present study demonstrated that spinal sagittal balance influences the LS and physical performance in community-living middle-aged and elderly women. SIA is a useful spinal parameter to evaluate the risk of LS, and its cutoff value is 6°.
authors.affiliation: Department of Spine Surgery, Kariya Toyota General Hospital, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Muramoto
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan. Electronic address: imagama@med.nagoya-u.ac.jp.
authors.forename: Shiro
authors.initials: S
authors.lastname: Imagama
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan.
authors.forename: Zenya
authors.initials: Z
authors.lastname: Ito
authors.affiliation: Department of Orthopedic Surgery, Japanese Red Cross Nagoya First Hospital, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Hirano
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishiguro
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan.
authors.forename: Yukiharu
authors.initials: Y
authors.lastname: Hasegawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008124:Locomotion / Q000502:physiology*; D017116:Low Back Pain / Q000503:physiopathology*; D008875:Middle Aged; D051346:Mobility Limitation; D053580:Muscle Strength / Q000502:physiology*; D004856:Postural Balance / Q000502:physiology*; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013577:Syndrome