著者

Masashi Uehara Shota Ikegami Takashi Takizawa Hiroki Oba Noriaki Yokogawa Takeshi Sasagawa Kei Ando Hiroaki Nakashima Naoki Segi Toru Funayama Fumihiko Eto Akihiro Yamaji Kota Watanabe Satoshi Nori Kazuki Takeda Takeo Furuya Sumihisa Orita Hideaki Nakajima Tomohiro Yamada Tomohiko Hasegawa Yoshinori Terashima Ryosuke Hirota Hidenori Suzuki Yasuaki Imajo Hitoshi Tonomura Munehiro Sakata Ko Hashimoto Yoshito Onoda Kenichi Kawaguchi Yohei Haruta Nobuyuki Suzuki Kenji Kato Hiroshi Uei Hirokatsu Sawada Kazuo Nakanishi Kosuke Misaki Hidetomi Terai Koji Tamai Eiki Shirasawa Gen Inoue Kenichiro Kakutani Yuji Kakiuchi Katsuhito Kiyasu Hiroyuki Tominaga Hiroto Tokumoto Yoichi Iizuka Eiji Takasawa Koji Akeda Norihiko Takegami Haruki Funao Yasushi Oshima Takashi Kaito Daisuke Sakai Toshitaka Yoshii Tetsuro Ohba Bungo Otsuki Shoji Seki Masashi Miyazaki Masayuki Ishihara Seiji Okada Yasuchika Aoki Katsumi Harimaya Hideki Murakami Ken Ishii Seiji Ohtori Shiro Imagama Satoshi Kato

出版者

The Japanese Society for Spine Surgery and Related Research

雑誌

Spine Surgery and Related Research (ISSN:2432261X)

巻号頁・発行日

pp.2021-0183, (Released:2021-12-27)

被引用文献数

2

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Background: In elderly patients with cervical spinal cord injury, comorbidities such as cardiovascular and cerebrovascular diseases are common, with frequent administration of antiplatelet/anticoagulant (APAC) drugs. Such patients may bleed easily or unexpectedly during surgery despite prior withdrawal of APAC medication. Few reports have examined the precise relationship between intraoperative blood loss and history of APAC use regarding surgery for cervical spine injury in the elderly.The presentmulticenter database survey aimed to answer the question of whether the use of APAC drugs affected the amount of intraoperative blood loss in elderly patients with cervical spinal cord trauma.Methods: The case histories of 1512 patients with cervical spine injury at 33 institutes were retrospectively reviewed. After excluding cases without spinal surgery or known blood loss volume, 797 patients were enrolled. Blood volume loss was the outcome of interest. We calculated propensity scores using the inverse probability of treatment weighting (IPTW) method. As an alternative sensitivity analysis, linear mixed model analyses were conducted as well.Results: Of the 776 patients (mean age: 75.1 ± 6.4 years) eligible for IPTW calculation, 157 (20.2%) were taking APAC medications before the injury. After weighting, mean estimated blood loss was 204 mL for non-APAC patients and 215 mL for APAC patients. APAC use in elderly patients was not significantly associated with surgical blood loss according to the IPTW method with propensity scoring or linear mixed model analyses. Thus, it appeared possible to perform surgery expecting comparable blood loss in APAC and non-APAC cases.Conclusions: This multicenter study revealed no significant increase in surgical blood loss in elderly patients with cervical trauma taking APAC drugs. Surgeons may be able to prioritize patient background, complications, and preexisting conditions over APAC use before injury when examining the surgical indications for cervical spine trauma in the elderly.

著者

Masashi Uehara Yukio Nakamura Jun Takahashi Mikio Kamimura Shota Ikegami Takako Suzuki Shigeharu Uchiyama Tomomi Yamaguchi Tomoki Kosho Hiroyuki Kato

出版者

Tohoku University Medical Press

雑誌

The Tohoku Journal of Experimental Medicine (ISSN:00408727)

巻号頁・発行日

vol.242, no.2, pp.115-120, 2017 (Released:2017-06-16)

参考文献数

25

被引用文献数

10 18

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Osteogenesis imperfecta (OI) is an inherited bone disorder that causes fractures due to impaired production of collagen type I. In recent years, denosumab, a human monoclonal antibody against receptor activator of nuclear factor κB ligand (RANKL), has become widely used as an anti-osteoclastic agent for osteoporosis. This study investigated osteoporotic cases of OI to examine effects of denosumab on bone fragility. This was a retrospective, consecutive case series that included 3 female patients aged 42, 40, and 14 years, respectively. One patient carries a point mutation (c.G769A) in the COL1A1 gene, encoding collagen type I alpha 1 chain, which causes an amino-acid substitution (p.G257R). By contrast, no mutation was found in the analyzed regions of the OI responsive genes in another two patients (mother and daughter). These three patients underwent subcutaneous injection of denosumab every 6 months. All patients underwent dual-energy X-ray absorptiometry for bone mineral density (BMD) measurement of the lumbar 1-4 spine (L-BMD) and bilateral hips (H-BMD) before and during treatment. BMD and laboratory data were evaluated before, between 2 and 4 months, and at 6, 12, 18, and 24 months of therapy. No fractures or severe side effects, such as hypocalcemia, were observed during denosumab treatment. Both L-BMD and H-BMD were increased by denosumab. At 24 months, the mean percentage changes in L-BMD and H-BMD were 14.7% and 15.1%, respectively. In conclusion, no bone fragility fractures occurred during 2 years of denosumab administration in OI patients. Denosumab therefore is a good therapeutic option in the OI patients.