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Introduction: 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 present multicenter 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., Competing Interests: Conflicts of Interest: The authors declare that there are no relevant conflicts of interest., (Copyright © 2022 by The Japanese Society for Spine Surgery and Related Research.)

Introduction: Although intervertebral disc degeneration (IVDD) and spinopelvic malalignment are likely key structural features of spinal degeneration and chronic low back pain (CLBP), the correlation analysis has not been fully conducted. This cross-sectional quantitative magnetic resonance imaging (MRI) T2 mapping study aimed to elucidate the association between IVDD and spinopelvic alignment in CLBP patients., Methods: The subjects included 45 CLBP patients (19 men and 26 women; mean age, 63.8 ± 2.0 years; range, 41-79 years). The T2 values of the anterior annulus fibrosus (AF), the nucleus pulposus (NP), and the posterior AF were evaluated using MRI T2 mapping. We compared the possible correlations of spinopelvic parameters with T2 values of anterior AF, NP, and posterior AF using Pearson's correlation coefficient analysis. T2 values in these regions were classified into upper (L1-L2 and L2-L3), middle (L3-L4), and lower (L4-L5 and L5-S1) disc levels, and we analyzed the correlations with spinopelvic parameters., Results: There were significant correlations of the anterior AF T2 values with lumbar lordosis (r = 0.51, p < 0.01), sacral slope (r = 0.43, p < 0.01), sagittal vertical axis (r = -0.40, p < 0.01), and pelvic tilt (r = -0.33, p < 0.01). In all lumbar levels, T2 values of anterior AF had significantly positive correlation with LL and significantly negative correlation with SVA. In lower disc level, T2 values of anterior AF had significantly positive correlation with SS and significantly negative correlation with PT. T2 values of NP and posterior AF had no significant correlations with spinopelvic parameters in all lumbar disc levels., Conclusions: In summary, this study indicated that the anterior AF degeneration is associated with hypolordosis of the lumbar spine, anterior translation of the body trunk, and posterior inclination of the pelvis in CLBP. Anterior AF degeneration in all lumbar disc levels was associated with hypolordosis of the lumbar spine and anterior translation of the body trunk. Anterior AF degeneration in lower disc level was associated with posterior inclination of the pelvis., Competing Interests: Conflicts of Interest: The authors declare that there are no relevant conflicts of interest., (Copyright © 2020 by The Japanese Society for Spine Surgery and Related Research.)

Introduction: There have been several reports on surgical techniques involving microendoscopy or percutaneous endoscopy for treating lumbar foraminal stenosis (LFS). However, no studies have assessed the mid-term clinical results of endoscopic techniques in spite of their relatively long history. In this study, we report 20 consecutive cases of LFS treated by our microendoscopic technique focusing on clinical results with a follow-up of at least two years., Methods: Twenty consecutive cases of LFS treated with microendoscopic decompression were followed up at 1, 2, 6, and 12 months postoperatively and annually thereafter. The patients were 14 males and 6 females, and the mean age at the time of surgery was 64.7 years. The Japanese Orthopaedic Association (JOA) score was used as the clinical outcome index., Results: Of the 20 patients, 16 were monitored successfully for more than 2 years. The follow-up rate was 80.0%, and the mean follow-up period was 66.3 months. The JOA score improved from 13.8 points before surgery to 24.6 points at final follow-up. Revision fusion surgeries were performed in two cases for LFS recurrence., Conclusions: The microendoscopic technique effectively treats LFS., Competing Interests: Conflicts of Interest: The authors declare that there are no relevant conflicts of interest.

Introduction: Magnetic resonance spectroscopy (MRS) enables detailed analysis of the composition of muscular fat tissues such as intramyocellular lipids (IMCLs) and extramyocellular lipids (EMCLs). The aim of this study was to analyze the EMCL and IMCL of the multifidus muscle (Mm) using MRS in chronic low-back pain (CLBP) patients and identify their possible correlations with age, body mass index (BMI), low-back pain (LBP) visual analog scale (VAS) score, cross-sectional area (CSA), and fat infiltration of the Mm., Methods: Eighty patients (32 men and 48 women; mean age, 64.7 ± 1.3 years; range, 22-83 years) with VAS scores >30 mm for CLBP were included. We analyzed the gender difference and the possible correlations of age, BMI, LBP VAS, CSA, and fat infiltration of the Mm with the IMCL and EMCL of the Mm. The subjects were divided into five groups as per their age range: < 40s, 50s, 60s, 70s, and 80s. We also analyzed the EMCL and IMCL of the Mm as per the fat infiltration classification., Results: CSA was larger in the male group, EMCL was higher in the female group, and there was no significant difference in IMCL between the female and male groups. There was a significant positive correlation of EMCL with age (r = 0.33, p < 0.01) and BMI (r = 0.42, p < 0.01) and a significant negative correlation of EMCL with CSA (r = -0.61, p < 0.01). There was a significant positive correlation between IMCL and VAS (r = 0.43, p < 0.01). The EMCL and CSA of the Mm decreased with age, whereas fat infiltration increased with age., Conclusions: These results suggest that EMCL could indicate Mm degeneration associated with aging, and IMCL could be an effective objective indicator of CLBP. The EMCL and IMCL of the Mm may be useful prognostic markers in rehabilitation strategies., Competing Interests: Conflicts of Interest: The authors declare that there are no relevant conflicts of interest.