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- 저자 : Mikito Tsushima (검색결과 3 건)
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Kazuyoshi Kobayashi,Kei Ando,Hideki Yagi,Kenyu Ito,Mikito Tsushima,Masayoshi Morozumi,Satoshi Tanaka,Masaaki Machino,Kyotaro Ota,Yukihiro Matsuyama,Naoki Ishiguro,Shiro Imagama 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.4
Study Design: Retrospective study. Purpose: To examine the relationship between postoperative bowel bladder disorder (BBD) and the efficacy of needle electrodes for the external anal sphincter (EAS) in intraoperative spinal cord monitoring with transcranial muscle action potentials (Tc-MsEP). Overview of Literature: Spinal surgery for spina bifida, spinal cord tumor, and spinal tethered cord syndrome has a high rate of postoperative BBD. Monitoring of the EAS with Tc-MsEP is frequently performed during spinal surgery. We initially used plug-surface electrodes for this purpose, but have more recently switched to needle electrodes for the monitoring of the EAS. To date, there has been no comparison between the utility of these electrodes. Methods: Waveform derivation, exacerbation of postoperative BBD, and sensitivity and specificity for prediction of BBD by 70% amplitude reduction of EAS activity using needle and plug-surface electrodes were investigated in 239 spine surgeries. The cut-off for the % drop in amplitude for BBD prediction was determined for EAS monitoring using a needle electrode. Results: The overall rate of postoperative BBD aggravation was 7.1% (17/239 cases), with the individual rates using needle and plug-surface electrodes being 6.9% (8/116) and 7.3% (9/123), respectively. The waveform derivation rate was significantly higher using needle electrodes (91.3% [106/116] vs. 76.4% [94/123], p <0.01). In patients with baseline waveform detection, the sensitivity and specificity for postoperative BBD were similar in the two groups. With needle electrodes, a cutoff amplitude of Tc-MsEP for the EAS at the end of surgery of 25% of the baseline amplitude had a sensitivity of 89% and specificity of 82% for the prediction of postoperative BBD aggravation. Conclusions: The significantly higher waveform derivation rate using needle electrodes suggests that these electrodes are effective for monitoring the EAS in spinal surgery in cases with preoperative BBD.
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Perioperative Management of Patients with Hemophilia during Spinal Surgery
Kazuyoshi Kobayashi,Shiro Imagama,Kei Ando,Kenyu Ito,Mikito Tsushima,Masayoshi Morozumi,Satoshi Tanaka,Masaaki Machino,Kyotaro Ota,Yoshihiro Nishida,Naoki Ishiguro 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.3
Study Design: Single-center retrospective study. Purpose: To optimize the perioperative management of patients with hemophilia who are undergoing spinal surgery. Overview of Literature: Hemophilia is a rare disease in which there is a tendency of bleeding because of a congenital deficiency in blood coagulation factor activity. There has been no previous report on spinal surgery in patients with hemophilia. Methods: The subjects were five patients (all males) with hemophilia who underwent spinal surgery at Nagoya University Hospital. Two patients had hemophilia A (deficiency of factor VIII) and three had hemophilia B (deficiency of factor IX). The mean age at the time of surgery was 63 years (range, 46–73 years). The following surgeries were performed: posterior lumbar interbody fusion (PLIF) in two patients, and lumbar fenestration, cervical laminoplasty and lumbar fenestration, and cervical laminoplasty and PLIF in one patient each. Results: Coagulation factor at a mean dose of 4.8 ×103 U (range, 3–6 ×103 U) was intravenously injected before surgery, and a mean dose of 5.2 ×103 U (rang, 4–6 ×103 U) was continuously administered for 24 hours after surgery. Factor activity was maintained at ≥80% until postoperative day 14 and at ≥50% thereafter. The average duration of surgery was 178 minutes (range, 133–233 minutes), the estimated blood loss was 661 mL (range, 272–1,344 mL), and a drain tube was left subfascially in place for 2 days in all patients. Reoperation due to postoperative surgical site infection was required in one patient, but there were no complications due to hemorrhagic diathesis. The total dose of coagulation factor administered during hospitalization was 102 ×103 U (range, 46–198 ×103 U). Conclusions: Coordination with a hematologist and dose adjustment of the coagulation factor preparation to maintain a target level of coagulation factor activity facilitated a smooth postoperative course with perioperative control of bleeding during spinal surgery for patients with hemophilia.
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Variety of the Wave Change in Compound Muscle Action Potential in an Animal Model
Zenya Ito,Shiro Imagama,Kei Ando,Akio Muramoto,Kazuyoshi Kobayashi,Tetsuro Hida,Kenyu Ito,Yoshimoto Ishikawa,Mikito Tsushima,Akiyuki Matsumoto,Satoshi Tanaka,Masayoshi Morozumi,Yukihiro Matsuyama,Naok 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.6
Study Design: Animal study. Purpose: To review the present warning point criteria of the compound muscle action potential (CMAP) and investigate new criteria for spinal surgery safety using an animal model. Overview of Literature: Little is known about correlation palesis and amplitude of spinal cord monitoring. Methods: After laminectomy of the tenth thoracic spinal lamina, 2–140 g force was delivered to the spinal cord with a tension gage to create a bilateral contusion injury. The study morphology change of the CMAP wave and locomotor scale were evaluated for one month. Results: Four different types of wave morphology changes were observed: no change, amplitude decrease only, morphology change only, and amplitude and morphology change. Amplitude and morphology changed simultaneously and significantly as the injury force increased (p <0.05) Locomotor scale in the amplitude and morphology group worsened more than the other groups. Conclusions: Amplitude and morphology change of the CMAP wave exists and could be the key of the alarm point in CMAP.
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