Long-term effect of intrathecal baclofen treatment on bone health and body composition after spinal cord injury:A case matched report  

作　　者：Dora E Ifon Mina P Ghatas John C Davis Refka E Khalil Robert A Adler Ashraf S Gorgey 

机构地区：[1]Spinal Cord Injury and Disorders Center,Central Virginia VA Health Care System,Richmond,VA 23249,United States [2]Medical Service,Central Virginia VA Health Care System,Richmond,VA 23249,United States [3]Department of Internal Medicine,Division of Endocrinology,Diabetes and Metabolism,Virginia Commonwealth University,Richmond,VA 23298,United States [4]Department of Physical Medicine and Rehabilitation,Virginia Commonwealth University,Richmond,VA 23298,United States

出　　处：《World Journal of Orthopedics》2020年第10期453-464,共12页世界骨科杂志（英文版）

基　　金：Supported by the DoD-CDRMP,No.W81XWH-14-SCIRP-CTA.

摘　　要：BACKGROUND Severe spasticity may negatively impact functionality and quality of life after spinal cord injury(SCI).Intrathecal baclofen treatment(IBT)is effectively used to manage severe spasticity and reduce comorbidities.However,long-term IBT may have a negative effect on bone mineral content(BMC),bone mineral density(BMD)and body composition(such as percentage fat mass and lean body mass).We demonstrated the negative effects of long-term IBT use in a single case compared with two non-IBT users.CASE SUMMARY A 46-year old Caucasian male Veteran(case)with a 21 year history of complete tetraplegia(complete C6 SCI)was implanted with IBT for 20 years.The case was matched to two participants with different time since injuries[2(match 1)and 13(match 2)years]without IBT.Knee BMC and BMD at the epiphysis and metaphysis of the distal femur and proximal tibia were evaluated using dual knee and the dual femur modules of GE Lunar iDXA software.Total and leg body composition assessments were also conducted for the three participants.Potential effect of long-term IBT was demonstrated by changes in BMD,consistent with bone demineralization,at the distal femur and proximal tibia and changes in percentage fat mass and lean mass of legs.The case showed 113%lower BMD at the distal femur,and 78.1%lower at the proximal tibia compared to match 1,moreover the case showed 45%lower BMD at the distal femur,and no observed changes at the proximal tibia compared to match 2.The case had 27.1%and 16.5%greater leg%fat mass compared to match 1 and match 2,respectively.Furthermore,the case had 17.4%and 11.8%lower%leg lean mass compared to match 1 and match 2,respectively.CONCLUSION Long-term IBT may impact bone health and body composition parameters in persons with complete SCI.It may be prudent to encourage regular screening of individuals on long-term IBT considering the prevalence of osteoporosis related fractures,cardiovascular diseases,and metabolic disorders in this population.

关 键 词：Intrathecal baclofen SPASTICITY Bone mineral density EPIPHYSIS METAPHYSIS Spinal cord injury Case report 

分 类 号：R651.2[医药卫生—外科学]