• Journal of Trauma and Injury
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• 제18권1호
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• pp.26-32
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• 2005

Purpose: We evaluate the characteristics of vertebral body fractures in two level flexion-distraction injuries of the thoracolumbar spine Methods: The findings of radiographs, computed tomographs, and MRIs of 43 patients with flexion-distraction injuries combined with vertebral body fractures were retrospectively evaluated. We divided the patients with bursting fractures into two groups, the distractive group (posterior vertebral height ratio >1) and the compressive group (vertebral height ratio <1). Results: There were 23 compression fractures and 20 bursting fractures. In bursting fractures, the distractive group had 5 cases, and the compressive group 15 cases. In 24 cases (55.8%), the interspinous distances were widened. The average of the canal encroachment was 4% in the distractive group and 40% in the compressive group. At last follow-up, the average loss of correction was 2.0 degree in compression fractures and 2.7 degree in bursting fractures. Conclusion: The configurations of vertebral body fractures in flexion-distraction injuries of the thoracolumbar spine were varied as to the location of the axis of flexion. Because bursting fractures in flexion-distraction injuries had distractive or compressive features, one should consider that in establishing operative plan.

• Journal of Korean Neurosurgical Society
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• 제41권3호
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• pp.161-165
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• 2007

Objective : Percutaneous approach to the middle thoracic vertebra through the transpedicular route for the patients with osteoporotic vertebral compression fractures is difficult due to the small size of the pedicle and parasagittally oriented vertebra body anatomy. The percutaneous vertebral body access [PVBA] technique utilizing the posterolateral extrapedicular approach avoids the pedicle and provides direct access to the vertebral body. The objective of this study is to evaluate the efficacy of the vertebroplasty utilizing PVBA technique for osteoporotic vertebral compression fractures in the middle thoracic vertebrae. Methods : A retrospective review was done on 20 patients who underwent vertebroplasty utilizing PVBA technique performed for painful osteoporotic compression fracture in the middle thoracic vertebrae at 22 levels from May 2003 to June 2006. The average amount of the injected cement was 1.5-2.5ml. The postprocedural outcome was assessed using a visual analogue scale [VAS]. Results : The treated vertebrae were T5 [1 level], T6 [5 levels], 17 [7 levels], and T8 [9 levels]. The compression rate and kyphotic angle were improved after procedure from $18%{\pm}13.4$ to $16%{\pm}13.8$ [p > 0.05] and from $6.9^{\circ}{\pm}6.7$ to $6.6^{\circ}{\pm}6.2$ [p>005], respectively. Preprocedural VAS was $8.2{\pm}0.70$ and was decreased to $2.1{\pm}1.02$ [p < 0.01] after treatment. Postprocedural cement leakage was noted in 3 levels [13.7%]. There were no cases of leakage to epidural space or neural foramen, segmental artery injury, and pneumothorax. Conclusion : These results suggest that the complication rates are low and good results can be achieved with vertebroplasty utilizing PVBA technique for the osteoporotic vertebral compression fractures especially in the middle thoracic vertebrae.

• Journal of Korean Neurosurgical Society
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• 제57권1호
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• pp.32-35
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• 2015

Objective : The purpose of this study was to analyze the relationship between fracture pattern and the development of acute radiculopathy after osteoporotic lumbar compression fracture. Methods : This study included 59 patients who underwent bone cement augmentation for osteoporotic compression fracture below the L2 level, which can lead to radiculopathic radiating pain. The patients were divided into two groups according to the presence of radiculopathy (group A : back pain only; group B : back pain with newly developed radiating pain). We categorized compression fractures into three types by the position of the fracture line. The incidence of newly developed radiculopathy was examined retrospectively for each compression fracture type. Results : The overall incidence of newly developed leg pain (group B) was 25%, and the frequency increased with descending spinal levels (L2 : 0%, L3 : 22%, L4 : 43%, and L5 : 63%). The back pain-only group (group A) had mostly superior-type fractures. On the other hand, the back pain with radiculopathy group (group B) had mostly inferior-type fractures. Most patients in group B showed significant relief of leg pain as well as back pain after bone cement augmentation. Conclusion : The incidence of a newly developed, radiating pain after osteoporotic compression fractures increased gradually from the L3 to L5 levels. Most of these fractures were of the inferior type, and the bone cement augmentation procedures seemed to be sufficient for relief of both back and radiating pain.

• 대한족부족관절학회지
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• 제15권2호
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• pp.51-57
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• 2011

Pilon fractures involving distal tibia remain one of the most difficult therapeutic challenges that confront the orthopedic surgeons because of associated soft tissue injury is common. To introduce and describe the diagnosis, current treatment, results and complications of the pilon fractures. In initial assessment, the correct evaluation of the fracture type through radiographic checkup and examination of the soft tissue envelope is needed to decide appropriate treatment planning of pilon fractures. Even though Ruedi and Allgower reported 74% good and excellent results with primary open reduction and internal fixation, recently the second staged treatment of pilon fractures is preferred to orthopedic traumatologist because of the soft tissue problem is common after primary open reduction and internal fixation. The components of the first stage are focused primarily on stabilization of the soft tissue envelope. If fibula is fractured, fibular open reduction and internal fixation is integral part of initial management for reducing the majority of tibial deformities. Ankle-spanning temporary external fixator is used to restore limb alignment and displaced intraarticular fragments through ligamentotaxis and distraction. And the second stage, definitive open reduction and internal fixation of the tibial component, is undertaken when the soft tissue injury has resolved and no infection sign is seen on pin site of external fixator. The goals of definitive internal fixation should include absolute stability and interfragmentary compression of reduced articular segments, stable fixation of the articular segment to the tibial diaphysis, and restoration of coronal, transverse, and sagittal plane alignments. The location, rigidity, and kinds of the implants are based on each individual fractures. The conventional plate fixation has more advantages in anatomical reduction of intraarticular fractures than locking compression plate. But it has more complications as infection, delayed union and nonunion. The locking compression plate fixation provides greater stability and lesser wound problem than conventional implants. But the locking compression plate remains poorly defined for intraarticular fractures of the distal tibia. Active, active assisted, passive range of motion of the ankle is recommended when postoperative rehabilitation is started. Splinting with the foot in neutral is continued until suture is removed at the 2~3 weeks and weight bearing is delayed for approximately 12 weeks. The recognition of the soft tissue injury has evolved as a critical component of the management of pilon fractures. At this point, the second staged treatment of pilon fractures is good treatment option because of it is designed to promote recovery of the soft tissue envelope in first stage operation and get a good result in definitive reduction and stabilization of the articular surface and axial alignment in second stage operation.

• The Korean Journal of Pain
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• 제21권3호
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• pp.197-201
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• 2008

Background: Kyphoplasty is a minimally invasive procedure that can stabilize osteoporotic and neoplastic vertebral fractures. We retrospectively evaluated the clinical outcomes of kyphoplasty for the treatment of vertebral compression fractures in cancer patients. Methods: We reviewed the clinical data of 27 cancer patients who were treated with kyphoplasty (55 vertebral bodies) between May 2003 and Feb 2008. The clinical parameters, using a visual analog 10 point scale (VAS) and the mobility scores, as well as consumption of analgesic, were evaluated preoperatively and at 1 week after kyphoplasty. Results: A total 55 cases of thoracic and lumbar kyphoplasties were performed without complications. The mean age of the patients was 66 years. All the patients experienced a significant improvement in their subjective pain and mobility immediately after the procedures. The pain scores (VAS), mobility scores and other functional evaluations using the Oswestry disability score and the SF-36 showed significant differences between the pre- and postoperational conditions. Conclusions: Kyphoplasty is an effective, minimally invasive procedure that can relieve the pain of patients with vertebral compression fractures and these fractures are the result of metastasis.

• Journal of Korean Neurosurgical Society
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• 제42권4호
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• pp.265-270
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• 2007

Objective : The current literature implies that the use of short-segment pedicle screw fixation for spinal fractures is dangerous and inappropriate because of its high failure rate, but favorable results have been reported. The purpose of this study is to report the short term results of thoracolumbar burst and compression fractures treated with short-segment pedicle instrumentation. Methods : A retrospective review of all surgically managed thoracolumbar fractures during six years were performed. The 19 surgically managed patients were instrumented by the short-segment technique. Patients' charts, operation notes, preoperative and postoperative radiographs (sagittal index, sagittal plane kyphosis, anterior body compression, vertebral kyphosis, regional kyphosis), computed tomography scans, neurological findings (Frankel functional classification), and follow-up records up to 12-month follow-up were reviewed. Results : No patients showed an increase in neurological deficit. A statistically significant difference existed between the patients preoperative, postoperative and follow-up sagittal index, sagittal plane kyphosis, anterior body compression, vertebral kyphosis and regional kyphosis. One screw pullout resulted in kyphotic angulation, one screw was misplaced and one patient suffered angulation of the proximal segment on follow-up, but these findings were not related to the radiographic findings. Significant bending of screws or hardware breakage were not encountered. Conclusion : Although long term follow-up evaluation needs to verified, the short term follow-up results suggest a favorable outcome for short-segment instrumentation. When applied to patients with isolated spinal fractures who were cooperative with 3-4 months of spinal bracing, short-segment pedicle screw fixation using the posterior approach seems to provide satisfactory result.

• Journal of Korean Neurosurgical Society
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• 제42권2호
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• pp.112-117
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• 2007

Objective : Kyphoplasty and vertebroplasty are two minimally invasive procedures for osteoporotic vertebral compression fractures. The purpose of this retrospective study was to compare the radiological findings and clinical outcomes between two procedures. Methods : Osteoporotic vertebral fractures were treated in 76 vertebrae, using kyphoplasty (n=35 vertebrae) and using vertebroplasty (n=41 vertebrae). Fractured vertebral bodies were diagnosed by correlating the clinical symptoms with radiologic study. The responses of pain symptoms were measured by a self-reported Visual Analog Scale (VAS) score. Plain X-rays were checked preoperatively and postoperatively at admission and 6 months. The vertebral body height and kyphotic angle were measured to assess the reduction of the sagittal alignment. Results : The mean pain scores were decreased significantly for both procedures postoperatively, but there were no significant differences between two groups. Kyphoplasty led to a significant reduction of the vertebral body height and improvement of kyphotic angle. There were no neurological deficits after kyphoplasty, but one patient experienced paraparesis after vertebroplasty. During the 6 months follow-up both procedures provided stabilization of the sagittal alignment. Conclusion : Kyphoplasty and vertebroplasty are considered effective minimally invasive techniques for the stabilization of osteoporotic vertebral body fractures, leading to a statistically significant reduction in pain. Kyphoplasty significantly restore sagittal alignment. Also, complications and the incidence of bone cement leakage are significantly lesser than vertebroplasty. Therefore, kyphoplasty seems to be reasonable procedure for osteoporotic vertebral body compression fractures when medical treatment fail.

• Journal of Korean Neurosurgical Society
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• 제45권6호
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• pp.369-374
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• 2009

Objective : Percutaneous vertebroplasty (VP) can provide immediate stabilization in pathologic fractures of spinal tumors. However, long term follow-up data in cases of pathologic fractures are lacking. The authors report follow-up results of VP in 185 pathologic fractures of 102 spinal tumor patients. Methods : Percutaneous VP was performed at 185 vertebral bodies of 102 patients from 2001 to 2007. Retrospective analysis was done with medical records and radiological data. The change of visual analogue score (VAS), vertebral body (VB) height and kyphotic angle were measured preoperatively and on postoperative one day and at 3, 6, and 12 months. Results : The patients were composed of metastatic spine tumors (81%) and multiple myeloma (19%). Involved spinal segments were between T6 and L5. Mean follow-up period was 12.2 months. VAS for back pain was 8.24 preoperatively, 3.59 (postoperative one day), 4.08 (three months) and 5.22 (one year). VB compression ratio changed from 21.33% preoperatively to 13.82% (postoperative one day), 14.36% (three month), and 16.04% (one year). Kyphotic angle changed from $15.35^{\circ}$ preoperatively to $12.03^{\circ}$ (postoperative one day), $13.64^{\circ}$ (three month), and $15.61^{\circ}$ (one year). Conclusion : Immediate pain relief was definite after VP in pathologic compression fracture of osteolytic spinal disease. Although VAS was slightly increased on one year follow-up, VP effect was maintained without significant change. These results indicate that VP could be a safe and effective procedure as a palliative treatment of the spinal tumor patients.

• Journal of Korean Neurosurgical Society
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• 제30권3호
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• pp.319-324
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• 2001

Objectives : The percutaneous vertebroplasty provides a good result in the treatment of osteoporotic vertebral compression fractures. But, the epidural leakage of polymethylmetacrylate(PMMA) after vertebroplasty may decrease the therapeutic effects because of the compression of thecal sac and/or nerve roots. The authors carried out a prospective study to evaluate the causative factors of epidural leakage of PMMA and to assess the influence on the outcome. Methods : This study involved 347 vertebral levels of compression fractures in 159 patients. Among these, the epidural leakages were identified in 92 vertebral levels(26.5%) in 64 patients(40.3%) on post-operative CT scan. Results : The incidence of epidural leakage of PMMA was significantly higher in the level above T7(p=0.001). The large amount of the injected PMMA and the use of an injector also increased the incidence(p=0.03 and p=0.045, respectively). The position of the needle tip in the vertebral body and the pattern of venous drainage did not influence. The immediate post-operative visual analogue scale(VAS) scores and facial scales(FS) were higher in the patients with epidural leakage(p=0.009). But there were no significant differences between the two groups after three months of operation(p=0.541). Conclusions : The incidence of epidural leakage of PMMA after percutaneous vertebroplasty appears to have relationship with the amount of PMMA and the levels injected. The epidural leakage of PMMA reduced the immediate therapeutic effects of vertebroplasty, but did not influence the late outcome. However, the epidural leakage should be avoided because of its potential neurological complications.

• Journal of Korean Neurosurgical Society
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• 제37권4호
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• pp.253-257
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• 2005

Objective: We analyze pain relief, deformity correction and complication rate after percutaneous kyphoplasty for osteoporotic vertebral compression fractures. Methods: The authors retrospectively reviewed medical records and radiological findings of 32 patients who underwent percutaneous kyphoplasty for osteoporotic vertebral compression fractures. Results: The patients had significant pain improvement with the procedure. The visual analogue scale score reduced from 8.6 to 3.4 significantly after the procedure. The midline vertebral body height significantly increased postoperatively, but mean kyphotic angle did not. There was no serious complication except one case of epidural cement leakage without neurological impairment. Conclusion: Balloon kyphoplasty safely can reduce severe back pain and returned geriatric patients to higher activity levels. The midline vertebral height is restored significantly. However kyphotic deformity correction is not significant as contrary to what we expected from the present study before it was carried out.