• Journal of Korean Neurosurgical Society
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• v.30 no.2
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• pp.173-179
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• 2001

Purpose : To assess therapeutic effects of percutaneous polymethylmethacrylate(PMMA) vertebroplasty on the pain caused by osteoporotic thoracic and lumbar vertebral body compression fractures in a large scale of a prospective clinical design, and to determine clinical factors influencing its therapeutic effects. Methods : A prospective clinical study was carried out in 349 vertebral levels of 159 patients between April 1998 and July 1999. The compression fractures were confirmed with bone scan and spine CT, and bone marrow density was measured. Visual analogue scale(VAS) score was used for pre- and post-operative assessments of the pain. All 159 patients were assessed immediately after surgery, and 140 patients of them were followed-up for about 6 months in average. Results : Partial and complete pain relief was sustained immediately after operation in 73%, through follow-up period in 88% of the patients. Pain relief was not proportional to the amount of PMMA or the rate of increase in the height of the compressed vertebral body. It appears that 3 to 6cc of PMMA was proper enough to sustain pain relief. Better clinical improvement was achieved in the patients treated within 6 months after occurrence of vertebral body fracture. The most frequent surgical complication was epidural leakage of PMMA, and the most serious complication was extravertebral leakage into the paravertebral muscles, which appeared to exert the worst influence on the outcome. However, surgery was not required in these patients. Conclusion : Therapeutic effects of PMMA percutaneous vertebroplasty on osteoporotic vertebral body compression fractures were confirmed in a relatively large scale of prospective clinical study. It appears that good outcome can be achieved in patients treated within 6 months after fracture, treated each level with 3 to 6cc of PMMA in amount. without serious complications.

• Journal of Korean Neurosurgical Society
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• v.45 no.6
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• pp.378-380
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• 2009

Osteoporotic patients who undergo percutaneous vertebroplasty (PVP) have the risk of a repeated collapse of their adjacent vertebral body due to alteration of load transfer into the adjacent vertebral body. The authors have experienced a rare case of repeated osteoporotic vertebral compression fractures (VCF) resulting in extreme multi-level PVP. A 74-year-old female developed severe back pain after slipping down one month ago. Her X-ray and MR images indicated a T11 VCF. She underwent successful PVP with polymethylmethacrylate (PMMA). Two weeks later, she returned to our hospital due to a similar back pain. Repeated X-ray and MR images showed an adjacent VCF on T12. A retrial of PVP was performed on T12, which provided immediate pain relief. Since then, repeated collapses of the vertebral body occurred 12 times in 13 levels within a 24-month period. Each time the woman was admitted to our hospital, she was diagnosed of newly developed VCFs and underwent repeated PVPs with PMMA, which finally eased back pain. Based on our experience with this patient, repeated multiple PVP is not dangerous because its few and minor complications. Therefore, repeated PVP can serve as an effective treatment modality for extreme-multi level VCFs.

• Journal of the Korean Orthopaedic Association
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• v.55 no.4
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• pp.318-323
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• 2020

Purpose: To examine the relationship between total fat infiltration (TFI) rate, which quantifies the reduction of muscles around the spine and is an important factor for sarcopenia, and the factors affecting osteoporotic vertebral compression fracture. Materials and Methods: Patients treated for osteoporotic compression fractures of the lumber spine from January 2012 to December 2016 were analyzed retrospectively. Among them, this study included ninety-eight patients who were 1) diagnosed with osteoporosis with a bone mineral density (BMD) T score of less than 2.5 g/cm², 2) received vertebroplasty or kyphoplasty for lumbar fractures, 3) involved one segment of the lumbar spine, and 4) were followed-up for more than one year. The TFI rate confirmed by analyzing magnetic resonance imagings with the Image J program was studied. Based on this, the relationship between the TFI of the multifidus and erector spinae muscles and the factors of osteoporosis were analyzed. Results: The mean TFI of the multifidus and erector spinae was 14.66±10.16. The spine BMD showed a positive correlation with the hip BMD, but a negative correlation with the TFI. A positive correlation was observed between the hip BMD and body mass index. In addition, vitamin D was positively correlated with both the hip and spine BMD but negatively correlated with the TFI rate. Conclusion: Muscle growth helps treat osteoporosis, and can prevent fractures that occur frequently in osteoporosis patients. Increasing the vitamin intake can also slow the progression of muscle atrophy.

• Journal of Korean Neurosurgical Society
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• v.46 no.6
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• pp.528-531
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• 2009

Objective : Although gadolinium enhancement of compression fractures is well known, the enhancement pattern of the acute stage of a fracture is not completely understood. Here, we investigated the enhancement pattern of acute vertebral compression fractures (VCFs). Methods : We conducted a retrospective study of patients with acute osteoporotic VCFs admitted to hospital between January 2004 and December 2005. The demographic details, stage of the fracture, management data, and results were analyzed. There were nine men and 22 women, and the mean age was 71 years (range, 53-92 years). According to the onset of pain, patients were divided into the following four groups : Group I (less than 3 days), Group II (4-7 days), Group III (8-14 days), and Group IV (14-30 days). Results : All patients had central low-signal intensity of the nonenhancing part of vertebral bodies on T1 images. Enhancing box sign (EBS) was seen 7 days of VCF development. After 7 days of onset (Groups III and IV), patch or Kummell's enhancements occurred. EBS has been statistically correlated with stage of compression fracture (Pearson's correlation = -0.774). However, EBS had no statistically significant correlation with prognosis in our study (Pearson's correlation = 0.059). Conclusion : EBS represents a characteristic sign 7 days of VCF development.

• The Korean Journal of Nuclear Medicine
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• v.38 no.6
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• pp.522-527
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• 2004

Purpose: The purpose of this study was to evaluate the usefulness of single photon emission computed tomography (SPECT) of bone using Tc-99m MDP in the diagnosis of osteoporotic vertebral fractures. Materials and Methods: Thirty two patients with osteoporotic vertebral fracture were included in this study (mean age: $67{\pm}8$, male: 5, female: 27). Seventy nine vertebral fractures were detected (38 thoracic/thoracolumbar lesions and 41 lumbar lesions), which were classified by type of deformity (wedge, biconcave or compression). The patterns and locations of increased uptakes were examined and analyzed. Results: Forty seven wedge fractures, 20 biconcave fractures and 12 compression fractures were found. Diffuse and asymmetric uptakes were common in fractured bodies. More than one uptake were examined in 69 posterior elements of fractured vertebrae (87.3%) including 40 of 47 wedge fractures (85.1%), 17 of 20 biconcave fractures (85.0%) and 12 of 12 compression fractures (100%). Wedge fractures were predominant fracture in thoracic/thoracolumbar spine whereas incidence of biconcave or compression type war similar to that of wedge fracture in lumbar spine (p=0.04). Spinous process uptake was more frequently seen in lumbar lesions than thoracic/thoracolumbar lesions (p=0.009). Facet joint uptake in biconcave fracture was more common in lumbar spine (92.3%) than thoracic/thoracolumbar spine (57.1%). Spinous process uptake in biconcave fracture was also more frequently detected in lumbar spine (p=0.043). Conclusion: Bone SPECT was useful in the evaluation of osteoporotic vertebral fracture, especially posterior elements of vertebrae.

• Journal of Korean Neurosurgical Society
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• v.30 no.11
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• pp.1271-1277
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• 2001

Objectives : Since vertebroplasty has been introduced, we performed short segment pedicle screw fixation with augmented intra-operative vertebroplasty in patients with unstable thoraco-lumbar fracture. Our intentions are to demonstrate the efficacy and indication of this new technique compare to conventional methods. Material and Methods : The surgery comprised of pedicle screw fixations on one level above and below the fracture site, and the fractured level itself, if pedicle is intact, and intra-operative vertebroplasty under the fluoroscopic guide with in-situ postero-lateral bone graft. Also, in cases of bone apposition, we removed those with small impactor through a transfascetal route. During the last 2 years, we performed in seven(7) unstable thoraco-lumbar fracture patients who consisted of two different characteristics, those four(4) with primary or secondary osteoporosis and three(3) of young and very healthy. All patients were followed clinically by A.S.I.A. score and radiography. Results : Mean follow up period was 14 months. We observed well decompressed state via transfascetal route in cases of bone fragments apposition and no hardware pullout in osteoporotic cases, no poly-methyl-methacrylate (PMMA) leakage through the fracture sites into the spinal canal, and no kyphotic deformities in both cases during follow-up periods. All patients demonstrated solid bony fusion except one following osteoporotic compression fracture on other sites. Conclusions : In the management of unstable thoraco-lumbar fracture, we believe that this short segment pedicle screw fixation with augmented intra-operative vertebroplasty reduce the total length or levels of pedicle screw fixation without post-operative kyphotic deformity.

• Journal of the Korean Orthopaedic Association
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• v.54 no.1
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• pp.24-29
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• 2019

Purpose: To evaluate the characteristics and the risk factors of early onset subsequent vertebral compression fractures after percutaneous vertebroplasty. Materials and Methods: A total of 44 patients, who had a new subsequent vertebral fracture after percutaneous vertebroplasty for an osteoporotic vertebral compression fracture between January 2013 and December 2015, were recruited. The patients were divided into two groups according to the onset period of subsequent fracture. The number of patients who had a fracture within 3 months following vertebroplasty were 22 cases (Group A); after 3 months were 22 cases (Group B). Variables, including age, sex, bone mineral density (BMD), body mass index (BMI), preexisting vertebral compression fracture, location of the initial fracture, intradiscal cement leakage, injected cement volume, restoration of vertebral body height, and correction of kyphosis, in the two groups were analyzed and compared retrospectively. Results: The age, sex, BMD, BMI, preexisting vertebral compression fracture, location of the initial fracture, intradiscal cement leakage, and correction of kyphosis were similar in the two groups. Both a greater volume of bone cement injected and a greater degree of vertebral height restoration contributed significantly to the risk of fracture within 3 months. Conclusion: The cement volume and degree of height restoration are risk factors for early onset fracture at the adjacent vertebrae after percutaneous vertebroplasty and close attention is needed during the follow-up period.

• Journal of Korean Neurosurgical Society
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• v.43 no.6
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• pp.288-293
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• 2008

Objective : Bone cement leakage is a well-known potential complication of percutaneous vertebroplasty (PVP) in patients with osteoporotic compression fracture. Even though there has been a controversy in the efficacy of antecedent venography to prevent this complication, many authors have performed intra osseous venography before bone cement injection. The goal of this study was to classify the venous drainage patterns of spine before PVP, and compare their patterns at different vertebral levels. Methods : The authors retrospectively reviewed 1,042 intraosseous venographic patterns in 321 patients with 574 osteoporotic compression fractures during six-year period in one institution. To classify venogram patterns, we selected simple lateral X-ray of spine taken immediately after injection of the contrast dye. We classified the venography patterns according to contrast leakage pattern and leakage direction as follows; trabecular (TR), trabecular anterior (TA), trabecular posterior (TP), trabecular anterior-posterior (TAP), trabecular lateral (TL), venous anterior(VA), venous posterior (VP), venous anterior-posterior (VAP), soft tissue (ST). Also, we compared venogram patterns according to different spinal levels. Results : In overall, the most common pattern was TP type accounting for 37.4% (390/1042) of all intraosseous venograms. This is followed by TAP in 21.5%, TR 17.4%, TA 116%, TL 5.8%, ST 4.1%, VA 1.2%, VP 0.6%, and VAP 0.4% in descending order of frequency. According to the spinal level, TR and TAP types were most common in thoracic spine (T6-T10), TP type was most common in thoraco-Iumbar spine (T11-L2), and TP and TAP types were most common in lumbo-sacral spine (L3-S1). Contrast dye leakage to soft tissue such as psoas muscle or disc were detected in 43 (4.1%) venograms. Direct venous drainage without staining of vertebral body was found in 23 (2.2%) venograms. The 8.3% of thoracic venogram showed direct venous drainage. Thoracic level showed a more tendency of direct venous drainage than other spine levels (p<001). Conclusion : The authors propose a new classification system of intra osseous venography during PVP. The trabecular-posterior (TP) type is most common through all spine, and venous-filling (V) type was most frequent in thoracic spine. Further study would be necessary to elucidate the efficacy of this classification system to prevent bone cement leakage during PVP.

• The Korean Journal of Pain
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• v.13 no.1
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• pp.126-129
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• 2000

Age-related osteoporotic compression fractures occur frequently in old aged group recently. Percutaneous vertebroplasty has recently been introduced as a therapeutic method for the treatment of pain associated with osteoporotic vertebral compression fracture. Percutaneous intravertebral injection of PMMA (polymethylmethacrylate) results in marked reduction in pain and morbidity. Among complications during vertebroplasty with PMMA, pulmonary embolism is repotred occasionally but the reports about hypotension are not common. This case is a report of a patient whom significant hypotension occured during percutaneous vertebroplasty.

• Journal of Korean Neurosurgical Society
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• v.42 no.5
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• pp.371-376
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• 2007

Objective : Balloon kyphoplasty can effectively relieve the symptomatic pain and correct the segmental deformity of osteoporotic vertebral compression fractures. While many articles have reported on the effectiveness of the procedure, there has not been any research on the factors affecting the deformity correction. Here, we evaluated both the relationship between postoperative pain relief and restoration of the vertebral height, and segmental kyphosis, as well as the various factors affecting segmental deformity correction after balloon kyphoplasty. Methods : Between January 2004 and December 2006, 137 patients (158 vertebral levels) underwent balloon kyphoplasty. We analyzed various factors such as the age and sex of the patient, preoperative compression ratio, kyphotic angle of compressed segment, injected PMMA volume, configuration of compression, preoperative bone mineral density (BMD) score, time interval between onset of symptom and the procedure, visual analogue scale (VAS) score for pain rating and surgery-related complications. Results : The mean postoperative VAS score improvement was $4.93{\pm}0.17$. The mean postoperative height restoration rate was $17.8{\pm}1.57%$ and the kyphotic angle reduction was $1.94{\pm}0.38^{\circ}$. However, there were no significant statistical correlations among VAS score improvement, height restoration rate, and kyphotic angle reduction. Among the various factors, the configuration of the compressed vertebral body (p=0.002) was related to the height restoration rate and the direction of the compression (p=0.006) was related with the kyphotic angle reduction. The preoperative compression ratio (p=0.023, p=0.006) and injected PMMA volume (p<0.001, p=0.035) affected both the height restoration and kyphotic angle reduction. Only the preoperative compression ratio was found to be as an independent affecting factor (95% CI : 1.064-5.068). Conclusion : The two major benefits of balloon kyphoplasty are immediate pain relief and local deformity correction, but segmental deformity correction achieved by balloon kyphoplasty does not result in additional pain relief. Among the factors that were shown to affect the segmental deformity correction, configuration of the compressed vertebral body, direction of the most compressed area, and preoperative compression ratio were not modifiable. However, careful preoperative consideration about the modifiable factor, the PMMA volume to inject, may contribute to the dynamic correction of the segmental deformity.