• Journal of Korean Neurosurgical Society
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• 제45권1호
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• pp.16-23
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• 2009

Objective : This retrospective study of 215 patients with 383 symptomatic osteoporotic vertebral compression fractures (VCFs) treated by percutaneous vertebroplasty (PVP), was performed to evaluate the clinical outcomes, and to analyze the various clinical factors affecting these results. Methods : The authors assessed the clinical outcome under the criteria such as the pain improvement, activity, requirement of analgesics, and the patient's satisfaction, and determined the relation to various peri- and intra-operative factors, and postoperative imaging findings. Results : The outcome was determined as 84.2% in relief of pain, 72.0% in change in activity, 65.7% in analgesics use, and 84.7% of satisfaction rate. More severe focal back pain, high uptake bone scan, and the lower mean T-score were related to the better pain relief following PVP. The longer the duration between fracture and PVP, the less severe focal back pain, low uptake bone scan, and leakage of PMMA into the paravertebral space were related to the less improvement in activity. Female and low uptake bone scan showed a correlation with more analgesic use. The longer the duration between fracture and PVP, low uptake bone scan, and the higher the mean T-score were correlated with the less the patients satisfaction. Conclusion : Our study suggests that PVP may be more effective in the acute phase of VCFs, more severe focal pain, and far advanced osteoporosis on BMD. Leakage of PMMA into the paravertebral spcae also could be affecting the surgical results.

• Journal of Korean Neurosurgical Society
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• 제39권4호
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• pp.256-259
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• 2006

Objective : Having a reliable and reproducible measurement technique to measure the sagittal contour in vertebral fractures is paramount to clinical decision making. This study is designed to determine the most reliable measurement technique in osteoporotic vertebral compression fracture. Methods : Fifteen lateral radiographs of thoracic and lumbar fractures were selected and measured on two separate occasions by three spine surgeons using six different measurement techniques [Centroid, Harrison Posterior Tangent Methods and 4 different types of modified Cobb method]. The radiograph quality was assessed and the center beam location was determined. Statistical analysis including ANOVA for repeated measures was carried out using the SAS software [v 8.0]. Results : The inter and intraobserver variance of the Cobb method 4 and Harrison posterior tangent method were significantly lower than the other four methods. The intraobserver correlation coefficients were the most consistent using the Cobb method 4 [0.982]. which was followed by the Harrison posterior tangent [0.953] and Cobb methods 1 [0.874]. The intraobserver agreement [% of repeated measures within 5 degrees of the original measurement] ranged from 42% to 98% for each technique for all three observers, with the Cobb method 4 showing the best agreement [97.8%] followed by the Harrison posterior tangent method [937%]. Conclusion : The Cobb method-4 and Harrison posterior tangent methods, when applied to measuring the kyphosis, are reliable and have a similar small error range. The Cobb method 4 shows the best overall reliability. However, the centroid method and Cobb method using a fractured endplate do not produce an accurate result due to inter and intraobserver differences in determining the baseline.

• Journal of Korean Neurosurgical Society
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• 제47권3호
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• pp.199-202
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• 2010

Objective : Balloon kyphoplasty is a minimally invasive procedure that is mainly performed for refractory pain due to osteoporotic compression fractures. The purpose of this study was to evaluate the results of balloon kyphoplasty performed at different times after an injury. Methods : In this retrospective study, the records of 99 patients who underwent one level of balloon kyphoplasty between January 2005 and December 2007 were reviewed. The patients were divided into three groups : 21 patients treated within 3 weeks of an injury (the acute group), 49 treated within 3 weeks to 2 months of an injury (the subacute group), and 29 patients treated at more than 2 months after an injury (the chronic group). Clinical outcomes were assessed using a visual analogue scale (VAS). In addition, modified MacNab's grading criteria was used to assess the subjective patient outcome. The radiology findings, including vertebral height restoration and procedure related complications, were analyzed based on the different time intervals after the injury. Results : Patients in all three groups achieved marked pain relief in terms of the VAS within 7 days of the procedure. Good or excellent results were achieved by most patients in all three groups. However, the height restoration, the main advantage to performing a balloon kyphoplasty, was not achieved in the chronic group. Moreover, evidence of complications including cement leakage was observed significantly less frequently in the subacute group compared to the other two groups. Conclusion : Although balloon kyphoplasty is an effective treatment for osteoporotic compression fractures, with regard to pain relief, the subacute stage appears to be optimal for treating patients with a balloon kyphoplasty in terms of achieving the best outcomes with minimal complications.

• 대한정형외과학회지
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• 제55권4호
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• pp.318-323
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• 2020

목적: 근감소증에 중요한 요소인 척추 주변 근육 감소를 수치화한 총 지방 침윤율(total fat infiltration rate, TFI rate)과 골다공증성 척추 압박 골절(osteoporotic vertebral compression fracture) 및 관련 수치와의 상관 관계를 찾는 것을 목표로 하였다. 대상 및 방법: 2012년 1월부터 2016년 12월까지 요추의 압박 골절 진료를 본 환자들 중 1) 골밀도(bone mineral density, BMD) T score -2.5 g/cm² 미만으로 골다공증을 진단받고, 2) 요추 골절로 경피적 척추성형술(vertebroplasty) 또는 경피적 풍선척추성형술(kyphoplasty)을 받았으며, 3) 요추의 한 분절만 골절된 4) 1년 이상 추시한 환자 98명을 대상으로 후향적 연구를 시행하였다. TFI는 Image J 프로그램으로 자기공명영상을 분석하여 확인하였다. 이를 바탕으로 다열근(multifidus) 및 척추기립근(erector spinae)의 TFI와 골다공증 요소들과의 연관성을 분석하였다. 결과: 다열근및 척추기립근의 평균 TFI는 14.66±10.16이었다. 척추 BMD는 고관절 BMD와 통계적으로 유의한 양의 상관 관계를 보였으나 TFI와 음의 상관 관계를 보였다. 고관절 BMD는 체질량지수(body mass index)와 유의한 양의 상관 관계를 보였다. 또한 비타민 D 수치는 척추 BMD와 고관절 BMD에서 모두 양의 상관 관계를 보였으나, TFI와는 음의 상관 관계를 보였다. 결론: 근육량은 근감소증 환자뿐만 아니라 골다공증 환자의 치료에 있어서도 도움이 되므로 주의깊게 보아야 할 것이다. 또한 비타민 D를 증가시키는 것은 근육 위축의 진행을 늦출 수 있으므로 이로써 골절을 예방하는 효과를 가져올 수 있다.

• Clinics in Shoulder and Elbow
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• 제16권1호
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• pp.33-39
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• 2013

목적: 고령 환자의 상완골 원위부 골절에서 이중 강선 장력대 고정술을 이용한 수술의 임상적 결과를 분석하여 그 유용성을 알아보고자 한다. 대상 및 방법: 상완골 원위부 골절 환자 중 AO 분류상 C형 골절과 골다공증을 가진 65세 이상의 고령 환자에서 이중 강선 장력대 고정술을 이용해 관혈적 정복과 내고정을 시행 받은 10예를 대상으로 하였다. 남자가 1명, 여자가 9명이었으며 평균 연령은 74.6(66~84)세였다. 평균 추시 기간은 39.2(20~74)개월이었다. 골유합 유무, 시기와 주관절의 운동 범위를 측정하였고, Mayo 주관절 수행 점수, Jupiter 등에 의한 평가법을 이용하여 기능 상태를 평가하였다. 결과: 골유합은 10명에서 2차적인 전위 없이 이루어졌고, 평균 골유합 기간은 16.6(13~22)주였다. 최종 추시시 측정한 평균 주관절 운동범위는 굴곡 구축은 8.5 (0~15)도, 후속 굴곡 119(100~140)도, Mayo 주관절 수행 점수는 82(70~90)점으로 각각 우수 2예(20%), 양호 7예(70%), 보통 1예(10%)였다. Jupiter 등에 의한 평가법을 따르면 각각 우수 7예(70%), 양호 1예(10%), 보통 2예(20%)였다. 1예에서 이소성 골화가 있었으나 그에 따른 증상은 동반되지 않아 추시 관찰하기로 하였으며, 1예에서 강선에 대한 피부 자극 증상이 발생하여 장력대 강선 교체 수술을 시행하였다. 결론: 골다공증을 가진 고령 환자의 상완골 원위부 C형 골절의 수술적 치료에서 이중 강선 장력대 고정술은 견고한 고정과 동시에 조기 관절 운동을 가능하게 하여 효과적이며 우수한 치료법으로 사료된다.

• 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.

• Clinics in Shoulder and Elbow
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• 제21권4호
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• pp.220-226
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• 2018

Background: This study introduces a surgical technique with good clinical outcome useful in the treatment of osteoporotic displaced 3- or 4-part proximal humeral fractures. Methods: From May 2014 to February 2016, 16 patients with displaced 3- or 4-part proximal humeral fractures were treated by application of a locking plate with an endosteal strut allograft via a deltoid splitting approach with a minimum follow-up of 12 months. The allograft was inserted through a fractured gap of the greater tuberosity to support the humeral head and then fixed by a locking plate with meticulous soft tissue dissection to protect the axillary nerve. Surgical outcomes were evaluated by the American Shoulder and Elbow Surgeons (ASES) and visual analogue scale (VAS) scores, radiological imaging, and clinical examination. Fixation failure on radiographs was defined as a >$5^{\circ}$ loss of neck shaft angle (NSA) compared to that on an immediate postoperative radiograph. Avascular necrosis (AVN) of the humeral head was also evaluated. Results: In all cases, complete union was achieved. The ASES and VAS scores were improved to $85.4{\pm}2.1$ and $3.2{\pm}1.3$, respectively. Twelve patients (75.0%) had greater than a $5^{\circ}$ change in NSA; the average NSA change was $3.8^{\circ}$. Five patients (31.3%) had unsatisfactory ranges of motion exhibiting a <$100^{\circ}$ active forward flexion. No axillary nerve injuries or AVN were observed at the last follow-up. One patient was converted to reverse total arthroplasty due to severe pain and functional deficit. Conclusions: Minimally invasive fixation via a locking compression plate and an endosteal fibula strut allograft in Neer classification 3-or 4-part fractures with severe osteoporosis in elderly patients can achieve good clinical results.

• The Korean Journal of Pain
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• 제13권1호
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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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• 제43권6호
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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.

• Journal of Trauma and Injury
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• 제18권2호
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• pp.87-93
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• 2005

Background: The most frequent fracture seen at the emergency department (ED) in the elderly is a femur fracture whereas they do not know the degree of osteoporosis. We analyzed the degree of osteoporosis in patients with femur fractures and compared patients with only femur fractures (FX) to patients with femur and vertebral fractures (VX) by examining the clinical features, the bone mineral density (BMD), and biochemical markers. Methods: From January 2004 to December 2004, we enrolled prospectively 30 femur fracture patients who visited the ED. The bone mineral densities of the lumbar spine and the femur were examined. Total calcium, phosphate, alkaline phosphatase, osteocalcin, and serum C-terminal telopeptide (s-CTx) were measured. The patients with femur fractures were divided into two subgroups according to the presence of vertebral fracture. Results: All BMDs of the FX group showed osteoporosis. The s-CTx levels were higher than normal. The patients in the FX with VX were older than those in the FX only group, and had lower BMDs. There were no significant differences in markers between the subgroups, but the incidence of trochanteric fractures was higher in FX with VX group than in the FX only group. Conclusion: Femur fractures in the elderly were associated with osteoporosis. In our study, despite a considerable difference in BMD between patients with femur fractures and those with femur fractures combined with vertebral fractures, there was no difference in biochemical markers on bone formation nor in the those of bone resorption. We will further investigate the biochemical markers and BMD in the population of osteoporotic fractures. So those indicators should be helpful for planning treatment and for prevention of FX in the elderly.