• Journal of Korean Neurosurgical Society
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• v.37 no.3
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• pp.187-192
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• 2005

Objective: Spinal myeloma has been treated with radiation therapy and chemotherapy. However, the role of surgery was not fully evaluated. This study is performed to evaluate the efficacy of surgery in the treatment of spinal myeloma. Methods: 22 patients who were treated with surgery for spinal myeloma from August 1999 to April 2003 were analyzed. Radiological finding, surgical methods and result were reviewed in retrospective study. For compression fracture due to myeloma infiltration, percutaneous vertebroplasy(PVP) was done. Decompression surgery with or without fixation was performed for patients with neurologic deficit. The modalities of surgery consist of PVP (14 cases), corpectomy and fixation (7 cases), and laminectomy and epidural mass removal (3 cases). To evaluate clinical outcome, visual analogue pain score and Frankel neurological scale were used. Results: In 14 cases of PVP, total 57 vertebral segments were treated including 21 thoracic vertebral bodies and 36 lumbar vertebral bodies. Pain relief was achieved in all cases. The pain score changed from 7.7 (preoperatively) to 2.5 (postoperatively). And pain relief effect was maintained over than one year. Frankel grade improved in decompression cases. Conclusion: Surgical treatment can alleviate pain and improve neurologic deficit immediately in spinal myeloma patients.

• Journal of Korean Neurosurgical Society
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• v.65 no.5
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• pp.730-740
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• 2022

Objective : Although several commercialized bone cements are used during percutaneous vertebroplasty (PVP) for patients with osteoporotic vertebral compression fracture (OVCF), there are no reports using domestic products from South Korea. In this study, we investigated the safety and efficacy of Spinofill^® (Injecta Inc., Gunpo, Korea), a new polymethyl methacrylate product. Methods : A prospective, single-center, and single-arm clinical trial of 30 participants who underwent PVP using Spinofill^® for painful thoracolumbar OVCF was performed with 6-months follow-up. Clinical and surgical outcomes included the Visual analog scale (VAS), Korean-Oswestry disability index (K-ODI), and Odom's criteria, complication rate, and recurrence rate. Radiological outcomes were evaluated by measuring the findings of postoperative computed tomography and simple radiograph. Results : The pain of VAS (from 8.95±1.05 to 4.65±2.06, p<0.001) and the life quality based on K-ODI (from 33.95±5.84 to 25.65±4.79, p<0.001) improved significantly, and successful patient satisfaction were achieved in 20 patients (66.7%) 1 day after surgery. These immediate improvements were maintained or more improved during the follow-up. There was no surgery- or product-related complications, but OVCF recurred in two patients (6.7%). Favorable cement interdigitation was reported in 24 patients (80.0%), and extra-vertebral cement leakage was reported in 13 patients (43.0%). The mean vertebral height ratio (from 60.49%±21.97% to 80.07%±13.16%, p<0.001) and segmental kyphotic angle (from 11.46°±8.50° to 7.79°±6.08°, p=0.002) improved one day after surgery. However, these short-term radiological findings somewhat regressed at the end. Conclusion : The overall outcomes of PVP using Spinofill^® were as favorable as those of other conventionally used products.

• The Korean Journal of Nuclear Medicine Technology
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• v.18 no.1
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• pp.49-61
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• 2014

Purpose: With the aging of the population, the attack rate of osteoporotic vertebral compression fracture is in the increasing trend, and percutaneous vertebroplasty (PVP) is the most commonly performed standardized treatment. Although there is a research report of the excellence of usefulness of the SPECT/CT examination in terns of the exact diagnosis before and after the procedure, the bone cement material used in the procedure influences the image quality by forming an artifact in the CT image. Therefore, the objective of the research lies on evaluating the effect the bone cement gives to a SPECT/CT image. Materials and Methods: The images were acquired by inserting a model cement to each cylinder, after setting the background (3.6 kBq/mL), hot cylinder (29.6 kBq/mL) and cold cylinder (water) to the NEMA-1994 phantom. It was reconstructed with Astonish (Iterative: 4 Subset: 16), and non attenuation correction (NAC), attenuation correction (AC+SC-) and attenuation and scatter correction (AC+SC+) were used for the CT correction method. The mean count by each correction method and the count change ratio by the existence of the cement material were compared and the contrast recovery coefficient (CRC) was obtained. Additionally, the bone/soft tissue ratio (B/S ratio) was obtained after measuring the mean count of the 4 places including the soft tissue(spine erector muscle) after dividing the vertebral body into fracture region, normal region and cement by selecting the 20 patients those have performed PVP from the 107 patients diagnosed of compression fracture. Results: The mean count by the existence of a cement material showed the rate of increase of 12.4%, 6.5%, 1.5% at the hot cylinder of the phantom by NAC, AC+SC- and AC+SC+ when cement existed, 75.2%, 85.4%, 102.9% at the cold cylinder, 13.6%, 18.2%, 9.1% at the background, 33.1%, 41.4%, 63.5% at the fracture region of the clinical image, 53.1%, 61.6%, 67.7% at the normal region and 10.0%, 4.7%, 3.6% at the soft tissue. Meanwhile, a relative count reduction could be verified at the cement adjacent part at the inside of the cylinder, and the phantom image on the lesion and the count increase ratio of the clinical image showed a contrary phase. CRC implying the contrast ratio and B/S ratio was improved in the order of NAC, AC+SC-, AC+SC+, and was constant without a big change in the cold cylinder of the phantom. AC+SC- for the quantitative count, and AC+SC+ for the contrast ratio was analyzed to be the highest. Conclusion: It is considered to be useful in a clinical diagnosis if the application of AC+SC+ that improves the contrast ratio is combined, as it increases the noise count of the soft tissue and the scatter region as well along with the effect of the bone cement in contrast to the fact that the use of AC+SC- in the spine SPECT/CT examination of a PVP performed patient drastically increases the image count and enables a high density of image of the lesion(fracture).

• Journal of the Korean Society of Radiology
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• v.11 no.2
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• pp.139-144
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• 2017

Percutaneous vertebroplasty (PVP) is increasingly used to treat osteoporotic vertebral fractures, myeloma and osteolytic vertebral metastases. The purpose of this study was to measure the absorbed radiation exposure dose and time during PVP and to assess the possibility of deterministic radiation effects to the operator and patient. The radiation dose and time measure by three pain physicians performed consecutive procedures using the twenty case PVP. Patient's dosimeter placed at the anteroposterior(AP) side was treatment of the vertebra body located in the upper level 2-3 and lateral(LAT) side was flank proximal to C-arm tube of back. Operator's dosimeter placed at the apron outside of upper sternum (thyroid), left chest, lower extremity and apron inside of left chest. Results: Radiation exposure times were $3.6{\pm}0.71min$. Measurements on the Patient radiation dose were AP $121.4{\pm}48.1{\mu}Sv$, LAT side $614.7{\pm}177.1{\mu}Sv$. Operator radiation dose were outside of the lead apron upper sternum $33.7{\pm}7.3{\mu}Sv$, outside of the lead apron chest $49.2{\pm}15.0{\mu}Sv$, outside of the lead apron lower extremity $12.8{\pm}3.8{\mu}Sv$ and inside of the lead apron chest $4.2{\pm}1.4{\mu}Sv$. To escape from the danger of radiation first long distance from the c-arm tube second exposure time reduced second lead apron used fluoroscopy during PVP is more safety patient and operation from the radiation exposure.