• The Korean Journal of Pain
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• v.19 no.2
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• pp.261-265
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• 2006

A vertebral compression fracture can cause chronic back pain, and may also result in progressive kyphosis. The traditional treatments of a vertebral compression fracture include bed rest, analgesics and bracing. Balloon kyphoplasty can restore the vertebral height and allow safe bone cement injection into the cavity made by the balloon, which significantly reduces the risk of cement leakage compared to vertebroplasty. An 82-year-old female patient suffered from severe low back pain. Due to the intractable pain and immobility, which could not be relieved by conventional care, as well as the empty vertebral body associated with communicated fractures of the vertebral surfaces, balloon kyphoplasty, with a thicker bone cement injection than usual with balloon kyphoplasty, was chosen. The preoperative intractable pain and immobility were dramatically relieved soon after the procedure, without any complications.

• Journal of Trauma and Injury
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• v.27 no.4
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• pp.186-191
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• 2014

Purpose: The objectives of this study were to assess pain relief according to the time after kyphoplasty and to evaluate the factors affecting pain relief after kyphoplasty in the treatment of a single-level osteoporotic vertebral compression fracture. Methods: A retrospective review of 34 kyphoplasties for single-level osteoporotic vertebral compression fractures was performed. Pain relief was assessed by using the visual analogue scale (VAS) at preoperatively and postoperatively at 6 weeks, 3 months, and 6 months. Associated factors, including age, sex, pain duration, bone mineral density, and cement leakage, were evaluated using the patients' medical records. Statistical analyses were conducted using the paired t-test to assess pain relief and using the independent t-test and Pearson's correlation coefficient to evaluate the relationship between those factors and pain relief. Results: Preoperatively, the mean VAS score was 7.06. Postoperatively, it declined to 3.66 (p=0.001), 2.81 (p=0.001) and 2.24 (p=0.001) at 6 weeks, 3 months and 6 months, respectively. Also, statistically significant pain relief was observed during the periods from 6 weeks to 3 months (p=0.001) and from 3 months to 6 months (p=0.001). However, reduction of the VAS score showed no significant correlation with age, sex, pain duration, bone mineral density, or cement leakage (p>0.05). Conclusion: Our study suggests that a kyphoplasty may be effective in osteoporotic vertebral compression fracture patients with acute pain and that after the kyphoplasty, pain is reduced remarkably for 6 weeks and then continuously for 6 months.

• 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.

• Journal of Acupuncture Research
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• v.35 no.4
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• pp.219-225
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• 2018

Background: The purpose of this study was to review whether Korean medicine treatment was effective to maintain the spinal stability and to relieve spinal symptom by reviewing medical records of 18 vertebral compression fracture patients. Methods: The subjects were 18 thoracolumbar compression fracture patients who were taken more than two lateral view x-rays of fractured vertebra from Jan, 2010 to June, 2018. They were divided into two groups: the time admitted into Department of Acupuncture & Moxibustion Medicine, Pohang Korean Medical Hospital of Daegu Hanny University from onset (Research 1) and whether or not they have a past history of osteoporosis (Research 2). Then, they were follow-up observed and compared by compression ratio and numerical rating scale (NRS) and so on. Results: The amount of weekly compression rate increase of 18 patients was 1.76% per week. According to the result of Research 1, the patients group (14 patients) who were admitted into the hospital within 1-2 weeks from getting injury was 1.88% per week whereas the patients group(4 patients) who were admitted into the hospital within 3-4 weeks from getting injury was 1.22% per week. By Research 2 result, the patients group (7 patients) who had been diagnosed as an osteoporosis patient was 2.19% per week, and those (11 patients) who had not was 1.49% per week. There was a statistical significance in the change of the amount of compression rate increase in the case of Research 1, but there was not in the case of Research 2. NRS was decreased without significant difference regardless of the time admitted into the hospital and whether or not the patients had the past history of osteoporosis. Conclusion: Considering that there were more amount of compression rate increase at 1-4 weeks from onset, it is necessary to offer treatment more actively on early time from onset. Further research is needed into the increase of compression rate by the patients' having a past history of osteoporosis or not. Given that NRS decreased without significant difference, it is assumed that Korean medicine treatment has a meaningful effect on relieving subjective symptom of patients who are diagnosed as vertebral compression fractures.

• 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.

• Journal of Korean Neurosurgical Society
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• v.56 no.3
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• pp.230-236
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• 2014

Objective : The technique of short segment pedicle screw fixation (SSPSF) has been widely used for stabilization in thoracolumbar burst fractures (TLBFs), but some studies reported high rate of kyphosis recurrence or hardware failure. This study was to evaluate the results of SSPSF including fractured level and to find the risk factors concerned with the kyphosis recurrence in TLBFs. Methods : This study included 42 patients, including 25 males and 17 females, who underwent SSPSF for stabilization of TLBFs between January 2003 and December 2010. For radiologic assessments, Cobb angle (CA), vertebral wedge angle (VWA), vertebral body compression ratio (VBCR), and difference between VWA and Cobb angle (DbVC) were measured. The relationships between kyphosis recurrence and radiologic parameters or demographic features were investigated. Frankel classification and low back outcome score (LBOS) were used for assessment of clinical outcomes. Results : The mean follow-up period was 38.6 months. CA, VWA, and VBCR were improved after SSPSF, and these parameters were well maintained at the final follow-up with minimal degree of correction loss. Kyphosis recurrence showed a significant increase in patients with Denis burst type A, load-sharing classification (LSC) score >6 or DbVC >6 (p<0.05). There were no patients who worsened to clinical outcome, and there was no significant correlation between kyphosis recurrence and clinical outcome in this series. Conclusion : SSPSF including the fractured vertebra is an effective surgical method for restoration and maintenance of vertebral column stability in TLBFs. However, kyphosis recurrence was significantly associated with Denis burst type A fracture, LSC score >6, or DbVC >6.

• The Korean Journal of Food And Nutrition
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• v.11 no.2
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• pp.165-170
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• 1998

Diagnostic radiology and conservative management for S75 patient with L1 lumbar fracture by traffic accidents were discussed with references, and then the obtained results were as follows ; 1. Wedging compression fractures with 10% deformity was confirmed at anterior vertebral body of L1 lumbar spine through lateral plain X-ray film. 2. Irregular bony fractures were observed at anterior vertebral body of L1 lumbar spine by CT scans, anatomically T12-L1 sites showed highly frequency of injuries, Denis's fracture type was classified as multiple compression fracture at anterior column without abnormal middle and posterior column, also no Cobb's angle, and then Frankel's neurological classification was E grade. 3. Orthopaedic treatments were performed with conservative methods. With rest on the bed, anti-in-flammatory medication, electrolyte and nutritional solution, the pain diminished. 4. After 3 weeks, rehabilitation was worked with putting on polyethylene back corset, although pains remained slightly until after 8 weeks, thereafter the spine showed gradually stability.

• Journal of Korean Neurosurgical Society
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• v.49 no.5
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• pp.273-277
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• 2011

Objective : A single balloon extrapedicular kyphoplasty has been introduced as one of the unilateral approaches for thoracic compression fractures; however, the unilateral extrapedicular technique in the lumbar area needs a further understanding of structures in the lumbar area. The purpose of the present study is to describe methods and pitfalls of this procedure based on the anatomy of the lumbar area and to analyze clinical outcome and complications. Methods : Anatomical evaluation was performed with 2 human cadavers. A retrospective review of unilateral extrapedicular approaches yielded 74 vertebral levels in 55 patients that were treated with unilateral extrapedicular vertebroplasty and kyphoplasty. Radiographic assessment included the restoration rate of vertebral height and correction of kyphosis. Results : Anatomical evaluation indicates that the safe needle entry zone of bone for the extrapedicular approach was located in the supero-lateral aspect of the junction between the pedicle and vertebral body. The unilateral extrapedicular procedure achieved adequate pain relief with a mean decreases in pain severity of $7.25{\pm}1.5$ and $2.0{\pm}1.4$, respectively. Complications were 1 retroperitoneal hematoma, 6 unilateral fillings and 3 epidural leak of the polymethylmethacrylate. Conclusion : The method of a unilateral extrapedicular approach in kyphoplasty and vertebroplasty in the lumbar area might be similar to that in thoracic approach using a route via the extrapedicular space. However, different anatomical characteristics of the lumbar area should be considered.

• Journal of the Korean Orthopaedic Association
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• v.55 no.1
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• pp.90-94
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• 2020

Percutaneous balloon kyphoplasty is an option for pain relief in pathological vertebral compression fractures. Complications related to cement leakage through cortical defects have been reported. On the other hand, dural compression due to retropulsion of the tumor mass is rarely reported. The authors report a case of a 65-year female patient who had cauda equina syndrome after a percutaneous balloon kyphoplasty in a pathological vertebral fracture, even though epidural compression were not found prior to surgery. Magnetic resonance imaging revealed retropulsion of the tumor mass into the spinal canal through the disrupted posterior vertebral cortex.

• Journal of Korean Neurosurgical Society
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• v.52 no.6
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• pp.513-516
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• 2012

Objective : It is rare that the medial loop in the V2 segment of the vertebral artery (VA) causes compression of the proximal cervical root of the spinal cord without leading to bony erosion and an enlarged foramen. We evaluated the clinical significance and incidence of the medial loop in the V2 segment of the VA. Methods : We reviewed the records from 1000 consecutive patients who had undergone magnetic resonance imaging evaluation of the cervical spine between January 2005 and January 2008. The inclusion criteria were that over a third of the axial aspect of the VA located in the intervertebral foramen was inside the line between the most ventral points of the bilateral lateral mass, and that the ipsilateral proximal root deviated dorsally because of the medial loop of the VA. We excluded cases of bone erosion, a widened foramen at the medial loop of the VA, any bony abnormalities, tumors displacing VA, or vertebral fractures. The medical records were reviewed retrospectively to search for factors of clinical significance. Results : In six patients (0.6%), the VA formed a medial loop that caused compression of the proximal cervical root. One of these patients had the cervical radiculopathy that developed after minor trauma but the others did not present with cervical radiculopathy related to the medial loop of the VA. Conclusion : The medial loop of the VA might have a direct effect on cervical radiculopathy. Therefore, this feature should be of critical consideration in preoperative planning and during surgery.