KJC Korea
Journal Central

Study Design: A retrospective study. Objectives: To evaluate the association between smoking and osteoporotic vertebral fractures (OVFs) in postmenopausal women. Summary of Literature Review: Several studies have examined the relationship of smoking with hip fractures, but few studies have analyzed the relationship of smoking with spine fractures in women thus far. Materials and Methods: This study considered 1255 postmenopausal women aged 50 years and older (enrollment from April 2008 to January 2009) from 62 study sites in a nationwide hospital. The amount of smoking was calculated in pack-years. Further, OVFs were diagnosed using a semi-quantitative method. To analyze the relationship between smoking and OVFs, we used a paired t-test, a χ2-test, and a binary logistic regression analysis. Results: The past history of smoking was 7.2% in the patient group and 4.3% in the control group (p=0.025). The mean pack-years of smoking was 0.34 in the control group and 0.62 in the patient group (p=130). The mean T-score in the lumbar bone mass density (BMD) was –1.64 in the control group and –2.19 in the patient group (p=0.409). Smoking was a risk factor of vertebral fractures in postmenopausal women (odd’s ratio=1.68, 95% confidence interval=1.020–2.759, p=0.042) irrespective of the lumbar BMD and the medical treatment for osteoporosis and obesity. Conclusions: Smoking is a risk factor for osteoporotic vertebral fractures in postmenopausal women independently without regard to lumbar BMD. Therefore, cessation of smoking is important for the prevention of OVFs in postmenopausal women.

Study Design: A retrospective study. Objectives: To understand the necessity of additional posterior decompression when treating a patient with posterior fusion for thoracolumbar fractures with a neurologic deficit. Summary of Literature Review: Additional posterior decompression is still controversial when treating a patient with posterior fusion for thoracolumbar fractures with neurologic a deficit. Materials and Methods: 40 patients who underwent posterior fusion surgery for thoracolumbar fractures with a neurologic deficit were evaluated. The posterior fusion group (Group 1) included 23 patients (M:F=14:9), and the posterior decompression with laminectomy and posterolateral fusion group (Group 2) included 17 patients (M:F=9:8). According to the Frankel grade, the most common neurologic deficit was grade D in both groups. Unstable burst fractures were the most commonly observed fractures in both groups according to the McAfee classification. A radiographic evaluation was carried out along with a comparison of the spinal canal encroachment and the kyphotic angle. We evaluated neurologic improvement as the clinical criterion. Results: The l-kyphotic angle at last follow-up was smaller than the preoperative kyphotic angle in both groups. The preoperative canal encroachment was 53.4% (Group 1) and 59.8% (Group 2). Further, neurologic improvement was observed in 19 cases (Group 1) and 14 cases (Group 2). There was no significant difference in the proportion of cases with neurologic improvement between the two groups (improvement in 19 cases in Group 1 and in 14 cases in Group 2) (p<0.05). Further, the preoperative canal encroachment, kyphotic angle, and final neurologic improvement showed no significant correlations between the two groups (p>0.05). Conclusion: We concluded that additional posterior decompression in the case of thoracolumbar fractures with neurologic deficit is not required for neurologic improvement.

Study Design: Retrospective study. Objectives: To compare serum vitamin D levels in elderly patients with or without osteoporotic spinal compression fractures (OSCFs) and to identify relationships between the serum vitamin D level and other variables, such as age, bone mineral density (BMD), and bone turnover markers (osteocalcin and C-telopeptide). Summary of Literature Review: Vitamin D plays a key role in calcium metabolism in the bone tissue. Vitamin D deficiency can lead to decreased BMD and an increased risk of falls and of osteoporotic fractures. Materials and Methods: We retrospectively reviewed the medical records of 95 elderly patients (≥60 years) with OSCFs (fracture group) and 118 subjects who had been diagnosed with osteoporosis without OSCFs (control group). Serum vitamin D levels were contrasted between the two groups taking into account other factors such as patient age, sex, and seasonal variations. For all the patients, we also evaluated the correlation between the vitamin D level and the patient age, BMD, and bone turnover markers. Results: The mean of the serum 25(OH) vitamin D3 levels was significantly lower in the fracture group than in the control group. There were significant differences in the 25(OH) vitamin D3 levels in autumn. In all patients, the mean serum 25(OH) vitamin D3 levels were the highest in autumn and the lowest in spring. Furthermore, the mean serum 25(OH) vitamin D3 levels were significantly correlated with patient age and BMD. Conclusions: A low serum vitamin D level might be a risk factor of OSCFs in elderly patients.

Study Design: A retrospective study. Objectives: To assess radiological follow-up results, including progression of bone cement augmented vertebrae, of patients who underwent percutaneous vertebroplasty (PVP). Summary of Literature Review: There are few studies of radiological follow-up results that include progression of bone cement augmented vertebrae after PVP, regardless of good clinical results. Materials and Methods: Between January 2000 and August 2007, 253 patients were treated with PVP for osteoporotic compression fracture. Among them, 81 patients died during follow-up and 101 patients (157 vertebrae) were available for follow-up over 7 years. We analyzed the radiologic outcomes, focusing on augmented bone cement feature and progressive change with adjacent vertebrae. Results: The mean follow-up period was 7.9 years. Anterior body height in the last follow-up was improved about 0.3 mm compared with the preprocedural value, but this improvement was not statistically significant. The focal kyphotic angle was reduced from 12.3° at the preprocedural state to 11.7° at the postprocedural state but this change was also not statistically significant (p>0.05). Out of the 101 cases, we observed 7 cases of radiolucent line with decreased bone density in the adjacent area of bone cement and 5 cases of bone cement cracks accompanied with vertebral collapse were observed. Eleven patients (10.8%) had a solid spontaneous fusion, and 8 patients (7.9%) had partially fused with adjacent vertebrae. Conclusions: The bone cement augmented vertebrae showed stable radiologic progression without significant changes in vertebral height or kyphotic angle. After percutaneous vertebroplasty, unpredictable spontaneous fusion with proximal adjacent vertebrae developed at a higher rate than 10% rate.

Study Design: A case report. Objectives: To report a rare case of remote cerebellar hemorrhage (RCH) as a complication of spinal surgery. Summary of Literature Review: Remote cerebellar hemorrhage is rare but lethal as a complication of spinal surgery. Interestingly, dural tears and cerebrospinal fluid (CSF) leakage are reported in all published cases of RCH. Materials and Methods: A 67-year-old man had posterior lumbar decompression and posterolateral fusion for spinal stenosis at L4/5/ S1. Intraoperatively, the dura was torn and there was a loss of CSF. The dural tear was sutured immediately in a water-tight manner. After surgery, the patient complained of headache and dizziness. On postoperative day 44, brain magnetic resonance imaging (MRI) showed meningeal enhancement suggesting meningitis. On postoperative day 54, brain computed tomography (CT) showed cerebellar edema and hemorrhage, and external ventricular derivation was performed. Results: The patient died. Conclusions: Special attention should be paid to prevent dural damage during spinal surgery or minimize CSF leakage in the case of dural damage and tears during spinal surgery, and CT and MRI should be promptly performed for symptomatic patients.

Study Design: A case report. Objectives: To report a rare case of cauda equina syndrome due to lumbar ossification of the posterior longitudinal ligament (OPLL). Summary of Literature Review: Lumbar OPLL with neurologic symptoms is very rare. Materials and Methods: A 49-year-old female had experienced weakness in both lower extremities and radiating pain for 1 day prior to presentation. Simple radiography and CT showed OPLL at the L1-L2 level. We performed a total laminectomy and posterolateral fusion at the L1-L2 level using a posterior approach. Results: After treatment, the patient showed improvement of symptoms and is currently living without discomfort. Conclusions: Cauda equina syndrome due to lumbar OPLL is rare; however, rapid neurologic recovery can be achieved through early diagnosis and surgery.

Study Design: A review of the literature. Objectives: To review the current evidence on the development of a viable surgical strategy for successful treatment of patients with osteoporotic vertebral fractures. Summary of Literature Review: Achieving rigid and stable spinal column reconstruction in elderly patients with osteoporosis is challenging because of the poor healing capacity and weak mechanical strength of their bones. Materials and Methods: A literature search of clinical and biomechanical studies on the issues of surgical treatment of patients with osteoporotic vertebral collapse was performed and reviewed in terms of the surgical approach, fixation, graft material, and medical considerations. Illustrative cases of the authors’ experiences were presented and reflected upon. Results: Posterior spinal fusion and vertebral augmentation showed shorter operating times, less bleeding, and fewer complications with comparable or superior clinical results than anterior corpectomy and fusion or a posterior closing wedge vertebral shortening procedure in multiple studies. Therefore, we recommend the former as a first-line surgical plan for patients with osteoporotic vertebral collapse. However, in some patients who suffer fixed kyphosis, or spinal cord compression by a retropulsed bony fragment or bone cement, or infected vertebroplasty, an anterior approach could be considered to remove the pertinent lesion and to restore anterior spinal column. For the enhancement of the purchasing strength of the screw in the osteoporotic vertebra (e), a technique of prefilled bone cement in the instrumented vertebra(e) or injection of bone cement through a fenestrated screw is useful. Further, preoperative assessment and correction of systemic and local factors that affect bone healing is required when spinal fusion surgery is considered in elderly osteoporotic patients. The selection of the graft material should be individualized according to the property among osteoconduction, osteoinduction, and ostegenesis, or structural support that is the most important for the successful bone healing of each patient. Conclusions: Comprehensive geriatric assessment and management of elderly patients before surgery and careful and meticulous surgical planning with respect to the surgical approach, instrumentation, and the graft material are important to achieve the best outcome of the surgical treatment of patients with osteoporotic vertebral collapse.

Study design: A literature review regarding the correlation between a kyphotic neck and its clinical outcomes. Objectives: This review examines normal cervical alignment, methods for assessing alignment, a specific correlation between kyphotic neck and clinical outcomes, and indications and methods of surgical treatment. Summary of Literature Review: Cervical kyphotic deformity is problematic in terms of HRQOL due to nerve damage or loss of horizontal gaze. Materials and Methods: Review of the literature. Results: Cervical kyphosis can be caused by postlaminectomy, degenerative disc disease, and trauma, and the symptoms exhibit diverse clinical progression including compensatory mechanisms, adjacent segment disease, changes in quality of life, and cervical myelopathy. Given the serious complications of cervical surgery, we need a deep understanding of spine anatomy, preoperative planning, and correction methods. Conclusions: It is vital to investigate cervical sagittal alignment and to perform intensive treatment and corrective surgery to achieve better clinical outcomes.

Study Design: Review of the literature. Objectives: To present an overview of current research on whiplash injury. Summary of Literature Review: There are controversies over the definition, symptoms, and treatment of whiplash injury. Materials and Methods: Review of the relevant literature. Results: Symptoms of whiplash injury caused by an acceleration-deceleration force may present as widespread pain involving the neck or trapezius muscles, the interscapular area, the shoulders and arms, or as suboccipital headaches. Accompanying symptoms may include neurologic symptoms such as sensory dysfunction, motor weakness, or deep tendon reflex loss; non-specific symptoms such as dysphagia, dizziness, visual disturbances, tinnitus, deafness, memory loss, or temporo-mandibular joint disorders; and psychological symptoms such as depression, acute stress syndrome, or fear avoidance. The most important factor that facilitates spontaneous resolution of whiplash injury, which is a self-limiting disorder, has been shown to be prevention of the acute-to-chronic pain transition. Yet in spite of this knowledge the efficacy of several treatment methods for whiplash injury remains controversial. Conclusions: The appropriateness of treatment for whiplash injury should be evaluated on the basis of up to date academic research on its diagnosis and natural history.