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Study Design: Retrospective study. Objectives: To compare the treatment outcomes of conservative treatment, early vertebroplasty (EVP), and delayed VP (DVP) of patients with osteoporotic compression fractures. Summary of Literature Review: VP is regarded as an effective treatment for osteoporotic compression fractures. Few studies have compared the outcomes of each of the following treatments: conservative treatment, EVP, and DVP. Materials and Methods: A total of 202 patients who presented with thoracolumbar osteoporotic vertebral compression fractures between January 2008 and December 2013 were divided into three groups: group 1 (conservative treatment), group 2 (VP within three weeks), and group 3 (VP after three weeks). We compared the collapse rate and the visual analog scale (VAS) score immediately after the trauma and at the 1-week, 3-week, 6-week, and 1-year follow-ups. Results: The three abovementioned groups consisted of 89 patients, 60 patients, and 53 patients, respectively. The bone mass density (BMD) score of group 1 was statistically significantly higher than that of the others (p<0.05). In group 2, the average VAS score was high immediately after the trauma and low at the 1-year follow-up. Only group 2 showed a significantly high vertebral compression rate immediately after the trauma (p<0.05). Although there were no statistically significant differences in the incidence between the adjacent and the non-adjacent vertebral compression fractures, more patients underwent additional VP in groups 2 and 3 (p= 0.980). Conclusion: The treatment method of performing EVP seems to yield the best clinical outcomes for patients with osteoporotic compression fractures who exhibit a relatively low BMD, high collapse rate, and high VAS score. Conservative management is the treatment of choice for osteoporotic compression fracture patients with a relatively high BMD, low collapse rate, and low VAS score.

Study Design: Retrospective analysis. Objectives: To analyze the usefulness of Zero-P® by analyzing the radiological and clinical outcomes with a minimum of 2 years of follow-up. Summary of Literature Review: Anterior discectomy and fusion (ACDF) using Zero-P® showed excellent results. However, there is a lack of studies focusing on long-term outcomes. Materials and Methods: Ninety-eight patients who underwent single-level ACDF using Zero-P® with more than 2 years of follow-up were included for analysis. In the radiological analysis, we evaluated disc height, segmental lordosis, and subsidence in the preoperative, postoperative, and last follow-up periods. The Neck Disability Index (NDI), Neck Visual Analogue Scale (VAS), and Arm VAS were also evaluated for clinical assessment. Radiological bony fusion was assessed, and radiological and clinical differences according to bony fusion were evaluated. Results: Intervertebral disc height had increased 2.92 mm after surgery and subsided to 2.36 mm at the final follow-up. Subsidence of the screw was 0.58 mm at final follow-up. Segmental lordosis was 3.97° at the preoperative assessment, 8.39° in the postoperative follow-up, and 5.83° in the last follow-up. The Neck VAS score was 4.47, 2.28, and 1.27, respectively. The Arm VAS score was 5.73, 3.13, and 2.18; and NDI score was 17.8, 11.7, and 7.89, respectively. There was no association between the radiological and clinical results. Radiological nonunion was found in 18 subjects. There were no significant differences in radiological and clinical parameters according to bony union. Conclusions: ACDF with Zero-P® for treatment of degenerative cervical disease showed subsidence in 55.1% and nonunion in 18% of cases. However, the radiological results were not related to the clinical results.

Study Design: Retrospective study. Objectives: To evaluate how the timing of pedicle screw fixation (early or late) in pyogenic spondylitis relates to the period of hospitalization, duration of intravenous antibiotic use, and recurrence of infection and to confirm the efficacy of early pedicle screw fixation for pyogenic spondylitis. Summary of Literature Review: Intravenous antibiotics and surgery including debridement and fixation are used as a treatment option for pyogenic spondylitis. Materials and Methods: We retrospectively reviewed 31 patients who underwent posterior decompression and pedicle screw fixation with intravenous antibiotic treatment for pyogenic spondylitis from November 2005 to February 2015. We divided the study group into an early fixation group, whose instrumentation was inserted no later than 15 days after antibiotic therapy, and a late fixation group for cases who underwent the procedure 15 days or more after antibiotic therapy. We compared the period of hospitalization and intravenous antibiotic treatment, the rate and period of the prescription of oral antibiotics, and the rate of recurrence or reoperation. Results: The period of hospitalization and intravenous antibiotic treatment of the early fixation group (55 and 43.4 days) were significantly shorter than those of the late fixation group (85 and 67.1 days). The rate and period of the prescription of oral antibiotics were not significantly different between the two groups. There was no case of recurrence or reoperation in either group. Conclusions: Early fixation using pedicle screws for pyogenic spondylitis reduces the period of hospitalization and intravenous antibiotic treatment compared to late fixation.

Study design: Retrospective study. Objectives: Whether osteoporotic vertebral fracture is associated with obesity is under debate. Therefore, this study aims to determine the relationship between osteoporotic vertebral fracture and body mass index (BMI) by comparing it with other types of osteoporotic fractures. Summary of Literature Review: Several authors have reported the factors that predict the risk of osteoporotic vertebral fracture in individuals with obesity, but the objective risk factors are still controversial. Materials and Methods: A retrospective study was conducted on postmenopausal women, including 100 people with osteoporotic vertebral fractures, 104 with femur neck fractures, 107 with distal radius fractures, and 103 with osteoporosis or osteopenia but without fractures. The BMI was calculated and bone mineral density (BMD) test was administered within 3 days after injury. For each type of fracture, the relationships with age, height, weight, BMI, and BMD were investigated. The relationship with the number of osteoporotic vertebral fractures according to BMI was also evaluated. Results: In comparing osteoporotic vertebral fractures and osteoporotic non-vertebral fractures, there were no significant differences in the relationship with age, height, or BMD (p>0.05). Osteoporotic vertebral fractures showed a statistically higher average weight and BMI, compared to other osteoporotic non-vertebral fracture groups (p<0.05). Among those with osteoporotic vertebral fractures, the number of fractures did not show a significant relationship with BMI (p=0.177). Conclusions: In osteoporotic vertebral fracture patients, compared to groups with other types of osteoporotic fractures, average weight and BMI were higher.

Study Design: Case report. Objectives: To report a case of mononeuritis multiplex as the initial manifestation of Candida infective endocarditis (IE). Summary of Literature Review: Mononeuritis multiplex is actually a group of diseases, not a distinct disease entity. It often results from blood vessel diseases, diabetes, or inflammation due to autoimmune connective tissue disorders, although many cases are idiopathic. IE is an infection of the endocardial surface of the heart. Multiple nerves were affected simultaneously in several cases of IE, making consideration of IE important in the differential diagnosis of mononeuritis multiplex. Materials and Methods: We present a rare case of a 71-year-old man with IE in whom mononeuritis multiplex was revealed on electromyography; further, he presented with lower back pain and sciatica. Results: The presence of the characteristic symptoms of lumbar radiculopathy in this case delayed the diagnosis and proper treatment of the patient. Conclusions: Physicians should carefully consider all patient-related data, and also provide accurate information to consultants when they refer patients. This can help to prevent serious complications.

Study Design: A case report. Objectives: To report a case of indirect repair of cerebrospinal fluid (CSF) leakage after cervical anterior foraminotomy using Surgicel® and fibrin glue. Summary of Literature Review: There is no single modality that is best practice for this type of case because it is difficult to apply primary repair for a case of CSF leakage after cervical anterior decompression. Materials and Methods: A 49-year-old female patient was diagnosed with CSF leakage on the second day after cervical anterior foraminotomy. We performed coverage with Surgicel® and fibrin glue at the CSF leak site. Results: The patient was treated with indirect repair of CSF leakage without any complications. The clinical and radiological outcomes were excellent upon follow-up 1 year postoperatively. Conclusions: Indirect repair using Surgicel® and fibrin glue is an effective treatment for postoperative CSF leakage after cervical anterior foraminotomy.

Study Design: Case report Objectives: To report a case of video-assisted thoracoscopic (VAT) minimally invasive anterior interbody fusion of the T11-T12 level using direct lateral interbody fusion (DLIF) devices. Summary of Literature Review: Interbody fusion of the thoracolumbar junction (especially T11-T12) is technically challenging from anterior, lateral, or posterior approaches. A VAT anterior interbody fusion approach using DLIF devices is a safe, minimally invasive alternative approach to the thoracolumbar spine. Materials and Methods: A 37-year-old male pedestrian was struck by a car sustaining fracture-dislocation at the T11-T12 level. The accident resulted in complete paraplegia of both lower extremities and multiple lower extremity fractures. A classical instrumented posterolateral fusion from T8 to L3 and staged VAT anterior interbody fusion at the T11-T12 level were performed. Results: At one year postoperatively, he was capable of independent ambulation using a wheelchair without back pain, and plain radiographs and CT scans showed a solid fusion at the T11-T12 level. Conclusions: VAT anterior interbody fusion using DLIF devices provides excellent access to the anterior spinal column with the added benefits of an improved field of view and can be a safe and effective alternative to open thoracotomy in the management of various thoracolumbar junction problems.

Study Design: A case report. Objectives: To report a rare case of atypical spinal tuberculosis. Summary of Literature Review: In spinal tuberculosis, non-contiguous multifocal involvement and isolated involvement of posterior elements of the spine have been considered atypical features. There have been a few reports of each of these atypical features but no reports have described spinal tuberculosis with both of these atypical features. Materials and Methods: A 39-year-old man presented with back pain and progressive weakness of both lower extremities. He was diagnosed with spinal tuberculosis from the cervical to sacral spine, showing multifocal non-contiguous involvement with multiple abscesses on magnetic resonance imaging. Notably, in the thoracic spine area, isolated involvement of posterior elements was found with an epidural abscess compressing the spinal cord. He underwent a total laminectomy of the thoracic spine and multiple abscesses were drained with pigtail catheter insertions into the cervical, thoracic, and lumbar spine. Results: At the 8-month follow-up, the patient’s neurologic status had improved to Frankel Grade D, and the patient was able to walk with the support of a walker. At the 3-year follow-up, the patient had recovered completely without any neurologic deficit. Conclusions: Since atypical spinal tuberculosis may show various patterns, examination of the entire spine is important for early diagnosis. Treatment should be provided properly from minimally invasive procedures to open surgery depending on the extent of structural instability and neurologic deficit.

Study Design: A review of the literature. Objectives: To discuss how to evaluate, interpret, and utilize measurements of spino-pelvic alignment before and after spinal surgery in patients with lumbar degenerative disease. Summary of Literature Review: Various spino-pelvic parameters are currently utilized in the evaluation of spinal patients; however, interpretation of these parameters is not easy. Materials and Methods: Each spino-pelvic parameter and factors affecting its value, and how to interpret and utilize the spino-pelvic parameters before and after spinal surgery were discussed for patients with lumbar degenerative disease with and without sagittal spinal deformity. Results: Sagittal modifiers in the SRS-Schwab classification including pelvic incidence minus lumbar lordosis (PI-LL), sagittal vertical axis (SVA), and pelvic tilt (PT) are widely accepted in the evaluation of lumbar degenerative disease with sagittal deformity. Surgery for sagittal realignment is meant to restore both the SVA and PT by restoring the LL in reference to the PI. However, patients with an extremely high SVA and PT or those with a high SVA and low PT can end up with postoperative residual malalignment. In patients without deformity, PI-LL mismatch (> 10°) should be highlighted and should be actively corrected by restoring the lordosis of the pathologic segment. Conclusions: Sagittal modifiers are beneficial for their simplicity and comprehensibility; however, they are insufficient for evaluating sub-regional spinal deformity. Spino-pelvic parameters can be useful for evaluating spinal patients in a clinical setting, but the measurements are greatly affected by confounding factors such as poor patient posture, unqualified testers, and manual measurement techniques.

Study design: A literature review on the radiologic findings of pelvic parameters for treatment of spinal deformity. Objectives: This review examines sagittal spine alignment, pelvic parameters, and methods for assessing alignment, and examines the relationships among all of these parameters to understand spinal deformity. Summary of Literature Review: Understanding the main pelvic and sagittal spinal parameters and recognizing their correlation is imperative in the diagnosis and treatment of various spinal disorders. Materials and Methods: Review of the literature. Results: As spinal and pelvic parameters tend to have a strong correlation, it is essential to measure not only spinal parameters but also pelvic parameters in analyzing sagittal balance. Degenerative changes have the potential to greatly disrupt the normal curvature of the spine, leading to sagittal malalignment. Analysis of sagittal balance is crucial to optimizing the management of spinal diseases. Improvement in surgical outcomes may be achieved through better understanding of radiographic spino-pelvic parameters and their association with deformity. Conclusions: Understanding spinal and pelvic parameters raises awareness of the relationship among alignment and balance, the soft tissue envelope, and compensatory mechanisms, which will, in turn, provide a more comprehensive understanding of the nature of spinal deformity and the modalities with which it is treated.