2017, Vol.24, No.1

Journal of Korean Society of Spine Surgery 2023 KCI Impact Factor : 0.03

pISSN : 2093-4378 / eISSN : 2093-4386
https://journal.kci.go.kr/krspine

Study design: Retrospective study. Objectives: The goal of this study was to evaluate the risk factors of osteoporotic vertebral fractures (OVFs) in patients with Cushing syndrome. Summary of Literature review: In most reports, vertebral fractures in Cushing syndrome have been found to be related to osteoporosis. However, few studies have analyzed the clinical risk factors for OVFs. Materials and Methods: Thirty-two patients with Cushing syndrome who visited the orthopaedic department complaining of back pain were included in this study. Standing lateral X-rays were performed to evaluate the presence of vertebral fractures, and bone mineral density (BMD) was measured. Results: Of the 32 patients with Cushing syndrome with back pain, 8 (25%) were diagnosed with OVFs using morphometric criteria. The average weight and body mass index of the vertebral fracture group (VF group) were significantly higher than the values observed in the non-vertebral fracture group (non-VF group) (p=0.004, p=0.018). Lumbar BMD was significantly lower in the VF group (p=0.006). A risk factor for OVFs in Cushing syndrome was osteoporosis (odds ratio=18.56, 95% confidence interval=1.72-200.21, p=0.016) regardless of gender, obesity, menopause, or urine free cortisol levels. Conclusions: OVFs in Cushing syndrome have been associated with overweight, and overweight is an indicator of compliance in the treatment of Cushing syndrome. Therefore, weight reduction and the prevention of osteoporosis should be emphasized in patients with Cushing syndrome to prevent OVFs.

Study Design: Retrospective study. Objectives: To analyze the outcomes of conservative management in elderly patients over 65 years of age who were diagnosed with pyogenic spondylitis. Summary of Literature Review: The surgical treatment of pyogenic spondylitis can lead to complications in elderly patients in a poor general condition or with underlying diseases. Materials and Methods: We performed a retrospective review of 32 patients who were diagnosed with pyogenic spondylitis and had a minimum of 12 months of follow-up. Age, sex, comorbidities, clinical symptoms, and the involved segments were analyzed retrospectively. The diagnosis was assessed using clinical, laboratory, and radiologic findings. Antibiotic therapy was either specific (if positive culture results were found) or broad-spectrum cephalosporin (when the pathogenic agent was not isolated). Outcomes were assessed using residual pain and neurologic deficits. Results: The mean onset time was 23.5 days (range, 3-90 days). The mean period of intravenous antibiotic therapy was 36.3 days (range, 10-90 days). All cases underwent conservative management, and 4 patients with progressive neurologic deficits due to epidural abscess underwent posterior laminectomy and abscess drainage. In all cases, the infection was successfully treated, although 12 cases reported residual lower back pain and 2 continued to exhibit minor neurologic deficits. Conclusions: In elderly patients with pyogenic spondylitis, satisfactory results were obtained with conservative management using antibiotics and orthosis after an early diagnosis, unless progressive neurologic symptom instability or spine deformities were noted.

Study Design: Retrospective study. Objectives: To evaluate the validity of the thoracolumbar injury classification system (TLICS) when making treatment decisions in a group of thoracolumbar fracture patients. Summary of Literature Review: Few studies have evaluated the validity of the TLICS in consecutively treated patients, although many have evaluated the application of the TLICS to thoracolumbar injuries. Materials and Methods: A retrospective study was performed among the 230 patients who were treated from 2003 to 2015 in our hospital for thoracolumbar injuries. Evaluations were made of clinical outcomes and radiologic results, and each case was analysed and scored according to the American Spinal Injury Association scale, the Magerl/AO classification, and the TLICS classification by 2 spinal surgeons. Results: Of the 230 patients, 116 (50.4%) received conservative treatment and 114 (49.6%) received surgical treatment. Of the 116 patients who received conservative treatment, 112 (96.6%) were treated according to the TLICS guidelines. Conservative treatment failed for 2 of the 4 patients (1.7%) whose treatment did not correspond with TLICS, and they required surgical treatment. Of the 114 patients who underwent surgical treatment, in 87 (76.3%) the treatment corresponded to the TLICS guidelines. Conclusions: The TLICS classification showed high validity for the conservative treatment of thoracolumbar injuries.