2017, Vol.24, No.4

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: A retrospective study. Objectives: To investigate the risk factors associated with new compression fractures in patients with osteoporotic vertebral compression fractures. Summary of Literature Review: Previous studies have reported that a history of osteoporotic vertebral fractures and decreased bone mineral density were risk factors for new compression fractures. It is not certain whether vertebroplasty is a risk factor for new compression vertebral fractures. Materials and Methods: This retrospective study included a total of 52 patients who were diagnosed with an osteoporotic vertebral compression fracture and could be followed up for at least 1 year. Age, sex, bone mineral density, body mass index, osteoporosis treatment, fat infiltration of the back muscles, the sagittal index, vertebroplasty, and underlying diabetes mellitus or hypertension were compared between patients who developed new compression fractures during 1 year of follow-up and those who did not. For statistical analysis, the t-test and chi-squ are test were used to analyz ethe relationship of each factor with osteoporotic vertebral compression fracture incidence, and multiple logistic regression analysis was performed to analyze multifactorial explanatory factors. Results: No significant differences were found between the 2 groups regarding sex, underlying disease, the sagittal index, and fat infiltration of the back muscles. Patients who developed a new compression fracture were significantly older (p=0.011), had a lower body mass index (p=0.001), had lower bone mineral density (p=0.008), and were more likely to have taken osteoporosis medication for less than 6 months (including no medication, p=0.019). The logistic regression analysis showed that the risk of developing new compression fractures was significantly elevated in patients with a low body mass index (odds ratio [OR]=0.69, p=0.02), bone mineral density (OR=0.43, p=0.005), and less than 6 months of osteoporosis medication use (including no medication, OR=1.083, p=0.041). Conclusions: The risk of developing new compression fractures in patients with osteoporotic vertebral compression fractures was associated with body mass index, bone mineral density, and having taken osteoporosis medication for less than 6 months.

Study Design: Retrospective case-control study. Objectives: To compare the clinical and radiographic outcomes of a hybrid construct (HC) of cervical artificial disc replacement (CADR) combined with anterior cervical discectomy and fusion (ACDF) (group I) with 2-level ACDF (group II) in patients with 2-level cervical disc disease. Summary of Literature Review: ACDF is reported to potentially promote degenerative changes in the adjacent segment. CADR has been expected to reduce the risk of adjacent segment degeneration. However, its clinical course has yet to be sufficiently clarified. Materials and Methods: Twenty-six patients underwent 2-level cervical disc surgery. Single-level CADR combined with ACDF was performed in 14 patients. Twelve patients underwent 2-level ACDF. Clinical profiles were assessed using the neck disability index (NDI) and visual analogue scale scores of arm and neck pain. Dynamic lateral cervical radiographs were obtained preoperatively and at 1, 6, 12, and 18 months postoperatively. The range of motion (ROM) of the overall cervical spine (C2-7) and the adjacent segments was measured. Results: Group I showed a superior NDI at 18 months postoperatively (p<0.05). The mean C2-7 ROM of bothgroups recovered to thepreoperative ROM. At 18 months postoperatively, the C2-7 ROM of group I was higher than that of group II (p<0.05). The superior adjacent segment ROM was higher in group II (p<0.05), starting at 6 months. The inferior adjacent segment ROM showed no significant difference between the groups (p>0.05). Conclusions: The HC group showed comparable clinical and radiographic outcomes to those of the 2-level ACDF group. HC can be used selectively in the treatment of patients with 2-level cervical disc disease.

Study Design: A retrospective study. Objective: To analyze the effectiveness of percutaneous endoscopic lumbar discectomy (PELD) for adjacent lumbar disc herniation through radiologic evaluations. Summary of Literature Review: PELD minimizes posterior structural damage, allowing rapid rehabilitation. Subjects and Methods: This study was conducted on 45 patients who were followed up for 1 year after PELD for adjacent lumbar disc herniation from March 2014 to February 2016. The modified Macnab criteria, the modified Suezawa and Schreiber score (MSS score), and visual analogue scales for the back (VAS-B) and legs (VAS-L) were evaluated. The disc height ratio and segmental angulation change were compared before posterolateral fusion and before PELD. Moreover, spinal stenosis was confirmed on magnetic resonance imaging (MRI) before PELD. Results: Based on the modified Macnab criteria, 53.3% patients received an evaluation of at least “good,” and the mean MSS score improved from 4.77 to 6.99 at 1 year after the operation. The mean VAS-B score decreased from 7.02 to 4.67, and the mean VAS-L score decreased from 8.15 to 4.24 at 1 year after the operation. The mean disc height ratio was 87.1%, and the mean segmental angulation change was 6.5°, with a greater change in the “fair” or “poor” group, and the rate of spinal stenosis on MRI was also higher in the “fair” or “poor” group. Conclusion: The clinical outcomes of PELD, which is accompanied by degenerative changes on simple radiographic images such as disc space narrowing and increased segmental angulation or spinal stenosis on MRI, may not be satisfactory. Therefore, decisions regarding surgery should be made carefully in such cases.