2018, Vol.25, No.3

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: Cross-sectional, multi-center survey study. Objectives: The objective of this study was to investigate the pain status, pain management methods, and pain experience after treatment among patients suffering from chronic non-cancer pain due to spinal disease. Summary of the Literature Review: No thorough investigation of the current status of chronic non-cancer pain management in patients with spinal disease has recently been reported. Materials and Methods: We surveyed 330 patients with chronic non-cancer pain who visited spine clinics in Korea. Results: Prior to treatment, 86.7% of the patients had severe pain and 99.4% of the patients had taken oral analgesics for pain control. After treatment, the percent of patients with severe pain was reduced to 42.1%, and 52.4% of patients responded that they experienced intermittent pain. End of dose failure was experienced by 29.1% of patients, and 41.7% of patients experienced pain again 3-6 hours after taking analgesics. Furthermore, 8.2% of patients experienced breakthrough pain, and 29.1% of patients experienced pain that interfered with sleeping. Conclusions: Many patients with chronic pain reported experiencing pain due to end of dose failure after medication. As the causes of chronic pain are complex, appropriate analgesics should be considered and selected for effective pain management.

Study Design: Retrospective study. Objectives: To evaluate the factors related to the incidence of a new fracture in an adjacent vertebra after kyphoplasty for single vertebral body fracture due to osteoporosis and to assess the impact of such factors on patients’ survival rate. Summary of Literature Review: It is controversial whether fracture of an adjacent vertebra after kyphoplasty is due to the natural course of osteoporosis or as a complication of kyphoplasty. Materials and Methods: From December 2006 to December 2016, among 490 cases of kyphoplasty for single vertebral body fracture due to osteoporosis, 153 cases were analyzed retrospectively. The survival rate was analyzed based on age, gender, body mass index (BMI), fracture level, leakage of cement, amount of cement, compression rate, recovery rate, bone density, osteoporotic medication rate and compliance, existence of a compression fracture, hypertension, diabetes, and smoking habit. The average follow-up duration was 15.1 months (range, 1 month to 8 years and 8 months) and the mean age was 74.4 years (range, 54-93 years). Results: A new fracture in an adjacent vertebral body occurred in 27 cases (17.3%). The 1-year survival rate was 82.6%, the 2-year survival rate was 72.5%, and the 6-year survival rate was 53.7%. The survival rate was significantly higher in patients younger than 75 years (p=0.0495). The survival rate was also significantly higher in patients with a preoperative vertebral bone density greater than −3.7 and hip bone density greater than −2.2 (p<0.0001, p=0.0114). The survival rate was significantly higher in patients with a BMI greater than 18.1 kg/m2 at the time of surgery (p=0.0014). Furthermore, the survival rate was significantly higher in patients with a postoperative recovery of vertebral height of 14% or less (p=0.0031). In addition, the survival rate was higher in patients without a compression fracture before surgery (p=0.0297). In multiple factor analysis, vertebral bone density (p=0.0049) and age (p=0.0408) were identified as statistically significant factors. Conclusions: The survival rate was significantly lower at 1, 2, and 6 years in patients with an adjacent vertebral fracture. The most crucial factors affecting the survival rate were age and vertebral bone density.

Study Design: Retrospective study. Objectives: To investigate the reliability of the lumbar extensor muscle degeneration classification as an indicator of potential risk for osteoporotic vertebral compression fractures (OVCF). Summary of Literature Review: Fatty degeneration of lumbar extensor muscles has attracted increased interest in the literature as a risk factor for OVCF. Materials and Methods: Ninety-one patients with OVCF (group 1) and 60 patients without OVCF (group 2) were investigated. Magnetic resonance imaging was used to measure and to analyze the muscle mass and fatty degeneration of the lumbar extensor muscle. The degree of fatty degeneration of the lumbar extensor muscle was classified into 4 stages: less than 10%, 10%-25%, 25%-50%, and more than 50%. Results: Fatty degeneration of the lumbar extensor muscle and the bone mineral density T-score were 29.66%±12.28% and −3.56±1.13 in group 1 and 24.04%±13.29% and −2.27±1.46 in group 2, which were statistically significant differences (p<0.05). Logistic regression analysis revealed that as the fatty degeneration of the lumbar extensor muscle increased, the risk of OVCF increased (odds ratio [OR]=1.21; p=0.01). The risk of OVCF increased as the lumbar extensor muscle degeneration classification scores increased (OR=13.53; p=0.02). Furthermore, as the muscle mass of the multifidus decreased, lumbar lordosis and sacral inclination decreased (β=0.33; p=0.01 and β =0.25; p=0.04, respectively). However, no factor affected thoracic kyphosis. Conclusions: Fatty degeneration of the lumbar extensor muscle was correlated with OVCF. A lumbar extensor muscle degeneration classification higher than stage 3 should be considered a risk factor of OVCF.