The Association of Low-energy Spine Fractures and Vitamin D Inadequacy: A Case-control Study

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.

Neurologic and Histological Study of Clip Compression Model for Rat Thoracic Spinal Cord Injuries

OBJECTIVE: The purpose of this study was to assess the time-response of clip compression model for the relationship between the duration of the injury on the rat thoracic spinal cord, and histological and functional outcome measures. METHODS: After laminectomy at T9 in Sprague-Dawley rats, a modified aneurysm clip with a closing force of 30-gram was applied extradurally around the spinal cord at T9, and then rapidly released with cord compression persisting for 1, 5, and 10 minutes, respectively. The locomotor function, according to the Basso-Beattie-Bresnahan (BBB) scale, was assessed weekly for 4 weeks after the injury. The injured spinal cord was then examined histologically including quantification of cavitation. RESULTS: Spinal cord injury by clip compression resulted in worsened BBB scale scores. However, there was spontaneous functional improvement in times for all 3 injury severities, with the greatest improvement in the 1-minute compression group. From 1 week after the injury, BBB scores in the 1-minute group were significantly higher than in the 5 or 10-minutes groups until the end of the follow-up period (p<0.05). For histological analysis, the cavitation area and cavity volume at 4 weeks was directly proportional to the severity of the injury. CONCLUSION: The results of this study show that the rat thoracic cord clip compression model is a reliable and reproducible spinal cord injury model. The duration of clip compression injury in the rat thoracic cord has been correlated with both functional and histologic outcome measures.

Surgical Treatment for the AVM Feeding Mainly from PCA

Among 51 intractanial AVM patients, 30 patients(58.8%) with AVM supplied mainly with PCA were studied for the relationship with feeding vessels, location and the size of AVM in connection with hemorrhage and also results in 20 surgical patients were analyzed. On cerebral angiogram, 56.7% accounted for AVM supplied only by PCA, 16.7% together with MCA and 26.6% with MCA and ACA. By location, 36.7% were for subcortical AVM and 63.3% were for deeply located paraventricular. 53.3% were large AVM and of them, 6.5% bleeded 30.0% accounted for small AVM, of which 88.9% bleeded. The total bleeding rate was high at 73.3%. Complete removal by surgery was available for 90.0%, and post operative improvement was at 75.0% with a mortality rate of 10.0%. 50.0% showed disappearance of seizure following total removal and 33.3% improved. 5.0%, however, had seizure for the first time following the surgery.

Posterior Approach for Cervical Spondylosis with Radiculomyelopathy

Of the 68 cervical spondyltic patients showing symptoms of radiculomyelopathy, assessments were made on 29 patients who underwent neural decompressive surgery with cervical laminectomy through posterior approach for the results of surgery. Analyses were also made on the anterior-posterior diameters of cervical canal on the plain film of cervical spine. The mean values of anterior-posterior diameters measured on the levels of cervical C3-7 were 16.5+/-1.83 mm in the normal adult and 7.3+/-1.08 mm in the cervical spondylotic patients with radiculomyelopathy, which is far narrower than that of the normal. In cervical spondylotic patients, the anterior-posterior diameters of directly upper and lower parts of the lesions were 11.9+/-1.20 mm and 12.1+/-1.61 mm respectively, also much narrower mean values than those of the normal control group. The results of the 29 patients who received cervical laminectomy by posterior approach were much improved for 51.7% and improved for 44.8%.

Posterior Fixation and Fusion for Posteriorly Displaced Odontoid Process Fractures

Several different methods of posterior wiring and fusion have been advocated for treatment of the odontoid process fractures, regardless of direction of displacement. Between 1983 and 190, 8 cases of type II odontoid process fracture underwent posterior wiring and fusion at Kyungpook National University Hospital. Among them, three cases were posteriorly displaced fractures. For these three cases, the authors modified wiring method and applied acrylic resin. The authors thought this procedure is not complex and a good method for posteriorly displaced type II fractures in which conventional posterior wiring may actually create a tration effect that further displaces the fractured odontoid into the spinal canal.

Serum Neopterin in Head Injury

Cell-mediated immunity frequently becomes impaired after major trauma. To investigate the immune response of the head injury, the authors measured the level of the serum neopterin, which represents the index of macrophage activation, in 53 head-injured patients. In the injured group the serum neopterin level was 5.4+/-3.1 nmol/l and slightly higher than that of the normal control group, 4.4+/-1.0 nmol/1. In the group of the patients with the Glasgow Coma Scale(GCS) 3-9, the level was significantly higher than the group GCS 10-15. The differences were not significantly related to the age or the presence of intracranial hematoma. It is conceivable that head injury will change the patient's immune response and it may be influenced by neural control.

Intramedullary Metastatic Spinal Cord Tumor: A Case Report

Intramedullary metastatic tumor comprise about 0.9 to 5% among the spinal metastatic tumors. Authors presented a rare case of intramedullary metastatic spinal cord tumor treated with operative total removal followed by radiation therapy and chemotherapy.

Ventricular Dilatation by Early Surgery on Aneurysms with SAH

Among 202 aneurysmal patients with SAH who were admitted to Kyungpook National University Hospital from Jan. 1984 through Jan. 1988, the incidence of ventricular dilatation confirmed by postoperative follow-up brain CT scannings was 32.2%(65 cases). And 33 cases(19.3%) was in mild ventricular dilatation, 9 cases(4.5%) was in moderate and 23 cases(11.4%) in severe who needed the shunting procedure were analysed. The incidence of ventricular dilatation to the site of aneurysm was highest in A-com A. aneurysm(42.2%), followed by P-com A. aneurysm(36.4%) and MCA aneurysm(11.3%). The incidence of ventricular dilatation and the need for shunting was higher in multiple bleeding patients than the single. The good risk patients had meaningfully lower incidence of ventricular dilatation than the poor risk group. In the delayed surgical group showed significantly more numbers of ventricular dilatation needing the shunt than the cases in early group.