The Incidence of New Vertebral Compression Fractures in Women after Kyphoplasty and Factors Involved

PURPOSE: To identify the incidence of new vertebral compression fractures in women after kyphoplasty and to analyze influential factors in these patients. MATERIALS AMD METHODS: One hundred and eleven consecutive female patients with osteoporotic vertebral compression fractures (VCFs) underwent kyphoplasty at 137 levels. These patients were followed for 15.2 months postoperatively. For the survey of new vertebral compression fractures, medical records and x-rays were reviewed, and telephone interviews were conducted with all patients. RESULTS: During that time 20 (18%) patients developed new VCFs. The rate of occurrence of new VCFs in one year was 15.5% using a Kaplan-Meier curve. Body mass index (BMI), symptom duration and kyphoplasty level were the statistically significant factors between the patient groups both with and without new VCFs after kyphoplasty. In the comparison between the adjacent and remote new VCF groups, the adjacent new VCF group showed a larger amount of polymethyl methacrylate (PMMA) use during kyphoplasty (p<0.05). Before kyphoplasty, 9.9% of the patients had been prescribed medication for osteoporosis, and 93.7% of the patients started or continued medication after kyphoplasty. The development of new VCFs was affected by the number of vertebrae involved in the kyphoplasty. However, the lower incidence rate (15.5%) of new compression fractures might be due to a greater percentage (93.7% in our study) of patients taking anti-osteoporotic medication before and/or after kyphoplasty. CONCLUSION: When kyphoplasty is planned for the management of patients with osteoporotic VCFs, the application of a small amount of PMMA can be considered in order to lower the risk of new fractures in adjacent vertebrae. The postoperative use of anti- osteoporotic medication is recommended for the prevention of new VCFs.

A Change of Pulmonary Function in the Patients with Severe Non-Idiopathic Scoliosis Following Reconstructive Spine Surgery / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study OBJECTIVES: We wanted to investigate the changes in pulmonary function after spine surgery for the patients suffering with severe non-idiopathic scoliosis. SUMMARY OF LITERATURE REVIEW: The potential for pulmonary function change after scoliosis surgery may be much greater for the patients with neuromuscular, congenital or neuro-fibromatosis because of the severe thoracic deformity. Yet few studies have been performed on this subject. MATERIALS AND METHODS: 12 non-idiopathic scoliosis patients (average age: 11.1 years) were followed up for more than one year. Among these patients, 7 had muscular dystrophy, 3 had spinal muscular atrophy, 1 had Guillain-BarreSyndrome and 1 had neuro-fibromatosis. Surgery was done through the anterior and posterior approaches in 7 cases, and the posterior approach was used in 5 cases. In the former group, open thoracotomy was performed in 6 cases. NIPPV (non-invasive positive pressure ventilation) was used for 4 patients before surgery. RESULTS: The average Cobb's angle improved from preoperative 93.9 to postoperative 42.4, showing 55% correction. The average FVC was 1270ml before surgery and 1365 ml postoperatively, and the average FEV1 was 1163 ml preoperatively and 1300 ml postoperatively, showing a slightly increased FEV1. When these data were analyzed in detail, the FVC was decreased from preoperative 72.3% to 63.8% postoperatively in the 6 patients who underwent open thoracotomy. On the other hand, it was increased from preoperative 43% to 47.5% postoperatively in the 6 patients who did not undergo thoracotomy. CONCLUSION: Although the pulmonary function deteriorated after reconstructive spine surgery in some patients, worsening was seen mainly in those patients who underwent thoracotomy. The pulmonary function was actually improved in the patients who underwent surgery without thoracotomy to correct their severe scoliosis

Comparison of the Predictive Value of Myelography, Computed Tomography and MRI on the Treadmill Test in Lumbar Spinal Stenosis

To date, there have been no prospective, objective studies comparing the accuracy of the MRI, myelo-CT and myelography. The purpose of this study is to compare the diagnostic and predictive values of MRIs, myelo-CTs, and myelographies. Myelographies with dynamic motion views, myelo-CTs, MRIs and exercise treadmill tests were performed in 35 cases. The narrowest AP diameter of the dural sac was measured by myelography. At the pathologic level, dural cross-sectional area (D-CSA) was calculated in the MRI and Myelo-CT. The time to the first symptoms (TAF) and the total ambulation time (TAT) were measured during the exercise treadmill test and used as the standard in the comparison of correlation between radiographic parameters and walking capacity. The mean D-CSA by CT was 58.3 mm2 and 47.6 mm2 by MRI. All radiographic parameters such as AP diameters and D-CSA have no correlation to TAF or TAT (p > 0.05). Our data showed no statistically significant differences in the correlation of the patients' walking capacity to the severity of stenosis as assessed by myelography, myelo-CT and MRI.