Sacral Insufficiency Fracture with Osteoporotic Compression Fracture of the Thoracolumbar Spine : Incidence and High Risk Factors

OBJECTIVE: The sacral insufficiency fractures (SIFs) are not uncommon and usually occur in osteoporotic bone with minimal or unremembered trauma. Especially, if they are accompanied by osteoporotic compression fracture of the thoracolumbar spine, SIFs can be usually overlooked due to subtle clinical symptoms and signs coupled with radiographic findings. The review aims to be raising awareness of the incidence & risk factors of the SIFs. METHODS: We retrospectively reviewed the 252 patients who were admitted at our hospital due to osteoporotic compression fracture of the thoracolumbar spine with minimal or unremembered trauma for 5 years. We assessed the incidence of the SIF being accompanied by osteoporotic compression fracture of the thoracolumbar spine and the effects according to sex, age, probable risk factors (diabetes mellitus & arterial hypertension), the location of fracture and the severity of osteoporosis. RESULTS: 252 patients, including 36 men (14.3%) and 216 women (85.7%) were involved in this study and the osteoporotic compression fractures were located at thoracic (36 cases), thoracolumbar junction (180 cases), lumbar spine (36 cases). There are 18 cases (the incidence: 7.1%), including 2 men (5.5%) and 16 women (7.4%) in which the SIF was accompanied by osteoporotic compression fracture of the thoracolumbar spine. The effects according to sex, age, probable risk factors, the location of fracture and the severity of osteoporosis were not statistically different in both groups (group with SIF and group without SIF). CONCLUSION:The clinicians need to consider the possibility of SIF in patients of osteoporotic compression fracture of the thoracolumbar spine.

Two-Level Anterior Cervical Discectomy and Fusion with Stand-alone Cages in Cervical Spinal Degenerative Diseases

OBJECTIVE: Anterior cervical discectomy and fusion(ACDF) is a highly successful surgical treatment for nerve root or spinal cord compression caused by disc herniation or spondylosis. Multilevel cervical discectomy usually requires plate and screw fixation for adequate bony fusion and stability. But the use of plate and screw fixation may cause some post-operative complications. So in this study we evaluate the safety and effectiveness of two-level ACDF with carbon or polyetheretherketone(PEEK) cages without cervical plate in cervical degenerative disc disease. METHODS: We retrospectively analyzed 18 patients who underwent two-level ACDF with carbon or PEEK cages from February 2002 to August 2008. The mean follow-up period was 31months. Clinical, radiologic and surgical morbidities were assessed in all cases. Outcome assessment was done using Odom's criteria and visual analogue scale(VAS) score. Radiological assessment was done with bony fusion rate, linear measure of cervical lordosis, cervical lordotic angle and cage subsidence. RESULTS: Radiculopathy was improved in all cases(100%) after surgery, whereas myelopathy was resolved in three of five patients(60%). Radiographic evidence of fusion was found in all patients(100%) at last follow-up. Preoperative mean VAS score was 8.1 compared with a postoperative score 2.5(p<0.05). The clinical outcome was excellent or good in 16 cases(89%). There were no serious complications such as dislodgement of cages, hardware failure, infection and neurologic deterioration. Linear measure of cervical lordosis at last follow-up was increased from 2.72+/-1.12mm to 7.84+/-1.09mm. Cervical lordotic angle at last follow-up was increased from 8.9+/-2.76 degrees to 15.1+/-2.38 degrees. The mean loss of disc height was 1.40mm during the follow-up period. However development of subsidence did not influence on clinical outcomes. CONCLUSION: ACDF in two-level stand-alone cages is a safe and effective procedure in multilevel cervical degenerative diseases. In spite of subsidence, interbody fusion with cages provides load-sharing function and stabilization of the cervical spine by increasing segmental rigidity, thus yielding excellent fusion rates and less graft failure, even in two- level cervical diseases.

Clinical Usefulness of Disc Degeneration and Facet Joint Degeneration as an Indicator of Judgment for Lumbar Segmental Instability

OBJECTIVE: Treatment for symptomatic lumbar stenosis is usually surgical decompression and additional global fusion is recommended for patients with segmental instability. The aim of this article is to evaluate that degeneration degree of the disc and facet joint could be the indicator of judgment for segmental instability. METHODS: We retrospectively reviewed 84 patients who underwent surgical treatment for lumbar spinal stenosis. Patients in Group 1(30 patients) with radiological instability underwent decompression with global fusion, patients in Group 2(54 patients) without radiological instability underwent decompression with global fusion or decompression only according to the existence and nonexistence of clinical instability. Magnetic resonance images were used to assess the disc degeneration from Grade I(normal) to Grade V(advanced) and the facet joints degeneration from Grade 0(normal) to Grade 3(advanced). All patients were checked with the simple X-ray stress view and evaluated. RESULTS: Severity of the disc degeneration had no significant association with the segmental instability, and no correlation with the facet joint degeneration. Severity of facet joint degeneration had significant correlation with the radiological instability. The segmental instability was increased with increasing severity of facet joint degeneration, especially tran slation. There was a significant association between facet joint degeneration and clinical instability. The facet joint degeneration was increased in patients with clinical instability. CONCLUSION: Our results suggest that the facet joint degeneration may be the useful indicator of judgment for segmental instability