Percutaneous Polymethylmethacrylate Vertebroplasty in the Treatment of Osteoporotic Thoracic and Lumbar Vertebral Body Compression Fractures: Outcome of 159 Patients

PURPOSE: To assess therapeutic effects of percutaneous polymethylmethacrylate(PMMA) vertebroplasty on the pain caused by osteoporotic thoracic and lumbar vertebral body compression fractures in a large scale of a prospective clinical design, and to determine clinical factors influencing its therapeutic effects. METHODS: A prospective clinical study was carried out in 349 vertebral levels of 159 patients between April 1998 and July 1999. The compression fractures were confirmed with bone scan and spine CT, and bone marrow density was measured. Visual analogue scale(VAS) score was used for pre- and post-operative assessments of the pain. All 159 patients were assessed immediately after surgery, and 140 patients of them were followed-up for about 6 months in average. RESULTS: Partial and complete pain relief was sustained immediately after operation in 73%, through follow-up period in 88% of the patients. Pain relief was not proportional to the amount of PMMA or the rate of increase in the height of the compressed vertebral body. It appears that 3 to 6cc of PMMA was proper enough to sustain pain relief. Better clinical improvement was achieved in the patients treated within 6 months after occurrence of vertebral body fracture. The most frequent surgical complication was epidural leakage of PMMA, and the most serious complication was extravertebral leakage into the paravertebral muscles, which appeared to exert the worst influence on the outcome. However, surgery was not required in these patients. CONCLUSION: Therapeutic effects of PMMA percutaneous vertebroplasty on osteoporotic vertebral body compression fractures were confirmed in a relatively large scale of prospective clinical study. It appears that good outcome can be achieved in patients treated within 6 months after fracture, treated each level with 3 to 6cc of PMMA in amount. without serious complications.

Hemodynamics of Poor-grade Subarachnoid Hemorrhage

Patients who are devastated neurologically or medically after aneurysmal subarachnoid hemorrhage(SAH) are described as 'poor grade' patients. More recent studies have documented that the initial hemorrhage is by far the most important determinant of outcome after aneurysmal subarachnoid hemorrhage. This review mainly includes hemodynamics and suspected mechanisms of acute brain injury after aneurysmal SAH, particularly in special reference to increased intracranial pressure and cerebral ischemia during and after SAH.

Management of Dissecting Aneurysm of Cervicocephalic Carotid and Vertebral Artery / 대한뇌혈관학회지

The pathogenesis of spontaneous cervicocephalic arterial dissection is still incompletely understood. The clinical presentation of the arterial dissection depends on the plane where the dissection occurred in the arterial wall. When the outer media or subadventitia is dissected, the intramural hematoma bulges outward to make dissecting aneurysm. When located in the subintima or inner media, the intramural hematoma produces narrowing or occlusion of the vessel lumen. Authors review etiopathogeness, clinical features, diagnosis and management of cerviococephalic arterial dissection.

Usefulness of Magnetic Resonance Imaging in the Evaluation of Spine Following Instrumentation with Titanium Implants

Over the past six years, titanium alloy has been replacing the stainless steel in spinal implants owing to its magnetic resonance imaging(MRI) compatibility. However, studies about the usefulness of MRI, from a clinical standpoint, when it is used for spinal implants have been scarce. The purpose, therefore, is to determine whether postoperative MRIs would provide satisfactory information in evaluating the spine having various titanium implants. Authors reviewed the spinal MR images of sixteen patients who had previously received eleven different kinds of titanium implants, and compared postoperative images to preoperative images regarding the quality of images of spinal cord, nerve root, spinal canal, and the aforementioned implants. Types of implants included anterior cervical plate/screws, lateral cervical mass plate/screws, Halifax interlaminar clamps, anterior thoracolumbar rods/screws, posterior thoracolumbar rods/hooks, and posterior thoracolumbar transpedicular rods/screws. Anterior cervical plate/screws, lateral cervical mass plate/screws, Halifax clamps, and anterior thoracolumbar rod/screws produced small distortions of the images at the spinal canal or neural foramen. In contrast, posterior thoracolumbar transpedicular rods/screws created severe image distortions at the neural foramen in the postoperative MRIs. Metal-induced artifacts were most marked in the image from gradient echo sequence. Posterior thoracolumbar rods/hooks produced some artifacts at the posterior portion of the spinal canal. Although our series are limited in number, it can be concluded that MRI is informative and it is useful in postoperative evaluation of the spine with most types of titanium implants. However, postmyelogram computed tomography is recommended in cases where posterior thoracolumbar transpedicular rods/screws have been used.

Anterior Cervical Interbody Fusion with or Without Plate and Screws System

Although anterior cervical plates are thought to be good tools, their clinical results have not been compared with those of anterior cervical fusion without a plating system in the domestic scientific literature. As there are some advantages as well as shortcomings in these two surgical methods, it is imperative to know which one might be better in terms of the postoperative complications and management. Therefore, the authors reviewed 80patients undergoing anterior cervical fusion during the period of January 1992 to May 1994. Top plate placement was made in 25 and simple fusion without a plating system was applied in 55. The average follow-up period was 9.6 months. In the patients undergoing simple cervical fusion, thirty-two patients(58%) needed rigid braces such as halo braces and Minerva casts for 3 months postoperatively. Thirteen patients(24%) showed graft complications including graft extrusion, whereas patients undergoing plate placement needed only semi-rigid Philadelphia braces for 4 to 8 weeks pos toperatively. Two patients(8%) showed graft setting and screw breakage without any indication of reoperation. However there appeared no difference in the immediate postoperative course of clinical symptoms and the fusion rate(95 vs 96%) at the final follow-up day between the simple fusion and the plate placement patients. The authors conclude that a plating system in anterior cervical fusion may be safe in spite of more extensive operations, and is more likely to offer postoperative stability in the cervical spine and early ambulation and rehabiliation without rigid braces.

Anterior Cervical Interbody Fusion with or Without Plate and Screws System

Although anterior cervical plates are thought to be good tools, their clinical results have not been compared with those of anterior cervical fusion without a plating system in the domestic scientific literature. As there are some advantages as well as shortcomings in these two surgical methods, it is imperative to know which one might be better in terms of the postoperative complications and management. Therefore, the authors reviewed 80patients undergoing anterior cervical fusion during the period of January 1992 to May 1994. Top plate placement was made in 25 and simple fusion without a plating system was applied in 55. The average follow-up period was 9.6 months. In the patients undergoing simple cervical fusion, thirty-two patients(58%) needed rigid braces such as halo braces and Minerva casts for 3 months postoperatively. Thirteen patients(24%) showed graft complications including graft extrusion, whereas patients undergoing plate placement needed only semi-rigid Philadelphia braces for 4 to 8 weeks pos toperatively. Two patients(8%) showed graft setting and screw breakage without any indication of reoperation. However there appeared no difference in the immediate postoperative course of clinical symptoms and the fusion rate(95 vs 96%) at the final follow-up day between the simple fusion and the plate placement patients. The authors conclude that a plating system in anterior cervical fusion may be safe in spite of more extensive operations, and is more likely to offer postoperative stability in the cervical spine and early ambulation and rehabiliation without rigid braces.

Monitoring of Somatosensory Evoked Potentials During Intracranial Aneurysm Surgery

Somatosensory evoked potentials(SEPs) in response to median nerve stimulation have been recorded as a guide to cortical function during temporary occlusion of the parent vessels in the treatment of 27 aneurysms of middle cerebral artery and internal carotid artery. The central conduction time(CCT), the time between the N14 peak and the N20 peak, were preserved for variable times during temporary occlusion, ranging from no significant change after 18 minutes of occlusion to disappearance of the N20 after 2 minutes. The rapid disappearance of N20 within three minutes after temporary occlusion was observed in all three cases which was developed new postoperative neurological deficits, neither permanent, and in one case of death. The total arterial occlusion time of each of these postoperative deficit cases was no longer than 20 minutes and the shortest time was 12 minutes. The rapid loss of the cortical wave after temporary occlusion, therefore, suggests the safty duration of the temporary occlusion would be short. Monitoring of the SEPs during intracranial aneurysm surgery can help the surgeon in the management of proximal vessel control and reduce the morbidity of aneurysm operation.

Monitoring of Somatosensory Evoked Potentials During Intracranial Aneurysm Surgery

Somatosensory evoked potentials(SEPs) in response to median nerve stimulation have been recorded as a guide to cortical function during temporary occlusion of the parent vessels in the treatment of 27 aneurysms of middle cerebral artery and internal carotid artery. The central conduction time(CCT), the time between the N14 peak and the N20 peak, were preserved for variable times during temporary occlusion, ranging from no significant change after 18 minutes of occlusion to disappearance of the N20 after 2 minutes. The rapid disappearance of N20 within three minutes after temporary occlusion was observed in all three cases which was developed new postoperative neurological deficits, neither permanent, and in one case of death. The total arterial occlusion time of each of these postoperative deficit cases was no longer than 20 minutes and the shortest time was 12 minutes. The rapid loss of the cortical wave after temporary occlusion, therefore, suggests the safty duration of the temporary occlusion would be short. Monitoring of the SEPs during intracranial aneurysm surgery can help the surgeon in the management of proximal vessel control and reduce the morbidity of aneurysm operation.

The effects of exponential rise rate of serum estradiol concentration on the follicular development and the outcome of in vitro fertilization and embryo transfer / 대한산부인과학회잡지

No abstract available.