Elevated BMPR2 expression amplifies osteoblast differentiation in ankylosing spondylitis

Objective@#Bone morphogenetic protein receptor type 2 (BMPR2) has been associated with radiographic changes in ankylosing spondylitis (AS), but further characterization of the cellular signaling pathway in osteoprogenitor (OP) is not clearly understood.The aim of this study was to investigate the expression of BMPR2 and bone morphogenetic protein 2 (BMP2)-mediated responsibility in AS. @*Methods@#We collected 10 healthy control (HC) and 14 AS-OPs derived from facet joints. Subsequently, we then conducted RNA sequencing with two samples per group and selected BMP-related genes. Facet joint tissues and derived primary OPs were evaluated by validation of selected RNA sequencing data, immunohistochemistry, and comparison of osteogenic differentiation potential. @*Results@#Based on RNA-sequencing analysis, we found that BMPR2 expression is higher in AS-OPs compared to in HC-OPs. We also validated the increased BMPR2 expression in facet joint tissues with AS and its derived OPs in messenger RNA and protein levels. Additionally, primary AS-OPs showed much greater response to osteogenic differentiation induced by BMP2 and a higher capacity for smad1/5/8-induced RUNX2 expression compared to HCs. @*Conclusion@#The expression of BMPR2 was found to be significantly increased in facet joint tissues of patients with AS. These findings suggest that BMPR2 may play a role in the BMP2-mediated progression of AS.

Re-stooping after Corrective Osteotomy in Patients with Ankylosing Spondylitis

Background@#Corrective osteotomy is an effective surgery for correcting posture in patients with ankylosing spondylitis (AS). Despite satisfactory correction, some patients experience re-stooping during follow-up. However, there have been no studies on restooping in AS. We aimed to analyze the factors that affect re-stooping. @*Methods@#Fifty patients (50 cases) who underwent thoracolumbar corrective osteotomy for AS from March 2006 to April 2018 were analyzed. We defined re-stooping as global kyphosis that recurs after corrective osteotomy. The patients were divided into two groups based on the ratio of correction loss: non-re-stooping group (N group) and re-stooping group (R group). We analyzed the demographic data and radiological parameters, such as modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), sagittal vertical axis, and various angles. We also investigated the factors affecting re-stooping by analyzing the correlation between the ratio of correction loss and various factors. @*Results@#A significant difference was seen in the change in the mSASSS from before surgery to the last follow-up between the N group (2.87 ± 3.08) and the R group (9.20 ± 5.44). In multivariate analysis, only the change in the mSASSS from before surgery to the last follow-up was significantly correlated with the ratio of correction loss. @*Conclusions@#Thoracolumbar corrective osteotomy seems to provide high satisfaction among patients with AS but can lead to re-stooping during follow-up. The change in mSASSS was related with re-stooping in the current study. We recommend active rehabilitative exercises and appropriate medication depending on the patient’s condition, which may help delay the postoperative progression of AS.

A Narrative Review on the Application of Artificial Intelligence on the Diagnosis and Outcome Prediction for Spinal Diseases / 대한정형외과학회잡지

Artificial intelligence is a concept that includes machine learning and artificial neural networks and is characterized by the rapid analysis of large-scale data based on fast computation of computers. Various medical studies have been reported to estimate the diagnosis and prognosis of specific diseases using artificial intelligence technology. Recently, many medical studies using a convolutional neural network, which is particularly useful for imaging recognition and analysis, have been reported. For various diseases in orthopedic surgery, including spinal diseases, imaging data, such as simple radiographs, computed tomography, and magnetic resonance imaging, are essential for determining the diagnosis and treatment of patients. Therefore, compared to other fields of medicine, there are many disease entities where artificial intelligence can be applied to the diagnosis and treatment of orthopedic diseases. With the increasing importance of medical informatics, the introduction of artificial intelligence by orthopedic surgeons will positively contribute to the development of medicine. This review outlines artificial intelligence and introduces studies using machine learning to diagnose and predict spinal diseases.

The TNF-NF-κB-DKK1 Axis Promoted Bone Formation in the Enthesis of Ankylosing Spondylitis

Objective@#This study aimed to determine the serum Dickkopf 1 (DKK1) levels in ankylosing spondylitis (AS) patients and decipher the mechanism of tumor necrosis factor (TNF)-mediated DKK1 regulation in human AS enthesis cells. @*Methods@#The sera were obtained from 103 patients with AS and 30 healthy controls (HCs). The enthesis of facet joints were obtained from 4 AS patients and 5 controls. The serum levels of DKK1 were measured using ELISA and compared between AS and HCs. The impact of TNF on DKK1 expression in human primary spinal enthesis cells was evaluated using various molecular biology techniques and bone formation indicators. @*Results@#AS patients showed higher serum DKK1 levels than HCs after adjusting for age (917.4 [615.3∼1,310.0] pg/mL vs. 826.2 [670.3∼927.8] pg/mL, p=0.043). TNF treatment promoted bone formation and DKK1 expression in both control enthesis cells and those of AS. This enhanced bone formation by TNF was pronounced in AS-enthesis than those of controls. Mechanically, TNF induced NF-κB activation upregulates the DKK1 transcript level. While, NF-κB inhibitor led to downregulate DKK1 expression in the enthesis. Besides, DKK1 overexpression promoted bone formation in enthesis. @*Conclusion@#TNF induced DKK1 expression in the enthesis through NF-κB activation. TNF-induced DKK1 expression may play a bone formation in the radiologic progression of ankylosing spondylitis.

The TNF-NF-κB-DKK1 Axis Promoted Bone Formation in the Enthesis of Ankylosing Spondylitis

Objective@#This study aimed to determine the serum Dickkopf 1 (DKK1) levels in ankylosing spondylitis (AS) patients and decipher the mechanism of tumor necrosis factor (TNF)-mediated DKK1 regulation in human AS enthesis cells. @*Methods@#The sera were obtained from 103 patients with AS and 30 healthy controls (HCs). The enthesis of facet joints were obtained from 4 AS patients and 5 controls. The serum levels of DKK1 were measured using ELISA and compared between AS and HCs. The impact of TNF on DKK1 expression in human primary spinal enthesis cells was evaluated using various molecular biology techniques and bone formation indicators. @*Results@#AS patients showed higher serum DKK1 levels than HCs after adjusting for age (917.4 [615.3∼1,310.0] pg/mL vs. 826.2 [670.3∼927.8] pg/mL, p=0.043). TNF treatment promoted bone formation and DKK1 expression in both control enthesis cells and those of AS. This enhanced bone formation by TNF was pronounced in AS-enthesis than those of controls. Mechanically, TNF induced NF-κB activation upregulates the DKK1 transcript level. While, NF-κB inhibitor led to downregulate DKK1 expression in the enthesis. Besides, DKK1 overexpression promoted bone formation in enthesis. @*Conclusion@#TNF induced DKK1 expression in the enthesis through NF-κB activation. TNF-induced DKK1 expression may play a bone formation in the radiologic progression of ankylosing spondylitis.

Treatment of Ankylosing Spondylitis / 대한정형외과학회잡지

Ankylosing spondylitis causes ankylosis of the spine due to ossification of the articular cartilage and ligaments around the vertebral body as well as the sacroiliac joint. This pathophysiology limits joint movement and, in many cases, causes pain and deformity of the spine. If this disease is left untreated, it ultimately causes ankylosis and ossification of the whole-body joints. The symptoms generally develop before age 30 years, and the gradual progression of the disease adversely affects the physical function, professional ability, and quality of life. This increases the likelihood of developing psychiatric disorders, such as depression. The authors are aware of this severity and introduce recent trends and studies to prevent surgical treatment with various medications before systemic ossification. This paper presents various surgical treatments and complications in patients who were unable to prevent progression and underwent surgical treatment.

Analgesic Efficacy and Safety of Prolonged-Release Oxycodone/Naloxone in Korean Patients with Chronic Pain from Spinal Disorders

BACKGROUND: A prolonged-release formulation of oxycodone/naloxone has been shown to be effective in European populations for the management of chronic moderate to severe pain. However, no clinical data exist for its use in Korean patients. The objective of this study was to assess efficacy and safety of prolonged-release oxycodone/naloxone in Korean patients for management of chronic moderate-to-severe pain. METHODS: In this multicenter, single-arm, open-label, phase IV study, Korean adults with moderate-to-severe spinal disorder-related pain that was not satisfactorily controlled with weak opioids and nonsteroidal anti-inflammatory drugs received prolonged-release oral oxycodone/naloxone at a starting dose of 10/5 mg/day (maximum 80/40 mg/day) for 8 weeks. Changes in pain intensity and quality of life (QoL) were measured using a numeric rating scale (NRS, 0–10) and the Korean-language EuroQol-five dimensions questionnaire, respectively. RESULTS: Among 209 patients assessed for efficacy, the mean NRS pain score was reduced by 25.9% between baseline and week 8 of treatment (p < 0.0001). There was also a significant improvement in QoL from baseline to week 8 (p < 0.0001). The incidence of adverse drug reactions was 27.7%, the most common being nausea, constipation, and dizziness; 77.9% of these adverse drug reactions had resolved or were resolving at the end of the study. CONCLUSIONS: Prolonged-release oxycodone/naloxone provided significant and clinically relevant reductions in pain intensity and improved QoL in Korean patients with chronic spinal disorders. (ClinicalTrials.gov identifier: NCT01811238)

Intra-cardiac Embolism of a Large Bone Cement Material after Percutaneous Vertebroplasty Removed through a Combination of an Endovascular Procedure and an Inferior Vena Cava Exploration: a Case Report

Percutaneous vertebroplasty (PVP) is a minimally invasive surgical treatment for patients with osteoporotic vertebral compression fracture (OVCF) and can rapidly alleviate pain, improve mobility, and stabilize the vertebrae. However, it has the potential to cause complications such as cement embolism. A 55-year-old female presented with pain in the lumbar region as a chief complaint. PVP was performed after diagnosis of acute OVCFs at L4 and L5. No abnormal symptoms were reported after surgery, but a large cement embolism was observed in her right atrium and ventricle. After discussion in a multi-disciplinary team, the large cement embolism was successfully removed by a combination of endovascular procedure and an inferior vena cava exploration. Surgeons must consider the possibility of intra-cardiac cement embolism after PVP. A hybrid approach of an endovascular procedure and a vascular surgery may be a reasonable treatment option to minimize the surgical procedure in cases of a large intra-cardiac cement embolism.

The Asian Federation of Osteoporosis Societies' call to action to improve the undertreatment of osteoporosis in Asia

No abstract available.

Surgical treatment of severe osteoporosis including new concept of advanced severe osteoporosis

Severe osteoporosis is classified as those with a bone mineral density (BMD) T-score of −2.5 or lower, and demonstrate one or more of osteoporotic, low-trauma, fragility fractures. According to the general principle of surgical approach, patients with severe osteoporosis require not only more thorough pre- and postoperative treatment plans, but improvements in surgical fixtures and techniques such as the concept of a locking plate to prevent bone deformity and maximizing the blood flow to the fracture site by using a minimally invasive plate osteosynthesis. Arthroplasty is often performed in cases of displaced femoral neck fracture. Otherwise internal fixation for the goal of bone union is the generally accepted option for intertrochanteric, subtrochanteric, and femoral shaft fractures. Most of osteoporotic spine fracture is stable compression fracture, but vertebroplasty or kyphoplasty may be performed some selective patients. If neurological paralysis, severe spinal instability, or kyphotic deformity occurs, open decompression or fusion surgery may be considered. In order to overcome shortcomings of the World Health Organization definition of osteoporosis, we proposed a concept of ‘advanced severe osteoporosis,’ which is defined by the presence of proximal femur fragility fracture or two or more fragility fractures in addition to BMD T-score of −2.5 or less. In conclusion, we need more meticulous approach for surgical treatment of severe osteoporosis who had fragility fracture. In cases of advanced severe osteoporosis, we recommend more aggressive managements using parathyroid hormone and receptor activator of nuclear factor kappa-B ligand monoclonal antibody.

The Effect of Anxiety, Depression, and Optimism on Postoperative Satisfaction and Clinical Outcomes in Lumbar Spinal Stenosis and Degenerative Spondylolisthesis Patients: Cohort Study

BACKGROUND: The aim of this study is to evaluate the effect of depression, anxiety, and optimism on postoperative satisfaction and clinical outcomes in patients who underwent less than two-level posterior instrumented fusions for lumbar spinal stenosis and degenerative spondylolisthesis. METHODS: Preoperative psychological status of subjects, such as depression, anxiety, and optimism, was evaluated using the Hospital Anxiety and Depression Scale (HADS) and the Revised Life Orientation Test (LOT-R). Clinical evaluation was determined by measuring changes in a visual analogue scale (VAS) and the Oswestry Disability Index (ODI) before and after surgery. Postoperative satisfaction of subjects assessed using the North American Spine Society lumbar spine questionnaire was comparatively analyzed against the preoperative psychological status. The correlation between patient's preoperative psychological status (depression, anxiety, and optimism) and clinical outcomes (VAS and ODI) was evaluated. RESULTS: VAS and ODI scores significantly decreased after surgery (p < 0.001), suggesting clinically favorable outcomes. Preoperative psychological status of patients (anxiety, depression, and optimism) was not related to the degree of improvement in clinical outcomes (VAS and ODI) after surgery. However, postoperative satisfaction was moderately correlated with optimism. CONCLUSIONS: Anxiety and optimism were more correlated with patient satisfaction than clinical outcomes. Accordingly, the surgeon can predict postoperative satisfaction of patients based on careful evaluation of psychological status before surgery.

Quality of Life in Patients with Osteoporotic Vertebral Compression Fractures

BACKGROUND: This study aimed to evaluate quality of life (QOL) using the EuroQOL-5 dimensions (EQ-5D) index and to examine factors affecting QOL in patients with an osteoporotic vertebral compression fracture (OVCF). METHODS: This ambispective study used a questionnaire interview. Patients over 50 years old with an OVCF at least 6 months previously were enrolled. Individual results were used to calculate the EQ-5D index. Statistical analysis was performed, and factors related to QOL were examined. RESULTS: Of 196 patients in the study, 84.2% were female, with an average age of 72.7 years. There were 66 (33.7%) patients with multilevel fractures. Conservative management was used in 75.0% of patients, and 56.1% received anti-osteoporosis treatment. The mean EQ-5D index was 0.737±0.221 and was significantly correlated with the Oswestry disability index score (correlation coefficient −0.807, P<0.001). The EQ-5D index was significantly correlated with age (Spearman's rho=−2.0, P=0.005), treatment method (P=0.005), and history of fracture (P=0.044) on univariate analysis and with conservative treatment (P<0.001) and osteoporotic treatment (P=0.017) on multivariate analysis. CONCLUSIONS: OVCF markedly lowers QOL in several dimensions for up to 12 months, even in patients who have healed. Treatment of osteoporosis and conservative treatment methods affect QOL and should be considered in OVCF management.

Prevalence of Neuropathic Pain and Patient-Reported Outcomes in Korean Adults with Chronic Low Back Pain Resulting from Neuropathic Low Back Pain

STUDY DESIGN: A noninterventional, multicenter, cross-sectional study. PURPOSE: We investigated the prevalence of neuropathic pain (NP) and patient-reported outcomes (PROs) of the quality of life (QoL) and functional disability in Korean adults with chronic low back pain (CLBP). OVERVIEW OF LITERATURE: Among patients with CLBP, 20%–55% had NP. METHODS: Patients older than 20 years with CLBP lasting for longer than three months, with a visual analog scale (VAS) pain score higher than four, and with pain medications being used for at least four weeks before enrollment were recruited from 27 general hospitals between December 2014 and May 2015. Medical chart reviews were performed to collect demographic/clinical features and diagnosis of NP (douleur neuropathique 4, DN4). The QoL (EuroQoL 5-dimension, EQ-5D; EQ-VAS) and functional disability (Quebec Back Pain Disability Scale, QBPDS) were determined through patient surveys. Multiple linear regression analyses were performed to compare PROs between the NP (DN4≥4) and non-NP (DN4 < 4) groups. RESULTS: A total of 1,200 patients (females: 65.7%; mean age: 63.4±13.0 years) were enrolled. The mean scores of EQ-5D, EQ-VAS, and QBPDS were 0.5±0.3, 55.7±19.4, and 40.4±21.1, respectively. Among all patients, 492 (41.0%; 95% confidence interval, 38.2%–43.8%) suffered from NP. The prevalence of NP was higher in male patients (46.8%; p < 0.01), in patients who had pain based on radiological and neurological findings (59.0%; p < 0.01), and in patients who had severe pain (49.0%; p < 0.01). There were significant mean differences in EQ-5D (NP group vs. non-NP group: 0.4±0.3 vs. 0.5±0.3; p < 0.01) and QBPDS (NP group vs. non-NP group: 45.8±21.2 vs. 36.3±20.2; p < 0.01) scores. In the multiple linear regression, patients with NP showed lower EQ-5D (β=−0.1; p < 0.01) and higher QBPDS (β=7.0; p < 0.01) scores than those without NP. CONCLUSIONS: NP was highly prevalent in Korean patients with CLBP. Patients with CLBP having NP had a lower QoL and more severe dysfunction than those without NP. To enhance the QoL and functional status of patients with CLBP, this study highlights the importance of appropriately diagnosing and treating NP.

Extensive Multiple Morel-Lavallée Lesions: A Case Report

Morel-Lavallée is a rare lesion caused by post-traumatic soft tissue injury. It usually occurs around the greater trochanter, and it occurs very rarely in the lumbar region. It is often difficult to be diagnosed in the emergency room. Delayed diagnosis may result in the need for open surgery. The authors report a patient with extensive multiple Morel-Lavallée lesions in the thoracolumbar, buttock, and thigh after trauma and provide a literature review.

Kyphotic Deformity after Spinal Fusion in a Patient with Diffuse Idiopathic Skeletal Hyperostosis: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: To report a case of progressive kyphotic deformity after spinal fusion in a patient with diffuse idiopathic skeletal hyperostosis (DISH). SUMMARY OF LITERATURE REVIEW: DISH is characterized by spinal and peripheral enthesopathy, and is a completely different disease from ankylosing spondylitis (AS). Though DISH can be associated with thoracic kyphosis, no reports have described a progressive thoracolumbar kyphotic deformity after spinal fusion surgery in a DISH patient. MATERIALS AND METHODS: A 47-year-old male presented with pain in the thoracolumbar region. After excluding the possibility of AS and confirming the diagnosis of DISH, we performed spinal fusion for the treatment of a T11-T12 flexion-distraction injury. The kyphotic deformity was found to be aggravated after the first operation, and we then performed corrective osteotomy and additional spinal fusion. Results: The kyphotic deformity of the patient was corrected after the second operation. RESULTS: The kyphotic deformity of the patient was corrected after the second operation. CONCLUSIONS: In DISH patients in whom AS must be excluded in the differential diagnosis, a kyphotic deformity can become aggravated despite spinal fusion surgery, so regular and continuous follow-up is required.

Clinical Usefulness of Long-term Application of Fentanyl Matrix in Chronic Non-Cancer Pain: Improvement of Pain and Physical and Emotional Functions

BACKGROUND: Opioids are recently recommended for those who do not gain adequate pain relief from the use of acetaminophen or nonsteroidal anti-inflammatory drugs. Medical opioids are administered in various routes, and transdermal opioid products that can make up for the weaknesses of the oral or intravenous products have been developed. This study is to evaluate the clinical usefulness of fentanyl matrix in terms of the long-term improvement in pain and physical and mental functions. METHODS: This was a multicenter, open, prospective, observational study that was conducted in 54 institutions in Korea. Patients with non-cancerous chronic pain completed questionnaires, and investigators also completed questionnaires. A total of 1,355 subjects participated in this study, and 639 subjects completed the study. Subjects received transdermal fentanyl matrix (12 µg/hr, 25 µg/hr, or 50 µg/hr depending on the patient's response and demand). Subjects visited at 29 ± 7 days, 85 ± 14 days, and 169 ± 14 days after administration, respectively, to receive drug titration and fill out the questionnaires. The results were analyzed using the intention-to-treat (ITT) analysis, full analysis set (FAS), and per-protocol (PP) analysis. The FAS analysis included only 451 participants; the PP analysis, 160 participants; and the ITT analysis, 1,355 participants. RESULTS: The intensity of pain measured by the Numeric Rating Scale decreased from 7.07 ± 1.78 to 4.93 ± 2.42. The physical assessment score and mental assessment score of the Short-Form Health Survey 12 improved from 28.94 ± 7.23 to 35.90 ± 10.25 and from 35.80 ± 11.76 to 42.52 ± 10.58, respectively. These differences were significant, and all the other indicators also showed improvement. Adverse events with an incidence of ≥ 1% were nausea, dizziness, vomiting, and pruritus. CONCLUSIONS: The long-term administration of fentanyl matrix in patients with non-cancerous pain can reduce the intensity of pain and significantly improves activities of daily living and physical and mental capabilities.

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.

Perception of severe osteoporosis amongst medical doctors in South Korea: Awareness, impact, and treatment

OBJECTIVES: Little is currently known about the issues surrounding management and treatment of severe osteoporosis in South Korea. Our objective was to assess doctors' views on the perception, diagnosis, and treatment of severe osteoporosis. METHODS: Face-to-face interviews were conducted (16 February-13 March 2015) with 100 doctors (specialists in orthopedic surgery, endocrinology, neurosurgery, family medicine, or rheumatology) who treated ≥5 severe osteoporosis (T-score ≤ -2.5, plus fracture) patients per month. Respondent demographic characteristics, their perception of severe osteoporosis, its impact and treatment, and their views on current practice and unmet needs were assessed. RESULTS: Of 416 doctors approached, 100 completed the survey (24% response rate). Most doctors (90%) specialized in orthopedic surgery, endocrinology, or neurosurgery. When diagnosing severe osteoporosis, most doctors (79%) considered both bone mineral density and fracture. Almost all doctors (≥91%) ranked disease impact and seriousness highly, but much fewer (≤25%) doctors thought society agreed. Most doctors (89%) had concerns with current treatments, switching treatments because of the efficacy and safety of bisphosphonates (>89%), the efficacy of selective estrogen receptor modulators (>71%), and the high cost of parathyroid hormone (>73%). Parathyroid hormone was ranked highest for efficacy and was preferentially prescribed to severe osteoporosis patients (mean 32.2% of prescriptions) compared with osteoporosis patients overall (3.7%). "Limitations with reimbursement" was the most commonly cited (76%) unmet need. CONCLUSIONS: There are concerns with the safety, efficacy, and affordability of current treatments for severe osteoporosis in South Korea, as well as a perceived lack of disease awareness amongst patients and doctors.

Proximal Junctional Kyphosis: Diagnosis, Pathogenesis, and Treatment

Proximal junctional kyphosis (PJK) is a common radiographic finding after long spinal fusion. A number of studies on the causes, risk factors, prevention, and treatment of PJK have been conducted. However, no clear definition of PJK has been established. In this paper, we aimed to clarify the diagnosis, prevention, and treatment of PJK by reviewing relevant papers that have been published to date. A literature search was conducted on PubMed using "proximal junctional", "proximal junctional kyphosis", and "proximal junctional failure" as search keywords. Only studies that were published in English were included in this study. The incidence of PJK ranges from 5% to 46%, and it has been reported that 66% of cases occur 3 months after surgery and approximately 80% occur within 18 months. A number of studies have reported that there is no significantly different clinical outcome between PJK patients and non-PJK patients. One study showed that PJK patients expressed more pain than non-PJK patients. However, recent studies focused on proximal junctional failure (PJF), which is accepted as a severe form of PJK. PJF showed significant adverse impact in clinical aspect such as pain, neurologic deficit, ambulatory difficulties, and social isolation. Numerous previous studies have identified various risk factors and reported on the treatment and prevention of PJK. Based on these studies, we determined the clinical significance and impact of PJK. In addition, it is important to find a strategic approach to the proper treatment of PJK.

A Interventional Study in a Real Life Setting to Assess the Clinical Efficacy and Effect on Fracture in the 1 Year after Injection of Zoledronic Acid in Osteoporotic Patients with Long Bone or Spine, Pelvic Fractures / 대한정형외과학회잡지

PURPOSE: We studied the improvement of back pain in vertebral fracture and fracture healing in non-vertebral fracture after treatment with zoledronate in postmenopausal patients. MATERIALS AND METHODS: Postmenopausal women with bone mineral density (BMD) T-score of -2.5 or less and existing vertebral fractures or non-vertebral fractures between January 2011 and June 2012 were included. Patients received a single intravenous infusion of zoledronate within 3 days after diagnosis of fractures. The primary outcome was BMD and secondary outcomes were visual analogue scale (VAS) for back pain, fracture healing, and new clinical fracture. RESULTS: T-score increased significantly in the vertebral fracture group (n=97) and non-vertebral fracture group (n=31) at 1 year (p<0.05). The average VAS for back pain decreased significantly in the vertebral fracture group (p<0.05) and there was no delayed union, nonunion in the non-vertebral fracture group. There was no re-fracture and 3 new clinical fractures (2.34%) occurred during the follow-up period. CONCLUSION: Zoledronate, as treatment in postmenopausal osteoporosis patients can improve BMD, reduce back pain in vertebral fracture, and has no negative effect on bone healing after fracture in non-vertebral fracture.