Bone Cement Augmentation of Short Segment Fixation for Unstable Burst Fracture in Severe Osteoporosis

OBJECTIVE: The purpose of this study was to determine the efficacy of short segment fixation following postural reduction for the re-expansion and stabilization of unstable burst fractures in patients with osteoporosis. METHODS: Twenty patients underwent short segment fixation following postural reduction using a soft roll at the involved vertebra in cases of severely collapsed vertebrae of more than half their original height. All patients had unstable burst fracture with canal compromise, but their motor power was intact. The surgical procedure included postural reduction for 2 days and bone cement-augmented pedicle screw fixations at one level above, one level below and the fractured level itself. Imaging and clinical findings, including the level of the vertebra involved, vertebral height restoration, injected cement volume, local kyphosis, clinical outcome and complications were analyzed. RESULTS: The mean follow-up period was 15 months. The mean pain score (visual analogue scale) prior to surgery was 8.1, which decreased to 2.8 at 7 days after surgery. The kyphotic angle improved significantly from 21.6+/-5.8degrees before surgery to 5.2+/-3.7degrees after surgery. The fraction of the height of the vertebra increased from 35% and 40% to 70% in the anterior and middle portion. There were no signs of hardware pull-out, cement leakage into the spinal canal or aggravation of kyphotic deformities. CONCLUSION: In the management of unstable burst fracture in patients with severe osteoporosis, short segment pedicle screw fixation with bone cement augmentation following postural reduction can be used to reduce the total levels of pedicle screw fixation and to correct kyphotic deformities.

Prognostic Factors of Percutaneous Radiofrequency Neurotomy on the Posterior Primary Ramus

OBJECTIVE: We report our experience of percutaneous radiofrequency neurotomy(PRN) on the posterior primary ramus with at least two years follow up. METHODS: Two hundred and twenty-eight patients were underwent PRN on the posterior primary ramus for refractory low back pain during last three years. One hundred and twenty-eight patients were met all inclusion criteria indicating facetal originated pain(group II), and 100 patients were not(group I). Radiofrequency procedures were done in usual manner. Pain reliefs were estimated at 1 week, 1 month, 6 months and 2 years using visual analog scale. RESULTS: Positive responders were 56% at 1 week, 46% at 1 month, 18% at 6 months, and 13% at 2 years after PRN in group I, and 78.9% at 1 week, 75.4% at 1 month, 62.5% at 6 months, and 54.7% at 2 years in group II. Prominent local tenderness, percussion tenderness, pain on getting up, extension and transitional movement, radiating pain on buttock and/or posterior thigh, and good immediate response were found to be significantly related to outcome. And age, sex, symptom duration, bilateral symptoms, favorable imaging study results, previous lumbar surgery, and degrees of pain relief from diagnostic block were not. CONCLUSION: Percutaneous radiofrequency neurotomy on the posterior primary ramus has long-term beneficial effect, without any morbidity in our series. And the long-term good results will be anticipated after proper selection among patients with facet joints related low back pain.

Prognostic Factors of Percutaneous Radiofrequency Neurotomy for Chronic Low Back Pain

BACKGROUNDS: Percutaneous radiofrequency neurotomy of posterior primary ramus has been in use as a treatment for persistent, mechanical low back pain for two decades. However, there has been limited studies regarding to prognostic factors related to outcome. We report our experience with at least 2-year follow up with special aftention on prognostic factors. METHODS: Of total 228 patients who underwent percutaneous radiofrequency neurotomy (PRN) of posterior primary ramus for refractory low back pain during last 3 years, 128 patients whose pain was considered to be originated from facets joints or their surrounding soft tissue and responded to temporary blocks were assigned to a group II. All patients had more than 6 months of pain. These patients were compared with 100 patients to whom PRN were provided for chronic nonspecific low back pain without all inclusion criteria (Group I). RF procedures were done under local anesthesia with C-arm intensifier guidance. Pain reliefs were estimated at 1week, 1month, 6months and 2 years using visual analog scale(VAS). For patients with more that 50% reduction of previous pain was regarded as positive responder. Various clinical variables such as age, sex, symptom duration, types of pain, bilaterality, and previous surgery were studied for prognostic factors. RESULTS: Positive responders were 56% at 1week, 46% at lmonth, 18% at 6months, and 13% at 2years after PRN in group I, and 78.9% at lweek, 75.4% at lmonth, 62.5% at 6months, and 54.7% at 2years in group II. Some variables were found to be significantly related to outcome including prominent local tenderness, percussion tenderness, combination of symptoms with pain on gefting up, extension, transitional movement, pain radiating to buttock and/or posterior thigh, and good immediate response. Age, sex, symptom duration, bilaterality, imaging study results, previous lumbar surgery, and degrees of pain relief from diagnostic block were not related to outcome. CONCLUSIONS: These results indicate that PRN of posterior primary ramus has a moderate overall long-term beneficial effect, with no morbidity in our series. But, the long-term good results will be anticipated only in properly selected patients with low back pain originating from facet joints and surrounding structures.

Primary Malignant Melanoma in the Fourth Ventricle: Case Report

We describe a case of primary malignant melanoma in the fourth ventricle treated with surgery and fractionated high dose radiotherapy. A 27-year-old man was referred to our institution due to drowsy mentality, dysconjugated gaze, and pupil dilatation following vertigo and posterior neck pain. Preoperative magnetic resonance images revealed a fourth ventricular tumor extending to C2 level. The mass was high-signal intensity on T1-weighted image, low- on T2-weighted and homogeneous strong enhancement. Extraneural focus of primary site was not found. After grossly total removal in two staged operations, fractionated high dose radiotherapy was given(6300 cGy, 180cGy X 35 fraction). No tumor recurrence was seen for 12 months after operation. Aggressive treatment involving operative total tumor removal and combined radiotherapy is considered to increase the life span of the patient even with this type of tumor.