Factors Affecting Periprosthetic Bone Loss after Hip Arthroplasty / 대한고관절학회지

Periprosthetic bone loss may lead to major complications in hip arthroplasty, including aseptic loosening, implant migration, and even periprosthetic fracture. Such a complication leads to revision surgeries, which are expensive, technically demanding, and result in a low satisfaction rate. Therefore, a study was conducted of the factors affecting the periprosthetic bone loss around the stem that caused these complications. Factors influencing periprosthetic bone loss include demographic factors such as age, sex, obesity, smoking, and comorbidity including diabetes and osteoporosis. The implant design and fixation method are also factors that are determined before surgery. In addition, there are surgical factors, such as surgical approach and surgical technique, and we wish to investigate the factors affecting periprosthetic bone loss around the stem by comparing the effects of postoperative rehabilitation protocols and osteoporosis drugs.

Internal Fixation of Pauwels Type-3 Undisplacedincomplete Insufficiency Femoral Neck Fractures with Cephalomedullary Nails / 대한고관절학회지

Femoral neck stress fractures are rare and when treating are difficult to achieve favorable outcomes. This study characterizes outcomes associated with the use of cephalomedullary nails for fixation of Pauwels type-3 vertical femoral neck undisplaced-incomplete insufficiency fractures. Four consecutive patients with a Pauwels type-3 vertical femoral neck tensile insufficiency fracture from 2016 to 2018 were reviewed. Magnetic resonance imaging data revealed tensile visible fracture lines and hip-joint effusions with a high shear angle. For all patients, bone mineral density and vitamin D levels were low; vitamin D therapy was initiated immediately. Surgical procedures were conducted with cephalomedullary nails (Gamma 3 locking nail system; Stryker) under general anesthesia. A cephalomedullary nail appears to be a safe and effective alternative to the use of multiple parallel screws or a sliding hip screw for fixation of vertical femoral neck stress fractures (level of evidence: Level V).

Management of Blood Loss in Hip Arthroplasty: Korean Hip Society Current Consensus / 대한고관절학회지

The volume of hip arthroplasty is stiffly increasing because of excellent clinical outcomes, however it has not been shown to decrease the incidence of transfusions due to bleeding related to this surgery. This is an important consideration since there are concerns about the side effects and social costs of transfusions. First, anemia should be assessed at least 30 days before elective hip arthroplasty, and if the subject is diagnosed as having anemia, an additional examination of the cause of the anemia should be carried and steps taken to address the anemia. Available iron treatments for anemia take 7 to 10 days to facilitate erythropoiesis, and preoperative iron supplementation, either oral or intravenous, is recommended. When using oral supplements for iron storage, administer elemental iron 100 mg daily for 2 to 6 weeks before surgery, and calculate the dose using intravenous supplement. Tranexamic acid (TXA) is a synthetic derivative of the lysine component, which reduces blood loss by inhibiting fibrinolysis and clot degradation. TXA is known to be an effective agent for reducing postoperative bleeding and reducing the need for transfusions in primary and revision total hip arthroplasties. Patient blood management has improved the clinical outcome after hip arthroplasty through the introduction and research of various agents, thereby reducing the need for allogeneic blood transfusions and reducing the risk of transfusion-related infections and the duration of hospitalizations.

Diagnosis and Treatment of Inflammatory Joint Disease / 대한고관절학회지

Arthritis damages the cartilage within joints, resulting in degenerative changes, including loss of function and joint instability. Ankylosing spondylitis (AS) is a chronic inflammatory condition affecting the spine and bone-to-tendon attachment area within the sacroiliac joint leading to back pain and progressive spinal stiffness. In the final stages, AS causes hyperkyphosis-a condition closely tied to the human leukocyte antigen-B27 gene. Rheumatoid arthritis is a chronic, systemic autoimmune disease characterized by the simultaneous inflammation of the synovium of multiple joints, leading to joint damage (e.g., destruction, deformation and disability). In the past, nonsteroidal anti-inflammatory drugs or conventional disease-modifying antirheumatic drug (DMARDs) have been used for the treatment of these autoimmune diseases, but biologic DMARDs have recently been introduced with excellent results. Gout is a chronic inflammatory disease that causes an alteration of joints resulting in severe pain. Specifically, gout is associated with an accumulation of uric acid within the body resulting from dysregulated purine metabolism, causing recurrent paroxysmal inflammation in the joints. Allopurinol and febuxostat are the primary treatment options for individuals with gout. It is necessary to have an accurate understanding of the pathogenesis, pathological ecology and treatment of AS, rheumatoid arthritis, and gouty arthritis, which are the representative diseases that may cause inflammatory arthritis.

Comparison of Perioperative Blood Loss in Primary Non-cemented Total Hip Arthroplasty for Rapidly Destructive Coxarthrosis and Osteonecrosis of the Femoral Head / 대한고관절학회지

PURPOSE: The purpose of this study is to compare the perioperative blood loss in primary non-cemented total hip arthroplasty (THA) performed for rapidly destructive coxarthrosis (RDC) with the perioperative blood loss in primary non-cemented THA for typical osteonecrosis of the femoral head (ONFH). MATERIALS AND METHODS: From January 2000 to December 2013, 19 patients were diagnosed with RDC (group 1) and 40 patients were diagnosed typical Ficat stage IV ONFH (group 2), comparison of perioperative blood loss between group 1 and group 2 in primary noncemented THA was done. Patients with preoperative usage of steroid or anticoagulants medication and with hemodynamic abnormal blood test results were excluded. The blood loss was measured up to the fifth post operation day and calculated with formula proposed by Mercuriali, Inghilleri and Nadler. RESULTS: Non-compensated blood loss calculated in milliliters of red blood cells was 362 mL (standard deviation [SD], 187; range, 77-675) in group 1 and 180 mL (SD, 145; range, 53-519) in group 2. Compensated blood loss was 630 mL (SD, 180; range, 380-760) in group 1 and 503 mL (SD, 260; range, 190-1, 505) in group 2. The total blood loss after primary non-cemented THA is greater when surgery is performed for RDC than for ONFH, with the volume of 992 mL (SD, 300; range, 457-1, 434) in group 1 and 683 mL (SD, 360; range, 226-1, 975) in group 2 respectively. CONCLUSION: Total perioperative blood loss was significantly greater in RDC than in ONFH in primary non-cemented THA.

The Result of In Situ Pinning for Valgus Impacted Femoral Neck Fractures of Patients over 70 Years Old / 대한고관절학회지

PURPOSE: We aimed to evaluate the outcome of fixation with cannulated screws for valgus impacted femoral neck fractures in patients over 70 years of age. MATERIALS AND METHODS: We reviewed the outcome in 33 patients older than 70 years with valgus impacted femoral neck fractures who were treated with cannulated screws fixation from May 2007 to December 2010. These patients were followed for at least a year. We assessed the fixation failure rate, body mass index (BMI), bone mineral density (BMD) of proximal femur, distance between screw tip and joint, number of screws and time from fracture to operation. RESULTS: We identified six patients (18.2%) with failure. Two patients with subtrochanteric fractures through the screw insertion site and another patient with osteonecrosis were excluded from the fixation failure group. No difference was found in age, BMI, BMD of proximal femur, distance between screw tip and joint, number of screws and time from fracture to operation between failure and non-failure groups. CONCLUSION: The failure rate of cannualted screw fixation for valgus impacted femoral neck fractures in the elderly patients was not low. Risk of failure should be considered in the management of these patients and accurate assessment for fracture type should be performed using computed tomogram and clinical evaluation.

Perforator-Based Propeller Flap for Lower Extremity Reconstruction

PURPOSE: To report the clinical results of the perforated-based propeller flap for lower extremity soft tissue reconstruction. MATERIALS AND METHODS: Between January 2010 and June 2012, a total of 16 defects in the lower extremities were covered with perforator-based propeller flaps. Retrospective data for location and size of the defect, flap dimension, pedicle artery, pedicle rotation, complications were obtained. RESULTS: Peroneal artery-based perforator flap were used in eleven cases, posterior tibial artery-based perforator flap in two cases, anterior tibial artery-based perforator flap in one case and medial plantar artery-based perforator flap in two cases. The average size of the flaps was 63 cm2. The marginal skin necrosis of the flaps as a complication was developed in two cases, one of which was covered with split-thickness skin graft. There were no functional deficits from the donor site. CONCLUSION: For the reconstruction of lower extremities, the perforator-based propeller flap could be a reasonable alternative as it is a simple, safe and versatile technique.

TNF-alpha and TNF-beta Polymorphisms are Associated with Susceptibility to Osteoarthritis in a Korean Population

BACKGROUND: The tumor necrosis factor (TNF) is believed to play an important role in the pathophysiology of osteoarthritis (OA). Evidence shows that genetic polymorphisms make substantial contributions to the etiology of OA. METHODS: We investigated the genotypes TNF-alpha and TNF-beta in 301 OA patients and 291 healthy subjects as controls. We employed a polymerase chain reaction-restriction fragment length polymorphism and a polymerase chain reaction-single strand conformation polymorphism assay to identify the genotypes TNFA -G308A and TNFB +G252A, respectively. RESULTS: For TNFA -G308A, the percentages of genotypes GG, AG, and AA were 26.3% (79/301), 62.5% (188/301), and 11.3% (34/301) in OA patients and 88.7% (258/291), 11.3% (33/291), and 0% (0/291) in controls. For TNFB +G252A, the percentages of genotypes GG, AG, and AA were 15.3% (46/301), 41.9% (126/301), and 42.9% (129/301) in OA patients and 12% (35/291), 52.6% (153/291), and 35.4% (103/291) in controls. There were significant differences in genotypes and alleles of TNFA -308 between OA patients and controls (p<0.0001) and in alleles of TNFB +252 (p=0.0325). The risk of OA was significantly higher for carriers of the TNFA -308A allele and the TNFB +252 AA homozygote (p=0.0224). CONCLUSIONS: The results suggest close relationships between TNFA -G308A and TNFB +G252A polymorphisms and individual susceptibility to OA in the Korean population.

Do You Need CAOS (Computer Assisted Orthopedic Surgery) in THA?: From a Negative Perspective

CAOS (Computer Assisted Orthopedic Surgery) has been introduced into the field of artificial joint replacement to increase the accuracy of implant placement. The advocates of CAOS insist that total hip replacement arthroplasty using CAOS will decrease dislocation, the wear rate, impingement and limb length discrepancy by increasing the accuracy and consistency of implant placement. However, we have to maximize the good results of total hip replacement arthroplasty by developing CAOS with understanding its disadvantages and limits, so we have reviewed CAOS using a critical eye for its negative aspects.

Extended Kocher Approach for Total Elbow Arthroplasty

PURPOSE: Total elbow arthroplasty is most commonly performed through a posterior approach by splitting or reflecting the triceps off the olecranon, but triceps avulsion, triceps weakness, and wound healing problems have been reported. We present the clinical results of total elbow arthroplasty using extended Kocher approach. MATERIALS AND METHODS: From September 2005 to October 2007, five patients who underwent total elbow arthroplasty using triceps preserving approach were evaluated. There were 4 women and 1 man. The mean age of the patients was 58 years (range, 36~68). The mean follow- up was 10 months. The patients were placed in the lateral decubitus position, and lateral Kocher interval is made through a straight posterior incision. Elbow joint is exposed by supinating the forearm and prosthesis was inserted. Postoperatively, the elbow was immobilized in extension for 1 week, and active range of motion exercise was begun. Range of motion, triceps strength, Mayo elbow performance score, Korean DASH questionnaire were evaluated at the last follow-up. RESULTS: Average operation time was 115 minutes (range, 97~138). Postoperative complications such infection, skin necrosis were not developed. Triceps strength was measured as grade IV in all patients except one who has triceps insufficiency preoperatively. Mean elbow range of motion was from 8 degrees to 124 degrees. Mean Mayo elbow performance score was 87 (range 75~95), and DASH score was 18 (range 9~34). CONCLUSIONS: Extended Kocher approach can be a reasonable alternative for total elbow arthroplasty. Linking the assembly can be difficult, so modification of the implant design is needed to solve this problem.

Minimally Invasive Total Hip Arthroplasty

Minimally invasive surgeries, such as laparoscopic, endoscopic and,arthroscopic surgery are currently being used throughout the world. The field of total hip arthroplasty has over 40 years of experience, and minimally invasive total hip arthtoplasty was introduced to reduce the perioperative morbidities. The advocates for minimally invasive total hip arthroplasty will point out the advantages of reduced pain and early ambulation after the operation because of the minimal soft tissue injury. However, we have to review the advantages and disadvantages of minimally invasive total hip arthroplasty to prevent anyharmful effects of this procedure for the patients who under go it.

Total Hip Replacement Arthroplasty with the Mallory-Head System : Minimum 8-Year Follow-up Results

PURPOSE: The purpose of this study was to assess the clinical and radiographic results of total hip arthroplasty with using the double tapered Mallory-Head system. MATERIALS AND METHODS: The clinical and radiographic results of a consecutive series of 81 total hip replacements in 75 patients were reviewed at eight to twelve years (average: 9.8 years) postoperatively. The underlying diseases were avascular necrosis in 46 hips (57%), osteoarthritis in 12 hips (15%), RA in 9 hips (11%) and others. The clinical result was evaluated on the basis of the modified Harris hip score and the modified Merle d'Aubigne-Postel score. A radiographic analysis was also performed. RESULTS: The average modified Harris hip score was improved from preoperative 56 points to postoperative 92 points. The average modified Merle d'Aubigne-Postel score was 15 points at the latest follow up, and 55 hips (68%) were classified as having clinical grades of excellent or good results. One acetabular component was revised because of loosening, and one was revised because of recurrent dislocation. CONCLUSION: The clinical and radiological evaluations of the total hip replacements using the Mallory-Head system showed good results.

Short Term Results of Cementation of a Polyethylene Liner into a Well-Fixed Metal Shell

PURPOSE: To evaluate the radiological and clinical results of cementation of a polyethylene liner into a well-fixed metal shell in revision total hip arthroplasty. MATERIALS AND METHODS: From November 2001 to April 2006, 11 cases (10 patients) were included in this study. There were 5 males (6 cases) and 5 females with a mean age of 54.3 years. The mean follow-up period was 35.2 months. The acetabular shells were stable and their position was acceptable in all cases. Pre-existing screws were removed and screw holes were filled with allogenic bone. The inner surface of the metal shells and convex backside of the liners were roughened with a burr. The clinical results were evaluated using the Harris hip score (HHS) and the radiological results with evidence of a positional change in the acetabular cup and liner, and the progression of osteolysis around the cup. RESULTS: The mean HHS was 69.5 points preoperatively and 89.2 at the last follow up. There was no change in the cup and liner position or progression of the osteolytic lesion around the femoral or acetabular components. CONCLUSION: Cementation of a polyethylene liner into a well-fixed metal shell showed satisfactory results in revisional total hip arthroplasty with a short term follow-up period.

Transposition Lateral Arm Flap for Coverage of the Elbow Defects

PURPOSE: Soft tissue defect can occur on the posterior aspect of the elbow after trauma or fracture fixation. To cover the defect and maintain elbow functions, various flap surgeries including latissimus dorsi muscle flap, lateral arm flap and radial forearm flap can be performed. We present the clinical results of transposition lateral arm flap for coverage of the elbow defect and discuss the cause of posterior soft tissue necrosis after fracture fixation. MATERIALS AND METHODS: Two patients who had posterior soft tissue defect of the elbow after open reduction of the fractures around the elbow were treated with transposition lateral arm flap. The mean size of skin defect was 20 cm2. The flap was elevated with posterior radial collateral artery pedicle and transposed to the defect area. Donor defect was covered with split thickness skin graft. The elbow was immobilized for 1 week in extended position and active range of motion was permitted. RESULTS: All two cases of transposition lateral arm flap survived without marginal necrosis. The average range of motion of the elbow was 10~115 degrees. Mayo elbow performance score was 72 and Korean DASH score was 23. CONCLUSION: When elbow fractures are fixed with three simultaneous plates and screws, skin necrosis can occur on the posterior aspect of the elbow around olecranon area. If the size of skin defect is relatively small, transposition lateral arm flap is very useful option for orthopaedic surgeons without microsurgical technique.

Surgical Treatment with Proximal Femoral Nail for Intertrochanteric Fracture of the Femur in Elderly Patients

PURPOSE: To evaluate the clinical result of Proximal Femoral Nail (PFN) fixation for intertrochanteric fracture of the femur in elderly patients. MATERIALS AND METHODS: Between January 2004 and June 2006, 119 patients older than 65 years of age, with intertrochanteric fractures, were treated with PFN fixation. Ten patients who died within 4 weeks after operation were excluded from the analysis. Mean duration of follow-up was 13 months. There were 34 males and 75 females, and the mean age was 77.8 years. Operation time, amount of blood loss, transfusion requirement, time to ambulation, length of hospital stay, pre- and post-operative walking status, and post-operative complications were evaluated. Radiologic parameters such as amount of impaction, time to union, and neck-shaft angle were also evaluated. RESULTS: The mean operation time was 42 minutes, transfusion requirement averaged 340 ml, and amount of blood loss averaged 78 ml. The mean hospital stay was 20 days, and time to ambulation averaged 10.3 days. Eighty-five percent of patients returned to previous walking status. The average amount of fracture impaction was 3.8 mm, and mean time to radiologic bony union was 11.7 weeks. Neck-shaft angle was changed to 2.5 degrees varus displacement. Complications included intraoperative femur shaft fracture in 5 cases, protrusion of lag screw into the hip joint in 3 cases, backing out of lag screw in 2 cases, fixation failure in 2 cases, and proximal femur fracture in 1 case. Among these cases, 5 hips (2 cases of fixation failure and 3 cases of femoral head perforation by lag screw) were converted to total hip replacement. CONCLUSION: Because of reduction in operation time, low complication rate, and favorable outcome, PFN fixation is an acceptable alternative for fixation of intertrochanteric fractures in elderly patients.

Coronoid view: A New Radiograph for the Evaluation of the Coronoid Fractures

PURPOSE: It is very important to evaluate and fix coronoid process fractures because they are a critical element for a stable, effective elbow function. The lateral view of the elbow joint is used for a radiographic evaluation of the coronoid but an understanding of the fracture pattern is often difficult because of overlap of the radial head and obliquity of the fracture line. We developed the coronoid view, which is a new radiograph for an evaluation of the coronoid process fracture, and discuss its advantages for a postoperative follow-up. MATERIALS AND METHODS: The coronoid view was designed for an evaluation of the anteromedial fragment of the coronoid process. After the patient sat on his side, the shoulder was abducted 45degrees and the elbow was flexed 90degrees The X-ray beam was shot perpendicular to the table. Since shoulder was abducted 45degrees the fracture line of the coronoid process can be parallel to the X-ray beam, and the radial head can be cleared. CONCLUSION: The coronoid view can be a good alternative radiograph for an evaluation of a coronoid process fracture because the beam is parallel to the fracture line. The coronoid view can be particularly useful in postoperative patient follow-up where computed tomography is impractical due to metal implants and cost.

Distal Transfer of Greater Trochanter in Patients with High-Standing Greater Trochanter by Legg-Calve-Perthes (LCP) Sequelae

PURPOSE: To evaluate the clinical and radiological results of distal transfer of the greater trochanter in patients with a high-standing greater trochanter as a sequela of LCP disease. MATERIALS AND METHODS: Between 1994 and 2005, ten cases (nine patients) underwent distal transfer of a highstanding greater trochanter and were followed up for more than 2 years after surgery. The clinical findings, such as the abduction of the hip, VAS score, and Trendelenburg sign, were evaluated. In addition, the centrotrochanteric distance (CTD) and Lever arm ratio (LAR) were used for the radiographic assessment. RESULTS: The mean range of abduction improved from 27.5degrees to 40degrees , and the VAS score improved from 4.1 to 1.2. Seven cases with positive Trendelenburg sign before surgery showed negative Trendelenburg sign after the surgery. At the last follow-up, the CTD improved from -1.52 cm to -0.2 cm and the LAR decreased from 2.2 to 1.8. CONCLUSION: The distal transfer of the greater trochanter in patients with a high standing greater trochanter as a consequence of LCP is an effective procedure that can reduce the level of hip pain and improve the hip abduction if careful patient selection is performed.

Epidemiologic Study and Analysis of Serum Markers for Osteonecrosis of Professional Divers

Purpose: To evaluate the risk factors for the development of osteonecrosis in civilian professional divers by an epidemiologic study and to determine the correlation between osteonecrosis in divers and coagulopathy by analysis of serologic markers that are related to thrombophilia and hypofibrinolysis. Materials and Methods: Forty-two divers, who collected pen shells (Atrina pinnata), and among whom 10 had osteonecrosis (group 1), were compared with 32 divers without osteonecrosis (group 2). Both groups were evaluated based on the number of years of diving experience, number of dives per year, mean number of dives per day, mean diving time and depth, and diving methods. We determined any statistically significant differences among these variables. We measured the levels of serologic markers that were related to hyperlipidemia, thrombophilia, and hypofibrinolysis from the divers and a control group of 20 physicians (group 3). The levels of the serologic markers were compared between groups 1 and 2 and between the divers and the control group, in order to determine the relationship between the serologic markers and the development of dysbaric osteonecrosis. Results: None of the variables demonstrated any statistically significant differences, except for the mean diving time, in which group 1 had a mean diving time of 124 minutes and group 2 had a mean diving time of 62.1 minutes (P<0.05). In the analysis of the serologic markers, there were no statistically significant differences between groups 1 and 2; however, in comparison with the group 3, the divers demonstrated significantly decreased activity levels of proteins C and S (Protein C: P<0.05; Protein S: P<0.05), and an increase in the levels of plasminogen activator inhibitor-1 (PAI-1) (P<0.05). Conclusion: The divers with osteonecrosis had a longer mean diving time than did those divers without osteonecrosis. In the serologic marker analysis, the divers with osteonecrosis demonstrated significantly decreased activity levels of Proteins C, S and a significant increase in the levels of PAI-1, compared with the control group.

Treatment of Pediatric Displaced Supracondylar Fractures of the Humerus by Pin Leverage Technique

PURPOSE: To evaluate a new treatment method by pin leverage technique in Gartland type III fractures to avoid forceful manipulation or open reduction. MATERIALS AND METHODS: 99 cases were included in this study and divided into 3 groups (I;open reduction, II; closed reduction and percutaneous pin fixation, III; pin leverage technique), and we analyzed timing to operation, length of operation, associated neurovascular injuries, complications, and clinical and radiological outcomes at final follow-up. RESULTS: The average length of operation 119, 57, and 68 minutes respectively. The associated nerve injuries were 8, 2, and 2 cases respectively. There were a case of superficial pin tract infection in group I, three cases of superficial pin tract infection and a case of iatrogenic ulnar nerve injury in group II. At final follow-up, clinical results were excellent or good in all cases and there were 5 cases (8.3%) of fair results in group II radiologically. Closed reduction with pin leverage technique were failed in 5 cases. CONCLUSION: In treatment of Gartland type III fractures, pin leverage reduction technique is considered to be a good alternative prior to open reduction, because it provides shortened length of operation, avoidance of forceful manipulation and open reduction.

Surgical Treatment for Lumbar Spinal Stenosis with Fracture in Multiple Osteoporotic Compression Fractures / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze the outcome of the surgical treatment for lumbar spinal stenosis with fracture in multiple osteoporotic vertebral body compression fractures. SUMMARY OF LITERATURE REVIEW: An osteoporotic vertebral compression fracture, without neurological symptom, has mainly been treated with conservative care. Sometimes, vertebroplasty or kyphoplasty has been used as a surgical treatment. In the case of a single thoracolumbar fracture with neurological symptoms, not improved by conservative care, decompression, fusion and instrumentation through an anterior or a posterior approach has been attempted. MATERIALS AND METHODS: 10 patients, who had received surgical treatment for symptomatic lumbar spinal stenosis with fracture out of those with multiple osteoporotic vertebral body compression fractures, and over the age of 60, were assessed. The surgical treatment was performed on the patient with all of the following five criteria; (1) severe back pain caused by fractures, (2) neurological symptoms of lumbar spinal stenosis, (3) radiological evidences of stenosis by lumbar fracture, (4) no response to conservative treatment for over 3 months, and (5) adequate physical ability for daily living without a severe medical condition. The surgical procedure included: decompressive laminectomy, posterior instrumentation using pedicle screw fixation, and fusion in situ. The pedicle screws were located 2-3 above and below the most cephalad and caudad fractured vertebral bodies. RESULTS: Clinically, favorable results were obtained in 8 of the 10 patients. In the roentgenographic assessment, the operated states were well maintained, without the metallic failure or instability. Halos around the pedicle screws were seen in 4 patients, but there was no significant evidence of loosening. There were no serious medical and systemic complications in the peri- and postoperative periods. Additional vertebral body fractures and pain were seen in 5 patients, but they had been well managed, conservatively. CONCLUSION: Favorable clinical results could be expected for the surgical treatment of lumbar spinal stenosis, with fracture, in the patients with multiple osteoporotic vertebral fractures, as long as the surgical treatment was indicated exactly and carefully.