Outcome Comparison between Percutaneous Vertebroplasty and Conservative Treatment in Acute Painful Osteoporotic Vertebral Compression Fracture

STUDY DESIGN: A retrospective comparative study. OBJECTIVES: To compare the outcome of percutaneous vertebroplasty (VP) and conservative treatment for the treatment of acute painful osteoporotic vertebral compression fractures (VCF). SUMMARY OF LITERATURE REVIEW: Vertebroplasty is a common procedure for the treatment of acute painful osteoporotic VCF. However, controversy still exists regarding clinical outcomes of the procedure compared with more conservative treatment. MATERIAL AND METHODS: A consecutive group of patients, undergoing VP and conservative treatment at our hospital, between July 2005 and October 2008, were reviewed retrospectively. All patients were reviewed with at least 1 year of follow up. A total of 58 patients underwent 59 VP procedures under local anesthesia at post injury 2 weeks; a total of 31 underwent conservative treatment. These two groups were compared by the kyphotic angle and loss of vertebral body height at immediate post-injury, post-injury 6weeks and 1y ear, radiologically. And they were compared by the visual analog scale(VAS) score and ambulatory status at the same time, clinically. RESULTS: At the time of immediate post-injury, six weeks after post-injury, one year after injury, height loss was 29.73%, 19.81%, 22.59% in the VP group, respectively, and 31.20%, 36.80%, 40.60% in the conservative treatment group, respectively. The Kyphotic angles were 13.44degrees, 9.10degrees, 11.31degrees in VP group, respectively, and 10.29degrees, 15.83degrees, 19.00degrees in the conservative treatment group, respectively. There was a statistically significant reduction of height loss and kyphotic angle in VP group at post-injury of 6 weeks and 1 year(p0.05). CONCLUSIONS: VP prevents further collapse and kyphosis relieves pain quickly and allows early ambulation, but in post-injury 1 year follow up, there was no significant difference in clinical outcomes. Proper treatment should be done with respect to patient's age, general condition, economic status and complication.

Comparison of Short Segment and Long Segment Posterior Instrumentation of Thoracolumbar and Lumbar Bursting Fractures at Load Sharing Score 7 or Above

STUDY DESIGN: A retrospective comparative analysis of the short-segment and long-segment posterior fixation in thoracolumbar burst fractures that are 7 points or above in load-sharing score was performed. OBJECTIVES: The purpose of this study is to demonstrate the appropriate level of fixation by comparing the results of short-segment and long-segment posterior fixation. SUMMARY OF LITERATURE REVIEW: There is general consensus that short-segment fixation should be done in thoracolumbar burst fractures that are 6 points or less in load-sharing classification. There is some controversy regarding whether short-segment or long-segment fixation should be done in thoracolumbar burst fractures that are 7 points or above in load-sharing classification. MATERIALS AND METHODS: From 1998 through 2008, 32 patients with thoracolumbar burst fractures above 7 points in load-sharing classification had been operated with short-segment (1 segment above and 1 segment below: 23 patients) or long-segment (2 segments above and 1 segment below: 9 patients) transpedicular screw fixation at the author's institution. They were divided by two groups (group I: short-segment fixation, group II: long-segment fixation). The mean age of patients was 49.2 years old and the mean follow-up period was 2.4 years (1-7 years). In preoperative and postoperative simple radiographs, the bony unions, breakages or loosening of implants were assessed, and the losses of correction angle and anterior vertebral body height were measured. RESULTS: In all cases, non-union or loosening of implants were not observed. There was 1 screw breakage in short-segment fixation group during the follow up period, but bony union was obtained at final follow-up. The mean score of load sharing classification was 7.3 in Group I and 7.1 in Group II, and there was no significant difference between two groups. (p>0.05) The mean anterior vertebral body height loss was 5.3% in Group I and 3.6% in Group II and the mean loss of correction angle were 4.72 in Group I and 3.38 in Group II. There was no significant difference between the two groups for both. (p>0.05) CONCLUSIONS: There was no significant difference in radiologic parameters between two groups. Short-segment fixation could be used successfully in selected cases of thoracolumbar burst fractures that are 7 points or above in load-sharing classification.

Femoral Neuropathy Secondary to Iliacus Hematoma: A Case Report / 대한고관절학회지

A 17-year-old male patient complained of acutely developed severe paresthesia, pain, and weakness of the right lower extremity. He fell to the ground during performance of hand-stand physical exercise. Despite administration of conservative treatment for two weeks in a private clinic, motor function of the hip flexor and knee extensor were measured as poor grade. EMG showed femoral nerve and lateral femoral cutaneous nerve injury. Findings on MRI and CT revealed a mass measuring 8x5x7 cm in the iliac fossa. After evacuation of the hematoma(400 cc), neurologic dysfunction and thigh circumference were fully recovered, compared with the contralateral side, after one and half year follow up. This condition rarely occurs in individuals without coagulopathy. We reported on a rare case of iliacus hematoma and femoral neuropathy treated by surgical decompression in a patient with no coagulopathy.

The Brain C.T. Analysis of the Patients with Convulsive Seizure

The pathological manifestation of the patient with convulsive seizures has not been clearly proved mostly until the clinical use of brain computerized tomography. The brain C.T. findings, anamnesis, clinical diagnosis in the 133 consecutive patients who admitted to this hospital because of convulsive seizures from Oct. 1981 to Feb. 1983 were analyzed and literature review was made. 1) The C.T. scan revealed structural abnormalities in 46% of patients with seizure disorders, and cortical atrophy non-specific granuloma etc. 2) The older patients had a high rate of abnormal findings in the brain C.T. than younger patients. 3) The patients having short duration of disease history had higher rate of abnormal C.T. findings. 4) The patients with focal seizure had higher abnormal findings than generalized seizure. 5) The patients with seizure only showed C.T. abnormalities in 22% of cases inspite of patients with positive neurological findings showing C.T. abnormalities in 80% of cases. 6) The patients with temporal lobe lesion showed focal seizures usually in higher rate in compare with the patients with lesion in other part of brain.