Risk Factors of New Adjacent Compression Fracture after Percutaneous Vertebroplasty: Effectiveness of Bisphosphonate in Osteoporotic or Osteopenic Elderly Patients / 대한신경손상학회지

OBJECTIVE: The purpose of this study is to investigate the incidence of new compression and to analyze factors that influence the fractures in adjacent levels after percutaneous vertebroplasty (PVP). METHODS: This retrospective study examined 206 patients who had undergone PVP for single level osteoporotic or osteopenic compression fractures during the last seven years in our department. After PVP, the patients were observed for at least over one year, and 29 patients showed new additional compression fractures in adjacent levels. One hundred seventy seven patients who did not show additional compression fractures were analyzed as the control group. Statistical comparisons were performed between the groups, in terms of age, gender, bone mineral density, whether bisphosphonate (BPP) was treated, preoperative kyphosis, preoperative wedge angle, change in wedge angle, amount of bone cement, existence of intradiscal bone cement leakage, and initial fracture levels. RESULTS: The statistically significant factors that influence new compression fractures in adjacent levels after PVP were as follows: being female, initial thoracolumbar junction fracture, preoperative large kyphotic, preoperative large wedge angle, change in wedge angle, administration of BPP in osteopenia group, and intradiscal cement leakage. CONCLUSION: This study identified many factors that influence newly developed compression fractures in adjacent levels after PVP. Interestingly, the administration of BPP in osteopenia group had positive influence on new fractures in this study. Therefore, we recommend early administration of BPP to patients with osteopenia.

ACDF Using the Solis Cage with Iliac Bone Graft in Single Level: Clinical and Radiological Outcomes in Average 36 months Follow-up

OBJECTIVE: To evaluate the utility of anterior cervical discectomy and fusion (ACDF) with polyetheretherketone (PEEK) cage and autograft through long term(average 36 months) follow-up. METHODS: Thirty selected patients (male:20/female:10) who suffered from cervical radiculopathy, myelopathy or radiculomyelopathy underwent a single level ACDF with PEEK cage and autograft from iliac crest from March 2006 to July 2008 in single institute. We followed patients for an average 36.4+/-8.1 months (ranged from 23 to 49 months). The Japanese Orthopedic Association (JOA) score for evaluation of myelopathy and visual analogue scale (VAS) for radiating pain was used to estimate postoperative clinical outcome. Plain x-ray on true lateral standing flexion, extension and neutral position view and 3D CT scan were used every 6 months after surgery during follow-up period. RESULTS: The mean VAS and JOA scoring improved significantly after the surgery and radiological fusion rate was accomplished by 100% 36 months after the surgery. We had no complication related with the surgery except one case of osteomyelitis. There was one case of Grade I fusion, four cases of grade II, and 25 cases of grade III by radiologic evaluation. CONCLUSION: This long term follow-up study for ACDF with PEEK cage shows that this surgical method is comparable with other anterior cervical fusion methods in terms of clinical outcomes and radiologic fusion rate.

Neuromyelitis Optica Mimicking Intramedullary Tumor

Neuromyelitis optica (NMO) is considered to be a rarer autoimmune disease than multiple sclerosis. It is very difficult to make a diagnosis of MNO for doctors who are not familiar with its clinical features and diagnostic criteria. We report a case of a young female patient who had been suffering motor weakness and radiating pain in both upper extremities. Cervical MRI showed tumorous lesion in spinal cord and performed surgery to remove lesion. We could not find a tumor mass in operation field and final diagnosis was NMO. NMO must be included in the differential diagnosis of lesions to rescue the patient from invasive surgical interventions. More specific diagnostic tools may be necessary for early diagnosis and proper treatment.