Percutaneous Vertebroplasty: Short-term Results of 38 Cases / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical outcome of vertebroplasty, and to analyze the causes of poor results. MATERIALS AND METHODS: The radiological and clinical results of thirty-eight patients who were followed for more than one year after vertebroplasty for painful osteoporotic compression fractures were retrospectively analyzed. RESULTS: There were 10 recollapses and 6 fractures of adjacent vertebrae. Most of these occurred in the thoracolumbar junction (9 and 5 respectively). Pain was significantly improved in the immediate postoperative period, that is, from 9.3+/-0.7 points on a 10-point pain scale preoperatively to 2.0+/-0.7 points postoperatively (p<0.001). However, at the last follow-up, this was aggravated to 3.9+/-3.3, and eleven (29%) patients had moderate (5-7 points) or severe (8-10) pain. The main causes of aggravation of pain were recollapses (5 cases) and/or fractures of adjacent vertebrae (5). CONCLUSION: Vertebroplasty resulted in excellent relief from pain in the immediate postoperative period, but the more-than-one-year follow-up results were less satisfactory, and this was particularly true in the thoracolumbar junction. The possibility of recollapse or of fractures of adjacent vertebrae must be kept in mind.

Tardy Paraplegia due to Myelomalacia in a Patient with Tuberculous Thoracic Kyphosis: A Case Report / 대한정형외과학회잡지

Many cases of tardy paraplegia after bony fusion have been reported among well-treated tuberculous spondylitis patients. In most cases, the cause of the paraplegia is known to be spinal cord compression caused by kyphosis, and in these patients cord decompression and kyphotic deformity correction have been commonly performed. A 44 year-old-male patient presenting with thoracic kyphosis and tardy paraplegia was admitted to our department. The cause of his paraplegia was considered to be a compression of the spinal cord by progressive kyphosis. The initial therapeutic plan involved decompression of the spinal cord and surgical correction of kyphotic deformity. However an MRI of the thoracic spine revealed a myelomalacia of the whole thoracic cord associated with severe cord atrophy. Myelomalacia is known to be an irreversible condition with no surgical remedy. Although this condition is very rare, an unnecessary decompressive surgical procedure may be performed if this possiblity is not considered. Because of its rarity and the importance of planning a therapeutic treatment modality, the authors report this case and include a review of the literature.