Quality of Life in Patients with Osteoporotic Vertebral Compression Fractures.

BACKGROUND: This study aimed to evaluate quality of life (QOL) using the EuroQOL-5 dimensions (EQ-5D) index and to examine factors affecting QOL in patients with an osteoporotic vertebral compression fracture (OVCF). METHODS: This ambispective study used a questionnaire interview. Patients over 50 years old with an OVCF at least 6 months previously were enrolled. Individual results were used to calculate the EQ-5D index. Statistical analysis was performed, and factors related to QOL were examined. RESULTS: Of 196 patients in the study, 84.2% were female, with an average age of 72.7 years. There were 66 (33.7%) patients with multilevel fractures. Conservative management was used in 75.0% of patients, and 56.1% received anti-osteoporosis treatment. The mean EQ-5D index was 0.737±0.221 and was significantly correlated with the Oswestry disability index score (correlation coefficient -0.807, P<0.001). The EQ-5D index was significantly correlated with age (Spearman's rho=-2.0, P=0.005), treatment method (P=0.005), and history of fracture (P=0.044) on univariate analysis and with conservative treatment (P<0.001) and osteoporotic treatment (P=0.017) on multivariate analysis. CONCLUSIONS: OVCF markedly lowers QOL in several dimensions for up to 12 months, even in patients who have healed. Treatment of osteoporosis and conservative treatment methods affect QOL and should be considered in OVCF management.

Selective Estrogen Receptor Modulators.

Selective estrogen receptor modulators (SERMs) are now being used as a treatment for breast cancer, osteoporosis and postmenopausal symptoms, as these drugs have features that can act as an estrogen agonist and an antagonist, depending on the target tissue. After tamoxifen, raloxifene, lasofoxifene and bazedoxifene SERMs have been developed and used for treatment. The clinically decisive difference among these drugs (i.e., the key difference) is their endometrial safety. Compared to bisphosphonate drug formulations for osteoporosis, SERMs are to be used primarily in postmenopausal women of younger age and are particularly recommended if there is a family history of invasive breast cancer, as their use greatly reduces the incidence of this type of cancer in women. Among the above mentioned SERMs, raloxifene has been widely used in prevention and treatment of postmenopausal osteoporosis and vertebral compression fractures, and clinical studies are now underway to test the comparative advantages of raloxifene with those of bazedoxifene, a more recently developed SERM. Research on a number of adverse side effects of SERM agents is being performed to determine the long-term safety of this class of compouds for treatment of osteoporosis.

Predictors of reduction loss in tibial plateau fracture surgery: Focusing on posterior coronal fractures.

INTRODUCTION: Some studies have reported that fracture pattern was associated with reduction loss after surgery. The purpose of this study was to evaluate various factors that can influence reduction loss, including fracture patterns in unicondylar and bicondylar tibial plateau fractures. MATERIALS AND METHODS: A total of 138 tibial plateau fractures that underwent open reduction and internal fixation using plates were retrospectively reviewed. The OTA/AO classification, fracture pattern, degree of comminution, and existence of reduction loss were evaluated based on simple radiographs and computed tomography. Patient information, including age, gender, and occupation, were acquired through chart reviews. The effect of each variable on reduction loss was evaluated through multiple logistic regression analysis. RESULTS: Of 138 knees, reduction loss was observed in 40 knees (29.0%). Reduction loss was found in 11 (20.4%) of the type B knees (54 knees) and 29 (34.5%) of the type C knees (84 knees), according to the OTA/AO classification. The multiple logistic regression analysis for all cases revealed that the existence of comminution and coronal fracture influenced the occurrence of reduction loss, with odds ratios of 9.148 and 4.823, respectively (P<0.001 and P=0.001, respectively). In type B and type C, according to the OTA/AO classification, the existence of comminution and coronal fracture had causal relationships with the occurrence of reduction loss. The odds ratios of comminution and coronal fracture for reduction loss for type B were 9.114 and 9.117, respectively (P=0.019 and P=0.031, respectively), and the odds ratios for type C were 8.490 and 4.782, respectively (P=0.001 and 0.009, respectively). CONCLUSIONS: When a tibial plateau fracture has a coronal fracture, if it is difficult to fix its fragments rigidly with medial or lateral plate fixation; therefore, buttress plating or direct fixation of fragments through the posteromedial, posterolateral, or posterior approach should be considered.

Comparison of Posterior Lumbar Interbody Fusion and Posterolateral Lumbar Fusion in Monosegmental Vacuum Phenomenon within an Intervertebral Disc.

STUDY DESIGN: Retrospective. PURPOSE: To compare the clinical and radiological outcomes of posterolateral lumbar interbody fusion (PLIF) and posterolateral lumbar fusion (PLF) in monosegmental vacuum phenomenon within an intervertebral disc. OVERVIEW OF LITERATURE: The vacuum phenomenon within an intervertebral disc is a serious form of degenerative disease that destabilizes the intervertebral body. Outcomes of PLIF and PLF in monosegmental vacuum phenomenon are unclear. METHODS: Monosegmental instrumented PLIF and PLF was performed on 84 degenerative lumbar disease patients with monosegmental vacuum phenomenon (PLIF, n=38; PLF, n=46). Minimum follow-up was 24 months. Clinical outcomes of leg and back pain were assessed using visual analogue scales for leg pain (LVAS) and back pain (BVAS), and the Oswestry disability index (ODI). The radiographic outcome was the estimated bony union rate. RESULTS: LVAS, BVAS, and ODI improved in both groups. There was no significant difference in the degree of these improvements between PLIF and PLF patients (p>0.05). Radiological union rate was 91.1% in PLIF group and 89.4% in PLF group at postoperative 24 months (p>0.05). CONCLUSIONS: No significant differences in clinical results and union rates were found between PLIF and PLF patients. Selection of the operation technique will reflect the surgeon's preferences and patient condition.

The factors affecting stiffness occurring with rotator cuff tear.

BACKGROUND: Stiffness after a rotator cuff tear is common, and it affects postoperative prognosis. This study aims to define the factors affecting stiffness that accompanies rotator cuff tear. MATERIALS AND METHODS: From June 2002 to May 2009 (84 months), 143 patients underwent arthroscopic rotator cuff repair. Of these, 119 were enrolled as subjects in this study. Preoperative range of motion was measured in all patients. Stiffness of the shoulder was defined as restriction of active and passive motion of 100° of elevation or less, less than 50% of external rotation, and internal rotation only to the sacrum. Factors that can affect stiffness were evaluated, including the type, size, and direction of rotator cuff; duration of symptoms; gender; age; presence of accompanying medical disease; degenerative factors (Goutallier classification); and presence of trauma. Retrospective analysis was conducted accordingly. RESULTS: A statistically significantly higher degree of stiffness was seen for full-thickness tears than for partial-thickness tears (P = .0187). Between 2 groups that were divided by direction of rotator cuff tear, posterosuperior cuff tears showed a statistically significantly higher prevalence of stiffness (P = .0415). Patients with trauma had a statistically higher prevalence of stiffness (P = .0264). The other factors did not show significant differences. CONCLUSION: In patients with rotator cuff tear, the type and direction of rotator cuff tear and the presence of trauma seem to increase the limitation of preoperative joint range of motion.

An in vitro animal study of the biomechanical responses of anulus fibrosus with aging.

STUDY DESIGN: In vitro biomechanical tests were performed on aged (group A) and young (group B) porcine intervertebral discs. OBJECTIVES: The in vitro biomechanical responses of aged and young porcine intervertebral discs were measured under designated axial compressive loads and analyzed. SUMMARY OF BACKGROUND DATA: From the biomechanical point of view, the major biomechanical functions of intervertebral discs are to absorb and distribute external loadings. Although the histological observation of intervertebral discs on the effect of aging and related degeneration has been extensively studied and described, the changes in those biomechanical functions attributable to aging are still left to be studied. METHODS: Two groups were set for mechanical tests. Group A consisted of 24 motion segments obtained from female porcine lumbar (44.0 +/- 2.8-months old). The group B consisted of 30 motion segments from female porcine lumbar (6.2 +/- 1.3 months old). The specimens were chosen randomly from all levels. For the measurements of biomechanical responses, a pressure transducer was placed on anterior and posterolateral locations of anulus fibrosus. Morphological and histological observations were carried out to confirm any age-related changes in both groups. Intradiscal pressures and relaxation times were measured and calculated at points in the anulus fibrosus under designated axial compressive loads. RESULTS: Morphological and histological difference between group A and group B were confirmed with H&E staining and other measurements. Group A showed a lower ratio of nucleus pulposus area to total disc area than did group B. There was no significant difference in the intradiscal pressure between groups as measured in the anterior zone, except at an axial load of 740 N. However, a significant pressure difference was found in the posterolateral zone when the axial load was 542 N or greater (P < 0.05). At 740 N, the average relaxation time for group A was significantly longer than that for group B (P < 0.05). CONCLUSIONS: Differences in biomechanical responses between groups were confirmed. Group A was less flexible and slower at energy relaxation under axial loading. A larger proportion of the external load was taken by the posterolateral part of the degenerative discs. These results were consistent with clinical experiences: 1) most hernias are observed more often at the posterolateral side than other sides, and 2) the degeneration attributable to age reduces the function of absorbing and distribution of external loadings.

Treatment recommendations for idiopathic scoliosis: an assessment of the Lenke classification.

OBJECTIVE: To determine the usefulness of the treatment recommendation criteria based on the Lenke classification for treatment of idiopathic scoliosis. DESIGN A retrospective radiographic review of 183 patients who underwent anterior and/or posterior fusion for the treatment of idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Recent studies have proven that the Lenke system is relatively efficient and consistent in classifying scoliosis curves. However, the recommendations regarding fusion level have yet to be established as reliable. MATERIALS AND METHODS: One hundred eighty-three patients with idiopathic scoliosis and with a minimum follow-up period of 24 months were included in the study and classified according to the Lenke system. Among these patients, 135 patients were treated with fusion and instrumentation in accordance with the Lenke classification system and are described as Group I. The 48 patients whose treatments were not based on the Lenke system constitute Group II. These two groups were compared in regard to the correction of the Cobb angle and the trunk shift after surgery in order to establish the effectiveness and reliability of the treatment recommendations based on the Lenke classification system. RESULTS: Type 1 primary thoracic curve: there was no difference between the results from the group with selective thoracic fusion (Group I) and from the group with both thoracic and lumbar curves fused (Group II). Type 2 double thoracic scoliosis: the correction of the upper thoracic curve, the first thoracic vertebral tilt, and left shoulder elevation were better in the group with both thoracic curves fused (Group I) than in the group with midthoracic fusion (Group II). Type 3 double major scoliosis: the lumbar curve correction was better in the group with both thoracic and lumbar curves fused (Group I) than in the group with selective thoracic fusion (Group II), and decompensation occurred more frequently in Group II. Type 4 triple major scoliosis: because there were only two patients with this type of curve, no analysis was completed. Type 5 thoracolumbar or lumbar curve: there was no difference between the results from the group with selective thoracolumbar or lumbar fusion (Group I) and the group with thoracic and lumbar curves fused (Group II). Type 6 double major scoliosis with larger lumbar curve: the thoracic curve correction was better in the group with both curves fused (Group I) than in the group with only the lumbar curve fused (Group II). CONCLUSION: Better radiologic results were achieved through the use of the Lenke classification system for the selection of fusion levels by avoiding unnecessary fusion of the nonstructural lumbar or thoracic spine as well as avoiding undercorrection of the structural secondary curves.