Study DesignRetrospective study.PurposeTo evaluate risk factors related to the development of new fractures in adjacent vertebrae after percutaneous vertebroplasty.Overview of LiteratureRecent reports indicate that undue numbers of new fractures in adjacent vertebral bodies occur after percutaneous vertebroplasty.MethodsOne hundred four of 369 patients who underwent percutaneous vertebroplasty were followed for over 1 year. Fifty-four patients (51.9%) subsequently suffered from adjacent vertebral fractures. Age, lumbar lordotic angle, sacral slope, pelvic tilt, pelvic incidence, bone mineral density, amounts of cement injected, the restoration of vertebral height, kyphotic angle differences preexisting fracture, and intradiscal cement leakage were noted.ResultsAverage bone mineral density was -3.52 in the fracture group and -2.91 in the fracture-free group; the risk of adjacent vertebral fracture increased as bone mineral density decreased (p < 0.05). Intradiscal cement leakage occurred in 18 patients (33.3%) in the fracture group, indicating that the risk of adjacent vertebral fracture increased with intradiscal cement leakage. In addition, 36 patients (66.7%) in the fracture group had a pre-existing fracture; thus, the presence of a preexisting fracture was found to be significantly associated with an increased risk of an adjacent vertebral fracture (p < 0.05). Higher restoration rates are associated with a greater likelihood of developing adjacent vertebral fractures (p < 0.05).ConclusionsThe factors found to contribute significantly to new fractures in adjacent vertebral bodies after percutaneous vertebroplasty were a lower bone mineral density, a greater restoration rate of vertebral height, a pre-existing fracture, and intradiscal cement leakage.
Jo u rn a l o f th e K o re a n F ra ctru re S o cie ty V o l. 2 0 , N o . 3 , Ju ly , 2 0 0 7 260 통신저자:민 상 혁Tel:041-550-3953․Fax:041-550-3950 E-mail:osmin71@naver.comAddress reprint requests to:Sang-Hyuk Min, M.D. Materials and Methods:The study was conducted on 46 patients in whom 296 patients were performed during last 9 years. We were especially concerned with the restoration rate of vertebral height and kyphotic angle and estimated them on simple X-ray films. Results: In patients experienced subsequent vertebral fractures and no subsequent vertebral fractures after vertebroplasty, the mean height restoration rate of treated vertebra were 16.7% and 7.07%, and the kyphotic angle difference were 2.53 degree and 4.2 degree. The greater degree of height restoration of the vertebral body, especially in middle vertebral height and the lesser degree of kyphotic angle difference increased the risk of adjacent vertebral fracture risk. This results were available statistically (all p<0.05, Logistic regression test, SPSS 13.0). Conclusion: It may be thought that the vertebral body height restoration rate will become risk factor of adjacent vertebral fractures.
Study DesignProspective controlled study.PurposeThe results of conventional open surgery was compared with those from minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for lumbar fusion to determine which approach resulted in less postoperative paraspinal muscle degeneration.Overview of LiteratureMI TLIF is new surgical technique that appears to minimize iatrogenic injury. However, there aren't any reports yet that have quantitatively analyzed and proved whether there's difference in back muscle injury and degeneration between the minimally invasive surgery and conventional open surgery in more than 1 year follow-up after surgery.MethodsThis study examined a consecutive series of 48 patients who underwent lumbar fusion in our hospital during the period, March 2006 to March 2008, with a 1-year follow-up evaluation using MRI. There were 17 cases of conventional open surgery and 31 cases of MI-TLIF (31 cases of single segment fusion and 17 cases of multi-segment fusion). The digital images of the paravertebral back muscles were analyzed and compared using the T2-weighted axial images. The point of interest was the paraspinal muscle of the intervertebral disc level from L1 to L5. Picture archiving and communication system viewing software was used for quantitative analysis of the change in fat infiltration percentage and the change in cross-sectional area of the paraspinal muscle, before and after surgery.ResultsA comparison of the traditional posterior fusion method with MI-TLIF revealed single segment fusion to result in an average increase in fat infiltration in the paraspinal muscle of 4.30% and 1.37% and a decrease in cross-sectional area of 0.10 and 0.07 before and after surgery, respectively. Multi-segment fusion showed an average 7.90% and 2.79% increase in fat infiltration and a 0.16 and 0.10 decrease in cross-sectional area, respectively. Both single and multi segment fusion showed less change in the fat infiltration percentage and cross-sectional area, particularly in multi segment fusion. There was no significant difference between the two groups in terms of the radiologic results.ConclusionsA comparison of conventional open surgery with MI-TLIF upon degeneration of the paraspinal muscle with a 1 year follow-up evaluation revealed that both single and multi segment fusion showed less change in fat infiltration percentage and cross-sectional area in the MI-TLIF but there was no significant difference between the two groups. This suggests that as time passes after surgery, there is no significant difference in the level of degeneration of the paraspinal muscle between surgical techniques.
PurposeTo investigate the clinical and radiological outcomes of multilevel minimally invasive transforaminal lumbar interbody fusion (MITLIF) in multilevel degenerative lumbar diseases.MethodsOf 172 patients who could be followed-up for at least 1 year after undergoing a MITLIF, a total of 127 patients in whom unilateral cages were used through a unilateral approach (consisting of 69 patients for single-level, 40 for two-level, and 18 for three- or higher-level) were retrospectively studied as subjects. In this study, clinical assessment parameters included Visual Analog Scale (VAS) score and Oswestry Disability Index (ODI), while radiologic assessment parameters included disc height, segmental lordotic angle, and lumbar lordotic angle. At the last follow-up, the level of bone fusion was determined in accordance with the Brantigan and Steffee criteria for classification of fusion results.ResultsThe VAS scores of back pain and radiating leg pain tended to improve postoperatively, and showed no significant difference among groups (p > 0.05). In terms of ODI, the results of functional assessments also indicated no significant difference among groups (p > 0.05). Similarly, there was no statistically significant difference in disc height, segmental lordotic angle, lumbar lordotic angle, and bone fusion depending on the number of fusion levels (p > 0.05).ConclusionsRegardless of the number of fused levels, satisfactory clinical and radiological outcomes of MITLIF were seen in patients with spinal stenosis, which suggests that the said surgical procedure may be useful even for patients with multilevel spinal stenosis.
A high rate of fusion was achieved in MI-TLIF in graft volume of more than 12 ml. We therefore recommend at least 12 ml of bone graft volume for successful fusion.
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