• Journal of Korean Neurosurgical Society
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• v.42 no.1
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• pp.6-10
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• 2007

Objective : The purpose of this study was to determine the effect of bone cement augmentation of pedicular screwing in severe osteoporotic spondylolisthetic patients. Methods : Twenty patients with spondylolisthesis (8 : spondylolytic spondylolisthesis 12 : degenerative spondylolisthesis) who had undergone pedicular screwing and interbody fusion for osteoporotic lumbar spine (T-score on bone mineral density<-3.0) from 2002 to 2005 were reviewed. Mean age was 62.3 years with 3 male and 17 female patients. Average follow-up period was 14 months. Average T-score on bone mineral density (BMD) was -3.62. After decompression of neural elements, about 6cc of polymethylmethacrylate (PMMA) was injected into the each vertebral body through transpedicular route. All patients underwent one level interbody fusion and pedicular screw fixation. Clinical outcome was assessed using Oswestry Disability Index (ODI) on the last clinical follow-up. In addition, a modified MacNab's grading criteria was used to objectively assess patient's outcome postoperatively. Radiographic analysis of sagittal contour was assessed preoperatively, immediately postoperatively, and at final follow-up including fusion rate. Results : Eighteen of 20 patients were graded as excellent or good according to the modified MacNab's criteria. An significant improvement of ODI was achieved in both groups. Mean sagittal angle at the preoperative state, postoperative state and at the last follow-up state was $11.0^{\circ},\;20.1^{\circ}$ and $18.3^{\circ}$, respectively, with mean sagittal angle correction gain $7.3^{\circ}$. Firm fusion was achieved in all patients. There were one compression fracture above the fused segment after 6 months follow-up and one case of seroma. But there were no postoperative complications related to bone cement leakage and pedicular screwings such as screw pullout or screw cut-up. Conclusion : Bone cement augmentation of pedicular screwing can be an effective procedure for osteoporotic lumbar spine in spondylolisthetic patients.

• Journal of Korean Neurosurgical Society
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• v.42 no.2
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• pp.112-117
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• 2007

Objective : Kyphoplasty and vertebroplasty are two minimally invasive procedures for osteoporotic vertebral compression fractures. The purpose of this retrospective study was to compare the radiological findings and clinical outcomes between two procedures. Methods : Osteoporotic vertebral fractures were treated in 76 vertebrae, using kyphoplasty (n=35 vertebrae) and using vertebroplasty (n=41 vertebrae). Fractured vertebral bodies were diagnosed by correlating the clinical symptoms with radiologic study. The responses of pain symptoms were measured by a self-reported Visual Analog Scale (VAS) score. Plain X-rays were checked preoperatively and postoperatively at admission and 6 months. The vertebral body height and kyphotic angle were measured to assess the reduction of the sagittal alignment. Results : The mean pain scores were decreased significantly for both procedures postoperatively, but there were no significant differences between two groups. Kyphoplasty led to a significant reduction of the vertebral body height and improvement of kyphotic angle. There were no neurological deficits after kyphoplasty, but one patient experienced paraparesis after vertebroplasty. During the 6 months follow-up both procedures provided stabilization of the sagittal alignment. Conclusion : Kyphoplasty and vertebroplasty are considered effective minimally invasive techniques for the stabilization of osteoporotic vertebral body fractures, leading to a statistically significant reduction in pain. Kyphoplasty significantly restore sagittal alignment. Also, complications and the incidence of bone cement leakage are significantly lesser than vertebroplasty. Therefore, kyphoplasty seems to be reasonable procedure for osteoporotic vertebral body compression fractures when medical treatment fail.

• Journal of Korean Neurosurgical Society
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• v.57 no.1
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• pp.32-35
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• 2015

Objective : The purpose of this study was to analyze the relationship between fracture pattern and the development of acute radiculopathy after osteoporotic lumbar compression fracture. Methods : This study included 59 patients who underwent bone cement augmentation for osteoporotic compression fracture below the L2 level, which can lead to radiculopathic radiating pain. The patients were divided into two groups according to the presence of radiculopathy (group A : back pain only; group B : back pain with newly developed radiating pain). We categorized compression fractures into three types by the position of the fracture line. The incidence of newly developed radiculopathy was examined retrospectively for each compression fracture type. Results : The overall incidence of newly developed leg pain (group B) was 25%, and the frequency increased with descending spinal levels (L2 : 0%, L3 : 22%, L4 : 43%, and L5 : 63%). The back pain-only group (group A) had mostly superior-type fractures. On the other hand, the back pain with radiculopathy group (group B) had mostly inferior-type fractures. Most patients in group B showed significant relief of leg pain as well as back pain after bone cement augmentation. Conclusion : The incidence of a newly developed, radiating pain after osteoporotic compression fractures increased gradually from the L3 to L5 levels. Most of these fractures were of the inferior type, and the bone cement augmentation procedures seemed to be sufficient for relief of both back and radiating pain.

• Nutritional Sciences
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• v.8 no.3
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• pp.159-168
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• 2005

Phytoestrogens, especially Yak-kong or soybean-derived isoflavones have been traditionally used as a supplement of estrogen for preventing postmemopausal osteoporosis in oriental folk medicine. In our previous study, the treatment of Yak-kong and soybean increased estrogen receptor-a (ERa) expression and proliferation of MG-63 osteoblastic cells. In contrast, the increase of estrogen receptor-$\beta$ (ER$\beta$) expression in proliferating MG-63 cells with Yak-kong and soybean treatment was less pronounced, which suggested that ER$\beta$ may play a role rather in the regulation of bone cell differentiation To determine the role of ER$\beta$ in Yak-kong or soybean mediated regulation of bone cell differentiation, we established MG-63 cell lines stably expressing either ER$\beta$ or antisense ER$\beta$ RNAs. Increased expression of ER$\beta$ did not affect ERa expression and proliferation of MG-63 cells. However, increased expression of ER$\beta$ in MG-63 cells (ER$\beta$-MG63 cells) selectively enhanced Yak-kong or soybean induced expression of osteoprotegerin (OPG), a novel soluble glycoprotein which is secreted from osteoblasts and mediates the signal for osteoclast differentiation. Inhibition of ER$\beta$ expression by antisense ER$\beta$ RNAs (As-ER$\beta$-MG63) caused these cells to insensitize Yak-kong or soybean induced expression of OPG but increased MG-63 cell proliferation. Furthermore, the comparable effects between Yak-kong and the combined treatment of genistein and daidzein at $0.5{\times}l0^{-8}$ M, which is a concentration of these two isoflavones similar to Yak-kong at 0.001 mg/mL, on OPG expression in ER$\beta$-MG63 cell demonstrate that the enhanced expression of OPG with Yak-kong treatment is mediated by the synergistic effect of low leveled isoflavones in the extracts. Together, coupled with low level of ER expression in osteoclasts, our data demonstrate that ER$\beta$ in osteoblasts plays an important role in Yak-kong and soybean mediated inhibition of osteoclast differentiation indirectly by enhancing the expression of OPG.

• Journal of Nutrition and Health
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• v.36 no.5
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• pp.452-458
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• 2003

Soybean is a rich source of isoflavones such as genistein and daidzein. Soy isoflavones have both weak estrogenic and anti-estrogenic effects and are structurally similar to tamoxifen, an agent that has an effect similar to that of estrogen in terms of reducing postmenopausal bone loss. The purpose of this study was to determine the effects of differences in protein source (casein vs soy) and isoflavone levels (reduced vs higher levels) on selected bone markers and hormones in growing male rats. Thirty weanling Sprague-Dawley young rats were divided into 3 groups: The control group was fed a casein-based diet, the soy concentrate group was fed soy protein with totally reduced isoflavones content (isoflavones 0.07 mg/g protein), and the soy isolate group was fed soy protein with a higher than normal isoflavones content (isoflavones 3.4 mg/g protein). The degree of bone formation was estimated by measuring serum osteocalcin and alkaline phosphoatase (ALP). By determining collagen cross-linkage by immunoassay and correcting with creatinine values, the bone resorption rate was compared. Serum osteocalcin, growth hormone, estrogen and calcitonin were analyzed using radio immunoassay kits. The bone formation marker and ALP activity were differentiated by protein source, showing higher values than casein in feeding either soy isolate or soy concentrate. In this study using growing rats, the differences in isoflavone contents were not a significant factor in either bone formation or bone reaborption markers. Moreover, the soy isolate group had significantly higher levels of growth hormone than the casein group. The findings of this study suggest that growth hormone is partially responsible for its bone-formation effects in young growing rats. Soy protein and the isoflavones in soy protein are beneficial for bone-formation in growing male rats. Therefore, exposure to soy protein and isoflavones early in life may have long-term health benefits in preventing bone diseases such as osteoporosis. Further study to evaluate the mechanism of action of isoflavones on bones is warranted. (Korean J Nutrition 36(5): 452∼458, 2003)

• Journal of Nutrition and Health
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• v.37 no.2
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• pp.132-142
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• 2004

Nutritional factors affecting bone mineral density (BMD) in the different age groups of Korean men were investigated to obtain baseline data for maintaining bone health. Information on diet and anthropometry was collected in 80 elementary school children, 83 high school students, 87 adults aged 25 to 35 years and 98 elderly people over 60 years of age. Data for food and nutrient intake were obtained by 24-hour recall method. BMDs of lumbar spine (L$_2$- L$_4$) and femoral neck were measured by dual energy x-ray absorptiometry. The relationship between BMD and nutritional factors were analyzed. In the femoral neck, 5.7% of adults was classified as osteopenia and 47.9% and 37.8% of the elderly were classified as osteopenia and osteoporosis. It was shown that plant protein, Ca, p, Fe, thiamin, riboflavin and vitamin C intakes were related with BMD in all age groups. As for the mean adequacy ratio (MAR) of nutrients, the lowest quartile group of BMD showed significantly lower MAR among children. The RDA percent of nutrients was a strong influential factor on BMD. Subjects who consumed below 75% of Korean RDA in energy, vitamin A, thiamin, and vitamin C showed lower BMD. Stepwise multiple regression analysis revealed that MAR in children, vegetable Ca in adolescents, and vitamin C in adults and elderly people were the highest influential factor on BMD. Therefore, the above results demonstrated that not only calcium but also other nutrients such as protein, iron, vitamin A, riboflavin, and vitamin C were necessary in order to keep the healthy bone status. In addition, although there were various dietary factors that influenced bone density, MAR was identified as the major factor that affected bone density. Thus, a balanced diet that includes all nutrients is necessary for a healthy bone density. (Korean J Nutrition 37(2) : 132-142, 2004)

• Nutritional Sciences
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• v.7 no.2
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• pp.107-112
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• 2004

This study investigated the interactions of bone health with several variables such as outdoor activity hours, nutritional status including habitual intake of calcium andvitamin D status in 72 high school girls aged 16-17 yearsattending day classes or night classes. The subjects consisted of 39 day-class students and 33 night-class students. Dietaty nutrient intakes were estimated using the 24-hour recall method. The daily activities of each subject were assessed using an activity questionnaire. Urinary calcium and creatinine excretion were assayed from subjects' 24-hoururine, while 25-OH-vitamin D[25-(OH)-D] and osteocalcin were measured from the subjects' fasting blood. Intake of energy, iron, vitamin A and vitamin C were worse in the night-class students. There was no significant difference in dietary calcium between the subjects in the different class types. Time spent on outdoor activities was significantly less in subjects attending night classes. Urinary calcium excretion of the night-class subjects was significantly higher than that of the day-class subjects (p<0.05). There was no significant difference in serum 25-(OH)-D level according to class type. Serum osteocalcin for night-class subjects was significantly higher than that for day-class subjects (p<0.01). It appeared that the night-class students had poorer dietary habits as well as fewer outdoor activities. Even though the estimated bone health of both groups of subjects appeared to be normal, the overall nutritional intake and duration of outdoor activities appeared to be important for maintaining bone health and lowering the future risk of osteoporosis.

• Journal of Korean Neurosurgical Society
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• v.40 no.2
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• pp.90-94
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• 2006

Objective : Acute vertebral burst fractures warrant extensive fixation and fusion on the spine. Osteoplasty [vertebroplasty with high density resin without vertebral expansion] has been used to treat osteoporotic vertebral compression fractures. We report our experiences with osteoplasty in acute vertebral burst fractures. Methods : Twenty-eight cases of acute vertebral burst fracture were operated with osteoplasty. Eighteen patients had osteoporosis concurrently. Preoperative MRI was performed in all cases to find fracture level and to evaluate the severity of injury. Preoperative CT revealed burst fracture in the series. The patients with severe ligament injury or spinal canal compromise were excluded from indication. Osteoplasty was performed under local anesthesia and high density polymethylmethacrylate[PMMA] was injected carefully avoiding cement leakage into spinal canal. The procedure was performed unilaterally in 21 cases and bilaterally in 7 cases. The patients were allowed to ambulate right after surgery. Most patients discharged within 5 days and followed up at least 6 months. Results : There were 12 men and 16 women with average age of 45.3[28-82]. Five patients had 2 level fractures and 2 patients had 3 level fractures. The average injection volume was 5.6cc per level Average VAS [Visual Analogue Scale] improved 26mm after surgery. The immediate postoperative X-ray showed 2 cases of filler spillage into spinal canal and 4 cases of leakage into the retroperitoneal space. One patient with intraspinal leakage was underwent the laminectomy to remove the resin. Conclusion : Osteoplasty is a safe and new treatment option in the burst fractures. Osteoplasty with minimally invasive technique reduced the hospital stay and recovery time in vertebral fracture patients.

• Journal of Korean Neurosurgical Society
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• v.37 no.6
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• pp.416-421
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• 2005

Objective: Despite general agreement on the goals of surgical treatment in thoracolumbar burst fractures, considerable controversy exists regarding the choice of operative techniques. This study is to evaluate the efficacy of short-segment fixation for thoracolumbar burst fractures after long-term follow-up and to analyze the causes of treatment failures. Methods: 48 out of 60 patients who underwent short-segment fixation for thoracolumbar burst fractures between January 1999 and October 2002 were enrolled in this study. Their neurological status, radiological images, and hospital records were retrospectively reviewed. Simple radiographs were evaluated to calculate kyphotic angles and percentages of anterior body compression (%ABC). Results: The average kyphotic angles were $20.0^{\circ}$ preoperatively, $9.6^{\circ}$ postoperatively, and $13.1^{\circ}$ at the latest follow-up. The average %ABC were 47.3% preoperatively, 31.2% postoperatively, and 33.3% at the latest follow-up. The treatment failure, defined as correction loss by $10^{\circ}$ or more or implant failure, was detected in 6 patients (12.5%). 5 out of 6 patients had implant failures. 2 out of 5 patients were related with osteoporosis, and the other 2 were related with poor compliance of spinal bracing. 3 patients with poor initial postoperative alignment had implant failure. 4 patients with screws only on the adjacent vertebrae and not on the injured vertebra itself showed poor initial and overall correction. Conclusion: With proper patient selection, adequate intraoperative reduction with screw fixation involving the injured vertebra, and strict postoperative spinal bracing, the short-segment fixation is an efficient and safe method in the treatment of thoracolumbar burst fracture.

• Journal of Korean Neurosurgical Society
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• v.41 no.5
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• pp.291-294
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• 2007

Objective : The purpose of this retrospective clinical study was to describe a treatment for osteoporotic burst fracture in the setting of severe fractures involving fragmentation of the posterior wall and neural compromise with symptoms of cord compression. Methods : Indication for microscopic decompression and open kyphoplasty were intractable pain at the level of a known osteoporotic burst fractures involving neural compression or posterior wall fragmentation. A total of 18 patients [mean age, 74.6 years] with osteoporotic thoracolumbar burst fractures [3 males, 15 females] were included in this study. In all cases, microscopic decompressive laminectomy was followed by open kyphoplasty. Clinical outcome using VAS score and modified MacNab's grade was assessed on last clinical follow up [mean 6.7 months]. Radiological analysis of sagittal alignment was assessed preoperatively, immediately postoperatively, and at final follow up. Results : One level augmentation and 1.8 level microscopic decompression were performed. Mean blood loss was less than 100 ml and there were no major complications. The mean pain score before operation and at final follow up was 7.2 and 1.9, respectively. Fourteen of 18 patients were graded as excellent and good according to the modified MacNab's criteria. Overall, 6.0 degrees of sagittal correction was obtained at final follow-up. Conclusion : The combined thoracolumbar microscopic decompression and open kyphoplasty for severe osteoporotic fractures involving fragmentation of posterior wall and neural compromise provide direct visualization of neural elements, allowing safe cement augmentation of burst fractures. Decompressive surgery is possible and risk of epidural cement leakage is controlled intraoperatively.