• Asian Spine Journal
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• 제12권6호
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• pp.992-997
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• 2018

Study Design: Feasibility study. Purpose: To evaluate the feasibility of using serum pentosidine level as a potential marker for osteoporotic vertebral compression fracture (OVCF). Overview of Literature: A review of previous studies suggests a negative correlation between serum pentosidine concentration and bone strength. However, it is unclear whether serum pentosidine level might be a potential marker of OVCF in Koreans. Methods: Forty patients who underwent bone mineral density examination were included in this study, and their serum pentosidine levels were prospectively analyzed. Serum pentosidine level was evaluated using enzyme-linked immunosorbent assay. Among all the patients, 11 with OVCF were assigned to the vertebral fracture group and 29 who did not have vertebral fracture were included in the non-fracture group. In addition, we used the Fracture Risk Assessment (FRAX) tool Korean version for assessing the 10-year probability of fracture. Results: There was a statistically significant difference in the mean serum pentosidine level (p=0.04) of the vertebral fracture group (110.8 ng/mL) and the non-fracture group (64.3 ng/mL). Logistic regression analyses showed that serum pentosidine was significantly associated with OVCF. The vertebral fracture group had significantly higher 10-year probability of major osteoporotic fracture as per FRAX than the non-fracture group. There was a positive correlation between pentosidine level and FRAX results (r=0.35, p=0.02). Conclusions: These results suggest that increased serum pentosidine level could be a potential marker for OVCF.

• Investigative Magnetic Resonance Imaging
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• 제21권3호
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• pp.154-161
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• 2017

Purpose: To evaluate the diagnostic performance of diffusion-weighted steady-state free precession (DW-SSFP) in comparison to diffusion-weighted echo-planar imaging (DW-EPI) for differentiating the neoplastic and benign osteoporotic vertebral compression fractures. Materials and Methods: The subjects were 40 patients with recent vertebral compression fractures but no history of vertebroplasty, spine operation, or chemotherapy. They had received 3-Tesla (T) spine magnetic resonance imaging (MRI), including both DW-SSFP and DW-EPI sequences. The 40 patients included 20 with neoplastic vertebral fracture and 20 with benign osteoporotic vertebral fracture. In each fracture lesion, we obtained the signal intensity normalized by the signal intensity of normal bone marrow (SI norm) on DW-SSFP and the apparent diffusion coefficient (ADC) on DW-EPI. The correlation between the SI norm and the ADC in each lesion was analyzed using linear regression. The optimal cut-off values for the diagnosis of neoplastic fracture were determined in each sequence using Youden's J statistics and receiver operating characteristic curve analyses. Results: In the neoplastic fracture, the median SI norm on DW-SSFP was higher and the median ADC on DW-EPI was lower than the benign osteoporotic fracture (5.24 vs. 1.30, P = 0.032, and 0.86 vs. 1.48, P = 0.041, respectively). Inverse linear correlations were evident between SI norm and ADC in both neoplastic and benign osteoporotic fractures (r = -0.45 and -0.61, respectively). The optimal cut-off values for diagnosis of neoplastic fracture were SI norm of 3.0 in DW-SSFP with the sensitivity and specificity of 90.4% (95% confidence interval [CI]: 81.0-99.0) and 95.3% (95% CI: 90.0-100.0), respectively, and ADC of 1.3 in DW-EPI with the sensitivity and specificity of 90.5% (95% CI: 80.0-100.0) and 70.4% (95% CI: 60.0-80.0), respectively. Conclusion: In 3-T MRI, DW-SSFP has comparable sensitivity and specificity to DW-EPI in differentiating the neoplastic vertebral fracture from the benign osteoporotic vertebral fracture.

• The Korean Journal of Pain
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• 제24권4호
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• pp.235-238
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• 2011

Vertebral compression fractures result in vertebral height loss and alter sagittal spinal alignment, which in turn can lead to increased morbidity and mortality. Acute osteoporotic vertebral compression fractures are known to increase mobility and instability of the spine. There are limited published data correlating the degree of dynamic mobility and the efficacy of kyphoplasty on vertebral compression fractures. Here we report a 73-year-old female with a severe acute osteoporotic L2 compression fracture who obtained total vertebral height restoration following kyphoplasty, with resolution of back pain.

• Journal of Korean Neurosurgical Society
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• 제48권6호
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• pp.490-495
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• 2010

Objective : Bone cement augmentation procedures such as percutaneous vertebroplasty and balloon kyphoplasty have been shown to be effective treatment for acute or subacute osteoporotic vertebral compression fractures. The purpose of this study was to determine the efficacy of bone cement augmentation procedures for long standing osteoporotic vertebral compression fracture with late vertebral collapse and persistent back pain. Methods : Among 278 single level osteoporotic vertebral compression fractures that were treated by vertebral augmentation procedures at our institute, 18 consecutive patients were included in this study. Study inclusion was limited to initially, minimal compression fractures, but showing a poor prognosis due to late vertebral collapse, intravertebral vacuum clefts and continuous back pain despite conservative treatment for more than one year. The subjects included three men and 15 women. The mean age was 70.7 with a range from 64 to 85 years of age. After postural reduction for two days, bone cement augmentation procedures following intraoperative pressure reduction were performed. Imaging and clinical findings, including the level of the vertebra involved, vertebral height restoration, injected cement volume, local kyphosis, clinical outcome and complications were analyzed. Results : The mean follow-up period after bone cement augmentation procedures was 14.3 months (range 12-27 months). The mean injected cement volume was 4.1 mL (range 2.4-5.9 mL). The unipedicular approach was possible in 15 patients. The mean pain score (visual analogue scale) prior to surgery was 7.1, which decreased to 3.1 at 7 days after the procedure. The pain relief was maintained at the final follow up. The kyphotic angle improved significantly from $21.2{\pm}4.9^{\circ}$ before surgery to $10.4{\pm}3.8^{\circ}$ after surgery. The fraction of vertebral height increased from 30% to 60% after bone cement augmentation, and the restored vertebral height was maintained at the final follow up. There were no serious complications related to cement leakage. Conclusion : In the management of even long-standing osteoporotic vertebral compression fracture for over one year, bone cement augmentation procedures following postural reduction were considered safe and effective treatment in cases of non-healing evidence.

• Journal of Korean Neurosurgical Society
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• 제59권2호
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• pp.137-142
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• 2016

Objective : To evaluate whether an early bone marrow edema pattern predicts vertebral deformity types and prognosis in osteoporotic vertebral compression fracture (OVCF). Methods : This retrospective study enrolled 64 patients with 75 acute OVCFs who underwent early MRI and followed up MRI. On early MRI, the low SI pattern of OVCF on T1WI were assessed and classified into 3 types (diffuse, globular or patchy, band-like). On followed up MRI, the vertebral deformity types (anterior wedge, biconcave, crush), degree of vertebral body height loss, incidence of vertebral osteonecrosis and spinal stenosis were assessed for each vertebral fracture types. Results : According to the early bone marrow edema pattern on T1WI, 26 vertebrae were type 1, 14 vertebrae were type 2 and 35 vertebrae were type 3. On followed up MRI, the crush-type vertebral deformity was most frequent among the type 1 OVCFs, the biconcave-type vertebral deformity was most frequent among the type 2 OVCFs and the anterior wedge-type vertebral deformity was most frequent among the type 3 OVCFs (p<0.001). In addition, type 1 early bone marrow edema pattern of OVCF on T1WI were associated with higher incidence of severe degree vertebral body height loss, vertebral osteonecrosis and spinal stenosis on the follow up MRI. Conclusion : Early bone marrow edema pattern of OVCF on T1WI, significant correlated with vertebral deformity types on the follow up MRI. The severe degree of vertebral height loss, vertebral osteonecrosis, and spinal stenosis were more frequent in patients with diffuse low SI pattern.

• Journal of Korean Neurosurgical Society
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• 제47권5호
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• pp.399-402
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• 2010

Osteoporosis is a worldwide problem and it mainly affects postmenopausal women. Osteoporosis associated with pregnancy or lactation is a rare condition. The incidence and mechanism of this phenomenon has not been clarified, but it can cause one or more vertebral compression fractures with severe, prolonged back pain in the affected women. We experienced this uncommon case, treated it with percutaneous vertebroplasty. A 35-old-woman visited our hospital with complaints of severe back pain and flank pain 2 months after normal vaginal delivery. She was diagnosed with osteoporotic vertebral compression fractures on the T5, 8, 9 and 11 vertebral bodies and we performed percutaneous vertebroplasty on the T8, 9 and 11 vertebrae with a good result. We present here an unusual case of pregnancy-associated compression fractures treated by percutaneous vertebroplasty.

• Journal of Trauma and Injury
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• 제18권2호
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• pp.107-111
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• 2005

Backgrounds: To evaluate the effectiveness of conservative treatment in osteoporotic thoraco-lumbar compression fractures and to identify the factors influencing the progression of compression. Materials and Methods: From January 2003 to October 2004, Patients who were admitted to our hospital for osteoporotic thoraco-lumbar compression fractures were reviewed retrospectively with follow-up more than 12 months (ave. 14.6 months). With simple x-ray lateral view, we evaluate wedge compression ratio (WCR) and kyphotic angle (KA) at initial and final follow-up. We separate the patients into two groups baesed on the amount of progression of vertebral compression and evaluate a relation with BMD, vertebral fracture level, initial WCR, initial KA. All datas were statistically analyzed. Results: An average of T-score was -3.5 and the changes of KA between initial and final follow-up were average $3.5^{\circ}$. Compression of anterior column were progressed to 8.5%. The changes between initial and final WCR in Group I (N=24) was 17.8%, and Group II (N=18) was 3.3%. T-score in group I was -3.4 and group II was -3.8 (p=0.228). vertebral fracture level were 10 T12, 12 L1, 2 L2 in group I; 6 T12, 6 L1, 6 L2 in group II (p=0.156). Initail WCR was 0.74 in group I, 0.63 in group II, and there was statistical difference between two groups(p=0002). Initial kyphotic angle was $13.9^{\circ}$in group I, $16.2^{\circ}$in group II repectively (p=0.392). Conclusion: The conservative treatment with short-term bed rest and early embulation is effective and valuable method to patients who have osteoporotic thoraco-lumbar compression fractures. There was no statistical difference between two groups according to BMD, vertebral fracture level, KA. But in comparison with initail WCR between two groups, there was statistical difference. That means, in the case of small initial compression of anterior column, the progression of compression was bigger than else. In these patients, more strict use of appropriate brace and careful follow-up should be needed.

• Journal of Trauma and Injury
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• 제27권4호
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• pp.186-191
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• 2014

Purpose: The objectives of this study were to assess pain relief according to the time after kyphoplasty and to evaluate the factors affecting pain relief after kyphoplasty in the treatment of a single-level osteoporotic vertebral compression fracture. Methods: A retrospective review of 34 kyphoplasties for single-level osteoporotic vertebral compression fractures was performed. Pain relief was assessed by using the visual analogue scale (VAS) at preoperatively and postoperatively at 6 weeks, 3 months, and 6 months. Associated factors, including age, sex, pain duration, bone mineral density, and cement leakage, were evaluated using the patients' medical records. Statistical analyses were conducted using the paired t-test to assess pain relief and using the independent t-test and Pearson's correlation coefficient to evaluate the relationship between those factors and pain relief. Results: Preoperatively, the mean VAS score was 7.06. Postoperatively, it declined to 3.66 (p=0.001), 2.81 (p=0.001) and 2.24 (p=0.001) at 6 weeks, 3 months and 6 months, respectively. Also, statistically significant pain relief was observed during the periods from 6 weeks to 3 months (p=0.001) and from 3 months to 6 months (p=0.001). However, reduction of the VAS score showed no significant correlation with age, sex, pain duration, bone mineral density, or cement leakage (p>0.05). Conclusion: Our study suggests that a kyphoplasty may be effective in osteoporotic vertebral compression fracture patients with acute pain and that after the kyphoplasty, pain is reduced remarkably for 6 weeks and then continuously for 6 months.

• Journal of Korean Medical Science
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• 제33권48호
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• pp.316.1-316.10
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• 2018

Background: Water pressure and muscle contraction may influence bone mineral density (BMD) in a positive way. However, divers experience weightlessness, which has a negative effect on BMD. The present study investigated BMD difference in normal controls and woman free-divers with vertebral fracture and with no fracture. Methods: Between January 2010 and December 2014, traditional woman divers (known as Haenyeo in Korean), and non-diving women were investigated. The study population was divided into osteoporotic vertebral fracture and non-fracture groups. The BMD of the lumbar spine and femoral neck was measured. The radiological parameters for global spinal sagittal balance were measured. Results: Thirty free-diving women and thirty-three non-diving women were enrolled in this study. The mean age of the divers was $72.1{\pm}4.7$ years and that of the controls was $72.7{\pm}4.0$ years (P = 0.61). There was no statistical difference in BMD between the divers and controls. In divers, cervical lordosis and pelvic tilt were significantly increased in the fracture subgroup compared to the non-fracture subgroup (P = 0.028 and P = 0.008, respectively). Sagittal vertical axis was statistically significantly correlated with cervical lordosis (Spearman's rho R = 0.41, P = 0.03), and pelvic tilt (Spearman's rho R = 0.46, P = 0.01) in divers. Conclusion: BMD did not differ significantly between divers and controls during their postmenopausal period. When osteoporotic spinal fractures develop, compensation mechanisms, such as increased cervical lordosis and pelvic tilt, was more evident in traditional woman divers. This may be due to the superior back muscle strength and spinal mobility of this group of women.

• Journal of Korean Neurosurgical Society
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• 제42권2호
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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.