• 대한추나의학회지
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• 제3권1호
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• pp.167-174
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• 2002

흉요추 이행부의 안정성 압박골절은 통증의 소실과 후만각 증가 억제에 의한 척추의 안정화이다. 이의 원인을 후방인대의 손상에 의한 손상으로 보고 프로로테라피(Prolotherapy)로 이의 치료를 시행 할 수 있다고 생각되며 한방적인 방법으로 화침을 적용할 수 있었다. 최근 저자는 흉요추 이행부의 안정성 압박골절에 의한 요배통 환자를 발견하고 화침치료를 통해 증세 회복에 도움이 되었기에 치료내용과 경과를 문헌고찰과 함께 보고하는 바이다.

• Journal of Acupuncture Research
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• 제35권2호
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• pp.75-80
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• 2018

Background: The aim of this study was to assess the feasibility of conducting a clinical study of using acupuncture for chronic pain in patients with osteoporotic thoracolumbar vertebral compression fractures (VCFs) in the outpatient setting. Methods: A prospective case-series attempting to recruit 20 participants was performed from February 11, 2016, to December 31, 2016. We provided Manual and electrical acupuncture was provided one 1 to three 3 times a week, for 6 weeks, up to 18 sessions. The primary clinical outcome was the average pain intensity as measured by the visual analog scale (VAS) at 6 weeks. Secondary outcomes included back-specific dysfunction (Oswestry disability index), quality of life (quality of life questionnaire-26), patient-reported improvement, use of other healthcare resources, and adverse events at 6 weeks. Use of healthcare resources and adverse events were additionally followed-up at 12 weeks by telephone. Results: Of 33 patients screened, a total of 7 were enrolled in the study. Manual and electrical acupuncture was provided 1 to 3 times a week, for 6 weeks, up to 18 sessions. We observed reduced pain intensity at 6 weeks in all participants. The change in the quality of life and back-specific dysfunction was inconsistent among participants. Mild, temporary adverse events were observed in three patients. Conclusion: In our clinical setting, it was not feasible to recruit sufficient participants and to assess the efficacy of acupuncture for chronic pain after osteoporotic thoracolumbar VCFs under a year. Strategies to improve recruitment and to identify barriers to participation are required for future clinical trials.

• Journal of Korean Neurosurgical Society
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• 제37권6호
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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.

• 대한한의학회지
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• 제44권2호
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• pp.149-169
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• 2023

Objectives: This study was designed to statistically analyze patients hospitalized for thoracolumbar compression fractures at Daejeon University Daejeon Korean Medicine Hospital from January 1, 2017 to December 31, 2021. Methods: A total of 62 patients were analyzed through electronic medical records in this study. The extracted data was analyzed using IBM SPSS ver.27.0. Results: 1. Traffic accident patients were more likely to reduce pain by more than half compared to falls and other patients. Patients without spinal disease were more likely to reduce pain by more than half compared to those without. The shorter the absolute bed rest and the longer the hospital stay, the higher the probability of pain reduction by more than half. 2. The duration of pain half-reduction was longer in patients with diabetes than in patients without diabetes. 3. The longer the hospitalization period and the shorter the absolute bed rest period, the less pain was reported upon discharge. Males complained of less pain at discharge than females, and patients without spinal disease complained less than those without. Patients who did not receive absolute bed rest complained of less pain upon discharge than those who did not. Conclusions: This study included patients hospitalized for thoracolumbar compression fractures and showed that etiology, absolute bed rest period, hospitalization period, gender, spinal disease, diabetes statistically affected the degree of pain reduction.

• 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.

• 대한정형외과학회지
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• 제54권4호
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• pp.336-342
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• 2019

목적: 자기공명영상(magnetic resonance imaging, MRI)을 이용하여 보존적 치료를 시행한 흉요추부 골다공증성 압박 골절 환자에서 후만 변형의 예측 인자를 조사하고자 하였다. 대상 및 방법: 2007년 1월부터 2016년 3월까지 흉요추 압박 골절 의심하에 진료를 본 환자들 중 보존적 치료를 시행한 환자를 따로 분류하였고 그들 중 골밀도 -2.0 미만의 골감소증 및 골다공증, 단일 분절 골절을 가진 환자 89명을 대상으로 후향적 연구를 시행하였다. 골절된 척추체에서 전·후종 인대 손상, 상부 또는 하부 종판 파열, 상부 또는 하부 추간판 손상, T2 강조 영상에서 저 신호 강도의 존재, 척추체의 골 부종 정도를 MRI를 통해 확인하였다. 결과: 상부 종판이 파열된 사례나 척추체 골 부종 수준이 높은 사례의 경우 후만각, 설상각, 전방 척추 압박이 현저하게 진행되었다. 전종 인대 손상이나 상부 추간판 손상이 있는 경우에는 후만각만 현저하게 진행되었다. T2 강조 영상에서 저 신호 강도의 병변을 보인 경우 설상각과 전방 척추 압박이 높게 나타났다. 그러나 후종 인대 손상과 하부 종판 파열 및 하부 추간판 손상의 경우는 후만 변형 및 척추 압박의 진행과 유의미한 상관관계는 없었다. 후만각이 5° 이상 증가될 위험 요인으로는 전종 인대의 손상 유무, 상부 종판 파열, 상부 추간판 손상이 있는데 손상 받지 않은 사례에 비해 각각 21.3, 5.1, 8.5배 위험했고 골 부종 수준에 따라 각각 위험도가 달랐다. 결론: 골감소증 및 흉요추부 골다공증성 압박 골절일지라도 전종 인대 손상, 상부 종판 및 추간판 손상 또는 MRI상 높은 수준의 부종이 있을 경우 후만 변형의 위험도가 증가한다.

• Journal of Korean Neurosurgical Society
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• 제63권6호
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• pp.794-805
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• 2020

Objective : Teriparatide is known as an effective anabolic agent not only for severe osteoporosis but also for bone healing and union. We explored the possibility of teriparatide as an alternative treatment option for osteoporotic thoracolumbar (TL) burst fracture. Methods : This retrospective study enrolled 35 female patients with mean age of 73.77±6.71 years (61-88) diagnosed as osteoporotic TL burst fracture with ≥4 of thoracolumbar injury classification and severity (TLICS) score and no neurological deficits. All patients were treated by teriparatide only (12 of group A), teriparatide plus vertebroplasty (12 of group B), or surgical fixation with fusion (11 of group C), and followed up for 12 months. Radiological outcomes were evaluated using radiological parameters including kyphotic angle (KA), segmental vertebral kyphotic angle (SVKA), compression ratio (CR), and vertebral body height (anterior [AH], middle [MH], posterior [PH]). Functional outcomes were evaluated using visual analog scale (VAS) and Macnab classification (MC). Results : There were no statistical significant differences in age, bone mineral density (-3.36±0.73), and TLICS score (4.34±0.48) among the three groups (p>0.05). Teriparatide was administered during 8.63±2.32 months in group A and B. In 12-month radiological outcomes, there were significant restoration in SVKA, CR, AH, and MH of group B and KA, SVKA, CR, AH, and MH of group C compared to group A with no radiological changes (p<0.05). All groups showed similar significant improvements in 12-month functional outcomes, although group B and C showed a better 1-month VAS, 1-month MC, 3-month MC compared to group A (p<0.05). Conclusion : Non-surgical treatment with teriparatide showed similar 12-month functional outcomes compared to surgical fixation with fusion. The additional vertebroplasty to teriparatide and surgical fixation with fusion were more helpful to improve short-term functional outcomes with structural restoration compared to teriparatide only.

• Journal of Korean Neurosurgical Society
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• 제40권4호
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• pp.249-255
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• 2006

Objective : This study is to evaluate the efficacy of dorsal short-segment fixation in unstable thoracolumbar junction fractures. Methods : The cases of 20 patients who underwent dorsal short-segment fixation were reviewed retrospectively. Clinical outcomes were analysed using Sonntag's pain level, work status, and neurological scale according to the modified Frankel classification. Radiological outcomes were analysed using Mumford's anterior body compression[%], canal compromise ratio, and Cobb's kyphotic angle. Results : At the latest clinical follow-up [average=14.6 months]. there were 19 [95.0%] in group I and 1 patient [5.0%] in II in pain level. The postoperative work status were 17 [85.0%] in group I, 2 patients [10.0%] in II, and 1 patient [5.0%] in V. Surgery brought to improve the neurologic status. In success group [19 cases, 95%], the average canal compromise ratio was reduced from 0.57 [${\pm}0.07$] to 0.05 [${\pm}0.08$] [P<005], the average anterior body compression [%] was reduced from 41% [${\pm}17$] to 18% [${\pm}14$] [P<0.05], and the average preoperative kyphotic angle was $20.0^{\circ}$ [${\pm}9.0$], and corrected to $5.7^{\circ}$ [${\pm}7.1$] postoperatively, and progressed to $7.8^{\circ}$ [${\pm}6.2$] at the latest follow-up. There was a case of implantation failure in an elderly osteoporotic patient. Conclusion : Although there are limitations in the patient number and follow-up period, the present study favors dorsal short-segment fixation for selective cases in unstable thoracolumbar junction fractures.

• 대한핵의학회지
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• 제38권6호
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• pp.522-527
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• 2004

목적 : 본 연구는 골다공증에 의한 척추 골절 환자를 대상으로 골SPECT를 시행하고 골 섭취 증가 병변의 형태와 분포를 분석하여, 척추 골절에서 골SPECT의 유용성을 알아보고자 하였다. 대상 및 방법: 골다공증에 의한 척추 골절이 있었던 32명의 환자를 대상으로 하였다. 평균 연령은 $67{\pm}8$세였으며, 남자 5명, 여자 27명이었다. 79개의 척추골절이 발견되었으며, 병소는 흉부 및 흉요추부 척추가 38개, 요추부 척추가 41개였다. 척추체의 골절 형태는 압박 형태에 따라 쐐기형, 양요형, 압박형으로 분류하였고, SPECT 상 척추체의 골 섭취 증가 병변은 국소성 혹은 미만성, 대칭성 혹은 비대칭성으로 분류하였다. 척추 후방부의 SPECT 소견은 척추경, 척추 후관절, 관절간부, 극상 돌기의 골섭취 증가 병변 유무로 분류하였다. 척추체 골절 형태와 골절 척추의 위치에 따른 골 SPECT소견에 차이가 있는지를 분석하였다. 결과: 79개의 척추제 압박 골절 중 쐐기형 병소가 47개, 양요형 병소가 20개, 압박형 병소가 12개이었다. 골 SPECT에서는 척추체의 섭취 증가가 모든 예에서 관찰되었으며, 골절의 형태와 관계없이 국소형 보다는 미만형이, 대칭성 보다는 비대칭성 골 섭취 증가가 많았다. 척추 후방부에 병소가 발견된 경우는 69개(87.3%) 였으며, 쐐기형이 40개(85.1%), 양요형 17개(85.0%), 압축형 12개(100%)에서 관찰되었다. 흉부 및 흉요추부 척추에서는 쐐기형 골절이 많은 반면, 요추부 척추에서는 골절형태 분포가 비교적 균일한 것으로 나타났다(p=0.04). 극상돌기의 골섭취는 흉부 및 흉요추부 골절의 5예(13.2%)에서 있었던 반면 요추부 척추 골절에서는 16개(39.0%)에서 발견되어 분포의 차이가 있었다(p=0.009). 요추부 척추에서 발생한 양요형 골절에서 척추 후관절에 골 섭취 증가를 보인 경우가 12개(92.3%)인데 반해 흉부 및 흉요추부 척추에 발생한 경우 4개(57.1%) 에서만 골섭취 증가 병변이 있었다. 극상돌기의 골섭취에도 차이가 있어서 요추가 8개(38.5%)인데 비해 흉부 및 흉요추부 척추에서는 1개(14.3%)에서만 골섭취가 있었다(p=0.043). 결론: 골SPECT는 골다공증에 의한 척추 골절 진단에 유용하며, 특히 척추 후방부의 골 섭취 증가 병변의 평가에 유용하였다.

• Journal of Korean Neurosurgical Society
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• 제41권5호
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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.