• Journal of Korean Neurosurgical Society
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• 제42권1호
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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.

• 한국정밀공학회지
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• 제27권4호
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• pp.95-101
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• 2010

The aim of this study was to detect longitudinal alterations on lumbar vertebral trabecular bone quality (microarchitecture and degree of mineralization) and bone mineral density (BMD) during pregnancy Virginal eighteen mice were used. Then, twelve mice were mated. Mice lumbar vertebrae were scanned before mate, at 7 days of pregnancy (early pregnancy, 6 mice) and immediately after delivery (late pregnancy, 6 mice) by using in-vivo micro-computed tomography Structural parameters, degree of mineralization and BMD were measured. During early pregnancy, there were no significant alterations on structural parameters, degree of mineralization and BMD. At late pregnancy, Tb.Th (11.8%) and BMD (12.7%) were significantly decreased and Tb.N (6.3%), Tb.Pf (43.0%) and BS/BV (15.1%) were significantly increased (p<0.05). Additionally, the lower degree of mineralization was increased, although, the higher degree of mineralization was decreased. These results indicated that the quality and BMD might be not affected during early pregnancy. At late pregnancy, however the bone quality and BMD were likely to be negatively affected.

• 대한정형외과학회지
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• 제54권1호
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• pp.24-29
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• 2019

목적: 골다공증성 척추 압박 골절에 대한 경피적 척추 성형술 후 조기에 발생하였던 새로운 연속 골절의 특성과 위험인자에 대하여 알아보고자 하였다. 대상 및 방법: 2013년 1월부터 2015년 12월까지 골다공증성 척추 압박 골절로 경피적 척추 성형술을 시행받은 환자 중 인접 추체에 새로운 골절이 발생한 44예를 대상으로 하였으며 골절 발생 시기에 따라 2군으로 나누었다. 3개월 내에 골절이 발생한 경우가 22예(A군)였고 3개월 이후에 발생한 경우가 22예(B군)였다. 두 군 간의 나이, 성별, 골밀도, 체질량 지수, 기존 척추 골절의 존재, 초기 골절 위치, 추간판 내 시멘트 누출, 시멘트 주입량, 추체의 높이 회복 정도, 후만각 교정 정도의 차이에 대하여 후향적으로 비교 분석하였다. 결과: 두 군 간의 나이, 성별, 골밀도, 체질량 지수, 기존 척추 골절의 존재, 초기 골절 위치, 추간판 내 시멘트 누출, 후만각 교정 정도에는 유의한 차이는 없었다. 시멘트 주입량이 많은 경우와 추체 높이 회복 정도가 큰 경우에서 3개월 내에 골절이 발생한 빈도가 유의하게 높았다. 결론: 경피적 척추 성형술 시 시멘트 양과 추체 높이 회복 정도는 3개월 이내에 발생하는 조기 인접 척추 골절의 위험인자로 판단되며 추시 과정에서 주의가 필요할 것으로 판단된다.

• Journal of Korean Neurosurgical Society
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• 제52권4호
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• pp.339-345
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• 2012

Objective : The purpose of this study was to investigate the patterns and the risk factors of newly developed vertebral compression fractures (VCFs) after percutaneous vertebroplasty (PVP). Methods : We performed a retrospective review of the 244 patients treated with PVP from September 2006 to February 2011. Among these patients, we selected 49 patients with newly developed VCFs following PVP as the new VCFs group, and the remaining 195 patients as the no VCFs group. The new VCFs group was further divided into 2 groups : an adjacent fractures group and a nonadjacent fractures group. The following data were collected from the groups : age, gender, body weight/height, body mass index (BMI), bone mineral density (BMD) score of the spine and femur, level of initial fracture, restoration rate of anterior/middle vertebral height, and intradiscal cement leakage, volume of polymethylmethacrylate (PMMA). Results : Age, gender, mean body height/weight, mean BMI and volume of PMMA of each of the group are not statistically significantly associated with fractures. In comparison between the new VCFs group and the no VCFs group, lower BMD, intradiscal cement leakage and anterior vertebral height restoration were the significant predictive factors of the fracture. In addition, new VCFs occurrence at the adjacent spines was statistically significant, when the initial fracture levels were confined to the thoracolumbar junction, among the subgroups of new VCFs. Conclusion : Lower spinal BMD, the greater anterior vertebral height restoration rate and intradiscal cement leakage were confirmed as risk factors for newly formed VCFs after PVP.

• Journal of Korean Neurosurgical Society
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• 제58권4호
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• pp.346-349
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• 2015

Objective : To investigate the value of lumbar bone mineral density (BMD) in fracture risk assessment (FRAX) tool. Methods : One hundred and ten patients aged over 60 years were enrolled and divided into 2 groups as non-osteoporotic vertebral fracture (OVF) and OVF groups. The 10-year-risk of major osteoporotic vertebral fracture of each group was calculated by FRAX tool with femoral and lumbar spine BMDs to compare the usefulness of lumbar spine BMD in prediction of OVF. The blood level of osteocalcin and C-terminal telopeptide (CTX) as markers of activities of osteoblast and osteoclast, respectively were analyzed using the institutional database. Results : In the OVF group, the ratio of patients with previous fracture history or use of glucocorticoid was higher than those in non-OVF group (p=0.000 and 0.030, respectively). The levels of T-score of femur neck and lumbar spine in OVF group were significantly lower than those in non-OVF group (p=0.001 and 0.000, respectively). The risk of OVF in FRAX using femur BMD in non-OVF and OVF groups was $6.7{\pm}6.13$ and $11.4{\pm}10.06$, respectively (p=0.007). The risk of using lumbar BMD in the 2 groups was $6.9{\pm}8.91$ and $15.1{\pm}15.08$, respectively (p=0.002). The areas under the receiver operator characteristic curve in the FRAX risk with lumbar and femur neck BMD were 0.726 and 0.684, respectively. The comparison of osteocalcin and CTX was not significant (p=0.162 and 0.369, respectively). Conclusion : In our study, the 10-year risk of major osteoporotic fracture in the OVF group of our study was lower than the recommended threshold of intervention for osteoporosis. Hence, a lower threshold for the treatment of osteoporosis may be set for the Korean population to prevent OVF. In the prediction of symptomatic OVF, FRAX tool using lumbar spine BMD may be more useful than that using femur neck BMD.

• Investigative Magnetic Resonance Imaging
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• 제16권1호
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• pp.16-24
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• 2012

목적: Dixon 정량 화학적 변위 자기공명영상(QCSI)의 척추 골수 지방함량과 이중에너지 방사선 흡수법 (DXA)를 통한 BMD 값과의 상관성을 알아본다. 대상과 방법: QCSI와 간의 화학적 변위영상을 포함한 전신 자기공명영상(MRI)과 요추의 DXA를 시행한 68명의 건강한 사람들[평균연령, 50.7세; 범위, 25-76세; 남/여=36/32]을 대상으로 후향적 연구를 시행하였다. 성별과 T-score에 따라 정상(남/여=27/23)과 골감소증(남/여=9/9)집단으로 나누고, MRI로 척추골수와 간의 지방함량을 측정하였다. 각 집단의 나이, 체질량지수(BMI), 골수 지방함량과 간의 지방함량을 비교하였고, 여성에서는 폐경 전후 각 변수들의 비교를 추가하여 Spearman's 상관계수로 평가하였다. 결과: 남성의 나이, BMI, 척추 골수와 간의 지방함량은 정상과 골감소증 집단 사이에 큰 차이를 보이지 않았다. 여성에서는, 골감소증 집단의 평균 나이가 정상집단에 비해 높았고(p=0.01), 폐경된 경우가 많았으나[폐경 전, 26.1%(6/23); 후, 77.8%(7/9); p<0.05], 다른 변수들은 유의한 차이를 보이지 않았다. 골수 지방함량과의 비교에 있어 여성의 나이는 유일한 의미 있는 변수였다(r=0.43, p<0.05). 결론: Dixon QCSI를 통한 척추 골수 지방함량의 측정은 남녀 모두에 있어 DXA BMD 감소를 정확히 반영하지는 않는다.

• 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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• 제42권5호
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• pp.371-376
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• 2007

Objective : Balloon kyphoplasty can effectively relieve the symptomatic pain and correct the segmental deformity of osteoporotic vertebral compression fractures. While many articles have reported on the effectiveness of the procedure, there has not been any research on the factors affecting the deformity correction. Here, we evaluated both the relationship between postoperative pain relief and restoration of the vertebral height, and segmental kyphosis, as well as the various factors affecting segmental deformity correction after balloon kyphoplasty. Methods : Between January 2004 and December 2006, 137 patients (158 vertebral levels) underwent balloon kyphoplasty. We analyzed various factors such as the age and sex of the patient, preoperative compression ratio, kyphotic angle of compressed segment, injected PMMA volume, configuration of compression, preoperative bone mineral density (BMD) score, time interval between onset of symptom and the procedure, visual analogue scale (VAS) score for pain rating and surgery-related complications. Results : The mean postoperative VAS score improvement was $4.93{\pm}0.17$. The mean postoperative height restoration rate was $17.8{\pm}1.57%$ and the kyphotic angle reduction was $1.94{\pm}0.38^{\circ}$. However, there were no significant statistical correlations among VAS score improvement, height restoration rate, and kyphotic angle reduction. Among the various factors, the configuration of the compressed vertebral body (p=0.002) was related to the height restoration rate and the direction of the compression (p=0.006) was related with the kyphotic angle reduction. The preoperative compression ratio (p=0.023, p=0.006) and injected PMMA volume (p<0.001, p=0.035) affected both the height restoration and kyphotic angle reduction. Only the preoperative compression ratio was found to be as an independent affecting factor (95% CI : 1.064-5.068). Conclusion : The two major benefits of balloon kyphoplasty are immediate pain relief and local deformity correction, but segmental deformity correction achieved by balloon kyphoplasty does not result in additional pain relief. Among the factors that were shown to affect the segmental deformity correction, configuration of the compressed vertebral body, direction of the most compressed area, and preoperative compression ratio were not modifiable. However, careful preoperative consideration about the modifiable factor, the PMMA volume to inject, may contribute to the dynamic correction of the segmental deformity.

• Journal of Ginseng Research
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• 제22권2호
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• pp.114-121
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• 1998

Osteoporosis is defined as a pathologic condition in which there occurs no change in the chemical composition of the bone, while bone resorption is abnormally increased. This compares with osteogenesis, which leads to a decrease in the amount of bone. Though many varieties of therapies have been tried, no fully effective method has been found. Korean red ginseng is an important variety of Korean ginsengs and many studies have been performed to investigate its effectiveness. But there has been no report on red ginseng's effects on osteoporosis. The purpose of this study was to determine the clinical effects of Korean red ginseng on postmenopausal osteoporosis patients. The study was designed as a double-blind study. Group I consisted of 30 postmenopausal osteoporosis patients who were administered red ginseng extracts and 15 patients who were administered maltose capsules, were included in group II. The following results were obtained after one-year administration to both groups. 1. There were no significant differences in the degree of wedging, number of compression fractures in the vertebral body, trabeculations, and Cobb's angles between the experimental and control groups. 2. Even though bone mineral density increased in the lumbar spine, and decreased in the femur, there was no significant statistical difference. 3. The serum levels of parathyroid hormone (PTH), calcium, phosphate, and alkaline phosphates showed no difference between the two groups regardless of treatment. 4. Urine Deoxy-pyridinoline (DPYD) decreased in the red ginseng group while it increased in the maltose group, but statistically there was no significant difference between the two groups. 5. The clinical presentations showed no significant differences using Visual Analog Scale. 6. The specific complications related with the long-term use of red ginseng did not occur in all patients. In conclusion, there were no statistically significant differences in clinical presentations, biochemical, and radiological studies between the red gins eng and maltose groups. No definite effectiveness of red ginseng on patients with osteoporosis was found.

• 대한정형외과학회지
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• 제54권4호
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• pp.327-335
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• 2019

목적: 골다공증성 척추 압박 골절 환자에서 척추경 나사못을 이용한 고정술을 시행 시 골시멘트(polymethylmethacrylate) 보강의 방사선적 효용성에 대해 조사하고자 하였다. 대상 및 방법: 골다공증성 압박 골절에서 골시멘트 보강술을 이용한 척추경 나사 고정을 시행한 20예의 환자가 연구에 포함되었다. 평균 추시 기간은 15.6개월이었으며, 인구학적인 자료, 골밀도(bone mineral density, BMD), 유합 분절, 척추경 나사의 사용 개수 및 골시멘트 주입량은 의무기록을 통하여 검토되었다. 방사선적인 결과를 산출하기 위하여 시간 순차적(수술 전, 수술 직후, 술 후 6주, 술 후 3, 6개월 및 술 후 1년) 추시를 통해 방사선적 지표를 측정하였다. 결과: 본 연구에 총 20명의 환자(여자 16예[80.0%]; 평균 나이, 69.1±8.9세)가 포함되었다. 평균 BMD는 -2.5±0.9 g/cm², 각각의 추체당 평균 골시멘트 주입량은 6.3 ml였다. 술 전 측정한 후만각(Cobb angle)은 32.7°±7.0°였으며, 술 후 측정값은 8.7°±6.9° (p<0.001)로 큰 호전을 나타내었고, 교정은 술 후 시간 순차적인 추시에서도 유지됨을 보였다. 기구 고정 후 후만각, 설상각, 시상지표 또한 유사한 호전 양상을 나타내었다. 또한 골절된 추체의 전방 높이 또한 수술 전 11.0±5.0 mm에서 수술 후 18.5±5.7 mm (p=0.006)로 호전되었고 3, 6개월 및 1년간의 추시 간에도 유지됨이 확인되었다. 결론: 골다공증성 압박 골절에서 골시멘트 보강술을 이용한 척추경 나사 고정은 효과적인 치료법이라 생각되며, 이 술식을 통해 국소 흉요추부 후만의 충분한 교정을 얻을 수 있고 술 후에도 잘 유지할 수 있는 방법으로 골다공증 척추 압박 골절 환자에서 유용한 술식으로 생각된다.