• Journal of Korean Neurosurgical Society
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• 제56권3호
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• pp.211-217
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• 2014

Objective : In Korea, early vertebroplasty (EVP) or delayed vertebroplasty (DVP, which is performed at least 2 weeks after diagnosis) were performed for the treatment of acute osteoporotic compression fracture (OCF) of the spine. The present study compared the outcomes of two surgical strategies for the treatment of single-level acute OCF in the thoracolumbar junction (T12-L2). Methods : From 2004 to 2010, 23 patients were allocated to the EVP group (EVPG) and 27 patients to the DVP group (DVPG). Overall mean age was $68.3{\pm}7.9$ and minimum follow-up period was 1.0 year. Retrospective study of clinical and radiological results was conducted. Results : No significant differences in baseline characteristics were observed between the two groups. As expected, mean duration from onset to vertebroplasty and mean duration of hospital stay were significantly longer in the DVPG ($17.1{\pm}2.1$ and $17.5{\pm}4.2$) than in the EVPG ($3.8{\pm}3.3$ and $10.8{\pm}5.1$, p=0.001). Final clinical outcome including visual analogue scale (VAS), Oswestry Disability Index, and Odom's criteria did not differ between the two groups. However, immediate improvement of the VAS after vertebroplasty was greater in the EVPG ($5.1{\pm}1.3$) than in the DVPG ($4.0{\pm}1.0$, p=0.002). The proportion of cement leakage was lower in the EVPG (30.4%) than in the DVPG (59.3%, p=0.039). In addition, semiquantitative grade of cement interdigitation was significantly more favorable in the EVPG than in the DVPG (p=0.003). Final vertebral body collapse and segmental kyphosis did not differ significantly between the two groups. Conclusion : Our findings suggest that EVP achieves a better immediate surgical effect with more favorable cost-effectiveness.

• The Korean Journal of Pain
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• 제13권1호
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• pp.126-129
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• 2000

Age-related osteoporotic compression fractures occur frequently in old aged group recently. Percutaneous vertebroplasty has recently been introduced as a therapeutic method for the treatment of pain associated with osteoporotic vertebral compression fracture. Percutaneous intravertebral injection of PMMA (polymethylmethacrylate) results in marked reduction in pain and morbidity. Among complications during vertebroplasty with PMMA, pulmonary embolism is repotred occasionally but the reports about hypotension are not common. This case is a report of a patient whom significant hypotension occured during percutaneous vertebroplasty.

• Journal of Korean Neurosurgical Society
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• 제30권2호
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• pp.163-167
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• 2001

Objective : Percutaneous vertebroplasty has recently been introduced as an interesting therapeutic alternative for the treatment of thoracolumbar vertebral body fractures in elderly persons with osteoporosis. The authors present the early results of this method. Method and Material : From July 1999 to April 2000, percutaneous transpedicular technique was used in 20 patients (2 men and 18 women) whose mean age was 67.5 years old(range 59-79) with painful vertebral compression(22) and burst(2) fractures. The interval between fracture and vertebroplasty ranged 1 day to 4 months. The procedure involved percutaneous puncture of the injured vertebra via transpedicular approach under fluoroscopic guidance, followed by injection of polymethylmetacrylate(PMMA) into the vertebral body through a disposable 11-guage Jamshidi needle. Result : The most common cause of fracture was slip down and the most frequent injured level was the twelfth thoracic spine. The procedure was technically successful bilaterally in 18 patients(9 thoracic and 15 lumbar spines) with an average injection amount of 7.7ml PMMA in each level. Seventeen(94.4%) patients reported significant pain relief immediately after treatment. Two leaks of PMMA were detected with postoperative CT in spinal epidural space and extravertebral soft tissue without clinical symptoms. Conclusion : Although this study represents the early results, percutaneous vertebroplasty seems to be valuable tool in the treatment of painful osteoporotic vertebral body fractures in elderly, providing acute pain relief and early mobilization.

• Journal of Chest Surgery
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• 제46권1호
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• pp.72-75
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• 2013

Percutaneous vertebroplasty is a relatively easy and minimally invasive procedure used in treating vertebral fractures. However, the procedure has many complications, one of which is bone cement leakage, which happens frequently. Leakage to the paravertebral venous system, in particular, may lead to especially devastating consequences. Here we report a case of a 65-year-old male patient with an intracardiac foreign body (bone cement) that generated a perforation on the right ventricle, and result in hemopericardium after percutaneous vertebroplasty. We performed open heart surgery to remove the foreign body.

• Journal of Korean Neurosurgical Society
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• 제49권2호
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• pp.131-133
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• 2011

We performed a percutaneous vertebroplasty at the compressed L2 vertebral body of a 73-year-old female using a left-sided unilateral extrapedicular approach. She complained severe radiating pain and a tingling sensation in her left leg two hours after the vertebroplasty. Spinal computed tomographic scan showed a large retroperitoneal hematoma, and a subsequent spinal angiography revealed a left L2 segmental artery injury. Bleeding was successfully controlled by endovascular embolization. Recently, extrapedicular approaches have been attempted, allowing for the avoidance of facet and pedicle injury with only a unilateral approach. With this approach, however, the needle punctures the vertebral body directly. Therefore, this procedure carries the potential risk of a spinal segmental artery.

• 한국정밀공학회지
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• 제23권8호
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• pp.185-194
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• 2006

In this paper, three dimensional finite element analyses have been performed to investigate the biomechanics of vertebroplasty in patient accurate FE models have been constructed from CT images of a PMMA injected vertebra. In order to apply various material properties of the spine(T12), the functional relation between the well known apparent density and HU(Hounsfield unit) from CT image were employed and thus real material properties can be assigned to each element of FE model. The FE analysis showed similar results with the experiments. With this approach accurate analysis of the vertebroplasty and its clinical applications can be expected.

• Journal of Korean Neurosurgical Society
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• 제30권11호
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• pp.1271-1277
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• 2001

Objectives : Since vertebroplasty has been introduced, we performed short segment pedicle screw fixation with augmented intra-operative vertebroplasty in patients with unstable thoraco-lumbar fracture. Our intentions are to demonstrate the efficacy and indication of this new technique compare to conventional methods. Material and Methods : The surgery comprised of pedicle screw fixations on one level above and below the fracture site, and the fractured level itself, if pedicle is intact, and intra-operative vertebroplasty under the fluoroscopic guide with in-situ postero-lateral bone graft. Also, in cases of bone apposition, we removed those with small impactor through a transfascetal route. During the last 2 years, we performed in seven(7) unstable thoraco-lumbar fracture patients who consisted of two different characteristics, those four(4) with primary or secondary osteoporosis and three(3) of young and very healthy. All patients were followed clinically by A.S.I.A. score and radiography. Results : Mean follow up period was 14 months. We observed well decompressed state via transfascetal route in cases of bone fragments apposition and no hardware pullout in osteoporotic cases, no poly-methyl-methacrylate (PMMA) leakage through the fracture sites into the spinal canal, and no kyphotic deformities in both cases during follow-up periods. All patients demonstrated solid bony fusion except one following osteoporotic compression fracture on other sites. Conclusions : In the management of unstable thoraco-lumbar fracture, we believe that this short segment pedicle screw fixation with augmented intra-operative vertebroplasty reduce the total length or levels of pedicle screw fixation without post-operative kyphotic deformity.

• Investigative Magnetic Resonance Imaging
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• 제21권3호
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• pp.148-153
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• 2017

Purpose: To identify the differences between injected cement volumes during vertebroplasty procedures according to the enhancement pattern of pre-procedure magnetic resonance imaging (MRI) findings. Materials and Methods: Thirty-two patients who underwent 52 vertebroplasty procedures as well as pre-procedure contrast-enhanced spine MRI in the authors' institution were reviewed retrospectively. The 52 procedures were divided into two groups according to different enhancement patterns shown by pre-procedure MR imaging [E(+) and E(-)]. The volumes of the enhancing/non-enhancing portions of the fractured vertebral body shown by pre-procedural MR imaging were calculated and compared to the volumes of the injected cement during the vertebroplasty procedures. Results: The 52 injections included 28 (56%) in Group E(+) and 24 (44%) in Group E(-). The actual volume ratio of the injected cement to the volume of the non-enhanced or enhanced region calculated based on the contrast-enhanced MRI was $0.22{\pm}0.11(cc/cm^3)$ in the E(+) group and $0.93{\pm}0.62(cc/cm^3)$ in the E(-) group. The average amount of injected cement was significantly different between Group E(+) and Group E(-) (P < 0.001). In addition, the ratio of the injected cement amount to the volume of the enhanced or non-enhanced portion based on the contrast-enhanced MRI in Group E(-) was significantly higher than that of Group E(+) (P < 0.001). Conclusion: Different enhancement patterns shown by pre-procedure MRI can predictors of the injected cement volume during vertebroplasty procedures for osteoporotic fractures.

• Journal of Korean Neurosurgical Society
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• 제30권3호
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• pp.319-324
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• 2001

Objectives : The percutaneous vertebroplasty provides a good result in the treatment of osteoporotic vertebral compression fractures. But, the epidural leakage of polymethylmetacrylate(PMMA) after vertebroplasty may decrease the therapeutic effects because of the compression of thecal sac and/or nerve roots. The authors carried out a prospective study to evaluate the causative factors of epidural leakage of PMMA and to assess the influence on the outcome. Methods : This study involved 347 vertebral levels of compression fractures in 159 patients. Among these, the epidural leakages were identified in 92 vertebral levels(26.5%) in 64 patients(40.3%) on post-operative CT scan. Results : The incidence of epidural leakage of PMMA was significantly higher in the level above T7(p=0.001). The large amount of the injected PMMA and the use of an injector also increased the incidence(p=0.03 and p=0.045, respectively). The position of the needle tip in the vertebral body and the pattern of venous drainage did not influence. The immediate post-operative visual analogue scale(VAS) scores and facial scales(FS) were higher in the patients with epidural leakage(p=0.009). But there were no significant differences between the two groups after three months of operation(p=0.541). Conclusions : The incidence of epidural leakage of PMMA after percutaneous vertebroplasty appears to have relationship with the amount of PMMA and the levels injected. The epidural leakage of PMMA reduced the immediate therapeutic effects of vertebroplasty, but did not influence the late outcome. However, the epidural leakage should be avoided because of its potential neurological complications.

• 정보처리학회논문지B
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• 제10B권5호
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• pp.503-508
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• 2003

척추에 대한 외과수술은 신경조직을 손상하지 않아야 하기 때문에 수술 절차가 신중하게 계획되고 고도의 정밀을 요구한다. 척추성형술(verte-broplasty)은 골다공증으로 인한 척추의 골절을 치료하기 위해 제안된 비교적 새로운 외과적인 수술방법으로 최소침습적인 수술 기법으로 피부를 통하여 골절된 척추부위에 구멍을 내고 그곳에 PMMA(polymethylmethacrylate)라 불리는 골시멘트(bone cement)를 주입하여 치료하는 방법이다. 최근의 연구결과, 수술 후 즉각적인 고통의 경감을 가져오며, 골다공증으로 인한 골절부위에 강도가 강한 골시멘트를 주입하게 됨으로써 골다공증 척추체에 구조적인 안정성을 제공해 주는 것으로 알려져 있다. 수술 후 발생하는 합병증의 대부분은 과도한 골시멘트의 주입으로 인한 것으로 알려져 있으며, 따라서 척추성형술의 치료에 가장 중요한 요인은 주입한 골시멘트의 양을 조절하는 것이다. 이에 본 연구에서는 환자의 컴퓨터단층촬영(computer tomography)을 통하여 획득한 영상을 토대로 척추성형술 시술시 필요한 의료 영상 시스템을 설계 및 개발하고, 텍스처 분석을 통하여 개개인의 환자에게 필요한 골시멘트의 양을 계산하는 알고리즘을 개발하여 이를 실제 환자의 시술시에 적용해 보았다. 결과적으로 본 시스템은 척추성형술시에 최적의 골시멘트의 양을 예측할 수 있었으며, 정형외과의 다른 부위의 수술시에도 적용가능성을 확인할 수 있었다.