Hong-Sik Kim

The Effect of Zoledronic Acid on the Volume of the Fusion-Mass in Lumbar Spinal Fusion

Background Few studies have explored the effects of bisphosphonates on bony healing in patients undergoing spinal fusion surgery. Most previous studies used animal models and found that bisphosphonate shows negative effects on spinal fusion consolidation. We intended to evaluate the effect of a single-dose of zoledronic acid on the volume of the fusion-mass in lumbar spinal fusion. Methods A retrospective review was carried out on 44 patients with symptomatic degenerative lumbar spinal stenosis who underwent one or two-level posterolateral fusion from January 2008 and January 2011. They were divided into 4 groups: group 1, autograft and zoledronic acid; group 2, allograft and zoledronic acid; group 3, autograft alone; and group 4, allograft alone. Functional radiography and three-dimensional computed tomography scans were used to evaluate and quantify the volume of the fusion-mass. The visual analog scale (VAS), the Oswestry disability index (ODI), and the short form 36 (SF-36) were used to evaluate the clinical outcomes. Results The mean volume of the fusion-mass per level was 8,814 mm3, 8,035 mm3, 8,383 mm3, and 7,550 mm3 in groups 1, 2, 3, and 4, respectively, but there were no significant differences between the groups (p = 0.829). There were no significant decreases in the volume of the fusion-mass (p = 0.533) in the zoledronic acid groups (groups 1 and 2). The VAS, the ODI, and the SF-36 at the 6-month follow-up after surgery were not significantly different (p > 0.05) among the 4 groups. The VAS, the ODI, and the SF-36 were not correlated with the volume of the fusion-mass (p = 0.120, 0.609, 0.642). Conclusions A single dose of zoledronic acid does not decrease the volume of the fusion-mass in patients undergoing spinal fusion with osteoporosis. Therefore, we recommend that zoledronic acid may be used after spinal fusion in osteoporotic patients.

Management of sacral fractures associated with spinal or pelvic ring injury.

BACKGROUND The proper treatment of sacral fracture has yet to be standardized. METHODS Seventy-one patients with sacral fractures who were treated from December 2001 to January 2009 were evaluated. Classification was made depending on the presence of a combined injury in the spine or pelvic ring, displacement of the sacral fracture, and fracture location with surgical indications in case of a displaced fracture or neurologic injury. The surgical procedure used was either spinopelvic fixation with iliac screws or percutaneous iliosacral screw fixation. Fracture causes, treatments, classifications, the availability of the radiologic bony union and its application period, and clinical results using the Oswestry Disability Index were evaluated. RESULTS There were 7 patients with isolated sacral fractures, 3 patients with sacral fractures that were combined with spinal injuries, 34 patients with sacral fractures with pelvic ring injuries, and 27 cases with both spinal and pelvic ring injuries. Among these, 11 patients also showed a neurologic deficit. Of the 26 patients who were indicated for surgical treatment, 23 achieved a bony union showing favorable clinical results; however, of the three patients who were not able to undergo operation, two showed a nonunion with bad clinical results including neurologic symptoms. CONCLUSION Sacral fracture often accompanies spinal or pelvic ring injuries. Depending on the presence of spinopelvic dissociation, spinopelvic fixation is recommended for cases with dissociation, and percutaneous iliosacral screw fixation is recommended for cases without dissociation. LEVEL OF EVIDENCE Therapeutic study, level IV.

The Effect of Anxiety, Depression, and Optimism on Postoperative Satisfaction and Clinical Outcomes in Lumbar Spinal Stenosis and Degenerative Spondylolisthesis Patients: Cohort Study

Background The aim of this study is to evaluate the effect of depression, anxiety, and optimism on postoperative satisfaction and clinical outcomes in patients who underwent less than two-level posterior instrumented fusions for lumbar spinal stenosis and degenerative spondylolisthesis. Methods Preoperative psychological status of subjects, such as depression, anxiety, and optimism, was evaluated using the Hospital Anxiety and Depression Scale (HADS) and the Revised Life Orientation Test (LOT-R). Clinical evaluation was determined by measuring changes in a visual analogue scale (VAS) and the Oswestry Disability Index (ODI) before and after surgery. Postoperative satisfaction of subjects assessed using the North American Spine Society lumbar spine questionnaire was comparatively analyzed against the preoperative psychological status. The correlation between patients preoperative psychological status (depression, anxiety, and optimism) and clinical outcomes (VAS and ODI) was evaluated. Results VAS and ODI scores significantly decreased after surgery (p < 0.001), suggesting clinically favorable outcomes. Preoperative psychological status of patients (anxiety, depression, and optimism) was not related to the degree of improvement in clinical outcomes (VAS and ODI) after surgery. However, postoperative satisfaction was moderately correlated with optimism. Conclusions Anxiety and optimism were more correlated with patient satisfaction than clinical outcomes. Accordingly, the surgeon can predict postoperative satisfaction of patients based on careful evaluation of psychological status before surgery.