Ki Chan An

The Clinical and Radiological Availability of Percutaneous Balloon Kyphoplasty as a Treatment for Osteoporotic Burst Fractures

Study Design We retrospectively assessed the results of percutaneous balloon kyphoplasty (KP) by clinical and radiological methods. Purpose To evaluate the outcome of KP as a treatment for osteoporotic burst fractures. Overview of Literature Many surgeons are concerned about the possibility of neurological complications after percutaneous kyphoplasty for osteoporotic burst fractures, secondary to intra-canal cement leakage. Methods We performed KP as a treatment for osteoporotic burst fractures. We studied 12 patients/13 vertebrae. The two control groups consisted of patients who only underwent conservative treatment and those who underwent posterior instrumentation and fusion. We measured each preoperative/postoperative vertebral kyphotic deformity angle (KDA) using simple lateral spine images and checked for leakage of cement, as well. The preoperative/postoperative visual analog scale (VAS) scores for back pain, degree of daily activity, and postoperative complications were evaluated. Results The mean improvement in KDA after KP was 9.7±2.2°. The mean preoperative and postoperative VAS scores for back pain were 8.3±0.4 and 3.1±0.17, respectively. Regarding the control group, the mean postoperative VAS score for the conservative group and the posterior surgery group decreased by 4.5±0.17 and 3.2±0.19, respectively. There was no statistically significant difference between the KP and posterior surgery groups (p=0.125). However, there was a statistically significant difference between the KP and conservative treatment groups (p=0.012). Conclusions KP is safe and useful for treating osteoporotic burst fractures.

Posterior lumbar interbody fusion using compressive bone graft with allograft and autograft in the pyogenic discitis.

Study Design This is a retrospective study. Purpose To evaluate the advantages and effects of posterior lumbar interbody fusion (PLIF) using allograft and posterior instrumentation in the lumbar pyogenic discitis, which are resistant to antibiotics. Overview of Literature To present preliminary results of PLIF using a compressive bone graft with allograft and pedicle screw fixation in the lumbar pyogenic discitis. Methods Fifteen patients who had lumbar pyogenic discitis were treated by posterior approach from May 2004 to July 2008. The mean follow-up duration was 27.2 ± 18.68 months. The standing radiographs of the lumbar spine and clinical results were compared and analyzed in order to assess the bony union, the changes in the distance between the two vertebral bodies and the changes in the lordotic angle formed between the fused bodies immediately after surgery and at the final follow-up. Results Fifteen solid unions at an average of 15.2 ± 3.5 weeks after operation. The mean preoperative lordotic angle of the affected segments was 14.3 ± 15.1°, compared to 20.3 ± 12.3° after surgery and 19.8 ± 15.2° at last follow-up. For the functional result according to the Kirkaldy-Willis criteria, the outcome was excellent in 9, good in 5, fair in 1, and there were no poor cases. The average visual analogue scale score was decreased from 7.4 before surgery to 3.4 at 2 weeks postoperative. Conclusions The main advantage in the procedure of PLIF using compressive bone graft with allograft and post instrumentation is early ambulation. We believe that this is another good procedure for patients with poor general condition because a further autograft bone harvest is not required.