Si Young Park

Comparative analysis of clinical outcomes in patients with osteoporotic vertebral compression fractures (OVCFs): conservative treatment versus balloon kyphoplasty

BACKGROUND CONTEXT Most osteoporotic vertebral compression fractures (OVCFs) can be treated conservatively. Recently, kyphoplasty has become a common treatment for painful osteoporotic compression fractures and has shown numerous benefits, such as early pain control and height restoration of the collapsed vertebral body. In spite of being a simple procedure, numerous complications related to kyphoplasty have been reported. Moreover, there is limited evidence to support its superiority. PURPOSE To compare the clinical outcomes of patients with OVCF according to different treatment modalities and identify clinical risk factors related to failure of conservative treatment of OVCF. STUDY DESIGN A prospective study consisting of a review of case report forms. PATIENTS SAMPLE: We prospectively enrolled 259 patients who had one or two acute painful OVCFs confirmed by magnetic resonance imaging. All patients were treated conservatively in the initial 3 weeks. Kyphoplasty was performed in 91 patients who complained of sustained back pain and disability in spite of conservative treatment for the initial 3 weeks. OUTCOME MEASURES Pain score using visual analog scale (VAS) and the Oswestry Disability Index (ODI). METHODS Participants were stratified according to age, sex, level and number of fractures, bone mineral density, body mass index (BMI), collapse rates, and history of spine fractures. Pain scores using VASs were assessed at 1 week and at 1, 3, 6, and 12 months. RESULTS A total of 259 patients were enrolled, and 231 patients (82 of 91 patients in the kyphoplasty group [KP] and 149 of 168 patients in the conservative treatment group) completed the 1-year follow-up. About 65% of patients were treated successfully with conservative treatment. Risk factors for failure of 3 weeks of conservative treatment were older age (older than 78.5 years), severe osteoporosis (t score less than -2.95), overweight (BMI more than 25.5), and larger collapse rates (more than 28.5%). There were significant reductions in VAS and ODI scores in both groups at each follow-up assessment. At the first month, better clinical results were observed in KP. However, there were no significant differences in outcome measures between the two groups at 3, 6, or 12 months. Thirteen subsequent compression fractures (five in KP and eight in the conservative treatment group) occurred during the 1-year follow-up period. CONCLUSION Both treatments of OVCF showed successful clinical results at the end of the 1-year follow-up period. Kyphoplasty showed better outcomes in the first month only. Given these results, prompt kyphoplasty should not be indicated in the case of a patient with OVCF that has no risk factors for failure with conservative treatment. Rather, a trial of conservative, 3-week treatment would be beneficial.

Correlations of adolescent idiopathic scoliosis and pectus excavatum.

Study Design: Radiologic study of scoliosis in pectus excavatum patients. Objectives: To determine the relation between pectus excavatum deformity and adolescent idiopathic scoliosis (AIS). Summary of Background Data: AIS may be related to other whole body deformities, but few reports have addressed the relation between chest deformity and scoliosis. Methods: A total of 248 patients with a diagnosis of pectus excavatum were enrolled in this study. All study patients underwent whole spine anteroposterior radiographs and chest computed tomography. Severity and type of scoliosis and chest deformity were measured using radiographs, and relations between pectus deformity and AIS were analyzed. Results: Overall, 56 of the 248 study patients had scoliosis (Cobb angle >10 degrees)—a prevalence of 22.58%. The incidence of scoliosis was significantly higher in female patients (38.46%) (P=0.002), and Lenke type 1 predominated in pectus patients (48.2%, P<0.0001). Mean age was greater in the scoliosis group than in the nonscoliosis group (P<0.0001), and the asymmetry of pectus deformity was more prominent in the scoliosis group (P=0.007). However, pectus deformity severity was similar in the 2 groups (P=0.061). Furthermore, although the scoliosis group showed a higher proportion of female patients (P=0.002), the severities of chest and spinal deformities were similar in the 2 groups for both sexes (P=0.314, P=0.227). Conclusions: Pectus excavatum and AIS were found to have a high concomitant incidence. And, the age, sex, and type of disease were significantly different in the scoliosis and pectus excavatum groups. Surgeons should consider these relationships when deciding upon treatment in patients with chest and spinal deformities.

Osteoporotic Fracture: 2015 Position Statement of the Korean Society for Bone and Mineral Research

Osteoporotic fractures are one of the most common causes of disability and a major contributor to medical care costs worldwide. Prior osteoporotic fracture at any site is one of the strongest risk factors for a new fracture, which occurs very soon after the first fracture. Bone mineral density (BMD) scan, a conventional diagnostic tool for osteoporosis, has clear limitations in diagnosing osteoporotic fractures and identifying the risk of subsequent fractures. Therefore, early and accurate diagnosis of osteoporotic fractures using the clinical definition which is applicable practically and independent of BMD, is essential for preventing subsequent fractures and reducing the socioeconomic burden of these fractures. Fractures caused by low-level trauma equivalent to a fall from a standing height or less at major (hip, spine, distal radius, and proximal humerus) or minor (pelvis, sacrum, ribs, distal femur and humerus, and ankle) sites in adults over age 50, should be first regarded as osteoporotic. In addition, if osteoporotic fractures are strongly suspected on history and physical examination even though there are no positive findings on conventional X-rays, more advanced imaging techniques such as computed tomography, bone scan, and magnetic resonance imaging are necessary as soon as possible.

Epidural cement leakage through pedicle violation after balloon kyphoplasty causing paraparesis in osteoporotic vertebral compression fractures - a report of two cases

Kyphoplasty is advantageous over vertebroplasty in terms of better kyphosis correction and diminished risk of cement extravasations. Literature described cement leakage causing neurological injury mainly after vertebroplasty procedure; only a few case reports show cement leakage with kyphoplasty without neurological injury or proper cause of leakage. We present a report two cases of osteoporotic vertebral compression fracture treated with kyphoplasty and developed cement leakage causing significant neurological injury. In both cases CT scan was the diagnostic tool to identify cause of cement leakage. CT scan exhibited violation of medial pedicle wall causing cement leakage in the spinal canal. Both patients displayed clinical improvement after decompression surgery with or without instrumentation. Retrospectively looking at stored fluoroscopic images, we found that improper position of trocar in AP and lateral view simultaneously while taking entry caused pedicle wall violation. We suggest not to cross medial pedicle wall in AP image throughout the entire procedure and keeping the trocar in the center of pedicle in lateral image would be the most important precaution to prevent such complication. Our case reports adds the neurological complications with kyphoplasty procedure and suggested that along with other precautions described in the literature, entry with trocar along the entire procedure keeping the oval shape of pedicle in mind (under C-arm) will probably help to prevent such complications.

Bone metabolism in postmenopausal women with lumbar spinal stenosis: analysis of bone mineral density and bone turnover markers.

Study Design. A cross-sectional study. Objective. To investigate bone mineral density (BMD) and the change of bone turnover rate in postmenopausal women with lumbar spinal stenosis (LSS). Summary of Background Data. Symptomatic LSS prevents elderly patients from performing daily activities because of back pain and neurogenic claudication. Walking intolerance due to neurologic claudication might have a negative effect on bone metabolism and BMD. However, there has been no study on the relationship between LSS and bone metabolism, especially on bone turnover rate. Methods. Sixty-seven patients were in the LSS group. As a control group, 67 age- and weight-matched subjects were selected. In both groups, BMD, bone turnover markers, vitamin D, severity of knee osteoarthritis, and demographic data were obtained. In the LSS group, walking distance without rest was also recorded. BMD, bone turnover markers, vitamin D, and severity of knee osteoarthritis were compared between the two groups. In the LSS group, the correlation between walking intolerance and bone turnover markers was also analyzed. Results. In the LSS group, urinary N-terminal telopeptide of type I collagen (u-NTx) and alkaline phosphatase were significantly elevated when compared with those of the control group (P < 0.05). However, BMD was significantly low in the control group in all of the measured sites (P < 0.05). In the LSS group, neither bone markers nor BMD were correlated with the extent of walking difficulty. Conclusion. Our study highlights the fact that limited physical activity results in high bone turnover rate in patients with LSS.

Usefulness of MRI in determining the appropriate level of cement augmentation for acute osteoporotic vertebral compression fractures

Study Design: This is a prospective study on consecutive patients with acute osteoporotic vertebral compression fractures (OVCFs). Objectives: To evaluate the usefulness of magnetic resonance imaging (MRI) for diagnosing appropriate acute lesions before a percutaneous cement augmentation technique. Background: Vertebral compression fractures related to osteoporosis are very common in the elderly. Acute OVCFs are usually treated conservatively. In recent years, minimally invasive percutaneous cement augmentation techniques, vertebroplasty and kyphoplasty, have been introduced as alternative treatment options. However, the localization of acute fractures of the spine can be difficult, yet is critical in implementing these treatments. Methods: A total of 168 patients were enrolled in this study. All participants were 50 years of age or older and were admitted via the emergency room because of acute severe back pain with suspected OVCFs with or without a history of trauma. Standard plain radiographs and a computed tomography (CT) scan of the spine were initially obtained in the emergency room. An MRI scan with short-tau inversion recovery (STIR) sequencing of the spine was performed within 3 days of hospitalization. Patients were divided into 2 groups: single group and multiple group. The single group consisted of those with a single fracture, and the multiple group consisted of those with multiple fractures of the vertebral body, as diagnosed using only standard radiographs and CT scans. We compared the level and number of fractures from the initial findings of the standard radiographs and CT scans with the MRI scan results within each group. Results: The mean age of the study participants was 68.9 years. Forty-nine patients were male and 119 were female. In the single group, the concordance rate of diagnosis was 77% (97/125) and the discordance rate was 23% (28/125). In the multiple group, the discordance rate was 65% (28/43). There was a significantly higher rate of misdiagnosis in the multiple group compared with the single group (P<0.01). Conclusions: MRI with STIR sequencing exhibited a multitude of benefits in the exact identification of acute lesions and hidden lesions. Because of the high rate of misdiagnosis using standard plain radiographs and CT scans of the spine for OVCFs, MRI with STIR sequencing should be considered before cement augmentation procedures. Moreover, in cases with multiple lesions or severe osteoporosis, the importance of MRI should be further emphasized.

Intramuscular and subcutaneous sparganosis: Sonographic findings.

A case of subcutaneous and intramuscular sparganosis was confirmed on surgical excision of a worm in a 60‐year‐old woman suffering from painful masses in the right thigh. Sonography and MRI revealed an ill‐defined intramuscular lesion and multiple cystic lesions in the subcutaneous tissue. At the time of the excision, a sparganum larva was found in the adductor longus muscle. If an intramuscular mass with a serpiginous cystic tract is seen on imaging studies in an endemic area, musculoskeletal sparganosis should be included in the differential diagnosis of a soft tissue tumor.

Ulnar artery pseudoaneurysm after tension band wiring of an olecranon fracture resulting in Volkmann's ischemic contracture: a case report.

Olecranon fracture and its fixation by tension band wiring (TBW) is a common clinical procedure in orthopedic surgery, and although TBW is considered a simple procedure, it is associated with a high complication rate. We report a patient with an ulnar artery pseudoaneurysm that resulted from unintended injury of the ulnar artery by prominent Kirschner (K) wire used for TBW. This led to chronic compartment syndrome and Volkmann’s ischemic contracture (VIC) of the dominant hand and severe disability. To our knowledge, this complication has not been previously reported in the English literature.

Centroid method: an alternative method of determining coronal curvature in scoliosis. A comparative study versus Cobb method in the degenerative spine.

BACKGROUND CONTEXT Although the Cobb method is considered the gold standard, the centroid method may offer a reasonable alternative in adult scoliosis because it has better inter- and intraobserver reliabilities in adolescent scoliosis. PURPOSE To compare the reliabilities of the Cobb and the centroid methods for measuring coronal curvature in degenerative scoliosis in older patients. STUDY DESIGN Observational study involving three examiners. PATIENT SAMPLE Sixty whole spine posteroanterior (PA) radiographs were collected. OUTCOME MEASURES Data were analyzed to determine inter- and intraobserver reliabilities. METHODS Sixty whole spine PA radiographs of patients older than 60 years were collected to compare the reliabilities of the centroid and the Cobb methods for measuring coronal curvature in degenerative scoliosis. Three examiners using both methods independently measured radiographs twice. Data were analyzed to determine inter- and intraobserver reliabilities. RESULTS Intraobserver comparisons of all the 60 radiographs revealed that inter- and intraclass correlation coefficients (ICCs) of the Cobb and the centroid methods were both excellent (greater than 0.979 vs. greater than 0.918), and mean absolute differences (MADs) were similar (less than 1.58 vs. less than 2.02). In interobserver comparisons, ICCs of the Cobb method were higher than that of the centroid method (greater than 0.922 vs. greater than 0.799), and the MADs of the Cobb method were lower than that of the centroid method (less than 2.91 vs. less than 4.84). Comparisons of radiographs subdivided by severity showed that the ICCs of the Cobb and the centroid methods were both excellent (greater than 0.819 vs. greater than 0.801), and their MADs were similar (less than 2.29 vs. less than 2.53) for intraobserver comparisons. Interobserver comparisons showed that ICCs and MADs were dependent on the severity of coronal curvature, and the ICCs of the Cobb method (greater than 0.698) were greater than that of the centroid method (greater than 0.507). Furthermore, MAD values for the Cobb method were lower than that for the centroid method (less than 3.59 vs. less than 6.07). Moreover, these results are contradictory to the previous study, which showed the higher reliability of the centroid method in measures of adolescent scoliosis. CONCLUSIONS In the present study, the reliability of the centroid method was found to be more susceptible to the severity of disease in older patients, despite its demonstrated greater reliability in adolescent scoliosis. Our findings show that the selective use of these two methods in old and young patients can increase the reliabilities of measurements made.

Necrotising fasciitis in both calves caused by Aeromonas caviae following aesthetic liposuction

Liposuction is the most widely performed cosmetic procedure in the world, and is considered safe and without serious complications. However, necrotising fasciitis has been documented as a rare complication following abdomen and thigh liposuction. We present a case of necrotising fasciitis in a 22-year-old female who underwent cosmetic liposuction in both calves. The diagnosis of necrotising fasciitis was delayed, leading to multi-organ dysfunction and skin necrosis with consequent massive skin loss. Non-cosmetic physicians are generally unfamiliar with liposuction-induced complications, and may not suspect necrotising fasciitis due to its rarity. However, awareness of its clinical features is critical since early diagnosis and prompt surgical debridement can prevent significant morbidity and even death.