Prediction of Subsequent Vertebral Collapse after Osteoporotic Thoracolumbar Vertebral Fractures

박세준,정성수 대한골다공증학회 2011 Osteoporosis and Sarcopenia Vol.9 No.2

Objectives: To evaluate the clinical significance of vertebral bone bruise (VBB) in terms of subsequent collapse after osteoporotic thoracolumbar vertebral fractures. Methods: We reviewed 41 consecutive patients with 46 osteoporotic thoracolumbar vertebral fractures treated nonoperatively from March 2007 to February 2010. Anterior wedge angle (AWA) was measured on plain radiographs and the change of AWA between the initial and last measurement was used to represent the subsequent vertebral collapse. The size of VBB was measured and VBB ratio was calculated on T1-weighted sagittal MR image. Results: The average VBB ratio was 49.1% and the average change of AWA was 7.1o. Only VBB ratio significantly correlated with the change of AWA (P<0.001, cc=0.660). The other factors such as age, initial AWA, and endplate status showed no significant correlation with the change of AWA (P=0.629, P=0.724, P=0.690, respectively). In DEXA group, no correlation was found between T-score and the change of AWA as well as between T-score and VBB ratio (P=0.548, P=0.370, respectively). Five fractures were diagnosed as delayed post-traumatic vertebral collapse. Their average VBB ratio was 71.2% which was significantly higher than that of the other subjects (P=0.015). The fractures with VBB ratio more than 60% was likely to progress to delayed post-traumatic vertebral collapse. Conclusions: VBB after osteoporotic thoracolumbar vertebral fracture was significantly correlated with subsequent vertebral collapse (cc=0.660). We recommend the patients with a large vertebral bone bruise, especially more than 60%, should be followed up meticulously for the early detection of delayed post-traumatic vertebral collapse.

흉요추부 굴곡-신연 손상에서 척추체의 골절 양상

고영도,김종오,윤여헌,유재두,정준모 대한골절학회 2003 대한골절학회지 Vol.16 No.2

목적 : 흉요추부 굴곡-신연 손상에 동반되는 척추체의 골절 양상을 알아 보고자 하였다. 대상 및 방법 : 흉요추부 굴곡 - 신연 손상 21례의 방사선 검사를 검토하여 골절된 척추체의 위치, 전후방 추체 높이, 손상된 분절의 후만각, 척추체 골편의 척추관내 침범 정도 및 척추체의 분쇄 정도를 관찰하였다. 결과 : 총 21례 중 압박 골절이 11례, 방출성 골절이 9례 있었다. 척추체 골절은 85%에서 굴곡-신연 손상된 분절내에서 하부 척추체에 위치하였다. 전방 추체 높이는 평균 27% 감소하였고, 압박 골절이 동반된 경우 18%, 방출성 골절이 동반된 경우 40% 감소하였다. 후방 추체 높이는 평균 1% 감소하였고, 압박 골절이 동반된 경우 1% 증가하였으며, 방출성 골절이 동반된 경우 4% 감소하였다. 손상된 분절의 후만각은 평균 19.5도이었고, 압박 골절이 동반된 경우는 15.4도, 방출성 골절이 동반된 경우는 26.8도이었다. 방출성 골절이 동반된 9례 중 골편의 척추관내 침범은 평균 27%이었으며, 척추체의 분쇄 정도는 71.4%에서 경미하였다, 결론 : 흉요추부 굴곡-신연 손상에서 척추세의 골절은 매우 흔하며 분절내 하부 척추체에 호발하였다. 가해진 힘에 비하여 전후방 추체 높이의 감소, 척추관내 침범 및 분쇄 정도가 적었으며, 이는 굴곡력이나 축성 부하의 효과가 신연력에 의해 일부 상쇄되었기 때문이다. Purpose : To evaluate the configuration of vertebral body fractures in flexion-distraction injuries of thoracolumbar spine. Materials and Method : We investigated the location of fractures, anterior or posterior vertebral body height, kyphotic angle of injured segments, canal encreachment and severity of comminution on radiologic examinations of 21 cases. Result : There were 11 compression fractures and 9 burst fractures. 85% of fractures were located in the inferior vertebrae of injured segments. Anterior vertebral height decreased by 27% on average with decrease of 18% in compression fractures and 40% in burst fractures. Posterior height decreased by 1% on average with increase of 1% in compression fractures and decrease of 4% in burst fractures. The average kyphotic angle of injured segments was 19.5˚ with 15.4˚ in compression fractures and 26.8˚ in burst fractures. The canal encreachment in 9 burst fractures was 27% on average, and the comminution of vertebral body was mild in 74%. Conclusion : The fracture of vertebral body in flexion-distraction injuries of thoracolumbar spine was very common, and located on the inferior vertebare of injured segment. The decrease of vertebral height, canal encreachment and severity of comminution was relatively less than the estimated from mechanism of injury, with offset effect of distraction force.

골다공증성 척추 압박 골절 환자에서 새로운 척추 골절 발생의 위험 인자

유성림,고영도,최신우 대한척추외과학회 2017 대한척추외과학회지 Vol.24 No.4

Study Design: A retrospective study. Objectives: To investigate the risk factors associated with new compression fractures in patients with osteoporotic vertebral compression fractures. Summary of Literature Review: Previous studies have reported that a history of osteoporotic vertebral fractures and decreased bone mineral density were risk factors for new compression fractures. It is not certain whether vertebroplasty is a risk factor for new compression vertebral fractures. Materials and Methods: This retrospective study included a total of 52 patients who were diagnosed with an osteoporotic vertebral compression fracture and could be followed up for at least 1 year. Age, sex, bone mineral density, body mass index, osteoporosis treatment, fat infiltration of the back muscles, the sagittal index, vertebroplasty, and underlying diabetes mellitus or hypertension were compared between patients who developed new compression fractures during 1 year of follow-up and those who did not. For statistical analysis, the t-test and chi-squ are test were used to analyz ethe relationship of each factor with osteoporotic vertebral compression fracture incidence, and multiple logistic regression analysis was performed to analyze multifactorial explanatory factors. Results: No significant differences were found between the 2 groups regarding sex, underlying disease, the sagittal index, and fat infiltration of the back muscles. Patients who developed a new compression fracture were significantly older (p=0.011), had a lower body mass index (p=0.001), had lower bone mineral density (p=0.008), and were more likely to have taken osteoporosis medication for less than 6 months (including no medication, p=0.019). The logistic regression analysis showed that the risk of developing new compression fractures was significantly elevated in patients with a low body mass index (odds ratio [OR]=0.69, p=0.02), bone mineral density (OR=0.43, p=0.005), and less than 6 months of osteoporosis medication use (including no medication, OR=1.083, p=0.041). Conclusions: The risk of developing new compression fractures in patients with osteoporotic vertebral compression fractures was associated with body mass index, bone mineral density, and having taken osteoporosis medication for less than 6 months. 연구 계획: 골다공증성 척추 골절 환자에 대해 보조기를 이용하여 보존적으로 치료 후 추시 결과에 대한 후향적 연구이다. 목적: 골다공증성 척추 골절 환자에서 재골절 발생의 위험인자를 알아보고자 한다. 선행 문헌의 요약: 이전에 골다공증성 척추 골절이 진단된 경우, 낮은 골밀도(BMD)는 재골절 위험을 높인다는 연구 결과가 있으며, 척추 성형술이 재골절의 위험 인자인지에 대해서는 논란이 있다. 대상 및 방법: 본원에서 골다공증성 척추 골절 진단받고 최소 1년 이상 추시 가능했던 환자 52명을 대상으로 후향적 연구를 진행하였다. 골다공증성 척추 골절 진단 후 추시에서 일년 이내에 재골절이 있었던 군과 재골절이 발생하지 않은 군간의 연령, 성별, 체질량지수(BMI), 골밀도(BMD), 고혈압, 당뇨병과 같은 기저질환 유무, 후방 신전근 위축정도, 척추 성형술 시행 여부, 골다공증 치료 여부, 시상 지수(sagittal index)를 비교하였다. 두 군 사이에 위에서제시한 요소들을 분석하기 위해 독립 표본 T-test, Chi-square test를 이용하여 검증하였다. 또한, 나이 및 성별을 보정한 후 각 요소들을 분석하기 위해 로지스틱 회귀분석을 하였다. 결과: 평균 연령은 재골절이 발생한 군은 81.3세로, 재골절이 발생하지 않은 군의 74세보다 높았으며, 이는 통계적으로 유의하였다(p=0.011). 재골절이발생한 군은 골밀도(BMD)가 T-score -4.23, 체질량지수(BMI)는 21.05 kg/m2였고, 재골절이 발생하지 않은 군은 골밀도(BMD)가 T-score -3.28, 체질량지수(BMI)는 24.13 kg/m2 였으며, 이는 모두 통계적으로 유의한 차이가 있었다(p=0.008, p=0.001). 또한, 골다공증 약물 치료를 받지 않거나 6개월 미만으로 치료받은 군은 6개월 이상 치료받은 군에 비해 통계적으로 유의하게 재골절이 많았다(p=0.019). 성별과 연령을 보정한 로지스틱 회귀분석에서는 골밀도(BMD) 및 체질량지수(BMI)의 odds ratio 는 각각 0.43, 0.69였고, 이는 모두 통계적으로 유의하였다(p=0.005, p=0.02). 6개월을 기준으로 한 골다공증 약물 치료 여부의 odds ratio 는 1.083 이었고, 이는 통계적으로 유의하였다(p=0.041). 결론: 골다공증성 척추 골절 환자에서 고령, 낮은 골밀도(BMD) 및 체질량지수(BMI), 6개월 미만의 약물 치료는 재골절의 가능성이 높으므로 보다 세심한추시 관찰이 필요하다. 약칭 제목: 척추 재골절 발생의 위험 인자

골다공증 척추 골절에서 전방 감압술 및 기기 이용 전방 유합술

하기용,류승준,윤형문 대한척추외과학회 2003 대한척추외과학회지 Vol.10 No.3

골다공증 척추골절에서 흉요추 시상균형의 지표로서 제 1요추 경사

이상민,박지훈,장영재,심승우,백성년,최용수 대한척추외과학회 2020 대한척추외과학회지 Vol.27 No.3

Study Design: Feasibility study. Objectives: To evaluate the association between L1 slope and thoracolumbar spinal parameters of sagittal balance in cases of osteoporotic vertebral fracture. Summary of Literature Review: Recently, interest has emerged in the sagittal parameters of the thoracolumbar spine in cases of osteoporotic vertebral fracture. Materials and Methods: Eighty-five patients were enrolled in this study, including 36 patients with recent osteoporotic vertebral fractures (group 1) and 49 patients who did not have vertebral fractures (group 2). Radiographic parameters including L1 slope, C7 plumb line (C7 PL), sagittal imbalance (C7 PL >50 mm), lumbar lordosis, thoracic kyphosis, pelvic tilt, S1 slope, local kyphotic angle were evaluated on standing lateral radiographs of the whole spine. We analyzed correlations between L1 slope and these parameters. Results: Of the sagittal parameters of the spine, the mean L1 slope, C7 PL, thoracic kyphosis, lumbar lordosis, S1 slope, pelvic tilt, and local kyphotic angle were 10.43°, 92.43 mm, 29.30°, 30.31°, 25.27°, 27.27°, 9.90° in group 1 and 9.41°, 68.50 mm, 20.09°, 23.25°, 22.03°, 31.43°, 8.21° in group 2, respectively. There were significant differences in thoracic kyphosis (p=0.01) and lumbar lordosis (p=0.04) between the two groups. L1 slope was positively correlated with thoracic kyphosis (r=0.46, p=0.01), lumbar lordosis (r=0.51, p=0.01), and local kyphotic angle (r=0.29, p=0.04) in group 1. Conclusions: These results suggest that L1 slope is a central indicator for the evaluation of thoracolumbar sagittal balance in osteoporotic vertebral fractures. 연구 계획: 타당성조사목적: 골다공증 척추골절에서 제 1요추경사와 흉요추의 시상균형지표와 관련성을 평가하고자 하였다. 선행 연구문헌의 요약: 최근 골다공증 척추골절에서 흉요추의 시상균형지표에 대한 관심이 증가하고 있다. 대상 및 방법: 골다공증 척추골절이 발생한 36명의 환자(그룹 1), 척추골절이 발생하지 않았던 49명의 환자(그룹 2), 총 85명의 환자를 연구대상으로 하였다. 척추전장기립측면 단순방사선검사에서 방사선지표로 제 1요추경사, 제 7경추수선, 시상불안정성(제 7경추수선>50 mm), 요추전만각, 흉추후만각, 골반기울기, 천추경사, 국소후만각을 측정하였고, 제1 요추경사와 방사선지표들의 상관관계를 분석하였다. 결과: 척추의 방사선지표인 제 1요추경사, 제 7경추수선, 흉추후만각, 요추전만각, 천추경사, 골반기울기, 국소후만각이 그룹 1에서 10.43도, 92.43 mm, 29.30도, 30.31도, 25.27도, 27.27도, 9.90도, 그룹 2에서 9.41도, 68.50 mm, 20.09도, 23.25도, 22.03도, 31.43 도, 8.21도로 각각 확인되었다. 양 군간의 흉추후만각(p=0.01), 요추전만각(p=0.04)에서 통계학적으로 유의한 차이를 보였다. 제 1요추경사는 흉추후만각(r=0.46, p=0.01), 요추전만각(r=0.51, p=0.01), 국소후만각(r=0.29, p=0.04)과 양의 상관관계를 보였다. 결론: 제 1요추경사는 골다공증 척추골절환자에서 흉요추의 시상균형을 평가하는 지표의하나로 사용될 수 있으리라 사료된다. 약칭 제목: 흉요추 시상균형으로 제 1요추경사

골다공증성 척추 압박골절의 보존적 치료 시압박률 증가 양상 및 관련 인자

고영도 ( Young Do Koh ),박정수 ( Jeong Soo Park ) 대한골절학회 2015 대한골절학회지 Vol.28 No.2

Purpose: The purpose of this study is to determine the ideal period of brace application for thoracolumbar (T10-L2) osteoporotic vertebral compression fracture (OVCF) based on the progression of the vertebral compression with passage of time and to evaluate the factors associated with progression of thoracolumbar OVCF, when treated conservatively. Materials and Methods: This retrospective study included a total of 46 patients who were diagnosed with thoracolumbar OVCF and could be followed-up for at least 6 months. In this study, the increase of compression rate and the mean slope of compression rate per weeks were compared between two periods (from diagnosed date to 8 weeks and from 8 weeks to 6 months), as the standard point. Age, bone mineral density (BMD), osteoporosis treatment after injury, diabetes mellitus (DM) as underlying disease were also compared between two groups (setting up 15% as standard point of increase of compression rate, <15% and ≥15%). Statistical analyses were performed using the paired t-test to assess the increase of compression rate and using the linear mixed model to assess the mean slope change. The relationships between the factors and progression of compression were analyzed using t-test, chi-square test, and logistic regression analysis. Results: The increase of compression rate was 13.03% and 1.97% in each period and the difference between those two periods was 11.06% (p=0.00). At 8 weeks of follow-up, the mean slope was reduced by 1.12 (p=0.00). No statistically significant difference in related factors was observed between two groups. Conclusion: Considering the increase of compression rate with passage of time, brace should be applied strictly for an initial 8 weeks. And age, BMD, osteoporosis treatment after injury, and DM as underlying disease are not predictors of progression of compression in vertebral fractures.

흉요추골절의 단분절 후방유합술시 골절추체부 나사못 고정 유무에 따른 교정각 소실의 비교

민학진,김근우,김용훈,윤의성,황준성 대한척추외과학회 2002 대한척추외과학회지 Vol.9 No.1

흉요추부 불안정성 방출성 골절, 굴곡-신연 손상에서 관혈적후방 고정 및 유합술과 경피적 척추경 나사못 고정술 비교

한진영,권기연 대한골절학회 2020 대한골절학회지 Vol.33 No.1

Purpose: This study compared the clinical and radiological results between two groups of patients with percutaneous fixation or conventional fixation after hardware removal. Materials and Methods: The study analyzed 68 patients (43 open fixation and 43 percutaneous screw fixation [PSF] 25) who had undergone fixation for unstable thoracolumbar fractures. The radiologic results were obtained using the lateral radiographs taken before and after the fixation and at the time of hardware removal. The clinical results included the time of operation, blood loss, time to ambulation, duration of the hospital stay and the visual analogue scale. Results: The percutaneous pedicle screw fixation (PPSF) group showed better results than did the conventional posterior fixation (CPF) group (p<0.05) in regard to the perioperative data such as operation time, blood loss, and duration of the hospital stay. There were no significant differences in wedge angle, local kyphotic angle, and the ΔKyphotic angle on the postoperative plane radiographs between the two groups (p>0.05). There were no significant differences in the wedge angle and local kyphotic angle after implant removal (p>0.05) between the two groups as well. However, there were significant differences in the segmental montion angle (p<0.001), and the PPSF group showed a larger segmental motion angle than did the CPF group (CPF 1.7°±1.2° vs PPSF 5.9°±3.2°, respectively). Conclusion: For the treatment of unstable thoracolumbar fractures, the PPSF technique could achieve better clinical results and an improved segmental motion angle after implant removal within a year than that of the conventional fixation method. 목적: 흉요추부 불안정성 골절에서 경피적 척추경 나사못 고정술과 고식적 방법으로 수술한 두 군을 영상의학적, 임상적으로 비교 분석하고자 한다. 대상 및 방법: 흉요추부의 불안정성 골절로 관혈적 후방 고정술 및 유합술(43명), 경피적 척추경 나사못 고정술(25명) 을 시행한 환자에서 고정술 전후, 기기 제거술 전후의 흉요추부 측면 방사선 사진을 촬영하여 영상의학적 결과를 비교하였다. 임상적 결과로는 수술시간, 출혈량, 자가 보행까지 시간, 입원기간, 수술 후 VAS를 비교하였다. 결과: 고정술 당시의 수술시간, 출혈량, 입원기간, 자가 보행시기 등의 결과는 경피적 척추경 나사못 고정술(PPSF)군에서 더 좋은 결과를 보였다(p<0.05). 단순 방사선 사진상에서설상각의 변화, 전방 추체 높이의 변화는 고식적인 관혈적 후방 고정술 및 유합술(CPF)군이 더 좋았다. 기기 제거술 후 3 개월에 시행한 KODI는 두 군 간의 차이가 없었다. 제거술 후국소 후만의 변화 및 분절 운동각(CPF 1.7°±1.2° vs PPSF 5.9°±3.2°)은 PPSF군이 더 좋은 결과를 보였다. 결론: 우리는 흉요추부 불안정성 골절에서 경피적 고정술식이 고전적 방법에 비해 임상적으로 좋으며, 1년 이내 기기 제거술 시행 시 고정분절의 운동성이 보다 향상된 것을 확인하였다.

Unilateral Posterior Surgery for Severe Osteoporotic Vertebrae Fractures’ Sequelae in Geriatric Population: Minimum 5-Year Results of 109 Patients

Tuna Pehlivanoglu,Yigit Erdag,Ismail Oltulu,Umut Dogu Akturk,Emre Korkmaz,Kerem Yildirim,Ender Sarioglu,Kerem Gun,Ender Ofluoglu,Mehmet Aydogan 대한척추신경외과학회 2021 Neurospine Vol.18 No.2

Objective: This study aimed to evaluate the efficacy and safety of modified posterior vertebral column resection (PVCR) combined with anterior column restoration in elderly patients presenting with thoracic or thoracolumbar osteoporotic fractures with spinal cord compression and severe pain. Methods: One hundred nine patients with one level thoracolumbar osteoporotic fracture and at least 5 years of follow-up were included. They underwent posterior instrumentation performed with polymethymetachrylate augmented pedicle screws. A modified PVCR (unilateral costotransversectomy+hemilaminectomy) combined with the insertion of an expandable titanium cage for anterior column restoration was undertaken. Patients were evaluated clinically and radiographically. Results: Patients had a mean age of 74.1 and a follow-up duration of 92.3 months. Mean duration of operations, hospital stays, and mean loss of blood were 172.3 minutes, 4.3 days, and 205.4 mL. All of the patients were mobilized immediately after surgery. The mean preoperative local kyphosis angle improved from 39.3° to 4.7° at the last follow-up (p=0.003). Patients preoperative mean visual analogue score, Japanese Orthopaedic Association, and Oswestry Disability Index scores improved from 7.7/8.6/76.3 to 1.6/26.1/17.4 (p<0.001 for all), respectively. The average 36-item Short-Form survey physical component summary/mental component summary scores at the last follow-up were 55.1/56.8. A dural tear was detected intraoperatively in 1 patient and repaired immediately. Conclusion: Subtotal PVCR combined with the insertion of an expandable titanium cage was detected as a safe and effective method for osteoporotic vertebrae fractures’ sequelae in the older population involving spinal cord compression by enabling the decompression of the spinal canal and reconstruction of the resected segment, resulting in significant improvement in clinical and radiographic outcomes.

Analysis of Factors Related to Neurological Deficit in Thoracolumbar Fractures

Chung, Joon-Ho,Yoon, Seung-Hwan,Park, Hyung-Chun,Park, Chong-Oon,Kim, Eun-Young,Ha, Yoon The Korean Neurosurgical Society 2007 Journal of Korean neurosurgical society Vol.41 No.1

Objective : The purpose of this study is to determine the factors that have effects on the neurological deficit in the patients with thoracolumbar fracture. Methods : Forty-eight patients were included. Cause of injury, type of injury, time interval, combined injury, kyphotic angle, spinal canal compromise, sagittal diameter, the most narrow sagittal diameter, transverse diameter, the most narrow transverse diameter, and remained height of vertebra body were concerned as the factors. The patients with American Spinal Injury Association[ASIA] impairment scale grade A to D were considered as having neurology while others with ASIA grade E were considered to be without neurology. The patients with ASIA grade A were classified to paraplegia group and the patients with ASIA grade B to E were not thought to be paraplegia. Statistical analysis for these groups were performed. Results : Spinal canal compromise [P<0.001] have correlation with neurological deficit. The most narrow sagittal diameter was smaller in the group with deficit than that in the group without deficit [P<0.004]. Also, combined injury have correlation with neurology [P=0.028]. Spinal canal compromise [P<0.001], sagittal diameter [P=0.032], the most narrow sagittal diameter [P=0.025], and Denis type [P<0.001] also have correlation with paraplegia. Conclusion : The factors of percentage of spinal canal compromise, the most narrow sagittal diameter, and combined injury are predictive of neurological deficit. The patients with paraplegia may be predicted by the factors such as type of injury, spinal canal compromise, sagittal diameter, the most narrow sagittal diameter, and Denis type.