STUDY DESIGN: Retrospective study. PURPOSE: To assess the feasibility and limitations of fracture risk assessment tool (FRAX) for osteoporotic vertebral fractures in the Korean population. OVERVIEW OF LITERATURE: The FRAX algorithm is country specific and uses clinical risk factor data to calculate an individual patient's 10-year probability of hip fracture and 10-year probability of major osteoporotic fracture. However, it has not been adequately investigated for Korean. METHODS: One hundred ninety four patients who had all risk factor data for the calculation of FRAX were divided into two groups depending on the existence of vertebral fractures: the fracture group was comprised of 88 patients and the non-facture group comprised of 105 patients. We analyzed prediction of the fracture by applying respectively the Korean, Japanese, USA and UK model, and compared their FRAX results by calculating lumbar bone mineral density (BMD) instead of femoral neck BMD. RESULTS: The prediction of vertebral fracture using FRAX was 10.9 +/- 6.2% in the fracture group, 9.5 +/- 5.5% of the non-fracture group in the Korean model (p = 0.108); 17.9 +/- 10.2% in the fracture group, 14.6 +/- 9.0% in the non-fracture group in the Japanese model (p = 0.017). Only the Japanese model exhibited significant difference in vertebral fracture risk. The prediction of vertebral fracture using lumbar BMD instead of femoral neck BMD was 19.5 +/- 12.1% in the fracture group, 16.0 +/- 10.3% in the non-fracture group in the Korean model (p = 0.029). All models had statistically significant differences for the prediction of osteoporotic vertebral fracture. CONCLUSIONS: The 10-year probability of osteoporotic vertebral fracture had underestimation of the risk considering treatment eligibility based on the National Osteoporosis Foundation guidelines. BMD that accurately reflects the contribution of each result to fracture risk should be preferred for the prediction of fracture using FRAX, when lumbar spine and hip BMD measurements are both performed for clinical purposes in Korean.
Asian Continental Ancestry Group ; Bone Density ; Femur Neck ; Hip ; Humans ; Korea ; Osteoporosis ; Osteoporotic Fractures ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Spine

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 +/- 15.1degrees, compared to 20.3 +/- 12.3degrees after surgery and 19.8 +/- 15.2degrees 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.
Discitis ; Early Ambulation ; Follow-Up Studies ; Humans ; Imidazoles ; Nitro Compounds ; Retrospective Studies ; Spine ; Transplantation, Homologous ; Transplants

STUDY DESIGN: This was designed as a retrospective study. PURPOSE: We assessed the radiographic and clinical outcome of patients who underwent percutaneous vertebroplasty (PVP) in osteoporotic compression fractures with a minimum of 5 years follow-up. OVERVIEW OF LITERATURE: Percutaneous vertebroplasty is effective surgical method for treating osteoporotic compression fracture. METHODS: Between January 2000 and August 2005, 159 patients were treated with PVP for osteoporotic compression fracture at our department; 43 patients died during follow-up, and 69 patients (121 vertebras) were available for follow-up for over 5 years. We analyzed the clinical and radiologic outcome including cement feature. RESULTS: The mean follow-up period was 5.7 years. Clinical outcome by mean visual analogue scale (VAS) score revealed a decreased 4.9 points perioperatively. A decreased score was maintained over 5 years in 46% of patients. A new adjacent vertebral fracture was documented by 33 vertebral bodies in 22 patients. During the follow-up period, 43 patients (38%) in 112 patients died. Anterior body heig ht in the last follow-up was improved about 0.3 mm compared with the preprocedural value, but was not statistically significant. Also, the focal kyphotic angle was reduced from 12.3degrees at the preprocedural state to 11.7degrees at the postprocedural state, but was not statistically significant (p > 0.05). CONCLUSIONS: PVP for osteoporotic compression fracture is an efficient procedure for pain relief by long term follow-up. The cement injected vertebrae showed stable radiologic progression without significant changes in vertebral height or kyphotic angle.
Follow-Up Studies ; Fractures, Compression ; Humans ; Retrospective Studies ; Spine ; Vertebroplasty

STUDY DESIGN: Prospective, randomized, controlled human study. PURPOSE: We checked the proportion of missed syrinx diagnoses among the examinees of the Korean military conscription. OVERVIEW OF LITERATURE: A syrinx is a fluid-filled cavity within the spinal cord or brain stem and causes various neurological symptoms. A syrinx could easily be diagnosed by magnetic resonance image (MRI), but missed diagnoses seldom occur. METHODS: In this study, we reviewed 103 cases using cervical images, cervical MRI, or whole spine sagittal MRI, and syrinxes was observed in 18 of these cases. A review of medical certificates or interviews was conducted, and the proportion of syrinx diagnoses was calculated. RESULTS: The proportion of syrinx diagnoses was about 66.7% (12 cases among 18). Missed diagnoses were not the result of the length of the syrinx, but due to the type of image used for the initial diagnosis. CONCLUSIONS: The missed diagnosis proportion of the syrinx is relatively high, therefore, a more careful imaging review is recommended.
Brain Stem ; Humans ; Korea ; Magnetic Resonance Spectroscopy ; Military Personnel ; Prospective Studies ; Spinal Cord ; Spine

Paroxetine is a selective serotonin reuptake inhibitor (SSRI) widely used for depression in brain damaged patients as it is known for its few affects on cognition or psychomotor function. Major side effects observed for paroxetine are vertigo, headache and tremor. It is reported that hyponatremia is also rarely observed. In 69 year-old male with left hemiplegia due to cerebral infarction had started taking 20 mg/day of paroxetine for depression. Next day the patient showed severe generalized weakness and decreased consciousness. Laboratory tests showed that serum sodium level was decreased to 102 mEq/L. Paroxetine administration was stopped and 3% sodium and oral furosemide were administered under the diagnosis of syndrome of inappropriate secretion of antidiuretic hormone (SIADH). We report a case of patient with severe hyponatremia due to SIADH within 2 days after use of paroxetine. This case emphasizes the need to monitor serum sodium level routinely at the initial treatment to prevent hyponatremia.
Brain ; Cerebral Infarction ; Cognition ; Consciousness ; Depression ; Furosemide ; Headache ; Hemiplegia ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Male ; Organothiophosphorus Compounds ; Paroxetine ; Serotonin ; Sodium ; Tremor ; Vertigo

We report a 77-year-old woman with bilateral pons infarction who presented with severe trismus, which was responsive to botulinum toxin-A injection. She was unable to open her mouth and showed anterior displacement of her temporo-mandibular (TM) joint on MRI findings. She was fed via nasogastric tube because of mouth opening limitation. There was no improvement of her mouth opening after range of motion exercise. She underwent closed reduction of the TM joints under general anesthesia but there was no significant improvement. Electromyography studies revealed continuous muscle activities on masseter and temporalis muscles during mouth opening. Botulinum toxin-A (Botox(R)) was injected into both the masseter and left temporalis muscles under ultrasonographic guidance. There was some improvement in mouth opening at post-injection 5 days. The inter-incisal distance improved gradually, and she could start oral feeding after 18 days. She could maintain an inter-incisal distance of 1.8 cm with favorable response during post-injection 4 months.
Aged ; Anesthesia, General ; Botulinum Toxins ; Displacement (Psychology) ; Electromyography ; Female ; Humans ; Infarction ; Joints ; Mouth ; Muscles ; Pons ; Range of Motion, Articular ; Trismus

OBJECTIVE: To investigate the training effects on balance and gait ability using balance control trainer combined with partial weight-bearing system in chronic hemiplegic stroke patients. METHOD: A prospective crossover clinical trial was designed. The subjects consisted of 16 chronic hemiplegic stroke patients. All patients had a stroke more than six months. In addition to conventional physical therapy (PT), 8 patients in group A were trained with the balance control trainer for 30 min/day, 5 day/week, for first 2 weeks and then received only conventional physical therapy for 2 weeks. The other 8 patients in group B received only conventional PT for first 2 weeks and then were trained with the balance control trainer for 30 min/day, 5 day/week, for next 2 weeks, with additional conventional PT. We evaluated with clinical tests including functional ambulation categories (FAC), Berg balance scale (BBS), 6 min walking distance (6mWT), timed up and go (TUG), Korean-modified barthel Index (K-MBI) and muscle strengthening of knee extensor (MMTknee) before training, 2 weeks and 4 weeks after training in those patients. RESULTS: After training, subjects in experimental period (2weeks period of conventional PT+Balance control trainer in group A&B) showed more improvement than those in control period (2 weeks period of only conventional PT in group A&B) in FAC, BBS, 6mWT, TUG, K-MBI (p<0.05). CONCLUSION: We think the balance control trainer combined with the partial weight-bearing system can be a useful tool for improving balance and gait ability in chronic hemiplegic stroke patients.
Gait ; Humans ; Knee ; Muscles ; Prospective Studies ; Stroke ; Walking ; Weight-Bearing

OBJECTIVE: The aim of this study was to evaluate the relationship between motor evoked potentials (MEPs) or somatosensory evoked potentials (SSEPs) and the recovery of function in acute or subacute stroke patients. METHOD: Twenty one hemiplegic stroke patients were examined with MEPs of extensor carpi radialis, abductor pollicis brevis, tibialis anterior and abductor hallucis and SSEPs of median and tibial nerves. A separate score was defined for upper and lower extremities within the Fugl-Meyer assessment and Korean-modified Barthel index. Motor performances were evaluated simultaneously with the evoked potential assessments and at 2 weeks after the first examination. RESULTS: The second motor function of upper extremity was significantly higher in patients with the presence of MEP or SSEP (p<0.05). The improvement of self care was correlated with the responsiveness in SSEP. Motor function of lower extremity was significantly associated with the responsiveness in MEP or SSEP (p>0.05). MEP in tibialis anterior or tibial SSEP were correlated with the mobility. CONCLUSION: MEP in tibialis anterior is useful in predicting in mobility after stroke. SSEP is predictive for activities in daily living after stroke.
Activities of Daily Living ; Evoked Potentials ; Evoked Potentials, Motor ; Evoked Potentials, Somatosensory ; Humans ; Lower Extremity ; Recovery of Function ; Self Care ; Stroke ; Tibial Nerve ; Upper Extremity

Approximately two thirds of stroke survivors have residual neurological deficits that persistently impair function. Hence, alternative strategies are needed to reduce the long-term disability and functional impairment from severe weakness of limbs. Generalization of treatment effect takes place when the effects of the therapy spread to a variety of related behaviors and similar movements. And the transfer effect that training of the limbs on one side of the body appeared to be shared by those on the other side simultaneously. The two concepts are closely linked together. These forms of learning are organized through a higher-level cerebral mechanism and can be associated corpus callosum. Several promising new rehabilitation approaches such as bilateral training are based on the transfer effect. The purpose of this review is to introduce transfer effect of treatment on motor learning after stroke.
Corpus Callosum ; Extremities ; Generalization (Psychology) ; Humans ; Hypogonadism ; Learning ; Mitochondrial Diseases ; Ophthalmoplegia ; Stroke ; Survivors

In stroke rehabilitation, risk factors, clinical course, and outcome of functional recovery can be different among age groups. In animal model of stroke, aged animals are more severely impaired behaviorally, and the functional recovery is delayed and reduced. Development of the glial scar and apoptosis is accelerated, and the timing of the cellular and genetic response is altered. The functional outcome is usually favorable in young adult patients, but it appears that the outcome of pediatric stroke is unfavorable. In most studies, the clinical symptoms are more severe, and functional recovery is poorer in elderly stroke patients. However, it is not clear whether or not the poor outcome is attributable to the old age per se. It is apparent that co-morbidity and risk factors also signficantly affect the outocme of stroke patients. Elderly stroke patients can achieve functional improvement through the rehabilitation program, if they were not disabled at the onset of stroke, and had few co-morbidities and risk factors. Physiatrists should be aware of those differences and can make a rehabilitatin plan that is appropriate for age of the patient.
Age Factors ; Aged ; Animals ; Apoptosis ; Cicatrix ; Humans ; Models, Animal ; Risk Factors ; Stroke ; Treatment Outcome ; Young Adult