STUDY DESIGN: Retrospective study OBJECTIVE: To analyze the treatment results of vertebroplasty in patients who suffered osteoporotic compression fractures during conservative treatments for pre-existing degenerative lumbar disease. SUMMARY AND LITERATURE REVIEW: Whilst spinal fusion has shown satisfactory clinical results, solid fusion has been reported to accelerate the degenerative changes at the unfused adjacent levels. Therefore, the level of spinal fusion in patients with compression fractures and pre-existing degenerative lumbar disease is controversial. Few studies have evaluated the outcomes of spinal fusion and adjacent segment vertebroplasty. MATERIALS AND METHODS: A retrospective review was carried out on 28 patients who suffered the osteoporotic compression fractures during conservative treatment for pre-existing degenerative lumbar disease. Posterolateral fusion and vertebroplasty were performed for degenerative disease and compression fractures. The average fusion level was 1.82. The mean compressed vertebral bodies were 1.68. The radiology results were evaluated to determine the progression of the compression rate and fractures in the adjacent segment. The clinical results were evaluated using the Denis pain scale for compression fractures and Katz satisfaction scale for degenerative lumbar disease. RESULTS: The average compression rate was 30.2% preoperatively, 21.4% postoperatively, and 24.6% at the final follow-up. There was no fracture in the adjacent segment. Clinically, the preoperative Denis score was P3 and P4 in 8 and 20 patients, respectively. On the other hand, the postoperative Denis score was P1, P2 and P3 in 8, 19 and 1 patients, respectively. In regard to degenerative diseases, the overall satisfaction was 82.1%. CONCLUSION: The stability of fracture sites in vertebroplasty of patients with pre-existing lumbar disease was confirmed. However, further compression of the fractured vertebral body was observed after vertebroplasty in long fusion. Therefore, a followup study of more cases will be necessary to confirm the changes in the vertebroplasty site.
Follow-Up Studies ; Fractures, Compression ; Hand ; Humans ; Retrospective Studies ; Spinal Fusion ; Vertebroplasty

PURPOSE: Evaluate the effects of sagittal imbalance on the clinical outcomes in thoracolumbar burst fractures. MATERIALS AND METHODS: We evaluated 11 patients who had received posterior fixation for unstable burst fractures. Radiologic assessment including the compression ratio, focal kyphotic angle and sagittal balance were obtained. The clinical outcomes were assessed by ODI, VAS and SF-36. We subdivided the patients into sagittal balance and imbalance group, and compared with clinical outcomes. The relationship between radiologic and clinical outcomes was examined using correlation analysis. RESULTS: The radiologic assessment were changed on preoperative and postoperative as follows: mean compression ratio: 15.2%, 4.9%, mean focal kyphotic angle: 43.2degrees, 20.9degrees. The mean sagittal balance was 11.5 cm. The mean score of VAS, ODI, Physical and Mental Component Summary of SF-36 were 3.7, 45.8, 43.3 and 39.8, respectively. The ODI was significantly higher in sagittal imbalance group, and SF-36 was significantly higher in sagittal balance group (p<0.05). The VAS was correlated with compression ratio and focal kyphotic angle. The ODI and Mental Component Summary of SF-36 were correlated with sagittal imbalance. CONCLUSION: Sagittal balance effects on the functions of spine, surgical treatment should be carefully considered with unstable burst fractures.
Humans ; Spine

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.
Aged ; Aged, 80 and over ; Bone Density Conservation Agents/*therapeutic use ; Diphosphonates/*therapeutic use ; Female ; Humans ; Imidazoles/*therapeutic use ; Lumbar Vertebrae/drug effects/pathology/radiography/surgery ; Male ; Middle Aged ; Osteoporosis/drug therapy ; Pain Measurement ; Pain, Postoperative ; Quality of Life ; Retrospective Studies ; Spinal Fusion/adverse effects/*methods ; Spinal Stenosis/pathology/radiography/*surgery ; Treatment Outcome

Placing instrumentation into the ilium has been shown to increase the biomechanical stability and the fusion rates, but it has some disadvantages. The diagonal S2 screw technique is an attractive surgical procedure for degenerative lumbar deformity. Between 2008 and 2010, we carried out long fusion across the lumbosacral junction in 13 patients with a degenerative lumbar deformity using the diagonal S2 screws. In 12 of these 13 patients, the lumbosacral fusion was graded as solid fusion with obvious bridging bone (92%). One patient had a rod dislodge at one S2 screw and breakage of one S1 screw and underwent revision nine months postoperatively. So, we present alternative method of lumbopelvic fixation for long fusion in degenerative lumbar deformity using diagonal S2 screw instead of iliac screw.
Aged ; *Bone Screws ; Cohort Studies ; Female ; Humans ; Ilium/surgery ; Lumbar Vertebrae/*abnormalities/*surgery ; Male ; Middle Aged ; Sacrum/surgery ; Spinal Fusion/adverse effects/*instrumentation/methods ; Treatment Outcome

A paraspinal foreign body reaction is a rare condition that can cause severe neurological complications or death. However, the condition is often neglected. The authors report a case of a paraspinal textiloma that was diagnosed and treated with a surgical excision.
Foreign-Body Reaction ; Granuloma, Foreign-Body

Abscesses of the epidural and subdural spine are relatively rare, but can rapidly progress and cause paraplegia; the mortality rate is high despite improvements in treatment method. In particular, the reoccurrence of subdural abscesses after treatment of an epidural abscess is extremely rare. We experienced a case in which the subdural abscess reoccurred after spinal decompression and drainage of an epidural abscess combined with a dural tear. We report this rare case with a review of the relevant literatures.
Abscess ; Decompression ; Drainage ; Epidural Abscess ; Humans ; Spine

OBJECTIVES: We investigated drug adherence of once yearly intravenous bisphosphonate in patients with osteoporosis or osteoporotic fractures, and factors that influence their adherence. MATERIALS AND METHODS: Patients treated with once yearly intravenous bisphosphonate were asked about drug information and drug adherence using questionnaires. Factors related drug adherence were analyzed between non adherence group and adherence group. RESULTS: 65 patients (49.6%) were adherence group, 66 patients (50.3%) were included in non-adherence group. In group 1, were administered mainly due to 'after physicians suggestion' in 22 cases (36.1%) and 'for ease of administration' in 17 cases (27.9%). In group 2, the patients were not readministered mainly due to economic reasons in 21 cases (42%), unconcerning to osteoporosis in 14 cases (28%). CONCLUSIONS: This study shows 'doctor's suggestion' and 'ease of administration' could enhance drug adherence.
Diphosphonates ; Humans ; Imidazoles ; Osteoporosis ; Osteoporotic Fractures ; Surveys and Questionnaires

Recently, vertebroplasy has been widely used to treat osteoporotic vertebral compression fractures in the elderly. Outstanding results such as immediate pain relief and functional improvement have been achieved using vertebroplasty. However, some elderly patients suffer from multiple osteoporotic compression fractures due to severe osteoporosis. Although treating single- or 2-level osteoporotic spinal compression fractures using vertebroplasty has shown some significant curative effects and results, few reports are available in the management of multiple-level compression fractures. The purpose of this study is to report the cases that brought good clinical results using vertebroplasty to multiple osteoporotic compression fractures, including a review of the relevant literatures.
Aged ; Fractures, Compression ; Humans ; Osteoporosis ; Vertebroplasty

OBJECTIVE: Rheumatoid arthritis (RA) is a chronic inflammatory disease, mainly involving joints and bones. Sauchinone is an anti-inflammatory agent isolated from Saururus chinensis, which was used in oriental medicine. The aim of this study was to evaluate the therapeutic effect of sauchinone on inflammatory arthritis and underlying mechanism of anti-arthritic effect. METHODS: Mice with collagen induced arthritis (CIA) was intraperitoneally injected with sauchinone (20 mg/kg) or vehicle. The clinical and histological evaluations were performed with arthritis scoring and hematoxylin-eosin staining, respectively. CD4+ interleukin (IL) 17+ T cells were determined under Th17 skewing condition treated with sauchinone. To evaluate the effect of sauchinone on osteoclastogenesis, mice bone marrow macrophages (BMMs) and human peripheral blood mononuclear cells (PBMCs) were cultured with macrophage-colony stimulating factor and receptor activator of nuclear factor-κB ligand in the absence or presence of sauchinone. RESULTS: Sauchinone significantly attenuated the inflammatory arthritis in CIA mice both clinically and histologically. The proportion of Th17 cells were decreased with treatment with sauchinone in vivo and in vitro. The expressions of Th17 cell markers (IL-17 and retinoic acid receptor-related orphan receptor gamma t) and B cell markers (activation-induced cytidine deaminase) were downregulated in the presence of sauchinone. Sauchinone also suppressed the formation of tartrate-resistant acid phosphatase positive cells from mice BMMs and human PBMCs, and the expression of osteoclastogenic markers. CONCLUSION: Sauchinone alleviates inflammatory arthritis in mice through inhibition of Th17 differentiation and osteoclastogenesis. Sauchinone, one of traditional herbal medicine, could be a therapeutic candidate for the treatment of RA.
Acid Phosphatase ; Animals ; Arthritis* ; Arthritis, Rheumatoid ; Bone Marrow ; Child ; Child, Orphaned ; Collagen ; Cytidine ; Herbal Medicine ; Humans ; In Vitro Techniques ; Interleukins ; Joints ; Macrophages ; Medicine, East Asian Traditional ; Mice* ; Saururaceae ; T-Lymphocytes ; Th17 Cells ; Tretinoin

OBJECTIVE: Methotrexate is the first-line drug in treatment of rheumatoid arthritis (RA) exhibiting higher efficacy and better tolerability than most other DMARDs. To have a better understanding of the anti-arthritic mechanism of methotrexate, we investigated the effect of methotrexate on suppressing the autoimmune inflammatory and destructive arthritis in collagen-induced arthritis (CIA) mice. METHODS: The effects of methotrexate on joint inflammation were assessed by clinical scoring and histologic analysis. Levels of cytokines and autoreactive antibodies were analyzed by immunohistochemistry and ELISA. The population of TH17 and Foxp3+ regulatory T (Treg) cells and phosphorylation of their critical transcription activators, STAT3 and STAT5, were examined by fluorescence microscopy and flow cytometry, respectively. RESULTS: Treatment with methotrexate significantly alleviated joint inflammation and cartilage destruction in CIA. Serum levels of total immunoglobulins G, G1, G2a specific to type II collagen were also reduced considerably in methotrexate-treated mice. The drug inhibited the expression of proinflammatory cytokines such as IL-1beta, TNF-alpha, IL-6 and IL-17 in arthritic joints ex vivo as well as by splenocytes in vitro. Moreover, methotrexate treatment resulted in reciprocal modulation of TH17 cells and Foxp3+ regulatory T (Treg) cells in spleen tissues, in which TH17 cells were decreased and Treg cells in number were increased. Subsequent analysis of CD4+T cells showed that phosphorylation of STAT3 was decreased whereas phosphorylation of STAT5 was increased in methotrexate-treated mice. CONCLUSION: Methotrexate treatment effectively suppressed autoimmune arthritis and restored homeostasis of the immune system by reciprocal regulation of TH17 and Treg cells in a mouse model of collagen-induced arthritis.
Animals ; Antibodies ; Antirheumatic Agents ; Arthritis ; Arthritis, Experimental ; Arthritis, Rheumatoid ; Cartilage ; Collagen Type II ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Flow Cytometry ; Homeostasis ; Immune System ; Immunoglobulins ; Immunohistochemistry ; Inflammation ; Interleukin-17 ; Interleukin-6 ; Joints ; Methotrexate ; Mice ; Microscopy, Fluorescence ; Phosphorylation ; Spleen ; T-Lymphocytes, Regulatory ; Th17 Cells ; Tumor Necrosis Factor-alpha