PURPOSE To evaluate the differences of radiological outcomes of uniportal and biportal vertebroplasty in the point of bone cement distribution and leakage. MATERIALS AND METHODS A retrospective study reviewing the period between May 2002 and January 2006 investigated 100 vertebrae which underwent vertebroplasty and followed for more than three months by uniportal approach (55 vertebrae, group 1) and biportal approach (45 vertebrae, group 2). The operative time, the amount of bone cement injected, anterior vertebral height restoration, kyphotic angle, bone cement distribution, and bone cement leakage were evaluated. RESULTS The amount of injected bone cement of group 1 (3.9 cc) was statistically smaller than that of group 2 (5.1 cc) (p=0.016). There were no significant differences in the operative time, anterior vertebral height restoration, kyphotic angle in both groups. The rate of bone cement distribution over 8 zones was significantly higher in group 2 than in group 1 (p=0.014). However, the rate of bone cement distribution over 7 zones and the rate of bone cement distributed on whole anterior vertebral body were not significantly different in both groups. The cement leakage was not also significantly different in both groups. CONCLUSION Although the amount of injected bone cement was smaller in uniportal vertebroplasty, the radiological results and cement leakage were similar to biportal vertebroplasty. These findings suggest that uniportal vertebroplasty can be the operative options in osteoporotic vertebral fracture.
The purposes of this study are to make an operative treatment option of thoracolumbar burst fractures by the degree of initial kyphotic deformity or by the degree of initial loss of anterior vertebral height. We analyzed sixty-three cases of one segmental thoracolumbar bursting fractures treated surgically by posterior or posterolateral fusion with short segmental transpedicular screws fixation method using Diapason or CD from January, 1992 to October, 1996. Indications of operative treatment were that the degree of initial kyphotic deformity was above 15degreesor initial loss of anterior vertebral height was above 30%. Minimum follow-up period was 12 months and the results were as follows : 1. Entirely, mean kyphotic angle was 21.6degreesinitially, 11.3degreespostoperatively and 14.2degrees at the end of follow-up. Mean anterior vertebral height was 59.6% initially, 83.8% postoperatively and 80.8% at the end of follow-up. So 10.3degrees , 24.2% was corrected postoperatively and loss of correction was 2.9degrees , 3% at the end of follow-up. 2. In the respect of the degree of initial kyphotic deformity, when compared above 30degrees with below 30degrees , loss of correction was 7.3degrees , 1.4degrees at the end of follow-up respectively and this result had significant difference between these two groups statistically. 3. In the respect of initial loss of anterior vertebral height, when compared above 55% with below 55%, loss of correction was 7.7%, 2.2% at the end of follow-up respectively and this result had significant difference between these two groups statistically. 4. In the respect of time interval from injury to operation, when compared within 2 weeks with after 2 weeks, respectively loss of correction was 1.7-2.2degrees , 3-3.9% and 4.1degrees , 6.7% at the end of follow-up and this results had significant difference between these two groups statistically. These data suggested if initial kyphotic angle is below 30degrees or initial loss of anterior vertebral height less than 55%, short segmental transpedicular screw fixation provide sufficient stability but if initial kyphotic angle is above 30degrees or initial loss of anterior vertebral height is above 55%,additional anterior interbody fusion may be considered.
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Compression fracture of thoracolumbar junction is considered to be stable, and usually treated by conservative methods, such as bed rest followed by bracing. However, we can often see the progression of deformity during follow-up. Authors had treated 62 cases with compression fractures of thoracolumbar junction conservatively at Ewha Woman' University Mokdong Hospital from September, 1993 to December, 1997, and analyzed risk factors of progression in anterior vertebral height (AVH) collapse and kyphotic angle after the minimum 1 year follow-up. The results were as follows; The anterior vertebral height significantly more decreased in the group with age over 60, but increase of kyphotic angle was not related with age factor. In female, decrease of AVH and increase of kyphotic angle were more than in male. AVH significantly more decreased in L1 than in T12 or L2, but increase of kyphotic angle was not related with fracture level. Decrease of AVH and increase of kyphotic angle were not related with fracture type. Osteoporosis seems to be the most important single risk factor in progression of compression and more strict wearing of well-fitting brace is necessary to protect the progression in case of severe osteoporosis.
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The diagnosis and management of thoracolumbar spine fracture have been progressrd greatly, because CT and MRI increase the apprehension to thoracolumbar fracture.
Middle dolumn was known to be important factor in determining fracture stability, according to "Three column concept by Denis and McAfee." From Jan. 1990 to Jan. 1994 we have managed 63 cases of thoracolumbar compressive fracture and stable burst type thoracolumbar wpine fracture nonoperatively Clinical and radiologic results(kyphotic angle, wedging angle) were evaluated according to fracture pattern.
We obtained the following results; 1. The change of kyphotic angle in stable burst fracture is more severe than compressive fracture.
2. The change of wedging angle in stable burst fracture is more severe than compressive fracture.
3. Clinical results of stable bursting fracture was worse than compressive fracture.
We concBuded that stable bursting thoracolumbar fracture need more aggressive management.