퇴행성 척추관 협착증과 동반된 골다공증성 압박 골절의 병합 치료
Combined Treatment of Degenerative Spinal Stenosis and Osteoporotic Compression Fracture
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Objectives: To analyze the treatment results of combined treatment with percutaneous vertebroplasty and adhesiolysis in the patients who happened the osteoporotic compression fractures during the conservative treatment of pre-existing degenerative spinal stenosis. Materials and Methods: A retrospective review was carried out on 38 patients who happened the osteoporotic compression fractures during the conservative treatment of pre-existing degenerative spinal stenosis. We performed percutaneous vertebroplasty for osteoporotic compression fractures and adhesiolysis for degenerative spinal stenosis after 4 weeks after vertebroplasty. Radiologic results were evaluated by progression of compression rate, fractures in adjacent segment and change of the BMD. Clinical results were evaluated with Denis pain scale for osteoporotic compression fractures and Katz satisfaction scale for degenerative spinal stenosis. Results: The compression rate was 30.2% preoperatively, 21.4% postoperatively, and 24.6% at 12 months postoperatively. There was no fracture in adjacent segment. Clinically, the Denis score were P3 in 13 and P4 in 25, preoperatively, P1 in 11 and P2 in 26, P3 in 1, postoperatively (P=0.03). In regard to degenerative diseases, the Kats scale were 38 to 5, 86.8% in low back pain (P=0.017) and 38 to 4, 89.4% in claudication (P=0.006). The overall Katz satisfaction scale was 81.5% at 12 months postoperatively. The BMD changes in patients who treated neuroplasty was not significant (P=0.175). Conclusions: The combined treatment with percutaneous vertebroplasty and adhesiolysis may be an effective treatment strategy for the osteoporotic compression fracture and spinal stenosis without surgical intervention in old age patients.
Abstract
Objectives: To analyze the treatment results of combined treatment with percutaneous vertebroplasty and adhesiolysis in the patients who happened the osteoporotic compression fractures during the conservative treatment of pre-existing degenerative spinal stenosis. Materials and Methods: A retrospective review was carried out on 38 patients who happened the osteoporotic compression fractures during the conservative treatment of pre-existing degenerative spinal stenosis. We performed percutaneous vertebroplasty for osteoporotic compression fractures and adhesiolysis for degenerative spinal stenosis after 4 weeks after vertebroplasty. Radiologic results were evaluated by progression of compression rate, fractures in adjacent segment and change of the BMD. Clinical results were evaluated with Denis pain scale for osteoporotic compression fractures and Katz satisfaction scale for degenerative spinal stenosis. Results: The compression rate was 30.2% preoperatively, 21.4% postoperatively, and 24.6% at 12 months postoperatively. There was no fracture in adjacent segment. Clinically, the Denis score were P3 in 13 and P4 in 25, preoperatively, P1 in 11 and P2 in 26, P3 in 1, postoperatively (P=0.03). In regard to degenerative diseases, the Kats scale were 38 to 5, 86.8% in low back pain (P=0.017) and 38 to 4, 89.4% in claudication (P=0.006). The overall Katz satisfaction scale was 81.5% at 12 months postoperatively. The BMD changes in patients who treated neuroplasty was not significant (P=0.175). Conclusions: The combined treatment with percutaneous vertebroplasty and adhesiolysis may be an effective treatment strategy for the osteoporotic compression fracture and spinal stenosis without surgical intervention in old age patients.
참고문헌 (19)
- Bonaldi G, "Percutaneous treatment of lumbar compression fracture with canal stenosis and neurogenic intermittent claudication: combining kyphoplasty and interspinous spacer", J Vasc Interv Radiol, 23(11), pp.1437~1441 (2012)
- Sills AK, "Lumbar stenosis with osteoporotic compression fracture and neurogenic claudication", J Spinal Disord, 6(3), pp.269~270 (1993)
- Guigui P, "Intraoperative and early postoperative complications of lumbar and lumbosacral fusion: prospective analysis of 872 patients", Rev Chir Orthop Reparatrice Appar Mot, 90(1), pp.5~15 (2004)
- Yamato M, "MR appearance at different ages of osteoporotic compression fractures of the vertebrae", Radiat Med, 16(5), pp.329~334 (1998)
- Denis F., "The three column spine and its significance in the classification of acute thoracolumbar spinal injuries", Spine (Phila Pa 1976), 8(8), pp.817~831 (1983)
- Katz JN, "Seven- to 10-year outcome of decompressive surgery for degenerative lumbar spinal stenosis", Spine (Phila Pa 1976), 21(1), pp.92~98 (1996)
- Wu ZX, "Surgical treatment of osteoporotic thoracolumbar compressive fractures with open vertebral cement augmentation of expandable pedicle screw fixation: a biomechanical study and a 2-year follow-up of 20 patients", J Surg Res, 173(1), pp.91~98 (2012)
- Mochida J, "Treatment of osteoporotic late collapse of a vertebral body of thoracic and lumbar spine", J Spinal Disord, 14(5), pp.393~398 (2001)
- Shikata J, "Surgical treatment for paraplegia resulting from vertebral fractures in senile osteoporosis", Spine (Phila Pa 1976), 15(6), pp.485~489 (1990)
- Acosta FL, Jr., "Kyphoplasty-augmented short-segment pedicle screw fixation of traumatic lumbar burst fractures: initial clinical experience and literature review", Neurosurg Focus, 18(3), pp.e9~ (2005)
- Schlegel JD, "Lumbar motion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions", Spine (Phila Pa 1976), 21(8), pp.970~981 (1996)
- Galibert P, "Percutaneous acrylic vertebroplasty as a treatment of vertebral angioma as well as painful and debilitating diseases", Chirurgie, 116(3), pp.326~334 (1990)
- Jensen ME, "Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures:technical aspects", AJNR Am J Neuroradiol, 18(10), pp.1897~1904 (1997)
- Heavner JE., "Response to comments by Omoigui in:A safer technique utilizing an intravenous catheter introducer for epidural catheter lysis of adhesions", Reg Anesth Pain Med, 24(2), pp.189~ (1999)
- Cortet B, "Percutaneous vertebroplasty in patients with osteolytic metastases or multiple myeloma", Rev Rhum Engl Ed, 64(3), pp.177~183 (1997)
- Devulder J, "Relevance of epidurography and epidural adhesiolysis in chronic failed back surgery patients", Clin J Pain, 11(2), pp.147~150 (1995)
- Al-Shoha A, "Effect of epidural steroid injection on bone mineral density and markers of bone turnover in postmenopausal women", Spine (Phila Pa 1976), 37(25), pp.E1567~E1571 (2012)
- Kang SS, "Changes in bone mineral density in postmenopausal women treated with epidural steroid injections for lower back pain", Pain Physician, 5(3), pp.229~236 (2012)
- Kim S, "Relationship between bone mineral density and the frequent administration of epidural steroid injections in postmenopausal women with low back pain", Pain Res Manag, 19(1), pp.30~34 (2014)