Abstract Injecting recombinant human bone morphogenetic protein-2 (rhBMP-2) into the uppermost instrumented vertebra (UIV) during surgery to increase the bone for adult spinal deformity (ASD) is expected to be protective against the development of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). The 25 patients from study group had received 0.5 mg rhBMP-2 mixed with 1.5 g β-tricalcium phosphate paste injection into the UIV during surgery. The control group consisted of 75 age and sex matched patients who underwent surgery immediately before the start of the study. The incidences of PJK and PJF were analyzed as primary outcomes. Spinopelvic parameters and patient-reported outcomes were analyzed as secondary outcomes. Hounsfield unit (HU) measurements were performed to confirm the effect of rhBMP-2 on bone formation at preoperative and postoperative computed tomography (CT). PJK and PJF was more occurred in control group than study group (p = 0.02, 0.29, respectively). The HU of the UIV significantly increased 6 months after surgery. And the increment at the UIV was also significantly greater than that at the UIV-1 6 months after surgery. Injection of rhBMP-2 with TCP into the UIV reduced PJK and PJF rates 6 months after surgery with new bone formation.
Background and Purpose Preexisting cognitive impairment is the strongest risk factor for delirium.We performed a pilot study to investigate whether the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), which is a good complement to direct cognitive testing, could be useful for predicting postoperative delirium in elderly patients.Methods Between June 2013 and May 2014, 37 patients aged 70 years or older underwent the Korean version of the Mini-Mental State Examination (K-MMSE) and completed the IQCODE (IQCODE-K) before elective spine surgery in the Spine Center at the Seoul National University Bundang Hospital.Delirium was assessed daily from the day after surgery until discharge.A Mann-Whitney U test was used to compare the K-MMSE scores and the IQCODE-K scores between the groups with and without postoperative delirium.Results A total of three of 37 (8.1%) patients developed delirium during their hospital stay.The K-MMSE scores were not different between the two groups (p=0.105),whereas the IQCODE-K scores of patients with delirium were significantly higher than those of patients without delirium (p=0.021),indicating greater cognitive and functional decline over the previous 10 years.Conclusions The IQCODE may be a suitable tool for assessing preoperative cognitive function and predicting postoperative delirium in elderly patients.
Study Design. Retrospective review of clinical and radiologic data in four major tertiary referral centers. Objectives. To report clinical and roentgenographic findings, to evaluate the results of various treatment methods, and to propose a protocol for management. Summary of Background Data. Langerhans' cell histiocytosis of the spine is a rare condition, and therefore, appropriate management is still controversial. Methods. Clinical and roentgenographic findings of 38 vertebral lesions of 23 children, with average follow-up of 5.4 years, were investigated. This is the most extensive report apparent in the literature to date. The results of treatment were assessed clinically and radiologically. Anterior vertebral body height was measured sequentially to evaluate reconstitution of the vertebral body. Results. The last follow-up examination demonstrated no clinical evidence of disease in all patients, regardless of treatment method. Neurologic deficits developed in four patients, but they completely disappeared. Satisfactory restoration of height was demonstrated in all except five vertebrae: one that had collapsed maximally when the patient was more than 15 years of age and four that had been fused anteriorly or posteriorly. Unsatisfactory results were also seen in a patient with progressive scoliosis and in one with an irregular endplate with disc space narrowing. Both of these complications developed after curettage. Conclusions. For treatment of single or dual spinal lesions, observation with or without bracing seems to be sufficient. In patients with multifocal lesions, chemotherapy produces good results. For treatment of neurologic deficit, low-dose radiotherapy is favored. Patients who underwent surgery—especially curettage and anterior fusion—had the worst outcome.
Study Design. A cross-sectional study. Objective. This study was designed to analyze the relationship between the presence and severity of depression and low back pain (LBP) in a representative sample of the general population using a self-report screening questionnaire for depression. Summary of Background Data. There is increasing evidence supporting an association between depression and LBP. However, the degree of the association between these two conditions in the general population is poorly understood. Methods. Health surveys and examinations were conducted on a nationally representative sample (n = 7550) of Koreans. LBP status was determined by a simple survey response concerning LBP >30 days during the past 3 months. Depression was defined as individuals with a total score >10 on the Patient Health Questionnaire (PHQ)-9 survey. The severity of depression was categorized as none (0–4), mild (5–9), moderate (10–14), moderately severe (15–19), and severe (20–27) according to PHQ-9 score. Data regarding demographics, socioeconomic history, and comorbid health conditions were used to analyze adjusted, weighted logistic regression models. Results. In the Korean population, the prevalence of depression was significantly greater in individuals with LBP (20.3%) than in those without LBP (4.5%). On multivariate logistic regression analysis, the presence of depression was significantly associated with LBP (adjusted odd ratio [aOR]: 3.93, P < 0.001). The risk of LBP increased with increasing severity of depression as follows: severe depression (aOR: 9.28, P < 0.001), moderately severe depression (aOR: 3.24, P = 0.001), moderate depression (aOR: 4.97, P < 0.001), and mild depression (aOR: 2.48, P < 0.001). Conclusion. Depression is more common in patients with LBP among Koreans. The presence of depression was significantly associated with LBP, especially in severely depressed individuals. Level of Evidence: 3
Study Design A retrospective review of three-dimensional CT scan images and radiographs. Purpose To investigate the prevalence and morphologic features of ponticulus posticus in Koreans. Overview of Literature There has been little reported on the prevalence or morphologic characteristics of ponticulus posticus in Asians, predisposing them to vertebral artery injury during screw placement in the lateral mass of the atlas. Methods The presence and types of ponticulus posticus were investigated on 225 consecutive cervical three-dimensional CT scans and 312 consecutive digital lateral cephalometric head radiographs. Results Various spectra of ponticulus posticus were found in 26% of the CT scans and 14% of the radiographs. Conclusions Ponticulus posticus is a relatively common anomaly in Koreans. Therefore, the presence of this anomaly should be carefully examined for on radiographs before lateral mass screw placement. If ponticulus posticus is suspected or confirmed on radiographs, three-dimensional CT scanning should be considered before placement of lateral mass screws into the posterior arch, especially given its wide variation of size and shape. Keywords: Ponticulus posticus; Atlas; Lateral mass screw
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