Introduction: With aging the population, the patients with osteoporotic vertebral fracture have been increasing. previously, conservative treatment is considered the standard treatment for osteoporotic vertebral fracture. Balloon kyphoplasty as a new method is minimally invasive surgery that are widely used for painful osteoporotic vertebral fractures. While balloon kyphoplasty is effective for most patients, not effective for some patients.

Aim: The aim of this study is to find predictors of poor outcome in patients with percutaneous balloon kyphoplasty for osteoporotic vertebral fractures by preoperative radiological findings.

Materials and Methods: Between June 2011 to March 2018, 145 consecutive patients were diagnosed osteoporotic vertebral body fracture and underwent balloon kyphoplasty at our institution. Inclusion criteria were as follows: dynamic radiographic examination in lateral view and MR examination were performed before surgery; and follow up period is more than a year. Of the 145 patients initially selected, 66 were included in the study. They were divided into 2 groups. A total of 47 patients (group A) improved in symptoms by balloon kyphoplasty. A total of 19 patients (group B) didn't improved in symptoms by balloon kyphoplasty.

Results: The average of local kyphotic angle was 14.5±12.5° in group A and 14.9±10.0° in group B, respectively. The average of vertebral instability 6.9±5.0° in group A and 5.3±4.0° in group B, respectively. The presence of intravertebral effusion were 15 patients (31.9%) in group A and 13 patients (68.4%) in group B, respectively. The differences were statistically significant for the presence of intravertebral effusion, but not the local kyphotic angle and the vertebral instability.

Conclusion: The presence of intravertebral effusion in preoperative MR examination is predictor of poor outcome in patients with percutaneous balloon kyphoplasty for osteoporotic vertebral fractures. Intravertebral effusion cause a gap between bone tissue and bone cement, and consequently micromotion of the gap between those is the cause of pain.

Objective: Osteoporotic vertebral fractures (OVFs) causes local kyphosis around the fractured vertebral body. The purpose of this study was to evaluate the compensation mechanism of spinal balance for local kyphosis.

Material and Methods: We reviewed the medical records and radiographs of 75 patients who had underwent surgical treatment for non-union, kyphotic deformity and neurological disorder due to OVFs. All patients were divided into two groups; the thoracolumbar vertebral fracture group (Th10-L2) and the lower lumbar vertebral fracture group (L3-5). Spinal sagittal alignment with whole spine radiography in the standing position were measured.

Results: In thoracolumbar vertebral fracture group, the local kyphosis in the thoracolumbar level was compensated for by pelvic retrograde and lumbar lordosis. In lower lumbar vertebral fracture group, the local kyphosis in the lumbar level was compensated for by pelvic retrograde and reduction of thoracic kyphosis. OVFs at the lumbar level had higher SVA and low back pain than those at the thoracolumbar level.

Conclusion: Lumbar vertebral fractures were decompensated due to reduced lumbar lordosis.

Treatment for osteoporotic vertebral fractures (OVF), if not done at the right time, worsens not only healthy life expectancy but also prognosis. Recently, the effectiveness of Balloon Kyphoplasty (BKP) has been reported, but there is no consensus on early BKP. Therefore, we developed a protocol of treatment and examined whether it is effective to perform BKP within two weeks after injury (early group) compared with the group of BKP over four weeks after injury (waiting group).

Pain of the early group at four weeks after surgery was significantly improved compared to the waiting group. There was no significant difference in ADL, medical complications during hospitalization, and subsequent new vertebral fractures, but those of the early group tended to be better.

BKP within two weeks after injury for OVF patients with strong pain even after leaving the bed significantly improved pain at four weeks after surgery compared to the group that performed surgery four weeks or more after injury, safe and useful.

Purpose: To investigate the mechanisms of vertebral fracture using finite element (FE) analysis in cases of diffuse idiopathic skeletal hyperostosis (DISH).

Methods: The study retrospectively reviewed a patient with DISH (61-year-old man) and an individual with a normal spine (56-year-old woman). Thoracic spine (T6-10) models were created from the computed tomography data of each patient, using the three-dimensional FE method. In the models, low-energy (≤2,000 N) load was applied to the anterior vertebra (T6) to mimic extension. Drucker-Prager equivalent stress was calculated, and fracture was generated by mimicking the simulated extension.

Results: In the FE model of DISH, equivalent stress was concentrated at the ossification of the anterior ligament and posterior column of the bottom vertebra, and fracture occurred at the three columns. On the other hand, in the FE model of the normal spine, equivalent stress was concentrated at the posterior column of the vertebrae, and fracture occurred at the same region.

Conclusion: Our findings demonstrate that the mechanisms of vertebral fracture in patients with DISH differ from those in individuals with a normal spine.

*The authors equally contributed to this work.

We reported the case of 71 years old male with a burst fracture and rupture of interspinous ligament (AO typeB-2) at the level of stenosis. We applied ballon kyphoplasty (BKP) and oblique lateral interbody fusion (OLIF) for spinal canal stenosis and interbody instability associated with OVF.

A spinal reconstruction from L3 to L5 with L4 BKP and OLIF could provide reliable neurologic improvement in patient with incomplete neurologic deficit, and could provide the stability and indirect decompression for lumbar canal stenosis and osteoporotic vertebral fracture.

The aim of this study was to evaluate the clinical results of balloon kyphoplasty (BKP) for osteoporotic spinal vertebral fragility fracture with middle column injury. Nine patients with a burst fracture were treated by BKP. Cement leakage was observed in 4 cases (psoas, 2 cases; disc, 2 cases), but without leakage into the spinal canal. The angulation of whole spinal kyphosis did not recover after operation, however the average JOA score showed significant recovery. BKP is generally contraindicated for vertebral fractures with middle column injury, however it may be indicated for vulnerable patients and for those who need early bed removal.

Objective: The purpose of this study was to analyze the relationship between fracture pattern and the development of radiculopathy after osteoporotic lumbar compression fracture.

Materials and Methods: This study comprised 9 patients who underwent surgical treatment between 2016 and 2018 for osteoporotic compression fracture below the L2 level, leading to radiculopathy. Osteoporotic vertebral fracture was classified into 3 types and the frequency of root signs was investigated. Imaging evaluation of the vertebral fracture was carried out and endplate fracture on the cranial and caudal sides was recorded.

Results: The cause of radiculopathy was lumbar canal stenosis in 2 patients and lumbar foraminal stenosis in 6 patients. One patient had both conditions. Endplate fracture on the caudal side was observed in 4 of the 7 patients (57%) with lumbar foraminal stenosis. Three patients showed pedicle fracture and pseudoarthrosis following osteoporotic vertebral fracture.

Conclusion: In this study, 7/9 (77.8%) cases of radiculopathy with osteoporotic vertebral fracture were caused by foraminal stenosis. Attention should be paid to foraminal lesions with endplate fracture and instability associated with osteoporotic vertebral fracture.

Objective: Spinal Injuries Center (our institution) has been performing nonoperative treatment for the geriatic patients with acute odontoid fracture, not showing any symptoms of spinal cord paralysis. We report the results of this nonoperative treatment of our institution, focused on the mortality, neck pain and walking function.

Methods: We investigated the patients over 65 years old with acute odontoid fracture from 2013 to 2019. Neck pain and waliking function of these patients were evaluated using VAS (Visual Analog Scale) and the JOA (Japanese Orthopaedic Association) scoring system for cervical myelopathy, respectively.

Results: A total of 12 patients (9 male, 3 female) were hospitalized and treated nonoperatively. The average age at the time of starting nonoperative treatment was 78.8 years. The fracture type of 5 patients was Anderson type II and that of 7 patients was type III. 8 patients were immobilized by cervical collar and 4 patients were halo vest. 3 patients died during outpatient follow-up. The average VAS of neck pain and the JOA score of lower extremity motor function were 0.5 and 2.5, respectively.

Introduction: Balloon Kyphoplasty (BKP) is a useful surgical method for reducing back pain due to osteoporotic vertebral fracture (OVF) and its non-union. However, adjacent vertebral fracture (AVF) following BKP is a major problem. The purpose of this study was to investigate associations between AVF and BKP, vertebral instability (VI) and intervertebral cleft (IC).

Methods: The study comprised 65 patients (9 male and 56 female, average age 80.3 years) who underwent BKP for non-union of OVF from 2016 to 2018 in our hospital. We recorded AVF, VI-affected vertebra and the location of IC-affected vertebra.

Results: The incidence of AVF was 12% (8/65). There was no statistically significant correlation between VI-affected vertebra and AVF. Patients with IC located at upper sites suffered AVF at upper vertebra of BKP vertebra. Conversely, patients with IC located at lower sites suffered AVF at lower vertebra of BKP vertebra. Patients with IC located at the center of vertebra experienced AVF.

Discussion: Many risk factors for AVF following BKP have been discussed. Although AVF could not be prevented completely, its location could be predicted using the location of IC. This may assist with the planning of appropriate postoperative treatment.

Conclusion: The location of AVF may be predicted by the location of IC.

We examined the short-term results of 5 cases with fixation of thoracolumbar burst fracture in patients >75 years old. PPS was placed above two vertebrae and open PS was combined with sublaminar hook at one caudal vertebrae. The average operative time was 106 minutes, the average bleeding volume was 66 mls and the average fixation number was 3.2. These were significantly lower than for conventional open fixation performed in our hospital. Postoperative improvements in average VAS were observed for lower back pain, lower extremity pain, numbness, the average score for each item in JOABPEQ, and the average score for ROMDQ. However, only the average VAS for lower back pain was significantly improved. The local kyphosis angle averaged 15.8° before surgery and 11.8° immediately after surgery, but increased to 19.4° at the final examination. Post-operative ADL improved in 4 cases with a cane or independent walking, and in one case with a walker.

Introduction: The goal of this study was to investigate preoperative factors associated with sole numbness in patients with lumbar degenerative disease. This was performed using radiological, electrophysiological and neurological findings.

Methods: A retrospective study was conducted involving 47 consecutive patients undergoing lumbar decompression surgery between 2005 and 2016. Patients were aged > 70 years and were followed up for 12 months. Patients with sole numbness were classified as Group SN and those without sole numbness as Group NSN. Univariate analyses were used to compare preoperative parameters for radiological, electrophysiological and neurological findings between the two groups.

Results: ATR, vibration sense, sensory disturbance (tactile sense and pain sense) on the bilateral side, position sense and CECT (cauda equina conduction time) on the affected side each differed significantly between Groups SN and NSN (P < 0.05). However, no significant differences in radiological findings were seen between the two groups. In multivariate logistic regression analysis, the dummy variable representing Group SN was set as the objective variable and all preoperative factors were set as explanatory variables. Using the stepwise method, patients with sole numbness had lower CECT and vibration sense than patients without numbness [P=0.011, odds ratio (OR) = 3.05, 95% confidence interval (CI): 1.29-7.21; and P=0.021, OR = 0.121, 95%: 0.02-0.72, respectively].

Conclusion: CECT and vibration sense on the affected side can be used as reliable preoperative factors for sole numbness.

Introduction: To examine the incidence of clinical vertebral fracture using the claim database, in those over 65 years of age in Kure, we used the medical care information of the National Health Insurance or Senior Elderly Care System in Kure City (Hiroshima Prefecture, Japan). And to elucidate the rate for operation among the clinical vertebral fractures.

Methods: Those with vertebral fractures as disease name, and either treatment/ operation / hospitalization was defined as clinical vertebral fractures. Among the claim database, we extracted the clinical vertebral fracture, and investigated the number of occurrences, and the incidence rate per 100,000. From the Basic Resident Registration system, which is a national registry of Japanese citizens, we surveyed the population, gender according to the 5-year-old class over the age of 65. We also investigated the rate for operation among the clinical vertebral fractures.

Result: The city population was 234,613 of whom 77,154 (32.9%) were age 65 years or older. The member who were aged 65 and over of the National Health Insurance or Senior Elderly Care System were 66,317 (26,739 male and 39,578 female) and the city population who were age 65 years or older was 77,154, thus the coverage rate accounted for 86.0% of the citizens. The incidence rate of clinical vertebral fractures of the elderly population (65 years or over) per 100,000 was 1,558 (729 male, 2,117 female, 2.90 female/male ratio). In both men and women, the incidence rate increased with aging. Among 1,033 clinical vertebral fractures, balloon kyphoplasty cases were 31 cases (3.0%), spinal fusion cases were 22 cases (2.1%), thus total of operation cases were 53 cases (5.1%).

Conclusion: This is the first report that investigated the incidence rate of the clinical vertebral fractures and the rate for operation using the claim database, which covered almost the whole number of 230,000 population area.

Osteoporotic vertebral body fracture is common in the elderly population.

Pedicle fracture is rare, however. Several studies have reported that pedicle stress fractures are associated with stress-related predisposing factors such as athletic activity, spondylolysis, previous spinal surgery and osteoporosis.

We report here 4 cases of bilateral pedicle fractures in patients aged > 70 years. Three of these fractures were detected at L4 and the other at L3 level. All patients presented with low back pain and lower extremity numbness or pain. MRI revealed lumbar spinal canal stenosis adjacent to the pedicle fracture. Three patients underwent decompressive laminectomy and posterior fusion with pedicle screw fixation. Symptoms improved after surgery and follow up CT showed evidence of pedicle fracture healing in 2 of the 3 patients.

Osteoporosis was present in all 4 patients and bisphosphonate therapy was ongoing. There was no episode of major trauma that may have caused the pedicle fractures. Similar to previous reports, these fractures may be linked to stress fractures.

We designed a new technique called combined open-closed osteotomy (COCO) to treat adult spinal deformity (ASD) with a rigid or inflexible spine. We developed this by applying the technique of inverted V-shaped high tibial osteotomy. COCO combines the open reduction in interbody on the concave side and closed reduction in the osteotomy area on the convex side. The axis of correction hinge is in the center of the vertebral body. COCO is a simpler and less invasive technique for ASD compared to existing spinal 3-column osteotomies. It may be considered as a preferred option for the corrective surgery of severe spinal deformities.

We repot a case of 78 years-old with lumbar extradural arteriovenous fistula after trauma of low limb. He complained of the abnormal sensation on the bilateral calf one year after operation of knee joint fracture. Lumbar MRI showed extradual flow void with mass effect extending between L1 and L4 bilaterally. Angiography of spinal artery (first -third lumbar arteries) demonstrated many feeders constituting venous pouch which connected to the extradual venous plexus. Endovascular treatment was performed via venous tract, whose catheter was set to venous pouch.

Embolization started from venous pouch to many feeders using coil and NBCA (adhesive lipiodol). The result remained 80% occlusion. However his symptom disappeared completely and persist.

There is an increase in the number of elderly people who undergo the surgery on vertebral fractures, as well as the aging population. The case was a 101-year-old woman. She fell over at home and came to the hospital complaining of back pain. CT / MRI confirmed L1 vertebral fracture and we performed conservative treatment. However, bone union was not obtained even after 6 months of injury, and delayed paralysis appeared 1 year and 1 month after the injury, so L1 laminectomy and Th11~L3 posterior fusion were performed, and a good course was obtained.

We should not decide the operation adaptation by their age. It was suggested by deciding the operation adaptation depending on individual cases; the state of the whole body's condition, informed consent of their family, and their social background.