Seventy-five-year female patient with diabetes, hypertension and hyperthyroidism visited our clinic for left shoulder radiating pain. In cervical radiologic study, multiple nodules were seen on both lung fields. In chest MDCT, active pulmonary tuberculosis and miliary tuberculosis were suspected and mass on 1st and 2nd thoracic vertebral body with destruction was seen. In cervico-thoracic MRI, 1st thoracic vertebral pathologic fracture was found. Miliary tuberculosis with spinal tuberculosis was diagnosed with right middle lobe biopsy. After 3 weeks with chemotherapy, lesion got advanced on MRI and radiating pain got worse. We performed 1st thoracic vertebral corpectomy with auto iliac bone graft, after 1 week posterior instrumentation was performed. After surgery, radiating pain and weakness got better, the patient is followed up at the outpatient. In general, spinal tuberculosis treats with antituberculous agent at first. But, if spinal deformity or neurologic symptom was accompanied, surgical correction will be necessary. In this case, advanced cervico-thoracic spinal tuberculosis with conservative therapy was treated 1st thoracic vertebral corpectomy with auto iliac bone graft and posterior instrumentation. The patient’s neurologic symptom was got better after surgery.

Purpose
To evaluate long term efficacy of percutaneous balloon kyphoplasty for osteoporotic compressive vertebral fracture.
Materials and Methods
Percutaneous balloon kyphoplasty was performed to 52 vertebral bodies, for 42 patients with compression fracture from March 2003 to October 2007. During observation, 32 patients (39 vertebral bodies) were followed over 5 years except 8 patients (19.0%) who have expired. Pre operational, post operational and final observational radiologic evaluation (vertebral height, compression ratio, kyphotic angle) and clinic evaluation(VAS score) were checked. And correlation with bone cement leakage, fracture of adjacent vertebral body, gender, age, bone mineral density and medication was analyzed.
Result
Average age was 71.3 years old and average observation period was 74.3 months. Average interval from injury to operation was 24.1 days. Vertebral compression ratio recovered 29.7% to 17.4% (12.3%), kyphotic angle improved 11.6 degree to 9.0 degree (2.6 degree) and there was no significant change until final observation. VAS score got better 7.60 to 3.57 (4.03) after operation. Bone cement leakage occurred in 5 cases (12.8%) and fracture of adjacent vertebral body occurred in 10 cases (25.6%), there was no correlation between two groups (p=1.000). Fracture of adjacent vertebral body showed meaningful correlation with bone mineral density only.
Conclusion
Percutaneous balloon kyphoplasty relieve the pain after compression fracture of vertebral body and is safe and efficient procedure to correct sagittal deformity. After 5 year follow up, the effect of procedure was maintained clinically. Bone cement leakage did not increase risk of fracture of adjacent vertebral body which occurred frequently in low bone mineral density.

Thirty-four-year old female patient visited our clinic for posterior neck pain for 3 days. She had no medical history or traumatic injury. On physical examination, posterior neck pain aggravating with neck motion was seen, there was no neurologic symptom. WBC, ESR and CRP were slightly increased. There was no specific finding on simple cervical radiologic study but, on cervical CT, calcified lesion was seen on the right lateral side of dens. The symptom got better after medication with NSAIDs, oral and intra venous steroid drugs for 2 days, disappeared after 4 days with NSAIDs and intra venous steroid drug. In following lab study, inflammatory marker decreased. Crowned Dens Syndrome could be misdiagnosed with meningitis, so cervical CT study is essential for differential diagnosis. Symptoms can be treated with NSAIDs and steroid drug.