Purpose
Osteoporosis is an age-related systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone contents, with a consequent increase in bone fragility. In severe osteoporosis progressive collapse of multiple vertebrae is and unsolved problem. Medical treatment appears to be too slow to prevent the course. Recently, there are some reports on the results of the percutaneous vertebroplasty (VP) in treating the multi-level osteoporotic vertebral compression fractures (VCFs). we reviewed painful multi-level osteoporotic VCFs treated by percutaneous VP and assess the efficacy and safety of multiple percutaneous cement VP in the treatment of multi-level osteoporotic VCFs.
Materials and Methods
From January 2008 to August 2010, the clinical cases and radiographic records were reviewed retrospectively for 28 patients treated for the multi-level painful osteoporotic VCFs by percutaneous cement VP. Initially radiography and MRI of the spine were performed. Spine radiographs were repeated at post-operation, 1,3 months and final follow-up. The patient’s outcomes of demographic, clinical, radiologic and procedural data were analyzed and assessed using self-report and physiological measures. A t-test was used for means of VAS, anterior vertebral height and kyphotic angle. Statistical analysis was performed with the SPSS(Version 15.0.1, Chicago, Illinois). The p-values of < 0.001 were deemed significant.
Results
The back pain recorded using the VAS improved significantly in all cases, from 7.7±1.0(6-10), points preoperatively to 2.0±0.7(1-3) points postoperatively (p<0.001) and then 2.8±0.8(1-4) points at the follow-up (p<0.001). The anterior heights increased from 17.40±4.98 to 21.02±5.36 after VP procedures (p<0.001) and finally 19.49±5.28 (p<0.001). The kyphotic angle was 12.58º preoperatively and improved to 4.39º postoperatively, but kyphotic deformities became worse in 12.80º.
Conclusion
The vertebroplasty for patients with multiple osteoporotic vertebral compression fractures may improve pain and can be effective for preventing adjacent fractures, restoration of vertebral height and maintenance of sagittal alignment. Patients with multiple osteoporotic compression fractures have many comorbidity, the surgeon should be conscious to all procedure.

Purpose
Despite the increasing prevalence of spinal deformity correction using lateral lumbar interbody fusion (LLIF) for degenerative adult spinal deformity, the amount of sagittal plane correction is reported to be suboptimal. Thus, authors have performed mini-open anterior lumbar interbody fusion (ALIF) at the most caudal segment in adjunct to LLIF to make sufficient lumbar lordosis (LL). This study is performed to demonstrate the feasibility of mini-open anterior lumbar interbody fusion (ALIF) combined with lateral lumbar interbody fusion (LLIF) followed by 2-stage posterior fixation in terms of the correction capacity and complications by comparing with a matched control group undergoing posterior-only surgery.
Materials and Methods
This study was case-control study. Thirty patients who underwent ALIF with LLIF followed by 2-stage posterior fixation (ALIF/LLIF group) for adult spinal deformity were compared to 60 patients who underwent posterior-only surgery (posterior group) and were matched according to age, sex, diagnosis, fusion length, pelvic incidence (PI), and follow-up duration. Spinopelvic parameters, hospitalization data, clinical outcomes, and complications were evaluated and compared between ALIF/LLIF and posterior groups.
Results
In the ALIF/LLIF group, interbody fusions were performed for a mean of 4.0 levels, comprising 1.6 and 2.4 levels for ALIF and LLIF, respectively. Interbody fusion in the posterior group was performed for a mean of 3.3 levels. The mean follow-up duration did not differ between two groups (16.7 mo vs. 19.2 mo, p=0.056). Postoperative LL was greater in the ALIF/LLIF than in the posterior group (52.0° vs. 40.9°, p<0.001). The reduction in the sagittal vertical axis was also greater for the ALIF/LLIF group than the posterior group (62.3 mm vs. 24.7 mm). The operation time of the ALIF/LLIF group was longer than the posterior group (11.2 hr vs. 8.6 hr, p<0.001), while estimated blood loss and red cell transfusion was less in the ALIF/LLIF group. Medical complications developed more frequently in the posterior group, while perioperative surgical complications were not different between groups. Delayed surgical complications were observed more in the posterior group. In the posterior group, there were 7 patients who experienced nonunion and rod breakage and 10 patients who experienced decompensation, while there were no such cases in the ALIF/LLIF group.
Conclusion
Mini-open ALIF combined with LLIF can restore sagittal balance more appropriately with a lower rate of complications compared with posterior-alone surgery for the correction of ASD.

The minimally invasive technique to correct deformity in scoliosis is not a familiar concept among spine surgeons but is interesting, as this innovative surgery, if it proves successful, will have the advantages of the minimally invasive technique in the final outcomes and will be the future of scoliosis surgery. We operated on 18 adolescent idiopathic scoliosis (AIS) patients using a newly designed technique which utilizes two or three 1-inch midline incisions to insert pedicle screws with a rod, facet fusion and de-rotation maneuver to correct the deformity. Post-operative complications were minimal and the results of the deformity corrections were comparable to the open scoliosis surgery in the follow up. The advantages of minimally invasive surgery observed in all cases include cosmetically fainter scars, reduced blood loss, shorter hospital stay, early mobilization and minimal need of analgesics for pain. Even though many challenges were faced in executing this procedure, the goal of inventing this novel approach was accomplished. We feel this technique is a good alternative to open surgery in certain curve types of AIS but large scale studies are needed in the future to recommend its routine use.

Purpose
Recently, there is concern for spinal sagittal alignment associated with back pain. Nowadays many women wear high heels or high-heeled shoes for their beauty. We study change of spinal sagittal alignment when women are wearing high heels.
Materials and Methods
We raised 15 female adult volunteers to accept our study. They do not have past history, operation history and especially back pain. We applied X-rays for anteroposterior and lateral whole spine radiography when women were bare foot (Group I). In addition, we applied each X-rays when women were wearing 5 cm high heels (Group II) and 12 cm high heels (Group III). We estimate the spinal sagittal alignment distinguishing pelvic index from spinal index. We use ANOVA test of SPSS v18.0 statistically.
Results
The average age of women was 29.3(23-41) years old, and mean BMI (Body Mass Index) was 18.7(16.2-24.5) kg/m 2 . When volunteers were bare foot, the average pelvic incidence (PI) was 49.3 degree, pelvic tilt (PT) was 10.8 degree, and sacral slope (SS) was 37.9 degree. The each average of lumbar lordosis (LL), thoracic kyphosis (TK), T12 slope, and sagittal vertical line on middle point of C7 (C7 SVA) and T12 (T12 SVA) was 55.5 degree, 28.5 degree, 19.3 degree, -1.2 cm, and -3.8 cm. When women were wearing 5 Cm high heels, the average was each 49.2 degree, 18.9 degree, 35.4 degree, 54.9 degree, 29.1 degree, 20.5 degree, -2.0 cm, -2.5 cm. When women were wearing 12 cm high heels, the average was each 49.9 degree, 18.2 degree, 31.2 degree, 52.6 degree, 30.8 degree, 22.8 degree, -4.1 Cm, -4.1 cm. Compared with each group, sacral slope (SS) and vertical line on middle point of C7 was statistically significant in group III (p<0.05). There was no statistically correlation between group I and group II.
Conclusion
Spinal sagittal alignment can be changed if adult women wear high heels excessively. For maintaining of normal spinal sagittal alignment, We conclude adult women wearing high heels for a long time pay attention to change of their spinal sagittal alignment.

Fifty-six-year old male patient visited our institution for low back pain for 2 months. The clinician of surgical department diagnosed as abscess or lymphocele on the basis of the findings of abdomen CT and lumbar MRI. The patient visited department of orthopaedic surgery after 6 months later from initial symptom. The back mass was grown larger on the CT and MRI. High grade pleomorphic sarcoma (malignant fibrous histiocytoma) was confirmed by aspiration biopsy. We performed massive excision of the mass with adjuvant chemotherapy and radiotherapy. No recurrence has been found during 1-year follow-up. Malignant fibrous histiocytoma can be mistaken for simple cyst or abscess on its early stage and can bring about bad prognosis because it grows rapidly. If the margin of the cystic lesion is irregular or thick, and the clinical findings are is not suitable for infection, malignant tumor should be suspected.