Pietro Persiani1, Jole Graci2, Claudia de Cristo1, Giovanni Noia1, Ciro Villani1, Mauro Celli3. 1. Universitary Department of Anatomic, Histologic, Forensic and Locomotor Apparatus Sciences, Section of Locomotor Apparatus Sciences, Policlinico Umberto I, Sapienza University of Rome, Piazzale Aldo Moro 5, 00162, Rome, Italy. 2. Universitary Department of Anatomic, Histologic, Forensic and Locomotor Apparatus Sciences, Section of Locomotor Apparatus Sciences, Policlinico Umberto I, Sapienza University of Rome, Piazzale Aldo Moro 5, 00162, Rome, Italy. jolegraci@yahoo.it. 3. Universitary Department of Pediatrics, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Abstract
PURPOSE: To investigate if an association between spondylolisthesis and L5 fracture occurs in patients affected by Osteogenesis Imperfecta (O.I.). METHODS: Anteroposterior and lateral radiograms were performed on the sample (38 O.I. patients, of whom 19 presenting listhesis); on imaging studies spondylolisthesis was quantified according to the Meyerding classification. Genant's semiquantitative classification was applied on lateral view to evaluate the L5 fractures; skeleton spinal morphometry (MXA) was carried out on the same images to collect quantitative data comparable and superimposable to Genant's classification. The gathered information were analyzed through statistical tests (O.R., χ 2 test, Fisher's test, Pearson's correlation coefficient). RESULTS: The prevalence of L5 fractures is 73.7 % in O.I. patients with spondylolisthesis and their risk of experiencing such a fracture is twice than O.I. patients without listhesis (OR 2.04). Pearson's χ 2 test demonstrates an association between L5 spondylolisthesis and L5 fracture, especially with moderate, posterior fractures (p = 0.017) and primarily in patients affected by type IV O.I. CONCLUSIONS: Spondylolisthesis represents a risk factor for the development of more severe and biconcave/posterior type fractures of L5 in patients suffering from O.I., especially in type IV. This fits the hypothesis that the anterior sliding of the soma of L5 alters the dynamics of action of the load forces, localizing them on the central and posterior heights that become the focus of the stress due to movement of flexion-extension and twisting of the spine. As a result, there is greater probability of developing an important subsidence of the central and posterior walls of the soma.
PURPOSE: To investigate if an association between spondylolisthesis and L5 fracture occurs in patients affected by Osteogenesis Imperfecta (O.I.). METHODS: Anteroposterior and lateral radiograms were performed on the sample (38 O.I. patients, of whom 19 presenting listhesis); on imaging studies spondylolisthesis was quantified according to the Meyerding classification. Genant's semiquantitative classification was applied on lateral view to evaluate the L5 fractures; skeleton spinal morphometry (MXA) was carried out on the same images to collect quantitative data comparable and superimposable to Genant's classification. The gathered information were analyzed through statistical tests (O.R., χ 2 test, Fisher's test, Pearson's correlation coefficient). RESULTS: The prevalence of L5 fractures is 73.7 % in O.I. patients with spondylolisthesis and their risk of experiencing such a fracture is twice than O.I. patients without listhesis (OR 2.04). Pearson's χ 2 test demonstrates an association between L5 spondylolisthesis and L5 fracture, especially with moderate, posterior fractures (p = 0.017) and primarily in patients affected by type IV O.I. CONCLUSIONS: Spondylolisthesis represents a risk factor for the development of more severe and biconcave/posterior type fractures of L5 in patients suffering from O.I., especially in type IV. This fits the hypothesis that the anterior sliding of the soma of L5 alters the dynamics of action of the load forces, localizing them on the central and posterior heights that become the focus of the stress due to movement of flexion-extension and twisting of the spine. As a result, there is greater probability of developing an important subsidence of the central and posterior walls of the soma.
Authors: Daniel Hatz; Paul W Esposito; Bruce Schroeder; Bridget Burke; Richard Lutz; Brian P Hasley Journal: J Pediatr Orthop Date: 2011-09 Impact factor: 2.324