Jun-Yeong Seo1, Yong-Suk Kwon1, Kwang-Jung Kim1, Jee-Yong Shin2, Young-Hoon Kim3, Kee-Yong Ha4. 1. Department of Orthopaedic Surgery, Jeju National University Hospital, School of Medicine, Jeju National University, Jeju, Republic of Korea. 2. School of Medicine, Jeju National University, Jeju, Republic of Korea. 3. Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 4. Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address: kyh@catholic.ac.kr.
Abstract
PURPOSE: To predict spinal canal compromise, the assessment of plain radiography with magnetic resonance imaging (MRI) can aid the detection of vertebral body collapse and prevent the development of neurological deficits. METHODS: Patients who suffered osteoporotic vertebral fractures (OVFs) between January 2012 and December 2014 underwent consecutive radiological assessments, including measurements of anterior height loss (AHL), posterior height loss (PHL), and the kyphotic angle (KA). The fracture morphology was classified by AOSpine thoracolumbar spine injury classification system. MRI was performed at the initial assessment and the extent of canal encroachment (CE) was calculated in all patients. Follow-up computed tomography (CT) or MRI was performed in patients exhibiting significant height loss in follow-up radiography. The fracture patterns in T1- and T2-weighted MRI were also assessed. RESULTS: A total of 485 patients visited our institute for treatment of OVFs and 97 were enrolled; 15 were male and 82 were female. The mean age at initial visit was 70.3±14.6years. The initial spinal CE was correlated with the initial PHL and the initial AHL. The follow-up CE was correlated with age, the initial PHL, and the difference between the initial and last PHL (ΔPHL(initial-last)). OVFs with both endplate fractures have a greater tendency of posterior wall collapse than those with single endplate fracture. On initial T1-weighted sagittal MRI, a diffuse low signal change pattern of the fractured vertebra was correlated with PHL. Delayed neurological deficits developed in four patients. These patients underwent surgical intervention. CONCLUSIONS: In patients with simple compression fractures, attention should be paid to the posterior vertebral body and both endplates as well as the T1-weighted MRI findings to allow early detection of spinal canal compromise, which can have devastating consequences.
PURPOSE: To predict spinal canal compromise, the assessment of plain radiography with magnetic resonance imaging (MRI) can aid the detection of vertebral body collapse and prevent the development of neurological deficits. METHODS:Patients who suffered osteoporotic vertebral fractures (OVFs) between January 2012 and December 2014 underwent consecutive radiological assessments, including measurements of anterior height loss (AHL), posterior height loss (PHL), and the kyphotic angle (KA). The fracture morphology was classified by AOSpine thoracolumbar spine injury classification system. MRI was performed at the initial assessment and the extent of canal encroachment (CE) was calculated in all patients. Follow-up computed tomography (CT) or MRI was performed in patients exhibiting significant height loss in follow-up radiography. The fracture patterns in T1- and T2-weighted MRI were also assessed. RESULTS: A total of 485 patients visited our institute for treatment of OVFs and 97 were enrolled; 15 were male and 82 were female. The mean age at initial visit was 70.3±14.6years. The initial spinal CE was correlated with the initial PHL and the initial AHL. The follow-up CE was correlated with age, the initial PHL, and the difference between the initial and last PHL (ΔPHL(initial-last)). OVFs with both endplate fractures have a greater tendency of posterior wall collapse than those with single endplate fracture. On initial T1-weighted sagittal MRI, a diffuse low signal change pattern of the fractured vertebra was correlated with PHL. Delayed neurological deficits developed in four patients. These patients underwent surgical intervention. CONCLUSIONS: In patients with simple compression fractures, attention should be paid to the posterior vertebral body and both endplates as well as the T1-weighted MRI findings to allow early detection of spinal canal compromise, which can have devastating consequences.
Authors: Max J Scheyerer; Ulrich J A Spiegl; Sebastian Grueninger; Frank Hartmann; Sebastian Katscher; Georg Osterhoff; Mario Perl; Matthias Pumberger; Gregor Schmeiser; Bernhard W Ullrich; Klaus J Schnake Journal: Global Spine J Date: 2021-02-05