Prediction of Subsequent Vertebral Collapse after Osteoporotic Thoracolumbar Vertebral Fractures

다국어 초록 (Multilingual Abstract)

Objectives: To evaluate the clinical significance of vertebral bone bruise (VBB) in terms of subsequent collapse after osteoporotic thoracolumbar vertebral fractures.
Methods: We reviewed 41 consecutive patients with 46 osteoporotic thoracolumbar vertebral fractures treated nonoperatively from March 2007 to February 2010. Anterior wedge angle (AWA) was measured on plain radiographs and the change of AWA between the initial and last measurement was used to represent the subsequent vertebral collapse. The size of VBB was measured and VBB ratio was calculated on T1-weighted sagittal MR image.
Results: The average VBB ratio was 49.1% and the average change of AWA was 7.1o. Only VBB ratio significantly correlated with the change of AWA (P<0.001, cc=0.660). The other factors such as age, initial AWA, and endplate status showed no significant correlation with the change of AWA (P=0.629, P=0.724, P=0.690, respectively). In DEXA group, no correlation was found between T-score and the change of AWA as well as between T-score and VBB ratio (P=0.548, P=0.370, respectively). Five fractures were diagnosed as delayed post-traumatic vertebral collapse. Their average VBB ratio was 71.2% which was significantly higher than that of the other subjects (P=0.015). The fractures with VBB ratio more than 60% was likely to progress to delayed post-traumatic vertebral collapse.
Conclusions: VBB after osteoporotic thoracolumbar vertebral fracture was significantly correlated with subsequent vertebral collapse (cc=0.660). We recommend the patients with a large vertebral bone bruise, especially more than 60%, should be followed up meticulously for the early detection of delayed post-traumatic vertebral collapse.

참고문헌 (Reference)

1 Saifuddin A, "The role of imaging in the diagnosis and management of thoracolumbar burst fractures: current concepts and a review of the literature" 25 : 603-613, 1996

2 Willen J, "The natural history of burst fractures at the thoracolumbar junction" 3 : 39-46, 1990

3 Miller MD, "The natural history of bone bruises. A prospective study of magnetic resonance imagingdetected trabecular microfractures in patients with isolated medial collateral ligament injuries" 26 : 15-19, 1998

4 Maldague BE, "The intravertebral vacuum cleft: a sign of ischemic vertebral collapse" 129 : 23-29, 1978

5 Teli M, "Radiographic outcome of vertebral bone bruise associated with fracture of the thoracic and lumbar spine in adults" 14 : 541-545, 2005

6 McBroom RJ, "Prediction of vertebral body compressive fracture using quantitative computed tomography" 67 : 1206-1214, 1985

7 Ito Y, "Pathogenesis and diagnosis of delayed vertebral collapse resulting from osteoporotic spinal fracture" 2 : 101-106, 2002

8 Labovitz JM, "Occult osseous injuries after ankle sprains: incidence, location, pattern, and age" 19 : 661-667, 1998

9 Yao L, "Occult intraosseous fracture: detection with MR imagin" 167 : 749-751, 1988

10 Mink JH, "Occult cartilage and bone injuries of the knee: detection, classification, and assessment with MR imaging" 170 : 823-829, 1989

11 Moller A, "Nonoperatively treated burst fractures of the thoracic and lumbar spine in adults: a 23- to 41-year follow-up" 7 : 701-707, 2007

12 Reinhold M, "Non-operative treatment of thoracolumbar spinal fractures. Long-term clinical results over 16 years" 106 : 566-576, 2003

13 Saifuddin A, "MRI of acute spinal trauma" 30 : 237-246, 2001

14 Boks SS, "MRI follow-up of posttraumatic bone bruises of the knee in general practice" 189 : 556-562, 2007

15 Oner FC, "MRI findings of thoracolumbar spine fractures: a categorisation based on MRI examinations of 100 fractures" 28 : 433-443, 1999

16 Eustace S, "MR imaging of bone oedema: mechanisms and interpretation" 56 : 4-12, 2001

17 Roemer FW, "Long-term osseous sequelae after acute trauma of the knee joint evaluated by MRI" 31 : 615-623, 2002

18 Silva MJ, "Load sharing between the shell and centrum in the lumbar vertebral body" 22 : 140-150, 1997

19 Silva MJ, "Direct and computed tomography thickness measurements of the human, lumbar vertebral shell and endplate" 15 : 409-414, 1994

20 Lee CS, "Delayed Post-traumatic Vertebral Collapse: MR Categorization and MR-Pathology Correlation" 1 : 32-37, 2007

21 Oner FC, "Correlation of MR images of disc injuries with anatomic sections in experimental thoracolumbar spine fractures" 8 : 194-198, 1999

22 Cummings SR, "Clinical use of bone densitometry: scientific review" 288 : 1889-1897, 2002

23 Wright RW, "Clinical outcome of isolated subcortical trabecular fractures (bone bruise) detected on magnetic resonance imaging in knees" 28 : 663-667, 2000

24 Boks SS, "Clinical consequences of posttraumatic bone bruise in the knee" 35 : 990-995, 2007

25 Rangger C, "Bone bruise of the knee: histology and cryosections in 5 cases" 69 : 291-294, 1998

26 Ferguson SJ, "Biomechanics of the aging spine" 12 (12): 97-103, 2003

27 Steiger P, "Age-related decrements in bone mineral density in women over 65" 7 : 625-632, 1992

28 Magerl F, "A comprehensive classification of thoracic and lumbar injuries" 3 : 184-201, 1994