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Khan MA, Jennings JW, Baker JC, Smolock AR, Shah LM, Pinchot JW, Wessell DE, Kim CY, Lenchik L, Parsons MS, Huhnke G, Shek-Man Lo S, Lu Y, Potter C, Reitman C, Sahgal A, Sharma A, Yalla NM, Beaman FD, Kapoor BS, Burns J. ACR Appropriateness Criteria® Management of Vertebral Compression Fractures: 2022 Update. J Am Coll Radiol 2023; 20:S102-S124. [PMID: 37236738 DOI: 10.1016/j.jacr.2023.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Vertebral compression fractures (VCFs) can have a variety of etiologies, including trauma, osteoporosis, or neoplastic infiltration. Osteoporosis related fractures are the most common cause of VCFs and have a high prevalence among all postmenopausal women with increasing incidence in similarly aged men. Trauma is the most common etiology in those >50 years of age. However, many cancers, such as breast, prostate, thyroid, and lung, have a propensity to metastasize to bone, which can lead to malignant VCFs. Indeed, the spine is third most common site of metastases after lung and liver. In addition, primary tumors of bone and lymphoproliferative diseases such as lymphoma and multiple myeloma can be the cause of malignant VCFs. Although patient clinical history could help raising suspicion for a particular disorder, the characterization of VCFs is usually referred to diagnostic imaging. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Majid A Khan
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
| | - Jack W Jennings
- Research Author, Washington University, Saint Louis, Missouri
| | - Jonathan C Baker
- Mallinckrodt Institute of Radiology Washington University School of Medicine, St. Louis, Missouri
| | - Amanda R Smolock
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lubdha M Shah
- Panel Chair, University of Utah, Salt Lake City, Utah
| | | | | | - Charles Y Kim
- Panel Vice-Chair, Duke University Medical Center, Durham, North Carolina
| | - Leon Lenchik
- Panel Vice-Chair, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Matthew S Parsons
- Panel Vice-Chair, Mallinckrodt Institute of Radiology, St. Louis, Missouri
| | - Gina Huhnke
- Deaconess Hospital, Evansville, Indiana American College of Emergency Physicians
| | - Simon Shek-Man Lo
- University of Washington School of Medicine, Seattle, Washington Commission on Radiation Oncology
| | - Yi Lu
- Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts American Association of Neurological Surgeons/Congress of Neurological Surgeons
| | - Christopher Potter
- Brigham & Women's Hospital, Boston, Massachusetts Committee on Emergency Radiology-GSER
| | - Charles Reitman
- Medical University of South Carolina, Charleston, South Carolina North American Spine Society
| | - Arjun Sahgal
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Commission on Radiation Oncology
| | - Akash Sharma
- Mayo Clinic, Jacksonville, Florida Commission on Nuclear Medicine and Molecular Imaging
| | - Naga M Yalla
- Mallinckrodt Institute of Radiology, Saint Louis, Missouri, Primary care physician
| | | | | | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
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Patterns of Vertebral Bone Marrow Edema in the Normal Healing Process of Lumbar Interbody Fusion: Baseline Data for Diagnosis of Pathological Events. Spine (Phila Pa 1976) 2023; 48:358-363. [PMID: 36730742 DOI: 10.1097/brs.0000000000004534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/29/2022] [Indexed: 02/04/2023]
Abstract
STUDY DESIGN Retrospective investigation using a prospectively collected database. OBJECTIVE To examine the appearance and characteristics of vertebral bone marrow edema (BME) in the normal healing of lumbar interbody fusion. SUMMARY OF BACKGROUND DATA Although BME in pathological spinal conditions has been well-documented, the patterns and characteristics of BME in the normal healing process of spinal fusion remains unexplored. MATERIALS AND METHODS We reviewed imaging from 225 patients with normal healing following posterior lumbar interbody fusion or transforaminal lumbar interbody fusion. BME was identified on magnetic resonance imaging at the third postoperative week and categorized with respect to its appearance, including assessment of area and extension within the relevant vertebrae. RESULTS Three hundred eighty-nine of the 450 instrumented vertebrae (86.4%) displayed evidence BME. All instances of BME were associated with the area of contact with the endplate. The average extent of BME was 32.7±1.0%. BME within normal healing following interbody fusion could be categorized into four types: no edema (13.6%), anterior corner (36.6%), around-the-cage focal (48.0%), and diffuse (1.8%). Anterior corner BME was significantly associated with instances of single cage placement than in dual cages (42.6% vs. 24.7%, P =0.0002). Single cages had a significantly higher rate of BME than dual cages (92.0% vs. 75.3%, P <0.0001). The extent of BME was significantly greater in the single cage cohort (36.9% vs. 24.2% in dual cages, P <0.0001). CONCLUSIONS This serves as the first study demonstrating the patterns of BME associated with normal healing following lumbar interbody fusion procedures. Anterior corner BME and around-the-cage focal BME were the most common patterns encountered, with diffuse BME a relatively rare pattern. These findings might contribute to the better differentiation of postoperative pathological events from normal healing following lumbar interbody fusion. LEVEL OF EVIDENCE 4.
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Dong ST, Zhu J, Yang H, Huang G, Zhao C, Yuan B. Development and Internal Validation of Supervised Machine Learning Algorithm for Predicting the Risk of Recollapse Following Minimally Invasive Kyphoplasty in Osteoporotic Vertebral Compression Fractures. Front Public Health 2022; 10:874672. [PMID: 35586015 PMCID: PMC9108356 DOI: 10.3389/fpubh.2022.874672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background The published literatures indicate that patients with osteoporotic vertebral compression fractures (OVCFs) benefit significantly from percutaneous kyphoplasty (PKP), but this surgical technique is associated with frequent postoperative recollapse, a complication that severely limits long-term postoperative functional recovery. Methods This study retrospectively analyzed single-segment OVCF patients who underwent bilateral PKP at our academic center from January 1, 2017 to September 30, 2019. Comparing the plain films of patients within 3 days after surgery and at the final follow-up, we classified patients with more than 10% loss of sagittal anterior height as the recollapse group. Univariate and multivariate logistic regression analyses were performed to determine the risk factors affecting recollapse after PKP. Based on the logistic regression results, we constructed one support vector machine (SVM) classifier to predict recollapse using machine learning (ML) algorithm. The predictive performance of this prediction model was validated by the receiver operating characteristic (ROC) curve, 10-fold cross validation, and confusion matrix. Results Among the 346 consecutive patients (346 vertebral bodies in total), postoperative recollapse was observed in 40 patients (11.56%). The results of the multivariate logistical regression analysis showed that high body mass index (BMI) (Odds ratio [OR]: 2.08, 95% confidence interval [CI]: 1.58–2.72, p < 0.001), low bone mineral density (BMD) T-scores (OR: 4.27, 95% CI: 1.55–11.75, p = 0.005), presence of intravertebral vacuum cleft (IVC) (OR: 3.10, 95% CI: 1.21–7.99, p = 0.019), separated cement masses (OR: 3.10, 95% CI: 1.21–7.99, p = 0.019), cranial endplate or anterior cortical wall violation (OR: 0.17, 95% CI: 0.04–0.79, p = 0.024), cement-contacted upper endplate alone (OR: 4.39, 95% CI: 1.20–16.08, p = 0.025), and thoracolumbar fracture (OR: 6.17, 95% CI: 1.04–36.71, p = 0.045) were identified as independent risk factors for recollapse after a kyphoplasty surgery. Furthermore, the evaluation indices demonstrated a superior predictive performance of the constructed SVM model, including mean area under receiver operating characteristic curve (AUC) of 0.81, maximum AUC of 0.85, accuracy of 0.81, precision of 0.89, and sensitivity of 0.98. Conclusions For patients with OVCFs, the risk factors leading to postoperative recollapse were multidimensional. The predictive model we constructed provided insights into treatment strategies targeting secondary recollapse prevention.
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Affiliation(s)
- Sheng-tao Dong
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jieyang Zhu
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hua Yang
- Department of Otolaryngology, Head and Neck Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guangyi Huang
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chenning Zhao
- Department of Orthopedics, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Bo Yuan
- Department of Reparative and Reconstructive Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Bo Yuan
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Posterior Fixation Combined with Vertebroplasty or Vertebral Column Resection for the Treatment of Osteoporotic Vertebral Compression Fractures with Intravertebral Cleft Complicated by Neurological Deficits. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4126818. [PMID: 31915692 PMCID: PMC6931022 DOI: 10.1155/2019/4126818] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/23/2019] [Accepted: 11/26/2019] [Indexed: 12/28/2022]
Abstract
Purpose The aim of the current study was to evaluate the relative benefits of posterior fixation combined with vertebroplasty (PFVP) or vertebral column resection (PVCR) for osteoporotic vertebral compression fractures (OVCFs) with intravertebral cleft (IVC) complicated by neurological deficits. Methods From June 2010 to January 2015, 45 consecutive patients suffering OVCFs with IVC and spinal cord injuries were treated with PFVP or PVCR in our department. The visual analogue scale (VAS) score, anterior vertebral height (AVH), posterior vertebral height (PVH), local kyphotic angle (LKA), and neurologic function were evaluated and compared, and the operative duration, blood loss, and complications were also recorded. Results They all achieved excellent pain relief, vertebral height recovery, and kyphosis correction one month after surgery, and no significant differences existed between the two groups. No significant differences were observed between the 1-month postoperative and final follow-up VAS, AVH, and LKA values in the PVCR group (P > 0.05), while AVH and LKA worsened in the PFVP group at the final follow-up (P < 0.05). Similarly, the initial improvements in VAS scores decreased over time (P < 0.05). Neurologic function improved in both groups, and no significant differences were observed between the 2 groups either preoperatively or postoperatively (P > 0.05). The blood loss and operative duration were significantly lower in the PFVP group than those in the PVCR group (P < 0.05). Conclusion Compared with PVCR, PFVP had equivalent short-term clinical outcomes with less blood loss and operative duration which can be very beneficial for treating elderly patients with extreme comorbidities in this condition. However, based on the long-term efficacy of pain relief, vertebral height maintenance, and deformity correction, PVCR is a more reasonable choice.
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The Prognostic Significance of Pedicle Enhancement from Contrast-enhanced MRI for the Further Collapse in Osteoporotic Vertebral Compression Fractures. Spine (Phila Pa 1976) 2018; 43:1586-1594. [PMID: 29649091 DOI: 10.1097/brs.0000000000002672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective observational study. OBJECTIVE The aim of this study was to investigate the prognostic significance of contrast-enhanced magnetic resonance imaging (MRI) for detecting pedicle enhancement and predicting future collapse in patients with acute benign osteoporotic vertebral compression fracture (OVCF). SUMMARY OF BACKGROUND DATA Traditional morphological classification regarding compression versus burst fractures cannot accurately anticipate the prognosis of further collapse. Identifying subgroups with a higher risk for further collapse may be beneficial in determining the treatment modality, which should be decided immediately after the injury. METHODS One hundred fourteen patients with benign OVCFs who, at the onset, underwent contrast-enhanced spine MRI between 2003 and 2016 were retrospectively analyzed. Patients were recruited on the basis of predefined inclusion and exclusion criteria. The primary outcome was the compression progression rate; other potential variables included demographic and clinical characteristics, initial compression rates, and kyphotic angles. In addition, other structural abnormalities on MRI were assessed. The compression progression rates were compared according to pedicle enhancement, and the prognostic significance of pedicle enhancement for further collapse were analyzed. RESULTS Further compression progression rates were significantly higher in the pedicle-enhanced (PE) group than in the nonenhanced (NE) group. Multivariate logistic analysis revealed that pedicle enhancement may be associated with further compression progression ≥10%. The vertebral augmentation (VAG) protective effect against collapse was only significant within the PE group, while bone densitometry and patients' mobility were significant only within the NE group. The log-rank test revealed a statistically significant difference in the rates of further collapse ≥10% during the 1 year between the groups. CONCLUSION Sign of pedicle enhancement is a potential risk factor for further compression progression. Contrast-enhanced MRI should be performed at the onset to better determine the future risk of collapse and to choose a better treatment modality for benign OVCF patients. LEVEL OF EVIDENCE 3.
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Wakao N, Takeuchi M, Riew DK, Hirasawa A, Imagama S, Kawanami K, Matsuo T, Murotani K, Deie M. Effect of an intensive conservative therapy with daily teriparatide administration and rehabilitation for osteoporotic delayed vertebral collapse and paralysis. Medicine (Baltimore) 2018; 97:e10906. [PMID: 29879028 PMCID: PMC5999469 DOI: 10.1097/md.0000000000010906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Although patients with osteoporotic delayed vertebral collapse (ODVC) have frequently been treated surgically, the efficacy and limitation of conservative treatment for it have not yet been reported. The purpose of this study was to investigate the effectiveness and limitation of further intensive conservative treatment for patients with ODVC.Patients treated for ODVC from 2011 to 2014 with a follow-up period of more than 1 year were eligible. The fundamental treatment strategy consisted of surgical treatment following intensive conservative treatment with daily teriparatide and rehabilitation for 3 months. We conducted a surgical treatment for patients who could not keep standing position by themselves because of prolonged leg paralysis or intolerable back pain. We performed a logistic regression model in which surgical treatment was set as an objective variable, and other related factors including sex, age, the level of affected vertebrae, the quality of paralysis, changing rate (δ) of spinal canal encroachment, local kyphotic angle, mobility of collapsed vertebrae, EuroQol questionnaires (EQ5D), numerical rating scale (NRS), and Frankel grade as explanatory variables. We also plotted receiver operating curves (ROCs) to investigate the cutoff values of parameters at the baseline.Thirty patients (6 males and 24 females, mean age 76.7 years) were enrolled. Eventually 12 out of 30 patients avoided surgical treatment because their symptoms were improved. Logistic regression showed that δ of local kyphotic angle (odds ratio: 1.072), P = .01), mobility of collapsed vertebrae (1.063, 0.01), EQ5D (0.98, 0.04), and NRS (1.113, 0.01) were significantly correlated with the need for surgical treatments. Among the factors at baseline, only the mobility of collapsed vertebrae showed a significant value of area under a curve (AUC = 0.727, P = .008).The results that 40% of patients with ODVC did not need further surgical treatment after the intensive conservative treatment was of great significance. Patients with greater mobility of collapsed vertebrae might be treated surgically as quickly as possible.
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Affiliation(s)
- Norimitsu Wakao
- Department of Spine Center
- Department of Orthopedic Surgery, Clinical Research Center, Aichi Medical University, Yazako,Nagakute-city, Aichi-pref, Japan
| | | | - Daniel K. Riew
- Department of Orthopedic Surgery, Columbia University, New York, NY
| | | | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University, Nagoya
| | - Katsuhisa Kawanami
- Department of Orthopedic Surgery, Clinical Research Center, Aichi Medical University, Yazako,Nagakute-city, Aichi-pref, Japan
| | - Toshihiro Matsuo
- Department of Orthopedic Surgery, Clinical Research Center, Aichi Medical University, Yazako,Nagakute-city, Aichi-pref, Japan
| | - Kenta Murotani
- Division of Biostatistics, Clinical Research Center, Aichi Medical University, Yazako,Nagakute-city, Aichi-pref, Japan
| | - Masataka Deie
- Department of Orthopedic Surgery, Clinical Research Center, Aichi Medical University, Yazako,Nagakute-city, Aichi-pref, Japan
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Jacobson RE, Palea O, Granville M. Progression of Vertebral Compression Fractures After Previous Vertebral Augmentation: Technical Reasons for Recurrent Fractures in a Previously Treated Vertebra. Cureus 2017; 9:e1776. [PMID: 29255655 PMCID: PMC5732011 DOI: 10.7759/cureus.1776] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
It is well recognized that patients can develop additional vertebral compression fractures (VCF) in an adjacent vertebra or at another vertebral level after successful vertebral augmentation. Factors such as the patient's bone mineral density, post procedure activity, and chronic corticosteroid use contribute to an increased risk of re-fracture or development of new fractures in the first three months after the initial procedure. However, there is a very small subgroup of patients that have unchanged or worse pain after the vertebral augmentation that may indicate continued progression of the treated compression fracture or a recurrent fracture at the previously treated level. This review examines the clinical findings, radiologic signs, and intraprocedural technical failures that may occur during the initial vertebral augmentation that can lead to a progressive fracture in a previously treated vertebra. Causes of failure of the initial vertebral augmentation procedure include inadequate or incomplete filling of the fracture site, the cement missing the actual fracture allowing continued osteoporotic compression, and persistent or worsened intravertebral fluid-filled clefts. The existence of an unfilled intravertebral fluid cleft on preoperative diagnostic studies is the most important indicator of risk for progression as is the later development of fluid at the bone cement interface.
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Affiliation(s)
| | - Ovidiu Palea
- Anesthesiology and Pain Management, Provita Hospital
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Guo D, Cai J, Zhang S, Zhang L, Feng X. Treating osteoporotic vertebral compression fractures with intraosseous vacuum phenomena using high-viscosity bone cement via bilateral percutaneous vertebroplasty. Medicine (Baltimore) 2017; 96:e6549. [PMID: 28383423 PMCID: PMC5411207 DOI: 10.1097/md.0000000000006549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Osteoporotic vertebral compression fractures with intraosseous vacuum phenomena could cause persistent back pains in patients, even after receiving conservative treatment. The aim of this study was to evaluate the efficacy of using high-viscosity bone cement via bilateral percutaneous vertebroplasty in treating patients who have osteoporotic vertebral compression fractures with intraosseous vacuum phenomena.Twenty osteoporotic vertebral compression fracture patients with intraosseous vacuum phenomena, who received at least 2 months of conservative treatment, were further treated by injecting high-viscosity bone cement via bilateral percutaneous vertebroplasty due to failure of conservative treatment. Treatment efficacy was evaluated by determining the anterior vertebral compression rates, visual analog scale (VAS) scores, and Oswestry disability index (ODI) scores at 1 day before the operation, on the first day of postoperation, at 1-month postoperation, and at 1-year postoperation.Three of 20 patients had asymptomatic bone cement leakage when treated via percutaneous vertebroplasty; however, no serious complications related to these treatments were observed during the 1-year follow-up period. A statistically significant improvement on the anterior vertebral compression rates, VAS scores, and ODI scores were achieved after percutaneous vertebroplasty. However, differences in the anterior vertebral compression rate, VAS score, and ODI score in the different time points during the 1-year follow-up period was not statistically significant (P > 0.05).Within the limitations of this study, the injection of high-viscosity bone cement via bilateral percutaneous vertebroplasty for patients who have osteoporotic vertebral compression fractures with intraosseous vacuum phenomena significantly relieved their back pains and improved their daily life activities shortly after the operation, thereby improving their life quality. In this study, the use of high-viscosity bone cement reduced the leakage rate and contributed to their successful treatment, as observed in patients during the 1-year follow-up period.
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Lee JM, Lee YS, Kim YB, Park SW, Kang DH, Lee SH. What Effects Does Necrotic Area of Contrast-Enhanced MRI in Osteoporotic Vertebral Fracture Have on Further Compression and Clinical Outcome? J Korean Neurosurg Soc 2017; 60:181-188. [PMID: 28264238 PMCID: PMC5365295 DOI: 10.3340/jkns.2016.0707.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/19/2016] [Accepted: 11/17/2016] [Indexed: 01/25/2023] Open
Abstract
Objective The objective of this study was to analyze the correlation between further compression and necrotic area in osteoporotic vertebral fracture (OVF) patients with contrast-enhanced magnetic resonance imaging (CEMRI). In addition, we investigated the radiological and clinical outcome according to the range of the necrotic area. Methods Between 2012 and 2014, the study subjects were 82 OVF patients who did not undergo vertebroplasty or surgical treatment. The fracture areas examined on CEMRI at admission were defined as edematous if enhancement was seen and as necrotic if no enhancement was seen. The correlation between further compression and the necrotic and edematous areas of CEMRI, age, and bone mineral density was examined. Also, necrotic areas were classified into those with less than 25% (non-necrosis group) and those with more than 25% (necrosis group) according to the percentages of the entire vertebral body. For both groups, further compression and the changes in wedge and kyphotic angles were examined at admission and at 1 week, 3 months, and 6 months after admission, while the clinical outcomes were compared using the visual analog scale (VAS) and Eastern Cooperative Oncology Group (ECOG) performance status grade. Results Further compression was 14.78±11.11% at 1 month and 21.75±14.43% at 6 months. There was a very strong correlation between the necrotic lesion of CEMRI and further compression (r=0.690, p<0.001). The compression of the necrosis group was 33.52±12.96%, which was higher than that of the non-necrosis group, 14.96±10.34% (p<0.005). Also, there was a statistically significantly higher number of intervertebral cleft development and surgical treatments being performed in the necrosis group than in the non-necrosis group (p<0.005). Moreover, there was a statistical difference in the decrease in the height of the vertebral body, and an increase was observed in the kyphotic change of wedge angle progression. There was also a difference in the VAS and ECOG performance scales. Conclusion The necrotic area of CEMRI in OVF had a strong correlation with further compression over time. In addition, with increasing necrosis, intervertebral clefts occurred more frequently, which induced kyphotic changes and resulted in poor clinical outcomes. Therefore, identifying necrotic areas by performing CEMRI on OVF patients would be helpful in determining their prognosis and treatment course.
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Affiliation(s)
- Ja Myoung Lee
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Seok Lee
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Baeg Kim
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seung Won Park
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Dong Ho Kang
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Shin Heon Lee
- Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea
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Takahashi S, Hoshino M, Takayama K, Iseki K, Sasaoka R, Tsujio T, Yasuda H, Sasaki T, Kanematsu F, Kono H, Toyoda H, Nakamura H. Time course of osteoporotic vertebral fractures by magnetic resonance imaging using a simple classification: a multicenter prospective cohort study. Osteoporos Int 2017; 28:473-482. [PMID: 27577726 DOI: 10.1007/s00198-016-3737-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 08/10/2016] [Indexed: 11/30/2022]
Abstract
UNLABELLED This study revealed the time course of osteoporotic vertebral fracture by magnetic resonance imaging using a simple classification. Signal changes were associated with the compression degree and mobility of the fractured vertebral body. This classification showed sufficient reliability in categorizing magnetic resonance imaging findings of osteoporotic vertebral fractures. INTRODUCTION Magnetic resonance imaging (MRI) is useful in diagnosing osteoporotic vertebral fractures (OVFs). This study investigated the time course of OVFs by MRI using a simple classification. METHODS This multicenter cohort study was performed from 2012 to 2015. Consecutive patients with ≤2-week-old OVFs were enrolled in 11 institutions. MRI was performed at enrollment and at 1-, 3-, 6-, and 12-month follow-up. Signal changes on T1-weighted imaging (T1WI), T2WI, and short τ inversion recovery (STIR) were classified according to signal intensity. Height and angular motion of vertebral bodies were also measured. RESULTS The 6-month follow-up was completed by 153 patients. At enrollment, fractured vertebrae signal changes were 43 % diffuse and 57 % confined low on T1WI; on T2WI, 56, 24, and 5 % were confined low, high, and diffuse low, respectively; on STIR, 100 % were high. On T1WI, diffuse low remained most common (90 % at 1 month and 60 % at 3 months) until 6 and 12 months, when most were confined low (54 and 52 %, respectively). On T2WI, confined low remained most common (decreasing to 41 % at 12 months). On STIR, high signal change was shown in 98, 87, and 64 % at 3, 6, and 12 months, respectively. At 3, 6, and 12 months, diffuse low signal change was associated with significantly lower vertebral height, and high signal change was associated with significantly greater angular motion. CONCLUSIONS MRI signal changes were associated with the compression degree and angular motion of fractured vertebrae. This classification showed sufficient reliability in categorizing MRI findings of OVFs.
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Affiliation(s)
- S Takahashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
| | - M Hoshino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - K Takayama
- Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai, Osaka, Japan
| | - K Iseki
- Department of Orthopaedic Surgery, Sato Hospital, Osaka, Japan
| | - R Sasaoka
- Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - T Tsujio
- Department of Orthopaedic Surgery, Shiraniwa Hospital, Ikoma, Nara, Japan
| | - H Yasuda
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - T Sasaki
- Department of Orthopaedic Surgery, Nishinomiya Watanabe Hospital, Nishinomiya, Hyogo, Japan
| | - F Kanematsu
- Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital, Osaka, Japan
| | - H Kono
- Department of Orthopaedic Surgery, Ishikiri Seiki Hospital, Higashi Osaka, Osaka, Japan
| | - H Toyoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - H Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Ahn SE, Ryu KN, Park JS, Jin W, Park SY, Kim SB. Early Bone Marrow Edema Pattern of the Osteoporotic Vertebral Compression Fracture : Can Be Predictor of Vertebral Deformity Types and Prognosis? J Korean Neurosurg Soc 2016; 59:137-42. [PMID: 26962419 PMCID: PMC4783479 DOI: 10.3340/jkns.2016.59.2.137] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 01/12/2016] [Accepted: 01/16/2016] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate whether an early bone marrow edema pattern predicts vertebral deformity types and prognosis in osteoporotic vertebral compression fracture (OVCF). Methods This retrospective study enrolled 64 patients with 75 acute OVCFs who underwent early MRI and followed up MRI. On early MRI, the low SI pattern of OVCF on T1WI were assessed and classified into 3 types (diffuse, globular or patchy, band-like). On followed up MRI, the vertebral deformity types (anterior wedge, biconcave, crush), degree of vertebral body height loss, incidence of vertebral osteonecrosis and spinal stenosis were assessed for each vertebral fracture types. Results According to the early bone marrow edema pattern on T1WI, 26 vertebrae were type 1, 14 vertebrae were type 2 and 35 vertebrae were type 3. On followed up MRI, the crush-type vertebral deformity was most frequent among the type 1 OVCFs, the biconcave-type vertebral deformity was most frequent among the type 2 OVCFs and the anterior wedge-type vertebral deformity was most frequent among the type 3 OVCFs (p<0.001). In addition, type 1 early bone marrow edema pattern of OVCF on T1WI were associated with higher incidence of severe degree vertebral body height loss, vertebral osteonecrosis and spinal stenosis on the follow up MRI. Conclusion Early bone marrow edema pattern of OVCF on T1WI, significant correlated with vertebral deformity types on the follow up MRI. The severe degree of vertebral height loss, vertebral osteonecrosis, and spinal stenosis were more frequent in patients with diffuse low SI pattern.
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Affiliation(s)
- Sung Eun Ahn
- Department of Radiology, Graduate School, Kyung Hee University, Seoul, Korea.; Department of Radiology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kyung Nam Ryu
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ji Seon Park
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - So Young Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Bum Kim
- Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
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Zou D, Zhang K, Ren Y. Therapeutic effects of PKP on chronic painful osteoporotic vertebral compression fractures with or without intravertebral cleft. Int J Clin Exp Med 2015; 8:15780-15786. [PMID: 26629076 PMCID: PMC4658965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 08/06/2015] [Indexed: 06/05/2023]
Abstract
This study aims to investigate clinical effects of protruding after percutaneous vertebral plasty (PKP holds) for treatment of chronic painful osteoporotic vertebral compression fractures (CPOVCFs), and assess its safety and effectiveness. One hundred and eighteen CPOVCFs patients were included, and analyzed and followed up therapeutic effects of PKP holds. All of these patients were divided into NIVC (73 cases) and IVC (45 cases) group. Comparing operation time, bone cement perfusion, pain intensity modulus visual grading scoring, Oswestry disability index, fracture fanterior relative height, local convex Angle, and surgical complications between the two groups. There were no significant differences between two groups for operation time of PKP holds (P>0.05). Amount of bone cement injection in IVC groups was significantly higher compared to NIVC group (P<0.05). Pain intensity visual modulus ratings and Oswestry disability index were significantly improved in both groups after surgery and postoperative follow-up period compared to pre-operation (P<0.05). Fracture fanterior margin relative height and local convex angle were also significantly improved (P<0.05). Fracture fanterior margin relative height was also significantly improved for IVC compared to NIVC group (P<0.05). There were no differences for bone cement leakage rate and adjacent segment fracture between two groups (P>0.05). But there was a case of bone cement loose, which needs to be treated for further step. In conclusion, PKP holds is a kind of effective and safe method for the IVC and NIVC patients. Especially for the IVC patients, PKP holds can significantly improve the fracture fanterior margin relative height.
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Affiliation(s)
- Debo Zou
- Department of Spine Surgery, Shandong Provincial Qianfoshan Hospital Jinan 250014, Shandong, P. R. China
| | - Kaining Zhang
- Department of Spine Surgery, Shandong Provincial Qianfoshan Hospital Jinan 250014, Shandong, P. R. China
| | - Yanjun Ren
- Department of Spine Surgery, Shandong Provincial Qianfoshan Hospital Jinan 250014, Shandong, P. R. China
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Basivertebral foramen could be connected with intravertebral cleft: a potential risk factor of cement leakage in percutaneous kyphoplasty. Spine J 2014; 14:1551-8. [PMID: 24314766 DOI: 10.1016/j.spinee.2013.09.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 07/24/2013] [Accepted: 09/19/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND CONTEXT Among different types of cement leakage in percutaneous kyphoplasty (PKP) for osteoporotic vertebral body compression fractures, leaks into the spinal canal are considered to be the most common complication. One potential structure causing this type of cement leakage is the potential connection between the basivertebral foramen and the intravertebral cleft, which is revealed clearly on magnetic resonance (MR) images, but is often ignored in the literature. PURPOSE The purpose of this study is to assess the incidence rate of different types of cement leakage in PKP with or without intravertebral clefts and to determine whether the basivertebral foramen could be connected to the intravertebral cleft. STUDY DESIGN This study is a retrospective assessment of the presence of an intravertebral cleft in osteoporotic vertebral bodies and the different types of cement leakage after PKP on radiographs, computed tomographic (CT) scans, and MR images. PATIENT SAMPLE A total of 164 consecutive patients underwent PKP to treat 204 osteoporotic vertebral compression fractures. OUTCOME MEASURES Outcome measures include the occurrence of different types of cement leakage in the groups with an intravertebral cleft and without intravertebral clefts. METHODS A total of 204 vertebrae in 164 consecutive patients who underwent PKP to treat osteoporotic vertebral compression fractures were classified into two patterns based on preoperative radiographs, CT scans, and/or MR images of the treated levels: cleft pattern (with an intravertebral cleft in the vertebral body) and trabecular pattern (without intravertebral clefts). When an intravertebral cleft was identified, the investigators examined the basivertebral foramen and looked for a communication between the two structures on three-dimensional CT scans and MR images. On direct postoperative images, the patterns of cement leakage were classified as five types: type A, through a cortical defect into the paraspinal soft tissues; type B, through the basivertebral foramen; type C, via the needle channel; type D, through a cortical defect into the disc space; and type E, via the paravertebral vein. The association of the distribution of the cement leakage and the presence of an intravertebral cleft was analyzed retrospectively. Moreover, the association of type B leakage with the communication between the basivertebral foramen and the intravertebral cleft was also assessed. RESULTS The average interobserver kappa values for determining the type of cement leakage and the presence of intravertebral cleft were 0.916 (range, 0.792-1) and 0.935, respectively. In 41 of 204 vertebrae (19.9%), an intravertebral cleft was confirmed on preoperative images. A communication between the intravertebral cleft and the basivertebral foramen was seen in 10 vertebrae (24.4%). Cement leakage was 36.2% in the group with a trabecular pattern and 41.5% in the group with a cleft pattern (p>.05). Leaks through the basivertebral foramen (type B; N=30, 14.7%) and through cortical defects into the disc space (type D; N=14, 6.9%) were more common than other types. Twenty of 163 vertebrae with the trabecular pattern (12.3%) and 10 of 41 vertebrae with the cleft pattern (24.4%) were identified as type B leaks, which reached statistical significance (p<.05). There was no statistical difference between the trabecular pattern and the cleft pattern on other types of leaks. CONCLUSIONS Type B leaks are more common in vertebrae with an intravertebral cleft, which supports the presence of a connection between an intravertebral cleft and the basivertebral foramen. Thus, care must be taken when PKP is performed in these patients to avoid direct cement leakage into the spinal canal through the basivertebral foramen.
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Patil S, Nene AM. Predictors of kyphotic deformity in osteoporotic vertebral compression fractures: a radiological study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:2737-42. [DOI: 10.1007/s00586-014-3457-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 07/01/2014] [Accepted: 07/02/2014] [Indexed: 10/25/2022]
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Chen B, Fan S, Zhao F. Percutaneous balloon kyphoplasty of osteoporotic vertebral compression fractures with intravertebral cleft. Indian J Orthop 2014; 48:53-9. [PMID: 24600064 PMCID: PMC3931154 DOI: 10.4103/0019-5413.125498] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Intravertebral cleft is a structural change in osteoporotic vertebral compression fractures (OVCF), which is the manifestation of ischemic vertebral osteonecrosis complicated with fracture nonunion and pseudoarthrosis and appears in the late stage of OVCF. Despite numerous studies on OVCF, few aim to evaluate the clinicoradiological characteristics and clinical significance of intravertebral cleft in OVCF. This study investigates clinicoradiological characteristics of intravertebral cleft in OVCF and the effect on the efficacy of percutaneous balloon kyphoplasty (PKP). MATERIALS AND METHODS PKP was performed on 139 OVCF patients without intravertebral cleft (group A) and 44 OVCF patients with intravertebral cleft (group B). The frequency distribution of the affected vertebral body, bone cement infusion volume, imaging manifestation, leakage rate and type, preoperative and postoperative height of the affected vertebral body, visual analog scale (VAS) and Oswestry disability index (ODI) score were evaluated. RESULTS Significant differences were found in the frequency distribution of the affected vertebral body and bone cement leakage type between the two groups (P < 0.05). However, differences in bone cement infusion volume and leakage rate (P > 0.05) were not detected. In both groups, the postoperative height of the affected vertebral body was significantly improved (P < 0.05). The restoration of vertebral body height in group B was more evident than that in group A (P < 0.05). The preoperative VAS and ODI scores in group B were significantly higher than those in group A (P < 0.05). After surgical treatment, pain relief and daily activity function in both groups were significantly improved (P < 0.05), and no significant difference in postoperative scores was detected between the two groups (P > 0.05). CONCLUSION Intravertebral cleft exhibits specific clinical and imaging as well as bone cement formation characteristics. PKP can effectively restore the affected vertebral body height, alleviate pain, and improve daily activity function of patients.
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Affiliation(s)
- Bao Chen
- Department of Orthopedics, Jiaxing Second Hospital, Jiaxing 314000, China
| | - Shunwu Fan
- Department of Orthopedics, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China,Address for correspondence: Dr. Shunwu Fan, Department of Orthopedics, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, No. 3 Qingchun East Road, Hangzhou 310016, China. E-mail:
| | - Fengdong Zhao
- Department of Orthopedics, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310016, China
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Contrast-enhanced MRI for detecting intravertebral cleft formation: relation to the time since onset of vertebral fracture. AJR Am J Roentgenol 2013; 201:W117-23. [PMID: 23789683 DOI: 10.2214/ajr.12.9621] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the advantages of contrast-enhanced MRI (CE-MRI) for detecting intravertebral clefts over unenhanced MRI in relation to the time since onset of vertebral fracture. MATERIALS AND METHODS In this retrospective study, a total of 115 patients (88 women, 27 men; mean age, 77.1 years) who underwent percutaneous vertebroplasty for a single-level compression fracture within 7 days of preprocedural MRI were enrolled. Two radiologists evaluated preprocedural unenhanced MRI (T1-weighted and STIR) and CE-MRI examinations for intravertebral clefts on separate days by consensus. The time from the onset of fracture to MRI was classified into three groups: early phase fractures (< 1 month), late phase fractures (1-3 months), and chronic phase fractures (≥ 3 months). The cement distribution during percutaneous vertebroplasty was used as a reference standard, and detectability of clefts was compared between unenhanced MRI and CE-MRI in relation to the time frame. An analog of the McNemar test was used for analyses. RESULTS There were 104 patients (90.4%) with and 11 patients (9.6%) without a cleft. The sensitivities of unenhanced MRI and CE-MRI, respectively, for detecting clefts were 60.9% and 91.3% for early phase fractures (p = 0.02); 78.6% and 100% for late phase fractures (p = 0.014); and 92.5% and 94.3% for chronic phase fractures (p = 0.3). The specificities were the same for both groups (100% for each time frame). CONCLUSION CE-MRI is more sensitive than unenhanced MRI for detecting intravertebral clefts in patents with benign compression fractures less than 3 months old.
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