Relationship between vertebral instability caused by
intravertebral clefts and neurologic injury

doi:10.3969/j.issn.2095-4344.2668

Abstract

Abstract:

BACKGROUND: The details of clinical symptoms of osteoporotic vertebral fracture with intravertebral clefts are poorly understood at present.

OBJECTIVE: To investigate the relationship between clinical symptoms and imaging features of osteoporotic vertebral fracture with intravertebral clefts.

METHODS: Clinical data of 168 patients with single-level osteoporotic vertebral fracture with intravertebral clefts were retrospectively analyzed. The clinical symptoms were evaluated by Visual Analogue Scale score and Oswestry Disability Index. The incidence of delayed neurologic deficit was recorded. X-ray was used to measure the local kyphosis angle and vertebral instability, and CT was used to diagnose the posterior wall fracture of the vertebral body. The relationship between clinical symptoms and imaging features of osteoporotic vertebral fracture with intravertebral clefts was analyzed.

RESULTS AND CONCLUSION: (1) The Visual Analogue Scale score and Oswestry Disability Index were 7.7±1.6 and (62.9±19.2)%, respectively. Delayed neurologic deficit occurred in 37 patients (22.0%). Local kyphosis angle and vertebral instability was (16.8±7.7)° and (7.9±4.4)°, respectively. The incidence of posterior wall fracture was 89.8%. (2) The Visual Analogue Scale and Oswestry Disability Index were significantly correlated with vertebral instability (r=0.33, P < 0.001; r=0.53, P < 0.001), but had weak correlation with local kyphosis angle (r=-0.16, P=0.03; r=-0.16, P=0.03). (3) The incidence of vertebral instability in patients with delayed neurologic deficit was significantly higher than that in patients without delayed neurologic deficit (P < 0.001), but there was no difference in local kyphosis angle between two groups (P=0.18). All patients with delayed neurologic deficit had posterior wall fracture, but only 2/3 patients with posterior wall fracture had delayed neurologic deficit. (4) In summary, vertebral instability is one of the factors leading to clinical symptoms of osteoporotic vertebral fracture patients with intravertebral clefts. The vertebral instability may be the main cause of delayed neurologic deficit. In order to treat back pain and delayed neurologic deficit effectively, it is important to control vertebral instability of osteoporotic vertebral fracture patients with intravertebral clefts.

Key words: osteoporotic vertebral fracture, intravertebral clefts, delayed neurologic deficit, vertebral instability, Kümmell’s disease

CLC Number:

Sun Yiqiang, Wang Xiushuang, Li Jianjun, Wang Xin, Zhao Zihao, Xing Jianqiang, Tian Lin, Geng Xiaopeng. Relationship between vertebral instability caused by intravertebral clefts and neurologic injury [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(18): 2900-2905.

Figures/Tables 6

References

[1] 高志祥,李淳,李磊,等.单侧与双侧椎体后凸成形治疗骨质疏松性椎体骨折的Meta分析[J].中国组织工程研究, 2018,22(7): 1140-1148.
[2] 王复案,陈允震.骨质疏松性椎体压缩性骨折诊疗现状及其对策[J].中国骨质疏松杂志,2019,25(5):590-594+599.
[3] TROY KL. Measurement of bone: diagnosis of sci-induced osteoporosis and fracture risk prediction. Top Spinal Cord Inj Rehabil. 2015;21:267-274.
[4] CHOI JH, KANG HD, PARK JH, et al. The efficacy of fentanyl transdermal patch as the first-line medicine for the conservative treatment of osteoporotic compression fracture. Korean J Neurotrauma. 2017;13:130-136.
[5] KIDA K, TANI T, KAWAZOE T. Thoracic radicular pain caused by extravertebral gas and fluid collections associated with osteoporotic vertebral fracture containing a vacuum cleft. Case Rep Orthop. 2019;2019:4284217.
[6] NAKAMAE T, YAMADA K, TSUCHIDA Y, et al. Risk factors for cement loosening after vertebroplasty for osteoporotic vertebral fracture with intravertebral cleft: a retrospective analysis. Asian Spine J. 2018;12:935-942.
[7] ALPANTAKI K, DOHM M, KOROVESSIS P. Surgical options for osteoporotic vertebral compression fractures complicated with spinal deformity and neurologic deficit.Injury. 2018;49: 261-271.
[8] SINGH K, HELLER JG, SAMARTZIS D, et al. Open vertebral cement augmentation combined with lumbar decompression for the operative management of thoracolumbar stenosis secondary to osteoporotic burst fractures. J Spinal Disord Tech. 2005;18:413-419.
[9] KIM H, JUN S, PARK SK, et al. Intravertebral vacuum cleft sign: a cause of vertebral cold defect on bone scan.Skeletal Radiol. 2016;45:707-712.
[10] 常莹,麦筱莉,辛小燕,等. 骨质疏松性椎体压缩骨折骨不连的X线平片和CT及MRI影像学表现[J]. 中华实用诊断与治疗杂志, 2019,33(3)：279-282.
[11] LIN CL, LIN RM, HUANG KY, et al. MRI fluid sign is reliable in correlation with osteonecrosis after vertebral fractures: a histopathologic study. Eur Spine J. 2013;22:1617-1623.
[12] PARK HY, AHN JH, HA KY, et al. Clinical and radiologic features of osteoporotic spine fracture with delayed neurologic compromises. World Neurosurg. 2018.
[13] NAKAMAE T, FUJIMOTO Y, YAMADA K, et al. Percutaneous vertebroplasty for osteoporotic vertebral compression fracture with intravertebral cleft associated with delayed neurologic deficit. Eur Spine J. 2013;22:1624-1632.
[14] YEUNG YK. Delayed neurological deficits after osteoporotic vertebral fractures: clinical outcomes after surgery. Asian Spine J. 2017;11:981-988.
[15] NAKAMAE T, FUJIMOTO Y, YAMADA K, et al. Relationship between clinical symptoms of osteoporotic vertebral fracture with intravertebral cleft and radiographic findings. J Orthop Sci. 2017;22(2):201-206.
[16] 俞海明,李毅中,姚学东,等. 经皮椎体成形或经皮椎体后凸成形治疗伴椎体后壁塌陷Kummell病：如何个体化选择[J]. 中国组织工程研究, 2016, 20(26):3856-3862.
[17] KAWAGUCHI S, HORIGOME K, YAJIMA H, et al. Symptomatic relevance of intravertebral cleft in patients with osteoporotic vertebral fracture. J Neurosurg Spine. 2010; 13(2): 267-275.
[18] HOSHINO M, NAKAMURA H, TERAI H, et al. Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture. Eur Spine J. 2009;18(9):1279-1286.
[19] KIM DY, LEE SH, JANG JS, et al. Intravertebral vacuum phenomenon in osteoporotic compression fracture: report of 67 cases with quantitative evaluation of intravertebral instability. J Neurosurg Spine. 2004;100(1):24-31.
[20] ATAKA H, TANNO T, YAMAZAKI M. Posterior instrumented fusion without neural decompression for incomplete neurological deficits following vertebral collapse in the osteoporotic thoracolumbar spine. Eur Spine J. 2009;18(1): 69-76.
[21] GLASSMAN SD, ALEGRE GM. Adult spinal deformity in the osteoporotic spine: options and pitfalls. Instr Course Lect. 2003;52:579-588.
[22] FANG X, YU F, FU S, et al. Intravertebral clefts in osteoporotic compression fractures of the spine: incidence, characteristics, and therapeutic efficacy. Int J Clin Exp Med. 2015;8(9):16960.
[23] MOREIRA-GONZALEZ A,DJOHAN R.Considerations surrounding reconstruction after resection of musculoskeletal sarcomas. Cleve Clin J Med. 2010;77 Suppl 1:S18-22.
[24] 李哲,苏庆军,海涌.伴有椎体内裂隙征的骨质疏松性椎体压缩骨折的诊治进展[J].中国脊柱脊髓杂志,2017,27(7):647-651.
[25] WENGER DR. Diagnosis of bone and joint disorders. J Pediatr Orthop. 1988;8(6):725.
[26] FORMICA M, BASSO M, CAVAGNARO L, et al. Kümmell disease: Illustrative case for definition criteria. Spine J. 2016; 16(10): e707-e708.
[27] LIM J, CHOI SW, YOUM JY, et al. Posttraumatic delayed vertebral collapse: Kummell’s disease. J Korean Neurosurg Soc. 2018; 61(1):1-9.
[28] MCKIERNAN F, FACISZEWSKI T. Intravertebral clefts in osteoporotic vertebral compression fractures. Arthrit Rheum. 2014; 48(5):1414-1419.
[29] PARK JW, PARK JH, JEON HJ, et al. Kümmell's disease treated with percutaneous vertebroplasty: minimum 1 year follow-up. Korean J Neurotrauma.2017;13:119-123.
[30] TSUJIO T, NAKAMURA H, TERAI H, et al. Characteristic radiographic or magnetic resonance images of fresh osteoporotic vertebral fractures predicting potential risk for nonunion. Spine. 2011; 36(15):1229-1235.
[31] STÄBLER A, SCHNEIDER P, LINK TM, et al. Intravertebral vacuum phenomenon following fractures: CT study on frequency and etiology. J Comput Assist Tomogr. 1999;23(6): 976-980.