Möller Anders, Maly Pavel, Besjakov Jack, Hasserius Ralph, Ohlin Acke, Karlsson Magnus K
Department of Orthopaedics, Malmö University Hospital, Malmö, Sweden.
Spine (Phila Pa 1976). 2007 Oct 15;32(22):2487-92. doi: 10.1097/BRS.0b013e3181573d6a.
Observational cohort study.
To evaluate by MRI whether a vertebral fracture during childhood is a risk factor for degeneration of adjacent discs.
Several studies infer that trauma is a major cause of disc degeneration. Only 1 study has by magnetic resonance imaging (MRI) evaluated disc degeneration in children with a former thoracic or lumbar vertebral fracture. That study reported a 50% prevalence of degenerative disc changes 4 years after the fracture. However, due to the sparse literature, it is still unclear whether a vertebral fracture in childhood represents a risk factor for disc degeneration in a long-term perspective.
Nine boys and 11 girls with a mean age of 12 years (range, 7-16 years) when sustaining a lumbar or thoracic vertebral fracture without neurologic deficits were examined at a mean of 40 years (range, 33-53 years) after the injury. Eighteen of the subjects had 1-column compression fractures, and 2 had Denis Type B burst fractures. All were mobilized without brace or surgery directly after being injured. A favorable long-term clinical and plain radiographic outcome has previously been reported for this cohort. In the present study, the intervertebral discs were evaluated with MRI by applying the Oner classification scheme. Degenerative disc changes were defined as loss of signal intensity on T2-weighted images with or without disc height reduction.
Degenerative changes were not more prevalent in discs adjacent to the previously fractured vertebrae than in discs at a distance from those segments. However, there were more Schmorl's nodes at the disc levels adjacent to the earlier fractures.
Stable vertebral fractures in childhood with no neurologic deficits at injury do not render more degenerative changes than can be expected according to age, but they are associated with more Schmorl's nodes at adjacent disc levels.
观察性队列研究。
通过磁共振成像（MRI）评估儿童期椎体骨折是否为相邻椎间盘退变的危险因素。
多项研究推断创伤是椎间盘退变的主要原因。仅有1项研究通过磁共振成像（MRI）评估了曾有胸椎或腰椎骨折的儿童的椎间盘退变情况。该研究报告称骨折后4年椎间盘退变改变的患病率为50%。然而，由于文献稀少，从长期来看儿童期椎体骨折是否为椎间盘退变的危险因素仍不清楚。
对9名男孩和11名女孩进行检查，他们在腰椎或胸椎骨折时平均年龄为12岁（范围7 - 16岁），且无神经功能缺损，受伤后平均40年（范围33 - 53岁）接受检查。其中18名受试者为单柱压缩骨折，2名受试者为Denis B型爆裂骨折。所有患者受伤后均未使用支具或手术，直接进行活动。此前已报道该队列有良好的长期临床和X线平片结果。在本研究中，采用Oner分类方案通过MRI评估椎间盘。椎间盘退变改变定义为T2加权图像上信号强度降低，伴或不伴有椎间盘高度降低。
与先前骨折椎体相邻的椎间盘退变改变并不比远离这些节段的椎间盘更普遍。然而，在早期骨折相邻的椎间盘水平有更多的许莫氏结节。
儿童期无神经功能缺损的稳定性椎体骨折不会导致比按年龄预期更多的退变改变，但与相邻椎间盘水平更多的许莫氏结节相关。
