Seo Jun-Yeong, Kwon Yong-Suk, Kim Kwang-Jung, Shin Jee-Yong, Kim Young-Hoon, Ha Kee-Yong
Department of Orthopaedic Surgery, Jeju National University Hospital, School of Medicine, Jeju National University, Jeju, Republic of Korea.
School of Medicine, Jeju National University, Jeju, Republic of Korea.
Injury. 2017 Jul;48(7):1503-1509. doi: 10.1016/j.injury.2017.04.057. Epub 2017 Apr 26.
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.
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.
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). 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.
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.
为预测椎管受压情况，采用磁共振成像（MRI）对X线平片进行评估有助于检测椎体塌陷并预防神经功能缺损的发生。
对2012年1月至2014年12月期间发生骨质疏松性椎体骨折（OVF）的患者进行连续的影像学评估，包括测量椎体前缘高度丢失（AHL）、椎体后缘高度丢失（PHL）和后凸角（KA）。采用AOSpine胸腰椎损伤分类系统对骨折形态进行分类。在初次评估时进行MRI检查，并计算所有患者的椎管侵占程度（CE）。对随访X线片显示有明显高度丢失的患者进行随访计算机断层扫描（CT）或MRI检查。还评估了T1加权和T2加权MRI上的骨折模式。
共有485例患者到我院治疗OVF，97例患者被纳入研究；其中男性15例，女性82例。初次就诊时的平均年龄为70.3±14.6岁。初次椎管CE与初次PHL和初次AHL相关。随访CE与年龄、初次PHL以及初次和末次PHL之间的差值（ΔPHL）相关。双终板骨折的OVF比单终板骨折的OVF后壁塌陷的倾向更大。在初次T1加权矢状位MRI上，骨折椎体的弥漫性低信号改变模式与PHL相关。4例患者出现延迟性神经功能缺损。这些患者接受了手术干预。
对于单纯压缩性骨折患者，应关注椎体后壁、双终板以及T1加权MRI表现，以便早期发现可能产生严重后果的椎管受压情况。
