Department of Orthopaedics, Traumatology and Rehabilitation, Orthopaedic and Trauma Centre, CTO, Hospital Città della Salute e della Scienza, Via Zuretti 29, 10126, Turin, Italy.
School of Orthopaedics and Traumatology, University of the Studies of Turin, Via Zuretti 29, 10126, Turin, Italy.
Eur Spine J. 2018 Oct;27(10):2565-2576. doi: 10.1007/s00586-017-5340-z. Epub 2017 Oct 13.
To analyze clinical, radiographic and magnetic resonance findings that might predict risk of complications and conservative treatment failure of osteoporotic vertebral fractures.
The authors conducted a systematic review of observational studies, collecting data on osteoporotic vertebral fracture and complications like vertebral collapse, kyphosis, pseudoarthrosis, and neurologic deficit. MeSH items such as 'spinal fracture/radiology,' 'spinal fracture/complications,' 'spinal fracture/diagnosis' were used. PRISMA statement criteria were applied, and the risk of bias was classified as low, medium, high, following the Newcastle-Ottawa Quality Assessment Scale (NOS).
Eleven cohort studies, either retrospective or prospective, met the eligibility criteria and were included in the review. Major risk factors that were statistically predictive of the following complications were as follows; (1) vertebral collapse: presence of intravertebral cleft, MR T1-WI 'total type fractures' and T2-WI 'hypointense-wide-type'. (2) Pseudoarthrosis (nonunion): middle-column damage, thoracolumbar vertebrae involvement, MR T2-WI confined high-intensity pattern and diffuse low intensity pattern. (3) Kyphotic deformity: thoracolumbar fracture and superior endplate fracture. (4) Neurologic impairment: a retropulsed bony fragment occupying more than 42% of the sagittal diameter of the spinal canal and a change of more than 15° in vertebral wedge angle on lateral dynamic radiography.
Shape and level of the fracture were risk factors associated with the progression of collapse, pseudoarthrosis, kyphotic deformity and neurologic impairment. MRI findings were often related to the failure of conservative treatment. If prognosis can be predicted at the early fracture stage, more aggressive treatment options, rather than conservative ones, might be considered.
分析可能预测骨质疏松性椎体骨折并发症和保守治疗失败风险的临床、影像学和磁共振表现。
作者对观察性研究进行了系统回顾，收集了骨质疏松性椎体骨折和并发症（如椎体塌陷、后凸畸形、假关节和神经功能缺损）的数据。使用了 MeSH 项目，如“脊柱骨折/放射学”、“脊柱骨折/并发症”、“脊柱骨折/诊断”。采用 PRISMA 声明标准，并根据纽卡斯尔-渥太华质量评估量表（NOS）将偏倚风险分为低、中、高。
符合入选标准并纳入综述的有 11 项回顾性或前瞻性队列研究。统计学上预测以下并发症的主要危险因素如下：（1）椎体塌陷：存在椎体内裂隙、MR T1-WI“完全型骨折”和 T2-WI“低信号宽型”。（2）假关节（骨不连）：中柱损伤、胸腰椎受累、MR T2-WI 局限高信号模式和弥漫低信号模式。（3）后凸畸形：胸腰椎骨折和上终板骨折。（4）神经功能障碍：骨块向后移位超过椎管矢状径的 42%，侧位动态影像学上椎体楔形变角变化超过 15°。
骨折的形态和部位是与塌陷、假关节、后凸畸形和神经功能障碍进展相关的危险因素。MRI 表现常与保守治疗失败有关。如果能在骨折早期预测预后，可能会考虑更积极的治疗方案，而不是保守治疗。
