Mattei Tobias A
Department of Neurosurgery, Eastern Maine Medical Center, Bangor, Maine, USA.
World Neurosurg. 2018 May;113:96-97. doi: 10.1016/j.wneu.2018.02.037. Epub 2018 Feb 14.
A non-osteoporotic adult presented with multilevel compression fractures at the apex of the thoracic kyphosis after strenuous rope jumping. Magnetic resonance imaging demonstrated diffuse bone marrow changes in the vertebral bodies with only a small unilateral endplate fracture. Besides highlighting the oftentimes neglected role of repetitive subpathological axial load forces in traumatic spinal injuries, the observed imaging pattern substantiates previous experimental studies which demonstrated that under cyclic axial loading the initial damage occurs in the cancellous regions of the bone (with observation of cracks with average length between 50-100 μM), ultimately leading to a reduction in its elastic modulus. This pathophysiological mechanism, in which unmitigated propagation of trabecular microscopic cracks through the vertebral bone marrow precedes endplate fractures, may provide a rationale for recent proposals of targeted cement-augmentation in traumatic compression fractures with cement injection directed toward the regions of bone marrow changes.
一名非骨质疏松的成年人在剧烈跳绳后出现胸椎后凸顶点处的多节段压缩性骨折。磁共振成像显示椎体弥漫性骨髓改变，仅伴有一个小的单侧终板骨折。除了强调重复性亚病理轴向负荷力在创伤性脊柱损伤中常常被忽视的作用外，观察到的影像学表现证实了先前的实验研究，该研究表明在周期性轴向负荷下，初始损伤发生在骨的松质区域（观察到平均长度在50 - 100微米之间的裂纹），最终导致其弹性模量降低。这种病理生理机制，即小梁微观裂纹在终板骨折之前通过椎骨髓无节制地扩展，可能为近期关于在创伤性压缩性骨折中针对骨髓改变区域进行水泥注射的靶向水泥强化建议提供理论依据。
