Department of Orthopedic Surgery, Hamawaki Orthopaedic Hospital, 4-6-6 Otemachi, Naka-ku, Hiroshima, 730-0051, Japan.
Department of Orthopedic Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Kitakyushu, Yahatanishi-ku, 807-8555, Japan.
Acta Neurochir (Wien). 2019 Oct;161(10):2211-2222. doi: 10.1007/s00701-019-04045-6. Epub 2019 Aug 28.
Most osteoporotic vertebral fractures (OVFs) occur in the thoracolumbar area without neurological symptoms. The pathogenesis and clinical results of symptomatic lower lumbar OVFs have not been analysed. We aimed to retrospectively investigate the risk factors for the occurrence of neurological symptoms in patients with lower lumbar OVFs and to assess the clinical results of these symptoms using magnetic resonance (MR) images.
Of the 104 patients enrolled, 21% reported neurological symptoms. We divided OVFs with neurological symptoms into various types using early MR images and investigated the risk factors for each type. Clinical results of symptomatic patients were also evaluated.
Symptomatic patients with lower lumbar OVFs mainly had one of two fracture types, indicated by total low and superior/inferior low-intensity signals on T1-weighted images. A multivariate logistic regression analysis showed that a smaller canal area and longer disease duration were risk factors for all patients. For patients with OVFs indicated by total low intensity, symptomatic patients had a significantly smaller canal area than non-symptomatic patients. For patients with OVFs indicated by superior/inferior low intensity, symptomatic patients had a significantly higher frequency of L4 and L5 vertebral fractures, longer disease duration, smaller canal area, smaller angle between the facets, and higher frequency of coexisting degenerative spondylolisthesis than non-symptomatic patients. Symptomatic patients with OVFs indicated by total low intensity had poorer clinical results regarding walking ability than symptomatic patients with OVFs indicated by superior/inferior low intensity.
Lower lumbar OVFs with neurological symptoms might have two different pathogeneses according to early MR images. Compared with symptomatic patients with OVFs indicated by superior/inferior low intensity, symptomatic patients with OVFs indicated by total low intensity may require different treatment strategies to avoid symptoms.
大多数骨质疏松性椎体骨折（OVF）发生在胸腰椎区域，没有神经症状。有症状的下腰椎 OVF 的发病机制和临床结果尚未得到分析。我们旨在回顾性分析下腰椎 OVF 患者发生神经症状的危险因素，并使用磁共振（MR）图像评估这些症状的临床结果。
在纳入的 104 名患者中，21%报告有神经症状。我们使用早期 MR 图像将有神经症状的 OVF 分为各种类型，并研究每种类型的危险因素。还评估了有症状患者的临床结果。
下腰椎 OVF 伴有神经症状的患者主要有两种骨折类型之一，T1 加权图像上总低信号和上/下低信号。多变量逻辑回归分析显示，椎管面积较小和病程较长是所有患者的危险因素。对于总低信号的 OVF 患者，有症状患者的椎管面积明显小于无症状患者。对于上/下低信号的 OVF 患者，有症状患者的 L4 和 L5 椎体骨折发生率更高，病程更长，椎管面积更小，小关节角度更小，并存退行性脊椎滑脱的发生率更高。总低信号的 OVF 患者的行走能力比上/下低信号的 OVF 患者的临床结果更差。
根据早期 MR 图像，下腰椎 OVF 伴有神经症状可能有两种不同的发病机制。与上/下低信号的 OVF 有症状患者相比，总低信号的 OVF 有症状患者可能需要不同的治疗策略来避免症状。
