Teraguchi Masatoshi, Kawakami Mamoru, Enyo Yoshio, Kagotani Ryohei, Mera Yoshimasa, Kitayama Keita, Oka Hiroyuki, Yamamoto Yoshio, Nakagawa Masafumi, Nakatani Tomohiro, Nakagawa Yukihiro
Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan.
Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan.
Spine Surg Relat Res. 2021 Sep 9;6(2):145-150. doi: 10.22603/ssrr.2021-0101. eCollection 2022.
Osteoporotic vertebral compression fracture (OVCF) in the elderly is a major public health concern. This retrospective case-control study aimed to determine the difference in interobserver reliability between radiography, magnetic resonance imaging (MRI), and computed tomography (CT), respectively, and whether CT radiological findings can predict prolonged back pain at 2 weeks after OVCFs.
Patients were divided into the prolonged back pain group or the recovered back pain group depending on the numerical rating scale at 2 weeks after admission. Radiography, MRI, and CT images were classified on the basis of conventions described by previous classifications. Interobserver reliability was calculated on images rated by two board-certified spine surgeons. Multivariate logistic regression models were used to evaluate whether the presence or absence of anterior wall injury, endplate deficit, posterior wall injury, lateral wall injury, or intervertebral disc deficit on CT was predictive of prolonged back pain.
Of the 130 patients, 89 cases (68.5%) involved prolonged back pain at 2 weeks after admission. Neither average age (79.8 vs. 80.1 years, respectively) nor duration to initial consultation (9.4 vs. 6.4 days, respectively) differed significantly between the prolonged and recovered back pain groups. Interobserver reliability was 0.51, 0.77 (0.67-0.86), and 0.82 (0.72-0.92) for radiography, MRI, and CT, respectively. After adjusting for confounding factors such as age, sex, duration to initial consultation, and extent of OVCF, the multivariate analysis showed that the presence of endplate deficit and posterior wall injury was a significant predictive factor for prolonged back pain (odds ratio [OR] 8.5, area under the curve (AUC); 0.79 and OR 2.5, AUC 0.72), respectively.
Good reliability assessments of CT-based evaluations were noted. After a detailed novel CT evaluation at initial presentation, the presence of an endplate deficit and posterior wall injury was the significant risk factor for prolonged back pain at 2 weeks after an OVCF.
老年人骨质疏松性椎体压缩骨折（OVCF）是一个重大的公共卫生问题。这项回顾性病例对照研究旨在确定X线摄影、磁共振成像（MRI）和计算机断层扫描（CT）之间观察者间可靠性的差异，以及CT影像学表现是否能预测OVCF后2周持续性背痛。
根据入院后2周的数字评分量表，将患者分为持续性背痛组或背痛恢复组。X线摄影、MRI和CT图像根据先前分类所描述的标准进行分类。由两位获得委员会认证的脊柱外科医生对图像进行评分，并计算观察者间可靠性。采用多因素逻辑回归模型评估CT上是否存在前壁损伤、终板缺损、后壁损伤、侧壁损伤或椎间盘缺损对持续性背痛的预测作用。
130例患者中，89例（68.5%）在入院后2周出现持续性背痛。持续性背痛组和背痛恢复组的平均年龄（分别为79.8岁和80.1岁）以及初次就诊时间（分别为9.4天和6.4天）差异均无统计学意义。X线摄影、MRI和CT的观察者间可靠性分别为0.51、0.77（0.67 - 0.86）和0.82（0.72 - 0.92）。在调整年龄、性别、初次就诊时间和OVCF范围等混杂因素后，多因素分析显示终板缺损和后壁损伤的存在是持续性背痛的显著预测因素（优势比[OR] 8.5，曲线下面积[AUC]；0.79和OR 2.5，AUC 0.72）。
基于CT的评估具有良好的可靠性。在初次就诊时进行详细的新型CT评估后，终板缺损和后壁损伤的存在是OVCF后2周持续性背痛的显著危险因素。
