Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, 87# Dingjiaqiao Road, Nanjing, 210009, China.
Surgery Research Center, School of Medicine, Southeast University, 87# Dingjiaqiao Road, Nanjing, 210009, China.
J Orthop Surg Res. 2023 Aug 30;18(1):643. doi: 10.1186/s13018-023-04140-6.
BACKGROUND: Thoracolumbar spine is at high risk of osteoporotic vertebral compression fractures (OVCF). This study aimed to identify the differences in risk factors, vertebral compression degree and back pain characteristics of thoracolumbar OVCF (TL-OVCF) and non-thoracolumbar OVCF (nTL-OVCF). METHODS: OVCF patients hospitalized in a spine center between June 2016 and October 2020 were retrospectively studied. Demographics, comorbidity, spine trauma, bone mineral density, duration of pre-hospital back pain, extent of vertebral marrow edema, and degree of vertebral compression of patients with nTL-OVCF were summarized and compared to those with TL-OVCF. RESULTS: A total of 944 patients with acute single-segment OVCF were included. There were 708 (75.0%) TL-OVCF located in T11-L2 and 236 (25.0%) nTL-OVCF in lower lumbar (L3-L5) and middle thoracic (T5-T10) spine. The female-male ratio was 4.1 in nTL-OVCF and differed not significantly from TL-OVCF. The middle thoracic OVCF were older and had higher comorbidity of coronary heart disease (21.3%) and cerebral infarction (36.3%) than TL-OVCF (12.1% and 20.6%). In nTL-OVCF the ratio of apparent spine trauma (44.9%) and pre-hospital back pain ≤ 1 week (47.5%) was lower than in TL-OVCF (66.9% and 62.6%). The T-score value of lumbar spine was - 2.99 ± 1.11, - 3.24 ± 1.14, - 3.05 ± 1.40 in < 70, 70-80, > 80 years old TL-OVCF and differed not significantly from nTL-OVCF. The lower lumbar OVCF had more cranial type of vertebral marrow edema (21.8%) and fewer concurrent lumbodorsal fasciitis (30.8%) than TL-OVCF (16.8% and 43.4%). In TL-OVCF the anterior-posterior vertebral height ratio was lower with back pain for > 4 weeks than for ≤ 1, 1-2, and 2-4 weeks. In nTL-OVCF the degree of vertebral compression differed not significantly with pre-hospital back pain for ≤ 1, 1-2, 2-4, and > 4 weeks. CONCLUSIONS: Thoracolumbar spine has 2-folds higher risk of OVCF than non-thoracolumbar spine. Non-thoracolumbar OVCF are not associated with female gender, apparent spine trauma or poor bone mineral density, but tend to maintain the degree of vertebral compression and cause longer duration of pre-hospital back pain.
背景：胸腰椎是骨质疏松性椎体压缩性骨折（OVCF）的高发部位。本研究旨在探讨胸腰椎 OVCF（TL-OVCF）和非胸腰椎 OVCF（nTL-OVCF）在危险因素、椎体压缩程度和腰背疼痛特征方面的差异。
方法：回顾性分析 2016 年 6 月至 2020 年 10 月期间在脊柱中心住院的 OVCF 患者。总结并比较了 nTL-OVCF 患者和 TL-OVCF 患者的一般资料、合并症、脊柱外伤、骨密度、院前腰背疼痛持续时间、椎体骨髓水肿程度和椎体压缩程度。
结果：共纳入 944 例急性单节段 OVCF 患者，其中 708 例（75.0%）TL-OVCF 位于 T11-L2，236 例（25.0%）nTL-OVCF 位于下腰椎（L3-L5）和中胸段（T5-T10）。nTL-OVCF 中女性与男性的比例为 4.1，与 TL-OVCF 无显著差异。中胸段 OVCF 患者年龄较大，合并冠心病（21.3%）和脑梗死（36.3%）的比例高于 TL-OVCF（12.1%和 20.6%）。nTL-OVCF 中明显脊柱外伤（44.9%）和院前腰背疼痛 ≤ 1 周（47.5%）的比例低于 TL-OVCF（66.9%和 62.6%）。<70、70-80、>80 岁 TL-OVCF 的腰椎 T 评分值分别为-2.99±1.11、-3.24±1.14、-3.05±1.40，与 nTL-OVCF 无显著差异。下腰椎 OVCF 颅型椎体骨髓水肿（21.8%）的比例高于 TL-OVCF（16.8%），同时伴有腰背筋膜炎（30.8%）的比例低于 TL-OVCF（43.4%）。TL-OVCF 中，疼痛持续时间>4 周的患者与疼痛持续时间≤1、1-2、2-4 周的患者相比，前后位椎体高度比值较低。nTL-OVCF 患者中，院前腰背疼痛持续时间≤1、1-2、2-4、>4 周的患者椎体压缩程度无显著差异。
结论：胸腰椎 OVCF 的发病风险比非胸腰椎高 2 倍。非胸腰椎 OVCF 与女性、明显的脊柱外伤或骨密度差无关，但倾向于保持椎体压缩程度，并导致更长时间的院前腰背疼痛。
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