Abstract
To assess the potential influence of multifidus atrophy and fatty degeneration on the incidence of adjacent vertebral compression fractures within one year after the index fracture. In a retrospective cohort study, patients who underwent surgery for an OVCF were identified and baseline characteristics, fracture patterns and the occurrence of secondary adjacent fractures within one year were obtained by chart review. Multifidus muscle atrophy and fatty degeneration were determined on preoperative MRI or CT scans. In this analysis of 191 patients (mean age 77 years, SD 8, 116 female), OF type 3 was the most common type of OVCF (49.2%). Symptomatic adjacent OVCFs within one year after index fracture were observed in 23/191 patients (12%) at mean 12, SD 12 weeks (range 1–42 weeks) postoperatively. The mean multifidus muscle area was 264, SD 53 mm2 in patients with an adjacent vertebral fracture and 271, SD 92 mm2 in patients without a secondary fracture (p = 0.755). Mean multifidus fatty infiltration was graded Goutallier 2.2, SD 0.6 in patients with an adjacent fracture and Goutallier 2.2, SD 0.7 in patients without an adjacent fracture (p = 0.694). Pre-existing medication with corticosteroids was associated with the occurrence of an adjacent fracture (p = 0.006). Multifidus area and multifidus fatty infiltration had no significant effect on the occurrence of adjacent vertebral fractures within one year after the index fracture. Patients with a pre-existing medication with corticosteroids were more likely to sustain an adjacent fracture.
Highlights
Osteoporotic vertebral compression fractures (OVCF) are common fractures in the elderly—especially in postmenopausal women [1]
It was our hypothesis that an impaired multifidus muscle support increases the likelihood for an adjacent fracture
Treatment consisted of kyphoplasty in 53 cases (27.7%), percutaneous posterior fixation in 95 (49.7%), and open fixation in 43
Summary
Osteoporotic vertebral compression fractures (OVCF) are common fractures in the elderly—especially in postmenopausal women [1]. OVCF are frequently associated with severe immobilizing pain. This results in an increased morbidity and mortality of these bed-ridden patients. About 20% of the patients with a primary OVCF suffer subsequent fractures in the spinal segments adjacent to and within one year after the index fracture [2,3,4]. There is debate about what factors contribute to an increased risk for such adjacent fractures. A recent study reported that in patients with OVCF, fatty degeneration of the paraspinal muscles is a predictive factor for progressive vertebral body collapse [8]. It is known that a decreased hand-grip strength is associated with an increased subsequent vertebral fracture risk [9]. The potential role of the autochthonous muscles of the back on the occurrence of secondary adjacent fractures, has—to the authors’ knowledge—not yet been evaluated
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