Abstract
BackgroundThe presence of vertebral fractures affect variations in the termination level of conus medullaris (TLCM) and alter neurological findings. However, few studies have examined association between vertebral fractures, TLCM, and neurological findings. Thus, we herein studied the number and severity of vertebral fractures, TLCM, and neurological findings to clarify the mechanism of neurological deterioration in patients with vertebral fractures.MethodsA total of 411 patients who underwent computed tomographic myelography were classified into those with (group F, n = 73) and those without vertebral fractures (group C, n = 338). We assessed correlations between TLCM and age, height, and gender in group C, differences in TLCM between groups F and C, and correlations between TLCM, and the number and severity score of fractures. Neurological evaluations were performed for the patellar tendon reflex (PTR), muscle weakness, sensory disturbance, and bladder contraction disorders.ResultsTLCM was most commonly located at the L1 vertebral body in group C and did not significantly differ with age, height, or gender. TLCM was most commonly located at L2 vertebral body in group F. TLCM was more caudally located in group F (P < 0.01). Additionally, there was a significant difference between TLCM and number of fractures, and the severity score of fractures (both P < 0.01). Twenty-three patients showed neurological deterioration by vertebral fractures. Some patients with T12 vertebral fracture showed hyperreflexia of PTR. Serious bladder contraction disorders were seen in patients with compression at close range of TLCM.ConclusionWe confirmed that vertebral fractures altered location of the TLCM, thus altering potential neurological symptoms. Moreover, there were correlations of the TLCM with the number and severity score of vertebral fractures. Spine surgeons should be cognizant of the relationship between TLCM, level of compressive lesion, and neurological findings to avoid the wrong level in spine surgery and unexpected neurological deteriorations after surgery.
Highlights
The presence of vertebral fractures affect variations in the termination level of conus medullaris (TLCM) and alter neurological findings
The TLCM ranged from the middle third of the T12 vertebral body to the L2–3 intervertebral disc in group C; the TLCM was most commonly located at the L1 vertebral body (249/338, 74%; Fig. 3)
There was no significant difference between the TLCM and gender (P = 0.74) in group C
Summary
The presence of vertebral fractures affect variations in the termination level of conus medullaris (TLCM) and alter neurological findings. We studied the number and severity of vertebral fractures, TLCM, and neurological findings to clarify the mechanism of neurological deterioration in patients with vertebral fractures. In comparison to subjects without vertebral fractures, the presence of vertebral fractures affect variations in the TLCM and alter neurological findings because of shortening of the total spinal length due to vertebral fractures with no change in the length of the spinal cord. We believe the presence of more severe and more numerous vertebral fractures affect variations in the TLCM and alter neurological findings. We studied the number and severity of vertebral fractures, TLCM, and neurological findings to clarify the mechanism of neurological deterioration in Japanese patients with fragility vertebral fractures
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