Acute Osteoporotic Compression Fractures Research Articles

Lumbar osteoporotic fractures develop in segments with less degenerated discs which then become more degenerated.

Our aim was to study the influence of segmental variations in intervertebral disc degeneration on the location of acute osteoporotic compression fractures and to investigate chronic effect of such fractures on adjacent discs. This retrospective study included 83 patients (69 females; mean ± SD age: 72.3 ± 14.0years) with osteoporotic vertebral fractures. Using lumbar MRI, two neuroradiologists evaluated 498 lumbar vertebral segments for the presence and acuity of fractures and graded adjacent intervertebral disc degeneration on Pfirrmann's scale. Absolute and relative (to average patient-specific degeneration grade) segmental degeneration grades were compared against the presence and chronicity of vertebral fractures for all segments and for upper (T12-L2) and lower (L3-L5) subgroups. Intergroup analysis was conducted using Mann-Whitney U tests, withpvalue of < .05 considered significant. Fractures involved 149/498 (29.9%; 15.1% acute) vertebral segments, majority (61.1%) involving T12-L2 segments. Segments with acute fractures had significantly lower degeneration grades (mean ± SD: absolute: 2.72 ± 0.62; relative: 0.91 ± 0.17) than those with no (absolute: 3.03 ± 0.79, p = 0.003; relative: 0.99 ± 0.16, p < 0.001) or chronic fractures (absolute: 3.03 ± 0.62, p = 0.003; relative: 1.02 ± 0.16, p < 0.001). Degeneration grades were higher in the lower lumbar spine (p < 0.001) in the absence of fractures, but comparable to upper spine for segments with acute or chronic fractures (p = 0.28 and 0.56, respectively). Osteoporotic vertebral fractures favour segments with lower burden of disc degeneration, but likely contribute to subsequent worsening of adjacent disc degeneration.

Analysis of radiologic and clinical outcome in acute osteoporotic vertebral compression fracture: Single-agent teriparatide vs. teriparatide with subsequent vertebroplasty

ObjectivesTo analyze the difference in union and clinical outcomes between teriparatide (T) and teriparatide with vertebroplasty (V) treatment modalities in osteoporotic vertebral compression fractures (OVCFs). MethodsPatients were divided into two groups (T and V: 87 and 92 patients with 105 fractures each). Radiological features (fracture type/grade, presence of fracture gap/intravertebral vacuum cleft (IVVC)/posterior vertebral wall fracture, change in compression rate (CR)/kyphotic angle (CA), and fusion status) were assessed with 3D-CT at 3 and 6 months. The outcome was divided into success or failure based on visual analog scale (<3), absence of percussion tenderness on the spinous process, and pain during motion. Univariate and multivariate analyses were performed to identify risk factors for nonunion and failed outcomes in each group. ResultsThe V group showed more favorable results than the T group at 3 months (CR>10%, 58% vs. 17%; CA>5°, 36% vs. 16%; union, 66% vs. 91%; successful outcome, 77% vs. 94%). At 6 months, no significant change was detected in CR and CA. A significant difference remained in union (89% vs. 100%) and successful outcomes (79% vs. 100%). The V group with age (>75 years) and initial CR (>40%) had more benefits than the T group in the subgroup analysis. In multivariate analysis for the T group, nonunion risk factors were hypertension (P = .0054) and fracture gap (P = .0075). IVVC (P = .047) was the sole risk factor for failure. ConclusionsTeriparatide with subsequent vertebroplasty can be selected as the first-line treatment with better sequelae and outcomes in acute osteoporotic compression fractures.

Early Vertebroplasty for Severely Painful Acute Osteoporotic Compression Fractures: A Critical Review of the Literature.

Vertebroplasty has emerged over the last 30years as a common treatment for painful osteoporotic vertebral fractures. Patient selection and the time at which vertebroplasty is offered to the patient varies between centres and regions. Vertebroplasty has been studied in comparison to placebo intervention in five blinded trials. One such trial showed more benefit from vertebroplasty than placebo when the procedure was mostly performed within 3weeks of fracture onset. Others showed no additional benefit from vertebroplasty compared to placebo when it was performed later in the natural history of the fracture. In this review, we examine data from blinded and open label randomised studies of vertebroplasty for evidence relating specifically to the use of early vertebroplasty for patients with severely painful acute osteoporotic fractures.

Adverse drug reaction due to combination of gabapentin and nortriptyline along with its causality assessment

The combination of gabapentin and nortriptyline is used as the first line drug treatment for management of neuropathic pain; however adverse drug reactions (ADRs) are one of the main causes for discontinuation of the therapy. This is a case study of erythematous maculopapular rash induced by combination of gabapentin and nortriptyline along with its causality assessment. A 55-year-old female came with complaint of back pain for 1 month. She was diagnosed as a case of L1 acute osteoporotic disc compression fracture. The patient was then administered combination tablet of gabapentin and nortriptyline (100 mg/10 mg) orally for the neuropathic pain. After 3 days she developed erythematous maculopapular rash on face, upper limbs and back. Following this the drug was then discontinued and pheniramine, hydrocortisone and combination tablet of levocetirizine and montelukast was administered to treat the rashes. Causality assessment was done using the Naranjo scale and WHO UMC assessment scale. The ADRs was reported by VigiFlow in the pharmacovigilance centre. Causality assessment using Naranjo scale (Score 6) and WHO UMC scale indicates probable relationship. Hence, monitoring is essential for any ADRs while using combination of gabapentin and nortriptyline therapy. In case of ADRs, discontinue the therapy and report the adverse drug reactions to pharmacovigilance centre.

Minimally invasive pedicle screw fixation, including the fractured vertebra, combined with percutaneous vertebroplasty for treatment of acute thoracolumbar osteoporotic compression fracture in middle-age and elderly individuals: A prospective clinical study.

To evaluate the feasibility, efficacy, and safety of minimally invasive pedicle screw (MIPS) fixation, including the fractured vertebra, combined with percutaneous vertebroplasty (PVP) for the treatment of acute thoracolumbar osteoporotic compression fracture in middle-age and elderly individuals.Between January 2016 and August 2019, a total of 30 patients, with a mean age of 69.4 years (range, 58–75 years), who experienced thoracic or lumbar fracture without neurological deficits, underwent the MIPS procedure combined with PVP. Preoperative and postoperative pain were assessed using a visual analog scale and Oswestry Disability Index. Cobb angles and anterior column height were measured on lateral radiographs before surgery and at 3 days, 1, 3, and 6 months, and 1 and 2 years at final follow-up after surgery.All patients underwent surgery successfully, with a mean follow-up of 18.2 ± 5.7 months (range, 12–45 months). Mean preoperative visual analog scale score decreased from 7.3 ± 2.2 to 1.4 ± 0.3 at the final follow-up (P < .05). Mean preoperative Oswestry Disability Index decreased from 84.2 ± 10.3 to 18.8 ± 7.5 (P < .05) at the final follow-up. The Kyphosis angle of operative segment was improved from preoperative (21.38 ± 1.68)° to (4.01 ± 1.38)° 3 days postoperatively and (5.02 ± 1.09)° at final follow-up (P < .05). The anterior vertebral height was improved from preoperative (49.86 ± 6.50)% to (94.01 ± 1.79)% 3 days postoperatively and (91.80 ± 1.88)% at final follow-up (P < .05). No significant changes in vertebral body height restoration were observed during 2 years of follow-up after surgery. In addition, there were no instrumentation failures or complications in any of the patients.MIPS, including the fractured vertebra, combined with PVP, was a reliable and safe procedure, with satisfactory clinical and radiological results for the treatment of thoracolumbar osteoporotic compression fracture in patients without neurological deficits.

Association Between Overweight Sarcopenic Population and Acute Vertebral Osteoporotic Compression Fractures in Females: Retrospective, Cross-Sectional Study.

Background: This study aimed to determine whether the prevalence of acute vertebral osteoporotic compression fractures (VOCF) in the elderly population is related to the distribution of muscles and fat in the human body.Methods: Data of acute VOCF and non-VOCF patients presenting at our institution between January 2018 and May 2020 were analyzed. Patients aged 65 years and older, who underwent body composition test and dual-energy X-ray absorptiometry at the same time were enrolled. After applying exclusion criteria, patients were divided into four groups: normal, sarcopenia without obesity, obesity without sarcopenia, and sarcopenic obesity. Body mass index ≥25 kg/m2 was considered obesity, and sarcopenia was defined as skeletal muscle index lower than 7.0 kg/m2 in males and 5.4 kg/m2 in females. The VOCF rate was analyzed between the groups.Discussion: A total of 461 patients were included, of whom 103 were males. Among them, 163 (35.36%) had normal body composition, 151 (32.75%) had sarcopenia without obesity, 110 (23.86%) had obesity without sarcopenia, and 37 (8.03%) had sarcopenic obesity. The sarcopenic obesity group had the highest rate of acute VOCF (37.8%), which was statistically significant. Specifically, females with sarcopenic obesity and sarcopenia without obesity had significantly higher acute VOCF rates compared to those with normal body compositions. Multivariate analysis showed that sarcopenic obesity was significantly associated with acute VOCF rate overall, as well as in females.Conclusion: Sarcopenic obesity is strongly associated with acute VOCF, especially in females, and it could be an essential criterion for the prevention of acute VOCF.

Predictors of residual low back pain after acute osteoporotic compression fracture

BackgroundStudies on the clinical and radiographic risk factors for the residual low back pain beyond 6 months after osteoporotic vertebral fractures (OVFs) are lacking. Hence, this study aimed to characterize a patient population with residual low back pain 48 weeks after acute OVFs and to identify the risk factors associated with residual low back pain. MethodsThis prospective multicenter study included 166 female patients aged 65–85 years with acute one-level OVFs. We defined the residual low back pain as visual analog scale (VAS) for low back pain ≥3.5 at 48 weeks in this study, as VAS score ≥3.5 is used to describe moderate or severe pain. Thus, outcome and risk factor analyses were performed by comparing patients with VAS scores <3.5 and ≥ 3.5. In the radiographic analysis, the anterior vertebral body compression percentage was measured at 0, 12, and 48 weeks. Magnetic resonance imaging (MRI) was performed at enrollment and 48 weeks. ResultsOf the 166 patients analyzed, 58 complained of residual low back pain at 48 weeks after OVFs. At 0 weeks, the VAS score was significantly higher, and the JOABPEQ mental health score and anterior vertebral body compression percentage were significantly lower in patients with persistent pain 48 weeks after OVFs. The independent risk factors in the acute phase for persistent pain 48 weeks after OVFs were a high VAS score, MRI T2 fluid-intensity image pattern, and a lower anterior vertebral body compression percentage. ConclusionsSevere low back pain, MRI T2 fluid-intensity image pattern, and severe vertebral body collapse in the acute phase were significant risk factors for residual low back pain 48 weeks after OVFs. Patients with acute OVFs who have these risk factors should be carefully monitored for the possible development of residual chronic low back pain.

Bracing for Acute and Subacute Osteoporotic Compression Fractures: A Systematic Review of the Literature

Many treatment options for osteoporotic vertebral fractures are available. However, limited and variable findings have been reported on the efficacy of the individual therapies. The objective of the present study was to systematically review the reported data for evidence of efficacy of spinal orthoses for osteoporotic vertebral fractures. A systematic review of the PubMed database was performed. Two reviewers evaluated the studies found for eligibility. Randomized controlled trails (RCTs) and prospective nonrandomized, prospective single-arm, and retrospective comparative studies of the treatment of acute osteoporotic vertebral fractures with spinal orthoses were included. A total of 16 studies were included: 5 RCTs, 6 nonrandomized prospective comparative studies, 1 retrospective case-control study, and 4 prospective single-arm studies. Of the 16 studies, 4 (3 single-arm studies and 1 nonrandomized study) provided low-quality evidence that bracing, with or without bedrest, was safe. Also, 1 nonrandomized and 1 single-arm study provided low-quality evidence that bracing improved pain and disability. In addition, 4 studies demonstrated that the use of a rigid brace was equivalent to the use of a soft brace or no brace (2 high-quality RCTs, 2 nonrandomized studies, 1 low-quality RCT). Two nonrandomized and one case-control study demonstrated a benefit of kyphoplasty compared with bracing alone (all low quality). Two RCTs had provided low-quality evidence that bracing was superior to no brace and one nonrandomized study provided low-quality evidence that a dynamic brace was superior to rigid orthosis. Limited evidence has suggested the safety of spinal orthoses for the treatment of osteoporotic compression fractures. At present, compelling evidence is not available to suggest that a rigid brace is superior to a soft brace or no brace. Kyphoplasty might be of benefit for select patients.

Cement leakage following percutaneous kyphoplasty in a patient after a posterior lumbar fusion: a case report

BackgroundPercutaneous kyphoplasty (PKP) has become an important minimally invasive surgical technique for fracture stabilization and pain relief in patients with vertebral compression fractures. However, intraspinal cement leakage following PKP is a serious postoperative complication that can lead to morbidity and mortality.Case presentationWe describe an uncommon case of epidural leakage of bone cement in an 81-year-old woman who underwent posterior lumbar decompression and fusion from L3–5 4 years prior and had an unremarkable postoperative course. The patient was admitted to Peking Union Medical College Hospital with complaints of muscle weakness and severe low back pain radiating to the left thigh 1 week after PKP of L5 due to an acute osteoporotic compression fracture. Computed tomographic imaging revealed massive leakage of cement into the spinal canal at L5-S1, and therefore, surgical decompression and removal of epidural cement were performed carefully without causing a dural tear. She improved remarkably and no neurologic deterioration was observed in the postoperative period during the one-year follow-up.ConclusionsWe present the rare reported case, to our knowledge, of epidural cement leakage after PKP at the segment of internal fixation and discuss the most likely etiologies and preventive measures for this condition.

Risk Factors of Nonunion After Acute Osteoporotic Vertebral Fractures: A Prospective Multicenter Cohort Study.

Prospective cohort study. To characterize a patient population with nonunion after acute osteoporotic vertebral fractures (OVFs) and compare the union and nonunion groups to identify risk factors for nonunion. While OVFs are the most common type of osteoporotic fracture, the predictive value of a clinical assessment for nonunion at 48 weeks after OVF has not been extensively studied. This prospective multicenter cohort study included female patients aged 65 to 85 years with acute one-level osteoporotic compression fractures. In the radiographic analysis, the anterior vertebral body compression percentage was measured at 0, 12, and 48 weeks. Magnetic resonance imaging (MRI) was performed at enrollment and at 48 weeks to confirm the diagnosis and union status. The patient-reported outcome measures included scores on the European Quality of Life-5 Dimensions (EQ-5D), a visual analogue scale for low back pain, and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) at 0, 12, and 48 weeks. In total, 166 patients completed the 12-month follow-up, 29 of whom had nonunion. Patients with nonunion at 48 weeks after OVF had lower EQ-5D and JOABPEQ walking ability, social life function, mental health, and lumbar function scores than those with union at 48 weeks after injury. The independent risk factors for nonunion after OVF in the acute phase were a diffuse low type pattern on T1-weighted MRI and diffuse low and fluid type patterns on T2-weighted MRI. The anterior vertebral body compression percentage and JOABPEQ social life function scores were independent risk factors at 12 weeks. A diffuse low type pattern on T1-weighted MRI and diffuse low and fluid type patterns on T2-weighted MRI were independent risk factors for nonunion in the acute phase. Patients who have acute OVFs with these risk factors should be carefully monitored for nonunion. 2.

Comparison of Rigid and Soft-Brace Treatments for Acute Osteoporotic Vertebral Compression Fracture: A Prospective, Randomized, Multicenter Study.

While bracing is the standard conservative treatment for acute osteoporotic compression fracture, the efficacy of different brace treatments has not been extensively studied. We aimed to clarify and compare the preventive effect of the different brace treatments on the deformity of the vertebral body and other clinical results in this patient cohort. This multicenter nationwide prospective randomized study included female patients aged 65–85 years with acute one-level osteoporotic compression fractures. We assigned patients within four weeks of injury to either a rigid-brace treatment or a soft-brace treatment. The main outcome measure was the anterior vertebral body compression percentage at 48 weeks. Secondary outcome measures included scores on the European Quality of Life-5 Dimensions (EQ-5D), visual analog scale (VAS) for lower back pain, and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). A total of 141 patients were assigned to the rigid-brace group, whereas 143 patients were assigned to the soft-brace group. There were no statistically significant differences in the primary outcome and secondary outcome measures between groups. In conclusion, among patients with fresh vertebral compression fractures, the 12-week rigid-brace treatment did not result in a statistically greater prevention of spinal deformity, better quality of life, or lesser back pain than soft-brace.

Vertebroplasty versus sham procedure for painful acute osteoporotic vertebral compression fractures (VERTOS IV): randomised sham controlled clinical trial

ObjectiveTo assess whether percutaneous vertebroplasty results in more pain relief than a sham procedure in patients with acute osteoporotic compression fractures of the vertebral body.DesignRandomised, double blind, sham controlled clinical...

Differentiation of Acute Osteoporotic and Malignant Vertebral Fractures by Quantification of Fat Fraction With a Dixon MRI Sequence.

The purpose of this study was to differentiate malignant compression fractures from acute osteoporotic compression fractures of the spine by use of a Dixon MRI sequence to quantify fat fraction (FF). Forty-four vertebral compression fractures were assessed with turbo spin-echo T1-weighted and six-echo Dixon sequences for FF quantification at 3-T MRI. The fractures were divided into malignant compression fractures (n = 24) and acute osteoporotic compression fractures (n = 20). Two radiologists independently measured quantitative parameters from ROIs in the fractures, including the T1 signal intensity of the fracture, the FF of the fracture, and the FF ratio (fracture FF divided by normal marrow FF). The mean values of the parameters were compared between the two groups, interobserver reliability between two radiologists was assessed, ROC curves were analyzed, and logistic regression analysis was performed. The fracture FF and FF ratio of malignant compression fractures were significantly lower than those of acute osteoporotic compression fractures (fracture FF, 2.73% vs 14.36% [p < 0.001]; FF ratio, 0.05 vs 0.22 [p < 0.001]). There was no difference in T1 signal intensity of the fracture. The ROC AUC of fracture FF was 0.98 and of FF ratio was 0.95. In logistic regression analysis, fracture FF remained a significant variable that could be used to independently differentiate malignant from acute osteoporotic compression fractures (odds ratio, 0.33; p < 0.005). FF and FF ratio obtained from FF maps obtained with a six-echo Dixon MRI sequence may be useful for differentiating acute osteoporotic compression fractures from malignant compression fractures.

Cost-Effectiveness Analysis of Percutaneous Vertebroplasty for Osteoporotic Compression Fractures.

Single-center, single-arm, prospective time-series study. To assess the cost-effectiveness and improvement in quality of life (QOL) of percutaneous vertebroplasty (PVP). PVP is known to relieve back pain and increase QOL for osteoporotic compression fractures. However, the economic value of PVP has never been evaluated in Japan where universal health care system is adopted. We prospectively followed up 163 patients with acute vertebral osteoporotic compression fractures, 44 males aged 76.4±6.0 years and 119 females aged 76.8±7.1 years, who underwent PVP. To measure health-related QOL and pain during 52 weeks observation, we used the European Quality of Life-5 Dimensions (EQ-5D), the Rolland-Morris Disability Questionnaire (RMD), the 8-item Short-Form health survey (SF-8), and visual analogue scale (VAS). Quality-adjusted life years (QALY) were calculated using the change of health utility of EQ-5D. The direct medical cost was calculated by accounting system of the hospital and Japanese health insurance system. Cost-effectiveness was analyzed using incremental cost-effectiveness ratio (ICER): Δ medical cost/Δ QALY. After PVP, improvement in EQ-5D, RMD, SF-8, and VAS scores were observed. The gain of QALY until 52 weeks was 0.162. The estimated lifetime gain of QALY reached 1.421. The direct medical cost for PVP was ¥286,740 (about 3061 US dollars). Cost-effectiveness analysis using ICER showed that lifetime medical cost for a gain of 1 QALY was ¥201,748 (about 2154 US dollars). Correlations between changes in EQ-5D scores and other parameters such as RMD, SF-8, and VAS were observed during most of the study period, which might support the reliability and applicability to measure health utilities by EQ-5D for osteoporotic compression fractures in Japan as well. PVP may improve QOL and ameliorate pain for acute osteoporotic compression fractures and be cost-effective in Japan.

Influence of Vertebral Bone Marrow Edema on Outcome in Non-Acute Osteoporotic Patients Treated with Percutaneous Vertebroplasty.

Study DesignProspective cohort study.PurposeTo prospectively investigate the influence of presence of bone marrow edema (BME) in non acute osteoporotic verterbral compression fractures on postoperative clinical outcome in patients treated by percutaneous vertebroplasty (PV).Overview of LiteratureAlthough PV is widely used to treat osteoporotic collapsed vertebral compression fractures (VCF); little is known about the influence of BME in osteoporotic VCF or about its relation with relief of pain.MethodsSixty seven patients with non acute osteoporotic verterbral compression fractures treated with PV. They were divided into edema group (56 patients with apparent vertebral BME in their magnetic resonance [MR] images), and non edema group (11 patients with no vertebral BME detected in their MR images). Pain was evaluated one week, one month, six months, and one year post procedure using visual analogue scale. Statistical analysis including a 2-tailed t test comparing postoperative data with preoperative values was done.ResultsA good clinical response to PV procedure was seen in all patients. Significant difference was seen between two groups in one week, and one month follow up periods. Regarding pain relief in the other periods of follow up, no significant difference was seen between two groups.ConclusionsPV resulted in significantly clinical improvement in patients with BME pattern than in those without in one week and one month follow up periods. But the absence of vertebral BME did not influence pain relief in patients with osteoporotic VCFs in six months, and one year post procedure.

Clinical comparative study of percutaneous kyphoplasty in treatment of acute and chronic and nonunion osteoporotic vertebral compression fractures and the operative opportunity

Objective Clinical comparative study of percutaneous kyphoplasty in treatment of acute and chronic and nonunion osteoporotic vertebral compression fractures and the operative opportunity. Methods Totally 91 elderly with osteoporotic thoracolumbar vertebral compression fractures were treated by PKP and divided into acute and chronic and nonunion fracture group, acute fracture group 59 patients,chronic and nonunion fracture group 32 patients, the surgical outcomes were evaluated by using visual analogue scale(VAS), Oswestry disability index(ODI)system, kyphosis angle(cobb method), the height of vertebrae body before and after 1 week, 3 months after surgery. Results All patients had rapid and significant improvement in back pain following percutaneous kyphoplasty.and followed 6- 12 and 3 months after surgery(P 0.05). The kyphosis angle(cobb method), the height of vertebrae body were improved significantly at 1 week and 3 months after surgery(P<0.05), and the acute fracture group was improved significantly than the chronic and nonunion fracture group(P<0.05). Conclusion The curative effect of percutaneous kyphoplasty for the treatment of acute painful osteoporotic vertebral compression fracture(POVCFs) and chronic and nonunion POVCFs was satisfactory, the kyphosis angle(cobb method), the height of vertebrae body for the acute fracture group were superior to than the chronic and nonunion fracture group(P< 0.05). Key words: Osteoporotic vertebral compressive fracture; Percutaneous kyphoplasty; Chronic; Nonunion; Operative opportunity

Differentiation of Acute Osteoporotic and Malignant Compression Fractures of the Spine: Use of Additive Qualitative and Quantitative Axial Diffusion-weighted MR Imaging to Conventional MR Imaging at 3.0 T

To retrospectively determine the value of adding qualitative and quantitative axial diffusion-weighted (DW) imaging to standard spine magnetic resonance (MR) imaging to differentiate between acute osteoporotic and malignant compression fractures at 3.0 T. The institutional ethics committee approved this retrospective study and waived the requirement to obtain informed consent. The authors retrospectively analyzed 3.0-T MR images, including DW images (b values: 0, 800, and 1400 sec/mm(2)), in 62 patients with acute compression fractures. Three radiologists independently interpreted MR images for the presence of malignancy by using conventional MR images alone and in combination with axial DW images with qualitative and quantitative analysis. Apparent diffusion coefficients (ADCs) were measured within solid portion with careful use of a small region of interest (ROI). The Mann-Whitney U test was performed. There were 30 malignant and 32 acute osteoporotic compression fractures. At qualitative analysis, hyperintensity relative to spinal cord was more frequent in malignant compression fractures than in acute osteoporotic compression fractures (87% vs 22%, respectively; P < .001). Median ADCs of malignant fractures were significantly lower than those of benign fractures (P < .001). With conventional MR imaging alone, sensitivity, specificity, and accuracy were 100%, 94%, and 97%, respectively, for reader 1; 97%, 78%, and 87% for reader 2; and 100%, 84%, and 92% for reader 3. With conventional and DW MR imaging combined, sensitivity, specificity, and accuracy were 100%, 97%, and 98% for all three readers. The addition of DW imaging led to correct changes in diagnosis: Reader 1 improved by 1.6% (one of 62 fractures), reader 2 improved by 11% (seven of 62 fractures), and reader 3 improved by 6.5% (four of 62 fractures). The addition of axial DW imaging to a conventional MR imaging protocol improved diagnostic accuracy in the differentiation of acute osteoporotic from malignant compression fractures by measuring ADCs in the solid portion with careful use of a small ROI.

Early Vertebroplasty versus Delayed Vertebroplasty for Acute Osteoporotic Compression Fracture : Are the Results of the Two Surgical Strategies the Same?

ObjectiveIn Korea, early vertebroplasty (EVP) or delayed vertebroplasty (DVP, which is performed at least 2 weeks after diagnosis) were performed for the treatment of acute osteoporotic compression fracture (OCF) of the spine. The present study compared the outcomes of two surgical strategies for the treatment of single-level acute OCF in the thoracolumbar junction (T12-L2).MethodsFrom 2004 to 2010, 23 patients were allocated to the EVP group (EVPG) and 27 patients to the DVP group (DVPG). Overall mean age was 68.3±7.9 and minimum follow-up period was 1.0 year. Retrospective study of clinical and radiological results was conducted.ResultsNo significant differences in baseline characteristics were observed between the two groups. As expected, mean duration from onset to vertebroplasty and mean duration of hospital stay were significantly longer in the DVPG (17.1±2.1 and 17.5±4.2) than in the EVPG (3.8±3.3 and 10.8±5.1, p=0.001). Final clinical outcome including visual analogue scale (VAS), Oswestry Disability Index, and Odom's criteria did not differ between the two groups. However, immediate improvement of the VAS after vertebroplasty was greater in the EVPG (5.1±1.3) than in the DVPG (4.0±1.0, p=0.002). The proportion of cement leakage was lower in the EVPG (30.4%) than in the DVPG (59.3%, p=0.039). In addition, semiquantitative grade of cement interdigitation was significantly more favorable in the EVPG than in the DVPG (p=0.003). Final vertebral body collapse and segmental kyphosis did not differ significantly between the two groups.ConclusionOur findings suggest that EVP achieves a better immediate surgical effect with more favorable cost-effectiveness.

Atraumatic vertebral compression fractures: differential diagnosis between benign osteoporotic and malignant fractures by MRI

Atraumatic vertebral compression fractures are a common clinical problem, especially in elderly population. Metastases are the most frequent source of bone tumors, and the spine is a common site of metastatic disease; in case of cortical involvement or osteolysis, they may result in pathological compression fractures. Atraumatic compression fractures may result from other primary neoplasms of vertebrae and also from osteomyelitis, Paget's disease, hyperparathyroidism and other metabolic processes. Osteoporosis is a common source of vertebral compression fractures in elderly population, which may be indistinguishable from those of metastatic origin. The differentiation between osteoporotic compression fractures and malignant fracture is necessary to establish an appropriate staging and a therapeutic planning, especially in the acute and subacute stages. Anamnestic data about preexisting disease can be useful to individuate the potential cause of vertebral collapse. Plain radiography shows some difficulties in distinguishing whether the fracture represents a consequence of osteoporosis, a metastatic lesion or some other primary bone neoplasm. Computed tomography is one of the most suitable imaging techniques for the evaluation of bone structure and fragments and to establish the degree of cortical bone destruction; MR imaging (MRI) is the most helpful radiological investigation in order to provide the basis for the distinction between metastatic and acute osteoporotic compression fractures. The most relevant MRI findings to establish a differential diagnosis are described.

Usefulness of SPAIR Image, Fracture Line and the Adjacent Discs Change on Magnetic Resonance Image in the Acute Osteoporotic Compression Fracture.

ObjectiveOsteoporotic compression fracture is an increasing issue in this community and its diagnosis depends on the magnetic resonance images (MRI). Although T1- and T2-weighted images (T1WI and T2WI) have high sensitivity and specificity, the fat suppression technique gives more clear delineation of this abnormalities. Accordingly, we re-evaluated its exact sensitivity and specificity for the imaging diagnosis of osteoporotic compression fractures in our cases. For additional information about the osteoporotic compression fractures, we evaluate the fracture lines, fluid sign and adjacent discs change on the MRI.MethodsRetrospectively, total 85 patients who had been diagnosed with acute osteoporotic compression fracture were enrolled. They all had been underwent MRI including T1WI, T2WI and T2-Spectral Adiabatic Inversion Recovery (SPAIR) sequence.ResultsIn this study, the incidence of high signal intensity on T2-SPAIR image was very high (0.9917). The fluid sign was seen in 56.7% on the SPAIR image. The fracture lines were more observed on the T2WI than T1WI (p=0.0062). The adjacent discs change on T2WI and T2-SPAIR image were higher than T1WI (p<0.001).ConclusionFor the acute osteoporotic compression fracture, T2-SPAIR image is the most specific sequence of the all sequences. The fluid sign is another suggestive finding when considered other studies. T2WI is more useful to find the fracture line than T1WI. Abnormal signal intensity on the adjacent discs may provide additional information for the acute osteoporotic compression fractures.